Dec 2015

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

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

<strong>Dec</strong>ember <strong>2015</strong><br />

Platinum Partners Cover3.indd 1<br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 1<br />

16/11/<strong>2015</strong> 11:56:33 a.m.<br />

19-Nov-15 3:26:37 PM


UK OPTOMS!<br />



Go to<br />

spectrum-blog.com<br />

for all the current<br />

opportunities!<br />

With a significant shortage of optometrists being<br />

experienced across the optometry profession<br />

in metro, regional and rural areas, we’re calling<br />

all UK and Irish optometrists currently in<br />

New Zealand and Australia to talk to us. We have a<br />

wide range of opportunities for you to consider.<br />

Across the two countries this year we will open<br />

15 new stores and expand a further 65 stores<br />

with additional consulting rooms and the latest<br />

automated equipment – and we need to beef up<br />

our professional team to meet demand, as it rises.<br />

About you<br />

You’re an OCANZ qualified optometrist and already<br />

working (or due to work) for the length of your<br />

current working visa – but you would like to stay<br />

on for longer, or even permanently.<br />

We can help<br />

If that sounds like you, we should talk.<br />

Lately, more and more OCANZ qualified UK<br />

and Irish optometrists are asking us about<br />

staying in either New Zealand or Australia<br />

for the longer term and we have the<br />

roles available to make that goal a reality<br />

in both countries.<br />

Let’s get the conversation started<br />

Whatever your goal, both short and longer<br />

term, now’s the time to talk to our professional<br />

recruitment team members about the options for<br />

employed and partnership roles – they’re ready to<br />

talk to you right now.<br />

In the first instance contact Raj Sundarjee on<br />

0800 773 077 or raj.sundarjee@specsavers.com<br />

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2 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 2<br />

19-Nov-15 3:26:38 PM

Strategy for<br />

distinction<br />

Coopervision’s Joe Tanner with Indie Grewal<br />

Indie Grewal knew he had to find a point of difference when he<br />

opened his optometry practice in 2001. At the time, the town of<br />

St. Alban’s—a half-hour’s commute north of London—already had<br />

seven practices servicing a population of 57,000.<br />

Grewal started with an idea borrowed from his former employer<br />

to do away with trial frames and lenses, relying strictly on a digital<br />

autorefractor instead. Grewal thought the concept “blew the idea of<br />

eye examination” out of the water, simply because nobody else was<br />

doing it, and that informed his thinking for developing his practice.<br />

“We wanted to take that idea to St. Albans with us,” Grewal told an<br />

audience of nearly 100 optometrists at a presentation in Auckland on<br />

October 14. “I wanted to wow people when they came in for an eye<br />

examination….We took a lot of time in our exams, talking to people<br />

and at first we wondered why they were walking away, but they came<br />

back to us in time, because we had talked to them.”<br />

Grewal’s efforts over the last 15 years helped him survive the global<br />

financial crisis and thrive in a market that by some measures is far<br />

more grinding on independents than in New Zealand. In addition<br />

to corporate chains and online competition, in the UK retailers such<br />

as Wal-Mart also employ optometrists to provide some form of<br />

vision test, relying on the speed of the transaction and reinforced by<br />

economies of scale to turn a profit.<br />

“At Tesco you can have an exam that costs you £15. I can’t see how<br />

they make money unless they are literally churning out customers.<br />

Interestingly, optometrists at Tesco, when they’re not busy , have to<br />

stock shelves,” said Grewal.<br />

Grewal’s presentation, Growing an optometry business in a highly<br />

competitive environment, offered a case study in lateral thinking. The<br />

presentation was part of an antipodean seminar tour, sponsored by<br />

Coopervision.<br />

While Grewal runs an independent practice, it is still part of an<br />

association of 30 practices throughout suburban England, he said.<br />

“I was lucky to have flexibility, as long as I gave them business plans.”<br />

And his plans have evolved over time. With so much competition<br />

from supermarkets, online outlets and chain optometrists (all of<br />

which, according to Grewal, forces them to compete on price) Grewal<br />

and his business partner went for eye exams in another town as a<br />

research exercise.<br />

The two things he said he found were that the big corporate chains<br />

appeared far more interested in selling spectacles than providing<br />

detailed eye exams—indeed, the chains did eye tests for visual acuity,<br />

but not real exams, in his opinion, and the people who examined him<br />

showed no interest in his particular case history, he said.<br />

“Nobody asked me what I did for a living. Nobody asked if I had any<br />

hobbies. Nobody talked to me about contact lenses.”<br />

So, with the information they collected, Grewal set out to find ways<br />

to “prevent our business from sliding.”<br />

To do this, his practice made three major changes: it extended its<br />

examinations from 30 minutes to 40 minutes; they began ordering<br />

contact lenses for every person they examined who needed them; and<br />

they began focusing on age-segments of the market overlooked by<br />

chains, particularly children below 14 years and adults over 45.<br />

With the extended exams, “I had a long time with each person<br />

coming in to find out a little more about them, to get a sense of what<br />

we could do, to create a need or to find something out about them<br />

that they didn’t know there was a visual solution for,” Grewal said.<br />

Stocking up on contact lenses matching patients’ prescriptions<br />

based on the most recent refraction allowed Grewal to have further<br />

conversations. Grewal said that for younger patients, he raises this as a<br />

“soft conversation” with parents.<br />

For older patients, namely presbyopes, the additional examination<br />

time allowed Grewal to measure best sphere, binocularly, as well as<br />

sensory dominance, which to the patient seemed to be simply part of<br />

the basic eye examination. Grewal would ask if the patient had ever<br />

tried contact lenses, and provided trial contacts which he had already<br />

ordered for the patient to walk around with outdoors for ten minutes.<br />

Grewal said the contact lens strategy is a long-term investment that<br />

provides more profitability over time than a pure spectacle business.<br />

The result of Grewal’s overall strategy was that after four years,<br />

the contact lens business has become lucrative, while his spectacle<br />

business has slowly, but inevitably recovered following the impact<br />

of the global financial crisis. Indeed, Grewal’s competition, which<br />

had reached 11 practices in his town in 2011, thinned out following<br />

the crisis and is now down to nine. ▀<br />

Happy holidays and thanks<br />


With the October-November conference season finally over,<br />

we can relax a little heading into the holiday season.<br />

And to be honest a little rest is needed after<br />

experiencing my first end-of-year CPD educational bootcamp-rush<br />

and my first, albeit fascinating and highly educational, RANZCO<br />

Congress, written up in detail in this issue.<br />

Others also marked their own firsts. Essilor held its first<br />

Platinum Partner conference, packed full of tips and ideas to<br />

motivate and help optical business owners. Christchurch Eye<br />

Surgery hosted its inaugural study day, attracting more than 40<br />

participants from across the South Island.<br />

Eye Doctor’s final Grand Rounds was also well-attended and<br />

well-received, while Eye Institute attracted its largest turnout ever<br />

with more than 275 optometrists plus 46 DOs and support staff<br />

to its inaugural DO conference. Read about what happened at all<br />

these events in this issue.<br />

I’d like to extend a special thanks to our columnists and all those<br />

who stepped in to help us with the multitude of happenings<br />

over the last few weeks, especially our wonderful conference<br />

contributors: for RANZCO, Keli Matheos, Sally-Anne Herring and<br />

Sally Rosenberg, who’s channelling a rather good inner columnist;<br />

OPSM’s Zoe Smith for covering OPSM’s Butterfly Creek gathering;<br />

Dr Rebecca Stack for her take on the Christchurch Study Day; Dr<br />

David Kent who was kind enough to point out my muddling of the<br />

AUSCRS and ASCRS acronyms ever so gently; Maryanne for always<br />

having her camera and a introductory hand ready; and finally<br />

Get to the main<br />

cause of dry,<br />

irritated eyes*<br />

How does Optrex ActiMist work?<br />

Optrex ActiMist contains<br />

liposomes (tiny bubbles fi lled with<br />

moisture) that migrate across the<br />

surface of the eyelid and collect<br />

at the edges of the eye.<br />

Hygienic. Can be used<br />

by multiple people<br />

Lasts 6 months<br />

after opening<br />

These liposomes mix with natural<br />

lipids on the eyelid.<br />

Won’t smudge<br />

make-up<br />

ActiMist liposomes<br />

Convenient and<br />

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Natural lipids<br />

ActiMist liposomes<br />

When the eyes are open the new<br />

lipid mixture spreads over the<br />

whole tear fi lm, and helps fi ll the<br />

gaps to restore the damaged<br />

lipid layer.<br />

Suitable for use<br />

with contact lenses<br />

Jauli Chaitanya, a journalist<br />

in the making who was<br />

thrown into the thick of<br />

things by NZ Optics at Eye<br />

Institute’s DO conference.<br />

I’d also like to thank all NZ Optics’ wonderful advertisers, many<br />

of whom took time out of their busy schedules at RANZCO to talk<br />

me through their products, introduce me to people I should meet<br />

and offer me a friendly shoulder when I appeared a little lost.<br />

And finally to all of you who have taken the trouble to meet us, explain<br />

things to us and welcome us into your industry. It’s been an amazing first<br />

few months and I’m looking forward to honing my knowledge with you all<br />

next year, when we return with our February issue.<br />

So from me, Simon and Kirsten (our ever so hard-working<br />

editor and designer) and Nick (hidden behind the scenes<br />

dealing patiently with our accounts and IT ) we wish you a very<br />

Merry Christmas, a very Happy Holiday and a fantastically (and<br />

hopefully, financially) rewarding New Year.<br />

4UP TO<br />

HOURS<br />

RELIEF 2<br />


Lesley Springall, publisher, NZ Optics<br />

Optrex ActiMist – clinically proven to work<br />

Order stock for your practice today<br />

FREE CALL 0800 393 564 EYELOGIC<br />

www.optrex.co.nz optrex@eyelogic.com.au<br />

Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. †When wearing make-up, it is recommended to apply from 20cm. *Due to disturbed lipid layer of the tear fi lm. References:<br />

1. Lee S et al. Klin Monatsbl Augenheilkd 2004; 221:1–12. 2. Khaireddin R, Schmidt KG. Klin Monatsbl Augenheilkd. 2010; 227: 128-134. 3. Pult H et al. Contact Lens Anterior Eye 2012, 35:203-207. Reckitt Benckiser, Auckland. TAPS DA1541<br />

<strong>Dec</strong>ember <strong>2015</strong><br />


3<br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 3<br />

19-Nov-15 3:26:41 PM

Independent bricks, group mortar<br />

Launched just last year, Essilor’s Platinum<br />

Partners programme has grown to more<br />

than 100 practices across the country<br />

continues to expand.<br />

To celebrate this growth and to explore the<br />

potential strength of the group if it really starts to<br />

work together, Essilor held its inaugural Platinum<br />

Partner Conference in Auckland in November,<br />

attracting attendance from 96 of its current 105<br />

partners.<br />

The information-packed, one-and-a-half day<br />

event highlighted efforts Essilor is undertaking to<br />

help independent practices remain independent in<br />

a competitive market.<br />

“You need to celebrate what makes you unique,<br />

because that is what brings your patients to<br />

you,” said Colin Madigan, Essilor ANZ’s director<br />

of communications and devices, launching the<br />

conference. “But there are also opportunities<br />

in terms of supply-chain, public relations, the<br />

Essilor Vision Foundation, frames and practice<br />

management systems software. And that’s what<br />

we want to talk to you about: how as a group<br />

of independents you can potentially look at the<br />

opportunity of leaning against one another,<br />

celebrating independence, but coming together to<br />

use your critical mass to create opportunity.”<br />

The conference ran from November 6 to<br />

November 7 at Auckland’s Stamford Hotel and<br />

gave partner optometrists the opportunity to<br />

put questions to Essilor executives, meet special<br />

product suppliers and learn about programmes<br />

the company has launched to help partners do<br />

business.<br />

Company presentations were anchored around<br />

charismatic, professional keynote speaker Jonar<br />

Nader, a sales, marketing and management guru<br />

from Australia, who was employed to shake<br />

things up a bit and empower the independent<br />

optometrists present to get out there, to stop<br />

worrying about corporate competition and to go<br />

grow their businesses.<br />

The state of things<br />

The share of the market available to independent<br />

practices in the country has been shrinking<br />

over the last few decades, said Essilor ANZ chief<br />

executive Phuong Nguyen, and the key to survival<br />

is fighting back.<br />

Nguyen gave an overview of the areas of practice<br />

independents can focus on to help seize part of<br />

their local market, including children, low vision<br />

patients, dry eye treatment and expanding eye<br />

exams to include OCT scans. He also mentioned<br />

expanding sunglass sales, using practice<br />

management systems (PMS) and purchasing<br />

consumer packages.<br />

Essilor provides services, products and financial<br />

support to its partners in each of these areas and<br />

has also begun to compete for national corporate<br />

contracts to provide on-site eye examination services<br />

for corporate health and safety programmes.<br />

The bottom-line is to help independents compete<br />

against the economy of scale enjoyed by corporate<br />

optometry stores, said Nguyen.<br />

“The value the big chains have is a unique<br />

advantage as they are vertically integrated. They have<br />

the frames, the lenses, the marketing, the systems<br />

and they can do it all faster than we can do it.”<br />

Associated products and finance<br />

To even the playing field, Essilor offers a PMS<br />

package which its independent partners can use<br />

to coordinate a frame order with a lens so that “it<br />

flows seamlessly behind the scene”.<br />

Essilor also promoted E>Eye, a device that directs<br />

intense pulsed light (IPL) flashes at the lower eye<br />

lid to treat dry eye symptoms from Meibomian<br />

gland dysfunction.<br />

Christchurch optometrist and E>Eye distributor,<br />

John Veale gave a brief presentation on the use of<br />

E>Eye in his practice, from researching the validity<br />

of IPL to finally using the E>Eye device as a point of<br />

difference to bring in new patients.<br />

Veale said he started taking ads out on radio,<br />

after being assured of its efficacy, highlighting his<br />

ability to treat dry eye with the device. “People<br />

started to flood in and they came in from other<br />

practices. They’re happy to get treated for dry eye.”<br />

Throughout the conference Essilor discussed<br />

opportunities to help finance new practices,<br />

remodel old practices and purchase equipment,<br />

including the E>Eye.<br />

Appealing to parents<br />

To help independents broaden services to<br />

younger patients, Essilor has launched the Power<br />

of Four programme: sturdy spectacles with UV<br />

protection and polycarbonate frames designed for<br />

affordability and a steady supply line.<br />

Richard and Amy Suckling and John Veale<br />

Essilor ANZ CEO Phuong Nguyen (centre) with<br />

John and Linda Tarbutt<br />

Joanne Hand, Liz Opie, Karen Chambers, Catherine<br />

Churchman and Ian Buchanan<br />

“Parents often come in and say they don’t want<br />

their child to have an expensive frame,” said<br />

Tim Thurn, Essilor ANZ’s director of professional<br />

services. “You’ve all seen parents worry about<br />

losing or breaking frames in days. But when you<br />

can give them this package, all in front of them, for<br />

one price, it’s so much easier.”<br />

Essilor supplies the frames from its warehouse,<br />

so it remains within its own logistics system<br />

and removes worries about stocks from the<br />

optometrists, who simply sell the model, order the<br />

frame and the lenses.<br />

Streamlining supplies<br />

Thurn framed the offering as one way partnering<br />

can streamline supply to support independents in<br />

the service of young patients.<br />

“If we look at the 96 businesses here, there are<br />

potentially 96 different supply chains. That’s not<br />

creating confusion, but it can delay the process.<br />

Having this organised supply chain, you press a<br />

button and you’re done.”<br />

Servicing low vision patients<br />

Finally, Jason Abrahams of HumanWare discussed<br />

the products his company sells which can extend<br />

the life-cycle of engagement with patients<br />

suffering from low vision. “The key benefit of our<br />

technology is independence.”<br />

HumanWare has four main product offerings:<br />

text to speech, magnification, reading machines<br />

for the blind and navigation.<br />

Abrahams said that 70% of Humanware’s market<br />

is aged over 65, with the rest being people of varying<br />

ages who are reaching the end of their options for<br />

correcting vision from different maladies.<br />

“These are vulnerable people and once lens<br />

correction and surgery are no longer viable, that’s<br />

when low vision products are necessary and needed.”<br />

Optometrists do not have to pass these patients<br />

on to the blind foundation, though that’s what<br />

typically happens, he said. “There is a perception<br />

that low vision is too hard to manage. That<br />

couldn’t be further from the truth.” (See associated<br />

story about HumanWare’s reseller offer in<br />

November NZ Optics)<br />

Discarding the invisible<br />

The highlight of the first day of the conference<br />

was the presentation given by Jonar Nader, who<br />

spoke broadly and at length on how small-sized<br />

business can innovate and improve their chances<br />

of success by acting like a bigger businesses. He<br />

also embraced Essilor’s key theme that if practices<br />

put aside their competitive differences with other<br />

independents, they could leverage group efforts to<br />

win against their bigger competitors.<br />

Underlying his thesis is the concept that<br />

innovation is an abused term from a commercial<br />

Renata Watene, Renee Edgar and Peter Grimmer<br />

Cool shirt brigade: Kevin O’Connor, Geoff Sargent,<br />

Greg Nel and Jeremy Fox<br />

Mahir Antwan, Regan Hirst, Nick Mulder, Barbara Collis<br />

and Diana Henderson<br />

perspective, but it’s still an important concept<br />

for all businesses to embrace, and that can only<br />

happen when we “discard the baggage that<br />

prohibits us” from thinking in new ways.<br />

Nader used the example of Amazon.com founder<br />

Jeff Bezos who started out having never sold a<br />

book in his life, but turned the business of book<br />

retail on its head because “he was not encumbered<br />

with all the rules of doing it this way or that way.<br />

“As he had no rules, he made them up.”<br />

The rules or conventions of business become<br />

“invisible” to business owners. They are the habits,<br />

practices and thinking that have become so<br />

routine, people stop thinking about them, he said,<br />

but that doesn’t make them right.<br />

Nader gave examples of “invisible” concepts,<br />

such as the fact that pressing down on a computer<br />

mouse is not what executes an operation, but<br />

rather it’s letting the button go after pressing<br />

down; or that windshield wipers are designed in<br />

such a way they tend to push water toward the<br />

driver’s side of the car, rather than away.<br />

“These subtleties are the cluttering of the brain<br />

where people can never get to the innovative point<br />

Essilor’s Vineet Chouhan with Jenny Stewart and<br />

Carolyn Campbell<br />

Catherine Perry, Bruce Nicholls, Chelsey Wood and<br />

Richard Newson<br />

of discovery, because they are burdened by bad<br />

news. People become so immune to what they do,<br />

they don’t cleanse. It’s not about what you amass;<br />

it’s about what you discard.”<br />

In Nader’s experience, the problems facing<br />

independent optometrists are not new and are<br />

almost identical to those of other small businesses<br />

in any sector.<br />

“Your vulnerabilities are ten years old, and true and<br />

painful, but they are not new. Nothing’s changed.”<br />

The internet, customers moving away, increased<br />

competition are common problems and in<br />

deciding how to make your business innovative<br />

and competitive, business owners should consider<br />

what is on their “wish list” for things to accomplish<br />

to make their businesses better, he said.<br />

“Those just in search of revenue are likely to fail,”<br />

said Nadar. Companies can easily find shortcuts to<br />

increasing revenue by cutting staff, staying open 24<br />

hours a day or other means, but while such moves<br />

may incur spikes in revenue growth, they do not<br />

address the business holistically. What businesses<br />

need to grow is not cost cutting and other methods<br />

of temporarily spiking revenue, he said, but finding<br />

ways to get customers to pay more for their<br />

products and services and to do so “with pleasure.”<br />

This is very much connected to your business’<br />

brand, which connects not only to the investment<br />

you make in marketing yourself—which can be<br />

helped by affiliating with a group—but to the<br />

culture one instills in their business, said Nadar.<br />

“Your brand is the beacon that speaks for you<br />

while you are asleep. It’s not a logo you stick<br />

somewhere...it’s (if a customer) would bet $10,000<br />

that everything they think is promised by your<br />

business will be delivered. And unless they are<br />

confident to bet that, then you don’t have a brand.<br />

You just have a name.” ▀<br />

Cancer Society tick for Essilor<br />

The Cancer Society of New Zealand has named<br />

Essilor’s Crizal UV an approved product, allowing<br />

it to be listed by the Society’s marketing and<br />

product wing, Daffodil Enterprises, as a preferred<br />

product for combating the development of cancer<br />

Crizal is a range of no-glare lenses designed<br />

to protect the eyes from UV radiation. The<br />

company’s listing with the Cancer Society of<br />

New Zealand comes two years after the Cancer<br />

Council of Australia gave the line a similar<br />

recommendation.<br />

UV rays have been shown to contribute to eye<br />

ageing and the appearance of cataracts. Typical<br />

lenses prevent transmission of UV rays through<br />

the front of the lens, but still allowed exposure<br />

from the back and sides. The Crizal range includes<br />

an anti-reflective coating on the back surface of<br />

the lens to mitigate this.<br />

“New Zealand has among the highest cancer<br />

rates in the world,” said Daffodil Enterprises<br />

manager Fiona Mawley in a video presentation.<br />

“It’s possible to be exposed to UV light without<br />

knowing it and our lifestyles dictate that we<br />

want to stay outside in the light 24/7.”<br />

The situation is similar in Australia, where,<br />

despite high rates of cancer and awareness of UV<br />

exposure risk, 75% of lenses sold there are still<br />

basic CR-39 optical plastic.<br />

“This agreement with the Cancer Society is a<br />

way to remind us that we can do something to<br />

make a difference,” said Tim Thurn, Essilor ANZ’s<br />

director of professional services. ▀<br />

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

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

For editorial and classifieds, please contact Simon Eskow, editor, at 027 288 5401 or editor@nzoptics.co.nz.<br />

For advertising, marketing, the OIG and everything else, please contact Lesley Springall, publisher, at<br />

027 445 3543 or lesley@nzoptics.co.nz.<br />

To submit artwork, or to query a graphic, please email kirsten.newton@outlook.co.nz and copy in Lesley.<br />

