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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 />

optical. Contact Susanne Bradley at<br />

susanne@nzoptics.co.nz and secure your<br />

listing or, for even more impact, take a<br />

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6 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>


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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 />

IMPLANTS OF THE<br />

TECNIS SYMFONY ® IOL<br />

350,000<br />

IMPLANTS OF TECNIS ® IOLs<br />

TECNIS and TECNIS Symfony are trademarks owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. All other trademarks are the intellectual property<br />

of their respective owners. AMO Australia Pty. Limited. Level 3, 299 Lane Cove Road, Macquarie Park, NSW 2113. AMO Australia Pty. Limited (Incorporated in Australia)<br />

PO Box 401, Shortland Street, Auckland, 1140. © <strong>2016</strong> Abbott Medical Optics Inc. | www.AbbottMedicalOptics.com | WH AMO20403<br />

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 />

• Retro shapes made with ultra-modern materials<br />

• Metal and acetate fronts<br />

• Optimum wearing comfort<br />

• An absolute design classic<br />

<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 />

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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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Euro Optics<br />

Adidas continues to offer many sunglasses in the performance<br />

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14 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2016</strong>


General Optical<br />

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MCM Eyewear is a unique collection where<br />

dynamic design meets with the artisanal heritage of<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 />

XAVIER GARCIA<br />

✖ character<br />

✖ quality<br />

✖ impetuosity<br />

For more, contact Cardinal Eyewear at www.cardinal.co.nz<br />

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 />

L2773 BLUE<br />

L2771 HAVANA<br />

Contact GenOp today to find out how you<br />

can become a stockist.<br />

Toll free: 0800 141 444<br />

www.generaloptical.co.nz<br />

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 />

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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 />

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<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 />

4UP TO<br />

HOURS<br />

RELIEF 2<br />

CLINICALLY PROVEN<br />

The 4 days of Optics<br />

06 - 09 October 2017<br />

Optrex ActiMist – clinically proven to work<br />

How does Optrex ActiMist work?<br />

ActiMist liposomes<br />

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>

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