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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 />

DECEMBER <strong>2016</strong><br />

www.essilor.co.nz<br />

Clear vision and comfortable<br />

posture for digital activities<br />

THE SOLUTION FOR MODERN<br />

PRESBYOPES’ DIGITAL NEEDS


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>Dec</strong>ember <strong>2016</strong>


Waiting times: a national problem<br />

BY JAI BREITNAUER<br />

Senior ophthalmologists are welcoming the<br />

national publicity achieved by the story that<br />

some South Island patients are going blind as<br />

a result of waiting times for follow-up care.<br />

“We had discussed this situation with the minister<br />

of health in March 2015 and no action has occurred<br />

from government,” says Royal Australian and New<br />

Zealand College of Ophthalmologists (RANZCO) NZ<br />

President Dr Stephen Ng. “For us, it’s a chance to<br />

highlight it’s a national problem. All DHBs are under<br />

the same pressure. All DHBs have large numbers<br />

of follow-up appointments that are delayed to the<br />

point where it is becoming a huge clinical risk. The<br />

people on the waiting list who are reported to have<br />

gone blind in Invercargill, well we all know of cases<br />

where this has happened in other DHBs.”<br />

Dr Ng says the issue finally came to light after two<br />

ophthalmologists, one from Nelson Marlborough<br />

DHB and one from Southland, placed patients on<br />

the local risk register. Usually, these occurrences<br />

are reported to a local manager in the DHB, but<br />

by placing them on the register they were picked<br />

up by the Health, Quality and Safety Commission<br />

and included in the commission’s Learning from<br />

adverse events report. The report, published on<br />

10 November, highlighted the rise in reported<br />

ophthalmology-related events to 44 this year,<br />

and the resultant risk of vision loss from too long<br />

waiting times. The national media coverage resulted<br />

from a RANZCO press release issued just prior<br />

to the report, which renewed calls for an urgent<br />

government review of waiting time targets. It<br />

highlighted the case of “KB” – a 23-year-old who<br />

was diagnosed with glaucoma and, due to the lack<br />

of timely follow-up, was left blind in one eye and<br />

needing urgent surgery to save the other eye.<br />

“This year, Southern and Nelson Marlborough<br />

DHBs both reported a number of individual<br />

ophthalmology events, including a delay in followup<br />

appointments. The Commission commends<br />

these DHBs for showing leadership in this reporting.<br />

These DHBs are currently reviewing these events<br />

and will make improvements based on the<br />

findings,” said commission chairman Professor Alan<br />

Merry.<br />

“This is a prompt for other DHBs to look closely<br />

at their ophthalmology services to ensure people<br />

are being seen in a timely manner, with high-risk<br />

patients prioritised.”<br />

Targets putting pressure on services<br />

Dr Ng believes the solution to this problem is<br />

greater than can be handled at a local level.<br />

“The health targets for seeing new patients need<br />

adjustment [which needs to be done at government<br />

level]. At present every DHB is required to have<br />

patients that are referred for specialist appointments<br />

to be seen within four months. That means those<br />

people get in the door, but those who have already<br />

been seen and need follow-up care get less priority.<br />

They end up in this delayed follow-ups cohort that is<br />

building up and building up because of the pressure<br />

to get [new patients] in the front door – it means the<br />

follow-ups are just being shut out.”<br />

The aging population, increased diabetes and<br />

the success of treatments for other eye conditions<br />

have resulted in a larger number of people needing<br />

ongoing ophthalmology care, explains Dr Ng.<br />

“This is an expected part of the baby boomer<br />

generation that everyone has been talking about<br />

for years – it’s here and now. It’s exacerbated by the<br />

fact the government has targets for new patients<br />

and surgery that don’t take into account the huge<br />

number of people requiring chronic care for the rest<br />

of their lives.”<br />

Dr Graham Reeves, a consultant ophthalmologist<br />

with Counties Manukau and new Eye Institute<br />

doctor (see story p16), agrees. “This is not<br />

necessarily an isolated problem. New Zealand has<br />

an ageing population with chronic eye disease [and]<br />

once diagnosed, you need to care for those patients<br />

for the rest of their lives.”<br />

Dr Reeves notes this task in itself is difficult under<br />

current conditions, but the Ministry of Health has<br />

120-day maximum wait time guidelines for surgery<br />

which (as well as the guidelines for new referrals) is<br />

shifting the focus away from the patients who need<br />

care the most, he says.<br />

“We have to focus on new surgical patients,<br />

mostly cataracts, to avoid being penalised. Other<br />

patients suffer the consequences because we can’t<br />

keep up. We don’t have enough doctors or physically<br />

enough space.<br />

“There’s no easy answer, but it’s difficult when<br />

priority is being placed on patients who may not<br />

be going blind. Having cataracts is traumatic, but<br />

completely reversible, while delays in the treatment<br />

of those with other conditions can result in<br />

permanent blindness.”<br />

A question of community care<br />

Both Dr Reeves and Dr Ng want more focus to be<br />

placed on increasing resources around patients with<br />

conditions like glaucoma and AMD.<br />

“We need more ophthalmologists and we<br />

need more investment in training for nurses and<br />

optometrists to work alongside us in teams to deal<br />

with the huge numbers we’re seeing in every DHB,”<br />

says Dr Ng, adding he favours some form of allied<br />

community care. Dr Reeves says many of the clinics<br />

he works in are already running joint initiatives with<br />

nurses and community optometrists.<br />

In a world where ophthalmologists are<br />

collaborating more with optometrists and the<br />

scope of prescribing rights within the optometry<br />

industry have been extended, it seems logical to<br />

support the opportunity to offer additional training<br />

to optometrists to take on this increased role of<br />

community-based patient care. However, one<br />

source who did not wish to be named, says that<br />

in the past shared-care programmes have fallen<br />

over due to one important sticking point – money.<br />

The public system can’t support the current rate<br />

of pay of the average optometrist working at their<br />

current speed. It’s not financially sustainable in a<br />

sector that many feel is underfunded and stretched<br />

already, the source says. “Simply put, it’s cheaper to<br />

keep this level of eye-care in a public hospital.”<br />

Another issue is risk and who is responsible for<br />

it. An issue highlighted earlier this year when a UK<br />

optometrist was taken to court and found guilty<br />

after failing to spot a serious medical condition in a<br />

young patient, resulting in the patient’s death.<br />

“Many optometrists would still prefer the<br />

ophthalmologist to have responsibility as the main<br />

care giver,” the source says, highlighting training<br />

differences. “Many lay-people see an optometrist<br />

and an ophthalmologist as the same thing, but we<br />

do two very different jobs.”<br />

Representatives of RANZCO met with the chief<br />

medical officer on 15 November, together with<br />

representatives from nursing and optometry, to try<br />

to get to grips with the problem.<br />

“Allowing chronic eye conditions to advance<br />

unchecked, places a significant burden on the<br />

health service with more complex, time-consuming<br />

and expensive treatments required,” explains<br />

RANZCO president Dr Brad Horsburgh. “Studies<br />

show that, while the cost of treating chronic<br />

eye conditions and having regular check-ups to<br />

maintain eye health is minimal, the economic<br />

impact of treating and supporting a person who<br />

has lost their vision is substantial. The government<br />

could make cost savings in the long run by<br />

preventing blindness now.”<br />

A report, Social and economic cost of macular<br />

degeneration in New Zealand, launched at the time<br />

of going to press by Macular Degeneration New<br />

Zealand shows the cost of blindness due to macular<br />

degeneration is around $216.6 million a year, which<br />

vastly outweighs the cost of treatment to prevent<br />

people going blind in the first place, continued<br />

RANZCO.<br />

“RANZCO is really trying to concentrate on the<br />

needs of our patients, they’re the ones suffering<br />

under the system,” says Dr Ng. “We want to be at<br />

the forefront of trying to define solutions.”<br />

For more, see our new column “Eye on optics by<br />

Happy holidays!<br />

EDITORIAL<br />

Welcome to the last issue of the year and<br />

two exciting new columns.<br />

Eye on Optics by Chalkeyes pays tribute<br />

to that rascally business columnist Chalkie, who<br />

used to frequent the back page of infamous Kiwibattler,<br />

the Independent Business Weekly. Like<br />

Chalkie, the column is anonymous to allow the<br />

small group of regular, authoritative writers to<br />

share their well-considered views without fear of<br />

losing their jobs.<br />

Macular milestones, meanwhile, has been<br />

put together with MDNZ and trustee Dr David<br />

Worsley to highlight interesting macular<br />

research. This new, quarterly column augments<br />

the work of our wonderful monthly research<br />

columns Eye on Opthalmology and Focus on<br />

Research (thanks Hutokshi, Charles and Hussain,<br />

we really couldn’t do it without you!)<br />

What a year! Each month we find ourselves<br />

struggling to include all the happenings in<br />

our exciting industry and this month was no<br />

exception. Silmo, Visionz, ADONZ and the Eye<br />

Institute conferences have all vyed for space<br />

between a wealth of news and views. We hope<br />

you enjoy reading it all as much as we enjoy<br />

covering it for you!<br />

Have a fabulous holiday. We’ll be back with<br />

even more in our February issue.<br />

Cheers and a very Merry Christmas,<br />

Chalkeyes” on p27. ▀<br />

Join us for a fantastic<br />

day at the track<br />

On Saturday 18th February 2017<br />

at Auckland Racing Club, Ellerslie<br />

Lesley Springall, publisher, NZ Optics<br />

Essilor launches Digitime<br />

Essilor has launched Varilux Digitime, a new<br />

range of occupational lenses for modern<br />

presbyopes, taking into account patients’<br />

daily digital needs.<br />

The new addition to the Varilux range of<br />

progressive lenses (worn by more than 400 million<br />

people worldwide) will add a point of difference<br />

to your practice, explained Tim Thurn, Essilor’s<br />

director of professional services, speaking at Essilor’s<br />

Platinum Partner’s regional conference in Auckland<br />

last month. They are also far easier and simpler to<br />

understand and prescribe, compared with Essilor<br />

and Nikon’s older occupational lens offerings,<br />

Interview and Weblens, designed in 1998 and 2000<br />

respectively, well before smartphones, he said.<br />

Today’s digital devices have changed presbyopes’<br />

visual and postural behaviour, with 70% of 45 to 65<br />

year olds saying they suffer from tired eyes and neck<br />

and shoulder pain - a common ailment as people<br />

stick their necks out and lean forward to read their<br />

screens more easily.<br />

It all comes down to how far away your screen is,<br />

said Thurn, with research by Essilor showing that<br />

people have very variable distances of preferred<br />

screen usage. A person’s average eye distance to<br />

their desk computer is 63 cm, but the range varies<br />

from between 38cm and 88cm, a whopping 50cm<br />

variation between users.<br />

The distance between eyes and device should be measured<br />

Thus in addition to normal progressive<br />

measurements, to maximise the effect of Digitime,<br />

Essilor requires the patient’s preferred eye distance<br />

from their desktop computer to be measured.<br />

Without this, the lens manufacturing process will<br />

default to the 63 cm average, which works, but not<br />

as well as when the actual device distance is known,<br />

stressed Thurn.<br />

Varilux Digitime comes in Near, Mid or Room<br />

variations, with the first focusing on near vision<br />

CONTINUED ON P4<br />

Join us for a fantastic<br />

day at the track<br />

On Saturday 18th February 2017 at Auckland Racing Club, Ellerslie<br />

Join us from 12 noon in the Guineas Room, where you will be treated to drinks on arrival and a<br />

delicious buffet lunch, plus much more. Witness the extravaganza of horse racing including the<br />

prestigious Avondale Cup and Avondale Guineas races. Enjoy a great day, while fundraising for<br />

Macular Degeneration New Zealand and their work in the Macular Degeneration community.<br />

A table of 10 package is $1,250<br />

(incl. GST) and includes:<br />

• Table in the Guineas Room for 10 guests, including<br />

drinks on arrival, buffet lunch, afternoon tea and<br />

cash bar<br />

• Entertainment throughout the day including<br />

tipsters, jockeys, celebrities and unique<br />

experiences<br />

• Opportunity to display product and branded<br />

pull-up banners in the Guineas Room for the day<br />

• Free carparking<br />

A Unique Experience is $100 (incl. GST)<br />

for 4 people for either option:<br />

1. Experience the Commentary Box<br />

2. Experience the Race Start<br />

Book now to be on the inside!<br />

Individual tickets $140 (incl. GST).<br />

Earlybird tickets $125 (incl. GST)<br />

(before 31 <strong>Dec</strong>ember).<br />

Visit www.mdnz.org.nz to secure your tickets online.<br />

1 in 7 people over 50 will get Macular Degeneration.<br />

All funds raised on the day will gratefully go to support the Macular Degeneration community.<br />

To take up this opportunity, please contact Alice McKinley at 027 634 0495 or events@mdnz.org.nz<br />

<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

3


News<br />

in brief<br />

NEW BRIEN HOLDEN AWARD<br />

The American Academy of Optometry (AAO)<br />

announced the establishment of the Brien<br />

Holden Humanitarian Award to honour the<br />

memory and work of the late great eye-care<br />

humanitarian, Professor Brien Holden. The<br />

new award, established by the Brien Holden<br />

Vision Institute and the Holden family estate,<br />

will be administered by the AAO and awarded<br />

annually to an individual or organisation who<br />

has made significant contributions to improve<br />

eye care within a country or region.<br />

NOVARTIS ALCON SALE?<br />

Drugmaker Novartis is considering selling its Alcon eye care division,<br />

chairman Joerg Reinhardt confirmed in an interview with Swiss<br />

weekly SonntagsZeitung. Alcon was bought from Nestlé in 2010<br />

after a lengthy series of deals totalling US$52bn as part of former<br />

CEO Dan Vasella’s vision to build a European healthcare giant. Since<br />

Vasella’s departure in 2013, Novartis has switched focus back to its<br />

prescription drugs and Sandoz generics business units, leaving Alcon<br />

to struggle, say commentators. “In the long run, the question arises<br />

as to whether we are the best owner for Alcon,” said Reinhardt.<br />

BETTER TESTS FOR HYPEROPES<br />

Research suggests noncycloplegic retinoscopy and the Retinomax<br />

autorefractor are better for detecting moderate hyperopia in<br />

children than other tests. The study, led by Dr Bruce Moore from<br />

the Massachusetts College of Optometry, screened more than<br />

4,000 three to five year olds for amblyopia, strabismus, significant<br />

cycloplegic refractive error and reduced visual acuity.<br />

AUSTRALIAN EYE-HEALTH REVEALED<br />

The results of the first Australian<br />

National Eye Health Survey were<br />

revealed on World Sight Day in<br />

October showing indigenous<br />

Australians are three time more<br />

likely to suffer from blindness<br />

and vision impairment than the<br />

non-indigenous population; and<br />

cataracts were the leading cause of blindness among indigenous<br />

Australians, while age-related macular degeneration was the<br />

main cause in the rest of the population. For more, visit www.<br />

vision2020australia.org.au<br />

ODOB FEE, PRACTICES REVIEWS<br />

The ODOB is conducting reviews of the 2017/18 fees and optometry<br />

scopes of practice. Consultation documents can be viewed on the<br />

ODOB website, www.odob.health.nz. Submissions are due by the 9<br />

and 23 <strong>Dec</strong>ember <strong>2016</strong> respectively.<br />

RANZCO UNDER FIRE<br />

Optometry Australia has criticised RANZCO’s Referral Pathway for<br />

Glaucoma Management released in August. The RANZCO guideline<br />

document “fails to reflect the diversity of optometry expertise<br />

and clinical circumstances and optometrists’ scope of practice,<br />

and diverges from current guidelines,” said Optometry Australia,<br />

in a statement released after consultation with the industry.<br />

“The RANZCO referral pathway was developed without advice<br />

from Optometry Australia, the professional organisation which<br />

represents the optometry profession in Australia, yet it seeks to<br />

advise our profession on patient care… Though RANZCO has every<br />

right to release referral pathways to its own members, it does<br />

not have authority to instruct the optometry profession on how<br />

patients should be managed or referred,” said national president<br />

Kate Gifford.<br />

PHARMAC PARTNERSHIP<br />

PHARMAC announced a new partnership with the Best Practice<br />

Advocacy Centre NZ, based in Dunedin, and the Goodfellow Unit<br />

of Auckland University, to support prescribing decisions and<br />

promote responsible use of medicines. The partnership will provide<br />

healthcare professionals with high-quality clinical information<br />

to enhance patient care and prevent the overuse or misuse of<br />

medication, said PHARMAC deputy medical director, Dr Bryan Betty.<br />

EXAGGERATED BLUE LIGHT CLAIMS CRITICISED<br />

UK high street opticians Boots and Vision Express have come under<br />

fire again in UK media for making allegedly exaggerated and bogus<br />

claims about the dangers of blue light from devices. Researchers<br />

for the BBC’s Watchdog programme (similar to Fair Go) found Boots<br />

staff are still misleading customers even after the Advertising<br />

Standards Authority banned Boots’ adverts last year. It was found<br />

there was no good scientific evidence to support the chain’s claims<br />

about their Protect Plus Blue lenses.<br />

DEXTENZA PASSES PHASE III<br />

Professor Brien Holden<br />

Indigenous populations have different eyehealth<br />

needs<br />

Ocular Therapeutix announced positive topline results from its<br />

phase III clinical trial of Dextenza (dexamethasone insert) 0.4 mg,<br />

for the treatment of post-surgical ocular inflammation and pain.<br />

The trial achieved statistically significant differences between<br />

the treatment group and the placebo group for the absence of<br />

inflammatory cells on day 14 and the absence of pain on day eight,<br />

respectively, said the company. ▀<br />

CONTINUED FROM P3<br />

devices; the mid, near to intermediate devices; and Room, more<br />

intermediate and extended vision (the television across the room).<br />

The new lenses are aimed at new and existing presbyope wearers<br />

looking for a solution for the office, specific occupational needs and<br />

other activities; people whose head/body posture is causing them<br />

discomfort when they use their computers; or people whose hobbies<br />

and leisure activities (like needlework) require specific correction.<br />

The new lenses are available in all materials including Transitions<br />

photochromic lenses and all coatings, and are available to all.<br />

Sunglass deal for Essilor partners<br />

Also announced at the Essilor Platinum Partners roadshow is the<br />

company’s new promotion to encourage more practices to sell more<br />

prescription sunglasses, Sun2Max.<br />

Research (Essilor’s and others) shows there’s a massive opportunity to<br />

grow revenues by growing sunglass sales, said Guy Parbury, Essilor NZ’s<br />

business development consultant.<br />

Seasonality in sunglass sales is not so much driven by the seasons,<br />

but by the enthusiasm of practice managers when their new sunglass<br />

stock arrives, he said. “You can sell sunglasses through the year.<br />

Seasonality is driven by our behaviour, not our patients behaviour.”<br />

Practice owners should ask themselves: do we have the frames<br />

to sell? Do we display them well? Do we have the right offer?<br />

Do our patients know our offer? Do we offer it at the right time?<br />

Sunglasses should be displayed all year round and should be displayed<br />

prominently alongside other frames, and patients should be given a<br />

simple and very cost effective offer to encourage them to buy. This<br />

It’s been a big couple of months for Wanakabased<br />

practice Eyes on Ardmore, who unveiled<br />

its new brand, Ocula, on 24 November.<br />

“Eyes on Ardmore was recently remodelled in<br />

anticipation of the new name, bringing it in line<br />

with the new, modern concept,” said Danielle Ross,<br />

director and principal optometrist.<br />

A new, second practice under the Ocula name<br />

will be opening on 9 <strong>Dec</strong>ember in Queenstown,<br />

owned by Danielle Ross and eyewear specialist<br />

John Winstone, who acquired Bridgman and Dean’s<br />

Queenstown practice in November. All the patient<br />

records from Bridgman & Dean Queenstown are<br />

being transferred to Ocula.<br />

Drivewear becomes sportswear<br />

Younger Optics’ award-winning polarised photochromatic<br />

Transitions Drivewear lenses and plano sunglasses are flying<br />

off the shelf, not for driving, but for sports people, says the<br />

company, leading to a whole new consumer marketing campaign and<br />

a new focus.<br />

“Transitions Drivewear has been around for a few years now and it<br />

was originally developed as a driving lens, but what we’ve found over<br />

the last couple of years is that we are selling more and more to sports<br />

people,” says Craig Johnston, Younger Optics’ ANZ national sales and<br />

marketing director.<br />

The lens is proving particularly popular with fishermen, golfers and<br />

cyclists, so for the first time the company has launched a direct-toconsumer<br />

marketing campaign in several Australian golf, fishing and<br />

cycling magazines, many of which are also available in New Zealand.<br />

The consumer campaign is echoed in practices with free point-of-sale<br />

materials, such as window posters, counter cards and brochures so<br />

eye care professionals can offer their sporty patients an edge, says<br />

can either be at the end of their visit, after they’ve selected their new<br />

frames and lenses or, if this is too much information for them, when<br />

they come back to collect their new glasses, suggested Parbury.<br />

This simple offer, however, was not simple in the making with Essilor<br />

engaging a marketing consultancy and contacting all its preferred<br />

frame partners to tie together something that works. The result:<br />

with every pair of prescription glasses a patient buys from an Essilor<br />

Platinum Partner, that patient can also buy a pair of sunglasses, with<br />

exactly the same prescription, coatings etc. for just $249.<br />

All lenses include Crizal Sun UV for added UV protection, and have<br />

the Cancer Society NZ tick of approval. Excluded are more high-end<br />

sunglass frames, and it costs an extra $80 for patients to upgrade to<br />

polarised lenses.<br />

New point-of-sale and window display materials have been produced<br />

and are available now for any partner practice that wishes to give it a<br />

go. The one trial practice that had, at the time of presentation, grew its<br />

sunglass sales from a yearly average of 6% to 18% in one week and 22%<br />

in week two, said Parbury. “So why wouldn’t you give it a go!”<br />

For more marketing wisdom from the Essilor Platinum Partner’s<br />

roadshow, see February’s NZ Optics.<br />

Would you like Transitions with that?<br />

All change for Eyes on Ardmore<br />

Fisherman and golfers are opting for Transitions Drivewear to give them “an edge”<br />

With evidence showing that once people have tried photochromatic<br />

lenses, they tend to stay with them, Essilor is also offering its<br />

Platinum Partners the opportunity to encourage their patients to<br />

give Transition lenses a go by making Transitions free with EyeZen<br />

or Digitime lens from now until the end of the year! ▀<br />

“Ocula exists to deliver an exceptional eyecare<br />

and eyewear experience, providing full-scope<br />

optometry, the latest diagnostic equipment and a<br />

range of exclusive eyewear brands,” said Ross.<br />

Eyes on Ardmore has been serving Wanaka since<br />

2001, with Ross acquiring the business in 2009.<br />

The company’s focus is on providing a high level<br />

of clinical expertise backed up by retail innovation<br />

and excellent customer service, said Ross.<br />

Reflecting this, Eyes on Ardmore’s team was<br />

the recipient of the prestigious Outstanding in<br />

Professional Services award at the inaugural<br />

Wanaka Chamber of Commerce Business Awards in<br />

November. ▀<br />

PICTURE FROM CAMPAIGN<br />

John Winstone and Danielle Ross at the<br />

Wanaka Chamber of Commerce Business<br />

Awards<br />

Johnston. “That’s the whole concept behind the campaign, because<br />

that’s what our Drivewear lenses do, they enhance your vision, to give<br />

you that extra edge, make you that little bit better at what you do.”<br />

Younger’s free point-of-sale materials are available in New Zealand<br />

and if the consumer campaign is successful in Australia – which it’s<br />

looking like it will be, says Johnston – it’s very likely this will be rolled<br />

out in similar magazines in New Zealand.<br />

The new marketing drive also gives the company an opportunity to<br />

re-educate the market about Transitions Drivewear lenses as they are<br />

still unique, says Johnston.<br />

Transitions Drivewear lenses are the only polarised, photochromatic<br />

lenses that automatically change to three different colours, while<br />

darkening and lightening.<br />

“The lenses change colour for a reason. The colours are designed to<br />

enhance vision and increase your visual field depth. That’s why sports<br />

people have picked them up, because they enhance the colour of<br />

the ball, the undulations on a golf course, and give you better vision,<br />

blocking blinding glare, whether you’re cycling, fishing or whatever.”<br />

More and more ophthalmologists in Australia and the US are also<br />

prescribing them for their low vision patients, says Johnston. “They<br />

can’t increase their patients’ prescriptions, but by enhancing their<br />

vision through colour, they can enhance their vision and increase<br />

their depth of field.”<br />

According to the company’s marketing materials, “in bright sunlight<br />

Transitions Drivewear darkens up to a 90% tint with a dark brown<br />

colour to block intense light. While in overcast conditions, the lens<br />

lightens to an olive colour with a 63% tint allowing wearers to see<br />

more of their world. When driving or in mid-light conditions, the<br />

lens darkens or lightens to a copper colour with approximately 75%<br />

tint for excellent depth perception and enhanced contrast for visual<br />

quality and safety.”<br />

Developed with ophthalmologists and optometrists in the US,<br />

Transitions Drivewear combines Transitions’ photochromic technology<br />

and Younger Optics’ NuPolar polarisation. The lenses are available<br />

in 1.50 hard resin, high-impact polycarbonate and Younger’s Trilogy<br />

materials and come in a wide range of designs and prescriptions. ▀<br />

To order the free point-of-sale material visit<br />

www.drivewear.com/ECP<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>Dec</strong>ember <strong>2016</strong>


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References: 1. Christensen M, Blackie CA, Korb DR, et al. An evaluation of the performance of a novel lubricant eye drop. Poster D692 presented at: The Association for Research<br />

in Vision and Ophthalmology Annual Meeting; May 2-6, 2010; Fort Lauderdale, FL. 2. Christensen, M, Martin, A, Meadows, D. An Evaluation of the Efficacy and Patient Acceptance of a New<br />

Lubricant Eye Gel. Presented at American Academy of Optometry 2011, Boston, MA. 3. Davitt WF, Bloomenstein M, Christensen M, et al. Efficacy in patients with dry eye after treatment<br />

with a new lubricant eye drop formulation. J Ocul Pharmacol Ther. 2010;26(4):347-353. 4. Aguilar A. Efficacy of a Novel Lubricant Eye Drops in Reducing Squamous Metaplasia in Dry Eye<br />

Subjects. Presented at the 29th Pan-American Congress of Ophthalmology in Buenos Aires, Argentina, July 7-9, 2011. 5. Geerling G, et al. The International Workshop on Meibomian<br />

Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction. IOVS. 2011;52(4):2050-2064. Alcon Laboratories (Australia)<br />

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<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

5


Southern Eye opens<br />

new facility<br />

Southern Eye Specialists officially opened<br />

its new buildings at 128 Kilmore Street,<br />

Christchurch Central on 26 October. The<br />

evening opened with a blessing, followed by<br />

speeches from chairman, Dr Jim Borthwick,<br />

welcoming over 200 guests to the event, and<br />

Dr Allan Simpson, who made a donation to the<br />

neighbouring Otakaro Orchard community garden<br />

project on behalf of Southern Eye Specialists. The<br />

event was attended by local referrers, colleagues<br />

and members of the local community.<br />

Chrissie Dodds, Southern Eye Specialists practice manager, and the team from Cardiology Associates<br />

