With a new venue and timings, fresh faces at the podium and more opportunities to visit the sponsors’ exhibition, the BCLA’s one-day autumn event looked and felt different from the previous 10 years of Pioneers Conferences. There was greater emphasis on future developments and news of further changes to the 2015 BCLA Clinical Conference and Exhibition.
CEO Cheryl Donnelly said that BCLA Liverpool 2015 (May 29-31), the last before the conference becomes biennial, would have a more compact three-day programme covering all core competencies. Hands-on workshops would be free for the first time, and the progamme would include a day dedicated to myopia management in practice.
The first two speakers then set the scene with topics that will be followed up at the Clinical Conference. Alistair Bridge, director of policy and communications at the General Optical Council, outlined the new strategy to tackle illegal contact lens sales (News 21.11.14).
Bridge announced a code of practice for online contact lens supply, a consumer campaign to raise awareness of how to purchase and wear contact lenses safely, and a new stakeholder group with representation from across the sector and from consumers, to help implement the GOC strategy.
Myopia management
[CaptionComponent="865"]Introducing myopia specialist Dr Nicola Logan, past president Dr Catherine Chisholm predicted 2015 was the year myopia management would arrive properly in practice, with new findings and more lens options expected. Although there were currently some promising interventions, these were slowing myopic progression rather than preventing onset, said Dr Logan.
More advanced methods were needed to explore peripheral refraction, which varied from patient to patient. Bespoke correction might be required. In the meantime, practitioners should be monitoring myopic progression in children and identifying those progressing at a rate greater than -0.50D per year.
Matthew Carter described his work at the optometrist-led Early Keratoconus Monitoring Clinic at Moorfields Eye Hospital. Collagen cross-linking (CXL) was the only current treatment proven to retard keratoconus progression. Risk factors for progression were recent progression in the other eye, age <21 years, pachymetry measurement <400 microns and steep K readings >53D. Non-Caucasians and atopic patients were also at greater risk.
Nine in 10 patients treated with CXL were not progressing at one year. Complications included corneal inflammation, sterile infiltrates and, in extremely rare cases, sterile corneal melt and perforation.
Specialist fitting
Sophie Taylor-West dispelled some of the myths surrounding specialist contact lenses, such as that they were uncomfortable, difficult to handle and the patient would not pay enough to make fitting them worthwhile. Her advice was to have a range of fitting sets, to include hybrids, corneo-sclerals, corneal RGPs for keratoconus, soft lenses for irregular corneas and mini sclerals.
Among the new lenses she recommended were the ICD 16.5 (No 7), Zenlens (Six Six Contacts) and Maxim (Bausch+Lomb) mini sclerals, the Synergeyes Duette Multifocal hybrid (No 7), Expert Progressive translating RGP multifocal (Six Six Contacts) and Rose K2 XL semi-scleral (David Thomas).
[CaptionComponent="866"]The presentation by Sarah Farrant was not for the squeamish. Demodex was emerging as a significant cause of blepharitis, with prevalence of up to 20 per cent in under-20s and 100 per cent in over-70s. The key signs were ‘cylindrical dandruff’ in the eyelashes and round collarettes at the lash roots. Once these were removed, the mites’ transparent tails could be seen protruding from the follicle opening. Patients experienced typical dry eye/blepharitis symptoms but could also be asymptomatic.
Treatment involved general hygiene improvements, washing bed linen and towels at 60°C, and replacing eye make-up. Mild cases were treated with lid hygiene but Farrant’s advice when moderate or severe was to ‘hit it hard’. Her protocol included using the BlephEx device to remove debris from the lids. Recent College of Optometrists’ guidance outlined the procedure for carefully treating lids with a 50 per cent mix of tea tree oil diluted with mineral oil.
Explaining the cause to the patient was just one of the challenges with this alarming condition.
‘Witless wearers’
Dr Nicole Carnt reported that a clinical audit at Moorfields identified nearly 200 cases of Acanthamoeba keratitis between 2000 and 2012, almost all (94 per cent) among contact lens wearers. About half were misdiagnosed initially as Herpes simplex keratitis.
Incidence of Acanthamoeba keratitis in the UK was 10 times higher than in the US. Likely factors were water hardness and domestic water storage tanks. Researchers were ‘fairly confident’ that the source of amoeba was tap water. In fact 90 per cent of cases could be prevented by avoiding contact between water and contact lenses.
Dr Carnt then talked about using the Health Belief Model to encourage patient compliance and introduced Shona, one of the ‘witless wearers’ featured in a series of YouTube videos of non-compliant contact lens wearers.
The day ended with Professor Harminder Dua’s BCLA Pioneers’ Lecture on identifying Dua’s layer. It started with a salute to the contact lens pioneers no longer with us from Tim Bowden. Company presentations of today’s pioneering new products completed the line-up for this interesting day.