Specsavers Clinical Conference: Celebrating 15 Years of Education

There’s nothing like opening a conference by reporting on strong performance and setting a clear direction for the future – and this is something that Specsavers has always done well.

“There’s a lot of numbers, but the one that resonates with me the most is 445,000 people over the last five years whose sight you have saved,” Clinical Services Director ANZ Dr Ben Ashby told conference delegates. He also reported that in the past five years Specsavers optometrists had cared for 25 million people across Australia and New Zealand and contributed AU$12 million to the Fred Hollows Foundation.

Being listed among the most trusted brands in Australia¹ and New Zealand² for five years was “absolutely no surprise”, he said, but being voted the 2026 Best Workplace in Australia in the large workplace category,¹ and number two in New Zealand in 2025 and 2026 in the combined medium/large corporation category,³ “was a very lovely surprise… that is your achievement because it’s the culture that you create”.

Specsavers’ Horizon 30 plan sets the bar higher again with stated aims to change the lives of 33 million patients by 2030, halve the company’s environmental footprint, welcome 200 new optometry partners, and expand myopia management, dry eye, and red eye services as well as remaining a best place to work. “We’ll focus on supporting our people because we know you are the ones who will make the biggest difference in enhancing and enabling great patient care.” A new optical coherence tomography (OCT) device is due to be rolled out within the next couple of years, with a wider field of view, axial length measurement, and fundus autofluorescence; dry eye treatment will extend to every store; and Specsavers’ ‘triple 80’ ambition aims to get 80% of young myopes into myopia management (up from just over 40%), make eyewear accessible for 80% of children who need it, and achieve a satisfaction rating of 80 for kids.

The warmest applause went to 50 fully funded clinical excellence scholarships over five years, the first 10 opening this year. “We want to support optometrists who are keen to progress their careers with Specsavers and then bring their learnings back to continue caring for patients in store,” Dr Ashby said.

Bridging the Angle

Melbourne ophthalmologist Dr Bob Wang, who began his career as an optometrist, led the clinical presentations with a talk built around a 48-year-old hyperope with intraocular pressure (IOP) of 21 mmHg, narrow angles, peripheral anterior synechiae, and nerve fibre layer thinning. Field loss is not required for primary angle closure glaucoma, he reminded delegates; optic nerve damage is enough.

After a laser peripheral iridotomy (LPI) and timolol, the patient’s field progressed despite a reduction in IOP to 17 mmHg, and over subsequent years the patient moved to combination drops, three agents and, finally, surgery. The target IOP, he stressed, changes with progression.

Cataract surgery is “the most common glaucoma operation”, he said, citing the EAGLE study.⁴ He implored optometrists to use gonioscopy: indentation distinguishes appositional from synechial closure, and it should be repeated after LPI. In acute angle closure, the fellow phakic eye needs an LPI too: “They’ve come from the same factory at the same time,” Dr Wang quipped.

The Great Pretenders

Brisbane ophthalmologist Dr Shyalle Kahawita continued the glaucoma discussion, with a focus on secondary glaucoma, defined as having an identifiable cause, often unilateral or asymmetric, with a mechanistic pathology that guides treatment.

Dr Kahawita ran through a series of cases to differentiate and discuss appropriate management of secondary glaucomas. Pseudoexfoliation, which she said makes up around 20% of open-angle glaucoma, is best spotted by examining the pupil margin for fibrillar material. It responds well to selective laser trabeculoplasty, escalates to surgery sooner, and warrants earlier cataract surgery. Pigment dispersion syndrome is seen more commonly in myopic patients in their 30s and decreases in severity by the time patients reach their 70s. These patients may get IOP spikes after exercise and may notice haloes or blurred vision. They need at least annual review, with 10–15% converting to glaucoma within five years. In neovascular glaucoma, the earliest sign is at the pupil margin, and she advised referral “sooner rather than later”, even with normal pressure. Uveitic glaucoma requires co-management. These patients often need initial treatment with topical steroids, which helps IOP. Avoid prostaglandin analogues as a first-line treatment, as these eyes are more susceptible to cystoid macular oedema.

More To It Than Blood

Vitreoretinal surgeon Dr Mali Okada (Melbourne) argued that the layer blood sits in refines the differential: flame haemorrhages point to hypertension or vein occlusion; boat-shaped preretinal blood to proliferative diabetic retinopathy or a tear; domed sub-inner limiting membrane blood to macroaneurysm, Valsalva, or Terson syndrome; and subretinal pigment epithelium blood to neovascular age-related macular degeneration or polypoidal choroidal vasculopathy.

