Feb 2016

THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY
PO BOX 106 954, AUCKLAND CITY 1143
Email: info@nzoptics.co.nz Website: www.nzoptics.co.nz
FEBRUARY 2016
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2 NEW ZEALAND OPTICS Feb 2016

What’s coming…
The New Year is well underway, but what does the next 12 months hold in store.
NZ Optics took a peek through the looking glass.
BY SIMON ESKOW
Morgenrot Eyewear employing the latest 3D laser-sintered eyewear technology
Technology, new materials and styles in
eyewear, research into common— and less
common — conditions and advances in
contact lens technology and education: wherever
you look in this constantly changing world of vision
health and eye care there are new developments
on the horizon. In New Zealand, there’s a new
course in the making for dispensing opticians,
there are new material developments in contact
lenses and there’s the exciting potential of OCT
angiography.
New tech affects change
Wherever you look, technology is helping us better
understand what is going on inside the eye, while
significantly changing the examination room from
what it was just a few years ago.
“It’s definitely slowly evolving with new
technology,” says Tim Way, managing director
of well-known Kiwi distributor Ophthalmic
Instrument Company (OIC). “Optometrists are
working smarter now, spending more time with
the patient in the examination room.”
Technology is also making the examination
process faster. Trained frontline staff, especially
dispensing opticians, are more commonly using
auto-refractors or four-in-one units to prescreen
patients. Measurement data is taken far
quicker than the old days of handling individual
keratometers, tonometers and the like. That data
gives the optometrist a starting point for refraction,
so they can put a scrip directly into a trial frame and
that speeds up the actual refraction itself, says Way.
But the evolution of diagnostic instruments is
also changing the information that practices can
collect, especially Optical Coherence Topography.
“OCT is rapidly becoming a basic feature,” Way
says. Of the three kinds of OCT on the market
today—Time Domain, Spectral Domain and the
more recent and promising Scanned Spectrum—
Way says he believes Spectral Domain continues to
give optometrists the basic diagnostic information
they require at a lower price than the alternatives.
It remains to be seen how other technologies,
such as OCT angiography, which helps to visualise
blood flow in the retina and choroid capillary
network without the need for an injected dye, will
change the examination room still further.
“OCT angiography has a lot of support but it’s
not mainstream in ophthalmology yet,” Way says.
“There remains a lot to be seen on how useful it is.
There are a lot more studies that need to come out.
It is definitely an emerging technology, though.”
No matter how promising the technology,
there will be unavoidable barriers to adoption.
Femtosecond laser assisted cataract surgery, for
example, will not replace phacoemulsification any
time soon because the laser equipment requires a
separate, temperature controlled space.
“I think it’s a platform that still needs to be
refined,” Way says.
Framework
Eyewear trends, so reliant on taste, are never easy
to predict. New fabrication techniques and mixed
materials, however, are becoming more prevalent,
with 3D printing at the cutting edge.
As Mark Collman of Phoenix Eyewear explains,
there are two kinds of 3D printing relevant to the
optometry practice.
“What is being used to produce frames is 3D
laser sintering, so a fusion process using a laser
to bond particles and build a
three dimensional object which
is strong and accurate. This
allows for thin light frames,
with perfect reproduction and
consistency. The common 3D
office or home printer is using
a liquid which then forms an
object which can be intricate
but not nearly good enough
to make a robust optical
frame from. This is a gap and
the challenge going forward.
It will be some time before
3D printers are sophisticated
enough to replicate what the
laser sintering devices can
produce.”
Collman says the process
is among the more exciting
trends emerging in the market.
“I still believe 3D laser
sintered frames are the most innovative and
advanced use of technology currently in the
eyewear business. However acetate is a beautiful
material to work with and the colours available are
limitless. The new laminates and effects coming
through can be simply amazing. Also stainless
steel is being cut thinner and frames are becoming
lighter.”
Light, is probably the catchphrase of design going
into 2016.
“People want frames to look and feel light on
the face,” says Collman. “In terms of shapes, softer
profiles are edging in and there are more round
shapes coming too. I think we will see thinner rims,
more use of lightweight materials (titanium and
stainless steel on metals, thin acetate and T90 on
plastics). Retro is still evident with the younger
brands but seemingly less important than last year.”
Wood frames, meanwhile, may not last as a trend
as the material tends to deteriorate over time.
New Zealand at one time may have lagged
behind larger overseas markets, but that has also
changed, Collman says.
“Nowadays (the lag time is) very short. In fact,
with some collections I brought samples back from
Silmo with me, we previewed to accounts and
delivered this week — meaning a total lag of only
nine weeks.”
Dry eye
Researchers are
predicted to continue
to make strides in
treating the spectrum
of dry eye causes
and symptoms.
New treatments
and approaches are
developing over time,
but there will never
be a one-size-fits all
approach.
“Dry eye is
multifactorial. With
Jennifer Craig
so many causes I
don’t think we’re ever
going to get a single therapy that’s going to resolve
the signs and symptoms for all patients,” says
Associate Professor Jennifer Craig. “Use of novel
technology such as intense pulsed light (IPL) has
certainly gathered momentum over the last year
with many more practices offering this modality as
a solution to meibomian gland dysfunction (MGD).
However, we would benefit from an improved
understanding of the mechanisms to better predict
the effect it might have on an individual patient.”
Research will continue to be the key to figuring
out which approaches work best, says Craig.
“Identifying a single best therapy is difficult in
the absence of scientific evidence comparing the
different therapies side-by-side. Heat application
remains the most commonly recommended
therapy and, if applied consistently over an
extended period of weeks to months, remains a
viable option in terms of symptom resolution for
many patients. However, treatments such as IPL
and thermal pulsation (Lipiflow) that are reported
in the literature to have beneficial effects beyond
the application period certainly have appeal in
overcoming compliance issues.”
Craig heads the Ocular Surface Laboratory
(OSL) at the University of Auckland. Its team of
CONTINUED ON P4
An exciting year ahead
Welcome back. We hope you had a great
break and are still enjoying the sun,
sea and school holidays. Well, maybe
not the lattermost so much. But then again
there’s nothing better than jumping off your
local wharf with your family, while a dozen or
more teenagers look on somewhat incredulously
as you abandon all traces of age (and decorum)
and plummet into the sea from a great height.
A new year is not just refreshing, it brings with
it a delightful optimism. It also brings a host of
exciting new developments in whatever world
you’re in and this couldn’t be truer than in the
ever-changing world of eye care. NZ Optics’
editor Simon Eskow touches on some of these
in his feature What’s coming… which starts on
this page, while our columnist Alan Saks takes
a closer look at what’s in store in the world of
contact lenses in 2016 in his In Contact
column (p14).
As well as material developments and
technology advancements, New Zealand’s eye
care education scene is going to be given a
boost this year with a new Ocular Therapeutics
Conference, designed by the clever people at
the University of Auckland’s Buchanan Ocular
Therapeutics Unit, and, hopefully, a more heavy
weight dispensing optician’s qualification put
together by our very own Waikato Institute of
Technology and ADONZ.
In fact DOs, optometrists and ophthalmologists
are spoilt for choice by the number of events
available to them this year, both at home and
abroad, including the latest from our own
wholesalers at the biennial Visionz conference in
Auckland in October. And we’ll be doing our best
to cover it all, featuring those who do attend, for
all those others who perhaps can’t make it
this year.
Here at NZ Optics we are always on the lookout
for what’s new and we warmly welcome your
comments, views and news about anything in
EDITORIAL BY LESLEY SPRINGALL
Wharf jumping. Photo - MarlboroughNZ
the optical world. Perhaps you’d even like to
pen your own piece about your experiences,
as rehabilitation optometrist Naomi Meltzer
kindly did for this issue on her adventures at the
Hadassah Hospital in Jerusalem.
Whatever it is about, Simon and I would love to
hear from you as we enter this new year with a
little more knowledge and a lot more calm than
we had when we took up the reins of NZ Optics
last year.
Happy New Year.
Lesley Springall, publisher, NZ Optics
Feb 2016
NEW ZEALAND OPTICS
3

News
in brief
DIABETES VISION RISK
Less than half of US adults with diabetes recognise their risk for vision
loss. The survey, conducted by Everyday Health’s Market Research
Group on behalf of Regeneron Pharmaceuticals, showed 18% of
respondents said they were familiar with diabetic macular edema;
but 30% reported they don’t get an annual comprehensive dilated
eye exam. Of respondents who don’t get an eye exam, 56% were
unaware the exam could help protect against vision loss associated
with diabetes.
Abbott and Toomac pair up in NZ
Vision care products company Abbott
Medical Optics and Kiwi ophthalmic
instrument supplier Toomac
Ophthalmic have formed a partnership to
boost each other’s marketing efforts and
provide a more complete service in
New Zealand.
The newly formed partnership had its
first (somewhat subtle) outing at the 2015
RANZCO Scientific Congress in Wellington
towards the end of last year, when the two
companies shared two halves of a large stand
with a combined seating bar at the front.
“We’ve got the lenses and they’ve got
the devices. So if a customer wants to deal
with just one supplier to source a complete
package, we can now offer that,” says
Matthew Northage, Abbott’s NZ account
manager.
“Matthew can only see so many customers
as working in ophthalmology sales is
quite time intense, so for us to enter into
an agreement with a well-known and
long-established supplier of ophthalmic
equipment and devices in New Zealand
really broadens our reach,” says Christian
Oster, Abbott’s Australia and New Zealand
product manager.
Toomac director Ian MacFarlane admits
he’s quite excited about the opportunity.
“We’ve been working on this for some
time as we see synergies between both
companies.”
Where Abbott has the phacoemulsification
system, Toomac has the microscopes, and
where Abbott has the IOLs, Toomac has
the Lenstar, providing highly accurate
optical biometry data of the entire eye,
says MacFarlane. “I think both companies
can work in harmony and provide a better
overall solution to customers.”
The partnership kicked off officially at the
beginning of this year and will be monitored
to ensure it’s beneficial to both companies
and customers alike, says MacFarlane. ▀
GENETIC CLUES TO GLAUCOMA
US Researchers have identified three genes that may influence
susceptibility to primary open angle glaucoma. In a paper published
in Nature Genetics, the researchers identified the TXNRD2, ATXN2
and FOXC1 genes. The study found the mitochondrial dysfunction of
TXNRD2, the protein that naturally regulates the production of a reactive
oxygen species in cells, can lead to glaucoma. Also, genetic variants
located in regions that regulate ATXN2 expression can be associated
with primary open angle glaucoma, while expression changes of FOXC1
may not lead to early onset glaucoma, but may contribute to milder,
later-onset disease. The researchers are hoping to use their findings to
develop gene-based testing and treatment strategies for glaucoma.
ORAL GLAUCOMA TREATMENT IN PHASE II
OphthaliX, a subsidiary of Israel-based Can-Fite BioPharma, has
completed patient enrollment for its Phase II trial of CF101, a novel,
small-molecule orally-bioavailable drug for treating glaucoma. The
Phase II tests are being run in Europe and Israel, with results expected
by mid-2016. CF101 is an A3 adenosine receptor (A3AR) agonist, which
binds to A3AR, known to over-express in inflammatory cells. The drug
acts as a neuro-protective agent and prevents apoptosis of retinal
ganglion cells. The drug’s mechanism of action has been validated in a
University College London study, which showed the A3AR agonist has
a neuroprotective effect in the eye via inhibition of retinal ganglion cell
apoptosis resulting in a significant decrease in intraocular pressure.
GOOD AND BAD FOR ANTI-VEGF
Increasing evidence supports the use of anti-VEGF agents in the
treatment of retinopathies, according to Dr Mary Elizabeth Hartnett
of the University of Utah, speaking at the Advanced Retinal Therapy
meeting in Vienna in December. Multiple case series and small
trials found efficacy in anti-VEGF agents reducing intravitreal
neovascularization and facilitating physiologic retinal vascular
development in some cases, she said, but, safety concerns remain over
their use in infants, requiring further investigation. “Serum VEGF is
reduced for 2 months after injections, a time that may be crucial for
the development of kidneys, brain and lungs. VEGF is also a survival
factor for photoreceptors and Müller cells. On the bright side, there is
less myopia after anti-VEGF than laser, but we need more studies.”
ORAL TREATMENT OF INFLAMMATORY DISEASE
Roche and Upsher-Smith Laboratories, through its wholly-owned
UK subsidiary Proximagen, announced a worldwide agreement for
the further development of a novel, oral small molecule inhibitor of
Vascular Adhesion Protein 1 (VAP-1), a cell-adhesion molecule that
may be effective in the treatment of inflammatory disease. The VAP-1
inhibitor is currently in Phase II clinical development. Roche now has
exclusive license to develop and commercialise the compound, and will
conduct additional Phase II studies with Proximagen to further define
the therapeutic potential of the VAP-1 inhibitor.
VALEANT SELLING OFF CONTACT LENSES?
Valeant Pharmaceuticals may seek buyers for its specialty contact
lens manufacturing division, Paragon Vision Sciences, amid scrutiny
from the US Federal Trade Commission. The sale of Paragon, which
Valeant’s Bausch & Lomb unit purchased in 2015, would deal a
blow to the company’s attempt to consolidate the market for
gas permeable contact lenses. The FTC has been investigating
Valeant for potentially cornering this portion of the lens market
and is concerned Valeant has allegedly been using this market
power to raise prices for the raw materials used in contact lens
manufacturing, in some cases by more than 100%. If Paragon were
an independent company, it would control about half the market for
ortho-K lenses.
NEW DEVICE FOR DIAGNOSING EYE INJURIES
University of Illinois bioengineering professor Dipanjan Pan and US
ophthalmologist Dr Leanne Labriola have teamed up to develop an
inexpensive portable vitamin C sensor, called OcuCheck, to quickly
determine if an eye injury is mild or severe. “The sensor takes
advantage of the fact that the ocular tear film contains low levels
of ascorbic acid, which is just vitamin C, while the interior of the eye
contains much higher levels,” said Pan. “So if there is severe damage to
the eye, the ascorbic acid will leak out in high concentration.” Pan and
Labriola have founded a new company, InnSight Technology, to bring
the device to market.
B+L BUYS ALDEN OPTICAL
Bausch + Lomb has expanded its specialty lens business with the
addition of Alden Optical Laboratories, a manufacturer of premium
specialty and custom soft and gas permeable contact lenses.
The expanded business, known as Bausch + Lomb Specialty Vision
Products will be dedicated to delivering innovative products,
education, and training for ECPs in the specialty and custom contact
lens space, said B+L in a statement in January. ▀
CONTINUED FROM P3
researchers is currently working
on a number of clinical and labbased
projects, ranging from dry
eye clinical trials to pre-clinical
evaluations of a novel therapy
to treat microbial keratitis. Craig
describes three of the projects:
••
“Our interest in developing a
Manuka Honey-based topical
formulation to promote
eyelid health continues.
After satisfying safety and
tolerability requirements
through preclinical and
clinical studies, we are now
evaluating the efficacy of the
product in reducing signs
and symptoms of dry eye
associated with lid margin
conditions such as MGD
and anterior blepharitis in a
larger-scale clinical trial.
••
“We are also continuing
our research into treatment
of MGD with IPL. As
already noted, IPL has
proven benefits, but the
mechanism(s) of action
remain poorly understood.
We are working to resolve
this, by evaluating a range of
tear film and ocular surface
parameters before and after
treatment, in a prospective,
double-masked, placebo
controlled, clinical trial.
••
“Further research on
Demodex, and the impact of
demodecosis on the ocular
surface, is also ongoing,
with a view to improving
diagnosis and management
for affected patients.
“These investigations and trials
have either begun or are due to
commence shortly,” Craig says.
REINVENTING BUSINESS.
23> 26 SEPT. 2016
PARIS NORD VILLEPINTE
“We welcome referral of patients
with relevant clinical signs who
are interested in participating in
any of our trials.”
Prospective participants who
meet the inclusion criteria
will be reviewed at the OSL
to determine eligibility to
participate. Participants are
entitled to receive treatment at
no charge, and petrol vouchers
to offset travel costs may be
offered in some trials.
Read more about dry eye
developments in our special
feature planned for NZ Optics
October issue.
Contact lenses
Jagrut Lallu expecting some big
advances in CL materials
At one point it may have
seemed that daily disposable
contact lenses were the
crowning achievement in
contact lens development. But
that’s not true, especially in the
development of new materials,
applications and technologies,
say some specialists.
“All contact lens companies are
working on projects at present
GRAND OPENING – 23 SEPT. 2016
Conception : CARLIN
SILMOPARIS.COM
which are developing the
contact lens material market,”
says Jagrut Lallu of Visque Rose
Optometrists in Hamilton. “The
next couple of years we will see
a whole range of new products
come to the fore.
“We will be seeing more
in the way of material and
optics advances with new
combinations of materials
in daily modality becoming
available, as well as wider ranges
of prescriptions making contact
lenses more available to more of
the population. There is always
something new on the horizon.”
Lallu says among the
more exciting emerging
developments in contact lenses
are multifocal optics and
aberration control.
“There is a growing trend for
centre-near designs moderated
by pupil size hitting both the
rigid and soft lens markets,”
he says. “Scleral contact
lenses seem to be making a
reappearance with multifocal
fitting and it will be interesting
to see how these affect New
Zealand practitioners. The
newest designs appear to be
useful for all optometrists,
not just specialist contact lens
fitters.”
Developments in contact
lens fabrication will give more
patients the option to use
contact lenses.
“More and more cases are now
coming to light which were not
traditional contact lens wearers
in the past,” Lallu says. “This is
due to the new geometries that
lathes can cut as well as the
optics that we can achieve on
high-Dk materials.”
Meanwhile, patients
wearing contact lenses for
myopia control have a new
friend in atropine.
“The growing amount of
evidence-based medicine
around myopia management
is certainly exciting,” says
Lallu. “Most treatments for
this condition have centred
around the contact lens
modality, however in our clinic
we are noticing promising
results with the use of low
dose atropine.” See more on
expected developments in
contact lenses in Alan Saks’ In
Contact column on p14.
Education
The New Zealand dispensing
opticians’ association ADONZ
continues its work with the
Waikato Institute of Technology
(WinTec) to develop a diploma
level dispensing optician
qualification based in New
Zealand and more closely
aligned with the British-based
qualification.
“We are still very much on
track with our plans,” says
ADONZ President Peggy
Savage. “We, on WinTec’s
behalf, have sent out a survey
to all members and this
feedback is vital for moving
forward. We met WinTec the
first week of December and the
timeframe is on track.”
If all continues as planned,
the new curriculum will be
offered as a distance learning
course beginning the first
semester of 2016, which starts
in July.
ADONZ is also looking forward
to hosting the International
Opticians Association’s (IOA’s)
32nd Biennial Convention in
Auckland, to run in conjunction
with ADONZ’s annual
conference.
“As Vanessa Cumming is
the (current) IOA President,
we are working with her to
showcase how we run our
annual conference and the
level of education it provides to
our DO’s, and also show off our
country,” Savage says.
But, she adds, ADONZ’s
main focus for 2016 will be its
education provider, the quality
of education and the possibility
of NZQA recognition.
“This is a crucial time looking
ahead as we further explore all
possibilities, suitable providers
and costs, which we began
in 2011 under Andrew Judd’s
presidency.”
Other educational highlights
for 2016 include Visionz 2016
in Auckland in October and a
brand new conference on Ocular
Therapeutics in April (see story
this issue) as well as a host
of opportunities from the
country’s ophthalmological
practices. Check out the
calendar of events on NZ Optics
website http://www.nzoptics.
co.nz/calendar to see more on
what’s coming up this year. ▀
www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand
For general enquiries, please email info@nzoptics.co.nz
For editorial and classifieds, please contact Simon Eskow, editor, at 027 288 5401 or
editor@nzoptics.co.nz.
For advertising, marketing, the OIG and everything else, please contact Lesley
Springall, publisher, at 027 445 3543 or lesley@nzoptics.co.nz.
To submit artwork, or to query a graphic, please email kirsten.newton@outlook.co.nz
and copy in Lesley.
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 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 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 those of NZ Optics (2015) Ltd.
4 NEW ZEALAND OPTICS Feb 2016

