WRITER Melanie Kell

Never one to disappoint, Specsavers recent annual Clinical Conference brought together over 900 optometrists in person in Melbourne, as well as an online, for a comprehensive weekend of clinical education and professional development. The event showcased the network’s commitment to excellence in patient care, with presentations from leading ophthalmologists and optometrists covering critical areas from paediatric eye disease to advanced glaucoma management. In this article, mivision reviews a selection of presentations.

Dr Ben Ashby, Director of Optometry for Specsavers Australia New Zealand, opened the conference by celebrating the health network’s significant achievements. In 2020, Specsavers set an ambitious target to increase detection rates for avoidable blindness from 80% to 95% by 2025. “This year you guys are all up to 94% detection rate for avoidable blindness,” Dr Ashby announced. “That is absolutely phenomenal, and it is completely down to your commitment and your dedication.”

The impact of this achievement extends far beyond statistics. “There are now hundreds of thousands of people across Australia and New Zealand in treatment that will protect their sight, hopefully now for the rest of their lives,” Dr Ashby explained. The Australian and New Zealand network has grown to care for over five million patients annually and has been recognised by Reader’s Digest as the most trusted optometrists in the community for six consecutive years.1 This year, Specsavers New Zealand was voted the second best ‘Great Place to Work’, while Specsavers Australia was voted fourth.2,3

GLAUCOMA: A GENERATIONAL OPPORTUNITY

Dr Ashby highlighted the network’s extraordinary progress in glaucoma detection and management, advising the audience that in the past five years, Specsavers stores had found 170,000 of the estimated 200,000 Australians and New Zealanders with undiagnosed glaucoma identified in 2020. “We have a genuinely generational opportunity here to stop glaucoma being the leading cause of blindness in the community,” he said.

Beyond individual patient care, by partnering with Glaucoma Australia to notify first-degree relatives, Specsavers’ program now aims to “get the next generation of people into treatment earlier than ever… so they can live their whole lives without losing their sight to this condition”.

DIABETES AND DRY EYE MANAGEMENT

Contributing to Diabetes Australia’s KeepSight program has proven equally transformative for diabetes management. With over one million interactions registered, the program has achieved a 20% increase in regular eye care attendance among patients with diabetes. “20,000 of them would have lost their sight if you hadn’t made the effort to register them to the KeepSight program,” Dr Ashby enthused.

A pilot program to advance dry eye management has rapidly expanded from three stores to 100 locations, offering treatments including low light therapy and intense pulsed light. “That is over 2,000 patients benefiting from the most effective and the most affordable solution for managing their dry eye problem,” Dr Ashby said. Northam in Western Australia became the 100th store to offer the service in early November.

PAEDIATRIC EYE CARE

When to Worry: Paediatric Presentations

Dr Elizabeth Conner, a Christchurch-based ophthalmologist specialising in paediatric eye disease, delivered an engaging presentation on critical presentations in children that warrant urgent referral. Her practical approach aimed to build confidence in managing paediatric eye problems while identifying genuine red flags.

“Less than 5% of children are going to have a serious condition and less than 1% are going to have a life-threatening condition,” Dr Conner reassured attendees. “So feel empowered to say, ‘yes, I’ll check out your child and see what’s going on’.”

Dr Conner urged optometrists to beware of conjunctivitis that’s unresponsive to antibiotics, has no discharge, or comes and goes. A key red flag is when parents report behavioural changes. “Ask if the child is avoiding outdoor activities? Does the child choose not to play outside because they’re light sensitive? That suggests a chronicity that the symptoms have been there enough to impact on this child’s life.”

For managing an anxious child with a suspected foreign body in the eye, Dr Conner shared a practical tip, explaining to the child: “I know your eye is really sore, but I can’t tell you what’s going on. We can’t make it better until we can have a look. And so I’ve got some magic eye drops that I’m going to put in your eye.” She advised applying oxybuprocaine to numb the eye while the child is lying down, letting the drop be drawn into the eye naturally, which often gains the child’s cooperation.

Regarding uveitis presentations, Dr Conner highlighted tubulointerstitial nephritis (TIN), a rare autoimmune disorder that simultaneously affects the kidneys and eyes. “Twenty per cent of children will present with uveitis before they develop kidney disease or renal disease,” she explained. “If you see a child with uveitis, that definitely warrants an acute referral.”

She also discussed the chronic allergic eye condition vernal keratoconjunctivitis (VKC), noting its management challenges. “It can be difficult for parents to bring these kids into the clinic, but they need lots of regular follow-up,” she said. “Trying to strike the balance between the benefits and harms of treating with steroids is difficult, but preventing ulcers and scars from forming is critical to long-term visual outcomes.”

