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NEW ZEALAND<br />

Pregnancy<br />

and the eye<br />

AUSCRS<br />

castaways<br />

OCTOBER <strong>2024</strong><br />

DOs’<br />

remake role<br />

Page 16<br />

Page 30<br />

Page 48<br />

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as required. Blink Intensive Tears, Blink Intensive Tears PF, Blink Intensive Tears PLUS: Place 1 or 2 drops in affected eye as required, then blink several times. Use as often as required. References: 1. Wasmanski A et al. Cross- Over Evaluation PEG-400 0.4% & 0.25% artificial tears<br />

in mild dry eye patients. Poster ARVO, 2010. 2. Montani G. lntrasubject tear osmolarity changes with two different types of eye drops. OVS. 2013; 90(4): 372-377. ©<strong>2024</strong> Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and<br />

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Inside<br />

14<br />

6 EDITORIAL<br />

NEWS<br />

8 Taking the sting out of cataract surgery<br />

10 ODOB tackles CPD woes<br />

14 Shingles and the over-50s<br />

22 Foureyes Foundation seeks partners<br />

24 Diabetes care by ethnicity<br />

34 Predicting glaucoma treatment response<br />

52 Eyeball <strong>2024</strong>: Starry night<br />

30<br />

FEATURES<br />

16 What to expect when patients are expecting<br />

40 MIGS – in the surgeon’s seat!<br />

48 The DO’s role in spectacle remakes<br />

34<br />

EDUCATION<br />

28 AI: an exciting frontier<br />

30 AUSCRS’ desert I-land castaways<br />

36 Glaucoma: stents, trabs and tubes<br />

44 Inaugural emergency eyecare seminar<br />

46 Retina Specialists’ genes and gems<br />

RESEARCH<br />

26 Shingles, uveitic glaucoma and more<br />

BUSINESS<br />

42 Your business’s BFFs<br />

52<br />

12<br />

54 CHALKEYES PRESENTS:<br />

The nothing that is not there<br />

53 CLASSIFIEDS<br />

51<br />

19<br />

www.nzoptics.co.nz | PO Box 32185, Devonport 0744 | New Zealand | ISSN 0110-8697 (Print) | ISSN 2703-660X (Online) | facebook.com/NZOptics<br />

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

For editorial, please contact Susie Hill at susie@nzoptics.co.nz or +64 21 815 504 or Drew Jones at drew@nzoptics.co.nz<br />

For all advertising/marketing enquiries, please contact Susanne Bradley at susanne@nzoptics.co.nz or +64 27 545 4357<br />

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

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<br />

2015 Ltd. As well as the magazine and the website, NZ Optics 2015 Ltd publishes the New Zealand Optical Information Guide (OIG), a comprehensive online listing guide that profiles the<br />

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<br />

those of NZ Optics 2015 Ltd or the editorial team.


Seeing things… differently<br />

SPRING HAS WELL and truly<br />

sprung and I’m loving the longer<br />

evenings, as I’m sure you are too.<br />

While our globetrotting<br />

publisher/editor Lesley is soaking<br />

up the latest trends at Silmo in<br />

Paris, Drew, Sara, our ‘editorto-the-rescue’<br />

Susie and I have<br />

been busy holding the fort. This<br />

month, we are pleased to present<br />

a fascinating feature on the<br />

impact of pregnancy on the eye<br />

by our wonderful optometrist<br />

contributor Layal Naji (p16), a<br />

CPD update from the ODOB<br />

(p10), musings from our ‘whitecaner’<br />

columnist Trevor Plumbly (p54), plus Dr Ben LaHood’s take on the<br />

latest AUSCRS conference, held on sunny Hamilton Island (p30) – never a<br />

dull moment there!<br />

And remember, World Sight Day is just around the corner on Thursday<br />

10 <strong>Oct</strong>ober. How will your practice mark it? Why not consider joining<br />

the final stretch of the Eye Health<br />

Aotearoa campaign spotlighting kids’<br />

eye health? For resources, see www.<br />

eyehealthaotearoa.org.nz/childrens_<br />

eye_health_campaign. Or, if you have<br />

a manual lensmeter collecting dust,<br />

Fred Hollows Foundation is seeking<br />

equipment support (see classifieds p53).<br />

Enjoy!<br />

Susanne Bradley,<br />

NZ Optics<br />

CONTRIBUTORS<br />

Vicky Wang<br />

Therapeutically qualified optometrist<br />

Vicky Wang grew up in a family with<br />

two generations of doctors and nurses,<br />

so curiosity about the human body<br />

was practically in her DNA, she says.<br />

“I remember the thrill of peeking at<br />

specimens and glass jars of organs<br />

whenever I visited my grandfather’s<br />

hospital.” But, as a high myope herself,<br />

it was the eye that really caught her<br />

attention and ultimately sparked her<br />

passion for optometry.<br />

Vicky says she vividly remembers fitting spectacles on a child with<br />

a significant refractive error for the first time. “The smile on his face<br />

was absolutely priceless. That was when I knew I had found something<br />

truly special. Even now, every time I place aphakic contact lenses on a<br />

baby and watch their eyes start to focus and connect, my heart pounds<br />

with excitement.”<br />

What gets Vicky fired up about the future of optometry is the human<br />

element, she says. She’s involved in a school screening project with<br />

Auckland University’s School of Optometry and Vision Science, which she<br />

says will be a highlight for the next couple of years. “We’ll be traveling across<br />

various parts of New Zealand to provide a much-needed service to kids.”<br />

After-hours, Vicky says her two children keep her on her toes, attending<br />

their music concerts and sports events. She also has an enduring love for<br />

music and baking. “At one point, I even dreamed of owning a cosy coffee<br />

shop where I could bake treats and host live music nights. Who knows,<br />

maybe one day I’ll combine all my passions into one!”<br />

Vicky reports on Greenlane’s inaugural emergency eyecare seminar on p44.<br />

Lynden Mason<br />

At 18 years of age, when Lynden Mason<br />

had been accepted into Otago medical<br />

school, his future was seemingly<br />

mapped out. “But my entrepreneurial<br />

ventures had given me a taste for<br />

making money without as much effort<br />

as I’d have to put into being a doctor,”<br />

he admits. The grumblings of a career<br />

counsellor, rather than his advice, was<br />

what eventually steered Lynden into<br />

optometry. “He complained he’d just<br />

spent 30 minutes getting his eyes<br />

tested and it had cost him $800 for new glasses. My interest was piqued!”<br />

Fiscal benefits aside, within his first year as an optom, Lynden says<br />

he’d realised how eyecare could make huge tangible improvements to<br />

patients’ lives. “To this day, this is still what I get such a buzz out of: either<br />

providing reassurance to someone who’s nervous about losing their vision<br />

or showing them how much improvement we can give them.”<br />

Lynden suggests any optom at the start of their career should learn to<br />

be a good communicator and a great listener and remember people are<br />

at optometry’s heart. He also encourages them to be open to exploring<br />

the many avenues the profession offers. “I went straight into focusing<br />

on business, which meant I didn’t take advantage of being young. I wish<br />

someone had told me not to take it all so seriously in my youth!”<br />

Lynden’s business partner, Teréze Taber, is also his wife. He says<br />

they’re fortunate to really enjoy working together. “Our skill sets are<br />

very complementary and we give each other space to thrive in the areas<br />

that we each excel. It’s always refreshing to be able to bounce ideas off<br />

someone who knows you well and sees your vision.”<br />

Lynden and Teréze offer practice owners some bottom-line fundamentals<br />

on p42.<br />

6 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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NEWS<br />

Taking the sting out of cataract surgery<br />

By Drew Jones<br />

WHAT IS EXPECTED to be permanent Pharmac funding of Ilevro, a<br />

non-steroidal anti-inflammatory drop for post-cataract surgery patients,<br />

has been welcomed by New Zealand eyecare professionals.<br />

Ilevro (nepafenac 0.3% ophthalmic suspension) is a “dream come<br />

true” for cataract patients who would have previously been prescribed<br />

Voltaren drops, which really sting, said Jagrut Lallu, co-owner and<br />

senior optometrist at Rose Optometry in Hamilton. “I only know<br />

about it because I recently had surgery myself and had to sort out my<br />

medication. It’s on the (Pharmac funding) schedule now and it’s light<br />

years ahead of Voltaren.”<br />

The Voltaren data sheets say approximately 15% of patients have<br />

‘transient stinging and burning’, said Nick Mathew, optometrist and<br />

clinic director at Re:Vision Laser & Cataract. “But I would say the<br />

stinging is almost universal; it’s just that some patients are affected by it<br />

more than others.”<br />

Ilevro has actually been available off and on for the last three years,<br />

he explained. “When Voltaren supplies were low in January 2021, Ilevro<br />

was brought in as a funded alternative. We hoped it would continue<br />

to be funded, but once Voltaren supply resumed in July 2021, Ilevro<br />

was de-funded and it was back to Voltaren.” However, with Voltaren<br />

production ceasing, it will be delisted from the schedule in December<br />

<strong>2024</strong>, meaning this time it should be a permanent change to Ilevro,<br />

said Mathew.<br />

Ilevro’s thickness means it blurs the vision a little, so it’s<br />

recommended patients use it at bedtime for an overnight antiinflammatory<br />

effect, he said. “They use their dexamethasone drops in<br />

the daytime, so I believe we<br />

have better anti-inflammatory<br />

cover this way. Clinically,<br />

there seems to be little<br />

difference to Voltaren, but<br />

patient comfort and oncedaily<br />

dosing (compared to<br />

four times daily with Voltaren)<br />

are major advantages.”<br />

Mathew said he expects<br />

this will lead to better<br />

patient compliance and,<br />

therefore, post-surgery<br />

outcomes. “Voltaren really<br />

stings. Patients prefer Ilevro, for<br />

sure. Hands down, it’s better.”<br />

The drops have other roles<br />

beyond cataract surgery recovery, he added. “Post-surgical is the main<br />

reason it is prescribed by me, in place of Voltaren or Acular (ketorolac). I<br />

have prescribed it twice daily for episcleritis with good effect.”<br />

Although the preservative benzalkonium chloride (BAK), whose<br />

cornea-damaging effects have been highlighted in a recent Glaucoma<br />

New Zealand campaign, is used in Ilevro, Mathew said this shouldn’t be<br />

a major concern for post-surgery use. “While it is helpful to avoid BAK<br />

in long-term medications, it can assist the penetration of the drop and<br />

improve clinical effectivity.”<br />

Eye Surgeons expands team<br />

Drs Verona Botha and Ammar Binsaqiq and A/Prof James McKelvie<br />

DRS VERONA BOTHA and Ammar Binsadiq have joined Associate<br />

Professor James McKelvie at his Waikato-based clinic Eye Surgeons,<br />

to accommodate growing demand from population growth and<br />

shifting demographics.<br />

Welcoming the new doctors, A/Prof McKelvie said the addition<br />

of Drs Botha and Binsadiq represents a significant step for Eye<br />

Surgeons. “We are constantly striving to enhance the level of care<br />

we provide. By welcoming these new specialists with expertise in<br />

oculoplastic and retinal surgery, respectively, we’re able to offer a<br />

more comprehensive range of treatments and stay at the forefront<br />

of advancements in eyecare.”<br />

A shared commitment to providing patient-centered care,<br />

leveraging advanced technology and fostering a collaborative<br />

approach appealed to Dr Botha. “By joining forces, we can offer a<br />

comprehensive range of services to patients in the Waikato. As one<br />

of the only fellowship-trained oculoplastic surgeons in this region,<br />

I’m personally committed to providing exceptional specialised care<br />

to our patients,” she said.<br />

To improve accessibility, especially for those living in the southern<br />

Waikato region, Eye Surgeons now offers clinics in both Hamilton<br />

and Cambridge, said A/Prof McKelvie.<br />

8 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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NEWS<br />

ODOB tackles<br />

CPD woes<br />

By Susanne Bradley<br />

RESPONDING TO FRUSTRATIONS from practitioners<br />

and education providers, the Optometrists and<br />

Dispensing Opticians Board (ODOB) has reviewed<br />

its CPD accreditation process and made changes to<br />

improve user experience and help facilitate compliance.<br />

The certification programme is not designed to be punitive or<br />

restrictive, said Suzanne Halpin, ODOB registrar and chief executive.<br />

“Its sole purpose is to facilitate practitioners maintaining their<br />

competence to practise and there’s no need for it to be overly complex<br />

or convoluted.”<br />

St George’s Eye Care<br />

Dr Paul Baddeley and Dr Oliver Comyn<br />

Cataract Surgery<br />

Glaucoma<br />

Medical Retina<br />

Retinal Surgery<br />

Oculoplastics<br />

Uveitis<br />

E: Eyecare.Reception@stgeorges.org.nz<br />

P: 03 375 633 W: stgeorges.org.nz<br />

Check ODOB’s events calendar to see which events have been accredited<br />

Following the review, there is no<br />

longer a requirement to reference the<br />

Board’s standards when applying for<br />

accreditation of a CPD event/activity;<br />

CPD providers will no longer need to<br />

provide multiple-choice questions for<br />

online events; if practitioners write<br />

and present (15 minutes or longer) at a<br />

CPD event or activity accredited by the<br />

ODOB, they may claim one CPD credit<br />

in addition to any CPD credits that<br />

apply for attendance at the event; and<br />

practitioners undertaking peer-to-peer<br />

Suzanne Halpin<br />

reviews or case discussions (which are<br />

not independent glaucoma-prescriber general peer reviews) may<br />

now apply for accreditation of these events using a standard CPD<br />

accreditation application form.<br />

Also, practitioners wishing to obtain CPD credits for conferences where<br />

the organiser has not obtained accreditation from the ODOB, now only<br />

need to make one application to cover accreditation of all conference<br />

sessions they attend, rather than one per session. For any CPD event or<br />

activity, Halpin encourages practitioners to check ODOB’s events calendar<br />

to see if the event has been accredited. If it hasn’t already, apply for<br />

accreditation well in advance (or as soon as possible afterwards), because<br />

CPD events aren’t accredited indefinitely, she said.<br />

Next, the ODOB is attempting to devise a better process for the<br />

accreditation of glaucoma peer reviews Halpin said. “The current system<br />

involves the event organiser having to chase up information from event<br />

attendees and then upload it to our system so it can be accredited, which<br />

is less than ideal. The practitioner should be solely responsible for that.”<br />

A change already initiated is that optometrists who aren’t independent<br />

glaucoma prescribers (IGPs), or IGPs who aren’t attending an IGP event<br />

for fulfilment of their IGP research vocational requirements, can now<br />

apply for general CPD credits, she added.<br />

Halpin reiterated the ODOB has a 20-working-day turnaround on<br />

each CPD accreditation application. However, she said it is typically<br />

done in a much shorter timeframe, especially when an application is<br />

complete or near complete from the start and requires fewer requests for<br />

additional information.<br />

If practitioners experience difficulties, they are strongly encouraged<br />

to contact the ODOB education officer, Penny Davenport, with their<br />

concerns as soon as they arise, said Halpin. “Penny is fantastic at getting<br />

people across the line and goes above and beyond to help practitioners<br />

and providers out. If it turns out there’s a potential systemic issue,<br />

she is also very good at advocating for change, taking a commonsense<br />

approach.”<br />

Finally, Halpin stressed that while the ODOB’s primary role is as<br />

a regulator of health professionals to protect the health and safety<br />

of patients and the public, it also prioritises agility, transparency,<br />

accountability and fairness. “When we receive complete applications<br />

for accreditation of CPD events and activities, all the changes we have<br />

implemented so far should make for a more streamlined process, which<br />

practitioners should perceive as less onerous and time consuming.”<br />

10 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


EDUCATION<br />

One patient’s arduous journey to<br />

cataract surgery<br />

By Naomi Meltzer<br />

A 74-YEAR-OLD insulin-dependent diabetic went for his<br />

diabetic retinal screening (DRS) last year but was told his retina<br />

could not be seen due to cataracts. They advised him to go to<br />

the eye clinic to arrange surgery.<br />

The patient is the caregiver for his wife, who’s had Parkinson’s<br />

disease for 50 years, along with other health issues. While<br />

waiting for his wife to have her DRS, and armed with a letter<br />

from his optometrist, he headed off to make an appointment,<br />

as advised. Shortly after taking a seat at the eye clinic, he was<br />

approached by a staff member who ranted at him about the<br />

incompetency of his optometrist for sending a letter that was<br />

not adequate for a referral, implying the patient was trying to<br />

dodge the system to get cataract surgery!<br />

Angry and confused, the man went home and decided his<br />

eyes were not a priority.<br />

As his 75th birthday approached, he plucked up the<br />

courage to deal with the renewal of his driver’s licence –<br />

essential to being able to attend the couple’s various medical<br />

appointments and going to the supermarket. As his last vestige<br />

of independence, financially and psychologically, the loss of his<br />

driver’s licence would be devastating.<br />

Having been assured by his optometrist he was right on the<br />

legal limit for driving, he high-tailed it out of there without<br />

admitting the extent to which his vision was troubling him,<br />

particularly his inability to read.<br />

A month later, he attended an appointment at the hospital<br />

eye clinic for his cataracts, only to be told that since he was<br />

just on the legal limit for driving, he did not qualify for publicly funded<br />

cataract surgery. There was no mention of diabetes, nor the fact he had<br />

been sent there after failing the DRS! In fact, his diabetes seemed to have<br />

completely slipped off the page. To this day, he has not been called back<br />

to the screening programme.<br />

He was, however, relieved that no eye surgery was imminent, as he<br />

was about to restart chemotherapy for colorectal cancer. He had been in<br />

remission for about a year, but it was now raising its head again. Sadly,<br />

though, he was no longer able to read books or newspapers to take<br />

his mind off the side effects of chemo or the intense sciatic pain, which<br />

eventually radiated down both legs. He was angry and frustrated, and<br />

his wife and family were not able to broach the subject of his worsening<br />

vision with him, as he had made up his mind that cataract surgery was<br />

not available to him.<br />

A turning point<br />

Eventually the gentleman in question was persuaded that, even though<br />

he could not afford new glasses and he had too many other things to<br />

deal with, a visit to his optometrist was needed to check out what might<br />

be going wrong with his eyes, besides cataracts. It was pointed out that,<br />

after 30 years of diabetes, macula damage was a strong possibility and<br />

potentially more urgent than cataract surgery.<br />

His optometrist confirmed advanced cataracts needing urgent<br />

attention and referred him to the Aotearoa Charity Hospital Trust (ARCH),<br />

which was established to provide free elective surgery and medical<br />

outpatient clinics to those in immediate need but unable to afford<br />

private treatment. To receive pro bono surgery at ARCH the patient must<br />

be referred by a health professional who signs a declaration confirming<br />

the patient meets all the criteria, such as being a New Zealand citizen<br />

who is unable to afford private treatment, not having medical insurance<br />

or ACC cover, and who has been declined access to treatment in the<br />

public system within the last six months.<br />

Difficulties in a patient journey can cause anger and frustration. Credit: Andy Urdaneta<br />

Auckland practices Re:Vision, Auckland Eye and Milford Eye Clinic<br />

regularly provide free cataract surgery under the ARCH umbrella. The<br />

patient then underwent a thorough examination at Re:Vision to rule out<br />

any other pathology. Fortunately, with no sign of diabetic maculopathy,<br />

cataracts were confirmed as the source of the problem.<br />

His latest spectacle prescription was: RE +4.25 -2.50 x 112, add +2.50;<br />

LE +2.75 -1.00 x 40, add +2.50. His right eye was slightly amblyopic, with<br />

best corrected acuity prior to cataract being 6/9. He had always been<br />

very dependent on his left eye, the acuity of which had now slipped<br />

to a poor 6/18. It was decided that immediately sequential, bilateralcataract<br />

surgery (ISBCS) would be the safest solution, given his high<br />

anisometropia, increasing the risk of a fall or a driving accident, were<br />

the surgeries separated by any length of time. His walking had become<br />

a little wobbly anyway, because his spine had collapsed in the last few<br />

months, causing immense pain and leading to an increased intake of<br />

painkillers just to enable him to stand upright.<br />

A couple of weeks later, his ISBCS went smoothly; his uncorrected<br />

vision at the first check-up the next day had returned to 6/12+. One<br />

month later, his uncorrected vision was 6/9 binocularly, and best<br />

corrected acuity 6/6+.<br />

He went from being reluctant to admit he had yet another problem<br />

to trumpeting how life-changing his cataract surgery had been and how<br />

thankful he was to ARCH for making this pro bono surgery possible, and<br />

to the Re:Vision team for their amazing philanthropic care.<br />

Fortunately, this patient is not one of my low-vision patients, he is<br />

my brother.<br />

Naomi Meltzer is an optometrist who runs an independent<br />

practice specialising in low-vision consultancy. She is a regular<br />

contributor to NZ Optics.<br />

12 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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NEWS<br />