There are eight ophthalmologists working at<br />

Southern Eye, Drs Jim Borthwick, Sean Every,<br />

Allan Simpson, Rebecca Stack, Jo-Ann Pon, John<br />

Rawstron, Rob Weatherhead and Logan Robinson.<br />

All are New Zealand and fellowship-trained and<br />

experts in their respective fields. The practice has<br />

grown significantly over the last few years and<br />

it was becoming clear that larger purpose-built<br />

premises would be required in the future.<br />

The new rooms comprise three floors across<br />

two buildings in a new development at 128<br />

Kilmore Street, Central<br />

Christchurch. There is<br />

also increased parking<br />

for patients on site. The<br />

number of consultation,<br />

nursing and treatment<br />

rooms has been doubled,<br />

ensuring that patients<br />

are treated efficiently,<br />

quickly, and in comfort.<br />

There has also been<br />

significant investment in<br />

new equipment, ensuring<br />

that the new premises<br />

offer among the best<br />

treatment options to<br />

Christchurch and South<br />

Island patients. ▀<br />

Guests gather outside the new building for the blessing<br />

Dr Jim Borthwick welcomes guests to the opening of the new building<br />

The building being blessed<br />

NZAO rocks New Plymouth<br />

In October the NZAO<br />

hosted their 86th annual<br />

conference at Novotel<br />

New Plymouth. Topics<br />

centred on therapeutic<br />

management and the role<br />

we play in the primary care<br />

setting. Approaches to<br />

clinical diagnosis and new<br />

areas of research were also<br />

discussed.<br />

NZAO president Callum<br />

Milburn welcomed attendees<br />

to open the conference,<br />

with a summary of the<br />

year so far and the recent<br />

developments for NZAO. I<br />

attended the conference as a<br />

representative of Wanganui<br />

Eyecare. As this was my first<br />

year, it was a great opportunity for networking within<br />

such a collegial atmosphere.<br />

The conferences took place over the weekend,<br />

structured as a series of lectures, seminars and<br />

interactive workshops. As the field of New Zealand based<br />

optometrist-prescribers grows, the State University of<br />

New York’s (SUNY) Dr. Mitchell Dul’s animated lecture<br />

series was certainly timely. In an environment where<br />

optometrists are more extensively involved in treatment<br />

than they are in New Zealand, it served an as insight into<br />

the direction we are heading. In keeping with the theme<br />

of community practice, a number of local optometrists<br />

further discussed community engagement. With<br />

presentations on various models, we were introduced<br />

to the idea of a union between hospital systems and<br />

community practices for the treatment of glaucoma.<br />

Our keynote speaker from Flinders University, Konrad<br />

BY JOHN BOYLE*<br />

(L to R) John Anderson, Tim Harrington, David Neil, Kathy Stone, A/Prof Rob Jacobs, Mike Frith, Peter Turner and Knox Laird<br />

Pesudovs, encouraged us to broaden our approach while<br />

making a clinical diagnosis. With a background in both<br />

general practice and academic settings, it was interesting<br />

to hear Konrad’s perspective on the deceptive and<br />

often insidious red eye. Workshops on Sunday featured<br />

discussions regarding glaucoma, binocular vision, low<br />

vision and courses from the NZ Red Cross on First Aid. This<br />

allowed us to gain first-hand experience with specialists<br />

in their respective fields. Plenty of time was set aside for<br />

questions and for a few contentious debates!<br />

Evenings were spent in conversation with other<br />

optometrists or specialists from across New Zealand<br />

and internationally. A highlight of Friday evening was<br />

inadvertently having my dinner paid for by a friend and<br />

colleague— thanks Rob! Saturday night’s annual formal<br />

dinner saw attendees dress up in their finest attire<br />

before sitting down to a three course meal. Stars of the<br />

evening were of course the<br />

retired boys’ at their reunion,<br />

where I was given some good<br />

humoured advice on love and<br />

romance, which can no doubt<br />

be attributed to 40-yearsexperience<br />

in the industry.<br />

With the night ending in no<br />

small amount of dancing and<br />

accompanied by karaoke, it was<br />

no surprise to see a few bleary<br />

eyed attendees at the following<br />

morning’s workshops. ▀<br />

Keratoconus far more<br />

prevalent<br />

The world’s first keratoconus study<br />

in school children, the Wellington<br />

Keratoconus Study (WELKS), is just<br />

over half-way through and is already<br />

providing some insightful initial findings.<br />

In an update, released last month by<br />

the charity Capital Vision Research Trust<br />

(CVRT), which is conducting the study,<br />

it was announced that more than 1000<br />

Wellington teenagers in years 9 to 11<br />

have been screened for keratoconus since<br />

the study’s launch earlier this year.<br />

Initial findings show that compared<br />

to previous estimates keratoconus is 25<br />

times more prevalent in year 11s and<br />

nine times more prevalent in year 9s than<br />

previously thought. Of those diagnosed<br />

with keratoconus, 85% are male and 83%<br />

are of Maori descent.<br />

The WELKS study is being conducted<br />

with support from the Lions Club, local<br />

eye health specialists, Ford, Bowen<br />

Hospital and Alcon Vision Care. “The<br />

results from this study will have both<br />

national and international significance<br />

for the eye health of our young people,”<br />

said CVRT.<br />

CVRT study coordinator Janet Paget,<br />

in an article in the Dominion Post, said<br />

little was known about the prevalence<br />

of keratoconus, which was often only<br />

detected later in life when it was more<br />

difficult to correct. If keratoconus is<br />

picked up early it can be corrected with<br />

glasses, but if undetected can eventually<br />

cause blindness and require cornea<br />

transplants. “We are expecting to pick<br />

up at least one kid per school, possibly<br />

more.” The study is also picking up<br />

children who needs glasses or suffer from<br />

other eye problems.<br />

CVRT kitted out a specially-equipped<br />

van, complete with a Pentagram corneal<br />

topographer, to travel to participating<br />

secondary schools to screen year 9<br />

to 11 children as part of the study. St<br />

Catherine’s school principal Mary Curran<br />

told the Dominion Post it was a “winwin”<br />

having the research conducted at<br />

the school, with students receiving a<br />

thorough eye exam. “As long as it’s not<br />

interfering with their learning, why<br />

wouldn’t you?”<br />

The aim of WELKS is to identify<br />

patterns of keratoconus in its early<br />

stages of development, with the hope<br />

of developing longer-term best-practice<br />

screening and treatment solutions. The<br />

study should be completed by the middle<br />

of next year. ▀<br />

For more information about WELKS,<br />

visit www.capitalvision.org.nz/<br />

wellington-keratoconus-study-worldfirst-2015-<strong>2016</strong>.<br />

(L to R) Sidney Salek, Bill McClellan, Helen and Kinnear Johnson, Susan and Roger Apperley and Peter Stevenson<br />

6 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong><br />

John Boyle is a 22-year-old graduate<br />

from Auckland University, who joined<br />

Wanganui Eyecare earlier this year as<br />

a therapeutically-trained optometrist.<br />

He enjoys the slower pace and lighter<br />

traffic of Wanganui, as well as amateur<br />

dramatics and snowboarding.<br />

Dave Forrest (Lions Wellington), Rachel Cox (Research Manager, CVRT), Sandie McIntosh (Lions), Janet Paget (CVRT),<br />

Dr Reece Hall (CVRT board), Viv Forrest (Lions) and Prof. Tony Wells, CVRT founder


<strong>Dec</strong>ember <strong>2016</strong> NEW ZEALAND OPTICS<br />

7


SPECIAL FEATURE: VISIONZ <strong>2016</strong><br />

Visionz <strong>2016</strong><br />

BY GARY EDGAR, PRESIDENT OF NZOWA<br />

The business of vision<br />

This year Visionz was held at the Ellerslie Events Centre, Greenlane in Auckland.<br />

The facility at Ellerslie is so manageable and ticks all the boxes for our needs as<br />

a conference venue. The Visionz trade exhibition attracted 28 companies, a little<br />

down on the last exhibition in 2014, but still a good turnout.<br />

The trade exhibition was free to attend by anyone in the optical industry and was<br />

supported by Eduvisionz, comprising a special Low Vision meeting on the Friday and<br />

a practical, practice management conference on the Saturday and Sunday. Delegates<br />

reported they thought it was a great line up of speakers, covering great topics, making<br />

it a thoroughly enjoyable event.<br />

Other highlights included the new addition of a St John’s first aid course, open<br />

to all to attend. St John played an integral part in the conference with practical<br />

demonstrations on CPR. Essilor’s Guy Parbury won the CPR challenge with Berdette<br />

Garnett, from Pearson & Hooker, a close second. The course gave delegates the<br />

confidence to handle a real life situation. Certificates have been sent to all participants<br />

for your efforts over the four-hour course.<br />

NZOWA hosted a cocktail party on the Friday evening with a blind wine tasting.<br />

Participants had to correctly name the four types of wine and wine was given as prizes<br />

to winners Pene Fox and Stuart Whelan.<br />

Over the weekend we also had a prize draw for those who registered for the<br />

conference, plus a host of wonderful exhibitor prizes for delegates who took part in<br />

the “passport control” challenges. The early-bird registration draw, and the Nespresso<br />

machine, was won by Clitz-Simmi Chopra, while Darren Savage and Viv Deaker<br />

won the two $250 travel vouchers, and Michelle O’Hanlon scooped the $500 travel<br />

voucher. All winners were announced and celebrated at the Gala dinner on Saturday<br />

night, where ADONZ members, other delegates and exhibitors danced up a storm.<br />

Congratulations to all our winners, we hope you enjoyed your weekend here in<br />

Auckland.<br />

Delegate numbers were down<br />

compared to 2014 with 151<br />

registrations which, when combined<br />

with the 130 ADONZ conference<br />

delegates, meant a total of 281<br />

guest attendees. But given the<br />

buzz in the exhibitor room and the<br />

feedback on EduVisionz, I would like<br />

to personally thank my committee<br />

and all those involved for making<br />

this a successful weekend.<br />

Planning is now underway for<br />

the next Visionz in Auckland, in<br />

October 2018, and we welcome<br />

your feedback and views on what<br />

should be included and the format<br />

of the next event.<br />

Barbara Collins, NZOWA President Gary Edgar and Regan Hirst<br />

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8 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong><br />

OptiMed’s Robert Nyenkamp and Craig Norman<br />

The <strong>2016</strong> Eduvisionz programme offered as part of<br />

the NZ Wholesalers Association (NZOWA) biennial<br />

Visionz exhibition offered those who work in the<br />

optometry sector a unique opportunity to learn about the<br />

latest business trends, marketing techniques and industry<br />

focussed innovations. There was also lessons about dealing<br />

with complaints, a St John’s First Aid course, and information<br />

about picking the best team.<br />

The following is an overview of just some of the highlights<br />

from some of the key speakers:<br />

Juanita Neville-Te Rito, The Retail Collective<br />

Our own retail columnist Juanita Neville Te-Rito opened the<br />

Eduvisionz’ day with her talk on the fundamentals of retail<br />

marketing. “Retail is about the selling of products, services<br />

and experiences. The optometry industry straddles those<br />

three areas in a very unique way.”<br />

In order to deliver an engaging customer experience, you<br />

need to understand the shopper and their journey on the<br />

path to purchase, Neville-Te Rito told her audience. “The<br />

average human attention span is eight seconds and your<br />

ability to interact in a positive way within<br />

that timeframe is essential. Physical,<br />

virtual and digital experiences for the<br />

customer are also opportunities for sales.<br />

You have many touch points to connect<br />

with your customer.”<br />

Shoppers want to purchase on their<br />

own terms, she said, a retailer’s job is<br />

to solve that unmet need. “Shoppers<br />

want to touch, smell and feel. They don’t<br />

want cheap, but they want to make a<br />

good choice, and they want to make an<br />

emotional connection.”<br />

Neville-Te Rito said she felt the<br />

“eyewear category has lost its mojo.”<br />

“The days of the expert behind the<br />

counter are long gone, it’s about how<br />

the product makes me look and feel. The<br />

provider who can make me look and feel<br />

better will get the share of my dollar.”<br />

She finished by looking at three<br />

overseas businesses doing eyewear well.<br />

• Kite, a British boutique who<br />

approach the selling of eyewear like<br />

shoes. The company makes shopping<br />

tactile and fun, said Neville-Te Rito. Staff<br />

are relaxed and friendly and there is no<br />

pressure, no hard sell, just the chance to<br />

try on the goods and make a choice. Kite<br />

also offers style advisors and a kiosk with<br />

a multi-touch display for taking selfies in<br />

their frames.<br />

• Walby Parker, a US-based boutique<br />

chain, that’s built around the mobileenabled<br />

shopper who researches<br />

online, but wants to touch and feel the<br />

merchanside. “Don’t copy them,” says<br />

self-confessed Walby Parker fan Neville-<br />

Te Rito. “Just get into the space where<br />

you are asking yourself ‘how do I define<br />

my customer experience’. Think about<br />

customer flow and their pain points and<br />

you will find your bit of magic.”<br />

• Toyshades, a UK-based, design-led<br />

eyewear brand aimed at millennials<br />

with a clear focus on fashion, is a great<br />

example of “sticky engagement’” she<br />

said. The company’s simple, stylish range<br />

of eyewear is available online and as a<br />

concession in the high street fashion<br />

chain Top Shop, and it frequently provides<br />

specials, new ranges and promotions to<br />

draw the customer in.<br />

7/11/<strong>2016</strong> 2:33:13 PM<br />

Neville-Te Rito ended with the following advice: be<br />

uncomplicated, distinctive and communicate that message<br />

clearly to our customers.<br />

Mike Brunel, author, speaker and lifelong sales<br />

person<br />

Any man who walks into a room with an ice axe immediately<br />

has your attention. That was the first lesson salesman and<br />

entrepreneur Mike Brunel had for the audience as he stood<br />

there wielding the aforementioned lethal weapon, which<br />

once belonged to Kiwi climber Rob Hall.<br />

“We are all in sales. We just don’t know it,” said Brunel.<br />

“You need to change the way your staff view sales.”<br />

To illustrate the point, he recalled how he and Rob Hall<br />

presented an idea to Unilever to fund an expedition to<br />

Everest. Hall wasn’t a salesman, but he was so passionate<br />

about his cause Unilever supported him to walk seven<br />

mountains. Sales is about telling an authentic story that<br />

makes a connection with your customer, said Brunel.<br />

His tips included knowing your product back to front.<br />

“You’re being researched every day (on the internet), so<br />

when someone comes into the store you need all the<br />

answers to solve their problems and look professional.” Also<br />

there’s been a shift in buying criteria – people are buying a<br />

solution to a problem, but it’s emotional too, he said. “They<br />

want to feel good. Glasses are an accessory, an emotional<br />

item. We want to be able to see, but that’s the necessity<br />

aspect. The only way you can overcome price is to position<br />

yourself as an expert. Optometrists have been doing that all<br />

along – they have my files, I trust them.”<br />

Brunel also implored the audience to own the one<br />

kilometre around their store: letter boxes, text messages,<br />

social media – focus on your immediate locale and dominate<br />

that market, he said. “The theory is that only 6% of people<br />

are ready to buy right now – you need to be in front of them<br />

when they are ready to buy. Connect with your client on a<br />

regular basis.”<br />

Now imagine a man walks through your door who has<br />

been in the desert for 60 days, he said. “You give them a<br />

drink of water first, but do you stop there? No, because they<br />

will also want a shower, some new clothes and some food.<br />

You should always be thinking about the upsell; what are<br />

your customer’s unmet needs?”<br />

Brunel is also a big fan of openness in businesses. “Tell<br />

your staff everything except what the other person gets<br />

paid. And have regular, short meetings with at least one<br />

team meeting each week.” He suggests regular one-on-one<br />

sessions with staff, getting your staff to sell to you, and a<br />

Friday night social event to help lift staff engagement.<br />

Linda Cole, Blue Banana<br />

Author of many books about social media, including Learn<br />

marketing with social media in 7 days and Start with hello,<br />

a book about networking, Linda Coles is a specialist in<br />

raising a company’s digital profile for free, or very cheap.<br />

Most people are full of questions, she said. “Do you need<br />

a social media presence? Which one? How much will it cost<br />

in time and money?” Social media is important, because it<br />

gives us a soap box from which we can raise our profile.<br />

“Online, its warts and all – people can see what’s behind<br />

the brand. But this isn’t necessarily a bad thing. You just<br />

need to keep your brand in front of your consumer’s<br />

eyeballs. Pick a strategy and deliver. It doesn’t have to be<br />

big or fancy, but you have to implement it consistently. For<br />

example, is it to deliver wacky content? Then keep serving<br />

it up.”<br />

The aim, she said, is to “go viral” – the holy grail of free<br />

marketing. “The things that catch on are the things that<br />

make people’s pulse change. If it makes you cry, excited,<br />

happy, smile or laugh then it is making your pulse change<br />

and you should share.”<br />

Although she cautioned about too much content that<br />

makes you cry. Humour works best, she said. “When a<br />

brand makes you smile, people perceive that brand as more


Clare Martin, Judith McKinlay and Janice Batty<br />

Christine Doorman and Pene Leadbeater<br />

Maui Jim’s Mark Buist and Rob Garrett<br />

General Optical’s Koenraad Groot and Pablo Hurford<br />

Anne and Michael Warner and Vineet Chauhan<br />

Trish Orr, Jill Stackhouse, Dianne Goodridge, Jackie Merritt and Caron Bowe<br />

courteous and competent.”<br />

Cole recommended starting with developing a<br />

Facebook audience as good “bang for your buck”.<br />

But know who you are talking to; is it the blue<br />

rinse brigade or the hipsters? Figure out what<br />

their problem, need or desire is and how you can<br />

fulfil it.<br />

“Useful tips work well, like how to keep glasses<br />

clean or fun eye care. They’re very sharable.<br />

Video content is very engaging; you don’t have to<br />

make it, but can share it from other people…Just<br />

remember to get your logo in there somewhere!”<br />

The best time to post on Facebook, said Coles,<br />

is between 6pm and 9pm, and get your team<br />

involved in generating new and interesting<br />

posting ideas. You don’t even have to be there<br />

to post, you can schedule posts using Hoot Suite<br />

or Facebook’s own built-in function, and you can<br />

promote (or “boost”) posts for as little as $5 a day.<br />

“Can you afford it?” said Coles. “It’s more a<br />

question of can you afford not to?”<br />

Jackie Merritt, Deborah Warn, Shelley Endicott, Louise Green and Mark Collman<br />

Bruce Keighley, Nicola Dunn and Carl Doherty<br />

Elaine Silk, Practice by Design<br />

Nelson-based Elaine Silk helps practices with<br />

interior design, but it’s not just about the chairs<br />

you choose or where you put your reception desk,<br />

she said as she went on to explain the principles<br />

of sensory design, and stores that use all five<br />

senses to engage the customer.<br />

“This is the touchy-feely stuff, literally….When<br />

a patient enters a practice, they stop and pause.<br />

This is the decompression zone and they will be<br />

seeing, smelling and touching.”<br />

Back in the 1970s, a group of psychologists got<br />

really excited about being able to measure the<br />

way a sensory experience affects emotions. This<br />

laid the foundation for using sensory design in<br />

business, she explained.<br />

“The nose is easily bored. If there is a nice<br />

smell, it will subdue it, but nasty smells won’t go<br />

away. Your practice has a smell and if you’re not<br />

controlling it, you’re missing out.”<br />

Research by Nike, where they constructed two<br />

identical stores, but scented just<br />

one of them, showed an 84%<br />

increase in sales in the scented<br />

store. Silk also noted that<br />

Langham hotels have a signature<br />

scent it’s had designed that<br />

unites the whole hotel group.<br />

“You don’t want it to be<br />

overwhelming though,” Silk<br />

cautioned. “Plants can be a<br />

good solution, as they not only<br />

exude a subtle, natural scent,<br />

but brighten the atmosphere.”<br />

One Sydney-based study, she<br />

shared, showed productivity<br />

increased 12% when plants were<br />

introduced in the workplace.<br />

“Often you don’t know where<br />

smell stops and taste starts,”<br />

said Silk, adding that something<br />

as simple as offering a branded<br />

chocolate with a cup of coffee<br />

can have a big impact on a<br />

customer. It’s a personal touch<br />

and they begin to associate a<br />

taste with your practice, she said.<br />

A review of 157 studies<br />

looking at the impact of sound<br />

and music demonstrated,<br />

overwhelmingly, that people like<br />

music being played as well. The<br />

beats per minute also affects<br />

people’s pulse rates, with loud<br />

and fast music proven to weaken<br />

self-control (think Hollister’s<br />

European stores which are a<br />

bit like nightclubs). Practice<br />

managers may want to focus<br />

on more relaxing music to put<br />

customers at ease, said Silk. Placing the speakers<br />

around the periphery of the waiting room and<br />

up high will make the room feel larger, which<br />

also helps decrease the perception of wait times.<br />

Ambient ‘pink noise’ can be used in the consulting<br />

rooms for privacy, masking conversation. A useful<br />

tool if space is an issue, she said.<br />

Touch is also important, said Silk. “The sense of<br />

touch creates warmth and a sense of ownership<br />

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or belonging. Locked frame bars are a problem, as<br />

the customer needs to interact with the frames.”<br />

The final sense to cover is vision. Make sure your<br />

chairs aren’t worn out, your carpet isn’t stained,<br />

your glass is clean, pens aren’t chewed, she said.<br />

“Customers make a subconscious decision in 90<br />

seconds based on vision. And 52% of customers<br />

don’t return to a store because of aesthetics.”<br />

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<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

9


SPECIAL FEATURE: VISIONZ <strong>2016</strong><br />

Visionz <strong>2016</strong>: what’s new<br />

The New Zealand Wholesalers Association<br />

(NZOWA) had a good turnout on the<br />

exhibitors’ floor at the Ellerslie Event Centre<br />

in October, with more than 24 companies and<br />

organisations taking stands. The following is a<br />

snapshot of what was on offer and what was new<br />

from some of the main exhibitors.<br />

Essilor<br />

Ramana Mallavarapu and Bolle’s Sandy Caddy<br />

Distributed by:<br />

Essilor NZ’s marketing director Kumuda Setty and<br />

her team were asking delegates to take the Eyezen<br />

challenge, designed to highlight issues around<br />

digital eye strain affecting many people between<br />

20 to 40 years of age. Essilor’s Vision Foundation<br />

also had a stand highlighting their achievements<br />

this year and seeking support for its communitybased<br />

programme in 2017. Setty said she was<br />

pleased with the number of optometrists who<br />

had volunteered their time to be a part of the eye<br />

screening programme.<br />

OptiMed<br />

Robert Nyenkamp and Craig Norman from OptiMed<br />

were keen to show-off their new wall-mounted<br />

column table, perfect for the smaller practice or<br />

clinicians who see a lot of patients with mobility<br />

aids. The table has no legs, instead a column is<br />

mounted against the wall of the examination room.<br />

The table’s height is adjustable with a clear space<br />

underneath making it perfect for wheelchair users.<br />

General Optical<br />

General Optical’s new team Koengraad Groot<br />

and Pablo Hurford were proudly showing off<br />

the new Columbia range, which is also new to<br />

General Optical. The tough, outdoorsy eyewear<br />

range, made in collaboration with Flexon (another<br />

General Optical brand specialising in highly flexible<br />

materials) is made in Portland, Oregon by the<br />

Columbia Sportswear Company, a leader in the<br />

outdoor gear industry for more than 40 years.<br />

“It’s got a bit of brand following here because<br />

Columbia’s so well known for its gear, like puffer<br />

jackets,” said Hurford.<br />

Also attracting attention was General Optical’s new<br />

Dragon and Nike ranges. “Nike is huge for us, it’s very,<br />

very popular in New Zealand and it’s increasing all<br />

the time.” New to the range is the cute, but tough,<br />

Nike Kids range, which is also proving popular, as is<br />

the sun Rx programme, added Hurford.<br />

Independent Lens Specialists (and Shamir)<br />

ILS was proudly showing off its Progear Sportshades<br />

range, which have been designed from the ground<br />

up with input from professional athletes to be a<br />

high-performance prescription product, explained<br />

director Glenn Bolton.<br />

The Shamir sales team were also on hand to<br />

phone: 09 443 0072<br />

email: tim@oic.co.nz<br />

Device Technologies’ Ryan Heggie and Diego Sonderegger flank CR Surfacing’s Linton Dodge<br />

