Nov 2016
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THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY<br />
FOR OPTOMETRISTS AND EYE CARE PROFESSIONALS<br />
PO BOX 106 954, AUCKLAND CITY 1143<br />
Email: info@nzoptics.co.nz Website: www.nzoptics.co.nz<br />
NOVEMBER <strong>2016</strong><br />
NP4: A2160859511<br />
World’s First and Only Water<br />
Gradient MULTIFOCAL contact lens
OUR EXPANSION…<br />
YOUR CAREER GROWTH<br />
A MUTUAL OPPORTUNITY<br />
As the Specsavers network of 370 New Zealand and Australian stores continues to<br />
experience significant growth, opportunities abound in metro and regional locations<br />
for career focussed optometry and dispensing professionals.<br />
For those taking a fresh look at what Specsavers offers as a working<br />
environment, the scale and format of our store locations continues to evolve<br />
with exciting results for our partners, our teams and our patients. Take<br />
Specsavers Ringwood as an example, recently recognised at the Australian<br />
Retail Awards as the outstanding retail design project of the past year. It is<br />
more than double the size of its previous location in the same shopping centre,<br />
with six consulting rooms, 12 dispensing desks, a contact lens teaching zone<br />
and four pre-testing rooms. Its investment in the latest retail and optometric<br />
technology is exemplary, offering a glimpse of the future.<br />
And now, as we look to the next phase of growth, we want to talk to you<br />
about our plans – and hear about yours. Our growth really can be your<br />
opportunity, whether you are looking at a store partner or an employed role -<br />
at every level of experience.<br />
To get the conversation started, contact Chanelle Coates on 0800 717 350 or by email on chanelle.coates@specsavers.com<br />
Retail<br />
Store Design<br />
Award<br />
<strong>2016</strong><br />
Retail<br />
Employer<br />
of the Year<br />
2015<br />
Overall<br />
National<br />
Supreme Winner<br />
2015<br />
ANZ Customer<br />
Service Excellence<br />
Award<br />
2015<br />
Franchise<br />
Innovation<br />
Award<br />
2015<br />
NZ Franchise<br />
System of<br />
the Year<br />
2014<br />
Retail<br />
Innovator<br />
of the Year<br />
2014<br />
Multichannel<br />
Retailer<br />
of the Year<br />
2014<br />
Roy Morgan<br />
Research<br />
No. 1 for eye tests<br />
2014<br />
FCA International<br />
Franchisor<br />
of the Year<br />
2014<br />
FCA Social<br />
Responsibility<br />
Award<br />
2014<br />
2 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
J&J to acquire AMO<br />
US-based healthcare company Johnson & Johnson is<br />
to acquire Abbott Medical Optics (AMO), a whollyowned<br />
subsidiary of fellow US healthcare firm<br />
Abbott Laboratories, for US$4.325 billion in cash.<br />
The acquisition includes AMO’s products in its three<br />
business divisions: cataract surgery, laser refractive surgery<br />
and consumer eye health. This includes AMO’s advanced<br />
laser vision (LASIK) technologies, dry eye drops and<br />
multipurpose solutions and hydrogen peroxide cleaning<br />
systems for contact lens patients.<br />
“Eye health is one of the largest, fastest growing and<br />
most underserved segments in health care today,” said<br />
Ashley McEvoy, J&J’s company group chairman responsible<br />
for J&J’s Vision Care companies, in a statement. “With<br />
the acquisition of Abbott Medical Optics’ strong and<br />
differentiated surgical ophthalmic portfolio, coupled with<br />
our world-leading Acuvue<br />
contact lens business, we<br />
will become a more broadbased<br />
leader in vision care.<br />
Importantly, with this<br />
acquisition we will enter<br />
cataract surgery – one of the<br />
most commonly performed<br />
surgeries and the number<br />
one cause of preventable<br />
blindness.”<br />
Boston-based financial<br />
markets analysts Trefis<br />
issued a statement saying,<br />
for J&J, the move was a<br />
good one. “As far as J&J<br />
is concerned we consider<br />
the transaction to be a<br />
good strategic move for its<br />
existing Vision Care division.<br />
We believe that there is<br />
enough potential in this<br />
segment which the company<br />
can tap into with a larger<br />
product portfolio.”<br />
The world vision care<br />
market is currently<br />
estimated at US$68bn and is<br />
expected to grow at around<br />
5% per annum. Areas of<br />
potential growth include<br />
the contact lens market<br />
Hoya launches Yuniku<br />
BY LESLEY SPRINGALL<br />
Causing a buzz among the media in the<br />
Silmo pressroom in Paris was news about<br />
lens company Hoya launching Yuniku, billed<br />
as the world’s first 3D printed tailored eyewear,<br />
designed entirely around the optimum lens for the<br />
wearer’s prescription and lifestyle.<br />
Speaking to NZ Optics at Silmo, Dave Nicoll,<br />
Hoya’s sales development manager, EMEA, says<br />
Yuniku was in development for two years following<br />
advancements in 3D technology, which finally<br />
made it possible.<br />
“The idea behind it is to make it vision centric.<br />
In the past the frame has defined the position of<br />
the lens, so it will never be optimum doing that.<br />
But with Yuniku, knowing the prescription and the<br />
lifestyle functional needs of the consumer, we can<br />
identify the optimum position of the lens and then<br />
design the frame to maintain that.”<br />
Optometrists and dispensing opticians who are<br />
interested in adopting Yuniku for their practices,<br />
will be trained to use the special Yuniku scanner<br />
which, after plugging in the patient’s prescription<br />
and functional lifestyle needs, allows them to help<br />
the patient choose which lens they want, which<br />
coatings and which frame design, size, texture<br />
and colour. If a frame size or design does not allow<br />
the lens to be in the optimum position, it will<br />
automatically be removed from the catalogue, so<br />
the patient never has that choice, says Nicoll.<br />
Practices will be given a sample set, so patients<br />
can feel the weight (only about 10g) and strength<br />
of the 3D-printed frames, before virtually trying<br />
them on, and playing with colour, size, texture and<br />
shape, through the system.<br />
Hoya’s Yuniku system in action<br />
Johnson & Johnson’s HQ in New Brunswick, New Jersey in the US<br />
– with just 11% of Americans wearing contact lenses<br />
today, compared with 64% who wear glasses (US National<br />
Eye Institute, September <strong>2016</strong>) – and the developing<br />
world, where increasing affluence means wider access to<br />
corrective lenses. There is also the ageing population to<br />
consider, said J&J in its statement, with the World Health<br />
Organisation estimating the total number of cataractaffected<br />
eyes to be “at least” 100 million.<br />
In 2015, AMO reported US$1.1bn in sales across its<br />
three divisions, with sales rising 6.2% year-on-year in the<br />
second quarter of <strong>2016</strong>, driven largely by demand around<br />
cataract surgery. In July, to great fanfare, AMO received<br />
FDA approval for its Tecnis Symphony range of intraocular<br />
lenses, a completely new class of IOL providing superior<br />
vision across a broad range of distances ( NZ Optics<br />
September <strong>2016</strong>).<br />
Abbott Laboratories’<br />
agreed to the sale after<br />
actively and strategically<br />
shaping its portfolio to focus<br />
primarily on cardiovascular<br />
devices and expanding<br />
diagnostics, so away from<br />
its vision care side. As part<br />
of this new focus, it agreed<br />
to acquire cardiac device<br />
specialist St. Jude Medical in<br />
April for US$25 billion.<br />
Johnson & Johnson’s eyehealth<br />
business was worth<br />
US$2.6bn in 2015. It said<br />
the acquisition will better<br />
position the company to<br />
reach patients in cataract<br />
surgery, laser refractive<br />
surgery and over the counter<br />
consumer eye health;<br />
three categories of care it<br />
currently has no, or a very<br />
limited, portfolio within.<br />
The agreement,<br />
announced in September,<br />
is subject to antitrust<br />
clearance and other US<br />
regulatory requirements,<br />
and is expected to close in<br />
the first quarter of 2017. ▀<br />
Dave Nicoll demonstrates Hoya’s new Yuniku 3D tailored eyewear system<br />
“What we’re bringing to optometrists is a new<br />
solution,” says Nicoll. “Frames are part of that<br />
solution, 3D manufacturing is part of the solution,<br />
and the software and lens design and manufacture<br />
is part of the solution.”<br />
Yuniku is the result of a partnership between Hoya<br />
and Belgium company Materialise, which provides<br />
3D printing software and services on a global scale;<br />
most recently achieving fame for creating a 3D<br />
printed heart for a baby born with holes in its heart<br />
from congenital heart disease in New York.<br />
Yuniku currently includes 12 different styles and<br />
will be priced at the premium end of the spectrum,<br />
says Nicoll. “It is absolutely the most personalised<br />
optical solution in the world.”<br />
Development has been top secret and given<br />
it was only unveiled at Silmo Paris at the end of<br />
September, it’s too early to know how the market<br />
will take it. But interest was strong at Silmo among<br />
the industry, as well as the media, so Hoya is<br />
expecting big things, says Nicoll.<br />
“I’ve been in optics 30 years and I’ve only ever<br />
seen two game-changing technologies and this is<br />
one of them, the other was freeform lens design.<br />
This is that big.”<br />
For more about Silmo Paris <strong>2016</strong>, see p17-19. ▀<br />
While the cat is away …<br />
Lesley has been gallivanting around<br />
Europe this month, visiting SILMO<br />
among other things, leaving me<br />
at the helm of the Good Ship Optics<br />
(very trusting she is!) Thankfully, it’s<br />
been a busy month full of events and<br />
activities, so I’ve not even had a minute<br />
to get lonely or worry about what<br />
might fill the pages of the magazine.<br />
Spring, it seems, has swept in a new<br />
era of change and hot on the heels of<br />
the Lensworx closure, Johnson and<br />
Johnson have announced they will<br />
buy Abbott Medical Optics. While we<br />
won’t see any practical change until<br />
the sale goes through in 2017, we<br />
have taken a short look at what we<br />
know so far (see story this page).<br />
Of course the high-rolling feature<br />
this issue, that everyone is turning the<br />
page for, is the summer sun-health<br />
special (p11-15). I’d like to extend<br />
huge thanks to Dr Peter Hadden, Dr<br />
David Worsely and Elisha Dudson for<br />
their contribution and for adding a<br />
wealth of clinical knowledge to our<br />
understanding about summer eye<br />
health. I’m sure you will also agree<br />
there are some stunning frames<br />
Silmo’s Australasian media contingent: Lesley<br />
Springall, Insight’s Coleby Nicholson and<br />
Mivision columnist Michael Jacobs<br />
DRY EYE: COVERED<br />
Optimel<br />
Antibacterial<br />
Manuka eye drops<br />
Eaglevision<br />
Punctal Plugs, Gauges and<br />
Dry Eye Management<br />
Mastrota Expression Paddle<br />
0800 338 800 • Ralph Mob. 021 990 200<br />
designsforvision.co.nz<br />
EDITORIAL<br />
- many of which were on display<br />
at the recent Visionz conference<br />
(full coverage in December), and<br />
exceptional style tips from the lovely<br />
Jo Eaton to boot.<br />
Of course I couldn’t let Lesley get off<br />
scott free, so don’t forget to turn to<br />
p18 for her round up of Silmo <strong>2016</strong> and<br />
some of the new tech and frame styles<br />
coming your way. While we are talking<br />
about overseas adventures, don’t<br />
forget to check out Dr Penny McAllum’s<br />
Niue trip on p23, and Devashini<br />
Devanandan’s review of her experience<br />
volunteering with VOSO in Samoa.<br />
VOSO feature again on p21, where you<br />
can check out the pictures from the<br />
Dine by Donation fundraising event at<br />
Meredith’s restaurant in Auckland.<br />
There’s so much in this issue, I<br />
don’t want to spoil some of the great<br />
surprises! I hope you enjoy reading<br />
and as always, please send your<br />
feedback to editor@nzoptics.co.nz<br />
Blephasteam<br />
Moist heat<br />
therapy<br />
Eye Eco<br />
Tranquileyes & DERM<br />
moist-heat therapy<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
Jai Breitnauer, Editor, NZ Optics<br />
DV841-1016<br />
NEW ZEALAND OPTICS<br />
3
News<br />
in brief<br />
COIN-SIZED RETINA SCANNER<br />
A European industry and academic consortium is working on a<br />
four-year project to reduce the size and cost of optical coherence<br />
tomography (OCT). The OCTChip (ophthalmic OCT on a chip)<br />
project is using photonic integrated circuits to produce a coin-sized<br />
retinal scanner to improve the screening and diagnosis of retinal<br />
diseases. Being so small the scanner can easily be transported to<br />
elderly patients, new-born infants and remote locations. Professor<br />
Wolfgang Drexler,<br />
head of the Centre<br />
for Medical Physics<br />
and Biomedical<br />
Engineering at the<br />
Medical University<br />
of Vienna, is<br />
leading the project.<br />
PRESCRIBING CONTROLLED DRUGS<br />
The ODOB issued a reminder to TPA optometrists that they are not<br />
authorised to prescribe controlled drugs. “It has come to the Board’s<br />
attention that there may be some confusion…To be clear, there are<br />
no circumstances under which an optometrist, in the optometrist<br />
(TPA endorsement) scope of practice or otherwise, may prescribe a<br />
controlled drug.”<br />
GLUCOSE SENSING CONTACT LENSES<br />
A team at the University of Houston have developed non-invasive<br />
glucose sensing contact lenses that sample glucose levels in tears,<br />
not blood. Though work still needs to be done to understand<br />
the correlation between tear and blood glucose levels, the more<br />
important finding is that the structure is an effective mechanism<br />
for using surface-enhanced Raman scattering spectroscopy,<br />
said Associate Professor Wei-Chuan Shih from Houston’s<br />
NanoBioPhotonics Group. “Everyone knows tears have a lot to mine.<br />
The question is whether you have a detector that is capable of<br />
mining it, and how significant is it for real diagnostics.”<br />
PARALYMPIANS BEAT OLYMPIANS<br />
Four visually-impaired<br />
Paralympian 1500m<br />
runners clocked faster<br />
times than their Olympic<br />
counterparts it’s been<br />
revealed. Winner of<br />
the T13 1500m final,<br />
Abdellatif Baka from<br />
Algeria, set a new<br />
Paralympic world record<br />
of 3 minutes and 48.29<br />
seconds, and now holds<br />
the fastest 1500m time recorded by any athlete in Rio. Olympic gold<br />
medallist Matthew Centrowitz from the US was 1.7 seconds slower<br />
than Baka as well as the second, third and fourth (Baka’s brother<br />
Fouad) place Paralympian runners.<br />
RESPECT AGREEMENT<br />
The Royal Australasian College of Surgeons (RACS) and the<br />
University of Otago Medical School have signed a landmark Letter<br />
of Agreement aimed at building respect and improving patient<br />
safety in surgery and strengthening the education of medical<br />
students. This is the first agreement signed between RACS and a<br />
university, and the first New Zealand collaboration under the Action<br />
Plan: Building Respect, Improving Patient Safety. The Agreement<br />
paves the way for a continuous focus on respect as a cornerstone<br />
of the profession and comes in the wake of continued complaints<br />
about sexual harassment and bullying.<br />
100 YEARS OF LIGHT<br />
Centenary congratulations to the US-based Optical Society (OSA),<br />
which has been championing all things relating to the science of<br />
light since October 1916. Over the last century The Optical Society<br />
and its 19,275 global members have been at the forefront of<br />
innovations that have changed our lives: barcodes making shopping<br />
a breeze; MRIs detecting injury and disease; cameras capturing life<br />
on Facebook and Instagram; telescopes discovering Pluto was a<br />
dwarf planet; and laser and lens technology restoring sight.<br />
BLAKE STEPS UP FOR OPHTHALMOLOGY<br />
Famous illustrator Quentin Blake<br />
has donated eight one-of-a-kind<br />
art pieces from his collection of<br />
illustrations for Roald Dahl’s books to<br />
the UK’s Stoke Mandeville hospital’s<br />
ophthalmology waiting area. The gift<br />
was in response to a request from<br />
consultant ophthalmologist Dr Sarah<br />
Maling who contacted The Roald<br />
Dahl Museum to see if they could<br />
provide some pictures to brighten<br />
up the dull and grim waiting area,<br />
which she thought was particularly<br />
unwelcoming for children. “We were<br />
hoping for a few posters,” Dr. Maling told Ophthalmology<br />
Times. “Quentin Blake felt that was not enough and gave us these<br />
eight absolutely phenomenal pictures.” ▀<br />
ILS steps up for Lensworx<br />
Christchurch-based Independent Lens<br />
Specialists (ILS) has come to the<br />
rescue of Lensworx’s customers and<br />
picked up all Lensworx’s contracts, following<br />
the company’s liquidation in August (see NZ<br />
Optics October issue).<br />
The companies had a long-standing<br />
relationship with both being co-distributors<br />
for Kodak lenses in New Zealand. ILS will now<br />
be the sole distributor and has employed<br />
Lensworx’s former managing director<br />
Albie Hanson to help service the ILS’ Kodak<br />
contracts, especially in the North Island, and<br />
manage other parts of ILS’ business.<br />
“This will allow us to concentrate better on<br />
promoting Kodak products and the Kodak<br />
Lens Vision Centres, as well as the excellent<br />
range of ILS optical products,” said Hanson.<br />
“It will also make a much stronger platform<br />
to provide the marketing and technical<br />
knowledge to practices with dedicated<br />
hands-on support that is needed to develop<br />
the world-leading Kodak Lens model.”<br />
Support for the Kodak Lens Vision Centres<br />
Thanks from a<br />
gentleman<br />
On Sunday September 25th, more than 50,000 dapper<br />
motorbike riders in more than 500 cities across 90<br />
countries donned their cravats, oiled their moustaches,<br />
dusted off their tweeds and rode their classic and vintage-styled<br />
motorcycles to raise funds and awareness for men’s health.<br />
Participants in the Distinguished Gentleman’s Ride (DGR) have<br />
more than doubled since it was launched in Sydney in 2012 to<br />
combat the often-negative stereotype of men on motorcycles,<br />
bring motorcycle communities together and support a worthy<br />
cause.<br />
Christchurch-based Glenn Bolton, director of Independent Lens<br />
Specialists (ILS), was one such Distinguished Gentlemen. He was<br />
ably supported in his cause by many of the country’s eye health<br />
professionals and wished to pass on his thanks.<br />
“A big thanks to all of you who sponsored me in the<br />
Distinguished Gentleman’s Ride. Your support helped New<br />
Zealand become the 6th highest fund raiser, while I managed to<br />
become the 110th highest fundraiser in the world.<br />
“I know many of you have old bikes tucked away in the<br />
garage, so get them ready for the DGR 2017.”<br />
Monies raised from this year’s event will go to support<br />
research into prostate cancer and people working to support<br />
men’s mental health.<br />
For more about the DGR go to www.gentlemansride.com ▀<br />
retail programme, which Lensworx had<br />
begun to roll out earlier this year, will be<br />
based out of Auckland, said Hanson. The<br />
programme offers independent practices<br />
the opportunity to partner with Kodak and<br />
use the brand, which is owned underlicence<br />
by Californian company Signet<br />
Armorlite, either in a small way or through<br />
comprehensive whole-of-practice branding<br />
and marketing support.<br />
“I partnered with ILS many years ago on<br />
Kodak distribution,” said Hanson. “I am<br />
very happy to be involved with the new<br />
arrangement. I think the model we have<br />
now is going to be much stronger and more<br />
proactive”<br />
Safety Eyewear and the Kodak frame<br />
range and retail programme will also be<br />
available through ILS, which is currently<br />
going through the process to become fully<br />
certified for the processing of prescription<br />
safety eyewear through the transfer of<br />
Lensworx certification.<br />
“We are very happy to have Albie on the<br />
team as a full time rep,” said ILS director<br />
Glenn Bolton. “Albie has worked hard over<br />
the years developing the Kodak brand.<br />
Kodak lenses are widely distributed in the<br />
UK and Europe via independent optometry<br />
practices and Albie will be working closely<br />
with the independents here to support<br />
them.<br />
“Independent Lens Specialists will<br />
continue to offer our own Alpha Freeform<br />
product range and AR coating service, which<br />
Albie will also be offering to practices as<br />
part of his new role, allowing us, more<br />
than ever, to provide the best service to<br />
independent optometry.”<br />
Run by Bolton and John Clemence, ILS<br />
is well-known in the industry as the only<br />
laboratory in New Zealand to manufacture<br />
freeform progressives and to offer AR<br />
coating and specialised edging on their MEI<br />
robotic edger.<br />
All Kodak enquiries should now be<br />
directed to ILS, with Albie Hanson as the<br />
first point of contact, said Bolton. ▀<br />
A dapper Glenn Bolton taking part in the <strong>2016</strong> Distinguished Gentleman’s Ride<br />
Video-streaming sunnies<br />
Millennial-friendly messaging service and social media platform Snapchat is<br />
gearing up to launch “Spectacles”. The new smart sunglasses are capable<br />
of recording and streaming ten second video clips or “snaps” that can be<br />
transferred directly to the Snapchat app.<br />
The California-based company announced Spectacles at the start of October and<br />
has renamed itself Snap Inc. to reflect its expansion into consumer hardware.<br />
Describing the US$130 Spectacles product as a “toy” aimed at teenagers, Snap<br />
CEO and co-founder Evan Spiegel, in an interview with the Wall Street Journal,<br />
said watching the footage of a hike he did wearing a prototype pair of<br />
Spectacles was like seeing your own memory. “It was unbelievable. It’s one<br />
thing to see images of an experience you had, but it’s another thing to have<br />
an experience of the experience. It was the closest I’d ever come to feeling<br />
like I was there again.”<br />
However, the announcement was met with distain and hostility by some<br />
commentators. The potential for privacy invasion is of great concern to<br />
the public, it seems, with commentators making reference to the hostile<br />
reaction to Google Glass, also capable of recording video, which saw<br />
some wearers banned from certain shops, bars and restaurants,<br />
putting people off the product. ▀<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 Jai Breitnauer, editor, on 022 424 9322 or editor@nzoptics.co.nz.<br />
For advertising, marketing, the OIG and everything else, please contact Lesley Springall, publisher, on 027 445 3543 or lesley@nzoptics.co.nz.<br />
To submit artwork, or to query a graphic, please email lesley@nzoptics.co.nz.<br />
NZ Optics magazine is the industry publication for New Zealand’s ophthalmic community. It is published monthly, 11 times a year, by New Zealand Optics 2015 Ltd. Copyright is held by<br />
NZ Optics 2015 Ltd. As well as the magazine and the website, NZ Optics publishes the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide that profiles the<br />
products and services of the industry. NZ Optics is an independent publication and has no affiliation with any organisations. The views expressed in this publication are not necessarily<br />
those of NZ Optics (2015) Ltd.<br />
4 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
<strong>Nov</strong>ember <strong>2016</strong> NEW ZEALAND OPTICS<br />
5
Frith & Laird celebrate 50<br />
years<br />
Manurewa-based optometrists Visique<br />
Frith and Laird celebrated its 50th<br />
birthday on Saturday 8 October, with<br />
a well-attended party at its premises on Great<br />
South Road, Auckland.<br />
Frith and Laird was established by optometrists<br />
Mike Frith and Knox and Heather Laird, who<br />
actually took over a branch of George Read and<br />
Sons, a city-wide practice founded in the early<br />
1900’s. Mike Frith and Knox Laird were part of<br />
the first intake of optometry students at the<br />
University of Auckland, under the stewardship<br />
of the late Professor Ted Grosvenor from the<br />
USA. After qualifying, Mike developed what<br />
was to become a life-long passion in low vision,<br />
starting the low vision clinic at Greenlane Clinical<br />
Centre, while Knox went on to become the first<br />
optometrist in New Zealand to gain his PhD.<br />
Heather also has a special interest in low vision.<br />
The three diligently ran the practice, which has<br />
served several generations of Maurewa families<br />
– many of whom were at the party – weathering<br />
the changes in the economy, the developing<br />
suburb and optometry itself. In 2000, Frith and<br />
Laird became a member of the Visique group, and<br />
in 2010 both Mike and Knox decided to retire,<br />
handing the reigns over to Heather Laird and<br />
new additions to the practice, Hadyn Treanor and<br />
Robert Ng.<br />
“A lot has changed in 50 years; the way we<br />
Mike Frith, Heather Laird, Hadyn Treanor and Robert Ng<br />
The 2017<br />
Optical<br />
Information<br />
Guide (OIG)<br />
is being put<br />
together now<br />
The <strong>2016</strong> Frith and Laird team<br />
practice and how we are perceived as an industry.<br />
We are proud of our legacy,” said Hadyn in a<br />
speech at the celebration. “We’ve seen big change<br />
in the last 10 years with optometrist’s becoming<br />
more recognised by the government and the<br />
wider community in healthcare. We’re being<br />
given more responsibility around prescribing and<br />
diagnosing, but we’ve had to fight for the right to<br />
do things young optometrists take for granted.”<br />
Hadyn recognised that optometrists like Mike,<br />
Knox and Heather have walked a revolutionary<br />
path, and that current practitioners need to<br />
change their outlook to make the most of the<br />
rights and responsibilities optometry has been<br />
given.<br />
“The health sector is under a lot of stress. There’s<br />
only so much the hospital can cope with. If we<br />
can share that burden it is in everybody’s best<br />
interests.”<br />
The Visique Frith and Laird’s team would like to<br />
thank all those who have shared the journey with<br />
them, and for those who will support them over<br />
the next 50 years.<br />
Editor’s note: It was really lovely to see so many<br />
local people, many of whom had been attending<br />
the practice since they were children, and were<br />
like family to the optometry team at the practice.<br />
In Heather’s own words, it’s great to be able to<br />
celebrate something so positive. Congratulations<br />
team! ▀<br />
Shamir expansion: New<br />
appointments, new partners<br />
Tony Egerton has been appointed National<br />
Sales Manager (Australia) for Shamir.<br />
A well-known personality in the Aotearoa<br />
optics industry, Egerton was previously a sales<br />
