July 2020

JULY 2020
NEW ZEALAND
Vaping and
eyes
Understanding
Charles Bonnet
Poor pandemic
promotion
Page 24
Page 28
Page 34
THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY
PO Box 106 954, Auckland City 1143
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Caring
for for our
communities
Since restrictions have eased towards routine eye care
following the lockdown period we - like many in the
optometry profession - are now making careful inroads
into a significant patient backlog.
To find out how we are providing optometry and
dispensing care to our local communities - and to keep up
to date with some emerging employment opportunities -
go to spectrum-anz.com

Inside
4 ​EDITORIAL
NEWS
6 Celebrating excellence despite Covid
8 Shock and emotion: a parental perspective
15 Review cuts DHB numbers
20 The beautiful and the curious
22 New device for retinal fixes
33 Optom wins photo comp.
12
FEATURES
12 The post-Covid shopping street
24 When smoke gets in your eyes
BUSINESS
32 Post-Covid – our new normal
34 When marketing and a crisis don’t mix
34
16
EDUCATION
16 Primary retinal telangiectasia
28 Understanding CBS
30 Residual refractive error
25
RESEARCH
10 Worrying results from WTS study
26 Cornea research update
38 ​CHALKEYES PRESENTS:
​ Read all about it
37 CLASSIFIEDS
20 36
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
For all advertising/marketing enquiries, please contact Lesley Springall at lesley@nzoptics.co.nz in the first instance, or Susanne Bradley at susanne@nzoptics.co.nz or +64 27 545 4357
To submit artwork or to query a graphic, please email susanne@nzoptics.co.nz
NZ Optics 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 2015 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.
WWW.EYEONOPTICS.CO.NZ | 3

Embracing uncertainty
It was Winston Churchill who said,
“Without a measureless and perpetual
uncertainty, the drama of human
life would be destroyed.” Well, life is
certainly interesting at the moment
but, like most business owners, I’d
probably settle for a little less drama
and a little more certainty.
If the recent drama involving the
two women from the UK who drove
to Wellington to see a dying relative,
resulting in a litany of isolation
breaches, teaches us anything, it’s
that nothing is certain. But, as all
the experts tell us, it’s also from
uncertainty, especially in tough times,
that we learn to adapt, to change,
leading to better products and ways
of doing business.
One change we’ve introduced is our newly redesigned, now A4
magazine. We hadn’t planned the change; it was made in response to NZ
Post’s decision to alter its processes as it attempts to improve efficiencies
in the pandemic’s wake. We hope you like it. We think it’s a good change
that has other benefits too, for us, for our advertisers and for you, we
hope, as we will now fit better into your bags and your hand.
This is also the last month we’ll be providing the magazine free online as
soon as it’s published, returning to our pre-pandemic subscription model,
which we paused for three months to help us all get through. Without
planning, David Slack discusses the plight of the media in this month’s
The only certainty is that
nothing is certain,
Pliny the elder
Experiencing the emotional ups and downs of uncertainty isn’t always a bad thing
Chalkeyes presents (p38) and puts into
words something we espouse, “…
publications that speak to our interests
and values, that cares about our
community of interest, about you, are
something to prize.” Thus, this month’s
magazine, together with all the news
and clinical learnings, continues to
provide what we hope is a plethora of
useful advice to support you and your
businesses during these uncertain times.
As David Pearson, our long-term
financial commentator, writes in
his Focus on Business column (p32)
getting through successfully isn’t
about making big leaps, “…it’s about
incremental change: take a small step,
reflect, learn, adjust and take another
small step.”
The last several weeks have been a bit of a roller coaster ride
emotionally, and probably continues to be for many of us, but as Siu-
Yin Shing says in this month’s Style Eyes (p34), developing a resilient,
successful business is based on creating a positive, lasting impression
among your target audience. Hopefully,
that’s something we’re achieving. We
welcome your feedback.
All the best,
Lesley Springall, publisher
and editor of NZ Optics
Thorndon Eye Clinic
Consultations Diagnostics Surgical Suite
OPTHALMOLOGY SERVICES ON THE KAPITI COAST
As one of the leading ophthalmology practices in Lower North Island, the
doctors at Thorndon Eye Clinic are pleased to offer clinical consultation,
ophthalmic diagnostics and intravitreal Avastin treatment to patients in
the Kapiti Coast area at the Boulcott Specialist Centre at Coastlands.
Please contact the team of Thorndon Eye Clinic for appointments with
Dr Nina Ashraff, Dr Neil Avery, Dr Kenneth Chan and Dr Steve Mackey
in the Kapiti Coast area.
info@thorndoneye.co.nz • Tel: 04 499 4940
CONTRIBUTORS
Rebecca Findlay
Sharing her work into the limitations of the B4 School
Check when it comes to our kids’ visual acuity (p10),
Auckland University researcher Rebecca Findlay
says she’s always been interested in science, and
optometry was a great way to combine science with
working with people. “I love that in my job and in my
research, I have the opportunity to make a difference in
kids’ lives in a very meaningful way by improving not only their vision but
their potential to learn in the school environment.” When not working,
she says she particularly enjoys spending time with her family, travelling
(pandemics allowing) and getting creative with craft activities.
Tracey Ellin
Behind the scenes, beavering away to make your
NZ Optics magazine look as beautiful as it does, is
our own Tracey Ellin, who this month gets a special
‘contributor’ mention for redesigning our magazine,
at short notice, to a standard A4 format. This is the
second time Tracey has redesigned the magazine
as she was also responsible for changing our old, A3
newspaper format into our much lauded (thank you!)
more reader-friendly, magazine-style publication in mid-2018.
Tracey is a former nurse who retrained as a graphic designer after her
children started school. From the get-go she loved the process of making
a magazine and being part of a small team, she says. Having worked for
several interior and lifestyle magazines, she’s also expanded her design
knowhow by completing Unitec’s interior design programme and working
part-time for Auckland design store, The Ivy House. In her spare time,
she’s kept busy upskilling her photography and video knowledge, making
things, walking the dog, spending time with family and taking the odd
adult ballet class. For rest, she says she loves a good film or book and
reading magazines, preferably printed ones!
4 | NEW ZEALAND OPTICS JULY 2020

Seeing more
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NEWS
Celebrating excellence despite Covid
By Lesley Springall
THE MUCH-ANTICIPATED
Excellence in Ophthalmology
and Vision Research Prize
Evening may have been
knocked back by the Covid-19
pandemic, but the 2020
awardees are still being
recognised and will be invited
to receive their awards at a
special, celebratory event later
this year.
Professor Charles
McGhee, chair and head
of ophthalmology at the
University of Auckland, said
it’s been two years of upset for
the awards unfortunately, with
last year’s 20-year anniversary
celebrations cancelled
following the Christchurch terror attack. The
awards still went ahead, but were a sombre
event given the effect of the attacks on many at
the university.
But now a new event is being planned,
“hopefully” in September, said Prof McGhee,
to truly celebrate the excellence awards 23rd
anniversary and the growth and success of the
expanded department as it notches up its 21st.
It will also celebrate all past award winners,
including this year’s, he said. “We never
envisaged the Department of Ophthalmology
would grow so rapidly, nor the number of truly
outstanding undergraduate and postgraduate
research students that would pass through
our hands, but this now numbers more than
100, many of whom are now in national and
international leadership roles.”
Prof McGhee congratulated this year’s award
winners who have all been notified. They were
all very worthy recipients whose work and
commitment to ophthalmology continues
the strong legacy of the awards and the
department, he said. “Year-on-year, the standard
of our students increases exponentially and
this year, many exhibit outstanding academic
credentials alongside impressive sporting, music
and other achievements. Indeed, it makes me
glad I am not competing for a career as a young
doctor in 2020 as I might struggle in such an
exemplary epoch!”
The Calvin Ring Prize – Shin Jee Tang
The Calvin Ring Prize is awarded to the best
all-round undergraduate medical student in
clinical ophthalmology.
This year’s award winner, Shin Jee Tang, is
a final-year trainee intern at Waikato Hospital.
She hopes to pursue a career in ophthalmology
as it offers a good mix of both medicine and
surgery, she said. “Winning the Calvin Ring Prize
meant a lot to me as my effort, enthusiasm and
passion in ophthalmology were recognised and
Excellence in Ophthalmology 2020 awardees, Shin Jee Tang, Sunny Sixiao Li and Keli Matheos
acknowledged. It further fortifies my love for
this specialty and hopefully serves as a good
steppingstone when I apply to join the training
programme.”
The William MacKenzie Medal –
Sunny Sixiao Li
Recognising the significant contribution made
by a medical student or trainee intern towards
a published research project, the William
MacKenzie Medal was awarded to second-year,
Auckland-based house officer Sunny Sixiao Li.
Li’s research focused on corneal wound
healing following cataract surgery, which
resulted in a number of published studies.
These included the validation of questionnaires
for prioritisation of elective cataract surgery
in New Zealand (The New Zealand Medical
Journal); corneal biomechanical changes
following cataract surgery (Clinical and
Experimental Ophthalmology); and prediction
of pseudophakic refractive error (Journal of
Cataract and Refractive Surgery).
Li said she was both honoured and humbled
to join the illustrious list of past recipients of
the Medal. “This would not have been possible
without my supervisors, Dr James McKelvie
and Dr Stuti Misra, who have encouraged and
supported me endlessly with their wealth of
experience and wisdom.” Also thanking Prof
McGhee and the ophthalmology department,
Li said she hopes to continue her work in eye
research for some time to come.
The Arthur Thomas Paterson
Scholarship – Dr Kaliopy Matheos
The 2020 Arthur Thomas Paterson Scholarship,
designed to assist with overseas postgraduate
training, was awarded to Dr Kaliopy Matheos.
Dr Matheos began her fellowship training
with the glaucoma team at the Greenlane
Clinical Centre in Auckland before using the
award to help her gain further experience as
the glaucoma and anterior segment fellow
at the University of Toronto in Canada. Her
focus there was primarily on the management
of complex glaucoma cases but included an
interesting foray into the surgical management
of ectopia lentis, she said.
Winning the award was a huge honour, said
Dr Matheos. “The scholarship meant I have
been able to achieve many of the goals I set out
to achieve when embarking on my fellowship
training.”
For a full list of the 2019-2020 Summer
Scholars, who would also have been honoured
at the March event, see: https://eyeonoptics.
co.nz/articles/archive/summer-scholarsymposium-2020/
Eyes reveal true age
BOSTON UNIVERSITY
MEDICAL researchers
have discovered a
specialised eye scanner
that accurately measures
spectroscopic signals
from proteins in the lens
can also detect and track A/Prof Lee Goldstein
biological aging.
Chronological age does not adequately
measure individual variation in the rate of
biological aging, said study lead, Associate
Professor Lee Goldstein. “The absence of
clinical tools and metrics to quantitatively
evaluate how each person is aging at
the molecular level represents a major
impediment to understanding aging and
maximising health throughout life. The lens
contains proteins that accumulate agingrelated
changes throughout life. Our eye
scanner can decode this record.”
The study was published in the Journal of
Gerontology: Biological Sciences.
6 | NEW ZEALAND OPTICS JULY 2020

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dry eye therapy
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NEWS
oDocs’ inaugural award winner
INNOVATIVE EYE CARE technology enterprise oDocs Eye Care has
awarded it’s first oDocs Project Grant Award to fifth year Otago medical
student Aqeeda Singh.
The new $5,000 award is designed to promote sight saving initiatives
and innovative research projects by medical students and residents, fellows
and researchers in the field of ophthalmology, said oDocs founder and
ophthalmology registrar Dr Sheng Chiong Hong.
Singh was chosen as the inaugural recipient of the new award given her
continuous achievement over the past year and the number of high-quality
research papers she’s published, he said. “Her tenacity and hard work in
ophthalmic science and research made her an outstanding candidate.”
Singh is using the grant to continue her work into creating guidelines
for acute ophthalmic conditions that present in primary care, creating a
protocol for non-eye specialists as part of a bigger teleophthalmology
project with oDocs’ sister company MedicMind. “This will help simplify
the management for clinicians hopefully,” she said. “The project is also
giving me a chance to satiate my eagerness to learn more about eyes!”
Singh said she’s keen to continue her journey in ophthalmology when
she graduates. “As a child, I used to say the eyes were my favourite body
part and it hasn’t really changed… However, almost every consultant has
advised us to remain flexible and keep our minds open!”
Thanking Dr Hong and her senior lecturer Dr Kelechi Ogbuehi, she said
she owes a great deal to their support and “encouraging nature” to have
got to where she is today. “I couldn’t have asked for better supervisors.”
The oDocs Project Grant Award will initially be awarded annually, but
the plan is to increase this, said Dr Hong. Award winners are selected
by Drs Hong, Ogbuehi and, oDocs co-founder, Ben O’Keeffe after being
Shock and emotion: a parental perspective
By Susanne Bradley
Aqeeda Singh and Dr Kelechi Ogbuehi
assessed on scientific merit, publication achievement and the strength of
the project idea.
oDocs offers PhD
Social enterprise eye care technology
companies, MedicMind and oDocs Eye Care,
have unveiled a new $90,000 PhD award.
The scholarship is being offered to a New
Zealand university PhD candidate in the field
of bioengineering, medical devices or deep learning. It covers $4,500
towards tuition fees and a $26,000 stipend per annum for three years.
To apply, please contact oDocs and MedicMind co-founder Dr Sheng
Chiong Hong at schong@odocs-tech.com.
A RECENT AUSTRALIAN survey
has found many parents are
shocked to learn their children
have vision problems and struggle
with a range of issues and
emotions at the time of diagnosis
and during treatment.
The Little Aussie Eyes Report
by Kids Eye Gear surveyed 450
Australian parents of children with
vision issues to provide insight
into their concerns, said Nicola
Rivett, Kids Eye Gear founder and
mother of a son who required
patching due to congenital
cataract and subsequent surgery.
“Noticing that your child has a
vision problem is not always easy.
Kids don’t know that what they see
isn’t ‘normal’. They learn to adapt to
what sight they have and parents
can be completely unaware there is
an underlying issue.”
Consequently, many parents
are shocked to find out their child
has a vision problem, she said,
describing feelings of guilt, being
overwhelmed and recalling the
diagnosis as a very emotional
experience. “I was actually very sad
and emotional,” one respondent
to the survey said while another
said they were “shocked, confused,
worried and overwhelmed”.
The majority of parents
surveyed had children who wear
prescription glasses (81%), with
70% diagnosed between the ages
of two and five. The three main
challenges parents identified with
kids and glasses were: keeping
glasses clean (62%); finding
frames that fit (43%); and finding
affordable glasses (41%).
Of those surveyed, 82% had
experience of patching, with one in
four of their children
prescribed at age
four and just over
half (53%) prescribed
between two and
five. The main reason
for patching was
amblyopia (60%).
By far the
Nicola Rivett
biggest challenge
with patching, identified by
parents, was getting the child
to actually wear the patch in the
first instance (65%), followed by
finding affordable patches (43%)
and patches that didn’t irritate
the child’s skin (30%), and fitting
in the required patch time in
their daily lives (30%). As many
as 58% of parents surveyed said
it was stressful having to patch
their child. Though many said
establishing a routine helped, with
51% preferring to patch in the
morning while providing close-up
activities for the child, such as
iPad/tablet, television, playing
with toys or doing crafts.
Commenting on the report,
Rivett said she has “huge” respect
for eye health professionals and
hoped the findings
will encourage
them to continue
advocating for early
vision screening and
providing exceptional
care.
“As the study
showed, many
parents experience
feelings of surprise, shock and
guilt when their young one is
diagnosed with a vision problem.
If eye care professionals can be
empathetic to these feelings and
equip parents with resources to
understand their child’s condition,
or at least point them in the
right direction for additional
information, this will help alleviate
any initial negative feelings or
fear about the diagnosis. I believe
this would create increased
positive outcomes for the child’s
vision and further strengthen the
practitioner/patient relationship.”
The Little Aussies Eye Report is freely
available at https://www.flipsnack.
com/KidsEyegear/little-aussie-eyesreport-2020.html
8 | NEW ZEALAND OPTICS JULY 2020