CALLING ALL
UK OPTOMS!
…WANT TO STAY IN
NEW ZEALAND OR AUSTRALIA?
Go to
spectrum-blog.com
for all the current
opportunities!
With a significant shortage of optometrists being
experienced across the optometry profession
in metro, regional and rural areas, we’re calling
all UK and Irish optometrists currently in
New Zealand and Australia to talk to us. We have a
wide range of opportunities for you to consider.
Across the two countries this year we will open
15 new stores and expand a further 65 stores
with additional consulting rooms and the latest
automated equipment – and we need to beef up
our professional team to meet demand, as it rises.
About you
You’re an OCANZ qualified optometrist and already
working (or due to work) for the length of your
current working visa – but you would like to stay
on for longer, or even permanently.
We can help
If that sounds like you, we should talk.
Lately, more and more OCANZ qualified UK
and Irish optometrists are asking us about
staying in either New Zealand or Australia
for the longer term and we have the
roles available to make that goal a reality
in both countries.
Let’s get the conversation started
Whatever your goal, both short and longer
term, now’s the time to talk to our professional
recruitment team members about the options for
employed and partnership roles – they’re ready to
talk to you right now.
In the first instance contact Raj Sundarjee on
0800 773 077 or raj.sundarjee@specsavers.com
NZ Franchise
System of
the Year
2014
Retail
Innovator
of the Year
2014
Multichannel
Retailer
of the Year
2014
Roy Morgan
Research
No. 1 for eye tests
2014
FCA International
Franchisor
of the Year
2014
FCA Social
Responsibility
Award
2014
FCA Established
Franchisor
of the Year
2013
FCA Excellence
in Marketing
Award Winner
2013
Australian
Retailer
of the Year
2013
Australian
Retail Employer
of the Year
2013
Asia-Pacific Best
Retail Training
Organisation
2013
Feb 2016
NEW ZEALAND OPTICS
5

Focus
on Business
NEW HEALTH AND SAFETY
LEGISLATION
BY DAVID PEARSON*
If robust Health and Safety isn’t on your list of New Year’s
resolutions—it should be.
Employers generally know if they have an effective Health
and Safety culture or whether it is more of a tick the box, do
the bare minimum and ‘she’ll be right’ mentality. Once you’ve
introduced a Health and Safety policy and set up processes for
hazard monitoring and accident reporting, it’s easy to become
complacent and assume everyone will get on with it.
We travel overseas to places where it seems nobody has heard
of Occupational Safety and Health (OSH) and see some high risk
stuff we are very confident would never happen here. But the Pike
River Mine tragedy happened here and up to mid-November 2015,
35 people died in workplace accidents in New Zealand (provisional
figures). The average for the last six years is 52 fatalities per year.
Although these figures have steadily decreased since the high of 77
fatalities in 2010, we still have a lot of progress to make in this area.
Although the optometry sector does not instantly come to mind
as one fraught with life threatening hazards, it is important that
we do not allow this to make us complacent. OSH is an area of
management that requires constant vigilance, commitment and
transparent leadership from the top. Managers and employees
focus much of their energy on performance-based measurements.
There needs to be continuous and genuine messages from business
owners and across the sector as a whole, that OSH matters as
much as other aspects of performance. We will measure it, report
on it, reward good practice and take action for poor performance.
This is exactly the emphasis of the Health and Safety at Work
Act 2015, which is due to come into effect on April 4 2016 this
year. Directors of optometry practices will need to step up and
be proactive in Health and Safety as new rigorous accountability
measures are enacted.
The Act focusses on the obligations of a “person conducting a
business or undertaking” (PCBU), as well as the responsibilities of
Officers and Directors. There is a primary duty on a PCBU to ensure,
as far as reasonably practicable, the safety of workers and others
associated with the work carried out by the PCBU. In many ways
this is not so different from the current responsibility on employers.
What’s new is the positive due diligence duty imposed on
officers of PCBUs. This means that those in governance roles must
proactively manage Health and Safety and this duty is individual
to Officers, not just the entity as a whole. The intent is that the
duty lies with the people in the best position to control Health
and Safety and these obligations cannot be contracted away.
Directors and Officers will need to:
••
Keep their knowledge of health and safety matters up to date
••
Understand the nature of operations of the PCBU and
associated risks and hazards
••
Ensure the PCBU has and uses appropriate resources to
eliminate or minimise risks to work-related health and safety
••
Verify the provision and use of resources
••
Ensure the PCBU has appropriate processes for receiving and
considering information regarding incidents, hazards and
risks; and for responding in a timely way
••
Ensure the PCBU has and implements processes for complying
with its obligations under the Act
The Act introduces significantly increased penalties for
individual PCBU Officers, body corporates and workers. There is
also renewed emphasis on worker participation with a duty to
involve and engage workers on Health and Safety. This includes
the implementation of participation practices appropriate to the
size and level of risk in the workplace.
Now is the time to start thinking about Health and Safety in
your practice and how it will stack up under the new legislation.
Some things you can implement now:
••
Familiarise yourself with the key concepts of the new legislation
••
Review your health and safety practices, both for your staff
and visitors
••
Identify health and safety risks in your business and take steps
to prevent them from causing harm
••
Lead by example
••
Make health and safety a part of your workplace culture
••
Document all of the above!
You can get detailed information about the Act from the Worksafe
New Zealand website (www.business.govt.nz/worksafe/). If you
are managing OSH well, there should be no need to be greatly
concerned by the new legislation. If you know there are weaknesses
in your current management of Health and Safety, act now—don’t
wait until the new law is in place. ▀
* David Pearson is Managing Partner with BDO Napier and has a
speciality interest in Advisory Services to the optometry sector.
For more information contact David at david.pearson@bdo.
co.nz or visit www.BDO.co.nz
Kimberly McKay, Human Resource Consultant
at BDO, also contributed to this article.
For more information contact Kimberly at
kimberly.mckay@bdo.co.nz.
New conference: the
practical side of therapeutics
BOTU Director Dr Ilva Rupenthal
Ever wondered what all those other
ingredients in an eye formulation
are doing there? Or perhaps why
you have to shake some medications
before giving them? Or why you treat
some conditions with drops and others
with ointments or gels?
The practical side of ocular therapeutics
is being tackled in a new conference, aptly
named the Ocular Therapeutics Conference,
on April 10 at the Waipuna Hotel and
Conference Centre in Auckland.
Organised by the Buchanan Ocular
Therapeutics Unit (BOTU), Department
BOTU turns two
The Buchanan Ocular Therapeutics
Unit (BOTU) at the University of
Auckland was a long time in the
planning before Dr Ilva Rupenthal came
along.
“Charles McGhee and Trevor Gray
had been talking for years about
doing something in the area of Ocular
Therapeutics,” says Rupenthal, who has
led BOTU since its launch in 2013.
Then Rupenthal met Gray at the CCLS
Conference in 2012, where she gave a
presentation on pharmaceuticals and
ophthalmology and finally the unit
began to take shape.
BOTU was established to develop and
translate ocular therapeutic-related
scientific research into the clinical
setting whether pharmaceutical-, cell- or
technology-based. Rupenthal currently
leads a team of six PhD students and one
post-doctoral candidate in the University’s
Department of Ophthalmology.
BOTU’s researchers have already
published 16 papers and produced more
than 30 conference abstracts with seven
invited-presentations nationally and
internationally.
“It’s been an absolutely amazing time,”
says Rupenthal. “I’ve had great support
establishing the unit and I have a great
team doing all this amazing work.”
BOTU started off with a $2.4 million
grant from the Buchanan Charitable
Foundation founded by Drs Trevor and
Caroline Gray. BOTU subsequently
received additional support from the
Health Research Council, the Paykel Trust
and the Save Sight Society.
The unit’s current projects are all at
the beginning stages, Rupenthal says,
of Ophthalmology, at the University
of Auckland, the conference is
aimed at optometrists, (especially
those trained or with an interest in
therapeutics) ophthalmologists, trainee
ophthalmologists, ophthalmic nurses
and pharmacists.
BOTU Director Dr Ilva Rupenthal says
this conference is an opportunity for
eye care professionals and budding eye
care professionals to learn how and why
therapeutics are applied in the clinic. “A
lot of this is not well-known or taught, but
it’s something that’s really important to
understand.”
Established two years ago (see
accompanying story) BOTU has two remits:
to undertake new research into ocular
therapeutics and to educate professionals
about therapeutics and their use. Rupenthal
says a conference has been mooted since
the unit’s establishment, but what form
that would take has been a little while
in the planning. “The establishment
of the unit took quite a bit of time and
research was given the priority—getting
PhD students in and getting the research
and mainly focus on the development
of stimuli-responsive implants for drug
delivery to the back of the eye. Other
projects involve creating an ex vivo
penetration model for Novaliq, a German
company developing artificial eye drops
based on semifluorinated alkanes, and
developing a Manuka honey-based
ointment for the management of
blepharitis in conjunction with University
of Auckland’s Associate Professor Jennifer
Craig. Finally, in collaboration with
Professor Colin Green, the unit is also
looking into an alternative to anti-VEGF
agents for repairing leaky blood vessels
in the treatment of AMD and diabetic
retinopathy.
“There is so much going on in this field
at the moment,” Rupenthal says. “I love
that I’m doing a job where I might help
people, even if it’s 20 years down the line.”
See associated story on BOTU’s
inaugural Ocular Therapeutics
Conference above. ▀
Pacific Eyewear liquidation
Frames wholesaler Pacific Eyewear has
gone into liquidation.
The Albany-based company,
bought in 2007 by David Betham,
ceased trading on December 1, when
Betham appointed Auckland chartered
accountants Rodgers Reidy as liquidator.
According to the first liquidator’s report,
published on the Companies Office
website, Betham advised, “that the reason
for insolvency was due to difficult trading
conditions, in particular cash flow issues
and a lack of working capital.”
The report went on to say that the
liquidators will attempt to sell the assets
of the company and “a large number of
optical frames have been uplifted and are
BOTU team members include (rear, L to R)
Frazer Coutinho, Ilva Rupenthal, Rohit Bisht
(front, L to R) Priyanka Agarwal, Erica Chen,
Odunayo Rotimi and Naveed Yasin
currently being valued by the liquidators
auctioneers.”
Pacific Eyewear’s brands included Vanni,
Dutz, l.a.Eye Works, Dior, Yves St. Laurent
and others. NZ Optics has learned that at
least one of the brands, Vanni, has been
taken up by another wholesaler, Little
Peach, while Dior was picked up by VMD
earlier last year to sit alongside its other
Safilo Group licensed brands.
l.a.Eye Works, Rodenstock and other
brands were listed among the 20 or so
creditors.
Betham said l.a.Eye Works has decided
to sell directly to clients in New Zealand,
while he will continue as an agent for
Bellinger House. ▀
started—and now we’re focusing on the
teaching side of things.”
Other speakers at the conference include
Professor Charles McGhee, Associate
Professor Jennifer Craig and a number of
ophthalmologists, including Dr Trevor Gray,
whose Buchanan Charitable Foundation
made the establishment of the unit possible
in the first place.
As well as providing some context about
the history of ocular therapeutics, the key
ingredients and why they are there and the
key differences between different forms of
therapeutics, the programme also includes
sessions on how drugs are approved, or not,
in New Zealand; an overview of glaucoma
drugs and corticosteroids and their
alternatives; and a look at what’s exciting
and new coming down the pipeline.
The conference will be run as a notfor-profit
event—free to students and
academics, while others will be charged a
low fee to cover the costs of hosting the
conference.
For more information keep an eye on your
in-box as details will be emailed to
NZ Optics subscribers shortly. ▀
Surf’s up
at Grylls
Keleher
The surf’s up at Grylls Keleher & Matthews
Optometrists in Kapiti with their Hawaiianthemed
summer window display winning
Maui Jim’s summer window competition.
The team at Grylls Keleher net themselves a
neat $2,500 prize package of super cool Maui Jim
sunglasses for their efforts, which included not just
the wonderful window display, but also a clever
Facebook promotion. Each Matthews’ practice is
giving away a $500 value Maui Jim prize pack—
which includes a pair of Maui Jim sunglasses, a
Maui Jim cap, a Maui Jim t-shirt, a cricket set and a
complimentary eye exam—to one lucky customer. ▀
What to do
about Alcon
Pharmaceutical giant Novartis has been
struggling to figure out what to do with
its troubled Alcon subsidiary.
Alcon’s sales have been on the decline since
2014, slipping 12% quarter-on-quarter to
US$2.35 billion in the third-quarter last year.
The company’s woes have been attributed to,
among other things, slumping revenue from
intraocular lens (IOL) implants and a slumping
over-the-counter contact lens solutions
business. Additionally, patent protection for
Alcon’s Travatan Z glaucoma treatment ended
in December, opening the door to further
diminished revenues from generic brand
competition.
Novartis announced it would unveil an
“innovation-heavy, growth acceleration
programme” for Alcon as part of its 2015
financial results meeting on January 27,
countering earlier reports it was selling the
division.
Financial speculators say the sale of Alcon
could make Novartis between US$1 billion and
US$1.6 billion. ▀
6 NEW ZEALAND OPTICS Feb 2016