rep for Shamir New Zealand, and will continue to<br />
assist Donald Crichton in that role.<br />
“It’s a brand new role. [Australia] used to<br />
handle most of the sales, but Shamir has grown<br />
substantially, and we’ve just expanded our lab<br />
in Brisbane,” said Paul Stacey, Shamir’s ANZ<br />
chief executive. “It made sense to have someone<br />
dedicated to that role.”<br />
This change also means that Shamir are<br />
able to focus more strategically on their New<br />
Zealand business, said Stacey.<br />
“We haven’t had the<br />
resources until now, but<br />
finally Shamir are able<br />
to cultivate a greater<br />
presence in New Zealand.”<br />
With that in mind,<br />
Stacey was also pleased<br />
to announce that from<br />
the start of October,<br />
Shamir has been<br />
working in partnership<br />
with Independent<br />
Lens Specialists (ILS) in<br />
Christchurch.<br />
“We produce Australianmade<br />
and certified lenses,<br />
and our lab is really<br />
well set up,” explained<br />
Stacey. “ILS also have<br />
a really well set-up lab<br />
and experienced staff. It<br />
made sense that we would work together, and<br />
encourage independent businesses to blossom.”<br />
Until now, only a small range of Shamir<br />
products have been available in New Zealand,<br />
but thanks to this new partnership, Shamir<br />
premium lenses and multi-coatings will now<br />
be available to the New Zealand market, with<br />
fittings on site in Christchurch.<br />
“We’ve worked very hard and even managed<br />
to secure overnight delivery with a courier<br />
company,” said Stacey. “Customers can place an<br />
order via Donald or directly with ILS.”<br />
ILS will continue to run their own lines, and<br />
offer Shamir’s specialist products in tandem. ▀<br />
Demonstrating their new camaraderie, Shamir’s Tony Egerton and Donald Crichton flank ILS directors<br />
Glenn Bolton and John Clemence at Visionz <strong>2016</strong><br />
Ben Sherman now in NZ<br />
Phoenix Eyewear has introduced a new brand<br />
to its portfolio and to New Zealand, Ben<br />
Sherman.<br />
Phoenix had been looking for a brand to replace<br />
Superdry (now distributed through Specsavers)<br />
and had begun brainstorming a number of ideas<br />
before going to Silmo last year, says Phoenix’s<br />
Mark Collman. Top of the list was Ben Sherman<br />
as Collman (already a fan in the clothing<br />
department) says he admired the brand’s style<br />
and spirit.<br />
“Ben Sherman epitomises ‘Cool Britannia’ -<br />
sharp styling, strong heritage, iconic brand. The<br />
Ben Sherman shirt and brand have been adopted<br />
by almost every youth culture or style movement<br />
of the last five decades. What more reason would<br />
you need to give it a go? Most of my friends have<br />
Ben Sherman polos or t-shirts and wear them<br />
with pride.”<br />
An iconic British brand, Ben Sherman was born<br />
in Brighton in 1963. Its colourful, button-down<br />
collared shirts - an invention of founder and<br />
designer Arthur Benjamin Sugarman - quickly<br />
became popular among the smart young men in<br />
the “mod” movement and jazz musicians of the<br />
day. Today this British lifestyle brand sells apparel,<br />
accessories and footwear worldwide and remains<br />
popular with celebrities counting electronic music<br />
group BS High Disclosure’s Res BS Pos.pdf 1 20/11/2015 brother-duo 15:55 Howard and Guy<br />
Lawrence, Gary Barlow, 50 cent, American actor<br />
Jesse Eisenberg and English actor Tom Sturridge<br />
among its supporters.<br />
Spurred on by what he knew about the brand, at<br />
Silmo 2015, Collman met with brand owner Fabris<br />
Lane, an Anglo-Italian eyewear company and<br />
affiliate of FGX International, a division of Essilor,<br />
whose other brands include Oliver Goldsmith,<br />
Hook LDN and Accessorize. He says he was so<br />
impressed with the brand’s latest collection and<br />
future direction he pretty much signed it up on<br />
the spot. However, given the brand’s parentage,<br />
there was some considerable tooing and froing<br />
before Phoenix could secure exclusive rights to<br />
Ben Sherman in New Zealand and introduce the<br />
brand at Visionz a couple of weeks ago.<br />
The brand is a particularly good fit with the New<br />
Zealand market says Collman: “British brands<br />
seem to translate very well into the NZ market,<br />
as does Brit culture. We share many of the same<br />
influences in apparel, pop music, TV shows and<br />
movies. I personally feel Brit brands work better<br />
than most other style influences. The eye shapes,<br />
colours and brand recognition all seem to click<br />
with our local consumers, especially the men.”<br />
Now available in New Zealand, the Ben Sherman<br />
range from Phoenix Eyewear comes in 10 optical<br />
styles (in three colours each) and eight sunglasses<br />
(also in three colours). ▀<br />
Make sure you’re listed in New Zealand’s<br />
only comprehensive guide to all things<br />
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susanne@nzoptics.co.nz and secure your<br />
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6 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
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<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
7
Focus on<br />
Eye Research<br />
What’s ‘the next big thing’ in<br />
eye research?<br />
PALEJWALA N, JIA Y, GAO SS, ET AL. (2015).<br />
DETECTION OF NONEXUDATIVE CHOROIDAL<br />
NEOVASCULARIZATION IN AGE-RELATED<br />
MACULAR DEGENERATION WITH OPTICAL<br />
COHERENCE TOMOGRAPHY ANGIOGRAPHY,<br />
RETINA, 35, 2204-2211.<br />
One instrument that I was most excited to get at<br />
the start of the year was a Zeiss OCT angiography<br />
(OCTA) machine; I know that there is also at least<br />
one other similar machine by a different company<br />
around and I suspect there are quite a few more<br />
who have got them or are looking at getting them<br />
of whom I am blissfully unaware. I suspect also<br />
that many optometrists who have purchased or<br />
are in the process of purchasing OCT machines will<br />
be thinking very carefully about whether they get<br />
this feature. Hence I think it is timely to talk about<br />
what it may or may not show. What OCTA does<br />
do, of course, is show up the retinal and choroidal<br />
vasculature in immense detail, without the need for<br />
a potentially toxic dye as we use to use in standard<br />
fluorescein angiography (FFA), and it takes less<br />
than a minute to do so. However, it does not show<br />
leakage and, being so new, we are still finding our<br />
way with its potential applications.<br />
This article was from a supplement in the journal<br />
Retina entirely devoted to this new imaging<br />
modality, which goes to show the excitement around<br />
it. I thought it was intriguing mainly because it<br />
demonstrated that OCT angiography can pick up<br />
choroidal neovascularisation (CNV) in eyes with AMD<br />
before leakage starts (ie. when it is nonexudative);<br />
presumably this will mean earlier and better<br />
treatment with fewer overall injections. They had 32<br />
eyes at high risk of CNV, because of the presence of<br />
active CNV in the other eye. Two were found to have<br />
nonexudative CNV not visible with FFA in their other<br />
eye. This is, of course, quite a low pick up rate, but<br />
not for the patients concerned, who will be having<br />
regular OCT examinations anyway since their other<br />
eye is being treated. Interestingly, one of these CNVs<br />
only slowly grew, so whether it really represents<br />
sinister pathology is unknown. However, although<br />
these nonexudative membranes are not visible on<br />
standard FA they do have a histological correlate.<br />
SZURMAN P, BODEN K, JANUSCHOWSKI K. (<strong>2016</strong>).<br />
SUPRACHOROIDAL HYDROGEL BUCKLING AS A<br />
SURGICAL TREATMENT OF RETINAL DETACHMENT:<br />
BIOCOMPATIBILITY AND FIRST EXPERIENCES,<br />
RETINA, 36, 1786-1790.<br />
Just when you thought scleral buckling was dead<br />
and buried (except for dialyses), along comes a new<br />
buckling technique. This article particularly sparked<br />
my interest because I had recently been made aware<br />
of a study involving a new hydrogel intraocular<br />
tamponade, a study which I declined getting<br />
involved in because it is a Phase I trial (ie. safety and<br />
efficacy, which means this is the first human trial)<br />
– I think I might wait a bit before experimenting<br />
on my patients! This material provides a temporary<br />
buckle that goes away, so the side effects of<br />
long-term refractive change and late exposure<br />
with inflammation and an irritated patient can be<br />
avoided, and which I’m sure most readers have seen<br />
in the past. The advantages would include avoiding<br />
a vitrectomy (for those patients who do avoid it),<br />
BY DR PETER HADDEN*<br />
with its risks, which of course is cataract, and better<br />
closure of the break, particularly an inferior one<br />
which can be hard to tamponade with gas in a<br />
vitrectomy.<br />
There were 21 patients included in this first human<br />
study using this buckling material, although<br />
admittedly 15 of these patients had a simultaneous<br />
vitrectomy, which perhaps helped in the repair<br />
of their detachment. Of those patients, 20 were<br />
successfully reattached after their surgery;<br />
interestingly, however, the one patient who didn’t<br />
go flat did not have a simultaneous vitrectomy, so<br />
perhaps we shall have to wait before we decide if<br />
this technique is really valuable or not.<br />
CHATTOPADHYAY C, KIM DW, GOMBOS DS, ET AL.<br />
(<strong>2016</strong>). UVEAL MELANOMA: FROM DIAGNOSIS<br />
TO TREATMENT AND THE SCIENCE IN BETWEEN,<br />
CANCER, 122, 2299-312.<br />
A great review article on one of my favourite topics!<br />
This is an excellent overview update on uveal<br />
melanoma. It is not original science but rather a<br />
review; nevertheless, it is an excellent review and<br />
one I would highly recommend to any registrars<br />
who wished to read in one place all they needed to<br />
know about uveal melanoma. Unfortunately, being<br />
not in the ophthalmic literature it is not one that<br />
many in this profession would have seen, hence I<br />
felt the need to include it in this journal review.<br />
One of the things it reviews are the recent studies<br />
looking at treatment of the metastases of uveal<br />
melanoma. Historically, we have basically been unable<br />
to do anything useful except slightly prolong disease<br />
free survival (DFS) and delay death. Now that we are<br />
able to look at the different mutations expressed and<br />
pathways activated by uveal melanoma there is hope<br />
that if we can target several of them at the same<br />
time we might be able to cure this disease by medical<br />
therapy. This article summarises all the recently<br />
completed trials looking at doing this. Unfortunately,<br />
the bad news is that none have to date provided a<br />
cure! Nevertheless, hope springs eternal ... but so<br />
far the only therapy with good long-term survival is<br />
surgical excision of liver metastases, which is possible<br />
only in under 10% of patients.<br />
It also gives an excellent overview of the clinical<br />
presentation of uveal melanoma and the<br />
therapeutic options. Unfortunately, transpupillary<br />
thermotherapy, which a decade ago seemed to<br />
hold so much promise, remains associated with an<br />
unacceptably high recurrence rate (as high as 20%)<br />
and no other new local therapies have emerged<br />
in the last 15 years that really are any better than<br />
what I learned when I was a fellow. ▀<br />
ABOUT THE AUTHOR:<br />
Dr Peter Hadden practises at<br />
Eye Institute Remuera and New<br />
Lynn, Retina Specialists and<br />
Greenlane Clinical Centre in<br />
Auckland, subspecialising in<br />
vitreoretinal surgery and adult<br />
chorioretinal tumours, as well<br />
as performing cataract surgery.<br />
Outside ophthalmology, he<br />
enjoys the company of his five<br />
children and doting wife!<br />
US grant awarded to New<br />
Zealand researchers<br />
Professor Paul Donaldson and Dr Ehsan<br />
Vaghefi, based at the University of Auckland,<br />
received a National Eye Institute (NEI) major<br />
research grant in August.<br />
Professor Donaldson (physiology) and Dr Vaghefi<br />
(optometry) were awarded funding of US$432,000<br />
from the NEI in the United States in collaboration<br />
with Professor Thomas White from the State<br />
University of New York, for five years. Their<br />
collaboration aims to examine the effects of aging<br />
on the lens transport systems that determine<br />
ion and water homeostasis, water content and<br />
therefore the optical properties of the normal<br />
and cataract lens. It is hoped the results of their<br />
work can be used to identify pharmacological<br />
interventions with a view to restoring the agerelated<br />
degeneration of water transport activity<br />
and optical properties observed in the human lens.<br />
Professor White’s group in the US will focus<br />
on the use of animal models to identify<br />
pharmacological interventions, while the Auckland<br />
group will look at the ability of these interventions<br />
to alter lens optics with non-invasive magnetic<br />
resonance imaging (MRI) and optical modelling<br />
approaches.<br />
In a statement, the University of Auckland<br />
acknowledged the high ranking (3rd percentile) of<br />
this project by the assessing committee, in a highly<br />
competitive international funding environment, is<br />
testament to the strength and innovation of the<br />
collaboration, which was facilitated by Professor<br />
White’s recent sabbatical at the University of<br />
Auckland. The project also provides funding for<br />
two PhD stipends, one in clinical optometry and<br />
the other in bioengineering/medical imaging<br />
Peptide study published<br />
In other news from the Faculty of Medical<br />
Sciences, Dr Cindy Guo and colleagues have<br />
published a peptide intervention study using a<br />
model that produces signs of age-related macular<br />
degeneration. The paper Connexin43 Mimetic<br />
Peptide Improves Retinal Function and Reduces<br />
Inflammation in a Light-Damaged Albino Rat<br />
Model appears in the online, peer reviewed journal<br />
Investigative Ophthalmology and Visual Science.<br />
This technology is licensed to CoDa Therapeutics<br />
in the USA. The peptide is now entering preclinical<br />
development. ▀<br />
New certificate in glaucoma<br />
In October, the<br />
Australian College<br />
of Optometry (ACO)<br />
announced the launch<br />
of their new Advanced<br />
Certificate in Glaucoma,<br />
(ACG ACO). This six-month<br />
post graduate level course<br />
provides optometrists<br />
across Australia and<br />
New Zealand with the<br />
opportunity to undertake<br />
comprehensive higher<br />
level study in this specific<br />
area, the college said in a<br />
statement.<br />
“The certificate has been<br />
under development for<br />
approximately 12 months.<br />
An advisory committee<br />
of ophthalmologists,<br />
optometrists and ACO<br />
staff have worked hard over this time to<br />
facilitate a comprehensive syllabus,” said<br />
Jolanda de Jong, general manager professional<br />
development & membership for the ACO. “We<br />
then engaged respected, knowledgeable and<br />
experienced lecturers to deliver the content.”<br />
De Jong said this new online, comprehensive<br />
course is designed to act as a refresher for<br />
therapeutically-qualified optometrists, who<br />
have completed previous study into glaucoma,<br />
as well as all<br />
other registered<br />
optometrists<br />
with an interest<br />
in glaucoma.<br />
As far as the<br />
ACO are aware,<br />
there are no<br />
other similar<br />
courses offered<br />
in Australasia.<br />
“The ACO<br />
believes that<br />
the provision<br />
Jolanda de Jong<br />
Roman Serebrianik is on the advisory committee for the certificate and he is the Head of<br />
Primary and Specialist Eye Care Services at the Australian College of Optometry (ACO)<br />
of a comprehensive glaucoma course would<br />
benefit the level of understanding across the<br />
profession in glaucoma, improve servicing of<br />
the general community and has the potential<br />
to improve and increase co-management<br />
with ophthalmologists,” said De Jong. “Other<br />
comparable courses don’t offer the clinical<br />
component or the level of depth of the ACO<br />
Advanced Certificate in Glaucoma. We have<br />
built a comprehensive postgraduate level<br />
course with a practical clinical focus. One major<br />
point of difference is that it is an academically<br />
rigorous course, however there is flexibility for<br />
students in the online delivery model.”<br />
The six-month syllabus covers four didactic<br />
modules at a postgraduate level. Students<br />
will access 68 CPD (therapeutic) points for re–<br />
registration purposes in Australia and CE points<br />
are currently under application in New Zealand.<br />
“Given that one in eight Australians over 80<br />
will develop glaucoma there is definitely a need<br />
for a high level understanding of glaucoma to<br />
improve outcomes for the ageing population,”<br />
said de Jong. ▀<br />
Young Optometrists New Zealand<br />
The Young Optometrists networking<br />
group in Australia has been active for<br />
around six years, but in New Zealand<br />
no one has stepped up to the cause – until<br />
now. Rotorua-based Natasha Smyrke and<br />
Cambridge-based Devashini devanandan,<br />
(along with Ashley Gray, who has since moved<br />
to the UK), launched their own group for<br />
young optometrists’ earlier this year.<br />
“We actually came up with the idea<br />
before we even knew what was happening<br />
in Australia,” said Smyrke, who is keen<br />
to see their reach expand due to the<br />
incredible amount of interest they’ve<br />
had so far. “When we heard about Young<br />
Optoms Australia we phoned the Sydney<br />
branch, and they met us for coffee during<br />
a visit to Auckland. We’re now affiliated<br />
with them.”<br />
While the group are getting guidance<br />
and support around their start-up from<br />
their more experienced colleagues over the<br />
ditch, they’re keen to express this group is<br />
definitely doing its own thing.<br />
“We want this to be an open, inclusive<br />
group for all New Zealand-based<br />
optometrists who have graduated in the<br />
last 10 years,” said Smyrke. “Early meetings<br />
in Auckland and Hamilton have had good<br />
interest, and issues people have raised are<br />
things like having a safe space to share case<br />
histories and a strong voice in the NZAO.”<br />
Smyrke says this endeavour isn’t just<br />
about supporting optometry graduates<br />
as they embark on their career, but about<br />
preserving the hard-won status of the<br />
profession as a whole.<br />
“I think there can be a lot of apathy<br />
among young graduates, who take<br />
things like TPA for granted. But the older<br />
generation fought hard for that. By creating<br />
a network we can increase support and<br />
understanding around our profession and<br />
carve our own path.”<br />
If you are interested in joining Young<br />
Optometrists New Zealand, you can do so<br />
via their Facebook page – www.facebook.<br />
com/groups/YoungOptomsNZ ▀<br />
The Auckland crowd: front Left to right Natasha Smyrke, Ashley Gray. Back Left to right Veeran Morar,<br />
Devashni Devanandan, Robyn Sterling, Sarah Denny, Zane Stellingwerf, Grace Elliot and Ayah Hadi<br />
8 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
The final Grand Round of <strong>2016</strong><br />
Wednesday 21 September saw the last in<br />
the Eye Doctor’s series of Grand Rounds<br />
for <strong>2016</strong>, held at <strong>Nov</strong>otel Ellerslie. There<br />
was a great turnout of 41 people, a reminder of<br />
the enduring popularity of these Bausch + Lombsponsored<br />
educational talks. Eye Doctor’s are also<br />
celebrating their 10-year anniversary and thanked<br />
the audience for being part of their success story.<br />
From baby rashes to strabismus surgery<br />
Dr Shuan Dai opened the evening with an interesting<br />
case of a six-week old baby presenting with skin<br />
rashes and watering eyes since she was two<br />
weeks old. There was no family history of any eye<br />
conditions. The child was irritable and crying with<br />
a swollen right eye, poor red reflex, and an IOP<br />
of 34mmHg. There was hyphema with no other<br />
causes and this led to the diagnosis of Juvenile<br />
Xanthogranuloma – the most common condition<br />
causing spontaneous hyphema in children.<br />
The condition is characterised by benign cutaneous<br />
histiocyte granulomatous inflammation with 10%<br />
involvement of eye and adnexa. It usually presents in<br />
the first 12 months, and the rash looks like yellowish<br />
slightly raised skin lesions that take a few months to<br />
disappear once treatment begins. It’s a self-limiting<br />
disease though raised intraocular pressure can cause<br />
permanent visual damage unless treated. After two<br />
months using a topical steroid and eye pressure<br />
lowering drops, the IOP came down to 17mmHg.<br />
Signs of amblyopia will need ongoing treatment.<br />
Dr Dai also showed some slides from his ‘working<br />
holiday’ to China, and talked about the new<br />
strabismus surgery techniques he was invited<br />
to present at the ophthalmology conference he<br />
attended in China. He showed excellent surgical<br />
outcome with transposition of superior rectus muscle<br />
to lateral rectus for correcting esotropia in patients<br />
with chronic 6th nerve palsy. The most amazing part<br />
is the restoration of nearly full-range movement<br />
to the eye, he said. Dr Dai showed some video of<br />
pre and post-op patients who had a full range of<br />
movement just a few weeks after surgery.<br />
Scleral thining<br />
Dr Penny McAllum opened with the topic of the<br />
blue/grey tinge to a patient’s eye caused by scleral<br />
thinning. This can be congenital or acquired. If<br />
congenital, it could be Ehlers Danlos Syndrome,<br />
an inherited collagen disorder – ask your patient<br />
to bend back their fingers to see if they have<br />
hyper extendable joints, she said. If their joints are<br />
normal, it could be osteogenesis imperfecta (brittle<br />
bone disease), another collagen defect – check<br />
your patient’s teeth, as people with this condition<br />
often have teeth abnormalities. Another condition<br />
causing the problem could be Marfan syndrome,<br />
a fibrillin disorder resulting in the patient being<br />
unusually tall, with long limbs, fingers and neck,<br />
some heart defects. Lens subluxation is present in<br />
75% due to weak zonules.<br />
Acquired scleral thinning could be the result<br />
of necrotising scleritis/scleromalacia due to<br />
rheumatoid arthritis. The main treatment is oral<br />
Prednisone or other oral immunosuppressant<br />
agents for active disease. Another uncommon<br />
acquired cause is radiation from pterygium<br />
surgery, which can cause scleral melting many<br />
years later. Fortunately, it’s no longer used in New<br />
Zealand. It can also be caused by eye whitening<br />
surgery using mitomycin C, particularly popular<br />
in Korea. Other causes of thin sclera include large<br />
eyes, such as in high myopes or buphthalmos<br />
from congenital glaucoma. A blue or grey scleral<br />
appearance can also result from staining with<br />
some drugs, like tetracyclines, after many years<br />
of regular use. Look for grey, brown or even green<br />
staining of their teeth, skin and nails as well.<br />
Dr McAllum then talked about the interesting<br />
case of a three-year-old Indian boy with yellow<br />
eyes, a sore throat, cough and a fever. He was<br />
diagnosed with jaundice and strep throat – but<br />
what was causing the jaundice? It’s not usual with<br />
strep throat.<br />
She explained that Jaundice is caused by high<br />
levels of bilirubin in the blood stream, a yellow<br />
breakdown product from haemoglobin. There are<br />
three types of jaundice – haemolytic<br />
(increased red blood cell breakdown),<br />
hepatocellular (when the liver is not<br />
functioning properly), and obstructive<br />
(when there is a blockage in the bile<br />
ducts, between liver and intestines),<br />
which is the most common but usually<br />
in adults. Dr McAllum’s patient had<br />
a condition called G6PD deficiency, a<br />
common genetic condition in African,<br />
South Asian and Middle Eastern people,<br />
triggered by some sort of stress on the<br />
body. The patient was in haemolytic<br />
crisis due to his G6PD deficiency,<br />
triggered by the strep throat. It can also<br />
be triggered by aspirin, antimalarial<br />
drugs, some antibiotics and fava<br />
(broad) beans. Once the cause of the<br />
crisis has been removed, the condition<br />
settles on its own.<br />
Dr McAllum said this example served<br />
as a reminder that sometimes you see<br />
things in the eyes that reflect what is<br />
happening elsewhere in the body.<br />
Retinal vasculitis<br />
Retinal vasculitis was the topic<br />
presented by Dr Mark Donaldson.<br />
Clinical signs include perivascular<br />
whitening, haemorrhage in the retina,<br />
a few cells in vitreous, and leakage. Systemic signs<br />
include diabetes, IBS, and smoking.<br />
Dr Donaldson talked us through the case of a fit<br />
asymptomatic 60-year-old woman referred with<br />
retinal haemorrhages. Ultra-wide fluorescein<br />
angiography demonstrated ischemic retina, a<br />
complication that could lead to neovascularisation<br />
and blindness. All possible systemic causes of<br />
vasculitis eliminated the diagnosis defaults<br />
to Eale’s disease with photocoagulation<br />
being recommended. The case succinctly<br />
demonstrated the diagnostic pathways followed in<br />
understanding patients with vasculitis.<br />
Cirrus OCT angiography<br />
Dr Andrew Riley reviewed the Cirrus OCT<br />
angiography, which Eye Doctors purchased after<br />
assessing its potential.<br />
Dr Riley talked about the machines capabilities.<br />
With advancements of live-tracking and faster<br />
Dr Andrew Riley, Stephen Hill, Hue Bullen and Gary Filer<br />
Dr Mark Donaldson, Cindy Tse, Lily Chang, Elkie Wong, and Dr Shuan Dai<br />
acquisition time we can now see the doppler<br />
effect of movement, he said. We actually see the<br />
erythrocyte movement so can map the vessels.<br />
However, he said it does not directly show<br />
leakage. Dr Riley said he is excited about what<br />
this technology provides. Abnormal vessels in<br />
diabetic macular oedema and vein occlusion were<br />
presented and definitions of macular ischaemia<br />
explored. Choroidal neovascularisation from<br />
myopic, trauma and age-related changes can<br />
be identified and mature nets highlighted. The<br />
cases highlighted how OCT angiography has a<br />
bright future not just in diagnosis but also in<br />
improved treatment decisions. This is likely to<br />
reduce considerably the need for fluorescein<br />
angiography, said Dr Riley, adding he envisaged<br />
wider scanning areas with time. Other conditions<br />
are being explored with this technology and optic<br />
nerve vasculature and choroidal circulation are two<br />
where we are just learning, he said. ▀<br />
Bradley Pillay, Dr Penny McCallum and Sonia Swan<br />
