The Yorkshire spa town of Harrogate this year played host for the first time to the Hospital Optometrists Annual Conference (HOAC). As has been customary in recent years, the National Optometric Conference (NOC) and the HOAC ran back to back at the same venue, on this occasion, the Barcelo Majestic Hotel.
A corneal ectasia-themed short paper session began on Saturday morning with a presentation from Matthew Rayner, consultant ophthalmologist in Sheffield, who spoke on collagen cross-linking for keratoconus. Having described the rationale behind the technique and its practicalities, Rayner reviewed some promising clinical trial results. Rayner was unable to present his own results - the technique being quite new to his unit - but he explained that it was applicable to young patients who have not developed the natural collagen cross-linking which occurs with increasing age. Also, he advised against recommending the procedure to patients with a spectacle acuity better than 6/7.5 because these patients may experience a small drop in best corrected spectacle acuity when undergoing cross-linking.
Those familiar with HOAC stalwart Ken Pullum will be amazed to learn that he spoke for nearly 20 minutes with barely a mention of scleral contact lenses. In a thought-provoking presentation, Pullum discussed the factors to consider when selecting an appropriate intraocular lens power for keratoconic patients undergoing cataract surgery. Pullum described a simple method of avoiding biometry-related mishaps which may complicate post-surgical contact lens wear. Jenni Turner of Royal Glamorgan Hospital in South Wales closed the session with the results of a carefully conducted trial demonstrating the advantages of contemporary silicone-based materials in taking impressions of the ocular surface.
Oliver Backhouse of St James University Hospital, Leeds gave a very clear and concise talk reviewing the ocular signs and treatment of uveitis. His presentation detailed some of the more common presentations of uveitis in association with systemic disease as well as describing the considerable impact that contemporary therapeutic agents are having on the management of the condition. The morning closed with an engaging session entitled 'Your profession, your future' led by Dr Gillian Rudduck, chairman of the Hospital Optometrists Committee. In her introduction, Dr Rudduck outlined how numerous government commissioned reports and legislative changes have impacted on our role both in and outside the hospital eye service. Having alluded to the inevitable impact upon health expenditure of the current financial climate, the presentation concluded with a upbeat discussion of how optometry is well placed to capitalise on these changes.
Glaucoma guidance
The afternoon's parallel sessions offered a variety of interactive presentations, ranging from didactic lectures on core hospital optometry subjects, such as advanced contact lens practice, to some interesting manufacturers' presentations. Unsurprisingly, having featured prominently on the programme of the NOC, the theme of the National Institute for Clinical Excellence's (NICE) clinical guideline 85 on the diagnosis and management of chronic open-angle glaucoma and ocular hypertension received a lot of attention at the HOAC. Association of Optometrists (AOP) chairman Michael Charlton, addressing the delegates prior to the conference dinner, said that in keeping the interests of practising optometrists paramount, the AOP had had little choice but to adopt its current stance on the referral of ocular hypertension into the hospital eye service. There was criticism from some quarters about the way the AOP had responded to the guidance, and concern as to what effect the resultant increase for suspect glaucoma to secondary care will have upon relations with our ophthalmologist colleagues. Despite this criticism, there seemed to be a general acknowledgement that the existence of the NICE guidance provides a valuable opportunity for optometrists to develop their role in the diagnosis and management of glaucoma and ocular hypertension in both primary and secondary care.
Visual impairment
The Sunday morning session followed a visual impairment theme. Hannah Dunbar of the Institute of Ophthalmology, UCL, London presented interim results from one of a number of centres participating in the IMT-UK study, a cohort study investigating the effect of a 3X implantable telescope in patients with moderate to severe central visual loss. Although visual acuity increased on average by 0.36 logMAR, improvements in reading performance and self-reported visual disability were more modest, not reaching statistical significance in this sub-set of the full study population. Those with an interest in visual impairment will also be concerned to learn that implantation of the device was associated with a significant reduction in contrast sensitivity. Also presenting in the opening session were Anita Lightstone, who gave a progress update on the UK Vision Strategy (a Vision 2020 UK initiative led by the RNIB to develop a unified plan for action on all issues relating to vision in the UK), and Nathan Davies, who described the Welsh Paediatric Low Vision Toolkit. This is a modular teaching programme Davies developed to help children and young people with visual impairment make more effective use of their vision.
There followed a presentation from Scott Robbie, a research fellow in the division of molecular therapy at the Institute of Ophthalmology UCL, London. Entitled 'Gene therapy in ophthalmology', Robbie's talk described the theory behind viral vector gene therapy, and how the eye's structure makes it particularly well suited to this novel therapeutic strategy. Robbie described the results of the Gene Therapy Trial for Early Onset Retinal Dystrophy, which is under way at the Institute of Ophthalmology and Moorfields Eye Hospital. The study seeks to assess the safety and effectiveness of gene therapy in patients with a form of Leber's congenital amaurosis. This condition is associated with a defect in the RPE65 gene which results in a degenerative retinal disease causing total blindness by the third decade of life. The therapy under investigation uses a viral vector to deliver normal copies of the gene to the retina via sub-retinal injection. Early results suggest that the treatment is safe and may offer visual improvement in a previously untreatable condition.
The Sunday conference programme also featured a number of talks describing extended roles for optometrists within the hospital eye service. The conference closed with a presentation from Ann Fittock, a pharmacist, independent prescriber and adviser to the national non-medical prescribing (NMP) centre. The speaker gave examples of NMP in other non-medical professions and anticipated how NMP might enhance optometric practice in the future. ?
? Dr Dan Rosser is head of optometry at Norfolk and Norwich University Hospital