On optic nerve assessment, Dr Conner advised: “If you’re getting a bit stressed out because you’ve seen a funny optic nerve… take a breath and look at the structure. What’s different about it? Then ask, how is it functioning? Have you looked at optical coherence tomography (OCT) imaging? Have you done vision, colour vision, a pupil check, and visual field testing? If you’re not sure, but it doesn’t look too serious, and the child is well, see the patient again in three months. Looking for progression or change can be a really useful way of trying to determine whether this is just an anomalous optic nerve or if it’s something that’s important.”

The Myopia Management Revolution

Dr Kate Gifford, co-founder of Myopia Profile, presented a comprehensive update on myopia management, framing it as “choose your own adventure” for practitioners to identify their next level up. Her presentation addressed the key barriers practitioners face and provided evidence-based solutions.

Cost is one of the greatest barriers to myopia treatment, especially for parents with no experience of myopia, and yet the cost of early management will be less than the cost of managing high myopia down the track.

When speaking with concerned parents/ carers, Dr Gifford recommended highlighting the short- rather than long-term advantages of early myopia management as these will be easier to understand.

With lenses to control myopia progression, explain to the parent that “your child will spend less time with blurry vision between eye exams,” she recommended. “Instead of their vision changing every three to six months, as maybe the case with progressive myopia, it might change in nine or 12 months.”

Regarding treatment efficacy, Dr Gifford said spectacles, contact lenses, and atropine treatments showing at least 50% reduction in axial elongation should be considered equally effective, with no treatment showing clear superiority.

On contact lens safety, she provided a reassuring framework for patient communication. “The risk of microbial keratitis with a daily disposable contact lens is two per 10,000 patient wearing years. So if you wore contact lenses for 5,000 years, you’re likely to get one eye infection.”

Demonstrating low level light therapy for dry eye management.

Dr Kenneth Ooi, Save Sight Institute.

Marissa Good, Good Optical Services.

Delegates at this year's Specsavers Clinical Conference.

The Specsavers team celebrating Subin Kim from Specsavers Helensvale (left with award) who won the Early Career Optometry Excellence Award, and Anas Mujtaba from Specsavers Nowra Plaza (right with award) who won the Graduate Optometry Excellence Award.

Dr Gifford reported that globally, 38% of soft contact lenses fitted to children aged 6–12 are for myopia control, whereas in Australia only 15% of all kids fit with contact lenses were fit with soft lenses for myopia control, creating a prime opportunity for optometry practices.

On atropine, she said “0.05% appears to achieve a balance between efficacy and minimal side effects”. She showed that higher concentrations don’t necessarily provide better results but do cause more side effects, while 0.01% doesn’t appear to meet the threshold of slowing eye growth by at least 0.1 mm per year.

For pre-myopia management, Dr Gifford identified key risk factors: “The biggest risk factor independent of all of those others is a child not being as hyperopic as they should be”. She cited the threshold of less than +0.75D at age 6–7 years from the CLEERE study,4 though noted recent Chinese data suggests higher thresholds may be appropriate for East Asian populations.

FROM CORNEAL ULCERS TO DRY EYE

Small Lesions, Big Decisions

Professor Chameen Samarawickrama, Professor of Cornea and Cataract at Sydney University, delivered a masterclass on approaching small corneal lesions. “The reality is a patient comes in and goes, ‘oh, my eye’s sore’, and you’ve seen them before and it’s a normal eye. And then you open the lid and you look in and you see this tiny little dot and you go, ‘what is it?’”

His systematic approach starts with a basic history, then examination looking for important positives and negatives, followed by a detailed history to confirm diagnosis and exclude differentials. “The process... is to stop these tiny things from becoming big things, which are much harder for me to treat,” he explained.

For erosions, Prof Samarawickrama stressed the importance of the one-year lubrication rule: “The epithelial basement membrane has to be resilient to withstand the outside world. And it does that by growing these fibrils or spikes called anchoring fibrils.” He explained that when the fibrils are broken by a traumatic injury, such as a child’s finger or a mascara wand connecting with the eye, it takes 12 months for the fibrils to grow back.

One of the best ways to heal an epithelial defect is by using Chloramphenicol ointment, which has lanolin as its base. However, lubricants need to be continued for up to a year to prevent erosions becoming recurrent. “The commonest thing that I see is that they’ll have an injury… (and) they get told to ‘lubricate it for a bit’. They lubricate it for a month or two and then it comes back as a recurrent erosion.”

Distinguishing marginal from microbial keratitis, he posed an audience question with a clear answer: “The most sensitive is AC (anterior chamber) activity because microbial causes inflammation, it’s bad for the eye, right? Whereas a marginal... is a sterile infiltrate. It’s not in the eye, it’s on the surface.”