NZ Optics magazine is the industry publication for New Zealand’s ophthalmic community. It is published monthly, 11<br />

times a year, by New Zealand Optics <strong>2015</strong> Ltd. Copyright is held by NZ Optics <strong>2015</strong> Ltd. As well as the magazine and the<br />

website, NZ Optics publishes 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 publication and has no affiliation<br />

with any organisations. The views expressed in this publication are not necessarily those of NZ Optics (<strong>2015</strong>) Ltd.<br />

4 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 4<br />

19-Nov-15 3:26:49 PM

Packed conference for Eye Institute<br />

Eye Institute’s 11th Annual Scientific Conference<br />

was another record-breaker with more than 320<br />

optometrists and, for the first time, dispensing<br />

opticians and support staff attending.<br />

The inaugural, parallel dispensing opticians and<br />

support staff conference (see separate story) filled its<br />

room at Auckland’s Waipuna Hotel and Conference<br />

Centre, while the main auditorium rippled with life as<br />

optometrists attended a series of sharp, 15-minute<br />

sessions from the Institute’s ophthalmologists and<br />

special guest, Margaret Lam, of theeyecarecompany,<br />

award-winning Sydney-based practices and specialist<br />

contact lens (CL) provider.<br />

The exhibitors’ hall and refreshment area also<br />

teemed with life during the breaks as sponsors (see<br />

box) caught up with all the news about the New<br />

Zealand optical scene and delegates discussed the<br />

new products on offer.<br />

CL nous to grow your practice<br />

Lam, who’s also state president of the Cornea<br />

and Contact Lens Society of Australia, kicked off<br />

the proceedings with an update on keratoconus<br />

management, explaining that it is challenging to<br />

get right, but also rewarding. “Patients literally have<br />

sight restored they thought they had lost,” she said.<br />

This was the first of three talks Lam gave through<br />

the day, all designed to show how important and<br />

rewarding (financially, personally and for patients)<br />

it can be if optometrists develop expertise in<br />

speciality CL management.<br />

Her presentation, From little things, big things<br />

grow–practice growth strategies, summarised a<br />

number of case studies showing what a difference<br />

optometrists can make to their patients with better<br />

CL understanding and how that can boost referrals,<br />

increase loyalty and so grow your practice.<br />

In her Ocular therapeutics and contact lenses–<br />

two peas in a pod talk, Lam provided a case study<br />

on microbial keratitis, and gave some insight on<br />

how to spot it. This included: sore, irritated eyes<br />

during waking hours; round focal central corneal<br />

lesion with indistinct, roundish borders with<br />

positive NaFl staining; photophobia; lid oedema;<br />

profuse epiphora; diffuse extensive conjunctival<br />

hyperaemia; and worsening or non-improvement<br />

of symptoms after the patient stops wearing CLs.<br />

Tina Gao, Renita Martis, Nafisa Slaimankhel and Teresa Hsu<br />

Treatment is with topical antibiotic and/or referral<br />

to an ophthalmologist.<br />

Drugs side effects, cataract surgery and AMD<br />

The first of Eye Institute’s ophthalmologists to<br />

take the floor was Dr Shanu Subbiah who outlined<br />

possible ocular side effects of commonly prescribed<br />

systemic medications. This is especially important<br />

for older patients, he said, who are often prescribed<br />

several drugs simultaneously which together can<br />

throw up any number of side-effects.<br />

The number of drugs that can cause ocular side<br />

effects is enormous, said Subbiah. More common<br />

ones, however, include: hydroxychloroquine<br />

(Plaquenil) used to treat malaria and certain autoimmune<br />

diseases, which can cause retinal toxicity<br />

and is often characterised by the “flying saucer sign”;<br />

bisphosphonates, used for osteoporosis, which can<br />

cause a range of “-itis’s” including conjunctivitis,<br />

uveitis, episcleritis and scleritis, but these should get<br />

better if the patient stops taking the drugs; fingolimod<br />

(Gilenya) for multiple sclerosis, which cause macular<br />

oedema in about 1% of cases; and sildenafil (Viagra),<br />

the infamous little blue pill that can cause users to see<br />

everything with a blue tint (cyanopsia).<br />

Later in the day Subbiah tackled Cataract surgery<br />

in the presence of retinal disease, explaining how<br />

one influences the other, and concluding that<br />

patients shouldn’t hesitate to remove cataracts if<br />

they have AMD (age-related macular degeneration)<br />

as it’s often essential to allow the continued<br />

management of their retinal disease.<br />

DED and spotting retinal detachment<br />

Dr Peter Hadden provided an overview of<br />

Amy Royal, Chloe Lovell and Angeline Ng<br />

diabetic eye disease, the extent of the problem<br />

in New Zealand and how it damages the retinal<br />

vasculature causing macular oedema. At minimum,<br />

diabetics should be screened every two years; those<br />

with mild diabetic retinopathy (microaneurysms,<br />

a few dot and blot haemorrhages and mild lipid<br />

exudates) should be reviewed every six months<br />

to a year, while moderate to severe patients<br />

(more extensive changes, plus any venous loops,<br />

beading or other vascular abnormalities) should<br />

be “semi-urgently” referred to an ophthalmologist.<br />

Treatment is by intravitreal injections, usually<br />

with Avastin as Eylea is still too expensive in New<br />

Zealand, he said.<br />

Hadden’s other session on the peripheral retina,<br />

discussed what was important when doing a retinal<br />

examination and what wasn’t. When it comes to<br />

increasing the risk of retinal detachment, benign findings<br />

include cystoid degeneration, paving stone or cobblestone<br />

degeneration, reticular pigmentary degeneration,<br />

equatorial drusen and choroidal or pigmentary<br />

degeneration. Things optometrists should be on the<br />

lookout for, however, include lattice degeneration, snail<br />

tracks (which may be a variant on lattice degeneration),<br />

retinoschisis, retinal tags, horseshoe tears and snowflake<br />

vitreoretinal degeneration.<br />

PDS and glaucoma myths<br />

Professor Helen Danesh-Meyer discussed<br />

pigment dispersion syndrome (PDS), which can<br />

lead to pigmentary glaucoma when pigment cells<br />

slough off from the back of the iris and float<br />

around in the aqueous humour. Those who get it<br />

tend to be young, caucasian myopes, usually male.<br />

Optometrists should identify patients who are<br />

Gary Crowley, David Roberts and Diane Pearson<br />

A surprised Maryanne Dransfield, former publisher of<br />

NZ Optics (now editor-at-large), receives flowers from<br />

Eye Institute’s Dr Trevor Gray to say thank you for her<br />

dedication to the NZ industry over the past 35+ years<br />

“actively dispersing pigment or have blurred vision<br />

during exercise” and monitor them carefully as it<br />

can lead to glaucoma and retinal detachment.<br />

Prior to lunch, Danesh-Meyer also tackled normal<br />

pressure glaucoma, stressing the term needs to<br />

be killed off once and for all as it “is a meaningless<br />

statistical construct that has done more to confuse the<br />

diagnosis and management of primary open-angle<br />

glaucoma than it ever did to enhance it.”<br />

Typical intraocular pressures (IOPs) can vary from<br />

day to day, at night and when we lie flat, she said.<br />

“IOP is a risk factor that varies in importance for<br />

each individual person.”<br />

Scleritis clues, marginal keratitis and laser<br />

review<br />

Dr Peter Ring explained how scleritis can be a<br />

sign for all sorts ailments, including auto-immune<br />

and metabolic disorders and a variety of bacterial<br />

infections. Symptoms include moderate to<br />

severe pain, often deep and boring, and waking<br />

the patient in the morning; redness of the eye;<br />


Looking forward to seeing you<br />

for bigger and better next year at our half day workshops on Saturday 5th of Nov<br />

