17.06.2018 Views

Feb 2017

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY<br />

FOR OPTOMETRISTS AND EYE CARE PROFESSIONALS<br />

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

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

FEBRUARY <strong>2017</strong><br />

UV<br />

HELP PROTECT<br />

FROM HARMFUL<br />

BLUE LIGHT<br />

UV & GLARE


RECOVER LENS SALES<br />

LOST ONLINE<br />

© 2015 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affiliates. Bausch & Lomb (New Zealand) Ltd c/- Bell Gully Auckland, Vero Centre, 48 Shortland Street, Auckland 1140, New Zealand. Marketed by Radiant Health Ltd. 0508 RADIANT.<br />

2 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


WITH SPARKLE<br />

You asked us to help stop the loss of valuable sales and profits to online retailers.<br />

We created Sparkle!<br />

Register your patients on it now. Call our team on 0800 658 386.<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

by Radiant Health<br />

NEW ZEALAND OPTICS<br />

3


<strong>2017</strong> starts with<br />

a bang!<br />

EDITORIAL BY JAI BREITNAUER<br />

Welcome back and happy New Year! The<br />

team at NZ Optics had a well deserved<br />

break and we hope you have too. Even<br />

so, the world keeps on turning and we are excited<br />

about this jam-packed issue to start <strong>2017</strong>.<br />

First off, though, it’s time for an introduction.<br />

We are really pleased to announce that Susanne<br />

Bradley, who many of you know from the OIG,<br />

has agreed to come on board permanantly,<br />

growing our team and improving our offering. As<br />

well as writing some editorial, Susanne will be<br />

your first port of call for classified ads. You can<br />

reach her by emailing susanne@nzoptics.co.nz.<br />

As always, our aim for <strong>2017</strong> is to provide<br />

interesting, relevant and expertly written<br />

editorial and this year we will continue to<br />

introduce new contributors and columnists to<br />

inform and delight. We will also be making some<br />

changes over the next few months as part of a<br />

long-overdue modernisation. Your feedback is<br />

crucial during this period so please don’t hesitate<br />

to get in touch and tell us what you think.<br />

And so, on to the <strong>Feb</strong>ruary issue of the<br />

magazine! We had so much to say it was difficult<br />

to fit it all in. There’s great news about eyes<br />

becoming a key part of the ‘Dunedin Study’ (this<br />

page) and also some awards for the New Year for<br />

Paul Rose (this page), Dr Shuan Dai (p15) and our<br />

very own Jo Eaton (p19).<br />

Don’t miss our overview of the MDNZ-Deloitte<br />

report revelations (p10) plus a look at the newly<br />

announced merger between Luxottica and<br />

Essilor (p6). Stephen Ng gives us RANZCO’s take<br />

on the ongoing issues around patient care (p8)<br />

and we also report on RANZCO’s stance on its<br />

guidelines (p14).<br />

There’s plenty more tucked away between the<br />

pages too. We hope<br />

you enjoy every<br />

word of it.<br />

Jai Breitnauer, NZ Optics<br />

Eyes on the Dunedin Study<br />

Our understanding about just how much<br />

our eyes can tell us about what’s going on<br />

in our bodies is set to become a whole lot<br />

clearer. A significant part of the next phase of the<br />

world famous Dunedin Study has been earmarked<br />

for eyes.<br />

“It’s very, very exciting,” says Gisborne<br />

ophthalmologist Dr Graham Wilson, who is<br />

principal investigator for the eye part of the study’s<br />

next phase. “It’s tremendous the study’s director,<br />

Professor Richard Poulton, is keen to incorporate<br />

more information on eyes into the next phase.<br />

It should lead to a goldmine of knowledge…<br />

and generate a host of new hypotheses and<br />

ophthalmic publications. This is an established,<br />

world-class study and it’s fantastic to now have a<br />

really active eye component.”<br />

The Dunedin Multidisciplinary Health and<br />

Development Research Study (better known as<br />

‘The Dunedin Study’) is a detailed research study,<br />

led by the University of Otago, into human health,<br />

development and behaviour. The study follows<br />

the lives and development of 1037 people born<br />

in Dunedin between 1 April 1972 and 31 March<br />

1973 and (due at least in part to the strict privacy<br />

protection of study participants) has an incredible<br />

95% retention rate.<br />

Eyes have always been a small part of the<br />

study, says Dr Wilson: the face and eyes of study<br />

members have been photographed repeatedly;<br />

there was a bunch of basic eye tests done when<br />

study members were aged 5 – 15 years old; and<br />

study participants’ eyes were photographed (on Dr<br />

Wilson’s recommendation) to look at their retinal<br />

blood vessels in the last phase, when they were 38<br />

years old.<br />

Dr Wilson first became involved more than a<br />

decade ago after his brother, Professor Nick Wilson<br />

from the Department of Public Health at Otago<br />

University, recommended he knock on the door of<br />

the Dunedin Study unit to see if they needed any<br />

help with eye research.<br />

“The eye is the window to the soul, so the<br />

question [in the last phase] was what can retinal<br />

blood vessels tell us about the vascular state of the<br />

body,” he explains. The retinal photograph data,<br />

for example, was then used by Madeline Meier, an<br />

www.contactlens.org.nz<br />

BY LESLEY SPRINGALL<br />

assistant professor at Arizona State University, and<br />

colleagues, to show how schizophrenia sufferers<br />

were distinguished by wider retinal venules. Their<br />

conclusion: retinal imaging could be a useful tool<br />

for further understanding the pathogenesis of<br />

schizophrenia.<br />

The success of this part of the study has led<br />

to retinal imaging becoming a standard part<br />

of the next phases of the study. Dr Wilson has<br />

also used data from earlier parts of the study for<br />

his own research, including studying whether<br />

amblyopia has a functional impact for his Master<br />

of Ophthalmology (an honour he achieved in<br />

2011 with a distinction, grade A+). Together with<br />

co-researcher David Welch, Dr Wilson concluded<br />

amblyopia within the cohort had no effect on the<br />

broad domains of everyday life. He’s currently<br />

working on the connection between migraine and<br />

retinal blood vessel changes and how these can<br />

be a useful biomarker for stroke and heart disease<br />

as well as the associations between periodontal<br />

disease and retinal blood vessel changes.<br />

The next official testing phase of the Dunedin<br />

Study has been funded by a $5 million Health<br />

Research Council grant and, given the focus<br />

on eyes, a further $25,000 from The Buchanan<br />

Charitable Foundation, run by fellow Kiwi<br />

ophthalmologist Dr Trevor Gray and his specialist<br />

breast physician wife Dr Caroline Gray.<br />

This phase begins in April and will last for more<br />

than a year as many of the study’s participants<br />

now have to be flown in from all over the world.<br />

Dr Wilson’s team will have just 30 minutes per<br />

patient for their eye studies, he says.<br />

“Every medical speciality wants to study the<br />

cohort, so you have to compete for time. The<br />

challenge for us is what tests are we going to do,<br />

what are we hoping to learn from the cohort, what<br />

hypotheses do we want to generate and what do<br />

we hope we might learn?”<br />

The last time the cohort had their eyes properly<br />

examined, nearly 30 years ago, optical coherence<br />

tomography (OCT) wasn’t even around, so this<br />

time OCT and OCT angiography and MRI scans (the<br />

study having just purchased the most advanced<br />

MRI Scanner in the world, courtesy of an American<br />

research grant) will be carried out on all study<br />

participants.<br />

Dr Wilson says he’s hoping to involve a number<br />

of colleagues from across the country, both from<br />

optometry and ophthalmology, to ensure the<br />

robustness of the data collected; colleagues such<br />

as A/Prof Jennifer Craig, who’s work on dry eye is<br />

world renowned; Dr Jesse Gale on how ophthalmic<br />

findings can be useful biomarkers for disease<br />

progression in neurodegenerative disorders such<br />

as dementia; Dr Stephen Ng and Kent Chowon<br />

on co-existing orbital disease; Prof. David Mackey<br />

from the University of Western Australia and<br />

Dr Graham Wilson at RANZCO 2016<br />

Nishan Ramachandran on how cannabis use might<br />

impact on the optic nerve; Dr Harry Bradshaw on<br />

refractive error and axial length; Dr Anmar Abdul-<br />

Rahman on OCT angiography; Prof. Steve Daikin<br />

and Dr Nicola Anstice on the role of contrast<br />

sensitivity as a measure of ageing; and Prof.<br />

Jonathan Crowston and Dr Peter van Wijngaarden<br />

from Melbourne on the ageing eye.<br />

Another person involved in Dr Wilson’s Dunedin<br />

Study eye research team is his former registrar,<br />

Dr Hong Sheng Chiong, who’s ground-breaking<br />

social enterprise oDocs, which developed a<br />

3D-printed, physical smartphone attachment<br />

to help optometrists perform basic eye tests<br />

anywhere in the world, has also been recognised<br />

internationally.<br />

“This is the world’s best study of its kind,” says<br />

Wilson. “It’s the jewel in New Zealand research’s<br />

crown. There’s simply nothing else like it in the<br />

world, and it is a privilege to be able to contribute,<br />

especially from Gisborne. It shows you can<br />

contribute from anywhere, even small town New<br />

Zealand, in today’s connected world.”<br />

To date, data from the study has been analysed<br />

for a host of different human health reasons and<br />

compared with local studies across the world,<br />

making it one, if not the most respected human<br />

health cohort study in the world. Now in its fifth<br />

decade, it has led to more than 1150 publications<br />

and reports, many of which have influenced or<br />

helped inform policy makers. The study achieved<br />

popular fame last year following the screening of<br />

an award-winning, four-part documentary ‘Why<br />

am I? The Science of Us’ on TVNZ. ▀<br />

If anyone from the industry would like to be<br />

involved and has some useful ideas, please contact<br />

Dr Wilson at Graham.Wilson@tdh.org.nz<br />

Paul Rose honoured<br />

CCLS CONFERENCE<br />

CORNEA : OCULAR SURFACE : CONTACT LENSES<br />

NELSON <strong>2017</strong><br />

MARC BLOOMENSTEIN OD, FAAO<br />

KEN NISCHAL MD, FRCOphth<br />

PROFESSOR FIONA STAPLETON School of Optometry and Vision Science, UNSW<br />

PROF CHARLES MCGHEE MB, BSc(Hons), PhD, DSc, FRCS(G), FRCOphth, FRANZCO<br />

A UNIQUE<br />

OPPORTUNITY<br />

TO SEE WORLD<br />

CLASS SPEAKERS<br />

UP-CLOSE AND<br />

PERSONAL!<br />

23-25 MARCH <strong>2017</strong><br />

RUTHERFORD HOTEL<br />

CORNEA & CONTACT LENS SOCIETY<br />

of New Zealand Incorporated<br />

Hamilton optometrist<br />

and inventor of<br />

the Rose K contact<br />

lens designs and fitting<br />

system for patients with<br />

keratoconus, Paul Rose,<br />

was made a Companion<br />

of the New Zealand Order<br />

of Merit (CNZM) in the<br />

New Year’s Honours list for<br />

services to optometry and<br />

ophthalmology.<br />

Rose, who started his<br />

own optometry practice in<br />

Hamilton in 1969, worked<br />

for more than a decade on<br />

developing a lens design<br />

and fitting system that<br />

would make it easier for<br />

optometrists with limited<br />

contact lens experience to fit keratoconic<br />

patients.<br />

“Never in my wildest dreams did I imagine it<br />

would take me where it has,” says Rose, who<br />

noted before his system became available,<br />

fitting lenses for keratoconus patients was a very<br />

specialised area. “It was almost like a cottage<br />

industry, with each lens being created from<br />

scratch. There were very few people who did it. I<br />

just wanted to make it easier.”<br />

Rose went through 12 prototypes and nearly<br />

gave up a year before he finally developed a<br />

solution that worked. Key to his success, he says,<br />

was the computerised lathe purchased by Corneal<br />

Hamilton-based optometrist Paul Rose CNZM<br />

Lens Corporation in the late<br />

‘80s as this dramatically<br />

improved accuracy and<br />

repeatability.<br />

“The Rose K system has<br />

five steps, with many of<br />

the decisions that had to<br />

be made by the specialist<br />

before already included<br />

in the design. It’s a bit like<br />

paint-by-numbers, and a<br />

practitioner with limited<br />

experience in the area of<br />

keratoconus lens fitting<br />

can still achieve excellent<br />

results. Most optometrists<br />

in New Zealand are able to<br />

offer this service today.”<br />

The first Rose K lens<br />

offered a 75% success rate<br />

and was made available in New Zealand in 1989.<br />

Australia followed soon after with FDA approval<br />

for US distribution gained in 1994. The Rose K<br />

lens system is also distributed in the UK, Europe,<br />

Middle East, South America and Asia. Today it is<br />

the most popular lens for keratoconus across the<br />

world, prescribed in more than 90 countries with<br />

a success rate of more than 80%. Despite this,<br />

Rose says he was still blown away by the honour.<br />

“I was overwhelmed. I’d been informed in mid-<br />

November I’d been nominated and then they<br />

contacted me again in mid-December to say the<br />

award had been ratified by the Prime Minister<br />

and the Queen. It’s a great, great honour.” ▀<br />

4 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


Long-lasting lubrication for dry eyes<br />

that is preservative-free and completely<br />

sterile, delivered through the unique<br />

COMOD ® multi-dose application system.<br />

For severe or<br />

chronic dry eye<br />

FULLY FUNDED<br />

Special authority criteria applies *<br />

For mild to<br />

moderate dry eye<br />

The systematic approach to eye lubrication<br />

for<br />

Dry Eyes<br />

Preservative-free and phosphate-free<br />

Can be used for 6 months after opening<br />

Compatible with all types of contact lenses<br />

At least 300 measured drops per pack,<br />

or 150 treatments (both eyes)<br />

For product enquiries contact:<br />

CORNEAL LENS<br />

CORPORATION N.Z. LTD<br />

www.corneal-lens.co.nz<br />

*Special Authority criteria applies only to HYLO ® -FRESH – please refer to the New Zealand Pharmaceutical Schedule for details.<br />

HYLO ® -FRESH (Sodium hyaluronate 0.1% w/v, 10mL) and HYLO-FORTE ® (Sodium hyaluronate 0.2% w/v, 10mL) eye drops are General Sales Medicines to improve the lubrication of the eyes, in eyes that are dry, irritated and tired from external factors.<br />

Always read the label and use strictly as directed. If symptoms persist see your healthcare professional. HYLO ® -FRESH, HYLO-FORTE ® and COMOD ® are registered trademarks of URSAPHARM. AFT Pharmaceuticals, Auckland. TAPS 1636HA.<br />

Health Headlines<br />

Hartley Atkinson M.Pharm, PhD<br />

Founder & CEO, AFT Pharmaceuticals<br />

0800 423 823<br />

www.aftpharm.com<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

5


Specialist practice for BOP<br />

Ortho-k advocate and specialist contact lens<br />

optometrist Alex Petty has opened his own<br />

practice in Tauranga. Based in the medical<br />

suites of Promed House in Tauranga town centre,<br />

Bay Eye Care will function as a standard clinical<br />

optometry practice, but without the retail.<br />

“I decided to move away from the traditional retail<br />

aspect of the business. I won’t be selling frames or<br />

spectacle lenses,” says Petty. “I believe we are rare in<br />

New Zealand in that sense.”<br />

Petty, who returned from Australia a year ago,<br />

says he’d originally been looking for a strong<br />

independent practice to buy in to, but when no<br />

opportunity arose he and his fiancé shifted to<br />

Tauranga for the lifestyle. He was encouraged by<br />

friends and colleagues to go it alone, so decided to<br />

focus on what he does<br />

best, he says.<br />

“I haven’t worked<br />

full-time for a year, so<br />

I’ve had a lot of time<br />

to think. This for me is<br />

a long-term plan. I’m<br />

passionate about the<br />

clinical side of optometry<br />

and the way optometry<br />

is going, with an<br />

increase in prescribing<br />

Alex Petty<br />

rights and a shift in<br />

focus to shared care of patients<br />

with diseases like glaucoma. It<br />

makes me feel there is a role for<br />

a strong, specialist, secondary<br />

care model.”<br />

Petty’s practice will focus on general diagnosis,<br />

the management of conditions like dry eye,<br />

keratoconus, blepharitis and the use of ortho-k<br />

for myopia control and other ocular diseases.<br />

Petty is working toward accreditation as a<br />

glaucoma prescriber and negotiating shared<br />

care arrangements with ophthalmologists in the<br />

area. He’s already had a lot of support from local<br />

clinicians which he says is reassuring.<br />

“The success of my business hinges on<br />

collaborative care. I will be dependent on referrals<br />

from ophthalmologists, optometrists and GPs. No<br />

one loses out. If a patient is referred to me from a<br />

traditional high street optometrist because they<br />

require some specialist care, I will send them back<br />

to the primary referrer when their eye glasses need<br />

updating.”<br />

Petty’s practice will be entrenched among other<br />

medical practitioners, with laser eye correction,<br />

dentistry, GPs, radiology and physiotherapy among<br />

the other services available in the suites.<br />

Look out for more from Petty in his quarterly NZ<br />

Optics’ column ‘Speciality CL Forum’ in March. ▀<br />

Luxottica and Essilor join forces<br />

Luxottica’s executive chair, Leonardo Del<br />

Vecchio, will control the new giant global<br />

eyewear entity<br />

Italy’s Luxottica and France’s Essilor have agreed to<br />

merge in a 46 billion euro (NZ$68.7 billion) deal.<br />

The all share deal is one of Europe’s largest crossborder<br />

tie-ups and will result in a new global eyewear<br />

giant, EssilorLuxottica, headquartered and listed in France<br />

and majority-owned by Leonardo Del Vecchio, Luxottica’s<br />

81-year-old billionaire founder and executive chairman.<br />

Del Vecchio will hold about a third of the newly merged<br />

company through Delfin, the Luxembourg-based holding<br />

company of the Del Vecchio family, which currently owns<br />

62% of Luxottica.<br />

In a combined statement, Del Vecchio said the merger<br />

is a dream come true. “With this agreement my dream to<br />

create a major global player in the eyewear industry, fully<br />

integrated and excellent in all its parts, comes finally true.<br />

University recognises<br />

“outstanding work”<br />

The Department of Ophthalmology at<br />

Auckland University has announced three<br />

new promotions: Professor Trevor Sherwin,<br />

Associate Professor Andrea Vincent and Dr Ilva<br />

Rupenthal, director of the Buchanan Ocular<br />

Therapeutics Unit, who’s been made senior<br />

lecturer above the bar.<br />

The new Professor Sherwin says it’s very rewarding<br />

to attain the professor title as it requires both<br />

international recognition of your work as well as<br />

recognition from peers closer to home. Part of the<br />

reason for Professor Sherwin’s promotion is the<br />

exciting work him and his team have been doing<br />

Professor Tevor Sherwin Dr Ilva Rupenthal Asoociate professor Andrea<br />

Vincent<br />

It was some time now that we knew that this was the<br />

right solution but only today are there the right conditions<br />

to make it possible. …Finally, after 50 years, two products<br />

which are naturally complementary, namely frames and<br />

lenses, will be designed, manufactured and distributed<br />

under the same roof.”<br />

The merged entity will have revenues of more than 15<br />

billion euros (NZ$22.4 billion), combined net EBITDA of<br />

approximately €3.5 billion (NZ$5.2 billion) and more than<br />

140,000 employees. It will be co-run by Del Vecchio and<br />

Hubert Sagnières, Essilor’s chair and CEO, as executive<br />

chair and vice-chair respectively, though the companies<br />

said the two will have “equal powers”.<br />

The transaction will “allow the combined group to<br />

better seize growth opportunities resulting from strong<br />

on regenerative medicine in the battle against<br />

keratoconus and myopia (see NZ Optics’ September<br />

2016). Professors Sherwin and Colin Green and<br />

research fellow Dr Carol Greene are in the last phase<br />

before clinical trials of a new eye drop which can<br />

reshape, stablise and, potentially, rebuild the cornea.<br />

“If successful, it could be ground-breaking, a huge<br />

advance in the treatment of eye disorders,” said<br />

Prof. Sherwin. The results of a large animal trial are<br />

expected towards the end of this year or early 2018.<br />

Associate Professor Andrea Vincent, a specialist<br />

in the genetics of eye diseases, says her promotion<br />

is a recognition of her teaching, research and<br />

services to the university and the<br />

ophthalmic community. Although<br />

the promotion doesn’t really<br />

change what she does or how<br />

she’ll do her work on a day-to-day<br />

basis, including current research<br />

modelling retinal diseases in<br />

zebrafish models, A/Prof Vincent<br />

says it will signal her credibility in<br />

the international ocular genetic<br />

field, with current and future<br />

collaborations. ▀<br />

demand in the eyewear market, driven by the increasing<br />

need for corrective and protective eyewear and the<br />

appetite for strong brands,” continued the companies in<br />

the statement.<br />

“The strategic rationale is strong,” said JPMorgan<br />

Cazenove analysts in a note, adding the deal defuses the<br />

risk of growing competition between the two companies<br />

as both fight slowing sales because of a weakening North<br />

American market, rising competition from cheaper rivals<br />

and the challenges of online distribution.<br />

Though the deal is still subject to Essilor shareholder<br />

approval and clearance from the relevant anti-trust<br />

authorities, it is expected to close by the end of the year.<br />

Del Vecchio said he’s confident there will be no problems<br />

gaining approval from competition authorities. ▀<br />

It’s easy to see why<br />

we love our new<br />

rooms in the heart<br />

of Christchurch.<br />

Dr James Borthwick<br />

MB ChB, FRANZCO<br />

Disease and surgery of the retina and macula, cataract<br />

Dr Sean Every<br />

MB ChB, MMedSci (Distinction), FRANZCO<br />

Disease and surgery of the retina and macula, cataract<br />

Dr Jo-Anne Pon<br />

MB ChB, FRANZCO<br />

Oculoplastics, cataract, neuro-ophthalmology, strabismus,<br />

general ophthalmology<br />

Dr John Rawstron<br />

MB ChB, MPH, GDipM (Refract Surg), FRANZCO<br />

Cataract, LASIK, corneal transplant<br />

For the specialist treatment of all eye conditions the new space provides an increase<br />

in consulting and treatment rooms, state of the art technology, an innovative new layout<br />

to increase comfort and plenty of free and easily available parking.<br />

Most importantly, it also provides the home for a proudly local team. As the number one<br />

South Island provider of specialist ophthalmic care our surgeons are fellowship and New Zealand<br />

trained sub-specialists. They are the best in their respective fields. They are excited to be<br />

part of our new city, to be the care behind the change, the insight behind the vision.<br />

Dr Rebecca Stack<br />

MB ChB (Distinction), MMedSci, FRANZCO<br />

Cataract, oculoplastic and reconstructive surgeon<br />

Dr Allan Simpson<br />

MB ChB, FRANZCO<br />

Cataract, glaucoma<br />

Dr Robert Weatherhead<br />

MB ChB, FRCS, FRACS, FRANZCO<br />

Oculoplastic and reconstructive surgeon<br />

Dr Logan Robinson<br />

MB Chb, PG Dip Ophth BS (Distinction), FRANZCO<br />

Vitreoretinal surgery, diseases of the retina and macula,<br />

refractive cataract surgery<br />

128 Kilmore Street, Christchurch ı P: 03 355 6397 ı W: www.southerneye.co.nz<br />

6 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


INTRODUCING AIR OPTIX ® plus HYDRAGLYDE ® contact lenses<br />

THIS IS WHY your<br />

patients can have excellent<br />

deposit protection, now with<br />

longer-lasting moisture 1-3<br />

EXCLUSIVE HYDRAGLYDE ®<br />

MOISTURE MATRIX<br />

The excellent deposit resistance of AIR OPTIX ®<br />

brand contact lenses, now combined with<br />

the enhanced moisture benefits of<br />

HydraGlyde ® Moisture Matrix,<br />

designed to keep the lens surface<br />

moist throughout the day. 1,2,4<br />

Contact your Alcon ® Business<br />

Development Manager to learn more.<br />

PROTECTIVE<br />

SMARTSHIELD TECHNOLOGY<br />

Featuring proprietary AIR OPTIX ® brand<br />

lens technology, which has demonstrated<br />

CONSISTENT COMFORT FROM<br />

DAY 1 TO DAY 30 5 *<br />

EXPANDED<br />

PARAMETERS<br />

+8.00D TO -12.00D<br />

NEW<br />

PERFORMANCE DRIVEN BY SCIENCE TM<br />

References: 1. Nash W et al. A comparison of various silicone hydrogel lenses; lipid and protein deposition as a result of daily wear. Optom Vis Sci<br />

2010;87:E-abstract 105110. 2. Alcon data on file, 2015. 3. In vitro wetting analysis: out-of-pack and wetting substantivity. Alcon data on file, 2014.<br />

4. In vitro study over 16 hours to measure wetting substantivity; Alcon data on file, 2015. 5. Eiden SB et al. Prospective study of lotrafilcon B lenses<br />

comparing 2 versus 4 weeks of wear for objective and subjective measures of health, comfort, and vision. Eye & Contact Lens 2013;39(4):290–294.<br />

@ 2016 Novartis. Alcon Laboratories (Australia) Pty. Ltd. ABN 88 000 740 830. Australia Phone: 1800 224 153. New Zealand Phone: 0800 101 106<br />

11/16 ALC0575 nzoptics NP4:A21611553818.<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

7


News<br />

in brief<br />

CHANGES AT OPTOMETRY AUSTRALIA<br />

Andrew Hogan is the new president of Optometry Australia<br />

following Kate Gifford’s resignation last year. Hogan, an optometrist<br />

and broadcaster based in Hobart, Tasmania, is former president<br />

of Optometry Tasmania. He is motivated by the diversity found in<br />

the industry, he told Optometry Australia’s magazine Australian<br />

Optometry. “Optometry can take you to so many places and involve<br />

doing so many different things. I see optometry politics and the<br />

work of the organisation as just another aspect of the profession.”<br />

In other news, Optometry Australia is looking for a new CEO<br />

following the resignation of Genevieve Quilty late last year. Quilty<br />

led the organisation since 2011. She leaves in mid-<strong>Feb</strong>ruary.<br />