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RESEARCH
Worrying results from WTS study
By Rebecca Findlay
UNCORRECTED REFRACTIVE ERRORS
account for up to 96% of visual impairment
in school-aged children and are
associated with amblyopia and strabismus
development, and reduced performance
in early literacy tests, reading ability
and academic achievement. Amblyopia
treatment is most effective before seven
years of age, thus, it’s important to identify
children with amblyopia risk factors at a
young age.
Preschool children in New Zealand
receive a universal, free, well-child check,
the B4 School Check (B4SC), at four-yearsold
to identify behavioural, developmental
and other health concerns which could
negatively impact their ability to learn. The
B4SC has excellent coverage, with 96.7%
of eligible children and 94.5% of children
living in high deprivation communities in
the Auckland region, completing the check
in 2017. As part of the B4SC, children’s
visual acuity (VA) is screened using the Parr
vision chart, specifically to identify children
with amblyopia. Distance VA measurement
is more effective for myopia detection than
hyperopia and astigmatism. There are currently
no contemporary refractive error data for New
Zealand children and it’s unknown whether
ethnic differences exist, particularly for Māori
and Pacific children.
The study
The Welcome to School (WTS) study was
a multidisciplinary, collaborative study of
children from schools in the Manaiakalani
Community of Learning in Tāmaki: the
Auckland suburbs of Glen Innes, Point England
and Panmure.
The aims of the study were to determine
the prevalence of refractive error and visual
impairment in a cohort of six to seven-year-old
children and evaluate the efficacy of the B4SC
programme in the multicultural community of
Tāmaki, where the majority of children are of
Māori or Pacific ethnicities.
Coffee’s surgery impact
Children were recruited on school entry
and received a comprehensive health,
developmental and social assessment. These
same children and whānau were contacted by
the WTS research nurse approximately one year
later at six to seven years of age. 114 children
received a comprehensive cycloplegic vision
examination in their schools.
Results
Almost one third (31.6%) of participants had
significant refractive error, of which 80.6% was
astigmatism. Myopia prevalence was low (3.5%)
and seven participants (6.1%) had amblyopia
risk factors. The B4SC vision screening was
effective in detecting amblyopia, with no
child with amblyopia risk factors passing the
screening. Though a significant number of
children (11.4%) did not receive a B4SC vision
screening and a similar number (10.5%) were
identified for B4SC rescreening which had not
been completed. Both included children with
amblyopia risk factors.
The B4SC was ineffective, however, at
A JOINT US-BRAZILIAN study has shown coffee hinders the
performance of new vitreoretinal (VR) surgeons, while beta
blockers may improve it.
Published in Jama Ophthamology, the single-blind, cross-sectional
study assessed the effects of caffeine alone, a β-blocker (propranolol)
alone or a β-blocker and caffeine combination on the surgical
performance of 15 VR surgeons with less than two years surgical
experience.
Propranolol alone was associated with improved surgical
performance compared with caffeine alone and the combination of caffeine and propranolol,
suggesting caffeine negatively affects surgical performance. “These results may be helpful for
novice vitreoretinal surgeons to improve microsurgical performance,” said the authors.
detecting significant refractive error with
more than half the children with significant
refractive error passing. Only 13.9% of
children with significant refractive error
and 57.1% with amblyopia risk factors were
wearing glasses at the time of assessment.
Nearly 60% of children with significant
refractive error passed the screening and
none were wearing glasses, suggesting
children who passed were unlikely to have
had a comprehensive eye examination
which would have detected mild to
moderate uncorrected refractive error.
Consequently, many children in this cohort
started school with uncorrected refractive
errors potentially impacting their academic
performance.
Recommendations
There is currently a mismatch between the
aims of the vision screening programme,
which is targeted at detecting amblyopia,
and the overall B4SC which aims to detect
and intervene on issues which could adversely
impact educational outcomes, particularly for
socioeconomically disadvantaged Māori and
Pacific children. This mismatch, in combination
with the differential reach of the B4SC, is likely
to be increasing inequities.
This study suggests urgent attention is
required to review the B4SC vision screening
protocol to ensure it is appropriate and
equitable, so all children receive high quality
vision screening and eye care to improve
their health, educational and social outcomes.
Alternative screening strategies may be more
appropriate to detect refractive error. A review
of the Well Child Tamariki Ora programme
is currently underway and provides an
opportunity to re-examine the rationale for
preschool vision screening and follow-up
protocol. While eligible children can receive the
Enable subsidy for glasses, the process can be
difficult for families to navigate. Cost should
not be a barrier. Eye care services should be
available for all children. Culturally appropriate
coordination is necessary to ensure children
who are referred or identified for rescreening
receive follow up and are assisted in accessing
services.
Rebecca Findlay is a PhD
candidate with the School of
Optometry and Vision Science
at Auckland University and
a paediatric optometrist for
Counties Manukau Health.
Her work is supported by
SJ Taylor Grant, the NZ
Association of Optometrists
and a senior health research
scholarship. The WTS study was
also supported by Cure Kids
and the Joyce Fisher and A+
charitable trusts.
10 | NEW ZEALAND OPTICS JULY 2020

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The post-Covid
shopping street
By Jai Breitnauer
NEW ZEALAND HAS fared well globally in
the fight against Covid-19, but it has not been
without cost. It is only now the smoke is clearing
enough to see how the pandemic has affected
our main shopping thoroughfares and what
impact that may have on optometry practices.
Thankfully, the big picture is looking much
better than expected. With a fiscal stimulus
package amounting to $62.1bn mixed with
quantitative easing and a low interest rate,
we’ve seen commentators roll back on their
dire predictions. Indeed, figures from early
June show retail spending is down just 2% on
last year, with The Bank of New Zealand now
predicting GDP will return to pre-Covid levels
by mid-2022, rather than the fourth quarter
of 2023 as previously suggested. However,
a recent Euromonitor International report
suggests globally, real economic growth will be
at its lowest this year since 1961, so there’s no
room to be complacent.
Complacency is one path Andrew Judd
could not afford to take. The owner of New
Plymouth-based Judd Opticians said they used
their time in level 4 lockdown to evaluate their
business model.
“The week prior to lockdown we were
already starting to be impacted by Covid-19,
mostly in a reduction of forward appointments
and foot traffic,” Judd said. “Obviously, going
The need for
eyewear hasn’t gone
away. Use social
media to promote
your business in a
gentle way
into level 4 the impact was immediate. We
used the time to evaluate and plan what postlockdown
could look like. Fundamentally what
we do remains, but it’s how we now do it.”
Increased online power
Judd identified that for his business, one
key area of deficit was online, and with the
Euromonitor report suggesting e-commerce
retailers are one of the four types of retail
business that will fare best through this crisis,
that doesn’t seem like a bad place to start.
“We researched all available business
support and secured regional development
funding towards upgrading our online activity.
We also reached out to surrounding businesses
to jointly promote on social media,” said Judd,
adding the joint online promotion had an
immediate positive impact on his business.
Daniel Feldman, a founding member of
The Visionaries Group in the US and owner
of the Optical Journal podcast, said in a recent
instalment of his show that if businesses aren’t
advertising, he doesn’t know how they are
staying afloat.
“You Tube have stopped optimising their
videos to save on bandwidth, a recognition
of the amount of time people are spending
online,” he said. “The reach I am getting in
Google ads is three to four times what I was
getting in February. Everyone has stopped
12 | NEW ZEALAND OPTICS JULY 2020

FEATURE
advertising, so I am not competing for eyeballs
as I was before. The need for eyewear hasn’t
gone away. Use social media to promote your
business in a gentle way.”
New Zealand retail consultant Chris
Wilkinson agreed for reaching consumers
online sales and advertising activity is of
greater importance right now.
“There is likely to be less footfall as we
come out of this as consumer behaviour
changes with more ‘purposeful’ journeys, less
browsing and, consequentially, fewer impulse
sales opportunities. More transactions will
likely start online as people browse ranges
and availability but still, the majority will end
in store. This means that businesses need to
redouble efforts around their online profile
and user experience.”
Doubling efforts in-store
User experience in-store is another essential
area optometry businesses need to be working
on as things ramp up, continued Wilkinson.
“Trust, welcome and recognition will be
even more vital as we come out of the Covid
environment. There is already trepidation
from consumers about medical environments,
so any situation which relies on one-on-one
interactions needs extra reassurance and
confidence.”
Lisa Donaldson of Retail X consultancy
said business owners should plan out their
physical stores in line with social distancing
measures, but with user experience at the
forefront of their
mind.*
“Walk your
store as a shopper
would to assess
how your current
environment meets
the recommended
health
requirements.
What can you do
to improve the flow
of shoppers in your
space?”
Katrina Hammon: look at
local marketing
Donaldson
recommended
freeing up space
where you can,
especially in the ‘landing zone’ at the front
of your practice, by removing displays. “You
might have to adapt to trade with less product
on the floor. To support this, you may need
to reorganise storage space, replenish your
product displays more frequently or present
your product in new ways.
“Engage with shoppers through
How will shoppers’ habits change post-Covid?
meaningful, well-thought-out displays and
storytelling – not just loads of product on a
stand.”
Solicitor Katrina Hammon, a franchise
specialist and partner at Wynn Williams in
Christchurch, said she believes that franchise
opportunities may become more desirable in
this new post-Covid climate, offering greater
security to franchise holders.
“The larger, corporate-owned or franchised
networks have been ramping up their
digital marketing and pushing online sales.
Larger competitors will also be leveraging
relationships and special offers to gain more
market share and exploit additional channels
to market to these potential new patients.”
Hammon said it is a big decision, but
if you are now considering a franchise
opportunity, make sure you understand the
fees and exit payments, and complete your
own due diligence. Also look at what help the
franchisor can offer with rent on premises,
especially if you can’t trade.
Consider local marketing initiatives
For those flying solo, she also has good advice.
“[Smaller businesses should] look at local
marketing opportunities… local papers or
radio advertising… building partnerships
and relationships with aged-care facilities,
industry associations, business groups and
even larger businesses may be an option.
Given the diverse population in New Zealand,
it is also sound advice to consider if you could
better market to different ethnic groups. For
example, have advertisements translated for
The Indian News, Chinese Herald or Home
Voice Chinese Newspaper. Your employees
should take the time to understand crosscultural
communication and focus on the
experience being welcoming for all.”
Andrew Judd said
this post-Covid retail
landscape actually
presents some
good opportunities
for independent
optometrists given
their business model
is based on longstanding
patients and
building trust.
“These changing
times offer an
exciting opportunity Andrew Judd: consider
for private practice joint, online promotions
to re-establish the
narrative of our
profession. As a dispensing optician who
qualified with the skills of edging and fitting,
frame repairs and adjustments, I was called
upon over level 4 and level 3 to use those skills
to assist frontline workers. I mention this to
remind our profession that we have many
aspects to patient care. It is the practice that
builds long-term trust and service that will
remain and grow.”
*For more about practice design in this
new post-Covid environment, visit: https://
eyeonoptics.co.nz/articles/archive/what-lies-instore-a-new-practice-design-reality/
Jai Breitnauer is a
freelance journalist
and regular contributor
to NZ Optics.
WWW.EYEONOPTICS.CO.NZ | 13

