Feb 2016

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PO BOX 106 954, AUCKLAND CITY 1143<br />

Email: info@nzoptics.co.nz Website: www.nzoptics.co.nz<br />

FEBRUARY <strong>2016</strong><br />

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ALWAYS READ THE LABEL, USE ONLY AS DIRECTED. References: 1. Powell H, Hoong L, Kilvington S, Lam A, Lonnen J. Evaporation effects on the efficacy of contact lens multipurpose solutions. Poster presented at: British Contact Lens Association’s 34th Clinical Conference and Exhibition; May 27-30, 2010; Birmingham,<br />

UK. 2. Data on file – 131, 2011. Abbott Medical Optics Inc. Santa Ana, CA. Global multi-site clinical assessment of RevitaLens OcuTec MPDS. Abbott Medical Optics – Australia: Abbott Medical Optics 299 Lane Cove Road, Macquarie Park, NSW 2113, Australia. Phone: 1800 266 111. New Zealand: Abbott Medical Optics (AMO<br />

Australia Pty Ltd) PO Box 401, Shortland Street, Auckland, 1140. Phone: 0800 266 700. © <strong>2016</strong> Abbott Medical Optics Inc. COMPLETE RevitaLens, OcuTec and the COMPLETE logo are trademarks owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. PP2015CN0184 TAPS PP7485 WH AMO20065_NZO

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REFERENCES: 1. Data on File, Bausch & Lomb Inc. Results from a 21 investigator, multi-site study of Biotrue ONEday lenses, with a total of 414 eligible subjects (210 daily disposable lens wearers, 204 planned replacement lens wearers). After 7 days of wear, subjects completed an online survey. Consumers rated Biotrue ONEday<br />

lens performance across a range of attributes and compared the performance to their habitual lenses. 2. Data on File, Bausch & Lomb Inc. Twenty-two subjects participated in a randomised, double-masked, contralateral eye study to evaluate water loss of Biotrue ONEday, 1-Day ACUVUE MOIST, and 1-Day ACUVUE TruEye. After 4, 8,<br />

12, and 16 hours of wear, lenses were removed and immediately weighed (wet weight). The lenses were then completely dried and reweighed (dry weight). The percent water loss was then calculated for each lens from the wet and dry weights (Statistically signifi cant.) 3. Data on File, Bausch & Lomb Inc. Results of in vitro study in which<br />

Biotrue ONEday, 1-Day ACUVUE Moist, DAILIES AquaComfort Plus, and 1-Day ACUVUE TruEye lenses were allowed to dehydrate under the same ambient conditions of approximately 72°F with a relative humidity of 30% (Statistically signifi cant.) 4. Brennan NA. A model of oxygen fl ux through contact lenses. Cornea. 2001;20(1):104-108<br />

5. Data on File, Bausch & Lomb Inc. UV Warning – Helps protect against transmission of harmful UV radiation to the cornea and into the eye. * WARNING: UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses because they do not completely cover the eye<br />

and surrounding area. The effectiveness of wearing UV-absorbing contact lenses in preventing or reducing the incidence of ocular disorders associated with exposure to UV light has not been established at this time. You should continue to<br />

use UV-absorbing eyewear as directed. NOTE: Long-term exposure to UV radiation is one of the risk factors associated with cataracts. Exposure is based on a number of factors such as environmental conditions (altitude, geography, cloud<br />

cover) and personal factors (extent and nature of outdoor activities). UV-blocking contact lenses help provide protection against harmful UV radiation. However, clinical studies have not been done to demonstrate that wearing UV-blocking<br />

contact lenses reduces the risk of developing cataracts or other eye disorders. Consult your eye care professional for more information. © 2013 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its<br />

affi liates. Other product names /brand names are trademarks of their respective owners. Bausch & Lomb (NZ) Ltd c/- Bell Gully Auckland, Vero Centre, 48 Shortland Street, Auckland 1140, New Zealand. Marketed by Radiant Health Ltd. 0508 RADIANT.<br />

2 NEW ZEALAND OPTICS <strong>Feb</strong> <strong>2016</strong>

What’s coming…<br />

The New Year is well underway, but what does the next 12 months hold in store.<br />

NZ Optics took a peek through the looking glass.<br />


Morgenrot Eyewear employing the latest 3D laser-sintered eyewear technology<br />

Technology, new materials and styles in<br />

eyewear, research into common— and less<br />

common — conditions and advances in<br />

contact lens technology and education: wherever<br />

you look in this constantly changing world of vision<br />

health and eye care there are new developments<br />

on the horizon. In New Zealand, there’s a new<br />

course in the making for dispensing opticians,<br />

there are new material developments in contact<br />

lenses and there’s the exciting potential of OCT<br />

angiography.<br />

New tech affects change<br />

Wherever you look, technology is helping us better<br />

understand what is going on inside the eye, while<br />

significantly changing the examination room from<br />

what it was just a few years ago.<br />

“It’s definitely slowly evolving with new<br />

technology,” says Tim Way, managing director<br />

of well-known Kiwi distributor Ophthalmic<br />

Instrument Company (OIC). “Optometrists are<br />

working smarter now, spending more time with<br />

the patient in the examination room.”<br />

Technology is also making the examination<br />

process faster. Trained frontline staff, especially<br />

dispensing opticians, are more commonly using<br />

auto-refractors or four-in-one units to prescreen<br />

patients. Measurement data is taken far<br />

quicker than the old days of handling individual<br />

keratometers, tonometers and the like. That data<br />

gives the optometrist a starting point for refraction,<br />

so they can put a scrip directly into a trial frame and<br />

that speeds up the actual refraction itself, says Way.<br />

But the evolution of diagnostic instruments is<br />

also changing the information that practices can<br />

collect, especially Optical Coherence Topography.<br />

“OCT is rapidly becoming a basic feature,” Way<br />

says. Of the three kinds of OCT on the market<br />

today—Time Domain, Spectral Domain and the<br />

more recent and promising Scanned Spectrum—<br />

Way says he believes Spectral Domain continues to<br />

give optometrists the basic diagnostic information<br />

they require at a lower price than the alternatives.<br />

It remains to be seen how other technologies,<br />

such as OCT angiography, which helps to visualise<br />

blood flow in the retina and choroid capillary<br />

network without the need for an injected dye, will<br />

change the examination room still further.<br />

“OCT angiography has a lot of support but it’s<br />

not mainstream in ophthalmology yet,” Way says.<br />

“There remains a lot to be seen on how useful it is.<br />

There are a lot more studies that need to come out.<br />

It is definitely an emerging technology, though.”<br />

No matter how promising the technology,<br />

there will be unavoidable barriers to adoption.<br />

Femtosecond laser assisted cataract surgery, for<br />

example, will not replace phacoemulsification any<br />

time soon because the laser equipment requires a<br />

separate, temperature controlled space.<br />

“I think it’s a platform that still needs to be<br />

refined,” Way says.<br />

Framework<br />

Eyewear trends, so reliant on taste, are never easy<br />

to predict. New fabrication techniques and mixed<br />

materials, however, are becoming more prevalent,<br />

with 3D printing at the cutting edge.<br />

As Mark Collman of Phoenix Eyewear explains,<br />

there are two kinds of 3D printing relevant to the<br />

optometry practice.<br />

“What is being used to produce frames is 3D<br />

laser sintering, so a fusion process using a laser<br />

to bond particles and build a<br />

three dimensional object which<br />

is strong and accurate. This<br />

allows for thin light frames,<br />

with perfect reproduction and<br />

consistency. The common 3D<br />

office or home printer is using<br />

a liquid which then forms an<br />

object which can be intricate<br />

but not nearly good enough<br />

to make a robust optical<br />

frame from. This is a gap and<br />

the challenge going forward.<br />

It will be some time before<br />

3D printers are sophisticated<br />

enough to replicate what the<br />

laser sintering devices can<br />

produce.”<br />

Collman says the process<br />

is among the more exciting<br />

trends emerging in the market.<br />

“I still believe 3D laser<br />

sintered frames are the most innovative and<br />

advanced use of technology currently in the<br />

eyewear business. However acetate is a beautiful<br />

material to work with and the colours available are<br />

limitless. The new laminates and effects coming<br />

through can be simply amazing. Also stainless<br />

steel is being cut thinner and frames are becoming<br />

lighter.”<br />

Light, is probably the catchphrase of design going<br />

into <strong>2016</strong>.<br />

“People want frames to look and feel light on<br />

the face,” says Collman. “In terms of shapes, softer<br />

profiles are edging in and there are more round<br />

shapes coming too. I think we will see thinner rims,<br />

more use of lightweight materials (titanium and<br />

stainless steel on metals, thin acetate and T90 on<br />

plastics). Retro is still evident with the younger<br />

brands but seemingly less important than last year.”<br />

Wood frames, meanwhile, may not last as a trend<br />

as the material tends to deteriorate over time.<br />

New Zealand at one time may have lagged<br />

behind larger overseas markets, but that has also<br />

changed, Collman says.<br />

“Nowadays (the lag time is) very short. In fact,<br />

with some collections I brought samples back from<br />

Silmo with me, we previewed to accounts and<br />

delivered this week — meaning a total lag of only<br />

nine weeks.”<br />

Dry eye<br />

Researchers are<br />

predicted to continue<br />

to make strides in<br />

treating the spectrum<br />

of dry eye causes<br />

and symptoms.<br />

New treatments<br />

and approaches are<br />

developing over time,<br />

but there will never<br />

be a one-size-fits all<br />

approach.<br />

“Dry eye is<br />

multifactorial. With<br />

Jennifer Craig<br />

so many causes I<br />

don’t think we’re ever<br />

going to get a single therapy that’s going to resolve<br />

the signs and symptoms for all patients,” says<br />

Associate Professor Jennifer Craig. “Use of novel<br />

technology such as intense pulsed light (IPL) has<br />

certainly gathered momentum over the last year<br />

with many more practices offering this modality as<br />

a solution to meibomian gland dysfunction (MGD).<br />

However, we would benefit from an improved<br />

understanding of the mechanisms to better predict<br />

the effect it might have on an individual patient.”<br />

Research will continue to be the key to figuring<br />

out which approaches work best, says Craig.<br />

“Identifying a single best therapy is difficult in<br />

the absence of scientific evidence comparing the<br />

different therapies side-by-side. Heat application<br />

remains the most commonly recommended<br />

therapy and, if applied consistently over an<br />

extended period of weeks to months, remains a<br />

viable option in terms of symptom resolution for<br />

many patients. However, treatments such as IPL<br />

and thermal pulsation (Lipiflow) that are reported<br />

in the literature to have beneficial effects beyond<br />

the application period certainly have appeal in<br />

overcoming compliance issues.”<br />

Craig heads the Ocular Surface Laboratory<br />

(OSL) at the University of Auckland. Its team of<br />


An exciting year ahead<br />

Welcome back. We hope you had a great<br />

break and are still enjoying the sun,<br />

sea and school holidays. Well, maybe<br />

not the lattermost so much. But then again<br />

there’s nothing better than jumping off your<br />

local wharf with your family, while a dozen or<br />

more teenagers look on somewhat incredulously<br />

as you abandon all traces of age (and decorum)<br />

and plummet into the sea from a great height.<br />

A new year is not just refreshing, it brings with<br />

it a delightful optimism. It also brings a host of<br />

exciting new developments in whatever world<br />

you’re in and this couldn’t be truer than in the<br />

ever-changing world of eye care. NZ Optics’<br />

editor Simon Eskow touches on some of these<br />

in his feature What’s coming… which starts on<br />

this page, while our columnist Alan Saks takes<br />

a closer look at what’s in store in the world of<br />

contact lenses in <strong>2016</strong> in his In Contact<br />

column (p14).<br />

As well as material developments and<br />

technology advancements, New Zealand’s eye<br />

care education scene is going to be given a<br />

boost this year with a new Ocular Therapeutics<br />

Conference, designed by the clever people at<br />

the University of Auckland’s Buchanan Ocular<br />

Therapeutics Unit, and, hopefully, a more heavy<br />

weight dispensing optician’s qualification put<br />

together by our very own Waikato Institute of<br />

Technology and ADONZ.<br />

In fact DOs, optometrists and ophthalmologists<br />

are spoilt for choice by the number of events<br />

available to them this year, both at home and<br />

abroad, including the latest from our own<br />

wholesalers at the biennial Visionz conference in<br />

Auckland in October. And we’ll be doing our best<br />

to cover it all, featuring those who do attend, for<br />

all those others who perhaps can’t make it<br />

this year.<br />

Here at NZ Optics we are always on the lookout<br />

for what’s new and we warmly welcome your<br />

comments, views and news about anything in<br />


Wharf jumping. Photo - MarlboroughNZ<br />

the optical world. Perhaps you’d even like to<br />

pen your own piece about your experiences,<br />

as rehabilitation optometrist Naomi Meltzer<br />

kindly did for this issue on her adventures at the<br />

Hadassah Hospital in Jerusalem.<br />

Whatever it is about, Simon and I would love to<br />

hear from you as we enter this new year with a<br />

little more knowledge and a lot more calm than<br />

we had when we took up the reins of NZ Optics<br />

last year.<br />

Happy New Year.<br />

Lesley Springall, publisher, NZ Optics<br />

<strong>Feb</strong> <strong>2016</strong><br />



News<br />

in brief<br />


Less than half of US adults with diabetes recognise their risk for vision<br />

loss. The survey, conducted by Everyday Health’s Market Research<br />

Group on behalf of Regeneron Pharmaceuticals, showed 18% of<br />

respondents said they were familiar with diabetic macular edema;<br />

but 30% reported they don’t get an annual comprehensive dilated<br />

eye exam. Of respondents who don’t get an eye exam, 56% were<br />

unaware the exam could help protect against vision loss associated<br />

with diabetes.<br />

Abbott and Toomac pair up in NZ<br />

Vision care products company Abbott<br />

Medical Optics and Kiwi ophthalmic<br />

instrument supplier Toomac<br />

Ophthalmic have formed a partnership to<br />

boost each other’s marketing efforts and<br />

provide a more complete service in<br />

New Zealand.<br />

The newly formed partnership had its<br />

first (somewhat subtle) outing at the 2015<br />

RANZCO Scientific Congress in Wellington<br />

towards the end of last year, when the two<br />

companies shared two halves of a large stand<br />

with a combined seating bar at the front.<br />

“We’ve got the lenses and they’ve got<br />

the devices. So if a customer wants to deal<br />

with just one supplier to source a complete<br />

package, we can now offer that,” says<br />

Matthew Northage, Abbott’s NZ account<br />

manager.<br />

“Matthew can only see so many customers<br />

as working in ophthalmology sales is<br />

quite time intense, so for us to enter into<br />

an agreement with a well-known and<br />

long-established supplier of ophthalmic<br />

equipment and devices in New Zealand<br />

really broadens our reach,” says Christian<br />

Oster, Abbott’s Australia and New Zealand<br />

product manager.<br />

Toomac director Ian MacFarlane admits<br />

he’s quite excited about the opportunity.<br />

“We’ve been working on this for some<br />

time as we see synergies between both<br />

companies.”<br />

Where Abbott has the phacoemulsification<br />

system, Toomac has the microscopes, and<br />

where Abbott has the IOLs, Toomac has<br />

the Lenstar, providing highly accurate<br />

optical biometry data of the entire eye,<br />

says MacFarlane. “I think both companies<br />

can work in harmony and provide a better<br />

overall solution to customers.”<br />

The partnership kicked off officially at the<br />

beginning of this year and will be monitored<br />

to ensure it’s beneficial to both companies<br />

and customers alike, says MacFarlane. ▀<br />


US Researchers have identified three genes that may influence<br />

susceptibility to primary open angle glaucoma. In a paper published<br />

in Nature Genetics, the researchers identified the TXNRD2, ATXN2<br />

and FOXC1 genes. The study found the mitochondrial dysfunction of<br />

TXNRD2, the protein that naturally regulates the production of a reactive<br />

oxygen species in cells, can lead to glaucoma. Also, genetic variants<br />

located in regions that regulate ATXN2 expression can be associated<br />

with primary open angle glaucoma, while expression changes of FOXC1<br />

may not lead to early onset glaucoma, but may contribute to milder,<br />

later-onset disease. The researchers are hoping to use their findings to<br />

develop gene-based testing and treatment strategies for glaucoma.<br />


OphthaliX, a subsidiary of Israel-based Can-Fite BioPharma, has<br />

completed patient enrollment for its Phase II trial of CF101, a novel,<br />

small-molecule orally-bioavailable drug for treating glaucoma. The<br />

Phase II tests are being run in Europe and Israel, with results expected<br />

by mid-<strong>2016</strong>. CF101 is an A3 adenosine receptor (A3AR) agonist, which<br />

binds to A3AR, known to over-express in inflammatory cells. The drug<br />

acts as a neuro-protective agent and prevents apoptosis of retinal<br />

ganglion cells. The drug’s mechanism of action has been validated in a<br />

University College London study, which showed the A3AR agonist has<br />

a neuroprotective effect in the eye via inhibition of retinal ganglion cell<br />

