Clubbing together

Clinical techniques and instrumentation were the themes for the latest meeting of CIBA Vision's Specialist Club, as optician reports

A wet Tuesday in Warrington might not seem the most attractive prospect for a day out of practice but there was a warm welcome awaiting the 75 delegates who travelled to the North West for CIBA Vision's latest educational event.

Like previous meetings of the Specialist Club, the programme offered an international speaker, in Dr Chris Snyder of the University of Alabama, and some hands-on CET in a workshop setting. There was also ample opportunity to meet and talk with like-minded practitioners and to enjoy CIBA's hospitality.

The Club concept was launched four years ago, when CIBA created a specialist lens business aimed at developing the RGP and conventional soft lens sectors. The 570 Club members benefit from the sharing their experiences with other practitioners through a web-based forum and regular meetings which are much in demand.

For the October meeting, the focus was on improving clinical techniques and using the latest instrumentation either to extend the scope of contact lens practice or to manage it more efficiently.

Dr Snyder began his lecture on the clinical issues surrounding the management of corneal staining with a review of the applications of sodium fluorescein and other dyes. He stressed the importance of using a yellow Wratten filter for enhanced slit-lamp viewing and the value of decimalising corneal fluorescein staining grading scales to include 0.5 steps.

For greater discrimination, clinicians could record the type, area and depth of staining, while researchers used grading by sector, including computer-assisted analysis of staining pictures.

As defined by Terry, unacceptable contact lens-associated corneal staining that required intervention was >grade 2 type (macropunctate), >grade 1 depth (superior epithelial involvement) and >grade 1 extent (1-15 per cent of surface). Others described significant staining in terms of the number of quadrants affected.

Dr Snyder pointed out that many normal, non-contact lens wearers also showed corneal staining. In soft lens wearers, this sign was associated with non-compliance with care systems, conventional lens replacement schedules and high lens power and thickness. There was, however, a 'disconnect' between signs and symptoms and he questioned whether statistical differences between levels of staining below grade 1 could really be considered clinically significant.

Moving on to discuss the classification of corneal infiltrative events, Dr Snyder said he was about to join this debate by publishing an updated matrix of symptoms, signs and general signs in sterile infiltrative keratitis related to contact lens wear. For the clinician, the presence of infiltrates with overlying staining was a 'soft guide' as to whether the condition was infectious or not.

The interactive session that followed revealed a lack of consensus on grading corneal staining and classifying corneal infiltrates but sent Club members back to their practices with a greater appreciation of the issues involved.

GADGETS AND GIZMOS

Northampton optometrist Brian Tompkins gave an overview of four in-practice tools for the CL practitioner. Each instrument was then demonstrated in a series of workshop sessions.

Anterior eye and retinal imaging had a wealth of applications from the recognition, monitoring and referral of abnormal conditions, to research and publications. For Tompkins, patient education was another important reason for photographing the eye. Blepharitis, poor tear break-up time, blinking problems and meibomian gland dysfunction were just some of the anterior conditions that could usefully be demonstrated to patients. Ocular photography could also be used to illustrate the need for switching lens type.

Among the features of the ARC system in the workshop demonstration were mega pixel imaging, video capture and an image annotation and tagging facility. ARC's Pat Falvey explained that the system used industrial sensors, rather than a conventional photographic system. Dealing with the raw data that constitute the image allowed it to be processed and presented in many different ways.

The Acuitas practice management system from Ocuco, demonstrated by Simon Butterworth, enables a paperless record of the patient journey from appointment to till. Tompkins said that the system was more efficient and better than paper for clinical recording and storing images, as well as providing an audit trail and avoiding the problem of lost records.

Recently back on the market, the Keeler Tearscope Plus is a non-invasive instrument for estimating the quality and quantity of tears under slit-lamp examination. Workshop presenter John O'Donnell of City University proposed a simplified version of Guillon's comprehensive grading system for classifying the lipid layer. 'Thin = foggy, medium = pattern, thick = colours' was his suggested formula.

Tompkins' final gizmo was the Optimed 3D-Eye patient education programme, demonstrated by Dr Trusit Dave. This system includes more than 100 animations - from progressive spectacle lenses to Lasik surgery - to enhance patient understanding, promote loyalty and act as a sales aid. Presentations can be customised to practice requirements and are designed to run throughout the practice.

TAKE-HOME TIPS

The remaining workshop was a presentation by Dr Clare O'Donnell of the University of Manchester, on contact lens fitting after PRK and Lasik. Common indications for contact lenses in these cases were over or under-correction, induced anisometropia, keratectasia, irregular astigmatism, poor cosmesis and presbyopia.

Silicone hydrogels were used immediately after surgery, for pain relief and to promote healing. If spectacle acuity was good it was worth trying soft lenses, choosing a material that minimised dryness. Soft torics could be successful for correcting residual astigmatism but where astigmatism was irregular RGPs were more likely to be successful.

Among her useful tips for fitting RGP lenses to previous wearers was to start by trying the original preoperative RGP lens on the eye or, where standard fitting approaches failed, ask the laser clinic to supply the preoperative topographical maps - just the sort of specialist advice that Club members can expect to take home from these excellent and well organised meetings.