MAY 2018

MAY 2018

MAY 2018


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<strong>MAY</strong> <strong>2018</strong><br />


PO BOX 106 954, AUCKLAND CITY 1143<br />

Email: info@nzoptics.co.nz<br />

Website: www.nzoptics.co.nz<br />



<strong>2018</strong> • Voted by New Zealanders • <strong>2018</strong><br />




At Specsavers we are focussed on providing the highest<br />

levels of optometry and dispensing care in all our New<br />

Zealand and Australian stores.<br />

Our equipment and technology strategies, our close working relationships<br />

with ophthalmology and various eye disease stakeholders alongside our<br />

major investments into dispensing qualifications all contribute to a singular<br />

purpose – to transform the eye health of New Zealanders and Australians.<br />

So, if you’re concerned at the 50 per cent undiagnosed glaucoma cohort<br />

and the under-indexing of diabetic retinopathy screenings; if you’re worried<br />

that available in-store technology isn’t being used on every patient due to<br />

extra fees and charges; and if you’re alarmed at the under-investment in<br />

professional dispensing programs and technology – then we urge you to<br />

talk to us about how you can make a genuine impact at Specsavers.<br />

We’re on a clear mission to transform eye health in New Zealand and<br />

Australia – and we’d like you to join us on that mission.<br />

To ask about optometry and dispensing roles right across the country at all levels, contact Chris Rickard on 027 579 5499<br />

or chris.rickard@specsavers.com, alternatively visit spectrum-anz.com for all the opportunities.<br />

Reader’s<br />

Digest<br />

<strong>2018</strong> • Voted by Australians • <strong>2018</strong><br />

Quality Service<br />

Award<br />

Reader’s<br />

Digest<br />

Quality Service<br />

Award<br />

AITD<br />

Voted by New Zealanders<br />

Reader’s Digest<br />

Quality Service<br />

Award<br />

2017<br />

Best Customer<br />

Service in AU<br />

Optometry<br />

<strong>2018</strong><br />

Best Customer<br />

Service in NZ<br />

Optometry<br />

Best Talent<br />

Development<br />

Program<br />

2017<br />

Best Talent<br />

Development<br />

Program<br />

2017<br />

Best Customer<br />

Service in NZ<br />

Optometry<br />

2017<br />

Millward Brown<br />

Research<br />

No.1 for eye tests<br />

2016<br />

Excellence in<br />

Marketing<br />

Award<br />

2016<br />

Retail<br />

Store Design<br />

Award<br />

2016<br />

Retail<br />

Employer<br />

of the Year<br />

2015<br />

<strong>2018</strong> Transforming eye health<br />

2 NEW ZEALAND OPTICS May <strong>2018</strong>

Re:Vision, re-imagining eye care<br />


Auckland ophthalmologist Dr Trevor<br />

Gray has opened Re:Vision, a new subspecialist<br />

surgery in Mt. Wellington,<br />

Auckland offering anterior segment surgery<br />

and medical care to those who can afford to pay<br />

and a sustainable model for those who can’t.<br />

“Re:Vision is my new home. It’s always been<br />

a little bit of a background dream, but I never<br />

thought I’d ever consider leaving the Eye<br />

Institute,” says Dr Gray. “But life changes and<br />

you have to roll with the punches and then<br />

make the most of what comes your way.”<br />

Dr Gray made the decision to leave Eye<br />

Institute and pursue his own dream of a<br />

dedicated anterior segment boutique practice<br />

late last year after what he describes as a<br />

parting of philosophical ways.<br />

Joining him at Re:Vision is most of his<br />

Eye Institute team, including receptionists,<br />

ophthalmic nurses, technicians and<br />

optometrists; 14 in total, he says. The Britishraised<br />

and Moorfields Eye Hospital-trained<br />

cornea and anterior segment fellow Dr Mo<br />

Ziaei, better known as “Dr Mo,” will also be<br />

joining Re:Vision, adding to his existing cornea<br />

clinical research at the University of Auckland.<br />

“Mo was head-hunted by Charles (Professor<br />

Charles McGhee) almost three years ago to be<br />

Charles’ fellow and he has turned out to be one<br />

of the most skilled, naturally-gifted surgeons<br />

we have ever come across,” says Dr Gray. “He’s<br />

also affectionately known as the ‘trainer of the<br />

trainers’ because of how he’s shared his new<br />

Moorfields’ techniques in corneal endothelial<br />

transplantation with the cornea consultants at<br />

“Dr T” and “Dr Mo” – principal surgeons at the new Re:Vision clinic<br />

Re:Vision opens for business in Auckland’s Mt. Wellington<br />

Greenlane Hospital.”<br />

Last month, the new Re:Vision practice and<br />

surgery was busy with final fit-outs before<br />

welcoming its first patient on 23 April.<br />

“We’re just a fledgling little unit and<br />

we’re pure anterior segment, so Re:Vision<br />

is not planning to be involved in glaucoma,<br />

oculoplastics or macular degeneration at this<br />

stage. We’ll essentially be offering more of<br />

what people know me for – patient-centric<br />

anterior segment care and going that extra<br />

mile – as that’s the challenge that my staff and<br />

I enjoy: how we can go the extra mile for every<br />

patient encounter and every referrer encounter;<br />

how we can make each patient’s life a little<br />

easier, a little bit more pleasant, a little bit more<br />

fun.”<br />

Mirroring some of his charitable work at<br />

Eye Institute, where his Buchanan Charitable<br />

Foundation installed a laser theatre ceiling<br />

hoist and funded free laser vision correction<br />

for tetraplegic patients, Dr Gray’s new venture<br />

is also starting off with a philanthropic focus.<br />

Re:Vision will be working with the wider<br />

charitable health and ophthalmic industry to<br />

help plug the ever-increasing gap between<br />

the public and the private systems, he says,<br />

promising to reveal more in a few months’ time,<br />

once a key partnership has been agreed and<br />

signed-off.<br />

“Part of Re:Vision’s philosophy is not only to<br />

be a centre of excellence for patients in our<br />

care, but to provide a philanthropic opportunity<br />

to help society in ways that haven’t been<br />

explored yet. It’s about being part of something<br />

that just feels good. Life is too short not to<br />

enjoy what you do and the nice thing about<br />

enjoying what you do is you naturally do it<br />

better… and that’s how a fledgling unit like<br />

Re:Vision grows.” ▀<br />

Blurring the<br />

boundaries<br />


Ophthalmology and optometry: New Zealand is<br />

better than most in breaking down the barriers<br />

between these two, crucially-linked sides of our<br />

industry so they can better work together and share<br />

the increasing workload to protect our nations’ eye<br />

sight and overall health.<br />

This month, particularly, demonstrates the<br />

overlapping areas of responsibility and celebrates<br />

this unique partnership with coverage of the 60th<br />

anniversary conference of the wonderful Cornea &<br />

Contact Lens Society of New Zealand (p8-12); the<br />

increasingly popular Ocular Therapeutics Conference<br />

(p16-17), which also expands this relationship<br />

into pharmacy; and the annual Excellence in<br />

Ophthalmology and Vision Science Awards (p15) that<br />

recognise the achievements of trainee practitioners<br />

from across the eye health spectrum.<br />

We’ve got all the updates from the different<br />

conferences, plus news galore relating to both<br />

optometry and ophthalmology, including a new<br />

ophthalmology surgery (p3), a new charitable<br />

initiative to support kids in need (p5) and the first<br />

electrophysiology workshop, designed to boost the<br />

skill levels and knowledge of eye health practitioners in<br />

this increasingly important diagnostic area (p5).<br />

Perhaps best illustrating the importance of our world<br />

is the incredible story of four-year old Lucas Kiser<br />

(p7) who despite having more than 25 eye-related<br />

surgeries and facing an uncertain future still retains<br />

his fascination for all things new. And if that wasn’t<br />

enough, check out this month’s Focus on Business<br />

column for some crucial tips for all optometry and<br />

ophthalmology practices on how not to fall foul of the<br />

privacy laws in the wake of Facebook’s censure.<br />

Enjoy.<br />

Lesley Springall, editor, NZ Optics<br />

BTP International Designz p: 07 307 2410 e: info@btpid.co.nz<br />

Anterior<br />

Segment<br />

Specialists<br />

0800 55 20 20<br />

www.re.vision.nz<br />

Dr Trevor Gray<br />

Dr Mo Ziaei<br />

May <strong>2018</strong><br />



News<br />

in brief<br />

<strong>2018</strong> SOVS CONFERENCE<br />

Registration is now open for the University of Auckland’s second<br />

School of Optometry and Vision Science (SOVS) conference on<br />

29 July in Auckland. The conference is aimed at all practicing<br />

optometrists, educators, vision scientists and students,<br />

offering hands-on workshops and up-to-the-minute scientific<br />

presentations. https://sovsconference.org.nz/<br />


Scientists at Western Sydney<br />

University have successfully grown<br />

human eye cells from human lens<br />

epithelial cells. These micro lenses<br />

will provide a powerful platform<br />

for defining molecular disease<br />

mechanisms, anti-cataract drug<br />

screening and clinically relevant<br />

toxicity assays, said lead researcher Dr Michael O’Connor.<br />


Data from the Institute of Environmental Science and Research<br />

shows the number of syphilis cases reported in New Zealand<br />

has more than doubled to 470 since 2015. Any unexplained<br />

neurological or ophthalmological signs, such as ocular nerve palsy<br />

and uveitis, can be symptoms of syphilis.<br />


The US Food and Drug Administration (FDA) has approved the<br />

first artificial intelligence (AI) diagnostic device that doesn’t<br />

require a specialist clinician to interpret the results. The device,<br />

IDx-DR, analyses retinal images to determine whether a patient<br />

has diabetic retinopathy (DR) and can be used by any primary<br />

healthcare provider.<br />


The US state of Virginia has passed a new law allowing<br />

optometrists to perform limited steroid injections to treat<br />

chalazia. To administer the injections, optometrists must be<br />

therapeutically-qualified, be board certified and have passed<br />

certain additional courses and exams.<br />


US-based EyeGate Pharma<br />

has developed a new<br />

ocular drug delivery<br />

system that doesn’t<br />

use needles or drops.<br />

The EyeGate II Delivery<br />

System uses transscleral<br />

iontophoresis, affectively a<br />

low-level electrical current, to deliver a specified drug amount into<br />

the ocular tissue. To date, the system has been used in more than<br />

2,000 treatments, including more than 1,300 for the company’s<br />

lead therapeutic candidate, EGP-437 for anterior uveitis.<br />


The time scale for Sjögren’s syndrome to be accurately diagnosed<br />

has more than halved from an average of six years in 2012 to just<br />

under three years today, said the Sjögren’s Syndrome Foundation.<br />

The foundation embarked on a five-year programme to raise<br />

awareness and reduce diagnosis time in 2012.<br />


Professors Carly Sy Lam and Chi Ho To from Hong Kong Polytechnic<br />

University won the grand prize at the 46th International Exhibition<br />

of Inventions of Geneva for their Defocus Incorporated Multiple<br />

Segments (DIMS) spectacle lens for myopia control. In studies, the<br />

DIMS lens provided clear vision for the wearer while simultaneously<br />

slowing down myopia progression in children by 60%, with 20%<br />

demonstrating no increase in myopia over the test period.<br />


A 20-year retrospective audit of Moorfield’s medical records<br />

provided risk factor insights for patients with acanthamoeba<br />

keratitis. Of 194 patients reviewed, 93 had poor outcomes,<br />

including corneal perforation, any ocular surgery, duration of<br />

antiamoebic therapy (AAT) of 10.5 months or more and VA of<br />

20/80 or less, plus severe inflammatory complications such as<br />

scleritis or corneal stromal ring infiltrates. High risk patients<br />

included those older than 34 who had used corticosteroids;<br />

had more advanced disease; or had herpes simplex virus (HSV)<br />

keratitis treatment before AAT.<br />


Italia Independent has signed a licensing agreement<br />

with The Walt Disney Company Italy for the<br />

development and distribution of Disney eyewear<br />

collections. The first, including Disney, Marvel and<br />

Lucas Film, will be unveiled in September <strong>2018</strong>,<br />

coinciding with Mickey Mouse’s 90th birthday.<br />


The Brien Holden Vision Institute has updated its free, web-based<br />

myopia calculator, adding new features such as an ‘ethnicity’<br />

option to allow users to switch between ‘Asian’ and ‘Caucasian’.<br />

Photochromic contacts unveiled<br />

Johnson & Johnson Vision (J&J) has teamed<br />

up with photochromic lens developer<br />

and manufacturer Transitions Optical to<br />

develop and launch the first ever contact lens<br />

which automatically adapts to changing light<br />

conditions.<br />

Combining Transitions’ Light Intelligent<br />

Technology and J&J’s Acuvue Oasys technology,<br />

the new lens creates a new category of contact lenses and expands the<br />

photochromic category beyond the now well-known spectacle lenses.<br />

“This breakthrough technology will revolutionise contact lenses<br />

and photochromics by introducing the benefits of light adaptation<br />

to more patients,” said Chrystel Barranger, president of Essilor<br />

Photochromics and Transitions Optical. “(This) first of its kind<br />

contact lens, provides wearers with vision correction and a dynamic<br />

photochromic filter that helps to continuously balance the amount<br />

of light entering the eye… quickly and seamlessly adjusting from<br />

clear to dark in response to changing sunlight conditions; reducing<br />

Drops replace<br />

glasses<br />

A<br />

team of Israeli researchers from<br />

Bar-Ilan University’s Institute of<br />

Nanotechnology and Advanced<br />

Materials (BINA), sent media outlets<br />

and the twitter sphere into a spin with<br />

the announcement they had developed<br />

some revolutionary eye drops that could<br />

replace glasses.<br />

The technology, known as Nano-Drops, was developed by<br />

Dr David Smadja, co-inventor of<br />

the revolutionary Nano-Drops<br />

ophthalmologist Dr David Smadja and Professors Zeev Zalevsky<br />

and Jean-Paul Moshe Lellouche. Patents have been filed by<br />

Birad Research & Development, the commercial arm of Bar-ILan<br />

University.<br />

Nano-Drops achieve their optical effect and correction by locally<br />

modifying the corneal refractive index, said the University in<br />

an announcement. “The magnitude and nature of the optical<br />

correction is adjusted by an optical pattern that is stamped onto<br />

the superficial layer of the corneal epithelium with a laser source.<br />

The shape of the optical pattern can be adjusted for correction<br />

of myopia, hyperopia or presbyopia. The laser stamping takes a<br />

few milliseconds and enables the nanoparticles to enhance and<br />

‘activate’ this optical pattern by locally changing the refractive<br />

index and ultimately modifying the trajectory of light passing<br />

through the cornea.”<br />

In the future this technology may enable patients to have their<br />

vision corrected in the comfort of their own home, said researchers,<br />

as the laser device is small and connects to a smartphone.<br />

So far, the technology has had positive results ex-vivo in pig<br />

eyes, correcting nearly 3 diopters for both myopia and presbyopia.<br />

In-vivo trials are about to begin on rabbits, to determine how<br />

long the effect of the Nano-Drops lasts after initial application. ▀<br />

Essilor unveils Varilux X<br />

Essilor has launched a new lens aimed at digitally-connected<br />

presbyopes who it says are unwilling to compromise their near or<br />

distance vision.<br />

The new Varilux X series lens, described as a technological stepchange,<br />

has 15 patents pending. This includes patents for some new<br />

proprietary technology developed by Essilor that re-shapes a specific<br />

lens zone to overcome that typical progressive wearer frustration<br />

forcing them to adjust their head position to see clearly when they<br />

change from near to far vision.<br />

“The Varilux X series lens is the result of a dramatic shift in lens<br />

design, Xtend technology, that delivers new benefits for today’s<br />

modern presbyope,” said Essilor ANZ in a press release announcing<br />

the launch. “In today’s world, much of our time is spent multi-tasking<br />

within the area of ‘arm’s length’, 40cm to 70cm. Activities range from<br />

reading smartphones, looking at computers, reading documents and<br />

talking with people. Patients need their vision to adjust seamlessly<br />

between each of these tasks without adjusting the head to find the<br />

right zone on the lens.”<br />

Essilor said its Xtend technology controls the level of acuity on the<br />

lens, resulting in the ability of the wearer to focus on multiple objects<br />

within arm’s reach in the same direction of gaze, providing sharp<br />

vision for the patient with no or minimal head movement. More than<br />

www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand<br />

exposure to bright light indoors and<br />

outdoors, including filtering blue light<br />

based on the level of activation and<br />

blocking UV rays.”<br />

The new innovation was triggered<br />

by changing consumer lifestyle needs<br />

and J&J’s commitment to care for human<br />

sight, said Dr Xiao-Yu Song, J&J’s global<br />

head of research and development in a parallel statement released<br />

with Transitions Optical’s. “After more than a decade of product<br />

development and numerous clinical trials involving more than 1,000<br />

patients, we are excited to bring to market a solution to help contact<br />

lenses wearers manage the changing light conditions they face every<br />

day in their modern, active lives.”<br />

The Acuvue Oasys with Transitions lens has received clearance from<br />

the US Food and Drug Administration (FDA). The two-week, reusable,<br />

spherical contact lens will be marketed by J&J and will be commercially<br />

available in first half of 2019, said the companies. ▀<br />

Eylea, close to<br />

funding<br />

As part of its long-running review on funding the<br />

anti-vascular endothelial growth factor (anti-<br />

VEGF) agent aflibercept (Eylea), Pharmac sought<br />

feedback on its latest proposal last month, which<br />

includes amending the current hospital restrictions for<br />

ranibizumab (Lucentis).<br />

Under the most recently proposed funding criteria<br />

for aflibercept, eligible patients with a range of<br />

ophthalmic conditions, including wet age-related macular degeneration<br />

(wAMD) and diabetic macular oedema (DMO), would be eligible to receive<br />

funded access to aflibercept, while patients who are currently receiving<br />

ranibizumab would have the option to switch, from 1 June <strong>2018</strong>.<br />

“Patients with wAMD are currently able to access bevacizumab (Avastin;<br />

off-label) and ranibizumab injections for the preservation of vision.<br />

Patients with DMO currently only have access to bevacizumab (off-label)<br />

injections. The current Pharmaceutical Schedule listing restrictions for<br />

both bevacizumab and ranibizumab only enable publicly-funded access<br />

when used in the DHB hospital setting,” details Pharmac’s proposal<br />

document. “This proposal is to list aflibercept in Section B and Section H of<br />

the Pharmaceutical Schedule as the second line anti-VEGF agent for both<br />

community and hospital use. There would be no change to the current<br />

listing of bevacizumab as a result of this proposal.”<br />

Following repeated pressure from some ophthalmologists and the<br />

wider eye health community. Pharmac’s primary clinical advisory<br />

committee, the Pharmacology and Therapeutics Advisory Committee<br />

(PTAC), recommended aflibercept be funded as a second line anti-VEGF<br />

treatment for wAMD after bevacizumab (Avastin) in May 2017, bumping<br />

it above ranibizumab. This was referred to Pharmac’s ophthalmology<br />

subcommittee for further consideration and the latest proposal follows<br />

these discussions. For more, visit: www.pharmac.govt.nz/news/<br />

consultation-<strong>2018</strong>-03-27-aflibercept-rivaroxaban/ ▀<br />

3,000 presbyopes around the world<br />

participated in the development of<br />

the Varilux X through focus group<br />

interviews, video selfies and new<br />

methodologies for real-life wearer<br />

testing, it said.<br />

“Varilux X series progressive<br />

lenses were developed to meet the<br />

needs of all presbyopes including<br />

Essilor launches Varilux-X for digitallyconnected<br />

presbyopes<br />

a new group, Generation X, who are very active in their personal and<br />

professional lives and who are avid users of digital technology devices,”<br />

said Pierre Longerna, Essilor ANZ’s chief operating officer.<br />

Research by Essilor in France found 95% of Varilux X wearers were<br />

satisfied with their lenses when performing multiple tasks within<br />

arm’s reach and more than 97% said they no longer had to move their<br />

head to see clearly.<br />

Created by Essilor in 1959, Varilux is one of the most popular<br />

progressive lens brands in the world, with more than 50 patent<br />

families protecting its technology.<br />

The Varilux X will be introduced to Essilor’s Platinum Partners in New<br />

Zealand at a special event on 7 May and then rolled out around the<br />

country through a series of roadshows. ▀<br />

For general enquiries or classifieds please email info@nzoptics.co.nz<br />

For editorial, please contact Lesley Springall at lesley@nzoptics.co.nz or +64 27 445 3543<br />

For all advertising/marketing enquiries, please contact Susanne Bradley at susanne@nzoptics.co.nz or +64 27 545 4357 in the first instance, or Lesley Springall at lesley@nzoptics.co.nz<br />

To submit artwork, or to query a graphic, please email susanne@nzoptics.co.nz<br />

NZ Optics magazine is the industry publication for New Zealand’s ophthalmic community. It is published monthly, 11 times a year, by New Zealand Optics 2015 Ltd. Copyright is held by<br />

