Nicola Anstice, Melinda Calderwood and Dr John Phillips with patient Samantha Zhang who participated in the study

Designed by Dr John Phillips, a senior lecturer at DOVS, the lens, named MiSight, is the first soft contact lens in the world that’s available commercially to inhibit myopia progression. Manufactured by Coopervision it has recently been launched in Hong Kong, the hub of Asia.

Myopia has become a major public health issue in many parts of the world, with the incidence of myopia in children at over 80% in some Asian countries. Retinal degeneration associated with the abnormal elongation of the eye in myopia is already the major cause of blindness in these countries.

MiSight, a daily disposable contact lens, uses ActivControl Technology which results in a clear central foveal image, while the peripheral treatment zones of the lens create myopic retinal defocus that slows the rate at which the eye elongates and thus slows the progression of myopia.

Highly myopic himself, Dr Phillips has been working in myopia research for some time. Before studying optometry, he worked in animal physiology in the UK. Dr Phillips emigrated to NZ in 1998 and took up a position as lecturer with the DOVS.  He said it was satisfying to see the project evolve from the basic physiological principles governing eye growth to an idea that could be used to treat children with myopia.

“It’s retinal defocus that controls eye growth in developing animals, so we took that idea and used it to control the abnormal enlargement of the eye in children with myopia,” said Dr Phillips.

Research on the project commenced about 9 years ago with funding at various times coming from the Maurice and Phyllis Paykel Trust, NZOVRF and the Cornea & Contact Lens Society (CCLS).

In 2004 Dr Phillips filed a patent application related to this technology and soon afterwards optometrist Nicola Anstice began her PhD project, supervised by Dr Phillips, trialling the new ‘dual focus’ lens on Auckland school-children with myopia. The lenses used in the trial were all specially made by Corneal Lens Corporation in Christchurch.

“We conducted a clinical trial in which the experimental lens was worn in one eye and a standard single vision contact lens was worn in the other and compared the myopia progression  in the two eyes to see if it was slower in the experimental eye,” said Dr Phillips. “It was slower, so we swapped the lenses over at 10 months and the progression in the other eye then slowed down so by 20 months, progression in both eyes had been slowed. During each period we could see the eye wearing the experimental lens was progressing more slowly than the other one.”

The clinical data showed that the lens slowed the rate of myopia progression by one third or more in three-quarters of children studied, half of those wearing the lens had their myopia progression slowed by 50% or more.

Soon after Nicola’s presentation of her preliminary data at the 2007 CCLS conference in Queenstown, Dr Phillips received a phone call from contact lens manufacturer Coopervision expressing an interest in commercialising the lens.

Dr Phillips assigned the intellectual property to The University of Auckland’s UniServices who has licensed it to Coopervision who has proceeded with the commercial development of the lens. Dr Phillips has a revenue sharing agreement with UniServices for the royalties involved in the sales of the lens.

“UniServices is very proud to be involved in the development of a product which will have such a significant impact on so many people. As the largest commercialisation company in Australasia, and wholly owned by The University of Auckland, it is inventions like this which allow us to say we are the start of something big,” said Peter Lee, CEO, Auckland UniServices Ltd.

Coopervision has named the lens MiSight to signify the responsibility and ownership of contact lens wear and myopia control for young people. It’s recommended that MiSight is used as part of the Myopia Management System to proactively manage young myopes, or young people at risk of becoming myopic.

MiSight is made from the proven Coopervision Proclear (omafilcon A) material and is a daily disposable lens making it ideal for children – easy to take care of with no cleaning, disinfection or worrying about lost lenses. It is currently available in Hong Kong in powers of -0.25 to -6.00D.

Nicola has successfully completed her thesis and her PhD degree will be conferred in May 2010. Dr Phillips will be presenting the results of their clinical trial at overseas meetings this year, including ARVO, BCLA and the International Myopia Conference in Germany.

For Dr Phillips the process has gone a full circle and his interest in myopia development is very much an ongoing project.

“We have developed a system that slows the progression of myopia but we really need to know why so many children are becoming myopic, with a view to preventing it developing in the first place. This involves understanding the various biochemical pathways in the eye and what triggers them to cause abnormal eye growth in myopia.

“The next generation of research might well suggest that we should change lifestyle, particularly of children, to prevent myopia development. At the moment we have gone back to working with animal models, looking at the fundamental issues of light exposure and drugs that may act in the eye to prevent myopia development. We are also looking directly at the effect of outdoor light exposure in children and whether this might have a beneficial effect, as has been suggested by a recent Australian study,” he said.

Under Dr Phillip’s leadership the Myopia Laboratory has developed a comprehensive portfolio of research said Professor Paul Donaldson, Head of the DOVS.

“This includes the genetic and epidemiological basis of myopia, functional and structure studies of myopia induction in experimental models and now clinical solutions to slow the rate of myopia,” he said. “John is one of only a few academics at the University of Auckland who has successfully translated their research into a commercial product, and should be congratulated on this personal milestone. He also needs to be commended for his ongoing mentorship of the young researchers in his group, since in the last two years, three optometry graduates have completed PhD projects under John’s supervision.  I am confident that these young people have a bright future in academic optometry in New Zealand.”