St. George’s Eye Care opens doors
St. George’s Hospital in Christchurch opened
the doors to its purpose-built eye care
facility in November.
The hospital says the facility was established
to extend ophthalmology services to more
patients at a lower price than elsewhere in the
private sector.
“St. George’s has a long standing commitment
to develop and extend its service offer to meet
the needs of those in the community who
require surgical or specialist healthcare,” says
hospital Chief Executive Greg Brooks. “The
decision to establish a specialist eye care service
within the St George’s offering is a reflection of
a commitment to provide world-class eye care to
those who need it, together with the surety of
patients’ ongoing care that comes with working
alongside primary eye care professionals.”
St. George’s had been planning the eye care
facility for more than a year before its opening.
The hospital conducted an international
search for staff, including two in-house
ophthalmologists, and has hired Dr Ralph Lim
as St. George’s Eye Care clinical director and Dr
Wilfried Rademaker.
“St. George’s is the first private hospital in
New Zealand to recruit specialist in-house
ophthalmologists,” says Brooks. “This model
delivers a number of efficiencies that makes the
surgical services significantly more affordable
for patients. For example, St George’s provides
cataract surgery at 30% below what was being
charged in the private healthcare sector prior to
opening its doors.”
Lim has ten years’ experience in medical and
surgical care of the eye, including a residency
at the Doheny Eye Institute in California and,
serving under some of the most challenging
conditions during his career as a flight surgeon
with the US Air Force in Iraq.
Lim started his medical training in Kansas
City, followed by an internship in Columbus,
before he secured a residence in ophthalmology
at Doheny Eye Institute, which was recently
named as one of the five leading ophthalmology
institutes among 5,000 hospitals in the
United States.
Rademaker graduated from medical school in
Germany. He went on to receive his specialist
training in the US, including at the Johns
Hopkins Wilmer Eye
Institute in Baltimore,
Maryland, one of the
highest-rated medical
facilities in the US.
Rademaker moved to
New Zealand in 2009 and
worked in Wellington
and in a number of DHBs
in a locum capacity after a
long tenure as the chief of
outpatient services at the
King Khaled Eye Specialist
Hospital in Riyadh,
Saudi Arabia.
Rademaker brings special
interest in managing
conditions affecting the cornea, external eye
disease and glaucoma to St. George’s Eye Care.
The 450-square-metre facility has six consulting
rooms with state-of-the-art specialist equipment.
“All waiting areas are well-appointed with
appropriate lighting and privacy,” says Brooks.
“The flow between consultation rooms, waiting
rooms and treatment rooms has been thought
Dr Wilfried Rademaker
Dr Ralph Lim
through to ensure minimal inconvenience and
increased efficiencies for patients.”
St. George’s is a registered charity and may
provide philanthropic support to patients
who otherwise may not be able to access the
specialist care they require. Applications for
Treatment Support Grants can be made through
the patient’s referring optometrist or GP. ▀
Behavioural
optometry
practice launches
A
former partner at Orewa Optics, north of Auckland, has gone
into solo practice as a pure behavioural optometrist.
Grant Dabb launched his new practice at the end of
November, joining The Connection in Silverdale, a multidisciplinary
centre with chiropractors, speech and language therapy, naturopathy,
massage and nutrition.
“I’ve been practising with a behavioural approach for 20 years and it’s
always been a dream of mine to open a practice like this,” says Dabb.
Grant Dabb Behavioural Optometrist was founded to provide a place
for primary optometry care providers and other professionals to refer
patients with visual conditions they are not comfortable dealing with
themselves, he says. “Behavioural optometry deals particularly well with
binocular vision problems, accommodation, convergence, and tracking.”
It also tackles the visual processing aspects of learning disorders and
brain injuries, which often includes augmenting the correct prescription
with vision therapy to develop and enhance visual function.
Dabb’s practice focuses on children with learning disabilities and
adults who have suffered vision problems due to stroke or brain
injury. His referrals come from general optometry practices, word of
mouth within the community and, significantly, schools.
“As an example most children with learning difficulties, genetic
or developmental delays will have visual problems as part of those
issues,” he says. “More of the brain is involved in processing vision
than any other sense, both in terms of cell numbers and brain
activity. Plus, vision is intimately linked with motor processes like
picking up a cup, parking the car, making a sandwich or putting your
clothes on. It’s an intrinsic and intimate part of the whole and the
primary director of action and behaviour.”
Dabb received behavioural optometry training through the University
of New South Wales. He later continued his studies to become a
Fellow of the Australasian College of Behavioural Optometry, which
coordinates training for optometrists in New Zealand.
He says his interest in behavioural optometry grew from
a fascination with the visual process and a realisation that
improvements to vision could not be explained strictly by the
mechanics of lenses and prisms.
“About 20 or more years ago, I realised that prescribing low plus
lenses had far greater effects than could be explained by simple
optics. It became clear that the lenses were working to change the
way the visual system functions, not just bending light. That led me
to expand the knowledge base that I had to discover how the visual
system could be influenced and guided to a much greater depth than
I had previously realised.”
What interested Dabb specifically was treating visual problems as
a neurological process that can be influenced due to neuroplasticity.
Therapy can help improve the ability of patients to unconsciously
process information that injury or learning difficulties have made
difficult, he says.
“There’s this constant interplay between peripheral and central
vision. All of that information is constantly presented as light
entering the pupil. But lenses, prisms and tints can shift attention
(between the two), thereby changing responses and outcomes. We
want the lower level functions of vision to be effortless, automatic
and unconscious, leaving more resources available for the higher
functions. If we think of vision as a process we can think of lenses
and prisms as supporting the system, and therapy to enhance the
system.”
Optometrists interested in vision therapy can attend a twoday
seminar in Auckland run by ACBO on March 12-13. For more
information visit: https://www.acbo.org.au/professionals/menu/
events/events/50-practical-vision-therapy-nz-workshop-1-2016 ▀
Time for renewal
Sometimes you just have to clear the
slate. For Geoff and Lynne Parker that
time came in March last year when they
re-branded the practice that is now known as
Parker & Co in Newmarket, Auckland.
“Geoff and I had been the co-owners of
Occhiali Optical Ponsonby and Occhiali
Optical Newmarket. We sold the Ponsonby
store and the Occhiali brand in December
2014 and then rebranded the Newmarket
store in mid-March as Parker & Co Eyewear,”
says Lynne. “The main reason for the redesign
was the existing interior was nine
years old and needed a freshen up. There also
was a small dispensing area, and we wanted
to expand that area to be more clientfriendly
and efficient for the staff to use.”
When Lynne and her optometrist husband
Geoff went to rebrand the practice it had
a dark earthy feel, but they wanted a
contemporary modern look to match the
kind of practice they were aiming to build.
“We market to a wide client base of 20 to
60 years in age, who want good eye care and
contemporary, modern eyewear,” says Lynne.
Lynne and Geoff got the inspiration for
their new look from a single picture in a
home magazine featuring a white table with
light and plants hung above it.
“That was the start of the look,” she says.
“The previous shop fit style had been dark
wood with magenta carpet and we wanted a
more modern look that created an enjoyable
environment for clients to choose glasses in.”
Although the couple hired the architecture
firm RCG to fit out Occhiali, Lynne and Geoff
planned and managed the project this time
around.
Rear-illuminated display cases, white
surfaces and sandstone-coloured concrete
flooring lend a bright airiness to Parker &
Co’s central retail space. Potted plants drape
gracefully from beneath the high ceilings,
creating a soft, organic bracketing effect
around the grids of eyewear on display.
Parker & Co carry Barton Perreira, Celine,
EyE DOctORS GRAND ROUNDS
2016
Dr Andrew Riley
FRANZCO
EYE 0765
Dr Penny McAllum
FRANZCO
Kilsgaard, Anne et Valentin, Kate Sylvester
and other brands.
“We try to align ourselves with suppliers
who are like-minded and value quality, style
and service. We aim to establish a long-term
relationship with our suppliers and only carry
between ten and 14 brands. This allows us
to have more depth in the collections and
really showcase the brand. We carry a variety
of price points and styles within this brief.
When we are taking on a new collection
it has to offer something different to the
brands we are currently stocking.”
The practice includes one examination
room and space for a second if the couple
needs to expand.
“Geoff loves the ability to spend more time
as an independent optometrist meeting
new and existing patients and being able to
engage with them at a personal level,” Lynne
says. “This allows him better empathy of their
situations and in turn understanding of the
best way to manage their care. Ultimately
Geoff thrives on these inter-personal relations
and his ability to help people.”
Lynne works as the in-practice stylist and is
responsible for finding the brands that match
Parker & Co’s vision, a task that takes her to
trade shows overseas.
Dr Mark Donaldson
FRANZCO
Dr Shuan Dai
FRANZCO
“I love the contrast between the fashion
aspect of eyewear and the technical aspects
of lenses and dispensing. I enjoy the
variety that is involved in owning your own
business. The areas I particularly enjoy are
frame buying and the concept and projectmanaging
when we shop fit. On a daily basis,
it’s having clients who love buying their
eyewear from Parker & Co which means we
have achieved our goal of providing quality
eyewear and eye care.”
Parker & Co embraces doing business
as an independent optometry practice
with a sense of liberation, says Lynne. “We
think as independents we have a unique
opportunity to create a niche in the eyewear
market. Because we are independent we
can make changes within our businesses
easily, train staff to a higher level than the
chain stores do and therefore offer a higher
level of service because of the quality of our
optometrists, dispensing staff and products.
We have niched our store which is in one of
New Zealand’s premium fashion shopping
areas by offering eyewear that is different
to what is stocked by our competitors and
ensuring we have staff who are passionate
about eyewear and lenses and make
informed recommendations to our clients.” ▀
GRAND ROUNDS - 2016
We look forward to seeing you.
23rd March - Novotel, Ellerslie
8th June - Ormiston Hospital
14th September - Novotel, Ellerslie
No registration fee . cPD points available
Visit our website for more details.
Ascot Clinic (09) 520 9689 - Botany Junction (09) 277 6787
www.eyedoctors.co.nz
Feb 2016
NEW ZEALAND OPTICS
7

