Setting Sights on Growth: Specsavers Clinical Conference

Reflecting on the company’s commitment to innovation and excellence in eye care, Dr Ben Ashby, Clinical Services Director for Specsavers Australia New Zealand, set the stage for a two-day ophthalmology-led clinical conference that provided optometrists with research updates and evidence-based practical tips for patient management.

Speaking to more than 400 people in the audience at the JW Marriott Gold Coast Resort and Spa, and a further 450 attending the conference online – optometrists from Australia and New Zealand – Dr Ashby announced that Specsavers has expanded its reach, increasing patient numbers by 25% since 2020 to care for five million patients annually across Australia and New Zealand.

He said Specsavers had achieved a record-breaking 92% detection rate for avoidable causes of blindness, surpassing the industry benchmark of 60%, translating to over 130,000 patients annually receiving early intervention to protect their sight.

Customer satisfaction has soared, with Specsavers voted the most trusted optometrist for the fifth consecutive year. The introduction of Net Promoter Score (NPS) measurements revealed customer service levels outperforming the tech giant Apple to be on par with global leaders like Amazon.

Dr Ashby attributed the success to key initiatives, including:

• The ‘Trusted Expert’ programme, which has led to an additional 80,000 patients with significant prescription changes obtaining vision correction in the past year.
• Glaucoma detection efforts, resulting in 215,000 first detections for glaucoma cases in Australia and New Zealand.
• The ‘KeepSight’ diabetes eye check reminder programme, with almost 600,000 unique patients with diabetes cared for by Specsavers, and almost 500,000 active participants now registered for regular follow-ups.
• Expanded therapeutic management, serving 80,000 patients across the network.

He went on to outline plans to further enhance patient care and optometrist development.

These include:

• Expanding the intense pulsed light (IPL) pilot for dry eye treatment to nine stores by year-end,
• Introducing new training programmes to elevate patient experiences and build trust, and
• Launching a ‘senior optometrist’ pilot to leverage experienced practitioners’ expertise and mentoring skills.

Dr Ashby concluded by praising the dedication of Specsavers optometrists, particularly highlighting the contributions of over 500 graduates and early-career optometrists.

Paediatric Ophthalmology

Dr Rushmia Karim (Sydney), delivered the first clinical presentation, sharing insights on the complexities and rewards of paediatric eye care, with a focus on amblyopia management.

With humour and empathy, she told the audience, “Sometimes my heart sinks when I see the whole waiting room is full of children… They’re unpredictable. You are worried if you miss anything. Did I really see the back of the eye? Did I really get that script correct?”

In the face of these challenges, she described herself as a “real busy body”, keenly observing children’s behaviour in the waiting room. Encouraging practitioners to do the same, she said observations can provide valuable insights into children’s visual function and overall wellbeing.

The art of paediatric examination is all about “toys, toys, toys”, Dr Karim explained. Simple items like wind-up toys can be invaluable for assessing fixing and following, as well as convergence.

Dr Karim said it is essential to be adaptable when testing for visual acuity, as children’s ability to recognise letters varies. They can also find some of the commonly used picture charts, that use outdated images of clocks and aeroplanes for example, difficult to recognise. Additionally, she advised practitioners to always include crowded optotypes for visual acuity when assessing for amblyopia.

Dr Karim’s approach to amblyopia management includes:

• Starting with full-time glasses wear before introducing patching,
• Short duration, high-quality patching sessions,
• Atropine as an adjunct treatment for non-compliant patients, and
• Recognising that up to 30% of cases may resolve with glasses alone.

She encouraged practitioners to persist with treatment, even in older children, citing the Pediatric Eye Disease Investigator Group (PEDIG) study, which showed potential benefits in patching patients aged eight to 16. “It’s not as effective as if you start when they are younger, but don’t rule it out”, she said.¹

Associate Professor Heather Russell (Southport, Queensland), built on strategies for amblyopia management.

Acknowledging optical correction as a first line treatment, she said careful frame selection is critical. She guides patients towards lightweight, comfortable, and durable frames with detachable straps for secure wear. For bifocals, rectangular frames are preferred over round, as they allow for better lens fit and are less likely to fall out.

She uses atropine penalisation as a second-line treatment if patching fails or is poorly tolerated and recommended weekend atropine use “on any two days that works for the family”.

Children being treated with atropine and those with significant allergic eye disease should be encouraged to wear photochromic lenses, which will increase wearing comfort, improving the chance of compliance.

Glaucoma Management

Drs Jason Cheng (Sydney) and Brian Ang (Melbourne) presented on glaucoma, with Dr Cheng offering practical tips for visual field testing and optical coherence tomography.