NOVARTIS BUYS PRESBYOPIA POTENTIAL<br />

Swiss medical giant Novartis, owner of Alcon, is set to acquire<br />

Encore Vision, a Texas-based company in the early stages of<br />

developing a drug for presbyopia. Novartis said the acquisition<br />

would add a “first-in-class” treatment to its ophthalmology<br />

pipeline, “providing a potentially disruptive innovation to patients<br />

in a new therapeutic area of high unmet need and high prevalence.”<br />

Encore Vision was founded 10 years ago by Bill Burns, a former Alcon<br />

executive.<br />

FRIZZELL’S SPECS A HIT<br />

New Zealanders swooped up iconic artist Dick Frizzell’s limitededition<br />

frames collection, which sold out in less than six weeks. The<br />

frames were designed by Frizzell and Specsavers as a fundraiser for<br />

The Fred Hollows Foundation, with $25 from each frame sold going<br />

to the Foundation to provide cataract kits for the Pacific.<br />

DR KIM WINS<br />

Dr Yeri Kim won first place at Auckland University’s School of<br />

Medicine Doctoral Showcase in December last year for her<br />

thesis, ‘Characterising the molecular mode of action of connexin<br />

therapeutics for the treatment of retinal injury and disease’. This<br />

is the fifth time the Department of Ophthalmology has won the<br />

Showcase since its inauguration in 2009.<br />

ALCON NEW MONTHLY CLS<br />

Alcon unveiled its new Air Optix plus HydraGlyde montly<br />

replacement contact lenses (CLs) at the American Academy of<br />

Optometry meeting in California in November last year. The new<br />

CLs combine Alcon’s SmartShield and HydraGlyde Moisture Matrix<br />

technologies to improve deposit resistance and provide longerlasting<br />

comfort, said the company. They will be available in New<br />

Zealand later this month.<br />

TESTOSTERONE FOR DRY EYE?<br />

Testosterone is being studied as a possible treatment for dry eye<br />

disease (DED). Talking to Ophthamology Times, Dr Terry Dawson<br />

from Alabama, said his informal study showed most of his female<br />

perimenopause patients have evaporative dry eye and responded<br />

favourably to an androgen eye drop. Men with a low level of<br />

testosterone and experiencing DED can also benefit, he said.<br />

HAPPY BIRTHDAY CR SURFACING<br />

CR Surfacing celebrated 40 years in the lens industry in November<br />

last year. Established in 1976, the company is now the largest<br />

Australian lens manufacturer and believed to be the third largest<br />

lens supplier to the Australian market. It opened its New Zealand<br />

office in Christchurch in 2008. CR Surfacing managing director<br />

Adam Fletcher told Insight magazine the company had recently<br />

invested A$3 million in design and manufacturing to continue to<br />

stay ahead of the<br />

competition in<br />

<strong>2017</strong>.<br />

Tackling eye care backlogs in NZ<br />

The demand for ophthalmology services<br />

in New Zealand is growing year-onyear.<br />

This is partly due to an ageing<br />

population and increasing rates of diabetes,<br />

resulting in a higher prevalence of age-related<br />

eye disease and diabetic eye disease.<br />

However, there are also positive reasons<br />

for increased demand. Recent innovations,<br />

particularly the use of anti-vascular<br />

endothelial growth factor drugs for agerelated<br />

macular degeneration (AMD) and<br />

other retinal vasculopathies, mean we can<br />

now treat conditions which previously would<br />

have resulted in irreversible loss of sight. Of<br />

course, with the ability to prevent blindness<br />

comes an inherent responsibility to do so.<br />

The New Zealand Ministry of Health’s<br />

waiting time targets primarily focus on first<br />

specialist appointments. This means that,<br />

with limited resources available, District<br />

Health Boards (DHBs) must focus funding<br />

on these appointments to the detriment of<br />

follow-up appointments. This causes serious<br />

delays in follow-up appointments. In some<br />

DHBs, there have been patients that have had<br />

their follow-up appointments delayed for 3, 6,<br />

9 or even 12 months or more.<br />

With ophthalmologic conditions such as<br />

glaucoma, diabetes, paediatric eye disease<br />

or age-related macular degeneration (AMD),<br />

follow-up appointments are essential for<br />

monitoring and managing a patient’s eye<br />

health. These follow-up appointments allow<br />

ophthalmologists to identify any potential<br />

worsening of a patient’s condition and adjust<br />

treatment accordingly. Without monitoring,<br />

a patient’s condition can worsen with few<br />

symptoms, potentially leading to irreversible<br />

vision loss.<br />

Ophthalmologists across the country<br />

have all seen the negative effects of underresourcing.<br />

Despite initiatives such as extra<br />

clinics, “virtual consults” and up-skilling of<br />

nurses and optometrists to work as part of the<br />

collaborative care team, there has simply been<br />

no way to meet the ever-increasing demand.<br />

This increased demand for services came<br />

to a head in 2016 when it became apparent<br />

that the New Zealand healthcare service was<br />

in the grip of an eye health care crisis. More<br />

and more reports of adverse events began to<br />

emerge – more people losing their sight due<br />

World-first study at Auckland Uni<br />

Each year more than 250 New<br />

Zealanders require a corneal<br />

transplant, but an innovative new<br />

study aims to tackle the ever-increasing<br />

need for donor corneas.<br />

Dr Jie Zhang is leading a research team<br />

Dr Jie Zhang<br />

BY DR STEPHEN NG, CHAIRMAN, RANZCO NZ<br />

to delayed follow-up appointments.<br />

The Royal Australian and New Zealand<br />

College of Ophthalmologists (RANZCO),<br />

having worked to raise awareness of this<br />

issue with political leaders for over a year,<br />

recognised the time had come for a widereaching<br />

campaign to highlight the plight of<br />

so many eye patients.<br />

RANZCO was informed in October that the<br />

Health Quality and Safety Commission’s 2016<br />

report was about to release details of large<br />

numbers of cases where eye patients had lost<br />

vision due to delayed follow-up appointments.<br />

RANZCO members worked with colleagues<br />

from Macular Degeneration New Zealand<br />

(MDNZ) and Ophthalmology New Zealand<br />

(ONZ) to bring together information, case<br />

studies and evidence to support the case for<br />

action to address these delays.<br />

RANZCO released this information in<br />

November. At about the same time, a number<br />

of DHBs released statements about the<br />

adverse events in their hospitals. The media<br />

response was immediate and comprehensive.<br />

The mainstream media – television, radio<br />

and newspapers – as well as the trade media,<br />

including NZ Optics, grasped the urgency<br />

of the issue and broadcast the message to a<br />

wide audience.<br />

Meanwhile, RANZCO wrote to all Members<br />

of Parliament, including the Prime Minister,<br />

the Minister for Health and the Opposition<br />

Spokesperson for Health, to raise political<br />

awareness of the issue. Again, the response<br />

was overwhelming. MPs from across all<br />

political parties offered support for RANZCO’s<br />

call for immediate action to address this<br />

important issue and stop people from going<br />

permanently and avoidably blind.<br />

RANZCO was invited to meet with the<br />

Acting Chief Medical Officer (CMO), Dr<br />

Andrew Simpson, and then with the Minister<br />

for Health, the Hon. Dr Jonathan Coleman.<br />

A number of ophthalmologists from DHBs<br />

across New Zealand attended these meetings,<br />

which were constructive. RANZCO was<br />

reassured this issue was being taken seriously<br />

and that action would be taken.<br />

Following these meetings, RANZCO<br />

continued communication with both the<br />

Minster and the CMO to provide additional<br />

information and be updated on progress.<br />

from Auckland University’s Department<br />

of Ophthalmology looking at how the<br />

corneal endothelium can be regenerated<br />

using a particular type of adult stem<br />

cell, recently discovered in an area of<br />

the cornea called the transition zone. If<br />

the study is successful it could lead to a<br />

number of patients being treated from a<br />

single donor, rather than the current oneto-one<br />

relationship.<br />

“The corneal endothelium does not<br />

regenerate. When cells are damaged due<br />

to disease, the other cells simply expand<br />

to fill the space,” said Dr Zhang. But the<br />

hypothesis is if these adult stem cells<br />

are stimulated in the right way, they will<br />

develop into endothelial cells promoting<br />

regeneration in the recipient’s eye. “These<br />

stem cells have only been discovered in<br />

RANZCO NZ Chair Dr Stephen Ng and Dr Jesse Gale at<br />

Parliament for the MDNZ-Deloitte report launch (see p10)<br />

Finally, just days before Christmas, RANZCO<br />

was delighted to be informed that the<br />

Ministry for Health was announcing funding<br />

of up to $2million for DHB ophthalmology<br />

services to address the backlog in follow-up<br />

appointments. DHBs are able to apply for this<br />

money to help develop, improve or implement<br />

models of care to best support their district’s<br />

ophthalmology services.<br />

In the longer term, RANZCO will be working<br />

closely with the Ministry of Health to develop<br />

clinical prioritisation tools and processes,<br />

effective models of care, on-going audits and<br />

workforce modelling to ensure, in the future,<br />

the supply of ophthalmology services is able<br />

to meet increasing demand.<br />

RANZCO and our Fellows in New Zealand are<br />

delighted this action has been taken and we<br />

look forward to continuing to work with the<br />

Ministry of Health and with DHBs to ensure<br />

that, in future, no more New Zealanders lose<br />

their sight due to delayed appointments.<br />

l Correction: In the December 2016 edition<br />

of NZ Optics, it was wrongly surmised that<br />

to assist with the increasing demands on<br />

eye health services…“Dr Ng… favours some<br />

form of allied community care…”. RANZCO<br />

values working with nursing and optometry<br />

colleagues and has highlighted increasing<br />

collaborative care as one of the solutions<br />

to the current eye health care crisis. But at<br />

present in New Zealand, RANZCO believes<br />

the most proven, efficient and cost-effective<br />

solution is to have suitably-trained nurses<br />

and optometrists working collaboratively<br />

alongside ophthalmologists, not in the<br />

community, but within hospital teams. ▀<br />

the last three to five years, so we don’t<br />

know much about them,” she said, adding<br />

that the process has, however, been<br />

casually observed.<br />

Dr Zhang’s team received approval for<br />

Marsden funding in October. The three<br />

year, $300,000 grant starts in March.<br />

“The endothelium is the main roadblock<br />

to corneal regeneration at the moment. If<br />

we can overcome that it would change the<br />

landscape for the treatment of many eye<br />

diseases,” said Dr Zhang.<br />

“At the end of three years we hope<br />

to have laid the foundations for the<br />

development of stem-cell treatment to<br />

regenerate the endothelium. Ultimately,<br />

this will relieve the pressure on the eye<br />

bank and more people in need can be<br />

helped.” ▀<br />

CR Surfacing’s Christchurch office<br />

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

or Jai Breitnauer at editor@nzoptics.co.nz or +64 22 424 9322<br />

For all advertising and marketing enquiries, please contact Susanne Bradley<br />

at susanne@nzoptics.co.nz or +64 27 545 4357 in the first instance,<br />

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.<br />

It is published monthly, 11 times a year, by New Zealand Optics 2015 Ltd. Copyright is<br />

held by NZ Optics 2015 Ltd. As well as the magazine and the website, NZ Optics publishes<br />

the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide<br />

that profiles the products and services of the industry. NZ Optics is an independent<br />

publication and has no affiliation with any organisations. The views expressed in this<br />

publication are not necessarily those of NZ Optics 2015 Ltd or the editorial team.<br />

TearLab appoints OIC<br />

After just over a year of going it alone,<br />

TearLab Australia has appointed<br />

Ophthalmic Instrument Company<br />

(OIC) to manage the distribution and sales<br />

of its ground-breaking osmolarity system in<br />

New Zealand.<br />

The company has created a good base in<br />

New Zealand but needs support to build<br />

on that, says George Koukides, manager of<br />

TearLab Australia. “[OIC managing director<br />

Tim Way’s] network and understanding of<br />

the ophthalmology and optometry market<br />

in New Zealand will take TearLab to the next<br />

level.”<br />

The opportunity is there, he says, both<br />

in ophthalmology where<br />

the TearLab system is being<br />

used to pre-screen cataract<br />

patients, to learn more about<br />

their tear film prior to surgery,<br />

and optometry for objective<br />

diagnosis of dry eye.<br />

Way says he’s excited to have<br />

TearLab on board as he’s been<br />

following them for a while.<br />

The TearLab system is a great<br />

addition to the company’s<br />

dry eye products portfolio, complementing<br />

other products such as the Medmont E300<br />

topographer and the eye cleansing product<br />

OIC’s Tim Way and TearLab’s George Koukides at RANZCO 2016<br />

Avenova, he says. “[TearLab] has been very<br />

supportive and we are really looking forward<br />

to working together.” ▀<br />

8 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


OUR EXPANSION…<br />

YOUR CAREER GROWTH<br />

A MUTUAL OPPORTUNITY<br />

As the Specsavers network of 370 New Zealand and Australian stores continues to<br />

experience significant growth, opportunities abound in metro and regional locations<br />

for career focussed optometry and dispensing professionals.<br />

For those taking a fresh look at what Specsavers offers as a working<br />

environment, the scale and format of our store locations continues to evolve<br />

with exciting results for our partners, our teams and our patients. Take<br />

Specsavers Ringwood as an example, recently recognised at the Australian<br />

Retail Awards as the outstanding retail design project of the past year. It is<br />

more than double the size of its previous location in the same shopping centre,<br />

with six consulting rooms, 12 dispensing desks, a contact lens teaching zone<br />

and four pre-testing rooms. Its investment in the latest retail and optometric<br />

technology is exemplary, offering a glimpse of the future.<br />

And now, as we look to the next phase of growth, we want to talk to you<br />

about our plans – and hear about yours. Our growth really can be your<br />

opportunity, whether you are looking at a store partner or an employed role -<br />

at every level of experience.<br />

To get the conversation started, contact Chanelle Coates on 0800 717 350 or by email on chanelle.coates@specsavers.com<br />

Retail<br />

Store Design<br />

Award<br />

2016<br />

Retail<br />

Employer<br />

of the Year<br />

2015<br />

Overall<br />

National<br />

Supreme Winner<br />

2015<br />

ANZ Customer<br />

Service Excellence<br />

Award<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 />

Multichannel<br />

Retailer<br />

of the Year<br />

2014<br />

Roy Morgan<br />

Research<br />

No. 1 for eye tests<br />

2014<br />

FCA International<br />

Franchisor<br />

of the Year<br />

2014<br />

FCA Social<br />

Responsibility<br />

Award<br />

2014<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

9


The cost of macular degeneration<br />

MDNZ trustees Allan and Viv Jones with MPs Andrew Bayly and Simon O’Connor Taranaki-King country MP Barbara Kuriger being scanned Zeiss’ Chris Money explains the scan process to MP Winston Peters while Dr Kolin Foo looks on<br />

Macular degeneration cost the country<br />

$391.1 million in 2016 or nearly $20,000<br />

per person, according to a new report<br />

into the true costs associated with this disease.<br />

The report, ‘Socioeconomic cost of macular<br />

degeneration in New Zealand’, by Deloitte and<br />

Macular Degeneration New Zealand (MDNZ) was<br />

presented to parliament on 15 November 2016 by<br />

MDNZ with the aid of Professor Alan Bird, surgeon<br />

at the Institute of Ophthalmology at Moorfields<br />

Hospital, East London.<br />

To encourage MPs to review the report and<br />

understand the true cost of macular degeneration<br />

(MD) to the country – and to hopefully gain some<br />

government funding for MDNZ and its vital public<br />

education work - MPs and Beehive staff were<br />

also invited to undergo a free screening as part<br />

of the launch, prior to the official evening event<br />

(see separate story). Around 50 people attended<br />

the evening, including many MPs. The launch<br />

was supported by Tamaki MP Simon O’Connor,<br />

chair of the Health Select Committee, who even<br />

posted about it on Facebook, thanking MDNZ for<br />

bringing the costs to Parliament’s attention and<br />

the free-screenings (which luckily didn’t pick up<br />

any incidents of MD).<br />

Key findings<br />

In the report, researchers noted age-related<br />

macular degeneration (AMD) is<br />

the most common cause of visual<br />

impairment in people over 50 in the<br />

developed world, with 50% of all<br />

blindness in New Zealand attributed<br />

to AMD - blindness defined as bestcorrected<br />

visual acuity of


SPECIAL FEATURE: RANZCO<br />

Record attendance at RANZCO 2016<br />

RANZCO’s 48th Annual Scientific Congress<br />

was notable for both its unprecedented<br />

size and its exemplary programme.<br />

Bringing around 1500 people together,<br />

including 85% of the ophthalmologists in<br />

Australia and in New Zealand, the 2016 Congress<br />

was RANZCO’s biggest ever. This allowed us to<br />

deliver a programme of activities which was<br />

varied, scientifically rigorous and incredibly<br />

engaging. There were sessions for everyone,<br />

focusing on both scientific and professional<br />

developments. And the trade exhibition was<br />

BY ASSOCIATE PROFESSOR MARK DANIELL, RANZCO PRESIDENT<br />

both our biggest ever and most successful, with<br />

a great deal of positive feedback offered.<br />

The quality of the sessions and the speakers<br />

was of particular note. In the plenary sessions,<br />

outstanding named lectures and disease<br />

update lectures were delivered by some of the<br />

leading names in the ophthalmology profession,<br />

including both local and international speakers.<br />

The focus on innovative scientific<br />

breakthroughs, which was a defining feature<br />

of the named and update lectures, continued<br />

with the posters, papers and films submitted by<br />

Fellows, trainees and medical students.<br />

Most importantly, RANZCO’s 2016<br />

Congress brought together a wide range of<br />

ophthalmologists and colleagues from the eye<br />

health sector to learn from each other, helping<br />

us all to further the quality of eye health care<br />

here and around the world. Ultimately, the<br />

success of this Congress will help to improve<br />

outcomes for all of our patients, now and in the<br />

future, and we would like to thank everyone who<br />

took part and made this possible.” ▀<br />

PICTURE BY JEFF MCEWAN, CAPTURE STUDIOS<br />

Associate Professor Mark Daniell, the new RANZCO president.<br />

RANZCO’s 48th Scientific Congress<br />

BY DR AARON WONG*<br />

There are a couple of recurring themes that<br />

I’ve noticed about Melbourne. The first is<br />

variety. My first conversation on touching<br />

down was that inevitable ‘four seasons in one<br />

day’ chat that every taxi ride into the city seems<br />

to feature. The second is that us New Zealanders<br />

can’t get enough of Melbourne. Whether it’s to<br />

holiday, work or find greener pastures, Kiwis seem<br />

to gravitate to the “Paris on the Yarra”.<br />

RANZCO’s 48th Scientific Congress held at<br />

the Melbourne Convention Centre from 19 - 23<br />

November, 2016, proved to be no exception to<br />

my twin observations. The programme featured<br />

a wide variety of subspecialty topics and a good<br />

dose of New Zealand presenters, not to mention<br />

a healthy contingent of Kiwis contributing to<br />

the 1,500 or so delegates. In fact, 2016 broke<br />

the attendance record, with almost 85% of all<br />

Australian and New Zealand ophthalmologists in<br />

Melbourne for the Congress.<br />

Day one<br />

Headlining the opening day was Professor Gerard<br />

Sutton’s Council lecture. The Sydney-based corneal<br />

specialist explained how he believed that synergy<br />

and serendipity were the key ingredients for<br />

innovation in corneal therapies. Synergy between<br />

corneal surgeon, scientist and the modern eye<br />

banker was key to his team’s breakthroughs into the<br />

pathogenesis of keratoconus. Their current theory<br />

is that a two-hit hypothesis, by which a genetic<br />

susceptibility combined with a secondary event,<br />

perhaps eye rubbing, culminates in the epithelial<br />

cell migration dysfunction seen in keratoconus.<br />

After lunch (and a vendor-sponsored coffee)<br />

delegates dispersed into one of five concurrent<br />

sessions. At the genetics/paediatrics rapid fire<br />

session, New Zealand ophthalmologist Dr Andrea<br />

Vincent from Retina Specialists gave two talks,<br />

the first about the prevalence of cystoid macular<br />

oedema (CMO) in rod cone dystrophies; and the<br />

second about novel genetic change found in a<br />

population of mainly Cook Island Maori patients<br />

with ectopia lentis, suggesting a founder effect.<br />

Dr Jina Han of the University of Auckland talked<br />

about telemedicine in retinopathy of prematurity<br />

screening. Her cohort included 1,217 neonates who<br />

had been screened across four different hospitals.<br />

Amongst the final sessions of the day was a very<br />

well attended ‘Controversies in Glaucoma’ session.<br />

Our own Professor Helen Danesh-Meyer discussed<br />

the role of lifestyle modifications in glaucoma.<br />

She explained that although there is little direct<br />

evidence for the benefit of lifestyle modifications<br />

in glaucoma, there is some promising indirect<br />

evidence. Hence when approached by patients she<br />

would endorse blood pressure lowering, exercise,<br />

collard greens, flavonoids and gingko biloba.<br />

Day two<br />

Professor Keith Martin is the first professor of<br />

ophthalmology at the University of Cambridge.<br />

His research team is known for bio-printing<br />

retinal cells using ink jets. In his glaucoma update<br />

lecture he talked about the search for the holy<br />

grail of glaucoma research – the ability to protect<br />

and regenerate the optic nerve. Although animal<br />

studies have shown promise for stem cell and<br />

growth factor-derived treatments, they are a long<br />

way from clinical use in humans. Professor Dennis<br />

Wakefield, an immunologist from Sydney, gave the<br />

Sir Norman Gregg lecture, discussing progress in<br />

elucidating the pathogenesis of HLA-B27 associated<br />

anterior uveitis. It would be hard to imagine a talk<br />

from Professor Boris Malyugin (inventor of the<br />

Malyugin ring) about complicated cataract surgery<br />

that did not delve in to techniques for small pupils.<br />

He described the new Malyugin 2.0 ring that has<br />

the benefits of fitting through a 2.0mm incision<br />

and thinner 5-0 prolene material.<br />

Following morning tea, a range of experts spoke<br />

at the ‘Clinical Controversies’ plenary. Professor<br />

Sutton talked about SMILE and its role in refractive<br />

surgery. Although there was a learning curve, he<br />

thought SMILE had a role for myopes of more than<br />

3-4 dioptres as it had equivalent visual outcomes<br />

to LASIK and slightly less dry eye within the<br />

first six months. Professor Malyugin presented<br />

his thoughts on a controversial new surgical<br />

technique for corneal endothelial dystrophies such<br />

as Fuchs. Descemetorhexis is essentially stripping<br />

the central endothelial layers of the cornea and<br />

not replacing them as you would traditionally with<br />

a corneal graft. In his experience most patients<br />

improved vision after months of corneal oedema,<br />

however some still required secondary grafts.<br />

In the public health rapid fire session Dr Riyaz<br />

Bhikoo and Dr Sid Ogra (both training registrars)<br />

gave accounts of their involvement in volunteer<br />

organisations in the Pacific. Both talks highlighted<br />

the challenges faced in delivering good eye care<br />

to these populations and the effort involved in<br />

keeping sustainable solutions in place. Akilesh<br />

Gokul a PhD candidate from Auckland highlighted<br />

issues closer to home, talking about the Aotearoa<br />

Research into Keratoconus (ARK) study.<br />

In the late afternoon, an instructive anterior<br />

segment course was co-chaired by Professor<br />

Charles McGhee, head of ophthalmology at<br />

the University of Auckland. Dr Sue Ormonde,<br />

a University of Auckland senior lecturer and<br />

consultant ophthalmologist at Greenlane Clinical<br />

Centre, spoke about the importance of primary<br />

repair in ocular trauma in order to restore the<br />

RANZCO new Fellows 2016, including New Zealand’s new Fellows Drs Rachael Niederer, Robin Jones, Shenton Chew, Rasha Altaie and Anu Mathew<br />