NZ Optics 2015 Ltd. As well as the magazine and the website, NZ Optics publishes the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide that profiles the<br />

products and services of the industry. NZ Optics is an independent publication and has no affiliation with any organisations. The views expressed in this publication are not necessarily<br />

those of NZ Optics 2015 Ltd or the editorial team.<br />

4 NEW ZEALAND OPTICS May <strong>2018</strong>

Electrophysiology<br />

meeting - all welcome!<br />

Medical retina specialist Dr Dianne Sharp<br />

and the Ophthalmic Instrument Company<br />

(OIC) are hosting a special Roland Consult<br />

Electrophysiology Users Meeting at the Greenlane<br />

Clinical Centre on 13 May, the Sunday after the<br />

RANZCO NZ <strong>2018</strong> conference in Auckland.<br />

The role of electrodiagnostic testing in<br />

ophthalmology has expanded as a diagnostic<br />

tool for retinal, macular and optic nerve disease<br />

and is now an important adjunct to genetic<br />

testing, says Dr Sharp. “It is used to monitor<br />

response to therapy in posterior uveitis, diagnose<br />

acquired retinal conditions, such as autoimmune<br />

retinopathy, and monitor at risk patients<br />

for signs of early toxicity to drugs, including<br />

hydroxychloroquine.”<br />

Dr Sharp is convening and coordinating the<br />

OIC-sponsored meeting and will be supported<br />

by ophthalmic electrodiagnostic technician,<br />

Juliet Ware, Roland Consult’s Oskar Stasche from<br />

Germany, and Tim Way from OIC.<br />

“The German-designed Roland system has been<br />

ideal for New Zealand, with excellent support<br />

from the German designers who have frequently<br />

visited to install and update units,” says Dr Sharp.<br />

There are now seven Roland systems in New<br />

Zealand at the Greenlane Clinical Centre, Auckland<br />

University, Retina Specialists, Hamilton Eye Clinic,<br />

Wellington Hospital, Christchurch Hospital and<br />

Dunedin Hospital.<br />

This inaugural users’ meeting will be split into<br />

two halves. The morning session is specifically<br />

for Roland electrodiagnostic system users<br />

(technicians and ophthalmologists) to gain greater<br />

familiarity with the equipment and discuss<br />

specific user issues. While the afternoon session<br />

is aimed at all ophthalmologists, registrars and<br />

technicians who have been invited to participate<br />

in clinical case discussions, which highlight the<br />

uses of electrodiagnostic testing, and share their<br />

diagnostic dilemmas.<br />

The day is an opportunity to gain further training<br />

to ensure the most accurate and reproducible<br />

results, to review setups for specialty tests, to<br />

address paediatric testing and to discuss reporting<br />

techniques, says Dr Sharp. “This is not to achieve a<br />

single standard (ISCEV provides the international<br />

standards) but to have some degree of uniformity<br />

across the country in the testing setups and<br />

reporting, so that complex cases and our collective<br />

experience can be shared with other users.”<br />

Anyone wishing to attend the day should<br />

contact Tim Way at Tim@oic.co.nz and cc. in Dr<br />

Sharp at dianne@retinaspecialists.co.nz ▀<br />

HDC report released<br />

The Health and Disability Commission (HDC)<br />

has released a report finding the Southern<br />

District Health Board (DHB) breached the<br />

Code of Health and Disability Services Consumers’<br />

Rights, when a man suffered irreversible vision<br />

loss after the DHB’s ophthalmology service failed<br />

to arrange timely follow-up care.<br />

The lack of follow-up ophthalmology care within<br />

DHBs across the country, made headline news in<br />

2016 and 2017 after the Royal Australian and New<br />

Zealand College of Ophthalmologists (RANZCO)<br />

revealed the extent of the problem. The HDC report<br />

is the latest part of that process to change the<br />

system to better prioritise treatment for patients<br />

with the greatness risk of going blind.<br />

RANZCO welcomed the report and called upon<br />

the government to release the report they<br />

commissioned EY to do last year, on developing<br />

a pathway of care for age-related macular<br />

degeneration.<br />

While applauding the work undertaken so far,<br />

Dr Brian Kent-Smith, RANZCO NZ Branch chair,<br />

stressed more still needs to be done. “Releasing the<br />

EY report will be a good step in enabling the DHBs<br />

to better meet clinical need and help more patients<br />

to have their sight preserved and restored.” ▀<br />

Eye Institute’s new<br />

community trust<br />


Eye Institute is formalising its social endeavours<br />

under a new community trust, which initially<br />

will be focused on providing assistance to<br />

Auckland-based families by funding up to 400 eye<br />

examinations and providing subsidies of up to $250<br />

towards glasses over the next 12 months.<br />

The new community trust will officially be<br />

launched at the Eye Institute’s next seminar, after<br />

work on 22 May at the Ellerslie Event Centre in<br />

Auckland, by trust co-chairs, and Eye Institute<br />

ophthalmologists, Professor Helen Danesh-Meyer<br />

and Dr Shanu Subbiah.<br />

“Eye Institute and its doctors have been involved<br />

in many levels of community service for a long<br />

time. The Eye Institute Community Trust is a way<br />

of framing our activities as well as providing us<br />

with the opportunity to expand our community<br />

service in a more structured manner,” explains Prof<br />

Danesh-Meyer. “At this stage, our focus is on our<br />

Auckland community. There is so much that can be<br />

done right in our own backyards, so this is where<br />

we are launching this new initiative.”<br />

Dr Subbiah says the idea to focus the trust’s<br />

first efforts on children came from Wellingtonbased<br />

optometrist Ravi Dass who he met last<br />

year on a Voluntary Ophthalmic Services Overseas<br />

(VOSO) trip to Fiji. Dass, together with his wife<br />

Stephanie Hill, take a more philanthropic approach<br />

to business, donating a pair of glasses to kids in<br />

need from their practice, Mr Foureyes, every time a<br />

patient buys a pair of glasses.<br />

“I had always assumed, incorrectly, that eyecare<br />

for children in New Zealand was comprehensively<br />

covered by the health boards,” said Dr Subbiah,<br />

who undertook a lot of his training in the UK<br />

where children’s eye care is covered under the<br />

National Health Service. After speaking to<br />

Greenlane’s orthoptic department, he says he<br />

realised that a lot of children who require glasses<br />

don’t have them because of the cost, especially<br />

those who were at high risk of visual loss from<br />

amblyopia, so it seemed like the ideal starting<br />

point for the trust’s work.<br />

Professor Helen Danesh-Meyer and Dr Shanu Subbiah, co-chairs of the<br />

Eye Institute’s new Community Trust<br />

The trust will work with others also engaged in<br />

this area, such as Essilor’s Vision Foundation, and<br />

Eye Institute doctors have already presented their<br />

aims for the trust to vision and hearing technicians<br />

(VHTs) at their national conference, resulting in<br />

some encouraging feedback, says Dr Subbiah.<br />

Though the initial focus of the trust is on<br />

Auckland and on children, so that it can finetune<br />

the logistics of what it does, it is hoped<br />

the trust’s work will be expanded nationally, he<br />

says. “We will be working closely with VHTs and<br />

primary school teachers to identify children that<br />

would benefit the most from this initiative. As a<br />

socially responsible company we are very excited<br />

to be able to give back to our community and we<br />

look forward to making a positive difference to<br />

hundreds of children in the years to come.”<br />

Prof Danesh-Meyer says everyone at Eye Institute is<br />

very excited about the trust’s launch. “We have been<br />

overwhelmed by the immense enthusiasm that this<br />

initiative has received. We are very excited to see it<br />

underway and we are open to new opportunities to<br />

serve the community as the programme evolves. We<br />

hope it will grow organically.”<br />

Any Auckland-based optometrist can apply to<br />

the Eye Institute Community Trust for additional<br />

funding for exams or glasses on behalf of their<br />

patients. The programme will be reviewed<br />

regularly to ensure the trust’s focus fits with the<br />

needs of Aucklanders, initially, and then nationally,<br />

with the aim of extending its support to adults<br />

who fall through the cracks of the publicly-funded<br />

health system, said Prof Danesh-Meyer. ▀<br />

Come to the official launch<br />

at our <strong>2018</strong> May Seminar!<br />

1.75 CPD<br />

and 0.25<br />

GC points<br />

available<br />

For many years the team at Eye Institute<br />

has been offering pro bono cases under the<br />

radar across Australasia, the Pacific Islands<br />

and beyond. The Eye Institute Community<br />

Trust has been formed to formalise our<br />

longstanding commitment to helping those<br />

in need.<br />

A significant proportion of New Zealanders<br />

do not qualify for often life changing<br />

Opthalmic care, and the Eye Institute<br />

Community Trust is working to change that.<br />

One group that falls through the cracks the<br />

most is children, and that is where our first<br />

pursuit begins.<br />

With your help, we aim to identify children<br />

with the greatest risk of permanent vision<br />

impairment due to Amblyopia, and provide<br />

assistance to families by funding 400 eye<br />

examinations and a subsidy of up to $250<br />

towards glasses for the next 12 months.<br />

BOOK ONLINE NOW! https://www.eyeinstitute.co.nz/optometry/<br />

May Seminar - FREE!<br />

Tuesday 22nd May <strong>2018</strong><br />

6.30pm - 8.45pm<br />

Ellerslie Event Centre, Racecourse<br />

80 Ascot Ave, Ellerslie, Auckland<br />

5.45pm - 6.30pm Light Meal &<br />

Beverages provided<br />

August Seminar<br />

Tuesday 14 Aug <strong>2018</strong><br />

6.30pm-8.45pm<br />

Ellerslie Event Centre<br />

Racecourse, 80 Ascot Ave<br />

Ellerslie, Auckland<br />

Optometry<br />

Conference<br />

Sunday 4 Nov <strong>2018</strong><br />

8am-5pm<br />

Waipuna Conference Centre<br />

Mt Wellington, Auckland<br />

For more information email<br />

amy.w@eyeinstitute.co.nz<br />

and be sure to register for<br />

our May Seminar.<br />


Or register by<br />

Phone 09 522 2125<br />

Fax 09 522 5770<br />

conference@eyeinstitute.co.nz<br />

May <strong>2018</strong><br />



APAO <strong>2018</strong> in Asia’s world city<br />


New Zealand still struggling to fill orthoptist vacancies<br />



OPEN NOW!<br />

UP TO<br />

42<br />

This year, the 33rd Asia-Pacific Academy of Ophthalmology<br />

(APAO) Congress was held in “Asia’s world city”, Hong Kong,<br />

where we were welcomed by unseasonably cold weather.<br />

The congress itself, however, warmed up the atmosphere quickly<br />

with more than 5,200 delegates from 87 countries attending;<br />

predominantly ophthalmologists, but also optometrists and vision<br />

scientists from across the world. Perhaps in honour of own Professor<br />

Charles McGhee, chair of ophthalmology at the University of<br />

Auckland and new APAO president, delegates were warmly welcomed<br />

by kilt-wearing, bagpipe players at the opening ceremony.<br />

This year’s meeting lived up to its theme, ‘Creativity and technology<br />

without boundaries’, offering many opportunities for young clinicianscientists<br />

to interact with their seasoned and experienced peers<br />

across the spectrum of ophthalmology and lots of news about new<br />

technological advances.<br />

The use of artificial intelligence (AI) using ‘deep learning’ –<br />

complicated software algorithms that allow powerful computers<br />

to “learn” from large datasets – is expected to revolutionise retinal<br />

examination. Deep learning uses artificial neural networks that<br />

allow machines to process and perceive the world in a similar way<br />

to humans, but with far, far greater speed and accuracy and without<br />

any bias. A research study in Thailand used this modality for diabetic<br />

retinopathy screening studies. According to the Thai researcher Dr<br />

Paisan Ruamviboonsuk, the very same technology may also be able<br />

to process retinal images to predict refractive errors, cardiovascular<br />

risk and cancer biopsies. AI certainly became a virtual theme (pun<br />

intended!) of the conference. In fact, one session was dedicated<br />

just to AI-based screening with presentations focusing on diabetic<br />

retinopathy, glaucoma and age-related macular degeneration.<br />

Another entertaining yet equally educational session from this<br />

year’s APAO meeting, was the ‘Ophthalmic premier league’, where<br />

four teams, in team jerseys no-less and accompanied by music galore,<br />

discussed challenging and complicated cataract cases together with<br />

different, potential lines of action. The resulting laugh-riot was full<br />

of confusion yet still delivered some excellent pearls to deal with<br />

unusual characters and cataracts.<br />

As APAO president, Prof McGhee had a busy schedule with a<br />

number of different speaking engagements, including seven<br />

scientific lectures! These ranged from the truly educational, on iris<br />

melanoma and corneal transplants, to some more entertaining ones,<br />

including, ‘Chevalier Taylor’, the oculist who blinded Handel and<br />

Bach: self-promoting quack or the target of fake news’. The lecture<br />

was as informative as its intriguing title!<br />

Technological advances were also on the menu of the corneal<br />

surgery symposium where advances in corneal endothelial surgery<br />

were discussed at great length. Although several ‘improved’ versions<br />

of endothelial keratoplasties have emerged, it is not clear whether<br />

they lead to better outcomes in terms of vision, according to Dr<br />

Sanjay Patel (Mayo Clinic, USA). Professor Donald Tan of Singapore<br />

National Eye centre also explained about alternative surgical<br />

approaches including ‘no touch’ and ‘hybrid-’.<br />

There were a significant number of invited lectures by New Zealandbased<br />

ophthalmology professors, lecturers and post-doctoral fellows.<br />

The anterior segment and cornea was well covered by Auckland’s clinical<br />

and laboratory-based research team. Professor Dipika Patel discussed<br />

imaging the inflamed cornea; Dr Rasha Al-Taie lectured on corneal<br />

transplantation in a paediatric population; Dr Akilesh Gokul tackled the<br />

biomechanical properties of the cornea and keratoconus management:<br />

Professor Trevor Sherwin and Dr Jie Zhang delivered lectures on stem<br />

cells; while I presented on imaging the cornea with systemic diseases.<br />

New Zealand’s contingent was not only a significant part of this<br />

internationally-renowned conference in terms of lectures and<br />

free paper presentations, but we also won a couple of awards! Dr<br />

Samantha Simkin won the best scientific free paper award for, ‘Widefield<br />

Digital Imaging and<br />

Telemedicine for Retinopathy<br />

of Prematurity: The Auckland<br />

Experience’ in the Paediatric<br />

Ophthalmology & Strabismus<br />

category; while Salim Ismail,<br />

Jane McGhee and Prof Sherwin<br />

won the best video award,<br />

‘Die Another Day: The Journey<br />

of a stem cell sphere to fulfil<br />

the promise of regenerative<br />

medicine’.<br />

The conference also played<br />

host to some star-studded<br />

social events! While the<br />

opening ceremony was a<br />

colourful musical event, the<br />

gala dinner had a few hearttouching<br />

performances by a group of blind musicians and a cheerful<br />

band of school kids. To conclude the evening, a seven-course dim sum<br />

meal delighted our pallets! APAO also organised its third charity run<br />

to raise funds for Blind Sports Hong Kong and the new APAO Satellite<br />

Congress educational programme.<br />

Overall, the 33rd APAO had numerous glitzy moments of science,<br />

innovation and entertainment. I am particularly looking forward to<br />

UP TO<br />

28T<br />

The New Zealand delegation to APAO <strong>2018</strong> with Dr Stuti Misra (centre, in red) and Professor Charles McGhee, APAO president (fourth)<br />

finding out more about the role of artificial intelligence and deep<br />

learning in ophthalmology at the next APAO annual meeting in<br />

Bangkok, Thailand, from 6-9 March 2019. ▀<br />

About the author<br />

*Dr Stuti Misra is a lecturer in the Department of Ophthalmology at the University of<br />

Auckland. Her research revolves around ocular surface and imaging in corneal disorders<br />

and systemic diseases.<br />

Orthoptists demand unrecognised<br />


The orthoptics profession is in high demand in New Zealand<br />

with a staggering one fifth of the clinical positions (five of 26)<br />

nationwide currently vacant. Yet the orthoptics profession<br />

does not appear on the skilled shortage list in New Zealand.<br />

Carly Henley, president of the New Zealand Orthoptics Society<br />

Incorporated (NZOSI) says orthoptics’ services are extremely<br />

stretched geographically and, recognizing the need, NZOSI has<br />

asked the government to add the profession to the skilled shortage<br />

list.<br />

In Australia, orthoptics is listed on the short-term skilled<br />

occupation list. There are currently 500 orthoptists practising<br />

and demand is predicted to exceed output in the next few years.<br />

In New Zealand there are currently two vacancies for orthoptists<br />

in Auckland, two in Dunedin, one in Hamilton and one in<br />

Christchurch, all within district health boards, except one in a<br />

private eye hospital.<br />

As there is presently no orthoptics training institute in New<br />

Zealand, orthoptists that practice in New Zealand have trained<br />

ether in Australia or the UK. In Australia, the course is a twoyear,<br />

full-time technical course with a clinical placement, which<br />

is offered by the University of Technology in Sydney or La Trobe<br />

University in Melbourne. In the UK, the course comprises three<br />

years full-time study with a six months honours extension offered<br />

at the Universities of Liverpool or Sheffield. The courses equip<br />

graduates with the skills to diagnose and manage eye conditions,<br />

including strabismus, amblyopia, traumatic injuries, tumours, head<br />

injuries, diabetes and strokes, in a range of patients from newborns<br />

to the elderly. In New Zealand, almost all orthoptists practicing<br />

have been trained in the UK.<br />

With only 26 orthoptic positions countrywide a training<br />

institute is currently not a viable option, but Henley admitted<br />

the geographical gaps and the busy, stressful clinics for those<br />

New Zealand still struggling to fill orthoptist vacancies<br />

few practicing orthoptists across the country are a problem. “The<br />

situation is concerning and getting a course registered is tricky,”<br />

she said, adding she would like to evaluate distance learning and<br />

hospital placements as an option for at least part of an orthoptics<br />

course here in New Zealand.<br />

She would also like to see more continuing professional<br />

development options for orthoptists in New Zealand. “Orthoptists<br />

are a very important group of clinicians who play an essential role<br />

in the management of ocular muscle imbalances and paediatric<br />

eye conditions.”<br />

For related news, see story on the latest Squint Club meeting in<br />

Sydney on p19.<br />

World orthoptic day – June 4, <strong>2018</strong><br />

The International Orthoptic Association (IOA) is the<br />

global voice of the orthoptic profession and is made up<br />

of 15 national professional organisations and six associate<br />

organisations. The IOA World Orthoptic Day aims to boost the<br />

visibility of the orthoptic profession and promote the activities<br />

of orthoptists locally, nationally, and internationally.<br />

World orthoptic day and the associated week-long<br />

celebrations help to increase the awareness of orthoptists<br />

and the association and the truly global impact of orthoptics.<br />

A key part of this is the annual, international photography<br />

contest, where all<br />

orthoptists and<br />

orthoptic students<br />

are asked to take<br />

out their cameras<br />

and cellphones<br />

and join in the fun.<br />

Previous<br />

competition<br />

entries have<br />

shown real flair<br />

and creativity,<br />

using lots<br />

of different<br />

Last year’s winning photo entry<br />

techniques to<br />

stage the perfect orthoptic-themed photo, said the Association.<br />

This year’s theme is ‘Reflections in orthoptics,’ which can be<br />

interpreted in any way as long as the image represents an<br />

aspect or aspects of orthoptic science. Entries for this year’s<br />

contest close on 20 May <strong>2018</strong>. This year, the Association is<br />