Dr Ang spoke about lifestyle advice optometrists can offer their patients to help reduce the risk of glaucoma progression. This was based around the five pillars of physical activity, stress management, sleep, diet and nutrition, and neuroprotection. The audience heard that aerobic exercise can temporarily reduce eye pressure by 1–6 mmHg, improve blood flow to the eyes, optic nerve and brain, and slow vision field loss in glaucoma. Dr Ang said patients can be advised to undertake moderate to brisk exercise for at least 30–45 minutes daily.2 Strength training, on the other hand, can be detrimental as during exertion, eye pressure can increase by up to 40 mmHg. Dr Ang recommended that instead of holding their breath, patients are advised to slowly exhale during exertion.² Daily meditation for 45–60 minutes can reduce eye pressure by up to 25%, also reducing circulating stress hormones and blood pressure.³

Dry Eye and the Cornea

Managing dry eye prior to surgery is critical to ensure accurate measurements and optimal postoperative results, particularly in cataract and refractive procedures.

Highlighting the prevalence of dry eye disease (DED), Dr Aanchal Gupta (Adelaide) said up to 80% of patients presenting for cataract surgery may have some level of ocular surface dysfunction, with only half reporting symptoms.

Noting the multifactorial nature of DED, with evaporative dry eye being most prevalent, she outlined key diagnostic criteria, including tear film break-up time under 10 seconds as one of the most sensitive indicators.

Outlining treatment approaches, she said regardless of severity, ocular surface inflammation must be addressed early.

Dr Gupta said lid hygiene and warm compresses are common for blepharitis management, and cyclosporin and intense pulsed light (IPL) therapy are emerging as some of the most effective treatments.

Dr Brendan Cronin (Brisbane) followed with “the entertainment”, arriving on stage with balloon sculptures representing the major risk factors for dry eye disease: demodex, Botox injections, and rosacea. Determined to make his “dry topic” of cornea and dry eye disease “outrageous and a little bit interesting”, he had the audience spellbound as he wove his inflated pranks into practical advice.

Building on Dr Gupta’s key messages, Dr Cronin said he firmly believes that IPL is coming as a first line treatment, stating “optometrists should use it; it’s effective”.

For patients with severe dry eye, Dr Cronin recommended combining IPL with omega 3 and the topical immunosuppressant medication ciclosporine. While adverse reactions have been associated with ciclosporine, he said optometrists should not be afraid of prescribing it for dry eye as the minimal amount required makes it safe for the purpose. If a patient has red angry eyes, prescribe steroids for two weeks before commencing ciclosporine to reduce the risk of stinging.

Associate Professor Chameen Samarawickrama (Sydney) spoke about two common ocular conditions frequently encountered by optometrists: allergic eye disease and herpes simplex virus (HSV) keratitis.

His discussion on management strategies for HSV keratitis, were based on the Herpetic Eye Disease Study (HEDS) trials. For epithelial disease, topical antiviral treatment for a week is usually sufficient. In stromal disease without epithelial involvement, he recommended a combination of topical antivirals and steroids for 10 weeks, with potential oral antivirals for improved compliance.

On necrotising stromal keratitis, he said, “If you get a stromal keratitis with an epithelial defect, alarm bells should be ringing”. Collaboration between optometrists and ophthalmologists is essential to manage these conditions.

Neuro-ophthalmology

Dr Kate Reid (Canberra) presented a systematic approach to diagnosing optic neuropathies. She emphasised the importance of taking a detailed patient history, using the mnemonic ‘Do Complete a Painfully Detailed History’:

• D = demographics of the patient (age, sex, race)
• C = central acuity (normal, reduced, variable)
• P = pain (on eye movement, headache)
• D = drugs (toxicity / intracranial hypertension promoting)
• H = systemic history (eg. thyroid, DVT, cancer)

A supporting diagnostic flow chart was referenced (downloadable at pticnervecanberra.com.au under Common conditions, Optic neuritis).

Dr Reid is passionate about raising awareness of sleep apnoea, as when untreated and moderate-severe, it threatens both life and vision. The risk of stroke and cancer rises three-fold, while a wide range of eye conditions are significantly increased in prevalence and severity, including non-arteritic anterior ischemic optic neuropathy, retinal vein occlusion, glaucoma, diabetic retinopathy, and age-related macular degeneration AMD). Acknowledging 15,000 mentions of sleep apnoea during Specsavers’ patient consultations in the 2023-2024 year, she congratulated Specsavers’ optometrists on their “fantastic effort… as health coaches for systemic health, not just vision”.

