Colour Vision deficiency – red looks brown

Colour plays a significant part in our daily lives. Though around 8 per cent of men and 0.5 per cent of women experiencing red-green colour vision deficiency, so for them, life may often be not so straightforward.

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Though it is noted that red-green colour deficiency affects around 1 in 12 men of Northern European heritage. This group includes those with any mutations in the red photoreceptor gene (causing protanopia) or the green one (causing deuteranopia). According to Wikipedia, 9.2% of Russian males, 9% of Norwegian males, 8.6% of French males

Africans are much less likely to be colour blind with 2.9% of Hutu males, 2.5% of Tutsi males, 2% of Tswana males, 1.7% of Congolese males.

Prevalence among Eastern Asians is somewhere between Europeans and Africans with 6.9% of Chinese males, 4% of Japanese males, 5.9% of Korean males

Fijians are the least colour blind people with 0.8% of Fijian males.

It is suspected that colour vision deficiency is more common among Europeans due to early migration. Evolution can be random sometimes and not all changes over time or differences between populations are the result of natural selection. Genetic drift can fixate alleles in small populations by pure chance if they are not seriously deleterious. demographic events, like a population bottleneck or a founder effect, can intensify genetic drift. A lot of genetic differences may be explained not by natural selection on this scenario, but by genetic drift, it is estimated there are over 250 million colour blind people around the world.

Colour deficiency, is caused by genetic mutations or damage to cells at the back of the eye. These cells are responsible for colour vision.

Most individuals who are colour vision deficient are unable to see one of the three colours that the human eye can distinguish: blue, green, and red.

In fact, no two people perceive a particular colour in the same way. That’s because colour vision is a complex interplay between photoreceptors, the optic nerve, and the brain. That is why we stock several types of iRo lenses so we can find the correct lens for your vision.

The cells responsible for colour vision are called cone cells and sit at the back of the eye, in the retina. Each cone cell has one type of colour photoreceptor that can pick up blue, green, or red light.

When light enters the eye, the photoreceptors on the cone cells are stimulated and pass messages to the brain via the optic nerve. The combination of input from all three photoreceptors allows us to see complex colours.

The reason why colour vision deficiency mostly affects men because the genes that are responsible for the green and red photoreceptors are located on the X chromosome.

A man who has inherited one mutated copy of one of these genes will, therefore, be colour-blind, as men only have one X chromosome. But women have two copies of this chromosome, and the chance of inheriting a non-mutated photoreceptor gene is subsequently greater.

 

 

Source: https://www.medicalnewstoday.com/articles/319115#The-many-shades-of-color-blindness-

https://www.reddit.com/r/ColorBlind/comments/ggkz94/color_blindness_prevalence_by_human_race/

https://colourvisionoptical.com.au

 

Q&A with Dr James Muecke AM

In our final Blog post for 2020, this is a nice way to finish off a tough year with a good news story with the 2020 Australian of the Year, Adelaide eye surgeon Dr James Muecke. He speaks to ODMA CEO, Finola Carey about his life and work in helping to prevent blindness with Sight For All a not-for-profit organisation dedicated to fighting avoidable blindness in the world. JAMES

When did you decide that you wanted to become an ophthalmologist/eye surgeon?

I wanted to be a doctor for as long as I can remember. There was no one single experience that steered me toward medicine. It was simply a desire to help, to cure, to make people’s lives better. Following my internship in 1988, I spent a year as a volunteer general doctor at Tumu Tumu Hospital in central Kenya, where I had the privilege of helping patients with a range of diseases, most of which were infective and imminently curable. The idea of being able to cure blindness in disadvantaged communities using microsurgery was really appealing. It combined my growing love of public health and the lifelong appeal of using my hands to do fine work. And so, I returned to Adelaide in 1990 to train as an ophthalmologist.

Who was your greatest mentor/influencer?

When I was toying with the idea of working in Africa for a year, most of the senior medical colleagues I consulted warned me against leaving the system. “You’ll never get back into speciality training programs.”, they exclaimed.

Colin Moore, the Head of Ophthalmology at Royal Adelaide Hospital at the time, gave me the opposite advice and encouraged me to follow my dream. I still remember receiving the phone call whilst I was in the operating theatre at Tumu Tumu Hospital when Colin gave me the wonderful and life-changing news that I’d been accepted into the ophthalmology program in Adelaide.

What did you hope to achieve when you set up Sight For All?

I co-founded Sight For All with colleagues from Royal Adelaide Hospital in 2009, to better coordinate and fundraise for projects that we were undertaking in a number of countries in Asia. Little did I realise that it would become a consuming passion and within a decade be impacting on the lives of over one million people every year.

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Which countries does Sight For All service?

Sight For All has completed projects in nine countries in Asia (Bangladesh, Bhutan, Cambodia, Lao, Mongolia, Myanmar, Nepal, Sri Lanka, and Vietnam) and two in Africa (Ethiopia and Kenya). We also have initiatives in Australia which are primarily focused on raising awareness of the major blinding diseases that afflict Aboriginal and mainstream communities.

What are the most common treatments you provide in these countries?

Our projects are aimed at sustainably training and equipping colleagues in poorer countries so that they can comprehensively deal with all the blinding diseases that they encounter – cataract, glaucoma, diabetic retinal disease, and the blinding conditions of childhood, just to name a few. We are a ‘teach a man to fish’ organisation rather than having a ‘fly-in-fly-out’ approach.

Do you receive government assistance in addition to your fundraising activities?

Sight For All has been accredited with the Australian Government’s Department of Foreign Affairs & Trade for three years. This gives us a small funding stream, however, more importantly, has allowed us to elevate our organisation to the highest level of international development work.

Richard Grills mentioned that you told him measles is the number one cause of blindness in children in Asia.  How did this information come to your attention?

Sight For All has conducted childhood blindness studies in five countries in Asia. During our study in Myanmar in 2007, we discovered that measles was the leading cause of blindness. We also found that it was a leading cause of blindness in Cambodia in 2008 and Laos in 2013.

To be surrounded by children in schools for the blind in each of these countries, who were permanently blind and horribly disfigured from measles, was the most disturbing experience of my medical life. It filled me with a passion to make a difference and spearheaded Sight For All’s fight against childhood blindness in Asia. We have now trained and equipped paediatric ophthalmologists in eight countries in Asia, in many the first for their countries.

What types of equipment does Sight For All use in its work?

 

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All too often, we see equipment that’s been donated to low income countries and yet the doctors and their staff have no idea how to use them. Whenever we train an ophthalmologist, we ensure they receive the specialised equipment that we’ve trained them on, and also a critical training in the use of such equipment. Our donated equipment is often brand new and spans the whole range of subspecialty fields in our profession, from argon lasers for retinal disease to phacoemulsification for cataract surgery and the highly specialised instruments required to treat the range of blinding diseases of childhood.

What is the smallest most effective instrument that you use most?

Some of the finest eye surgeries involve the use of ultra-microsurgical instrumentation to conduct procedures on the delicate tissue of the retina which lines the inside the back of our eyes. The diabetic retinal disease usually presents late in poor countries and so restoring sight often requires the finest of instruments such as intra-ocular forceps, scissors, and suction tubes that can be manipulated inside the eye to remove blinding scar tissue and blood.

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What is the equipment you find hardest to fund?

Sight For All is needing to fund the next generation of vitrector for use in a number of our partner countries. This device powers the instrumentation discussed above, that is so critical for dealing with the ophthalmic complications of diabetes, which is a huge, rapidly growing and often poorly managed cause of blindness in the low-income countries of the world.

 

Now that you have received the Australian Of The Year Award will this alter any of the plans for Sight For All?

I’m hoping that the Award will raise awareness of the high impact work being undertaken by Sight For All, work that’s being supported by the voluntary expertise of nearly 170 ophthalmologists, optometrists, orthoptists, scientists and nurse from across Australia, New Zealand and further afield. I’m also using the platform to raise awareness of diabetes, a growing epidemic that’s now the leading cause of blindness amongst working-age adults in Australia, and, at a cost of close to $20 billion annually, the greatest threat to Australia’s health system.

www.sightforall.org/donate

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Raising glaucoma awareness by Annie Gibbins, Glaucoma Australia CEO

 

His Excellency General the Honourable David Hurley AC DSC (Retd), Governor-General of the Commonwealth of Australia receives representatives of Glaucoma Australia at Admiralty House, Sydney: Ms Annie Gibbons (CEO), Associate Professor Simon Skalicky (President) and Mr Kirk Pengilly (Ambassador).