Shingles: a crucial<br />

conversation for the over-50s<br />

By Susie Hill<br />

SINCE HERPES zoster (HZ) infections<br />

can cause permanent vision loss, eyecare<br />

professionals should make it a priority to<br />

talk to patients aged over 50 years about the<br />

importance of preventing shingles through<br />

vaccination, said Dr Rachael Niederer,<br />

an ophthalmologist and senior lecturer at<br />

Auckland University.<br />

Dr Niederer emphasised the importance<br />

of the Shingrix vaccine, administered in two<br />

doses, two to six weeks apart. This vaccine has<br />

shown remarkable efficacy, she said, with an<br />

overall effectiveness of 97.2% in individuals<br />

aged 50 and older, and 91.3% in those aged<br />

70 and older. “About 1 in 10 people who get<br />

shingles will lose their vision. I frequently see<br />

people who lose their vision due to shingles,”<br />

she said.<br />

When the varicella-zoster virus reactivates<br />

in the ophthalmic division V1 of the<br />

trigeminal nerve, it can lead to herpes zoster<br />

ophthalmicus (HZO), which often manifests<br />

as conjunctivitis, uveitis and keratitis, she said.<br />

Approximately one in three New Zealanders<br />

Distribution of shingles associated with the ophthalmic nerve<br />

will experience shingles in<br />

their lifetime, with 10–15% of<br />

these cases showing V1 distribution and half of<br />

these involving the eye. The risk of moderate<br />

(6/15) permanent vision loss is 1 in 10, while<br />

severe (6/60 or worse) vision loss is 1 in 30 for<br />

those with this distribution.<br />

Further HZO complications include<br />

corneal scar, neurotrophic keratopathy, band<br />

keratopathy, corneal melt, corneal perforation<br />

and acute retinal necrosis or panuveitis, all<br />

contributing to vision loss, she added.<br />

Patients with shingles can suffer<br />

from permanent nerve pain, chronic dry eye,<br />

and even dementia, said Dr Niederer, with<br />

cranial nerve palsy leading to stroke and<br />

double vision in rare cases.<br />

Recent evidence suggests shingles can<br />

have profound neurological effects. “Strokes<br />

typically occur two to four months after<br />

infection. The risk of dementia persists for<br />

several years after a shingles episode.”<br />

Dr Niederer said she is excited by the<br />

research in this area, citing a large metaanalysis<br />

in Neurology which concluded the<br />

herpes zoster vaccination was associated with a<br />

reduction of the risk of dementia.<br />

A study in Nature Medicine also found<br />

subjects receiving Shingrix had a 17% lower<br />

risk of being diagnosed with dementia in<br />

the six years after inoculation, compared to<br />

people who got the Zostavax vaccine. Further,<br />

a GSK study of 600,000 patients showed<br />

those who got the Shingrix vaccine were<br />

about 23% less likely after five years to have a<br />

diagnosis of dementia, compared with people<br />

receiving Zostavax.<br />

In New Zealand, only those aged 65 years<br />

or who are immunosuppressed are eligible for<br />

the free vaccine; for others, immunisation costs<br />

between $600 to $800. “If you are 66, you don’t<br />

get it funded, which is crazy!” said Dr Niederer.<br />

Dr Niederer advised that patients must<br />

wait at least 12 months after their shingles<br />

episode (off treatment and no flare-ups) before<br />

receiving the vaccine.<br />

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Health checks for older doctors?<br />

FOLLOWING DATA REVEALING patient complaints jump significantly<br />

with increasing age of their doctor, the Medical Board of Australia (MBA)<br />

is considering regular health checks for medical practitioners over 70<br />

years old.<br />

The rate of notifications related to health impairments is more than<br />

three times higher for those over 70 compared with younger colleagues,<br />

according to an MBA statement. “The Australian Health Practitioner<br />

Regulation Agency’s complaints data show that doctors aged over 70<br />

are 81% more likely to be the subject of a notification for any reason (not<br />

just impairment) than those under 70. Proposals for keeping late-career<br />

doctors in safe practice are now open for public comment.”<br />

Doctors in the 70–74-year-old bracket “jumped disturbingly” rising<br />

more than 130% from 2015 to 2023. For medical practitioners aged 80<br />

and over, notifications climbed by more than 180% per 1,000 doctors<br />

between 2015 and 2023, the statement revealed.<br />

While late-career doctors make up a relatively small proportion of the<br />

medical workforce, health ministers<br />

and the community expect the<br />

MBA to prevent avoidable harm to<br />

patients, said the MBA. “To protect<br />

patients while also extending the<br />

careers of medical practitioners in<br />

a safe way, the Board is consulting<br />

on a range of proposals to<br />

safeguard the health, privacy<br />

and independence of late-career<br />

doctors by managing preventable<br />

risks to patient safety.”<br />

The Board’s preferred proposal<br />

would require late-career doctors<br />

to undergo general health checks<br />

with their GP or another doctor<br />

every three years and yearly from<br />

80 years of age.<br />

Such a measure could prevent<br />

future patient harm and provide<br />

opportunities for practitioners<br />

to extend their careers, said MBA<br />

chair Dr Anne Tonkin AO. “It’s in line<br />

with all public health screening<br />

measures. Early detection means<br />

early management, which can<br />

mean preventing avoidable<br />

risks,” she said. “Doctors are often<br />

reluctant patients and we are<br />

concerned they don’t always seek<br />

the care they need. We’re looking<br />

for a way to keep late-career<br />

doctors in charge of their career.”<br />

Under the proposal, results of<br />

such checks would be confidential<br />

between the late-career doctor<br />

and their treating practitioner.<br />

The MBA would only be informed<br />

if a treating practitioner made a<br />

mandatory report about a latecareer<br />

doctor who refused to<br />

manage the risk to patients caused<br />

by ill health.<br />

Public consultation is open until<br />

4 <strong>Oct</strong>ober <strong>2024</strong>. For more, see<br />

www.medicalboard.gov.au/News/<br />

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NZOPTICS.CO.NZ | 15


What to expect when your patient is expecting<br />

By Layal Naji<br />

ANYONE WHO HAS been pregnant or lived with someone who<br />

was pregnant knows that being expectant comes with its fair share of<br />

surprises – good and bad. Changes in the release of hormones such<br />

as oestrogen, progesterone, relaxin and others incite a chain reaction<br />

with subsequent changes in vascularity, fluid retention and tissue<br />

remodelling. These changes may also have effects on how the eyes look<br />

and function, too. Let’s take a look at some of the eye-related clinical<br />

considerations and possible pathologies during pregnancy.<br />

Pigmentation<br />

An increase in the release of oestrogen, progesterone and melanocytestimulating<br />

hormones during pregnancy can lead to an increase in<br />

pigmentation in the body, including periorbitally 1 . As clinicians, we need<br />

to be able to differentiate iatrogenic causes of hyperpigmentation (for<br />

example, use of prostaglandin analogues) from those related to pregnancy.<br />

Vision<br />

Hormonal modulations also lead to swelling in the lens and cornea,<br />

most often creating a myopic shift (although sometimes it may be<br />

hyperopic or astigmatic). This is why procedures addressing refractive<br />

correction (such as LASIK) are contraindicated during pregnancy.<br />

When screening women of child-bearing age for laser eye surgery, we<br />

must enquire about pregnancy or breastfeeding, says Dr Lana Del Porto,<br />

a Melbourne-based ophthalmologist specialising in cataract, refractive<br />

and strabismus surgery. “It’s important we have a very accurate<br />

understanding of the patient’s refractive error and that the prescription<br />

is not changing when planning laser eye surgery. For this reason, we<br />

do not offer it when the patient is pregnant or breastfeeding. Instead,<br />

we invite them to return for an assessment, generally six weeks after<br />

cessation of breastfeeding.”<br />

The ocular surface<br />

Increasing gestational age is associated with changes to tear-film<br />

physiology and increased incidence of dry eye in pregnant women.<br />

Pregnancy leads to several ocular surface changes, which are further<br />

exacerbated by existing pathology, says Dr Stuti Misra, an optometristscientist<br />

and senior lecturer at the University of Auckland’s Department<br />

of Ophthalmology. “Dry eye disease is known to occur throughout<br />

pregnancy but increases with gestational age 2 . Common assessments<br />

including tear breakup time and Schirmer test are reported to worsen in<br />

the third trimester of pregnancy 3 .”<br />

There is conflicting evidence on the cause of this association.<br />

Hormonal modulations to oestrogen/prolactin/testosterone levels<br />

and immunoarchitectural changes to the lacrimal gland have been<br />

postulated to play a role 4 . Similarly, there is no consensus on whether<br />

pregnancy is related to evaporative, aqueous deficient, or mixed dry<br />

eye 5,2 . Following the DEWS II dry eye sub-group diagnostic tests,<br />

including a dry eye questionnaire, non-invasive tear breakup time,<br />

Schirmer test and identification of meibomian gland disorder (eg,<br />

through meibography/meibomian gland assessment) can help us<br />

adequately assess and manage the presentation of dry eye in our<br />

pregnant patients 5,6 .<br />

Keratoconus<br />

Pregnancy can also be considered a risk factor for keratoconus<br />

progression, affecting not only corneal topography, thickness<br />

measurements and curvature, but also biomechanical properties<br />

such as corneal hysteresis and corneal resistance factor 7 . Again, the<br />

mechanisms behind these changes are unclear; they could be related to<br />

lower thyroxine levels, changing oestrogen levels, or increasing relaxin<br />

levels (changing synthesis of MMPs and TIMPs) 8 . Interestingly, there<br />

is some evidence there may be some partial recovery after cessation of<br />

breastfeeding 9 , indicating that clinicians should wait for stabilisation of<br />

corneal parameters before determining a management approach. “I had<br />

a patient last year who had recently moved to Australia from Canada,”<br />

says Dr Del Porto. “She had keratoconus. Her corneal tomography<br />

showed significant worsening of her keratoconus compared to three<br />

years prior. During that time, she had been pregnant twice.”<br />

Keratectasia<br />

Dr Misra points out that a scoping review noted the tendency of<br />

pregnant patients to develop iatrogenic keratectasia several years<br />

after receiving LASIK, with or without preoperative risk factors.<br />

“Importantly, the ectasia may re-occur in second or third pregnancies.<br />

However, most of the related ocular symptoms are likely to persist<br />

postpartum 10 . A few studies have also shown steepening of topography,<br />

a decline in spherical equivalent refraction and an increase in<br />

astigmatism 11 .” So, in addition to standard refraction for pregnant<br />

patients, it may be of benefit for optometrists to conduct a complete dry<br />

eye disease work-up, along with corneal topography, Dr Misra suggests.<br />

Continued on p18<br />

16 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


Eye Institute Annual<br />

Optometry Conference<br />

A FREE<br />

half day<br />

educational<br />

conference at<br />

Aotea Centre<br />

Please join us for an exciting and informative<br />

half day of valuable CPD points and engaging<br />

rapid fire presentations. Accompany your peers<br />

in listening to our world class surgeons speak<br />

on the latest in ophthalmic topics.<br />

This conference includes a stand-up breakfast, morning<br />

tea, lunch with beverages and a barista onsite!<br />

We recognise how the economic slow-down has<br />

impacted New Zealand, including throughout the health<br />

sector. Eye Institute has decided to make this a free event<br />

to thank and recognise the support that our optometrist<br />

colleagues have provided for almost 30 years.<br />

Venue: Aotea Centre,<br />

50 Mayoral Drive, Auckland<br />

Date: Sunday 10th November <strong>2024</strong><br />

Time: 8.30am – 1.30pm<br />

(including breakfast and lunch)<br />

Parking: Free parking is available at The Civic<br />

undercover carpark if your ticket is validated<br />

by the event manager on the day.<br />

Tickets: To thank our optometry colleagues,<br />

we have made this a FREE event. Any<br />

purchased tickets will be automatically<br />

refunded.<br />

THANK YOU TO OUR SPONSORS<br />

Book now for your CPD credits (including therapeutics).<br />

Visit eyeinstitute.co.nz and go to our event page to REGISTER.<br />

NZOPTICS.CO.NZ | 17


FEATURE<br />

Continued from p16<br />

Intraocular pressure and<br />

glaucoma<br />

Studies have shown intraocular<br />

pressure (IOP) can decrease by up to<br />

20% during pregnancy 12 . There are<br />

not enough randomised controlled<br />

trials to understand the physiology<br />

behind this change, but it has been<br />

hypothesised it could be multifactorial<br />

– attributable to increased aqueous<br />

outflow, decreased episcleral venous<br />

pressure (from an overall decrease<br />

in systemic vascular resistance)<br />

and decreased scleral rigidity due<br />

to increase in tissue elasticity (from<br />

oestrogen and progesterone release) 13 .<br />

This is a genuine decrease in IOP<br />

and not artefactual, so normal IOP<br />

cut-offs for our pregnant patients with<br />

glaucoma and ocular hypertension<br />

should be applied.<br />

Conversely, there is some evidence<br />

that a history of pregnancy that<br />

results in delivery (especially three or more) can be associated with<br />

an increased incidence of open-angle glaucoma 14 . This has been<br />

suggested to be related to high oestrogen levels during pregnancy;<br />

transient events during labour (including systemic hypotension and<br />

decreased ocular perfusion because of bleeding) inducing glaucomalike<br />

changes in the optic nerve; oxytocin levels during labour inducing<br />

capillary constriction and decreasing aqueous outflow; stress during<br />

labour causing the release of adrenaline and noradrenaline that lead<br />

to an increase in IOP; and the valsalva reflex during labour producing<br />

intermittent increases in IOP.<br />

Uveitis<br />

It is hard to generalise about pregnant<br />

women who have uveitis associated<br />

with autoimmune conditions (Behçet<br />

disease, idiopathic, sarcoidosis,<br />

Vogt-Koyanagi-Harada-associated,<br />

juvenile idiopathic arthritis etc.) as<br />

there are issues with sample size and<br />

limited studies when it comes to the<br />

literature. From what is available,<br />

though, uveitis appears to worsen in<br />

the first trimester, be less active later<br />

on, and increases postpartum, with an<br />

increased risk of uveitis flare within six<br />

months of delivery 15,16 . More than 50%<br />

of patients in a case series experienced a uveitis episode in the first six<br />

months postpartum 16 .<br />

Neuro-ophthalmic presentations<br />

Multiple sclerosis is another autoimmune inflammatory condition that<br />

presents a similar situation: most cases improve during pregnancy, but<br />

attacks (including episodes of optic neuritis) can increase in the first few<br />

months postpartum 17 .<br />

Idiopathic intracranial hypertension can be exacerbated during<br />

pregnancy, especially as maternal weight gain increases with increasing<br />

gestational age 18 . Pituitary adenomas are another pathology that can<br />

progress during pregnancy, with the classic bitemporal visual-field<br />

defect becoming more prominent or deepening/expanding 19 . For each<br />

of these presentations we should follow our pregnant patients a little<br />

more frequently, with appropriate visual field and optical coherence<br />

tomography performed as indicated.<br />

There is some evidence that a<br />

history of pregnancy that results<br />

in delivery … can be associated<br />

with an increased incidence of<br />

open-angle glaucoma<br />

During the postpartum period, pituitary<br />

apoplexy/Sheehan syndrome is a neuroophthalmic<br />

presentation to watch out for.<br />

With the significant blood loss associated<br />

with labour and the postpartum period, a<br />

large haemorrhage can decrease perfusion<br />

of the pituitary gland. This infarct leads to<br />

swelling of the pituitary gland, which leads<br />

to compression of the visual pathway and<br />

symptoms such as sudden headache, diplopia,<br />

or vision loss 20 .<br />

Posterior eye and visual pathway<br />

Pregnancy can be considered an immune<br />

condition (since there are genetic<br />

differences between the mother and foetus).<br />

This can alter immune functionality<br />

and in some instances be related to<br />

toxoplasmosis reactivation 21 .<br />

Preeclampsia is a condition that may<br />

develop in women who are more than 20<br />

weeks pregnant. Blood pressure rises above<br />

140/90 (this does not need to be sustained)<br />

and there is proteinuria. Preeclampsia<br />

exists on a spectrum, with a variant<br />

being HELLP (haemolysis, elevated liver enzymes and low platelets)<br />

syndrome, and more end-stage presentations including eclampsia<br />

and posterior reversible encephalopathy syndrome (PRES). Each of<br />

these presentations can cause visual changes such as blurred vision,<br />

photopsias, scotomas, diplopia and, in the case of PRES, even cortical<br />

infarcts that lead to visual field defects and cortical blindness 22 . The<br />

treatment for these presentations targets the eclampsia; if your patient’s<br />

vision is affected and they have a positive history for one of these<br />

presentations, then you must take a multidisciplinary approach and<br />

contact their obstetrics team. This spectrum of presentations can also<br />

lead to ocular signs such as bilateral serous retinal detachments, or<br />

retrograde retinal nerve fibre layer/<br />

ganglion cell damage. Since first<br />

observation could even be in the<br />

postpartum period, it is important to<br />

get a thorough history of the patient’s<br />

pregnancy, where relevant. If there<br />

is a positive history, once again, a<br />

multidisciplinary approach with<br />

involvement from general practice<br />

(including vascular workup), obstetrics<br />

and endocrinology could be indicated.<br />

The exact pathophysiology of the<br />

serous detachments is unknown,<br />

but current knowledge points to a<br />

link to the higher choriocapillaris<br />

vascular density in pregnant women. When there is a comorbidity of<br />

hypertension, there can be formation of microthrombi in the choroidal<br />

vasculature, and this ischaemic environment causes a breakdown of<br />

the blood-retina barrier and reduced resorption of subretinal fluid,<br />

ultimately leading to a serous retinal detachment 23 .<br />

Vascular changes<br />

During pregnancy cardiac output and systemic volume increases by<br />

30–50%, blood vessels swell and become more friable and there is a<br />

decrease in fibrinolytic activity, creating a hypercoagulable state. This<br />

can lead to retinal arterial and venous occlusion during pregnancy.<br />

This is especially relevant for patients with pre-existing thrombophilic<br />

conditions or other underlying disease (such as preeclampsia/<br />

thrombotic thrombocytopenic purpura). The resulting increase<br />

in venostasis means relevant patients are often prescribed<br />

prophylactic anticoagulants 24 .<br />

18 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


Diabetes<br />

Worldwide, there is an increased incidence of diabetes, obesity and<br />

increased maternal age at first pregnancy. This has created an increasing<br />

likelihood of comorbidity of pregnancy and diabetes. It is important<br />

to note that a patient with gestational diabetes is less likely to develop<br />

diabetic retinopathy (DR); rather, it is the patients with existing DR<br />

who we should watch more closely as their retinopathy is more likely to<br />

progress. This is because the haemodilution associated with pregnancy<br />

leads to a more hypoxic/ischaemic retinal environment, which<br />

can exacerbate the DR. The risk factors for progressing DR during<br />

pregnancy are poor glycaemic control, comorbid hypertension, and<br />

degree of retinopathy pre-pregnancy 25 . Interestingly, during pregnancy<br />

HbA1c is no longer the gold standard method to gauge glycaemic<br />

control, since the increased renal clearance during pregnancy makes<br />

HbA1c artificially low. Instead, clinicians may ask to review blood<br />

glucose log sheets, and obstetricians will make decisions based on the<br />

glucose tolerance test 26 .<br />

Patients with non-proliferative DR (NPDR) can experience up to<br />

50% progression, with some regressions being observed postpartum.<br />

Severe NPDR transitions to proliferative diabetes in 5–20% of cases and<br />

there is progression of up to 45% in those with existing proliferative DR<br />

(PDR) 27 . So, depending on the severity of your pregnant patient’s prepregnancy<br />

level of DR, comorbidities and glycaemic control, they may<br />

need to be reviewed every trimester, or even monthly.<br />

next year. If they are, it is better<br />

to pursue treatment of the<br />

DR and get it under control<br />

before they are pregnant,<br />

since we know it is<br />

likely to progress. For<br />

example, it would be<br />

clinically justified to treat<br />

a patient with severe<br />

NPDR who is planning<br />

to become pregnant in<br />

the next 12 months. It<br />

could also be a motivation<br />

to better define the full extent<br />

of DR (since some peripheral<br />

neovascularisation is undetected<br />

at times). As optometrists, we can<br />

refer our patients for fluorescein<br />

Delay changes in lens refraction until<br />

after pregnancy or breastfeeding<br />

angiography once it is established that the patient is definitely not<br />

pregnant at the time of testing.<br />

Clinical pearls from Professor Stephanie Watson<br />

Professor Stephanie Watson, chair of the Ophthalmic Research<br />

Institute of Australia, has some clinical pearls to share when it comes to<br />

managing our pregnant and breastfeeding patients:<br />

• Due to changes in refractive error, it is best to delay changes<br />

in spectacle or contact lens refraction until after pregnancy<br />

or breastfeeding<br />

• In cases of accommodative loss or insufficiency, reading glasses could<br />

be provided as a temporary measure<br />

Continued on p20<br />

Pregnant women with existing DR should be watched more closely<br />

Guidelines for treating DR<br />

Guidelines based on the available evidence on DR and pregnancy<br />

recommend treatment in pregnant patients only when their DR has<br />

progressed to PDR. This is because the treatment paradigms for<br />

pregnant women with DR are different. Since anti-VEGF therapy<br />

can alter placental growth factor it must be avoided in pregnancy,<br />

especially during the first trimester. Beyond that, it will be a riskbenefit<br />