apoptosis resulting in a significant decrease in intraocular pressure.<br />


Increasing evidence supports the use of anti-VEGF agents in the<br />

treatment of retinopathies, according to Dr Mary Elizabeth Hartnett<br />

of the University of Utah, speaking at the Advanced Retinal Therapy<br />

meeting in Vienna in December. Multiple case series and small<br />

trials found efficacy in anti-VEGF agents reducing intravitreal<br />

neovascularization and facilitating physiologic retinal vascular<br />

development in some cases, she said, but, safety concerns remain over<br />

their use in infants, requiring further investigation. “Serum VEGF is<br />

reduced for 2 months after injections, a time that may be crucial for<br />

the development of kidneys, brain and lungs. VEGF is also a survival<br />

factor for photoreceptors and Müller cells. On the bright side, there is<br />

less myopia after anti-VEGF than laser, but we need more studies.”<br />


Roche and Upsher-Smith Laboratories, through its wholly-owned<br />

UK subsidiary Proximagen, announced a worldwide agreement for<br />

the further development of a novel, oral small molecule inhibitor of<br />

Vascular Adhesion Protein 1 (VAP-1), a cell-adhesion molecule that<br />

may be effective in the treatment of inflammatory disease. The VAP-1<br />

inhibitor is currently in Phase II clinical development. Roche now has<br />

exclusive license to develop and commercialise the compound, and will<br />

conduct additional Phase II studies with Proximagen to further define<br />

the therapeutic potential of the VAP-1 inhibitor.<br />


Valeant Pharmaceuticals may seek buyers for its specialty contact<br />

lens manufacturing division, Paragon Vision Sciences, amid scrutiny<br />

from the US Federal Trade Commission. The sale of Paragon, which<br />

Valeant’s Bausch & Lomb unit purchased in 2015, would deal a<br />

blow to the company’s attempt to consolidate the market for<br />

gas permeable contact lenses. The FTC has been investigating<br />

Valeant for potentially cornering this portion of the lens market<br />

and is concerned Valeant has allegedly been using this market<br />

power to raise prices for the raw materials used in contact lens<br />

manufacturing, in some cases by more than 100%. If Paragon were<br />

an independent company, it would control about half the market for<br />

ortho-K lenses.<br />


University of Illinois bioengineering professor Dipanjan Pan and US<br />

ophthalmologist Dr Leanne Labriola have teamed up to develop an<br />

inexpensive portable vitamin C sensor, called OcuCheck, to quickly<br />

determine if an eye injury is mild or severe. “The sensor takes<br />

advantage of the fact that the ocular tear film contains low levels<br />

of ascorbic acid, which is just vitamin C, while the interior of the eye<br />

contains much higher levels,” said Pan. “So if there is severe damage to<br />

the eye, the ascorbic acid will leak out in high concentration.” Pan and<br />

Labriola have founded a new company, InnSight Technology, to bring<br />

the device to market.<br />


Bausch + Lomb has expanded its specialty lens business with the<br />

addition of Alden Optical Laboratories, a manufacturer of premium<br />

specialty and custom soft and gas permeable contact lenses.<br />

The expanded business, known as Bausch + Lomb Specialty Vision<br />

Products will be dedicated to delivering innovative products,<br />

education, and training for ECPs in the specialty and custom contact<br />

lens space, said B+L in a statement in January. ▀<br />


researchers is currently working<br />

on a number of clinical and labbased<br />

projects, ranging from dry<br />

eye clinical trials to pre-clinical<br />

evaluations of a novel therapy<br />

to treat microbial keratitis. Craig<br />

describes three of the projects:<br />

••<br />

“Our interest in developing a<br />

Manuka Honey-based topical<br />

formulation to promote<br />

eyelid health continues.<br />

After satisfying safety and<br />

tolerability requirements<br />

through preclinical and<br />

clinical studies, we are now<br />

evaluating the efficacy of the<br />

product in reducing signs<br />

and symptoms of dry eye<br />

associated with lid margin<br />

conditions such as MGD<br />

and anterior blepharitis in a<br />

larger-scale clinical trial.<br />

••<br />

“We are also continuing<br />

our research into treatment<br />

of MGD with IPL. As<br />

already noted, IPL has<br />

proven benefits, but the<br />

mechanism(s) of action<br />

remain poorly understood.<br />

We are working to resolve<br />

this, by evaluating a range of<br />

tear film and ocular surface<br />

parameters before and after<br />

treatment, in a prospective,<br />

double-masked, placebo<br />

controlled, clinical trial.<br />

••<br />

“Further research on<br />

Demodex, and the impact of<br />

demodecosis on the ocular<br />

surface, is also ongoing,<br />

with a view to improving<br />

diagnosis and management<br />

for affected patients.<br />

“These investigations and trials<br />

have either begun or are due to<br />

commence shortly,” Craig says.<br />


23> 26 SEPT. <strong>2016</strong><br />


“We welcome referral of patients<br />

with relevant clinical signs who<br />

are interested in participating in<br />

any of our trials.”<br />

Prospective participants who<br />

meet the inclusion criteria<br />

will be reviewed at the OSL<br />

to determine eligibility to<br />

participate. Participants are<br />

entitled to receive treatment at<br />

no charge, and petrol vouchers<br />

to offset travel costs may be<br />

offered in some trials.<br />

Read more about dry eye<br />

developments in our special<br />

feature planned for NZ Optics<br />

October issue.<br />

Contact lenses<br />

Jagrut Lallu expecting some big<br />

advances in CL materials<br />

At one point it may have<br />

seemed that daily disposable<br />

contact lenses were the<br />

crowning achievement in<br />

contact lens development. But<br />

that’s not true, especially in the<br />

development of new materials,<br />

applications and technologies,<br />

say some specialists.<br />

“All contact lens companies are<br />

working on projects at present<br />

GRAND OPENING – 23 SEPT. <strong>2016</strong><br />

Conception : CARLIN<br />


which are developing the<br />

contact lens material market,”<br />

says Jagrut Lallu of Visque Rose<br />

Optometrists in Hamilton. “The<br />

next couple of years we will see<br />

a whole range of new products<br />

come to the fore.<br />

“We will be seeing more<br />

in the way of material and<br />

optics advances with new<br />

combinations of materials<br />

in daily modality becoming<br />

available, as well as wider ranges<br />

of prescriptions making contact<br />

lenses more available to more of<br />

the population. There is always<br />

something new on the horizon.”<br />

Lallu says among the<br />

more exciting emerging<br />

developments in contact lenses<br />

are multifocal optics and<br />

aberration control.<br />

“There is a growing trend for<br />

centre-near designs moderated<br />

by pupil size hitting both the<br />

rigid and soft lens markets,”<br />

he says. “Scleral contact<br />

lenses seem to be making a<br />

reappearance with multifocal<br />

fitting and it will be interesting<br />

to see how these affect New<br />

Zealand practitioners. The<br />

newest designs appear to be<br />

useful for all optometrists,<br />

not just specialist contact lens<br />

fitters.”<br />

Developments in contact<br />

lens fabrication will give more<br />

patients the option to use<br />

contact lenses.<br />

“More and more cases are now<br />

coming to light which were not<br />

traditional contact lens wearers<br />

in the past,” Lallu says. “This is<br />

due to the new geometries that<br />

lathes can cut as well as the<br />

optics that we can achieve on<br />

high-Dk materials.”<br />

Meanwhile, patients<br />

wearing contact lenses for<br />

myopia control have a new<br />

friend in atropine.<br />

“The growing amount of<br />

evidence-based medicine<br />

around myopia management<br />

is certainly exciting,” says<br />

Lallu. “Most treatments for<br />

this condition have centred<br />

around the contact lens<br />

modality, however in our clinic<br />

we are noticing promising<br />

results with the use of low<br />

dose atropine.” See more on<br />

expected developments in<br />

contact lenses in Alan Saks’ In<br />

Contact column on p14.<br />

Education<br />

The New Zealand dispensing<br />

opticians’ association ADONZ<br />

continues its work with the<br />

Waikato Institute of Technology<br />

(WinTec) to develop a diploma<br />

level dispensing optician<br />

qualification based in New<br />

Zealand and more closely<br />

aligned with the British-based<br />

qualification.<br />

“We are still very much on<br />

track with our plans,” says<br />

ADONZ President Peggy<br />

Savage. “We, on WinTec’s<br />

behalf, have sent out a survey<br />

to all members and this<br />

feedback is vital for moving<br />

forward. We met WinTec the<br />

first week of December and the<br />

timeframe is on track.”<br />

If all continues as planned,<br />

the new curriculum will be<br />

offered as a distance learning<br />

course beginning the first<br />

semester of <strong>2016</strong>, which starts<br />

in July.<br />

ADONZ is also looking forward<br />

to hosting the International<br />

Opticians Association’s (IOA’s)<br />

32nd Biennial Convention in<br />

Auckland, to run in conjunction<br />

with ADONZ’s annual<br />

conference.<br />

“As Vanessa Cumming is<br />

the (current) IOA President,<br />

we are working with her to<br />

showcase how we run our<br />

annual conference and the<br />

level of education it provides to<br />

our DO’s, and also show off our<br />

country,” Savage says.<br />

But, she adds, ADONZ’s<br />

main focus for <strong>2016</strong> will be its<br />

education provider, the quality<br />

of education and the possibility<br />

of NZQA recognition.<br />

“This is a crucial time looking<br />

ahead as we further explore all<br />

possibilities, suitable providers<br />

and costs, which we began<br />

in 2011 under Andrew Judd’s<br />

presidency.”<br />

Other educational highlights<br />

for <strong>2016</strong> include Visionz <strong>2016</strong><br />

in Auckland in October and a<br />

brand new conference on Ocular<br />

Therapeutics in April (see story<br />

this issue) as well as a host<br />

of opportunities from the<br />

country’s ophthalmological<br />

practices. Check out the<br />

calendar of events on NZ Optics<br />

website http://www.nzoptics.<br />

co.nz/calendar to see more on<br />

what’s coming up this year. ▀<br />

www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand<br />

For general enquiries, please email info@nzoptics.co.nz<br />

For editorial and classifieds, please contact Simon Eskow, editor, at 027 288 5401 or<br />

editor@nzoptics.co.nz.<br />

For advertising, marketing, the OIG and everything else, please contact Lesley<br />

Springall, publisher, at 027 445 3543 or lesley@nzoptics.co.nz.<br />

To submit artwork, or to query a graphic, please email kirsten.newton@outlook.co.nz<br />

and copy in Lesley.<br />

NZ Optics magazine is the industry publication for New Zealand’s ophthalmic<br />

community. It is published monthly, 11 times a year, by New Zealand Optics 2015 Ltd.<br />

Copyright is held by NZ Optics 2015 Ltd. As well as the magazine and the website,<br />

NZ Optics publishes the annual New Zealand Optical Information Guide (OIG), a<br />

comprehensive listing guide that profiles the products and services of the industry. NZ<br />

Optics is an independent publication and has no affiliation with any organisations. The<br />

views expressed in this publication are not necessarily those of NZ Optics (2015) Ltd.<br />

4 NEW ZEALAND OPTICS <strong>Feb</strong> <strong>2016</strong>


UK OPTOMS!<br />



Go to<br />

spectrum-blog.com<br />

for all the current<br />

opportunities!<br />

With a significant shortage of optometrists being<br />

experienced across the optometry profession<br />

in metro, regional and rural areas, we’re calling<br />

all UK and Irish optometrists currently in<br />

New Zealand and Australia to talk to us. We have a<br />

wide range of opportunities for you to consider.<br />

Across the two countries this year we will open<br />

15 new stores and expand a further 65 stores<br />

with additional consulting rooms and the latest<br />

automated equipment – and we need to beef up<br />

our professional team to meet demand, as it rises.<br />

About you<br />

You’re an OCANZ qualified optometrist and already<br />

working (or due to work) for the length of your<br />

current working visa – but you would like to stay<br />

on for longer, or even permanently.<br />

We can help<br />

If that sounds like you, we should talk.<br />

Lately, more and more OCANZ qualified UK<br />

and Irish optometrists are asking us about<br />

staying in either New Zealand or Australia<br />

for the longer term and we have the<br />

roles available to make that goal a reality<br />

in both countries.<br />

Let’s get the conversation started<br />

Whatever your goal, both short and longer<br />

term, now’s the time to talk to our professional<br />

recruitment team members about the options for<br />

employed and partnership roles – they’re ready to<br />

talk to you right now.<br />

In the first instance contact Raj Sundarjee on<br />

0800 773 077 or raj.sundarjee@specsavers.com<br />

NZ Franchise<br />

System of<br />

the Year<br />

2014<br />

Retail<br />

Innovator<br />

of the Year<br />

2014<br />

Multichannel<br />

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of the Year<br />

2014<br />

Roy Morgan<br />

Research<br />

No. 1 for eye tests<br />

2014<br />

FCA International<br />

Franchisor<br />

of the Year<br />

2014<br />

FCA Social<br />

Responsibility<br />

Award<br />

2014<br />

FCA Established<br />

Franchisor<br />

of the Year<br />

2013<br />

FCA Excellence<br />

in Marketing<br />

Award Winner<br />

2013<br />

Australian<br />

Retailer<br />

of the Year<br />

2013<br />

Australian<br />

Retail Employer<br />

of the Year<br />

2013<br />

Asia-Pacific Best<br />

Retail Training<br />

Organisation<br />

2013<br />

<strong>Feb</strong> <strong>2016</strong><br />



Focus<br />

on Business<br />




If robust Health and Safety isn’t on your list of New Year’s<br />

resolutions—it should be.<br />

Employers generally know if they have an effective Health<br />

and Safety culture or whether it is more of a tick the box, do<br />

the bare minimum and ‘she’ll be right’ mentality. Once you’ve<br />

introduced a Health and Safety policy and set up processes for<br />

hazard monitoring and accident reporting, it’s easy to become<br />

complacent and assume everyone will get on with it.<br />

We travel overseas to places where it seems nobody has heard<br />

of Occupational Safety and Health (OSH) and see some high risk<br />

stuff we are very confident would never happen here. But the Pike<br />

River Mine tragedy happened here and up to mid-November 2015,<br />

35 people died in workplace accidents in New Zealand (provisional<br />

figures). The average for the last six years is 52 fatalities per year.<br />

Although these figures have steadily decreased since the high of 77<br />

fatalities in 2010, we still have a lot of progress to make in this area.<br />

Although the optometry sector does not instantly come to mind<br />

as one fraught with life threatening hazards, it is important that<br />

we do not allow this to make us complacent. OSH is an area of<br />

management that requires constant vigilance, commitment and<br />

transparent leadership from the top. Managers and employees<br />

focus much of their energy on performance-based measurements.<br />

There needs to be continuous and genuine messages from business<br />

owners and across the sector as a whole, that OSH matters as<br />

much as other aspects of performance. We will measure it, report<br />

on it, reward good practice and take action for poor performance.<br />

This is exactly the emphasis of the Health and Safety at Work<br />

Act 2015, which is due to come into effect on April 4 <strong>2016</strong> this<br />