also running a ‘World Orthoptic Day Selfie Contest’ where<br />

orthoptists are asked to send in a photo of themselves relating<br />

to orthoptics in clincial practice, such as wearing a patch, using<br />

a prism or an occluder, or anything. The prize for the most<br />

original entry is an 16GB iPad mini. Entries open on World<br />

Orthoptic Day on Monday 4 June and close at 11.00pm GMT on<br />

Friday June 8th.<br />

6<br />

NZ Optics advert 1/4PageHoriz.indd 1<br />

NEW ZEALAND OPTICS May <strong>2018</strong><br />

12/04/<strong>2018</strong> 10:30 AM

Seeking help for Stickler’s<br />


In rural Taranaki, on a dairy farm that looks just<br />

like any other there is a boy playing with his dad’s<br />

tractor. Just four years old, he marvels at the giant<br />

wheels and squeals with delight when the engine<br />

starts. It’s a scene endemic to rural New Zealand, but<br />

this particular little lad, Lucas Kiser, is not like other<br />

four-year-old boys. In fact, he’s very rare indeed.<br />

“Lucas was diagnosed with Stickler Syndrome,<br />

infantile glaucoma and severe myopia when<br />

he was four months old,” says his mum Sonia,<br />

who is married to Michael and has another son,<br />

Andre, now three. “He had pressures of 38 in his<br />

right eye and 24 in his left the day we saw the<br />

ophthalmologist, and he has been as high as 48.’’<br />

Stickler Syndrome is rare but not unheard of in<br />

New Zealand. Characterised by structural problems<br />

of the eye and unusual facial features, the biggest<br />

optical risk for the patient is usually retinal<br />

detachment. However, Lucas has an especially rare<br />

version of this recessive genetic disorder that walks<br />

hand-in-hand with glaucoma and is estimated to<br />

affect just 5%-10% of people with the condition.<br />

“He wasn’t a happy baby. The first four months<br />

were hard,” admits Sonia. “He cried a lot, rarely<br />

slept, didn’t feed well and was sensitive to light so<br />

we couldn’t go outside much.”<br />

The family went to their GP frequently for what<br />

everyone thought was repetitive conjunctivitis, but<br />

when Michael saw the cloudy film on Lucas’ eye<br />

he decided enough was enough and they bundled<br />

Lucas off to see their local ophthalmologist, Dr<br />

Ross Neville-Lamb who referred them directly to<br />

paediatric specialist Dr Justin Mora in Auckland<br />

with suspected glaucoma.<br />

Having seen a patient with Stickler before,<br />

Dr Mora recognised the characteristics of the<br />

condition and sent a blood sample to the USA<br />

where the diagnosis was confirmed by geneticists.<br />

“We’ve been so lucky to have Dr Mora, he’s<br />

amazing,” says Sonia. “He’s seen Lucas over 40 times<br />

in the last four years and he’s brilliant with him.”<br />

To date Lucas has had over 25 surgeries,<br />

anaesthetics and sedations, including three<br />

goniotomies; a molten tube insertion; a lens<br />

implant, later removed following a detached<br />

retina; cataract; and cry and laser therapy. He has<br />

Lucas’ Give a Little page<br />

May is for macula<br />

Mirroring its counterpart across the<br />

Tasman, the Macular Degeneration New<br />

Zealand (MDNZ) team is gearing up for<br />

‘Macula Month’ from 1-31 May.<br />

Originally started by the Macular Disease<br />

Foundation Australia, Macular Month (well, it used<br />

to be a week) is an annual campaign designed to<br />

raise awareness of macular disease both directly,<br />

through an annual consumer campaign, and<br />

through eye health practitioners who are at the<br />

cutting edge of catching the disease early and thus<br />

preventing blindness.<br />

In New Zealand, supplements company<br />

Blackmores and pharmacy chain Health 2000 are<br />

running a promotion through Health 2000 stores<br />

throughout New Zealand to promote awareness<br />

and raise funds for MDNZ. The charity receives 5%<br />

of all sales of Blackmores’ eye health products.<br />

MDNZ has written to all optometrists and<br />

ophthalmologists reiterating the need to keep<br />

patients informed of the dangers of macular<br />

degeneration and the importance of Macular<br />

Month, with the hope they will get involved. It<br />

is providing free consumer cards to give away<br />

to at risk patients and is talking to media and<br />

advertising organisations with the hope of<br />

encouraging some support.<br />

eye drops every day, has had months of patching<br />

and can currently only see out of one eye, and it’s<br />

not clear if he will be able to see out of it again.<br />

On top of his eye problems he has a hearing<br />

impairment and could suffer early-onset arthritis<br />

as he grows older.<br />

“He’s a trooper and hasn’t let it stop him,” says<br />

Sonia. “He loves doing jobs on the farm and goes<br />

to kindy a couple of days a week. He’s such a happy<br />

boy, loves his friends, and loves his tractors!”<br />

When the Kiser family heard about the Stickler<br />

conference in Portland, Oregon, in July this year<br />

they were instantly keen to go. It will be packed<br />

full of specialists from across the globe, plus other<br />

families the Kiser’s can relate to.<br />

“There are two other families in New Zealand<br />

who have been in touch with us, who have<br />

Stickler,” says Sonia. “But as far as I’m aware they<br />

don’t have glaucoma as well. We feel so alone.<br />

To be able to meet people who are actually living<br />

through this, to talk to their specialists and learn<br />

how we can support Lucas, and how we can<br />

support his teachers when he starts school, that<br />

would be amazing.”<br />

Sonia notes how isolated New Zealand is, not just<br />

geographically but in terms of Stickler experience.<br />

“Dr Mora and other specialists have been learning<br />

with us on this journey. (At the conference) we<br />

could find contacts and information that could be<br />

essential to their continued help with Lucas and<br />

other Stickler patients in New Zealand.”<br />

The airfares alone will cost $10,000 so the family<br />

has reached out to their local community for help.<br />

They’ve received donations from two local charities,<br />

Team Hope and Little Fighters Trust. They also have<br />

a Give A Little page that has raised $4525 so far.<br />

“We’ve had amazing support from our friends,<br />

family and our community so far,” says Sonia. “This<br />

is such a great opportunity for us, and we feel so<br />

grateful and humbled by the help that we’ve been<br />

given.”<br />

The ophthalmologist’s view<br />

NZ Optics spoke to Lucas’ lead medical<br />

professional, ophthalmologist Dr Justin Mora from<br />

Auckland Eye, about this case.<br />

“Stickler syndrome is not uncommon, but to have<br />

infantile glaucoma and Stickler syndrome is very<br />

rare. There are three cases in the<br />

literature of children who were<br />

diagnosed with Stickler syndrome<br />

based on these characteristics.<br />

Lucas Kiser is the only confirmed<br />

genetic case in medical history. He<br />

is unique.<br />

“While Stickler syndrome is<br />

a connective tissue disorder, a<br />

major characteristic is a structural<br />

abnormality of the eyes causing<br />

severe myopia. Invariably Stickler<br />

patients are very short-sighted.<br />

In some children, there is also<br />

an abnormality of the anterior<br />

segment, which can lead to<br />

glaucoma.<br />

“It’s been interesting for me to<br />

look after Lucas, from a medical<br />

perspective. He’s a very challenging<br />

case. As a paediatric specialist, I see a<br />

1 in 7 people over 50<br />

will get Macular<br />

Degeneration<br />

At Risk<br />

1,500,000<br />

We need to<br />

reach these<br />

people early<br />

Diagnosed<br />

160,000 Vision<br />

Loss<br />

33,000<br />

So that<br />

effective<br />

treatment is<br />

given<br />

Meaning<br />

less<br />

become<br />

blind<br />

With one in four people expected to be aged over<br />

65 by 2030 and 41% still unaware they could be at<br />

risk of macular degeneration, this is not something<br />

Early detection saves sight<br />

that can wait, says Phillippa Pitcher, MDNZ general<br />

0800 622 852 mdnz.org.nz<br />

manager in her letter to eye care professionals. “To<br />

halt a potential epidemic of blindness, we need to<br />

be proactive to save sight so that New Zealanders<br />

can live well in old age.”<br />

So, for the month of May at least, when you think<br />

‘May’, think ‘macula’ too. For more about MDNZ<br />

and how you can become a “professional friend”,<br />

visit, http://mdnz.org.nz/ ▀<br />

Michael, Lucas, Sonia and Andre, looking for help for Lucas<br />

lot of children with infantile glaucoma, but not with<br />

a refractive error of -17, which is what Lucas had.<br />

When we removed his cataract in the right eye we<br />

had to answer the question as to what to do with the<br />

left, which still had a -16 refractive error. Do you leave<br />

him unbalanced? Do you remove a healthy lens?<br />

There have been some tricky questions to answer.<br />

“There are other Stickler cases in New Zealand,<br />

and it can be diagnosed in young adults as well as<br />

children. Severe short-sightedness at a very young<br />

age should raise the question, ‘is there something<br />

else going on?’ Always refer such cases to a<br />

paediatric ophthalmologist. Retinal detachment is<br />

the main risk for Stickler patients.<br />

“The Kisers have been up to Auckland countless<br />

times and Lucas has had several surgeries under<br />

anaesthetic, but they’re such a positive family and<br />

he’s a happy boy. I’d love to see them participate<br />

in this conference. Any family with a child with a<br />

rare condition will value meeting other families<br />

with similar problems, knowing they’re not alone.<br />

It could also open up future treatment options to<br />

Lucas as the family develop networks with families<br />

and practitioners in the US. It would be a great<br />

thing for them and I fully support it.<br />

To help the Kiser family make it to the Stickler<br />

conference in the US, please visit www.givealittle.<br />

co.nz/cause/help-get-lucas-and-his-family-thestickler<br />

Editor’s note: Writer Jai Breitnauer was so moved<br />

by Lucas’ story she has donated part of her writing<br />

fee to the family’s cause.<br />

Stickler Syndrome – The facts<br />

• Stickler Syndrome is the umbrella name for<br />

a group of hereditary conditions. The main<br />

characteristic is a distinctive facial appearance<br />

• Abnormalities include eye structure issues,<br />

joint problems and hearing loss<br />

• Cleft palate and small lower jaw can also lead<br />

to breathing and feeding problems in infants<br />

• Patient joints can be loose and hypermobile.<br />

Arthritis and osteoporosis can occur early in life<br />

• It’s an inherited condition, but the more severe<br />

type that Lucas has is recessive<br />




1st Floor, Entrance B, 31-35 Carbine Rd<br />

Mt Wellington, Auckland 1060<br />

New Zealand Account Manager<br />

Francois Cronje 021 449 819<br />

www.shamir.co.nz<br />

May <strong>2018</strong><br />




Celebrating 60 years with warmth and style<br />


This year the Cornea and Contact Lens Society<br />

celebrated its 60th birthday. Though the<br />

educational content and knowledge has<br />

dramatically evolved over the last 60 years, the<br />

high standard of clinical learning and warm<br />

collegial environment never changes, making it<br />

always one of the better conferences to attend.<br />

Following a popular OCT and glaucoma workshop<br />

(see story p10) on the Saturday and a night’s<br />

quizzing (with prizes kindly donated by specialty<br />

and custom contact lens manufacturer Precision<br />

Contact Lenses) this year’s one-day conference<br />

was opened by CCLS president Jagrut Lallu who<br />

introduced our first speaker, Associate Professor<br />

Jennifer Craig.<br />

Dry eye advances<br />

Jennifer discussed the widely-anticipated findings<br />

of the Tear Film and Ocular Surface Society’s<br />

second Dry Eye Workshop (TFOS DEWS II), which<br />

will no doubt become the basis for our in-office<br />

classification and care models for patients affected<br />

with dry eye symptomatology. She also explored<br />

the predisposition of the Asian eye to dry eye<br />

disease, with meibomian gland dysfunction and<br />

incomplete blinking being the main culprits, and<br />

discussed the dry eye elixir that is manuka honey.<br />

Research in the area of cyclodextrin-enhanced<br />

manuka honey-based ophthalmic products used<br />

to treat blepharitis and demodex-related issues<br />

has shown huge benefit and we now eagerly await<br />

these products becoming commercially available.<br />

Optometrist-turned-doctor, Dr William<br />

Shew then discussed the early results of his<br />

chalazion study and the potential link between<br />

chalazia (or meibomian cysts) and dry eye,<br />

demonstrating how chalazia significantly alter<br />

lid anatomy. The majority resolve within six<br />

months, but a proportion require either steroid<br />

injection or incision and curettage. “This has<br />

important implications for those undergoing<br />

repeat procedures as meibomian glands have no<br />

regenerative capacity,” he said.<br />

Dr Ilva Rupenthal continued the dry eye theme<br />

later that morning, introducing NovaTears, the<br />

most recent addition to the ocular lubricant<br />

market. This product is both lipophobic and<br />

lipophilic, arranging itself to offer the best<br />

contact to the ocular surface (lipophillic) and<br />

the atmosphere (lipophobic) without the use of<br />

H2O. By not having H2O, the product remains<br />

preservative free and carries no buffers, spreading<br />

readily across the eyes, feels like silk and remains<br />

longer on the eye than other ocular lubricants. For<br />

more, see p11.<br />

From iris reconstruction to Down Syndrome<br />

and keratoconus<br />

Professor Charles McGhee wowed us with<br />

impressive surgical procedures that can be<br />

employed to reconstruct irises and regional areas<br />

of the cornea, such as in cases of corneal limbal<br />

thinning. He also presented some interesting and<br />

worrying figures on keratoconus rates among<br />

individuals with Down Syndrome tested at the<br />

Special Olympics. Prevalence as high as 37% may<br />

well suggest a need for screening with a view to<br />

cross-linking in this group of Kiwis.<br />

An update on the economy<br />

Having our ears trained on eyes all morning, it<br />

was delightful to see the return of Tony Alexander,<br />

chief economist at the BNZ, who provided an<br />

upbeat update on the New Zealand economy.<br />

In 2016 he discussed the effect on the economy<br />

of the Auckland housing crisis and the reduced<br />

dairy payouts, but this year his talk centred<br />

Pamper your eyes with<br />

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free of preservatives ensure maximum lubrication<br />

and protection of the tear film …. a gift for your eyes!<br />

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Richard Newson, Jonathan Foate and Miriam Foate<br />

Speakers Dr William Shew, Professor Charles McGhee, Dr Ilva Rupenthal and A/Prof<br />

Jennifer Craig<br />

Sanje Munathanthiri, Situ Thakersi and Eleisha Dudson<br />

around increasing migration and investment in<br />

infrastructure, which are keeping us employed and<br />

house prices high.<br />

Ortho-k to coating CLs and keratometry<br />

After a break for lunch and time to catch up with<br />

colleagues, optometrist Alex Petty, always an<br />

enthusiastic speaker with clinically-relevant pearls,<br />

offered a commentary on a variety of everyday<br />

complications we see with specialty contact<br />

lens fitting, including ortho-k and the now more<br />

frequently used scleral lenses. It is always reassuring<br />

to find that those minor epithelial desquamations<br />

are being experienced by other speciality contact lens<br />

fitters, but also that they have fairly simple causes<br />

and solutions, such as dealing with solution toxicity<br />

and re-fitting techniques.<br />

Auckland optometrist Emilie Langley then<br />

discussed the rates of ortho-k regression in<br />

patients coming out of their lenses, noting<br />

that regression rates are more rapid for higher<br />

prescriptions and female candidates in general.<br />

Overseas guest speaker, Professor Heather<br />

Sheardown, from the chemical engineering<br />

department and optometry school at Waterloo<br />

University, Canada, talked about the benefits of<br />

coating contact lenses with different compounds.<br />

This included the use of hyaluronic acid to lower<br />

deposition and protein build-up to increase<br />

the lubricity and wettability of contact lenses<br />

to enable a more comfortable and tolerant<br />

experience for the contact lens wearer – the<br />

ultimate goal of her work.<br />

Dr Dean Corbett spoke to us about new<br />

techniques employed in patients with radial<br />

keratotomy (common in the ‘80s and ‘90s) who now<br />

present with cataracts. This is a complex situation<br />

where patients have relatively unstable corneas,<br />

meaning the biometric data is compromised and<br />

thus their outcomes can be unpredictable.<br />

Lifetime membership awards<br />

To honour the 60th year of the CCLS, two lifetime<br />

memberships were awarded to Dr Malcolm<br />

McKellar and Alan Saks both of whom have<br />

contributed enormously to this Society and in the<br />

area of contact lenses.<br />

Dr Malcolm McKellar was the one of the first<br />

optometrists to retrain as an ophthalmologist. He<br />

trained in New Zealand and then gained further<br />

subspecialty experience in treating diseases of<br />

the anterior segment, cornea<br />

and external eye in Israel and<br />

England. He helped established<br />

the Cornea Clinic at Christchurch<br />

Public Hospital, is a founding<br />

member of the New Zealand<br />

Ocular Tumour Service, has<br />

helped and continues to help<br />

train both optometrists and<br />

ophthalmologists and has served<br />

as an active Society councillor.<br />

He’s also been very active in<br />

charity work, donating his<br />

time and skills to the Volunteer<br />

Ophthalmic Services Overseas<br />

(VOSO) in Vanuatu and Fiji, and<br />

further afield in the Gaza Strip.<br />

Leith O’Connor and Peter Turner<br />

Dharshie Hughes, Joy Hoshek and Sandhya Mathew<br />

Kent Napier, Richard Johnson and Greg Nel<br />

Alan Saks is a South African-born and trained<br />

third generation optometrist who worked for<br />

many years in New Zealand. A long-serving<br />

consultant and advisory board member to Johnson<br />

& Johnson Vision Care, he’s an advocate for new<br />

CL technologies, pushing for higher Dk lenses,<br />

safer systems and better performance. A former<br />

president of the Society, he now lives in Australia,<br />

where he continues to take part in workshops,<br />

international panels and conferences and write on<br />

all things contact lens.<br />

We were lucky to have them among us.<br />

A look back and forward to the next 60<br />

years<br />

After accepting their awards, Alan then went<br />

on to round out the weekend, regaling us with<br />

memories and wisdom from his years in practice<br />

and as a member of the Society. He reminded us<br />

how important the relationships are that we build<br />

in the profession and the role that the Cornea<br />

and Contact Lens Society has played for him, and<br />

continues to play for us.<br />

After 60 years, it appears the CCLS is still going<br />

strong and we look forward to the next 60 years<br />

of friendship with colleagues who care for the<br />

anterior eye, contact lenses and, most importantly,<br />

the patients they’re attached to.<br />

*Roberta McIlraith is a CCLS councillor and Christchurch-based<br />

optometrist, specialising in specialty contact lenses, ortho-k,<br />

myopia control and fitting keratoconic corneas. Adele (Ralston)<br />

Jefferies is a therapeutic optometrist and national clinical manager<br />

for Matthews Eyewear Eyecare. She has a special interest in<br />

contact lenses, dry eye and other ocular surface disease, ocular<br />

therapeutics, ophthalmology co-management, patient education<br />

and optometric education.<br />

Drs Chris Murphy, Malcolm McKellar, awarded a lifetime membership of CCLS for services to the<br />

industry, and Reece Hall<br />

8 NEW ZEALAND OPTICS May <strong>2018</strong>

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at the surface of hydrogels characterised with microrheology. Invest Ophthalmol Vis Sci 2013;54:E-Abstract 500. 3. Dunn A, Uruena J, Huo Y. Lubricity of surface hydrogel layers.<br />

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May <strong>2018</strong><br />




Stephen Hill, Peter Grimmer and Aniell Esposito DFV’s Ralph Thompson and Will Robertson flank Sarah Lord and Stephanie Wallen Claire McDonald and Dr Dean Corbett<br />

Wielding the power of OCT<br />


A<br />

one-off, all-day workshop providing a full<br />

overview of OCT technology and its clinical<br />

uses was arranged immediately before the<br />

CCLS one-day conference on Saturday 17 March<br />

<strong>2018</strong>.<br />

More and more optometry practices across<br />

the country are either considering or have<br />

purchased OCT machines. OCT investigations<br />

and OCT-assisted monitoring lead to a dramatic<br />

improvement in clinical care, so the board of CCLS<br />

thought it was timely to arrange a workshop to<br />

provide an insight into OCT technology and the<br />

interpretation of results.<br />

I opened the workshop and presented the<br />

first lecture, which discussed the basics of<br />

OCT technology: how the initial time domain<br />

technology created a relatively poor image and<br />

how technological advances have led to the<br />

newer spectral domain technology, which is now<br />

the technology of choice for nearly all OCT’s on<br />

the market. I also discussed swept-source OCT<br />

technology, the latest advancement, which is more<br />

expensive but has a number of benefits, such as<br />

greater clarity of images and greater penetration,<br />

allowing the choroidal vasculature to be visualised.<br />

While this technology is currently only available<br />

with the Topcon Atlantis OCT machine, other<br />

manufacturers are in the process of developing<br />

their own swept-source OCT machines, which<br />

should be available soon.<br />

Dr Jesse Gale, an ophthalmologist and glaucoma<br />

subspecialist from Wellington, then provided<br />

a comprehensive overview of OCT use in the<br />

diagnosis and management of glaucoma. He gave<br />

many helpful hints about how to maximise the<br />

use of OCT in this area and interpret the glaucoma<br />

assessment printout. This allows for a much more<br />

accurate diagnosis, and thus management of the<br />

disease, rather than the simple “red is bad, green<br />

is good” guide. Jesse then went on to cover many<br />

of the pitfalls of glaucoma and ocular hypertensive<br />

monitoring techniques and reinforced appropriate<br />

referral guidelines. He discussed the benefits and<br />

weaknesses of some scans, including ganglion<br />

cell patterns, which are available with some<br />

machines such as Zeiss’ Cirrus, and the need<br />

to incorporate the information into an overall<br />

glaucoma assessment. He ended his presentation<br />

with a look at where OCT can be helpful in neuroophthalmology<br />

diagnosis, such as identifying<br />

papilloedema.<br />

This was followed by an hour-long lunch with<br />

much socialising and catching up with colleagues<br />

from around the country.<br />

I then presented another lecture, this time<br />

on the uses of OCT in the anterior segment,<br />

discussing the assessment of the angle in<br />

multiple axis, which the new swept-source OCT<br />

scans do particularly well, and providing some<br />

examples of corneal surgery where the depth<br />

and accuracy of the incisions can be<br />

easily assessed. As an aside, at the<br />

request of the CCLS President Jagrut<br />

Lallu, I also discussed the current<br />

uses of Avastin in the treatment of<br />

corneal neovascularisation, which<br />

is a very difficult condition to treat.<br />

Examples include vascularisation of<br />

the cornea from severe limbal vernal<br />

keratoconjunctivitis or vascularising<br />

hydrops. Avastin is a simple,<br />

inexpensive and effective treatment<br />

and is now available publicly from<br />

many hospital eye departments<br />

including Waikato.<br />

The next speaker, Richard Johnson, a well-known<br />

optometrist working in the Greenlane Clinical<br />

Centre in Auckland, gave an informative and<br />

entertaining lecture on OCT uses in medical retina<br />

treatment, in particular, macular assessment. He<br />

covered many of the common conditions that<br />

optometrists are likely to encounter, explaining the<br />

“normal range” which could not be assessed before<br />

OCT scans were available.<br />

Complementing Richard’s talk was a presentation<br />

by Auckland-based ophthalmologist Dr Andrew<br />

Riley, who gave a comprehensive review of medical<br />

Tim Eagle, keynote speaker BNZ’s Tony Alexander and Simon Rose<br />

retina conditions, including macular pathology,<br />

treatment and referral guidelines. In a wideranging<br />

and engaging talk, Andrew also discussed<br />

OCT assessment of vitreoretinal conditions and<br />

their treatment.<br />

On behalf of the CCLS board, I would like to take<br />

this opportunity to thank the speakers for their<br />

time and efforts, the Capital Vision Research Trust<br />

for the faculty and the 53 attendees for their<br />

participation. We hope you found it useful for your<br />

continuing clinical practice.<br />

*Dr Chris Murphy is a Hamilton-based ophthalmologist and CCLS<br />

councillor.<br />

Craig: 027 565 7200 Robert: 027 565 7720 P: 0800 657 720 info@oppmed.co.nz<br />

Renata Watene and Nick Burbery<br />

Radiant Health ramps up<br />

B+L team<br />

Radiant Health’s Bausch+Lomb (B+L) team<br />

has been reorganised and expanded to<br />

include two more people chosen for their<br />

skills to help practices.<br />

Key account manager Yvette Beattie has been<br />

promoted to national sales representative and<br />

will be supported in her role across the country<br />

by Conor Fitzgerald and Leanne Fierro.<br />

Fitzgerald has been with Radiant for nearly<br />

three years, having first been employed to sort<br />

out a new customer relationship management<br />

system. This included bringing the B+L customer<br />

service in-house, which has been good, he says,<br />

as it’s given Radiant more control, providing a<br />

far better service. With a background primarily<br />

in marketing, including some consumer<br />

healthcare, he admits, however, that the world<br />

of eye health is new to him. “There is a lot to<br />

learn, but I’m enjoying getting into it.”<br />

Beattie says Fitzgerald will help provide<br />

support in the field and tailor campaigns and<br />

merchandising to what optometrists actually<br />

need. “It’s great to have him on board because<br />

he’s young and dynamic and he’s tapped into<br />

using social media and marketing.”<br />

Fitzgerald will be helping B+L practices with<br />

their social media, specifically to target new<br />

Kylie Dreaver and Andrew Black<br />

Yvette Beattie and Conor Fitzgerald<br />

and existing local customers, and is currently<br />

trialling the new initiative with one practice<br />

before rolling it out to others.<br />

It’s also great to have Fierro join the sales<br />

team, says Beattie, as she has more than 25<br />

years’ experience in sales and advertising. “She<br />

has a lot of merchandising experience with<br />

pharmacies so she will be able to help practices<br />

with in-store merchandising and window<br />

displays, while remaining part of the customer<br />

service team. So, we’ve got a really nice little<br />

team now.”<br />

10 NEW ZEALAND OPTICS May <strong>2018</strong>

From the exhibitor’s hall<br />

As one of the main events in the New Zealand ophthalmic<br />

calendar for both optometrists and anterior segment<br />

ophthalmologists, the Cornea and Contact Lens Society (CCLS)<br />

of New Zealand’s annual conference is well supported by sponsors.<br />

This year’s one-day conference was no exception with some of the<br />

industry’s best-known companies on-hand to demonstrate and<br />

discuss their latest technical advances with delegates.<br />

The following is a brief snapshot of what was new and was<br />

attracting attention at the <strong>2018</strong> CCLS NZ conference in Wellington.<br />