PICTURE BY JEFF MCEWAN, CAPTURE STUDIOS<br />

integrity of the globe, allow resolution of hypotony<br />

and restore a bacterial barrier. Auckland University<br />

colleague Dr Jay Meyer shared his corneal surgery<br />

‘life hacks’, including techniques for removing<br />

Salzmann’s nodules and applying cyanoacrylate<br />

glue for small corneal perforations. While Professor<br />

McGhee rounded out the session talking about<br />

surgical techniques for patients with compromised<br />

irises and lenses. As always, prevention is the<br />

best treatment and clues such as advanced age<br />

should alert a surgeon to factors such as zonular<br />

weakness.<br />

Day three<br />

Day three started with the prestigious best paper<br />

presentations. The University of Auckland’s<br />

Samantha Simkin was amongst the top three<br />

junior researchers selected to present their<br />

research. She spoke about a prospective study<br />

of a universal newborn screening service using<br />

RetCam imaging. Over 300 babies were screened<br />

in Auckland (including my son when he was born<br />

six months ago) and in a few instances long-term<br />

conditions were picked up early because of it.<br />

FUNDUS MODULE 300<br />

Instant fundus imaging<br />

on the slit lamp<br />

Efficient workflow<br />

Available from:<br />

Toomac Ophthalmic<br />

09 443 5347<br />

sales@toomac.co.nz<br />

www.toomacophthalmic.co.nz<br />

With impressive simplicity the new Fundus<br />

Module 300 allows integration of non-mydriatic<br />

retina imaging as part of the regular slit lamp<br />

examination.<br />

Simple image capturing<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

Fast and accurate automatic exposure control<br />

Pink banners led the way to the RANZCO 48th Congress in Melbourne<br />

CONTINUED ON PAGE 12<br />

Simple image<br />

capturing<br />

Fast and accurate<br />

automatic exposure<br />

FUNDUS control allows MODULE simple 300<br />

Instant image fundus capturing imaging while<br />

on the you slit are lamp concentrating<br />

on the patient.<br />

Effi cient workfl ow<br />

With impressive simplicity the new Fundus<br />

Module 300 allows integration of non-mydriatic<br />

retina imaging Images as part are of the easily regular slit lamp<br />

examination.<br />

captured and can be<br />

Simple edited image and capturing displayed<br />

Fast and accurate automatic exposure control<br />

allows simple in this image well capturing structured while you are<br />

concentrating on the patient.<br />

system that complements<br />

Intuitive daily software practice.<br />

Images are easily captured and can be edited<br />

and displayed in this well structured system that<br />

complements daily practice.<br />

www.haag-streit.com<br />

Efficient workflow<br />

With impressive<br />

simplicity the new<br />

Fundus Module 300<br />

allows integration of<br />

non-mydriatic retina<br />

imaging as part of<br />

the regular slit lamp<br />

examination.<br />

Intuitive software<br />

NEW ZEALAND OPTICS<br />

11<br />

ADV_Eurotimes_FM300_QR_ESCRS16_V1.indd 1 27.10.2016 12:14:14


SPECIAL FEATURE: RANZCO<br />

Registrars Drs Verona Botha, Ken Ng and Aaron Wong<br />

FROM ON PAGE 11<br />

Professor Ursula Schmidt-Erfurth from Vienna<br />

gave the retina update lecture. She hopes that<br />

improvements in technology allowing machinelearning<br />

OCT will help us predict visual outcomes<br />

in the future.<br />

Professor Mourits, an ophthalmologist from<br />

Amsterdam who first described the clinical activity<br />

score in thyroid eye disease, gave the Ida Mann<br />

lecture. He explained how in Graves’ orbitopathy<br />

both muscle and fat volumes increase within the<br />

orbit due to activity of orbital fibroblasts.<br />

Peter Savino, clinical professor of ophthalmology<br />

and neurosciences at San Diego’s Shiley Eye<br />

Institute, and Professor Danesh-Meyer convened<br />

the always entertaining neuro-ophthalmology<br />

challenges session. The cases were a mix of the<br />

common and the obscure and served as the<br />

catalyst for sparking audience discussion about<br />

diagnostic dilemmas in neuro-ophthalmology.<br />

The day finished on a high note with the<br />

conference dinner at the hallowed Melbourne<br />

Cricket Ground. Although the dinner included a<br />

tour around the largest cricket stadium by capacity<br />

in the world, many Kiwis preferred not to relive the<br />

pain of the 1981 underarm bowling incident and<br />

the 2015 cricket world cup final.<br />

Day four<br />

The final day of Congress started with a session<br />

on keeping your cool during complicated cataract<br />

surgery. Auckland University Associate Professor<br />

Dipika Patel started by reassuring the audience<br />

that complication rates such as posterior capsule<br />

rupture have improved over the last few decades.<br />

In part, this is due to improvements in equipment<br />

360˚<br />

Pachymetry<br />

Refraction<br />

Jina Han, Professor Charles McGhee, Dr Hannah Kersten and<br />

Samantha Simkin<br />

Drs Graham Wilson, Nick Mantell, Stephen Ng and Justin Mora<br />

and, as Dr Mo Ziaei explained in the<br />

next talk, this includes the treatment of<br />

small pupil and floppy iris. Dr Ormonde<br />

spoke about a dreaded fear for most<br />

cataract surgeons, posterior capsular<br />

rupture with vitreous loss. Professor<br />

McGhee’s express vignettes provided<br />

insights into dealing with iris and<br />

zonular deficiencies. He advocated for<br />

a good understanding of the modern<br />

tool kit and plenty of surgical and wet<br />

lab experience to prepare surgeons<br />

for dealing with these cases. While Dr<br />

Bia Kim spoke of the importance of<br />

pre-operative risk stratification scoring<br />

prior to cataract surgery. A modified risk<br />

stratification score is to be trialed at<br />

Auckland DHB in <strong>2017</strong> so watch this space.<br />

Associate Professor Fiona Costello from<br />

the University of Calgary gave the neuroophthalmology<br />

update lecture and explained how<br />

TRK-2P<br />

Four in one<br />

Save Time, Save Space<br />

One-touch operation<br />

Operate from any position<br />

Himanshu Wadhwa, A/Prof Dipika Patel, Aki Gokul, Dr Divya Perumal<br />

and Professor Trevor Sherwin<br />

Drs Simon Dean, Andrea Vincent, Michael Merriman, Hannah Kersten and<br />

Andrew Riley<br />

Bayer’s Christie Murzello with Professor Anthony Molteno and<br />

Dr Tahira Malik<br />

Drs Graham Wilson and Shuan Dai<br />

the eyes are in fact the window to the soul (or<br />

perhaps in this case the central nervous system).<br />

Her dual training as a neurologist and neuroophthalmologist<br />

give her a unique insight into how<br />

assessment of the eye can give you important<br />

information about diseases of the brain such as<br />

multiple sclerosis. In particular OCT may play a<br />

bigger role in neurological disease in the future<br />

as more is understood about how the neuronal<br />

structure in the eye reflects changes in the brain.<br />

Dr James Muecke from the South Australia<br />

Institute of Ophthalmology gave the Hollows<br />

lecture and talked about his experience in<br />

working in more than 10 developing countries.<br />

In countries such as Myanmar, cataracts have<br />

become such a problem that nearly one in 10<br />

adults over the age of 40 are blind or severely<br />

visually impaired. The Sight for All charity, which<br />

Dr Muecke chairs, aims to make it possible<br />

for ophthalmologists working in developed<br />

countries to have the same skill and knowledge<br />

as those in developed countries.<br />

The afternoon’s rapid fire session covered<br />

a range of topics including uveitis, ocular<br />

oncology, neuro-ophthalmology and<br />

oculoplastics. Dr Ken Ng spoke about<br />

the unique spectrum of uveitis in elderly<br />

patients presenting to clinics in Auckland.<br />

Drs John Beaumont and Kevin Taylor with OptiMed’s Rob Nyenkamp<br />

Drs Peter Hadden, John Ah-Chan and Ross Neville-Lamb and<br />

Steve McConnell<br />

Old ophthalmology equipment on the<br />

RANZCO museum display<br />

Dr Rachel Niederer discussed risk factors for<br />

choroidal neovascularisation in punctate inner<br />

choroidopathy. Treatment with oral corticosteroids<br />

may help to reduce the risk of choroidal<br />

neovascular membrane development. Dr Hannah<br />

Kersten spoke about eye findings, including<br />

downbeat nystagmus and temporal retinal nerve<br />

fibre layer thinning, in the recently described<br />

neurological syndrome CANVAS (cerebellar ataxia,<br />

neuropathy and vestibular areflexia).<br />

The Congress was brought to a close with the<br />

annual awards for best paper, poster and film. Dr<br />

Elisabeth de Smit won best junior presentation<br />

for her study of the genomic associations of giant<br />

cell arteritis and Associate Professor John Landers<br />

won best senior presentation for presenting the<br />

findings of the Central Australian Ocular Health<br />

Study. The other speakers in the session, including<br />

Samantha Simkin, were highly commended for<br />

their excellent presentations. As always there was<br />

some New Zealand representation within the<br />

prizewinners with Dr Shong Min Voon winning<br />

best film for ‘A Novel Method for Rapid Production<br />

of Basic Diagnostic Ophthalmic Equipment’. ▀<br />

*Dr Aaron Wong is an ophthalmology trainee at the University<br />

of Auckland. He was helped in the writing of this article by Dr<br />

Hannah Kersten, a lecturer and research fellow at the University<br />

of Auckland.<br />

Tonometry<br />

Keratometry<br />

Visit us at<br />

CCLS <strong>2017</strong><br />

Your complete automated refraction solution<br />

Matthew Northage and Henri Buhagiar from Abbott flank Tania<br />

Murray from Rotorua Eye Clinic<br />

Sylvia Hewison and Marie Taylor with Drs Simon Dean and Nadeem<br />

Ahmad<br />

EMR<br />

patient<br />

record<br />

For further information regarding these leading-edge products<br />

please contact Device Technologies Sales:<br />

P: 0508 338 423<br />

sales@device.co.nz | www.device.co.nz<br />

Drs Muhammad Khalid and John Beaumont<br />

Drs Hussain Patel and Mark Donaldson<br />

12 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


Orthoptics at<br />

RANZCO 2016<br />

BY ELIZABETH GATELY-TAYLOR AND CLAIRE FITZGERALD*<br />

We were fortunate enough to attend<br />

the Orthoptics Australia 73rd Annual<br />

Scientific Meeting in November held<br />

with, but separate to, RANZCO’s 2016 Congress<br />

at the Melbourne Convention Centre. The<br />

programme was full and varied and we were<br />

also able to attend RANZCO’s Congress sessions.<br />

Connecting in<br />

person and online<br />

Orthoptists are<br />

so small in number<br />

in New Zealand it<br />

is important we<br />

stay in touch with<br />

orthoptists around<br />

the globe. The role<br />

of an orthoptist<br />

has expanded,<br />

particularly in<br />

Australia, taking on a<br />

more technical slant.<br />

However, there was<br />

still plenty of content<br />

on traditional<br />

orthoptics - binocular<br />

vision and ocular<br />

motility.<br />

Connecting was<br />

also a topic of one of<br />

the sessions looking at the importance of social<br />

media, both the good and the bad. We are often<br />

quick to criticise the misinformation available<br />

online, but we all need to work to replace this<br />

with professional advice. We were interested<br />

to hear that Google is falling away from being<br />

the go-to search engine with millennials<br />

increasingly turning to groups on Facebook<br />

and YouTube to find health advice instead.<br />

Digital healthcare is not well funded and it is<br />

hard to regulate but people are keen to access<br />

healthcare apps. The positive implications of<br />

better compliance with medications this digital<br />

approach can provide are beginning to become<br />

apparent, with some clinicians increasingly<br />

getting left behind. Plus, the current change<br />

in funding for disability services in Australia<br />

means people are starting to make more<br />

choices about their healthcare provider. They<br />

are doing their own research, using online<br />

profiles to influence their decision.<br />

Looking back to look forward<br />

A theme that came through clearly at the<br />

meeting was looking back in order to look<br />

forward. A couple of sessions concentrated on<br />

the history of orthoptics and it was interesting<br />

to reflect on past research trends and how these<br />

impacted on clinical practice.<br />

Technology-based treatments for amblyopia<br />

continue to be a hot topic, although it is clear<br />

work needs to continue to validate its use.<br />

Interesting feedback from some of the study<br />

groups is that many patients find the games<br />

boring. This highlights the fast changing<br />

expectations people have around technology.<br />

As a consequence, there was no real<br />

improvement in compliance between occlusion<br />

therapy and dichoptic therapy, however,<br />

it is still an area that’s showing exciting<br />

developments and it will be interesting to see<br />

the results of current studies.<br />

The expanding role of an orthoptist<br />

The meeting provided an opportunity to hear<br />

about the results of research from across a wide<br />

range of topics. In addition to the detective<br />

work involved in investigating complex squint<br />

cases, we heard about the variety of orthoptic<br />

work in today’s world, from orthoptist-led<br />

The Blind Foundation’s Elizabeth Gately-Taylor and Claire Fitzgerald with Dr Sean Every<br />

Orthoptists Elizabeth Gately-Taylor and Claire Fitzgerald in Federation Square, Melbourne<br />

diabetic screening clinics to the ongoing<br />

management of glaucoma suspects.<br />

Orthoptists build a close relationship with<br />

their patients over time. This is obvious in the<br />

paediatric setting and also valuable in adult<br />

clinics, where the orthoptist can be the one<br />

constant for the patient who may be examined<br />

by a different ophthalmologist at each visit.<br />

This relationship-building was reflected in many<br />

of the presentations, especially in the area of<br />

vision impairment. Jess Boyle, a PhD candidate<br />

at La Trobe University in Melbourne, shared<br />

a thought-provoking evaluation of patient<br />

experience and perceptions when undergoing<br />

repeated anti-VEGF injections for AMD. Of<br />

note, patient satisfaction increased when given<br />

the opportunity to view the OCT results. Jess<br />

also looked at the provision of information<br />

about vision rehabilitation and patient<br />

support groups. She found many patients felt<br />

uninformed about what<br />

support services were<br />

available to them. Barriers<br />

to the referral of patients<br />

to low vision services and<br />

support groups included:<br />

• patient identified:<br />

timing of referral, financial<br />

outlay, perceived benefit<br />

and accessibility<br />

• orthoptist identified:<br />

practical factors,<br />

knowledge-based factors,<br />

patient factors, clinical<br />

protocol.<br />

The role of the orthoptist<br />

in Australia is firmly<br />

embedded in adult and<br />

paediatric low vision<br />

services across the<br />

spectrum of government<br />

funded, not-for-profit<br />

and private habilitation<br />

and rehabilitation services. Attending this<br />

conference was a valuable opportunity for us to<br />

learn from Australian low vision orthoptists and<br />

share some insights about what we do well in<br />

New Zealand.<br />

Often we become so busy in our clinical<br />

practice we forget why we became orthoptists.<br />

Hearing the passion of the presenters, both<br />

through case studies and the tabling of new<br />

research, helps to spark that excitement again.<br />

We certainly recommend attendance at the<br />

next Orthoptics Australia Annual Scientific<br />

Conference to New Zealand orthoptists. There<br />

was much to learn and share, and the Aussies<br />

are a friendly bunch! ▀<br />

* Claire Fitzgerald and Elizabeth Gately-Taylor are both<br />

orthoptists working with The Blind Foundation, which<br />

supported their attendance at the Meeting. Elizabeth also<br />

works with the Terrace Eye Centre in Wellington<br />

RANZCO 2016: Practice<br />

Managers Conference<br />

The 2016 RANZCO<br />

Practice Managers<br />

conference in<br />

Melbourne kicked off<br />

with a fun networking<br />

session, which saw<br />

many of us initially quite<br />

bleary-eyed and not<br />

so ready to share our<br />

thoughts and ideas early<br />

on a Sunday morning!<br />

Once the caffeine kicked<br />

in, however, the creative<br />

juices began to flow<br />

and so did some lively<br />

discussion on issues<br />

affecting ophthalmology practices in today’s<br />

competitive and busy environment.<br />

The key themes of the 2016 conference were<br />

the importance of ensuring ongoing quality staff<br />

development and education; updating patient<br />

management systems and other medical software<br />

to best meet the needs of the practices for now<br />

and into the future; and ways to attract and retain<br />

good staff to ensure a seamless quality service.<br />

As someone fresh off the boat (plane really) from<br />

Wellington, the key areas for me were disaster<br />

management and uninterrupted power supply!<br />

The panel discussion following this session was<br />

very informative and helpful with ideas on how<br />

to ensure your aged-debtors were kept to a<br />

minimum and useful tips on marketing practices.<br />

The importance of continuing to send clinic letters<br />

to GP’s and optometrists, both as a way of sharing<br />

information about patients and as a valuable<br />

marketing tool for the practice, could not be<br />

stressed enough. Quotes were also in high use and<br />

this one, attributed to Richard Branson, struck a<br />

chord with this conference attendee: “Train them<br />

(staff) well so they are good enough to leave. Treat<br />

them well, so that they want to stay.”<br />

BY SYLVIA HEWISON*<br />

Sylvia Hewison and Judith Parnell at the Practice Manager’s conference<br />

LEAVE A LEGACY<br />

OF VISUAL FREEDOM.<br />

TECNIS ®<br />

PRESBYOPIA-CORRECTING IOLs<br />

Inservio’s Katarina<br />

Steele gave a thoughtprovoking<br />

talk on<br />

‘Customer Service,<br />

Connection and<br />

Empathy’. Her video,<br />

designed to make us<br />

all remember that<br />

everyone we meet<br />

has a back story that<br />

shapes the way they<br />

behave at any given<br />

point in time, brought<br />

some in the room to<br />

tears. There was much<br />

emphasis on what<br />

empathy is and the different types of empathy.<br />

All were amused by Katarina’s description of the<br />

selfie stick as “the wand of narcissism”!<br />

Simon Thiessen from The Real Learning<br />

Experience had a lot to say on managing<br />

challenging patient conversations and focusing,<br />

in particular, on emotional self-management with<br />

the timely reminder that you can’t deal with other<br />

people’s “stuff” unless you have your own “stuff”<br />

together.<br />

The update on accreditation from RANZCO was<br />

timely. Key points included: the process to gain<br />

accreditation requires a huge effort, not only from<br />

the practice manager but every member of the<br />

healthcare team from the business owner through<br />

to the person cleaning the bathrooms; it is a great<br />

process for continuous quality improvement; and<br />

practices need to be realistic in setting timeframes<br />

for completion of this process, recognising it could<br />

take upwards of 12 months to achieve.<br />

The other big topic on the conference agenda<br />

was “going paperless” or, as most interpreted it,<br />

creating less paper waste. The upshot of these<br />

CONTINUED ON PAGE 14<br />

TECNIS is a trademark owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. All other trademarks are the intellectual property of their<br />

respective owners. AMO Australia Pty. Limited. Level 3, 299 Lane Cove Road, Macquarie Park, NSW 2113. AMO Australia Pty. Limited (Incorporated in<br />

Australia) PO Box 401, Shortland Street, Auckland, 1140. © <strong>2017</strong> Abbott Medical Optics Inc. | www.AbbottMedicalOptics.com | PP2016CT1775<br />

AMO20468 Tecnis Symfony Adv NZ-Optics.indd 1<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

4/1/17 10:59 am<br />

13


SPECIAL FEATURE: RANZCO<br />

FROM PAGE 13<br />

discussions was there is no magic bullet in patient management<br />

systems and time is needed to find the system that works<br />

best for the individual practice. Ideally having a system that<br />

integrates well with other software, to enable all data in one<br />

repository to be viewed, is the way to go, however no one<br />

system has all this functionality, so do your homework and<br />

choose a system that works best for you and your practice.<br />

The advice from one practice that has gone down this route is<br />

to be realistic, as one of the key requirements is to be able to<br />

scan and create an electronic version of the current paper file;<br />

use professional people to do the job; and recognise the cost is<br />

money well spent.<br />

Other highlights included Australian Health Industry Group<br />

managing director David Wenban’s talks on ‘Handling HR<br />

Headaches’ and ‘OH&S - What Every Practice Manager Needs<br />

to Know’. David always manages to deliver his invaluable<br />

messages in a thought-provoking and entertaining way. His take<br />

home messages: “process protects everybody” and “document<br />

everything”. Australian Association of Practice Management’s<br />

Colleen Sullivan always willingly shares her vast knowledge<br />

and experience and this year was no exception with her talks<br />

on ‘Success Skills’ and ‘Tactics for Inspiring and Engaging<br />

Your Practice Team’. Marcus Wilson from Focus Eyecare also<br />

gave us plenty to think about with his talk on ‘Workplace<br />

and Automation’. Marcus also hosted a very successful and<br />

enjoyable practice manager’s dinner, which gave us the<br />

opportunity to meet each other in a setting that involved good<br />

food, decent wine and plenty of laughter!<br />

The ‘Strategic Planning in Ophthalmology’ group talk from<br />

Moira McInerney, Dr Stephen Best and Dr Bill Glasson was a<br />

timely reminder that many of our practices have grown from<br />

a “cottage industry” into a business; mainly the business of<br />

people - both staff and patients. The words of wisdom they<br />

shared were invaluable, recognising the importance of good<br />

strategic planning and management for ophthalmology<br />

practices to be successful now and into the future.<br />

For future RANZCO conferences, it would be great to have<br />

many of these topics revisited and combined in sessions with<br />

our ophthalmologists, as both practice managers and business<br />

owners need to work in partnership if our ophthalmology<br />

practices are to continue to grow in a meaningful way.<br />

For this conference attendee, the biggest highlight was<br />

the people – not only the speakers, who willingly and often<br />

entertainingly shared their knowledge and skills, but the other<br />

delegates who collectively had vast knowledge and expertise,<br />

and shared the common goal of wanting to do their job well<br />

and look after their staff and patients with equal amounts of<br />

empathy and professionalism.<br />

While the Melbourne weather was a mixed bag, at least it was<br />

warmer than Wellington and earthquake free! And then there<br />

were the additional highlights outside of RANZCO, including<br />

the David Hockney and Viktor&Rolf exhibitions at the National<br />

Gallery of Victoria and the Glamour Puss Tap Dancing Academy<br />

end of year concert at The National Theatre in St Kilda! If you are<br />

in Melbourne at this time of year, this show is a ‘must see’! ▀<br />

*Sylvia Hewison is a registered nurse, specialised in ophthalmology, and practice<br />

manager at the Terrace Eye Centre in Wellington<br />

EasyRet launched at RANZCO<br />

Taking pride of place on the busy Device<br />

Technologies stand at RANZCO was<br />

Quantel Medical’s new Easyret fullyintegrated<br />

577nm yellow photocoagulator<br />

laser for macular and peripheral retinal<br />

pathologies. This was the first time the new<br />

technology had been shown in Australasia<br />

after its worldwide launch at the European<br />

Society of Cataract & Refractive Surgeons<br />

(ESCRS) in Copehagen just two months earlier.<br />

Franck Morand, Quantel’s Asia Pacific sales<br />

manager, said EasyRet is particularly novel<br />

because it utilises fibre laser technology so<br />

requires no reflecting mirrors in its main<br />

cavity (which in other laser systems often<br />

require adjustment) allowing the company<br />

to offer a unique five-year warranty on the<br />

entire system. Plus the whole kit is integrated<br />

into the table with one large touchscreen<br />

and foot pedal control, so it’s easy to control,<br />

there’s no wires to get in the way and there’s<br />

no swapping from technology to technology,<br />

said Morand. Feedback on previous laser<br />

technologies also means Quantel has<br />

integrated an “intelligent, resume mode”<br />

which allows the surgeon to stop and<br />

continue from the same spot to finish off<br />

the desired laser pattern<br />

should the patient move.<br />

According to the official<br />

marketing material, the<br />

Easyret has a broad range<br />

of settings for treatment<br />

of pathologies such as<br />

diabetic retinopathy,<br />

macular oedema<br />

and central serous<br />

chorioretinopathy. “In<br />

addition to SingleSpot<br />

treatment mode,<br />

surgeons can select<br />

Multispot mode for a<br />

pattern of simultaneous<br />

targets or the<br />

subthreshold Micropulse<br />

mode, which enables<br />

them to customise a train of short pulses<br />

to precisely manage the thermal effect on<br />

targeted tissues.” The system also allows<br />

the surgeon to store treatment images so<br />

they can be compared over time, which is<br />

particularly important for micropulse laser<br />

treatment when you can’t see the impact<br />

straight away, said Morand.<br />

Oculo partners with GTS<br />

Ophthalmic<br />

communications<br />

platform Oculo has added<br />

another technology firm to its<br />

growing partnership list, Global<br />

Transcription Services (GTS).<br />

GTS is an online medical<br />

typing service, designed to<br />

reduce practice costs and<br />

enhance operational efficiency.<br />

Ophthalmologists and other<br />

medical specialists can use<br />

any mobile device or tablet<br />

for dictation, review and edit<br />

drafts and electronically sign<br />

correspondence.<br />

The new partnership means<br />

transcribed correspondence<br />

can be transmitted through Oculo’s secure<br />

cloud-based clinical communication platform<br />

to referring optometrists and general<br />

practitioners.<br />

“GTS enables ophthalmologists to<br />

outsource the transcription of dictation and<br />

Franck Morand and Dr Rodney Keillor<br />

Oculo’s Dr Kate Taylor (left) with another recent Oculo partner BP Software’s Johanna Monson and<br />

Paul Ansley on either side of Dr Mike Mair at RANZCO 2016<br />

then to manage correspondence portably.<br />

Outsourcing and secure cloud-based<br />

technology increase busy practices’ efficiency<br />

and flexibility,” said Mark Silbermann, GTS’<br />

CEO in a statement.<br />

Kate Taylor, head of Australian-based<br />

In a press release announcing the launch,<br />

Jean-Marc Gendre, CEO of Quantel Medical,<br />

said EasyRet was a new revolution in fibre<br />

laser technology. “Quantel engineers worked<br />

closely with surgeons to design a fullyintegrated<br />

system with an intuitive interface<br />

to ensure optimal ergonomics and ease of<br />

use.” ▀<br />

Oculo, added she is excited about<br />

this new integration and what it<br />

means for Oculo’s clients – currently<br />

325 ophthalmologists and 900<br />

optometrists.<br />

“The build is underway and<br />

will be released with the next<br />

upgrade,” she said, adding this<br />

is one of a series of integrations<br />

Oculo are looking at with a view to<br />

improving patients eye-health care<br />

and making practice management<br />

easier.<br />

“As correspondence goes back<br />

and forth it effectively builds an<br />

e-eye health record, which helps<br />

with continuity of care. This is<br />

particularly good for patients with<br />

chronic eye disease where you want to look at<br />

progression over time when making decisions<br />

about treatment. It’s about bringing it all<br />

together in one secure but accessible place.”<br />

The long-anticipated launch of Oculo in<br />

New Zealand is scheduled for early <strong>2017</strong>. ▀<br />

Referral guidelines “unabashedly” RANZCO’s<br />

BY LESLEY SPRINGALL<br />

RANZCO’s 2016 Scientific Meeting opened<br />

on a comical note as outgoing President Dr<br />

Brad Horsburgh told the audience it wasn’t<br />

a good time to have an eye problem in the region<br />

as 85% of Australasia’s ophthalmologists were in<br />

Melbourne for the conference. But the humour<br />

quickly turned to more serious matters with the<br />

somewhat controversial (for some optometrists<br />

anyway) new clinical referral guidelines from<br />

RANZCO being thrust front and centre into the<br />

opening speeches.<br />

The new guidelines represent a default standard<br />

of care for the whole eye care profession, said Dr<br />

Horsburgh, a language by which ophthalmology<br />

will engage with optometry and general practice.<br />

“It is a branding strategy, undoubtedly…we want<br />

to be the Microsoft of ophthalmology; we want to<br />

be the default language that everyone uses, the<br />

default standard of care.”<br />

RANZCO launched the first of its planned<br />

series of referral guides for optometrists and<br />

GPs, on glaucoma management, in July last<br />

year. Two further “Referral Pathways” for<br />

diabetic retinopathy and age-related macular<br />

degeneration were released just prior to the<br />

RANZCO conference in November to coincide with<br />

training on the guidelines for optometrists and<br />

GPs at the conference.<br />

Initially the guidelines are being reviewed<br />

in a two-year pilot study in partnership with<br />

Specsavers. Though RANZCO says feedback<br />

from other optometrists has on the whole been<br />

positive and is welcome, it also says at this stage<br />

it doesn’t have the ability to collate and assess<br />

data from multiple sources, all using different<br />

assessment equipment and techniques and<br />

software systems, though it recognises these<br />

differences will need to be considered in the<br />

longer-term to ensure the referral guidelines are<br />

accepted by the eye care profession as a whole.<br />

Unhappy about being left out of the design of<br />

the referral guidelines, Optometry Australia (OA)<br />

issued a stinging rebuke about the glaucoma<br />

guidelines in a statement in October saying<br />

the guidelines failed to reflect the diversity of<br />

optometry expertise, clinical circumstances<br />

and scope of practice in Australia. “The RANZCO<br />

referral pathway instead encourages potentially<br />

unnecessary referrals and an increased burden<br />

on Medicare, as well as an unnecessary financial<br />

burden for patients in clinical, travel and timerelated<br />

costs,” said OA National President Kate<br />

Gifford in the statement. “The pathway appears<br />

to be more compatible with practice in the UK<br />

and omits gonioscopy from the standard baseline<br />

examination, which is an entry-level competency<br />

in Australia.”<br />

When asked why OA wasn’t involved in the<br />

design process at the conference, Dr Horsburgh<br />

said the College had been down this path at<br />

least three times in the past, with the last time<br />

resulting in a drawn out legal battle.<br />

This legal battle was settled in November 2014<br />

after 18 months of court action and an initial<br />

win by the ophthalmology bodies after they<br />

challenged the Australian Health Practitioner<br />

Regulation Agency (AHPRA) and the Optometry<br />

Board of Australia’s decision to extend the scope<br />

of practice of optometrists to diagnose and<br />

treat glaucoma without ophthalmic oversight.<br />

The eventual settlement led to a rewrite of the<br />

controversial optometry guidelines, allowing<br />

therapeutically-qualified optometrists to still<br />

diagnose and treat glaucoma independently,<br />

but ensuring they referred patients to an<br />

ophthalmologist within four months of their<br />

diagnosis so it could be confirmed and a<br />

management plan agreed.<br />

At the conference, Dr Horsburgh proudly<br />

admitted the guidelines are pure RANZCO. “The<br />

reason it has not worked [in the past] is it has<br />

tended to degenerate into straight politics….As<br />

we receive feedback and feel we are informed<br />

about what works well and what doesn’t work<br />

well, we will adjust accordingly but, yes, these<br />

are evidence-based and unabashedly RANZCO<br />

guidelines, they are the language we choose to<br />

deliver it.”<br />

The pilot programme with Specsavers is just<br />

the beginning, however, he said, a way to collect<br />

data relatively quickly from a uniform group and<br />

smooth out initial wrinkles. “We have to start<br />

small, because the history of antipathy and at<br />

times unhelpful behaviour between optometry and<br />

ophthalmology goes back decades.” But given that<br />

the guidelines are designed to lead to a registry<br />

of information, the process will go on for years<br />

as more data is collected, collated and analysed,<br />

and the results used to educate and improve<br />

the current system for patients, for all eye care<br />

professionals and for the public purse, he said.<br />

Last year RANZCO changed its tagline to<br />

“collaborative eye care” because it wanted to<br />

collaborate with everyone, added Dr Horsburgh.<br />

“We need to formalise that and we need to<br />

formalise the systems with which we collaborate…<br />

and I have a dream that this College will live out<br />

the meaning of its tagline. It’s not enough to say<br />

we are the leaders in collaborative healthcare, we<br />

Former RANZCO president Dr Brad Horsburgh and Dr Guy D’Mellow<br />

must live it out, we must do it and we must prove<br />

it to our patients and to the government, and<br />

that’s what this is about.”<br />

RANZCO plans to release further referral<br />

guidelines next year, including one on paediatrics<br />

based on current guidelines penned by New<br />

Zealand’s Dr Shuan Dai. It also expects to appoint<br />

a project officer next year to assist with the pilot<br />

studies and ensure that as time goes on, the<br />

whole of the optometry profession is consulted<br />

to ensure the guidelines are as effective and<br />

accepted as they can be. ▀<br />

14 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


Glaucoma treatment<br />

first in NZ<br />

A<br />

team<br />

from Oasis Sugical have carried<br />

out the first micropulse trans-scleral<br />

cyclophotocoagulation (mTSCPC) treatment<br />

for primary glaucoma in New Zealand.<br />

Previously managing glaucoma was restricted to<br />

medicated drops or invasive surgery, said Dr Justin<br />

Mora, the Oasis team leader who carried out the<br />

first procedure in October last year. “Now with<br />

the development of the mTSCPC treatment, there<br />

is a new innovative, minimally-invasive way for<br />

ophthalmologists to treat open angle glaucoma<br />

that can help reduce and, in some cases, eliminate<br />

the need for medicated drops.”<br />

The procedure uses the Iridex Cyclo G6 Laser<br />

System and a proprietary MP3 Laser Probe<br />

(supplied by OptiMed in New Zealand) to deliver<br />

micropulse laser energy to the eye in a slow,<br />

repetitive circular motion in a 180-degree arc for<br />

approximately 80 seconds. Once completed, the<br />

second 180-degree arc is then treated.<br />

The Micro-Pulse Trans-Scleral<br />

Cyclophotocoagulation procedure works by<br />

delivering very short pulses (micropulses) of<br />

810nm laser energy to the Ciliary Process. Because<br />

the micropulses don’t cause any thermal damage<br />

or scarring, and because it is minimally invasive<br />

and does not require any incisions to be placed<br />

Dr Justin Mora and fellow Oasis team members, Maryanne Considine and Julian Blakley,<br />