year. Directors of optometry practices will need to step up and<br />

be proactive in Health and Safety as new rigorous accountability<br />

measures are enacted.<br />

The Act focusses on the obligations of a “person conducting a<br />

business or undertaking” (PCBU), as well as the responsibilities of<br />

Officers and Directors. There is a primary duty on a PCBU to ensure,<br />

as far as reasonably practicable, the safety of workers and others<br />

associated with the work carried out by the PCBU. In many ways<br />

this is not so different from the current responsibility on employers.<br />

What’s new is the positive due diligence duty imposed on<br />

officers of PCBUs. This means that those in governance roles must<br />

proactively manage Health and Safety and this duty is individual<br />

to Officers, not just the entity as a whole. The intent is that the<br />

duty lies with the people in the best position to control Health<br />

and Safety and these obligations cannot be contracted away.<br />

Directors and Officers will need to:<br />

••<br />

Keep their knowledge of health and safety matters up to date<br />

••<br />

Understand the nature of operations of the PCBU and<br />

associated risks and hazards<br />

••<br />

Ensure the PCBU has and uses appropriate resources to<br />

eliminate or minimise risks to work-related health and safety<br />

••<br />

Verify the provision and use of resources<br />

••<br />

Ensure the PCBU has appropriate processes for receiving and<br />

considering information regarding incidents, hazards and<br />

risks; and for responding in a timely way<br />

••<br />

Ensure the PCBU has and implements processes for complying<br />

with its obligations under the Act<br />

The Act introduces significantly increased penalties for<br />

individual PCBU Officers, body corporates and workers. There is<br />

also renewed emphasis on worker participation with a duty to<br />

involve and engage workers on Health and Safety. This includes<br />

the implementation of participation practices appropriate to the<br />

size and level of risk in the workplace.<br />

Now is the time to start thinking about Health and Safety in<br />

your practice and how it will stack up under the new legislation.<br />

Some things you can implement now:<br />

••<br />

Familiarise yourself with the key concepts of the new legislation<br />

••<br />

Review your health and safety practices, both for your staff<br />

and visitors<br />

••<br />

Identify health and safety risks in your business and take steps<br />

to prevent them from causing harm<br />

••<br />

Lead by example<br />

••<br />

Make health and safety a part of your workplace culture<br />

••<br />

Document all of the above!<br />

You can get detailed information about the Act from the Worksafe<br />

New Zealand website (www.business.govt.nz/worksafe/). If you<br />

are managing OSH well, there should be no need to be greatly<br />

concerned by the new legislation. If you know there are weaknesses<br />

in your current management of Health and Safety, act now—don’t<br />

wait until the new law is in place. ▀<br />

* David Pearson is Managing Partner with BDO Napier and has a<br />

speciality interest in Advisory Services to the optometry sector.<br />

For more information contact David at david.pearson@bdo.<br />

co.nz or visit www.BDO.co.nz<br />

Kimberly McKay, Human Resource Consultant<br />

at BDO, also contributed to this article.<br />

For more information contact Kimberly at<br />

kimberly.mckay@bdo.co.nz.<br />

New conference: the<br />

practical side of therapeutics<br />

BOTU Director Dr Ilva Rupenthal<br />

Ever wondered what all those other<br />

ingredients in an eye formulation<br />

are doing there? Or perhaps why<br />

you have to shake some medications<br />

before giving them? Or why you treat<br />

some conditions with drops and others<br />

with ointments or gels?<br />

The practical side of ocular therapeutics<br />

is being tackled in a new conference, aptly<br />

named the Ocular Therapeutics Conference,<br />

on April 10 at the Waipuna Hotel and<br />

Conference Centre in Auckland.<br />

Organised by the Buchanan Ocular<br />

Therapeutics Unit (BOTU), Department<br />

BOTU turns two<br />

The Buchanan Ocular Therapeutics<br />

Unit (BOTU) at the University of<br />

Auckland was a long time in the<br />

planning before Dr Ilva Rupenthal came<br />

along.<br />

“Charles McGhee and Trevor Gray<br />

had been talking for years about<br />

doing something in the area of Ocular<br />

Therapeutics,” says Rupenthal, who has<br />

led BOTU since its launch in 2013.<br />

Then Rupenthal met Gray at the CCLS<br />

Conference in 2012, where she gave a<br />

presentation on pharmaceuticals and<br />

ophthalmology and finally the unit<br />

began to take shape.<br />

BOTU was established to develop and<br />

translate ocular therapeutic-related<br />

scientific research into the clinical<br />

setting whether pharmaceutical-, cell- or<br />

technology-based. Rupenthal currently<br />

leads a team of six PhD students and one<br />

post-doctoral candidate in the University’s<br />

Department of Ophthalmology.<br />

BOTU’s researchers have already<br />

published 16 papers and produced more<br />

than 30 conference abstracts with seven<br />

invited-presentations nationally and<br />

internationally.<br />

“It’s been an absolutely amazing time,”<br />

says Rupenthal. “I’ve had great support<br />

establishing the unit and I have a great<br />

team doing all this amazing work.”<br />

BOTU started off with a $2.4 million<br />

grant from the Buchanan Charitable<br />

Foundation founded by Drs Trevor and<br />

Caroline Gray. BOTU subsequently<br />

received additional support from the<br />

Health Research Council, the Paykel Trust<br />

and the Save Sight Society.<br />

The unit’s current projects are all at<br />

the beginning stages, Rupenthal says,<br />

of Ophthalmology, at the University<br />

of Auckland, the conference is<br />

aimed at optometrists, (especially<br />

those trained or with an interest in<br />

therapeutics) ophthalmologists, trainee<br />

ophthalmologists, ophthalmic nurses<br />

and pharmacists.<br />

BOTU Director Dr Ilva Rupenthal says<br />

this conference is an opportunity for<br />

eye care professionals and budding eye<br />

care professionals to learn how and why<br />

therapeutics are applied in the clinic. “A<br />

lot of this is not well-known or taught, but<br />

it’s something that’s really important to<br />

understand.”<br />

Established two years ago (see<br />

accompanying story) BOTU has two remits:<br />

to undertake new research into ocular<br />

therapeutics and to educate professionals<br />

about therapeutics and their use. Rupenthal<br />

says a conference has been mooted since<br />

the unit’s establishment, but what form<br />

that would take has been a little while<br />

in the planning. “The establishment<br />

of the unit took quite a bit of time and<br />

research was given the priority—getting<br />

PhD students in and getting the research<br />

and mainly focus on the development<br />

of stimuli-responsive implants for drug<br />

delivery to the back of the eye. Other<br />

projects involve creating an ex vivo<br />

penetration model for Novaliq, a German<br />

company developing artificial eye drops<br />

based on semifluorinated alkanes, and<br />

developing a Manuka honey-based<br />

ointment for the management of<br />

blepharitis in conjunction with University<br />

of Auckland’s Associate Professor Jennifer<br />

Craig. Finally, in collaboration with<br />

Professor Colin Green, the unit is also<br />

looking into an alternative to anti-VEGF<br />

agents for repairing leaky blood vessels<br />

in the treatment of AMD and diabetic<br />

retinopathy.<br />

“There is so much going on in this field<br />

at the moment,” Rupenthal says. “I love<br />

that I’m doing a job where I might help<br />

people, even if it’s 20 years down the line.”<br />

See associated story on BOTU’s<br />

inaugural Ocular Therapeutics<br />

Conference above. ▀<br />

Pacific Eyewear liquidation<br />

Frames wholesaler Pacific Eyewear has<br />

gone into liquidation.<br />

The Albany-based company,<br />

bought in 2007 by David Betham,<br />

ceased trading on December 1, when<br />

Betham appointed Auckland chartered<br />

accountants Rodgers Reidy as liquidator.<br />

According to the first liquidator’s report,<br />

published on the Companies Office<br />

website, Betham advised, “that the reason<br />

for insolvency was due to difficult trading<br />

conditions, in particular cash flow issues<br />

and a lack of working capital.”<br />

The report went on to say that the<br />

liquidators will attempt to sell the assets<br />

of the company and “a large number of<br />

optical frames have been uplifted and are<br />

BOTU team members include (rear, L to R)<br />

Frazer Coutinho, Ilva Rupenthal, Rohit Bisht<br />

(front, L to R) Priyanka Agarwal, Erica Chen,<br />

Odunayo Rotimi and Naveed Yasin<br />

currently being valued by the liquidators<br />

auctioneers.”<br />

Pacific Eyewear’s brands included Vanni,<br />

Dutz, l.a.Eye Works, Dior, Yves St. Laurent<br />

and others. NZ Optics has learned that at<br />

least one of the brands, Vanni, has been<br />

taken up by another wholesaler, Little<br />

Peach, while Dior was picked up by VMD<br />

earlier last year to sit alongside its other<br />

Safilo Group licensed brands.<br />

l.a.Eye Works, Rodenstock and other<br />

brands were listed among the 20 or so<br />

creditors.<br />

Betham said l.a.Eye Works has decided<br />

to sell directly to clients in New Zealand,<br />

while he will continue as an agent for<br />

Bellinger House. ▀<br />

started—and now we’re focusing on the<br />

teaching side of things.”<br />

Other speakers at the conference include<br />

Professor Charles McGhee, Associate<br />

Professor Jennifer Craig and a number of<br />

ophthalmologists, including Dr Trevor Gray,<br />

whose Buchanan Charitable Foundation<br />

made the establishment of the unit possible<br />

in the first place.<br />

As well as providing some context about<br />

the history of ocular therapeutics, the key<br />

ingredients and why they are there and the<br />

key differences between different forms of<br />

therapeutics, the programme also includes<br />

sessions on how drugs are approved, or not,<br />

in New Zealand; an overview of glaucoma<br />

drugs and corticosteroids and their<br />

alternatives; and a look at what’s exciting<br />

and new coming down the pipeline.<br />

The conference will be run as a notfor-profit<br />

event—free to students and<br />

academics, while others will be charged a<br />

low fee to cover the costs of hosting the<br />

conference.<br />

For more information keep an eye on your<br />

in-box as details will be emailed to<br />

NZ Optics subscribers shortly. ▀<br />

Surf’s up<br />

at Grylls<br />

Keleher<br />

The surf’s up at Grylls Keleher & Matthews<br />

Optometrists in Kapiti with their Hawaiianthemed<br />

summer window display winning<br />

Maui Jim’s summer window competition.<br />

The team at Grylls Keleher net themselves a<br />

neat $2,500 prize package of super cool Maui Jim<br />

sunglasses for their efforts, which included not just<br />

the wonderful window display, but also a clever<br />

Facebook promotion. Each Matthews’ practice is<br />

giving away a $500 value Maui Jim prize pack—<br />

which includes a pair of Maui Jim sunglasses, a<br />

Maui Jim cap, a Maui Jim t-shirt, a cricket set and a<br />

complimentary eye exam—to one lucky customer. ▀<br />

What to do<br />

about Alcon<br />

Pharmaceutical giant Novartis has been<br />

struggling to figure out what to do with<br />

its troubled Alcon subsidiary.<br />

Alcon’s sales have been on the decline since<br />

2014, slipping 12% quarter-on-quarter to<br />

US$2.35 billion in the third-quarter last year.<br />

The company’s woes have been attributed to,<br />

among other things, slumping revenue from<br />

intraocular lens (IOL) implants and a slumping<br />

over-the-counter contact lens solutions<br />

business. Additionally, patent protection for<br />

Alcon’s Travatan Z glaucoma treatment ended<br />

in December, opening the door to further<br />

diminished revenues from generic brand<br />

competition.<br />

Novartis announced it would unveil an<br />

“innovation-heavy, growth acceleration<br />

programme” for Alcon as part of its 2015<br />

financial results meeting on January 27,<br />

countering earlier reports it was selling the<br />

division.<br />

Financial speculators say the sale of Alcon<br />

could make Novartis between US$1 billion and<br />

US$1.6 billion. ▀<br />

6 NEW ZEALAND OPTICS <strong>Feb</strong> <strong>2016</strong>

St. George’s Eye Care opens doors<br />

St. George’s Hospital in Christchurch opened<br />

the doors to its purpose-built eye care<br />

facility in November.<br />

The hospital says the facility was established<br />

to extend ophthalmology services to more<br />

patients at a lower price than elsewhere in the<br />

private sector.<br />

“St. George’s has a long standing commitment<br />

to develop and extend its service offer to meet<br />

the needs of those in the community who<br />

require surgical or specialist healthcare,” says<br />

hospital Chief Executive Greg Brooks. “The<br />

decision to establish a specialist eye care service<br />

within the St George’s offering is a reflection of<br />

a commitment to provide world-class eye care to<br />

those who need it, together with the surety of<br />

patients’ ongoing care that comes with working<br />

alongside primary eye care professionals.”<br />

St. George’s had been planning the eye care<br />

facility for more than a year before its opening.<br />

The hospital conducted an international<br />

search for staff, including two in-house<br />

ophthalmologists, and has hired Dr Ralph Lim<br />

as St. George’s Eye Care clinical director and Dr<br />

Wilfried Rademaker.<br />

“St. George’s is the first private hospital in<br />

New Zealand to recruit specialist in-house<br />

ophthalmologists,” says Brooks. “This model<br />

delivers a number of efficiencies that makes the<br />

surgical services significantly more affordable<br />

for patients. For example, St George’s provides<br />

cataract surgery at 30% below what was being<br />

charged in the private healthcare sector prior to<br />

opening its doors.”<br />

Lim has ten years’ experience in medical and<br />

surgical care of the eye, including a residency<br />

at the Doheny Eye Institute in California and,<br />

serving under some of the most challenging<br />

conditions during his career as a flight surgeon<br />

with the US Air Force in Iraq.<br />

Lim started his medical training in Kansas<br />

City, followed by an internship in Columbus,<br />

before he secured a residence in ophthalmology<br />

at Doheny Eye Institute, which was recently<br />

named as one of the five leading ophthalmology<br />

institutes among 5,000 hospitals in the<br />

United States.<br />

Rademaker graduated from medical school in<br />

Germany. He went on to receive his specialist<br />

training in the US, including at the Johns<br />

Hopkins Wilmer Eye<br />

Institute in Baltimore,<br />

Maryland, one of the<br />

highest-rated medical<br />

facilities in the US.<br />

Rademaker moved to<br />

New Zealand in 2009 and<br />

worked in Wellington<br />

and in a number of DHBs<br />

in a locum capacity after a<br />

long tenure as the chief of<br />

outpatient services at the<br />

King Khaled Eye Specialist<br />

Hospital in Riyadh,<br />

Saudi Arabia.<br />

Rademaker brings special<br />

interest in managing<br />

conditions affecting the cornea, external eye<br />

disease and glaucoma to St. George’s Eye Care.<br />

The 450-square-metre facility has six consulting<br />

rooms with state-of-the-art specialist equipment.<br />

“All waiting areas are well-appointed with<br />

appropriate lighting and privacy,” says Brooks.<br />

“The flow between consultation rooms, waiting<br />

rooms and treatment rooms has been thought<br />

Dr Wilfried Rademaker<br />

Dr Ralph Lim<br />

through to ensure minimal inconvenience and<br />

increased efficiencies for patients.”<br />

St. George’s is a registered charity and may<br />

provide philanthropic support to patients<br />

who otherwise may not be able to access the<br />

specialist care they require. Applications for<br />

Treatment Support Grants can be made through<br />

the patient’s referring optometrist or GP. ▀<br />

Behavioural<br />

optometry<br />

practice launches<br />

A<br />

former partner at Orewa Optics, north of Auckland, has gone<br />

into solo practice as a pure behavioural optometrist.<br />

Grant Dabb launched his new practice at the end of<br />

November, joining The Connection in Silverdale, a multidisciplinary<br />

centre with chiropractors, speech and language therapy, naturopathy,<br />

massage and nutrition.<br />

“I’ve been practising with a behavioural approach for 20 years and it’s<br />

always been a dream of mine to open a practice like this,” says Dabb.<br />

Grant Dabb Behavioural Optometrist was founded to provide a place<br />

for primary optometry care providers and other professionals to refer<br />

patients with visual conditions they are not comfortable dealing with<br />

themselves, he says. “Behavioural optometry deals particularly well with<br />

binocular vision problems, accommodation, convergence, and tracking.”<br />

It also tackles the visual processing aspects of learning disorders and<br />

brain injuries, which often includes augmenting the correct prescription<br />

with vision therapy to develop and enhance visual function.<br />

Dabb’s practice focuses on children with learning disabilities and<br />

adults who have suffered vision problems due to stroke or brain<br />

injury. His referrals come from general optometry practices, word of<br />

mouth within the community and, significantly, schools.<br />

“As an example most children with learning difficulties, genetic<br />

or developmental delays will have visual problems as part of those<br />

issues,” he says. “More of the brain is involved in processing vision<br />

than any other sense, both in terms of cell numbers and brain<br />

activity. Plus, vision is intimately linked with motor processes like<br />

picking up a cup, parking the car, making a sandwich or putting your<br />

clothes on. It’s an intrinsic and intimate part of the whole and the<br />

primary director of action and behaviour.”<br />

Dabb received behavioural optometry training through the University<br />

of New South Wales. He later continued his studies to become a<br />

Fellow of the Australasian College of Behavioural Optometry, which<br />

coordinates training for optometrists in New Zealand.<br />

He says his interest in behavioural optometry grew from<br />

a fascination with the visual process and a realisation that<br />

improvements to vision could not be explained strictly by the<br />

mechanics of lenses and prisms.<br />

“About 20 or more years ago, I realised that prescribing low plus<br />

lenses had far greater effects than could be explained by simple<br />

optics. It became clear that the lenses were working to change the<br />

way the visual system functions, not just bending light. That led me<br />

to expand the knowledge base that I had to discover how the visual<br />

system could be influenced and guided to a much greater depth than<br />

I had previously realised.”<br />

What interested Dabb specifically was treating visual problems as<br />

a neurological process that can be influenced due to neuroplasticity.<br />

Therapy can help improve the ability of patients to unconsciously<br />

process information that injury or learning difficulties have made<br />

difficult, he says.<br />

“There’s this constant interplay between peripheral and central<br />

vision. All of that information is constantly presented as light<br />

entering the pupil. But lenses, prisms and tints can shift attention<br />

(between the two), thereby changing responses and outcomes. We<br />

want the lower level functions of vision to be effortless, automatic<br />

and unconscious, leaving more resources available for the higher<br />

functions. If we think of vision as a process we can think of lenses<br />

and prisms as supporting the system, and therapy to enhance the<br />

system.”<br />

Optometrists interested in vision therapy can attend a twoday<br />

seminar in Auckland run by ACBO on March 12-13. For more<br />

information visit: https://www.acbo.org.au/professionals/menu/<br />

events/events/50-practical-vision-therapy-nz-workshop-1-<strong>2016</strong> ▀<br />

