Feature, Report

What’s in store for 2021?

With one of the most turbulent years in living memory behind us, this year promises to be a year of recovery and renewal. We ask some of the Australian ophthalmic sector’s brightest minds to gaze into their crystal ball and predict what’s ahead in 2021.

Name: Dr Brendan Cronin
Organisation: Queensland Eye Institute, corneal and interior segment surgeon
Area of interest: Cataract surgery, corneal disease, dry eye and glaucoma

Hopefully 2021 will be the year we switch from epithelium off corneal collagen cross-linking to epithelium on, oxygen enhanced cross- linking. We are already performing the new procedure called Boost but the Glaukos FDA study results should be released in the next 12 months on this protocol, seeing it go mainstream.

We have now combined oxygen enhanced epithelium on cross- linking with our topography-guided cross-linking system (the only one in Australia) for over a year. This means people can have their corneal topography and vision improved with faster recoveries, without even having their epithelium removed. It’s definitely the way forward in cross-linking.

The ongoing challenges from COVID-19 will continue in 2021. We are a large clinic with an on-site hospital. Managing patients with social distancing as well as patient and visitor registration will be an ongoing issue. Hopefully a vaccine makes that much easier.

Name: Amanda Lea
Organisation: UNSW Optometry Clinic, staff optometrist
Area of interest: Myopia and paediatric optometry

Innovations in spectacle and contact lens designs, investigations into the efficacy of different atropine doses, and a growing public and optometric awareness mean 2021 promises to be the year of myopia management, and hopefully the year of getting outside for some green time.

The UNSW Myopia Clinic has been bursting at the seams, which is indicative of the year we’ve had, being stuck indoors and on devices.

I’m excited our students graduate with a good understanding of the importance and mechanics of myopia management. This will shape outcomes for kids Australia-wide. Advocacy by optometrists, whether it’s locally or as part of global efforts, will reduce the burden of eye disease and disability in future.

While we prescribe contact lenses to lots of kids, there’s still some resistance to the idea. Contact lenses can be life-changing for a myopic child, and are safe and effective for myopia control. There’s opportunity to investigate and overcome barriers in this area.

Name: Finola Carey
Organisation: Optical Distributors & Manufacturers Association (ODMA)
Area of interest: Manufacturers and suppliers

Someone recently said the pace of change in technology development has never been faster and will never be this slow again. The key feature that will shape the ophthalmic equipment market is not so much keeping up with new technology as the software behind it; incorporating AI algorithms that use data to diagnose disease or predict treatment outcomes.

Suppliers will be keen to return to face-to-face demonstrations to maximise the instant asset write-off available to practitioners. ODMA’s biggest challenge – but one we’re certain we can deliver – is instilling confidence that September’s O=MEGA21 in Melbourne will be COVID- safe for everyone to attend. While there is plenty of talk about virtual events, we won’t pursue them as we feel they offer reach but not depth.

A major milestone for 2021 is my 25th year as CEO. When you have been in a job this long it’s critical to remain agile and I’m proud of our ability to reinvent our shows during my tenure, while successfully collaborating with 10 different chairpersons.

Name: Dr Peter Sumich
Organisation: Australian Society of Ophthalmologists, vice-president
Area of interest: Ophthalmology, cataract and refractive surgeon

Medibank Private has taken a 49% shareholding in Eastern Sydney Hospital and it appears that vertical integration is on the agenda.

It will initially invest $8.8 million in the business to fund capital investment and operational costs required for the hospital to scale its short stay model of care.

We continue to monitor the insurers and note how their policy plans are incrementally coming between patient choices and surgeons. We feel strongly that patients should come to surgeons by way of referral, rather than as directed by insurers who have packaged up surgery with their own contracted doctors and hospitals.

Similarly, there are instances of private hospitals elsewhere doing deals with insurers to cut non-contract surgeons from care pathways. When a patient is directed by their health fund to follow a clinical pathway where the insurer determines the hospital, doctor and treatment, we are seeing US-style managed care in operation.

Name: Charles Hornor
Organisation: Specsavers Australia & New Zealand, communications director
Area of interest: Optometry – corporate

We see the year ahead as one of new momentum and growth for our store partners, while being mindful that COVID-19 could re-emerge unexpectedly.

In the run up to the new year we announced the first raft of 2021 new store openings and in addition we will be expanding many existing stores into larger premises. We know the competition for the limited number of optometrists in the market will be as strong as ever this year and so we are excited to see the new University of Western Australia optometry school get up and running to create a new stream of graduates for the future.

