How do you think the year of 2023 will be remembered in the ophthalmic sector? Insight reflects on the key industry issues that shaped the past 12 months.
When the ophthalmic sector of the future looks back on 2023, it will be remembered as the year that many seeds were sown. Five to 10 years from now, the industry will likely be bearing the fruits of its labour, with this period considered a turning point in some respects.
In fact, if you’re reading this article many years from now, it’s likely Chemist Warehouse’s foray into optometry is in full swing with a national rollout across Australia. Corporate optometry would have strengthened its market grip, and more networks may have embedded additional allied health streams to diversify their businesses.
Like intraocular lenses, there will also probably be a multitude of myopia management options for practitioners to choose from and individualise for their patients, while more groundbreaking solutions like red light therapy may have become more mainstream. Eye researchers would have discovered new ways to harness the power of gene therapy to tackle the most common eye diseases too.
And, in all likelihood, the use of artificial intelligence (AI) will be the norm eye clinics, with many practitioners wondering what they were initially so worried about.
With an ageing population and expanding cohort of progressing myopes, there are increasing demands on the ophthalmic industry. As such, the sector is ripe for innovation, and 2023 was no exception with major business deals, personnel changes and breakthrough products that will shape the Australian ophthalmic sector in years to come.
Key business highlights
Without a doubt, the biggest announcement to drop in 2023 was Chemist Warehouse’s entry into the optometry market. In fact, it was Insight’s most-read story of the year. The pharmacy giant’s Optometrist Warehouse venture began by opening its first store in the Melbourne suburb of Malvern in February, followed by the first NSW store in Cambelltown in October.
Eventually, it’s expected there will be “a mass network rollout which will see Optometrist Warehouse become a household name and the go-to optometry service provider within the Australian market”.
It’s a bold plan, but Chemist Warehouse isn’t mucking around. It has appointed prominent industry figure Mr Peter Larsen as its managing director, as well as Mr Charles Hornor, to run the show. Both were instrumental in bringing Specsavers into Australia around 15 years ago, and in several events attended by Insight, there was a lot of curiosity about corporate optometry’s newest player.
In other changes to the optometry scene, George & Matilda Eyecare – now supporting more than 100 communities – revealed its blueprint for a rollout of audiology that promises to offer hearing care services beyond industry norms. This began in May 2023 via a pilot at George & Matilda Eyecare for Antonello Palmisani Optometrist, the company’s Leichhardt practice in Sydney.
The network also welcomed new additions including Mr Ian Brigden’s Nelson Bay practice in northern NSW, Wand Optometrists in Toukley on the Central Coast of NSW, and Joyce Optometrists in Melbourne.
Meanwhile, Vision Eye Institute (VEI) continued its expansion amid a leadership change in June that saw Ms Amanda Cranage, a long-standing member of the organisation, replace Mr James Thiedeman after 5.5 years of service.
Australia’s larger provider of private ophthalmology also partnered with Western Eye Specialists to create the largest private ophthalmology clinic in Melbourne. Taking effect from 1 July, all patients of Western Eye Specialists’ Maribyrnong location are now being seen at VEI’s state-of-the-art Footscray clinic, while patients attending Western Eye Specialists clinics in St Albans and East Melbourne will continue to have appointments at those locations.
VEI then announced in August that Boroondara Day Surgery in Victoria would join its Vision Hospital Group business, bringing the number of day surgeries it operates across Australia to 11.
In other acquisitions, it was a big year for ophthalmic industry giant Bausch + Lomb. The company in July confirmed the purchase of Blink eye and contact lens drops from Johnson & Johnson Vision for US$106 million (AU$155 m).
It came hot on the heels of a separate deal to take over the Xiidra prescription dry eye drug from Novartis. And earlier in the year, B+L brought AcuFocus into its fold, a privately held ophthalmic medical device company that has developed a small aperture extended depth of focus (EDOF) IOL, IC-8 (more about this on page 20).
In a bid to shine a light on the harsh reality facing the optometry workforce, Specsavers released its second Deloitte Access Economics report showing that, on the current trajectory, Australia will have a shortfall of 1,102 full time equivalent (FTE) optometrists by 2042.
Queensland is expected to be the hardest-hit state. Unsurprisingly, the deficit is expected to impact rural areas most, with an approximate shortage of 799 FTE optometrists over the next two decades. In urban areas the shortage will be less significant, totalling 303 FTE optometrists. It’s a concerning trend, the company says, especially considering that within its own network around 40% of Australian locations currently have an unfilled optometry vacancy.
Meanwhile, the supply and demand of ophthalmic professionals influences wages, and the latest data from the Australian Tax Office shows that male ophthalmologists again reported the largest annual taxable income out of all occupations in Australia ($703,700).
In the latest available data (from the 2020-21 financial year), the figures showed that female ophthalmologists earn $346,100 on average, while the average taxable income for optometrists (both men and women) was $106,800, optical dispensers $45,500, orthoptists $68,200 and practice managers $80,800.