and our Sunday conference on 6th Nov 2016<br />

<strong>Dec</strong>ember <strong>2015</strong><br />


5<br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 5<br />

19-Nov-15 3:26:53 PM

News<br />

in brief<br />


ZEISS launched a new scratch resistant AR coating that filters blue<br />

light transmissions from LEDs and computer devices. The DuraVision<br />

Blue Protect coating filters blue light in the 440nm range, which<br />

provides protection from potential phototoxicity, while having<br />

minor impact on the circadian day-night rhythm. Research indicates<br />

exposure to light in the spectrum between 400 and 520nm, with a<br />

maximum at 460nm, is required for biological processes, including<br />

regulating the circadian rhythm and sleep patterns. However, too<br />

much light below 460nm, could be damaging to the eye.<br />


Jono Hennessy is selling a limitededition<br />

Summer in Australia range<br />

of sunglasses for the <strong>2015</strong>/2016<br />

season. The range, designed for<br />

women, features colour, fabric<br />

prints and flattering shapes, with<br />

CR39 graduated lenses from rosetinted<br />

to oceanic. Distributed in<br />

NZ by Phoenix Eyewear.<br />


Mondottica has collaborated with Finnish design house<br />

Marimekko on a collection of 11 eyewear styles for women using<br />

the most popular female names in Finland. This <strong>2015</strong>-2016<br />

Winter (Northern Hemisphere) range—with names like Eeva,<br />

Niina and Riita—is marked by “daring shapes, thick temples and<br />

laser-engraved branding” emphasising the “empowered woman<br />

equipped with a positive, openhearted and liberal approach<br />

to life.” Sub-groups of the collection use different materials,<br />

including stainless steel.<br />


Researchers at the Institute of Transformative Bio-Molecules<br />

(ITbM) at Nagoya University in Japan have developed a new<br />

fluorescent dye that offers enhanced photostability for live-cell<br />

imaging by stimulated emission depletion (STED) microscopy. The<br />

dye, C-Naphox, could allow for observation of real-time biological<br />

events over extended time frames at high resolution.<br />

Advances in STED microscopy have enabled nanoscale visualisation<br />

of biological systems. It allows up to 10x higher resolution in living<br />

cells with respect to conventional microscopes by employing a<br />

fluorescence excitation beam in combination with a surrounding<br />

doughnut-shaped STED beam. While the molecules at the centre are<br />

excited to a higher energy state and fluoresce, the molecules exposed<br />

to the STED beam are confined to the ground energy state.<br />


Various news sources in October confirmed two pharmaceutical<br />

giants, Pfizer Inc. and Allergan Plc, have been discussing a<br />

potential merger. The deal, if it eventuates, would be one of the<br />

largest mergers in the history of the pharmaceutical industry.<br />

The Wall Street Journal broke the story, reporting that Pfizer<br />

recently approached Allergan, but the process is at an early stage.<br />

A merger would create a company with a combined market value<br />

exceeding US$330 billion and would provide US-based Allergan<br />

with a tax-haven as Pfizer is “domiciled” in Ireland.<br />


A study by researchers at the Keio University School of Medicine<br />

in Tokyo, published in the Asia-Pacific Journal of Ophthalmology,<br />

has hinted at the efficacy of oral pilocarpine in treating dry eye in<br />

patients with Sjögren’s syndrome who are resistant to traditional<br />

treatment. In 15 patients, the dry eye occurred as a complication<br />

of Sjögren syndrome and was too severe to be controlled with<br />

conventional conservative treatment. Depending on the severity<br />

of dry eye symptoms, patients received either 2.5 mg or 5 mg<br />

of pilocarpine, each three times per day. At 3 months, dry eye<br />

sensation declined to 1.7 from 2.5 at baseline. Eye pain scores<br />

also declined and tear film break-up time increased from 2.6 at<br />

baseline to 1.6 seconds at month 1 and, finally, 3.3 at month 3.<br />


A US-based company announced it is developing a contact<br />

lens that will allow for manual adjustment of focal length to<br />

far, middle and near-vision. E-Vision Smart Optics says it has<br />

already developed the basic technology for application in glasses,<br />

ophthalmic diagnostic equipment and augmented-reality headmounted<br />

displays for the military. It recently closed a financing<br />

round to expedite development of the contact lens, which will<br />

contain an electric field surrounded by a near-invisible layer of<br />

liquid crystal material powered by electrodes. These electrodes<br />

can change the liquid crystal layer to create aspheric, hyperopic or<br />

myopic spherical shapes.<br />


Professor Joanne Wood of Queensland University of Technology<br />

(QUT) has won the <strong>2015</strong> Glenn A. Fry Award, considered the<br />

Nobel Prize of international optometry. Wood is considered to be<br />

one of the world’s leading experts on visual impairment, aging<br />

and driving. As part of the award presentation, Wood provided<br />

a snapshot of her recent vision and driving studies, including<br />

glaucoma and driving and investigating the impact of various<br />

visual conditions on night-time driving and visibility. ▀<br />

Classifying the visually-impaired<br />

With less than one year to go to<br />

the Rio 2016 Paralympic Games,<br />

Paralympics New Zealand (PNZ)<br />

threw a fundraising event to mark the<br />

countdown and garner support.<br />

The one-year-to-go event in September<br />

was dubbed the Spirit of Gold. It attracted<br />

three corporate sponsors: Cadbury, ACC and<br />

Sanford, and celebrated the involvement of<br />

many incumbent supporters.<br />

PNZ relies heavily on grants, scholarships,<br />

donations and volunteers and the<br />

latter category now includes 17 vision<br />

professionals who have been trained to be<br />

National Classifiers for New Zealand.<br />

Paralympic sport uses a standard national<br />

and international classification system to<br />

ensure competitors are matched properly.<br />

The volunteer classifiers play a pivotal role in<br />

determining an applicant’s qualification as a<br />

“Para-Athlete with Visual Impairment” and<br />

in assessing the classification under which a<br />

qualifying para-athlete can compete.<br />

“What I did last year through funding from<br />

a High Performance Sport NZ scholarship<br />

was to get Dr Richard Warton from Australia<br />

to run a National Classifiers course for Visual<br />

impairment with seminars in Wellington<br />

and Auckland,” says Marguerite Christopher,<br />

PNZ’s classification manager.<br />

Christopher says to become a national<br />

classifier of para-athletes with visual<br />

impairment, you have to be a licensed<br />

ophthalmologist, optometrist or orthoptist<br />

with experience in low vision. International<br />

classifier’s are further trained in courses<br />

associated with a particular event and<br />

are used to qualify para-athletes prior to<br />

international competition. As of this writing,<br />

none of NZ’s visual impairment classifiers<br />

have trained for international classification.<br />

Renee Edgar, an optometrist with<br />

McClellan Grimmer Edgar in Wellington,<br />

Buy-one-give-one<br />

startup turns one<br />

Mr Foureyes is a work in progress.<br />

The social enterprise launched in<br />

October 2014 under the premise<br />

that for every pair of glasses it sold, Mr<br />

Foureyes would donate a second pair to a<br />

child in a low-decile school.<br />

Ravi Dass, the optometrist who co-founded<br />

Mr Foureyes with his wife, Stephanie Hill, is<br />

currently filling out the paperwork required<br />

to set up the “give-one” side of the business<br />

as an official charity.<br />

“We are setting up the charitable arm<br />

because we want to make the business as<br />

clean as possible, from an accountability<br />

point of view,” Dass says, adding that<br />

while there is no need to establish a formal<br />

charity, potential investors and supporters<br />

like to be clear on the structure.<br />

Mr Foureyes, headquartered in Wellington,<br />

already has an inventory of 500 glasses ready<br />

for fitting. It is looking to work with KidsCan<br />

to connect the glasses to the students who<br />

need them. Dass says the company will be<br />

piloting the partnership with KidsCan at a<br />

school in the capital region, soon. But the<br />

aim of the social enterprise is not simply the<br />

provision glasses.<br />

“That is a stepping stone to what we really<br />

want to achieve,” Dass says. “We would like to<br />

be actively working with parents, schools and<br />

their communities to help identify kids who<br />

need glasses. This is particularly important for<br />

kids who might have undiagnosed eyesight<br />

problems—especially hyperopia— that are<br />

affecting their school work.”<br />

The entire idea for the social enterprise<br />

arose partly from Dass’s work as a locum.<br />

“I was working at a paediatric clinic and I saw<br />

there were some children slipping through<br />

the cracks,” says Dass. “There are a number of<br />

procedures put in place to pick up eye problems,<br />

optometrists to do the eye tests, subsidised<br />

glasses, but not everyone has a realtionship with<br />

a GP, or takes advantage of clinics, and that’s<br />

prevalent in low-decile schools.”<br />

The concept of social enterprise is not<br />

the same as a charity. As Dass says it is<br />

was one of the 17<br />

vision professionals<br />

to train as a classifier.<br />

“PNZ sent out a<br />

message to every<br />

optometrist to see<br />

if we’d be interested<br />

in getting involved. I<br />

thought it was quite a<br />

natural fit.”<br />

Edgar says she has<br />

“always been into<br />

sports” and in her spare<br />

time coaches a netball<br />

team, following years of<br />

playing the sport. In the<br />

last 18 months, she has begun treating more<br />

athletes in her practice, and she has also<br />

co-authored a published research paper on<br />

the ability of cricketers to hit a moving target<br />

to determine if their dynamic visual acuity is<br />

superior to non-cricket players.<br />

“The answer was, no, it’s not,” Edgar says,<br />

a little wryly.<br />

Edgar says she has already participated in<br />

one panel to determine if a new para-athlete<br />

was eligible to compete. Initially, a panel of<br />

at least two vision professionals assemble to<br />

review an application. In order to be eligible to<br />

compete, the applying para-athlete must have<br />

impairment of the eye structure or receptors,<br />

impairment of the optic nerves or optic<br />

pathway or impairment of the visual cortex.<br />

Before a new athlete can receive classification,<br />

they must present a reference from their<br />

ophthalmologist and a specific form that<br />

defines the health condition and impairment<br />

they have. The initial panel assesses the<br />

application and conducts further tests.<br />

“We had the first classification and four<br />

of us got together to classify the applicant,”<br />

says Edgar. “We kind of knew he might not<br />

make it and testing confirmed that, but for<br />

a business with a social aim; a business<br />

entity that addresses a social need. Social<br />

enterprise and buy-one-give-one models<br />

are increasingly common overseas and Dass<br />

has found increasing interest in the New<br />

Zealand industry through partnerships with<br />

lens suppliers and frame makers.<br />

“We would love to be working cohesively<br />

with others in the industry to achieve the<br />

overall aim of better identification and<br />

correction of kids’ vision problems so they<br />

can thrive at school,” Dass says.<br />

Dass and Hill, who has worked in public<br />

sector research, analysis and project<br />

management for more than 10 years,<br />

undertook training in social enterprise<br />

management through the Akina Foundation,<br />

an organisation devoted to spurring social<br />

enterprise growth. Mr Foureyes was one of<br />

11 companies to undergo Akina’s inaugural<br />

Launchpad programme, an “intensive<br />

accelerator for teams with big ideas who will<br />

benefit from support, coaching and training”<br />

from experts. The programme includes start-up<br />

training, mentoring and leadership coaching.<br />

Since then, the organisation has found<br />

a willing partner in KidsCan, a long-time<br />

charitable organisation with a readymade<br />

network and resources on which Mr<br />

Foureyes hopes to piggyback as it develops<br />

the eye screening and patient tracking that<br />

is its ultimate goal.<br />

Likewise, a number of lens suppliers have<br />

shown interest in supporting the charitable<br />

side, while one frame supplier, Proof Eyewear,<br />

has found a kindred spirit in Mr Foureyes.<br />

Proof, which sells wooden frames, has made<br />

charitable work part of its fabric, donating<br />

to eye clinics, and supporting reforestation<br />

projects, among other initiatives.<br />

“You’ll find there will be interest in<br />

supporting a social enterprise,” Dass says.<br />

“You just have to look for it and ask.”<br />

Dass himself has been active in charitable<br />

activities since he began his optometry career<br />

in 2004, notably as a participant in VOSO trips,<br />

and serving on the organisation’s board. ▀<br />

Emma Foy and Laura Fairweather train for Rio. Picture: Paralympics NZ<br />

us, it was a great experience.”<br />

The PNZ website currently lists two paraathletes<br />

with visual impairment, Emma<br />

Foy and Mary Fisher. Foy is a para-cyclist<br />

originally from Dargaville, who is a record<br />

breaking, three-time gold medalist in the<br />

UCI Para-Cycling Track World Championship<br />

annual events. As a cyclist with visual<br />

impairment, Foy races on a tandem with<br />

Laura Thompson, a sighted pilot who sits<br />

in front. Generally speaking, cyclists with<br />

visual impairment either have low visual<br />

acuity, less than 6/60, and/or a visual field<br />

less than 20 degrees radius.<br />

Mary Fisher, a student from Wellington,<br />

is a 12-time gold medallist para-swimmer.<br />

Fisher is classified for the individual medley,<br />

backstroke, butterfly, breaststroke and<br />

freestyle. In Fisher’s particular sports class<br />

the range includes para-athletes with “a<br />

complete or nearly complete loss of sight”<br />

who compete with blackened goggles.<br />

Edgar says she looks forward to continuing<br />

as a volunteer classifier. “A lot of times we as<br />

optometrists say, ‘here’s your vision, here’s<br />

what do about it and there’s the door’. I think<br />

it’s really nice to be able to give a little extra.” ▀<br />

Innotec new<br />

frame-lines<br />

Innotec, a member of the Ogi Eyewear<br />

family, has introduced two new styles to<br />

its innovative carbon fibre line, Bowen and<br />

Reiner.<br />

Both styles incorporate “ultramodern<br />

frames” designed to meet the challenge of<br />

marrying comfort, durability and weight,<br />

the company said in a statement.<br />

“At just sixteen grams light, these<br />

futuristic frames integrate stainless steel<br />

and carbon fibre into a classic semi-rimless<br />

shape. Pushing the frontiers of technology,<br />

the Bowen and Reiner define a new pulse<br />

design that is poised to propel Innotec to<br />

the apex of high-tech eyewear.”<br />

The Bowen frames are cut from a single<br />

block of stainless steel, using a process<br />

that eliminates solder-points. The temples<br />

are “featherlight” carbon fibre around a<br />

stainless steel core, fastened to the front<br />

with working rivets and five-barrel hinges<br />

for comfort and lasting fit.<br />

The Reiner frames’ are cut from a select<br />

block of pure stainless steel, also with no<br />

solder-points or weak spots, with carbon<br />

fibre temples attached to the front with<br />

German OBE screws and working rivets,<br />

flexible temple tips and adjustable<br />

nose-pads.<br />

The New Zealand distributor for Ogi<br />

Eyewear is BTP, based in Whakatane. ▀<br />

6 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 6<br />

19-Nov-15 3:26:54 PM

ODMA’s<br />

<strong>2015</strong><br />

AGM<br />

ODMA’s new chair, Optimed’s Robert Sparkes<br />

The Optical Distributors and Manufacturers<br />

Association of Australia (ODMA) held its<br />

annual general meeting on November 11,<br />

electing members to its executive committee and<br />

appointing Optimed managing director Robert<br />

Sparkes to replace Designs for Vision founder<br />

Richard Grills as chair.<br />

Grills is not vanishing from the scene, however,<br />

being elected to serve on the executive committee,<br />

along with Mark Altman of Device Technologies,<br />

Phuong Nguyen of Essilor, Brad Saffin of General<br />

Optical, Craig Chick of Hoya, Lionel Minter of Mimo<br />

Australia, Nicole Perry of Safilo and Samantha<br />

Crooke of Younger Optics.<br />

A press release from ODMA referred to Grills as<br />

the “elder statesman” of the organisation, “having<br />

served on the board since 1996.”<br />

During the AGM, Grills paid homage to the<br />

volunteer leadership.<br />

“The nine member executive committee<br />

not only serve unpaid, but the cost to them in<br />

business time and incidental expenses should be<br />

recognised,” he said.<br />

He particularly commended the three outgoing<br />

members, Shamir Australia’s Paul Stacey, Bollé<br />

Australia’s John Toouli and Eyes Right Optical’s<br />

Gaye Wymond, as well as General Optical’s<br />

Johnathon Lewis who left the board earlier this<br />

year after serving for six years.<br />

In other business, Grills said surveys of visitors to<br />

the ODMA <strong>2015</strong> indicated general satisfaction, but<br />

that given the absence of some frame makers, the<br />

organisers would look for a more accessible venue<br />

for ODMA 2017 than the one used this year.<br />

Grills also mentioned that following the success<br />

of the training manuals for independents—<br />

the Optical Retail Guide and the Basic Lens<br />

Dispensing handbook—ODMA has released a<br />

Start Your Own Practice handbook designed “to<br />

provide a starting point for anyone who wants to<br />

open a new practice.”<br />

“The booklet is based on a financial model which<br />

can be used at any stage of a practice from start up<br />

to retirement,” Grills said. ▀<br />

Twitches, bumps and blebs<br />

Eye Doctors made their final Grand Rounds<br />

of the year on October 28 with an overview<br />

of bumps, blebs, twitches and everything<br />

an optometrist needs to know about commonly<br />

used ophthalmic drugs.<br />

Nearly 60 people attended the two-hour<br />

session at the Novotel Greenlane; all well-fed<br />

and feted during the ample breaks between<br />

presentations.<br />

Dr Shuan Dai opened with his keynote<br />

presentation Drugs cure and drugs kill: what do<br />

we need to know? Drugs, he said, have changed<br />

ophthalmology for the better, but frequently<br />

come with side effects that optometrists should<br />

look out for.<br />

Dr Shuan Dai with Theresa Nowak, Anne Durrant<br />

and Dr Andrew Riley<br />

Zane Stellingwerf and Grace Elliott<br />

Dr Mark Donaldson with Dennis Oliver<br />

“I remember in the old days when we treated<br />

glaucoma and 80 to 90% of patients would need<br />

an operation,” Dai said. “Now it’s about 10% and<br />

most of the time the eye drops work like magic, with<br />

minor and not very serious side effects.”<br />

However, as with all pharmacology, drugs not used<br />

as directed can be lethal, as in cases of intentional<br />

poisoning in which the weapon of choice was Visine,<br />

which at one time listed tetrahydrozoline alpha (a<br />

vasoconstrictor) as an active ingredient.<br />

Cycloplegic drops, such as cyclogyl, an<br />

anticholinergic used for dilation in paediatric<br />

eye exams, can lead to necrotising enterocolitis<br />

if not properly diluted or if administered too<br />

often. Dai said optometrists only have to worry<br />

about this for children aged five and under or<br />

those with persistent gastro intestinal issues.<br />

In glaucoma treatment, Trusopt, or dorzolamide<br />

hydrochloride, can cause an immune reaction<br />

in elderly patients, while beta blockers used<br />

at length can cause depression, occasionally<br />

leading to suicide, trigger asthma attacks, and<br />

cause sick sinus symptom.<br />

“None of this is to scare you from prescribing, but<br />

to make us all aware of our responsibility,” Dai said.<br />

Myokymia<br />

Dr Andrew Riley presented on Ocular Myokymia, the<br />

involuntary muscular twitching around the eyes.<br />

“We do see a lot of myokymia and I’m sure<br />

you see that in your practice, as well,” said Riley<br />

“Most of these things are nothing to worry<br />

about. It’s important to reassure your patients.”<br />

Myokymia typically goes away on its own, lasting<br />

short periods of hours or days, but in rare cases it<br />

can last up to 20 years. Myokymia is commonly<br />

associated with fatigue, stress, lack of exercise,<br />

poor diet, caffeine consumption and heavy alcohol<br />

intake. In cases where optometrists can rule out<br />

such associations, Riley advised to look out for<br />

signs of dry eye syndrome, allergies, eye strain or<br />

latent hyperopia.<br />

Riley also discussed conditions that may seem<br />

like myokomia at first, but are of a different nature.<br />

Hemifacial spasms are unilateral twitches around<br />

the eyes, the mouth and the lower face. They are<br />

typically associated with the pressure of a blood<br />

vessel stimulating a close facial nerve as it pulses.<br />

Another condition, blephora spasm, is a bilateral<br />

condition usually presenting with sore eyes and<br />

most often suffered by women aged 50 to 70 years,<br />

but with no clear pathology. As with myokymia,<br />

blephora spasm will often resolve itself in a matter<br />

of days, but the bilateral blinking can become<br />

partly a habit, Riley said. Patients will attempt to<br />

resolve blephora spasm with botox treatment,<br />

which wears off after three to six months. Riley<br />

said optometrists can help by advising patients to<br />

wear ptosis crutches.<br />

Conjunctival lumps<br />

Dr Penny McAllum presented cases to illustrate<br />

different kinds of lumps patients can present to<br />

an optometrist.<br />

In one case, a woman who was to be married<br />

in a few months presented with a cauliflowerlike<br />

lesion in one fornix, which was irritated and<br />

sometimes sticky. This conjuctival papilloma,<br />

with finger-like, vascular lesions and thick<br />

epithelial inclusion bodies, was a symptom of<br />

the HPV-6 virus, McAllum said, which can be<br />

contracted by hand to hand contact. The HPV-6<br />

strain is not associated with cancer, McAllum<br />

added, but they can spread. Interventions<br />

include cutting and cauterising.<br />

Another patient case presented with a red, at<br />

times tender, swelling at the left lower lid, which<br />

had lasted for months, varying in size over time.<br />

McAllum said the patient suffered meibomian<br />

gland dysfunction, and the swelling produced<br />

a discharge, which led her to conclude it was<br />

a granuloma. This is a vascular tumour caused<br />

by inflammation caused by leakage of mucous<br />

material from the meibomian gland producing<br />

an inflammatory reaction inducing rapid growth<br />

of the lump. These too can often go away of their<br />

own accord, but if the underlying cause (such<br />

as a ruptured meibomian cyst) is not obvious,<br />

optometrists can treat persistent symptoms with<br />

hot compresses, massages and scrubs.<br />

Other cases McAllum discussed were a<br />

capillary haemangioma—a red spot filled with<br />

corkscrew shaped blood vessels causing the<br />

patient irritation and intermittent watery eyes;<br />

a conjunctival mixoma—a benign tumour filled<br />

with mucous; and a cyst over a conjunctival<br />

incision from previous squint surgery.<br />

Blebs<br />

Bleb Needling ab interno<br />

Finally, Dr Mark Donaldson discussed bleb needling<br />

to treat complications rising after trabeculectomies,<br />

particularly sight-threatening infections.<br />

According to Donaldson, 1 to 2% of<br />

trabeculectomies result in bleb-related<br />

infections within five years of glaucoma surgery.<br />

There is a higher incidence rate among thinwalled<br />

cystic blebs, which Donaldson said<br />

happened to be the kind of bleb that has the<br />

best pressure-lowering impact.<br />

Infections can take years to present and, over<br />

time, a patient may not associate eye problems<br />

with a trabeculectomy, putting the onus on<br />

optometrists to remind such patients to seek<br />

help should symptoms, such as redness, blurring<br />

and eye pain, arise. ▀<br />

Personalised eye care<br />

every time.<br />

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www.eyedoctors.co.nz<br />

<strong>Dec</strong>ember <strong>2015</strong><br />


7<br />

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Notes from the lecture hall<br />


The 47th RANZCO Annual Scientific Congress offered an<br />

action-packed scientific programme with an amazing array of<br />

international speakers and local experts.<br />

The calibre of speakers at this year’s event testifies to RANZCO’s<br />

success year after year, attracting leading overseas ophthalmologists<br />

from Australia, the UK, the US and Canada, who presented the latest<br />

in eye research and developments in cataract surgery, glaucoma and<br />

uveitis, to name but a few topics.<br />

Day one: Sunday<br />

The congress commenced on November 1, with several speakers<br />

presenting as part of an Ophthalmic Research Institute of Australia<br />

(ORIA) session. This covered recent progress in understanding the<br />

genetic basis of corneal dystrophies, corneal cross-linking, RPE stem<br />

cell development and applications and new techniques for genetic<br />

manipulations.<br />

Keynote speaker Dr Randall Olson, chair of the department of<br />

ophthalmology and visual science at the University of Utah School<br />

of Medicine, gave the Cornea Update Lecture. A vibrant and practical<br />

presentation, demonstrating how to respect the corneal endothelium<br />

in cataract surgery.<br />

Next Associate Professor John Grigg, head of the Discipline of<br />

Ophthalmology at The University of Sydney’s Save Sight Institute,<br />

gave an insightful overview of the challenges posed by childhood<br />

visual impairment in the annual Council Lecture. Grigg illustrated the<br />

importance of an effective screening programme to detect childhood<br />

Ashton Lindsay, Courteney Lindsay, Drs Jessica and Alistair Papali’i-Curtin<br />

refractive error, and how it rated amongst the most common causes<br />

of childhood disability. He went on to discuss other childhood visual<br />

problems such as cataract, paediatric glaucoma and uveitis reminding<br />

the audience these rare eye diseases are more common than childhood<br />

cancers and cystic fibrosis. Delegates were also given a taste of<br />

emerging new technologies, such as gene-splicing, that potentially will<br />

change the future of diagnostic and therapeutic treatment options.<br />

Day two: Monday<br />

The Best Paper presentations demonstrated the high standard of<br />

research within the ophthalmological community, from the most<br />

junior medical students through to the most senior experts within<br />

each specialty.<br />

Dr Nitin Verma, Suzie Tegan and Drs Stephen Best and Iain Dunlop<br />

Dr Mike O’Rourke, Chantel Burton and Dr Andrew Thompson<br />

3891_bp_wish_NZO_185x260.indd 1<br />

8 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

13/11/<strong>2015</strong> 11:58 am<br />

The John Parr Trophy was awarded to Jessica Trollip for her<br />

presentation on New Zealand laser treatment for retinopathy<br />

of prematurity in the era of ETROP: a ten year outcome. Trollip<br />

presented a retrospective review of 143 patients treated with laser<br />

for ROP from 2005 to <strong>2015</strong>, showing the long-term outcomes for<br />

these children appeared more successful compared to international<br />

data, with favourable ROP regression rates.<br />

The Gerard Crock Trophy was awarded to Professor Mark Gillies<br />

for his presentation titled Long-term outcomes of treatment of<br />

neovascular age-related macular degeneration: data from an<br />

observational study, focusing on outcomes of treatment-naïve eyes<br />

with neovascular ARMD using anti-VEGF. Gillies concluded that the<br />

long-term outcome in terms of change in visual acuity appeared<br />

good with a mean improvement of approximately 6.3 letters after six<br />

months of treatment. Visual acuity also appeared to remain better<br />

than pre-treatment acuity for at least a six-year period.<br />

Professor Tin Aung, executive director of the Singapore Eye<br />

Research Institute, presented an update on angle closure glaucoma.<br />

Aung asserted that glaucoma is not a simple disease, as viewed<br />

traditionally. For Angle Closure Glaucoma (ACG), there are many<br />

and variable mechanisms by which the angle can close and there<br />

are many genetic factors associated with ACG. Aung discussed<br />

the increasing evidence clinicians can rely on in choosing an ACG<br />

treatment approach, specifically Selective Laser Trabeculoplasty and<br />

lens removal.<br />

The Sir Norman Gregg lecture was given by Professor Peter<br />

McCluskey, director of the Save Sight Institute at Sydney University,<br />

who presented delegates with an overview of scleritis and a review of<br />

clinical and research-based perspectives from the last 30 years.<br />

The current system of classifying scleritis as nodular or diffuse, he<br />

said, is still valid and useful. Identifying and adequately treating the<br />

underlying systemic disease has improved over the decades, to the<br />

point that complications from scleromalacia perforans, for example,<br />

are rarely seen today.<br />

The Plenary Symposium on Cataract Surgery in <strong>2015</strong> was a novel<br />

and well-executed session with Clinical Associate Professor Michael<br />

Lawless, of Sydney University, leading an “interrogation” of experts<br />

including Drs Ike Ahmed and David Kent and Professors Charles<br />

McGhee and Randall Olsen.<br />

The panel compared their preferences in the management of<br />

various problems commonly encountered clinically and in surgery.<br />

It was refreshing for those of us on the bottom rungs of the surgical<br />

ladder that more than one “correct” and safe approach exists to<br />

manage problems arising in anterior segment surgery.<br />

That afternoon Professors Stuart Graham of Macquarie University<br />

and Jonathan Crowston of Melbourne University chaired a Diagnostic<br />

Dilemmas in Glaucoma discussion. Professor Helen Danesh-Meyer<br />

of Auckland University discussed when to suspect a patient has<br />

more than a “typical glaucomatous progression”. She illustrated the<br />

clinical features that would favour a glaucoma diagnosis compared<br />

to those that would not, reminding all to correlate clinical findings<br />

with the nerve appearance. If progression appears inconsistent with<br />

the vision, visual field or colour vision, neuroimaging is required to<br />

exclude a non-glaucomatous optic neuropathy. Sydney University<br />

Associate Professor Paul Healey undertook a journey through<br />

iridology demonstrating that trauma, inflammation and proliferative<br />

disease can induce iris changes which can help tell a story of<br />

glaucomatous pathology if the clinician is in tune to interpret the<br />

changes demonstrated.<br />

Later in the afternoon delegates had the opportunity to view the<br />

posters and films while being treated to craft beer and dumplings.<br />

This year’s winner of the Community Ophthalmology film was Dr<br />

Angus Turner, McCusker Director of Lions Outback Vision, with Beat<br />

that Sugar. While the winner of the surgical technique section,<br />

and overall winner, was specialist cataract surgeon Professor Rasik<br />

Vajpayee of the Vision Eye Institute with Intrastromal fluid drainage<br />

with air tamponade: anterior segment optical coherence guided<br />

technique for the management of acute corneal hydrops.<br />


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<strong>Dec</strong>ember <strong>2015</strong>.indd 8<br />

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Day three: Tuesday<br />

Dr Ike Ahmed, from Credit Valley Eyecare in Canada,<br />

presented surgical videos of difficult cataract<br />

procedures, demonstrating the techniques that<br />

have earned him his reputation in the diagnosis and<br />

surgical treatment of highly complex eye diseases.<br />

WA University’s Prof. Dao Yi-Yu’s Ida Mann<br />

Lecture Research discoveries to clinical application:<br />

Developing a new glaucoma filtration surgery,<br />

gave the audience an account of his methodical<br />

approach to developing an effective aqueous stent,<br />

providing insight to the immense time and effort<br />

required to develop new treatments in eye disease.<br />

The Ethics and Professionalism session chaired<br />

by Dr Arthur Karagiannis, from the SA Institute<br />

of Ophthalmology, proposed some challenging<br />

questions to Dr Linda Swan, Prof. Peter McCluskey<br />

and Chai Chuah, director-general of NZ’s Ministry<br />

of Health. The session illustrated the challenges<br />

health professionals face to deliver effective health<br />

interventions (with ever-expanding treatment<br />

options) against the reality of limited funding.<br />

Tuesday concluded with a formal Congress<br />

dinner at parliament house no less. This was a<br />

great occasion executed in an amazing venue,<br />

treating the delegates to fantastic food and some<br />

light-hearted musical entertainment thanks to<br />

<strong>2015</strong> Congress Convenor Dr Keith Small and Kiwi<br />

ophthalmologist-in-training Alistair Papali’i-Curtin.<br />

What a wonderful way to bring the Congress to<br />

a wind-down and showcase some of the hidden<br />

home-grown talent this little windy city has to offer.<br />

Day four: Wednesday<br />

The final day saw Associate Professor Anthony<br />

Kwan, from the QLD Eye Institute, chair ANZSRS<br />

evidence based guide to management of dilemmas<br />

in retinal diseases, covering often tricky areas in the<br />

management of retinal conditions ranging from<br />

prophylactic treatment of Sticklers Syndrome to the<br />

current role of scleral buckling. Later Drs Jo Sims<br />

and Ehud Zamir chaired Ocular inflammation in the<br />

complex patient, covering current management<br />

protocols for uveitis in the immunocompromised,<br />

immunosuppressed patient.<br />

In summary, the 47th RANZCO Annual Scientific<br />

Congress showed ophthalmology to be an everexpanding<br />

area with a constant flow of new<br />

insights and advancing technology. ▀<br />

* Dr Kaliopy Matheos is a trainee ophthalmology registrar,<br />

currently working at Greelane Clinical Centre, Auckland.<br />

Congress <strong>2015</strong>: a breath of fresh air<br />


RANZCO chair Dr Brad Horsburgh and past<br />

chair, Dr Stephen Best, showing there’s no<br />

hard feelings after watching the RWC final<br />

at RANZCO <strong>2015</strong><br />

Awards recognise service<br />

The highlight of every RANZCO<br />

Congress is the graduation and<br />

awards ceremony where several<br />

ophthalmologists are recognised for the<br />

years of service they have given to the<br />

College and the community.<br />

At this year’s event the guest of<br />

honour was Sir Geoffrey Palmer who<br />

recited some interesting medical<br />

cases he has been involved with as<br />

a lawyer.<br />

The College Medal was presented<br />

to Associate Professor Ivan Goldberg<br />

for his leadership and dedication<br />

to colleagues and the broader<br />

ophthalmic community. Dr Stephen<br />

Cains also received the College<br />

medal for his selfless dedication and<br />

leadership.<br />

The Distinguished Service<br />

Award was presented to Professor<br />

Stuart Graham, while Wellington<br />

ophthalmologist Dr Peter Wellings<br />

Wellington, you did us proud!<br />

As host city for our 47th<br />

Annual Scientific Congress,<br />

you enabled the College to stage a<br />

gathering that truly delighted not only<br />

our senses but our intellects too.<br />

To the Scientific Program<br />

Committee, we owe a vote of thanks<br />

for a star-studded line-up of speakers<br />

who challenged our orthodoxies and<br />

dared us to push the boundaries of<br />

our understandings ever further.<br />

No matter what the subject, if<br />

you listened you learned. And that<br />

is the backbone of our beloved and<br />

wonderfully complex discipline. Never<br />

can we know it all. Our path is one<br />

of constant learning and the insights<br />

was awarded the Meritorious Service<br />

Award by the NZ Branch for his<br />

outstanding contribution to clinical<br />

and academic ophthalmology in New<br />

Zealand and Australia.<br />

In private practice since 1976,<br />

Wellings has an enviable reputation<br />

for being an astute diagnostician,<br />

an excellent physician and surgeon<br />

and a demanding and inspiring<br />

teacher, the audience was told.<br />

An outstanding example of the<br />

comprehensive ophthalmologist<br />

the College aims to produce today<br />

Wellings was also credited for<br />

his long involvement with the<br />

Ophthalmological Society of New<br />

Zealand and the Royal Australian<br />

College of Ophthalmologists.<br />

A Distinguished Service Award<br />

was also given to Christchurch<br />

ophthalmologist Associate Professor<br />

Mark Elder, a past chair of the<br />

we gleaned from our colleagues in<br />

Wellington will, above all else, enable<br />

us to continue delivering the best<br />

possible care to our patients and the<br />

broader community.<br />

To our newly-admitted Fellows,<br />

we all offer congratulations. Your<br />

graduation ceremony is one of<br />

life’s most memorable occasions.<br />

Cherish this reward for your years of<br />

discipline and dedication and enjoy<br />

the supportive fellowship of a most<br />

remarkable group of people who share<br />

your passions and ideals.<br />

Congress is always a time for renewal<br />

of old friendships and the flourishing of<br />

new ones. To talk shop with colleagues<br />

in a convivial atmosphere is one of the<br />

Our new Kiwi Fellows (from left): Drs Anne-Marie Yardley,<br />

Logan Robinson, Nathan Kerr, Genevieve Oliver, Jern Yee<br />

Chen and Jesse Gale<br />

NZ QEC and chair of the board of<br />

Ophthalmology Path Examiners and<br />

the College accreditation processes.<br />

The new College Fellows were<br />

presented, among them six New<br />

Zealanders: Drs Anne-Marie Yardley,<br />

Logan Robinson, Nathan Kerr,<br />

Genevieve Oliver, Jern Yee Chen and<br />

Jesse Gale, who had the honour of<br />

reading the College Oath.<br />

great pleasures and benefits of this<br />

annual gathering.<br />

To experience the attractions and<br />

differences of a new city each time<br />

imparts a sense of occasion that<br />

is unique to each Congress. In this<br />

regard, New Zealand hospitality was<br />

an absolute winner! How could we<br />

not be entranced by the extraordinary<br />

natural beauty of the country and the<br />

specific delights of Wellington?<br />

This Congress demonstrated the<br />

admirable strength that a trans-Tasman<br />

College can enjoy. It is something we<br />

should never take for granted.<br />

And so, Melbourne in 2016. I hope<br />

I can meet you all again to share a<br />

new collection of warm memories. ▀<br />

Dr Peter Wellings with his wife Gillian and Drs Bruce and<br />

Wendy Hadden at RANZCO’s awards ceremony<br />

Two New Zealand ophthalmologists,<br />

Drs Stephen Guest and Antony<br />

Bedggood, were among the Trainers of<br />

Excellence recognised.<br />

And finally, a special Certificate<br />

of Appreciation was given to Neil<br />

Forbes, editor of Australian trade<br />

magazine Insight, for his contribution<br />

to ophthalmology throughout the 40<br />

years he has published. ▀<br />

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Orthoptic Scientific Conference <strong>2015</strong><br />


