On Wednesday evenings at 6pm throughout last month, a collection of key opinion leaders and contact lens companies discussed some of the hottest topics in the contact lens sector.
Each Contact lens Month webinar opened with an Optician-selected key opinion leader (KOL) interviewed by series host and Optician’s editor-in-chief, Chris Bennett. The KOL then faced questions from the live audience.
The second half of the webinar saw the evening’s sponsoring company field a speaker for a second presentation with the evening topped off by a second Q&A session.
Presbyopia with Neil Retallic
Week one chose the topic of presbyopia in a session sponsored by Bausch+Lomb (B+L). The choice of the ageing eye coincided with B+L’s extension to its range of multifocal toric contact lenses, which now has a range of multifocals for astigmatic patients spanning 6,068 parameters.
Opening with a generic look at the latest thoughts on presbyopia and contact lenses was Neil Retallic. The past president of the British Contact Lens Association (BCLA) has experience in practice, education and professional services. He is currently the head of professional development at Specsavers and an assessor and examiner for the College of Optometrists.
Previously, he worked in the contact lens industry, held several teaching positions at various UK universities and worked both in-store and in support centre roles for multiple opticians. He is currently completing a PhD on the mental welfare status of the optical profession and has served as a council and committee member for numerous organisations across the sector.
Retallic discussed the British Contact lens Association’s Clear presbyopia report with Bennett. Clear stands for; continued learning evidence-based academic, and is a series of reports designed to set the information standards for researchers and eye care professionals across a range of topics.
In the interview, Retallic discussed the prevalence of presbyopia and the latest thinking on communication and how the modern world has changed the incidence and management of presbyopia.
This discussion moved on to how the onset of presbyopia can lead to contact lens drop out and how this can be mitigated. Communication was a recurring theme and Retallic provided some useful insights into raising the topic of presbyopia and readying patients for its onset.
A Q&A followed the interview, with questions on Retallic’s comment that medication, such as anti-depressants, can have a big impact on presbyopia. He responded that such powerful medication had to be taken into account when dealing with patients, but caution should be exercised when advising patients on continued use of any drug.
B+L on astigmatic presbyopes
In a three-headed approach, B+L, the evening sponsors, discussed a product that not only keeps presbyopes in contact lenses but also engages astigmatic presbyopes.
Leading the discussion was Richard Smith, head of professional affairs Europe, the Middle East and Africa at B+L. With 25 years of optical industry experience, including former chair of the Association of Contact Lens Manufacturers and current president of Euromcontact, Smith shed light on the B+L Ultra Multifocal for Astigmatism lens.
A detailed presentation was given on the lens, its material properties, design and ease of fitting. Then, he described the problem of contact lens wear drop out among presbyopes and the role Ultra Multifocal for Astigmatism can play in meeting wearers’ needs.
Supplementing Smith’s presentation was Rakhee Thakrar, (pictured right) senior
professional affairs associate at B+L Vision Care UK and Ireland. Thakrar has worked in numerous practices as a locum optometrist in high street chains and independent opticians.
Within her current role, she writes and delivers a variety of educational presentations to a wide range of audiences. She discussed the design of the lens, its stability and the three-zone progressive design power that simplifies fitting and improves patient satisfaction.
Last in the lineup was clinician Dr Sarah Smith, who has a background in multiple and independent practices, research, teaching and for manufacturers. In 2012, she was awarded her PhD, which looked at the role of optometrists in the UK, and became an independent practice owner in 2014.
Dr Smith explained the role Ultra Multifocal for Astigmatism had played in her practice and the significance of the extended range, before running through a series of case studies. She was quizzed by Bennett on combatting drop out among presbyopes and provided fitting tips to enhance patient satisfaction and success with the lens.
Dr Smith (left) was joined by Retallic for the live Q&A session, whereby Bennett picked some themes and specific questions. Audience questions came thick and fast with many keen to know how emerging presbyopes should be managed and the use of communication.
Retallic referred again to the BCLA’s Clear reports and the articles it has published in Optician to spread Clear’s finding. Dr Smith offered some practical tips on booster lenses and how these can help ease patients into a multifocal design. There was also keen interest in the lens’s stabilisation design and the use of fewer adds to simplify fitting.
Keratoconus
Week two invited viewers to keep ahead of the keratoconus curve in a February 19 webinar sponsored by Ultravision and featuring its Optician Award-nominated Kerasoft AV lens.
Helping the audience navigate the world of irregular corneas was Nick Howard, a specialty contact lens optician who qualified over 40 
years ago. As well as working in two Lancashire hospitals and independent practice, he also lectures and writes on the subject and is developing new techniques in myopia and dry eye.
The ever-popular presenter provided a snapshot of the incidence of keratoconus and its incidence in practice before stressing the need for early and accurate detection. Then, Howard explored treatment for management of irregular corneal issues and where soft, hard and scleral lenses fitted into a patient’s journey.
Keen to engage and demystify the management of keratoconus, Howard described how equipment found in most practices was sufficient for detection and fitting of lenses.
Slightly more fraught was relationship management with hospital services, but Howard was keen to encourage practitioners to reach out to their hospital colleagues when referring patients on for corneal cross-linking treatments. Geography was a factor but it was worth making contact, he concluded.
Audience questions flooded in for Howard, with equipment and management featuring strongly. He provided tips on what to look for in the post-cross-linked patient and gave his thoughts on exactly which topographers and keratometers were suitable for assessment and discussed the need for optical coherence tomography. Relationships with secondary care were also discussed along with NHS versus private treatment options.
