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CONTENTS 05 SAFILO AND SPECIAL OLYMPICS INTERNATIONAL TOGETHER AGAIN UNTIL 2024 07 SCIENTISTS ENABLE A BLIND WOMAN TO SEE SIMPLE SHAPES USING A BRAIN IMPLANT 09 SCREEN TIME LINKED TO RISK OF MYOPIA IN YOUNG PEOPLE 11 SCIENTISTS IDENTIFY A POSSIBLE NEW TREATMENT FOR DIABETIC RETINOPATHY 13 MYOPIA CONTROL EFFECT OF DIMS FINDINGS OF A 3 YEAR FOLLOW UP STUDY 16 SAOA HEADLINE NEWS 19 ALLIANCE OF SOUTH AFRICA INDEPENDENT PRACTITIONERS ASSOCIATION ASAIPA AWARDS 20 EXPANDED SCOPE SAOA RESPONSE TO OSSA POSITION 21 SAOA SUPPORTS LEGAL ACTION INSTITUTED BY PHYSIOTHERAPY SOCIETY SASP AGAINST SCHEMES AND ADMINISTRATORS 24 RETINA SOUTH AFRICA SADLY ANNOUNCES THE PASSING OF OUR CHAIRMAN JAMES CAPE IN JULY 2021 26 WORLD DIABETES DAY 14 NOVEMBER 2021 27 DIS CHEM RIDE FOR SIGHT RACE REPORT FROM JONNY KOEN 29 WE NEED TO TALK ABOUT THE ELEPHANT IN THE ROOM CHARLES BONNET SYNDROME 33 ZEISS CELEBRATES 175 YEARS OF INNOVATION PASSION AND THE COURAGE TO DEVELOP 37 Q A ZEISS 175 YEARS 39 CAN YOUR PATIENTS HANDLE IT 46 INSPIRED BY THE SCIENCE OF TEARS

EDITOR S LETTER WELCOME TO THE 2ND ISSUE OF GLANCE Here are some highlights of what you should find interesting to read In SAOA Headline News you can read about their challenging year they had especially after the unrest in July 2021 and what they managed to achieve see the winners from the ASAIPA awards and meet the newly elected SAOA Directors Retina SA pays tribute to its former chairman James Cape who sadly passed away last year The Dischem Ride to Sight event returned earlier this year and we get to hear from wellknown cyclist Jonny Koen In November 2021 ZEISS celebrated 175 years in a Q A we get to find out more about this amazing achievement that was celebrated around the world We also learn how the company has evolved and how it has navigated itself through the covid pandemic Karen Denton briefly discusses the impact covid has had on certain issues such as Charles Bonnet Syndrome you can also watch her full presentation that she did on behalf of the Low Vision Centre of Learning You can also read about a Myopia Control study conducted by the Hong Kong Polytechnic University On the contact lens side you can read an interesting article about how the Science and Psychology handling is providing new insights and another article on an innovative contact lens designed to work with the tear film Happy reading Front Cover Image Modern Optical Pebble Model For further information email info modernoptical co za Tel 010 4477 772 WhatsApp 082 788 5052

EVENTS ZEISS 175 YEARS ANNIVERSARY AT RN 17 11 21 TE SILMO PARIS 2021 THE ENTHUSIASM IN 24 09 21 PLANNING AN EVENT LET US KNOW AL N IO It was much awaited albeit with cautious excitement But when it finally happened it surpassed all expectations SILMO PARIS welcomed cheerful professionals who were thrilled to gather converse do business show and share in the incredible energy of the optical and eyewear industry READ MORE I AT RN TE IN AL N O When ZEISS was established 175 years ago it was curiosity passion and precision that inspired us and our customers Over time new perspectives have shaped our view of the world And we have seen great opportunities in great challenges Even though the world has changed significantly over the past 175 years one thing will remain the same Together we challenge the limits of our imagination READ MORE EMAIL THE DETAILS OF YOUR UPCOMING EVENT TO SIMON EYESITE CO ZA TO GET LISTED ONLINE AN OPTICAL INSIGHT GLANCE 01

SCAN ME TO LEARN MORE The Most True To Life Virtual Try On ochovision com info ochovision com info modernoptical co za A F R I C A

FEATURED PRODUCTS RETINA 400 FUNDUS CAMERA With its wide field of vision and high resolution sensor Retina 400 is the ideal solution for high quality retinal imaging It benefits from software with automated operations for faster and more effective analysis This flexible and user friendly non mydriatic retinal camera can be adapted to all types of practice set up and will ensure the comfort of your patients NFC 700 FULLY AUTOMATED NON MYDRIATIC RETINAL CAMERA Fully Automatic Image Capture All in one with Built in Computer Large 10 1 Touch Screen Enhanced Connectivity User friendly Interface High Quality Retinal Image Selectable Fixation Targets and Montage HUVITZ ALL IN ONE OCT HOCT 1 1F All in One HOCT is smart 3D OCT Fundus Camera Totally integrated system combined with PC Provides OCT and Fundus data on one Screen All in One HOCT is easy to use One button it creates a High speed Scan and a High quality Image giving greater insight for the ophthalmology clinic One space allows the acquisition of various types of analysis and diagnosis results Easy to use and results are outstanding and easily follow Huvitz All in One HOCT will be the icon for leading a new era of Optical Coherence Tomography OCT AN OPTICAL INSIGHT GLANCE 03

ZEISS VISUFIT 1000 PLATFORM DIGITIZE YOUR CONSULTATION AND OFFER STAND OUT SERVICES SUCH AS FRAME COMPARISON DIGITAL CENTRATION AND VIRTUAL TRY ON OF FRAMES IN 3D RAISING YOUR BUSINESS PROFILE IN A DIGITAL WORLD UNDERSTANDING THE NEEDS OF PATIENTS The digital age is redefining the optometry practice Patients are always connected and more demanding than ever The key differentiators for practices are customisation convenience and a unique patient experience More and more patients are thinking of buying their glasses online What the internet cannot provide however is expert consultation professional centration and a unique patient experience With the ZEISS VISUFIT 1000 Platform you can achieve new levels of precision speed service and convenience making the future of buying glasses real now You can help your patients understand what they need validate their own research and guide them to a great solution TAKE YOUR BUSINESS FROM VISION TO VISIONARY Raise your business profile Impress your patients Ensure precise centration Enjoy more convenience Digitalize your business 69 OF PATIENTS RETURN TO PRACTICES OFFERING DIGITAL CENTRATION WITH A ZEISS INSTRUMENT AN OPTICAL INSIGHT GLANCE 04

INTERNATIONAL NEWS SAFILO AND SPECIAL OLYMPICS INTERNATIONAL TOGETHER AGAIN UNTIL 2024 Safilo Group Press Office Safilo Group a worldwide leader in the design manufacturing and distribution of optical frames and sunglasses sports eyewear goggles and helmets and Special Olympics the international non profit organisation dedicated to transforming the lives of people with intellectual disabilities renew their partnership which will see them united again for the next three years Thanks to this renewal Safilo and Special Olympics have further strengthened their relationship which began in 2003 and is now celebrating its 18th anniversary It is an important milestone especially considering that over the years more than 1 3 million frames and sunglasses have been donated to Special Olympics athletes all over the world as part of the Special Olympics Lions Clubs International Foundation Opening Eyes programme IN 18 YEARS OF COLLABORATION 1 3 MILLION FRAMES AND SUNGLASSES DONATED TO ATHLETES ALL OVER THE WORLD GLANCE 05

Safilo s commitment however is not only represented by the donation of optical frames but also by the personal involvement of the Group s employees who in recent years have participated as volunteers in concrete initiatives linked to the organisation of Opening Eyes events for the benefit of athletes with intellectual disabilities We are very proud to announce the renewal for the next three years of our partnership with Special Olympics as we are continuing to strengthen the journey we began 18 years ago said Angelo Trocchia CEO of Safilo Group Our goal from the very first day has been to create a lasting relationship and commit ourselves daily to supporting specific programmes aimed at correcting sight defects with the awareness of having a decisive and positive impact on the lives of millions of people around the world through the donation of our frames and sunglasses This commitment is also part of our sustainability strategies an ongoing engagement based on three main pillars people products and planet Special Olympics is honored to gain the continued support of Safilo Group as part of a shared commitment to providing inclusive health for individuals with intellectual disabilities Together with the eye health vision care and global health community Special Olympics is excited to enter into this renewed partnership with Safilo to drive needed support to Special Olympics athletes around the world according to David Evangelista President and Managing Director Special Olympics Europe Eurasia In addition to donations of frames and sunglasses the partnership also provides Special Olympics athletes with the opportunity to benefit from eye examinations and referrals for follow up checks through Opening Eyes services supported by Safilo and other cooperate sponsors in the eye care community Special Olympics is honored to gain the continued support of Safilo Group as part of a shared commitment to providing inclusive health for individuals with intellectual disabilities ABOUT SPECIAL OLYMPICS FOUNDED IN 1968 SPECIAL OLYMPICS IS A GLOBAL MOVEMENT TO END DISCRIMINATION AGAINST PEOPLE WITH INTELLECTUAL DISABILITIES WE FOSTER ACCEPTANCE OF ALL PEOPLE THROUGH THE POWER OF SPORT AND PROGRAMMING IN EDUCATION HEALTH AND LEADERSHIP WITH MORE THAN SIX MILLION ATHLETES AND UNIFIED SPORTS PARTNERS IN OVER 201 COUNTRIES AND TERRITORIES AND MORE THAN ONE MILLION COACHES AND VOLUNTEERS SPECIAL OLYMPICS DELIVERS MORE THAN 30 OLYMPIC TYPE SPORTS AND OVER 100 000 GAMES AND COMPETITIONS IN A TYPICAL YEAR ENGAGE WITH US ON TWITTER FACEBOOK YOUTUBE INSTAGRAM LINKEDIN AND OUR BLOG ON MEDIUM LEARN MORE AT WWW SPECIALOLYMPICS ORG ABOUT SAFILO GROUP ESTABLISHED IN 1934 IN ITALY S VENETO REGION SAFILO GROUP IS ONE OF THE EYEWEAR INDUSTRY S PRINCIPAL PLAYERS IN DESIGN MANUFACTURING AND DISTRIBUTION OF OPTICAL FRAMES SUNGLASSES SPORTS EYEWEAR GOGGLES AND HELMETS THE GROUP DESIGNS AND MANUFACTURES ITS COLLECTIONS BY BLENDING STYLISTIC TECHNICAL AND INDUSTRIAL INNOVATION WITH QUALITY AND SKILLFUL CRAFTSMANSHIP WITH AN EXTENSIVE GLOBAL PRESENCE SAFILO S BUSINESS MODEL ENABLES IT TO MONITOR ITS ENTIRE PRODUCTION AND DISTRIBUTION CHAIN FROM RESEARCH AND DEVELOPMENT IN FIVE PRESTIGIOUS DESIGN STUDIOS LOCATED IN PADUA MILAN NEW YORK HONG KONG AND PORTLAND TO ITS COMPANY OWNED PRODUCTION FACILITIES AND NETWORK OF QUALIFIED MANUFACTURING PARTNERS SAFILO GROUP ENSURES THAT EVERY PRODUCT OFFERS THE PERFECT FIT AND MEETS THE HIGHEST QUALITY STANDARDS REACHING APPROXIMATELY 100 000 SELECTED POINTS OF SALE WORLDWIDE WITH AN EXTENSIVE WHOLLY OWNED NETWORK OF SUBSIDIARIES IN 40 COUNTRIES AND MORE THAN 50 PARTNERS IN 70 COUNTRIES SAFILO S WELL ESTABLISHED TRADITIONAL WHOLESALE DISTRIBUTION MODEL WHICH ENCOMPASSES EYECARE RETAILERS CHAINS DEPARTMENT STORES SPECIALIZED RETAILERS BOUTIQUES DUTY FREE SHOPS AND SPORTING GOODS STORES IS COMPLEMENTED BY DIRECT TO CONSUMER AND INTERNET PURE PLAYER SALES PLATFORMS IN LINE WITH THE GROUP S DEVELOPMENT STRATEGIES SAFILO GROUP S PORTFOLIO ENCOMPASSES OWN CORE BRANDS CARRERA POLAROID SMITH SAFILO BLENDERS PRIV REVAUX AND SEVENTH STREET LICENSED BRANDS INCLUDE BANANA REPUBLIC BOSS EYEWEAR BY DAVID BECKHAM ELIE SAAB FOSSIL GIVENCHY HAVAIANAS HUGO ISABEL MARANT JIMMY CHOO JUICY COUTURE KATE SPADE NEW YORK LEVI S LIZ CLAIBORNE LOVE MOSCHINO MARC JACOBS MISSONI M MISSONI MOSCHINO PIERRE CARDIN PORTS RAG BONE REBECCA MINKOFF TOMMY HILFIGER TOMMY JEANS AND UNDER ARMOUR THE PARENT COMPANY SAFILO GROUP S P A IS LISTED ON THE ITALIAN STOCK EXCHANGE MTA ORGANIZED AND MANAGED BY BORSA ITALIANA ISIN CODE IT0004604762 BLOOMBERG SFL IM REUTERS SFLG MI IN 2020 SAFILO GROUP RECORDED NET REVENUES FOR EURO 780 3 MILLION AN OPTICAL INSIGHT GLANCE 06