Time for renewal<br />

Sometimes you just have to clear the<br />

slate. For Geoff and Lynne Parker that<br />

time came in March last year when they<br />

re-branded the practice that is now known as<br />

Parker & Co in Newmarket, Auckland.<br />

“Geoff and I had been the co-owners of<br />

Occhiali Optical Ponsonby and Occhiali<br />

Optical Newmarket. We sold the Ponsonby<br />

store and the Occhiali brand in December<br />

2014 and then rebranded the Newmarket<br />

store in mid-March as Parker & Co Eyewear,”<br />

says Lynne. “The main reason for the redesign<br />

was the existing interior was nine<br />

years old and needed a freshen up. There also<br />

was a small dispensing area, and we wanted<br />

to expand that area to be more clientfriendly<br />

and efficient for the staff to use.”<br />

When Lynne and her optometrist husband<br />

Geoff went to rebrand the practice it had<br />

a dark earthy feel, but they wanted a<br />

contemporary modern look to match the<br />

kind of practice they were aiming to build.<br />

“We market to a wide client base of 20 to<br />

60 years in age, who want good eye care and<br />

contemporary, modern eyewear,” says Lynne.<br />

Lynne and Geoff got the inspiration for<br />

their new look from a single picture in a<br />

home magazine featuring a white table with<br />

light and plants hung above it.<br />

“That was the start of the look,” she says.<br />

“The previous shop fit style had been dark<br />

wood with magenta carpet and we wanted a<br />

more modern look that created an enjoyable<br />

environment for clients to choose glasses in.”<br />

Although the couple hired the architecture<br />

firm RCG to fit out Occhiali, Lynne and Geoff<br />

planned and managed the project this time<br />

around.<br />

Rear-illuminated display cases, white<br />

surfaces and sandstone-coloured concrete<br />

flooring lend a bright airiness to Parker &<br />

Co’s central retail space. Potted plants drape<br />

gracefully from beneath the high ceilings,<br />

creating a soft, organic bracketing effect<br />

around the grids of eyewear on display.<br />

Parker & Co carry Barton Perreira, Celine,<br />


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

Dr Andrew Riley<br />


EYE 0765<br />

Dr Penny McAllum<br />


Kilsgaard, Anne et Valentin, Kate Sylvester<br />

and other brands.<br />

“We try to align ourselves with suppliers<br />

who are like-minded and value quality, style<br />

and service. We aim to establish a long-term<br />

relationship with our suppliers and only carry<br />

between ten and 14 brands. This allows us<br />

to have more depth in the collections and<br />

really showcase the brand. We carry a variety<br />

of price points and styles within this brief.<br />

When we are taking on a new collection<br />

it has to offer something different to the<br />

brands we are currently stocking.”<br />

The practice includes one examination<br />

room and space for a second if the couple<br />

needs to expand.<br />

“Geoff loves the ability to spend more time<br />

as an independent optometrist meeting<br />

new and existing patients and being able to<br />

engage with them at a personal level,” Lynne<br />

says. “This allows him better empathy of their<br />

situations and in turn understanding of the<br />

best way to manage their care. Ultimately<br />

Geoff thrives on these inter-personal relations<br />

and his ability to help people.”<br />

Lynne works as the in-practice stylist and is<br />

responsible for finding the brands that match<br />

Parker & Co’s vision, a task that takes her to<br />

trade shows overseas.<br />

Dr Mark Donaldson<br />


Dr Shuan Dai<br />


“I love the contrast between the fashion<br />

aspect of eyewear and the technical aspects<br />

of lenses and dispensing. I enjoy the<br />

variety that is involved in owning your own<br />

business. The areas I particularly enjoy are<br />

frame buying and the concept and projectmanaging<br />

when we shop fit. On a daily basis,<br />

it’s having clients who love buying their<br />

eyewear from Parker & Co which means we<br />

have achieved our goal of providing quality<br />

eyewear and eye care.”<br />

Parker & Co embraces doing business<br />

as an independent optometry practice<br />

with a sense of liberation, says Lynne. “We<br />

think as independents we have a unique<br />

opportunity to create a niche in the eyewear<br />

market. Because we are independent we<br />

can make changes within our businesses<br />

easily, train staff to a higher level than the<br />

chain stores do and therefore offer a higher<br />

level of service because of the quality of our<br />

optometrists, dispensing staff and products.<br />

We have niched our store which is in one of<br />

New Zealand’s premium fashion shopping<br />

areas by offering eyewear that is different<br />

to what is stocked by our competitors and<br />

ensuring we have staff who are passionate<br />

about eyewear and lenses and make<br />

informed recommendations to our clients.” ▀<br />

GRAND ROUNDS - <strong>2016</strong><br />

We look forward to seeing you.<br />

23rd March - Novotel, Ellerslie<br />

8th June - Ormiston Hospital<br />

14th September - Novotel, Ellerslie<br />

No registration fee . cPD points available<br />

Visit our website for more details.<br />

Ascot Clinic (09) 520 9689 - Botany Junction (09) 277 6787<br />

www.eyedoctors.co.nz<br />

<strong>Feb</strong> <strong>2016</strong><br />





Many orthokeratology lens designs<br />

suggest that in determining a patient’s<br />

suitability for orthokeratology the<br />

astigmatic component of their prescription<br />

should be no more than half of the spherical<br />

component. With the availability of the modern<br />

topography-based toric ortho-K lens designs,<br />

this no longer holds true. This case shows how<br />

a patient with principally astigmatic refractive<br />

error can be corrected with a non-rotationally<br />

symmetrical orthokeratology lens and get clear<br />

vision throughout the day.<br />

A dentist of 33 years visited my practice,<br />

curious if orthokeratology would be appropriate<br />

for him. He had never worn contact lenses<br />

before, and was motivated as his glasses would<br />

frequently fog up and slip down during his work.<br />

His spectacle prescription was R -0.25/-1.50 x<br />

170 (6/5), L -0.25/-1.75 x 009 (6/5). Unaided<br />

vision was R 6/7.5, N4 (40cm) and L 6/10, N8<br />

(40cm).<br />

Figure 1: Initial astigmatic topographies R+L<br />

Topography shows regular with-the-rule<br />

astigmatism with ΔSimK R -1.80D, L -2.2D<br />

which is only slightly more corneal cylinder<br />

than the spectacle astigmatism present. Given<br />

that the cornea closely matched with his<br />

refraction I proceeded to design a Forge Myopia<br />

Toric orthokeratology lens for each eye using<br />

Eyespace. Trial fitting a spherical lens on eye<br />

will be of little use in this instance as the fit will<br />

need to fit very differently in each meridian to<br />

seal the cornea correctly and mold the cornea<br />

accurately.<br />

Because the spherical component of this<br />

patient’s prescription is almost zero we do<br />

not require much flattening of the cornea<br />

horizontally. As a result the lens has a tear<br />

profile very similar to an alignment fit lens in<br />

this meridian. In the steep meridian however<br />

we need to correct -1.75D of myopia hence<br />

the conventional ortho-K tear profile pattern.<br />

Research suggests that fitting a lens with a<br />

spherical base curve will correct ~50% of the<br />

corneal astigmatism present , however in my<br />

experience this percentage is closer to ~70%. In<br />

this instance we need more than 1.25D of WTR<br />

astigmatism corrected so the steep meridian’s<br />

BC is 0.1 flatter to ensure full astigmatic<br />

correction.<br />

In order to stabilise the lens on the eye the<br />

alignment curve radii match the underlying<br />

corneal topography in the same way as a bitoric<br />

RGP would. In this way a modern orthokeratology<br />

lens can be fully customised with independent<br />

toricity in the base-curve, Z-Zone (reverse curve)<br />

and the alignment curve. The left lens was<br />

designed in the same way, giving lenses with<br />

significant sagittal height difference of ~140µm<br />

between meridians.<br />

Figure 2: Eyespace simulation of each meridian of the<br />

left toric orthokeratology lens showing the almost<br />

alignment fit horizontally and more conventional<br />

ortho-K tear profile vertically<br />

Specialty contact<br />

lenses forum<br />


Figure 3: NaFl image of the left lens on eye illustrating<br />

the accuracy of the rotation simulation of Eyespace and<br />

the NaFl pattern in the steep meridian<br />

After a short period of wear to allow full<br />

stability of the refractive change the patient<br />

presented for aftercare with excellent distance<br />

vision of 6/5 R+L. Residual refraction was<br />

R +0.25/-0.25 x 180 and L plano, showing<br />

full correction of the pre-orthokeratology<br />

astigmatism. Axial difference maps of the right<br />

eye shows a characteristic ‘figure 8’ pattern of<br />

astigmatic correction that closely matches the<br />

residual refraction.<br />

Figure 4: Axial difference map showing excellent<br />

astigmatic correction<br />

The patient was very pleased with the results<br />

and was asked to return in three months for<br />

routine review. This report shows how significant<br />

astigmatism can now be successfully corrected<br />

with orthokeratology by using toric alignment and<br />

base curves to control the fit of the lens and the<br />

refractive change respectively.<br />

Much higher prescriptions than this case can<br />

also be well corrected with OK if you are prepared<br />

to get creative! The below image shows a mixed<br />

myopia (steep meridian)/ hyperopia (flat meridian)<br />

custom Ortho-K lens designed with Eyespace that<br />

corrected a patient with a spectacle prescription<br />

of R +0.75/-4.50 x 178, L +0.25/-3.50 x 12 to give<br />

6/6+ vision in each eye with no astigmatism<br />

present in the residual refraction! ▀<br />

Figure 5: Axial difference maps and NaFl photo of a lens<br />

correcting high astigmatism!<br />

A more detailed report of this case can be found<br />

at eyespace.com.au/blog<br />


1. Mountford J, Pesudovs K. An analysis of the astigmatic<br />

changes induced by accelerated orthokeratology. Clin<br />

Exp Optom. 2002 Sep;85(5):284-93.<br />


* Alex Petty is a Kiwi optometrist<br />

who graduated from the<br />

University of Auckland in 2010.<br />

He has an interest in specialty<br />

contact lenses, ortho-K and<br />

myopia control.<br />

New CEO for Auckland Eye<br />

Auckland Eye has appointed e-health<br />

management consultant Deb Boyd as their<br />

new chief executive.<br />

Previous to her recent consultancy experience,<br />

Boyd was general manager at Australia’s first<br />

fully-integrated digital hospital, St Stephens in<br />

Hervey Bay, a coastal city in southern Queensland.<br />

St Stephens opened in October 2014 and<br />

achieved HIMSS Level 6 in November 2014. HIMSS<br />

(Healthcare Information and Management Systems<br />

Society) is a global, not-for-profit organisation<br />

focused on optimising care outcomes and<br />

improving information management in hospitals<br />

through its Electronic Medical Record Adoption<br />

Model (EMRAM), which has 7 levels in total.<br />

“This was a thrilling project to be part of and to<br />

experience such incredible technology with a fully<br />

functioning EMR (Electronic Medical Record) and<br />

closed loop medication management system. It was<br />

a privilege to see first-hand the patients and staff<br />

experiences as they transitioned from old ways of<br />

doing things to successfully using new technology.”<br />

A self-confessed technophile and passionate<br />

advocate for the value technology can bring to<br />

organisations and customer care, Boyd says her key<br />

strengths are in operational management, change<br />

management, systems improvement, healthcare<br />

innovation, digital integration and developing<br />

teams. “I use transformational leadership to bring<br />

teams together and find creative solutions for<br />

success,” she says in her LinkedIn biography.<br />

Boyd’s previous roles in New Zealand include<br />

hospital manager at Southern Cross Hospital<br />

in Wellington; ward and day stay manager at<br />

Southern Cross Hospital in Christchurch; and<br />

business manager and child health services and<br />

community services manager for the Canterbury<br />

TearLab goes it alone<br />

in ANZ<br />

TearLab’s George Koukides at RANZCO 2015 in Wellington<br />

TearLab has commenced direct distribution<br />

of its ground-breaking Osmolarity System,<br />

through its manufacturing partner MiniFAB<br />

based in Scoresby, Victoria, Australia.<br />

The Osmolarity System is believed to be the<br />

first objective and quantitative point-of-care test<br />

enabling eyecare professionals to easily measure the<br />

osmolarity of human tears to diagnose and manage<br />

patients suspected of having dry eye disease.<br />

Osmolarity is a key test as recognised by the first<br />

DEWS (Dry Eye Workshop) report and previously<br />

was only able to be tested in the laboratory.<br />

Manager George Koukides, who was appointed<br />

to set up and run TearLab Australia last year, says<br />

MiniFAB wanted to get closer to the market for<br />

research and development purposes so it made<br />

sense for them to take over the distribution of the<br />

System in their own area and TearLab, based in<br />

San Diego, agreed.<br />

TearLab has been out on its own in Australia<br />

since April last year, but its first real foray into<br />

New Zealand was at RANZCO’s 2015 Scientific<br />

Auckland Eye’s new CEO Deb Boyd. (Fraser Coast Chronicle)<br />

District Health Board. According to her LinkedIn<br />

biog. she was also the owner-operator of a<br />

Brumby’s bakery franchise in Christchurch, during<br />

the time of the quakes.<br />

Her governance experience includes time on the<br />

inaugural board of Partnership Health PHO and<br />

she is a current member of the board of Health<br />

Informatics New Zealand (HiNZ).<br />

Auckland Eye’s board chair Dr Stephen Best says,<br />

“We’re delighted to have Deb at Auckland Eye and<br />

feel her vast experience in hospital management<br />

and health infomatics will be invaluable to our<br />

organisation.” ▀<br />

Congress in Wellington in November last year.<br />

“That was the start for New Zealand,” said<br />

Koukides, who expects to be visiting New Zealand<br />

on a quarterly basis from now on.<br />

Currently the TearLab system is being employed<br />

on a regular basis in New Zealand by just a<br />

handful of practitioners, he says. These include<br />

Associate Professor Jennifer Craig, who leads the<br />

Ocular Surface Laboratory at Auckland University<br />

and is the vice-chair of the Tear Film & Ocular<br />

Society’s second dry eye workshop (DEWS II); the<br />

Auckland-based Eye Institute; and Fendalton Eye<br />

Clinic in Christchurch.<br />

The TearLab system has a better predictive value<br />

for dry eye than any other test, claims Koukides,<br />

and is particularly useful for ophthalmologists<br />

in the pre-surgical workup as it identifies<br />

hyperosmolarity which can significantly affect<br />

visual acuity and K-readings and thus affects<br />

lens choice.<br />

TearLab’s system was previously distributed in<br />

New Zealand by Designs for Vision. ▀<br />

8 NEW ZEALAND OPTICS <strong>Feb</strong> <strong>2016</strong>

CCLS Conference:<br />

a new look<br />

Planning for the Cornea & Contact Lens<br />

Society (CCLS) conference began more than<br />

eight months ago, when it was decided to<br />

make some modifications to the annual event.<br />

“There were a lot of elements that work for<br />

the conference, but we wanted to try some<br />

new things such as holding the conference in<br />

Wellington,” says Anne Matheson, CCLS president.<br />

“Tony Alexander, chief economist at the BNZ, is<br />

coming in to talk about business, the economy<br />

and finance—topics which are of interest to<br />

anyone who owns a business or to anyone who<br />

gets paid, for that matter.”<br />

Whether you’re a speciality lens practitioner or<br />

work in a busy soft contact lens practice, the <strong>2016</strong><br />

conference will offer something of interest, says<br />

Matheson.<br />

Taking<br />

action on<br />

diabetes<br />

Diabetes New Zealand held its first<br />

Diabetes Action Month last November<br />

with a campaign to get Kiwis to make<br />

lifestyle changes to avoid developing the<br />

disease.<br />

The campaign included TV and print<br />

advertising, the launch of an online risk<br />

awareness tool and a national roadshow<br />

visiting 33 locations in 14 towns and<br />

cities presenting the various risk factors<br />

to the public. Among the 3,500 people<br />

that undertook the roadshow’s risk factor<br />

assessments, 68% were found to have a<br />

propensity for type 2 diabetes.<br />

“We identified almost 2,500 people who<br />

really need to see their GP for a clinical test,”<br />

Diabetes NZ chief executive Steve Crew said.<br />

The number of New Zealanders living<br />

with diabetes has doubled from 125,000 to<br />

250,000 in the past 10 years, with 40 new<br />

diagnoses every day. Moreover, approximately<br />

30% of people with diabetes have retinopathy<br />

while 10% have the disease so severely it is<br />

threatening their vision, according to the<br />

organisation.<br />

“Alarmingly there were even people scoring<br />

above 20, suggesting they are at extremely<br />

high risk for having or developing type 2<br />

diabetes and need to see their doctor,” Crews<br />

said.<br />

The risk assessment tool scored a range of<br />

factors for type 2, including ethnicity, weight<br />

and exercise traits, and recommended people<br />

scoring above 6 points to seek medical advice.<br />

The inaugural action month was designed<br />

to encourage people to know their risk and<br />

didn’t extend to medical ramifications such as<br />

blindness and amputations.<br />

Diabetes Action Month returns this<br />

November. The theme of this year’s campaign<br />

will be developed over the next few months,<br />

according to Diabetes NZ. ▀<br />

“As usual<br />

the focus will<br />

be on short<br />

presentations<br />

that get to<br />

the core of<br />

the subject<br />

meaning great<br />

take away<br />

information.”<br />

The<br />

conference<br />