Chris Earnshaw and Stuart Campbell<br />
VSP wearables study<br />
Introduced<br />
<strong>Nov</strong>ember 2014<br />
“OptiMed NZ have now sold over 50 Takagi<br />
700GL Slit Lamps”<br />
Slitlamp Microscope<br />
700GL<br />
See your patients’ eyes<br />
in a new light.<br />
VSP Global announced it is<br />
launching a major academic study<br />
and consumer pilot test with the<br />
latest version of the company’s techembedded<br />
eyewear, called Level. The<br />
study is in partnership with University of<br />
Southern California (USC) Center for Body<br />
Computing (CBC),<br />
VSP Global’s innovation lab, The Shop,<br />
debuted an early version of the prototype<br />
in 2015 as Project Genesis— touted as<br />
the first wearable to seamlessly integrate<br />
health-tracking technology into the<br />
temple of an optical frame. A partnership<br />
with USC CBC followed soon after.<br />
“Our partnership with VSP Global will<br />
accelerate research and discovery as to how to<br />
create digital health products and experiences<br />
that will elevate, enhance and expand the lives<br />
of users,” said USC CBC founder and executive<br />
director Dr Leslie Saxon. “This study is the first<br />
of its kind and will provide a crucial roadmap<br />
for validating future products and platforms<br />
and for understanding overall consumer health<br />
engagement.”<br />
The pilot study, launched in September<br />
with USC employees, is being managed by<br />
USC CBC in partnership with USC Roski Eye<br />
Institute. Participants receive a Level frame<br />
and accompanying smartphone app that<br />
allows them to track their activity. The app<br />
also syncs with the VSP Global’s Eyes of Hope<br />
initiative, allowing participants to accrue points<br />
for reaching daily step goals. Once a certain<br />
number of points are achieved, that user<br />
will automatically trigger the donation of a<br />
comprehensive eye exam and a pair of glasses to<br />
someone in need.<br />
VSP’s tech-embedded eyewear Level<br />
“As a community-based not-for-profit, we’re<br />
curious not only about the technology and how<br />
it can benefit the individual utilising it, but<br />
also about the motivations that drive certain<br />
behavior,” said Jay Sales, co-lead of The Shop.<br />
“Connecting Level to our Eyes of Hope initiative<br />
was a perfect way to explore how technology<br />
within a platform as common as eyewear could<br />
increase health and wellness as well as empathy<br />
and opportunity for someone in need.”<br />
Though still in prototype mode, the technology<br />
embedded within the Level frames—including a<br />
gyroscope, accelerometer and magnetometer—<br />
will track a wearer’s steps, calories burned,<br />
and activity time. Users will be able to locate<br />
misplaced frames through the app’s “Find My<br />
Glasses” feature.<br />
It is hoped the study will provide useful feedback<br />
on how individuals interact with the device, which<br />
will inform future strategies for the prototype.<br />
Select eye care providers within the VSP network<br />
will also have an opportunity to test and provide<br />
feedback about the Level experience. ▀<br />
Optional Extras<br />
• Camera Adapter With Yellow Filter<br />
• Adjustable Inclined Eye Piece<br />
• Inclined Eye Piece Adapter<br />
• Yellow Filter<br />
For further information or to order a Takagi Slit Lamp today<br />
Ph: 0800 657 720 info@optimed.co.nz<br />
Craig 0275 657 200 or Robert 0275 657 720<br />
t 012 3456 7890<br />
f 012 3456 7890 e user@yoursite.com<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
9
Exciting programme for RANZCO’s 48th Congress<br />
Your toothbrush should be the only thing<br />
left to pack for RANZCO’s landmark annual<br />
calendar event, kicking off in just a couple<br />
of weeks in Melbourne. Here’s NZ Optics need to<br />
know guide.<br />
Location<br />
The majority of the Congress will be held at the<br />
Melbourne Convention Centre on South Wharf.<br />
However, the graduation and awards ceremony<br />
and president’s reception on the Sunday will<br />
be held at Myer Mural Hall on Bourke Street.<br />
This chic, Parisian style ballroom was originally<br />
designed by Sydney Myer to host lavish parties<br />
and private fashion shows, and is named after<br />
the eight unique murals that adorn the walls.<br />
The Congress Dinner will be held on Tuesday<br />
evening in the Olympic room at the Melbourne<br />
Cricket ground, offering unique views of Yarra<br />
Park. Guided tours of the stadium will also be<br />
available.<br />
Programme<br />
The Congress promises a selection of lectures,<br />
rapid-fire presentations and poster sessions with<br />
a line-up of international speakers that include<br />
Professor Gerard Sutton from Vision Eye Institute<br />
Australia, Professor Maarten Mourits from the<br />
Melbourne: Host to RANZO’s <strong>2016</strong> Congress<br />
Department of Ophthalmology at the Academic<br />
Medical Centre, Netherlands, Professor Keith<br />
Martin from the University of Cambridge and<br />
Dr Fiona Costello from the University of Canada,<br />
among others. There will be a Practice Managers<br />
conference, GP and optometry workshops and<br />
professional development sessions. Special<br />
guests include Dr Helen Szoke, CEO of Oxfam<br />
Australia, who will be speaking at the RANZCO<br />
Graduation Ceremony. There will also be a<br />
number of non-scientific sessions running<br />
alongside the Scientific Congress. These sessions<br />
include Ethics, Training and Professionalism and<br />
Cultural Awareness in Practice.<br />
Getting social<br />
Don’t miss the welcome event in the exhibition<br />
hall, with hawker-style food bars and wine<br />
on offer. Outside of the awards ceremony and<br />
the main dinner, there will also be a Practice<br />
Managers’ dinner, a Young Fellows dinner, a<br />
Senior and Retired Fellows dinner and a Registrar<br />
Networking Event. If you find yourself with a<br />
little free-time and fancy exploring Melbourne<br />
you can download a series of self-guided walks<br />
from www.thatsmelbourne.com.au. They will<br />
guide you through Melbourne’s cobbled laneway<br />
districts and Victorian arcades, full of history and<br />
– in many cases – captivating street art, not to<br />
mention the enticing alfresco eateries.<br />
See you there! ▀<br />
Dr Fiona Costello<br />
Prof Gerard Sutton<br />
Aye, eye sailor<br />
Celebrating<br />
milestones<br />
IN AUSTRALIA AND NEW ZEALAND<br />
10,000<br />
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Optometrist Ian Perry, a partner at Specsavers Wanganui,<br />
moved to the Manawatu six years ago and loves the water.<br />
“I’ve been sailing since the age of 11,” says Perry. “The boat I<br />
most loved was the International Canoe which is a high performance<br />
single-handed boat that I sailed in my 20’s and is quite different! I’ve<br />
been crewing a 470 for the last few years.”<br />
Perry is a member of Sailing Wanganui which runs sail training for<br />
all ages, and is chairman of the Sailability Whanganui Trust, which<br />
offers sailing as a sport to the disabled community.<br />
“At an annual prize giving for Sailability Whanganui there was a<br />
presentation from two club members who had just returned from<br />
the 2013 Blind Sailing World Championships in Tokyo. Kiwi sailors,<br />
Phil Paterson, who is sighted, and Russell Lowry who is totally blind<br />
through retinitis pigmentosa.”<br />
Paterson suggested Perry might join them as a tactician for the next<br />
championship, so he was inspired to volunteer.<br />
“I began working with Phil, Russell, and Jonathan Godfrey,” says<br />
Perry. Godfrey, from Palmerston North, is totally blind from retinitis<br />
pigmentosa. “Although new to sailing, he was fit from martial arts<br />
and matched Russell’s strong competitive drive. Incredibly, we were<br />
offered a place at the Blind Sailing World Championships in Chicago.”<br />
With just a couple of months to train, the odds were against them –<br />
many of the other teams were very experienced and had been sailing<br />
together for years.<br />
“It was a big ask to put this team into such a high-level international<br />
competition,” says Perry, but it was an opportunity they weren’t<br />
prepared to turn down. “The biggest barrier was that we were training<br />
in winter with strong winds and the river in flood. We didn’t get to sail<br />
against another boat until the practice day of the regatta!”<br />
Perry’s biggest personal challenge was to verbalise all instructions<br />
and not touch any of the controls. “My role was to be the team’s eyes,”<br />
says Perry. “If I so much as touched the mainsheet or tiller we’d be<br />
penalised – that’s a big ask for an active and reflexive sailor.”<br />
When they arrived in Chicago they had two practice days and a<br />
deteriorating weather forecast, but the rough weather at least gave<br />
Perry’s team a fighting chance.<br />
“We had five races on the first day and were disappointed with our<br />
performance, but as the weather got worse the better we did!” he<br />
laughs. “The other teams were used to training in smooth conditions,<br />
while we’d had the brunt of Wanganui’s winter weather. In the last<br />
and roughest race we placed first!”<br />
Russell Lowry’s B1, (completely blind) team with Ian as tactician<br />
had to content themselves with that one win on the first day, but the<br />
B2 partially-sighted team of Dave Allerton and Dave Parker brought<br />
home a gold medal.<br />
“It was an amazing experience, although I found it mentally<br />
exhausting!” says Perry, who says the team have not decided if they<br />
will enter in 2017. “I sail to switch off, but as a tactician you have<br />
to be hyper-alert and giving constant verbal commands. It was<br />
an honour to spend time with the New Zealand and international<br />
teams though, and especially to work with Russell who has so<br />
much spirit.” ▀<br />
10 AMO20403_Tecnis_Symfony_CelebratingMilestones_FPAdv.indd NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>1<br />
7/10/16 10:15 am
SPECIAL FEATURE: SUMMER SPECIAL AND SUNGLASSES<br />
Summer sun: don’t forget your eyes<br />
EDITORIAL BY JAI BREITNAUER<br />
The highly successful Slip, Slop, Slap campaign,<br />
first launched in Australia in the 1980’s,<br />
didn’t include a reference to sunglasses<br />
for many years. In a part of the world where the<br />
percentage of damaging UV rays is generally<br />
known to be high, it seems crazy that eyes would<br />
be left out for so long.<br />
In New Zealand, the campaign has been known<br />
as Slip, Slop, Slap and Wrap (with the wrap referring<br />
to sunglasses), for many years, and is currently<br />
reaching out to the fourth generation of young<br />
sun seekers in the hope of reducing the number<br />
of preventable diseases – including melanoma –<br />
caused by unprotected exposure to the sun.<br />
It’s a delicate balance though isn’t it? As an<br />
exceptionally fair-skinned child growing up in<br />
the UK, my mum was so paranoid about the risks<br />
associated with the sun we rarely spent much<br />
time outdoors in the height of summer and didn’t<br />
holiday abroad until I was in my teens. The upshot<br />
of this is actually the reverse of what she hoped to<br />
achieve – in my twenties and early thirties, I was<br />
quite slap-dash with sun cream and barely wore<br />
sunglasses or protective lenses. It was only after<br />
developing a blister on my conjunctiva in 2013<br />
that I began looking into eye health and the sun,<br />
and realised just how thin is the wire we walk.<br />
Cataracts, cancer, dry eye, AMD … the list of<br />
eye-conditions that could possibly be affected<br />
by exposure to the sun goes on. And yet, reports<br />
have shown sun exposure can also help reduce<br />
myopia, counteract the negative effects of too much<br />
gaming, reduce the risk of diabetes (let’s face it, if<br />
you’re outside you’re probably active) and, according<br />
to one 2015 study, potentially counteract the<br />
symptoms of dry eye by increasing vitamin D*.<br />
Giving our clients good quality advice about<br />
caring for their eyes in the summer months has<br />
never been more vital, and this special feature is<br />
designed to help you do just that. I’d like to thank<br />
everybody who has contributed to this timely<br />
feature, in particular Drs Peter Hadden and David<br />
Worsely and Eleisha Dudson, for their articles. You’ll<br />
also find some style tips from the fabulous Jo Eaton,<br />
a product round up, and some industry news all<br />
related to summer eye wear and care.<br />
I hope you enjoy reading and, as always, please<br />
send us your feedback via editor@nzoptics.co.nz<br />
*Yildrim P, et al. Dry eye in vitamin D deficiency: more than an<br />
incidental association. Published in the International Journal of<br />
Rheumatic Diseases<br />
Selling sunnies: what your customers need to know<br />
Research conducted by The Vision Council in the US revealed<br />
that 48% of people regularly wear one or more pairs of<br />
non-prescription sunglasses, while 64% of people wear<br />
prescription glasses, suggesting a huge opportunity to upsell<br />
prescription sunnies.<br />
NZ Optics has tapped the minds of many specialists in the<br />
industry to provide the following five important facts if you have a<br />
patient (or ‘client’ as many of you now say you prefer to call them)<br />
interested in tinted or photochromic lenses:<br />
1. UV rating of normal lenses and CLs<br />
Your client will probably be interested to know their prescription<br />
lenses have some UV protection already.<br />
“The actual lens material blocks most of the UV from being<br />
transmitted ‘through’ the lens,” says Emma Gee, training<br />
manager for OPSM. “Different materials will block differing<br />
amounts, for example, polycarbonate blocks 99% without<br />
additional coatings.”<br />
However, while reassuring for your client, this doesn’t mean<br />
they can forget about sunglasses altogether.<br />
“Quality sunglasses provide 100% protection from UVA and<br />
UVB,” says Gee. “They provide visual comfort with tinting and<br />
optional polarisation. Certain sunglass tints can also help with<br />
increasing contrast in conditions such as cycling, golf and skiing.<br />
Sunglass frames are also much better suited in terms of their<br />
size and wrap to provide correct coverage for UV protection than<br />
an optical frame.”<br />
Your patients might also be interested to know about back-UV<br />
coatings that can be added to the back surface of the lenses to<br />
stop light coming around the edges and reflecting off the back of<br />
the lenses into the eye.<br />
Contact lenses also have built in UV protection but, says<br />
contact lens specialist Alex Petty, they are no substitute for<br />
wearing sunglasses. “The majority of contact lenses have UV<br />
protection, however, they will only cover the 14mm or so of the<br />
lens diameter. The conjunctiva, lids and lid tissue all needs UV<br />
protection to decrease the chance of skin cancer and UV related<br />
tissue degeneration.<br />
“Contact lens wearers will also still suffer from glare so<br />
sunglasses are an important part of improving the visual<br />
experience when outside,” he says.<br />
2. Sunnies have standards<br />
Your clients need to understand the quality of sunglasses they<br />
buy from you, compared with the quality they buy from a nonoptical<br />
business, varies dramatically. Even if your client isn’t<br />
interested in purchasing prescription sunglasses, there is important<br />
information you should pass on to them to protect their eye health.<br />
A practice needs to make sure its clients know their sunglasses<br />
meet NZ standards (AS/NZS 1067:2003) with UV 400 protection,<br />
says Mark Gaunt from Zeiss, and that the eyes are covered enough<br />
to protect them from incidental light entering the eye - a good hat<br />
helps here.<br />
“If they make the wrong choice, they may be doing more harm<br />
than good,” he says. “If they purchase a pair without UV400nm<br />
protection their pupils may enlarge and cause harm from the extra<br />
UV being transmitted into their retina.”<br />
Many sunglasses are labelled as having UV protection, but that<br />
doesn’t mean they have the right protection for New Zealand<br />
or for anywhere for that matter. Your client needs to know the<br />
CONTINUED ON P12<br />
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<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
11
SPECIAL FEATURE: SUMMER SPECIAL AND SUNGLASSES<br />
NZ standard is voluntary; in fact, there is no standard<br />
sunglasses have to meet, and the price of the sunglasses<br />
doesn’t necessarily reflect the quality of the UV<br />
protection. Glasses claiming they are UV400 should also<br />
be avoided, says Gaunt, unless they also state they meet<br />
the above standard, as there is no universally accepted<br />
definition of what UV400 actually means.<br />
3. Choosing frames<br />
CONTINUED FROM P11<br />
Just like optical glasses, your clients need to be advised<br />
on the right sunglass frames for their face shape, lifestyle<br />
and purpose.<br />
Sporty-types and those who do a lot of driving or<br />
work outside, might prefer wrap-style frames that<br />
give a greater area of coverage and have a darker tint<br />
or reflective lenses for added clarity outside, while<br />
those who wear sunglasses more casually might prefer<br />
something that fits with their own sense of style – such<br />
as oversized frames or vintage. If your client expresses<br />
any concerns over losing their<br />
sunglasses or where they might keep a<br />
second pair, then photochromic lenses<br />
that change with the environment are<br />
probably the better lifestyle choice.<br />
The same style tips you’d use for<br />
helping a patient chose prescription<br />
lenses work for sunglasses. For example,<br />
a rounder face would benefit from<br />
square-shaped sunglasses to balance<br />
their face shape, while oval faces<br />
shouldn’t wear glasses that are too<br />
wide. And a good thing to remember<br />
is if your client has a strong affiliation<br />
with a particular style of frames, they<br />
can probably have tinted lenses fitted in<br />
those frames too.<br />
4. Clip ons/over glasses<br />
For the customer who sees sunglasses<br />
as pure necessity, the resurgence of<br />
‘over glasses’ and clip-ons is no doubt a<br />
dream come true. Coverspecs are wraps<br />
that go over the top of your clients<br />
existing glasses, and they are approved<br />
by the Cancer Society of New Zealand –<br />
giving protection along the side of the<br />
frame as well as over the lens. Other<br />
brands include Cocoons eyewear and<br />
Horizons eyewear.<br />
Alternatively, clip-ons – available from<br />
a number of different suppliers – are<br />
armless frames with sunglass lenses<br />
that clip on to your clients’ existing<br />
glasses. They fold up when not in use so<br />
they don’t have to be removed (and are<br />
less likely to be misplaced).<br />
5. Photochromic lenses are just as useful<br />
inside as out<br />
Photochromic lenses, like Transitions and Hoya Sensity, are<br />
really great for those people who just want a pair of glasses<br />
for all occasions, without having to remember to take out<br />
their sunnies or accessories.<br />
“Transitions lenses are not sunglasses. But for patients<br />
looking to find an everyday lens they can wear from<br />
morning to night, indoors to outdoors, Transitions lenses<br />
will be the lens to recommend,” says Stuart Cannon,<br />
Transitions Optical general manager, Asia-Pacific.<br />
“Outdoors, Transitions lenses block 100% UVA and UVB<br />
rays from the sun and also help protect our wearer’s eyes<br />
from glare and harmful blue light.”<br />
These lenses are also useful indoors. Transitions<br />
Signature VII lenses block at least 20% of harmful blue<br />
light indoors – up to two times more than standard<br />
clear lenses – while still being clear, and more than<br />
85% outdoors. Transitions XTRActive help provide more<br />
protection everywhere they are needed, blocking at least<br />
34% of harmful blue light indoors and 88-95% outdoors,<br />
according to a recent study.<br />
Sunlight exposure<br />
and AMD<br />
Dr David Worsley*<br />
Whether, and to what degree, sunlight exposure is an age-related<br />
macular degeneration (AMD) risk factor is controversial. Although visual<br />
perception occurs between wavelengths 380-760 nm, the retina/retinal<br />
pigment epithelium (RPE) complex is exposed to light from 320nm and above.<br />
Wavelengths below 320nm, including most UVA and UVB, are blocked by the<br />
cornea and crystalline lens.<br />
Laboratory studies provide evidence to suggest a vulnerability to sunlight<br />
exposure. Wavelengths beween 400-760nm absorbed by retinal/RPE proteins, such<br />
as melanin and lipofuscin, can lead to cell damage. The RPE is prone to oxidative<br />
stress, especially from UV and blue light, with DNA damage, alteration of RPE<br />
cell size and movement. The age-related increase in both number of lipofuscin<br />
granules in human RPE cells and in their photoreactivity may impose a greater risk<br />
of oxidative damage in the aged RPE, suggesting a light-sensitive mechanism in<br />
the development of AMD. Blue light related photoreactivity of melanosomes also<br />
increases with age. Blue<br />
light exposure in an<br />
experimental rat model<br />
of dry AMD induces<br />
retinal injury.<br />
The retina possesses<br />
inherent protection<br />
against sunlight<br />
damage via antioxidant<br />
enymes, light<br />
absorbing pigments<br />
such as melanin and<br />
flavoproteins, and the<br />
shedding of damaged<br />
photoreceptor outer<br />
segments.<br />
Epidemiological<br />
Does UV contribute to AMD?<br />
evidence for light<br />
exposure as an AMD risk<br />
factor is inconclusive<br />
and only a few studies report a positive association. One of the best, the Beaver<br />
Dam Eye Study (BDES), found that exposure to summer sun as teenagers through<br />
to the thirties was associated with later development of early AMD. Estimated<br />
ultraviolet-B exposure and historical markers of sun sensitivity were not<br />
associated. An inverse association was found between the level of protection from<br />
sunlight via use of brimmed hats and sunglasses and AMD, but only in men. Follow<br />
up five-year incidence of early AMD confirmed this association; however the 10-<br />
year incidence study showed few significant associations between environmental<br />
light and incidence and progression of early AMD. A recent analysis of long-term<br />
data from the BDES found some evidence that light eye or hair colour combined<br />
with sunlight exposure is associated with increased risk of developing early<br />
AMD. The link may be a genetically determined lower level of photo-protective<br />
eumelanin. Other studies have similar findings; for example the Chesapeake<br />
Bay Waterman Study found late AMD to be associated with long-term high blue<br />
light exposure. An Australian study found that sensitivity to sunburn may be a<br />
risk factor. In contrast to these studies, several case-control studies have failed to<br />
show associations between sunlight exposure and AMD. Several studies showed<br />
a lowered risk of AMD. A review of the literature in 2012 noted these conflicting<br />
findings but by met-analysis found overall evidence in favour of an association.<br />
We need to be cognisant of the inherent<br />
weaknesses of epidemiology studies dealing<br />
with a complex exposure. Issues include<br />
challenges in measuring acute and chronic<br />
lifetime exposure and the effect of potential<br />
confounding variables, such as sun sensitivity<br />
and sun avoidance behaviours. Furthermore,<br />
each study evaluates a different population<br />
(ethnic and genetic makeup) with different<br />
confounding factors and located in a variety of<br />
geographical areas with very different exposure<br />
intensities.<br />
In conclusion, the literature is conflicting. That<br />
doesn’t provide a practical solution for advising<br />
your patient. So my take on the controversy<br />
is that the data does not support a strong<br />
association of sunlight exposure and AMD, but<br />
a modest effect can’t be ruled out. Therefore<br />
it is reasonable to advise simple measures to<br />
reduce potential risk. A wide-brimmed hat will<br />
drastically reduce sun exposure. Sunglasses<br />
will give additional protection. However, strict<br />
wearing of sunglasses is not indicated, indeed<br />
there are some circumstances where tinted<br />
lenses may have a functional impact for an AMD<br />
patient with reduced macular function.<br />
ABOUT THE AUTHOR<br />
– BUILD TO<br />
PERFORM<br />
VIS ION EN H ANCEMENT<br />
EYEWEA R<br />
* Dr David Worsley is<br />
an ophthalmologist at<br />
Hamilton Eye Clinic and<br />
Waikato Hospital. He is a<br />
retina specialist with an<br />
interest in AMD and sits on<br />
the medical advisory board<br />
for MDNZ.<br />
12 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
Choroidal melanoma: a spotter’s guide<br />
BY PETER HADDEN*<br />
There are not many truly life-threatening<br />
ocular conditions, but choroidal melanoma<br />
is certainly one of them. Overall, about 50%<br />
of people diagnosed with it will, in the fullness<br />
of time, die from it, so one can certainly say that<br />
it is something no one wants to miss. Missing it<br />
has been the subject of lawsuits in the USA and,<br />
even in New Zealand, this diagnosis has graced<br />
the adverse comments section of our Health and<br />
Disability Commission, wondering if “x failed to<br />
provide services with reasonable care and skill…”.<br />
Luckily, that happened 16 years ago (before my<br />
time, may I add!), but we certainly don’t want it to<br />
come up again. So how can we avoid that?<br />
Obviously the first step is not to miss the<br />
diagnosis. Unfortunately, although melanoma is<br />
rare, naevi are not and sometimes the differences<br />
can be subtle. Furthermore, the only time when<br />
maybe we might be able to make a difference to<br />
the prognosis, ie. reduce the risk of metastatic<br />
disease in the future, is if we can catch and treat<br />
melanomas when they’re small, which of course is<br />
when they are most easily confused for naevi.<br />
One study found that, for small indeterminate<br />
pigmented tumours, ie. ones that might be<br />
naevi or might be melanoma, there was a 5%<br />
cumulative chance of metastatic death for<br />
each of the following risk factors: margin at the<br />
disc, lipofuscin, symptoms and subretinal fluid.<br />
Therefore if you’ve got all four there’s a 20%<br />
chance you’ll be dead in a few years.<br />
Some bright spark then came up with a<br />
mnemonic to help people remember what to look<br />
for if you think you’ve seen a naevus but don’t<br />
want to miss a small melanoma (small being less<br />
than 2.5mm thick). That mnemonic is “To find<br />
small ocular melanoma”. This stands for thickness,<br />
fluid, symptoms, orange pigment and margin at<br />
the disc. Naturally of course others subsequently<br />
pointed out that this didn’t really cover everything;<br />
ophthalmologists routinely do an ultrasound<br />
(B-scan) on all such lesions and therefore we<br />
routinely add two letters to this, looking for<br />
hypoechogenicity and characteristic shapes (as<br />