explain the new partnership between ILS and<br />

Shamir (see NZ Optics’ November issue), which<br />

expands ILS’ lens offerings. “Customers are really<br />

pleased because Shamir hasn’t had a fitting<br />

lab that was as well-equipped as ours is,” said<br />

Bolton. Shamir products now available via ILS<br />

include the digitally-designed Autograph3 lens<br />

and its Glacier Plus range.<br />

Albie Hanson, formerly of Lensworx, now<br />

ILS, was also at Visionz to explain how ILS is<br />

now running the Kodak Lens Vision Centre<br />

programme (see NZ Optics’ October and<br />

November issues) across the country.<br />

In other news, ILS’s popular magnetic<br />

Chemistrie Sunlenses clip-ons, which are custom<br />

made to fit virtually any frame, has introduced<br />

Chemistrie Blue to cut out blue light.<br />

Euro-Optics and Elegance in Eyewear<br />

Central to the Euro-Optics stand was its new<br />

range, produced in collaboration with iconic<br />

Kiwi menswear brand, Barkers. “This is our first<br />

chance to show the full collection all at once,”<br />

said general manager Carl Doherty. “It’s been<br />

really well received by the market so far. We’ve<br />

had a lot of interest and a lot of good feedback.”<br />

Doherty said as the new Barkers Eyewear range<br />

is a direct collaboration, Euro-Optics has some<br />

direct influence over the design. “So if people<br />

have demand for a particular style or element<br />

they need, like if they need a bigger bridge for<br />

bigger guys, then we can look at integrating that<br />

into new releases. We have tried to make sure<br />

the range has some statement pieces as well as<br />

some good selling, classical shapes and colours<br />

that really appeal to New Zealand men.”<br />

Euro-Optics is also offering a Barkers’ Optical<br />

Starter pack to independents, which includes<br />

$40 Barkers’ promotional gift cards for patients<br />

who buy a Barkers’ frame and $20 for sunglasses,<br />

which was proving very attractive, he said.<br />

On the stand was also Silhouette’s new range<br />

from its younger, urban lifestyle brand Neubau,<br />

which is going to be incorporating more natural,<br />

recyclable materials into its frames and packaging.<br />

There was also a new range from Inface, part<br />

of the Design Eyewear Group, which has a<br />

great entry level price deal, said Doherty. While<br />

Silhouette is re-positioning the brand for a<br />

younger demographic with the help of a new,<br />

attractive marketing campaign. “The design<br />

element will always remain on lightweight and<br />

rimless frames, but with different interpretations<br />

of that,” said Doherty, with new styles entitled<br />

“urban fusion” etc. reflecting the new positioning.<br />

Finally, Italia Independent have released<br />

some metal frames with just standard glazing,<br />

making them not so restrictive to use; new flat<br />

sunglasses, which are right on trend now; and the<br />

latest Adidas Originals range, including a “really<br />

well-priced” sunglass range,” said Doherty.<br />

BTP International<br />

BTP International’s busy stand had an extra hand<br />

at Visionz in the form of Chris Hanley, national<br />

sales manager for De Rigo Australia, representing<br />

BTP’s new upmarket De Rigo brands - Chopard,<br />

Furla, Dunhill, Lanvin and Escada (see full story<br />

p11.).<br />

Also taking pride of place was Rodenstock’s<br />

frame brands, including Porsche, and<br />

information about its high quality lens system.<br />

Rodenstock’s Nicola Peaper, a speaker at the<br />

EduVisionz conference who explained multifocal<br />

lens technology, was also present to help Visionz<br />

attendees understand multifocals and how<br />

to choose what’s best for your patient. BTP’s<br />

Trish Orr said there had been a lot of interest<br />

in the lenses, while Peaper said optometrists<br />

and dispensing opticians are best to familiarise<br />

themselves with a couple of lens systems and<br />

manufacturers as customisation is key in the<br />

independent market to really make a difference<br />

to your patients.<br />

BTP’s other brands include Ogi (see p 18.),<br />

Seraphin, Bon Vivant and Red Rose from Ogi<br />

Eyewear; Area 98’s La Matta and Kaos; and Nova<br />

Rx sunglasses (for more see the OIG).<br />

Eyes Right Optical<br />

The launch of the Face à Face 16/17 sunglasses<br />

collection, as worn by Catherine Zeta Jones, was<br />

a priority for Trish Bloxham and her team. With<br />

100 pieces in the collection, all of which bring<br />

the highlights from the optical range into the<br />

sunglasses frame design, there was plenty to<br />

showcase. Eyes Right also had the new collection<br />

by ProDesign on display, a vintage-inspired range<br />

called Danish Heritage.<br />

Phoenix Eyewear<br />

Kate Sylvester<br />

With the lead up to summer, Phoenix Eyewear’s<br />

main focus at Visionz was its new prescription<br />

sunglass ranges from CAT, O’Neill, William Morris<br />

and its new brand Ben Sherman, which are all in<br />

the entry-level prescription sunglass programme<br />

(see p4.) with Essilor, said Mark Collman. “Then<br />

we’ve got our Kate Sylvester premium brand,<br />

which sits above that, but they are all prescriptable<br />

styles, which has been our major focus.”<br />

New brand Ben Sherman was attracting a lot<br />

of attention, especially with its clever “button”<br />

and fabric-design detailing. Visionz is ideal for<br />

introducing new brands as it allows you to see a<br />

lot of people quickly and modify your purchasing<br />

to suit what the customers want, rather than<br />

what you think they want, he said.<br />

On the stand were also all the wonderful new<br />

styles from William Morris released at Silmo<br />

Paris this year (see NZ Optics’ November issue),<br />

which were also attracting attention. People<br />

are getting braver, said Collman, especially with<br />

colour, though this takes a little while sometimes<br />

to filter out to the more rural regions.<br />

Sales of O’Neill sunglasses are also going well,<br />

he added, “because they are colourful, bright,<br />

lightweight and they are polarised, so lots of nice<br />

aspects there for younger people who want a<br />

good solution.” While the thinner acetates and<br />

round frames from Carter Bond, sister brand to<br />

the wonderfully colourful Jono Hennessy, were<br />

also proving to be a hit.<br />

Device Technologies<br />

Device Technologies’ Diego Sonderegger<br />

said given the increasing interest and use of<br />

OCT-Angiography (see this month’s Eye on<br />

Ophthalmology, p24.), there’s been a lot more<br />

interest in the company’s new Swept Source DRI<br />

OCT Triton SS from Topcon.<br />

Also attracting interesting was Topcon’s CV-<br />

5000, a computerised vision tester offering the<br />

latest features in automated refraction. “The<br />

great thing about this, is it’s all automated,”<br />

said Vision Team product manager Ryan Heggie.<br />

“So it takes an optometrist from standing and<br />

leaning to control the manual refractor heads<br />

in front of the patient’s face, to sitting down,<br />

at their desk, using the touchscreen one-dial<br />

control to digitally control the lenses. So it’s a<br />

great relief for neck and shoulder pain.”<br />

The CV-5000 also includes an LCD visual acuity<br />

10 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>


chart and easily interfaces<br />

with an optometrists’ other<br />

technologies, including<br />

the patient database, so<br />

everything is automatically<br />

inputted and saved where<br />

it needs to be, said Heggie,<br />

plus the price has come<br />

down. “So it’s now getting<br />

great momentum as it’s a<br />

lot more affordable.”<br />

The big news on the stand,<br />

however was the launch<br />

into New Zealand of Frey’s<br />

automated perimeters. The<br />

Frey product range covers<br />

the entire spectrum of visual<br />

field test technologies,<br />

from complete testing to<br />

data analysing systems. The<br />

technology behind Frey’s<br />

perimeters is born from the<br />

high-performance automotive industry, so it’s proven, long-lasting and<br />

durable, and its affordable, said Sonderegger. The perimeters come in<br />

three different sizes from the portable version, weighing just 9kg, to<br />

the top AP-300 model, incorporating an extensive range of strategies,<br />

fields and test parametres.<br />

CR Surfacing<br />

Sharing a stand with Device Technologies was CR Surfacing as<br />

both are members of the Optical Alliance, a professional business<br />

development and loyalty programme designed to support<br />

independent optometrists. General manager Linton Dodge said<br />

the alliance has been in operation for more than four years and is<br />

working well, providing customers with good package deals for<br />

equipment and lenses, for example, as well as referrals for those<br />

involved in the Alliance.<br />

CR Surfacing’s stand featured Shaw lenses, designed by Dr Peter<br />

Shaw in Canada in response to spectacle-induced anisekonia; Satin<br />

Blue coating to combat harmful blue-light from the sun and LED<br />

screens to help relieve sore and tired eyes; and the Signature Anti-<br />

Fatigue ST, a specially-formulated free-form lens, also designed to<br />

sooth hard-working eyes, and now available in a stock lens format<br />

with the added protection of Satin Blue.<br />

Optique Line<br />

Bob Graham from Optique Line was keen to show off the company’s<br />

increasingly popular Mersey Beat house brand. Paying homage to the<br />

signature fashion of the early 1960’s music scene, combined with a<br />

fresh, contemporary twist on design and manufacturing processes,<br />

the new range showcases the best traits of the current vintage style<br />

trend at a very affordable price.<br />

Bollé and Serengeti<br />

St John’s demonstrating the lighter side of saving lives<br />

Growth in Bollé and Serengeti’s prescription sunglass programme<br />

has been amazing, said Sandy Caddy, the brand’s New Zealand<br />

business manager. “We’ve been in the programme three years and it<br />

is just going from strength to strength.”<br />

Having Bollé and Serengeti authentic lenses helps create more<br />

choice for patients, she said. “We run the European programme…<br />

generally everything is back within two to three weeks, and it’s easy<br />

to use the website portal. New Zealand has really embraced it.”<br />

Caddy was also keen to communicate the breadth of the brands<br />

script range, which is one of the largest at +6 to -8 and up to a -4 cyl.<br />

“So we exceed a lot of those parametres, so for those who are a bit<br />

tricky we’ve got options and solutions.”<br />

Fashion-wise, matt finishes and mirrored glasses are very much on<br />

trend, said Caddy, especially coloured mirrors and a return to more<br />

‘80s and ‘90s-inspired looks.<br />

Bollé is also promoting its sports solutions (it’s even released a high<br />

performance cycling helmet), which are proving to be increasingly<br />

popular with consumers, she added. “So it’s an opportunity to grow<br />

where the market is growing…because the technology has just<br />

improved so much, so it’s pretty exciting really.”<br />

De Rigo and BTP in NZ<br />

New Zealand high-end frames<br />

distributor BTP International<br />

introduced a number of new<br />

international frame brands at Visionz <strong>2016</strong><br />

after agreeing to become the agent for<br />

Italian company De Rigo in New Zealand<br />

earlier this year.<br />

On show were stunning examples from<br />

the latest ranges of some of De Rigo’s<br />

flagship brands including Chopard, Furla,<br />

Dunhill, Lanvin and Escada. Chris Hanley,<br />

national sales manager for De Rigo<br />

Australia, was also on hand to present the<br />

frames and support their launch (re-launch<br />

in the case of Chopard) into New Zealand.<br />

Hanley said he approached Trish Orr from<br />

BTP to become the company’s distributor<br />

in New Zealand for some of De Rigo’s<br />

higher-end brands as she’s already wellknown<br />

and established in the market in<br />

this field and carries a number of similar,<br />

but different, compatible brands.<br />

Though most of the brands are new to<br />

New Zealand, one is not new to Orr as she<br />

looked after the very high-end Chopard<br />

account many years ago when she worked<br />

at Eyeworld. She says she’s delighted to be<br />

able to represent Chopard again and to have<br />

expanded her portfolio with some of De<br />

Rigo’s other brands. “These are all famous<br />

international brands…so it’s very exciting to<br />

take on these new brands. We are known for<br />

point-of-difference and high quality product<br />

so it was really the way to go.”<br />

Orr says all the new De Rigo brands<br />

work well with BTP’s other brands,<br />

which are also all high quality, especially<br />

Rodenstock (maker of Porsche frames) and<br />

Rodenstock’s high quality lenses. “So it<br />

seemed like the right marriage for us. We<br />

also just love fashion, so we love to have<br />

the connection with high quality product.<br />

It really is eye jewellery.”<br />

Chopard, particularly, is well-known for<br />

its eye-jewellery credentials, incorporating<br />

precious jewels, rhinestones and 22<br />

carat gold plating to create a timeless<br />

and elegant collection, a<br />

reputation enhanced by its<br />

annual sponsorship of the<br />

Cannes Film Festival. It even<br />

makes the coveted Palme<br />

d’Or trophies.<br />

De Rigo is one of the<br />

largest family-run optical<br />

manufacturing companies<br />

in the world. Founded in<br />

1978 by brothers Ennio and<br />

Walter De Rigo as a small<br />

company of artisans working<br />

in Belluno in Northern Italy,<br />

it’s brands are now sold<br />

in 80 countries through<br />

15 companies and more<br />

than 100 independent<br />

distributors. Other De<br />

Rigo brands include Police,<br />

Loewe, Nina Ricci and<br />

Zadig&Voltaire.<br />

The company strengthened<br />

BTP’s Trish Orr, wearing Chopard’s elegant opera-inspired palladium readers, and De Rigo’s Chris Hanley at Vsionz <strong>2016</strong><br />

Chopard’s “Happy Diamonds”<br />

its position in the Asia Pacific region earlier<br />

this year by acquiring its major Australian<br />

distributor L’Amy Australia in September.<br />

Former L’Amy managing director Mark<br />

Holloway is now managing director of the<br />

new subsidiary, which operates officially<br />

under the name De Rigo Vision Australia,<br />

based in Sydney. In a statement at the<br />

time of the purchase, De Rigo CEO Michele<br />

Aracri said, “Australia is a key market for<br />

our consolidation in Asia Pacific, one of<br />

the most dynamic economies of the area<br />

360˚<br />

From Furla’s 2017 sun range<br />

with impressive potential. This investment<br />

is another step forward in the wholesale<br />

level of the De Rigo Group.” He said having<br />

a direct Australian subsidiary means De<br />

Rigo would now be “well placed to respond<br />

quickly to customer’s needs, especially<br />

relating to sales, marketing and aftersales<br />

services”.<br />

There was so much great stuff at Visionz and<br />

ADONZ <strong>2016</strong> that we were unable to fit it all<br />

in, so coverage of the Low Vision conference<br />

day will be in our February 2017 issue. Ed.<br />

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<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

11


SPECIAL FEATURE: VISIONZ AND ADONZ <strong>2016</strong><br />

ADONZ <strong>2016</strong><br />

The ADONZ<br />

Annual<br />

Conference<br />

was a great success<br />

with a raft of varied<br />

and interesting<br />

lectures. With the<br />

NZOWA trade fair<br />

held alongside<br />

our weekend, we<br />

enjoyed the best of<br />

both stimulating<br />

educational<br />

presentations and<br />

products and services<br />

that enhance our<br />

industry. Over the<br />

past few years we<br />

have valued the<br />

lectures provided by<br />

the Association of<br />

British Dispensing<br />

Opticians (ABDO)<br />

and it was especially<br />

BY PEGGY SAVAGE, ADONZ PRESIDENT<br />

ADONZ president Peggy Savage and speaker Julien<br />

Porte from Morel France<br />

pleasing to have the International Opticians Association (IOA)<br />

convention delegates attend our conference.<br />

Our AGM was held on the Friday. My presidency was extended<br />

for a further year; Donald Crichton will continue as vice president;<br />

while the executive consists of Vineet Chauhan, Lynette Hunter,<br />

Lucie Single and Andy Willmott. It was a little disappointing that<br />

AGM attendee numbers were down slightly this year, however,<br />

the executive is very excited about our future and the education<br />

requirements, along with ensuring we keep pace with an ever<br />

changing industry.<br />

ADONZ is open to suggestion for the proposed David Wilson<br />

memorial trophy/award. He was sorely missed at conference,<br />

however we were greatly appreciative that Jan came to our Gala<br />

Dinner, which was an evening shared with the NZOWA and a<br />

great success. It appears the older DOs have a learned stamina for<br />

dancing the night away compared to the young’uns who have yet<br />

to hone this skill!<br />

See you next year.<br />

ADONZ <strong>2016</strong> National Conference<br />

– “All things Kiwi”<br />

The Association of Dispensing<br />

Opticians of New Zealand (ADONZ)<br />

held their <strong>2016</strong> national conference<br />

at the Ellerslie Events Centre. The<br />

conference opened to the resonance of Poi<br />

E, a quintessential Kiwi song that summed<br />

up the conference theme ‘All things Kiwi’.<br />

In a New Zealand Herald poll in 2014 we,<br />

as Kiwis, identified ourselves as friendly,<br />

having a can-do attitude, and being<br />

laid-back. These three great traits were<br />

personified in the wonderful conference<br />

delegates of ADONZ <strong>2016</strong>. Ellerslie was<br />

buzzing with colleagues meeting, friends<br />

reuniting, stimulating discussion, and<br />

a fabulous trade-show with an array of<br />

frame, lens and instrument companies<br />

represented. This was the backdrop for a<br />

variety of great speakers to inform, inspire<br />

and entertain the delegates. It was an<br />

honour, as an optometrist, to be a part of<br />

the ADONZ conference as both a speaker<br />

and delegate.<br />

Stephen Caunter, the business training<br />

manager of ANZ Bank, was first to the bat<br />

discussing how customer complaints can<br />

improve business. He gave a comprehensive<br />

and highly entertaining presentation<br />

with practical examples of dealing with<br />

unsatisfied customers. We were then off<br />

for a quick trip around the ‘globe’ with<br />

the lovely tour guide, Elaine Grisdale.<br />

Elaine is the current head of professional<br />

services and international development<br />

at the Association of British Dispensing<br />

Opticians (ABDO). The anatomy overview<br />

was informative and well-linked to day-today<br />

situations that dispensing optician’s<br />

encounter.<br />

The next speakers covered the full range<br />

of ages and appealed to them all, much<br />

like Country Calendar. Dispensing tips were<br />

given for challenging paediatric patients<br />

as well as problem solving in multi-focal<br />

wearers. I had the privilege of presenting on<br />

paediatric visual impairment in Aotearoa,<br />

a topic close to my heart. Nicola Peaper,<br />

the professional services manager of<br />

Rodenstock Australia, spoke on maximising<br />

multifocals for distance and near. Through<br />

her presentation Nicola took us back to<br />

some of the basics of dispensing including<br />

appropriate measurements and the impact<br />

these have on the final lens design.<br />

After a day of learning we were put to<br />

the test with an evening of nibbles and<br />

wine tasting, New Zealand wine of course,<br />

with winners receiving prizes from the<br />

conferences sponsors. It was a wonderful<br />

cocktail party that caused the Bachelor NZ<br />

to pale in comparison.<br />

The next day began with the main<br />

lecture hall being filled with the wonderful<br />

presentation skills of Dr Trevor Gray, a<br />

refractive-cataract surgery and corneal<br />

surgery specialist. Trevor eloquently covered<br />

the interesting topics of ‘cataracts – is there<br />

now a cure’, ‘adenoviral conjunctivitis’ and<br />

‘demodex and the eye’. All three topics<br />

were discussed with much interest over the<br />

BY SAMANTHA SIMPKIN*<br />

ADONZ keynote speakers, ABDO’s Fiona Anderson, Barry Duncan and Elaine Grisdale<br />

following delicious morning tea treats and<br />

coffee. Running concurrently with Trevor’s<br />

talk was a Paediatric Dispensing Workshop,<br />

which I chose to attend. The workshop<br />

was overseen by the multi-talented,<br />

Fiona Anderson who is the current ABDO<br />

president, a passionate dispensing optician<br />

and a member of too many boards to begin<br />

listing. Fiona’s excitement for educating<br />

others was evident from the moment she<br />

entered the room. Real-life cases were<br />

presented with an ensuing small group<br />

discussion, then feedback time to the session<br />

as a whole. Many interesting prescriptions<br />

were shown which stimulated dialogue<br />

between colleagues. Fiona encouraged<br />

taking the time to research challenging<br />

cases, understand your clients, and learn<br />

to say ‘no’ when needed, all to ensure our<br />

patients get the best outcomes possible.<br />

This session made me consider the multiple<br />

options of dispensing for high prescriptions<br />

and possible techniques to employ to<br />

maximise visual and cosmetic results. It is<br />

much like the All Blacks scoring a try, the<br />

main goal is to get over the line, but if you<br />

can make it look good you will have fans for<br />

life, just ask Dan Carter and Julian Savea!<br />

Staying in the sport theme, Dr Nicola<br />

Anstice a senior lecturer in the School<br />

of Optometry and Vision Science at the<br />

University of Auckland, highlighted the<br />

importance of outdoor time for children.<br />

Nicola presented a thorough and concise<br />

review of the extensive literature on myopia<br />

control modalities and reiterated the<br />

growing importance of this in optometric<br />

practices as myopia continues to increase.<br />

This was a timely reminder of the<br />

importance of the right correction in myopia<br />

control and the role dispensing opticians<br />

play in communicating with the optometrist<br />

and patient. From the wonderful New<br />

Zealand accent of the local Dr Nicola Anstice<br />

we moved to the lilting French accent<br />

of Julien Porte, from Morel France, who<br />

discussed frames. Julien took us through the<br />

process of designing a frame, from the artist<br />

to deciding material to final production.<br />

He also took the time to review important<br />

features of the different materials used for<br />

frames, aspects we should be considering as<br />

we select spectacles for our patients.<br />

After lunch we came back to New<br />

Zealand with a session on ‘Knowledge risk<br />

management within an optometry practice’<br />

by Vineet Chauhan and ‘Understanding and<br />

responding to migrant health services in<br />

New Zealand’ by Raj Singh. Following this<br />

was one of my personal highlights of the<br />

conference, three presentations from the<br />

effervescent Carly Henley, an orthoptist<br />

from Greenlane Clinical Centre. Carly wins<br />

the prize for the most animated presenter<br />

of the conference, her enthusiasm for her<br />

work is contagious! Carly spoke on ‘Nobody<br />

loves you when you are down and out’<br />

(strabismus), ‘To see or not to see – that is<br />

the question’ (amblyopia), and ‘practical<br />

magic’ (prism). A trio to rival Sol3 Mio.<br />

Next came L&P, Lindsey Pine, Optometrists<br />

and Dispensing Opticians Board registrar,<br />

who covered the important information<br />

on practising legally and within scope. She<br />

was followed by Essilor’s Gordon Stevenson<br />

on the importance of prescription safety<br />

eyewear, a hard topic with our ‘she’ll be<br />

right’ Kiwi attitude. Gordon reminded us of<br />

the incidence and preventability of a lot of<br />

eye injuries. A review of correct dispensing<br />

techniques of safety frames and lenses was<br />

appropriate as the sun peaked through the<br />

clouds and Summer began to feel close.<br />

The venue and delegates transformed<br />

into their gala dinner best for the Saturday<br />

evening. The ball room was decked out with<br />

Kiwiana; flax, paua, and the quintessential<br />

buzzy-bee toy. It was a night of dancing,<br />

dinner and drinks with of course some Dave<br />

Dobbyn thrown in!<br />

The delegates reassembled, more<br />

quietly this time, for the final morning of<br />

conference on Sunday. We were provided<br />

with a morning of strabismus, Shaw lenses,<br />

professionalism and the secret life of lenses.<br />

These fascinating topics were covered by an<br />

abundance of talent. Firstly, Dr Justin Mora,<br />

a paediatric ophthalmologist who relished<br />

showing videos of strabismus surgery and<br />

articulate the complexities of strabismus.<br />

Evan Brown, optometrist (TPA, FCOVD)<br />

covered the intricacies of aniseikonic<br />

corrections with Shaw lenses. Grant Dabb,<br />

another optometrist (FACBO), illuminated<br />

the amazing impact lenses have on function<br />

including visual space, motor function and<br />

perception.<br />

The variety and range presented at this<br />

conference was comparable to that Kiwi<br />

icon, the Kiwi Burger, an interesting mix,<br />

that results in all who try it being satisfied.<br />

It was an absolute privilege to be able to<br />

attend a dispensing optician conference<br />

as an optometrist, it was an excellent<br />

conference that comprised all the best<br />

bits of being Kiwi. To all the organisers,<br />

delegates and ADONZ, I would like to say<br />

thank you and ka pai! ▀<br />

Samantha Simkin and Anthony Simpson<br />

* Samantha Simkin is a therapeutically-qualified<br />

optometrist currently pursuing her PhD in the<br />

Department of Ophthalmology at the University of<br />

Auckland.<br />

12 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>


<strong>Dec</strong>ember <strong>2016</strong> NEW ZEALAND OPTICS<br />

13


Focus on<br />

Eye Research<br />

Crosslinking, keratoconus and herpes<br />

BY DR RASHA ALTAIE*<br />

CORNEAL COLLAGEN<br />

CROSSLINKING IN CHILDREN<br />

WITH KERATOCONUS (J AAPOS<br />

2015;19:228-232)<br />

This study reports on the visual,<br />

refractive, and tomographic<br />

outcomes of corneal collagen<br />

crosslinking (CXL) in paediatric<br />

patients with keratoconus (KC).<br />

A total of 25 eyes of 14 patients<br />

(11 males) were included. Mean<br />

age at surgery was 16.2 years<br />

(range, 13-18 years).<br />

The following parameters<br />

were analysed: astigmatism;<br />

maximum-, minimum-, meankeratometry<br />

values (Kmax,<br />

Kmin, and Kmean, respectively.)<br />

and thinnest corneal depth.<br />

All patients had CXL in theatre<br />

with epithelium off. Follow up<br />

intervals were at three months,<br />

six months and one year for all<br />

patients and at two and three<br />

years where available. Changes<br />

in Kmax, as described by Koller<br />

and colleagues, were defined as<br />

Kmax regression (>1 D decrease<br />

in Kmax), Kmax stabilisation (1 D increase in<br />

Kmax). The results showed<br />

at one year, compared with<br />

preoperative Kmax values, five<br />

eyes (20%) showed regression;<br />

13 eyes (52%) stabilisation; and<br />

seven eyes (18%) progression.<br />

There was a significant reduction<br />

in the mean thinnest corneal<br />

area from baseline (473.6 ±<br />

37.68 mm) to six months (424.55<br />

±70.2 mm), but this recovered<br />

at one year (452.82 ±53.5 mm).<br />

There were no significant<br />

postoperative complications.<br />

This study showed that CXL is<br />

safe in kids, and CXL effectively<br />

stabilised uncorrected visual<br />

acuity, refractive indices and<br />

keratometry values at one year,<br />

while improving best-corrected<br />

visual acuity.<br />

The author policy is to treat<br />

paediatric KC following initial<br />

diagnosis, rather than to wait<br />

for documented progression.<br />

This study highlights the<br />

importance of early treatment of<br />

KC in children, which we highly<br />

recommend.<br />

PAEDIATRIC KERATOCONUS IN<br />

A TERTIARY REFERRAL CENTRE:<br />

INCIDENCE, PRESENTATION,<br />

RISK FACTORS AND TREATMENT<br />

JOURNAL OF REFRACTIVE<br />

SURGERY <strong>2016</strong>; 32(8):534-541.<br />

Keratoconus (KC) is rare in<br />

children, however it seems<br />

to progress faster and to be<br />

more advanced at the time of<br />

diagnosis than adults. This study<br />

highlights the importance of<br />

early detection of KC in children.<br />

Also it reports the incidence,<br />

clinical presentation, risk factors<br />

and treatment outcome of<br />

paediatric KC. The author reports<br />

on the incidence of paediatric KC<br />

in children among patients with<br />

keratoconus of all ages during<br />

five years (2010-2014). 16,808<br />

patients were examined, and the<br />

incidence of paediatric KC was<br />

0.53%.<br />

<strong>Dec</strong>reased visual acuity was<br />

the most frequent complaint at<br />

initial presentation, in addition<br />

to allergic conjunctivitis, hydrops<br />

scar (mistaken as bacterial<br />

keratitis scar) and family history<br />

of KC. All eyes received corneal<br />

cross-linking treatment and<br />

16 eyes received additional<br />

intra-corneal ring segment<br />

implantation. Other treatment<br />

modalities have also been<br />

used like implantable collamer<br />

lens (ICL). The authors set a<br />

nomogram for the treatment<br />

of KC in kids, depending on the<br />

initial best correct visual acuity,<br />

ability to tolerate contact lenses,<br />

anisometropia and presence of<br />

corneal scaring.<br />

The study concludes the<br />

importance of suspecting KC in<br />

children with a positive family<br />

history of KC, poor correct<br />

distance visual acuity, high<br />

astigmatism and/or history of<br />

eye rubbing and allergic eye<br />

disease with reduced visual<br />

acuity. The disease has a fast<br />

progression rate. Therefore, no<br />

time should be lost between<br />

diagnosis and treatment.<br />

EPIDEMIOLOGY OF HERPES<br />

ZOSTER OPHTHALMICUS,<br />

RECURRENCE AND CHRONICITY<br />

OPHTHALMOLOGY VOLUME<br />

123, NUMBER 7, JULY <strong>2016</strong><br />

This is a retrospective<br />

epidemiological study, with the<br />

aim to describe the prevalence<br />

of herpes zoster ophthalmicus<br />

(HZO) and risk factors for its<br />

recurrence and chronicity.<br />

All the medical records of<br />

patients, whom were diagnosed<br />

with HZO from January 2010 to<br />

<strong>Dec</strong>ember 2014, were reviewed.<br />

A total of 90 patients were<br />

included in the study with mean<br />

age at initial presentation, of<br />

68±13.5 (range of 27-95 yrs); the<br />

peak age was 60-69 years. The<br />

author of the study describes<br />

the presenting ophthalmic<br />

manifestation in HZO,<br />

conjunctivitis or episcleritis as<br />

the most common presentations,<br />

followed by uveitis and epithelia<br />

keratitis. All these patients were<br />

monitored for recurrence of HZO.<br />

Also the clinical course of the<br />

disease was defined as acute<br />

and chronic. Chronic disease was<br />

defined as active disease that<br />

requires antiviral therapy or antiinflammatory<br />

therapy (or both)<br />

for more than 90 days from the<br />

initial presentations.<br />

The recurrence rate was up<br />

to 25%. Of note, most of the<br />

recurrence occurs in immune<br />

competent patients, white race,<br />

male gender, with no history<br />

of HZO vaccination during the<br />

follow up.<br />

Interestingly, several ocular<br />

findings on initial presentation<br />

increased the risk of recurrent<br />

disease. These risk factors<br />

included ocular hypertension<br />

and uveitis.<br />

Similarly both these two factors<br />

increased the risk of chronicity as<br />

well, but after adjusting for age<br />

and gender, ocular hypertension<br />

was the main risk factor for<br />

both recurrence of HZO and its<br />

chronicity.<br />

In conclusion this study<br />

highlights the risk factors for<br />

recurrence (or chronic course<br />

of HZO) as well the role of<br />

vaccination and oral antiviral<br />

therapy to reduce the chance of<br />

recurrence of HZO. ▀<br />

ABOUT THE AUTHOR:<br />

* Dr Rasha Altaie is an<br />

ophthalmologist with particular<br />

interest in pterygium surgery,<br />

paediatrics, cornea and cataracts.<br />

After training in Ireland she received<br />

advanced clinical fellowship and<br />

sub-specialty training in cornea and<br />

anterior segment reconstruction, and<br />

paediatric ophthalmology at Auckland<br />

University. She is currently working as<br />

a specialist in the public sector with<br />

Counties Manukau DHB and as well as<br />

privately at the Milford Eye Clinic.<br />

Record attendance<br />

for DOCC<br />

A<br />

record<br />

37 budding ophthalmologists attended the Dunedin<br />

Ophthalmology Clinical Course (DOCC) this year. The course, run<br />

by the Ophthalmology Department at the Dunedin School of<br />

Medicine from 31 October to 11 November, is an intensive, two-week<br />

residential course for New Zealand and Australian medical graduates<br />

in their final years of the RANZCO training programme. Running since<br />

1998, the course has been specially-designed to prepare registrars<br />

sitting the RANZCO Advanced Clinical Examination (RACE) on their<br />

journey to become fellows of the Royal Australian and New Zealand<br />

College of Ophthalmologists (FRANZCO).<br />

“The RANZCO RACE is a frightening prospect for most eye registrars,”<br />

said Gisborne ophthalmologist Dr Graham Wilson, an Otago University<br />

senior lecturer and course speaker. “The DOCC course is totally<br />

dedicated to helping them pass.”<br />

Dr Wilson praised course manager Sally Boult, who he says has<br />

everything running “super smoothly”, and the Dunedin Hospital Eye<br />

Department team – Drs Logan Mitchell, Casey Ung, Harry Bradshaw<br />

and Mary Jane Sime and Associate Professor Gordon Sanderson – for<br />

“the massive amount of organising and planning” needed to make the<br />

course such a success.<br />

This year’s course involved 21 speakers addressing a number of subspeciality<br />

topics, each with clinically-orientated interactive modules,<br />

seminars and case presentations, followed by a number of mock<br />

written and Objective Structured Clinical Examinations (OSCEs). New<br />

lecturers this year included Drs Rob Jones and Antony Bedggood, from<br />

Nelson and Christchurch respectively, and Ben LaHood from Adelaide.<br />

Ruth Ferraro, RANZCO’s new deputy CEO and head of education,<br />

also attended one day of lectures and, together with Dr Justin Mora,<br />

course lecturer and newly-appointed RANZCO censor-in-chief, hosted<br />

the registrars at a reception on behalf of RANZCO, where Dr Mora<br />

encouraged them to continue to support the work of the College once<br />

the all-consuming RACE was behind them.<br />

Of the record 37 attendees on this year’s course, five were New<br />

Zealanders and 32 were Australian.<br />

DOCC <strong>2016</strong> attendees with RANZCO’s Ruth Ferraro (bottom left)<br />

