March 2017

Focus
on Business
BDO: Protecting business
secrets from cyber threats
A
company was busily preparing
its tender document for a
major project – unaware
spying eyes from a foreign country
were watching through a cybersecurity
infiltration of their network.
Leon Fouche, BDO’s Australasian
leader in cyber-security, says this
does not only happen in movies. This
is a real cyber threat happening to
New Zealand companies – a threat
to which no entity – even small scale
clinical practices – is immune.
According to Leon, BDO has
been involved in cyber intrusion
investigations similar to this. In one of
these investigations, a BDO client was
going through a large merger and
acquisition process when they alerted
BDO that a foreign body had been in
their network for a number of months
before they became aware of it.
The company was able to clean the
intruder – which had been looking
for information to advantage its own
tender – out of the network.
The potential disaster was
contained, but this and other forms of
cyber-crime are already costing New
Zealand millions of dollars.
Internet security company Netsafe,
in its 2015 report, estimated cybercrime
as totalling between $250m
and $400m annually. New Zealand
law does not require companies to
report cyber-crime, so many don’t.
Few admit to a breach that could
damage their brand, business and
customer trust.
Netsafe reported 8,570 cyber
attacks in New Zealand last year,
costing $13.4m – with the biggest
attack costing the target just over
$2m. But that only covers known
breaches. Netsafe estimates that’s
only about 4% of all cyber-crime.
I take Fouche’s warnings very
seriously. His long list of cybersecurity
credentials includes
establishing and running a cybersecurity
programme for the
Australian Government’s hosting of
the G20 summit in 2014. His view
of cyber-crime is that there are only
two kinds of companies in the world
– those who have experienced a data
breach and those who don’t know
they’ve already been breached.
But most alarming is that whilst
this is a big problem, so many
companies just accept it as a fact of
life and don’t do much about it. Yet
a cyber breach can not only damage
a business – it can close it. This point
is most pertinent to optometrists as
you are in a business that is founded
on trust, and if you lose the trust of
your customers because your data
and their privacy has been breached,
it can be fatal.
It may be easy to be lulled into a
false sense of security because you
don’t think optometry is a line of
business that one of the four main
kinds of hackers would target –
activists making a political or social
point; cyber-criminals for whom
money is the motivation; statesponsored
hackers seeking a political
or commercial edge; and those who
use disgruntled employees or human
error to gain access to a company’s
network and data.
Yet, as Fouche warns, it is not
only large multinational companies
that are at risk. Indeed, two recent
BY DAVID PEARSON*
examples prove that any New
Zealand entity is susceptible to these
attacks. In July 2016, Fairfax Media
reported that Hunting and Fishing’s
website had been targeted by
hackers who were seeking customer
information. As a result their website
was shutdown including all online
trading activity. As of the end of
September, they were still offline as
they have been unable to guarantee
the security of customer details,
including payment information. At
the other end of the scale, a small
Wairarapa business was the target of
a crypto-ransomware attack, where
the hacker attempts to encrypt
valuable files and demand a ransom
in return for decrypting them.
One of the best defences against
crypto-ransomware attacks is
ensuring your staff are vigilant when
receiving unsolicited emails with
suspicious attachments. This is the
most common method of infiltrating
a business and antivirus software
won’t always keep pace with the
latest methods used by the hackers.
An employee who opens a suspicious
attachment can unknowingly
release one of these viruses into the
company’s network.
BDO had a specific incidence of this,
where one of our optometry clients
had exactly that happen to them.
Luckily BDO’s in-house IT specialist
was able to recover their data with
minimal disruption to the business. A
potentially destructive event became
nothing more than a minor headache.
This was largely due to the ongoing
relationship we have with the client
and the backup processes that we
had previously implemented for them
in case of this type of event occurring.