AFT Pharmaceuticals – NovaTears<br />

Kiwi-based pharmaceuticals company AFT’s latest eye product,<br />

NovaTears, manufactured by Novaliq, was attracting a lot of<br />

attention in the exhibitor’s hall following a talk about it by Auckland<br />

University’s Buchanan Ocular Therapeutics Unit director Dr Ilva<br />

Rupenthal.<br />

There are more than 100 artificial tears products on the market<br />

today, but most are aqueous-based and so have little effect on<br />

the lipid layer, she told the audience, disclosing how her unit was<br />

involved in some of the research on NovaTears. “But NovaTears is<br />

a disruptive technology, completely different to anything on the<br />

market today... It lubricates the eye and stabilizes the lipid layer.”<br />

NovaTears incorporates Novaliq’s proprietary EyeSol technology, an<br />

innovative multi-dose, non-aqueous and preservative-free topical eye<br />

drop, which forms a thin and smooth protecting film to support the<br />

lipid layer and prevent tear evaporation, thus relieving dry eye and<br />

irritated eye symptoms. The special formulation allows the drop to<br />

spread over the surface of the eye quickly, with less “spill-over” and<br />

no vision blurring, explained Dr Rupenthal.<br />

This technology is now being applied across Novaliq’s clinical<br />

pipeline, which includes variations on NovaTears, combining it with<br />

other well-known eye health benefactors, such as Omega 3. The<br />

EyeSol technology is also being tested with some of Novaliq’s other<br />

eye health drug products, all of which could potential be exciting<br />

treatment options for the other ophthalmic indications, she said.<br />

OptiMed<br />

Taking pride of place on the OptiMed stand was the Optopol REVO<br />

OCT and the REVO NX model, providing scanning speeds faster than<br />

any other OCT in the world, said Craig Norman from OptiMed NZ.<br />

“You get far more reference points and higher resolution in a much<br />

shorter period of time. It’s so fast, the patient barely has a chance to<br />

move their fixation, so you minimise any artefact errors, just better<br />

quality results!”<br />

The new REVO also has the optional extra of OCT-angiography<br />

(OCT-A) to visualise the microvasculature of the retina. With the<br />

latest upgrade, it can now combine these images into a detailed,<br />

12x12mm widefield mosaic to allow eye health practitioners to<br />

view a far larger area of the eye than was previously possible, said<br />

Norman. “So, this can take OCT-A images of the retina, the macula<br />

plus the disc and knit them together to give you the big picture; all in<br />

one view, rather than having to look at several smaller images.” Plus,<br />

the new REVO has the option of OCT biometry, allowing practitioners<br />

to combine their OCT data with axial length measurements, which<br />

can be important for looking at myopia progression in children, for<br />

example, he explained.<br />

Corneal Lens Corporation (CLC)<br />

Echoing one of the main themes of the conference, CLC has<br />

introduced a new range of preservative-free solutions for mild to<br />

moderate and severe dry eye. The new Lumecare Camellose 0.5% and<br />

1% concentrations are both available in single dose applications and C<br />

are a good alternative to Thera Tears until the latter comes back into<br />

M<br />

the market later this year, said CLC director Graeme Curtis. “Each has<br />

its own uniqueness, both with low osmolarity.”<br />

Y<br />

Lumecare also offers a broad spectrum, multi-dose, preservativefree<br />

range called Evolve, for all severities of dry eye, favoured by<br />

CM<br />

MY<br />

the UK’s National Health Service. These products have a unique<br />

delivery system; a generation two, blue-tip technology, which<br />

CY<br />

uses a one-way valve to deliver a measured dose, while preventing<br />

CMY<br />

any contamination, said Curtis. “It’s very patient friendly so you<br />

don’t have to plunge solution into the eye. These bottles deliver a K<br />

measured drop, with one touch, so no wastage and no concerns<br />

about putting the plunger in your eye. Arthritic patients love them<br />

because they are so much more user-friendly.”<br />

This next generation delivery system is also being employed for<br />

other drop products, some of which CLC hopes to introduce to the<br />

market soon, he added.<br />

Ophthalmic Instrument Company (OIC)<br />

OCT technology was a key talking point for OIC at this year’s<br />

conference. It’s Spectralis system, combining scanning laser fundus<br />

with high-resolution OCT, made by Heidelberg Engineering, featured<br />

prominently in the CCLS NZ’s OCT Workshop day, run by Dr Chris<br />

Murphy (see page 10), while Nidek’s Retina Scan Duo, providing highdefinition,<br />

3D auto-tracking and auto-shot functions in a compact<br />

machine was attracting attention on OIC’s main stand.<br />

“Picking the right OCT depends on the practice, whether they are<br />

starting out or have had OCT before, or if they have specialised in<br />

some way,” explained OIC’s Tim Way. “The Duo, for example, is a<br />

great screening tool for general optometry practices. It offers a lot of<br />

flexibility for different pathologies yet is still very simple to use.”<br />

Given the dry eye theme of this year’s conference another product<br />

attracting attention was OIC’s Eye Doctor Hot/Cold Eye Compresses<br />

which are reusable, have a removeable, washable cover and can be<br />

heated in the microwave or oven, or cooled in the freezer. The Eye<br />

Doctor Compress is used to alleviate the symptoms and discomfort of<br />

Meibomian gland dysfunction, eyelid cysts and dry eye disease.<br />

CooperVision<br />

CooperVision’s Joe Tanner and Cherie Norton were focusing on the<br />

company’s MyDay and MyDay Toric daily disposable lenses and Biofinity<br />

Energys, the latest lens in the Biofinity<br />

range designed specifically to help manage<br />

and alleviate digital eye fatigue.<br />

According to the company, the<br />

technologically-advanced silicone<br />

channels in the MyDay material transport<br />

oxygen so efficiently that less raw silicon<br />

is required, sustaining wettability and<br />

optimal water content. Whereas Energys<br />

has been digitally engineered with<br />

multiple front-surface aspheric curves<br />

to distribute power evenly to simulate<br />

more positive power centrally. Energys’<br />

‘Digital Zone Optics’, when combined<br />

with Biofinity’s Aquaform Technology (which improves the lenses’<br />

moisture, breathability and deposit resistance) help combat dryness<br />

and tiredness, two key symptoms associated with digital eye fatigue.<br />

Also attracting attention was CooperVision’s Optomism, which<br />

is currently being presented to practices across the country.<br />

This packages CooperVision’s products and services together to<br />

support practice growth and explains CooperVision’s international<br />

commitment to more sustainable practices and charitable support.<br />

Designs for Vision<br />

Dry eye was the main theme of the Designs for Vision (DFV) stand at<br />

this year’s CCLS conference, with the company’s complete suite of dry<br />

eye products on display.<br />

It’s Oculos Keratography 5M is well-known to dry eye researchers,<br />

CooperVision Half Page NZ Optics May <strong>2018</strong>.pdf 1 11/04/<strong>2018</strong> 11:33:44 AM<br />



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May <strong>2018</strong><br />




Andrew Sangster, Frances Misich and Anne Matheson<br />


having been the preferred tool for dry eye analysis for a number of<br />

years. It easily and efficiently integrates complex examinations such as<br />

meibography into ophthalmological and optometric practices, revealing<br />

morphological changes in the glandular tissue and evaluating the tear<br />

film. This is complemented by other products such as the Blephasteam,<br />

which provides moisture heat therapy to relieve symptoms of<br />

meibomian gland dysfunction (MGD); Optimel’s manuka honey dry<br />

eye drops; and the Eye-Light intense pulsed light (IPL) technology for<br />

treatment of both the bottom and top lids.<br />

DFV has been in the dry eye space for more than six years, so it’s<br />

something the company really understands, said DFV’s William<br />

Robertson. “The biggest thing for optometrists when it comes to dry<br />

eye is to actually make the psychological leap to ‘I’m really going to<br />

treat my patients’, rather than ‘here are some drops’, because it is<br />

Recommend ACUVUE® Brand contact lenses<br />

Always read the label. Use only as directed.<br />

John Veale, Dharshie Hughes, Jeremy Fox and Iris Xu<br />

and give your patients the power of choice<br />

a commitment in time,<br />

and dry eye patients can<br />

be quite testing.” But for<br />

those who do invest in<br />

it, it adds another string<br />

to their bow, which can<br />

attract a number of new,<br />

long-term, loyal patients,<br />

he said.<br />

Johnson & Johnson Vision Care, a division of Johnson & Johnson Pacific Pty Ltd, 45 Jones Street, Ultimo, NSW, 2007, Australia.<br />

Phone: 1-800-736-912. www.acuvue.com.au<br />

Johnson & Johnson Vision Care, a division of Johnson & Johnson ( New Zealand ) Ltd., 507 Mt. Wellington Highway, Mt. Wellington, Auckland,<br />

New Zealand. 0800-466-173. www.acuvue.co.nz<br />

CCP 8907/18 TAPS PP2169<br />

Alcon<br />

The “SmarTears”<br />

technology of Alcon’s<br />

Dailies Total 1 contact<br />

lens range was the main<br />

topic of conversation on the Alcon stand this year. According to the<br />

company literature, SmarTears helps stabilizes the eye’s tear film to<br />

reduce dryness and provide better contrast sensitivity by releasing<br />

phosphatidylcholine (PC), an ingredient found in natural tears,<br />

which, together with Dailies water gradient technology and oxygen<br />

transmissibility, helps provide extra moisture and restore the lipid<br />

layer.<br />

“PC is present in natural tears. It adheres the lipid layer to<br />

the aqueous layer… providing a more comfortable contact lens,<br />

especially for our presbyopes,” said Caroline Perkinson, Alcon’s<br />

business development manager for New Zealand. “There are a lot of<br />

presbyopes out there, and people do experience more discomfort as<br />

they get older, so for optometrists, being able to give provide better<br />

multifocal technology, which their patients can wear for longer helps<br />

them grow that side of the business.”<br />

Alcon will be demonstrating this technology directly to practices<br />

later this year in a series of roadshows around the country.<br />

J&J new NZ recruit<br />

Johnson & Johnson Vision’s professional affairs manager and<br />

optometrist Dr Emma Gillies was manning the J&J Vision<br />

stand to explain the benefits of Acuvue Oasys 1-Day, and<br />

its unique<br />

Hydraluxe<br />

technology,<br />

and<br />

introduce<br />

new recruit<br />

Alisha<br />

Walker.<br />

A trained<br />

dispensing<br />

optician,<br />

Walker was<br />

formerly<br />

employed<br />

by Paterson<br />

Burn<br />

optometrists<br />

in Auckland<br />

before<br />

joining J&J<br />

Vision in<br />

August last<br />

year. A 20-<br />

year veteran<br />

in New<br />

J&J’s Emma Gillies and Alisha Walker<br />

Zealand’s<br />

optometry<br />

industry, she says she’s greatly enjoying her new role as a J&J<br />

customer development manager in New Zealand, especially as<br />

it allows her to travel around the country and share some of the<br />

skills she’s learnt managing different practices.<br />

“It’s more than just a sales role, it’s about business support.<br />

I bring a lot of frontline understanding about the challenges<br />

of growing and maintaining a practice’s success, which<br />

involves everything from staff training and discussing the right<br />

language to use for patients to helping optometrists identify<br />

opportunities to maintain and improve their patient database.”<br />

Dr Gillies says she’s also delighted to have Walker on board.<br />

“Alisha brings a breadth of experience and level of enthusiasm<br />

to the role which is refreshing and I just know she’s going to do<br />

very well in the New Zealand industry.”<br />

BHVI disproves CL<br />

theory<br />

Single vision contact<br />

lenses with optical<br />

designs that aim to<br />

reduce inherent spherical<br />

aberrations (SAs) of the<br />

eye are not effective<br />

in improving visual<br />

performance, according to<br />

a recent study¹ by the Brien<br />

Holden Vision Institute<br />

(BHVI).<br />

The results of the study,<br />

published in Clinical Optometry, show the assumption among<br />

manufacturers that reducing the inherent SA of the eye will improve<br />

vision is wrong, said study co-author, Dr Cathleen Fedtke, a senior<br />

research fellow at BHVI, adding there are also no known published<br />

studies to support this assumption.<br />

To test the assumption, BHVI researchers randomly selected nonpresbyopic,<br />

adult myopes, aged between 18 and 33 years, and asked<br />

them to wear either a lens with minimal or no spherical aberration<br />

or a commercial lens designed with negative SA.<br />

Visual acuity measures and binocular vision assessments were<br />

conducted and a questionnaire completed after the lenses were<br />

fitted. Responses on vision quality (clarity and lack of ghosting for<br />

distance, intermediate, near, and driving vision in day and nighttime),<br />

vision stability, overall vision satisfaction and ocular comfort,<br />

were rated. After five days of wear, the same tests were conducted<br />

and the survey repeated.<br />

“We found that the introduction of negative SA into contact<br />

lenses did not produce appreciable visual performance gains in<br />

terms of visual acuity or subjective metrics,” said Dr Fedtke. “This is<br />

the first study to show that inducing negative SA, as done in many<br />

commercial single vision contact lenses, does not improve visual<br />

performance.”<br />

Furthermore, the authors warned that power profiles of soft<br />

contact lenses with negative SA “can induce measurable changes in<br />

peripheral refraction (including relative peripheral hyperopia)”, and<br />

“this could have a negative consequence on the myopia progression.”<br />

Consequently, they suggest that, “given current clinical interest<br />

in the peripheral retina in relation to myopia, clinicians should be<br />

aware of the insignificant visual performance gains when fitting soft<br />

contact lenses of this design on young and progressing myopes.” ▀<br />

Reference<br />

1. Kho D, Fedtke C, Tilia D, Diec J, Sha J, Thomas V, Bakaraju RC, Effects of relative<br />

negative spherical aberration in single vision contact lens visual performance.<br />

Clinical Optometry, <strong>2018</strong>:10 9-17.<br />

12 NEW ZEALAND OPTICS May <strong>2018</strong><br />

9562 NZ Optics - Half Page Poster-OUTPUT.indd 1 17/4/18 9:26 am



ON COMFORT 1<br />

Warning: UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses because they do not<br />

completely cover the eye and surrounding area. You should continue to use UV-absorbing eyewear as directed.<br />

Always read the label. Use only as directed.<br />

1. JJVC data on file 2017. Claim for the family of ACUVUE OASYS® Brand Contact Lenses (2-week reusable) using clinical trials cited on www.clinicaltrials.gov website.<br />

Johnson & Johnson Vision Care, a division of Johnson & Johnson Pacific Pty Ltd., 45 Jones Street, Ultimo NSW 2007, 1-800-736-912. www.acuvue.com.au<br />

Johnson & Johnson Vision Care, a division of Johnson & Johnson ( New Zealand ) Ltd., 507 Mt. Wellington Highway, Mt. Wellington, Auckland. New Zealand ,<br />

0800 466 173. www.acuvue.co.nz May CCP8908/18 <strong>2018</strong> NEW ZEALAND TAPS OPTICS PP2166<br />