conversation between the ophthalmologist and the patient 24 .<br />

Additionally, bevacizumab (Avastin) has a prolonged systemic effects<br />

profile. There are limited data on this matter, but it is interesting to<br />

note that in a study with three patients who received intravitreal<br />

bevacizumab therapy during pregnancy, all of the resulting toddlers<br />

reached developmental milestones appropriately during infancy 28 .<br />

Another notable finding in this review is that more than 50% of the<br />

women receiving intravitreal anti-VEGF were only discovered to be<br />

pregnant after receiving the injection 28 . This raises the question of<br />

whether pregnancy tests should be a routine consideration in relevant<br />

patients before administering intravitreal anti-VEGF.<br />

Intravitreal steroid injection also risks systemic absorption,<br />

so typically the treatment of choice during pregnancy is<br />

retinal laser therapy 27 .<br />

One way this knowledge can improve our practice is by asking<br />

relevant patients with DR if they are planning to be pregnant in the<br />

GRAND ROUNDS <strong>2024</strong><br />

Join us for our next Grand Rounds event at the Remuera Golf Club.<br />

We welcome you and your team to this information CPD points evening.<br />

Wednesday 16 <strong>Oct</strong>ober <strong>2024</strong>, 5.30pm<br />

Remuera Golf Club, 120 Abbotts Way, Remuera<br />

• Dr Mark Donaldson - Lens Replacement & Cataract Surgery<br />

• Dr Penny McAllum - Corneal Epithelial Basement Membrane Dystrophy<br />

• Dr Andrew Riley - Blepharoplasty for Dermatochalasis<br />

• Dr Julia Escardo-Paton - Abusive Head Trauma in Children<br />

• Dr Arvind Gupta - Obstructive Sleep Apnea and Eyes<br />

Dinner from 5.30pm; Presentations begin 6pm<br />

Please register your attendance via eyedoctors.co.nz<br />

NZOPTICS.CO.NZ | 19


NEWS<br />

J&J boosts non-invasive<br />

refractive tech<br />

JOHNSON &<br />

JOHNSON (J&J)<br />

has invested in<br />

TECLens, a startup<br />

developing a nonincisional<br />

procedure<br />

leveraging<br />

crosslinking (CXL)<br />

technology to<br />

address keratoconus<br />

and correct<br />

refractive errors. Rendering of TECLens treatment with CXLens device<br />

According to<br />

TECLens, while most current treatments to reshape the cornea<br />

require laser ablation or invasive surgery, the company’s noninvasive<br />

treatment incorporates quantitative CXL technology and<br />

a CXLens device bathing the eye in UV light from a fibre-opticconnected<br />

scleral contact lens. The computationally optimised UV<br />

pattern is accompanied by a dose of riboflavin customised for each<br />

eye, stiffening and reshaping the cornea to a specific prescription.<br />

The correction effect is monitored in real time with ultrasound,<br />

said TECLens.<br />

TECLens has conducted a successful pilot study in keratoconus<br />

patients and is currently planning the first refractive-correction<br />

clinical studies.<br />

LD atropine use deemed safe<br />

with exotropia<br />

THE RESULTS OF a Chinese study of myopic children with basic-type<br />

intermittent exotropia support the use of 0.01% atropine eye drops<br />

for slowing myopia progression without interfering with exotropia or<br />

binocular vision, said authors.<br />

Led by Dr Zijin Wang, Nanjing Medical University, researchers<br />

recruited 300 children aged six to 12 years old with myopia of −0.50<br />

to −6.00 diopters. Of these, 200 received 0.01% atropine drops nightly<br />

in both eyes for 12 months, while 100 received placebo. The mean<br />

accommodative amplitude<br />

(AA) change was −3.06D<br />

vs 0.12D in the atropine<br />

and placebo groups,<br />

respectively. The 0.01%<br />

atropine group also<br />

had a decrease in near<br />

magnitude of exodeviation,<br />

whereas the placebo group<br />

had an increase (−1.25<br />

prism diopters (PD) vs<br />

0.74PD, respectively).<br />

Although their findings<br />

support the use of lowdose<br />

(LD) atropine in<br />

these children, AA was<br />

compromised to some<br />

extent, noted authors. Exotropia. Credit: Community Eye Health<br />

Continued from p19<br />

• Corneal crosslinking for keratoconus is contraindicated in pregnancy<br />

but can be considered postpartum if there has been progression<br />

• If vision is reduced during pregnancy or breastfeeding, don’t assume<br />

it is due to refractive error – check for exacerbation of underlying<br />

systemic disease.<br />

Keeping these considerations in mind can prevent unwelcome surprises<br />

for our patients’ ocular and systemic health and help them make the<br />

most of this special time in their life.<br />

References<br />

1. Handel A, Miot L, Miot H. (2014) Melasma: a clinical and epidemiological review. An Bras Dermatol.<br />

Sep-<strong>Oct</strong>;89(5):771-82.<br />

2. Asiedu K, Kyei S, Adanusa M, Ephraim R, Animful S, et al. (2021) Dry eye, its clinical subtypes and<br />

associated factors in healthy pregnancy: A cross-sectional study. PLOS ONE 16(10): e0258233.<br />

3. Stella O, Uden N. (2019). Dry eye disease: a longitudinal study among pregnant women in Enugu, south<br />

east Nigeria. Ocul Surf, 17(3), 458-463.<br />

4. Schechter J, Pidgeon M, Chang D, Fong Y, Trousdale M, Chang N. (2002). Potential role of disrupted<br />

lacrimal acinar cells in dry eye during pregnancy. Adv Exp Med Biol, vol 506.<br />

5. Kunduracı M, Koçkar A, Helvacıoğlu Ç, et al. (2023) Evaluation of dry eye and meibomian gland function<br />

in pregnancy. Int Ophthalmol 43, 4263–4269<br />

6. Craig J, Nichols K, Akpek E, Caffery B, Dua H, Joo C, Liu Z, Nelson J, Nichols J, Tsubota K, Stapleton F.<br />

(2017). TFOS DEWS II definition and classification report. Ocul Surf. 15(3):276-283.<br />

7. Naderan, M. and Jahanrad, A. (2017), Topographic, tomographic and biomechanical corneal changes<br />

during pregnancy in patients with keratoconus: a cohort study. Acta Ophthalmol, 95: e291-e296.<br />

8. Bilgihan K, Hondur A, Sul S, Ozturk S.(2011) Pregnancy-induced progression of keratoconus. Cornea.<br />

Sep;30(9):991-4.<br />

9. Toprak I. To what extent is pregnancy-induced keratoconus progression reversible? A case-report and<br />

literature review. (2023) Eur J Ophthalmol. 33(1):NP37-NP41.<br />

10. Jani D, McKelvie J, Misra S. (2021). Progressive corneal ectatic disease in pregnancy. Clin Exp Optom,<br />

104(8), 815-825.<br />

11. Ataş M, Duru N, Ulusoy D, et al. Evaluation of anterior segment parameters during and after pregnancy.<br />

Cont Lens Anterior Eye. 2014;37:447–450.<br />

12. Pilas-Pomykalska M, Luczak M, Czajkowski J, Woźniak P. (2004) Changes in intraocular pressure during<br />

pregnancy. Klin Oczna. 106(Suppl 1-2):238–9.<br />

13. Yenerel N, Küçümen . (2015) Pregnancy and the eye. Turk J Ophthalmol. 45(5):213-219.<br />

14. Lee J, Kim J, Kim S, Kim I, Kim H, Chung P, Bae J, Won Y, Lee M, Park K. (2019) Epidemiologic Survey<br />

Committee of the Korean Ophthalmological Society. Associations among pregnancy, parturition, and<br />

open-angle glaucoma: Korea National Health and Nutrition Examination Survey 2010 to 2011. J Glaucoma<br />

28(1):14-19.<br />

15. Chiam N, Hall A, Stawell R, Busija L, Lim L. (2013) The course of uveitis in pregnancy and postpartum. Br<br />

J Ophthalmol. 97:1284-1288.<br />

16. Rabiah P, Vitale A. (2003) Noninfectious uveitis and pregnancy. Am J Ophthalmol.136:91-98.<br />

17. Varytė G, Zakarevičienė J, Ramašauskaitė D, Laužikienė D, Arlauskienė A. (2020) Pregnancy and multiple<br />

sclerosis: an update on the disease modifying treatment strategy and a review of pregnancy’s impact on<br />

disease activity. Medicina (Kaunas). 21;56(2):49.<br />

18. Thaller M, Wakerley BR, Abbott S, et al. (2022). Managing idiopathic intracranial hypertension in<br />

pregnancy: practical advice. Practical Neurology 22:295-300.<br />

19. Sirilert S, Traisrisilp K, Pantasri T, Tongsong T. (2019) Pregnancy-induced progressive change of prolactinsecreting<br />

macroadenoma with the development of bitemporal hemianopia and severe headache. Clin Case<br />

Rep. 3;7(7):1365-1369.<br />

20. Woodmansee W. Pituitary disorders in pregnancy. (2019) Neurol Clin. ;37(1):63-83.<br />

21. Elbez-Rubinstein A, Ajzenberg D, Dardé M-L, Cohen R, Dumètre A, Year H, Gondon E, Janaud J-C,<br />

Thulliez P. (2009) Congenital toxoplasmosis and reinfection during pregnancy: case report, strain<br />

characterization, experimental model of reinfection, and review, J Infect Dis, 199(2): 280–285<br />

22. Hindjua A. (2020). Posterior reversible encephalopathy syndrome: clinical features and outcome. Front.<br />

Neurol., Vol 11<br />

23. Kovács E, Molvarec A, Rigó J Jr, et al. (2011) Bilateral serous retinal detachment as a complication of<br />

acquired peripartum thrombotic thrombocytopenic purpura bout. J Obstet Gynaecol Res. 37(10):1506-9.<br />

24. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. (2016). Physiological changes in pregnancy.<br />

Cardiovasc J Afr. 27(2):89-94.<br />

25. Blumer I, Hadar E, Hadden D, Jovanovič L, Mestman J, Murad M, Yogev Y. (2013) Diabetes and<br />

pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 98(11):4227-49.<br />

Update in: J Clin Endocrinol Metab. 2018 Nov 1;103(11):4042<br />

26. Radin M. (2014) Pitfalls in hemoglobin A1c measurement: when results may be misleading. J Gen Intern<br />

Med. 29(2):388-94<br />

27. Chandrasekaran P, Madanagopalan V, Narayanan R. (2021) Diabetic retinopathy in pregnancy - a review.<br />

Indian J Ophthalmol. 69(11):3015-3025.<br />

28. Polizzi S, Mahajan VB. (2015) Intravitreal anti-VEGF injections in pregnancy: case series and review of<br />

literature. J Ocul Pharmacol Ther. 31(10):605-10.<br />

Layal Naji is an Australia-based optometrist, a lecturer of<br />

optometry at the University of Canberra, a co-founder of the<br />

outreach optometry clinic at the Asylum Seekers Centre in<br />

Newtown, Sydney, and a regular contributor to NZ Optics.<br />

20 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


Plastic<br />

neutral †


NEWS<br />

Kids’ vision champion appeals for partners<br />

By Susanne Bradley<br />

WELLINGTON OPTOMETRIST<br />

RAVI Dass, founder of the Foureyes<br />

Foundation, is seeking optical<br />

partnerships to sustain a long-term<br />

expansion of vision services for primaryschool-aged<br />

kids in Aotearoa.<br />

On a mission to help remove<br />

barriers to eyecare for children in need,<br />

the foundation provides free vision<br />

screening, eye exams and glasses through<br />

a network of three clinics in Wellington,<br />

Porirua and Masterton. Partnering with<br />

the Eye Institute in 2020, the charity ran a<br />

successful pilot programme in Dargaville,<br />

which Dass said he is now keen to give a<br />

sustainable, long-term future.<br />

One potential avenue to fund a<br />

Dargaville clinic, besides industry<br />

partnerships, is through research,<br />

said Dass. “As the clinic is based out<br />

of a medical centre, someone with a<br />

research project could capitalise on the<br />

infrastructure and the partnerships<br />

within the systems that I’ve created for the Foureyes Foundation to setup<br />

and fund research.”<br />

Launched in 2016, the foundation’s vision-screening programme<br />

followed Dass’ encounter with a 19-year-old who needed glasses but<br />

had somehow slipped through the system and his vision error had never<br />

been picked up, Dass said. “He had dropped out of school at a young<br />

age and eventually ended up on benefits. I couldn’t help thinking ‘if<br />

his vision problem had been identified earlier, could his life have been<br />

different?’ That encounter became a catalyst for me.”<br />

One in five kids fall through the cracks<br />

Ravi Dass is ‘Mr Foureyes’ to the students he screens<br />

Looking at the B4 School and Well Child programmes to avoid<br />

duplicating existing services, Dass partnered with local schools and<br />

started screening five-to-10-year-olds<br />

for whom there appeared to be a gap<br />

in services and no straightforward<br />

pathway for teachers picking up<br />

suspected vision issues with a child,<br />

he said. Equipped with a Plusoptix<br />

vision screener provided by OptiMed<br />

New Zealand, Dass said he was<br />

averaging about 20% referrals during<br />

screenings, indicating a significant<br />

shortfall in vision problems being<br />

detected through existing channels.<br />

To manage the referral load<br />

and programme expansion, the<br />

screening part of the programme<br />

was successfully transferred to the<br />

participating schools’ learning<br />

support coordinators, Dass said.<br />

This freed up his time to manage the<br />

referrals at the three small, low-cost<br />

clinics he had set up in partnership<br />

with iwi-led medical centres in the<br />

region. “This opened a path for the<br />

kids being referred from the school to get a proper examination and be<br />

equipped with glasses, should they need them,” he said.<br />

What is really needed now is someone who can help fund the service<br />

to make it sustainable long term and to expand the programme to<br />

include areas in the North and South Islands, Dass said. “I know that<br />

there are a lot of optometrists and ophthalmologists out there who<br />

would like to be involved in this process; I welcome them to get in<br />

touch. I can’t replicate myself, so partnering is the key thing for us to<br />

continue to grow our services sustainably.”<br />

Since 2016, the Foureyes Foundation has screened nearly 8,000 kids<br />

and donated around 700 pairs of glasses. The glasses are manufactured<br />

in Dass’ Wellington lab and are paid for through fundraising. For more,<br />

email hello@foureyesfoundation.org.nz<br />

Robotic guide-dog substitute<br />

RESEARCHERS FROM SHANGHAI Jiao Tong University reported a<br />

robot ‘guide dog’ is in development to improve independence for the<br />

visually impaired and shore up demand for traditional guide dogs.<br />

The researchers report the six-legged robo-dog (three legs are<br />

always on the ground) is about the size of an English bulldog and<br />

navigates the physical environment using cameras and sensors. It also<br />

has route-planning capabilities and can communicate with its visually<br />

impaired operator using AI technology and, unlike traditional guide<br />

dogs, it can recognise traffic light signals.<br />

A prototype is being field tested by Shanghai married couple, Li<br />

Fei, who is completely blind, and Zhu Sibin, who is partially blind,<br />

reported researchers. Zhu, who uses a cane to assist him in getting<br />

around, told Reuters that if the robot guide dog came onto the<br />

market, it could solve some of his problems in travelling alone. “If I<br />

want to go to work, the hospital or the supermarket (now) I cannot go<br />

out alone and must be accompanied by my family or volunteers.”<br />

Lead researcher Professor Gao Feng said robot guide dogs are under<br />

development in other countries, including Australia and the UK, but<br />

China has a greater shortage of traditional guide dogs, with just over<br />

Shanghai Jiao Tong University's robot guide. Credit: TrimFeed<br />

400 animals for almost 20 million blind people. “I think this could<br />

be a very large market, because there might be tens of millions of<br />

people in the world who need guide dogs,” he said.<br />

__<br />

22 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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NEWS<br />

Diabetes care by ethnicity at<br />

Greenlane Clinical Centre<br />

By Jahnvee Solanki and Drs Rachael Niederer and Sarah Welch<br />

MĀORI PATIENTS ARE disproportionately<br />

affected by diabetes in New Zealand 1 . The<br />

prevalence of diabetes among Māori is twice<br />

that of Pakeha 1 , and Māori have higher<br />

rates of diabetic complications, including<br />

hospitalisation due to end-stage renal disease,<br />

lower-limb amputations, reduced time to<br />

first major cardiovascular event, and sightthreatening<br />

diabetic retinopathy (DR) 2-4 .<br />

Inequities in healthcare provision to Māori<br />

patients have also been documented across a<br />

range of specialty services 5,6 .<br />

Although DR prevalence is increasing,<br />

and disproportionately affects Māori and<br />

Pasifika, the extent of inequity in the standards<br />

of DR care provided by ethnicity is largely<br />

unknown 7-9 . Our study aimed to evaluate<br />

the comprehensiveness of history taking,<br />

examination and treatment decisions in first<br />

specialist DR appointments by ethnicity at<br />

Greenlane Clinical Centre, Auckland.<br />

Clinical records of all 388 patients seen in<br />

the DR clinic, referred between January 2021<br />

to August 2022, were analysed. We found no<br />

difference in the quality of history taking,<br />

examination, investigations and treatment<br />

offered to patients by ethnicity. These are<br />

unique and promising findings – studies of<br />

general practice and cardiac revascularisation<br />

have found less time on history taking and<br />

fewer investigations and treatments offered to<br />

Māori patients, despite the same eligibility for<br />

treatment as Europeans 5,6 .<br />

Māori patients were under-represented in<br />

referrals to ophthalmology for their disease<br />

burden in the Auckland population and had a<br />

significantly higher number of treatments they<br />

were eligible for (see Fig 1). This represents<br />

more severe disease, delayed presentation and<br />

increased barriers to accessing DR screening<br />

and referral to tertiary care. Known barriers<br />

from previous literature include physical<br />

distance, cost, fewer GP referrals, poor<br />

diabetes education and previous experiences<br />

Fig 1. Māori patients had a significantly higher number<br />

of treatments they were eligible for at presentation<br />

(p=0.003)<br />

of culturally insensitive<br />

comments 10-12 . Marae-based<br />

diabetes education and cervical<br />

screening clinics in Auckland<br />

have improved participation in<br />

exercise and health screening<br />

among Māori 13,14 . Promoting<br />

such educational and DR screening clinics in<br />

marae may improve the uptake of screening<br />

and referral to ophthalmology.<br />

Although referral numbers for Māori<br />

patients were low, the overall rates of<br />

attendance to initial and rescheduled<br />

ophthalmology appointments were<br />

comparable between Māori and other<br />

ethnicities in this study. Previous research<br />

has shown the non-attendance rate to<br />

ophthalmology specialist appointments<br />

among Māori is initially high but improves<br />

for follow-up appointments 15 . Common<br />

reasons for missing appointments include<br />

previous negative staff interactions and<br />

inability to contact clinic schedulers 15 . Our<br />

study highlights that, with significant effort by<br />

clinic schedulers and with culturally sensitive<br />

care, we are able to achieve equivalent<br />

eventual clinic attendance for Māori patients.<br />

Greenlane Clinical Centre staff must be<br />

commended for these efforts and this work<br />

should be continued.<br />

The overall documentation of a complete<br />

assessment and treatment plan was suboptimal<br />

across all ethnicities. Common treatments<br />

missed were performing CPAC scores for<br />

significant cataract, referral to diabetic<br />

nurse clinic for an HbA1c of >100 mmol/<br />

mol, and commencing intravitreal Avastin<br />

(bevacizumab) for macula oedema with a<br />

visual acuity of 6/9 or worse. A proforma<br />

for DR consultations could improve quality<br />

of assessment and hence treatment for<br />

all patients.<br />

References<br />

1. Te Whatu Ora Health New Zealand. Virtual Diabetes Register and<br />

web tool. 2021 [updated 2023 Mar 27; cited 2023 Apr 2]. www.<br />

tewhatuora.govt.nz/our-health-system/data-and-statistics/virtualdiabetes-tool<br />

2. Ministry of Health. Tatau Kahukura: Māori Health Chart Book<br />

2015 (3rd Edition). [updated 2018 Aug 2; cited 2023 Apr 2]. www.<br />

health.govt.nz/our-work/populations/maori-health/tatau-kahukuramaori-health-statistics/nga-mana-hauora-tutohu-health-statusindicators/diabetes<br />

3. Kenealy T, Elley CR, Robinson E, et al. An association between<br />

ethnicity and cardiovascular outcomes for people with Type 2<br />

diabetes in New Zealand. Diabet Med. 2008 Nov;25(11):1302-8<br />

4. Yu D, Zhao Z, Osuagwu UL, et al. Ethnic differences in mortality<br />

and hospital admission rates between Māori, Pacific, and European<br />

New Zealanders with type 2 diabetes between 1994 and 2018: a<br />

retrospective, population-based, longitudinal cohort study. Lancet<br />

Glob Health. 2021 Feb;9(2):e209-217<br />

5. Sandiford P, Bramley DM, El-Jack SS, Scott AG. Ethnic differences in<br />

coronary artery revascularisation in New Zealand: does the inverse<br />

care law still apply? Heart Lung Circ. 2015 <strong>Oct</strong>;24(10):969-74<br />