with the Iridex Cyclo G6 Laser System<br />

in the eye, there is less inflammation and less<br />

likelihood of post-operative infections, explained<br />

Dr Mora.<br />

Singapore-based ophthalmologist Professor Paul<br />

Chew, the pioneer of mTSCPC treatment, recently<br />

presented his 78-month study into the procedure.<br />

Results for 14 patients, from his initial study group<br />

of 23, showed the procedure was effective and<br />

safe in lowering IOP by ≥30%, with consequent<br />

reduction in medications 1 . Other US surgeons<br />

Dr Justin Mora conducting the first mTSCPC procedure in NZ<br />

have demonstrated similar results. Connecticut<br />

ophthalmologist Dr Robert Noecker reported a<br />

62% IOP reduction in 50 patients with follow-up,<br />

up to six months 2 . The results are looking positive<br />

here as well, with an IOP drop from 28mmHg preop,<br />

to 10mmHg at one-week post op.<br />

“I have known Professor Paul Chew for years<br />

and I have watched with interest his work with<br />

micropulse cyclodiode,” said Dr Mora. “At the<br />

World Ophthalmology Congress in Guadalajara<br />

in <strong>Feb</strong>ruary, I had the opportunity to look at the<br />

new unit and catch up with the latest results.<br />

They suggested to me that this could be a major<br />

step forward with a low risk, quick and relatively<br />

straightforward procedure for<br />

lowering the IOP that avoids any<br />

intraocular penetration. As we<br />

all know there is no universally<br />

successful glaucoma procedure but<br />

the mTSCPC data show a good IOP<br />

lowering effect with no cases of<br />

phthisis and much less inflammation<br />

than standard CPC.<br />

“Traditionally we have reserved the<br />

latter for end-stage or very severe<br />

glaucoma as it is so destructive and<br />

because of the risk of phthisis. Paul<br />

believes that the pulsed application<br />

not only reduces aqueous production<br />

but also increases uveo-scleral<br />

outflow which might explain how it<br />

can be so effective without severely<br />

damaging the ciliary body.”<br />

The procedure can also be used<br />

for patients who have had previous<br />

glaucoma treatment but where the<br />

surgeon wants to reduce or even eliminate their<br />

need for medicated drops, and it can be completed<br />

at the same time as other eye surgery, such as<br />

cataract removal. ▀<br />

References<br />

1. Long-term Efficacy of Micropulse Diode Transscleral<br />

Cyclophotocoagulation in the Treatment of Refractory<br />

Glaucoma – Poster presentation at ASCRS 2016<br />

2. Micropulse P3 Glaucoma Device Revolutionises<br />

Cyclophotocoagulation – Glaucoma Today Insert March/April<br />

2015<br />

Pharmac drops Eylea<br />

Following consultation,<br />

Pharmac has decided<br />

against accepting<br />

aflibercept (Eylea) as an<br />

additional treatment listed<br />

for wet age-related macular<br />

degeneration (wAMD) despite<br />

noting a strong preference for<br />

it from some clinicians over and<br />

above ranibizumab (Lucentis).<br />

The government’s<br />

Pharmaceutical Management<br />

Agency (better known as<br />

‘Pharmac’) consulted on a<br />

proposal to list ranibizumab and<br />

aflibercept in Section H of the<br />

Pharmaceutical Schedule for the<br />

second and third line treatment (respectively) of<br />

wAMD last year. The proposal arose following a<br />

Request for Proposals (RFP) for the supply of antiendothelial<br />

growth factor (anti-VEGF) agents in<br />

May.<br />

But in a statement in December, Pharmac said,<br />

“Having reviewed all the consultation feedback<br />

the Pharmac Board resolved to not accept any<br />

proposal and to terminate the RPF process.”<br />

In practice this means the proposal will not<br />

Accolade for Dr Dai<br />

Dr Shuan Dai was awarded<br />

the 2016 Distinguished<br />

Clinical Teacher Award<br />

from the University of Auckland<br />

in recognition of the valuable<br />

contribution to teaching he has<br />

made across the University’s<br />

Faculty of Medical and Health<br />

Sciences.<br />

According to the Department of<br />

Ophthalmology’s staff newsletter,<br />

Dr Dai “has an admirable<br />

dedication to providing topquality,<br />

interactive teaching that<br />

few can equal. Indeed, he has been<br />

an absolute stalwart in providing<br />

Dr Shuan Dai<br />

be progressed; provisional<br />

agreements with Novartis<br />

(for ranibizumab) and Bayer<br />

(for aflibercept) will not come<br />

into effect; and the current<br />

listing of ranibizumab in<br />

Part II of Section H of the<br />

Pharmaceutical Schedule as<br />

a second line treatment for<br />

wAMD will remain unchanged.<br />

Sarah Fitt, Pharmac’s director<br />

of operations said, “It’s back<br />

to the drawing board, but it<br />

was really good to get such a<br />

detailed and useful response<br />

to the consultation. We<br />

would like to thank everyone<br />

who took the time to provide feedback on the<br />

proposal.”<br />

PHARMAC intends to seek further advice from<br />

its clinical advisory committee(s) on the issues<br />

raised in consultation feedback and to consider<br />

the appropriateness of running a new RFP in the<br />

future for anti-VEGF agents for the treatment<br />

of both wAMD and diabetic macular oedema<br />

(DMO). ▀<br />

For more on Eylea see p16.<br />

teaching in aspects of paediatric<br />

ophthalmology to medical<br />

students, optometrists and nurses<br />

at a personal time-cost, which<br />

often sees him teaching and<br />

coaching in his own free time.”<br />

Dr Dai thanked Professor<br />

Charles McGhee and his team at<br />

the Department saying he was<br />

deeply honoured to receive the<br />

award: “I enjoy the interaction<br />

with students and younger<br />

doctors coming through the<br />

Ophthalmology Department…and<br />

feel proud of being able to share<br />

my experiences with them.” ▀<br />

BOOK REVIEW:<br />

Video Atlas of Oculofacial Plastic and<br />

Reconstructive Surgery, 2nd edition<br />

by Bobby S. Korn, Don O. Kikkawa. Published by Elsevier<br />

REVIEWED BY DR BRIAN SLOAN*<br />

I am old enough to consider this ‘Surgical Atlas’<br />

as a text book that includes free web access to<br />

multimedia. Younger readers will doubtless see<br />

themselves as buying the multimedia access<br />

and getting a free printed book thrown in, and<br />

they are probably right. The authors have chosen<br />

to illustrate this surgical technique multimedia<br />

reference exclusively via photos and videos. With<br />

over 1600 illustrations, most of the photos in the<br />

textbook are necessarily small. Standardisation<br />

of style is relatively good (especially so for a<br />

multi-author text), but the well-annotated<br />

photos are more effective in the online version,<br />

where they are of sufficient resolution to enable<br />

magnification up to full-screen. Pre and postoperative<br />

photo pairs are well matched for<br />

composition and lighting.<br />

Diagrams are used sparsely and largely to<br />

illustrate anatomy. Drawings do have the ability<br />

to remove the “visual noise” and show the<br />

essence of a situation, and there are some places<br />

where this atlas might have benefitted from<br />

more of these.<br />

The chapters are commendably structured,<br />

with separate tables for indications, pre-operative<br />

assessment,<br />

complications<br />

and consumables<br />

used for all 75<br />

procedures<br />

covered. The online<br />

version also allows<br />

you to make notes<br />

in association with<br />

specific sections,<br />

and of course<br />

allows searches,<br />

although the paper<br />

Dr Brian Sloan<br />

version rejoices in a<br />

20-page index.<br />

This Atlas would make a worthy addition to<br />

any departmental library, and is a useful resource<br />

for the ophthalmologist who is an “occasional<br />

oculoplastic surgeon”. It is probably more than<br />

most ophthalmic trainees require, but would suit<br />

trainees with an interest in oculoplastics as well<br />

as those undergoing fellowship training in the<br />

area. ▀<br />

*Dr Brian Sloan is an ophthalmologist specialising in<br />

oculoplastic surgery after training in Auckland, Melbourne,<br />

Cincinnati and Vancouver. He is based at Greenlane Clinical<br />

Centre and in private practice in Auckland.<br />

IRIDEX<br />

CYCLO G6<br />

Innovative MicroPulse<br />

Cyclophotocoagulation Technology<br />

Powered by the NEW CYCLO G6 TM<br />

Glaucoma Laser System.<br />

FEATURES<br />

Proprietary MicroPulse TSCPC settings<br />

Intuitive touch screen design<br />

10 User Memory settings<br />

Refractory settings for use with patented G Probe<br />

Call: 0800 657 720<br />

M: info@optimed.co.nz<br />

W: www.optimed.co.nz<br />

F : facebook.com/OptiMedNZ<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

15


Focus on<br />

Eye Research<br />

Three glaucoma studies<br />

Relationship between Optical<br />

Coherence Tomography Angiography<br />

Vessel Density and Severity of Visual<br />

Field Loss in Glaucoma<br />

YARMOHAMMADI A, ZANGWILL LM, DINIZ-<br />

FILHO,A ET AL<br />

Ophthalmology 2016;123:2498-2508<br />

Review: The aim of this study was to assess the<br />

association between vessel density measurements<br />

using optical coherence tomography angiography<br />

(OCT-A) and severity of visual field loss in primary<br />

open-angle glaucoma.<br />

An observational cross-sectional study was<br />

performed and included a total of 153 eyes from<br />

31 healthy participants, 48 glaucoma suspects, and<br />

74 glaucoma patients enrolled in the Diagnostic<br />

Innovations in Glaucoma Study. All eyes underwent<br />

imaging using OCT-A, spectral-domain OCT and<br />

standard automated perimetry (SAP). Retinal<br />

vasculature information was summarised as vessel<br />

density, the percentage of area occupied by flowing<br />

blood vessels in the selected region.<br />

Associations between the severity of visual field<br />

loss, reported as SAP mean deviation (MD), and<br />

OCT-A vessel density was evaluated. Compared<br />

with glaucoma eyes, normal eyes demonstrated a<br />

denser micro-vascular network within the RNFL.<br />

Vessel density was higher in normal eyes followed by<br />

glaucoma suspects, mild glaucoma, and moderate to<br />

severe glaucoma eyes (P < 0.001). Each 1% decrease<br />

in vessel density was associated with a 0.66 dB loss<br />

in MD. In addition, the association between vessel<br />

density and severity of visual field damage was<br />

found to be significant even after controlling for the<br />

effect of structural loss.<br />

Comment: Optical coherence tomography<br />

angiography is a promising technology in glaucoma<br />

management. This study identified that decreased<br />

vessel density was significantly associated with<br />

the severity of visual field damage independent<br />

of the structural loss. Applications include clinical<br />

monitoring of vascular changes in glaucoma as well<br />

as potentially enhancing our understanding of the<br />

pathophysiology of the disease, specifically any<br />

underlying vascular mechanism.<br />

High rate of incidental glaucoma<br />

detection in New Zealand<br />

LAHOOD BR, ERCEG J, BEVIN TH ET AL<br />

New Zealand Medical Journal (online) Dec 2016:<br />

33-37,5.<br />

Review: In this study the authors investigated how<br />

glaucoma is initially detected in a New Zealand<br />

population and what factors lead to suspicion of<br />

the disease. They conducted a postal survey of 500<br />

randomly selected members of the Glaucoma New<br />

Zealand database. The overall response rate was 80%<br />

(376/468) of eligible participants. The average age of<br />

respondents was 76 years, 64% female and 84% NZ<br />

European.<br />

Before a diagnosis of glaucoma was made, 80% of<br />

participants did not report a history of suspicion for<br />

glaucoma. The majority of theses patients (82%) had<br />

their initial assessment with an optometrist and the<br />

vast majority (96%) were spectacle wearers.<br />

If there was a suspicion of glaucoma (13% of<br />

total sample), having a positive family history for<br />

glaucoma was the most common reason (65%)<br />

Heidelberg founder honoured<br />

Dr Gerhard Zinser, cofounder<br />

and managing<br />

director of Heidelberg<br />

Engineering, became the first<br />

non-clinician to be awarded<br />

the Founders’ Award of the<br />

Optometric Glaucoma Society<br />

(OGS). The award was presented<br />

by Society co-founder Dr John<br />

Flanagan at the Society’s Annual<br />

Scientific Meeting in Anaheim,<br />

California on 8 November last year.<br />

In his laudatory speech, Dr<br />

Flanagan, dean of the School<br />

of Optometry at UC Berkeley,<br />

BY DR HUSSAIN PATEL*<br />

followed by symptoms (27%). After diagnosis, 95%<br />

(357/376) of respondents reported that they had<br />

informed family members of their diagnosis and<br />

advised them to have regular eye exams.<br />

The authors concluded that in New Zealand the<br />

majority of glaucoma was discovered through<br />

incidental findings and a positive family history was<br />

the most risk factor prompting an assessment.<br />

Comment:This study reports that the vast majority<br />

of glaucoma patients do not have a prior suspicion<br />

of glaucoma or family history prior to their<br />

diagnosis. For patients without a prior suspicion for<br />

glaucoma they are most likely to diagnosed by their<br />

optometrist during a routine vision assessment<br />

hence confirming the importance of including a<br />

glaucoma screen as part of this process.<br />

Optic disc haemorrhage in glaucoma:<br />

pathophysiology and prognostic<br />

significance<br />

KIM KE, PARK KH<br />

Current Opinion in Ophthalmology (online) Dec<br />

2016, DOI:10.1097<br />

Review: In this article the authors provide a<br />

review of the recent findings with regard to the<br />

pathophysiology and clinical signficance of optic disc<br />

haemorrhage in glaucoma.<br />

The underlying mechanism of disc haemorrhage has<br />

been extensively investigated but remains unclear. In<br />

this review the authors report that recent evidence<br />

as a result of advances in OCT, suggest a possible<br />

mechanical vascular disruption as the most likely<br />

mechanism. In particular – microvascular damage<br />

occurs as a result of alterations in the structure of<br />

the lamina cribosa at the optic nerve head. However<br />

they conclude that underlying vascular factors are<br />

also likely to be playing a role still.<br />

The review also confirms the association between<br />

optic disc haemorrhage and higher rate of glaucoma<br />

progression both in terms of visual field loss and, in<br />

more recent studies, retinal nerve fiber layer thinning.<br />

The authors comment that consideration should<br />

be given to more intensive treatment and more<br />

frequent follow-up after disc haemorrhage episodes.<br />

Additionally, treatments or clinical plans should be<br />

tailored patient-by-patient, as each individual has<br />

different risk factors other than disc haemorrhage, a<br />

different progression rate, a different disease status<br />

and a different level of compliance.<br />

Comment: The underlying mechanisms of optic disc<br />

haemorrhage are still not fully understood but are<br />

most likely to be a combination of both mechanical<br />

and vascular factors. Although the exact role of disc<br />

haemorrhage in glaucoma is not yet known, their<br />

incidence remains of clinical importance and are an<br />

indication for more intensive glaucoma treatment<br />

and follow up to prevent progression occuring. ▀<br />

ABOUT THE AUTHOR:<br />

PHOTO BY ANDIE PETKUS PHOTOGRAPHY<br />

* Dr Hussain Patel (MBChB, MD,<br />

FRANZCO) is an ophthalmologist<br />

based at Auckland’s Eye Surgery<br />

Associates and senior lecturer<br />

in ophthalmology with the New<br />

Zealand National Eye Centre,<br />

University of Auckland. He has a<br />

special interest in glaucoma, and<br />

is actively involved in glaucoma<br />

research, supervision of research<br />

fellows and teaching.<br />

emphasised Dr Zinzer’s<br />

significant and long-standing<br />

contribution to diagnostic<br />

imaging in eye care.<br />

l In other news, Heidelberg<br />

Engineering announced its<br />

OCT-angiography module for<br />

Spectralis OCT is now available<br />

outside the US.<br />

Spectralis OCT2 registered<br />

owners can download it directly<br />

from the web. ▀<br />

Dr Gerhard Zinser (right)<br />

with Dr John Flanagan of the<br />

Optometric Glaucoma Society.<br />

Bangkok’s Exotic Allure<br />

A report on the Asia-Pacific Vitreo-retina Society (APVRS)<br />

conference, including the latest study findings in the battle<br />

against macular degeneration<br />

BY DR ANDREW THOMPSON*<br />

The city of angels, great city of immortals,<br />

magnificent city of the nine gems and<br />

seat of the royal family, Bangkok hosted<br />

the 10th APVRS Congress in conjunction with<br />

the 38th Annual Meeting of the Royal College<br />

of Ophthalmologists of Thailand from 8-10<br />

December.<br />

I attended this meeting with Drs Dianne Sharp,<br />

Peter Hadden, Kolin Foo and Stephen Guest. Over<br />

200 invited regional and international speakers<br />

from more than 20 countries addressed a range<br />

of current medical and surgical ophthalmology<br />

challenges. Here are just some of the highlights.<br />

Drs Kolin Foo, Peter Hadden, Dianne Sharp and Andrew Thompson at the Bayer trade<br />

stand, respectfully attired in black and white as Thailand mourns the king’s death<br />

Named lectures<br />

China’s Professor Xiaoxin Li, who identified a new<br />

gene UBE3D that plays a role in the pathogenesis<br />

of neovascular AMD and may be a potential<br />

target for therapy, gave The Tano Lecture. In<br />

the Constable Lecture, India’s Dr Jay Chhablani<br />

reported on the efficacy and safety of zivaflibercept,<br />

an inexpensive alternative to Eylea.<br />

Ziv-aflibercept requires further investigation<br />

comparing efficacy and safety against currently<br />

approved anti-VEGF agents, he concluded. While<br />

Chicago’s Dr Paul Chan highlighted the Optos,<br />

RetCam and PanoCam imaging systems that<br />

better accommodate children and paediatric<br />

retinal pathology in the Rutnin Lecture. More<br />

information enables better treatment decisions,<br />

may influence disease classification and provide<br />

prognostic markers for paediatric vitreoretinal<br />

disease, he said.<br />

Pathologic myopia<br />

With the increasing worldwide prevalence of<br />

myopia, medical and surgical treatments for<br />

pathologic myopia were highlighted. Further<br />

research is recommended to determine the<br />

relationship between school and pathologic<br />

myopia to see if early intervention reduces<br />

pathologic myopia and associated blindness.<br />

The sensitivity of OCT angiography (OCT-A) for<br />

detecting myopic choroidal neovascularisation<br />

(CNV) is only 63% in quiescent eyes. Although<br />

OCT-A is not always helpful diagnosing CNV in<br />

this situation, it is useful as an initial non-invasive<br />

investigation. Otherwise, multimodal imaging is<br />

required.<br />

Early anti-VEGF therapy for myopic CNV results<br />

in better visual outcomes than delayed treatment.<br />

Avastin and Lucentis are considered equally<br />

efficacious. Delayed treatment still improves vision,<br />

but not to the same extent as early treatment. The<br />

MYRROR trial using Eylea also supports the premise<br />

that early treatment is better.<br />

Dome shaped macula (DSM) occurs in 20% of<br />

high myopes, and up to 50% of these have serous<br />

retinal detachment without CNV. Anti-VEGF<br />

therapy is ineffective and most cases resolve<br />

spontaneously. Photodynamic therapy (PDT) is<br />

useful in cases with poor vision.<br />

Surgical treatment of myopic foveoschisis<br />

focused on the lack of elasticity of the internal<br />

limiting membrane (ILM). Vitrectomy/ILM peel/<br />

gas can be effective but up to 28% of cases<br />

develop macular hole. Modified ILM peeling<br />

is recommended to avoid foveal damage and<br />

involves centripetal ILM peeling from outside to<br />

in leaving a 500-micron circular area of ILM at the<br />

fovea (foveal sparing maculorrhexis). Face down<br />

posturing for one week is recommended.<br />

Scleral shortening with vitrectomy/PVD<br />

induction/ILM peel/gas is effective in managing<br />

myopic traction maculopathy and preventing<br />

macular hole development. Secondary toric IOL<br />

implantation can manage any surgically-induced<br />

astigmatism.<br />

Treatment of myopic macular hole/retinal<br />

detachment (MHRD) utilising vitrectomy/Cshaped<br />

ILM flap/gas without intentional<br />

subretinal fluid drainage is effective in achieving<br />

a good anatomical result with restoration of the<br />

ellipsoid zone and improved vision.<br />

Retinal and choroidal vasculopathies<br />

There are no generally accepted therapies for the<br />

non-proliferative stages of macular telangiectasia.<br />

PDT is recommended for the proliferative stage.<br />

Anti-VEGF treatment requires further study.<br />

Dr Susan Bressler, professor of<br />

ophthalmology at John Hopkins<br />

Medicine in Maryland, presented the<br />

HOME study and showed how patients<br />

using the ForseeHome device, that<br />

detects wet AMD at its earliest stage,<br />

lost less vision than the standard<br />

care group. Earlier CNV treatment is<br />

associated with better vision.<br />

The pachychoroid spectrum<br />

includes PCV, with the upper limit of<br />

normal subfoveal choroidal thickness<br />

accepted to be 200 microns. In PCV,<br />

dilated choroidal vessels precede<br />

polyp development. PCV has a high<br />

recurrence rate and risk factors for<br />

recurrence were male gender, thick<br />

choroid, history of CSC, smoking and<br />

hypertension.<br />

The origin of hyperreflective foci in AMD/PCV<br />

remains uncertain, but most likely represents<br />

activated microglial cells. Seen mainly in<br />

subretinal fluid, and abundant at the top of<br />

each polyp in PCV, the initial number of foci may<br />

predict final VA in patients with AMD/PCV.<br />

In the treatment of PCV, EVEREST II showed<br />

PDT and Lucentis were superior to Lucentis<br />

monotherapy in achieving improved vision and<br />

complete polyp regression.<br />

The Bayer Symposium and associated press<br />

announcement revealed the findings of the<br />

PLANET study, showing that at 52 weeks Eylea<br />

monotherapy led to a 10.7 letter gain compared<br />

to 10.8 letters with combined Eylea and PDT. There<br />

was no significant difference between the groups<br />

in VA, proportion of patients losing < 15 letters,<br />

reduced central subfield thickness and proportion<br />

of patients with complete polyp regression.<br />

Aflibercept monotherapy can be used first for<br />

patients with visual impairment due to PCV.<br />

OCT angiography (OCT-A)<br />

OCT-A featured strongly for CNV/PCV diagnosis<br />

and uveitis. Typically used to image the posterior<br />

segment, OCT-A can image iris vessels in uveitis.<br />

Changing the OCT focus to 28 dioptres and scanning<br />

nasal and temporal iris vessels can demonstrate<br />

vascular dilation and tortuosity allowing iris<br />

vascular volume to be measured. Posterior segment<br />

OCT-A has identified new pathophysiology such<br />

as granulomata compressing the choriocapillaris<br />

resulting in ischaemia.<br />

Whilst FFA remains the gold standard for<br />

vascular imaging, OCT-A provides greater vessel<br />

detail mainly because dye leakage obscures<br />

vessels during FFA. OCT-A is also better at<br />

detecting RAP lesions. OCT-A is unlikely to<br />

CONTINUED ON PAGE 17<br />

Bayer’s virtual reality experience showing delegates catching VEGF<br />

molecules with Eylea controlled by their hands<br />

16 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


FROM PAGE 16<br />

replace ICG angiography because the latter is<br />

a dynamic study. It is likely that multimodal<br />

imaging will now become commonplace.<br />

Angioanalytics is a function of OCT-A whereby<br />

a perfusion density map is combined with OCT-A<br />

to provide an OCT-A perfusion map. Blue areas<br />

represent nonperfusion and red shows where<br />

the vessels are. This is useful for demonstrating<br />

ischaemia in diabetic retinopathy, FAZ<br />

enlargement, new vessels and microaneurysms.<br />

Vessel density decreases with disease progression<br />

and this concept may have a future role in<br />

evaluating diabetic eye disease.<br />

Intraoperative OCT (iOCT) can be fully<br />

integrated with an operating microscope to<br />

provide real-time information to guide surgical<br />

manoeuvres. iOCT increased surgical time by only<br />

4.9 minutes and, in the DISCOVER study, showed<br />

that 22% of cases had residual membranes that<br />

required peeling.<br />

Uveitis<br />

The Multicentre Uveitis Steroid Treatment (MUST)<br />

trial showed steroid implants and standard<br />

immunosuppression to be equally effective with<br />

similar visual outcomes. After five years, 91% of<br />

steroid implant recipients had cataract (45% in<br />

the standard immunosuppression group) and<br />

53% (18% respectively) had raised IOP. The steroid<br />

pellets are also falling off and many require<br />

surgical removal. Whilst unpublished seven-year<br />

data suggests the systemic group is doing better,<br />

steroid implants may be better for unilateral<br />

disease or patients intolerant of systemic<br />

immunosuppression.<br />

Diabetic macular oedema<br />

Anti-VEGF treatment works well for some patients<br />

with DME but not others. University of Sydney<br />

Professor Mark Gillies’ research showed for every<br />

anti-VEGF injection, patients gained one letter in<br />

their first year of treatment, and eight injections<br />

gained eight letters, for example.<br />

Protocol T has shown Avastin, Lucentis and Eylea<br />

all improve visual acuity at one year with Eylea<br />

superior at year one, but no significant difference<br />

between the three agents at two years. Half<br />

the number of injections given in year one was<br />

required in year two.<br />

Protocol I suggests the response to three<br />

anti-VEGF injections is a strong predictor of<br />

final VA and the Bevordex study showed anti-<br />

VEGF and steroid treatment to be comparable<br />

over two years. Data from these trials suggests<br />

it is reasonable to switch anti-VEGF to steroid<br />

treatment early, even at three months, in order to<br />

maximise outcomes.<br />

For PDR, Protocol S showed Lucentis is an<br />

effective treatment alternative to PRP.<br />

Retinal surgery advances<br />

The digitally-assisted vitreoretinal surgery (DAVS)<br />

platform NGEUNITY 3D incorporates a 3D camera<br />

attached to the operating microscope and a high<br />

definition 4K OLED monitor. The surgeon sees<br />

a 3D stereoscopic image of the surgical field<br />

through passive glasses. Benefits include higher<br />

magnification, enhanced depth of field and<br />

increased image brightness that permits reduced<br />

endoillumination levels which should be better for<br />

maculae and lead to better visual outcomes.<br />

Augmented reality (AR) is another novel<br />

technology, based on a fighter pilot’s helmet and<br />

visual screen that uses a head and eye tracker for<br />

seamless surgical control. Two ultra-resolution<br />

cameras replace the operating microscope and<br />

project to a display worn by the surgeon that<br />

shows the camera view but can also add in real<br />

time data such as iOCT.<br />

Other updates<br />

Multiple concurrent sessions were running<br />

that made it difficult to attend everything of<br />

interest. Other updates included improvements in<br />

choroidal tumour imaging and therapy, managing<br />

complications of anterior segment surgery, stem<br />

cells and artificial vision and advances in retinal<br />

surgery such as endovascular surgery for retinal<br />

vein occlusion.<br />

Highlights outside the conference<br />

One cannot visit Bangkok without seeing the Royal<br />

Palace, Emerald Buddha, Reclining Buddha and<br />

the Jim Thompson House for some respite from<br />

Bangkok’s heat and attack on the senses. But one<br />

or two congress delegates ended up in the long<br />

line of Thai nationals entering the Royal Palace to<br />

pay respects to the deceased king and missed the<br />

tourist entry. ▀<br />

* Dr Andrew Thompson is a consultant ophthalmologist at<br />

Tauranga Eye Specialists with special interests in medical<br />

retina, glaucoma and cataract. He is a member of the American<br />

and the Australia and NZ Societies of Retinal Specialists and<br />

chair of the RANZCO Ophthalmic Sciences Board of Examiners.<br />

High-noon on the high street?<br />

As we head into <strong>2017</strong>, NZ Optics’ Jai Breitnauer takes a personal look at the changing face<br />