will be held on<br />

Sunday March<br />

20 at Mac’s<br />



WELLINGTON MARCH 20 <strong>2016</strong><br />


CCLS <strong>2016</strong> keynote speaker<br />

Professor Fiona Stapleton<br />

Function Centre on Wellington’s waterfront. A<br />

short ride from the airport and within walking<br />

distance from major hotels, the venue is the<br />

perfect location for anyone from out of town.<br />

Delegates can fly in for the day or take some extra<br />

time to re-discover Wellington. Locals already<br />

know there is plenty of handy parking.<br />

Another innovation is the Glaucoma Workshop<br />

being held the day before the conference.<br />

The main speakers will be Wellington<br />

ophthalmologists Jesse Gale and Graham Reeves,<br />

with contributions from Professor Tony Wells and<br />

Dr Chris Murphy. The objective of the workshop is<br />

to promote safe collaborative care for glaucoma.<br />

There will be interactive discussions centring on<br />

clinical cases highlighting evidence based decision<br />

making, recognising dangerous situations and<br />

some concepts and models relevant to managing<br />

glaucoma. The workshop is only available to<br />

conference delegates, but if you do register for<br />

both, the conference registration fee will be<br />

discounted by 10%.<br />

The CCLS has a reputation for delivering a<br />

great conference and this year is no exception.<br />

In addition to the conference’s keynote speaker,<br />

Professor Fiona Stapleton, head of the School of<br />

Optometry and Vision Science at the University<br />

of New South Wales, there are excellent local<br />

speakers including Reece Hall, Greg Nel, Grant<br />

Watters, Eleisha Dudson, Reuben Gordon, Sid<br />

Ogra, John Veale and Adele Jefferies. Topics range<br />

from practice management of dry eye to updates<br />

on keratoconus. CPD points will be applied for.<br />

“One thing that won’t change is the relaxed<br />

informal atmosphere. We welcome members, non<br />

members and students to the conference” says<br />

Matheson. “We recognise that the networking<br />

time is another core element of our conferences.”<br />

For detailed information about the programme,<br />

go to http://www.contactlens.org.nz/in-focus/<br />

upcoming-events/ and to register online, go to<br />

https://www.regonline.co.nz/CCLS<strong>2016</strong> ▀<br />


Prof Fiona Stapleton, University of NSW<br />





www.contactlens.org.nz<br />

Free guidelines for kids<br />

Six paediatric optometrists have collaborated<br />

to assist Optometry Australia in producing its<br />

first Paediatric Eye Health and Vision<br />

Care Guidelines.<br />

The guidelines were developed over a ninemonth<br />

period with several teleconferences<br />

between the working group and chairman Simon<br />

Hanna, Optometry Australia’s national clinical<br />

policy adviser.<br />

Hanna said that in creating the first paediatric<br />



Run by Wellington ophthalmologists<br />

Jesse Gale, Graham Reeves, with contributions<br />

from Prof Tony Wells and Dr Chris Murphy<br />



LEVEL 2, 148 CUBA STREET<br />


9.00 AM START<br />

guidelines for members, Optometry Australia was<br />

aiming to target the wider optometric profession,<br />

encouraging and enabling more practitioners to<br />

provide paediatric clinical services, with tips and<br />

referral pathways indicated both to specialists and<br />

to experienced paediatric optometrists.<br />

Australian optometrists Rod Baker, Liz<br />

Jackson, Stephen Leslie, Tim Martin, Marissa<br />

Megaloconomos and Christine Nearchou formed<br />

the working group.<br />

“Their role was to review and comment and<br />

to suggest changes to the guidelines as a work<br />

in progress. From start to finish the project was<br />

written by Optometry Australia’s policy team<br />

and the working group members were effectively<br />

expert consultants,” said Mr Hanna. “The paediatric<br />

guidelines were developed with a full literature<br />

review to ensure an evidence-based, up-to-date<br />

document with the intention to review them at an<br />

appropriate time.”<br />

The guidelines are divided into three main<br />

parts: infants and toddlers (birth to two years 11<br />

months); pre-school children (three years to six<br />

years 11 months); and school-aged children (seven<br />

to 14 years).<br />

Paediatric Eye Health and Vision Care Guidelines<br />

is a free resource available for the optometry<br />

profession. Download the guidelines at<br />

www.optometry.org.au. ▀<br />

Pfizer-Allergan: “It’s<br />

about growth”<br />

The CEOs of Pfizer and Allergan claim their<br />

US$160 billion merger is about growth, not<br />

cost-cutting.<br />

Currently awaiting US antitrust clearance, the<br />

deal will shift Pfizer’s official headquarters for<br />

tax purposes from New York to Allergan’s base<br />

in Dublin, greatly reducing its tax rate, allowing<br />

it to access cash overseas and leading to the<br />

loss of thousands of jobs in the US, resulting in<br />

considerable criticism from several high-profile<br />

senior US lawmakers.<br />

Presidential candidate Hillary Clinton vowed<br />

to fight to reform the US tax system to stop<br />

companies doing this: “This proposed merger, and<br />

so-called inversions by other companies, will leave<br />

US taxpayers holding the bag.”<br />

The two companies hit back at the annual JP<br />

Morgan Healthcare Conference in January saying<br />

the deal is not just a tax-saving tool. “This isn’t<br />

about cost-cutting. This is about leadership<br />

and growth,” said Allergan CEO Brett Saunders,<br />

adding the companies have “lots of new drugs”<br />

in the pipeline. While Pfizer chief executive Ian<br />

Read said the companies have little overlap in<br />

their operations and both have already removed<br />

considerable excess costs. “This is going to be a<br />

powerhouse company with a strong dividend…<br />

and the best pipeline in the industry.”<br />

Some US analysts believe Allergan’s pipeline<br />

will significantly improve Pfizer’s sales and<br />

earnings growth in 2018-2020, while Allergan<br />

will benefit from Pfizer’s global salesforce, as<br />

currently less than 20% of the company’s sales<br />

come from outside the US. Many market experts,<br />

however, disagree with the claimed R&D benefits<br />

of the deal, saying the portfolios of the two<br />

companies are so diverse, it’s unlikely there<br />

will be any overlap between them to deliver<br />

better drugs.<br />

The deal, expected to close by the second half<br />

of this year, will create the world’s biggest drugmaker,<br />

worth more than US$300 billion. ▀<br />


of New Zealand Incorporated<br />

<strong>Feb</strong> <strong>2016</strong><br />



Reflections: Mike Mair<br />

Focus on<br />

Eye Research<br />

Glaucoma<br />





Kuang TM, Zhang C, Zangwill LM et al<br />

Ophthalmology 2015;122:2002-2009<br />

Review<br />

The aim of this study was to determine the<br />

diagnostic accuracy and lead time gained<br />

by retinal nerve fibre layer (RNFL) thickness<br />

measurements from OCT for detecting<br />

glaucoma before the development of visual<br />

field defects.<br />

The study included 75 eyes of 75 patients<br />

suspected of having glaucoma. These eyes all<br />

had normal baseline automated perimetry<br />

and developed repeatable (3 consecutive)<br />

abnormal visual field tests during a median<br />

follow up of 6.3 years. A control group of age<br />

matched healthy subjects was included. RNFL<br />

thickness measurements were analysed from<br />

the time of development of the earliest visual<br />

field defect and the preceding years.<br />

At the time of conversion to the earliest<br />

visual field defect, average RNFL thickness<br />

was significantly less in glaucomatous eyes<br />

compared to controls (75 vs 90 microns, p <<br />

0.001). In fact significant differences were<br />

seen 8 years before the development of visual<br />

field defects (86 vs 91 microns, p = 0.02). At<br />

95% specificity, 44% of eyes had an abnormal<br />

average RNFL thickness 2 years before a visual<br />

field defect, 35% of eyes 4 years before this,<br />

and 19% of eyes 8 years before a visual field<br />

defect.<br />

The authors concluded that assessment of<br />

RNFL thickness with OCT was able to detect<br />

glaucomatous damage before the appearance<br />

of visual field defects and often significantly<br />

large lead times was seen.<br />

Comment<br />

This is an important study that demonstrates<br />

glaucomatous damage may be seen on OCT<br />

RNFL analysis significantly earlier than the<br />

first visual field defect. This suggests that<br />

OCT is a valuable ancillary tool in monitoring<br />

glaucoma suspects and could lead to earlier<br />

diagnosis and treatment — even before the<br />

development of any visual field loss.<br />



Keenan J, Shahid H, Bourne R, et al<br />

Clinical and Experimental Ophthalmology 2015;43:221-227<br />

Review<br />

This study evaluated the Cambridge<br />

Community Optometry Glaucoma Scheme<br />

(COGS). This was initiated in 2010 to help<br />

with the demand for glaucoma services in the<br />

UK. In the scheme community optometrists<br />

with a special interest in glaucoma evaluated<br />

new referrals for suspected glaucoma. Each<br />

patient underwent a clinical assessment<br />

(including Goldmann applanation tonometry,<br />

pachymetry, optic disc photos and visual fields)<br />

by an optometrist at a remote site. A clinical<br />

decision is made as to whether a patient has<br />

glaucoma or is a suspect, and referred on or<br />

discharged as a false positive referral. The<br />

clinical findings, optic disc photos and visual<br />

fields are then electronically transmitted for<br />

virtual review by an ophthalmologist.<br />

There were 1,733 patients evaluated by<br />

scheme between 2010 and 2013. Of all the<br />

patients, the optometrist discharged 46.6%<br />

and a further 5.7% were discharged following<br />

virtual review by the ophthalmologist. Of the<br />

patients initially discharged, only 2.8% were<br />


recalled following virtual review. Following<br />

assessment at the hospital a further 10.5%<br />

were discharged after a single visit.<br />

The authors concluded that the COGS<br />

community-based glaucoma screening<br />

programme is a safe and effective way<br />

of evaluating glaucoma referrals in the<br />

community and for reducing false-positive<br />

referrals for glaucoma into the hospital<br />

system.<br />

Comment<br />

This appears to be a very effective and safe<br />

scheme that significantly reduces the number<br />

of false positive referrals to the hospital<br />

service. This scheme could be implemented<br />

by the district health boards in New Zealand<br />

and would help to reduce the ever increasing<br />

demand for glaucoma services and free<br />

up resources for managing more complex<br />

glaucoma patients.<br />



Pradhan ZS, Braganza MS, Abraham LM<br />

Journal of Glaucoma <strong>2016</strong>;25:e1-e4<br />





Dave P, Shah J<br />

British Journal of Ophthalmology 2015;99:1713–1717<br />

Review<br />

The purpose of the above studies was to<br />

determine whether the ISNT rule (Inferior ><br />

Superior > Nasal > Temporal) could be applied<br />

to the peripapillary retinal nerve fibre layer<br />

(RNFL) thickness as measured by OCT. Both<br />

were prospective cross sectional studies that<br />

included normal and early glaucomatous eyes.<br />

In the study by Dave et al, 55% of normal<br />

eyes and 37% of early glaucoma eyes followed<br />

the ISNT rule. The sensitivity and specificity for<br />

early glaucoma diagnosis based on violation<br />

of the ISNT rule was 63% and 47% respectively,<br />

and the positive/negative likelihood ratio was<br />

1.4/0.67. In the study by Pradhan et al, 47%<br />

of normal eyes and 31% of glaucoma eyes<br />

followed the ISNT rule. The sensitivity was<br />

76% and specificity 47% for early glaucoma<br />

diagnosis using violation of the ISNT rule.<br />

Both of these studies concluded that the<br />

ISNT rule by itself does not clearly distinguish<br />

between normal eyes and glaucoma when<br />

applied to the retinal nerve fibre layer using<br />

OCT.<br />

Comment<br />

Although the ISNT rule is of clinical benefit<br />

in optic disc examination and evaluation of<br />

the neuro-retinal rim, it does not appear to<br />

have any clinical use at present in assessment<br />

of the retinal nerve fibre layer for glaucoma<br />

diagnosis. ▀<br />

* Dr Hussain Patel<br />

is a glaucoma and<br />

cataract specialist.<br />

He works as a<br />

Senior Lecturer<br />

in ophthalmology<br />

with the University<br />

of Auckland, a<br />

consultant at<br />

Greenlane Clinical<br />

Centre, and in<br />

private practice<br />

at Eye Surgery<br />

Associates in<br />

Auckland and<br />

Hamilton Eye Clinic.<br />

Dr Michael Mair’s career has gone full circle.<br />

The English-born ophthalmologist actually<br />

began as a social anthropology student<br />

in 1968, learning theories of language and brain<br />

development. In the 1990s, he created a paperless<br />

office computer program, based in part on those<br />

studies, and he has run several practices designed<br />

to care for public and private patients, with those<br />

theories in mind.<br />

He may have retired in 2015 from the Timaru<br />

Eye Clinic he founded in 2006, but he’s not done<br />

working.<br />

Dr Mike Mair<br />

“I’m going back to the project I started involving<br />

facial movement and voices and basically trying to<br />

understand the brain,” Mair told NZ Optics’s editorat-large<br />

Maryanne Dransfield in an interview last<br />

year. Mair said he built his practices using the same<br />

principles he discovered in his human interactionbrain<br />

research.<br />

“The rooms were built according to the cycle<br />

of interaction: meeting, parting and the story in<br />

between. It’s a holistic model of how interaction—<br />

and maybe the brain—works, how the clinic works<br />

and ultimately how the record-keeping works<br />

because records are the chain of summaries of<br />

these interactions.”<br />

Mair said he applied the theories he’d researched<br />

in ideas of speech and language to the pursuit of a<br />

paperless office software system through the early<br />

1990s, resulting in a programme for glaucoma and<br />

cataract records.<br />

“Because in Timaru I couldn’t do the research in<br />

eye and nose movement I’d wanted, the other area<br />

where I could apply my theory was in computers.”<br />

In fact, his work led to a collaboration with<br />

Derek Gower, the then chief executive of Houston<br />

Medical (now Best Practice Software) which had<br />

been developing medical record systems since its<br />

inception in 1988. Gower shared the work he had<br />

already done and contributed to Houston’s first<br />

ophthalmology record system. By 1995, Mair said,<br />

his practice went fully paperless.<br />

Back to the beginning<br />

Mair was born into a family of doctors and,<br />

according to an article in The Timaru Times, it was<br />

his father’s temporary blindness due to Devics<br />

disease (a neurological disorder) that set him on<br />

the path to ophthalmology.<br />

He studied at Cambridge University and<br />

Westminster Medical School and took his first job in<br />

the Ear, Nose, and Throat Department at Moorfields<br />

Hospital under the tutelage of Dr Patrick Trevor-<br />

Roper, who among other claims to fame, founded<br />

Moorfields Eye Bank a few years prior.<br />

Mair joined Trevor-Roper on a medical mission<br />

to Sierra Leone in 1972 where he took charge of<br />

a mobile eye unit, mostly removing cataracts.<br />

Device Technologies at Mantells<br />

More than 100 guests turned up to<br />

celebrate the end of the year with Device<br />

Technologies at Mantells in the leafy<br />

Auckland suburb of Mount Eden. Hosts and guests<br />

pictured here include (left) Diego Sonderegger,<br />

He also encountered an unanticipated incidence<br />

rate of onchocerciasis (river blindness, caused<br />

by infection with a parasitic worm) which he<br />

described as a “disastrous” experience, as the<br />

doctors simply “didn’t know what we were<br />

doing”; a situation that has fortunately changed<br />

with improved drug treatment.<br />

Returning to Moorfields as a house physician,<br />

Mair worked in casualty and then ophthalmology,<br />

earning his ophthalmology diploma in 1974 from<br />

the UK Royal College of Surgeons.<br />

In 1975, he returned to anthropology and brain<br />

research, splitting his time between clinics and<br />

his work on the “melody of text” - a micro analysis<br />

of spontaneous conversation, focusing on brain<br />

function and eye movements.<br />

The research used the first frame-by-frame<br />

video recorder to closely analyse people in<br />

spontaneous conversation, in order to track nose<br />

and expression in correlation with eye movement<br />

and voice analysis.<br />

Mair said it had been a hard choice to<br />

choose between doing a primary fellowship in<br />

ophthalmology and the “melody of the text” work,<br />

but after he had published a number of papers<br />

based on his research, he did a neurology and<br />

ophthalmology fellowship at Cambridge, followed<br />

by a surgical rotation at Moorfields.<br />

The New Zealand way<br />

A lecturer position at Otago University drew Mair<br />

to New Zealand in 1985, but finding Dunedin not<br />

to his liking he relocated to Timaru.<br />

In 1988, he went into practice for himself, first in<br />

rooms rented from an ENT specialist, then in his<br />

own house, until about 1995 when he persuaded<br />

a private hospital to let him have space near them,<br />

with the aim of providing a combined “public and<br />

private sector” practice.<br />

“There was an environment at the time<br />

encouraging the kind of enterprise I was doing. It<br />

was the time of the Crown Health Enterprises and<br />

so on. So they approved of me contracting public<br />

sector service in my private rooms.”<br />

Mair said the practice was “very successful”<br />

financially and, being paperless, very efficient for<br />

all concerned. “And I had the delight of being able<br />

to put public and private patients through the<br />

same basic treatment,” he said.<br />

The practice carried on under that effective<br />

“egalitarian model” for a while but it wasn’t “well<br />

appreciated” unfortunately, Mair said, by private<br />

practice or the public health system in the end. “I’m<br />

slightly socialist,” Mair told The Timaru Herald in an<br />

