While most optical practitioners are well versed in the impact smoking can have on vision, this one-day conference - cleverly titled 'But will it make me go blind?' - shed light on other health-related choices, such as poor nutrition and excess alcohol consumption, and the ocular damage they can cause.
Ash Sharma, a Birmingham ophthalmologist, opened the conference with a talk on lifestyle choices and ocular disease. He highlighted the folly of unprotected sex with the examples of HIV/Aids and chlamydia. Advances in the treatment of HIV/Aids had dramatically changed the nature of the associated eye disease.
However, one of the difficulties in patient management was that patients may not fully comply with treatment and can present with non-classic ocular disease. It was therefore crucial, he said, to assess a patient's CD4 count which monitors the state of the immune system. A high viral load and, therefore, low CD4 count, correlates with eye disease. He then outlined both the external and internal manifestations of the disease. This linked to a brief discussion of the ocular effects of chlamydia, which served to warn practitioners about the dangers of ignoring a non-responding conjunctivitis.
AMD risk factors
Wing CommanderRobert Scott, ophthalmologist at the Royal Centre of Defence Medicine, began by relating the known risk factors for AMD, including poor diet, lack of exercise, genetics and raised cholesterol. After describing the physical changes in AMD, Scott discussed the recent and dramatic changes in drug treatments for AMD. The anti-vegF treatment Macugen (pegaptanib) he described as 'space age work' - being engineered specifically to target VegF. The treatment works because it reduces the permeability of the vessels and thus moderates the trigger for neovascularisation. Moving on to 'the competition' he then discussed Lucentis (ranibizumab). He described this as 'rougher and readier' - not specifically engineered but developed from modified mouse antibodies. He said it was something of a 'magic wand' in comparison to current treatments. Trials of Lucentis have indicated that it not only maintained but improved vision in many people. He finished by outlining the practical details and explaining the risks of intraocular injection and some of the milder side effects. Unsurprisingly, he was quizzed about funding. One useful piece of information was that in some cases St Dunstan's, the organisation supporting ex-service men and women, has been able to help.
Cooking up an interest
Ian Grierson, professor of ophthalmology at Liverpool, described himself as a 'lab scientist with an interest in MD and cooking'. He concentrated on the role of nutrition in ocular disease. He described the macula as a 'battleground' with the retina as the 'war-zone' and went on to outline the role of anti-oxidants in strengthening the retinal defences. He backed this up with evidence from the ARED study, and went on to add some of the recent thoughts about the role of the pigments lutein and zeaxanthin. Entering the debate on supplements versus general nutrition he concentrated on the role of a good diet, giving examples from his cook book, Vegetables for Vision.
After lunch delegates participated in the blind driving challenge, which involved blindfolded delegates driving radio controlled toy cars around a circuit, picking up fruit and vegetables and avoiding empty bottles. The winning team was awarded with a basket of healthy goodies.
Carol Carter, a stop smoking nurse specialist, discussed why people smoke and the myriad of associated health issues. Each year, 105,000 people die in the UK from tobacco use. One-half of all smokers die prematurely at an estimated cost of £1.7bn to the health service. She described the evidence basis for smoking cessation programmes and outlined an approach which advocated nicotine therapy, group and one-to-one work.
Images of trauma
Barry Bench, senior lecturer from Aston University, led a session entitled 'Who needs protection?'. He began by warning the audience of a macabre interest in the subject and didn't disappoint with several graphic slides illustrating the folly of not using the appropriate eye protection. A slide of an angle grinder injury was particularly memorable. He finished his talk running through the various materials available - outlining the different characteristics of such materials as safety glass, CR39, Trivex and polycarbonate.
Stepping in for Dr Colin Fowler, Dr Robert Cubbidge ended the day with a discussion on tinted lenses. He described the nature of ultraviolet light and its impact on ocular structures and went on to explain that many of these issues have been recognised for some time. He looked at the development of standards for sunglasses - reminding delegates of the current regulations. He stressed the importance of being able to assess the physical qualities of devices. He illustrated this with some interesting tales from Dr Fowler's collection. One of these involved bargain-hunting for sunglasses and a comparison between 'Poundland' sunglasses and other low cost samples. Although the ultra-cheap pairs - just 36p - failed, the 'Poundland' version passed the test. A salutary note for those practitioners returning to designer outlets.
Mary Bairstow is low vision implementation officer at the RNIB