SPONSORED FEATURE
MyHealth1st launches managed
advertising services
By 1st Group
THE COVID-19 PANDEMIC has, to put it mildly,
made things hard for businesses across New
Zealand. Even with lockdown restrictions being
eased and the world slowly returning to the
new normal, consumer confidence is low, so
making sure patients return to your practice
is vital, not only for the financial wellbeing of
your practice but for the eye health of your
patients as well.
Since 1stGroup launched MyHealth1st in
2012, it has been dedicated to one mission –
making it simple for patients to connect with
practices to get the healthcare they need in
a timely and effective manner. This mission
statement drives all our efforts, from how
we consistently improve our online booking
process to the launch and support of new
products and services. As such, expanding
into helping practices succeed through digital
advertising was a necessary step to ensure our
goal of connecting patients with the eye health
services they need.
At MyHealth1st, we understand the
challenges that come with running an
independent optometry practice because we
work with thousands of practices just like yours,
right around New Zealand and Australia. It’s
because of this understanding of the needs of
independent practices that we have developed
our managed advertising service.
So what exactly are we offering? We will
provide managed Google and social media
advertising campaigns for all practices, with
packages and offers being individually tailored
to meet the needs of single practices and
chains alike. Google advertising, an active
social media presence and well targeted social
Covid-19 breathalyser
media advertising on Facebook and Instagram
are of vital importance when it comes to
increasing the visibility of any practice.
An effectively managed Google advertising
plan can help you climb to the top of search
engine rankings, so you can reach more
patients at every stage of the booking funnel,
from patients researching symptoms to
making the decision, to actively booking
an appointment for an eye test, glasses or
contact lens fitting or other consult. Our
team has extensive experience planning,
OHIO STATE UNIVERSITY researchers are testing a new breathalyser that could act as a cheap,
quick and more patient-friendly test for Covid-19 compared with the current deep nasal swab.
The new project builds on primary investigator Professor Perena Gouma’s invention of a
hand-held breath monitor for the early detection of flu. The sensor detects nitric oxide and
volatile organic compounds from a person’s breath, which can indicate the onset of an infectious
disease. Testing for this has now been expanded to two other metabolites that can reveal if a
person is infected with Covid-19, even if they’re
asymptomatic, she said. “Exhaling once in the
breathalyser may help with earlier detection of
the onset of the disease, as well as monitoring
the severity of infection… allowing more timely
therapeutic intervention.”
If proved accurate, the breathalyser could become
a key diagnosis platform for a range of metabolic
diseases such as cancer, Alzheimer’s or diabetes,
by simply choosing the appropriate biomarker to
sample, said Prof Gouma adding it will also allow for
mass screening at airports or other gatherings.
Prof Perena Gouma with the prototype
implementing and managing successful and
cost-effective Google AdWords campaigns. We
want to drive new patients to optical practices
and a managed Google advertising service
allows practices to monitor and measure the
advertising spend and return on investment for
each campaign.
A social media presence is vital, but there’s
no point in putting money or effort into ads
if they’re not being seen by the right people
or the messaging is wrong. Managed social
media advertising can plan and roll out
campaigns across Facebook, Instagram and
LinkedIn and help practices reach the right
people in the right areas to help you achieve
your goals.
With a tailored Google and social media
marketing campaign, you will be able to
reach more patients in your area as well as
re-engage with existing patients that may have
been putting off visiting your practice due to
Covid-19 fears. With our tailored, managed
advertising services your messaging will be
unique to your practice, speaking directly
to your market, speeding your recovery
after this time of economic uncertainty
and differentiating your practice from your
competitors.
Find out more at myhealth1st.co.nz or by calling
0800 424 303.
14 | NEW ZEALAND OPTICS JULY 2020

NEWS
Vision therapy inspired by bats
EUROPEAN SCIENTISTS HAVE developed a new therapeutic approach
based on gene therapy, that could provide a new form of sight to
patients suffering from degenerative eye diseases such as macular
degeneration (MD) and retinitis pigmentosa (RP).
MD and RP are caused by the degeneration of photoreceptors.
Researchers from the Institute of Molecular and Clinical Ophthalmology
Basel and the German Leibniz Institute for Primate Research (DPZ)
successfully re-activated degenerated photoreceptors allowing animal
models to see infrared heat signatures without negatively affecting
remaining vision.
The team were inspired by bats and snakes which use infrared heat
signatures alongside typical vision to hunt prey. This enables bats and
snakes to superimpose thermal and visual images in the brain and thus
react to their environment with greater precision. To replicate this, the team
developed a three-component system. The first element was engineered
DNA, ensuring gene coding for the heat-sensitive channel is only expressed
in photoreceptors; the
second, a gold nanorod
that efficiently absorbs
near-infrared light; and
the third, an antibody
to bind the first two
together.
Trialling the system
on mice with retinal
degeneration, the
team confirmed nearinfrared
light effectively excited the photoreceptors and the signal was
transmitted to the higher visual centres in the brain. Encouraged by this,
co-author, Assistant Professor Arnold Szabo from Semmelweis University
in Hungary, tested the model on cultured human retinas, successfully
reactivating their visual circuitry. The study was published in Science.
Review cuts
DHB numbers
THE FINAL REPORT on the
government’s long-awaited Health
and Disability System Review
confirmed New Zealand’s health
services and workforce are under
considerable stress and the health
system is complex and fragmented.
Though our system is better than
many, the review sets out a path
towards a better, more sustainable
health system with clear lines of
accountability, said health minister
Dr David Clark. “One that is more
responsive to the needs of local
communities.”
Chaired by health economist
Heather Simpson, the review’s
recommendations include:
l Shifting to a greater focus on
population health
l Creating a new crown entity,
provisionally called Health NZ,
focused on operational delivery of
health and disability services and
financial performance
l Reducing the number of district
health boards from 20 to 8-12
within five years, and moving to
fully appointed boards
l Creating a Māori Health Authority
to advise on all aspects of Māori
Health policy
l Greater integration between
primary and community care and
hospital/specialist services
Cabinet has accepted the case for
reform and the direction outlined in
the review, said Dr Clark. The prime
minister will drive the changes,
supported by her finance and health
ministers.
https://systemreview.health.govt.nz/
final-report
WWW.EYEONOPTICS.CO.NZ | 15

EDUCATION
Primary retinal telangiectasia
By Dr Shanu Subbiah
PRIMARY OR CONGENITAL
retinal telangiectasia, more
commonly called Coats’ disease
or Coats’ syndrome, is a nonhereditary,
developmental, retinal
vascular disorder characterised
by dilatation and exudation of
the retinal vasculature, and an
important cause of leucocoria in
children.
Case report
A 13-year-old boy attended the
emergency eye clinic with a oneday
history of sudden onset loss
of superior field of vision affecting
his right eye. He had been
trampolining the previous day.
There was no history of trauma,
photopsia or floaters. He had no
past ocular history and was in
good general health. He was not
premature and had achieved all
developmental milestones.
On examination, visual acuity
was 6/24+1 right and 6/4 left.
He had a relative afferent pupil
defect in his right eye. He was
orthotropic on cover testing.
Anterior segment examination
was normal. Dilated fundal
examination of his right eye
revealed marked intraretinal
exudation with an inferior
non-rhegmatogenous retinal
detachment and multiple large
telangiectatic vessels with light
bulb-shaped aneurysms (Fig
1 and 2). The left retina was
normal. Indirect indentation
ophthalmoscopy of his right
retina did not reveal any
peripheral retinal tears. Ocular
ultrasound revealed no posterior
segment mass. A provisional
diagnosis of Coats’ disease was
made. Baseline bloods, including
autoimmune and infective panels,
were all normal. Both parents
underwent fundal examination
which was normal.
Considering the patient was
very cooperative, Argon focal
laser was carried out directly to
the telangiectatic vessels in the
right eye. The patient was seen
two weeks later for further focal
laser. A large degree of the exudate
had resorbed with a reduction in
the size of the detachment (Fig
3). Visual acuity had improved to
6/9-2. The patient had a further
final episode of focal laser three
weeks later. Visual acuity improved
and has been maintained at 6/6 in
this eye. Twelve months later the
macula remains flat with peripheral
subretinal fibrosis (Fig 4). There has
been no reoccurrence of subretinal
fluid or exudation.
History
In 1908, George Coats described
“exudative retinitis,” which
was best characterised as
vascular abnormalities with
massive subretinal exudation 1 .
Today, congenital or primary
telangiectasia goes by his name,
Coats’ disease. It consists of
dilated retinal capillaries, microand
macroaneurysms, ischemia,
nonperfusion and retinal vascular
leakage. It typically presents
unilaterally in males.
Four years later, Theodor Leber
described “miliary aneurysms 2 ,”
which were quite similar clinically
to the cases seen by Coats.
The term retinal telangiectasis
was coined by the paediatric
ophthalmologist Algernon Reese
in 1956. He suggested that
Coats’ disease and Lebers’ miliary
Fig 1. Exudative retinal detachment involving the macula
Fig 2. Classic light bulb-shaped telangiectasis
Fig 3. Right eye two weeks after first episode of laser
Fig 4. Right eye 12 months post treatment
16 | NEW ZEALAND OPTICS JULY 2020

Eye Institute Education Series
Post COVID-19
At Eye Institute, we have decided to bring a fresh change to our Education Series. Along with
the Eye Institute Annual Conference and Workshop in September, we plan to bring you some
more exciting education opportunities for 2020.
We will continue with our very popular small group virtual meetings every 6 weeks to keep you
updated on topics of interest to you. This will give you the chance to discuss issues/topics/
cases with one of our surgeons in a more personalised setting as well as keeping you abreast
of the latest techniques and advances in ophthalmology.
We plan to bring you online tutorials, as well as keeping you
entertained with our usual “in person” live conferences and events.
This is going to be a new way of working, which will
provide you with greater knowledge and varied skills.
We would also like to hear from you about ideas you may
have for virtual meetings and workshops.
Please email Jenny Springett at
professionaleducation@eyeinstitute.co.nz

EDUCATION
aneurysms were one and the
same, occurring either in child or
adulthood 3 .
In 1968, Donald Gass described
a new distinct entity which he
called idiopathic juxtafoveolar
retinal telangiectasis to
differentiate it from Coats’
disease. This resulted in a detailed
classification of all telangiectatic
diseases in 1993 4 .
By 2006, Lawrence Yannuzzi,
using new imaging systems such
as optical coherence tomography
(OCT) and high-speed stereo
angiography, simplified
telangiectasias classification
into two distinct types: Type I,
aneurysmal telangiectasia (Coats’
disease); and Type II, perifoveal
telangiectasia 5 . Now when we
refer to macula telangiectasia or
MacTel, we are often talking about
the common bilateral disease
(Type II) that we see in middleaged
patients.
Aetiology
Coats’ disease is a non-hereditary
ocular disease. The exact
underlying mechanism remains
unknown but a mutation of the
norrin disease protein (NDP) gene
has been proposed 6 , as this results
in a deficiency of the protein
norrin which regulates vascular
development in the developing
retina.
The pathophysiological
processes of Coats’ disease include
the breakdown of the blood-retina
barrier at the level of the vascular
endothelium, predominantly
affecting the capillaries but often
with focal arterial involvement.
Subsequent leakage leads to
aneurysm formation and vessel
blockage with exudation of blood,
lipid and fibrin into the intra
and subretinal spaces 7 . Vascular
endothelial growth factor (VEGF),
which plays an important role in
the formation of normal retinal
vessels and vascular permeability,
is also elevated 8 .
The end result is exudative
retinal detachment. Chronic
detachment can involve the
anterior segment secondarily and
lead to neovascular glaucoma and
blindness 9 .
Diagnosis
Coats’ disease (Type I, aneurysmal
Professional Education
Programme
Don’t forget to enrol
in the 2020 Programme!
• The online web-based Professional Education
l The online web-based Professional Education
Programme
Programme
is
is
approved
approved by
by
the
the
NZ
NZ
Optometrists
Optometrists
& & Dispensing Opticians Board CPD CPD Accreditation
Committee for a maximum of of 14 14 Clinical Diagnostic
(CD) (CD) Credits OR OR 14 14 Glaucoma Education(GE)
credits for for registered Glaucoma Prescribers.
l
•
The The programme consists of seven new cases each each
year year –– each with a case history, questions and and
answers for for self-directed learning, followed by an by an
associated associated web-based examination.
l
• Successfully passing a all case seven awards cases the awards maximum the
of
maximum
2 CD credits
of 14
or
CD
2
credits
GE credits.
or 14 GE credits.
For more information please email info@glaucoma.
org.nz or visit www.glaucoma.org.nz
Stage Clinical findings Vision

