April 2018

THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY
PO BOX 106 954, AUCKLAND CITY 1143
APRIL 2018
Email: info@nzoptics.co.nz Website: www.nzoptics.co.nz
SHAMIR OPENS NEW
GLAZING & CUSTOMER SERVICE
FACILITY IN AUCKLAND!
1st Floor, Entrance B, 31-35 Carbine Rd
Mt Wellington, Auckland 1060
Phone 0800 SHAMIR
New Zealand Account Manager
Francois Cronje 021 449 819
www.shamir.co.nz

2018 • Voted by New Zealanders • 2018
TRANSFORMING
EYE HEALTH
THE ULTIMATE OPHTHALMIC COLLABORATION
At Specsavers we are focussed on providing the highest
levels of optometry and dispensing care in all our New
Zealand and Australian stores.
Our equipment and technology strategies, our close working relationships
with ophthalmology and various eye disease stakeholders alongside our
major investments into dispensing qualifications all contribute to a singular
purpose – to transform the eye health of New Zealanders and Australians.
So, if you’re concerned at the 50 per cent undiagnosed glaucoma cohort
and the under-indexing of diabetic retinopathy screenings; if you’re worried
that available in-store technology isn’t being used on every patient due to
extra fees and charges; and if you’re alarmed at the under-investment in
professional dispensing programs and technology – then we urge you to
talk to us about how you can make a genuine impact at Specsavers.
We’re on a clear mission to transform eye health in New Zealand and
Australia – and we’d like you to join us on that mission.
To ask about optometry and dispensing roles right across the country at all levels, contact Chris Rickard on 027 579 5499
or chris.rickard@specsavers.com, alternatively visit spectrum-anz.com for all the opportunities.
Reader’s
Digest
Quality Service
Award
2018 • Voted by Australians • 2018
Reader’s
Digest
Quality Service
Award
AITD
Voted by New Zealanders
Reader’s Digest
Quality Service
Award
2017
Best Customer
Service in AU
Optometry
2018
Best Customer
Service in NZ
Optometry
Best Talent
Development
Program
2017
Best Talent
Development
Program
2017
Best Customer
Service in NZ
Optometry
2017
Millward Brown
Research
No.1 for eye tests
2016
Excellence in
Marketing
Award
2016
Retail
Store Design
Award
2016
Retail
Employer
of the Year
2015
2018 Transforming eye health
2 NEW ZEALAND OPTICS April 2018

Oculo rolls out in NZ
Oculo says it will now be rolling out its cloud-based secure
messaging and clinical communication software, designed
to better connect optometrists and ophthalmologists, in
New Zealand over the next few of months.
The launch will be kicked-off through Oculo’s agreement with
Specsavers, which has signed a multi-year commitment to use
Oculo on both sides of the Tasman. But Oculo is keen to sign up
as many optometrists and ophthalmologists to its technology as
possible to enable consistency in the quantity and quality of data
shared.
Oculo’s software provides a secure, online system for
optometrists to identify ophthalmologists with particular
specialities and to safely share clinical records, including patient
data, photos and scans for referrals. The system was the brainchild
of Professor Jonathan Crowston, managing director of the Centre
for Eye Research Australia (CERA), and Peter Larsen, director of CERA
and Specsavers optometry director. It was spun out from CERA as a
standalone company in 2015.
The Australian roll-out began in April 2016 and it’s now employed
by more than 1,700 optometrists and 440 ophthalmologists,
managing over 200,000 patients across Australia. An agreement
with Glaucoma Australia last year also allows eye care professionals
to refer patients directly to the charity for help and support.
“Oculo is a fundamental component of our ability to measure
clinical activity and outcomes,” said Larsen. “Through Oculo, we
can access data on detection, referral and diagnosis rates to further
improve clinical standards and contribute to transforming eye
health in Australia and New Zealand. For example, Specsavers-wide
Oculo screen shot
Oculo data will
provide us with
the evidencebase
to show
how we are
closing the gap
on undiagnosed
glaucoma in
Australia and
New Zealand.
That sort of
information
has not been
available before
and helps not
just us and our
optometrists, but
also government
and other health
stakeholders.
It adds value
because it allows
us to specify the
Oculo’s Dr Kate Taylor and Specsavers’ Peter Larsen
impact we are
making on patient wellbeing.”
“There is so much innovation in eye care – the technologies
available for diagnosis and management are really exciting,” said
Dr Kate Taylor, Oculo’s CEO. “So more than ever, it’s important
to use technology to enhance clinical communication so that
practitioners can share digital information to increase the quality
and efficiency of patient care.”
Background
Oculo was developed by CERA, a not-for-profit medical research
institute based at the Royal Victorian Eye and Ear Hospital (RVEEH)
in Melbourne, in collaboration with Specsavers, OPSM, and Bupa
Optical. Its aim is to promote the efficiency and quality of clinical
communications to support collaboration to improve eye care; to
“be better than a letter,” said Prof Crowston, chair of Oculo, at the
company’s launch back in 2016. “The team has invested thousands
of hours to develop privacy and data security controls that mean
that correspondence by Oculo is indeed better than a letter, and
so much more. It has intelligent prompts and other features to
enhance the quality of referrals and to create a shared eye e-health
record.”
Oculo’s major shareholders are CERA and an angel investor who
had a life-changing intervention at the RVEEH and wanted to give
back. No other individual or corporate involved in optometry or
The hard end of
eye health
EDITORIAL
This month we are proud to include a handful of dedicated low
vision stories and opinions, including an amusing view from
the dark side (as he calls it) from our wonderful new low vision
columnist, Trevor Plumbly (p6). Some put low vision patients in
the too-hard or too-scary basket. But as these stories show there’s
lots that can be done to help New Zealand’s low vision community
and optometrists, new and experienced, are ideally positioned to
help them lead more fulfilling lives, however bad their vision. One
well-known low vision patient advocate, John Veale, has often been
quoted in NZ Optics’ pages championing this area, saying how
rewarding it is to help people with low vision, especially as their
relatives and friends often choose to become your patients as well.
The major causes of low vision will, of course, be a key topic at this
year’s unmissable RANZCO NZ Branch conference in mid-May, which
once again incorporates parallel meetings for our ophthalmic nurses
and our orthoptists. We’ve got the inside scoop, hot-off-the press,
about this year’s programme and keynotes. Plus, we’ve had a look at
what’s on in Auckland around the same time for all the out-of-towners
visiting. We’ve also got all the happenings from sister conferences
in Australia, past and future, and there’s news about RANZCO’s Eye
Foundation, ORIA and a new worm that’s been found in patients’ eyes
in the little-known Mariana Islands (p10-18).
We also celebrate New Zealands’s hosting of the very well-received
and smoothly organised (well done guys) Retina International world
conference (p21) and the work of our combined School of Optometry
and Vision Science and Department of Ophthalmology’s Summer
students (p20).
Meanwhile Style-Eyes tackles the lighter end of the eye health
spectrum with a look at how pop-up stores could mean extra revenue
and customers for the more entrepreneurial among you, and Chalkeyes
gets his typing in a tizz about the lack of decent, compatible practice
software tools on the market (p26). But then again, Oculo (p3) and
1stGroup (p23) might be able to help!
Enjoy, and please get in touch if you’ve got an issue you want us to
cover or you want to comment on anything in NZ Optics. We always
love to hear from you.
Next month: all the happenings from CCLS
NZ, the Ocular Therapeutics Conference
and Excellence in Ophthalmology
Lesley Springall, editor, NZ Optics
ophthalmology has any stake. ▀
0800 55 20 20
First Sanderson
Scholarship
Less than a year after announcing the
establishment of the Gordon Sanderson
Scholarship, Glaucoma New Zealand (GNZ)
has announced its first awardee – Hilary Goh,
a fifth-year medical student for her summer
research project investigating nailfold capillary
abnormalities in glaucoma.
Goh, who undertook her research project within
the Department of Ophthalmology at the University
of Auckland, is one of the top medical students at
the University, said Professor Helen Danesh-Meyer,
chair of GNZ. “She is razor sharp, dedicated and
great with patients. She was a natural fit for the
project as it was very demanding.”
Goh’s project explored whether nailfold capillary
health can be used as a biomarker for glaucoma
progression, based on the hypothesis that glaucoma
involves vascular dysautoregulation, explained Prof
Danesh-Meyer, who was also Goh’s supervisor for
the project. “There is some evidence to support
this from Harvard which demonstrates there is
a difference between the nailfold capillary of
glaucoma patients compared to controls. Hilary’s
project is an extension of this work to see if it
correlates with glaucoma severity and progression.”
Presenting her work at the Auckland Summer
Student Symposium in March (p21), Goh concluded
that primary open angle glaucoma (POAG)
patients did indeed have nailfold capillary (NFC)
abnormalities and abnormal NFC is associated with
increased risk of POAG and more severe visual field
loss. However, more studies were needed as was an
improved capillary grading system, she said.
Prof Danesh-Meyer said GNZ decided to
award the first scholarship this year as they had
received a number of pledges and donations
since announcing the new scholarship in August
last year. The scholarship was set up in honour of
the much-admired Associate Professor Gordon
Sanderson, a founding trustee of GNZ, who died
earlier in the year.
“Gordon was very passionate about GNZ and the
prevention of blindness from glaucoma. He was
Hilary Goh, recipient of the inaugural Gordon Sanderson Scholarship
from Glaucoma New Zealand
a huge advocate for students and relished seeing
students involved in research,” said Prof Danesh-
Meyer. “I know from personal experience that
Gordon always helped provide opportunities to
students to be involved in eye research. I was one
of these students. GNZ is committed to ensuring
his passion for students and research is continued
through this scholarship.”
GNZ will be advertising for applications for
the 2019 scholarship from June this year. The
scholarship is available to medical and optometry
students, ophthalmologists or optometrists
undertaking research or teaching experience in
glaucoma from the Universities of Auckland, Otago
or Sydney as these institutions had close ties with
A/Prof Sanderson.
To find out more or to contribute to the Gordon
Sanderson Scholarship fund, please visit www.
glaucoma.org.nz. ▀
To read more about the 2017-2018 Summer
student projects, please turn to p21.
www.re.vision.nz
Dr Trevor Gray
April 2018 NEW ZEALAND OPTICS
3

News
in brief
CLS WITH BUILT-IN TELESCOPE
An international collaboration of
scientists has created a contact
lens (CL) which can shift between
magnified and normal vision. The
lens, which increases peripheral
vision three-fold, is safer and
cheaper than surgery and will allow people with sight loss to read
text better and see faces, said Dr Eric Tremblay, a Swiss Federal
Institute of Technology designer. The lenses have tiny telescopes
built into the centre which work like binoculars and are activated by
specially-adapted glasses that recognise winks, but ignore blinks.
The new lens could be available for sale in two years.
VITAMIN B3 FOR GLAUCOMA?
Researchers from the Centre for Eye Research Australia (CERA)
have started a six-month clinical trial to see if high-dose vitamin
B3 (nicotinamide) can support existing therapies for glaucoma by
protecting nerve cells from dying. The ability to recover from an
eye injury diminishes with age, so CERA’s looking for treatments
to boost recovery, said study lead Professor Jonathan Crowston. “If
you can improve optic nerve recovery after an injury then we can
reduce the risk of glaucoma progressing.”
ARTIFICIAL PHOTORECEPTORS RESTORE SIGHT
A Fudan University team in
China has developed artificial
photoreceptors to replace
diseased and no longer
functioning rod and cone cells
within the retina. A study on
laboratory mice, published
in Nature Communications,
showed the artificial photoreceptors, made from gold and titanium
oxide nanowire arrays, could successfully convert light into
electrical signals.
COLLABORATION HELPS GLAUCOMA CARE
A collaborative clinic at the University of New South Wales Centre
for Eye Health, where optometrists and ophthalmologists work sideby-side,
is providing beneficial for glaucoma patients. A study of the
clinic’s first 18 months showed patients waited 43 days on average
for an appointment; most (51%) were diagnosed with glaucoma; 41%
had suspected glaucoma requiring monitoring; 2% had a different
optical neuropathy; and 6% had no eye disease. The new model
of care has great potential for helping to assess new, non-urgent
outpatient referrals, said study co-author Dr Michael Hennessy.
START-UP MAKES VISION CARE MORE ACCESSIBLE
A Massachusetts Institute of Technology
(MIT) spinout, PlenOptika has developed a
highly accurate, portable autorefractor called
QuickSee. Costing about a third of the price of
traditional autorefractors, the device is ideal
for developing countries and hard to reach areas, said the company.
After six years in development, eight product iterations and clinical
studies involving 1,500 patients across five countries, The QuickSee
has just been released in India.
ESSILOR-LUX MERGER GIVEN THE GO AHEAD
The proposed merger of international eyecare heavyweights, Essilor
and Luxottica, is all but a done deal after being unconditionally
cleared by both the European and US Federal Trade Commissions.
In other news, Essilor reported solid 2017 earnings with good
overall performance in its lenses and optical instruments divisions,
reflecting strong online sales and US growth, offsetting lower
sales in other areas, notably Australia and Brazil.
HAITI OPENS OPTOMETRY SCHOOL
Supported by the Brien Holden Vision Institute (BHVI), the first
School of Optometry has opened in Haiti, welcoming 17 new
students, selected from 144 applicants, onto its Bachelor of Vision
Sciences programme. Five years in the making, the new school,
which is part of the Faculty of Medicine at l’Universite d’Etat d’Haiti
in Port au Prince, will be of huge benefit to the 70% of Haitians who
currently have little or no access to eye care, said Dr Luigi Bilotto,
BHVI’s director of global human resource development.
O-SHOW 2018 – FILLING UP FAST
The take up of exhibitor space at this year’s boutique style O-Show
in Melbourne, from 14-15 July, has been extraordinary, with just
10 booths left to fill, said Finola Carey, ODMA CEO, adding she’s
delighted, but not surprised by the response. ‘’Certainly, the fact
that the O-Show is owned and organised by ODMA for the benefit
of the industry, has been warmly received.”
RETINA SCANS AND AI TO DETECT HEART DISEASE
The necrotic photoreceptor layer in the blind
retina is replaced by an Au–TiO2 NW array
Scientists from Google and its health-tech subsidiary Verily
are assessing a person’s risk of heart disease using computer
learning and retina scans. Using deep learning algorithms,
trained on retina data from 284,335 patients, combined with
knowledge about the patient’s age, blood pressure and smoking
habits, Google’s software successfully predicted 70% of future
cardiovascular events, such as a heart attack or stroke, that would
occur within five years of the retinal exam.
Regarding the retina
BY ELLA EWENS
The first of the two-repeated autumn seminar evenings by
Retina Specialists was held on 6 March in the leafy Auckland
suburb of Parnell. Attending optometrists were greeted by the
Retina Specialists team, wine and canapés.
The all-female speaking line-up for the evening included Retina
Specialists’ Dr Rachel Barnes, Associate Professor Andrea Vincent, Dr
Dianne Sharp and Dr Narme Deva.
A pictorial FAF journey
A/Prof Vincent kicked off the evening with a pictorial journey through
fundus autofluorescence (FAF) in clinical practice, showing us “pretty
pictures” depicting the presentation of various retinal dystrophies
and disorders. FAF is a non-invasive technique, which highlights
lipofuscin (the main fluroflore in the retinal pigment epithelium). FAF
may detect abnormalities beyond the clinical exam and is useful in
classifying various retinal dystrophies and disorders, she said.
In albinism, where the retina is not metabolically affected, the
FAF appears normal. However, in choroideremia (an X-linked retinal
condition affecting males) widefield Optos images show patchy
changes with scalloped edges where the retina is ‘metabolically
dead’. In X-linked retinitis pigmentosa there is a so-called water-shed
zone seen between the good and bad metabolic areas of the retina.
In PDE6B retinitis pigmentosa, FAF is very useful – visual results are
closely correlated to FAF, so generally visual fields are not necessary
and don’t give any extra information, A/Prof Vincent explained.
Among other fascinating pearls, Vincent also revealed what she
calls the ‘moustache sign’ of the adRP rhodopsin mutation – an
inferior central rim of hyperfluorescence – and showed FAF images
of eight siblings with different presentations of ABCA4 retinal
dystrophies, where the whole retina may be affected.
AMD new treatments?
Dr Barnes spoke about the new treatment options for age-related
macular degeneration (AMD). She begun her presentation by
outlining the goals of the different treatments for both dry and wet
AMD, and enthusiastically explained what else waits in the wings in
the long journey to market.
The first drug she discussed, Roche’s lampalizumab, an antigenbinding
fragment of a humanised, monoclonal antibody directed
against complement factor D (CFD), had showed promising initial results
in early trials with a 20% reduction in geographic atrophy. The phase III
results, however, showed no benefit at all. Nano-second laser may also
have an application in early dry AMD, with pilot studies indicating a
reduction in drusen. Phase III results are expected later this year.
Looking at possible treatments for wet AMD, Barnes reminded us
gravely that there is no permanent cure for this devastating disease
and that real-world results often fall short of drug trials due to under
treatment. A new pigment-derived growth factor, which it was hoped
would work to reduce fibrosis and help mature vessels to regress,
looked hopeful early on but was ineffective in phase III trials. Roche,
however is still in the game, with its drug, also based on angiopoitein
(a proangiogenic cytokine involved in neovascular AMD), and is
persevering with the expensive trials required.
A new formulation of ranibizumab (Lucentis: a recombinant
humanized IgG1 monoclonal antibody fragment that binds to and
inhibits vascular endothelial growth factor A) delivered by a port
system is also an exciting possibility with more results planned soon,
said Dr Barnes. Gene therapies using new viral vectors are also being
trialled. While many trials seem to show early promise and then fall
at the final hurdle, brolucizumab is in Phase III trials and results are
looking very positive. With its small molecule size allowing higher
potency in the eye, results are showing significant reduction in retinal
thickness and better performance than aflibercept (Eylea), she said.
Lastly Dr Barnes discussed the new imaging technique, OCT-A
that offers a quick, non-invasive 3D method to image the retinal
vasculature. It is particularly useful for showing the structure
of choroidal neovascularisation and for visualising occult
neovascularisation not visible by any other means, she said.
MD and the ageing eye
Dr Sharp presented a practical presentation on MD in the ageing
eye. The high metabolic demand of the macular area of the retina
makes it particularly susceptible to oxidative damage, she said.
With more than 10% of babies born today destined to become
centenarians, MD is more relevant today than ever.
A recent model-of-care, commissioned by the government,
highlighted the national low understanding of the disease and areas
requiring improvement, such as speed to treatment. This model set out
the importance of prompt care and said the time from first diagnosis
to first treatment should be no more than one week. The Beckman
classification can be used to identify different stages of AMD and help
to predict the risk of progression at each stage, she said.
“Small fine drusen (or druplets as they are sometimes called) are
not MD and it is wrong to call them this. Soft drusen combined with
pigment changes are high risk. Give the patient an Amsler Grid test
www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand
Drs Narme Deva, Dianne Sharp and Rachel Barnes
Stuart Campbell and Richard Chinn
and monitor them closely.” Those with choroidal neovascularisation
can particularly be helped by getting them treatment fast, she added.
Dr Sharp also shared some data from UK records over a 12-month
period, showing that the starting vision level is of great importance.
Optometrists present were also interested in discussing RANZCO’s
revised referral pathway for MD. “Too often a patient stops attending
appointments after anti-VEGF treatments because their vision
is good, only to have problems reoccur,” said Dr Sharp, providing
examples of the sequelae of neovascular MD. Patients must be
educated that this is a chronic disease that requires long-term
management, she stressed.
DR, risks and treatment
Dr Deva tackled diabetic retinopathy, a main cause of the blindness in
working-age people. One third of diabetics will have retinopathy and
for a third of those it will threaten their vision. To reduce risk during
the early stages, optometrists must ask about how well patients are
controlling their blood sugar levels, she said, citing data that intensive
therapy, reduced the risk of developing retinopathy by 76%. A good
understanding of the disease and encouraging patients to form good,
healthy-eating and monitoring habits is key in these early stages.
The second question that optometrists should ask is, “how is
your blood pressure?” said Dr Deva. The Wisconsin epidemiologic
study of diabetic retinopathy showed that lowering blood pressure
can half the risk of retinopathy. The third question centres around
cholesterol levels, and while this is not as well-supported by clinical
data as blood sugar levels, good cholesterol control can reduce the
progression of retinopathy, she said.
Dr Deva then summarised the treatments for diabetic retinopathy
and associated macular oedema focusing on lasers and anti-VEGF
injections. Widefield imaging is helping us monitor treatments over
time, she said. Keeping to the technological theme, Dr Deva also
discussed the growing interest in artificial intelligence and the rise
of studies using machines that can perform deep learning (see NZ
Optics March 2018 issue, p14), “that is, showing a machine data and
have it teach itself how to analyse it,” may well at some point in the
future replace optometrists and ophthalmologists, analysing many
data points, from diagnosis and classification to risk assessment, in
mere minutes, and suggesting appropriate treatment plans.
Concluding remarks
Sandhya Mathew and Surekha Parag
Hilary Rayner, Retina Specialists practice manager, said the evening
was a great success. “It was wonderful to see so many people at our
event and we are looking forward to meeting our next group in a
couple of weeks. Everyone is busy these days so we really try to make
the education meetings we hold interesting and useful and we really
appreciate the effort that people make to come along.” ▀
Retina Specialists’ Spring seminar evenings will be held on the 4 and
18 September.
For general enquiries or classifieds please email info@nzoptics.co.nz
For editorial, please contact Lesley Springall at lesley@nzoptics.co.nz or +64 27 445 3543
For all advertising/marketing enquiries, please contact Susanne Bradley at susanne@nzoptics.co.nz or +64 27 545 4357 in the first instance, or Lesley Springall at lesley@nzoptics.co.nz
To submit artwork, or to query a graphic, please email susanne@nzoptics.co.nz
NZ Optics magazine is the industry publication for New Zealand’s ophthalmic community. It is published monthly, 11 times a year, by New Zealand Optics 2015 Ltd. Copyright is held by
NZ Optics 2015 Ltd. As well as the magazine and the website, NZ Optics publishes the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide that profiles the
products and services of the industry. NZ Optics is an independent publication and has no affiliation with any organisations. The views expressed in this publication are not necessarily
those of NZ Optics 2015 Ltd or the editorial team.
4 NEW ZEALAND OPTICS April 2018

