ASO EyeWatch June 2020 Edition

Message from the President Peter Sumich

I feel hungry.  Hungry for knowledge and stimulation after COVID-19 locked us down… and I’m sure you feel the same!

So, when we planned the revamped ASO Expo this year we wanted to satisfy your hunger… and I believe we will.

We considered the lack of clinical meetings available and have decided to present a combined clinical / medico political / business / industry theme.

Enjoy the luxury of The Grand Hyatt and dine out in Melbourne like old times.  If the AFL Grand Final is played then expect the city to be jumping – and your Grand Hyatt ASO reserved room will be a prized possession indeed!

However, given the current situation, we need an early indication of numbers before we can complete our planning.  Remember, the event is free for ASO members so register now to avoid disappointment.  

The preliminary programme includes:

“Cataractus interruptus”

Delivered by a mixture of clinical and industry speakers in both didactic and discussion panel format with town hall audience participation we will feature:

  • COVID-19 recovery
  • The latest cataract surgery trends in 2020; device industry plans for 2021 and the latest implant technologies
  • An analysis and update of the medico political landscape and MBS review

 Glaucoma management in the Post Covid-19 world:

Open your eyes to the new horizon:

  • What needs to change and why 
  • When, and when not to use MIGS / MBGS… and how
  • Understanding standalone MIGS and the new item number

Oculoplastics surgery

Dr JJ Khong will feature updates on:

  • Current trends in common eyelid surgeries- tips and pearls
  • Cosmetic eyelid procedures – must know
  • MBS update on blepharoplasty and peri ocular skin lesion excision 

Retina – the essentials / takeaway edition

We examine the current clinical, political and industrial landscape in relation to retina including:

  • Retinal technology for your clinic: Comparison of available equipment and software
  • Medico political update – MBS Review, advocacy, and beyond
  • Retinal therapy pipeline: What’s around the corner, and how close is it?

Practice Management Session

Learn some of the easiest, efficient and effective strategies, including:

  • Accreditation – practical tools for effective day to day running of your business
  • Practice Pearls Panel – discover invaluable practice management information and including podcasts, how to keep staff motivated, human resource essential & much more!
  • EMR / PM software comparisons

The Small Business Essentials

  • Cybersecurity and digital marketing update
  • Share Investment in the COVID-19 age
  • Digital marketing strategies
  • Younger Fellows session – operating, ageing and anxiety
  • Young Fellows Chair Dr Chameen Samarawickrama presents updates and recent issues
  • Photo Booth returns – update your professional photo for the ‘Find an Ophthalmologist’ page on our website

Day Surgery Breakfast – Phaco Bacon and Eggs

Come SWOT with us as we examine:

  • COVID-19 economic challenges
  • Private insurance trends
  • Spotting a day surgery opportunity
  • Industry wish lists

AFL Grand Final contingency plans

It’s uncertain when or if the AFL game is going to be.  If we do have a clash, the plan is to watch it in the plenary ballroom with champagne, chicken, pies and finger food.  Dress in your favourite team colours and enjoy the company of your colleagues and our friends from industry.  At the conclusion, stagger out safely for private dinners.

For the non-football fans there will be parallel seminar presentations.

I hope that brief outline of what is to come has sufficiently whetted your appetite for what will be a truly memorable and stimulating experience.  As mentioned earlier, it is free for ASO members… but due to potential COVID-19 restrictions we do need an early indication of numbers before we can complete our planning.

Depending on COVID-19 restrictions at the time, it may be necessary to cull numbers to the event.  If this has to occur then please note that confirmation of attendance will be made on a first in, last out basis (i.e.: book now to avoid disappointment!)

To reserve your spot early, simply CLICK HERE NOW!

I look forward to seeing you all in person then!



MGBS Critiera


After 3 years of very hard work, Medicare have approved a new item 42504 for Micro-bypass Glaucoma Surgery stent implantation as a stand-alone procedure.


The ASO has been at the forefront of efforts to argue the case for MBGS as a standalone procedure for over two years, ever since approval for use of the goniotomy item number for MBGS use was summarily revoked in May 2017, leading to severe limitations on clinicians’ ability to use this next generation microsurgical technology.


Below are some answers to frequently asked questions about the procedure. The Medicare Services Advisory Committee (MSAC) have published a Public Summary Document (PSD 1541) which explains the basis for the new item. It is important to read this in order to understand how to use the item. It is available to view here.


What is the new Item?


Item: 42504

Descriptor: Glaucoma, implantation of a micro-bypass surgery stent system into the trabecular meshwork, if:

(a) conservative therapies have failed, are likely to fail, or are contraindicated; and

(b) the service is performed by a specialist with training that is recognised by the Conjoint Committee for the Recognition of Training in Micro-Bypass Glaucoma Surgery (Anaes.)

Schedule fee: $305.55

Start date: 01.05.2020


What is Micro-Bypass Glaucoma Surgery and what is a micro-bypass surgery stent system?


