Oct 2016

Collaborative care
and practical learnings
The fifth Specsavers Clinical Conference (SCC5) from the
10-11 September, held for the second year in Brisbane,
attracted a record 550 delegates
Our first conference in Melbourne in 2011
saw 130 optometrists in attendance and we
felt that was a huge success,” says Charles
Horner, Specsavers’ director of communications.
“This year we are pleased to have seen over 350
delegates attend the education sessions on the
Saturday (introduced last year), and over 550 come
to the main clinical conference on the Sunday.
“We were delighted to also have 60 students
and over 80 optometrists from practices outside
of Specsavers, attend as our guests,” says Horner,
adding that while some were invited in person,
many signed up after hearing positive reviews of
previous Specsavers’ conferences.
The extra clinical education sessions on
Saturday were primarily optometry-led content,
while Sunday was largely ophthalmology-led.
This format is based on delegate feedback from
previous conferences, says Horner.
There was also a chance to earn CPD points
with Australian attendees able to download a
comprehensive conference app, which included
the ability to answer questions at the end of each
session in real time, with the anonymous results
posted on screens around the conference room, and
which automatically earned them their points. New
Zealand delegates still needed to fill in a paper form,
however. The conference also included many device
charging points and excellent free Wi-Fi.
The event’s platinum sponsors were Alcon and
Johnson & Johnson, with the team from the latter
displaying their new Acuvue Vita contact lenses,
which will be available to Specsavers’ owners
in New Zealand and Australia exclusively from
November (see p6).
“There’s huge consumer demand for contact
lenses and we need to make sure Specsavers
practices can capitalise on that,” says Horner. “In
the last 12 months, Specsavers optometrists in
New Zealand have prescribed over seven million
lenses – a welcome surprise that has really driven
business growth”.
SSC5 gold sponsors included BOC, Zeiss, Hilco,
CooperVision and health insurance funding
company HICAPS.
Horner believes that Specsavers investment
in continued professional development for both
optometrists and dispensing opticians is a huge
draw card for franchise holders, as is the back office
management model that frees up a clinician’s time
to focus on their patients. He also noted the support
Specsavers is giving to the Young Optometrists (YO)
network, which supports optometrists during the
first ten years of their career (a New Zealand chapter
is currently in the process of being established –
more on this in subsequent NZ Optics’ issues).
Showing this support for YO, Specsavers ran an
Instagram competition at SSC5, with several prizes
including the chance for one optometrist to go to
Everest with the Eyes for Everest charity. Jokingly
Ben Ashby, Specsavers’ optometry development
manager (ANZ) told delegates that if they weren’t
able to use Instagram, then they were probably too
old to be Young Optometrists!
As for future Specsavers Clinical Conferences,
no decision has been made on where to hold
next year’s – the conference is held in a different
city every two years – but Auckland hasn’t been
ruled out as a potential location, says Hornor,
adding he’s “thrilled” by the level of participation
Specsavers has from its New Zealand professionals.
Peter Larsen
Collaboration and better patient care
Hot off the heels of the announcement regarding
the memorandum of understanding between
Specsavers and RANZCO (see NZ Optics’ September
issue), this year’s conference included a strong
collaboration theme. Peter Larsen, optometrist and
Specsavers’ professional services director, opened
SSC5 on Sunday with a clear focus on the need
for optometry and ophthalmology to work better
together to achieve more measurable outcomes.
“Opinions don’t count for anything,” said Larsen,
noting there was still an old guard of clinical
practitioners who felt the structures RANZCO and
Specsavers are working toward are unnecessary.
“Measurable clinical outcomes are essential to
improve best practice and patient care.”
With up to 30% false-positive referral rates for
glaucoma, 15% of referrals failing to attend tertiary
care and 50% of glaucoma sufferers still going
undiagnosed, now was the time to put politics
aside, and for optometry and ophthalmology to
work better together, reducing risk, increasing
education, streamlining services and ultimately
improving patient care, he said.
A key aspect to making the collaboration
with RANZCO work, ensuring it received the
feedback it needed on its new referral guides, was
continuing education and working toward uniform
standards and processes, said Larsen. To achieve
this, optometrists needed data so Specsavers is
investing in a number of platforms to provide that
data, he said.
Having rolled out the new, secure informationsharing
portal Oculo to many of its Australian stores
in June this year, Larsen said he was delighted to
announce Specsavers would be subsidising Oculo
for franchise holders for the next six months.
“We are delighted to have Specsavers continued
support as we expand our network with independent
optometrists and ophthalmologists,” said Oculo’s
Dr Kate Taylor.
Dr Russel Bach
RANZCO guidelines for DED
RANZCO board member Dr Russell Bach, senior
medical officer, ophthalmology at the Prince
Alexandra Hospital in Brisbane, reinforced Fussey’s
emphasis on collaboration during his session on
RANZCO’s newly drafted clinical guidelines for
diabetic eye disease (DED). The guidelines, which
will be formally released later this year, aim to
give all optometrists a clear clinical pathway from
seeing a new patient through to when to refer
and how to continue caring for low-risk patients.