well as the thickness, which ultrasound is very<br />
good at measuring). Then of course, documented<br />
growth is another risk factor. Fortunately many<br />
of you probably don’t have ultrasound anyway so<br />
you don’t have to remember those two letters, but<br />
do remember to look at old photos to see if it has<br />
changed.<br />
It might be helpful at this juncture to go over<br />
what each of these “suspicious features” actually<br />
are:<br />
T is for thickness<br />
If it’s more than 2mm thick, that’s a bad sign. This<br />
suspicious feature actually is best appreciated by<br />
ultrasound, since on ultrasound you can measure it<br />
very easily, as previously mentioned. But if you’ve<br />
got OCT, you can switch on “enhanced depth<br />
imaging” (EDI) or push the OCT machine forward<br />
so that the image flips and you can get a pretty<br />
image of the choroid and usually you can measure<br />
the thickness of the tumour on this, but only if it’s<br />
less than about 1mm thick.<br />
F is for fluid<br />
Subretinal fluid is a danger sign. Naevi can often<br />
have a bit of fluid over the top of them, which<br />
doesn’t matter, but if it’s leaking fluid around it,<br />
that’s bad (unless of course it’s from something<br />
else, like a choroidal neovascular membrane, which<br />
you can get with naevi). Often you can see this<br />
around the tumour or, if you get the patient to look<br />
down, you might notice an inferior serous retinal<br />
detachment. However, even a small bit of fluid is<br />
important to spot and so if you’ve got a camera,<br />
try putting it on autofluorescence; if it’s leaking<br />
fluid, this will show up white beside the tumour.<br />
OCT of course also comes in handy here, as it will<br />
show fluid directly.<br />
S is for symptoms<br />
If your patient has an itchy eye, that’s a symptom<br />
but it really doesn’t have anything to do with<br />
whether there’s a naevus or melanoma in the<br />
fluid. Pain doesn’t matter either (unless it’s huge,<br />
melanoma is not associated with pain, and most<br />
people would suspect that something’s amiss if<br />
you have a really massive melanoma that takes up<br />
the whole eye. The symptoms that really matter<br />
are visual loss (not attributable to some other<br />
cause, of course), field loss or flashes. The flashes<br />
that you get with melanoma are different from the<br />
Moore’s lightening streaks of vitreoretinal traction.<br />
They tend to last longer, maybe a few minutes,<br />
move slowly around, sometimes in circular<br />
Pic 1&2. A small choroidal melanoma. Note the visible subretinal fluid and orange<br />
pigment (lipofuscin). This patient was also symptomatic, with blurred vision and<br />
flashing lights, as this tumour was under the fovea.<br />
patterns, sometimes like a lava lamp, and aren’t<br />
always temporal but instead can be anywhere. Ask<br />
the patient if they’ve noticed any funny lights if<br />
you’re wondering about melanoma.<br />
O is for orange pigment<br />
Orange pigment, ie. lipofuscin, is bad. Sometimes<br />
it can be hard to see – it doesn’t stand out as<br />
well as drusen against a dark background like a<br />
melanoma, but is easier to see with an indirect<br />
(where it kind of looks like someone’s got an<br />
orange pepper shaker and shaken it across the<br />
tumour). On autofluorescence, which you may<br />
have on your camera, it shows up very obviously<br />
as very light white spots over the tumour. One<br />
caveat, however, RPE changes and drusen, both of<br />
which are good signs (see below), can also show<br />
up light on autofluorescence, but RPE changes<br />
look more “geographic” (like how scattered islands<br />
might look on a black and white map) and drusen<br />
just don’t light up as much – no one said that<br />
autofluorescence was completely straight forward!<br />
M is for margin at the disc<br />
This one’s easy. If the tumour is at the disc, or<br />
within a disc diameter of the disc, then that’s a<br />
suspicious feature.<br />
Pic 3 (above). A colour photo and EDI OCT of a melanoma. Note the lipofuscin (orange pigment) on the tumour, the obvious tumour in the<br />
choroid on EDI and the subretinal fluid above it which extends outside the borders of the tumour. Pic 4 (below). A colour photo and fundus<br />
autofluorescence (FAF) image of a peripapillary melanoma. Note how the fluid shows up very brightly just below the melanoma. The central,<br />
thickest part of the melanoma is dark, indicating RPE changes, but they aren’t very marked.<br />
There are also a couple of signs that imply it’s<br />
just a naevus. Drusen over the surface of it or RPE<br />
changes such as hyper or hypopigmentation either<br />
over the top of the tumour or around it, imply that<br />
it’s been there a long time. That of course means<br />
that it’s probably a naevus, as melanomas usually<br />
haven’t been there a long time (or else they’d be<br />
bigger). Melanomas are usually much more evenly<br />
coloured and have a very distinct border without<br />
RPE changes around them (for some reason,<br />
some people seem to have the impression that an<br />
indistinct border is bad; this is distinctly untrue).<br />
There are also other pigmented things in the eye;<br />
choroidal freckles, melanocytomas and CHRPEs<br />
to name a few. Often also choroidal neovascular<br />
membranes look pigmented too. Little spots<br />
of pigment also are common in the retina. The<br />
key thing with most of these is that they don’t<br />
have the above features, except for pigmented<br />
scleral crescents beside the optic disc, commonly<br />
temporally – but these are flat and don’t have any<br />
of the other features.<br />
The bottom line has to be that, at the least, any<br />
pigmented tumour with any of the suspicious<br />
features mentioned has to be seen by an<br />
ophthalmologist, except for little spots of pigment<br />
that are otherwise completely benign looking<br />
beside the disc. Those with suspicious<br />
features will be offered treatment, but<br />
it depends on how suspicious it is, how<br />
worried the patient is and how badly<br />
treatment of it will affect the vision as to<br />
whether treatment will be delivered. If it<br />
is watched, the standard recommendation<br />
is to see it again in three months and then<br />
once a year, to look for growth. This is often<br />
done by optometrists and the main thing<br />
here really is to make sure you look back<br />
at the old photos to make sure it hasn’t<br />
changed. Sometimes even with photos it<br />
can be hard – if a photo is overexposed, it<br />
might make the very thin pigmented border<br />
of the tumour invisible and then, on a<br />
subsequent normally-exposed photo, it will<br />
look bigger. If you have autofluorescence,<br />
make sure you do take an autofluorescence image<br />
at the start because often the borders can be<br />
much easier to see and less open to problems with<br />
exposure than standard photos. Photos taken with<br />
a red filter can also be useful, for the same reason;<br />
they image pigmented choroidal tumours better<br />
since they are less absorbed in the overlying retina<br />
and RPE.<br />
Good luck then with spotting naevi! And if you’re<br />
thinking of buying a camera, consider one that<br />
does autofluorescence; it’s useful in many other<br />
conditions with fluid and RPE changes too, like<br />
macular degeneration and dystrophies. ▀<br />
ABOUT THE AUTHOR<br />
* Dr Peter Hadden practises<br />
at Eye Institute Remuera and<br />
New Lynn, Retina Specialists<br />
and Greenlane Clinical Centre<br />
in Auckland, subspecialising<br />
in vitreoretinal surgery and<br />
adult chorioretinal tumours,<br />
as well as performing<br />
cataract surgery.<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
13
SPECIAL FEATURE: SUMMER SPECIAL AND SUNGLASSES<br />
Sunnies for summer ‘16/17<br />
rocco by Rodenstock<br />
It was first seen in the 60s, and then suddenly disappeared like it was<br />
swallowed up by the earth, but then rocco by Rodenstock returned to<br />
the scene in 2014. In a retro design and wrought with ultramodern<br />
materials, the eyewear is mainly something for trendsetters and the<br />
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Maui Jim<br />
Maui Jim got its start in 1980 as a small company selling sunglasses<br />
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sunglass styles, our Classic Collection was introduced. We now offer<br />
over 125 styles of sunglasses, 100% of which are polarized and<br />
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Euro Optics<br />
Adidas continues to offer many sunglasses in the performance<br />
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Adidas is pleased to release the Zonyk (with photo chromatic<br />
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14 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
General Optical<br />
Founded in 1976, during the Golden Age of Munich<br />
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MCM Eyewear is a unique collection where<br />
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Transitions range of adaptive lenses provides<br />
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and especially during summer! Transitions lenses<br />
adapt continuously through varying light conditions<br />
Contact lenses and summer<br />
BY ELEISHA DUDSON*<br />
With the warming spring and summer<br />
seasons approaching, we see an<br />
increase in both new and existing<br />
patients coming in for their contact lens review.<br />
When renewing the patient’s script, we also have<br />
the opportunity to emphasise good contact lens<br />
routines and offer advice about new products<br />
tailored for their specific needs.<br />
Allergies in spring and summer<br />
With spring we see the uncanny sight of thick<br />
yellow pine pollen resting on every surface<br />
outdoors. This is the harbinger of pollens to come.<br />
The pine pollen though, due to its large size, is not<br />
as big an allergy concern for allergy sufferers as<br />
the smaller grass pollens that come later in the<br />
season 1,2 . If we want patients who suffer from<br />
these allergies to continue successful contact lens<br />
wear, then there are a few things we should be<br />
advising.<br />
Artificial Tears We know for sensitive eyes that<br />
preservative free artificial tears are a great option.<br />
There is recent research suggesting that inflamed<br />
and dry eyes settle quicker with drops that contain<br />
hyaluronic acid 3,4,5 . For patients with dry eyes<br />
and allergies, recommending hyaluronic acid eye<br />
drops could help provide better comfort. Examples<br />
of preservative-free artificial tears containing<br />
hyaluronic acid include Hylofresh and Systane<br />
Hydration.<br />
Medicated Drops Oral antihistamine tablets<br />
dry the eye out which can further exacerbate<br />
an allergic eye. Therefore, for some contact lens<br />
wearers, a topical medication can be a great<br />
adjunct. I often talk to patients about the use<br />
of Patanol over the summer. Because Patanol<br />
is a preventer (mast cell stabiliser) and treater<br />
(antihistamine) it works really well when using<br />
twice a day, prior to and after contact lens<br />
removal. From my clinical experience I advise that<br />
Patanol should not be used immediately prior<br />
to sleep as the patient could wake with stingy<br />
eyes due to the lack of tear pump occurring while<br />
asleep. Patanol is best used at least 15 minutes<br />
before sleep and then artificial tears just prior to<br />
sleep.<br />
Travelling<br />
One key thing to discuss with patients is their use of<br />
contact lenses while flying. Patients usually know<br />
they shouldn’t wear their contact lenses on long<br />
haul flights, but they often don’t fully understand<br />
why. Believe it or not, it’s not because their contact<br />
lens solution is limited to 100mls or because toilets<br />
on planes are unhygienic! Rather it is due to the<br />
cabin pressure and oxygen levels. Aeroplane cabin<br />
pressures can be likened to being on a mountain<br />
at an altitude of 1800-2400m 6 . At this level there<br />
is about 76-81% oxygen pressure compared to<br />
sea level 7 and with the eye shut the oxygen levels<br />
at the corneas drop by 60-75% 8 . This can be<br />
uncomfortable and risky for the eye, especially as<br />
there is usually some sleeping involved on long haul<br />
flights. It’s also good to remind patients that as well<br />
as skin and lip dryness from flying, eyes are affected<br />
too.<br />
Contact lens options<br />
For both allergies and travelling there is the obvious<br />
option of daily disposables.<br />
I have many patients who are on what I call “dual<br />
prescriptions”. They have their “usual” lenses for<br />
their day-to-day lives, and then run a second daily<br />
disposable prescription for travelling. This means<br />
MCM range RRP $500<br />
shapes are combined with colourful prints and<br />
modern embellishments.<br />
The brand is modern, progressive, cosmopolitan<br />
and aspiring: while embracing the past and its<br />
German origins it looks toward the future.<br />
outdoors, enhancing the wearer’s vision and<br />
reducing their eye fatigue. Additionally, they offer<br />
well-rounded protection from the sun’s harmful<br />
rays. Outdoors, the lenses not only block 100% of<br />
UVA/UVB rays, but they also help protect eyes from<br />
glares and harmful blue light from the sun, which<br />
emits more than 100 times the intensity of blue<br />
light than electronic devices and digital screens.<br />
there is no need to worry about solutions while<br />
travelling, especially for those sensitive patients<br />
who use a hydrogen peroxide care system. The<br />
hassle of travelling with AOsept has provided me<br />
with some interesting stories; including the demise<br />
of a mobile phone, drowned by a river of semineutralised<br />
AOSept from a knocked-over case!<br />
For dailies there are now more options than<br />
ever with the latest releases including Oasys<br />
1-day, Alcon Dailies Total 1, Cooper Myday and<br />
Bausch and Lomb Biotrue. With all the options<br />
now available there is really no reason why you<br />
shouldn’t be able to find a compatible contact lens<br />
for your patient.<br />
Orthokeratology (ortho-k) For some adults who<br />
suffer dry and irritable eyes, wearing contact lenses<br />
throughout the day is just not an option. For these<br />
patients it can be worth considering ortho-k.<br />
New ortho-k designs with larger optic zones,<br />
multifocal, and astigmatism options now make<br />
ortho-k a viable option for more patients who are<br />
intolerant to daily contact wear.<br />
Ortho-k can be an effective myopia progression<br />
control option in children. The understanding of<br />
how ortho-k slows myopia progression has brought<br />
about new designs, that are further improving the<br />
efficacy of myopia progression control in ortho-k.<br />
Ortho-k should also be part of any myopia<br />
control discussion with younger patients and their<br />
caregivers. With summer’s increased daylight and<br />
potential for outdoor activities, it is also a great<br />
time to discuss recent research about myopia<br />
progression and light exposure. Research suggests<br />
that 60-90 mins of outdoor activity a day is likely to<br />
help slow myopia progression 9 . As good an excuse<br />
as any to get out and enjoy some backyard cricket,<br />
beach outings and BBQs!<br />
References<br />
1. Zealand, Allergy New. A-Z Allergies. s.l. : www.allergy.org.<br />
nz/A-Z+Allergies/Pollen+allergy.html, 2010.<br />
2. Crump, Vincent St Aubyn. Pollen Allergy and Cross-Reactions<br />
in New Zealand. s.l. : www.allergyclinic.co.nz/pollen_allergy.<br />
aspx, 2014.<br />
3. A randomized, controlled study of the efficacy and safety of<br />
a new eyedrop formulation for moderate to severe dry eye<br />
syndrome. F, Chiambaretta. s.l. : Eur J Ophthalmol. <strong>2016</strong> Jul<br />
20:0. doi: 10.5301/ejo.5000836., <strong>2016</strong>.<br />
4. Efficacy and safety of two new formulations of artificial<br />
tears in subjects with dry eye disease: a 3-month,<br />
multicenter, active-controlled, randomized trial. PA,<br />
Simmons. s.l. : Clin Ophthalmol. 2015 Apr 15;9:665-75. doi:<br />
10.2147/OPTH.S78184. eCollection 2015., 2015.<br />
5. Comparison of treatment with preservative-free versus<br />
preserved sodium hyaluronate 0.1% and fluorometholone<br />
0.1% eyedrops after cataract surgery in patients with<br />
preexisting dry-eye syndrome. D, Jee. s.l. : J Cataract Refract<br />
Surg. 2015 Apr;41(4):756-63. doi: 10.1016/j.jcrs.2014.11.034.<br />
Epub 2014 Dec 5, 2015.<br />
6. WHO. International travel and Health: Cabin air pressure. s.l.<br />
: www.who.int/ith/mode_of_travel/cab/en/, <strong>2016</strong>.<br />
7. Baillie, K. Altitude air pressure calculator. s.l. : www.altitude.<br />
org/air_pressure.php, 2010.<br />
8. 8. Oxygen transmissibility corneal Oxygen. Weissman, B. A.<br />
s.l. : Contact Lens Spectrum, Volume: 30 , Issue: <strong>Nov</strong>ember<br />
2015, page(s): 25-29, 55 , 2015.<br />
9. Light exposure and physical activity in myopic and<br />
emmetropic children. SA, Read. s.l. : Optom Vis Sci. 2014<br />
Mar;91(3):330-41. doi: 10.1097/OPX.0000000000000160.,<br />
2014.<br />
ABOUT THE AUTHOR<br />
* Eleisha Dudson is an<br />
optometrist at Stevenson,<br />
Sangster and Matthews in<br />
Wellington, and has a special<br />
interest in orthoK<br />
Style-Eyes<br />
BY JO EATON*<br />
et’s talk about sunglasses<br />
L trends for summer<br />
<strong>2016</strong>/17. Things finally<br />
seem to be shifting from<br />
the gigantic acetate frames<br />
that have dominated the<br />
past several years. Here’s a<br />
rundown of what you can<br />
expect this season.<br />
Frame shapes<br />
Rounder shapes are still a<br />
popular choice.<br />
Phil Thomas at Edel-Optics<br />
says, “This summer, we shall see glasses in<br />
panto or butterfly styles everywhere… Men<br />
and women alike are going for round frames<br />
with lenses that are slightly flattened at the<br />
top. …This year, the glasses will not be quite as<br />
oversized as last year.”<br />
Interesting geometric shapes are also in many<br />
collections.<br />
Colours<br />
Pastel colours are coming through again. Gold<br />
and rose gold are popular in metal frames.<br />
Lenses<br />
In non-prescription glasses, flat-look lenses are<br />
having their moment in the sun.<br />
Mirrored lenses are big again this year. Super<br />
are offering unusual colours to choose from,<br />
such as bright pink mirror lenses.<br />
Transitions<br />
Transitions has been working on marketing with<br />
well-known opticians, bloggers and designers<br />
in the States in an effort to banish the daggy<br />
reputation of photochromic lenses. They’re<br />
pushing the fact the lenses clear when you walk<br />
out of UV light a lot faster than they used to.<br />
Coyote DeGroot of Labrabbit Optics in Chicago,<br />
fashion blogger Leandra Medine of Man Repeller<br />
and eyewear designers Coco & Breezy have been<br />
some of the stars of the resulting campaign.<br />
Check out the lookbook at www.transitions.<br />
com/en-us/look-book/<br />
Clips<br />
Clip-on sunglass fronts, to be fitted over a<br />
related pair of prescription spectacles, have been<br />
making a quiet comeback for the past several<br />
years and they’ve finally dropped the dorky<br />
sports-dad feel. You’ll find them everywhere<br />
from Luxottica brands like Oliver Peoples to<br />
avant-garde Korean brand Gentle Monster,<br />
through to many affordable brands.<br />
Metal frames<br />
With smaller frames making<br />
a comeback, metal frames are<br />
also on the way back in.<br />
Karen Walker has just<br />
released a range of metal<br />
frames making use of<br />
negative space, as if they are<br />
outlines of her classic acetate<br />
styles. It’s very clever!<br />
As with spectacles, there is a<br />
move towards smaller metal<br />
frames in sunglasses for this<br />
season. Check out AM Eyewear’s NOJ and Chico<br />
frames and RVS Eyewear’s Palladium range.<br />
Luxury<br />
High-end eyewear brand Barton Perreira are<br />
leading the way with sunglasses this year. Their<br />
beautiful frame Belvedere is small, round and<br />
comes with a clip.<br />
Their rectangular Rango frame combines both<br />
metal and acetate in a very masculine way,<br />
while Beauregard does the same for femmes.<br />
The real stunner of their latest collection,<br />
however is the Boleyn frame, of which they<br />
say, “[Its] name inspiration becomes very<br />
apparent once seen, as it has a metal top half<br />
and a plastic bottom, a reverse of the norm in<br />
which the plastic half is traditionally on the<br />
top. The metal has a filigree of very intricate<br />
detail that evokes the distinctive car grills of<br />
the past, it can be thought of as a spin on an<br />
aviator, creating a unisex frame for the fashion<br />
forward.”<br />
Bold and unusual<br />
If you’re going to go for big acetate sunglasses<br />
this season, they have to look bonkers. Brands<br />
leading the way here include Fakoshima, Stella<br />
McCartney and Super.<br />
You do you<br />
Something I particularly love about <strong>2016</strong> is, that<br />
while there are definite themes emerging as<br />
trends, anything is acceptable as long as they are<br />
worn with confidence. I’ve noticed sunglasses<br />
styles associated with every decade from the<br />
past 60 years worn lately without a sideways<br />
glance from the arbiters of style! So, as my<br />
friends are fond of saying, you do you!<br />
* Jo Eaton is a native Wellingtonian, now studying optical<br />
dispensing in Melbourne. She runs eyewear fashion blog,<br />
Eye Heart Glasses’.<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
15
SPECIALITY CL FORUM BY ALEX PETTY*<br />
HOW NOT TO REVOLUTIONISE CONTACT LENSES DESIGN<br />
In the annals of history there exists a number of<br />
important discoveries that were conceived over<br />
a few beers. Arthur Holmes and his colleagues<br />
developed the theory of continental drift whilst<br />
sipping cocktails in Hawaii. Watson and Crick<br />
unravelled the mysteries of DNA’s double helix in<br />
the now-famous Eagle Tavern in Cambridge. Trivial<br />
Pursuit, the Iron-Man triathlon and even Harry<br />
Potter’s fictional sport Quidditch are all famous<br />
ideas that may not have come to be without the<br />
influence of a chilled alcoholic beverage.<br />
The following innovation is not one of these.<br />
Picture this scenario: on a balmy summer’s evening<br />
last year, a colleague and I decided a quenching ale<br />
was just the ticket after a long Friday of checking<br />
eyeballs. My final appointment of the day was a<br />
scleral contact lens fitting for a chap with advanced<br />
keratoconus. Once I had finished regaling my fellow<br />
optometrist with tales of the complexity of the case<br />
our conversation (rightly) turned to weekend plans.<br />
Given the heat, a swim at the local beach was on<br />
the agenda. “That patient of mine would have a<br />
tough time checking the water for sharks!” I laughed<br />
sympathetically. “Did you not design his sclerals<br />
to see underwater too?” my colleague retorted.<br />
Chuckles simultaneously turned to quiet speculation<br />
as metaphorical light-bulbs switched on above our<br />
heads. What if it could be done ...?<br />
Water-wear<br />
One of the few limitations of day-wear contact<br />
lenses are the difficulties when swimming. In my<br />
younger years I would dive and swim with lids<br />
clenched tight for fear of my soft dailies drifting<br />
away (Fig 1.). Three years ago I had laser refractive<br />
eye surgery and still I get a guilty kick when opening<br />
my eyes underwater to experience the (blurry)<br />
wonders beneath the waves. This freedom is one<br />
of the main reasons I recommend orthokeratology<br />
lenses to patients who enjoy the water. Goggles are<br />
all good, but they have their limitations: fogging<br />
of the lens, water influx, discomfort, field of view,<br />
and those lovely compression marks visible after<br />
removal. Plus, you’d never see a trendy surfer<br />
waiting for the next set with a pair of goggles<br />
strapped on. Wouldn’t it be neat if we could design<br />
a scleral lens swimming goggle that could offer<br />
great vision in and out of the water instead?<br />
Several high-fives later we calmed down, ordered<br />
another round and extra napkins, and got serious.<br />
First things first: would a scleral lens stay in an open<br />
Fig 1. One from the family album: Me as an 11-year-old soft contact lens<br />
wearer demonstrating the clenched-eye diving technique that I had perfected<br />
Fig 2. Is than an RGP lens? Or a pneumatic retinopexy gone wrong? No, this<br />
ladies and gentleman, is a scleral swimming goggle<br />
eye underwater? We decided yes: the large surface<br />
area provides ample surface tension (when was the<br />
last time you were able to pull a scleral or hybrid<br />
lens straight off the eye without a suction tool?<br />
Clue: it’s not easy) and the lids should provide an<br />
additional barrier.<br />
Second: how do we get around the issue of<br />
the vergence changes when a rigid contact lens<br />
is moved from air to water? As most of you will<br />
appreciate when underwater the human eye<br />
becomes severely hyperopic, by approximately 40<br />
diopters, due to the cornea being almost entirely<br />
neutralised. A traditional rigid lens would behave<br />
similarly. Simply adjusting the contact lens front<br />
curvature to focus correctly underwater would<br />
lead to a colossal level of myopia when above the<br />
surface. Not ideal. One solution would to create a<br />
monovision-type set up, with one lens designed for<br />
vision in air and the other for vision underwater.<br />
Again highly impractical.<br />
Eureka!<br />
Then it hit us. Why not make a tiny goggle for each<br />
eye? Create the lens with a completely flat front<br />
and back surface, and insert the lens with an air<br />
gap, rather than filled with solution, so that the air/<br />
cornea refractive interface, and therefore the power<br />
of the eye, remained the same in air and water! In<br />
theory it would work perfectly. We left the bar that<br />
night with a sense of purpose rarely experienced by<br />
slightly-inebriated eye care professionals.<br />
First thing on Monday morning I called Graeme<br />
Curtis at Contact Lens Corporation in Christchurch.<br />
“Was it even possible?” I asked. This lens would have<br />
quite possibly the flattest base curve ever created<br />
on a rigid lens, with essentially a radius of infinity.<br />
It is testament to the technology of modern day<br />
lathes (not to mention Graeme’s patience with<br />
seemingly foolish requests) that his reply was “Sure,<br />
let’s give it a try”. I heavily modified the parameters<br />
of a trial scleral lens using rigid lens design software<br />
Eyespace to match the cocktail napkin diagrams we<br />
had sketched previously. Regrettably ‘infinity’ was<br />
not a BOZR value I could input, so I had to settle on r<br />
= 99999mm. You read that correctly: Our lens had a<br />
100 metre base-curve radius.<br />
Weird science<br />
As I opened the courier parcel from CLC you could<br />
have cut the tension with a knife. As it turned out<br />
the parcel’s contents; possibly the world’s first<br />
scleral swimming goggle, was the weirdest<br />
