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And for the audience of more than 1,520, nearly 1,300 of them Dutch, the formula works. As many as 50-60 per cent of contact lens practitioners in The Netherlands attended the NCC this year, and many others had to be turned away as numbers reached maximum.
The NH Conference Centre Konigshof, a former convent on the outskirts of Eindhoven, is the largest venue in the Benelux region and was filled to capacity for this, the fourth congress organised by two Dutch organisations: the NAC (Nederlandse Associatie van Contactlensleveranciers) and ANVC (Algemene Nederlandse Vereniging voor Contactlensspecialisten).
Informal style
'Getting in Control' was the theme for the programme which featured three tracks of lectures plus workshops and seminars. The two-day meeting had more than 30 industry sponsors and exhibitors, with many local labs participating alongside the major multinationals, reflecting the unusual nature of the Dutch market.
Each session followed the overall theme, from 'Getting in Control of Nerves' for the novice presenters in the rapid-fire session to 'Getting Out of Control' that led into a happy hour to close the first day's proceedings and prepare for the evening's enjoyable 'social' (no gala dinner here).
Most of the presentations were delivered in English. Not surprisingly, a session called 'Getting in Control of the Dutch Guys' was entirely in Dutch, with slides in both languages, as were some of the sponsor lectures.
Presentational style was informal with head-mounted microphones and a catwalk stage extending into the audience in the main auditorium rather than speakers standing at the podium.
The overall aim was clearly to entertain and engage with the delegates, who were the focus of attention for the organisers throughout the meeting.
Chairman of the programme committee Marco van Beusekom explained its appeal: 'One of the reasons this conference has become so popular among Dutch ECPs is the fact that it has a practical approach, so today's knowledge can be used in practice tomorrow. Since this conference is biennial, it also functions as a reunion meeting where people from all types of practices join and talk about their passion: fitting contact lenses. And last but not least, we always try to connect clinical science and practice to fun elements - like we did with the Contact Lens Fairy Tale during this conference.'
UK contingent
Familiar names from Canada, the US, Australia and Hong Kong appeared on the programme, along with many from Benelux and elsewhere in Europe. The UK contingent included Sarah and Philip Morgan, who along with NCC regular Brian Tompkins, were prominent in the 'edutainment'.
Lyndon Jones described the NCC as 'a fantastic meeting', and one that presenters looked forward to being invited to. 'It's a privilege to come here, not just for the quality of the talks but for the quality of the audience. And can you guys party!'
Other than speakers and industry representatives, there were few delegates from the UK. CLO Mark Chatham was one of several CooperVision clinical specialists attending a meeting to coincide with the congress. A first-time visitor, he liked the NCC's informal approach to learning which created an atmosphere different from most other conferences.
'It's much more laid back,' he said. 'The educational content is very good, although I'd like to gain CET points for attending. I'd also prefer two tracks to three so that I didn't have too many choices to make.'
Chatham attends the BCLA clinical conference every year although the UK event's Thursday to Sunday format means more time out of practice. Practices in Holland often open late on Monday so a two-day meeting running from Sunday morning is a popular option.
Regional differences
Aside from a relaxed approach and convenient timing, what does the NCC offer visitors in comparison with other meetings? Running the event every other year means that speakers tend to review developments over the previous two years rather than presenting new data for the first time, as they might at the BCLA, American Academy of Optometry or research meetings such as ARVO. The NCC's emphasis was more on education than research. There was also the chance to hear more about RGP and specialist fitting, reflecting differences in prescribing between Holland and its neighbours, and to learn about lenses and instruments that are either unavailable or not widely used in the UK.
Dutch practitioners fit one of the highest proportions of rigid lenses in the world with one if five of all fits in 2011 an RGP lens. The reason is regulatory: contact lens sales have few restrictions in Holland which makes fitting RGPs more attractive than soft lenses.
Remarkably, Dutch practitioners were as likely to fit orthokeratology lenses as daily disposable lenses, which both accounted for 6 per cent of all fits last year. Contrast this with the Nordic countries which have some of the highest prescribing rates for soft lenses and for daily disposable lenses in the world. Norway tops the chart (along with Italy) with 44 per cent of all lenses fitted a daily disposable, with the UK not far behind on 38 per cent.