His Excellency General the Honourable David Hurley AC DSC (Retd), Governor-General of the Commonwealth of Australia receives representatives of Glaucoma Australia at Admiralty House, Sydney: Ms Annie Gibbons (CEO), Associate Professor Simon Skalicky (President) and Mr Kirk Pengilly (Ambassador).

Glaucoma Australia’s mission to eliminate glaucoma blindness focusses strongly on risk awareness and early detection; as well as appointment and treatment adherence for individuals known to have glaucoma. This means Glaucoma Australia are targeting their sight saving messages to people aged 40+ who are often difficult to engage but essential to reach.

Glaucoma is the leading cause of preventable yet irreversible blindness worldwide with half of the estimated 300,000 affected Australians currently unaware they have the condition. The insidious nature of this disease means sight loss occurs slowly and it is often termed the ‘sneak thief of sight’ as the peripheral vision loss caused by glaucoma can go unnoticed until an advanced stage. As a consequence, patients are denied access to sight-saving early interventions, counselling and support, all of which may provide incalculable benefit.

Glaucoma Australia believes that while eye health professionals can make a strong impact individually, the biggest impact for patients will occur when all stakeholders proactively work together to improve risk awareness, early detection and treatment adherence. For this reason, their referral response pathway marketing campaign is titled ‘Every hero needs a sidekick’ as they are keen to be the Robin to your Batman in the fight to save sight.

A framework which continually raises glaucoma awareness drives testing and then refers patients to support services at the earliest opportunity is crucial to eliminating glaucoma blindness.

“Glaucoma awareness, early diagnosis and a strong understanding about the importance of treatment adherence is saving my sight,” said Gaela Hilditch

In 2018, Glaucoma Australia designed and implemented a four-stage patient support journey with referrals being received via Oculo, the website or brochure.

Patient support is enhanced throughout the specific stages by personal access to orthoptist educators, weblinks to high-quality patient-centric resources and support groups to build community.  Kirk Pengilly Return from the brink of Blindness 2400x1268px

Stage 1:  Suspected Glaucoma Diagnosis

Explore preliminary diagnosis response

Provide basic information

Promote Ophthalmology appointment

Provide referral resource

Stage 2:  Recently diagnosed and starting treatment

Discuss the treatment plan

Answer questions

Provide education, resources and support

Discuss ongoing appointment and treatment requirements

Stage 3:  Six months post-diagnosis

Review adherence to the treatment plan

Identify reasons for poor adherence

Educate to improve adherence

Provide resources

Encourage relatives to get tested

Stage 4:  12 months post-diagnosis

Grow knowledge and confidence in eye health management

Promote appointment adherence

Promote treatment adherence

Drive family link ‘at risk’ testing

Educate and support change management.

The proactive approach and innovative design, coupled with highly skilled educators and technological advancements have led to more than 6000 patients being referred via Ophthalmology, Optometry and Pharmacy channels. We know that patient education and support leads to better clinical outcomes, so Glaucoma Australia works collaboratively with eye health professionals to maximise the support services provided to patients at all stages of their glaucoma journey.  A strong patient-centred culture, enhanced and supported by industry collaboration, digital technology and campaigns which drive measurable results are all ways to eliminate glaucoma blindness over the years ahead. An extremely encouraging result of the early intervention initiative is that the age of the first contact to Glaucoma Australia has dropped from 80-89 years to 60-69 years in just 2 years.

Glaucoma Australia Patron His Excellency General the Honourable David Hurley AC DSC (Retd) and Ambassador Kirk Pengilly are proactively extending Glaucoma Australia’s risk awareness campaign far and wide nationally.

Mr Hurley recently had his eyes tested for glaucoma at Flinders Medical Centre by Professor Jamie Craig and then spoke of his experience and his Patronage to patients in Adelaide who attended the Glaucoma Australia Patient Symposium.

Kirk’s high profile and personal experience resonates powerfully and his call to action is simple: ‘if you value your sight and are at risk, go and get tested’.

“When I got glaucoma it really hit home how important sight was to me and obviously to everyone. It was a real wake up call for me as I came within a millimetre of losing my eyesight. As a result, I’m certainly more aware of my eyes, my eye health and the importance of looking after my sight,” said Kirk.

He added, “I feel the need to encourage people to be aware of eye health and the importance of getting their eyes checked regularly. Most eye disease is preventable if you can get to it early so I’m keen to encourage ‘people at risk’ to get their eyes checked regularly.”

Their high-profiles and influence will be accessed at events and through social media to amplify Glaucoma Australia’s key focus areas including:

Improving appointment adherence

Improving treatment adherence

Improving knowledge

Reducing anxiety

Promoting family link awareness which drives ‘at risk’ testing.

What is Glaucoma?

Glaucoma is the name given to a group of eye diseases where vision is lost due to damage to the optic nerve. It causes irreversible vision loss due to damage to the optic nerve. The loss of sight is usually gradual and a considerable amount of peripheral (side) vision may be lost before there is an awareness of any problem. Unfortunately there is no cure for glaucoma, and vision loss is irreversible.

What causes glaucoma?

Glaucoma is usually caused by an increase in intraocular pressure (IOP) which can damage the optic nerve. The level of elevated eye pressure which causes progressive damage to the optic nerve varies between people.

The eye is constantly producing a clear liquid called aqueous humour which it secretes into itself. This fluid nourishes the eye and holds the eye in shape. The fluid is then drained out though an area called the anterior chamber angle or drainage angle. If there is damage to the drainage angle, the rate at which the eye produces the aqueous humour then becomes greater than the rate the eye can drain it – causing high IOP in the eye.

This increased pressure begins to damage the optic nerve which lies at the back of the eye. The optic nerve is made up of approximately one million nerve fibres which connect the back of the eye to the brain. Damage to the cells of the optic nerve results in irreversible damage to your eyesight.

www.glaucoma.org.au

15 interesting facts about the human eye by Bolle

Vision is so fundamental to the human experience that sometimes we take our eyes for granted. The human eye is a highly complex organ that provides us with the ability to experience the world in ways that our other senses cannot. Even though we use our eyes during the majority of our waking hours, there are a number of fun and interesting things you may not have realised about your eyes and how they function.

  1. The Eyes Perceive Things Upside Down

What we see are made up of light reflected from the objects and scenes we look at. However, because the cornea at the front of the eye is curved, it bends the light as it enters eye, meaning the image is upside down when it hits the retina at the back of the eye. When the brain interprets the image it turns it back the right way up so we see the world correctly.

  1. Eyes are Filled with Jelly-Like substance

80% of the human eye is made of a firm jelly-like fluid called vitreous humour that is vital to eye health and function. This clear, colourless substance fills the space between the lens and the retina of your eye. Vitreous humour is 99% water, the rest is a mixture of collagen, proteins, salts and sugars. By filling the eye, vitreous humour is essential to maintaining the eye’s shape and keeping the fragile retina in the place.

  1. There are Many Protective Features Around the Eye

Our skull and facial features have evolved over millions of years to protect the fragile eyeball. The socket itself is depressed into the skull, thereby protecting half the eye with bone. Eyebrows are there to catch sweat from the forehead and divert it away from the eyes. Eyelids close to shield the eye from light and particles when needed. Eyelashes create a filter for dust and other particles but also act like the whiskers of a cat or mouse, by sensing when something is close to the eye and triggering the eyelid to close

Despite these elements, the eye is still one of our most fragile organs, especially in the face of modern hazards like artificial light and industrial substances. Evolution has not caught up with these new hazards, so eye protection is crucial in these modern environments.

  1. We All Have a Blind Spot

We may feel like we see everything in front of us, but we actually have a tiny blind spot. This small portion of the visual field corresponds to the location of the optic disk, where the optic nerve exits the eye and blood vessels enter. Experts are still unsure why we rarely notice this blind spot. One theory is that the brain fills in the missing information using visual cues in the environment, the other is that the overlapping vision of two eyes means they see each other’s blind spots.

  1. The Human Eye Can Detect 10 Million Different Colours

While there are several theories on the topic, studies based on the work of Gunter Wyszecki suggest that we can distinguish as many as 10 million colours. All colours in the light spectrum visible to humans are made up of combinations of red, green and blue. When we see yellow it is a combination of red and green, whereas purple is a combination of red and blue, and so on.

  1. Eye Colour has Little or No Influence on Vision

It has been suggested that blue and green eyes are more sensitive to light than brown eyes, and that brown eyes are more susceptible to cataracts. Some studies even claim that people with brown eyes are better at responsive actions such as racquet sports, while people with lighter coloured eyes may be better at strategic thinking. Other studies dispute these theories. Experts, however, agree that everyone, regardless of eye colour, should use tinted glasses to protect their eyes from the sun.