Elsewhere in August, Specsavers was named one of Australia’s Best Workplaces for 2023 by Great Place To Work, a global authority on workplace culture. The optometry provider was ranked 8th in the Best Workplaces in Australia list in the large (1,000-plus employees) category, featuring alongside companies like Cisco, Hilton, DHL Express and Marriott International Australia.
Key decisions and policies
Tariff pain experienced by eyewear wholesales continued this year. An Australian Border Force (ABF) decision in 2022 to impose a 5% border tax on acetate eyewear – which blindsided the industry and was triggered by Port Macquarie manufacturer Optex Australia – was upgraded to also cover metal frames in 2023.
After learning of the AFB’s decision to cover both metal and acetate frames, Safilo Asia Pacific senior director Mr David Pearson said at the time it was “a very poor decision and will only result in putting additional costs on consumers and pressure on the industry”.
Eyewear suppliers have been pinning their hopes on a 2024 free trade agreement with the European Union – where the majority of imports come from – but this now appears dead in the water after Trade Minister Mr Don Farrell said on 30 October that both sides have been unable to make progress.
In one of the most-read stories of 2023, the National Health Practitioner Ombudsman (NHPO) announced it was reviewing the way Australian Health Practitioner Regulation Agency (Ahpra) handles vexatious complaints.
The Australian Society of Ophthalmologists supported the Australian Medical Association’s position that the handling of vexatious complaints – and the notification process broadly – must be improved. The body said it was imperative Ahpra addressed growing distrust of the regulator, and cases where people can make a false complaint and face no repercussions regardless of the impact on the doctor’s life.
In a win for ophthalmic surgeons, a new law was passed in September restricting use of the ‘surgeon’ title. Prior to this, any registered medical practitioner could refer to themselves as a ‘surgeon’ without completing specialist surgery training or being registered in a surgical specialty, a loophole that was being exploited by rogue operators in the cosmetic industry.
From now on, ophthalmology, obstetrics and gynaecology are the only specialities that can now refer to themselves surgeons, with those found misusing the title facing potential criminal prosecution with a maximum fine of $60,000- or three-years’ imprisonment, or both.
Globally, one of the biggest health stories of the year was the contaminated eye drops saga in the US that saw 14 patients suffer vision loss, an additional four requiring enucleation (surgical removal of the eye), and four deaths, in the latest data. The outbreak of a lethal drug-resistant bacteria strain has been linked to an alleged eye drop manufacturing breakdown at Global Pharma Healthcare in India.
People and leadership
Legendary Western Australian ophthalmologist Professor Graham Barrett received another accolade in 2023 when he was inducted into inaugural Ophthalmologist Power List Hall of Fame. Barrett is perhaps best known as ophthalmic innovator, helping develop the world’s first foldable IOL implanted in 1983, the Barrett Toric Formula and Calculator, as well as the Rayner RayOne EMV, the first and only available IOL optimised for use with monovision.
The Ophthalmologist magazine’s new initiative honours ophthalmologists and scientists whose impact on the field will last beyond their lifetimes. Barrett was the only Australian and among 10 recipients to make the inaugural list. Each year from now will see five new figures inducted.
But Barrett wasn’t the only Australian ophthalmologist recognised by The Ophthalmologist magazine in 2023. The publication also compiles an annual Power List featuring the world’s top 100 eye doctors. Featuring this year was South Australian Dr Ben LaHood for the first time who, at 39-years-old, was the youngest Aussie to make the list. Others included were Sydney’s Professor Stephanie Watson, WA ophthalmologist Professor David Mackey, Professor Mingguang He, who has affiliations with the Centre for Eye Research Australia (CERA) and The University of Melbourne, and New Zealand’s Professor Helen Danesh-Meyer who made the top 20.
The Australian ophthalmic sector never has a shortage of honourees in the King’s Birthday Honours (previously Queen’s Birthday Honours). This year there were 10, with the most notable being posthumous recognition of Mr Richard Grills – a former ODMA board chair and founder of Designs For Vision who passed away in July 2022.
He was awarded Member (AM) in the General Division, alongside other industry recipients: Clinical Associate Professor at The University of Sydney Dr Andrew Chang (AM), Distinguished Professor Justine Smith (AM) from Flinders University, oculoplastic reconstructive and cosmetic surgeon at St Vincent’s Private Hospital Sydney and Mater Hospital Dr Brett O’Donnell who was awarded Medal (OAM) in the General Division, UNSW Scientia Professor Fiona Stapleton awarded Officer (AO) in the General Division, chief scientist innovation officer at BHVI Conjoint Professor Arthur Ho (AM), the Lions Eye Institute’s Dr Margaret Crowley (AM), CERA research fellow and clinical orthoptist Dr Sandra Staffieri (AO), Scientia Professor Rebecca Ivers (AM) who is an epidemiologist and former optometrist at UNSW, and Professor Alice Pébay (AM) from The University of Melbourne.
