2015: Breaking into the Year Ahead

Over the next 11 months, eye health professionals will adjust to new funding models, collaborate across professions and witness some exciting medical breakthroughs. Yes, the economy is most likely to remain flat, but with new strategic directions, a focus on differentiation and a commitment to further improving patient outcomes, 2015 could well be your year of growth and opportunity.

Discovery

What medical breakthroughs do you believe will impact eye health in 2015?

Dr. Jim Kokkinakis, optometrist, The Eye Practice: “Anti VEGF therapy for macular degeneration will transition from an injection every month or two to a single slow release implant that might need replacing every five years or so. Currently the burden on the patient, the carer and the taxpayer is huge.

… stem cell transplantation, maybe even genetic intervention, will transform eye care

“Retinal prosthesis and direct stimulation of the visual cortex will give the blind some form of useful vision. And stem cell transplantation, maybe even genetic intervention, will transform eye care. Hopefully we will see this within the next 10 years.”

Dr. Michael Lawless, ophthalmologist, Vision Eye Institute: “In 2015 ophthalmologists will finally build posterior corneal astigmatism into their intraocular lens calculations because of the work of Doug Koch, but in particular two Australians, Graham Barrett in Perth and Michael Goggin in Adelaide. These formulae will be part of our routine calculations and make toric intraocular lens selection more accurate for the benefit of patients.

“2015 will be the year that SMILE becomes mainstream in Australia and gradually replaces LASIK, the first big corneal refractive change in a decade.

“The profession will continue to debate the cost effectiveness of treatments and whether bringing technology and incremental benefits are to be paid for by society or by individuals. This debate will become more acute as demand increases for sophisticated ophthalmology services.”

Dr. Margaret Lam, optometrist, the eye care company: “The advantages of trigger fish contact lenses will be recognised and there will be further developments in Google contact lenses. I believe there will also be greater customisation of contact lenses to meet the needs of patients with higher astigmatism. Also, keep an eye on emerging treatments for dry age-related macular degeneration.”

Dr. Brad Horsburgh, President, RANZCO: “Anti VEGF intravitreal injections, such as Avastin, are the greatest advance in ophthalmic eye care since phaco cataract surgery. The rise and rise of these treatment modalities will prove a boon for patients and at the same time a financial headache for the state and federal governments of Australia and New Zealand.”

Dr. Nicole Carnt, University of Sydney: “A keen area of my research involves genetic studies of complex conditions, such as corneal infections.

“Recently, I attended a Genetic Symposium, in which a cancer group had developed a sequencing chip to screen for breast cancer. The speaker noted the genetic changes that did not have a high confidence of association should be discounted and that there was a danger of mastectomy for many women for whom the risk of breast cancer was likely to be very low. There was quite a lot of debate in the room signaling that while there may be a lot we know, we still have quite a long way to go. Given the decrease in the costs of gene sequencing and the explosion of knowledge in this area, it may not be too long before we see many more discoveries that will facilitate truly personalised medicine and this will include eye health.”

Dr. Gerard Sutton, ophthalmologist, Vision Eye Institute: “I think the recent stem cell work in neural regeneration is promising. Olfactory ensheathing cells (from the nose) were injected above and below the spinal injury. It is early days but this research may have implications for optic nerve disease. I also think the Australian initiated new treatments for melanoma, which target the immune response, are exciting.

“In eye disease, Professor Noriko Koizumi and Professor Shigeru Kinoshita have successfully treated endothelial failure by harvesting endothelial cells, culturing them, and injecting them into the eyes of three patients, together with a special formula that includes ROCK (rho kinase) inhibitor (Y027632). The future of endothelial disease such as Fuchs dystrophy may be simply treated by an injection with no transplant surgeons whatsoever. This, together with the fact that keratoconus can now be successfully treated with crosslinking, means that we corneal surgeons may become redundant in the years to come.”

