Eyecare 3000 in Glasgow

Eyecare 3000 in Glasgow has become well established on the optometry education circuit. This January saw the first Belfast-based event. Organiser Dr Scott Mackie is sufficiently pleased with the outcome and delegate feedback to want to run the event in Belfast every year from now on.
The two days, as with the Glasgow event, was a busy mix of lectures, workshops and exhibition which kept the 198 delegates on their toes.

New Blood
The lectures began with a presentation by Professor Wallace Foulds (Glasgow University) who described the current state of knowledge on new vessel growth. Hypoxia stimulates the production of growth factors promoting new vessel formation (such as the now well-known vascular endothelial growth factor  VEGF) while increased oxygen levels leads to an increase in inhibitory factors, such as retinal pigment epithelium derived growth factor (PEDF). Stability of the vasculature within a structure such as the eye depends upon a constant balance between these two types of factors. The clinical implications for this are important. For example, elderly eyes are more likely to experience atrophic changes to blood vessels. The resultant ischaemia leads to the promotion of new vessel growth. Similar age-related changes to the RPE result in a reduction in the amount of inhibitory factor available. This results in a proportion of elderly patients exhibiting age-related macular degeneration involving choroidal neovascularisation.

Headache
Dr Fion Bremner (National Hospital for Neurology and Neurosurgery, London) gave an excellent resum of headaches and their possible causes - something of great interest to all in eye care practice. Indeed he introduced his talk by emphasising that headache was the commonest presenting symptom in medicine. He argued that the majority of headaches were benign and self-limiting, usually treated with over-the-counter remedies.
Possibly because of the few very serious causes of headache, many professionals were reluctant to be involved in headache assessment and management. Bremner argued, however, that a basic understanding of headache was important if only to identify danger signs and to be able to refer if appropriate.
Obviously optometrists are important in this context. The pain itself is not from the brain, which has no nociceptors, but from pain receptors in the meninges, blood vessels, or extracranial tissues such as the eye. Because the afferent signals from extracranial sources pass along the same route as intracranial sources of pain, there is no way a patient can easily localise the origin of the pain. Ocular pathology can cause headache, but the converse is also true.
The key to evaluation is an accurate history. It is important to establish the timing (onset, frequency, duration), any triggers (either predisposing, aggravating or relieving), the type of headache (intensity, location, associated features) as well as establishing the effects of any treatment so far. Although physical examination is often of little benefit, it is essential to rule out systemic, neurological, cardiovascular, ophthalmic or other head or neck pathology.

Visual Impairment
Professor Gordon Dutton (Gartnaval Hospital, Glasgow) gave an excellent review of the ways in which visual impairment may affect development in children, and how intervention by ophthalmologists and optometrists might be helpful. Over 50 per cent of visual impairment in children is due to brain damage. The visual impairment (reduced acuity, contrast sensitivity, colour perception, restricted fields and impaired movement perception) may lead to poor navigational skills, impaired object recognition, impaired visually guided movement and impaired attention (due to problems in processing lots of sensory information at one time).
Several things should be considered to make life easier to cope with for such visually impaired people. Information should be magnified and be readily accessible. A practitioner should also judge the face recognition distance and incorporate this into their examination. This may involve the careful use of make-up to make the carer's face more easily identifiable. Limitations to mobility should be considered and strategies to reduce these be considered.

Trauma
A presentation by Dr Lennox Webb (Royal Alexandria Hospital, Paisley) managed to turn a few stomachs at the start of the second day. He outlined graphically some of the typical advances in cataract surgery and reminded the audience of how phacoemulsification and the use of new implant materials had significantly reduced the number of postoperative complications while at the same time speeding up the procedure and recovery times. He then described a case he had recently dealt with, of a shattered orbit subsequent to severe blunt trauma. In accessing the bony orbit for reconstruction purposes, he showed how an incision across the top of the scalp allowed the forehead, brow and upper face skin to be peeled forward (as in the film 'Face Off') and, once reconstruction with pins was complete, the skin could be re-laid and sutured to its starting position. Amazingly, the patient recovered well with the minimum of oedema or evident bruising.
Quiz Time
As is becoming customary at these events, the conference ended with a quiz run by Professor Roger Anderson of the University of Coleraine. Of the more unusual questions asked, perhaps most difficult was: 'What is the average number of eyes per individual resident in Northern Ireland?' The answer is not two!