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NEW ZEALAND OPTICS
5

Low Vision Day: a real eye-opener
BY SUSANNE BRADLEY
How do you tell someone they’re losing
their sight? What can you do to really
help a low vision patient? How do you
explain the often-complex web of support and
technology available? These, and many other
important questions were the focus of the School
of Optometry and Vision Science (SOVS) Low Vision
Day on 1 March.
The day included lectures, workshops and a panel
discussion where students had the opportunity to
talk directly with low vision patients and ask them
questions about their lives and the help they had
or hadn’t received.
Nick Lee, New Zealand Optometry Student
Society (NZOSS) president, said it was the first
time many students had had an opportunity
to be exposed to true low vision patients. The
day provided a safe and encouraging learning
environment and the students he spoke to really
appreciated the opportunity to talk openly to
patients who had low vision and were comfortable
with and open about their condition, he said.
“Previously, it felt like there was a certain negative
stigma surrounding low vision patients, but
everyone who volunteered their time was just
happy to be helped and helped our learning too.”
Samantha Simkin from the Blind and Low
Vision Education Network NZ (BLENNZ), started
the day with a talk about BLENNZ’s role helping
low vision and blind children access education.
Low Vision Day team Claire MacDonald, Sam Simkin, Michelle O’Hanlon, Shireen Ali and Katy Webber
Ophthalmologists, optometrists and teachers can
refer to BLENNZ. As there are different levels of
support available, it’s important to refer even in
cases when the child is perhaps not fulfilling all
the criteria, said Simkin.
Katy Webber, a counsellor with the Blind
Foundation (BF), talked next about how BF can
support adults and children alike, with different
practical and emotional aspects of their life, to
work towards a more independent and fulfilled
life. Webber said the perception that BF is only for
adults is wrong, BF and BLENNZ work together
with the age group 0-21, but where BLENNZ’s
focus is on education, BF focuses on supporting
the individual in their daily life. So, it’s important
to always make two referrals, one for BLENNZ and
one for BF, she said.
Low vision patients Trevor Plumbly (see Blind
ignorance, this page), Susan Grimsdell, Camille Guy
and Michael Lloyd made up the much-anticipated
panel for the day’s discussion session. From
sharing their life stories and answering the many
questions put to them by the audience, it was clear
life with low vision isn’t all bad, but it certainly has
its challenges. “It doesn’t stop me from doing the
things I want to do, I just need to find another way
to do them,” explained Lloyd.
The discussion covered everything from good
and bad optometry visits, with most saying ‘telling
it, how it is’ was the preferred way to receive and
deliver bad news, to how public spaces could
be improved to better support our low vision
community.
The three afternoon
workshops were practical,
providing insights into
adaptive technology, how
to best communicate with
patients with low vision and
how to use electronic devices
designed to assist patients
with low vision, orientation
and mobility. The latter
included role-play testing
techniques for correctly
performing sighted-guide
assistance.
The day ended with a
WELCOME TO OUR NEWEST DIRECTOR
Dr Logan Robinson,
MB ChB, PG Dip Ophth BS (Distinction),
FRANZCO
An experienced cataract surgeon
with an enthusiasm for vitreoretinal
surgery, Logan, completed a medical
degree in 2003 at the University of Otago
and completed a Postgraduate Diploma
in Ophthalmic Basic Sciences (with
distinction) in 2008.
Continuing his professional development
via a fellowship in vitreoretinal surgery
at Wellington Hospital, Logan then moved to the UK, completing a second
vitreoretinal surgery fellowship at the Manchester Royal Eye Hospital.
Returning to Christchurch in 2015, Logan took up a position as a consultant
ophthalmologist at Christchurch Hospital and subsequently joined us at SES.
Away from work Logan enjoys spending time with his young family and is an
avid sports fan, enjoying mountain biking, golf and fishing.
From everyone at SES, ‘Welcome aboard Logan’.
128 Kilmore Street, Christchurch, New Zealand
PO Box 21023, Edgeware, Christchurch 8143
t: +64 3355 6397 f: +64 3 355 6156
e: info@southerneye.co.nz www.southerneye.co.nz
refraction clinic, offering
students an opportunity
to perform a low vision
refraction test. Student
Andrew Kim said this part
of the day was one of his
highlights and a valuable
experience. Melissa Zhu
said it was one of the most
rewarding and challenging
practical learning sessions
she’d experienced.
“As students, we mostly
encounter patients with
no pathology or patients
who have pathology but
are sufficiently sighted
enough to come to our
clinics. The duty of telling someone they will lose
their driving and independence was a topic on a
lecture slide I had once thought was far, far away.
It was easy to avoid. (So) I felt most challenged by
the hard truth that there are simply no cures yet to
restore vision in some patients.
“This led to a sense of collective awkwardness
when we faced our volunteers in the clinic; as if we
have, somehow, failed to do our jobs. However, by
talking to the volunteers both in clinic and in the
panel, I have come to see people living fulfilling
lives with their vision problems. This was the
Blind ignorance
BY TREVOR PLUMBLY*
Sight loss, I discovered, is such a gradual
process that it’s generally detected by others
before the victims themselves.
Certainly, the indications I had came at me,
rather suddenly. I was sitting down, quietly
enjoying a cup of tea, when my wife Pam said:
“we really need to talk”. Now anyone with
any experience of married life or full-time
employment, knows that when someone says
that, good news is not about to follow.
The conversation started innocently enough,
along the lines of, “do you realise how often you’re
bumping into things lately?” I put on, what I hoped
was a pensive, reasonable expression, waiting
for the final verdict and sure enough it arrived.
“You need to get your eyes tested again, but go to
someone a bit more high-tech than old Charlie.”
I thought that was a bit harsh, Charlie had done
my glasses for years and never given me any grief.
Anyway, if there was bad news out there why go
looking for it? I tried the usual, “I’ll think about it”
and “as soon as work eases off a bit”.
Occasionally this ploy works, but not this
time and a couple of days later off I went, feet
dragging, to the high-tech optometrist (HTO).
Mentally debating the difference between an
‘HTO’ and a normal optometrist, I decided it was
probably the size of the bill.
The HTO looked more like a cemetery for posh
spectacle frames than a place to get your sight
fixed. The decor was a floor to ceiling sort of
glaucoma grey which matched the hair colour
of the chirpy, competent looking women behind
the counter. My optometrist was a really pleasant
young Australian woman who shuffled and dealt
the test lenses with all the panache of a Las
Vegas croupier. Whilst I gained confidence from
this dexterity, she obviously wasn’t satisfied. She
followed up the first act by shining a magnifying
torch into my eyes muttering ‘Hmm’.
It’s a personal opinion of course, but a ‘Hmm’
coming from anyone in the medical game has got
to be one of scariest expressions in the English
language. Its only got two meanings; a) “I haven’t
got a clue what’s wrong with you”; or b) “I don’t
want to be the one to tell you.”
We talked about my vision and I mentioned
having problems driving at night. She trumped
this by saying, “I don’t think you should be driving
in daylight either and you definitely need to see a
specialist.” Not really what I wanted to hear.
Seeing a specialist implied that what I had was
beyond her ability, and then there was the cost.
With Charlie, it was in and out with glasses for
around $300 but this little number was looking
like $600 plus, with the specialist in the game, I
was starting to feel like I was involved in some
sort of optical pyramid scheme.
The specialist oozed professional competence.
He sat me in front of an ancient-looking machine,
explained the process, gave me a buzzer and said,
“press this when you see the lights.” After a while
he said, “when you’re ready,” and then, with a
Students testing sighted-guide techniques with their blindfolded partners – Yasmeen Musa, Melissa Zhu,
Tish Peat, Susan Cordery and Amelia Hardcastle
highlight of my day,” explained Zhu.
“The most important message to me was that
we, as practitioners, cannot carry a misguided idea
that low vision’ is a euphemism for the traditional
meaning of ‘blindness’, and therefore an end to a
person’s productivity in society. We must treat the
subject with sensitivity but not taboo, as our role is
to help our patients do the best in life with their own
vision – whether that means spectacles, surgery,
CCTVs or a referral to the Blind Foundation.” ▀
See p21 for more on low vision and the world of
retina.
touch of insistence, “when you see the lights.”
Anxious to please, I finally spotted one and
jabbed the button in triumph. He didn’t cheer,
but I thought I detected a bit of relief in his
expression. From there we moved into the surgery,
which really looked as if it could do the biz: bright
lights, lots of neatly laid-out implements that
looked essential and expensive, with a patient
chair that could have been salvaged from a
space shuttle. He did the old shuffle and deal
with the test lenses, not quite with the flourish
of the optometrist, but more measured, as if he
was catering to the high rollers. I eased back in
the astronaut chair with all the confidence of
someone getting their money’s worth.
When the magnifying light elicited another
“Hmm” I wondered if it was some sort of
diagnostic code for unrecorded ailments. But no!
He rolled back his chair and said, “You’ve got RP.”
I chewed on this medical morsel for a moment
before asking, “Is that good?” He then treated me
to a short, honest opinion on the joys of retinitis
pigmentosa. Briefly, I could lose my sight or some
of it, I could lose all or some of it quickly or slowly
and it was inoperable. Not what I wanted to hear.
See what I mean about going out and looking for
trouble?
Somewhat poorer and not exactly buoyed with
hope I left, clutching an appointment for the
Dunedin Eye Clinic.
The clinic was all business, lots of fellow patients
dotted around the waiting area, half-hoping
and half-dreading the appointment and the
result. The staff here are frontline troops, a mix
of eager younger types and urbane, battle-worn
professionals who’ve seen it all before, and if the
line outside is anything to go by, they were going
to see a fair bit more of it.
Similar tests, same diagnosis, same prognosis,
but good, helpful advice on what to expect and
how to cope with it. Top marks all round for the
public health system. I left quite upbeat and halfconvinced
there wasn’t that much wrong with my
sight anyway. But on reflection I guess it was more
wishful thinking and a natural reluctance to face
the reality of life.
NZ Optics is pleased to welcome Trevor Plumbly
as a new contributor. Trevor will share more about
his life on the ‘dark side’ or as a ‘white caner’, as he
also likes to be called, in future issues.
*Trevor Plumbly is a retired arts and antiques dealer, diagnosed
with retinitis pigmentosa 15 years ago. Originally from Tunbridge
Wells in England, Plumbly, together with wife Pam, formerly
owned Plumbly’s Auction House
in Dunedin. In the 1980s, he was
one of the antique experts in the
popular television programme,
Antiques for Love or Money,
and became a well-known face
in Dunedin as a result. In 2008,
when sight loss put a stop to the
antiques dealing, Trevor and Pam
decided they wanted to be closer
to family, so they sold up and
relocated to Auckland. This is his
first column for NZ Optics.
6 NEW ZEALAND OPTICS April 2018

Greenlane ups low
vision services
The low vision (LV) clinic at Greenlane
Clinical Centre has recently welcomed
two new optometrists to its team. Deepa
Kumar and Deborah Chan, have joined Sandy
Grant, LV clinic coordinator and therapist, to
provide a multi-disciplinary low vision service
to patients referred by eye health specialists,
general practitioners, the Blind Foundation and
other ADHB departments.
The most common referrals are for patients
with macular degeneration (MD) and
glaucoma, although the clinic will accept
anyone with functional vision issues, said
Grant.
Patients seen at early stages of MD often
identify reading, handwriting and glare issues
as their main difficulties, while patients with
glaucoma, retinitis pigmentosa, hemianopias
or monocular vision may experience mobility
and reading issues. Other visual concerns
highlighted in the assessment are also
addressed through LV strategies such as
eccentric viewing, low vision aids, both optical
and non-optical (eg. magnifiers, task lamps,
signature guides), basic training with aids or
sighted-guide, information, peer support or
referrals, such as Blind Foundation membership.
Early intervention often alleviates many
patients and helps the patient develop coping
mechanisms, said Grant.
The low vision clinic runs Tuesday and
Thursday afternoons and on average about
four patients per clinic are seen. Wednesday
afternoons is a therapist-only clinic, though
Grant said she hopes to add another fullservice
clinic in the near future.
Patients referred to the clinic are interviewed
first by Grant and then the optometrist,
who refracts the patient and determines
magnification requirements. Follow-up
appointments are often required, or patients
can self-refer back should they feel their vision
has deteriorated.
Originally from Canada, and trained in
rehabilitation teaching, orientation and
Greenlane low vision optometrists Sandy Grant and Deepa Kumar
mobility, Grant came to New Zealand in 1992
to work for the Blind Foundation. “As the clinic
coordinator, I love the interaction with patients
and in playing my part on the LV team.
“It’s rewarding work, encouraging and
demonstrating what is possible to patients
through a variety of strategies, low vision
aids, appropriate support, referrals to enable
the patient to approach their low vision with
added confidence, motivation and a boost in
self-esteem.”
Grant said she’s excited about the recent
expansion of the clinic and is looking forward
to providing more patients with a range of
services to start them on their journey to living
successfully with low vision.
The LV clinic at Greenlane also recently made
a sizeable donation of older model (and never
used) magnifiers to volunteer ophthalmic
services overseas (VOSO) for their trip to the
Pacific Islands in an effort to support LV work
on this history-making VOSO trip. We wish
Naomi Meltzer and the rest of the VOSO team
all the very best for this new chapter in VOSO’s
evolution, said Grant. ▀
If you would like to a refer a patient to the low
vision service at Greenlane Clinical Centre,
referral forms can be found on the Healthpoint
website or email sandy@adhb.govt.nz. For
questions, call 09 3074949 extn 27641.
Calling mentors
The School of Optometry and Vision Science
(SOVS) at the University of Auckland needs more
externship mentors for their final year BOptom
students.
During their last year of study, each New Zealand
BOptom student undertakes a three-week externship
in a community-based optometry practice. Through
these externships, students gain further experience in
the direct examination and management of patients
away from the confines of the university clinics, says
Dr Geraint Phillips, SOVS senior lecturer and clinic
director. “Feedback from the profession shows many
optometrist mentors enjoy the exchange of ideas and
information with the next generation of optometrists.”
The externship period can be broken up so that the
student attends more than one practice, for example,
when a practice is keen on taking part, but cannot
host the student for the full three weeks. Optometrist
mentors supervise the student during their externship,
which includes being available to check the clinical
findings for every patient the student examines. Mentors
also complete an evaluation at the end of the student’s
externship; a format is provided with pre-set questions.
Optometrist mentors are invited to become
New vision-tech hub
Australian low vision service provider, Vision
Australia, has opened a new interactive
site so people who are visually-impaired
can experience the abundance of new technology
available to help them today.
Located in Vision Australia’s new Parramatta centre
in Western Sydney, the new Vision Store and Tech Hub
showcases the latest specialist adaptive technology and
how more mainstream devices can be optimised and
used to support people who are blind or have low vision.
“Whether it’s living independently, being active in their
community, finding employment or staying connected
with family and friends, technology is often the key to
unlocking opportunities for people who are blind or
have low vision,” said Ron Hooton, Vision Australia’s CEO.
“Individuals have different circumstances and goals and
what we have at Parramatta is a location where anybody
who is blind or has low vision can come and be exposed
to a huge range of technology that can support them
Honorary
Teaching
Fellows with
the University
of Auckland,
a position SOVS: Calling more optometry mentors
which offers full access to the extensive resources the
Auckland University library offers, including all of its
electronic resources (encompassing many excellent
journals); use of the title “Honorary Teaching Fellow
affiliated with the School of Optometry & Vision
Science at the University of Auckland”; preferential
and cost-reduced access to continuing professional
development events within SOVS; use of the following
phrase on practice websites and similar: “Our practice
provides teaching services for the University of
Auckland’s School of Optometry & Vision Science for
their Bachelor of Optometry degree”.
The School of Optometry & Vision Science is keen to
welcome new and returning mentors for externships
in June and July 2018. If you are interested in becoming
a new or returning externship mentor, please contact
Gini Parslow, practicum placement co-ordinator at
v.parslow@auckland.ac.nz or phone 027 406 8543. ▀
and get expert advice about what is likely to best suit
their needs.”
Technology advice is provided by Vision Australia
staff plus representatives from tech organisation
partners, including Samsung, Apple and Google,
and specialist adaptive technology providers such as
IrisVision and OrCam.
Other highlights of the new space include
demonstration home environments, including an
accessible kitchen and cooking aids (both low and
high-tech solutions); a living room with TV/voice
integration home devices; workplace/home study
tools; Google Home to control lighting and provide
audio cooking instructions; and other tools such as
Samsung’s voice-controlled screen magnification tech.
“Accessibility is a key consideration for people who
are blind or have low vision and we’ve taken that into
account with the design, layout and other features in
the space,” Mr Hooton said. ▀
We’re bringing more
optometry events and
webinars to you
MyHealth1st is revolutionising digital customer engagement
for independent optometrists.
Don’t miss our free events and webinars on how you can join
the digital revolution and put your business growth 1st.
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myhealth1st.co.nz/optometryevents
April 2018
NEW ZEALAND OPTICS
7