contact lens I had ever seen. The completely<br />
flat 6mm optic gave the lens a sinister<br />
appearance: It looked more like a part from<br />
a Terminator than something a water-sports<br />
enthusiast would wear. After the initial<br />
excitement subsided, human trials began.<br />
Much like Australian Dr Barry Marshall, who<br />
drank a petri dish filled with the bacterium H.<br />
Pylori to prove the cause of stomach ulcers,<br />
in the name of science I bravely inserted the<br />
dry scleral lens onto my left eye.<br />
Initial impressions were positive. For those<br />
of you who have not worn a well-fitting<br />
scleral lens they are surprisingly comfortable.<br />
I could feel this lens a little more than usual<br />
due to the abrupt junction at the optic zone<br />
edge but it was not irritating. And I could see!<br />
I could happily make out the 6/6 line on the<br />
chart due to my plano unaided refraction.<br />
Topography over the lens confirmed a front<br />
surface power equalling zero diopters;<br />
the lens was as flat as a pancake. OCT<br />
and anterior photography highlighted<br />
the unusual shape of the lens (Fig 3.) and<br />
confirmed ~250μm of central clearance -<br />
important when the lens is 35D flatter than<br />
alignment.<br />
However, things did not stay hunky-dory<br />
for long. After a few minutes my vision<br />
started to blur; I was struggling to see 6/12.<br />
Under the slit-lamp the rear surface of the<br />
lens was misting up like a bathroom mirror.<br />
We removed the lens and added a lubricant<br />
drop to the lens bowl prior to insertion. This<br />
helped for about five more minutes but the<br />
blur slowly returned. Only this time the lens<br />
was starting to become quite uncomfortable.<br />
Fig 3 & 4. OCT and slit lamp appearance of the flat scleral lens profile on eye<br />
Fig 4.<br />
Inspection showed the lens was fitting well in the<br />
peripheral area and still had adequate clearance. I<br />
managed to keep the lens in the eye for a further<br />
ten minutes, before the pain and significant blur<br />
necessitated removal.<br />
We created a monster<br />
Rather than relief, my first emotion was concern:<br />
the vision in my left eye was still very hazy: I was<br />
only reading 6/36 in my guinea-pig eye! The cornea<br />
was clear and uninflamed however instillation<br />
of sodium fluorescein revealed a subtle patchy<br />
negative staining of the central epithelium. Further<br />
investigation with corneal topography showed<br />
very irregular central mires (Fig 5.). Realisation<br />
dawned: we had created a corneal exposure<br />
scenario mimicking the pathophysiology of<br />
patients with conditions like Bell’s Palsy, thyroid<br />
orbitopathy, restrictive eyelid disease and nocturnal<br />
lagophthalmos. Even a healthy eye with excellent<br />
tear film function will experience significant visual<br />
problems and discomfort when the lids are not<br />
regularly smoothing and spreading fresh tears over<br />
our fragile corneal surface.<br />
A case of one of my colleagues highlights this<br />
concept in a similar way. At routine aftercare a<br />
happy keratoconic patient noted that from time<br />
to time his lenses would be very painful and<br />
irritable for the duration of the day. The lens was<br />
fitting beautifully and in the chair his eyes looked<br />
pristine. The patient was asked to return wearing<br />
his lens if the irritation arose. A few weeks later<br />
the patient returned with a very red eye. One look<br />
explained his troubles - poor insertion technique<br />
had trapped a bubble of air under his lens (Fig 6.).<br />
As the bubble was for the most part off the optic<br />
axis he was unaware of it. Following removal,<br />
a kidney-shaped depression was evident at the<br />
site of the bubble, with dense epithelial staining<br />
within its confines (Fig 7.). Needless to say it is<br />
important to educate scleral lens patients to check<br />
for bubbles after insertion with the aid of a mirror<br />
and sometimes a penlight. Like a stone trapped<br />
in a shoe, even a small pocket of air will gradually<br />
cause problems.<br />
In the end it took roughly an hour for my vision<br />
to return to normal. Despite my scare I gamely<br />
tried the scleral lens one further time, except with<br />
a soft bandage lens worn beneath. The discomfort<br />
was not noticeable but vision became equally poor<br />
as the soft lens surface desiccated slowly. It was to<br />
be the last time that the scleral goggle would ever<br />
be worn.<br />
Reinventing the wheel<br />
The novel concept of using an air gap under the<br />
lens had ultimately proven the design’s downfall.<br />
So disappointing (and not to mention traumatic)<br />
Fig 5. The exposure keratopathy induced by the air-filled scleral lens.<br />
Note the distorted mires seen on topography<br />
Fig 6 & 7. Epitheliopathy and inflammation caused by a trapped bubble<br />
under a well-fitting scleral lens. Images: Lachlan Scott-Hoy<br />
Fig 7.<br />
was the outcome that the lens was never even<br />
tested underwater. With our luck it would have<br />
just floated off anyway!<br />
It may seem like a waste of time to publish an<br />
account of this fruitless escapade. However, I think<br />
failures in science can also be viewed as learning<br />
opportunities. Rome wasn’t built in a day after all.<br />
I discovered:<br />
Contact lens technology is progressing at an<br />
incredible rate and more and more is possible<br />
when designing rigid lenses.<br />
A healthy lid-wiper should not be<br />
underestimated in patients with irritation and<br />
dryness symptoms. Neither should the absence of<br />
obvious clinical problems preclude patients from<br />
a diagnosis of dry eye. As I personally found out<br />
symptoms can far exceed signs.<br />
We are not born with two eyes as a handy<br />
surplus should one be blinded through<br />
irresponsible self-experimentation.<br />
And perhaps the most important life lesson we<br />
glean from this tale, the grander a pub idea is, the<br />
more miserably it will fail!<br />
On that sour note thank you for your support<br />
this year. Have a safe and happy holiday period. I<br />
look forward to entertaining with further specialty<br />
contact lens reports in 2017. ▀<br />
ABOUT THE AUTHOR<br />
*Alex Petty is a New Zealand<br />
optometrist based in<br />
Tauranga with a particular<br />
interest and knowledge in<br />
speciality contact lenses,<br />
ortho-k and myopia control.<br />
16 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
SPECIAL FEATURE: SILMO <strong>2016</strong><br />
A spectacle of choice<br />
Silmo <strong>2016</strong> wowed with the pure breadth of options on display. Lesley Springall<br />
shares some highlights from her first visit to one of Europe’s most popular<br />
international optical fairs.<br />
The sheer scale of Silmo Paris, the annual<br />
European optical fair held just outside<br />
France’s capital city, surely must be daunting<br />
to most, but especially to the novice fair attendee.<br />
Two huge, purpose-built exhibition spaces,<br />
with row upon row of 950 different size stands<br />
– most cleverly decorated to stand out from<br />
their neighbours as they vie for attention from<br />
nearly 34,000 visitors – at first seems like a test of<br />
orienteering. But by the second day, even a novice<br />
such as myself was counting down the stand<br />
numbers like a pro.<br />
It was hard to identify themes at this year’s show<br />
as there seemed to be just about everything on<br />
display in terms of frame colours, materials (I’ve<br />
never seen so many buffalo horns) and frame<br />
shapes. If there was a standout, however, it was<br />
the return of round – large round and, especially<br />
for men, small round, somewhat retro-looking<br />
frames. Colour was everywhere, with some brave<br />
designers even presenting frames in those trickiest<br />
of facial-match colours, yellow and green. Blue was<br />
Eye catching displays at Silmo <strong>2016</strong><br />
particularly popular, however, with clever patterns<br />
(on metal or acetate) now the norm.<br />
The other key themes from this year’s fair were<br />
customisation, innovation and authenticity<br />
with French and Italian frame makers reeling off<br />
their “we really are, really made” in France/Italy<br />
credentials, as soon as you start talking to them.<br />
Both are less than impressed by their governments’<br />
decision to award “made in France/Italy” labels to<br />
any manufacturer who simply designs or makes just<br />
part of their frames in the country.<br />
As for innovation, Silmo has always been a<br />
showcase for new materials and advancements<br />
in frame technology, but it seemed like nearly<br />
everyone had a new way of dealing with the old<br />
hinge and screw technology at this year’s fair. The<br />
technology on display from the lens and equipment<br />
manufacturers was equally fascinating. But of<br />
particular interest was Silmo’s Experience Store,<br />
which featured the latest technologies on offer<br />
to draw patients into practices and keep them<br />
entertained. This included hologram greeters<br />
Silmo Paris: what an experience!<br />
BY CLAIRE MCDONALD*<br />
There was a palpable sense of anticipation<br />
as we walked from the train across the<br />
forecourt to Silmo. Sporting a limp,<br />
courtesy of a collision with a fare jumper<br />
hurdling the metro gate, I was not exactly sure<br />
what to expect.<br />
The show was as big as everyone had<br />
promised; at times a bit overwhelming. The<br />
two large halls dedicated to Silmo at the Parc<br />
des Expositions exhibition centre in Paris Nord<br />
Villepinte had definite themes; Hall 5 seemed<br />
colourful with flamboyant frame designers and<br />
stands, while Hall 6 had clinical equipment and<br />
lots of brands, which were less familiar to me,<br />
plus all the lens suppliers.<br />
Making contact with frame designers from the<br />
other side of the globe gave me insights into the<br />
story of the products we stock and use to help<br />
our patients on a daily basis. For me, however, the<br />
true high point was the one-on-one time I spent<br />
with some of our key brands: Alan Peterson from<br />
Monoqool kindly spent a fascinating hour talking<br />
to me about his vision for the company and the<br />
challenges of developing his 3D printing process.<br />
Technology and customisation featured<br />
everywhere. I talked with a young IT whiz about<br />
his app to put virtual stock onto customers faces.<br />
There were frames made from paper and lens<br />
cloths made from recycled PET bottles. At the<br />
Hoya stand, Hoya executives were scanning faces<br />
to design a customised lens with a 3D printed<br />
frame, optimising Hoya’s lens’ performance (see<br />
separate story). I am not sure if people will want<br />
customisation at the expense of choice in frames,<br />
however, though it was a nice touch to see all<br />
Hoya’s staff wearing the frames, giving a uniform<br />
effect similar to the French Morel team, who were<br />
all sporting bright yellow sneakers!<br />
The stands at Silmo Paris ranged from highly<br />
creative to slick; with orange Dutch cows,<br />
American milk bars (complete with rock and roll<br />
dancers) and a British double decker red bus; all<br />
of which is impossible to experience without<br />
considering our own street appeal.<br />
For me, Silmo also highlighted how crowded<br />
the optical frame market is. The idea of selecting<br />
unique brands at a fair on this scale might give<br />
you the sense of unlimited choice. I suspect it<br />
is very easy, too easy, to order out-there new<br />
designs, which may prove less than successful in<br />
your own practice. So for this kiwi optom at least,<br />
we will continue to enjoy the selection curated by<br />
our own trusted suppliers.<br />
and a variety of frame<br />
simulation technologies<br />
from table top displays<br />
to wall-hanging<br />
technologies and freestanding<br />
screens in a host<br />
of sizes. Often wrapped<br />
up closely with innovation<br />
was customisation, with<br />
a number of companies<br />
offering new ways for<br />
practices to customise<br />
their frame and lens<br />
offerings to patients<br />
(see below and the Hoya<br />
story on p3). All of which clearly demonstrated that<br />
innovation is thriving in the industry.<br />
NZ Optics’ Lesley Springall talking frames with Xavier Garcia<br />
Paperstyle<br />
Demonstrating this innovation, and something<br />
a little bit different from the host of acetate,<br />
wood, horn and metal frame manufacturers,<br />
was Paperstyle, a South Tyrolean brand of paper<br />
eyewear, made entirely by hand.<br />
Through a patented process, premium paper<br />
(15 to 18 sheets) is pressed, glued, vacuum-dried<br />
and shaped with special milling machines. The<br />
outcome is amazing; a moldable, durable, but very<br />
lightweight product that can be customised to<br />
whatever the customer desires, with many using<br />
their own photographs as the basis of their, highly<br />
personalised, new frame designs.<br />
Monkey Glasses<br />
Another frame brand that caught my eye was<br />
Monkey Glasses, with its “Save the Orangutan”-<br />
themed stand, complete with jar of yummy<br />
banana lollies, this six-year old Danish company<br />
majored on its environmental, sustainable and<br />
biodegradeable credentials. Monkey Glasses’<br />
frames are handmade and are manufactured from<br />
a special biodegradable material - cotton acetate<br />
- that can look like wood, horn or even crystal. To<br />
add to the feel-good factor, and the story that can<br />
be sold to environmentally-minded patients, is the<br />
knowledge that a percentage of every frame sold<br />
goes to support the work of Danish conservationist<br />
Lone Dröscher Nielsen’s who’s working to save the<br />
orangutans in Borneo; even the cases are made<br />
from recycled paper.<br />
Area 98<br />
Area 98 prides itself on being a “braver” brand<br />
company, featuring brands such as La Matta,<br />
Kaos and, the rather mind-blowing detailing and<br />
handmade individualism of Coco Song, inspired<br />
by the opulence of ancient Chinese dynasties,<br />
incorporating feathers, silks, lacquers, leaves and<br />
even flowers in its temples.<br />
La Matta’s new collection, launched at Silmo (and<br />
available in New Zealand through BTP) is described<br />
as “an anthem to the modern and sensual woman. A<br />
mysterious woman who likes to transform herself, by<br />
showing her personality through the accessories she<br />
wears.” The slightly accentuated temples, giving an<br />
unusual cat-eye effect, in animal-themed acetate, are<br />
decorated with small, coloured inserts at the hinges.<br />
Kaos’ new Silmo range, meanwhile, focused on<br />
colour and detail, designed to appeal to a younger<br />
audience, with their squared, rounded and oval<br />
shapes, alternating with contrasting shades or<br />
absolute black.<br />
Area 98’s Michela Del Tin, while demonstrating<br />
the latest handmade offerings from Coco Song,<br />
featuring feathers and silks embedded into the<br />
acetate temples and semi-precious stones such<br />
as lapis lazuli, said Area 98 was formed from the<br />
merging of three companies: Area 98 which is Italian,<br />
and its subsidiary company in Hong Kong, and the<br />
company’s main US distributor, Poets Eyewear. The<br />
design is divided between Italy and Hong Kong.<br />
Both La Matta and Coco Song sport very powerful<br />
decoration on the temples, but La Matta, with its<br />
animal prints, is more for the provocative, strong<br />
woman, while Coco Song is more for the elegant,<br />
dreaming woman, said Del Tin. “La Matta really<br />
wants to break the rules; there is a lot in the frames<br />
and it takes inspiration from jewellery…Kaos is the<br />
younger brother of La Matta, more unisex in style,<br />
but still colourful…they are all unified by colour.”<br />
One of La Matta’s new styles<br />
launched at Silmo<br />
Fitting Box<br />
In the Experience Store section, Fitting Box<br />
was busy demonstrating Owiz Street, it’s latest<br />
innovation in augmented reality virtual try-on<br />
technology. Designed to grab attention in a<br />
practice’s window, Owiz Street transforms the<br />
window into an interactive experience, remotecontrolled<br />
from the passing shopper’s or patient’s<br />
own smartphone. The mounted display acts<br />
like a mirror, recognising the viewer’s face and<br />
allowing them to virtually try on any eyewear<br />
CONTINUED ON P18<br />
William Morris’ Robert Morris and Claire McDonald<br />
*Claire McDonald is an optometrist and co-owner of McDonald<br />
Adams in Warkworth. This was her first visit to Silmo.<br />
Phone: 0508 FRAMES (372 637)<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
17
SPECIAL FEATURE: SILMO <strong>2016</strong><br />
CONTINUED FROM P17<br />
they select from the practice’s own range. Other<br />
products in its Owiz range include Plugin, which<br />
adds a practice’s digital frame catalogue to its<br />
website or Facebook page; Web, a web-to-store<br />
turnkey website, compatible with tablets and<br />
smartphones; and Mirror, a touchscreen mirror<br />
which allows your customer to virtually try on<br />
different frames in your collection either through<br />
a standalone mirror or iPad.<br />
WOOW, Face à Face, ProDesign and Inface<br />
Four large, very popular stands clustered around a<br />
crossroads made up the Design Eyewear Group: the<br />
French brands Face à Face, (classical architectural<br />
influence), and its younger, more affordable<br />
sister, created in 2014, WOOW. Then, the more<br />
minimalist (less flamboyant), but still eye catching<br />
Scandanavian ranges from ProDesign Denmark and<br />
Inface.<br />
Though the Design Eyewear Group had a host of<br />
staff on hand to help with enquiries, there never<br />
quite seemed to be enough and there was even a<br />
queue for Face à Face, which unusually had a totally<br />
enclosed stand, where admittance was by invite<br />
only for buyers.<br />
Distributed by Eyes Right Optical in Australia and<br />
New Zealand, the Eyes Right team Gaye Wymond,<br />
son Mark and daughter Lisa, were hard at work<br />
buying exciting new stock for the coming season.<br />
Face à Face – Akiko 2<br />
William Morris<br />
William Morris’ popular and busy stand was<br />
dominated with an iconic British double-decker red<br />
bus that doubled as a selling and ordering platform<br />
(the top floor of the bus), office and storage room<br />
and made it crystal clear to the whole show what<br />
the company was all about.<br />
The wonderful founder and designer Robert<br />
Morris (he thought his middle name, William,<br />
sounded more British) was on flamboyant form<br />
WOOW’s colourful stand Sabine Pretz from PaperStyle Michela Del Tin, shows off Coco Song’s amazing frames<br />
welcoming Kiwi optometrist Claire McDonald and<br />
myself to the stand as if we were long lost friends.<br />
Centre stage was William Morris’ new Wills<br />
collection, aimed at a younger audience, the<br />
collection has a retro look and is light and carefully<br />
crafted in easy-to-wear shapes and energetic<br />
colours, to show off the wearer’s personality, but<br />
with a feel that treats older children more as adults.<br />
“Kids don’t want to be kids,” said Morris. “We<br />
are targeting kids between 9 and 12 who want to<br />
look like their grown-up brother or sister, so there’s<br />
nothing childish about our kid’s range…it’s very<br />
sophisticated.”<br />
Another highlight was the company’s new Autumn<br />
and Winter collection, which takes its inspiration<br />
from the heart of London and is backed by an eyecatching<br />
advertising campaign featuring British<br />
bulldog Quincy. These British credentials are key<br />
to the success of the brand and Morris says one<br />
of things he’s most-proud of is being selected as<br />
the only eyewear brand in the UK to be allowed to<br />
be part of the GREAT Britain campaign, allowing<br />
it to use the “FASHION IS GREAT Britain” logo and<br />
imagery, and be part of the country’s drive to<br />
reposition itself as a vibrant, inspiring and innovative<br />
place; an honour it beat several other well-known<br />
British brands such as Victoria Beckham and Paul<br />
Smith for and will hold for the next five years.<br />
Xavier Garcia<br />
Xavier Garcia himself, took time out to show some<br />
of his new Autumn-Winter collection, featuring<br />
seven new acetate designs and four new metal<br />
designs, grouped together as “the Skin collection”,<br />
because they are made from thin metal sheets<br />
known as “skins”.<br />
He says he’s often asked by journalists what his<br />
inspiration is for each new collection to which<br />
he likes to reply: “There is no inspiration, there is<br />
always work, work, work.” But he says he has been<br />
inspired by metal in this collection, and particularly<br />
the use of layering with the metal skins, so that the<br />
design becomes part of the structure. His “Heidi”<br />
model, for example, features a round shape with a<br />
double bridge and a clever inner “skin” on the top<br />
bar of the bridge; “Helen” uses skins along the front<br />
to evoke the “flutter of dragonfly’s wings”; while<br />
“Landa” has a distinctly masculine air created by the<br />
inner skin, which lines the bar at the front, creating<br />
a colour contrast.<br />
Xavier Garcia’s “Heidi” frame demonstrating his metal “skins” design<br />
Jono Hennessy<br />
Jono Hennessy Sceats, his son Jasper and Peter<br />
Grunfeld were manning the Jono Hennessy<br />
stand at Silmo and attracting a lot of attention<br />
particularly for the Australian company’s new<br />
Carter Bond styles, featuring fine wood-look<br />
profiles with split metal temples in natural<br />
finishes. The company’s “upside down round<br />
THE INSPIRATION OF SPANISH DESIGNER<br />
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✖ quality<br />
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18 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
Jono Hennessy Sceats and his son, and brand manager, Jasper<br />
eye” was particularly eye catching and would suit<br />
anyone, agreed Hennessy Sceats. On the Jono<br />
Hennessy side, the company was using more<br />
combination constructions, featuring interesting<br />
temples and changing some of the colours to<br />
matt finishes, so it’s a more modern finish. “The<br />
big thing that’s happening is everything is round<br />
now, and smaller rounds,” says Hennessy Sceats.<br />
“And everything has to have more detailed<br />
construction now, which is a worldwide trend<br />
to distinguish the quality of the frames and<br />
make the patient feel special.” The company now<br />
exports more than 50% of its range to Europe and<br />
says Silmo is its key sales fair.<br />
TO BE CONTINUED…with so much to see,<br />
we couldn’t fit it all in. Part II of Silmo<br />
<strong>2016</strong> will be in our December issue.<br />
Silmo endures, expands<br />
Given the terrible<br />
Paris terrorist<br />
attacks at the<br />
end of last year, Silmo<br />
organisers had feared<br />
its flagship exhibition,<br />
showcasing more than<br />
1,350 optical industry<br />
brands, would not attract<br />
anywhere near the same<br />
numbers as last year,<br />
especially as many other<br />
shows in the region had<br />
poor visitor numbers in the<br />
preceding months.<br />
But the optical industry<br />
is obviously a hardy lot<br />
as visitor numbers were<br />
down just 1.3% on last<br />
year, to 33,791, including<br />
56.5% from abroad and<br />
43.5% from France. Plus,<br />
given the obvious activity<br />
on most stands, it looks like orders are unlikely to<br />
be affected and could even be up on last year, says<br />
director Éric Lenoir.<br />
Last year’s show saw the launch of a new concept,<br />
new image and new look, so changes to this year’s<br />
show were more minor, he says, with tweaks to do<br />
with hospitality and layout as part of the organisers’<br />
continual focus to improve the experience for both<br />
visitor and exhibitor alike. There was, however,<br />
more focus on the “phygital” - convergence of<br />
physical and digital – exhibition side, with an<br />
expanded Experience Store, demonstrating how<br />
optometry businesses, and those who serve them,<br />
can incorporate more digital solutions into their<br />
practices, allowing them to “get smarter” about<br />
how they serve their patients and increase revenues.<br />
Sporting the latest trend in his own eyewear -<br />
round, retro-looking frames from Lafont - Lenoir<br />
says next year’s show from 6-9 October, 2017,<br />
however, will be something special as it will be the<br />
50th anniversary of Silmo Paris; a company he is<br />
still completely passionate about after working for<br />
it for more than 21 years, having joined straight<br />
Silmo Sydney event organiser Gary Fitz-Roy with Silmo director<br />
Eric Lenoir<br />
from college. “I love it. We<br />
are dealing with fashion,<br />
technology, health. It is<br />
a brilliant mix, and even<br />
though it’s a big show, with<br />
a lot of people, it’s a small<br />
family. The optics world<br />
is not that big in terms of<br />
world turnover, but it’s so<br />
creative, so innovative and<br />
every season there is always<br />
a surprise, and it’s a serious<br />
product – because if I didn’t<br />
have my glasses I couldn’t<br />
see you,” he laughs.<br />
Silmo overseas<br />
He is also excited about<br />
Silmo’s international<br />
expansion. After just two<br />
years Silmo Istanbul - a<br />
joint venture with a Turkish<br />
optics media company<br />
and Silmo’s first foray abroad – has made all its<br />
targets, has most, if not all, of the local companies<br />
exhibiting and is now attracting interest from other<br />
countries in the region, including the Middle East,<br />
Africa and North-East Asia. While the new Silmo<br />
Sydney show is set to launch in March next year.<br />
Exporting the brand gives Silmo an opportunity<br />
to grow, says Lenoir. It also helps Silmo Paris attract<br />
more visitors as the exhibitors at Silmo Istanbul, for<br />
example, are the wholesalers and distributors from<br />
the region and thus the most likely visitors to Paris.<br />
He’s expecting the same to happen with Silmo<br />
Sydney. There’s a lot of opportunity in the region<br />
as the market, both for small and new exhibitors<br />
and the level of choice on show for the practices<br />
and stores themselves, has been a bit controlled by<br />
the Australian Optical and Wholesalers Association<br />
(ODMA), which, until 2017, had run the main show<br />
in the region every two years, he says.<br />
Silmo is looking at other areas for expansion,<br />
including South East Asia and South America, both<br />
of which are currently poorly served in the optics<br />
arena, says Lenoir. ▀<br />
<strong>2016</strong> Silmo d’Or<br />
Awards<br />
Silmo’s <strong>2016</strong> Silmo d’Or Awards night was<br />
a festive evening liberally fuelled with<br />
canapés and champagne. Belgian designer<br />
Alain Gilles and Silmo president Phillippe Lafont<br />
announced the awards, designed to recognise<br />
and reward the creativity and innovation of the<br />
industry, amid a cabaret of singing, dancing,<br />
visual light illusions and a bubble man at the<br />
Maison de la Mutualité in central Paris. The<br />