NEWS
Eye tracking for MS?
References
1. Coats G. Forms of retinal disease with massive
exudation. R Lond Ophthalmic Hosp Rep
1907-1908;17:440-525
2. Leber T. Ueber Vorkommen durch eine
Form von multipler Miliaraneurysmen
charakterisierte Retinaldegeneration. F Arch
Ophthalmol. 1912;81:1–14
3. Reese AB. Telangiectasis of the retina and
Coats’ disease. AM J Ophthalmol 1956;42:1-8
4. Gass BDM, Blodi BA. Idiopathic juxtafoveolar
retinal telangiectasis; update of classification
and follow-up study. Ophthalmology
1993;100:1536-46
5. Yannuzzi LA, et al. Idiopathic Macular
Telangiectasia. Arch Ophthalmol.
2006;124:450-460
6. Black GC et al. Coats’ Disease of the
Retina Caused by Somatic Mutation
in the NDP Gene: A Role for Norrin in
Retinal Angiogenesis. Hum Mol Genet.
1999;8(11):2031-2035
7. Ghorbanian S et al. Diagnosis and Treatment
of Coats’ Disease: A Review of the Literature.
Ophthalmologica. 2012;227(4):175-182
8. Sigler EJ et al. Current Management of Coats
Disease. Surv Ophthalmol. 2014;59(1):30-46
9. Shields JA et al. Classification and
Management of Coats Disease: The
2000 Proctor Lecture Am J Ophthalmol.
2001;131(5):572-583
10. Villegas VM et al. Advanced Coats’ Disease
Treated With Intravitreal Bevacizumab
Combined With Laser Vascular Ablation. Clin
Ophthalmol. 2014;8:973-976
11. Morris B et al. A Population-Based Study
of Coats Disease in the United Kingdom
I: Epidemiology and Clinical Features at
Diagnosis. Eye. 2010;24(12):1797-1801
NEUROTECH AND ARTIFICIAL
intelligence start-up C Light has
developed a non-invasive, fast
and objective retinal eye-tracking
technology to help doctors
quickly and more accurately
diagnose neurological conditions,
such as multiple sclerosis (MS).
Based at the University
of California Berkeley’s tech
incubator, the company was
formed around a tracking
scanning laser ophthalmoscope
(TSLO) developed by C Light cofounder
Dr Christy Sheehy. The
TSLO technology measures the
motion of the eye on a cellular
scale; movements as small as
1/100 the size of human hair.
“The back of your eye is actually
the front of your brain. We use
AI paired with eye tracking to
create a digital fingerprint of
your neurological health with
unprecedented speed and
sensitivity,” said co-founder Dr
Zachary Helft. “Other technologies
use the pupil to track eye motion,
Dr Zachary Helft
but our technique images
the retina for 120 times more
sensitivity… C Light measures eye
motion that has been otherwise
invisible through existing pupil
tracking technologies.”
In this era of digital health, C
Light is creating a completely new
data stream about the status of
brain health via the eye, said Dr
Sheehy. “Our growing databases
and accompanying AI can change
the way we monitor and treat all
neurological diseases for future
generations.”
Patients can be tested in
10 seconds, are free to blink
and don’t require eye drops or
dilation, said Dr Sheehy. Though
testing has begun with MS,
future applications can extend
to Alzheimer’s, Parkinson’s,
Amyotrophic lateral sclerosis (ALS)
and concussions, she added.
WWW.EYEONOPTICS.CO.NZ | 19

NEWS
Art and optics:
The beautiful and the curious
By Susanne Bradley
In the artist’s self-portrait as Saint Lucy, patron of sight, the eyes on a plate
have been replaced with the medication that cured da Silva from acute
diplopia
(Left) da Silva’s glass eyes were inspired by the museum’s diseased eye
models. The double pupil represents her experience of double vision
THE BRITISH OPTICAL
Association Museum’s
latest exhibition,
Pathos Ocularis – The
Beautiful and the
Curious, was inspired
by artist Iluá Hauck da
Silva’s own experience
of dry eye, diplopia
and photophobia.
Brazilian-born da
Silva, the museum’s
third artist-inresidence,
is an artist
and glassmaker
who specialises
in anatomical
and pathological
symbolism. Drawing
inspiration from her
personal experiences,
the museum’s
collections and from
Iluá Hauck da Silva
medical, scientific and
historical research
conducted in the College of Optometrists’ library, da Silva’s exhibition
creates a modern-day ‘cabinet of curiosities’ dedicated to eyes.
Her residency at the museum resulted when a collector friend
commissioned an eye sculpture, she said. “I thought I’d go to the British
Optical Association Museum, which I had been meaning to visit for
quite some time, to look at eye models and get inspired. My friend and I
booked an appointment with curator Neil Handley and during our visit…
Neil asked to see my work and immediately asked me if I wanted to
exhibit there, which I was delighted about!”
Conceptually, da Silva said her art focuses on the human condition
with body parts and internal organs featuring heavily in her work.
“Growing up in Brazil as the daughter of a doctor, I spent countless time
in hospitals and practices… I have always had an interest in the depiction
of medicine,” she said in the podcast, Through the eyes of an artist.
Developing work about ocular pathology felt particularly pertinent,
said da Silva, as she developed sixth nerve palsy and acute diplopia in
2015, after contracting a severe ear infection which spread. Her residency
and this exhibition offered da Silva an opportunity to creatively explore
eye dryness and photophobia, conditions she still suffers as a result of her
illness. “Creating art that raises awareness of (these conditions), as well
as how to prevent and soothe their symptoms, is not only relevant, but
important to the general public.”
Although the exhibition is a story of recovery, da Silva wanted to
include the word ‘pathos’ in the title as in many cultures it “evokes
suffering and pain, thus prompting empathy and compassion in the
viewer for the sufferer,” she said.
The British Optical Association Museum at the College of Optometrists
in London was founded in 1901. It is the oldest optical museum in the
world with a collection of more than 28,000 items. The Pathos Ocularis
exhibition has been extended due to Covid-19 and will be available to
visit by appointment for a minimum of six weeks once current restrictions
have been lifted in the UK.
da Silva’s recreation of a gritty surface representing what it’s like to experience an
uncomfortable or painful eye condition
20 | NEW ZEALAND OPTICS JULY 2020

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NEWS
Amblyopia screening tool
The Blinq in action.
Credit: Dr Andrew Schuman
For more personalised
eye care, talk to
Eye Surgery
SERVICES INCLUDE:
• Cataract surgery specialists
• Glaucoma
• Medical & Surgical Retina
• Acute & General Ophthalmology
Clinics on the North Shore, Central and South Auckland
Dr Hussain Patel
Ophthalmologist
MBChB, MD, FRANZCO
Phone 0800 750 750 or Fax 09 282 4148
admin@eyesurgeryassociates.co.nz
www.eyesurgeryassociates.co.nz
Healthlink # ESA4EYES or Via Oculo
Eye Surgery Associates are a
Southern Cross Health Society Affiliated Provider
US MEDICAL START-UP Rebion has
developed a handheld paediatric vision
scanner to help clinicians screen for
amblyopia.
The Blinq scanner can detect even
subtle strabismus, said inventor Dr David
Hunter, head of ophthalmology at Boston
Children’s Hospital and co-founder of
Rebion. “It can help facilitate earlier
identification of children who need visionsaving
treatment when therapy is likely to
be more effective and reduce unnecessary
referrals to ophthalmologists.”
Dr Hunter and co-inventor Dr
David Guyton, professor of paediatric
ophthalmology at Johns Hopkins Hospital, said eye charts work well for
six-to-seven-year-olds and some five-year-olds but detect amblyopia too
late to fully treat. “Though photo screeners help identify more children at
risk of amblyopia, their accuracy is limited by low detection of strabismus
and high false positive rates,” said Dr Hunter.
Using a polarised laser scan to probe the nerve fibres inside the retina,
Blinq can detect a 1° misalignment between foveas, a sign amblyopia is
present, he explained. “When detected with precision, misalignment of
the foveas identifies essentially 100% of children who have amblyopia,
with fewer false positives compared with photo screeners.” The scanner
also calculates a binocularity score indicating whether a child requires
referral to an ophthalmologist for further investigation.
Two separate studies supporting Blinq’s effectiveness were presented
at the American Academy of Ophthalmology. One, including 80 children,
found Blinq offered 100% accuracy and a false referral rate of just 3%.
Dr Monika Pradhan
Ophthalmologist
MS, DOMS, FCPS, MRCOphth
Appointments
Dr Joel Yap
Dr Joel Yap joins EI
Bradley Dale
Dr Joel Yap has joined Eye Institute.
After undertaking training and
research in New Zealand, he went
to Toronto to study retinal diseases
and vitreo-retinal surgery.
Dr Adam Watson said he is
delighted to have Dr Yap join the
team. “Joel is an excellent surgeon.
This, coupled with his passion
for research and commitment to
the highest level of patient care,
makes him a very valuable addition.
Already he has contributed to
Eye Institute’s education series
with his webinar presentation,
demonstrating his dexterous
surgical skills in managing diabetic
eye disease.”
When not working, Dr Yap likes
to spend time with his wife, Ploy, a
trained pastry chef, and two young
children, Elle and Ethan.
Dr Yap also consults at Eye
Doctors and Auckland and
Counties Manakau DHBs.
Hoya appoints Bradley Dale
Bradley Dale has joined Hoya Vision
as territory manager.
Dale’s optics career spans
14 years and three continents,
Prof Nitin Verma
including roles in London and
South Africa. In January 2018, his
family moved New Zealand, settling
in Wellington where Dale joined
OPSM as its Lambton Quay store
manager. “After gaining valuable
experience in retail, I decided it was
time to get back into the optical
wholesale environment,” he said.
Hoya NZ country manager Stuart
Whelan said he is very pleased
to welcome Dale. “Bradley has a
broad range of optical experience.
I look forward to introducing
him to all the practitioners in his
territory over the coming months.”
Outside of work, Dale said he’s
“mad” about fishing, “and what a
country to experience this in!”
RANZCO president
RANZCO has announced Professor
Nitin Verma will be the next
president, replacing Dr Heather
Mack when her term ends on 10
October. Prof Verma is a longstanding
RANZCO board member
and former vice president. He
currently chairs the RANZCO Future
of Ophthalmology Taskforce and
is director of the Macular Disease
Foundation of Australia.
New device for retinal fixes
US-BASED OPHTHALMIC device manufacturer BVI has launched
CryoTreq, a single-use, handheld cryo-surgery device it claims will
“revolutionise” retinal tear and detachment treatment.
Developed in partnership with Professor Stanislao Rizzo, a retinal
surgeon with the University of Florence, the CryoTreq functions
without external connections to other equipment, gas tanks or power
and does not require any service or maintenance, said BVI. “Within a
minute of opening the sterile blister I am ready to treat retinal tears or
detachment, whether I’m in my office or in the operating room,” said
Prof Stanislao.
CryoTreq enables a minimally invasive ab externo approach to
treat retinal tears and detachments, providing an alternative to laser
photocoagulation, especially for lesions located towards the anterior
of the eye, said BVI president Shervin Korangy. “CryoTreq
will be a game changer. It requires minimal time
for preparation, is easy and intuitive to use,
with a hand-controlled, single button
activation.”
22 | NEW ZEALAND OPTICS JULY 2020