Diabetic retinopathy disproportionately affects Māori and Pasifika<br />

6. Crengle S, Lay-Yee R, Davis P, Pearson J. A Comparison of Māori<br />

and Non-Māori Patient Visits to Doctors: The National Primary<br />

Medical Care Survey (NatMedCa). Wellington (NZ): Ministry of<br />

Health; 2005<br />

7. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and<br />

major risk factors of diabetic retinopathy. Diabetes Care. 2012<br />

Mar;35(3):556-64<br />

8. Rogers JT, Black J, Harwood M, Wilkinson B, Gordon I, Ramke J.<br />

Vision impairment and differential access to eye health services in<br />

Aotearoa New Zealand: protocol for a scoping review. BMJ Open.<br />

2021 Sep 13;11(9):e048215<br />

9. PwC New Zealand. The Economic and Social Cost of Type 2<br />

Diabetes. 2021 Mar [cited 2023 Apr 3] https://healthierlives.co.nz/<br />

wp-content/uploads/Economic-and-Social-Cost-of-Type-2-Diabetes-<br />

FINAL-REPORT.pdf<br />

10. Simmons D, Weblemoe T, Voyle J, et al. Personal barriers to diabetes<br />

care: lessons from a multi-ethnic community in New Zealand.<br />

Diabet Med. 1998 Nov;15(11):958-64<br />

11. Harbers A, Davidson S, Eggleton K. Understanding barriers to<br />

diabetes eye screening in a large rural general practice: an audit of<br />

patients not reached by screening services. J Prim Health Care. 2022<br />

Sep;14(3):273-79<br />

12. Low J, Cunningham WJ, Niederer RL, Danesh-Meyer HV. Patient<br />

factors associated with appointment non-attendance at an<br />

ophthalmology department in Aotearoa New Zealand. N Z Med J.<br />

2023 Apr 14;136(1573):77-87<br />

13. Ormandy J, Phillips S, Campbell M, et al. ‘I was able to make a<br />

better decision about my health.’ Wāhine experiences of colposcopy<br />

at a marae-based health clinic: A qualitative study. Aust N Z J<br />

Obstet Gynaecol. <strong>2024</strong> Feb 29. Epub ahead of print<br />

14. Simmons D, Voyle JA. Reaching hard-to-reach, high-risk<br />

populations: piloting a health promotion and diabetes disease<br />

prevention programme on an urban marae in New Zealand. Health<br />

Promot Int. 2003 Mar;18(1):41-50<br />

15. Low J, Cunningham WJ, Niederer RL, Danesh-Meyer HV. Patient<br />

factors associated with appointment non-attendance at an<br />

ophthalmology department in Aotearoa New Zealand. N Z Med J.<br />

2023 Apr 14;136(1573):77-87<br />

Jahnvee Solanki is a non-vocational<br />

ophthalmology registrar at<br />

Greenlane Clinical Centre. She<br />

completed her bachelor of<br />

medicine and bachelor of surgery at<br />

Auckland University in 2020 and a<br />

postgraduate diploma in ophthalmic<br />

basic sciences with the University of<br />

Sydney in <strong>2024</strong>.<br />

Dr Rachael Niederer is a RANCZO<br />

ophthalmologist and researcher.<br />

She is a member of the RANZCO<br />

Māori and Pasifika Committee<br />

and has been involved in previous<br />

research exploring health disparities<br />

in eye health in New Zealand.<br />

Dr Sarah Welch is a consultant<br />

ophthalmologist and the clinical<br />

director of the Ophthalmology<br />

Department at Greenlane<br />

Clinical Centre.<br />

24 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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FOCUS ON EYE RESEARCH<br />

NEWS<br />

Dr Mo Ziaei,<br />

series editor<br />

Herpes zoster ophthalmicus, uveitic<br />

glaucoma, and more<br />

By Drs Lucy Lu and Joseph Kam<br />

Herpes zoster ophthalmicus recurrence: risk factors and long-term<br />

clinical outcomes<br />

DAR Scott, et al<br />

Am J Ophthalmol. <strong>2024</strong> Jun 22;268:1-9<br />

Review: This paper is the largest study looking at herpes zoster<br />

ophthalmicus (HZO) recurrence. The authors reviewed 869 patients with<br />

HZO treated at Auckland’s Greenlane Eye Clinic between 2006 and 2016<br />

and found at least one recurrence of ocular inflammation in 200 subjects<br />

(23%) during a median follow up of 6.3 years. The median time from HZO<br />

onset to first recurrence was 3.5 months. Uveitis was the most common<br />

form of recurrence, followed by keratouveitis and keratitis. In subjects<br />

who required topical steroid treatment, the median time to recurrence<br />

was 1.4 months following steroid cessation.<br />

Significant risk factors for recurrence include immunosuppression,<br />

higher presenting IOP, corneal involvement, and uveitis. Moderate vision<br />

loss (6/15 or worse) at final follow-up occurred in 19.6% of patients. There<br />

was a significant association between a greater number of recurrences<br />

and poorer final vision.<br />

Comment: HZO is one of the most common acute eye conditions treated<br />

in eye emergency clinics. Recurrent ocular inflammation can lead to<br />

vision threatening complications such as neurotrophic keratopathy,<br />

glaucoma and optic neuropathy. This study highlights those patients at<br />

greater risk of recurrence so that measures can be taken to prevent poor<br />

visual outcomes. A longer taper of steroid may be required for higherrisk<br />

patients, such as immunosuppressed individuals and those with<br />

hypertensive kerato-uveitis. The general practice pattern at Greenlane<br />

Eye Clinic is a three-month gradual taper of topical steroids, along with<br />

monitoring for recurrence on steroid cessation.<br />

Malignancy risk associated with the use of systemic<br />

immunomodulatory therapy in the management of<br />

noninfectious uveitis<br />

GN Papaliodis et al<br />

Am J Ophthalmol. <strong>2024</strong> Apr 26;265:241-247<br />

Review: This US nationwide retrospective cohort study from<br />

Massachusetts evaluated the risk of developing malignancy in<br />

patients treated with systemic immunomodulatory therapy (IMT)<br />

for noninfectious uveitis (NIU). The incidence rate of malignancy was<br />

compared between NIU patients who were treated with IMT and those<br />

who were not. All cancer types were included, except non-melanoma<br />

skin cancer. In the 15-year enrolment period, 492 of the 318,498 (0.15%)<br />

NIU patients on IMT developed malignancies. The NIU patients who did<br />

develop malignancy were treated with either systemic corticosteroids,<br />

antimetabolites, T-cell inhibitors, TNA-alpha inhibitors, IL-6 inhibitors, or<br />

CD-20 antibodies. No patient on alkylating agents developed secondary<br />

malignancy. In addition, multi-variable Cox regression analysis did not<br />

identify any association with the incidence of malignancy with any of the<br />

drug classes.<br />

Comment: This is the largest study to date to evaluate the incidence<br />

of malignancy in patients on a variety of IMT drug classes for noninfectious<br />

uveitis. While previous studies with smaller sample sizes did<br />

show a similar finding, the lack of power made it difficult to draw strong<br />

conclusions. The results reassure both the treating clinician and the<br />

patient starting on IMT for uveitis that the therapy does not significantly<br />

increase the risk of secondary malignancy development.<br />

Herpes zoster virus keratitis<br />

Preserflo Microshunt implant for the treatment of refractory uveitic<br />

glaucoma: 36-month outcomes<br />

G Triolo et al<br />

Eye (Lond). 2023 Aug;37(12):2535-2541<br />

Review: This paper from Moorfields is the first to report 36-month<br />

outcomes of Preserflo Microshunt in uveitic glaucoma. Twenty-one eyes<br />

with refractory uveitic glaucoma on maximal tolerated medical therapy<br />

were included. The overall cumulative success rate was 47% over three<br />

years. The overall mean IOP decreased by 30% (from 26.0±9.0mmHg<br />

at baseline to 15.2±5.4mmHg at final follow-up), and the number of<br />

IOP-lowering medications dropped by an average of 3.8 medications<br />

(from 4.1±0.9 at baseline to 0.9±1.2 at three years). Twelve of the 21 eyes<br />

(57.1%) required revision of the Preserflo or additional glaucoma surgery.<br />

There were no cases of sight-threatening complications, such as loss of<br />

vision, hypotony with sequelae or bleb-related ocular infections. Non-<br />

White ethnicity was a significant risk factor for failure.<br />

Comment: Preserflo Microshunt is a bleb-forming glaucoma filtering<br />

device that is gaining popularity in New Zealand. It is less invasive,<br />

provides faster visual recovery and requires less intensive follow-up<br />

compared to traditional trabeculectomy. This is a promising treatment<br />

in uveitic patients in whom post-op hypotony and inflammation are<br />

major risks, and very low IOPs are usually not required. This case series<br />

demonstrates the device’s success and safety in this patient group,<br />

but also highlights the lower success rate in non-White ethnicities and<br />

the frequent need for revision due to subconjunctival fibrosis or shunt<br />

blockage. More experience and data of its use in uveitic glaucoma will be<br />

useful to inform glaucoma surgeons managing these difficult cases.<br />

Dr Jospeh Kam is a senior uveitis fellow at Greenlane Eye<br />

Clinic, supervised by Drs Jo Sims and Rachael Niederer. He is<br />

from McGill University, Montreal, Canada.<br />

Dr Lucy Lu is currently a senior uveitis fellow at Greenlane Eye<br />

Clinic, supervised by Drs Jo Sims and Rachael Niederer. She is<br />

an Auckland-based RANZCO trainee in her final year.<br />

26 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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glaucoma (POAG) currently treated with ocular hypotensive medication. The device can be implanted with or without cataract surgery. CONTRAINDICATIONS: The device is contraindicated for use in eyes<br />

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NEWS<br />

Transforming clinical practice and outcomes with AI<br />

By Rishi Kattar<br />

AT A RECENT CPD event held at Southern<br />

Cross Hospital in Hamilton, optometrists<br />

from the Waikato region gathered to<br />

discuss one of the most exciting topics in<br />

eyecare today: artificial intelligence (AI).<br />

The event was a resounding success, with<br />

attendees excited about AI’s potential<br />

to revolutionise clinical practice and<br />

patient outcomes. The speakers provided<br />

a deep dive into AI’s transformative<br />

capacity, highlighting tools already in<br />

use and those on the horizon that could<br />

revolutionise eyecare.<br />

Associate Professor James McKelvie,<br />

consultant ophthalmologist and CEO of<br />

CatTrax, discussed exciting updates to<br />

his cutting-edge clinical management<br />

platform that is already being used in<br />

many regions within the country. CatTrax<br />

is expanding to manage everything from<br />

referrals and prescriptions to clinical diaries,<br />

with secure cloud-based storage for ocular<br />

data easily accessible to both optometrists<br />

and ophthalmologists. This feature promises<br />

to improve collaboration and streamline<br />

patient care.<br />

Another innovation A/Prof McKelvie<br />

highlighted was an AI scribe which<br />

automatically generates clinical notes and<br />

referrals during consultations, reducing<br />

administrative workload and allowing more<br />

focus on patient care. He also introduced an AI<br />

voice agent used to assess post-cataract surgery<br />

patient satisfaction, providing efficient, realtime<br />

feedback during follow-ups.<br />

Enhancing image analysis<br />

Consultant ophthalmologist Dr Ammar Binsadiq<br />

presented promising AI tools he is testing for<br />

ocular image analysis. These tools can enhance<br />

the accuracy and speed of detecting conditions<br />

such as diabetic retinopathy, glaucoma and<br />

macular degeneration. With AI’s help, early<br />

Daphene Rong and Rishi Khattar with<br />

A/Prof James McKelvie<br />

detection could become<br />

more precise, allowing<br />

for timely interventions<br />

and potentially better<br />

patient outcomes.<br />

Next, Dr Finley Breeze, a<br />

Bay of Plenty house officer,<br />

introduced an innovative AIdriven<br />

solution to predict nonattendance<br />

at ophthalmic clinics.<br />

By analysing patient data, his<br />

machine-learning model identifies patterns<br />

that predict missed appointments. This could<br />

significantly improve clinic efficiency by<br />

reducing non-attendance, helping clinics better<br />

allocate resources and enhance continuity of<br />

patient care.<br />

AI-assisted cataract surgery feedback<br />

CatTrax software engineer Jesse Whitten<br />

demonstrated a periscope device used in<br />

cataract surgeries, currently deployed in A/<br />

Prof McKelvie’s clinic. Attached to a surgical<br />

microscope, this device provides automated,<br />

real-time statistical feedback and records video<br />

Nigel Thrush and<br />

Dr Ammar Binsadiq<br />

for later review. This tool is poised to<br />

play a crucial role in training future<br />

ophthalmologists by offering immediate<br />

insights into surgical performance.<br />

Concluding the evening, Dr Henry<br />

Wallace, an ophthalmology registrar,<br />

made a presentation on semantic<br />

analysis. He proposed creating AI<br />

models that allow practitioners to<br />

evaluate their own clinical performance<br />

helping them identify strengths and<br />

areas for improvement. This data-driven<br />

approach empowers clinicians to<br />

continuously enhance their techniques<br />

and deliver better patient outcomes.<br />

Better clinical efficiency<br />

The overarching theme of<br />

the event was clear: AI is not<br />

here to replace clinicians, but<br />

to act as a powerful tool for<br />

enhancing clinical efficiency<br />

and patient outcomes.<br />

Whether through automated<br />

notetaking, predictive analytics or<br />

real-time surgical feedback, AI offers<br />

a multitude of opportunities to make<br />

eyecare practices more efficient and<br />

personalised. The evening illustrated<br />

how AI’s integration into clinical practice<br />

can free up valuable time for practitioners,<br />

allowing them to focus on delivering better<br />

care to their patients.<br />

AI in eyecare is undoubtedly an exciting<br />

frontier and we look forward to seeing these<br />

advancements rolled out in practices across<br />

the country.<br />

Rishi Khattar and Daphene Rong are optometrists at<br />

Specsavers in Hamilton who share a keen interest in AI<br />

in eyecare. As part of their Specsavers year 2 project,<br />

they organised this CPD event to promote innovation<br />

in clinical practice and empower fellow practitioners to<br />

embrace new and upcoming technology.<br />

Novel cataract drop’s promising results<br />

A NOVEL EYE drop of 2.6% EDTA ophthalmic<br />

solution (C-KAD, Livionex) showed<br />

significant and consistent improvement<br />

in visual quality and function in patients<br />

with early-stage cataract, according to<br />

US researchers.<br />

Writing in the American Journal of<br />

Ophthalmology, researchers at the<br />

University of Utah conducted the phase<br />

1/2 clinical trial of 41 subjects, who were<br />

given C-KAD (n=21) or placebo (n=20).<br />

The primary endpoint of the proportion of<br />

eyes with mesopic contrast sensitivity (CS)<br />

improvements ≥ 0.30 logCS (equivalent<br />

to 100% CS improvement) in at least<br />

two of the five spatial frequencies was<br />

significantly greater for C-KAD (66.7%<br />

vs. 35.0% for placebo, p=0.043) at day<br />

120, they said. “The proportion of eyes<br />

achieving ≥ 0.30 logCS improvement<br />

(mesopic) was also significantly greater<br />

for C-KAD, with 42.9% compared to 15.0%<br />

for placebo (p=0.050) at day 120. Positive<br />

best-corrected visual acuity trends and<br />

statistical significance in lens density were<br />

also observed.”<br />

28 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


In cataract surgery<br />

References: 1. Suzuki, H., Oki, K., Shiwa, T., Oharazawa, H. & Takahashi, H. Effect of bottle height on the corneal endothelium during phacoemulsification. J Cataract Refract Surg 35, 2014-2017, doi:10.1016/j.<br />

jcrs.2009.05.057 (2009). 2. Vasavada, V. et al. Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative<br />

outcomes: a randomized clinical trial. J Refract Surg 30, 534-540, doi:10.3928/108159 7X-20140711-06 (2014). 3. Vasavada, A. R. et al. Impact of high and low aspiration parameters on postoperative outcomes<br />

of phacoemulsification: randomized clinical trial. J Cataract Refract Surg 36, 588-593, doi:10.1016/j.jcrs.2009.11.009 (2010). 4. Kokubun, T. et al. The protective effect of normal-IOP cataract surgery on the corneal<br />

endothelium, The 26th Annual Meeting of the Japanese Ophthalmological Society. 5. Miller KM, et al. Experimental study of occlusion break surge volume in 3 different phacoemulsification systems. J Cataract Refract<br />

Surg. 2021:47;1466. 6. Vasavada V et al. Real-time dynamic changes in intraocular pressure after occlusion break: Comparing 2 phacoemulsification systems. J Cataract Refract Surg. 2021;47:1205. 7. JiráskováN &<br />

Stepanov A. Our experience with Active Sentry and Centurion Ozil handpieces. Czech and Slovak Ophthalmology. 2021;77(1):18-21.<br />

Please refer to product direction for use (or operator manual) for list of indications, contraindications and warnings.<br />

© Alcon <strong>2024</strong>. Alcon Laboratories Pty Ltd. Aus: 1800 224 153; Auckland NZ: 0800 809 189. ALC2169 6/24 ANZ-CNT-2400007.


EDUCATION<br />

Desert I-land AUSCRS castaways<br />

By Dr Ben LaHood<br />

AS I STEPPED off the plane onto the sun-kissed shores of<br />

Hamilton Island for the <strong>2024</strong> meeting of the Australasian<br />

Society of Cataract and Refractive Surgeons (AUSCRS), I<br />

couldn’t help but feel a blend of excitement and mild dread.<br />

After all, I was about to immerse myself in a whirlwind of<br />

cutting-edge ophthalmic knowledge while trying not to think<br />

about the fact I was on a beautiful tropical island, but in a dark<br />

lecture hall… So near, yet so far!<br />

Like the Olympic Games’ openings, the AUSCRS opening<br />

ceremony is always something to look forward to. Previous<br />

years have seen the presidents arrive in sports cars or on magic<br />

carpets, usually accompanied by video montages of years gone<br />

by. This year, being on the ‘I-land’ we had a Gilligan’s Islandthemed<br />

video from members of the organising committee. As<br />

someone assigned to wearing a dress and having to dance in<br />

front of the crowd, it would rank pretty highly in terms of my<br />

worst-case scenarios. But this is how AUSCRS rolls. The idea<br />

behind making speakers wear costumes and look silly is to level<br />

the playing field, creating a relaxed atmosphere and removing<br />

the formalities of other meetings.<br />

From IOLs to LOLs<br />

The following morning, we kicked off the meeting in style with<br />

the Barrett/Wolfe Gold Medal Lecture (named after AUSCRS’<br />

founders) given by AUSCRS stalwart Dr Florian Kretz from Germany.<br />

In front of his proud family, Dr Kretz clarified the multiple options<br />

we have for presbyopia-correcting intraocular lenses (IOLs), speaking<br />

on his significant experience and, thankfully, giving us all realistic<br />

expectations of what can be achieved, given that even someone of his<br />

experience still gets refractive surprises. Another unique feature of<br />

AUSCRS is that all sponsors are given a chance to get on stage and<br />

tell the audience about themselves, which is always entertaining as<br />

companies get into the AUSCRS spirit. This year, Rayner’s reps, with<br />

their laugh-out-loud rendition of The Brady Bunch theme song, stole<br />

the show.<br />

Among the meeting’s many famous themed scientific sessions,<br />

these presentations stood out to me and made me think about my<br />

own practice. Singapore’s ever-popular Dr Ronald Yeoh, fresh from<br />

teaching trainees how to deliver a memorable presentation, did just that.<br />

Always a trailblazer with new technology, Dr Yeoh originally described<br />

the pupil-snap sign to indicate posterior capsule rupture during<br />

hydrodissection about 20 years ago. His experience in dealing with such<br />

nightmare scenarios meant<br />

he could suggest methods for<br />

salvaging a dropping nucleus.<br />

He also discussed using OCT<br />

intraoperatively to see a<br />

newly described scroll sign of<br />

ruptured posterior capsule.<br />

We then went on to uncover<br />

the treasure of improving<br />

cataract outcomes. There<br />

was some great debate<br />

around thresholds for using<br />

implantable collamer lenses<br />

(ICLs), even for lower<br />

prescriptions. With so much<br />

variation in comfort with this<br />

procedure, thresholds vary<br />

accordingly. The majority of<br />

Drs David Kent and Ben LaHood as Ginger and<br />

Mary Ann from Gilligan’s Island<br />

the audience said they would<br />

only consider them for high<br />

Fendalton Eye Clinic team at the<br />

Under the Sea gala dinner<br />

refractive errors<br />

not amenable<br />

to other<br />

keratorefractive<br />

methods, but<br />

Germany’s Dr<br />

Lena Beckers<br />

raised the<br />

Eye, eye, cap’n! Drs Dean Corbett, Andrea Ang and Ben LaHood<br />

question of<br />

whether we should expand our range for considering this treatment.<br />

In this session, I discussed my own case series of treating young<br />

pre-presbyopic eyes with unilateral cataract surgery following trauma<br />

associated with implantation of an extended depth of focus IOL.<br />

Although the outcomes were very good, these eyes can certainly throw<br />

some unexpected drama at you. The session ended with the legend of<br />

IOL calculation himself, Professor Graham Barrett, from the University<br />

of Western Australia. Spoiler alert: the future of IOL calculation<br />

includes more AI than you can shake a stick at, which is great, unless<br />

that AI starts recommending eye drops to stop cataract formation!<br />

Offshore pearls<br />

Some of the international invited speakers gave us some pearls of<br />

wisdom in the first day’s afternoon session. Dr Elizabeth Yeu, Virginia,<br />

US, showed her strategies for IOL exchange – an operation which<br />

none of us enjoy but which is sometimes necessary. One of the most<br />

difficult and potentially hazardous parts of the operation is to dissect<br />

the capsule away from the haptics of the existing IOL. Dr Yeu showed<br />

that sometimes she will resort to amputating and leaving haptics behind<br />

in order to preserve the capsular bag. It’s nice to know that even such a<br />

skilled and experienced surgeon sometimes has problems too.<br />

Singapore Eye Research Institute’s Distinguished Professor Jod<br />

Mehta advised waiting as long as possible with multifocal IOLs before<br />

exchanging them, as dysphotopsias often become much more tolerable<br />

and the lens can be left in place. That’s easier to say than do when you<br />

have an unhappy patient sitting in front of you, but the facts and figures<br />

he presented were very compelling.<br />

Continued on p32<br />

30 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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EDUCATION<br />

