Sep 2018

NEW ZEALAND SEPTEMBER 2018 

Feature 

DRY EYE 2018 

The latest research 

Page 17 

Business 

Measuring practice 

intelligence 

Page 46 

Education 

Allergic to glasses? 

Page 52 

THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY 

PO Box 106 954, Auckland City 1143 

NEW 

Sensity Shine mirror 

A new and exclusive light-reactive, mirror look 

Hoya_NZoptics_FC_215x257mm_Sept18_Sensity.indd 1 

WWW.EYEONOPTICS.CO.NZ | 1 

13/8/18 12:53 pm

2018 • Voted by Australians • 2018 

2018 • Voted by New Zealanders • 2018 

Voted by New Zealanders 

ROLLOUT ALMOST COMPLETE! 

OCT IN EVERY 

PRACTICE 

EYE HEALTH IMPACTS, INVESTMENT UNDERWAY 

At Specsavers, our optometrists are at the forefront of improving detection, referral and diagnosis 

rates for eye disease and a range of eye conditions in both New Zealand and Australia. 

With the rollout of OCT technology into every practice now underway across 

New Zealand, linked to our patient management and electronic referral 

systems, our optometrists are already starting to make a marked difference 

to eye health outcomes. In one of the most ambitious screening programs 

ever undertaken, we are using OCT as a standard element of our pre-test 

routine, with every patient. 

Our aim? To give Specsavers optometrists access to the readings, data and 

3-D images that will enable them to deliver a new standard in eye health 

assessment and patient care. 

That’s why we’re making multi-million-dollar investments into technology, 

the latest equipment and professional development, while our optometry 

support team is developing ever closer working relationships with 

ophthalmology and eye disease stakeholders. And we continue to make 

parallel investments into dispensing qualifications and professional 

development. 

It all adds up to the fact that we’re on a clear mission to transform eye health 

in Australia and New Zealand – and we’d like you to join us on that mission. 

To find out more about optometry and dispensing roles across the country at all levels, contact Chris Rickard on 

027 579 5499 or email chris.rickard@specsavers.com. Alternatively, visit spectrum-anz.com for all the opportunities. 

Reader’s 

Digest 

Quality Service 

Award 

Reader’s 

Digest 


Award 

AITD 

Reader’s Digest 


Award 

2017 

Best 

Wellbeing 

Project 

2018 

Best Customer 

Service in AU 

Optometry 


Best Customer 

Service in NZ 

Optometry 


Best Talent 

Development 

Program 

2017 

Best Talent 

Development 

Program 

2017 

Best Customer 

Service in NZ 

Optometry 

2017 

Millward Brown 

Research 

No.1 for eye tests 

2016 

Excellence in 

Marketing 

Award 

2016 

Retail 

Store Design 

Award 

2016 

Transforming eye health

4 EDITORIAL 

NEWS 

6 Empowering disabled choice 

15 Retinal surgery trends 

44 Personalising glaucoma 

48 EyeBall’s island of vision 

48 


17 A year on from TFOS DEWS II 

30 Cataract surgery and dry eye 

34 Dry eye and autologous serum 

40 Setting up a dry eye clinic 

BUSINESS 

46 Measuring practice intelligence 

EDUCATION 

52 Allergic to glasses? 

53 A celebrity’s corneal erosion pain 

15 

26 

FASHION 

47 Jono: time for design 

50 News and warmth from the O-Show 

55 CLASSIFIEDS 

58 CHALKEYES PRESENTS 

6 

53 

www.eyeonoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand 

For general enquiries or classifieds please email info@nzoptics.co.nz 

For editorial, please contact Lesley Springall at lesley@nzoptics.co.nz or +64 27 445 3543, or Heather Douglas at heather@nzoptics.co.nz 

For all advertising/marketing enquiries, please contact Susanne Bradley at susanne@nzoptics.co.nz or +64 27 545 4357 in the first instance, or Lesley Springall at lesley@nzoptics.co.nz 

To submit artwork, or to query a graphic, please email susanne@nzoptics.co.nz 

NZ Optics magazine is the industry publication for New Zealand’s ophthalmic community. It is published monthly, 11 times a year, by New Zealand Optics 2015 Ltd. Copyright is held by NZ Optics 2015 Ltd. 

As well as the magazine and the website, NZ Optics publishes the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide that profiles the products and services of the industry. 

NZ Optics is an independent publication and has no affiliation with any organisations. The views expressed in this publication are not necessarily those of NZ Optics 2015 Ltd or the editorial team.

EDITORIAL 

Delving into dry eye, and more 

PHEW! THIS IS OUR BIGGEST issue ever, 60 

pages, and I couldn’t be more proud of it or our 

fourth and biggest Dry Eye 2018 special feature. 

There’s no denying that in the wake of the 

TFOS DEWS II report, dry eye has become 

big business and not just for those looking to 

profit, but among researchers who are finally 

receiving the funding they need to unravel 

the complexities of this too-long-ignored 

disease. We are lucky to have one of the 

world’s emerging gurus on all things dry eye, 

Associate Professor Jennifer Craig, based in 

New Zealand, leading and collaborating on 

much of the research tackling dry eye disease 

conundrums. Under Jen’s careful eye we have 

pulled together updates on much of this 

research (p17-43); shared insights into some 

big dry eye discussions - dry eye and cataract 

surgery (p30), allergies (p32) and autologous 

serum (p34); reviewed advances in eye drops 

(p37); and provided advice on setting up your 

own dry eye clinic (p40). 

To accommodate this very special annual 

feature we’ve had to move a lot of our news to 

online, so do check out www.eyeonoptics.co.nz 

when you can. That said, we’ve still got plenty of 

non-dry eye news in this month’s issue, including 

the latest funding changes for the country’s low 

vision population (p6); international retinal 

surgery trends (p15); and the big drawcards at 

the 2018 OSO and RANZCO conferences (p44 

and p47). 

We review what happened at this year’s 

O-Show (p50) and Silmo Sydney (p54) and 

feature the glamorous outfits from this year’s 

EyeBall (p48). Plus, don’t miss this month’s 

Stars and their Eyes which reviews Fox News 

queen Shannon Bream’s nightmare corneal 

erosion misdiagnosis, and the appalling 

attitude of her first ophthalmologist (p53); Style 

Eyes, which tackles patients’ spec allergies; and 

Chalkeyes presents, which fuels our imagination 

with a bit of shark waving. 

Enjoy! 

Lesley Springall, editor, 

NZ Optics 

CONTRIBUTORS 

Associate Professor Jennifer Craig 

It’s hard to imagine anyone who is anyone 

within dry eye research today who has not 

heard of our own dry eye specialist, Associate 

Professor Jennifer Craig. Vice chair of the 

hugely influential Tear Film & Ocular Surface 

Society’s second international dry eye 

workshop (TFOS DEWS II), Jen has travelled 

the world discussing the workshop’s findings; 

something she describes as “a privilege” given 

it’s in a field where the unmet need is so great. 

“If we persevere in our quest to seek answers and learn more through 

our research, we might be able to make a real difference to the quality 

of life of our patients.” Given the rise in interest and funds for dry eye, 

she says she’s hopeful we might see similar advances within the next 

decade to those we’ve seen over the last 25 years. 

Of all the places she’s visited, one stand-out was Transylvania and 

the obligatory visit to ‘Dracula’s castle’, she says. Peru also sparked 

her interest in exploring Latin America and perhaps visiting the real 

Machu Picchu (see p17) next time she’s there. 

When not spreading the dry eye-word internationally or focusing on 

her own or her growing team’s research into dry eye, her family keeps 

her busy, she says. “With two teenage sons and an ophthalmologist 

husband who all live life to the full, there’s always plenty going on. 

We all get a lot of enjoyment from music, jamming together and 

contributing to various bands as musicians, or in my case as a ceilidh 

dance caller and demonstrator. I love to dance when I get the chance 

and aspire to becoming a better fiddle (violin) player.” 

Jen is the hard-working clinical editor on our very special, annual dry 

eye feature (p17-43). 

4 | NEW ZEALAND OPTICS SEPTEMBER 2018

SHE LOVES HER ASTIGMATISM. 

YOUR PATIENTS DON’T. 

Biotrue ® ONEday lenses for Astigmatism have arrived! 

Designed to retain 98% of their moisture for up to 16 hours 1 

your patients will love the clear, comfortable vision Biotrue ONEday provides 2 . 

Now there is a complete range of bio-inspired daily contact lenses from 

Did you know, seals have a high degree of astigmatism in air but very little underwater 3 

- this helps them have clear vision when they need it most! 

Reference 1: Data on fi le. 2. Rah, M. (2014). Patient Satisfaction with Nesofi licon A Contact Lenses. Poster session presented at Global Specialty Lens Symposium, Las Vegas, NV. 3. Hanke et al. Corneal topography, refractive state, and accommodation in harbor seals 

(Phoca vitulina). Vision research 46.6-7 2006. © 2018 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affi liates. Other product names/ brand names are trademarks of their respective owners. Bausch & Lomb (New Zealand) 

Ltd c/- Bell Gully Auckland, Vero Centre, 48 Shortland Street, Auckland 1140, New Zealand. Marketed by Radiant Health Ltd. 0508 RADIANT. BFA.0016.NZ.18 

WWW.EYEONOPTICS.CO.NZ | 5

NEWS 

Empowering disabled choice 

By Heather Douglas 

A NEW DISABILITY support system, including 

a new funding model, will be trialled from 1 

October in the MidCentral District Health Board 

(DHB). 

The new Enabling Good Lives (EGL) initiative 

shifts the decision-making power to the 

disabled person to make choices about what 

works best for them and includes a personal 

budget, moving the funding model away from 

government-contracted services, to allow each 

disabled person to buy the services they need. 

While personal budgets have been around 

for several years, the key difference with 

the MidCentral roll-out is that anyone who 

currently receives funding from the Ministry of 

Health or Ministry of Social Development will 

automatically qualify for a personal budget, 

said Dr Garth Bennie, CEO of the New Zealand 

Disability Support Network (NZDSN). This 

personal budget is also more flexible than either 

the individualised funding (IF) scheme or the 

enhanced individualised funding (EIF) scheme 

currently offered in some regions, he says. The new 

MidCentral initiative “is about disabled people and 

their whānau having more options and greater 

decision making over what supports they need 

to live the life they want, rather than their lives 

having to fit around what has been on offer,” 

explains disability issues minister Carmel Sepuloni. 

In the longer term, the new funding model 

could lead to major changes for governmentfunded 

disability organisations, says Dr Bennie, 

noting that communities are looking forward 

to the coming changes while providers are 

variously enthusiastic, tentative, nervous and 

terrified by them. 

Feedback from disabled 

people… has been 

overwhelmingly positive, 

with most feeling 

significantly more 

independent” 

What it means for low vision patients 

“We have a contract with the Ministry of Health 

to deliver New Zealand vision rehabilitation 

services… That’s not up for challenge at the 

moment,” says Blind Foundation policy manager 

Dianne Rogers, but this initiative will still mean 

the Foundation has to offer the best services it 

can to what is essentially a new market where 

people get to choose the services they need. 

It is a big challenge, she concedes, but the 

changes won’t affect everyone, mostly just the 

younger market. “So, we want to make sure 

that we’re agile, we’re flexible, we’re thinking 

about what their needs are. We’re looking at our 

infrastructure and systems, making sure that 

people will want to engage with them on a oneon-one 

basis.” 

Australia’s model 

Across the Tasman, disability support providers 

have faced a shake-up with the introduction 

of Australia’s National Disability Insurance 

Scheme (NDIS), which is being rolled out 

nationwide over three years (2016-9). Although 

there are significant differences, it, too, aims 

to give people with disability better access to 

personalised support services. Vision Australia 

NDIS programme manager Scott Jacobs says the 

shift has been exceptionally positive, but warns 

the change can be challenging for support 

organisations. “The NDIS funds more services, 

to more people, in the blindness and low vision 

community than ever before. The biggest shift 

has been changing the relationship dynamic 

between clients and the organisation… Don’t 

underestimate the burden of change. Everything 

from administration and service agreements 

through to billing and financials will be different, 

and it requires methodical planning.” 

Jason Abrahams, Australasian general 

manager of Humanware, a manufacturer and 

supplier of low vision and blindness-assistive 

technologies, agrees the change to NDIS has 

been hugely disruptive. In hindsight, he says, 

he would have worked quicker to arm his team, 

his advocates and his clients with literature 

to help them with funding submissions. 

Providing simple ‘Why fund me?’ sheets and 

website content alongside product and service 

information would have avoided many lengthy 

funding refusals. 

But with most teething problems now ironed 

out, overall the change has been positive, he says. 

Returning to New Zealand 

There would be no overnight avalanche of 

applications in New Zealand, stressed Dr Bennie. 

While NZDSN supported the direction of 

change, questions still needed answering, such 

as, who’s doing the maths? “We are engaged 

right now in some very difficult conversations 

with government around appropriate levels of 

funding, which has been exacerbated by the 

recent pay settlement.” 

Feedback from disabled people who have 

had more say in shaping their support has been 

overwhelmingly positive, however, with most 

feeling significantly more independent, while 

many families say they feel their burden has 

been eased. 

The MidCentral initiative will be implemented 

on a ‘try, learn and adjust’ approach in the first 

year with changes expected following feedback 

from disabled people using the scheme, their 

whānau and others in the disability sector. No 

decisions have been made about expanding the 

new support system beyond MidCentral region, 

but ministers will be provided with advice on 

this in late 2020, said MoH spokesperson Emily 

Barrett. 

For the longer version of this story, please visit 

www.eyeonoptics.co.nz 

More news? See 

online… 

• How blue light speeds blindness 

• Amniotic membrane for dry eye? 

• Ethnicity and trabeculectomy outcomes 

• Cold as ocular anaesthetic alternative 

For more news, more international 

stories and all your favourite stories and 

columns from NZ Optics, 

visit www.eyeonoptics.co.nz 


3 tools to revolutionise 

your patient engagement 

Enable the anytime, anywhere convenience your 

patients have been looking for. MyHealth1st is your 

complete digital engagement solution. 

1 2 3 

MY LOCAL 

OPTOMETRIST 

Get more online 

bookings from patients 

seeking dry eye treatment 

Smarter, more convenient 

recalls for their next 

appointment 

Stay informed 

on their treatment 

post-consultation 

The simplest way to see 

more dry eye patients 

Find out more at myhealth1st.co.nz 

or by calling 0800 424 303

NEWS 

New smartphone 

ophthalmoscope 

oDocs Eye Care is set to release the 

oDocs nun, a portable smartphone 

ophthalmoscope, capable of both 

mydriatic and non-mydriatic retinal 

imaging. The device can be used 

independently as a handheld 

ophthalmoscope or with a broad 

range of smartphone gadgets 

running on the iOS and Android 

platforms. 

“The direct ophthalmoscope was 

invented 160 years ago. The optics 

remain the same. No wonder many 

physicians struggle with it,” said the company’s founder Dr Sheng Chiong 

Hong. “It is time for a complete upgrade.” 

The ODocs nun has already achieved the CE Mark as a Class 1 medical 

device and is registered with MedSafe and the Therapeutic Goods 

Administration (TGA). Pre-orders should be available from November, 

ahead of the official launch planned for the first quarter of 2019. Customers 

who pre-order the device will save up to $170 and receive it before the end 

of this year, said Dr Hong. 

oDocs Eye Care is a New Zealand social enterprise which designs and 

manufactures professional, portable eye care adaptors that can be used by 

anyone with a smartphone. Its mission is to end preventable blindness by 

ensuring professional eye care is accessible to anyone who needs it. 

For more information see ad on p47. 

2018 Spring Update 

Retina Specialists invites you to an educational evening 

(This event has been accredited by NZAO for 1.75 CPD points) 

Speakers 

Dr Rachel Barnes 

Interpreting OCTs: tips, tricks and pitfalls to avoid 

Dr Andrea Vincent 

Stem cells in eye disease treatment - myths, risks and reality 

Dr Narme Deva 

Myopic maculopathy 

Dr Peter Hadden 

Retinal Detachment and its differential diagnosis 

When: Tuesday 4 th September – 6pm to 8.30pm or 

Tuesday 18 th September – 6pm to 8.30pm 

Where: Retina Specialists,1 st Floor, 20 Titoki Street, Parnell 

Nibbles and drinks will be provided. 

RSVP to: 

09-307-2020 or email: practicemanager@retinaspecialists.co.nz 

by 3 rd September 2018. Please state which event you would like 

to attend and provide NZAO No. and Board Registration. 

The Texas A&M University team and their NOVA cane prototype. 

White cane goes high-tech 

FOUR ENGINEERING STUDENTS at Texas A&M University have 

developed a white cane attachment that detects objects and helps the 

user navigate around them using an ultrasonic sensor and a variety of 

vibrations. 

Electronics systems engineering technology students Garrett 

Friedrichs, Hunter Schwedler, Brady Langston, Jason Belmares and Lathan 

Moore spent more than a year developing the Navigational and Object 

Visual Assistant (NOVA), which uses an ultrasonic sensor and vibration 

motors to alert white cane users of any obstacles above the waist with 

specific vibration patterns. The team also created a mobile application that 

interacts with NOVA to signal directions to the user (eg. turn left, turn 

right). 

“[NOVA] has no auditory feedback at all, which is a big thing that 

visually impaired students stressed they wanted,” said Schwedler. “They 

need to closely listen to their surroundings and any sort of unnecessary 

sound can be distracting.” 

AOA complains to Facebook 

THE AMERICAN OPTOMETRIC ASSOCIATION (AOA) has written to 

Facebook founder Mark Zuckerberg, asking the social media giant not 

to accept advertising from online eye test developer, Opternative. 

Fighting fire from the health industry, Opternative, which is finalising 

partnerships to enter New Zealand and Australia, is also the subject 

of enforcement action by the US Food and Drug Administration (FDA) 

for what the FDA said is a lack of review of the product’s safety and 

efficacy and premarket approval prior to marketing. 

“Given the serious nature of the FDA warning against Opternative, 

we wanted to ensure that you are aware that your platform is being 

used to advertise a company that has marketed its app-based vision 

test without clearance or approval required by the government, in 

violation of federal law,” AOA recent past president Christopher Quinn 

told Zuckerberg. 

Opternative claims its digital refractive test can be used by its 

partners to offer vision tests and acuity screenings, anywhere at any 

time and said it is working with the FDA to comply with regulatory 

requirements. 

The Facebook letter is the latest weapon employed by the AOA 

against Opternative, which has previously raised questions about 

the Opternative product’s safety and efficacy and concerns about 

inaccurate prescriptions and the inability of the product to diagnose 

more serious health conditions. 

Credit: Taylor Phillips-Rodriguez 


Imaging ultra-wide 

without compromise. 

ZEISS HD Ultra-widefield 

// INNOVATION 

MADE BY ZEISS 

ZEISS CLARUS 500 

Colour. Clarity. Comfort. 

Compromising image quality may leave some pathology 

unseen. Introducing CLARUS 500, a next generation fundus 

imaging system from ZEISS that provides true colour and 

high resolution in a 200 degree ultra-widefield image. 

ZEISS 

Ph: 1300 365 470 

med.au@zeiss.com 

Visit www.zeiss.com/clarus

NEWS 

1st Group eyes ophthalmology 

AFTER TAKING THE Australasian optometry 

market by storm, 1st Group, the parent company 

of online booking and patient referral software 

platform MyHealth1st, is branching into 

ophthalmology. 

Just a week after announcing it had signed 

25% of New Zealand’s optometry practices in 

a few months*, the Australian Stock Exchange 

(ASX)-listed company issued another ASX 

announcement to say it had signed Vision Eye 

Institute (VEI) to its online patient engagement 

platform. With 16 sites across Victoria, New South 

Wales and Queensland, VEI is one of the biggest 

ophthalmology service providers in Australia. 

“This is an important strategic extension of our 

dominant market presence in the optometry 

market, where MyHealth1st will become 

increasingly involved in assisting the referral 

process to the ophthalmology sector by 

simplifying the experience for patients,” said 

Klaus Bartosch, 1st Group’s managing director in 

the ASX announcement. 

“Our collaboration with 1st Group will streamline 

the appointment making process and give us 

the opportunity to obtain real time feedback 

from our patients,” said James Thiedeman, VEI 

managing director. 

Promoting its role as patient booking and 

contact facilitator between optometry and 

ophthalmology, 1st Group can also operate 

with Oculo, the cloud-based secure messaging 

and clinical communication software company 

formed specifically to improve communication 

between optometry and ophthalmology, 

Bartosch told NZ Optics. 

“Ophthalmology patient referral processes are 

changing. Oculo now enables the clinical referral 

to be seamlessly transferred electronically, but 

the patient who had conveniently and easily 

booked their appointment online with their 

optometrist through MyHealth1st, is now 

Klaus Bartosch 

back to the dark ages, having to pick up the 

telephone to make their appointment to see the 

ophthalmologist. Over 65% of consumers find 

that process frustrating and inconvenient and 

many simply don’t bother at all or worse, wait 

until their condition worsens.” 

With 65% of the Australian independent 

optometry market along with 25% of the New 

Zealand market now using the MyHealth1st 

platform, Bartosch said it made sense to 

add ophthalmology to the mix, bringing the 

ophthalmic industry in-line with just about every 

other industry globally. 

“Patients increasingly prefer digital channels 

when accessing their healthcare services. I 

predict it won’t be long before all referrals 

between optometrists, GP’s and other referrers 

to specialists are conveniently handled through 

MyHealth1st, improving the connection 

between patient and their chosen healthcare 

service providers and complementing clinical 

referral systems like Oculo.” 

*www.eyeonoptics.co.nz/articles/archive/kiwipractices-embrace-online-booking/ 

Kat Rollings Photography 

Negating 

poor practise 

RANZCO IS DEVELOPING a process 

to provide active assurance of safe 

practise across the region to safeguard 

the public from poorly performing or 

incompetent doctors. While the number 

of practitioners not performing up 

to standard was small, they are overrepresented 

in complaints and reflect 

poorly on the rest of the profession, said 

RANZCO president Associate Professor 

Mark Daniell in his address in RANZCO’s 

Eye2Eye magazine. 

Two of the biggest risk factors for 

under-performance are increasing age 

and professional isolation. RANZCO’s 

process will closely align to the Medical 

Board of Australia’s (MBA’s) five pillars 

of professional performance and will 

build on structures RANZCO already 

has in place, said A/Prof Daniell, 

including strengthened assessment 

of practitioners with multiple 

substantiated complaints against them 

and a formal peer review. It is also likely 

peer reviews and health checks will be 

required for doctors aged 70 and every 

three years after that. 

Details of this process are being 

finalised in conjunction with the MBA 

and the Australian Health Practitioner 

Registration Agency (AHPRA), and 

the College will have a key role in 

supporting those with performance 

issues so they are carefully rehabilitated 

back into safe practise and assisted with 

remediation strategies, said RANZCO. 

Assistant Professor Amy Schefler 

Targeted therapy for eye cancer? 

LIGHT-ACTIVATED AU-011 has the potential 

to be the first targeted therapy for the primary 

treatment of ocular melanoma, said Clinical 

Assistant Professor Amy Schefler from New 

York’s Weill Cornell Medicine, at the 36th 

American Society of Retina Specialists meeting 

in Vancouver, Canada. 

Dr Schefler presented data from an openlabel 

phase 1b/2 study on 30 adult subjects with 

clinically diagnosed small to medium primary 

choroidal melanoma. Early efficacy results 

continue to be promising, with several subjects 

in the multiple-ascending-dose cohorts showing 

evidence of reduction in tumour height and 

100% of patients meeting the endpoint of stable 

disease at three months, she said. 

No targeted therapies are available at 

present and current radiotherapy treatments 

can be associated with severe visual loss and 

other long-term sequelae such as dry eye, 

glaucoma, cataracts and radiation retinopathy, 

said Dr Schefler, who is an investigator for 

Aura Biosciences, which developed the new 

treatment. 

AU-011 therapy consists of patented viral 

capsid conjugates (VCC) with IR-700DX dye 

molecules that are activated with an ophthalmic 

laser, which causes the drug to disrupt the cell 

membrane of tumour cells while sparing key 

eye structures. AU-011 has been granted orphan 

drug and fast track designations by the US Food 

and Drug Administration. 


You make every move with the 

utmost care and consideration. 

Shouldn’t you choose your 

phacoemulsification system 

that way too? 

Australia: AMO Australia Pty Ltd, 1-5 Khartoum Road, North Ryde, NSW 2113, Australia. Phone: 1800 266 111. 

New Zealand: AMO Australia Pty. Ltd 507 Mount Wellington Hwy, Mount Wellington, Auckland 1060, New Zealand. Phone: 0800 266 700. 

WHITESTAR SIGNATURE is a trademark of Johnson & Johnson Surgical Vision, Inc. © Johnson & Johnson Surgical Vision, Inc. 2018 | PP2018CT5002 


NEWS 

Pierre Longerna: 

optometry’s opportunities 

Essilor ANZ’s new French-born chief operating officer, 

Pierre Longerna, is optimistic about independent 

optometry’s future. Lesley Springall asked him about that 

future and ‘that merger’. 

Essilor New Zealand’s revenue held up well 

compared to Australia’s after the Luxottica 

merger announcement. Why was that? 

The combination of Essilor and Luxottica has 

raised a lot of questions for a lot of people. What 

the New Zealand team has done very well is to 

stay close to our customers, showing them that 

things are not going to change. Essilor is going 

to remain Essilor and Luxottica is going to remain 

Luxottica. In Australia, the situation was a little 

different because the team has not been as 

stable as in New Zealand. We had some gaps in 

the team at the wrong time, when our customers 

had a lot of questions. But it’s a combination 

of many factors in Australia that we’re now 

addressing. 

So, are Essilor ANZ’s closest customers not 

worried about the Luxottica merger? 

No, they are. Everywhere 

people are wondering 

what’s it about and that’s 

very fair. Most of our 

clients are independent 

and most are small, and 

they are dealing with a 

big company. So, they are 

looking at Essilor and are 

saying, ‘Now you are going 

to be part of something 

that’s even bigger. Am I 

going to be relevant to 

you? Are you going to 

continue to support me?’ 

And that’s a fair concern 

because, for them, bigger 

doesn’t mean better. 

It’s our job is to explain that Essilor is not going 

to leave them; Essilor is just going to be stronger. 

We are going to be the same Essilor, it’s just that 

in our group there will be more assets, there will 

be more expertise, and we will find ways to use 

that expertise to give them additional services, 

additional solutions to continue to grow their 

business. 

What about concerns about competing 

against Luxottica’s OPSM chain? 

Again, our customer base is the same as it was 

yesterday, mainly independent optometrists. 

Our job is to continue to grow that segment of 

the market. But there are different segments in 

the market. OPSM focuses on Luxottica frames. 

It’s about fashion. Whereas an independent 

optometrist is all about vision care. So, when we 

introduce something like (our new progressive 

lens) the new Varilux X 

lens, that goes to the 

independent segment; 

those who have the 

training to understand and 

sell the lens. And that will 

remain the case tomorrow; 

it won’t go to OPSM. 

What are the key issues 

facing independent 

optometry today? 

Many people are 

pessimistic, they talk 

about fierce competition 

and difficulties in the 

industry and so on. But 

we are in a good industry. 

The industry is growing and there are drivers for 

that - the population is growing, the population 

is aging, we are introducing new solutions for 

their needs. 

We are also in an industry where people are 

used to good products, premium products so 

there are opportunities. There are plenty of 

people who need eyeglasses, but they only have 

one pair of eyeglasses, they don’t even have 

prescription sunglasses. 