Focus on<br />

Eye Research<br />

DSAEK, DMEK, epitheliumoff<br />

crosslinking and<br />

blepharitis treatments<br />




Saiqun Li, Liangping Liu, Wei Wang,<br />

Ting Huang, Xingwu Zhong, Jin Yuan,<br />

Lingyi Liang<br />

PLoS One. 2017; 12(12): e0182275.<br />

The surgical management of corneal<br />

decompensation has traditionally<br />

been with full thickness corneal<br />

transplantation or penetrating<br />

keratoplasty (PK) and more recently with<br />

lamellar transplantation techniques<br />

such as Descemet stripping automated<br />

endothelial keratoplasty (DSAEK), in<br />

which the Descemet’s membrane<br />

endothelial complex is transplanted<br />

with a sheet of stroma, and Descemet’s<br />

membrane endothelial keratoplasty<br />

(DMEK), in which the Descemet’s<br />

membrane endothelial complex is<br />

transplanted in isolation and attached<br />

in a suture-free method through gas<br />

tamponade.<br />

In this meta-analysis, the authors<br />

evaluated 19 published articles<br />

comparing the outcomes of DSAEK and<br />

DMEK. The overall pooled estimates<br />

demonstrated a significantly superior<br />

post-operative best corrected visual<br />

acuity, a comparable endothelial<br />

cell density, and an increased graft<br />

detachment rate in the DMEK group<br />

compared with the DSAEK group.<br />

Comment: Endothelial keratoplasty is<br />

now the gold standard procedure for<br />

endothelial disease comprising 31%<br />

of corneal transplants performed in<br />

New Zealand in 2015. There is now<br />

increasing evidence to suggest that<br />

whilst technically more challenging,<br />

DMEK surgery provides better visual<br />

outcomes following surgery compared<br />

to more traditional DSAEK surgery,<br />

but further surgical refinements are<br />

required to shorten the learning curve<br />

and improve potential intra-operative<br />

and post-operative complications. Results<br />

of the currently running, multicentre,<br />

randomised clinical trial comparing<br />

DSAEK and DMEK are keenly awaited.<br />




Price M, Feng M, Price F<br />

J Cataract Refract Surg. <strong>2018</strong> Mar 28<br />

Crosslinking is the creation of bonds that<br />

connect one polymer chain to another.<br />

Corneal collagen crosslinking (CXL) is a<br />

technique used to strengthen corneal<br />

tissue utilising riboflavin (vitamin B2)<br />

as a photo-sensitizer and ultraviolet-A<br />

(UVA) to increase the formation of intra<br />

and inter-fibrillar carbonyl-based covalent<br />

bonds through the process of photopolymerisation.<br />

In this article, the authors evaluate the<br />

satisfaction rate of 448 patients after<br />

a mean period of 3.5 years following<br />

epithelium-off CXL. The mean satisfaction<br />

score was 8.8 ± 1.7 (SD) on a scale of<br />

1 (would not recommend CXL) to 10<br />

(definitely would recommend) among<br />

those treated for keratoconus. The<br />

authors also demonstrate that 93% of<br />

patients felt that the treatment halted<br />

the progression of the disease with<br />

younger patients reporting a higher<br />

efficacy rate. Regarding vision, 87%<br />

reported an improvement or stability of<br />

their vision following treatment. Only<br />

1.7% of the 644 eyes treated required<br />

keratoplasty.<br />

Comment: Keratoconus is a debilitating<br />


condition with a disproportionately<br />

high-impact on public health resources<br />

and vision specific quality of life. CXL<br />

has revolutionised the management of<br />

keratoconus in recent years by effectively<br />

stabilising the underlying ectatic process<br />

and in some cases reversing the disease<br />

as quantified by key topographic,<br />

refractive and visual outcomes. More<br />

than a decade after being introduced,<br />

this minimally invasive treatment<br />

modality is now fulfilling the promise of<br />

treating keratoectasia at an earlier stage,<br />

preventing the morbidity associated with<br />

disease progression and precluding the<br />

need for the more invasive keratoplasty<br />

procedure. This article demonstrates that<br />

CXL is viewed by patients as effective in<br />

halting the progression of their ectatic<br />

disease and also stabilising or improving<br />

their vision.<br />




Sung J, Wang MTM, Lee SH, Cheung<br />

IMY, Ismail S, Sherwin T, Craig JP<br />

Ocul Surf. <strong>2018</strong> Jan;16(1):77-83.<br />

Blepharitis is complex ocular disorder<br />

characterised by an imbalance in ocular<br />

flora, meibomian gland dysfunction<br />

and eyelid/ocular surface inflammation.<br />

Blepharitis is one of the most prevalent<br />

ocular disorders encountered by eye<br />

care professionals. In this randomised,<br />

double-masked trial, the authors<br />

compared the efficacy of two lid hygiene<br />

techniques by asking patients to use a<br />

commercial eyelid cleanser in one eye<br />

and conventional lid hygiene technique<br />

using diluted baby shampoo in the other.<br />

The results showed that whilst both<br />

treatments reduced the patient reported<br />

SPEED symptom score and improved<br />

lash crusting and trichiasis, the eyelid<br />

cleanser was the preferred treatment<br />

of choice for most patients (53% vs. 9%,<br />

p < 0.001). The cleanser also resulted in<br />

superior improvements in clinical features<br />

such as tear lipid layer and ocular surface<br />

inflammatory markers such as MMP-9<br />

expression. In a concerning finding, the<br />

authors reported that baby shampoo<br />

treatment was associated with adverse<br />

outcomes such as meibomian gland<br />

capping and MUC5AC expression (a<br />

marker of goblet cell density and function<br />

within the conjunctiva).<br />

Comment: Blepharitis is a common<br />

ocular disorder that can lead to<br />

significantly altered quality of life. All<br />

eye care professionals are well aware<br />

of the challenges associated with<br />

satisfactorily treating patients with this<br />

chronic disease. This article provides an<br />

insight into the potential advantages<br />

of using commercial cleansing products<br />

over traditional methods of lid hygiene<br />

and highlights the need for further<br />

studies looking into the effects of<br />

using household products such as baby<br />

shampoo on the ocular surface.<br />


*Dr Mo Ziaei has undergone quadruple fellowship<br />

training in the field of cornea, ocular surface<br />

disorders and anterior segment surgery at<br />

Moorfields Eye<br />

Hospital, London, and<br />

New Zealand National<br />

Eye Centre, Auckland.<br />

He is an honorary<br />

senior lecturer at the<br />

University of Auckland<br />

and a cornea and sight<br />

correction specialist at<br />

Re: Vision clinic and<br />

surgery centre (see<br />

story p3).<br />

Eye Doctors provide a warm<br />

start to autumn<br />


The arrival of autumn heralds the Eye Doctor’s first<br />

Grand Round of the year. Held at the Novotel in Ellerslie,<br />

Auckland, this year’s inaugural seminar on 28 March was<br />

a warm and welcoming affair with many local optometrists<br />

attending keen to kick off their annual cpd hunt and hear the<br />

latest surgical updates from Eye Doctors’ surgeons.<br />

Wobbly eyes<br />

Paediatric eye specialist, Dr Shuan Dai kicked-off proceedings<br />

this year with a talk about childhood nystagmus or “wobbly<br />

eyes”, a disorder distinguished by involuntary eye movement.<br />

He presented examples of different types of wobbly eyes,<br />

explaining how to reach the correct diagnosis, which is<br />

important not only for treatment but because the disorder<br />

can be a sign of something more sinister, like multiple<br />

sclerosis or a brain tumour, requiring further investigation<br />

such as neuroimaging.<br />

When the condition is associated with photophobia or<br />

vision loss, this can be caused by albinism, aniridia, retinal<br />

dystrophies, Leber’s congenital amaurosis, optic atrophy/<br />

hypoplasia, foveal hypoplasia and retinopathy of prematurity<br />

(ROP). Occasionally, systemic conditions such as ataxia (acute<br />

onset) and hydrocephalus can cause nystagmus.<br />

Dr Dai told the audience if you suspect nystagmus in a<br />

patient with normal ocular examination results, remember<br />

“in medicine, nothing comes in isolation”, you need to<br />

look for other symptoms and patterns, such as laterality<br />

(monocular must exclude central nervous systems gliomas),<br />

jerk/pendular, horizontal/vertical/mixed movements,<br />

amplitude, frequency and other abnormalities such as head<br />

nodding to direct you to the likely diagnosis and further<br />

investigations.<br />

After establishing the reason for the nystagmus and making<br />

a full diagnosis, including any link to secondary central<br />

nervous system diseases, managing the patient includes<br />

offering treatment of amblyopia, low vision services and,<br />

possibly, nystagmus surgery.<br />

Ditch the lingo<br />

Next up, Dr Andrew Riley took to the podium on a mission<br />

to stop what he calls our “secret language”, or using medical<br />

terminology when prescribing.<br />

With 396 recognised abbreviations, it’s no wonder patients<br />

and sometimes even pharmacists and doctors get it wrong<br />

when eye health professionals discuss conditions using a series<br />

of ophthalmic acronyms, argued Dr Riley. Worryingly, according<br />

to some statistics presented, 20% of all medical negligence<br />

treatment claims result from the incorrect use of a treatment<br />

drug and that can result from simple miscommunication.<br />

There are guidelines available on good prescribing practice<br />

from the New Zealand Medical Council, said Dr Riley,<br />

admitting sometimes he too was guilty of too much lingo,<br />

but if you follow the guidelines and write in plain English,<br />

using for example “every second day” rather than QOD (que<br />

otra dia), this will help reduce errors. If the prescriber, the<br />

patient and the pharmacist can read the script fewer errors<br />

will occur.<br />

Computer-derived scripts are also helping to solve the<br />

miscommunication problem, he said, as well as better patient<br />

knowledge through improved education, familiarity with<br />

the therapeutic goal and the drug in question, plus ongoing<br />

monitoring of side effects and adverse events.<br />

In summary, you need to get the five rights, right: the right<br />

patient, the right drug, the right time, the right dose and the<br />

right route, he said, and if in doubt, ask!<br />

Glaucoma drops and complications<br />

After a short break, Dr Mark Donaldson shared three cases<br />

illustrating how different glaucoma eye drop treatments can<br />

cause unexpected and undesired complications.<br />

One case involved a myopic, 70-year-old engineer who<br />

presented with suspected cystoid macular oedema (CMO),<br />

after post-operatively using a topical prostaglandin<br />

analogue/beta-blocker combination.<br />

The patient had been treated for epiretinal membrane<br />

left eye vitrectomy in 2014. He had open angle glaucoma.<br />

The concern was the patient’s intraocular pressure, said Dr<br />

Donaldson, which was why beta-blockers were prescribed. But<br />

the patient’s vision began deteriorating. Test results showed<br />

that CMO, which is statistically associated with post-operative<br />

Dr Andrew Riley, Lizette Jordaan, Vandana Kumar and Anna Maitland<br />

Ilana Gutnik, Shelley Brannigan, Debra So and Richard Johnson<br />

Dr Mark Donaldson, Isla Hills, Hue Bullen and Dr Shuan Dai<br />

use of topical PGAs – relative risk (RR) 1.86, 95% CI 1.04 to 3.32<br />

and topical beta-blockers (RR) 2.64, 95% CI 1.08 to 6.49.<br />

The post-operative use of each bimatoprost (RR 2.73, 95%<br />

CI 1.35 to 5.53%) and travoprost/travoprost/z (RR 3.16, 95%<br />

CI 1.42 to 7.03) in the year prior to diagnosis had been shown<br />

to have a statistically significantly association with the<br />

prevalence of pseudophakic CMO. This association, however,<br />

said Dr Donaldson, was not observed to be statistically<br />

significant with the post-operative use of latanoprost (RR<br />

1.55, 95% CI 0.84 to 2.88). Interestingly, however, his patient<br />

responded to having the hysite (latanoprost) stopped.<br />

Pterygium surgery<br />

Pterygium surgery has come a long way in recent decades,<br />

said the final presenter of the evening, Dr Penny McAllum,<br />

with surgeons changing to techniques providing lower<br />

recurrence rates, such as conjunctival autografting with a<br />

2-18% rate of recurrence. This compares with the old-school,<br />

five-minute scraping the sclera process which resulted in up<br />

to a hefty 88% recurrence.<br />

There is also a method called P.E.R.F.E.C.T, Dr McAllum<br />

said, now considered the gold standard in some centres,<br />

with reported recurrence rates of less than 0.1%. So far,<br />

this procedure (pterygium extended removal followed by<br />

extended conjunctival transplant) has been successfully<br />

carried out in Australia and comparable results have been<br />

shown in a recent European study.<br />

To further reduce recurrence, Dr McAllum said she prefers<br />

tissue glue to sutures. When used correctly, a meta-analysis<br />

shows it reduces the recurrence rate by 47% due to less<br />

postoperative inflammation, she explained.<br />

The main problem with current surgery is the lack of<br />

standardisation in and recording of the techniques used and<br />

the resulting outcomes, she said, adding that there was a<br />

healthy debate on the topic at the recent Australia and New<br />

Zealand Cornea Society meeting (see NZ Optics’ April issue).<br />

Some surgeons, who have developed a new surgery technique,<br />

using a femtosecond laser to harvest the conjunctival graft, are<br />

suggesting this will improve results by avoiding undertaking a<br />

technically challenging part of the surgery manually. A point Dr<br />

McAllum explained using the analogy, “if you’ve got a hammer,<br />

everything will look like a nail”.<br />

With proper training and standardising measured cosmetic<br />

and medical outcomes, pterygium surgery results will<br />

continue to improve, she said, ending the evening on a<br />

resounding upbeat note.<br />

The next Eye Doctors’ Grand Round will be held at Ormiston<br />

Hospital on 13 June by invitation only, given space<br />

constraints, while the final Grand Round for the year will be<br />

held on 31 October. ▀<br />

Linda Zhang, Trevor Skinner and Anh-Dao Le<br />

14 NEW ZEALAND OPTICS May <strong>2018</strong>

Ophthalmology wall of fame<br />


The annual Excellence in Ophthalmology and<br />

Vision Research prize evening celebrates<br />

talented personalities early in their<br />

ophthalmic careers as well as remembering<br />

ophthalmologists from yesteryear whose names<br />

grace a number of the awards.<br />

This year’s event was held at the medical and<br />

health sciences campus at the University of<br />

Auckland in March and was well attended by staff,<br />

researchers, benefactors, students and the friends<br />

and families of the award winners.<br />

Professor Charles McGhee, head of the<br />

ophthalmology department, opened the evening<br />

by welcoming everyone and thanking benefactors<br />

and clinical contributors, including Associate<br />

Professor Bruce Hadden and Dr Wendy Hadden,<br />

for their contribution to the department and to<br />

furthering ophthalmology in New Zealand. He<br />

updated the audience on the annual activities of<br />

the department, detailing how with nearly 300<br />

undergraduates and a growing number of PhDs, the<br />

department continues to grow and evolve each year.<br />

William MacKenzie Medal<br />

This year, the William MacKenzie Medal was<br />

presented to Himanshu Wadhwa by Professor<br />

Trevor Sherwin.<br />

This award is for early excellence in eye research<br />

and recognises a significant contribution made by<br />

a medical student towards a research project that<br />

has reached publication status. Judges consider the<br />

recipient’s contribution, originality and importance<br />

of the article (as well as the standing of the journal<br />

in which it is published).<br />

Wadhwa, a previous recipient of the Tom Cat<br />

Trust summer studentship award, undertook a<br />

fascinating research project investigating how<br />

corneal stem cell-enriched spheres implanted<br />

into keratoconic tissue behave to assess their<br />

therapeutic potential.<br />

He presented his research at the Healthex<br />

conference, a student-organised conference designed<br />

to promote research activity and excellence among<br />

postgraduate students, and the Royal Australia and<br />

New Zealand College of Ophthalmologists (RANZCO)<br />

conference last year, and was the top-ranked student<br />

during his 2014 thesis year.<br />

Arthur Thomas Paterson Scholarship<br />

The Arthur Thomas Paterson Scholarship was<br />

presented to junior research fellow Dr CheeFoong<br />

Chong by Dr Shaun Dai.<br />

This scholarship was set up to assist newly<br />

qualified Kiwi ophthalmologists continue their postgraduate<br />

studies overseas, so they can return with<br />

new skills to serve the New Zealand population.<br />

Dr Chong has published research on visual<br />

impairment among New Zealand children and<br />

produced one of the best databases of it’s type<br />

in the world, explained Dr Dai. He has also<br />

published several other publications in paediatric<br />

ophthalmology while completing his medical<br />

training.<br />

Calvin Ring Prize<br />

The Calvin Ring Prize was presented to fifth year<br />

medical student, Lize Angelo by Dr Peter Ring,<br />

son of Calvin Ring, one of the forefathers of<br />

New Zealand ophthalmology whose own father<br />

fortuitously won a horse race and was able to pay<br />

for his son to attend medical school.<br />

The Calvin Ring Prize recognises the best allround<br />

undergraduate medical student in clinical<br />

ophthalmology and was established to encourage<br />

interest and awareness of ophthalmology among<br />

medical students in memory of Dr Calvin Ring who<br />

believed ophthalmology in Auckland needed an<br />

academic focus. Selection for the award is based<br />

on excellence in examination, clinical knowledge<br />

and diagnostic and management skills.<br />

Angelo, who was also a summer studentship<br />

recipient in 2016, undertook her schooling in<br />

England, New Zealand and South Africa and was<br />

described by Ring as a ‘well-rounded student”,<br />

involved in volunteer work at hospices and also<br />

the charity, Habitat for Humanity.<br />

On accepting the award, Angelo said she had<br />

been inspired by the many passionate people she<br />

has met in ophthalmology and hopes to continue<br />

her endeavors and see where ophthalmology will<br />

take her.<br />

Gordon Sanderson Scholarship<br />

Professor Helen Danesh-Meyer presented the<br />

first Gordon Sanderson Scholarship to Hillary Goh<br />

for her research investigating nailfold capillary<br />

abnormalities in glaucoma (see full story in April’s<br />

NZ Optics).<br />

The scholarship was set up last year in memory<br />

of the late and much-admired Associate Professor<br />

Gordon Sanderson to further research into<br />

Some of the evening’s award winners: Catherine Tian, Hilary Goh, Hannah Ng, Himanshu Wadhwa, Lize Angelo and Joyce Mathan.<br />

glaucoma. It is available to students from Auckland,<br />

Otago or Sydney Universities, recognizing A/Prof<br />

Sanderson’s former teaching hubs.<br />

PhD Presentation<br />

The invited PhD presenter for this year’s Excellence<br />

in Ophthalmology awards was Dr Akilesh Gokul<br />

who took to the podium to discuss his research on<br />

keratoconus.<br />

Summarising three years of research in 10<br />

minutes is no easy feat, but Gokul conquered<br />

it well, describing how his ‘Aotearoa Research<br />

into Keratoconus (ARK)’ project looked at the<br />

demographics and clinical characteristics of<br />

keratoconus in New Zealand.<br />

The research surveyed Kiwi optometrists and<br />

showed that a large number of keratoconics reside<br />

in Auckland and Wellington with Maori and Pacific<br />

island patients having the highest mean corneal K<br />

readings and more severe disease. Corneal crosslinking<br />

can stabilise the disease for at least 10<br />

years by creating more covalent collagen bonds<br />

and strengthening the cornea. Gokul’s research<br />

evaluated an accelerated cross-linking methodology,<br />

which he illustrated elegantly in his presentation.<br />

While cross-linking can prevent disease progression<br />

and reduce the corneal transplant rate, Gokul<br />

explained “early detection is a major challenge in<br />

keratoconus with many patients presenting too late<br />

to benefit from the procedure.”<br />

Summer Studentships<br />

Dr Ilva Rupenthal, director of the Buchanan<br />

Ocular Therapeutics Unit at Auckland University,<br />

presented this year’s Summer Students with their<br />

awards. The award recipients were:<br />

• Spheres of Influence, Catherine Tian (Tom Cat<br />

Trust)<br />

• Influence of high glucose and inflammation on<br />

barrier properties of retinal pigment epithelial<br />

(ARPE) cells, Charisse Kuo<br />

• Differentiation of transition zone stem cells into<br />

corneal endothelial cells, Hannah Ng (Eye Institute)<br />

• Comparison and review of visual field referrals to<br />

ADHB glaucoma clinic, Catherine Kwak<br />

• Crystallin protein modification and spatial<br />

mapping in an aging lens model, Jerry Shen<br />

• Evaluating the long-term usability of ex-vivo<br />

bovine corneas for drug delivery applications,<br />

Darshan Shrestha (Buchanan Charitable<br />

Foundation)<br />

• The effect of erythropoietin on the vasculature<br />

of the premature sheep retina: a cellular and<br />

molecular characterisation, Muthana Noori<br />

• Nailfold capillary abnormalities in glaucoma,<br />

Hilary Goh (Gordon Sanderson Scholarship from<br />

Glaucoma New Zealand)<br />

• Review of glaucoma referrals to ADHB glaucoma<br />

clinic, Tess McCaffrey<br />

• Confirmation of UV filter distribution in the<br />

aging human lens, Arwa Ibrahim (Molecular<br />

Dr Penny McAllum<br />


Professor Charles McGhee, Dr Raisha Altaie and Jina Han (photobombed by Dr Stuti Misra) Drs Shuan Dai and Peter Ring. Photo by Alec Lou Hin<br />