of the optometry business<br />

I<br />

go to a lot of conferences, and admittedly I<br />

struggle a bit with in-depth clinical analysis,<br />

video clips of cataract surgery and that perilsome<br />

little organism, the Demodex mite. But last year’s<br />

Eduvisionz conference was absolutely my cup of<br />

tea. Listening to the various speakers talk about<br />

marketing, practice design, using social media and<br />

other related topics made me feel quite excited<br />

about the future of our industry.<br />

There is this one word though, that came up time<br />

and time again. I know it’s contentious to some, so<br />

I’m going to say it quickly, like ripping off a plaster…<br />

retail.<br />

Along with e-tail and me-tail, retail makes up<br />

the essential trilogy of selling anything in this<br />

modern world and, whether we like it or not, being<br />

successful in any business means selling stuff. What<br />

optometrists are here to sell (healthcare or fashion<br />

products) and how they do it (retail-forward or<br />

essential service), however, still engenders serious<br />

debate.<br />

“How you see yourself, largely depends on which<br />

hat you have on,” says Stu Allan of Optics NZ. “In<br />

the examination room itself you will be healthcare,<br />

outside the examination room it’s a retail<br />

environment.”<br />

That latter isn’t just driven by the necessity of<br />

selling product, but by the location of a practice,<br />

which is often positioned in an area where the<br />

business is highly visible and trying to attract<br />

passing traffic, like a high street or mall.<br />

“Optometrists are increasingly located next to<br />

other retailers, in a business where normally 85%<br />

of the revenue is through the sale of products,” says<br />

Allan. “Ask the patient where they think they are,<br />

that is more important than what we might think.”<br />

How the patient – or customer – views the<br />

optometry business is indeed very important,<br />

according to other speakers at Eduvisionz. Retail<br />

guru Juanita Neville-Te Rito constantly reminded us<br />

that businesses and business strategy are driven by<br />

the customer. The service you provide will make or<br />

break you, she said.<br />

“Independent optometrists need to differentiate,”<br />

says Daniel He from Australian new concept brand,<br />

Dresden. “Find out exactly what you do better than<br />

any other optometrist and go do that, because in this<br />

changing industry it’s no longer okay to be vanilla.”<br />

The seed for Dresden was planted in the year<br />

2000, when co-founder Bruce Jeffrey’s went to<br />

a music gig in Amsterdam - at an optometrist’s!<br />

That experience made him reconsider the whole<br />

experience of glasses for the consumer, he said.<br />

He went on to create, with his business partner,<br />

designer Jason McDermott, a simple, modular<br />

eyewear system that is completely interchangeable,<br />

even the lenses. All Dresden’s frames and lenses are<br />

manufactured in Sydney and are 100% recyclable<br />

and, given how affordable they are, means Dresden<br />

is looking to sell its consumers not just one or two<br />

pairs of glasses, but several, in a variety of colours.<br />

Once upon a time glasses were a necessity. They<br />

were expensive, you owned one pair and you<br />

upgraded them when your prescription changed. But<br />

the changing pace of technology means the price of<br />

frames is plummeting – even many designer pairs<br />

come in at an affordable price for an average income<br />

earner. Then there’s advances like 3D printing, which<br />

is making new, affordable products even more viable.<br />

The current generation of under 30s is also being<br />

touted as one of the most narcissistic in history, the<br />

‘generation-selfie’. This image-focused but cashstrapped<br />

troupe want affordable, quality eyewear<br />

they can switch about on a daily basis.<br />

“I think it is fair to say that optometry continues<br />

to change and that there is a greater retail focus<br />

across the board, whether that’s from us or OPSM<br />

or even most independent practices – and that’s<br />

Kiwi keynote at<br />

Harvard Fall Festival<br />

Professor Helen Danesh-Meyer<br />

was a visiting professor at the<br />

Massachusetts Eye and Ear Glaucoma<br />

Fall Festival and Neuro-Ophthalmology<br />

Fall Festival in September last year, the<br />

first time a speaker from Australasia has<br />

been invited to attend. The theme of the<br />

2016 conference was the overlap between<br />

glaucoma and neuro-ophthalmology.<br />

Professor Danesh-Meyer, from the<br />

Dresden Optics’ founders Jason McDermott (standing) and Bruce Jeffreys are two of an increasing number of entrepreneurs determined to break<br />

the mould of traditional high street optometry<br />

because customers are asking all of us for value,<br />

more affordable pricing and constantly refreshed<br />

product ranges,” says Brendan Thompson, a director<br />

at Specsavers.<br />

“We’ve made optometry services more affordable<br />

and more accessible to New Zealanders, that’s why<br />

the number of New Zealanders having an eye test<br />

over the past eight years has gone through the roof.”<br />

With that affordability has also come a demand<br />

for increased and varied access points. Over the<br />

last decade, opening hours have extended and<br />

weekends have become just another opportunity<br />

to do business. Dresden even has a solar-powered<br />

mobile unit to go to remote areas. Flexibility and<br />

availability are key touch points for the millennial<br />

customer-base, says Thompson adding he believes<br />

this change will have the biggest impact in the<br />

independent sector.<br />

“We are going through another period of change<br />

in the industry now as people find their place –<br />

and that’s in all forms of location, from online to<br />

the traditional bricks and mortar store. You have<br />

newcomers like Bailey Nelson with a fresh-looking<br />

offer, and OPSM are going down the road of enticing<br />

customers into store with value.”<br />

Another strongly emerging competitor, says<br />

Thompson, is the internet, with outlets like<br />

glassesonline and Essilor-owned Clearly. “As in<br />

all other segments of our market, the traditional<br />

independent way of doing things won’t last forever.<br />

People change, and business changes and we’re<br />

seeing it now, as many independents adapt to a<br />

more retail-focused model, which in part they’ve<br />

learned from Specsavers.”<br />

Bay of Plenty-based behavioural optometrist Keith<br />

Miller, however, feels we might be thinking about<br />

the picture all wrong.<br />

“I don’t think it is right to say optometry has a<br />

more retail-focused approach. The whole optical<br />

industry has moved forward and it is better to<br />

say optometry has become more medical and<br />

professionally-focused, while the dispensing<br />

optician area has become more prominent. [New<br />

Zealand now has] excellent dispensing opticians<br />

who have taken the retail part of providing<br />

spectacle solutions to a higher profile.”<br />

Miller says there is confusion among the public<br />

about the role of an optometrist that needs to be<br />

cleared up.<br />

“It is fair to say there has always been a blurred<br />

understanding of the professional and dispensing<br />

parts of optometry by the wider public and, apart<br />

from a basic understanding that having a medical<br />

eye evaluation is a good idea, the public just<br />

assumes the person selling them the glasses is the<br />

University of Auckland’s Ophthalmology<br />

Department, presented two keynote<br />

lectures including ‘The Crossroads of<br />

Glaucoma and Neuro-ophthalmology’,<br />

and ‘Mistakes, Lies and Lessons’. One<br />

of the highlights of the conference<br />

was a session when challenging cases<br />

were presented to the panel who were<br />

expected to solve the mystery in front of<br />

the audience, she said. ▀<br />

optometrist.”<br />

This confusion has a public health impact, he<br />

says, as there is less perceived value in an eye<br />

examination when discounted or free eye tests are<br />

heavily marketed. “Optometrists may run the risk of<br />

becoming just ‘refractionists’, in the public mind.”<br />

Miller doesn’t sell product, preferring to focus on<br />

patient health. He will give a patient a prescription<br />

post-exam so they can ‘chase the cheapest deal<br />

on eyewear’. As technology around diagnosis and<br />

vision correction improves, the demand for services<br />

that focus purely on eye-health will increase, he<br />

says, running concurrent with the increasingly<br />

fashion-focused retail model.<br />

“I see the future of optometry recognising<br />

specialisation and those willing to take on extra<br />

learning and fellowship programmes. Demand<br />

from people with less than perfect visual skills or<br />

eye health will grow. People will seek options to<br />

allow better visual comfort and endurance such<br />

as corrections with low cyls., plus lenses, prisms,<br />

filters and a plethora of occupational lenses. Good<br />

optometrists will add value by offering medical<br />

therapy, functional therapy and appliance options<br />

tailored to the patient’s needs as a care plan where<br />

a patient can participate in and understand their<br />

choices.”<br />

Miller notes we are already seeing more<br />

collaboration between optometry and<br />

ophthalmology and says he would like to see<br />

more cross-referral within optometry as well for<br />

optometrists who wish to fulfil their professional<br />

potential by taking a step-up from refractions.<br />

“Using retailing to subsidise a technology-rich<br />

and skilful vision consultation will not survive.<br />

Basic refraction services will be taken over by<br />

technology…so up-skilling in expanded areas of<br />

therapeutics, perceptual learning/vision therapy,<br />

myopia control and customised/hybrid contact lens<br />

technologies will be necessary. If optometry does<br />

not step up, then others will move in to fill the void.”<br />

Whether you have a retail hat on or find your<br />

business more healthcare driven, there is one<br />

consensus – the need for value.<br />

“We all want value and the value equation<br />

is simple,” says Allan. “The benefit bundle is a<br />

mixture of genuine levels of care and empathy<br />

from professionals that can engage, understand<br />

customer need and provide solutions.<br />

“Value means different things to different<br />

people, but you can find it by delivering genuine<br />

care, engaging with people as individuals, treating<br />

them with respect and giving them confidence.<br />

Then they will follow you for life and help grow<br />

your business.” ▀<br />

Professor Helen Danesh-Meyer (centre front) with other speakers at the Harvard Fall Festival - Drs<br />

Mark Moster, Heather Moss, Sashank Prasad, Dean Cestari, Joe Rizzo and John Gittinger<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

17


What’s new in <strong>2017</strong>…<br />

NZ Optics’ top five predictions for what’s going to be optically hot in the Year of the Rooster.<br />

BY JAI BREITNAUER<br />

1. Artificial intelligence (AI)<br />

If you were excited by the self-driving cars in sci-fi<br />

classics like I, Robot and The Minority Report, then<br />

<strong>2017</strong> is the year for you, says Professor Steven<br />

Dakin, head of the School of Optometry and Vision<br />

Science at the University of Auckland.<br />

“The year 2016 ushered in several significant<br />

developments in artificial intelligence, with<br />

machines getting much better at performing<br />

everyday tasks like driving cars, recognising objects<br />

and translating foreign languages. Such systems<br />

use “deep learning’ to perform tasks that have<br />

long been considered impossible to automate. This<br />

trend is set to continue in <strong>2017</strong>.”<br />

Vision and vision science is key to the success of<br />

AI, as those machines need to be able to ‘see’ in<br />

order to learn and process information about their<br />

environment in real time.<br />

Professor Dakin predicts we will see more<br />

collaborations between corporations and<br />

healthcare providers to explore how AI innovations<br />

can help patients in <strong>2017</strong>.<br />

One such example is the collaboration between<br />

Moorfields Eye Hospital in London and Google<br />

DeepMind, which is developing systems to<br />

automatically detect symptoms of diabetic<br />

retinopathy using OCT imagery, he says. “Such<br />

collaborations are a win-win for both parties:<br />

Moorfields gets a tool that has the potential to<br />

deliver more reliable diagnosis of this condition<br />

and Google gets to be the nice guy (while gaining<br />

access to a hugely valuable set of patient records).<br />

Given the flexibility and power of such systems, it<br />

seems inevitable we will see them being applied<br />

to other areas of healthcare that currently require<br />

human expertise.”<br />

2. 3D printing and customisation<br />

Advancements in 3D printing techniques are going<br />

from strength to strength and are now making their<br />

way into the more mainstream world of optics.<br />

Monoqool, the 3D-printed frames pioneer based<br />

in Denmark, was hot at Silmo Paris and continues<br />

to attract a host of copycat companies. Monoqool’s<br />

new designs weigh just four grams and are due<br />

to be launched this year. The lightness and design<br />

strength of 3D-printed frames are just two of the<br />

amazing benefits of today’s 3D technology.<br />

The other area 3D printing has thrown open<br />

is customisation. Dutch company Sfered has<br />

partnered with Monoqool to offer patients a<br />

customised fit on their chosen frame. Once the<br />

customer has settled on a stock design, the<br />

optomestrist scan’s the patient’s face and the<br />

data is used to print frames that offer them an<br />

exclusive and highly comfortable fit, they claim.<br />

The service will be rolled out in Holland this year<br />

and internationally next year. Meanwhile, French<br />

start-up Netlooks has taken this a step further with<br />

technology that actually creates an avatar for the<br />

patient for fitting and testing frames.<br />

Visual customisation is also a popular theme,<br />

with companies like <strong>Feb</strong> 31st offering customers<br />

various ways to customise their wooden frames and<br />

Paperstyle offering handmade paper frames to a<br />

personalised design.<br />

3. Round and retro<br />

When it comes to picking eyewear off the rack<br />

though, the trend this year will be more vintage<br />

than futuristic, with John Lennon-style lenses all the<br />

rage again. General Optical, for example, have just<br />

revealed their new range by Chloe offering oversized<br />

round frames in sand and peach hues that look<br />

like they’re straight off the set of Charlie’s Angels.<br />

While Face à Face have a new range of eye wear in<br />

round or ‘cat-eye’ shapes, with metal and walnut<br />

effect finishes, that will have you channelling<br />

that sexy 1960’s secretary from the get-go. And<br />

Xavier Garcia’s take on the old aviator style offers<br />

sophistication combined with rogue - imagine<br />

George Clooney in a Top Gun remake!<br />

4. Myopia control<br />

Myopia control is a hot topic and increasingly a key<br />

theme at many conferences, including the American<br />

Association of Optometrists (AAO) meeting at the<br />

end of 2016 which focused on the active treatment<br />

of myopia, rather than simple management with<br />

eyeglasses. Orthokeratology specialist and NZ<br />

Optics’ popular contributor Alex Petty says many<br />

optometrists are now recognising myopia control<br />

is a big issue that they need to raise with their<br />

patients. Just prescribing eyeglasses isn’t going to<br />

cut the mustard anymore, he says.<br />

“In my view orthokeratology is the best way to<br />

slow myopia progression (in children). This year I<br />

think we will see more optometrists raising myopia<br />

control as a real thing with their patients. Even if<br />

they’re not orthokeratologists they realise myopia<br />

control is something we need to be thinking very<br />

seriously about.”<br />

Petty notes that laser eye correction and<br />

implantable lenses are both legitimate treatments<br />

for adults with myopia whose prescriptions<br />

have remained steady. However, for those with<br />

a changing prescription and those who have<br />

developed myopia at a young age, it’s important<br />

to offer a treatment that can actually slow the<br />

progression of an elongating eye.<br />

“Ortho-k is the one I’d rate as having the best<br />

overall desired outcomes and it can be used in older<br />

patients with different refractive problems too. After<br />

that, I’d probably suggest atropine drops which offer<br />

a reasonable level of myopia control, but of course<br />

the patient will also have to wear glasses and the<br />

cost of the compunded drops is quite high. Beyond<br />

that, there are other things like CooperVision’s<br />

MySight lens, a myopia control soft daily lens that is<br />

more preferable for some young people who don’t<br />

like a rigid lens or wearing a lens at night.”<br />

Whatever treatments and control options<br />

optometrists offer, it seems myopia is going to be<br />

an important issue for patients in <strong>2017</strong>, who will<br />

increasingly demand more sophisticated solutions.<br />

5. Glaucoma treatments<br />

Aerie Pharmacuticals are reportedly on track to<br />

revolutionise glaucoma care with its new rhokinase<br />

(ROCK) inhibitors Rhopressa and Roclatan<br />

(a fixed dose combination of Rhopressa and widely<br />

prescribed PGA latanoprost) going through FDA<br />

approval and Phase III trials at the end of last year.<br />

Rhopressa is a novel, once-daily eye drop designed<br />

to significantly lower intraocular pressure in<br />

patients with glaucoma or ocular hypertension.<br />

Aerie were hoping to have Rhopressa ready for the<br />

US market by January <strong>2017</strong>, but issues with their<br />

manufacturing plant in Florida have delayed the<br />

necessary FDA inspection. An inspection should go<br />

ahead this month however, leaving them on track to<br />

release the drug this year. This is the first of a wave<br />

of new treatments expected to hit the market over<br />

the next few years as other new companies look<br />

to shake up the US$5.6 billion global market for<br />

glaucoma with new treatments. ▀<br />

France Medical’s Kiwi now<br />

France Medical, the exclusive<br />

distributor of E>Eye medical IPL<br />

systems in Australasia, has expanded<br />

its business partnership with optometrist<br />

and low-vision specialist John Veale to<br />

boost its operations in New Zealand.<br />

“We launched around September<br />

2015, with John as our partner in New<br />

Zealand,” said Aurelien Coursodon,<br />

managing director of France Medical ANZ,<br />

adding it made sense to have someone<br />

on the ground in New Zealand, as it was<br />

considered a new growth area for France<br />

Medical’s business.<br />

The new partnership means France<br />

Medical can now distribute its entire range<br />

of products in New Zealand, which includes<br />

virtual reality systems for strabismus and<br />

amblyopia and a large range of diagnostic<br />

instruments and ophthalmic furniture.<br />

Previously, only the E>Eye was available to<br />

New Zealand customers.<br />

“Purchasing an E>Eye device for the<br />

treatment of MGD (meibomian gland<br />

dysfunction) has been one of the best<br />

business decisions made in my professional<br />

life,” said John Veale, explaining why he<br />

decided to take on the E>Eye device’s New<br />

Zealand distribution. “The treatment<br />

is so successful…not only solving dry<br />

eye symptoms but also helping people<br />

who struggle with discomfort due to<br />

contact lens wear. The innovative treatment has<br />

introduced many new patients to my new practice<br />

in Merivale.”<br />

Veale, a well-known and respected optometrist<br />

in Christchurch, said however it was time for him<br />

share the workload. “Helping France Medical<br />

in Australia to sell the E>Eye in New Zealand<br />

has been a wonderful opportunity to catch up<br />

John Veale<br />

Aurelien Coursodon<br />

with so many people in the ophthalmic world.<br />

But it is time for me to move on. I have joined<br />

France Medical NZ who will take over the sale of<br />

ophthalmic equipment and consumables from Dry<br />

Eye Technology Ltd.”<br />

David Monsellier has been appointed sales and<br />

accounts manager for France Medical NZ and is<br />

based in Auckland. ▀<br />

MDNZ <strong>2017</strong> RACE DAY:<br />

Have you bought your tickets yet?<br />

Tables and tickets are selling fast for the<br />

popular annual Macular Degeneration<br />

Race Day at Ellerslie Racecourse in<br />

Auckland. This year the event is being held<br />

on Saturday 18 <strong>Feb</strong>ruary so there’s still<br />

time to secure a seat and enjoy a great<br />

day with family, friends and colleagues<br />

while fundraising for MDNZ’s vital work<br />

in the macular degeneration community.<br />

Ten races will see fast-paced entertainment<br />

for the entire day with back-to-back action<br />

as the main stars of the day, the horses,<br />

thunder along the track in a bid to win one<br />

of the day’s rousing races.<br />

Take part in this wonderful<br />

event, enjoying good food<br />

and wine while contributing<br />

to a worthwhile cause!<br />

For more information or to buy tickets ($140 each) or a table ($1,250) please contact Grace Jones<br />

on 022 675 3880 or book online http://www.mdnz.org.nz/race-day-ticket-purchase/<br />

18 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


To ophthalmology and beyond<br />

As little as 18 months ago, Sunny Li was just<br />

another medical student fighting to meet<br />

the demands of her degree. But when she<br />

mistakenly entered the wrong operating theatre<br />

while on an anaesthetics rotation, the course of<br />

her studies – and life – changed.<br />

“The surgeon, [Dr Tracy Wong], was so<br />

welcoming. Despite being busy, she invited me<br />

to stay and let me look through the microscope<br />

when she was performing cataract surgeries,”<br />

says Li.<br />

At one point, Li remembers looking through the<br />

microscope at a bright blue patient’s eye.<br />

“It was the most beautiful thing I’d ever seen.<br />

I felt really emotional. All the patients – who<br />

were awake during their cataract surgery – were<br />

so grateful and I realised how rewarding and<br />

worthwhile this work could be. I could visualise<br />

myself in Dr Wong’s shoes.”<br />

Li’s sudden interest in ophthalmology was<br />

encouraged by Dr Wong, who invited her to<br />

Greenlane Clinical Centre to see some of the<br />

equipment and ask some more questions. After<br />

spending time with Dr Wong, Li’s mind was<br />

very much made up; she wanted a future in<br />

ophthalmology.<br />

Around the same time as she was coming to<br />

this conclusion, she attended the Festival for<br />

the Future conference and heard Wellington<br />

ophthalmology registrar Dr Sheng Chiong Hong<br />

(better known to all as Hong), one of the cofounders<br />

of ethically-inspired eye technology<br />

company oDocs, speak.<br />

“I felt very inspired by him. His sentiments<br />

really resonated with what I believe in. Surgery is<br />

cheap, yet every minute a child goes blind. I feel<br />

doctors have a social responsibility to improve<br />

healthcare outcomes not just for their patient,<br />

but on a wider scale.”<br />

Li sought out Hong and asked him what<br />

she could do. As a medical student she was<br />

unable to provide help in a surgical or medical<br />

care capacity, but her natural curiosity about<br />

technology inspired Hong to pair her up with<br />

software developer Harikrishnan Jayaramen.<br />

“They’d been working on an idea to develop an<br />

app, Mobile Eye, to help those already living with<br />

low vision,” says Li. “The app would use artificial<br />

intelligence to help people with everyday tasks.”<br />

Since Li has been working with the oDocs team,<br />

two American apps have become available, so<br />

they’ve altered their Mobile Eye plans slightly.<br />

“We don’t want to compete. But there is<br />

definitely a need for something New Zealandspecific,<br />

and for something very feature focused.”<br />

Li has also been working with Blind Foundation<br />

clients who have told her text<br />

recognition is a priority. Struggling to see<br />

a menu in a restaurant or missing the<br />

bus because you can’t see the number<br />

on the front are real issues There’s also a<br />

need for something that recognises New<br />

Zealand currency and local cards, like Fly<br />

Buys, and they have said they would like<br />

the ability to share images via the app so<br />

friends and family can answer questions<br />

if the tech falls short.<br />

Li is planning to spend some time in<br />

the home environments of low vision<br />

people in the next few months to<br />

identify more areas the app can help<br />

with. “It’s still very much a work in<br />

progress but I’m really passionate about<br />

it. You need to empower people who are<br />

blind so they can live the best life they<br />

can.”<br />

Li and oDocs hope to have an initial<br />

form of the app ready for the market by<br />

mid-<strong>2017</strong>. ▀<br />

For more on Sunny Li and Low Vision go<br />

to p25.<br />

Sunny Li, tackling low vision via a Kiwi-made app<br />

Lumenis appoints<br />

Kiwi rep<br />

The Australian arm of<br />

energy-based medical<br />

device company Lumenis<br />

has appointed Mike Mckenzie as<br />

its national sales manager in New<br />

Zealand.<br />

Mckenzie, who is based in<br />

Auckland and was previously<br />

sales director for cosmetics<br />

company Revlon NZ and national<br />

sales manager for Allergan in the<br />

UK, will have responsibility for<br />

selling all Lumenis’ products in<br />

New Zealand. On the ophthalmic<br />

side this includes the company’s<br />

M22 system, combining its<br />

Jo’s a qualified<br />

DO!<br />

Our hugely talented<br />

style columnist,<br />

Jo Eaton, is now<br />

a qualified dispensing<br />

optician. Kiwi Jo, who<br />

now lives in Melbourne,<br />

has had a passion for<br />

eye wear for many years<br />

before turning it into<br />

her profession. She runs<br />

a blog, eyeheartglasses.<br />

com, works in the industry,<br />

writes for us and has been<br />

studying for the Certificate<br />

IV in Optical Dispensing<br />

Jo: it’s official now!<br />

at RMIT University in<br />

Melbourne since <strong>Feb</strong>ruary.<br />

“In Australia [because of] deregulation, anyone can work as a<br />

dispenser. I did [the qualification] because I wanted to learn as much<br />

as I could,” said Eaton. “It’s useful in the workplace and I’m the one<br />

people come to in the practice when they have tricky questions. I<br />

suspect it will put me in a good place professionally in the future.”<br />

Congratulations Jo, and best of luck with your career, from the NZ<br />

Optics team. ▀<br />

Read Jo’s style column on p22<br />

Mike Mckenzie, Lumenis’ new NZ<br />

representative<br />

unique Optimal Pulse Technology with Intense Pulsed Light (IPL)<br />

technology; Selecta II, its selective laser trabeculoplasty (SLT)<br />

technology; and Lumenis’ photocoagulators and photodisruptors.<br />

Talking to NZ Optics at RANZCO 2016, after just four months in<br />

the role, Mckenzie said his move to Lumenis was driven by Lumenis’<br />

commitment to improving the quality of patients’ lives and its<br />

technological reputation, which he was already familiar with through<br />

his “aesthetics” background. “I’m still getting my knowledge of the<br />

eye world up-to-speed, but the principles of laser remain the same as<br />

these systems do far more than dry eye.<br />

“Lumenis invests more than 20% of its revenue on R&D and the<br />

technology is evolving quicker all the time, as more and more data is<br />

collected, which is very exciting.” ▀<br />

SAFETY,<br />

DRIVEN BY VISION.<br />

Confidence behind the wheel with Rodenstock Road driving glasses.<br />

See better. Look perfect.<br />

GREATER SAFETY COMES FROM<br />

1. UNRESTRICTED FIELD OF VISION FOR RAPID CHANGE OF FOCUS.<br />

2. LESS GLARE AND MORE CONTRAST.<br />

3. EXCELLENT NIGHT VISION.<br />

4. SAFE ASSESSMENT OF DISTANCES.<br />

Without Rodenstock Road: Restricted peripheral vision with conventional<br />

progressive lenses.<br />

With Rodenstock Road: Perfect overview of traffic and rapid change of focus<br />

between dashboard, GPS and mirrors thanks to optimal fields of vision.<br />

For more information speak to your Rodenstock Account Manager or visit www.rodenstock.com.au<br />