This was the first time the New Zealand<br />

Orthoptic Society Inc ( NZOSI) has had the<br />

pleasure of welcoming the Orthoptics Australia<br />

Conference to our shores. Elizabeth Gately-Taylor,<br />

orthoptist from the Wellington DHB provided a<br />

welcome greeting and introduced the Kapa Haka<br />

group to the welcome reception dinner.<br />

The feedback received from the event was<br />

excellent, which boded well for good international<br />

relations. Even the early morning start on Sunday<br />

for the Rugby World Cup, and the less than<br />

favourable outcome for half the delegates didn’t<br />

dampen the atmosphere!<br />

Lisette Wesseling, a Braille teacher and lecturer for<br />

the Blind Foundation NZ (as well as a professional<br />

soprano), gave the welcome address on the Monday.<br />

Profoundly blind, she provided an insight into<br />

how Braille is still providing an independent, selfmotivating<br />

avenue to allow those with no or partial<br />

vision to widen their horizons and explore the world<br />

of literature and science. New apps are now available<br />

that link with a refreshable Braille board and iPads or<br />

computers, so this ancient medium is still expanding<br />

in use in the 21st century.<br />

The highlight, from my perspective, was the Pat<br />

Lance lecture from invited speaker Dr Fiona Rowe, a<br />

highly regarded UK orthoptist. Her recent research<br />

into vision problems post-stroke consolidated the<br />

importance of the orthoptist to provide information,<br />

advice and treatment to enable speedy rehabilitation<br />

of those afflicted. Liaising with other therapists<br />

regarding vision problems allows a more holistic<br />

rehabilitation programme to be established reducing<br />

the financial health burden to the hospital system.<br />

Dr Rowe has even drafted professional best practice<br />

guidelines to assess patients within one month of a<br />

stroke. This does not occur in Australasia due to a lack<br />

of resources namely, staffing and funding.<br />

This linked well with my presentation, which I<br />

gave on behalf of AHANZ (and followed a talk by<br />

Neryla Jolly from the AHPA—the NZ and Australian<br />

Allied Health forums respectively) regarding the<br />

strengthening of inter-professional ties to benefit<br />

the health of our wider populations and the<br />

critical role we, as Allied health professionals, play<br />

in speeding patient discharge from hospital and<br />

maintaining their mobility and independence so<br />

they can remain in the community.<br />

The Myopia Symposium generated a good<br />

interactive panel discussion. Ian Morgan gave<br />

an excellent resume of the emerging epidemic<br />

of myopia. Others then widened the topic with<br />

feedback from recent research showing the current<br />

emerging trend of outdoor light intensities delaying<br />

the progression of myopia. Updates on research<br />

and treatment protocols for Ortho-K and low dose<br />

atropine showed current best practice appears to be<br />

leaning to 0.001% atropine for highly progressing<br />

myopia to delay this over the longer-term. It will be<br />

interesting to see what the future holds in this area.<br />

The low vision session highlighted new aids,<br />

the pros and cons of optical vs electronic options<br />

and other training techniques to maximise vision,<br />

cataract, retinal, strabismus and paediatrics and<br />

the growing issue of diabetes and ophthalmic care<br />

provision.<br />

As New Zealand orthoptists mainly work in<br />

the field of binocular vision, strabismus and<br />

paediatrics, it was good to attend lectures on these<br />

subjects and to have our current practice reinforced<br />

as best practice by those speaking.<br />

We also took the opportunity to hold our<br />

AGM due to the good number of attending NZ<br />

orthoptists. Carly Henley (Auckland) remained<br />

as President and Tammy Miller (Auckland) as<br />

Treasurer, while I handed over the reins as<br />

secretary, after 9 years, to Libby Kelly (New<br />

Plymouth). Lora Parsons (Christchurch) will take<br />

over as IOA rep from myself and Carly. The Next<br />

AGM will be held in conjunction with the RANZCO<br />

and NZOSI meeting in May 2016 in Dunedin. ▀<br />

* Sally-Anne Herring is a part of the Eye Surgeons of Hawkes Bay<br />

practice, an employee of the Hawkes Bay DHB and a regional<br />

specialist in eye movement disorders and their treatment. She is<br />

secretary of the New Zealand Orthoptic Society Inc. and an executive<br />

officer of Allied Health Aotearoa New Zealand (AHANZ).<br />

10 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 10<br />

19-Nov-15 3:27:01 PM


RANZCO practice<br />

manager’s conference<br />


For those of us who braved the early hours of November 1 to<br />

watch the All Blacks decisively beat the Wallabies there was no<br />

more fitting start to a conference designed as a New Zealand and<br />

Australian joint meeting. We Kiwis felt well proud of our efforts on the<br />

field and could therefore hold our heads high throughout a conference<br />

which had a strong Australian influence.<br />

Not that that is a bad thing—on balance Australia has 40<br />

ophthalmologists per million, whereas New Zealand only has 26<br />

and the number of practices differs greatly too. However, the kinship<br />

the practice managers felt when discussing issues such as privacy<br />

and information security, how to manage doctors with persistently<br />

‘lingering’ clinics and how to manage the balance between workplace<br />

roles and friendships spanned ‘the ditch’ without a problem.<br />

Lisa Hartley (RANZCO’s practice managers group chair) and her<br />

committee are to be congratulated on a thorough programme and<br />

speakers of calibre and sufficient variety to keep that post-lunch<br />

session free of the often troublesome desire to snooze. My one<br />

niggle would be that there should have been an explanation of<br />

housekeeping at the venue and reminders throughout the day.<br />

Timekeeping during the sessions would also have been useful.<br />

Not downplaying any speakers not specifically mentioned,<br />

highlights for me, included Scott Bell’s opening session on marketing<br />

the practice; the Medical Insurance Group’s (miga’s) eye-popping<br />

stories; the update from RANZCO CEO David Andrews; the Real<br />

Learning Experience founder Simon Thiessen’s talk on leadership; and<br />

David Wenban, managing director of the Australian Health Industry<br />

Group, on performance management.<br />

Bell, from Nexus Day Hospitals, engaged us all in a table top exercise<br />

identifying what we use for ‘marketing’ our practices, having first<br />

provided a good background and definition of marketing. Debunking the<br />

marketing = advertising myth was the key message. Our group exercise<br />

identified many elements of brand strategy and promotion, the other<br />

two cornerstones of marketing. The footer on practice emails through<br />

to the use of face-to-face visits, signage in rooms, uniforms and public<br />

education events are all opportunities to market beyond advertising.<br />

Bell’s research indicates that the number one marketing tool is<br />

the patient letter or report back to the referrer. His data shows that<br />

making a special effort to personalise that communication will<br />

generate more new referrals than any other method.<br />

Patient complaints form the basis of most legal action against both<br />

doctors and, increasingly, against practices in Australia. Although New<br />

Zealand has the Accident Compensation Corporation (ACC), which<br />

is a shield against most medico-legal claims, the miga presentation<br />

was still relevant. Mitigating the risk of legal action arising from<br />

complaints, the majority of which are about treatment received, is<br />

important for any practice. Mitigation can take the form of sending<br />

a note to a referrer about persistent non-attendance of a patient,<br />

documenting phone calls attempting to rebook and training staff to<br />

recognise urgent cases. Miga advise this training should extend to all<br />

front-line staff as they are often the first point of contact.<br />

I could not write this article without mentioning MDFA and MDNZ. As<br />

a well-established organisation Macular Disease Foundation Australia<br />

have set the bar high and offer a wealth of programmes, services and<br />

research. The A$2.8million in research grant money it provided this year<br />

will no doubt lead to discoveries about how to manage a pervasive health<br />

issue. The advocacy role played by the Foundation to central Government<br />

is extremely important to keep macular disease front of mind and<br />

therefore more likely to attract further funding. Its early days for Macular<br />

Degeneration NZ and the population here has a long way to go simply<br />

in terms of awareness. However, the helpline, public education and free<br />

online CPD course for medical professionals are all effective steps in a<br />

pathway to management and relief for those with macular degeneration.<br />

Keep up the good work!<br />

The update from David Andrews provided a good balance between HR<br />

advice on performance appraisal and learning needs analysis. Andrews<br />

reminded us that the RANZCO Employee Assistance Programme is<br />

available to all members’ practices. One unanswered question, however,<br />

is the benchmark of staffing ratio per doctor in practices. That could be a<br />

challenge given the spectrum of single doctor practices through to multidisciplinary<br />

businesses but one we should not give up asking.<br />

Simon Thiessen and David Wenban provided two excellent sessions<br />

on leadership and performance management, separated by a panel<br />

discussion on leadership and a technical update about laser-assisted<br />

cataract surgery. Both of these sessions were aimed at the chunky<br />

end of the challenges practice managers face every day. Impactful<br />

messages from both included “you manage ‘things’, you lead people”<br />

and “process protects everybody”.<br />

The two presentations were well timed for day three of the<br />

conference as they included elements of management that could<br />

be absorbed and personalised to each practice’s needs. Delegates<br />

had created such good collegiality by day three that we were able<br />

to compare and contrast our own situations and learn from others,<br />

providing some good final discussions from the conference.<br />

Why were these particular sessions highlights for me? Because the<br />

response of the delegates in the room and the engaging conversation<br />

afterwards meant the benefits were easily learned. That said, every<br />

delegate will have his or her own take on the conference; there were<br />

plenty of notes being taken throughout.<br />

Overall I’d like to extend a thank you to the organisers of the<br />

conference. The topics were relevant, meaningful and, for most<br />

people, there would have been take out ideas that could be<br />

implemented. After all, we are practice managers. ▀<br />

* Sally Rosenberg is practice manager of Hamilton Eye Clinic. She was also a speaker<br />

at the Practice Managers Conference, giving a fascinating account of what happened<br />

when fire damaged her practice earlier this year and providing several invaluable crisis<br />

management tips, leading to acknowledgements for a job well done.<br />

RANZCO: What’s new<br />

The exhibitors’ hall at the 47th RANZCO<br />

Scientific Congress was abuzz with<br />

chat about new products, including<br />

the latest developments in cross-linking,<br />

intraocular lenses (IOLs), software, scanners<br />

and OCT angiography. But for many of the<br />

exhibitors NZ Optics spoke with, the congress<br />

was as much about catching up with the<br />

doctors, practice managers and news, as<br />

introducing new products and promoting the<br />

success of older ones.<br />

AFT Pharmaceuticals<br />

“Activity on the first day of any congress is<br />

always mix-and-mingle and ‘where are my<br />

mates’,” said Ben Olsen, AFT Pharmaceuticals<br />

key accounts manager.<br />

Given the ever-increasing interest in dry eye,<br />

Olsen was kept busy throughout most of the<br />

conference demonstrating the correct use of<br />

AFT’s Hylo-Fresh and Hylo-Forte multi-dose,<br />

preservative- and sulphate-free eye drops<br />

for post-operative lubrication and dry eye<br />

treatment. The bottles are designed to deliver<br />

the same dosage with each application, with a<br />

pump system that keeps the drops from going<br />

back into the reservoir and an anti-bacterial<br />

strip, all to prevent contamination.<br />

“A patient will go to the pharmacy for their<br />

dry eyes, and they’ll use anything because it<br />

Dr Will Cunningham, Professor Helen Danesh-<br />

Meyer and Dr Narme Deva<br />

is cheap,” Olsen said. “But, for older patients,<br />

the dosage can be inconsistent, and many will<br />

ultimately seek a more effective treatment<br />

if their dry eye persists. The advantage of<br />

Hylo-Forte is because its viscosity is so high,<br />

and the size of the nozzle allows to express at<br />

a horizontal level, they can apply the product<br />

easily, with the correct training.”<br />

BP Software<br />

Best Practice (BP) Software launched in<br />

2004 and has been steadily grabbing market<br />

share in Australia with its management<br />

software since. In April this year it entered<br />

New Zealand, having acquired Houston<br />

Technology, the Hamilton-based medical<br />

The Cataract<br />

Refractive Suite<br />

BY ALCON<br />

software company.<br />

Houston Technology not only expanded<br />

BP’s market but gave it the product<br />

Australasian doctors had been asking for:<br />

a software programme for specialists and<br />

allied-health organisations, said Lorraine<br />

Pyefinch, who co-founded BP with her<br />

husband, Frank. “Houston specialised in<br />

specialists.”<br />

In fact, with contributions to its coding<br />

from the likes of now-retired Kiwi<br />

ophthalmologist Dr Mike Mair, Houston’s<br />

VIP programme has particular strength in<br />

ophthalmological practice. Thus, the team<br />

from BP was eager to attend Congress to<br />

connect with practice managers and doctors<br />

who have been looking for the combination<br />

of Houston’s specialist focus and BP’s easeof-use,<br />

said Pyefinch.<br />

“Everyone is starting to get their head<br />

around the concept of accessing more<br />

data, sharing more data, improving overall<br />

care and connecting with other health<br />

care providers. So specialists are taking up<br />

technology now in a more serious way.”<br />

After establishing a new office in Hamilton<br />

(opened officially just after RANZCO) and<br />

beefing up its staff numbers, BP is on a<br />

brand-building campaign and is focusing on<br />

how VIP can be improved still further.<br />

Advancing<br />


Advancing<br />



Alcon NZ Optics UltraSert-ORA single page 420x297_099-15_4 outlines.indd 2<br />

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Focus<br />

on Business<br />




Hiring new staff can be a minefield.<br />

Your intention will be to attract, source, recruit and retain the very<br />

best talent and skill set for your business, but how can you be sure<br />

you are doing this effectively? How can you reduce costly hiring<br />

mistakes; and how can you ensure you are doing your best to attract<br />

and retain the best talent?<br />

To get your recruitment project off to a flying start, begin by<br />

focusing on the position description you need. Get it wrong and<br />

it can have an impact not only on how your recruit, but whom<br />

you recruit. Planning is key. Taking time to write a well-defined<br />

position description will ensure you attract the right level and<br />

quality of candidates, reduce attrition in the long-term and support<br />

a successful employer/employee relationship. It gives clarity and<br />

guidelines, helping to manage future expectations for both the<br />

new staff member and for their manager. Use it to support your<br />

recruitment and selection process, job review times and training and<br />

development. Other key recruitment considerations include:<br />

Analysing what’s missing<br />

Clearly identify the resource gap/skills that are missing and need to<br />

be found for your business. If you are replacing someone, ask yourself<br />

if you would you look for the same skill set? Is there someone suitable<br />

in the business that could be upskilled to fill this role? This is a good<br />

time to re-evaluate what you need to make the position description<br />

more successful for all concerned.<br />

Considering the impact<br />

Define the purpose of the role and identify the main impact you<br />

want. Think about the outcomes you require.<br />

Identifying core skills<br />

Identify the skills needed to help achieve the key purpose of the<br />

position. Consider core critical skills that are negotiable and those<br />

that are not negotiable for the role. What is the minimum level of<br />

tertiary qualifications required? Remember most skills can be taught<br />

but a good attitude cannot!<br />

Working out the support required<br />

Do you have or will you need an induction plan? What training is<br />

needed? What career path are you offering? What scope and level of<br />

remuneration and incentives are required? Consider why the person<br />

you want, would want to work for you? And how will you will attract<br />

and source them?<br />

Leading the recruitment process?<br />

Have you got the time and in-house level of expertise to conduct the<br />

recruitment for your business? Consider outsourcing some or all of<br />

the process to a recruitment professional to help you save time and<br />

money.<br />

Here is a WOF-style checklist for a position description:<br />

• Company information - the title of the position, reporting to.<br />

• Purpose/description of the role—an outline of the overall purpose<br />

and content of the role.<br />

• Job Requirements—a list of the Key Result Areas (KRA’s)—4-8<br />

specific tasks or duties you want them to contribute. First list the<br />

key area and then list the key tasks/activities they will need to<br />

undertake, eg. Manage financials—provide up to date monthly<br />

sales and P&L reports.<br />

• Key Performance Indicators (KPI’s)—how you will measure the<br />

results: sales, milestones, goals, targets etc.<br />

• Relationships both internal and external they will manage<br />

• Experience required - consider the specific experience you require<br />

for this role including skills, knowledge and qualifications. List skills<br />

and describe the level of competency required in each, eg. Customer<br />

service—at least three years of telephone and face-to-face<br />

• Personal attributes—in today’s ever-changing work environment<br />

consider flexibility, adaptability and a positive attitude to learning.<br />

All go a long way to creating a positive and productive work force.<br />

Other considerations<br />

During this process, think about how you can highlight your<br />

company’s key selling-points in the position description. Identify<br />

unique features this role offers a candidate and highlight incentives<br />

and opportunities for career development and innovation, investment<br />

in education and community involvement.<br />

Lastly, you may also consider outlining the remuneration package<br />

components—base, targets, benefits, staff discounts, health<br />

insurance etc. where applicable. You can keep this on your own copy<br />

and remove for applicants if you wish it to be confidential.<br />

In further columns for NZ Optics I will expand on the considerations<br />

above, outline tips for writing good recruitment ads and provide you<br />

with some compelling interview techniques. ▀<br />

* Therese McNaughten is a director and founder of Wholeoranges<br />

Consulting, a boutique recruitment firm that provides flexible<br />

recruitment services to businesses nationwide, and a business<br />

coach for those going through career transitions. For more, contact<br />

Therese at therese@wholeoranges.co.nz or visit<br />

www.wholeoranges.co.nz.<br />

Largest ever AUSCRS meeting<br />


A<br />

record number of attendees gathered<br />

to listen to the most comprehensive<br />

programme on cataract and refractive<br />

surgery available in this part of the world at<br />

this year’s Australasian Society of Cataract<br />

and Refractive Surgery (AUSCRS) meeting.<br />

Held at Peppers Resort in Noosa from<br />

October 7-10, AUSCRS <strong>2015</strong> continued<br />

to uphold practices making it uniquely<br />

entertaining, including the banning of ties<br />

and jackets, allocating amusing themes<br />

to many of the sessions and dressing up<br />

speakers in outrageous costumes, with<br />

accompanying music and videos.<br />

Many ophthalmology registrars also<br />

attended the AUSCRS Advanced Trainee<br />

Programme, which provided the basics in<br />

cataract surgery, intraocular lenses and<br />

corneal and refractive surgery.<br />

At the main meeting four overseas<br />

speakers presented: the current president<br />

of the American Society of Cataract and<br />

Refractive Surgery (ASCRS) Robert Cionni;<br />

the immediate past president of ASCRS, Eric<br />

Donnenfeld; Roberto Bellucci from Italy; and<br />

Gilles Lesieur from France.<br />

Cionni presented The Gold Medal Lecture,<br />

Managing Loose Zonules. He outlined the most<br />

important innovations in cataract surgery in the<br />

presence of compromised zonules, including<br />

the development of phacoemulsification,<br />

viscoelastics and capsular tension rings, and<br />

he discussed the Ahmed capsular tension<br />

segmentas well as the Malyugin modified CTR<br />

that can be injected.<br />

Until recently the loops around the anterior<br />

capsule margin were usually sutured to the<br />

sclera in the ciliary sulcus using Prolene. More<br />

recently—since the discovery that Prolene<br />

degrades and gives way over 10-20 years—<br />

there has been a move to using Gortex 6-0<br />

sutures as the best choice for scleral sutures.<br />

Cionni showed how to do two separate<br />

sclerotomies and then use 25 gauge<br />

disposable retinal forceps to pull the two<br />

ends of the Gortex suture through the two<br />

sclerotomies. He recommended using a two,<br />

one and then one throw knot with Gortex<br />

sutures before rotating the knot inside the<br />

eye. He also covered important surgical<br />

principles and gave many useful insights.<br />

The presenters were all dressed up in outfits<br />

and helmets suitable for extreme outdoor<br />

sports for the next session on, Complications<br />

and challenging cases: too close for comfort.<br />

President Dr Graham Barrett channels his inner Kermit at AUSCRS <strong>2015</strong>. Photos courtesy of MiVision<br />

