Sep 2016

International Orthoptic
Congress 2016
BY MIRIAM LANGESLAG-SMITH*
RANZCO & Specsavers?
In this modern, commercial
world we are seeing ever more
collaboration between large
groups, commercial operations,
medical-insurers and so on.
The AA collaboration with
Specsavers offering ‘free eye tests’ for
AA members and the similarly free
eye exams being offered by OPSM to
Southern Cross medical insurance
members are good examples.
There are various other such things
promoted by loyalty schemes and so
on. In some parts of the world it is
even more complex with a variety of
players involved. Some professions
are also being ‘controlled’ by either
being in an affiliated provider
scheme or not. Ophthalmology too
has had such arrangements ‘forced’
on it. In recent times we have seen
Southern Cross ‘forbid’ its members
from having femtosecond aided
cataract surgery, to the point that if
a patient elected to have this option
done - at their own cost - they were
then told the medical insurer would
not cover any of the cataract surgery!
This is in my view crazy and smacks
of being unjust and unfair and one
wonders if there are vested interests
or political issues at play? It makes
no difference to their cost if the
patient elects to have what they may
deem a more advanced option to
their surgery. This has led to some of
the groups who shelled out on such
advanced equipment literally having
a million dollar white elephant
wasting valuable theatre space. One
group even sent their laser unit back
to the provider.
I don’t like being economically
forced to have to ‘choose’ a certain
provider of medical services, which
may not be my first choice or the
best choice, simply due to financial
considerations. When I joined
Southern Cross that was not one of
the conditions but now it is being
forced on me. Of course the insurers
will tell you that this is to keep costs
under control but there’s more to it
than that.
As we know loyalty schemes are
designed to make us more inclined
to deal with certain companies
that reward us for our loyalty. It can
certainly lock one in. It does in some
cases have benefits but at other times
it can make it more hassle or cost
more to stay with say a certain airline.
I don’t agree with such control
of relationships and the proposed
RANZCO-Specsavers collaboration
(see news story p6) will not
likely foster or enhance good
relations between optometry and
ophthalmology.
Although RANZCO mentions
Specsavers as the largest group
in retail optometry they do not
represent the majority. All told
OPSM commands about one third
of the optometry market with
independents another third and
Specsavers also about one third.
I believe RANZCO have made a
mistake in how they went about
this initiative, as it should have been
inclusive of the whole profession. I
do note RANZCO’s point of it being a
good test vehicle for their scheme as
Specavers run pretty much the same
systems throughout their network
of ‘stores’. Surely that should have
been a clue to RANZCO as they are
talking about high level medical
collaboration not retail business that
takes place in stores?
There are many independent
practitioners who I believe could
have made an excellent contribution
to this process and their speciality
practices may in fact have been a
better vehicle to gather the valuable
data, which is what RANZCO claims
to be seeking.
Although the collaboration does
not seem to be a commercial
arrangement – and they do state that
the referral guidelines and education
are open to all optometrists – it still
does not sit well with the people I’ve
had feedback from.
At any rate I gather there are moves
afoot to create a more level playing
field and potentially we may see
some alterations to this proposal
over the next while.
It’s also been interesting to note
that Specsavers have tried to
trademark the word ‘Should’ve’ as
used in their clever ‘Should’ve gone
to Specsavers’ advertisements (which
is already trademarked). Some people
think this is ridiculous and that they
are unlikely to succeed. ▀
Acuity chart for AMD
A
team
of researchers from
Ulster, Moorfields Eye Hospital
and Auckland have developed
a new acuity chart to detect early
signs of macular degeneration, called
the Moorfields Acuity Chart.
With age-related macular
degeneration (AMD) still the leading
cause of sight loss in Western
countries, having an easy to use,
early detection test will result in
much better outcomes for AMD
patients. Until now letter charts
have not been consistent or sensitive
enough to give an early diagnosis or
to monitor progress.
The research team, which included
Professor Steven Dakin from the
School of Optometry and Vision
Science at the University of Auckland,
worked on the new acuity chart. The
chart uses letters built up from fine
black-and-white stripes, as previous
research showed these ‘high-pass’
letters are more equally readable
than standard letters, but also that
they appear to vanish altogether
when they are too small to be
recognised.