INTERNATIONAL NEWS SCIENTISTS ENABLE A BLIND WOMAN TO SEE SIMPLE SHAPES USING A BRAIN IMPLANT Netherlands Institute for Neuroscience SOURCE NIN NL NEWLY PUBLISHED RESEARCH DETAILS HOW A TEAM OF SCIENTISTS FROM THE UNIVERSITY MIGUEL HERN NDEZ SPAIN THE NETHERLANDS INSTITUTE OF NEUROSCIENCE NETHERLANDS AND THE JOHN A MORAN EYE CENTER AT THE UNIVERSITY OF UTAH USA SUCCESSFULLY CREATED A FORM OF ARTIFICIAL VISION FOR A BLIND WOMAN USING A BRAIN IMPLANT In the article Visual percepts evoked with an Intracortical 96 channel Microelectrode Array inserted in human occipital cortex published in The Journal of Clinical Investigation Eduardo Fern ndez MD PhD from the University Miguel Hern ndez details how an array of penetrating electrodes produced a simple form of vision for a 58 year old blind volunteer The team conducted a series of experiments with the blind volunteer in their laboratory in Elche Spain The results represent a leap forward for scientists hoping to create a visual brain prosthesis to increase independence of the blind AN OPTICAL INSIGHT PHOSPHENES A neurosurgeon implanted a microelectrode array composed of 100 microneedles into the visual cortex of the blind woman to both record from and stimulate neurons located close to the electrodes She wore eyeglasses equipped with a miniature video camera specialized software encoded the visual data collected by the camera and sent it to electrodes located in the brain The array then stimulated the surrounding neurons to produce white points of light known as phosphenes to create an image The blind woman was a former science teacher and had been completely blind for 16 years at the time of the study She had no complications from the surgery and researchers determined that the implant did not impair or negatively affect brain function GLANCE 07

These results are very exciting because they demonstrate both safety and efficacy and could help to achieve a long held dream of many scientists which is the transfer information from the outside world directly to the visual cortex of blind individuals thereby restoring a rudimentary form of sight said Prof Eduardo Fern ndez With the help of the implant she was able to identify lines shapes and simple letters evoked by different patterns of stimulation To assist her in practicing with the prosthesis researchers created a video game with a character from the popular television show The Simpsons Due to her extensive involvement and insight she is also co author on the article He also added that although these preliminary results are very encouraging we should be aware that there are still a number of important unanswered questions and that many problems have to be solved before a cortical visual prothesis AN OPTICAL INSIGHT prosthesis can be considered a viable clinical therapy This new study provides proof ofprinciple and demonstrate that our previous findings in monkey experiments can be translated to humans said Prof P Roelfsema a co author on the study One goal of this research is to give a blind person more mobility said Prof R A Normann also a co author on the study It could allow them to identify a person doorways or cars It could increase independence and safety That s what we re working toward The research team hopes that the next set of experiments will use a more sophisticated image encoder system capable of stimulating more electrodes simultaneously and to elicit more complex visual images This work is likely to become a milestone for the development of new technologies that could transform the treatment of blindness GLANCE 08

INTERNATIONAL NEWS SCREEN TIME LINKED TO RISK OF MYOPIA IN YOUNG PEOPLE Anglia Ruskin University SOURCE ARU AC UK HIGH LEVELS OF EXPOSURE CAN INCREASE RISK OF SHORT SIGHTEDNESS BY UP TO 80 STUDY A new study published in one of the world s leading medical journals has revealed a link between screen time and higher risk and severity of myopia or short sightedness in children and young adults The open access research published this week in The Lancet Digital Health was undertaken by researchers and eye health experts from Singapore Australia China and the UK including Professor Rupert Bourne from Anglia Ruskin University ARU The authors examined more than 3 000 studies investigating smart device exposure and myopia in children and young adults aged between 3 months old and 33 years old After analysing and statistically combining the available studies the authors revealed that high levels of smart device screen time such as looking at a mobile phone is associated with around a 30 higher risk of myopia and when combined with excessive computer use that risk rose to around 80 Professor Bourne Professor of Ophthalmology in the Vision and Eye Research Institute at Anglia Ruskin University ARU said Around half the global population is expected to have myopia by 2050 so it is a health concern that is escalating quickly Our study is the most comprehensive yet on this issue and shows a potential link between screen time and myopia in young people This research comes at a time when our children have been spending more time than ever looking at screens for long periods due to school closures and it is clear that urgent research is needed to further understand how exposure to digital devices can affect our eyes and vision We also know that people underestimate their own screen time so future studies should use objective measures to capture this information The research comes as millions of children around the world have spent substantial time using remote learning methods following the closure of schools due to the COVID 19 pandemic AN OPTICAL INSIGHT GLANCE 09

INTERNATIONAL NEWS SCIENTISTS IDENTIFY A POSSIBLE NEW TREATMENT FOR DIABETIC RETINOPATHY Elsevier SOURCE ELSEVIER COM FINDINGS REPORTED IN THE AMERICAN JOURNAL OF PATHOLOGY SUGGEST THAT AN ENZYMATIC PRECURSOR MAY BE TOXIC TO RETINAL CELLS IN DIABETIC PATIENTS About one in three diabetic patients develops diabetic retinopathy DR which can impair vision and lead to blindness A new study in The American Journal of Pathology published by Elsevier provides clear evidence that high glucose increases the levels of enzymatic precursor lysyl oxidase propeptide LOX PP that promotes cell death which was verified in an animal model of diabetes These findings may help develop novel DR treatments by targeting LOX PP or its metabolites We found that hyperglycemic and diabetic conditions increased LOX PP levels explained lead investigator Sayon Roy PhD of the Departments of Medicine and Ophthalmology at Boston University School of Medicine Boston MA USA LOX PP may induce cell death by compromising a cell survival pathway and in retinas of diabetic rats increased LOX PP contributed to retinal vascular cell death associated with DR AN OPTICAL INSIGHT Administration of recombinant LOX PP alone was sufficient to induce cell death This report shows novel functionality of LOX PP in mediating cell death under high glucose condition in retinal endothelial cells as well as in diabetic animals Studies in pancreatic and breast cancer cells suggest that LOX PP overexpression may trigger cell death The researchers therefore studied the role of LOX PP in the retinal tissue The retinal blood vessels of normal and diabetic rats and normal rats administered artificially synthesized LOX PP recombinant LOX PP r LOX PP directly into the eye were examined Changes associated with DR such as swelling blood vessel leakage blockage or thickening of vascular walls and histologic indicators such as acellular capillaries AC and pericyte loss PL were studied GLANCE 11