interview at the time.<br />

The payment method ultimately changed, but the<br />

Timaru practice was able to continue giving public<br />

and private patients the same service, but with<br />

funding streams and wait times that were different.<br />

The future of Timaru Eye<br />

After Mair’s retirement last year, a South<br />

Canterbury District Health Board (SCDHB)<br />

subsidiary, the South Canterbury Eye Clinic,<br />

purchased Timaru Eye Clinic and continues to<br />

provide both public and private ophthalmology<br />

services.<br />

The SCDHB issued a request for someone from<br />

the private sector to take over the practice, but only<br />

received one response. The SCDHB is currently in<br />

talks with that respondent to work out a potential<br />

sale of the practice. A spokesperson for the SCDHB<br />

says there are no plans to re-issue the RFP at the<br />

moment. ▀<br />

Caroline Svadlenak, Laser Eye Centre Hamilton<br />

optometrist Oliver Svadlenak and Campbell<br />

Gordon; and (right) the team from Auckland Eye,<br />

Janet Wigmore, Drs Dean Corbett and Alison<br />

Pereira and Tracey Molloy. ▀<br />

10 NEW ZEALAND OPTICS <strong>Feb</strong> <strong>2016</strong>

John Parr prize<br />

awarded<br />

MDNZ <strong>2016</strong> Race Day:<br />

Have you bought your<br />

tickets yet?<br />

Dr Logan Mitchell and Dr Samy Karki with John Parr prize winner Deepesh<br />

Mehta, Samuel Pau, Trenton Taylor and Dr Kelechi Ogbuehi.<br />

The University of Otago’s<br />

Dunedin School of<br />

Medicine has awarded<br />

the annual John Parr Prize<br />

to Deepesh Mehta. The prize<br />

is granted to the top fifthyear<br />

medical student in<br />

ophthalmology.<br />

Mehta was among 17 leading<br />

students who were invited to<br />

sit for a quiz to take the prize.<br />

Samuel Pau was the first runner<br />

up and Trenton Taylor was third.<br />

Dr Logan Mitchell, senior<br />

lecturer, said the standard of<br />

competition was very high.<br />

Mehta received a panophthalmoscope<br />

provided by<br />

EBOS Healthcare in recognition<br />

of the award.<br />

The prize was named for<br />

educator and researcher Dr<br />

John Parr (1922-2009) who<br />

helped raise the standard of<br />

ophthalmological training<br />

in New Zealand, laid the<br />

foundations for a postgraduate<br />

training programme at<br />

the school and authored<br />

Introduction to Ophthalmology,<br />

a classic text for undergraduate<br />

medical students.<br />

2015 Clinical Course<br />

highlights<br />

In other news, the Dunedin<br />

School of Medicine hosted the<br />

annual Dunedin Ophthalmology<br />

Clinical Course over 11 days in<br />

November. This highly-regarded<br />

residential course is aimed at<br />

trainees preparing for their<br />

Deepesh Mehta with Dr Logan<br />

Mitchell<br />

RANZCO RACE (Part 2) Exams<br />

and is made up of lectures and<br />

workshops delivered by invited<br />

faculty members, including<br />

many RACE examiners, from<br />

both Australia and New<br />

Zealand.<br />

This year’s course attracted 33<br />

participants: 27 from Australia<br />

and six from New Zealand.<br />

Twenty-three speakers gave<br />

talks, including first-time<br />

lecturers Drs Con Petsoglou,<br />

Xavier Fagan, Stuart Carroll,<br />

Yvonne Ng, David Squirrell and<br />

Jesse Gale.<br />

A highlight was the eight<br />

Observed Structured Clinical<br />

Exams (OSCEs) prepared and<br />

run by Drs Ben LaHood and<br />

Elizabeth Insull.<br />

RANZCO, and its immediate<br />

past-president Dr Stephen<br />

Best, hosted a reception at the<br />

University of Otago’s Hunter<br />

Centre for the participants. ▀<br />

The team from MDNZ at the 2015 Race Day<br />

Tables and tickets<br />

are selling fast for<br />

the popular annual<br />

Macular Degeneration Race<br />

Day. This year the event<br />

is being held on Saturday<br />

20 <strong>Feb</strong>ruary, so there’s<br />

still plenty of time to treat<br />

yourself, your friends, family<br />

or colleagues and support<br />

the vital work of Macular<br />

Degeneration New Zealand<br />

(MDNZ). Or<br />

perhaps you’d like to<br />

sponsor a table of 10<br />

and host your own party.<br />

Ten races will keep you<br />

and your guests entertained<br />

for an entire day watching<br />

the main stars, the horses,<br />

thunder along the track<br />

in a bid to win one of the<br />

day's exhilarating races - the<br />

Group II Avondale Cup and<br />

Come join the fun<br />

at Ellersile<br />

For more information<br />

or to buy tickets ($140 each)<br />

or a table ($1,250) please contact<br />

Phillippa Pitcher on<br />

0800 Macula (622 852)<br />

or email events@mdnz.org.nz<br />

the Avondale Guineas.<br />

Tickets include drinks<br />

on arrival, buffet lunch,<br />

afternoon tea and cash<br />

bar, plus entertainment<br />

throughout the day.<br />

Westgate Optometrists<br />

changes hands<br />

Jan Thompson<br />

After 20 years in the Optometry industry,<br />

Jan Thompson has sold her Westgate<br />

Optometrists business in Auckland to New<br />

Zealand-trained optometrist Ricky Lee.<br />

Saying she made the decision to sell to spend<br />

more time with her family, Thompson was keen to<br />

assure staff and patients that it will be business<br />

as usual at the popular independent practice at<br />

Westgate Shopping Centre in Massey.<br />

“Present staff and patient records remain as<br />

before for continuity. I have total confidence and<br />

peace of mind that Ricky and our very capable<br />

team will continue to provide excellent service<br />

and eye care for our valued clients.”<br />

Thompson has operated Westgate Optometrists<br />

since 2006. She originally took on the practice<br />

with business partner, and former classmate,<br />

Paul Sampson, who now resides in Australia. The<br />

practice will continue with the same name and<br />

staff, including optometrists Shelley Brannigan<br />

and Hans Vellara, under Lee’s ownership.<br />

Lee trained to become an optometrist in New<br />

Zealand and has spent the last few years working<br />

in Australia.<br />

Thompson says the most rewarding aspect<br />

of optometry has been “moments with longterm<br />

customers built up over the years, who<br />

appreciate a job well-done with friendly, thorough<br />

and professional eye care and detecting and<br />

monitoring interesting pathology.<br />

“I have certainly had some very rewarding<br />

moments providing the best eye care I possibly<br />

could for my patients.”<br />

She’s also enjoyed being a part of New Zealand’s<br />

close knit ophthalmic community, she says. “I<br />

appreciate the very kind referrals and support I<br />

have had and the learning opportunities provided<br />

by local ophthalmologists and suppliers and have<br />

really enjoyed continuing education seminars and<br />

conferences with colleagues and friends.”<br />

In a parting message to the public in her local<br />

newspaper, Thompson implored readers to have<br />

glasses and contact lenses fitted by a professional<br />

who genuinely cares about patients’ eyes and can<br />

monitor their eye health on a continuous basis.<br />

“The ideal would be for schools to teach the<br />

importance of regular eye tests for health reasons,<br />

rather than people waiting to have an eye test<br />

later in life only because their vision deteriorates.<br />

I have certainly done my very best in passing on<br />

this important message.” ▀<br />

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<strong>Feb</strong> <strong>2016</strong><br />



with<br />

Prof Charles McGhee<br />

& A/Prof Dipika Patel<br />

Series Editors<br />

Ocular drug delivery—eye on innovation<br />


One would think that a small organ such as the eye which is<br />

readily accessible from the outside of the body would be easy<br />

to treat. However, the eye has a number of protective barriers<br />

in place which pose major challenges to effective drug delivery.<br />

Conventional eye drops generally result in less than 5% of the applied<br />

dose reaching the ocular tissues. This is mainly due to the fast<br />

nasolacrimal drainage and the poor permeation across the sandwichlike<br />

structure of the cornea, with the lipophilic corneal epithelium<br />

being the main penetration barrier. This not only leads to low<br />

efficacy, but can also pose significant risks due to systemic absorption<br />

and associated side effects of the majority of the given dose. To<br />

improve the efficacy of topical ocular formulations, researchers have<br />

mainly focused on two strategies: 1) To increase the corneal residence<br />

time using viscosity enhancing, mucoadhesive, particulate and/or<br />

in situ gelling systems; and 2) to increase the corneal permeability<br />

using penetration enhancers, prodrugs and colloidal systems<br />

such as nanoparticles and liposomes. While many of these have<br />

been investigated over the past decades with some success in the<br />

treatment of anterior segment diseases, they are unable to deliver<br />

sufficient drug concentrations to the back of the eye.<br />

The gold-standard to treat posterior segment conditions<br />

such as wet age-related macular degeneration (AMD) remains<br />

intravitreal injection of the drug-containing solution. Although a<br />

relatively site specific application into the confined vitreal space,<br />

injected drugs face elimination processes and need to diffuse<br />

through the vitreous network before crossing the inner limiting<br />

membrane to reach the retina. When aiming to reach the choroid,<br />

additional permeation barriers such as the retinal pigment<br />

epithelium (RPE) and Bruch’s membrane have to be crossed. Thus,<br />

periocular injection may offer a more direct route for choroidal<br />

drug delivery with the sclera allowing molecules up to 20 kDa<br />

to permeate. Moreover, larger volumes can be injected into the<br />

periocular space (≤1 ml compared to ≤100 µl intravitreally). Even<br />

more localised are suprachoroidal injections using microneedles<br />

which allow the drug to spread between sclera and choroid. The<br />

injection volume is hereby limited to ≤35 µl with simple drug<br />

solutions eliminated relatively quickly. However, injecting drugloaded<br />

particles and/or in situ gelling systems into this space<br />

could offer localised sustained drug release in the future 1 . Finally,<br />

the active could also be administered systemically; however,<br />

generally less than 2% of the administered dose reaches the<br />

ocular tissues mainly owing to the tight blood-retinal barrier. An<br />

overview of the ocular structures and some of the recent delivery<br />

technologies, which will be further discussed below, is given in<br />

Figure 1.<br />

Figure 1: Overview of the ocular structures and some recent delivery<br />

technologies (modified with permission). 2,3<br />


OF THE EYE<br />

While a vast number of approaches have been explored over the past<br />

decades to increase precorneal retention and/or corneal permeation,<br />

only a few advanced drug delivery systems have entered the market.<br />

These include prodrug-based eye drops such as Propine® from the<br />

1970s, ion-exchange resin particle-based Betoptic® S, the membranecontrolled<br />

reservoir system Ocusert® and in situ gelling eye drops<br />

such as gellan gum based Timoptic® XE. However, over the past<br />

years there has been an enormous increase in novel and exciting<br />

approaches being researched and/or having entered into clinical<br />

trials. Novaliq GmbH, for example, is developing topical ocular<br />

formulations based on semi-fluorinated alkanes particularly suitable<br />

for the delivery of poorly soluble drugs such a cyclosporine A, with<br />

the added advantage of not requiring preservatives and lubricating<br />

the ocular surface, both aspects of particular benefit in the treatment<br />

of dry eye. Kala Pharmaceuticals is investigating mucus penetrating<br />

particles (MPP) which allow efficient penetration of the tear film<br />

mucin layer, the first defense mechanism encountered after topical<br />

administration 4 . Envisia Therapeutics is researching a PRINT-based<br />

biodegradable polymer rod intended for intracameral injection for<br />

three to eight months of drug delivery (Figure 2). Currently in clinical<br />

trials is also Ocular Therapeutix’s drug-containing punctum plug<br />

delivering its cargo over three months and containing a visualisation<br />

aid to monitor plug retention 5 . Finally, drug-eluting contact lenses<br />

have also gained considerable interest for drug delivery to the<br />

anterior segment. Drug loading approaches hereby include simple<br />

soaking of the lens in the drug solution, incorporation of particles or<br />

molecular imprinting with the latter two having shown drug delivery<br />

for up to one month.<br />

Figure 2: (A) Envisia PRINT technology-based intracameral implant (B) injected<br />

into New Zealand white rabbits and (C) IOP-lowering effect in normotensive<br />

beagle dogs (green: ENV55-8, purple: placebo) (modified with permission) 4<br />


OF THE EYE<br />

The gold-standard to treat posterior segment conditions remains<br />

intravitreal injection with drugs administered as solution having a<br />

relatively short half-life. However, four sustained release implants<br />

have also made it onto the market so far. These include nonbiodegradable<br />

Vitrasert®, a ganciclovir containing scleral implant<br />

approved in 1996 for the treatment of CMV retinitis, and Retisert®,<br />

containing fluocinolone acetonide approved for the treatment of<br />

non-infectious posterior uveitis in 2005. FDA-approved Iluvien®, also<br />

a non-biodegradable implant, is injected into the vitreous using a<br />

25G needle rather than being sutured into the sclera. This implant<br />

can deliver fluocinolone acetonide over three years for the treatment<br />

of diabetic macula edema (DME). The first ever biodegradable<br />

intravitreal implant, Ozurdex®, approved in 2009 consists of a PLGAbased<br />

rod containing dexamethasone for the treatment of DME,<br />

retinal vein occlusion and posterior uveitis, with the same technology<br />

also being investigated in a Phase I/II trial for bimatoprost<br />

delivery. GrayBug is currently evalutating a proprietary PLGA–<br />

based technology proven to reduce the inflammation seen with<br />

conventional PLGA systems, with their lead product for wet AMD<br />

targeted to last up to six months 3 . Another platform technology,<br />

Tethadur by pSivida, is based on a suspension of micronised particles<br />

of oxidised meso-porous silicon, with the size of the pores adjustable<br />

to control drug release 3 . While the majority of the above-mentioned<br />

particle systems are preformed, the Verisome® technology allows<br />

implant formation in situ once in contact with the aqueous vitreous<br />

environment. Depending on the volume of the formulation injected,<br />

drug levels can be maintained for up to 12 months.<br />

While all of the above implantable systems may achieve sustained<br />

release, the release rate cannot be altered if the condition worsens<br />

or aborted in the case of serious side effects unless the implant is<br />

surgically removed. This shortcoming has partially been addressed in<br />

the port delivery system by ForSight Vision, a scleral plug consisting<br />

of a porous container, a semi-permeable non-biodegradable<br />

membrane with a refill port (to increase the device’s life span) and<br />

exit ports to release the drug into the vitreous humor but also allow<br />

for flushing to abort drug delivery. However, the drug release rate<br />

is still fixed. To be able to tune drug delivery on-demand, there has<br />

been a paradigm shift from conventional to stimuli-responsive<br />

devices over recent years, with such systems also having great<br />

potential in eye 2 . While to date only open-loop systems responsive to<br />

light (e.g. ODTx), an electrical stimulus (Figure 3) or a magnetic field<br />

have been explored in the eye, self-regulating systems releasing drug<br />

in response to a change in a certain physiological parameter could<br />

offer tailored treatment of posterior segment diseases in the future.<br />

Figure 3: Schematic representation of the Replenish MicroPump TM implanted<br />

at the pars plana position showing the refill port (green arrow), suture tab (red<br />

arrow) and pars plana cannula (blue arrow) (reproduced with permission from<br />

the Association for Research in Vision and Ophthalmology (ARVO)) 6<br />


A number of innovative drug delivery technologies are currently<br />

in the pipeline to treat ocular diseases more efficiently while<br />

minimising side effects, with the majority aiming to sustain<br />

drug release over prolonged periods. However, long-term effects<br />

of sustained drug levels especially in the posterior segment are<br />

currently unknown and tunable drug release may be of advantage<br />

if the condition improves to avoid unnecessary side effects. The<br />

major hurdle with successful development of such tunable implants<br />

remains the device size restriction, which in turn reduces the amount<br />

of drug loading. Such devices are therefore generally limited to highly<br />

potent drugs such as steroids and may become difficult to adapt to<br />

macromolecules such as anti-VEGF agents. Moreover, matching these<br />

new technologies with drug pharmacokinetics and translating preclinical<br />

studies into human clinical trials remains a major challenge.<br />

Nevertheless, novel ocular drug delivery technologies offer great<br />

market potential and it is certainly a very exciting area to be working<br />

in at the moment. ▀<br />


1. Albini TA, Moshfeghi AA, Yeh S 2014. A Peek down the pipeline: Emerging drug<br />

delivery options for retinal disease. Retina Today JUL/AUG:70-77.<br />

2. Yasin MN, Svirskis D, Seyfoddin A, Rupenthal ID 2014. Implants for drug delivery<br />

to the posterior segment of the eye: A focus on stimuli-responsive and tunable<br />

release systems. Journal of Controlled Release 196:208-221.<br />

3. Frederick Furness Publishing Ltd. 2015. Ophthalmic Drug Delivery.<br />

ONdrugDelivery 54:1-32.<br />

4. Frederick Furness Publishing Ltd. 2014. Ophthalmic Drug Delivery.<br />

ONdrugDelivery 48:1-36.<br />

5. Boyer DS et al. 2014. Emerging technologies approach complex eye diseases from<br />

new directions. Ocular Surgery News APAO MAY:8-22.<br />

6. Gutierrez-Hernandez JC et al. 2014. One-Year Feasibility Study of Replenish<br />

MicroPump for Intravitreal Drug Delivery: A Pilot Study. Translational Vision<br />

