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In advance of this year’s ABDO Conference and Exhibition, which took place earlier in Manchester earlier this autumn, president of the association Peter Black announced: ‘This year for the first time we have enlisted the help and support of the Association of Optometrists and the British Contact Lens Association to ensure we have a programme that is second to none for all registrant groups, including students and their supervisors.’
The primary care sector is increasingly developing management strategies and care pathways involving a wide range of eye care professionals. This interdisciplinary approach was well reflected in a varied programme. Even a casual glance at the subjects on offer during the two days of lectures and workshops clearly reflected interests way beyond the realms of the ‘optical appliances’ subject area.
Paediatric care
Dr Nicola Logan (Aston University) reviewed the evidence for the various interventions being researched as possibly capable of slowing down the progression of myopia. With the prevalence of myopia now of epidemic proportions, anything that might help reduce the refractive burden was of great interest, she said.
Strategies such as increasing daylight exposure showed promise, and practitioner interventions, such as the use of orthokeratology and the use of corrective lenses, either to cause a reduction in accommodative lag or in producing a hyperopic off-axis defocus, were also showing promise. It is essential for all practitioners to keep up to date in this area as increasing numbers of worried parents will be asking for information.
Paediatrics figured strongly throughout the event. ABDO members were able to take part in an accredited level 2 training programme about safeguarding children. In another excellent lecture, Professor Anita Simmers (Glasgow Caledonian University) explained the concept of amblyopia, how it was detected, and how it was often missed or ignored to the detriment of the developing child.
Importantly, she explained how management strategies required good compliance by patients and the use of video and computer game techniques had significantly helped encourage participation in therapy.
Internationally renowned expert in paediatric vision, with particular interest in children with learning impairment, Professor Maggie Woodhouse (Cardiff University) offered a useful overview of the vision of people with Down’s syndrome. In explaining the predisposition to refractive error, strabismus, keratoconus and accommodative insufficiency, she highlighted that the very people who needed regular and thorough eye care were all too often being denied it, typically because of myths surrounding what could be achieved by testing.
Visual impact
The visual environment is rarely replicated in the testing room. This was borne out at the conference by several presentations describing the impact of environmental conditions on vision and eye health. Professor David Whitaker (Bradford University) focused on disability glare, and hammered home the significance of glare which prevented people from seeing adequately by citing a real life case where disability glare had been found to be the main contributor towards a fatal car accident. Modern light sources, including the latest car headlamps, inadequate luminaires and the gradual loss of transparency of the ocular media throughout life conspired to make daily routines difficult.
The phenomenon could be assessed, for example, by using controlled glare sources and contrast sensitivity targets, and appropriate advice could be given, either in reducing the impact of incoming glaring light, or in advising on better lighting design in the first place.
ABDO stalwart Andy Hepworth (Essilor) took on the controversial topic of blue light impact. Citing the published evidence base, he emphasised that the cumulative impact of short wavelength visible light was significant, both on ocular surface structures and also, in those with clear media, further into the eye. The intraocular penetration of the visible was greater than that of shorter wavelength UV and so eyes with transparent media might be vulnerable at a retinal level.
Low vision
Low vision services (such as the Welsh Low Vision Scheme) significantly utilise the skills of the dispensing optician and this core competency is always popular at conference. Past president of ABDO, Jennifer Brower, a keen advocate of low vision practice, was on hand to provide, with colleague Annette Ball (low vision practitioner in Norfolk), an essential primer in low vision aid dispensing. There were separate sessions, one from Nick Black (BBR Optometry) and another from Helen Denton (Manchester University) which each showed how challenging but ultimately rewarding low vision practice could be.
Optician and Heidelberg
[CaptionComponent="1894"]Optician clinical editor Bill Harvey teamed up with Heidelberg director of clinical services, Christopher Mody, to run a series of workshops looking at how modern technology was revolutionising the way people with central vision loss might be managed.
Macular degeneration is the commonest cause of visual impairment in the UK population, but when you also consider the high prevalence of central vision loss in the under 65s due to diabetic maculopathy, it becomes clear that the majority of visually impaired people are of an older age and have central vision loss.
The commonest disability, therefore, is not so much one of mobility (indeed many visually impaired suffer from a lack of empathy from others who assume their continued ability to move around safely implies exaggerated sight loss), but of seeing useful detail, such as on a TV screen or particularly in reading.
[CaptionComponent="1895"]At the first station, Mody introduced delegates to the macular assessment programme on the Heidelberg Spectralis OCT. It is very often a dispensing optician who undertakes the scanning with OCTs so there was keen interest in these instruments throughout conference.
Mody showed data from maculopathy patients and explained how retinal thinning might be accurately mapped (Figure 1) and the extent of tissue loss be visualised in cross-sectional assessment (Figure 2). The key point was that repeatability of OCT assessment, with the accurate tracking available in the modern instrument, allowed a useful way of monitoring any progress of a disease.
[CaptionComponent="1896"]Bill Harvey then highlighted how best to help the patient adapt their remaining peripheral vision in a way that might improve their quality of life. He began by showing results taken from an automated visual field analyser showing the impact of diseases such as stroke or vascular occlusion. Sudden loss requires significant adaptation, and the nature of the loss dictates the impact. For example, inferior altitudinal loss made walking difficult, while a right homonymous hemianopia was going to make reading from right to left almost impossible.
But what about central loss? As the loss was rarely concentric nor perfectly centred, there was usually an area of remaining healthy tissue which the patient adopts for fixation – the preferred retinal locus (PRL). Amsler grids have proved to be a very gross method of establishing the PRL, said Harvey. Other techniques, such as staring at the centre of a clock face to see which number is clearest, had been found more useful by many. By asking the patient to look in the direction away from the clearest number, the eye might more likely refixate with a useful PRL.
[CaptionComponent="1897"]Microperimetry is a way of using regulated light stimuli closer together and centred nearer to fixation in order to map out the remaining functional capability of central retina.
Figure 3 shows the plot from the Nidek MP3 microperimeter and demonstrates the varying sensitivities of paracentral retinal points. This might then allow one to define a functional PRL more accurately. Patients with progressive maculopathy often cling onto an established PRL despite their retina now having a different functional profile.
Delegates were able to try out the MAIA (distributed by Haag Streit UK) which has a useful PRL ‘retraining’ option. Figure 4 shows how fixation (in blue) is very poor with the adopted PRL previously established.
[CaptionComponent="1898"]The patient is able to move their eye to a more functional fixation position and is encouraged to do so by an increasing intensity audio signal. Once the new PRL is found, the patient may undergo a period of training using audio feedback to ensure the new PRL is easily adopted. Instruments like the MAIA are making inroads in helping patients with changing vision to continually readapt.
[CaptionComponent="1899"]Delegates participated in these developing study areas enthusiastically and it is to the organisers’ credit that such an array of subjects were represented.