award winners were:<br />
● Children: KNCO for “Bili” by Karavan Kids<br />
Sport Equipment: Demetz for “Lazer-Run”<br />
● Low Vision: special prize: Visiole for “Go<br />
Vision”; Essilor for “My Eye”; and Ceciaa for<br />
“NuEyes”<br />
● Frame Technological Innovation: Oxibis Group<br />
for “77H” by Exalto<br />
● Premiere Classe prize: Pride Eyewear for<br />
“305 BL”<br />
● Material/Equipment: Netlooks for “Netlooks<br />
3D”<br />
● Vision: Essilor for its “Eye Protect System”<br />
● Sunglasses: Parasite Design for “Anti Retro X”<br />
● Optical Frame: Blake Kuwahara for “Khan”<br />
● Jury Special Prize: Kuboraum for “Maske E3”<br />
Pride Eyewear’s “305 BL”<br />
Kuboraum’s<br />
“Maske E3”<br />
Blake Kuwahara’s “Khan”<br />
More than 75 years after its creation,<br />
Lacoste has become a lifestyle brand<br />
which exemplifies elegance and comfort.<br />
Lacoste looks at life in an optimistic way by<br />
telling itself it is a beautiful sport: a sport in<br />
which you compete with elegance, show<br />
off your panache, and combine a quest for<br />
performance with an eye on elegance.<br />
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customerservice@genop.co.nz<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
19
Orthokeratology Society of Oceania Conference <strong>2016</strong><br />
BY ALEX PETTY*<br />
The Orthokeratology Society of Oceania (OSO)<br />
is the longest running group dedicated<br />
to the practice of fitting ortho-k contact<br />
lenses in the world. In September <strong>2016</strong>, Surfers<br />
Paradise played host to the 12th Biennial Congress<br />
of the OSO and combined this with the 5th<br />
Annual Congress of the International Academy of<br />
Orthokeratology and Myopia Control. Both of these<br />
independent, non-profit organisations exist to<br />
promote research, professional development and<br />
safe-practice in the field of orthokeratology and<br />
reduce the impact of the global myopia epidemic.<br />
The OSO conference is always a highlight of the<br />
calendar for me as it attracts a certain breed of<br />
highly passionate and motivated practitioners.<br />
Close to 300 orthokeratologists from around<br />
the world made their way to the Gold Coast this<br />
year, making it the largest OSO conference to<br />
date. It was especially pleasing to see a strong<br />
New Zealand contingent, which highlights the<br />
commitment Kiwi optometrists have to offering<br />
cutting-edge treatment options and long-term<br />
eye care to their patients. The meeting attracted<br />
international speakers from around the globe,<br />
including America, Europe and Asia as well as local<br />
experts from Australian and New Zealand-based<br />
universities and private practices.<br />
As always the content of the lectures was<br />
enlightening and each session was broken down<br />
into key areas including: myopia control, beginners<br />
and advanced orthokeratology fitting, problem<br />
solving, specialised ortho-k fitting, latest research<br />
and scleral lens fitting. It is perhaps no surprise<br />
that discussion around myopia control was the<br />
focus of many of these talks, as orthokeratology<br />
lenses are a key treatment in the fight against<br />
rampant myopia development in our children.<br />
Staggeringly, predictions suggest that 10% of the<br />
world’s population will have high myopia by 2050,<br />
a 4x increase in prevalence since 2000. As we know<br />
the risk of ocular disease increases dramatically at<br />
these levels of myopia. It is fortunate that these<br />
days we have the treatments to prevent someone’s<br />
retinal detachment or maculopathy later in life: as<br />
a profession we just need to start offering them.<br />
The main message I took home from the<br />
Congress is that reports out of Asia from<br />
practices and hospitals that have been controlling<br />
myopia for several decades suggest that the<br />
myopia control effect of atropine drops is overestimated.<br />
Speciality ortho-k lenses with small<br />
diameter treatment zones designed for the young<br />
progressing myope show significantly higher<br />
myopia control rates than conventional ‘adult’<br />
ortho-k lenses. These are the main treatment<br />
modality employed by these centres. It is<br />
imperative that we stay as updated as possible<br />
when it comes to myopia control. Simply fitting<br />
a standard orthokeratology lens or giving a<br />
prescription of 0.01% atropine may not be an<br />
optimal myopia control strategy for your young<br />
patients.<br />
The shock of the conference came at the<br />
conclusion of Australian ortho-k guru John<br />
Mountford’s lecture. Following a straight-talking<br />
and scientifically robust account of the modern<br />
advances of astigmatic ortho-k (including an<br />
amusing mis-credit of a photo to a certain Kiwi<br />
optometrist by the name of Alex Perry) John<br />
finished by saying it would be the last lecture<br />
he would ever give. John has been one of the<br />
pioneers of orthokeratology worldwide and was<br />
instrumental in starting the OSO several decades<br />
ago. He has researched and lectured extensively on<br />
the topic and is the principal author of the ortho-k<br />
bible Orthokeratology: Principles and Practice.<br />
John received a standing ovation from the floor<br />
followed by a heartfelt speech from OSO president<br />
Gavin Boneham thanking John for his commitment<br />
and passion over the years.<br />
The other uncanny quality about<br />
orthokeratologists is that they all know how to<br />
have fun! There were numerous opportunities<br />
for networking and letting one’s hair down<br />
throughout the conference, including a meet-thespeakers<br />
drinks by the exotic Marriott lagoon pool<br />
and the Gala Dinner held in the luxurious hotel<br />
ballroom on the Saturday night. The Gala Dinner<br />
had an Olympics theme and involved a range of<br />
‘events’ throughout the night that each country/<br />
table competed in. I’m sad to report that our New<br />
Zealand All Blacks table finished middle of the pack,<br />
but at least we beat Australia! Ortho-k Olympics<br />
powerhouse Latvia took out the gold medal.<br />
I would encourage anyone with an interest in<br />
speciality contact lenses or myopia control to<br />
attend the next conference in two years. It is truly<br />
a unique gathering of like-minded individuals and I<br />
challenge even the savviest practitioner to leave the<br />
conference without some insightful pearls of clinical<br />
wisdom to apply in their practice. Thanks to the OSO<br />
committee, including our NZ liaison Jagrut Lallu, for<br />
organising another successful event. I know I speak<br />
for a number of practitioners when I say we can’t<br />
wait for the next one.<br />
I also implore health care practitioners here<br />
in NZ; optometrists, ophthalmologists, general<br />
practitioners and paediatricians, to sit up and<br />
take responsibility for the young myopes in our<br />
community. I don’t believe it is good enough to<br />
ignore myopia progression in the 21st century.<br />
Simply prescribing single vision spectacles or single<br />
vision soft contact lens has been shown to worsen<br />
myopia progression and increase the risk of ocular<br />
disease later in life. If you are not confident or wellequipped<br />
to offer effective and proven myopia<br />
control treatment options to your patients, please<br />
refer these patients to a colleague who can assist<br />
them. A list of OSO members in New Zealand can<br />
be found at www.oso.net.au<br />
Clinical summary<br />
Myopia control<br />
Fabian Conrad from the Brian Holden Vision<br />
Institute shared some startling statistics about the<br />
myopia epidemic: 50% of the world population<br />
will be myopic by 2050, which carries a significant<br />
social and economic burden. Currently disease due<br />
to myopia is the #1 cause of blindness in Japan<br />
and Shanghai. Mathematically reducing the rate<br />
of myopia progression by 50% will decrease the<br />
amount of myopia over 5.00D by 97%.<br />
Zhi Chen, a physician from Fudan University<br />
Hospital in Shanghai, informed us that the choroid<br />
will change in thickness within hours to match<br />
the eye’s defocus. He cautioned against reading<br />
too much into axial length measurements as a<br />
decrease over time may not rule out an increase in<br />
myopia.<br />
Continuing the choroidal thickness theme<br />
our very own John Phillips from the University<br />
of Auckland shared some fascinating insights:<br />
-2.00D and +2.00D of blur changes choroidal<br />
thickness by 20μm after just an hour. Experiments<br />
suggest atropine prevents the choroidal thinning<br />
response, a clue to its mechanism as a myopia<br />
retardation agent. A novel multifocal ortho-k<br />
lens design caused an immediate and sustained<br />
increase in choroidal thickness when compared to<br />
a conventional lens. This highlights the potential of<br />
new ortho-k lens designs to combine with atropine<br />
drops for optimal efficacy of myopia control.<br />
Spanish optometrist and researcher Jacinto<br />
Santodomingo-Rubido showed that in a<br />
Melbourne based study 64% of young ortho-k<br />
patients had a total arrestment of myopia over 5+<br />
years. In a study of his own 33% of ortho-k patients<br />
had a decrease in axial length after eight years,<br />
although this was not statistically significant due<br />
to the low sample size.<br />
Francoise Rateau reflected on her experiences<br />
treating myopia with atropine in her private<br />
practice. She had found that 50% of her patients<br />
did not require further atropine drops to halt<br />
their progression beyond 15 years of age, and 70%<br />
beyond 18 years. She also observed that 0.01%<br />
atropine was not as effective for children younger<br />
than nine years or for patients with high myopia.<br />
Paul Gifford, an Australian researcher shared some<br />
of the undertakings he has been working on to<br />
offer online tools for the practitioner and public to<br />
understand myopia and how<br />
to prevent it. These are great<br />
resources and can be found at<br />
www.myopiaprofile.com and<br />
www.mykidsvision.org<br />
Rob Gerowitz, American<br />
practitioner, ran through some<br />
relevant research in the field of<br />
ortho-k and myopia control.<br />
Patients with two myopic<br />
parents have a 5x increased<br />
risk of myopia and the risk<br />
of microbial keratitis is 7.7<br />
incidences per 10,000 patient<br />
years, a similar figure to<br />
other overnight contact lens<br />
modalities. These risks can be<br />
decreased with correct hygiene<br />
and lens care behaviours.<br />
The Sydney Myopia Study<br />
showed that higher levels<br />
of time spent outdoors was<br />
associated with less myopia.<br />
Scott Read from QUT<br />
Optometry School described his<br />
novel study using wrist-band<br />
light meters. Myopes showed<br />
less light exposure than the<br />
non-myopes and there was<br />
59% faster axial eye growth<br />
in the children classified as<br />
having low-light exposure<br />
over the course of the study.<br />
He suggested children should<br />
still be encouraged to wear<br />
sunglasses outside as the lux<br />
OSO and IAO board members<br />
level behind a sunglass was still in excess of that<br />
received when indoors.<br />
Orthokeratology<br />
Helen Swarbrick, esteemed leader of the ROK<br />
research group at QUT, gave compelling evidence<br />
to prove that orthokeratology does not bend the<br />
stroma, but only changes the thickness of the<br />
epithelial layer. An insignificant 5μm increase in<br />
corneal thickness is observed after ortho-k wear<br />
which is consistent with ~1% corneal swelling due<br />
to hypoxic oedema.<br />
Kate Gifford, Optometry Australia president,<br />
showed us some of her PhD research looking into<br />
the binocular vision effects of orthokeratology.<br />
Her results showed that ortho-k lenses decreased<br />
accommodative lag and decreased esophoria,<br />
whilst increasing spherical aberration in the visual<br />
system. It is thought that these effects contribute<br />
to the myopia control effect of orthokeratology<br />
lenses.<br />
Randy Kojima, an academic from Vancouver who<br />
has lectured extensively on behalf of Medmont,<br />
highlighted some key aspects to using topography<br />
to fit rigid contact lenses. He illustrated how<br />
the elevation plot on a topography is crucial<br />
to predicting where a lens may decentre and<br />
suggested modification to lens parameters may<br />
be required when a perfectly fitting lens does not<br />
behave as expected.<br />
Jaume Pauné Fabré, another Spaniard and<br />
chairman of the European Ortho-K Fellowship,<br />
analysed the results of Eddie Chow’s study into a<br />
new myopia control orthokeratology lens design<br />
with a smaller aspheric back optic zone. His results<br />
showed that the treatment zone gave a better<br />
myopia control effect in low levels of myopia.<br />
Pieying Xie, director of the Beijing Beiyi<br />
Optometry and Ophthalmology Centre, showed<br />
evidence answering the question of what happens<br />
after long-term ortho-k lens wear is discontinued.<br />
There was no significant increase in myopia in<br />
these patients, giving us confidence that myopia<br />
will not ‘catch-up’ after cessation of treatment.<br />
Pat Caroline, associate professor at Pacific<br />
University College of Optometry, explored the<br />
myopia control optics of orthokeratology lenses.<br />
He reasoned that a lens with a larger ring of midperipheral<br />
corneal steepening leads to larger blur<br />
circles at the retinal level. This optical affect may<br />
have an effect on the dopamine-storing amacrine<br />
Kiwi delegates relaxing by the pool Sarah Stevens, John Phillips, Damien Koppens, Sarah Tait and<br />
Alex Petty<br />
Some kiwi and not so kiwi All Blacks: Andrew Sangster, Alex Petty,<br />
Stephanie Fox, Eleisha Finlay, Charl Lass (SA), Jake Brown (AUS).<br />
The Marriott lagoon pool<br />
cells in the peripheral retina. Increased dopamine<br />
in animal models has been shown to decrease<br />
axial eye growth, a clue to the mechanism of how<br />
peripheral myopic defocus may signal the eye to<br />
stop growing.<br />
Scleral lenses<br />
Steve Vincent, senior lecturer at QUT Optometry<br />
School, gave a fascinating insight into current<br />
research surrounding hyopixia and scleral lens<br />
wear. Although theoretical models predict most<br />
scleral lens designs should lead to hypoxia and<br />
resultant corneal oedema, clinical research<br />
suggests that oedema following scleral wear is<br />
less than 1.7%, approximately half that could be<br />
expected. Research has also shown that decreased<br />
lens thickness and decreased lens clearance had<br />
no effect on corneal swelling in a high Dk material.<br />
It should be noted that these tests were done on<br />
healthy eyes. The same conclusions may not be<br />
valid in a compromised cornea, the patients that<br />
often have the most to gain from scleral lens wear.<br />
Pat Caroline gave a second talk exploring<br />
the scleral shape and concluded that corneal<br />
astigmatism does not predict scleral toricity. The<br />
majority of patients have a scleral shape that is<br />
best fitted with a toric or quadrant specific scleral<br />
lens for centration and comfort. He also posed the<br />
idea that overnight scleral wear may be a great<br />
option to manage persistent epithelial defects. In<br />
these case the 10% overnight corneal oedema is<br />
acceptable if the post-lens tear film is replenished<br />
twice daily. ▀<br />
OSO President Gavin Boneham<br />
OSO NZ liaison Jagrut Lallu chairs the panel discussion with Nitesh<br />
Barot, Ken Kopp, Lachlan Scott-Hoy and Jaume Pauné Fabré<br />
Jason Anderson from Medmont showing the tear film analyis function<br />
of the E300 topographer. with Brian Naylor looking on.<br />
*Alex Petty is a New Zealand optometrist based in Tauranga with<br />
a particular interest and knowledge in speciality contact lenses,<br />
ortho-k and myopia control.<br />
20 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
Dining for VOSO<br />
Volunteer Ophthalmic Services Overseas (VOSO) was honoured<br />
to be the chosen charity during the month of October for<br />
Meredith’s Dine by Donation night, something VOSO had not<br />
been involved in before.<br />
Meredith’s, the intimate Dominion Road restaurant in Auckland<br />
owned and run by chef Michael Meredith, holds a regular Dine by<br />
Donation event every Tuesday to raise money for charitable groups and<br />
organisations across Auckland. The boutique dining location say they<br />
offer degustation only menu’s, paired with ‘superb wine’ and ‘inviting<br />
hospitality’.<br />
The first Tuesday of October saw the restaurant fully booked out<br />
by VOSO supporters, including Dr Shuan Dai, Darryl Eastbrook, Kylie<br />
Dreaver, John Tarbutt, Dr Rosie Murdoch and Maryanne Dransfield.<br />
Although, at the time of going to press, the full amount raised<br />
during the month of October had not yet been tallied, Meredith’s has<br />
indicated that Dine by Donation raises around $2000 each Tuesday for<br />
the chosen charity.<br />
“Michael Meredith is a wonderful man, who is also behind the<br />
Eat My Lunch project,” said VOSO secretary Kylie Dreaver, who was<br />
instrumental in organising the event. “The funds raised will be used for<br />
continuing the great work VOSO does next year. VOSO is planning to<br />
travel to Fiji, Samoa and Tonga.”<br />
Mike Frith, Ramana Malavarapu, Mark Dromgoole, Kylie Dreaver, Richard Johnson, Rosie Murdoch,<br />
John Tarbutt and Bob Kinnear<br />
Dreaver was overwhelmed by the positive response from the charity’s<br />
supporters and the great atmosphere.<br />
“The food was amazing and I have wanted to dine here for ages,” said<br />
Dreaver. “I am delighted so many people have come out to support<br />
VOSO. It is very appreciated.” ▀<br />
Brng Liang, Brn Duan, Hong Duan and Dr Shuan Dai<br />
First New Zealand ortho-k fellows<br />
Four New Zealand optometrists, Jagrut Lallu (Hamilton),<br />
Eleisha Dudson (Wellington), Alex Petty (Tauranga) and<br />
Shonit Jagmohan (based in Melbourne), were made fellows of<br />
the International Academy of Orthokeratology at the recent OSO<br />
and IAO congress in Surfers Paradise. These four orthokeratologists<br />
are the first New Zealanders to attain this honour.<br />
The FIAO (Fellow of the International Orthokeratology Academy)<br />
is the gold standard for practitioners of orthokeratology.<br />
Fellowship status in the academy is determined by practitioner<br />
experience and expertise and follows a rigorous case evaluation<br />
and testing procedure over the course of several years.<br />
Orthokeratologists who achieve fellowship status are committed<br />
to adhering to the highest standards of care in this specialty and<br />
are required to possess and demonstrate the highest level of<br />
knowledge, ethics and patient care with respect to the practice of<br />
orthokeratology. Fellows also serve as mentors and role models for<br />
new ortho-k practitioners.<br />
There are now a total of nine fellows of the academy in Australia<br />
and New Zealand, who join an international cohort of experts<br />
throughout the world. ▀<br />
The first NZ fellows of the International Academy of Orthokeratology (L to R) Shonit Jagmohan, Eleisha<br />
Dudson, Jagrut Lallu and Alex Petty with Gavin Boneham, OSO president who also was made a fellow<br />
(centre with tie) and new Australian fellow Celia Bloxsom (far right)<br />
Daryl Eastabrook, Helen Eastabrook, Joheen Dagg and Maria Pais<br />
John Tarbutt, Sandra Cameron, Helen Beckwith, Victoria Elias, Colin Beckwith, Hamish<br />
Caithness, Linda Tarbutt and Clint Bird<br />
Mike Frith, Phillippa Pitcher and Jasha Morarji<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
21
New shore clinic for Auckland Eye<br />
Auckland Eye opened its new North Shore<br />
clinic and operating suite at 3 Fred<br />
Thomas Drive, Takapuna, at the end of<br />
August, followed by a launch celebration on 22<br />
September. Auckland Eye’s doctors work from<br />
14 clinics around the Super-city, and while this<br />
facility is brand new, it replaces a previous clinic<br />
in the Takapuna area.<br />
“I’ve had a surgery of some sort in Takapuna<br />
for the best part of 20 years,” says Dr Archie<br />
McGeorge. “But around 10 years ago we<br />
transferred most of our ‘North of the bridge’<br />
Drs John Russell, Jenni Waddell and John Arcus<br />
Xieda Man, Varny Ganesalingam, Naomi Bicheno and Alex Bicheno<br />
activity to Albany, where we had a hub. But we<br />
still had a small, 50sqm clinic at 2 Fred Thomas<br />
Drive, Takapuna, which was very popular.”<br />
When Dr McGeorge discovered, thanks to local<br />
optometrist Martin Davey, that a 400sqm site<br />
was to become available next door, at No 3 Fred<br />
Thomas Drive, he took the idea of creating a new,<br />
state-of-the-art hub in Takapuna to the other<br />
shareholders. To Dr McGeorge’s delight, his idea<br />
was supported.<br />
“Our previous premises were restricted to<br />
one person, there wasn’t much space, and<br />
any patients for surgery had to<br />
come down to Remuera,” says Dr<br />
McGeorge. “We’ve been wanting<br />
to develop operating facilities<br />
on the shore for a long time, and<br />
Takapuna is a great, centralised<br />
location – close to the bus station,<br />
the motorways, and we now have<br />
free parking for 34 cars.”<br />
The new, purpose-designed-andbuilt<br />
facility has four state of the<br />
art consulting rooms, plus a fully<br />
equipped operating theatre.<br />
“We’re starting with cataract<br />
surgery, which of course is a key<br />
service of ours, but we have the<br />
equipment here for a variety of<br />
operations, from diabetic laser to<br />
vitrectomy,” says Dr McGeorge. “By<br />
next year we expect to have the<br />
facilities required to cover all adult<br />
eye surgery at North Shore.”<br />
This will be good news for the<br />
often older demographic who<br />
may not wish to travel across the<br />
bridge. While the new clinic will<br />
serve Auckland as far north as<br />
Warkworth, there will still be a<br />
small, regional consulting clinic in<br />
Albany where the old hub used to<br />
be.<br />
Auckland Eye doctors working<br />
from the premises include Drs<br />
Stuart Carroll, Dean Corbett,<br />
Archie McGeorge, Yvonne Ng, Sue<br />
Ormonde and Alison Pereira, and<br />
the clinic is open five days a week.<br />
Prior to the opening,<br />
the site was blessed<br />
at a dawn ceremony,<br />
attended by staff and<br />
contractors on Friday<br />
26 August.<br />
During design, the<br />
team at Focusplan<br />
addressed common<br />
difficulties sight<br />
impaired often<br />
encounter. As a result,<br />
flooring materials,<br />
surface colours and<br />
lighting has been<br />
carefully selected to<br />
help guide patients<br />
through each space.<br />
The launch party<br />
saw around 100<br />
invited guests,<br />
including local GPs<br />
and optometrists,<br />
enjoy a short tour of<br />
the facility and hear<br />
Dr Corbett explain<br />
Auckland Eye’s plans for the future.<br />
“There’s plenty of room for expansion here,”<br />
says Dr McGeorge. “And we are looking forward<br />
Dr Dean Corbett and nurses Jillian and Miriam in the new theatre. The team were the first team to operate at<br />
Auckland Eye North Shore<br />
to offering a full range of ophthalmic services<br />
on the North Shore. This is a quantum leap from<br />
anything we’ve had on the shore before.” ▀<br />
Silmo Sydney organiser recognised<br />
Gary Fitz-Roy, managing director of<br />
Expertise Events, organiser of Silmo<br />
Sydney, was recognised as a Paul Harris<br />
Fellow, following the efforts of Expertise Events<br />
in facilitating a nationwide initiative to raise<br />
awareness to the risks of macular degeneration.<br />
Through the programme, Expertise Events<br />
distributed 500,000 Amsler Grid cards, a simple<br />
test people can use to see if they are at risk of<br />
macular degeneration. The cards were distributed<br />
at a number of needlecraft consumer events<br />
organised by Expertise Events in Australia.<br />
“We worked with Rotary Club Victoria member,<br />
Jeannie Handsaker, to distribute the cards at our<br />
craft events and set up a designated area where<br />
eye specialists had the opportunity to educate<br />
people on how to effectively complete the test,”<br />
said Fitz-Roy in a statement. “We recognised<br />
these events host the demographic most at risk<br />
of macular degeneration.”<br />
Established in 1957, The Paul Harris Fellow<br />
recognition acknowledges individuals who<br />
contribute, or who have contributions made<br />
in their name, of US$1,000 plus to The Rotary<br />
Foundation of Rotary International.<br />
See associated picture and Silmo story on p19 ▀<br />
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22 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
‘A celebration of research’<br />
The 10th annual HealtheX Conference<br />
was hosted by the Faculty of Medical and<br />
Health Sciences, University of Auckland, on<br />
9 September <strong>2016</strong>. Sponsored by the Auckland<br />
Medical Research Foundation (AMRF) and<br />
the Maurice and Phyllis Paykel Trust (MPPT)<br />
among others, the event was attended by over<br />
200 members of the University of Auckland<br />
community, including Vice Chancellor Professor<br />
Stuart McCutcheon and Deputy Vice Chancellor of<br />
Research Professor James Metson.<br />
This year saw around $15,000 worth of prizes on<br />
offer, including three AMRF travel awards, more<br />
than ever before at HealtheX, in what the Faculty<br />
called, ‘a day of celebration of student research<br />
conducted at the Faculty’.<br />
Among the winners were Hans Vellara and<br />
Himanshu Wadhwa from the Department of<br />
Helping<br />
Niue<br />
Eye Doctors’ and Counties Manukau<br />
specialist Dr Penny McAllum recently<br />
returned from her fifth trip to the island<br />
of Niue, where she helps provide eye care to the<br />
1400 residents.<br />
“There are usually two or three doctors on the<br />
island, which is quite a good ratio for the small<br />
population,” she says. “Niuean’s are also citizens<br />
of New Zealand, so they are entitled to treatment<br />
here as well, but by sending an eye team, more<br />
patients can have access to eye care close to<br />
home, eye disease can be identified at an earlier<br />
stage and a lot fewer patients need to travel for<br />
treatment.”<br />
Dr McAllum, together with Auckland Eye’s<br />
Dr Sarah Welch, were originally asked to help<br />
Niue by the late Dr David Murdoch, who had<br />
a particular passion for making sure underequipped<br />
Pacific regions had access to specialist<br />
eye care. Both have now been helping the island<br />
population since 2009, travelling to Niue every<br />
two years and performing mainly cataract and<br />
pterygium surgery, and providing intravitreal<br />
Avastin injections.<br />
They see patients with a variety of eye<br />
conditions, including a number of young people<br />
with keratoconus, some of whom have now been<br />
treated with cross-linking, says Dr McAllum.<br />
Last year two Counties Manukau DHB-based<br />
diabetic retinopathy photo-screeners, with a<br />
retinal camera, also came with the Niue eye<br />