Surgical videos included management of an<br />

eye that had a chronically dislocating anterior<br />

chamber IOL, astigmatic surprise with a<br />

trifocal IOL due to IOL tilt, dislocating of a<br />

Verisyse iris clip IOL, the use of an artificial iris<br />

in a patient with trauma and IOL exchange in<br />

juvenile chronic arthritis.<br />

In the following session there were<br />

presentations on adjustable IOL, controversies<br />

in corneal collagen cross-linking and the use<br />

of toric IOLs in keratoconus.<br />

AUSCRS president Dr Graham Barrett<br />

dressed as Kermit the Frog for the session<br />

entitled Muppets or Masters: The role of<br />

new technology, while other presenters<br />

dressed up as science fiction heroes. The<br />

topics included femtosecond laser assisted<br />

cataract surgery, trifocal IOLs, intra-operative<br />

aberrometry to assist with IOL power and<br />

astigmatism management and extendeddepth-of-focus<br />

IOLs. The audience was asked<br />

to vote if each topic made the presenter a<br />

muppet or a master?<br />

Day two included a discussion about<br />

the role of posterior corneal astigmatism<br />

estimation and/or measurement to assist<br />

with toric IOLs. There were presentations that<br />

compared the three different trifocal IOLs<br />

from Zeiss, FineVision and Alcon, as well as<br />

comparisons of different extended-depth-offocus<br />

from AMO Surgical and Oculentis.<br />

Another presentation compared contrast<br />

sensitivity and glare testing in patients with<br />

trifocal IOLs and normal age-matched eyes<br />

and found no significant difference. There<br />

was general agreement there was now no<br />

reason to use a bifocal diffractive multifocal<br />

IOL when trifocal IOLs all gave a much better<br />

range of unaided vision and extended-depthof-focus<br />

gave useful near vision, without<br />

the same degradation of low light and<br />

night time vision found with trifocal IOLs.<br />

Another session included presentations and<br />

Dr’s Rod Keillor, Mark Ruddel and Brett Rogers at AUSCRS<br />

debate about the merits or lack of merit of<br />

femtosecond laser assisted cataract surgery.<br />

The third and final day was also of a<br />

high standard. The first session on corneal<br />

surgical controversies debated the merits<br />

of endokeratoplasty surgery, deep anterior<br />

lamellar keratoplasty in keratoconus and<br />

whether or not there was a role for excimer<br />

laser in combination with corneal collagen<br />

cross-linking for patients with keratoconus.<br />

One of the highlights of day three was a<br />

session entitled Refractive Round Up, in which<br />

Barrett dressed as a native American chief<br />

complete with a small live pony, while the<br />

other presenters dressed as cowboys. There<br />

was a case presentation of a woman in her<br />

70s who developed progressive keratoconus<br />

leading Eric Donnenfeld to comment that<br />

most late keratoconus cases are due to floppy<br />

eyelid syndrome and chronic rubbing of the<br />

affected eye.<br />

The final night was celebrated with the<br />

Gala Dinner, with the theme Hot Night in<br />

Havana.<br />

Next year the 20th meeting of the AUSCRS<br />

will be held at the newly renovated Sheridan<br />

Mirage in Port Douglas from July 20-23rd. ▀<br />

* Dr David Kent is an Ophthalmologist with Fendalton<br />

Eye Clinic in Christchurch and the current New Zealand<br />

representative to the International Society of Refractive<br />

Surgery and AUSCRS<br />

OPSM a-flutter in Butterfly Creek<br />


OPSM held its National Mini-<br />

Conference on October 18, with 40<br />

optometrists attending from as far<br />

north as Whangarei down to Dunedin.<br />

The one-day event at Butterfly Creek<br />

in Auckland included guest speakers<br />

Drs Rachel Barnes and Andrea Vincent<br />

from Retina Specialists, who led a talk on<br />

abnormal and normal peripheral retinal<br />

conditions. Vincent discussed the use of<br />

Optos ultra-widefield imaging scanner and<br />

its ability to diagnose rod-cone dystrophies.<br />

In using Optos’ fundus autofluorescence<br />

(FAF) imaging, she said, abnormal FAF<br />

images in rod-cone dystrophy correlate<br />

highly with the visual field loss.<br />

Optometrists then shared case<br />

reports, confirming diagnoses with the<br />

ophthalmologists. My favourite case was<br />

one from Evan Tennant of OPSM Dunedin,<br />

who discussed the case of a man who’d<br />

been diagnosed several years ago as<br />

simply having retinal pigment, but a reexamination<br />

of his FAF images indicated the<br />

patient actually had a rod-cone dystrophy.<br />

The event included a Red Eye Workshop<br />

led by fellow optometrist Jason Dhana and<br />

myself. In the workshop, attendees were<br />

split into two groups to review eight cases<br />

of red eye, covering differential diagnosis,<br />

treatment and management. Dr Hussain<br />

Patel was on hand to give feedback on tricky<br />

treatment scenarios and advice on “dodgy<br />

looking discs,” glaucoma case analysis.<br />

Emma Gilles from Johnson & Johnson<br />

gave a presentation on the new 1-day<br />

Moist Multifocal. It was refreshing to learn<br />

about the reasoning behind material choice<br />

and design of the lens to help give our<br />

presbyopic patients more natural vision.<br />

Graeme Curtis from CLC then led us through<br />

piggybacking solutions in Keratoconus and<br />

other ways to improve lens centration for<br />

those troublesome cone fits.<br />

The day ended with another round of<br />

cases, including successful orthoptic<br />

treatment of intermittent exotropia in<br />

a child presented by Melissa Thomson<br />

of Thames OPSM; and a spontaneous<br />

hyphaema case presented by Craig Holmes<br />

of Tauranga OPSM.<br />

Many thanks must go to the event<br />

sponsors Johnson and Johnson Visioncare,<br />

Designs for Vision and Alcon, without whom<br />

the event would not have been possible. ▀<br />

* Zoe Smith is an optometrist at OPSM Royal Oak and<br />

a clinical supervisor teaching fellow at Auckland<br />

University Eye Clinic.<br />

Pauraic O’Sullivan, Jared Beetham and Hirdesh Nair<br />

Zoe Smith, Dr Andrea Vincent and Dr Rachel Barnes<br />

AFT mulls IPO<br />

AFT may go public to raise capital on<br />

the NZX and ASX stock exchanges,<br />

the company said in a statement.<br />

AFT is considering an initial public offering<br />

to raise of $45 million, with a $4 million selldown<br />

by the Atkinson Family Trust, which<br />

owns 87% of the company.<br />

The company intends to continue<br />

introducing new products in New Zealand<br />

and Australia, and expand internationally<br />

through third-party licensees and<br />

distributors. Half of AFT’s <strong>2015</strong> revenue was<br />

from New Zealand, 47% from Australia and<br />

the remainder from the rest of the world,<br />

primarily southeast Asia, where the company<br />

began doing business in mid-2014.<br />

The company sells 109 products across<br />

Australia and New Zealand, and has<br />

licensing or distribution agreements in over<br />

35 countries. ▀<br />

12 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 12<br />

19-Nov-15 3:27:08 PM

Award-winning oDocs<br />

OphthalmicDocs’ Eye Care project won the<br />

People’s Choice award and was highly<br />

commended in the Health and Science<br />

category at this year’s New Zealand Innovators<br />

Awards.<br />

oDocs, the brainchild of Gisborne Hospitalbased<br />

registrar Dr Hong Sheng Chiong, combines<br />

smartphones with an app and 3D printable<br />

attachments to allow accurate, but low cost,<br />

mobile visual acuity tests, slit-lamp examinations<br />

and retinal imaging with a lens that gives a 40<br />

degree look into the back of the eye (see NZ<br />

Optics October <strong>2015</strong>).<br />

oDocs was nominated in five categories at the<br />

Awards, including Hong himself being nominated<br />

for the “Most Inspiring Individual” category.<br />

The New Zealand Innovation Council held its<br />

Innovation Awards on October 21 at the Cloud<br />

in Auckland.<br />

It was a month of awards for oDocs, with<br />

the company also being named winner of the<br />

Clinician’s Challenge-Act Project award at the<br />

<strong>2015</strong> Health Infomatics New Zealand (HiNZ)<br />

conference in Christchurch the previous day.<br />

While fellow eye professional, senior registrar,<br />

Dr James McKelvie won the Clinician’s Challenge-<br />

New Ideas category for his electronic referral,<br />

risk assessment and real-time audit of cataract<br />

surgery initiative.<br />

McKelvie’s concept is a web-based, end-toend<br />

application, which replaces the paper-based<br />

system currently used in the health service,<br />

for tracking and assessing the 37,000 cataract<br />

surgeries performed in New Zealand every year.<br />

The system features instant online referrals,<br />

pre-operative surgical risk analysis and real-time<br />

audit of surgical results. Both Hong and McKelvie<br />

received $8,000 to continue developing their<br />

initiatives as part of their awards.<br />

Health Minister Jonathan Coleman<br />

congratulated McKelvie and Hong in a statement,<br />

saying their initiatives showed innovation was<br />

alive and well in the health IT sector. “It’s great<br />

to see clinicians finding better use of information<br />

and technology to deliver more timely quality<br />

patient care which can enable clinicians to<br />

spend more time with patients and less on<br />

administration. We want to see more health<br />

Dr Hong Sheng Chiong and Hanna Eastvold-Edwin receive<br />

the People’s Choice award from Idealog’s Vincent Heeringa<br />

Maryanne Dransfield with Sandra Budd, Hong Sheng<br />

Chiong, Paulette Cotter and Rick Hoskin in the Cloud<br />

care delivered in the community and people<br />

living healthier lives away from hospitals. Using<br />

technology has a key role to play in this.” ▀<br />

Chch first Study Day a hit<br />


Christchurch Eye Surgery held its inaugural<br />

optometry Study Day on November 7, with<br />

more than 40 attendees from throughout<br />

the South Island.<br />

The Study Day included a morning lecture series<br />

followed by an afternoon of clinical case discussions<br />

and debates, presented and presided over by the<br />

ophthalmologists of Christchurch Eye Surgery.<br />

Dr Malcolm McKellar gave a presentation on<br />

pterygium management, concluding that even<br />

small, innocuous pterygia can significantly degrade<br />

vision and removal should be considered when<br />

patients have altered vision.<br />

I presented on watery eyes. An altered blinking<br />

pattern is a common cause of watery eyes<br />

and optometrists should check for a patient’s<br />

completeness of blink, lid laxity and eyelid closure.<br />

In Dr Jim Borthwick’s presentation on macular<br />

hole surgery, he said a dry cornea degrades the<br />

image in OCT, but artificial tears can improve the<br />

scan when the quality is poor.<br />

In her lecture, Visual disturbances after stroke,<br />

Dr Jo-Anne Pon pointed out that hemianopia poststroke<br />

can be as debilitating as hemiparesis.<br />

Other topics covered included:<br />

• Cross-linking is not indicated in patients with<br />

keratoconus if their vision cannot be corrected<br />

with glasses or contact lenses (Spectrum of<br />

corneal ectasias by Dr John Rawstron)<br />

• Patients with an epiretinal membrane need a<br />

dilated fundal exam to exclude a peripheral<br />

retinal tear (Interpreting a macular OCT by Dr<br />

Sean Every)<br />

• All patients on topical, inhaled and oral steroid<br />

should have regular IOP screening (Steroid<br />

induced glaucoma by Dr Allan Simpson)<br />

• Biometry before cataract surgery needs to be<br />

repeated until stable in contact lens wearers;<br />

there is no arbitrary time frame. (“Presbyond”<br />

laser correction by Dr Ian Dallison)<br />

• The refractive goal after cataract surgery<br />

is the patient’s refractive goal not piano.<br />

Dr James McKelvie recieves his Clinician’s Challenge award<br />

from Graeme Osborne, National Health IT Board director<br />

Alan Benjamin, Michael Brown and Stephen McCreadie<br />

tour the plant room of Christchurch Eye Surgery<br />

(Accommodative options after cataract surgery<br />

by Dr David Kent)<br />

Optometrists were given a lunchtime tour of the<br />

newly opened theatre facility, a highlight for some,<br />

especially exploring the first floor plant room.<br />

The expert panel discussion in the afternoon was<br />

led by Dr Malcolm McKellar, presenting anonymous<br />

questions from the audience. This challenged the<br />

ophthalmologist panel on a range of clinical and<br />

ethical issues including access to care in the public<br />

sector and co-management of glaucoma patients.<br />

This session provided a valuable opportunity to<br />

discuss issues in a collaborative fashion.<br />

The day ended on a less serious note with an<br />

ophthalmic quiz, which I presented. The Richie<br />

McCaws team, also known as Dr Every, Rochelle van<br />

Eysden, Alistair Thomson, Leesa Stewart, Dabin Kim,<br />

Susan Thompson and Rich Faloon-Cavender, were<br />

victorious. They successfully solved the World Health<br />

Organisation acronym S.A.F.E. and made 34 words of<br />

four or more letters from the word “optometry”. (See<br />

if you can get closer to the 98 there are in total!)<br />

The Christchurch Eye team look forward to<br />

hosting the next symposium following its first<br />

successful outing. ▀<br />

* Dr Rebecca Stack of Southern Eye Specialists is a director of<br />

Christchurch Eye Surgery<br />

Focus on<br />

Eye Research<br />

Paediatrics: Retinopathy<br />

of Prematurity<br />




Dai S, Austin N et al<br />

Journal of Paediatrics and Child Health <strong>2015</strong>; 51:<br />

955-9<br />

This paper sets out recommendations for<br />

retinopathy of prematurity screening (ROP) in<br />

New Zealand.<br />

Review:<br />

The current guidelines provide a comprehensive<br />

framework for good practice, stating that infants<br />

must be screened if they are 26 weeks<br />

first screen at 4 weeks postnatally), as well as for<br />

subsequent screenings according to examination<br />

findings. The authors suggest Retcam screening<br />

is the preferred screening modality performing<br />

as well as binocular indirect ophthalmoscopy, but<br />

provides an objective record, can be undertaken<br />

by trained non-physicians and a remote ‘expert’<br />

opinion obtained when required. When treatment<br />

is required, it must be undertaken in a centre<br />

with available expertise. Diode laser remains the<br />

established modality (although argon laser is an<br />

alternative where diode is unavailable). Intravitreal<br />

bevacizumab should be considered where ROP has<br />

not responded to laser and aggressive posterior<br />

ROP (APROP).<br />

Comment:<br />

These screening recommendations provide a<br />

comprehensive framework for any clinicians<br />

undertaking ROP screening. Prior to this paper, the<br />

only published ROP screening recommendations<br />

in New Zealand date from 1990. While the 1990<br />

recommendations are unlikely to miss children with<br />

severe ROP resulting in severe visual impairment,<br />

there was concern regarding documentation of<br />

screening and delays in screening/treatment due to<br />

babies being transferred between different units.<br />

Such occurrences are much less likely with these<br />

guidelines.<br />



A 22-YEAR REVIEW<br />

Tan Z, Chong C et al<br />

British Journal of Ophthalmology <strong>2015</strong>; 99: 801-6<br />

Review:<br />

This retrospective case notes review focuses on<br />

children registered with the Blind and Low Vision<br />

Education Network New Zealand (BLENNZ),<br />

registered with ROP as the primary cause of<br />

visual impairment between 1991-2012. Data<br />

was analysed in two study periods (1991-2004<br />

and 2005-2012) due to changes in ROP screening<br />

and treatment following the ETROP trial, which<br />

advocated earlier treatment of less severe ROP. In<br />

all, 232 children were identified as being treated<br />

for ROP within the study period (109 in period<br />

1, 123 in period 2). Of these, 36 children were<br />

identified as having significant visual impairment<br />


SPECIAL FEATURE: ADONZ Conference (continued from November’s NZ Optics)<br />

Daring to be different<br />

Global myopia<br />

There are a number of things that irk Elaine Grisdale,<br />

head of professional services and international<br />

development at the Association of British Dispensing<br />

Opticians (ABDO). One is the declining number of DOs in<br />

Britain who still offer bespoke eyewear to their patients,<br />

another is ill-fitting eyewear paraded around as if it’s the<br />

latest fashion by Hollywood icons, like Zoe Saldana (see<br />

picture). Yet another is DOs feeling bored or frustrated by<br />

others’ lack of understanding or use of their abilities.<br />

With the latter in mind, the <strong>2015</strong> ADONZ key note<br />

speaker set out to inspire New Zealand’s dispensing<br />

opticians with ideas to put some excitement back into their<br />

roles and demonstrate their long list of oft forgotten skills.<br />

Her first presentation, titled Dare to be different -<br />

creating opportunities with bespoke eyewear, though<br />

a little off the mark as Kiwi DO’s qualifications don’t<br />

include a bespoke block, was a fascinating insight into<br />

the skills and tools of the trade of a good DO. It provided<br />

a number of options of what to do should you be faced<br />

with a returning All Black’s nose, which doesn’t lend<br />

itself to off-the-shelf frame options, and encompassed<br />

the dos and don’ts of good fitting, tips for both inspiring<br />

patients and taking control of the process.<br />

In Smarter dispensing for presbyopes, Grisdale<br />

guided delegates through the myriad possible mishaps<br />

for getting it right for presbyopes and provided an<br />

enlightening history lesson on the development of<br />

lenses, including some personal insight about the man<br />

who invented progressive lenses, Bernard Maitenaz, for<br />

Essilor forerunner Société des Lunetiers.<br />

With so many lens options for presbyopes today, it’s<br />

important for a good DO to do their own research, she<br />

said, so ask for the results of clinical trials, especially<br />

double-blind wearer trials. “Make your lens rep work.<br />

And ask to trial their lenses if you wear progressives.”<br />

Another key part of every successful dispense is factfinding<br />

to build a picture of the person in front of you:<br />

what do they want to wear their glasses for?<br />

“We are all very bad at multiple dispensing, but you don’t<br />

have one pair of shoes for every occasion, so why should<br />

you have one pair of glasses for everything,” said Grisdale.<br />

Other presbyopic dispensing tips included not over<br />

promising; letting the patient tell you what is the<br />

most comfortable reading distance for them; correct<br />

measuring; having the best tools for measuring and<br />

fitting; and making time for measuring, even it means<br />

Actor Zoe Saldana in her “ill-fitting” specs<br />

ADONZ key note ABDO’s Elaine Grisdale<br />

making a second appointment.<br />

All the best practices keep two diaries, one for the<br />

optometrist and one for the DO, she said.<br />

“When a patient leaves your practice they will not<br />

judge it on the quality of the eye exam unless the<br />

optometrist has discovered something that will stop<br />

them going blind; they will judge you on the quality of<br />

their vision, so dispense what is best for your patient’s<br />

needs, remembering that might be more than one pair.”<br />

And finally, she added, “don’t say ‘come back if you have<br />

any problems’. Don’t plant the word ‘problems’ in their<br />

mind. Just say, ‘come back, any time if you have<br />

any questions’.” ▀<br />

epidemic looms<br />

There’s a dim future ahead of us<br />

in global vision health if we don’t<br />

start doing something about<br />

the increasing prevalence of myopia, Dr<br />

David Wilson told delegates at the <strong>2015</strong><br />

ADONZ meeting in Hamilton.<br />

According to a research paper authored<br />

by Wilson, research manager, Asia- Pacific,<br />

for the International Centre for Eyecare<br />

Education at the University of New<br />

South Wales, and the late Brien Holden<br />

and others, and presented as part of<br />

Wilson talk’s at ADONZ, there will be five<br />

billion myopes in the world by 2050, 20%<br />

of them with high myopia and facing loss<br />

of vision.<br />

“Our hypothesis was that with this<br />

massive increase in myopia and high<br />

myopia, it’s imperative to control the rate<br />

of high myopia to reduce the financial<br />

and social burden costs associated with<br />

it,” he said.<br />

The research paper was a metaanalysis<br />

of population studies of myopic<br />

rates, which sifted through more than<br />

2,000 published surveys to find 145<br />

papers that matched the project’s criteria.<br />

Recent published studies on myopia<br />

in China have made headlines (see<br />

associated story in November’s NZ<br />

Optics) and there is some response by the<br />

governments of China and Taiwan to curb<br />

the prevalence and progression of the<br />

condition.<br />

In Taiwan, one study showed 97%<br />

of military conscripts are myopic.<br />

The government has recently passed<br />

legislation prohibiting children under<br />

two from using smartphones and<br />

iPads threatening parents with a steep<br />

fine if caught.<br />

Research predicts 75% of Japanese and<br />

77% of people living in Singapore will<br />

be myopic by 2050, said Wilson,<br />

while New Zealand, with a current<br />

7% myopic rate, faces a sobering 53%<br />

prevalence in 2050.<br />

The research shows we are seeing a<br />

much higher level of high myopia than<br />

any time in the past and because the<br />

problem is related to axial length, the<br />

risk of myopic macular degeneration and<br />

retinal detachment etc. will threaten<br />

vision more and more, he continued.<br />

Wilson and his fellow Australian<br />

researchers persuaded the government<br />

to invite World Health Organisation<br />

representatives, together with global<br />

myopia experts from 16 countries, to<br />

convene to tackle the problem. The<br />

group developed a standard definition<br />

of myopia and, more importantly,<br />

agreed to lobby WHO leadership<br />

to recognise myopia as a separate disease.<br />

“The next step is in their hands,” Wilson<br />

said, but practitioners need to keep up to<br />

date with control measures. “The younger<br />

you can get to myopes, the better you can<br />

control the effects.”<br />

Controls includes Ortho-k, other<br />

contact lenses, extended-focus lenses,<br />

atropine therapy and spending more<br />

time outdoors with less “near-work” or<br />

other behavioural modifications.<br />

“In Australia, the message is about<br />

getting more time outdoors, not doing<br />

as much homework and limiting time<br />

on screens,” Wilson said. “Countries like<br />

Taiwan are taking notice and treating it<br />

seriously. But Australia and New Zealand<br />

have been complacent because myopia<br />

hasn’t raised its ugly head yet.” ▀<br />

NEW Shades of Brown<br />

now available in brown<br />

GRAND OPENING – 23 SEPT. 2016<br />

The appeal of Transitions ® XTRActive ® lenses just became a lot more<br />

compelling: it is now available in brown through Younger Optics.<br />

During the past European Summer, brown sunglass tints proved to be<br />

hotter than ever in the fashion stakes.<br />

Beyond fashion, Transitions XTRActive in brown also deliver significant<br />

wearer benefits:<br />

• Brown offers superior contrast<br />

and visual acuity<br />

• Brown is ideal for both bright<br />

and overcast conditions<br />

• Brown provides extra definition<br />

for wearers with diminishing vision<br />

• Darkest Transitions everyday<br />

lens outdoors<br />

• Activation behind the windscreen<br />

of a car<br />

• 100% UV blockage<br />

Now is the time to recommend the additional benefits of brown<br />

Available at Younger Optics<br />

Phone: +61 8 8241 9800 Email: info@youngeroptics.com.au<br />

Transitions, the swirl, and XTRActive are registered trademarks and Adaptive Lenses<br />

is a trademark of Transitions Optical Inc., used under licensed by Transitions Optical Ltd.<br />