Science & Technology 3(4):8.<br />


* Dr Ilva Rupenthal is a Senior Lecturer in the University<br />

of Auckland’s Department of Ophthalmology and the<br />

Director of the Buchanan Ocular Therapeutics Unit<br />

(www.botu.nz), which aims to develop and translate<br />

ocular therapeutic related scientific research into the<br />

clinical setting.<br />

See more on BOTU and the new Ocular Therapeutics<br />

Conference on page 6.<br />

12 NEW ZEALAND OPTICS <strong>Feb</strong> <strong>2016</strong>

Innovating against preventable blindness<br />

Ophthalmologists have helped to address<br />

the main cause of avoidable blindness in<br />

developing countries through a variety of<br />

innovative programmes making cataract surgery<br />

affordable and accessible, said Dr Neil Murray,<br />

who gave the annual Fred Hollows Lecture at<br />

the 2015 RANZCO Scientific Congress, but the<br />

next leading cause of preventable blindness—<br />

diabetes—will require more innovative thinking<br />

to combat.<br />

“Change is required to bring about a solution to<br />

this massive problem of avoidable blindness and<br />

that change needs to be transformative,” Murray<br />

said during his presentation Progress through<br />

innovation: The Fred Hollows effect.<br />

He divided “transformative change” into two<br />

broad camps.<br />

“There is innovation that occurs within a known<br />

paradigm, or value added innovation, and then<br />

there’s innovation that is totally disruptive.”<br />

As of 2010, there were 32.5 million blind people<br />

in the world, 80% of which was avoidable.<br />

The vast majority of those with preventable<br />

blindness live in the developing world and while<br />

efforts like Vision 2020—launched in 1997—<br />

presented a “disruptive innovation” to combat<br />

preventable blindness, similar efforts will be<br />

necessary as diabetic retinopathy increases.<br />

“(Vision 2020) represented a unique<br />

collaboration of public, private and not-forprofit<br />

organisations seeking to develop enduring<br />

solutions to eliminating avoidable blindness by<br />

2020.<br />

“It emphasised there were three key areas to<br />

those enduring blindness solutions,” Murray said.<br />

This included cataract surgery, which has been<br />

proven to be one of the most cost-effective<br />

surgical interventions available; infrastructure<br />

and technology development; and human<br />

resource development.<br />

Murray said Vision 2020 went further by calling<br />

for solutions that integrated with existing health<br />

systems, were sustainable within those systems,<br />

were equitably accessible and provided excellent<br />

of care.<br />

Transformative change at work<br />

Murray noted that extracapsular cataract surgery<br />

with posterior chamber IOLs was a “value-added”<br />

innovation that enabled developing world<br />

surgeons “to aspire to achieve 6/18 or better<br />

vision for their cataract patients.”<br />

Affordability prevented the developing world<br />

from using this “value-added” innovation until<br />

Fred Hollows instituted high-quality, low cost IOL<br />

production facilities in developing nations, which<br />

“disrupted the paradigm.”<br />

Another value-added innovation has been the<br />

visiting team, the “fly-in/fly-out service provision<br />

model to an area that has little or no health<br />

resource to deal with their own eye care needs.”<br />

“This can and has been a successful model and<br />

will remain a part of the fight against avoidable<br />

blindness, but there are some issues with this,<br />

relating primarily to the quality of outcomes that<br />

the visiting teams achieve,” Murray said.<br />

Developing a local resource, along the lines of<br />

Vision 2020’s concept of integrated, sustainable,<br />

equitable and excellent (shortened to ISEE)<br />

solutions, that are fit for purpose and fit for the<br />

future, would be an enduring transformation.<br />

“Nepal is a fantastic example of how an<br />

enduring solution can make a difference,” Murray<br />

said.<br />

Following a rapid assessment of avoidable<br />

blindness in 1981, eye care groups banded<br />

together to combat the problem and 30 years<br />

later have cut the prevalence of blindness in Nepal<br />

by half, while increasing the number of training<br />

programmes within the country from zero to six,<br />

so that today, Nepal is a net exporter of trained<br />

ophthalmologists.<br />

The next problem<br />

Diabetes has exploded in recent history, but<br />

nowhere as much as in the Pacific, which Murray<br />

described as a “vast blue continent with little<br />

pockets of humanity, isolated”.<br />

“Nine of the top-ten countries in the world for<br />

prevalence of diabetes are in the Pacific…at our<br />

back door,” Murray said.<br />

Murray discussed the case of Fiji, one of<br />

those top ten nations, to illustrate how quickly<br />

diabetes has exploded. In 1985 the prevalence of<br />

diabetes was 4%, in 2010 it had shot up to just<br />

under 30% of the entire population. Meanwhile,<br />

the prevalence of diabetic retinopathy among<br />

diabetics in Fiji is around 50%, totalling 80,000<br />

diabetics with retinopathy as of 2012.<br />

“This is all too common a presentation,” Murray<br />

said.<br />

He also noted an anecdotal cultural shift in<br />

which, at one time, if you asked for a sweet drink<br />

in Fiji, you would have been offered coconut milk.<br />

Today, that may be true for more remote locations,<br />

but in the main, Murray said, you will be offered<br />

a “heavily sugared, carbonated fizzy drink that is<br />

black or orange or raspberry.”<br />

“That whole cultural norm needs to change in<br />

our ‘whole of society’ response,” he said.<br />

Cultural shifts take decades and in the meantime,<br />

“what will happen to the people who have diabetes<br />

in a low-resource environment: how can we stop<br />

them from becoming blind?” said Murray.<br />

“Innovation again is required and that<br />

innovation may very well be value-added, as<br />

with micro-pulse lasers and smarter treatment<br />

protocols. We can certainly do with affordable,<br />

accessible anti-VEGFs that are actually not a<br />

part of the current treatment paradigm in the<br />

developing world.<br />

“The innovation will almost certainly not need<br />

to be disruptive,” he added.<br />

The good news, perhaps, is that ophthalmic<br />

resources have been coming together throughout<br />

the Pacific, with two training programmes<br />

established in Fiji in 2007, bringing the total<br />

throughout the Pacific to 11 and an anticipated 20<br />

programmes by the beginning of the next decade.<br />

“I want to embed the disruptive, innovative<br />

spirit Fred Hollows had and re-present it to you<br />

as a challenge.” In conclusion, Murray posed a<br />

question: “How are we going to, in a low-resource<br />

context, prevent avoidable blindness until<br />

societies get the diabetes epidemic under control<br />

and what are you going to do about it?” ▀<br />

Eye Doctors’<br />

Shuan Dai<br />

applauded<br />

Eye Doctors’ Dr Shuan Dai (second from<br />

right) was recognised for services to the<br />

Asian community at the end of last year<br />

and presented with an award for excellence in<br />

service for the Health of the Asian Community<br />

by the New Zealand Health Foundation for<br />

Asian and Ethnic Communities.<br />

The award was presented by (from left to right)<br />

Peter Goodfellow, NZ National Party president<br />

and Dr Jian Yang, Parliament Health Committee<br />

vice-chair, in the presence of Chen Mao Song, the<br />

Vice Consul-General of the Chinese Embassy in<br />

Auckland, at Auckland’s Metropolitan Museum. ▀<br />

Turning back the clock<br />

A patient’s perspective by Australian artist John Lovett on his experience with LISA tri IOL.<br />