Proliferative diabetic retinopathy is the most common cause of adult vitreous haemorrhage, followed by posterior vitreous detachment (PVD) and trauma. A symptomatic PVD carries a 9% tear risk; with vitreous haemorrhage that rises to 70–95%.

In children, trauma and non-accidental injury must be considered.

Her five ‘must not miss’ diagnoses were tear or detachment, active neovascular disease, occult globe rupture, inflammation or infection, and occult tumour. Rupture, trauma, macula-on detachment, and any paediatric presentation need same-day review. “Blood is a sign, it’s not a diagnosis,” she concluded, inviting colleagues to call for advice.

Around The Eyes In 80 Days

Back for a fourth consecutive year, Sydney ophthalmologist Dr Rushmia Karim pitched her cranial nerve refresher at the many new graduates in the room, opening with a practical message: “There are many tests but at the end of the day, if we just use our eyes, think a bit, use our history, we might come to the diagnosis earlier.”

Third nerve palsies received the most attention. Describing them as “complex”, she said anyone suspected of having a third nerve palsy should be referred or sent to emergency. Dr Karim dismissed the old distinction between pupil-sparing and pupil-involving thirds as a relic of the days when it was difficult to arrange scans: “Just because the pupil is spared doesn’t mean that the person can’t have something pretty bad going on in their brain.”

Her plan of action was the same for every nerve: neuroimaging of brain and orbits with contrast, thyroid function, blood sugar, considering myasthenia gravis in the differential, carotid Dopplers and an up-to-date refraction. No surgery is considered for at least six to 12 months, allowing time for recovery, with prism or fogging in the interim.

Seeing The Problem When There Is Nothing To See

Neuro-ophthalmologist Professor Clare Fraser (Sydney) tackled unexplained visual loss with a simple premise: “History gives you 90% of the diagnosis.” Four questions structure history taking:

• Is it transient or persistent?
• Is it monocular, binocular or hemifield?
• Was onset fast or slow?
• What are the associated symptoms?

Retinal transient ischaemic attacks (TIAs) carry up to a 25% risk of cerebral TIA or stroke at three years, and she recommended referring patients to a TIA rapid access clinic, where possible, for a complete stroke workup in just one day.

Ophthalmic investigations cover assessment for relative afferent pupillary defect, colour vision, visual fields, magnified review of fundus imaging, OCT and, where useful, fundus fluorescein angiography and B-scan. Systemic workup covers blood pressure and pulse for atrial fibrillation, ESR and CRP, carotid Doppler, full cardiac assessment and MRI of brain and orbits, always with gadolinium.

Her one thing not to forget: “Never forget giant cell arteritis in anyone over 50”, suspected cases should go straight to emergency. Prof Fraser reminded delegates to state concerns very plainly in the referral: “emergency department doctors and neurology doctors really put a lot of weight on what you guys say in your letter”.

The Human Side of Care

Day one closed with sessions on communication. Specsavers Clinical Performance Consultant Sarah Halloran asked delegates to rethink patient objections to treatment plans and consider, “What if an objection is actually one of the clearest signs that our patient trusts us enough to be honest?” The real risk is the unspoken objection: someone who chooses not to follow the proposed plan rather than query it in the consult room.

Mentalist and behavioural expert Anthony Laye followed, highlighting the importance of a clinician’s composure in the consult room to build patient confidence. His three-step formula for the first 60 seconds of a consult: check your state, get the patient talking, and break expectations. “You don’t need to learn a whole bunch of social skills. You just need to be more human.”

Children In Focus

Paediatric eye care is an important growth area for Specsavers and so day two opened with paediatric ophthalmologist Associate Professor James Elder (Melbourne) providing advice on how best to communicate with these patients. He said working with children starts with preparation and manner: he speaks four languages in the room: ‘babyese’, ‘toddlarian’, ‘preptarian’, and ‘adolestonian’, and a fifth for anxious parents. The main feature of his consult room is a toy table with the slit lamp pushed to one side. Dad jokes are “absolutely fantastic” for toddlers, and a sleeping baby after dilating drops is a gift: refract them in the pram. His “magic wand” trick refracts a nervous child’s elbow and nose before their eyes. “Make it playful and keep a banter up that’s nothing to do with what you’re doing.” Assoc Prof Elder directed delegates to mivision for an article he wrote on the subject.⁵

Dr Kate Gifford (Tasmania) followed with a session on myopia management, including countering parental barriers to treatment strategies. She recommended leading with short-term benefits because people generally are more influenced by a certain, immediate cost than a distant gain. Fewer prescription changes and stable vision between visits are tangible now; the lifelong reduction in eye disease risk follows. Modelling suggests single vision wearers face a higher lifetime cost of correction anyway.