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FEATURE
By Louise Wood
ELECTRONIC CIGARETTES
(E-CIGARETTES) or vaping devices heat
nicotine, flavours and other chemicals to create
a vapour the user inhales. Vaping has been
marketed as a substitute for tobacco cigarettes to
help smokers kick their addiction, but vaping’s
harmful effects are still largely unknown.
Nicotine is addictive¹ and is found in the
majority of e-cigarettes, potentially making
them as addictive as tobacco, leading the US
Food and Drug Administration to classify
them as “tobacco products”. More worryingly,
a 2019 study found 64% of e-cigarette users
in New Zealand were still smoking tobacco²,
compounding health risks.
Vapour vs tobacco?
The health implications of vaping are starting
to emerge in the literature. A paper published
last year in Respiratory Research, revealed
the bacterial persistence and inflammatory
potential in the lungs caused by e-cigarette
vapour is similar to that found in a tobacco
smoker³. Lead researcher Dr Deirdre Gilpin
said, “Bacteria have long been associated with
the development of lung diseases, such as
bronchitis and pneumonia, where smoking
plays a role. Our study is the first of its kind
which aimed to compare the effect of cigarette
smoke and e-cigarette vapour on key lung
bacteria. E-cigarettes are perceived as being
safer and we are really concerned about that.”
Nicotine in tobacco and e-cigarettes is
associated with cardiovascular risks and
activation of carcinogenic pathways, including
proliferation and angiogenesis, and can
predispose a person to inflammation, infection
and neoplastic disease¹ , ⁴. Studies have also
shown second-hand e-cigarette exposure leads
to the same nicotine blood levels as secondhand
cigarette smoke inhalation⁴. Plus, like
tobacco, e-cigarettes contain high levels of
formaldehyde and other carcinogens, such as
acetaldehyde⁴, and a 2015 study showed an
increase in bacterial virulence and decrease in
host defence with e-cigarettes when compared
with tobacco⁵.
Tobacco and the eye
We have long understood how smoking
tobacco can affect the integrity of the ocular
surface and contribute to the development
of macular degeneration and cataracts.
Chronic smoking has also been linked to
squamous metaplasia and loss of goblet cells
which makes it a significant risk factor in the
development of ocular surface disease⁶ , ⁷.
Smoking promotes molecular and
pathological changes in the body: vascular
inflammation, endothelial cell abnormality,
oxidative and toxic damage⁸. These changes can
lead to the development of macular degeneration
and choroidal neovascular membranes. An
increased prevalence of age-related cataracts
has also been associated with smoking⁹. Several
biological mechanisms have been put forward
for the likely cause including oxidative damage,
chemicals causing lens toxicity and opacity and
increased aldehyde levels in smokers’ blood
which modifies lens proteins.
Vaping and the eye
The effect of vaping on ocular health is still
widely unknown but literature is evolving.
Complaints of eye irritation by users and
bystanders when exposed to vaping aerosols
have been reported but there’s been few peerreviewed
studies. Formaldehyde is a biproduct
of combustion in tobacco and e-cigarettes
and the American National Cancer Institute
warned that when airborne, it can cause a
burning sensation and watering of the eyes.
Another known eye irritant, propylene glycol
is also one of the common base ingredients of
vape e-liquid. Exposure to it can cause ocular
and respiratory irritation 10 .
In the first study of its kind, published in
September 2019, Malaysian researchers looked
at ocular surface data from 21 vapour users
and compared it with 21 non-smokers¹¹. They
looked at the clinical features of the ocular
surface, tear breakup time, fluorescein breakup
time, surface staining, tear meniscus and
Schirmer test scores to evaluate ocular surface
health. Results revealed a significant reduction
in non-invasive tear breakup time, fluorescein
breakup time and tear meniscus height when
compared with non-smokers, while an increase
in vaping voltage increased tear film instability,
indicating vapour users experience moderateto-severe
symptomatic dry eye when compared
to healthy non-smokers.
There has been no specific research into
other ocular side effects of e-cigarettes though
a 2014 study found that nicotine can affect the
eye when ingested¹². In this study, patients
who chewed nicotine gum had significantly
thinner choroids than non-gum chewers,
possibly as a result of reduced ocular blood
flow from the vasoconstrictive properties of
nicotine. Thus, given the presence of nicotine
in most e-cigarettes, it is reasonable to assume
comparable side effects. Similarly, an increased
prevalence of age-related cataracts may be
connected to the toxic chemicals found in
e-cigarette vapour in much the same way
studies have found with tobacco use.
In conclusion
Vaping is becoming a popular craze, especially
among younger people. Vaping products have
been found to transiently reduce blood flow
and oxygen use in the body, and the eye has a
great demand for both. It may take decades to
categorically determine if it is a safer longterm
option than tobacco, but e-cigarette use
is rapidly increasing and preliminary research
shows close similarities between the two.
We should continue to counsel patients on
their lifestyle choices and how these may affect
their health with time. E-cigarettes may be
used as an alternative to tobacco to help with
smoking cessation but should be stopped as
soon as possible to mitigate long-term health
issues, including eye disease.
References
1. Mishra A, Chaturvedi P, Datta S, Sinukumar S, Joshi P, Garg
A. Harmful effects of nicotine. Indian J Med Paediatr Oncol.
2015;36(1):24‐31
2. Oakly A, & Martin G. (2019). Dual use of electronic cigarettes and
tobacco in New Zealand from a nationally representative sample.
Australian and New Zealand Journal of Public Health
3. Gilpin DF, McGown K, Gallagher K et al. Electronic cigarette vapour
increases virulence and inflammatory potential of respiratory
pathogens. Respir Res 20, 267 (2019)
4. Crotty Alexander LE, Vyas A, Schraufnagel DE, Malhotra A. Electronic
cigarettes: the new face of nicotine delivery and addiction. J Thorac Dis.
2015;7(8):E248–E251
5. Crotty Alexander LE, Hwang JH, Lyes M, et al. E-Cigarette Vapor
Decreases Antimicrobial Function of Macrophages, Neutrophils and
Airway Epithelial Cells. American Thoracic Society Journals, 2015
6. Agrawal N, Jharawal MK, Paharia N, Bansal K. Effect of Smoking on
Ocular Surface and Tear Film: A Clinico Pathological Study. Madridge
J Ophthalmol. 2018; 3(1): 39-42
7. Uchino, Y. et al. Impact of Cigarette Smoking on Tear Function and
Correlation between Conjunctival Goblet Cells and Tear MUC5AC
Concentration in Office Workers. Sci. Rep. 6, 27699 (2016)
8. Velilla S, García-Medina JJ, García-Layana A, et al. Smoking and agerelated
macular degeneration: review and update. J Ophthalmol. 2013
9. Ye J, He J, Wang C, Wu H, Shi X, Zhang H et al. Smoking and Risk
of Age-Related Cataract: A Meta-Analysis. Inv Ophth & Vis Sci. June
2012, Vol.53, 3885-3895
10. Grana R, Benowitz N, Glantz S. E-Cigarettes. A Scientific Review.
Originally published13 May 2014
11. Md Isa NA, Koh PY, Doraj P. The tear function in electronic cigarette
smokers. Optom Vis Sci. 2019 Sep;96(9):678-685
12. Zengin M, Cinar E, Kucukerdonmez C. The effect of nicotine on
choroidal thickness. Br J Ophthamol.l 2014;98:233–237
Louise Wood is a
therapeutically qualified
optometrist working at City
Eye Specialists in Auckland.
24 | NEW ZEALAND OPTICS JULY 2020

Vaping legalities in NZ
The Ministry of Health (MoH) ruled
the sale of nicotine-containing vaping
devices was legal in New Zealand in May
2018. Following criticism, the Smokefree
Environments and Regulated Products
(Vaping) Amendment Bill was put to
Parliament on 24 February 2020 to:
• Ban the sale of vaping products to under-18-year-olds
• Stop vaping or smokeless tobacco use in smokefree areas
• Prohibit advertising of vaping products
• Restrict the sale of flavoured vaping products and e-cigarettes
to R-18 specialty stores, and limit general retailers’ sales to three
flavours
• Introduce a product safety system, enabling the MoH to recall,
suspend and issue warnings about vaping products
“The Bill aims to strike the right balance between making sure
vaping is available for smokers who want to use it as a quit tool
for cigarettes while ensuring vaping products are not marketed or
sold to children and young people,” said associate health minister
Jenny Salesa.
But many are concerned restrictions don’t go far enough,
including some who profit from the industry. “Currently, it appears
that anyone will still be able to make a purchase from an overseas
website and have the product shipped to their door, which may
bypass age restrictions and quality controls,” said Paul Williamson
from Shosha, the country’s largest retailer of e-cigarettes.
The government has set a long-term goal of making New
Zealand essentially smokefree by 2025. Submissions on the Bill
closed at the end of April with the Health Select Committee
expected to report back this month.
WWW.EYEONOPTICS.CO.NZ | 25

FOCUS ON EYE RESEARCH
Dr Mo Ziaei,
series editor
Cornea research update
By Dr Verona Botha
CXL-assisted infection reduction: a
randomised clinical trial evaluating the
effect of adjuvant CXL on outcomes in
fungal keratitis
Prajna NV, Radhakrishnan N, Lalitha P, Austin
A, Ray KJ, Keenan JD, Porco TC, Lietman TM,
Rose-Nussbaumer J.
Ophthalmology 2020 Feb;127(2):159-166
Design: Randomised control trial of 403 patients
with smear-positive filamentous fungal keratitis.
Eyes were randomised to one of four treatment
arms: (1) topical natamycin 5% alone; (2) topical
natamycin 5% plus cross-linking (CXL); (3) topical
amphotericin B 0.15% alone; or (4) topical
amphotericin B 0.15% plus CXL.
Outcome: There was no difference in culture
positivity 24 hours after commencing treatment
between those randomised to amphotericin or
natamycin, regardless of whether they received
CXL. Those that received CXL had worse visual
acuity (VA) outcomes: best corrected VA was
0.22 logMAR (2.2 Snellen lines) worse at three
weeks and 0.32 logMAR (3.2 Snellen lines) worse
at three months. There was no difference in
infiltrate, scar size or adverse events between
the groups.
New RP therapy
SCIENTISTS HAVE DEVELOPED a new gene
therapy approach that could treat retinitis
pigmentosa (RP).
Genetics, virology and ophthalmology
researchers from Trinity College Dublin and
University College London (UCL) teamed up
to deliver a normal, functioning copy of the
RP2 gene, which provides instructions for
making a protein essential for normal vision,
into ‘mini retinas’, engineered from stem cells
and containing a defective form of the gene.
The mini retinas successfully took up the
functioning RP2 gene and produced the
essential protein resulting in significant
improvement, said PhD researcher Ciara
Shortall, co-author of the study published in
Stem Cell Reports.
“It is an important development that we
can now reproduce so many elements of
inherited disease using these mini retinas.
It makes it possible for us to study in
detail why people go blind and try to find
ways to prevent blindness,” said Professor
Michael Cheetham from UCL which led the
development of the mini retinas to road-test
the gene therapy.
Limitations: This study was performed in
India, where there is a high incidence of fungal
keratitis often associated with agricultural
exposure. The spectrum of organisms
responsible for fungal keratitis in New
Zealand and other developed countries may
be different and exhibit dissimilar response
patterns to treatment. As the study included
eyes with fungal keratitis due to multiple
filamentous organisms, only small numbers
of individual fungi were included making it
difficult to detect the presence of a benefit for
CXL for any particular organism.
Comment: Fungal keratitis remains a
challenging condition to manage. Despite the
recent interest in CXL as a treatment option in
microbial keratitis, this article suggests there
is no benefit in using adjuvant CXL in the
treatment of filamentous fungal keratitis and it
may result in worse visual outcomes.
Efficacy of amniotic membrane
transplantation for the treatment of corneal
ulcers
Schuerch K, Baeriswyl A, Frueh BE, Tappeiner C
Cornea 2020 Apr;39(4):479-483
Design: Retrospective analysis of 149
patients treated with amniotic membrane
transplantation (AMTX) for refractory corneal
ulcers. The underlying cause of the ulcers
were diverse, including herpetic, bacterial and
rheumatic disease, previous corneal surgery,
bullous keratopathy, limbal stem cell deficiency
and neurotrophic ulcers.
Outcome: The mean duration between ulcer
onset and AMTX was 42 ±46 days. However,
it occurred much earlier for cases following
chemical injury (mean 14 days) compared to
bacterial keratitis (mean 65 days). In 70% of
cases, a single AMTX was sufficient to achieve
epithelial closure: 21% within the first month,
40% within one to three months and 9% within
three to six months. Epithelial closure was also
achieved in 41% and 40% respectively of those
undergoing a second and third AMTX. The
highest epithelial closure rates were found in
neurotrophic, herpetic and bacterial ulcers (93%,
85% and 80% respectively). The lowest success
rates were found in ulcers after corneal surgery
or associated with rheumatic disease (52% and
57% respectively).
Limitations: This was a retrospective study
with no control group.
Comment: Amniotic membranes contain a high
concentration of fibroblast growth factors and
cytokines. It forms a mechanical barrier and
promotes epithelial recovery while suppressing
inflammation. It offers a valuable treatment
option to promote corneal epithelial healing
in refractory ulcers particularly neurotrophic,
herpetic and bacterial ulcers. Even if not initially
successful, a second or even third AMTX may
result in epithelial healing.
A case-control study of keratoconus risk
factors
Moran S, Gomez L, Zuber K, Gatinel D.
Cornea 2020 Jun;39(6):697-701
Design: Single centre, prospective case control
study evaluating 202 patients with keratoconus
and 355 controls. Patients were surveyed
regarding their ophthalmic and medical
histories and data regarding multiple variables
was gathered and analysed.
Outcome: After multivariate analysis, the
following factors showed significant results:
eye rubbing with knuckles or fingertips, history
of dry eye, male sex, night-time work, increased
screen time, prone and side sleep position were
all associated with keratoconus. Conversely,
sleeping supine was found to be a protective
factor. No link was found between a family
history of keratoconus and development of the
condition.
Limitations: Most of the data required for this
study was reliant on patients’ history which is
dependent on patient recollection and subject
to recall bias, and there was a relatively small
number of patients included.
Comment: The high prevalence of keratoconus
in New Zealand is well known. Despite great
improvements in diagnosis and management
in recent years, the underlying pathogenesis
is still a subject of debate. Eye rubbing has
long been implicated as an exogenous
environmental factor in the development of
keratoconus, however this study also implicates
other associations including sleep position,
night-time work and screen time. These
associations may merit further investigations
and may guide future advice to patients at risk.
Dr Verona Botha is a senior
ophthalmology registrar
at Waikato District Health
Board with a special interest
in cornea and oculoplastics.
26 | NEW ZEALAND OPTICS JULY 2020

In treatment-naïve patients...
START
STRONG
STAY
STRONG 1- 6
EYLEA is fully funded under Special Authority
and Restricted Criteria for Wet Age Related Macular
Degeneration and Diabetic Macular Oedema 7
References: 1. Eylea data sheet, November 7, 2019. 2. Schmidt-Erfurth, U. et al. (2014)
Intravitreal aflibercept injection for neovascular age-related macular degeneration. Ophthalmology.
121:193-201. 3. Brown, D.M. et al. (2015) Intravitreal Aflibercept for Diabetic Macular Edema - 100-Week Results
From the VISTA and VIVID Studies. Ophthalmology. 122(10):2044-52. 4. Ogura, Y. et al. (2014) Intravitreal Aflibercept for
Macular Edema Secondary to Central Retinal Vein Occlusion: 18-Month Results of the Phase 3 GALILEO Study. Am J Ophthalmol.
158:1032–1038. 5. Heier, J.S. et al. (2014) Intravitreal aflibercept injection for macular edema due to central retinal vein occlusion: Two-year results
from the COPERNICUS study. Ophthalmology. 121(7):1414-1420. 6. Clark, W. L. et al. (2016) Intravitreal Aflibercept for Macular Edema Following Branch Retinal
Vein Occlusion: 52-Week Results of the VIBRANT Study. Ophthalmology. 123:330-336. 7. PHARMAC Schedule, www.pharmac.govt.nz, 1 March 2019.
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 treatand-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: Based on the physician’s judgement of visual and/or anatomic outcomes,
the treatment interval may be maintained at two months or further extended using a treat-and-extend dosing regimen, by increasing injection intervals in 2- or 4-weekly increments while
maintaining stable visual and/or anatomic outcomes. If visual and/or anatomic outcomes deteriorate, the treatment interval should be shortened to a minimum of four weeks based on
anatomical and/or visual outcomes. 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. Treatment intervals greater than four months (16 weeks) between injections have not been studied. 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, in myopic CNV there is 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, eyelidoedema, 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 Data Sheet dated November 7,
2019. FUNDING INFORMATION: EYLEA is fully funded under Special Authority and Restricted Criteria for Wet Age-Related Macular Degeneration and Diabetic Macular
Oedema. Refer - PHARMAC Schedule, www.pharmac.govt.nz. FURTHER INFORMATION: Before prescribing, please review full Data Sheet for further information on the risks and
benefits. Full Data Sheet is available from http://bayer.co.nz/products/product-details.php?id=650 or Bayer New Zealand Limited, 3 Argus Place, Hillcrest North Shore, Auckland 0627.
Telephone 0800 233 988. ® Registered trademark of the Bayer Group, Germany. PP-EYL-NZ-0006-1 NA 11573. Prepared January 2020. BY9443

