Birmingham is the home of great curries, one of the largest fountains in Europe, Cadbury’s chocolate, the birthplace of the Mini… and, from 6–9 June June 2014, home to the 38th British Contact Lens Association (BCLA) Clinical Conference.
This year saw a change in the BCLA structure, with the four day event at the International Convention Centre split into two parts, the first of which was primarily aimed at the research community.
The second part of the conference was held on the Sunday and Monday and more geared for practitioners and business owners. New features such as “live surgery” and the continued partnership with the US Vision Expo (Global Contact Lens Forum), gave the conference an innovative and transatlantic flavour.
The audience of 1,000 was split, as in previous years, between UK and European attendees, with a total of 51 countries represented. There was also strong representation from industry – entirely understandable as BCLA is the event where exciting new products are, if not launched, showcased.
Having a grading scale on display in the testing room either makes the patient ask questions about the pictures or is something you can refer to
The conference began with a session on contact lens dropouts, rounded up by this year’s Global Contact Lens Forum, where the focus was on retaining contact lens customers with a clinical professional approach. On Monday morning a keen audience watched as Professor Sunil Shah performed a standard modern day phacoemulsification procedure with implantation of an intraocular lens, followed by a Lensar femtosecond laser cataract procedure with a premium lens implant. The surgery was transmitted ‘live’ to the auditorium with commentary from Professor Shah who then returned to join in the discussion.
Workshops are a highlightof BCLA
Last year, and again this year, I attended an offsite session at Optegra, a group of private eye hospitals that employs a wide range of optometrists. It was very interesting to see how refractive surgery has developed in 12 months and exciting to see new developments such as Raindrop near vision corneal inlay. In the presentations we workshopped case histories balancing different patient lifestyle needs with the types of corrections available. A key message to keep in mind was how the refractive solution would work in the future for a particular individual.
Later in the session, we were able to observe patients who have had procedures, work some of the instruments used – such as the IOL master, and interpret the results. Then, having been talked through a video of phacoemulsification, we observed a volunteer from our group perform phako on an artificial eye. I think we all secretly wanted to have a go, though perhaps not watched by the whole group.
Irving Fatt Memorial Lecture
The 2014 Irving Fatt Memorial Lecture, ‘Clinical evaluation of dry eye: a year of research’ was given by Dr. Heiko Pult. Dr. Pult, a successful practitioner and independent researcher, gave plenty of clinical pearls in his lecture, which included LIPCOF (lid parallel conjunctival folds), meibomian gland disease and the mechanics of blinking. Here are a few of his tips:
- Non-invasive break up time (NIBT) and LIPCOF are the best predictors for non CL related dry eye;
- Observe LIPCOF without any staining dyes, without contact lenses and at high magnification. Interestingly LIPCOF are not age related;
- Lid wiper epitheliopathy (LWE), is a useful predictor of contact lens related dry eye. It is essential to use lissamine green, and important not to confuse LWE with Marx’s line;
- Neither conjunctival nor corneal staining correlated with CLDEQ, a quality of life scale for contact lens dry eye.
2014 Dallos Award
Pauline Kang received the 2014 Dallos award for her study on the effects on binocular and peripheral vision functions using distance centre multifocal soft lens designs. Using two adds, +1.50 and +3.00, in the Proclear lenses, 20 young myopes wore each lens add for two weeks with a one week washout in between. While there was a small decrease in central acuity, it was clinically not significant. There was an improvement in peripheral detection ability and, for the higher add, a near exophoria shift in the region of 3.67 prism diopters. Although peripheral refraction was not measured in this study, the results suggest that peripheral hyperopic defocus was reduced. This looks a promising strategy to improve visual comfort in near esophoric myopes and may also have benefits of reduced myopic progression.
Meredith Jansen, now a research optometrist with J&J, presented some elegant work from her previous experience in the contact lens clinics at University of Iowa. They used anterior segment OCT to image the presentation and resolution of sterile contact lens peripheral ulcers (CLPUs). This of course has practical implications for tracking the resolution of these events and ensuring they are not early infection in which, deeper infiltration, less regularity and possible satellites may be present.
Increasing Contact Lens Safety
There is currently a great buzz in the UK about the need to increase the safety of contact lens wear. You may be aware that the BCLA donated a charity exhibition stand for the Moorfields Biomedical Research Centre to host the Healthy Contact Lens Wear Project. Part of our brief was to publicise the “No water” stickers, a concept and design invented by Ms. Irenie Ekkeshis, a patient with Acanthamoeba Keratitis. A major risk factor for AK is contact lens exposure to water, especially in hard water areas such as London. Ms. Ekkeshis was able to attend the conference on the Sunday, when I presented a talk on the quality of life of patients with AK. She later joined me on the stand where she spoke frankly about her experience and motivationfor the stickers.
However it was optometrist Hannow Mahmood who came up with the top compliance tip:
“Having a grading scale on display in the testing room either makes the patient ask questions about the pictures or is something you can refer to, not to scare the patient but to make them aware of some consequences of non-compliance
to make them more cautious. You can also use it to demonstrate what condition their eyes are in and to prevent things from getting worse.”
This tip showed great understanding of how visual aides can be used in a variety of ways to reinforce compliance. Also, simply having such a grading scale on display conveys to the wearer that the health of their eyes is a priority.
2015 BCLA Clinical Conference and Exhibition
The 39th BCLA Clinical Conference and Exhibition will take place at the ACC Liverpool (the Guinness Book of Records Capital of Pop), UK, from Friday 29 May to Monday 1 June 2015.
Professor Fiona Stapleton, Head of School Optometry and Vision Science, UNSW will present the 2015 BCLA Medal Lecture, and the Irving Fatt Memorial Lecture will be delivered by Dr. Michael Read from University of Manchester. Dr. Simon Kilvington, from the University of Leicester, and I will receive the 2015 Dallos Award presenting, ‘The relationship between environmental sources and the susceptibility and severity of Acanthamoeba keratitis in theUnited Kingdom’.
The full program is out later in the year, but I am expecting more live surgery and would certainly welcome that. Having had the opportunity at Moorfields Eye Hospital to observe external eye and corneal surgery, such as corneal transplants, cross linking, and laser procedures, I have learnt a great deal about the anatomy of the eye, indications for and the response to surgery. I highly recommend taking opportunities to observe surgery, even if you are squeamish (like me).
Dr. Nicole Carnt is a Post-Doctoral Research Optometrist at Moorfields Eye Hospital in London. She is also a contact lens professional affairs consultant for the Contact Lens Industry.
Originally from Sydney, Dr. Carnt was previously with the Brien Holden Vision Institute and is a regular contributor to mivision’s independent clinical education centre.