Low vision in the 21st century
BY NAOMI MELTZER*
Last century, low vision services were regarded
as a last resort and an admission of failure.
Generally, when patients enquired as to
whether there was anything available to help
them see, the answer was either a tentative, ‘you
could buy a magnifier’ or a more defensive, ‘you’re
not bad enough for that yet’.
When medical and surgical options ran out,
the patient was dismissed with ‘there is nothing
more that can be done, sorry’. This was effective
at getting the patient out the door, but left them
emotionally and physically stranded, unable to
comprehend how to function visually when they
were neither blind nor seeing. More patients were
rendered functionally “blind” by this statement
than by any other documented pathology and,
sadly, many continue to exist in this state today,
convinced this statement remains true as it was
given by those they trusted.
For some, this attitude has continued into this
century, despite huge changes in medical, optical
and electronic technology, and the current view
of low vision as a spectrum of functional changes
that occur along the pathway between normal
vision and no light perception. A few weeks after I
started my low vision practice in 2011, I ran into an
ophthalmological colleague who told me, ‘I hope
you never get to see any of my patients!’ But for
many, there has been a shift in thinking towards
understanding that visual function cannot be
defined by the size of letter read on a high-contrast
distance chart or a monocular electronic visual field
analysis; and visual rehabilitation does not mean
restoring vision to normal, but the rehabilitation
of a person with visual loss to function within their
family, whanau, community or workplace.
Much of this change has been driven by the
realisation that even with the amazing advances
in medical science in the management of
ongoing problems such as glaucoma, macular
degeneration or other retinopathies, it is just that
– management of the condition – not restoration
of normal visual function. Thus, the best outcomes
are obtained when patients are given as much
information as possible on the range and type of
additional services available to them sooner rather
than later when all else has failed.
Times are changing for low vision patients, and about time too
Today, the modern low vision consultation reviews
how a patient with low or declining vision functions
in their everyday environment and how we can help
them use the vision they have more efficiently to
manage their day-to-day activities. This involves
taking a holistic view incorporating their general
health, and the impact of perhaps other health
problems such as stroke, Parkinson’s or diabetes
on their visual functioning; and their physical
environment – are they confined to one, poorly-lit
room in a rest home or actively participating in
sport or looking after other family members? Does
their visual problem extend to passive reading or
do they have other needs such as mobility or glare
control? Is there a history of amblyopia, binocular
vision instability or balance problems that has been
forgotten along the way or considered irrelevant due
to the patient’s poor distance acuity? Has the need
for prescription glasses to focus at near range been
overlooked as their vision deteriorated? Or do they
perhaps simply need reassurance there are options
available to help them if and when they need it?
A functional, low vision consultation helps assess
each patient on an individual, case-by-case basis,
going way beyond the ‘let’s see if a magnifier will
help’ approach.
Recently, a request for assistance from a resource
teacher brought home to me how much a bit of
lateral thinking and a good stock of low vision
aids can change an
otherwise ordinary
day. A 12-year-old
boy with low vision
due to retinopathy
of prematurity, copes
well in the classroom
with just his spectacle
prescription correcting
his hypermetropia and
high cyls plus a closeworking
distance to
use his accommodation
for extra magnification.
However, given he was
starting woodwork
and sewing and would
have to use sewing
machines, fretsaws and
grinding machines and the like, the resource teacher
was on the hunt for some additional magnification
for him.
She had found a magnifier attached to a
goose neck stand, but this got in the way of the
student and couldn’t be moved easily from one
piece of equipment to another. The boy was also
required to wear safety glasses for the woodwork
equipment so an initial idea to use a head loupe
was a non-starter, while a large magnifier on a
tilting wire frame, ‘just got in the way’. We settled
on a hands-free “embroidery” magnifier, which
sits against his chest with a cord around his neck
and is LED-illuminated. While only providing 2x
magnification (he needs 3.5x to read a mm ruler)
it was sufficient to help him see the needle or the
blade of the saw at a normal working distance.
What was exciting however, was watching the
student. He was like a kid in a candy store trying out
all my high-tech and low-tech electronic stuff. In his
lifetime, he will no doubt use way more high-tech
aids than are available today, but this exercise at
least showed both of us, how a simple low-tech, lowcost
magnifier and a good dollop of lateral thinking
can triumph. A very satisfying outcome all round. ▀
*After 30 years in general optometry,
Naomi Meltzer realised her passion
lay in visual rehabilitation and now
runs an independent, low vision
consultancy service in Auckland. She is
a MDNZ founding trustee, a qualified
CentraSight and eSight assessor and
OrCam trainer. For more, see the Low
Vision Services classified on p26.
Tackling trachoma and
other NTDs
BY ELLA EWENS
In December 2017, Dr Martin Kollmann, a
consultant ophthalmologist and associate
professor at the University of Nairobi, travelled
to New Zealand to address delegates from the
partnerships, humanitarian and multilateral
division of the New Zealand aid programme at the
Ministry of Foreign Affairs and Trade (MFAT). The
main aim of the visit was to build awareness of the
link between neglected tropical diseases (NTDs)
and poverty and demonstrate how tackling NTDs
is key to a region’s socio-economic development.
Dr Kollman, a senior advisor on NTDs for the
international charity CBM (formerly the Christian
Blind Mission), was accompanied by CBM NZ
chief executive, Stephen Hunt, and international
programmes manager, Linabel Hadlee.
NTDs are a diverse group of tropical infections,
especially prevalent in low-income populations in
developing regions. They are caused by a variety
of pathogens such as viruses, bacteria, protozoa
and helminths. The disabling and debilitating
effects of NTDs include blindness, mobility
impairment, preventing children’s growth and
development, malnutrition and extreme pain.
They are labelled ‘neglected’ because they affect
communities in extreme poverty. In some cases,
the uncontrolled spread of NTDs has resulted
in pastoral communities abandoning their land
to escape the transmitting pathogen but, as a
result of NTD control programmes, in more recent
times 25 million hectares of arable land has been
regained, feeding 17 million people annually.
Two of the most common blinding NTDs are
onchocerciasis (river blindness), found in Africa
and some parts of the Americas, and trachoma,
the leading cause of infectious blindness in
humans, caused by infection with the bacterium
Chlamydia trachomatis, which is still found in
Africa, the Americas, Asia, the Middle East and
the Pacific. Ethiopia carries 39% of the global
trachoma burden, with an estimated 74 million
people at risk and 40% of children aged 1-9
infected. Women are highly susceptible due to
greater exposure to young children, who typically
spread the disease. Trachoma is active in the
Pacific, particularly Papua New Guinea and
Australia in remote communities.
A doctor treats a trachoma sufferer in Ethiopia
Blindness from trachoma is irreversible. Infection
is spread through personal contact and by flies
that have been in contact with facial discharges
from an infected person. With repeated episodes of
infection over many years, a sufferer’s eyelashes may
be drawn in so they rub on the surface of the eye,
causing pain and permanent damage to the cornea.
CBM supports NTD control and elimination
programmes in 12 countries promoting the
SAFE (surgery, antibiotics, facial cleanliness
and environmental educational) strategy at
a community level. Over the last 12 years,
CBM has funded nearly 16 million mass drug
administration projects and almost 900,000
trachoma surgeries. CBM has also supported the
training and education of more than 83 million
health and community workers.
At his meeting with MFAT, Dr Kollmann
showcased a CBM-funded programme in
Amhara, Ethiopia which received an award for
its innovative approach embracing community
engagement and ownership. International aid will
not achieve its sustainable development goals
with an economic focus only, he said, but must
also focus on preventing and eliminating NTDs to
be successful.
Although NTD interventions have proved to
be very cost-effective, globally only 0.6% of
health expenditure targets NTDs, hence CBM’s
government awareness programme, which wants
aid givers to target more aid towards health to
support more NTD elimination programmes. This
will represent a tangible benefit for children,
women and adults; solidly contributing to poverty
eradication and sustainable development goals,
explained Dr Kollman.
Dr Martin Kollmann
Dr Martin Kollmann, a consultant ophthalmologist and associate professor at
the University Nairobi, is a senior CBM advisor, coordinating global activities
in the fight against diseases of poverty and inequity. He studied human
medicine in Germany and worked for three years with the German volunteer
service, DED, in rural hospitals in Ethiopia before completing his training in
ophthalmology at Munich University. He holds a degree in tropical medicine
and medical parasitology and an MBA in healthcare management. Today,
at the University of Nairobi Institute of Tropical and Infectious Diseases,
Dr Kollmann trains postgraduates, undergraduates and mid-level eye care
Dr Martin Kollmann, raising
awareness of trachoma and other
NTDs
professionals and is heavily involved in research. He has also developed an innovative sponsorship
programme, which supports training for young Africans at recognised institutions in the region.
8 NEW ZEALAND OPTICS April 2018

Constant Progress
ZEISS Precision Lenses
1912
Punktal ®
The first axially symmetric spectacle
lenses with point-focal Imagery, a
concept that still plays a significant
role in today’s lens designs. This
invention was enabled by a close
collaboration with Moritz von Rohr
and Alvar Gullstrand.
1935
Patent for AR coatings
ZEISS invents a process to create
durable coatings to reduce reflections
on optical lens surfaces.
1969
The photos of the first moon landing
were taken with ZEISS camera lenses.
1970
First photochromic spectacle lenses
A partnership with SCHOTT helps ZEISS
launch the world’s first brown glass
photochromic spectacle, known as
Umbramatic.
1980
Gradal ® HS
ZEISS unveils the world’s first progressive
lens design based on splines. It is the
predecessor of freeform lenses.
1997
Patent for a new manufacturing process
With the Hof / Hanssen patent ZEISS sets a new
standard in progressive lens production. To date,
this manufacturing process has been licenced to
the entire ophthalmic market by ZEISS.
2000
Gradal Individual ®
Progressive Lenses
For the first time in history,
ZEISS offers personalised
parameters in the computation
of progressive lens surfaces.
2007
i.Scription ®
ZEISS launches the first lens
technology that incorporates
higher-order aberrations and
combines subjective refraction
and wavefront analysis.
2010
MyoVision ®
The world’s first lens that
enables a reduction in myopia
progression by an average of
30% in Asian children.
2014
Digital Lenses
ZEISS introduces a new first-pair lens
product category that is an eye care
solution for mobile devices
1992
Video Infral ®
The world’s first computer-based
centration device is introduced
by ZEISS to set new standards in
individualised lens fitting.
2015
DriveSafe Lenses
ZEISS develops an everyday
lens solution consisting of three
elements to make driving safer
and more comfortable.
2018
Watch this Space!
Our breakthrough innovations are the result of every decision we have made, every idea
we have had and every contribution that everyone at ZEISS has made. We are proud of
our long history and tradition in shaping the future of optics. We even made it to the
moon, and we are aiming for even greater heights. Be part of this never-ending story.
Find out which ZEISS lens solutions are most suitable for you and your
business at www.zeiss.com.au/vision or 1800 882 041.
April 2018
NEW ZEALAND OPTICS
9

SPECIAL FEATURE: RANZCO 2018
Welcome to the RANZCO
NZ 2018 Conference
The New Zealand Branch
RANZCO committee
welcomes everyone
to Auckland for the 2018
conference.
This year we have decided to
not have a specific educational
theme, but rather to offer a
broad range of subspecialty
topics, useful to both
generalists and subspecialists
in medical, nursing and
orthoptic fields. The meeting
is combined with the NZ
Ophthalmic Nurses and the
NZ Orthoptic Society, offering
plenary sessions targeted to all attendees,
followed by concurrent streams for each group.
Our keynote speakers are Professor David
Mackey (genetic ophthalmologist, Australia),
Dr Brendan Vote (vitreoretinal and cataract
specialist, Australia), Associate Professor
Lyndell Lim (uveitis and retinal disease,
Australia), and Helen Gibbons (Clinical Lead
Nurse, UK). These speakers are internationally
renowned for their clinical and scientific
expertise and their dynamic presentations.
They will be joined by a further 60 speakers
covering a very wide range of topics including
anterior segment, cornea, cataract, uveitis,
glaucoma, retina, paediatrics, oculoplastics,
oncology, infectious disease, trauma, health
care provision, nursing, psychophysics, basic
science and emerging technologies.
The conference will be held at the Hilton
Hotel which sits in a prime waterfront location
in the heart of Auckland, adjacent to all the
central Auckland shopping and entertainment
venues.
We would like the conference to have a
relaxed, collegial, “weekend” feel, and as such,
BY DR SUE ORMONDE*
Auckland ‘city of sails’ and RANZCO NZ 2018 Meeting venue, the Hilton Hotel (centre,
waterfront)
the dress code is casual.
The conference dinner will be held at
The Maritime Museum, an iconic venue in
Auckland, that celebrates New Zealand’s long
and broad association with the sea. In line with
the casual tone of the meeting, the dinner
will offer a wide variety of quality street food,
street entertainers, and a live band.
We are very grateful to the multiple industry
sponsors who are facilitating the meeting
and there will be a large industry exhibition,
covering the latest and greatest ophthalmic
technology available in New Zealand.
The venue has a set capacity and so we
encourage early registration for what
promises to be a broad ranging, contemporary,
educational and fun meeting.
To register, please visit: https://
ranzcomeetingnz.cvent.com/2018
*Dr Sue Ormonde is a consultant ophthalmologist at Auckland
Eye and Greenlane Clinical Centre, a senior lecturer at the
University of Auckland and a member of the 2018 RANZCO
NZ organising committee together with Professor Trevor
Sherwin and Sue Raynel from the University’s Department of
Ophthalmology.
An enjoyable, educational
affair
The RANZCO New Zealand Annual Scientific
Meeting is one of the most important
meetings in the New Zealand ophthalmic
calendar and is unique in that it incorporates the
New Zealand Ophthalmic Nurses Group Meeting
and the New Zealand Orthoptic Society Meeting.
The programme
This year, the two-day programme from 11 – 12
May at Auckland’s Hilton Hotel, features concurrent
streams, focusing on each speciality, with
presentations ranging from five to 25 minutes from
more than 60 speakers (40 in the Scientific Meeting
alone) followed by question and answer sessions
from the floor.
The programme kicks off with a welcome function,
with canapés and drinks in the exhibitors’ hall of the
Hilton on Thursday 10 May from 5.30-7.30pm. This
year, the popular annual meeting dinner will be held
on Friday 11 May in The Maritime Room, just a short
walk from the Hilton, with views over Auckland’s
famous Viaduct Harbour. As well as the normal good
food, great atmosphere and general bonhomie, this
year’s organisers are also promising a few surprises
at the dinner, so definitely not one to be missed.
The main Scientific Meeting this year welcomes
a number of overseas specialist speakers, as
well as a plethora of local talent, many of whom
will be sharing their own unique experiences
across a number of different, and often unusual,
cases, including, ‘Duped by BDump’; an unusual
presentation of systemic lupus erythematous; and
panuveitis in Sweet’s syndrome.
Other topics include, New Zealand cataract risk
stratification, audit and paediatric surgical outcomes;
psychophysics; the development of a novel webbased
deep learning system, to identify common
retinal pathologies, and an open-source pupilometer;
Vogt-Koyanagi-Harada disease; orbital decompression
surgery in thyroid eye disease; keratoconus in Down
syndrome in New Zealand; corneal cross-linking
outcomes; and, tackling that biggest of questions, oft
lauded by eye health professionals: “are the eyes really
the window to the soul?”
Meet the speakers…
And that’s just some of the smaller sessions. As
a further taster of what’s on offer at this year’s
RANZCO NZ gathering, NZ Optics’ approached the
four keynote speakers from the Scientific Meeting
and the Nurses Meeting and asked them to tell us a
little bit about what they would be presenting, how
they came to be working in ophthalmology and what
they were most looking forward to from this years
meeting.
Professor
David Mackey
Internationally-renowned
genetic ophthalmologist,
Professor David Mackey is
managing director of the
Lions Eye Institute and
professor of ophthalmology
and director of the Centre
for Ophthalmology and
Professor David Mackey
Vision Science at the
University of Western Australia. Having devoted
his career to decreasing blindness from optic nerve
disorders, his work has helped revolutionise the
management of hereditary optic atrophy (Leber and
ADOA) and glaucoma.
In 1993 he initiated the Glaucoma Inheritance Study
in Tasmania, creating one of the largest glaucoma
biobanks in the world that led to the discovery of the
myocilin gene and its association with glaucoma.
His work with the Twins Eye Study in Tasmania and
Brisbane characterised the heritability of many ocular
measurements, while his Genome Wide Association
Studies have identified genes for myopia, corneal
thickness, intra-ocular pressure optic nerve size and
glaucoma. In 2007-8, he led the Norfolk Island Eye
Study, examining 800 mixed-race descendants of
the Bounty mutineers as part of a major genetic eye
study. In Western Australia, he has collected ocular
CONTINUED ON PAGE 12
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References: 1. AcrySof® IQ PanOptix® Toric IOL Directions for Use. 2. Charness N, Dijkstra K, Jastrzembski T, et al. Monitor viewing distance for younger and older workers. Proceedings of the Human Factors and Ergonomics Society 52nd Annual Meeting, 2008. http://
www.academia.edu/477435/Monitor_Viewing_Distance_for_Younger_and_Older_Workers. Accessed September 16, 2016. 3. Average of American OSHA, Canadian OSHA and American Optometric Association Recommendations for Computer Monitor Distances. 4. Alcon
Data on File. TDOC-0018723 (Dec 19, 2014). 5. Alcon Data on File. TDOC-0050480 (June 12, 2015) 6. Alcon Laboratory Notebook:14073:77-78. 7. Lane SS, Burgi P, Milios GS, Orchowski MW, Vaughan M, Schwarte E. Comparison of the biomechanical behavior of foldable
intraocular lenses. J Cataract Refract Surg. 2004;30:2397-2402. 8. Lane SS, Ernest P, Miller KM, Hileman KS, Harris B, Waycaster CR. Comparison of clinical and patient reported outcomes with bilateral AcrySof® Toric or spherical control intraocular lenses. J Refract Surg.
2009;25(10):899-901. 9. Wirtitsch MG, et al. Effect of haptic design on change in axial lens position after cataract surgery. J Cataract Refract Surg. 2004;30(1):45-51. 10. Nejima R, et al. Prospective intrapatient comparison of 6.0-millimeter optic single-piece and 3-piece
hydrophobic acrylic foldable intraocular lenses. Ophthalmology. 2006;113(4):585-590. 11. Rotational stability of a single-piece toric acrylic intraocular lens. J Cataract Refract Surg. 2010;36(10):1665-1670. 12. Alcon Data on File. TDOC-0016076 (Jul 30, 2013).
© 2018 Novartis. Alcon Laboratories (Australia) Pty Ltd. ABN 88 000 740 830. Phone: 1800 224 153; NZ Phone: 0800 101 106. NP4: A21702597704
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11

SPECIAL FEATURE: RANZCO 2018
Zeiss
Clarus 500 is the next generation, ultrawidefield
fundus imaging system from Zeiss,
providing true colour and high-resolution
across a 200-degree ultra-wide image.
The true colour images are essential for
differential diagnosis. Each can be split into
red, green and blue channels. In addition,
fundus auto-fluorescence images are
available, displaying important information
about RPE health. Utilising Zeiss optics, the
Clarus 500 achieves seven-micron resolution,
eyelash-free images allowing the user to
zoom in to visualise fine details. Lastly,
being based on a traditional fundus camera
design and utilising an IR preview, the
Clarus provides a more comfortable patient
experience whilst avoiding inconvenient
recaptures.
Device Technologies
Visit our stand at RANZCO NZ and experience
the revolutionary Topcon Triton Swept
Source OCT-A and other exciting innovations
first hand. Learn more about our range
of ergonomic and time-saving devices:
EndoOptik endo-camera and laser system,
Quantel lasers, a full range of chairs and
stands, new polarised Frey VA charts and
perimeters. Also on display will be the
Maestro OCT providing a one-click wide
scan plus all relevant retinal info. in a single
report. It’s an easy to use, reliable, affordable
and space-saving combo-OCT (anterior scan
and networking available). Plus we have the
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which integrates virtually every ophthalmic
device into one intuitive platform and is
compliant with all the major international
medical communication protocols.
CONTINUED FROM PAGE 10
and environmental data on 2000 20-year old Raine
Cohort participants. A follow-up study of these
participants at age 27 commenced in 2017, while
a new study he started in 2012 is examining the
positive-negative effects of UV sun exposure.
How did you come to focus on this area of eye
health?
I am an ophthalmic geneticist, which is an
uncommon subspecialty in ophthalmology. I’ve
always been interested in genetics, since school.
During medical school, I was also fascinated
by ophthalmology, so I combined them in my
fellowships at the Royal Children’s Hospital
in Melbourne, the Johns Hopkins Centre for
Hereditary Eye Disease in the USA and Moorfields
Eye Hospital in London.
Genetics are at the cutting edge of science and
we have been part of the major discoveries of
genes associated with many different eye diseases.
We learn new pathways for disease and can predict
those at high risk, and in diseases like glaucoma or
retinoblastoma we can intervene to reduce vision
loss.
Can you tell us about your talks this year?
I am giving four talks. First, an overview of where
genetics is taking us. Gene therapy to treat eye
disease has been in the press a lot of late with a
treatment just licenced in the US being marketed
at $850,000! (Luxturna, NZ Optics Feb 2018, p21).
However, we need to consider genetic testing to
prevent genetic eye disease, which may be cheaper.
Plus, the new technologies for visually impaired
people like smart phone apps and driverless cars
offer an exciting future of independence. We need
to follow all these paths.
Second, we have been studying families to find
glaucoma genes since the Glaucoma Inheritance
Study in Tasmania began in 1994. In the coming
months, several papers will show a large number
of genes causing adult glaucoma are also the ones
that cause childhood glaucoma.
Third, there is a global epidemic of myopia, where
a lack of time outdoors is a contributing factor.
However, in Australia and New Zealand, where we
already have the highest risk of skin cancer, what
will happen if we send our kids outdoors more to
prevent myopia?
Fourth, a disease I studied for my doctorate thesis
called Leber Hereditary Optic Neuropathy is now
undergoing clinical trials for a new gene therapy.
Dr Brendan Vote
Dr Brendan Vote is
a clinical associate
professor with the
University of Tasmania
and a vitreoretinal and
cataract specialist. He
was a medical officer in
the RAAF for six years
before commencing his
ophthalmology training
in Dunedin and completing retinal fellowships in
Auckland, Brighton and at Moorfields Eye Hospital
in London. He established the Tasmanian Eye
Institute in 2008 to offer research, educational
and ophthalmic service to the Tasmanian
community.
He is currently involved in multicentre trials
assessing intravitreal therapies in diabetic
maculopathy, age-related macular degeneration
(AMD) and vascular occlusion, including evaluating
the long-term effectiveness of Lucentis for the
treatment of MD in a large cohort of patients
treated now for more than 10 years. He has also
been an active researcher of femtosecond laser
in cataract surgery through the first prospective
comparative cohort study, which began in 2012.
Can you tell us about your topics at RANZCO NZ?
My first topic is ‘Lessons from my 10+ year macular
degeneration relationship utilising intravitreal
injections’; the second is, ‘Cataract surgery and a
doctor’s role in emerging technologies’; the third,
‘CRISPR-Cas 9 is the exponential game changer
in gene therapy; and the fourth, ‘Crypto currency,
Blockchain and healthcare – a dystopian future or
necessary evolution?’.
I am always excited by the technological
breakthroughs we are making. But I like to see
how these will apply in the real world beyond the
marketing and hype. I suppose that makes me an
enthusiastic sceptic; keen to try new things but
looking for the evidence it works.
What are you looking forward to at this year’s
meeting?
I think the New Zealand meeting is one of the best,
as it has the perfect mix of science and social, so I
always look forward to attending.
I enjoy hearing from speakers without industry
associations presenting their research and insights.
The New Zealand RANZCO Branch meeting has
always had this balance and I think this is where
more of our international scientific congresses
need to head.
Associate Professor
Lyndell Lim
Associate Professor
Lyndell Lim is principal
research fellow at the
Centre for Eye Research
Australia (CERA) at the
University of Melbourne,
where she also heads the
Clinical Trials Research
Unit. A consultant
ophthalmologist at the Royal Melbourne Hospital
and the Royal Victorian Eye and Ear Hospital
(RVEEH), where she leads the Ocular Immunology
Clinic, her sub-specialities include medical retina
and ocular inflammatory disease. Her current
areas of research include the possible role of
inflammation in the pathogenesis of several
retinal diseases such as AMD, as well as clinical
studies in diabetic retinopathy and uveitis.
At RANZCO NZ, A/Prof Lyndell Lim will be
presenting on cataract surgery in patients with
uveitis and diabetic macular oedema; and ‘the rise
and rise of infectious uveitis’. Other topics to be
confirmed.
Why eye health and research?
I became a doctor because I liked the idea of
helping people; an ophthalmologist, as it’s the
perfect blend of medicine and surgery; a uveitis
specialist, because no one patient with uveitis is
the same and there are so many unknowns; and a
researcher because it presents the chance to make
a real difference to patients’ lives.
As a doctor, you can help hundreds to thousands
in your lifetime of work. But as a researcher, you
have the chance to help millions.
What are you most excited about for this year’s
meeting?
The chance to talk about uveitis and my research
is always fun, especially with such a nice group of
people.
Ophthalmic nurses
keynote: Helen
Gibbons
Heading up the New
Zealand Ophthalmic
Nurses Group Meeting,
Helen Gibbons is currently
the clinical lead nurse
(education and research)
at Moorfields Eye Hospital
in London. She has
extensive clinical ophthalmology experience in
pre- and post-operative care, out-patients and
establishing a nurse-led ophthalmic emergency
clinic within a district general hospital. Gibbons
was the first nurse to be trained to perform
Nd:YAG laser capsulotomy and Nd:Yag laser
iridotomy. She has used her knowledge to help
develop more skilled nursing roles in a new eye
hospital in Accra, Ghana, and visits every 18
months to support the team.
How did you come to your profession?
At 18, I had a place to undertake my Enrolled
Nurse training but there was an 18-month wait,
so I got a job as a nursing auxiliary which was on
an ophthalmic ward. I loved ophthalmology. The
only other speciality I considered was cardiology,
however, on qualifying I was one of two people
from my set to be offered a job, mine was parttime
so I decided to apply back to my old ward and
focus on ophthalmology.
Throughout my career the patients have always
been my main focus. As a nurse practitioner, I
enjoyed treating my patients independently giving
the best care I could and when performing YAG laser
capsulotomies, I never tired of seeing the joy of
patients’ vision improving. Now, as an educator, I get
so much pleasure out of supporting and developing
future ophthalmic nurses, but I still enjoy patient
contact when I support staff in their clinical areas.
What are you focusing on at RANZCO NZ?
I am giving five presentations at the conference:
how we train our staff to understand what it’s like
to have a visual impairment; the research link nurse
programme we have introduced at Moorfields to
encourage nurses to take part in nursing research
and audit; advance practice roles for nurses at
Moorfields; the ‘New to Ophthalmology’ Induction
programme for staff new to ophthalmology; and
my work in Korle Bu, West Africa. All the topics are
relevant to everyday practice and I have learnt from
each experience and subject.
Craig: 027 565 7200 Robert: 027 565 7720 P: 0800 657 720 info@oppmed.co.nz
Corneal Lens Corporation (CLC)
Corneal Lens is very excited to be showcasing
our new eyecare range at the RANZCO NZ
conference.
Our premium range Evolve highlights four
different formulations which are designed
to target specific areas of dry eye. The
Evolve range is a generation 2 technology,
preservative-free delivery system, which
gives the multi-dose benefits of a single dose
unit with the familiarity of a standard bottle.
It has a soft, squeezable bottle to improve
ease of use offering the blue-tip technology
designed to improve accuracy of dispensing
a drop and maintaining a preservative-free
environment. The Evolve range consists of HA
2, Carmellose 0.5%, Hypromellose 0.3% and
Eyelid Wipes.
Designs for Vision
Designs for Vision is turning 40 and is
thrilled to be associated with RANZCO NZ.
To celebrate, DFV has assembled a number
of state-of-the-art instruments for delegates
to view and to talk to the experts about. The
Oculus Pentacam AXL, the gold-standard
for anterior segment analysis, now comes
with biometry including Barrett in the IOL
calculator. Combine this with the Corvis
ST for true IOP measurement, incredibly
sensitive ectasia detection and cross-linking
visualisation – the complete package for
the glaucoma and refractive surgeon. Also
on show will be the Tomey OA-2000 Optical
Biometer: topography, pachymetry, axial
length, pupil diameter, Barrett, all at a class
leading price.
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13