  1. Red-Eye in Photos is Due to Blood Vessels in the Eye

Ever wondered why eyes sometimes appear red in photos? The “red-eye” effect occurs when the light of a camera flash or other bright light source is reflected back at the camera. The reflected light illuminates the blood vessels of the connective tissue at the back of the eye, which produces the red colour you see in photos.

  1. Iris Scans Are More Secure than Fingerprints

Like a fingerprint, the iris is unique to each individual; unlike corresponding fingers on each hand the iris in each of our eyes are also different from one another. Our irises have over 256 unique characteristics, compared that to fingerprints that only have about 40. This makes iris scan for biometric systems much more secure than fingerprints.

  1. Being Nearsighted or Farsighted Depends on the Shape of Your Eye

Being nearsighted or farsighted depends on the shape of the eye. Those with near-sightedness or myopia, the most common vision problem, have longer eyes meaning light is focused just short of the retina when looking into the distance.

  1. Your Eyes Can Get Sunburned

Sunburn of the skin is now well understood but did you know you can also get sunburn of the eye. The condition is called photokeratitis and can cause pain, redness, blurriness, tearing, swelling and sensitivity to light. Just like how your skin can peel after sunburn, photokeratitis can lead to the corneal epithelium “sloughing off”. Effects can be felt long after exposure, so always wear good sunglasses when in the sun.

  1. We Blink Between 20,000 and 30,000 Times Every Day

Scientists have estimated that we blink between 20,000 and 30,000 times per day on average. Each blink lasts just two-tenths of a second but that adds up to approximately 1.5 hours per day. Blinking removes dirt and lubricates the eye with moist tears. Each blink brings nutrients to the eye surface structures keeping them healthy.

12. 80% of All Vision Impairment Can be Prevented or Cured

The World Health Organization (WHO) estimates that more than 80% of all vision impairment around the world can be prevented and even cured. The WHO highlights a number of successful public-private partnerships that have brought about real change in eye health for those countries who encouraged them. Such measures have led to a substantial reduction in onchocerciasis and trachoma-related blindness and a consequent reduction in the spread of infectious diseases.

  1. Are Carrots Actually Good For Your Eyes?

Many of us have been brought up being told that carrots are the best food for eyesight, even that eating carrots will help us see in the dark. While the beta-carotene rich vegetable is a healthy addition to your diet, it does not have specific benefits for the eyes aside from vitamin A, which is converted from beta-carotene in the body, but there are much better sources of vitamin A.

  1. You’ll Need Glasses When You Get Older

Around age 40, the vast majority of people start to experience a condition called presbyopia. Presbyopia is the hardening of lenses in the eye and makes it more difficult to focus on objects that are too close. Presbyopia often intensifies around age 50 as the lenses continue to harden with age. As a result, most people will need glasses by the time they reach 40 or 50 years old.

  1. Using Screens Causes Computer Vision Syndrome

Studies suggest that 50% to 90% of people who work at a computer screen show symptoms of computer vision syndrome (CVS). CVS is not one specific problem but a whole range of issues relating to eye strain and pain from too much exposure to screens.
Using a screen forces your eyes to focus and refocus all the time, the brightness and glare also make your eyes work harder, over time this repetitive strain can take a toll on your eye muscles.

The End in Sight

Better understanding the complex nature of our eyes can help us appreciate how lucky we are to have them and how important vision is to the evolution of our species.
Understanding our eyes can also help us appreciate how fragile they are so we might better protect them from injury and deterioration. To make sure we keep our eyes healthy and safe from harm we must limit their exposure to light, heat and particles such as dust, by protecting them with quality glasses we can enjoy all the benefits of vision but without the risk.

Read More in LOOKBOOK2021

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Challenging times for the Optical Industry by Finola Carey, Chief Executive Officer

generic-image-1290574857_sml2020 started as a great year. We laughed about how 2020 related to eyes and vision and enjoyed the 12 months of mileage we would receive out of that pun. Now sadly 2020 is going to have a whole new meaning and reflection in years (and in history) to come.

At ODMA we have faced challenges with OSHOW being cancelled here and MIDO and SILMO around the Globe. Maintaining CPD points for Optoms in an interactive setting has become more challenging. Social distancing makes it even harder for distributors to get their products to clients. Product arriving from overseas has been delayed, businesses are under pressure and some even closing – everything is out of kilter.

As your Industry Association, we are here to help. We are happy to talk with you to discuss ways in which we can help you get through this. Conversations to date have included discussions with landlords, banking requirements, physical distancing and communication to your clients.

What can you do? What are you doing? Let us know what you are planning for the next 12 months.

With each state of Australia operating under different guidelines, it makes it harder to have continuity of messaging and working across the industry. The number one thing for everyone is social distancing. We have all seen how New Zealand went well, and they relaxed, and then it reared its head again. These measures will be here to stay for quite a while, so we all have to plan with this in mind long term. By sharing tactics and ideas, the industry can come together with a uniformed strategy to ensure customer satisfaction and comfort.

Please be aware too, that our active social media channels can help support any products and issues Members have. The new LookBook due out in October can also support product lines along with Eyetalk Magazine and our websites.

Our offices are still open due to the small community hub we belong to so please do not hesitate to get in touch via email or phone – we are here to help.

We are focussing all our energy now on 2021 and making OMEGA21 to be held 2-4 September a huge success.

THE DO’S AND DONT’S WHEN LOOKING AFTER YOUR LENSES by Hoya

Helpful tips to maintaining your lenses and ensuring a longer lifespan

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Anyone that owns glasses can think of a time when their lenses were dirty and they had to use the shirt they were wearing to clean them. While this may not be the best solution to clean your lenses, it’s the small things you don’t see that cause the problems. Small particles and dust can get onto the surface of your lenses. Rubbing off the dust, especially with the wrong cloth or paper tissue, may, unfortunately, scratch them. Follow these easy care tips to keep your lenses in top condition for longer.


DO Clean the lenses and frame regularly with lukewarm water and a drop of mild liquid soap.
DO Dry the lenses with a soft, clean microfiber lens cloth, often provided by your optician.
DO Keep your glasses away from household detergents and beauty products such as hairspray and perfume. These can damage lenses and coatings.
DO Use both hands when you put on and take off your glasses.
DO Keep your glasses in a hard case, often provided by your optician.
DO Ask your optician about anti-reflective and scratch-resistant coatings, which guarantee comfort, performance and durability.
DO Hold your glasses by the bridge, not the temples.

Don’t Wipe your lenses with tissues, paper towels or paper napkins. These often contain wood fibres that can permanently damage the lens surface.
Don’t Wipe your lenses with a towel that has been washed with fabric softener, as this can leave a misty film on your lenses.
Don’t Spit on your lenses; saliva may contain oil or other damaging substances. Buy a small bottle of lens cleaner and take it with you when you’re away from
home.
Don’t Put your glasses down on heat sources, such as ovens or central heating, or leave them in a hot car.
Don’t Put your glasses down on the curved side of the lenses. This can damage the coating and cause scratches.
Don’t Keep your glasses on your head. This can misalign the frame, affecting the position of the lenses in front of your eyes.

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Emerging technologies in Optometry by Arthur Stevens

In 1983 Gerald Hawkins, in his book “Mindsteps to the Cosmos”, wrote about the different “mindsteps” that have, in conjunction with the accompanying technology, revolutionized the world and led to the inventions of writing, mathematics, radios, spacecraft & computers.1 He wrote that “The waiting period between the mindsteps is getting shorter. One can’t help noticing the acceleration.” This notion that the rate of change in a wide variety of systems increases exponentially was explored by Ray Kurzweil in his 1999 book “The age of Spiritual machines” and referred to as the “Law of accelerating returns”.2

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This article explores a brief moment in this accelerating progress and reviews some of the technologies that are currently investigated and their impact in the optical industry in the coming decades.

The article is divided into 3 sections:

  • Retail
  • Clinical
  • Business

 

The retail section will look into areas where we can improve the patient experience from online appointments, to dispensing tools and consumer products.

The clinical section will look at the advances in technology that have recently been introduced or is hoped to be introduced in the coming years to ensure we can provide the best diagnosis and management for the patient.

The business section is specifically tailored to the independent optometrist and will explore how, as small business owners, we can embrace the new technologies to ensure that our business continues to thrive in such a competitive environment.  The latest news, labelled a “retail apocalypse” coming into 2020, that so many retail businesses have shut shop, is of concern so any advantage we can utilise to ensure we continue to thrive will be explored3.

The areas that are discussed are by no means exhaustive but ones coloured by my own interests. There are many other topics that I could have covered and are missing from the review but one common theme is that as we head into 2020 technological advances will only accelerate and make working in the profession even more exciting.