Micro-bypass glaucoma surgery is a type of surgery in which the outflow resistance of the trabecular meshwork is overcome to lower intraocular pressure. A micro-bypass glaucoma surgery stent system is a stent or stents that are implanted into the eye to overcome trabecular meshwork resistance.


What micro-bypass surgery stent systems are available in Australia?


The iStent system from Glaukos (both G1 and G2 versions) and the Hydrus stent system from Ivantis are the only two TGA approved MBGS stents systems currently available in Australia. Item 42504 only applies to the implantation of these devices. The item is claimed for the entire procedure irrespective of how many stents are implanted.

As a reminder, item 42505, “Complete removal from the eye of a trans-trabecular drainage device or devices, with or without replacement, following device related medical complications necessitating complete removal.   (Anaes.)” has been on the MBS since 1.11.2018 and can be used for the removal/ replacement of stents implanted under item 42504.


What does “conservative therapies have failed, are likely to fail, or are contraindicated” mean?


This has the same meaning as in item 42746 for glaucoma filtering surgery. Conservative therapies include medications and laser trabeculoplasty.

From PSD 1541:

MSAC noted that the proposed MBS item descriptor has been modified … to further reinforce the requirement that patients must not only have failed, be likely to fail or be contraindicated to conservative medical therapies such as drops, but they must also be otherwise considered candidates for incisional glaucoma surgery such as trabeculectomy.


this procedure is confined to those who genuinely need it (i.e. those who need trabeculectomy, but do not want or cannot have it)”


What does “the service is performed by a specialist with training that is recognised by the Conjoint Committee for the Recognition of Training in Micro-Bypass Glaucoma Surgery” mean?


The recommendation for approval for this item number was provisional and conditional on the following:

1.     The use of this procedure only in patients who would otherwise have had some sort of glaucoma filtering procedure

2.     The collection of outcomes data from all stand-alone cases funded under the MBS

3.     The review by Medicare of this outcomes data in 2 years time to determine whether it provides high-value care and whether the MBS will continue to fund this procedure.


MSAC were concerned that too many surgeons would insert these devices in too many patients and that this would make MBGS low-value care for Medicare. MSAC recommended restricting MBGS to properly qualified and trained specialists.  Whilst MSAC envisaged a Committee to recognise that training, Medicare have since decided that this step was not necessary as long as all the training requirements were met.


It remains very important for ongoing MBS funding of this device that all who wish to use item 42504 participate in outcomes data collection and consider very carefully the restrictions in the item descriptor. Medicare will be keeping a close watch on all surgeons implanting these stents to ensure compliance.


Your attention is also drawn to MSAC’s notes about the role of item 42504 in relation to trabeculectomy and the need for glaucoma surgery experience: “MSAC noted that it should be made clear that TB MBGS is intended for use instead of, not in addition to, trabeculectomy, and that the procedure should be performed only by ophthalmologists who regularly perform trabeculectomies, and not by general glaucoma surgeons”. This is not part of the item descriptor but should be considered as Medicare do have the relevant data should they chose to examine it.

What criteria are required to be recognised for item 42504?


Any specialist must be able to provide evidence of meeting the training criteria if they are audited by Medicare. There are three criteria, two of which are mandatory:

  1. The surgeon must be a qualified registered ophthalmologist (Mandatory).
  2. The surgeon must be certified by the medical device supplier to ensure they have undergone training and possess the appropriate understanding, training and skills specific to the insertion of these devices (Mandatory).
  3. Registration and recording of all standalone cases (participation in clinical audit) is recommended (Optional).


How does this work practically?


If you are recognised as an ophthalmologist by Medicare then you have already fulfilled the first criterion.


For the second criterion you should ensure you have completed the training for the specific device you wish to use. This training is offered by the device suppliers. You should also ensure you have plenty of experience using the device combined with cataract surgery prior to embarking on stand-alone MBGS. It is particularly important that you are comfortable and competent performing the MBGS part of the combined procedure BOTH before and after cataract extraction so you can manage stand-alone insertion in Phakic and Pseudophakic patients. You should also be happy with your own outcomes for the device you plan to use.


For the third criterion, there is an excellent free online resource called the Save Sight Registries. The new Glaucoma module (the retina module has been going some 10 years) is called Fight Glaucoma Blindness. Go to and click “Request Access”.


The Save Sight Registries is an initiative of RANZCO Fellows in partnership with Sydney University. It has RANZCO HREC approval and fulfils all Australian requirements for data privacy.

Once enrolled, you can enter your MBGS (or any other glaucoma surgery) data prospectively or retrospectively. When you print a Glaucoma Outcomes Report, your outcomes are shown compared with the average outcomes for all surgeons. Your data is completely anonymous to SSR and other surgeons.


Can I get some recognition myself for my audit?


If you use your MBGS audit to help you improve your practice you will also fulfil your CPD Audit requirements for RANZCO. If you wish to participate in  FGB, you will also be able to contribute to the many important research papers that will come out of the Save Sight Registries which can also gain CPD points.


What will happen after the Medicare review in 2 years?


That all depends on how we use the item number and the outcomes.