Total experience
For this reason it was surprising to find that CIBA Vision's Total 1 silicone hydrogel (SiH) daily disposable lens has already been available in Benelux for six months. For most UK delegates this was the first chance to hear about the new lens which is likely to be launched here later this year.
Sebastian Marx (JENVIS Research Institute, Germany) described Total 1 as the first 'water gradient' SiH lens with an increase in water content from core to surface from 33 per cent to more than 80 per cent. The surface was 10 per cent of the lens thickness and was designed to bind water while not disturbing the high transmissibility of the core (Dk/L 156 @ -3.00D). A key feature of the lens surface was its lubricity, said Marx.
Clinical trials at the University of Waterloo comparing Total 1 with Clariti 1 day and 1-Day Acuvue TruEye in 104 asymptomatic and symptomatic subjects found higher ratings for overall comfort and satisfaction for the new lens, he said.
Marx's own evaluation from 16 subjects was that the lens performed well for end of day vision and dryness, showed slightly more movement than their habitual lenses and handled well overall. Removal could take 2-3 attempts and required the hands to be dry, he added. The material is delefilcon A and in Holland the lens comes in an 8.5mm base curve, 14.1mm diameter and minus powers to -10.00D.
Controlling myopia
New applications for contact lenses were among the best covered topics on the lecture programme. The opening sessions on myopia control, in particular, brought together some of the world's leading authorities to review the latest findings.
First up was Earl Smith (University of Houston) who described the animal studies that led to our current understanding of myopia development. Light exposure was an important factor and time spent outdoors had a strong protective effect against myopia in children.
Preliminary clinical results suggested that optical treatments that took peripheral refractive error into account were more likely to be effective than other myopia control strategies such as progressive addition spectacle lenses.
Dual-focus soft contact lenses and orthokeratology 'showed promise' and researchers could now talk with confidence about lenses that not only corrected vision but had therapeutic value. It was unclear how successful these strategies could be; as yet the treatment effect was small, 40-50 per cent at most, and gold standard clinical trials were needed, he said.
Jeff Walline (Ohio State University) agreed that these contact lenses were the best approach to slowing myopic progression. 'We're on the cusp of results becoming clinically meaningful but not quite there yet,' was his assessment.
Michael Collins (QUT, Brisbane) added new information about the role of the choroid in eye growth regulation. Introducing positive and negative blur resulted in thickening or thinning of the choroid 'in a matter of minutes', effectively changing the axial length of the eye. Short-term changes in the choroid could therefore be markers or precursors to longer term changes related to refractive error development.
Choroidal thickness also varied with time of day, exercise and in different directions of gaze, raising some interesting clinical implications.
Orthokeratology
The focus for anti-myopia strategies was mainly on orthokeratology, which was also the subject of a separate session looking at ways of evaluating the ortho-K eye. Helen Swarbrick (UNSW, Sydney) identified the key questions about the technique that parents needed to have answered: Will OK work for my child? Will it stop my child from becoming more myopic? How long will the lenses need to be worn? Is there a risk? And is OK the best choice? Only one of these had so far been answered: there was an increased risk of infection with ortho-K and it was similar to that of overnight soft lens wear. Rebound effects on ceasing treatment, whether lenses might need to be worn from ages 6-8 to 18 years, how to predict which child would respond? All were unclear. It was early days, said Swarbrick.
Pauline Cho (Hong Kong Polytechnic University) and Jacinto Santodomingo (Menicon) both reported results comparing myopic progression with the Menicon Z Night lens with single-vision spectacles over two years, from the ROMIO and MCOS studies respectively. Cho had seen encouraging results with toric orthoK in the TO-SEE study. Santodomingo suggested switching and combining treatments, periods of time without treatment and optimised lens designs were among the future prospects for myopia control.
The final speaker of this useful session, José Gonzalez-Méijome (University of Minho, Portugal) reviewed the literature on soft lenses for myopia control and the differences between the dual-focus (Anstice and Philips) and peripheral gradient (Sankaridurg et al) approaches.
Earl Smith summed up with the comment that currently used anti-myopia lens designs were 'very primitive' and were not optimised for individuals.
In fact the need for more customised lenses and personalised correction was one of the take-home messages from NCC2012, again reflecting the skills and interests of its audience. For UK visitors, the meeting provided a welcome change and a fresh perspective on contact lens practice from a market very different from our own. ?
? www.ncc2012.nl. The next NCC takes place on March 16-17, 2014.