Feature, Report

2021: Year in Review

From lockdowns and vaccines to major acquisitions and breakthrough technology, Insight reflects on the major developments across the Australian and global ophthalmic sector in 2021.

When Insight compiled a similar report last year reflecting on the major events of 2020, it ran with the headline: “2020 – a year like no other.”

At the time, Victoria was emerging from its back-breaking winter lockdown, business was rebounding, and the summer months were in full swing. There was a palpable sense of hope and positivity; the fact that many could face yet another year of turmoil seemed unimaginable.

But COVID-19 and the Delta strain brought all-new problems, with the impact of extended lockdowns continuing to dominate headlines throughout 2021 in the most populous states of NSW and Victoria. Thankfully, this time there are vaccines, strangely bringing a similar sense of hope felt at the end of 2020.

COVID-19 wasn’t the only topic making news, however, with major product launches, business deals, personnel changes and breakthrough research shaping some of the biggest moments in the Australian ophthalmic sector in 2021.

Expansion and acquisition

Despite optometrists being unable to offer routine care for several months across NSW and Victoria, some of the country’s largest players forged ahead with their expansion plans.

Specsavers entered Alice Springs, Mt Isa, Parkes and South Melbourne, and launched another program to expand existing stores. Optical chain Oscar Wylee opened its 100th retail store, with 27 of those locations added to its network across Australia and New Zealand this year.

Both Specsavers and Oscar Wylee also broke into the Canadian market, with Specsavers announcing it will launch its first 16 practices from November 2021, with ambitions to open 200 stores by 2024. Oscar Wylee opened its first store in Alberta in August and was planning to establish four further locations in Halifax, Calgary and Toronto.

Jason Gowie, National Optical Care CEO.

Back on home soil, National Optical Care (NOC) launched a new division of its business, offering independent optometry practices new subscription-based buying group and managed services opportunities, called Optical Growth Partners. NOC also unveiled new acquisitions, taking its portfolio to 17, while Healthia – which acquired The Optical Company for $43 million last year – grew its network to 45. George & Matilda Eyecare added two Queensland practices, with several more to be announced soon.

In March, London-based global private equity advisory firm Apax Funds reached an agreement to acquire ophthalmic lens manufacturer Rodenstock Group, reportedly worth AU$2.3 billion.

In other global news, EssilorLuxottica completed the acquisition of optical retail giant GrandVision in a 7.3 billion euro (AU$11.2 b) deal in July, adding 7,000 stores across 40 countries, as well as 37,000 employees.

Glaukos agreed to settle with Ivantis over a patent infringement lawsuit regarding the latter’s Hydrus Microstent. Ivantis was ordered to pay Glaukos US$60 million (AU$83m), as well as an ongoing royalty.

Education and employment

RMIT University announced the closure of its Certificate IV in Optical Dispensing, with final students completing their training in June, ending a 52-year history of educating and training Australian optical dispensers.

Australasian College of Optical Dispensing directors Chedy Kalach and James Gibbins experienced a surge in enrolments.

While RMIT reported student numbers had been consistently low in recent years, other trainers experienced a surge in enrolments after the Federal Government announced a wage subsidy of up to $28,000 per employee as part of its COVID-19 economic recovery – a program that has been expanded multiple times.

New figures revealed optometry graduates have among the highest rates of full-time employment compared with other sectors, sparking debate over future workforce supply that will increase once the first set of graduates emerge from optometry schools in WA and Canberra.

According to Quality Indicators for Learning and Teaching (QILT), in 2020 around 95% of optometry graduates were employed in full-time work, with a median salary ranging between $80,000 to $85,000.

Speaking of salaries, Insight analysed tax office data showing ophthalmologist are the second highest paid specialty (behind neurosurgeons), with an average taxable income of $524,800. For optometrists the average income was $94,800, health practice managers $74,956, orthoptists $62,417, optical mechanics $60,666 and optical dispensers $41,783.

Ophthalmic therapies and equipment

The TGA approval of the Luxturna gene therapy was a major moment in 2020, and in 2021 it was confirmed that at least four patients with RPE65 mutations had received it.