SPECIAL FEATURE: RANZCO 2018
What’s on in Auckland in May…
As well as being home to some of the country’s top restaurants, bars and tourist attractions,
Auckland, the city of sails, hosts a plethora of events throughout the year. Here’s our pick of just a
few on offer in May for those attending the 2018 RANZCO NZ conference who want to make a little
more of their stay.
Body Worlds exhibition 23 April to 13 July, the
Hilton Hotel
https://www.bodyworldsvital.com
The highly anticipated and internationally
acclaimed original exhibition of real human bodies
is being hosted by the same venue as RANZCO NZ
2018, the Hilton Hotel. Visited by more than 45
million people worldwide, the exhibition takes
you on an intricate journey of the workings of the
human body, through an authentic, visual display
of over 150 donated specimens.
The human bodies and body parts, donated for
the benefit of public education, have gone through
a meticulous year-long process of plastination, and
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visually demonstrate the complexity, resilience
and vulnerability of the human body in distress,
disease and optimal health.
World of Wine Festival 12-13 May, AUT’s City
Campus, opposite Auckland Art Gallery
https://theworldofwinefestival.nz/
New Zealand’s newest wine festival, is our first to
showcase purely international wines, designed to
open Kiwi sauvignon blanc drinkers’ eyes to new
producers, wineries, grapes, regions and styles.
The Auckland University of Technology’s (AUT’s)
Tasting Hall will play host to more than 130 wines
from 13 countries and a revolving wine bar. The
weekend also includes master classes and
special events, such as the Mas Daumas
Gassac vertical tasting, when the Southern
French winery’s head wine-maker Samuel
Guibert, will host a multi-vintage tasting of
the company’s legendary Grand Vin Blanc
and Rouge wines.
Mrs Warren’s Profession 1 – 16 May, ASB
Waterfront theatre, Wynyard Quarter
https://www.atc.co.nz/aucklandtheatre-company/2017-18/mrs-warrensprofession/
When Vivie discovers that her expensive
education was funded by her mother’s
earnings from a string of brothels, Vivie’s
thoroughly modern worldview is thrown
into tumult. Written in 1893, George
Bernard Shaw’s play was originally banned
by the censors for its subject matter and
the hypocrisies it exposed. What continues
to shock is how old taboos stay topical and
how little things have changed.
Celebrated New Zealand theatremaker
Eleanor Bishop returns from New
York to direct her own version of this
rarely-performed classic that takes a
Radiant Health &
Bausch+Lomb
Bausch + Lomb (B+L) is excited to
announce the launch of the next
generation Stellaris Elite phaco
system with ‘adaptive fluidics’.
Join us at the Radiant Health and
Bausch+Lomb stand at RANZCO
NZ where we will be showcasing
Stellaris Elite, and find out about
other new products B+L will have for
2018, especially in the VR segment.
We will also be demonstrating
Finevision trifocal and enVista IOLs.
Stem cells
restore
sight
Two patients with severe wet
AMD, implanted with a speciallyengineered
retinal pigment
epithelium cells patch, derived from stem
cells, have regained their reading vision
in a ground-breaking clinical study at
Moorfields Eye Hospital in London.
The study investigated whether the
diseased cells at the back of the patients’
affected eye could be replenished using the
stem cell-based patch. The patients were
monitored for 12 months and went from
not being able to read at all to reading with
normal reading glasses.
The study, published in Nature Biotech, is
a major milestone for the London Project
to Cure Blindness, a partnership between
Professor Pete Coffey from University
College London and Professor Lyndon da
Cruz, a Moorfields retinal surgeon.
contemporary lens to centuriesold
questions of sexuality and
empowerment.
‘Let me be myself’ – the story
of Anne Frank 9 Feb to 13 May,
Auckland Museum
http://www.aucklandmuseum.com/
visit/exhibitions/let-me-be-myself
Developed by Anne Frank House
in Amsterdam, this international
exhibition ‘Let Me Be Myself’ explores
what life was like for Anne Frank
and her family, looks at the events
surrounding the Holocaust and the
rise of the Nazi Party in Germany and
explores identity, prejudice, exclusion
and discrimination.
Best Comedy Show on Earth 13 May,
Sky City
https://www.skycityauckland.co.nz/
whats-on/theatre/best-comedyshow-on-earth/
Ten comedians, 100s of jokes and thousands of
laughs, get a sneak peak of the Auckland Comedy
Fest’s brightest stars and freshest talent in this
fast-paced stand-up showcase, billed as having
something to suit everyone.
Dans le Noir? Dining in the dark Thursday, Friday
and Saturday, from 6:30pm to 7:30pm, Rydges
Hotel
https://www.rydges.com/accommodation/newzealand/auckland/eat-drink/dans-le-noir-rydges/
Presented by Auckland’s Rydges Hotel and the
Blind Foundation, Dans le Noir is a unique, sensory
dining experience where patrons eat in complete
darkness, guided and served by low vision or blind
people. More than 1.3 million people have already
lived this experience worldwide. Organisers say
Swept Source OCT Angiography
RA:28042016/CS
The internationally-acclaimed ‘Body Worlds’ exhibition also at the Hilton
Jennifer Ward-Lealand stars in Mrs Warren’s Profession
DRI OCT Triton Plus
Multi-Modal Imaging
OCT-1Triton
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swept source Extremely fast scanning speed
DRI
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Swept Source OCT now with 1050nm OCT invisible wavelengths Angiography
penetrates
Cataracts and Haemorrhages
See. Discover. Explore.
Feeder vessels in a CNV with GA
OCT Angiography image taken with a Topcon OCT Triton
Courtesy OCT of Dr. Angiography Carl Glittenberg, MD image Karl Lansteiner taken Institute with for a Topcon Retinal Research OCT and Triton Imaging
Courtesy of Dr. Carl Glittenberg, MD Karl Lansteiner Institute for Retinal Research and Imaging
The Topcon Swept Source DRI OCT-1 Triton Series 1 features a 1 micron, 1050nm light
source with a scanning speed of 100,000 A Scans/Sec., providing multi-modal fundus
imaging.The DRI OCT-1 Model Triton rapidly penetrates all ocular tissue without being obscured by
media opacity or NZ hemorrhage. ) 0508 See you DEVICE at AAO Booth (338 3732. 423)
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Color FA FAF OCT-A
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DRI OCT-1Trito
Swept Source OCT now with OC
See. Discover. Exp
Feeder vessels in a CNV with GA
Auckland plays host to NZ’s first international wine show in May
a full immersion in this sensual dining adventure
will impress you as a once in a lifetime experience.
OCT Ang
Courtesy of Dr. Carl Glittenberg, MD Karl Lans
The Topcon Swept Source DRI OCT-1 Triton Series 1
source with a scanning speed of 100,000 A Scans/
imaging.The DRI OCT-1 Model Triton rapidly penetrates all ocular tiss
media opacity or hemorrhage. See you at AAO Booth 3732.
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ONZ: Ophthalmology
with one voice
BY MOIRA MCINERNEY, ONZ EXECUTIVE DIRECTOR
The board of ONZ is delighted
to announce that we have
welcomed many new members
to the organisation over the last
four months. With 85 members,
ONZ truly represents the majority of
ophthalmologists in New Zealand.
This growth in membership is due to
two factors, a more visible profile and
a wish on behalf of ophthalmology to
speak with one voice on current affairs.
With this voice, ONZ can unite our
ophthalmologists, giving them the
tools and techniques to deal with the
many commercial issues in their field.
This initiative is never more important
than now with ophthalmologists
facing many challenges in funding in
both the private and public sectors. As
their central representative body, we
are forging relationships with providers
and advisors. We are fortunate to have
great resources on the board, but more
importantly amongst our members. Let
us not succumb to the Kiwi “she’ll be
right” attitude, evidenced elsewhere,
such as Auckland traffic and Hawke’s
Bay water, two prime examples of poor
leadership and planning.
ONZ’s role to represent
ophthalmologists and their patients’
interests can already be seen in our
lobbying of insurers for the Xen
implant, MIGs in general and Ozurdex.
We have worked within the board but
also had great engagement from Sonya
Bennett to move a plan and direction
forward, in a coordinated fashion,
for funders to come to the party on
technology for glaucoma care. Another
example, with thanks to Rebecca Stack,
is our support and facilitation of the
Clinical Leaders Forum on 27 March in
Wellington. Plus, there is our Business
Forum, ‘The Other Matters’ (see below),
which will run just after the RANZCO
NZ Branch meeting in May in Auckland.
We will be asking members to help
us coordinate our efforts over the next
few weeks by way of information and
thoughts, but also by directing general,
non-contract insurance queries to
ONZ. This will help ophthalmologists
to speak with one voice on behalf of
all our members, old and new. We
also expect to increase our presence
at meetings and via email to let
you all know we are now working
in a unified fashion to amplify the
voice of concerned New Zealand
ophthalmologists.
ONZ: The Other Matters
This year, in an attempt to ensure more
members can attend, we will hold
our ONZ Business Forum on Saturday
12 May, from 5pm to 7 pm at the
Hilton, directly following the RANZCO
NZ Branch meeting. Please join us
for this event and drinks afterwards.
Invites will be issued shortly or see our
website for information.
Finally, ONZ is helping to find
placements for the RANZCO-sponsored
ophthalmology leadership programme.
If you are interested, or know of
someone who is interested, please
email us at admin@ophthalmologynz.
co.nz.
RANZCO to run Foundation
The Royal Australian and New Zealand College of
Ophthalmologists (RANZCO) has wound up its charitable
arm, the Eye Surgeons’ Foundation (ESF) as a separate legal
entity and will run its own version, together the administration
of its research arm, the Ophthalmic Research Institute of
Australia (ORIA) in-house to save costs.
The ESF had been operating for 15 years to raise money
to support medical research and sustainable development
projects across the Asia-Pacific region. “In recent years the
pressures of an increasingly competitive charity sector
have meant that it has been difficult to build a sustainable
fundraising base to meet the costs of a standalone charitable
organisation,” said Dr David Andrews, RANZCO CEO. “It was
clear, therefore, that changes to the organisational model
were required to ensure that the support provided by ESF
fundraising could be continued.”
The ESF Board decided to wind up ESF on 30 September 2017
and made their final distribution of funds to international
development projects. To ensure the ESF legacy continues,
however, the majority of its functions are being taken in-house
where the running costs can be reduced, said Dr Andrews.
New worm found in eye
A
new
species of parasitic nematode has now been
identified in three previously healthy, relatively young
residents of Saipan, the largest island of the USmanaged
Northern Mariana Islands in the Pacific.
According to a case report published by the Marianas Eye
Institute in the American Journal of Ophthalmology, the three
patients, identified over a 20-year period, all had the same
unidentified worm in their eyes, causing corneal opacification,
conjunctival injection and uveitis.
“This is a fascinating series of cases,” said Dr David Khorram, the
co-founder and prior ophthalmologist at Marianas Eye Institute.
“When the first patient came into us in 1997 with a live worm in
their eye, we knew we were seeing something never seen before.
We weren’t sure what to do. We tried removing the worm which
didn’t work; we tried killing the worm with a laser, but it didn’t
die. Finally, with the help of Dr Stephen Gee in Hawaii, a special
technique was used to successfully extract the worm.”
The first worm was handed to a pathologist for analysis and
identification, but was lost, while the second worm to be found
(some years later) was removed, but was not intact and could
RANZCO is now looking to appoint a new “Foundation
committee”, including representatives from its indigenous and
international development committees, the ORIA Board and Save
Sight Society NZ and RANZCO fellows interested in philanthropy
and education, to run an in-house version, which can continue to
raise funds for education and research. RANZCO will be able to
accept donations from Australian members directly or from New
Zealand members through the NZ Branch, though not from the
public, except as bequests. The donations will be used to fund
early stage research through ORIA, and education programmes.
ORIA
ORIA will also be administered in-house by RANZCO following
the retirement of executive officer Anne Dunn-Snape last year,
after 15 years in the role, and a request by ORIA’s board. Unlike
the situation with ESF, ORIA remains a separate legal entity,
though much of the day-to-day administration will now be
run by RANZCO staff, again providing reduced overheads for
ORIA and maximising the benefit that can be achieved with
the available funds, explained Dr Andrews. The ORIA Board will,
however, continue to manage the research organisation and set
its direction and strategic priorities.
not be successfully analysed
or identified. The third and
final case was identified in
2008. The worm was removed
intact and sent for analysis
Intrastromal haze and poorly visible worm
inferiorly (circled)
and identification to the Armed Forces Institute of Pathology in
Washington, DC, and was found to be a completely new parasite.
The published case report describes the details of each of the
three cases, showing that each worm was an isolated finding,
with no other worms found in other parts of the body. All the
patients were young and healthy. It is not known how the
worm entered the eye, but it is speculated that it was probably
introduced through an insect bite and grew within the body,
migrating to the cornea, said Dr Khorram. “Although these are
the first three reported cases in the world, now that doctors
know that a tiny worm can live in the cornea, we are certain
that more cases will be found.”
Future clinical findings regarding this newly described
nematode are needed to further develop understanding of the
disease, he added.
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NEW ZEALAND OPTICS
15

SPECIAL FEATURE: RANZCO 2018
ANZGS 2018
Toomac Ophthalmic
Toomac Ophthalmic is proud to introduce
the latest development in MIGS, the Glaukos
iStent inject, a tiny surgical implant that can
effectively lower IOP in adult patients with
mild to moderate open-angle glaucoma.
Trabecular micro-bypass technology
developed by Glaukos has taken a leap
forward with the new titanium microbypass
stent that’s preloaded in a single-use
sterile inserter. Come and see our stand at
RANZCO NZ, where Ian and Mark together
with the Glaukos representative will be
happy to answer all your questions. Also
new for RANZCO NZ is the MALOSA singleuse
instrument range. See us for a bespoke
surgical pack.
Allergan – Xen
The latest innovation in glaucoma
management, the XEN Gel Implant, is
now available in New Zealand for patients
whose condition is not well managed with
glaucoma drops. The unique technology
is based on the same principle as
trabeculectomy, creating a new outflow
channel bypassing trabecular and scleral
resistance forming a diffuse, low-lying bleb.
As the technique becomes more familiar,
the XEN procedure can offer a less intensive
and less time-consuming alternative to
the mainstay trabeculectomy. In the APEX
clinical study, 70% of patients with XEN
achieved an IOP of ≤ 15mmHg following the
treatment with a significant reduction in
glaucoma drop use. See the Allergan stand
for more.
BY DR GRAHAM REEVES*
This was the first gathering of the group
formerly known as ANZGIG, now the
Australian and New Zealand Glaucoma
Society (ANZGS), where glaucoma subspecialists
from the region come together to meet colleagues,
discuss difficult cases and gain insights from both
local and international speakers.
This year’s conference in Sydney from 23 to 24
February commenced with presentations on a
variety of rare conditions and challenging cases
with robust discussion about different approaches.
The second session of paper presentations
included two projects introducing new technology
into patient testing. The first showed that an
iPad-based perimetry programme could deliver
similar results to a Humphrey visual field analyser.
While there are some minor technical issues to
fine tune, this is a promising development. The
second looked at use of home tonometry to detect
significant diurnal IOP variation in patients whose
clinic IOPs had been unremarkable but whose
glaucoma was progressing.
The afternoon started with a fascinating nonophthalmic
lecture by invited speaker Mr Peter
Ellerton from the University of Queenslands’
Critical Thinking Project. He delivered a thoughtprovoking
lecture on the nature of critical thinking
and deliberate practice in gaining and maintaining
skills or expertise. It highlighted the importance
of contact with our peers to challenge biases that
may influence our decision making.
This was followed by Professor John Salmon,
from Oxford University who shared his views on
‘Diagnosing glaucoma. The seven deadly sins’.
These included the mistakes of not taking a good
history, not doing gonioscopy, not using sufficient
magnification to examine the optic disc (leading
to disc haemorrhages being overlooked) and not
correlating disc changes with visual field findings.
These ‘sins’ were illustrated by cases from his
vast clinical experience and even for those seeing
glaucoma patients on a daily basis they were a
timely reminder of possible pitfalls.
Dr Shenton Chew from Auckland outlined the
campaign he was involved in to try and highlight
the burden of overdue follow-up patients and
Drs Nicholas Johnston and Sonya Bennett at ANZGS
showed how well-organised patient advocacy can
achieve tangible results.
A number of new treatment techniques were
showcased at the meeting, including Associate
Professor Paul Chew from the National University
of Singapore who discussed the increasing use
of micropulse diode laser in different clinical
situations. Another promising new technique
was the use of tissue glue in reducing the size of
dysaesthesetic trabeculectomy blebs.
Associate Professor Paul Healey from Sydney gave
the Gillies lecture titled ‘100 years of progress in
glaucoma’. This highlighted three paradigm shifts
that have occurred over this time. The first was the
move from using IOP as a defining feature to a risk
factor in glaucoma. The second was to understand
the chronic nature of glaucoma so that when we
assess patients with glaucoma we are considering
both the current state (determining how it may
be affecting quality of life) and also the rate of
progression (how the patient is likely to be affected
in the future). Lastly, he presented data showing
low rates of glaucoma medication adherence in
Australia. This showed the importance of patient
education and participation in treatment decisions
given that for many patients their only symptoms
are from the treatments we prescribe.
Professor Salmons’ final talk detailed the seven
Drs Jesse Gale and Graham Reeves at ANZGS
types of challenging patients who require glaucoma
surgery. Most in the audience could think of patients
who fell into at least one of these categories.
These included “the patient who has researched
the options on the internet”, “the patient at risk of
visual loss from the surgery” and the “the patient no
one else will do”.
The final session covered minimally-invasive
glaucoma surgery (MIGS) with a collection of
experts sharing their experience with different
devices including the iStent inject and the Cypass
supraciliary stent and offering advice on patient
selection and technical tips. Associate Professor
Michael Coote from Melbourne gave a salient talk
about the costs involved with adding these new
techniques to our armamentarium, both in terms
of the financial costs and the risk of losing skills
needed for traditional glaucoma surgery.
Overall this was a very interesting meeting and
I look forward to next year when it will be timed
to coincide
with the World
Glaucoma
Congress in
Melbourne.
*Dr Graham Reeves is a glaucoma subspecialist practicing at
Manukau Superclinic and the Eye Institute.
Rethink glaucoma management
The power of simplicity 1
Reference: 1. Allergan XEN directions for use.
The XEN ® Gel Implant is intended to reduce intraocular pressure in patients with primary open angle glaucoma where previous medical treatments have failed.
Always refer to full instructions before use. Adverse events should be reported to your local Allergan office, Australia 1800 252 224 or New Zealand 0800 659 912.
XEN ® is a registered trademark of AqueSys, Inc., an Allergan affiliate. Trademark of Allergan, Inc. ©2017 Allergan. All rights reserved. Allergan Australia Pty Ltd, 810 Pacific Highway,
Gordon NSW 2072. ABN 85 000 612 831. Allergan New Zealand Limited, Auckland. NZBN 9429 0321 20141. ANZ/0016/2017e. DA1731CB. Date of Preparation: October 2017.
16 NEW ZEALAND OPTICS April 2018