COMING SOON<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

19


Behold – Ocula!<br />

The December opening the new Ocula<br />

practice in Queenstown was attended by 60<br />

plus guests, including the mayor Jim Boult,<br />

local business owners and previous Bridgman<br />

and Dean patients. The new practice is owned by<br />

Danielle Ross and John Winstone, who rebranded<br />

their Wanaka store, Eyes on Ardmore as Ocula and<br />

added Queenstown to the business by buying<br />

Bridgman and Dean’s Queenstown practice last<br />

year (see December’s NZ Optics).<br />

We asked Ross about the changes and the new,<br />

high-end store fit-out.<br />

This is a big change for you – how long<br />

have you been planning it?<br />

Actually the opportunity to expand into<br />

Queenstown came about unexpectedly in<br />

October, so we had just 10 weeks from initial<br />

discussions to opening the new store. But we<br />

had been thinking of ways to improve the use<br />

of space and design in our current store, so have<br />

been inadvertently conceptualising our ‘dream’<br />

store for some time now; it just took the project<br />

manager and builders to turn it into a reality.<br />

How did you come up with the idea<br />

behind the rebrand?<br />

The name ‘Ocula’ is a play on the Latin medical<br />

term ‘ocular’. Our brand name is designed to<br />

be a little obscure to the general public and<br />

we purposefully did not include the terms<br />

optometry, eyewear or eyecare in the name, as<br />

we didn’t want to be pigeonholed into traditional<br />

optometry. We wanted a name that wasn’t going<br />

to limit us and would allow us to continue to<br />

expand the retail sector of the business.<br />

Since purchasing Eyes on Ardmore in 2011, a<br />

rebrand and renovation was always on the cards.<br />

We had dreams of where we wanted to take the<br />

business and we felt the Eyes on Ardmore brand<br />

was too restrictive – not just for location, but<br />

also for growth. In 2015, we developed Ocula<br />

with a branding specialist and started to plan the<br />

Wanaka renovation. Soon after, the Queenstown<br />

opportunity presented itself. Whist perhaps<br />

timely, the situation quickly became a pressurecooker!<br />

Already committed to the Wanaka<br />

rebrand, we had many sleepless nights managing<br />

the Wanaka renovation, building a new website,<br />

implementing the new Optomate Touch platform,<br />

managing the Bridgman and Dean acquisition,<br />

and negotiating the Queenstown retail store build<br />

and business set up. Let’s just say we’ve got a few<br />

more grey hairs!<br />

What is the inspiration behind your store<br />

design?<br />

We [wanted] a boutique retail store that<br />

encouraged shopping and browsing and,<br />

specifically, a space that was far removed from a<br />

typical medical reception and waiting room. On<br />

the premise one buys an experience and walks<br />

out the door with a product, we aimed to create a<br />

unique and beautiful experience that we feel truly<br />

reflects the product suite we offer. The design<br />

brief was to be simple, but not sterile; classy but<br />

not exclusive.<br />

The retail fit-out, including the internal build,<br />

furniture and styling, cost approximately<br />

$150,000. John (Winstone) is an architectural<br />

draftsman, with a keen eye for design and<br />

functionality, and we both had a clear idea of<br />

what we wanted. We bounced ideas off my<br />

interior design sister and Lynn Parker, from Parker<br />

and Co. to ensure we were on the right track.<br />

We also really appreciated looking through John<br />

Kelsey’s practice, Optik Eyecare, which is very<br />

DT’s Christmas at Mantells<br />

Device Technologies had<br />

more RSVPs than it could<br />

handle this year, with the<br />

medical equipment company<br />

forced to say “no” to some last<br />

minute replies to its December<br />

Christmas get together. But<br />

still many health professionals,<br />

including a few ophthalmic<br />

specialists (pictured), enjoyed<br />

some delightful canapés and<br />

wines at Mantell’s in Auckland’s<br />

Mt Eden suburb in December. ▀<br />

Silmo Sydney has arrived!<br />

A<br />

brand<br />

new event on the Australasian<br />

optics calendar, the inaugural Silmo Sydney<br />

optical fair, opens its doors in just under six<br />

weeks.<br />

Organisers Expertise Events are promising three<br />

days of exciting events and stylish soirees from<br />

the 9 – 11 March at Sydney’s new International<br />

Convention Centre in Darling Harbour. The new<br />

fair has partnered with Optometry Australia’s<br />

NSW and ACT Super Sunday conference and the<br />

National Retail Association to offer educational<br />

elements to all those involved both from an<br />

optometry and a business perspective. Other<br />

highlights to look out for include:<br />

• The Silmo Village, where designers from<br />

Europe, America and beyond will be profiling<br />

what’s hot for <strong>2017</strong>. Visitors can see the winners<br />

Dr Penny McAllum<br />

FRANZCO<br />

. Wed 29th March, Novotel, Ellerslie<br />

. Wed 28th June, Ormiston Hospital<br />

of the prestigious 2016 Silmo D’Or Awards for<br />

innovation and design, which are being flown out<br />

to Sydney especially for the show.<br />

• The Brand Arcade, where exhibitors can design<br />

a shop window and learn how to style a particular<br />

product campaign.<br />

• The Retail Power programme, which is a series<br />

of quick-fire sessions with some high-profile<br />

business experts from optics and retail, offering<br />

practice owners their own secrets to success.<br />

Load-up on advice for business strategy and<br />

structure and then visit the trends wall to see<br />

what looks you should be stocking in <strong>2017</strong>.<br />

• The Mega Rox Party with more than 500 tickets<br />

already sold, the event is proving to be a popular<br />

way to spend the show’s Saturday night. Being<br />

Ocula Queenstown throws open its door for the launch party<br />

thoughtfully designed with a clever use of space.<br />

Have you used any sensory design<br />

principles?<br />

Our stores play a Spotify music playlist chosen<br />

to appeal to our key clientele and an Oakmoss<br />

George & Edi fragrance to heighten the sensory<br />

experience. The artwork was chosen to be<br />

aesthetically beautiful to look at and intentionally<br />

not industry related to further enhance the visual<br />

experience and retail store concept. We keep a<br />

clean aesthetic by creating our own point-of-sale<br />

for the product brands to ensure uniformity,<br />

which in turn highlights the differences in the<br />

actual product and takes the visual emphasis off<br />

the displays.<br />

How has the redesign improved the<br />

functionality of the store?<br />

The Wanaka renovation allowed us to create more<br />

retail and office space, as well as bring the store<br />

design into line with the new brand concept. The<br />

concept we really wanted to achieve with the<br />

Queenstown design was to have the ‘working’<br />

parts of the business (waiting room, lab, offices<br />

and consultation rooms) hidden from the retail<br />

Claus and Kerstin Doering, Campbell Gordon, Tracy Richmond and Andrew Schwamm Dr Dean Corbett, Janet Wigmore, Tracey Molloy and Jasha Morarji<br />

Eye Doctors Grand Rounds <strong>2017</strong><br />

held at<br />

the Italian<br />

Village in<br />

The Rocks,<br />

whether<br />

you would<br />

like to<br />

dance the night away or just catch up in a quiet<br />

corner with friends, organisers are promising no<br />

speeches or awards, just the chance to network<br />

and have a bit of fun.<br />

Silmo Sydney is also supporting the Royal<br />

Institute for Deaf and Blind Children. The show<br />

will be formally opened on 10 March by Jillian<br />

Skinner, the NSW health minister. ▀<br />

Read Chalkeyes take on Silmo Sydney vs<br />

ODMA<strong>2017</strong> on p27<br />

. Wed 8th November, Novotel, Ellerslie . www.eyedoctors.co.nz<br />

ASCOT CLINIC (09) 520 9689 - BOTANY JUNCTION (09) 277 6787<br />

Dr Shuan Dai<br />

FRANZCO<br />

. No registration fee<br />

. CPD points available<br />

Dr Andrew Riley<br />

FRANZCO<br />

Dr Mark Donaldson<br />

FRANZCO<br />

EYE 0810<br />

John Winstone, Danielle Ross and Queenstown Lakes Mayor Jim Boult<br />

Interior of the new Queenstown store<br />

floor to accentuate a hero space for the retail<br />

product. Though a similar size to Wanaka, we<br />

managed to achieve two consultation rooms in<br />

the Queenstown store, which we may not need<br />

for a while yet, but allows us room to grow and<br />

expand. ▀<br />

Vision screening<br />

success<br />

Since 2014, the School of Optometry and<br />

Vision Science has been building its school<br />

screening programme for children in the<br />

greater Auckland region. Bachelor of Optometry<br />

students tested 700 children in that first year,<br />

increasing to 1500 in 2015. In 2016 the School<br />

screened a record 2000 children with more than<br />

100 referred on to clinic.<br />

The focus of the programme is to ensure all<br />

children have access to comprehensive eyescreening<br />

to help improve academic performance<br />

and to provide the undergraduate optometry<br />

students involved in the testing programme with<br />

vital work experience in the field.<br />

The programme is set to continue its expansion<br />

in <strong>2017</strong> as partnerships with additional schools<br />

and local optometrists are nurtured. As part<br />

of the University of Auckland’s ‘For All Our<br />

Futures’ fundraising campaign, the School is<br />

looking to purchase and run a mobile optometry<br />

clinic, allowing the provision of full on-site eye<br />

examinations. This will be used in the schools<br />

programme and for rural and underfunded<br />

areas. ▀<br />

Obituary –<br />

David Ren<br />

BY BELINDA WAY, DIRECTOR, OPHTHALMIC<br />

INSTRUMENT COMPANY (OIC)<br />

OIC was<br />

advised by<br />

David Ren’s<br />

family of his sudden<br />

passing on 12<br />

November 2016 at<br />

the age of 53. David<br />

emigrated from<br />

China with help of<br />

OIC’s sponsorship<br />

and worked with<br />

OIC from 2004 till 2011, when he left to start<br />

his own prescription lens laboratory with Nidek<br />

Edging equipment. He continued to work for<br />

OIC and service Nidek edgers. He was a very<br />

loyal and conscientious worker and many will<br />

remember his smiling face. David leaves a wife<br />

and three children. He was very close and proud<br />

of his family. His elder daughter is studying<br />

medicine in Brisbane. ▀<br />

20 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


A/Prof Rob Jacobs retires<br />

BY PROFESSOR STEVEN DAIKIN*<br />

Associate Professor Rob Jacobs’ career is<br />

defined by a path of continuing achievement.<br />

Following a PhD in optometry at the<br />

University of Melbourne (1978), he was appointed<br />

to one of only three optometry lectureships at<br />

the University of Auckland in 1984. This was<br />

followed by promotion to Associate Professor, Clinic<br />

Director, Coordinator of Clinical and Professional<br />

Programmes, Academic Director and Head of the<br />

then Department of Optometry and Vision Science.<br />

When passing the headship to me in 2014, it was<br />

my great fortune that Rob agreed to continue in his<br />

role as Academic director and in that period I have<br />

been privileged to witness at first-hand what many<br />

people know to be the defining characteristics of<br />

Rob’s work. To every task Rob brings an extraordinary<br />

level of diligence, humility and generosity - both of<br />

spirit, and of time. His achievements fall into several<br />

categories.<br />

The first has been his ability to provide advice<br />

on vision (especially colour vision) and visual<br />

ergonomics to many national bodies. These have<br />

included the development of vision standards for<br />

Police officers who have undergone eye surgery.<br />

He advises the NZ Civil Aviation Authority and<br />

has helped establish a credentialing system for<br />

optometrists to undertake eye examinations for<br />

pilots and air traffic controllers, here and in Australia.<br />

Rob has also advised NZ children’s organisations<br />

such as Ministry of Health Well-Child – Tamariki<br />

Ora and the See Here project for the JR McKenzie<br />

Foundation. His advice to the Ministry of Health<br />

Diabetic Retinopathy Screening Forum contributed<br />

to the development of national standards for<br />

managing this disease. He has also served as an<br />

Yes! e-yes now<br />

in NZ<br />

expert witness to District and Supreme Courts<br />

on issues involving colour vision, driving, and<br />

visual issues arising from aircraft laser strike. He<br />

has chaired or participated in organisations too<br />

numerous to list in full but including the directorship<br />

of the Optometry Council of Australia and New<br />

Zealand, and chair of the International Fellowship<br />

Admittance Committee of the American Academy of<br />

Optometry.<br />

Rob’s second area of achievement is in research.<br />

Rob serves as an associate editor of the professions’<br />

Australasian Journal: Clinical and Experimental<br />

Optometry. He has published more than 70 research<br />

articles, as well as the first comprehensive evidencebased<br />

textbook on ocular prosthetics. He has built<br />

numerous national and international collaborations<br />

across disciplinary boundaries and was also involved<br />

with establishing a research partnership with Essilor,<br />

the world’s largest manufacturer of corrective lenses.<br />

Rob’s third and crowning area of achievement<br />

relates to the training of optometrists. For more<br />

than a generation he has led development of<br />

optometry teaching in New Zealand through<br />

ongoing modernisation of the Bachelor of Optometry<br />

programme, and through his mentoring of staff<br />

to ensure quality teaching. Notable contributions<br />

include his work revising the curriculum in 1996 to<br />

allow optometry graduates to use certain diagnostic<br />

medicines, and in 2003 to contributing to the<br />

curriculum change that allowed optometrists to<br />

prescribe<br />

medicines to<br />

treat a wide<br />

range of eye<br />

conditions.<br />

In recent<br />

years, Rob’s<br />

Cardinal Eyewear has introduced e-yes lightweight frames<br />

and polarised magnetic clip-ons to New Zealand.<br />

The new frames range is made from ultem, a very light,<br />

heat and solvent resistant polymer material, and incorporates<br />

metal hinges with embedded steel rods in the tips to enable<br />

adjustments. The clip-on magnets are invisible from the front<br />

of the frame, yet have a strong, positive grip onto the clip while<br />

the clips have no protrusions, are light and easy to carry, said<br />

Cardinal’s John Wedlake.<br />

“We had been looking for a frame range that used magnetic<br />

clip-ons for a couple of years. I am a fan because I believe that<br />

polarised clip-ons<br />

are an excellent<br />

solution for people<br />

just like me:<br />

people who use<br />

progressive lenses<br />

and are in and<br />

out of cars and<br />

buildings all day.”<br />

Wedlake said<br />

he found e-yes at<br />

Mido last year and<br />

selected it because<br />

it offered a good<br />

range of models<br />

and colours that<br />

suit the Kiwi<br />

lifestyle. He<br />

also particularly<br />

wanted a product<br />

that didn’t have<br />

protruding<br />

Cardinal Eyewear’s John Wedlake modelling his own e-yes<br />

frames and clip-ons, now in NZ<br />

magnets, which tend to catch on clothing and can break off.<br />

“I was convinced that technology would come up with a better<br />

solution and sure enough we found it. The sleek design of the<br />

hidden magnets is the outstanding feature of e-yes frames. They<br />

fit so perfectly that they look like they are part of the frame.”<br />

All the clips are polarised and come in grey, brown or green<br />

tints with the tint colour matched to the frame fronts; some are<br />

also graduated and some mirrored, and the clip sub-frame can be<br />

re-glazed for specific customer requirements.<br />

The e-yes frames and clips will appeal to anyone who wears<br />

glasses, but especially those who don’t like the inconvenience<br />

and cost of having both a pair of glasses and a pair of sunglasses,<br />

said Wedlake. “Wearers of progressive lenses will really<br />

appreciate these frames because they are particularly light<br />

weight so designed for all day use. The clip-on is also extremely<br />

light and can simply slip into a shirt pocket or into the cloth<br />

pouch that is provided.”<br />

Additional clips are available for customers who need a pair<br />

in the car and one in the boat, he said, adding that Cardinal<br />

Eyewear has also asked the brand owner to develop some smaller<br />

models, more suited to ladies. ▀<br />

innovation in the B Optom programme has set the<br />

template for training for years to come.<br />

Because the School of Optometry and Vision<br />

Science (SOVS) is the only accredited training<br />

programme for optometrists in the country, it would<br />

be no exaggeration to say that Rob has guided the<br />

education of virtually every New Zealand-trained<br />

optometrist practicing in the country today. These<br />

people – and the way they have improved Kiwi’s<br />

lives – are in some sense Rob’s greatest contribution.<br />

Former students describe his teaching style as<br />

‘exemplary’, ‘dedicated’, ‘meticulous’, ‘motivating’<br />

and that he has ‘extreme patience’ with all his<br />

students. Although our school has a small staff we<br />

train optometrists to a standard that is recognised<br />

to be among the very highest within Australasia.<br />

Our ability to deliver this training has been a direct<br />

consequence of Rob’s dedication. Anyone who spent<br />

any time in the School quickly realises that Rob<br />

serves not only the academic director role, but is also<br />

the glue that held the programme together. It is Rob<br />

who continues to mentor staff members who have<br />

problems writing exams, using new educational<br />

software, or navigating the sometimes bewildering<br />

bureaucracy that surrounds modern university<br />

degree programmes. It is Rob who always steps up<br />

to sit on committees, to develop new courses, to lead<br />

initiatives to recruit more Maori/Pasifika students to<br />

the programme, or to write and edit reports for the<br />

myriad review processes that SOVS undergoes. All<br />

of these things Rob<br />

does with a level of<br />

quiet expertise and<br />

modesty that is his<br />

trademark.<br />

Others have also<br />

recognised this<br />

achievement. Rob<br />

was the recipient<br />

A/Prof Rob Jacobs<br />

of the Bott Medal<br />

in 2007 from the New Zealand Optometric Vision<br />

Research Foundation and was awarded the HS<br />

Gilberd Medal in 2014 by the NZAO, an organisation<br />

that conferred honorary membership to Rob in 2002.<br />

In short, Rob truly has a lifetime of achievement<br />

characterised by an unparalleled dedication to<br />

his field. To quote Head of Ophthalomlogy, Prof.<br />

Charles McGhee, “no other individual … has made<br />

such positive and wide-ranging contributions to<br />

the profession” in New Zealand. I personally have<br />

worked in many universities and I have never<br />

experienced commitment to academia – be it in<br />

teaching, service or research – to match Rob’s. To<br />

have advanced one’s discipline to the extent he has,<br />

with the resources at his disposal, and to remain<br />

the nicest guy in optometry is a trick only Rob could<br />

achieve. This contribution is one any academic would<br />

be proud to have made. ▀<br />

* Professor Steven Daikin is head of Optometry and Vision Science<br />

at the University of Auckland.<br />

SILMO <strong>2017</strong> – MIX BUSINESS WITH PLEASURE<br />

AND DISCOVER THE NEXT BIG SELLERS.<br />

KICK-START YOUR SALES WITH SILMO <strong>2017</strong> AND GIVE YOUR<br />

BUSINESS AN IMMEDIATE COMPETITIVE EDGE.<br />

The new year is a restocking period coinciding with the availability of new release products fresh from<br />

around the world. Come over and celebrate with the visionaries and see: • SILMO PARIS D’OR winners<br />

SILMO VILLAGE showcasing the latest in international and local trends •FREE RETAIL POWER<br />

SESSIONS by industry experts •MEGA ROX – the party of the year•Earn a year’s CPD points in one<br />

day with Optometry Australia Super Sunday Conference •TRENDS WALL – showing the latest designs<br />

for the year ahead. So book your flight and register your interest today at www.silmosydney.com<br />

Organised by:<br />

events<br />

March 9 – 11, <strong>2017</strong>, International Convention Centre Sydney<br />

For more information contact us on +61 2 9452 7575 or email info@silmosydney.com<br />

Supported by:<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

21


Style-Eyes<br />

BY JO EATON<br />

When children head back to school this month, unnoticed<br />

problems with their vision should be picked up either by teachers<br />

or a screening programme. If they need glasses, there are several<br />

things to take into consideration. For example, rapidly growing<br />

children might have their pupillary distance (PD) widen and that<br />

means that lenses or frames could need changing more often.<br />

Both frames and lenses need to have the durability to withstand<br />

kids’ rough-and-tumble lifestyles. Kids always want to look good,<br />

too. So with this in mind, I’ve explored a few brands taking on the<br />

style versus function balance for children.<br />

Tomato Glasses<br />

South Korean dad Sungjoon Kim’s son needed glasses and he had<br />

trouble finding suitable frames, so in 2003 he started Tomato<br />

Glasses. Tomato Glasses frames are highly flexible, durable and<br />

adjustable, while still managing to be adorable and brightly<br />

coloured.<br />

Tomato glasses make frames suitable for newborns through to 16<br />

years of age. For very small children, the shapes are simple - oval,<br />

rectangular and round. For older kids, they’re more fashionable. The<br />

frames are made out of TR90 nylon, which is a ‘shape intelligent’<br />

material – when twisted, it springs back into shape.<br />

The glasses come in a kit with two spare nosepads, spare<br />

ear tips, a headband, case and a cloth. Both the nosepad<br />

position and temple length is adjustable by unscrewing and<br />

moving these parts. It’s very clever! Check out their website for<br />

plenty of diagrams and instructions of how this works. www.<br />

tomatoglasses.com.au<br />

Nike<br />

Nike frames are a brand recognition no-brainer for label conscious<br />

kids. Nike Vision have a wide range of sunglasses and optical<br />

frames in a variety of materials. Simple metal, fashionable acetate<br />

shapes and many of them are accented with child-friendly bright<br />

colours.<br />

Ogi<br />

Ogi’s Ogi Kids range is now available. There are four frame designs,<br />

all made out of TR90 nylon and in different vibrant colours. The<br />

IN100 and 101 come with adjustable temple tips so the glasses<br />

grow with the child. The IN102 and 103 are for older children and<br />

come in different tortoiseshell patterns and two-tone colours.<br />

These are great grown-up looking styles for precocious kids.<br />

Safilo<br />

Safilo’s Kids By Safilo range claims their eyewear does “not weigh<br />

on the nose, they don’t hurt behind the ears, and they are never<br />

tiring, even if worn all day: resistant to perspiration, dirt and<br />

sometimes harmful curiosity.” They also claim to stay firm on the<br />

nose while kids are active. With no metal parts or exposed hinges,<br />

kids with nickel allergies will be just fine. They’re made of biobased<br />

non-toxic materials. There are plenty of colours and styles<br />

available to satisfy the choosiest young customers. “For little ones<br />

who want to make their own choices”, as they say!<br />

Very French Gangsters<br />

For the tiny style icons, Very French Gangsters<br />

(veryfrenchgangsters.com) are perfect. I don’t think I’ve seen more<br />

delightful and on-trend frames for children anywhere else. French<br />

founders Anne Masanet and Karoline Bothorel-Bolzinger are selfdescribed<br />

glasses addicts and it shows in their products. Founded<br />

in 2012, Very French Gangsters also make sunglasses to protect<br />

our little friends’ eyes.<br />

Zoobug<br />

Zoobug are super cute, but don’t have New Zealand distribution<br />

at this point. Their frames are designed by eye surgeon Dr Julie<br />

Diem Le for kids aged 0-12. A lot of their frames for the youngest<br />

children come with built-in elasticised straps that go around the<br />

back of the head to hold the glasses in place.<br />

And…<br />

There are plenty of other brands available. Check out Miraflex<br />

(miraflexglasses.net), Australia’s Frankie Ray sunglasses<br />

(frankieray.com.au) and Anne et Valetin’s ‘Enfants Terribles’ &<br />

‘Superkids’ ranges for starters and Luxottica’s Ray-Ban also do<br />

children’s eyewear.<br />

May <strong>2017</strong>’s back-to-school season be fashionable and practical<br />

for our littlest customers! ▀<br />

* Jo Eaton is a native Wellingtonian, now working as a qualified DO in Melbourne.<br />

She runs eyewear fashion blog, eyeheartglasses.com<br />

<strong>2017</strong> fashion update<br />

The new ranges’ press releases were flying into our in-boxes<br />

at the end of 2016 and the beginning of <strong>2017</strong>. Here’s our<br />

‘most newsy for New Zealand’ top picks.<br />

Xavier Garcia<br />

Xavier Garcia has released<br />

his autumn/winter<br />

collection, ‘Barcelona’. The<br />

clean lines and vibrant<br />

colours of the contemporary<br />

Barcelona collection are<br />

inspired by the elegance<br />

and authenticity of the<br />

Catalan capital, offering a<br />

variety of modern takes on<br />

classic shapes in a range of<br />

hues that would rival the<br />

Sagrada Família.<br />

Distributed by Cardinal<br />

Eyewear.<br />

Blackfin Elemento<br />

Italian titanium frame designer Blackfin has launched “Elemento”,<br />

a limited edition range combining its trademark titanium with gold.<br />

The Elemento range comes in six limited-edition models, all 24<br />

carat, 2 micron, gold-plated. The company says the use of the gold<br />

is not ostentatious but “crafted in elegant detail that enhances the<br />

frames and emphasises the colourings so typical of the brand.”<br />

Distributed by Beni Vision.<br />

Columbia<br />

Outdoor gear company Columbia have released a new range<br />

of hardy but stylish eyewear for the sports enthusiast. Using<br />

durable memory metal Flexon technology, these classicallyshaped<br />

specs are designed to take what life throws at you and<br />

spring back into shape.<br />

Distributed by General Optical.<br />

TAVAT - SoupCan 2.0<br />

TAVAT has launched a refined version of the popular shapes from the original SoupCan<br />

collection. Using more acetate in the construction, the new collection is suited for all<br />

day wear as the overall weight is reduced by 25%.<br />

The SoupCan Shield Collection is TAVAT’s first step to include some unique features to<br />

the popular SoupCan frame – drawing on Italian craftsmanship they have created a shield<br />

of acetate using the round pantos shape and gluing together 8mm + 4mm acetate.<br />

Distributed by Beni Vision.<br />

Rodenstock hits the road<br />

Face à Face classic returns<br />

More than 10 years after the release of the Hollywood feel-good<br />

film ‘The Holiday’, Face à Face still receives requests about the ‘Oscar’<br />

frame worn by Jude Law. Now the company has responded to this<br />

interest by issuing a limited edition re-release of the frame in three<br />

colours: transparent smoked grey, black and tortoiseshell. The frames<br />

also feature special The Holiday branding on temple internals.<br />

Face à Face is distributed by Mike Sladen Optical.<br />

La Matta<br />

La Matta’s new<br />

collection claims<br />

to be ‘an anthem<br />

to the modern and sensual<br />

woman. A mysterious woman who likes to transform herself,<br />

by showing her strong personality through the accessories she wears’.<br />

Made by Area98, the collection features animal prints and<br />

intricate detail, but with softer, more sober tones. The large frames<br />

facilitate progressive lenses with a mix of metallic and acetate<br />

bodies for lightness and longevity.<br />

Distributed by BTP International Designz.<br />

Ogi: the future is green<br />

With Pantone declaring ‘greenery’ as the colour of the year for <strong>2017</strong>,<br />