CASE STUDY: CORRECTING ASTIGMATISM
WITH ORTHO-K
Many orthokeratology lens designs
suggest that in determining a patient’s
suitability for orthokeratology the
astigmatic component of their prescription
should be no more than half of the spherical
component. With the availability of the modern
topography-based toric ortho-K lens designs,
this no longer holds true. This case shows how
a patient with principally astigmatic refractive
error can be corrected with a non-rotationally
symmetrical orthokeratology lens and get clear
vision throughout the day.
A dentist of 33 years visited my practice,
curious if orthokeratology would be appropriate
for him. He had never worn contact lenses
before, and was motivated as his glasses would
frequently fog up and slip down during his work.
His spectacle prescription was R -0.25/-1.50 x
170 (6/5), L -0.25/-1.75 x 009 (6/5). Unaided
vision was R 6/7.5, N4 (40cm) and L 6/10, N8
(40cm).
Figure 1: Initial astigmatic topographies R+L
Topography shows regular with-the-rule
astigmatism with ΔSimK R -1.80D, L -2.2D
which is only slightly more corneal cylinder
than the spectacle astigmatism present. Given
that the cornea closely matched with his
refraction I proceeded to design a Forge Myopia
Toric orthokeratology lens for each eye using
Eyespace. Trial fitting a spherical lens on eye
will be of little use in this instance as the fit will
need to fit very differently in each meridian to
seal the cornea correctly and mold the cornea
accurately.
Because the spherical component of this
patient’s prescription is almost zero we do
not require much flattening of the cornea
horizontally. As a result the lens has a tear
profile very similar to an alignment fit lens in
this meridian. In the steep meridian however
we need to correct -1.75D of myopia hence
the conventional ortho-K tear profile pattern.
Research suggests that fitting a lens with a
spherical base curve will correct ~50% of the
corneal astigmatism present , however in my
experience this percentage is closer to ~70%. In
this instance we need more than 1.25D of WTR
astigmatism corrected so the steep meridian’s
BC is 0.1 flatter to ensure full astigmatic
correction.
In order to stabilise the lens on the eye the
alignment curve radii match the underlying
corneal topography in the same way as a bitoric
RGP would. In this way a modern orthokeratology
lens can be fully customised with independent
toricity in the base-curve, Z-Zone (reverse curve)
and the alignment curve. The left lens was
designed in the same way, giving lenses with
significant sagittal height difference of ~140µm
between meridians.
Figure 2: Eyespace simulation of each meridian of the
left toric orthokeratology lens showing the almost
alignment fit horizontally and more conventional
ortho-K tear profile vertically
Specialty contact
lenses forum
BY ALEX PETTY
Figure 3: NaFl image of the left lens on eye illustrating
the accuracy of the rotation simulation of Eyespace and
the NaFl pattern in the steep meridian
After a short period of wear to allow full
stability of the refractive change the patient
presented for aftercare with excellent distance
vision of 6/5 R+L. Residual refraction was
R +0.25/-0.25 x 180 and L plano, showing
full correction of the pre-orthokeratology
astigmatism. Axial difference maps of the right
eye shows a characteristic ‘figure 8’ pattern of
astigmatic correction that closely matches the
residual refraction.
Figure 4: Axial difference map showing excellent
astigmatic correction
The patient was very pleased with the results
and was asked to return in three months for
routine review. This report shows how significant
astigmatism can now be successfully corrected
with orthokeratology by using toric alignment and
base curves to control the fit of the lens and the
refractive change respectively.
Much higher prescriptions than this case can
also be well corrected with OK if you are prepared
to get creative! The below image shows a mixed
myopia (steep meridian)/ hyperopia (flat meridian)
custom Ortho-K lens designed with Eyespace that
corrected a patient with a spectacle prescription
of R +0.75/-4.50 x 178, L +0.25/-3.50 x 12 to give
6/6+ vision in each eye with no astigmatism
present in the residual refraction! ▀
Figure 5: Axial difference maps and NaFl photo of a lens
correcting high astigmatism!
A more detailed report of this case can be found
at eyespace.com.au/blog
REFERENCES
1. Mountford J, Pesudovs K. An analysis of the astigmatic
changes induced by accelerated orthokeratology. Clin
Exp Optom. 2002 Sep;85(5):284-93.
ABOUT THE AUTHOR
* Alex Petty is a Kiwi optometrist
who graduated from the
University of Auckland in 2010.
He has an interest in specialty
contact lenses, ortho-K and
myopia control.
New CEO for Auckland Eye
Auckland Eye has appointed e-health
management consultant Deb Boyd as their
new chief executive.
Previous to her recent consultancy experience,
Boyd was general manager at Australia’s first
fully-integrated digital hospital, St Stephens in
Hervey Bay, a coastal city in southern Queensland.
St Stephens opened in October 2014 and
achieved HIMSS Level 6 in November 2014. HIMSS
(Healthcare Information and Management Systems
Society) is a global, not-for-profit organisation
focused on optimising care outcomes and
improving information management in hospitals
through its Electronic Medical Record Adoption
Model (EMRAM), which has 7 levels in total.
“This was a thrilling project to be part of and to
experience such incredible technology with a fully
functioning EMR (Electronic Medical Record) and
closed loop medication management system. It was
a privilege to see first-hand the patients and staff
experiences as they transitioned from old ways of
doing things to successfully using new technology.”
A self-confessed technophile and passionate
advocate for the value technology can bring to
organisations and customer care, Boyd says her key
strengths are in operational management, change
management, systems improvement, healthcare
innovation, digital integration and developing
teams. “I use transformational leadership to bring
teams together and find creative solutions for
success,” she says in her LinkedIn biography.
Boyd’s previous roles in New Zealand include
hospital manager at Southern Cross Hospital
in Wellington; ward and day stay manager at
Southern Cross Hospital in Christchurch; and
business manager and child health services and
community services manager for the Canterbury
TearLab goes it alone
in ANZ
TearLab’s George Koukides at RANZCO 2015 in Wellington
TearLab has commenced direct distribution
of its ground-breaking Osmolarity System,
through its manufacturing partner MiniFAB
based in Scoresby, Victoria, Australia.
The Osmolarity System is believed to be the
first objective and quantitative point-of-care test
enabling eyecare professionals to easily measure the
osmolarity of human tears to diagnose and manage
patients suspected of having dry eye disease.
Osmolarity is a key test as recognised by the first
DEWS (Dry Eye Workshop) report and previously
was only able to be tested in the laboratory.
Manager George Koukides, who was appointed
to set up and run TearLab Australia last year, says
MiniFAB wanted to get closer to the market for
research and development purposes so it made
sense for them to take over the distribution of the
System in their own area and TearLab, based in
San Diego, agreed.
TearLab has been out on its own in Australia
since April last year, but its first real foray into
New Zealand was at RANZCO’s 2015 Scientific
Auckland Eye’s new CEO Deb Boyd. (Fraser Coast Chronicle)
District Health Board. According to her LinkedIn
biog. she was also the owner-operator of a
Brumby’s bakery franchise in Christchurch, during
the time of the quakes.
Her governance experience includes time on the
inaugural board of Partnership Health PHO and
she is a current member of the board of Health
Informatics New Zealand (HiNZ).
Auckland Eye’s board chair Dr Stephen Best says,
“We’re delighted to have Deb at Auckland Eye and
feel her vast experience in hospital management
and health infomatics will be invaluable to our
organisation.” ▀
Congress in Wellington in November last year.
“That was the start for New Zealand,” said
Koukides, who expects to be visiting New Zealand
on a quarterly basis from now on.
Currently the TearLab system is being employed
on a regular basis in New Zealand by just a
handful of practitioners, he says. These include
Associate Professor Jennifer Craig, who leads the
Ocular Surface Laboratory at Auckland University
and is the vice-chair of the Tear Film & Ocular
Society’s second dry eye workshop (DEWS II); the
Auckland-based Eye Institute; and Fendalton Eye
Clinic in Christchurch.
The TearLab system has a better predictive value
for dry eye than any other test, claims Koukides,
and is particularly useful for ophthalmologists
in the pre-surgical workup as it identifies
hyperosmolarity which can significantly affect
visual acuity and K-readings and thus affects
lens choice.
TearLab’s system was previously distributed in
New Zealand by Designs for Vision. ▀
8 NEW ZEALAND OPTICS Feb 2016

CCLS Conference:
a new look
Planning for the Cornea & Contact Lens
Society (CCLS) conference began more than
eight months ago, when it was decided to
make some modifications to the annual event.
“There were a lot of elements that work for
the conference, but we wanted to try some
new things such as holding the conference in
Wellington,” says Anne Matheson, CCLS president.
“Tony Alexander, chief economist at the BNZ, is
coming in to talk about business, the economy
and finance—topics which are of interest to
anyone who owns a business or to anyone who
gets paid, for that matter.”
Whether you’re a speciality lens practitioner or
work in a busy soft contact lens practice, the 2016
conference will offer something of interest, says
Matheson.
Taking
action on
diabetes
Diabetes New Zealand held its first
Diabetes Action Month last November
with a campaign to get Kiwis to make
lifestyle changes to avoid developing the
disease.
The campaign included TV and print
advertising, the launch of an online risk
awareness tool and a national roadshow
visiting 33 locations in 14 towns and
cities presenting the various risk factors
to the public. Among the 3,500 people
that undertook the roadshow’s risk factor
assessments, 68% were found to have a
propensity for type 2 diabetes.
“We identified almost 2,500 people who
really need to see their GP for a clinical test,”
Diabetes NZ chief executive Steve Crew said.
The number of New Zealanders living
with diabetes has doubled from 125,000 to
250,000 in the past 10 years, with 40 new
diagnoses every day. Moreover, approximately
30% of people with diabetes have retinopathy
while 10% have the disease so severely it is
threatening their vision, according to the
organisation.
“Alarmingly there were even people scoring
above 20, suggesting they are at extremely
high risk for having or developing type 2
diabetes and need to see their doctor,” Crews
said.
The risk assessment tool scored a range of
factors for type 2, including ethnicity, weight
and exercise traits, and recommended people
scoring above 6 points to seek medical advice.
The inaugural action month was designed
to encourage people to know their risk and
didn’t extend to medical ramifications such as
blindness and amputations.
Diabetes Action Month returns this
November. The theme of this year’s campaign
will be developed over the next few months,
according to Diabetes NZ. ▀
“As usual
the focus will
be on short
presentations
that get to
the core of
the subject
meaning great
take away
information.”
The
conference
will be held on
Sunday March
20 at Mac’s
CCLS CONFERENCE
CORNEA : OCULAR SURFACE : CONTACT LENSES
WELLINGTON MARCH 20 2016
CONFERENCE
CCLS 2016 keynote speaker
Professor Fiona Stapleton
Function Centre on Wellington’s waterfront. A
short ride from the airport and within walking
distance from major hotels, the venue is the
perfect location for anyone from out of town.
Delegates can fly in for the day or take some extra
time to re-discover Wellington. Locals already
know there is plenty of handy parking.
Another innovation is the Glaucoma Workshop
being held the day before the conference.
The main speakers will be Wellington
ophthalmologists Jesse Gale and Graham Reeves,
with contributions from Professor Tony Wells and
Dr Chris Murphy. The objective of the workshop is
to promote safe collaborative care for glaucoma.
There will be interactive discussions centring on
clinical cases highlighting evidence based decision
making, recognising dangerous situations and
some concepts and models relevant to managing
glaucoma. The workshop is only available to
conference delegates, but if you do register for
both, the conference registration fee will be
discounted by 10%.
The CCLS has a reputation for delivering a
great conference and this year is no exception.
In addition to the conference’s keynote speaker,
Professor Fiona Stapleton, head of the School of
Optometry and Vision Science at the University
of New South Wales, there are excellent local
speakers including Reece Hall, Greg Nel, Grant
Watters, Eleisha Dudson, Reuben Gordon, Sid
Ogra, John Veale and Adele Jefferies. Topics range
from practice management of dry eye to updates
on keratoconus. CPD points will be applied for.
“One thing that won’t change is the relaxed
informal atmosphere. We welcome members, non
members and students to the conference” says
Matheson. “We recognise that the networking
time is another core element of our conferences.”
For detailed information about the programme,
go to http://www.contactlens.org.nz/in-focus/
upcoming-events/ and to register online, go to
https://www.regonline.co.nz/CCLS2016 ▀
KEYNOTE SPEAKER
Prof Fiona Stapleton, University of NSW
SUNDAY 20 MARCH
MAC’S FUNCTION CENTRE
4 TARANAKI STREET
WELLINGTON
www.contactlens.org.nz
Free guidelines for kids
Six paediatric optometrists have collaborated
to assist Optometry Australia in producing its
first Paediatric Eye Health and Vision
Care Guidelines.
The guidelines were developed over a ninemonth
period with several teleconferences
between the working group and chairman Simon
Hanna, Optometry Australia’s national clinical
policy adviser.
Hanna said that in creating the first paediatric
ADDITIONAL WORKSHOP
GLAUCOMA WORKSHOP
Run by Wellington ophthalmologists
Jesse Gale, Graham Reeves, with contributions
from Prof Tony Wells and Dr Chris Murphy
SATURDAY 19 MARCH
THE MEETING SPACE
LEVEL 2, 148 CUBA STREET
WELLINGTON
9.00 AM START
guidelines for members, Optometry Australia was
aiming to target the wider optometric profession,
encouraging and enabling more practitioners to
provide paediatric clinical services, with tips and
referral pathways indicated both to specialists and
to experienced paediatric optometrists.
Australian optometrists Rod Baker, Liz
Jackson, Stephen Leslie, Tim Martin, Marissa
Megaloconomos and Christine Nearchou formed
the working group.
“Their role was to review and comment and
to suggest changes to the guidelines as a work
in progress. From start to finish the project was
written by Optometry Australia’s policy team
and the working group members were effectively
expert consultants,” said Mr Hanna. “The paediatric
guidelines were developed with a full literature
review to ensure an evidence-based, up-to-date
document with the intention to review them at an
appropriate time.”
The guidelines are divided into three main
parts: infants and toddlers (birth to two years 11
months); pre-school children (three years to six
years 11 months); and school-aged children (seven
to 14 years).
Paediatric Eye Health and Vision Care Guidelines
is a free resource available for the optometry
profession. Download the guidelines at
www.optometry.org.au. ▀
Pfizer-Allergan: “It’s
about growth”
The CEOs of Pfizer and Allergan claim their
US$160 billion merger is about growth, not
cost-cutting.
Currently awaiting US antitrust clearance, the
deal will shift Pfizer’s official headquarters for
tax purposes from New York to Allergan’s base
in Dublin, greatly reducing its tax rate, allowing
it to access cash overseas and leading to the
loss of thousands of jobs in the US, resulting in
considerable criticism from several high-profile
senior US lawmakers.
Presidential candidate Hillary Clinton vowed
to fight to reform the US tax system to stop
companies doing this: “This proposed merger, and
so-called inversions by other companies, will leave
US taxpayers holding the bag.”
The two companies hit back at the annual JP
Morgan Healthcare Conference in January saying
the deal is not just a tax-saving tool. “This isn’t
about cost-cutting. This is about leadership
and growth,” said Allergan CEO Brett Saunders,
adding the companies have “lots of new drugs”
in the pipeline. While Pfizer chief executive Ian
Read said the companies have little overlap in
their operations and both have already removed
considerable excess costs. “This is going to be a
powerhouse company with a strong dividend…
and the best pipeline in the industry.”
Some US analysts believe Allergan’s pipeline
will significantly improve Pfizer’s sales and
earnings growth in 2018-2020, while Allergan
will benefit from Pfizer’s global salesforce, as
currently less than 20% of the company’s sales
come from outside the US. Many market experts,
however, disagree with the claimed R&D benefits
of the deal, saying the portfolios of the two
companies are so diverse, it’s unlikely there
will be any overlap between them to deliver
better drugs.
The deal, expected to close by the second half
of this year, will create the world’s biggest drugmaker,
worth more than US$300 billion. ▀
CORNEA & CONTACT LENS SOCIETY
of New Zealand Incorporated
Feb 2016
NEW ZEALAND OPTICS
9