Continued from p30<br />

It was great to see AUSCRS having a session dedicated to<br />

lenticule-based keratorefractive surgery for the first time.<br />

These procedures to remove a lenticule of corneal stroma<br />

to alter the refractive state of the eye go by a different name<br />

from each company, but all aim to achieve the same goal of<br />

spectacular vision. We are still in the stages of refining our<br />

predictive models and determining which biometric factors<br />

are the most important inputs. Talks on adjusting energy<br />

settings and the impact of energy output on corneal healing<br />

were fascinating. Dr Kishore Pradhan, founder, medical director<br />

and a senior refractive surgeon at Matrika Eye Center, Kathmandu,<br />

used machine-learning models to determine which factors to put into his<br />

own nomogram for determining lenticule parameters. While his work<br />

appeared complex – and worrying that we will all soon need maths PhDs<br />

to do laser surgery – I applaud people like Dr Pradhan, who, through<br />

their own hard work, make outcomes better for all laser surgeons.<br />

Well, well, well<br />

Surprisingly, one of the most controversial sessions of the meeting was<br />

focused on wellbeing and thriving in ophthalmology. AUSCRS copresident<br />

Dr Jacqueline Beltz and Dr Jo Mitchell – high-performance<br />

coach, psychologist and previous AUSCRS advanced trainee mentor<br />

– hosted this section on sharing experiences: the good, the bad and<br />

the upsetting. The discussion from presenters around the struggles<br />

during training, and lack of support at times, received varied audience<br />

responses. I found the negative feedback surprising, but every story<br />

needs a villain to bring people together and the AUSCRS family got<br />

through a heated discussion together in the end.<br />

I may be incredibly biased, as I was hosting the session, but<br />

‘Technological icebergs: navigating updates in surgery’ was jam-packed<br />

full of interesting points. Not to mention the Titanic theme, which<br />

involved a re-enactment of the famous movie scene at the front of<br />

the ship with Germany’s Dr David Beckers and Australia’s Associate<br />

Professor Smita Agarwal as Jack and Rose, as well as the violinists going<br />

down with the ‘ship’. Dr Luke Anderson (UK) asked whether cataract<br />

surgeons should be doing minimally invasive glaucoma surgery (we<br />

all agreed they should), while Dr Beckers talked about how AI will<br />

realistically be used in the clinic and A/Prof Agarwal spoke on her<br />

cataract surgeries now being done at physiological intraocular pressure.<br />

Dr David Kent wins Best Sport award from co-presidents<br />

Prof Gerard Sutton and Dr Jacqui Beltz for having to dress<br />

up as a woman twice<br />

CAIRS and<br />

crosslinking<br />

In the ‘Shark<br />

Tank’ session, we<br />

were fortunate to<br />

hear from two of<br />

the world’s most<br />

experienced surgeons<br />

in their own areas<br />

of managing<br />

irregular corneas. Dr<br />

David Gunn from<br />

Brisbane discussed<br />

his work with<br />

corneal allogenic<br />

intrastromal ring<br />

segments (CAIRS) to<br />

manage keratoconic<br />

eyes, while Dr John<br />

Kanellopoulos from<br />

Greece discussed<br />

his Athens protocol<br />

for crosslinking<br />

and using laser<br />

treatments to<br />

Dr Sean Every winning<br />

the film festival award<br />

regularise corneas. Both have provided us with so much knowledge and<br />

revolutionised the way we look after ectatic corneas.<br />

Two of the things I love most about AUSCRS are a good rigorous<br />

debate without fear of upsetting anyone and the film festival. Both were<br />

top notch this year and rounded out the final sessions.<br />

This year’s debate was about immediately sequential bilateral cataract<br />

surgery (ISBCS). It was such a great crowd to hold the debate in front<br />

of, since these are likely the surgeons doing the majority of the cataract<br />

surgery in Australasia. So it was surprising that the crowd favourite<br />

was delayed surgery rather than doing both on the same day. I would<br />

much prefer to do ISBCS, but the stumbling block in my area is that<br />

day surgeries would earn less, so it is discouraged. We shall see what the<br />

future holds, as surely it’s the way forward for our patients.<br />

The film festival is the final part of the programme, with points given<br />

for content and entertainment value. Having won it myself last year, it<br />

was nice to see another Kiwi pick up this year’s gong. Christchurch’s Dr<br />

Sean Every delivered a pirate-infused, Kiwi-accent-laden poem while<br />

describing heroic surgery to explant and implant a lens in an extremely<br />

difficult case. Dr Every is a vitreoretinal surgeon but clearly didn’t lose<br />

too many points from the judges for his transition to refractive surgery!<br />

Aqueous humour<br />

President Professor Gerard Sutton, Gina Sutton,<br />

Jane Patterson and Dr David Kent<br />

With all of the science and debate out of the way, it was finally time to<br />

let our hair down and party. The aquatic-themed costumes throughout<br />

the sessions were great but the gala dinner saw some incredible and<br />

hilarious efforts. We had amazing jellyfish and turtles and mermaids<br />

galore for the under-the-sea-themed event. Sydney’s Dr Alison Chiu,<br />

always a fan favourite, won the best costume prize as Ursula the sea<br />

witch. We partied and danced into the night. Being all shipwrecked on<br />

the same island, there was no escaping seeing each other all looking<br />

worse for wear at the airport on our way home in the morning.<br />

As the conference came to a close, I couldn’t help but reflect on the<br />

wealth of knowledge gained, the connections made and the fact that I<br />

had acquired a large turtle costume I probably won’t wear again. The<br />

<strong>2024</strong> AUSCRS meeting was not just an opportunity to learn, it was a<br />

reminder of why we do what we do: connecting with peers, exchanging<br />

ideas and occasionally finding ourselves taking a fishing charter instead<br />

of sitting in lectures.<br />

AUSCRS 2025 will be held in Darwin from 16–19 July. I can’t wait to<br />

see how we will top this year on Hamilton Island, but I’m confident it<br />

will be even bigger and better yet again!<br />

Dr Ben LaHood is an Australasian-trained consultant ophthalmologist based in<br />

Adelaide, with subspeciality fellowship training in laser vision correction and<br />

refractive cataract surgery and a special interest in astigmatism correction. He<br />

was named among The Ophthalmologist’s annual Power List of the world’s top 100<br />

industry leaders in 2023 and <strong>2024</strong>.<br />

32 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


NEWS<br />

The perils of<br />

keratopigmentation<br />

THE AMERICAN ACADEMY of Ophthalmology (AAO) has warned that<br />

keratopigmentation, a cosmetic procedure to change a patient’s eye<br />

colour by ‘tattooing’ the iris, carries serious risks including cataract,<br />

elevated IOP leading to glaucoma, corneal damage leading to vision<br />

loss, and infection. Other concerns include light sensitivity, plus<br />

leakage of, and allergic reactions to, the dye.<br />

US online retailer Overnight Glasses claims its research showed<br />

eye-colour-change surgery (including keratopigmentation, cosmetic<br />

iris implants and laser pigment removal) topped its list of most<br />

dangerous cosmetic procedures, with a complication rate of 92.3%.<br />

However, New York-based ophthalmologist Dr Alexander<br />

Movshovich told CNN Health that, having performed his own version<br />

of keratopigmentation on more than 1,000 patients, none of them has<br />

reported serious problems related<br />

to the procedure. Dr Movshovich<br />

said he developed a surgical<br />

instrument that creates a tiny<br />

channel in the cornea for pigment<br />

injection, which he said he closes<br />

at the end of the procedure.<br />

Keratopigmentation has been<br />

popular in parts of Europe for<br />

over a decade, but has recently<br />

taken off in the US, thanks to<br />

patients sharing their new eye<br />

colours on social media, according<br />

to CNN Health. The hashtag<br />

#keratopigmentation appears on<br />

571 TikTok posts.<br />

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The study, published in JAMA<br />

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be attributable to one or more<br />

types of vision loss. Researchers<br />

noted dementia could have been<br />

prevented in nearly 20% of cases,<br />

had loss of vision been addressed.<br />

“While not proving a causeand-effect<br />

relationship, these<br />

findings support inclusion of<br />

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NEWS<br />

Biomarkers predictive of glaucoma<br />

treatment response<br />

RESEARCHERS FROM University College London (UCL) and<br />

Moorfields Eye Hospital have identified biomarkers that may<br />

predict which glaucoma patients are at higher risk of continued<br />

vision loss, despite conventional treatment.<br />

The study, published in Nature Medicine, examined whether<br />

mitochondrial function in white blood cells is lower in people with<br />

glaucoma than in healthy patients and whether it is associated with<br />

the rate at which glaucoma patients lose vision.<br />

Enrolling 139 participants diagnosed with glaucoma and on<br />

treatment to lower intraocular pressure (IOP), plus 50 healthy<br />

individuals as controls, researchers measured how well cells in<br />

the blood use oxygen, how much vision was lost over time, and<br />

nicotinamide adenine dinucleotide (NAD*) levels.<br />

They discovered peripheral blood mononuclear cells use oxygen<br />

differently in people with glaucoma and that people whose blood<br />

cells used less oxygen tended to lose their vision faster, even if they<br />

were on IOP-lowering treatment. This measurement explained 13%<br />

of the differences in how fast patients lost vision, they said.<br />

Additionally, the blood cells of people with glaucoma were found<br />

to have lower levels of NAD compared to those without glaucoma.<br />

These lower NAD levels were also linked to the lower oxygen use in<br />

the blood cells.<br />

“White blood cell mitochondrial function and NAD levels, if<br />

introduced as a clinical test, would enable clinicians to predict<br />

which patients are at higher<br />

risk of continued vision<br />

loss, allowing them to<br />

be prioritised for more<br />

intensive monitoring<br />

and treatment,” said<br />

senior author<br />

Professor David<br />

Garway-Heath. “If<br />

further research shows<br />

that low mitochondrial<br />

function or low NAD levels<br />

are a cause for glaucoma,<br />

then this opens the way for<br />

new treatments.”<br />

UCL and Moorfields Eye<br />

Hospital are currently leading a<br />

Mitochondrial function was<br />

associated with glaucoma<br />

treatment response<br />

major clinical trial to establish whether high-dose vitamin B3 can boost<br />

mitochondrial function and reduce vision loss in glaucoma, he added.<br />

“We hope that this will open a new avenue for treatment of glaucoma<br />

patients which does not depend on lowering the eye pressure.”<br />

*The NAD molecule is derived from vitamin B3 and helps cells<br />

produce energy.<br />

BOOK REVIEW<br />

Steinert’s Cataract Surgery, 4th edition<br />

Edited by Professor Sumit Garg and Dr Douglas Koch | Reviewed by Professor Charles McGhee<br />

STEINERT’S CATARACT SURGERY is an excellent 530-page hardback<br />

textbook pioneered by the late Professor Roger Steinert. This edition<br />

is edited by Professor Sumit Garg and Dr Douglas Koch, both doyens<br />

in the field of cataract surgery. The editors have assembled an<br />

extensive group of expert contributors, not only from North America,<br />

but also from around the world, to add 10 new chapters and update<br />

this more international edition.<br />

The book is particularly well organised, being divided into eight<br />

logical, progressive sections, including: preoperative considerations,<br />

intraocular lenses, anaesthesia and initial steps, nuclear disassembly,<br />

astigmatism management, complex cases, intraoperative<br />

complications and postoperative complications. Each section is<br />

subdivided into several short chapters, each composed of relatively<br />

short, easily readable paragraphs with copious high-quality colour<br />

illustrations. Each chapter is also accompanied by links to several<br />

online videos which provide a veritable library, bringing a very<br />

contemporary and easily digestible feel to the whole product.<br />

Each chapter’s well thought-through structure reveals the<br />

expertise of its highly respected author. If one had any small gripes,<br />

it would be that the typeface is small and, therefore, slightly dense<br />

and intimidating to read when you have two to three pages without<br />

illustrations; plus, some of the images are clearly from older editions<br />

and could be updated. That said, it is an easy read, with most of its<br />

56 chapters readily explored and their key points assimilated within<br />

30–60 minutes. Combing through the reference section, it is notable<br />

that most chapters are well referenced and generally very up to date<br />

– no small feat in a subject area that changes very quickly.<br />

The readership of this book likely consists of two main groups.<br />

Firstly, residents and other trainees embarking on cataract surgery<br />

who wish to have a<br />

comprehensive, well-written<br />

source with illustrative<br />

videos that can provide<br />

all the key information in<br />

one place. These topics<br />

might include cataract<br />

development, intraocular<br />

lens design, biometry,<br />

phacoemulsification<br />

techniques and surgical complications. This text covers<br />

all those areas well and certainly could be read in conjunction<br />

with clinical practice to provide a strong basis for cataract surgery<br />

training. The second group is more established practitioners<br />

seeking an update in some areas, but who do not necessarily wish<br />

to peruse multiple publications to find a comprehensive summary<br />

to form an opinion. This book will serve that group well and a copy<br />

certainly should be kept in the office or department library to be<br />

dipped into. Overall, I genuinely enjoyed reading Steinert’s Cataract<br />

Surgery 4th edition and recommend it highly for those involved in<br />

the management of cataract.<br />

Professor Charles McGhee heads the Department of<br />

Ophthalmology and is director of the New Zealand<br />

National Eye Centre at the University of Auckland. His<br />

interests include keratoconus, corneal diseases and corneal<br />

transplantation, complex cataract and anterior segment<br />

trauma, and complex anterior segment pathology, including<br />

iris and conjunctival melanoma and other rare anterior<br />

segment tumours, for which he receives nationwide referrals.<br />

34 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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NEWS<br />

EYE ON OPHTHALMOLOGY<br />

Glaucoma – improving control with stents,<br />

trabs, and tubes<br />

By Dr Hussain Patel<br />

GLAUCOMA MANAGEMENT HAS traditionally been<br />

focused on medical therapy as initial treatment with<br />

intensification until maximum tolerated medical therapy<br />

(MTMT) is reached. Often patients end up taking multiple<br />

eyedrops several times a day, which can sometimes lead to<br />

issues with side effects and adverse events, poor adherence,<br />

inconvenience and reduction in quality-of-life measures.<br />

The results from the ‘Laser in glaucoma and ocular<br />

hypertension trial’ (LiGHT) indicated that selective laser<br />

trabeculoplasty (SLT) may offer better glaucoma control<br />

over medical therapy in the initial treatment of primary<br />

open-angle glaucoma (POAG) and ocular hypertension<br />

(OHT) 1 . The development of safer and less invasive surgical<br />

options, termed minimally invasive glaucoma surgery<br />

(MIGS) has enabled surgical intervention at an earlier stage<br />

as an alternative to intensive medical therapy.<br />

Although medical treatment still remains an important<br />

part of glaucoma care, these newer developments are leading to a<br />

paradigm shift in glaucoma management, where we are able to offer<br />

patients safe and effective alternatives if they are struggling with multiple<br />

daily eyedrop usage. Many MIGS procedures are now readily available<br />

for clinical use in New Zealand and have become an essential part of our<br />

current glaucoma management armamentarium.<br />

MIGS<br />

Fig 1. The iStent inject<br />

MIGS refers to a group of newer glaucoma procedures considered<br />

less invasive in comparison to traditional glaucoma surgery, while<br />

still providing meaningful intraocular pressure (IOP) lowering. They<br />

have been developed to bridge the gap between initial medical and<br />

SLT treatment and the more invasive options of trabeculectomy and<br />

tube-shunt surgery. The different MIGS procedures share common<br />

characteristics, including a high safety profile, minimal disruption of<br />

normal anatomical structures, ease of use and rapid recovery time.<br />

MIGS may be combined with cataract surgery or be performed as<br />

standalone procedures.<br />

MIGS procedures have been developed to target almost every aspect<br />

of both the conventional and uveoscleral aqueous outflow pathways. The<br />

most common MIGS devices currently used in New Zealand include the<br />

iStent (Glaukos), Kahook Dual Blade (KDB, New World Medical) and the<br />

Preserflo MicroShunt (Santen).<br />

The safety and efficacy of iStent is now well established. Meta-analysis<br />

data confirms the superiority of iStent with cataract surgery over cataract<br />

surgery alone, in terms of both absolute IOP lowering and number of<br />

medications needed for glaucoma control 2 . The clinical benefits are often<br />

sustained for many years post-operatively 2 . The current generation of<br />

iStent (iStent inject W) allows for two devices to be injected into the TM<br />

of the same eye using a single pre-loaded injector. A recent prospective<br />

randomised multi-surgeon trial demonstrated that with the use of two<br />

iStent injects in the same eye, it is also safe and effective as a standalone<br />

procedure (without cataract surgery) for the treatment of mild to<br />

moderate glaucoma 3 .<br />

iStent technology has progressed further with the introduction of the<br />

iStent infinite, which enables three iStents to be injected into the TM<br />

with the same injector. Research has shown this leads to additional IOP<br />

lowering and better glaucoma control than what was achieved with two<br />

iStents 4 . This could potentially play a role in patients with more advanced<br />

glaucoma and evidence suggests it may be effective even in patients<br />

with previous failed glaucoma surgery 4 .<br />

KDB<br />

The KDB is another MIGS procedure targeting the TM and would be<br />

considered an alternative to iStent. The KDB is a specifically designed<br />

iStent<br />

iStent is a MIGS device implanted into the trabecular<br />

meshwork (TM) to enable drainage of aqueous humour<br />

from the anterior chamber directly into Schlemm’s canal,<br />

bypassing the TM (Fig 1). It is recommended for patients<br />

with mild to moderate POAG, OHT, normal-tension<br />

glaucoma (NTG), pseudoexfoliative glaucoma (PXG) and<br />

pigmentary glaucoma (PG). iStent is contraindicated in<br />

patients with angle-closure glaucoma and most forms<br />

of secondary glaucoma other than PXG/PG. As the iStent<br />

is most commonly used in combination with cataract<br />

surgery, the patients most suitable would be those who<br />

also have visually significant cataract along with being<br />

on multiple glaucoma eye drops and/or having<br />

uncontrolled glaucoma.<br />

Fig 2. Kahook Dual Blade goniotomy<br />

36 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


Professors<br />

Charles McGhee<br />

& Dipika Dr Jie Zhang, Patel,<br />

series editors<br />

goniotomy blade that allows the ab interno<br />

(via anterior chamber) removal of a strip<br />

of TM while minimising collateral damage<br />

to surrounding structures (Fig 2). By<br />

removing a section of TM, the KDB allows<br />

aqueous drainage directly into the collector<br />

channels of Schlemm’s canal and the distal<br />

outflow system. KDB can be performed as<br />

a standalone procedure or combined with<br />

cataract surgery. Similar to iStent, the ideal<br />

patient has mild to moderate open-angle<br />

glaucoma, is on multiple medications and<br />

undergoing cataract surgery.<br />

Clinical studies have demonstrated a high<br />

safety profile comparable to other MIGS<br />

procedures and enhanced safety when<br />

compared to trabeculectomy 5 . The clinical<br />

efficacy, in terms of long-term IOP lowering<br />

and reduction in number of medications,<br />

is also comparable to other MIGS procedures 5 . KDB may be effective in<br />

severe or refractory glaucoma and hence like the iStent infinite it could<br />

provide a possible alternative in high-risk eyes that would otherwise<br />

need more invasive surgery 6 .<br />

Preserflo MicroShunt<br />

The Preserflo MicroShunt can be considered the next level in MIGS<br />

intervention when iStent or KDB is unsuitable or unsuccessful for a<br />

particular patient. The Preserflo device provides greater IOP lowering<br />

than these other MIGS devices and is best suited to patients with<br />

uncontrolled moderate to advanced glaucoma. Preserflo is considered a<br />

more direct alternative to trabeculectomy than other MIGS procedures.<br />

The device is a ‘microtube’ made from biocompatible material<br />

known as ‘SIBS’ (synthetic polymer of poly(styrene-block-isobutyleneblock-styrene))<br />

and is 8.5mm long with a 350mm outer diameter and<br />

70mm lumen. These dimensions were designed to allow adequate<br />

outflow while preventing hypotony. The Preserflo is implanted<br />

subconjunctivally through a scleral tunnel so that the proximal tip rests<br />

in the anterior chamber and the distal end sits under the conjunctiva and<br />

the Tenon capsule approximately 6mm from the limbus (Fig 3A). Aqueous<br />

drains from the anterior chamber to the subconjunctival space, resulting<br />

in the formation of a bleb much like with a trabeculectomy – hence<br />

mitomycin-C application within the sub-conjunctival space at the time<br />

of surgery is required. Unlike trabeculectomy, there is no need for scleral<br />

flap formation, sclerotomy or iridectomy as part of the procedure.<br />

Preserflo requires less operating time and post-operative additional<br />

measures, has a faster recovery time and a lower risk of intraoperative<br />

and post-operative complications, compared to trabeculectomy 7-9 .<br />

Several clinical trials evaluating Preserflo have demonstrated a high<br />

safety profile and effectiveness at controlling glaucoma over many years<br />

of follow up 7-9 . The complete success rate (no additional medications<br />

to achieve target IOP) was reported to be between 75–80% and the<br />

qualified success rate (requiring additional medications) was over 90%<br />

in these studies at least two years after surgery. However, Preserflo does<br />

not result in the same level of IOP lowering that can be achieved with<br />

trabeculectomy, hence for patients who require a low target IOP, the<br />

latter option is still preferred 9 .<br />

Fig 3. The Preserflo MicroShunt (A) in comparison to a traditional tube-shunt (Paul tube in the sulcus) (B)<br />

Traditional tube-shunt surgery (Ahmed, Baerveldt, Molteno and Paul<br />

implants) will also continue to play an essential role due to their different<br />

clinical indications. In particular, patients with complex secondary<br />

glaucoma (eg, active neovascular or uveitic glaucoma) have far better<br />

outcomes with tube-shunt surgery than with trabeculectomy. Other<br />

indications include conjunctival scarring precluding filtration surgery or<br />

previous failed trabeculectomy.<br />

In contrast to Preserflo, these tubes have a much larger lumen<br />

diameter and an external plate implanted subconjunctivally, which<br />

allows for formation of an external reservoir. Tube-shunts are available in<br />

different sizes, material and design, with some being valved and others<br />

non-valved. The Paul tube (Fig 3B) is a relatively new device with a lumen<br />

diameter (0.1mm) somewhat midway between the Preserflo (70μm)<br />

and other tubes (0.3mm) and has been well-adopted as it maintains the<br />

clinical effectiveness of other tube-shunts while having a lower risk of<br />

hypotony and other post-operative complications.<br />

References<br />

1. Gazzard G et al. Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and<br />

glaucoma: the LiGHT RCT. Health Technol Assess. 2019;23(31):1–102<br />

2. Malvankar-Mehta, M.S, Iordanous, Y, Chen, Y.N et al. iStent with Phacoemulsification versus<br />

Phacoemulsification Alone for Patients with Glaucoma and Cataract: A Meta-Analysis. PLoS<br />