Coopervision decided to do a limited launch in Hong Kong to better understand the market and the communication tools practitioners require to talk to parents and children about myopia and myopia management.

MiSight is to be launched in other markets around the world including New Zealand, but no dates have yet been set.

From left: Raj Maiti, Jian Li, Ankita Umapathy, Erin Tan, Will Ikink, Sophie Chan, Brian Granger with Trevor Sherwin who organised the event

“It has been a bumper year for students in our labs,” enthused Professor Trevor Sherwin who chaired the event. “The students have been an absolute pleasure to be around; they have been hardworking, intelligent and industrious.

“It is appropriate that now we have the NZ NEC well established and a considerable number of students in the programme that we hold a symposium to give the students an opportunity to present what they’ve been doing all summer.”

Professor Charles McGhee and A/Professor Rob Jacobs judged the presentations based on clarity, content and style.

“The first summer student symposium was really excellent,” said Professor McGhee. “All the speakers were entertaining and the projects were so diverse. It’s a real testimony to the benefits of bringing the professions and disciplines together and it was therefore very difficult in deciding on a winner. In the end, however, we did come to a unanimous decision, Ankita Umapathy.

“From this symposium we can see that some of these projects will turn into bigger projects and several will ultimately turn into scientific papers. I believe we’re seeing the future of ophthalmology, optometry, and visual sciences here today.”

Following is a brief synopsis of each of the student’s projects:

Ankita Umapathy Molecular Vision Laboratory

Cystine Supplementation – can it reduce oxidative damage to cataractous rat lenses?

Supervisors: Dr Julie Lim, Professor Paul Donaldson

Age related nuclear cataract is the leading cause of blindness in the world and is associated with oxidative damage to the lens. In the young lens, such damage is minimised by high levels of antioxidants.  However, with increasing age there is a significant depletion of antioxidants specifically in the lens centre making proteins in this region especially susceptible to oxidative damage. The aim of my project was to determine whether supplementation of cystine to the rat lens was protective against oxidative stress and therefore effective as an antioxidant.  I developed an in vitro model of nuclear cataract by incubating rat lenses in sodium selenite supplemented with or without cystine. My results revealed that with the addition of cystine, there was not only a reduction in lens opacity but also a 28.6% decrease in malondialdehyde, an end product of lipid peroxidation suggesting that cystine was protective against oxidative damage.

Brian Granger Department of Ophthalmology

Connexin 43 expression in the optic nerve head following retrobulbar optic nerve injury

Supervisor: Professors Helen Danesh-Meyer and Colin Green

My research investigated how traumatic optic nerve injury leads to changes in the histology of the optic nerve head. This involved using two rodent models of optic nerve injury developed previously by graduate students in the Department of Ophthalmology – Dr Taras Papchenko and Dr Shenton Chew.

We were interested in seeing what if any changes were occurring in the nerve head region, given its known importance in non-traumatic optic neuropathies such as glaucoma. We found that there are are indeed reactive changes in astrocytes (the inflammatory cells of the central nervous system) within the head region of the optic nerve far removed from the local changes which occur at the site of injury. These changes are mediated by gap junctions between astrocytes containing the protein Connexin 43, which is the target of the novel anti-inflammatory agent Nexagon developed by Professor Green in previous work investigating central nervous system injury.

Erin Tan          Department of Optometry & Vision Science

Blurring the boundaries: taking aim at myopia

Supervisors: Drs Simon Backhouse and Ben Thompson, Andrew Collins

We investigated the effect of differing visual demands on the blur adaptation response of myopic and emmetropic subjects.  Participants were binocularly blurred by +1.00D for one hour while playing either an action video game (visually demanding) or a non-action video game (less demanding).  Sinusoidal grating and Bailey-Lovie logMAR acuity measures were made before and after the adaptation period.  Blur significantly decreased logMAR acuity in both groups (greater decrease in myopes).  Both groups showed equal blur adaptation over one hour (improvement in logMAR acuity).  On removal of the blur myopes returned to baseline acuity while emmetropes showed a blur after-effect (logMAR acuity significantly better than baseline).  The type of video game had no significant effect, and there were no changes in grating acuity. The failure of emmetropisation in myopes may be related to the differential logMAR blur adaptation response of this group.

Sophie Chan     Department of Ophthalmology

Understanding angiogenesis in the cornea

Supervisor: Associate Professor Trevor Sherwin

We aimed to determine the angiogenic growth factor/inhibitor profile for the peripheral cornea and limbal transition zone in normal human tissue, and to compare it with neovascularised human cornea.

Using angiogenesis antibody arrays which screen 43 angiogenic molecules, significantly greater levels of angiogenin (P < 0.044) and interleukin-8 (P < 0.044) were demonstrated in the neovascularised cornea compared to normal limbal and peripheral cornea. Interestingly, no significant differences (P < 0.05) were found between levels of the factors screened for in normal limbus compared to normal peripheral cornea. With immunohistochemical staining, angiogenin and vascular endothelial growth factor were strongly positive in vascular endothelial cells, and weakly positive in stromal keratocytes and corneal epithelium.