US-based Ogi is very on trend launching three new designs featuring<br />

this zesty colour. One of the new designs is an addition to the<br />

Evolution collection (9220/1978), combining the ever-popular cat-eye<br />

optical frame with a sporty dual-stripe detail. Available in different<br />

bold colour combinations, including the greenery-inspired Amazon<br />

Queen Green<br />

featured here.<br />

Distributed in<br />

New Zealand by<br />

BTP International<br />

Designz.<br />

Rodenstock is launching ‘Rodenstock Road’, a lens designed<br />

to provide “a better perspective on the road, even when<br />

visibility is difficult”.<br />

The new Road lenses will be available from 1 <strong>Feb</strong>ruary in both<br />

single vision and progressive and are designed to offer large<br />

zones of clear vision to help with the rapid changes of focus<br />

necessary when driving, especially in low visibility conditions,<br />

said the company. The new lens also features Solitaire Protect<br />

Road 2, a new multifunctional coating, which combines a<br />

premium anti-reflection coating and a slight 12% filter tint to<br />

minimise back surface reflections “and distracting headlight<br />

glare, whilst also ensuring high-contrast vision during the day”.<br />

Rodenstock’s patented Eye Lens Technology, especially<br />

DNEye, also ensures sharper and higher-contrast vision, said<br />

the company especially during poor visibility. Rodenstock<br />

recommends its Road lenses are combined with its T-Lite, extralight<br />

frames, with very thin temples that don’t compromise the<br />

field of vision when doing over the shoulder checks. ▀<br />

Rodenstock is distributed in NZ by BTP International Designz.<br />

22 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


TESTED TOUGH<br />

IN THE PACIFIC<br />

NORTHWEST<br />

WHERE DIRT IS A FASHION ACCESSORY.<br />

Sku - C8003 002 $229.90 RRP<br />

Gert Boyle<br />

Chariman, Columbia Sportswear<br />

Tough frames, easy price.<br />

Columbia frames from $229.90 RRP<br />

For over 70 years, Columbia Sportswear Company has been a leader<br />

in the outdoor apparel and accessories industry. Columbia’s latest<br />

opcal collecon delivers high quality product through innovave<br />

materials, classic styling, durability and comfort.<br />

Contact your GenOp Account<br />

Manager to become a stockist.<br />

General Opcal<br />

NZ Toll Free 0800 141 444<br />

customerservice@genop.com.au<br />

www.generalopcal.co.nz<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

23


with<br />

Prof Charles McGhee<br />

& A/Prof Dipika Patel<br />

Series Editors<br />

Central serous chorioretinopathy<br />

update<br />

BY DRS MOAZ ALSHAIKHI AND DAVID SQUIRRELL*<br />

Central serous chorioretinopathy (CSCR)<br />

is a retinal disorder characterised by<br />

localised macular serous detachment of<br />

the neurosensory retina and, often, with retinal<br />

pigment epithelium (RPE) detachments. CSCR<br />

is the fourth most common retinopathy after<br />

age-related macular degeneration (AMD), diabetic<br />

retinopathy and retinal vein occlusion. Initially<br />

thought to be an inflammatory condition, it was<br />

called “central recurrent retinitis” before the term<br />

CSCR was coined by Gass in the 1960s 1 . CSCR was<br />

perceived as a disease of young males, but recent<br />

population-based and retrospective studies report<br />

the average age of presentation is between 40<br />

and 51 years 2,3 . A five-year retrospective review of<br />

CSCR cases of two retinal specialists in Auckland<br />

District Health Board’s Ophthalmology Department<br />

revealed an overall mean age at presentation of<br />

47 years. CSCR can also present in the elderly and<br />

can mimic neovascular “wet” AMD. Older patients<br />

are more likely to present with diffuse loss of RPE<br />

and, to confuse the issue, may also have secondary<br />

choroidal neovascularisation (CNVM). Whilst not<br />

always a “disease of the young” CSCR is six times<br />

more common in males, with an observed annual<br />

incidence of 9.9 per 10,000 compared to 1.7 per<br />

10,000 in females 2 .<br />

Risk factors and pathophysiology<br />

Elevated levels of corticosteroid has long been<br />

recognised as a risk factor and these corticosteroids<br />

can be from both exogenous and, less commonly,<br />

endogenous sources. Oral corticosteroid therapy<br />

is the most commonly reported route of<br />

administration, however, other routes have also<br />

been documented including topical, inhalers,<br />

intranasal and intra-articular. Steroid-induced CSCR<br />

seems to act in an individually dependent manner<br />

rather than a dose-dependent manner, as a very low<br />

dose of corticosteroid can be enough to trigger the<br />

formation of subretinal fluid (SRF) in susceptible<br />

individuals 1,3 . Steroid-induced CSCR is more likely<br />

to be bilateral with atypical features and shows<br />

less predilection for males. Whilst corticosteroids<br />

are generally used in medicine to treat oedema in<br />

different conditions, it is believed to increase the<br />

permeability of the inner choroid in CSCR leading<br />

to the accumulation of SRF. It has recently been<br />

suggested that the pro-oedematous effect of<br />

glucocorticoids in CSCR is due to the binding and<br />

activation of the mineralocorticoid receptors (MR)<br />

responsible for fluid retention 3 . A recently published<br />

meta-analysis of risk factors reported significant<br />

associations between CSCR and hypertension,<br />

H. pylori infection, obstructive sleep apnoea,<br />

autoimmune disease and type-A behaviour 4 .<br />

Pregnancy is another risk factor, with the condition<br />

often occurring in the third trimester and usually<br />

resolving within two months of birth 1,3 .<br />

The pathophysiology underlying CSCR remains<br />

poorly understood, however advances in retinal<br />

Fig 1. A case of non-resolving multifocal CSCR with an underlying micro break of the RPE. These leaks<br />

were successfully treated with focal argon laser. Colour photo: Blue arrows reveal the extent of the serous<br />

detachments. Fluorescein angiogram: Yellow arrows reveal the site of two focal leaks. High resolution EDI<br />

OCT: Yellow arrow reveals a small micro-break at the level of the RPE.<br />

24 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong><br />

imaging modalities<br />

have given us<br />

some insights into<br />

morphological<br />

abnormalities.<br />

It has long been<br />

recognised that CSCR<br />

is the result of a<br />

localised breakdown<br />

of the blood-retinal barrier with the subsequent<br />

development of a leak of fluid from the choroid<br />

to the subretinal space. This leak may be focal,<br />

multifocal or diffuse and is caused by micro<br />

breaks within the RPE (fig 1). Spectral domain<br />

OCT studies have also consistently demonstrated<br />

that CSCR is associated with a thick choroid, or<br />

“pachychoroid” when compared to healthy subjects 3<br />

(fig 2). Patients also have evidence of increased<br />

choroidal permeability on both fluorescein and<br />

ICG angiography. A “hyper-vascular” choroid<br />

therefore appears to be a risk factor for the<br />

development of CSCR and the co-localisation of<br />

pigment epithelium detachments in many cases of<br />

CSCR, supports this hypothesis 3 . Nevertheless, the<br />

underlying mechanism of the choroidal disease,<br />

and whether the RPE dysfunction can be explained<br />

by these observed changes or whether there is<br />

an independent pathology at the level of the RPE<br />

remains to be determined.<br />

Fig 2. A case of bilateral, recurrent non resolving multifocal CSCR. (Normal 24 hour urinary<br />

cortisol levels). a. Colour photo: Note the central pigmentary disturbance consistent with<br />

“chronic recurrent CSCR”. b. Fluorescein angiogram: Reveals a perifoveal leak that is not<br />

Clinical presentation and classification<br />

The term “CSCR” is used to describe several clinical<br />

presentations and has until recently been classified<br />

into “acute” and “chronic”. Acute CSCR describes the<br />

form that typically presents unilaterally in younger<br />

patients with symptoms related to SRF under the<br />

central macular, including a relative central scotoma<br />

and a patch of blurred vision. Best-corrected visual<br />

acuity is usually reduced to between 6/7.5 and<br />

6/60 and can be improved in some cases with a<br />

weak plus lens, which corrects for the hypermeropic<br />

shift caused by the elevated photoreceptor layer 1 .<br />

Other symptoms include dyschromatopisa, reduced<br />

contrast sensitivity and micropisa.<br />

The “acute” form of the disease usually refers to<br />

the first presentation of the disease in an otherwise<br />

healthy macular, but the definition of “chronic” CSCR<br />

has been somewhat ambiguous, (used to refer to<br />

CSCR with persistent SRF of duration longer than<br />

four to six months as well as cases with diffuse<br />

RPE atrophy formally known as “diffuse retinal<br />

epitheliopathy”). A recently published review of<br />

CSCR suggested the use of “non-resolving CSCR”<br />

to describe patients with persistent SRF with no<br />

signs of diffuse RPE atrophy 3 . “Chronic” CSCR<br />

usually affects older patients and is characterised<br />

by RPE changes (fig 2) and permanent visual loss<br />

which can be severe. Less common forms of CSCR<br />

includes bullous CSCR, which is characterised by<br />

multiple areas of exudative SRF with subretinal<br />

fibrin deposits. Bullous CSCR tends to be more<br />

aggressive in nature,<br />

often aggravated by<br />

corticosteroid treatment<br />

and more common in<br />

Asian populations 1,3 .<br />

Prognosis<br />

CSCR has often been<br />

regarded as a relatively<br />

benign retinal disease as<br />

spontaneous resolution<br />

is observed in the<br />

majority of cases (56%-<br />

90%) 3 . Although best<br />

corrected, high-contrast<br />

visual acuity mostly<br />

appears to return to<br />

normal, residual deficits<br />

in colour vision and/<br />

or contrast sensitivity<br />

are often reported.<br />

Recurrence is also<br />

common with rates of<br />

between 31% and 50%<br />

being reported. Typically<br />

recurrences are within<br />

the first year 3 . Whilst visual recovery after an episode<br />

of CSCR is the rule, patients with recurrent disease,<br />

non-resolving disease or the bullous form of the<br />

disease often experience significant and permanent<br />

visual impairment. Long-standing, chronic CSCR can<br />

be associated with the development of a secondary<br />

CNVM but such cases often have a characteristic<br />

pachychoroid which helps distinguish them from<br />

“typical” AMD.<br />

Management<br />

Initial Assessment and Investigation:<br />

Observation remains the appropriate first-line<br />

management in most cases of acute CSCR as it is<br />

typically a self-limiting condition. Although there is<br />

no general agreement of the management of CSCR<br />

and the optimal time of intervention, treatment is<br />

usually recommended in those cases where there<br />

is a threat of permanent visual impairment 1 . It is<br />

therefore appropriate to refer all cases of suspected<br />

CSCR for specialist review. In the majority of cases<br />

of CSCR, serial observation with OCT, documenting<br />

resolution of the SRF, is all that is required. However,<br />

if the patient falls into one of the high risk categories,<br />

fluorescein angiography will determine the location<br />

and nature of the leak.<br />

In the meantime, modification of risk factors such<br />

as discontinuation of steroid use should be attempted<br />

when practical, to assist with the resolution of SRF<br />

and prevent complications of chronic disease. Rarely<br />

CSCR can be the presenting symptom of serious<br />

underlying systemic disease and the physician<br />

needs to be prepared to investigate beyond the eye<br />

in atypical cases. We would advocate that 24 hour<br />

urinary cortisol levels be assessed in patients who<br />

present with bilateral, multifocal disease with referral<br />

to an endocrinologist if elevated.<br />

Oral medications:<br />

Small, non-randomised case series over the last five<br />

years, looking at the effectiveness of oral medications<br />

including aspirin, Rifampicin, and omeprazole have<br />

offered underwhelming conclusions. It is recognised<br />

that over-activation of the mineralocorticoid<br />

receptors (MR) plays a role in some cases of CSCR<br />

and MR antagonists’ spironolactone and eplerenoe<br />

have therefore been used for the treatment of nonresolving<br />

CSCR with encouraging results 9 . Whilst<br />

their exact role is yet to be defined MR antagonists<br />

offer a promising non-invasive option.<br />

Laser photocoagulation:<br />

Although often over-looked, Argon laser focal<br />

photocoagulation can be very effective in sealing the<br />

leak associated with CSCR and hasten the resolution<br />

of the SRF 5 . Argon photocoagulation does cause focal<br />

RPE damage and is therefore not an appropriate<br />

treatment option in cases where the leak is under<br />

or close to the fovea. Argon photocoagulation is<br />

relatively cheap, readily available and therefore an<br />

effective option in cases of extrafoveal persistent<br />

CSCR (fig 1). More recently, Diode micropulse laser<br />

has also been used in CSCR. Although the initial<br />

results are promising, six more studies are needed to<br />

evaluate the long-term outcomes.<br />

Photodynamic Therapy (PDT)<br />

It has long been accepted that Photodynamic<br />

therapy (PDT) both hastens the resolution of SRF<br />

and reduces the likelihood CSCR recurrence. The<br />

free radicals released by stimulating verteporfin<br />

induce choroidal vascular remodeling and reduce<br />

choroidal thickness, thus reversing the underlying<br />

pathology. However, significant complication rates<br />

were reported with standard “full dose/ full fluence”<br />

PDT, including permanent choriocapillaris ischemia<br />

and RPE atrophy, secondary CNVM formation and<br />

reduced visual acuity 3 . As a result, the treatment<br />

amenable to focal argon laser treatment. c. High resolution EDI OCT reveals persisting SRF and<br />

an underlying ‘pachychoroid.” The fellow eye’s choroid was similarly thick. d. High resolution<br />

EDI OCT six weeks after ½ fluence PDT with complete resolution of the SRF.<br />

was “safety-modified” by altering either the dose<br />

of verteporfin (half-strength PDT) or the fluence of<br />

the laser that was applied (half-fluence PDT). Safety<br />

modified PDT regimens have subsequently been<br />

confirmed as effective compared to standard PDT.<br />

As a result, safety modified PDT has now established<br />

itself as the treatment of choice for non-resolving<br />

foveal involving CSCR 7 .<br />

Anti-VEGF factors and Oral medications:<br />

Investigators studied the role of anti-VEGF in the<br />

treatment of acute and chronic CSCR. No significant<br />

differences have been found in terms of final visual<br />

acuity, macular thickness and duration of SRF8. Anti-<br />

VEGF therapy was also inferior to PDT in treating<br />

patients with chronic CSCR. The role of anti-VEGF<br />

therapy is limited to cases with CSCR-related CNVM.<br />

Summary<br />

CSCR is a common retinal condition that all<br />

optometrists and general ophthalmologists<br />

should be aware of. Whilst mainly a self-limiting<br />

condition, it is not as benign as once assumed and<br />

the conventional approach of waiting months and<br />

months before intervening is no longer accepted<br />

practice. After excluding an exogenous source of<br />

steroids, most retinal specialists would be happy<br />

to observe a typical case of CSCR for up to three<br />

months before intervening, but in cases where the<br />

SRF is clearly not resolving within eight to 10 weeks<br />

a fluorescein angiogram would be appropriate.<br />

If the CSCR leak is focal and extrafoveal, a gentle<br />

focal argon laser can be safely applied. If the leak is<br />

central and/or diffuse, oral MR antagonists or safety<br />

modified PDT would be offered. ▀<br />

References<br />

1. Nicholson B, Noble J, Forooghian F, et al. Central Serous<br />

Chorioretinopathy: Update on Pathophysiology and Treatment.<br />

Survey of Ophthalmology 2013;58(2):103-26.<br />

2. Kitzmann AS, Pulido JS, Diehl NN, et al. The Incidence<br />

of Central Serous Chorioretinopathy in Olmsted County,<br />

Minnesota, 1980–2002. Ophthalmology2008;115(1):169-73.<br />

3. Daruich A, Matet A, Dirani A, et al. Central serous<br />

chorioretinopathy: Recent findings and new physiopathology<br />

hypothesis. Progress in Retinal and Eye Research 2015;48:82-<br />

118.<br />

4. Liu B, Deng T, Zhang J. RISK FACTORS FOR CENTRAL SEROUS<br />

CHORIORETINOPATHY: A Systematic Review and Meta-<br />

Analysis. Retina 2016;36(1):9-19.<br />

5. Ficker L, Vafidis G, While A, et al. Long-term follow-up of<br />

a prospective trial of argon laser photocoagulation in the<br />

treatment of central serous retinopathy. British Journal of<br />

Ophthalmology 1988;72(11):829-34.<br />

6. Verma L, Sinha R, Venkatesh P, et al. Comparative evaluation<br />

of diode laser versus argon laser photocoagulation in<br />

patients with central serous retinopathy: A pilot, randomized<br />

controlled trial [ISRCTN84128484]. BMC Ophthalmology<br />

2004;4(1):15.<br />

7. Liu H-Y, Yang C-H, Yang C-M, et al. Half-dose Versus Half-time<br />

Photodynamic Therapy for Central Serous Chorioretinopathy.<br />

American Journal of Ophthalmology 2016;167:57-64.<br />

8. Lim JW, Ryu SJ, Shin MC. The Effect of Intravitreal Bevacizumab<br />

in Patients with Acute Central Serous Chorioretinopathy.<br />

Korean J Ophthalmol 2010;24(3):155-58.<br />

9. Bousquet E, Beydoun T, Rothschild P-R, et al. Spironolactone<br />

For Nonresolving Central Serous Chorioretinopathy:<br />

A Randomized Controlled Crossover Study. Retina<br />

2015;35(12):2505-15.<br />

About the authors<br />

* Dr Moaz Alshaikhi is an ophthalmology non-training registrar<br />

at Waikato Hospital and, formerly, Greenlane Clinical Centre.<br />

With a degree in genetics, he is interested in retinal disorders<br />

and ophthalmic genetics and is looking forward to further<br />

training and research experience<br />

* Dr David Squirrell is an ophthalmologist with Auckland District<br />

Health Board and Milford Eye Clinic. His primary interest is<br />

medical retina<br />

and AMD. Dr<br />

Squirrell has served<br />

as the principle<br />

investigator for<br />

numerous studies<br />

in AMD, including<br />

the IVAN trial.<br />

Dr Moaz Alshaikhi<br />

Dr David Squirrell


Tackling low vision<br />

In November 2016 the NZ Wholesalers<br />

Association (NZOWA) held a fantastic Visionz<br />

event at Ellerslie, including the Eduvisionz<br />

educational programme and the ADONZ<br />

conference, which was run concurrently (see NZ<br />

Optics December issue). For the first time, NZOWA<br />

also offered a separate Low Vision Conference. Here<br />

are some of the highlights.<br />

LogMar principles<br />

Dr Alan Johnston, an associate professor in the<br />

optometry department at Melbourne University,<br />

kicked off the day with a talk on visual acuity and<br />

logMAR principles.<br />

He mentioned Snellen charts, but noted they<br />

are irregular. The spaces between the lines are not<br />

consistent so can’t be used at separate distances. In<br />

contrast, logMAR helps with the definition of legal<br />

blindness – many people have terrible vision but<br />

can still see a Snellen chart quite well.<br />

A/Prof Johnston reminded the audience that any<br />

three-line improvement on a logMAR test is two<br />

times better vision, which gives predictability. He<br />

showed the audience how to use his Near Visual<br />

Acuity Calculator and then shared some interesting<br />

cases, which challenged the diagnostic tools and<br />

principles and can change the way low vision aids<br />

are prescribed.<br />

Lighting research<br />

Dr Mary Butler, principal lecturer at the school of<br />

occupational therapy at Otago Polytechnic offered<br />

an overview of the research she and her colleagues<br />

have been working on over the last few years,<br />

looking at lighting, teaching around digital devices,<br />

using mobility scooters with low vision and visual<br />

impairment after an acquired brain injury. Dr Butler<br />

noted people over the age of 60 required three to 10<br />

times as much light as those aged 20 or younger to<br />

perform the same visual tasks, and younger people<br />

with low vision underestimate their needs.<br />

Otago Polytechnic’s lighting project looked at<br />

the difference between the types of bulbs on the<br />

market and how it affects low vision patients. It was<br />

a participation-based study with low vision clients<br />

from all walks of life.<br />

There is a wide variety of digital devices available<br />

to help low vision patients, said Butler, such as<br />

the lightchooser app – a little black box that helps<br />

adjust the lighting environment to your prescription<br />

needs. But with many low vision patients at the<br />

older end of the spectrum, they need to be taught<br />

to use digital devices. At age 74 the percentage of<br />

people with access to the internet drops to 29%<br />

compared to 92% of 15 – 64 year olds (2013 census<br />

stats). Yet digital literacy is a significant pathway to<br />

overcoming issues related with low vision.<br />

Dr Butler also noted there are big issues around<br />

public transport in New Zealand making the use of<br />

mobility scooters an essential lifeline for many.<br />

Game changer apps<br />

Fifth year medical student Sunny Li talked us<br />

through a project she is working on developing a<br />

low vision app (see separate story p19). Apps, she<br />

said, can be a game changer for people with low<br />

vision especially as smart phones and mobile apps<br />

are now household items. Li conducted a survey last<br />

year, which showed that 85% of Blind Foundation<br />

members had access to a smartphone.<br />

There are a variety of apps that are designed to<br />

help those with low vision complete everyday tasks,<br />

while phones themselves have accessibility options<br />

like the talkback setting that allows your phone to<br />

speak to you when you tap on the icons.<br />

There are also two assisted-sight apps: Aipoly,<br />

an object and colour recogniser free on the Apple<br />

store; and TapTapSee, a similar app, which analyses<br />

your photos and tells you what they are with the<br />

talkback function, available on Android and iPhone.<br />

Li’s app, Mobile Eye, is being developed together<br />

with ethical eye technology company oDocs. The<br />

aim of the app is to produce something that caters<br />

for New Zealand audiences and improves on current<br />

available technologies, she said.<br />

Avoiding falls<br />

Professor Stephen Lord, senior principal research<br />

fellow at Neuroscience Research Australia, talked<br />

about falls in older people, running through<br />

research that involved participants being asked<br />

to stand steady on a foam mat. No one can stand<br />

steady, but they constantly correct their balance<br />

allowing data to be collected, he said. Depth<br />

perception, contrast and visual acuity are major risk<br />

factors around balance. He ran through a series of<br />

vision tests designed to be a predictor of falls, such<br />

as the Melbourne Edge Contrast Test or the Howard<br />

Dolman depth perception test.<br />

Vision-related disability can lead to social<br />

isolation, depression, anxiety and reduced<br />

activity, particularly if paired with an additional<br />

impairment like hearing loss. These associated<br />

disorders are all risk factors for falls, said Professor<br />

Lord. Glasses, while designed to help, can also<br />

be a concern, he said, especially multifocals. The<br />

number one environmental cause of falls is footpath<br />

misalignment and if part of your visual field is<br />

blurred that will more than double your risk of<br />

misjudging the footpath and falling.<br />

Exercises that challenge balance control have<br />

proven to be one of the most effective programmes<br />

for combating fall rates, he said, noting that Otago<br />

has a world famous balance training programme.<br />

Tai Chi is also useful. Professor Lord recommended<br />

pharmacy education around drugs, as antidepressants,<br />

sleeping tablets and anxiety agents<br />

all double the risk of falls. If you can reduce the<br />

intake, then you can reduce the risks, he said. While<br />

seeing a good podiatrist if you have foot pain or foot<br />

problems is essential; vitamin D is also useful as it<br />

helps with muscle movement, receptors and the<br />

like and many older people in residential care are<br />

vitamin D deficient.<br />

Always a highlight, Dr Mike O’Rouke closed the<br />

morning with a talk about the CentraSight mini<br />

telescope procedure (see NZ Optics’ June 2016<br />

issue).<br />

Low vision rehab course<br />

After lunch, Dr Butler returned to share her<br />

journey in developing the country’s first Low Vision<br />

Rehabilitation Course for allied health professionals<br />

and what a great success it’s been with occupational<br />

therapists, who can see the real difference it’s<br />

making to their patients. Retina NZ has also got<br />

behind the course, sponsoring an honours student<br />

to attend, and offering work placements. For more,<br />

she referred the audience to the Vision Matters OT<br />

Facebook page.<br />

CCLS heads to Nelson<br />

Registration is now open for the <strong>2017</strong> Cornea<br />

and Contact Lens Society (CCLS) conference,<br />

which this year is being held in sunny Nelson<br />

from Thursday 23 to Saturday 25 March.<br />

“When it comes to conferencing, the Cornea &<br />

Contact Lens Society has an enviable reputation of<br />

facilitating world-class conferences – right in your<br />

back yard,” says Anne Matheson, CCLS president,<br />

adding this year’s conference has a particularly<br />

strong programme, which will be of interest to both<br />

optometrists and ophthalmologists. “With four<br />

keynote speakers of international repute, we will<br />

deliver a diverse range of topics, aimed at corneal<br />

health and contact lens developments.”<br />

Keynote speakers include Dr Marc Bloomenstein,<br />

a founding member of the Optometric Council<br />

on Refractive Technology and adjunct assistant<br />

professor at the Southern California and New<br />

England Colleges of Optometry; Professor Ken<br />

Nischal, head of Paediatric Ophthalmology at the<br />

Children’s Hospital of Pittsburg; Professor Fiona<br />

Stapleton, head of the School of Optometry and<br />

Vision Science at the University of New South<br />

Wales; and our own Professor Charles McGhee,<br />

chair of ophthalmology at the University of<br />

Auckland. Other local speakers include Auckland<br />

optometrist, CL specialist<br />

and researcher Grant<br />

Watters, Professor<br />

Trevor Sherwin and<br />

ophthalmologist Dr<br />

Trevor Gray.<br />

As usual, the conference<br />

also offers four<br />

workshops, each with<br />

limited numbers ensuring<br />

the participants a handson<br />

experience. Places are<br />

CCLS President Anne Matheson<br />

allocated on a first-come,<br />

first-served basis.<br />

The conference is being held at the Rutherford<br />

Hotel and opens with a welcome function at 5.45<br />

pm on the Thursday. It includes a Best-of-Britishthemed<br />

conference dinner on the Friday night,<br />

featuring one of Nelson’s top bands, Cover Me, and<br />

is due to end around 4.30 pm on the Saturday.<br />

“These conferences are a little bit legendary,<br />

offering terrific learning, a relaxed atmosphere<br />

and plenty of networking opportunities,” says<br />

Matheson. ▀<br />

For more, see the ad on p4 or visit www.<br />

contactlens.org.nz<br />

Low vision clinics in<br />

practices<br />

Well-known low vision<br />

champion, Merivale<br />

optometrist John Veale,<br />

showed how easy it was for<br />

practices to instigate their<br />

own low vision clinics. “Don’t<br />

reinvent the wheel…there is<br />

all the material out there if<br />

you want to help low vision<br />

people.” He also pointed<br />

out that many of the larger<br />

chains aren’t geared up to<br />

help low vision patients, so<br />

you can contact them and<br />

suggest they refer those<br />

patients to you, especially<br />

as this often leads to their<br />

friends and families becoming patients of yours<br />

too. He then went on to demonstrate the resources<br />

available and encouraged the audience to contact<br />

him to obtain many of the charts and other tools<br />

useful for starting a low vision practice.<br />

Dealing with the day-to-day<br />

Occupational therapist Gail Hughes, who works<br />

with John Veale, shared many tips for making a low<br />

vision person’s life easier. “Low vision isn’t an illness,<br />

so I don’t like to call them patients, but it can steal<br />

their independence, so our work is all about giving<br />

them back that independence.”<br />

She noted low vision often leads to depression,<br />

so she shared some tips for identifying depression<br />

early and for dealing with it. This included regular<br />

exercise, to stimulate the body’s endorphins;<br />

exposure to sunlight (the importance of vitamin D<br />

was a recurring theme); drinking plenty of water;<br />

eating plenty of Omega-3 fatty acids; having<br />

daily social contact with people other than your<br />

immediate family or partner; getting plenty of<br />

sleep; and doing some sort of regular, meaningful<br />

activity.<br />

Friends and family can also be an obstacle in a<br />

low vision person’s journey back to independence<br />

as they tend to do too much for them. We have an<br />

“arsenal” of other senses, low vision people just<br />

need to learn how to use them, she said. There’s<br />

a plethora of tools to help, including those for the<br />

important three Bs – bigger, bolder, brighter, such as<br />

large universal remotes; black on yellow keyboards;<br />

and special book reading illuminators. Finally, you<br />

need to do home visits, said Hughes. “When you see<br />

Low vision speakers Claire Fizgerald, Dr Mary Butler, John Veale and Gail Hughes<br />

what they have to overcome every day, it’s a whole<br />

new ball game.”<br />

Blind Foundation reaches out<br />

Orthoptist Claire Fitzgerald, from the Blind<br />

Foundation, reiterated the Foundation’s goal to<br />

reach and help more low vision people and spread<br />

the word that the Foundation is not just about blind<br />

people anymore. “Only 4% of our 12,500 clients are<br />

totally blind.”<br />

Yes, people still have to have an assessed visual<br />

acuity not exceeding 6/24 or serious limitations<br />

in the field of vision to become a client, but the<br />

Foundation’s Prevalence Study indicated there are<br />

more than 29,000 people eligible for its help, and it’s<br />

currently not even reaching half of that.<br />

Fitzgerald also stressed the Foundation is now<br />

more open to monitoring or at least keeping a list<br />

of those who aren’t eligible today, but are likely to<br />

be eligible in the short to medium term, so they can<br />

also receive help.<br />

The seven ages of low vision<br />

Associate Professor Gordon Sanderson from the<br />

Department of Ophthalmology at Otago University,<br />

closed the day with an amusing speech looking at<br />

the seven ages of low vision from the difficulties of<br />

identifying it in the very young, through to dealing<br />

with it through the school years, the working years<br />

and finally into old age.<br />

“Low vision is not just about trying out lots of<br />

equipment…it’s all about what fits,” he said, adding<br />

that it’s appalling how little is spent on road safety<br />

for low vision people in New Zealand. ▀<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