Understanding
Charles Bonnet Syndrome
By Naomi Meltzer
IMAGINE BEING A passenger in a car and a
brick wall suddenly appears in front of you, or
rows of brown, high-rise buildings start to sway
and bend gracefully towards you. Perhaps, as
you prepare for bed, you pull back your covers
and find a brown, furry thing there. You’re not
afraid because although you have no pets,
you have seen this furry thing quite frequently
recently.
These are real examples of Charles Bonnet
Syndrome (CBS) as told to me by sane, lucid and
sometimes, understandably, extremely anxious
people.
Another patient of mine recalled finding
her retirement village garden planted with
gloriously coloured flowers and even thanked
the gardener before returning to her apartment
to find the flowers had disappeared. While
another said she saw an army of Roman-like
soldiers, marching around the room before
disappearing into the ceiling. Her husband
laughed and called her a “silly old ding-bat”.
Though CBS hallucinations are rarely the
stuff of horror movies, they are confusing and
worrying for patients, leading many to question
their own sanity.
Patient hallucination description, involving Lilliputian visions, which
are commonly seen in patients suffering from CBS³
The syndrome is named after the 18thcentury
Swiss naturalist and philosopher
Charles Bonnet who first described the visual
hallucinations in 1760, after his 87-year-old
grandfather began telling him what he’d been
seeing. Bonnet’s grandfather was thought
to have macular degeneration and possibly
cataracts and, until quite recently, it was
thought that CBS only occurred in conjunction
with macular degeneration. Recent research,
however, indicates it’s associated with a loss of
a patient’s visual ability to distinguish an object
from its background, which can occur with
many visual or neurological conditions.
Mary Lou Jackson, an ophthalmologist and
director of the Vision Rehabilitation Center at
Harvard Medical School, has published several,
frequently quoted papers investigating CBS
in glaucoma patients. Her research indicates
CBS occurs in similar frequency in glaucoma
patients to other eye and neurological
conditions and also concluded its appearance
is most closely linked to contrast sensitivity loss
rather than visual acuity.
In CBS, a person often sees complex visual
hallucinations such as patterns like brickwork,
“Not one, but a whole herd of elephants, blocking the main street of Taupo…”
said Gael Spence, sharing one strange, realistic hallucination 2
basketwork or lace, superimposed on everyday
items like walls or furniture, or people,
animals or inanimate objects, not necessarily
identifiable as something previously seen. The
defining elements which differentiate CBS from
other hallucinatory conditions include:
l Well-formed visual hallucinations the patient
can describe, rather than vague flashes of light
l Insight into the unreal nature of the
hallucination, especially after it is explained to
the patient. For example, a patient told me how
on waking she’d found papers scattered on her
bedroom floor. She knew there was no open
window and no pile of papers that could be
blowing around, yet she still got out of bed to
pick them up before they disappeared
l Some degree of vision loss before
experiencing the hallucinations
l No other previously diagnosed psychiatric
or neurological diagnoses to explain the
hallucination, i.e. the patient appears to have
no other sign of dementia or cognitive change
CBS hallucinations are thought to
originate in the brain. Many attribute them
to deafferentation causing a lack of true
visual input into the
visual cortex, which
results in a release
phenomenon analogous
to phantom pain after
limb amputation. Others
simply describe the
phenomenon as the
brain trying to fill in the
gaps in a patient’s vision,
where, without visual
input, unregulated visual
cortex activity emerges
as hallucinations.
28 | NEW ZEALAND OPTICS JULY 2020

EDUCATION
The exacerbation of social isolation
Regardless of the origin, it is well documented
that the occurrence of visual hallucinations
increases at times of sensory deprivation,
such as when a person is socially isolated or
in the early hours of the morning when the
sufferer is awake, but there is nothing much
else happening. Usually it disappears when
distractions, such as the radio or television, or
some new activity are initiated.
The prevalence of CBS in elderly patients is
reported to be anywhere from 0.5% to 40%;
the high variance due to CBS frequently being
attributed to mental illness. Generally, however,
it is thought to affect about 30% of patients
with some form of vision loss. But it is believed
to be heavily under reported due to patient
anxiety about the onset of dementia and
negative comments from family, friends and
medical personnel.
My experience, from talking to almost all of
my low vision patients about CBS, is that this
anxiety is warranted. It does not matter how
sensitively I initiate the conversation, a large
proportion of accompanying family and indeed
patients, will immediately make some sort of
joke or negative comment. For those who have
experienced CBS however, I can usually sense a
change in body language immediately.
A simple question such as, “has
anything like that ever happened
to you?” can result in a myriad
of responses from tears of relief
to embarrassment or anger that
nobody took them seriously when
they tried to speak of it.
Although CBS is usually associated Charles Bonnet
with visual hallucinations, it also occurs
with other sensory deprivation. There are
similar phenomena reported for the olfactory
and auditory senses. Olfactory deprivation has
been shown to result in functional changes
and even structural changes, such as decreased
mucosa thickness in the nose and possible
changes in the number of receptor neurons.
In the auditory pathways, tinnitus is defined
as a perception of a sound that is not related
to an acoustic source or electrical stimulation.
Usually, but not always, this is associated
with hearing loss. It can range from simple
sounds to complex musical or even verbal
hallucinations. Was Beethoven experiencing
auditory CBS?
One experience of a 99-year-old widow
continues to resonate with me. Fiercely
independent and very lucid, this lady had
resisted moving out of her home into a rest
home for a long time. Three weeks after she
gave in and moved, and before staff
had really got to know her, she
noticed a man standing by her bed
in the early hours of the morning.
As she watched he floated up into
the top corner of her wardrobe and
disappeared. He appeared several
times over the next few weeks and
unwilling to speak to staff about it for fear
that they would write her off as a dementia case,
she concluded it was the ghost of a previous
occupier and continued to worry he was trying
to tell her something. As she related this to me,
her younger sister who was hearing all this for
the first time was clearly aghast at what must
have been a frightening experience alone in
this new place. She asked her sister, was it her
husband who appeared by her bed leaning
over her? “Oh no” said the 99-year-old with a big
smile, “he was much more handsome.”
References
1. ML Jackson, K Bassett, PV Nirmalan and EC Sayre. Contrast
sensitivity and visual hallucinations in patients referred to a low
vision rehabilitation clinic. Br J Ophthalmol. 2007 Mar; 91(3):
296–298.
2. https://eyeonoptics.co.nz/articles/archive/living-with-cbs/
3. Linda Pang. Hallucinations experienced by visually impaired: CBS.
Optom Vis Sci. 2016 Dec; 93(12): 1466–1478
Naomi Meltzer has worked in optometry for more than
30 years. She runs an independent optometry practice
specialising in low vision consultancy in Auckland.
Be prepared to change your view of IOLs.
Built on the trusted TECNIS ® platform and designed
to give your patients distance to intermediate VA.
TECNIS and TECNIS Eyhance are trademarks of Johnson & Johnson Surgical
Vision, Inc. 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. © Johnson & Johnson Surgical Vision, Inc. 2019. The product
for health and medical safety. Before use it is important to read the instructions
for use, warnings and possible
changes associated with the use
of the product. PP2020CT4185
WWW.EYEONOPTICS.CO.NZ | 29

EYE ON OPHTHALMOLOGY
Professors
Charles McGhee
& Dipika Patel,
series editors
Residual refractive error after
cataract surgery
By Drs Ye Li and Mo Ziaei
CATARACT SURGERY IS the most
commonly performed operation globally,
with over 30,000 performed per annum in
New Zealand. The surgery has transformed
into a refractive procedure in recent years,
with patients often expecting the surgery
to minimise their dependence on glasses.
However, residual refractive error following
surgery is still relatively common. In 2015,
postoperative visual and refractive outcomes
in New Zealand were found to be comparable
to international standards¹, which aims to
have 85% of patients achieve a spherical
equivalent (SE) within 1 dioptre (D) and 55%
of patients within 0.5D of the intended target².
This translates into more than 4,500 patients
a year with a residual refractive error of >1D
following surgery every year.
Multidisciplinary care of the cataract patient
is continuously evolving to meet postoperative
refractive benchmarks, with the development
of an assortment of intraocular lenses (IOLs),
advanced biometric measurements, modern
IOL calculation formulae and the improvement
in surgical options available to perform
postoperative enhancement.
Current cataract surgery techniques
Phacoemulsification remains the gold standard
technique for cataract surgery. It has replaced
previously conventional methods such as
intracapsular cataract extraction (ICCE),
extracapsular cataract extraction (ECCE)
and manual small incision cataract surgery
(MSICS), due to advantages in visual outcomes
and a lower complication rate.
Recently, the femtosecond laser has been
employed for use in cataract surgery due
to theoretically higher precision in surgical
incisions, more predictable capsulotomy
and reduced ultrasound energy. There is a
sparsity of large, long-term studies comparing
femtosecond laser-assisted cataract surgery
to phacoemulsification, however, at this
stage, there is no compelling evidence to
suggest significant differences in refractive
or visual outcomes. One European registry
study suggests that femtosecond laserassisted
cataract surgery has a similar
intraoperative complication profile compared
with phacoemulsification but a higher rate of
postoperative refractive surprise due to corneal
oedema and posterior capsule opacification.
Fig 1. Proliferation of residual lens epithelial cells causing posterior capsule opacification with pearl-like clusters (left),
and anterior capsular contraction with circumferential fibrosis (right)
Minimising preoperative sources of error
Recognising potential sources of postoperative
refractive error is instrumental in achieving
desirable postoperative outcomes. In most
cases, a detailed ocular history, thorough
examination and appropriate imaging is
adequate for detecting significant risk factors
that converge to lead to inappropriate IOL
power selection. Such risk factors include
ocular surface disease (OSD), contact lens
wear, prior refractive surgery, keratoconus,
astigmatism and extremes of axial length
(AL).
Ocular surface disease
OSD is an underdiagnosed condition that has
a prevalence of 5-50% globally. One study of
patients presenting for cataract assessment
revealed that 77% of cases exhibited corneal
fluorescein staining, while only 22% had a
formal diagnosis of dry eye. Untreated OSD
resulting in hyperosmolarity and tear film
instability, compromises the quality of the
refractive surface, which directly affects
keratometric measurements and can lead to
erroneous measurements of keratometric
astigmatism. Errors in measured astigmatism
can be significant in IOL power calculations,
particularly for astigmatic correcting (toric)
IOLs.
Error due to OSD can be avoided
through vigilant assessment and subsequent
comprehensive treatment of the ocular surface
for at least four weeks, at which point repeat
biometry measurements will be necessary.
Treatment should involve frequent lubrication
and lid hygiene with adjuvant treatment
such as topical steroid and oral azithromycin
reserved for recalcitrant cases.
Contact lens wear
Contact lens wearers are also subject to an
increased risk of postoperative refractive
error. Extensive contact lens wear leading
to prolonged hypoxia and subsequent
corneal warpage can influence the
accuracy of keratometric measurements³.
Discontinuation of contact lens wear for
a minimum of two to three days for soft
lens and one to two weeks for rigid gas
permeable lenses, prior to biometric and
topographic measurements, is essential. A
more prolonged discontinuation period may
be required if the preoperative biometric
and topographic measurements still exhibit
evidence of corneal warpage, and multiple
visits and measurements may be required in a
small proportion of patients.
Refractive surgery
Prior refractive surgery, such as laser in
situ keratomileusis (LASIK), laser epithelial
keratomileusis (LASEK), photorefractive
keratectomy (PRK) and radial keratotomy
(RK), can instigate multiple errors in
IOL power calculations due to erroneous
preoperative keratometric measurements⁴.
Traditional topography and biometry
devices only measured the anterior radius
of curvature while assumptions were made
about the posterior cornea contribution
for the index of refraction. After all types
of refractive surgery, with the exception of
RK where anterior-posterior changes are
relatively proportional, these assumptions
are violated. If not accounted for, patients
with myopic refractive surgery generally
experience a hyperopic shift following
cataract surgery and a myopic surprise
can be expected after hyperopic refractive
surgery. Development of multiple modern
IOL formulae and supplementary adjustment
tools have tailored calculations to account for
these factors, but it remains prudent upon
the referring optometrist and the cataract
surgeon to actively ask for a history of
refractive surgery.
30 | NEW ZEALAND OPTICS JULY 2020

FOR ALL EYE CARE PROFESSIONALS
Fig 2. Slit-lamp image demonstrating fluorescein uptake,
indicating ocular surface disease
Keratoconus
Other conditions resulting in corneal
irregularities, such as corneal ectasia, present
similar challenges in IOL calculations. Accurate
biometry measurements are notably difficult to
obtain in patients with keratoconus, especially
in those with severe disease who are more
prone to cataract formation due to concurrent
atopy and possible previous topical steroid
use. Displacement of the steep axis causing
misalignment with the visual axis and the
presence of severe corneal distortion induces
error in keratometric measurements and
effective lens position, typically resulting in an
underestimated IOL power and postoperative
hyperopia. In preoperative assessments, vigilant
detection for keratoconus, accurate staging and
obtaining an understanding of the patient’s
disease status and possible progression can be
essential in minimising postoperative refractive
error which may have accentuated downstream
effects due to future interventions that may be
required for the treatment of the ectatic process
(eg. keratoplasty).
Astigmatism
Astigmatism can be challenging to address
and accurate assessment of its magnitude
is helpful in surgical planning. Previous
research has revealed the residual refractive
error is more common in individuals with
higher levels of preoperative astigmatism.
Varying degrees of astigmatism are managed
differently. Patients with 1D often benefit from
a toric IOL⁵. A recent meta-analysis showed
that toric IOLs are superior in astigmatism
correction compared to corneal incisions, but
these lenses need to be placed accurately on
the steep axis in order to effectively neutralise
astigmatism⁶.
Axial length and modern formulae
Patients with extremes of AL are also more
prone to refractive surprise. The use of
modern biometry devices that use optical
coherence tomography (OCT) to generate
Fig 3. LASIK enhancement in a patient with hyperopic
refractive surprise following routine cataract surgery
accurate AL measurements as well as modern
formulae has led to a significant reduction
in refractive error. The recently introduced
formulae analyse multiple biometric
parameters such as AL, keratometry, lens
thickness, anterior chamber depth and whiteto-white
distance, and employ regression
models or artificial intelligence to better
predict the postoperative position of the IOL
(effective lens position) and improve refractive
outcomes. In one recent study, the refractive
accuracy was found to be most challenging to
achieve in short eyes