Yes, there are new players in the market - 

Specsavers, Bailey Nelson, George & Matilda - 

they are investing into the market because they 

understand there is a lot of potential. But… you 

have different segments in the market. You have 

businesses whose first criteria is price; you have 

people where it’s all about fashion; then the final 

segment is about vision. 

The main challenge for optometrists is to be 

clear about where they are going to compete 

and how they are going to make a difference. 

For independent optometrists, it’s about leading 

the vision care segment. They also have to keep 

investing; investing in their business, investing in 

their customers, investing in what makes them 

different if they want to grow. If we stop investing 

in research and development (R&D), what can 

we expect? To continue to sell the same thing at 

the same price? No. It will become a price war. 

So, we are investing in R&D, we are investing in 

our customers, we are investing in training, in 

marketing, that’s the way to continue to grow the 

business and it’s the same for our customers. 

For the full interview go to www.eyeonoptics.co.nz 

EVF update 

NEARLY HALF OF the students screened 

for undiagnosed eye conditions in one 

Manawatu school were referred for further 

treatment, while 31% of all students across 

the five schools screened were referred, reveal 

the latest results from the Essilor Vision 

Foundation screening programme. 

To date, about 4000 Kiwi children have 

been screened by the charity since launching 

its screening initiative in New Zealand more 

than two years ago, with almost a third found to 

have a range of eyesight conditions. Manawatu, 

Taranaki and Wanganui are the most recent 

regions to be screened, with South Auckland 

next in line. 

Helping in the Manawatu region were 

volunteers from Visique Eye Spy and Visique 

Naylor Palmer. “The work of the charity has 

made a real difference in the lives of thousands 

of these low decile school children who were 

living with undiagnosed vision conditions,” said 

Eye Spy optometrist Maile Tarsau (pictured). 


NEWS 

The Gordon Sanderson Award 

Richard Grills 

NEW 

He wears Sensity, Grey 

He wears Sensity Dark, Grey 

She wears Sensity Shine, 

Light Copper Mirror Brown 

RICHARD GRILLS, THE founder 

of Designs for Vision, well-known 

optometry and ophthalmology 

educator and long-time friend 

of Associate Professor Gordon 

Sanderson who died last year, has 

been named the inaugural winner 

of a new award named in honour 

of his friend. 


was introduced this year by the 

Australian Save Sight Institute and 

the Department of Ophthalmology 

at the University of Sydney, where 

both A/Prof Sanderson and Grills 

taught. 

Step into the light 

Sensity 

Stand out with outstanding comfort 

• Lenses darken outdoors and fade back 

indoors 

• Comfortable vision in all light conditions 

without having to change glasses 

New Sensity Dark 

Stand out with more performance 

• Extra dark outdoors 

• Darkens behind the car windscreen 

New Sensity Shine 

Stand out with more style 

• An exclusive light-reactive, mirror look 

• Extra dark outdoors & darkens behind 

the car windscreen 

Contact your Hoya Sales Consultant for more information 

NZ Customer Service | P: 0800 744 692 | E: hapl_cs_nz@hoya.com 

Aimed at ophthalmology 

educators, it was introduced to 

recognise the legacy of Gordon 

Sanderson as a pre-eminent 

teacher, said Professor Peter 

McCluskey, director of the Institute 

and chair of ophthalmology at 

Sydney University. “It recognises 

others who have made similar 

outstanding contributions to 

teaching… Richard was the 

obvious choice for the inaugural 

award. He has taught optics with 

Gordon from the time Gordon 

first arrived in Dunedin. They 

have both been involved in various 

Available in Grey, Brown & Green 

Available in Grey, Brown & Green 

Available in Grey Silver, Brown Copper & Green Blue 

teaching courses - the old firstpart 

ophthalmology courses 

and the Collaborative Otago and 

Sydney Masters of Ophthalmology 

programme started by Gordon. 

Like Gordon, Richard is an 

outstanding teacher who has 

taught optics to generations of 

ophthalmologists in Australia and 

New Zealand. He is a most worthy 

and fitting recipient.” 

On being asked about what the 

award meant to him, Grills said it 

was a great honour and reminisced 

about the good times he’d had with 

his friend. “Gordon was an iconic 

teacher of ophthalmic optics who 

I have known as a colleague and 

a great friend for about 45 years. 

We had several fishing outings 

together, both in New Zealand and 

Australia, and of course a few jars 

on too many occasions to count.” 


is the second award in the region 

introduced in memory of 

A/Prof Sanderson. The first, the 

Gordon Sanderson Scholarship, 

was introduced by Glaucoma 

New Zealand in 2017 and is 

awarded annually to an optometry 

or medical trainee from the 

Universities of Auckland, Otago or 

Sydney (reflecting where A/Prof 

Sanderson taught) for research or 

education into glaucoma. 

Dead eye 

IN TRUE JAMES BOND 

style, researchers from 

Warsaw University of Technology 

have trained artificial intelligence 

(AI) algorithms to tell the difference 

between the irises of dead and 

live people to prevent a dead 

person’s eyeball from being used to 

circumvent security measures. The 

team used a database of iris scans 

from dead bodies and living people 

to train the algorithm, resulting 

in dead irises being detected 

with 100% accuracy, and giving 

the probability of live irises being 

misclassified at just 1%. 

However, this level of accuracy 

is only reached after the person 

has been dead for 16 hours or 

more, said the study’s authors in 

MIT Technology Review. “Samples 

collected briefly after death can fail 

to provide post-mortem changes 

pronounced enough to serve as 

cues for liveness detection… giving 

these gruesome hackers a window 

of opportunity since freshly plucked 

eyeballs should work a treat.” 

NZOptics_HP_Sensity_209x147mm.indd 1 

14 | NEW ZEALAND OPTICS SEPTEMBER 2018 

15/8/18 10:51 am

Retinal surgery trends 

ACCORDING TO THE 

American Society of Retina 

Specialists’ (ASRS’) 2018 Global 

Trends in Retina survey, most 

ophthalmologist respondents 

had learned a new technique via 

online video less than 24 hours 

before performing it. The trend 

was greatest in Africa/Middle 

East (72.6%) and least in the US 

(53.8%). 

Most respondents also felt the 

greatest unmet need relating to wet 

age-related macular degeneration 

(wAMD) treatment was the 

availability of long-acting/sustained 

delivery options. While the firstline 

anti-vascular endothelial 

growth factor (anti-VEGF) agent 

for wAMD in Africa/Middle 

East and the United States was 

bevacizumab (Avastin), at 79.3% 

and 70.2% respectively, Aflibercept 

(Eylea) was the leading option 

in Asia/Pacific (41.7%), Central 

& South America (47.3%) and 

Europe (37.2%). The majority 

of respondents said they would 

consider switching anti-VEGF 

agents due to inadequate response 

after three to six injections. 

Treatment preference for a submacular 

haemorrhage due to AMD 

with visual acuity (VA) =20/200 

varied, with Africa/Middle East 

favouring vitrectomy with tissue 

plasminogen activator (t-PA) 

injection over anti-VEGF injection 

therapy, while the majority of 

other regions opted for anti-VEGF 

injection over vitrectomy with 

t-PA, though in Europe preference 

for the two options was almost 

evenly split. 

Just over half of all respondents 

said they performed pneumatic 

retinopexy less than once a month 

while a significant majority (70.2%- 

89.7%) said they had not used 

intraoperative optical coherence 

tomography (OCT). 

For the full article, see www. 

eyeonoptics.co.nz/articles/archive/ 

global-trends-in-retina/. 

LaHood joins EI 

REFRACTIVE SURGEON 

Dr Ben LaHood has joined 

the team at Eye Institute. 

After graduating with 

distinction from Otago 

Medical School, Dr 

LaHood undertook 

subspecialty training in 

laser and cataract surgery, 

including astigmatism 

management, in Sydney 

before gaining further experience 

in the US. 

“Being the only candidate of 

the post-graduate diploma in 

ophthalmology to be awarded all 

three prizes in ophthalmic anatomy, 

physiology and optics from the 

University of Sydney, there is no 

denying that Ben is knowledgeable 

and passionate about his field,” said 

Eye Institute’s Dr Adam Watson. 

“This coupled with his warm 

personality and genuine interest 

in patient health, drives him to 

continue his academic 

pursuits in improving 

outcomes for his 

patients.” 

This recently resulted 

in Dr LaHood being 

awarded a grant 

from the European 

Society of Cataract and 

Refractive Surgeons 

to present his findings 

on his master’s topic of posterior 

corneal astigmatism. He also 

specialises in ocular surface disease 

as well as the management of 

keratoconus. 

Dr LaHood said it’s greatly 

rewarding to provide patients 

with refractive solutions they had 

considered impossible. “Joining Eye 

Institute has been wonderful as our 

technology is absolutely state of the 

art and the team are so experienced 

and helpful. I already feel like part 

of the family.” 


EDUCATION 

SOVS: ADVANCING CLINICAL PRACTICE 

The second School of Optometry and Vision 

Science conference promised to be thoughtprovoking 

and informative. It didn’t fail to 

deliver, reports Rebecca Findlay. 

AFTER THE WELCOME and 

mihi, Jack Phu from the Centre 

for Eye Health in Sydney opened 

this year’s University of Auckland 

School of Optometry and Vision 

Science (SOVS) conference with a 

talk on reconciling structure and 

function in disease diagnosis. 

He illustrated the clinical 

conundrum whereby some patients 

have a deficit in structure with 

an accompanying loss of visual 

function, whereas other patients do 

not appear to have loss of function. 

He underlined the need to use 

pathophysiology of the disease to 

understand the structure-function 

relationship and the importance of 

identifying the most appropriate 

clinical tests by changing how we 

take a patient’s history. 

With an increasing number 

of migrants in New Zealand, 

SOVS professional teaching fellow 

John McLennan challenged us 

to consider glaucoma in people 

of European ethnicity to be the 

exception rather than the norm. 

He presented a literature review 

highlighting the variations in 

prevalence of primary glaucoma 

with ethnicity. 

Robert Ng reported on his time 

at SUNY (the State University 

of New York) on his Snowvision 

Scholarship and discussed some 

of the similarities and differences 

between the American and New 

Zealand models of eye care, 

highlighting the lack of identity 

of medical optometry in New 

Zealand. In the US, this is more 

clearly defined with dilation the 

minimum standard of care and 

systemic blood pressure routinely 

measured by optometrists. 

An update on treatment for 

adenovirus was presented by fellow 

SOVS staffer Dr Geraint Phillips. 

A combination of povidone iodine 

and steroid reduces the course of 

the condition and prevents corneal 

complications. A commercial 

formulation is not yet available, so 

the drops require compounding. 

Dr Phillips also clarified the ability 

of optometrists to issue medical 

certificates under the Holidays 

Amendment Act so we can keep 

these patients from sharing their 

viruses with their colleagues. 

Dr Angelica Ly, also from the 

Centre for Eye Health, presented 

on multimodal imaging. She 

provided a concise review of 

imaging technologies currently 

available and demonstrated the 

multimodal imaging use with 

a series of case studies showing 

how it can improve diagnosis 

and disease prognostication and 

allow better case management. 

Multimodal imaging allows 

clinicians to ensure nothing is 

missed and, in some cases, it may 

dramatically alter the best practice 

management plan. 

Tauranga optometrist Alex Petty 

then discussed the need to develop 

a New Zealand myopia action 

group and undertake research to 

establish the prevalence of myopia 

Jean Choi, Zaria Burden, Grace Elliott, Zane Stellingwerf and Bradley Pillay 

Angelica Ly, visiting 

presenter, and Jenny 

Ogier at the low vision 

workshop 

here to support prevention and 

intervention measures to reduce 

future economic and social 

costs. CooperVision’s Joe Tanner 

continued this theme, providing 

a study update on MiSight 1-day 

contact lenses for myopia control. 

The lenses continue to be effective 

after four years and are showing 

good results in older children, he 

said. 

Vision science research 

updates 

Associate Professor Sam 

Schwarzkopf opened his talk 

by demonstrating variability in 

response to ocular illusions. He 

described his visual cortex tuning 

research and its links to perception 

and illustrated functional MRI 

methods used to model how visual 

objects are represented in the visual 

cortex. 

The results of a series of 

studies measuring recognition 

acuity in children were shared 

by Dr Lisa Hamm. She described 

the development of a new set of 

optotypes for use in children as 

well as the use of technology to 

reduce scoring variability and to 

estimate viewing distance. 

A group of current optometry 

undergraduate students presented 

results from their summer student 

projects on a range of topics 

including visual impairment in 

stroke (Carla Fasher), virtual 

reality on tear film quality and 

dry eye (Joyce Wong, see p39), 

erythropoietin on the premature 

sheep eye (Muthana Noori) and 

a novel eyelid massage device for 

meibomian gland dysfunction 

(Jasmine Feng). 

Workshops 

The afternoon consisted of 

two workshop sessions, with 

attendees able to choose from a 

variety of topics: myopia control, 

ocular imaging, orthokeratology, 

low vision, colour vision and a 

glaucoma peer review session. 

These workshops provided an 

in-depth and hands on approach 

to the subjects and were a great 

opportunity to refresh and expand 

knowledge of these specialist areas. 

Posters provided by optometry 

staff and postgraduate students 

were available for viewing 

throughout the day, during session 

breaks. 

The conference concluded 

with drinks and nibbles and a 

‘prize draw’ for those who had 

visited each of the trade displays 

during the day and stamped their 

“passports”. Congratulations to all 

the winners and to the School of 

Optometry and Vision Science on 

a second conference that exceeded 

expectations and set the bar for 

future events. 

Rebecca Findlay is a PhD candidate with 

the School of Optometry and Vision 

Science and a paediatric optometrist for 

Counties Manukau Health. 

For more from SOVS, see p48 

for all the glamour from this 

years EyeBall. 



Dry eye in practice By 

Lesley Springall, editor NZ Optics 

SINCE OUR LAST dry eye special feature, 

dry eye has gone mainstream. My in-box 

never empties of news about the latest dry 

eye products and dry eye research or different 

organisations offering the next best thing for dry 

eye sufferers. Spurred on by the hard-working TFOS DEWS II team and 

the multitude of international ambassadors who have come to the 

organisation’s aid to champion dry eye in their region (see main story, 

this page), dry eye is finally beginning to get the attention it deserves. 

Since the TFOS DEWS II report was released last year, there’s been a 

plethora of research started, completed and ongoing; a great deal more 

sharing of ideas; and a far greater focus on dry eye from across the eye 

health spectrum, all of which can only be good for patients whose lives 

are often severely affected by the pain and discomfort of dry eye disease. 

We are proud to bring you the latest update on all things dry eye from 

this part of the world and further afield, recognising the collaborative 

efforts ongoing in dry eye today, many initiated or involving our own 

University of Auckland. 

We would like to thank the many contributors to this year’s Dry Eye 

Special Feature, but especially our clinical editor, Associate Professor 

Jennifer Craig, New Zealand’s own international dry eye expert who, 

with considerable time and effort on her part, makes this feature 

possible. Jennifer not only helps us celebrate the work on dry eye on 

this side of the world, but also ensures the quality and breadth of the 

dry eye research and news we share continues to further all of our 

understanding and knowledge of dry eye. 

TFOS DEWS II: 

a year on… 

By A/Prof Jennifer Craig, vice-chair, TFOS DEWS II 

IT’S BEEN A full year since the outcomes of the Tear Film & Ocular 

Surface Society’s second Dry Eye Workshop (now better known as TFOS 

DEWS II) were released to the world in a series of 10 reports that distilled 

the scientific evidence and provided an updated global consensus view on 

various aspects of dry eye… and what a year it’s been! 

Whether it was greater public awareness; increased recognition of 

the impact dry eye has on quality of life; a sense of optimism that there 

are more available therapeutic options than ever to make a difference 

to affected patients’ lives; or simply a lack of patience to see the longpromised 

outcomes of the two and a half years’ of effort by more than 

150 experts, I’m not sure, but the results were certainly eagerly awaited by 

YOUR VISION. OUR FOCUS. 

researchers, clinicians, industry, regulators and patients alike. 

Ensuring outcomes reach those who matter 

A year on, as I pack for the third Ocular Surface and Keratoprosthesis 

Topcon SL-D701 

Conference (OSKON) in Chennai, India - the most recent area in the 

Topcon’s premium digital ready Slit Lamp with tower style illumination column. 

world in which TFOS DEWS II is being Homogeneous showcased LED illumination - there’s Optional been enhanced little filter sign 

system for Meibomian 

5-step magnification up to 40x 

of this initial interest dwindling. Practitioners across the world gland observation remain and Superior 

14mm Slit illumination 

Fluorescein observation 

eager to improve their understanding DC-4 Digital of dry Camera option eye disease (DED), learn 

more about the key outcomes from the report and update their practices 

accordingly to provide the best service possible to their patients. 

Topcon CV-5000 

It’s been pleasing to see entire international conference sessions devoted 

Computerised Vision Tester - optional integration with PC-50s LCD Visual Acuity Chart. 

to the presentation 

Automated Refractor 

of the 

Head controlled 

TFOS 

by KB-50 

DEWS 

colour touch 

II 

screen 

reports. 

& dial controller 

The first such sessions 

Advanced integration – pull through previous script and/or auto-refraction. Export final 

were at the TFOS conference in Montpellier, ARVO in Baltimore and 

subjective data to practice management software 

in Washington DC in 2017. In Washington, interest was so keen, the 

interactive presentations were live-streamed to other countries. Interest 

has continued to spread and I’ve Topcon had the TRK-2P opportunity to present TFOS 

DEWS II sessions, in person, at conferences Completely automated alignment, as far focus afield and measurement as Romania acquisition.Flexible (Sibiu, 

colour 

touch-screen for versatile positioning. Integration with Practice Management Software. 

Transylvania), India (Chennai), and All four measurements, Peru (Lima) in both eyes, as in less well than 60 as seconds! to ensure 

Auto-Refraction 

Auto-Keratometry 

that our new found dry eye knowledge 

Non-contact 

is passed 

Tonometry 

on more locally 

Non-contact 

in 

Pachymetry 

New 

Zealand. I’ve also had the pleasure of contributing to a sponsored Canadawide 

tour, an initiative designed to take TFOS DEWS II to Canadian 

optometrists throughout the country, beyond just the main centres. 

We’ve tried to maximise the relevance of the workshop’s outcomes to 

clinicians in optometric practice, so a practical format to the presentations 

has been adopted. A conventional slide presentation has been supplemented 

with a relatable, live demonstration of the recommended TFOS DEWS 

II dry eye diagnostic process, including examples of how appropriate 

therapeutic strategies might be applied. This has been very well-received by 

practitioners around the world who report having made changes to their 

1300 DEVICE (338 423) customers@device.com.au device.com.au 

daily practice after realising how easily the new diagnostic criteria can be 

implemented in a clinical setting. 

An example of this live demonstration teaching format can be viewed 

A/Prof Jennifer Craig in Lima flanked by TFOS’ A/Prof David Sullivan and Prof James Wolffsohn 

SEE WHAT OTHERS CAN’T SEE 

Topcon CA-800 

Topcon Triton Swept-Source OCT 

• Corneal Analyser with Infra-Red Placido disk topography. 

• Automated alignment, focus and capture – controlled by 

colour touchscreen or digital control stick 

• Includes Meibomian Gland imaging, tear film breakup time, 

and Zernike Analysis reports 

The only commercially 

available Posterior & 

Anterior SWEPT 

SOURCE OCT. 

• Invisible 1050nm wavelength 

penetrates cataracts and other 

media opacities 

• 100,000 A-scans/sec - 12mm x 

9mm WIDE scans provides a 

dense data set 

• Comprehensive reports, including 

Glaucoma & hood reports 

• Red-free & Colour fundus 

photography standard 

• Optional Anterior Segment, 

Fluorescein Angiography, Fundus 

Auto-Fluorescence and 

OCT-Angiography 

0508 DEVICE (338 423) customers@device.co.nz device.co.nz 



from the first TFOS DEWS II presentation of this kind I delivered along with 

Professor James Wolffsohn (UK) and Professor Lyndon Jones (Canada). 

This was recorded by the British Contact Lens Association (BCLA) at 

their conference in June 2017 and is freely available at www.tearfilm.org/ 

dettconferences-tfos_dews_ii_live_presentations/5857_5581/eng/. 

Attempts have been made to address different practitioner learning 

styles and opportunities by providing the material in multiple formats: 

editorials and continuing education articles as well as podcasts and online 

CPD. Moderating an online CPD session for international online medical 

information provider Medscape was a novel experience (see picture). 

Encouraging education and discussion… 

Supplementing the recommendations from the report, TFOS has 

further sponsored the creation of nine educational videos on diagnostic 

techniques – tear film stability assessment and evaluation of ocular 

surface staining, including lid margin staining , amongst others - www. 

tearfilm.org/dettconferences-diagnostic_videos/5582_5581/eng/ - as well 

as five videos on recommended management strategies, covering a range 

of therapies from lid hygiene to punctal plugging - www.tearfilm.org/ 

dettconferences-therapeutic_treatment_videos/5583_5581/eng/. These 

have been designed to encourage global consistency in technique and are 

suitable for use by practitioners who wish to expand their skills in dry eye 

or brush-up on existing skills and students learning the techniques for the 

first time. 

Getting the word out to all those who might benefit was always a major 

goal of TFOS DEWS II. As a result, and thanks to industry sponsorship, 

the executive summary and in some cases, the entire report (close to 400 

pages) have been, or are in the process of being, translated into multiple 

languages, including French, Italian, German, Spanish (sponsored by 

Allergan), Chinese, Korean, Portuguese, Vietnamese (sponsored by 

Novartis), Romanian, and Turkish (sponsored by SIFI). In addition, a 

more layman’s version of the executive summary has been written for 

English-speaking patients to encourage awareness and understanding of 

Add data to your insights. 

There is quantitative data in every eye. Uncovering this information 

can help guide your diagnosis and management of the ocular surface. 

In fact, the point-of-care TearLab Diagnostic Test provides precise 

and predictive information regarding tear osmolarity, an important 

biomarker of ocular surface health. 

© 2016 Tearlab Corp. I 920275ROW REV A 

phone 09 443 0072 email tim@oic.co.nz 

To learn more, 

visit Tearlab.com 

TearLab® 

A/Prof Craig moderating Medscape’s online CPD session 

the disease amongst those directly affected. This is currently also being 

considered for translation into other languages. 

…and further research and awareness 

The report continues to help increase awareness and recently has been 

used in an attempt to encourage better government funding in the US 

for dry eye research. In July 2018, TFOS and the Alliance for Eye and 

Vision Research (AEVR) joined with the vision community and coalition 

partners (including major US stakeholders in eye care and research such as 

ARVO and the American Academies of Optometry and Ophthalmology) 

to attend a Congressional Briefing and delegation visits on Capitol Hill 

in Washington DC. This was the second year that the Dry Eye Awareness 

Month of July has been recognised in this way. The Briefing focused on 

TFOS DEWS II and its impact on clinical practice and research. 

Recognising that the work of TFOS is not possible without the help 

of many people, TFOS has appointed ambassadors across the world to 

facilitate the dissemination of ocular surface knowledge gained through 

TFOS DEWS II. I’m honoured to have been appointed the ambassador for 

New Zealand while Dr Maria Markoulli and Dr Laura Downie serve as 

the ambassadors for Australia. So, if you’re aware of an unmet need where 

TFOS might be able to assist, be sure to let us know. 

Where to next – creating benchmarks 

One of the major gaps in knowledge identified by TFOS DEWS II was the 

management of different subtypes and severities of DED. Certainly, we 

no longer expect all patients to achieve adequate resolution of symptoms 

from aqueous tear supplementation alone, but as we introduce a range 

of therapies to manage lid disease as well as lacrimal gland insufficiency, 

TFOS DEWS II recognises there’s a need for better evidence regarding 

which therapies will best suit which patients and at which point in their 

disease. As a starting point, a survey, to which many New Zealand clinicians 

contributed, has been conducted. Once analysed, the outcomes will 

describe how practitioners in different parts of the world are diagnosing 

and managing dry eye to provide a benchmark of standard of care and to 

highlight areas where scientific evidence is lacking and where adequately 

masked, randomised and controlled clinical trials should be conducted. 

Understanding the natural history of DED 

Another gap to be filled is in better understanding the natural history 

of DED and its common cause, meibomian gland dysfunction. To that 

end, through collaborations at Aston University in the UK with Professor 

James Wolffsohn, I was able to participate in the Royal Society’s Summer 

Science Symposium in London in early July. Members of the public who 

visited the seven-day exhibition, were offered an opportunity to learn 

about dry eye and to contribute to the research. This resulted in more 

than 1750 individuals providing data on their demographics, symptoms 

and comfortable staring capabilities (see p26), and around 1400 of those 

undergoing a rapid dry eye workup on the Oculus Keratograph 5M. 

This initiative has generated a wealth of data which it is anticipated will 

contribute to our understanding of how commonly dry eye occurs and 

offer insights into its relationship with age, sex and other risk factors. 

Associate Professor Jennifer Craig is head of the Ocular Surface Laboratory at the 

University of Auckland, was vice-chair of TFOS DEWS II and is clinical editor of NZ Optics’ 

annual special feature on dry eye. 


Long-lasting lubrication for dry eyes 

that is preservative-free and completely 

sterile, delivered through the unique 

COMOD ® multi-dose application system. 

For severe or 

chronic dry eye 

FULLY FUNDED 

Special authority criteria applies * 

For mild to 

moderate dry eye 

The systematic approach to eye lubrication 

for 

Dry Eyes 

Preservative-free and phosphate-free 

Can be used for 6 months after opening 

Compatible with all types of contact lenses 

At least 300 measured drops per pack, 

or 150 treatments (both eyes) 

For product enquiries contact: 

CORNEAL LENS 

CORPORATION N.Z. LTD 

www.corneal-lens.co.nz 

*Special Authority criteria applies only to HYLO ® -FRESH – please refer to the New Zealand Pharmaceutical Schedule for details. 

HYLO ® -FRESH (Sodium hyaluronate 0.1% w/v, 10mL) and HYLO-FORTE ® (Sodium hyaluronate 0.2% w/v, 10mL) eye drops are General Sales Medicines to improve the lubrication of the eyes, in eyes that are dry, irritated and tired from external factors. 

Always read the label and use strictly as directed. If symptoms persist see your healthcare professional. HYLO ® -FRESH, HYLO-FORTE ® and COMOD ® are registered trademarks of URSAPHARM. AFT Pharmaceuticals, Auckland. 

For information & samples: 

0800 423 823 

customer.service@aftpharm.com


Ocular Surface Laboratory update 

By A/Prof Jennifer Craig, head of OSL 

OVER THE YEAR there’s been 

a strong team of individuals 

working under the Ocular Surface 

Laboratory (OSL) banner. 

We’ve had some fantastic 

research support on the latest stage 

of our exploratory work on manuka 

honey as a treatment for blepharitis 

(www.eyeonoptics.co.nz/articles/ 

archive/honey-for-blepharitis/) 

from part-time research fellow Dr 

Andrea Cruzat, who joined us from 

Schepens Eye Institute in Boston. 

A difficult career choice required 

Andrea to relocate to Chile recently, 

sadly, but we plan to continue our 

collaborations and hope to work 

together again in future. Helping 

to soften the blow of Andrea’s 

departure, we’ve been delighted to 

welcome clinician scientist and full-time research fellow, Dr Alex Muntz, 

who joins us from the University of Waterloo where he completed his PhD 

under the supervision of Professor Lyndon Jones. His article in this special 

feature describes the research he’s been involved in, evaluating the eyelid 

margin at a cellular level. 