Our results suggest that drugs that block a range of angiogenic molecules, including angiogenin and interleukin-8, may be the future of anti-angiogenic therapy for corneal neovascularisation.

Luzinda Lo     Department of Optometry & Vision Science

The effect of infection-sensitised hypoxia on pre-term fetal sheep retina

Supervisors: Drs Ellen Knapp and Monica Acosta, Professors Alistair Gunn and Laura Bennett

In an effort to investigate the impact of environmental toxins on fetal pre-term retina, the eyes of fetal sheep exposed to simultaneous damage from asphyxia and lipopolysaccharide (LPS) were obtained. The central retina surrounding the optic nerve, being rich in blood vessel supply, was the first area analysed. Visually we have seen through immunocytochemistry that Glial Fibrillary Acidic Protein (GFAP) is less upregulated in our experimental model compared with studies featuring LPS bolus alone, suggesting that reactive gliosis caused by LPS is occurring to a lesser degree in our experimental model. The results indicate that no other morphological changes affect central retina in the animal model of complications of prematurity.

Jian Li             Department of Ophthalmology

Mutations in the VSX1 gene in a New Zealand Dystrophy Population

Supervisor: Dr Andrea Vincent

The VSX1 gene, a transcription factor, has been implicated in the pathogenesis of Keratoconus (KC) and Posterior Polymorphous Corneal Dystrophy (PPCD). Although initial studies found mutations in this gene in PPCD and KC, an equal number of studies have failed to detect mutations in these disorders. The study aim was to determine the genetic contribution of VSX1 in KC and PPCD in our New Zealand cohort; a total of 58 patients (Keratoconus=43, PPCD=10) underwent VSX1.screening by High Resolution Melting and DNA sequencing.  1 previously reported mutation was identified in a Keratoconus patient (2.3%).  This mutation was previously reported in keratoconus. 4 other non-disease causing changes were also found. Therefore VSX1 plays a minor role in the pathogenesis of KC and PPCD in a New Zealand, and therefore is consistent with other studies suggesting there is a population specific contribution of VSX1 to disease.

Raj Maiti         Department of Optometry & Vision Science

Colour vision of bees

Supervisor: Dr Misha Vorobyev

Do honeybees use chromatic or achromatic vision to find their hive? Using a Y-tube entrance hive entrance, we trained honeybees to discriminate dark yellow (entrance open) from light blue (entrance closed). We then tested the bees with light yellow and dark blue colours. We calculated quantum catches of the honeybee photoreceptors and predicted that, in the test, the bees would prefer light yellow if they relied on chromatic cues and dark blue if they relied on achromatic cues. Bees preferred light yellow, indicating that they used chromatic vision. In additional experiment, we tested whether the bees preferred light yellow or dark yellow after being trained to dark yellow against light blue. Interestingly, the bees preferred light yellow indicating that bees prefer colours with high luminance.

Will Ikink         Department of Ophthalmology

The role of corneal topography in the clinical diagnosis of Marfan syndrome

Supervisor: Dr Andrea Vincent

The aim of our research was to determine the corneal thickness, curvature and anterior chamber depth (ACD) in patients with known and suspected Marfan syndrome, use the Orbscan and Pentacam. An abnormally flat cornea is a minor criterion in the current diagnostic criteria for Marfan syndrome, a connective tissue disorder affecting primarily the cardiovascular, skeletal and ocular systems.

Despite this, corneal curvature is not effectively used in clinical practice as a definite cut-off value indicative of Marfan syndrome has not been clearly established.

Preliminary results from Orbscan System  readings show that the average corneal curvature in patients from our study with a definitive diagnosis of Marfan syndrome was 40.95 diopters (D) as compared with 42.89D in the control group, which was statistically significant (p=0.0007). Mean ACD and thickness were similarly decreased however this was not statistically significant.

These findings suggest keratometry should be a routine examination in the ophthalmic work up of suspected Marfan patients.

Looking over the March issue of NZ Optics are from left: Evon Chan, Clifford Kam and Linda Ea

“Personally I get a lot out of the NZ Optics magazine. I particularly find the articles regarding certain conditions and their management very useful and often from a different ophthalmic perspective than we are used to. Because the articles are from leaders in their fields, the information is up to date and relevant and is a good way to keep our knowledge base as current and accurate as possible.

“It is also great getting an insight into the optical industry and the goings on as we prepare ourselves to graduate at the end of the year,” said final year student, Alex Petty.

Part 4 Student Representative, Preshodin Thaver, surveyed approximately one third of the class on what they read first.

“Everybody I spoke to reads the Eye on Ophthalmology and Point of View articles as well as the other pathology related articles. Most of us work part time in an optometry practice and have accessed these articles for some time now,” he said.

Preshodin commented that the general consensus was that almost everybody appreciated the fact that they could keep up to date with what’s happening in the industry.

“I do believe that Essilor’s and NZ Optics’ initiative for us to receive the magazine plays a key role in introducing us to Optometry outside of University,” he said.

John McLennan

The Optometrists and Dispensing Opticians’ Board Chairman John McLennan said as of March 16, less than five per cent of all APC holders (approximately 30 optometrists) were still to meet the recertification programme requirements. Of these, almost half are of retirement age, however not all have informed the Board whether their intention is to retire or not.