ONE 2015, 10, e0131770<br />

3. Fechtner, R.D, Voskanyan, L, Vold, S.D et al. Five-Year, Prospective, Randomized, Multi-Surgeon<br />

Trial of Two Trabecular Bypass Stents versus Prostaglandin for Newly Diagnosed Open-Angle<br />

Glaucoma. Ophthalmol. Glaucoma 2019, 2, 156–166.<br />

4. Sarkisian, S.R.; Grover, D.S.; Gallardo, M.J et al. iStent infinite Study Group. Effectiveness and Safety of<br />

iStent Infinite Trabecular Micro-Bypass for Uncontrolled Glaucoma. J. Glaucoma 2023, 32, 9–18.<br />

5. Dorairaj S, Radcliffe NM, Grover DS et al. A Review of Excisional Goniotomy Performed with the Kahook<br />

Dual Blade for Glaucoma Management. J Curr Glaucoma Pract 2022; 16 (1):59-64.<br />

6. Bravetti, G.E., Gillmann, K., Salinas, L. et al. Surgical outcomes of excisional goniotomy using the kahook<br />

dual blade in severe and refractory glaucoma: 12-month results. Eye 37, 1608–1613 (2023).<br />

7. Beckers H.J.M., Aptel F., Webers C.A.B., Bluwol E et al. Safety and Effectiveness of the PRESERFLO(R)<br />

MicroShunt in Primary Open-Angle Glaucoma: Results from a 2-Year Multicenter Study. Ophthalmol.<br />

Glaucoma. 2021.<br />

8. Gubser, P.A., Pfeiffer, V., Hug, S. et al. PRESERFLO MicroShunt implantation versus trabeculectomy for<br />

primary open-angle glaucoma: a two-year follow-up study. Eye and Vis 10, 50 (2023).<br />

9. Khan, A. & Khan, A.U. (<strong>2024</strong>) Comparing the safety and efficacy of Preserflo Microshunt implantation<br />

and trabeculectomy for glaucoma: A systematic review and meta-analysis. Acta Ophthalmologica, 102,<br />

e443–e451.<br />

The current role of trabeculectomy and tube-shunt surgery<br />

With the advent of MIGS there has been a decreasing trend in the need<br />

for trabeculectomy. However, it has long been considered the gold<br />

standard of glaucoma surgery and still has an important role to play.<br />

Trabeculectomy is the preferred option in patients with uncontrolled<br />

moderate to advanced glaucoma on MTMT who require a low target IOP.<br />

Furthermore, trabeculectomy may be necessary when access to MIGS is<br />

not possible or as a subsequent step if previous MIGS was unsuccessful.<br />

Dr Hussain Patel is a glaucoma and cataract specialist at<br />

Eye Surgery Associates and Greenlane Clinical Centre in<br />

Auckland. He is also a senior lecturer with the Department of<br />

Ophthalmology, University of Auckland.<br />

NZOPTICS.CO.NZ | 37


NEWS<br />

Melanoma prediction with a<br />

smartphone?<br />

(L to R) Professor Minas Coroneo AO and study participant Peter Phillips. Credit: Prince of<br />

Wales Hospital<br />

RESEARCHERS AT AUSTRALIA’S Prince of Wales Hospital have<br />

begun a study of a prototype smartphone-based tool to assess ultraviolet<br />

(UV) damage to the eye, which can be an early predictor for skin cancer.<br />

Despite the country having some of the world’s highest levels of<br />

UV radiation, with skin cancer and eye diseases impacting millions of<br />

Australians, there are currently no readily available, objective means of<br />

assessing early ocular UV damage, said Professor Minas Coroneo AO,<br />

study lead and the hospital’s head of ophthalmology. “Our team was one<br />

of the first to document that the UV-related conditions affecting the eye,<br />

such as pterygium and one type of cataract, could be an early sign of<br />

skin cancer, decades before its manifestation,” he said.<br />

The team’s optical add-on can be retrofitted to smartphones, enabling<br />

instant and portable UV eye damage detection, he said. The study,<br />

made possible thanks to a $125,000 grant from Prince of Wales Hospital<br />

Foundation, is currently recruiting participants.<br />

Otago Region<br />

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New Queenstown eye<br />

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EXPANDING BEYOND<br />

DUNEDIN, Otago<br />

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opening a new eye<br />

specialist clinic in<br />

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in the city centre’s<br />

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Lakes regions.<br />

“We are thrilled to<br />

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patient, ensuring the best<br />

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Dr Sheng Hong (L) with nurse Danielle Wilson,<br />

ophthalmic technician Gabriel Bilkey and nurse<br />

Melanie Peck outside the new Queenstown<br />

eye clinic<br />

The clinic offers cornea, cataract, uveitis, glaucoma, eyelid,<br />

retina and paediatric ophthalmology specialist services. The<br />

Queenstown team also includes Drs Mimi Chiu, Ammar Binsadiq<br />

and Harry Bradshaw.<br />

World’s first spiral IOL<br />

designed with AI<br />

RAYNER, A GLOBAL<br />

manufacturer of<br />

cataract surgery<br />

products, has launched<br />

a world-first spiral<br />

intraocular lens<br />

(IOL) designed using<br />

artificial intelligence<br />

(AI): RayOne Galaxy<br />

and Galaxy Toric.<br />

Introduced at this<br />

year’s European Society of Cataract and Refractive Surgeons (ESCRS)<br />

congress in Barcelona, the RayOne Galaxy IOL comes to market 75 years<br />

after Rayner pioneered the first IOL with ophthalmologist and inventor<br />

Sir Harold Ridley.<br />

However, unlike in Sir Harold’s day, this new lens was designed<br />

using a proprietary AI engine trained on patient outcomes, which the<br />

company said delivers “a continuous full range of vision with minimised<br />

dysphotopsia, achieved through a non-diffractive optic with 0% light loss’’.<br />

Everyone has read about the life-changing potential of AI, but this<br />

is a real-world example of technology impacting the outcomes of<br />

patients, said Tim Clover, Rayner CEO. “RayOne Galaxy represents a nextgeneration<br />

technology in intraocular lenses to enable patients to see<br />

without spectacles.”<br />

RayOne Galaxy is available in a wide range of toric powers and comes<br />

fully preloaded in the same single-use injector system as the RayOne<br />

family of lenses, said the company.<br />

38 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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NZOPTICS.CO.NZ | 39


NEWS<br />

MIGS – in the surgeon’s seat!<br />

By Susanne Bradley<br />

RE:VISION’S FIRST minimally<br />

invasive glaucoma surgery (MIGS)<br />

dry lab workshop provided<br />

keen optometrists with a unique<br />

opportunity to put their surgical<br />

skills to the test. A bit like speed<br />

dating, optometrists moved<br />

between six stations, inserting<br />

Glaukos’ latest iStent infinite and<br />

Preserflo as well as trying their<br />

hand at using the Kahook Dual<br />

Blade before examining four<br />

volunteer MIGS patients.<br />

Passionate shared-care<br />

advocate Dr Divya Perumal<br />

said the workshop had been a<br />

dream of hers for a long time.<br />

Enhancing optometrists’ MIGS<br />

knowledge is important since<br />

MIGS patients are ideal candidates<br />

for co-management, she said.<br />

“A collaborative approach between<br />

optometrists and ophthalmologists<br />

in evaluating, educating and<br />

Re:Vision hosts Jennifer Silvester, Dr Mo Ziaei, Elkie Wong, Dr Divya Perumal,<br />

Nick Mathew, and Glaukos’ Chris Money<br />

managing patients undergoing MIGS leads to better outcomes, efficient<br />

use of resources, enhanced patient satisfaction and better continuity of<br />

care,” she said.<br />

Discussing pre- and post-surgery considerations and different surgery<br />

techniques, Dr Perumal said MIGS candidates are patients with mild to<br />

moderate glaucoma and glaucoma patients with cataracts who want to<br />

get off medication, have poor medication compliance or are medication<br />

Guided by Dr Divya Perumal, Paula Farrar<br />

manoeuvres the slightly floppy Preserflo stent<br />

into place<br />

Vandana Kumar handles the Kahook Dual Blade<br />

intolerant, are challenged in attending regular follow-ups or want a<br />

faster post-operative recovery.<br />

One important aspect of the optometrist’s role in a shared-care<br />

arrangements is education and counselling, said Dr Perumal, including<br />

informing patients of the benefits and risks and advising them of<br />

realistic outcomes. “MIGS is not cataract surgery, it’s a lifetime process,”<br />

she concluded.<br />

Optique’s acquisition creates one-stop shop<br />

OPTIQUE LINE HAS acquired key<br />

assets from McCann Optical Parts,<br />

including plant, equipment and<br />

inventory, allowing it to expand its<br />

offering with an extensive range of<br />

tailored optical accessories.<br />

“We believe this integration will<br />

enhance our services, allowing us<br />

to deliver more tailored solutions<br />

meeting the unique needs of<br />

our customers in New Zealand,”<br />

said Optique Line’s director John<br />

Nicola. “The purchase is a perfect<br />

fit for Optique Line, allowing<br />

our account managers to offer a<br />

comprehensive, one-stop shop. The<br />

team is committed to creating a<br />

seamless transition,” he said. “Greg Optique Line’s John Nicola at O=Mega19<br />

McCann and his team have provided<br />

exceptional expertise and service for many years and we plan to<br />

continue their great work.”<br />

The former McCann Optical Parts will be represented in New<br />

Zealand by Optique Line’s account manager Vicki Evans.<br />

Partner programme boost<br />

In other news, Optique Line’s Supply & Fit<br />

tiered partner programme is rewarding<br />

loyal customers with the addition of gold<br />

and platinum benefits. A gold partner<br />

(who constantly maintains 60-plus pieces<br />

of stock) will receive $200 account credit<br />

every two years and a two-year warranty covering manufacturing<br />

defects and material faults. A platinum partner (who constantly<br />

maintains 100-plus pieces of stock) will receive $500 account credit<br />

every two years and an unconditional two-year warranty.<br />

40 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


ALWAYS READ THE LABEL AND FOLLOW THE DIRECTIONS FOR USE.<br />

LASTS 6 MONTHS<br />

AFTER OPENING<br />

*For up to 16 hours. ^Based on laboratory studies on selected organisms. **Compared to Opti-Free Replenish Multi-Purpose Disinfecting Solution ECONOMY PACK. References: 1. Lally, J. et al. A new lens<br />

care solution provides moisture and comfort with today’s CLs. Optician 2011. 241 (62960): 42-46. 2. Resnick, S. What makes OPTI-FREE PureMoist MPDS an attractive solution. Review of Cornea & Contact<br />

Lenses September 2011. 3. Subbaraman, L. et al. In Vitro Efficiency of Contact Lens Care Solutions in Removing Cholesterol Deposits from Silicone Hydrogel Contact Lenses. Contact Lens & Anterior Eye 36<br />

(2013) e16-46. 4. Rosenthal, A. et al. Broad Spectrum Antimicrobial Activity of a New Multi-Purpose Disinfecting Solution. CLAO 2000. 26(3). 5. Codling, C. et al. Aspects of the Antimicrobial Mechanisms of<br />

a Polyquaternium and Amidoamine. JAC 2003(51):1153-1158. 6. Gabriel, M. et al. Effect of Contact Lenses and Lens Cases on Disinfection Efficacy of Four Multipurpose Disinfection Solutions. ARVO 2013.<br />

7. Kern, J. et al. Antimicrobial properties of a novel contact lens disinfecting solution, OPTI-FREE EverMoist. BCLA 2011. 8. Gabriel, M. et al. Antimicrobial Efficacy of Multipurpose Disinfecting Solutions in the<br />

Presence of Contact Lenses and Lens Cases. Eye and Contact Lens 2016;0: 1-7. ©<strong>2024</strong> Alcon Laboratories Pty Ltd. AUS: 1800 224 153; Auckland NZ: 0800 101 106. ANZ-OFM-2400008


BUSINESS<br />

Brought to you<br />

by the IOGroup<br />

BEST PRACTICE, MADE EASY<br />

The bottom line: business focus<br />

fundamentals – part one<br />

By Lynden Mason, with Teréze Taber<br />

OPERATING A SUCCESSFUL practice<br />

requires so much more than just<br />

clinical expertise. One of the biggest<br />

challenges for business owners is<br />

balancing time working on their<br />

business – not just in it.<br />

Instead of feeling overwhelmed by<br />

the numerous hats you’re expected<br />

to wear as a business owner, let me<br />

introduce you to the business focus<br />

fundamentals, or BFFs (can you tell<br />

I have teenage daughters?). It’s not<br />

perhaps the most sophisticated<br />

abbreviation, but it’s a simple tool<br />

you can refer to daily by asking: am I<br />

spending enough time developing a healthy relationship with my BFFs<br />

and, therefore, my business?<br />

I have spent 20 years owning and operating businesses in New<br />

Zealand, both as an optometrist and an entrepreneur. After growing<br />

a group of 10 optometry practices and selling to Luxottica in 2010, I<br />

then switched to another field. Initially, I opened one hairdressing salon<br />

and rebranded it Vivo. Over the next decade, I expanded Vivo into a<br />

nationwide group (I never picked up a pair of scissors or learned how to<br />

dye hair!). As time went on, I focused on certain principles and realised<br />

they could be relied upon in any business operation. However, they’re<br />

easily diluted by the numerous pressures that every business owner has<br />

on their time, finances and energy. Throw in a recession and a cost-ofliving<br />

crisis and it’s fair to say things feel a little stressful right now. But if<br />

you focus on the BFFs, they are a proven, effective and simple maxim for<br />

keeping your clinic profitable, no matter the financial climate.<br />

The BFFs include vision and strategy, financial management<br />

recruitment, staff development and training, branding, marketing, client<br />

experience, inventory/supplier management and time management (to<br />

enable you to juggle all of these things!).<br />

In the first of this series, Teréze and I will help you become comfortable<br />

with the BFFs.<br />

Financial statements and management<br />

This is the place to start; and it’s a biggie. A financially viable business<br />

model allows us to provide sustainable care for our clients, while<br />

personally being able to enjoy the success of our labour. However, it’s<br />

our experience that many business owners don’t have a good grip on<br />

their numbers.<br />

Financial statements are normally provided by your accountant at the<br />

end of the financial year. You likely glance at the numbers swimming<br />

on the page, swear a little at the cost of IRD compliance and the tax bill<br />

you’ve incurred, then swirl your signature at the ‘sign here’ Post-it note.<br />

That’s a wrap for this year, let’s get back into the practice…<br />

Not so fast! Financial statements are an absolute treasure trove of<br />

information. Because they’re done at the end of a financial period, by<br />

the time you receive them they’re technically out of date. But think of<br />

them this way: would you see a patient<br />

without taking a clinical history? Of<br />

course not – it’s the first thing you’d<br />

do. A clinical history allows you to<br />

understand so much about the client:<br />

what has happened; predisposing<br />

risk factors; challenges they may be<br />

facing; areas that need assistance and<br />

attention; and identifying trends. It<br />

also gives you an idea of the demands<br />

of the patient’s lifestyle and their<br />

hoped-for outcomes.<br />

It’s a game-changer to adopt the<br />

same perspective with the numbers in<br />

your financial statement by recognising<br />

they reflect your business’ actions and behaviours. As well as offering<br />

signposts, financial statements offer areas we call levers or drivers. For<br />

example, a typical optometry practice’s fixed costs are high, with wages<br />

and overheads both sizable monthly outgoings. To meet these expenses,<br />

a critical area to focus on in the profit and loss statement is your cost of<br />

goods (COG) and gross profit margin (GPM). This margin is a vital lever. For<br />

an optometry practice, there’s minimal COG related to eye examinations, so<br />

the main COG relate to retail: frames, lenses and contact lenses. The GPM is<br />

what’s left once you’ve paid your suppliers for these items.<br />

We encourage owners to review this area monthly, with laser focus. The<br />

two ways to influence this number is to either buy goods for less or sell<br />

goods for more. Ideally, both! This means constantly looking at your<br />

product mix, talking to your suppliers, looking at your pricing strategy<br />

and communicating sales focus areas to your team. What’s the bottom<br />

line for your COG margin? The lower the better, of course, but an ideal<br />

goal is 25–35%, which means a GPM of 65–75%.<br />

For optometry practices, therefore, a very important formula to<br />

increase the overall profitability and value of your business, is to reduce<br />

COG to increase GPM. It might not be as simple as it sounds, but it’s a<br />

fundamental focus. A warning here: it may require some uncomfortable<br />

and challenging conversations and changing your established habits.<br />

This is the power and importance of financial statements – to see the<br />

signposts, help you to set about changing key drivers and pulling the<br />

available levers. Over the coming months, we’ll continue to unpack the<br />

BFFs that are going to work hard for you, just like good friends.<br />

Lynden Mason is the co-founder and former co-owner of Vivo,<br />

a large Southern Hemisphere group of privately owned hair<br />

salons. An optometrist, he started his career by growing 10<br />

optometry clinics across the North Island.<br />

Lynden@behindthebrand.co.nz<br />

Teréze Taber – a former television producer – is a passionate<br />

content writer and brand specialist. With Lynden, she is now<br />

focused on their private consultancy practice, Behind the Brand.<br />

Tereze@behindthebrand.co.nz<br />

To learn more about the IOGroup, contact Neil Human:<br />

0210 292 8683 neil.human@iogroup.co.nz<br />

42 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong><br />

THE INDEPENDENT<br />

OPTOMETRY GROUP


NEWS<br />

Visual reality<br />

BERLIN-BASED STARTUP Even<br />

Realities has released its first Rxable<br />

smartglasses, the G1.<br />

Currently available in a<br />

classic rounded panto shape,<br />

the G1 offers a digital display<br />

superimposed onto the wearer’s<br />

view via the prescription lens. This<br />

is usually only visible when receiving<br />

a new notification from the user’s phone,<br />

but upon tilting the head upwards the wearer can bring up the time,<br />

date, ambient temperature and a summary of any unaddressed phone<br />

notifications. In a YouTube video, frame stylist and manager of UK<br />

optometrist The Spectacle Factory, Robert Sands explained that since<br />

the green LED-style display appears to be in the distance, rather than on<br />

the actual lenses, the wearer is not required to refocus, which he said is<br />

far less tiring on the eyes.<br />

The G1 can also provide real-time translation on screen when<br />

listening to someone speaking in another language, or act as a<br />

teleprompter for speeches and presentations, suggested Sands. An<br />

onboard AI-driven digital assistant, can be activated and respond to the<br />

wearer’s questions by tapping the left end tip, while tapping the right<br />

end tip records a voice note. Having come to market in August this year,<br />

G1’s most recent updates include navigation for walkers and cyclists.<br />

The smartglasses’ battery packs are located in the end tips of the<br />

lightweight magnesium frame, meaning they’re inconspicuous while<br />

helping to balance them on the face, said Sands.<br />

The G1 retails at US$599 (NZ$962), with prescription lenses an extra<br />

US$150 (NZ$241).<br />

Gelflex new distributor for<br />

NaturalVue multifocal<br />

US-BASED VISIONEERING Technologies Inc (VTI) has appointed Gelflex<br />

as its Australia and New Zealand distribution partner for the NaturalVue<br />

multifocal 1-day contact lenses. Gelflex, through Ophthalmic Instrument<br />

Company, is now New Zealand’s exclusive NaturalVue distributor.<br />

“We are thrilled to provide our customers with VTI’s portfolio of<br />

products,” said David Masel, managing director, Gelflex. “The unique<br />

extended depth of focus design of the NaturalVue multifocal provides<br />

practitioners the ability to serve a wide range of patient types – from<br />

progressing myopes to advanced presbyopia – all with one lens.”<br />

Masel said the<br />

product has been<br />

well received by<br />

practitioners and<br />

fits in perfectly<br />

with Gelflex’s suite<br />

of offerings. “By<br />

partnering with VTI,<br />

we now offer our<br />

customers another<br />

way to differentiate<br />

their practices and<br />

reflect our ongoing<br />

commitment to<br />

investing in and<br />

supporting the<br />

specialty lens<br />

industry,” he added.<br />

NZOPTICS.CO.NZ | 43


EDUCATION<br />

Strengthening bonds to enhance acute care<br />

By Vicky Wang<br />

ON A CHILLY August evening,<br />

Greenlane Eye Clinic proudly<br />

hosted its inaugural seminar on<br />

emergency eyecare, aimed at<br />

enhancing collaboration between<br />

community optometrists and our<br />

acute eyecare team. The event<br />

began with a warm welcome<br />

from our hospital team, including<br />

optometrists Richard Johnson,<br />

Reuben Gordon, Robyn Stirling,<br />

Deborah Chan, Tracey Jones,<br />

Harpreet Singh and myself.<br />

Dr Kathleeya Stang-Veldhouse,<br />

a lead ophthalmologist in<br />

our Acute Eye Service (AES),<br />

noted the service receives over<br />

60 referrals per day from community optometrists and GPs. Her<br />

presentation detailed the AES structure, including referral guidelines,<br />

triage procedures and the essentials of a quality referral. The service is<br />

supported by a diverse team of consultants, fellows, both training and<br />

non-training registrars, junior research fellows, nurse practitioners,<br />

clinical nurse specialists, optometrists and acute clinic nurses. Each role<br />

is crucial in ensuring timely and effective patient care.<br />

Not a walk-in service<br />

Dr Stang-Veldhouse emphasised the clinic is not a walk-in service<br />

– referrals should be made via HealthLink or phone consult (after<br />

which an online referral is still required). Patients without such<br />

referrals will undergo triage by nurses and senior clinicians and, if no<br />

immediate issue is identified, they may be advised to return to their<br />

GP or optometrist, or be rescheduled into the Acute Referrals Clinic or<br />

another subspecialty clinic as appropriate.<br />

Several ocular emergencies require same-day assessment, including<br />

open-globe/penetrating eye injuries, chemical injuries, endophthalmitis,<br />

acute angle closure and macula-on retinal detachment. Inpatients and<br />

the very young, very old, or very ill are given priority. A thorough<br />

referral includes the patient’s name, date of birth, NHI number, a<br />

concise history of symptoms, vital signs of the eye, visual acuity and<br />

intraocular pressure.<br />

Dr Stang-Veldhouse urged practitioners not to take offence if<br />

additional information is requested. “Due to our limited resources,<br />

certain pertinent details are required to triage referrals accordingly,”<br />

she explained. Community optometrists should also inform<br />

patients of expected wait times of at least two hours (and sometimes<br />

exceeding five). Non-urgent cases may be rescheduled.<br />

Our second speaker, nurse practitioner Kathryn Millichamp,<br />

presented her research on ocular emergencies. She analysed 7,641<br />

cases presenting to the Greenlane Clinic over a six-month period.<br />

Her findings included the following distributions of true ophthalmic<br />

emergencies: chemical injury, 1.88% (n=123, with 2 out of 123 requiring<br />

admission); acute angle closure crisis, 0.11% (n=7); orbital cellulitis,<br />

0.06% (n=4); endophthalmitis/hypopyon, 0.03% (n=2); penetrating<br />

eye injury/globe rupture, 0.015% (n=1). Other conditions requiring<br />

same-day review included: uveitis, 13% (n=871); blunt trauma, 10.5%<br />

(n=687); keratitis, 9.3% (n=610); preseptal cellulitis, 2.2% (n=145);<br />

retinal detachment, 0.52% (n=34).<br />

Millichamp also discussed vision loss due to systemic or vascular<br />

causes, which accounted for 4.2% of cases. She demonstrated the<br />

management of chemical injuries, detailing the appropriate on-site care,<br />

practices in optometry and protocols upon patient arrival at Greenlane.<br />

She also explained red flags for ocular trauma and vision loss and<br />

provided tips for effective referrals, emphasising the importance of<br />

L-R: Dr Vince Wilkinson, Kathryn Millichamp (front), Richard Johnson (back), Carly Henley,<br />