Retail

  • Online appointments

We live in an era where, as a result of the huge amount of available information and wanting to be in control of how we use that information, we prefer to book many of our appointments online rather than spend, potentially many lost minutes of our lives, calling and booking appointments4.  Further studies, in comparative professions, have shown that “when primary care agents book outpatient clinic appointments online it improves outpatient attendance”5.

Some of the options available to the optometric business include:

  • My health1st6 – Is the most used online appointment book and has been adopted as our method of online booking for our customers at Kosmac & Clemens. One of its major advantages is the ease to set up and use and most importantly, integration with PMS (Optomate & Sunix). Anyone implementing this system needs to decide how many and which appointments they will allocate to online booking.
  • WordPress7 – WPForms claims to be the best WordPress contact form plugin.  It provides you with the options of building your own forms that send the booking request as an email. The staff process the email and reply either by SMS or email. Unfortunately, there is no integration with Optomate or Sunix. Their basics package is very good value and if you like to send marketing thru email /SMS then their plus package is even better value.
  • Apointuit8 – is for medical practices only and does not integrate with Optomate & Sunix. It offers a smartphone app that allows for online booking. Perhaps, the optical industry can adopt the features this package offers.
  • Patient tracking9

Patient tracking (also referred to as PSI – patient identification system) is usually used in hospitals for a healthcare provider to monitor the progress of a person in their care. The healthcare professional has access to the patient’s electronic records, it can be used to store a patient’s imaging files, as well as check-in and check-outs.

In private practice, it can inform the healthcare professional if the patient is in the clinic, can send SMS reminders about when a patient can take their medication & by wearing additional smart devices can inform the practitioner if the patient has taken their medication.  This ensures maximal compliance and the best possible outcome for the patient.  The 2 major concerns relate to cybersecurity and interference with a patient’s privacy.

In optometry, I can envisage the system being used to ensure the patient is taking their medication e.g. glaucoma drops, ensuring the patient turns up for an appointment and for marketing purposes.

  • Frames
    • Materials – Up until now, frame materials have been limited to various plastics, metal and wood. Technological progress and concerns with sustainability means we will see biodegradable frames (e.g. made from castor beans10), high-tech lightweight frames and frames incorporating various sensors, often referred to as “smart glasses”11. The introduction of 5G connectivity will see this technology to be taken to the next level. There is a high possibility that smart frames will compete with mobile phones in their functionality.
    • Print your own frame12 – As 3D printers become more affordable customers will be able to print their own frames based on templates readily available for free download or for a small fee. The potential for 3D printed frames comes from the expression ““The only limit is your own imagination” and the fact that 3D printing allows for the creation of very complex structures which would not be possible with traditional manufacturing. 3D technology also makes screwless hinges more accessible10.  Hoya has taken the process one –step further with its “Yuniku”13 system where “the world’s first vision-centric 3D eyewear , combines 3D scanner technology with advanced algorithms, to position the lenses for optimal vision and then 3D build the frame around the lenses.
  • Lenses
    • Rx measurement

Lens measurements have advanced significantly from using a PD ruler to measure interpupillary distance and heights of a bifocal or multifocal. Some of these include:

Hoya’s VisuReal Master system14 has been designed to look like a contemporary wall mirror. The patient looks at themselves in the mirror. The dispenser operates an end device (e.g. an iPad) which is connected via Wi-Fi with the mirror. The 6 cameras behind the mirror capture information such as – PDs, fitting height, frame size (boxing method), distance between lenses, back vertex distance BVD, inclination or pantascopic angle & frame face form or wrap angle. The device is relatively compact 64.5cm x 22cm x 3.5cm (HxWxD). The software can be installed on a stationary or mobile electronic device, including smartphone and most operating systems are supported.

Hoya have also developed the binocular harmonization technology (BHT)15. The technology claims to relieve eyestrain while wearing standard progressive lenses, particularly if there is a difference in prescription between the 2 eyes.  The patented Binocular Harmonization Technology (BHT) recalculates and adjusts the progressive power distribution according to the actual used positions on each lens so that both eyes will experience the same binocular support.  The technology evaluates a Binocular Clearness Index which takes into account Convergence Difference, Accommodation Demand Difference, Magnification Difference and Vertical Prismatic Difference between the two eyes.  The Clearness Index estimates how clearly the wearer sees an image through the spectacle lens. Balancing this enhances binocular clarity throughout the entire lens.

A simpler version of the VisuReal Master system is Hoya’s Spectangle Pro and Essilor’s Eyeruler 2.  Both are very similar in that they use an ipad or equivalent device e.g. EY-stick or parameter clip (that provides a reference that sits on the patient’s frame) to take pictures and make adjustments.  These technologies are considerably faster and more accurate than the older systems that are available and should provide a point of difference to the customer experience than simply using a PD ruler to take measurements.  This is particularly true for the high end free-form lenses that the companies provide.  In addition to a measurement module the app has a lens selection module, a frame selection module and an augmented selection module that allows patients to take certain lens features for a test ride around your office or pre-built environments. Taking the lens selection process one step further and wowing them along the way.

Dr Wolfgang Wesemann16 in 2010 compared 4 high end video centration systems Essilor: ‘Visioffice’, Rodenstock: ‘ImpressionIST’, Ollendorf: ‘Visureal’ & Zeiss: ‘Remote Vision Terminal (RVT)’ with pupilometers. He concluded that “all tested video-based systems measure the PD to a higher precision than conventional pupillometers”. Furthermore, the “video centration devices present as ‘point of sale’ additional information on high-end spectacle lenses and personalised lens designs.”  This argument holds true today as it did 10 years ago and even more so as the technology has been refined to provide even more accurate results with a reduction in error such as when a customer is not positioned accurately.

Equivalent systems exist for Zeiss e.g. Visufit 100017, iterminal 218. The improved software eliminates the use of a frame calibrating clip and increases the accuracy of centration to maximize optical performance.  Zeiss claims that taking measurements is up to 60% faster for the i.Terminal 2 than using manual measuring procedures and that the measurements are 84% more accurate than a manual process.  For the small business owner who wishes to retain customers, in addition to eliminating remake errors this technology offers exceptional “wow” factor.

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Types of lenses

Lens materials has significantly improved since the 1st half of the 20th century from crown glass with an index of 1.523 and a specific gravity of 2.54 to CR39 which is significantly lighter with a specific gravity of 1.32 but thicker with an index of 1.5. Polycarbonate, Trivex, & high-index materials ranging from 1.6 to 1.9 followed, each with their own benefits.  Looking forward we can expect advances in coatings and even higher indices19 up to 5.5 and only one two-thousandth the thickness of a human hair. Some of these are already in production such as permanent antifog coat20, anti-scratch coats (that actually work)21.

In addition to advances in materials, we will also see advances in design. One of these already in circulation is the Myosmart22 lens from Hoya which uses D.I.M.S. (Defocus Incorporated Multiple Segments) technology for myopia control A two-year clinical trial found that MyoSmart lenses were able to reduce myopia progression by up to 59% and halt myopia progression by 21.5%.

It would be great if we can eliminate the biggest bugbear of multifocal lenses, the distortions that are experienced when changing viewing distances from far to near.  Electronic focusing eyewear using liquid crystal display technology has been studied over the last decade and some products are starting to appear23,24.  Currently, they are price prohibitive for most people at ~ US$2,220 a pair – plus tax.

Clinical

Telehealth – This has probably more applications in medicine than optometry but optometry can certainly benefit from expanded use of telehealth. Telehealth offers significant advantages especially in a country as large as Australia with the remote areas having vastly isolated populations25,26. As Telehealth becomes more utilised it is predicted that more virtual clinical trials occur, increased access to healthcare for remote communities, development of paediatric platforms27.

Vision

Myopia

Various studies have acknowledged that we are facing a global myopia epidemic which may lead to various ocular complications including vision loss28, 29.  There have been various technologies available to combat this progression from education, to specific myopia lenses and contact lenses and medications30.  The science on the exact mechanism and treatment options is still unclear but is expected to make significant progress in the coming decade31.

Amblyopia

Amblyopia is the most common cause of monocular visual impairment affecting up to5% of the population. Traditional treatments have included penalisation of the non-amblyopic eye with either patching or pharmaceutical penalisation32-35. Unfortunately, success as measured by visual acuity equalisation or development of stereopsis has been hampered by non-compliance contributing to treatment failures.  Alternative therapies include: vision therapy, binocular therapy, and liquid crystal display eyeglasses have only been sparingly used with moderate success.  The Pediatric Eye Investigative Group (PEDIG) has shown that age should not be a restrictive factor & that “even older patients can show improvement in VA in the amblyopic eye”. Recent studies from Vanderbilt University have learned that visual signals are merged as they arrive in the neocortex to form a singular image36. It was thought that the initial processing happened in the upper layers, but it’s actually in the middle layers. By identifying which neurons are involved in visual processing targeted brain therapies can be developed to treat amblyopia.