The first were a pair of Sydney teenage siblings with Leber congenital amaurosis, marking the next revolution in ophthalmic medicine. The therapy was delivered as part of a new Sydney-based collaborative called Ocular Gene and Cell Therapies Australia (OGCTA), which has also treated two adults in their 40s with the therapy.

Another major feat was meant to take place Queensland in October when the first official iteration of the homegrown Cylite Hyperparallel-OCT (HP-OCT) was to be showcased to the local market.

Although this did not transpire due to COVID, it was exciting to learn the instrument is ready, with the company planning to get the device in the hands of optometrists and ophthalmologists in 2022.

Preservative-free dry eye therapy Cationorm.

Preservative-free dry eye therapy Cationorm was listed on the Pharmaceutical Benefits Scheme (PBS) in Australia from 1 August, followed by Ikervis in September, becoming Australia’s first listed disease modifying ciclosporin eye drop for severe keratitis in adults with dry eye disease.

Both therapies are in-licensed in Australia by pharmaceutical company Seqirus, a new player to the Australian ophthalmic market, and a subsidiary of Melbourne biotechnology company CSL that was contracted to manufacture the AstraZeneca COVID-19 vaccine.

In June, Glaukos announced it had secured Therapeutic Goods Administration (TGA) approval for the Preserflo MicroShunt, offering late-stage glaucoma patients a more elegant surgical alternative to conventional filtration procedures. Glaukos is planning a full commercial launch in Australia in mid-2022.

Earlier in the year, the Australian government disclosed it spent more than $610 million on anti-VEGF treatments from July 2019 to June 2020. In total, the government spent $392 million (not including rebates) on aflibercept (Eylea) to cover 315,200 prescriptions, making it the most expensive PBS treatment. For ranibizumab (Lucentis), which ranked seventh by cost, it paid $218 million for 190,126 injections.

This came as another anti-VEGF was listed on the PBS in October. Beovu, from Novartis, can be subsidised for patients who have not responded to first-line anti-VEGF therapy, and could prevent 12,800 Australians from more than $8,800 per year.

Key decisions and policies

In the most-read report on Insight’s website this year, the Fair Work Commission handed down a long-awaited decision regarding pay awards coverage for optometry practices.

The saga began more than two years ago when a note was discovered the Fair Work Ombudsman (FWO) website stating the Health Professionals and Support Services (HPSS) Award was applicable to optometrists and staff such as optical dispensers and administration employees.

Lyn Brodie, Optometry Australia CEO.

OA had two major concerns, the first being that it could lead to underpayment claims if front-of-house staff were being paid under a retail award. Fair Work later indicated there would be no penalties if staff passed the ‘better off overall test’, but OA still held concerns about optometrists – traditionally an award-free profession – being classified under an award, potentially driving down wages.

OA CEO Ms Lyn Brodie said Fair Work’s ultimate decision to neither exclude optometrists from the HPSS Award, nor include them on the List of Common Health Professionals in Schedule B of the Award, meant things were slightly unclear. Ultimately, however, it meant the status quo was maintained – a win for the sector.

Elsewhere, the Australian Society of Ophthalmologists (ASO) spearheaded a challenge against the introduction of “US-style managed care” following an interim decision in July to allow a new buying group to collectively negotiate contracts with healthcare providers.

In its final decision, the Australian Competition and Consumer Commission authorised Honeysuckle and nib health funds to form and operate the Honeysuckle Health Buying Group, but it imposed a condition that major insurers Medibank, Bupa, HCF and HBF in Western Australia couldn’t join.

After several years in development, the nation’s first Cataract Clinical Care Standard caused a stir when it launched in August. It failed to win the full support of RANZCO and the ASO, with the college citing two major issues with the finalised document.

It didn’t agree with the inclusion of 6/12 visual acuity as a measure for cataract, and the recommendation to offer all patients bilateral same day surgery, however the Australian Commission on Safety and Quality in Health Care has challenged these interpretations.

However, RANZCO was supportive of a new continuing professional development (CPD) framework for ophthalmologists, set to come into effect in January 2023. Three core changes to the CPD registration standard include CPD Homes and Professional Development Plans for all doctors, and a requirement to conduct different types of CPD.