The lab supports a large number of research students who work 

diligently to complete degrees at doctoral, masters and honours level, 

or join us for shorter-term projects for medical programme selectives, 

research electives or as summer students. It’s exciting to see senior PhD 

students, Sanjay Marasini and Ally Xue, close to completion of their PhD 

studies, and we were delighted to see Dr Priyanka Agarwal, who was 

supervised by Dr Ilva Rupenthal and myself, successfully defend her PhD 

thesis recently and receive the honour of placement on the Dean’s list of 

Excellence. 

We also welcome Dr Michael Wang as the newest PhD candidate in 

the group. His project will focus largely on epidemiological studies of 

dry eye, but his extensive experience in the tear film and ocular surface, 

from his collaboration with the lab over many years, will no doubt see 

his involvement across many other areas during this time. Doctoral cosupervision 

opportunities extend as far as Melbourne where second-year 

PhD student, Ceecee Zhang (University of Auckland optometry graduate) 

is exploring the neurotrophic potential of omega-3 in a study in diabetes, 

under the primary supervision of senior lecturer, Dr Laura Downie. 

BOptom honours students Lexia Ah Kit, Brinda Mamidi, Alicia Han and 

Kylie Mann completed projects with us last year, some published examples 

of which are described below. 

We were delighted to have optometrist and now junior doctor Dr 

William Shew, return to the OSL to conduct a repeatability evaluation 

of infrared meibography and to work with Dr Simon Dean, Dr Kosar 

Kheirabi and the team, on projects evaluating the impact of chalazion 

surgery on the meibomian glands, in collaboration with Dr Brian Sloan, 

Olga Brochner and Kathryn Lee at Auckland Hospital. Results of this 

work are currently in preparation for publication, after which we hope to 

share the outcomes in a future issue of NZ Optics. 

Publishing more than 20 articles in peer-reviewed scientific optometry 

and ophthalmology literature last year alone, the OSL was a veritable 

hive of industry and all credit goes to those who worked hard to get these 

papers to this level. 

During the year, our team focused on three main dry eye disease 

research areas including studies relating to its epidemiology and 

diagnostic test refinement as well as clinical trials that seek, through 

clinical and laboratory testing, to evaluate the outcomes of the increasing 

number of therapeutic and management strategies. The following articles 

(entitled OSL) provide an overview of some of the recently published 

projects from the OSL team in each of these three areas. 

The Ocular Surface Laboratory (OSL) is a research facility located within the 

Department of Ophthalmology at the University of Auckland. Led by A/Prof Jennifer 

Craig, a team of clinical researchers contribute to the better understanding of ocular 

surface disease to improve patient management of anterior segment disorders and, in 

particular, dry eye disease. 


DRY EYE 

TREATMENT 

EYE-LIGHT® 

The solution for meibomian gland dysfunction 

OPE ® /IPL + Light Modulation ® /LLLT 

• No GEL, no mess, streamlined treatment times 

• Lower ongoing and consumable costs 

• Improved safety margins with OPE ® technology 

- no contact surfaces and no risk of gel burns 

• IPL for treatment of the Lower Lid 

• LLLT for direct treatment of the Upper lid and face 

• Skin Type detected automatically, no guess work using a grading card 

• Pulse intensity is controlled automatically, but can be overridden by experienced operator 

Both technologies are certified with FDA and CE Medical Certification. 

CATARACT 

SURGERY 

HOYA Vivinex XY1A Toric IOLs 

Preloaded IOL system with hydrophobic acrylic Vivinex 

Innovative HOYA technology provides outstanding performance and 

long-lasting ophthalmic surgical outcomes. 

Vivinex XY1A Toric 

Fully preloaded range, now including T2 to T9 Toric. 

· 

· 

· 

· 

Fully preloaded range 

Down to 2.0mm incision 

No Glistenings1 

Reduced PCO 

Uncompromised Stability! 

- absolute rotation median 1.1° with 100 % of cases 5 degrees or less 2 

1 Data on file: in vitro test achieved according to published method: Effects of glistening in intraocular lens 

Marrie van der Mooren et al, BIOMEDICAL OPTICS EXPRESS, vol 4, No.8, P1294-1304(2013). 

2 True rotational stability of a single-piece hydrophobic intraocular lens, 

Schartmüller D, et al. Br J Ophthalmol 2018;0:1–5. doi:10.1136/bjophthalmol-2017-311797 

DV969-0818 

0800 338 800 Diagnostic: 021 990 200 Surgical: 021 0270 0649 

designsforvision.co.nz Ralph.Thompson@dfv.com.au Keith.Procter@dfv.com.au


OSL: Blinking 

and the tear film 

By Dr Michael Wang, Leslie Tien, Alicia Han, Jung Min Lee, Dabin Kim, A/Prof Jennifer 

Craig (Auckland) and Dr Maria Markoulli (Sydney) 

ALTHOUGH BLINKING TRAINING is 

commonly recommended as part of the multimodal 

management of dry eye disease, the 

relationship between clinical measurements 

of blinking patterns and markers of dry eye 

severity remains yet to be established. The 

influence of blinking patterns on tear film 

parameters, ocular surface characteristics 

and dry eye symptomology was therefore 

explored in a recently published age, gender 

and ethnicity-matched cross-sectional study 1 , 

conducted by the University of Auckland Ocular 

Surface Laboratory (OSL), in collaboration with 

senior lecturer Dr Maria Markoulli from the 

School of Optometry and Vision Science at the 

University of New South Wales. 

A total of 154 participants were recruited 

in the study, of which 77 exhibited clinically 

detectable incomplete blinking and 77 did not. 

Blink rate, dry eye symptomology, tear film 

parameters and ocular surface characteristics 

were assessed in a single clinical session. The 

results demonstrated 

that incomplete blinking 

was associated with a 

two-fold increased risk 

of dry eye disease, as 

defined by the global 

consensus TFOS DEWS 

II dry eye diagnostic 

criteria. Participants exhibiting incomplete 

blinking exhibited significantly higher levels 

of symptoms and meibomian gland dropout, 

as well as poorer tear film stability, lipid layer 

thickness, expressed meibum quality, eyelid 

notching and anterior blepharitis grades. 

Interestingly, no significant correlations were 

observed between blinking frequency and 

ocular surface parameters. 

The findings of the study provide evidence 

in favour of the hypothesis that incomplete 

blinking may predispose towards the 

development of meibomian gland dysfunction 

and evaporative dry eye, through diminishing 

Fig 1. Partial meibomian gland drop out 

the flow of meibomian lipids into the tear film, 

which may potentially contribute towards 

dropout and atrophy of the meibomian glands 

(Fig 1). Furthermore, the potential association 

between incomplete blinking and development 

of meibomian gland dysfunction would also 

support current recommendations of offering 

blinking training as part of the multi-modal 

management of dry eye disease. 

References 

1. Wang MT, Tien L, Han A, Lee JM, Kim D, Markoulli M, Craig JP. Impact 

of blinking on ocular surface and tear film parameters. doi: 10.1016/j. 

jtos.2018.06.001. Ocul Surf. 2018. 

OSL: Ethnic differences in the paediatric ocular surface 

By Ji Soo Kim, Dr Michael Wang and A/Prof Jennifer Craig 

ASIAN ETHNICITY IS recognised to be a 

significant risk factor for the development of dry 

eye disease, with a higher prevalence and severity 

of dry eye signs and symptoms consistently 

reported in Asian populations relative to 

Caucasian cohorts in the literature. However, 

the effects of environmental differences 

between Asian and Caucasian population 

studies conducted in different parts of the 

world, as well as the lack of consistency 

in methodology of earlier studies, created 

significant challenges when interpreting 

their findings. 

In a previous age and environmentallycontrolled 

cross-sectional study 1 conducted 

by the University of Auckland Ocular Surface 

Laboratory (OSL), involving 74 co-located young 

adults, aged between 18 to 30 years, the Asian 

eye was found to exhibit a significantly higher 

degree of meibomian gland dropout and 

incomplete blinking, although no significant 

ethnic difference in dry eye symptomology was 

identified in this age group. It was hypothesised 

that incomplete blinking may predispose towards 

eventual meibomian gland atrophy (see story this 

page) through reducing the flow of meibomian 

secretions and potential blockage and 

inflammation of the ductal system. In addition, it 

was thought the ethnic differences in the ocular 

surface observed may predispose towards a 

greater severity of dry eye symptomology and 

signs in the Asian eye with advancing age. 

Asian ethnicity: a significant risk factor for dry eye 

The TFOS DEWS II epidemiology report, released 

in July last year, identified limited literature 

on the natural history of dry eye disease, as 

well as studies surrounding the status of the 

ocular surface and tear film in the paediatric 

population. To help address some of these gaps 

in knowledge, an age and environmentallycontrolled 

cross-sectional study 2 of 70 co-located 

paediatric participants, aged between 5 and 18 

years, was recently conducted by the OSL. 

The results showed there were no significant 

overall ethnic differences in tear film quality, dry 

eye symptomology or meibomian gland dropout 

between the Asian and Caucasian paediatric 

cohorts. Nevertheless, in agreement with the 

previous young adult study, a higher proportion 

of Asian participants demonstrated incomplete 

blinking than Caucasian participants. Ethnic 

differences in meibomian gland morphology 

patterns were also observed, with gland 

shortening being more common in the Asian 

paediatric eye, while gland tortuosity was 

more frequently observed in the Caucasian 

eye, although the reasons for this are as yet 

unknown. Furthermore, Asian participants 

without an eyelid crease were found to exhibit a 

higher degree of inferior lid wiper epitheliopathy 

and corneal astigmatism, which would both 

appear to suggest possible effects from higher 

levels of eyelid tension. 

Overall, the findings of the study suggest that 

eyelid anatomy and tensions may potentially 

be implicated in the Asian ethnic predisposition 

towards incomplete blinking and meibomian 

gland dysfunction, which may eventually 

manifest with increased prevalence and severity 

of dry eye disease with advancing age. 

References 

1. Craig JP, Wang MT, Kim D, Lee JM. Exploring the Predisposition of the Asian 

Eye to Development of Dry Eye. Ocul Surf. 2016 Jul;14(3):385-92. 

2. Kim JS, Wang MT, Craig JP. Exploring the Asian ethnic predisposition to dry 

eye disease in a paediatric population. Ocul Surf. 2018 (in press). 


LAUNCHING 

LATE 2018


OSL: Fluorescein and tear 

film stability assessment 

By Dr Michael Wang, Dr Jennifer Mooi, Joevy Lim, Dr Andreas Müller and A/Prof Jennifer Craig 

TEAR FILM STABILITY measurement is 

an integral component of the assessment of 

dry eye disease. Although ocular instillation 

of sodium fluorescein via impregnated strips 

is conventionally used to visualise tear film 

breakup, it is also recognised to destabilise 

the tear film, reducing stability measurements 

obtained. In recent years, however, automated, 

non-invasive measurement techniques have 

become available and are recommended by 

the global consensus TFOS DEWS II dry eye 

diagnostic criteria, in preference to fluorescein 

breakup time measurement. 

Two recent studies conducted by the 

University of Auckland Ocular Surface 

Laboratory (OSL) compared tear film stability 

measurements obtained by the traditional 

fluorescein and contemporary non-invasive 

methods. 

The first, recently published randomised 

crossover study 1 of 74 participants (including 

37 dry eye patients and 37 age, gender and 

ethnicity-matched healthy participants) 

compared measurements obtained by the 

conventional fluorescein method with those 

from an automated non-invasive corneal 

topographer (Oculus Keratograph 5M) and 

evaluated their respective discriminative ability 

in detecting symptomatic dry eye. 

Automated non-invasive keratograph 

breakup time (NIKBUT) measurements were 

found to be significantly longer than fluorescein 

breakup time in both dry eye patients and 

healthy participants. The optimal diagnostic 

cut-off for NIKBUT was also longer, at ≤9 

seconds, than the best cut-off point for the 

fluorescein breakup time, which was shown 

to be ≤5 seconds. Furthermore, NIKBUT 

measurements had better discriminative ability, 

sensitivity and specificity than the conventional 

fluorescein breakup time test. 

The other prospective crossover study 2 of 

41 participants compared tear film breakup 

time measurements obtained non-invasively, 

with minimal fluorescein instillation (1μL), 

and conventional fluorescein strips (15-30 

μL). The results showed that breakup time 

values measured with conventional fluorescein 

instillation were significantly shortened, while 

those obtained with tiny amounts of fluorescein 

instillation compared much better to noninvasive 

measurement techniques. 

The findings suggest, that where noninvasive 

measures are not available, we can 

reduce the destabilising impact of fluorescein on 

clinical measurements of tear film stability by 

minimising the volumes we instil! 

References 

1. Wang MT, Craig JP. Comparative Evaluation of Clinical Methods of Tear Film 

Stability Assessment: A Randomized Crossover Trial. JAMA Ophthalmology. 

2018;136(3):291-294. 

2. Mooi JK, Wang MT, Lim J, Müller A, Craig JP. Minimising instilled volume 

reduces the impact of fluorescein on clinical measurements of tear film 

stability. Contact Lens Anterior Eye. 2017;40(3):170-174. 

Automated non-invasive keratograph breakup time measurements 

OSL: Lid cleanser versus baby shampoo for blepharitis 

By Dr Justin Sung, Dr Michael Wang, Sang Lee, Dr Isabella Cheung, Salim Ismail, Prof Trevor Sherwin and A/Prof Jennifer Craig 

BLEPHARITIS IS A common ophthalmic 

condition characterised by chronic eyelid 

inflammation and associated symptoms 

of ocular irritation and dry eye. It can have 

a profound impact on quality of life. The 

management of blepharitis involves both 

the prevention and treatment of intermittent 

episodes of inflammatory exacerbation and 

regular eyelid hygiene regimens. Warm compress 

therapies are commonly advised for long-term 

symptomatic relief. 

The efficacy of a dedicated eyelid cleansing 

formulation (TheraTears SteriLid) and diluted 

baby shampoo in blepharitis patients was 

compared in a recently published, doublemasked, 

randomised trial conducted by 

the University of Auckland Ocular Surface 

Laboratory (OSL) 1 . A total of 43 participants 

with clinical signs of blepharitis were recruited 

and were randomised to apply the dedicated 

eyelid cleanser to one eye and diluted baby 

shampoo to the fellow eye (from bottles that 

Blepharitis 

were identical other than the marking of right 

and left eye), twice daily for four weeks. Ocular 

symptoms, tear film quality, ocular surface 

characteristics and inflammatory markers were 

assessed at baseline and following the treatment 

period. 

The results of the trial showed that blepharitis 

was improved, clinically, by both treatments, 

including SPEED symptomology scores, superior 

lid wiper epitheliopathy, seborrhoeic lash 

crusting and lash misdirection grading. However, 

improvements in tear film lipid layer thickness, 

inferior lid wiper epitheliopathy, cylindrical 

collarette grading and MMP-9 expression (a 

marker of ocular surface inflammation), as well 

in SANDE symptom scores, occurred only with 

the dedicated eyelid cleanser. Furthermore, 

meibomian gland orifice capping and MUC5AC 

expression (a marker of goblet cell function) 

were found to actually worsen with baby 

shampoo treatment. 

Overall, the dedicated eyelid cleansing 

formulation demonstrated superior efficacy and 

was the preferred treatment among blepharitis 

patients. The findings also highlighted potential 

long-term adverse effects of baby shampoo 

treatment on goblet cell function that warrant 

further exploration in future studies. 

References 

1. Sung J, Wang MT, Lee SH, Cheung IM, Ismail S, Sherwin T, Craig JP. 

Randomized double-masked trial of eyelid cleansing treatments for 

blepharitis. Ocular Surface. 2018;16(1):77-83. 


OSL: Desktop humidifier for DED relief? 

By Dr Michael Wang, Evon Chan, Linda Ea, Clifford Kam, 

Yvonne Lu, Dr Stuti Misra and A/Prof Jennifer Craig 

IN RECENT DECADES, the significant 

increase in digital screen use, both at home and 

at work, has been accompanied by a growing 

prevalence of dry eye disease worldwide. The 

high visual and cognitive load associated with 

digital screen use, along with sustained visual 

attention, can result in a reduction of blinking 

frequency by a factor of two or three times. 

Reduced blinking frequency or quality can 

compromise the delivery and distribution of 

tear film components over the ocular surface, 

leading to tear film destabilisation and breakup, 

and the consequent development of dry eye 

symptoms. 

Furthermore, low humidity environments 

are common in the modern workplace with the 

widespread use of air conditioning and central 

heating. These are recognised to exacerbate 

dry eye severity through creating a larger water 

vapour pressure gradient between the ocular 

surface and external environment, increasing 

the rate of aqueous tear evaporation. 

The efficacy of a USB-powered desktop 

humidifier to provide dry eye relief was 

examined in a recently published, masked, 

randomised, crossover trial conducted by 


Laboratory (OSL) 1 . A total of 44 participants 

were recruited and randomised, on separate 

days, to a one-hour period of continuous 

computer use, with and without exposure to the 

desktop humidifier. Tear film parameters and 

ocular comfort were assessed before and after 

computer use. 

The results of the study showed that while 

the desktop humidifier effected only a modest 

increase in relatively humidity locally, a 

significant increase in tear film stability was 

observed, which was associated with a higher 

proportion of participants reporting greater 

subjective ocular comfort. 

References 

1. Wang MT, Chan E, Ea L, Kam C, Lu Y, Misra SL, Craig JP. Randomized Trial 

of a Desktop Humidifier for Dry Eye Relief in Computer Users. Optometry & 

Vision Science. 2017;94(11):1052-1057. 

14th Annual 

Scientific Conference 

1/2 day workshops 

Saturday afternoon 

3rd November 2018 

Optometry Conference 

Sunday 8.00am - 5.00pm 

November 4th 2018 

Join us for another exciting weekend in 

support of Optometrists, Dispensers and Staff 

Venue: Waipuna Hotel & Conference Centre. 

58 Waipuna Rd, Mt Wellington Auckland 

Book now: for your 2018/2019 CPD Credits 

(including Therapeutics) 

Register online: https://www.eyeinstitute.co.nz/healthprofessionals/events 

Email: professionaleducation@eyeinstitute.co.nz 

We are honoured to present our 2018 international 

guest speaker, Professor Joanne Wood. 

Joanne is 

a Professor in the School of Optometry and Vision 

Science and has extensive research experience in 

several areas: vision and driving, vision and falls and 

clinical psychophysics. Her research experience spans 

over 25 years and includes a PhD in Visual Science 

at Aston University UK, followed by a Post-Doctoral 

Fellowship in Clinical Psychophysics. In 1991, Professor 

Wood established a vision and driving research 

laboratory. This lab uses an experimental design, incorporating measurements of actual 

driving performance on a closed circuit driving course, as well as on the open road, 

rather than making indirect judgements via crash rate data or driving simulators. This 

unique approach to investigating vision, ageing and driving has attracted a number 

of international scholars to collaborate in research projects led by Professor Wood. 

Thanks to our Conference Sponsors 

Platinum 

Sponsor 

Silver 

Sponsors 

Bronze 

Sponsor 



OSL:Tear supplements vs the environment 

By Dr Akilesh Gokul, Dr Michael Wang and A/Prof Jennifer Craig 

ADVERSE ENVIRONMENTAL 

CONDITIONS, including high airflow velocity 

and low relative humidity, are recognised to 

exacerbate dry eye signs and symptoms. Topical 

artificial tear supplements are among the most 

commonly used therapies for dry eye disease, 

although the protective effects of eye drop 

application prior to the exposure of adverse 

environmental conditions have not yet been 

established. 

The prophylactic efficacy of a lipomimetic 

eye drop (Systane Balance) and a non-lipid 

containing drop (Systane Ultra) were compared 

in a recently published, double-masked, 

randomised trial conducted by the University 

of Auckland Ocular Surface Laboratory (OSL)¹. 

A total of 30 patients with symptomatic dry eye 

were recruited and randomised to lipomimetic 

drop application in one eye and the non-lipid 

containing drop in the fellow eye. Participants 

were then exposed to a validated simulated 

adverse environment model and tear film 

quality and dry eye symptomology assessed 

at baseline and following exposure to the 

simulated adverse environment. 

The results of the trial showed that 

both therapies resulted in an immediate 

improvement in tear film stability and 

prevented its decline below baseline following 

simulated adverse environment exposure. 

However, improvements in tear film lipid layer 

quality and the prevention of its decline below 

baseline was limited only to the lipomimetic 

drop which, interestingly, also demonstrated 

superior post-instillation and post-exposure 

tear film stability, lipid layer thickness and 

ocular comfort than the non-lipid containing 

eye drop. 

Overall, the findings demonstrated 

that application of both lipid and nonlipid 

containing eye drops conferred 

prophylactic efficacy against exposure 

to adverse environmental conditions in 

patients with symptomatic dry eye. However, 

the lipomimetic drop conferred superior 

protective effects and was the preferred 

treatment among dry eye patients. 

References 

1. Gokul A, Wang MTM, Craig JP. Tear lipid supplement prophylaxis 

against dry eye in adverse environments. Cont Lens Anterior Eye. 2018 

Feb;41(1):97-100. 

Blink test for DED 

By Prof James Wolffsohn, Maria Vidal-Roht, 

Sonia Trave Huarte, A/Prof Jennifer Craig, Lexia Ah-Kit 

and Dr Michael Wang 

THE OPTREX DRY EYE BLINK TEST 1 is a simple, 

online self-assessment tool which provides 

patients and clinicians with a convenient and 

rapid preliminary screening instrument for dry 

eye disease, without the need for specialist 

instrumentation or the instillation of ocular 

dyes. The Blink Test measures the amount of 

time taken following two, non-forceful blinks 

for a patient to experience symptoms of ocular 

discomfort or dry eye. 

A recently published diagnostic accuracy study, 

jointly conducted by the Aston University 

Ophthalmic Research Group and the University 

of Auckland Ocular Surface Laboratory, 

evaluated the discriminative ability of the Blink 

Test in detecting patients with dry eye disease, 

as defined by the global consensus TFOS DEWS II 

diagnostic criteria. 

A total of 87 participants were recruited and 

the study results demonstrated that the Blink 

Test values were significantly correlated with 

tear film stability, dry eye symptomology 

scores, conjunctival staining and lid wiper 

epitheliopathy. At the optimal diagnostic cut 

off of

6 

months 

shelf life after 

opening 

NOVATEARS ® 

for Evaporative Dry Eye & Meibomian Gland Dysfunction 

NovaTears ® is a unique preservative-free eye lubricant, which 

acts as a lipid layer substitute and evaporative barrier for 

improved tear film stability and quality. 

Clinically validated with significant improvement in signs and 

symptoms with Evaporative Dry Eye Disease and Meibomian 

Gland Dysfunction patients 1,2 

Innovative water-free 

mode of action 

Lipid layer deficiency Apply NovaTears ® Spreads quickly and 

easily on the lipid layer 

References: 1. Steven, Philipp, et al. “Semifluorinated Alkane Eye Drops for Treatment of Dry Eye Disease – A Prospective, Multicenter Noninterventional Study.” Journal of Ocular Pharmacology and Therapeutics 31 (8), 498-503 (2015). 2. Steven, Philipp, 

et al. “Semifluorinated Alkane Eye Drops for Treatment of Dry Eye Disease Due to Meibomian Gland Disease.” Journal of Ocular Pharmacology and Therapeutics. 33(9), 678-685 (2017). Sponsored by Novaliq GmbH. NovaTears ® Eye Drops (Perfluorohexyloctane 

100% v/v, 3mL) are for the lubrication and relief of dry and irritated eyes. Do not use NovaTears ® with contact lenses. If using any other eye medication, allow at least 15 minutes between using the other product and applying NovaTears ® . NovaTears ® 

should not be used in children under 18 years. NovaTears ® should not be used while pregnant or breastfeeding. AFT Pharmaceuticals, Auckland. 

For information & samples: 

0800 423 823 

customer.service@aftpharm.com

Want more? 

Visit eyeonoptics.co.nz or eyeonoptics.com.au 

for the latest news, features, research updates, 

event photos, job adverts and more. 



OSL: Cosmetics and the tear film 

By Dr Michael Wang and A/Prof Jennifer Craig 

Eye cosmetics are widely used by mostly female populations of all age 

groups globally for religious, cultural and cosmetic purposes. The literature 

surrounding the effects of eye cosmetics on tear film quality and dry 

eye disease was assessed by a recent review 1 conducted by University of 

Auckland Ocular Surface Laboratory (OSL) researchers. 

Consistent evidence, both cross-sectional and prospective, was identified 

for the migration of cosmetic products across the eyelid margin and into 

the tear film. This compromises the quality of the surface lipid layer of 

the tear film and predisposes towards tear film instability and dry eye 

symptoms. Multiple adverse effects and complications associated with 

eye cosmetic wear have also been reported, raising the possibility that 

tear film contamination with cosmetic products may be associated with 

ocular surface inflammatory responses, which can contribute to further 

predisposition towards the development of dry eye disease. Prospective 

studies have also shown that eyeliner application at the inner eyelash line, 

known as ‘tightlining’, results in a higher degree of tear film contamination 

and ocular discomfort than application to the outer periocular skin. 

Finally, a recently published investigator-masked randomised trial of 50 

participants 2 , conducted by OSL, also demonstrated that eye cosmetic wear 

may have the potential to compromise the efficacy of topical lipid-based 

dry eye treatments. 

References 

1. Wang MT, Craig JP. Investigating the effect of eye cosmetics on the tear film: current insights. Clinical Optometry. 

2018;10:33-40. 

2. Wang MT, Cho ISH, Jung SH, Craig JP. Effect of lipid-based dry eye supplements on the tear film in wearers of eye 

cosmetics. Contact Lens Anterior Eye. 2017;40(4):236-241. 

Microblepharon exfoliation to improve CL comfort 

By Sowjanya Siddireddy, Dr Ajay Kumar Vijay, Dr Jackie Tan-Showyin and Prof Mark Willcox 

CONTACT LENS WEAR is associated with discomfort. This presents a 

real problem for wearers, practitioners and industry as discomfort is one 

of the main reasons for contact lens wearers to drop out of lens wear. 

At the School of Optometry and Vision Science at the University of 

New South Wales we have recently studied whether changes to ocular 

microbiota are associated with discomfort during wear and whether 

microblepharon exfoliation of the lid margin changes the ocular 

microbiota and if this is associated with improved comfort. 

We enrolled 30 contact lens wearers, measured their comfort during 

lens wear using the CLDEQ-8 questionnaire and swabbed their eyelids. 

The swabs were then cultured to identify and enumerate the types of 

microbes colonising the lids. Culture and identification used standard 

microbiological techniques. We then either washed their eyelids once with 

a foam cleanser or used the foam cleanser along with microblepharon 

exfoliation with BlephEx. After treatment, we gave them the CLDEQ-8 

questionnaire again and swabbed their eyelids for microbial identification 

and enumeration. We then left the subjects for 7-10 days and repeated the 

CLDEQ-8 and microbial workup to assess which changes lasted for that 

time period. 

Treating eyes with either a foam cleanser or the foam cleanser with 

microblepharon exfoliation improved the comfort of symptomatic lens 

wearers (CLDEQ-8 >12 points). By 7-10 days after treatment, with the 

foam cleanser alone, the scores of symptomatic wearers improved by two 

points on the CLDEQ-8 scale, but they remained above the cut-off of 12 

and so were still classified as symptomatic. On the other hand, use of the 

foam cleanser with the microblepharon exfoliation improved the CLDEQ-8 

scores by six points and most symptomatic wearers had scores below 12, 

converting them to asymptomatic wearers. 