Richard Grills, Chairman, Optical Distributors and Manufacturers Association (ODMA): “The two outstanding advances I have seen in recent times in ophthalmic care are: Micro Stents for glaucoma – for example the “iStent” – and genetic testing for various hereditary eye conditions.

“The objective of the miniature iStent device, which can be implanted during routine cataract surgery or as a standalone procedure, is to improve aqueous outflow which reduces IOP and the patient’s reliance on medication.

“New and improved techniques and equipment for genetic testing will enable patients with a family history of an ocular disease; for instance, age-related macular degeneration, to be tested early in an effort to determine the probability of contracting the condition.”

Annette Hoskin, Lions Eye Institute University of Western Australia: “Extensive research to unlock the complex environmental factors associated with myopia continues. Key factors being investigated include the influence of light and the effect of outdoor activity and levels of education, with groups internationally conducting studies in this area. With links to levels of outdoor activity, children are being encouraged to spend more time outdoors. Research into safe outdoor exposure is being conducted by the Eye Protection Study at Perth’s Lion’s Eye Institute. This study targets sportspeople who spend time outdoors and looks at ultraviolet damage to their eyes and their eye protection habits.

“Research to understand the complex genetic and immune influences associated with eye diseases such as glaucoma, macular degeneration and myopia. Exciting developments in understanding the triggers for Sjorgen’s were recently discovered. Work will continue in 2015, with more targeted therapeutic treatments the aim. The development of animal models to understand abnormal functioning of the retinal pigment epithelial cells is enabling researchers to understand the changes that occur in the development of AMD and design strategies to prevent or delay its progression.”

Murray O’Brien, President, Australian Dispensing Opticians Association (Victoria): “Irrespective of advances in techniques such as refractive and cataract surgery, the market place for the reliable and easily implemented visual enhancement device called spectacles remains strong and will surely continue to remain that way. The ageing population has ensured continuing growth in the market overall even in the face of competition from the ready-made market and surgery. Both those forces are well and truly embedded so barring a massive and unexpected sudden leap forward in technology, one would be sticking their neck out to suggest otherwise.

“Clearly the optical dispensing sector itself will continue to change with online and corporate competition continuing to outstrip traditional independent optometrists and optical dispensers in terms of overall market share. In particular, health fund owned optical doors are likely to increase in number with them easily tapping into their massive patient databases.

“Those in the independent market will have to rely on market differentiation to promote their products and services if they are going to prosper. They will not only have to look different, they will have to be different in order to stay in the game.”

Government

What impact will government have on the delivery of eye care?

Genevieve Quilty: “We welcome the government’s decision to open additional access to regular eye care to Australians aged over 65, supported by Medicare, but regret its decision to reduce funding for optometry services to those aged 65 and under. Optometry Australia will continue to push to have this decision reversed as we believe that reducing public funding for this younger age group will impact negatively on the need to decrease the incidence of preventable eye health and vision issues.

Dr. Brad Horsburgh: “The current listing of Medibank Private is potentially disruptive. With the sale of Medibank Private, there will be a shift in the private insurance marketplace, such that two thirds of the private health insurance organisations are now ‘for profit’. There will be a push towards vertical integration of primary health care and specialist services, despite the government’s assertions to the contrary. The entry into the market place of major overseas players such as GE Health would suggest that disruptive changes are afoot.”

Dr. Gerard Sutton: “I think the government will continually look at costs – it has to – and the increasing cost of intravitreal injections for age-related macular degeneration, while necessary, may come under scrutiny. The solution, of course, is drugs that can work for longer – ideally inserts (though I am not an expert in this area).”

Dr. Jim Kokkinakis: “Very few government activities actually do anything positive. The government’s role is to spend taxpayers’ money effectively. Unfortunately things need to go wrong before they will react. All I can see going forward is the market polarising from very cheap and very basic delivery of eyecare to very good quality customised eyecare… What will wither is medium level eye care.”