SPONSORED FEATURE<br />

Hill-RBF installed<br />

in Gisborne<br />

The Hill-RBF method represents a new<br />

approach in IOL calculation, based on<br />

pattern recognition, data interpolation and a<br />

validating boundary model, for improved accuracy<br />

and confidence with IOL power prediction.<br />

The first Hill-RBF Calculator has just been<br />

installed at Kiwi Eye in Gisborne on Dr Graham<br />

Wilson’s Lenstar LS 900, an all-in-one cataract<br />

planning platform offering unique dual zone<br />

keratometry. This is the first installation in New<br />

Zealand, although some Kiwi ophthalmologists<br />

have already been accessing the Hill-RBF<br />

Calculator on-line.<br />

With the heightened emphasis on cataract surgery<br />

being a refractive procedure for many patients, the<br />

drive to optimise the formulas used to determine<br />

IOL selection has also revved up. We have been<br />

fortunate to have access to two new formulas over<br />

the last couple of years – the Olsen and the Barrett.<br />

The Hill-RBF Calculator is likely to be another<br />

incremental improvement on both formulas.<br />

Dr Wilson said: “It is exciting to be able to offer<br />

this new technology to patients and optimise<br />

their post phaco-refractive outcomes. The Hill-<br />

RBF Calculator is very cool – utilising artificial<br />

intelligence and being a continuously updated<br />

‘big data’ exercise.”<br />

Background on the Hill-RBF Calculator<br />

Lenstar with T-Cone and monitor<br />

The Hill-RBF Calculator is a joint project with<br />

the RBF (Radial Basis Function) Calculator<br />

physician team, Haag-Streit in Switzerland and<br />

US mathematical computing software firm<br />

Mathworks.<br />

The Hill-RBF Calculator is an advanced, selfvalidating<br />

method for IOL power selection<br />

employing pattern recognition and sophisticated<br />

data interpolation. It has been optimised for<br />

use with the Haag-Streit Lenstar, using optical<br />

biometry for all axial measurements and high<br />

density autokeratometry.<br />

Radial basis function IOL power selection<br />

performs the same for short, normal and long eyes.<br />

Based in artificial intelligence, this methodology<br />

is entirely data driven and free of calculation bias.<br />

This approach also employs a validating boundary<br />

model, indicating when it is performing within a<br />

defined area of accuracy.<br />

The fundamental advantage of pattern<br />

recognition for selecting an IOL power is achieved<br />

through the process of adaptive learning – the<br />

ability to learn tasks based solely on data,<br />

independent of what is previously known. Current<br />

methods limit possibilities to situations that are<br />

already understood. This method is also selforganising,<br />

meaning that it has the ability to create<br />

its own organisation, or representation of data.<br />

Such an approach is well-suited to the complex,<br />

non-linear relationships that make up many<br />

aspects of the human eye.<br />

Unlike static theoretical formulas, this approach<br />

will be an ongoing project and continuously<br />

updated as a “big data” exercise. The greater<br />

the number of surgical outcomes that are fit<br />

to the RBF model, the greater the overall depth<br />

of accuracy. In its present form, the Hill-RBF<br />

Calculator has been optimised for biconvex IOLs<br />

from +6.00 D to +30.00 D.<br />

The Hill-RBF method is now part of the Haag-<br />

Streit LENSTAR EyeSuite biometry software.<br />

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


Eye Institute conference highlights<br />

BY JASON DHANA*<br />

Giving up a sunny Sunday in November<br />

is usually a question requiring much<br />

deliberation, but when it coincides with Eye<br />

Institute’s annual conference, the answer for 177<br />

optometrists was obvious.<br />

Once again held at the lakeside Waipuna Hotel<br />

in Auckland’s Eastern suburbs, the conference<br />

covered the common, the rare, the new, and handy<br />

tips such as closing wounds with super glue!<br />

Probably to prevent us from having a Sunday<br />

snooze, the format comprised rapid quick-fire<br />

sessions, as well as speaker panels for opportunities<br />

to submit questions. This year’s International<br />

keynote speaker was Dr Jason Holland, an<br />

optometrist based in Brisbane. Dr Holland is<br />

passionate about shared-care responsibilities for<br />

glaucoma and ocular surface disease patients. He<br />

opened the morning with his lecture titled ‘Show<br />

me the light – MGD & IPL’, which touched on<br />

meibomography and meibomian gland expression,<br />

and successful cases following treatment with<br />

intense pulsed-light (IPL) devices.<br />

During the morning, Dr Trevor Gray enlightened<br />

us on the latest advances in implantable contact<br />

lenses (ICLs), specifically highlighting the benefits<br />

of the new Aquaport ICLs, while Dr Peter Ring<br />

detailed clues to the diagnosis and the protean<br />

causes of unilateral proptosis, as well as diagnosis<br />

and long-term management of retinoblastoma.<br />

Although potentially life-threatening conditions<br />

are less commonly encountered in optometric<br />

practice, they do happen, and accurate and<br />

thorough assessment is crucial in preventing<br />

misdiagnosis. Signs of unilateral proptosis include<br />

a hyperopic shift, tethering of the inferior rectus<br />

and an IOP difference greater than 4mmHg<br />

between the eyes. These should also alert the<br />

clinician to rule out thyroid eye disease, which is<br />

the most common cause of unilateral proptosis.<br />

Commonly encountered in optometric practice,<br />

foveal pathologies were covered by Dr Peter<br />

Hadden. A useful piece of information to pass onto<br />

patients is that approximately half the patients<br />

with an epiretinal membrane will remain stable,<br />

while half will worsen. Vitreomacular traction<br />

is commonly seen on OCT and Dr Hadden spoke<br />

Trish Collins and Noel Templeton Nicola Dunn, Gary Edgar and Bruce Keighley Chloe Lovell, Hadyn Treanor and Angeline Ng<br />

Teresa Flanagan and Selina Phuah<br />

about the chances of progression to a retinal hole<br />

and assessment, based on quick and easy OCT<br />

measurements. The rule is the vitreous will break<br />

free from the macula if the adhesion is less than<br />

200µm, while those greater than 600µm will lead<br />

to stronger adhesions and pulling on the macula.<br />

This of course can lead to a macula hole, either<br />

lamellar or full-thickness in nature. Simple tests<br />

to differentiate these when an OCT is out of reach,<br />

include the Watzke-Allen test or our trustworthy<br />

Amsler grid.<br />

Dr Adam Watson introduced us to Tacrolimus<br />

ointment. Tacrolimus works well for inflammatory<br />

conditions such as AKC, VKC and dry eye. Some<br />

evidence exists on treatment for SLK, and<br />

prophylaxis for graft rejection as well. As expected<br />

of any quality conference, the topic of glaucoma<br />

for optometrists was strongly covered. Dr Holland<br />

highlighted that half of glaucoma patients are still<br />

undiagnosed and that a ‘normal’ IOP in turn does<br />

not make a disc ‘normal’ – a very important point in<br />

Dr Peter Hadden, Darryl Eastabrook and Michael White<br />

my experience and opinion. One can almost ignore<br />

(but still measure) IOP, and instead undertake a<br />

careful disc assessment without any bias from<br />

whether IOP is normal or elevated. Because (as we<br />

know) glaucoma does exist without elevated IOP.<br />

Dr Holland went on to cover the outcomes of the<br />

Advanced Glaucoma Intervention Study (AGIS) and<br />

the Ocular Hypertension Treatment Study (OHTS),<br />

reporting that thinner corneas lead to a higher risk<br />

of progression and being aware of the numerous<br />

causes for short-term IOP fluctuations. As well as<br />

IOP, patients may also perform visual fields with<br />

great variability. According to the NHMRC guidelines<br />

(2010), it is recommended that two to three visual<br />

field tests per year are performed to detect change.<br />

Dr Graham Reeves covered the EAGLE study,<br />

which concluded favouring clear-lens extraction for<br />

angle closure, either with or without elevated IOP.<br />

This is already a frequently-performed procedure<br />

in cases of angle closure in New Zealand. Professor<br />

Helen Danesh-Meyer also shared her always<br />

Optrex’s Ernest Tobia with Laura Crosby<br />

Dennis Oliver, Chris Earnshaw and Younus Bhikoo<br />

well-received glaucoma wisdom with us, stating<br />

that the role of IOP in glaucoma is evolving and<br />

that NTG as a discreet entity does not exist. She<br />

presented studies which revealed that 40-60% of<br />

glaucomatous patients have IOP within the normal<br />

range. Interestingly, the association between disc<br />

CONTINUED ON P16<br />

Thank you<br />

Please mark your calendars for<br />

next year’s series<br />

for attending Eye Institute’s Seminars, Workshops<br />

and 12th Annual Conferences this year.<br />

Seminars 23rd May, 22nd August 2017<br />

Conference 4th and 5th November 2017<br />

Register online or email:<br />

conference@eyeinstitute.co.nz<br />

Eye Institute 2015.indd 1<br />

<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

15<br />

20/11/14 4:18 PM


CONTINUED FROM P15<br />

Aaron Mirkin, Susie Partington and Tony Devcich<br />

haemorrhages and NTG are debatable according<br />

to numerous studies. With regard to patient<br />

education, patients may wonder how or why<br />

they have developed glaucoma when they have<br />

a normal IOP, unlike their friend/relative who has<br />

glaucoma with elevated IOP. Professor Danesh-<br />

Meyer likes to explain glaucoma to her patients in<br />

that it is “a disease of pressure sensitivity”, where<br />

the IOP in that particular eye may be too high for<br />

that particular optic nerve. I find this a quick and<br />

useful tip which patients easily understand.<br />

Gingko biloba is a well-known and thoroughlyinvestigated<br />

neuroprotector. It has been shown<br />

to relax vasospasm and acts as an antioxidant. It<br />

can however thin blood and even though a JAMA<br />

study showed no adverse effects on patients<br />

taking blood thinners, it’s probably best to discuss<br />

management of these particular patients with<br />

their GP prior to commencing treatment with<br />

gingko biloba. Importantly, a rare yet significant<br />

side effect of prostaglandin analogues, which I<br />

have seen in my patients, is orbital fat atrophy.<br />

This is reported to take effect within 6-12 months,<br />

particularly with bimatoprost.<br />

As the conference came to a close, Dr Simon<br />

Dean spoke about his dark-horse product, which he<br />

carries around in his first-aid kit – cyanoacrylates,<br />

or superglue. A tale emerged about how Dr Dean<br />

had closed a wound secondary to ‘surfboard versus<br />

head’, which was a definite Bear Grylls moment for<br />

him. Non-toxic and self-sloughing after a few days,<br />

cyanoacrylates such as Dermabond and Histacryl<br />

have a slower setting time compared to your<br />

run-of-the-mill commercial superglue, due to their<br />

longer-chained chemical structure. Glue is a great<br />

Alex Petty testing out OptiMed’s equipment with Robert Nyenkamp<br />

alternative to sutures, says Dr Dean, especially<br />

when managing patients who aren’t the easiest to<br />

suture – kids.<br />

As usual, Eye Institute delivered a top quality<br />

conference and I look forward to their 2017 CPD<br />

events. In the meantime – I’m off to my local<br />

Bunnings to stock up my first-aid kit. ▀<br />

* Jason Dhana is an optometrist in ophthalmology, Greenlane<br />

Clinical Centre, and a Professional Teaching Fellow in the School<br />

of Optometry and Vision Science, University of Auckland.<br />

Vipti Harry and Yvette Beattie<br />

Jyotika Lal, Selina Phuah and Maria Pais<br />

Practical workshops focus on OCT<br />

Eye Institute extended its annual conference<br />

this year to include two afternoon workshops<br />

the day before the main Sunday optometrist<br />

and DO conferences. Both were practical,<br />

discussion-focused workshops that took a slightly<br />

different look at the pros and cons of optical<br />

coherence tomography (OCT), including the<br />

different products currently on the market and<br />

their use in diagnosing glaucoma.<br />

Each workshop ran for about one and a half hours<br />

and the 90 or so delegates who attended – about<br />

50% of which had OCTs and 50% didn’t, but were<br />

considering buying them – could choose which one<br />

to go to first or second as they were repeated.<br />

Optical coherence tomography<br />

The OCT Workshop was run by Eye Institute Drs<br />

Peter Hadden, Trevor Gray and (new appointee – see<br />

Dr Graham Reeves<br />

joins Eye Institute<br />

Dr Graham Reeves has joined the Eye<br />

Institute after relocating to Auckland at<br />

the beginning of this year and becoming<br />

one of the consultant ophthalmologists with<br />

Counties Manukau District Health Board.<br />

Born in Palmerston North, Dr Reeves went to<br />

medical school in New Zealand, but completed<br />

his ophthalmology training in the UK before<br />

returning to Wellington in 2012 to undertake a<br />

glaucoma fellowship with Professor Tony Wells.<br />

Previously with Capital Eye Specialists in<br />

Wellington, Dr Reeves, who is a glaucoma and<br />

cataract specialist, says he moved to Auckland to<br />

take up an “exciting opportunity” with Manukau<br />

SuperClinic to help their recently beefed-up<br />

glaucoma treatment service.<br />

Dr Reeves joined two other new appointees<br />

on the glaucoma team, Drs Shenton Chew and<br />

Jim Stewart, who all joined within about two<br />

weeks of each other. Having made the move and<br />

knowing several of his Eye Institute colleagues<br />

from his training days, he says he was delighted<br />

to be offered the opportunity to join the Eye<br />

Institute. “I am very excited to be adding my<br />

skills and experience to the great team at the Eye<br />

Institute.”<br />

The move to Auckland is not a new one, as<br />

Dr Reeves spent six months here in 2003-2004<br />

and says he’s enjoying the cultural and sporting<br />

activities Auckland is offering him and his young<br />

family. ▀<br />

Eye Institute Dr Graham Reeves<br />

separate story) Graham Reeves. This covered the<br />

different types of OCT: the original time-domain<br />

(TD) OCT, which is somewhat eclipsed today by<br />

spectral-domain (SD) OCT as it offers far higher<br />

resolutions (1μm to 3μm axial resolution vs 10μm<br />

with TD-OCT) and scans per second (at least 20,000<br />

compared with TD’s 400), and Swept-source OCT<br />

(SS-OCT; DRI-OCT made by Topcon), which is the<br />

latest milestone in retinal and choroidal imaging.<br />

“Every machine has a role,” said Dr Gray. “But TD<br />

has largely been superseded by SD, which is clearly<br />

the technology here to stay.” While Swept-Source<br />

is still a bit too highly priced, so is probably more<br />

for specialists in public hospitals until the price<br />

becomes more affordable. Dr Gray recommended<br />

http://eyewiki.org/, the American Academy of<br />

Ophthalmology’s online Eye Encyclopaedia as “a<br />

great resource” for optometrists who really wanted<br />

to compare the different technologies.<br />

Dr Hadden tackled the technical aspects of<br />

OCT, why they are called OCTs and how they<br />

work and then explained how he used OCT<br />

to study “the amazing sub-cellular anatomy”<br />

of the retina and some of the pitfalls of OCT<br />

analysis. While Dr Reeves looked at other<br />

clinical uses for OCT, particularly diagnosing<br />

glaucoma – a tricky business even with the latest<br />

equipment. He admitted he had been interested<br />

in the technology enough to visit Spectralis<br />

OCT manufacturer Heidelberg’s head office in<br />

Germany, of his own volition and at his own<br />

expense, but (laughing) officially disclosed how<br />

the company had given him a couple of teddy<br />

bears for his kids!<br />

In summary, OCT makes early detection of<br />

anything and everything far easier, said Dr<br />

Gray. While having an accurate and detailed<br />

baseline from which to work from aids any future<br />

diagnoses, said Dr Reeves. “It’s all about getting<br />

to really know your machine; how it scans,<br />

what it scans each time, so you can really see<br />

comparisons between the scans over time. But no<br />

machine is infallible.”<br />

Other tips, especially for diagnosing glaucoma,<br />

included: use the power of progression analysis;<br />

actively search for artifacts; be aware of normal<br />

variants; find the scleral spur with anterior<br />

segment OCT; and always evaluate and treat<br />

new technology with a high degree of healthy<br />

scepticism. “This machine has no brain, so you<br />

need to use your own,” ended Dr Reeves.<br />

Practical aspects of<br />

diagnosing glaucoma<br />

The other workshop ‘Practical<br />

aspects of diagnosing<br />

glaucoma’ was chaired by<br />

Eye Institute’s Dr Shanu<br />

Subbiah and featured guest<br />

speakers Drs Jason Holland,<br />

from Brisbane, and Jay<br />

Meyer, originally a US-based<br />

ophthalmologist and now<br />

a fellow of the Department<br />

of Ophthalmology at the<br />

University of Auckland.<br />

Dr Subbiah proved an<br />

amusing and interactive chair<br />

describing in no uncertain<br />

terms why he used to hate doing gonioscopy, but<br />

why there’s really no alternative. “Anterior OCT is<br />

a great communication tool, but gonioscopy is still<br />

the gold standard.”<br />

Both Dr Subbiah and Dr Meyer provided tips on<br />

how to get the best iridocorneal angles and why<br />

this can be, and sometimes cannot be, helpful<br />

in diagnosing glaucoma; the dos and don’ts<br />

and controversies surrounding PIs (peripheral<br />

iridotomies, the preferred laser procedure in New<br />

Zealand for treating narrow angles) and whether<br />

even treating narrow angles works.<br />

Dr Meyer says OCT is important as a diagnostic<br />

tool as it’s the only provider of objective<br />

information, a quantitative assessment of the<br />

inner retina, while all the other tests – indirect<br />

fundoscopy, visual field testing, stereo disc photos<br />

and disc drawings – are all subjective. But there are<br />

“still many potential confounders” in OCT when<br />

it comes to diagnosing glaucoma and glaucoma<br />

progression, including:<br />

• Unrepresentative normative databases (did<br />

you know the data for most OCTs is based on a<br />

sample of just 200 to 500 cases, making accurate<br />

breakdown by sex, age, ethnicity and/or region<br />

somewhat inaccurate?)<br />

• Poor quality images<br />

• Atypical nerves<br />

• Measurement and segmentation errors, and<br />

• Masquerading conditions<br />

Dr Holland stressed the importance of taking<br />

more than one scan, especially if you’re concerned<br />

about anything amiss or unexplainable on<br />

How, what and why for DOs<br />

For the second year, Eye Institute ran a second<br />

conference parallel to the main conference<br />

for dispensing opticians. This covered a<br />

number of topics including how to identify<br />

dangers, what makes something dangerous and<br />

why and when red flags should be waved.<br />

Dr Peter Hadden’s first session looked at ‘Flashes<br />

and floaters – what’s dangerous, what’s not?’ He<br />

noted he had only ever had one migraine, which<br />

was characterised not by a headache but by partial<br />

vision loss and the presence of an unusual visual<br />

aura. These symptoms are the most common<br />

visual disturbance, but can be indicative of far<br />

more serious conditions like brain cancer, so should<br />

be checked out if they are sudden or different to<br />

normal. Good triage of the patient – often done over<br />

the phone – is the gateway to the best treatment,<br />

he said.<br />

Later that morning, Dr Hadden discussed the<br />

refractive consequences of vitreoretinal surgery,<br />

looking at combined cataract and vitreoretinal<br />

surgery and how post-operatively patients can find<br />

a big change in their vision, beyond the obvious<br />

benefits of the cataract removal. Many patients<br />

can find themselves with a new astigmatism<br />

or may need glasses to correct a new refractive<br />

error. The benefits of removing a cataract far<br />

out-weigh these consequences but, he explained,<br />

it was important to understand all the methods<br />

employed for correcting them.<br />

Dr Simon Dean gave an informative talk<br />

about the therapeutic uses of tissue glue in eye<br />

surgery. He noted tissue adhesives are now in<br />

widespread use and can aid the reduction of<br />

surgical time while also speeding up patient<br />

recovery. Cyanoacrylates, fibrin glues and the<br />

common-all-garden Steri-Strips are some examples<br />

of these adhesives. Being aware of the benefits<br />

Glaucoma and OCT workshop speakers Drs Jason Holland, Jay Meyer and Shanu Subbiah<br />

the first scan. If you have access to different<br />

machines, it’s also helpful to do another scan on<br />

another machine to test the first one’s accuracy. “I<br />

encourage multiple tests as diagnoses are only as<br />

good as the raw data you’re getting.”<br />

The most important thing, however, is to<br />

think, he said, to use your judgement and your<br />

experience and to not wholly trust the data you<br />

get from any OCT scan.<br />

As to which OCT, the speakers agreed each<br />

machine has different pros and cons and while<br />

they said some were better than others, this was<br />

also affected by price, especially if every add-on is<br />

an additional expense.<br />

Dr Holland said when buying, optometrists<br />

should look for simple reporting functions, not<br />

pages and pages of data, which can be confusing<br />

and difficult to find and assess progression. The<br />

capabilities of SD-OCT are also rapidly advancing<br />

with 3D imaging, reproducible registration and<br />

advanced segmentation algorithms of macular<br />

and optic nerve head regions. A review of the<br />

evidence to date, said Dr Holland, suggests retinal<br />

nerve fibre layer (RNFL) remains the dominant<br />

parameter for glaucoma diagnosis and detection<br />

of progression, while initial studies of macular<br />

and optic nerve head parameters have shown<br />

promising results. But simply taking regular disc<br />

photos for comparison is also important.<br />

In both workshops, chairs Drs Gray and Subbiah<br />

stressed that feedback from all delegates is more<br />

than welcome to hone subsequent workshops<br />

next year. ▀<br />

See more on OCT-A on p24.<br />

and limitations of these adhesives is essential to<br />

good post-operative care, he said, before running<br />

through a few case studies drawing the audience’s<br />

attention to the importance of keeping a would<br />

bacteria-free for fast healing and good cosmetic<br />

recovery.<br />

Dr Nick Mantell welcomed the audience back<br />

from morning tea with a look at refractive laser<br />

surgery and who is suitable. He noted this field<br />

is continuously evolving and as a result the<br />

criteria for assessing patient suitability is also in<br />

a state of flux. Astigmatism, corneal thickness<br />

and dry eye are all issues which might restrict<br />

patient suitability, but he described a number of<br />

circumstances under which these patients might<br />

be accepted.<br />

CONTINUED ON P17<br />

16 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>


CONTINUED FROM P16<br />

Dr Adam Watson looked at eyelashes. He<br />

discussed what is a normal eyelash and the role<br />

eyelashes have as the first level protectors of<br />

our ocular surface, before moving on to what<br />

can go wrong. Demodex, blepharitis, styes and<br />

madarosis (eyelash loss) are some common<br />

conditions patients might present with. Dr<br />

Watson then shared various management<br />

options and things to watch out for.<br />

The next two sessions were adapted talks<br />

from the main conference. Key note speaker<br />

Dr Jason Holland, a specialist optometrist<br />

from Brisbane, opened with his talk, ‘Show me<br />

the light – a look at the science, mechanisms<br />

and evidence behind IPL in the treatment of<br />

meibomian gland dysfunction and dry eye<br />

disease’; while Dr Trevor Gray tackled the issues<br />

and changes with implantable contact lenses<br />

(ICLs) noting he had personally performed<br />

more than 1,200 ICL procedures to date. Dr<br />

Gray also reviewed the latest international<br />

papers relating to ICLs, the new Aquaport ICL<br />

design and the different approaches to shared<br />

post-operative care required for ICL patients.<br />

Dr Peter Ring wrapped up the early-afternoon<br />

session with his look at the evolution of<br />

intraocular lenses (IOLs). Up until about 60<br />

years ago, all patients were aphakic following<br />

cataract surgery. So the insertion of the first<br />

intraocular lens in 1950 permanently changed<br />

expected outcomes for cataract surgery<br />

patients. However, it wasn’t until they were<br />

re-designed in 1975 that they finally found an<br />

accepted place among cataract surgeons, he<br />

said, before discussing newer developments in<br />

the evolution of this now essential prosthetic.<br />

The final talk of the day, ‘Evolution of laser<br />

vision correction’, was also presented by Dr<br />

Gray, who looked at the improvements offered<br />

by wavefront guided treatments against the<br />

more well-known LASIK and SMILE. Wavefront,<br />

also known as ‘custom LASIK’, uses unique<br />

precision technology to measure prescriptions<br />

down to 0.01dioptors and then gathers<br />

information about the unique architecture of<br />

the eye to customise the laser’s response. Your<br />

eye is re-shaped not just according to your<br />

prescription but in response to its own unique<br />

landscape, explained Dr Gray. ▀<br />

Make it<br />

readable<br />

BY NAOMI MELTZER*<br />

Have you ever tried to read an article, a notice,<br />

a telephone number or directions on a packet<br />

and given up in frustration? You are not alone.<br />

That is why Sight Loss Services Charitable Trust<br />

launched the Make It Readable (MIR) campaign<br />

in June 2015. We wanted to draw attention to<br />

this issue and advocate for readable material by<br />

persuading those producing print materials to adopt<br />

readable print guidelines.<br />

The campaign was funded as part of the Think<br />

Differently fund, a social change campaign seeking<br />

to encourage and support a fundamental shift in<br />

attitudes and behaviours towards disabled people.<br />

As part of the MIR campaign, a survey was<br />

conducted with support from Synergia Ltd. This<br />

survey asked people to provide information on the<br />

materials that they struggled to read during their<br />

daily lives and the reasons these materials were<br />

hard to read.<br />

The results from the MIR survey provide a useful<br />

insight into the types of materials that are difficult<br />

to read and the reasons for this difficulty. The MIR<br />

survey has shown that there are a large number<br />

of items that people find hard to read. Some of<br />

the most frequently identified items included<br />

newspapers, food products, and phone books,<br />

though the survey also returned a lot of comments<br />

about poor website design making it difficult to<br />

access material by computer as is so often required<br />

nowadays. These are items that will impact on most<br />

people, but particularly the quality of life of people<br />

with vision impairments, reducing their connection<br />

with community and being less informed about the<br />

products they can purchase.<br />

Sight Loss Services continues to distribute the MIR<br />

guidelines to various organisations particularly those<br />

who send newsletters or other material out to a<br />

target audience in the over-50 age group. ▀<br />

* Naomi Meltzer is an Auckland-based optometrist specialised<br />

in low vision and rehabilitation, and a trustee of the charitable<br />

trust Sight Loss Services.<br />

If you want it to be read, it must be readable.<br />

These guidelines have been specially created to enable everyday informaon to be immediately accessed by<br />

more people and for all types of documents.<br />

Who benets from Clear Print?<br />

CLEAR PRINT<br />

GUIDELINES<br />

Because Clear Print is designed to be used for all documents, it has far reaching benets. A clearly designed<br />

and easy to read document will convey your essenal informaon to everyone who reads it, and in the process<br />

can convey a posive view of the originang individual or organisaon.<br />

Contrast is how you see things against their background. Aging causes a natural decline in contrast sensivity,<br />

our ability to detect a difference in contrast.<br />

Approximately 1 in 7 people over 50 years of age have signicant loss of vision due to condions such as<br />

Macular Degeneraon or Glaucoma. This rises to at least 1 in 4 over 80 years old. One of the major effects<br />

of such condions is to reduce contrast sensivity beyond the normal loss, so that the world starts to take<br />

a “washed out” faded look. This has the most signicant effect on reading print. Maximum contrast is black<br />

leers on a white non-shiny background or white leers on a black background.<br />

The modern era of digital print means that newspapers, newsleer, forms and noces are produced on a<br />

computer screen where prey coloured backgrounds and prinng over graphics such as picture or paerns<br />

are easily seen on the screen, but the end product on paper is at best difficult to read by those with normal<br />

vision and impossible to read for those with reduced. The same applies to websites which may look prey<br />

but unless the principles of contrast as well as size are applied to the layout, the important informaon<br />

becomes unreadable. Many people just don’t bother to read something that requires too much effort.<br />

For printed informaon to be accessible to its reader the following guidelines should be followed:<br />

1) Bold black print is easiest to see. Black print on white background or white print on black background<br />

is the best contrast. Black print on a yellow background or yellow on black is also good<br />

contrast.<br />

2) Items can be highlighted with a coloured border but should not be printed over coloured backgrounds<br />

or paerns. The closer the background colour is to the colour of the print the harder it is<br />

to read.<br />

3) A minimum font size of 10 point should be used for a target market over 65 years of age. Any<br />

important informaon should be in bold 12 point font with headings and key points in bold 14 point.<br />