The effect of high glucose on retinal endothelial cells grown in culture was also studied Adding glucose to the cell cultures up regulated LOX PP expression and reduced AKT protein kinase B activation Cells exposed to r LOX PP alone exhibited increased cell death along with decreased AKT phosphorylation The present study provides clear evidence that high glucose increases LOX PP levels which in turn promotes cell death Furthermore LOX PP appears to induce cell death by compromising a pathway involved in cell survival Effect of recombinant lysyl oxidase propeptide r LOX PP on the development of acellular capillaries ACs and pericyte loss PL in rat retinas A D Representative retinal trypsin digest images showing retinal vascular networks of a control rat A diabetic DM rat B rat intravitreally injected with r LOX PP C and rat intravitreally injected with phosphate buffered saline PBS D LOX PP administration promoted the development of ACs arrows and PL arrowheads associated with diabetic retinopathy Enlarged images correspond to boxed areas Right panels of A B C D Scale bar 100 m More AC and PL were observed in the retinas of diabetic rats compared to controls In nondiabetic rats injection of r LOX PP directly into the eye also increased the number of ACs and PLs compared to rats receiving a control injection DR is the leading cause of blindness in the working age population noted Dr Roy Unfortunately there is no cure for this devastating ocular complication Our findings suggest a novel mechanism for high glucose induced cell death involving LOX PP which may be a therapeutic target in preventing retinal vascular cell loss associated with DR LOX is an extracellular enzyme responsible for cross linking collagen and elastin molecules to form a stable extracellular matrix The role of the LOX propeptide LOX PP is less understood although it may play a role in keeping LOX in an inactive state ABOUT THE AMERICAN JOURNAL OF PATHOLOGY THE AMERICAN JOURNAL OF PATHOLOGY OFFICIAL JOURNAL OF THE AMERICAN SOCIETY FOR INVESTIGATIVE PATHOLOGY PUBLISHED BY ELSEVIER SEEKS HIGH QUALITY ORIGINAL RESEARCH REPORTS REVIEWS AND COMMENTARIES RELATED TO THE MOLECULAR AND CELLULAR BASIS OF DISEASE THE EDITORS WILL CONSIDER BASIC TRANSLATIONAL AND CLINICAL INVESTIGATIONS THAT DIRECTLY ADDRESS MECHANISMS OF PATHOGENESIS OR PROVIDE A FOUNDATION FOR FUTURE MECHANISTIC INQUIRIES EXAMPLES OF SUCH FOUNDATIONAL INVESTIGATIONS INCLUDE DATA MINING IDENTIFICATION OF BIOMARKERS MOLECULAR PATHOLOGY AND DISCOVERY RESEARCH HIGH PRIORITY IS GIVEN TO STUDIES OF HUMAN DISEASE AND RELEVANT EXPERIMENTAL MODELS USING MOLECULAR CELLULAR AND ORGANISMAL APPROACHES AJP AMJPATHOL ORG ABOUT ELSEVIER AS A GLOBAL LEADER IN INFORMATION AND ANALYTICS ELSEVIER HELPS RESEARCHERS AND HEALTHCARE PROFESSIONALS ADVANCE SCIENCE AND IMPROVE HEALTH OUTCOMES FOR THE BENEFIT OF SOCIETY WE DO THIS BY FACILITATING INSIGHTS AND CRITICAL DECISION MAKING FOR CUSTOMERS ACROSS THE GLOBAL RESEARCH AND HEALTH ECOSYSTEMS IN EVERYTHING WE PUBLISH WE UPHOLD THE HIGHEST STANDARDS OF QUALITY AND INTEGRITY WE BRING THAT SAME RIGOR TO OUR INFORMATION ANALYTICS SOLUTIONS FOR RESEARCHERS HEALTH PROFESSIONALS INSTITUTIONS AND FUNDERS ELSEVIER EMPLOYS 8 100 PEOPLE WORLDWIDE WE HAVE SUPPORTED THE WORK OF OUR RESEARCH AND HEALTH PARTNERS FOR MORE THAN 140 YEARS GROWING FROM OUR ROOTS IN PUBLISHING WE OFFER KNOWLEDGE AND VALUABLE ANALYTICS THAT HELP OUR USERS MAKE BREAKTHROUGHS AND DRIVE SOCIETAL PROGRESS DIGITAL SOLUTIONS SUCH AS SCIENCEDIRECT SCOPUS SCIVAL CLINICALKEY AND SHERPATH SUPPORT STRATEGIC RESEARCH MANAGEMENT R D PERFORMANCE CLINICAL DECISION SUPPORT AND HEALTH EDUCATION RESEARCHERS AND HEALTHCARE PROFESSIONALS RELY ON OUR 2 500 DIGITIZED JOURNALS INCLUDING THE LANCET AND CELL OUR 40 000 EBOOK TITLES AND OUR ICONIC REFERENCE WORKS SUCH AS GRAY S ANATOMY WITH THE ELSEVIER FOUNDATION AND OUR EXTERNAL INCLUSION DIVERSITY ADVISORY BOARD WE WORK IN PARTNERSHIP WITH DIVERSE STAKEHOLDERS TO ADVANCE INCLUSION AND DIVERSITY IN SCIENCE RESEARCH AND HEALTHCARE IN DEVELOPING COUNTRIES AND AROUND THE WORLD ELSEVIER IS PART OF RELX A GLOBAL PROVIDER OF INFORMATION BASED ANALYTICS AND DECISION TOOLS FOR PROFESSIONAL AND BUSINESS CUSTOMERS WWW ELSEVIER COM AN OPTICAL INSIGHT GLANCE 12

INTERNATIONAL NEWS MYOPIA CONTROL EFFECT OF DIMS FINDINGS OF A 3 YEAR FOLLOW UP STUDY INTRODUCTION To determine myopia progression in children who continued to wear the defocus incorporated multiple segments DIMS lenses or switched from single vision SV to DIMS lenses for a 1year period following a 2 year myopia control trial METHODS The children who had previously worn DIMS lenses continued to wear DIMS lenses DIMS group and children who had worn previously single vision lenses switched to wear DIMS lenses Control to DIMS group Cycloplegic spherical equivalent refraction SER and axial length AL were measured at 6 month interval BASELINE CHARACTERISTICS 160 completed the 2 year RCT among them 128 participated in the one year follow up study At the end of the third year 120 subjects completed the 3 years study DIMS 65 Control to DIMS 55 Mean age yrs 10 15 1 52 10 24 1 42 SER D 2 98 0 96 2 73 0 99 AL mm 24 68 0 82 24 57 0 88 Carly SY Lam W i n g C h u n T a n g1 P a u l H L e e2 H a n Y u Z h a n g1 H u a Q i 3 K e i g o H a s e g a w a3 C h i H o T o1 1 1 Centre for Myopia Research School of Optometry The Hong Kong Polytechnic University 2 School of Nursing The Hong Kong Polytechnic University 3 Hoya Corporation GLANCE 13

RESULTS Distributions of myopia progression and axial elongation in the third year Changes in SER over 3 years Myopia progression D DIMS group Control to DIMS group The slow down effect of MiYOSMART spectacle lens on myopia progression over 3 years is sustained Annual progression 0 18D 0 16D and 0 18D respectively Children who switched to MiYOSMART spectacle lens showed a significant slowdown effect and the benefit of starting the treatment at anytime Annual progression 0 49D 0 38D and 0 05D respectively Changes in AL over 3 years DIMS group Axial elongation mm The myopia of 80 of the subjects in the DIMS group progressed by less than 0 5D in the third year 52 and 58 in the DIMS and Control to DIMS groups had axial elongation less than 0 1 mm CONCLUSIONS Myopia progression and axial elongation were less in the subjects wearing DIMS lenses throughout the 3 years first compared with the initial control group which subsequently became the Control to DIMS group The subjects in the Control to DIMS group showed significant reductions in myopia progression and axial elongation after switching from SV to DIMS lenses wear Their changes in SER and AL in the third year were comparable to the first year changes in the DIMS group even though these subjects were 2 years older Control to DIMS group The axial elongation did not change significantly in the DIMS group annual progression being 0 1 mm 0 1 mm and 0 11 mm respectively Reference Lam CS Tang WC Lee PH et al Myopia control effect of defocus incorporated multiple segments DIMS spectacle lens in Chinese children results of a 3 year follow up study British Journal of Ophthalmology Published Online First 17 March 2021 doi 10 1136 bjophthalmol 2020 317664 For the group who switched to DIMS lens after 24 months slow down effect is significant with annual axial elongation being 0 29 mm 0 20 mm and 0 08 mm respectively This collaborative research was supported by HOYA Corporation Tokyo Japan ZG5N and PolyU grants ZVN1 ZVN2 ZE1A 8 8475 AN OPTICAL INSIGHT GLANCE 14

60 slow down of myopia progression 3 YEAR clinical study results MiYOSMART the smart way to treat myopia in children nd out more The slow down effect of MiYOSMART spectacle lenses on myopia progression over 3 years is sustained Lam CS Tang WC Lee PH et al Myopia control effect of defocus incorporated multiple segments DIMS spectacle lens in Chinese children result of a 3 year follow up study British Journal of Ophthalmology Published Online First 17 March 2021 doi 10 1136 bjophthalmol 2020 317664

LOCAL NEWS SAOA HEADLINE NEWS The past few years have introduced unprecedented challenges which have significantly impacted on the professions of optometry and dispensing opticians in South Africa It is not a matter of one thing after the other but one thing on top of another The devastating effects of Covid 19 added to the destruction of practices due to looting and vandalism primarily in KZN and Gauteng are examples of factors which have caused hardship and misery This has been aggravated by the conduct of organisations such as Opticlear which have placed unnecessary pressure on practitioners To a large extent the above described factors and forces have forced the SAOA to demonstrate its mettle and provide support and assistance for its members In general SAOA staff and office bearers have risen to the occasion working long hours and tirelessly committed to unselfishly ensure that the interests of its members are accommodated Harry Rosen SAOA CEO GLANCE 16

SAOA ACTIONS ACHIEVEMENTS AND SUBMISSIONS 2021 During the past year the SAOA took the professions of optometry and dispensing opticianry to another level in difficult circumstances Achievements during this period included but were not restricted to Orchestration of Covid 19 vaccination roll out for optometrists dispensing opticians and staff Guidance relating to compliance of both POPIA and PAIA within stipulated timelines Drafting and introduction of revised procedural codes Acceptance of an expanded scope by key stakeholders including the CMS Optometry and Dispensing Opticianry recognised as essential services due to SAOA submission Continued engagements with key stakeholders and regulatory authorities Withdrawal of sales of contact lenses by nonregistered retail outlets such as Takealot Cessation of random audits by Opticlear and GEMS More than 11001 webinar series x 17 BHF allocation of practice numbers to identify optometrists with therapeutic privileges Engagement with Discovery regarding intended involvement with frame selection Nelson Mandela Day initiative in collaboration with Russel Nugent Pharmacy assistance and support to accommodate scripts from optometrists with therapeutic privileges Extensive marketing of eye care to the public throughout the year Eye care awareness initiatives throughout the year with particular emphasis during Eye Care Awareness Month Focus on Gender based Violence GBV during National Women s Month and National Women s Day 9 August Virtual warehouse for practitioners affected by vandalism and looting Relief funds established in collaboration with key stakeholders to assist practitioners affected by the looting and vandalism Member survey re Certificate of Need AN OPTICAL INSIGHT Member survey re random audits by medical schemes Membership Hotline assistance provided regarding ethics human resources and practice management in general Initiation of Student body under the wing of the SAOA Promotion of healthy vision linked to road safety during National Transport Month Partnership with PPS Weekly News Flashes Financially stable SUBMISSIONS SAOA Response to draft rules pertaining to online sale of optical devices SAOA Contributions to HPCSA Strategic Review SAOA Submission to Dept Health in opposition to the draft regulations pertaining to the Certificate of Need SAOA Submission to SAHPRA for extended list of pharmaceutical substances SAOA Official complaint lodged against Opticlear for undesirable conduct SAOA official complaint lodged against OSSA President for casting reflections aspersions against reputation probity and skills of profession of optometry SAOA Submission to landlords in support of practitioners requesting payment latitude due to impact of Covid 19 SAOA media Release warning public of dangers of adjustable readers without consulting an optometrist SAOA report on NGOs submitted to HPCSA PBODO SAOA position in response to medical device regulations SAOA ANNUAL GENERAL MEETING HELD ON 19 FRBRUARY 2022 The SAOA held its AGM to address the 2020 2021 fiscal period on Saturday 19 February 2022 via a virtual platform 54 fifty four members in Good Standing attended the event which significantly exceeded the requirement of 25 twenty five members in good standing to be present for the meeting to be quorate GLANCE 17