Symptomatic lens wearers were found to have approximately 50% more 

microbes on their lids than asymptomatic wearers. The foam cleanser 

alone reduced the number of microbes on eyelids of symptomatic wearers 

by approximately 50% within 7-10 days after treatment. Treatment with 

microblepharon exfoliation reduced microbe numbers by 60% in the 

same post-treatment timeframe. Gram-negative bacteria were isolated 

from symptomatic lens wearers only and were significantly reduced from 

baseline to follow-up with both treatments. 

This data points to the importance of contact lens wearers maintaining 

good lid hygiene. Practitioners should consider treating the lids of contact 

lens wearers who are complaining of discomfort during wear and also 

talking to the wearers about how they could improve the hygiene of their 

lids. 

Sowjanya Siddireddy is a clinician and researcher at the School of Optometry and Vision 

Science at the University of New South Wales in Sydney, working with research fellows Dr 

Ajay Kumar Vijay and Dr Jackie Tan-Showyin, and with Professor Mark Willcox. Prof Wilcox 

specialises in ocular microbiology, ocular inflammation and infection and bio-prospecting. 

His current research focuses on understanding the aetiology of adverse events and 

comfort during contact lens wear, including adhesion and biofilm formation of ocular 

pathogenic microbes and development of novel antimicrobial surfaces. 

Evolve ® Hypromellose 0.3% 

For Mild Dry Eye 

Evolve ® HA - Sodium Hyaluronate 0.2% 

For Severe Dry Eye 

Evolve ® Carmellose 0.5% 

For Moderate Dry Eye 

Evolve ® Eyelid Wipes 

For Daily Eyelid Hygiene 

New Zealand Distributor: Corneal Lens Corporation NZ Ltd. 

2 Ballarat Way, Wigram, Christchurch 8042 New Zealand. Ph 03 3666247 

0500m - 07.08.18 



Cataract surgery and dry eye 

By Dr Stuart Carroll 

CATARACT SURGERY IS one of the most 

common elective surgical procedures performed 

worldwide. Advancements with surgical 

instrumentation and lens implant technology 

have made it increasingly popular as a treatment 

for both visual rehabilitation and refractive 

correction. Patient expectations have never been 

higher, and superb results with rapid recovery 

are readily achievable. Sounds great, right, so 

what’s the problem? “My eyes are constantly 

irritated… they were never like that before the 

surgery, doctor!” 

Unfortunately, dry eye disease (DED), while 

frequently dismissed as a minor annoyance 

following cataract surgery, can be a significant 

cause of patient dissatisfaction, visual symptoms 

and poor surgical outcomes. Preoperatively, 

accurate biometric measurements require an 

optimal ocular surface state 1 . Furthermore, the 

numerous presbyopia-correcting IOL options that 

are becoming increasingly popular, are notoriously 

unforgiving with regard to visual quality in the 

presence of a suboptimal ocular surface. 

The prevalence of ocular surface signs in the 

patient demographic that undergoes cataract 

surgery is extremely high. In the PHACO 

study, 77% of patients had corneal staining 

preoperatively 2 . Although, many of these 

patients may be asymptomatic 3 , disruption of 

the delicate homeostasis of the tear film and 

ocular surface can lead to manifestation of 

symptoms which then become frustratingly 

difficult to manage reliably, despite the 

significant advances in our understanding of 

DED and its treatment options. Several studies 

have indicated that patient symptoms and signs 

are negatively influenced by cataract surgery 

and some may take up to six months to recover 4 . 

The TFOS DEWS II report represents an 

extensive body of work led by world experts in 

dry eye, and their recently published iatrogenic 

dry eye report presents a comprehensive 

literature review which includes cataract 

surgery 5 . There is no question that many 

interventions involved in cataract surgery are 

responsible for post-operative DED. The most 

likely perpetrators are topical medications 

(and their preservatives) used pre- and postoperatively, 

oxygen free radicals and proinflammatory 

cytokines generated in response 

to surgical trauma, and the corneal incisions 

which invariably sever corneal nerves. Similar, 

though more extensive, corneal nerve injury is 

well described following LASIK surgery where 

postoperative dry eye is one of the chief sources 

of postoperative dissatisfaction. Light toxicity 

from the operating microscope has also been 

implicated. Diabetic patients in particular seem 

to be more at risk of iatrogenic DED 5 . 

Therefore, a comprehensive dry eye 

evaluation should be performed for all 

prospective cataract surgery patients. Preoperative 

recognition and optimisation of DED 

signs and symptoms is a critically important 

factor in managing such patients. Ideally this 

should begin at the point of referral, when 

surgery is being considered. The TFOS DEWS 

II reports are an ideal source for up-to-date 

diagnosis and management recommendations. 

Avoiding topical preservatives in at-risk 

patients, minimising postoperative drop toxicity 

and actively managing dry eye symptoms with 

Fig 1. Fluorescein dye showing poor tear film homogeneity and 

break-up. Credit: Dr Dean Corbett 

topical lubricants where necessary are simple 

measures that can help post-operatively. 

On the horizon, “dropless cataract surgery” 

(where intraocular slow-release preparations of 

steroid and antibiotic are used instead of topical 

post-operative medications) may be a useful 

step forward in preventing DED in cataract 

surgery patients. Stay tuned! 

Laser refractive surgeons recognised all of 

this long ago and consider it standard care to 

treat dry eye pre- and post-operatively. We 

should all adopt the same standard of care for 

our cataract patients. 

References 

1. Epitropolous AT et al. Effect of tear osmolarity on repeatability of keratometry 

for cataract surgery planning. J Cat Refract Surg 41(8):1672-7. 

2. Trattler WB et al. The Prospective Health Assessment of Cataract Patients’ 

Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017; 

7(11):1423-30. 

3. Cochener B et al. Prevalence of meibomian gland dysfunction at the time 

of cataract surgery. J Cataract Refract Surg. 2018 Feb;44(2):144-148 

4. Xue W et al. Long-term impact of dry eye symptoms on vision-related quality 

of life after phacoemulsification surgery. Int Ophthalmol. 2018 Feb 1. doi: 

10.1007/s10792-018-0828-z. [Epub ahead of print] 

5. Gomes JAP et al. TFOS DEWS II iatrogenic report. The Ocular Surface 

(2017) 15(3):511-38. 

Dr Stuart Carroll is a consultant ophthalmologist 

at Auckland Eye and Greenlane Clinical Centre in 

New Zealand with specialist knowledge in cataract 

and refractive surgery, strabismus and paediatric 


Castor oil for dry eye? Demodex? 

By Dr Emma Sandford and Grant Watters, with A/Prof Jennifer Craig 

CASTOR OIL HAS a long and ancient history 

as a traditional remedy for skin, scalp and hair 

ailments, and internally for gastrointestinal 

and reproductive applications. It is even 

mentioned in herbal medicine lists on papyrus 

from ancient Egypt. 

Today, castor oil continues to appear 

intermittently in online searches for natural 

treatments for blepharitis, so we’ve decided 

to study its effects in relation to dry eye, 

specifically with respect to anterior blepharitis 

and Demodex mites, and examine its likely 

mechanisms of action, in a scientific manner. 

Castor oil’s main constituent is ricinoleic acid, 

which has a number of properties applicable 

to the different facets of the pathophysiology 

of blepharitis and dry eye. It is an emollient, 

anti-inflammatory, anti-microbial, anti-oxidant, 

and a surfactant with lipid layer-forming 

abilities, so it spreads across the tear film in 

a thin layer. It penetrates the lash follicles 

and there is every reason to 

suspect it might interfere with 

the physiology of Demodex mites, 

rather like tea tree oil. 

We are employing a unique 

rollerball application method, 

which ensures application of a thin 

film close to the lid margins. The 

hypothesis is this may have some 

therapeutic benefit in controlling blepharitis and 

Demodex, along with the possibility that a small 

degree of ingress into the tear film will enhance 

the lipid layer and could potentially address lipid 

layer deficiency which leads to dry eye symptoms 

associated with blepharitis. 

Under the guidance of Associate Professor 

Jennifer Craig, we are conducting a prospective, 

randomised, investigator-masked trial of 

topically-applied castor oil for blepharitis as 

an optometry honours research project. This 

is being conducted by Part V students, Marna 

Auckland optometry student 

Marna Claassen demonstrating the 

castor oil rollerball lid applicator 

Claassen, Lauren Curd and Alice 

Jackson, who are recording 

a range of subjective and 

objective parameters to elicit 

symptomatic and biometric 

changes of the eyelids and 

tear film, including changes in 

ocular surface inflammatory 

biomarkers. We are excited to 

find out, when the data are 

unmasked at the conclusion 

of the study, whether a onemonth 

application period has 

resulted in improvements in these parameters 

and lower titres of inflammatory markers. 

If so, this could infer long-term benefits 

with respect to minimising ocular surface 

inflammation and reducing the incidence of 

dry eye in blepharitis patients. 

We are currently recruiting for this study. For 

more information and to check eligibility 

please call or text us on 022 EYE PAIN. 

Dr Emma Sandford is a GP in the Bay of Plenty and 

an honorary academic, and Grant Watters is an 

optometrist and researcher at the University of 

Auckland. 


Understanding the “lid wiper” 

By Dr Alex Muntz 

WE BLINK AROUND 10,000 times a day, with the eyelids traversing the 

length of a football pitch in distance each day. Wiping over the eye’s 

surface with every blink is the “lid wiper”, a 1-2mm thin portion of the 

inner eyelid margin. We assume that friction is increased here during 

blinking, especially when lubrication is sub-par because of an altered 

tear film, or by wearing contact lenses. Higher friction may induce a 

mechanical or hyperosmotic insult 

of the lid wiper, driving symptoms 

of dryness and discomfort in dry eye 

and contact lens patients. 

Fig 1. LWE on the everted upper eyelid 

margin, shown by lissamine green staining 

Clinically, this association appears 

to be reflected in “lid wiper 

epitheliopathy” (LWE), a staining 

pattern observed at the upper 

and/or lower lid margins following 

lissamine green instillation and lid 

eversion (Fig 1). But if vital stains 

are able to highlight a degree of cellular damage, what does this damage 

look like at a cellular level? 

While dry eye and contact lens wear are recognised to be associated 

with cellular changes of the ocular surface (including within the cornea, 

limbus and bulbar conjunctiva), we know surprisingly little about 

clinically-relevant variations in the cellular anatomy and physiology 

of the lid wiper; the area in exclusive apposition with the eye’s surface 

during blinking. The cornea, bulbar or tarsal conjunctival are commonly 

and easily assessed by application and removal of a membrane to 

which superficial cells adhere. This “impression cytology” technique is 

a quick and convenient tool for sample collection from patient prior 

to histological cellular analysis. However, the narrow, sharply curved 

lid margin does not easily lend itself to such a sampling method. The 

optimisation of impression cytology for lid marginal use was the focus of 

my PhD studies at the University of Waterloo in Canada. During this time, 

we determined the ideal membrane material, the optimal location, angle 

and pressure, and the duration of application (Fig 2). We chose specialised 

histological dyes that change their colour according to the keratinisation 

level of cells to reflect friction at the lid margin (Fig 3). 

Armed with this new tool, lid marginal epithelial cells were collected from 

patients presenting with varying levels of LWE, including contact lens 

wearers and non-lens wearers with a range of self-reported discomfort 

and dryness levels. By investigating the cellular morphology (size, shape, 

state, type, number of cells etc.) of the lid margin and its correlation with 

clinical signs and subjective symptoms, we are hoping to shed new light 

on the role of this region for dry eye and contact lens patients. 

A video demonstrating this technique as well as our published methods 

paper are available at www.imuntz.com/ic. Stay tuned for a full report on 

these studies in an upcoming issue of 

NZ Optics! 

Reference and pictures reproduced with permission, courtesy 

of A Muntz, K van Doorn, L N Subbaraman, L W Jones, 

Impression cytology of the lid wiper area, J Vis Exp. (2016) 

e54261–e54261. 

Dr Alex Muntz, an optometrist, is a postdoctoral 

research fellow in the Ocular Surface 

Laboratory at the University of Auckland and 

was previously a clinical research scientist 

with the University of Waterloo’s Centre for 

Ocular Research & Education 

Dry Eye 

Therapy 

Providing effective long 

term relief from dry, 

uncomfortable eyes 

At Oasis Spa you will receive a full 

clinicial evaluation of the likely cause 

of your Dry Eye and provided with a 

tailored treatment plan. 

During your treatment you will have 

access to proven state-of the art dry 

eye technology, including LipiFlow and 

Lumenis Optima IPL. 

0800 AKL EYES 

oasisspa@aucklandeye.co.nz 

www.aucklandeye.co.nz 

Fig 2. Impression cytology on 

the upper lid wiper region 

Fig 3. Cells of the lid wiper region 

show varying morphology and 

different keratinisation degrees 

through differential staining dyes: no 

keratinisation (a); advanced keratinisation 

(c); and incipient keratinisation (b) 



Ocular allergy 

and dry eye 

By Prof James Wolffsohn 

OCULAR ALLERGY REPRESENTS a group of 

hypersensitivity disorders that primarily affects 

the conjunctiva. 

The most common form of ocular allergy 

is seasonal allergic conjunctivitis (SAC), 

accounting for 90% of cases¹ , ². The most 

prevalent allergens in SAC are grass, tree and 

weed pollen, and outdoor moulds². In the 

United Kingdom, the prevalence of ocular 

allergy to grass pollen in patients attending 

optometric practice is estimated to be 8%³ – no 

data is currently available from Australasian 

countries. 

Similar to dry eye, although the signs and 

symptoms of SAC are usually mild, they may 

hinder school performance, work productivity 

and everyday tasks such as driving 4 . The 

primary treatment strategy for SAC involves 

avoidance of the offending allergen to prevent 

the initiation of the allergic response. However, 

complete avoidance is not often possible and 

use of topical anti-allergic medications is 

required when signs and symptoms occur 5 . 

While non-pharmacological treatments, such 

as artificial tears developed for dry eye and cold 

compresses have been used for many years, in 

conjunction with allergen avoidance strategies 

and anti-allergic medications to help bring 

about symptomatic relief 5,6 , evidence showing 

the effectiveness of this approach has only 

relatively recently been published 7 . In this study, 

patients had controlled exposure to grass pollen 

and either used cold compresses or artificial 

tears, resulting in therapeutic effects on the 

signs and symptoms of allergic conjunctivitis. A 

cold compress enhanced the use of epinastine (a 

mast cell stabiliser/antihistamine combination) 

and was the only treatment to reduce symptoms 

to baseline within an hour of antigenic 

challenge. Signs of allergic conjunctivitis were 

generally reduced most by a combination of 

cold compress and artificial tears or epinastine. 

In a separate, recent study, acute allergic 

rhinoconjuctivitis has been shown to be 

characterised by tear hyperosmolarity, which 

can be rehabilitated with the administration of 

hypotonic artificial tears, much like dry eye 8 . 

Considerable overlap of reported symptoms 

of itch and dryness has been reported in groups 

with presumed dry eye and seasonal allergic 

conjunctivitis 9 . As with ocular allergy, there can 

be seasonal (summer and winter) and weatherrelated 

aspects to dry eye symptoms 10 . Similar 

biomarkers for the biological ‘diagnosis’ of both 

dry eye and ocular allergy have been proposed 11 , 

along with imaging techniques such as in-vivo 

confocal microscopy 12 , but these have not been 

adopted clinically. 

Dry eye symptoms are generally greater in 

those with ocular allergy 13 and some ocular 

allergy medications can induce signs and 

symptoms of dry eye 14 . Hence it would seem 

that clinically the conditions are often confused 

and careful questioning of when the symptoms 

occur is advised to aid with the selection of 

appropriate management. 

References 

1. Abelson MB, Leonardi A, Smith L. The mechanisms, diagnosis and treatment 

of allergy. Rev Ophthalmol 2002;9:74-84. 

2. Bielory L. Ocular allergy overview. Immunology Allergy Clin 2008;28:1-23. 

3. Wolffsohn JS, Naroo SA, Gupta N, Emberlin J. Prevalence and impact of 

ocular allergy in the population attending UK optometric practice. Contact 

Lens Ant Eye 2011;34:133-8. 

4. Smith AF, Pitt AD, Rodruiguez AE, et al. The economic and quality of life 

impact of seasonal allergic conjunctivitis in Spanish setting. Ophthalmic 

Epidemiol 2005;12:233-42. 

5. Bielory L. Ocular allergy treatment. Immunology Allergy Clin 2008;28:189- 

224. 

6. Chigbu DI. The management of allergic eye disease in primary care. Contact 

Lens Ant Eye 2009;32:260-72. 

7. Bilkhu PS, Wolffsohn JS, Naroo SA, Robertson L, Kennedy R. Effewctivenes 

of non-pharmaceutical treatments for acute seasonal conjunctivitis. 

Ophthalmology 2014;121:72-8. 

8. Nitoda E, Lavaris A, Laios K, Androudi S, Kalogeropoulos CD, Tsatsos M, 

Damaskos C, Garmpis N, Moschos MM. Tear Film Osmolarity in Subjects 

with Acute Allergic Rhinoconjunctivitis . In Vivo 2018;32:403-8. 

9. Hom MM, Nguyen AL, Bielory L. Allergic conjunctivitis and dry eye 

syndrome. Annals Allergy, Asthma, Immunol 2012;108:163-6. 

10. van Setten G, Labetoulle M, Baudouin C, Rolando M. Evidence of seasonality 

and effects of psychrometry in dry eye disease. Acta Ophthalmol 2016;94:499- 

506. 

11. Enriquez-de-Salamanca A, Bonini S, Calonge M. Molecular and cellular 

biomarkers in dry eye disease and ocular allergy. Curr Opin Allergy Clin 

Immunol 2012;12:523-33. 

12. Villani E, Mantelli F, Nucci P. In-vivo confocal microscopy of the ocular 

surface: ocular allergy and dry eye . Curr Opin Allergy Clin Immunol 

2013;13:569-76. 

13. Vehof J Smitt-Kamminga NS, Nibourg SA, Hammond CJ. Predictors of 

discordance between symptoms and signs in dry eye disease. Ophthalmol 

2017;124:280-6 

14. Ousler GW, Workman DA, Torkildsen GL. An open-label, investigatormasked, 

crossover study of the ocular drying effects of two antihistamines, 

topical epinastine and systemic loratadine, in adult volunteers with seasonal 

allergic conjunctivitis. Clin Therapeutics 2007;29:611-6. 

Professor James Wolffsohn is pro-vice chancellor of 

Aston University, Birmingham, England and was a subcommittee 

chair for TFOS DEWS II. His main research 

areas include the development and evaluation of 

ophthalmic instrumentation, contact lenses, intraocular 

lenses and the tear film. 


DED and the 

Dunedin Study 

By Dr Graham Wilson, A/Prof Jennifer Craig and Dr 

Michael Wang 

THE DUNEDIN MULTIDISCIPLINARY 

Health and Development Study is a wellestablished, 

large longitudinal study on human 

health, development, ageing and behaviour, 

which has been ongoing for more than 40 years. 

The study has been tracking more than 1000 

participants since they were born in 1972 or 

1973. In 2017, for the first time, dry eye disease 

(DED) was included as part of the study, as the 

participants turn 45. 

TFOS DEWS II identified significant gaps in 

the existing dry eye literature, including a lack 

of population-based prevalence studies from the 

Southern Hemisphere over the past decade, as 

well as limited scientific literature investigating 

the natural history of DED. The TFOS DEWS 

II epidemiology subcommittee also identified 

a significant shortage of scientific evidence, 

which is needed to provide a comprehensive 

understanding of the risk factors for DED and 

to better understand the relationship between 

medical conditions and dry disease. 

It is hoped that the dry eye arm of the 

Dunedin Study will be able to help address 

some of the identified gaps in the current dry 

eye literature, through characterising ocular 

surface and tear film parameters within a 

large, age-controlled cohort based in the 

Southern Hemisphere, exploring the potential 

interactions between systemic conditions and 

DED and assessing whether dry eye may be a 

biomarker of the ageing process. 

Data collection is currently well underway 

and it is hoped the findings will be released over 

the next two years. 

Dr Graham Wilson is a Gisborne-based ophthalmologist 

and principal investigator for all eye-related matters on 

the Dunedin Study. A/Prof Jennifer Craig and Dr Michael 

Wang are based at the Ocular Surface Laboratory at the 

University of Auckland. 

AcrySof®IQ PanOptix®Toric 

PRESBYOPIA-CORRECTING IOL 

Advancing 

CATARACT SURGERY 

160220IOL_PanOptix Half Page NZ Optics 2018.indd 1 

WWW.EYEONOPTICS.CO.NZ 13/08/2018 9:22:35 | AM 

33


Dry eye and autologous serum 

By Dr Nick Mantell 

THE TEAR FILM and ocular 

surface are extremely complex, 

with tear film playing a vital role 

in maintaining ocular surface 

health. Not only does it provide 

lubrication but also many 

neuropeptides, vitamins and 

growth factors essential for the 

health of the corneal epithelium. 

Given the complexity of the tear 

film, it seems a small miracle that it 

functions normally in anyone. 

Meanwhile dry eye disease 

(DED) is encountered on a daily 

basis by eye health professionals 

and accounts for a range of mild 

to severe discomfort symptoms 

(pain, burning sensations, eye 

fatigue, light sensitivity, redness 

etc.) made worse by virtually 

all types of ocular surgery. The 

worsening of this condition 

post-surgery is fortunately 

present for only a finite period for 

most people and will eventually 

return to its preoperative level. 

As ophthalmologists, we see this 

regularly after refractive laser 

procedures, but also after cataract 

and retinal surgery (see p30). Less 

commonly, surgery exacerbates 

severe ocular surface disease 

following chemical trauma, or 

associated with neurotrophic 

epithelial defects, or conjunctival 

cicatrising conditions like Stevens 

Johnston syndrome. 

“...SEDs are recognised by most 

factors in the tear film are vital to 

the health of the ocular surface, 

supplementing these proteins 

has not, to date, been an integral 

component of DED treatment. 

This has, in part, been because 

the actions of these factors have 

not been well understood, but it 

has also been difficult to isolate 

ophthalmologists as an important option 

for some dry eye disease patients who have 

not responded to other treatments.” 

Traditionally when treating 

DED, we focus on optimising the 

lipid layer on the surface of the 

tear film to reduce the evaporation 

of tears and facilitate spreading of 

the tear film on the ocular surface; 

maintaining or supplementing the 

aqueous layer to normalise the 

osmolarity of the tear film; and 

treating any concurrent ocular 

inflammation, typically with 

steroids. 

Although it is recognised that 

the neuropeptides and growth 

and produce these proteins. With 

the increasing recognition of 

the prevalence and significant 

socioeconomic costs of this 

condition, however, there has been 

renewed interest in DED. 

In the 1970s, doctors recognised 

that many of the proteins and 

growth factors present in the tear 

film were also present in serum. 

Autologous serum eye drops 

have been used with considerable 

success in patients with severe 

chemical burns. Then, in the 1980s, 

the application of serum eye drops 

was extended to the treatment 

of other forms of severe ocular 

surface disease and non-healing 

neurotrophic corneal ulcers, 

resulting in significant clinical 

evidence for the benefit of serum 

in these conditions (Fig 1 and Fig 

2). 

In 1984, Fox et al published a 

paper showing autologous serum 

eye drops (SEDs) were helpful in 

treating severe DED, leading to 

increasing interest in this area. 

However, it is still not considered 

a mainstream therapy for this 

condition. This is partly because 

of the logistics of generating SEDs, 

but also because clinical trials have 

demonstrated variable benefits 

with respect to treating dry eye. 

A recent Cochrane review, 

based on a limited number 

of randomised clinical trials, 

demonstrated that SEDs alleviate 

dry eye symptoms better than 

artificial eye drops for the first 

couple of weeks, but data still 

remains inconclusive regarding 

clinical efficacy over long-term 

periods. 

SEDs are essentially prepared by 

taking a patient’s blood, allowing 

it to clot, then spinning it in a 

centrifuge to separate the red 

blood cells from serum. The serum 

is then removed and mixed in 

varying proportions with normal 

saline, before being separated into 

bottles, each with enough serum to 

provide up to a week’s treatment. 

These are then frozen and, at the 

beginning each week’s treatment, a 

single bottle is defrosted. 

Preparing SEDs involves a 

considerable amount of resource 

and there is a small risk of 

contamination if not handled 

appropriately, so it’s important the 

patient is fully informed about the 

need for careful handling. There 

are also strict protocols regarding 

drop preparation. These may 

vary from one service to another, 

although my understanding is 

that this is standardised across 

the New Zealand blood service, 

where the drops are 25% serum 

and 75% saline. In other countries 

50% or 100% serum mixtures 

may be used. Unfortunately, there 

isn’t consensus in the literature 

regarding the most effective serum 

concentration. 

If a patient is unable to give 

blood due to concurrent medical 

conditions, it is also possible to 

prescribe allogenic serum eye 

drops. These are prepared in the 

same way as autologous serum eye 

drops, except the blood is sourced 

from another patient. 

As medical professionals, we 

like our practices to be guided 

by sound scientific evidence 

regarding clinical efficacy. The 

clinical evidence for treating 

chemical ocular burns, severe 

ocular surface disease (Stevens 

Johnston Syndrome) and nonhealing 

neurotrophic ulcers 

is relatively strong, however a 

similar level of evidence does not 

yet exist for DED. Despite this, 

SEDs are recognised by most 

ophthalmologists as an important 

option for some DED patients 

who have not responded to other 

treatments. It is generally accepted 

that not all, but many patients 

show clinical improvement on this 

treatment, when other traditional 

treatments fail. 

The lack of evidence highlights 

the difficulties in running clinical 

trials on conditions that have, until 


ecently with TFOS DEWS II, been 

relatively ill-defined, and where 

clinical signs often show very 

little relationship to the patient’s 

symptoms. 

Serum drops remain an evolving 

therapeutic option. Some groups 

are now using other blood-derived 

products which may offer superior 

therapeutic benefits over standard 

SEDs. The first is Eye PRP which 

uses a process to create platelet 

enriched plasma with a reportedly 

higher concentration of growth 

factors. The second is ‘plasma rich 

in growth factors’ PRGF which uses 

a different process again to increase 

the concentration of growth 

factors. Preliminary trials involving 

both preparations have shown 

clinical benefits. 

Finally, Moorfield’s Eye Hospital 

ran a small trial where patients 

were taught how to use a drop 

of whole blood from a pinprick 

on their finger, four times a 

day for eight weeks. Significant 

improvements were noted in 

several parameters, such as visual 

acuity, corneal staining, tear 

break-up time (TBUT) and ocular 

comfort index (OCI), but not the 

Schirmer’ test. 

So, we can expect more exciting 

developments to come in this area. 

 

References 

1. Alio JL, Arnalich-Montiel F, Rodriguez AE. The role of 

“eye platelet rich plasma (E-PRP)” for wound healing in 

ophthalmology. Curr Pharm Biotechnol (2012) 

2. Anitua E, de la Fuente M, Riestra A, Merayo-Lloves J, 

Muruzabal F, Orive G. Preservation of biological activity 

of plasma and platelet-derived eye drops after their 

different time and temperature conditions of storage. 

