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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 />







© 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>


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

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

a bang!<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 />


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 />



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



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


A UNIQUE<br />






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

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Founder & CEO, AFT Pharmaceuticals<br />

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www.aftpharm.com<br />

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



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 />


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 />


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 />


Cataract, glaucoma<br />

Dr Robert Weatherhead<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 />

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



News<br />

in brief<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 />


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 />


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 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 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 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 />


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 />


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>




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 />



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


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 />


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 />


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

RANZCO’s 48th Scientific Congress<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 />


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 />


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the regular slit lamp<br />

examination.<br />

Intuitive software<br />


11<br />

ADV_Eurotimes_FM300_QR_ESCRS16_V1.indd 1 27.10.2016 12:14:14


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 />

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

Orthoptics at<br />

RANZCO 2016<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 />


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



TECNIS ®<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 />


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 />


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


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 />


Video Atlas of Oculofacial Plastic and<br />

Reconstructive Surgery, 2nd edition<br />

by Bobby S. Korn, Don O. Kikkawa. Published by Elsevier<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 />

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



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 />



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 />


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 />


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 />


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 />



* 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 />


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 />


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 />



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 />


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 />


Confidence behind the wheel with Rodenstock Road driving glasses.<br />

See better. Look perfect.<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 />


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



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 />


. 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 />


. No registration fee<br />

. CPD points available<br />

Dr Andrew Riley<br />


Dr Mark Donaldson<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 />



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 />


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 />




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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 />

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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 />

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Supported by:<br />

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



Style-Eyes<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>





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



with<br />

Prof Charles McGhee<br />

& A/Prof Dipika Patel<br />

Series Editors<br />

Central serous chorioretinopathy<br />

update<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 />


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 />



My Cambodian Journey<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 />


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 />



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 />


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For more, contact Cardinal Eyewear at www.cardinal.co.nz<br />

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


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 />


• Chartwell<br />

• Henderson<br />

• Lower Hutt<br />

• Masterton<br />

• Mt Maunganui<br />

• Palmerston North<br />

• Paraparaumu<br />

• Wellington CBD<br />

South<br />

• Whakatane<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 />


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 />

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Please email mtmaunganui@hotmail.com<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 />


Licensed Agent REAA 2008<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 />





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 />




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 />


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 />




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 />


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 />


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

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