“We are getting daily changes as more practitioners achieve the requirement.  The Board has already communicated with these practitioners about what is likely to happen if they do not meet requirements by the time their current APC expires. Decisions will be made by the Board on a case by case basis,” he said.

Optometrists first started administering certain diagnostic drugs in 1996 when statutory permission was given in an amendment to the Optometrists and Dispensing Opticians Act. Since 1991, graduates from the Department of Optometry & Vision Science (DOVS) at the University of Auckland have been educated to use DPAs.

With the introduction of the HPCA Act in 2004, it was a function of the Board to assure the Minister of Health that all optometrists were competent. At the time the Act was introduced 242 optometrists had graduated DPA qualified from the DOVS and a further 133 optometrists had completed the Certificate in Ocular Pharmacology, a total of 70% of the current APC holders at the time. At that stage optometrists who did not have the qualification were given five years to become certified.

In the last five years, after seeking advice from the General Optical Council in the UK, the Board granted an exemption to the written component of the DOVS Endorsement in the DPA programme, mainly to registered MBCO and MCOptom holders from 1980 and thereafter. This also applied to several British and South African optometrists that are practising in New Zealand. There was also a practical component which some were required to complete, if exemption criteria were not met.

Mr McLennan said the Board has bent over backwards in the last five years to get all practitioners up to the required level.

“The Board has financially underwritten two courses run by the DOVS which were under-subscribed. We have encouraged people to do the course, and the fact that some have chosen not to do it, is quite disappointing. The Board has constantly reminded people of the deadline and we are confident that most will make it,” he said.

Despite the fact that at least 10-15 practitioners will not have their APC renewed, Mr McLennan said he does not believe this will create a short-term shortage of optometrists.

“Our role is to assure the Minister, and the public, that all optometrists are competent.”

Asked if it is likely that the TPA (Optometrist with Therapeutic Pharmaceutical Agents Endorsement) qualification will become mandatory for practising or remain as an optional extra for those who choose to do therapeutics, Mr McLennan said it has not been discussed by the Board.

“Our focus has been on ensuring that all the optometrists who needed to become DPA qualified, did so. However, at the new registration level, as far as graduates go, every graduate from Auckland and Melbourne universities is now TPA qualified. Within the next couple of years all the graduates from the other Australian optometry courses will also be TPA qualified. Definitely at that point all new graduates will have this qualification so it will need to be reviewed to see what the profession wants,” he said.

Ernest Khoo with a young patient

Run in conjunction with the local Thailand partners, the mission ran over two weeks in early December last year and tested a staggering 17,000 patients over a period of eight days.

The opportunity to be part of an international OneSight clinic is a chance of a lifetime for a young optometrist, providing not only an eye-opening and humbling experience, but also the chance to interact with a community of like-minded eyecare professionals from around the world.

The only Kiwi on the mission, Ernest was one of 12 optometrists who made up a team of 45 in total, including a number of optical dispensers, who all worked together to examine and dispense a huge volume of recycled and new prescription spectacles and plano sunglasses.

Patients travelled from nearby towns and villages, some covering distances of up to 16km on foot to arrive by 7am at the clinic, which was held in a local stadium in order to accommodate the 2,000 plus patients seen by the team each day.

Having been given registration cards on arrival, patients initially waited in a ‘pre-dilation area’ before being moved through for auto-refractive tests and an ophthalmoscope exam. Patients who needed further examination were referred to the local ophthalmology department at Phayao Hospital, and the remainder were sent through to the ‘scripting area’ where they were seen by one of the optometrists to determine their prescription and discuss which type of optical correction best suited their needs.

Once final prescriptions were ascertained, they were entered into a computer system which found the closest possible match from the recycled spectacles available, and once chosen, patients were directed to the ‘dispensing area’ where their new spectacles were fitted and their visual acuities checked. Also on hand were new rading glasses and specially designed frames called ‘Chabella’, round ‘Harry Potter’ style spectacles that make axis rotation straight-forward for patients who require an exact match.

Overall the clinic saw a wide range of prescriptions and pathology such as diabetic retinopathy, retinitis pigmentosa, toxic maculopaties and hypertensive retinopathy among many others. By the end of the eight days of intensive examinations, over 400 patients were referred on for further testing.

Ernest found the Thai people to be extremely grateful, patient and friendly, especially considering the average wait time was around three hours.

“I remember meeting a 14-year-old girl who had a -14D prescription and had never had any form of optical correction. It was incredible to see the look on her face as she was fitted with her first pair of spectacles. I’ll also never forget the delight of three elderly life-long friends who were able to see each other clearly for the first time – it was a very humbling experience,” he said.

Despite the hectic pace of the clinic, it was bittersweet for Ernest to leave for home.

“There were a huge range of emotions as people were all exhausted and ready to head home, but we were also reluctant to leave the community that had made us feel so welcomed,” he said.

Calling the trip one of the highlights of his year, Ernest says he wouldn’t hesitate to do it all over again, and highly recommends the experience to other eye care professionals. However on a smaller scale, he feels that one of the most vital lessons learned is the importance of spreading the message of recycling usable spectacles, whether by donating them at OPSM stores or through relevant charities.