On another note, we are excited about the development of Specsavers HealthHub. 2021 will see a full year of national reports produced and delivered via the site using anonymised eye health data. Importantly, each report will coincide with the key dates in the eye health calendar for glaucoma, diabetes, the Medicare year-end and more.

Name: Associate Professor Simon Skalicky
Organisation: Glaucoma Australia, president
Area of interest: Glaucoma

COVID-induced primary care service reductions will have a lingering impact this year. Many established glaucoma patients didn’t access routine monitoring visits, and fewer undiagnosed patients were detected. Now care is being accessed, there’s a significant backlog of clinical and surgical work that may strain the healthcare system. Telehealth may be utilised in glaucoma monitoring for isolated patients should further outbreaks occur.

GA’s period of strategic growth and transformation will continue through 2021 and 2022. This includes expanding risk awareness campaigns driving early detection, improving board and governance processes, expanding revenue sources to support patients and fund meaningful Australian glaucoma research. GA is developing objective metrics and collecting data to quantify the benefits of its services.

During Glaucoma Awareness Week (7-13 March) we’re launching a new ‘Treat Your Eyes’ campaign, prompting people to consider the value of their sight and get tested. GA’s family link risk awareness campaign ‘Begins with You’ prompts people with glaucoma to ask their family to get tested.

Name: Dr Fred Chen
Organisation: Lions Eye Institute, clinician-researcher
Area of interest: Macular degenerations and inherited retinal diseases

Recognition of geographic atrophy as a potentially treatable condition – with new trials on the horizon – could be a key feature shaping retinal disease landscape in Australia and globally this year.

I’m also eager to see the emergence of longer acting drugs for neovascular age-related macular degeneration (AMD) and new trials of port delivery systems for old drugs like Lucentis, allowing longer actions. Inherited retinal disease (IRD) is increasingly recognised as a subspecialty with multidisciplinary approach to management.

At LEI in 2021, we will run multiple clinical trials in AMD, retinal vascular disease and IRDs. There will also be a focus on long-term outcomes of chorioretinal anastomosis for retinal vein occlusion, expanding genetic analysis of patients with IRDs, and diabetic retinopathy imaging of retinal vasculature. We will also continue collaboration with PYC Therapeutics on development of a retinitis pigmentosa (RP) therapy. We’ve also been awarded research funding to genotype dominant and recessive RP and Stargardt disease families, and investigate juvenile diabetic retinopathy and retinopathy of prematurity.

Name: Jane Schuller
Organisation: Orthoptics Australia, president
Area of interest: Orthoptics

Innovative care models will be a key feature in 2021. There are already good examples of orthoptic-led clinics within the public system, but this was bolstered in 2020 with the emergence of the orthoptic-led post-operative cataract clinic (OSOP) at The Royal Victorian Eye and Ear Hospital, and a student-led orthoptic clinic at La Trobe University.

Orthoptists are highly skilled, and I’d like to see more clinics like these to address cataract and other waitlists.

A challenge in 2021 will be continued uncertainty around COVID-19 until a vaccine rollout. Our events are planned well in advance so we are predicting member confidence to travel, while finding the right balance between face-to-face and virtual meetings. We expect to see further innovation with our online learning capabilities.

Our annual scientific conference is planned for the Brisbane Convention and Exhibition Centre, co-located with RANZCO 20 to 22 November.

Name: Professor Keith Martin
Organisation: Centre for Eye Research Australia, director
Area of interest: Eye research and glaucoma

The legacy of COVID-19 and the backlog of undiagnosed and untreated eye conditions will be a key focus of eye research in 2021.

CERA’s new Health Services Research Unit will examine how innovative new technologies, telemedicine and better coordination of the eyecare sector can tackle the backlog and prevent blindness.

The pandemic has also accelerated the development of technologies for remote screening and diagnosis, which reduce a patient’s need to attend clinic. Using artificial intelligence and powerful new imaging technologies, our team is investigating new ways of detecting eye disease earlier to prevent vision loss.

We are excited about the next phase of our research into the role of vitamin B3 in preventing nerve cell damage from glaucoma. We’re also continuing research to develop new gene therapies – and look forward to enabling Australian patients to be part of international gene therapy trials.

Name: Lyn Brodie
Organisation: Optometry Australia, CEO
Area of interest: Optometry

Optometry Australia is full of optimism for 2021. In the new year we will launch our 2021-2024 Strategic Plan to guide the evolution of the sector over the next three years and towards our 2040 transformation goals.