Cornea (2015) 

3. Del Castillo JM, de la Casa JM, Sardina RC, et al. 

Treatment of recurrent corneal erosions using autologous 

serum. Cornea 2002;21:781–3. 

4. Fox RI, Chan R, Michelson JB, et al. Beneficial effect 

of artificial tears made with autologous serum in 

patients with keratoconjunctivitis sicca. Arthritis Rheum 

1984;27:459–61 

5. Lopez-Plandolit S, Morales MC, Freire V, Grau AE, 

Duran JA. Efficacy of plasma rich in growth factors for 

the treatment of dry eye. Cornea (2011) 

6. Pan Q, Angelina A, Marrone M, Stark WJ, Akpek EK. 

Autologous serum eye drops for dry eye. Cochrane 

Database Syst Rev (2017) 

7. Than J, Balal S, Wawrzynski J, Nesaratnam N, Saleh 

GM, Moore J, Sharma A et al. Fingerprick autologous 

blood: a novel treatment for dry eye syndrome. Eye 

(Lond) (2017) 

8. Tsubota K , Goto E, Fujita H, et al. Treatment of dry eye 

by autologous serum application in Sjögren’s syndrome. 

Br J Ophthalmol 1999;83:390–5 

9. Tsubota K , Satake Y, Ohyama M, et al. Surgical 

reconstruction of the ocular surface in advanced ocular 

cicatricial pemphigoid and Stevens-Johnson syndrome 

[see comments]. Am J Ophthalmol 1996;122:38–52. 

Dr Nick Mantell specialises in cataract, 

laser vision correction and vitreoretinal 

surgery with the Eye Institute in Auckland 

and is a former clinical senior lecturer 

with the Department of Ophthalmology 

at Auckland University 

Fig 1. Neurotrophic ocular surface disease, due to presumed HSV, 

prior to treatment with SEDs 

DRY EYE 

RELIEF 

FROM 

THE INSIDE 

• Works systemically from the inside 

• Improves tear film quality 

• Increases tear production 

• Excellent adjunct to drops 

P Concentrated Fish Oil 

P Flax Seed Oil 

P Borage Oil 

Research has shown that the combination of Omega-3 containing DHA and EPA plus Alpha 

Linolenic Acid and plant-based Omega-6 fatty acids like Gamma-Linolenic Acid can help improve 

the oily lipid layer of the tear, reduce inflammation resulting in improved tear production and 

tear film break-up time. Lacritec is specially formulated based from this research and because it is 

systemic, provides more continuous relief from dry eye discomfort and may replace the need for 

eye drops for many patients. 

Available at selected Optometrists or FreeCall 0800 622 883. 

Always read the label. Use only as directed. If symptoms persist see a healthcare professional. 

Supplementary to and not a replacement for a balanced diet. 

Contact Stiltec Global on 0800 622 883 

or info@stiltec.com.au 

Fig 2. The same case showing dramatic improvement four weeks after 

commencing SEDs 

www.lacritec.co.nz 



Diabetes, dry eye and ‘substance P’? 

By Drs James Slater and Stuti Misra 

DIABETES HAS NOW reached epidemic 

proportions affecting millions of people across 

the world. It is estimated around 54% of patients 

with diabetes suffer from some degree of dry eye 

syndrome 1 . 

Patients with diabetes commonly complain of 

burning and foreign body sensation in their 

eyes. In severe cases, this may result in reduced 

corneal sensitivity, aberrant wound healing 

ability of the cornea, increased risk of infection 

and the eventual development of diabetic 

neurotrophic keratopathy 2 . Interestingly, there 

is growing evidence of the involvement of 

neurotransmitters in the tear film offering an 

interesting potential pathway for future ocular 

surface treatment strategies 3 . 

Chronic hyperglycaemia, diabetic peripheral 

neuropathy, decreased insulin levels, 

microvasculopathy and systemic hyperosmotic 

disturbances are the most common risk 

factors for diabetes mellitus associated dry 

eye syndrome (DMDES). Insulin is critical for 

proliferation of the acinar lacrimal gland and 

corneal epithelial cells, whereas hyperglycaemia 

induces significant histological changes in the 

lacrimal gland. This suggests a strong role of 

oxidative stress in dry eye syndrome. A number 

of factors, however, are responsible for ocular 

surface changes in patients with diabetes which 

ultimately may lead to corneal nerve damage 

(fig 1). 

Substance P is a neuropeptide released from the 

trigeminal nerve endings located in the cornea, 

lacrimal gland and conjunctiva 4 . In isolation and 

with other hormones (including neuropeptide Y, 

gene-related peptide, insulin-like growth factor 

1 and vasoactive-intestinal peptide) substance 

P plays a crucial role in wound healing while 

providing maintenance and nutrition to the 

cornea by promoting the migration, proliferation 

and differentiation of corneal epithelial cells. 

In diabetes, substance P levels decrease, 

contributing to poorer wound healing and 

increased susceptibility to corneal neurotrophic 

ulcers, due to decreased epithelial migration 5 . 

This finding has been confirmed in a recent 

pilot study by Markoulli et al (see p38). which 

compared patients with diabetes to a healthy 

control group 5 . Substance P also decreases in 

spinal fluid and the peripheral nervous system 

which plays an important role in causing 

diabetic peripheral neuropathy 6 . Evidently, 

diclofenac decreases the levels of Substance P in 

the tear film, something one might want to take 

into account when using Voltaren eye drops in 

patients with diabetes 7 . Substance P and insulin 

growth factor-1, however, reportedly show 

good efficacy in healing neurotrophic diabetic 

keratopathy, but these treatment options are yet 

to be completely explored. 

Where to from here 

A number of studies focusing on 

neurotransmitters and their potential role 

in treating diabetes-associated dry eye are 

underway or planned. As well as focusing on 

diabetic retinopathy, the leading cause of 

blindness in diabetes, significant attention 

needs to be paid to DMDES in clinical practice 

as it can have a severe effect on quality of life. 

The pathogenesis of DMDES, however, remains 

elusive and further clinical trials are warranted 

and ongoing by different research groups in the 

UK, Australia and also Auckland. 

We will certainly have more to report on this 

interesting topic in next year’s review of dry eye 

research in the region. 

References 

1. Manaviat MR, Rashidi M, Afkhami-Ardekani M, Shoja MR. Prevalence of 

dry eye syndrome and diabetic retinopathy in type 2 diabetic patients. BMC 

Ophthalmol 2008;8:10. 

2. Alves Mde C, Carvalheira JB, Modulo CM, Rocha EM. Tear film and ocular 

surface changes in diabetes mellitus. Arq Bras Oftalmol 2008;71:96-103. 

3. Nishida T, Inui M, Nomizu M. Peptide therapies for ocular surface 

disturbances based on fibronectin–integrin interactions. Progress in retinal 

and eye research 2015;47:38-63. 

4. Davidson HJ, Kuonen VJ. The tear film and ocular mucins. Veterinary 

ophthalmology 2004;7:71-77. 

5. Markoulli M, You J, Kim J, et al. Corneal nerve morphology and tear film 

substance P in diabetes. Optometry and Vision Science 2017;94:726-731. 

6. Marfurt CF, Echtenkamp SF. The effect of diabetes on neuropeptide content 

in the rat cornea and iris. Investigative ophthalmology & visual science 

1995;36:1100-1106. 

7. Yamada M, Ogata M, Kawai M, Mochizuki H, Mashima Y. Topical 

diclofenac sodium decreases the substance P content of tears. Archives of 

Ophthalmology 2002;120:51-54. 

Dr James Slater is a clinical research fellow in the 

New Zealand National Eye Centre at the University of 

Auckland, where he is focusing on corneal nerves and 

diabetes. Dr Stuti Misra is a lecturer and researcher at 

the University’s Department of Ophthalmology. Her 

research focus includes ocular surface abnormalities 

and corneal imaging. 

Fig 1. A range of factors lead to nerve damage in diabetes 


Image modified from "Stern, Beuerman, & Pflugfelder (2004) 

Fig 1. Healthy tear film (left) and unstable tear film (right), typically characterised by (A) a 

discontinuous lipid layer, (B) a hyperosmolar aqueous layer and (C) reduced mucins and goblet cells 

Not all eye drops are created equal! 

By Drs Priyanka Agarwal and Ilva Rupenthal 

DEFICIENCY IN TEAR film quality and 

quantity are often considered key defining 

characteristics of dry eye disease (DED). 

The complex, dynamic multi-component 

structure, which comprises an underlying 

aqueous-mucous layer and a superficial lipid 

layer, synergistically maintains ocular surface 

homeostasis. Functionally, the aqueous-mucus 

layer is believed to improve the wettability 

and support corneal adhesion of the tear film, 

while the lipid layer tends to form a superficial 

protective “blanket”, providing an occlusive 

effect. “Holes” in the blanket (see Fig 1), as 

typically observed in evaporative DED and 

especially in meibomian gland dysfunction, can 

increase exposure of the underlying aqueous 

layer of the tear fluid to the environment and 

evaporation, leading to hyperosmolarity of the 

tear film and epithelial apoptosis. Consequently, 

artificial tears are frequently used for the 

management of tear film deficiencies. However, 

the term “artificial tears” is a misnomer as 

most products do not mimic the complex 

composition of human tears and contrary to 

their name, they typically “supplement” rather 

than “replace” the tear fluid. 

Artificial tear supplements can be isotonic 

or hypotonic aqueous eye drops, which may 

have additional viscosity building agents 

such as carboxymethylcellulose (Refresh, 

Allergan), hydroxypropyl guar (Systane, Alcon) 

or sodium hyaluronate (Hylo-Forte, AFT 

Pharmaceuticals). They typically function by 

augmenting the aqueous layer and transiently 

reducing tear fluid osmolarity; however, their 

effect is generally short-lived due to rapid 

drainage and evaporation from the ocular 

surface. Osmoprotective agents, such as 

trehalose and erythritol (believed to reduce 

the concentration of intracellular organic salts 

without disturbing cellular macromolecular 

components) may also be added to aqueous 

eye drops to reduce hyperosmolar stress. On 

the other hand, lipid-based eye drops, which 

generally contain amphiphilic lipids and/or 

surfactants, fortify the tear film lipid layer to 

inhibit excessive evaporation. 

Lipid-based artificial tear supplements are 

generally believed to have a more sustained 

effect than non-lipid eye drops and may be 

superior in the management of DED, especially 

when it is associated with meibomian gland 

dysfunction. For instance, instillation of lipidbased 

eye drops has shown a significantly 

greater improvement in tear film lipid layer 

thickness and consequent reduction in tear 

evaporation in patients with DED, resulting in 

superior prophylactic efficacy on exposure to 

desiccating environmental stress 1 . 

Consequently, several lipid-based artificial 

tear supplements have been developed with 

the objective of reducing tear evaporation and 

providing long-term relief to patients with dry 

eyes. Lipid-based eye drops are most frequently 

available in the form of oil-in-water emulsions 

such as Cationorm (Santen SAS) or ointments 

such as VitA-POS (AFT Pharmaceuticals). 

Liposomal sprays such as Optrex ActiMist 

(Optima Pharmazeutische), which potentially 

improve tear film integrity by replenishing 

the phospholipid layer at the aqueouslipid 

interface, have also shown significant 

improvement in tear film quality 2 . 

A significant concern with long-term eye 

drop use, however, is the presence of irritating 

preservatives, which can compromise the 

ocular surface and worsen patient discomfort. 

Surfactants typically used to prepare oil-inwater 

lipid-based eye drops may also exacerbate 

dry eye symptoms by transiently destabilising 

the tear film. Consequently, several surfactants 

have been listed in the TFOS DEWS II 

iatrogenic report as agents that potentially 

cause dry eye 3 . In an attempt to avoid such 

components, a preservative-free lipid layer 

stabilising eye drop has recently been developed 

by Novaliq using a novel, optically transparent, 

non-aqueous, semifluorinated alkane. This 

product is currently marketed as EvoTears 

(Ursapharm) in Europe and as NovaTears 

(AFT) in Australia and New Zealand and has 

shown promising results in multi-centre clinical 

trials performed in patients with evaporative 

dry eye disease 4 . Recent research has also shown 

that semifluorinated alkanes can be used as a 

vehicle for delivery of therapeutic agents to the 

eye 5 and potentially simplify the dosage regimen 

for patients with chronic dry eye disease. 

References 

1. Gokul A, Wang MTM, Craig JP. Tear lipid supplement prophylaxis against 

dry eye in adverse environments. Contact Lens and Anterior Eye. 2017. 

2. Craig JP, Purslow C, Murphy PJ, et al. Effect of a liposomal spray on the preocular 

tear film. Contact Lens and Anterior Eye. 2010;33(2):83-7. 

3. Gomes JAP, Azar DT, Baudouin C, et al. TFOS DEWS II iatrogenic report. 

The Ocular Surface. 2017;15(3):511-38. 

4. Steven P, Scherer D, Krösser S, et al. Semifluorinated Alkane Eye Drops for 

Treatment of Dry Eye Disease--A Prospective, Multicenter Noninterventional 

Study. Journal of Ocular Pharmacology and Therapeutics. 2015;31(8):498- 

503. 

5. Agarwal P, Scherer D, Günther B, et al. Semifluorinated alkane based systems 

for enhanced corneal penetration of poorly soluble drugs. International 

Journal of Pharmaceutics. 2018;538(1):119-29. 

Dr Priyanka Agarwal is currently a research fellow in the 

University of Auckland’s School of Pharmacy. Her research 

interests include drug delivery and bench-to-bedside 

formulation development. Dr Ilva Rupenthal is a senior 

lecturer in the University of Auckland’s Department of 

Ophthalmology and director of the Buchanan Ocular 

Therapeutics Unit (www.botu.nz), which aims to translate 

ocular therapeutic-related scientific research into the 

clinical setting. Disclosure: Dr Agarwal’s doctoral studies, 

supervised by Dr Rupenthal, were funded by Novaliq GmbH, 

manufacturer of NovaTears. 



Trans-Tasman dry eye research collaborators Dr Maria Markoulli, Dr Stuti Misra, A/Prof Jennifer Craig and Dr Laura Downie at ARVO 2018 

The immune system, the nervous system 

and the ocular surface 

By Drs Maria Markoulli, Luisa Colorado and Katie Edwards 

A CHARACTERISTIC OF dry eye disease (DED) 

is the presence of inflammation, a significant 

driving factor of the vicious circle that is 

DED. TFOS second dry eye workshop (TFOS 

DEWS II) aptly described this process as being 

initiated by evaporative water loss leading to 

hyperosmolar tissue damage. This contributes 

to the inflammatory cascade, with an increased 

presence of inflammatory markers in the 

tear film, such as matrix metalloproteinase-9 

(MMP-9)¹. These changes cause damage to 

both epithelial and goblet cells, manifesting in 

the clinical signs of corneal and conjunctival 

staining and reduced tear break-up time. This 

further feeds into the initial hyperosmolarity, 

perpetuating the process². This cycle of events 

also causes damage to the corneal nerves³ 

which provide nutritional support to the corneal 

epithelium by releasing factors important for 

growth and wound healing, such as substance 

P⁴. Epithelial cells reciprocate by providing 

support to corneal nerves by secreting growth 

factors that promote nerve growth⁴. In DED, the 

equilibrium of these supporting growth factors 

and inflammatory markers is affected. 

A possible relationship has been described 

between the ocular surface immune and 

nervous systems⁵. To understand what impact 

DED has on these systems, it is important to 

first understand what is normal in the healthy 

eye. This can help us understand what we need 

to do to maintain the equilibrium of the ocular 

surface. To do this, we set out to understand the 

relationship between corneal nerve structure 

and the presence of inflammatory mediators 

and neuromediators in the tear film. We 

collected the tears of 21 healthy participants 

and also took images of their corneal nerves 

using an in vivo corneal confocal microscope. 

We found that neuromediator substance P in 

the tear film correlated with measures of nerve 

fibre morphology, where higher levels were 

associated with a greater number of nerves. 

We also found that higher levels of tissueinhibitor 

of MMPs (TIMP-1) and the inflammatory 

mediator interleukin-6 (IL-6) were associated 

with a reduced presence of corneal nerves. 

These results confirm the immune and nervous 

systems in the ocular surface are interlinked and 

that what affects one, may affect the other. 

Another exciting finding from our research was 

that a higher number of hours spent sleeping 

meant a higher number of corneal nerves being 

present, and more hours spent exercising was 

associated with thicker corneal nerves. This 

reinforces the need for a greater understanding 

into the impact that exercise and sleep have on 

the nervous system and the impact that such 

modifiable factors might have on ocular health. 

With the understanding of the healthy ocular 

surface, we can now look towards understanding 

how this changes in DED and work towards 

restoring its equilibrium. 

References 

1. Chotikavanich, S, CS de Paiva, Q Li de, JJ Chen, F Bian, WJ Farley and SC 

Pflugfelder (2009). “Production and activity of matrix metalloproteinase-9 

on the ocular surface increase in dysfunctional tear syndrome.” Invest 

Ophthalmol Vis Sci 50(7): 3203-3209. 

2. Bron, AJ, CS de Paiva, SK Chauhan, S Bonini, EE Gabison, S Jain, E Knop, 

M Markoulli, Y Ogawa, V Perez, Y Uchino, N Yokoi, D Zoukhri and DA 

Sullivan (2017). “TFOS DEWS II pathophysiology report.” Ocul Surf 15(3): 

438-510. 

3. Belmonte, C, JJ Nichols, SM Cox, JA Brock, CG Begley, DA Bereiter, DA 

Dartt, A Galor, P Hamrah, JJ Ivanusic, DS Jacobs, NA McNamara, MI 

Rosenblatt, F Stapleton and JS Wolffsohn (2017). “TFOS DEWS II pain and 

sensation report.” Ocul Surf 15(3): 404-437. 

4. Muller, LJ, CF Marfurt, F Kruse and TM Tervo (2003). “Corneal nerves: 

structure, contents and function.” Exp Eye Res 76(5): 521-542. 

5. Cruzat, A, D Witkin, N Baniasadi, L Zheng, JB Ciolino, UV Jurkunas, J 

Chodosh, D Pavan-Langston, R Dana and P Hamrah (2011). “Inflammation 

and the nervous system: the connection in the cornea in patients with 

infectious keratitis.” Invest Ophthalmol Vis Sci 52(8): 5136-5143. 

Dr Maria Markoulli is an optometrist and senior 

lecturer at the University of New South Wales School 

of Optometry and Vision Science. Dr Luisa Colorado is 

a post-doctoral research fellow and Dr Katie Edwards a 

lecturer at the School of Optometry and Vision Science 

at the Queensland University of Technology. 


VR to tackle work DED? 

By Dr Philip Turnbull 

THE MODERN WORKPLACE is a 

hostile environment for a dry eye sufferer. 

Computer use decreases blink frequency and 

completeness, leading to lipid layer breakdown 

and increased aqueous tear evaporation, while 

air-conditioned office environments frequently 

further aggravate the disrupted tear film. 

As an academic, I spend a large part of 

my day in front of a computer and I am not 

immune to the feeling of tired, gritty eyes at the 

end of the day. When developing applications 

for virtual reality (VR), however, my eyes 

felt some relief. To explore this, optometry 

student Joyce Wong joined Associate Professor 

Jennifer Craig and me in the Ocular Surface 

Laboratory at the University of Auckland to 

complete a summer studentship, investigating 

whether the use of VR can influence the tear 

film. Participants attended two visits that were 

randomised in order: one where they used a 

desktop computer; and another where they 

wore a VR headset. Within the VR headset we 

projected a ‘virtual desktop’, which meant an 

image of the real desktop monitor could be 

seen and used within the headset, like a movie 

projecting onto a cinema screen. A battery 

of dry eye tests were performed before and 

immediately after 40 minutes of computer use. 

There was little change in the temperature 

and relative humidity during the desktop 

condition, but there was a significant increase 

in the temperature of the air within the VR 

headset (from the ambient 22°C to 31°C), 

which warmed the anterior eye by 0.6°C. This is 

hypothesised to have increased meibum output 

as the lipid layer thickness was, on average, 

almost one grade higher after VR, whereas 

thinning of the lipid layer was observed after 

desktop use. This translated to a functional 

change in tear film quality, such that the tear 

breakup time increased by about three seconds 

following VR use while it decreased by three 

seconds after desktop viewing. 

VR headsets also offer other advantages, like 

shifting the focal plane towards the distance 

so that only distance spectacle prescriptions 

need to be worn and no accommodation is 

required and the ability to transform the work 

environment to somewhere more pleasant, 

perhaps a mountaintop or beach. 

The promising results of our study, 

combined with improvements in virtual reality 

By providing a heated microenvironment, VR headsets may 

improve the comfort of computer use for dry eye sufferers 

technologies and ergonomics, suggest VR may 

become a viable option for dry eye suffers who 

are otherwise unable to use a computer. 

Dr Philip Turnbull is a lecturer in the School of 

Optometry and Vision Science at the University of 

Auckland. His research involves developing new tools 

using technology such as eye tracking and virtual reality 

to investigate visual function. 

CLINICAL OUTCOMES 

▶ optomap ® imaging takes less than half a second 

to uncover critical information 

the ONLY 200° single-capture autofluorescence image 

optomap ultra-widefield imaging is a proven tool 

for effective clinical decision making. 

More than 400 peer reviewed studies show the value 

of optomap imaging in diagnosis, treatment planning, 

and patient engagement. 

To find out more please contact us at 08 8444 6500 

or auinfo@optos.com 

www.optos.com 

Building The Retina Company 

©2017 Optos. All rights reserved. Optos ® , optos ® and optomap ® are registered trademarks of Optos plc. 



So you want to set up a dry eye clinic? 

By A/Prof Jennifer Craig 

IT’S BECOME CLEAR, as 

our knowledge has evolved, 

that dry eye management, if 

performed thoroughly, cannot 

be squeezed into a normal 

examination as part of a standard 

eye examination. You wouldn’t 

expect to perform a full glaucoma 

work-up within a standard 

eye examination and neither 

should you expect to perform a 

detailed dry eye assessment in 

this time. This specialised area 

requires time, dedicated staff 

and an individualised approach, 

in the development of the final 

management plan. 

Preliminary testing 

The TFOS DEWS II diagnostic 

process leads us through the most 

important features of a dry eye 

assessment 1 . The first critical 

component is history-taking 

as this allows the clinician to 

develop an understanding of the 

individual presenting patient. In a 

symptomatic patient, the clinician 

must first establish that dry eye 

is the most likely problem. This 

requires a triaging process, to 

help differentiate dry eye from 

other underlying causes of ocular 

surface discomfort, such as allergy 

or infection. Having the patient 

answer such triaging questions, 

with the aid of a questionnaire 

either prior to their appointment 

or via an interview with the 

assistance of ancillary staff, before 

diagnostic testing takes place 

can help streamline the process, 

especially when it comes to 

recording successes and failures 

of previous dry eye treatment 

attempts. The same is true in 

determining relevant risk factors. 

A pre-attendance checklist will 

allow key information to be passed 

to the clinician about possible dry 

eye aetiologies and modifiable risk 

factors, that will allow for more 

focused history-taking on site and 

can be addressed as appropriate 

within the management plan. 

TFOS DEWS II recommends 

using one of two validated 

questionnaires for evaluating the 

symptoms component of a dry 

eye diagnosis: the Ocular Surface 

Disease Index (OSDI) and the 

five-item Dry Eye Questionnaire 

(DEQ-5). One or other should be 

chosen, noting the appropriate 

cut-off for a positive score for each. 

Adopting the same questionnaire 

within any one practice is advisable 

to facilitate monitoring even if the 

patient sees a different practitioner. 

The symptom recording, like the 

triaging and risk factor assessment, 

can be undertaken prior to 

attendance but is ideally completed 

in the waiting room immediately 

before consultation as symptoms 

are best recorded on the same day 

as the clinical signs are evaluated. 

Clinical testing 

Dry eye can be diagnosed with 

instrumentation ranging from 

the slit lamp that’s available in 

every clinical practice, through to 

complex standalone equipment 

such as the Keratograph 5M 

(Oculus) or TearScience Lipiview 

II (Johnson & Johnson). A variety 

of other standalone devices and 

slit-lamp-mounted instruments 

offer diagnostic capabilities 

somewhere in between. The 

instrumentation available for 

clinical testing in any individual 

practice will dictate the order 

in which testing should be 

Clinical 

parameter 

Basic testing 

Advanced testing 

Symptoms OSDI or DEQ-5 OSDI or DEQ-5 

Global testing 

Subtype testing 

for aqueous 

deficiency 

Subtype testing 

for evaporative 

dry eye 

1. Stability testing with minimal 

fluorescein 

2. Osmolarity may be unavailable 

3. Fluorescein and lissamine green 

staining of cornea, conjunctiva and lid 

margin 

Tear meniscus height (slit lamp estimate) 

Phenol red thread (moderately invasive) 

Schirmer test (useful when applied 

without anaesthetic only for confirming 

severe aqueous deficiency, as highly 

invasive test) 

1. Lid margin assessment (thickening, 

rounding, notching, telangiectasia, 

capped orifices, etc.) 

Table 1. Standard and advanced tests for DED diagnosis 

performed. Tests must be 

conducted the same way each time, 

and ordered from least invasive 

to most invasive to minimise 

the effect of reflex tearing on 

subsequent test results. 

Encompassing as many of the 

global tests that contribute to a 

diagnosis of dry eye (according 

to TFOS DEWS II) as possible is 

ideal – along with symptoms: at 

least one positive result from tests 

for tear film stability, osmolarity, 

and ocular surface staining is 

needed to make a diagnosis. 

Conducting additional tests for 

subtyping is also important as this 

helps confirm whether the dry eye 

is primarily aqueous-deficient or 

evaporative in nature (see Table 1). 

The move towards more 

non-invasive and objective 

testing of the tear film may mean 

well-trained ancillary staff could 

perform (although not interpret) 

parts of the assessment, rather 

than the clinician themselves. 

Interpretation of the combined 

set of results (the more tests, the 

better) by the clinician should 

2. Lash assessment for madarosis, poliosis, 

misdirection, crusting and cylindrical 

collarettes 

3. Diagnostic gland expression performed 

digitally to evaluate meibum 

expressibility and quality 

be used to inform the patient’s 

tailored management strategy. 

Management strategies 

Consideration must be given to the 

treatments and recommendations 

that will be offered to patients who 

are diagnosed with dry eye disease 

(DED). Artificial tear supplements 

remain the mainstay of treatment, 

but therapies that address both 

evaporative as well as aqueousdeficient 

subtypes of dry eye need 

to be considered (see other articles 

in this feature). This may involve 

stocking lipid supplements, lid 

hygiene products, including those 

that tackle Demodex infestation, 

and microwaveable wheat or bead 

bags for warm compress therapy, 

through to offering punctal 

plugging for aqueous deficiency 

or advanced treatments such as 

IPL (intense pulsed light) therapy 

and LipiFlow for evaporative dry 

eye associated with meibomian 

gland dysfunction. Offering 

other in-practice therapies 

such as BlephEx to remove 

crusting associated with anterior 

blepharitis (see article, p29), 

1. Non-invasive tear film stability 

assessment (using reflected mires) 

2. Osmolarity testing 

3. Fluorescein and lissamine green staining 

of cornea, conjunctiva and lid margin 

Tear meniscus height quantified digitally 

from infrared imaging (IR minimises risk of 

reflex tearing) 

1. Lid margin assessment (as for basic 

testing, plus infrared meibography) 

2. Lash assessment (as for basic, plus 

epilation for Demodex evaluation under 

100x light microscopy) 

3. Diagnostic gland expression for meibum 

expressibility and quality performed with 

Korb Meibomian Gland Evaluator 

4. Lipid layer interferometry 


SOVS’ dry eye clinic opens 

By Dr Geraint Phillips 

OPTOMETRISTS ARE BECOMING 

increasingly aware of the 

challenges facing dry eye 

patients. Compliance with home 

treatments for dry eye can be 

variable and patient adherence 

to treatment instructions tend to 

diminish following an enthusiastic 

start. The recent TFOS DEWS II 

report provides excellent current 

information about the diagnosis 

and management of dry eye. 