www.youngeroptics.com<br />


23> 26 SEPT. 2016<br />


Conception : CARLIN<br />


14 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 14<br />

19-Nov-15 3:27:12 PM

Society of the 3D spectacle<br />

Last issue we brought you an insight<br />

into Silmo <strong>2015</strong>, but with so much going<br />

on we decided to split the article in two.<br />

Here’s the promised part II.<br />


In the Village section of the fair, where design and<br />

the most innovative ideas jockey for position, I<br />

discovered there is more to a frame than acetate<br />

and metal. The compelling story about the frame<br />

and how it is designed goes deeper, with designers<br />

responding to ever-changing public taste and<br />

exploring new methods of fabrication.<br />

The burgeoning 3D and wooden frame market<br />

was obvious with new companies entering this<br />

sector, along with established brands trying their<br />

hand in these fields.<br />

One of the first in is now taking 3D production<br />

one step further with customisation. Allan Petersen<br />

from Danish company Monoqool has teamed up<br />

with Dutch company Sfered which has developed<br />

3D software and scanning technologies to measure<br />

the face through more than one million points. This<br />

can be used to produce the perfect-fitting frame in<br />

3D printing and milling.<br />

“More companies are entering this market and<br />

I think 3D frames will become a category on its<br />

own,” Petersen said. “My fear is that if newcomers<br />

don’t understand the technology, poor quality<br />

frames are going to be produced and I don’t want<br />

the reputation of this category to be ruined. It’s<br />

not easy and it’s not cheap and the technology is<br />

still evolving.”<br />

Petersen sees customisation as key to the future<br />

of 3D fabrication.<br />

“When I got into 3D printing five years ago, I<br />

always had customisation in the back of my mind.<br />

First I needed to perfect the process and now I<br />

think we have ‘cracked the code’.”<br />

Monoqool’s collaboration with Sfered allows the<br />

customer to choose a frame’s shape and colour.<br />

The Sfered software’s algorithms generate the<br />

chosen frame as a first fit suggestion. An optician<br />

or optometrist can then manually adjust and<br />

customise the frame,<br />

fine-tuning the nose<br />

bridge, base curve<br />

and the pantoscopic<br />

angle.<br />

“This type of product<br />

is what’s going to<br />

set practices apart<br />

from the increasing<br />

competition from<br />

the chains and<br />

Alan Saks getting measured by Monoqool<br />

discounters,” Petersen<br />

said. “Customisation<br />

will differentiate a practice and also puts the<br />

technology into the hands of the practitioner.”<br />

Petersen believes that customised eyewear<br />

eventually will make up 10 to 20% of his business.<br />

Mykita has also entered the digital revolution of<br />

bespoke eyewear. The company says it is bringing<br />

together “anatomical design with avant-garde<br />

technology to set the standard for digitally tailored<br />

eyewear” with all the luxurious attributes of a<br />

hand-crafted product.<br />

At Silmo, Mykita set up a demonstration laboratory<br />

to show off its MY VERY OWN (MVO) system—an<br />

integration of 3D scanning, parametric design<br />

and additive manufacturing that digitally creates<br />

eyewear tailored to the individual topography of a<br />

customer’s face. After selecting an eyewear shape<br />

from the MVO collection, the customer’s face is<br />

scanned and visualised with the selected frame<br />

adjusted to the face contours. The colour of the<br />

frame, lenses and hinges are selected and virtually<br />

composed for a truly bespoke pair of prescription<br />

specs or sunglasses and then 3D printed.<br />

Into the wood<br />

Danish frame design company Fleye presented its<br />

latest stylish collection at Silmo which features a<br />

combination of carbon fibre together with titanium<br />

and wood. The construction involves 23 layers of<br />

carbon fibre finished off with one paper-thin layer<br />

of wood either in ebony, rose wood or oak.<br />

“The technology used ensures a very light<br />

structure. Finished off with titanium temples, the<br />

finished product gives a very warm and natural<br />

Mykita’s lab-like exhibit, featuring a<br />

scanning device to create 3D frames<br />

look to the face. By playing with different colours<br />

in the titanium, you can achieve a very trendy and<br />

unique product and it is very uplifting on the face,”<br />

said Annette Estø, Fleye designer and CEO.<br />

Fleye has been making carbon fibre frames for the<br />

past two years and this is now making up 35% of<br />

the company’s sales. Its next launch will be at the<br />

Munich fair in January. This collection will involve<br />

thin layers of acetate with beta-titanium as a<br />

middle layer to provide extra strength.<br />

Canadian company Spectacle Eyeworks, which<br />

has been in the eyewear business for two decades,<br />

featured an array of show-stopping styles;<br />

eccentric, experimental shapes to fashion-forward<br />

classics with a twist. As well as its new ‘Retro’ and<br />

‘Pussy Galore’ collections, the company also has a<br />

luxury wood & horn collection, featuring stunning<br />

artistic flair. Chief designer Mehran Baghaie<br />

said the firm’s collections consist of a diverse<br />

combination of plastic, titanium and stainlesssteel<br />

styles. Every frame is produced with a slogan.<br />

His favourite is ‘Love is the irresistible desire to be<br />

desired irresistibly.’<br />

More from Oz<br />

Niloca designer Colin Redmond and his wife Josie<br />

have all the prerequisites to be in the eyewear<br />

business. Colin is an international award-winning<br />

industrial designer with a fierce passion for<br />

creating. He designed for Audi in the late ‘90s,<br />

culminating in a Red Dot award received as part<br />

of the iconic TT-model design team. While Josie<br />

Allan Petersen with<br />

Monoqool’s 3D printed<br />

frames<br />

WeWood, which specialises in wood<br />

watches, shows off an example of its new<br />

wood frames<br />

is a dispensing optician who owns a practice in<br />

Melbourne called Scoogle.<br />

After three years of research, designing and<br />

refining ideas, Niloca was officially released in 2011<br />

with a commitment to production within Australia.<br />

Now in eight countries, the company is continuing<br />

to grow and launched a brand new collection for<br />

Silmo called Exotic Fruit. Featuring new bespoke<br />

acetates, the collection is an all-star line-up of<br />

hatched black pin stripe layers and a new tortoise<br />

shell glitter mosaic, finished with a laser engraved<br />

texture map resulting in a very dimensional look.<br />

“All the acetates are custom-made for us. The<br />

design of the frames involved three layers of acetate<br />

being sandwiched together to form the chequered<br />

pattern and a pastel acetate put on top which is<br />

laser etched to achieve the matte finish,” said Josie.<br />

Unlike the previous collection that was hand-made<br />

in France, Exotic Fruit is made in a state-of-the-art<br />

manufacturing facility in Dubbo, Australia by Optex.<br />

Having walked around the show, Josie said she<br />

was concerned about the trend she was seeing in<br />

flat eyewear design.<br />

“It’s very fade orientated and not suitable for<br />

ophthalmic lenses. By nature lenses cannot be<br />

completely flat and especially at the high end of<br />

the market people want free-form lenses and these<br />

can’t be flat. You need the product to work so this<br />

type of design is not sustainable. It’s also very<br />

unflattering for the older face.”<br />

Silmo 2016 will be held in Paris from 23 to 26<br />

September. For more visit: http://en.silmoparis.com/ ▀<br />

The<br />

secret<br />

behind<br />

perfect<br />

vision<br />

“<br />

Fantastic<br />

lenses!<br />

These iD WorkStyle V+ lenses are<br />

fantastic. Put them on and could not believe<br />

how clear they are! No distortion between<br />

distance, intermediate and near. The frame<br />

also feels really good, so many thanks HOYA<br />

for the perfect fitting! ”<br />

− Maryanne Dransfield, New Zealand<br />

hoyalens.com.au/VplusTestimonials<br />

NZOptics_halfpage_V+_18x28cm_<strong>Dec</strong>15.indd 1<br />

<strong>Dec</strong>ember <strong>2015</strong><br />


16/11/<strong>2015</strong> 12:28:36 PM<br />

15<br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 15<br />

19-Nov-15 3:27:15 PM

with<br />

Prof Charles McGhee<br />

& A/Prof Dipika Patel<br />

Series Editors<br />

From corneal transplants<br />

to engineered corneal tissue<br />


Introduction<br />

Serious vision loss due to corneal<br />

diseases can be treated by corneal<br />

transplantation. Despite its relative<br />

success, the procedure is not suitable<br />

for all cases and suffers some<br />

limitations. Alternatives approaches<br />

are therefore being explored to<br />

further enhance the treatment<br />

of corneal diseases. This article<br />

provides an overview of the various<br />

corneal transplantation techniques,<br />

commercially available artificial<br />

corneas, and current research on<br />

advanced engineered corneal tissue.<br />


Each year, approximately 250-300 corneal transplants are performed<br />

in New Zealand. The major indications for corneal transplantation<br />

in New Zealand include keratoconus (41.1%), regraft (17%), aphakic<br />

or pseudophakic bullous keratopathy (13.9%), corneal dystrophy<br />

(10.7%), keratitis (7.9%), and trauma (3.7%). Corneal transplants may<br />

be either full thickness (penetrating keratoplasty (PKP)) or partial<br />

thickness (lamellar keratoplasty). Recent years have seen a surge<br />

in the proportion of lamellar keratoplasties being performed, with<br />

proportions in 2009 of 30.2% in New Zealand, 31.8% in USA, and 40%<br />

in Australia. 1<br />

PKP is the traditional corneal transplant procedure in which the<br />

full thickness diseased cornea is replaced with a full thickness<br />

donor cornea.<br />

The first successful PKP was performed by Eduard Zirm in 1905,<br />

and the technique has been developed and refined over the last<br />

century. The Australian corneal graft registry has recorded 5 and<br />

10 year survival rates of 76% and 49% for ‘contemporary’ PKP<br />

performed from 2000 onwards. 1 Despite the plateauing of success<br />

rates in recent years, limitations of PKP still exist. In particular,<br />

cadaveric donor tissue is a limited resource in most countries<br />

(unavailable in some), with demand increasingly exceeding supply.<br />

The presence of foreign antigens in the donor tissue means that<br />

the grafted tissue is at risk of immunological rejection. Indeed,<br />

graft rejection occurs in one third of corneal transplants and is the<br />

leading cause of graft failure. Although host immune activation<br />

against any layer of the donor cornea is possible, stromal-epithelial<br />

rejection tends to be relatively minor compared to endothelial<br />

rejection which is a major threat to graft survival. It is estimated<br />

that more than half of all PKP failures may be related to acute<br />

endothelial rejection or late endothelial failure. Some of these<br />

problems can be circumvented by transplanting only the layers of<br />

cornea affected by disease whilst leaving the healthy tissue in place<br />

by performing lamellar keratoplasty.<br />

Deep anterior lamellar keratoplasty (DALK) is a procedure that<br />

replaces only the anterior layers of the cornea, leaving the host<br />

endothelium intact, thus avoiding the risk of endothelial graft<br />

rejection, and some of the other complications associated with<br />

PKP and open globe surgery. Post-operative recovery is also faster<br />

than PKP. DALK is suitable for diseases that spare the endothelium<br />

(e.g.stromal scarring, stromal dystrophies, and ectatic disorders such<br />

as keratoconus or post-LASIK ectasia). Visual outcomes, preservation of<br />

endothelial cell density, and the 5 and 10 year graft survival rates (69%<br />

and 49%) are reported to be similar to PKP. 1<br />

Descemet’s stripping endothelial keratoplasty (DSEK) is a procedure<br />

that replaces the host Descemet’s membrane and diseased<br />

endothelium with donor endothelium, Descemet’s membrane, and<br />

a thin layer of posterior stroma. The host epithelium and stroma<br />

remains intact, thus fostering better structural integrity of the<br />

cornea, faster visual recovery, reduced suture-related complications,<br />

and avoids complications associated with open globe surgery.<br />

It is suitable for conditions that affect the endothelium such as<br />

Fuchs’ endothelial corneal dystrophy and bullous keratopathy.<br />

Complications include donor dislocation and endothelial cell loss<br />

during graft insertion. The graft survival rate at 5 years of DSEK is<br />

47%; data for 10 years is not available yet since the technique was<br />

introduced less than 10 years ago. 1<br />

Figure 1. Schematic diagrams of the replacement of different corneal<br />

layers during penetrating keratoplasty, anterior lamellar keratoplasty, and<br />

endothelial keratoplasty.<br />

Artificial corneas<br />

Despite the relative success of PKP and lamellar keratoplasties, they<br />

are not suitable in all cases. For end-stage corneal blindness due to<br />

severe ocular surface disease (e.g. Stevens-Johnson syndrome) and<br />

multiple graft failures, the only approved alternatives for human use<br />

are keratoprostheses (KPro’s). 2<br />

The most widely accepted is the Boston KPro type I, comprising a<br />

front plate with stem containing a PMMA optic, a back plate with<br />

holes for nutrient diffusion, and a titanium locking c-ring; the device<br />

is implanted into a donor cornea before being sutured into the<br />

patient’s eye. Due to improvements in design and improved postoperative<br />

management, the Boston type I KPro was shown to have an<br />

excellent 80-100% retention rate over average follow up periods of<br />

8.5-33.6 months. The Boston type II KPro and the osteo-odonto KPro<br />

are reserved for cases with severe ocular surface disease. The Boston<br />

type II KPro is similar to type I, with the addition of an anterior nub.<br />

The osteo-odonto KPro comprises of a PMMA central optic glued to an<br />

osteodental lamina from a tooth extracted from the patient.<br />

A similar concept is used in the tibia bone KPro. Both autologous<br />

KPros have good biocompatibility and biointegration, but are more<br />

invasive and requires healthy tooth, jaw or tibia from the patient. The<br />

AlphaCor comprises a PHEMA hydrogel central optic interpenetrated<br />

by a spongy PHEMA skirt, but is now rarely used due to complications<br />

including infection, extrusion, rejection, tissue necrosis and<br />

calcification.<br />

In general, KPros suffer complications due to poor tissue integration;<br />

these include formation of a retro-prosthetic membrane, extrusion,<br />

chronic inflammation, infection, melting at the cornea prosthesis<br />

interface, and leakage.<br />

Figure 2. Schematics of the Boston KPro and the Osteo-Odonto KPro.<br />

Engineered corneal tissue<br />

Due to the limitations of corneal transplantation and artificial<br />

corneas, researchers are investigating alternative corneal tissue<br />

substitutes. The ideal substitute should be transparent, closely<br />

resemble the structure of the cornea, have similar elasticity<br />

and tensile strength to that of native tissue (thereby enabling<br />

surgical manipulation), support cell attachment, proliferation and<br />

differentiation, and induce minimal inflammatory response. Here we<br />

describe several lines of research in this field.<br />

Researchers have decellularized and decalcified Tilapia fish scales to<br />

produce an extracellular matrix that consists mainly of type I collagen. 3<br />

The resulting matrix is highly transparent, but has a mismatched<br />

curvature and insufficient elasticity, causing confined cracking when<br />

sutured. The decellularised and decalcified scales are associated with<br />

chronic inflammatory reactions when implanted in vivo. Further<br />

modifications are required before we can consider this to be a clinically<br />

applicable corneal substitute.<br />

Xenotransplantation of porcine corneas is another strategy that<br />

has abundance of supply, and similarity in anatomy and refractive<br />

properties to the human cornea. However, one of the main limits to<br />

xenotransplantation in humans is the existence of natural antibodies<br />

to the terminal galactose α1, 3 galactose (α-gal) epitope expressed<br />

in the cell membranes of all mammals except those of humans and<br />

primates. These antibodies mediate hyperacute or delayed rejection of<br />

the xenograft. Therefore researchers have devised various protocols to<br />

remove cells and xeno-antigens from porcine corneas. Unfortunately,<br />

such treatments are harsh and result in reduced transparency, and are<br />

only able to achieve partial decellularisation. 4<br />

Researchers have developed hydrogels consisting of recombinant<br />

human collagen type III. In vitro studies confirmed that the scaffold<br />

is highly transparent and may be produced with a curvature that<br />

matches the human cornea.<br />

A phase 1 clinical study implanted these hydrogel ALKs in 10 patients<br />

(9 keratoconus, 1 corneal scar). 5 Four years post-operatively all hydrogel<br />

grafts were stably integrated with no rejection episodes. However,<br />

some limitations exist. Overlying sutures were required to keep the<br />

implant in place due to its low mechanical strength, which delayed<br />

epithelialisation prior to suture removal at 6 weeks. Epithelialisation<br />

was complete after suture removal, but the resulting focal corneal haze<br />

remained at 24 months. Overlying sutures likely also caused localised<br />

thinning, fibrosis and surface irregularity. The best corrected visual<br />

acuity at 24 months was below that achieved by PKP for keratoconus.<br />

Therefore improvements to this hydrogel are needed to enhance<br />

clinical application.<br />

A collagen I based scaffold has recently been developed by our<br />

group, possessing many of the desired properties of an ideal corneal<br />

substitute. The scaffold is highly transparent, corneal shaped, and<br />

consists of lamellae of collagen closely resembling the structure of the<br />

human corneal stroma. One distinguishing feature of this scaffold is its<br />

mechanical strength, which is comparable to that of a human cornea.<br />

It has also been shown to support corneal epithelial and stromal<br />

cell attachment and migration. Further work is underway to test the<br />

potential of this material for clinical application.<br />

Conclusions<br />

Whilst penetrating and lamellar keratoplasties continue to be reliable<br />

treatments for blinding corneal diseases, limitations still exist. This<br />

necessitates research into advanced biological engineered corneas<br />

for corneal transplantation. With the advancement of technology,<br />

engineered corneas that are strong and biocompatible hold promise<br />

for the future of corneal replacement.<br />



* Jie is a research fellow in the Department of Ophthalmology,<br />

University of Auckland, supervised by A/Prof. Dipika Patel<br />

and Prof Charles McGhee. Jie is using her biomedical science<br />

background to devise treatments for Ophthalmic conditions,<br />

and is currently focusing on the synthesis and testing of a<br />

novel collagen based scaffold for corneal transplantation.<br />

1. Williams, K.A., M.C. Keane, R.A. Galettis, V.J. Jones, R.A.D. Mills, and D.J. DJ<br />

Coster, THE AUSTRALIAN CORNEAL GRAFT REGISTRY <strong>2015</strong> REPORT. <strong>2015</strong>,<br />

South Australian Health and Medical Research Institute: Department of<br />

Ophthalmology, Flinders University<br />

2. Avadhanam, V.S., H.E. Smith, and C. Liu, Keratoprostheses for corneal blindness: a<br />

review of contemporary devices. Clin Ophthalmol, <strong>2015</strong>. 9: p. 697-720.<br />

3. Ivan Essen, T.H., C.C. Lin, A.K. Hussain, S. Maas, H.J. Lai, H. Linnartz, T.J. van den<br />

Berg, D.C. Salvatori, G.P. Luyten, and M.J. Jager, A fish scale-derived collagen matrix<br />

as artificial cornea in rats: properties and potential. Invest Ophthalmol Vis Sci,<br />

2013. 54(5): p. 3224-33.<br />

4. Lee, W., Y. Miyagawa, C. Long, D.K. Cooper, and H. Hara, A comparison of three<br />

methods of decellularization of pig corneas to reduce immunogenicity. Int J<br />

Ophthalmol, 2014. 7(4): p. 587-93.<br />

5. Fagerholm, P., N.S. Lagali, J.A. Ong, K. Merrett, W.B. Jackson, J.W. Polarek, E.J.<br />

Suuronen, Y. Liu, I. Brunette, and M. Griffith, Stable corneal regeneration four<br />

years after implantation of a cell-free recombinant human collagen scaffold.<br />