Reflections: Mike Mair
Focus on
Eye Research
Glaucoma
ESTIMATING LEAD TIME GAINED BY
OPTICAL COHERENCE TOMOGRAPHY
IN DETECTING GLAUCOMA BEFORE
DEVELOPMENT OF VISUAL FIELD DEFECTS
Kuang TM, Zhang C, Zangwill LM et al
Ophthalmology 2015;122:2002-2009
Review
The aim of this study was to determine the
diagnostic accuracy and lead time gained
by retinal nerve fibre layer (RNFL) thickness
measurements from OCT for detecting
glaucoma before the development of visual
field defects.
The study included 75 eyes of 75 patients
suspected of having glaucoma. These eyes all
had normal baseline automated perimetry
and developed repeatable (3 consecutive)
abnormal visual field tests during a median
follow up of 6.3 years. A control group of age
matched healthy subjects was included. RNFL
thickness measurements were analysed from
the time of development of the earliest visual
field defect and the preceding years.
At the time of conversion to the earliest
visual field defect, average RNFL thickness
was significantly less in glaucomatous eyes
compared to controls (75 vs 90 microns, p <
0.001). In fact significant differences were
seen 8 years before the development of visual
field defects (86 vs 91 microns, p = 0.02). At
95% specificity, 44% of eyes had an abnormal
average RNFL thickness 2 years before a visual
field defect, 35% of eyes 4 years before this,
and 19% of eyes 8 years before a visual field
defect.
The authors concluded that assessment of
RNFL thickness with OCT was able to detect
glaucomatous damage before the appearance
of visual field defects and often significantly
large lead times was seen.
Comment
This is an important study that demonstrates
glaucomatous damage may be seen on OCT
RNFL analysis significantly earlier than the
first visual field defect. This suggests that
OCT is a valuable ancillary tool in monitoring
glaucoma suspects and could lead to earlier
diagnosis and treatment — even before the
development of any visual field loss.
CAMBRIDGE COMMUNITY OPTOMETRY
GLAUCOMA SCHEME
Keenan J, Shahid H, Bourne R, et al
Clinical and Experimental Ophthalmology 2015;43:221-227
Review
This study evaluated the Cambridge
Community Optometry Glaucoma Scheme
(COGS). This was initiated in 2010 to help
with the demand for glaucoma services in the
UK. In the scheme community optometrists
with a special interest in glaucoma evaluated
new referrals for suspected glaucoma. Each
patient underwent a clinical assessment
(including Goldmann applanation tonometry,
pachymetry, optic disc photos and visual fields)
by an optometrist at a remote site. A clinical
decision is made as to whether a patient has
glaucoma or is a suspect, and referred on or
discharged as a false positive referral. The
clinical findings, optic disc photos and visual
fields are then electronically transmitted for
virtual review by an ophthalmologist.
There were 1,733 patients evaluated by
scheme between 2010 and 2013. Of all the
patients, the optometrist discharged 46.6%
and a further 5.7% were discharged following
virtual review by the ophthalmologist. Of the
patients initially discharged, only 2.8% were
REVIEWED BY DR HUSSAIN PATEL*
recalled following virtual review. Following
assessment at the hospital a further 10.5%
were discharged after a single visit.
The authors concluded that the COGS
community-based glaucoma screening
programme is a safe and effective way
of evaluating glaucoma referrals in the
community and for reducing false-positive
referrals for glaucoma into the hospital
system.
Comment
This appears to be a very effective and safe
scheme that significantly reduces the number
of false positive referrals to the hospital
service. This scheme could be implemented
by the district health boards in New Zealand
and would help to reduce the ever increasing
demand for glaucoma services and free
up resources for managing more complex
glaucoma patients.
DOES THE ISNT RULE APPLY TO THE
RETINAL NERVE FIBRE LAYER?
Pradhan ZS, Braganza MS, Abraham LM
Journal of Glaucoma 2016;25:e1-e4
APPLICABILITY OF ISNT AND IST RULES TO
THE RETINAL NERVE FIBRE LAYER USING
SPECTRAL DOMAIN OPTICAL COHERENCE
TOMOGRAPHY IN EARLY GLAUCOMA
Dave P, Shah J
British Journal of Ophthalmology 2015;99:1713–1717
Review
The purpose of the above studies was to
determine whether the ISNT rule (Inferior >
Superior > Nasal > Temporal) could be applied
to the peripapillary retinal nerve fibre layer
(RNFL) thickness as measured by OCT. Both
were prospective cross sectional studies that
included normal and early glaucomatous eyes.
In the study by Dave et al, 55% of normal
eyes and 37% of early glaucoma eyes followed
the ISNT rule. The sensitivity and specificity for
early glaucoma diagnosis based on violation
of the ISNT rule was 63% and 47% respectively,
and the positive/negative likelihood ratio was
1.4/0.67. In the study by Pradhan et al, 47%
of normal eyes and 31% of glaucoma eyes
followed the ISNT rule. The sensitivity was
76% and specificity 47% for early glaucoma
diagnosis using violation of the ISNT rule.
Both of these studies concluded that the
ISNT rule by itself does not clearly distinguish
between normal eyes and glaucoma when
applied to the retinal nerve fibre layer using
OCT.
Comment
Although the ISNT rule is of clinical benefit
in optic disc examination and evaluation of
the neuro-retinal rim, it does not appear to
have any clinical use at present in assessment
of the retinal nerve fibre layer for glaucoma
diagnosis. ▀
* Dr Hussain Patel
is a glaucoma and
cataract specialist.
He works as a
Senior Lecturer
in ophthalmology
with the University
of Auckland, a
consultant at
Greenlane Clinical
Centre, and in
private practice
at Eye Surgery
Associates in
Auckland and
Hamilton Eye Clinic.
Dr Michael Mair’s career has gone full circle.
The English-born ophthalmologist actually
began as a social anthropology student
in 1968, learning theories of language and brain
development. In the 1990s, he created a paperless
office computer program, based in part on those
studies, and he has run several practices designed
to care for public and private patients, with those
theories in mind.
He may have retired in 2015 from the Timaru
Eye Clinic he founded in 2006, but he’s not done
working.
Dr Mike Mair
“I’m going back to the project I started involving
facial movement and voices and basically trying to
understand the brain,” Mair told NZ Optics’s editorat-large
Maryanne Dransfield in an interview last
year. Mair said he built his practices using the same
principles he discovered in his human interactionbrain
research.
“The rooms were built according to the cycle
of interaction: meeting, parting and the story in
between. It’s a holistic model of how interaction—
and maybe the brain—works, how the clinic works
and ultimately how the record-keeping works
because records are the chain of summaries of
these interactions.”
Mair said he applied the theories he’d researched
in ideas of speech and language to the pursuit of a
paperless office software system through the early
1990s, resulting in a programme for glaucoma and
cataract records.
“Because in Timaru I couldn’t do the research in
eye and nose movement I’d wanted, the other area
where I could apply my theory was in computers.”
In fact, his work led to a collaboration with
Derek Gower, the then chief executive of Houston
Medical (now Best Practice Software) which had
been developing medical record systems since its
inception in 1988. Gower shared the work he had
already done and contributed to Houston’s first
ophthalmology record system. By 1995, Mair said,
his practice went fully paperless.
Back to the beginning
Mair was born into a family of doctors and,
according to an article in The Timaru Times, it was
his father’s temporary blindness due to Devics
disease (a neurological disorder) that set him on
the path to ophthalmology.
He studied at Cambridge University and
Westminster Medical School and took his first job in
the Ear, Nose, and Throat Department at Moorfields
Hospital under the tutelage of Dr Patrick Trevor-
Roper, who among other claims to fame, founded
Moorfields Eye Bank a few years prior.
Mair joined Trevor-Roper on a medical mission
to Sierra Leone in 1972 where he took charge of
a mobile eye unit, mostly removing cataracts.
Device Technologies at Mantells
More than 100 guests turned up to
celebrate the end of the year with Device
Technologies at Mantells in the leafy
Auckland suburb of Mount Eden. Hosts and guests
pictured here include (left) Diego Sonderegger,
He also encountered an unanticipated incidence
rate of onchocerciasis (river blindness, caused
by infection with a parasitic worm) which he
described as a “disastrous” experience, as the
doctors simply “didn’t know what we were
doing”; a situation that has fortunately changed
with improved drug treatment.
Returning to Moorfields as a house physician,
Mair worked in casualty and then ophthalmology,
earning his ophthalmology diploma in 1974 from
the UK Royal College of Surgeons.
In 1975, he returned to anthropology and brain
research, splitting his time between clinics and
his work on the “melody of text” - a micro analysis
of spontaneous conversation, focusing on brain
function and eye movements.
The research used the first frame-by-frame
video recorder to closely analyse people in
spontaneous conversation, in order to track nose
and expression in correlation with eye movement
and voice analysis.
Mair said it had been a hard choice to
choose between doing a primary fellowship in
ophthalmology and the “melody of the text” work,
but after he had published a number of papers
based on his research, he did a neurology and
ophthalmology fellowship at Cambridge, followed
by a surgical rotation at Moorfields.
The New Zealand way
A lecturer position at Otago University drew Mair
to New Zealand in 1985, but finding Dunedin not
to his liking he relocated to Timaru.
In 1988, he went into practice for himself, first in
rooms rented from an ENT specialist, then in his
own house, until about 1995 when he persuaded
a private hospital to let him have space near them,
with the aim of providing a combined “public and
private sector” practice.
“There was an environment at the time
encouraging the kind of enterprise I was doing. It
was the time of the Crown Health Enterprises and
so on. So they approved of me contracting public
sector service in my private rooms.”
Mair said the practice was “very successful”
financially and, being paperless, very efficient for
all concerned. “And I had the delight of being able
to put public and private patients through the
same basic treatment,” he said.
The practice carried on under that effective
“egalitarian model” for a while but it wasn’t “well
appreciated” unfortunately, Mair said, by private
practice or the public health system in the end. “I’m
slightly socialist,” Mair told The Timaru Herald in an
interview at the time.
The payment method ultimately changed, but the
Timaru practice was able to continue giving public
and private patients the same service, but with
funding streams and wait times that were different.
The future of Timaru Eye
After Mair’s retirement last year, a South
Canterbury District Health Board (SCDHB)
subsidiary, the South Canterbury Eye Clinic,
purchased Timaru Eye Clinic and continues to
provide both public and private ophthalmology
services.
The SCDHB issued a request for someone from
the private sector to take over the practice, but only
received one response. The SCDHB is currently in
talks with that respondent to work out a potential
sale of the practice. A spokesperson for the SCDHB
says there are no plans to re-issue the RFP at the
moment. ▀
Caroline Svadlenak, Laser Eye Centre Hamilton
optometrist Oliver Svadlenak and Campbell
Gordon; and (right) the team from Auckland Eye,
Janet Wigmore, Drs Dean Corbett and Alison
Pereira and Tracey Molloy. ▀
10 NEW ZEALAND OPTICS Feb 2016

John Parr prize
awarded
MDNZ 2016 Race Day:
Have you bought your
tickets yet?
Dr Logan Mitchell and Dr Samy Karki with John Parr prize winner Deepesh
Mehta, Samuel Pau, Trenton Taylor and Dr Kelechi Ogbuehi.
The University of Otago’s
Dunedin School of
Medicine has awarded
the annual John Parr Prize
to Deepesh Mehta. The prize
is granted to the top fifthyear
medical student in
ophthalmology.
Mehta was among 17 leading
students who were invited to
sit for a quiz to take the prize.
Samuel Pau was the first runner
up and Trenton Taylor was third.
Dr Logan Mitchell, senior
lecturer, said the standard of
competition was very high.
Mehta received a panophthalmoscope
provided by
EBOS Healthcare in recognition
of the award.
The prize was named for
educator and researcher Dr
John Parr (1922-2009) who
helped raise the standard of
ophthalmological training
in New Zealand, laid the
foundations for a postgraduate
training programme at
the school and authored
Introduction to Ophthalmology,
a classic text for undergraduate
medical students.
2015 Clinical Course
highlights
In other news, the Dunedin
School of Medicine hosted the
annual Dunedin Ophthalmology
Clinical Course over 11 days in
November. This highly-regarded
residential course is aimed at
trainees preparing for their
Deepesh Mehta with Dr Logan
Mitchell
RANZCO RACE (Part 2) Exams
and is made up of lectures and
workshops delivered by invited
faculty members, including
many RACE examiners, from
both Australia and New
Zealand.
This year’s course attracted 33
participants: 27 from Australia
and six from New Zealand.
Twenty-three speakers gave
talks, including first-time
lecturers Drs Con Petsoglou,
Xavier Fagan, Stuart Carroll,
Yvonne Ng, David Squirrell and
Jesse Gale.
A highlight was the eight
Observed Structured Clinical
Exams (OSCEs) prepared and
run by Drs Ben LaHood and
Elizabeth Insull.
RANZCO, and its immediate
past-president Dr Stephen
Best, hosted a reception at the
University of Otago’s Hunter
Centre for the participants. ▀
The team from MDNZ at the 2015 Race Day
Tables and tickets
are selling fast for
the popular annual
Macular Degeneration Race
Day. This year the event
is being held on Saturday
20 February, so there’s
still plenty of time to treat
yourself, your friends, family
or colleagues and support
the vital work of Macular
Degeneration New Zealand
(MDNZ). Or
perhaps you’d like to
sponsor a table of 10
and host your own party.
Ten races will keep you
and your guests entertained
for an entire day watching
the main stars, the horses,
thunder along the track
in a bid to win one of the
day's exhilarating races - the
Group II Avondale Cup and
Come join the fun
at Ellersile
For more information
or to buy tickets ($140 each)
or a table ($1,250) please contact
Phillippa Pitcher on
0800 Macula (622 852)
or email events@mdnz.org.nz
the Avondale Guineas.
Tickets include drinks
on arrival, buffet lunch,
afternoon tea and cash
bar, plus entertainment
throughout the day.
Westgate Optometrists
changes hands
Jan Thompson
After 20 years in the Optometry industry,
Jan Thompson has sold her Westgate
Optometrists business in Auckland to New
Zealand-trained optometrist Ricky Lee.
Saying she made the decision to sell to spend
more time with her family, Thompson was keen to
assure staff and patients that it will be business
as usual at the popular independent practice at
Westgate Shopping Centre in Massey.
“Present staff and patient records remain as
before for continuity. I have total confidence and
peace of mind that Ricky and our very capable
team will continue to provide excellent service
and eye care for our valued clients.”
Thompson has operated Westgate Optometrists
since 2006. She originally took on the practice
with business partner, and former classmate,
Paul Sampson, who now resides in Australia. The
practice will continue with the same name and
staff, including optometrists Shelley Brannigan
and Hans Vellara, under Lee’s ownership.
Lee trained to become an optometrist in New
Zealand and has spent the last few years working
in Australia.
Thompson says the most rewarding aspect
of optometry has been “moments with longterm
customers built up over the years, who
appreciate a job well-done with friendly, thorough
and professional eye care and detecting and
monitoring interesting pathology.
“I have certainly had some very rewarding
moments providing the best eye care I possibly
could for my patients.”
She’s also enjoyed being a part of New Zealand’s
close knit ophthalmic community, she says. “I
appreciate the very kind referrals and support I
have had and the learning opportunities provided
by local ophthalmologists and suppliers and have
really enjoyed continuing education seminars and
conferences with colleagues and friends.”
In a parting message to the public in her local
newspaper, Thompson implored readers to have
glasses and contact lenses fitted by a professional
who genuinely cares about patients’ eyes and can
monitor their eye health on a continuous basis.
“The ideal would be for schools to teach the
importance of regular eye tests for health reasons,
rather than people waiting to have an eye test
later in life only because their vision deteriorates.
I have certainly done my very best in passing on
this important message.” ▀
Hyperosmolarity is not your friend.
He is a meddlesome troublemaker who undermines your effort to achieve
great vision. Discover how the TearLab ® Osmolarity Test provides a fast and
accurate osmolarity measurement to uncover and manage hyperosmolarity.
©2015 TearLab Corp. 920228 REV A
Visit www.tearlab.com
Visit www.tearlab.com
or call George Koukides on
to find out why.
+61 437 648746 to find out why.
Feb 2016
NEW ZEALAND OPTICS
11

