At the start of a new CET point-gathering year, 493 delegates attended the largest three-day UK CET course - Eyecare 3000.
The Glasgow conference was also underpinned by the support of 60 exhibitors displaying the newest products and technology. There were additional CET opportunities in the form of three multiple choice quizzes based on the presentations and mini-symposia, giving three extra CET points a day. This year also saw the introduction of plasma screens throughout the exhibition, allowing delegates to listen to the presentations over a coffee and still earn CET points.
Graphic start
Dr Anita Reynolds, consultant ophthalmologist and visiting lecturer at the University of Bradford, started the day with a graphic lecture on ocular first aid, which was certainly not for the faint-hearted. The presentation introduced a problem-solving approach to acute ophthalmological conditions, focusing on what and when to refer. Reynolds took us through the signs patients may present with and the symptoms that should be looked for. Interesting cases were used to demonstrate various red eye conditions, trauma or acute pain.
David Austen (private practice) discussed the most challenging and unusual cases he has treated in his Loughborough practice. These included fitting a free diver, prescribing multiple glasses to aphakic patients - due to pupil dilation causing movement of the IOL-punctum plug fitting and removal - but it was only for the determined, those immune to pain or simply stupid. On a more serious note he used case studies to demonstrate how easy it was to misdiagnose. For example a young boy who had four years of orthoptic treatment in the form of patching - on his first sight-test having been discharged, he was found to have optic nerve hyperplasia, causing the reduction in vision, not amblyopia. Delegates were reminded not to focus so exclusively on the most likely problem, that other possibilities are forgotten.
A field of his own
After the networking lunch, delegates had the choice of seven mini-symposiums to attend. One of the best-attended mini-symposiums was 'Analysing visual fields' by Professor John Wild from the University of Cardiff. This was particularly appropriate for Scottish optometrists, with threshold perimetry being an integral part of the new GOS contract. Wild discussed a variety of case histories and illustrated how to analyse the visual field in more depth and detail, particularly reminding the audience to always 'WANDER' through our visual fields.
Alicia Crilley from Glasgow's St Vincent's School for the Deaf, delivered a presentation on 'How to communicate effectively with patients who have hearing loss'. She gave an insight into the world of a deaf person and highlighted methods that could be used in test rooms to aid communication.
New technology also featured highly, with workshops on Optomap and a presentation by Kevin Lewis, president of the College of Optometrists, on 'Peripheral retinal disease using Optomap'. He outlined the advantages of incorporating peripheral retinal imaging techniques into routine practice, and what might be missed if this is not done.
To round off the first day Dr Gavin Walters, consultant ophthalmic surgeon at Harrogate District Hospital and York Hospital, spoke on 'Adult inherited retinal diseases'. The key to Walters' presentation was appropriately diagnosing inherited diseases and that not all pathology found at the macula is ARMD. He detailed some of the more common hereditary diseases, including RP, which affects one in 4,000 people, and others including Best's disease, dominant drusen and pattern dystrophy.
Strange symptoms
The second day began with Dr Richard Metcalfe, consultant neurologist and senior lecturer at the Institute of Neurological Sciences in Glasgow, discussing various syndromes and neurological problems and the difficulty faced when you 'can't see what the problem is'.
He used case studies to underline the importance of patients' symptoms and problems, regardless of how strange they may seem. Clinical syndromes that occur as a result of disease in the occipito-parietal or occipito-temporal cerebral cortex were described.
Dr Clifford Weir, Gartnavel General Hospital, presented the well-known quandary in an optometric practice, 'Differential diagnosis of the red eye'. The importance of a thorough history was discussed to aid clinical decision making. It is known that, in most cases, practitioners can have an idea of the pathology before reaching for a slit-lamp. Careful and methodical assessment, from front to back will confirm diagnosis, along with careful documentation of the examination and referral where necessary.
Glaucoma therapy
Dr Donald Montgomery, consultant ophthalmologist at Glasgow Royal Infirmary, covered the 'Principles of glaucoma therapy'. This talk discussed, through clinical examples, the value of a tailored approach to an individual's treatment regime. The best treatment is that which maintains vision without reducing quality of life through over-treatment. Ideally, this involves keeping the loss of nerve fibres in line with age-related normal loss, about 15-20 per cent of nerve fibres throughout life.