With this in mind, the University 

of Auckland School of Optometry 

and Vision Science (SOVS) is 

planning to establish a dry eye 

clinic which will be open to referrals 

from community optometrists. 

The clinic will be well equipped, 

and its aim will be to expose our 

final year optometry students to 

evidence-based, best practice dry 

eye care. This in turn will give our 

new graduates the confidence to 

take their skills and knowledge 

into practice to ensure the public 

receives world-class care in this 

field. As well as providing detailed 

diagnoses and recommendations for 

home therapies, a range of in-office 

treatments will also be available. 

We are very fortunate to have 

Associate Professor Jennifer Craig 

as our advisor and the clinic will 

be led by Dr Marcy Tong, a SOVS 

professional teaching fellow who 

already has significant experience 

in diagnosing and manging dry 

eye disease. To attract referrals and 

maximise student exposure to dry 

eye cases, we will endeavour to set 

fees for this service at a level that 

will allow access by all patients who 

might benefit. 

Planning for this clinic is now well 

underway and SOVS will announce 

more details in the coming months. 

The start date will be the beginning 

of March 2019. 

We look forward to offering 

comprehensive dry eye care 

to the patients of community 

optometrists while at the same 

time providing research-led, first 

class teaching to our students. 

Dr Geraint Phillips, clinic director, 

University of Auckland School of 

Optometry and Vision Science 

Ed’s note: In separate news, the 

University of New South Wales 

School of Optometry and Vision 

Science (SOVS) announced it has 

newly launched a dry eye clinic 

which it hopes will become a statewide 

referral centre for the diagnosis, 

imaging and management of the 

disease. 

diluted tea tree oil application 

for Demodex eradication (see Eye 

on Ophthalmology, overleaf), lid 

margin debridement to manage 

excess lid margin keratinisation 

and therapeutic gland expression 

to relieve meibomian gland 

blockage might also be considered. 

Eye care professionals are 

assuming greater responsibility 

than ever in addressing their 

patients’ needs through more 

targeted management of dry eye. 

Whether in a specialist practice 

offering a dedicated ‘Dry Eye 

Clinic’ or in a general practice, 

the commitment to following 

consensus recommendations 

in diagnosing and managing 

dry eye will offer consistency to 

patients and help advance our 

understanding of the disease. This, 

in turn, will improve the care we 

can offer to the increasing number 

of affected patients. Recognising 

risks and limitations in dry 

eye and ocular surface disease 

management, however, remains 

critical. Patients with significant 

corneal involvement continue to 

require ophthalmological review 

and those with a neuropathic 

component to their ocular surface 

condition might benefit from 

referral to a pain clinic for the most 

appropriate care, so having suitable 

referral options for particularly 

complex cases is advisable. 

Reference 

1. Wolffsohn JS et al. TFOS DEWS II Diagnostic 

Methodology report. Ocul Surf 2017; 15(3): 539-74. 

Associate Professor Jennifer Craig is 

head of the Ocular Surface Laboratory 

at the University of Auckland, vice-chair 

of TFOS DEWS II and clinical editor of NZ 

Optics’ annual special feature on dry eye. 

86% 

Treat 

MGD has been shown 

to affect 86% of 

patients with dry eye 1 

INDICATIONS FOR USE: The LipiFlow System is intended for the application of localized heat and pressure therapy in adult patients with chronic cystic conditions 

of the eyelids, including Meibomian Gland Dysfunction (MGD), also known as Evaporative Dry Eye or Lipid Deficiency Dry Eye. CONTRAINDICATIONS: 

Do not use the LipiFlow System in patients with the following conditions. Use of the device in patients with these conditions may cause injury. Safety and effectiveness 

of the device have not been studied in patients with these conditions.•Ocular surgery within prior 3 months, including intraocular, oculo-plastic, corneal or 

refractive surgery procedure•Ocular injury within prior 3 months Ocular herpes of eye or eyelid within prior 3 months•Active ocular infection (e.g., viral, 

bacterial, mycobacterial, protozoan, or fungal infection of the cornea, conjunctiva, lacrimal gland, lacrimal sac, or eyelids including a hordeolum or stye)•Active 

ocular inflammation or history of chronic, recurrent ocular inflammation within prior 3 months (e.g., retinitis, macular inflammation, choroiditis, uveitis, iritis, scleritis, 

episcleritis, keratitis)•Eyelid abnormalities that affect lid function (e.g., entropion, ectropion, tumor, edema, blepharospasm, lagophthalmos, severe trichiasis, 

severe ptosis)•Ocular surface abnormality that may compromise corneal integrity (e.g., prior chemical burn, recurrent corneal erosion, corneal epithelial 

defect, Grade 3 corneal fluorescein staining, or map dot fingerprint dystrophy) PRECAUTIONS: The Activator or Activator II (Disposable) may not fit all eyes, 

such as eyes with small palpebral fornices. Use of the LipiFlow System in patients with the following conditions may result in reduced treatment effectiveness 

because these conditions may cause ocular symptoms unrelated to cystic meibomian glands and require other medical management. Safety and effectiveness 

of the device have not been studied in patients with these conditions.•Moderate to severe (Grade 2-4) allergic, vernal or giant papillary conjunctivitis•Severe 

(Grade 3 or 4) eyelid inflammation(e.g., blepharochalasis, staphylococcal blepharitis or seborrheic blepharitis). Patients with severe eyelid inflammation should 

be treated medically prior to device use•Systemic disease conditions that cause dry eye(e.g., Stevens-Johnson syndrome, vitamin A deficiency, rheumatoid 

arthritis, Wegener’s granulomatosis, sarcoidosis, leukemia, Riley-Day syndrome, systemic lupus erythematosus, Sjögren’s syndrome)•Taking medications known 

to cause dryness (e.g., isotretinoin (Accutane ® ) and systemic antihistamines)•Esthetic eyelid and eyelash procedures (e.g., blepharoplasty, lash extensions, 

eyelid tattooing). In addition, the treatment procedure may loosen previously inserted punctal plugs, which may worsen the patient’s dry eye symptoms. 

Reference: 1. Lemp, M. A., Crews, L. A., Bron, A. J., Foulks, G. N., & Sullivan, B. D. (2012). Distribution of Aqueous-Deficient and Evaporative Dry Eye in a 

Clinic-Based Patient Cohort. Cornea, 31(5), 472-478. doi:10.1097/ico.0b013e318225415a. Australia: AMO Australia Pty Ltd, 1-5 Khartoum Road, North 

Ryde, NSW 2113, Australia. Phone: 1800 266 111. New Zealand: AMO Australia Pty. Ltd. 507 Mount Wellington Hwy, Mount Wellington, Auckland 1060, 

New Zealand. Phone: 0800 266 700.| PP2018TS4191 



EYE ON OPHTHALMOLOGY 

FOR ALL EYE CARE PROFESSIONALS 

Antiparasitic efficacy of eyelid cleansers for 

the treatment of Demodex blepharitis 

By Dr Michael Wang and A/Prof Jennifer Craig 

Ocular surface infestation with Demodex 

mites is recognised as a significant risk factor 

for the development of chronic blepharitis 1 . 

Although 50% tea tree oil (Melaleuca 

alternifolia) is currently the mainstay for 

anti-demodectic treatment, it can cause 

considerable ocular irritation, restricting its 

use to brief in-office application 2 . 

This article briefly reviews the relationship 

between ocular Demodex and blepharitis, 

as well as two recent studies conducted by 


laboratory exploring the anti-demodectic 

efficacy of commercially-available eyelid 

cleansers and manuka honey 3,4 . 

Ocular Demodex and blepharitis 

Blepharitis is among the most commonly 

encountered ophthalmic conditions in 

clinical practice, affecting up to 47% of 

patients presenting to eye care practitioners. 

The condition is characterised by chronic 

inflammation of the eyelids and is recognised 

to have profound impacts on ocular comfort, 

vision and quality of life. It is commonly 

associated with signs and symptoms of 

ocular surface irritation, dry eye syndrome, 

intermittent visual disturbance, conjunctival 

hyperaemia, palpebral erythema and eyelid 

crusting. In severe cases, the inflammatory 

processes can also contribute to the 

development of irreversible sight-threatening 

corneal damage 5,6 . 

Although the complex pathophysiological 

mechanisms underlying the development of 

chronic blepharitis are not fully understood, 

Fig 1. Cylindrical collarettes suggestive of Demodex 

recent research would suggest that ocular 

infestation with Demodex might be an 

important cause. Indeed, ocular demodicosis is 

observed in up to 68% of patients with chronic 

blepharitis and 60% of those with meibomian 

gland dysfunction, the most common subtype of 

posterior blepharitis. Infestation with Demodex 

folliculorum and Demodex brevis species (Fig 

1), predominantly in the eyelash follicles and 

meibomian glands respectively, is thought to 

trigger an over-activation of host immune and 

inflammatory responses through a number of 

different mechanisms. Mechanical obstruction 

of the eyelash follicles and meibomian glands, 

as well as direct consumption and physical 

damage of the epithelium by the sharp 

appendages of the Demodex mites can directly 

induce inflammatory cascades. The associated 

reduction in the quality and quantity of 

meibomian gland secretions may also exacerbate 

aqueous tear evaporation, leading to tear film 

instability, hyperosmolarity, and ocular surface 

inflammation. In addition, chitin (the main 

constituent of the Demodex exoskeleton), 

as well as mite break-down products are 

strongly antigenic in some individuals. Finally, 

Demodex mites are also a potential vector 

for bacteria, especially Bacillus oleronius, and 

ocular infestation can contribute to bacterial 

hypercolonisation of the eyelids 7-9 . 

The diagnosis of ocular demodicosis is 

usually made clinically by the pathognomonic 

observation of cylindrical eyelash collarettes 

under slit lamp bio-microscopy (Fig 2), although 

the examination of epilated eyelashes for the 

presence of mites under light microscopy 

remains the gold standard diagnostic test. 

Treatment with 50% tea tree oil is the 

current mainstay for demodectic blepharitis 

management, although the considerable ocular 

irritation triggered by topical application limits 

its use to brief in-office application periods 

of less than 30 minutes. Self-administered 

eyelid cleansing formulations containing lower 

concentrations are usually recommended for 

patient use during intervening periods. The 

anti-demodectic efficacy of tea tree oil is thought 

to be primarily mediated by its terpinen-4-ol 

constituent, although the exact mechanisms by 

which inhibition of Demodex viability occurs 

has not yet been fully established 1,2,10-12 . 

Anti-demodectic efficacy of commercial 

eyelid cleansers 

A number of dedicated eyelid cleansing 

formulations are available commercially and 

are marketed to facilitate ocular hygiene 

in the management of chronic blepharitis. 

However, the antiparasitic efficacy of these 

topical formulations has not been previously 

established. A recent in vitro study conducted 


Laboratory compared the anti-demodectic 

activity of four commercially available dedicated 

eyelid cleansers (Cliradex towelette cleanser, 

Oust Demodex cleanser, Blephadex eyelid 

foam and TheraTears SteriLid eyelid cleanser) 

with 50% tea tree oil. The study also sought to 

identify and quantify the active antiparasitic 

constituents of the commercial formulations 3 . 

Consistent with the results of earlier studies, 

potent antiparasitic activity of undiluted 

terpinen-4-ol was observed against ocular 

Demodex mites acquired from epilated eyelashes 

of blepharitis patients. Interestingly, linalool, a 


Professors Charles McGhee 

& Dipika Patel, series editors 

constituent of TheraTears SteriLid, was found to 

exhibit comparable anti-demodectic efficacy to 

terpinen-4-ol in its undiluted form. The specific 

antiparasitic activity of linalool against ocular 

Demodex has not been previously described 

in the literature and this novel finding would 

support future clinical studies exploring the 

efficacy of linalool-based formulations in the 

management of demodectic blepharitis. 

Although anti-demodectic activity was 

demonstrated by all four commercial eyelid 

cleansers, the Cliradex towelette cleanser 

was the only formulation that demonstrated 

comparable antiparasitic efficacy to 50% tea tree 

oil. This was thought to be potentially related to 

Cliradex containing the highest terpinen-4-ol 

content among the commercial formulations. 

Anti-demodectic efficacy of manuka 

honey 

Natural honey is well known for its antiinflammatory 

and antimicrobial capacities, 

which is likely attributed to its low pH, high 

Consistent with the results of earlier 

studies, potent antiparasitic activity 

of undiluted terpinen-4-ol was 

observed against ocular Demodex 

mites acquired from epilated 

eyelashes of blepharitis patients. 

osmolarity hydrogen peroxide content, and nonperoxide 

constituents, including methylglyoxal. 

New Zealand native manuka (Leptospermum 

scoparium) honey, in particular, has gained 

significant interest in recent years, due to its 

high concentrations of methylglyoxal, which is 

recognised to be more resistant to inactivation 

Fig 2. Adult Demodex brevis 

by heat and catalases then antimicrobial 

peroxide constituents. A cyclodextrincomplexed 

microemulsion formulation of MGO 

manuka honey has recently been developed 

for overnight topical eyelid application and is 

currently under investigation with regard to 

its to ocular hygiene potential in the clinical 

management of blepharitis. The eyelid cream 

has been observed to exhibit manuka honey 

in vitro anti-bacterial activity against ocular 

microbiota and successfully underwent 

safety and tolerability testing in a two-week 

randomised masked clinical trial of healthy 

human participants 13,14 . 

The in vitro anti-demodectic activity of 

MGO manuka honey was compared with 

50% tea tree oil in a recently published study 

conducted by the University of Auckland Ocular 

Surface Laboratory 4 . The findings demonstrated 

that cyclodextrin-complexed manuka honey 

exhibited comparable antiparasitic efficacy to 

50% tea tree oil against ocular Demodex mites 

acquired from blepharitis 

patients. Together with the 

results from the earlier clinical 

tolerability trial, this would 

suggest that manuka honey 

shows the potential to offer 

an alternative non-irritating 

topical treatment to 50% tea 

tree oil. Clinical trials exploring 

the efficacy of manuka honey 

in demodectic and nondemodectic 

blepharitis are 

already underway. 

Conclusions 

Ocular surface infestation with 

Demodex mites is emerging as a 

significant cause of chronic blepharitis. Topical 

50% tea tree oil formulations are the current 

mainstay of treatment for demodectic blepharitis, 

although the significant ocular irritation restricts 

its use to brief application periods under 

clinical supervision. A recent study conducted 


Laboratory demonstrated antiparasitic activity 

of four commercially available, dedicated eyelid 

cleansers, although among the formulations 

tested, only Cliradex exhibited comparable 

efficacy to 50% tea tree oil. A separate study 

showed that comparable anti-demodectic 

activity was observed between MGO manuka 

honey and 50% tea tree oil, which would suggest 

promise for complexed manuka honey to offer 

an alternative non-irritating topical treatment for 

ocular Demodex infestation. 

References 

1. Nicholls SG, Oakley CL, Tan A, Vote BJ. Demodex species in human 

ocular disease: new clinicopathological aspects. Int Ophthalmol. 

2017;37(1):303-312. 

2. Koo H, Kim TH, Kim KW, Wee SW, Chun YS, Kim JC. Ocular Surface 

Discomfort and Demodex: Effect of Tea Tree Oil Eyelid Scrub in Demodex 

Blepharitis. J Korean Med Sci. 2012;27(12):1574-1579. 

3. Cheung IMY, Xue AL, Kim A, Ammundsen K, Wang MTM, Craig JP. 

In vitro anti-demodectic effects and terpinen-4-ol content of commercial 

eyelid cleansers. Contact Lens Anterior Eye. 2018 (in press). 

4. Frame K, Cheung IMY, Wang MTM, Turnbull PR, Watters GA, Craig JP. 

Comparing the in vitro effects of MGO Manuka honey and tea tree oil on 

ocular Demodex viability. Contact Lens Anterior Eye. 2018 (in press). 

5. Duncan K, Jeng BH. Medical management of blepharitis. Curr Opin 

Ophthalmol. Jul 2015;26(4):289-294. 

6. Sung J, Wang MTM, Lee SH, Cheung IMY, Ismail S, Sherwin T, Craig 

JP. Randomized double-masked trial of eyelid cleansing treatments for 

blepharitis. Ocul Surf. 2018;16(1):77-83. 

7. Liu J, Sheha H, Tseng SCG. Pathogenic role of Demodex mites in 

blepharitis. Curr Opin Allergy Cl. 2010;10(5):505-510. 

8. English FP, Nutting WB. Feeding characteristics in demodectic mites of the 

eyelid Aust J Opthalmol. 1981;9(4):311-313. 

9. Kim JH, Chun YS, Kim JC. Clinical and Immunological Responses in 

Ocular Demodecosis. J Korean Med Sci. 2011;26(9):1231-1237. 

10. Gao YY, Di Pascuale MA, Li W, et al. In vitro and in vivo killing of ocular 

Demodex by tea tree oil. Br J Ophthalmol. 2005;89(11):1468-1473. 

11. Gao Y-Y, Di Pascuale MA, Elizondo A, Tseng SCG. Clinical Treatment 

of Ocular Demodecosis by Lid Scrub With Tea Tree Oil. Cornea. 

2007;26(2):136-143. 

12. Kheirkhah A, Casas V, Li W, Raju VK, Tseng SC. Corneal manifestations 

of ocular demodex infestation. Am J Opthalmol. 2007;143(5):743-749. 

13. Craig JP, Rupenthal ID, Seyfoddin A, Cheung IMY, Uy B, Wang MTM, 

Watters GA, Swift S. Preclinical development of MGO Manuka Honey 

microemulsion for blepharitis management. BMJ Open Ophthalmol. 

2017;1(1):e000065. 

14. Craig JP, Wang MTM, Ganesalingam K, Rupenthal ID, Swift S, Loh CS, 

Te Weehi L, Cheung IMY, Watters GA. Randomised masked trial of the 

clinical safety and tolerability of MGO Manuka Honey eye cream for the 

management of blepharitis. BMJ Open Ophthalmol. 2017;1(1):e000066. 

Dr Michael Wang is a part-time 

PhD student in the Department 

of Ophthalmology at the 

University of Auckland, under 

the supervision of A/Prof 

Jennifer Craig. 


NEWS 

Personalising glaucoma 

By Lesley Springall 

PERSONALISED MEDICINE, MOVING away from a one-size-fits-all 

approach, is a big thing in today’s British National Health Service and 

this can make a big difference for glaucoma patients, said Professor Keith 

Martin, head of ophthalmology at the University of Cambridge. 

Speaking at Allergan’s Beyond glaucoma meeting in Sydney in July, Prof 

Martin, the meeting’s keynote speaker, said primary open-angle glaucoma 

(POAG) tends to be considered as one disease with one treatment path - 

lowering intraocular pressure (IOP) - despite patients being very different 

and having a range of other conditions. 

“If you look at what’s happened in other areas of medicine in recent 

years, they have been revolutionised by their ability to diagnose specific 

variants of their disease more accurately.” This is particularly true for breast 

cancer, with every UK patient now molecularly phenotyped and their 

treatment plan designed to fit to their specific form of breast cancer. 

Driving this personalisation are advancements in understanding our 

own genomes and technology innovations. Technologies like the Sensimed 

Triggerfish contact lens sensor which can detect IOP-related changes over 

a 24-hour period, may help provide a better understanding of a patient’s 

glaucoma: slow versus fast progression or stable ocular hypertension 

versus ocular hypertension converting to glaucoma, said Prof Martin. 

“Health systems and health providers are now looking at ways to integrate 

this knowledge into patient care… to help us predict risk for diseases like 

glaucoma; who’s going to do well and who’s going to do badly and so will 

need more resources devoted to them.” 

Within glaucoma there’s been a plethora of innovations in recent years, 

such as minimally invasive glaucoma surgery (MIGS) and Allergan’s 

Xen Gel stent. But that makes it even more important to work out which 

treatment is the best for each, individual patient, he said. “Because none of 

these treatments are right for everyone.” 

At Cambridge, Prof Martin and his team are conducting a number of 

different studies looking at new, more personalised treatments for glaucoma 

patients, including stem cell research and other cell therapies. These have 

been shown to work in animal models but, as yet, there’s been no real 

clinical evidence. More worrying, he said, are the complications shown by 

patients who have had unsanctioned stem cell treatments off-shore, such as 

severe retinal scarring. 

Advancements in gene therapy are showing particular promise for 

eye diseases, said Prof Martin, highlighting a number of ongoing clinical 

studies. “The main problem is you’re limited in the amount of information 

Professor Keith Martin from Cambridge University presenting at Allergan’s Beyond glaucoma 

meeting in Sydney 

you can send into cells by the virus (gene carrier). Instead of a long email, 

it’s more like a tweet. So, you can only deliver limited instructions into the 

cell.” 

Prof Martin and his team have the go-ahead and the funding to 

sequence the whole genome of up to 60,000 patients a year with glaucoma, 

macular degeneration and diabetic retinopathy in the UK. “Whole genome 

sequencing on that number of patients is mind blowing in terms of the 

amount of data that will be generated, but also a huge opportunity.” 

While we wait for the results of these studies and other gene therapy 

clinical trials to come to fruition (and the cost of gene therapies to come 

down) we can still improve care for our glaucoma patients today, by better 

individualising care to maximse the benefits of both the new and older 

glaucoma treatments currently available, said Prof Martin. “This is where 

we get to become doctors again, to actually understand what our patients’ 

needs are, what their fears are, and to help them weigh up the risks and the 

benefits of different treatments and make sensible decisions.” 

Allergan’s Beyond glaucoma meeting ran concurrently with its sister 

meeting, Beyond the retina, focusing on diabetic macular oedema (DMO). 

The two events were designed to talk about current and future treatments 

for glaucoma and DMO and introduce Allergan’s Xen Gel stent, a surgical 

implant designed to lower eye pressure in open-angle glaucoma patients, 

and Ozurdex, a sustained-release dexamethasone intravitreal implant, 

designed to treat DMO, to the Australia market. Both products were 

introduced to New Zealand at the end of last year. For more on both, search 

“Xen” or “Ozurdex” on www.eyeonoptics.co.nz 

RANZCO’s golden jubilee 

THE ROYAL AUSTRALIAN and New Zealand College of Ophthalmology’s 

(RANZCO’s) 50th Annual Scientific Congress, and associated parallel 

conferences for Australasian ophthalmic nurses and practice managers, 

will take place at the Adelaide Convention Centre from 17-21 November. 

The Scientific Congress will feature a range of eminent international 

and local speakers including Profs Robyn Guymer, Giovanni Staurenghi 

and Stephanie Watson, A/Prof Angus Turner and Drs Marlene Moster, 

Ramin Salouti, Russell Van Gelder and Bradley Randleman. Convenor 

Dr Neil Gehling promises an exceptional programme with thoughtprovoking 

presentations, interactive workshops and distinguished 

keynote addresses. 

The practice manager’s conference will focus on different 

management aspects, including bench marking, social media 

security and environmental sustainability, and features more than 20 

presentations from specialist speakers and leaders within their fields. 

The ophthalmic nurses’ Pacific Rim Conference, will be held on 

Sunday 18 November and includes speakers such as: Elethia Dean, a USregistered 

nurse with specialist experience in clinical and administrative 

care in acute and ambulatory settings; and New Zealand’s David Garland, 

an ophthalmic nurse practitioner with more than 15 years’ experience in 


Visitors will have ample opportunity to savour Adelaide’s renowned 

local wines and cuisine in the Congress centre precinct as well as in 

nearby Adelaide Hills, McLaren Vale and Barossa Valley. This year’s social 

programme also includes the opportunity to visit local treasures such as 

Adelaide Zoo, venue for the 2018 welcome reception, and the Adelaide 

Oval, which will host the congress dinner. 

RANZCO early bird rates close 12 September 2018. For more and to 

register, please visit www.ranzco2018.com or www.aonavic.com.au 


ONZ Update 

By the ONZ Board 

OPHTHALMOLOGY NEW ZEALAND (ONZ) has had a busy start to the 

year, working behind the scenes on the introduction of minimally-invasive 

glaucoma surgery (MIGS) and devices into private ophthalmology and 

member queries. 

The annual Royal Australia and New Zealand College of Ophthalmology 

(RANZCO) NZ Branch meeting, held this year at the Hilton in Auckland, 

was another great opportunity for New Zealand ophthalmologists to meet 

the board members of ONZ, to hear the issues members face and to let those 

members know about the work that goes on behind the scenes by ONZ. 

The ONZ board consists of six members: Drs Michael Merriman, Kevin 

Taylor, Peter Hadden, Rebecca Stack, Dean Corbett and Shenton Chew, who 

all work tirelessly and voluntarily on the issues that are outside RANZCO’s 

normal remit. ONZ also works closely on a number of issues with RANZCO 

as many of our board members are also on committees and in advisorial 

roles with RANZCO. 

The key issues ONZ acts on range from commercial insurance matters 

to how to serve the ophthalmologists and their patients better. Of necessity, 

many of our discussions are around insurance relationships... but more about 

that later. 

Regarding representing and supporting our members, we now have two 

key events as part of our members’ calendar: our Clinical Leaders Forum, 

facilitated by Dr Rebecca Stack; and our Business Forum. 

Our Clinical Leaders Forum was held in Wellington in March and 

covered updates from the EAG (expert advisory group), RANZCO, the 

Ministry of Health and Health Workforce New Zealand and reviewed the 

new glaucoma and macular degeneration guidelines and RANZCO’s work 

on managing poorly-performing doctors (see p10). 

ONZ Business Forum – The Other Matters 

It was pleasing to see a good turnout at this year’s Business Forum, The Other 

Matters, despite the difficult timing around the RANZCO NZ meeting. We 

would like to thank our sponsors for their support of this event, especially 

Legacy Insurance for supporting our welcome drinks. It was great to relax 

together at the Hilton Bar. 

Despite the time restrictions, we still managed to cover a number of 

important topics at this year’s Business Forum including the legal structuring 

of our businesses, risk, engaging staff and ONZ strategy, plus an interesting 

presentation from Dr Stephen Childs, Southern Cross Healthcare’s chief 

medical officer. 

Feedback on both the Clinical and Business Forum events was positive 

and helps us to format a needs-based agenda for the next Forums. 

Insurance relationships 

It is no surprise to NZ Optics readers that costs in health care are rising 

and that providers have been forced to shoulder the burden of these costs 

to ensure a healthy public and private sector. There are many publications 

discussing the underlying factors in current and projected cost rises, but 

these are mainly due to an aging demographic needing more care; increasing 

life expectancies; rising costs in technology and aids; and the rising cost of 

pharmaceuticals. 

As these costs impact on the private health insurance industry bodies, 

and they struggle to maintain their funds, pressure is brought to bear on 

providers to shoulder the increased costs. ONZ seeks to support its members 

whilst ensuring a fair and transparent playing field for members, insurers 

and consumers of health care. Thus, we are working with insurance bodies to 

form robust relationships and provide consultation on clinical matters. We 

also made a recent submission to the Insurance Contracts Review, conducted 

by the MBIE, highlighting the need for reform in New Zealand Health 

Insurance law and identifying strategies used in other jurisdictions. 

