Of all the educational events on the crowded spring calendar, Optometry Tomorrow is one that seems to go from strength to strength. With record attendance of just over 700 delegates, more CET points on offer and a larger trade exhibition, the 2015 conference built on the success of previous years.
Eight parallel streams of lectures, workshops, peer discussion, interactive and sponsor sessions over the two days of the conference gave rise to a constant fear of missing out. But with a little forward planning, delegates could visit the topics that interested them most and were delivered in their preferred learning formats.
A dedicated therapeutics stream on the opening day provided the IP qualified with much-needed points and a small poster display was CET-approved for the first time. This year there was also more emphasis on the College’s own resources, with moderators promoting related patient leaflets, research reports and higher qualifications after each session.
On the lecture programme, a series of review lectures covered topics from macular degeneration and glaucoma to recent findings in contact lenses and myopia control. Patient-centred approaches to optometric services were another strong theme and there was information about community eye care schemes underway around the country.
Here are just some of the key messages to take home from a small selection of lectures and seminars, along with news of recent developments.
Advances in AMD
[CaptionComponent="1153"]Ophthalmologist Shahram Kashani (East Sussex Healthcare Trust) said that better diagnostics and treatment interventions were needed for managing age-related macular degeneration.
Therapeutic approaches included new drug delivery methods such as implants and topical agents, visual cycle modification and inflammation suppression. Longer lasting injections, gene therapy and radiotherapy treatments were also in prospect.
On oxidative preventative measures, Kashani advised supplements only for patients with intermediate AMD in one or both eyes and for those with advanced AMD in one eye but not in the other. ‘Make sure whatever product you’re offering reflects that used in the AREDS trial, and for current or ex-smokers avoid formulations with beta-carotene,’ he said.
John Lawrenson (City University) continued the theme with a review of lifestyle factors and their effects on vision. Around 70 per cent of causes of visual impairment were linked to modifiable risk factors, said Professor Lawrenson, and smoking was consistently found to double the risk of AMD.
Only 30 per cent of optometrists, compared to 70 per cent of ophthalmologists, asked patients at every visit whether they smoked. A pilot scheme in Shropshire looking at the impact of an educational intervention centred on smoking cessation found that patients’ knowledge and actions improved.
Since 2013, local authorities in England had been responsible for risk assessment and health promotion. NHS Health Checks provided an opportunity for optometrists to get involved. Dudley LOC was about to begin a Healthy Living Optician pilot, incorporating the NHS Health Check with smoking cessation, weight loss and alcohol advice.
Karen Walsh (Johnson & Johnson Vision Care) provided an update on another lifestyle exposure: UV and the eye. Recent studies found that ascorbic acid had a protective effect against cataract formation and that UV-blocking contact lenses maintained levels of this antioxidant in the anterior chamber.
Macular pigment had a density-related protective effect against developing AMD. Macular pigment density was 25 per cent higher in a group wearing UV-blocking contact lenses for five years than in a control group.
Researchers at Aston University were working towards an equivalent of SPF factors for contact lenses, similar to those used in skin care, that might ‘elevate conversations in practice’ about the effects of UV on the eye, said Walsh.
Falls prevention
Can optometrists help prevent falls? asked David Elliott (University of Bradford). The answer was yes, by following his evidence-based recommendations. Identify those at higher risk of falls: the frail, elderly (75+), patients using more than three medications or on sedatives, and those with arthritis, dizziness, diabetes, Parkinson’s or Ménière’s disease.
Ask the patient about their history of falls, he advised. If the patient were at risk, avoid first-time prescribing of bifocals or varifocals and, for active patients, distance-only spectacles for outdoor use could be considered. Prescribe conservatively with small changes (<1D) in Rx and limited change of lens type. Counsel the patient on potential magnification, distortion and ‘swimming’ effects with new glasses.
Pressure points
Ophthalmologist Nicholas Strouthidis (Moorfields Eye Hospital NHS Foundation Trust) offered practical advice on glaucoma detection. His recommended resources were the UK Glaucoma Treatment Study, EPIC-Norfolk Eye Study and NICE guidance.
Central corneal thickness was a very important measurement to take at baseline and gonioscopy remained the gold standard for assessing the anterior chamber. For Strouthidis, the single most important skill was identifying the ‘corneal wedge’ to define the location of Schwalbe’s line, which played a crucial role in assessing whether the angle was open or closed.
His top tips for diagnosing glaucoma were to tune in to detecting focal rim thinning or increased cup size. Optic disc imaging was helpful but not necessarily needed to confirm these signs. Clinicians were not so skilled at detecting focal nerve fibre layer loss. Importantly, always try to match the visual field defect to the appearance of the disc, he said.
