Specsavers Mini Professional Advancement Conferences (MiniPAC) 2023 ran from March through to June and saw more than 2,300 delegates register.
The series offered an impressive 181 continuing professional development (CPD) sessions, a combination of virtual and live, with 32 speakers, 54 facilitators and nearly 70,000 CPD points issued.
The last of the ten face-to-face events was at The Chelsea Harbour Hotel in London. Delegates selected between four tracks of education, enjoyed the opportunity to network with exhibitors and shared best practice experiences with fellow clinicians.
The event opened in style with a thank you from Paul Morris, director of professional advancement at Specsavers, for the great work leading to the delivery of 12 million sight tests and the high customer satisfaction scores averaging 96%.
He discussed how a growth mindset will help overcome the challenges we face from factors including the cost-of-living crisis and how we can best support ophthalmology to reduce waiting times and burden, by providing enhanced optical services (EOS) in the community.
This is important considering the data released by NHS England that in ophthalmology there were over 650,000 referrals waiting to be seen in November 2022, with nearly 40% waiting longer than 18 weeks. This similar bleak picture appears to be mirrored across the devolved nations.
When considering the landscape of EOS related services across England there are vast differences, the coverage is:
- 74% Minor Eye Conditions Services (MECS)/ Community Urgent Eyecare Service (CUES)
- 81% Glaucoma referral refinement
- 29% Glaucoma monitoring
- 63% Cataract referral refinement
To help with addressing this postcode lottery of EOS availability, in a dedicated session created by Ross Campbell, optometrist and store director at Specsavers, delegates shared their personal learnings from the one million EOS interactions which took place across Specsavers UK practices last year. The aim was to explore how we can best work together to provide these services in practice and to understand how we can support and evolve the commissioning of new and existing services.
Event welcome and recognition of achievements
Useful discussions included the use of triaging, team training and effective diary management, to ensure the appropriate access to care is available alongside all the other great eye services provided.
Given more than 700,000 people in the UK are estimated to have glaucoma, with approximately half of them unaware of their condition, it is no coincidence glaucoma related sessions featured on the programme (figure 3).
Jagdeep Singh, head of new clinical services pathway development at Specsavers, developed a session to support with understanding diagnostic test selection, clinical management, and the appropriate referral pathways for glaucoma patients or those with associated risk factors.
The National Institute for Health and Care Excellence (NICE) guidelines were discussed, and some were surprised by the published recommendations to not offer treatment to people with ocular hypertension who are not at risk of visual impairment within their lifetime, and to provide advice regarding regular visits to their primary eye care professional, at clinically appropriate intervals. [NICE, NG81, 2017].
To support with clinical decision making of suspected occluded angles in primary angle-closure suspects (PACS), the useful ‘PACS PLUS’ and ‘PACS MINUS’ criteria were highlighted (as seen below). The finding of ‘PACS PLUS’ should trigger referral and in the absence of any of these criteria, a ‘PACS MINUS’ individual who does not meet NICE glaucoma referral guidelines, should be advised to seek an annual NHS sight test.
PACS PLUS’ criteria:
Angle Criteria either:
- a limbal chamber depth grade < ¼ Or
- an anterior segment OCT showing irido-trabecular contact (ITC)
PLUS: one of the following criteria:
- A patient with only one good eye
- Patients who are vulnerable and might not be able to report an acute angle closure attack
- High hypermetropia (usually greater than +6.00DS)
- Family history of angle closure
- Diabetic patient that is dilated regularly
- Those using antidepressants or medication with an anticholinergic action
During sessions, cases discussed were typically based on real patient encounters and delegates were reminded of wider aspects, such as the need to flag in cataract referrals any signs of pseudoexfoliation, so surgeons can take extra precautions such as capsular tension rings and iris hooks.
This is because there is an increased risk of fragility of zonules, phacodonesis (tremulousness or vibration of the lens with eye movement) and lens subluxation intra/post cataract surgery.
A common theme throughout the day was a reminder of the need to be proactive in maintaining and developing our clinical skills, with encouragement to complete College of Optometrists higher qualifications, especially as demand for eyecare services will dramatically increase.