RANZCO released its first set of guidelines on
glaucoma management in August, DED is next
with AMD planned for late this year.
“It’s exciting to be representing RANZCO and
standing in front of a large group of eager
Sunday speakers Drs Russell Bach, Jesse Gale, Andrew White and Christolyn Raj, Peter Larsen, Dr Nathan Walker and Professor Stuart Graham
(missing Dr Sunil Warrier)
Amy Winter and Megan Glover
Leilei Zhou, Jingyi Xu, Daria Kozub and Sephy Cheng
Debra So and Kiwi speaker Richard Johnson with Niall McCormack and ODOB board
chair Damian Koppens
participants. That gives me a very positive feeling,”
said Dr Bach, noting how in this day and age we
are inundated with data and it is beyond the ability
of the human brain to cope with it all.
While this data – big data – is useful, he said,
clear structures and guidelines need to be put
in place to make sure patients aren’t overlooked
and don’t fall out of the system. “By following
these guidelines, clinical practitioners can ensure
the quality and standard of care that all patients
receive, and can also begin to streamline practices
and prevent duplication.”
Dr Bach referred to a Michigan-based study from
2005 which showed that by simply introducing
guidelines for patient diagnosis and care, the
survival rate of acute myocardial infarction (heart
attack) patients improved. “Medicine based
on memory is unreliable. Guidelines improve
collaborative care for the benefit of the patients.”
Dr Bach went on to preview the draft guidelines,
which give optometrists a clear pathway from
recognising an issue through to referral and
ongoing patient care.
Dr Nathan Walker
Vitreoretinal surgery advances
Dr Nathan Walker, an ophthalmologist and
vitreoretinal surgeon based on the Gold Coast,
followed with a look at advances in vitreoretinal
surgery. Referring to a range of common retinal
conditions seen by optometrists, such as macular
hole, epiretinal membrane and retinal detachment,
and how they are managed by specialists postreferral,
he demonstrated the vital role optometry
plays in identifying, referring and following up
these patients.
He also reviewed ocular trauma, emphasised
the importance of urgent referral and discussed
indications for surgery and the essential role
optometrists must play in post-operative care.
Dr Andrew White
Glaucoma care
Dr Andrew White, a senior lecturer at the University
of Sydney and consultant ophthalmologist at
Westmead Hospital, focussed on glaucoma care.
With the increasing volume of glaucoma patients,
neither optometry nor ophthalmology are able to
review them all without working together, he said.
Collaboration done well allows high-risk patients to
see consultants sooner, while those of moderate risk
Monica Lee, Bo Kim, Renee Song and Olivia Lee, Kiwis now working in Adelaide
and Queensland
Kiwi presenter Dr Jesse Gale discusses swollen optic discs
Hector Chang and now Fiji-based Sashi and Namita Singh
can be monitored, with a clear referral pathway, by
optometrists where they may otherwise have fallen
out of the system. Dr White referred to a study from
Stanford University, which showed compliance with
medicine and keeping appointments is higher when
patients are seen regularly; if people are not seen
regularly by a clinician, their condition deteriorates.
He ran through scenarios where patients should
be seen by an ophthalmologist and noted the
standard of referrals from some optometrists
can be quite poor, with no visual field or even
refraction notes passed on. Referring to the recently
released guidelines on referrals from the Asia-
Pacific Glaucoma Society, he emphasised the need
for the standardisation of referrals and discussed
the benefits and pitfalls of different diagnostic
tools, noting an OCT won’t always give an accurate
reading because of the parameters of the preprogrammed
data; and that a fundus – limited as it
can be in this modern technological age – offers a
comparable image with that of 20 years ago or 20
years into the future, as the technology does not
change. Ultimately, he emphasised the importance
of a practitioner’s own clinical skills – machines are
only as good as their operator!
Professor Stuart Graham:
Glaucoma case studies
In the last session before lunch, Professor Stuart
Graham, head of ophthalmology and visual science
at the Faculty of Medicine and Health Science at
Macquarie University, discussed the circumstances
under which a glaucoma patient might find
themselves in surgery, when to refer and what
cases are suitable for monitoring by an optometrist.
He ran through several interesting case histories,
including an 84-year-old male with non-specific
reduced vision. Despite having a normal optic
nerve, open angle and normal IOP, his visual fields
were really bad. Professor Graham noted glaucoma
diagnosis rarely begins with poor visual field
results and this was a referral alarm bell for other
conditions. If this patient walked into your clinic,
it is vital more questions are asked and a full case
history taken, he said, as the result for this patient
was melanoma and, caught early, melanoma
patients have a good outcome. Another case of a
46-year-old woman with exceptionally high IOP
was highlighted. Although treatment progressed
normally and her disease was halted, an initial
post-treatment OCT revealed very unusual results
20 NEW ZEALAND OPTICS October 2016