ONZ also pointed out the perils of obscuring the rising costs in health 

care, encouraging a system which improves transparency and choice for 

private health consumers while limiting cost shifting to providers. If we 

cannot limit this shift to providers, it will become increasingly unattractive 

for providers to go into private care and the burden shifts to the public 

system. 

FULLY 

FUNDED 

FROM 1 JUNE 2018 

in both the community 

and hospital settings 1 

EYLEA is fully funded under Special Authority and Restricted criteria for 

Wet Age Related Macular Degeneration and Diabetic Macular Oedema. 1 

For information on the full reimbursement criteria view the Pharmac 

notification at www.pharmac.govt.nz 1 

Reference: 1. PHARMAC website www.pharmac.govt.nz accessed 13/6/2018. 

EYLEA® (aflibercept) EYLEA is used in ophthalmology. Prescription medicine. 40 mg/mL solution for 

intravitreal injection containing aflibercept. INDICATIONS: EYLEA (aflibercept) is indicated in adults for the 

treatment of neovascular (wet) age-related macular degeneration (wet AMD), visual impairment due to macular 

oedema secondary to central retinal vein occlusion (CRVO), visual impairment due to macular oedema secondary 

to branch retinal vein occlusion (BRVO), diabetic macular oedema (DME), visual impairment due to myopic 

choroidal neovascularisation (myopic CNV). DOSAGE REGIMEN AND ADMINISTRATION: 2 mg aflibercept 

(equivalent to injection volume of 50 μL). The interval between doses injected into the same eye should not 

be shorter than one month. Once optimal visual acuity is achieved and/or there are no signs of disease activity, 

treatment may then be continued with a treat-and-extend regimen with gradually increased treatment intervals 

to maintain stable visual and/or anatomic outcomes. If disease activity persists or recurs, the treatment 

interval may be shortened accordingly. Monitoring should be done at injection visits. There is limited information 

on the optimal dosing interval and monitoring interval especially for long-term (e.g. > 12 months) treatment. 

The monitoring and treatment schedule should be determined by the treating ophthalmologist based on the 

individual patient’s response. If visual and anatomic outcomes indicate that the patient is not benefiting from 

continued treatment, EYLEA should be discontinued. For wet AMD: Treatment is initiated with one intravitreal 

injection per month for three consecutive months, followed by one injection every two months. Long term, it 

is recommended to continue EYLEA every 2 months. Generally, once optimal visual acuity is achieved and/or 

there are no signs of disease activity, the treatment interval may be adjusted based on visual and/or anatomic 

outcomes. The dosing interval can be extended up to every 3 months. For CRVO: Treatment is initiated with 

one injection per month for three consecutive months. After the first three monthly injections, the treatment 

interval may be adjusted based on visual and/or anatomic outcomes. For BRVO: Treatment is initiated with one 

injection per month for three consecutive months. After the first three monthly injections, the treatment interval 

may be adjusted based on visual and/or anatomic outcomes. For DME: Treatment is initiated with one injection 

per month for five consecutive months, followed by one injection every two months. After the first 12 months, 

the treatment interval may be adjusted based on visual and/or anatomic outcomes. For myopic CNV: EYLEA 

treatment is initiated with one injection of 2 mg aflibercept (equivalent to 50 μL). Additional doses should be 

administered only if visual and/or anatomic outcomes indicate that the disease persists. Recurrences are treated 

like a new manifestation of the disease. CONTRAINDICATIONS: Known hypersensitivity to aflibercept or excipients; 

ocular or periocular infection; active severe intraocular inflammation. PRECAUTIONS: Endophthalmitis, increase 

in intraocular pressure; immunogenicity; arterial thromboembolic events; bilateral treatment; risk factors for 

retinal pigment epithelial tears; treatment should be withheld in case of rhegmatogenous retinal detachment, 

stage 3 or 4 macular holes, retinal break, decrease in best-corrected visual acuity of ≥ 30 letters, subretinal 

haemorrhage or intraocular surgery; treatment not recommended in patients with irreversible ischemic visual 

function loss; population with limited data (diabetic macular oedema due to type 1 diabetes, diabetic patients 

with HbA1c > 12 %, proliferative diabetic retinopathy, active systemic infections, concurrent eye conditions, 

uncontrolled hypertension, myopic CNV: no experience in the treatment of non-Asian patients, previous treatment 

for myopic CNV and extrafoveal lesions), see full Data Sheet for effects on fertility, pregnancy, lactation, effects 

on ability to drive or use machines. INTERACTIONS: No formal drug interaction studies have been performed. 

ADVERSE EFFECTS: Very common: conjunctival haemorrhage, visual acuity reduced, eye pain. Common: retinal 

pigment epithelial tear, detachment of retinal pigment epithelium, retinal degeneration, vitreous haemorrhage, 

cataract, cataract cortical, cataract nuclear, cataract subcapsular, corneal erosion, corneal abrasion, intraocular 

pressure increased, vision blurred, vitreous floaters, vitreous detachment, injection site pain, foreign body 

sensation in eyes, lacrimation increased, eyelid oedema, injection site haemorrhage, punctate keratitis, 

conjunctival hyperaemia, ocular hyperaemia. Serious: endophthalmitis, retinal detachment, cataract traumatic, 

cataract, vitreous detachment, intraocular pressure increased, arterial thromboembolic events, hypersensitivity 

including isolated cases of severe anaphylactic/anaphylactoid reactions. Others: 

see full Data Sheet. Based on DS: Dated 31 May 2016. Eylea is fully funded from 

1 June 2018. A prescription fee will apply. This medicine has risks and benefits. 

Before prescribing, please review Data Sheet for further information on the risks 

and benefits. Full Data Sheet is available from www.medsafe.govt.nz or Bayer 

New Zealand Limited, 3 Argus Place, Hillcrest, Auckland 0627. Telephone 

0800 233 988. BY8749 Approval number NZ-EYL-00012-08-2018 NA10154 

Prepared July 2018. ® Registered trademark of the Bayer Group, Germany 


BUSINESS 

FOCUS ON BUSINESS SPONSORED BY 

THE INDEPENDENT 

OPTOMETRY GROUP 

Practice intelligence: What gets measured, gets done 

By Robert Springer 

TODAY’S PRACTICE OWNER has access to 

more information and insights into how the 

practice is performing than ever before. With a 

focused approach, you will be able to monitor 

key metrics delivering improved results. 

In our daily interactions with practice 

owners, we find that the most important term to 

be familiar with is “conversions”. A conversion 

is simply the successful result of a patient 

responding to your message with the desired 

outcome - a booked appointment, a practice 

visit, a purchase or a positive word-of-mouth 

testimonial. 

In the past, conversion tracking was an 

expensive exercise and tracking tools were 

not well integrated into practice management 

systems, often resulting in information gaps. Did 

the patient book an appointment? Did the patient 

buy something? If you can’t measure it, you are 

missing out on very valuable information which 

can help shape your future activities. 

Conversion measurement can be applied 

across all facets of practice management. Here 

are some of the more important ones: 

Recalls 

The most important conversion tracking is 

your recall process, which is usually entrenched 

within your practice management system. 

Although you can view recall statistics over 

a longer period of time, we recommend 

monitoring recall effectiveness at 90 days. 

Beyond this, there is an increasing probability 

the patient may find an interim eye care solution 

elsewhere. Recall rates can be split by phone, 

SMS or email, and you can use a combination to 

increase response effectiveness. 

Website 

You may already be familiar with Google 

Analytics as the most common way to track 

the performance of your website. An example 

of conversion tracking is to identify how many 

visitors click your “Request an appointment” 

button or web form. There are other website 

plugins that sync with your marketing list to 

reveal who within your database is viewing your 

webpage and how long they are engaged with 

reading your content. 

Social media 

Facebook is a viable way to generate new 

appointments and to showcase all the great 

things that you do in practice. Likes, shares 

and comments are all the visible ways you can 

monitor activity on your page, but this represents 

only a very small portion of people who are 

viewing your posts. Installing the Facebook Pixel, 

a tracking code, on your website will allow you to 

track conversions from Facebook to your website 

and through to online booking. 

Email newsletters 

Sending occasional email communications to 

your database can be an effective way to keep 

patients informed of your latest offers, campaign 

messages or promotions. Email is a way to 

create a digital on-going connection with your 

patients, which also brings additional insights 

because you can track what patients are viewing 

on your website after they click from the email. 

Promotional campaigns 

You have a message you want everyone to know 

about? Be sure to include a measurable call-toaction. 

SMS campaigns should use clickable 

links to capture who has shown interest to read 

more. Alternatively, you can use two-way SMS, 

asking the patient to reply via SMS in response 

to a yes/no question. Printed letters should 

include a call-to-action which uses a specific 

campaign phone number or a webpage that is 

unique to the message you are promoting so 

you can get some idea about patient response. 

Remember to ensure you have patient 

permissions in place before contacting them 

with any SMS or email promotions, however. 

How can you increase “conversions”? 

1. Reduce the points of friction - Put yourself 

in the shoes of your patient. How can you make 

the booking and eye care process as easy as 

possible? Which technology systems will you 

offer to appeal to your target audience: online 

self-booking appointments, pre-appointing 

with SMS reminders, Facebook Messenger, 

personalised letters, phone calls from your 

staff… all of these can make it easier for 

patients, so chose the technology stack that’s 

right for your practice. 

2. A/B message testing - How do you know 

if your message will be effective? You need to 

test it! Put simply, an A/B Test is running two 

simultaneous versions of a message to see which 

one gets the better response. Use the one that 

gets greater conversions more often! 

Ensure that everything you do can be 

measured and create a simple monthly 

dashboard for yourself which includes the areas 

you are actively investing time and money into. 

Every successful conversion will reinforce that 

you have a process that works and will build 

your confidence in taking proactive steps to 

grow your practice successfully. 

Robert Springer is 

the technical director 

of OptomEDGE, an optometryfocused 

marketing agency 

covering campaigns, printed 

and digital recalls and patient 

communications. To learn more, 

please call +64 9 889 3179 or 

email ask@optomedge.co.nz 

The Independent Optometry Group, providing the advice 

and service independents need to thrive. 

To find out more contact Neil Human on 0210 292 8683 

or neil.human@iogroup.co.nz 


NEWS 

Jono: time for design 


AUSTRALIAN EYEWEAR 

DESIGNER Jono Hennessy Sceats, 

creator of popular Australasian 

brands, Jono Hennessy, Carter 

Bond and Zeffer, says the best 

thing about joining international 

Australasian eyewear distributor 

Sunshades is he can get back to 

doing what he loves best - design. 

“We built an international 

company. We now sell 40% of 

our frames in Europe, but there 

were only four of us running the 

business. It got too hard… we 

needed help… we were spending 

too much time on administration 

and not enough time on the 

product.” 

So, it was exciting, he says, 

when Sunshades CEO Rodney 

Grunseit, son of Sunshades 

founder Bette Lasse, approached 

him and his business partner wife, 

Louise Sceats, 10 months ago 

with a business proposition to do 

something special together. 

Becoming part of Sunshades 

Eyewear business is the 

culmination of a personal and 

professional friendship first formed 

more than 30 years ago, says Jono. 

“Betty Lasse was my first account 

and she was so supportive and 

wonderful. My designs at the time 

were a totally new look and not 

getting great interest. Betty then 

sold them well and Vogue did a 

story, so it was all then accepted.” 

Even when the businesses were 

no longer connected, Jono was still 

welcome on Betty’s guest list, he 

says. “She was a very special person 

and I am grateful for her uplifting 

support. Today I see the same 

feelings surrounding the team 

at Sunshades, including her son 

Rodney who continues her legacy 

so proudly.” 

The decision to join Sunshades 

makes sense given the increasingly 

competitive nature of eyewear 

today, says Jono, as it allows him 

and Louise to concentrate on 

design while still being part of a 

family-run company, harnessing its 

larger distribution and back-end 

support infrastructure. “Sunshades 

is a design-led company. They 

export brands across the world 

from New Zealand and Australia, 

Jono Hennessy Sceats (left) with Sunshades’ Anthony Whittle and Alyssa Piva, and Louise Sceats, 

Kerry Carey and Jesse Nel 

brands like Karen Walker, its 

extraordinary and something to be 

proud of.” 

Being design-led is vital for 

businesses in Australia and 

New Zealand, he adds, because 

companies here can’t compete on 

price. 

With his newest accolade being 

made a member of the Design 

Institute of Australia’s Hall of Fame, 

Jono says he hopes to influence 

the Australian government to 

rank design more highly within its 

research and development business 

grants. But that’s a little way down 

the track. 

First, he’s getting back to 

basics with his eyewear brands, 

he says, researching and working 

new materials to provide the 

most comfortable fit, while still 

maintaining the style his brands 

have become known for. 

Without giving too much 

away, Jono says his current design 

influences include original wire 

frames made in China in the 1880s 

to 1890s, Japanese construction 

and car paint colours. Sounds like 

fun? “Yes, yes it is,” he says with a 

smile. 

Welcome to OSO18 

The 13th Congress of the 

Orthokeratology Society of Oceania, 

OSO18, will run from 5-7 October 

at the Royal Pines Resort on 

Queensland’s Gold Coast. 

The conference will feature some 

of the best practitioners and 

researchers in the world discussing 

the latest in ortho-k lens design and 

research, said Gavin Boneham, OSO 

president. “The programme has a 

strong focus on myopia control and 

will offer something for everyone 

who is, or wants to be, involved in 

the stimulating field of ortho-k and 

myopia control.” 

As well as lectures, the programme 

includes workshops on ortho-k, 

specialty lens fitting and advanced 

topography, with a special practical 

session on Sunday morning on how 

to set up and run a myopia control 

practice. International keynote is 

acclaimed Professor Earl Smith, 

College of Optometry dean at the 

University of Houston, who received 

the Glenn Fry Award and the 

Prentice Medal from the American 

Academy of Optometry for his 

research on the role of vision in 

regulating refractive development 

and eye growth. 

The popular “Meet the Speakers” 

Friday night drink is back, 

complementing the ‘world famous’ 

themed gala dinner party on 

Saturday evening. To register, visit: 

www.oso.net.au/whats-on 


NEWS 

Most creative dress award went to Alice Jackson, Marna Claassen, Paddy Perrett and Lauren Curd 

EyeBall’s island 

of vision 

By Aimee Aitken, NZOSS executive team 

The fabulous SOVS staff: Bhav Solanki, Zaria Bradley, Jean Choi, Kristine Hammond, 

Alyssa Lie, Adina Giurgiu, Kathryn Sands, Zoe Smith and Lisa Silva 

DESPITE THE CHILLY winter weather, the atmosphere was warm at 

the Grand Millennium at the end of July as the University of Auckland’s 

School of Optometry and Vision Science celebrated their annual EyeBall, 

themed Utropia: Welcome to the Island of Vision! 

The evening was a success and thoroughly enjoyed by more than 200 

students, staff and sponsors, all of whom were dressed impeccably. An 

impressive number of guests dressed to the island theme, with prizes 

awarded for both Best dressed (Robert Burnie) and Most creative (Alice 

Jackson, Marna Claassen, Paddy Perrett and Lauren Curd). The Ball 

Committee was certainly faced with a difficult decision to determine the 

winners! 

The EyeBall is the most anticipated social event of the year for 

optometry students and staff at the university, and it would not be such 

an amazing night without the help of our generous sponsors: Specsavers, 

Eye Institute, OPSM, Essilor, NZAO, CooperVision, Designs for Vision, 

Optimed, Eyeline Optical and NZOSS. Thank you all! 

The Ball Committee also deserves thanks for all their hard work: Anna 

Chen, Mary Rush, Nileesha Parbhu and Maggie Xu, plus we’d like to say a 

special thank you to Muthana Noori for being a talented MC on the night 

and to the Red Frogs University support volunteers for all their help. We’re 

already waiting in anticipation for the 2019 EyeBall and can’t wait to see 

what the next committee comes up with! 

For more from SOVS, see p16 

Jason Kumar, Nadiah Madahi, Sushmita Chinchankar, Hannah Pike, Anna-Marie Rohs, 

and Amosa Lene at the EyeBall 

Part III students enjoying the EyeBall 

Photos courtesy of Alethea Lim. 


LIQUID COMFORT 

FOR EACH AND 

EVERYONE 

makes your life easy with its comprehensive range of solutions 

NEW 

NEW 

RRP 

$8.95 

NEW 

RRP 

$19.95 

Viscotears 

Ocular lubricating gel. 

Preservative Free now available 

Splash 

Great value saline solution 

EasySept 

Preservative free hydrogen 

peroxide at a great price 

renu Fresh & renu Sensitive Biotrue Multipurpose Boston 

Excellent disinfection 

at a value price 

Premium solution for superior 

all-day comfort 1,2 

New Zealand’s No.1 hard 

contact lens care brand 3 

References: 1. Bausch + Lomb data on file. Merchea MM et al. Patient satisfaction with multipurpose solutions in over 4000 subjects. 2. Bausch + Lomb data on file. Scheuer C et al. Wetting agent retention and release from hydrogel and silicone hydrogel contact 

lenses. 3. IMS Data June 2018. © 2018 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affiliates. Other product names/ brand names are trademarks of their respective owners. Bausch & Lomb (New Zealand) Ltd 

c/- Bell Gully Auckland, Vero Centre, 48 Shortland Street, Auckland 1140, New Zealand. Marketed by Radiant Health Ltd. 0508 RADIANT. BIO.0014.NZ.18 


NEWS 

Winter warmth at the O-Show 


Eyes Right and Modstyle’s Lisa and Mark Wymond 

OptiMed’s Craig Norman and the new Thermaeye 

50 | NEW ZEALAND OPTICS SEPTEMBER 2018 

STEPPING INTO THE darkened hall of the 

biennial O-Show, again held at Central Pier in 

Melbourne’s Docklands, is like stepping into a 

cocoon of warm hospitality. 

The larger exhibition halls of other 

conferences and fairs are a far cry from 

this boutique offering from the Optical 

Manufacturing Association of Australia 

(ODMA). There’s no CPD-session pressure to 

see exhibitors at certain times, allowing for a 

leisurely flow of visitors throughout the show’s 

two days. 

Exhibitor space at this year’s O-Show sold 

Clic’s Helen Najar (right) 

Eyepro’s Tom Frowde and Chris Clark 

out quickly to many of the region’s biggest 

frames and equipment suppliers. The 2018 

event also attracted more than 700 visitors; the 

majority from Victoria, but nearly a quarter 

from elsewhere in Australia and overseas, 

including New Zealand. 

Matt Wensor, Zeiss Australasia’s strategic 

marketing manager, said ODMA members 

didn’t just support the event because they were 

ODMA members, but because the event works. 

“The O-Show has a smaller boutique feel about 

it, which creates a good opportunity to catch up 

with customers and others within the industry 

in a relaxed and unhurried environment.” 

Eyes Right Optical’s new managing director 

Mark Wymond, son of founders Gaye and 

David Wymond, also commented on the show’s 

relaxed feel, allowing exhibitors to catch up with 

a lot of people in just a couple of days. 

Popular Australian eyewear designer Jono 

Hennessy Sceats is another fan, saying he’d be 

happy to attend O-Shows annually in different 

centres if ODMA decided to run them. “Other 

exhibitions have become too expensive, 

too commercial, while the O-Show is more 

personable. It’s like having a chat with someone 

at your house; there’s no pressure to spend 

$50,000 on doing your stand.” 

As well as the exhibition, this year’s O-Show 

included informal presentations from David 

Inderias from Techprint on his 3D-printed 

eyewear; Yvette Wadell, the newly appointed 

CEO of Brien Holden Vision Institute, on the 

myopia epidemic; and Vivienne Forbes from 

Social Ties, who provided some social media 

tips and tricks. Retail stylist, Kerry van Beuge, 

once again filled out her slots for her lowcost 

window display tips, while the Saturday 

evening’s cocktail party appeared to increase 

visitor numbers several-fold.

O-Show news 

There was also a good deal of news on offer with 

several companies introducing new products to 

the market. News highlights included: 

• OptiMed’s Thermawave – the latest offering 

in the intense pulsed light (IPL) equipment 

battle, Thermawave was developed by 

ophthalmologists in Spain, requiring no filters 

and no additional cooling systems; simple 

to use; and targeted to help patients with 

meibomian gland dysfunction, conjunctivitis, 

blepharitis and Demodex infection* 

• Clic brochure and Manhattan – Clic 

has launched a detailed brochure for eye 

professionals to discuss different styles with their 

patients. The brochure is available online or in 

hard copy and features Clic’s entire range from 

its traditional, smaller-lensed Clic reader styles, 

to its big ‘Manhattan’ with 50ml wide lenses, a 

large band and flex over the ear. 

• Little4eyes – introduced two new children’s 

brands to the market, Star Wars (inspired by 

the 40th anniversary of the film franchise) and 

Tartine et Chocolat. Like the company’s other 

brands, Catamini and Jacadi, Tartine et Chocolat 

is a high-end children’s clothing brand, which 

has introduced a cute eyewear range for kids. 

Tartine et Chocolat eyewear is available through 

Little4Eyes in New Zealand and Australia, though 

Star Wars is currently only available in Australia. 

ODMA chair, OptiMed’s Robert Sparkes, said 

he was delighted with this year’s show. “This 

pop-up boutique event is what the independent 

optical industry asked for and is now a 

confirmed favourite. This is the kind of show that 

could easily move to Sydney, Brisbane or other 

locations if there is a demand.” 

Next year, the O-Show has a break while its 

newly revamped big sister takes over, in the 

form of O=MEGA19 (see side story). Where the 

O-Show appears in 2020, however, is still under 

wraps. 

*For more on Demodex, see p42 

ODMA chairman Robert Sparkes, Optometry Victoria president Murray Smith, ODMA CEO Finola Carey and Optometry 

Victoria CEO Pete Haydon at the launch of O=MEGA19 at the O-Show 2018 

O=MEGA19, more mega? 

OPTOMETRY VICTORIA (OV) and Optometry 

South Australia (OSA) members will vote 

on their proposed merger to become one 

representative optometry body at their AGMs 

in October. Should the majority of members 

accept the proposal, the newly amalgamated 

organisation will become the co-partner of 

the Optical Distributors & Manufacturers 

Association of Australia (ODMA’s) recently 

announced new joint event, O=MEGA19, 

which is replacing OV’s Southern Regional 

Congress (SRC) and the biennial ODMA fair. 

Given the timing of the members’ vote, 

OSA’s annual BlueSky conference will be held 

in November as usual, but will then move to 

being biennial should the members accept 

the merger plans. Thus O=MEGA will be held 

every two years (2019, 2021 etc.) in Melbourne 

and Blue Sky every two years in Adelaide from 

2020. 

In the ‘off’ year in the two states, a 

comprehensive plan of one day CPD events is 

also being developed, said Pete Haydon, CEO 

of Optometry Victoria. This CPD potential will 

also extend to O=MEGA19 for New Zealandbased 

optometrists, he added. 

“We’ve welcomed hundreds of New 

Zealand optoms to SRC over the years, and 

offered accredited CPD for them… I anticipate 

we’ll continue this arrangement and am 

looking forward to making O=MEGA19 a truly 

regional event.” 

O=MEGA and the proposed merger of OV 

and OSA also have the backing of Australia’s 

national optometry body, Optometry 

Australia. “Optometry Victoria and Optometry 

South Australia are putting members first 

and working to provide enhanced services, 

while ensuring great value for members,” OA 

national president Andrew Hogan told the 

association’s online magazine of the same 

name. While OA’s national CEO Lyn Brodie told 

NZ Optics, “Optometry Australia is delighted 

that Optometry Victoria and ODMA have 

joined forces to launch the new education, eye 

care and eye wear event, O=MEGA. It is terrific 

to see sector leaders challenging existing 

ways of doing business and finding new and 

interesting ways to support optometrists in 

meeting their clinical, patient and practice 

management obligations.” 

O=MEGA19 will be held at the newlyexpanded 

Melbourne Convention and 

Exhibition Centre from July 19-21 2019 and 

will include dedicated exhibition-only time to 

suit both delegates and exhibitors. 


FASHION 

STYLE EYES 

Allergic to glasses? 

Why specs can make your patients suffer 

By Renee Lunder 

UGLY, RED BLOTCHES; itchy, inflamed spots; 

oozing sores. No, this is not a description of a 

zombie from the latest horror flick, but a patient 

suffering from an allergy to their glasses. 

Common allergies… 

According to the Australasian Society 

of Clinical Immunology and Allergy, 

approximately 8% of the population has a nickel 

allergy. Considering nickel is present in so 

many things – coins, jewellery, mobile phones, 

keys, pens, clothing (zips/buttons/bra hooks/ 

hairpins) and spectacle frames – it can be tricky 

for sufferers to avoid it. 

The most common reaction to nickel is 

dermatitis which usually presents as itchy 

eczema or red blisters wherever the metal 

touches the skin. 

Another allergy that gets people all itchy 

and scratchy is silicone. While it is rarer than a 

nickel allergy, it still one of the more common 

complaints from allergy-suffering spec wearers, 

with silicon nose pads causing bumps or skin 

rashes across the nose. 

… and not-so-common allergies 

An allergy to chemical coatings on lenses, such 

as scratch-resistant and anti-reflective layers, 

can be another cause of distress for some specswearers. 

The usual sign is eye irritation. 

Plastic is yet another offender, but this one 

can be infinitely harder to diagnose as frames 

are usually made out of a combination of 

materials. The allergy could very well be linked 

to the solvents, rubbers, dyes or waxes used to 

make the frames. Reactions are similar to those 

who have a nickel allergy. 

Allergy versus irritant 

It’s hard to distinguish between an allergic 

reaction to something the glasses are made 

from and an irritation caused by the glasses 

themselves as symptoms are similar. With 

Nickel allergy 

irritations, repeated contact or 

friction with frames can cause 

a rash to appear; heat (sweat) 

can also be a factor here. 

Allergies, however, occur 

when a person is oversensitised 

to a substance in the 

specs and the patient’s immune 

system reacts by producing 

rashes and blisters. The best way to 

distinguish between the two is through 

allergy testing. 

Helping allergic specs-wearers 

There are a number of options for allergy 

patients. First, suggest they track their 

symptoms over a certain period of time to work 

out if it is their specs that are the problem. Ask 

them to carefully note down exactly 

where the rash appears and what it 

looks like – is it mask-like or behind 

their ears? If their glasses appear 

to be the perpetrator, suggest they 

are allergy tested for nickel, plastics, 

silicone and other common chemicals 

found in coatings. As a tip: if a customer 

has an allergy to costume jewellery, they 

are likely to have a nickel allergy. 

For nickel and plastic allergy sufferers, 

recommend titanium, stainless steel or noble 

metal (pure gold or silver) frames as these are 

far less likely to cause a reaction. 

But be cautious when suggesting titanium 

alloy frames as there’s a chance there’s some 

nickel mixed in. If you aren’t sure about the 

composition of a frame, you can invest in an 

inexpensive nickel-allergy testing kit. Test all 

components of the glasses from frame to screws 

to hinges, the solution won’t harm the frame so 

it will still be sellable! 

If a customer has a silicone allergy, there 

are plenty of alternative nose pad options on 

the market. Consider vinyl, 

titanium or stainless-steel 

pads instead. 

You may need to do some 

extra legwork contacting 

manufacturers and suppliers 

to find out what allergy-free 

alternatives are out there or 

to determine all the elements 

in a particular frame. So, 

it’s good to keep records about your patient’s 

reactions to frames and note down what works 

for them. 