To put this into context, 20% of the 8 million outpatient ophthalmology appointments are for glaucoma and the demand for these services alone is expected to nearly double by 2035 (a predicted increase of 44%).
A fun interactive session delivered by Michael Bradbury, clinical operations communications manager took inspiration from the television game show Take Me Out. Delegates responded using light buzzers as to whether they believed there was evidenced based support for various statements.
Delegates gained an appreciation of the benefits of self-reflection from reviewing clinical data, reports and audits, to enhance patient care. Topics of interest included appropriate clinical test selection, recall frequencies and whether to refer based on the individual’s needs, rather than taking a more general ‘blanket’ approach.
Nigel Kirkpatrick, medical director of Newmedica, presented an interesting session on how OCT is interpreted from an Ophthalmologist’s viewpoint. He discussed how to identify true pathology from potential noise in the data, and how to analysis subsequent plots to build a better picture of disease progression.
He warned about the need for good scan quality control to drive appropriate management decisions. Poor capture of data can be due to various reasons including blink, attenuation, or artefacts, and can lead to misinterpretation when compared to the normative data sets.
Myopia management featured in several sessions. Richard Edwards, clinical consultant to the Optical Consumer Complaints Service, used insights from consumer concerns received by the OCCS to provide top tips to avoid future complaints.
Key take homes were to recommend myopia management options where appropriate, the need to maintain good record keeping and the fact that early intervention has been proven to help slow progression. He advised taking a prevention is better than cure approach during conversations.
Industry partner sessions covered the “how” with best practice myopia management guidance when dispensing spectacles and/or contact lenses.
In the dispensing track Dr Alicia Thompson, director of education, research and professional development at ABDO, expertly guided delegates through a hands-on session where delegates took facial measurements to create a card frame for the patient.
Discussions evolved around the differences between various populations and the natural changes that occur with age, to help support better patient dispensing outcomes. There are several anatomical differences between children and adults, which should be reflected in the choice of frame.
The most creative session on the agenda was the dispensing escape room, masterminded by Dan Green, dispensing training manager at Specsavers, where those who accepted the challenge applied optical theory and completed dispensing calculations, within the allocated 45 minutes.
Popular peer review sessions included maximising success with contact lenses, paediatric eyecare and peripheral retina pathology. The latter highlighted how we need to be careful not to miss subtle peripheral tears, which may present with vague or no symptoms and be difficult to detect without comprehensive dilated examination. The use of digital wide field equipment is advantageous and can provide visualisation of up to 200 degrees of the retina.
Peer review sessions
Therapeutic sessions covered ocular pathology that can be successfully managed in practice by those with and without an Independent Prescriber (IP) qualification.
Tips from IP optometrists Kevin Liu and Will Lok shared the importance of developing local relationships with ophthalmology teams and how experience shapes clinical decision making beyond the IP related guidelines available.
Interestingly there appears to be local variations when it comes to first choice drugs, dosages, and with formulations which will influence management plans.
The shift to CPD was reflected by a more diverse agenda. Sessions on supervision, facilitation, leadership, and professionalism were included.
Delegates explored in a session inspired by Dr Josie Forte, Optometrist Store Director, and GOC Council Member, what professionalism means, and ways to embed professionalism in practice.
There was also a chance to reflect on videos kindly supplied from the College of Optometrists and ABDO and which provoked a great deal of thought on the future direction of our professions.
The good news is the high energy levels and community spirit at the miniPAC events has set the precedent for a fantastic main PAC event, scheduled at the ICC in Birmingham on 17th September 2023.
The agenda boasts an impressive 10 tracks of high-quality education, open to all GOC registrants, with something for everyone.
The programme features expert speakers from across the sector with a comprehensive blend of peer reviews, hands on practical workshops, lectures, and discussion sessions. This will be the place to be for networking with fellow peers and over 30 exhibitors.
For more details and to avoid that ‘should’ve gone to PAC feeling’ book today and we look forward to welcoming you at the event. The registration site can be found at: specsaversevents.co.uk/pac/general/home.asp
- Neil Retallic is head of professional development at Specsavers.