Laser correction & IOLs

I’ve put these 2 categories together because I’m referring to patients who want to eliminate glasses and don’t want to wear contact lenses.  With laser eye correction which was introduced in the 1990s first with PRK & then LASIK the techniques have been well refined and the visual outcomes are relatively predictable. The latest option to provide a patient is ReLEx SMILE surgery, (Small Incision Lenticule Extraction), a flapless, minimally invasive procedure. In this procedure, a Carl Zeiss VisuMax laser places a series of precise pulses in the centre of the cornea which form bubbles that are less than 1/100th the width of a human hair, and which outline the tissue that needs to be removed to effectively change the shape of the cornea.  The laser also creates a small incision point through which the surgeon draws out this tissue. No flap is created like in conventional laser eye surgery, so the healing time is significantly faster37.

Clear lens extraction or refractive lens exchange is another procedure that your patient may wish to consider if they do not want or are unable to wear corrective eyewear.  I suggest this procedure to all my patients over the age of 45 who are looking to eliminate eyewear. The merits and complications of this procedure have been discussed but what makes it more appealing is the improved technology of IOLs38-40. The advances to the new IOLs include small aperture IOLs, IOLs that eliminate dysphotopsias, trifocal IOLs, electronic IOLs with the ultimate being an accommodative IOL41,42.

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Electronic low vision aids43-45

The numbers of low vision patients is expected to increase, according to the National Eye Institute, and the prevalence of low vision is expected to almost triple by the year 2050. An excellent article in CEO (2014) reviewed the models of low vision care, past, present and future.  The article mentioned the move from low vision aids to a more multidisciplinary, holistic rehabilitation process.  Nevertheless, the changes that will come will be governed by the advances that technology brings. Some of these include:

  • Advanced telescopic devices, in particular wearable electronic binoculars that automatically focus and come with rechargeable batteries that last all day.
  • Portable vision enhancement systems can be made in the form of a tablet and are ideal for people who want more assistance than non-electronic optical aids can provide, but who do not necessarily want a large, cumbersome CCTV. Furthermore, with the addition of speech enabling technology, the devices can be an all in one calendar, diary, and a magnifier to make daily tasks significantly more manageable with a singular device.
  • Head-worn vision enhancement systems are excellent options for those patients with tremors or muscle weakness. The devices offer wide magnification ranges, vision enhancement options, and they can include voice control or remote control.  In the near future, using artificial intelligence, it will be able to communicate with the user providing a description of their surroundings. The main drawback is cost, which ranges from $2000 to $10000, and Medicare does not yet cover magnification devices.
  • Apps and accessibility hardware offer accessibility features at little to no cost and are easy to use and are available on both Android and Apple devices. These features include text enlargement, text-reading, and zoom capabilities. Voice command is probably the most useful feature and allows the users to make phone calls, hear and send text messages, and store lists and reminders. Additional apps that can provide convenience to low vision patients include features that provide assistance with daily tasks like calculating, managing bank accounts, reading aloud text and handwriting, reading bar codes, identifying currency, recognizing colours, and recognizing people. These apps make separate costly devices no longer necessary.
  • Crowd assistance services connect blind and low-vision individuals with sighted volunteers and professionals through live video calls on smart phones or smart glasses. Depending upon the particular service or version, the app may be free for use anytime in certain locations that pay for the service, such as drug stores, airports and federal buildings, or it may require a paid user account or pay-per-minute fee. Service is available anytime, providing an excellent opportunity for independence and safety for visually impaired individuals.
  • Bionic eyes.

Around 35-40 million people in the world suffer from blindness.  The technology has progressed from the Argus II system (2009) where inbuilt cameras in spectacle frames send a signal to a retinal implant which is then interpreted by the visual cortex to more sophisticated systems like the Orion Visual Cortical prosthesis (2019) where the electronics are implanted directly into the brain.46 The current system takes many weeks of training for the patient to learn to use and the images are still rather low resolution.  There are other systems being developed, some of which are under clinical trials, which assist patients in improving their awareness of their surroundings47,48  It is expected these prostheses will become available in the next 10 years.

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Eye diseases

Artificial intelligence algorithms 49-52

Some would consider it strange that a topic entitled eye diseases starts with AI.  However, the single biggest technological development in the industry, particularly going forward, is the development of algorithms which assist the practitioner to come up with not only the most accurate diagnosis but offer the best treatment outcome possible. AI algorithms are basically computer programs, often referred to as neural networks, that have been

written to “learn” from a specified set of data and they use the new formulated rules to diagnose various diseases or predict the success of treatment outcomes.

AI algorithms have been used as screening tools to diagnose various ophthalmic diseases including diabetic retinopathy, age-related macular degeneration, macular edema, glaucoma, keratoconus, post-LASIK corneal ectasia, retinopathy of prematurity, and cataracts.

In the case of diabetic retinopathy, the sensitivity & specificity of the AI programs has improved from 73% & 91% to 97.5% & 98.5% respectively.  The AI can detect CMO using only colour fundus photography although OCT images improve the diagnosis even more.

In the case of ARMD, the AI can delineate the areas of pathologic retinal fluid and even grade the severity of AMD present.  Incorporating fundus autofluorescence imaging has allowed for areas of geographic atrophy to be delineated.

Furthermore, these programs have been shown to be able to predict the prognosis of various ophthalmic diseases. For example an AI program was able to predict with 96% accuracy which diabetic patients would need laser or surgical intervention versus no intervention at all, whilst another program used OCT imaging to predict the need for an anti-VEGF injection in patients with neovascular AMD or the likelihood that an eye with intermediate AMD would progress to neovascular AMD or geographic atrophy.

Whilst most of the AI research is focussed on the retina there has been significant advances in using AI to:

  • automatically grade cataracts and determine which patients will benefit the most from an IOL implant,
  • in glaucoma AI algorithms use ONH & NFL analysis coupled with visual field results to accurately detect glaucoma and provide options for treatment.

Going forward coupling AI & retinal images allows the medical professional to make medical assessments beyond eye-specific disease that reflect the overall health of the patient such as cardiovascular diseases and Alzheimers.

An advantage of AI is that combining this technology with Telehealth enables it to be used across the nation without transporting specialist across the continent thereby preventing vision loss in remote communities.

Another advantage is that once developed these technologies can be transferred to all parts of the country and are very cost effective, requiring fewer resources than time-intensive and expensive human-led screening programs.

The risks associated with AI include:

  • a risk of deskilling the workforce with implementation of AI technologies
  • despite the impressive diagnostic accuracy of AI programs, some algorithms result in relatively high false-negative rates of detection of disease, which means that the algorithms incorrectly classify eyes as being disease-free or not requiring further evaluation. Hopefully, this risk will decrease as the AI program improves in its diagnostic ability.
  • Potential loss of jobs in the service industry, optometric and even ophthalmological industry.52-54

Contact lens (CL) monitoring

Contact lens technology has evolved greatly over the last half of the 20th century. Since 1987 when J&J introduced the disposable CL, the market has evolved to have options for a variety of needs including reduction of myopia progression, yet dropouts remain high. In addition to new materials, most of which will focus on comfort & wettability rather than oxygen transmission (the technology is such now that any increases in oxygen transmission are irrelevant – the analogy being a car that can go 200 kph in a 100 kph zone) contact lenses will incorporate technologies that will see them being used for medical purposes and for information exchange.

These technologies will be used to monitor glaucoma (like the Sensimed Triggerfish), monitor cancer, as lacryglobin is elevated in human tears in patients with breast, colon, lung, prostate, and ovarian cancers and monitor glucose levels in diabetics.55-57

Finally, contact lenses can be used to administer drugs in glaucoma, diabetes, uveitis and infections in the elderly where continual usage of drops is not possible.58,59

Another possibility is to develop emebedded circuitry so that the CL functions like the augmented reality eyewear used in Google Glass or Focals, the difference being that Mojo Vision’s contacts have the display integrated into the contact lens.60

Glaucoma

The causes of glaucomatous optic neuropathy includes a wide variety of factors that are not fully understood.  The resulting loss of retinal ganglion cells can be shown using OCT imaging and their axons as shown by specific morphological changes of the optic nerve. The corresponding functional loss of the ganglion cell and axon is shown by specific defects in the visual field.