If you wanted to go the extra mile and set 

yourself a little more apart from your peers, 

you might want to consider researching and 

stocking a number of hypoallergenic frames, 

which take all spec parts into consideration – 

the screws, hinges, pads and temples – ensuring 

none contain potential allergens. 

It’s a bit of added work, but your allergy 

patients will love you for it, and so will their 

families! 

Renee Lunder is an Australian 

freelance journalist and proud 

specs wearer. 

Allergy-friendly titanium and 

gold specs from Blackfin, and 

titanium nose pads 


Fashion update 

Kate Sylvester 

Kate Sylvester’s spring collection 

features three new sun- and five 

optical frames. The collection offers 

“strong, feminine shapes imbued 

with Kate’s understated, effortless 

aesthetic and introduces pops 

of rose pink and vibrant green 

alongside a tonal colour palette,” 

said the company. An avid reader, 

Sylvester has named her optical 

frames after authors she loves. 

Featured here is Renata (Renata 

Alder) while the sunglasses are 

named after some of her favourite 

book characters, for example Peggy 

(Guggenheim) and Dorian (Gray). 

Distributed by Phoenix Eyewear. 

Stars 

eyes 

and 

their 

Shannon 

Bream 

Dokomotto 

After a successful introduction of 

Dokomotto in New Zealand, Beni 

Vision is extending the French 

brand’s handmade frames portfolio, 

offering pairs from its classic frame 

collection “Seaman”. 

As with the designer range, the 

acetate collection is limited to 500 

pieces worldwide. Distributed by 

Beni Vision. 

WOOW and Face à Face 

Woow’s new season range has 

re-interpreted the big ʹ70s 

shapes and styles and introduced 

transparencies in new and 

different ways. Illustrated here 

by its bold Pop-Up frame featuring 

a combination of 

thin metal and 

colourful acetate. 

Face à Face’s 

new concepts have 

also arrived and 

like its sister brand Woow, 

they play with transparencies 

and colours. Blast, featured here, 

gives the wearer an “edgy look” 

and is available in two shapes, ʹ50s 

inspired high-square and wide 

Lacoste 

Lacoste Eyewear has extended its 

tweens design concept to include 

two new junior frames. Designed 

for sporty kids, the company says 

the frames are durable with vibrant 

colours and playful finishes. The oval 

Lacoste 3628 featured here has soft 

rubber nose pads for comfort and the 

distinctive Lacoste rubber croc on 

both temples. Available in a variety 

of happy colour combinations. 

Distributed by VSP Australia. 

classic cat-eye, and comes in five 

different colours. Distributed by 

Eyes Right Optical. 

Well-known US Fox News reporter Shannon Bream, a former lawyer and 

crowned beauty queen, battled through 18 months of excruciating pain 

and chronic fatigue as a result of undiagnosed recurring corneal erosions 

(epithelial basement membrane dystrophy). 

In a Washington Post interview, Bream described how it started in 2010, 

waking her up with a pain in her left eye “so searing it sat me straight up 

in bed”. Her eye was tearing profusely but after a few hours, the pain and 

tearing subsided. After a few recurring episodes, Bream sought help from 

her optometrist who suggested she could be suffering from dry eye and 

prescribed lubricating eye drops. When the problem kept recurring, the 

optometrist referred Bream to an ophthalmologist. 

Bream said she turned to a respected corneal specialist in Virginia who 

agreed that dryness was the most likely cause and prescribed Restasis, a 

treatment for chronic dry eye. Initially, this helped ease the pain, said 

Bream, but then the pain and tearing became more frequent, with both 

eyes suffering episodes several times a week. 

Her ophthalmologist urged her to be patient, but after several months, 

Bream said she was getting desperate; waking every two or three hours a 

night to put in her eye drops, and existing in a perpetual state of chronic 

fatigue and pain. She returned again to her ophthalmologist, but again 

he told her to be patient and said she was probably overreacting and 

“emotional”. This was a devastating blow, Bream told the Washington 

Post, adding by then she had started to doubt she would ever find 

relief. But her husband urged her to seek advice from a different 

ophthalmologist and Bream reluctantly set up an appointment with a 

Washington corneal specialist. 

Anxious at the prospect of not being taken seriously, Bream described 

her immense relief when during the examination, the specialist 

explained he could see her cornea was covered with tiny, superficial 

scratches and signs of a disorder called map-dot-fingerprint dystrophy, 

featuring clusters of dots resembling fingerprints on layers of the cornea. 

The Washington cornea specialist explained the condition, most 

common in people aged 40-70, results in cellular abnormalities causing 

the corneal epithelium to weakly adhere to the underlying membrane, 

exposing the underlying nerves, which can be excruciatingly painful. 

Several weeks later, as Bream’s eyes had finally begun to heal using the 

ointment and eye drops prescribed, she said she slept a whole night for 

the first time in a year. 

“It felt like I’d won the $300 million lottery,” she said. 


NEWS 

Silmo 

Sydney 2018 


THE SECOND SILMO Sydney was a quieter 

affair than its inaugural unveiling last year, 

with few of the major equipment and frames 

companies that were exhibiting the weekend 

prior, in Melbourne at its rival ODMA’s O-Show 

(see p50). 

That said, this year’s show still featured some 

eye-catching stands. One was the stunning, 

more avant garde frame offerings from Patrick 

Quinn, owner-operator of Perth-based 

optometrists Blink 138. 

Patrick and his son James, both dispensing 

opticians, have been making their own specs 

for about eight years before deciding to set up 

Quinn Eyewear and introduce them to others. 

The pair unveiled their collection at Vision 

Expo East in New York in March and, despite 

being in the boondocks of the show on a shared 

stand, quickly snapped up three American 

accounts. Silmo Sydney was their second show 

and father and son said they were both excited 

and terrified, but also pleasantly surprised at the 

interest they’d received. 

According to the show’s organisers, Expertise 

Events, despite the quieter turnout, other 

exhibitors were also pleased with event sales. 

“Came with zero expectations, happily surprised,” 

Sam Tomashover from Mattisse Handpainted 

Eyewear told Expertise. “An incredible success. 

Saw qualified and quality buyers,” added Mark 

Blackadder from MYM Group. 

The show was supported by its far larger 

European namesake through the presence of 

Silmo Paris director Eric Lenoir who flew into 

Sydney for just a few days to be there. 

“Silmo Sydney is proud to be a ‘buyer-led’ 

show,” said Gary Fitz-Roy, managing director 

of Expertise Events. “The market has evolved 

– it’s no longer about the volume of visitors, it’s 

about delivering the right audience. Having a 

show that has a strong frame focus is important 

as they are constantly changing and evolving 

with market trends and are a major contributor 

to optometry practices’ and retail outlets’ 

profitability.” 

An eye for music 

Mercury Bay optometrist Brett Howes has 

written and released his latest composition 

Lovelight, sung by New Zealand singer-song 

writer and Kiwi Indie music champion LA 

Thompson (aka Shirley Howe). 

When not an optometrist, specialising in sports 

vision and soft contact lenses, Howes has been 

creating music for 20 years and recording pieces 

for about 11 years. 

Described as a soulful ballad, Lovelight came to 

him at a close friend’s funeral. He wrote a few 

lyrics and chord sequences during the service 

and completed it later in collaboration with 

pianist Kevin Crowe, to honour his dear friend, 

he said. To hear the song for yourself, head to 

https://youtu.be/tXyOjByi8N 

Eschenbach Optik’s Brett Sheil and MSO’s Rae Long and 

Gethin Sladen 

Patrick and James Quinn and their new eye-catching frames range 

Silmo Sydney will return to Sydney’s International 

Convention Centre from 5-7 July 2019, two weeks 

ahead of its larger Australasian rival, ODMA’s 

new O=MEGA19 in Melbourne from 19-21 July 

2019 (see p51). 

Fleye Eyewear’s Annette Estø and 

Silmo Paris director Eric Lenoir 

will.i.am specs 

Specsavers has launched an exclusive, new 

eyewear range from musician, producer 

and entrepreneur will.i.am. Building on his 

lifelong passion for striking eyewear, the 

17-piece collection is inspired by the hip 

hop icons of his youth, such as Run DMC 

and Flava Flav, and references classic and 

iconic styles with a twist, said will.i.am. 

“What makes my collection and designs 

unique are the subtleties and attention to 

detail that gives them extra ‘oomph’, while 

remaining entirely wearable.” Any outfit is 

incomplete without a great pair of glasses, 

he added. 

Eye Doctors last Grand Rounds 2018 

Eye Doctors last Grand Rounds 2018 

Eye Eye Doctors last Grand Rounds 2018 

. Wed 

. 31st October, Novotel, Ellerslie . No registration fee 

Wed . Wed 31st 31st October, Novotel, Ellerslie 

. 

. No 

. registration No registration fee fee 

CPD 

. points available 

. CPD . CPD points points available available 

www.eyedoctors.co.nz 

. www.eyedoctors.co.nz 

. www.eyedoctors.co.nz 

ASCOT CLINIC (09) 520 9689 - BOTANY JUNCTION (09) 277 6787 

ASCOT CLINIC (09) 520 

ASCOT 9689 CLINIC - BOTANY (09) JUNCTION 520 9689 (09) - 277 BOTANY 6787 

JUNCTION 

nny McAllum 

ZCO Dr Penny McAllum 

r Penny McAllum FRANZCO 

RANZCO 

Dr Shuan Dai 

FRANZCO Dr Shuan Dai 

FRANZCO Dr Shuan Dai 

FRANZCO 

Dr Andrew Riley 

Dr Andrew FRANZCO Riley 

FRANZCO 

Dr Andrew Riley 

FRANZCO 

Dr Mark Donaldson 

FRANZCO Dr Mark Donaldson 

FRANZCO 

Dr Mark Donaldson 

FRANZCO 

EYE 0810 


CLASSIFIEDS 

Transitions: light 

under control 

HOT ON THE heels of unveiling its new branding, Transitions Optical 

has launched a new consumer campaign Light Under Control. 

The new campaign and rejuvenated brand aims to recruit new 

wearers and attract a younger generation of single vision wearers to 

the photochromic lens category, and responds to research showing 

that 87% of glasses wearers report being sensitive to light, said Stuart 

Cannon, Transitions Optical general manager for Asia Pacific. 

“The Light Under Control campaign dramatises light, making light the 

hero of our story. Light is 

illuminating but it can also 

be harmful or inhibiting. So, 

it has to be under control. 

Our light-intelligent lenses 

allow a hassle-free life, with 

ultimate light protection.” 

Starting in October, 

Transitions is running an 

online consumer media 

campaign, aimed at 

younger wearers, using 

selected social media 

influencers. 

To order your new campaign 

free point-of-sale material, 

see Transitions’ ad on p9. 

To advertise in 

NZ Optics classified section 

contact Susanne Bradley 

susanne@nzoptics.co.nz 

Print and online 

SO MUCH MORE 

THAN JUST A FAIR 

FROM SEPTEMBER 28 TH 

TO OCTOBER 1 ST 2018 

PARIS NORD VILLEPINTE 

silmoparis.com 

LOCUM DIRECTLY 

WITH OPSM 

– AUSTRALIA’S LEADING EYE 

CARE & EYEWEAR RETAILER 

• Choose first from priority placements 

• Choose short or long-term contracts 

• Choose to work with luxury brands 

and world class technology 

• Choose from varying locations across 

Australia and New Zealand 

• Choose higher hourly rates than agency 

locums and enjoy a flexible lifestyle 

Meet extraordinary people, make new 

friends, have fun while you explore 

different locations with us! We’ll even 

organise your travel and accommodation. 

CONTACT DAVID 

luxotticalocums@luxottica.com.au 

to know more. 

OPSM.COM.AU 

WWW.EYEONOPTICS.CO.NZ | 55 

LX95_OPSM_Classified_NZOpticsLocum_102.5x142mm.indd 1 

15/8/18 4:51 pm

CLASSIFIEDS 

To advertise in 

NZ Optics classified 

section contact 

Susanne Bradley 

susanne@nzoptics.co.nz 

Print and online 

For all your 

optical and 

ophthalmic 

needs 

nzowa.org.nz 

FULL-TIME OPTOMETRIST 

Christchurch 

Our practices support independent optometric practice and value an 

optometrist who has a passion for clinical excellence and patient care. 

The Matthews group prides itself on being a family owned and operated 

business and professional growth in all optometry sub- specialties is 

encouraged. 

We are the largest independent optometry group in NZ, with plans for 

future growth. We are looking for someone to join us in our Christchurch 

practices, who is passionate about optometry and wants to be part of a 

company striving for excellence. 

Please contact John Grylls, john.grylls@seekapiti.co.nz or Michelle Diez, 

michelle.diez@matthews.co.nz for more information. 

Confidentiality is assured. 

BAILEY NELSON - OPTOMETRIST 

Riccarton, Christchurch 

Here at Bailey Nelson, we see things a little differently. 

We believe eye care doesn’t have to be boring, and that’s why it’s our 

mission to have passionate and caring Optometrists who ensure all 

patients enjoy an experience worth remembering. 

Our eye tests are tailored for each individual so everyone walks away 

feeling and looking different. 

Bailey Nelson currently has a vacancy in Riccarton. If you want to further 

yourself as a leader and business contributor, all while delivering amazing 

eye care then get in touch. 

To apply, please contact Maddy Mortiaux on 021 351 401 

or maddy@baileynelson.co.nz 

OPTOMETRISTS WANTED 

South Australia & Victoria 

Kevin Paisley Optometry is looking for confident and passionate 

optometrists to join our Mt Gambier, Naracoorte and Portland stores in 

September 2018. If you have a focus on exceptional patient care, client 

service and enjoy working within an experienced team, this is for you! 

Attractive salary package, relocation allowance, fully-maintained car 

and bonus scheme is on offer as well as mentoring and professional 

development. This is an ideal opportunity to grow your optometry career. 

New graduates are encouraged to apply. 

Our Mt Gambier and Naracoorte stores are located in beautiful South 

Australia, and the Portland store is on the stunning Victoria coastline. 

If this sounds interesting to you, please forward CV to Darren Wills, 

darrenw@theopticalco.com.au or +61 424 989 600 

Thinking of selling your practice? 

Optics NZ specialises in optometry practice 

sales, we’ve helped dozens of Optometrists buy 

and sell their practices. 

WORKING AT OPSM 

MEANS YOU’RE PART 

OF SOMETHING BIGGER 

At OPSM, we are passionate about opening 

eyes to the unseen. Our advanced technology 

enables us to look deeper to ensure we give 

the best care to every customer. 

We currently have opportunities for passionate, 

energetic optometrists in a variety of metro and 

regional Queensland and Northern Territory 

locations: Brisbane, Gold Coast, Darwin, Cairns, 

Hervey Bay, Lismore, Townsville and Ballina. 

Whether you like the city, the surf or the outback, 

you will be welcomed into a dynamic and 

supportive team and work with our world-class 

technology including the Optos Daytona ultra-wide 

field scanner. Very attractive remuneration packages 

can be tailored to the right person and we can 

also offer you many opportunities for continuing 

professional development through financially 

supported industry training, conferences, peerlearning 

communities and product training. 

If you are a passionate professional, who is eager 

to build loyal and trusting relationships, this is the 

opportunity for you! You can look to take on a fixed 

period role or even consider a more permanent move. 

CONTACT: BRENDAN PHILP 

brendan.philp@luxottica.com.au or call 0418 845 197 

LEARN MORE OPSM.COM.AU/CAREERS 

Contact Stuart Allan on 03 546 6996 or 027 436 9091 

stu@opticsnz.co.nz www.opticsnz.co.nz 

Locum Service • Recruitment Services 

Practice Brokering • Business Consultants 

21_OPSM_QLD_Generic_MiVision_102.5x142._July18.indd 1 

15/8/18 4:52 pm

21_OPSM_Classified_NZOptics_102.5x142mm.indd 1 

15/8/18 12:44 pm 

OPTOMETRIST 

Invercargill 

SEEKING AMAZING OPTOMETRISTS 

Cambridge / Tokoroa / TeAwamutu / Waiuku 

We’re on the hunt for passionate optometrists! Whether you are looking to 

relocate to the Waikato or Waiuku for that lifestyle change or just wanting 

to base yourself outside the Auckland madness, we can make it worth your 

while! 

What do you need to apply for these amazing roles? 

Experience 

1-2 years’ experience will be beneficial but not essential 

Skills and abilities 

Excellent talent to interact with people in a positive and courteous manner 

Strong written and verbal communication skills 

Dependable and punctual 

Sparkling and caring personality that can provide our patients the best 

experience possible 

The benefits 

Competitive salary - we’ll make it worth your while! 

Opportunities to specialise in your personal field of interest 

Being part of an amazing independent company in a fun and supportive 

environment 

Flexible working arrangements 

We are looking for a friendly and enthusiastic Optometrist to join our busy 

and growing optometry practice in Invercargill. This position would suit 

someone who is seeking: 

Excellent work-life balance 

With a short, five to 10-minute drive to work, and a nine to five, Monday 

to Thursday working week, you can enjoy more free time with family and 

friends. 

An opportunity to get ahead 

With an extremely competitive remuneration package and an average 

house price in Invercargill of only $260,000, this position represents a great 

opportunity. 

A great place to live 

Invercargill is only a few hour’s drive/ferry from some of New Zealand’s 

most beautiful destinations, including Queenstown, Milford Sound, 

Stewart Island and the Catlins. 

Professional development 

Our friendly and supportive team, with over 40 years of optometry 

experience, and over 35 years of combined dispensing experience, can 

help take your career to the next level. 

If this sound like the ideal role for you, please email your CV and cover 

letter to 7720store@opsm.co.nz 

Recommend your friend (or yourself) to send their brilliant cover letter 

and CV (indicating which practice you would like to work in) to Sandri 

Killian on sandri.killian@patersonburn.co.nz 

READY FOR A CHANGE? 

When you join OPSM, you work within 

a team who are committed to providing 

the best possible eyecare solution with 

exceptional customer service. You will 

work with world class technology 

and have many opportunities for 

professional development. You can 

also make a real difference in the 

way people see the world by 

participating in our OneSight outreach 

program. OPSM New Zealand is looking 

for passionate Optometrists to join the 

team in these locations: 

– TAUPO 

– AUCKLAND 

– THAMES 

JOIN OUR TEAM 

If you are interested to find out more about 

joining the team, contact Jonathan Payne 

for a confidential chat. 

jonathan.payne@opsm.co.nz or 

call 021 195 3549 

OPSM.CO.NZ/CAREERS 

EXPERIENCED OPTOMETRISTS 

FULL-TIME AND PART-TIME 

Nelson Tasman / Top of the South 

Ever had the desire to move to Nelson, but finding the right role was always 

the challenge? Well, here is your chance. 

The Positions 

Nelson and Richmond Specsavers are looking to appoint a full-time 

experienced Optometrist and a part-time Optometrist. Both positions 

are available as soon as the right candidates are recruited, but ideally, the 

client would need the vacancies filled by 1 December 2018. Top salary 

levels can be expected for the right candidates. 

Both practices (Nelson and Richmond) have a positive team culture, superb 

equipment (OCT in both practices) and highly-experienced support staff. 

The Richmond practice has just been refitted, with a spacious 240m2 and 

four consulting rooms. Both practices operate on 25 to 30-minutes testing. 

There is also the long-term opportunity to consider becoming a partner in 

the businesses and the risk/reward potential here is one of the most secure 

we have been involved with for a long time. 

The Location 

The Nelson region is blessed with a some of the country’s highest sunshine 

hours, with mild winters and warm summers and easy access to multiple 

national parks. The locale is also known for its wines, fruit, hops, and 

vibrant art and cafe culture. Nelson provides a slower pace of life and a 

lower cost of living. Everything is within easy access; there are seldom any 

traffic issues. The region also benefits from having nationally recognised 

education options, excellent healthcare professionals and the countries 

fourth busiest airport ensures you will remain well connected to the 

balance of the country. 

Next Steps 

To apply you must be eligible to work in New Zealand and have a current 

annual practising certificate. If you do not meet these criteria, please do 

not apply. 

Applications close at 5pm Thursday 25 October 2018. 

Please send your CV and cover letter outlining your skills and experience 

to: Stuart Allan at OpticsNZ, PO Box 1300, Nelson T: (03) 5466 996, 

M: (027) 436 9091, E: stu@opticsnz.co.nz 


Chalkeyes presents... 

Slack Times 

By David Slack 

Not drowning, waving at sharks 

PEOPLE COME FROM all over to see the 

biggest tourist attraction in Auckland. Paris has 

a tower, San Francisco has a bridge, Auckland 

has an old sewage tank. Down under the ground 

you go, and for 30, 40 dollars you get to take a 

good old look around. Of course, it’s a bit more 

than a sewage tank. It has penguins. It has a gift 

shop. It has a perspex tunnel that makes it feel 

like you’re under the sea. And, it has sharks. 

People love Kelly Tarlton’s. I couldn’t count 

how many times we took our daughter and 

she stood patiently in line for an hour or more. 

Much more patiently than me. Years later, she 

told me the look I sometimes get is, “your Kelly 

Tarlton’s queue face.” 

But what a great object lesson. With a bit of 

imagination you can go so very far. I want to 

go from one side of the harbour to the other. 

My great dream of nearly 20 years now is an 

underwater tunnel between the picturesque 

seaside village of Devonport and the city. An 

under-harbour tunnel connecting us to the 

bottom of Queen Street, with one of those 

travellator things you get in big international 

airports. And all under a perspex cover, like 

Kelly Tarlton’s. 

acceleration from breaking people. The same 

in reverse at the other end... could you create 

an artificial tail wind to help negate the air 

resistance?” 

It turned out that very question was already 

being tackled elsewhere. In France - where 

they call it a trottoir - I found they had one at 

a station interchange inside the Paris metro. 

It was 180 metres long and accelerating up to 

11 km/hr. Hell, that’s nothing, I thought. We’re 

bungee jumpers here. I’d say we’re good for 

hanging on at 30km/hr, no worries! 

Another said: “Maybe you should get Kelly 

Tarlton’s in on the action and make the tunnel 

perspex. You’d probably want to clean up the 

You wrap the tunnel in another layer of perspex, 

and you fill that up with warm water and fill it up 

with beautiful tropical fish. A beautiful Samoan 

reef here in our chilly waters. 

that murky water?” And then I thought: no 

worries. You wrap the tunnel in another layer of 

perspex, and you fill that up with warm water 

and fill it up with beautiful tropical fish. A 

beautiful Samoan reef here in our chilly waters. 

Imagine it. You just stroll whenever you 

like from one side to the other. You get to the 

bottom of Queen St, you just keep on rolling, 

to Devonport. No need for a multi-billiondollar 

harbour crossing, just a beautiful tourist 

attraction to stroll across or glide through on 

your e-bike. My liberal-minded friends also like 

the idea that if the coming referendum takes us 

in the direction of legalised weed, well, people 

will be down there in the perspex with the 

tropical fish all day long, my dudes. 

You may say I’m a dreamer, but I’m not the 

only one who’s watched The Castle. The story of 

life is the way we can climb down into a sewage 

tank, take a look around and say: “Okay, here’s 

what we can do. Who’s got a tape measure? Who 

knows about sharks? And do we know anybody 

who makes perspex?” 

Just imagine! 

I have been banging on about this idea 

forever. I enthused about it to the mayor of 

Auckland. His eyes glazed over. I proposed it in 

a debate with our Prime Minister. She didn’t say 

no, reader, she didn’t say no. I live in hope. 

And, I offer this as a little object lesson 

in how a rough little nub of an idea can turn 

into something more through the magic of 

collaboration. As soon as I first wrote about it 

(at this point all I imagined was an underwater 

travellator in a tunnel) people were helpfully 

suggesting how to make it better. 

“I can’t help but wonder how fast you 

could make a travellator that long,” one 

said. “Obviously you’d need several abutting 

travellators of graduating speeds to keep the 

scum that is our harbour and you’d need some 

clever robot thingy to keep it clean, but wouldn’t 

it be cool to have the harbour as a sightseeing 

attraction?” 

This was the genius moment for me. Ever 

since, I have believed in the power of perspex. 

That particular responder also said: “Of course 

you’d want to make the harbour a marine 

reserve to get the fish back but seriously how 

many people do you know who are silly enough 

to eat fish caught in the inner harbour?” 

Years went on. I wrote about it; I talked on 

the radio about it; I bored New Zealand about 

it. “We love it,” said a few people. “Have another 

drink” said others. Various people said to me: 

“Well okay, but how will you see anything in 

David Slack is an author, 

radio and TV commentator and 

speechwriter. He established 

the website speeches.com, and 

has published several books 

including ‘Bullshit, Backlash 

and Bleeding Hearts’, exploring 

Treaty of Waitangi issues, and 

‘Bullrush’, a social history of the 

popular children’s game. 


2018 • Voted by Australians • 2018 

2018 • Voted by New Zealanders • 2018 

Voted by New Zealanders 

HERE TO HELP 

LOOKING FOR WORK? LOOK NO FURTHER. 

Are you an optometrist looking to advance to the next stage of your career? We’ve got good news for you. 

Specsavers Recruitment Services (SRS) is a team of professional recruitment specialists dedicated to placing 

talented and passionate optometrists from all stages of their careers into desired employment. 

With strong relationships with all Specsavers optometry business partners and a 

comprehensive understanding of the two markets we operate in, we’re the perfect 

solution to help you take the next step in your optometry journey. 

Our locally based consultants are readily available to answer any questions you have. 

We can assist with: 

• A dedicated consultant who will tailor their service to support your needs 

• Employment opportunities in our 52-strong store network across varying 

levels – locum, permanent, fixed-term contract, full-time and part-time 

• Guidance and support in helping you become a self-employed locum 

• Management of locum diaries (work as little or as much as you like) 

and travel bookings 

• Advice on market-rate salaries and assistance in negotiating the right 

salary for you 

• Guidance on the right store for you in your preferred area/s 

• The most up-to-date live locum and permanent vacancies across New Zealand 

(sent out twice a week) 

• Special offers and bonuses including referring a friend (up to $16K) and VIP 

packages to industry events 

• Exclusive FIFO / DIDO employment opportunities managed entirely by 

SRS – you could earn up to $150,000! 

Looking for a sea change? We can also help you relocate between Australia 

and New Zealand. 

We are a free service backed by experts who are experienced at getting our network 

of partners and optometrists the best possible outcomes. 

So – what are you waiting for? Get in touch today and find out more. 

For a confidential chat about the various opportunities we have available, 

contact Chris Rickard on 027 579 5499 or email chris.rickard@specsavers.com 

VIEW ALL THE OPPORTUNITIES AVAILABLE ON SPECTRUM-ANZ.COM 

Reader’s 

Digest 


Award 

Reader’s 

Digest 


Award 

AITD 

Reader’s Digest 


Award 

2017 

Best 

Wellbeing 

Project 


Best Customer 

Service in AU 

Optometry 


Best Customer 

Service in NZ 

Optometry 


Best Talent 

Development 

Program 

2017 

Best Talent 

Development 

Program 

2017 

Best Customer 

Service in NZ 

Optometry 

2017 

Millward Brown 

Research 

No.1 for eye tests 

2016 

Excellence in 

Marketing 

Award 

2016 

Retail 

Store Design 

Award 

2016 

Transforming eye health

LAUNCHING 

LATE 2018

Sep 2018

Transform your PDFs into Flipbooks and boost your revenue!

Delete template?

Save as template ?