Ophthalmology department benefactor and former staff member Joan<br />

Ready with some award winners in the audience<br />

Han Li, Joyce Wong and Jasmine Feng<br />

Vision Laboratory)<br />

• To give or not to give? Should I provide feedback<br />

during acuity measurement, Maggie Xu<br />

• Monitoring age-related changes of the vitreous<br />

of the eye using MRI, Louisa Howse<br />

• Evaluating the utility of an eyelid massage<br />

device for the management of meibomian gland<br />

dysfunction, Jasmine Feng (NZAO Education and<br />

Research Fund)<br />

• Effect of temperature on the thickness of the<br />

human ocular choroid measured with optical<br />

Eye Doctors Grand Rounds <strong>2018</strong><br />

. Wed 13th June, Ormiston Hospital<br />

(invitation only)<br />

. Wed 31st October, Novotel, Ellerslie<br />

Dr Shuan Dai<br />


. No registration fee<br />

. CPD points available<br />

. www.eyedoctors.co.nz<br />

Dr Andrew Riley<br />


Dr Ilva Rupenthal (right) presenting Joyce Wong with her award.<br />

Dr Akilesh Gokul presenting his PhD research<br />

Dr Jie Zhang, Nigel Brookes and Ismail Salim<br />

coherence tomography, Sungyeon Kim<br />

• The effect of virtual reality on the tear film and<br />

ocular surface, Joyce Wong<br />

• Adaptation of jumping spider behaviour to a<br />

modified focal environment, Aimee Aitken (Paul<br />

Dunlop Memorial Research Scholarship, NZAO)<br />

• Visual impairment in stroke in a New Zealand<br />

context: patient characteristics in the CBR Stroke<br />

Recovery Clinic, Carla Fasher ▀<br />

For more, including pictures, please see April’s<br />

NZ Optics.<br />

ASCOT CLINIC (09) 520 9689 - BOTANY JUNCTION (09) 277 6787<br />

Dr Mark Donaldson<br />


EYE 0810<br />


May <strong>2018</strong><br />



Information packed Ocular Therapeutics Conference<br />


The Waipuna Hotel and Conference Centre<br />

in Mount Wellington, Auckland on a March<br />

summer’s day was the setting for the<br />

third Ocular Therapeutics Conference, run by<br />

the Buchanan Ocular Therapeutics Unit at the<br />

University of Auckland.<br />

Once again, this increasingly popular conference<br />

boasted a mix of short, informative and exciting<br />

talks from local and international specialists, as<br />

well as an arena for optometric and pharmacy<br />

colleagues to catch up and share their different,<br />

but related worlds.<br />

Meds: the good, the bad and the ugly<br />

The morning’s lectures covered both oral and<br />

topical medicines with Dr Jay Meyer kicking off<br />

proceedings with a talk about oral medications for<br />

ocular conditions. He warned his audience about<br />

the potential risk of death from anaphylaxis with<br />

many medications, however, oral antihistamines,<br />

which work on H1 receptors, are quite safe and<br />

available over the counter, he said.<br />

He covered anti-virals for use in herpes simplex<br />

and herpes zoster infections, noting that<br />

valacyclovir, which has greater bioavailability<br />

and a less frequent dosage, is not funded in New<br />

Zealand, and touched on alternative treatments<br />

to anti-virals, such as turmeric and lysine. Next,<br />

he covered oral medications for meibomian<br />

gland dysfunction (MGD). Azithromycin has<br />

become popular with optometrists for its antiinflammatory<br />

and antimicrobial effects, however<br />

it is contraindicated in those with any significant<br />

cardiac history or heart arrhythmia. Doxycycline<br />

with its shorter half-life, can also be used and is<br />

contraindicated in children and pregnancy.<br />

Next, Dr Taras Papchenko tackled toxicity<br />

of common medications in the eye. He took a<br />

systemic approach, first looking at medications<br />

effecting the anterior eye, the iris and pupil (eg.<br />

tamulosin and venlafaxine), before moving to<br />

the lens (steroids, chlorpromazine) and on to the<br />

retina (cholorquine, tamoxifen) and the optic nerve<br />

(amiodarone). His take home message was that all<br />

structures in the eye require oxygen and nutrients,<br />

provided by capillaries or tears, and so systemic<br />

drugs can cause a wide range of ocular side effects.<br />

A thorough history is required to identify all the<br />

medications a patient is on, he said.<br />

Professor Charles McGhee provided a synopsis<br />

of avoiding and managing corneal transplants,<br />

discussing the pathophysiology of graft rejection<br />

and the drugs used such as steroids, cyclosporine<br />

and mycophenolate. In general, you should just<br />

“believe the patient if they say they are worried<br />

about their graft” and see them as soon as possible<br />

as a precaution, he said.<br />

Dr Nicola Anstice, who had returned home from<br />

her new role as the University of Canberra’s head<br />

of discipline for its new five-year optometry course,<br />

Kent Napier, Tim Eagle and Chris Edwards<br />



presented data on the prescribing trends of New<br />

Zealand optometrists.<br />

Auckland was disproportionately represented<br />

in prescribing with 11% of the population being<br />

based in Auckland and 21% of the therapeutic<br />

prescribing-authorised optometrists living there.<br />

The Bay of Plenty was also over-represented<br />

while Canterbury showed lower levels of<br />

prescribing when compared with its population.<br />

The most prescribed medications in New Zealand<br />

were topical anti-invectives and anti-virals<br />

followed by anti-allergy (olopatadine was a<br />

favourite). Dry eye and anti-glaucoma medications<br />

each made up 8% of the total, with anti-glaucoma<br />

predicted to increase in the near future. Oral<br />

medications currently make up only a small<br />

proportion of those prescribed, she said.<br />

The final talk of the session was given by<br />

community pharmacist and Auckland University<br />

lecturer and researcher Maree Jensen, who<br />

discussed and explained the pharmacist’s role<br />

and responsibilities in managing and triaging<br />

eye conditions. “Pharmacists know their patients<br />

well (especially frequent users) and we use our<br />

interactions with them as a opportunity to make<br />

a difference to their lives and refer them to the<br />

appropriate person,” she said.<br />

Pharmacists see a large number of patients<br />

with conjunctivitis, dry eyes, tired eyes,<br />

medications that cause dry eyes, sub-conjunctival<br />

haemorrhages and styes, she added. “We have<br />

a major part to play in the management of eye<br />

disease. There is a huge disconnect between<br />

pharmacists and optometrists even though there<br />

is a huge amount of synchronicity of the role.”<br />

Regarding the posterior segment<br />

During the next session, Professor Colin<br />

Green looked at oral treatments targeting the<br />

inflammasome pathway for the treatment of<br />

diabetic retinopathy and macular degeneration.<br />

Xiflam is a small<br />

molecule that blocks<br />

the hemi-channel<br />

opening that inhibits<br />

the release of the<br />

cell’s high-energy<br />

molecule adenosine<br />

triphosphare (ATP)<br />

and in turn the<br />

perpetuation of<br />

inflammasomes and<br />

cytokine release.<br />

So far, this new oral<br />

medication, which<br />

addresses vascular<br />

integrity, has proven<br />

safety in 100 patients<br />

and there are further<br />


TO OCTOBER 1 ST <strong>2018</strong><br />


silmoparis.com<br />

trials planned.<br />

Next, Dr Narme<br />

Deva explained<br />

the use of topical<br />

medications for<br />

cystoid macular<br />

oedema starting<br />

with non-steroidal<br />

anti-inflammatories,<br />

which work<br />

by inhibiting<br />

cyclooxygenase<br />

enzymes (COX 1<br />

and 2). Diclofenac is<br />

subsidised in New<br />

Zealand and has some<br />

side-effects such as<br />

burning and punctate<br />

epitheliopathy.<br />

Diclofenac is<br />

contraindicated<br />

in pregnancy and<br />

Shelley Brannigan and Leesa Stuart<br />

those with NSAID-sensitive allergies. Steroids<br />

are often used synergistically in this condition<br />

and prednisolone acetate is the pick of the<br />

bunch due to its ocular penetration. These drugs<br />

work in many ways to reduce the inflammatory<br />

response, decrease oedema, fibrin formation,<br />

capillary dilation and proliferation. An increase in<br />

intraocular pressure in response to steroids (in one<br />

third of patients) is something to be mindful of,<br />

she explained.<br />

Associate Professor Andrea Vincent led an<br />

interesting talk about new gene therapies<br />

for conditions such as retinitis pigmentosa,<br />

choiroidemia and Leber’s hereditary optic<br />

neuropathy. There are many advances in gene<br />

therapy on the horizon which aim to use<br />

optokinetics to circumvent the gene defect,<br />

however, they are expensive and limited to gene<br />

specific eye disease, she said.<br />

Next up, Dr Emma Sandford, an ophthalmologist<br />

studying natural medicine, discussed nutrition<br />

and supplements for posterior eye disease such<br />

as diabetic retinopathy, epiretinal membrane<br />

and even retinitis pigmentosa. Sandford urged<br />

her audience not to see progression as a fait<br />

accompli, explaining we can affect our patient’s<br />

gene expression and disease progression. She gave<br />

a historical perspective on age-related macular<br />

degeneration (AMD) and discussed good (olive and<br />

coconut) and bad (refined vegetable and seed) oils<br />

and fats.<br />

“A good diet is a traditional diet” said Dr<br />

Sandford, giving examples from the traditional<br />

Mediterranean diet rich in vegetables, fruits, nuts,<br />

seeds and olive oil and the traditional Maori diet<br />

featuring seaweed, fern shoots, kumara, taro,<br />

berries and huhu grubs.<br />

Dr David Squirrell provided a practical<br />

presentation about ocular coherence tomography<br />

(OCT) interpretation of macular disease, taking<br />

us through a systematic set of questions to help<br />

identify the type of macular disease. Firstly, what<br />

is the clinical context? Where is the pathology (pre,<br />

intra or sub-retinal)? Is there oedema or subretinal<br />

fluid? How is the macula functioning (integrity of<br />

the inner segment/outer segment layer)?<br />

OCT, he said, can take a “minute to learn and<br />

a lifetime to master.” It’s another weapon in our<br />

arsenal of imaging techniques, such as fundus<br />

autofluorescence, which can be used to accurately<br />

identify retinal disease such as atrophy, oedema<br />

and schisis, amongst many other conditions, he<br />

said, using many examples to demonstrate both<br />

OCT’s uses and shortfalls.<br />

Anterior segment pearls<br />

Dr David Squirrell, Fiona Bamforth, A/Prof Andrea Vincent and Dr Rasha Altaie<br />

Professor Heather Sheardown from Canada (see p8)<br />

presented on the surface modification of contact<br />

lenses to improve their function and comfort. She<br />

began by explaining the main reason for the lack of<br />

Angela Garner, Nikki Hewitt and Raewyn Hart<br />

adoption and continuation of contact lenses among<br />

patients – discomfort. There are many patient and<br />

lens factors that influence comfort, she said, but<br />

one of the most important is improving surface<br />

wettability, which can be achieved through surface<br />

modification, internal wetting agents, migratory<br />

polymers, packaging and/or lens care products.<br />

Hyaluronic acid (HA) as an alternative wetting agent<br />

was explored, including the use of HA as a method<br />

to facilitate the release of drugs such as atropine<br />

and dexamethasone.<br />

Dr Rasha Altaie then discussed the hot topic of<br />

myopia control in children, from the pathological<br />

end-stage effects of high myopia to some of the<br />

methodologies currently being researched, such<br />

as orthokeratology and peripheral defocus contact<br />

lenses and atropine.<br />

Professor Dipika Patel treated us to a talk about<br />

the problems of tackling the rising scourge of<br />

acanthamoeba keratitis. She outlined her sevenyear<br />

review of the presentation and outcomes with<br />

58 eyes.<br />

In this review, it was found that 96% of cases<br />

involved contact lenses, the mean duration of<br />

symptoms at presentation was 21 days and<br />

in only 12% of cases was the initial diagnosis<br />

acanthamoeba keratitis. Steroid treatment at<br />

diagnosis was associated with a poor prognosis<br />

and this occurred in 10% of cases.<br />

Prof Patel used photos to discuss some of the<br />

clinical signs such as the radial keratoneuritis,<br />

stromal ring infiltrates and hypopyon.<br />

Acanthamoeba keratitis requires aggressive<br />

therapy with propamidine isethionate and either<br />

polyhexamethylene biguanide or chlorhexidine,<br />

she said. Poor yields from corneal scrapes and<br />

the difficulty or delay of diagnosis are some of<br />

the challenges faced in treating this devastating<br />

corneal disease.<br />

‘Challenging glaucoma cases’ was the title of Dr<br />

Hussain Patel’s talk. His cases ranged from a severe<br />

steroid-responder, with retinitis pigmentosa and<br />

cystoid macular oedema, to a patient with glaucoma,<br />

soaring high pressures and severe dry eye. He showed<br />

that a creative and persistent approach is required in<br />

handling these tricky patients.<br />

Ending with dry eye<br />

The post-coffee sessions addressed dry eye and<br />

reviewed some of the latest results from the Tear<br />

Film and Ocular Surface Society (TFOS) second<br />

Dry Eye Workshop (DEWS II). Associate Professor<br />

Jennifer Craig, who was vice-chair of DEWS II,<br />

showed how the Workshop’s findings had redefined<br />

and reclassified dry eye. If based on signs only, dry<br />

eye could have a prevalence as high as 75%.<br />

Risk factors can be classified into modifiable<br />

(such as computer use, contact lens wear,<br />

environment and medications) and un-modifiable<br />

(age, female sex, Asian race and Sjogren’s<br />

16 NEW ZEALAND OPTICS May <strong>2018</strong>

Squint Club <strong>2018</strong><br />


Dr Andrew Collins and Alex Petty<br />

Amanda Snedden and Kate Blackett<br />

syndrome). A/Prof Craig detailed the vicious cycle<br />

of factors that perpetuate dry eye and discussed<br />

the classification flow charts, showing conditions<br />

with symptoms and without signs and the<br />

converse, which are not considered dry eye, and<br />

explaining how these charts can aid practitioners<br />

in their clinical management of dry eye.<br />

Dr Stuti Misra looked at dry eye diagnostic<br />

methods, suggesting that clinicians start with<br />

triaging questions, before conducting risk factor<br />

analysis, diagnostic tests (non-invasive tear<br />

breakup time, osmolarity and staining) and finally<br />

tests that grade aqueous deficiency or evaporative<br />

dry eye subtypes. While Dr Trevor Gray looked at<br />

iatrogenic dry eye in refractive surgery.<br />

Though iatrogenic dry eye is increasingly<br />

recognised, it is still underestimated, he said.<br />

SMILE, LASIK and PRK are all techniques that<br />

temporarily increase dry eye. Dr Gray provided<br />

some tips for prophylaxis before laser vision<br />

correction, including lubricants, azithromycin<br />

and steroids, lid massage, and omega-3<br />

supplementation. Treatment should not only<br />

address lubrication but also denervation,<br />

inflammation and other elements of this condition.<br />

Senior lecturer and director of the Buchanan<br />

Ocular Therapeutics Unit, Dr Ilva Rupenthal<br />

discussed the science of ocular lubricants.<br />

Lubricant eyedrops aim to replace some tear<br />

components, reduce osmolarity and also<br />

dilute inflammatory cytokines. Dr Rupenthal<br />

demystified the vast array of ocular lubricants<br />

available today, classifying water-based<br />

lubricants, ointments and liposomal sprays and<br />

outlining the technology of some of the latest<br />

drops to hit the market.<br />

Lastly, Dr Maria Markoulli presented a lecture<br />

about future management and therapy of dry<br />

eye. Markoulli explained the four-step treatment<br />

algorithim which includes all the latest research<br />

from TFOS DEWS II and extends in a step-wise<br />

manner covering everything from education<br />

and lid hygiene to punctual plugs and amniotic<br />

membrane grafts.<br />

Starting with methods for aqueous deficiency,<br />

Markoulli then looked at the various warm<br />

compress methods and treatments for blepharitis<br />

and Demodex. She covered anti-inflammatory<br />

interventions, manuka honey eye-drops and<br />

surgical interventions. ”Dry eye treatment is<br />

an art, but classification is essential in order to<br />

develop a targeted treatment approach,” she said.<br />

A final panel discussion was held and closing<br />

remarks were said before delegates came<br />

together for drinks and networking to discuss the<br />

day’s learnings. ▀<br />

Next year’s Ocular Therapeutics Conference will<br />

again be held again at the Waipuna Hotel in<br />

Auckland in March 2019.<br />

This year’s meeting of the Australian and<br />

New Zealand Strabismus Society (ANZSS),<br />

better known as the Squint Club, was held<br />

at the Sydney Eye Hospital, the oldest hospital in<br />

Australia dating back to 1788. Set in the historic<br />

sandstone Victorian building with ornate metal<br />

balustrades and stained-glass windows, it was a<br />

magnificent juxtaposition of the old and the new<br />

with the vibrant and modern city of Sydney being a<br />

few steps away.<br />

This year’s event was well attended by 129<br />

participants including ophthalmologists, registrars<br />

and orthoptists from the Australasia region and<br />

one delegate from China. International guest<br />

speakers included: Dr Ramesh Kekunnaya, head<br />

of paediatric ophthalmology, strabismus and<br />

neuroophthalmology at LV Prasad Eye Institute<br />

in Hyderabad, India, and a member of the<br />

executive bureau of the World Society of Paediatric<br />

Ophthalmology and Strabismus; and Daisy Godts,<br />

chief orthoptist at the University of Antwerp in<br />

Belgium and council member of the International<br />

Orthoptic Association.<br />

The <strong>2018</strong> meeting kicked off with a welcome<br />

address by Dr Craig Donaldson, president of ANZSS,<br />

followed by a series of complex strabismus case<br />

presentations with an expert panel discussion<br />

consisting of Dr Kekunnaya, Godts, Dr Donaldson<br />

(Sydney), Associate Professor James Elder<br />

(Melbourne) and Dr Wendy Marshman (Melbourne).<br />

This session was filled with “what to do”, “what<br />

not to do” and “what I should’ve done instead”,<br />

carried out in convivial manner where even senior<br />

ophthalmologists shared their learning pitfalls.<br />

Dr Kekunnaya shared his experience in<br />

performing strabismus surgery under topical<br />

anaesthesia which is usually reserved for adult<br />

squint cases. It can be performed successfully<br />

with minimal discomfort, but patient selection<br />

is key, he said. Patients who can comfortably<br />

tolerate a cotton tip applicator soaked with topical<br />

anaesthesia on their conjunctival limbus are<br />

suitable candidates. Effective haemostasis can be<br />

aided by vascular vasoconstriction with topical<br />

brimonidine or phenylephrine at the beginning of<br />

surgery. Topical anaesthesia surgery can be useful<br />

in re-operation cases within 10 to 15 days of the<br />

first surgery, for example in cases of a slipped<br />

muscle, he added.<br />

Motility examination of neurological patients<br />

is one of the least understood and inadequately<br />

performed ocular assessments for most<br />

ophthalmology trainees. This was succinctly<br />

covered in a practical and step-by-step manner by<br />

Daisy Godts in her refreshing back-to-the-basics<br />

lecture.<br />

Dr Lionel Kowal from Melbourne presented, ‘MRI<br />

in Strabismus’, interestingly highlighting the role<br />

of radiological imaging of the extraocular muscles<br />

and its pulley system in squint assessment and<br />

surgical planning. It is particularly useful in cases<br />

of superior oblique palsy, abduction deficits<br />

and strabismus in high myopia to establish<br />

the underlying pathophysiological cause of<br />

each condition, which will help determine the<br />

appropriate surgical strategy, he said. Most<br />

importantly, is the interpretation of extraocular<br />

muscle system imaging and the need to further<br />

educate both ophthalmologists and radiologists<br />

on what is normal versus abnormal and<br />

whether the abnormal findings have any clinical<br />

significance.<br />

Age-related distance esotropia which may be<br />

part of sagging eye syndrome is now a wellrecognized<br />

diagnostic entity. Godts gave a<br />

comprehensive lecture on its diagnosis and longterm<br />

follow up where prismatic correction can be<br />

an effective initial therapy. However, the angle<br />

of deviation typically increases over time and<br />

larger doses of standard bilateral medical rectus<br />

recessions have been successful in Belgium.<br />

The William Gillies Lecture was delivered by<br />

Dr Kekunnaya in a two-part series on Duane<br />

retraction syndrome (DRS), where he outlined<br />

the esotropic and exotropic types. He shared his<br />

review of an impressive 400+ patients with DRS<br />

and the principles of DRS strabismus surgery<br />

which is based on primary position of deviation,<br />

degree of anomalous head posture (AHP), severity<br />

of globe retraction and overshoots, degree of<br />

limitation of ductions and forced duction testing<br />

(FDT). Superior rectus transposition to the<br />

lateral rectus (LR), with or without medial rectus<br />

(MR) recession may be considered as an initial<br />

procedure in esotropic DRS as it has the advantage<br />

of improving abduction. However, there is a risk of<br />

inducing vertical or torsional deviation. Exotropic<br />

DRS is commonly associated with globe retraction<br />

and overshoots, hence LR and MR recessions in the<br />

affected eye with Y-splitting of LR are effective in<br />

Drs Malisa Ami and Stuart Carroll with Tammy Miller, Dr CheeFoong Chong, Nia Stonex, Noirin Kelly, Drs Justin Mora, Shuan Dai and Sigal Zmudjak<br />

addressing these issues.<br />

The unique ‘live cases’ presentation<br />

was undeniably the crowd puller for<br />

this meeting where patients were<br />

examined by senior strabismologists<br />

including Professor Glen Gole (Brisbane)<br />

and Drs Lionel Kowal (Melbourne),<br />

Shuan Dai (Auckland), Ross Fitzsimons<br />

(Sydney), Kekunnaya and Daisy Godts,<br />

and video projected for the audience.<br />

Six highly-puzzling strabismus patients,<br />

including one who had travelled from<br />

Auckland, with either a diagnostic<br />

dilemma or challenging surgical<br />

management or both, were presented.<br />

A fruitful discussion between the<br />

experts and members of the audience<br />

helped formulate the best management strategies<br />

for these patients, be it active or inactive.<br />

The social aspect of the meeting was not left<br />

unattended with the conference dinner being held<br />

at the iconic Sydney Tower, standing 1014 feet above<br />

the central business district and offering spectacular<br />

views of Sydney and its harbour. Participants enjoyed<br />

a delectable meal in a most amiable atmosphere<br />

with old and new acquaintances.<br />

Overall, this year’s Squint Club meeting has<br />

Keynote speaker Dr Ramesh Kekunnaya (middle) with Drs Malisa Ami and Sigal Zmudjak<br />

maintained its reputation as a highly educational,<br />

engaging and congenial affair, and much credit goes<br />

to the organising committee, volunteer patients and<br />

ANZSS members. I hope the tradition continues and<br />

wish the Squint Club more prosperous meetings<br />

in the future under the new presidency of our own<br />

Auckland-based expert, Dr Shuan Dai. ▀<br />

*Dr Malisa Ami is currently on one-year study leave from<br />

the National University of Malaysia as a fellow in paediatric<br />

ophthalmology at the University of Auckland.<br />


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May <strong>2018</strong><br />



for optometrists and eye care professionals<br />

with<br />

Professors Charles<br />

McGhee & Dipika Patel<br />

Series Editors<br />

Post-cataract endophthalmitis<br />



A<br />

great deal has been learnt in the last 10<br />

years about the prevention of cataract<br />

endophthalmitis, making it a relatively<br />

uncommon complication in New Zealand. While<br />

it is difficult to isolate all the factors that account<br />

for this change in frequency, there are interesting<br />

parallels with other types of surgery, including<br />

reduced morbidity associated with small incisions,<br />

reduction in surgical times, use of gloves, masks<br />

and disposable and adhesive drapes.<br />

In addition to these soft changes there have<br />

been other well-documented changes in<br />

practice. For example, a recent report conducted<br />

by the University of Auckland showed the usage<br />

of intracameral antibiotics as prophylaxis had<br />

increased from 24% in 2007 to approximately<br />

50% by 2016. This change in pattern was no<br />

doubt based on the multiple studies performed<br />

in the US and Europe which showed a decrease<br />

in endophthalmitis when intracameral<br />

antibiotics were administered. Other common<br />

prophylactic measures used in New Zealand<br />

include the use of aqueous betadine iodine as<br />

a surgical wash, attention to pre-existing risk<br />

factors such as blepharitis and diabetes and, in<br />

many cases, topical antibiotics for the first postoperative<br />

week. Chlorhexidine is substituted for<br />

patients allergic to iodine and many facilities<br />

use sub-conjunctival vancomycin if the patient is<br />

allergic to cephalosporins, the preferred class of<br />

antibiotics for intracameral use.<br />

In spite of the best attempts to prevent postcataract<br />

endophthalmitis, however, infection can<br />

still occur.<br />

Some years ago, we analysed the common<br />

symptoms and signs of endophthalmitis and<br />

some previously thought reliable symptoms<br />

such as ocular pain were not universal. Equally<br />

hypopyon was not always present. In short,<br />

the diagnosis is often difficult and the clinical<br />

features vary enormously. The continuum<br />

includes eyes that have undergone apparently<br />

uneventful cataract surgery with a normal<br />

post-operative course, yet proven to be culture<br />

positive when the aqueous is sampled, and eyes<br />

that appear to have “more inflammation” than<br />

normal, yet still settle with standard topical<br />

treatment protocols to those eyes that are<br />

diagnosed as having endophthalmitis. Plus there<br />

is the exceptionally rare case, usually neglected,<br />

that progresses to panophthalmitis.<br />

This test could<br />

save your sight<br />

0800 622 852<br />

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18 NEW ZEALAND OPTICS May <strong>2018</strong><br />

Fig 1. A patient with panophthalmitis following cataract surgery. A delay in treatment of this patient’s<br />

endophthalmitis led to dehiscence of the cataract section, partial extrusion of the intra-ocular lens and<br />

ultimately removal of the eye<br />

For nearly 25 years, the treatment of postcataract<br />

endophthalmitis has been relatively<br />

well accepted. A randomised study called the<br />

Endophthalmitis Vitrectomy Study, published<br />

in 1995, showed for eyes presenting with a<br />

clinical diagnosis<br />

of endophthalmitis<br />

following recent<br />

cataract surgery,<br />

and providing the<br />

presenting acuity<br />

was better than PLO<br />

(perception of light<br />

only) then there was no<br />

difference in outcome<br />

for eyes undergoing<br />

tap and inject as<br />

opposed to vitrectomy.<br />

Conversely, certain<br />

subsets such as diabetic<br />

patients did fare<br />

better with vitrectomy<br />

surgery. Another<br />

significant outcome<br />

of that study was the<br />

finding that intravenous<br />

administration<br />

of antibiotics was not<br />

helpful in either of the<br />

two treatment groups.<br />

Tap and inject,<br />

involves (as the name<br />

suggests) inserting<br />

a needle, connected<br />

to a syringe into<br />

the eye followed<br />

by aspiration of a<br />

vitreous sample, which<br />

is then sent to the<br />

microbiology laboratory<br />

for examination.<br />

Antibiotics are then injected into the vitreous<br />

cavity, selected to treat empirically both<br />

gram-positive and gram-negative bacteria.<br />

This technique has not changed in 25 years<br />

and neither has the outcome; meaning<br />

approximately 15% of patients will have acuities<br />

less than 6/60, and 5% will have no perception<br />

of light. Conversely vitrectomy surgery has<br />

advanced greatly over the last 25 years with<br />

both the speed and efficiency of the cutter<br />

having been improved greatly and the size of<br />

the vitrector becoming significantly smaller.<br />

Typically, 25 gauge instruments are used,<br />

equating to less than 0.5mm. Furthermore, the<br />

viewing systems have greatly improved. So,<br />

the tide of technology has created a trend to<br />

perform vitrectomy on all eyes with presumed<br />

endophthalmitis following cataract surgery.<br />

The hurdle to perform such surgery has also<br />

lessened, as the surgery is less invasive. The<br />

surgery is usually performed under local<br />

anaesthesia; there are more centres in New<br />

Zealand that undertake VR surgery and<br />

importantly greater access to oncall VR surgeons.<br />

Anecdotally, our experience suggests vitreous<br />

biopsies are more likely to be culture positive than<br />

those cases where the vitreous has been aspirated<br />

into a syringe. That, potentially, is an important<br />

consideration when antibiotic resistance appears<br />

to be increasing. There is also the suggestion that<br />

there is a decreased need to perform additional<br />

surgeries with a primary vitrectomy as opposed to<br />

the traditional tap and inject. Our local experience<br />

also indicates that the functional improvement<br />

is better with vitrectomy surgery and that may<br />

be related to better clearance of contaminated<br />

vitreous with removal of the toxic soup in the eye.<br />

We have also found eyes that have undergone<br />

vitrectomy have faster rates of recovery and<br />

become culture negative more quickly.<br />

Twenty-five years ago those differentials<br />

Fig 2. Post-cataract endophthalmitis. This diabetic patient had complicated cataract surgery and presented three<br />

days after surgery with a painful eye. The cornea is oedematous and a hypoyon is present<br />

Fig 3a and 3b. The presence of fibrin and a hypoyon often makes the view of the posterior segment difficult. Fig 3a demonstrates this difficulty and fig 3b illustrates the utility of removing this material<br />

didn’t exist, but if the current trend and shift<br />

to vitrectomy is substantiated with better<br />

outcomes then we can be more optimistic about<br />

the future when managing eyes with postcataract<br />

endophthalmitis.<br />

There are still multiple questions unanswered<br />

about endophthalmitis and some of the most<br />

puzzling include, why is the anterior chamber<br />

culture often negative relative to the vitreous<br />

culture? Is that due to bacteria in the anterior<br />

chamber existing in planktonic form whereas<br />

in the vitreous, the bacteria form biofilms? Why<br />

do some patients with bacteria in the anterior<br />

chamber at the end of cataract surgery not<br />

progress to a clinical infection? Is there as yet<br />

an unidentified systemic factor that facilitates<br />

the conversion to endophthalmitis? Does that<br />

risk factor translate into increased mortality for<br />

patients undergoing cataract surgery?<br />

Hopefully some of these questions and<br />

improvements in therapy will lead to a<br />

continuing improvement in management<br />

for patients undergoing cataract surgery<br />

and a lessening in the risk of post-cataract<br />

endophthalmitis. ▀<br />

About the author<br />

*Associate Professor<br />

Philip Polkinghorne<br />

specialises in retinal,<br />

vitreo-retinal and<br />

cataract surgery. He has<br />

subspecialty training<br />

in both medical and<br />

surgical retina and is<br />

active in clinical and<br />

basic science research.<br />

He has published over<br />

70 papers in peer<br />

reviewed journals, edits<br />

ophthalmology journals<br />

and contributes as a<br />

reviewer to a number of<br />

international journals.