ANZCS 2018
BY DR JENNIFER COURT*
This year’s annual Australia and New Zealand Cornea Society
(ANZCS) meeting was held in Sydney in February and was
organised by Drs Con Petsoglou, Noni Lewis and Chameen
Samarawickrama and Jane Treloggen from the NSW Tissue Bank.
The well attended meeting, originally developed by Professor
Douglas Coster in the 1980s, is now in its 35th year. The venue for this
year’s gathering was the InterContinental Hotel, set back from the
bustling Circular Quay which had been wonderfully decorated for the
‘Year of the Dog’ Chinese New Year Festival.
In the first session, entitled ’Cutting Edge’, invited guest speaker
Associate Professor Jod Metha of the Singapore National Eye Centre
kicked off proceedings with an interesting talk on developing nonsurgical
therapies for TGFBI (transforming growth factor beta-induced
gene) dystrophies by identifying peptide targets to reduce corneal
opacity formation. Dr Greg Moloney then described his experiences
introducing a successful keratoprosthesis service in Sydney, using the
osteo-odonto keratoprosthesis (OOKP) technique, with his colleague
and friend Dr Shannon Webber who provides maxillofacial expertise.
Professor Gerard Sutton from the Save Sight Institute introduced
the iFix pen and iFix bio-ink, which was the winner of the inaugural
‘Big Idea’ research funding challenge last year. His 3D-printed
technology promises the exciting prospect of a biocompatible
transparent ‘ink’ delivered by a handheld device that actually
facilitates cell proliferation and thus ulcer repair.
Dr Petsoglou and microbiologist Professor Wieland Meyer provided
a detailed account of the recent ‘therapeutic goods recall’ by the
Lions NSW Eye Bank following an apparent cluster of cases of candida
endophthalmitis in DSAEK cases with pre-cut tissue. The honest and
detailed account of the course of events and thorough investigation
provided reassurance to surgeons of the quality and safety of service
strived for.
The annual report from the Australian Corneal Graft Registry was
received with interest, as usual. The number of DMEK cases continues
to rise with good visual outcomes, but reduced survival compared
with penetrating keratoplasty and Descemet’s stripping endothelial
keratoplasty (DSEK) in-keeping with results from around the world.
But the numbers remain small and the follow-up short for now.
Professor Stephanie Watson presented the Keratitis Antimicrobial
Resistance Surveillance Program (KARSP) update. Resistance remains
low and is stable; others were encouraged to join the programme.
The first day concluded with a debate on whether femtosecondassisted
pterygium surgery was a ‘welcome application of new
knowledge’ (W.A.N.K.) or not. The fiercely argued cases for and
against reflected the scientific but still humorous tone of the
meeting! For now, at least, the audience was not swayed towards the
femtosecond technique.
The relaxed and informal meeting dinner, hosted in The Pavilion in
the Royal Botanical Gardens, was a welcome opportunity to catch up
with colleagues and meet new friends, and was very well attended.
It was a particularly pleasure to chat to invited guest speaker Dr Mike
Straiko, from the Devers Eye Institute in Portland, Oregan, prior to his
informative and instructive talk which began the DMEK session on
Saturday morning. His presentation was full of videos and pearls of
wisdom for those starting out with this often tricky to master technique
for replacing Descemet’s membrane and the corneal endothelium with
a true anatomical likeness. The significantly lower rejection risk of DMEK
versus DSEK and PK and the improved quality of vision remains the
significant attraction for mastering this technique. There were more tips
to come the following day too, for those attending the Sydney DMEK
course, organised by Dr Moloney, where Dr Straiko was joined by A/Prof
Mehta and Drs John Males and Andrew Apel.
Later on the Saturday, Professor Minas Coroneo presented cases of
ocular surface squamous neoplasia (OSSN) treated medically with
retinoic acid and interferon, and topical cidofovir for refractory cases,
with very promising success.
This year’s Blandford Lecture was given by Professor Gordon Wallace
of the University of Wollongong who provided a fascinating look at
3D bio-printing and its exciting potential applications in medicine
and ophthalmology.
The next session
focused on crosslinking
with talks
covering the use of a
soft contact lens to
allow treatment of thin
corneas; iontophoresis;
combining the treatment
with intra-stromal
corneal ring segments in
anisometropic patients
from asymmetric disease
with clear corneas; and
Professors Gordon Wallace and Charles McGhee
the effective treatment of
children. Attention was
drawn to the potential for rapid progression in children with need for
close monitoring. The Doug Coster lecture titled ‘Corneal endothelial
cell engineering – it’s not just culture’ was given by A/Prof Mehta.
The afternoon then split into concurrent sessions on eye banking
and ‘News from the lab’ focusing on dry eye, which included
Auckland’s own Associate Professor Jennifer Craig as one of the
speakers. Topics discussed in this session included how a poor blink
can lead to ‘drop-out’ and atrophy of the meibomian glands and
how blink exercises can be helpful; how intense pulsed light (IPL)
can restore meibomian gland function with an accumulative effect;
and how the cholesterol-lowering agent, atorvastatin, is being
investigated as a novel treatment for evaporative dry eye.
Dr Tom Cuneen then shared how patients with Stevens Johnson
Syndrome, the rare blistering skin reaction that can devastate the
LEAVE A LEGACY
OF VISUAL FREEDOM.
Professors Laurie Hirst and Minas Coroneo, A/Prof Jod Mehta and Dr Jacqueline Beltz who led the
femtosecond laser-assisted pterygium debate
ocular surface, can benefit from early amniotic membrane transplant.
He described his effective surgical technique that can be performed
outside the operating theatre, if necessary.
The conference then ended with an interesting interactive complex
case presentation and video session.
Overall the meeting provided open, in-depth discussion with
informative and entertaining speakers in a friendly and informal
manner. There is a lot of exciting research in the field of cornea and
I, for one, am looking forward to seeing where bio-printing, corneal
endothelial regeneration and novel treatments for previous ‘surgical’
diseases will take us next.
*Dr Jennifer Court is a senior corneal fellow at the Department of Ophthalmology at
the University of Auckland
OptiMed
Optopol REVO NX, the world’s fastest OCT will be on display
at RANZCO NZ 2018. Come and visit the OptiMed NZ booth
to view our latest technology. Be sure to check out the
Eidon Ultra-Wide Field Confocal Scanner for high-resolution
fundus imaging as well as other innovations and diagnostic
equipment. OptiMed NZ will have product specialists available
to answer all your queries. Robert, Craig and Richard invite you
to come and discuss your interests, have a chat or just “hang
out”.
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diagnosis and treatment planning. Visit us at this year’s
RANZCO NZ branch meeting to find out more about the latest
technology from Optos. See ad on p10 for more details.
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AMO Australia Pty. Limited. Level 3, 299 Lane Cove Road, Macquarie Park, NSW 2113. AMO Australia Pty. Limited (Incorporated in Australia) PO Box 401, Shortland Street, Auckland, 1140.
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April 2018
NEW ZEALAND OPTICS
14/3/17 10:00 am
17

SPECIAL FEATURE: RANZCO 2018
Calling all Kiwi doctors to AUSCRS 2018
BY DR DAVID KENT*
This year’s annual meeting of the Australasian Society of Cataract
and Refractive Surgeons (AUSCRS) will be held at Macquarie
Conference Centre, Peppers (previously known as the Outrigger),
Noosa from Wednesday 17 October to Saturday 20 October.
Since its beginnings in 1996, AUSCRS has been the only local
Australian and New Zealand annual meeting devoted to cataract and
refractive surgery. Despite this, it remains poorly attended by New
Zealand ophthalmologists many of whom are refractive surgeons
and almost all of us are cataract surgeons. I’d like to encourage
more attendance at our local meeting by New Zealand-based
ophthalmologists many of whom would find this a useful and very
enjoyable meeting to attend.
AUSCRS is a much less formal meeting than either the American or
European cataract and refractive surgery meetings. Dress has always
been casual with no jackets, suits or ties and the meeting has always
intentionally been held at “resort” destinations in Australia and New
Zealand, making it very “family friendly” to attend. The relaxed and
friendly atmosphere, is also more than complemented by the high
calibre of speakers drawn from across the world and locally.
There’s lots of discussion and debate, and plenty of opportunity to
freely discuss topics with both internationally-renowned and local
experts, truly unrivalled by similar meetings. Another annual AUSCRS
highlight and tradition is the imaginative themes and formats of
the sessions, with local and international speakers often dressing
up in entertaining costumes, sometimes bordering on the bizarre.
It has been very entertaining over the years to see world-renowned
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Drs Dean Corbett, Peter Ring, Michael Merrimen and David Kent demonstrating the more relaxed
attire favoured at AUSCRS at the 2015 conference in Noosa
ophthalmologists dressed up in amusing costumes debating often
quite controversial topics.
Some New Zealand ophthalmologists appear to be put off
attending AUSCRS because of a perception the meeting is largely for
refractive surgeons. This has never been the case and most of the
meeting remains primarily concentrated on advances in cataract
surgery. So any New Zealand ophthalmologist who performs cataract
surgery would also find AUSCRS a very useful meeting to attend.
Another unique part of AUSCRS is the advanced trainee session on the
Wednesday morning where some of the leading Australasian cataract
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Noosa, venue for AUSCRS 2018
and refractive surgeons present a series of educational lectures and
interactive sessions for senior registrars and fellows. Feedback from
registrars has always been very positive for this programme.
The conference-proper starts with an opening street party on
Wednesday evening, then there are three days of academic sessions on
Thursday, Friday and Saturday with the Gold Medal Lecture on Thursday
morning. The meeting finishes with the AUSCRS Gala Event on Saturday
night, leaving Sunday for delegates to sight-see and travel home.
The overseas speakers are yet to be announced for this year’s
AUSCRS, but usually include some of the world’s leading cataract and
refractive surgeons. Professor Graham Barrett continues to preside
over AUSCRS and there really isn’t anyone better in Australasia with
the experience and academic mana to be the leader of our local
cataract and refractive surgery meeting.
I believe most New Zealand ophthalmologists should consider
attending AUSCRS as they will truly enjoy it and find the calibre of
education second-to-none. We should also all be supporting this
‘local’ meeting to keep it sustainable in the long term. So, I hope
you’ll join me at AUSCRS 2018 in Noosa this October.
For more: please visit http://www.auscrs2018.org.au/
*Dr David Kent is a consultant ophthalmologist with Fendalton Eye Clinic and
Christchurch Eye Hospital. He has co-authored many papers and presented at many
international meetings on laser refractive surgery. He is a member of both the
American and Australasian Societies of Cataract and Refractive Surgery, and the New
Zealand AUSCRS council representative.
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Dr Jacqui Beltz overseeing new VR training at RVEEH
The Royal Victorian Eye and Ear Hospital (RVEEH) has introduced
state-of-the-art virtual reality simulators to train the next
generation of eye surgeons.
The RVEEH’s new Eyesi Surgical simulators allow ophthalmology
trainees to learn highly specialised micro-surgery skills in a safe
and controlled environment, and the trainer to objectively monitor
and track an individual’s progress, said Dr Jacqueline Beltz, RVEEH
ophthalmologist and training director for the Victorian Branch of
RANZCO. “Practice is vital to learn any skill and microsurgery is no
exception. Virtual reality simulation provides a setting that forgives
failure, and allows trainees to develop fine motor skills as well as
learn from their errors without causing harm.”
Studies have shown that patient outcomes are improved when
trainees have undertaken virtual reality training. Virtual reality
simulation training will be used alongside traditional training
methods, including wet and dry labs, to increase the breadth of
surgical training for young ophthalmologists, said Dr Beltz. “With the
data that is collected, we can track each individual trainee’s progress,
identifying and addressing any gaps that may require extra practice
or additional teaching. We can also compare trainees’ progress both
locally and globally, so we can evaluate and improve our training
programme.”
The first stage of RVEEH’s virtual reality training programme will
focus on preparing first year trainees for cataract surgery. Future
programmes will include training for vitreoretinal surgery and
complication management. ▀
18 NEW ZEALAND OPTICS April 2018

Case study: Mycobacterium chelonae keratitis
following cataract surgery
BY DR LUCY LU, DR JENNIFER COURT AND
PROFESSOR CHARLES MCGHEE*
Here we present a rare case of postcataract
surgery and corneal wound
infection caused by the non-tuberculous
mycobacterium species Mycobacterium chelonae.
This case illustrates the difficulties in diagnosis and
treatment of this uncommon condition to increase
awareness of this potentially devastating infection
among optometrists and ophthalmologists.
Case history
A usually fit and well, 85-year-old, New Zealand
European female presented with redness, pain and
reduced vision in her left eye, eight weeks after
routine, uncomplicated, cataract phacoemulsification
with intraocular lens implantation.
Visual acuity OS at presentation was reduced
to 6/30 unaided, 6/15 with pinhole (previously
6/7.5 corrected post-op). The left cornea had a
1.0 x 2.8mm stromal infiltrate in the temporal
clear corneal wound site, without an overlying
epithelial defect. The anterior chamber exhibited
2+ cells but no hypopyon. The vitreous was quiet
and the fundus examination was normal. She was
admitted to hospital and treated with intensive
topical antibiotic drops (hourly cefuroxime 5%
and tobramycin 1.36%). However, the intraocular
inflammation worsened so she underwent anterior
chamber washout, vitrectomy and administration
of intravitreal antibiotics (ceftazidime and
vancomycin). Oral doxycycline, ciprofloxacin and
prednisone were added. Surprisingly, aqueous
and vitreous samples were entirely negative for
bacterial and fungal culture as well as for viral PCR.
After slow improvement, she was discharged on
day 16 on topical ciprofloxacin and prednisolone 1%.
She was monitored closely as an outpatient and the
infection waxed and waned over the subsequent
two months (Figs 1 and 2). A large corneal biopsy
also failed to identify any causative organism.
Therefore, after 13 weeks of treatment, ciprofloxacin
was cautiously tapered and stopped, however, the
infection recurred with greater severity with an
overlying corneal melt and the prospect of corneal
perforation. Subsequently, a superficial keratectomy,
accompanied by a focal, partial-thickness, tectonic
corneal graft (5mm), was performed to excise the
majority of the lesion, approximately four months
after initial presentation.
Two weeks later, white flecks were noted in the
graft-host-interface (Fig 3) and a rapidly growing
mycobacterium species, Mycobacterium chelonae
was also isolated from the superficial keratectomy.
This isolate was notably resistant to ciprofloxacin
and doxycycline, but sensitive to clarithromycin,
tobramycin and linezolid on standard MIC (mean
inhibitory concentration) testing. Therefore,
intensive topical tobramycin and linezolid were
started, and topical prednisolone withheld.
Despite intensive, appropriate, dual-antibiotic
topical treatment the inflammation increased and
the overlying graft became oedematous and opaque
(Figs 4a and 4b). Consequently, the lamellar graft
was removed to reduce the infective load and allow
better drug penetration to the underlying host
cornea. After an extended two-month course of
treatment, the infection gradually settled, almost 10
months after her initial cataract surgery (Fig 5). Her
vision at this stage was 6/15 unaided, 6/9 pinhole
and her eye was comfortable. She is expected to
continue on low dose topical antibiotics, under close
monitoring, for up to a year.
Discussion
Non-tuberculous mycobacteria (NTM) refers to a
group of Mycobacterium species other than the
Mycobacterium tuberculosis complex. NTM exist
ubiquitously in the environment including in soil
and drinking water. They are rare causes of systemic
and ocular infections, particularly related to trauma
and surgery 1 . The Mycobacterium chelonae species is
an insidious yet aggressive pathogen that has been
reported as a devastating cause of post-LASIK and
post-cataract surgery keratitis and endophthalmitis 2-6 .
There are several cases of Mycobacterium chelonae
keratitis after clear cornea cataract surgery reported
in the literature, many requiring significant
intervention such as corneal transplant, but typically
with poor visual outcomes 4-6 .
Known risk factors for developing mycobacterial
keratitis include trauma, ocular surgery, poor tear film
integrity, inappropriate use of topical corticosteroids
and contact lens use 4 . Systemic conditions such as
diabetes mellitus or immunosuppression increase the
susceptibility to infection. Our patient did not have
any of these risk factors, other than routine postoperative
steroid drops.
Fig 1. Recurrence of dense stromal infiltrate at the temporal clear
corneal wound with keratic precipitates, two weeks after discharge from
hospital, while on treatment with topical ciprofloxacin
Fig 4a. Progessive infection with development of interface fluid affecting the
temporal, lamellar tectonic corneal graft with loosening of sutures (6 weeks
post-op)
Fig 5. After two months of continuous topical Linezolid and Tobramycin,
the base of the previous patch graft site had epithelialised and was
clinically free of infection
Post-operative Mycobacterium chelonae keratitis
has an insidious onset, with variable time between
surgery and onset of symptoms, from days to
months. The affected cornea may exhibit a “cracked
windshield” appearance around the edges of a
stromal infiltrate, often without an overlying
epithelial defect. Infiltrates may have irregular
margins or stellate lesions, mimicking a fungal
keratitis 1 .
NTM infections are particularly dangerous
because most routinely used topical antibiotics
are ineffective against them, and antibiotic
resistance is a significant issue 7 . A review of
in vitro microbiological susceptibilities of
NTM showed the following susceptibilities:
clarithromycin (93%), amikacin (81%), linezolid
(36%), moxifloxacin (21%), and ciprofloxacin
(10%). In the M. abscessus/chelonae subgroup,
only 1% were susceptible to ciprofloxacin 8 . In
addition, Mycobacterium chelonae can be difficult
to culture, with fastidious growth requirements,
which increases the risk of false negative reports
and delayed diagnosis as in this case 7 .
Mycobacteria keratitis requires aggressive
treatment, ideally with multiple fortified topical
antibiotics with consideration of systemic cover
(such as oral clarithromycin) if severe 7, 8 . An
extended treatment course is required.
As illustrated in the presented case,
Mycobacterium chelonae keratitis can take a
prolonged, waxing and waning course that
may falsely reassure the clinician of impending
resolution. Negative corneal scrapes in a nonresponding
infection warrants surgical biopsy to
enable correct diagnosis and prevent complications,
such as infective scleritis or endophthalmitis.
Surgical debridement of infected tissue may reduce
the bacterial load and also improve antibiotic
penetration into deep stroma, where organisms
may have been seeded into a surgical wound.
While mycobacterial ocular infection is rare, it
must be kept in mind by all ophthalmic health
providers when evaluating any atypical post-laser
or post-surgical infection. NTM are a particular
diagnostic and treatment challenge compared
to other microbes due to delays in pathogen
identification, multiple antibiotic resistances and
a higher likelihood to require surgical intervention.
Therefore, maintaining a high level of suspicion
in unusual cases, obtaining early, accurate
microbial diagnosis, with aggressive and extended
antimicrobial treatment and early surgical
intervention are key to minimising morbidity and
maximizing visual outcome. ▀
Fig 2. Apparent early control of keratitis after three months of treatment.
Note the quiescent eye but suspicious white deposits in stroma.
Ciprofloxacin was stopped at this stage
Fig 4b. Anterior segment optical coherence tomography (AS-OCT) image through infected graft, demonstrating fluid in the graft-host interface
References
1. Kheir WJ, Sheheitli H, Abdul Fattah M, Hamam RN.
Nontuberculous mycobacterial ocular infections: A Systematic
Review of the Literature. Biomed Res Int. 2015;2015:164989.
2. Freitas D, Alvarenga L, Sampaio J, Mannis M, Sato E, Sousa L, et
al. An outbreak of Mycobacterium chelonae infection after LASIK.
Ophthalmology. 2003 Feb;110(2):276-85.
3. John T1, Velotta E. Nontuberculous (atypical) mycobacterial
keratitis after LASIK: current status and clinical implications.
Cornea. 2005 Apr;24(3):245-55.
4. Martinez JD, Amescua G, Lozano-Cárdenas J, Suh LH. Bilateral
Mycobacterium chelonae keratitis after phacoemulsification
cataract surgery. Case Rep Ophthalmol Med. 2017;2017:6413160.
5. Servat JJ, Ramos-Esteban JC, Tauber S, Bia FJ. Mycobacterium
chelonae-Mycobacterium abscessus complex clear corneal
wound infection with recurrent hypopyon and perforation after
phacoemulsification and intraocular lens implantation. J Cataract
Refract Surg. 2005 Jul;31(7):1448-51.
6. Ramaswamy AA, Biswas J, Bhaskar V, Gopal L, Rajagopal
Coming
soon
Fig 3. Appearance of the (5mm) temporal, lamellar tectonic corneal graft
post-op, day 19, demonstrating white interface specks on retro-illumination,
heralding the return of infection
R, Madhavan HN. Postoperative Mycobacterium chelonae
endophthalmitis after extracapsular cataract extraction and
posterior chamber intraocular lens implantation. Ophthalmology.
2000 Jul;107(7):1283-6.
7. De la Cruz J, Behlau I, Pineda R. Atypical mycobacteria keratitis
after laser in situ keratomileusis unresponsive to fourthgeneration
fluoroquinolone therapy. J Cataract Refract Surg. 2007
Jul;33(7):1318-21.
8. Girgis DO, Karp CL, Miller D. Ocular infections caused by
non-tuberculous mycobacteria: update on epidemiology and
management. Clin Exp Ophthalmol. 2012 Jul;40(5):467-75.
*Dr Lucy Lu (pictured) is a clinical research
fellow and Dr Jennifer Court is a senior
corneal fellow with the Department of
Ophthalmology at Auckland University.
Professor Charles McGhee is department
head, a consultant ophthalmologist and
chair of RANZCO’s Cornea Society
iStent inject is intended to provide safe and effective
IOP reduction by addressing OAG at the primary
site of resistance to outflow
iStent inject:
• Re-establishes physiological outflow to significantly decrease IOP
• Reduces or eliminates drug burden
• Indicated with and without cataract surgery
• Developed by Glaukos Corporation, the corporate founder
of Micro-Invasive Glaucoma Surgery (MIGS)
Toomac
Ophthalmic
DIVISION OF TOOMAC HOLDINGS LTD
32D Poland Road, Wairau Valley, Auckland
Tel: 0508 443 534 Email: mark@toomac.co.nz
©2018 Glaukos Corporation. Glaukos and iStent inject
are registered trademarks of Glaukos Corporation.
GL33071 Glaukos iStent Inject QtrPage Adv.indd 1
March 2018
16/3/18 10:28 am
NEW ZEALAND OPTICS
19