If we have used the item in small numbers of cases and it delays or prevents the need for filtering surgery (as shown by a reduction in the number of glaucoma filters) then it will continue. If data show that the surgery would be cost-effective for milder cases we may have a much-expanded indications for these stents.

If the stents are ineffective OR if they are used in very large numbers with no corresponding reduction in the numbers of glaucoma filters then Medicare will most likely conclude that the item descriptor is not being followed and MBS funding will be withdrawn.


A/Prof. Paul Healey

Secretary, ANZGS



ASO Expo: MBGS – a hot topic


Micro-bypass Glaucoma Surgery will be covered by the ASO Expo this 23-25 October, Grand Hyatt Melbourne. We will examine explore the latest evidence of efficacy and variations including:

  • When, and when not to use MIGS / MBGS… and how
  • Understanding standalone MIGS audit requirements by the department of health/RANZCO
  • Technical tips for insertion and removal of MGBS/MIGS

To register or find out more information click here to visit our website.

ASO in the Media

ASO in the Media

The ASO has once again had a busy month media-wise.  President Dr Peter Sumich was interviewed for the ‘HiberNation’ (COVID-19 supplement) for News Corp on eye health for people working from home. Following on from our media release about macular degeneration, we received three requests for radio interviews which Dr Shish Lal was happy to accommodate. Click here to hear more.

What is the real cost of employee turnover? What is the real cost of employee turnover?

The ABS estimated that over 1 million Australian employees changed their employment in 2018, two thirds of those voluntarily.  We hear all the time that ‘it costs more to replace staff than it does to retain staff’.  So, what is the real cost of employee turnover?

The costs to your business are not limited to hard costs, such as annual leave payouts and recruitment costs, each time a staff member leaves.  You also need to consider the impact on workplace productivity and morale.  When an employee leaves, their responsibilities are absorbed by the employees around them.  In some cases, turnover can prompt additional turnover, as staff tasked with additional workloads question their own reason for staying with an organisation.  Losing people can mean losing knowledge, teamwork is much more difficult, and your loss may be your competitors gain…. 

Once you find your new employee, you face the training process yet again.  Training new staff can take several months.  New hires have a lot to learn and require assistance from colleagues, and every minute an employee spends training a new staff member is a minute they are not being productive. 

So how do you reduce turnover and retain staff?  You might assume that all it takes to reduce turnover is to increase wages, however most employees today want more than money.  Employees want opportunities to improve their skills, advance in their careers and to feel valued in the workplace.  Online staff training has proven to not only increase productivity, but also improve employee engagement and retention.  When a staff member feels valued, their productivity naturally improves. 

Eye Learning offers online staff training courses, specifically developed to teach ophthalmic knowledge and skills required to work efficiently and effectively in an ophthalmic clinic.  This also dramatically reduces the time taken and dependence on existing staff to train new staff.  So, the question is not whether online learning will benefit your business, but rather whether you can afford not to join the online staff training trend.  If you want to invest in your staff and your business, like many of your colleagues have, contact Eye Learning at, and find out about their exclusive ASO member discounts.

Start-ups are not for the faint heartedStart-ups are not for the faint hearted

When thinking about start-ups and venture capital we often think of brilliant young entrepreneurs with exciting disruptive innovative ideas and spectacular returns.  In reality, less than 5% of early stage investments go to the moon with most start-ups failing completely.  Alliance partners Cutcher and Neale have prepared a wealth of information to help.  Click here to learn more.

How to Sanitize N95 Masks for Reuse: NIH StudyHow to Sanitize N95 Masks for Reuse: NIH Study

Exposing contaminated N95 respirators to vaporized hydrogen peroxide(VHP) or ultraviolet (UV) light appears to eliminate the SARS-CoV-2 virus from the material and preserve the integrity of the masks’ fit for up to three uses, a National Institutes of Health (NIH) study shows.  Discover more here.

A/Prof Chameen Samarawickrama

Two minutes with…

Name: A/Prof Chameen Samarawickrama
Location: Sydney
Sub-specialty/special interest area: Cornea, Anterior Segment
Tea or coffee? Coffee. Lots and lots of coffee…
Savoury or sweet? Sweet. I have a massive sweet tooth and love anything chocolate.
Noise or quiet? At the moment, quiet. With 2 kids under 2, quiet is a luxury!
Last book I read: The Riyria Revelations by Michael J Sullivan. Exciting swashbuckling adventure.
What I’m listening to right now: Nursery Rhymes. All of them. All the time.
I’ve always wanted to try…  Sailing around Croatia.
A great weekend is…  A weekend away with good food, friends and family.
I switch off from work by… Reading, enjoying a glass of wine, watching a movie.
Best piece of advice I’ve ever been given? Take the opportunity of a lifetime within the lifetime of the opportunity.

New Members

Welcome aboard to the new members who have recently joined the ASO: 

Dr Mitchell Lee
Dr Georgina Clark
Dr Matthew Russell
Dr David Gunn
Dr Tani Brown 
Dr Rowan Porter

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