Treatment of glaucoma can be broadly categorised into either medications or surgery (including laser), both of which decrease the IOP.  Many of the medications are used as either monotherapy or combination therapy. Medications to manage glaucoma can be grouped into mode of action or by their pharmaceutical category e.g. adrenergic antagonists such as Timolol or prostaglandin analogues such as Latanaprost. 61

New therapies are continually being developed and whilst the mechanisms are mostly unknown, many of these work by a different mechanism than decreasing IOP and either improve blood flow to the optic nerve or interfere with the mechanisms of retinal ganglion cell apoptosis and provide neuroprotection. There are still no reliably proven neuroprotective treatments related to glaucoma but this is an area which is expected to grow in the coming decade.62,63

A surgical technique that has recently emerged and performed often with cataract surgery is MIGS (Minimally invasive glaucoma surgery). MIGS devices lower the IOP by increasing aqueous outflow through existing anatomical outflow pathways including through the TM into Schlemm’s canal, through the uveoscleral pathway, as well as through alternate pathways, which are created iatrogenically such as subconjunctivally. The main advantage of MIGS is that most devices are non-penetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony.  Various studies have shown that MIGS is as effective as eye drops without the complications of patient compliance.  There has also been complications requiring the removal of the CYPASS device due to unacceptable endothelial cell count loss over 5 years64.  It would appear that MIGS procedures will exist alongside rather than replacing more invasive IOP-lowering surgical options.

I think the biggest advance is glaucoma management is not the medication or surgical methods but the care pathways that have been developed as a result of optometry being able to co-manage with ophthalmology. This collaboration between professions has enabled more people to access eyecare without long wait times and thereby reduce the possibility of irreversible loss of vision.65

Going forwards, the challenge of patient adherence to taking the medication still needs to be addressed but this may be overcome by providing new medication delivery systems for glaucoma which can be broadly categorised as on the eye, in the eye, and around the eye66.

  • On the eye: sophisticated new gel drops, contact lenses, or other technologies that release a steady amount of medication over time
  • In the eye: implants that release drug over longer periods, requiring less total amount of medication, thus fewer side effects
  • Around the eye: punctal (tear duct) plugs that release medication over time in a relatively non-invasive manner

I have included genetic testing in this section, although the technology can be applied to all areas of eye disease which has a genetic basis.  The advancements in genetic testing are highlighted in a recent article which reports that researchers at Flinders University in Australia, have identified 107 genes that increase the risk of glaucoma. They have developed a glaucoma polygenic risk score that predicts the progression of glaucoma. It is envisaged that a saliva or blood screening test, will be developed to determine a patient’s glaucoma risk.67 As more genes and their functions are identified this technology will enable earlier treatment thereby reducing the likelihood of vision loss.

ARMD68

Developments in the treatment of macula degeneration are currently restricted to those with the “wet” (also referred to as neovascular or exudative AMD).   The treatment involves regular injections of drugs that block vascular endothelial growth factor (VEGF) such as Lucentis or Avastin.  Recent developments include:

Abicipar is an anti-VEGF  drug that is long acting drug (lasting up to 12 weeks in Phase III trials).

PDS or port delivery system is a device which stores and slowly releases Lucentis.  It requires a refill every 15 months resulting in fewer office visits and significant cost savings to the patient.

RGX-314 is an anti-VEGF treatment delivered by gene therapy. The gene carrying the anti-VEGF is inserted into an adeno-associated virus and injected under the retina. The treatment has the potential to block VEGF for many years and phase II trials showed no further treatment was required for at least 6 months following the initial injection.

ADVM-022 is another AAV-anti-VEGF gene therapy, but in contrast to RGX-314, it is injected into the vitreous. The advantage being that the procedure can be performed in office rather than an operating theatre.

Like RGX-314, in a phase I trial with 6 patients, none has needed any further anti-VEGF injections in the six to ten months following the initial injection.

X-82 is another VEGF / PDGF receptor inhibitor, but its advantage is that it is delivered orally. These drugs, which are in phase II trials, may work alone or in combination with other drugs injected into the eye. In phase I trials 60% did not require any other treatment whilst 40% required on average 0.68 intravitreous anti-VEGF injections

There are at least 3 combination therapies which usually involve anti-VEGF injections in combination with either Cosopt, OPT-302 (a new form of VEGF) or RG7716 (an antibody targeting Angiopoietin II).  Research has shown that these combination therapies are more effective than anti-VEGF drugs alone.

Additional drug developments are also being tested and some are in clinical trials including the proteins endoglin, activin, and tissue factor. These proteins are involved in the growth of new blood vessels, which is a key process involved in the development of the wet form of AMD.

Whilst no drugs are approved for the dry form of ARMD or geographic atrophy there are several treatments in clinical trials.  These include two drugs which inhibit proteins in the complement cascade.

Apl-2 is a complement C3inhibitor and is in phase II clinical trials. It is injected usually monthly and has been show to significantly inhibit the expansion of the area of atrophy.

Zimura (avacincaptad pegol), inhibits another protein in the complement cascade, C5. In a phase II trials, intraocular injections of Zimura slowed the growth of geographic atrophy by ~ 27% and a reduced loss of vision.

Stem cells are also been investigated and have been injected in trials for the treatment of geographic atrophy. The results appear promising but many more clinical trials are required before this modality can become more routine.69,70

Business

Whilst people will continue to spend their hard-earned money in the future, the small business owner needs to evolve with the changing landscape.  Only those that can quickly adapt to the changing consumer needs and continues to innovate and offer more than just a product will thrive.  To that end I’ve outlined some of the changes that have been identified in the retail sector and have provided examples specific to the optometric sector.

  1. More stores will close as online sales will continue to grow & new stores formats will expand. However, not all consumer transactions will be online. A study by KPMG reported that online penetration is likely to be 35%-40% 10 years from now71 although it will vary across sub-sectors of retail, for example CL, sunglass and frame sales will be significantly higher online than lens sales.  It is important for the small retailer to ensure they have developed their online eCommerce platforms such as Shopify.  See the reference for a list of highly-rated platforms.72
  2. Retailers with tight online to offline integrations will gain a competitive edge e.g. selling Frames & CLs thru website online offers increased revenue for sales & using Facebook/Instagram to advertise will promote the online sales shop as well as the bricks & mortar business.
  3. Independent business owners should be wary of direct-to-consumer stores appearing from major corporates and factor the increasing buying power these corporates have and how, as small businesses, they can effectively survive in such a competitive environment. g. OPSM-Luxoticca  merger73 & Essilor buying out stores in Europe74. Two simple solutions are (i) to acknowledge that these corporations are large and that a small business has the flexibility to rapidly change to changing trends and also (ii) to specialise in areas that the larger retailers do not find financially rewarding75.
  4. Inventory will need to be under tighter control as the cost of rent increases substantially particularly in cities and major shopping centres. An excellent innovation provided by Provision is ProSupply which enables the small business owner to manage their inventory effectively whilst minimizing costs.
  5. A business that is shown to be socially aware and responsible will be viewed more favourably with the current generation of consumers. As a business you will be expected to be part of the circular economy, in an effort to minimise waste and promote sustainability e.g. minimizing CL packaging by recycling, recycling of frames thru organizations such as the Lions Foundation, bioorganic frames made from materials such as wood, beans etc
  6. We will see more private label growth in the retail sector76. In the optical industry, we have already discussed the use of (i) 3D printing & (ii) own labelled frames due to easy access to wholesalers in China especially. This provides increased choice for the consumer & the small business owner.
  7. Social media and retail will be even more intertwined77. In optometry, social media provides the opportunity to educate the patient and Alcon’s initiative is an excellent example where a large corporation has helped expand the industry by increasing the knowledge of eyecare among the public78.  Social media has also been used for education, training and diagnosis in various youtube channels e.g. the excellent myopia resources provided by the Brien Holden Foundation79,80.
  8. Providing your customers with various payment options will become paramount81. Afterpay is one of the standout performers of the sharemarket of 2019 and its buy now pay later model is a growing trend leading to various alternatives which have taken the retail market by storm. It allows the consumer to obtain immediate joy and pay for that in the future without the stress of interest payments.  Optometric businesses where the value of the transaction is on average ~ $500 fits perfectly well into this payment method and should be offered by all small businesses.
  9. In a technologically forward-thinking society where anti-ageing is a hot topic, all aspects of healthcare, including vision will be a top priority82. Your retail strategy will need to take into account your customers concerns of health and vision is considered by many to be their most important sense of all83. Furthermore, recent advances in technology have extended the application beyond the eyes and into the brain where research has shown early diagnosis of Alzheimers may be possible with eye examinations84.
  10. Improvements in IT speeds (introduction of 5G) and faster computer hardware (SSDs), as well as an exponential increase in performance for a given price point, will continue to make inroads into the industry85. This is especially important for telehealth consultations in remote areas or even in cities between colleagues where a nurse or assistant can perform the tests and in real-time a diagnosis can be made. Currently, the data generated by OCT and some other imaging software is too large to transfer in real-time across the internet. Fibre and 5G technology will allow such transfers to occur almost instantaneously86.
  11. The increased convenience that the consumer experiences in the era of food delivery services has altered their mindset to expect similar type services from other industries87. In the optical industry, more retailers will explore subscriptions such as with CLs or dry eye medications where the consumer will order online & receive yearly packages & only come in for an annual eye health check.

