Glasgow from A-Z

Now that compulsory CET is making its presence felt in optometric practices all over the UK, it is perhaps unsurprising that over 450 delegates escaped the January chill to hide away in Glasgow's Marriott hotel.


Professor Bernard Gilmartin of Aston University gave the keynote lecture entitled 'The global epidemic of myopia - pathways to therapy'. This presentation gave an up-to-date overview of the prevalence, aetiology and treatment of what to many of us is our bread and butter. Although increasing numbers of people with myopia could be seen to be a boon to optometrists everywhere, it was clearly stated that the European prevalence of around 25 per cent of population was low compared with 80 per cent of young people in Hong Kong.

This level of myopia produces a substantial economic burden and significant increases in risk a variety of associated ocular pathology.

Professor Gilmartin presented the current thinking on the risk factors for myopic progression, mentioning in the process local contributors Professor Heron, Dr Gray and Dr Seidel, all of Glasgow Caledonian University. An area that inspired particular interest was the insight into the 3D ocular modelling currently being worked on at Aston's School of Life and Health Sciences. Also covered was a summary of recent research into treatment strategies and where the future might lead.

Following Professor Gilmartin, delegates had a choice of interesting lectures at either end of an optometrist's remit: 'Why the detection of systemic hypertension is important to optometrists' by Dr Russell Watkins or 'A spectrum of corneal disease' from Dr Joe Colerio.

The former was a highly popular lecture which, although may not have fulfilled its early sex, drugs and rock 'n' roll promise, certainly didn't disappoint with the systemic and ocular effects of hypertension being explained, alongside useful tips on detection and referral. Cardiovascular disease is the most common cause of death in the UK and early detection followed by careful management has been proved to reduce morbidity and mortality. Dr Watkins pointed out that optometry is ideally placed to provide a much-needed screening service. The variety and wide range of content that was included is, perhaps, related to the varied and wide-ranging career of the speaker. Optometry, vision research, ophthalmology, journal editing and now pathology at Leeds General Infirmary, all feature on Dr Watkins' impressive CV.

Dr Colerio, of Ninewells Hospital in Dundee, explained how the cornea is subjected to a wide variety of microbial insults on a daily basis, and what occurs when the eye's innate defences fail. As Dr Colerio noted, this was especially common in soft contact lens wear and, as such, competent aftercare was vital for long-term ocular health.

Dr Colerio then explained how both herpes simplex and zoster have a tendency to recur, with potentially devastating effects. It was also mentioned that most optometrists come into contact with patients who have corneal dystrophies, especially keratoconus, and practitioners should be aware of how to manage them correctly.

The lectures continued with Professor Sudi Patel talking on the subject, 'How much abuse can the visual system tolerate?' The optometric adviser for NHS Scotland took time out to give a well attended and well presented paper which covered the effects of a wide spectrum of substance abuse, the tell-tale signs of physical abuse, including the legal ramifications of locating them, as well as the ocular manifestations of malnutrition. Also covered was the management of failed ocular or refractive surgery. This is a small proportion of patients but ones with particular needs and requirements, and Dr Patel walked us through these in detail.

Also being presented at this time was 'What's new in amblyopia treatment?' by Dr Brendan Barrett of the University of Bradford. This was an up-to-date review of recent research, including the much-publicised 1997 NHS report, which questioned the effectiveness of patching. However, as Dr Barrett demonstrated, recent research has provided stronger evidence for treatment in most, if not all, degrees of amblyopia. Of central importance in this area is the results of the recent amblyopia work coordinated by Dr MP Clarke published in the British Medical Journal (BMJ 2003; 327: 1251). This large-scale randomly controlled trial showed a large treatment effect, from patching, on those with moderate (6/12 to 6/18) and severe (6/24) amblyopia but very little effect gained by combining patching and refractive correction for those with milder amblyopia.

Coupled with secondary findings such as the similarity of results when treatment is deferred by a year should give optometrists the courage to refract, dispense and monitor this group of patients knowing that even if the visual acuity doesn't improve, no lasting damage has been caused.

Also noted was the difficulty in differentiating mild optic nerve hypoplasia from amblyopia, a possible cause for the large numbers of patients, up to 40 per cent in some studies, who fail to improve with compliant treatment.

Dr Barrett also sought to reopen the debate on the causes, associations and correlates of amblyopia. Given the prevalence of amblyopia, at up to 6 per cent, this is an area that optometrists should continue to be interested in.


CONTACT LENS CONFIDENCE
One of the more oversubscribed workshops was Dr Vicki Evans (Ciba Vision) presenting on the subject of silicone hydrogels in all their forms and wearing modalities. Dr Evans was eager to point out that, often in practice, we base our lens decisions on 20-year-old research, and that both current knowledge and lens options have moved on in that time. One of the latest options is O2Optix lens, a daily wear silicone hydrogel lens with a dk/t of 138. This lens enables a safety margin for those times the patient just has to have that night out after work or really needs that nap without removing their lenses.

Ron Loveridge (also Ciba Vision) discussed his views on specialist lens fitting and how cultivating these skills are good for patients and practitioners alike. The take-home message was that by becoming more confident with RGPs, soft torics and multifocal contact lenses we can offer the services that patients want, and thus secure a bright future.

New technology also featured highly, with workshops on Optomap and the use of digital image capture in diabetic screening. Kevin Lewis, vice president of the College of Optometrists, presented on the advantages gained by incorporating peripheral retina imaging techniques into routine practice, and also what might be missed if one doesn't. Lewis noted that increased detection does not mean increased referral, as with experience comes knowledge and confidence.

Dr Trusit Dave took practitioners through the National Screening Committee's camera specifications and the advantages of going beyond their minimum chip and pixel levels.