25


My Cambodian Journey<br />

BY MIKE WEBBER*<br />

Rose Charities New Zealand, part of Rose<br />

Charities International in Canada, have been<br />

involved in improving facilities and eye care at<br />

an eye clinic in Phnom Penh, Cambodia, since 2005.<br />

Some background<br />

The clinic was started in the late 1990s by Rose<br />

Charities International founder Dr William Grut<br />

of Canada and Dr Basant Sharma, a Nepalese eye<br />

surgeon, who went on to employ former Cambodian<br />

gynaecologist, Dr Hang Vra, who they re-trained in<br />

basic ophthalmology and extracapsular cataract<br />

surgery. The clinic was robbed of all its surgical and<br />

examination equipment in 2002, but struggled on<br />

with basic equipment supplied by Rose Canada.<br />

This situation was remedied by Kiwi optometrist<br />

John Veale, a Rose Charities NZ trustee, who was<br />

passing through Cambodia in 2004 and saw<br />

the difficulties the clinic was working under.<br />

He persuaded Rose Charities NZ to take up the<br />

challenge of supplying new and better equipment<br />

and upskilling Dr Vra and his team in all areas<br />

of ophthalmic examination, treatment, surgery,<br />

refractive skills and prescribing.<br />

Dr David Sabiston and I, both new Rose Charities<br />

NZ trustees at the time, then went to Cambodia on<br />

what was basically a fact-finding trip. We found a<br />

very poorly equipped clinic being run by a wonderful,<br />

dedicated man, Dr Vra, and good staff. David set<br />

about upskilling Dr Vra in examination techniques<br />

and increasing his knowledge of ophthalmic<br />

pathology and cataract surgery, commenting at the<br />

time that he had never seen a better pair of hands<br />

undertaking eye surgery. I spent my time teaching<br />

refraction techniques and the prescribing of<br />

spectacle Rx’s to other members of the team. David<br />

and I also made a list of equipment required to help<br />

improve the clinic’s ophthalmic capabilities. At that<br />

time there were only 14 registered ophthalmologists<br />

and 12 registered optometrists to service a<br />

population of 15 million people in Cambodia.<br />

We made another trip over in 2006 with new<br />

equipment, bought with funds raised in New<br />

Zealand, when we supervised the upgrading of the<br />

operating theatre, which had been in a very poor<br />

condition, and set about further upskilling the staff.<br />

The reputation of the clinic had spread and we were<br />

now seeing between 60 and 100 patients a day, with<br />

about 10 to 15 cataract operations performed each<br />

afternoon. There were two tables in the theatre, and<br />

visiting eye surgeons would help Dr Vra with the list.<br />

The support<br />

Over the intervening years, some $300,000<br />

worth of new and used equipment has been<br />

sourced and sent from New Zealand, with many<br />

noteworthy donations including a Millennium<br />

Phaco machine from Dr Jim Borthwick and his<br />

colleagues a few years back and an A-scan from Dr<br />

Geoff Duff. I also managed to score a Moller-Wedel<br />

operating microscope in perfect order from the Eye<br />

Department at Wanganui DHB after it had upgraded<br />

to a newer model.<br />

Since 2005, I have made 13 visits to Cambodia and<br />

have sometimes been accompanied by volunteer<br />

ophthalmologists. David made four trips until 2008<br />

when for health reasons he had to give up; Dr Ewan<br />

Fraser made two trips in 2012 and 2013 to teach<br />

vitreoretinal treatment and surgery; while Dr Rob<br />

Weatherhead came in 2015 to teach oculoplastics. In<br />

2015 and 2016, Dr Muhammad Khalid accompanied<br />

me to teach vitreoretinal treatment and surgery; and<br />

last but not least, John Veale made three working<br />

trips during this time.<br />

All this has resulted in Dr Vra and his recentlyqualified<br />

ophthalmologist wife Dr Natalia, a former<br />

Ukranian nurse, becoming reasonably highly-skilled<br />

practitioners in their country.<br />

Rose Charities NZ is very grateful to the<br />

aforementioned ophthalmologists who voluntarily<br />

have given their time and services to enhance this<br />

project and help the people of Cambodia.<br />

Over the years some major advances have<br />

taken place in the eye care scene in Cambodia.<br />

Two of note, both in 2008, were the inception<br />

of a three-year ophthalmology training course,<br />

which included significant input from RANZCO,<br />

and a course to train ophthalmic nurses in basic<br />

refraction techniques, started up, with some<br />

encouragement from me, by the team at the<br />

Brien Holden Research Institute, which still has<br />

an office in Phnom Penh, and some Cambodian<br />

agencies.<br />

Another event of note occurred in 2012, when<br />

Introducing the new NZOSS exec<br />

BY ALICIA HAN, NZOSS <strong>2017</strong> PRESIDENT<br />

Hello and welcome from the <strong>2017</strong> New<br />

Zealand Optometry Students Society<br />

(NZOSS) executive.<br />

The NZOSS was established in 2013 and serves<br />

as a platform between our peers, past students,<br />

future colleagues and professionals in the wider<br />

optical industry. From a great initiative, and<br />

perhaps humbler beginnings, the NZOSS has<br />

flourished and grown steadily with every year.<br />

Now here we are in <strong>2017</strong>. We have added two<br />

new roles to the executive committee and, despite<br />

it being not so long ago when we<br />

first started working together, we<br />

are already running like a welloiled<br />

machine - our meetings filled<br />

with fresh ideas, enthusiasm and<br />

refreshing puns.<br />

The new executive team is<br />

excited and ready to continue the<br />

tradition of fun and academia,<br />

including annual events such<br />

as camp, Round The Bays,<br />

educational seminars, quiz nights<br />

and the EyeBall, to name but<br />

a few. The first-ever monthly<br />

NZOSS newsletter is currently<br />

in production and we have<br />

introduced a wine and cheese<br />

night, networking evenings and the Auckland<br />

Marathon, with regular training during the year<br />

via an optometry run club. We have also created<br />

an “Optom Buddy” system for supporting newer<br />

students and to bridge the gaps between year<br />

levels.<br />

If you have suggestions, ideas, would like to<br />

contribute to our newsletter or find out more<br />

about our events, please email us at nzoss.uoa@<br />

gmail.com. All welcome!<br />

It is looking to be a promising year, and we look<br />

forward to sharing it with you. ▀<br />

The <strong>2017</strong> NZOSS executive (L to R): Darina Khun, Nick Stuhlmann, Nick Lee, Gemma Ji,<br />

Katarina Marcijasz, Alice Jackson, George Stewart, Marna Claassen, Alicia Han, Andrew Kim,<br />

Menaga Manokaran<br />

Australian-Cambodian businessman Henry Ngai of<br />

ABC Tissue Products offered to give US$40 for every<br />

cataract operation carried out to 2018 to support the<br />

work of the clinic.<br />

Rose Charities Cambodia have a second clinic now,<br />

built and mostly funded by Dr Vra and his wife, and<br />

a Russian friend of theirs. This second clinic does see<br />

poor patients, but also targets the more affluent<br />

patients who pay private fees, which helps augment<br />

the costs of serving the poorer patients.<br />

Our 2016 trip<br />

Our trip last year started with a laugh. Dr<br />

Muhammad Khalid missed his connecting flight from<br />

Christchurch to Auckland, due to suffering a flat tyre<br />

driving from Timaru to Christchurch airport. Not to<br />

be deterred, flights were rejigged and he arrived in<br />

Phnom Penh just a day later. This trip did have some<br />

frustrations, however, as an allegedly not-altogetherhonest,<br />

lower-order bureaucrat forced Rose Charities<br />

to vacate the building it had used for nigh on 20<br />

years, and move all its equipment during the time<br />

we were there. This was quite a distraction for Dr<br />

Vra and his team. Muhammad, however, was able<br />

to spend some time teaching correct retinal lesion<br />

diagnosis techniques and demonstrating some of<br />

the finer points of vitreoretinal surgery. Since my first<br />

visit in 2005, we have noticed a significant increase<br />

in the presentation of diabetic retinopathy, resulting<br />

in the purchase of an Argon laser in 2013. Most of my<br />

time on this visit, however, was spent on fine tuning<br />

refraction techniques and planning future strategies<br />

for the clinics. We had one really busy Sunday,<br />

however, when five of us examined and screened<br />

290 villagers at an outreach clinic in the countryside.<br />

From this, 70 patients were identified and brought<br />

back to the clinic in Phnom Penh for cataract surgery<br />

and other forms of treatment, many in the Rose<br />

truck, funded by money raised in Whanganui.<br />

In summary, my Cambodian journey has been<br />

a challenging but rewarding and fascinating<br />

experience. ▀<br />

* Mike Webber MNZM is a well-known, retired Kiwi optometrist<br />

who, over the past 45 years, has enjoyed being involved in 36<br />

overseas, voluntary eye care trips to Kenya, the Pacific and<br />

Cambodia to help provide eye care to those who can’t afford or<br />

access it. This was “probably” his last trip, he says.<br />

ODMA Fair ups the ante<br />

Facing competition for the first<br />

time from new rival, Silmo<br />

Sydney, the <strong>2017</strong> ODMA<br />

Fair organisers are promising “to<br />

deliver the very latest in fashion,<br />

innovation and technology.”<br />

New for the <strong>2017</strong> Australian<br />

industry-owned fair is ‘Design<br />

Junction’, a showcase of premium<br />

high-end international and<br />

Australian eyewear brands. “All<br />

the major equipment and lens<br />

companies are already confirmed and have been<br />

joined by frame and sunglass brands like Tom Ford,<br />

Jono Henessy, Face à Face, Lafont, and Salvatore<br />

Ferragamo to name a few,” said organisers in their<br />

latest press release. “A special feature of Frame<br />

MORE CLASSIFIEDS ON PAGE 28<br />

Dr Muhammad Khalid discussing the diagnosis of a retinal pathology<br />

with Drs Hang Vra and Natalia and a patient<br />

Fashion Week, ODMA<strong>2017</strong> will be<br />

transformed with new features<br />

and many exciting attractions,<br />

promoting ODMA<strong>2017</strong> as<br />

Australia’s key buying fair.”<br />

Details of speakers are also<br />

beginning to emerge for the<br />

ODMA17 Vision Summit, with<br />

Professor John Marshall, the Frost<br />

Professor of Ophthalmology from<br />

University College London, now<br />

confirmed as a keynote speaker.<br />

ODMA<strong>2017</strong> will take place from 7-9 July <strong>2017</strong><br />

at the Sydney International Convention Centre in<br />

Darling Harbour. ▀<br />

Read Chalkeyes take on ODMA<strong>2017</strong> vs Silmo<br />

Sydney on p27.<br />

FULL TIME - DISPENSING OPTICIAN<br />

SPECSAVERS SYLVIA PARK<br />

We are looking for an experienced dispensing optician to join our three room practice at Specsavers<br />

Sylvia Park. This is a great opportunity to work in a central location in Auckland. Competitive Salary<br />

and bonus package based on experience. Great training opportunities available through Specsavers on<br />

management and leadership. Specsavers experience is not essential. Please email Ryan Mahmoud at<br />

dir.sylviapark.nz@specsavers.com or call 021 166 5899.<br />

Stars and their eyes: Dame Judi Dench<br />

In 2012, enigmatic star of stage and screen Judi Dench<br />

announced she had age-related macular degeneration. Her<br />

mother suffered with the same condition.<br />

“I’m not going to make it something that’s going to stop me,” the<br />

82-year-old told People magazine in March 2015, but she admits<br />

she can no longer travel on the London Underground on her own<br />

and finds her favourite pastime of painting increasingly difficult. She<br />

overcomes her visual problems at work by having her scripts printed<br />

in a larger font, and has kept a sense of humour about it.<br />

“If six of us were coming in to read a sonnet they’d all have one<br />

piece of paper and I’d have two or three,” she told People. “They’d<br />

think, ‘why does she have a bigger part?’” ▀<br />

Dame Judi Dench<br />

26 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>


SILMO Sydney vs ODMA<br />

by<br />

Chalkeyes<br />

dancing,<br />

Every second year, many of us venture<br />

across the Tasman to attend the ODMA<br />

Fair, Australia’s largest optical exhibition.<br />

We weigh up the benefits, timing and costs of<br />

boarding the plane with order book in hand. The<br />

only questions being to go or not to go and how<br />

much do we spend?<br />

But in <strong>2017</strong> the Aussie tradeshow landscape<br />

is presenting us with a quandary; we now have<br />

two tradeshows to choose from – the ODMA Fair<br />

(7-9 July) and Silmo Sydney (9-11 March) – both<br />

held at the new International Convention Centre<br />

in Sydney. So the question many of us are now<br />

asking is which show do we attend?<br />

Since 1979, the ODMA Fair has been held<br />

every two years by the Optical Distributors &<br />

Manufacturers Association of Australia (ODMA).<br />

The members of ODMA are wholesale optical<br />

industry organisations whose wares include<br />

lenses, optical frames, sunglasses and equipment.<br />

ODMA’s mission is to “strengthen, support and<br />

grow the optical industry for the benefit of its<br />

members.”<br />

The new kid on the block is Silmo Sydney;<br />

though Silmo is far from new having run the large,<br />

internationally well-known Paris optical fair of the<br />

same name for 50 years this November. The 2016<br />

Paris show boasted 900 exhibitors and 34,000<br />

visitors over its four-day duration. Having reached<br />

capacity, Silmo’s owners have been looking<br />

overseas for expansion opportunities for some<br />

years. They launched Silmo Istanbul in 2015 and<br />

have now followed with Silmo Sydney.<br />

So with an oft-commented on shrinking<br />

Australian and New Zealand independent<br />

market, how have we come to the stage where<br />

it’s considered viable to hold two large optical<br />

tradeshows at the same place, in the same year?<br />

History provides some insight into how we arrived<br />

at this point. Silmo Sydney organiser, Expertise<br />

Events, managed the ODMA Fair in 2013 and 2015.<br />

Then after an allegedly somewhat acrimonious<br />

falling out, Expertise Events approached and<br />

partnered with Silmo to create Silmo Sydney and<br />

ODMA appointed rival events company, IEC Group,<br />

and, taa daa, we now have two large optical<br />

tradeshows in one year to mull over.<br />

So who’s exhibiting?<br />

Some of us attend tradeshows to purchase<br />

new season frames. Some of us attend to buy<br />

equipment. We also like to investigate industry<br />

innovation such as new technology and services.<br />

Examining exhibitor lists indicates the types of<br />

exhibitors we can<br />

expect to see at<br />

each show. These<br />

lists are evolving<br />

day-by-day, but<br />

it does provide<br />

some direction.<br />

On 2 January<br />

(so there’s still<br />

some time<br />

to go), Silmo<br />

Sydney listed 36<br />

exhibitors on its The last ODMA Fair<br />

website. Twothirds<br />

of these are frame or sunglass suppliers, so<br />

there’s relatively few equipment or lens suppliers,<br />

and around 40% have not exhibited at recent<br />

ODMA Fairs.<br />

In contrast, the <strong>2017</strong> ODMA Fair had 47<br />

exhibitors listed on its website. Frame or<br />

sunglass suppliers make up about 40%, with the<br />

remainder being the major equipment companies<br />

and several lens companies. The majority<br />

(approximately 90%) have participated in past<br />

ODMA Fairs.<br />

So at this stage, Silmo Sydney has more frame<br />

suppliers than ODMA, while the ODMA Fair has<br />

significantly more equipment and lens suppliers.<br />

Interestingly though, Silmo Sydney appears to<br />

have attracted far more ‘new’ exhibitors not seen<br />

at recent ODMA Fairs.<br />

We must feel some empathy for industry<br />

suppliers. Participating in a tradeshow is a costly<br />

business. While some companies may get away<br />

with only spending $10K on a small stand, others<br />

can spend up to $200K. Seriously! So it’s little<br />

wonder few suppliers’ budgets will extend to both<br />

the ODMA Fair and Silmo this year. Their marketing<br />

and exhibition budgets haven’t doubled, so they<br />

are faced with a similar quandary.<br />

What’s their focus?<br />

With more frame suppliers and the Silmo brand<br />

association, it appears Silmo Sydney is positioning<br />

itself more as a fashion show with the brand<br />

statement, “where fashion meets function”. It<br />

is also shaping up to have a strong retail focus<br />

through its partnership with the National Retail<br />

Association, which should (if done well) provide<br />

valuable retailing and merchandising ideas for<br />

practices. Plus, it’s looking a little more “rock’n’roll”<br />

than ODMA with its relatively heavily marketed<br />

Saturday night event, Silmo Sydney’s Mega Rox<br />

Party, which is being touted as an evening of<br />

drinking<br />

and dining,<br />

without the<br />

normal awards or<br />

speeches!<br />

Looking at<br />

ODMA’s exhibitor<br />

list, it appears<br />

to have more<br />

of a focus on<br />

equipment and<br />

lenses, which is<br />

in keeping with<br />

its membership,<br />

though frame and sunglass suppliers still make<br />

up about 40% of the Fair’s current floor space, but<br />

there is a lot longer to go to July. Tradition lends<br />

itself to the assumption that the ODMA Fair is<br />

not focusing on being a ‘fashion’ show, but then,<br />

it is making moves to try to change this (how<br />

much of this change results from Silmo Sydney’s<br />

appearance can only be guessed at) with a new<br />

area called ‘The Design Junction’ to showcase<br />

exhibitors’ premium frame brands. This is being<br />

promoted as part of Australia’s inaugural Frame<br />

Fashion Week (July 1-10), details of which are still<br />

unclear, though it appears the audience is only<br />

trade, not consumers. While the usual ODMA gala<br />

dinner, with speeches and awards, appears (at this<br />

early stage at least) to have been dropped?!<br />

Is there an educational element?<br />

Optometry Australia is the optometrist association<br />

in Australia. Each of the state branches typically<br />

run CPD education events each year. The largest<br />

is New South Wales’ Super Sunday event, which<br />

this year has partnered with Silmo Sydney. Two<br />

conference streams, including 18 educational<br />

sessions, representing 53 Australian CPD points<br />

will be available to delegates. At the time of going<br />

to press, however, no application had been made<br />

for CPD points for Kiwis. Few details are presently<br />

available, but it looks like the topics will be<br />

business and retail-related.<br />

The ODMA Fair included a conference programme<br />

for the first time in 2013 with 30 CPD points on<br />

offer in 2015 and four CD and five general credits<br />

available to New Zealand delegates. ODMA is<br />

including a conference this year, though again little<br />

detail is available and no New Zealand CPD points<br />

as yet applied for, though I suspect they will be<br />

available if they adopt the 2015 model. There will<br />

also be masterclass sessions which typically focus<br />

on dispensing and business topics.<br />

The overall feel?<br />

For some of us, the place, ambience and<br />

atmosphere of an event is also a factor for<br />

consideration. Not a deciding factor, but certainly a<br />

consideration given the time and financial costs of<br />

attending a show. Given they are both in Sydney, at<br />

the same conference venue, place isn’t much of a<br />

consideration this time (though one is being held in<br />

summer and one in winter).<br />

But in my humble opinion, and this is only one<br />

industry participant’s view, ODMA has grown a<br />

little tired. Nothing surprising happens. Granted,<br />

it is much smaller than the big international fairs,<br />

but it doesn’t even come close to the energy and<br />

excitement of Mido in Milan or Silmo in Paris.<br />

Hopefully Silmo Sydney will emulate some of the<br />

Silmo Paris magic (the 2016 event captured well in<br />

the pages of our own NZ Optics last year). At this<br />

stage, Expertise Events certainly appears to have<br />

more control over the Silmo Sydney event than<br />

ODMA’s event organiser IEC, which should result in<br />

a more dynamic and enjoyable experience.<br />

Decisions, decisions?<br />

Identifying your main objective for attending a<br />

show should solve some of your ODMA Fair versus<br />

Silmo Sydney quandary.<br />

For example, if you’re into frames with all the<br />

new frame exhibitors and focus on fashion at Silmo<br />

Sydney that would probably be the best choice.<br />

Whereas if it’s a new OCT you’re after, or any other<br />

bigger pieces of technology, the ODMA Fair is a clear<br />

winner with most of the major equipment suppliers<br />

signed up, giving you a great platform to compare<br />

brands in one place. Education is tricky as neither<br />

has applied for NZ CPD points yet and we aren’t<br />

short of educational events in either market. And<br />

finally, there’s the ambience thing, which is also<br />

difficult to gauge as this is Silmo Sydney’s inaugural<br />

event. But in this individual’s mind at least, the<br />

newcomer looks like it’s shaping up to be something<br />

new and fun, and it is being held in Sydney’s<br />

summer months. So I have chosen Silmo Sydney. If I<br />

lament my decision, I can at least do so in the balmy<br />

harbourside weather with wine in hand.<br />

Cheers! ▀<br />

The views expressed by Chalkeyes are his, or<br />

hers, alone and not necessarily the views of NZ<br />

Optics. If you wish to comment on Chalkeyes’<br />

views, please email a brief letter to the editor<br />

at info@nzoptics.co.nz for consideration.<br />

REVOLUTIONARY MAGNETIC CLIP-ON FRAMES FROM E-YES<br />

Polarised, fashionable and sleek, e-yes frames and clip-ons are made from ultem,<br />

a strong, light, heat and solvent-resistant polymer material, making them both<br />

lightweight and comfortable to wear, with no unsightly magnets. Additional clips<br />

are available for customers who need a pair in the car and in the boat.<br />

For more, contact Cardinal Eyewear at www.cardinal.co.nz<br />

<strong>Feb</strong>ruary <strong>2017</strong><br />

NEW ZEALAND OPTICS<br />

27


OUR EXPANSION…<br />

YOUR CAREER GROWTH<br />

A MUTUAL OPPORTUNITY<br />

As the Specsavers network of 370 Australian and New Zealand stores<br />

continues to experience significant growth, opportunities abound in<br />

many locations across both countries for career focussed optometry<br />

and dispensing professionals.<br />

OPPORTUNITIES NOW AVAILABLE…<br />

Last financial year Specsavers New Zealand grew<br />

significantly and already this year we are seeing further<br />

growth – which presents ongoing opportunities for<br />

optometrists in the following locations:<br />

NORTH ISLAND<br />

• Chartwell<br />

• Henderson<br />

• Lower Hutt<br />

• Masterton<br />

• Mt Maunganui<br />

• Palmerston North<br />

• Paraparaumu<br />

• Wellington CBD<br />

South<br />

• Whakatane<br />

SOUTH ISLAND<br />

• Dunedin<br />

• Invercargill<br />

• Shirley<br />

We are currently also seeking experienced dispensers in a<br />

number of our New Zealand stores.<br />

To find out more, contact Chanelle Coates on<br />

0800 717 350 or chanelle.coates@specsavers.com –<br />

or visit spectrum-blog.com to review all your options<br />

and currently available locations.<br />

PRACTICE FOR SALE TAURANGA<br />

Want to work and live in a holiday paradise? <strong>2017</strong> is a great year to<br />

pursue your dream. The practice is well situated with very high<br />

traffic. Turnover is increasing annually with excellent potential in<br />

the fast growing Tauranga. Single testing room fitted with state-ofthe-art<br />

equipment. From BIO to topographer to retinal camera<br />

simply walk in and work! Tauranga, ‘NZ’s mini Gold Coast’ is a<br />

coastal resort town, which enjoys great weather all year round.<br />

Only walking distance to beautiful beaches and mountains; you<br />

can surf, swim, play golf, shop and dine. Reasonably priced with<br />

genuine reasons for selling. Confidentiality assured.<br />

Please email mtmaunganui@hotmail.com<br />

PRACTICE FOR SALE AUCKLAND CBD<br />

Live the dream and own your own practice in the heart of Auckland<br />

City. Be your own boss and practice independent optometry. Great<br />

loyal customer base that appreciate personal and professional<br />

eyecare as well as offering contemporary eyewear. The store is<br />

attractive with current quality stock, versatile display units and a<br />

modern, well optimised website. Don’t miss out on this great<br />

opportunity as a business like this rarely comes up for sale.<br />

Contact: Tony Davenport 027 555 5938<br />

Email: tonyd@clythbiz.co.nz<br />

CLYTH MACLEOD LIMITED<br />

Licensed Agent REAA 2008<br />

MORE CLASSIFIEDS ON PAGE 26<br />

NEED TO REPLACE<br />

YOUR LETTER CHART?<br />

AcuityKit has a comprehensive range of digital eyecharts for eyecare<br />

professionals. Ideal for low vision and domiciliary work.<br />

Visit our website www.acuitykit.com or email john@acuitkit.com<br />

CHOOSE YOUR<br />

AUSSIE ADVENTURE<br />

WE SEE YOUR<br />

FUTURE WITH US<br />

At OPSM, we are passionate about opening eyes to<br />

the unseen. Our advanced technology enables us to look<br />

deeper to ensure we give the best care to every customer.<br />

At OPSM, we are passionate about opening eyes to<br />

the unseen. Our advanced technology enables us to look<br />

deeper to ensure we give the best care to every customer.<br />

OPTOMETRISTS<br />

QUEENSLAND AND NORTHERN TERRITORY<br />

WITH ATTRACTIVE SALARY PACKAGES<br />

We are looking for Optometrists who share our passion<br />

and want to make a difference to how people see the<br />

world. Whether you like the city, the surf or the outback,<br />

we’ve got the role for you with our teams in:<br />

• Bundaberg<br />

• Darwin<br />

• Katherine<br />

• Mackay<br />

• Mt Isa<br />

• Toowoomba<br />

• Townsville<br />

JOIN OUR TEAM<br />

You can look to take on a fixed period role or even<br />

consider a more permanent move - who knows, you might<br />

fall in love with the place. Depending on the location,<br />

salary packages up to 175K including superannuation,<br />

accommodation, annual return flights to visit family and<br />

friends and relocation support for the right candidate.<br />

Start your journey with us today! Graduates or recent<br />

graduates are very welcome to apply.<br />

CONTACT:<br />

Brendan Philp<br />

brendan.philp@luxottica.com.au or call +61 418 845 197<br />

Kim Shepherd<br />

kim.shepherd@opsm.com.au or call +61 408 763 575<br />

OPSM.COM.AU/CAREERS<br />

OPTOMETRISTS<br />

NORTH & SOUTH ISLAND, NEW ZEALAND<br />

Our New Zealand business is looking for passionate<br />

Optometrists to join the team.<br />

• Whangarei – full time<br />

• Wellington Float – full time<br />

• Thames – full time<br />

• Dunedin – full time<br />

• The Plaza – full time<br />

• Napier/Hastings – 32 hours per week<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 work<br />

with world class technology including our exclusive<br />

Optos Daytona ultrawide digital retina scanner. You<br />

will have many opportunities for continuing professional<br />

development and can enjoy career flexibility through<br />

our extensive store network. You can also make a<br />

real difference in the way people see the world by<br />

participating in our OneSight outreach program.<br />

JOIN OUR TEAM<br />

Start your journey with us today! Recent graduates are<br />

very welcome to apply.<br />

CONTACT:<br />

Hirdesh Nair<br />

hirdesh.nair@opsm.co.nz or call +64 21 523 282<br />

Robbie Singh<br />

robbie.singh@luxottica.com.au or call +64 21 750 847<br />

OPSM.CO.NZ/CAREERS<br />

LX21_OPSM_NZOpticsAU_Advert_A4.indd 1<br />

12/1/17 7:47 am<br />

LX21_OPSM_NZOpticsAdvert_A4.indd 1<br />

11/1/17 11:07 am<br />

28 NEW ZEALAND OPTICS <strong>Feb</strong>ruary <strong>2017</strong>

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!