Biomaterials, 2014. 35(8): p. 2420-7.<br />

16 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 16<br />

19-Nov-15 3:27:15 PM



Device Technologies<br />

Device Technologies’ large booth was packed with<br />

new technologies and equipment. One of the<br />

highlights was the Topcon Triton DRI/Swept Source<br />

OCT.<br />

The Triton has been on the market regionally for<br />

six months after debuting in Australia at ODMA<br />

this year. The machine was the first commercially<br />

available SS-OCT, a technology that promises more<br />

options for ophthalmologists to peer through<br />

layers of the eye and glean more information on<br />

choroidal structure than time-domain OCT.<br />

Dr Andrew Thompson between Diego Sondregger (left)<br />

and Campbell Gordon (right) of Device Technologies<br />

“The wavelengths allow you to get a broader<br />

depth of focus,” said Device Technologies’ Ryan<br />

Hegge. “So, previously you may focus on the ILM<br />

or RPE and you’d see a dropout depending on<br />

what you were focusing on. Here you can see<br />

we’re focused right up into the vitreous as well as<br />

right down into the choroid.”<br />

A software upgrade to the unit allows for<br />

non-invasive OCT angiography, which—given<br />

the promise of the SS-OCT’s ability greater depth<br />

of focus—could obviate the need for injected<br />

fluorescein angiography in some cases, said Hegge.<br />

Ophthalmic Instrument Company (OIC)<br />

OIC’s team was busy on the other side of the<br />

exhibition floor talking to delegates about the<br />

Nidek Tonoreft III Autorefractor/Keratometer<br />

as well as the Nidek RetinaScan DUO HD OCT &<br />

Fundus imager.<br />

Dr Shuan Dai visits the OIC stand<br />

“OCT is becoming the standard of care for optometry<br />

practice,” said Tim Way, OIC’s general manager.<br />

Going by the recent NZAO conference in October,<br />

Way estimated that at least 80 practices have OCT<br />

units in New Zealand distributed by his company<br />

alone. And the standard for OCT units is quickly<br />

moving toward OCT Angiography. “I think that’s going<br />

to open up a whole world for optometry, because<br />

optometrists can’t do fluorescein or ICG injections, and<br />

being able to provide something that does that could<br />

save the health service a lot of money.”<br />

Alcon<br />

As a Platinum Sponsor of RANZCO, Alcon had a<br />

strong presence during the Congress showcasing<br />

multiple new technologies.<br />

Alcon’s Jonathan Spencer with Drs Rebecca Stack and<br />

David Kent and Greg Engelbrecht, also of Alcon<br />

Alcon’s Centurion Vision System was celebrating<br />

a proud milestone with 100 units installed in ANZ<br />

as of September <strong>2015</strong> and over 90,000 potentially<br />

sight-enhancing procedures expected to be<br />

performed using active fluidics technology by the<br />

end of <strong>2015</strong>.<br />

The company has also added to its<br />

cataract refractive suite with ORA with<br />

VerifEYE+ technology. Claimed by Alcon to be<br />

the world’s first intra-operative Wavefront<br />

Aberrometer, ORA with VerifEYE+ provides real time<br />

verification of the surgical plan and information<br />

to change the IOL choice, if required, to achieve a<br />

better refractive outcome for the patient.<br />

Two new additions to Alcon’s AcrySof IOL<br />

range were also presented at RANZCO: Acrysof<br />

IQ PanOptix, Alcon’s trifocal IOL, and Acrysof IQ<br />

UltraSert, Alcon’s pre-loaded delivery system.<br />

PanOptix is a modified quad-focal design with<br />

proprietary ‘Enlighten’ technology, which allows<br />

more light transmission to the retina. It also offers<br />

patients continuous intermediate-to-near vision<br />

with an intermediate focal point at 60cm, which<br />

for many will be more convenient and practical for<br />

various daily tasks than the 80cm working distance<br />

offered by other trifocal IOLs, said Colette Parkinson,<br />

Alcon ANZ’s cataract equipment product manager.<br />

The feedback from surgeons on the Acrysof IQ<br />

UltraSert demonstrations and how smooth<br />

and controlled the delivery system is has been<br />

overwhelmingly positive, she added.<br />

Abbott Medical Optics (AMO)<br />

Towards the middle of the hall, AMO shared one<br />

half of a large stand with popular Kiwi ophthalmic<br />

equipment distributor Toomac (more about this<br />

interesting arrangement in our next issue) with a<br />

joint, and popular, tea and coffee bar.<br />

On show on AMO’s half of the stand were<br />

materials promoting the company’s high-spec,<br />

Tecnis family of intraocular lenses (IOPs). Christian<br />

Oster, the relatively new AMO surgical product<br />

manager, explained the company’s current Legacy<br />

campaign. “We have a broad range of intraocular<br />

lenses and when you put an IOL into your patients<br />

you are leaving a legacy, and we’re suggesting you<br />

should leave a lasting legacy by using the Tecnis<br />

family of IOLs.”<br />

AMO-sponsored breakfast meetings discussed<br />

the benefits of Tecnis IOLs and also featured<br />

Auckland Eye’s Dr Dean Corbett who, together<br />

with Rotorua’s Dr Neil Murray, undertook one<br />

of the first studies on AMO’s Tecnis Symphony<br />

extended range of vision IOL, which resulted in<br />

high levels of patient satisfaction with the brand<br />

new, first-of-its-kind product.<br />

Launched in February this year, initial feedback<br />

has been very positive said Matthew Northage,<br />

RANZCO NZ Executive<br />

Given RANZCO’s 47th Annual Scientific<br />

Congress was held in Wellington, the New<br />

Zealand Branch combined their branch<br />

meeting and AGM with the gathering.<br />

The 2016 NZ Branch Executive is as follows:<br />

Chair: Dr Stephen Ng<br />

Vice chair: Dr Keith Small<br />

Honorary treasurer and secretary: Dr Andrea<br />

Vincent<br />

Members: Dr James Borthwick (ex-officio chair);<br />

Dr Derek Sherwood; Dr Michael Merriman<br />

(chair of the Education & Qualifications<br />

Committee); Dr Jo Sims (director of training);<br />

Dr Peter Hadden; Dr Graham Wilson; Dr James<br />

McKelvie (registrar representative); Dr Mary<br />

Jane Sime; Dr Stephen Best (ex-officio RANZCO<br />

president); Dr Kolin Foo (continuing professional<br />

development representative); Dr Mike O’ Rourke<br />

(Ophthalmology NZ representative); Dr Jo<br />

Koppens: and Dr Brian Kent-Smith.<br />

AMO’s NZ account manager. “It’s going great<br />

guns. It’s really charging. People are getting very<br />

good results, better than they anticipated, which<br />

is really driving growth through word of mouth.”<br />

Designs for Vision (DFV)<br />

Designs for Vision showcased a number of new<br />

products. The Oculus Pentacam AXL was so new,<br />

general manager Brad Grills and his team didn’t<br />

even have a brochure available and, though<br />

they were taking orders for the new all-in-one<br />

cataract surgery device, which also provides IOL<br />

calculations, buyers won’t be sent the product until<br />

after it’s officially launched in February next year.<br />

Another new DFV product, but with<br />

accompanying brochure this time, was the<br />

compact, all-in-one Tomey UD-800, ultrasonic A/B<br />

scanner and pachymeter, the most versatile and<br />

affordable scanner in the marketplace, said Grills,<br />

adding that when Tomey finally settles on the price<br />

it should be about 15% cheaper than its nearest<br />

competitor products. “It’s a really cool product.”<br />

Also on display was the new Nidek MP-3<br />

Microperimeter (distributed in NZ by OIC.), which<br />

incorporates a “real” fundus camera, said Grills.<br />

According to the brochure, the new MP-3 has a<br />

wider range of stimulus intensity, from 0 to 34 dB<br />

and measures perimetric threshold values, even for<br />

normal eyes, while a maximum stimulus luminance<br />

of 10,000 asb allows evaluation of low-sensitivity.<br />

Grills’ response to the Congress: “RANZCO has<br />

been fantastic, apart from the rugby final.”<br />

Heidelberg Engineering<br />

Heidelberg Engineering’s new-improved Spectralis<br />

OCT2 combines a high scan rate with the company’s<br />

proprietary TruTrack Active Eye Tracking technology.<br />

Designed so that Heidelberg’s OCT Angiography<br />

package, due for release next year, can be built in,<br />

with speeds of 85,000 Hz, the OCT2 is more than<br />

twice as fast as previous models.<br />

“There is demand for faster machines,” said<br />

general manager Carey Hazelbank. “When you<br />

do OCT Angiography it is very important that it’s<br />

done at very high speed because it can be a timeconsuming<br />

process. So obviously a machine that is<br />

more than twice as fast reduces the scan time and<br />

increases patient comfort.”<br />

Spectralis is particularly appealing to buyers,<br />

because it is a platform technology, said<br />

Hazelbank, so it can be upgraded and added to as<br />

new developments come to the market.<br />

Heidelberg is also gearing up to launch a new<br />

cataract and refractive imaging platform in 2016,<br />

a product that’s so new, it doesn’t even have a<br />

name yet, let alone a brochure!<br />

OptiMed<br />

A busy Optimed stand<br />

Optimed was kept busy showing a host<br />

of new developments in its catalogue of<br />

diagnostic instruments, laser, surgical and dry<br />

eye products. On show and attracting particular<br />

interest, to name but a few, was the new OCT<br />

and retinal imaging software from Canon; the<br />

new Iridex IQ series of MicroPulse lasers; the new<br />

Accutome Foresight system, released just two<br />

weeks before RANZCO, which integrates A-Scan,<br />

Pachymetry, B-Scan and UBM into one compact<br />

and far more portable console; and the new<br />

LightLink-CXL Corneal Cross-Linking System, with<br />

pulsed mode features to allow the cornea to reoxygenate<br />

during procedures —an advancement<br />

still under study in the US, but attracting a lot of<br />

positive attention in the cross-linking community,<br />

says OptiMed’s Craig Norman.<br />

Optos<br />

Widefield retinal imaging company Optos also<br />

hosted some pretty high traffic throughout the<br />

duration of the RANZCO Congress, with most<br />

interest centred on the company’s latest ultrawidefield<br />

device, The California.<br />

The California is now available in two different<br />

models, one with all four modalities including<br />

colour, autofluorescence (AF), fluorescein<br />

angiography (FA) and indocyanine green (ICG),<br />

and one with the three modalities of colour,<br />

AF and FA. Both models produce 200 degrees,<br />

or 82% of the retina in one single image, for all<br />

modalities.<br />

Optos also showcased its latest<br />

comprehensive image management solution<br />

software, OptosAdvance, available with The<br />

California, which proved to be pretty popular<br />

among delegate ophthalmologists, said Jason<br />

Martone, Optos ANZ’s managing director.<br />

Zeiss<br />

Taking pride of place on Zeiss’ stand was its new<br />

AngioPlex OCT Angiography technology, the first<br />

angiography technology to receive clearance from<br />

the US Food and Drug Administration.<br />

“Ophthalmologists can now utilise OCT images to<br />

assess the blood vessels of the retina at a depth and<br />

clarity never available before,” the company said in a<br />

statement announcing the FDA approval. “AngioPlex<br />

OCT Angiography delivers high-resolution, depthresolved<br />

visualisation of the separate layers of the<br />

retinal and choroidal vasculature, without the need<br />

for an injected contrast dye, as is standard with<br />

fluorescein angiography.”<br />

AngioPlex OCT Angiography visualises blood flow<br />

by detecting motion of scattering particles, such<br />

as red blood cells, within sequential OCT B-scans<br />

performed repeatedly at the same location of the<br />

retina, said Matthew Wensor, Zeiss’ product manager.<br />

“It’s attracting a lot of interest. It’s definitely the No. 1<br />

thing people are talking to us about.”<br />

That interest was evidenced by a special evening<br />

event Zeiss held to discuss its new angiography<br />

technology, featuring Dr Amir Kashani of the<br />

University of Southern California who was<br />

involved in the technology’s development, which<br />

attracted more than 60 ophthalmologists.<br />

Wensor was quick to stress, however, that this<br />

was still very new technology and would not<br />

necessarily replace fluorescein angiography, but<br />

could work as preliminary, non-invasive, quick<br />

screen to see if FA is required. “There is definitely<br />

a buzz about it. It has got the potential to be a<br />

really significant development and we’re all very<br />

excited to be at the forefront of it.”<br />

Corneal Lens Corporation (CLC)<br />

New Zealand’s own CLC was showcasing two key<br />

products Oculocin Propo and MacuShield.<br />

Oculocin Propo is a new product to the NZ<br />

and Australian markets targeting two key areas,<br />

chronic conjunctivitis and periodic inflammation<br />

and dry eye. A sterile, natural pharmaceutical<br />

grade extracts-based eye drop, it contains no<br />

preservatives and is designed to lubricate and<br />

protect the eye from bacterial, viral or fungal<br />

infection as well speed healing and reduce pain.<br />

The better known MacuShield is a food<br />

supplement containing Lutein, Zeaxanthin and<br />

Meso-Zeaxanthin, derived from the marigold<br />

flower, and specifically designed to protect and<br />

support the macula.<br />

Others<br />

With more than 100 exhibitors supporting the<br />

Congress, delegates were spoilt for choice when<br />

it came to trialing new equipment or discussing<br />

new technologies. Other exhibitors who caught<br />

NZ Optics’ eye were: Stiltec, producers of popular<br />

dry AMD product Macutec and dry eye-relief<br />

supplement Lacritec, which delivers a proprietary<br />

blend of omega fatty acids from flax seed, fish oil<br />

and borage oil; Medi’Ray NZ and Capes Medical,<br />

NZ representatives for the Paragon Care range of<br />

medical equipment and devices, and suppliers<br />

of all manner of medical consumables; Bayer,<br />

manufacturer of the increasingly popular Macular<br />

Degeneration drug Eylea; Bausch + Lomb, which<br />

was showcasing a range of new eye health products<br />

including IOLs and other eye surgery products;<br />

Blackmore’s MacuVision; and TearLab, whose<br />

Osmolarity System attracted significant attention<br />

(more on TearLab in our next issue).<br />

Drs Andrew Riley, Paul Herrick and Shuan Dai<br />

A comprehensive delegate pack containing<br />

a multitude of brochures and other marketing<br />

material added to the comprehensive product<br />

education on offer, with some RANZCO supporters,<br />

such as medical publishing company Mi-tec,<br />

opting just for the delegate bag option. Mi-tec<br />

produces high-quality, peer-reviewed patient<br />

education publications for 25 colleges, societies and<br />

associations in Australia and New Zealand.<br />

Given there was so much to take in, here at NZ<br />

Optics we can’t wait to see what RANZCO 2016<br />

has to offer.<br />

See you in Melbourne in November 2016. ▀<br />

<strong>Dec</strong>ember <strong>2015</strong><br />


17<br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 17<br />

19-Nov-15 3:27:20 PM

The annual Saks “Best of the Web” 2016<br />

Here follows my 15th<br />

annual Best of the Web.<br />

It’s best read online.<br />

Due to the power of search engines and<br />

the fact that there are only so many<br />

decent eye-related websites, there’s<br />

no point repeating the same old websites year<br />

after year. The numbers of good online journals,<br />

image databases, educational sites and the like<br />

tend to remain relatively static. There are not<br />

floods of worthy newcomers every year.<br />

Hence it is best to review my archived annual<br />

‘Best of the Web’ versions for thousands of<br />

interesting links: 2014, 2013, 2012, 2011, 2010,<br />

2009, 2008, 2007, 2006, 2005, 2004, 2003, 2002<br />

and 2001. (Due to the nature of the web some of<br />

the historical links will be broken.)<br />

This edition will however provide some links to<br />

interesting sites, apps and other interesting and<br />

sometimes random, irreverent pages.<br />

One of the growth areas and trends I<br />

continue to monitor is the role that social<br />

media plays. This is not only in the obvious<br />

arena of marketing one’s services but more<br />

interestingly in closed “educational” groups.<br />

These focused groups cover professional<br />

development, with fantastic learning<br />

opportunities across the professions.<br />

World leading experts are happy to share<br />

their knowledge and skills. Case histories<br />

are presented often with fantastic OCTs,<br />

traditional fundus/super wide field images,<br />

FAF as well as anterior segment, NaFl RGP<br />

images and much else in between. These<br />

groups also foster debate and discuss issues<br />

and challenges that face our professions.<br />

One such group, OD’s on Facebook, boasts<br />

around 24,000 ECP members and is growing<br />

fast. Another Aussie- based group is a much<br />

more intimate affair and I’d say one of the<br />

best educational forums I’ve taken part in. The<br />

interactive discussions can be purely clinical<br />

but are often balanced with humour and<br />

unrelated irreverent comments from some<br />

of the characters we are fortunate to have in<br />

our professions. At times it even gets a little<br />

risqué. There are occasional heated exchanges<br />

between professionals. It’s a seeming evolution<br />

of the longer-running and more static websites<br />

such as the very successful, ODWire.<br />

These guys all claim to be the biggest or<br />

longest running sites – but many are only<br />

a year old with none coming close to the<br />

longevity of In Contact, which hit its 20th<br />

anniversary edition this year.<br />

Despite my doubts about Facebook, it’s a<br />

massive success (1.55 billion regular users!)<br />

Growth and numbers are ridiculous. If you<br />

doubt the power of the Internet (and like<br />

online shopping) visit AliExpress. They did<br />

$US 14.3 billion of turnover in their 11/11 one<br />

day sale with over 54 million discounted items<br />

available!<br />

We may have our issues Downunder but in<br />

many ways we don’t know how lucky we are!<br />

US optometrists are often qualifying with<br />

$US 200,000 student debt and enter a<br />

challenging employment/business market.<br />

Commercialism is rife and managed care<br />

is hurting the professions. To add to their<br />

frustrations many want to pull their hair out<br />

dealing with electronic health records, complex<br />

systems and the bureaucratic dog they call ICD-<br />

10 coding. For the eyes alone there are about<br />

80 pages of codes for every little thing. One<br />

also has to code all the other general health/<br />

medical issues with the total document and<br />

codes covering nearly 1600 pages!<br />

It would kill me.<br />

Conferences, EXPOs, Journals, CPD, Imaging,<br />

Apps & More<br />

If you ever want to view a seemingly<br />

unlimited range for frames then SILMO is the<br />

place to go. They have plenty of equipment<br />

and low vision exhibitors too. I made my first,<br />

long awaited trip to SILMO this year and it<br />

was great. Paris is nice too. They say that the<br />

forthcoming MIDO Expo is another not to be<br />

missed.<br />

The AAO conference was interesting but<br />

personally I find these large meetings too big.<br />

The stats for the <strong>2015</strong> New Orleans meeting<br />

are impressive; 7,489 delegates, 340 CE hours,<br />

2,116 total speakers, and over 170 companies<br />

represented. This of course means it is possible<br />

to attend only a tiny percentage of talks.<br />

There are often conflicts; more than one talk<br />

at the same time one wants to attend, in the<br />

numerous concurrent streams that are run.<br />

This summary of a plenary session is worth<br />

checking out. This caught my eye too; no shit,<br />

really?<br />

I prefer our more intimate and boutique style<br />

conferences we have in this part of the world.<br />

I’ve closely followed the so-called corneal<br />

oxygen wars since my student days. The<br />

research in this arena was performed by<br />

many of my gurus. It formed a very strong<br />

cornerstone of my prescribing. Barry Weissman<br />

has taken another in depth look at it in Corneal<br />

Oxygen: <strong>2015</strong>. There’s still much debate. Values<br />

vary quite dramatically between researchers.<br />

Shouldn’t oxygen levels that approach<br />

no-lens conditions be our target? For some<br />

patients a “balance of properties” is needed.<br />

A few patients cannot tolerate si-hy lenses.<br />

Some seem to have a low corneal oxygen<br />

uptake (sippers) while others have a very<br />

high demand for oxygen (gulpers). Observant<br />

clinicians can tell when a given patient needs<br />

more oxygen or a different material. Comfort,<br />

modality, surface friction, biocompatibility<br />

and quality optics, as well as parameter<br />

range and surface properties are also critical<br />

to success. This excellent article sums it up<br />

rather well.<br />

Fortunately most lenses we use today provide<br />

safe daily wear oxygen levels in hydrogels while<br />

many silicone-hydrogels approach no-lens<br />

levels of oxygen supply to the cornea. Reading<br />

his conclusions it seems Barry and I are pretty<br />

much on the same page.<br />

Customising diameter can also make a<br />

difference to comfort for the outliers. Tomas<br />

Quinn makes some good points about<br />

determining the dominant eye for multifocal<br />

and monovision CL fitting. Some history here,<br />

and here too.<br />

CXL controversies are a topical issue. CL<br />

hygiene is important but one eliminates 60% of<br />

lens care risk factors by fitting dailies!<br />

The snowballing move online is leading to<br />

historical changes in the delivery of content. As<br />

of 2016, two of the top three rated optometry<br />

journals, will become online only. Hold onto<br />

your last editions of Optometry and Vision<br />

Science (OVS) and Clinical and Experimental<br />

Optometry (CXO), and one day show your<br />

kids how we used to read journals! The<br />

upside is massive savings in postage, printing<br />

and packaging, which in turn will reduce<br />

plastic pollution, save many trees and much<br />

greenhouse gas. One does hope that these<br />

cost reductions will be passed on in the form of<br />

lower subscriptions and membership fees. The<br />

cynic in me says probably not; they’ll just keep<br />

all the extra dosh.<br />

One of the upsides of online journals is that<br />

it’s easy to save and index papers that interest<br />

you, which I do into the fantastic Papers app.<br />

There is also rich content in terms or more<br />

colour, larger tables and graphs, video and<br />

the ability to save/export something as a<br />

PowerPoint or Keynote slide for lecturing.<br />

Bundled with the latest version of Keynote<br />

- when installed on an iPhone - is the ability<br />

to remote control the presentation from your<br />

phone, as well as see the forthcoming slide,<br />

which frees you to roam when presenting.<br />

I recently upgraded to an iPhone 6S and iOS9.<br />

The 6S is a big step up from my flaky 5. Imaging<br />

is way better, speed is great but battery power<br />

is still an issue. The iPhone is one of the top<br />

inventions of all time. I also upgraded my<br />

MacBook Pro to El Capitan. There are millions of<br />

apps to choose from. Over one hundred billion<br />

have been downloaded from Apple alone.<br />

Serious revenue.<br />

My advice on Apps remains similar to last<br />

year and my favourites remain much the same<br />

too. Uber has proved useful when travelling<br />

but in many countries it is being challenged.<br />

Airbnb is doing to hotels what Uber did to the<br />

Taxi industry. WEMO is useful too. I recently<br />

setup a TILE to track my superb Kiwi-invented<br />

BLUNT umbrella. The only downside of TILE is<br />

that one has to leave Bluetooth on to maintain<br />

the connection and tracking. Photoshop Touch<br />

looks like a great imaging App for iPhone.<br />

Fisheye? Although I use my iPhone camera for<br />

most things, the remarkable Sony Aplha7IIR is<br />

something I’d like. There are just some things<br />

a tiny 5mm camera like the iPhone cannot<br />

do properly. Check out PCMag’s <strong>2015</strong> ‘Best<br />

of’ lists: Useful stuff for SOE, Blogs, CRM, web<br />

monitoring and more.<br />

Here are some useful Low Vision Apps. These<br />

hand-eye coordination apps may be useful for<br />

VT patients, gamers, hackers and nerds alike.<br />

More medical and eye apps here. Will these<br />

‘save your eyes’ apps make a difference? They<br />

can reduce your blue light exposure at certain<br />

times, remind you to take breaks and more. Get<br />

with the spectrum.<br />

Sue, we even care about the eyes of android<br />

users. <br />

Allaboutvision provides some more useful<br />

eye-related apps,<br />

The Leo Wanker Appreciation Society offers<br />

you the Arthur Dunger fitness program, which<br />

he says is “not half bad for the optic nerve”.<br />

Lifehacks. This guy is funny. So is he. He just got<br />

a big gig. How about the great gig in the sky?<br />

Syd doco.<br />

I need some chicken soup aka Jewish<br />

antibiotics. Some coleslaw would be good too.<br />

My tomatoes have set fruit and we should be<br />