The threat is now at the point
where cyber insurance is just as
important as building, general
liability or professional indemnity
insurance. Equally important is the
implementation of robust backup
procedures, appropriate malware
and antivirus protection and keeping
network infrastructure up-to-date. As
noted above, staff are an important
line of defence and password
strength is also key to this. The more
complex the password, including
upper and lowercase letters, numbers
and symbols, the more exponentially
difficult it becomes for a hacker to
crack. Finally, the maintenance of
current software protection versions
is essential as with all technologies,
the pace of change is significant. ▀
Written in conjunction with Leon
Fouche – National Leader of Cyber
Security, Brisbane.
ABOUT THE AUTHOR:
* David Pearson is managing partner with
BDO Central and has a speciality interest in
advisory services to the optometry sector.
For more
information
contact David at
david.pearson@
bdo.co.nz or visit
www.bdo.nz
Myopia Control – is it the new
standard of care?
One measure of how significant the discussion around
myopia control has become was illustrated by the
American Academy of Optometry holding a joint
AAO/ARVO symposium on the first morning of its November
2016 annual conference titled ‘Control vs Correction of
Early Myopia: Has the Standard of Care Changed?’. This
question reflects the current state of evidence supporting
the use of optical
and pharmacological
interventions to
reduce the progression
of myopia and
environmental
interventions to reduce
the incidence of new
cases of myopia. It
challenges practitioners
to consider whether
simply correcting myopia
by prescribing glasses
or contact lenses for
children and adolescents
showing progression is a
sufficient management
option or should advice
regarding myopia
control also be provided
to the patients and their
caregivers from the
onset.
High myopia, often
taken as a refraction
greater than -6DS, has
long been recognised
as being associated with sight-threatening conditions
including myopic maculopathy, retinal detachment, cataract
and glaucoma. However, this threshold is arbitrary and even
low to moderate degrees of myopia increase the risk of such
conditions developing. Furthermore, while high myopia has
been considered to be more genetic than environmental in
origin, the rapid increase in prevalence of myopia in East
and Southeast Asia over the last few decades has revealed a
new pattern of development of high myopia 1 . In this pattern,
high myopia develops at around 11 years of age, due to the
onset of common (or school) myopia at 6-7 years of age,
associated with a relatively high progression rate of -1D per
year or greater. This form of rapidly progressing common
myopia appears to be associated with the adoption of an
intensive and prolonged education system. While the current
“epidemic” of myopia is commonly associated with Asian
countries and states, a similar association between extensive
academic education and myopia was also noted over 150
years ago in Germany by the ophthalmologist, Hermann
Cohn 2 .
While a few dioptres of myopic refractive error may even
be considered quite useful once presbyopia has developed,
the aim of myopia control is to identify early signs of myopic
progression in children and adolescent patients and offer an
appropriate myopia control option with the aim of reducing
the rate of progression, and hence the final degree of myopia
developed in adulthood. The overall aim is to reduce the
future risk of loss of sight due to myopic maculopathy and
associated conditions. Current evidence-based myopia
control options, which have been shown in controlled studies
to reduce myopia progression, can be divided into optical
(orthokeratology, peripheral/dual focus modifying soft contact
lenses, progressive addition spectacles lens and executivestyle
bifocals) and pharmacological (low concentration/dose
atropine) methods.
Optical control
BY ANDREW COLLINS*
Myopia is now considered an “epidemic” by many commentators
Optical interventions for myopia were traditionally based on
the concept of managing accommodative demand and/or lag
associated with near work and so under-correction of myopia
was often promoted. However, when tested in a randomised
clinical trial (RCT) under-correction actually resulted in a
small, but significant increase in myopia progression relative
to the control group who wore their full refractive correction.
Conversely, myopia correction with progressive addition
lenses (PAL) has been shown to slow myopia progression
by 11-13% in a number of RCT studies, although the clinical
benefit has been considered to be too small to promote as
a clinical intervention. Interestingly, a larger reduction in
myopia progression (39-51%) has been demonstrated in a
RCT using executive-style bifocal spectacle wear, either with
or without base-in prism incorporated in the near segments.