 There is no doubt that the retail market is the most competitive it has ever been. One way in which independent optometry can thrive is to join like-minded people in groups like Provision & EyeCarePlus to help the small business owner tackle the challenges they face as we look forward to all the exciting prospects that the 2020’s will give us.

Disclaimers:

  1. The author is a member of Provision.
  2. The author has not received any financial incentives from any of the companies mentioned in the article.

 

References

  1. https://www.goodreads.com/book/show/1038909.Mindsteps_to_the_Cosmos
  2. https://www.kurzweilai.net/the-law-of-accelerating-returns
  3. https://www.businessinsider.com.au/stores-closing-in-2020-list-2020-1
  4. https://www.checkfront.com/5-reasons-why-your-customers-prefer-to-book-online
  5. https://pdfs.semanticscholar.org/1cfb/ed95cb187cd3b1e9bdc93761088d3c94279e.pdf
  6. https://www.myhealth1st.com.au/
  7. https://wpforms.com/
  8. https://appointuit.com/home/
  9. https://www.scnsoft.com/blog/rfid-and-iot-in-a-smart-hospital-benefits-and-challenges-of-smart-patient-tracking
  10. https://monoqool.com/screwless-hinges/
  11. https://www.wareable.com/ar/the-best-smartglasses-google-glass-and-the-rest
  12. https://www.sculpteo.com/blog/2019/08/07/3d-printed-glasses-taking-the-eyewear-industry-to-the-next-level-2/
  13. https://www.hoyavision.com/yuniku/
  14. https://www.visusolution.com/en/visureal-master-en
  15. https://blog.hoyavision.com/eye-care-professionals/what-is-binocular-harmonization-technology
  16. http://www.mmoptik.cz/upload/mmoptik/docs/Wesemann PD measuring devices 2010k.pdf
  17. https://www.zeiss.com/vision-care/int/eye-care-professionals/products/instruments-technology/visufit-1000.html
  18. https://www.zeiss.com/vision-care/int/eye-care-professionals/products/instruments-technology/i-terminal-2-lens-customisation.html
  19. https://www.engineersaustralia.org.au/News/worlds-thinnest-lens-bends-light-atomic-scale
  20. https://www.advancednanotechnologies.com/anti-fog-coating-the-mechanism-and-application/
  21. https://www.sciencedaily.com/releases/2019/09/190909123717.htm
  22. https://www.hoyavision.com/en-hk/discover-products/for-spectacle-wearers/special-lenses/myosmart/
  23. https://newatlas.com/touchfocus-electronic-adaptive-eyeglasses/56888/
  24. http://www.deepoptics.com/do_site/
  25. https://www.who.int/goe/policies/countries/aus__support_tele.pdf/
  26. https://www.illuminancesolutions.com.au/telehealth-benefits/
  27. https://www.healthitoutcomes.com/doc/the-future-of-telehealth-predictions-0001
  28. https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-018-0829-8
  29. https://www.aaojournal.org/article/S0161-6420(16)00025-7/abstract
  30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313317/
  31. https://iovs.arvojournals.org/article.aspx?articleid=2727316
  32. https://bjo.bmj.com/content/102/11/1492
  33. https://www.ncbi.nlm.nih.gov/pubmed/29871968
  34. https://guldenophthalmics.com/advances-in-amblyopia-research/
  35. https://journals.sagepub.com/doi/full/10.1177/2515841419857379
  36. https://news.vanderbilt.edu/2019/01/17/findings-on-eye-signal-blending-re-examine-nobel-winning-research/
  37. https://www.allaboutvision.com/visionsurgery/smile.htm
  38. https://www.optometrytimes.com/modern-medicine-cases/pros-and-cons-clear-lens-exchange
  39. https://theophthalmologist.com/subspecialties/the-new-generation-electronic-iols
  40. https://www.reviewofophthalmology.com/article/new-hightech-iol-options-in-the-pipeline
  41. https://www.reviewofophthalmology.com/article/accommodating-iols-two-more-possibilities
  42. https://www.ophthalmologytimes.com/iol-advances/future-development-true-accommodative-iols
  43. https://onlinelibrary.wiley.com/doi/pdf/10.1111/cxo.12157
  44. https://scanmarker.com/2019/09/25/the-best-aids-for-vision-impairment/
  45. https://lowvision.preventblindness.org/2019/12/07/whats-new-in-low-vision-technology/
  46. https://www.electropages.com/blog/2019/11/bionic-eyes-future-sight
  47. https://eyesmart.com.au/newsarticle/5935-bvt-announces-interim-pilot-study-results-of-bionic-eye-system
  48. https://www.ukessays.com/essays/engineering/the-history-of-the-bionic-eye-engineering-essay.php
  49. https://www.reviewofophthalmology.com/article/the-incoming-wave-of-ai-in-retina
  50. https://www.aao.org/newsroom/news-releases/detail/using-ai-to-screen-diabetic-eye-disease-feasible
  51. https://www.theverge.com/2018/2/19/17027902/google-verily-ai-algorithm-eye-scan-heart-disease-cardiovascular-risk
  52. https://emerj.com/ai-sector-overviews/robots-in-retail-examples/
  53. https://www.roboticsbusinessreview.com/health-medical/5-surgical-robots-2019/
  54. https://www.eenewseurope.com/news/robotic-trends-2020
  55. https://www.zdnet.com/article/how-smart-contact-lenses-will-help-keep-an-eye-on-your-health/
  56. https://www.sensimed.ch/sensimed-triggerfish/
  57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210255/
  58. http://telecareaware.com/contact-lenses-as-a-drug-delivery-system-take-home-mit-sloan-healthcare-prize/
  59. https://www.researchgate.net/publication/335563854_Newer_Technologies_for_Ocular_Drug_Development_and_Deployment
  60. https://www.wired.com/story/mojo-vision-smart-contact-lens/
  61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464991/
  62. https://www.glaucomaconcepts.com/book/glaucoma-research-and-clinical-advances-2018-to-2020/
  63. https://www.nature.com/articles/s41433-019-0671-0
  64. https://www.glaucoma.org.au/articles/cypass-withdrawal-article/
  65. https://www.nature.com/articles/s41433-019-0633-6
  66. https://www.glaucoma.org.au/media/1726/gap-manual_-13_6_14.pdf
  67. https://www.nature.com/articles/s41588-019-0556-y
  68. https://www.brightfocus.org/macular/article/update-on-the-age-related-macular-degeneration-drug-pipeline
  69. https://www.moorfields.nhs.uk/news/successful-trials-new-treatment-moorfields-fight-against-sight-loss-caused-amd
  70. https://www.closerlookatstemcells.org/stem-cells-medicine/macular-degeneration/
  71. http://www.retailthinktank.co.uk/whitepaper/august-2019-retail-2025/
  72. https://webaroo.com.au/ecommerce-platforms-australia
  73. https://www.retailbiz.com.au/latest-news/optical-retail-giants-luxottica-essilor-merge-almost-line/
  74. https://www.reuters.com/article/us-essilorluxottica-results/essilorluxottica-sets-sights-on-retail-dominance-with-8-billion-grandvision-deal-idUSKCN1UQ0JW
  75. https://www.godaddy.com/garage/how-your-small-retail-shop-can-compete-with-a-big-box-store/
  76. 66 https://www.nielsen.com/wp-content/uploads/sites/3/2019/04/global-private-label-report.pdf
  77. https://www.vendhq.com/au/retail-trends-and-predictions
  78. http://www.myeyes.com/
  79. https://globalmyopiacentre.org/myopia-resources
  80. https://www.youtube.com/watch?v=YSMl4tDTsMA
  81. https://www.entrepreneur.com/article/204932
  82. https://www.forbes.com/sites/robinseatonjefferson/2019/08/26/how-extraordinary-breakthroughs-in-anti-aging-research-will-happen-faster-than-people-think/#539b25033dd5
  83. https://medium.com/@SmartVisionLabs/why-vision-is-the-most-important-sense-organ-60a2cec1c164
  84. https://www.allaboutvision.com/eye-exam/alzheimer.html
  85. https://ourworldindata.org/technological-progress
  86. https://academic.oup.com/pcm/article/2/4/205/5591013
  87. https://www.smartcompany.com.au/industries/hospitality/pressure-mounts-on-food-retailers-to-go-digital/

Martin Wells: A Giant in Its Time – By Neil Forbes*

In this Blog we look back at some of the iconic history of our industry –

Spectacle-frame manufacturer Martin Wells Pty Ltd was established in 1954 by Eric Hurst, originally from Czechoslovakia, and Dino Zingarelli, originally from Italy, with Sidney Sinclair, formerly from England, as chairman of the company. Annotation 2020-05-14 085708

Eric Hurst was a great salesman, Dino Zingarelli a technical whizz and Sidney Sinclair a hard-nosed businessman, who was a joint founder of men’s-suit manufacturer Anthony Squires. They made a powerful team.