Summer Students Symposium 2018
The ninth joint Auckland University Department of
Ophthalmology and School of Optometry and Vision
Science Summer Student Symposium in March
was an upbeat affair. Amusingly chaired by Professor
Trevor Sherwin, 17 students from across the departments
presented projects and findings from their 10-week
studies in rapid, strictly-timed, four-minute sessions.
The presentations crossed the gamut of eye disorders
and concerns from glaucoma and aging to dry eye and
drug delivery mechanisms, each attracting a number
of questions and sparking discussion among the
70-strong audience.
School of Medicine head, Professor Alan Merry, and
Associate Dean (research) Professor Andrew Shelling
from the University’s Faculty of Medical and Health
Sciences had the tough job of selecting the best
presentations on the night. “It’s a challenge to present
in four minutes and the standard this evening was
uniformly very high,” said Prof Merry.
The following is summary of the presentations:
• Spheres of Influence, Catherine Tian (Tom Cat Trust)
– 1st prize
• Influence of high glucose and inflammation on
barrier properties of retinal pigment epithelial (ARPE)
cells, Charisse Kuo – 2nd prize
• Differentiation of transition zone stem cells into
corneal endothelial cells, Hannah Ng (Eye Institute) –
3rd prize
• Comparison and review of visual field referrals to
ADHB glaucoma clinic, Catherine Kwak
• Crystallin protein modification and spatial mapping
in an aging lens model, Jerry Shen
• Evaluating the long-term usability of ex-vivo
bovine corneas for drug delivery applications, Darshan
Shrestha (Buchanan Charitable Foundation)
• The effect of erythropoietin on the vasculature of
the premature sheep retina: a cellular and molecular
characterisation, Muthana Noori
• Nailfold capillary abnormalities in glaucoma, Hilary
Goh (Gordon Sanderson Scholarship from Glaucoma
New Zealand, see full story p3)
• Review of glaucoma referrals to ADHB glaucoma
clinic, Tess McCaffrey
• Confirmation of UV filter distribution in the
aging human lens, Arwa Ibrahim (Molecular Vision
Laboratory)
• To give or not to give? Should I provide feedback
during acuity measurement, Maggie Xu
• Monitoring age-related changes of the vitreous of
the eye using MRI, Louisa Howse
• Evaluating the utility of an eyelid massage device
for the management of meibomian gland dysfunction,
Jasmine Feng (NZAO Education and Research Fund)
• Effect of temperature on the thickness of the
human ocular choroid measured with optical coherence
tomography, Sungyeon Kim
• The effect of virtual reality on the tear film and
ocular surface, Joyce Wong
• Adaptation of jumping spider behaviour to a
modified focal environment, Aimee Aitken (Paul Dunlop
Memorial Research Scholarship, NZAO)
• Visual impairment in stroke in a New Zealand
context: patient characteristics in the CBR Stroke
Recovery Clinic, Carla Fasher ▀
The 2017-2018 Summer students
Sam Simkin, Chelsea Wood and Dr Hannah Kersten
Safal Khanal, Soheil Mohammadpour and Lily Chang
PHOTO BY TREVE DROMGOOL
Prof Trevor Sherwin, Salim Ismail, Catherine Tian and Jason Xu Jane McGhee, Dr Rachel Barnes and A/Prof Bruce Hadden Dr Andrew Collins, Joanna Black, Monica Acosta and A/Prof Sam Schwarzkopf
BOOK REVIEW
The Neuro-Ophthalmology Survival Guide,
second edition
By Anthony Pane, Neil R. Miller and Mike Burdon
REVIEWED BY DR STEPHEN BEST*
I was delighted to be invited by the NZ Optics’
editorial team to review this book as I had not
taken the opportunity to read the previous
edition, although I had heard many references
to it from colleagues both here, in New Zealand,
and in Australia, where the principle author, Dr
Anthony Pane is based.
I have listened to Anthony’s presentations over
the years and appreciate his directness about
the potential pitfalls (sometimes known as
medico-legal watch cases) of neuro-ophthalmic
conditions that might have irreversible sightthreatening
sequelae or be life-threatening
emergencies seen in routine ophthalmic clinics,
but potentially under-diagnosed! Additionally,
I have spent time with, and greatly respect, Drs
Neil Miller and Michael Burdon, so anticipated
this small text book would be a good read and
live up to expectations!
I was not disappointed; especially after reading
the first chapter ‘Staying out of trouble’ which
lists 20 neuro “rules” to keep you out of strife.
Each rule is illustrated with a case example and
cross-referenced to the expanded discussion
on that topic in subsequent chapters. This
chapter alone should pique interest about
common neuro-ophthalmic conditions and,
as stated in the introduction, you can’t avoid
neuro-ophthalmology – neuro-ophthalmology is
special, you want your patients to see well, you
want your patients to stay healthy, you want to
stay out of trouble, you want to pass your exam
(if you still have it ahead of you).
This is a short text book designed to be of
everyday practical use for ophthalmologists,
trainees, optometrists and neurologists, based
on clinical symptoms, examination checklists,
management flowcharts and referral guidelines.
There are 12 chapters (340 pages) that cover
blurred vision or field loss, swollen disc(s), double
vision, unequal pupils and unexplained eye pain,
orbital pain or headaches.
The final chapter outlines
neurophthalmic history
and examination, with
particular reference to giant
cell arteritis and an excellent table 13.1 titled
‘Localizing value of visual field defects’. This last
chapter, in my opinion, should be a must read
for all ophthalmic trainees not only to reinforce
sound clinical practice but also to help with
challenging formal examinations.
The chapter on ‘Double vision’ is a wonderful
synthesis of an extremely complex topic, but
presented in an easily understandable and
clinically significant format. While the discussion
on cranial mono-neuropathies and localising
value flowcharts should guide clinicians to
appropriate investigations in particular third
nerve disease processes that might have very
serious consequences!
One of my favourite chapters, however, dealt
with ‘Seeing things’. Patients may see things
because of eye, optic nerve or brain disease and
unusual visual symptoms need to be explained.
Visual illusions and hallucinations are explained
with excellent cartoons and flow charts, and
Anthony reminds the reader that if the patient
presents with visual phenomena that are not
consistent with visible intraocular disease
processes then referral to a neuro-ophthalmologist
or a neurologist is appropriate with neuro-imaging
to check for serious brain disease.
This is a great book to have close to your
consulting room and, as with many modern texts,
when you purchase the second edition it comes
with an eBook version which is downloadable to
your electronic screen ensuring great portability
and a fantastic set of clinical videos.
*Dr Stephen Best is a consultant ophthalmologist, with
sub-specialities in glaucoma and neuro-ophthalmology, with
Auckland Eye and the Greenlane Clinical Centre.
20 NEW ZEALAND OPTICS April 2018

NZ hosts the world of retina
BY DR HANNAH KERSTEN*
The biennial Retina International World Congress was held
for the first time in Auckland on the 10 and 11 February.
With recent host cities including Taipei and Paris, Auckland
had a lot to live up to!
The Retina International Congress is a unique meeting,
bringing together the world’s foremost retinal scientists and
clinicians, patients and their families, health professionals and
patient advocates. The scientific programme, organised by local
retina specialist Associate Professor Andrea Vincent, boasted an
incredible line-up of 11 international speakers as well as many
local and national presenters. The speakers and delegates were
joined by a large group of volunteers, from the Blind Foundation
and the University of Auckland, to assist the many low-vision or
blind delegates.
Speaking to such a diverse audience was always going to be a
difficult task, but the speakers more than rose to the challenge.
The scientific programme was opened by Professor Elise Héon,
from the University and Hospital for Sick Kids in Toronto, who
gave a brilliant clinical overview of inherited retinal disease,
putting into context much of what was going to be discussed at
the meeting. This was followed by a presentation by Professor
Eric Pierce, from Harvard Medical School, summarising the
genetic causality of inherited retinal diseases and current
therapeutic approaches for treating these conditions. Both
opening speakers spoke of the difficulties associated with the
current inherited retinal disease nomenclature; many disease
names (for example, retinitis pigmentosa) cover a range of
genetic mutations and phenotypes.
The second session of the day covered the somewhat daunting
topic of Genetics and Gene Therapy. A/Prof Andrea Vincent,
outlined the clinical findings that can provide clues to the genetic
diagnosis in inherited retinal disease, while Associate Professor
Alex Hewitt (Tasmania) provided an overview of the advances
in genetic testing for retinal disease. He included a memorable
analogy, where each DNA nucleotide was a matchstick,
explaining how changes in the ‘matchstick’ configuration
can lead to genetic disease. Professor Jean Bennett, from the
University of Pennsylvania, then took to the stage to discuss the
enormous amount of work that goes into conducting a clinical
trial, and the phenomenal costs involved (up to US$1.8 billion if
conducted by a pharmaceutical company!).
In the afternoon, the meeting broke off into two parallel
sessions, ‘Retinal degenerations’ and ‘AMD and other
maculopathies’. I attended the AMD session and one of the
highlights was Professor Mark Gillies from Sydney discussing
the Australian Fight Retinal Blindness project and the role of big
data. He emphasised the importance of natural history disease
studies – by understanding the course of disease in individuals,
we are able to gather information that cannot be acquired
through clinical trials alone.
In this session, we also heard from a number of local speakers;
Drs Narme Deva, Rachel Barnes, David Squirell and Dianne
Sharp covered a range of topics including advances in treating
age-related macular degeneration (AMD) and diabetic eye
disease, and the latest in retinal imaging for AMD.
Claire Fitzgerald, Gary Williamson and Margaret McLeod from the Blind Foundation with
volunteer Nancy and Martine Able-Willamson
Diego Sonderegger, Drs David Squirrell, Graham Wilson and Angus Hatfield-Smith
Part III Optom students and volunteers Linda Zhou, Lusi Yu, Joyce Wong and Kate Lee
Speakers Dr Daniel Chung, Prof Elise Héon, A/Prof Andrea Vincent and Dr Thomas
Edwards
Blind Foundation’s Sue Emirali and Gail Mann (third left) with Jenny and Kyle Dobson
The final session of the day included presentations by Associate
Professors Alice Pébay, from Melbourne, and Alex Hewitt on using
stem cells to model eye disease, and CRISPR gene editing in retinal
disease. A/Prof Hewitt explained that although the possibilities for
CRISPR gene editing in humans are vast and exciting, it could be
many years before they are used in patients with retinal diseases.
Dr Kent Small then spoke about his work in North Carolina Macular
Dystrophy with patients from across the world.
The interesting topics continued on day two of the
programme, with ‘Scientific Breaking News’. Professor Bennett,
who conducted the first gene therapy treatment trial for
patients with inherited retinal disease, spoke about the recent
FDA approval of Luxturna (or voretigene neparvovec-rzyl to use
its proper name) for the treatment of patients with mutations
in the RPE65 gene. Professor Pierce gave an update on the
ReNeuron clinical trial of human retinal progenitor cells for
patients with advanced retinitis pigmentosa. Dr Sharp discussed
treatment difficulties in patients with polypoidal choroidopathy
and retinal angiomatous proliferation. Professor Gillies gave an
overview of AMD clinical trial results, including brolucizumab
as a potentially longer-lasting treatment for neovascular AMD
and lampalizumab, trialled for the treatment of geographic
atrophy. Finally, Dr Tom Edwards from Melbourne, gave an
overview of the safety and efficacy of a robot-assisted retinal
surgery system. The robot is able to make very fine movements,
particularly important in patients with fragile retinas (including
patients with inherited retinal disease). In the video, ‘Robot
vs. Surgeon’, the robot was much steadier, with slower, more
deliberate movements.
The futuristic theme continued, with a session on artificial
vision. Dr Edwards discussed the first attempt at artificial vision
(back in 1968!) and the considerable progress that has been
made since then. Artificial vision requires an intact inner retina,
so retinitis pigmentosa is often a good target. Dr Penny Allen
from the Royal Victorian Eye and Ear Hospital, talked about
Bionic Vision Australia’s suprachoroidal retinal prosthesis, and
presented the results of a prototype clinical trial, where all
three patients showed improvement in navigational ability
following the surgery. Dr Thiran Jayasundera, a New Zealandtrained
retinal specialist now working in the USA, was the first
to implant the Argus II over a decade ago. Today, there have
now been over 350 Argus II implant surgeries. He discussed the
Argus II’s surgical procedure and clinical journey. Because the
implant only provides very basic vision, pre-operative vision
needs to be light perception or worse, he said.
The afternoon was again split into parallel sessions, with
separate sessions for patients and professionals. I chaired one of
the patient sessions, which included an illuminating presentation
by ophthalmic nurses Sandy Grant and Olga Brocher on the
services offered by the Auckland District Health Board’s low
vision clinics. Blindness consultant Jonathan Mosen, blind since
birth, talked about why it is the best time in history to be a blind
person. Technology was also the focus of the Blind Foundation’s
adaptive technology trainer Matthew Rudland, who turned our
attention to the Seeing AI app for those with visual impairment,
while the Blind Foundation’s Sandra Budd detailed some of the
Foundation’s services.
Following the parallel sessions, Professor Gerald Chader from
the Doheny Institute in the USA, gave the closing keynote
presentation, summarising the decades of laboratory and
clinical work that have led to clinical trials and better outcomes
for patients with retinal disease.
Feedback about the conference was positive, with attendees
commenting on the high quality of the speakers and the fantastic
networking opportunities available. The next Retina International
World Congress will be held in Reykjavik, Iceland, in 2020; the
perfect excuse to organise a trip to the Northern Hemisphere. ▀
*Dr Hannah Kersten is a lecturer in the School of Optometry and Vision Science at
the University of Auckland and a member of the local organising committee for the
2018 Retina International World Congress.
Focus on
Eye Research
Retinal detachment,
epiretinal membranes
and anti-VEGF for DMO
VISUAL RECOVERY AFTER RETINAL
DETACHMENT WITH MACULA-
OFF: IS SURGERY IN THE FIRST 72H
BETTER?
Frings A, Markau N, Katz T et al
British Journal of Ophthalmology.
2016;100:1466 -1469
Unlike macula-on retinal detachment,
which is often treated as an
“ophthalmic emergency” and repaired
swiftly before the macula detaches,
macula-off retinal detachment
is usually considered less of an
emergency. However, determining
the ideal time for repair of maculaoff
retinal detachment before
compromising the visual prognosis
can be difficult. The purpose of this
study was to evaluate the influence
of lag-time between the onset of
central visual acuity loss and surgical
intervention of macula-off retinal
detachment.
A retrospective review of 1727 patients
was undertaken, with 89 patients
meeting the inclusion criteria. The
main outcome measure was final
visual acuity as a function of symptom
duration of macula-off detachment.
Symptom duration was defined as the
time from the onset of loss of central
vision (macula detachment) to surgical
intervention.
The results showed there was no
clinically significant difference in
final visual acuity in those operated
within 10 to 30 days of macula-off
retinal detachment. But patients with
symptom duration of three days or
less achieved best final visual acuity
(p