Change of guard at VOSO<br />

Long-serving Volunteer<br />

Ophthalmic Services Overseas<br />

(VOSO) board member,<br />

optometrist Michael Brown is retiring<br />

from the board, while Drs Jesse Gale<br />

and Hussain Patel have cemented<br />

their commitment to helping those<br />

less able in the Pacific by becoming<br />

trustees.<br />

VOSO chair Dr Andrew Riley<br />

welcomed Drs Gale and Patel and paid<br />

tribute to Brown’s three decades of<br />

service. It has been a pleasure having<br />

him on the team, he said. “Michael<br />

has been an incredibly hard-working<br />

trustee who led many VOSO teams to<br />

Labasa in Fiji. He also worked closely<br />

with the Lions Club in Labasa and<br />

Rangiora, helping with fundraising<br />

and logistics. Michael will be missed<br />

by the team, both here and in Labasa.”<br />

Drs Gale and Patel both formed part<br />

of the VOSO trip teams in 2017. Dr<br />

Gale is a consultant ophthalmologist<br />

at Wellington Hospital and Kenepuru Community<br />

Hospital and a senior clinical lecturer at the<br />

University of Otago. Dr Patel is a glaucoma and<br />

cataract surgery specialist who practises at<br />

Greenlane Clinical Centre and in private practice in<br />

Auckland.<br />

Kylie Dreaver, VOSO secretary, says while they<br />

will all miss Brown, everyone on the team is very<br />

excited to have two new ophthalmologists joining<br />

their ranks.<br />

Michael Brown reflects<br />

Michael Brown is not just stepping down from<br />

VOSO but from his practice, Rangiora Eyecare, after<br />

being a working optometrist for more than 40<br />

years.<br />

He’s sold his share in Rangiora Eyecare, a fourperson<br />

partnership with three optometrists and<br />

one dispenser, to Kimberley Shea, who joined the<br />

clinic three years ago after graduating.<br />

Brown says he has loved being an optometrist,<br />

especially the relational aspect of the job:<br />

relationships with patients, often spanning over<br />

several generations, and with staff. “If I was to<br />

give any word of advice to the next generation of<br />

optometrists it would be that relationships are key.<br />

If you’re emphatic and listen to your patients, as<br />

well as being focused on solutions for their needs,<br />

they will know you care and come back.”<br />

Drs Jesse Gale and Hussain Patel in Labasa for VOSO last year<br />

For more<br />

personalised<br />

eye care, talk to<br />

Eye Surgery<br />

Associates<br />


• Cataract surgery specialists<br />

• Glaucoma<br />

• Medical & Surgical Retina<br />

• Acute & General Ophthalmology<br />

Clinics on the North Shore,<br />

Central and South Auckland<br />

Phone 0800 750 750 or Fax 09 282 4148<br />

info@eyesurgeryassociates.co.nz<br />


www.eyesurgeryassociates.co.nz<br />

Michael Brown helping a patient in Fiji on his last trip with VOSO<br />

Eye Surgery Associates are a Southern Cross Health Society Affiliated Provider<br />

Brown developed an interest in eye health<br />

early in his life after his mother had a retinal<br />

detachment and later became blind in one eye.<br />

So, when it was time to decide on a career path,<br />

optometry stood out. Plus the prospect of being<br />

your own boss was a key driver, he says.<br />

When asked about the highlight of his career,<br />

without hesitation, Brown says when the scope of<br />

practice changed for optometrists in New Zealand,<br />

giving them greater freedom to discuss and comanage<br />

eye health care and prescribe ophthalmic<br />

medications for their patients.<br />

“When I was a graduate, we had to ring a GP<br />

if we wanted to put dilating drops in a patient’s<br />

eyes and we weren’t allowed to say the word<br />

“cataract” to a patient because of the fear factor<br />

associated with it.” This was all very challenging,<br />

he recalls, adding it is deeply satisfactory to see<br />

how the relationship between optometry and<br />

ophthalmology has improved.<br />

Looking to the future, Brown says he’s going<br />

to enjoy spending more time in the garden,<br />

cultivating his hobby developing plant breeds,<br />

especially roses and daffodils.<br />

As to a leaving party, he hasn’t had an official<br />

send-off yet, but rumour has it that this may<br />

coincide with the 40th anniversary celebration of<br />

Rangiora Eyecare on 1 August later this year. ▀<br />

Dr Hussain Patel<br />

Ophthalmologist<br />


Dr Monika Pradhan<br />

Ophthalmologist<br />

MS, DOMS, FCPS, MRCOphth<br />

Focus on Business<br />

sponsored by<br />

Independent spirit, collective strength<br />

Privacy FOCUS ON in the BUSINESS wake of<br />

How the Facebook to become scandal a better<br />

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Um facimusam la doluptatum About the quae. author: Erspe<br />

sandae ex estiores pa Jennifer dollitiuste Dann pro is a quaturiat freelance<br />

ellaut alit et dolore ni writer doluptatiur? for the NZ Osamus Herald and<br />

arciant. Um facimusam various la doluptatum publications. quae. She has<br />

Erspe sandae ex estiores 20 years’ pa dollitiuste experience pro as an<br />

award-winning journalist for<br />

quaturiat ellaut alit et the dolore likes of ni Radio doluptatiur? New Zealand<br />

Osamus arciant.earit volecus. and the Sunday Star Times.<br />

About the Author<br />

Ga. Ad es dolo corem ea<br />

dolo etur re omnihilique<br />

pa voloreptat. Caes que se<br />

nihiliquodi bea sequatur?<br />

Atio. Lorrovidia peliquamus<br />

utenderat enimpore<br />

exerorepuda parum re id<br />

quidi distr? Atio. Lorrovidia<br />



To find out more contact Neil Human on 0210 292 8683<br />

or neil.human@iogroup.co.nz<br />

peliquamus utenderat<br />

enimpore exerorepuda<br />

parum re id quidi dist<br />

May <strong>2018</strong> NEW ZEALAND OPTICS<br />


The AND Independent SERVICE Optometry INDEPENDENTS Group, NEED providing TO THRIVE. the advice<br />


Fashion update<br />

Style-Eyes<br />

Embarrassed to enticing:<br />

a personal glasses journey<br />

La Matta<br />

La Matta’s new capsule collection is sophisticated<br />

and striking with gems, stones and bracelet-styled<br />

details. The LM3230 model has three small round stones<br />

on a metal base, giving a fabric effect. The LM3228’s<br />

decoration recalls the mesh of a watch strap and, thanks<br />

to its strong chromatic contrasts, creates a highly striking<br />

visual effect. Distributed by BTP International Designz.<br />


It seems that most adolescents go through<br />

their own “ugly duckling” phase, and while<br />

it might be an awkward growth spurt, a<br />

difficult to deal with complexion, or something<br />

else altogether, it happens to all of us. For me,<br />

being a school nerd with frizzy hair and braces<br />

wasn’t enough when I was in middle school, the<br />

universe had to bestow upon me the unwanted<br />

gift of glasses.<br />

Around age 12, I started having a hard time<br />

seeing the chalkboard from the back of the<br />

classroom and, like any good parents would,<br />

mine took me to the local optometrist for a<br />

vision test. Low and behold, I needed specs to<br />

address my nearsightedness. While I didn’t have<br />

to wear them all of the time, the classroom was<br />

one of the places where I’d be donning them the<br />

most.<br />

That ‘90s fashion!<br />

Just to set the record straight, I’m 33, so when I<br />

got my first set of glasses at age 12 it was 1996,<br />

when optical fashion was quite different than<br />

today’s far more engaging trends. Nowhere<br />

to be found were cute and bold styles like the<br />

collection I own today, instead, round metals<br />

dominated the landscape.<br />

My husband probably remembers this pair<br />

well, as I opted to re-lens it time and time again<br />

despite being in the industry and knowing that<br />

frames only hold up for so long. A rectangular<br />

black style with thicker temples (the epitome of<br />

cool in 2007), I finally felt like I could accept the<br />

fact I was a glasses wearer.<br />

Subsequent pairs of glasses after these<br />

don’t even come to mind, so I’m sure they<br />

were nothing special. It was only around 2012<br />

that I finally heard the message I’d obviously<br />

been waiting to hear. A frame sales rep visited<br />

the office I was working in and showed me a<br />

plethora of really cute frames, telling me to just<br />

“go for it.” I instantly noticed a bright purple<br />

frame in an oversized shape and knew I had<br />

to have it. This frame by Kensie became my<br />

“signature look” for years to come.<br />

Xavier Garcia<br />

Xavier Garcia’s new sunglass collection takes us<br />

back to the ‘60s with retro elegance. The collection<br />

is characterised by its original shapes, reinterpreting<br />

vintage design with a modern touch. They stand out<br />

for their amazing colour combinations, which match<br />

the lenses. For this collection, all models have antiglare<br />

coating at the back to avoid any discomfort<br />

caused by sunlight. All lenses are adjustable and are<br />

subtly layered and mirrored. Distributed by Cardinal<br />

Eyewear.<br />

Kaos<br />

The new, bold and colourful Kaos collection in<br />

metal and acetates moulded into boxy or round<br />

shapes results in young, easy-to-wear frames. The<br />

key bridge model featured here is characterised<br />

by a combination of different acetates along the<br />

frame front and/or the temples and by a twotone<br />

airbrushed effect decoration at the hinges.<br />

Distributed by BTP International Designz.<br />

Going for gold with Carter Bond<br />

Australian swimmer Mack Horton, winner of the<br />

Commonwealth Games men’s 400m freestyle, proudly<br />

received his gold medal, standing tall and sporting<br />

Carter Bond specs, made by the Australian-based team<br />

at Jono Hennessy Group. Horton’s double bridge model<br />

features wood-look highlights on the end pieces and<br />

temples. Distributed by Phoenix Eyewear.<br />

My current glasses are all modern and fun<br />

I recall so vividly asking my mother if there<br />

were other options available, as I didn’t feel<br />

comfortable in any of the choices in front of me.<br />

A few weeks later we returned for me to pick<br />

up my very first pair of glasses: you guessed it,<br />

round metal with a slight tortoise-shell print.<br />

Although I was a straight-A student, I opted<br />

to go without my glasses as often as possible.<br />

When I needed to see the board, I’d wear them,<br />

but the moment the bell rang and class was<br />

over, I took them off in a heartbeat. After all, a<br />

12-year-old girl doesn’t need any more reason to<br />

feel embarrassed in front of her peers.<br />

Onward and upward<br />

The funny thing is that my relationship with<br />

glasses didn’t change until much later in life,<br />

even when fashion trends changed for the<br />

better. The first acetate frame I ever purchased<br />

was a cute purple little number by CoverGirl that<br />

actually got me to wear them full time, but I<br />

wasn’t in love. As the mid-2000s approached and<br />

frames got smaller and smaller, only then did I<br />

find comfort in the ability to wear my glasses<br />

and feel slightly stylish.<br />

Finally, happy in my purple peepers!<br />

How can we make the difference?<br />

At the end of the day, my journey isn’t unlike<br />

many others that millennials have faced when<br />

it comes to eyewear. We didn’t have amazing<br />

choices way back when, and it somehow<br />

has jaded our perception of what wearing<br />

glasses means. Once we see ourselves looking<br />

unattractive in spectacles, we can’t ever seem to<br />

believe anything different.<br />

Thankfully, awesome frame styles now abound<br />

that can help make the sales process not just<br />

easier, but fun too. But it takes a talented<br />

individual to get through to the more difficult<br />

patients.<br />

Try asking them about their experience with<br />

glasses and find out why they’re opposed to<br />

certain styles. Develop trust and a rapport with<br />

them before opening them up to the idea that<br />

a super funky colour or unique shape might,<br />

actually, really look great on them.<br />

It’s a process to get to a place where you love<br />

your glasses like I do, especially considering how<br />

my journey started. If I hadn’t taken up a career<br />

in optics, I might never have gotten to where I<br />

am now.<br />

When working with patients who are<br />

hesitant to try a new style or who simply “hate<br />

themselves in glasses,” remember what it was<br />

like for me at age 12. It’s really about making<br />

your patient feel comfortable in their own skin<br />

and selecting a set of frames that accents their<br />

true style. Tap into the compassion needed to<br />

get through to your patient, so you can make a<br />

difference and, believe me, when you get it right,<br />

you really do make an incredible difference to<br />

someone’s life!<br />

*Courtney Elder has<br />

more than 10 years<br />

of optical experience<br />

and loves wearing<br />

fashionable eyewear in<br />

Portland, OR, USA. Today<br />

she owns a content<br />

creation company with<br />

her husband. Visit www.<br />

author-eyes.com for<br />

more info.<br />

Stars and their eyes…<br />

Paris Jackson<br />

Ever wondered why Paris Jackson, daughter of Michael<br />

Jackson, has eyes that are so strikingly blue? According<br />

to an interview in Teen Vogue with Jo Baker, a Jackson<br />

makeup artist, the colour is due to a “rare eye condition”.<br />

Although Baker doesn’t name the condition in the<br />

interview, she said it wasn’t impacting Jackson’s eyesight,<br />

fuelling media speculation that Paris has Waardenburg<br />

syndrome (WS), a rare genetic condition affecting one in<br />

40,000 people. WS can cause hearing loss and changes in<br />

pigmentation of the hair, skin and eyes. It is associated with<br />

the underdevelopment of tissue fibres in the eye that make<br />

up the iris, causing the striking blue colour. Jackson has<br />

neither confirmed nor denied the WS claims, though she<br />

has repeatedly defended her status as Michael Jackson’s<br />

biological daughter.<br />

My blurry baby face and favorite frames circa 2007<br />

20 NEW ZEALAND OPTICS May <strong>2018</strong>

DokoMotto’s difference<br />

comes to NZ<br />

After being wowed at Mido, Beni Vision is<br />

shaking things up with the introduction<br />

of it’s new capsule collection of genuinely<br />

different frames handcrafted by DokoMotto of<br />

France.<br />

“We have a limited collection of 12 pieces in<br />

stunning acetates restricted to only 500 pieces<br />

worldwide,” said Dennis van der Maas, director of<br />

Beni Vision, which specialises in importing exclusive<br />

European eyewear. “These are truly unique frames<br />

and are all individually numbered and produced by<br />

the artist craftsman Florent Grellet.”<br />

Grellet honed his design skills in the Jura, an area<br />

in east France named after the Jura Mountains,<br />

famed for being the birthplace and home to many of<br />

France’s top eyewear design houses. He established<br />

DokoMotto<br />

in 2011 to<br />

allow him<br />

to produce<br />

his own<br />

uniquelyshaped<br />

glasses in audacious colours or, as he<br />

describes them, “rare pieces that give style to the<br />

ones who are wearing them.”<br />

A limited collection of DokoMotto frames are now<br />

available in New Zealand through Beni Vision. ▀<br />

The flying optometrist<br />

The Brien Holden Vision Institute (BHVI)<br />

and the National Library of Australia<br />

have published a new book, The Flying<br />

Optometrist, to help introduce good eye health<br />

practices to young children and celebrate the work<br />

of eye health practitioners, especially those who<br />

work in remote regions in Australia.<br />

The book has been written by author Joanne<br />

Anderton and is based on the adventures of her<br />

dad, flying optometrist Dr Phil Anderton.<br />

‘I really liked hearing Dad’s stories when he came<br />

back from these outback visits,’ Joanne said in an<br />

interview with Optometry Australia. “Also, I was<br />

one of the first to get glasses at school and it was<br />

hard being a bit different so I wanted to help kids<br />

understand how it is normal and wonderful, and<br />

an adventure to wear glasses.”<br />

Professor Brian Layland, BHVI chair, said The<br />

Flying Optometrist is an important educational<br />

tool that will help raise awareness about vision<br />

problems, in particular myopia. “This book will<br />

help reach children, parents and teachers living in<br />

remote areas of Australia and educate them about<br />

eye health issues such as myopia. It also highlights<br />

the important role that optometrists can play in<br />

safeguarding children’s health and enabling better<br />

future life outcomes simply through having better<br />

vision.”<br />

The story is about Stephanie, a little girl who<br />

lives in a remote part of Australia on a large<br />

farm, near a very small town, which relies on the<br />

healthcare provided by Australia’s flying doctor<br />

and optometry services. Stephanie has broken her<br />

only pair of glasses and can’t see well, so she can’t<br />

play cricket or play with her friends. She’s one of<br />

several people in the town who really need to see<br />

Phil and Joanne Anderton<br />

the optometrist, but the weather is closing in. Will<br />

Dr Phil’s little red plane make it through? Other<br />

characters featured in the book are inspired by<br />

real life Wanaaring residents, including pub owner<br />

Narelle, stockman Reg, plumber Bill and Aboriginal<br />

elder Auntie Pat, all of whom have their own eye<br />

issues to deal with.<br />

The book highlights the isolation of Australian<br />

outback towns and includes informative sections<br />

at the end on the Visiting Optometrists Scheme,<br />

the BHVI and its Aboriginal Eye Care Programme<br />

and the Royal Flying Doctor Service.<br />

It is illustrated by Karen Erasmus who based<br />

her pictures on Phil’s own photos. The Flying<br />

Optometrist can be purchased from book stores or<br />

online at Booktopia.<br />

New locum biz for NZ<br />

Optom Locum Service, formerly known as the<br />

Phillip Fent Locum Service, is expanding its<br />

services from Australia into New Zealand.<br />

Optometrist Philip Fent established the company<br />

back in 2002, after he had trouble getting<br />

optometrist cover for his Warringah Mall practice<br />

in Sydney. Since then the company has grown from<br />

a one-man band to employing five staff covering<br />

Australia and, now, New Zealand.<br />

Although Optom Locum Service has often placed<br />

New Zealand optometrists in roles in Australia,<br />

Fent says his operations in New Zealand hadn’t<br />

been formalised until now. He is hoping to attract<br />

both New Zealand optometrists to locum in<br />

Australia and Australian optometrists to locum<br />

in New Zealand, allowing both to travel and work<br />

either in New Zealand or Australia.<br />

Many locums on both sides of the Tasman enjoy<br />

the freedom locuming brings as well as offering a<br />

great opportunity to travel and meet all types of<br />

Vision Expo East<br />

people, both optometrists and patients,<br />

he says, adding that, best of all,<br />

it’s really easy. “Travel and<br />

accommodation is organised<br />

on your behalf and<br />

paid for. All you need<br />

to do is fly in and<br />

fly out.”<br />

For optometrists<br />

looking to work<br />

in Australia,<br />

you will<br />

need to<br />

register<br />

Phillip and Sally Fent of Optom Locum Service<br />

with the<br />

Australian<br />

Health Practitioner Regulation Agency (AHPRA). ▀<br />

For more information and how to register, see ad<br />

on p20.<br />

Vision Expo East at<br />

Kiwi frame distributors<br />

the Javits Centre<br />

Trish Orr and Caron Bowe<br />

New York in March,<br />

from BTP International<br />

wrapped up its 32nd show<br />

Designz, who count De<br />

reporting it once again<br />

Rigo as one of their brand<br />

had earned a ‘top show’<br />

partners, attended the<br />

plaudit from the Trade<br />

fair. “Expo New York<br />

Show News Network<br />

was fantastic for us. We<br />

(TSNN). With a total of<br />

have developed some<br />

715 exhibitors, including<br />

new business partners<br />

190 new to the show, and<br />

alongside our current<br />

more than over 16,000<br />

ones, Ogi, Seraphin and<br />

visitors, organisers said it<br />

Bon Vivant, which all<br />

was a hugely successful<br />

had a very busy show as<br />

and busy four days. For<br />

always. The fair had a great<br />

the first time at Vision<br />

atmosphere and the Irish<br />

Expo East, attendees<br />

band playing music for St<br />

voted for their favourite<br />

Patrick’s Day added to the<br />

exhibitors in two<br />

ambiance in the halls.”<br />

BTP’s Caron Bowe (right) selecting Safarro frames<br />

categories.<br />

As to what stood out as<br />

The winner in the category of ‘Most Creative the latest trend at the fair, team BTP picked pastel<br />