The President of the Ghana Optometric Association Dr Remi Ninkpe attended the event as a guest of the SAOA The meeting agenda included a comprehensive presentation of the President s Report by SAOA President Dollars Boloka a presentation relating to the financial health of the SAOA presented by Finance Director Nivien Subramany tributes to colleagues and friends who have passed during the past year and presentation of awards for well deserving recipients Following the conclusion of the business of the AGM an Ethics talk entitled Ethical Dilemma in Optometric Practice was delivered by SAOA CEO Harry Rosen CONGRATULATIONS AWARD RECIPIENTS TO THE FOLLOWING President Discretion Award Professor Percy Mashige Distinguished Service Award Mr Brian Sneag Distinguished Service Award Professor Alan Rubin Certificate of Appreciation Dr Unben Pillay ASAIPA Certificate of Appreciation Liezel Kotze Cooper Vision Recognition for Academic Excellence was presented to a student from each academic institution as nominated by the respective Heads of Department Cherise Prithipal UKZN Hemani Bhika UJ Precious Ndlovu CPUT Kayla Gerber UFS Eslitha Tshekisokefilwe Mocheko UL AN OPTICAL INSIGHT CONGRATLATIONS TO NEWLY ELECTED SAOA DIRECTORS Hearty congratulations to Nivien Subramany Bignocia Masinge and Martelie Burger who were elected to the SAOA Board to serve a tenure of 3 three years as presented by Electoral Officer Raymond Mabaso at the SAOA AGM held on Saturday 19 February 2022 The elections follow the nomination process which was initiated in November 2021 and concluded on 8 January 2022 SAOA PORTFOLIO ANNOUNCEMENTS As per resolution adopted by the Board on Sunday 20 February 2022 with newly elected Directors in attendance the following represents the Board portfolios with responsible Directors moving into 2022 PRESIDENT Dollars Boloka VICE PRESIDENT Marna Pieterse EDUCATION AND CLINICAL STANDARDS Casandra Seethal ETHICS AND TRANSFORMATION Harry Rosen CEO FINANCE Nivien Subramany MARKETING Sandy Govender PRIVATE PRACTICE Martelie Burger Dollars Boloka co chairs PUBLIC HEALTH Bignocia Masinge SPECIAL PROJECTS Marna Pieterse BEST WISHES TO ALL GLANCE 18

SAOA HEADLINE NEWS ALLIANCE OF SOUTH AFRICA INDEPENDENT PRACTITIONERS ASSOCIATION ASAIPA AWARDS ASAIPA pays tribute and acknowledges the contributions and accomplishments of individuals and entities active within the healthcare arena as hosts of the National Medical Awards In this regard nominations are put forward primarily by professional associations in accordance with award categories as defined by ASAIPA The following were the award recipients for 2021 per category HCP EXCELLENCE AWARD This award recognises private practice practitioners contributing significantly to improving Primary Health Care PHC delivery Recipient Paul Ramkissoon COMMUNITY SERVICE AWARD This award is given to an organisation group or individual dedicating their time skill and expertise to assist community advancement by making a positive effect on the health and wellbeing of the community Recipient Ntombi Zitha HEALTH SCIENCE STUDENT AWARD This award is given to a Health Science student each year for exemplary dedication commitment and leadership Recipient Kayla Gerber 4th year Optometry student at the University of the Free State HEALTHCARE LEADERSHIP AWARD This award recognises organisations groups or individuals who exemplifies the qualities of dedicated leadership to inspire impactful solutions within South Africa s healthcare system that positively affect both patients and colleagues Recipient Dollars Boloka on behalf of the SAOA Board The award recipients across a spectrum of health care disciplines were invited to attend a ceremony in their respective provinces where presentation of the awards took place CONGRATULATIONS TO ALL CONCERNED AN OPTICAL INSIGHT GLANCE 19

SAOA HEADLINE NEWS EXPANDED SCOPE SAOA RESPONSE TO OSSA POSITION The SAOA has noted the position published by OSSA in their December issue of their Newsletter which once again opposes the expanded scope of optometry despite assurances of non opposition to the principle in March 2018 and a pledge to collaborate with the SAOA regarding implementation of the training underpinned by the well being of patients Indeed OSSA has attempted to stop the expanded scope for optometrists by approaching various regulatory authorities without success The SAOA position places emphasis on points which include The number of registered optometrists in South Africa outweighs the number of registered ophthalmologists in South Africa on a scale of 10 1 actually 3800 optometrists vs 300 ophthalmologists The expanded scope where applicable obviates the necessity of patients having to wait long periods to see an ophthalmologist which is also not an inexpensive exercise The expanded scope also obviates the necessity of patients where applicable having to be referred to an ophthalmologist at an additional cost There is a register for optometrists with the therapeutic privileges on similar lines to Diagnostics i e Independent Practice Ocular Therapeutics The opposition by Ophthalmology to the expanded scope of Optometry is an international phenomenon as evidenced in the USA where Ophthalmology over decades has also attempted to prevent Optometry from evolving without success It will also not succeed in South Africa The SAOA of course recognises and respects the critical role played by Ophthalmologists in the treatment of eye disease in South Africa In the same vein the SAOA reasonably requests the same acknowledgment and respect be given to Optometrists in their rightful role as primary eye care practitioners TO READ THE FULL SAOA RESPONSE CLICK HERE AN OPTICAL INSIGHT GLANCE 20

SAOA HEADLINE NEWS SAOA SUPPORTS LEGAL ACTION INSTITUTED BY PHYSIOTHERAPY SOCIETY SASP AGAINST SCHEMES AND ADMINISTRATORS SASP has embarked on a path in an attempt stop funders from acting as prosecutor judge and jury when auditing practices Emphasis is placed on Section 59 of the Medical Schemes Act used by medical schemes as justification to clawback and or withhold payments of claims received The SASP strategy is to bring substantial court action challenging the funders interpretation of the relevant Section 59 clause of the Medical Schemes Act and have it declared unconstitutional with the request that it be set aside until such time as Parliament could amend it appropriately TO VIEW SECTION 59 OF THE ACT CLICK HERE The case has been lodged in the High Court of South Africa Gauteng Division where the Notice of Motion a summary of the reliefs sought names all medical schemes administrators the Council for Medical Schemes as well as the Minister of Health as defendants in the matter and is currently being served on all the respondents THE RELIEFS SOUGHT INCLUDE An immediate declaration of Section 59 3 as unconstitutional and invalid The final decision making process be removed from the funder or administrator and handed to an independent party suitably qualified and appointed A review of contested audits to date The SAOA has provided a letter of support to the Physiotherapists TO VIEW THE LETTER CLICK HERE AN OPTICAL INSIGHT GLANCE 21

CENTENNIAL CELEBRATION COMMITTEE The SAOA is to celebrate its 100th birthday in March 2024 to be considered a very significant milestone in the history of both the professions of optometry and dispensing opticianry as well as the SAOA as the representative body A committee comprising highly experienced and knowledgeable members of the SAOA well represented demographically was formed by the SAOA Board and mandated to assume responsibility for the planning of the centenary celebrations The Committee comprises of Faith Chabedi Brian Sneag Patrick Mawila Colin Tonkil and Harry Rosen i e 4 four past Presidents of the SAOA to be chaired and facilitated by the SAOA CEO In practical terms the Committee will have had 36 thirty six months in which to plan for this prestigious centenary event PROMOTION OF ACCESS TO INFORMATION ACT PAIA MANUAL Please be reminded that it will be mandatory for all organisations and practices regardless of size or turnover to have a PAIA manual as from 1 January 2022 The Regulator has recently published templates and also a PAIA Guide on its website but bear in mind that these templates are only generic examples and will have to be adapted to the needs of the organisation The SAOA has made available a simpler version of a PAIA manual which may be used by practices Also remember that if your practice has not been exempted and has an existing PAIA manual it will need to be updated to provide for the new provisions under POPIA TO VIEW THE SAOA PAIA TEMPLATE CLICK HERE Do not confuse a PAIA manual with the various policies etc under POPIA Protection of Personal Information Act The latter deals with the protection of personal information only whilst PAIA has to do with external requests for accessing any information that the practice holds Both areas are however administrated and enforced by the Information Regulator as from 1 July 2021 WMA DEMANDS ACTION AGAINST SELF DIAGNOSIS SELF PRESCRIPTION AND SELF MEDICATION The World Medical Association WMA has called on national healthcare user associations to combat the growing culture of ill advised self diagnosis self prescription and self medication at its annual general assembly The WMA an international and independent confederation of free professional medical associations representing physicians worldwide believes there should be stricter regulations imposed on businesses selling medical products and that websites promoting fake and substandard products should be shut down The WMA position is consistent with the media releases recently disseminated by both the SAOA and HPCSA PBODO warning the public of the dangers of eg purchasing adjustable readers without consultation by a registered eye care practitioner AN OPTICAL INSIGHT GLANCE 22

OMICRON HAS HIGHER ASYMPTOMATIC CARRIAGE RATE UBUNTU STUDY DRIVER LICENCE RENEWAL PERIOD CHANGE PROPOSED FROM 5 TO 10 YEARS Preliminary findings from SA clinical trials suggest the Omicron coronavirus variant have a much higher rate of asymptomatic carriage than earlier variants Civil society group Outa has called on the government to scrap South Africa s five year driver licence in favour of a system that will see licences renewed every 10 years The studies one of which was carried out when Omicron infections were surging in SA last month and another which resampled participants around the same time found a far greater number of people tested positive for the coronavirus but were not showing symptoms compared with previous trials TO VIEW THE FULL REPORT CLICK HERE TO READ MORE CLICK HERE DRIVER DEMERIT UNCONSTITUTIONAL SYSTEM RULED The introduction of a long awaited points demerit system for drivers is on hold again after a ruling in the Pretoria high court that the enabling legislation is unconstitutional TO VIEW THE FULL REPORT CLICK HERE AN OPTICAL INSIGHT CONCLUSION It would be remiss of me not to acknowledge those practitioners who fell victim to Covid during the past year A special tribute was arranged by the SAOA Board at the SAOA AGM See below the video of tributes to colleagues and friends who have passed during the past year THE SOUTH AFRICAN OPTOMETRIC ASSOCIATION IS A PROFESSIONAL ASSOCIATION REGISTERED AS A NONPROFIT COMPANY WHICH REPRESENTS THE PROFESSIONS OF OPTOMETRY AND DISPENSING OPTICIANRY IN SOUTH AFRICA WWW SAOA CO ZA GLANCE 23

LOCAL NEWS RETINA SOUTH AFRICA SADLY ANNOUNCES THE PASSING OF OUR CHAIRMAN JAMES CAPE IN JULY 2021 James was Chairman of Retina South Africa for 15 years and will be sorely missed James Cape was an active and dedicated member of the Retina South Africa team since the early 1980s He served on both regional and national committees in various roles such as Treasurer Vice Chairman Branch Chairman and was elected national chairman in 2006 He was the driving force in uniting the foundation to be one strong national organisation backed with a robust and comprehensive governance code The strategies policies and documents he instituted will ensure the health of the Foundation far into the future He also led the formulation of a new Mission and Vision which reinforced our focus on finding treatments for retinal vision loss He spearheaded the establishment of a dynamic secure patient registry to which we have now linked our digital voting process Claudette Medefindt Retina South Africa He was very proud of the Management Committee elected in 2020 which was the first democratically elected MC in the history of the Foundation He would be equally proud of the new MC that was elected on August 14th GLANCE 24

Seeing beyond When ZEISS started 175 years ago we and our customers were inspired by curiosity passion and precision new perspectives that shaped how we looked at the world To see major challenges and turn them into great opportunities Despite the many ways the world has changed over the past 175 years one thing will stay the same Together we challenge the limits of imagination www zeiss com 175