In a study published in the British
Journal of Ophthalmology, the
sensitivity of the Moorfields Acuity
Chart was compared with the
standard test in 80 AMD patients
and 38 people with normal vision.
The results showed the Moorfields
chart was more reliable from one
test to the next for people with
AMD, but not the participants with
normal vision.
Sir Peng Tee Khaw, director of
the NIHR Moorfields Biomedical
Research Centre said, “This marks
a significant advancement in our
ability to diagnose vision loss arising
from the leading cause of sight loss
in industrialised countries. This is
exciting for us all as improved testing
methods lead to better diagnosis and
treatment development.” ▀
From the 27 to 30 June 2016, 700 members of the
International Orthoptic Association (IOA) from 42
countries met in Rotterdam in the Netherlands to share
their research, knowledge and experiences in and around
the world of orthoptics at the XIIIth International Orthoptic
Congress. Among the attendees were three orthoptists from
New Zealand: Karen Fyles from MidCentral District Health
Board, Gisela Rademaker from Timaru Eye Clinic and myself,
Miriam Langeslag-Smith from Counties Manukau Health.
The Congress is held every four years and is attended not
only by orthopists, but also ophthalmologists, researchers
and educators, fitting with the theme, “Bridging Worlds”
where bridges between the different fields related to
orthoptics are being built.
This year the Congress was held at De Doelen International
Congress Centre in the heart of Rotterdam. Rotterdam is a
dynamic city with a lively cultural scene and long maritime
history, and the largest cargo port in Europe. The near-complete
destruction of Rotterdam’s city centre during World War II has
resulted in a varied architectural landscape. On a more personal
level, Rotterdam is the city where I started my working career
as an orthoptist many moons ago. It was great to be back in
familiar surroundings although in an ever-evolving city like
Rotterdam a lot had changed since I worked here.
The first day of the Congress started with an education
session for attendees who are educating orthoptics students,
residents, medical students or other ophthalmic personnel,
and two workshops. The first focused on the change in the
personal and professional identities of orthoptists across
the world, demonstrating that many orthoptists now have
expanded roles in their practices. The first orthoptist to be
accredited to perform intravitreal injection is an example
of this. The second workshop was about assessment and
intervention in cerebral visual impairment in children.
The following three days were filled with three invited
symposia from IOA partners: the International Paediatric
& Strabismus Council; the International Strabismological
Association; and the World Society of Paediatric
Ophthalmology and Strabismus. There were 76 oral
presentations, 20 rapid-fire poster presentations and 84
posters divided into 12 different themed blocks, with themes
such as binocular vision, low vision, technology in eye
disease, strabismus and neuro-ophthalmology, just to name
a few. I had the privilege of presenting in the amblyopia block
on Amblyopia improves more than just visual acuity, which
included results of a study I conducted as part of my master’s
degree at the University of Auckland. I also had two posters in
the theme block Expanding orthoptic practice, one with Carly
Henley from Auckland DHB who unfortunately was unable to
attend the Congress.
The Congress was completely paperless. All delegates
had free WiFi access and were encouraged to download a
Welcome to the XIIIth IOA Congress in Rotterdam
CentraSight training in NZ
CentraSight, the ground-breaking macular
degeneration treatment that inserts a tiny telescope
into a patient’s eye, now has a formal point of
contact in New Zealand - specialist low vision consultant,
Naomi Meltzer.
Meltzer, based in Auckland and a former partner at Barry
and Beale optometrists for 30 years, says she’s always
had a special interest in low vision. She took a diploma
in rehabilitation at Massey in 2009 to help her low vision
patients and, while she was on the course, met Paula
Daye, the outgoing CEO of the NZ Foundation of the Blind.
Together they set up the Sight Loss Services Charitable
Trust, to provide information, equipment and support to
New Zealanders with low vision and their families, and to
promote better understanding of low vision in the wider
community. She also helped establish the NZ Association of
Optometrists’ accreditation for optometrists in low vision,
which became available earlier this year.