We will progress opportunities for optometrists to work to their fullness of scope, particularly in management of chronic conditions, patient access, system efficiency and continue to advocate for telehealth.

As members transition to the new CPD regime, we will provide the systems and tools to meet the OBA’s regulations whilst delivering our quality education program.

We will watch carefully the launch of new technology and AI and work with the sector on advancing these into the Australian market where applicable.

And as consumers become more environmentally conscious, we will need to start finding ways that optometry can reduce its collective footprint. In pursuit of these efforts, we will recall the powerful lessons of 2020, and remain agile, attuned to changing contexts and the new opportunities they present.

Name: Philip Rose
Organisation: Eyecare Plus, national business development manager
Area of interest: Optometry – independent

During the pandemic, independent optometry proved a reliable partner to the communities in which they operate. Many of the chains closed, while the local independent kept offering in-person services, as the official guidelines allowed it. This brought in many new patients and the challenge is to now keep them. Another primary focus will be catching up on delayed patient recalls.

We’ve now won the Canstar Award for Most Satisfied Customers three years in a row. We will focus strongly on our group brand advertising into our practices’ local communities, particularly as many patients continue to work from home. Our members will continue to benefit from cost sharing, to maintain a consistent presence across various advertising channels.

We’re looking forward to our national conference in October and, obviously, we’re excited about the positive news around a vaccine. 2020 has caused much reflection about personal priorities, and changes will be implemented throughout 2021. We look forward to a prosperous year ahead.

Name: Associate Professor Ashish Agar
Organisation: Australian Society of Ophthalmologists, president
Area of interest: Cataract, glaucoma and general ophthalmology

In 2021 ophthalmology will continue to adapt to the ‘new normal’ brought about by the COVID-19 pandemic.

Following COVID-safe guidelines for social distancing and infection control doesn’t just protect patients and the community. The pandemic has exposed just how vulnerable healthcare workers are to infectious diseases, especially eyecare professionals, who work 400mm from the patient.

The after-effect of lockdowns is also still reverberating across the nation, especially in Victoria. Delayed presentations mean more severe eye conditions to be managed, along with a backlog of patients. Public surgery waiting lists have blown out and some hospitals still yet to resume normal levels of activity despite restrictions being eased months ago.

Name: Professor Nitin Verma
Organisation: RANZCO, president
Area of interest: Ophthalmology

Obviously COVID-19 will, unfortunately, still be with us in 2021. I am looking forward to seeing how technology can connect us better; to peers, to family, to patients and to community.

At RANZCO, we’ll be working to implement our strategic plan with a focus on education, members, community, equity and sustainability. We will continue to work productively with the New Zealand and Australian (federal and state level) governments, especially on the outcomes of the MBS Taskforce Review into ophthalmology items where we are keeping patient access and safety front of mind.

Addressing inequity across both countries represents an enormous challenge but I hope RANZCO can lead collaborative efforts and partnerships to meet this most critical of needs. I am optimistically looking forward to a face-to-face RANZCO Congress in November in Brisbane. I hope to see everyone there!

Name: Chris Beer
Organisation: George & Matilda Eyecare, CEO
Area of interest: Optometry – independent

While 2020 has presented many challenges for our industry, those who are prepared to be bold and adaptable can thrive.

We ended 2020 by bringing onboard more practices, after a period of us focusing on how we can evolve our existing business to be as future-proof as possible.

Our focus going into 2021 will be to attract the best practices and talent into our growing community. We then leverage the benefits of technology and data-analytics to provide a customer experience like no other.

As CEO, I will be constantly challenging myself and my team to think differently about how we can offer our patients a world-class experience. In a world where nothing stays the same, innovation is no longer a ‘nice to have’ but a necessity.

Name: Professor Hugh Taylor
Organisation: University of Melbourne, Indigenous Eye Health chair
Area of interest: Indigenous eye health

The Aboriginal Community Controlled Health Organisations (ACCHOs) were outstanding and showed their leadership when they took charge of arrangements to protect their communities from COVID-19 last year. This should set the pattern for the ongoing development of eyecare services that should be based in ACCHOs and primary care.

There is also a pressing need to catch up on eye exams and care, including surgery, that has been postponed or cancelled because of the lockdowns. Eyecare provision will be shaped by the long-awaited national road map of action to “eliminate avoidable blindness by 2025” as listed in the Long Term National Health Plan.

We will continue to provide technical support and advocacy for regional eyecare networks and services, and the promotion of good hygiene and safe housing in the trachoma areas.