RETINA SA NEWS WORLD DIABETES DAY 14 NOVEMBER 2021 Karen Denton SOURCE RETINA SOUTH AFRICA THE THEME FOR WORLD DIABETES DAY WDD 2021 IS ACCESS TO DIABETES CARE THE YEAR 2021 IS SIGNIFICANT FOR THE DIABETES WORLD AS IT IS THE CENTENARY OF THE DISCOVERY OF INSULIN BY BANTING AND BEST IN A SMALL LABORATORY IN TORONTO It is notable that a hundred years after this life saving discovery there are millions around the world who do not receive adequate care As many as 20 of people who are diagnosed with Type 2 Diabetes for the first time already have eye damage that they are usually unaware of This is of such significance that in 2007 the UN General Assembly adopted a resolution to recognise November 14th as World Diabetes Day WDD to highlight the urgent need to pursue multilateral efforts to promote and improve human health and provide access to treatment and health care education People with type 1 or type 2 diabetes need ongoing care support and education to live a fulfilling meaningful life and to delay or prevent the complications that impact the individual the family and society One of the questions that we are frequently asked at Retina SA is which is more dangerous Type 1 or Type 2 The answer surprises many because it doesn t depend on the type of Diabetes People who are given the tools to care for themselves know what to do and how to do it can live a long healthy life However Diabetes is dangerous and can precipitate short and longterm problems when there is insufficient care AN OPTICAL INSIGHT Sadly as stated above many people do not have access to adequate care and face complications such as heart attacks strokes amputations kidney failure and blindness The International Council of Ophthalmology states that one third of people with diabetes have some form of diabetic eye disease that can lead to vision impairment and blindness With effective diabetes management and early detection through regular eye exams and timely treatment almost all vision impairment and blindness from diabetic eye disease can be prevented If you already have a retinal condition you need to ensure that you protect yourself against the further loss of vision that Diabetes causes Prevention strategies include Regular exercise Healthy food choices No smoking Control BMI BP and Cholesterol Get regular eye checks For further information referrals access to counselling education and advocacy please email headoffice retinasa org za GLANCE 26

RETINA SA NEWS DIS CHEM RIDE FOR SIGHT RACE REPORT FROM JONNY KOEN Jonny Koen for Retina SA SOURCE RETINA SOUTH AFRICA THE 33RD DIS CHEM RIDE FOR SIGHT WAS HELD IN NEAR PERFECT WEATHER CONDITIONS AT BOKSBURG CITY STADIUM ON SUNDAY 20TH FEBRUARY The road race saw a surprisingly large field in these Corona Virus affected times of 2 480 loyal supporters of this event a seeding event for the Cape Town Cycle Tour 2023 In the men s race over a tough 116km course the event for the first time in many years went to a full bunch finish The fast and favourable conditions meant that the bunch were unable to split themselves from any of the big sprinters and ended in the very exciting sprint finish sadly not witnessed by the usual enthusiastic spectators who were restricted due to Covid regulations This saw the best bunch sprinter of the lot Josh van Wyk who is a renowned Velodrome track expert multiple SA champion and the record holder of the Paarl Boxing Day 25 miler at 53 minutes 11 seconds having to go 2 and a half times his favourite distance to beat all comers in the dash for the cash at the fast and tricky finish In the second wheel in a narrowly fought finish in fact quite a heavily contested finish was Gustav Basson who rode brilliantly and race favourite going down by just a bicycle to the flying van Wyk The third wheel went to the hardest worker in the peloton David Maree Maree is known as Mr Fetch once again almost fetched the gold but ended up on the third rung of the podium AN OPTICAL INSIGHT GLANCE 27

Jacque Fullard a previous race winner and Vets A category winner came back today to win the Vets B category from David Cooke Fullard has won many races over the years including the SA Road championships twice This was a superbly presented race with very few casualties and a good field of almost 2500 The prestige of this event means that it is rapidly emerging as one of the country s most important single day bike races the Dis Chem Ride for Sight proudly sponsored by Dis Chem Pharmacies All the categories were hotly contested with many bunch finishes throughout the morning The women s race was a small but high quality field that saw race favourite Carla Oberholzer the bronze medallist at the recent SA Champs securing herself yet another victory Oberholzer was too good for the opposition and outsprinted second placed Lize Ann Louw with Michel Botha coming in third Retina South Africa is the beneficiary of this event which funds research and upliftment projects in the fight against retinal blindness Over the last 33 years the event has raised over R10m and ensured South African patients will have access to emerging treatments DISTRIBUTED BY RETINA SOUTH AFRICA NATIONAL RETINASA ORG ZA CLAUDETTE MEDEFINDT RACE SECRETARY CLAUDETTE RETINASA ORG ZA FULL RACE RESULTS AT WWW RACETEC CO ZA AN OPTICAL INSIGHT GLANCE 28

LOW VISION WE NEED TO TALK ABOUT THE ELEPHANT IN THE ROOM CHARLES BONNET SYNDROME COVID HAS HAD MANY EFFECTS THAT WERE UNEXPECTED AND IT ACTUALLY HIGHLIGHTED ISSUES THAT HAD LURKED IN THE BACKGROUND FOR MANY DECADES EVEN CENTURIES ONE OF THESE ISSUES IS CHARLES BONNET SYNDROME To start at the beginning then this Syndrome was first described by Charles Bonnet almost three hundred years ago Charles Bonnet noted that his grandfather a highly respected retired magistrate saw patterns figures birds and other images that were not there It is important to note that his grandfather was mentally healthy And this is the important point People with Charles Bonnet Syndrome CBS have hallucinations but they enjoy good mental health Besides these two facts there is little known about the syndrome hundreds of years later even in the 21st century However the Covid pandemic is bringing more evidence to light First until now we believe that the syndrome has been grossly under reported Many factors contribute to this People are terrified of being labelled as mentally ill if they report the hallucinations and we are beginning to realise that some individuals may even have been erroneously diagnosed with various forms of dementia AN OPTICAL INSIGHT In addition far too many health care professionals are unaware of CBS and thinking that it occurs very rarely they relegate it to a back burner Finally the diagnostic criteria are often not clarified Until now If we look at the causes and conditions associated with CBS it is easy to understand why this condition is receiving more and more attention today CBS is associated with Ageing Visual loss Isolation Stress Certain medications However the events that unfolded during the past 18 months have highlighted many hitherto unknown facts and a closer look has given us added insights GLANCE 29

First CBS is far more widespread than previously believed However much research is required to establish the exact causes and effects that CBS produces Secondly all ages can be affected and e g at a UK hospital it was found that 50 of children admitted with Covid had neurological symptoms that they had never experienced before The diagnosis is made when an individual experiences hallucinations and has sufficient insight to recognise that they are not real Study Sees mysterious Covid related Inflammation leading to Hallucinations confusion by Tera News April 16 2021 Thirdly the conditions surrounding the Covid 19 virus including isolation have exacerbated the symptoms for most sufferers SO WHAT THEN IS CBS PUT SIMPLY IT IS THE EXPERIENCE OF VISUAL HALLUCINATIONS IN MENTALLY HEALTHY PEOPLE Looking at the hallucinations in more details provides few answers They are varied and unique to each individual Some are simple taking the form of patterns blocs dots etc Some are very complex involving inexplicable images They may be friendly funny hostile and while some are quite terrifying some are pleasant They may be fleeting or last a few hours They rarely persist for longer than a few weeks or months There is documentation of a few people experiencing CBS for up to eight years The pandemic has resulted in reports that both the duration frequency and persistence has increased After a time it appears that the brain readjusts to the gaps in information and the abnormal firing of neurones decreases Different measures to cope with an episode of hallucinations include change the lighting in the room distractions are effective blink slowly stare directly at the hallucination stand and move around relaxing deep breathing exercises The management of CBS is based on recognising the situation explaining the phenomenon clearly to the individual and reassurance that it is not a mental problem It is physiological and will pass with time The pathogenesis of CBS is rather unclear One theory deafferentation theory presumes that a reduced visual input to the brain results in the brain attempting to make sense of the fragments that are seen The brain then tries to fill the missing gaps with images that are stored in memory or may be produced at the time In other words ageing vascular changes sensory deprivation and visual impairment individually or together cause abnormal activity in the visual areas of the brain resulting in hallucinations SHARING KNOWLEDGE FOR THE MULTIDISCIPLINARY TEAM CARING FOR THE VISUALLY IMPAIRED VISIT THE WEBSITE WWW LOWVISION CO ZA AN OPTICAL INSIGHT GLANCE 30

New to ACUVUE Experience EXCEPTIONAL DISINFECTION 1 3 AND ALL DAY COMFORT 4 5 Contact Lens Solution Applicant Genop healthcare Ptd Ltd PO Box 3911 Halfway house 1685 South Africa Tel 0861 436 674 Reg No 1984 011575 07 www genop co za 11 2020 PROMO 120 Marketed and Distributed by Moscon Optics Pty Ltd Reg No 1982 009257 07 P O Box 46073 Orange Grove 2119 South Africa Tel 27 0 11 483 8001 Reg No G1180601630009 1 Heaselgrave W et al Efficacy CL care solutions against clinical microorganisms Poster BCLA 2011 2 Nikolic M et al Comparative Efficacy of new CL care solutions against bacteria fungi and acanthamoeba Poster BCLA 2011 or Poster ARVO 2011 3 Kilvington S et al Development of a new contact lens multipurpose solution Comparative analysis of microbiological biological and clinical performance J Optom 2010 3 3 134 142 4 Berntsen DA Hickson Curran SB Jones LW Mathew JH Maldonado Codina C Morgan PB Schulze MM Nichols JJ Subjective Comfort and Physiology with Modern Contact Lens Care Products Optom Vis Sci 2016 Aug 93 8 809 19 5 JJV data on file 2017 Multi center 1 month dispensing daily wear study with senofilcon C toric CLs with Revitalens OcuTec worn for 30 days N 130 habitual soft toric CL wearers in US 6 JJV data on file 2016 LACREON HYDRACLEAR HYDRACLEAR AND HydraLuxTM Tear Films Technologies 7 JJV data on file 2014 Digital Device Claims for ACUVUE OASYS and ACUVUE OASYS for ASTIGMATISM Brand Contact Lenses 8 JJV Data on File 2017 ACUVUE Brand Reusable Spherical Contact Lenses vs widely prescribed conventional contact lenses in Korea 9 JJV data on file 2018 Blink RevitaLens MPDS Compatibility Clinical Performance with Reusable ACUVUE Brand CLs All ACUVUE Brand Contact Lenses have UV Blocking to help provide protection against transmission of harmful UV radiation to the cornea and into the eye UV absorbing contact lenses are NOT substitutes for protective UV absorbing eyewear such as UV absorbing goggles or sunglasses because they do not completely cover the eye and surrounding area You should continue to use UV absorbing eyewear as directed by your eye care professional Read and retain the manufacturers instruction leaflet for a full list of precautions and instructions for use All instructions must be followed Failure to do so may result in serious eye infection or injury If eye irritation occurs immediately discontinue lens wear and contact your eye care professional Product images are for illustration purposes only ACUVUE ACUVUE RevitaLens ACUVUE OASYS and HYDRACLEAR are trademarks of Johnson Johnson Medical Pty Ltd Johnson Johnson Medical Pty Ltd 2019 PP2019CN4029 AM70574RH10E Rev A GAME ID 190321082447210

