Muriel Glenn reports from another successful hospital optometrists conference
Congratulations to the Hospital Optometry Committee who once again organised and delivered another hugely successful, high quality Hospital Optometry Annual Conference; this time their 31st.
Dr Charles Cottriall (Oxford Eye Hospital) has been working for the past 10 years to find a clinically effective drug to treat myopia. Significant research has endeavoured to identify why eyes become myopic and what can reduce its rate of progression. Atropine has been shown to be effective, but unfortunately isn't a viable option due to its associated side effects.
Another more selective muscarinic antagonist, pirenzepine, has been identified - a drug more commonly known for its treatment of stomach ulcers. Clinical trials have been carried out and a pleasing 50 per cent reduction in myopia occurred.
However, the drug appeared not to be as effective in the second year of usage, suggesting an adaptation effect. Before this drug can be used as a therapeutic treatment, further research is required.
For the past three years, optometrists have been running YAG clinics in the Royal Victoria Infirmary, explained Kevin Gales. YAG laser is used to treat the most common complication of extracapsular cataract extraction - opacification of the posterior capsule.
This technique has been traditionally performed by medical staff, therefore, ongoing audit is required to prove that there is no increased risk in patient care when the procedure is performed by an optometrist.
The most common complication that can occur is damage to the intraocular lens (pitting) which happens if the laser is not correctly focused on the capsule. Rarer complications include cystoid macular oedema, retinal breaks and raised IOP. So far, things are going well and 1,500 patients have passed through the optometry led YAG service.
Posters
The winning poster was titled 'Visual Acuity beyond Snellen', authored by LK Lim, DG Frazer and AJ Jackson (Royal Victoria Hospital, Belfast). This poster highlighted that, functionally, the majority of patients are not totally 'blind'. Varying levels of defocus were used to show three fingers alongside a Snellen letter, illustrating that fingers are easier to detect and are not standardised. The clinical message included:
- Save 'counting fingers' for those exceptional circumstances where optotype test cards cannot be used to obtain a measure of acuity at any working distance
- Save 'hand movements' for cases where resolution of spatial detail is impossible
- Record optimal acuity measurements with logMAR based charts and crowded optotype symbols.
Workshops
Dr Robert Harper from Manchester Royal Eye Hospital covered medico-legal matters relevant to the optometrist. Between April 04 and March 05, 24 cases were heard by the General Optical Council of which 17 were charged with serious professional misconduct. Helpful top tips from the witness box included:
- Speak clearly, be brief, answer only what is asked
- Acknowledge professional limitations
- Do not evade the question; if you don't know, say so
- Do not argue.
An important take-home message from this workshop is the necessity of a clear and detailed record card. Thought processes for decisions should also be recorded. Blanket 'ophthalmoscopy NAD' is not enough, details are needed of each structure. If the hospital is contacted, record whom you spoke to and a summary of the conversation.
M Bradbury (Specialist Support Services, Birmingham), a qualified teacher, gave invaluable insight into the problems visually impaired (VI) children face at school. One such problem that can be easily overlooked are the social aspects of inclusion, eg a teacher giving 'the look' for children to stop talking, results in the VI child always being the last to be silent.
Ways to get round this, is for the teacher to speak or to give a raised hand signal, therefore allowing all children to have the same chance to obey. Visual fatigue is another issue for these children. If the class is asked to make notes on a chapter from the textbook, the VI child should be given a photocopy and asked to highlight the keywords.
Additional Presentations
Dr Dan Rosser (Norfolk and Norwich University Hospital) pointed out the variability of visual acuity measurements in the absence of true clinical change. He indicated that VA measurements can be dramatically affected by even small degrees of uncorrected refractive error and that this amount of variability may have considerable implications in detecting clinical change in individuals as well as in the design of clinical trials.
Suggestions given to minimise this include the use of strict scoring rules employing interpolation scoring (letter rather than line scoring) and also to test VA with the full refractive correction.
Ocular coherence tomography (OCT) was discussed by Emma Staples (Manchester). OCT performs a high resolution scan of the retina allowing subtle changes of the retina to be detected, which would otherwise be missed by more conventional methods of retinal examination.
A small scale pilot study was conducted in Manchester on 14 highly myopic eyes. Abnormal OCT findings were found in a third of these eyes. It is hoped that OCT will provide the answer to why some myopes are occasionally found to have reduced vision without any obvious cause.
Overall the conference was a huge success and delegates found the weekend stimulating and beneficial. The conference provided the opportunity to air views, ask questions and provoke plenty of food for thought. Look out for advertisements of the 32nd Hospital Optometry Annual Conference to be held in autumn 2006, so you won't miss out next year.
* Muriel Armstrong is an optometrist at Wirral Hospital NHS Trust