Always innovating, Specsavers created an exceptional hybrid event this year for its annual clinical conference, held with the first bursts of Spring in early September.
As has been the case in recent years, the 2022 conference was open to all optometrists and it attracted strong interest across Australia and New Zealand. Optometrists from Specsavers in Australia and New Zealand as well as those from outside the organisation attended, along with stakeholders from groups including The Fred Hollows Foundation, Optometry Australia, and the Optometry Board of Australia.
quality of life studies… have shown that patients with strabismus suffer the same impact as those with bilateral AMD
Images of ‘before and after’ botox treatment for patients with strabismus.
In his welcome address, Dr Ben Ashby shared Specsavers impressive progress, in its quest to achieve goals set down in 2020 across the categories of Care, Growth, Partnerships, Customer and People.
- Specsavers practices are now picking up 93% of avoidable blindness in the community – closing in on its five-year goal to achieve a 95% detection rate for avoidable blindness.
- Specsavers is aiming to provide eye care services to a further 1,000,000 patients per year by 2025. According to the company, 10 million people across Australia and New Zealand are unable to engage in regular eye care. To date, only 170,000 additional people of the targeted million have been reached by the organisation, mostly due to COVID restrictions shutting down routine care for long periods. More significant progress is anticipated soon.
- Specsavers has established 135 new optometry partners across Australia and New Zealand since 2020.
- More than 500 graduate optometrists have been employed across stores in Australia and New Zealand over the past two and a half years.
- Of patients who provided feedback post a consultation with Specsavers, 98% reported feeling care for.
On avoidable eye disease, Dr Ashby reported that since 2017, Specsavers has found 150,000 previously undetected glaucoma patients in the community.
Additionally, 500,000 registrations to KeepSight had been made for patients with diabetes from Specsavers practices since the beginning of the program.
He said the next opportunity for the organisation is age-related macular degeneration (AMD), with one in 400 patients over 40 having wet AMD. With 30% of patients dropping out of treatment for wet AMD within 12 months, Specsavers has partnered with Macular Disease Foundation Australia (MDFA) on a program that hopes to achieve much longer-term treatment compliance. The pilot program, which involves 16 stores and is in its early days, is already yielding “amazing outcomes”. Specsavers hopes to scale it across the whole country.
CLINICAL PROGRAM
Across two packed days, delegates to SCC 2022 heard from ophthalmologists, optometrists and academics in Australia and New Zealand, who spoke about diagnosing and treating ocular conditions, ranging from the common to the rare, as well as research underway that will lead to exciting future eye health solutions.
Strabismus in Children and Adults
Dr Shanel Sharma, Eye and Laser Surgeons Sydney, presented guidelines for assessing patients with strabismus. She said there are always four key considerations: what is the underlying cause; how to maximise vision; how to prevent suppression from developing (and the loss of binocular cells in children under eight years); and finally, how to treat for restoration.
The underlying causes of esotropias, exotropias and vertical tropias differ according to age (children vs. adults). A patient who presents with a palsy indicates a tumour or underlying neurological disease until proven otherwise – it may be congenital but we can’t presume this in case a serious disease is missed.
The aim of treating a tropia in a child eight years and under is to save binocular cells for long-term ocular alignment. Binocular cells cannot be regained, and the more a person maintains, the more effective and longer-lasting future ocular intervention will be. For those over eight years, the aim is to treat the diplopia. With both groups, we aim to minimise ocular misalignment and restore normal anatomy.
Dr Sharma stressed the importance of taking strabismus treatment seriously.
“We often hear people talking about having a turn treated for cosmetic reasons, however for our patients, a turn is never cosmetic – it is a disease process and we are restoring normal appearance.”
Strabismus can have a significant impact on a person’s quality of life, their self-esteem, their perceived ability to secure employment and establish relationships, and therefore, their long-term mental health.