CLEANING CARE For Reusable Soft Contact Lenses Soft Contact Lens Disinfection Directions 1 W ash hands with soap warm water and dry with a lint free towel to reduce the chance of getting an infection 2 After removing your contact lenses clean and disinfect your lenses by placing 3 or more drops of ACUVUE RevitaLens Multi Purpose Solution Oon one side of lens surface 3 R ub lens gently in a non circular motion from the center to the edges for 2 to 4 seconds 4 Turn the lens over and repeat steps 2 3 5 R inse each side of lens for 5 seconds with fresh solution Place lenses in clean lens case and fill with solution Close case tightly 6 S oak lenses for a minimum of 6 hours for disinfection cleaning and protein removal Soft Contact Lens Case Care 1 A lways use ACUVUE RevitaLens Multi Purpose Disinfecting Solution with the non sterile lens case provided 2 F ill both chambers with fresh ACUVUE RevitaLens MultiPurpose Disinfecting Solution Replace lens case caps and soak for at least 6 hours for disinfection protein and lipid removal 3 Your lenses are now ready for wear Rinse the lens case with ACUVUE RevitaLens Multi Purpose Disinfecting Solution and leave to air dry 4 D o not rinse or store your lenses lens case with tap water Discard any remaining solution in your contact lens case before disinfecting your lenses again 5 Always discard your old lens case and use the new lens case provided Steps do not replace instructions for use provided by the manufacturer All Instructions provided with your fresh contact lens solution and lens case must be followed if available Exceptional Disinfection 1 3 Dual disinfecting technology effectively kills harmful germs and bacteria All Day Comfort 4 5 90 of users agree that ACUVUE RevitaLens Contact Lens Solution was effective in keeping their contact lenses feeling comfortable Great Match8 With ACUVUE Brand Contact Lenses HYDRACLEAR PLUS technology helps minimise contact lens related dryness maintain moisture6 Provides excellent comfort when using digital screens7 The best in class UV protection simultaneously blocking greater than 90 of UVA and greater than 99 of UVB rays8

INTERNATIONAL NEWS ZEISS CELEBRATES 175 YEARS OF INNOVATION PASSION AND THE COURAGE TO DEVELOP ZEISS International SOURCE WWW ZEISS COM ZEISS RAN A VIRTUAL CELEBRATION TO MARK ITS 175TH ANNIVERSARY AT ITS FOUNDING SITE IN JENA 175 years ago on 17 November 1846 young mechanic Carl Zeiss opened his workshop for precision mechanics and optics in Jena thus laying the foundation for what would become ZEISS To mark this special day the company ran a celebration event the highlight of a jam packed anniversary year The virtual event took place on 16 November 2021 at the Volkshaus in the company s founding city Jena During the virtual event Dr Karl Lamprecht President and CEO of the ZEISS Group praised the company s successful past celebrated its present and shared his outlook on the future ZEISS unique history and its exceptional achievements make it a truly extraordinary company Its 175 years also demonstrate the company s high level of resilience and its willingness to accept change And above all ZEISS tremendous passion coupled with its pioneering spirit and its pragmatism in challenging and pushing the limits of the technically feasible said Dr Lamprecht AN OPTICAL INSIGHT In a video message German Federal President Frank Walter Steinmeier congratulated all ZEISS employees around the world 175 years of ZEISS is much more than an anniversary Its interplay of entrepreneurial spirit drive to research and inventiveness make the ZEISS Group a pioneer of modern industry The President underlined ZEISS responsibility as a foundation owned company Thanks to Ernst Abbe s visionary realization that economic success scientific progress and social cohesion all go together he set up the Carl Zeiss Foundation and thus paved the way for the company to take entrepreneurial responsibility for the common good 175 years of ZEISS are more than just a historical milestone in our corporate history It s also what motivates us to look ahead and help contribute to a bright future shaped by technological innovations GLANCE 33

German Federal President Frank Walter Steinmeier said Its interplay of entrepreneurial spirit drive to research and inventiveness make the ZEISS Group a pioneer of modern industry He also expressed his conviction that we most definitely need this collaboration between science and industry to achieve goals like climate neutrality as well as to safeguard jobs and ensure social welfare As ZEISS sole shareholder the Carl Zeiss Foundation benefits in particular from the economic success of its foundation company said Minister Theresia Bauer Chair of the Carl Zeiss Foundation Administration adding Upwards of 300 million euros have been invested in more than 700 research projects since 2007 alone This makes it one of the largest private foundations in Germany committed to the promotion of science I d like to thank all our employees for enabling us to promote science through their innovative power said Dr Dieter Kurz Chairman of the Carl Zeiss Foundation Council and Chairman of the Supervisory Board of Carl Zeiss AG and SCHOTT AG AN OPTICAL INSIGHT He analyzed the reasons behind ZEISS s success ZEISS 175 is the fascinating story of an evolution from a small workshop with just one employee in Jena to a global market leader for the optics industry that employs 35 000 people However it s a success story that s not as straightforward as it looks today In fact it s a story packed with twists and turns ups and downs Its long term success has been possible because core virtues values and skills have always been protected while plenty of other aspects have been reinvented time and again This is part of ZEISS innovation culture ZEISS Group President and CEO Dr Karl Lamprecht during the virtual event to mark ZEISS GLANCE 34

LAUNCH OF FUTURE INITIATIVE A HEART FOR SCIENCE ZEISS is taking the anniversary as an opportunity to look back over its successful technology story After a 5 million euro donation to the Deutsches Museum last summer the initiative A Heart for Science will now be launched ZEISS is thus expanding its social commitment and pooling existing STEM projects in the global initiative to bring kids and teenagers together under one roof Meanwhile new activities are being run worldwide Social responsibility has a long tradition at ZEISS Social commitment and the promotion of science and education are among the company s basic principles The Carl Zeiss Foundation was established in 1889 and quickly compiled guidelines that have remained key for ZEISS to this very day The new initiative A Heart for Science is ZEISS way of forging a link with this tradition and it is campaigning to encourage young people to pursue the STEM subjects After a 5 million euro donation to the Deutsches Museum the global initiative A Heart for Science will serve as inspiration for tomorrow s discoveries ZEISS HIGH TECH SITE IN JENA BUILT ON FOUNDING SITE Thuringia s prime minister Bodo Ramelow also congratulated the company on its anniversary This year ZEISS is looking back over a history spanning 175 years And with the high tech site in Jena far into the future as well Here the future is a tradition This tagline clearly applies to ZEISS in particular said Ramelow adding This company is steeped in tradition while also standing for innovation Following on from Germany s eventful history the company is now a top global player in the optics and optoelectronics industries ZEISS is a boon for Jena and for Thuringia as a whole I would like to congratulate ZEISS on its 175th anniversary and thank the Executive Board and the entire workforce for their exceptional efforts and their loyalty to the company s founding site To mark its 175th anniversary ZEISS launched the global initiative A Heart for Science to pool its projects to encourage young people to pursue a career in the STEM subjects and to get new activities off the ground The initiative was presented as part of a kinetics show with a musical accompaniment and a dance performance at the Volkshaus in Jena ZEISS has invested over 350 million in the hightech site On an area measuring 80 000 square meters the new ZEISS high tech site in Jena will accommodate more than 2 000 employees The aim of the new facility at ZEISS founding site is to lay the groundwork for further growth at the ZEISS Group An efficient building new infrastructure and cutting edge workplaces will all play their role here MORE INFORMATION AT WWW AHEARTFOR SCIENCE FURTHER INFORMATION WWW ZEISS DE JENA AN OPTICAL INSIGHT GLANCE 35

A COLLECTION OF PHOTOS FROM THE ZEISS 175 YEARS ANNIVERSARY LOCAL EVENT TO VIEW ALL OF THE EVENT PHOTOS CLICK HERE AN OPTICAL INSIGHT GLANCE 36

Q A ZEISS 175 YEARS How will ZEISS be celebrating this special milestone The company will be celebrating its 175th anniversary through a variety of activities and events Its close links to science are evident in projects such as the ZEISS Beyond Talks interview series In these interviews pioneers and eminent figures from across the globe including climate researcher Professor Antje Boetius speak about their work their visions their passion and the topics that are having a major impact on our world This anniversary year is also a great time for ZEISS to pool in a new initiative its strategic efforts funding and the commitments it has made for the common good over many years in a bid to encourage children and young people to consider a career in the sciences and conduct open minded research AN OPTICAL INSIGHT An official anniversary celebration was held in November 2021 Employees from around the world were able to tune into a virtual event which welcomed prominent figures from the worlds of science politics and the economy What do you think is the reason for the success that ZEISS has been around for 175 years ZEISS has a unique and rather turbulent history And its many technological milestones attest to its repeated and successful attempts to challenge the limits of what is physically and technically feasible This unique innovative spirit has imbued the company with real staying power while helping both us and our customers to be successful GLANCE 37

How long has ZEISS operated in South Africa ZEISS has been operating in South Africa for 82 years now How has ZEISS evolved since its inception in 1846 Since it was founded as a business in 1846 it has been transformed into a large researchoriented enterprise that distributes a host of optical products across the world With a portfolio aligned with future growth areas like digitalization healthcare and Smart Production and a strong brand ZEISS is shaping the future of technology and constantly advancing the world of optics and related fields with its solutions The company s significant sustainable investments in research and development lay the foundation for the success and continued expansion of ZEISS technology and market leadership ZEISS invests 12 percent of its revenue in research and development this high level of expenditure has a long tradition at ZEISS and is also an investment in the future What is the most exciting innovation for ZEISS in the last 25 years ZEISS manufactures products that make a key contribution to medical progress The optical system for the very first slit lamp also formed the basis for the development of the first ZEISS surgical microscope the OPMI 1 which was launched in 1953 To this day ZEISS is shaping ophthalmology and microsurgery in a lasting way through its innovative technologies and application oriented solutions Microsurgery s recently launched product portfolio includes technologies such as the ZEISS KINEVO 900 used for spine and neurosurgery Comprising more than 100 innovations and 180 patents the system marries robotics digital visualization and modern assistance solutions AN OPTICAL INSIGHT What effect has the Covid pandemic had on ZEISS For a global company like ZEISS the outbreak of the coronavirus was a challenging time full of uncertainty and unknowns and we wanted to help our colleagues around the world navigate it as safely as possible The central task force was immediately formed which allowed us to feel a great sense of responsibility in terms of ensuring that we protect our more than 32 000 employees worldwide as best we can Our four pillar strategy helped us to protect the health and safety of all those at the company while safeguarding our business and all of our jobs We had to act in a fast flexible and agile way in order to ensure this Every day brought a new challenge We made sure to closely monitor the pandemic s evolution at all times evaluate its impact and immediately take appropriate action throughout the entire ZEISS Group It was ultimately a team effort but the hurdles will certainly keep coming We are very proud of how ZEISS has not only admirably brought the situation under control but also how we have contributed our own know how expertise and the technologies produced by our segments to the global fight against the coronavirus An official anniversary celebration was held in November 2021 Employees from around the world were able to tune into a virtual event which welcomed prominent figures from the worlds of science politics and the economy GLANCE 38