Aspects of the Prime Minister’s speech (9 February 2010) will have been welcomed by property investors.  Mr Key confirmed that there will be no land tax, and no comprehensive capital gains tax.  The proposed “risk free return” method for calculating rental profits will not be implemented.  However, (at this stage, unspecified) measures will be introduced to change the way that income from rental properties is taxed.

The inference is that an unfair tax system treats property investment more favourably than other investments and that skews investors’ preferences towards the property market to the detriment of other sectors.  It is worth considering those claims and reviewing whether or not an investment in property really does have tax advantages compared with alternatives.

For the purposes of this exercise, a comparison will be made between investing in a residential rental property, investing in shares and investing directly in a business.

Income

Regardless of the form of investment, all income is subject to tax. For a rental property, that income takes the form of rent received from tenants. For shares, the income stream comes from dividends paid by the company. Business income is earned through the sale of goods and/or services.

Financing costs

An investor will often have to borrow money in order to fund the purchase of the income-generating asset, whether that be a property, shares or a business. In each case, the cost of interest incurred is a deductible expense. For the property investor, the cost will be mortgage interest. For the business owner, it will be the interest paid on business loans. Even the share market investor is entitled to a deduction for interest on funds borrowed to buy shares, on the basis that the shares will produce dividend income.

Cash expenses

A very broad rule of thumb is that if you have to spend money to help you earn money, the expenditure can be deducted against the income earned when calculating the tax liability. For the share investor, those costs may include management fees charged by an advisor. For the business owner, the costs will include materials, wages and overhead costs. For the property owner, the costs include rates, insurance and repairs. The rules are the same regardless of the type of investment.

Depreciation

A business owner will use fixed assets, such as machinery, computers and office equipment, to help generate income. An up-front deduction for such long term assets is not allowed. Instead, a depreciation claim can be made, based on rates set by Inland Revenue. This recognises the diminishing value of these assets over time.

The same is true for a property investor. Although land cannot be depreciated, other assets, such as appliances, furniture and carpets, can be claimed. Depreciation can also be claimed on buildings. That is contentious – mainly because buildings have generally increased in value over time. However, that is a result of the market at work; people are willing to pay increasing amounts of money for an asset despite the fact that it actually does physically deteriorate over time. A property investor is therefore allowed a tax deduction today for a notional expense that is likely to never actually materialise. What critics generally tend to overlook is that if an asset is sold for more than it’s written value, the amount previously claimed as a deduction becomes taxable income in the year of sale (“depreciation recovered”). At worst, depreciation on buildings amounts to nothing more than an interest free loan. If the evidence is that buildings do not decline in value, then there is an argument to support a depreciation rate of 0%.

Shares are not depreciable property, so no deduction is available.

Capital gains

If a business is sold for more than the book value of the net tangible assets, through the recognition of goodwill, the capital gain that is earned is generally not taxed (although any depreciation recoveries will be).

The same applies to a share investor. Capital gains earned on the sale of shares are generally not taxed, provided the investor did not acquire the shares with the intention of selling them for a profit and provided the investor is not in the business of buying and selling shares. Those with longer memories may recall that a number of investors sought “dealer” status following the share market crash of 1987.

Again, the same rule generally applies to property investors. Provided they do not buy a property with the intention of selling it for a profit and provided they are not in the business of dealing in properties, any capital gain will be tax free. In fact, the rules applying to land investments are harsher than those for other investments. That is because an investor can be “tainted” as a dealer in property because of their association with another person. In other words, a property investor may have to pay tax on what would otherwise be a tax free capital gain, not because they are in the business of dealing in property but because someone else that they happen to be associated with is.

Tax rates

The tax rates that apply to various entities (eg companies 30%, trusts 33%, individuals up to 38%) apply regardless of the activity of the entity.

Loss Attributing Qualifying Companies

LAQCs have a special tax status that allows losses to be passed through to shareholders. That has often made them the target of property investment critics.

The use of LAQCs has become so prevalent that many property investors believe that they need to use one to be able to use tax losses arising from their investment. Such claims are unfounded. Losses are able to be offset against other income even where a property is held in an individual’s name. The advantage of using an LAQC for property investment is generally limited to only a couple of specific situations. LAQCs are appropriate for situations other than property investment; simply abolishing them would be disruptive and inappropriate.

Conclusion

New Zealanders have long had a love affair with the property market.  That may be due to the comfort of being able to see and touch the tangible or the perceived stability of prices.  However, there are factors other than taxation that drive investment choices and it is unfair to point the finger at the tax system in isolation.

The current tax rules generally apply equally to all investments regardless of type.  In some cases, that may be inappropriate, such as the case for depreciation on buildings.  In other cases, property is subject to more onerous rules than that faced by alternatives, as is the case with capital gains “tainted” by association.  We will have to wait until the Government delivers its budget on 20 May to find out the specifics of the changes to be made to the taxation of property.  Whether that will be denying depreciation claims or ring-fencing losses, it will lead to further distortions in the way that property is taxed compared to other investments.

