Sep 2016

Bionic eye goes commercial
The bionic eye system, IRIS II, developed by
French company Pixum Vision, has been
awarded the CE mark. This 150-electrode
epiretinal implant features a design intended to be
explantable and upgradeable, and is now CE-mark
approved for people with vision loss from outer
retinal degeneration.
“The CE mark certification is a major step forward
for Pixium Vision and for retinal dystrophy patients
who have lost their sight,” said Khalid Ishaque,
CEO of Pixium Vision. “This recognition by an
independent expert body validates the longterm
multidisciplinary work that has resulted
in market approval of the IRIS II system. We
will continue to develop our bionic vision
systems with the aim to deliver improved
visual perception and help retinal dystrophy
patients lead more independent lives.”
The IRIS II features a bio-inspired camera
intended to mimic the functioning of the
human eye; an epiretinal implant with 150
electrodes, almost three times the number
of electrodes than the previous version; and
an explantable design – the electrode array
is secured on the retinal surface by a support
system that is intended to allow for future
replacements or upgrades.
Clinical trials are currently underway in Germany,
Austria and France. Moorfields Eye Hospital in
London received approval from the UK regulatory
authority MHRA to launch their own clinical trial
at the end of May. The focus right now is on IRIS II
as a solution for retinitis pigmentosa patients, said
the company, adding it was also working on an
implant for AMD patients. ▀
New doc for Timaru
Hawke’s Bay
ophthalmologist, Dr
Muhammad Khalid has
now filled the long-vacant role
of Timaru ophthalmologist for,
a presumably-much relieved,
South Canterbury District
Health Board (SCDHB).
Talking to NZ Optics in
August, shortly before
moving to Timaru to take up
his new role, Dr Khalid said
he was excited about the
new position and getting
back to being part of a small
community once again.
“My father was a GP in a
small town. I feel comfortable in and understand
smaller communities so I will enjoy being part of
one again.”
Dr Khalid says a smaller community offers a lot
more opportunities to get to know people and
to help solve a multitude of different problems,
problems you might not be exposed to from an
eye-health perspective as part of a larger team.
With three young children in tow (a girl and
two boys aged 13, 10 and 8), however, Dr Khalid
admits it was an important decision for him and
his wife, but they are all now looking forward to
the move. “You don’t go to small communities
like this to just work, you have to want to be a
part of the community.”
Dr Khalid has locumed in Timaru a few times
over the past year since his predecessor, Dr
Mike Mair’s retirement in July 2015. When
he mentioned to people at
SCDHB that he thought it
was a great place and was
surprised they hadn’t found
anyone to replace Mike, they
asked him to come in and
consider it.
SCDHB chief
executive Nigel Trainor,
talking to the Timaru Herald,
said having Dr Khalid meant
cataract surgery could once
again be performed at
Timaru Hospital and private
alternatives would now be
Dr Muhammed Kahlid at RANZCO NZ
available through the eye
in Dunedin in May
clinic.
“The search for an ophthalmololgist has been
extensive and during this time Dr Khalid was
able to provide support to South Canterbury
DHB as a locum doctor. We are delighted that
he liked what he saw and has decided to make
the move to Timaru permanent. He brings with
him extensive global experience and will be a
real asset to the community,” said Trainor.
Originally from Pakistan, Dr Khalid also
trained in Ireland and obtained his fellowship
in ophthalmology from the Royal College
of Surgeons of Edinburgh. He also has a
postgraduate degree in medicine from the
National University of Ireland in Galway
and a diploma from the European Board of
Ophthalmology. He moved to New Zealand with
his family in 2013 to be nearer to family in this
part of the world. ▀
RANZCO launches referral
guides; signs Specsavers MoU
The Royal
Australian
and New
Zealand College of
Ophthalmologists
(RANZCO) has
released the first of
a series of planned
referral guides for
optometrists and
GPs to help provide
more effective and
efficient patient
care pathways
and improve eye
health outcomes
for patients across
Australasia.
The first of the
referral guidelines,
looking at glaucoma
management, was
released at the beginning of August. Guidelines
on diabetic retinopathy and age-related macular
degeneration (AMD) are expected to be released
in the near future, with other indications to be
released later, following feedback.
In a statement RANZCO said these referral
guidelines do not favour and are not dependent
upon any one particular practice referral system
or methodology. “They simply provide a resource
which lays out a suggested referral pathway if
certain signs and/or symptoms are identified.
The aim is to ensure patients receive the best
care possible, in the most appropriate timeframe
and from the appropriate healthcare provider.”
The referral guidelines are based on peerreviewed
publications about best practice in
relation to referrals for symptoms and disease
areas. “That said, we recognise that what works
best in theory is not always what works best
in practice and so we will be assessing the
effectiveness and usability of the guidelines,”
said Dr Bradley Horsburgh, RANZCO president.
“We are all part of the eye healthcare system
and it’s important that we deliver that as
smoothly and effectively as possible for
patients.”
Dr David Andrews (RANZCO), Peter Larsen (Specsavers), Dr Bradley Horsburgh (RANZCO), Charles Hornor
(Specsavers) and Dr Russell Bach (RANZCO) celebrate the agreement between RANZCO and Specsavers
MoU with Specsavers
Though RANZCO stressed it is seeking feedback
from all optometrists, ophthalmologists and GPs
who use the new referral guidelines, to ensure
it gathers information quickly it has agreed
a Memorandum of Understanding (MoU), or
statement of intent, with Specsavers Australia
and New Zealand to run a two-year pilot
programme to gather metrics and data. “Given
the number of Specsavers optometric practices,
this pilot will allow us to efficiently gather data
to assess the effectiveness of the guidelines,” said
RANZCO.