Economy

How will the economy affect your ability to deliver quality eye care over the next 12 months?

Genevieve Quilty: “The challenge for everyone working within the optometry sector is to ensure that, regardless of the economy, we remain focused on increasing public awareness of early and regular preventative eye health and vision care.”

Dr. Margaret Lam: “Optometry is so closely linked to retail that the economy is inherently connected to our practice business. Scrapping the fee cap, as announced in the 2014 federal budget, will have a profound change on how we practise in the emerging landscape.”

Dr. Jim Kokkinakis: “How the economy will impact retail and the profession of optometry depends on how it changes over time. Some are predicting another global financial crisis. In this context; it’s hard times ahead. If the economy keeps going as is; then nothing changes.”

Gary Rodney, Behavioural Optometrist, Eyes In Design: “A friend recently said to me, ‘Well, you guys won’t be affected (by the economy) because everybody needs glasses’. My answer was to the contrary: there is a huge difference between what we want and what we need as a consumer. Then I suggested that if he was struggling financially he would persevere with his old glasses for longer or choose the ‘supermarket’ optics option to ‘get by’.

“This makes it tougher, and therefore more essential, to justify why somebody should attend the consultation or pay for a more comprehensive treatment option.”

Dr. Brad Horsburgh: “Mainstream healthcare demonstrates what economists call ‘inelasticity of demand’. Notwithstanding a repeat of the GFC, mainstream ophthalmology such as cataracts, glaucoma and surgical retina will increase in line with demographic changes. AMD treatments, on the other hand, will experience continued demand with the number of intravitreal treatments somewhat contingent upon new drugs and the required frequency of administration
of those drugs.”

Dr. Gerard Sutton: “Consumer sentiment in Australia remains fragile. I don’t see that changing anytime soon. Sight-threatening conditions will need to be treated but elective surgery – such as refractive – will always rely on discretionary spending. I know nothing about economics but I wonder what will happen when interest rates begin to rise again.”

Collaboration

How can eye health professionals work better together in 2015 for the benefit of patient outcomes?

Dr. Brad Horsburgh: “The recent resolution of the glaucoma issue between RANZCO/ASO and the OBA provides us with a golden opportunity. An opportunity for RANZCO and its ophthalmologists, to work together with community optometrists, to collaboratively address the public health issue of treating glaucoma in an ageing demographic.”

Genevieve Quilty: “Our professions have always worked closely together in the interest of patient care and this will continue strongly in 2015.”

Dr. Jim Kokkinakis: “This will improve as ophthalmology evolves into more specialised delivery of eye care. This will mean optometry will need to step up to the void left. This will only create better co-operation between the professions and more importantly better patient outcomes.

“It is disappointing for patient care to have the glaucoma regulations recently amended. I understand the position of ophthalmology to try to keep control of glaucoma but ultimately it makes sense to allow trained optometrists to look after garden variety glaucoma, like our US colleagues have for over 20 years.”

Dr. Nicole Carnt: “As a Research Optometrist at Moorfields Eye
Hospital, I have had a very productive working relationship with ophthalmology and I am looking forward to working at Save Sight Institute, Sydney Medical School, USyd in 2015. I think we could improve the relationship between optometry and ophthalmology by talking with each other more and working together on collaborative projects. By this, both would be able to see the unique experience that the professions have and can benefit by sharing and working together.”

Annette Hoskin: “Work on the development of sports eye protection standards and the development and promotion of eye injury prevention strategies represents an important opportunity for optometrists, ophthalmologists and orthoptists to work together to help reduce unnecessary vision impairment in children.

Dr. Gerard Sutton: “My working relationship with optometrists has always been based on mutual respect and a shared desire to provide great outcomes for our patients. That will not change. I am not involved in the politics but sense that there will be ongoing challenges in the relationship between the two professions.”

Dr. Margaret Lam: “Better collaboration, improved recognition and mutual respect for different areas of specialty can help to drive better patient outcomes.”

