In a wide-ranging interview, PETER LARSEN details his rationale for bringing Specsavers to Australia, as well as the opposition he’s faced trying to change optometry’s ‘belief systems’. He also discusses his new roles at Topcon and the Centre for Eye Research Australia.
Throughout his career Australian optometrist-turned-global company executive Mr Peter Larsen has felt misunderstood. Labelled a pariah, a mad scientist, as well as a visionary, he even resorted to practising presentations to his teenage daughter en route to her weekend soccer matches to ensure his message was decipherable.
But, as he has found, it’s part of the deal when trying to fulfil his mission to make Australian optometry more competitive – hence offering more accessible eyecare – while changing ingrained beliefs around the profession’s role in the eye health ecosystem.
In a career spanning 34 years, Larsen has worked in high volume practices in the UK seeing 30 patients a day, operated the wholesale contact lens business Aspect Vision that was sold to CooperVision, and spearheaded Specsavers’ rapid Australian entrance. His fingerprints can also be found on the Oculo e-referral platform, a $40 million Specsavers-wide OCT rollout and world-first benchmarking system for optometrists, KeepSight and an improved relationship between ophthalmology and optometry. There’s also the additional 50,000 people detected for glaucoma who he says otherwise wouldn’t have been, if it wasn’t for the systems he helped build.
“Data repositories, benchmarking, understanding of outcomes that lead to actions: that language in our industry is fairly rudimentary, where it has been all about how many pairs of glasses you sell and how many sight tests you do, so it has been a massive journey,” he says.
“There wouldn’t be many people with my background, breadth of experience and insight – and sometimes the language I use isn’t easily understood because of that. I’m amazed people in the industry often still can’t understand it, while outsiders can.”
Earlier this year, Larsen entered the next phase of his career as president of Topcon Medical Systems in North America and vice-president of business development for Topcon Healthcare Solutions. He’s performing both roles from his home near Geelong in Victoria, while heading up the Centre for Eye Research Australia (CERA)’s new Health Services Research unit.
As far back as 2001, he recalls feeling like an outlier when he owned the independent Melbourne practice Andrew Gaddes Pty Ltd, which he took over from his father.
He says he embraced technology much earlier than others, installing a digital retinal camera and a Heidelberg Retinal Tomograph (HRT) 2, and performing scans on every patient.
“There were very few optometry practices with digital retinal cameras back then and there were very few Heidelbergs in the country generally – it was globally exceptional, however, for an optometrist to utilise both in a routine eye examination at that time. People were shaking their heads and asking what I was doing with a piece of kit only hospitals and glaucoma specialists should have,” he recalls.
“But six months later I knew I was picking up the 50% undiagnosed glaucoma. People also didn’t understand I’d developed close relationships with my local specialist and in particular my glaucoma specialist, Associate Professor Julian Rait, who helped my team through interpreting the results and ensuring we weren’t referring false-positives. We found there was variation between the optometrists, so we held regular meetings and discussed the need for visual fields so we were only sending those with structure and an associated functional loss.”
After 12 months, Larsen formed the belief this was the methodology to improve eye health outcomes, but still his assertions fell on deaf ears. That was until around 2012 when he was asked to develop the professional side of the Specsavers business in Australia where he was able to embed his model on a national scale – but more on that later.
Selling to Specsavers
Larsen is arguably best known for leading Specsavers’ 2007 entrance into the Australian market – a role that made him famous or infamous, depending who you ask.
In 2004, he founded the Optovision buying group with Mr Charles Hornor, the current communications director for Specsavers ANZ, with more than 250 independents joining in the first six months.
Optovision had only been in operation for two years when the opportunity arose for a discussion with Specsavers co-founder Mr Doug Perkins about finally introducing the brand into Australia via a part-purchase of Optovision. Initially, a supply chain would be set up and tested with Optovision members before assessing the potential for a full retail model. Within months of the supply chain launch, there was significant interest among independents to convert their stores to the Specsavers banner under a franchise model.
“Before talking to Specsavers it had dawned on us that the scale you can achieve with local buying-group consolidation at that time was limited; the gap between what the global players were paying for product versus an independent buying group in Australia was massive, so we knew that Specsavers’ arrival would give participating optometrists a chance to more than match up with the big players and provide more affordable care,” he says.
“I had one of most successful independent stores in the country, I was doing very well, but I felt uncomfortable with an expensive supply chain and the consequent prices we were having to charge our customers and knew the industry was vulnerable. The Specsavers deal was absolutely critical to change the paradigm for business-minded independents and for patients.
“Many in optometry disagreed and I was very unpopular for a while because people thought I turned against the industry, but in my mind I’m very comfortable. If we hadn’t made the move, we would have had Big W or Walmart enter the market and marginalise optometry – optometrists wouldn’t have had some level of control over their businesses. And, of course, Specsavers has been an unqualified success in this country, introducing a customer-focussed business that is also great for owners.”
Technology and benchmarking
After leading Specsavers as managing director through that growth phase – including the famous 100 stores in 100-odd days – Larsen was asked to lead the professional services side of the business in 2012. While this role traditionally focuses on recruitment and training, he wanted to have a more meaningful impact.
He was still convinced of the need for the model from his independent practice more than a decade earlier, so he set about using his influence in Specsavers to draw up a blueprint centred around technology and collaborating with medicine.
At the time, the relationship between optometry and ophthalmology was fractious due to RANZCO and the Australian Society of Ophthalmologists taking the Optometry Board of Australia to court over guidelines that would have seen therapeutically endorsed optometrists independently diagnosing and managing glaucoma.