Booth Design’ was De Rigo.<br />

tones and metallic gold and silver as top of the list. ▀<br />

New appointments<br />

Optique Line NZ new account manager<br />

Vicki Evans has joined<br />

Optique Line as their New<br />

Zealand national account<br />

manager, replacing Bob<br />

Graham who is retiring<br />

after 38 loyal years in the<br />

optical industry.<br />

John Nicola, Optique<br />

Line director welcomed<br />

Evans to the team,<br />

“Although we are sad to<br />

see our much-admired<br />

Bob Graham retire, we are<br />

excited to see the new energy Vicki brings to the<br />

team. Coming from an optical retail background,<br />

Vicki understands the New Zealand market and<br />

the challenges practices face day-to-day. Also, she<br />

comes with the knowledge and experience of the<br />

Optique Line brands, which is a big bonus for us.”<br />

Before joining Optique Line, Evans was an<br />

optical assistant with Visique Rotorua where she<br />

gained first-hand experience working with the<br />

Optique Line brands. “The Optique Line range is<br />

my favourite, I particularly like the Convertibles<br />

which to me stand out as a really good, quality<br />

solution. I also know from experience that Optique<br />

Line’s customer service is great which allows me to<br />

confidently promote the brands to our customers.”<br />

Evans kicks-off with training in Melbourne in<br />

April, after which she hits the road straight away.<br />

She’s most looking forward to meeting all the<br />

new clients, she says, and taking on the territory<br />

responsibility for Optique Line New Zealand.<br />

BP Software strengthens NZ leadership<br />

Software developer Greg Wood is joining Best<br />

Practice Software’s management team based in<br />

Hamilton. Wood will oversee delivery operations<br />

in New Zealand and will be a member of the<br />

company’s global management team.<br />

Craig Hodges, BP Software’s chief operating<br />

officer, says he is delighted to welcome Wood to<br />

the team. “Greg has extensive experience as a<br />

senior technical advisor in the public and private<br />

sectors in New Zealand.<br />

He is also a certified<br />

scrum master and is very<br />

familiar with leading agile<br />

environments. We look<br />

forward to having him<br />

on board with us to lead<br />

our very committed and<br />

experienced local New<br />

Zealand team.”<br />

Wood will take up his<br />

new position in mid-May. ▀<br />




Contact Vicki Evans now<br />

027 220 2954<br />

vicki@optiqueline.com.au<br />

0508 678 478 | optiqueline.co.nz<br />

May <strong>2018</strong><br />






We are looking for an experience TPA qualified, full-time Optometrist<br />

to join our team at Browning & (Matthews), New Plymouth. This is a<br />

busy, well equipped practice with a great support team.<br />

Please contact Michelle Diez on 027 246 7499 or email<br />

michelle.diez@matthews.co.nz<br />



1-2 week-days per week plus 2-3 Saturdays<br />

per month.<br />

Hours: 10 -5.30pm week days, 10 -5pm Saturdays<br />

Hourly rate $25-40 depending on experience<br />

Become part of the team at Parker & Co, Newmarket, Auckland, selling<br />

fabulous eyewear. You will be working with a small team of experienced<br />

consultants/Dispensers and Optometrist who love eyewear and helping<br />

people to find the perfect fit of eyewear and lenses.<br />

We are not a chain, we don’t pressure sell. We love what we do, and<br />

we need someone to join the team. If you have two or more years<br />

experience in the industry and this sounds like you please email<br />

lynne@parkerandco.nz<br />

by<br />

A day in the life<br />

of a new,<br />

21st century<br />

optometrist (sort of)...<br />

Chalkeyes<br />



A change is as good as a holiday! Take control of your professional life<br />

and earn $120+ (AUD) per hour, + travel and accommodation.<br />

30 Minute appointments. Choose where and when you want to work.<br />

Email us on info@optomlocumservice.com.au to join our obligation<br />

free mailing list and let us tell you about the work we have available<br />

from Hobart to Broome, from Adelaide to Cairns, from Canberra to<br />

Perth, Auckland to Gold Coast and everywhere in between.<br />

For over 16 years we have been finding well paid and interesting<br />

work for optometrists.<br />

www.optomlocumservice.com.au<br />




Boutique optometry destination within a medical centre with an<br />

excellent dispensing support and state of the art equipment.<br />

The practice has a strong interest in specialty contact lenses, including<br />

ortho-k and while experineced optometrists are preferred, new<br />

graduates are welcome to apply.<br />

The practice supports independent optometric practice and values an<br />

optometrist who has a passion for clinical excellence and patient care.<br />

The Matthew group prides itself on being a family owned and<br />

operated business and professional growth in all optometry subspecialties<br />

is encouranged.<br />

We are the largest independent optometry group in NZ, with plans<br />

for future growth. We are looking for someone to join us in our<br />

Christchurch practice who is passionate about optometry and wants<br />

to be part of a company striving for excellence.<br />

Please contact John Grylls, john.grylls@seekapiti.co.nz or<br />

Michelle Diez, michelle.diez@matthews.co.nz for more information.<br />

Confidentiality is assured.<br />

7.12am. Eeek, I forgot to put the wash<br />

on again on. That’s the trouble with this<br />

job: What normal person is able to have<br />

their assigned, five uniform shirts (in<br />

mustard yellow of all colours) cleaned<br />

and dried in time for the following week?<br />

Dave, my retail executive, said any more<br />

would be excessive and wasteful. With<br />

the number of patients and their relatives<br />

that cram into my short-form exam room<br />

every quarter of an hour (some of which<br />

with less than optimum hygiene habits)<br />

I really need a spare to change into at<br />

lunchtime. Dave said he would see if he<br />

could arrange some air freshener.<br />

8.29am. Ready for the first patient of<br />

the day. McDonald’s next door have<br />

half-price frozen cola on a Thursday,<br />

which starts my morning off with sugary<br />

big bang. I’m not too sure about the<br />

new fit-out, however, that head-office<br />

‘strongly suggested’ we undergo last<br />

month. They said it was about creating<br />

consistency across the country. I’m quite<br />

sure I’m sitting in the same chair, just<br />

with a darker trim. Dave says the new<br />

furniture allows our patients to move<br />

from autorefractor to the frame stands<br />

3% quicker, which is a good thing I guess.<br />

10.12am. Laura, one of the new front<br />

staff, foolishly interrupted my fifth<br />

patient of the day to confirm whether<br />

left eye meant the patient’s left eye or<br />

the eye on the left when she looked at<br />

them. Fortunately, it didn’t matter as<br />

the patient had chosen one of our new<br />

reversible frames. She had sold them a<br />

second pair in pink as a backup too, which<br />

will please Dave. Maybe Laura won’t<br />

resign in a few months like most frame<br />

minions tend to.<br />

11.40am. Another young patient asked me<br />

about contact lenses again, today. I was<br />

running a little behind time so fortunately<br />

she was happy with just the new<br />

tortoiseshell frames I suggested she try<br />

instead. I sort of see the point of contact<br />

lenses, but as soon as I open my (nowexpired)<br />

trial lens cases, I just run even<br />

further behind schedule, so it’s not really<br />

worth it – is it? I asked Dave about it and<br />

he said sunglasses are a better alternative.<br />

Dave is always thinking about patient<br />

well-being; there is a lot of UV around<br />

these days, he says.<br />

12.47pm. In my lunch break, I had<br />

enough time to whip across the road<br />

from the mall to the little sushi place I<br />

love. All the staff there are patients of<br />

ours, including their young kids. They<br />

look so cute in their little frames! Dave<br />

always reminds me what a great service<br />

we provide – being able to update their<br />

glasses affordably as soon as their<br />

prescription gets a little worse, is pretty<br />

special!<br />

3.30pm. A lady just saw me complaining<br />

that she was seeing her long dead cat<br />

walking around in front of her. The silly<br />

old thing had saved up her hundred<br />

bottle caps from her Anchor milk for<br />

her complimentary examination and<br />

then completely wasted my time with<br />

her foolish imaginings. It’s almost as if<br />

they think Fonterra actually pays us for<br />

their consult! I politely told her she was<br />

making it up and sold her another pair<br />

of dark sunglasses to help her bilateral<br />

macular degeneration. Hopefully she<br />

sees a locum when she has next saved up<br />

enough caps.<br />

5.27pm. Dave squeezed in a patient for<br />

a check at the end of the day again. He is<br />

always doing that. The guy had a loose<br />

nylon on his rimless frame that keep<br />

waving and distracting his peripheral<br />

vision. Talk about rude though – the guy<br />

had the nerve to ask if I was qualified<br />

to test his eye health! Apparently,<br />

he was overdue for a check with his<br />

ophthalmologist. It was a bright evening<br />

outside so I whacked in some tropicamide<br />

and phenylephrine to teach him a lesson.<br />

Fortunate I did though – when I looked,<br />

both of his eyes had retinoschisis in the<br />

far temporal retinal periphery! I took<br />

some photos and scans to show the chap<br />

and he was amazed, no one else had ever<br />

mentioned it before. The guy looked me<br />

in the eye, shook my hand and said ‘thank<br />

you for being so thorough’. Somewhat<br />

embarrassed I said ‘don’t mention it – I’m<br />

just doing my job’.<br />

In the end, the guy only bought a single<br />

pair of affordable hobby glasses. Dave<br />

was not pleased. But I felt pretty good<br />

driving home today. That is what I get up<br />

every morning to go to work for – to help<br />

people with their vision and eye health.<br />

I just wish they would let us have a few<br />

more shirts to use...<br />


Spectacle frame inventory for sale. Designer frames offered at below<br />

wholesale prices. Prefer to sell entire lot to single buyer. Fendi,<br />

Marchon, Flexon, Coach, Calvin Klein etc. About 350 in total. Please<br />

contact seller at tyghbn73@gmail.com or 0210483139<br />



Are you a Customer Service Superstar?<br />

Would you like to join one of the leading frame suppliers in NZ<br />

representing many of the best performing brands in the independent<br />

market? Then we have a wonderful opportunity for you here at<br />

Phoenix Eyewear!<br />

Based from our offices on Auckland’s North Shore, the role offering<br />

sales support to our sales team and large customer base can be varied<br />

at times but is very heavily customer service focussed. You will need<br />

to be organised, self-motivated and happy to work within a small but<br />

dedicated team.<br />

Experience using MYOB or similar a must, as are outstanding<br />

communication skills.<br />

We are offering a competitive salary package complete with car park<br />

and no weekend work.<br />

If you see yourself becoming part of our exciting future then please<br />

submit your CV under strictest confidence to Mark Collman at<br />

mark@phoenixeyewear.co.nz<br />

Ophthalmology trainees:<br />

a step closer<br />

Eye Institute has been helping prepare<br />

ophthalmology registrars for their final<br />

exams for about 15 years, running two mock<br />

Objective Structured Clinical Exams (OSCEs) during<br />

the trainees’ fourth year of specialist training.<br />

The OSCE is a performance-based assessment<br />

measuring candidates’ clinical competence.<br />

Trainees are observed and evaluated as they<br />

go through a series of stations in which they<br />

interview, examine and treat standardised patients<br />

who present with some type of medical problem.<br />

Dr Peter Ring initiated the annual mock OSCEs<br />

after requests for help from registrars when he<br />

was a part 2 examiner, and continues to run<br />

then to this day. “It gives the candidates practical<br />

experience of an OSCE without the added pressure<br />

of a formal exam,” he says. “Also, they may see<br />

clinical cases they may not have seen before as we<br />

try to set up less common cases, but not rare ones.”<br />

Particularly valuable is the discussion with the other “mock”<br />

examiners about the cases they have just seen, said Dr Ring, giving<br />

Dr Peter Ring explains this year’s mock OSCE to trainee ophthalmology fellows<br />

the registrars some great insight and extra knowledge before they<br />

sit their final exams. ▀<br />

22 NEW ZEALAND OPTICS May <strong>2018</strong>

<strong>2018</strong> • Voted by New Zealanders • <strong>2018</strong><br />




Are you looking to secure your future with New Zealand’s leading provider of eye care services? At Specsavers, we offer<br />

some of the best rates of pay in the market, giving certainty to our employed optometrists, partners and locums.<br />

And while monetary reward is important, there are other critical factors to<br />

consider. We’re taking investment to a new level with a multimillion dollar rollout of<br />

the latest technology and an extended professional development program, while<br />

our optometry support team is developing ever closer working relationships with<br />

ophthalmology and other eye disease stakeholders. You will also be supported by<br />

an experienced team of dispensers and optical retail staff, providing you with the<br />

best environment to develop your clinical skills and advance your optometry career.<br />

A range of both metro and regional opportunities are currently on offer across New<br />

Zealand, including full-time and part-time roles. Due to continued growth, we also<br />

have a number of opportunities for optometrists seeking to lead their own store as<br />

Joint Venture Partners.<br />

Either way, why not find out how you can make the most impact at Specsavers.<br />

We’re on a clear mission to transform eye health in New Zealand and Australia –<br />

and we’d like you to join us on that mission.<br />

Alternatively, if you know an exceptional optometrist with a passion for delivering<br />

high quality eye care who is seeking career progression, ask us about our ‘Refer a<br />

Friend’ referral bonus.<br />

For a confidential chat about the various opportunities we have available,<br />

contact Chris Rickard on 027 579 5499 or email chris.rickard@specsavers.com<br />


Reader’s<br />

Digest<br />

Quality Service<br />

Award<br />

Voted by New Zealanders<br />

Reader’s Digest<br />

Quality Service<br />

Award<br />

2017<br />

Best Customer<br />

Service in NZ<br />

Optometry<br />

<strong>2018</strong><br />

Millward Brown<br />

Research<br />

No.1 for eye tests<br />

<strong>2018</strong><br />

Best Talent<br />

Development<br />

Program<br />

2017<br />

Best Customer<br />

Service in NZ<br />

Optometry<br />

2017<br />

Excellence in<br />

Marketing<br />

Award<br />

2016<br />

Retail<br />

Employer<br />

of the Year<br />

2015<br />

Overall<br />

National<br />

Supreme Winner<br />

2015<br />

Franchise<br />

Innovation<br />

Award<br />

2015<br />

NZ Franchise<br />

System of<br />

the Year<br />

2014<br />

Retail<br />

Innovator<br />

of the Year<br />

2014<br />

Transforming eye health<br />

May <strong>2018</strong><br />




For all your optical and ophthalmic needs<br />

nzowa.org.nz<br />



We are looking for a friendly and enthusiastic Optometrist to<br />

join our busy and growing optometry practice in Invercargill. This<br />

position would suit someone who is seeking:<br />

Excellent work-life balance. With a short, 5 to 10-minute drive to<br />

work, and a 9 to 5, Monday to Thursday working week, you can<br />

enjoy more free time with family and friends.<br />

An opportunity to get ahead. With an extremely competitive<br />

remuneration package and an average house price in Invercargill<br />

of only $260,000, this position represents a great opportunity.<br />

A great place to live. Invercargill is only a few hour’s drive/<br />

ferry from some of New Zealand’s most beautiful destinations,<br />

including Queenstown, Milford Sound, Stewart Island and the<br />

Catlins.<br />

Professional development. Our friendly and supportive team,<br />

with over 70 years of combined optometry experience, and over<br />

60 years of combined dispensing experience, can help take your<br />

career to the next level.<br />

If this sound like the ideal role for you, please email your CV and<br />

cover letter to 7720store@opsm.co.nz<br />


Demand for well-operated, consistently profitable independent<br />

practices in central Auckland is high, OpticsNZ is proud to bring<br />

this practice to the market. Operating with two examination<br />

rooms, double testing 5.5 days per week. The optometry<br />

equipment is ideal, the location and product offering are<br />

superb. In the heart of Auckland, strategically this is an excellent<br />

opportunity in so many ways.<br />

For more information, please contact (confidentiality assured)<br />

Stuart Allan at OpticsNZ on (03) 5466 996, 027 436 9091 or email<br />

stu@opticsnz.co.nz<br />


Maternity cover required for east Auckland optometrist.<br />

Up to 20 hours a week over three days May through August.<br />

Work alongside a team of well trained professionals and in a well<br />

equiped practice.<br />

Email any enquiries to outeastoptom@gmail.com<br />



This is an opportunity to join our professional fun-filled team at<br />

Eyes of Howick. Being an independent practice we pride ourselves<br />

on our client service and personalised optical solutions.<br />

We require a star team player who also thrives in an autonomous<br />

environment. If you have an eye for detail and organisation, have<br />

a passion for eyewear and fashion and enjoy the sales challenge<br />

then we would love to discuss the position with you further.<br />

Optical experience essential.<br />

Hours include a late night and some Saturday work on a rostered<br />

basis.<br />

Email your CV to Kristine on kjensen@eyesofhowick.co.nz or<br />

phone 0274824477.<br />



Ready to settle down in the beautiful Coromandel town of<br />

Thames or more drawn to the country living in Waiuku? Paterson<br />

Burn Optometrists have exciting opportunities for passionate TPA<br />

endorsed Optometrists to work in our Waiuku / Thames practices.<br />

Working with Paterson Burn Optometrists will offer you the<br />

ability to develop your clinical skills to its full potential and the<br />

opportunity to specialise in your desired field. You will have<br />

the ability to work independently and, with fourteen other<br />

optometrists in the group, you will be part of a larger group of<br />

highly-qualified, experienced and dedicated optometrists. Our<br />

Optometrists have special interests in Low Vision, Children’s Vision,<br />

Ortho K, Specialised contact lens fits, Dry eye and Irlen lenses. You<br />

will also have the opportunity to meet regularly for peer review<br />

sessions while gaining CE points within our practice.<br />

This position can be part-time in Waiuku / Thames or full-time if<br />

willing to travel between the branches.<br />

Please send your CV with a covering letter to<br />

sandri@patersonburn.co.nz or call 07 9035406 for more<br />

information.<br />



Here at Bailey Nelson, we see things a little differently. We believe eye<br />

care doesn’t have to be boring, and that’s why it’s our mission to have<br />

passionate and caring Optometrists who ensure all patients enjoy an<br />

experience worth remembering. Our eye tests are tailored for each<br />

individual so everyone walks away feeling and looking different.<br />

Bailey Nelson is opening a new store in Christchurch CBD. If you<br />

want to further yourself as a leader and business contributor, all<br />

while delivering amazing eye care then get in touch.<br />

Please contact Maddy Mortiaux on<br />

maddy@baileynelson.co.nz or 021 351 401<br />

DREAM OF<br />


Have you ever wanted to travel NZ? Do you like<br />

flexibility and crave variety? OPSM New Zealand is<br />

looking to expand its relief team with a combination<br />

of area and regional floats. As a float you will be<br />

exposed to lots of different patients and locations<br />

across New Zealand. We are looking for Optometrists<br />

who share our passion, and want to join our customer<br />

focussed teams in making a difference to how people<br />

see the world.<br />

We are looking for optometry floats in these<br />

key locations:<br />




Alternatively OPSM NZ is also on the lookout for locums<br />

willing to service the Wellington, Bay of Plenty and<br />

Waikato regions.<br />


If interested in joining our fun loving team, please contact<br />

Jonathan Payne<br />

Jonathan.Payne@opsm.co.nz or call 021 195 3549<br />



A CHANGE?<br />

When you join OPSM, you work within a team who<br />

are committed to providing the best possible eyecare<br />

solution with exceptional customer service. You will<br />

work with world class technology and have many<br />

opportunities for professional development. You can<br />

also make a real difference in the way people see<br />

the world by participating in our OneSight outreach<br />

program. OPSM New Zealand is looking for passionate<br />

Optometrists to join the team in these locations:<br />


Where the mountain meets the sea; New Plymouth is<br />

a vibrant city of culture, art, and the great outdoors.<br />

Our exciting practice is looking for an equally exciting<br />

optometrist to join this high-performance store. With a<br />

great community vibe and strong optometry network,<br />

New Plymouth is an excellent place to either start or<br />

enhance your career.<br />

THAMES<br />

Located on the doorstep of the Coromandel, Thames is<br />

a gateway to outdoor adventures and fantastic beaches.<br />

An opportunity has arisen for a full time optometrist to<br />

join an amazing team in our community based store with<br />

interesting and appreciative clientele. Only 1 hour outside<br />

of South Auckland, Thames is close enough to enjoy the<br />

big city, without the traffic or house prices!<br />


A rare vacancy has arisen in our much sort after Lower Hutt<br />

practice. We are currently looking to expand our energetic<br />

and vibrant team. Only 15 minutes from the capital, Lower<br />

Hutt is close enough to enjoy the sport, culture and cuisine<br />

that central Wellington has to offer.<br />


If you are interested to find out more about joining the<br />

team, contact Jonathan Payne for a confidential chat.<br />

jonathan.payne@opsm.co.nz or call 021 195 3549<br />


Thinking of selling your practice - we have buyers<br />

Considering buying - we’ll give you all the options<br />

OpticsNZ specialises in optometry practice sales,<br />

we've helped dozens of Optometrists buy and sell their practices<br />

For more information contact Stuart Allan on: 03 546 6996<br />

027 436 9091 stu@opticsnz.co.nz www.opticsnz.co.nz<br />

• Locum Service<br />

• Recruitment Services<br />

• Practice Brokering<br />

• Business Consultants<br />

24 NEW ZEALAND OPTICS May <strong>2018</strong>

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