team for the first time. This was a very successful<br />
addition to the service, so yearly photo-screening<br />
visits have now been instituted, with the full<br />
team undertaking surgery still on alternate years.<br />
“This year was a short trip, focused on diabetic<br />
Dr Penny McAllum, far right with Niuean colleagues Charmaine,<br />
middle, and Raina, left<br />
Ophthalmology. Vellara, whose supervisor is A/<br />
Prof Dipika Patel, was a runner up in the AMRF<br />
Doctoral Oral Presentation category for his In vivo<br />
orbital compliance in thyroid eye disease research.<br />
Wadhwa, whose supervisor is A/Prof Trevor<br />
Sherwin, was awarded second-runner up in the<br />
non-doctoral oral presentation award category,<br />
for research titled Investigating the use of corneal<br />
stem cell-enriched spheres in keratoconic corneal<br />
tissue repair.<br />
Spurred on by his success at Healthex, Wadhwa<br />
went on to win first prize for his oral presentation<br />
at the University of Auckland’s Exposure (postgraduate<br />
research) Exposition, on the same topic.<br />
Exposure is open to all currently enrolled research<br />
postgraduate students at UoA. The Healthcare Oral<br />
Competition, won by Wadhwa, was sponsored by<br />
Fisher and Paykel. ▀<br />
Over 80 patients were examined on this trip<br />
screening. It was just one diabetic photo<br />
screener, the Australia-based Niuean eye nurse<br />
and myself on this visit. We saw more than 80<br />
patients,” Dr McAllum said. “There was one lady<br />
with bad AMD and a young man with severe<br />
iritis. I referred half a dozen cataract patients<br />
back to New Zealand for treatment.”<br />
Dr McAllum always involves local doctors,<br />
whenever they are available. “The young man<br />
with iritis started treatment and responded well,<br />
but it was a good teaching opportunity for me to<br />
show the local doctors how to diagnose iritis and<br />
operate the slit lamp. This helps them manage<br />
eye patients between the team’s visits. We<br />
also keep in touch by email.”<br />
The vast majority of patients Dr McAllum<br />
saw this year were suffering from diabetic<br />
retinopathy. “Diabetes is a big problem in<br />
Niue, with about 250 diabetics in the small<br />
population. There seems to be a genetic<br />
predisposition to diabetes, but lifestyle and<br />
dietary factors also contribute.”<br />
Seven diabetic patients were referred back to<br />
New Zealand for laser or surgical treatment,<br />
while Avastin treatment was started with<br />
some others.<br />
During this trip, Dr McAllum was also<br />
interviewed by a local television crew, which<br />
featured the eye team on their news that<br />
night. “It was a great chance to get the word<br />
out in the community that diabetes can cause<br />
serious eye problems and that, as well as good<br />
control, it needs regular screening to catch it<br />
before vision is lost.”<br />
Dr McAllum says she really enjoys helping<br />
the Niueans in Niue. “Everyone is so friendly<br />
and it’s a lovely place to spend a few days. It’s<br />
a pleasure catching up with the many patients<br />
and staff who we now know quite well, and<br />
feeling like we’re making a difference to eye<br />
health in Niue.” ▀<br />
MDNZ public lecture on 9 <strong>Nov</strong>ember<br />
On 9 <strong>Nov</strong>ember, Macular Degeneration New<br />
Zealand will be hosting a free public lecture<br />
at the Auckland War Memorial Events<br />
centre and again on 15 <strong>Nov</strong>ember at the Grand<br />
Hall, Parliament, Wellington, to raise awareness of<br />
macular degeneration. The speaker will be Professor<br />
Alan Bird, a British ophthalmologist, internationally<br />
recognised as one of the pioneers of medical retina.<br />
He is a professor and consultant at the Institute of<br />
Ophthalmology at the Moorfields Eye Hospital in<br />
London, UK.<br />
Professor Bird’s talk, “The Treatment Revolution<br />
of AMD”, will take a look at how the management<br />
of AMD has changed, and is still changing,<br />
for the benefit of the patient – something he<br />
himself is very well versed in. Prof Bird created<br />
a multidisciplinary research team based at<br />
Moorfields that investigates monogenic retinal<br />
disorders and age-related macular disease.<br />
Investigative techniques include molecular genetics,<br />
electrophysiology, psychophysics, specialised<br />
imaging and morphology.<br />
This research resulted in<br />
the development of new<br />
technologies to define<br />
the clinical characteristics<br />
of retinal disease<br />
providing a clearer<br />
understanding of retinal<br />
degenerative diseases.<br />
Professor Alan Bird<br />
Prof Bird has also<br />
undertaken extensive<br />
international work in Africa on river blindness and<br />
in Jamaica on retinal changes in sickle cell disease.<br />
He has written more than 370 papers published<br />
in refereed journals as well more than 80 book<br />
contributions.<br />
The Auckland event is open to all optometrists,<br />
ophthalmologists and ophthalmic nurses, and for<br />
optometrists CPD points are being applied for. The<br />
lecture starts at 6:30pm and if you wish to attend<br />
you should email education@mdnz.org.nz. ▀<br />
VOSO visits Samoa<br />
Aside from the<br />
television<br />
advertisements<br />
showcasing tranquil<br />
island getaways,<br />
I knew very little<br />
about Samoa when<br />
I decided to take<br />
the opportunity to<br />
accompany John<br />
Tarbutt on VOSO’s<br />
annual optometric<br />
outreach trip to<br />
Samoa in August<br />
this year.<br />
We spent a week<br />
on the beautiful island of Savai’i; working<br />
at Safotu and Tuasivi hospitals; refracting,<br />
examining and giving out new and pre-loved<br />
spectacles we had brought with us from NZ.<br />
We were fortunate to be able to work with<br />
Samoa’s only resident optometrist, Fuiavailili<br />
Erna Takazawa, who is based in the capital<br />
Facilities in Samoa are very basic<br />
E Y E W E A R<br />
MERSEYBEATEYEWEAR.CO.UK<br />
BY DEVASHINI DEVANANDAN*<br />
Devashini Devanandan hard at work<br />
Apia, as well as<br />
several welltrained<br />
eye nurses<br />
at the local<br />
hospitals. For most<br />
of the year, these<br />
nurses offer the<br />
only optometric<br />
and ophthalmic<br />
care to the island’s<br />
residents.<br />
We were also<br />
able to identify<br />
many cases of<br />
pathology which<br />
were referred<br />
for ophthalmic<br />
care when the next surgical team arrive on<br />
the island. With the lack of adequate eye<br />
care, many simple pathological cases, such as<br />
cataract, pterygia and diabetic retinopathy,<br />
were in their most advanced states; to a level<br />
which we would never see in NZ. While acutely<br />
aware of how much more I would be able to<br />
offer these patients if they<br />
were in my home practice<br />
in Waikato, their gratitude<br />
for our services provided<br />
the driving force to make<br />
this appeal a success.<br />
My week in Samoa was<br />
an eye-opening experience<br />
which enabled me to<br />
appreciate the true value<br />
of the care we offer as<br />
optometrists. It was a<br />
privilege to be able to<br />
help the lovely people of<br />
Savai’i, and I encourage any<br />
interested optometrists<br />
to volunteer their time for<br />
future outreaches should<br />
the opportunity arise. ▀<br />
*Devashini Devanandan is a<br />
Cambridge-based recent optometry<br />
graduate<br />
SHOP ONLINE NOW!<br />
Get the latest models exclusively at<br />
(NZ) 0508 678 478 optiqueline.co.nz<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
23
with<br />
Prof Charles McGhee<br />
& A/Prof Dipika Patel<br />
Series Editors<br />
Age-related macular<br />
degeneration: update<br />
Background<br />
Age-related macular degeneration (AMD) is the<br />
leading cause of blindness or severe irreversible<br />
visual impairment in people over 50, in the<br />
developed world. As of 2009, 49% of the current<br />
blind foundation registrations in New Zealand<br />
were for AMD 1 . The incidence, prevalence and<br />
progression of AMD increases with age and<br />
varies by ethnicity. In the Beaver Dam Eye<br />
Study, a primarily Caucasian population, the<br />
prevalence of AMD was 10% in individuals aged<br />
55 to 64 year rising to 46% for those aged ≥<br />
75 2 . The prevalence of AMD in Asians over 55 is<br />
estimated 6.8% 3 . AMD is comparatively rare in<br />
the Asian subcontinent and Hispanic populations<br />
and is virtually unknown in African, Maori and<br />
Polynesian populations. The subtype of AMD<br />
that is seen clearly differs between ethnicities.<br />
Whilst classical AMD is seen most commonly in<br />
Causasians, polypoidal choriovasculopathy (PCV)<br />
is the commonest type of AMD seen in Asians. In<br />
2014, the prevalence of AMD in New Zealanders<br />
aged 45-85 year age group was estimated to<br />
be 184,000, numbers which are projected to<br />
increase markedly to 208,200 by 2026 4 . With the<br />
impending demographic shift towards an aging<br />
population, AMD represents a significant and<br />
increasing burden on the health care provision in<br />
New Zealand in the coming years.<br />
Risk Factors and pathophysiology<br />
It has long been recognised that the likelihood of<br />
an individual developing AMD is the result of a<br />
complex interplay of genetic and environmental<br />
risk factors; factors which are probably<br />
cumulative with respect to the risk of developing<br />
the disease. Whilst the genetics of AMD are<br />
beyond the scope of this article it is clear that<br />
certain genetic anomalies carry a significant<br />
risk for affected individuals, the classic example<br />
being complement factor H polymorphisms.<br />
Gene products for CFH play an important role<br />
in the regulation of the host immune system<br />
and individuals who carry a CFH polymorphism<br />
therefore posses a dysfunctional and “over active”<br />
immune system. This risk is not insignificant, for<br />
example individuals who are homozygous for<br />
the Y420H risk allele of CFH are known to be 7x<br />
more likely to develop AMD compared to normal<br />
controls. These results suggest that inflammation,<br />
plays a significant although as yet ill understood<br />
role in the development of AMD. Apart from age,<br />
ethnicity and genetics – strong non-modifiable<br />
risk factors – numerous studies have identified<br />
cigarette smoking to increase the risk of<br />
developing AMD. Smoking significantly increases<br />
AMD risk in a dose response relationship with<br />
the relative risk increasing in proportion to<br />
the number of pack years 5 . Smoking cessation<br />
reduces the risk of progression and thus smoking<br />
cessation remains the single most effective<br />
population intervention to reduce the burden<br />
that AMD represents.<br />
The conventional hypothesis for the<br />
development of AMD holds that the primary<br />
event in the development of AMD is dysfunction<br />
of the RPE, with build-up of drusen, RPE<br />
atrophy, ischaemia of the outer retina and<br />
ultimately the production of VEGF and subretinal<br />
neovascularization. However this conventional<br />
hypothesis ignores the role of the choroid and in<br />
particular the role that the choriocapillaris plays<br />
in the maintenance of the Bruchs/ RPE complex<br />
and the outer retina. What is now clear is that<br />
irrespective of the mechanism a thin choroid, and<br />
in particular a thin inner choroid is a significant<br />
risk factor for the development of “classical” AMD.<br />
How “risk” CFH polymorphisms and smoking fits<br />
into this story remains a matter of conjecture<br />
but it is highly likely that inflammation plays<br />
a key role in the loss of the choroicapillaris.<br />
Whether this is the primary event, or the end<br />
game of AMD needs further study but the answer<br />
to this question has huge implications for the<br />
development of new therapeutic targets in both<br />
dry and wet AMD.<br />
DAVID SQUIRRELL AND PAVANI KURRA*<br />
Classification and natural history<br />
Most readers will be familiar with the classification<br />
of AMD and recognise that AMD encompasses<br />
a wide spectrum of disease. Dry AMD is<br />
characterised by the presence of one or more of<br />
the following: presence of at least intermediate<br />
size drusen (63 microns or larger in diameter),<br />
retinal pigment epithelium (RPE) abnormalities,<br />
reticular pseudodrusen and/or of geographical<br />
-atrophy (GA) of RPE. Wet AMD is characterised<br />
by the development of subretinal and intraretinal<br />
neovascularisation. Soft drusen and pigmentary<br />
abnormalities increase with age and strongly<br />
predict progression towards advanced AMD.<br />
The risk of progression of AMD also seems<br />
to accelerate the more advanced the disease<br />
becomes. Whilst approximately 15% of patients<br />
with early AMD developed large drusen at 10<br />
years the risk of advanced AMD developing over<br />
this time period was low. However if a patient has<br />
Intermediate AMD the five year risk of developing<br />
advanced AMD increases steeply to near 20%. It<br />
is also noteworthy that patients with reticular<br />
pseudodrusen have a particularly high propensity<br />
to develop advanced AMD. The risk of a patient<br />
who has advanced AMD in one eye, developing<br />
advanced AMD in the other eye is approximately<br />
50% at five years. In all cases the risk of progression<br />
to advanced AMD, is inversely associated with<br />
choroidal thickness.<br />
Prevention<br />
By far and away the single most effective<br />
preventative strategy for the development of<br />
advanced AMD is to stop smoking. The large and<br />
hugely influential AREDS studies demonstrated<br />
that antioxidant supplements may slow the<br />
progression of moderate AMD (soft drusen<br />
and pigmentary changes) to wet AMD but the<br />
therapeutic effects are sometimes overstated.<br />
Although the relative risk reduction for patients<br />
taking antioxidant supplements was around 25%<br />
in real terms the more important absolute risk<br />
reduction was smaller at around 8%. There have<br />
also been concerns raised by some that, in a small<br />
sub-set of patients, antioxidant supplements may<br />
actually accelerate AMD. However, generally one<br />
would still advocate antioxidant supplements in<br />
all patients with moderate AMD. There is currently<br />
no evidence to suggest AREDS supplements help in<br />
halting progression of dry AMD.<br />
The reported ability of lutein, xeothanine and<br />
mesoxanthine supplementation to increase the<br />
density of macular pigments is interesting and<br />
the results emerging from the clinical trials with<br />
subjects on these supplements report better<br />
subjective and objective measures of visual<br />
functioning compared to controls. However<br />
whether such interventions actually reduce the<br />
risk of the development of AMD remains uncertain<br />
and at the present time one can only say that their<br />
role is unknown.<br />
The drug treatment of dry AMD remains an<br />
exciting area of research with a number of<br />
neuroprotective and inflammatory modulating<br />
agents the subject of large clinical trials. The<br />
technologies underpinning stem cell transplants<br />
also continue to improve and show great promise,<br />
but at the time of writing the drug treatment of<br />
dry AMD remains a story of unfulfilled promises.<br />
Wet AMD treatment<br />
It is perhaps not too much of an exaggeration to say<br />
that the use of antiVEGF agents in ophthalmology<br />
has been one of the single greatest advances in<br />
modern medicine. Certainly the advent of the<br />
antiVEGF era has transformed the outcome of<br />
wet AMD with the improvement in visual acuity<br />
observed in the key note ANCHOR and MARINA<br />
trials extending out to five years and beyond 6,7 . The<br />
question of which antiVEGF agent to use (Avastin,<br />
Lucentis or Eylea) remains the subject of debate<br />
and the choice of which drug is used in which<br />
country may have as much to do with politics and<br />
economics as it does evidence. The key note trials<br />
demonstrated that regardless of the drug used,<br />
most patients with classical<br />
wet AMD did well and,<br />
at a population level at<br />
least, there was little to<br />
choose between the agents.<br />
However as always there<br />
are nuances; not every<br />
patient responds equally<br />
well to each drug and the<br />
treating clinician needs<br />
to be prepared to switch<br />
drugs early if the agent used<br />
proves to be ineffective. One<br />
exception is that Aflibercept<br />
is more effective than the<br />
other two agents at treating<br />
patients who have the PCV<br />
variant of AMD. Currently in<br />
New Zealand avastin is the<br />
first line treatment for wet<br />
AMD, Lucentis being the<br />
funded second line agent.<br />
In <strong>Nov</strong>ember, Pharmac will<br />
announce the results of<br />
their long-awaited review<br />
of antiVEGF agents and it<br />
is anticipated that they will<br />
add Eylea to this list. The<br />
drug treatment of wet AMD<br />
continues to evolve at a fast<br />
pace and whilst it is not<br />
possible to “pick a winner”<br />
at this time, what is certain<br />
is that new, longer-acting<br />
treatments will enter the<br />
market over the coming<br />
years.<br />
Putting the excitement of<br />
emerging drug treatments<br />
to one side, currently the<br />
greatest challenge for<br />
clinicians, particularly<br />
those in the public sector,<br />
is to provide the treatment<br />
patients need. Despite<br />
innervations such as<br />
utilising trained nursing<br />
staff to deliver injections,<br />
most public eye clinics are<br />
struggling to provide the<br />
treatments their patients need. In Auckland alone,<br />
we are now providing about 20,000 appointments<br />
annually to treat wAMD, a growth in demand that<br />
has not been matched by increased resources. It is<br />
widely accepted that under treatment of wet AMD<br />
is associated with worse outcomes and MDNZ and<br />
others continue to lobby central government and<br />
local DHBs for more resources.<br />
In summary the outlook for our patients with AMD<br />
has never looked better. Challenges do however<br />
remain. Early detection and treatment is crucial and<br />
MDNZ and others continue to work hard raising<br />
awareness of AMD. Once diagnosed patients,<br />
optometrists and general practitioners need an easily<br />
accessible “fast track” referral process to ensure<br />
treatment is delivered promptly. The availability of<br />
these “fast track” services are patchy and patients<br />
often have to rely on the private sector in the first<br />
instance to get prompt treatment. Thereafter, eye<br />
clinics need the resource to provide capacity for the<br />
ongoing review and treatment of what is a chronic<br />
disease. Our score card for the management of wet<br />
AMD in New Zealand remains “heading in the right<br />
direction, but could do better” ▀<br />
About the authors<br />
* Dr David Squirrell<br />
David is a specialist whose primary interest is medical retina<br />
and AMD. David has severed as the principle investigator for<br />
numerous studies in AMD, including the key note IVAN trial.<br />
David works at Greenlane Clinical centre and Milford Eye clinic<br />
Auckland.<br />
* Dr Pavani Kurra<br />
Pavani is currently working as a junior clinical fellow<br />
in medical retina at the University of Auckland and<br />
Greenlane Clinical Centre. She also spent time undertaking<br />
ophthalmology electives at L. V. Prasad Eye Institute and in<br />
Alice Springs prior to her fellowship in New Zealand.<br />
Fig 1. (a) Colour photograph, (b) fluorescein angiogram and (c) OCT of patient with classic wet AMD.<br />
Fig 2. (a) Colour photograph, (b) infrared image and (c) OCT of a patient with reticulo-pseudodrusen.<br />
Note there are very few drusen seen on fundoscopy but marked changes are seen on the infrared<br />
image. The OCT image is characteristic with focal subretinal protrusions and a thin choroid<br />
Fig3. Five year outcome data from the CATT trial revels that patients maintain their vision into year 5<br />
with appropriate and timely treatment<br />
References:<br />
1. Blind Foundation. Blindness by cause among New<br />
Zealanders aged 50 or over. . (Blind Foundation<br />
New Zealand, Auckland, 2009).<br />
2. Klein, R., Klein, B. & Linton, K. Prevalence of agerelated<br />
maculopathy: The Beaver Dam Eye Study.<br />
Ophthalmology 99, 933-943 (1992).<br />
3. Kawasaki, R., et al. The prevalence of AMD in<br />
Asians: A systematic review and meta-analysis.<br />
OPhthalmology 117, 921-927 (2010).<br />
4. Worsley, D. & Worsley, A. Prevalence predictions for<br />
age-related macular degeneration in New Zealand<br />
have implications for provision of health care<br />
services. New Zealand Medical Journal 128, 44-55<br />
(2015).<br />
5. Khan, J., Thurlby, D., Shahid, H. & etal. Smoking<br />
and age related macular degeneration: the<br />
number of pack years of smoking is a major<br />
determinant of risk for both geographic atrophy<br />
and choroidal neovascularisation. British Journal of<br />
Ophthalmology 90, 75-80 (2006).<br />
6. Brown, D., Kaiser, P., Michels, M., Soubrane, G. &<br />
Schenider, S. Ranibizumab versus verteporfin for<br />
nAMD (ANCHOR study). New England Journal of<br />
Medicine 355, 1432-1444 (2006).<br />
7. Rosenfeld, P., et al. Ranibizumab for neovascular<br />
AMD. The New England Journal of Medicine 355,<br />
1419-1431 (2006).<br />
Dr David Squirrell<br />
Dr Pavani Kurra<br />
24 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
Glaucoma New Zealand Symposium<br />
BY DR HANNAH KERSTEN*<br />
The Inaugural Glaucoma New Zealand (GNZ)<br />
Glaucoma Symposium was held on September<br />
18 at Alexandra Park in Auckland. The<br />
Symposium was an initiative of the GNZ trustees:<br />
Professor Helen Danesh-Meyer, A/Professor Gordon<br />
Sanderson, Dr Sam Kain and Dr Mark Donaldson.<br />
It was the first full day optometry education event<br />
in New Zealand focussed solely on glaucoma. The<br />
Symposium was timely given the increasing role<br />
of therapeutic optometrists in the management<br />
of glaucoma. Thanks to our Silver Sponsors, AFT<br />
Pharmaceuticals, Clinicians, and Ophthalmic<br />
Instruments. Other supporters included Device<br />
Technologies and Toomac Opthalmic.<br />
The overall theme of the Symposium was<br />
Glaucoma – from Diagnosis to Management and<br />
the programme was divided into four sections.<br />
Dr Mark Donaldson welcomed the more than 90<br />
delegates, who came from all over New Zealand,<br />
and one who travelled from Australia. The<br />
academic programme commenced with a section<br />
on Glaucoma Diagnosis and was opened by Dr<br />
Shenton Chew, who spoke about risk factors for<br />
glaucoma and the importance of early detection<br />
in order to avoid permanent visual loss. Dr Chew<br />
also outlined the role of ocular perfusion pressure<br />
and intracranial pressure in glaucoma progression.<br />
This presentation was followed by an entertaining<br />
overview of disc assessment (described as a<br />
‘complex beast’) by Dr Kain. His analogies to<br />
the character Homer Simpson provided useful<br />
insight into the importance of looking at disc size,<br />
regularity of the neuro-retinal rim (the donut) and<br />
symmetry between the eyes. Dr Geraint Phillips<br />
of the School of Optometry at the University<br />
of Auckland tackled the challenging topic of<br />
visual field progression in glaucoma, including<br />
the difficulty in determining the optimum<br />
number of visual field tests (always a patient<br />
favourite) needed. Dr Jesse Gale kindly travelled<br />
from Wellington for the Symposium. His first<br />
presentation beautifully outlined conditions that<br />
Jonathon Taylor from Invercargill and Niall McCormack from Hastings<br />
Gary Filer, Dr Hussein Patel and Dr Graham Reeves<br />
may mimic glaucoma, including compressive optic<br />
neuropathies. Dr Alex Buller from Hawke’s Bay<br />
gave a hugely informative presentation, complete<br />
with a number of excellent videos, on the difficult<br />
topic of gonioscopy, considered to be the gold<br />
standard of anterior chamber angle assessment.<br />
The angle theme continued into the next talk,<br />
another by Dr Chew. He informed us of some large<br />
studies soon to be published that may change the<br />
way that patients with narrow angles or angle<br />
closure glaucoma are referred and managed. Dr<br />
Graham Reeves closed the first session with an<br />
excellent talk on the Disc Damage Likelihood Scale,<br />
developed by glaucoma guru Dr George Spaeth.<br />
This emphasised that it is essential to pay close<br />
attention to the rim to disc ratio, taking the size of<br />
the optic disc into account.<br />
Session two was all about Special Issues in<br />
Glaucoma. Professor Charles McGhee gave an<br />
illuminating overview of corneal conditions<br />
associated with glaucoma, particularly the ICE<br />
syndromes. I discussed the management of<br />
corticosteroid induced glaucoma and ocular<br />
hypertension, which is extremely common in<br />
patients on long-term topical steroid therapy. Dr<br />
Simpson was an early adopter of OCT imaging,<br />
and highlighted its importance in glaucoma<br />
management today. Dr Sonya Bennett rose to the<br />
challenge of summarising the critical things to<br />
look for in secondary glaucomas and said to always<br />
assume you are looking for something, rather<br />
than expecting to see a normal eye. Associate<br />
Professor Jennifer Craig brought our attention to<br />
the extremely common co-morbidities of dry eye<br />
and glaucoma. The main culprit is the cytotoxic<br />
agent benzalkonium chloride, so we should strive<br />
to reduce the application of preserved eye drops.<br />
Professor Danesh-Meyer completed the second<br />
session line-up and provided an eloquent update on<br />
the management of ocular hypertension, bringing<br />
our attention to the risk factors that can increase the<br />
chance of converting to glaucoma.<br />
The theme for session three was Glaucoma<br />
Management and a broad range of topics<br />
were presented. Dr Dean Corbett discussed<br />
the role of selective laser trabeculoplasty,<br />
which is increasingly being used as a first-line<br />
glaucoma treatment. Dr Hussain Patel gave two<br />
presentations in this session. The first outlined the<br />
challenge of deciding who to treat and the pattern<br />
of treatment intensification. In his second talk, Dr<br />
Patel spoke on trabeculectomy surgery, its postoperative<br />
management and what optometrists<br />
should be on the look-out for in the late postoperative<br />
period. Dr Gale took the podium again to<br />
enlighten the audience on glaucoma management<br />
in pregnancy (a tricky task!). Interestingly, IOP<br />
may drop during pregnancy. The possibility of<br />
pregnancy should be considered in all women of<br />
reproductive age who have glaucoma. Professor<br />
Editorial: The hard work paid off<br />
BY JAI BREITNAUER<br />
When the team from Glaucoma New Zealand (GNZ)<br />
came to see us in early April, just a few weeks after<br />
I joined NZ Optics, there was much excitement<br />
around the idea for a dedicated Glaucoma symposium, and that<br />