This year also marked several high profile leadership changes. Australia’s Professor Peter Hendicott ended his term as president of the World Council of Optometry, replaced by American Dr Sandra Block. There were changes to the Vision 2020 Australia Board too, with CEO of Guide Dogs NSW/ACT Mr Dale Cleaver and Melbourne optometrist and former Optometry Australia president Mr Murray Smith joining the fray, and former Orthoptics Australia president Ms Jane Schuller elected as deputy chair.
Elsewhere, Oculo co-founder and former CEO Dr Kate Taylor started a new position within iCare as vice president of strategy and business development. This came about after Finnish company Revenio – which supplies ophthalmic devices under the iCare brand – acquired the Oculo e-referral platform in 2021.
Therapies and equipment
Myopia management dominated headlines as far as the latest ophthalmic technology is concerned.
Of most interest was the new Eyerising Myopia Management Device by Australian-based firm Eyerising International. A new approach, the technology is based on repeated-low level red-light (RLRL) that gently stimulates blood flow in the retina, helping to slow the elongation of axial length and control myopia progression. The company reports that studies have demonstrated children who undergo RLRL for three minutes twice a day, five days a week, experience a significant reduction in myopia progression over a 12-month period, with a 69.4% efficacy in controlling axial length elongation and a 76.6% efficacy in managing myopia progression.
In October, the company addressed questions over the safety of the device, following two case reports on a probable “super responder” who experienced afterimages and vision loss, but ultimately made a full recovery. The patient is among five cases of significant adverse side effects reported among the 80,000 daily users of the device in China. At a rate of 1:20,000, the company reported that side effects with RLRL are extremely rare.
Spectacle lens myopia control interventions were also a hot topic in 2022 and the trend continued this year. Rodenstock and ZEISS Vision Care became the latest to launch lenses in this space with the respective MyCon and MyoCare lenses. What’s interesting about MyoCare is that it’s an age-related solution comprising two lens design options, depending on whether the child is under the age of 10, or 10 and older.
HOYA also continued its leadership in this space, with two new sun lens options for its MiYOSMART range: MiYOSMART Chameleon – photochromic spectacle lenses, offering an all-in-one solution, and MiYOSMART Sunbird – polarised spectacle lenses that complement addition to MiYOSMART clear spectacle lenses.
It was a milestone year for the macular disease community too after the US approved the first-ever therapy for geographic atrophy (GA) in February. Developed by Apellis Pharmaceuticals – and not yet available in Australia – SYFOVRE (pegcetacoplan injection) targets complement C3 and was heralded as the most important event in retinal ophthalmology in more than a decade.
The approval was followed by a second GA therapy approval in the US in August, with Iveric Bio’s IZERVAY (avacincaptad pegol intravitreal solution) – a complement C5 inhibitor – cleared following the GATHER1 and GATHER2 Phase 3 clinical trials.
In dry eye, Australian practitioners welcomed a new treatment approach from InMode – a provider of medical aesthetic devices – which entered the local ophthalmic scene with its Envision platform, featuring three devices encompassing radio frequency and intense pulsed light technologies.
Key events and trade shows
The return of O=MEGA23, this time in combination with the 4th World Congress of Optometry, after four years was the highlight on the ophthalmic event calendar. It was a chance to present the Australian optical industry to the globe and it didn’t disappoint, with more than 3,500 people attending, including 200 international visitors.
The RANZCO Congress is always a highlight – and this year it headed to Perth where almost 1,500 delegtes heard the latest updates from a high-powered speaker line-up, including neuro-ophthalmology global authority Professor Neil Miller.
Insight also headed to Sydney four times to attended the inaugural Optical Dispensers Australia national conference and Specsavers Partner Seminar – both in April – the Ophthalmology Updates! conference in August, and Specsavers Clinical Conference in October.
One of the most interesting papers of 2023 was on the topic of artificial intelligence (AI) by researchers at the Centre for Eye Health, School of Optometry and Vision Science, UNSW Sydney, including – PhD candidate Ms Sharon Ho, Associate Professor Gordon Doig and senior lecturer Dr Angelica Ly.
Their myth-busting work found, on average, that Australian optometrists had positive attitudes towards using AI as a tool to aid the diagnosis of retinal disease. Participants surveyed also agreed there will be an overall need for AI in primary eyecare and were excited by future increased use.
“This is promising for the future implementation of AI clinical decision support systems into clinical practice as it suggests that optometrists’ attitudes will not be a major limiting factor,” the researchers noted.
It could be argued the debate around blue light blocking lenses was put to bed by a group of University of Melbourne researchers in 2023. Associate Professor Andrew Anderson and Associate Professor Laura Downie presented their work at O=MEGA23, comprising a review of several randomised controlled trials that found these lenses probably make no difference to eye strain caused by computer use or to sleep quality. Nor did the study find any evidence that blue-light filtering lenses protect against damage to the retina.
Finally, in a world first, Flinders University’s Professor Jamie Craig will lead a trial on the use of selective laser trabeculoplasty (SLT) as a preventative measure in high risk glaucoma patients. With $1.7 million in funding, the study will determine the effectiveness and suitability of SLT laser as an early intervention to prevent the onset of visual loss from glaucoma.