Nathan Efron

The Order of Australia is a national honours system that was introduced on 15 February 1975, and this year marks the 50th anniversary of its introduction. In celebration of this significant milestone, Australia Post has released a special commemorative stamp (Figure 1). Figure 1. Special stamp issued by Australia Post celebrating the 50th anniversary of the Australian honours system, featuring the medal and ribbon of the Companion of the Order of Australia. ©Australia Post. Design by Jason Watts. Figure 1. Special stamp issued by Australia Post celebrating the 50th anniversary of the Australian honours system, featuring the medal and ribbon of the Companion of the Order of Australia. ©Australia Post. Design by Jason Watts. Display full size The aim of this honours system is to recognise Australians who have demonstrated outstanding service or exceptional achievement. The full history of the recognition of optometrists within Order of Australia has been published previouslyCitation1; the aim of this editorial is to update the listing of all optometrists who have been honoured within the Order of Australia over the past half century (February 1975–February 2025) and to celebrate their contributions to the profession.

Objective: The progression of myopia can be slowed using soft myopia control (SMC) and orthokeratology myopia control (OKMC) contact lenses. The purpose of this work is to update an earlier survey (covering years 2011-2018) by describing international trends in SMC and OKMC fitting between 2011 and 2024. Methods: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2011 and 2024. Data are reported here for 8,578 lens fits undertaken across 20 countries to 6-12-year-old children, comprising 688 SMC fits, 918 OKMC fits, and 6,972 non-myopia control (NMC) fits. To assess current trends, the proportion of fits between 2020 and 2024 for 12 countries returning ≥30 myopia control fits was analysed (n = 2,277 fits). Results: There was a small increase in SMC fitting from 0.0 % in 2011 to 3.9 % in 2016, a significant increase to 29.5 % in 2021, and a slower increase to 30.4 % in 2024 (p < 0.0001). The proportion of OKMC fits, in relation to all rigid lens fits, increased from 40.8 % in 2011 to 86.9 % in 2024 (p < 0.0001). Of all soft lens fits, SMC fits were 7.2 % and 8.7 % to males and females, respectively (p = 0.0008). There was a decrease in the percentage of SMC fits with increasing age (p < 0.0001). No such sex/age associations were evident with OKMC fits. The proportion of all contact lens fits over the past 5 years (2020-2024) were as follows: SMC fits - 24 % (n = 525), OKMC fits - 17 % (n = 320), and NMC lens fits - 59 % (n = 1,332). Conclusions: There has been a substantial increase in SMC and OKMC lens fitting over the past 14 years, reflecting a heightened awareness among eye care practitioners and parents of the importance of slowing the progression of myopia in children.

Objective: Advanced cardiac autonomic neuropathy (CAN) is associated with increased mortality in people with diabetes. Early identification and reduction of risk factors can limit the progression of CAN. However, the diagnosis of early CAN relies on cardiac autonomic reflex testing (CART's) which is not widely available. We have compared the diagnostic utility of corneal confocal microscopy (CCM) to CART's in diagnosing CAN. Methods: Two-hundred and thirty eight individuals with type 1 and type 2 diabetes and thirty seven healthy controls were assessed using CARTs and CCM. Results: There was a progressive and significant reduction in DB-HRV, E:I ratio, 30:15 ratio, corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fibre length (CNFL) with increasing severity of CAN. The receiver operating characteristic (ROC) area under the curve (AUC) and sensitivity/specificity of CCM were comparable to those of CARTs for identifying early and definite CAN. Conclusions: CCM is a rapid, non-invasive ophthalmic test which could be used to detect early and established CAN.

In this Prentice Medal Award lecture, I shall recount my career in vision science in the context of three types of inspiration-"being inspired," "personal inspiration," and "inspiring others." My research has derived inspiration from a variety of sources, such as contemporary and historical research doyens in the ophthalmic field and beyond, artists, Greek philosophers, and abstract constructs such as principles and adages. A given moment of inspiration can range from being a profound experience to a subtle realization during a quiet moment of reflection. Here I shall recount the primary research domains of vision science that have defined my academic career in the context of the three types of inspiration defined above. These research domains are ophthalmic markers of diabetic neuropathy, ocular response to contact lens wear, contact lens-induced parainflammation, contact lens-associated microbial keratitis, grading scales for contact lens complications, contact lens prescribing surveys, material properties of contact lenses, contact lens compliance, history of contact lenses, ocular thermography, and ophthalmic bibliometrics. The notions of "being inspired" and "personal inspiration" are necessarily subjective, although I have endeavored to present them here in a scientific context. Conversely, the notion of "inspiring others" can be objectively gauged, at least in part, by counting article citations or the number of times articles are read online or downloaded from a journal website. In conclusion, my research in the vision sciences has been inspired by others, derived from personal ideas, and perhaps in turn has inspired others.

Objective: Numerous multifocal soft contact lenses have been introduced into clinical practice over the past half century. The purpose of this work is to update earlier surveys by describing international trends in multifocal and monovision soft lens fitting for presbyopia between 2000-2023, inclusive. Methods: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000-2023. Data relating to 52,580 soft daily wear lens fits to presbyopes (those ≥45 years of age) undertaken in 20 countries returning reliable longitudinal data were analysed in respect of multifocal and monovision soft daily wear lens fits. Results: Overall, multifocal and monovision soft daily wear lens prescribing to presbyopes has more than doubled over the course of this survey, from 26.4 % of standard soft daily wear lens fits in 2000 to 61.1 % in 2023 (p < 0.0001). There were significant differences between countries in presbyopia soft daily wear lens prescribing (p < 0.0001). Of all soft daily wear fits to males, 45.1 % were multifocal and monovision soft lenses, compared with 52.7 % for females (p < 0.0001). When considered as the proportion of lenses fitted by age, multifocal soft lens fitting peaked between 50-65 years, followed by a precipitous drop until 85-90 years of age, and then an increase beyond 90 years of age. Analysis of 13,014 recent soft lens fits to presbyopes (2019-2023) revealed the following fitting proportions: multifocal lenses - 51 %; monovision - 10 %; and non-presbyopia fitting - 39 %. Conclusions: There has been a substantial increase in soft contact lens correction of presbyopia using multifocal and monovision corrections throughout the 24 years of this survey. A significant number of soft contact lens-wearing presbyopes are not receiving a presbyopia contact lens correction.