This is because as a human species, we have evolved to judge facial symmetry within 150 milliseconds. Facial asymmetry is a basic genetic warning sign that innately implies poor health and bad genes – it is perceived as unattractive across all races.
Dr Sharma referred to quality of life studies, which have shown that patients with strabismus suffer the same impact as those with bilateral AMD and levels similar to patients who have had a stroke with physical impairment.
Employment agencies found that only patients with severe acne or visibly missing teeth had more difficulty finding jobs than patients with strabismus; and those with strabismus were less likely to be promoted. Almost all (92.5%) of dating agencies noted people with strabismus struggled to find a partner – they were perceived to be less intelligent, less attractive, less fun, less sporty, and less erotic.
Strabismus can also be challenging for children. Up to the age of four, children will play with dolls whether the dolls have strabismus or not, however when the innate genetic warning system kicks in at around age five, they no longer wish to play with dolls with strabismus. Children with strabismus are often excluded from parties and become the last to be picked for a sports team, leading them to suffer social isolation from a young age, which can impact mental health.
All of this, aside from vision issues, makes treatment a valid consideration. Dr Sharma went on to discuss the pros and cons of treatment options (do nothing; glasses with +/- prisms; Botulinum toxin (Botox); surgery and occlusion therapy).
Describing Botox in further detail, she said it was first trialled on monkeys for strabismus in the United States in 1973 by Alan Scott; and then on a human patient for strabismus in 1977. It was TGA approved in Australia in 1999 and there is a Medicare rebate for strabismus, hemifacial spasms and blepharospasm (the three indications for which Botox has FDA approval). Used to treat small to large angle squints, toxin is injected into the ocular muscle under local anaesthetic with guidance by electromyography. It usually takes two to three days to have any effect and two weeks to have a full effect. Duration of effect is usually temporary (average three to 12 months) but in patients with a high number of binocular cells, it can last longer and even a lifetime. With risks of both under and over correction, Dr Sharma stated that she titrates the dose for each patient.
Dr Sharma also emphasised how important the optometrist is in the care of these patients, to determine which patients need to be referred and how urgently, what treatment options the patients may be offered, and help guide the patients through the treatments – particularly to reassure and assist in reassuring patients during this process. She said many patients will be unaware that Botulinum toxin is a treatment option, and you may be the first person who mentions this to them.
Ptosis and More
Dr Lewis Levitz, from Vision Eye Institute in Melbourne, highlighted various ocular pathologies, using case studies to differentiate between malignant and benign lid tumours. He also spoke about ptosis surgery for aponeurotic defects, making the point that a very delicate and thorough understanding of the anatomy must be mastered in order to achieve a good result.
Droopy eyelids – a natural part of the ageing process – can cause a superior visual field defect, however Dr Levitz stressed that not all patients with a brow ptosis need brow ptosis surgery. He explained that as people get older, the brow moves down laterally and the lids look hooded. Although the patient may notice a cosmetic difference, they may not be bothered by the subtle change in their vision that this condition can cause. His advice was “don’t bring attention to a problem they don’t know they have – if they don’t complain about lateral brow hooding, they don’t need to be referred for surgery”.
Dr Levitz also spoke about ptosis and dermatochalasis, which require very different operations. Discussing ptosis, his takeaway message was that if you get a patient with a bilateral, symmetrical ptosis, check their vision, pupil, their levator function, ocular motor test (which should be normal), corneal sensation and for Bells Phenomenon (which means their eyes roll upon forced lid closure). For these patients, he recommended a phenylephrine test 2.5% to lift the lid. Phenylephrine 2.5% drops are placed in the fornix of the eye with the ptosis. If the lid lifts, correction surgery can be successfully performed from the inside of the lid to shorten the Muller’s Muscle. If the other lid drops, you’ve unmasked a bilateral ptosis. Not all ophthalmologists will perform surgery on Muller’s Muscle, so you need to check before referring.
