While introducing the programme, BCLA president Neil Retallic was excited about the wide range of programmes on offer, which covered every avenue of the anterior eye and contact lenses: scleral lenses, meibomian gland dysfunction (MGD) and dry eye, contact lens compliance, pearls for contact lens practice, myopia management, corneal topography, anterior eye OCT, paediatric contact lenses, and orthokeratology.
The conference planning started more than one year back, and the BCLA council and the academic committee were behind the design, planning and implementation of many great ideas, as well as supporting CEO Luke Stevens-Burt and the BCLA office team. The whole team deserve applause for successfully delivering this programme after four years.
Fresh vision
Dr Debarun Dutta, lecturer at Aston University and author of this report, coordinated BCLA student ambassadors from seven British contact lens educational institutes to present their views on the future of contact lens practice. The budding clinicians hailed from Aston University, University of Bradford, Cardiff University, Bradford College, Glasgow Caledonian University, University of Hertfordshire and Manchester University.
In a combined effort, they showcased their thoughts on the future of contact lens sustainability, student resources, future technologies that can change optometry practice patterns, contact lens complications and the perspective of international candidates while studying optometry in the UK.
The meeting included 16 peer review and skill development workshops, which offered a wide range of key topics in the field: myopia management by contact lenses, dry eye and ocular surface management and speciality contact lenses. This year BCLA saw 62 cutting-edge research presentations, which were attended by packed rooms of delegates.
Rabia Mobeen from the University of New South Wales, Australia won the BCLA Da Vinci Award, which recognises significant work by an early researcher or member of staff contributing to a better understanding of contact lenses or manufacturing.
Her presentation on ocular response to immediate soft contact lens wear summarised how, immediately after soft contact lens wear, corneal nerves and cells closely communicate with each other and respond to immune reaction.
This work implies that when eye care professionals (ECP) prescribe a contact lens, a passive immune response should be expected, which may not be visible with regular slit lamp examination.
Micro-credentials
Throughout the three days, four parallel tracks of clinical lectures, workshop/skill development, and CPD events were planned. One of the innovative additions to this year’s event was the introduction of micro-credentials, which were designed to identify that an individual who has focused learning on a particular specialism.
Micro-credential certificates were offered in four topics for 2023: advanced contact lenses, dry eye, myopia control and ocular health, which were tagged each session. The workshops/skill development sessions had two micro-credential themes: a dry eye management course, and a myopia management course.
One of the keynote presentations was delivered by Professor Gregory Sawyer, chair of the department of bioengineering at the Moffitt Cancer Centre in Tampa, Florida. Prof Sawyer summarised that the surface friction of contact lenses may not be the most important parameter for contact lens comfort, rather sheer stress is likely the key.
Lowering the contact pressure may lower the chances of inflammatory ocular reaction, leading to comfortable contact lens wear and reduced adverse events.
He also outlined the interaction of contact lenses and mucins in the corneal epithelial cells, which may trigger inflammatory reactions that make contact lens wear uncomfortable.
In another keynote session, Professor Frank Schaeffel began by detailing the importance of visual cues for emmetropisation and mechanics of myopia control. Stimulatory and inhibitory pathways are key for appropriate eye growth, whereas the absence of an inhibitory signal in myopic eyes underpins the reason behind uncontrolled ocular growth.
Professor Schaeffel also stressed that we need a better understanding of the mechanics of myopia-controlling factors. He detailed the latest literature on human and animal model studies and concluded that, perhaps, positive defocus may not inhibit myopia progression but rather an alternative well-defined retinal image blur responsible for the inhibition pathway.
Myopia management
There were plenty of lectures and evidence-based clinical discussions in the area of myopia management. The first session was kick-started by Professor Nicola Logan, Dr Neema Ghorbani Mojarrad and Kathryn Sanders, discussing how well children adapt to contact lenses.