- ends -

Further enquiries, please contact:

Geordie Hooft

T +64 (0)3 379 9580

M +64 (0)21 670 330

E geordie.hooft@nz.gt.com

*Photo from the Eyez Launch party

Eyez is a not-for-profit organisation and was founded by two passionate New Zealand health professionals with the aim of providing an online community and resource to help support:

1. Optometrists
2. The transition from Senior Optom Student to professional

Being an Optometrist can be stressful and challenging. Eyez looks to bring together resources to make life as an Optometrist easier. These resources come in the form of informative blogs, active forums, resources on organisations, video interviews, Current Optom vacancies (coming soon!) and much more. The Eyez founders found that by providing these resources Optometrists would be less inclined to make the mistakes of their predecessors.

Eyez promotes:

1. A work/ life balance
2. Empowerment of Optometrists in career progression and career decisions
3. A cohesive and supported New Zealand wide Optometry community

Eyez is not just online- Eyez organises regular events, which have grown from just in Auckland to, currently being held in Auckland, Hamilton, Wellington and Christchurch. Eyez is also looking to expand these events further afield and the aim is for every Optometrist in New Zealand to have an Eyez event to attend.

*Photo from the Eyez Launch party

Eyez also relishes regular feedback and input from our members. After all, Eyez was made by Optometrists for Optometrists and the decisions that are made on new modules and initiatives are nearly always founded from an idea from a New Zealand Optometrist.

If you have any comments or feedback for Eyez please contact the Hamish Macdonald, the Eyez manager, on Hamish@eyez.co.nz.

The two teams from Wellington and Otago with the adjudicator and event sponsor. From left: Andrew Black, Gordon Sanderson, Roger Apperley, Geoff Sargent, Jack Crawford, Greg Nel and Laurence O’Connell with Tom Frowde from Essilor who sponsored the event

No NZAO Conference would be complete without the annual entertaining Alan Styles Memorial Debate. Jack Crawford, debater extraordinaire, optometrist and partner at Fairmaid, Chance & Crawford in Dunedin participated in the debate and presents here a fairly unbiased and balanced view of the event.

The moot this year was that ‘there is always more than one way to interpret an optometrist’s prescription’, with Wellington arguing the affirmative. Adjudicator, Roger Apperley, revealed his North Island bias early in the fray by trying to unsettle the Otago team by stating that ‘Otago and negativity don’t go together’. He otherwise performed his task with aplomb and not just a little flair.

Wellington team leader, Geoff Sargent, opened with a predictable grovel to the audience and summarised his contribution by stating that optometrists are effectively ‘interpretating’ (sic) prescriptions as part of their daily lives. This after having defined ‘interpreting’ and ‘prescription’ in a manner destined to suit his line of reasoning.

Assoc Prof Gordon Sanderson, leader of the negative team, also chose to enter the definition battle, pointing out that ‘always is an absolute, allowing no room for exceptions’. The debate was therefore effectively over, in Otago’s steady hands. He pointed out to an audience, who could not have guessed, that he was ‘approaching middle age’ and had investigated alternative ways to further his career. He had tried a variety of practice modalities, each of which allowed no opportunity for other optometrists to interpret his prescriptions. He tried iridometry, he tried optometry counselling (for those distraught souls who had lost their contact lenses or specs), he tried complementary optometry, and had developed a virtual visual exam.

Greg Nel, for the affirmative, described Gordon as one of the ‘grandfathers of optometry’. This created a brief exchange where Gordon had to reassure Greg that, as far as he could recall, he was not Greg’s grandfather. Greg built on Geoff Sargent’s premise that prescriptions coming to an optometrist always require at least some interpretation – changing plus cyls to minus etc. Therapeutic pharmaceutical prescriptions allow generic substitutions, which may not always feature the same efficacy.

As second member for the negative, I pointed out that if my (or any of my colleagues’) prescriptions always require interpretation it doesn’t say much for the coherency of our prescribing skills. I also paralleled some real life examples (the armed forces, and Andrew Black’s chaotic personal life) where commands or social instructions respectively could be seen realistically as ‘prescriptions’ and where any attempt to ‘interpret’ said prescription would result in unmitigated disaster. Interpreting a prescription is effectively ‘re-prescribing’ with all the responsibility that that entails.

Andrew Black continued the Wellington grovel theme, this time with Judge Roger in the frame. He accused the Otago team members of being relics from a bygone era, who are still into ‘full time occlusion of amblyopes’. He then fruitlessly enlisted assistance from the Almighty in quoting from the Bible; John 8 Verse 7 (look it up). If that wasn’t enough he quoted a passage from the HPCA Act, claiming that it bolstered Wellington’s case.

‘Laurence of Alexandra’ expressed concern about the misuse and misinterpretation of optometrists’ prescriptions in this age of ‘conversion rates’ and short-term gain through the emphasis of spectacle sales. The Otago team were at the cliff top to ensure that the mantra of patient care and welfare reigns supreme against this commercial mire, a mire often perpetrated on-line by semi-literate operatives. He reminded the audience (as if he needed to) that members of the Wellington team go to family reunions to meet girls. And, just to ensure that the audience was awake, ‘Which dinosaur had two heads, two tails and 8 legs?’ A Diplopiasaurus.