To parents pushing back on myopia with the argument to just “wait and see”, she observed that children under 10 typically progress at least a dioptre a year, and onset at seven or eight ends on average at −6.00 D. Social proof helps convince patients of the recommended strategy, so frame recommendations around past experience: what you, as a clinician, “usually recommend”, what parents “usually decide”, what children “usually find”.

Prescribing for Paeds, Pregnancy, and Breastfeeding

Brisbane ophthalmologist Dr Phillipa Sharwood offered a framework for prescribing in pregnancy, when breastfeeding, and in childhood, where patient and practitioner anxiety can outstrip actual risk: consider patient factors (e.g., a child’s age and weight, a woman’s trimester of pregnancy), ask yourself what happens if the condition is not treated, understand the consequences of drug exposure, then choose the safest drug, formulation, concentration, and frequency. Almost everything in paediatrics is off label, which is fine provided rationale and consent are documented; prescribers should stay within their confidence range.

Children, she said, “are very small humans”. A 30–50 microlitre drop lands on seven microlitres of tear volume, and the excess drains to the nasopharynx, bypassing the liver to reach a small body with a more permeable blood–brain barrier. In pregnancy, timing and systemic exposure matter more than the Therapeutic Goods Administration assigned category, whose B subdivisions reflect evidence rather than safety. Anything that crosses the cornea will cross the placenta, so the first trimester demands most caution. Breast milk exposure is far lower but not zero, so dose after a feed. Punctal occlusion after a drop is essential in all these populations to reduce systemic absorption.

Specifics included never using phenylephrine 10% in children or pregnancy, chloramphenicol being fine in pregnancy, doxycycline contraindicated in children under eight and during pregnancy, alpha-2 agonists contraindicated in infants and NSAIDs to be avoided in pregnancy. Steroid response in children can be “spectacular”, so start low potency, check baseline IOP, and never write open-ended repeats.

Help or Harm

Cataract and refractive surgeon Dr Christolyn Raj (Melbourne) framed corneal care as a race against the clock: the cornea cannot regenerate, and donor corneal tissue is in limited supply. While some corneal grafts are unavoidable, the other common indications for grafting – trauma, herpetic disease and microbial keratitis – are, in many cases, preventable in the consulting room.

When prescribing, consider not only what is being treated, but also where in the cornea the medication will reach. The epithelium can be manipulated or debrided to improve drug penetration, or protected to preserve its important role as a barrier against infection. Although invisible, Bowman’s membrane is the level of the cornea at which irreversible scarring can occur, meaning epithelial haze should not be ignored.

The DEWS and Don’ts

Auckland optometrist Adelle Jefferies reminded delegates that dry eye affects vision, productivity, and mood.

She spoke about the changed criteria for dry eye diagnosis, as set out in the Tear Film and Ocular Surface Society’s third Dry Eye Workshop report (DEWS III). The biggest change is aetiological: rather than DEWS II’s stepwise ladder, clinicians must identify whether tear film deficiency, ocular surface abnormality, or lid disease is driving the condition (it can be more than one), and match treatment accordingly.

Specsavers Optometrists Close the Show

The final two presentations came from Specsavers optometrists Nihaama Narayanan from Specsavers Wendouree, Victoria, and Mariella Coluccio from Specsavers Bankstown, New South Wales. Ms Narayanan walked through a single patient case to demonstrate her framework for diagnosing and managing glaucoma using the EDGE acronym (Examine, Detect, Get the full picture, Escalate). Ms Coluccio offered practical tips for examining children and left delegates with a clear message not to miss “the brain’s cry for help through the eye”. This was illustrated by a three-year-old with a headache and signs of a right esotropia. Sending this child straight to hospital saved her sight and her life. She was treated for a blood clot caused by a sinus infection. Eighteen months later, her optic nerves were normal. This final case was a moving reminder of the power of optometry.

The next SCC will take place in Sydney from 11 to 12 September 2027.

References

1. 2026 Trusted Brands Australia, Available at trustedbrands.com.au/results [accessed Sept 2026].
2. Brands consumers can trust. Available at trustedbrands.co.nz [accessed Sept 2026]
3. Great Place to Work Australia. Available at greatplacetowork.com.au/companies/specsavers [accessed Sept 2026]
4. Azuara-Blanco A, Burr J, Norrie J, et al.; EAGLE study group. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016 Oct 1;388(10052):1389-1397. doi: 10.1016/S0140-6736(16)30956-4.
5. Elder J. Tips and tricks for paediatric eye assessment. mivision. Feb 2024;179:40. Available at: mivision.com.au/2024/02/tips-and-tricks-for-paediatric-eye-assessment [accessed Sept 2026]