On microbial keratitis, he said there will always be an identifiable risk factor (“if there’s no risk factor, that’s weird and that’s worrisome”).

“Your eye is meant to be able to deal with incidental exposure to bacteria. If the bacteria is setting in, something has changed”, he said, noting that over 50% of contact lens-related cases involve Pseudomonas.

On treatment, Prof Samarawickrama advised that 95% of typical bacterial infections can be treated “without a scrape”. He warned that although ciprofloxacin is a suitable treatment for small infections, it should be avoided as it can lead to white corneal precipitates. “For proper microbial keratitis, where you are worried, it’s straight to oflox (ofloxacin)”.

Regarding steroids, he cited the Steroids for Corneal Ulcers (SCUT) trial, which aimed to determine whether topical corticosteroids as adjunctive therapy for bacterial keratitis improve long-term clinical outcomes.5 “Non nocardia infections... had a one-line improvement in vision, one line, not one letter, one line with the addition of steroids at 48 hours. That’s the difference between 6/18 and 6/12, driving versus not driving vision,” he stressed.

Dry Eye: A Comprehensive Approach

Dr Kenneth Ooi, from Save Sight Institute, Sydney, presented an intricate case study demonstrating the complexity of dry eye management and the importance of considering systemic factors. His presentation demonstrated the need to build a “pyramid” of treatment to control inflammation associated with dry eye disease.

Dr Ooi highlighted often-overlooked contributing factors. “Stress can lead to exacerbation of dry eye in terms of sympathetic overload, reduced lacrimal gland secretion, and depression,” he explained, noting the patient used in his case study was a midwife caring for an autistic son.

Regarding screen time, he shared research on children and dry eye: “When I was a kid, I’d love to read... my palpebral aperture (PA) would be around 7 mm. Nowadays when you’re in front of computer screens... it’ll be around 9 mm.” With phones held up, “your PA really then increases to around 11 mm. So a lot more drying.”

Dr Ooi presented new research linking diet to dry eye. “We looked at levels of intake of micro and macronutrients and tried to correlate these with dry eye symptoms,” he explained. Key findings included protective effects of vitamin B12, B1, B9, polyunsaturated fats, vitamin C, and calcium, while high total fat, saturated fat, and calorie intake worsened symptoms.

On the link between rosacea and cholesterol, Dr Ooi shared groundbreaking research. “We’re postulating that rosacea, meibomian gland dysfunction, and blepharitis may actually be markers for earlier associated problems with cholesterol and also inflammation detection.” He noted that patients with meibomian gland dysfunction under 40 are “already much more predisposed to having high cholesterol”.

Regarding vitamin D deficiency and dry eye, he said the normal range is very large. “It’s 50 to 150... but if my level, for example, is at 51, still within the normal range, and I have dry eye, then certainly it’s worthwhile increasing vitamin D levels, especially during the wintertime.”

Dr Ooi discussed his own work to develop a formulation of topical atorvastatin for the treatment of inflammatory dry eye. “We’ve come up with a formulation of atorvastatin in eye drop form to reduce the inflammation associated with dry eye as they are anti-inflammatory. We have also just received NHMRC (National Health and Medical Research Council) and University of Sydney grant funding for further development,” he reported.

GLAUCOMA: DETECTION, MONITORING, AND CO-MANAGEMENT

Piecing Together Structure and Function

Dr Jason Cheng (Vision Eye Institute and Sydney Eye Hospital) presented a detailed guide to using OCT and visual fields in tandem for glaucoma diagnosis. “By putting both visual fields and OCT together, and putting this into clinical context, taking a history, looking at risk factors and looking at the eye pressure... your diagnosis rate and your treatment rate improves,” he explained.

Dr Cheng clarified the limitations of the ISNT rule (‘normally the neuro-retinal rim is thickest Inferiorly and thinnest Temporally), often used to help detect glaucoma. “It’s valid about 40% of the time” (however), “the T temporal side is almost always thinnest in 80% of the cases. So, if you ever see the superior or the inferior that is thinner than the temporal, be very suspicious for glaucoma.”

He reminded the audience of the complementary nature of OCT and visual fields: “It’s quite rare to just get OCT and visual field progression together. It’s only in about 10% of cases. In most of the cases that you see progression, you see on OCT only 30%, and 30% you see on automatic perimetry.”

For visual field interpretation, Dr Cheng recommended the 24-2 pattern because “it looks at 24 degrees... it’s a tighter area that spreads across the inferior nasal side. That’s much better for glaucoma detection,” he explained. He prefers 24-2C because “it gives you extra spots within the central area”.