In May, Macular Disease Foundation Australia (MDFA) patron Ms Ita Buttrose used a National Press Club address in Canberra to warn that many older Australians will no longer be able to afford anti-VEGF treatments if the Federal Government adopts a MBS Review Taskforce recommendation to slash the Medicare Benefits Schedule (MBS) fee from $310 with a rebate of around $250, to a $96 fee with a rebate of around $75.

MDFA patron Ita Buttrose delivers her National Press Club address in Canberra in May, pleading with the government not to slash the Medicare rebate for anti-VEGF injections.

She said economic modelling commissioned by MDFA predicts the proposed rebate cut will result in out-of-pocket costs increasing from $1,900 to $3,900 a year on average – double for patients needing injections in both eyes. This translates to an additional 47,000 Australians experiencing severe vision loss and blindness within the next five years if a Medicare rebate cut for intravitreal injections is given the green light.

Staunch in its view that expanded scope is the only way to tackle longstanding eye health issues, in July OA released a new policy platform, ‘Working Together for Better Eye Care’, to remind the government, vision sector and consumers about Australia’s serious eye health challenges, and to recommend practical ways they can be tackled.

Oral therapeutics, intravitreal injections and telehealth MBS items are among six areas OA is calling for change so the nation’s “seriously under-utilised” optometric workforce can combat urgent issues looming over the eyecare sector.

Key events and trade shows

Two major events in the eyecare sector were impacted by the ongoing pandemic.

Organisers cancelled O=MEGA21 scheduled for September 2-4 in Melbourne, stating that it would have been unwise to postpone due to ongoing uncertainty surrounding COVID-19 lockdowns across Australia.

However, the CPD educational component proceeded virtually on the same dates as part of a relaunched Southern Regional Congress (SRC).

RANZCO postponed its 52nd Annual Scientific Congress, to give ophthalmologists and other attendees the best chance at meeting at a face-to-face event.

Taking place at the Brisbane Convention & Exhibition Centre, it was originally scheduled for 19-23 November 2021, but COVID-19 lockdowns across the country prompted the RANZCO Board to formulate a new plan. The event will now run 25 February to 1 March 2022. The official 2022 congress booked for 3-8 November in Perth will go ahead as planned.

People and leadership

There were several high-profile personnel changes throughout the year.

Zeiss appointed former managing director of Carl Zeiss Vision South Africa Ms Gail Giordani to head its vision care business in Australia and New Zealand, relocating to Adelaide and taking over from Ms Hilke Fitzsimons who was promoted into a global role.

Vision 2020 Australia appointed former Aged and Community Services Australia head Ms Patricia Sparrow as its new CEO. Sparrow commenced in the role in September, taking over from Ms Judith Abbott who is assuming the role of CEO at Carers Victoria.

The Australian College of Optometry (ACO) announced Mr Pete Haydon has been appointed CEO, resigning from his position at the helm of Optometry Victoria South Australia after seven years. Haydon replaced Ms Maureen O’Keefe who resigned as CEO in July after eight years, but has retained leadership roles at Vision 2020 Australia.

EyeQ Optometrists announced its CEO Mr Ray Fortescue will chair a new joint-committee, overseeing the operations of the EyeQ Optometrists/National Optical Care Alliance. Former EyeQ chief business development officer Ms Lily Wegrzynowski transitioned into a new role as general manager eyecare and professional services as part of the alliance.

Professor Stephanie Watson.

Sydney’s Professor Stephanie Watson was recognised this year as one of the world’s top 100 female ophthalmologists. She was the only Australian to make the 2021 Power List of the Top 100 Women in Ophthalmology, a first-of-its-kind list released by The Ophthalmologist magazine.

Nine people from the ophthalmic sector featured in the Australia Day 2021 Honours List for their service to ophthalmology and eyecare.

Those to receive a member of the order (AM) were ophthalmologists Associate Professor Anne Brooks from East Melbourne, Dr John Crompton from North Adelaide, Dr Tom Playfair from Woollahra, Dr Richard Stawell from Hawthorn and Dr Kevin Vandeleur from Brisbane, as well as former Orthoptics Australia president Mrs Marion Rivers from Gisborne South.

