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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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Gary Edgar, NZOWA president (centre) presenting the Visionz <strong>2016</strong> best stand award, as judged by Visionz <strong>2016</strong> MC, former TVNZ presenter,<br />
Kay Gregory, to Eyeline Optical’s Brian Black and Jodi Farrell<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>