4) Use plain sans serif fonts such as Ariel or Calibri. Fancy prints are decorave but impossible to read<br />

for people with low vision.<br />

5) Leave good white space between blocks of print. If print is crowded together it becomes more<br />

difficult to read.<br />

6) Do not wrap columns of print around graphics such as photos. People using magnifying aids have<br />

enough problems keeping their place on a line of print without having to search for it elsewhere<br />

on the page.<br />

<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

17


SPECIAL FEATURE: SILMO <strong>2016</strong> (CONT.)<br />

A spectacle of choice<br />

Silmo <strong>2016</strong> wowed with the pure breadth of options on display. Read<br />

on for the second instalment from NZ Optic’s own Lesley Springall<br />

as she shares more highlights from SILMO <strong>2016</strong> (continued from<br />

November’s issue).<br />

Menrad<br />

Philip Crabtree, general manager of VMD Eyewear,<br />

was at Silmo to meet a number of suppliers. He met<br />

with NZ Optics on the Menrad stand, where the<br />

company’s flagship Jaguar range was in prominent<br />

display, along with Menrad’s other brands including<br />

Morgan and JOOP! Menrad’s Davidoff brand,<br />

however, wasn’t allowed to be shown because<br />

of France’s strict rules on tobacco advertising –<br />

Davidoff makes cigarettes as well as eyewear.<br />

Jaguar is a particularly popular brand in New<br />

Zealand, said Crabtree, having such a strong brand<br />

image and having been available for more than 25<br />

years (distributed by Tony Brooks who retired about<br />

three years ago).<br />

Apart from Davidoff, the new collections of all<br />

Menrad’s brands were available to view at Silmo,<br />

said managing director Eberhard Müller-Menrad,<br />

who runs Menrad with his brother and whose greatgrandfather<br />

founded Menrad. He kindly joined us to<br />

show us some of the highlights of the new Jaguar,<br />

Morgan and JOOP! collections, the latter being very<br />

much on trend with a rounder, strong-coloured look.<br />

Monoqool<br />

3D-printed frames pioneer Monoqool, from<br />

Denmark, had a truly eye-catching stand with its<br />

far larger-than-life backdrop picture of two models<br />

sporting frames from its latest collection. A very<br />

busy co-founder and CEO Allan Petersen showed off<br />

the company’s wonderful new collection, including<br />

some very stylish, round, retro-looking styles.<br />

Five times lighter than acetate, the frames weigh<br />

just six grams and are very flexible and adaptable.<br />

They also come with a number of different nosepad<br />

options for different ethnicities, making it very easy<br />

for the optician to fit, he said.<br />

Despite growing competition, Monoqool is still<br />

very much leading the way in what’s possible in<br />

the 3D printed frame world, said Petersen, pulling<br />

a box of “super thin” (and gorgeous) new frames<br />

out from under the counter. These, he said, will<br />

be launched in January and are, incredibly, even<br />

lighter at just four grams, making you feel like you<br />

are not wearing any frames at all! “We are now<br />

really pushing the limits of what is possible with 3D<br />

printing,” he said.<br />

Sfered<br />

Hoya was not the only company to unveil a DIY<br />

3D-printing service for practices to offer patients<br />

the opportunity to customise their own frames.<br />

Sfered has partnered with Monoqool in a nonexclusive<br />

arrangement to offer the same thing (but<br />

without the Hoya lens being central to the design).<br />

Patients select the type of frame they want, the<br />

optician or optometrist then scans the patient’s<br />

face, customises the frame accordingly for the best<br />

look and comfort, and then sends this to Monoqool<br />

(or any other 3D frame manufacturer who signs up)<br />

which then makes the final frame. Sfered software<br />

developer Maarten Mathot said following Silmo, the<br />

new system will be rolled out to opticians in Holland<br />

first followed by the rest of the world. Monoqool’s<br />

Allan Petersen said he has always wanted to do<br />

customised eyewear and now he can.<br />

Blackfin<br />

Blackfin’s slot system nominated for a Silmo Gold award<br />

Innovation, customisation and authenticity were<br />

all jostling for pride of place on the Blackfin stand.<br />

The titanium frame manufacturer, based in the<br />

beautiful Agordino region of the Dolomites, is so<br />

proud of its Italian heritage and that it’s frames are<br />

100% handmade in Italy, that it has created its own<br />

authenticity label “Neo Made in Italy” which, said<br />

Blackfin’s PR lady Silvia Bocardi, “means they really,<br />

really are made in Italy!”<br />

Every frame in the Blackfin range is made from<br />

titanium – the purest titanium in the world from<br />

Japan, it claims – and starts as a concept, that<br />

becomes a sketch and finally a prototype. In total<br />

the company says it takes 53 “macro-phases” to<br />

make a Blackfin frame, which it calls the frame’s<br />

“rites of passage.” As each frame is handmade,<br />

it can be customised to the wearer, with temple<br />

adaption, laser personalisation and an everchanging<br />

raft of colours.<br />

Oxibis Group<br />

French frame manufacturer Oxibis Group achieved<br />

a Silmo Gold award in the technical innovation<br />

category for its “Exalto” men’s frame which<br />

features a cleverly-designed hinge that is designed<br />

to reduce friction with no hinges and a ceramic<br />

centrepiece. Oxibis’ Caroline Boisson said men are<br />

very interested in the technical side of the frames.<br />

“It’s only a small part, but it does a big job.”<br />

Netlooks<br />

Winner of the Silmo d’Or (Gold) Award in the<br />

material/equipment category, French startup<br />

Netlooks if offering the ultimate in customisation.<br />

Its Netlooks 3D technology is a new concept which<br />

allows eye care professionals to scan a customer’s<br />

face in three dimensions and create an avatar<br />

for fitting and testing frames, which can then be<br />

ordered directly from Netlooks. The technology and<br />

manufacturing process has taken more than three<br />

years to develop, said Pierre Andrieu, Netlooks’<br />

chief executive and founder and a former physicist,<br />

who until three years ago was also Professor of<br />

Optical Science at the ESOL Schools of Optics and<br />

Eyewear, which he also co-founded. Andrieu said<br />

he’s very proud to have won the award, which is an<br />

endorsement of the technology, which is now being<br />

sold in several pilot stores in France.<br />

3D frame pioneer Allan Petersen from Monoqool<br />

OGI Eyewear<br />

Ogi red rose<br />

A welcome relief to my poor French and the, incomparison,<br />

exceptional English of most of the<br />

exhibitors at Silmo was Ogi Eyewear’s creative<br />

team manager Katy Dajnowski who had flown in<br />

from Minneapolis to help at Silmo.<br />

Known for its colour and fashion-forward<br />

designs, the Ogi stand delivered a luxurious<br />

smorgasbord of choice: its neoclassic Seraphin<br />

brand, sporting the latest and still popular “cat<br />

eye” styles and multidimensional layering of<br />

colour; its Evolution Collection; its cosmopolitan,<br />

luxury Bon Vivant brand; the younger-focused Ogi<br />

brand, whose new range cleverly mixes metal and<br />

acetate, with detailing showing the metal below<br />

the acetate; and its Innotec (innovation meets<br />

technology) range made from unique materials<br />

including TR-90 surgical plastic and ultem, an<br />

ultra-lightweight and flexible plastic that’s<br />

used in the aerospace industry. “This is great<br />

material because it can withstand really extreme<br />

conditions and doesn’t lose its shape, while<br />

remaining comfortable,” said Dajnowski.<br />

Last but not least was Ogi’s minimalist, metal<br />

Red Rose collection featuring screwless hinges<br />

and innovative stamped textures, that is both<br />

strong and lightweight, and primarily aimed at<br />

men.<br />

The company considers itself American, but<br />

incorporates a lot of European styling. Its Bon<br />

Vivant styles, some now sporting an attractive<br />

double bridge, are even made in Italy, said<br />

Dajnowski. “The Red Rose and Bon Vivant have<br />

caught people’s eye the most, because these<br />

are our two newest collections. People are really<br />

looking for something unique and different,<br />

but not so unique and different that they aren’t<br />

willing to wear it. So it has to be very wearable<br />

and have a lot of style to it, so details like the<br />

double bridge and pebbly texture have really<br />

been appealing, as well as the multidimensional<br />

acetate, where the acetate layers give it more of<br />

an intriguing look.”<br />

Komono<br />

Komono’s “Clovis”<br />

Komono is a Belgian brand, developed seven years<br />

ago by some professional snowboarders and surfers,<br />

and focused on watches and sunglasses. But this<br />

focus was extended this year with the launch of<br />

its first optical frame range. Marketing manager<br />

Annabel Greeve said the range is very affordable and<br />

consists of 60 products spread over 13 new styles. All<br />

styles are made of premium Italian acetate and/or<br />

stainless steel. Greeve said the company had so much<br />

demand from sunglass customers for optical frames,<br />

the company decided to launch its own optical range,<br />

which will only be available through practices.<br />

Falvin<br />

Falvin Shade<br />

Birgitte Falvin, a Danish jewellery designer and<br />

founder of the still new Falvin eyewear company<br />

(now available in New Zealand for the first time<br />

through Beni Vision) says her new luxury range,<br />

Black Crystal, was inspired by the Black Diamond<br />

Library in Copenhagen – its not-quite-official name<br />

reflecting the polished black granite cladding and<br />

irregular angles of the building.<br />

The titanium range is all handmade in Japan and<br />

incorporates 24 carat gold, rosegold, palladium and<br />

diamonds.<br />

“To me, eyewear is your most powerful accessory.<br />

You can tweak and style everything else, but your<br />

glasses reflect your true personal style. I’ve designed<br />

a collection of glasses with aesthetic attitude, a<br />

graphical expression and distinct architectural<br />

references that give character. My collection is<br />

VMD’s Philip Crabtree and Glenn Nolan flank Menrad MD Eberhard Muller-Menrad Blackfin CEO Nicola Del Din Katy Dajnowski from OGI Eyewear Netlooks’ founder Pierre Andrieu shows off his coveted Silmo d’Or award<br />

18 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>


Birgitte Falvin, Falvin’s designer and founder Jeroen Manders from C-Zone Budri’s “marble drapes” heralding its new marble eyewear range Little Peach’s Jon and David Bearpark with Vanni designer Irene Chinaglia<br />