Vicky Wang, Dr Kathleeya Stang-Veldhouse and Robyn Stirling<br />

comprehensive information in<br />

managing ocular emergencies.<br />

An eye for detail<br />

Carly Henley, the Allied Health<br />

Unit manager, oversees a team<br />

of 34 professionals, including<br />

optometrists, orthoptists and<br />

ophthalmic technicians. A UKqualified<br />

orthoptist with over<br />

28 years of experience in both<br />

paediatric and adult binocular<br />

vision disorders, she discussed<br />

the triaging of paediatric referrals.<br />

She stressed the importance of<br />

including detailed information<br />

to help the Greenlane team accurately identify and prioritise acute<br />

paediatric ocular conditions.<br />

Essential referral details include:<br />

• Previous ocular history<br />

• Family history of eye problems (eg, refractive error, squint,<br />

patching or significant conditions like infantile glaucoma, cataract, or<br />

retinoblastoma)<br />

• General health and medical history, including developmental issues<br />

• Birth history (eg, gestational age, delivery details, birth weight and<br />

any complications).<br />

Henley also reviewed the paediatric referral guidelines on Healthpoint,<br />

which assist optometrists in gathering critical information to ensure<br />

appropriate triage. She highlighted the importance of thorough clinical<br />

examination and attentive listening to symptoms.<br />

Dr Vince Wilkinson, a junior medical retina fellow at Greenlane,<br />

provided an update on herpes zoster ophthalmicus (HZO). He<br />

explained that approximately 1 in 3 of adults will develop shingles*.<br />

Of those, 10–20% will experience HZO, which can lead to moderate<br />

vision loss (≤6/15) in 9.6% of cases and severe vision loss (≤6/60) in<br />

3.6%. Risk factors for vision loss in HZO include poor presenting visual<br />

acuity, older age, uveitis and immunosuppression. Complications can<br />

include corneal scarring, corneal perforation and secondary glaucoma.<br />

Dr Wilkinson stressed that antiviral treatment within 72 hours of<br />

symptoms developing is crucial to reduce the risk of vision loss and<br />

cerebrovascular accidents, particularly for individuals under 40. He also<br />

noted that HZO relapses occur in about 20% of cases, highlighting the<br />

importance of timely treatment and vaccination.<br />

Richard Johnson, a senior hospital optometrist, presented three<br />

challenging case studies: diabetic vitreous haemorrhage, phacomorphic<br />

glaucoma and hypertensive retinopathy. Despite each initially<br />

presenting with diverse clinical signs, the correct diagnoses were made<br />

and good outcomes were achieved. Johnson’s key takeaway was to avoid<br />

assuming previous diagnoses are correct and ensure clinical findings<br />

align with the current diagnosis.<br />

Attendees were invited to observe various hospital clinics, including<br />

emergency, paediatric, advanced contact lens, postoperative and<br />

low vision.<br />

*See pages 14 and 26 for more on shingles<br />

Vicky Wang is a therapeutically qualified optometrist currently<br />

working for Health NZ Te Whatu Ora Auckland.<br />

44 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


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NZOPTICS.CO.NZ | 45


EDUCATION<br />

Genes and gems with Retina Specialists<br />

By Naomi Meltzer<br />

RETINA SPECIALISTS’ WINTER<br />

educational evening for<br />

optometrists had both genes and<br />

gems on the menu.<br />

Associate Professor Andrea<br />

Vincent kicked the evening off with<br />

a story fit to tug the heart strings. It<br />

concerned a two-year-old boy from<br />

Christchurch with suspected early<br />

onset Leber congenital amaurosis<br />

(LCA), a group of inherited retinal<br />

diseases characterised by severely<br />

impaired vision or blindness, typically<br />

presenting between birth and five<br />

years of age. The condition causes<br />

degeneration and/or dysfunction of<br />

photoreceptors and, in some cases,<br />

other body organs, such as kidneys,<br />

may become affected. There are four<br />

common gene mutations associated with LCA, including RPE65.<br />

At the time of referral, no measure of vision could be obtained, but<br />

the prognosis was that because he had two mutations of the gene he<br />

would generally have few photoreceptors left by the time he was five. In<br />

effect, left untreated, he would have had no usable vision by the time he<br />

started school.<br />

The boy appeared to be 4–5 dioptres hypermetropic and rubbed<br />

or poked his eyes a lot, which is typical of children with LCA and can<br />

potentially cause associated corneal and other ocular damage. In<br />

December 2017, Spark Therapeutics obtained FDA approval for Luxturna<br />

(voretigene neparvovec), a gene therapy which has improved vision in<br />

children and young adults with the RPE65 mutation. The adenovirusmediated<br />

gene augmentation therapy is injected under the retina. Cells<br />

with the non-functioning gene are invaded by a functioning gene that<br />

replaces the non-functioning gene to make the cell function normally. Of<br />

course, that is only viable while there are still functioning photoreceptors<br />

to work with, which means time is of the essence.<br />

There are thought to be only three patients in New Zealand with<br />

this genetic variant but, at the time of writing, Pharmac will not fund<br />

the $700,000-per-eye Luxturna treatment. Fortunately A/Prof Vincent<br />

became aware that Moorfields have treated one eye only in each of four<br />

children with this rare disease with Luxturna, which has been approved<br />

by the European Medical Agency (EMA).<br />

Moorfields agreed to treat this boy on a “compassionate use on trial”<br />

basis. The family had to pay for the travel costs to the UK, but not the<br />

treatment. Four months later, the vision in the treated right eye was 25%<br />

better than at the start of the trial. On 6 June this year, the second eye<br />

was treated. The child appears to be favouring the right eye, so some<br />

Stuart and Carolyn Campbell<br />

Retina Specialists’ Drs Rachel Barnes and Leo Sheck and A/Prof Andrea Vincent<br />

Anh Dao Le, Alice Ku and Kathreena Lim<br />

amblyopia is likely from the delay in<br />

treating the left eye, but he is making<br />

progress, indicating he appears<br />

to have some photoreceptors still<br />

working. OCT showed a thin layer of<br />

residual photoreceptors.<br />

The parents, however, need<br />

answers quickly. They want to know<br />

if he will go blind and whether other<br />

members of the family will develop it<br />

or potentially be born with the same<br />

genetic issue. Can anything be done<br />

to slow down the process and what<br />

decisions do they need to make,<br />

in terms of the child’s educational<br />

pathways? Clinicians also need to<br />

know what else might be happening<br />

in this child’s body that may be<br />

associated with the retinal changes.<br />

When a child presents with unexplained loss of vision, the search for<br />

inherited disorders begins. Many countries do not have access to genetic<br />

testing and, in a small country such as New Zealand, the numbers of<br />

cases with such rare genetic disorders can be infinitesimal, which not<br />

only emphasises the need for geneticists such as A/Prof Vincent to<br />

have international connections, but also to have the tools to make a<br />

timely diagnosis.<br />

A/Prof Vincent explained that even when she gets a referral with<br />

a diagnosis, she prefers to start with a blank sheet and not assume<br />

anything, otherwise she can be led down the wrong path with an<br />

unconscious bias. The starting point is always to look at the rest of the<br />

family; however, this information may be patchy. Autofluorescence helps<br />

a lot, as it gives much more detail of the changes occurring at the macula,<br />

she said.<br />

Asked how long the treatment will last, she replied, “How long is a<br />

piece of string? We just don’t know because we only have approximately<br />

seven years of data.” Hopefully, we will get an answer in future<br />

educational evenings. Watch this space!<br />

Watch and learn<br />

Dr Rachel Barnes continued with some interactive case studies<br />

for those who like to test their IT skills at the same time as their<br />

optometric knowledge.<br />

Her case concerned a 26-year-old who presented with sudden vision<br />

loss in one eye after a two-week history of mild upper respiratory<br />

infection. OCT showed a big central cyst within the bacillary layer of the<br />

retina (Fig 1). This is typical of acute posterior multifocal placoid pigment<br />

epitheliopathy (APMPPE), a form of cystic retinal oedema. Usually bilateral,<br />

it mostly appears in a person’s second<br />

to fourth decade, often after a virus<br />

and, importantly, may be associated<br />

with cerebral vasculitis.<br />

A bacillary layer detachment (a<br />

term coined as recently as 2018) is<br />

separation of the bacillary layer of the<br />

retina due to a relative weakness in the<br />

myeloid layer. There is a breakdown<br />

of the retinal pigment epithelium<br />

blood retina barrier while the external<br />

limiting membrane is preserved,<br />

allowing fluid to get into the intraretinal<br />

space. The fluid can often look<br />

quite turbid.<br />

46 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


Fig 1. Bacillary layer detachment. A retinal cyst usually resolves in 4–8 weeks, but steroids may hasten the process<br />

The one that nearly got away!<br />

The next case history was about a middle-aged male who’d had a routine<br />

normal dilated examination one year before presenting for his annual<br />

examination related to a history of rheumatoid arthritis.<br />

On this occasion he reported recently attending an A&E clinic for<br />

vague discomfort and blur in one eye. He was given ocular lubricants,<br />

which appeared to resolve the issue, though not entirely.<br />

Dr Barnes noted what appeared to be a group of inferiorly located<br />

dilated episcleral vessels that could be taken for mild blepharitis, possible<br />

episcleritis or even an odd-appearing early pterygium. Dilation revealed<br />

what was lurking below the surface: dilated sentinel episcleral vessels<br />

were disproportionately dilated, with tortuous episcleral blood vessels,<br />

which provided a clue for the presence of an underlying asymptomatic<br />

occult ciliary body melanoma.<br />

Dr Barnes confessed her blood runs cold every time she looks at the<br />

slide of ‘the one that nearly got away’.<br />

to track effectiveness, since<br />

there is no obvious change in<br />

fundus appearance or vision.<br />

A pathway for assessment<br />

of functional change is by<br />

doing microperimetry, which<br />

is available through the<br />

University of Auckland.<br />

The treatment is also not<br />

without risk of infection<br />

and potential neovascular<br />

transformation, said Dr Sheck.<br />

Ultimately, the best outcome<br />

at this stage is that progression<br />

of GA is slowed. It’s certainly a<br />

hard sell for the average patient with GA, even if they have deep pockets!<br />

There is a strong case for the ‘wait and see’ approach, unless there is an<br />

urgent reason to take the deep dive.<br />

However, there is a route to apply for continued treatments for<br />

patients who have already started treatment overseas. If they need<br />

treatment and are well informed, the drug can be accessed. Patients who<br />

have GA and have previously been treated for neovascular maculopathy<br />

are, at present, excluded from trials. It’s good to know that progress is<br />

being made.<br />

Naomi Meltzer is an optometrist who runs an independent<br />

practice specialising in low-vision consultancy. She is a regular<br />

contributor to NZ Optics.<br />

Assessment and treatment of geographic atrophy<br />

Dr Leo Sheck advocated the use of autofluorescence as the best imaging<br />

modality for assessing geographic atrophy (GA). His experience with the<br />

use of C3 (Syfovre) and C5 (Izervay) inhibitors, which are FDA- (but not yet<br />

Medsafe-) approved<br />

treatments for GA,<br />

is that there are<br />

practical problems,<br />

quite apart from the<br />

expense (self-funding<br />

at approximately<br />

$3,000 per injection,<br />

plus transportation<br />

from the US).<br />

One problem is<br />

deciding when to<br />

start treatment. It<br />

is also very difficult<br />

Tiffany Ong and Eva Woodward<br />

Specialised.<br />

Experts.<br />

Care.<br />

The Centre of Excellence<br />

in the Care and<br />

Treatment of Retinal<br />

Diseases in New Zealand<br />

retinaspecialists.co.nz<br />

Richard Chinn, John Adam and Dennis Oliver<br />

NZOPTICS.CO.NZ | 47


DISPENSING MATTERS<br />

The dispensing optician’s role in the<br />

remake puzzle<br />

By Virgilia Readett<br />

TIME, MONEY AND reduced productivity – this is what a spectacle<br />

remake costs a store, optical laboratories and customer. With the<br />

precision required – and intricate balance of priorities needed for a pair<br />

of specs to perform to their full potential – it has long been accepted<br />

that remakes are unavoidable. However, dispensing opticians (DOs)<br />

play a vital role in reducing remake rates. The DO’s skill set cannot be<br />

overstated in the success of spectacle functionality. By looking deeper<br />

at the importance of the DO’s role in the dispensing process we can find<br />

numerous solutions to reduce remake rates.<br />

Nicole Hibbert, Shamir Academy training manager, explains poor<br />

frame selection is one factor leading to less than perfect vision and a<br />

lack of comfort for the customer, increasing remake rates. Unnecessary<br />

thickness, weight, aberrations and field-of-view restrictions can all be<br />

reduced through expert frame selection, she says. “It’s useful for DOs to<br />

be aware of limitations and best practice when ordering. For instance,<br />

mid to high minus Rx ordered in a curved frame, or a similar Rx ordered<br />

with a high height in a large frame will result in thick lenses. These kinds<br />

of issues result in remakes.”<br />

Frame selection is a balance of fashion, feel, financials and function.<br />

• Fashion – appropriate frames will meet the customer’s<br />

aesthetic preferences<br />

• Feel – they will feel comfortable. DOs can ensure they are the<br />

appropriate dimensions for the customer’s anatomy and complement<br />

this with expert frame adjustments<br />

• Financials – with the increasing cost of living, customers may be<br />

investing in a longer-term frame – a statement worn for many years,<br />

unlike clothing that can be changed more readily. Careful and considered<br />

frame selection will improve a successful full-cycle dispense – one that<br />

leads to future dispenses rather than a remake<br />

• Function – the frames will allow the lenses to perform as intended,<br />

while reducing potential problems. Appropriate frame depth must be<br />

allowed for the required lens design<br />

As an aesthetic representation of their identity, frames require unique<br />

levels of assistance for each customer. Some will require multiple visits<br />

of extended length and opinions from various DOs, family and friends.<br />

Others will decline assistance and select independently within minutes.<br />

High-level interpersonal skills will allow a DO to read the customer and<br />

adapt their approach accordingly. A skilled DO able to find a frame<br />

that satisfies the customer’s requirements will instil confidence in the<br />

selection while reducing the potential for remakes.<br />

Questions vs assumptions<br />

Open and closed questions will aid a good dispense. Lifestyle questions<br />

will make sure outcomes exceed the customer’s expectations and<br />

prevent remakes due to issues where the spectacles are not fit<br />

for purpose.<br />

There isn’t a checklist of which lifestyle questions to ask every<br />

customer; questions flow naturally from one from the other, specific to<br />

the customer’s needs. A good starting point is looking deeper at the<br />

intended purpose of the spectacles. If they are for reading, what is the<br />

reading material and how far away will it be? The leadership team at<br />

Specsavers Erina Fair, Australia, identified this as an area for improvement,<br />

according to retail manager and Australasian College of Optical<br />

Dispensing (ACOD) trainer and assessor Rayleen Tamblyn. “We required<br />

all optometrists to include intermediate adds in the prescription, to<br />

determine working distance and correct Rx for visual display unit usage.<br />

This significantly reduced the number of specs being made as readers<br />

(which should have been made as single-vision intermediate).”<br />

If the patient is looking for distance lenses, what activities will they<br />

be wearing them for? Would they benefit from lens treatments tailored<br />

for that specific task? If, like many customers, they are needing specs for<br />

multiple tasks and distances, have you offered the most suitable design<br />

rather than your go-to lens?<br />

Knowing the product and the nuances of each progressive design is<br />

key to reducing remakes, says Hibbert. This is echoed by Glenn Bolton,<br />

48 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


Inappropriate amounts of pantoscopic angle will negatively impact the performance of the lens. Left shows an inappropriate<br />

amount (0) while right shows an appropriate amount (12). Credit: April Petrusma.<br />

compared to the test vertex will<br />

significantly change the effective<br />

prescription experienced by the<br />

customer. Care in adjustments and<br />

potential prescription compensation<br />

should also be taken into<br />

account here.<br />

Considering we are ordering<br />

precise measurements in increments<br />

of fractions of a millimetre, the<br />

importance of conducting a high<br />

level, appropriate final fit cannot be<br />

overstated. While not responsible<br />

for the refraction and the intended<br />

prescription, DOs are the gatekeepers<br />

of the effective prescription.<br />

Precision measurements and careful<br />

frame adjustment will ensure the<br />

prescription can function as intended.<br />

Shamir New Zealand managing director, who says he has seen a need for<br />

greater understanding in occupational designs.<br />

Ethical dispensing practice is a common theme discussed by ACOD<br />

students in their assessment pieces. It is ethical to sell customers what<br />

they require, so it is important for DOs to keep in mind that our duty<br />

of care is to recommend the best optical product for them. This means<br />

that upsells for higher-bracket lenses, lens treatments and, in some<br />

instances, additional pairs are ethical recommendations. When tailored to<br />

a customer’s specific needs, such recommendations will reduce the need<br />

to remake.<br />

Tim Thurn, Essilor Luxottica’s<br />

medical and professional relations<br />

director ANZ, says customers not<br />

only want your advice, they need it!<br />

“Fortunately, you have a broad range<br />

of products, services and<br />

clinical skills to meet those needs…<br />

however, personalisation begins<br />

with an in-depth understanding of<br />

the patient” 1 .<br />

DO fundamentals for final fit<br />

Final fitting is a vital skill for DOs. Done well, it sets the spectacles up<br />