for optometrists and eye care professionals
with
Professors Charles
McGhee & Dipika Patel
Series Editors
Should glaucoma patients avoid caffeine?
BY DR JINNY YOON AND
PROFESSOR HELEN DANESH-MEYER*
Caffeine is a popular psychostimulant that
acts as an adenosine receptor antagonist at
physiological concentrations. It is the most
widely used drug in history, consumed daily by
more than 70% of New Zealanders in the form of
coffee, tea, chocolate and caffeinated soft drinks. It
has been estimated that adults aged between 20
and 64 years are exposed to an average of 3.5mg
of caffeine/kg body weight/day 1 .
Historical studies suggest some
ophthalmologists have long expressed concerns
about the effect of caffeine on intraocular pressure
(IOP) in glaucoma patients 2,3 . To date, IOP remains
the only treatable risk factor in primary open
angle glaucoma (POAG), the most common type
of glaucoma. Thus, establishing the link between
caffeine and IOP is of great importance for
improving the management of POAG.
Effect of caffeine on IOP
A number of clinical trials have investigated the
immediate effect of caffeine on IOP. The effect
of caffeine has been regarded as controversial
due to inconsistencies amongst study findings.
These inconsistencies can be attributed to variable
study protocols, such as sources and doses of
caffeine, methods of tonometry and time points
of IOP measurement. Additionally, participant
characteristics and severity of glaucoma were
often not clearly documented in some studies.
Nonetheless, a careful review of the literature
reveals a common trend.
In young and healthy volunteers without history
of ocular diseases, no significant changes in IOP
were detected up to four hours following ingestion
of caffeine capsules 4,5 . One study, however,
demonstrated a post-caffeine increase in IOP of
2-3 mmHg in healthy volunteers aged between
20 and 29 and this increase was maintained for
three hours 6 . However, the volunteers drank a litre
of coffee in this study and the authors did not
delineate the effects of volume overload and high
dose caffeine.
Several randomised controlled trials and
subsequent meta-analysis of those studies
reported IOP changes in patients with POAG or
ocular hypertension following caffeine ingestion.
There was a statistically significant increase in
IOP when the patients were exposed to 180mg of
caffeine in coffee, equivalent to approximately one
double-shot espresso 7,9 (see Table 1). The metaanalysis
showed the weighted mean IOP differences
before and after coffee consumption in patients
with glaucoma or ocular hypertension: 0.347 at
30 minutes, 2.395 at 60 minutes and 1.998 at 90
minutes (95% confidence interval 0.078-0.616,
1.741-3.049, 1.522-2.474, respectively) 7 .
A major shortcoming of this meta-analysis is the
lack of age-matched controls, leaving the effect of
aging unknown. The healthy controls were mostly
in their 20s. The age range of glaucoma patients
were not stated in the papers but were expected
to be in a much older age group. Furthermore,
the authors did not differentiate high tension
POAG from ocular hypertension, or normo-tension
POAG, when they could represent distinct disease
entities. Despite these weaknesses, the consensus
is that caffeine, at least transiently, induces a small
increase in IOP in glaucomatous eyes, but not in
young healthy eyes.
What is the pathophysiological significance
of the IOP change?
Two large-scale epidemiologic studies addressed
the question whether caffeine consumption is
associated with the development or progression
22 NEW ZEALAND OPTICS April 2018
of glaucoma. The Blue Mountains
Eye Study, a cross-sectional
study conducted in Australia,
investigated correlation between
IOP and regular daily caffeine
intake in POAG patients 10 .
The participants completed
questionnaires on their pattern
of coffee consumption and
underwent comprehensive
glaucoma assessment. The
study demonstrated a positive
association between daily coffee
drinking and high IOP, only in
people with POAG. POAG patients
who drank coffee daily had higher
mean IOP (19.6mmHg) than
those who did not (16.8mmHg).
This result reached statistical
significance after adjusting for
age, sex, systolic blood pressure,
myopia, current smoking and
diabetes.
A large-scale prospective study
of health professionals in the
USA showed an association
between coffee consumption
and development of POAG in
people with a family history of
glaucoma¹¹. A large number of
health professionals over 40 years of age and
without a history of POAG were followed up for
18 years in this study. Daily caffeine intake of up
to 600mg per day (approximately four doubleshot
espresso coffees or five cups of brewed
coffee) was not associated with increased risk
of developing POAG as shown by relative risks
of around 1. With over 600mg of daily caffeine
intake, the relative risk increased slightly to
1.61. Notably, in people with a family history
of glaucoma, high caffeine intake of more than
600mg per day increased the relative risk from
0.94 to 2.01. In other words, people with a family
history were twice as likely to develop POAG as
those without, if they were heavy coffee drinkers
(>600mg per day).
Taken together, there is still insufficient evidence
to support caffeine as an independent risk factor
for the development of POAG, but people with
POAG or with a family history of glaucoma (ie.
genetic susceptibility) may be more vulnerable to
the effects of caffeine.
Mechanism of caffeine-induced IOP
elevation
The main mechanism of caffeine’s effect is via
adenosine receptor antagonism and subsequent
increase in sympathetic tone and a slight
elevation of blood pressure¹². In young and
healthy volunteers, 200mg of oral caffeine led
to significant retinal vasoconstriction one hour
post-ingestion 4 . This was negatively correlated
with mean arterial pressure, suggesting an
auto-regulatory response to increased blood
pressure. Another study demonstrated that
ingestion of 300mg of caffeine caused an increase
in the resistive index of retrobulbar arteries in
young and healthy volunteers¹³. Hypothetically,
the increase in systemic blood pressure will
increase pressure within the ciliary arteries,
which in turn will increase ultrafiltration and
aqueous production, thereby elevating IOP.
Increased arterial pressure can also increase
venous pressure and reduce aqueous clearance,
thereby contributing to elevated IOP. Caffeineinduced
vasoconstriction was however not
associated with high IOP in the young and
healthy, suggesting the presence of an unknown
homeostatic mechanism to maintain the IOP.
Table 1. Average IOP before and after caffeine ingestion in patients with normo-tension glaucoma and ocular hypertension 9
Coffee and glaucoma?
Consequently, more questions arise as to
why caffeine elevates IOP in only glaucoma
patients. Several researchers postulate there
may be an inherent susceptibility to the effect
of caffeine in glaucomatous eyes. There is
mounting evidence that vascular and autonomic
dysfunction is a key pathologic process in
glaucoma (for a comprehensive review, see
reference 14). Doppler ultrasound imaging
studies demonstrated that POAG patients failed
to auto-regulate central retinal artery blood
flow during postural change. Gene expression
studies identified impairment of nitric oxidemediated
smooth muscle cell relaxation and
excessive plasma levels of endothelin, a potent
vasoconstrictor, in response to physiological
perturbations in POAG patients. Polymorphisms
of nitric oxide synthase and caveolin, which lead
to impaired vasodilation, have been associated
with POAG. Genetic dysautonomic conditions
such as familial dysautonomia and nail-patella
syndrome are associated with subtypes of
POAG. Moreover, examination of the nail bed
capillary network revealed abnormal peripheral
microvascular circulation in glaucoma patients.
It is possible that caffeine produces a pathologic
haemodynamic response and consequent IOP
change in glaucoma patients with structurally
and functionally impaired microvasculature.
The debate continues…
Based on the evidence accumulated to date,
glaucoma patients may be advised to avoid
caffeine intake for 90 minutes before IOP
measurement, in order to obtain a more accurate
IOP reading. However, there is no known clinical
benefit of avoiding caffeine in the long-term
management of POAG and without clear
evidence we are more likely to cause unnecessary
anxiety associated with caffeine consumption.
A few crucial questions remain to be answered
before clinicians can make evidence-based
recommendations on caffeine consumption.
l If caffeine transiently elevates IOP, does
frequent coffee drinking lead to sustained
elevation in IOP? What is the effect of repetitive
caffeine intake?
l Vasoconstriction was observed in healthy
eyes following caffeine administration, but the
haemodynamic response to caffeine is yet to be
explored in glaucoma patients.
l The link between chronic caffeine exposure
and the severity of glaucoma has not been
established. Is chronic caffeine exposure
associated with more advanced POAG? Does
withholding caffeine provide any long-term
benefit in terms of POAG progression?
These questions need to be addressed in
future studies to establish evidence-based
recommendations. In the meantime, it would be
reasonable to advise patients to avoid excessive
caffeine intake if IOP control is critical since
even a small reduction in IOP has been shown to
reduce the risk of glaucoma progression 15 . ▀
References
1. Ministry for Primary Industries. Caffeine. New Zealand:
2012 November.
2. Leydhecker W. Influence of coffee upon ocular tension in
normal and in glaucomatous eyes. Am J Ophthalmol. 1955
May;39(5):700-5.
3. Davis RH. Does caffeine ingestion affect intraocular
pressure?. Ophthalmology. 1989 Nov;96(11):1680-1.
4. Terai N, Spoerl E, Pillunat LE, Stodtmeister R. The effect
of caffeine on retinal vessel diameter in young healthy
subjects. Acta Ophthalmol (Oxf). 2012 Nov;90(7):524.
5. Adams BA, Brubaker RF. Caffeine has no clinically
significant effect on aqueous humor flow in the normal
human eye. Ophthalmology. 1990 Aug;97(8):1030-1.
6. Okimi PH, Sportsman S, Pickard MR, Fritsche MB. Effects of
caffeinated coffee on intraocular pressure. Appl Nurs Res.
1991 May;4(2):72-6.
7. Li M, Wang M, Guo W, Wang J, Sun X. The effect of
caffeine on intraocular pressure: a systematic review and
meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2011
Mar;249(3):435-42.
8. Higginbotham EJ, Kilimanjaro HA, Wilensky JT, Batenhorst
RL, Hermann D. The effect of caffeine on intraocular
pressure in glaucoma patients. Ophthalmology. 1989
May;96(5):624-6.
9. Avisar R, Avisar E, Weinberger D. Effect of coffee
consumption on intraocular pressure. Ann Pharmacother.
2002 Jun;36(6):992-5.
10. Chandrasekaran S, Rochtchina E, Mitchell P. Effects of
caffeine on intraocular pressure: the Blue Mountains Eye
Study. J Glaucoma. 2005 Dec;14(6):504-7.
11. Kang JH, Willett WC, Rosner BA, Hankinson SE, Pasquale
LR. Caffeine consumption and the risk of primary
open-angle glaucoma: a prospective cohort study. Invest
Ophthalmol Vis Sci. 2008 May;49(5):1924-31.
12. James JE. Critical review of dietary caffeine and blood
pressure: a relationship that should be taken more
seriously. Psychosom Med. 2004;66(1):63-71.
13. Ozkan B, Yuksel N, Anik Y, Altintas O, Demirci A, Caglar Y.
The effect of caffeine on retrobulbar hemodynamics. Curr
Eye Res. 2008 Sep;33(9):804-9.
14. Pasquale LR. Vascular and autonomic dysregulation in
primary open-angle glaucoma. Curr Opin Ophthalmol.
2016 Mar;27(2):94-101.
15. Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L,
Komaroff E, et al. Factors for glaucoma progression and
the effect of treatment: the early manifest glaucoma trial.
Arch Ophthalmol. 2003 Jan;121(1):48-56.
Dr Jinni Yoon
Prof Helen Danesh-Meyer
About the authors
*Dr Jinny Yoon is a neuroophthalmology
research fellow.
She studied neuroscience at
the University of Auckland
and graduated with a PhD.
After completing basic medical
training in Auckland, she
followed her passion for
eye health and joined the
Department of Ophthalmology.
Professor Helen Danesh-Meyer
is an international authority
on glaucoma and neuroophthalmology
and chair of
Glaucoma NZ. She is a sought
after international speaker, has
published more than 150 articles
and is a respected international
journal editor.

MyHealth1st now in NZ
BY LESLEY SPRINGALL
Klaus Bartosch knows more than most the
importance of being able to act on a whim and
book a health appointment quickly and easily,
out of hours.
The co-founder of patient booking and engagement
software MyHealth1st, and managing director of
the platform’s parent company 1stGroup, had just
finalised plans for his Vision Crusaders cycling team
to complete the Australian Ride to Conquer Cancer
fundraising races when his family urged him to get
the swelling of his right knee looked at. Bartosch
thought it was just a symptom of his recently
diagnosed arthritis, but given his family’s concerns he
somewhat begrudgingly went online, using his own
platform, at 9pm to book an appointment the next
day with a local doctor.
He had no white blood cells left in his body. The
doctor packed him off to a specialist pronto and he
was diagnosed with advanced-stage leukaemia and
committed to hospital for emergency treatment.
If he’d gone cycling; if it had not been so simple to
book the appointment, he could easily have died, he
says. The memory is a powerful one, and few at the
Auckland launch of MyHealth1st didn’t tear up when
Bartosch went on to share how his daughter took
his place in the endurance race, raising the promised
funds for much-needed cancer research.
That was 2013 and neatly illustrates why Bartosch,
together with an experienced team of online and
health practice veterans, had joined forces to shake up
the age-old way of booking healthcare appointments
and engaging with patients.
Background
Since launching in Australia in 2012, first in dentistry
before moving into other health areas, MyHealth1st
has netted more than 6,000 customers and booked
more than 6.5 million online appointments. It
began selling the platform to Australian optometry
practices just over a year ago and today books online
appointments for more than 1,200 Australian practice
owners; over 60% of the country’s independent
optometry market.
Of the optometry bookings made online in Australia
today, 43% are new customers and 57% are existing.
But perhaps the most interesting statistic of all, says
Bartosch, is that 70% of all online bookings are made
during business hours, demonstrating that the vast
majority of patients, if given the choice, would rather
book online than have to call a practice.
A Kiwi case study
Sharing the Auckland launch platform in March for
MyHealth1st in New Zealand, was Whangarei-based
practice Visualeyez director Craig Robertson.
Frustrated by his own business’ inability to allow
new and existing customers to book online, last year
Robertson asked his practice management software
provider, Optomate, for help and was referred
to 1stGroup. After just two months of using the
MyHealth1st booking system, Robertson was hooked.
It helped drive bookings to his practice, was simple
to use and integrated seamlessly with Optomate,
his website and his Facebook page, he says. He also
can’t wait to add 1stGroup’s patient recall service,
EasyRecall, to his online marketing toolbox, despite
the extra cost, he says, as soon as it becomes available
in New Zealand.
“As a consumer I want to be part of the digital
revolution. I want to contact people with emails
and book online and I found it very frustrating that I
couldn’t do that with my own practice, so that’s why
I tried it. It’s a cost effective, very simple platform. It’s
easy,” Robertson told the Auckland launch audience.
More compelling numbers
Of the 30-plus practice owners and managers at the
Auckland launch, all the ones NZ Optics’ spoke too
were having the same frustrations and were keen to
provide an easy and effective online booking service
to their current practice management systems. Many
Klaus Bartosch presenting at the Auckland launch
Klaus Bartosch, MD of MyHealth1st platform, and Visualeyez director Craig
Robertson at the Auckland launch
signed up on the night.
Bartosch, quoting from an international survey, says
these frustrations are common among consumers,
with 90% saying they wanted to use digital channels
to manage their healthcare, 88% preferring digital
reminders and a worrying 37% who switched
providers to ones who offered online appointments.
Using an online booking and engagement platform
like MyHealth1st allows you to convert your website
and social media traffic into booked appointments,
24/7, says Bartosch. To date, the average return
on investment for practices which have joined
MyHealth1st’s booking and patient recall service
is A$5,000 to A$20,000 a month per practice, with
an average 41% of bookings being new patients,
according to the ASX-listed company’s own data.
Other services
As well as its patient online booking and EasyRecall
services, 1stGroup will also be rolling out its
EasyFeedback service, allowing patients to engage
more easily with the practice and let it know how it’s
performed and what it can do better. The company
also runs a free, optional contact lens service,
designed to encourage more patients to consider
contact lenses as an option. On average, those
practices which have opted in to the contact lens addon
are having 20% more discussions about contact
lenses, says Bartosch, 62% of which are converted
into contact lens sales.
As in Australia, 1stGroup also intends to launch
a MyHealth1st portal in New Zealand in June or
July, which acts as an independent online directory
to drive consumers to your practice, says Bartosch.
Once a consumer selects and books with a practice,
however, those consumers won’t see any competitor
practices when they decide to sort out their next
booking, just the first practice they booked with, and
complimentary local healthcare service providers,
such as dentists or GPs, until they’ve built up a group
of their preferred suppliers and can then use the
portal to book all their health requirements online,
whatever the time of day or night, he explains.
The pitch
Given the way the internet is changing the way we
do business, you can’t just sit idly by, Bartosch tells
his audience. “Here we are, in the age of the internet
and yet nearly all of us still require patients to pick
up a telephone in business hours to do something as
simple as book an appointment… Can you imagine
booking hotels like we used to… looking for a job,
browsing for a home?
“The way we do business is changing, whether we
like it or not. We can’t stop it. The question is how are
you going to engage
with it, leverage
it, get ahead of
the curve and do
it, before others
do!” ▀
Focus on Business
sponsored by
Independent spirit, collective strength
FOCUS Too small ON BUSINESS for
How
independent
to become
advice?
a better
BY DAVID PEARSON*
independent
the optical sector assume that
Many small business owners in
company boards are for the big
boys, yet the BY benefits JANE SMITH* of independent
directors or advisors apply to all businesses,
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irrespective of size or structure.
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Owner-run businesses can be averse to
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and growth
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esciis
This
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many owner-run businesses. Looking at
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family businesses run in New Zealand,
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most do not have a functioning board of
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directors. Many only have a single director,
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provide access to a broader base of skills
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and experience, as well as becoming an
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protect the margins under which most
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industries operate. Business owners are
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commonly guilty of working too hard ‘in
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the business’ instead of working ‘on the
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business’.
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‘big picture’ aspects of your business.
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labor with sitinct those otatesciet risks. maximos voluptium
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THE INDEPENDENT OPTOMETRY GROUP, PROVIDING
parum
THE
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ADVICE
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AND SERVICE INDEPENDENTS NEED TO THRIVE.
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THE INDEPENDENT OPTOMETRY GROUP, PROVIDING THE ADVICE
The To find AND Independent out SERVICE more contact Optometry INDEPENDENTS Neil Group, Human NEED providing on 0210 TO THRIVE. 292 the 8683 advice
and service or neil.human@iogroup.co.nz
independents need to thrive
To find out more contact Neil Human On 0210 292 8683
To find out more contact Neil or neil.human@iogroup.co.nz
Human on 0210 292 8683 or neil.human@iogroup.co.nz
April 2018 NEW ZEALAND OPTICS
14 NEW ZEALAND OPTICS April 2018
that is the case, it is still worthwhile having
an external advisor. That person will be an
advisor to the board and still participate
in discussions, but will not be a formal
director, and they can carefully define the
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boundary over which they will not cross so
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that they do not become deemed a director.
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niscia not currently sinctib uscienis exist in esequat your business. eos re nobitium
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In the current competitive environment,
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businesses need to take extra steps to gain
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market share or improved margin. A person
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Institute of Directors can assist. Look for
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quidendistem to your business ut quianduntem advisers – accountants quunt. and
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and given sufficient material to properly
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understand your business, your part of
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the industry and the market environment.
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They need to know what the problems and
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change from the way you have previously
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operated and should result in a significant
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improvement to the way the business
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operates and its performance as a whole.
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Um About facimusam the author la doluptatum quae. Erspe
sandae *David Pearson ex estiores is managing pa dollitiuste partner of pro chartered quaturiat
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arciant. has a speciality Um facimusam interest in advisory la doluptatum services to quae. the
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has extensive
experience
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assisting both
small and medium
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dolo etur range re omnihilique of advisory
pa voloreptat. services. Caes For que se
nihiliquodi more information
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Atio. Lorrovidia contact David peliquamus at
utenderat david.pearson@
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exerorepuda bdo.co.nz parum or visit re id
quidi www.bdo.nz
distr? Atio. Lorrovidia
peliquamus utenderat
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23

Style-Eyes
A unique way to sell more
Tapping into the ‘pop-up’ phenomena
BY RENEE LUNDER*
Commerce has rapidly changed over the past
decade and the optometry game is not
immune. Today, many customers begin their
eyewear search online rather than in traditional
storefronts, especially when it comes to the
younger generation. Social media plays a huge part
in their buying decisions too.
To ensure you’re adequately tapping into this
burgeoning market, here’s an interesting and yet
innovative way you may not have considered to
help you increase your revenue.
Why try a pop-up?
hold too much merchandise. People understand
the exclusivity of a pop-up so don’t expect you to
have more than one of anything!
Fashion update
Jono Hennessey
The latest releases from Jono Limited Edition includes the 2018
Liberty of London fabric collection, transformed using Hennessy’s
unique technique of fabric lamination to create these beautiful
new models. Both are available in three different colours
featuring Liberty’s classic paisleys and garden-inspired designs,
including gold detailing. Distributed by Phoenix Eyewear.
Ogi Eyewear
Neubau
Ogi’s latest releases are a continuation of the brand’s statementmaking
styles and bold colour options. The masculine, larger
frame is designed with marbled acetate and accented with
subtle stainless-steel temple detailing, and is “ultra-wearable,”
said the company. While the delicate, cat-eye silhouette of the
other model, pictured here, is available in subdued pastels, with
transparent touches of acetate in a primarily translucent frame,
making it beautifully balanced. Distributed by BTP DesigNZ.
A glimpse of the future was on display this year at Neubau’s MIDO
stand, where the company launched its new 3D-printed frames.
The 3D printing process allows for exceptionally precise detailing,
environmentally sustainable production and the highest standards of
quality, said the company, for example, fine details and textures appear
like engravings, all of which would be hard to achieve in conventional
manufacturing. Neubau’s 3D models will be available from April in
seven striking colour finishes combined with stainless steel in gold,
silver, rose, black ink and black ink matte. Distributed by Euro-Optics.
Carter Bond
Also by Jono Hennessy, Carter Bond’s new luxury vintage collections include
this lightweight stainless-steel
frame; classic and stylish, it’s
available in matt and shiny
finishes. Distributed by
Phoenix Eyewear.
At its most basic level, a pop-up is a small, physical
store with an expiry date – think temporary, not
permanent. There are many options when it comes
to running one, but the most common is a standalone
pop-up at an event such as a farmers’ or crafts’
market, or perhaps it’s a way of using a vacant
tenancy space within a shopping centre to attract
new customers.
There are many varieties on the pop-up theme,
such as a collaboration with another store (where
you take over a small space within their store and
you both benefit from increased traffic); a kiosk
or booth at a shopping centre or along a busy
shopping strip; or align yourself with a specific space
or event such as an art gallery or trade show. The
possibilities are only limited by your imagination
and resourcefulness. For example, an interesting
collaboration might be with a local bookstore. After
all, bookworms often wear glasses!
Each space
has its own
pros and
cons but
the good
usually
outweighs
the bad.
The major
benefit of
a pop-up
means you
get to target a whole new selection of customers,
many of whom may not even know you exist!
Depending on the pop-up location, the foot traffic
can be considerable and you may also be a novelty
attraction (an optometrist selling their wares at a say,
craft market) and pull a bigger crowd.
One further tip, is to try to pick a location close to
your physical store, or within reasonable traveling
distance, should customers need an eye test and
updated prescription for their new glasses. Or
perhaps consider taking the whole kit and caboodle
to them, like US-based Warby+Parker has done
with its mobile optometry store bus or, closer to
home, Auckland-based EyeLove EyeCare’s mobile
optometrist service for rest homes.
A great way to test the waters
A pop-up can help you move old stock, but it may
be an even better way to test out a new brand or
concept. Perhaps you’ve always had a penchant for
funky eyewear or custom work, but never taken the
plunge because it’s too risky for your bricks-andmortar
store. A pop-up gives you the chance to try
it out.
You can do small orders of new stock – be it
outrageous, one-offs or bespoke – and also keep
up to date with what’s on trend without having to
Be brave with your pop-up merchandise (Face à Face and Silhouette)
Furthermore, by its very nature, a pop-up is not
forever. Some are just for one day, at an event of
you choosing, so the cost outlay can be kept to a
minimum. Others may require more investment
with a 30 or 60-day lease for retail space, for
example.
Whatever avenue you pick, at the end of the
exercise, it makes business sense to review success
based on foot traffic, how long customers spent
looking at particular products, sales conversion
rates and general feedback and follow-up from
clients. Compare this to your traditional storefront
and online sales too (if you have them) to
determine viability.
Support pop-ups with social media
If you like
the sound of
a pop-up, it’s
important
to realise
its success
relies on a
thorough
social media
campaign
launched Support your pop-up venture with social media
before it,
run alongside it and maintained after it. While this
may sound a little daunting or labour-intensive,
pop-ups really are a fantastic way to generate
social buzz, increase your brand awareness and
bring more traffic to your website and physical
store (especially if there’s a competition or discount
voucher attached to them!).
Like many of us, you may find yourself completely
stuck when it comes to social media. To combat
this, considering hiring a student – with or without
optometry experience – for a few hours a week
to run the campaign for you. A further option
is to do some research online about how to run
a successful social media campaign. There’s a
plethora of blog posts and articles on this verypopular
topic. Another great recourse is to get your
kids to do it (or a well-loved niece or nephew)!
Should you decide to go ahead with a pop-up,
start your social media campaign early to build
up anticipation. Flog the pop-up on all your social
media channels (Facebook, Snapchat, Instagram
and Twitter). Don’t have those? You should get
them set up as they are important, especially if you
want to capture the youth market.
Lastly, it doesn’t hurt to advertise your pop-up
using more traditional methods such as direct
flyers, local papers and word-of-mouth in your
store too.
So go on, give it a pop-up!
*Renee Lunder is an Australian freelance journalist and proud
specs wearer. “They are as much a part of me as my limbs! My
children have only ever known me with them. I wouldn’t be ‘Mum’
without them!”
Vanni
Pantone’s annual celebration of colour, nominated ‘ultraviolet’ as
the colour of the year, something Italian frame maker Vanni picked
up as a challenge. The ultraviolet that rages on the catwalks and
among the 2018 accessory collections is a colour that is both for
the strong and more peaceful hearted, said the company. “We think
that violet is an unconventional colour that gives a vibrant and
interesting look.” The Vanni violet is streaked into the acetates of its
Monochromo collection and used as “assertive” block colour in its
Colours range. Distributed by Little Peach.
Coco Song
Coco Song’s new collection introduced at Mido is a tribute to
faraway cultures with beautiful colours and dreamy detailing.
The Sunset Horizon model featured here has a delicate
feather on silk between the acetate layers of the
frame front and temples, creating incredible colour
contrasts, with semi-precious stones inserted in the
enamelled metal profiles. Available direct.
Stars and their Eyes…
Ella Fitzgerald
The first lady of song, Ella Fitzgerald was
one of the most prolific jazz recording
artists of all time. She began her sixdecade
career when she was just 16 years
of age. Fitzgerald was famous for her scat
improvisation and her almost three-octave
range. Throughout her career she
won 13 Grammy awards (more
than any other jazz musician) and
was awarded honorary doctorates,
from Yale and Dartmouth, and the
National Medal of Arts.
Fitzgerald, however, had type
II diabetes which had a massive
impact on her life, causing vascular
problems, congestive heart failure
and eventually leg amputation. From
the early 1970s, when Fitzgerald was
in her 50s, she began to have vision
problems from advanced diabetic
retinopathy, leading to severe vision
problems from her late 60s.
AC/DC
AC/DC and Vinylize launched the
loudest eyewear collection ever at
Vision Expo East, New York in March, presenting three
different optical frames in three sizes and three sunglass
models made from the vinyl of the multi-platinum album
‘Back in Black’ records themselves. Model Hell, featured
here, is named after “Hell’s Bells” the first track on side A
– an absolute must for AC/DC fans! Available direct.
A shy woman, who was very sensitive to
criticism, she spent her last years in the garden
of her Beverly Hills mansion in a wheelchair with
her son and granddaughter. “I just want to smell
the air, listen to the birds and hear Alice laugh,”
she said. She died, aged 79 in 1996.
24 NEW ZEALAND OPTICS April 2018

