Luke Stevens-Burt and Ian Humphreys
Optometry Tomorrow 2024 incorporating BCLA Focus is a flagship conference organised collaboratively by the College of Optometrists and the British Contact Lens Association (BCLA). The event took place after two years at the Telford International Centre on April 28-29, 2024.
While introducing the two-day program, the CEO of the College of Optometrists, Ian Humphreys, and the CEO of BCLA Luke Stevens-Burt shared their excitement for the ongoing collaboration for the event followed by a welcome speech by the presidents of the respective organisations Professor Leon Davies and Rakesh Kapoor.
The programme offered two days of lectures, workshops, sponsored sessions and exhibitions. The attendees gained hands-on experience in clinical techniques, participated in small workshops and discussion groups for personalised face-to-face learning, explored the latest innovations in the optometry profession, networked with colleagues, and earned CPD points in the final year of the GOC cycle.
There were a total of 22 lectures, seven practical workshops, 56 small group sessions, 12 peer-review sessions including IP sessions, and 10 business and communication skills sessions.
A total of 30 exhibitors participated in this mega event, which saw hundreds of optometrists, clinicians, academics and opticians participate enthusiastically. Overall, the event provided a valuable platform for all to enhance their knowledge, skills and professional connections.
BCLA Clear Presbyopia session
One of the key opening sessions was BCLA’s continued learning evidence-based academic report (CLEAR ) on presbyopia. The New BCLA global consensus reports, which delivered evidence-based guidance to BCLA members and the wider profession on all aspects of presbyopia and its management to allow for best patient care.
The report included a total of seven consensus reports and one report on the definitions. The session was chaired by Professor Philip Morgan of Manchester University, and organised by Dr Debarun Dutta of Aston University.
The first paper detailed the mechanism and optics of presbyopia, presented by Dr Syantan Biswas of Aston University, followed by Epidemiology and impact of presbyopia presented by Neil Retallic of Specsavers. The next paper on the evaluation and diagnosis was presented by Dr Marta Vianya-Estopa from Anglia Ruskin University.
This was followed by three consecutive discussions that detailed various management and treatment options for presbyopia: Management by Contact Lenses and Spectacles was presented by Dr Debarun Dutta, Management with Corneal Techniques was presented by Dr Neema Ghorbani Mojarrad, and lastly Management with Scleral and Pharmaceutical Techniques by Professor Shehzad Naroo. Overall, the sessions were well attended, providing the latest evidence and understanding on presbyopia.
Building on the first issue (published in April 2021), the latest BCLA CLEAR Presbyopia is being published (May 2024) in the journal Contact Lens and Anterior Eye and feature work from panels of globally respected experts allowing us to draw conclusions and to form a global consensus to 1) support clinicians with what information is supported by evidence, 2) inform researchers as to the gaps in current knowledge and 3) guide industry in what still needs to be achieved.
Keynote lectures
There were two keynote lectures for the event. The first one was the 20th-anniversary lecture on Transforming Eye Care with Artificial Intelligence, delivered by Pearce Keane, professor of artificial medical intelligence at UCL Institute of Ophthalmology. He discussed the basic concepts of artificial intelligence (AI) and explained how AI systems can be applied in eye care.
He debriefed some of his experience with developing the OCT algorithm in the early days, and the other systems that are now commercially available. He detailed that several of the AI-driven ophthalmic detection systems are still in the early stage of application and require further processes for translation of these systems ‘from code to clinic’.
Some of the strengths and weaknesses of current clinical AI systems were demonstrated, specifically in the field of detection of retinal disease using OCT or imaging. Prof Keane outlined the potential use of ‘oculomics’, which utilises ocular imaging biomarkers providing insights into systemic diseases.
On the second day, the charter keynote lecture in collaboration with BCLA was on Myopia Management: Current Evidence and Future Directions delivered by Professor Kathryn Saunders of Ulster University. Prof Saunders summarised the various myopia management and treatment options that optometrists should be aware of, their efficacy and downsides.
She emphasised the requirement for a thorough assessment of paediatric vision and refractive development among the current UK population. Prof Saunders also demonstrated a few examples of paediatric cases from her clinic and lastly detailed the development of a new, research-based digital health app for eye care clinicians to manage childhood myopia: Predicting Myopia Onset and Progression Risk Indicator (PreMO) app.
Research at Ulster University in collaboration with other universities has led to this innovation, which can stratify the risk of myopia development in the UK and East Asian population.
CPD events: skill workshops and peer review
There were plenty of skill development workshops for delegates to upskill their clinical knowledge, such as lacrimal syringing, foreign body removal, OCT and glaucoma management, posterior vitreous detachment, paediatric dispensing, dry eye diagnosis and management using IPL and light therapy, gonioscopy, orthokeratology and indirect ophthalmology, including leadership skills such as career planning, attaining goals and effective communication.
Plenty of discussion workshops, seminars, peer reviews and interactive sessions were planned on contact lenses, independent prescribing, managing myopia, glaucoma and retinal disease. Overall, a total of eight tracks were dedicated to
various CPD events, which were well attended throughout the conference.
Several discussion workshops were fully subscribed. Sessions such as mastering myopia management, scleral lenses, dry eye management, refining refraction and application of OCT for glaucoma were fully pre-booked and saw delegates mastering with discussions, interactions and reviews with peers. The wide and comprehensive range of available topics allowed delegates to upskill a variety of clinical competencies.