Evaluating the Efferent System

Professor Celia Chen (Adelaide) delivered an entertaining presentation on what can go wrong with eyelids and as it turns out, there’s plenty; ranging from “too little” when there is under-action of the eyelid causing ptosis or “too much” when there is lid retraction or involuntary eyelid movements. The trick is to determine the underlying cause; then you can make an enormous difference to the patient’s outcome and life ahead.

For ptosis, consider whether the cause is neurological (e.g. third nerve palsy or Horner’s syndrome), neuro muscular (e.g. ocular myasthenia), muscular, aponeurotic or mechanical.

For those with “too much”, lid traction may be due to neurogenic (e.g Parinaud midbrain syndrome), myogenic (thyroid eye disease), or mechanical causes. Some patients may have involuntary eyelid movements like benign essential blepharospasm or hemifacial spasm.

All About the Retina

Dr Warren Apel (Sunshine Coast) and Associate Professor Elaine Chong (Melbourne) spoke about retinal disease, with Dr Apel delving into the intricate relationship between the cardiovascular system and posterior segment conditions, and Assoc Prof Chong focussing on AMD.

The retina has a dual blood supply, and the cardiovascular system can affect the posterior segment in multiple ways, unilaterally or bilaterally, depending on the condition. Via several case studies, Dr Apel challenged optometrists to make spot diagnoses before providing insights into patient management and treatment processes for disease including diabetic eye disease, ocular ischemic syndrome, retinal vein occlusion, branch retinal vein occlusion, and branch retinal artery occlusion. Collaborative systemic management, ocular interventions and patient education is essential, involving optometrists, ophthalmologists, and other medical specialists.

Assoc Prof Chong’s presentation, ‘A no-nonsense guide for optometrists on optical coherence tomography (OCT) in AMD management’ focussed on the importance of thorough OCT interpretation and understanding of retinal anatomy.

It is important to be able to recognise crucial AMD features such as drusen, reticular pseudodrusen, and sub-retinal hyperreflective material (SHRM); and to use comparative sequence tracking for patient monitoring.

Dr Chong has developed a tool for patient care and education called One Right Eye. Available free at onerighteye.com, it has been developed to help eye care professionals enhance engagement when discussing eye conditions with their patients.

Dr Mali Okada (Melbourne) presented on the diagnosis, assessment, and referral of retinal detachment cases, also highlighting the importance of OCT, particularly for diagnosing borderline cases and differentiating between retinal detachment and conditions that may mimic it, such as retinoschisis.

Providing a framework for referral urgency, based on the type and symptoms of retinal pathology, she said symptomatic retinal tears typically require the most urgent treatment. Other patient risk factors when deciding on treatment and referral include high myopia, family history of detachment, and previous detachment in the fellow eye.

Ocular Oncology

Dr Riyaz Bhikoo (Auckland) reminded the audience of the critical role of thorough eye examinations in detecting ocular tumours, particularly choroidal melanomas. Despite their rarity, these malignancies can have devastating consequences if left undetected.

He introduced the MOLES scoring system, a user-friendly tool for optometrists to assess suspicious lesions, that considers the factors: Mushroom shape, Orange pigment, Large size, Enlargement, and Subretinal fluid.

Dr Bhikoo discussed various mimics of choroidal melanomas, including choroidal naevi, peripheral exudative haemorrhagic chorioretinopathy, and congenital hypertrophy of the retinal pigment epithelium. He advised caution in diagnosing these conditions and recommended referral for any atypical or concerning lesions.

Anterior segment tumours were also discussed, with emphasis on iris melanomas and conjunctival lesions.

Dr Tani Brown (Gold Coast) spoke about anterior uveitis, which is commonly accompanied by a classic triad of pain, photophobia, and ache.

She encouraged optometrists to “look at your patients off the slit lamp”, explaining that this can reveal important signs like ciliary flush, pupil irregularities and scleral changes. Observing patients as they enter the clinic can provide valuable diagnostic clues. “Look at their face, look at their legs. Do they have funny rashes?” she suggested. Enquire about autoimmune conditions, cancer treatments, and sexual history when relevant.

Not all uveitis cases require extensive testing, however, optometrists should have a low threshold for referral in more complex cases. While OCT and fundus photography are valuable tools, they are not sufficient on their own – a dilated fundus examination remains crucial for comprehensive uveitis management, ensuring that no significant posterior involvement is missed.

Specsavers annual clinical conference will return to Melbourne in September next year.

References

1. Chen AM, Cotter SA. The amblyopia treatment studies: Implications for clinical practice. Adv Ophthalmol Optom. 2016 Aug;1(1):287-305. doi: 10.1016/j.yaoo.2016.03.007.
   2. Dickerman RD, et al. Neurol Res 1999: 21(3):243-246.
   3. Dada T, et al. Glaucoma 2024: 33(3):149-154.