focused on aesthetics, elegance and quality, that<br />

always come first,” explained Falvin.<br />

Feb 31st<br />

Just five years old, Feb 31st now distributes its<br />

customised wooden frames worldwide, including<br />

New Zealand. Co-owner Stefano Minelli explained<br />

how practices can help patients “play” and design<br />

their own wooden frames, with different colours<br />

inside and out, and even different coloured temples,<br />

if they want, in different shapes. The frames feel<br />

smooth and soft, are flexible (a feat that took a<br />

number of years to master) and are comfortable<br />

to wear. Once a style and the desired colours have<br />

been selected they can be made in just two weeks,<br />

said Minelli, and the unique design makes it easy for<br />

the eyewear professional to fit the patient’s lenses.<br />

Vanni<br />

Vanni Sunshine - first in New Zealand<br />

Little Peach’s David and Jon Bearpark were on<br />

the Vanni stand ordering, among other things,<br />

sunglasses for our summer, allowing New Zealand’s<br />

optical patients and sunglass consumers to be<br />

ahead of Europe for a change.<br />

“Vanni is releasing these styles right now in<br />

Europe, so they are for Europe’s summer next year,<br />

so we will have them first,” said David in Paris.<br />

Vanni sunglasses are aimed at the lady prescription<br />

wearer who will spend a little more, but won’t<br />

spend a fortune, he said. “They are colourful,<br />

innovative and tomorrow’s styles for Europe.”<br />

Key to Vanni is its Italian authenticity, branding<br />

all its products, “Made in Italy, for sure” to<br />

distinguish itself from other brands that are only<br />

designed in Italy.<br />

Vanni designer Irene Chinaglia demonstrated<br />

Vanni’s new acetate Raster collection, sporting<br />

Vanni’s trademark colour combinations and<br />

incorporating a textured weave, that draws<br />

inspiration from a pixelated digital image, creating<br />

the optical illusion of a cubic geometric pattern.<br />

Similarly, in metal, Vanni’s Surf-ing range, is made<br />

from lightweight laminated steel and engraved<br />

Feb 31st’s Stefano Minelli<br />

bronze, incorporating delicate horizontal lines in<br />

different tones and colours with ultra-thin temples.<br />

Finally, Chinaglia, demonstrated Vanni’s TMT<br />

(thin milling technology) range, which allows the<br />

company to create 30% thinner acetate frames than<br />

other companies – 2 mm versus the normal 3 mm –<br />

weighing just 16 grams.<br />

C-Zone<br />

Jeroen Manders from Dutch stainless steel frame<br />

company C-Zone, another Little Peach company,<br />

said the company’s name reflects who it is: “C”<br />

for seeing, cool and comfort. Though the base<br />

material is always stainless steel, the company does<br />

combine it with other materials like acetate, wood<br />

lamination, silk and even denim. Every design comes<br />

in four different colour combinations and each<br />

collection incorporates about 25 new models with a<br />

broad spread of sizes to cater for women with very<br />

petite faces to men with very broad faces.<br />

“The New Zealand market has been doing very<br />

well, so we’re very happy,” says Manders, adding<br />

he’s planning a trip to New Zealand to visit<br />

customers with David next year.<br />

Face & Cie<br />

Design your own Face && Cie clip<br />

A particular highlight at the fair was the ability to<br />

design your very own clip-on at the very colourful<br />

Face & Cie stand. Alain Racary said the four-year-old<br />

company has gone from strength to strength as<br />

women around the world embraced the ability to<br />

select different frames and purchase as many clips<br />

as they like, as different as they like, to give them a<br />

different look for every occasion. Each clip is priced<br />

the same whatever their colour or style (and some<br />

of the lacy styles are quite complex and beautiful)<br />

making it easy for the optician, said Racary.<br />

David Bearpark, who launched Face & Cie to the<br />

New Zealand market at the ADONZ conference<br />

in Hamilton last year, says it’s one of the hottest<br />

brands in New Zealand at the moment. “We’ve just<br />

surpassed three clips for every frame we’ve sold. It is<br />

seriously gaining momentum.” Though the clips are<br />

primarily aimed at the middle-aged lady, who is a<br />

progressive wearer, and likes to accessorise without<br />

spending a fortune, the brand is also attracting a<br />

younger audience, said Racary, especially as people<br />

can now design their own clips and order their own<br />

customised clip direct from Face & Cie.<br />

Budri<br />

Budri’s marble eyewear<br />

New to the optical market, but with more than 50<br />

years-experience in marble craftsmanship, Budri’s<br />

transition into the optical market came about by<br />

accident when a small piece of decorative marble,<br />

from its latest installation, fell down and the wife of<br />

the founder put it to her eye and said, jokingly, “we<br />

could make glasses out of this,” said Budri’s area<br />

manager Giulia Voza. After two years of research,<br />

culminating in the in-house development of a<br />

specific production technology, Budri has launched<br />

its first eyewear collection at Silmo. Each frame is<br />

made from a single slab of stone, which undergoes<br />

a sophisticated milling-cutting process to produce<br />

a solid convex piece, from which the shape of the<br />

glasses frame is cut. Budri’s first eyewear collection<br />

features five models named, appropriately, after<br />

famous Italian sculptors. Each weighs between 38<br />

and 43 grams each.<br />

Sunshades<br />

Sunshades’ new Karen Walker “Metals” range was<br />

attracting a lot of rather unwanted interest from<br />

picture-taking Chinese manufacturers’ keen to “gain<br />

inspiration” from the range. Creative director Hamish<br />

Tame (shooing off one particularly persistent mobile<br />

phone snapping visitor) highlighted the luxurious<br />

and innovative new hexagonal and round Karen<br />

Walker range, which is made from stainless steel in<br />

gold, silver and blue, and incorporates Zeiss lenses.<br />

Other highlights on the stand included the new<br />

Vilebrequin eyewear range, new from popular men’s<br />

swimming trunks company Vilebrequin, which will<br />

officially be launched in March, Le Specs’ new flat<br />

lenses and Adam Selman’s new collection, popular<br />

with many of today’s high profile celebrities.<br />

Shamir<br />

Lens manufacturer Shamir was proudly displaying<br />

its new tabletop device Spark Mi, which looks like a<br />

tabletop mirror, but is actually a measurement tool,<br />

capturing all the patient’s measurements in one click<br />

when they are looking at themselves in their new<br />

glasses, even if they are sunglasses. Measurements<br />

include pupillary distance, fitting height, panoramic<br />

angle, pantoscopic tilt and vertex distance and are<br />

passed directly to the patient’s computerised record<br />

at the practice. ‘The object of this device is to allow<br />

the optician to have a very simple way to measure<br />

patients and sell very personalised lenses,” explained<br />

Laurent Israel, Shamir’s French product manager.<br />

Lafont<br />

Lafont had a large,<br />

particularly colourful stand,<br />

covering two sides of one<br />

of the through corridors,<br />

with easy to view stands for<br />

passing visitors divided into<br />

women’s, men’s, children’s<br />

and sun frames. Lafont’s<br />

Marina Louis explained<br />

how, from this year, many<br />

of Lafont’s frames are now<br />

labelled “Origin France,”<br />

meaning they have been<br />

independently verified<br />

to ensure that more than<br />

90% of the product is<br />

designed and made in<br />

France. More than 90%<br />

of Lafont’s frames also<br />

employ colours exclusively<br />

belonging to Lafont. “The<br />

colour combination is very<br />

important for us,” because<br />

that’s what Lafont is all<br />

about, explained Louis,<br />

showing how colour has<br />

been brought into the men’s<br />

frames more subtlety with<br />

colour detailing on the<br />

temples. A big drawcard was<br />

the special limited edition<br />

version of its Socrate frame,<br />

designed to celebrate the<br />

centenary of the French<br />

Airforce’s Lafayette squadron,<br />

and two other limited<br />

edition sunglass frames only<br />

available to buyers at Silmo.<br />

Fleye Eyewear<br />

Fleye 524 from its new contemporay acetate range<br />

Danish eyewear label Fleye officially launched<br />

its new marketing campaign at Silmo <strong>2016</strong>,<br />

presenting a mood-driven lookbook to showcase<br />

their contemporary designs and brand aesthetics.<br />

The new campaign was shot by Silvia Conde, an<br />

upcoming photographer from Barcelona, known<br />

for her work in leading magazines such as Spanish<br />

Vogue and for creating campaigns for labels like<br />

Dior and Gucci. Also unveiled at Silmo was Fleye’s<br />

new range incorporating special, high-density<br />

compressed acetate for ultra-thin, lightweight<br />

frames. “This new material allows us to minimize<br />

acetate width and depth, providing a very slim and<br />

minimalistic look while retaining its beautiful glow<br />

and hues,” said Annette Saust Esto, Fleye’s cofounder<br />

and head of creative developments. ▀<br />

Fleye founder Annette Saust Esto<br />

The 4 days of Optics<br />

06 - 09 October 2017<br />

LIVE THE EXPERIENCE<br />

<strong>Dec</strong>ember <strong>2016</strong><br />

silmoparis.com<br />

NEW ZEALAND OPTICS<br />

19


Focus<br />

on Business<br />

INTERVIEWING TIPS<br />

The job interview is your key recruitment<br />

tool. It will support you in assessing<br />

candidates to get the right cultural fit<br />

along with suitability for the role available<br />

within your company.<br />

Outlined below are a few tips to help<br />

identify the best future employees.<br />

1. Preparing for the job interview<br />

For an effective and informative interview to<br />

take place you need to prepare for it. Look at<br />

your current in-house recruitment tools<br />

to support this process. Use your position<br />

description and your list of key competencies<br />

(qualities, skills and experience) to drive your<br />

interview.<br />

Do you have an in-house application<br />

form that you want them to fill out prior to<br />

interview? Do you wish them to bring ID?<br />

Copies of work they have done? References?<br />

Let them know that this forms part of your<br />

recruitment process. Will there be any<br />

assessments to conduct while they are there?<br />

Let them know so they can come prepared.<br />

2. Before scheduling an interview review<br />

each candidate’s CV<br />

Assess their suitability against the<br />

competencies you require for the role, look<br />

at the quality and content of their letter<br />

and select those suitable for a telephone<br />

screening interview first. You may have a<br />

selection of tools to support you with this<br />

(eg. Seek’s automation process)<br />

3. Conduct a telephone screening interview<br />

first<br />

During this process ask a selection of your<br />

competency-based questions to assess if<br />

the candidate’s experience, qualifications,<br />

qualities, knowledge and attitude fit with<br />

your company’s needs. You will be able to see<br />

how passionate they are about your role and<br />

can find out salary expectations to ensure<br />

everything is in line with your requirements.<br />

The telephone interview is a fundamental<br />

pre-requisite before a face-to-face interview<br />

and will save you time in the long run.<br />

4. Interviewers – who should interview?<br />

Interviews should be conducted by at least<br />

two interviewers. Ensure each interviewer<br />

knows what his part should be during this<br />

assessment of the candidate. Questions are<br />

prepared and ratings can be compared and<br />

agreed upon before the interview, which will<br />

decrease any personal biases.<br />

5. How do I rate the candidate’s answers?<br />

Scoring questions<br />

There are interview questions for each of the<br />

competencies/skills/knowledge/experience<br />

identified in the profile. Ask the candidate<br />

these questions and score their response<br />

using the rating scale in the box below.<br />

Sample scoring<br />

3 Strong evidence that the skill and proven<br />

expertise IS present<br />

2 Evidence that skill IS present<br />

1 Insufficient evidence despite probing<br />

0 Strong evidence that competency/<br />

attribute/knowledge/experience is NOT<br />

present<br />

6. How long will the interview typically take?<br />

Allow up to 1 to 1½ hours for the interview.<br />

Ensure you allow time to interview effectively<br />

and then review the competency ratings<br />

straight after the interview.<br />

7. Interview Process<br />

• To relax and make them feel welcome<br />

outline the interview process and what will<br />

be involved.<br />

• Next ask them why they are interested in<br />

your role and why they are suitable.<br />

• Ask them to walk you through their<br />

resume, highlighting the key skills that relate<br />

to this role.<br />

• Ask where they have added significant<br />

value in each position eg. innovation,<br />

BY THERESE MCNAUGHTEN*<br />

profitability, customer service.<br />

• During the interview ask what motivates<br />

them and to describe their preferred working<br />

style and how they like to be managed, how<br />

they deal with stress, how interested they are<br />

in the role and what their salary expectations<br />

and availability are.<br />

What type of interview is recommended?<br />

Today a structured, competency-based<br />

interview approach is preferred, also known<br />

as a behavioural-based interview, with<br />

questions requiring candidates to provide<br />

specific behavioural examples of past<br />

experiences that showcase their skills in each<br />

specific competency. This type of interview<br />

will help the candidate tell you how they<br />

have demonstrated their attributes in the<br />

past and improve your ability to predict<br />

future performance in the job.<br />

A ‘structured interview’ means that:<br />

questions are planned carefully before the<br />

interview; all candidates are asked the same<br />

questions; answers can be scored using<br />

a rating system; questions focus on the<br />

attributes needed in the job; and specific<br />

behavioural type questions are asked about<br />

each attribute. As well as noting verbal<br />

responses you will also be observing nonverbal<br />

reactions throughout the interview<br />

too. Some candidates need guidance during<br />

this process, so you may have to give them<br />

an example first. For each competency<br />

that needs validation ask them to describe<br />

the situation or task that needs to be<br />

accomplished and using the STAR technique<br />

(see below) they can set the scene and put<br />

the example in context.<br />

STAR Technique – when asking for specific<br />

examples around specific competencies/<br />

skills ask them to: S – set the SCENE; T –<br />

outline the TASKS they owned; A – describe<br />

the ACTIONS they took; and R – the RESULTS<br />

8. Sample questions<br />

• Leadership – In your current role what<br />

have you done to lead transitional change<br />

and how did you manage this?<br />

• Team orientation (managing conflict) – Tell<br />

me about a time when there was conflict in<br />

your team and what steps you put in place to<br />

handle this?<br />

• Customer service – Describe a specific time<br />

when you managed a challenging issue for a<br />

customer and what you did to resolve this?<br />

• Project management – Describe a time<br />

when you had uncertainty in a project. How<br />

did you manage this? Outcomes?<br />

9. Additional Steps<br />

Reference checks are critical. Seek a<br />

candidate’s authorisation prior to speaking<br />

to referees. Check tertiary qualifications and<br />

include specific assessments as part of the<br />

process where necessary. In addition, you<br />

could add in a second stage. Ask if they were<br />

to be selected for the role, what would be<br />

their key focus in the first 100 days? Or ask<br />

them for solutions to a specific problem. This<br />

could be done in a presentation or workshop<br />

style by the candidate. Be creative and<br />

involved other staff.<br />

10. Finally…<br />

Good luck with your recruitment and all the<br />

best for attracting and securing top talent<br />

for your business. I wish you all the best for<br />

the festive season. If you wish to look at<br />

further tips, please visit my website www.<br />

wholeornanges.co.nz<br />

ABOUT THE AUTHOR:<br />

* Therese McNaughten is<br />

the founder of Wholeoranges<br />

Consulting, a boutique<br />

recruitment firm that<br />

provides flexible recruitment<br />

services to businesses<br />

nationwide, and a business<br />

coach for those going<br />

through career transitions.<br />

VOSO’s dining success<br />

October’s Dine for a Donation event<br />

at Meredith’s restaurant in Auckland<br />

raised a whopping $10,713 for<br />

Volunteer Ophthalmic Services Overseas<br />

(VOSO). The month-long event saw patrons<br />

dining for a donation on Tuesday evenings<br />

during the whole month of October, with<br />

all the money paid for food, going direct to<br />

VOSO.<br />

“The donated money paid for Erna<br />

Takazawa to attend the Eye Institute<br />

conference (see p13)” said Kylie Dreaver<br />

from VOSO. “Erna is a New Zealand-trained<br />

optometrist based in Apia. As (restaurant<br />

owner) Michael Meredith comes from<br />

Samoa, VOSO wanted to do something<br />

special for Samoa and helping their only<br />

optometrist attend a conference back<br />

in the city where she studied seemed<br />

appropriate.”<br />

We caught up with Takazawa at the Eye<br />

Institute conference, who was delighted to<br />

be there. “To keep up with my CPD points I have to do<br />

it all online, so it’s great to come to an event like this,<br />

BP and Oculo pair up<br />

Best Practice (BP software), providers of leadng<br />

ophthalmology clinical management software<br />

VIP.net, and clinical communications platform<br />

Oculo have agreed to integrate their systems.<br />

In a statement, Lorraine Pyefinch, chief relationship<br />

officer and co-founder of BP software said, “We were<br />

keen to respond to the clear feedback from our VIP.<br />

net users that they wanted to be able to receive<br />

referrals and send correspondence via Oculo. They<br />

recognise the benefits of being part of the Oculo<br />

network.”<br />

CCLS <strong>2016</strong> Scholarship<br />

Mortimer Hirst optometrist<br />

Emilie Langley is the <strong>2016</strong><br />

Cornea and Contact Lens<br />

Society (CCLS) Scholarship recipient.<br />

The society awards the annual<br />

scholarship (up to $2,500 for course<br />

costs and expenses) to a member of<br />

the society to upskill in either cornea<br />

or contact lens speciality fields.<br />

Langley thanked the CCLS for “this<br />

amazing opportunity” and says she is<br />

thrilled to be the <strong>2016</strong> recipient. She<br />

plans to spend a week undertaking<br />

some intensive hands-on experience<br />

with the contact lens specialists at<br />

Innovative Eyecare in Adelaide.<br />

“I am really looking forward to using Emilie Langley<br />

the scholarship to further up-skill<br />

and develop as an optometrist in the area of specialty<br />

contact lenses. I hope this further training will fasttrack<br />

my speciality contact lens practical experience<br />

and improve my first contact lens fit success rate for<br />

those complex cases, which do not present every day.<br />

Reuben Gordon and Erna Takazawa at the Eye Institure conference<br />

learning and developing with other optometrists. I’m<br />

really grateful to VOSO for sponsoring my trip here.” ▀<br />

“Busy ophthalmology practices are committed to<br />

business efficiency and clinical excellence,” added<br />

Dr Kate Taylor, CEO of Oculo. “Integrating Oculo and<br />

having better communications with optometrists<br />

and GPs is good for both….We believe that better<br />

communication will mean better care for patients.”<br />

Pyefinch added that BP software is committed to<br />

developing VIP.net as a flexible and functionally-rich<br />

application and will have the integration with Oculo<br />

ready for the software’s next planned upgrade in<br />

2017. ▀<br />

This further training will enable me<br />

to confidently provide contact lens<br />

treatment options to a greater number<br />

of clients.”<br />

CCLS 2017 Conference<br />

The 2017 CCLS Conference will be<br />

held at the Rutherford Hotel in sunny<br />

Nelson from the evening of Thursday<br />

23 March to 4pm on Saturday 25<br />

March. Friday and Saturday include<br />

lectures from Professors Fiona<br />

Stapleton and Charles McGhee and Drs<br />

Ken Nischal and Marc Bloomenstein,<br />

plus many local New Zealand<br />

presenters. “Nelson offers a relaxed,<br />

but easy to get to, picturesque and laid<br />

back style, where top quality education<br />

can be mingled with great company, food and wine,”<br />

says CCLS secretary Richard Newson.<br />

More information about when and how to register for<br />

the CCLS conference will be shared through NZ Optics<br />

soon, so keep an eye on your in-box. ▀<br />

20 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>


Paediatric binocular vision<br />

What about that phoria? Jack’s story<br />

Jack presents to a paediatric optometric<br />

practice, on referral following a recent<br />

educational psychology assessment. Jack, age<br />

12, thinks his eyes are fine, and this was recently<br />

confirmed at his ‘free’ optometric eye test two<br />

weeks ago.<br />

At school Jack has always struggled with<br />

handwriting, copying off the board and maths. He<br />

is OK at reading but has a low processing speed,<br />

and is not completing tests or assignments on<br />

time. He is off to grammar school next year and<br />

Mum is concerned about how well he will keep up<br />

with the curriculum, “I know he is smarter than his<br />

test results show”. Jack is fit, happy and well with<br />

no general health concerns.<br />

Their family history is positive for maternal<br />

moderate myopia of late teen onset. Jack’s<br />

developmental history is uncomplicated and he<br />

has no history of concussion or significant injury.<br />

Structurally Jack’s eyes are fine, he is an<br />

emmetrope with healthy eyes and normal colour<br />

vision. He has passed his B4 school check, school<br />

vision screenings, GP eyesight check and the recent<br />

optometric eye test.<br />

During an ocular motility examination Jack can<br />

Fig 1. Howell Near Phoria<br />

BY EVAN BROWN*<br />

make smooth eye movements in all positions of<br />

gaze but he would prefer to track and saccade by<br />

moving his head, rather than his eyes. He has a<br />

normal near point of convergence. Cover testing<br />

reveals a mild exophoria of 4pd using a Howell<br />

Card (fig 1.) and 6pd behind the refractor head.<br />

Jack shows a normal accommodative range and<br />

his relative accommodation findings are normal.<br />

His MEM for complex word reading is +0.50 DS OU,<br />

and moves out to +0.82 on easily-known words. He<br />

finds the green side prominent and dots clearer on<br />

the Shapiro-Evans Golf Ball (fig 2.).<br />

A brock string probe shows remote vergence<br />

posture, and positive fusional vergence ranges<br />

at near are low. AC/A assessment reveals a low<br />

minus gradient and moderate plus gradient. The<br />

Richman-Garzia Developmental Eye Movement<br />

Test shows vertical processing speed at 30th<br />

percentile (primarily recognition), horizontal at<br />

the 2nd percentile (recognition and tracking). The<br />

Berry-Buktenica Visual-Motor Integration test<br />

demonstrates normal graphic-motor (drawing)<br />

ability, but Jack’s knuckles are white with tension<br />

and effort.<br />

Discussion<br />

Fig 2. Shapiro-Evans paddle<br />

So does Jack have a<br />

visual problem that<br />

might impact upon his<br />

learning aptitude? The<br />

literature demonstrating<br />

association between<br />

vision problems,<br />

behaviourally at-risk<br />

pupils and adjudicated<br />

adolescents would<br />

suggest this is an<br />

important question to<br />

answer 1-6 .<br />

We can think about<br />

a phoria as a muscle<br />

Surviving a brain injury<br />

When Professor Clark Elliot suffered<br />

a traumatic brain injury in a car<br />

accident, he was told to get used to the<br />

debilitating symptoms that prevented him from<br />

living the life he loved. But as a single father and<br />

professor of cognitive science, he wasn’t about<br />

to let that be the end. Together with a neurooptometrist,<br />

he fought to restore his visual and<br />

mental function. NZ Optics caught up with him to<br />

ask him a bit about his life, his work and his book,<br />

The Ghost In My Brain, about overcoming brain<br />

injury.<br />

What did you do before your injury?<br />

At the time of the accident in 1999, I was a<br />

tenured professor of artificial intelligence and<br />

cognitive science at DePaul University in Chicago.<br />

My research area was computational models of<br />

human emotion. I was working on a computable<br />

model of story generation based on complex<br />

emotional interactions of the characters. Prior<br />

to my life as a professor, I was a professional<br />

classical musician studying at the Eastman School<br />

of Music.<br />

How did the injury happen and when did<br />

you know something was wrong?<br />

I was rear-ended by an SUV while waiting at a<br />

red light. I didn’t think much of the crash at the<br />

time. I seemed to be OK, but from the moment of<br />

impact very strange things began happening to<br />

me. For example, I was holding my insurance card<br />

in my hand, but I couldn’t figure out how to give<br />

it to the police officer. On my way home, I realised<br />

I had completely lost my previously infallible<br />

sense of direction. I couldn’t figure out how to<br />

walk from the car to my front door and I couldn’t<br />

work out how to unlock the door.<br />

Concussion is insidious this way: often the brain<br />

machinery necessary to realise that something<br />

has gone missing is exactly the same machinery<br />

that is gone. I couldn’t initiate action; it might<br />

take me 10 minutes to rise from a chair. I couldn’t<br />

make decisions. I was often nauseated from<br />

balance problems. I didn’t understand time or<br />

dates any more. I couldn’t understand what<br />

people were saying to me. I was overwhelmed by<br />

any kind of loud sound. But I still didn’t realise<br />

BY JAI BREITNAUER<br />

anything important was wrong until days later.<br />

I finally sought help after deciding it wasn’t<br />

normal for me to take six hours to figure out I had<br />

put my shoes on the wrong feet.<br />

Even so, it was probably six months before I<br />

even began to understand this wasn’t like a case<br />

of the flu that would soon get better - that I had<br />

a serious injury. Doctors told me many times that<br />

I would never recover, but it wasn’t until my third<br />

year that I finally came to terms with that.<br />

Why weren’t the professionals you first<br />

spoke to more helpful?<br />

The doctors were almost universally wellmeaning<br />

and had something been immediately<br />

dangerous they would have saved my life.<br />

Unfortunately, especially then, the medical<br />

treatment for brain injury was essentially, “Can<br />

you go away now? …because I can’t help you<br />

and if you don’t get better on your own there<br />

is nothing we can do.” This was frustrating for<br />

everyone. What I heard over and over was that<br />

after two years of possibly terraced improvement,<br />

no one ever gets better so I should learn to live<br />

with my symptoms.<br />

What was the turning point for you?<br />

After eight years I was at the breaking<br />

point where I would lose my job, my house,<br />

custodianship of my children and become a ward<br />

of the state. In a last-ditch effort, after reading<br />

Norman Doidge’s The Brain That Changes Itself<br />

we began searches on ‘brain plasticity’ and found<br />

Dr Donalee Markus (originator of Designs for<br />

Strong Minds, a programme to improve ‘mental<br />

flexibility’), who in turn immediately referred<br />

me to her colleague Dr Deborah Zelinsky, (a<br />

neuro-optometrist in Illinois). Within a month of<br />

starting (brain retraining) treatment I was about<br />

70% recovered.<br />

That’s incredible, what did they do and<br />

how important was the vision element?<br />

Dr Donalee and Dr Zelinsky both work at<br />

reconfiguring the brain through retinal<br />

stimulation, taking advantage of the brain’s<br />

plastic nature. Dr Donalee works at cognitive<br />

restructuring with visual puzzles and Dr Zelinsky<br />

or motor imbalance, however another way<br />

of interpreting the information is that it is an<br />

indication of the ease and accuracy with which<br />

that individual is centring the visual process to<br />

gather and process information.<br />

Is there a vergence lag or lead in the process?<br />

How does this person organise associated<br />

processes such as accommodation, central<br />

suppression, attention and effort to achieve single<br />

clear perception?<br />

Will this phoria cause more problems when the<br />

visual process for acquiring information becomes<br />

dynamic, as when making the continuous,<br />

effortless saccades required to read fluently?<br />

The optometric results for Jack suggest this is<br />

probable. Jack can recognise and name a vertical<br />

array of numbers within the normal variance for<br />

his age, but place the numbers in a horizontal<br />

spatial array and his accuracy and speed slow to<br />

below the fifth percentile! Acquiring information is<br />

now slow and an effort.<br />

Jack can draw patterns and shapes to the<br />

80th percentile for his age on a standardised<br />

assessment of drawing, but produces the content<br />

equivalent to a nine-year-old in a simple sentence<br />

copy test under time constraint.<br />

So the message here is simple. All children<br />

attending an optometric evaluation should<br />

receive in-depth binocular and accommodative<br />

assessment when presenting with performance<br />

problems at school.<br />

How should you measure that phoria?<br />

The question phoria assessment asks is: “does<br />

this person organise their visual system closer<br />

to or further away from the stimulus presented.<br />

To answer this question it is important to not<br />

penalise proximal awareness - this is why I like<br />

using the Howell Card as a primary tool for<br />

assessing the ‘phoria’ 7 .<br />

The Howell Card probes the disassociated phoria.<br />

Disassociation uncouples the disparity component<br />

used in centring but proximal, tonic, consensual<br />

and blur driven components remain active.<br />

When asking the patient to look through two<br />

small apertures (the refractor head) we penalise<br />

proximal awareness and will likely obtain a finding<br />

that does not reflect the person’s true proximal<br />

works with prescription<br />

eyeglasses. In my case,<br />

Dr Zelinsky, using neurooptometric<br />

testing, found<br />

healthy tissue in my brain<br />

which she could work with.<br />

She redirected the output<br />

from my retinas to emphasise<br />

those healthy pathways<br />

through my brain, balancing<br />

centre, peripheral and nonimage-forming<br />

retinal input<br />

as well. We think of these as<br />

dirt roads through new brain<br />

areas. Dr Donalee then had<br />

me rehearse structured visual<br />

Professor Clark Elliot<br />

puzzles over and over to turn<br />

those dirt roads back into the<br />

super-highways that let me return to my work as<br />

a professor.<br />

The key that makes these treatments effective<br />

is that the human brain is primarily a visualspatial<br />

processing device, down to the very core<br />

of how we represent the symbols that are at the<br />

root of what makes us human. And our retinas<br />

are essentially a crucially important part of our<br />

brains hanging out the front of our heads—the<br />

perfect window for assessing and treating this<br />

magnificent device.<br />

How has your recovery affected your own<br />

professional life?<br />

response.<br />

If the target does not offer a strong<br />

accommodative stimulus we will likely receive a<br />

different result. Clinically, the tests we use need<br />

to be consistent and we need to understand the<br />

limitations of the information generated.<br />

The magnocellular dorsal ambient stream<br />

has been credited as providing us with the<br />

construct platform from which we perceive space.<br />

Proprioception, audition and vestibular input<br />

have a role in the overall interpretation of spatial<br />

relationships such as ‘which way is up’, ‘me to it’<br />

and ‘it to it’. But ophthalmic professionals know<br />

that changing a person’s visual input with lenses<br />

or prism will alter their perception of distance,<br />

velocity, midline projection and balance.<br />

We can help Jack to manage his remote visual<br />

centring responses by prescribing appropriate<br />

lenses, prisms and or optometric vision therapy, so<br />

that he can enjoy and achieve academically with<br />

an efficient and sustainable visual process. ▀<br />

References:<br />

1. Zaba J. Social, emotional, and educational consequences<br />

of undetected children’s vision problems. J Behav Optom<br />

2001;12:66-70.<br />

2. Johnson R, Nottingham D, Stratton R, et al. The vision<br />

screening of academically and behaviorally at-risk pupils.<br />

J Behav Optom 1996;7:39-42.<br />

3. Johnson R, Zaba J. Vision screening of at risk college<br />

students. J Behav Optom 1995;6:63-65.<br />

4. Johnson R, Zaba J. The visual screening of adjudicated<br />

adolescents. J Behav Optom 1996;10;13-17.<br />

5. Maples W, A comparison of visual abilities, race and<br />

socio-economic factors as predictors of academic<br />

achievement. J Behav Optom 2001;12:60-65.<br />

6. Johnson R, Zaba J. The link: vision and illiteracy. J Behav<br />

Optom 1994;5:41-43.<br />

7. Howell E. The differential diagnosis of accommodation/<br />

convergence disorders. J Behav Optom 1991;1:20-26<br />

* Evan Brown is a certified<br />

behavioural optometrist with<br />

specific interest in visual<br />

dysfunctions related to learning<br />

and paediatric optometry. He is<br />

co-lecturer for the ACBO practical<br />

vision therapy programme and<br />

clinical co-director for the NZ Special<br />

Olympics Healthy Athletes Opening<br />

Eyes Programme.<br />

Because of my own experiences, I am filled with<br />

compassion for the six million people living<br />

with the long-term effects of brain injury in the<br />

US alone. I wrote The Ghost In My Brain with<br />

the idea that we might make some dent in<br />

this epidemic. Coinciding with publication I’ve<br />

seen an international groundswell of interest in<br />

understanding brain injury, and because of this<br />

I’ve spoken to more than ten million people via<br />

radio and TV interviews. Along the way I’ve run<br />

into scores of highly dedicated people working<br />

at the leading edge of these new plasticitybased<br />

approaches to treatment. Through them<br />

I’ve learned a great deal about neuroscience<br />

approaches to understanding the brain.<br />

I’m still an A1 scientist at heart. But I’ve<br />

come to realise how crucial it is to develop<br />

much more sophisticated models of the visualspatial<br />

nature of human<br />

symbol processing - the<br />

symbols that give us our<br />

internal human voice and<br />

awareness.<br />

What role do you think<br />

optometry has in the<br />

rehabilitation of brain<br />

injury patients?<br />

Neuro-developmental<br />

optometry is the wave of<br />

the future. It will be at<br />

the core of understanding<br />

how the brain works and<br />

of diagnosing problems<br />

and fixing them when<br />

something goes wrong<br />

with cognition. Consider, for example, that even<br />

in listening to the world around us, including<br />

speech, once our brain has detected the audio<br />

input signal all the rest of the massive processing<br />

that goes on to interpret the meaning of those<br />

sounds is visual-spatial in nature: I tap a wine<br />

glass behind your ear, you see the glass in your<br />

mind’s eye, you understand what it is, where<br />

it is, and that it is not you. You see the color of<br />

red wine. You know you can drink it. You recall<br />

two friends you shared wine with last week at a<br />

restaurant. So hearing is primarily visual-spatial<br />

in nature, so is proprioception, so is planning and<br />

decision making, and significant elements of<br />

both our complex human emotion system and<br />

our spiritual lives. Retinal processing is also part<br />

of our balance systems and helps control our<br />

emotional body states.<br />

You are having hearing problems? You might<br />

need glasses that treat all three of the retinal<br />

pathways. You have balance problems? You<br />

might need glasses. You can’t think? You might<br />

need glasses. You are anxious or have attention<br />

problems? You might need glasses.<br />

A major pathway into understanding cognition<br />

is through the retinas and neuro-developmental<br />

optometry will be one of the foundations of<br />

neuroscience in the years to come. ▀<br />

For more information about Professor Elliot<br />

or his book, The Ghost In My Brain, visit www.<br />

ClarkElliott.com<br />

<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

21


Frizzell, Fred Hollows and Specsavers<br />

Iconic New Zealand artist, Dick Frizzell<br />

has joined forces with Specsavers to raise<br />

money for The Fred Hollows Foundation<br />

NZ through a limited edition Frizzell frame.<br />

The funky frames feature Frizzell’s famous<br />

‘woodgrain’ print that first featured on Crown<br />

Lynn ceramics 27 years ago, before becoming<br />

an iconic fabric print.<br />

Frizzell, Specsavers and the Fred Hollows<br />

Foundation have been working on the project<br />

for two years and Frizzell says the print has<br />

never been used on anything as complex<br />

as glasses. “I hadn’t worked with the Fred<br />

Hollows Foundation before but I was totally<br />

flattered and excited to be asked. The bloke<br />

himself (Fred Hollows) is so inspiring, his<br />

no-nonsense, humble approach to his work<br />

appealed to me.”<br />

Frizzell’s new frame range<br />

Kiwi musician and Frizzell’s friend Tiki<br />

Tane was part of a documentary crew that<br />

followed the Fred Hollows Foundation to<br />

Papua New Guinea, so Frizzell discussed the<br />

project with him. “We had a chat about it<br />

and Tiki’s enthusiasm reinforced my initial<br />

instincts. This is a powerful cause to put your<br />

name to.”<br />

Frizzell has worn glasses since the late<br />

‘70s and they’ve now become “a bit of a<br />

trademark” for him, he says. “Some years<br />

ago I decided to design my own glasses, so I<br />

could get exactly what I wanted. When I sent<br />

the drawings to the manufacturer in London,<br />

they refused to proceed because they were<br />

concerned the designs wouldn’t work. I ended<br />

up making a working model of them, out of<br />

wire and papier-mâché.”<br />

Frizzell painted them tortoise<br />

shell, put them in a glasses box<br />

and posted them to London.<br />

“The model was exactly how<br />

I imagined they would look,<br />

exactly how I wanted them,”<br />

laughs Frizzell, who received an<br />

identical, working pair of glasses<br />

back a few weeks later. He<br />

admits, however, he did not have<br />

as much hands on involvement<br />

with this project, but is equally<br />

pleased with the result.<br />

Brendan Thompson, Specsavers<br />

NZ retail director, says Frizzell’s<br />

status as a Kiwi icon meant the<br />

decision to approach him was<br />

elementary. “We did something<br />

similar with an aboriginal artist in Australia.<br />

When it came to New Zealand, who better to<br />

approach than Dick Frizzell?”<br />

Specsavers have released 500 pairs of the<br />

limited edition, unisex frames and will donate<br />

$25 from each frame sold to the Foundation.<br />

Gabi Hollows, the Foundation’s founding<br />

director and patron, says the money will go<br />

towards cataract kits that include the vital<br />

components needed for cataract surgery. ▀<br />

Hollow’s mobile magic<br />

One thing visiting ophthalmologists<br />

noticed when they went to help in Fiji was<br />