BUSINESS
Best practice.
Made easy.
Brought to you by
the IOGroup
Business post-Covid-19: our new normal
By David Pearson
THE COVID-19 PANDEMIC will likely change
the way we do business for a long time
to come. For most businesses’ turnover is
down and owners are having to deal with
an environment that is constantly changing,
affecting inventory requirements (especially
those reliant on imports) and staffing capacity.
Maintaining profitability or, in some cases
viability and liquidity, can prove challenging.
Here are some key elements to increase the
likelihood of success.
Short-term cash flow forecast
Prepare a 13-week cash flow forecast. This
is often an eye-opening exercise and will
effectively capture most entities’ business cycles.
The forecast will help navigate stormy waters
in the near-term, as it will highlight shortfalls
in necessary cash balances. Maintaining an
up-to-date forecast will allow you to easily
identify if and when there is an upcoming risk of
running out of cash and will reveal if borrowing
requirements fall short of actual availability from
credit lines. You will need to ensure any forecast
is subject to regular revisions in light of Covid-19
and its ongoing impact on the market.
Being in a position to identify when cash
may be short puts you on the front foot to
source more capital or organise new payment
arrangements for extended loan facilities, tax
payment plans, starting conversations about
supplier arrangements and/or liaising with
landlords regarding rent relief.
Monitor actual against forecast
Cash is king! A business can be reporting
profits but still have trouble meeting current
obligations to lenders and key creditors. Having
accurate, monthly financial statements can
prove invaluable in keeping on top of where
your cash flow is at in real time. This also helps
you to fully utilise short-term cash flow to its
full capacity, allowing you to identify problems
that may develop as patients become slower
to pay or don’t pay at all. Some problems
may also not be immediately recognised,
including changes in product/service demands,
increasing overhead costs, use of obsolete
pricing methods or increasing competition due
to industry adaptation.
Where possible review all non-essential
expenses and capital projects to identify
opportunities to free up cash surpluses quickly
if needed. Reviewing inventory levels cannot
be underestimated as post-Covid optimums
may be quite different to pre-Covid optimums
and these changes may also free up working
capital. Finally, ensure your patients clearly
understand your payment terms which must
be targeted at minimising credit terms.
Learning by doing
When faced with great uncertainty, we
have three options: remove the uncertainty
and proceed; proceed anyway and adjust
as necessary; or do nothing. If we assume
option one is unrealistic and option three is
unacceptable, we’re left with only one option
– take action, learn and adapt. The objective
of adaptive management is to provide a
framework that drives action now, despite
uncertainty. The goal is not necessarily a
predetermined target, at least not initially, it’s
about achieving incremental change: take
a small step, reflect, learn, adjust and take
another small step.
Adaptation goes past simply responding to
disruptive events; it also means seeking out
and seizing opportunities created by market
forces. At times like this, it’s this sort of iterative
decision making that should be the foundation
of your strategic planning.
Short-term action plan
The potential output of a short-term action
plan should be a succinct, fit-for-purpose plan
that prioritises the what, who and when for
your business, and can be used as a roadmap
in upcoming months as well as a discussion
document for sharing with stakeholders. The
following areas should be noted:
l Current government rules and requirements
for your business
l What you know for certain, what you can be
doing now to prepare
l Short-term goals
l SWOT analysis
l Overall solvency
l Working capital needs
l Supply chain continuity, logistics
l Patients and sales
l Employment issues and business structure
l Finance and funding (cashflows, plans etc.)
Ideally, a short-term action plan should focus
on a 90-day time period that lends itself to
becoming the basis for a reviewed annual plan.
It’s important you not only focus on the threats
and weaknesses of the current market, but
also identify opportunities to reinvent, grow or
diversify your business offerings and operating
style. While you may not be in the right place
financially to take advantage of these now, they
could possibly be worked into your long-term,
more growth-orientated action plan.
While the above tools will help ensure
your business is well placed to adapt to this
uncertain operating landscape, it’s paramount
the planning put in place is robust and brutally
honest. There is no room for rose-coloured
glasses here! Remember, your business is there
to serve you, not for you to serve it; being
aware of what you need to get out of the
business will provide direction and guidance
for forward momentum.
David Pearson is managing
partner of chartered
accountants and business
advisors BDO Central. He
has a special interest in
providing advisory services
to the optometry sector and
extensive experience assisting
both small and medium-sized
entities. Contact David at
david.pearson@bdo.co.nz or
visit www.bdo.nz
To learn more about the IOGroup, contact Neil Human:
0210 292 8683 neil.human@ioggroup.co.nz
THE INDEPENDENT
OPTOMETRY GROUP
32 | NEW ZEALAND OPTICS JULY 2020

NEWS
Continued from p31
When counselling patients regarding
postoperative residual refractive error,
it is important to acknowledge the
patient’s concern and ensure preoperative
measurements are reviewed to confirm the
correct IOL was implanted. After ensuring
the correct IOL was implanted, it is also
important to reiterate that residual refractive
error is not an uncommon issue. Patient
reassurance regarding the availability of
solutions can eliminate potential distress
and dissatisfaction, but before committing
to an enhancement procedure, it is vital to
ensure the patient understands the visual
consequences, particularly if they are left
myopic after surgery and are enjoying the
benefits of unintended “monovision”.
Conclusion
Advances in cataract surgery have enabled
patients to achieve improved visual
outcomes, with the rise of more IOL options,
surgical accessories and improved precision
in IOL power calculation . Despite such
developments, postoperative refractive error
remains relatively common.
Refractive error after cataract surgery
can be minimised through recognition
and correction of potential risk factors. In
instances where the amount of refractive
error is perceived as unacceptable,
enhancement procedures can provide
excellent refractive and visual outcomes.
Whilst perfection in postoperative
refraction cannot yet be guaranteed,
achieving patient satisfaction is absolutely
within reach through patient-centred care,
appropriate counselling and adequate
utilisation of enhancement procedures
following cataract surgery.
References
1. Kim BZ, Patel DV, McGhee CN. Auckland cataract study 2: clinical
outcomes of phacoemulsification cataract surgery in a public
teaching hospital. Clin Exp Ophthalmol. 2017;45(6):584-91
2. Gale RP, Saldana M, Johnston RL, Zuberbuhler B, McKibbin M.
Benchmark standards for refractive outcomes after NHS cataract
surgery. Eye (Lond). 2009;23(1):149-52.
3. Lewis JR, Knellinger AE, Mahmoud AM, Mauger TF. Effect of
soft contact lenses on optical measurements of axial length and
keratometry for biometry in eyes with corneal irregularities. Invest
Ophthalmol Vis Sci. 2008;49(8):3371-8.
4. Hoffer KJ. Intraocular lens power calculation after previous laser
refractive surgery. J Cataract Refract Surg. 2009;35(4):759-65.
5. Khan MI, Muhtaseb M. Prevalence of corneal astigmatism in
patients having routine cataract surgery at a teaching hospital in the
United Kingdom. J Cataract Refract Surg. 2011;37(10):1751-5.
6. Lake JC, Victor G, Clare G, Porfírio GJ, Kernohan A, Evans JR.
Toric intraocular lens versus limbal relaxing incisions for corneal
astigmatism after phacoemulsification. Cochrane Database Syst Rev.
2019;12(12):Cd012801.
7. Tang KS, Tran EM, Chen AJ, Rivera DR, Rivera JJ, Greenberg
PB. Accuracy of biometric formulae for intraocular lens power
calculation in a teaching hospital. Int J Ophthalmol. 2020;13(1):61-
5.
8. Caglar C, Batur M, Eser E, Demir H, Yaşar T. The Stabilization
Time of Ocular Measurements after Cataract Surgery. Semin
Ophthalmol. 2017;32(4):412-7..
9. Fernández-Buenaga R, Alió JL, Pérez Ardoy AL, Quesada AL,
Pinilla-Cortés L, Barraquer RI. Resolving refractive error after
cataract surgery: IOL exchange, piggyback lens, or LASIK. J Refract
Surg. 2013;29(10):676-83.
10. de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. Multifocal
versus monofocal intraocular lenses after cataract extraction.
Cochrane Database Syst Rev. 2016;12:Cd003169.
Optom wins photo comp
AUCKLAND OPTOMETRIST JEREMY
Wong was one of six winners announced
in New Zealand photographer Chris
McLennan’s lockdown photo challenge,
#CMflattenthecurve, which invited fellow
photographers to capture one moment
every day during lockdown.
Wong’s winning shot was of his gorgeous
pet cavoodle Otis who, like most of us, was
in dire need of a haircut during lockdown.
“I think his eyes say, oh no, not another
photo!” laughed Wong adding he was
very happy with the photo, especially the
outdoor, natural light on the deck which
highlighted Otis’ golden fur colour. “I really
enjoyed the competition. It was great fun
and allowed me to be creative.”
The photo of Otis was taken with
a Samsung S10. See more of Wong’s
photography on Instagram:
@jeremywongphotography
What’s your secret hobby?
The winning shot – Otis the cavoodle
Do you have a hobby or a special talent outside of work, or perhaps you’ve won something
that you would like to share with us? If you do, we’d love to hear from you. Just drop us a line
at info@nzoptics.co.nz
Vision monitor app
UK-BASED OKKO Health has launched a new
app allowing eye care practitioners (ECPs) to
monitor their patients’ eyes remotely.
Developed by vision scientists, optometrists
and ophthalmologists, the app instructs
patients to tap on visual cues and pattern
anomalies to assess their visual acuity and
contrast sensitivity. It uses a secure online
portal for ECPs to access readings and identify
patients needing help.
Founder Dr Stephanie Campbell said she
is optimistic about the positive impact the
software will have on vulnerable patients. “With
our app, they can now track key indicators of
De Rigo’s early Christmas
their eye health from the safety of their own
homes. I have no doubt this technology will be
a sight-saver for many.”
DE RIGO HAS launched a Christmas promotion to help independents tempt customers back into
practices while creating a bit of fun and reward participating staff.
“Covid-19 has been very challenging for everyone, however
New Zealand has led the world with its recovery,” said De
Rigo’s Chris Hanley. “De Rigo NZ is running a Christmas
promotion to help continue that recovery by giving practice
staff an added incentive to gain extra Christmas gifts.”
The promotion is running for the next six months and the
rewards catalogue is full of local brands and products which
will also support local businesses, he said.
To be eligible, a practice must stock four De Rigo brands
with a minimum of 12 pieces in each brand. The campaign
runs from 1 June to 30 November 2020.
See your printed OIG or https://eyeonoptics.co.nz/nz-optics/searchableoig/ for contact details.
WWW.EYEONOPTICS.CO.NZ | 33

When marketing and a crisis don’t mix!
By Siu-Yin Shing
BEFORE EYEWEAR, I worked in PR and marketing for the fashion
sector, so I understand how essential it is for businesses to broadcast
the right messages in today’s social media world because, if you get it
wrong, people are quick to voice their opinion. So, I was curious, when
I saw how many people were angry at cut-price, online frame and lens
company Polette Eyewear. “Ooooo, what did they do to upset their
followers?” I thought.
It wasn’t hard to spot the issue.
Right now, we are in the worst pandemic of
our lifetime. Covid-19 is on the news every day.
Different countries are tackling it (or not) in all
sorts of different ways but wherever you are,
there is no way of not knowing about it.
In the UK, the news regularly reported there
were not enough protective medical supplies for
healthcare workers as cases continued to rise.
It became a top priority to source and deliver
enough masks and sanitisers and other personal
protective equipment (PPE) for health staff on
the frontline, fighting the virus to keep their
patients alive.
Riding the back of this, at the beginning
of the outbreak in Europe in March, Polette
thought it was a good idea to run a See clear,
stay safe promotion giving away two free face
masks with every purchase. The response was
immediate and angry, upsetting about 95% of
the company’s followers on social media.
People felt they were at best insensitive to
the pandemic; at worst, helping to fuel it. Many
asked, “Why give masks to ordinary people like
us when medical staff don’t even have enough
and they are the ones battling Covid-19,” and,
“Why not donate what you have to them?” Both
very valid questions!
Polette’s ill-considered pandemic promotion
Was Polette insensitive?
After SARS in 2002, almost everyone across Asia adopted the habit of
wearing a mask for minor things like a common cold. Wearing a mask
is normal practice; it’s no big deal. But this is not the case in all cultures.
Polette has factories in China and when the outbreak first happened,
masks were hard to find, so many businesses in Hong Kong, for example,
gave out free masks to the general public as a marketing tool.
So I don’t think Polette purposely meant to be
insensitive, but their marketing team should have
done more research and a lot more thinking and
discussing before they jumped into grab some
publicity off the back of the pandemic.
Fuelling the furore
The public reaction was so negative, Polette
made two separate statements explaining its
reasons for the campaign.
The first apologised for any
‘miscommunication’ then rattled on about caring
for its staff in China and the self-proclaimed
good work the company was doing to provide
masks to all, and that the company had values
and heart, “…maybe you considered it misplaced
tonight but if you follow us, you should by now
know where our hearts stand! We thank you for
your support and sorry for hurting all of your
feelings! Polette loves you.”
Instead of quelling the rage, the statement
fuelled it with many lambasting the way they
thought the company had responded with an ad
rather than any words of contrition.
Statement number two was written by the
boss, “Hello everyone, I am Pierre Wizman, I am
French and the founder of polette.com. Our last
communication was not an advertisement but
an act of support in this crisis! I regret that our
34 | NEW ZEALAND OPTICS JULY 2020

