‘A New View: Insight, Inspiration, Innovation’ was the theme of Johnson & Johnson’s latest clinical roadshow, a one-day education event that toured Manchester and Leeds before heading to London.
The London event, held in the impressive setting of Church House in Westminster, drew over 700 eye care professionals (ECPs) keen to gain interactive CET points through lectures and peer review sessions. A total of nine interactive CET points were on offer for optometrists and CLOs while DOs were eligible for eight interactive points.
Johnson & Johnson’s director of professional affairs, Marcella McParland, opened proceedings with a brief outline of the history and principles of the healthcare company, which was started by three brothers in 1887. She showed a short film about Johnson & Johnson’s philanthropic work in modern times with particular reference to the Sight for Kids programme. McParland said that more than 20 million children across the Asia-Pacific region have been screened and given access to local services due to the programme. The project is now being extended to Kenya and Turkey.
Other subjects mentioned by McParland included the company’s television advertising campaign for 1-Day Acuvue Define (running from March 9 to the end of May) and the Success Through Education Programme (STEP support) that supports pre-reg students as they make the transition to full-time professionals.
Is there a role for hydrogels?
The first CET lecture of the day was presented by Dr Noel Brennan, clinical research fellow for myopia control at Johnson & Johnson, on the question ‘Is there a role for hydrogels in modern contact lens practice?’. Dr Brennan challenged the assumption that silicone hydrogel (SiH) products are the contact lens (CL) of first choice for fittings.
Welcome packs, handed to attendees at registration, contained coloured cards for the purpose of audience feedback during lectures. Dr Brennan started his address humorously by showing the image of a dress that had recently been the subject of widespread debate on social media due to ambiguity over its colour – people either saw it as black and blue or white and gold. Sure enough, when asked to hold up one card for black and blue and another for white and gold, the audience was split pretty much down the middle.
Dr Brennan then used the same technique to poll the audience on their attitudes to hydrogels versus SiHs with the majority of the audience saying the latter was their first choice. ‘This leads to the question why we should use SiHs as lens of first choice,’ he said. ‘For me the three most important factors in fitting a CL are comfort, comfort and comfort. So what is the case for SiHs in terms of comfort?’
He cited studies that have shown that the etafilcon material used in hydrogels such as the 1-Day Acuvue Moist range provided similar levels of comfort to the senofilcon A material used in the SiH Acuvue Oasys. ‘The picture is complex and SiHs are not always the most comfortable option,’ he said.
On the question of safety, Dr Brennan referred to sources showing hydrogels were associated with fewer corneal infiltrative events than SiHs. Oxygen transmission was an important measure of how the cornea was able to function normally but shouldn’t be considered the most important factor in selecting a CL for fitting.
Considering the two types overall, Dr Brennan felt it was a case of weighing up the limbal redness, polymegethism and vascularisation sometimes associated with hydrogels against the corneal infiltrates, staining and papillary conjunctivitis possible with SiHs.
‘For extended wear, SiHs are the preferred option but for daily wear SiHs and hydrogels both have advantages,’ he concluded. ‘Daily disposables are preferred overall.’
At the end of the lecture Dr Brennan asked the audience again, via the colour cards, if their first choice was SiHs. This time there was a more mixed response with many attendees agreeing that there was a place for both products.
Understanding multifocals
Next up to the podium was Dr Trusit Dave, practice owner and CL consultant, who discussed ‘Understanding multifocals and getting them to work’ with specific reference to the challenges of correcting presbyopia in CLs.
Dr Dave made the point that presbyopes were proportionally under-represented in the UK CL wearer base and more could be switched from single-vision to multifocal lenses. Switching would avoid positioning multifocals later into presbyopia and the attendant more extreme adaptation conditions which lower success rates.
Significantly, said Dr Dave, refractive error may influence mesopic pupil size, which offered the chance to optimise multifocal designs. Most multifocal designs were adapted to reflect smaller pupil size associated with age but a new design would also be optimised for refractive group.
Dr Dave spoke about the importance of using materials that perform and not relying just on one multifocal design. ‘Lens material is almost as important as the lens design,’ he said. ‘Select a lens that is best for the tear film, has pupil optics optimised for age and refractive group, centres well on the eye and offers flexibility as well as an easy modality.’
He also made the point that patient expectations should be managed whenever possible. ‘Consider using a phrase like “all round vision” rather than “not perfect” and “balance between distance and near” rather than talking of “compromising”,’ he said.
Overall, Dr Dave felt, it ‘boils down to chair time’ and the ‘role of the practitioner is to find the lens that is most likely to result in a good outcome’.
Myopia control
Dr Brennan returned to discuss ‘Myopia control: what can you do in your practice tomorrow’. Dr Brennan outlined the well-documented increasing incidence of myopia across the world. In the UK, he said, almost half the population had at least 0.75D of myopia but the rate in countries including China, Korea and Taiwan was over 95 per cent.
‘Myopia is increasing and it is inconvenient in that it makes people insecure and dependent on glasses but the real problem is the diseases that arise in populations with high levels of myopia,’ he explained. ‘These populations are prone to cataract, retinal detachment, choroidal neovascularisation and glaucoma.
Considering whether myopia would become the leading cause of vision loss in the world, Dr Brennan said this would be the case even in countries like the US within the next 20 years or so as relatively unaffected generations pass away. He went as far as to say ‘there is a tsunami of eye disease headed our way’.
Contributing factors for the development of myopia included ethnicity, family history, time spent outdoors and time spent reading. There was evidence to show that children who spent at least two hours outdoors per day were less at risk but, significantly, time spent outdoors did not affect progression once myopia was established in an individual.
Dr Brennan stated that no product in the UK currently claimed to function as a myopia control lens, but he was leading myopia control studies at Johnson & Johnson and predicted a product would be available in two years.
The final lecture of the day was delivered by consultant ophthalmologist Damian Lake on ‘Anterior eye. Signs, symptoms, management’. Lake outlined a structured approach to history-taking and clinical examination. He advocated ECPs adopt the ‘surgical sieve’ process in diagnosis. This method categorised a presented case into neoplastic, inflammatory, infective, metabolic, trauma or idiopathic. Also paramount was the need to examine and evaluate a whole patient rather than just the eyes.
The day finished with a peer review session on CLs for presbyopes with attendees split in small groups with facilitators chairing discussion.