Dr. Michael Lawless: “The Google X/Alcon Novartis collaboration on the Smart Contact Lens will impact the way optometry and ophthalmology work. This computer built into a contact lens acts as a diagnostic tool for a variety of diseases, in particular diabetes, but also to act as an optical device, a telescope and an accommodative lens. Connected wirelessly this turns people into Avatars with the knowledge of the web linked to their contact lens. The possibilities are intriguing, perhaps frightening, and ophthalmology and optometry will be part of this journey.”

Change

What plans do you have to change the way you – or your organisation – does business in the New Year?

Genevieve Quilty: “This year we launch our 2015–18 strategic plan that will reinforce our mission to lead, engage and promote optometry, optometrists and community eye health. In collaboration with our State divisions, this will give us a national action plan focused on delivering a strong and progressive profession that benefits all Australian communities.”

Dr. Brad Horsburgh: “The federal government has frozen Medicare rebates. In order to provide high-quality care to patients (and maintain reasonable ‘out of pocket’ costs), whilst maintaining business efficiencies, we will need to look very closely at how we deliver our professional care.

Veronica Kypros, Executive Officer, Australasian College of Behavioural Optometrists: “In 2015, ACBO will be sending the message that Behavioural Optometry is a whole body approach to vision care. The organisation will focus on patient engagement with targeted public relations and social media campaigns to educate patients, parents and educators about how behavioural optometry can help them. The centrepiece of ACBO’s communication strategy is the new patient-oriented website featuring loads of information for the public, and brilliant new functionality for members.”

Dr. Gerard Sutton: “As Medical Director of the Lions NSW Eyebank I will be working with a great team to develop a biosynthetic substrate for endothelial cells and we hope to reintroduce the supply of amniotic membrane for ocular and skin reconstruction. We also hope to finalise our collaboration with Singapore National Eye Centre and deliver the Sydney University Refractive Surgery Degree to ophthalmologists in South East Asia, China and India.

“I intend to travel less in my professorial role in 2015 apart from key conferences and for the Myanmar Corneal Surgical and Eye Bank program I am setting up.”

Dr. Jim Kokkinakis: “I’m planning to deliver even more quality customised care. Delivery of commodity items will mean fighting huge marketing forces – I will keep right away from that.”

Professor Nathan Efron, Researcher, Queensland University of Technology: “Year 2015 is shaping up to be an interesting year in the contact lens world. Daily disposable contact lenses have been steadily increasing in popularity ever since they entered the market two decades ago, and this trend is likely to accelerate significantly with the acquisition of Sauflon Pharmaceuticals by CooperVision. Sauflon have been developing an innovative range of daily disposable contact lens products, in spherical, toric and multifocal designs, and all made from silicone hydrogel materials. These lenses are produced in a modular and cost-effective manufacturing facility in Hungary, that will allow CooperVision to rapidly upscale production to meet increasing demand. With CooperVision’s extensive global reach and marketing and professional support networks, the uptake of daily disposable lenses is set to take off in 2015.

“As occurs in all commercial domains, the other contact lens companies will not sit idly by and let one company capture the market. All of the major contact lens companies have excellent daily disposable lenses, and may well be preparing to adapt their own manufacturing processes to compete effectively on price and availability.

“More convenient and comfortable contact lens wear is certain to grow the overall contact lens market, to the benefit of eye care practitioners. But the ultimate beneficiaries will be contact lens wearers, who will soon have access to a wider range of high quality, low cost daily disposable lenses.”

Gary Rodney: One of the exciting areas for us is myopia prevention – this is becoming an epidemic among our kids. The opportunity to involve the whole family in minimising or preventing the onset and progression of short sightedness is a huge asset for optometry’s future.

Dr. Margaret Lam: “The role of optometry in different care models will continue to evolve and we will see a greater necessity for optometry to recognise contact lenses
as our area of specialised expertise.”