Lecture tracks
Similar to skill development and peer review sessions, lecture tracks were well decorated with a variety of flavours including topics such as retinal diseases, glaucoma, ocular surface diseases, contact lenses, independent prescribing and myopia management. Dr Rebekka Heitmar lectured on retinal imaging and its diagnostic potential, explaining current developments in retinal imaging for clinical purposes.
Her talk included OCT, OCT-A, wide-field imaging and structural and functional markers. She also explored how early implementation of AI may be useful in the area of retinal diagnostics, typically the advantages and disadvantages. Dr Imran Jawaid, a consultant ophthalmologist at Queen’s Medical Centre in Nottingham discussed the management of uncertainty and anxiety for eye care professionals (ECPs) while dealing with diagnosis and treatment dilemmas.
Dr Jawaid explored the psychological impact of being diagnosed with eye diseases and considered approaches to address any barriers to receiving ophthalmic treatment such as surgical intervention, contact lenses and non-compliance with planned management.
He shared a few of his experiences with clinical cases such as dry eye, keratoconus and blepharitis discussing how we can best approach working together as a part of a multidisciplinary team to provide the best patient outcomes.
British and Irish College of Contact Lens Educators (BUCCLE) members presented evidence-based recommendations for various aspects of anterior eye and contact lens practice. Dr Marta Vianya-Estopa detailed the importance of handling and training in soft contact lens wearers. In fact, it was an eye-opener that nearly 25% of contact lens dropouts are related to difficulty in handling issues.
This session recommended that teaching of contact lens handling should be conducted over 30 minutes by ECPs, which should include handwashing and instructions for care and storage of lenses and cases. Written instruction for lens handling and ocular emergencies such as red eye are likely to enhance patient compliance.
Dean Dunning summarised a recent peer-review article by the BUCCLE group on lissamine green staining in dry eye patients, which showed that the method of lissamine green staining certainly impacts the ability to visualise bulbar conjunctival staining.
The optimal approach for maximising the visualisation of the staining includes two applications of the same strip five seconds after wetting, preferably one minute apart. The paper suggested that for the best clinical outcome, the ocular surface should be viewed immediately after lissamine green application.
Dr Debarun Dutta discussed the current paradigm of contact lens aftercare in the UK. He explored the current understanding based on the 2024 General Optical Council (GOC) response to the consultation on a statement on verification of contact lens specification and definition of aftercare.
He summarised that GOC did not provide detailed advice on what aftercare appointments should include, however, the seller must make arrangements for the buyer ‘to receive aftercare in so far as, and for as long as, may be reasonable in his particular case’. ECPs should use clinical judgment and should follow updated guidelines provided by professional bodies such as the College of Optometrists and the Association of British Dispensing Opticians (ABDO).
Dr Neema Ghorbani Mojarrad shared his views on ChatGPT response for contact lens-related questions that could be used by optometry students and ECPs. He observed that ChatGPT is particularly poor at questions related to rigid lens fitting, estimating K-readings for rigid lenses, back vertex power calculations and some of the similar acronyms such as Smile staining confusing with Small Incision Lenticule Extraction.
Dr Omar Mahroo, a consultant ophthalmologist at Moorfields Eye Hospital and St Thomas’ Hospital lectured on inherited retinal diseases that are the biggest single cause of blindness for working age individuals in several countries. He detailed the significant advances made in recent days enhancing our understanding of the genetic basis and in making progress towards therapies.
The session discussed the latest in the management of patients with inherited retinal disease, the top genetic causes, and new therapies on the horizon. The new Tear Film Ocular Surface (TFOS) workshop, ‘A Lifestyle Epidemic: Ocular Surface Disease’ aimed to increase awareness of the potential impacts of lifestyle choices on ocular surface health.
The global panel of experts (158 members from 38 countries) were the first to undertake a comprehensive evidence-based review of the literature on how lifestyle and societal factors impact the ocular surface. The outcomes were published earlier in eight reports – contact lens, cosmetics, digital screen usage, elective medications and procedures, climate, lifestyle and societal challenges. The overall summary for each of the reports was briefed by Dr Nikolina Budimlija at this event.
In a combined interactive session Dr Jonathan Jackson, Dr Siobhan Wren and Ms Shreeti Lakhani provided an overview of the indications, contraindications and complications of medical contact lenses.
The best part was a series of case studies that were presented as part of the explanation that allowed us to highlight important learning points and showcased how the optometry and ophthalmology professions can work collaboratively to reduce risks related to contact lens wear, maximise value and reduce the potential for conflicting advice.
Some of the later sessions on the final day were dedicated to rapid-fire presentations on evidence-based research for clinical practice. A total of five hand-picked research topics on dry eye, myopia, contact lens, presbyopia and corneal sensitivity were outlined.
Dr Gillian Ruddock chaired a session with a panel of experts on the future direction of optometry: the profound changes palpable across all nations in the UK, the way eye care is delivered and optometry as a profession is taught.
Overall, it was envisaged that it is very likely that eye care will look different in five years’ time thanks to multiple factors: the impact of AI in eye care, the future of independent prescribing, the future of spectacle prescribing, and significant innovations in various technologies.
The 44th annual general meeting of the College of Optometrists discussed reports on the charity’s activities and finances for the previous year and saw Dr Gillian Rudduck succeed Prof Leon Davies. Prof Davies was thanked for his role as the president and was congratulated for his new role as the chair of the board.
The members also welcomed new council members who will promote and continue to support the ongoing success of optometry.
- Dr Debarun Dutta is a tenured lecturer at the School of Optometry, Aston University. In this balanced academic role, he is responsible for excellence in research and teaching, his primary area of research and teaching interest are contact lenses, ocular surface, and eye infections.