Dr Levitz stressed that any patient with a new onset ptosis and pupil dilation should be sent to the nearest emergency room or neuro-ophthalmologist.
Optical Coherence Tomography
With Specsavers a driving force behind the implementation of optical coherence tomography (OCT) in optometry, a presentation by Dr Khoi Tran had relevance to attending clinicians. Dr Tran stated that the aim for his presentation was to further improve optometrists’ OCT diagnostic and grading skills, with a focus on images of the macula.
Asserting that OCT has become a cornerstone in the diagnosis and monitoring of ocular conditions, especially at the macula and optic nerve he said, beside a slit lamp, there is no other tool in the office that will give you as much information.
To benefit from OCT, the key is to know what a ‘normal’ anatomy of a retina looks like on OCT – because it’s only when you know what ‘normal’ looks like, that you’ll be able to pick up on subtle differentiations.
Dr Tran explored the basic types of reflectivity patterns seen on OCT and what they may represent, before going on to describe some of the subtle structural changes commonly missed on macula OCTs and what they encompass. He discussed OCT grading of common vitreoretinal findings and disorders (e.g., posterior vitreous detachments, epiretinal membranes and macular holes), then explored less common maculopathies before taking a closer look at the choroid and the pachychoroid spectrum.
Having provided practical tips to optimise the use and interpretation of scans for various maculopathies, he concluded, “Expect not to diagnose anything and everything but rather to recognise what is abnormal – from the obvious to the subtle. A systematic process of review is essential so that nothing is missed.”
FACE-TO-FACE FUN
The Specsavers virtual congress was punctuated by local face-to-face social events in each major city, across Australia and New Zealand. These provided attendees with a welcome opportunity to catch up with each other.
Recognising Extraordinary Optometrists
Specsavers Dubbo and Dapto in Australia, and Specsavers Hornby and Dunedin in New Zealand, received the annual awards for clinical care and excellence.
Nick Gidas, Specsavers Head of Clinical Performance, presented the prestigious Doug Perkins Medal to Yvonne O’Sullivan, Brian Thio and Claire Curtin from Specsavers Dubbo, and Lachlan Martin and Hallie McCloy from Specsavers Hornby.
Mr Gidas said the top 10 finalists represented the top 3% of practices in each country that had consistently demonstrated clinical excellence across all areas of practice.
“The award is based on nationwide analysis using data collected through Specsavers clinical reporting. This information was combined with data from Specsavers’ patient feedback platform, as well as health outcome data from the Oculo electronic referral system,” said Mr Gidas.
“We were looking for practices that are leaders in delivering exceptional patient outcomes; that demonstrate a consistently outstanding patient experience; that implement and improve store processes that deliver consistent quality eye care; who are committed to accessible eye health and who lead a positive workplace and culture.”
This year’s recipients of the Dame Mary Perkins Award were Surendran Naidoo from Specsavers Dapto, and Jennifer Robinson from Specsavers Dunedin, who stood out for going above and beyond in customer service, clinical care, clinical leadership, and teamwork.
Mr Naidoo’s nomination involved a patient who had a pituitary tumour detected in an eye test, leading to an urgent diagnosis and surgery that saved the patient’s life.
Ms Robinson was nominated for her followup care for a young patient who required chemotherapy treatment for a brain tumour. The award also recognised the care Ms Robinson provided for a farmer with a retinal detachment requiring same-day surgery.
The Dame Mary Perkins Medals were judged by leading industry professionals Justine Cain, CEO of Diabetes Australia; Pippa Martin, Managing Director of Glaucoma New Zealand; and Ian Wishart, CEO of The Fred Hollows Foundation.
Mr Wishart said he was incredibly impressed by the calibre of the nominees.
“They embodied kindness, compassion and integrity in their everyday lives. In the words of Fred himself, they truly demonstrate that ‘every eye is an eye,’ and ensure all people receive the care they deserve. Thank you for the opportunity to recognise their actions,” he said.