with
Prof Charles McGhee
& A/Prof Dipika Patel
Series Editors
Ocular drug delivery—eye on innovation
BY ILVA D. RUPENTHAL*
One would think that a small organ such as the eye which is
readily accessible from the outside of the body would be easy
to treat. However, the eye has a number of protective barriers
in place which pose major challenges to effective drug delivery.
Conventional eye drops generally result in less than 5% of the applied
dose reaching the ocular tissues. This is mainly due to the fast
nasolacrimal drainage and the poor permeation across the sandwichlike
structure of the cornea, with the lipophilic corneal epithelium
being the main penetration barrier. This not only leads to low
efficacy, but can also pose significant risks due to systemic absorption
and associated side effects of the majority of the given dose. To
improve the efficacy of topical ocular formulations, researchers have
mainly focused on two strategies: 1) To increase the corneal residence
time using viscosity enhancing, mucoadhesive, particulate and/or
in situ gelling systems; and 2) to increase the corneal permeability
using penetration enhancers, prodrugs and colloidal systems
such as nanoparticles and liposomes. While many of these have
been investigated over the past decades with some success in the
treatment of anterior segment diseases, they are unable to deliver
sufficient drug concentrations to the back of the eye.
The gold-standard to treat posterior segment conditions
such as wet age-related macular degeneration (AMD) remains
intravitreal injection of the drug-containing solution. Although a
relatively site specific application into the confined vitreal space,
injected drugs face elimination processes and need to diffuse
through the vitreous network before crossing the inner limiting
membrane to reach the retina. When aiming to reach the choroid,
additional permeation barriers such as the retinal pigment
epithelium (RPE) and Bruch’s membrane have to be crossed. Thus,
periocular injection may offer a more direct route for choroidal
drug delivery with the sclera allowing molecules up to 20 kDa
to permeate. Moreover, larger volumes can be injected into the
periocular space (≤1 ml compared to ≤100 µl intravitreally). Even
more localised are suprachoroidal injections using microneedles
which allow the drug to spread between sclera and choroid. The
injection volume is hereby limited to ≤35 µl with simple drug
solutions eliminated relatively quickly. However, injecting drugloaded
particles and/or in situ gelling systems into this space
could offer localised sustained drug release in the future 1 . Finally,
the active could also be administered systemically; however,
generally less than 2% of the administered dose reaches the
ocular tissues mainly owing to the tight blood-retinal barrier. An
overview of the ocular structures and some of the recent delivery
technologies, which will be further discussed below, is given in
Figure 1.
Figure 1: Overview of the ocular structures and some recent delivery
technologies (modified with permission). 2,3
RECENT PROGRESS IN DRUG DELIVERY TO THE FRONT
OF THE EYE
While a vast number of approaches have been explored over the past
decades to increase precorneal retention and/or corneal permeation,
only a few advanced drug delivery systems have entered the market.
These include prodrug-based eye drops such as Propine® from the
1970s, ion-exchange resin particle-based Betoptic® S, the membranecontrolled
reservoir system Ocusert® and in situ gelling eye drops
such as gellan gum based Timoptic® XE. However, over the past
years there has been an enormous increase in novel and exciting
approaches being researched and/or having entered into clinical
trials. Novaliq GmbH, for example, is developing topical ocular
formulations based on semi-fluorinated alkanes particularly suitable
for the delivery of poorly soluble drugs such a cyclosporine A, with
the added advantage of not requiring preservatives and lubricating
the ocular surface, both aspects of particular benefit in the treatment
of dry eye. Kala Pharmaceuticals is investigating mucus penetrating
particles (MPP) which allow efficient penetration of the tear film
mucin layer, the first defense mechanism encountered after topical
administration 4 . Envisia Therapeutics is researching a PRINT-based
biodegradable polymer rod intended for intracameral injection for
three to eight months of drug delivery (Figure 2). Currently in clinical
trials is also Ocular Therapeutix’s drug-containing punctum plug
delivering its cargo over three months and containing a visualisation
aid to monitor plug retention 5 . Finally, drug-eluting contact lenses
have also gained considerable interest for drug delivery to the
anterior segment. Drug loading approaches hereby include simple
soaking of the lens in the drug solution, incorporation of particles or
molecular imprinting with the latter two having shown drug delivery
for up to one month.
Figure 2: (A) Envisia PRINT technology-based intracameral implant (B) injected
into New Zealand white rabbits and (C) IOP-lowering effect in normotensive
beagle dogs (green: ENV55-8, purple: placebo) (modified with permission) 4
RECENT PROGRESS IN DRUG DELIVERY TO THE BACK
OF THE EYE
The gold-standard to treat posterior segment conditions remains
intravitreal injection with drugs administered as solution having a
relatively short half-life. However, four sustained release implants
have also made it onto the market so far. These include nonbiodegradable
Vitrasert®, a ganciclovir containing scleral implant
approved in 1996 for the treatment of CMV retinitis, and Retisert®,
containing fluocinolone acetonide approved for the treatment of
non-infectious posterior uveitis in 2005. FDA-approved Iluvien®, also
a non-biodegradable implant, is injected into the vitreous using a
25G needle rather than being sutured into the sclera. This implant
can deliver fluocinolone acetonide over three years for the treatment
of diabetic macula edema (DME). The first ever biodegradable
intravitreal implant, Ozurdex®, approved in 2009 consists of a PLGAbased
rod containing dexamethasone for the treatment of DME,
retinal vein occlusion and posterior uveitis, with the same technology
also being investigated in a Phase I/II trial for bimatoprost
delivery. GrayBug is currently evalutating a proprietary PLGA–
based technology proven to reduce the inflammation seen with
conventional PLGA systems, with their lead product for wet AMD
targeted to last up to six months 3 . Another platform technology,
Tethadur by pSivida, is based on a suspension of micronised particles
of oxidised meso-porous silicon, with the size of the pores adjustable
to control drug release 3 . While the majority of the above-mentioned
particle systems are preformed, the Verisome® technology allows
implant formation in situ once in contact with the aqueous vitreous
environment. Depending on the volume of the formulation injected,
drug levels can be maintained for up to 12 months.
While all of the above implantable systems may achieve sustained
release, the release rate cannot be altered if the condition worsens
or aborted in the case of serious side effects unless the implant is
surgically removed. This shortcoming has partially been addressed in
the port delivery system by ForSight Vision, a scleral plug consisting
of a porous container, a semi-permeable non-biodegradable
membrane with a refill port (to increase the device’s life span) and
exit ports to release the drug into the vitreous humor but also allow
for flushing to abort drug delivery. However, the drug release rate
is still fixed. To be able to tune drug delivery on-demand, there has
been a paradigm shift from conventional to stimuli-responsive
devices over recent years, with such systems also having great
potential in eye 2 . While to date only open-loop systems responsive to
light (e.g. ODTx), an electrical stimulus (Figure 3) or a magnetic field
have been explored in the eye, self-regulating systems releasing drug
in response to a change in a certain physiological parameter could
offer tailored treatment of posterior segment diseases in the future.
Figure 3: Schematic representation of the Replenish MicroPump TM implanted
at the pars plana position showing the refill port (green arrow), suture tab (red
arrow) and pars plana cannula (blue arrow) (reproduced with permission from
the Association for Research in Vision and Ophthalmology (ARVO)) 6
CONCLUSION
A number of innovative drug delivery technologies are currently
in the pipeline to treat ocular diseases more efficiently while
minimising side effects, with the majority aiming to sustain
drug release over prolonged periods. However, long-term effects
of sustained drug levels especially in the posterior segment are
currently unknown and tunable drug release may be of advantage
if the condition improves to avoid unnecessary side effects. The
major hurdle with successful development of such tunable implants
remains the device size restriction, which in turn reduces the amount
of drug loading. Such devices are therefore generally limited to highly
potent drugs such as steroids and may become difficult to adapt to
macromolecules such as anti-VEGF agents. Moreover, matching these
new technologies with drug pharmacokinetics and translating preclinical
studies into human clinical trials remains a major challenge.
Nevertheless, novel ocular drug delivery technologies offer great
market potential and it is certainly a very exciting area to be working
in at the moment. ▀
REFERENCES
1. Albini TA, Moshfeghi AA, Yeh S 2014. A Peek down the pipeline: Emerging drug
delivery options for retinal disease. Retina Today JUL/AUG:70-77.
2. Yasin MN, Svirskis D, Seyfoddin A, Rupenthal ID 2014. Implants for drug delivery
to the posterior segment of the eye: A focus on stimuli-responsive and tunable
release systems. Journal of Controlled Release 196:208-221.
3. Frederick Furness Publishing Ltd. 2015. Ophthalmic Drug Delivery.
ONdrugDelivery 54:1-32.
4. Frederick Furness Publishing Ltd. 2014. Ophthalmic Drug Delivery.
ONdrugDelivery 48:1-36.
5. Boyer DS et al. 2014. Emerging technologies approach complex eye diseases from
new directions. Ocular Surgery News APAO MAY:8-22.
6. Gutierrez-Hernandez JC et al. 2014. One-Year Feasibility Study of Replenish
MicroPump for Intravitreal Drug Delivery: A Pilot Study. Translational Vision
Science & Technology 3(4):8.
ABOUT THE AUTHOR
* Dr Ilva Rupenthal is a Senior Lecturer in the University
of Auckland’s Department of Ophthalmology and the
Director of the Buchanan Ocular Therapeutics Unit
(www.botu.nz), which aims to develop and translate
ocular therapeutic related scientific research into the
clinical setting.
See more on BOTU and the new Ocular Therapeutics
Conference on page 6.
12 NEW ZEALAND OPTICS Feb 2016