that during the week they were there,<br />

more people turned up on a Friday than<br />

on a Monday, said Andrew Bell, executive<br />

director of the Fred Hollows Foundation<br />

NZ, at the Dick Frizzell launch. “It’s because<br />

the patients have to travel long distances.<br />

They’re old, they’re blind and they live<br />

in remote areas. Even 10km can be too<br />

much.”<br />

The Fred Hollow’s team realised this<br />

meant many Fijian’s were not receiving<br />

treatment during the Foundation’s visits.<br />

The solution was a mobile surgery unit,<br />

which came into operation in November<br />

2014. One half of the unit is designed for<br />

cataract surgery and the other for diabetic<br />

eye problems. Since its launch, this mobile<br />

unit has treated 11,000 people, all in<br />

remote areas of Fiji who would otherwise<br />

be blind, said Bell.<br />

Dick Frizzell and Brendan Thompson<br />

Highlights from AAO <strong>2016</strong><br />

News from the American Academy of<br />

Ophthalmology’s 120th annual meeting in<br />

Chicago poured out over the wires at the<br />

end of October as researchers released the results<br />

of studies, and presenters questioned current<br />

practices.<br />

More than 25,000 eye surgeons and other eye<br />

care professionals attended the annual meeting,<br />

which is considered to be the world’s largest<br />

showcase for vision research and innovation.<br />

It featured more than 350 instruction courses,<br />

56 surgical skills labs, 51 symposia and 585<br />

exhibitors, collectively addressing all aspects of<br />

ophthalmology. Highlights included:<br />

Progress in the precision of cataract and<br />

LASIK surgery – Professor Douglas Koch, from<br />

the Baylor College of Medicine, discussed how<br />

new technology has great potential to improve<br />

the precision of cataract and LASIK surgery<br />

in the Jackson Memorial Lecture, including<br />

innovations such as the latest class of intraocular<br />

lenses whose optical power can be modified<br />

postoperatively<br />

Surgical alternatives to reading glasses – Dr<br />

Julian Stevens from Moorfields Eye Hospital<br />

discussed corneal inlays, while Dr Dimitri Azar,<br />

Dean of the College of Medicine at University of<br />

Illinois, reviewed recent advancements including<br />

the Google/Verily smart accommodating<br />

intraocular lenses. (See side story)<br />

Mediterranean diet may cut AMD risk – new<br />

data from the ongoing Portuguese Coimbra Eye<br />

Study, presented during a poster discussion,<br />

showed the risk for age-related macular<br />

degeneration (AMD) can be cut by more than<br />

one-third by eating a Mediterranean-style<br />

diet heavy in fruit, vegetables, legumes, whole<br />

grains, fish and lean meats. Also caffeine, not<br />

traditionally included in the Mediterranean diet<br />

but consumed in beverages popular in the region<br />

and high in anti-oxidants, might be especially<br />

protective against AMD, said co-author Dr Joao<br />

Figueira, from the Department of Ophthalmology<br />

at the University of Coimbra in Portugal.<br />

The next step in this study is to rescreen<br />

patients to see if those who did not have<br />

macular degeneration developed it and to look<br />

at the diet those patients were<br />

eating, he added.<br />

The IRIS Registry: Measuring<br />

value and improving quality – a<br />

detailed discussion about how the<br />

IRIS Registry (Intelligent Research<br />

in Sight), the world’s largest<br />

real-time database of ophthalmic<br />

patient outcomes, is helping<br />

ophthalmologists track, report<br />

and improve quality performance,<br />

evaluate patient outcomes and<br />

perform simple analytics.<br />

International award winners<br />

Each year, the Academy presents<br />

a series of awards, the most<br />

prestigious of which is the Laureate<br />

Recognition Award, which recognises<br />

ophthalmologists who have made<br />

exceptional scientific contributions<br />

to preventing blindness and<br />

restoring sight worldwide. The <strong>2016</strong><br />

recipient was Dr Matthew Davis,<br />

from the University of Wisconsin-<br />

Madison School of Medicine and<br />

Public Health Department of<br />

Ophthalmology and Visual Sciences,<br />

for his ground-breaking work in<br />

the study of retinal diseases, especially diabetic<br />

retinopathy.<br />

Other notable international award winners from<br />

this year’s meeting included Dr Paul Bernstein,<br />

from the John A. Moran Eye Centre at Utah<br />

University, and Dr Benjamin Roberts, a missionary<br />

ophthalmologist affiliated with the University of<br />

Alabama Hospital, who were both awarded the<br />

Outstanding Humanitarian Service Award.<br />

AAO <strong>2016</strong>’s exhibition floor in Chicago<br />

Cutting-edge treatments for presbyopia<br />

Studies presented at AAO <strong>2016</strong> showed that a<br />

new method using lasers to reshape a small part<br />

of the cornea, and a separate technique using<br />

painless electrostimulation, may be effective in<br />

treating presbyopia.<br />

The first treatment uses a femtosecond laser<br />

to extract a disc of corneal tissue, which is<br />

then sculpted. This treatment may offer safety<br />

advantages over synthetic corneal inlays for<br />

presbyopia as it uses the person’s own more<br />

biologically-compatible corneal tissue, said Dr<br />

Soosan Jacob, lead author and creator of the<br />

new PEARL, or PrEsbyopic Allogenic Refractive<br />

Lenticule, technique. “Because it’s made of human<br />

corneal tissue, the inlay remains stable. Our<br />

preliminary findings have been very promising,”<br />

Dr Bernstein spent eight years training<br />

ophthalmologists in developing nations, and<br />

expanding the availability of retinal care from<br />

Ghana to Nepal, while Dr Roberts has dedicated his<br />

career to preventing blindness in the developing<br />

world, focusing on the people of East Africa.<br />

Dr Van Charles Lansingh, a medical officer in<br />

Latin America for HelpMeSee was awarded the<br />

International Blindness Prevention Award for<br />

making major contributions to reduce blindness<br />

said Dr Jacob, who is also director and chief of Dr.<br />

Agarwal’s Group of Eye Hospitals in India.<br />

The other treatment is for people who have<br />

mild presbyopia. It uses electrostimulation to<br />

activate and exercise the eye’s ciliary muscle,<br />

located behind the lens of the eye, which controls<br />

near vision. As this muscle contracts, it causes the<br />

flexible lens to change shape to enable seeing<br />

up close. The technique requires no surgery,<br />

providing a potential advantage over invasive<br />

presbyopia treatments, said Dr Luca Gualdi, lead<br />

author and a refractive and anterior segment<br />

surgeon at Dignostica Oculistica e Microchirurgia<br />

Ambulatoriale in Italy. “This is like going to the<br />

gym. I tell patients electrostimulation helps them<br />

train their eye muscles to delay development<br />

and restore eyesight in Latin America, North<br />

America, South East Asia and the Pacific. ▀<br />

For more information and news from AAO <strong>2016</strong><br />

visit: www.aao.org/newsroom/news-releases/<br />

detail/innovation-surgical-eye-care-center-stageaao<strong>2016</strong><br />

AAO 2017 will be held in New Orleans from<br />

11-14 November<br />

of presbyopia. The key is early treatment.<br />

Electrostimulation is much more effective when<br />

it’s performed in people who are early in the<br />

process of developing presbyopia before their eyes<br />

become dependent on reading glasses and the<br />

ciliary muscle is less reactive to treatment.”<br />

The contact lens-shaped device that is<br />

connected to a micro-current generator via tiny<br />

cables, developed by the Italian research team,<br />

has already received European approval but has<br />

not yet been submitted for FDA approval. The<br />

researchers noted studies with longer follow-up<br />

should be done to verify their findings.<br />

Other studies involving electrostimulation<br />

for other eye conditions, such as glaucoma and<br />

macular degeneration, are also underway.<br />

22 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>


ODOB consultation on<br />

Optometrist Scopes of Practice<br />

The Optometrists and Dispensing Opticians<br />

Board (ODOB) is seeking views on a proposal<br />

to reduce its four current scopes of practice<br />

for the optometry profession to one general scope.<br />

The ODOB has wanted to rationalise the<br />

scopes for some time to make sure that all new<br />

optometrists added to the register meet the same<br />

standard, wherever they have been educated,<br />

they said. They also felt four scopes of practice in a<br />

small profession can be confusing to the public.<br />

The proposal is to create one general scope, with<br />

the addition of a separate time-limited scope to<br />

allow overseas optometrists who don’t have the<br />

qualifications to prescribe therapeutic medicines,<br />

to upskill to the current New Zealand and<br />

Australian standard. It closes a loophole whereby<br />

overseas applicants are able to register with a<br />

lower-level qualification than that required of New<br />

Zealand and Australian graduates.<br />

If the proposal is approved, all currently<br />

registered optometrists would transfer to the<br />

new General Scope of Optometry and conditions<br />

would be applied to the scope of practice of<br />

some practitioners in order that they can be<br />

deemed safe to practise. Optometrists without<br />

qualifications to prescribe therapeutic medicines,<br />

for example, would have a condition applied to<br />

their scope of practice indicating to the public<br />

Bon Vivant goes semi-rimless<br />

frame designer Ogi Eyewear has added<br />

US two new semi-rimless models to its<br />

Bob Vivant collection of architecturally-inspired<br />

eyewear. According to the company, “The Adele<br />

and Marius demonstrate a fashion-forward<br />

interpretation of a timeless aesthetic and<br />

display tremendously rich and sophisticated<br />

coloration.<br />

“Adele is a feminine, semi-rimless combination<br />

pair that has been handcrafted in Italy from<br />

stainless steel and the finest Mazzucchelli<br />

acetate…. Marius is a classic semi-rimless optical<br />

frame that adds a dash of sophistication to the<br />

contemporary professional’s attire.”<br />

Bon Vivant is distributed by BTP International<br />

in New Zealand. ▀<br />

Objective Acuity heads out<br />

Objective Acuity, a new company born from<br />

research by Auckland University research<br />

fellow Dr Jason Turuwhenua and Associate<br />

Professor Ben Thompson into measuring visual<br />

acuity in young patients and those with special<br />

needs (see NZ Optics September <strong>2016</strong>) was listed<br />

as a company on 12 October.<br />

ASX-listed tech investor Powerhouse Ventures<br />

has invested an unspecified amount into<br />

Objective Acuity and Adam Podmore, formerly<br />

commercialisation manager at Auckland<br />

Uniservices, has joined as CEO as the young<br />

company gears up to take its first products to<br />

market.<br />

The investment by Powerhouse is the first<br />

ever by the Christchurch-based company into a<br />

University of Auckland spinout.<br />

Powerhouse Ventures<br />

specialises in developing<br />

and shaping research from<br />

New Zealand and Australian<br />

universities into businesses.<br />

Its portfolio currently<br />

comprises 22 early stage<br />

that they may not prescribe medicines. Those<br />

originally registered in an educator scope of<br />

practice would similarly have a condition applied<br />

indicating to the public that they are restricted to<br />

working in an educational setting.<br />

The principle aim of scopes of practice under<br />

the Health Practitioners Competence Assurance<br />

(HPCA) Act 2003 is to provide a transparent<br />

framework so that health professionals and<br />

consumers of health and disability services can<br />

easily know the parameters a health professional<br />

is competent to work within. It is intended<br />

that the General Scope of Optometry would<br />

encompass the full breadth of optometry, so the<br />

purpose of any conditions imposed would be to<br />

identify to health professionals and the public<br />

areas of practice where a practitioner was not<br />

authorised by the Board as competent to practise,<br />

the ODOB said.<br />

In developing this proposal, the ODOB said they<br />

considered feedback from earlier consultations,<br />

changes in the health care environment in New<br />

Zealand, a change to registration standards in<br />

Australia as well as the legal framework and<br />

guiding principles of the HPCA Act.<br />

The consultation document can be downloaded<br />

from the ‘Latest News’ page of the ODOB’s website.<br />

Submissions close on 23 <strong>Dec</strong>ember <strong>2016</strong>. ▀<br />

Stars and their<br />

eyes: Bono<br />

The charismatically cool lead singer of uber-band<br />

U2, Bono, opened up about his glaucoma diagnosis<br />

in 2014. The 57-year-old said he had been dealing<br />

with the condition for 20 years and his trademark dark<br />

or coloured-lens glasses help alleviate symptoms of the<br />

condition. In an interview with British chat show host<br />

Graham Norton, Bono was asked if he ever removed<br />

his shades. “This is a good place to explain to people<br />

that I’ve had glaucoma for the last 20 years. I have good<br />

treatments and I am going to be fine.” Commentators<br />

said he is the perfect example of someone who despite<br />

his glaucoma leads a full and active life with the right<br />

support and treatment. ▀<br />

to mature businesses founded on university and<br />

research institutes’ intellectual property.<br />

Dr Turuwhenua and A/Prof Thompson’s<br />

technology uses optokinetic nystagmus (OKN) and<br />

involuntary ocular reflex, and requires no input<br />

from the subject. A child can sit on their parent’s lap<br />

in front of a screen watching a moving stimulus. If<br />

they can see the movement, it induces OKN, which<br />

is measured by a head and eye tracking device.<br />

Novel imaging processing algorithms extract<br />

the OKN image from the video footage of the<br />

subject’s eyes. Unlike an eye chart it requires no<br />

communication or understanding from the patient.<br />

The technology means that serious visual issues<br />

can be picked up in very young children, allowing<br />

earlier treatment. The system also has the potential<br />

to be used for non-verbal older<br />

children and adults.<br />

As well as Powerhouse<br />

Ventures, Objective Acuity also<br />

has backing from UniServices,<br />

through the University of<br />

Auckland Inventors Fund, and<br />

Callaghan Innovation. ▀<br />

Style-Eyes<br />

With Christmas approaching, it’s time to<br />

think about gifts for the eyewear fans in<br />

our and our customer’s lives. Ideally we’d like to<br />

sell them more specs, but there are some great<br />

eyewear-related accessories sure to please<br />

when unwrapped on Christmas day.<br />

How do we keep hold of our<br />

sunglasses this summer?<br />

American company La LOOP make eyewear<br />

necklaces with a small ‘loop’ to thread through<br />

one temple of a folded pair of glasses. La<br />

LOOP make everything from affordable sporty<br />

eyewear necklaces, necklaces out of stretch silk,<br />

acetate chains and leather through to US$500+<br />

necklaces made of metals and semi-precious<br />

stones. A great gift for the person always<br />

rummaging in their bag for their sunnies.<br />

Another brand that is turning the process of<br />

holding eyewear into jewellery is Kimba – check<br />

them out on Instagram at @shopkimba.<br />

Glasses chains and cords (AKA retainers.<br />

Apparently they are also nicknamed ‘croakies’!)<br />

to hang open eyewear around the neck have<br />

been making a slow comeback over the past<br />

several years. Balenciaga seem to be the main<br />

force making this comeback happen. Giselle<br />

Bundchen was pictured in their Spring 2011<br />

campaign wearing a subtle cord attached to<br />

her sunglasses. In Spring 2015, Balenciaga<br />

sent models down the runway with sunglasses<br />

strapped to their head by pads of thick<br />

luxurious fabrics. Earlier this year, they took<br />

it a step further and their Fall show featured<br />

oversized flocked eyewear chains attached to<br />

the model’s sunglasses.<br />

This trend is filtering to the mainstream. I’ve<br />

seen fashion chains and cords in various stores<br />

around Melbourne and they featured strongly<br />

at ODMA’s O-Show earlier this year.<br />

Australian-based Loops (www.weareloops.<br />

com) are making eyewear cords and they are<br />

launching very soon. Expect to see colourful<br />

woven cords and metallic-dipped leather.<br />

As someone who is ALWAYS telling customers<br />

that wearing their sunglasses on their head is<br />

going to bend the temples out, I welcome this<br />

trend!<br />

Store it<br />

Carry cases are a tricky thing. Often, the cases<br />

that the brand provides are not very durable<br />

or practical. I’m always keeping an eye out for<br />

great cases and often with not much luck. There<br />

are a lot of independent leather workers on Etsy<br />

BY JO EATON*<br />

Balenciaga<br />

selling very individual handmade cases.<br />

For storage at home, Bushakan make wooden<br />

stands for those of us with multiple pairs to<br />

display their frames www.bushakan.com/<br />

collections/bushakan. Oyo Box have smart<br />

storage solutions for eyewear collections www.<br />

oyobox.com/shop.html.<br />

What else?<br />

For the die-hard eyewear fans, some excellent<br />

books have come out in the past few years.<br />

Cult Eyewear by Neil Handley and published<br />

by Merrell came out in 2011 and I managed to<br />

find a copy. It’s a beautiful coffee table style<br />

book featuring photographs and histories of<br />

brands such as Oliver Goldsmith, Kirk Brothers/<br />

Originals, Cutler and Gross and many more.<br />

I’m also hoping to get my hands on the<br />

book Forgotten Eyewear, Art of the Frame by<br />

Mark Jensen which was published this year. It<br />

contains over 140 photographs of frame details<br />

from the 1950s to present day. You can order it<br />

through @forgotteneyewear on Instagram.<br />

Taschen’s Eyewear: A Visual History, by Moss<br />

Lipow is another must-have book. It documents<br />

Lipow’s eyewear obsession and has spectacle<br />

history dating back 500 years.<br />

If you’re trying to find something for someone<br />

who has everything, perhaps<br />

Kerin Rose Gold’s A-morir<br />

eyewear is the place to start.<br />

Kerin embellishes eyewear<br />

with chains, tassels, and<br />

various shiny objects. You<br />

might have seen her work on<br />

the likes of Rihanna, Beyonce<br />

and Lady Gaga. Check it out at<br />

www.a-morir.com.<br />

Have a great summer. As for<br />

me, I’m looking forward to<br />

reading new eyewear books in<br />

the sun, under the protection<br />

of new sunglasses! ▀<br />

* Jo Eaton is a native Wellingtonian,<br />

now studying optical dispensing in<br />

Melbourne. She runs eyewear fashion<br />

blog, Eye Heart Glasses’.<br />

Bushakan<br />

<strong>Dec</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 />

OCT-A in macular and optic<br />

nerve disease<br />

BY DR ANMAR ABDUL-RAHMAN*<br />

Optical coherence tomography angiography<br />

(OCT-A) is a nascent non-invasive imaging<br />

OCT modality applicable to retinal and optic<br />

nerve assessment of the microvascular network 1 .<br />

Its main indication is in the diagnosis and follow<br />

up of exudative and ischemic maculopathies in<br />

addition to establishing a diagnosis of some forms<br />

of optic neuropathy where there is associated<br />

atrophy or vasculopathy.<br />

Due to the similarity of OCT-A and the more<br />

familiar fluorescein/indocyanine green angiography<br />

(FFA/ICG) images it is prudent to note when<br />

interpreting OCT-A images there is a poor<br />

concordance in regards to hyper-fluorescence (FFA/<br />

ICG) and hyper-reflectivity (OCT-A), the two methods<br />

are complementary and not comparative 2 . Table 1.<br />

compares the attributes of the two techniques.<br />

All images in this article are obtained using the<br />

DRI Triton Swept Source OCT (SS-OCT), which<br />

utilises central wavelength 1,050 nm, allowing<br />

some level of imaging through optical opacities.<br />

Scan speed 100,000 A-scan/sec.<br />

Interpretation of normal OCT-A images<br />

In spite of the use of the recently available<br />

OCT-A, there is limited information on normative<br />

databases 3 . The macular scan of the DRI Triton<br />

SS-OCT printout generates the following seven<br />

images (fig 1).<br />

1. The superficial vascular plexus: Located in<br />

the ganglion cell and the nerve fiber layer.<br />

Course retinal vessels appear in this layer that<br />

demonstrate dichotomous branching pattern<br />

converging on the foveal avascular zone (FAZ). The<br />

finer branches of this network form a continuous<br />

circumferential vascular plexus around the FAZ.<br />

2. The deep vascular plexus: Located in the inner<br />

nuclear and the external plexiform layer. These<br />

vessels originate from vertical anastomoses with<br />

the superficial vascular plexus the terminal ends<br />

forming a network of a fine interconnected network<br />

of vessels with a concentric pattern around the<br />

FAZ. 2, 4 . The FAZ area is variable, reported normal<br />

population mean values are 0.266 ± 0.097 mm2 in<br />

the superficial plexus and 0.495 ± 0.227 mm2 in the<br />

deep plexus. Therefore FAZ area is larger in the deep<br />

plexus compared to the superficial plexus 5 .<br />

3. The outer retina (photoreceptor layer): A fine<br />

granular layer, normally devoid of vascularity.<br />

4. The choriocapillaris: A homogenous granular<br />

layer.<br />

5. OCT B-scan provides a cross section through<br />

the examined choroidal retinal interfaces, which<br />

provides an overview of the distribution of the<br />

pathologic process.<br />

6. Composite angiogram of all retinal layers<br />

7. A color fundus photograph centered on the macula<br />

demonstrating the scanned area and centration.<br />

(Fig 1.) Right eye in a 40-year-old male. Internal<br />

limiting membrane to choriocapillaris, 4.5 x 4.5mm.<br />

The optic nerve is supplied by two main sources of<br />

FFA/ICG<br />

OCT-A<br />

Mydriasis Required Required<br />

Contrast dye Required Not required<br />

blood flow: the superficial layers (nerve fiber layer)<br />

by the central retinal artery; and the deeper layers<br />

(the prelaminar, lamina cribrosa, and retrolaminar<br />

regions) by the posterior ciliary artery. 6 The structural<br />

differences of these fine capillary networks are not<br />

discernable by OCT-A. The optic nerve scan of the<br />

DRI Triton SS-OCT use the following reference levels<br />

in addition to the OCT B-scan and color fundus<br />

photograph:<br />

1. The superficial optic nerve head scan.<br />

2. The deep scan at the level of the vitreo-retinal<br />

interface.<br />

3. The radial capillary network, which lie within the<br />

retinal nerve fiber layer (RNFL).<br />

4. The optic nerve at the level of the choroid.<br />

5. OCT projection, which is a composite of surface<br />

points generated from all scans of the optic nerve<br />

and peri-papillary retina.<br />

Selected ocular diseases<br />

Choroidal neovascularisation (CNV) in AMD<br />

CNV is classified by location in the deep retinal<br />

layers below (type I) or above (type II) the retinal<br />

pigment epithelium, or within the neurosensory<br />

retina (type III) 7 . Treatment naïve membranes have<br />

a characteristic pathophysiologic stage dependent<br />

appearance in the form of a fan-like arborescent<br />

mesh, unlike normal retinal and choroidal vessels,<br />

the irregular flow gives the membrane a faint<br />

signature. Associated anastomoses and feeder<br />

vessels are common (fig 2.) 2 .<br />

Treatment causes fragmentation of the lesion<br />

in addition to reducing the number of secondary<br />

branches. This appearance precedes regression of<br />

the associated exudative changes. Intralesional fine<br />

vessels are seen in the presence of longstanding<br />

fibrosis 2 . Caution should be exercised when<br />

attempting to establish a diagnosis of CNV on<br />

the basis of OCT-A only as exudative and fibrotic<br />

changes can mask the characteristic appearances.<br />

Although a high specificity (91%) has been reported<br />

in the diagnosis of CNV, Talisa et al in the same<br />

study of 48 eyes, reported a sensitivity of 50% 8 .<br />

(Fig 2.) A 78-year-old Caucasian female with wet<br />

AMD partially treated with Bevacizumab. Visual<br />

acuity 6/30 OS. A 4.5 x 4.5mm OCT-A showing a<br />

mesh of abnormal vessels surrounded by a patchy<br />

loss of choriocapillaris homogeneity. The abnormal<br />

vessels exist both below and above Bruch’s<br />

membrane and extending to the deep capillary<br />

plexus. Vascular texture of the deep capillary<br />

plexus is disrupted by intra-neurosensory oedema<br />

as demonstrated on the OCT B-scan image.<br />

Diabetic retinopathy<br />

Optical opacity Image degradation + Image degradation ++<br />

Image target<br />

Image acquisition speed<br />

Anterior segment, retinal<br />

Periphery, posterior pole<br />

Slow acquisition<br />

Late phase requires<br />

FFA 10-15 minutes<br />

ICG 20-30 minutes<br />

OCT-A demonstrates structural changes due<br />

to microangiopathy in both the superficial and<br />

deep capillary layers (fig 3.). Capillary loops,<br />

anastomoses, microaneurysms, widening of<br />

the FAZ and remodeling of the fine perifoveal<br />

capillaries have been described 9, 10 . Retinal nonperfusion<br />

is of particular prognostic importance.<br />

Agemy et al have shown a significant decrease in<br />

retinal capillary perfusion<br />

Posterior pole (macula and optic<br />

nerve)<br />

Rapid acquisition: 5-10 seconds.<br />

Image dimensions 2 dimensional imaging 3 dimensional imaging<br />

Imaging phases (Early-Late),<br />

leakage pooling, staining<br />

Distinction of the anatomical<br />

layers of the retina and choroid<br />

Imaging the microvascular<br />

network of the macula and optic<br />

disc and separating the layers<br />

Available<br />

No lesion depth resolution<br />

Not applicable<br />

Not Applicable<br />

Produces en-face images<br />

including the internal limiting<br />

membrane (ILM) to the choroid<br />

Primary indication<br />

Imaging artifacts Less prone More prone<br />

Shadow artifact from large<br />

retinal vessels, fluid and blood.<br />

Signal decorrelation artefacts<br />

with movement.<br />

Blink artifact.<br />

Table 1. Comparison of OCT-A with Fluorescein (FFA) and Indocyanine Green Angiography (ICG)<br />

density with increase in<br />

severity of DR using OCT-A 11 .<br />

Some of these changes can<br />

be observed in the absence<br />

of clinical retinopathy.<br />

Impaired vascular perfusion<br />

is seen as flow void resulting<br />

in disruption of the regular<br />

texture.<br />

Neovascularisation could<br />

be detected at early stages<br />

of the proliferative process.<br />

(Fig 3.) A 57-year-old Asian<br />

male showing disruption<br />

of the superficial capillary<br />

network and deep capillary<br />

network in addition to<br />

posterior shadowing of the<br />

deep capillary and outer<br />

retinal layers indicated by<br />

a loss of granularity in the<br />

image texture. A punctate<br />

loss of choriocapillaris<br />

homogeneity can be noted<br />

secondary to patchy loss<br />

or flow reduction in the<br />

choriocapillaris. Intraretinal<br />

and subretinal fluid in addition<br />

to high signal areas can be seen<br />

on the OCT B-Scan. Vessels of<br />

the superficial retinal layers are<br />

artefactually projecting in the<br />

images of the deep capillary<br />

plexus and choriocapillaris.<br />

Normal tension glaucoma<br />

Impairment of the optic nerve<br />

circulation is an important<br />

pathophysiologic factor in<br />

the etiology of glaucoma<br />

OCT-A of the optic nerve may<br />

add structural information<br />

that complements existing<br />

investigative methodology<br />

(fig 4). Retinal capillary<br />

non-perfusion is associated<br />

with areas of RNFL thinning,<br />

ganglion cell complex loss and<br />

visual field defects.<br />

(Fig 4.) A 39-year-old<br />

Caucasian female presented<br />

with an incidental left superior<br />

nasal step on automated<br />

visual field assessment. A<br />

retinal nerve fiber layer bundle<br />

defect can be seen from the<br />

superficial through to the<br />

radial capillary layer, in addition<br />

to the color fundus photograph<br />

(arrow). A notch is seen in the<br />

lower pole of the optic nerve in<br />

the OCT project image (circle).<br />

Research/future directions<br />

1. Ultra-high speed swept<br />

source OCT-A with scan speeds<br />

of 400-kHz A-scan rate, 5-10x<br />

faster than commercially<br />

available devices, allows<br />

a wider field of view (12 x<br />

12mm), faster acquisition of<br />

images and higher image 12, 13 .<br />

2. OCT-A using variable<br />

interscan time analysis (VISTA)<br />

which allows visualisation of<br />

relative flow speed, especially<br />

valuable when assessing<br />

diseases in which progression<br />

is linked to flow impairment,<br />

rather than vasculature loss,<br />

thereby offering possible<br />

quantitative data 12 .<br />

Fig 1. Normal OCT-A of the macula<br />

3. Jones matrix optical coherence tomography in<br />

this technique, tissue pigment contrast is used to<br />

enhance the interpretation of vascular images 14 . ▀<br />

References<br />

1. Methods and algorithms for optical coherence tomographybased<br />

angiography: a review and comparison. Zhang<br />

A., Zhang Q., Chen C. L. and Wang R. K.J Biomed Opt<br />

20(10):100901 (2015).<br />

2. Clinical Guide to Angio-OCT: Non Invasive, Dyeless OCT<br />

Angiography. Lumbroso B., Huang D., Jia Y., Fujimoto J.G.,<br />

Rispoli M.(2015).<br />

Optical coherence tomography angiography in retinal<br />

diseases. Chalam K. V. and Sambhav K.Journal of ophthalmic<br />

& vision research 11(1):84 (<strong>2016</strong>).<br />

In vivo characterization of retinal vascularization morphology<br />

using optical coherence tomography angiography. Savastano<br />

M. C., Lumbroso B. and Rispoli M.Retina 35(11):2196-203 (2015).<br />

Correlation of foveal avascular zone size with foveal<br />

morphology in normal eyes using optical coherence<br />

tomography angiography. Samara W. A., Say E. A., Khoo C. T.,<br />

Higgins T. P., Magrath G., Ferenczy S. and Shields C. L.Retina<br />

35(11):2188-95 (2015).<br />

3. Blood supply of the optic nerve head and its role in optic<br />

atrophy, glaucoma, and oedema of the optic discHayreh S.<br />

S.Br J Ophthalmol 53(11):721-48 (1969).<br />

4. The incidence of neovascular subtypes in newly diagnosed<br />

neovascular age-related macular degenerationJung J. J., Chen<br />

C. Y., Mrejen S., Gallego-Pinazo R., Xu L., Marsiglia M., Boddu<br />

S. and Freund K. B.Am J Ophthalmol 158(4):769-779.e2 (2014).<br />

5. Spectral-domain optical coherence tomography angiography<br />

of choroidal neovascularizationTalisa E., Bonini Filho M.<br />

A., Chin A. T., Adhi M., Ferrara D., Baumal C. R., Witkin A.<br />

J., Reichel E., Duker J. S. and Waheed N. K.Ophthalmology<br />

122(6):1228-38 (2015).<br />

Optical Coherence Tomography Angiography of Diabetic<br />

RetinopathyBandello F., Corbelli E., Carnevali A., Pierro L. and<br />

Querques G.Dev Ophthalmol 56:107-12 (<strong>2016</strong>).<br />

Fig 2. OCT-A of Choroidal Neovascularization (CNV) in AMD<br />

Fig 3. OCT-A in diabetic maculopathy<br />

Fig 4.<br />

Detection of microvascular changes in eyes of patients with<br />

diabetes but not clinical diabetic retinopathy using optical<br />

coherence tomography angiography. Talisa E., Chin A. T., Bonini<br />

Filho M. A., Adhi M., Branchini L., Salz D. A., Baumal C. R.,<br />

Crawford C., Reichel E. and Witkin A. J.Retina 35(11):2364-70<br />

(2015).<br />

6. Retinal vascular perfusion density mapping using optical<br />

coherence tomography angiography in normals and diabetic<br />

retinopathy patients. Agemy S. A., Scripsema N. K., Shah C.<br />

M., Chui T., Garcia P. M., Lee J. G., Gentile R. C., Hsiao Y. S.,<br />

Zhou Q., Ko T. and Rosen R. B.Retina 35(11):2353-63 (2015).<br />

Ultrahigh-Speed, Swept-Source Optical Coherence<br />

Tomography Angiography in Nonexudative Age-Related<br />

Macular Degeneration with Geographic Atrophy. Choi W.,<br />

Moult E. M., Waheed N. K., Adhi M., Lee B., Lu C. D., de Carlo<br />

T. E., Jayaraman V., Rosenfeld P. J., Duker J. S. and Fujimoto J.<br />

G.Ophthalmology 122(12):2532-44 (2015).<br />

7. Ultrahigh-speed swept-source OCT angiography in exudative<br />

AMD. Moult E., Choi W., Waheed N. K., Adhi M., Lee B., Lu<br />

C. D., Jayaraman V., Potsaid B., Rosenfeld P. J., Duker J. S.<br />

and Fujimoto J. G.Ophthalmic Surg Lasers Imaging Retina<br />

45(6):496-505 (2014).<br />

Birefringence imaging of posterior eye by multi-functional<br />

Jones matrix optical coherence tomography. Sugiyama S., Hong<br />

Y. J., Kasaragod D., Makita S., Uematsu S., Ikuno Y., Miura M.<br />

and Yasuno Y.Biomed Opt Express 6(12):4951-74 (2015).<br />

About the author<br />

* Anmar is a medical retina<br />

and glaucoma sub-specialist<br />

at CMDHB. He was the first<br />

eye surgeon to graduate from<br />

the University of Otago with<br />

a Master of Ophthalmology<br />

degree in 2008.<br />

24 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>


Hoya’s builds presence in ANZ<br />

Lens company Hoya announced it is to<br />

invest millions of dollars in beefing up<br />

production, introducing new technologies<br />

and building a new state-of-the-art<br />

Australasian headquarters in Sydney after the<br />

city council purchased the company’s current<br />

site earlier this year.<br />

“It’s an interesting time for us,” said Craig<br />

Chick, Hoya Lens Australia’s managing director.<br />

“We’ve been in our current location since 1994,<br />

and it was designed and built according to our<br />

business structure, which was very different<br />

22 years ago. We manufactured everything in<br />

Sydney then.”<br />

Hoya have a lab in Bangkok, where around<br />

65% of their lenses are now made.<br />

“This has been a real opportunity to look at<br />

our business and make some key decisions,”<br />

said Chick. “Currently we make more entry-level<br />

products in Sydney, with the high-end products<br />

coming via Bangkok. We are aiming to flip that<br />

around and have Australia focus on the highervalue<br />

products, with Thailand concentrating on<br />

the entry level lines.”<br />

This will improve delivery times by around 24<br />

hours and allow Hoya to focus more on service<br />

and quality, particularly for the company’s<br />

multifocal products.<br />

“We are taking delivery this week of a new<br />

free-form generator and we will also be<br />

purchasing a new robotic edger,” said Chick.<br />

“We want the new equipment in place and<br />

functioning before we move buildings to ensure<br />

a smooth transition.”<br />

In the short-term this will mean a small<br />

reduction in staff, but staff numbers will then<br />

be increased when the company moves to its<br />

new site and into its new building, something<br />

Chick said he hopes would happen before<br />

<strong>Dec</strong>ember 2018.<br />

Chick was keen to stress that on the ground<br />

in both Australia and New Zealand, customers<br />

will see little change, except for the intended<br />

improvement in delivery times and service<br />

standards. He noted that Hoya products already<br />

arrive in New Zealand direct from Bangkok with<br />

no middle-man involved, and that New Zealand<br />

fitting will continue to take place at the current<br />

Auckland site.<br />

“This move is about refining the production<br />

process. Our end goal is for the customer to<br />

order as usual, and for us to decide where it<br />

will be produced. The practitioner will receive<br />

the job back with the same quality and delivery<br />

time regardless of where the manufacturing<br />

takes place.”<br />

The investment being made by Hoya<br />

Corporation in its Australasian business is<br />

unspecified, but is rumoured to be several<br />

million Australian dollars. The company,<br />

Craig Chick<br />

currently celebrating 75 years in business,<br />

announced the changes at their anniversary<br />

events in September and October, and will<br />

continue to keep customers updated on the<br />

changes. ▀<br />

Global eye<br />

care index<br />

According to the <strong>2016</strong> World Eye Care Index,<br />

an overview of the current status quo of<br />

international eye health, New Zealand is<br />

ninth in the world for access to eye care, with<br />

just 0.44% of the New Zealand population who<br />

need eye care unable to access it.<br />

The research, from British online optician<br />

Mister Spex, also showed New Zealand ranked<br />

48th out of 65 countries for the percentage of<br />

the population using glasses, at 48%; was about<br />

average for contact lens (CL) wear, at 6%; and<br />

was relatively low among developed nations for<br />

those who’d had laser surgery, at just 0.55% - this<br />

compares to 8% of the UK population, which had<br />

the highest proportion.<br />

At 0%, Norway and Italy were top of the list<br />

for access to eye care, while Eritrea was bottom<br />

with 29.4%. China and Japan, at 65.5% and 63.2%<br />

respectively, topped the glasses wearing table,<br />

while the Philippines was lowest with 33%. The<br />

Czech Republic and France have the highest<br />

proportion of CL wearers with 14.5% and 14.22%,<br />

and Romania the lowest at 1%.<br />

For the full table, visit www.misterspex.co.uk/<br />

world-eye-care-coverage-index#<strong>2016</strong> ▀<br />

Change at The Terrace Eye Centre<br />

The Terrace Eye Centre and<br />

Ophthalmology from the University of<br />

Wellington Public Hospital have<br />

Otago. She undertook a further two<br />

a new ophthalmologist on the<br />

years of fellowship training in paediatrics<br />

team, Dr Anne-Marie Yardley.<br />

Dr Anne-Marie Yardley is a general<br />

ophthalmologist and cataract surgeon<br />

who specialises in all aspects of<br />

paediatric ophthalmology and adult<br />

strabismus. She says she’s particularly<br />

passionate about children’s eye health<br />

and delivering the best possible care<br />

to our paediatric population. “I am<br />

delighted to be home in New Zealand<br />

and working at The Terrace Eye Centre<br />

with such a great team. It is wonderful<br />

to be working with supportive<br />

colleagues who have mentored me and<br />

played an integral role in my training.<br />

Our new facilities are a pleasure to work<br />

in and the purpose-built environment<br />

helps us to provide our patients with<br />

the highest standard of care.”<br />

Dr Yardley completed her medical<br />

degree at the University of Auckland<br />

in 2003 and went on to complete her<br />

Dr Anne-Marie Yardley joins Wellington’s Terrace Eye Centre<br />

and strabismus, working at the Lions Eye<br />

Institute and Princess Margaret Hospital<br />

for Children in Western Australia and<br />

then the Hospital for Sick Children in<br />

Toronto, Canada.<br />

Dr Yardley will be taking over Dr Keith<br />

Maslin’s paediatric ophthalmology and<br />

strabismus work, while he continues to<br />

practice at The Terrace Eye Centre and<br />

Masterton in general ophthalmology,<br />

including cataract surgery, and his<br />

subspecialty, medical retina especially<br />

diabetic retinopathy.<br />

In other news earlier this year, The<br />

Terrace Eye Centre moved to its new<br />

purpose-built premises in Wakefield<br />

House, 90 The Terrace, above the Rise<br />

café, and long-serving Wellington<br />

ophthalmologist Dr Peter Wellings<br />

retired to pursue interests outside<br />

ophthalmology. The Terrace Eye Centre’s<br />

other doctors Keith Maslin, Keith Small<br />

postgraduate professional training in Dunedin, Christchurch<br />

and Wellington, during which time she obtained a Master of<br />

and Kolin Foo, wished Dr Wellings all the very best for his<br />

retirement. ▀<br />

Insight provided<br />

by Auckland Eye<br />

BY AUCKLAND EYE<br />

Auckland Eye was pleased to bring together many of their<br />

much valued optometrist referrers on 18 October for another<br />

enjoyable evening of good food and education at their second<br />

insight seminar for <strong>2016</strong>. There was a wonderful line up of Auckland<br />

