Over the past four years the event has doubled in size, this year attracting over 200 delegates, who were able to access an impressive range of 11 lectures, 12 workshops and an exhibition. This article can only pick highlights of the many on offer.
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The conference was opened by John Tickner (private practice) who holds the College diploma in ocular conditions and has a special interest in medical statistics. Tickner encouraged delegates to get involved in therapeutics, a rapidly changing area of optometric practice. As a consequence of this change, traditional sources of information that give guidance on how we should practice are out of date, but we must still seek evidence-based medicine to guide treatment options.
To understand the validity of studies, mathematical theory is used to establish the significance of the data, the risk ratio, and the confidence factor among other validity predictors. There are many methods of analysis which may be used to present data in the most favourable light.
To illustrate his point, Tickner asked the audience to decide from four seemingly conflicting sets of results, which they would most trust for the treatment of glaucoma. In fact, all the results were derived from the same study. Understanding methods of analysis points the optometrist to search for those sources that have meta-analysis, which is a systematic review of all studies in a subject area, and is the most reliable method on which to base treatment options.
Dr Fiona Fylan, a reader in psychology at Leeds Metropolitan University, researches into applying psychology in the eye care environment. She gave tips based on observation and interviews with patients and professionals for better management of our patients. We need to understand our patient’s perception of the eye examination and modify our behaviours accordingly. Patients do not like being hurried, so throughout the examination we should use open body language and not give any impression of impatience. Patients may be concerned that we encroach upon their personal space and also whether we are recording adverse findings. Hence, we should warn that we may be close for some of the tests we perform and explain what we are doing, our findings and our note taking as we go along. A tip is to ask the patient if there are any questions they would like to ask. Our patients will understand the relevance of our tests if we avoid technical language with the added benefit of improved compliance with any course of action recommended.
A workshop run by Sarah Morgan, visiting lecturer at Manchester University, gave delegates a further opportunity to consider their consulting room behaviours. Morgan suggested that we consider how we put over our questions and, where possible, use questions to help educate about our role and the importance of the eye examination.
Morgan also suggested that when introducing products to patients, it is important they understand the product and this can be achieved using a ‘features, advantages and benefits’ approach. Finally, Morgan considers that everyone should be dilated at least once to appreciate presbyopia and all that that entails.
At the conference, the College launched iPRO, a research support facility, funded by the College. This is designed to encourage and support practice-based research carried out within the setting of community practice. This presents optometrists with the opportunity to develop skills in research with access to expertise in this area, attend courses and apply for grants. Further details are available from the College.
Memorial lecture
The 2007 George Giles memorial lecture, ‘Prospects for change in the treatment of uveal melanoma’ was given by Professor Bertil Damato, Director of the Ocular Oncology Service at the Royal Liverpool University Hospital.
In Liverpool, small tumours are now treated with radiotherapy and larger tumours, that were previously treated radically, with enucleation, are now also treated by radiotherapy, in the hope of conserving the eye with as much useful vision as possible.
Most uveal melanomas are detected by optometrists and many patients are asymptomatic at the time of detection. However, there are symptomatic patients that are not detected by optometrists, with the detection failure contributing to loss of useful vision.
Damato acknowledged this is a difficult area for optometrist as they see very few cases in their career.
To help diagnosis he explained that the optometrist should listen carefully to the patient’s history and there are features that will alert the optometrist, which he gave as an acronym – MELANOMA:
? Melanoma visible externally
? Eccentric visual phenomena
? Lens abnormalities
? Afferent pupil defect
? No optical correction
? Ocular hypertensive
? Melanocytosis
? Asymmetric episcleral vessels.
Damato’s Liverpool unit has set up an online atlas facility that gives optometrists access to a gallery of photographs and the option to complete a scorecard that gives an indication of the action that should be taken from ‘monitor’ through to ‘urgent referral’. This is available at www.eyetumours.com.
James Talk, consultant ophthalmologist at the Royal Victoria Infirmary, Newcastle, discussed recent innovation in the treatment of AMD. Until recently, the treatments available were laser or photodynamic therapy, both which are potentially destructive with only about 20 per cent of patients eligible. There is now a more targeted approach using anti-VEGF (vascular epithelial growth factor), treatments such as Macugen, Lucentis and Avastin. In particular, Lucentis and Avastin appear to not only slow progress of AMD, but may improve acuity. Lucentis is licensed for use, while Avastin can only be used ‘off label’, so it is important that the patient knows that research data is limited and gives informed consent. Knowledge of these new areas of treatment is developing rapidly and it would be surprising if the College conference next year does not return to this subject.
? David Cartwright is past president of the College of Optometrists