The fourth National Aboriginal and Torres Strait Islander Eye Health Conference will be held virtually 20 to 22 April. It will be a great opportunity to celebrate successes and identify and define areas requiring work.

Name: Associate Professor Tim Roberts
Organisation: Vision Eye Institute, medical director
Area of interest: Ophthalmology – private

Private health insurers are likely to continue to seek ‘package’ arrangements from doctors and hospitals to ensure certainty around out-of-pocket costs for their members. We have already seen a number of large insurers seek tender responses and expressions of interest from hospitals that incorporate the fees for the attending surgeon and anaesthetist.

Succession planning in the context of an ageing medical and nursing workforce is also a priority, as well as balancing increasing patient numbers with the various, prudent COVID-safe processes and procedures across our 27 clinics in Victoria, New South Wales, Queensland and South Australia.

With the pandemic forcing us toward a virtual interactive environment, we expect most of our continuing professional development activities, including our large scale Eye360 and EnVision events, will be delivered online given the success of this approach in 2020.

Name: Brendon Gardner
Organisation: The Royal Victorian Eye and Ear Hospital, CEO
Area of interest: Public eye hospital

It is an understatement to say 2020 was a challenge. The key focus for the hospital in the first part of 2021 will be attending to the backlog of elective surgery and specialist clinic patients.

I was pleased to see how the hospital innovated during this period both in response to COVID-19 and in further embedding telehealth, where appropriate, into safe patient care. Understandably, last year took a toll on our staff which has prompted a focus on hospital-wide wellness initiatives.

What I am most proud of is how the hospital has still managed to move forward during this time. Some very exciting milestones included the progress of the hospital’s redevelopment, with the first of our departments moving to the new Surgical Admissions and Recovery suite. Further achievements saw the launch of our Innovate Reconciliation Action Plan which marks a significant second step on our journey towards reconciliation.

Name: Professor Michael Kalloniatis
Organisation: Centre for Eye Health, centre director
Area of interest: Advanced ocular imaging, diagnostic and management services

2020 laid the foundations for an exciting period of growth and development at CFEH and optometry in general. The disruption in clinical care challenged us and triggered the initiation of alternate procedures for clinical care delivery through the expanded use of information and communication technologies (ICTs): the genesis of ‘tele-optometry’.

CFEH expanded the use of ICTs through online/virtual history and identified patients in need of care: we have modified and continued to use this approach as restrictions were lifted. Further, through research collaborations, we will begin further multi-year research studies in 2021 to further develop this. We will also launch a new education initiative with the development of the “CFEH Atlas” – an online resource for optometrists showcasing posterior eye disease through the use of multimodal imaging helping users better understand how to interpret advanced imaging, and assist with disease diagnosis: another use of ICTs.

We expect use of ICTs to become the new norm thereby streamlining optometric care, communication and changing the way we practice.

Name: Steven Johnston
Organisation: ProVision, CEO
Area of interest: Optometry – independent

ProVision hopes that many of the behavioural shifts that have gained rapid adoption in 2020 become lifelong habits.

This includes increased take up of ordering technology such as ProSupply, which needs to continue to help make the independent supply chain as efficient as possible in 2021 and beyond.

We also hope more patients continue to embrace online bookings which is a win for both the patient (convenience) and the practice (time). Changes to the way we work, such as working from home rather than office, will impact the way we consume our eyecare with many patients choosing to support genuine “locals”.

This year may also see increased utilisation of digital channels among patients to research and choose eyecare providers. ProVision is well placed to help progressive independent practices grasp these opportunities with both hands with inhouse systems complemented by best of breed referral partners.

We will be announcing exciting developments to our members and supplier partners at separate meetings in February.

Name: Tim McCann
Organisation: Rodenstock Australia, general manager
Area of interest: Spectacles/lenses

The final months of 2020 were promising and give a good indication of a positive 2021, and we can put all the challenges of 2020 behind us and into perspective.

We are definitely seeing a development in product mix to higher quality product and a continued increase of interest in technical innovation and lens improvements. Rodenstock will continue to focus on the DNEye innovation that provides an extremely high level of personalisation using measurements from the DNEye Scanner 2 device. Practices that have implemented so far are experiencing high levels of interest from patients and reporting success in many areas of their practice.

Rodenstock has been working with Matrix Eyewear for a number of years and this partnership will continue. From 2021, however, the Porsche Design Eyewear, which is manufactured by Rodenstock and distributed by Matrix, will instead by distributed and sold directly by Rodenstock. The brand is developing worldwide and there are a number of exciting releases planned for 2021.

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