STYLE NEWS
message was wrongly interpreted, and I
hope you will understand our intention
was never about business but to share
information...”
Again, the statement was long. Again,
Wizman attempted to explain why the
company had run the promotion, “…It is
purely an act of kindness from a country
that is slowly getting out of the crisis.”
But instead of apologising, he claimed
the negative response was not deserved,
“Polette is a brand that always puts a stress
on solidarity and benevolence. All our
actions express more than this message
itself!” He continuing with how good
the company has been and called on its
followers “…to remain united… Polette is a strong and loving family and
will continue to be! Love Pierre Wizman.”
He might have ended the statement with ‘love’, but again all it did
was compound the situation. The company was labelled “arrogant” for
blaming its audience for not understanding what the company was
trying to achieve and stating it was simply trying to do everyone a favour.
This is a non-apology. The company said it was sorry, but then went on
to say that it hadn’t actually done anything wrong and it wasn’t its fault
it had been misunderstood. It even said its followers understood that –
after it had deleted most of the really bad comments, leaving behind just
the not-so negative ones in an attempt to rewrite social media history.
My advice to Polette’s marketing team is to do a lot more research
about different cultures before they launch their next promotional
campaign and, if they muck up again, don’t issue a statement trying to
justify what they did otherwise they will lose yet more of their current
and future customers. Sometimes there is simply no way to rectify a
marketing disaster, except to say, “Sorry. We messed up and we will learn
from it. We can now see why this may be insensitive. Please forgive us.”
How this relates to you
Polette is a big company, so perhaps you’re thinking, what can an
independent practice learn from this? The key for any business of any
size when it comes to your marketing ideas is to know and understand
your audience. If the area you practise in is family orientated for example,
make sure you run events and promotions aimed at families, with plenty
of eyewear suitable for the entire family. Be thoughtful about which topics
might upset your audience, but also think about what might grab their
attention. For families, children’s health is always at the heart of their
parents’ interest and actions, so a good campaign idea might focus on
simple tips to help protect their children’s eyes and eye health, for example.
Many independent practice owners are often a little afraid to use social
media to promote their businesses. Some may even choose not to have
a social media presence to avoid the possibilities of backlash and dealing
with angry or unreasonable customers. But don’t be afraid to reach out to
customers and potential customers through social media and, if you do
get it wrong, to apologise and show empathy. Consumers would much
rather deal with a business that can demonstrate these traits and, if you
handle the situation well, you can actually turn a negative situation into a
positive one.*
So, in summary, here’s a couple of ideas for building awareness for your
business online:
l Understand your local area – is it family, older people or business
orientated, for example? And what sort of things do your audience enjoy/
find interesting/important? Target social media interaction appropriately
l Follow local groups to keep up to date with what’s happening and gain
an even greater understanding of and involvement in your local area,
offering your help and expertise when appropriate to reach more groups
within your area
l Consider timely promotions and information for your audiences. In the
summer say, run a special sunglasses promotion; during winter, when
people are more indoors, on their devices,
discuss blue-light lenses for example
Everyone wants to see instant results
with marketing, but successful marketing
is based on creating a lasting impression
of your business among your target
audience. All marketing should be viewed
as a long-term investment, building
subsequent promotions to gain a lasting,
positive reputation. There is no point in
having a great looking practice, top quality
optometrists and dispensers, offering
great products if you don’t tell people
about it. But, most importantly, do your
research to really understand your practice’s
demographics, so whatever you do say,
makes a good impression on those you’re wishing to reach and, if you do
get it wrong, apologise!
*For more about ‘Facing the feedback’, see https://eyeonoptics.co.nz/articles/
archive/facing-the-feedback/
EYEWEAR
Siu-Yin Shing is an eyewear blogger. Born in Hong
Kong but now based in the UK, she owns more
than 30 pairs of glasses and so many sunglasses,
she’s lost count!
This article was adapted from a similar article which
first appeared on https://theeyewearforum.com/
De Rigo Vision | sales@derigo.com.au
WWW.EYEONOPTICS.CO.NZ | 35

STYLE NEWS
Style
news
Mykita Liva
More progressive; more Mykita
Berlin-based handmade eyewear company Mykita has
released several new collections offering contemporary
optical eyewear displaying the brand’s signature
progressive design. The Lite collection showcases classic
to contemporary styles with soft lines and rounded edges,
including the ultra-light Lessrim construction and refined
colour compositions for the mixed material models,
offering a contemporary touch to timeless shapes.
Distributed by Proper Goods.
Mykita Oniki
Caroline by Vera Wang
Vera Wang summer style
Vera Wang has released new sun styles featuring cat-eye shapes with
intricate details. The V568 is a fun acetate and metal combination, available
in coral crunch (pictured), emerald and spotted tortoise, while Caroline is
a dramatic full acetate model with Swarovski crystals accenting the frame
front. Available in black, tortoise and crystal pink.
Distributed by Eyes Right Optical.
V568 by Vera Wang
Mykita Lahti
Want more?
Visit eyeonoptics.co.nz or eyeonoptics.com.au
for the latest news, features, research updates,
industry comment, job adverts and more.
Woow: Love me
Iconic, bold and traditionally
acetate Woow’s two new Love
Me styles offer a minimalistic metal look.
Love Me 1 (featured here), offers a slightly
sharper shape compared to the softer Love Me
2. Both stainless steel frames are available in a range of delectable colours,
including white, turquoise, raspberry, green and matt black.
Distributed by CMI Optical
“Improved” work lens
SHAMIR NZ AND INDEPENDENT Lens Specialists
(ILS) have released Shamir Vocational Digital, a
new, improved occupational lens designed
for the office and reading.
“Shamir Vocational Digital comes
with two dynamic shifts, 0.75 and 1.25,
and helps alleviate computer vision
syndrome, providing crystal clear
vision for printed pages and computer
screen viewing; ideal for near and
mid-distance work,” said Shamir NZ’s
Francois Cronje.
The new lens is also a more affordable
option compared with other occupational
lenses, said Cronje, adding it’s available in 1.5
index with higher indexes coming soon, and in
clear, Transitions and Shamir Blue Zero.
NZ Optics_house ad_FP_print_0520.indd 1
23/04/20 4:05 PM
36 | NEW ZEALAND OPTICS JULY 2020

Decades of California style
American surf brand O’Neill was founded in 1952 by Jack O’Neill in San
Francisco and, nearly 70 years later, still embodies its original laidback,
California style. O’Neill’s new optical range includes Kellsy, a glossy, crystal
layered 100% plant-based and biodegradable acetate frame, available
in bright teal, brown, black or purple. Kellsy’s stainless steel moulded
temples and adjustable core-wire tips ensures a comfortable fit. Model
Aidan offers a sheet stainless
steel front and bespoke O’Neill
acetate printed temples,
available in four different colour
combinations. O’Neill also offers
a smaller fit for younger surfers.
Distributed by Phoenix Eyewear.
Stars
and their eyes…
Bradley Walsh, the
Dr Who and Coronation
Street actor, footballer and
witty presenter of UK ITV’s The
Chase, now starring in Bradley
Walsh & Son: Breaking Dad on
TVNZ, suffers from blepharitis.
It was during a Chase episode that
viewers flocked to Twitter remarking
on Walsh’s odd behaviour when
he decided to speak out about
his condition. Walsh developed
blepharitis in his teens and told
This Morning hosts that viewers
often mistake him for being
drunk because of his condition. “People don’t realise I have seriously
bad blepharitis. I have to take one pill a day (anti-allergy medication)
for it or I really struggle.” Walsh said he is pondering surgery as a
solution to his problem. “I am going to need my eyes operated
on at some point to sort it out. So many times, people have
commented on how I look. But they don’t realise
that if I take medication, I’m fine,” he said.
Oneill Aidan
CLASSIFIEDS
For sale / vacancies
To advertise in
NZ Optics classified
section contact
Susanne Bradley
susanne@nzoptics.co.nz
OPTOMETRIST OPPORTUNITY
Northland, New Zealand
Are you ready to combine lifestyle with your
chosen career in optometry?
If you are the OPTOMETRIST that we are looking for you are driven, self
motivated and great at finding the best optical solutions for our clients.
You will be supported in many different ways by our outstanding team
as you strive for total client and personal satisfaction.
We have a variety of remuneration choices for you to consider including
full salary, retainer plus commission and partnership options.
Contact Gavin today on 021 487 428 or email
gavin@lowespartners.co.nz to discuss the endless possibilities available
to you. www.lowespartners.co.nz
For all your
optical and
ophthalmic
needs
nzowa.org.nz
LEASE OPPORTUNITY
Papamoa, Tauranga
Here’s a great opportunity to set
up your own practice in a wellestablished,
high-end medical
hub in one of the fastest growing
suburbs in the country! We
currently have six suites occupied
in the existing complex (including
a medical centre, pharmacy,
physio and audiologist) and are
now extending it by another five.
Call Daryl today to secure your
new practice suite – 021 321 240.
OPT0M LICENCE
PLATE FOR SALE
Great opportunity to promote
your optometry practice,
especially in your local
community!
Asking price $9990.
Contact Jyotika on 021678667
or Jyotika.Lal@xtra.co.nz
COULD YOU DO
YOUR JOB
WITHOUT
TOOLS?
Help our graduates
get the equipment
they need
hollows.org.nz
0800 227 229
WWW.EYEONOPTICS.CO.NZ | 37
NZOptics- eightpg-advert.indd 1 3/06/20 11:53

Chalkeyes presents...
Read all about it
By David Slack
IF YOU ARE reading this in its lustrous
glossy printed form, you have in your hands
a suddenly quite rare and precious thing: a
magazine.
Things are in turmoil in all kinds of ways
and the media is not missing out on its share.
That party was well underway before this
pandemic.
The worse it gets, the more it seems to
echo farming in 1984: there was clearly a place
for it; there was also clearly no way things
could go on the way they were. Things were
proceeding on the fond assumption the glory
days of export dollars for slabs of frozen meat
and bales of wool would return and all we had
to do was wait and dish out subsidies. It was a
delusion.
Media has had a long, golden age, awash
in advertising dollars. Now those dollars are
being hoovered up by Facebook, Google and
YouTube. Good luck ever getting them back.
Moreover, in a world of free online media,
how do you get people to pay?
For farming, the moment of truth arrived
in 1984 with Rogernomics. In came the free
market, out went the subsidies; no more
oxygen for the patient. For several years, it
was awful carnage. Eventually farming found
a new level; off it went again. Before long, the
accepted wisdom was it had all been inevitable
and the sector was the better for it.
What will become the accepted wisdom
for the media? Probably the prevailing order
was no longer the right size or shape, that
a sustainable future lies beyond the present
arrangement of huge media organisations and
expensive executives.
What are the prospects for those of us who
toil in this particular field, making lustrous
publications, and what are the prospects for
you, the reader, who might like to turn their
lustrous pages?
It doesn’t take all that much to tell a story.
You need someone to begin with, “once upon a
time”, and you need an audience that wants to
hear what happened after that. That’s what the
media is at its heart, perhaps with a preference
sometimes for the story that involves
something that someone, somewhere doesn’t
want anyone to hear.
In this digital world, it’s become possible
to do that without much costly overhead. So,
how about in place of the costly giants, we get
an abundance of smaller operations, offering
many different perspectives to many different,
smaller audiences – crucially – connecting
people sharing a common interest? They
might live in the same neighbourhood, they
might have a love for the same subject, they
may follow a particular field, let’s say, oh,
optometry and ophthalmology.
The important thing is that whatever you
do, whatever your interest, the media can
enrich it, improve it, if it does its job well. The
effect can be remarkable.
For many years now I have had an
association with a newspaper man in Mexico.
His family had a small daily paper, a modest
affair. He went off to study journalism in
America, came home with a head full of ideas
about freedom of the press in a country where
there was none. This was 40 years ago. Back
then, what got printed was determined by how
much someone paid, or how much you were
being threatened. He set about making a whole
new kind of newspaper, one that printed the
truth without fear or favour; no kickbacks, no
censorship. They put it in the paper and put it
on the streets. Every vested interest hated it.
The people loved it.
In the face of fierce and unending resistance
and intimidation, he and his young idealistic
team kept their nerve. They kept on reporting
Credit: pxhere.com
without fear or favour and each day more
people bought a copy, and day by day, year
upon year, that little newspaper grew. Today
they print some of the country’s biggest daily
newspapers and their influence, through
exposing corruption, has been profound. They
continue to succeed because their readers know
they will be able to read in those newspapers
what they cannot find anywhere else.
In an age where you can read for free about
Kardashians and trash, the publication that
reports what no one else is reporting is the one
you turn to. When the online world seems to
be subverting democracy, publications that
speak to our interests and values, that cares
about our community of interest, about you,
are something to prize.
When the dust settles, I hope those will be
the hearts still beating.
David Slack is an
Auckland-based
author, radio and TV
commentator and
speechwriter.
38 | NEW ZEALAND OPTICS JULY 2020

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WWW.SILMOPARIS.COM
WWW.EYEONOPTICS.CO.NZ | 39

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