The company was located at St Marys, a far-western suburb of Sydney, in what was formerly a group of factories that were part of a large complex where ammunition was manufactured and stored during World War II.

The reason for selecting those premises was the plastic material used then for the manufacture of spectacle frames was cellulose nitrate, which was highly flammable. The material was later changed to cellulose acetate.

The concept was that if there was a fire, the ‘blast’ in a storage building some way from the manufacturing facility, would go up through the relatively weak structure of the roof because the walls were very thick and capable of resisting the blast…

There was a major setback early on when the factory was burnt to the ground; however, there was a benefit in the form of the not-so-young plant being replaced under insurance policies.

At the time Martin Wells was founded, the frame-manufacturing industry in Australia was not renowned as a leader, with basic frames, limited colour selections and traditional overseas suppliers, having recovered from the war. Messrs Hurst and Zingarelli, who had come here after the war to work for a local manufacturer, soon saw their opportunity.

Before long, they had opened for business, quickly gaining recognition among wholesalers and practitioners for what their business was producing; the company had distributors in each state, competing against each other, often with the same styles.

MW Womens1

In those pre-Trade-Practices-Act days, disregarding ex-wholesale prices set by the manufacturer to practices was frowned upon, with the threat of being sacked as a distributor ever-present, but in the case of Martin Wells and other frame manufacturers that was never pursued.

By the time the company listed on the stock exchange, it had built outstanding goodwill and the listing was a success.

Part of the reason for that was the addition of marcasite stones to its plastic frames, which gained considerable publicity, then ‘anodised’ frames, consisting of a plastic front with anodised aluminium sides and brow pieces in almost any combination of colour and engraving, with finishes that others could not match.

Over time, the company produced some big sellers, including Super Ambassador, Envoy, 727, 747 and Mustang for gents and Amorette, Spellbound and a host of others for ladies.

In 1968, the company bought its largest wholesale distributor in Australia, Optical Products, followed soon after by its United Kingdom distributor, M Bender Northern, in Newcastle-upon-Tyne. Later the company bought its distributor in the United States, which turned out to be an expensive mistake.

Apart from its substantial prescription-lens business, Optical Products brought to the table the Rodenstock agency, which from then on was tenuous, given that the new owner of OPs was a rival frame manufacturer.

Meantime the company’s export business continued to grow, reaching just over 50 per cent of total ex-factory sales and covering over 50 countries, with markets in Asia and South Africa being particularly successful.

As a measure of its export success, Martin Wells won a Hoover Award for its efforts, written up as ‘Beating the Giants’, which set out its strategies and tactics to take on European manufacturers. Three export awards were won in later years.

All was well until the advent of sudden and substantial demand for metal frames, commencing in the early 1970s.

ForbBU

Martin Wells tried to resist that, but the tide had turned and the plastic frames that had been popular after World War II were suddenly largely on the way out, and metal frames were in!

That was a turning point for the company, which attempted to resist the advent of metal frames, but before long realised it had to become a metal-frame manufacturer too or continue to lose market share to overseas manufacturers, particularly those in Europe. It did that.

Curiously, later on its metal-manufacturing plant was sold to smaller, rival company Engelhardt in Adelaide, which eventually closed it down and concentrated on importing components and assembling them.

Viewing the success of branded sunglasses, Martin Wells joined the fray, launching its Passport sunglasses brand in 1969, however it did not invest sufficient marketing funds to seriously take on market leaders Polaroid and Sunoroid and eventually the Passport brand was sold to another company.

By the mid-1980s, the whole Martin Wells group had been sold to the Adelaide Steamship consortium, which in turn on-sold it to the Hancock & Gore organisation (now HGL), which in turn on-sold the Martin Wells name to Diane and Mike Quaife’s OPs Optical Products.

The name has now been sold to Van Staveren Eyewear, based in Victoria.

Martin Wells was a giant in its time; no doubt about that. At its peak, it employed 620 staff at its St Marys facility.

*Neil Forbes was marketing manager at Martin Wells from 1967 to 1975, before becoming editor of Insight for just over 40 years – from 1975 to 2016.

Article supplied by John Van Staveren from VS Eyewear Australia click here for website

Top Tips for Selling Sunglasses

Annotation 2020-04-15 140938

Opening

Welcome the customer into the store with a non-business related opening line, for example, What brings you into the store today?

Establish Customer Needs

Ask open-ended questions to determine what the customer wants as well as why they want it. Open-ended questions begin with Who, What, Why, When and How? They are questions that can’t be answered with a Yes or a No.

Product Selection

Once you have established what the sunglasses are needed for, eg for during or playing golf, offer a style with a specialised driving lens or a specialist golf lens.

Recommend Multiple Pairs

Suggest buying a second pair for a specific lifestyle choice or for the glove box in the car.

Polarised Sunglasses

Recommend polarised sunglasses for activities such as snow sand or water. That is because when normal rays of light bounce off any reflective surface they become disorganised and produce glare. Polarisation filters work like mini Venetian blinds organising chaotic light coming through the lens to eliminate glare and reduce eye fatigue.

Recommend Styles

Recognising the best styles that suit a particular face shape (s) is an important part of the product selection. Explain why certain frames suit better than others.

Demonstrate Product

Show the customer the features and benefits of the product, for example, wrap-around lens reduce the sun damaging the eyes, or UV coating is beneficial because…

Present with Enthusiasm and involve the Customer

Be genuine, the one thing that puts people off is an overzealous salesperson. Enable the customer to try sunglasses on, explain the reasons for the feel and the fit. Gain their trust that you are helping them make the right decision.

Remember people buy off people they like so be aware of a customers body language and if they want your help or they want to be left alone.

Your Optical Professionals – Who’s Who

Definitions of Eye Care Professionals

EYES

OPTOMETRISTS

Optometrists conduct eye and vision examinations, prescribe spectacles and contact lenses and carry out treatment for eye disorders. Optometrists do not perform surgery but may use drugs to treat eye diseases if they are therapeutically qualified. Optometrists must complete a three to five-year university qualification specifically on the eye and its care before they can be registered to practice. Optometrists may also dispense eyewear, such as glasses and contact lenses, from their own practice. An increasing proportion of the work optometrists do relates to eye disease and problems which affect the way in which the eyes work together (binocular vision). Optometrists provide approximately three-quarters of all eye examinations given by eye care professionals in Australia

OPHTHALMOLOGISTS

Ophthalmologists are medical practitioners who concentrate on treating eye disease with drugs and surgery. Although their specialist training is centered in these areas they also prescribe spectacles. There is a considerable degree of overlap in the services optometrists and ophthalmologists provide. Both perform refraction and prescribe spectacles and contact lenses, both are qualified in the detection of eye disease and there is a growing overlap in the treatment of minor ocular disorders. Only ophthalmologists perform major eye surgery and treat serious eye disease.

OPTICAL DISPENSERS

Optical dispensers interpret optical prescriptions and fit and service optical appliances such as spectacle frames and lenses. They advise on, fit and supply the most appropriate spectacles after taking account of each patient’s visual, lifestyle and vocational needs. Qualified dispensers have completed a Certificate IV in Optical Dispensing from TAFE or a Registered Training Organisation. An optical dispenser works as part of the eye care team in the optical practice alongside the eyecare practitioners who issue the optical prescription. Behind the scenes optical dispensers are often employed in optical laboratories of large practices and by the lens companies who grind and manufacture lenses.

ORTHOPTISTS

Orthoptists are university qualified eye health professionals who care for patients with eye disorders. Orthoptists specialise in a variety of areas including (but not limited to): Children’s vision, Eye movement disorder, Low vision care / Rehabilitation, Cataract care, Retinal disorders, Neurological vision disorders, Clinical Research and education. Orthoptists work in a range of settings, including hospitals, private practices, low vision and rehabilitation settings, community health areas, clinical research centres, universities and within the ophthalmic sales industry. Orthoptists may work independently, in conjunction with ophthalmologists or in a variety of multidisciplinary teams.