excitement has been infectious.<br />
NZ Optics is pleased to support eye-health charities in New<br />
Zealand, and we’ve enjoyed being able to help Glaucoma NZ as<br />
the date was set and the symposium took shape.<br />
When I arrived at the event I was overjoyed to see 92 delegates<br />
from as far as Invercargill and even Australia. The majority were<br />
optometrists but also among the crowd were six nurses, a rep<br />
from the Blind Foundation, some students and ophthalmologists.<br />
There were 17 speakers in total, including Dr Hannah Kersten who<br />
recently had her PhD accepted and was instrumental in getting the<br />
conference off the ground. The speakers and delegates were united<br />
in the cause of in-depth glaucoma education – an event that is a<br />
first not just for Glaucoma NZ but also for New Zealand in general.<br />
Kristine Jensen and Teresa Hsu<br />
Speakers (L to R) Drs Allan Simpson, Hannah Kersten and Sonya Bennett, A/Profs Jennifer Craig and Gordon Sanderson, Drs Hussain Patel, Dean<br />
Corbett and Geraint Phillips, Professors Helen Danesh-Meyer and Charles McGhee with Drs Shenton Chew, Graham Reeves, Jesse Gale and Alex Buller<br />
Danesh-Meyer gave an informative<br />
presentation on lifestyle factors<br />
and glaucoma, including blood<br />
pressure, exercise, diet, stress and<br />
supplementation with omega<br />
three and ginkgo biloba. Grant<br />
Watters concluded the session<br />
by discussing the management<br />
of glaucoma patients who wear<br />
contact lenses. The management<br />
of vulnerable groups (patients with<br />
keratoconus or diabetes) was also<br />
highlighted.<br />
The final session of the day was a<br />
collection of cases. A/Prof Gordon<br />
Sanderson presented a case that<br />
involved forensic optometry,<br />
certainly raising some interesting<br />
questions in the minds of listeners.<br />
I outlined two methods of<br />
measuring IOP fluctuation. Dr Kain<br />
spoke about a rare case of angle<br />
closure associated with an iris<br />
melanoma. Dr Simpson discussed<br />
the diagnosis and management of<br />
twins who presented independently<br />
with narrow angles. Finally, the<br />
question of is it glaucoma or<br />
something else was posed by<br />
Professor Danesh-Meyer who gave<br />
examples of glaucomatous and nonglaucomatous<br />
optic neuropathy, and<br />
ways to differentiate between them.<br />
Overall, the day provided<br />
fantastic glaucoma education and<br />
a platform for glaucoma discussion<br />
between optometrists,<br />
ophthalmologists and<br />
industry. Glaucoma NZ<br />
is hoping to make this a<br />
regular event, so watch this<br />
space!<br />
*Dr Hannah Kersten is a lecturer<br />
and research fellow at the<br />
University of Auckland and a<br />
therapeutic optometrist with Eye<br />
Institute.<br />
Lyn Scott, Brian Appleyard and Bruce Keighley<br />
Glaucoma NZ team from (L to R) Dr Hannah Kersten, Professor Helen Danesh-Meyer, Helen<br />
Mawn, Ana Cunliffe and A/Prof Gordon Sanderson<br />
A B<br />
C<br />
D<br />
“We’re thrilled by the turnout,” said Professor Helen Danesh-<br />
Meyer, the chairperson of GNZ. “To have this many people<br />
committed to a day of glaucoma shows an exciting move forward<br />
for glaucoma care in New Zealand.”<br />
A/Prof Gordon Sanderson echoed the sentiment. “We’re<br />
pleased to have such a good turnout for this event, offering<br />
in-depth discussion on a range of pertinent topics that are often<br />
given a once-over-lightly treatment. This is an opportunity<br />
to go into depth and share cutting edge information, latest<br />
management techniques and diagnostic technology. The way<br />
glaucoma is managed will change dramatically in the next<br />
few years, moving toward a more community based model<br />
that is better for our often elderly patients. The involvement of<br />
optometrists in this game-changing shift is crucial to that new<br />
model.”<br />
Glaucoma is still the leading cause of preventable blindness, but<br />
E<br />
F<br />
A/Prof Sanderson visualises that with education programmes in<br />
the optometry sector, this will reduce remarkably over the next<br />
12 cards in each pack<br />
No message inside<br />
12<br />
cards<br />
in each<br />
pack<br />
Or with your chosen message<br />
for orders of 10 packs and over*<br />
To order online go to<br />
www.glaucoma.org.nz<br />
or call 0800 452 826<br />
<strong>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
25
Focus<br />
on Business<br />
THE BUSINESS PRE-NUPTIAL<br />
AGREEMENT:<br />
Bringing in a new owner or partner<br />
There are many reasons why you may<br />
want a new owner or partner in your<br />
optometry business, such as;<br />
••<br />
You need additional capital;<br />
••<br />
It’s part of your succession plan;<br />
••<br />
They complement your existing<br />
operations, whether it be from their<br />
personal skill set, a business that can<br />
be bolted on to yours or they have the<br />
contacts or geographical reach you’re<br />
seeking;<br />
••<br />
You just want a running mate and to<br />
de-risk.<br />
All are very valid reasons, but before<br />
you confirm such an important decision, I<br />
strongly recommend that you consider the<br />
points below.<br />
Ambiguity can often lead to conflict<br />
Ambiguity from the outset is more likely<br />
to lead to conflict in the future. So, whilst<br />
it’s easy to overlook and avoid difficult<br />
conversations in the early stages of a<br />
business relationship as you want to<br />
promote optimism and positivity, it’s<br />
essential to discuss exit.<br />
The procedure for exit of either party<br />
should be clear. How much notice do you<br />
need to give, when is exit forced and who<br />
can you sell your share(s) to?<br />
Are the parties aware of their roles<br />
and responsibilities? Relationships can<br />
deteriorate rapidly where roles and<br />
responsibilities are not clearly defined.<br />
Issues can arise if one party carries<br />
out more work than the other and is<br />
not adequately rewarded. If roles and<br />
responsibilities are not to be equally<br />
shared, it’s worth having a conversation<br />
about remuneration and/or profit share.<br />
I can’t stress enough how important<br />
agreements are to successful business<br />
relationships - robust shareholder and<br />
partnership agreements ensure there’s<br />
clarity if a certain event occurs, and<br />
prescribe rules that each party agrees to<br />
and is aware of. Quite simply they are prenuptial<br />
agreements for businesses.<br />
Do your due diligence – do you really know<br />
your prospective partner?<br />
You are giving up power, control and<br />
influence to someone else – and it’s far<br />
easier to give it up than take it back. So it’s<br />
worth checking their background facts.<br />
Understand that you might be taking<br />
on additional risk. The extent depends<br />
on your legal structure and on how the<br />
other party’s may impact you; especially<br />
in a partnership where liability is joint<br />
and several (in the absence of forming a<br />
limited partnership).<br />
Scan the internet, have they been barred<br />
as a director of a company in the past…?<br />
Often employers will undertake checks<br />
on prospective employees, why not for a<br />
prospective business partner?<br />
Expectation – price<br />
Frequently the owner’s expectation of<br />
value is vastly different from what it is<br />
actually worth. So what looks to be a<br />
great business proposition often falls over<br />
because the owner has overvalued the<br />
business from the outset. Suffice it say, get<br />
an independent valuation of your business<br />
and realign expectations (if required),<br />
otherwise conversations with prospective<br />
investors are likely to be short-lived.<br />
Letting go<br />
Ask yourself, ‘’Am I really willing to give<br />
up control?’’ If not, then you may wish<br />
to reconsider other options, such as a<br />
BY DAVID PEARSON*<br />
different class of shares with no voting<br />
rights if you need a capital injection,<br />
without having to relinquish any control.<br />
Tax<br />
Tax legislation always plays its role<br />
and has to be considered. Once the<br />
transaction has been executed it is very<br />
difficult to remedy or reverse adverse tax<br />
outcomes. So canvass the tax position<br />
first.<br />
• Shareholder continuity rules for a<br />
company to carry forward tax losses<br />
and/or imputation credits must<br />
be considered if introducing a new<br />
shareholder. It is easy to inadvertently<br />
breach the thresholds and lose the<br />
value of tax losses and imputation<br />
credits;<br />
• If you are encouraging an existing<br />
employee into the business as a<br />
succession plan, price is relevant from a<br />
tax perspective. An income tax liability<br />
will arise to the extent an employee<br />
does not pay full market value for a<br />
shareholding;<br />
• Will the introduction of a partner<br />
change your legal structure from sole<br />
trader to partnership? How does this<br />
impact on income tax and GST status?<br />
Could this give rise to potential tax<br />
liabilities?<br />
• If you are looking to combine<br />
businesses, how will you do this? Will<br />
this require transfer of assets and<br />
liabilities to a new company? A tax cash<br />
cost may arise, even though no real<br />
income has come in;<br />
• Have you considered the operating<br />
structure for tax efficiency? Does the<br />
introduction of a new business partner<br />
change anything?<br />
• At what price will a prospective new<br />
partner/owner be introduced to the<br />
business? To assist in mitigating risk<br />
and to facilitate the transaction, we<br />
often see “earn-out” clauses included<br />
within sale and purchase agreements.<br />
Under an earn-out clause the purchase<br />
price is dependent upon future trading<br />
activities and performance. The clauses<br />
are often coupled with a “lowest price<br />
clause” to reduce the risk of adverse tax<br />
consequences arising.<br />
A common-sense approach<br />
It’s common-sense, but do you like them?<br />
Or would you duck under cover if you<br />
encountered them in the street rather<br />
than enjoy a coffee together?<br />
While you don’t necessarily need to be<br />
great mates you must acknowledge that<br />
you will potentially be spending a lot of<br />
time with them.<br />
This is not an exhaustive check list<br />
but it’s certainly well worth considering<br />
before making what could be one of the<br />
most important business decisions you<br />
will ever make. ▀<br />
ABOUT THE AUTHOR:<br />
* David Pearson is<br />
Managing Partner<br />
in the Napier firm<br />
of BDO, a global<br />
network of chartered<br />
accountants and<br />
advisers. He has a<br />
specialisation in<br />
advice to the medical<br />
sector.<br />
BV secures Falvin<br />
Dennis van der Maas from Beni Vision is excited<br />
to announce they are now the New Zealand<br />
supplier for Falvin, a boutique frame designer<br />
based in Denmark.<br />
“We spotted them at a European optical fair in<br />
February, in the emerging designers room,” said van<br />
der Maas. “We did a double take and went back –<br />
their product is stunning.”<br />
After several months and emails and phone<br />
calls, Beni Vision were able to meet up with<br />
representatives from Falvin in Copenhagen in August,<br />
where the deal was sealed.<br />
“Our samples arrived just a few weeks ago and<br />
we’ve had excellent uptake already,” said van der<br />
FEB31st lightweight wooden frames<br />
Excessive gaming causing<br />
retinal damage?<br />
Concerns that New Zealanders’ increasing<br />
dependence on electronic devices for gaming,<br />
lifestyle and work could be causing eye strain<br />
and long-term retinal damage to their eyes have<br />
resurfaced as a result of new research conducted on<br />
behalf of Essilor’s new Eyezen lens.<br />
A nationwide survey of New Zealand optometrists<br />
found that nine in ten (87%) expressed concerns<br />
about the number of people presenting with eye<br />
damage, some as young as five years old, as a result of<br />
heavy digital device use.<br />
The Eyezen study also showed that eight in 10 (80%)<br />
of optometrists believed those patients most affected<br />
were aged between 30 and 40 and one in five (19%)<br />
said in their experience, teenagers were also a high<br />
risk demographic.<br />
The research also found the most frequent symptom<br />
of excessive device use was dry eyes with almost eight<br />
in 10 (77%) of optometrist’s saying patients were<br />
presenting with this condition frequently. Eyestrain<br />
Stars and their<br />
eyes: Mila Kunis<br />
The 33-year-old Hollywood actress, who starred<br />
in <strong>2016</strong> hit movie Bad Moms, revealed in<br />
2011 that she suffered from chronic iritis.<br />
The disease, which at one point was so bad Mila<br />
Kunis admitted she was practically blind in one eye,<br />
causes inflammation of the iris resulting in blurred<br />
vision. Kunis hid the condition, worried it would<br />
affect her career, but eventually she developed a<br />
cataract. She had life changing surgery in 2010. “I<br />
was blind. I’m not blind anymore,” said Kunis in an<br />
interview with Cosmopolitan magazine in the US,<br />
describing her cataract surgery. “They cut it open<br />
and dropped a new lens in there.” ▀<br />
Falvin Eclipse<br />
Maas. “Their range is quite small, just nine optical<br />
frames and one set of sunglasses, but each comes<br />
in six colours and you can even have them diamond<br />
encrusted. It’s an exclusive, selective and luxurious<br />
range – the designer describes her glasses as<br />
‘jewellery for the eyes’.”<br />
Feb 31st new range<br />
Another Beni Vision supplier, FEB31st, has also<br />
released a new range, FEB31st 2.0.<br />
“They’re the world’s leading manufacturer of<br />
wooden eyewear,” explains van der Maas. “We’ve had<br />
them for about four years and their product is already<br />
very popular, but this new range, just revealed at<br />
Silmo, is thinner, stronger and lighter than before.”<br />
Beni Vision are also expecting new post-Silmo styles<br />
to arrive from Blackfin and TAVAT.<br />
For more on Falvin and FEB31st, see Silmo<br />
coverage p17 ▀<br />
and headaches were seen almost as often at 72% and<br />
52% respectively.<br />
Other common symptoms revealed in the research<br />
were stinging/tired or itching eyes, discomfort caused<br />
by the glare of the screen, and a progressive difficulty<br />
in staring at the device.<br />
Brown’s Bay optometrist Bruce Nicholls said,<br />
“strained vision, headaches and sleep deprivation<br />
are all linked to the high energy blue light emitted<br />
by flat screens and the cumulative effect of regularly<br />
switching between multiple devices.” He claimed<br />
many of us are looking at our phone screens up to 150<br />
times a day along with additional exposure to laptops,<br />
tablets and PC’s, with one study showing that using<br />
multiple devices increases your risk of symptoms by<br />
almost 25%.<br />
“What we are seeing now is that concentrated<br />
numbers of hours spent in intensive screen time<br />
while gaming and even long work days are causing<br />
noticeable symptoms in device users. Essentially overexposure<br />
to that blue light<br />
- which occurs on the light<br />
spectrum next to harmful<br />
invisible ultraviolet light<br />
could cause significant, long<br />
term damage,” he said.<br />
Nicholls, who is backing<br />
a consumer campaign by<br />
Eyezen, said a better-safethan-sorry<br />
approach needs<br />
to be adopted and advocates<br />
blue light protection as a<br />
counter to increased screen<br />
use for patients under 40. He<br />
said he currently prescribes<br />
blue-light blocking lenses to<br />
increasing numbers of Kiwis<br />
displaying symptoms of<br />
digital eye strain.<br />
“The pretext is that if you<br />
stop blue light from entering<br />
the eye then potentially you<br />
stop its damaging effects.” ▀<br />
26 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>
OPTICAL ASSISTANTS AND<br />
DISPENSING OPTICIANS<br />
Welcome to OCULA. Purveyors of fine eyewear.<br />
We are looking for that unique someone who can take our new<br />
flagship eyewear boutique in Queenstown from zero to hero.<br />
Contact us for more information.<br />
Email danielle@eyesonardmore.co.nz for more information.<br />
OPTOMETRIST WANTED<br />
WANAKA<br />
Are you passionate about what you do? Do you (or want to)<br />
specialise in contact lenses, paediatrics and therapeutics?<br />
Eyes on Ardmore is offering arguably the most lucrative<br />
opportunity; to live in paradise and develop your career.<br />
Our busy boutique practice is equiped with all the toys you<br />
could want (OCT, Tonoref 3 and digital phoropter, IPL...). In addition,<br />
you will be supported by a trained clincial assistant.<br />
The position is flexible for 3 to 5 days per week and would suit<br />
somebody wanting to make the Southern Alps home.<br />
Email danielle@eyesonardmore.co.nz for more information.<br />
SALES ACCOUNT MANAGER<br />
FULL OR PART-TIME<br />
An opportunity exists for an account manager to represent a<br />
number of VMD Eyewear’s established brands in the North<br />
Island. Our collections can be viewed online at www.vmd.co.nz<br />
Industry experience (optical sales or dispensing) or a successful<br />
track record in sales will be an advantage for this role which<br />
involves servicing our existing North Island accounts and<br />
developing new accounts.<br />
If you wish to be part of a successful New Zealand company<br />
that has offices in New Zealand, Australia and the United<br />
Kingdom, please forward your resume to careers@vmd.co.nz<br />
or contact Nigel Butler for further information 09 525 6601.<br />
OPTOM PLATE FOR SALE<br />
The personalised plate OPTOM is for sale after 18 years. Asking<br />
price is $1500+GST or make an offer. Additional fees apply to<br />
change or remove message and have the plate made.<br />
Contact stuart.warren@nsoptom.co.nz<br />
MORE CLASSIFIEDS ON PAGE 28<br />
Bayer and DelSiTech partner-up<br />
Bayer and Finnish drug<br />
delivery technology<br />
and development firm<br />
DelSiTech have signed a<br />
Collaboration and Technology<br />
Licence Agreement for the<br />
worldwide application of<br />
DelSiTech’s Silica Matrix drug<br />
delivery platform. "Successful<br />
ocular drug delivery is one<br />
of the biggest challenges<br />
in developing novel drug<br />
therapies for ophthalmic<br />
diseases," said Professor<br />
Andreas Busch, Bayer’s<br />
head of drug discovery in a<br />
statement announcing the<br />
new partnership. ▀<br />
Specsavers’ ad wins award<br />
Specsavers has won the Excellence<br />
in Marketing award at the <strong>2016</strong><br />
Franchise Council of Australia (FCA)<br />
Awards for Excellence for its Australian<br />
and New Zealand ‘Beach Volleyball’<br />
marketing campaign, launched in<br />
December 2015.<br />
The campaign, filmed in Queensland,<br />
features a beach volleyball player who<br />
mistakes a seagull for the volleyball with<br />
predictable consequences. The campaign<br />
was backed by an A$2 million media<br />
spend including TV, video-on-demand<br />
and digital media as well as a 12-page<br />
catalogue distributed to 2.3 million homes in Australia. This is the second time Specsavers has won the<br />
Marketing Excellence category and the fourth year in a row it has won a FCA award. ▀<br />
Get to the main<br />
cause of dry,<br />
irritated eyes*<br />
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HOURS<br />
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How does Optrex ActiMist work?<br />
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Natural lipids<br />
LIVE THE EXPERIENCE<br />
silmoparis.com<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 />
These liposomes mix with natural<br />
lipids on the eyelid.<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 />
Hygienic. Can be used<br />
by multiple people<br />
Lasts 6 months<br />
after opening<br />
Won’t smudge<br />
make-up<br />
Convenient and<br />
portable<br />
Suitable for use<br />
with contact lenses<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>Nov</strong>ember <strong>2016</strong><br />
NEW ZEALAND OPTICS<br />
27
OPTOMETRY OPPORTUNITIES<br />
State of the Art Technology<br />
Exclusive Optos Daytona Ultrawide<br />
Digital Retinal Scanner<br />
Corporate Social Responsibility<br />
OneSight Charity– We will not stop<br />
until the world can see<br />
Work-Lifestyle Balance<br />
Flexibility with attractive<br />
OPPORTUNITIES AVAILABLE IN NEW ZEALAND<br />
AND AUSTRALIA<br />
MORE CLASSIFIEDS INSIDE<br />
ON PAGE 27<br />
PART-TIME DO/OPTICAL ASSISTANT<br />
Nicholls Optometrists in Browns Bay are looking for a part-time<br />
Dispensing Optician or Optical Assistant to provide maternity<br />
cover for 12 months from <strong>Nov</strong>ember <strong>2016</strong>. Days required are<br />
Mon & Fri 8.30-5.30 and Sat 8.30-1.30. You will become part of an<br />
experienced team in a well resourced independent practice. Please<br />
contact Bruce Nicholls in confidence at nicholls4@gmail.com<br />
For a confidential chat, give me a call<br />
Hirdesh Nair<br />
E: Hirdesh.Nair@opsm.co.nz<br />
P: +64 21 523 282<br />
Location Hours Term Location Hours Term<br />
Newmarket 40 Long Term Wellington Float 40 Long term<br />
Queenstown 40 Long term Ch’ch Float 40 Long Term<br />
Thames 24 Long term Masterton 40 6 months<br />
Lynnmall 16 Long term New Plymouth 40 6 months<br />
St Lukes 16 Long term Papanui 40 6 months<br />
DISPENSING OPTICIAN OR<br />
EXPERIENCED OPTICAL ASSISTANT<br />
Our modern progressive independent practice requires a<br />
dispensing optician to join our experienced dispensing team. A<br />
dispensing qualification is not necessarily required, but experience<br />
is a must. The main role will be dispensing but also includes<br />
auxiliary testing as the practice has a strong clinical focus. Our<br />
large onsite Laboratory allows for fast and efficient glazing and<br />
adjustment services. Pukekohe is a fast growing area, 30 minutes<br />
south of Auckland central (travelling against the traffic).<br />
John Kelsey and his team are proud of the high standard of our<br />
services and would like to welcome an enthusiastic and motivated<br />
new staff member to join our well established team.<br />
This position is full time with some Saturday morning work. In<br />
the first instance please contact Laurraine at admin@optik.co.nz<br />
AUCKLAND PRACTICE FOR SALE<br />
Finally, a bustling, central Auckland practice for sale!<br />
The current owner is looking to retire and would like to find<br />
someone to take over this profitable, independent practice and<br />
their loyal customers. There’s tremendous scope for growth for the<br />
right owner who has the skills and the energy, drive and marketing<br />
know-how to make this practice stand out.<br />
This practice is ideally suited to an optometrist who yearns to be<br />
truly independent and is ready to run their own business, make<br />
their own decisions and reap the rewards from the hard work they<br />
put in. Or perhaps you’re overseas and looking to move or return to<br />
New Zealand?<br />
Situated in a very sought after suburb with good schools and<br />
amenities close by, with many high-value customers and a great<br />
team, this practice has it all, and you’ll receive the full support of<br />
the current owner in a comprehensive handover process.<br />
If this sounds like you, please email, in strictest confidence,<br />
info@nzoptics.co.nz, quoting code PFSB20<br />
CUSTOMER SERVICE REPRESENATIVE<br />
Euro Optics Ltd, a well-established eyewear wholesale<br />
distribution company, are looking for an outgoing person to join<br />
our small customer service team.<br />
This role is for someone who likes to be up on their feet all day<br />
with plenty of variety. The main responsibilities include:<br />
- Inbound sales calls and enquiries from existing customers<br />
- Picking and packing of customer orders<br />
- Checking off inwards shipments from suppliers<br />
- Invoicing customers’ orders and processing customers returns<br />
& credits<br />
- Warranty assessment and processing<br />
- Processing and sending out customer back orders<br />
Excellent English both written and verbal is required as are<br />
computer skills. Experience in the optical industry will be big<br />
advantage. Would suit someone who has had a similar role in the<br />
past or someone working in optical retail who would like to work<br />
in the wholesale side of the industry.<br />
The company is located in Mt. Wellington, Auckland.<br />
If you think this sounds like the job for you, apply now.<br />
You must be a New Zealand citizen or permanent resident. Please<br />
note there is no flexibility around this requirement.<br />
Please email your CV to: marketing@adidas-ep.co.nz<br />
OPTOMETRIST WANTED<br />
ROLLESTON EYE<br />
We see a wide range of ages and nationalities. An interest in<br />
extension learning in behavioural optometry and binocular vision<br />
is essential.<br />
Rolleston Eye is located with access to the outdoors of Canterbury<br />
and the South Island. There is vibrant city life in the suburban<br />
surrounds of Christchurch.<br />
This position would suit an optometrist who likes to work<br />
independently but have advice a phone call away. See our website<br />
and contact leesastuart@gmail.com<br />
MANUAL VERT NEEDED<br />
Do you have an old manual lens meter lying around gathering<br />
dust? Why not sell, or rent it to a training DO? If you can help,<br />
please email mgr.pukekohe.nz@specsavers.com<br />
OUR EXPANSION…<br />
YOUR CAREER GROWTH<br />
A MUTUAL OPPORTUNITY<br />
As the Specsavers network of 370 Australian and New Zealand stores<br />
continues to experience significant growth, opportunities abound in<br />
many locations across both countries for career focussed optometry<br />
and dispensing professionals.<br />
OPPORTUNITIES NOW AVAILABLE…<br />
Last financial year Specsavers New Zealand grew<br />
significantly and already this year we are seeing further<br />
growth – which presents ongoing opportunities for<br />
optometrists in the following locations:<br />
NORTH ISLAND<br />
• Lower Hutt<br />
• Masterton<br />
• Palmerston North<br />
• Paraparaumu<br />
• Rotorua<br />
• Te Rapa<br />
• Wellington CBD<br />
• Whakatane<br />
SOUTH ISLAND<br />
• Dunedin<br />
• Invercargill<br />
• Riccarton<br />
Westfield<br />
We are currently also seeking experienced dispensers in a<br />
number of our New Zealand stores.<br />
To find out more, contact Chanelle Coates on<br />
0800 717 350 or chanelle.coates@specsavers.com –<br />
or visit spectrum-blog.com to review all your options<br />
and currently available locations.<br />
C<br />
M<br />
Y<br />
CM<br />
MY<br />
CY<br />
MY<br />
K<br />
Thinking of selling your practice - we have buyers<br />
Considering buying - we’ll give you all the options<br />
OpticsNZ specialises in optometry practice sales,<br />
we've helped dozens of Optometrists buy and sell their practices<br />
For more information contact Stuart Allan on: 03 546 6996<br />
027 436 9091 stu@opticsnz.co.nz www.opticsnz.co.nz<br />
• Locum Service<br />
• Recruitment Services<br />
• Practice Brokering<br />
• Business Consultants<br />
28 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>