For the negative, A/Prof Sanderson summed up by suggesting that Geoff Sargent was a congenital optometrist who has eccentric fixation … but he was not prepared to share just what this fixation actually is. He showed us the nature of Greg Nel’s ‘half-priced glasses’ ie: a monocle. He continued with his personal journey sampling alternative modes of practise (having been interrupted earlier by Judge Apperley’s strict timekeeping); he had joined the NZ Assn of Alternative Optometrists, who offer a variety of herbal remedies, including Prozac for Amblyopia and Viagra for Hyperopia. There is only one way to interpret these prescriptions – ‘enjoy!’

Finally, Geoff Sargent summed up by affirming that, in his mind, there exist numerous ways to interpret prescriptions. In fact, there is a high risk to the prescriber who is too prescriptive; implicit that any reasonable optometric prescription will require a degree of interpretation. He branded the Otago team as intractably archaic in their reasoning. Further, he crudely reminded Laurence O’Connell that his reliance on the high-tec and computers was because in Central Otago girls are so scarce that there are unlikely to be any, even at family reunions. Optometry is an art as much as a science, he concluded.

Judge Apperley, having asked the crowd to vote by acclamation then stated that this was ‘unhelpful’ despite their resounding support for Otago.

And indeed it was to be, once the points were added up – Otago won by a slender head. Thus it will go down in the annals of the NZAO ‘there is NOT always more than one way to interpret an optometrist’s prescription’.

Thanks to all involved, and especially to Essilor, represented by the urbane Tom Frowde, who sponsored the Debate and the associated social frivolities and trappings. O

Thank you to NZOptics for allowing Eyez to use this article

In his address to open the 79th annual conference of the New Zealand Association of Optometrists, Professor Paul Donaldson, Chair of Optometry and Vision Science, said there needs to be strategic initiatives put in place to achieve this goal. He outlined some of the challenges to achieve this including how it could be resourced and what it will mean for the profession.

“This can be achieved by a combination of more domestic undergraduate students, foreign fee paying students and/or an increase in post-graduate courses for practising optometrists, potentially in specialist areas of optometry care.

“What we are trying to do is raise the bar to achieve our ultimate goal of being an internationally recognised research-led teaching institute that produces high quality optometry graduates. As life-long learners these graduates will remain connected to their alma mater and therefore will be more fully equipped to fulfil roles as primary eye care providers in a health sector that is bound to change in the future,” he said.

Professor Donaldson said the University needs feedback from the profession on some of the strategic directions planned. He stressed that changes will not come at the expense of clinical care.

Collaboration, employing the best people and expanding clinical and research staff are the key components to becoming the premier School of Optometry and Vision Science in Australasia.

“The people, as in any organisation, are the key. Currently we have some very good people who work very hard to train the next generation of optometrists. The problem is we don’t have enough of them and it can sometimes be difficult to keep them. To get the best out of good people you need the right environment and to understand that, you need to understand how the University works and how the University measures the success of its individual academics and the Departmental academic unit.”

Professor Donaldson said if you likened the Department to a business unit, it needs to strike a balance between teaching and research, both of which produce revenue streams that contribute to the Department’s ability to grow. At the same time, he needs the profession to determine what it needs in terms of capacity and work force training, both for the traditional private practice and for future roles in the public eye care sector.

“My point here is, as a department, we need to grow student numbers if we are to get the necessary resources to build our human capital and capacity to more fully engage in research and with the profession. Like any business, if we don’t grow our income streams and our fixed costs increase, we will become unprofitable and unable to fund growth. The key is getting the right growth strategy so I would welcome input and comment, since there is no point increasing student numbers if there are no jobs or putting on courses that no one wants to take,” he said.

Another revenue stream is via external research income.

“If teaching revenues are the bread and butter of a Department then research income is the icing on the cake. It brings not only income but extra positions, graduate students and prestige to a Department.”

He gave examples of recent successes such as Dr Ben Thompson’s Marsden Fund grant for research into amblyopia which will increase the number of people in the Department with 2 PhD students, a research technician and a post doctoral fellowship for Joanne Black, an optometry graduate who is completing her PhD Another success is John Phillips’ Myopia Research Lab that has produced, to date, three optometrically qualified PhD students with a fourth having just started. One of these graduates, Simon Backhouse, is the inaugural recipient of the NERF Post Doctoral fellowship.

“So research success is more than dollars in the door, it grows your pool of people and once you have the people you can do more than tread water, you can actively seek new opportunities to further grow the Department, the people within it and the relationships with the profession and the general community.”

Research success is also the key for academic advancement. Since research productivity is considered by the University’s promotion system as an objective measure of success, it is the main driver of career progression. The inability of academic staff members to advance their research careers in a teaching intensive course like Optometry has been a major impediment to staff retention and morale. Also research success can be infectious and improves the departmental environment which makes it easier to recruit excellent staff.

Change is also going to be needed in the way the Department approaches clinical optometry research.

