The publicity of oxygen

Jayne Schofield reports on a recent education symposium on silicone hydrogel lenses

The De Vere Belfry Hotel near Birmingham was the venue of The European Symposium on Silicone Hydrogels on 26th May 2005.

Ron Loveridge, professional services manager at CIBA Vision, opened the meeting and introduced the first speaker Craig Butler, executive director for education and business growth at the Vision Cooperative Research Centre (Vision CRC). All delegates had interactive handsets and were able to see instant feedback to questions posed by Craig to assess current attitudes in practice. Practitioners learned how silicone hydrogels were used in practice, when and how they present the benefits to their patients, opinions on aftercare schedules and the level of concern about adverse events. Finally, in what was a most illuminating interactive session, Craig explored what communication strategies are employed to promote silicone hydrogels in practice.

Paul Shimell, a contact lens optician from Specsavers in Swindon, shared some statistics on how silicone hydrogels have transformed his practice, now representing 40 per cent of new fits. Two case studies on silicone hydrogels were shown, highlighting where they had been used successfully to solve problems caused by hydrogel lenses. He detailed his strategy of upgrading his patients and how this has resulted in fewer dropouts.

Independent optometrist Brian Tompkins then presented some clinical case studies where silicone hydrogels had solved problems caused by both hydrogel and rigid gas-permeable lenses. Confirmation was given that fitting requires no more specialised skills than any other soft lens, although refraction may occasionally be different from that obtained with hydrogels. Some interesting changes to corneal topography after wearing a silicone hydrogel inside out were cited. His experience had shown that this occurs in higher powers, both plus and minus, but reverses within hours with no detrimental effect. Tompkins concluded that these lenses have a positive impact on wearing times, lifestyle and motivation and, if suitable, should be the number one choice in any contact lens practice.

Associate professor Debbie Sweeney (chief executive officer of the Vision Cooperative Research Centre) presented a lecture on the 'Oxygen story' beginning with an historical perspective of adverse events of contact lens induced hypoxia with low Dk materials in the 1970s and 80s. The Holden Merz oxygen requirements for daily and extended wear and the development of silicone hydrogels in the 90s were covered, followed by a description of the effects on the cornea of increased oxygenation. Sweeney informed delegates that hypoxia has been eliminated with silicone hydrogels and then discussed several situations where maximising oxygen is important for daily wear. Then followed an explanation of  oxygen flux which concluded that, because we are not all the same, responses to 1 per cent oxygen vary widely with different levels of corneal oedema.

Professor Desmond Fonn, director of the Centre for Contact Lens Research at Waterloo University, stated in his lecture that silicone hydrogels had been studied more than any other lens in history before he described their successful fitting. Wettability of various materials, mucin balls and overnight swelling were discussed. Audience feedback was requested via interactive handsets to explore issues of comfort relating to fit, design, modulus, water content etc. He then described a study which suggests comfort with hydrogels reduces during the day but remains more constant with silicone hydrogels, resulting in end-of-day comfort and dryness which is much improved with silicone hydrogels. Professor Fonn also spoke about the compatibility of materials and lens care solutions, refractive changes and aftercare schedules. In conclusion he presented an overview where he listed reasons to fit silicone hydrogels and the importance of patient education. His final message emphasised that patients deserve the extra protection of these materials to reduce their chances of ocular complications.

After lunch, Debbie Sweeney and Des Fonn ran an interactive workshop on management of adverse events. The delegates were split into groups and were presented in turn with a case history and each group had to make a diagnosis. The correct response was then revealed and an appropriate action plan suggested by the experts.

The final interactive workshop was presented by Craig Butler who explored some practitioner barriers to the growth of contact lens fits, which revealed that 48 per cent of the audience felt that discussing the options was too time consuming. He told the audience that motivation comes from a customer, inspiration from the practitioner and contact lens wearers are 44 per cent more profitable to our businesses. At this point the delegates were split into groups and were encouraged to discover how it felt to be both practitioner and customer when discussing vision care options and exploring the benefits of wearing silicone hydrogels. Butler highlighted communication skills which allowed delegates to quickly identify the vision related lifestyle needs of the patient and gain confidence to make recommendations. This exercise was preceded by a very amusing video, starring Eric Papas among others, showing how not to conduct a patient consultation and demonstrating some of the pitfalls of this process. By the end of the workshop the venue was buzzing as the whole audience had taken part with great enthusiasm.

Feedback from the day suggests that delegates view the combination of lecture and interactive workshop very positively indeed.