Innovating against preventable blindness
Ophthalmologists have helped to address
the main cause of avoidable blindness in
developing countries through a variety of
innovative programmes making cataract surgery
affordable and accessible, said Dr Neil Murray,
who gave the annual Fred Hollows Lecture at
the 2015 RANZCO Scientific Congress, but the
next leading cause of preventable blindness—
diabetes—will require more innovative thinking
to combat.
“Change is required to bring about a solution to
this massive problem of avoidable blindness and
that change needs to be transformative,” Murray
said during his presentation Progress through
innovation: The Fred Hollows effect.
He divided “transformative change” into two
broad camps.
“There is innovation that occurs within a known
paradigm, or value added innovation, and then
there’s innovation that is totally disruptive.”
As of 2010, there were 32.5 million blind people
in the world, 80% of which was avoidable.
The vast majority of those with preventable
blindness live in the developing world and while
efforts like Vision 2020—launched in 1997—
presented a “disruptive innovation” to combat
preventable blindness, similar efforts will be
necessary as diabetic retinopathy increases.
“(Vision 2020) represented a unique
collaboration of public, private and not-forprofit
organisations seeking to develop enduring
solutions to eliminating avoidable blindness by
2020.
“It emphasised there were three key areas to
those enduring blindness solutions,” Murray said.
This included cataract surgery, which has been
proven to be one of the most cost-effective
surgical interventions available; infrastructure
and technology development; and human
resource development.
Murray said Vision 2020 went further by calling
for solutions that integrated with existing health
systems, were sustainable within those systems,
were equitably accessible and provided excellent
of care.
Transformative change at work
Murray noted that extracapsular cataract surgery
with posterior chamber IOLs was a “value-added”
innovation that enabled developing world
surgeons “to aspire to achieve 6/18 or better
vision for their cataract patients.”
Affordability prevented the developing world
from using this “value-added” innovation until
Fred Hollows instituted high-quality, low cost IOL
production facilities in developing nations, which
“disrupted the paradigm.”
Another value-added innovation has been the
visiting team, the “fly-in/fly-out service provision
model to an area that has little or no health
resource to deal with their own eye care needs.”
“This can and has been a successful model and
will remain a part of the fight against avoidable
blindness, but there are some issues with this,
relating primarily to the quality of outcomes that
the visiting teams achieve,” Murray said.
Developing a local resource, along the lines of
Vision 2020’s concept of integrated, sustainable,
equitable and excellent (shortened to ISEE)
solutions, that are fit for purpose and fit for the
future, would be an enduring transformation.
“Nepal is a fantastic example of how an
enduring solution can make a difference,” Murray
said.
Following a rapid assessment of avoidable
blindness in 1981, eye care groups banded
together to combat the problem and 30 years
later have cut the prevalence of blindness in Nepal
by half, while increasing the number of training
programmes within the country from zero to six,
so that today, Nepal is a net exporter of trained
ophthalmologists.
The next problem
Diabetes has exploded in recent history, but
nowhere as much as in the Pacific, which Murray
described as a “vast blue continent with little
pockets of humanity, isolated”.
“Nine of the top-ten countries in the world for
prevalence of diabetes are in the Pacific…at our
back door,” Murray said.
Murray discussed the case of Fiji, one of
those top ten nations, to illustrate how quickly
diabetes has exploded. In 1985 the prevalence of
diabetes was 4%, in 2010 it had shot up to just
under 30% of the entire population. Meanwhile,
the prevalence of diabetic retinopathy among
diabetics in Fiji is around 50%, totalling 80,000
diabetics with retinopathy as of 2012.
“This is all too common a presentation,” Murray
said.
He also noted an anecdotal cultural shift in
which, at one time, if you asked for a sweet drink
in Fiji, you would have been offered coconut milk.
Today, that may be true for more remote locations,
but in the main, Murray said, you will be offered
a “heavily sugared, carbonated fizzy drink that is
black or orange or raspberry.”
“That whole cultural norm needs to change in
our ‘whole of society’ response,” he said.
Cultural shifts take decades and in the meantime,
“what will happen to the people who have diabetes
in a low-resource environment: how can we stop
them from becoming blind?” said Murray.
“Innovation again is required and that
innovation may very well be value-added, as
with micro-pulse lasers and smarter treatment
protocols. We can certainly do with affordable,
accessible anti-VEGFs that are actually not a
part of the current treatment paradigm in the
developing world.
“The innovation will almost certainly not need
to be disruptive,” he added.
The good news, perhaps, is that ophthalmic
resources have been coming together throughout
the Pacific, with two training programmes
established in Fiji in 2007, bringing the total
throughout the Pacific to 11 and an anticipated 20
programmes by the beginning of the next decade.
“I want to embed the disruptive, innovative
spirit Fred Hollows had and re-present it to you
as a challenge.” In conclusion, Murray posed a
question: “How are we going to, in a low-resource
context, prevent avoidable blindness until
societies get the diabetes epidemic under control
and what are you going to do about it?” ▀
Eye Doctors’
Shuan Dai
applauded
Eye Doctors’ Dr Shuan Dai (second from
right) was recognised for services to the
Asian community at the end of last year
and presented with an award for excellence in
service for the Health of the Asian Community
by the New Zealand Health Foundation for
Asian and Ethnic Communities.
The award was presented by (from left to right)
Peter Goodfellow, NZ National Party president
and Dr Jian Yang, Parliament Health Committee
vice-chair, in the presence of Chen Mao Song, the
Vice Consul-General of the Chinese Embassy in
Auckland, at Auckland’s Metropolitan Museum. ▀
Turning back the clock
A patient’s perspective by Australian artist John Lovett on his experience with LISA tri IOL.
John Lovett having his eyes measured
This may seem an unusual thing to discuss,
but far more important than brands of colour,
types of paper or any painting technique, the
ability to see clearly has a huge impact on what we
create.
One thing that has crept up on me over the years
is a gradual loss of close vision. Glasses didn’t really
solve the problem— they would focus on the area
right in front of me, but the far end of a large sheet
of paper would require craning over to bring it back
into focus. I tried multifocal lenses but they felt like
looking through distorted glass.
Mono-vision contact lenses, where one eye
wears a close up lens and the other a distance lens,
worked well for a number of years, but the twice
daily chore of removing and inserting contact
lenses and the problems associated with outback
dust and smoke, plus the AUD$1200 a year cost
finally pushed me to inquire about laser surgery.
The specialist I spoke to said because of my
age (61) and there was the first sign of cataracts
present, cataract surgery would be my best option.
Cataract surgery requires removing the natural
lens and replacing it with a small precision acrylic
lens. The newest lenses made by Carl Zeiss are a
trifocal lens employing a series of tiny concentric
rings giving clear close up, middle and distant
vision. My eye surgeon recommended these
lenses based on the results he had had since their
introduction.
Tests were done, forms filled out and a surgery
date arranged.
The surgery was quick and painless. I was
rendered semi-conscious as soon as I entered the
theatre and the next thing I remember was sitting
in a recovery room with a cup of tea and a number
of other patients decorated with similar eye
patches to mine. A nurse explained what I should
and should not do for the next month while the
eye heals and settles.
Next morning I woke up, removed the eye patch
and immediately could read close up and clearly
focus on distant objects without glasses or contact
lenses, and this was with just one eye done. A
follow up appointment that morning confirmed
my new eye was working perfectly.
I asked the surgeon about the colour shift I
noticed between the eye with the new lens and
the other eye. Once cataracts begin, he explained,
colour saturation and contrast diminish and the
eye takes on a yellow cast. So what I was seeing
through the new eye was how things should
appear. The slight magenta tint will disappear over
the next few days.
A slight colour shift was noticeable between the natural
deteriorated eye (left) and the new lens (right)
A couple of weeks passed and I had the second
eye done with similar results.
Since the day after my first eye was operated on
I have not worn glasses or contacts and my vision
now is better than I can ever remember it being.
The only noticeable downside to the new lenses
is a slight halo around strong light sources at night.
The eye surgeon said this will diminish as I become
more used to the lenses.
So, for me it’s no more lost glasses, no more
fiddling around with contact lenses and clear,
sharp vision for the rest of my life - these lenses
don’t deteriorate like a natural lens. As far as
painting is concerned, the best sable brush is only
as good as the eyes of the person holding it, so I’m
very happy - all my brushes work better now!
Case study from John Lovett supplied by Zeiss. ▀
INTRODUCING.......THE NEW
SOCT COPERNICUS REVO
OCT made simple as never
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for every practice
High quality of OCT image
For further information regarding the SOCT Copernicus REVO
please contact OptiMed NZ customer service:
P: 0800 657 720
info@optimed.co.nz
Craig 0275 657 200 or Robert 0275 657 720
For standard anterior scans no addiional lens or
adapters are required. An addiional adapter can
be provided allowing this device to produce
images as seen below
Position the patient and press the START button to acquire
examinations of both eyes.
Small system footprint, single USB cable connection, various
operator and patient positions allow to install SOCT
Copernicus REVO even in the smallest examination room.
Variety of review and analysis tools give the operator a choice
of using it as a screening or as an advanced diagnostic device.
The noise reduction technology provides the nest details
proven to be important for early disease detection
Feb 2016
NEW ZEALAND OPTICS
13

ACO- OCT
2016 enrolling
now
Yesterday
2016 is now well underway and I am sure
everyone has enjoyed the Festive Season
and New Year. It’s a great time in New
Zealand. Summer finally arrives and we are
treated to some of the best apricots, plums
and cherries that one can find anywhere on the
planet. We finally shed the damp winter, enjoy
great times at the beach and share fun and happy
moments with friends and family.
Professionally, I like to take stock of the eye care
world, review the past and look into what the
future has in store.
Next year it will be thirty years since I first sat
on the Johnson & Jonson Vision Care Advisory
Board (AB). It seems hard to believe that we’ve
had disposable contact lenses for so long. It was
only when going through some old papers a few
months ago that I came across the original AB
contract from 1987. South Africa was the first
market outside the US to have access to the
revolutionary Acuvue disposable contact lens.
The renowned Stan Yamane came out to South
Africa from Jacksonville to help us launch the lens.
In those days, the lenses came in a hard plastic
“clamshell” box containing six lenses in an early
version of the now-familiar, foil blister pack. It was
quite a contrast to the glass vials and crimped vial
caps of conventional soft lens packaging.
I quickly got into converting a lot of patients to
Acuvue, with great results.
In those days the original etafilcon A (58% water
content Acuvue lens with a Dk/L of around 25
units) was approved for extended wear (EW) in the
US. It was promoted as a one-week EW modality.
We were not keen on EW. The lens did not
meet our standard for satisfactory oxygen
transmissibility, as we were already familiar with
the Holden-Mertz criteria (Dk/L 87 units). which
had been published in 1984. On top of that, we
were practising at an altitude of around 1400m
so the equivalent oxygen percentage was around
17%, compared to 21% at sea level. The partial
oxygen pressure that drives oxygen through a
gas permeable material was reduced. Avoiding
hypoxia and its resultant complications was
tantamount to our philosophy—first, do no harm.
We thus insisted on using the lens as a twoweek
daily wear disposable. In time that modality
stuck and we still use Acuvue lenses on that
basis. It was also a lens that had UV protection
built in and suited our high UV environment and
outdoor lifestyle. It was a high water lens that
had satisfactory oxygen performance for daily
wear: transmissibility was comparable to the
custom-made 60% water content Duragel and
Biogel lenses we were using at the time. It was
way ahead of the lathe-cut and spun-cast low
Dk HEMA 38% water content lenses, which were
typically used for a year or two, all too often for as
long as three years or more!
We soon saw the benefits of frequent
replacement!
We did have issues, as we still do today,
with disinfecting solutions. In some cases, the
solutions still contained the mercury-based
thimerosal disinfectant, and the Acuvue polymer
was not suited to our default system of thermal
disinfection in unpreserved drip-saline.
In March 1990, the president of the Northern
Transvaal Rugby Union, based at the legendary
Loftus Versveld rugby ground, called into our
practice with an urgent request. He had in tow a
famous Australian rugby player who had lost his
soft contact lens. He urgently needed another in
order to play the Springboks in what was known
as a “rebel tour” after the world had cut ties with
South Africa due the apartheid regime. There was
an arms embargo, sanctions and a sports ban
in place. The famous Aussie player told me how
it was costing him about AUD$120 a pop every
time he lost a lens. He was amazed when I gave
him a six-pack of lenses that cost a mere 10 ZAR
per lens. Back then the Rand was strong so it was
in real terms about AUD$5 per lens. That’s a hell
of a lot cheaper than AUD$120 he was paying
for conventional lenses at the time! He was
impressed with the comfort and vision and the
fact that he could have a few spares in his kit bag,
ready to go. He later became a spokesperson for
Acuvue in Australia.
One-day disposables entered the fray In 1996, in
the form of 1-Day Acuvue, and the rest is history.
They were still pretty pricey back then, but I was
convinced that daily disposables were the way to
go. In 1998, I decided to convert all my soft lens
patients, wherever possible, to one-day lenses. We
set up favourable deals to provide patients with a
bulk supply of dailies at a very competitive price.
The majority of problems and contact lens
complications disappeared and we rarely saw
patients for unscheduled visits. Many of those I
fitted then are still loyal and happy patients today.
I’ve spent much of the past two decades
promoting the benefits of daily disposables in my
writing and lectures. I won’t repeat it here, but
here are two links to some international journal
articles I’ve published on this topic.
I got into hot water in my first In Contact column
(as referred to in my, 20th Anniversary edition) for
too strongly voicing my opinion on such issues as
Beware Extended Wear, and being critical of the
use of low Dk lenses. At that stage the HEMA 38
Hydron Z6, usually prescribed for a year or two was
the “standard of care”. I’d spent much effort trying
to convince colleagues that high-water lenses and
disposables were the way to go. Many saw the
light, but it’s taken a lot longer to spread the word
and the job is not yet complete.
Just a few years ago daily disposable use
in the US was in single digit percentages. In
2010 the American Academy of Optometry
(AAO) summarily rejected our paper on Daily
Disposables as having ‘limited appeal’. The very
next year however they’d seen the light and
Jason Nichols gave a detailed talk on the subject.
Etty Bitton, Associate Professor of Optometry at
Montreal University, had asked me if she could
co-present this paper with me in 2010, having
heard me deliver the talk in Paris the year before.
She was also surprised they’d rejected us. It was
however heartening to hear her finally present
the guts of this talk at the AAO in New Orleans
in October 2015, where she made reference to
this story.
Today
The US market for dallies has grown significantly
but lingers behind Denmark, Australia and New
Zealand, among others.
These days the majority of fits, in many markets,
are in silicone hydrogel daily, two-week or
monthly lenses.
Oxygen is hardly an issue anymore.
Of course we still have other issues to contend
with.
Alcon’s DAILIES TOTAL1 has had a significant
impact on the market. It appears that for a
number of prescribers it is the go-to lens, with
excellent results. Observing responses of a group
of US optometrists, it would seem that ACUVUE
OASYS 1-Day is also impressing patients and
prescribers. We hope to soon be able to judge for
ourselves.
I have been very impressed with great results
in some tricky patients with high cyls, where
the around-the-clock -2.75cyl Acuvue Oasys for
Astigmatism is making a significant difference
in acuity and stability. It’s pleasing to see one
company with a -2.75 cyl Si-Hy lens.
Tomorrow
What else will we see in 2016?
B+L will release their Ultra Si-Hy monthly
disposable which is also delivering promising
reports. They will also launch their Biotrue
ONEday multifocal. I’m not sure what Cooper
Vision has planned but hopefully they will at last
launch their XR range of Biofinity Torics, which will
be a boon for tricky eyes.
Will we see a smart lens with broader appeal
than Triggerfish? Will we see a drug eluting
contact lens? These are some of the trends I will
cover throughout the year but space limitations
preclude much more this month.
Another issue close to my heart are the
problems associated with make-up, cosmetics,
moisturised liquid hand soaps and contact lens
complications: lens surface contamination,
greasing up, tear film instability, MGD and
allergic/toxic reactions go hand-in-hand with
their use in contact lens wearers. I’ll get into that
too as there’s now some ‘evidence base’ to back it
up. Hopefully my fanatical ranting’s on the subject
for so many years will be taken more seriously
in our evidence-base obsessed culture. Maybe
there’s a new psychological syndrome, EBOD or
Evidence Base Obsessive Disorder?
Sometimes practitioners don’t see the wood for
the trees.
There’s no substitute for experience, careful
observation and history taking, symptomology
and the application of deductive skills.
Anecdotal these observations may be, but what
more do you need than to observe cause and
affect on real live patients?
As The Doors once wrote “keep your eyes on the
road, your hands upon the wheel.”
Here’s to a great 2016 for all. ▀
The Australian
College of
Optometry
(ACO) has opened
enrolments for its
annual Certificate in
Ocular Therapeutics
(ACO-COT) course.
The 2016 course
commences on April
18 and is designed
to ensure graduates
from both sides of the
Tasman are suitably
qualified to prescribe
Optometrist John Adam
soon to complete the ACO-
COT course
and administer medicines for ocular conditions.
Auckland optometrist John Adam joined the
course last year after considering it for a number
of years.
“To be relevant and useful to our aging
community…it will be imperative that optometry
takes a leading role in eye healthcare as well as
vision care. With that in mind, I felt I needed the
training and qualifications to recognise, diagnose
and treat certain medical conditions associated
with eyes,” he explained. “I also specialise in
contact lens correction and appreciate the ability
to prescribe if necessary for lens-related issues,
rather than sending people to the pharmacy to
get OCT medication that I can’t prescribe.”
Adam said he selected ACO’s course because
it fitted well around running his practice, Adam
Optometrists in Remuera, and his family time. “It
was well suited to a sole practitioner who could
study after work and have lectures online in the
evening rather than having to take off valuable time
from my business day….and I have not missed out
on too much golf.”
The only criticism he had was that the legal side
was too Australian focused, but this has been
changed for the 2016 course with more New
Zealand-centric legal content.
The year-long course is designed for remote
learning with local clinical placements and
assessments. It has also been accredited for
60 CPD points in New Zealand upon successful
completion of the certificate.
For more information, see ACO’s ad on page 3. ▀
BTP, Bailey
Sun and
Rodenstock
Specsavers Gisborne wins Asia-Pacific
The Federation of Asia-Pacific Retailers
Association (FAPRA) awarded Gisborne
Specsavers its top customer service
Nick Whittingham, Tania Richards (third from right)
and the team at Gisborne Specsavers
excellence award in its bi-annual awards
programme.
Retailers from 17 countries, including Singapore,
Thailand, Malaysia, Indonesia, Vietnam, the
Philippines, China, Hong Kong, Chinese Taipei,
Japan, Korea, Australia, New Zealand, India,
Mongolia, Fiji and Turkey, were nominated by
their respective national retail associations.
“We define customer service as going the
extra mile to help customers understand their
needs and to provide the best solution for
each individual,” says Gisborne Specsavers codirector
Tania Richards. “To achieve this, we are
friendly and approachable, carefully listening
to our customers and treating each one as an
individual. Then using up-to-date technology, we
demonstrate a number of solutions that will suit
their needs and their budget.”
Gisborne Specsavers was nominated for the
Asia-Pacific award after winning three prizes
in Retail NZ’s Top Shop Awards last year: the
Central North Island – fashion and footwear
category; the Central North Island regional
overall winner; and the Overall National
Supreme Top Shop Award for the country.
Dispensing optician Tania Richards runs the
Gisborne store with business partner, optometrist
Nick Whittingham who, upon receiving the
Supreme Top Shop award for New Zealand said: “I
used to think that retail was easy, just treat people
how you’d like to be treated yourself. That’s not
good enough now. We all do more than that.” ▀
Ogi Eyewear brand Seraphin has launched Bailey
Sun, described as “a butterfly sunglass with a
bounty of style points.
“It’s dolled up design—curved feminine profile,
diamond-shaped raised accents, and signature
silver hinge accents—showcases a first-rate
sunglass suited for a superstar.”
Bailey Sun is available in New Zealand in three
pearlescent colour options from BTP International
Designz.
• In other news, Whakatane-based BTP has picked
up distribution for Rodenstock’s brands including
Porsche Design, Rocco, Mercedes-Benz and Claudia
Schiffer. Rodenstock was previously distributed by
Pacific Eyewear, now in liquidation (see story p6). ▀
14 NEW ZEALAND OPTICS Feb 2016