Dr Catharine Chisholm, of the University of Bradford, presented 'Vision and driving - Would you accept a lift from your 1 o'clock patient?'. She reviewed current vision/visual acuity requirements for driving for both category 1 and 2 driving licences and then discussed the importance of an accurate visual field test on all drivers. The gold standard is currently the binocular Estermann plot. However, this design has numerous limitations. Various tests including the 'integrate visual field', 'the useful field of view' and the 'hazard perception test' were also discussed as alternatives to the Estermann test. In answer to Dr Chisholm's proposed question, it is a definitive 'No!'
Fundus photography
The day continued with a presentation by Brian Moran and Colin West from Keeler. They used new Kowa Non Myd cameras to demonstrate the importance of fundus photography in today's practice. Coinciding with this was a presentation by Anna Sulley, past president and a fellow of the BCLA on 'Management of dry eye' which reviewed a range of clinical evaluations to help understanding of the aetiology of dry eye, the signs and symptoms that should be recognised, the management options for tear replacement and retention along with nutritional advice and patient education.
Bill Harvey tried to develop slit-lamp experts with his mini-symposia on 'Advanced slit-lamp techniques'. He reintroduced a few of the standard techniques including Van Herrick's and the alternative method for assessing anterior chamber depth - Smith's technique. He also revised how to view cells in the anterior chamber and view flare (extra protein in the anterior chamber), both of which are important indicators in the diagnosis and management of anterior uveitis.
Over the course of the first two days, there were two didactic presentations on 'Diabetic screening', from Dr Meena Virdi, Hairmyres Hospital, Lanarkshire, and Dr Alasdair Purdie from the Royal Alexandra Hospital, Argyll and Clyde. Three per cent of the Scottish population have diabetes and the prevalence will double in the next 10 years. The national diabetic screening programme was discussed in more detail, particularly the different levels involved in the grading process. The delegates were able to test their individual ability as a Level 2 screener.
To round off the second day, Keeler sponsored an optometric quiz hosted by Harvey. The quiz tested delegates' knowledge on diagnosis and treatment procedures and processes, with some questions a little more taxing than others. Harvey made everyone stop and think, especially with questions such as 'What eye relation is there between Monet, Van Gogh and El Greco?'. Winner Ian Lucas was presented with a new Volk 4 mirror Gonioscopy lens.
Contact lens day
The final day got off to a mystical start with Dr Phil Morgan (Manchester) doing a little 'Crystal ball gazing: Predicting the future of contact lenses'. He discussed how adequately current contact lenses meet five standards - clinical performance, vision, comfort, physiology and accessibility. He predicted improvements within these standards for commonly used contact lenses, including the introduction of an anti-bacterial coating, an enhancement in comfort in nearly all contact lens groups and a continual increase in our soft contact lens users, especially extended wear users.
Caroline Christie (private practice) discussed the range of contact lens solutions currently available and introduced new products, including OptiFree Replenish which has been specifically designed for silicone hydrogel lenses and incorporates a new agent called TearGlyde to retain surface moisture and enhance wettability. Christie also presented a mini-symposia on 'Successful fitting of the presbyopic patient'. This was an up-to-date review on current contact lens options, covering multifocal soft and hard contact lenses. However, in spite of this, the vast majority of practitioners still opt for good old monovision.
Brian Tompkins (private practice) gave a multimedia presentation on 'Tales of contact lenses'. He took an animated look at the history of the contact lens, recalling the highs and lows. He also spoke about his work in private practice having being fitting silicone hydrogel lenses for seven years and Ortho-K for two years.
The afternoon gave delegates the choice of five mini-symposiums, all covering various aspects of contact lens practice, including specialist fitting, advanced material and new technology.
Edinburgh-based optometrist Scott Brown presented a workshop on orthokeratology (Ortho-K), exploring in more detail the ocular changes involved, the patient selection process and analysis of topographical maps.
The exhibition finished with an 'Interactive contact lens quiz', hosted by Dr Clare O'Donnell, from the University of Manchester.
? Lucy Macfadden is completing her PhD at Glasgow Caledonian University