Bellinger returns to NZ
New Zealand frame distributor Euro Optics has
added Danish brand Bellinger to its portfolio.
Carl Doherty, Euro Optics’ managing director,
says Bellinger is already a familiar brand among
high-end independent eyecare professionals and is
well-established in Europe and North America.
Some New Zealand practices used to stock
Bellinger in the past when a previous distributor
was selling it, explains Doherty. “We liked the new
Bellinger collections and saw an opportunity to
re-launch this well-respected brand back into the
New Zealand market.”
Feedback received from customers so far has
been extremely positive, he says. “Bellinger is a
top-quality product that prides itself on being
different and special. The acetate mixes that
Bellinger uses are unique. They add extra textures
to the acetate.”
For example, some frames have a small amount
of glitter mixed into the acetate, says Doherty,
through a production technique not that dissimilar
to making candy. “The acetate is made of cotton
mixed with acetone and alcohol forming a
homogeneous dough. It’s filtered, kneaded, heated
and finally pushed into large blocks; only then, the
creative work with Bellinger techniques begins.”
The most amazing effects are obtained by
mixing, heating and twisting up to five different
types of acetate together until the desired effect is
achieved, he adds.
Innovative Mido trends
Mido is to eyewear,
what Oscar night is to
cinema,” said Giovanni
Vitaloni, Mido president at this
year’s event in Milan.
Organisers said the 48th
Mido event this year welcomed
more than 58,000 eyewear
professionals and 1,305 exhibitors
across three days to seven
pavilions, showcasing eyewear,
technology and new innovations,
the latter being the theme of
this year’s event. Mido organisers
noted a strong increase in foreign
attendees, resulting in a 4.9%
increase in overall attendance and
5% in the exhibitor space.
Phoenix Eyewear’s Mark
Collman, a veteran of 21 Midos,
said this year’s fair certainly delivered. “In typical
Italian style, especially during Milan fashion
Bellinger back in New Zealand
Bellinger’s latest range is now available from Euro
Optics. ▀
Mark Collman and Phillip Wilson with Robert Morris of William Morris (centre) at Mido
week, the event was full of immaculately dressed
locals, oceans of espresso and prosecco, gorgeous
promo girls, lavish stands plus the
occasional sneaky pick pocket.”
When queried about the latest
trends, both Collman and his
colleague Phillip Wilson agreed
it’s clear the double bridge metal
aviator is back with a vengeance
both for men and women. Metal
frames were also once again
at the forefront of many of the
new optical collections, which
the Phoenix team thought was
interesting as metal frames have
long been a great seller in New
Zealand and growing still. For
all lovers of colourful acetates,
however, it’s not all gloom as
Collman and Wilson said plastic still
pretty much dominates the fashion
scene, many in large 70s and 80s
inspired oversized looks.
“I honestly feel that after a couple
of flat years this year’s vibe was the
most optimistic and positive I have
experienced in recent times,” said
Collman. “Everyone we came across
supplying the independent eyewear
sector were really busy and in great
shape which has to be good for the
future!” ▀
CPD for NZ DOs at AVC
A
comprehensive
dispensers’
education programme, with
CPD points for accredited Kiwi
dispensing opticians, will run alongside the
optometrists’ programme for the first time
at the Australian Vision Convention (AVC) in
Brisbane, Queensland from 7–8 April, 2018.
Supported by AVC sponsor Rodenstock,
the inaugural Dispenser Programme features five
sessions on the latest lens technologies, patient
communication strategies and advantages of
premium lenses:
• Resolving non-tolerance issues with digital
lenses – Nicola Peaper, sales and professional
services manager, Rodenstock
• The digital world needs digital lenses, not
progressives – Steven Daras, course coordinator,
optical dispensing, TAFE
• Wham, Bam, Pow. How position
of wear measurements will knock your
patients out – Leigh Robinson, Consultant
and Training Facilitator, Spectrum Optical
• Dispensing to enhance sports
performance – Helen Venturato,
optometrist and principal consultant at
Helen Venturato Consulting
• Complex cases and compensated
values – Grant Hannaford, adjunct senior lecturer at
School of Optometry and Vision Science, UNSW and
director, Academy of Advanced Ophthalmic Optics
The programme runs from 10.45am to 3.15pm
on Sunday 8 April and has been accredited for
Kiwi dispensing optician attendees with 2.5 CPD
points. For more or to register, please visit: https://
oa.optometry.org.au. ▀
Essilor Transitions’ prize
draw
A
patient
from Noel Templeton’s
Marlborough Optical practice is the first
to win one of three patient prize trips to
Fiji, courtesy of Essilor New Zealand’s Transitions
promotion.
All patients from Essilor-partner independent
optometrists who purchase Transition lenses
from 1 February until 30 April are eligible to enter
one of three-monthly draws to win a three-night
package at the Sofitel Fiji Resort on Denarau
Island. The draws take place on the 9th of March,
April and May, with an independent guest asked
to make the draw on Essilor’s behalf. This month,
the drawee was none other than NZ Optics’ own
editor Lesley Springall. There’s also an additional
draw in April for practice eye care professionals,
linked to their Transition lens sales.
Each prize package includes economy return
flights for two people to Nadi from Auckland,
Wellington or Christchurch, and shared
accommodation at the Sofitel Fiji Resort. Draw
Essilor’s Chris Aldous with NZ Optics’ Lesley Springall who was invited
to draw the first prize winner in the Transitions Fiji promotion
One closed on 28 February; draw two closes on
31 March; and draw three closes on 30 April
2018. Entry is open to all New Zealand residents
purchasing Transitions Lenses from selected
independent optometrists in New Zealand
and limited to one entry per person per pair of
Transitions lenses sold.
0800 573 224
April 2018
NEW ZEALAND OPTICS
25

The power at our finger tips…
by
Chalkeyes
“Red sky in the morning, shepherds warning.
Red sky at night, shepherds delight.”
The Mavis Beacon Teaches Typing software had me type this over
and over. We had just decided that we were going to ditch paper and
use our practice management system for clinical records too.
Until now we had only used our system for recording dispensing
details, generating lens orders and doing the billing, so this was a
big move for us. Our major concern was losing the data when the
system went down. Should we do an interim period of recording
everything twice? One hard copy and one soft copy? Do automatic
backups really work?
Paper records were real! Even if they were lost to misfiling at least
one patient a day; and how the hell did you figure a system for
filing Scottish surnames? Then there was handwriting, of course. I
couldn’t really blame my colleagues because I couldn’t even read my
own in the end. But it wasn’t until the system did go down that we
fully appreciated digital records. They could be re-birthed; emerging
from the panic like nothing had ever happened.
THE
EVENT
SEPT. 28 TH
OCT. 1 ST
2018
Digital record cards are normal now, as are
those awkward silences when the healthcare
practitioner turns their attention, and usually
their backs, away from us to write something up.
A mutually disagreeable experience! Both the
record and the personal interaction suffer. There
are not too many practitioners of my generation
(and this Chalkeyes has been around for a while)
or older, that have ever really adapted. The records
show this very clearly.
Compare, if you will, the oldest optometrist in
your practice’s notes with the youngest. Many
records are not to standard with the notes very
brief and incomplete – not really an accurate or
complete record of what was examined and how
the patient responded. At the end of the day, how
can you do both in such a limited time?
A complex case was referred to me recently
and the accompanying information was a fax of
a handwritten card. It was almost completely
indecipherable. Once my recoil wore off and I was
able to work it out I was immediately struck by
how much information had been recorded on that messy page, in
abbreviations, ticks, scribbles and sketches. I’ll bet it was all done
while chatting to the patient too. We have definitely lost something
going digital!
But there is also lots to be gained if we could just have better
systems that work for us and our patients, and if they were
compatible with each other.
I have, at one time or another, had the opportunity to look at all
the available digital record systems used in New Zealand. Some
practitioners are definitely better at recording than others, maybe
it’s Mavis Beacon, but then maybe it’s talking to the patient instead
of pecking at their keyboard with their backs turned.
The last decade has been transformative in eyecare. The
technology that is now found in most practices is mind boggling
compared with when I started out! Automated perimetry and
digital fundus imaging is an expectation. Even OCT today is almost
normal. Widefield confocal images are also becoming standard
as are topography, digital eye charts and many other things.
Modern optometrists are able to get a very good idea of what is
going on in and behind our patients’ eyes. Yet, typically, all of this
technology runs on its own separate databases – I use seven – on
different platforms and all of it poorly integrates with the practice
management system, digital or written.
I am sure this is not just a Kiwi thing. American practice
management advice recommends having a “scribe” in your
consulting room to record your results. I suppose you would mumble
your findings as you go along for them to record on a laptop.
Personally, I don’t think I’d like doing that very much!
All the practice management systems on the market today have
strengths and weaknesses, but are all ultimately similar. Our
practice uses the Sunix Vision system, written in Foxpro. A Microsoft
product that has been unsupported by them since 2007, written for
the IT environment of the 1980s and ‘90s. A heritage application
that surely can’t have much more to offer for the future. Although
it is totally inadequate, it is familiar and no worse than the other
systems when you look at the big picture.
We use many hacks to get it to work better for us. We import
clinical images, once they’ve been zoomed and manipulated to
highlight the detail we try to record, via the windows clipboard
into Microsoft Paint, to attach them to patient’s files. We have to
remember to record pinhole acuities on referral letters because
that field can’t be transferred and contact lens orders are treated as
consultations, which is just downright obstructive. And that’s just a
few of the things I find frustrating about just our system!
It’s hard not to get a little sad about all this. It’s a major
opportunity that is being missed. We all use databases that record
findings from a diversity of people of different ages and stages, from
all walks of life and in all sorts of states of health. We record notes
on the same findings, using the same techniques in very much the
same way, albeit that the specifics are a little loose. Imagine if this
data could be anonymised and pooled. What learnings are hidden in
those little boxes on our screens; across all our patients from across
the country, or even the world!
We’ve got the gadgets, now let’s get the software. Surely it can
be better that this! The current providers seem complacent and are
unlikely to cannibalize their own market share to disrupt things. The
“new cloud system” by Sunix seems to have burned off. It is time for
better, surely! Is our industry too small? Are we too difficult?
This Chalkeyes would like to challenge someone from all those
competing software providers to do better, to share better, to really
make a difference for individual practices and, in-turn, the wider eye
health world to better record and share our data. Now wouldn’t that
be a technological advance worth talking about!
In the meantime, I better keep practicing my typing…
“Red sky in the morning, shepherds warning.
Red sky at night, shepherds delight.”
MORE CLASSIFIEDS ON PAGE 28
For all your optical and ophthalmic needs
nzowa.org.nz
Refer your low vision patients to Naomi Meltzer,
optometrist specialising in low vision rehabilitation.
For appointments and information
low vision
services
Phone (09) 520 5208 or 0800 555 546 Email info@lowvisionservices.nz
www.lowvisionservices.nz
Oasis spa open for business
Auckland Eye’s new Oasis Spa, premium
dry eye treatment facility, has opened for
business.
Patients referred to the new Oasis Spa or those
simply seeking help for dry and itchy eyes, will
be given a full clinical evaluation of the likely
causes of their eye irritation and a tailored
treatment plan, in what Auckland Eye says is “a
luxurious, relaxing environment.”
Traditional approaches to dry eye, such as
lid margin hygiene, topical lubricants and
antibiotics or steroids, for example, only help
a percentage of patients, whereas a tailoredtreatment
approach, undertaken at the spa,
should help far more patients, both with efficacy
and compliance, explained Auckland Eye’s Dr
Dean Corbett. “The Spa is a means to provide a
more complete service to our eye patients.”
The quality of a patient’s tears and tear film
and the health of their meibomian glands will
all be assessed. Treatments include Lipiflow
and Lumenis’ Optima intense pulsed light (IPL)
technology, often in the comfort of the spa’s
massage chairs.
Though the Oasis Spa has only been open for a few weeks, and
Auckland Eye isn’t going to begin marketing it more widely until it
has had an opportunity to assess what works best, the team have
already received positive feedback about the equipment, treatments
and staff skills, said Dr Corbett.
There are also plans to expand the spa’s offerings to treat rosacea
and possibly some other cosmetic conditions, he added. ▀
Auckland Eye’s Oasis Spa, a
luxurious take on eye care
26 NEW ZEALAND OPTICS April 2018

PUT DOWN YOUR
ROOTS IN REGIONAL NZ
PERMANENT ROLES IN YOUR CHOICE OF REGIONAL LOCATION
Multiple opportunities available across both the North and South Islands to suit your career aspirations
Specsavers’ growing New Zealand store network offers a variety of roles catering
to different development needs and are available for optometrists at all stages of
their career.
Joining one of our regional New Zealand stores provides an ideal opportunity to
firmly establish yourself within a community while progressing your clinical skills.
You will be equipped with the latest ophthalmic equipment and presented with
a range of interesting conditions across a high-volume patient base – all with the
support of an experienced dispensing and pre-testing team, the mentorship of the
store partners, and access to an exemplary professional development program.
Or if you’re ready to move into practice ownership, our regional New Zealand stores
present an attractive business venture. With average annual sales running at $2.4
million per store, and Support Office training and assistance available every step of
the way, there’s no better time to uncover the leader within you.
Ask us about the opportunities we have waiting for you – contact Chris Rickard
on 027 579 5499 or via chris.rickard@specsavers.com
VIEW ALL THE OPPORTUNITIES AVAILABLE ON SPECTRUM-ANZ.COM
Voted by New Zealanders
Reader’s Digest
Quality Service
Award
2017
Best Talent
Development
Program
2017
Best Customer
Service in NZ
Optometry
2017
Millward Brown
Research
No.1 for eye tests
2016
Excellence in
Marketing
Award
2016
Retail
Store Design
Award
2016
Retail
Employer
of the Year
2015
Overall
National
Supreme Winner
2015
Franchise
Innovation
Award
2015
NZ Franchise
System of
the Year
2014
Retail
Innovator
of the Year
2014
April 2018
NEW ZEALAND OPTICS
27

To advertise in NZ Optics’ classified pages
contact: Susanne Bradley at susanne@nzoptics.co.nz
OPTOMETRIST / PALMERSTON NORTH
Our client provides leading edge eyecare services seven days per
week and is seeking to employ an additional full-time Optometrist
from June 2018 or sooner.
The successful candidate will be sharing a monthly roster with
three other full-time Optometrists. The equipment is superb, the
wider team are all highly experienced.
Salary level is $125k for the right candidate, subject to experience.
There is also an opportunity (long term) to purchase a shareholding
in the business.
If this sparks your interest, please contact Stu Allan at OpticsNZ
(confidentiality assured). Applications for this position close at
5pm, Wednesday 18 April 2018.
OpticsNZ, PO Box 1300, Nelson or
Tel (03) 5466 996 or 027 436 9091 or email stu@opticsnz.co.nz
DESIGNER FRAMES FOR SALE
Spectacle frame inventory for sale. Designer frames offered at
below wholesale prices. Prefer to sell entire lot to single buyer.
Fendi, Marchon, Flexon, Coach, Calvin Klein etc. About 350 in total.
Please contact seller at tyghbn73@gmail.com or 0210483139
DUNEDIN PRACTICE FOR SALE
If you are looking for your first practice or wish to add scale to
existing operations, this long-standing and very well-run practice,
which is showing impressive performance, could be the answer.
Enquiries welcome to Stuart Allan at OpticsNZ, Tel (03) 5466 996,
027 436 9091 or stu@opticsnz.co.nz
PART-TIME DISPENSER/
OPTICAL CONSULTANT
1-2 week-days per week plus 2-3 Saturdays
per month.
Hours: 10 -5.30pm week days, 10 -5pm Saturdays
Hourly rate $25-40 depending on experience
Become part of the team at Parker & Co, Newmarket, Auckland, selling
fabulous eyewear. You will be working with a small team of experienced
consultants/Dispensers and Optometrist who love eyewear and
helping people to find the perfect fit of eyewear and lenses.
We are not a chain, we don’t pressure sell. We love what we do, and
we need someone to join the team. If you have two or more years
experience in the industry and this sounds like you please email
lynne@parkerandco.nz
OPTOMETRIST / HASTINGS /
SUNNY HAWKES BAY
Our client provides leading edge eye care services seven days per
week and is seeking to employ an additional full-time Optometrist
from May 2018 or sooner.
The successful candidate will be sharing a monthly roster with two
other highly experienced full-time Optometrists. The equipment is
superb and the wider team are all highly experienced as well.
Salary level is $125k for the right candidate, subject to experience.
There is also an opportunity (long term) to purchase a shareholding
in the business.
If this sparks your interest, please contact Stu Allan at OpticsNZ
(confidentiality assured). Applications for this position close at 5pm,
Wednesday 18 April 2018.
OpticsNZ, PO Box 1300, Nelson or
Tel (03) 5466 996 or 027 436 9091 or email
stu@opticsnz.co.nz
OPTOMETRIST
HAMILTON
Paterson Burn Optometrists
are currently looking for a passionate TPA endorsed Optometrist to
join our team.
Working with Paterson Burn Optometrists will offer you the ability
to develop your clinical skills to full potential and the opportunity
to specialise in your desired field. You will have the ability to work
independently and, with fourteen other optometrists in the group,
you will be part of a larger group of highly qualified, experienced
and dedicated optometrists.
Our Optometrists have special interests in Low Vision, Children’s
Vision, Ortho K, Specialised contact lens fits, Dry eye and Irlen
lenses. You will also have the opportunity to meet regularly for
peer review sessions while gaining CE points within our practice.
As an Optometrist with Paterson Burn Optometrists you will be
able to provide exceptional patient care with access to the most up
to date technology and state of the art equipment (OCT, Corneal
Topographer, Medmont VFA’s, IPL etc).
This position is for 4-5 days per week, including some Saturdays.
If this sounds like you, please send your CV with a covering letter to
sandri@patersonburn.co.nz
OPTOMETRIST
NEW PLYMOUTH
We are looking for an experience TPA qualified, full-time
Optometrist to join our team at Browning & (Matthews), New
Plymouth. This is a busy, well equipped practice with a great
support team.
Please contact Michelle Diez on 027 246 7499 or email
michelle.diez@matthews.co.nz
DREAM OF
TRAVELLING
Have you ever wanted to travel NZ? Do you like
flexibility and crave variety? OPSM New Zealand is
looking to expand its relief team with a combination
of area and regional floats. As a float you will be
exposed to lots of different patients and locations
across New Zealand. We are looking for Optometrists
who share our passion, and want to join our customer
focussed teams in making a difference to how people
see the world.
We are looking for optometry floats in these
key locations:
• GREATER WELLINGTON AREA
• AUCKLAND & WAIKATO AREA
• NATIONAL (NZ WIDE) REGION
Alternatively OPSM NZ is also on the lookout for locums
willing to service the Wellington, Bay of Plenty and
Waikato regions.
JOIN OUR TEAM
If interested in joining our fun loving team, please contact
Jonathan Payne
Jonathan.Payne@opsm.co.nz or call 021 195 3549
OPSM.CO.NZ/CAREERS
READY FOR
A CHANGE?
When you join OPSM, you work within a team who are
committed to providing the best possible eyecare solution
with exceptional customer service. You will work with world
class technology and have many opportunities for professional
development. You can also make a real difference in the
way people see the world by participating in our OneSight
outreach program. OPSM New Zealand is looking for
passionate Optometrists to join the team in these locations:
THAMES
Located on the doorstep of the Coromandel, Thames is
a gateway to outdoor adventures and fantastic beaches.
An opportunity has arisen for a full time optometrist to
join an amazing team in our community based store with
interesting and appreciative clientele. Only 1 hour outside
of South Auckland, Thames is close enough to enjoy the
big city, without the traffic or house prices!
MT MAUNGANUI
Why visit this holiday hot spot when you can live there!
Our brand new Mt Maunganui store is looking for a fresh
optometrist eager to grow with the store. Located only 800
meters from the beach, with relaxed easy going clientele.
If you are seeking for a great mix of work and play,
whether its surfing or just relaxing at the beach –
“The Mount” is the ultimate summer destination.
LOWER HUTT
A rare vacancy has arisen in our much sort after Lower
Hutt practice. We are currently looking to expand our
energetic and vibrant team. Only 15 minutes from the
capital, Lower Hutt is close enough to enjoy the sport,
culture and cuisine that central Wellington has to offer.
JOIN OUR TEAM
If you are interested to find out more about joining the
team, contact Jonathan Payne for a confidential chat.
jonathan.payne@opsm.co.nz or call 021 195 3549
OPSM.CO.NZ/CAREERS
28 NEW ZEALAND OPTICS April 2018