CONTACT LENSES CAN YOUR PATIENTS HANDLE IT Jane Veys Director Global Professional Education Development SOURCE JOHNSON JOHNSON VISION The science and psychology behind contact lens handling is providing new insights to enhance new wearer success and encourage retention Jane Veys highlights opportunities to put these insights into practice and improve patient experience It s sometimes said that handling contact lenses is as easy as brushing your teeth But patients real life experiences suggest that s not always the case While we may assume we re doing a great job when teaching our patients how to apply and remove their lenses patients themselves report that we could do better Johnson Johnson Vision interviewed consumers eye care professionals psychologists and industry experts to gain a better understanding of contact lens handling and identify new ways of addressing our patients concerns THE PROBLEM What we know about the consequences of difficulties or concerns with contact lens handling is summarised in figure 1 To understand these problems in greater detail we conducted consumer research first with over a thousand consumers and then indepth interviews with a further 21 individuals We interviewed 1 200 consumers in four countries who had either considered trialled or dropped out from contact lens wear 1 We identified that 19 individual steps are needed to apply and remove a contact lens figure 2 But we also found as many as 155 unique needs that consumers use to measure the successful completion of the job For instance not only do wearers have to remove the lens they also have to minimise the likelihood of losing it when attempting removal whether the lens is off centre under the eyelid or in the sink Here s what we learnt AN OPTICAL INSIGHT GLANCE 39

CONSUMER STRESS LEVELS AND TIME TAKEN About five in 10 non lens wearers report touching their eyes is a key barrier to wearing contact lenses 3 Handling difficulties are the principal reason given by the one in four spherical wearers who drop out in the first year 2 Handling issues and questions feature highly in social media chatter 4 FIGURE 1 Concerns and difficulties with handling The complexity of this apparently simple process has also been highlighted in a recent study which suggests that as many as 53 steps may be required for patients to be fully compliant with daily lens wear and care of reusable lenses 5 We then conducted 21 in depth home interviews among contact lens wearers and those who were trialing lenses 6 The aim of this time and motion study was to find the time taken to complete each step in the application and removal process and to monitor the wearer s stress levels see figure 3 Devised by psychologists this study was designed to help differentiate patients perceptions of lens handling issues from the actual difficulties they experience and to understand levels of anxiety at each step in the process The time and motion study told us Many contact lens wearers skip preparation steps preparing the lens and positioning it on the finger to save time but this can result in problems Application and resolving difficulties with application takes most time Approaching the eye during application and removal induces the most anxiety From our study we learnt that the key handling steps patients consider of highest importance and lowest satisfaction are Preparing and positioning the lens for application Applying the lens to the eye Removing the lens In fact only one in four triallists were motivated and satisfied enough with the way they were taught to put their lenses on and remove them to become wearers 1 Of special concern were issues with lens application technique Wearers report difficulty securing the upper lid adequately which inevitably results in blinking as the lens approaches so that it either falls off the finger or sticks to the lid or lashes Learn how to wear contact lenses Prepare your hands for lens application Prepare your eyes for lens application Open the new lens container Retrieve the lenses from the lens container Prepare the lens for application Position the lens for application Secure your eyelids to accept the lens Approach your eye with the lens Seat the lens on your eye Secure the lens on your eye Keep the lenses secure on your eye Keep your eyes from getting irritated Secure your eyelid to remove the lens Approach your eye to remove the lens Remove each lens Clean each lens Store each lens Dispose of lenses Possibly overwhelmed steps to apply and remove CL FIGURE 2 Individual steps in lens application and removal 19 Contact lens education may also take place in a less than optimal environment Lack of privacy lack of hygiene in the teaching area and a lack of empathy or trust in the person conducting the teaching can also undermine success AN OPTICAL INSIGHT GLANCE 40

FIGURE 3 Time and motion study results THE MYTHS MANY AND VARIED THE OPPORTUNITY MOTIVATION The consumer interviews also revealed as many as 30 different fears about contact lens use whether related to the eye the lens the wearing process or concerns about complications 1 Since we know motivation drives satisfaction it s important to understand individual motivating factors So we also identified the specific triggers that drive consumers to try contact lenses whether to look good avoid being awkward hide their vision problems or not have to wear glasses 1 Although some fears will be familiar to anyone who discusses contact lenses with patients others may seem surprising Being aware of all potential anxieties allows us to prepare for reassuring our patients Importantly whilst not all consumers have these concerns nearly eight in 10 contact lens considerers agreed that such fears could be a barrier to wearing lenses 1 Considerers fell into two distinct high and low fear groups in other words they were either fearful or they weren t 1 And this wasn t the only revealing finding Although fear could interfere with the education process there was no correlation between anxiety and ease of application and removal What we found was that the stronger the motivation of the patient to succeed the higher the satisfaction with their ability to apply and remove lenses Our research therefore dispelled some common myths about lens handling discussed in Table 1 AN OPTICAL INSIGHT The top ranked motivations were not having to squint to see having 180 vision and feeling more confident overall We can use this knowledge to help drive our patients motivation to wear contact lenses Remember that not all triallists have the same level of motiva tion Highly motivated patients whether their level of fear is high or not achieve high levels of satisfaction with wearing lenses Satisfied patients experience anxieties and handling diffi culties too but their motivation enables them to persist TOP TIP Once we ve recognised which driving factor is most important to an individual we can use that to remotivate that patient during the contact lens teach and encourage them to continue GLANCE 41

MYTH THE SOLUTIONS FACT Patient related All patients can experience fear and fear gets in the way Not all considerers are fearful and some triallists are highly motivated Motivation drives satisfaction fear and anxiety don t play a significant role From our research and studies making handling easier from the patient s perspective depends on optimising three factors in prac tice environment approach and process Figure 4 Patient related Men and older patients find handling more difficult Gender isn t a factor men don t struggle with lens handling more than women Age isn t that relevant either Let s look at each of these in detail and see what our Best Practice for teaching lens handling might look like Contact lens related Daily disposable lenses are more difficult Daily disposable lens wearers don t struggle more than reusable lens users Contact lens related Lenses handle in a similar way There are differences between lenses some brands handle better than others as clinical studies have shown7 1 AN OPTIMUM ENVIRONMENT It may go without saying but an unhygienic practice environment or a teaching area lacking in comfort or privacy is not conducive to successful patient education TABLE 1 Common myths about contact lens handling THE OPPORTUNITY TEACHING METHODS BEST PRACTICE A wide variety of methods are used in practice to teach lens han dling and patients introduce different approaches to application and removal themselves This can lead to variable and unpredict able wearer success Addressing this through consistent in practice training the use of written and digital support materi als and regular practice follow up appealing to patient motivations rather than fears can help to reduce this variation There are significant opportunities to improve where when and how education takes place especially in this digital age If we could make the process more consistent and effective by establishing an evidence based Best Practice for educating our patients they would have a better chance of enhancing their sat isfaction and continuing with contact lenses We ve identified a significant opportunity to combine science with clinical experience to help develop better teaching and learning of lens handling Attention to environment approach and process can help make your contact lens teach more effective AN OPTICAL INSIGHT Lack of hygiene may provoke negative emotions and cause the patient to withdraw And feeling exposed when trying to over come barriers can make patients feel uncomfortable and more likely to give up So ensure your contact lens teaches are conducted in a private clean area with access to a sink well lit mirror lint free tissues contact lens solutions and support materials Remember to advise patients that the home environment is just as important Recommend they select a quiet dedicated space to practice in at home away from cluttered bathrooms with their hazards of sinks and toilets TOP TIPS TO RELIEVE ANXIETY Allow your patient to touch a contact lens during fitting Ensure your staff are prepared and confident in all aspects of the teaching session Give exercises prior to fitting such as touching the white of the eye with a clean finger to help desensitise the eye and lid reflex Ask patient to relax their breathing and jaw to relieve tension First have the patient approach the eye with the lens but without putting it on Regularly mention why the patient first wanted contact lenses to re motivate GLANCE 42

APPROACH Optimise the environment in practice and advise patient on space at home Approach each patient in the best way possible tailor for each individual ENVIRONMENT Develop a best practice process for teaching the required techniques PROCESS FIGURE 4 Three factors to consider to make handling easier 2 AN OPTIMUM APPROACH Using empathy and building trust plays an important part in relieving patients fears and anxieties We found that patients who have a higher level of trust in their eye care professional achieve significantly higher levels of satisfaction 4 Gentle positive communication is the best teaching approach Encourage and congratulate the patient after each successful step and allow plenty of time for them to build confidence Break the process down into small steps explaining why each is important Pay close attention to those steps we know patients struggle with especially lens preparation positioning and appli cation Digital resources should be recommended to supplement your face to face contact With so many steps to consider it s easy to lose track of which are most important Here s our list of three key tips for patients for successful application and removal overall Ensure hands are dry to make lid and lens handling much easier Secure the lids by placing two fingers at the lid margins one above the eye and one below figure 5 Approach the eye slowly not quickly and make fewer attempts It s also worth investing time and resources in training staff to ensure all involved in teaching are proficient well motivated and worthy of recognition as handling experts Help set expectations and emphasise that lens handling needs practice and the importance of establishing a routine Use analo gies relevant to their daily life such as tying your shoelaces riding a bike or learning a new dance move These involve many steps too 3 AN OPTIMUM PROCESS Our overall aim should be to apply best practice training to every one while remaining aware that not all our patients are the same We need to appreciate that some patients learn more quickly than others or have difficulty with particular steps Use your experi ence in practice to tailor your teaching to each patient And be aware that patients will adapt their own technique as they gain confidence and experience TOP TIPS Not all lenses are the same to handle Modulus can affect handling and some lenses have low surface adhesion which can aid removal 8 Design features such as a visibility tint or the inversion indicator can help with preparation 9 AN OPTICAL INSIGHT FIGURE 5 Holding the lids the correct way to secure lids is an essential first step for successful lens application in a new wearer ALSO KEEP IN MIND THE FOLLOWING Approaching the eye to apply the first lens is the most stressful step Repeated failures cause anxiety The number of failed attempts counts slow down and concen trate on quality rather than quantity Watch your language talk about applying or putting on a lens rather than more alarmingly inserting it Watch for increasing anxiety levels patients cannot retain information when feeling stressed GLANCE 43