“Working with Specsavers does not limit
the availability of the referral guidelines. The
guidelines will be promoted and made widely
available to all optometrists and GPs across
Australia and New Zealand.”
In a joint statement RANZCO and Specsavers
said both parties will share resultant data with
healthcare funding and management bodies
to shed greater light on eye health and broader
healthcare outputs.
“With a growing and ageing population in
both Australia and New Zealand we have a duty
to ensure that there is ingrained collaboration
between optometry and ophthalmology,” said
Peter Larsen, Specsavers’ optometry director.
“It is not enough to say we work together, we
actually need to set ourselves specific areas of
collaboration and measure the effectiveness
and efficiency of that collaboration. This
arrangement between Specsavers and RANZCO
does just that, the goal being superior patient
outcomes.”
Larsen said the first discussions with RANZCO
about using Specsavers’ ANZ network of
optometrists to proactively review the guidelines
took place in March. “And a meeting of minds
quickly emerged, leading to this MoU.”
RANZCO will be running training sessions on
the guidelines at the 2016 RANZCO Congress
in Melbourne in November for all optometrists
and GPs who wish to attend, while Specsavers
will be releasing more details about the MoU
and what it means in practice for Specsavers’
optometrists at its 2016 Clinical Conference in
Brisbane this month.
To download and review the first RANZCO
Referral Pathway for Glaucoma Management go
to: https://ranzco.edu/ophthalmology-and-eyehealth/collaborative-care/referral-pathway-forglaucoma-management
▀
How Pharmac makes funding decidions
Clinical advice from experts is the bedrock of Pharmac’s medicines assessments,
writes Medical Director Dr John Wyeth
Advice from clinical experts is an important
part of the Pharmac funding process.
There are multiple ways in which health
professionals provide input to our funding
decisions. From trained medical professionals on
Pharmac’s staff to experts on our specialist panels,
and members of our clinical advisory committees
and wider consultation, input from the medical
profession is central to Pharmac’s decisions on
medicine funding.
Our main clinical committee is the Pharmacology
and Therapeutics Advisory Committee (PTAC),
which has 21 subcommittees in clinical
specialities like cardiovascular disease, diabetes
and ophthalmology. The key skills of our clinical
committee members are reviewing and advising us
on the evidence for the use of medicines in a New
Zealand clinical setting.
We’re sometimes asked why we need to seek
advice on the evidence around medicines,
when a lot of this work is already undertaken
internationally. The answer is that we need to
clearly understand the way a new medicine might
be used in New Zealand. What are the currently
favoured treatments in New Zealand that we
are comparing the medicine under assessment
with? We need to know we are using the right
comparator in our assessment. Our advisory
committee members can help answer this
question, and they are also expected to use their
clinical networks and experience to provide advice
to Pharmac on all aspects of a medicine under
consideration.
All together, Pharmac has around 140 expert
doctors and other health professionals providing
formal advice on medicine funding applications – a
considerable resource.
Because New Zealand has a medicine funding
environment with a defined budget, we can’t
afford every medicine that is available on the
market, so choices have to be made. We know
there are high public expectations around
accessing the ‘latest and greatest’ medicines, but
we know in practice that these high expectations
around effectiveness of new medicines don’t
always play out. We need to carefully examine
the evidence and take a dispassionate view of
the medicines being looked at. We can’t spend
the same dollar twice, so we need to make sure
the choice we make is the one that gets the best
health outcomes for New Zealanders.
The main pathway to medicine funding is
through the Pharmaceutical Schedule. This
is the list of medicines funded for all eligible
patients. A medicine considered for Schedule
listing goes through a rigorous process
involving the assessment of clinical evidence,
pharmacoeconomic evaluation by Pharmac’s team
of health economists and negotiation with the
company that supplies the medicine. If we get
to the point of a provisional agreement with a
company, we then consult with the wider public.
What we want to know is what benefit any new
medicine has over and above the medicines that
are already funded on the Schedule – and what
will the additional cost of that benefit be?
Pharmac’s commercial skills can provide benefits
also. We’re hoping that’s the case with a process
we’re currently running, which emerged from
recommendations made by PTAC. Two anti-VEGF
agents are currently listed for use in DHB hospitals
for wet macular degeneration – bevacizumab
(Avastin) and ranibizumab (Lucentis). In reviewing
an application for another agent aflibercept, PTAC
recommended Pharmac run a commercial process
that might
lead to further
agents being
listed. That
process is now
underway.
Sometimes
people have
unusual clinical
circumstances
that might
mean a funded
medicine isn’t
right for them,
and there is
Dr John Wyeth
an unfunded
medicine that
is. Pharmac also has a process for assessing
individual patient applications for unfunded
medicines – the Named Patient Pharmaceutical
Assessment (NPPA) process. Pharmac receives
nearly 2000 applications a year under NPPA, most
of which are approved. NPPA isn’t a mechanism
to provide access to every unfunded medicine –
it aims to fill a specific need for some patients
whose clinical circumstances aren’t served by
medicines listed on the Schedule.
We encourage health professionals to get
involved in Pharmac funding processes and
have links with associations and societies. But
any clinician can be part of our consultation
database. We’d be happy to add you if you email
consultation@pharmac.govt.nz ▀
6 NEW ZEALAND OPTICS September 2016