Ophthalmologists Dr Henry Lew from Caulfield North, Dr John Willoughby from Gawler, and Mr Larry Kornhauser, a founding member of Keratoconus Australia and president since 2000, received a medal of the order of Australia (OAM).

A further four eyecare professionals received Queen’s Birthday Honours, including Associate Professor Heather Mack, who was made a Member in the General Division (AM), Bellevue Hill eye doctor Dr Michael Newman, who was awarded a Medal in the General Division (OAM), South Australian optometrist Associate Professor Anthony (Tony) Phillips (AM), and NSW’s Ms Shayne Brown (AM) for her service to orthoptics.

Sadly, the sector lost three legends this year with the passing of Emeritus Professor Barry Cole, Dr Tony Adams and Professor Peter Swann.

Ophthalmic surgery

A spatula is used to enter into the laser channels in the cornea to prepare them for implantation of the CAIRS implant.

The first corneal allogenic intrastromal ring segment (CAIRS) surgery in Australia was performed at the Queensland Eye Institute (QEI) in June, paving the way to better sight for keratoconus patients. Ophthalmologist Dr David Gunn conducted the procedure that overcomes higher complications rates associated with current synthetic corneal implants by using donor tissue instead.

In another first, also in Queensland, OKKO Eye Specialist Centre become the first in Australia to offer the CAPSULaser procedure, enabling surgeons to perform highly accurate and consistent capsulotomies in less than one-third of a second.

The impact of COVID-19 lockdowns on ophthalmic surgery wait lists is expected to be eye-watering in 2022, particularly in eastern states. However, RANZCO joined specialist medical colleges to support the temporary postponement of all non-urgent elective surgery in areas of high prevalence of COVID-19 infection.

Vaccination and COVID

In February, it was reported that Australian optometrists and ophthalmologists, their support staff and students and trainees on placement would be eligible to receive a COVID-19 vaccine as part of the second wave of a national rollout strategy, commencing 22 March.

As the Delta variant spread and vaccination rates stagnated, optometrists were approved to prepare and administer COVID-19 vaccines in Victoria as the state government worked to supercharge the jab rollout. At the Federal level, optometrists later featured among 12 regulated health professions that authorities approved to expand the nation’s COVID-19 response workforce, joining other allied health professionals.

More recently, states have imposed mandates requiring eyecare professionals and their staff to be fully vaccinated. Limitations have also been imposed on patients who aren’t vaccinated.

Australian research

In March, Australia’s first clinical trials of an investigational gene therapy for dry age-related macular degeneration (AMD) commenced at the Centre for Eye Research Australia (CERA).

CERA’s principal investigator of retinal gene therapy research and vitreoretinal surgeon Dr Tom Edwards performed the first surgeries to administer Gyroscope Therapeutics’ gene therapy, GT005, to patients at The Royal Victorian Eye and Ear Hospital in Melbourne.

Melbourne ophthalmologist Dr Tom Edwards (centre), with the team that delivered the investigational GT005 gene therapy for dry AMD as part of the CERA trial in March.

Australian researchers have also led the development of a promising new genetic test for glaucoma that can potentially identify 15-times more people at high risk of glaucoma than an existing genetic test. Those involved in the work are also launching a spin-off company to develop an accredited test for use in clinical trials, with recruitment expected to begin in 2022.

Prominent Melbourne retinal disease researcher Professor Robyn Guymer shared her enthusiasm for the Phase 3 results of a trial she was involved in, investigating pegcetacoplan, which she says is the only intervention shown to significantly slow the growth of lesions in dry AMD.

US-based Apellis Pharmaceuticals told Insight it now plans to discuss the results with regulatory authorities worldwide, including the TGA.

Overseas, a Hong Kong study highlighting a significant decrease in the time schoolchildren have been able to spend outdoors and a sharp increase in screen time was the latest to join mounting evidence that a rise in childhood myopia may be linked to the coronavirus pandemic.

The research follows a similar Chinese study published last year that found myopia prevalence was three times higher in six-year-olds during the COVID-19 pandemic, giving rise to the term “quarantine myopia”.

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