A presentation from David Crabb (City University) took a very different approach. To achieve good results in glaucoma detection and monitoring the focus should be on the patient, he argued. His own studies related visual fields and the stage of the disease to what the patient could and couldn’t do, in relation to reading, tasks, searching, mobility and driving.
Integrated visual fields software that combined the two monocular fields together and estimated what the patient actually saw binocularly revealed surprising results. Professor Crabb had used this to reveal the impact of the location of a field defect on deficits in visually guided tasks such as reaching and grasping.
More striking still were his animations of the effect of various field defects on eye movements and fixation when driving. He used the Hazards Perception Test on-road videos from the theory part of the UK driving test to demonstrate clear differences between normal subjects and those with glaucoma, who tended to employ various techniques to compensate for loss of visual field.
Most illustrations of what glaucoma looked like to patients were misleading; they did not see black patches in their vision and most did not have ‘tunnel vision’. ‘Blurred parts’ was the symptom most often described and ‘missing’ the key word they used to explain what they saw.
A new patient information app from Alcon, available from May, would use interaction with everyday scenes to show how visual field loss in one eye might not be detected until an advanced stage. Visit @crabblab to find out more about this and other resources for educating patients.
Contact lenses and myopia control
[CaptionComponent="1154"]This year there was more coverage of contact lenses at Optometry Tomorrow, including news that some commercial applications of myopia control may be in prospect sooner than expected.
Katharine Evans (Cardiff University) reviewed some of the latest product launches aimed at increasing replacement frequency, reducing friction, improving lens design, and optimising lens care solution, all thought to be factors involved in contact lens comfort. Among the latest releases were the Maxim CV semi-scleral lens from Bausch + Lomb and Alcon’s AO Sept Plus with HydraGlade.
Future innovations included myopia control strategies. Results from Asia with the CooperVision MiSight lens were expected in 2017 and there were ‘no immediate plans’ to bring it to the UK. But Contamac’s licensing agreement with the Brien Holden Vision Institute to commercialise myopia control technologies might see these lenses entering the market as early as May this year, said Dr Evans.
‘All the major contact lens manufacturers are working on and researching myopia control products. Before long we will, I’m sure, see TV advertising to parents,’ predicted Bruce Evans (Institute of Optometry). Evidence for myopia control was now ‘starting to become convincing’ and was changing the way he practised.
Soft mutifocals such as Acuvue Oasys for Presbyopia and the Proclear or Biofinity Multifocal centre-distance design, although off-label for this purpose, could slow myopic progression by about 50 per cent or by two thirds in children who were esophoric at near.
Professor Evans’ advice was to prescribe the lens in both eyes with a reading add that eliminated eso fixation disparity at near, and opt for the maximum add that would give good distance vision. Since treatment effect seemed to be dose related, lenses should be worn at least for the school day and for homework.
Vision and driving
[CaptionComponent="1155"]Keynote speaker Joanne Wood (Queensland University of Technology) is a leading authority on vision, ageing and driving performance. Given the recent changes to UK licensing regulations, her views on the topic were timely (News, 20.03.15).
Licensing standards were lagging ‘well behind’ research evidence but evidence was now starting to build and there were now much better tests than visual acuity for predicting driving performance and safety. Patients were often unaware that their vision or driving performance was changing. If they were informed of relevant changes to vision they could modify their driving habits accordingly.
No measure alone seemed to account for all the variation in driving ability. Using a battery of tests – of visual, sensory motor and cognitive function – all of which contributed to the capacity to drive, was a better predictor of driving safety. Licensing should be based on performance rather than on age or disease status, said Professor Wood.
Optometrists had an important role in driver safety. Key clinical measures other than high-contrast visual acuity were contrast sensitivity, visual fields outside 30 degrees (although central field was probably even more relevant, particularly inferiorly), and binocular vision.
The gadget show
[CaptionComponent="1156"]Finally, one speaker truly reflecting the Optometry Tomorrow theme was David Thomson (Thomson Software Solutions) with his comparison of optometric technology in 1980 when the first computers arrived, today and in 2050.
New gadgets for automated assessment were already available for many measures of visual performance. ‘If you took all of that, shrunk it and put it into a pod, that pod would be capable of doing a pretty good eye examination,’ said Professor Thomson. Good to hear, then, that the Optical Confederation recently launched a review of the impact of technology on the future of optometry and the sector as a whole.
Optometry Tomorrow 2016 will run in Coventry from March 13-14. Presentations from this year’s event can be found at www.college-optometrists.org