Today Meltzer runs a specialist low vision practice, Low
Vision Services, and it was while she was contacting low
vision specialists in the UK that she was put in touch with
Graham Brown, director of CentraSight.
“I’d heard of CentraSight through Rodney Stedall, one of
the optometrists already trained to do assessments in New
Zealand.” says Meltzer. “Graham was going to be in New
Zealand, to be present at (Tauranga ophthalmologist) Mike
O’Rourke’s first CentraSight operation, so we arranged to
meet.”
From that initial meeting, Meltzer entered the UK-based
training programme to become an optometrist qualified to
assess and rehabilitate patients.
“The success of the treatment is reliant upon a rigorous
screening of candidates and good post-operative
rehabilitation, as well as excellent communication between
the surgeon, the patient and the low vision optometrist,”
she explains. “Once they’ve had the implant, the patient
needs to be trained to use their implanted eye for detail and
their other eye for getting around. It’s not for everyone.”
designated congress app on their smartphones or tablets,
which showed which presentation or event was going on in
real time. There was even the ability to add your own notes
on the online presentations.
Overall the presentations were of a high calibre and covered
a wide variety of subjects. There were many highlights for me,
too many to name here, but one that did stand out was the
need for consistency around the world in naming orthoptic
disorders. People naïve to visual experiments respond very
differently to “visual experts” therefore we should not be
using orthoptic/optometry students as a control group in
ophthalmology research.
Not all the presentations were on new and novel research,
which was good as they confirmed previous findings,
refreshed subjects and brought forward knowledge that over
the years may have gone to the back of our minds.
Although the orthoptist market is still very small, 13 exhibitors
took part in the Congress, many displaying novel products.
These included a redesigned picture visual acuity chart, a
new strabismus test, electronic amblyopia treatment glasses,
research and examination equipment and children’s glasses.
Besides the very interesting presentations, there was also
time to relax and socialise. The social side of the Congress
was, as always, a great opportunity to catch up with
colleagues, old class mates and friends from around the
world. The welcome reception, VIP reception and Congress
dinner at St. Laurenskerk, or Great Church of Rotterdam, plus
the lovely buffet lunches with ample Dutch delicacies, were
the perfect times to do just that. For the very keen, there was
even a morning run through Rotterdam on the third day.
The next IOA Congress will be in June 2020 in Liverpool in
the UK. It would be great if we can have more New Zealand
orthoptists attending this very worthwhile and inspiring
Congress. If you can’t make it to Liverpool, perhaps you can
make it to Lisbon, Portugal in 2024. ▀
*Miriam Langeslag-Smith is an orthoptist with Counties Manukau DHB.
While Meltzer wasn’t
the first optometrist
to qualify – Rodney
Stedall from Paterson
Burn Hamilton was the
first and Lynley Smith
from Langford Callard
in Tauranga the second
– it became clear to
CentraSight she was well
set up to be the contact
point for the whole of
Australasia and assist
Naomi Meltzer
with the training of other
teams in this part of the world.
“My experience in low vision, plus the fact I already have
a dedicated low vision practice and an 0800 number for
people from all over the country to phone for advice, made
me the ideal candidate for this role,” says Meltzer, who is
going to be helping CentraSight train other optometrists for
the CentraSight programme. “But I am in touch with both
Rodney and Lynley, and we are continuing to learn together.”
The CentraSight surgery isn’t a switch that suddenly turns
on good vision, warns Meltzer. “There’s a lot of work to be
done both before and after the operation to rehabilitate the
patient and their motivation, as well as additional health
concerns, travel and finances all have to be considered. But
for those patients who fit the criteria, CentraSight offers the
ability to recognise family members’ faces, read a book and
see other detail, which they may not have been able to do
for a long time, either at all or without magnification.” ▀
If you are an optometrist with a patient you’d like to refer
for assessment, or you are interested in finding out more
about training yourself, you can contact Naomi Meltzer
by calling 0800 555546. CentraSight surgery is currently
offered by Mike O’Rouke at Tauranga Eye Specialists and
Dr Stephen Guest at Hamilton Eye Clinic. The equipment is
distributed by Toomac.
24 NEW ZEALAND OPTICS September 2016