Low vision adventures in Israel
BY NAOMI MELTZER*
Going from New Zealand to Hadassah
Hospital in Jerusalem in September 2015, I
imagined there would be armed guards at
every entrance searching bags and checking IDs.
Security was not the problem. Finding my way to
the Michaelson Institute in the main building of
Hadassah’s sprawling campus outside Jerusalem,
was the problem.
The Michaelson Institute is a multi-disciplinary,
low-vision clinic staffed by ophthalmologists,
optometrists, a social worker, a genetic counsellor
and a very experienced rehabilitation instructor.
Hadassah is a teaching hospital where all medical
students, particularly ophthalmology registrars,
attend a lecture on low vision as part of their
course. The lecture is given in a mix of Hebrew,
Arabic and English. Fortunately, instead of letter
charts they use number charts, and I was able to
learn my numbers in Hebrew very quickly this way.
Israel, though not a wealthy country, has a social
welfare scheme for people with low vision and
blindness, based on visual and financial need.
Those with very severe loss (less than 6/120)
receive a benefit similar to New Zealand’s disability
benefit. However, those with low vision between
6/12 and 6/120 or less than 20 degrees visual
fields, including homonymous hemianopia, receive
a means-tested subsidy from the government,
which pays for between 50% and 90% of consulting
fees and cost of low vision devices, depending on
their income.
The Israeli technology I was keen to learn about
was the OrCam device for those with really
significant loss of vision. This head-mounted device
is worn with a transmitter, strapped to a belt or
carried in a bag, and a small attachment worn on
a finger. The device recognises objects through a
smart camera, mounted on your glasses, and speaks
through an earpiece. Patients can activate OrCam
by pointing the device at text or a product, or by
pushing a button while looking in the direction of
text, a face or product. These options allow for even
a blind person to operate it, according to the sales
team, although they add that it is not suitable for
everyone and requires training. The sales team also
concede that the better the vision, the easier it is to
learn to use it, which correlates with the advice of
colleagues at Hadassah, who pointed out that if you
have sufficient vision to use it, you would usually use
other cheaper and more readily available technology.
I visited other Low Vision clinics in Israel. I was
introduced to new lens technology designed
Hadassah Hospital, Jerusalem
specifically for people with macular degeneration,
but suitable for other low vision situations as well,
which I hope will be available here shortly.
For reading and other near tasks there is a special
type of magnifying spectacle which incorporates
three LED lights beautifully aligned with the point
of focus. These come in a range of magnifications
and are supplied with a USB cable-charger. For
distance, there are spectacle lenses which give a
small amount of magnification and a tinted filter
to enhance contrast. Another advance is a spectacle
prescription lens which shifts the image to a better
seeing point on the retina.
I was hoping to find a centre for rehabilitation
of stroke and traumatic brain injury victims at
Hadassah. Unfortunately, despite my research
on the internet indicating such a centre exists, in
reality this turned out to be a small research team
in the neuro-ophthalmology department.
I did, however, finally manage to meet up briefly
with the one person who seemed to know the
most about visual rehabilitation, Haya Shames.
This optometrist takes some clients privately for
rehabilitation, while also doing a PhD in Posterior
Cortical Atrophy. PCA is a very interesting type of
Alzheimer’s disease which strikes at an earlier age
(about 50 to 60 years old) and affects a person’s
ability to read because the part of the brain which is
responsible for reading—not just seeing—is affected
first. People in the early stages often do the rounds
of optometrists and ophthalmologists complaining
they can’t read and are told there is nothing wrong
with the health of their eyes or with their vision,
which indeed is quite normal when tested on a
(high-contrast) distance single letter chart. In my
limited experience (n=2) of this condition, maximal
enhancement of contrast can be of great assistance
New appointments
at Essilor Australia
in the early stages when the patient still has the
cognitive ability to read but is struggling.
Overall, the experience of living and working in
such a different environment was wonderful and
confirmed for me that there is always something
new or different to be absorbed particularly in
low vision where so much relies on observation of
and communication with the client, whatever
Abbott rebrands
Revitalens
Abbott Medical Optics has rebranded
its premium Revitalens multipurpose
disinfecting solution brand to bring all
its contact lens solutions under its well-known
Complete brand.
Now called Complete Revitalens MPDS, the
rebranded product has been available since the
beginning of this year. According to a company
announcement the “solution provides proven
peroxide quality disinfection with advanced
Ocutec Duel Cleansing action, for 16hr long
Complete Dry Eye
Solutions: diagnosis and
therapeutic treatment options
• Oculus Keratograph 5M
Diagnostic Dry Eye Assessment
Meibo-scan
• Infra Red LED
Imaging
• Blue & White LED
TF-Scan
• White LED
OrCam is a tiny camera that can help visually impaired
people recognise and interpret the world around them
TF-Scan, R-scan
• White or IR Placido-ring
* Naomi Meltzer is a rehabilitation
optometrist with Sight Loss
Services. She was the recipient
of the Valda Knight Memorial
Scholarship, awarded by the NZ
branch of Hadassah International
to assist a New Zealand medical
professional to study their
particular area of interest at
Hadassah Hospital in Jerusalem.
lasting comfort….The formulation removes lipid
and proteins to condition the contact lens.”
Recent studies by the company show,
Complete Revitalens has a significantly lower
(up to four times lower) incident of adverse
events and lower rate of solution-induced
corneal staining and, perhaps most importantly,
is still effective with even the most noncompliant
patients.
More details about the findings of these
studies can be found on Abbott’s website. ▀
their age. ▀
Freecall: 0800 338 800
Eric Breda has been appointed general
manager for Independents & Affiliated
Optometry, Essilor Australia. Another key
appointment is that of Laurent Soudier who has
joined the company as operations director.
Breda joined the Essilor Australia team in August
taking direct responsibility for driving Essilor’s
organic growth objectives across the independent
optometry market through effective strategic
partnering and relationship management. Well
known in the industry, Breda more recently
held the position of business director ANZ with
Transitions Optical for more than ten years. During
this time, the company not only saw tremendous
sales growth, but also the establishment of
the Transitions Lenses brand in the psyche of
Australian and New Zealand consumers. Prior to
Eric Breda
Laurent Soudier
joining Transitions Optical in 1999, he held various
marketing related roles and holds a Bachelor of
Business degree, majoring in marketing.
Soudier joins the team from Essilor Greater
China where he has held the role of senior
director, Operations and I.T. He returns for what
is his third working period in Australia, after
several years working overseas and has been with
Essilor for an impressive 28 years. According to
a company announcement he brings with him
an extensive amount of insight, knowledge and
expertise to the Australia market. Soudier holds
a master degree in engineering (CNAM Poitoux
Charentes).
In his new role Soudier will take charge
of, and be responsible for, all manufacturing
processes and activities across Australia and
New Zealand, including
the branch laboratory
network, supply chain
and logistics, quality
assurance, maintenance
and the cluster’s offshoring
strategy. He will
be directly responsible
for defining and
implementing the core
operational strategies to
ensure reliable quality
and great service to all
our customers,
said Essilor. ▀
• Blephasteam
Therapeutic heat and moisture treatment for the relief
of Meibomian Gland Disfunction and associated diseases
• Optimel
Antibacterial Honey Eye Drops
for improved ocular surface health
and reduced inflammation
www.designsforvision.co.nz
A division of Paragon Care Group of Companies
Feb 2016
NEW ZEALAND OPTICS
15

SPECIALIST SHOPFITTERS & dESIgnERS TO THE OPTOMETRIC PROFESSIOn
TEL:(09) 486-2070 MOB:(0274) 798-798
Email: tony.maddocks@xtra.co.nz
practicE For salE
Get double-digit earnings without the seat and toil of a CBD
location. Enjoy the superior work-life balance of the countryside,
while still within an easy drive of divilisation in downtown
Auckland. Ideally suited to an optometrist breaking out on their
own, or breaking back into the business after maternity leave or
OE, or a dispenser-optometrist team. Yes, double-digit earnings,
and potential for even more growth. If this sounds like something
you’d like to pursue, please apply in strictest confidence c/- NZ
Optics, info@nzoptics.co.nz Code PFSS1.
tErritory salEs managErs—nZ
• Highly motivated.
• Proven sales experience.
• Excellent communication skills.
• Proven optical knowledge.
• Sound understanding of eyesight tests.
• Brand management experience.
• Product placement experience.
• Starting Remuneration—commission only + sales related
expenses.
• Highly achievable sales targets.
• Earn in access of $75K p.a.
• Must have own car.
Role for the right sales person, will eventually merge in to a
more comprehensive job description with a retainer, and plus an
attractive commission base.
Contact: One Vision Australasia Pty Ltd. Call +61 423 229 297
optical assistant—part-timE
We are looking for preferably experienced, friendly, selfmotivated,
organised staff-member to join our team at OPSM
Lincoln North.
If you like helping people, taking initiative and are passionate
about eye care, fashion and customer service, this role is for you.
This is a part-time position and would suit person who is
wheeling to work flexible hours.
Please e-mail your your cover letter and C.V. to
Stephen.Hill@opsm.co.nz
Exciting partnErship
opportunity at
Buchanan optomEtrists
Buchanan Optometrists is an independent, well established
practice in Christchurch, which provides a high level of
professionalism and service. We are looking for a full time
optometrist to join our business with a view to a partnership
opportunity. Buchanan Optometrists prides itself in providing a
great customer experience, so we are looking for the right person
to join us in this key role.
The practice is equipped with the latest Nidek 4 in 1 (autorefractor,
keratometer, pachymeter, tonometer), Nidek automatic
phoropter, Zeiss OCT, Zeiss retinal camera, topographer and
Medmont VFA.
You will have the opportunity to develop professionally with
Ortho-K. We encourage professional development and encourage
CPD opportunities in NZ and overseas. We see quite a lot of
pathology as we are located within a medical centre, and we also
have a fantastic range of frames.
We are looking for an optometrist who has a keen interest in
optometry and wants to develop professionally. The candidate
must be therapeutically endorsed, have a minimum of 2 years
experience, be comfortable working as a sole optometrist in the
practice, and have an interest in business ownership. We have a
great team, and we have a lot of fun. Optom hours are 8.30 – 5.00
Monday - Friday, late night Thursday (6.30pm); no Saturdays or
Sundays. Appointment times are every 30 minutes.
This is a rare opportunity to be part of an enjoyable profitable
practice. The partnership structure includes a competitive salary
and the opportunity to buy shares progressively in the business
and so be rewarded for your hard work and enthusiasm.
Please email ian@buchanan-optometrists.co.nz to find out more.
All enquiries will be treated with utmost confidence.
customEr sErvicE pErson
rEquirEd
Here’s a chance to work in a great independent Optometry
practice in Newmarket. We are looking for an amazing passionate
customer service person for a fulltime role with a potential
career path. You need to be efficent, totally customer focussed,
well presented, able to multitask and absolutely love beautiful
eyewear. If you reckon you’ve got what it takes to work in our
busy practice please email your CV to jeremy@gateseyewear.co.nz
EquipmEnt For salE
Topcon Chair and stand, phoroptor, slit lamp, keratometer,
hydraulic table, projector, NCT, Matrix, trial lens set— all in good
condition. Contact c/- info@nzoptics.co.nz, Code: EQFS12
odoB appointment
The Optometrists and
Dispensing Opticians
Board (ODOB) has
appointed Joanne
Talbot as one of two lay
members.
Talbot, replaces lay member
Kiri Rikihana, who was also
the board deputy chair. The
board will elect a new chair and
deputy chair at its first meeting
of the year in February.
Talbot, a health policy
Joanne talbot
consultant, brings more than
15 years' experience to ODOB.
She spent five years developing Deaf Child Worldwide (DCW),
a non-governmental organisation that provides technical and
educational resources for deaf children and their families in
developing countries.
She returned to New Zealand in 2005, working for the Ministry
of Social Development as a senior policy analyst on the Working
Age People’s Policy Team, before moving to Australia where she
worked as the Policy Manager at the Consumer Health Forum of
Australia (CHF).
Between 2013 and 2015, Talbot lived in Tonga where she was
vice president of the Tonga Red Cross Society, while undertaking
a range of voluntary work and independent research, before
returning once again to New Zealand.
Talbot has a bachelor of arts from Bristol University and a
Certificate in Business Administration and a post-graduate
diploma in Public Health from Massey University.
In addition to her ODOB appointment, Talbot sits on the New
Zealand Psychologists Board.
Whether you are looking for new staff, to sell
your practice or buy some equipment, NZ
Optics classified page connects you.
For all your advertising needs email
lesley@nzoptics.co.nz or
(for classifieds only) do it online at
www.nzoptics.co.nz
NZ Optics supporting New Zealand’s
ophthalmic community for
more than 30 years
20 16 NEW ZEALAND OPTICS
February 2016 2016