Eye specialists presenting on a wide variety of topics. Dr Stephen Best<br />

discussed the intricacies of a number of neuro-ophthalmology case<br />

studies, highlighting the importance to look beyond the obvious and<br />

also be aware that more than one condition can exist at one time.<br />

Dr Justin Mora ran an interactive session on ophthalmic congenital<br />

anomalies, which tested attendees’ general knowledge of common<br />

and less common paediatric eye conditions. Lastly, Dr Sue Ormonde<br />

discussed a systematic approach to the use of steroids, which gave<br />

tremendous insight into the benefits and potential side effects of<br />

treating eye conditions in this way.<br />

Feedback was that<br />

the evening provided<br />

another excellent learning<br />

opportunity (with the bonus<br />

of yummy food and drink)<br />

and attendees said they were<br />

looking forward to the 2017<br />

insight series. ▀<br />

NZOSS exec: thanks<br />

and farewell<br />

BY NIKKU SINGH, NZOSS <strong>2016</strong> PRESIDENT<br />

Since its establishment in 2013, the New<br />

Zealand Optometry Student Society (NZOSS)<br />

has served as a platform for all optometry<br />

students, providing us invaluable exposure to the<br />

professional community. With <strong>2016</strong> coming to<br />

a close, not only does this mark the 4th year of<br />

operation for our little student society, but also<br />

our class’ final year of undergraduate study, so<br />

forgive me for being a little nostalgic!<br />

It all started in 2013, where our class embarked<br />

on its very first year of optometry. Sheepish as all<br />

new students are, we sensibly sat in our very first<br />

lecture and were greeted by an enthusiastic part<br />

V student, convincing us to join the illustrious<br />

NZOSS. Little did we know, this was it’s very first<br />

year of being. Despite this, we headed off to the<br />

first BBQ of the year, which has now become a<br />

tradition of sorts. This was followed by what has<br />

now become the usual suspects; the pub crawl,<br />

pub quiz and the Eyeball. The first committee did<br />

a fantastic job setting up NZOSS and really helped<br />

welcome us warmly into the degree.<br />

As we progressed through optometry school,<br />

NZOSS developed rapidly. We begun to appreciate<br />

the society as its own entity. It offered exposure<br />

to optometry outside the university and now<br />

plays a vital role in bridging the gap between<br />

students and the professional community. It also<br />

successfully brings together students from all<br />

years, fostering long-lasting relationships within<br />

a network that includes recent graduates as well.<br />

Although we didn’t get to tick everything off our<br />

to do list, I am incredibly proud of the work the<br />

<strong>2016</strong> executive committee has put in. This year<br />

we kept up with our usual social traditions and<br />

further explored the educational front. For 2017,<br />

we have expanded the committee by an extra<br />

two members, which will help distribute the work<br />

load more efficiently and allow NZOSS to grow.<br />

Of course, the relationship which has been<br />

achieved between NZOSS and the optometry<br />

profession would not be possible without the<br />

help of many organisations within the industry.<br />

On behalf of all the students, I would like to thank<br />

these industry organisation for their ongoing<br />

generosity and willingness to collaborate with us.<br />

On behalf of the part V class of <strong>2016</strong>, I would<br />

like to thank the teaching staff at the University<br />

of Auckland. From part II through to part V, you<br />

have all played a vital role in our development,<br />

Goodbye from the <strong>2016</strong> NZOSS Executive: Jada Meni, Kendall Johnston, Sophie Woodburn, Nikku Singh (lying down), Aaron Chin, Gunnika Gill, Alicia<br />

Han, Jonathan Albert and Oli Munro<br />

and for that we cannot thank you enough. To<br />

all the supervisors in clinic, I don’t know how<br />

appreciative we come across during a reasonably<br />

stressful year, but we are forever grateful for the<br />

dedication, patience and wisdom you have shared<br />

with us. Without your guidance, we would not be<br />

the practitioners we are today.<br />

Finally, good luck to Alicia Han (2017 NZOSS<br />

President) and her team! I’m sure you will do a<br />

fantastic job and I can’t wait to see what you guys<br />

bring to the table next year! ▀<br />

<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

25


MACULAR MILESTONES<br />

“<br />

What’s hot in the world of<br />

macular disease research<br />

Improving wet AMD<br />

therapy<br />

Every solution breeds new problems,”<br />

was coined by Arthur Bloch (of Murphy’s<br />

Law fame). Anti-VEGF agents have<br />

revolutionised wet AMD therapy but have<br />

created problems: many patients exhibit a suboptimal<br />

response; treatment burden and cost<br />

have become major healthcare issues; and there<br />

is an emerging concern that long-term therapy<br />

may lead to geographic atrophy.<br />

Improved anti-VEGF therapy<br />

There are a large number of research initiatives<br />

aiming to improve anti-VEGF activity, either<br />

lengthening activity of current agents or using<br />

new longer-acting anti-VEGFs. An implanted<br />

delivery system with a refillable subconjunctival<br />

port providing long-term Lucentis therapy<br />

is currently in a phase II trial; a hydrogelbased<br />

sustained release formulation of Eylea<br />

providing six months’ therapy with a good<br />

safety profile is in preclinical development; an<br />

implantable semi-permeable capsule containing<br />

a genetically modified cell line secreting<br />

Lucentis (NT-503 ECT) is also in a Phase II trial;<br />

and abicipar pegol (a DARPin), a potent new<br />

anti-VEGF agent with double the half-life of<br />

current anti-VEGFs, is about to commence phase<br />

III trials.<br />

Gene therapy is another approach making<br />

significant headway. The eye is well-suited to<br />

gene therapy; it is small and easily accessible,<br />

allowing precise, localised delivery of a small<br />

dose. The small dose reduces the risk of systemic<br />

side-effects. As the eye is immune-privileged,<br />

there is a reduced chance of an immune<br />

response. Two potential approaches for treating<br />

wet AMD would be to upregulate naturally<br />

occurring bioactive molecules or manufacture<br />

new ones.<br />

One promising approach now in phase II<br />

trials, involves upregulating an existing anti-<br />

VEGF molecule by encoding a viral vector with<br />

an anti-VEGF complementary DNA construct<br />

and injecting it adjacent to the choroidal<br />

neovascularization (CNV) from where it<br />

transfects nearby photoreceptors and RPE cells.<br />

Specifically, the agent is an adenoviral vector<br />

harbouring a gene encoding soluble fms-like<br />

tyrosine kinase-1 (sFLT-1) protein, also known as<br />

VEGF receptor 1 (VEGFR-1). It is the only known<br />

endogenous VEGF inhibitor in the body and,<br />

interestingly, Eylea binds to the same receptor<br />

complex.<br />

The treatment is given as a single subretinal<br />

injection, having first given a dose of Lucentis<br />

to establish initial and short-term VEGF<br />

suppression. Lucentis is then used as required to<br />

manage any breakthrough CNV activity. A phase<br />

I study treated six advanced wet AMD eyes and<br />

the treatment was found to be safe. Although<br />

Phase I studies are not designed to assess<br />

efficacy, only two of the six vector-treated eyes<br />

required a single repeat Lucentis injection over<br />

12 months, and five of the six eyes showed<br />

improvement in vision despite previously<br />

responding poorly to a mean of 10 anti-VEGF<br />

injections. These findings suggest the treatment<br />

exerted a biological effect over a sustained<br />

period of time. A phase II study of 32 subjects<br />

for three years is in process.<br />

Additional targets in the CNV complex<br />

Many factors other than VEGF are involved<br />

in the pathogenesis of CNV and may serve<br />

as therapeutic targets. Anti-VEGF agents kill<br />

only endothelial cells that aren’t covered with<br />

protective pericytes. This prevents the complex<br />

enlarging by killing the tip cells, but existing<br />

vessels protected by pericytes mature rather<br />

than regress. Platelet derived growth factor<br />

(PDGF) is essential for pericyte survival. So an<br />

BY DR DAVID WORSLEY*<br />

anti-PDGF agent will strip pericytes from the<br />

CNV, expose the endothelial cells and allow an<br />

anti-VEGF agent to kill them.<br />

Therefore, a combination treatment of an anti-<br />

PDGF agent with an anti-VEGF is a promising<br />

approach. The phase IIb trial of an anti-PDGF<br />

called Fovista in combination with Lucentis<br />

showed a 62% improvement in visual acuity<br />

compared to Lucentis alone, with the visual<br />

acuity improvement with Fovista continuing to<br />

outpace and diverge from Lucentis monotherapy<br />

over the course of six months. Further, there<br />

were fewer patients with visual loss compared to<br />

Lucentis alone. In those eyes with robust vision<br />

gain, Fovista combined with Lucentis shrank the<br />

CNV, while with Lucentis alone, the CNV only<br />

stabilized. Among patients who experienced<br />

vision loss, those on Lucentis alone had disciform<br />

scar formation while in the combination therapy<br />

arm, there was little, if any, scarring.<br />

In short, the dual inhibition of VEGF and PDGF<br />

has demonstrated the potential of not just<br />

reducing exudation from choroidal neovascular<br />

lesions, but actually arresting and destroying<br />

the neovascular complexes.<br />

The phase III Fovista programme is evaluating<br />

the combination with Eylea and Avastin as well<br />

as Lucentis.<br />

Squalamine, a small potent anti-angiogenic<br />

molecule, works intracellularly to give broadspectrum<br />

inhibition of VEGF, platelet derived<br />

growth factor (PDGF), and other factors. Phase<br />

II trials of squalamine eyedrops, in combination<br />

with intravitreal Lucentis, were promising with<br />

improvements in vision and a reduction in<br />

intraretinal fluid compared to Lucentis alone. A<br />

Phase III trial is underway.<br />

OPT-302 is a soluble VEGF-3 receptor that<br />

‘traps’ VEGF-C and VEGF-D. ‘VEGF’ is actually<br />

a contraction of VEGF-A; VEGF-C and D are<br />

distinct and potent angiogenic factors. A<br />

phase I trial combining this with Lucentis<br />

recently reported an excellent safety profile<br />

and evidence to suggest an improved clinical<br />

outcome. A phase II trial is in process.<br />

Gene therapy can also be used to deliver<br />

other agents. A lentiviral vector, Retinostat,<br />

expressing two endogenous anti-neovascular<br />

proteins, endostatin and angiostatin, has<br />

recently undergone a phase I study. Retinostat<br />

demonstrated safety and also evidence of<br />

biological activity over a sustained period of time.<br />

Conclusion<br />

We face serious problems in the treatment of<br />

wet AMD. We have three excellent anti-VEGF<br />

agents, but there are issues with suboptimal<br />

outcomes and the burden of frequent<br />

injections is unsustainable. One potential<br />

solution is improved and longer-acting anti-<br />

VEGF therapy. Another potential solution is<br />

new anti-angiogenesis agents, alone or in<br />

combination with current anti-VEGF agents.<br />

Undoubtedly, the next few years will bring<br />

improved therapies that will change the<br />

way we manage wet AMD, provide superior<br />

outcomes and reduce treatment burden.<br />

About the author<br />

* Dr David Worsley is a medical<br />

and surgical retinal specialist at<br />

Hamilton Eye Clinic and Waikato<br />

Hospital, with a particular interest<br />

in the rapidly evolving treatments<br />

for AMD. He is a trustee for<br />

Macular Degeneration New<br />

Zealand and is a medical advisor<br />

for several biomedical companies.<br />

Disclosure: David is a clinical<br />

advisor for, and has a financial<br />

interest in, OPT-302.<br />

Working on the Taveuni<br />

Eye Project<br />

BY DR DAVID PENDERGRAST*<br />

The hospital on Taveuni Island is on a hillside<br />

above the main town overlooking the<br />

straights between Taveuni and Vanua Levu.<br />

It’s an area famous for diving, especially for soft<br />

corals on the Rainbow Reef. In past trips, however,<br />

we’ve never had enough time to go diving. So each<br />

day, during breaks from surgery, I would stand in<br />

the front entrance of the hospital and gaze out<br />

at the beautiful changing colours of the sea as<br />

the tide flowed over the reef. But this time, the<br />

surgical load was less frantic, so when someone<br />

organised a snorkelling trip, Lois and I went out<br />

as well. Beautiful colours, tropical fish and clear<br />

water; a great change from our normal recreation<br />

break – walking home from the hospital along the<br />

coast road: something that seems like a good idea<br />

at the time, but after about an hour we usually<br />

put our thumbs out to hitch a ride the rest of the<br />

way. The road goes through the main town on the<br />

island, where we usually buy a drinking coconut<br />

or vegetables – eggplant, pumpkin, greens, snake<br />

beans, chillies or pineapple. Last year there were<br />

mangoes, but this year Cyclone Winston, which tore<br />

through here in February, ruined the Island’s mango<br />

crop.<br />

The patients for the Taveuni Eye Project eye clinic<br />

come from all over Fiji. Rotary organises transport<br />

from their villages, which usually means a bus and<br />

boat trip, which can be a 12-hour or overnighttrip<br />

for some from the more distant parts of the<br />

country, then the Rotary van from the wharf to the<br />

patient accommodation in the hospital, church or<br />

school. On post-op day, patients with eye patches<br />

sit in rows on chairs, watched by others who<br />

have either just had their surgery or are awaiting<br />

surgery the next day. The local hospital team<br />

provides food for the patients: hundreds of kilos<br />

of taro; sacks of rice; and lots and lots of sugar for<br />

tea. Most patients would be unable to afford to<br />

come for surgery if transport, accommodation and<br />

food was not provided.<br />

The medical team is a great mix of locals and<br />

New Zealanders. The Taveuni Eye Project has been<br />

going for 11 years now and some of the team have<br />

come each year. Ineke Van Laar from Tauranga is<br />

the very efficient organiser from the nursing and<br />

theatre side. Generally, there are seven to nine<br />

assistants in theatre, pre- and post-op, including<br />

some registered nurses and theatre technicians,<br />

plus there are usually two or three local nurses.<br />

The transport, logistics and food is all organised<br />

by Michael Prasad, a tireless and enthusiastic local<br />

businessman. He sits at the hub of the clinic area<br />

and makes sure we all have enough to do. We have<br />

Patients sleep in the hospital just before and following surgery<br />

MORE CLASSIFIEDS ON PAGE 28<br />

OPTOMETRIST WANTED<br />

FOR SUNNY, TROPICAL<br />

FIJI!<br />

Brand new, fully equipped practice opened in<br />

Suva CBD. Perfect opportunity to travel and<br />

earn at the same time!<br />

Looking for an experienced optometrist to<br />

cover a short term/ long term period.<br />

Attractive rate plus relocation salary offered.<br />

Please email<br />

optique-fiji@gmail.com or text/call<br />

+6799990866<br />

Dr David Pendergrast examining a patient<br />

learned never to believe Michael when he says,<br />

“only another four more cases and we are finished<br />

for the day” – somehow he always manages to fill<br />

the day up to the brim.<br />

There are difficult cases and the frustration<br />

of having patients who could be treated if they<br />

were in New Zealand, but there are no, or limited,<br />

options for them here. There are no vitreoretinal<br />

services in Taveuni and so patients with posterior<br />

segment disease generally have no options, for<br />

example. In addition, access to ongoing medication<br />

is difficult and expensive, so even simple things<br />

like intraocular inflammation or glaucoma may not<br />

get adequate or, indeed, any treatment once the<br />

team leaves. But anyone who has participated in<br />

a trip like this, be it through Rotary or VOSO, will<br />

understand the satisfaction of helping people who<br />

are often severely visually impaired and would<br />

not otherwise have access to any treatment. The<br />

faces of the patients on post-op day, their thanks,<br />

the beautiful singing that always seems to follow,<br />

especially on the final day, makes all the hard<br />

work and many of the frustrations more than<br />

worthwhile.<br />

The leader of our surgical team is Dr Jeff Rutgard,<br />

an American surgeon from San Diego who has<br />

been operating in Taveuni since the project<br />

started. The type of cataract surgery we carry out<br />

is manual small incision cataract extraction. This<br />

avoids the need for phaco equipment, and has<br />

been shown to have similar outcomes to phaco in<br />

several studies.<br />

Pterygium surgery is challenging, as these are<br />

generally large and vascular, and often recurrent.<br />

One case last year had four pterygiums on the same<br />

eye, overlapping each other. I generally carry out a<br />

free conjunctival graft, as I would do here in New<br />

Zealand, but sutured rather than using Artiss glue.<br />

Many instrument and surgical supply companies<br />

also assist with the project. This year we had the<br />

benefit of two beautiful operating microscopes<br />

supplied by Zeiss, one at minimal cost and one<br />

donated. They were much appreciated.<br />

Dr Jeff was impressed that in New Zealand there<br />

is a tradition of voluntary surgery, with significant<br />

numbers of surgeons regularly participating<br />

in VOSO or similar trips, as well as those who<br />

work with the Pacific Eye Institute or other<br />

organisations, as only a handful of US surgeons<br />

are interested in voluntary surgery, he said. ▀<br />

* *Dr David Pendergrast is an ophthalmologist at Auckland Eye,<br />

with sub-specialty expertise in cataract surgery, refractive<br />

and laser surgery, corneal transplantation, anterior segment<br />

surgery, conjunctival surgery and external eye diseases. He is<br />

clinical director of the NZ National Eye Bank, clinical senior<br />

lecturer at Auckland University and a member of the NZ<br />

Society of Contact Lens Practitioners. He is married to Lois, an<br />

ophthalmic nurse, who also volunteers her time and expertise<br />

to the Taveuni Eye Project.<br />

OPTOMETRIST WANTED<br />

ROLLESTON EYE<br />

We see a wide range of ages and<br />

nationalities. An interest in extension<br />

learning in behavioural optometry and<br />

binocular vision is essential.<br />

Rolleston Eye is located with access to the<br />

outdoors of Canterbury and the South<br />

Island. There is vibrant city life in the suburban<br />

surrounds of Christchurch.<br />

This position would suit an optometrist who<br />

likes to work independently but have advice<br />

a phone call away. See our website and<br />

contact leesastuart@gmail.com<br />

26 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>


Eye on optics<br />

by<br />

Chalkeyes<br />

There’s a saying, maybe Taoist, that ‘if you<br />

carry on the way you are going you will get<br />

to where you are going to’ and this may be<br />

true for the provision of eye care services in New<br />

Zealand.<br />

New Zealand has a unique<br />

mix of public and private<br />

sector funding. Like the<br />

UK, it has a universally free<br />

public sector, but the private<br />

sector provides a much<br />

larger slice of the total care<br />

given than in the UK. In<br />

Australia the margins are<br />

blurred by Medicare, which<br />

funds most of the total<br />

care given, although this is<br />

supplemented by private<br />

contributions. In the UK it<br />

is common for user-pays<br />

private care to be given<br />

in public hospitals, but in<br />

New Zealand that is taboo,<br />

apart from a handful of private providers who<br />

contract some clinical services. But it is becoming<br />

more and more common for our, dare I say, failing<br />

public sector to contract out both clinical and<br />

surgical services to meet a quota specified by the<br />

Ministry of Health, to avoid retaliatory funding<br />

cuts. In my opinion, nearly all public sector eye<br />

care services are failing in New Zealand, especially<br />

in the provision of follow up appointments in<br />

routine eye care – an opinion supported by the<br />

recent furore about the significant delays in<br />

treatment at our southern hospitals last month<br />

(see story p3).<br />

With a few exceptions, the public sector eye<br />

clinics are ‘paper bound’. This makes the rapid<br />

review of records and test results very difficult.<br />

It makes clinical audit almost impossible, except<br />

for laboriously kept records on applications,<br />

which seldom interoperate, or with even more<br />

laboriously reworked paper records. In practice,<br />

the plethora of paper forms and electronic<br />

transactions in separate silos hinders rather<br />

than helps the doctors and has recently been<br />

identified as a cause of physician burnout. Yet<br />

specialists and hospitals refuse to change to<br />

the more efficient paperless systems that are<br />

now readily available, partly, I believe, because<br />

they shortcut established financial and power<br />

In practice, the plethora<br />

of paper forms and<br />

electronic transactions<br />

in separate silos hinders<br />

rather than helps the<br />

doctors and has recently<br />

been identified as a cause<br />

of physician burnout.<br />

hierarchies, which therefore act as ‘destructive<br />

technology’ for the status quo.<br />

Issues of power, control and lack of foresight<br />

abound. Traditionally the relationship between<br />

ophthalmologist and<br />

optometrist has been<br />

adversarial. This drama is<br />

still playing out but the<br />

optometrists have ‘won’<br />

on a number of issues,<br />

which is a good thing if we<br />

are to tackle the problems<br />

in our healthcare system.<br />

For example, optometrists<br />

are now ranked equal<br />

with ophthalmologists by<br />

government in planning for<br />

eye care’s future and some<br />

have prescribing rights on<br />

some medications, including<br />

glaucoma medications,<br />

though they have to have<br />

attended additional courses.<br />

The ideal review interval after changing<br />

treatment for glaucoma is six weeks. This is<br />

unachievable in the public sector, where there<br />

are great wait-lists-in-the-sky of unallocated<br />

follow-up appointments. So you would<br />

think there would be a good opportunity for<br />

therapeutically-qualified optometrists to pick up<br />

this work but, unlike Australia where Medicare<br />

funds optometrist visits, Kiwis must fund their<br />

own optometry visits, and most New Zealand<br />

pensioners do not have the funds for regular<br />

optometrist visits, or indeed at all in many cases,<br />

sadly!<br />

There are other unexplored options for the<br />

future of eye care services, however. The clinical<br />

service could be outsourced to external providers<br />

through the internet. Tests such as visual field<br />

interpretation, reporting on photographs and<br />

scans could all be outsourced. The ground<br />

work for this has already been done for other<br />

specialties such as radiology and cardiology,<br />

so it shouldn’t be that hard for optometry<br />

methinks. Again, funding would be a problem,<br />

but a price war in such services would bring<br />

down prices. Maybe, horror of horrors, we could<br />

even encourage ‘virtual medical tourism’, with<br />

basic facilities like field and OCT machines being<br />

publicly-funded, but reporting done by the<br />

cheapest bidder, perhaps in a remote location –<br />

Fiji seems nice! This would involve de-regulation<br />

of eye care and might bring local optometrists<br />

and ophthalmologists closer together finally,<br />

after more than a century of unnecessary turf<br />

wrangling!<br />

There has been an argument that high-tech<br />

services should be centralised and people outside<br />

our few larger centres bussed or flown in for<br />

treatment. But as soon as the argument swings<br />

in that direction, it seems to Chalkeyes that it just<br />

becomes a big resource grab by the larger centres.<br />

An unholy alliance has developed between some<br />

ophthalmologists and DHB managements, in<br />

some cases to protect the extant order which<br />

‘works’ best for them, and not necessarily<br />

the patient. While the formally adversarial<br />

relationship between<br />

ophthalmologists<br />

and DHBs persists,<br />

a ‘way through’ for<br />

public services is rarely<br />

discussed. Indeed, there<br />

is an assumption on<br />

the ‘market’ model that<br />

services are worth much<br />

more than the public<br />

sector funding allocation.<br />

Sometimes there is even<br />

feuding between private<br />

institutions (for example,<br />

St George’s and Southern<br />

Eye in Christchurch) which<br />

leads to, in my opinion, an<br />

unnecessary duplication<br />

of facilities. And our<br />

Southern providers are<br />

not alone, other private<br />

eye clinics have also found<br />

it necessary to build<br />

their own new, concrete<br />

Paperwork, as much a cause of burnout as too many patients<br />

palaces – the cost of which will all be factored into<br />

the bill for the consumer.<br />

Arguably the New Zealand public sector has<br />

never met the demand and is not designed to.<br />

Demand has hugely increased and expectations<br />

have changed as a greater proportion of the public<br />

learn there is a lot more that can be done to help<br />

them. But if we carry on the way we are going,<br />

then access to contemporary standards of eye care<br />

will simply be unobtainable for the majority of<br />

the population, with all the unattended morbidity<br />

this will bring. Somehow we must bring all the<br />

people involved, and their skills, together to<br />

deliver a standard of care, which keeps up with<br />

the pathology in our populations.<br />

Keep an eye on this column to learn more<br />

about Chalkeyes’ master plan. ▀<br />

Welcome to Eye on optics by Chalkeyes, a new column brought to you by the team at NZ Optics.<br />

Inspired by the once legendary (and anonymous) Chalkie who used to grace the back page of that<br />

once wonderful, independent battler for all things business in New Zealand, The Independent<br />

Business Weekly, the views expressed by Chalkeyes are his, or hers, alone and not necessarily the<br />

views of NZ Optics. Anyone wishing to comment on Chalkeyes’ views should email a brief letter to<br />

the editor at info@nzoptics.co.nz.<br />

❄<br />

Merry Christmas from NZ Optics<br />

If you have any news, case studies or stories you wish to share, or if you have a job vacancy<br />

you need to fill or equipment you need to sell, please just drop us a line at info@nzoptics.co.nz.<br />

We always love to hear from you.<br />

We hope you have a wonderful Christmas and New Year and a good break.<br />

We’ll be back at the end of January with our February issue.<br />

All the best and Merry Christmas, from Lesley, Jai, Nick, Susanne and Tracey.<br />

❄<br />

❄<br />

For all the news, views, social occasions and latest research from our part of the world, let NZ Optics help keep you informed<br />

NZ Optics: your publication – supporting New Zealand’s ophthalmic industry<br />

<strong>Dec</strong>ember <strong>2016</strong><br />

NEW ZEALAND OPTICS<br />

27


DISPENSING OPTICIAN OR<br />

EXPERIENCED OPTICAL<br />

ASSISTANT<br />

Our modern progressive independent practice requires a dispensing optician to join our experienced<br />

dispensing team. A dispensing qualification is not necessarily required, but experience is a must.<br />

The main role will be dispensing but also includes auxiliary testing as the practice has a strong clinical<br />

focus. Our large onsite Laboratory allows for fast and efficient glazing and adjustment services.<br />

Pukekohe is a fast growing area, 30 minutes south<br />

of Auckland central (travelling against the traffic).<br />

John Kelsey and his team are proud of the high<br />

standard of our services and would like to welcome<br />

an enthusiastic and motivated new staff member<br />

to join our well established team.<br />

This position is full-time with some Saturday<br />

morning work. In the first instance please contact<br />

Laurraine at admin@optik.co.nz<br />

Low Vision Consultations available at<br />

REMUERA, TAKAPUNA, MANUKAU and<br />

PUKEKOHE<br />

An Optometrist dedicated to Low Vision<br />

support.<br />

FULL-TIME ORTHOPTIST<br />

WANTED<br />

Auckland Eye is New Zealand's Centre of<br />

Excellence for eye care and we are looking for<br />

an experienced full-time orthoptist to join<br />

our team.<br />

Auckland Eye is a dedicated private<br />

ophthalmic care provider, with 13 specialists.<br />

We have a state of the art clinic and day stay facility in central Remuera and<br />

Takapuna. We also provide a number of suburban clinics throughout Auckland.<br />

We are looking for an orthoptist to join our team to provide assistance to the<br />

ophthalmologists covering all ophthalmic sub-specialties including three<br />

paediatric ophthmologists plus adult and neuro-ophthalmology.<br />

For more information, please contact janet@aucklandeye.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 someone to take<br />

over this profitable, independent practice and their loyal customers. There’s<br />

tremendous scope for growth for the right owner who has the skills and the<br />

energy, drive and marketing know-how to make this practice stand out.<br />

This practice is ideally suited to an optometrist who yearns to be truly<br />

independent and is ready to run their own business, make their own decisions<br />

and reap the rewards from the hard work they put in. Or perhaps you’re<br />

overseas and looking to move or return to New Zealand?<br />

Situated in a very sought after suburb with good schools and amenities close by,<br />

with many high-value customers and a great team, this practice has it all, and you’ll<br />

receive the full support of 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 />

MORE CLASSIFIEDS ON PAGE 26<br />

28 NEW ZEALAND OPTICS <strong>Dec</strong>ember <strong>2016</strong>

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