The Year that Was and the Year that Will Be…

Professor Ivan Goldberg

Ophthalmologist

Several advances in glaucoma management are approaching usefulness. Exciting.

With over 75 per cent of vision loss avoidable, our work to raise awareness can make a significant impact on a person’s life

New methods of drug delivery will be with us in a practical sense, if not in 2017, then soon after. ‘Taking the patient out of the treatment program’ might not be fully achievable, but in terms of medications for glaucoma is a highly worthwhile goal to minimise visual disability through non-adherence and non-persistence as well as to overcome physical barriers to self-instillation of eye drops. Conjunctival rings, sub-conjunctival and even intra-cameral depots are beginning to reach approvable status.

Equally promising are the emerging options in glaucoma surgery, with multiple devices in the market place, offering choices for patients and ophthalmologists previously only dreamt of. More evidence appearing in the peer-reviewed literature is increasingly underpinning appropriate choices for glaucoma patients, with and without cataracts who require surgery, for different types of glaucoma, and the spectrum of disease impact.

We have much to anticipate in the near future.

Dr. Devinder Chauhan

Ophthalmologist

Intravitreal injections are the gold standard for wet macular degeneration. However, the goal of individualised treatment has yet to be achieved; some patients receive fewer injections than is optimal (a consequence of pro re nata regimens) and some receive more injections than the underlying disease warrants (treat and extend protocols often have an arbitrary maximum interval between injections).

In 2016 optical coherence tomography (OCT) angiography became commercially available in Australia and this is already being used routinely in my practice to diagnose, observe and monitor choroidal neovascularisation in a way that was previously impossible – fluorescein angiography doesn’t delineate vessels and is difficult to interpret in treated age related macular degeneration. Already, I have a number of patients who have been able to have intravitreal injections deferred well beyond the standard 12-week interval, albeit with frequent review and imaging.

With this technology, 2017 promises the achievement of my treatment goal – the best vision with the fewest injections.

Dr. Michael Lawless

Ophthalmologist

In 2017, Berger’s space will come to people’s attention. No one really gives this space a second thought. It is the area between the posterior capsule and the anterior face of the hyaloid and it can now be imaged by intraoperative OCT. People are starting to think about performing a primary laser posterior capsulotomy without disturbing the anterior hyaloid of the vitreous, and placing the optic of the lens into Berger’s space. The aim is to completely, once and for all, eliminate posterior capsular opacification. Watch this space.

In 2017 in Australia, I am particularly looking forward to clinical trials that will begin for the FluidVision intraocular lens. This lens, placed into the lens capsule like a standard IOL, is the first to truly accommodate by changing shape and becoming thicker when the patient attempts to accommodate. It will need to be refined but it is exciting to see technology finally arriving that will start to allow us to provide proper accommodation in an intraocular lens.

Margaret Lam

Optometrist

Before our very eyes, the optometry profession is changing and evolving at the fastest rate I have ever seen. The interplay between corporate and independent optometry practices, and the diverse optometry networks in between, as well as the need to remain clinically independent has never been more important.

Across the year we have increased the scope of practice in many different ways. We’ve achieved increased recognition in co-management of patients with pathology. Although tumultuous, we’re inching closer towards more recognition for defined subspecialties in our mode of practice, particularly in areas such as behavioural optometry and specialty contact lenses.

Writer and romantic poet, Kahlil Gibran, said, “Progress lies not in enhancing what is, but in advancing toward what will be”. In so many ways, things have changed, yet have remained the same – we are fortunate to be in a profession where we can restore sight, our expertise is ever-growing, and our scope of practice for complementary skill sets with other health care professionals is exponentially improving with time. Bring on 2017!

Dr. Simon Chen

Ophthalmologist

Over the last year, the new things that have stood out most for me in my own clinical practice have been the introduction of optical coherence tomography angiography (OCT-A) for the routine assessment of many common retinal disorders such as age-related macular degeneration and retinal vascular disease; the routine use of a new generation of optical biometers (the IOL Master 700) and new biometry formulae including the Hill RBF and Barrett formulae, which have introduced a new level of accuracy in calculating IOL power and hitting refractive targets with cataract surgery.

Looking ahead clinically, I am looking forward to the imminent Pharmaceutical Benefits Scheme (PBS) listing of new intravitreal therapies for retinal diseases including ocriplasmin (Jetrea) for vitreomacular traction and a dexamethasone implant (Ozurdex) for retinal vascular disease. These will both increase patient access to new options for the management of these conditions.

Dr. David Andrews

RANZCO CEO

Over the past year, RANZCO has sought to drive collaboration between professionals from across the eye health care sector, with the aim of delivering more efficient and effective results for patients and to reduce incidence of avoidable blindness.