They stressed that despite strong longitudinal clinical evidence and available treatment options, most ECPs still prescribe single-vision glasses to myopic children. Slowly but certainly, the habits of paediatric prescribing are changing, however, significant differences still exist in clinician approaches and prescribing habits.
Dr Debbie Jones, Indie Grewal and Dr Elena Garcia Rubio presented an overview of the prevalence of myopia and detailed their decision-making process for young myopia patients. They also discussed how to manage compliance and tailor myopia management based on lifestyle.
A series of scientific presentations on myopia control was planned for day two. This included topics such as global trends in prescribing patterns and attitudes towards myopia control why ECPs are reluctant to fit contact lenses on children; defocus patterns on a proprietary myopia control contact lens; and a 2022 CooperVision Force competition winner presentation on accommodative micro-fluctuation and reading speed in children using various myopia management contact lens designs.
The third series of white papers from the International Myopia Institute was published in May 2023, and the key findings for the past two years were discussed at the conference.
In a series of discussions, Professor Ian Flitcroft, Professor Ed Mallen, Associate Professor Lisa Ostrin, Dr Kate Gifford, Professor James Wolffsohn and Professor Nicola Logan summarised implications of wavelength and intensity of light on eye growth. They also observed results of new pharmacological agents and scleral crosslinking as potential strategies for slowing myopia progression.
Although topical atropine remains the only widely used pharmacological treatment, a rebound effect can be observed with higher concentrations, but unlikely for lower concentrations of atropine and optical corrections. Good results were observed across the myopia control strategies delivered by contact lenses, in the form of multifocal lenses and orthokeratology.
Overall myopia control treatment strategies remained safe with negligible or no side effects for children. This treatment provided significant improvement in visual outcomes.
Given that now we have several well-established myopia control strategies, it is hotly debated if it is ethical to prescribe single-vision glasses to children with early or low myopia.
The presenters argue that additional regulations may be required for widespread awareness and use of myopia control strategies in high street practices. In addition, a new term, ‘pre-myopia’, is gaining interest with increased attention to the early implementation of myopia control.
Dry eye Management
Not surprisingly, there were several sessions at this year’s BCLA that looked at the implications of contact lenses on ocular surface and dry eye disease. Professor Lyndon Jones, Professor Jennifer Craig, and Professor James Wolffsohn outlined the new practical tool Dry Eye Wheel, which was co-developed as a joint venture between the World Council of Optometry and Alcon.
This is an interactive tool designed to help with the diagnosis and treatment of dry eye disease. The wheel has three key components: measurement, management and mitigation.
The first component, measurement, includes diagnosis and subclassification of the disease, whereas the second component, management, is aimed at three subcategories: mild, moderate and severe.
The last step, mitigation, has two components: triaging and risk factors. The wheel is designed in such a way that ECPs worldwide are able to use and apply it in their practice.
BCLA 2023 saw some of the early dissemination of the latest TFOS Lifestyles report on the ocular surface, which involved 158 experts from 38 countries. This was presented by some of the subcommittee leads of the report: Professor Jennifer Craig, Professor Lyndon Jones, Professor Fiona Stapleton and Professor James Wolffsohn.
Given that the ocular surface, particularly the tear film, is susceptible to modifications due to external, applied or internal environments, the report sought to summarise and increase awareness of the potential impacts of patients’ lifestyle choices.
Eight topics were discussed that focused on the digital environment, contact lenses, cosmetics, elective medications and procedures, nutrition, environmental conditions, lifestyle challenges and societal challenges.
Professor Etty Bitton from Université de Montréal began by outlining a number of studies, including the recent TFOS Lifestyle report,
showing the impact of the composition of ocular lubricants, such as artificial tears and ointments, on the eye.
She provided an overview of the ingredients to gain a better understanding of their function in the treatment and management of dry eye. In addition, innovations in bottle technology were also presented, which aid current practitioners to consider when selecting an ocular lubricant.