KEY POINTS PROBLEM Only one in four wearers are satisfied with the way they are taught handling1 Handling difficulties are a key reason for dropout in new wearers 2 Preparing and positioning the lens for application are key issues for patients 1 OPPORTUNITY SOLUTIONS Optimising the teaching of contact lens handling can reduce dropout and benefit patient and practice Recognise patients personal motivations these rather than fear or anxiety drive satisfaction with lens handling Once home experiencing repeated application and removal failures may result in frustration We need to provide effective learning aids written information video links and apps that are available 24 7 to support patients in their home environ ments through the early stages A better environment approach and process can all help in patient success Use a full range of resources for contact lens teaching and learning Direct patient to digital support which is available 24 7 to supplement face to face teaching USE OUR CHECKLIST TO COMMUNICATE WITH NEW WEARERS We should offer practical tips on the optimum environment for trialling contact lenses at home Examples might be trying them first at the weekend or during school holidays without the pres sure of getting to work or school or during practice hours when help is at hand if needed Don t forget to provide a contact num ber to call with any questions or concerns Congratulate and encourage Give information on the product and why it was prescribed and reassure them that other lenses are available if for any rea son they are not satisfied Give written information supply link to application and removal video and apps and provide contact details for any concerns Arrange a progress phone call after a few days and a follow up appointment At follow up check performance vision and comfort using 1 10 scales and offer alternatives if not working well Finally arrange ongoing contact with the patient In addition to a follow up appointment a phone call from a member of the prac tice team after a couple of days can be invaluable to address any difficulties that may have arisen early on and keep motivation high There are many opportunities to help improve retention among those new to contact lenses While both vision and com fort are important factors confidence in lens handling and habit formation play significant roles in new wearers especially in the first few weeks of wear 10 The early stages of contact lens wear are crucial to ongoing success So in summary there s a huge opportunity to help our patients achieve success and to keep them in contact lenses Implement simple changes to optimise the environment approach and pro cess to deliver Best Practice handling education and support for your patients REFERENCES 1 JJV Data on file 2014 Training Wheels Research n 1 200 Quantitative interviews in China Japan Russia and US with considerers triallists and dropouts 2 Sulley A Young G and Hunt C Factors in the success of new contact lens wearers Cont Lens Anterior Eye 2016 40 1 15 24 3 JJV Data on file 2017 Quest Study 4 JJV Data on file 2016 Social Listening Project 5 Efron N and Morgan PB Rethinking contact lens aftercare Clin Exp Optom 2017 100 411 431 6 JJV Data on file 2014 Training Wheels Research n 21 wear ers Qualitative home interviews and observations China and US 7 Court H Greenland K and Margrain TH Evaluating patient anxiety levels during CL fitting Optom Vis Sci 2008 85 7 573 80 8 Scales C Popwell S Pall B et al Sticky business How cross linker content can have a profound effect on the adhesiveness of contact lenses Invest Ophthalmol Vis Sci 2017 58 ARVO E Abstract 3094 AO348 9 Sulley A Osborn Lorenz K and Jubin P Handling the forgot ten factor in soft contact lens success Optician 2013 246 6426 25 30 10 Veys J and Sulley A Pay attention to retention Optician 2017 253 6604 26 30 Thanks to Audrey Adams at Johnson Johnson Vision for her input and Alison Ewbank for help in preparing this article AN OPTICAL INSIGHT GLANCE 44

Exceptional comfort combined with CLEAR STABLE VISION for your astigmatic patients1 Ask your ACUVUE Account Manager for more information ACUVUE ACUVUE OASYS and HydraLuxe are registered trademarks of Johnson Johnson Medical Pty Ltd Johnson Johnson Medical Pty Ltd 2020

CONTACT LENSES INSPIRED BY THE SCIENCE OF TEARS Bart Johnson Brian Pall O D M S F A A O and Charles W Scales Ph D SOURCE JOHNSON JOHNSON VISION CARE INC AN INNOVATIVE NEW CONTACT LENS DESIGNED TO WORK WITH THE TEAR FILM Tears are vital to maintain a healthy ocular surface and an optically clear entrance to the eye Without them we would not have the sharp retinal image that allows us to see the world and each other clearly Tears are rich and complex and that richness is necessary for their efficacy Water alone could not nourish and protect the delicate corneal and conjunctival epithelia nor give us the clear stable vision we experience daily The human tear film is optimized to address a unique additional challenge create a smooth optically transparent refractive interface between the hydrophilic environment of the eye and the hydrophobic external environment of the air This interface is stabilized through synergistic interactions of hydrophilic amphiphilic and lipophilic tear film components including ocular mucins proteins and lipids AN OPTICAL INSIGHT These components work in concert to continuously lubricate moisturize smooth oxygenate eliminate waste and protect the ocular surface during and between blink cycles A COMPLEX STRUCTURE The old picture of the tear film consisted of a simple three layer mucin aqueous and lipid structure Recent research has revealed it to be much more complex with more than 18 known mucins 491 proteins identified so far and at least 153 lipid types all of which interact to provide structural integrity to the tear film while also performing their individual functions 1 2 3 And each of the three major components of the tear film is itself multifunctional and complex in makeup FUNCTIONS OF THE TEAR FILM MUCINS Anchor and stabilize the tear film Protect ocular surface from abrasion through formation of the glycocalyx Lubricate cell surfaces so corneal epithelium doesn t stick to tarsal conjunctiva Reduce shear stress during blink GLANCE 46

The human tear film is optimized to address a unique challenge create a smooth optically transparent refractive interface between the eye and the air The base layer of the tear film is comprised of tear film mucins which extend from inside the epithelial cells through the hydrophobic cell membrane to the outside of the cell Called the glycocalyx these high molecular weight mucins are bound to the cornea on one end but have hydrophilic tails that extend into and hold the aqueous to the cell surface Figure 1 1 Because cell membranes are largely hydrophobic without the mucin glycocalyx tears could run off the corneal surface like water off a teflon frying pan At the same time the mucins act as a disadhesive so the corneal epithelium doesn t stick to the tarsal conjunctiva Figure 1 High molecular weight mucins are bound to the cornea on one end but have hydrophilic tails that extend into and hold the aqueous to the cell surface Because cell membranes are largely hydrophobic without these mucins tears would run off the corneal surface At the same time the mucins act as a disadhesive so the corneal epithelium doesn t stick to the tarsal conjunctiva Other mucins float freely in the aqueous compartment which functions to clean protect and transport nutrients and oxygen to the cornea 4 Much more than water the aqueous contains large and small chemical entities including environmental debris that will be disposed of through tear drainage 3 Above the aqueous is the lipid layer Once considered a simple barrier to prevent evaporation it is at least a two layer structure with polar lipids at the aqueous lipid interface and a thicker layer of nonpolar lipids situated above the polar lipids and facing the air 5 AN OPTICAL INSIGHT The lipid layer aids in lubrication prevents loss of aqueous and helps maintain a smooth optical surface Without the amphiphilic polar phospholipid interface though nonpolar lipids would spread poorly over the aqueous creating a less stable lipid layer and leading to more rapid tear film break up 5 IMPACT OF A CONTACT LENS In healthy eyes tear film components work in harmony When the tear film is compromised this system can break down leading to dryness and discomfort corneal staining and conjunctival redness and vision disturbances What s more the changing environments that people experience daily as well as the intense demands we make on our eyes all may affect optical performance and comfort A contact lens changes the ocular surface environment dramatically On the eye a contact lens splits the tear film trapping the vital mucin layer behind the lens dramatically reducing the volume of aqueous and disrupting the lipid layer 7 A thinner pre lens tear film layer increases evaporation and shortens tear film break up time which can impact vision 8 Ideally a contact lens would mimic the tear film To do that electively requires a lens with tearlike properties that can interact with and support not just its water component but the full range of tear film constituents mucins aqueous and lipids Figure 2 ACUVUE OASYS Brand Contact Lenses 1 Day with HydraLuxe Technology the middle lighter section are comprised of an enhanced network of tear like molecules plus highly breathable hydrated silicone that integrates with the patient s own tear film each day GLANCE 47

TEAR INFUSED DESIGN To meet this challenge Johnson Johnson Vision Care Inc has introduced ACUVUE OASYS Brand Contact Lenses 1 Day with HydraLuxe Technology with a tear infused design These new lenses are comprised of an enhanced network of tearlike molecules plus highly breathable hydrated silicone that integrates with the patient s own tear film each day Figure 2 and leverages all the benefits of daily disposability as well This network of tearlike molecules is uniform throughout the lens not simply a coating and works consistently all day as opposed to having to be blink released Because the natural tear film is a complex system the lenses are designed to work with the key tear film components not just water to lubricate and moisturize the lens and support the tear film throughout the day HOW TO MIMIC MUCINS AND WHY At the heart of HydraLuxe Technology is an enhanced moisture network with increased covalent bonding designed to further reduce the adhesiveness of the lens to better mimic the eye s own mucins Distributed evenly throughout the enhanced moisture network is high molecular weight polyvinyl pyrrolidone PVP a remarkable wetting agent with a long history of use in ophthalmics and biomaterials 9 TEAR INFUSED DESIGN HydraLuxe Technology Consists of a uniform tear like network throughout the lens not a coating Works continuously all day not blink released Works with key tear components not just water These abilities derive from the amphiphilic nature of PVP that allows it to bind hydrophilic as well as hydrophobic components The uniform nanoscale distribution of PVP throughout the lens allows the material to interact with the ocular environment in such a way that water and tear film components can spread homogenously across and throughout the lens with minimal heterogeneous precipitation or deposition so that the lens works with key tear components 10 Recognizing that demanding days require innovative materials and design ACUVUE OASYS 1 Day with HydraLuxe Technology contact lenses take advantage of the most advanced tear film and contact lens science The continuous lubrication and moisturizing made possible by precisely formulated PVP combined with the daily disposable modality make these lenses ones that will help keep your patients comfortable throughout their demanding days In HydraLuxe Technology PVP with a specifically formulated chain length and molecular weight is added to a reactive monomer mix to create a matrix that closely mimics the properties of mucin Like naturally occurring tear film mucins the PVP in the lenses contains sites that interact with all key tear components References 1 Mantelli F Arg eso P Functions of ocular surface mucins in health and disease Curr Opin Allergy Clin Immunol 2008 8 5 477 83 2 de Souza GA Godoy LM Mann M Identi cation of 491 proteins in the tear fluid proteome reveals a large number of proteases and protease inhibitors Genome Biology 2006 7 8 R72 3 Rantam ki AH Sepp nen Laakso T Oresic M et al Human tear fluid lipidome from composition to function PLoS One 2011 6 5 e19553 doi 10 1371 journal pone 0019553 4 Abelson M Dartt D McLaughlin J Mucins Foundation of A Good Tear Film Review of Ophthalmology November 7 2011 www reviewofophthalmology com content d therapeutic_topics c 30968 Accessed September 2 2015 5 Green Church KB Butovich I Willcox M et al The International Workshop on Meibomian Gland Dysfunction Report of the Subcommittee on Tear Film Lipids and Lipid Protein Interactions in Health and Disease Invest Ophthalmol Vis Sci 2011 52 4 1979 93 6 Definition and Classification of Dry Eye Disease Report of the definition and classification subcommittee of the International Dry Eye WorkShop 2007 Ocul Surf 2007 5 2 75 92 7 Nichols JJ Willcox MDP Bron AJ et al The TFOS International Workshop on Contact Lens Discomfort Executive Summary Invest Ophthalmol Vis Sci 2013 54 TFOS7 TFOS13 8 Nichols JJ Sinnott LT Tear lm contact lens and patient related factors associated with contact lens related dry eye Invest Ophthalmol Vis Sci 2006 47 1319 28 9 Polyvinylpyrrolidone National Library of Medicine Accessed September 4 2015 http toxnet nlm nih gov cgi bin sis search a dbs hsdb term DOCNO 205 10 Oasys patents US5998498 US6270218 US6367929 US6822016 US6943203 US7461937 US6020445 US6849671 US7052131 US7396890 US7666921 US7691916 US7825170 US8399538 US8450387 D458023 D465416 D496790 D503087 and RE37558 AN OPTICAL INSIGHT GLANCE 48

freshness is just a blink away Applicant Genop Healthcare Pty Ltd PO BOX 3911 Halfway House 1685 South Africa Tel 0861 436 674 Co Reg No 1984 011575 07 www genop co za 11 2020 PROMO 119 Marketed and Distributed by Moscon Optics Pty Ltd Reg No 1982 009257 07 P O Box 46073 Orange Grove 2119 South Africa Tel 27 0 11 483 8001 Johnson Johnson Vision Care Inc 2020 Reg No G1180601630009 PP2020MLT4305

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