In fact, the observation has been made across a number of
spectacle-based myopia control studies that there appears to
be a positive relationship between the size of near segment
or zone, and the magnitude of the treatment effect. This
observation has led to an alternative hypothesis that such
spectacle lenses may be producing their reduction in myopia
progression by the near segment altering peripheral retinal
defocus when the wearer is looking through the distance
portion of the lens.
The role of peripheral retinal defocus in the control
of refractive development is supported by a number of
experiments in animal models of myopia. In these models,
manipulation of the retinal focal plane so that it lies behind
the retina (hyperopic defocus) promotes a compensatory
axial elongation of the eye, resulting in the development
of a myopic refractive error. Conversely, relative peripheral
myopic defocus (image plane in front of the retina) slows axial
elongation and myopia development, even when the foveal
region is experiencing hyperopic defocus.
These findings have led to a number of optical solutions,
including novel spectacle lens designs, intended to produce
relative peripheral myopic defocus with the aim of reducing
myopia progression. A one-year trial of peripheral defocuscontrolling
spectacle lenses demonstrated that a sub-group of
6 to 12-year-old children with a parental history of myopia did
display significantly less progression (0.29D less) with one lens
design, however, the effect was not statistically significant
across all participants. One possible explanation for the overall
lack of a significant effect is that with spectacles the eyes can
move behind the lens altering the optical effectiveness of the
peripheral defocus-control. For example, when the principal
of peripheral defocus-control was incorporated into a contact
lens correction, a 34% reduction of myopia progression was
found in a similar age group of children 3 .
Further evidence for the potential of optical control of
myopia progression with a novel contact lens design has been
provided by the local research of Drs Nicola Anstice and John
Phillips at the School of Optometry and Vision Science. These
researchers trialled a dual-focus soft contact lens design
where the central distance correction zone was surrounded by
a concentric addition zone to produce simultaneous myopic
retinal defocus. Myopia progression in adolescent children
was reduced by at least 30% in the eye wearing the dualfocus
treatment lens during the first 10 months of the study 4 .
This lens design provided the basis for the CooperVision
MiSight lens which is currently undergoing worldwide clinical
trials (see p6).
Orthokeratology (ortho-k) is typically utilised to correct
myopia by flattening the corneal epithelium overnight to
reduce the effective corneal power during waking hours. A
secondary effect has been identified in several longitudinal
studies where ortho-k has been shown to significantly reduce
myopia progression by up to 45%. As ortho-k lenses flatten the
central cornea, while leaving the peripheral cornea relatively
steeper, the production of relative peripheral myopic defocus
has been suggested as the potential mechanism for the
reduction of myopia progression effect.
A retrospective audit of clinical records from the public
Myopia Control Clinic at the University of Auckland shows
both dual-focus soft contact lens wear and ortho-k were
equally efficacious in controlling myopia progression, with
rates of progression following treatment falling to about 1/10
of the pre-treatment rates in young adolescent patients 5 .
The authors concluded that clinicians, on the basis of current
evidence, should be offering contact lens-based methods of
myopia control to patients at-risk of progression.
Pharmacological control
The ability of atropine to reduce the progression of axial
myopia has been recognised for nearly 150 years. However,
with the commercially available topical 1% concentration,
the side-effects of mydriasis, photophobia and cycloplegia
have limited its use as a myopia intervention. Meta-analysis
of recent RCT studies has convincingly demonstrated that
atropine eye drops in high dose (1% and 0.5%), moderatedose
(0.1%) and low dose (0.01%) can slow the progression of
myopia in children 6 . The demonstration in a number of trials
that the low dose 0.01% atropine has comparable clinical
efficacy, but minimal side effects, when compared to the
higher doses, has led to its use in myopia control by a number
of practitioners in New Zealand. Furthermore, a lower degree
20 NEW ZEALAND OPTICS March 2017