Larsen was also a member of the CERA board, so he had formed relationships with the ophthalmological world. Eventually, he worked with RANZCO to sign an exclusive Memorandum of Understanding seeing RANZCO work with Specsavers and others to produce referral guidelines for several diseases – starting with glaucoma – and Specsavers adopting these across its stores.
“It annoyed a lot of people that a commercial operator like Specsavers would have an agreement with the college, but I am an optometrist without a professional ego; I believed it was fundamental to first establish the referral rules and then proactively play by them – to be ambitious beyond that is counterproductive,” he says.
“I was able to be honest about the 50% undiagnosed glaucoma and say this is a problem that optometry – and ophthalmology – has; having those frank conversations means you’re not shutting doors. That’s a different conversation to the one optometry generally has with ophthalmology. Today, I believe it’s still one of the few clinical pathways agreed between optometry and ophthalmology globally.”
Larsen says the next necessary component to underpin this collaboration was a consistent and secure communications system. Hence Oculo was born, a platform sharing clinical imaging, referrals, and other clinical correspondence securely and instantly between healthcare professionals. (Oculo was sold to Finnish company Revenio in March, valued at AU$18.5 million).
In his role with CERA, Larsen supported co-founders Professor Jonathan Crowston and Dr Kate Taylor in its development. After some initial trepidation on usage and implementation costs, Specsavers got behind it and Larsen conducted a pilot.
“Unless we systemise and measure, then you have to assume there’s a spectrum out there and the quality isn’t what you think,” he explains.
“We managed to implement it across Specsavers with the support of store partners, and that gave us the important technology piece needed to conduct and measure referral rates per optometrist.”
The next puzzle piece required a reporting system for all Specsavers optometrists to ensure individual optometrist referrals were aligning with disease prevalence rates. Known as benchmarking, the concept had been discussed within the industry for years but had never been clearly described.
The reports provide weekly summaries so optometrists can understand their practice compared to the practice average, regional optometric norms and national benchmarks. In designing the reports, Larsen took inspiration from the Australian primary schools Naplan tests and added a traffic light system.
“I thought this was an inoffensive method, if it’s being sent to parents then you can send something similar to optometrists. And while many were worried about sending benchmark reports, we pressed on and sent them to 800-odd optometrists and only had one complaint,” he explains.
Larsen says it created an environment for self-directed training and professional development for optometrists to improve patient outcomes.
“Most corporates will measure glasses sales, sight test numbers and experience, but I strongly felt we needed to start giving our optometrists insight into their clinical performance, otherwise they’re unaware. And I believe it’s still the only reporting going to individual optometrists anywhere in the world on their diagnostic rates.”
With these systems in place, Larsen says this confirmed his belief optometrists were missing 50% of glaucoma.
This provided the impetus, in 2016, for the commencement of the well-known $40 million-plus OCT rollout to every Specsavers store, with scans performed on every patient without an out-of-pocket fee. Larsen selected the Topcon Maestro as the most user-friendly, automated instrument that could also capture the macula and optic nerve in the same shot, but again people doubted his decision.
“I was thinking, we’re responsible for 3.5 million examinations a year, and so we have to build something into a customer journey in a busy store that will create consistent outcomes,” he says.
“To test the concept, I put two Maestro OCTs into my own Specsavers store in Eastland (Victoria), measured referrals before and after and proved it worked, then installed them in another six stores over a three-month period and then rolled it out.”
He continues: “Normally when optometrists purchase a piece of kit, the first question is how can I get my money back, and yes we have got improved Medicare utilisation, but I think it’s still the only OCT rollout in optometry whose primary purpose was to drive out improved, measurable clinical outcomes.
“In the over 50 population, 2-3% have glaucoma with estimates around 150,000 were undiagnosed. Subsequent to the implementation of benchmarking and OCT across Specsavers, by the time I moved out of the Australian business in 2019, there had been over 50,000 people detected with glaucoma who otherwise wouldn’t have been.
“If you look at the PBS medications data, since 2016 glaucoma therapies have shot up. I’m not a practising clinician anymore, but I know the original insights of my experience with technology some 16 years ago, together with my colleagues at Specsavers, I’ve had a substantial impact on glaucoma in this country, and still it hasn’t been well understood a lot of the time.”
Of course, Larsen says it is critical to understand that commercial outcomes are a priority. It is a unique grasp of store operations and the people involved that has enabled a parallel positive impact in store profitability.
“Benchmarking and change management experience are rare qualities in allied health,” he adds.
In 2019, Larsen moved from Melbourne to take up a newly established role as group eye health strategy director. In that role, he was based at Specsavers headquarters in Guernsey, UK, to implement the Australian and New Zealand model in Specsavers’ other markets. Less than a year into this role, the pandemic forced his return to Australia where other opportunities awaited.
One of those was for Topcon Medical Systems. Larsen is now responsible for the company’s ophthalmic equipment business in the North American market. Alongside this, for Topcon Healthcare Solutions, he is seeking business opportunities with key customers and stakeholders globally.
He says it has been fascinating to have a bird’s eye view of the global market, which has reinforced his belief that Australian optometry needs to come together to tackle the big issues like diabetic eye disease through initiatives like KeepSight.
Elsewhere, as an honorary principal investigator for CERA and head of the Health Services unit, he’s exploring solutions that drive better coordination between the eyecare system. Initially, this is focused on how optometrists communicate with The Royal Victorian Eye and Ear Hospital.
“The hypothesis is that it should enable the hospital to make better decisions and triage more effectively to guide the appropriate utilisation of resources; it sounds simple, but hospitals are complex,” he says.
“In my mind, referrals coming from optometry in an electronic format with set data fields is the methodology that should drive better outcomes, but it’s about making this inclusive, the last thing we need is an exclusive system solving problems on a smaller scale.”