On glaucoma staging, he explained, “if the mean deviation is above -6, that’s mild; if it’s between -6 to -12, it’s moderate. And if it’s less than -12, then that’s advanced”. However, he added an important caveat: “If any of the central four spots are included... we call this split fixation... we would call this advanced glaucoma”.

For progression analysis, Dr Cheng demonstrated both event-based and trend-based approaches. “Deepening and enlarging... this is the thing to look out for,” he said about visual field progression. On trend analysis, he showed how Visual Field Index (a global metric that represents the entire visual field as a single percentage of normal), can predict future outcomes. “VFI is really good to use for patient communication… it gives you a (charted) prediction for what's going to happen in the next five years based on the patient’s current rate of progression.”

First-Line Treatment and Collaborative Care

Melbourne ophthalmologist Dr Tu Tran presented on the practical aspects of glaucoma management and the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) collaborative care pathway.6 She began by contextualising glaucoma’s public health impact. “One in 10 Australians over the age of 80 will develop glaucoma; 50% of patients with glaucoma are not detected,” she advised.

Dr Tran presented evidence from the LiGHT trial for selective laser trabeculoplasty (SLT) as first-line treatment.7 “This trial showed that SLT is clinically effective, and is cost effective as a primary treatment for open angle glaucoma,” she explained. The six-year results demonstrated that “78% at three years and 70% at six years remained at target pressures with SLT without the use of medication and not needing surgery”.

Importantly, “more eyes in the drop group experienced disease progression” and required more interventions. “There were three times less patients requiring trabeculectomy in the SLT group,” Dr Tran noted; “more cataract surgeries were actually performed in the drop group, 95 compared to 57 eyes in the SLT group”.

She said SLT is most appropriate for patients with ocular hypertension and mild to moderate open angle glaucoma. “However, if a patient’s got advanced glaucoma, with really high pressures on initial treatment, then you don’t want to do SLT, you want to put them on topical therapy.”

On the collaborative care pathway, Dr Tran outlined clear referral criteria. Low-risk suspects without risk factors can be monitored in primary care, but “if they’re a low-risk suspect; they have one risk factor... such as high myopia, pigment dispersion, pseudoexfoliation or a strong family history, those patients should be referred for an initial assessment.”

She said optometrists can initiate treatment for early glaucoma or moderate glaucoma “if you are happy to do so after discussions with them about SLT or treatment and then refer within four months”. However, “if patients have early or moderate glaucoma but they’re unstable and the visual field or OCT is progressing, or the pressures are not at target, they need to be referred on for escalation of treatment”.

COMING SOON

The conference concluded with Dr Ashby outlining future directions, including expanded dry eye services, enhanced paediatric programs including “Optom Monsters” (characters that will become part of the Specsavers’ brand to improve children’s eye test experience), and new senior optometry roles. “If you think this five year plan was amazing, you will not believe what’s in the next five years,” he teased.

Specsavers Clinical Conference 2026 will take place from 12–13 September at the JW Marriott Hotel on the Gold Coast.

References

1. Trusted Brands Australia, 2025 trusted brands: Australian winners. Available at: trustedbrands.com.au/ results [accessed Oct 2025].
2. Great Place to Work, Best workplaces in New Zealand 2025. Available at: greatplacetowork.co.nz/best-workplaces-in-new-zealand-2025 [accessed Oct 2025].
3. Great Place to Work, Best workplaces in Australia 2025. Available at: greatplacetowork.com.au/best-workplaces-in-australia-2025 [accessed Oct 2025].
4. Zadnik K, Sinnott LT, Mutti DO, et al; Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group. Prediction of juvenile-onset myopia. JAMA Ophthalmol. 2015 Jun;133(6):683-9. doi: 10.1001/ jamaophthalmol.2015.0471.
5. Srinivasan M, Mascarenhas J, Acharya NR, et al. Steroids for Corneal Ulcers Trial Group. The steroids for corneal ulcers trial (SCUT): secondary 12-month clinical outcomes of a randomized controlled trial. Am J Ophthalmol. 2014 Feb;157(2):327-333.e3. doi: 10.1016/j.ajo.2013.09.025.
6. White A, Goldberg I; Australian and New Zealand Glaucoma Interest Group and the Royal Australian and New Zealand College of Ophthalmologists. Guidelines for the collaborative care of glaucoma patients and suspects by ophthalmologists and optometrists in Australia. Clin Exp Ophthalmol. 2014; 42(2):107-117. doi: 10.1111/ceo.12270.
7. Gazzard G, Konstantakopoulou E, LiGHT Trial Study Group, et al. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-year results of primary selective laser trabeculoplasty versus eye drops for the treatment of glaucoma and ocular hypertension. Ophthalmology. 2023 Feb;130(2):139-151. doi: 10.1016/j.ophtha.2022.09.009.