July 2020

nzoptics

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


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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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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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