eating some before Xmas. Some more tips here.<br />

My Central Otago export quality cherries are<br />

on order. I’m also looking forward to the plum<br />

season. NZ has arguably the best plums and<br />

apples in the universe. What baffles me is why<br />

do councils plant weed trees on pavements<br />

when every pavement tree should be a fruit<br />

tree or olive? Also every pavement or “berm”<br />

should be a veggie garden but alas our councils<br />

are myopic.<br />

He must have been well pissed by the last<br />

one! I have drawers at home just like this<br />

(old frame storage drawers). So does my Dad,<br />

with lots of similar stuff in them. Tools too.<br />

Little drummer boy; innovation. Ben & Jerry.<br />

Gaystarnews has ten gay scenes from 007<br />

(and much more interesting stuff you probably<br />

didn’t know). One of these is on my wish list for<br />

sure; Trakka Jabiru 4x4<br />

This year I heard some super Jazz in New<br />

Orleans at the legendary Preservation Hall.<br />

Book ahead if y’all gonna be in Norlins.<br />

Although he was pretty ill by this stage this<br />

interview makes for interesting watching.<br />

He still has a Camel in his right hand! Crazy<br />

what doctors were endorsing. I used to see<br />

adverts like this in my Dad’s 1950s and 1960s<br />

Popular Science magazines. He bought the<br />

’57 Ford Fairlane back to South Africa when he<br />

did post-grad optometry studies at Indiana in<br />

1957 under the legendary Henry W. Hofstetter.<br />

#Totesamazeballs car. Shoulda kept that Ford.<br />

Worth a few bob now. Dig the wings.<br />

45 years later we are still “just about” to<br />

get the jetpack. I want one but for now I’ll<br />

settle for one of these. When they get the<br />

hoverboard sorted, I want one for sure!<br />

Dynamic earth maps.<br />

Captain Beefheart was another character!<br />

How about some Higgs Bosun Blues? Chris<br />

Prior is the Rock Professor!<br />

That’s it until 2016 when I look forward to<br />

keeping it interesting in my 21st year of In<br />

Contact.<br />

Have a good one, take care and be safe.<br />

Peace on Earth! ▀<br />


photophobia; and lacrimation. Non-necrotising scleritis can<br />

be treated with topical steroids and NSAIDs and necrotising<br />

sclertitis, topical and oral steroids and immune suppression.<br />

There’s no effective treatment for scleromalacia perforans.<br />

Dr Adam Watson discussed the symptoms of marginal<br />

keratitis, which “all starts in the meibomian glands” and<br />

causes immune hypersensitivity. Those with a history of<br />

systemic disease are more prone and symptoms include<br />

redness, ocular surface discomfort, pain, light sensitivity and<br />

watering.<br />

It’s common, but can be treated with lid hygiene methods,<br />

oral doxycycline, and toptical antibiotics and steroids.<br />

Patients should also be persuaded to give their CLs a holiday<br />

until acute symptoms subside and consider IPL (intense<br />

pulsed light therapy) to improve meibomian gland function.<br />

Dr Nick Mantell reviewed PRK and LASIK data over the<br />

last 10-15 years, saying there is some long-term data<br />

showing overall safety is good, but visual acuity has been<br />

“pretty average”. This is improving, however, with improved<br />

techniques, which should come through in further studies.<br />

Weighing up cross-linking<br />

Both Watson and his colleague Dr Simon Dean discussed<br />

corneal collagen cross-linking.<br />

Dean explained how it was becoming more standard to<br />

treat corneal ectatic disorders so people are starting to push<br />

the boundaries a little more, especially as the only risk is to<br />

the cornea.<br />

In isolated cases there is endothelial damage, he said, but<br />

the risks need to weighed up against the positives of treating<br />

a “sick cornea.”<br />

Watson’s talk on cross-linking focused on how most<br />

patients believe it will make them see better. “You have to<br />

temper that. Yes, about 50% do see some improvement, but<br />

it’s more about strengthening the cornea…to stablise vision,”<br />

he said<br />

Cataract complications and corneal transplants<br />

Professor Charles McGhee provided a sometimes<br />

amusing look at the dark side of cataract complications<br />

and, later in the day, an overview of what’s new in corneal<br />

transplantation.<br />

Cataract operations are the “most successful surgeries we<br />

do,” he said, but of course there are occasional complications,<br />

though these are typically mild.<br />

According to the Auckland Cataract Studies I (2002) and<br />

II (<strong>2015</strong>), co-authored by McGhee, there has been some<br />

improvement over the years, with reported posterior<br />

capsule tears reducing from 4.9% to 2.6%; cystoid macular<br />

oedema, remaining steady as expected, at 3.8% to 3.5%; and<br />

unaided visual acuity (UAVA) of 6/12 or better improving<br />

from 67.7% to 73.9%.<br />

The most common complications include striate<br />

keratopathy, elevated IOP, aqueous leak, persisting anterior<br />

uveitis, cystoids macula oedema and loose sutures. Rare<br />

complications include retinal detachment, choroidal<br />

haemorrhage and endophthalmitis (about 2 per 1000).<br />

As far as corneal transplants are concerned, the long-term<br />

outcome of penetrating keratoplasty (PKP) for keratoconus<br />

is excellent with a 97% survival after 20 years. The jury is<br />

still out on PKP versus deep anterior lamellar keratoplast,<br />

he said, but at least one study has shown there are fewer<br />

complications with DALK, which is becoming well established.<br />

Demodex, Sjorgren’s and ocular rosacea<br />

Dr Trevor Gray and Dean tackled dry eye-related topics<br />

through three sessions. Gray reviewed our understanding<br />

of demodex mites and their role within, and affect on, our<br />

optically-related bodily functions, causing some amusement<br />

among the audience, and ocular rosacea, which can be<br />

treated with improved lid hygiene, artificial tears and<br />

antibiotics. While Dean tackled Sjorgren’s Syndrome, joking<br />

this was “the most dry talk” delegates would hear that day.<br />

An immune disorder, Sjogren’s (SHOW-grins) syndrome<br />

is most commonly identified by having dry eyes and a dry<br />

mouth and can be tackled with normal dry eye treatments.<br />

Closing: more to come?<br />

Closing the conference, Gray confirmed the record<br />

attendance and thanked delegates, many of whom have<br />

travelled from outside Auckland and even the North Island to<br />

be there.<br />

Given the conference’s popularity, and others, such as<br />

Essilor and Visique, timing their conferences to coincide<br />

with the Eye Institute’s, Gray said Eye Institute staff were<br />

currently considering running a workshop series on Saturday<br />

afternoon, before the conference proper on Sunday, and will<br />

be seeking delegates’ views on this over the coming month<br />

and in early 2016. ▀<br />

Eye Insitute <strong>2015</strong><br />

Conference sponsors<br />

Abbott Medical Optics, Alcon, Bausch+Lomb,<br />

Corneal Lens Corporation, Designs for Vision,<br />

Device Technologies, HumanWare, Ophthalmic<br />

Instrument Company, OptiMed, Optrex,<br />

Toomac Ophthalmic, Glaucoma New Zealand<br />

and Macular Degeneration New Zealand<br />

18 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 18<br />

19-Nov-15 3:27:20 PM

DO’s programme packed<br />

with positives<br />

Eye Institute’s inaugural Dispensing Opticians<br />

conference, which ran parallel to its popular<br />

one day, annual optometrists’ conference,<br />

was packed to capacity, with extra chairs having<br />

to be brought into the back of the room to seat<br />

everyone.<br />

Dispensing opticians and support staff from<br />

around the country attended the event to hear<br />

about surgical advances, new technologies and<br />

shared care management that could impact<br />

on their side of the business. The 30 minute<br />

Alice Ku, Alisha Walker and Jan Birt<br />

Eye Insitute keynote Margaret Lam shares her wisdom<br />

with our DOs<br />

Dr Trevor Gray chairs Eye Institute’s inaugural DO<br />

conference<br />

As Dr Margaret Lam said, “life is<br />

a continual learning process and<br />

when we start thinking we’ve<br />

learnt enough that’s probably<br />

when we’ve got the wrong<br />

attitude towards life. ”<br />

presentations were delivered by Eye Institute<br />

ophthalmologists and guest speakers Dr Margaret<br />

Lam from Australia’s theeyecarecompany and<br />

contact lens specialists Alan Saks and Grant<br />

Watters of Mortimer Hirst.<br />

Dr Trevor Gray chaired the day and opened the<br />

event with a bold statement: “Education is best<br />

kept fresh and alive, brisk and fast.” He highlighted<br />

that cataract surgery is the most common and<br />

safest prosthetic operation within the ophthalmic<br />

industry whilst being “the most positively<br />

impactful life event for senior citizens.”<br />

Dr Simon Dean discussed meibomian gland<br />

dysfunction (MGD) a common disease and a<br />

leading cause of dry eyes which, if left untreated,<br />

can result in permanent damage to the tear film.<br />

The final morning speaker was Dr Dean Conger<br />

who specialises in glaucoma. Being a lifelong<br />

disease Conger stressed that “most patients, even<br />

if fairly stable,” should be seen every six months<br />

after laser surgery.<br />

Lam gave a number of clinical tips about patient<br />

care and treating ocular emergencies, including<br />

retinal detachments and picking up on red flags<br />

such as flashing lights and floaters. Lam says her<br />

mantra is: “if patients thrive, it means our practices<br />

thrive”.<br />

Dr Peter Hadden emphasised the importance of<br />

early treatment for suspected retinal attachment,<br />

leading to better outcomes requiring less<br />

treatment. He was followed by Grant Watters<br />

who discussed contact lens care and maintenance<br />

and stressed the need for contact lens wearers to<br />

ensure their contacts remain hydrated and clean.<br />

Dr Nick Mantell who specialises in laser vision<br />

correction said the key focus of cataract surgery<br />

was to give the patient the “best possible range of<br />

vision without glasses.” While Dr Shanu Subbiah<br />

discussed the topic of triage and its importance.<br />

The final guest speaker, NZ Optics’ popular<br />

columnist Alan Saks, explained how a monovision<br />

contact lens fitting is a good way to help<br />

presbyopes who struggle with multifocal lenses.<br />

Wrapping up the day Dr Adam Watson talked<br />

about basal cell carcinoma (BCC) and other<br />

common eyelid tumours. He describes BCC as<br />

a “rodent ulcer eating away at the tissue of an<br />

eyelid” if left untreated. Preventions include<br />

sunglasses and sunscreen and educating younger<br />

members of society about the implications of not<br />

caring about their skin and their eyes.<br />

As Dr Margaret Lam said, “life is a continual<br />

learning process and when we start thinking<br />

we’ve learnt enough that’s probably when we’ve<br />

got the wrong attitude towards life. We make our<br />

patients live a better life by providing them with<br />

meaningful improvement in their vision.” ▀<br />

Optoms step up for Kiwi kids<br />

The Essilor Vision Foundation (EVF) has signed<br />

on more than 60 optometrists to provide free<br />

eye exams for students in decile 1 and decile 2<br />

schools across New Zealand.<br />

Established in the US, EVF’s aim is to eliminate<br />

poor vision and its lifelong consequences among<br />

underprivileged populations. As well as the US, there<br />

are now EVF chapters in India, Singapore, Ethiopia,<br />

Namibia, France, Gambia, Tunisia and China, with<br />

Indonesia, Canada, Australia, Colombia and New<br />

Zealand joining this year.<br />

“Our Mission in New Zealand is not just about the<br />

children, but that will be a large part of it,” Essilor’s<br />

director of professional services Tim Thurn said at<br />

the company’s recent platinum conference (see<br />

other story, this issue). “Better vision for kids means<br />

better literacy and fewer societal issues. Fewer<br />

vision issues also means a stronger economy.”<br />

The economic impact is significant, said Thurn.<br />

Research shows that on a global basis, lost<br />

productivity due to vision loss amounts to roughly<br />

US$275 billion a year, with some data showing<br />

a correlation with uncorrected poor vision in<br />

childhood, illiteracy and time spent in prison.<br />

The EVF held its pilot school-screening programme<br />

at Flaxmere Primary School in Hastings (NZ<br />

Optics October), with volunteer help from local<br />

optometrists Jenny Stewart, Frederick Swain, Anita<br />

Pistorius and Tracey Jones and equipment kindly<br />

loaned by Tim Way from the Ophthalmic Instrument<br />

Company (OIC). This pilot found 40% of examined<br />

students were suffering some vision problem,<br />

including high myopia and hyperopia.<br />

“The publicity around this meant others wanted<br />

to get involved and now more than 60 schools<br />

have put their hands up,” said Thurn, adding it’s a<br />

two-way thing for optometrists who get involved.<br />

“These are the communities around which your<br />

practices are built.”<br />

Louisa Wall, MP for Manurewa, also praised the<br />

programme at the conference, commenting that<br />

the video made at Flaxmere School brought a tear<br />

to her eye. “Part of my job here today is to thank<br />

Specsavers reappoints Larsen<br />

Specsavers ANZ<br />

has reappointed<br />

Peter Larsen<br />

to its board as<br />

optometry director,<br />

following a four-year<br />

stint for the company<br />

in a non-executive<br />

consulting role.<br />

Larsen will lead<br />

Specsavers’<br />

Optometry and<br />

Professional Services team, providing education<br />

support and services to the optometrists working in<br />

its 350 stores in Australia and New Zealand (ANZ).<br />

Larsen is a trained optometrist who in 1995 cofounded<br />

a wholesaler that brought branded contact<br />

lenses to Australia and New Zealand, which was<br />

later sold to Coopervision. In 2005 he co-founded<br />

Optovision, a buying group that serves 300 practicemembers<br />

in Australia. He joined Specsavers in 2006.<br />

Specsavers says its regional growth will require an<br />

you and to see if we can get more of you to sign on.<br />

In my community is 27 of 29 of my schools qualify<br />

as decile 1 or decile 2.”<br />

Wall aid that while the DHBs do screen school<br />

children, the information they glean from those<br />

exams does not progress further than sitting in a<br />

file. In-school screenings and follow-ups remove<br />

the barrier many families in low-decile areas face<br />

in taking children to optometrists. Single mothers<br />

working two jobs find it difficult to bring their<br />

children in for tests and many don’t realise their<br />

Community Service cards will cover the cost of eye<br />

tests and glasses.<br />

“From my experience growing up in a low-decile<br />

community and wearing glasses, I know how<br />

important it is to have that clarity,” Wall said.<br />

OPSM helps push eye care<br />

message<br />

OPSM issued a press release to the general media<br />

at the end of October as part of a campaign to<br />

encourage more people to get their eyes tested.<br />

The release stressed that eye strain and damaged<br />

vision was on the increase among children and office<br />

workers and “employers and parents need to do more<br />

to protect the vision of those in their care.”<br />

OPSM optometrist Ashreet Nath was quoted as<br />

saying those Kiwis most at risk are between the<br />

ages of five to 35 due to the long hours on screens<br />

at school, university, the workplace and while they<br />

are socialising. “More and more people are having<br />

problems with their vision including blurred vision, red<br />

eyes, dry eyes, and headaches caused by strain, due to<br />

the amount of time we spend on devices now.”<br />

In the release Nath encouraged people to take<br />

breaks, hold screens as far away as possible and<br />

blink regularly, while parents were encouraged to<br />

limit the screen time of their children. Anyone who<br />

is concerned about their eyes should visit their<br />

optometrist… and ask how they can avoid digital<br />

eye strain, he concluded. ▀<br />

additional 200 optometrists to its current list of 800<br />

full-time equivalent partners, employed and locum<br />

optometrists in ANZ. The company offers 100 CPD<br />

points through its clinical development programme,<br />

provides digital retinal cameras to every practice and<br />

plans to add more support services.<br />

Specsavers ANZ CEO Paul Fussey said the company<br />

needed the right team to support this investment<br />

in the company’s future. “Apart from leading our<br />

optometry and professional services agenda, I know<br />

that Peter is focussed on working with all stakeholders<br />

when it comes to the debate and the formulation<br />

of policy relating to changes and developments in<br />

optometry and professional scope of practice across<br />

the ANZ region.”<br />

Larsen will work with Harrison Weisinger, newlyappointed<br />

director of professional services (global)<br />

on a “host of initiatives, with a focus on enhanced<br />

services and scope of practice issues,” said Fussey.<br />

Wesinger is another Specsavers veteran, having run<br />

its ANZ recruitment section prior to founding the<br />

Deakin University School of Optometry. ▀<br />



WELLINGTON 2016<br />



Prof Fiona Stapleton, University of NSW<br />







Run by Wellington ophthalmologists<br />

Jesse Gale, Graham Reeves, with contributions<br />

from Prof Tony Wells and Dr Chris Murphy<br />



Conference and workshop registration opens <strong>Dec</strong>ember <strong>2015</strong>.<br />

For more information visit www.contactlens.org.nz<br />


of New Zealand Incorporated<br />

<strong>Dec</strong>ember <strong>2015</strong><br />


19<br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 19<br />

19-Nov-15 3:27:22 PM


TEL:(09) 486-2070 MOB:(0274) 798-798<br />

Email: tony.maddocks@xtra.co.nz<br />


Bharat Raniga. Call 021424253 or Email: bharatraniga@yahoo.com<br />




Optometry partnership for sale in an established Specsavers<br />

practice. Great central city Tauranga location for over 5 years, and<br />

not in a mall! Excellent growth and returns, a rare opportunity<br />

not to be missed. Contact: Brendan.thompson@specsavers.com<br />

to register your interest!<br />


Topcon Chair and stand, phoroptor, slit lamp, keratometer,<br />

hydraulic table, projector, NCT, Matrix, trial lens set— all in good<br />

condition. Contact c/- info@nzoptics.co.nz, Code: EQFS12<br />






We are looking for an experienced, friendly, self-motivated staff<br />

member to join our small independent team at Epsom Eyecare<br />

Optometrists in the leafy suburb of Epsom, close to Newmarket,<br />

Mount Eden and just five km south of the city centre.<br />

If you like dealing with people, taking initiative, are passionate<br />

about eye health and quality eyewear, and you want to be a<br />

senior and valued member of a team committed to providing the<br />

best customer service, we would love to hear from you.<br />

Please email expressions of interest to Jyotika@epsomeyecare.<br />

co.nz. All applications will be treated in the strictest of confidence.<br />


Move to a laid-back harbour town surrounded by world class<br />

beaches and forests. Work “flexi-time”, perfect if you enjoy an<br />

outdoor lifestyle or want to have more family time. Independent<br />

practice for sale in Whangarei. Quality fit-out only two years old,<br />

prominent CBD street-corner with large traffic movement, great<br />

landlord and low rent. Loyal patient base that expects premium<br />

eye-care and eyewear. Present owner available to stay on as DO if<br />

required. Contact stu@opticsnz.co.nz or craig@visualeyez.co.nz.<br />

Eyes opened<br />

on VOSO trip<br />


Malo e Lelei. This<br />

<br />

Volunteer Ophthalmic<br />

Services Overseas (VOSO) trip,<br />

<br />

visit to the beautiful Kingdom<br />

of Tonga.<br />

I was excited, yet apprehensive<br />

in the lead-up to the visit. I<br />

didn’t know what to expect.<br />

Of course I had no need to<br />

be worried as it turned out I<br />

enjoyed every moment of my<br />

time in Tonga and I returned<br />

to New Zealand with a new<br />

perspective on eye care.<br />

The trip was from September<br />

19 to 26. Thames-based locum<br />

Hywel Bowen and I provided<br />

optometric services through<br />

the week, going wherever<br />

we were needed and seeing<br />

every patient that turned up.<br />

We provided a basic exam,<br />

taking a brief history—via<br />

translator—followed by<br />

retinoscopy, basic refraction<br />

and external and internal<br />

examinations of the eyes.<br />

We distributed spectacles<br />

from the stock that had been<br />

sent ahead of us. These were<br />

mostly recycled spectacles,<br />

donated by the Lion’s Club and<br />

others, along with some readymades.<br />

We were even able to<br />

give out recycled progressives<br />

and bifocals to some patients,<br />

which was really great. Over<br />

<br />

and I saw more than 100<br />

patients and provided about<br />

200 pairs of glasses.<br />

Drs Andrew Riley and<br />

John-Paul Blanc had a full<br />

operating list booked up for<br />

the whole week. They powered<br />

through nearly 50 surgeries,<br />

from cataracts to pterygiums<br />

to melanoma excisions,<br />

making a huge difference in<br />

a country with no resident<br />

ophthalmologists. They were<br />

met with many happy, smiling<br />

faces in post op.<br />

I could write all about the<br />

The author at work<br />

extracurricular activities we<br />

got up to in our week on<br />

Tongatapu—the country’s main<br />

island—but I have been told<br />

what goes on tour, stays on tour,<br />

so I dare not.<br />

It was great to see that every<br />

little bit that was donated to<br />

VOSO really counted. I was<br />

pleasantly surprised by the<br />

high level of organisation that<br />

went into this trip. Everything<br />

ran very smoothly and we<br />

seemed to have everything<br />

we needed. The local nurses<br />

and staff welcomed us<br />

warmly and they impressed<br />

me with their knowledge and<br />

enthusiasm for eye care. I was<br />

very appreciative of all the<br />

work and planning that was<br />

put into our one week. I know<br />

that a lot of effort went into<br />

the organisation and shipping<br />

of all the spectacles, medicine<br />

and surgical equipment.<br />

<br />

certainly very busy, but it was<br />

also incredibly rewarding. While<br />

I left the island with a heavy<br />

heart because I wanted to stay<br />

much longer, I also left knowing<br />

that I had made a bunch of great<br />

new friends and had a pretty<br />

life-changing set of experiences<br />

along the way. I highly<br />

recommend getting involved in<br />

this fantastic organisation.<br />

For information on joining<br />

upcoming VOSO trips in 2016,<br />

contact visionzsecretary@<br />

gmail.com. <br />

* Ashley Gray is a therapeutically<br />

qualified optometrist with Gary<br />

Filer Optometrist in Auckland. She<br />

graduated with first class honours<br />

in Optometry from the University of<br />

Auckland and a BSc in Neuroscience<br />

from the University of Otago.<br />

CCLS conference 2016<br />

The Cornea and Contact<br />

Lens Society (CCLS) will<br />

host its 2016 annual<br />

conference on March 20.<br />

This one-day event will be held<br />

at Mac’s Function Centre on<br />

Wellington’s waterfront, near<br />

Te Papa museum. The keynote<br />

speaker will be Professor Fiona<br />

Stapleton, head of the School of<br />

Optometry and Vision Science<br />

at the University of New<br />

South Wales.<br />

Stapleton’s research areas<br />

include the epidemiology of<br />

lens-related disease, ocular<br />

microbiology, bacterial<br />

resistance, contact lens care<br />

systems and ocular defence<br />

mechanisms. According<br />

to the University website,<br />

Stapleton has more than 160<br />

peer reviewed publications,<br />

has contributed 15 chapters<br />

to textbooks and published<br />

a book on the diagnosis and<br />

management of anterior<br />

segment disease.<br />

The CCLS is also offering a<br />

Glaucoma Workshop to delegates<br />

on March 19 to promote safe,<br />

collaborative care for glaucoma.<br />

The seminar will be an interactive<br />

discussion focssing on clinical<br />

cases to highlight evidence-based<br />

decision-making, recognising<br />

dangerous situations and<br />

underscoring concepts relevant<br />

to managing glaucoma in a<br />

population.<br />

The main speakers will be<br />

Wellington ophthalmologists<br />

Drs Jesse Gale and Graham<br />

Reeves, with contributions<br />

from Professor Tony Wells and<br />

Dr Chris Murphy. Registration<br />

for the workshop will be via<br />

the conference registration. A<br />

discount on registration fees<br />

is likely to apply if attending<br />

both the workshop and the<br />

conference.<br />

Registrations will open<br />

in January 2016. For more<br />

information and to register, stay<br />

tuned to www.contactlens.org.<br />

nz. If you aren’t a CCLS member<br />

and are interested in<br />

attending, please contact<br />

secretary@contactlens.org.nz. <br />


<strong>Dec</strong>ember <strong>2015</strong><br />

<strong>Dec</strong>ember <strong>2015</strong>.indd 20<br />

19-Nov-15 3:27:22 PM

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