“As well as more clinical teaching and research capacity, we need a change in approach. This will require a move away from small research projects led by individuals to bigger team based projects which can provide salary support for clinical researchers. This clinical research needs to be framed so that it supports and develops the professional standing of clinical academics and informs our clinical teaching,” said Professor Donaldson.

The Department is currently advertising for an Associate Professor in Children’s Vision to grow its expertise in this area. This position will complement on-going vision screening conducted in schools by the optometry students and could lead to the development of an ambyopia clinic that would support the basic research being conducted by Ben Thompson.

Professor Donaldson elaborated on the New Zealand National Eye Centre and the extremely positive influence it has had on the culture of the Department as the catalyst for many joint research projects and collaborations.

“This spirit of cooperation between optometry and ophthalmology can only grow stronger as the distance between the two Departments will physically diminish in 2012 as part of the Grafton redevelopment plan which will see the DOVS occupy new premises that will include a shared clinic facility.”

Another area Professor Donaldson would like to pursue is working more closely with private practices to enable optometry students to have increased exposure to sub-specialities.

“To achieve this we would like to engage with practitioners to investigate possibilities of establishing student training places to increase student exposure to low vision patients, contact lens fitting and paediatric optometry. This is more than just our current externship programme, it  is more of a partnership in which we seek practices that could become affiliated with the University as official training sites. Again the key would be how to resource it.”

Before officially declaring the conference open, Professor Donaldson said the future of DOVS is very bright.

“By increasing our research profile we have effectively begun to develop the next generation of optometry academics. We have identified strategies for growth and we are emerging from our ivory tower and endeavouring to engage more effectively with the profession.”  O

Thank you to NZOptics for providing this article for Eyez to use.

The patient originally had surgery for removal of corneal ‘fibromas’ at the age of one year and subsequently had x-ray therapy performed at the age of two. She developed radiation cataracts and had the right cataract removed at the age of 5. Her vision at that time improved to 6/24. The left eye was considered amblyopic and was not operated on.

In 1980, her vision had deteriorated markedly and her right best corrected vision was only 6/26 while the left vision was hand movements vision only. She was found at that time to have dry eyes, dense corneal opacification with vascularisation and a dense left cataract.

In 1991 she had a left penetrating keratoplasty, cataract extraction and anterior vitrectomy. Her postoperative course was uneventful, but vision did not improve beyond CF vision.

By 1996 her right vision had deteriorated to 6/60 and in 1996 she had a penetrating keratoplasty performed. Her postoperative course was uneventful, but vision never improved beyond about 4/60 due to corneal epithelial irregularity.

In recent years, she has had problems with poor vision and ocular discomfort due to a poor ocular surface. Her current ophthalmologist Dr Andrew Logan, felt that performing a further keratoplasty would not offer much chance of improved vision.

“Her existing right graft had a relatively clear stroma but the graft epithelium was very irregular and normal limbal architecture was absent, probably from loss of limbal stem cells due to the previous radiotherapy. However her aqueous tear production was normal,” he said.

After extensive discussion with the patient, the decision was made to proceed with insertion of a Boston keratoprosthesis.

The surgery was performed uneventfully at the end of June this year and the results exceeded Dr Logan’s expectations. At one day postoperatively, her unaided acuity was 6/24. Since that time her postoperative course has been uneventful and by September her unaided acuity had improved to 6/18.

“Whereas traditional donor corneas take six to 12 months to get reasonable vision, she was able to see almost straight away. The patient is able to read, do her Sudoku and has greatly improved visual independence. Her right eye is almost certainly amblyopic and she has probably reached her ultimate visual potential,” said Dr Logan.

The Boston keratoprosthesis has been developed since the 1960’s by Dr Claes Dohlman at the Massachusetts Eye and Ear Infirmary, and received FDA approval in 1992. It has become the most widely used keratoprosthesis in the world. About 3,500 of these devices have been implanted since 1992.

In 2005 less than 200 were implanted, while in 2008 over 900 were implanted, most in the USA but with increasing numbers used elsewhere.

Dr Logan said implantation of the Boston keratoprosthesis is not particularly difficult and requires a similar skill set to penetrating keratoplasty.

“The device is inserted into a 3mm central hole in a conventional corneal donor graft button, which is then sutured into the donor tissue in the same manner as a conventional graft. Patients require long term follow up and must wear a large diameter extended wear soft contact lens and use long term prophylactic antibiotics,” he said.

The Boston keratoprosthesis has a number of advantages over other current corneal prostheses. It is not excessively expensive (currently US$3,000), is a one stage procedure not requiring a new skill set, has very good statistics for long term survival and has relatively few contraindications.  Patients with autoimmune diseases such as ocular cicatricial pemphigoid or Stevens-Johnson syndrome, very severe burns or longstanding uveitis are generally not considered suitable for the Boston keratoprosthesis.

Generally, indications that a patient is suitable for a Boston keratoprosthesis include; one or two failed grafts with poor prognosis for further grafting, vision less than 6/120 in the affected eye with less than optimal vision in the opposite eye and no end stage glaucoma or retinal disease.

Even with this new procedure, a donor cornea is still required to create the base for the graft, but work is under way to create a completely artificial cornea.

Dr Logan now has one other patient waiting for the operation. O