Ultravision’s Kerasoft AV
The second half of the evening took the opportunity to zero in on a specific product by featuring Kerasoft AV, a soft contact lens for keratoconus from the evening’s sponsor, Ultravision. Providing more information on the lens from Ultravision were clinical services manager, Sujata Paul, and commercial director, Thomas Hedley.
Paul (pictured) specialises in education and training for optical professionals and has wide experience across the sector. She qualified over 25 
years ago and has worked for a variety of practices as a clinician and a professional services lead in the contact lens supply sector. Hedley has a background in contact lens manufacture and technical support and has been with Ultravision for 16 years.
Hedley described how Ultravsion’s parent, CLPL, had been providing keratoconus lenses since the 1960s. He said often lenses for the condition were custom made or seen as complex to fit, with rigid gas-permeable lenses - often a first option for keratoconus- having comfort issues while sclerals could be costly. Kerasoft AV is a less complex option and fills a gap in the market for such a lens, he said.
Ultravision wanted to communicate that Kerasoft AV was an effective lens that was simple to fit and available from stock. The lens was launched last June and is the latest iteration of a family of soft lenses first released in 2002.
Paul went on to describe the silicone hydrogel, monthly lens, the scope of keratoconus it can be used for and its novel peripheral stabilisation zones. She stressed the simplicity of fitting compared to traditional options and its suitability for a range of irregular corneas and post-cross-linking patients.
A mass of questions were posed by the evening’s online audience and Howard returned to join Paul and Hedley for a concluding Q&A session. The cost and ease of fitting featured highly in the questions, with Paul stressing the affordability of the lens and support available. She encouraged anyone interested in learning more to contact Ultravision for information.
Questions about the availability of training were also high on the agenda and Paul reiterated that all contact lens opticians and optometrists were welcome to attend training sessions or contact Ultravision for support.
More general questions continued to flow in around keratoconus-specific equipment, with Howard pushed to provide recommendations on keratometers and topographers. Questioners were also keen to learn more about cross-linking with Howard stressing that treatment does not mean losing a patient. He confirmed that cross-linking arrests corneal irregularity but patients will still need lenses to correct cones already formed.
Delivery of myopia management
The final Wednesday night webinar took on perhaps the hottest topic of all as CooperVision sponsored an all-live session discussing how wider teams can be engaged in the delivery of myopia management services.
Discussing the important role all practice members play in communicating myopia management were Nicky Latham and Indie Grewal, who both have a wealth of knowledge in this area.
Latham is an optometrist and educator with a long-standing special interest in understanding children’s vision and contact lenses. She has held a number of practice and professional service roles and is currently the professional affairs lead for myopia management at CooperVision.
Grewal is a past president of the BCLA and an early adopter of myopia management in practice. He is a qualified dispensing optician, optometrist with 30 years’ experience, a research optometrist and a practice owner since 2001. Grewal is a keen participant in contact lens trials and has a special interest in myopia management and multifocal contact lens fitting.
Latham kicked off the evening by providing a snapshot of the UK myopia landscape, using data from the Office of National Statistics to give a sense of how big the role of managing myopia is. Working on the basis of there being 16,000 optometrists registered with the GOC, each and every one should be managing the myopia of 11 children a week. Myopia is higher in urban areas, she added, highlighting areas where most cases could be found and demand even higher.
Latham outlined the College of Optometrists’ guidance on myopia management, including the need to keep up to speed with training, offering the right advice to patients and understanding the risk factors. Having a solid management plan was crucial in understanding the progression of myopia in the patient and measure outcomes, she said. 
Latham then compared and contrasted typical patient journeys in the 1990s and the 2020s for existing and new myopes, before suggesting areas where the front of house team could improve the process.
Grewal (pictured right) offered his experience of 18 years offering myopia control and said the involvement of the wider team was crucial. He highlighted the role front of house team members can play in collecting information from patients and the communication they can provide to parents on the suitability of contact lenses for youngsters. ‘We are time poor, so anything they can add is gold,’ he said.
Latham referred to the Association of British Dispensing Opticians’ position on myopia management and its promotion of multidisciplinary teams in the clinical environment.
Grewal provided pointers on understanding the candidates suitable for myopia management and said contact lenses were his go-to because of their ‘on all the time’ nature. Unworn spectacles of any type could exacerbate myopic progression, he added.
Significance of Plano Seven-year-olds
Latham then turned her attention to the plano seven-year-old to discuss the pre-myope and what practitioners should be doing. In the past, we would see a plano seven year old and thought ‘all’s fine’, not anymore. She then explained what communication should look like in those cases.
Plano seven-year-olds are the next generation of myopes and these are the people we should be concentrating on, said Grewal. In the first instance that may be advice on outdoor time or digital device use but that could delay their need for lenses.
Questions from the audience followed the themes of communication, cost and consultations. Latham referred to the CooperVision fitting guides for MiSight and said there is no reason why fitting myopia management lenses should be an onerous task.
Grewal agreed but added that an emerging myopia patient at seven would stay with you until adulthood and beyond so, if necessary, investing in consulting room time early on made sense.
The issue of back-up spectacles was discussed with both Latham and Grewal stressing that, from a licensing point of view, standard spectacles should be offered as the back-up pair. Cycloplegic refraction, correction of astigmatism, training, evidence of slowed progression for parents and wearing times were also discussed at length.
- All of the webinars are available to watch in full, on demand, at opticiancontactlensmonth.co.uk.