John Lovett having his eyes measured<br />

This may seem an unusual thing to discuss,<br />

but far more important than brands of colour,<br />

types of paper or any painting technique, the<br />

ability to see clearly has a huge impact on what we<br />

create.<br />

One thing that has crept up on me over the years<br />

is a gradual loss of close vision. Glasses didn’t really<br />

solve the problem— they would focus on the area<br />

right in front of me, but the far end of a large sheet<br />

of paper would require craning over to bring it back<br />

into focus. I tried multifocal lenses but they felt like<br />

looking through distorted glass.<br />

Mono-vision contact lenses, where one eye<br />

wears a close up lens and the other a distance lens,<br />

worked well for a number of years, but the twice<br />

daily chore of removing and inserting contact<br />

lenses and the problems associated with outback<br />

dust and smoke, plus the AUD$1200 a year cost<br />

finally pushed me to inquire about laser surgery.<br />

The specialist I spoke to said because of my<br />

age (61) and there was the first sign of cataracts<br />

present, cataract surgery would be my best option.<br />

Cataract surgery requires removing the natural<br />

lens and replacing it with a small precision acrylic<br />

lens. The newest lenses made by Carl Zeiss are a<br />

trifocal lens employing a series of tiny concentric<br />

rings giving clear close up, middle and distant<br />

vision. My eye surgeon recommended these<br />

lenses based on the results he had had since their<br />

introduction.<br />

Tests were done, forms filled out and a surgery<br />

date arranged.<br />

The surgery was quick and painless. I was<br />

rendered semi-conscious as soon as I entered the<br />

theatre and the next thing I remember was sitting<br />

in a recovery room with a cup of tea and a number<br />

of other patients decorated with similar eye<br />

patches to mine. A nurse explained what I should<br />

and should not do for the next month while the<br />

eye heals and settles.<br />

Next morning I woke up, removed the eye patch<br />

and immediately could read close up and clearly<br />

focus on distant objects without glasses or contact<br />

lenses, and this was with just one eye done. A<br />

follow up appointment that morning confirmed<br />

my new eye was working perfectly.<br />

I asked the surgeon about the colour shift I<br />

noticed between the eye with the new lens and<br />

the other eye. Once cataracts begin, he explained,<br />

colour saturation and contrast diminish and the<br />

eye takes on a yellow cast. So what I was seeing<br />

through the new eye was how things should<br />

appear. The slight magenta tint will disappear over<br />

the next few days.<br />

A slight colour shift was noticeable between the natural<br />

deteriorated eye (left) and the new lens (right)<br />

A couple of weeks passed and I had the second<br />

eye done with similar results.<br />

Since the day after my first eye was operated on<br />

I have not worn glasses or contacts and my vision<br />

now is better than I can ever remember it being.<br />

The only noticeable downside to the new lenses<br />

is a slight halo around strong light sources at night.<br />

The eye surgeon said this will diminish as I become<br />

more used to the lenses.<br />

So, for me it’s no more lost glasses, no more<br />

fiddling around with contact lenses and clear,<br />

sharp vision for the rest of my life - these lenses<br />

don’t deteriorate like a natural lens. As far as<br />

painting is concerned, the best sable brush is only<br />

as good as the eyes of the person holding it, so I’m<br />

very happy - all my brushes work better now!<br />

Case study from John Lovett supplied by Zeiss. ▀<br />



OCT made simple as never<br />

before<br />

Perfectly tted instrument<br />

for every practice<br />

High quality of OCT image<br />

For further information regarding the SOCT Copernicus REVO<br />

please contact OptiMed NZ customer service:<br />

P: 0800 657 720<br />

info@optimed.co.nz<br />

Craig 0275 657 200 or Robert 0275 657 720<br />

For standard anterior scans no addiional lens or<br />

adapters are required. An addiional adapter can<br />

be provided allowing this device to produce<br />

images as seen below<br />

Position the patient and press the START button to acquire<br />

examinations of both eyes.<br />

Small system footprint, single USB cable connection, various<br />

operator and patient positions allow to install SOCT<br />

Copernicus REVO even in the smallest examination room.<br />

Variety of review and analysis tools give the operator a choice<br />

of using it as a screening or as an advanced diagnostic device.<br />

The noise reduction technology provides the nest details<br />

proven to be important for early disease detection<br />

<strong>Feb</strong> <strong>2016</strong><br />



ACO- OCT<br />

<strong>2016</strong> enrolling<br />

now<br />

Yesterday<br />

<strong>2016</strong> is now well underway and I am sure<br />

everyone has enjoyed the Festive Season<br />

and New Year. It’s a great time in New<br />

Zealand. Summer finally arrives and we are<br />

treated to some of the best apricots, plums<br />

and cherries that one can find anywhere on the<br />

planet. We finally shed the damp winter, enjoy<br />

great times at the beach and share fun and happy<br />

moments with friends and family.<br />

Professionally, I like to take stock of the eye care<br />

world, review the past and look into what the<br />

future has in store.<br />

Next year it will be thirty years since I first sat<br />

on the Johnson & Jonson Vision Care Advisory<br />

Board (AB). It seems hard to believe that we’ve<br />

had disposable contact lenses for so long. It was<br />

only when going through some old papers a few<br />

months ago that I came across the original AB<br />

contract from 1987. South Africa was the first<br />

market outside the US to have access to the<br />

revolutionary Acuvue disposable contact lens.<br />

The renowned Stan Yamane came out to South<br />

Africa from Jacksonville to help us launch the lens.<br />

In those days, the lenses came in a hard plastic<br />

“clamshell” box containing six lenses in an early<br />

version of the now-familiar, foil blister pack. It was<br />

quite a contrast to the glass vials and crimped vial<br />

caps of conventional soft lens packaging.<br />

I quickly got into converting a lot of patients to<br />

Acuvue, with great results.<br />

In those days the original etafilcon A (58% water<br />

content Acuvue lens with a Dk/L of around 25<br />

units) was approved for extended wear (EW) in the<br />

US. It was promoted as a one-week EW modality.<br />

We were not keen on EW. The lens did not<br />

meet our standard for satisfactory oxygen<br />

transmissibility, as we were already familiar with<br />

the Holden-Mertz criteria (Dk/L 87 units). which<br />

had been published in 1984. On top of that, we<br />

were practising at an altitude of around 1400m<br />

so the equivalent oxygen percentage was around<br />

17%, compared to 21% at sea level. The partial<br />

oxygen pressure that drives oxygen through a<br />

gas permeable material was reduced. Avoiding<br />

hypoxia and its resultant complications was<br />

tantamount to our philosophy—first, do no harm.<br />

We thus insisted on using the lens as a twoweek<br />

daily wear disposable. In time that modality<br />

stuck and we still use Acuvue lenses on that<br />

basis. It was also a lens that had UV protection<br />

built in and suited our high UV environment and<br />

outdoor lifestyle. It was a high water lens that<br />

had satisfactory oxygen performance for daily<br />

wear: transmissibility was comparable to the<br />

custom-made 60% water content Duragel and<br />

Biogel lenses we were using at the time. It was<br />

way ahead of the lathe-cut and spun-cast low<br />

Dk HEMA 38% water content lenses, which were<br />

typically used for a year or two, all too often for as<br />

long as three years or more!<br />

We soon saw the benefits of frequent<br />

replacement!<br />

We did have issues, as we still do today,<br />

with disinfecting solutions. In some cases, the<br />

solutions still contained the mercury-based<br />

thimerosal disinfectant, and the Acuvue polymer<br />

was not suited to our default system of thermal<br />

disinfection in unpreserved drip-saline.<br />

In March 1990, the president of the Northern<br />

Transvaal Rugby Union, based at the legendary<br />

Loftus Versveld rugby ground, called into our<br />

practice with an urgent request. He had in tow a<br />

famous Australian rugby player who had lost his<br />

soft contact lens. He urgently needed another in<br />

order to play the Springboks in what was known<br />

as a “rebel tour” after the world had cut ties with<br />

South Africa due the apartheid regime. There was<br />

an arms embargo, sanctions and a sports ban<br />

in place. The famous Aussie player told me how<br />

it was costing him about AUD$120 a pop every<br />

time he lost a lens. He was amazed when I gave<br />

him a six-pack of lenses that cost a mere 10 ZAR<br />

per lens. Back then the Rand was strong so it was<br />

in real terms about AUD$5 per lens. That’s a hell<br />

of a lot cheaper than AUD$120 he was paying<br />

for conventional lenses at the time! He was<br />

impressed with the comfort and vision and the<br />

fact that he could have a few spares in his kit bag,<br />

ready to go. He later became a spokesperson for<br />

Acuvue in Australia.<br />

One-day disposables entered the fray In 1996, in<br />

the form of 1-Day Acuvue, and the rest is history.<br />

They were still pretty pricey back then, but I was<br />

convinced that daily disposables were the way to<br />

go. In 1998, I decided to convert all my soft lens<br />

patients, wherever possible, to one-day lenses. We<br />

set up favourable deals to provide patients with a<br />

bulk supply of dailies at a very competitive price.<br />

The majority of problems and contact lens<br />

complications disappeared and we rarely saw<br />

patients for unscheduled visits. Many of those I<br />

fitted then are still loyal and happy patients today.<br />

I’ve spent much of the past two decades<br />

promoting the benefits of daily disposables in my<br />

writing and lectures. I won’t repeat it here, but<br />

here are two links to some international journal<br />

articles I’ve published on this topic.<br />

I got into hot water in my first In Contact column<br />

(as referred to in my, 20th Anniversary edition) for<br />

too strongly voicing my opinion on such issues as<br />

Beware Extended Wear, and being critical of the<br />

use of low Dk lenses. At that stage the HEMA 38<br />

Hydron Z6, usually prescribed for a year or two was<br />

the “standard of care”. I’d spent much effort trying<br />

to convince colleagues that high-water lenses and<br />

disposables were the way to go. Many saw the<br />

light, but it’s taken a lot longer to spread the word<br />

and the job is not yet complete.<br />

Just a few years ago daily disposable use<br />

in the US was in single digit percentages. In<br />

2010 the American Academy of Optometry<br />

(AAO) summarily rejected our paper on Daily<br />

Disposables as having ‘limited appeal’. The very<br />

next year however they’d seen the light and<br />

Jason Nichols gave a detailed talk on the subject.<br />

Etty Bitton, Associate Professor of Optometry at<br />

Montreal University, had asked me if she could<br />

co-present this paper with me in 2010, having<br />

heard me deliver the talk in Paris the year before.<br />

She was also surprised they’d rejected us. It was<br />

however heartening to hear her finally present<br />

the guts of this talk at the AAO in New Orleans<br />

in October 2015, where she made reference to<br />

this story.<br />

Today<br />

The US market for dallies has grown significantly<br />

but lingers behind Denmark, Australia and New<br />

Zealand, among others.<br />

These days the majority of fits, in many markets,<br />

are in silicone hydrogel daily, two-week or<br />

monthly lenses.<br />

Oxygen is hardly an issue anymore.<br />

Of course we still have other issues to contend<br />

with.<br />

Alcon’s DAILIES TOTAL1 has had a significant<br />

impact on the market. It appears that for a<br />

number of prescribers it is the go-to lens, with<br />

excellent results. Observing responses of a group<br />

of US optometrists, it would seem that ACUVUE<br />

OASYS 1-Day is also impressing patients and<br />

prescribers. We hope to soon be able to judge for<br />

ourselves.<br />

I have been very impressed with great results<br />

in some tricky patients with high cyls, where<br />

the around-the-clock -2.75cyl Acuvue Oasys for<br />

Astigmatism is making a significant difference<br />

in acuity and stability. It’s pleasing to see one<br />

company with a -2.75 cyl Si-Hy lens.<br />

Tomorrow<br />

What else will we see in <strong>2016</strong>?<br />

B+L will release their Ultra Si-Hy monthly<br />

disposable which is also delivering promising<br />

reports. They will also launch their Biotrue<br />

ONEday multifocal. I’m not sure what Cooper<br />

Vision has planned but hopefully they will at last<br />

launch their XR range of Biofinity Torics, which will<br />

be a boon for tricky eyes.<br />

Will we see a smart lens with broader appeal<br />

than Triggerfish? Will we see a drug eluting<br />

contact lens? These are some of the trends I will<br />

cover throughout the year but space limitations<br />

preclude much more this month.<br />

Another issue close to my heart are the<br />

problems associated with make-up, cosmetics,<br />

moisturised liquid hand soaps and contact lens<br />

complications: lens surface contamination,<br />

greasing up, tear film instability, MGD and<br />

allergic/toxic reactions go hand-in-hand with<br />

their use in contact lens wearers. I’ll get into that<br />

too as there’s now some ‘evidence base’ to back it<br />

up. Hopefully my fanatical ranting’s on the subject<br />

for so many years will be taken more seriously<br />

in our evidence-base obsessed culture. Maybe<br />

there’s a new psychological syndrome, EBOD or<br />

Evidence Base Obsessive Disorder?<br />

Sometimes practitioners don’t see the wood for<br />

the trees.<br />

There’s no substitute for experience, careful<br />

observation and history taking, symptomology<br />

and the application of deductive skills.<br />

Anecdotal these observations may be, but what<br />

more do you need than to observe cause and<br />

affect on real live patients?<br />

As The Doors once wrote “keep your eyes on the<br />

road, your hands upon the wheel.”<br />

Here’s to a great <strong>2016</strong> for all. ▀<br />

The Australian<br />

College of<br />

Optometry<br />

(ACO) has opened<br />

enrolments for its<br />

annual Certificate in<br />

Ocular Therapeutics<br />

(ACO-COT) course.<br />

The <strong>2016</strong> course<br />

commences on April<br />

18 and is designed<br />

to ensure graduates<br />

from both sides of the<br />

Tasman are suitably<br />

qualified to prescribe<br />

Optometrist John Adam<br />

soon to complete the ACO-<br />

COT course<br />

and administer medicines for ocular conditions.<br />

Auckland optometrist John Adam joined the<br />

course last year after considering it for a number<br />

of years.<br />

“To be relevant and useful to our aging<br />

community…it will be imperative that optometry<br />

takes a leading role in eye healthcare as well as<br />

vision care. With that in mind, I felt I needed the<br />

training and qualifications to recognise, diagnose<br />

and treat certain medical conditions associated<br />

with eyes,” he explained. “I also specialise in<br />

contact lens correction and appreciate the ability<br />

to prescribe if necessary for lens-related issues,<br />

rather than sending people to the pharmacy to<br />

get OCT medication that I can’t prescribe.”<br />

Adam said he selected ACO’s course because<br />

it fitted well around running his practice, Adam<br />

Optometrists in Remuera, and his family time. “It<br />

was well suited to a sole practitioner who could<br />

study after work and have lectures online in the<br />

evening rather than having to take off valuable time<br />

from my business day….and I have not missed out<br />

on too much golf.”<br />

The only criticism he had was that the legal side<br />

was too Australian focused, but this has been<br />

changed for the <strong>2016</strong> course with more New<br />

Zealand-centric legal content.<br />

The year-long course is designed for remote<br />

learning with local clinical placements and<br />

assessments. It has also been accredited for<br />

60 CPD points in New Zealand upon successful<br />

completion of the certificate.<br />

For more information, see ACO’s ad on page 3. ▀<br />

BTP, Bailey<br />

Sun and<br />

Rodenstock<br />

Specsavers Gisborne wins Asia-Pacific<br />

The Federation of Asia-Pacific Retailers<br />

Association (FAPRA) awarded Gisborne<br />

Specsavers its top customer service<br />

Nick Whittingham, Tania Richards (third from right)<br />

and the team at Gisborne Specsavers<br />

excellence award in its bi-annual awards<br />

programme.<br />

Retailers from 17 countries, including Singapore,<br />

Thailand, Malaysia, Indonesia, Vietnam, the<br />

Philippines, China, Hong Kong, Chinese Taipei,<br />

Japan, Korea, Australia, New Zealand, India,<br />

Mongolia, Fiji and Turkey, were nominated by<br />

their respective national retail associations.<br />

“We define customer service as going the<br />

extra mile to help customers understand their<br />

needs and to provide the best solution for<br />

each individual,” says Gisborne Specsavers codirector<br />

Tania Richards. “To achieve this, we are<br />

friendly and approachable, carefully listening<br />

to our customers and treating each one as an<br />

individual. Then using up-to-date technology, we<br />

demonstrate a number of solutions that will suit<br />

their needs and their budget.”<br />

Gisborne Specsavers was nominated for the<br />

Asia-Pacific award after winning three prizes<br />

in Retail NZ’s Top Shop Awards last year: the<br />

Central North Island – fashion and footwear<br />

category; the Central North Island regional<br />

overall winner; and the Overall National<br />

Supreme Top Shop Award for the country.<br />

Dispensing optician Tania Richards runs the<br />

Gisborne store with business partner, optometrist<br />

Nick Whittingham who, upon receiving the<br />

Supreme Top Shop award for New Zealand said: “I<br />

used to think that retail was easy, just treat people<br />

how you’d like to be treated yourself. That’s not<br />

good enough now. We all do more than that.” ▀<br />

Ogi Eyewear brand Seraphin has launched Bailey<br />

Sun, described as “a butterfly sunglass with a<br />

bounty of style points.<br />

“It’s dolled up design—curved feminine profile,<br />

diamond-shaped raised accents, and signature<br />

silver hinge accents—showcases a first-rate<br />

sunglass suited for a superstar.”<br />

Bailey Sun is available in New Zealand in three<br />

pearlescent colour options from BTP International<br />

Designz.<br />

• In other news, Whakatane-based BTP has picked<br />

up distribution for Rodenstock’s brands including<br />

Porsche Design, Rocco, Mercedes-Benz and Claudia<br />

Schiffer. Rodenstock was previously distributed by<br />

Pacific Eyewear, now in liquidation (see story p6). ▀<br />

14 NEW ZEALAND OPTICS <strong>Feb</strong> <strong>2016</strong>

Low vision adventures in Israel<br />


Going from New Zealand to Hadassah<br />

Hospital in Jerusalem in September 2015, I<br />

imagined there would be armed guards at<br />

every entrance searching bags and checking IDs.<br />

Security was not the problem. Finding my way to<br />

the Michaelson Institute in the main building of<br />

Hadassah’s sprawling campus outside Jerusalem,<br />

was the problem.<br />

The Michaelson Institute is a multi-disciplinary,<br />

low-vision clinic staffed by ophthalmologists,<br />

optometrists, a social worker, a genetic counsellor<br />

and a very experienced rehabilitation instructor.<br />

Hadassah is a teaching hospital where all medical<br />

students, particularly ophthalmology registrars,<br />

attend a lecture on low vision as part of their<br />

course. The lecture is given in a mix of Hebrew,<br />

Arabic and English. Fortunately, instead of letter<br />

charts they use number charts, and I was able to<br />

learn my numbers in Hebrew very quickly this way.<br />

Israel, though not a wealthy country, has a social<br />

welfare scheme for people with low vision and<br />

blindness, based on visual and financial need.<br />

Those with very severe loss (less than 6/120)<br />

receive a benefit similar to New Zealand’s disability<br />

benefit. However, those with low vision between<br />

6/12 and 6/120 or less than 20 degrees visual<br />

fields, including homonymous hemianopia, receive<br />

a means-tested subsidy from the government,<br />

which pays for between 50% and 90% of consulting<br />

fees and cost of low vision devices, depending on<br />

their income.<br />

The Israeli technology I was keen to learn about<br />

was the OrCam device for those with really<br />

significant loss of vision. This head-mounted device<br />

is worn with a transmitter, strapped to a belt or<br />

carried in a bag, and a small attachment worn on<br />

a finger. The device recognises objects through a<br />

smart camera, mounted on your glasses, and speaks<br />

through an earpiece. Patients can activate OrCam<br />

by pointing the device at text or a product, or by<br />

pushing a button while looking in the direction of<br />

text, a face or product. These options allow for even<br />

a blind person to operate it, according to the sales<br />

team, although they add that it is not suitable for<br />

everyone and requires training. The sales team also<br />

concede that the better the vision, the easier it is to<br />

learn to use it, which correlates with the advice of<br />

colleagues at Hadassah, who pointed out that if you<br />

have sufficient vision to use it, you would usually use<br />

other cheaper and more readily available technology.<br />

I visited other Low Vision clinics in Israel. I was<br />

introduced to new lens technology designed<br />

Hadassah Hospital, Jerusalem<br />

specifically for people with macular degeneration,<br />

but suitable for other low vision situations as well,<br />

which I hope will be available here shortly.<br />

For reading and other near tasks there is a special<br />

type of magnifying spectacle which incorporates<br />

three LED lights beautifully aligned with the point<br />

of focus. These come in a range of magnifications<br />

and are supplied with a USB cable-charger. For<br />

distance, there are spectacle lenses which give a<br />

small amount of magnification and a tinted filter<br />

to enhance contrast. Another advance is a spectacle<br />

prescription lens which shifts the image to a better<br />

seeing point on the retina.<br />

I was hoping to find a centre for rehabilitation<br />

of stroke and traumatic brain injury victims at<br />

Hadassah. Unfortunately, despite my research<br />

on the internet indicating such a centre exists, in<br />

reality this turned out to be a small research team<br />

in the neuro-ophthalmology department.<br />

I did, however, finally manage to meet up briefly<br />

with the one person who seemed to know the<br />

most about visual rehabilitation, Haya Shames.<br />

This optometrist takes some clients privately for<br />

rehabilitation, while also doing a PhD in Posterior<br />

Cortical Atrophy. PCA is a very interesting type of<br />

Alzheimer’s disease which strikes at an earlier age<br />

(about 50 to 60 years old) and affects a person’s<br />

ability to read because the part of the brain which is<br />

responsible for reading—not just seeing—is affected<br />

first. People in the early stages often do the rounds<br />

of optometrists and ophthalmologists complaining<br />

they can’t read and are told there is nothing wrong<br />

with the health of their eyes or with their vision,<br />

which indeed is quite normal when tested on a<br />

(high-contrast) distance single letter chart. In my<br />

limited experience (n=2) of this condition, maximal<br />

enhancement of contrast can be of great assistance<br />

New appointments<br />

at Essilor Australia<br />

in the early stages when the patient still has the<br />

cognitive ability to read but is struggling.<br />

Overall, the experience of living and working in<br />

such a different environment was wonderful and<br />

confirmed for me that there is always something<br />

new or different to be absorbed particularly in<br />

low vision where so much relies on observation of<br />

and communication with the client, whatever<br />

Abbott rebrands<br />

Revitalens<br />

Abbott Medical Optics has rebranded<br />

its premium Revitalens multipurpose<br />

disinfecting solution brand to bring all<br />

its contact lens solutions under its well-known<br />

Complete brand.<br />

Now called Complete Revitalens MPDS, the<br />

rebranded product has been available since the<br />

beginning of this year. According to a company<br />

announcement the “solution provides proven<br />

peroxide quality disinfection with advanced<br />

Ocutec Duel Cleansing action, for 16hr long<br />

Complete Dry Eye<br />

Solutions: diagnosis and<br />

therapeutic treatment options<br />

• Oculus Keratograph 5M<br />

Diagnostic Dry Eye Assessment<br />

Meibo-scan<br />

• Infra Red LED<br />

Imaging<br />

• Blue & White LED<br />

TF-Scan<br />

• White LED<br />

OrCam is a tiny camera that can help visually impaired<br />

people recognise and interpret the world around them<br />

TF-Scan, R-scan<br />

• White or IR Placido-ring<br />

* Naomi Meltzer is a rehabilitation<br />

optometrist with Sight Loss<br />

Services. She was the recipient<br />

of the Valda Knight Memorial<br />

Scholarship, awarded by the NZ<br />

branch of Hadassah International<br />

to assist a New Zealand medical<br />

professional to study their<br />

particular area of interest at<br />

Hadassah Hospital in Jerusalem.<br />

lasting comfort….The formulation removes lipid<br />

and proteins to condition the contact lens.”<br />

Recent studies by the company show,<br />

Complete Revitalens has a significantly lower<br />

(up to four times lower) incident of adverse<br />

events and lower rate of solution-induced<br />

corneal staining and, perhaps most importantly,<br />

is still effective with even the most noncompliant<br />

patients.<br />

More details about the findings of these<br />

studies can be found on Abbott’s website. ▀<br />

their age. ▀<br />

Freecall: 0800 338 800<br />

Eric Breda has been appointed general<br />

manager for Independents & Affiliated<br />

Optometry, Essilor Australia. Another key<br />

appointment is that of Laurent Soudier who has<br />

joined the company as operations director.<br />

Breda joined the Essilor Australia team in August<br />

taking direct responsibility for driving Essilor’s<br />

organic growth objectives across the independent<br />

optometry market through effective strategic<br />

partnering and relationship management. Well<br />

known in the industry, Breda more recently<br />

held the position of business director ANZ with<br />

Transitions Optical for more than ten years. During<br />

this time, the company not only saw tremendous<br />

sales growth, but also the establishment of<br />

the Transitions Lenses brand in the psyche of<br />

Australian and New Zealand consumers. Prior to<br />

Eric Breda<br />

Laurent Soudier<br />

joining Transitions Optical in 1999, he held various<br />

marketing related roles and holds a Bachelor of<br />

Business degree, majoring in marketing.<br />

Soudier joins the team from Essilor Greater<br />

China where he has held the role of senior<br />

director, Operations and I.T. He returns for what<br />

is his third working period in Australia, after<br />

several years working overseas and has been with<br />

Essilor for an impressive 28 years. According to<br />

a company announcement he brings with him<br />

an extensive amount of insight, knowledge and<br />

expertise to the Australia market. Soudier holds<br />

a master degree in engineering (CNAM Poitoux<br />

Charentes).<br />

In his new role Soudier will take charge<br />

of, and be responsible for, all manufacturing<br />

processes and activities across Australia and<br />

New Zealand, including<br />

the branch laboratory<br />

network, supply chain<br />

and logistics, quality<br />

assurance, maintenance<br />

and the cluster’s offshoring<br />

strategy. He will<br />

be directly responsible<br />

for defining and<br />

implementing the core<br />

operational strategies to<br />

ensure reliable quality<br />

and great service to all<br />

our customers,<br />

said Essilor. ▀<br />

• Blephasteam<br />

Therapeutic heat and moisture treatment for the relief<br />

of Meibomian Gland Disfunction and associated diseases<br />

• Optimel<br />

Antibacterial Honey Eye Drops<br />

for improved ocular surface health<br />

and reduced inflammation<br />

www.designsforvision.co.nz<br />

A division of Paragon Care Group of Companies<br />

<strong>Feb</strong> <strong>2016</strong><br />




TEL:(09) 486-2070 MOB:(0274) 798-798<br />

Email: tony.maddocks@xtra.co.nz<br />

practicE For salE<br />

Get double-digit earnings without the seat and toil of a CBD<br />

location. Enjoy the superior work-life balance of the countryside,<br />

while still within an easy drive of divilisation in downtown<br />

Auckland. Ideally suited to an optometrist breaking out on their<br />

own, or breaking back into the business after maternity leave or<br />

OE, or a dispenser-optometrist team. Yes, double-digit earnings,<br />

and potential for even more growth. If this sounds like something<br />

you’d like to pursue, please apply in strictest confidence c/- NZ<br />

Optics, info@nzoptics.co.nz Code PFSS1.<br />

tErritory salEs managErs—nZ<br />

• Highly motivated.<br />

• Proven sales experience.<br />

• Excellent communication skills.<br />

• Proven optical knowledge.<br />

• Sound understanding of eyesight tests.<br />

• Brand management experience.<br />

• Product placement experience.<br />

• Starting Remuneration—commission only + sales related<br />

expenses.<br />

• Highly achievable sales targets.<br />

• Earn in access of $75K p.a.<br />

• Must have own car.<br />

Role for the right sales person, will eventually merge in to a<br />

more comprehensive job description with a retainer, and plus an<br />

attractive commission base.<br />

Contact: One Vision Australasia Pty Ltd. Call +61 423 229 297<br />

optical assistant—part-timE<br />

We are looking for preferably experienced, friendly, selfmotivated,<br />

organised staff-member to join our team at OPSM<br />

Lincoln North.<br />

If you like helping people, taking initiative and are passionate<br />

about eye care, fashion and customer service, this role is for you.<br />

This is a part-time position and would suit person who is<br />

wheeling to work flexible hours.<br />

Please e-mail your your cover letter and C.V. to<br />

Stephen.Hill@opsm.co.nz<br />

Exciting partnErship<br />

opportunity at<br />

Buchanan optomEtrists<br />

Buchanan Optometrists is an independent, well established<br />

practice in Christchurch, which provides a high level of<br />

professionalism and service. We are looking for a full time<br />

optometrist to join our business with a view to a partnership<br />

opportunity. Buchanan Optometrists prides itself in providing a<br />

great customer experience, so we are looking for the right person<br />

to join us in this key role.<br />

The practice is equipped with the latest Nidek 4 in 1 (autorefractor,<br />

keratometer, pachymeter, tonometer), Nidek automatic<br />

phoropter, Zeiss OCT, Zeiss retinal camera, topographer and<br />

Medmont VFA.<br />

You will have the opportunity to develop professionally with<br />

Ortho-K. We encourage professional development and encourage<br />

CPD opportunities in NZ and overseas. We see quite a lot of<br />

pathology as we are located within a medical centre, and we also<br />

have a fantastic range of frames.<br />

We are looking for an optometrist who has a keen interest in<br />

optometry and wants to develop professionally. The candidate<br />

must be therapeutically endorsed, have a minimum of 2 years<br />

experience, be comfortable working as a sole optometrist in the<br />

practice, and have an interest in business ownership. We have a<br />

great team, and we have a lot of fun. Optom hours are 8.30 – 5.00<br />

Monday - Friday, late night Thursday (6.30pm); no Saturdays or<br />

Sundays. Appointment times are every 30 minutes.<br />

This is a rare opportunity to be part of an enjoyable profitable<br />

practice. The partnership structure includes a competitive salary<br />

and the opportunity to buy shares progressively in the business<br />

and so be rewarded for your hard work and enthusiasm.<br />

Please email ian@buchanan-optometrists.co.nz to find out more.<br />

All enquiries will be treated with utmost confidence.<br />

customEr sErvicE pErson<br />

rEquirEd<br />

Here’s a chance to work in a great independent Optometry<br />

practice in Newmarket. We are looking for an amazing passionate<br />

customer service person for a fulltime role with a potential<br />

career path. You need to be efficent, totally customer focussed,<br />

well presented, able to multitask and absolutely love beautiful<br />

eyewear. If you reckon you’ve got what it takes to work in our<br />

busy practice please email your CV to jeremy@gateseyewear.co.nz<br />

EquipmEnt For salE<br />

Topcon Chair and stand, phoroptor, slit lamp, keratometer,<br />

hydraulic table, projector, NCT, Matrix, trial lens set— all in good<br />

condition. Contact c/- info@nzoptics.co.nz, Code: EQFS12<br />

odoB appointment<br />

The Optometrists and<br />

Dispensing Opticians<br />

Board (ODOB) has<br />

appointed Joanne<br />

Talbot as one of two lay<br />

members.<br />

Talbot, replaces lay member<br />

Kiri Rikihana, who was also<br />

the board deputy chair. The<br />

board will elect a new chair and<br />

deputy chair at its first meeting<br />

of the year in <strong>Feb</strong>ruary.<br />

Talbot, a health policy<br />

Joanne talbot<br />

consultant, brings more than<br />

15 years' experience to ODOB.<br />

She spent five years developing Deaf Child Worldwide (DCW),<br />

a non-governmental organisation that provides technical and<br />

educational resources for deaf children and their families in<br />

developing countries.<br />

She returned to New Zealand in 2005, working for the Ministry<br />

of Social Development as a senior policy analyst on the Working<br />

Age People’s Policy Team, before moving to Australia where she<br />

worked as the Policy Manager at the Consumer Health Forum of<br />

Australia (CHF).<br />

Between 2013 and 2015, Talbot lived in Tonga where she was<br />

vice president of the Tonga Red Cross Society, while undertaking<br />

a range of voluntary work and independent research, before<br />

returning once again to New Zealand.<br />

Talbot has a bachelor of arts from Bristol University and a<br />

Certificate in Business Administration and a post-graduate<br />

diploma in Public Health from Massey University.<br />

In addition to her ODOB appointment, Talbot sits on the New<br />

Zealand Psychologists Board.<br />

Whether you are looking for new staff, to sell<br />

your practice or buy some equipment, NZ<br />

Optics classified page connects you.<br />

For all your advertising needs email<br />

lesley@nzoptics.co.nz or<br />

(for classifieds only) do it online at<br />

www.nzoptics.co.nz<br />

NZ Optics supporting New Zealand’s<br />

ophthalmic community for<br />

more than 30 years<br />


<strong>Feb</strong>ruary <strong>2016</strong> <strong>2016</strong>

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