For example, RANZCO’s new referral guidelines for glaucoma, age related macular degeneration and diabetic retinopathy aim to provide a clear pathway for optometrists and GPs in referring patients to ophthalmologists. Each of the guidelines will be reviewed and updated based on feedback from ophthalmologists, optometrists, GPs and other experts.

Another important development was the recent National Eye Health Survey, produced by Vision 2020 Australia and CERA, which provided important information about the state of eye health in Australia. It was reassuring to see that together we are making real progress towards improving visions and eliminating avoidable blindness. However, there is still a great deal to do. At RANZCO we are excited to meet this challenge and believe we can all do that by working together in the best interests of the patients that we serve.

Dr. Rick Wolfe

Ophthalmologist

The most significant happening in our practice this year was the disappearance of postoperative astigmatism following cataract surgery. With the application of the Barrett nomogram for toric IOLs, the use of a toric IOL when called for and the Alcon Verion intraoperative alignment system, we achieved 93 per cent with half D or less astigmatism. I realised greater astigmatism only occurs when something goes wrong. This happened because of a confluence of factors and not one killer technology. The other big deal of 2016 was the application of topographic-guided LASIK to virgin eyes. High-level visual results seem more attainable than with standard techniques. We will be investigating this into 2017.

Genevieve Quilty

Optometry Australia CEO

In September 2016 Optometry Australia launched a significant multi-channel promotional campaign designed to raise awareness in the Australian community about eye health and encourage regular visitation to their local optometrist, under the banner, Good Vision for Life.

Deliberately positive, fresh and informative, the campaign is one of the highlights of the work of Optometry Australia during 2016 on behalf of the optometry profession. The consumer campaign is being supported by a GP campaign aimed at heightening awareness of the role of optometrists among general medical practitioners to improve referral pathways.

Both campaigns complement the work Optometry Australia undertakes on a day-to-day basis where we dedicate significant resources to generate editorial in mainstream media on eye health matters. This year we have generated over 148 articles.

With over 75 per cent of vision loss avoidable, our work to raise awareness can make a significant impact on a person’s life. The first ever National Eye Health Survey was released on World Sight Day – vision impairment and blindness appear to be on the decline however more than 50 per cent of those patients in the survey were found to have an eye condition they were not aware of. Almost two thirds of vision impairment discovered during the survey was associated with the correction of refractive error – easily remedied through provision of a pair of prescribed glasses or contact lenses.

Our profession is making a significant difference to the lives of millions of patients every year. Through the Good Vision for Life awareness campaign, which we plan to run at least through 2017, we will make an even greater difference, raising awareness and encouraging early and regular access to optometry services. The impact of the regular preventative eye health examination can be significant – it can save someone’s sight. For Optometry Australia in 2017 we are delighted to be able to work with our profession to continue to raise awareness and positively impact patient’s lives.

Annette Hoskin

Optometrist

In 2016 we continued to focus our understanding on the epidemiology of eye injuries to ensure injury prevention messaging can become more effective.

In 2017 I predict eye protectors, sunglasses and prescription spectacles will become even more application specific and customisable in an effort to achieve the greatest level of protection and best possible vision for wearers.

I hope to see the professions continuing to work together to encourage people at risk of eye injury, both at work and at home, to wear the right type of prescription or non-prescription eye protection. Figures from 2016 demonstrate the importance of doing so – according to Medicare statistics from the 12 months to August 2016, 8,222 patients presented for foreign body removal!

Announced in 2016, the National Innovation and Science Agenda is a key platform for the government and aims to fast track industry-focussed research. The impact of these changes on NHMRC funding and in particular clinician researchers and universities remains controversial.

Emmanuel Calligeros

Optometrist

As I complete my first year with Device Technologies I pause to reflect on the amazing recent advances in ophthalmic diagnosis and treatment.

Eye care practitioners can now have instruments that can accurately measure the eye to 0.01mm, detect eye disease in its very early stages and guide treatments with incredible accuracy.

Refractive multifocal intraocular lenses (MFIOL’s) are fast gaining acceptance with eye surgeons as ‘new age’ presbyopes demand better vision for their demanding lifestyles. New MFIOL products and formulae have made it possible for eye surgeons to meet their patients’ demands. Among them are Oculentis refractive MFIOL’s which can be custom manufactured in toric form to an accuracy of 0.01D and 1° steps.

Then there is the Haag-Streit Lenstar that incorporates a sophisticated toric IOL surgical planner and integrates the latest generation IOL formulae and the Hill-RBF method. The Topcon Triton Plus combined anterior and posterior swept-source OCT makes scanning and angiography possible at an extremely fast 100,000 a-scans per second.

I look forward to 2017 as we continue to strive for the perfect balance between diagnostics and treatment.