for success. Done poorly, it sets them up for failure. When the topic<br />

is taught in ACOD classes, there are students who flag that it’s not<br />

common practice to do so within their store prior to taking dispensing<br />

measurements. A range of reasons is given, the primary one being lack<br />

of time. Consider the full picture of the dispensing lifecycle: selection,<br />

dispense, collection and either return business or troubleshoot and<br />

potential remake. It’s not hard to make the point that more time<br />

invested in the initial stages not only saves time in troubleshooting<br />

later, but also money in potential remakes, customer satisfaction and<br />

trust in your practice.<br />

Investigating time management and patient expectations, Thurn<br />

says, “When asked ‘How long does an eye test take?’, the common<br />

answer is ‘about 30 minutes’. However, it is not unusual for a patient to<br />

spend upwards of an hour or more in your practice” 2 . Here, the age-old<br />

saying rings true: under-promise and over-deliver. If we quote a longer<br />

timeframe as our norm, we set realistic expectations for the customer so<br />

they won’t be rushed, nor will the DO feel pressure to take shortcuts with<br />

adjustments and measurements.<br />

“Consider the optical ramifications of our adjustments, particularly in<br />

areas of pantoscopic angle and vertex distance,” say Wilson and Daras<br />

in Practical Optical Dispensing 3 . Inappropriate amounts of pantoscopic<br />

angle will create undue amounts of oblique astigmatism, negatively<br />

impacting the performance of the lens. DOs play a vital role in minimising<br />

this aberration by ensuring appropriate ranges of pantoscopic angle<br />

are applied. For higher prescriptions, changes in the vertex distance<br />

Measurements for success<br />

While not responsible for the<br />

refraction and the intended<br />

prescription, DOs are the gatekeepers<br />

of the effective prescription<br />

Dispensing tools have come a long way from the humble pupillary<br />

distance (PD) rule. Advancements in manual tools have improved ease,<br />

accuracy and professionalism, while digital measuring systems offer<br />

precision measurements. But they are tools nonetheless and their<br />

precision and accuracy depend on the DO using them.<br />

There is a clear and pressing need to capture accurate measurements<br />

and provide these details on orders. The Shamir New Zealand<br />

laboratory provided data showing approximately 80% of orders provide<br />

monocular PDs. This means the<br />

accuracy of 20% of orders could<br />

be improved – there is definitely<br />

potential in remake reduction by<br />

conducting and including this<br />

fundamental measurement. As<br />

Bolton explains, “If a lens design<br />

can be compensated with the<br />

binocular vision dysfunction, panto<br />

and wrap, then the measurements<br />

need to be provided. Close to<br />

50% provide the full measurements.” Given the high price tag of lenses<br />

requiring these measurements, there is a massive opportunity to reduce<br />

potential remakes and costs by taking them accurately and including<br />

when required.<br />

Conclusion<br />

ACOD director and teacher James Gibbins describes DOs as, “Frames,<br />

lenses and completed spectacles experts”. For these areas, we have the<br />

ability to alleviate and reduce spectacle remakes. Not only will expert<br />

frame and lens recommendations, adjustments and measurements see<br />

a reduction in remakes, but an increase in customer satisfaction, store<br />

profitability and store-to-laboratory productivity.<br />

References<br />

1. Thurn T. The Power of Personalisation, MiVision, 30 September 2018<br />

2. Thurn T. Practice Possibilities: Don’t Miss the Future, MiVision, 31 August 2018<br />

3. Wilson D and Daras S. Practical Optical Dispensing (3rd Ed). The Open Training and Education Network,<br />

2014.<br />

Virgilia Readett, in optics since 2012, is an ACOD teacher.<br />

She holds a Certificate IV in Optical Dispensing, Certificate<br />

IV in Training & Assessing and a Bachelor of Arts, majoring in<br />

communications.<br />

NZOPTICS.CO.NZ | 49


STYLE NEWS<br />

Embracing colourful hues<br />

Looking ahead to 2025, Dutz<br />

predicts a resurgence of retro<br />

styles, minimalist designs,<br />

bold and oversized frames,<br />

geometric shapes and vibrant<br />

palettes will dominate the<br />

eyewear market. The brand’s<br />

latest collection ticks all of<br />

these boxes, it said, offering<br />

individual, modern designs<br />

with a timeless appeal. The coral<br />

red solid lining of model DZ2346-<br />

46, featured here, pops against<br />

translucent aqua and burgundy with<br />

hints of brown for a striking yet elegant look.<br />

Distributed by Dynamic Eyewear.<br />

Making waves with new sun range<br />

An official partner to the 37th America’s Cup, Etnia Barcelona’s limited<br />

edition America’s Cup capsule collection is out now. Made with recyclable<br />

materials, the glasses come with high-definition polarised blue mineral<br />

lenses offering 100% UV protection. Designed for a perfect day on the<br />

water, the lenses also have anti-scratch and anti-glare treatments, as well<br />

as oleophobic and hydrophobic treatment to reduce fingerprints and<br />

repel water.<br />

Etnia Barcelona is distributed by CMI Optical.<br />

Distributed by Euro Optics – a Division of VMD Ltd<br />

Saving the world from<br />

mediocre eyewear<br />

New York-based eyewear<br />

designer and The Eyewear<br />

Forum editor Maarten<br />

Weidema has released<br />

a second edition in<br />

the Amazing Eyewear<br />

coffee table book series.<br />

Having completed it<br />

in just three years, he said he is “on a mission to save the world from<br />

mediocre eyewear” and aims to inspire, connect and celebrate the best of<br />

independent eyewear design.<br />

With over 250 pages capturing the evolving world of eyewear<br />

design, Weidema delves into industry-changing innovations such as<br />

artificial intelligence, full-colour 3D-printed frames and sustainability<br />

initiatives, plus the technical nuances of eyewear design. Mixing<br />

established and emerging names, he highlights 25 unique independent<br />

eyewear brands, all pursuing their passions without support from the<br />

mainstream fashion industry.<br />

For more, see http://tefmagazine.com<br />

Z_Optical 50 trade | press_91,5x136mm.indd NEW ZEALAND 1OPTICS OCTOBER <strong>2024</strong><br />

27-08-<strong>2024</strong> 09:19:28


La Dolce Vita<br />

Inspired by the famously<br />

carefree Italian lifestyle,<br />

Woodys’ latest campaign<br />

and collection, La Dolce<br />

Vita, exudes delicious<br />

colours and quirky<br />

shapes. The round,<br />

milled acetate frame<br />

Hella, pictured here,<br />

features German fiveaxis<br />

hinges and Woodys’<br />

wood inlays on the<br />

temple tips. Available in<br />

a range of fresh, striking<br />

colour combinations.<br />

Distributed by Phoenix<br />

Eyewear.<br />

Young tennis star face of Lacoste<br />

French tennis talent Arthur Fils is the face of Lacoste’s new eyewear<br />

collection, The Line. Now 20 years old, Fils became the youngest player<br />

in the men’s top 50 ranking after winning his first ATP title aged just<br />

19. “Arthur matches his exceptional achievements on the court with<br />

his charming attitude, perfectly embodying Lacoste’s DNA,” said the<br />

company. The Line combines timeless, classic shapes elevated by<br />

transparent tortoise colourations, typical of Lacoste’s versatility and style.<br />

Distributed by Titan Optical, Marchon Eyewear’s agent in New Zealand.<br />

The apple of your eye<br />

Maison Lafont’s latest children’s<br />

collection is a delight to behold,<br />

full of fun and fashionable options<br />

for young wearers. Committed<br />

to creating a sustainable and<br />

eco-friendly future, each new<br />

collection from the brand<br />

increases the use of bio-based<br />

and renewable materials. Stylish<br />

new model Pomme’s unique<br />

bevelling makes it anything but<br />

ordinary and will surely appeal to<br />

young girls (size 46). Available in a<br />

selection of bright, contemporary<br />

colours and patterns.<br />

Distributed by Little Peach.<br />

A Parisian state of mind<br />

Elle Eyewear’s latest vintage<br />

and wave motifs signal new<br />

Bohemian influences. For instant<br />

Parisian-inspired glamour, the<br />

soft rectangular model (EL13564)<br />

featured here is made of light<br />

acetate. Available in green, wine<br />

and brown, its large temples<br />

reveal metal details with<br />

botanical engravings and eyecatching<br />

patterns.<br />

Distributed by Phoenix Eyewear.<br />

AUG <strong>2024</strong> - Half page verticle wide NZ OPTICS - PD.indd 2<br />

0800 447 272 @eyesrightoptical<br />

NEW RELEASE<br />

OUT NOW!<br />

View all of our collections and<br />

order online with ease at<br />

www.eyesright.com.au<br />

6/09/<strong>2024</strong> 9:16:01 AM<br />

NZOPTICS.CO.NZ | 51


NEWS<br />

Stars in<br />

their eyes<br />

By Luke Wang and Hector Leong<br />

THE NEW ZEALAND Optometry<br />

Student Society (NZOSS) hosted<br />

a sparkling annual Eyeball at<br />

Auckland Hilton Hotel at the end<br />

of August. Themed ‘Starry Night’,<br />

the evening was filled with celestialstyle<br />

decorations and sound-tracked<br />

by a DJ. Distinguished guests from<br />

the School of Optometry and Vision<br />

Science (SOVS) dressed up for a<br />

night of spectacle, which included<br />

an open bar, lavish buffet and<br />

dazzling dance floor.<br />

The Eyeball provided a rare<br />

opportunity for students and staff<br />

to come together and socialise with<br />

future colleagues and sponsors.<br />

It would not have been possible<br />

without our sponsors: a huge thank<br />

you to our diamond sponsor,<br />

Specsavers, also sponsoring merch<br />

for our students; our gold sponsor,<br />

EssilorLuxottica, also sponsoring<br />

prizes for the best partners; our<br />

silver sponsor, the New Zealand<br />

Association of Optometrists; and<br />

bronze sponsors Bailey Nelson<br />

and Ocula. Prizes for categories<br />

including the best-dressed duo in<br />

A sparkling part V class<br />

NZOSS <strong>2024</strong> team: Sarah Yang, Emily Kamimura, Joanna<br />

Cao, Hana Shin, Shivon Mudaliar, Manishka Sharma (back),<br />

Shubham Gupta, Hector Leong, Luke Wang, Jabez Zeleke,<br />

Joshua Lobo (front)<br />

each cohort were provided by Oscar Wylee, Coopervision and Optimed.<br />

The success of the night was contingent also on NZOSS executive team’s<br />

months of planning.<br />

SOVS clinic supervisors and lecturers: Adina Giurgiu, Dr Alyssa Lie,<br />

Zaria Bradley, Kristine Hammond, Bhavini Solanki, Dr Wanda Lam<br />

and John McLennan<br />

Hector Leong and Luke Wang are the NZOSS <strong>2024</strong> president and vice president,<br />

respectively.<br />

Superior aesthetics and UV protection<br />

HOYA VISION CARE Australia & New Zealand’s Hi-Vision Sun Pro lens<br />

coating is now available on its Sensity lenses, offering enhanced<br />

aesthetics and UV protection this spring and summer.<br />

The anti-reflective coating offers double-sided UV protection<br />

and improves the aesthetics and<br />

convenience of the outdoor<br />

tinting, due to the neutral<br />

reflection in dark state and<br />

the increased contrast<br />

it provides, said Craig<br />

Chick, managing<br />

director, Hoya Vision<br />

Care ANZ. “Hi-Vision<br />

Sun Pro will elevate<br />

Sensity aesthetics<br />

to the next level in<br />

the darkened state of<br />

the lens.”<br />

The Hi-Vision Sun Pro<br />

coating not only prevents<br />

UV transmission through the<br />

lens but also reduces the amount<br />

of UV rays reflected into the eyes from the back surface, providing<br />

comprehensive protection, he added. “The expansion of the Hi-<br />

Vision Sun Pro coating to our Sensity lenses in Australia and New<br />

Zealand underscores Hoya’s commitment to supporting eyecare<br />

professionals and delivering innovative products that meet the<br />

evolving needs of their patients.”<br />

The coating is scratch-resistant for durability and repels water,<br />

grease and dirt, making the lenses easy to clean, Hoya said. The<br />

Hi-Vision Sun Pro coating is now available on all Hoya Sensity<br />

lenses, excluding Sensity Shine, as well as on its tinted and<br />

polarised lenses.<br />

Hoya Order Centre up and running<br />

Adding to the Hoya Hub, the Hoya Order Centre is now available<br />

to partners. Also available through the hub and integrated with<br />

Hoya Consultation Centre 360 is the Hoya Digital Fitting app.<br />

Using a smart centration software, it allows practitioners to take<br />

fast, accurate and precise fitting measurements. “The Hoya Digital<br />

Fitting app delivers a comfortable and technologically advanced<br />

experience for the patient and is easy to use by practice staff,” the<br />

company said. No jig or other attachments are required to capture<br />

position of wear measurements.<br />

52 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


CLASSIFIEDS<br />

For sale / vacancies<br />

To advertise in<br />

NZ Optics classified<br />

section contact<br />

Susanne Bradley<br />

susanne@nzoptics.co.nz<br />

SUMMER CALLING -<br />

LOCUM AVAILABLE<br />

Christchurch-based Optometrist<br />

available for sessional work<br />

locally or block work further<br />

afield.<br />

I have 20 years experience in<br />

full-scope optometry, in both<br />

independent and corporate<br />

environments. I’m enthusiastic<br />

and enjoy being part of a team<br />

delivering excellent outcomes<br />

for patients.<br />

Contact: robertamcIlraith@<br />

gmail.com or 021323812.<br />

Join our vibrant team in Timaru, where lifestyle meets career satisfaction!<br />

Nestled near the beach, ski fields and lakes, we seek two passionate<br />

optometrists to embrace flexible hours and work-life balance.<br />

No weekends, just Monday to Friday.<br />

Our independent practice prioritises community eye health, offering<br />

diverse cases from pathology to myopia control. We empower<br />

optometrists to pursue their interests and excel in their expertise. Be<br />

part of a client-focused team dedicated to delivering exceptional care.<br />

Enjoy an attractive package tailored to your needs. Express your<br />

interest in shaping your future with us by contacting us at<br />

vanessa@canonstreet.co.nz<br />

OPTOMETRIST WANTED<br />

New Plymouth/Taranaki<br />

Mountain, surf and an outstanding cultural environment.<br />

We are looking for an experienced Optometrist to join our long<br />

established independent family practice of sixty years plus.<br />

Our well-equipped practice has an exceptional reputation for service,<br />

an awesome Dispensing Optician with over 30 years experience and an<br />

ancillary staff like no other!<br />

Weekends are a no no and our hours are flexible for the right applicant.<br />

Our ethos - ‘ Service Matters - People Matter ‘.<br />

Sounds like you? Full-time or part-time considered.<br />

Apply in the first instance to Michael Warner,<br />

fitzroyopticians@gmail.com. For more, ring 06 7584974.<br />

OPTOMETRIST OPPORTUNITY!<br />

Whitianga<br />

Our thriving independent practice in the picturesque town of Whitianga<br />

is searching for a passionate Optometrist to join our dedicated team.<br />

You’ll work alongside an experienced team including a Dispensing<br />

Optician and a rare opportunity to collaborate with our regular visiting<br />

Ophthalmologist to refine patient care.<br />

Enjoy a competitive salary, a supportive work environment and the<br />

unbeatable work-life balance that comes with living in one of New<br />

Zealand’s most beautiful coastal towns. To top that there are no late<br />

nights or weekends and you get to enjoy a day off every second week to<br />

make the most of what life has to offer here. Step into a role where your<br />

expertise is valued, your lifestyle is prioritised, and your career can truly<br />

flourish. This friendly community is ready to welcome you.<br />

Please send CV to lynette@mbo.co.nz or contact Glen 0275929125.<br />

Comprehensive functional low vision consultation<br />

Wide range of LV aids from traditional magnifiers<br />

to world leading technology<br />

Information and support<br />

Phone (09) 520 5208 or 0800 555 546 Email info@lowvisionservices.nz<br />

www.lowvisionservices.nz<br />

A Call for<br />

Donations<br />

Manual Lensmeters<br />

We are looking to support our graduates<br />

throughout the Pacific region by<br />

equipping them with manual lensmeters<br />

to enable the delivery of refraction<br />

services in rural communities.<br />

If you would like to kindly donate a used<br />

but fully functional unit, please contact Yves Yang:<br />

T +64 21 228 4768 E yyang@hollows.nz<br />

LOOKING FOR A CHANGE?<br />

The Optical Co in Australia is hiring Optometrists!<br />

We are the Eyes and Ears division of Healthia, Australia’s largest allied<br />

health provider, with a network of 350+ stores across optometry,<br />

audiology, podiatry and physiotherapy. We are actively building our<br />

team and want the very best people to join and share in our success.<br />

Our current vacancies are in some of the most picturesque and<br />

liveable communities in Australia, including Helensvale, Hervey Bay<br />

and Maryborough (QLD)– so you get the benefits of a great lifestyle<br />

as well as being supported by the structure and resources of an allied<br />

healthcare leader.<br />

We offer: extensive learning and development opportunities; support to<br />

build clinical skills and careers (inc a Clinic Class Shareholder partnership<br />

model); attractive remuneration including incentives and relocation<br />

assistance; discounts on private health insurance and products; and<br />

down-to-earth culture and great working relationships.<br />

As an Optometrist with us, you will be at the heart of the practice,<br />

working alongside a highly skilled team and with the latest tools and<br />

technology, to provide our patients with superior eyecare.<br />

We are looking for Optoms who are: qualified in New Zealand and<br />

eligible to emigrate to Australia; able to examine, prescribe, recommend<br />

and refer (when required) to ensure the best solutions for our patient’s<br />

needs; adept at building strong working relationships with patients and<br />

colleagues; and clinically-focused and driven to build career success.<br />

Visit https://theopticalcompany.com.au/ for more info and contact<br />

StephanieM@theopticalco.com.au for a confidential discussion!<br />

NZOPTICS.CO.NZ | 53


Chalkeyes presents…<br />

The Nothing that is not there …<br />

By Trevor Plumbly<br />

GIVEN A CLEAR trot, I shall be 83 this year. Apart from<br />

‘seeing’ the difference between bright light and black, I’m now<br />

a ‘total blindy’, which brings on the need for a bit of reflection.<br />

A couple of things have forced the issue, the first being<br />

when Pam popped away for four days in December and left<br />

me with a bit of a wake-up call. The dependency thing’s a<br />

given these days, so it was down to the grandkids to pick<br />

up the slack. Catering was easy – fish and chips, KFC and<br />

McDonald’s, with the single-malt nightcap placed to hand as<br />

they left. All in all, I think it went rather well, to the extent<br />

that one remarked to Pam, “He’s amazing! He never moans”.<br />

That may be true of the vast majority of blindies, but it<br />

certainly doesn’t apply to me. Judiciously used, I reckon a<br />

good moan can be as mentally stimulating as The Guardian’s<br />

cryptic crossword.<br />

The ‘it is what it is’ philosophy doesn’t really do it for me;<br />

when it comes to sight loss, I’m more: ‘it ain’t what it is’, which,<br />

up to this point, has worked pretty well. The second ‘challenge’<br />

(God, I hate that word!) is that I’ve developed a hearing<br />

problem. I can cope with ‘see no evil’ and even ‘hear no evil’ but it’s<br />

tough not to speak it when you can’t find the brand-new hearing aids. In<br />

the past I’ve found groping blindly and muttering oaths doesn’t help, so<br />

the safest course is to seek the safety of the armchair. Once there, there’s<br />

little else to do but reflect, but that can lead to what I consider one of the<br />

most pernicious aspects of sight loss: Nothing!<br />

‘Nothing’ is not in the blindy DIY books. It’s not a treatable symptom,<br />

more one of those things waiting to whack you when you don’t need it.<br />

In my case it interrupts the re-grouping process in times of that form of<br />

stress, monopolising parts of the brain, accusing me of inactivity while<br />

smothering the parts struggling to remember where I left the hearing<br />

aids. I reckon Nothing’s been around for ages, as far as blindies are<br />

concerned but, in my opinion, it’s been totally overlooked in the pursuit<br />

of breakthroughs and warm, PC fuzzies. Chronic sufferers should be<br />

schooled against Nothing – anything from iPad updates to ill-matched<br />

chargers can bring on an attack. While it doesn’t rank up there with<br />

Charles Bonnet’s revelations, there must be something there for the<br />

enquiring academic and the possibility of a paper or two. I will, of<br />

course, be happy to assist in any way with the research on this one.<br />

…the Nothing that is there<br />

In my experience, Nothing fights dirty. Once I’ve retreated to the<br />

armchair, it lays siege, blocking off constructive or independent thought.<br />

Thus, my “Don’t just sit here! Get off your butt and look for them”, gets a<br />

retort from Nothing, like “Why not wait for Pam to come home?”<br />

In an effort to shed a bit of light on the matter, I mentioned it to a few<br />

people in our support group, but nobody owned up to experiencing it.<br />

I consider myself many things but psychologically unique is not one of<br />

them, so my first thought was that, like the first outing with the white<br />

cane, it was an acceptance thing. My second theory didn’t fit so well – it<br />

shifted things back to me, since the possibility existed that all those<br />

other blindies were too busy doing stuff for Nothing to have any effect.<br />

And there’s no doubt they’re all busier than I am. Camille is a retired<br />

journalist and, as with most of that calling, shows a seemingly limitless<br />

curiosity in all manner of worldly things. Plus, she’s highly social, to the<br />

point that I often suspect her of being capable of holding two phone<br />

conversations at the same time. Peter, a retired mechanic, is an ‘out<br />

there’ blindy – swimming, biking and travelling to Brisbane or Bali<br />

– it’s all the same to him. It’s distinctly possible he doesn’t even own<br />

an armchair.<br />

Susan is the brainiac blindy. A retired audiologist and thoroughly<br />

organised, she does stuff I don’t, like travel by bus and join protest<br />

marches. And with her addiction to word games and near resident<br />

status at the public library, there seems little chance of Nothing finding<br />

much of a role there. Finally, there’s Janet, another ‘out there’ blindy –<br />

art teacher, artist and recent book author. Janet’s what’s best described as<br />

‘active’; she also does stuff I don’t, like sit through committee meetings<br />

and brave theatre access. Last I heard, she was off to the Highland<br />

Games in Hamilton – not to compete, of course, but even at 80-plus I<br />

wouldn’t put it past her.<br />

...and how I deal with it<br />

It seems to me that those guys, defeating the threat of Nothing when<br />

it comes to sight loss, attack it with ‘busy’. For me, though, it’s to be<br />

coped with rather than defeated. Although I think optometrists and<br />

the good folk at the Blind Foundation should be fully au fait with the<br />

thing, as with most things blindy, it boils down to personal choice, so<br />

I’ve opted for a tri-party truce between the keyboard, the armchair and<br />

Glenmorangie. Meantime, there are questions I need to consider from<br />

politicians and the like, such as, do I consider myself handicapped or<br />

disabled? It’s a tricky one – there might be nothing in it but, like I said,<br />

ya gotta watch that Nothing!<br />

Born in the UK, our ‘white-caner’ columnist, retired Dunedin<br />

antiques dealer Trevor Plumbly, was diagnosed with retinitis<br />

pigmentosa more than 20 years ago and now lives in Auckland.<br />

54 | NEW ZEALAND OPTICS OCTOBER <strong>2024</strong>


NEW ZEALAND<br />

Everyone you need to know and everything<br />

you need to find in the New Zealand optical<br />

industry at your fingertips<br />

Contact Nick Griffiths at accounts@nzoptics.co.nz<br />

now to secure your place<br />

NZOPTICS.CO.NZ | 55


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