The 2023 BCLA Irving Fatt memorial lecture was delivered by Dr Sònia Travé-Huarte (pictured), a post-doctoral research fellow at Aston University. She detailed her PhD work aiming to streamline dry eye management and treatment supported by evidence emerging from her doctoral research.
Corneal and ocular surface diseases
There were multiple topics covering a wide range of lecture and workshop sessions on corneal and ocular surface disease. Cindy Thomas, head of optometry services at Manchester Royal Eye Hospital, looked at the common cataract pathways that utilise primary care optometrists in preoperative assessment, referral and post-operative management.
Given that more and more optometrists in the UK are gaining therapeutic training and becoming accredited for independent prescribing, Thomas emphasised therapeutic management of blepharitis, postoperative treatment and management, management of complications and emergency conditions, such as endophthalmitis.
Professor Sail Kolli, an ophthalmologist and a lead consultant for cataract and corneal surgery at University Hospitals Birmingham, shared his views discussing the management of bacterial keratitis and patterns of antibiotic resistance found in the UK.
He explained the need for an appropriate referral for contact lens-related keratitis and procedures of ocular swabs for timely detection of causative microorganisms of keratitis, particularly important for fungal and acanthamoeba infections.
In a second lecture, Prof Kolli discussed the management of pinguecula and pterygium. Although they may rarely cause major ocular symptoms and can become irritable for contact lens wearers, perhaps a close co-management of optometry and ophthalmology is required for better patient diagnosis and treatment outcome.
Consultant ophthalmologist Dr Soupramanien Sandramouli detailed the diagnosis and management of lumps and bumps of the anterior eye. He mentioned that these are common conditions of ophthalmic healthcare and affect all age groups.
They are primarily benign and not sight-threatening, except for the malignant ones. He explained the distinct characteristics that can aid early diagnosis, leading to better prognosis and outcome.
Optometrists play an important role in early recognition and appropriate referral, which are highly essential to manage such conditions successfully.
Gladiatorial combat
In a fun-filled session titled ‘Gladiators Pitch’, four gladiators, Professor Nicholas Rumney, Brian Tomkins, Keith Tempany and Prof Etty Bitton, pursued BCLA emperors to part with their cash to invest their ideas for contact lens practice. BCLA CEO Luke Stevens-Burt, Dr Jonathan Jackson, Sarah Farrant and Rakesh Kapoor acted as the emperors.
Tomkins argues to invest in him with a happy tears towel, whereas Prof Bitton’s plea for service was the most popular among the audience. Overall, they argued the current eye care delivery models and the scope of growth and opportunity in contact lens practice.
Professor Eric Papas was the recipient of the 2023 BCLA medal award, and his lecture was saved as the last session of this year’s BCLA conference. It is the Association’s most prestigious award, given to an individual at the biennial BCLA Clinical Conference and Exhibition and recognises outstanding achievement in the field of contact lenses and/or anterior eye.
Professor Papas showcased his life journey working on contact lenses and the anterior eye, working with giants of this field and training
the next generation of clinicians and scientists. Starting as a humble optometry graduate from Manchester University to a professor at the University of New South Wales, Australia, his life was shaped by good people, good luck and football.
The closing session saw Rakesh Kapoor (pictured) succeed Neil Retallic as the president of BCLA, who described his vision for an ‘inclusive and accessible’ future supported by skills and knowledge sharing among the BCLA members and beyond.
He said the outgoing president coped very well over the past two years, what must be the most turbulent time for contact lens and anterior eye practice. The conference part of the event ended with a promise to meet again next year with a BCLA UK conference, which will be organised in collaboration with the College of Optometrists’ annual meeting on April 28-29, 2024, in Telford.
Dr Debarun Dutta is a tenured lecturer at the Optometry School, Aston University. In this balanced academic role, he is responsible for reach and teaching, his primary area of research and teaching interest are contact lenses, ocular surface, and eye infections.