Specsavers Clinical Conference

Specsavers Director of Professional Services Peter Larsen kicked off proceedings by welcoming both Specsavers and guest optometrists to the conference.

Specsavers performed more than three million eye tests over the preceding 12 months in Australia and New Zealand.

As the market leader Mr. Larsen said “we need to work out different ways to demonstrate value for a patient’s overall eye care”.

He said social reformer Florence Nightingale pursued best patient outcomes and changed the way nursing was done. In so doing she improved healthcare for not only Britain but all sections of society.

“This is our Florence moment,” he said. He also stressed that education has to be targeted and that it’s “no point doing 40 points if it’s not effective for your practice”.

The conference program was rich in local talent.

Speaker: Assoc. Prof. Alex Huynor

Topic: Vitreoretinal Case Studies

Assoc. Prof. Huynor began the lecture discussing the newest classification of vitreo retinal disorders, which were released in 2013, describing them as OCT based and simple to use.

He continued with a discussion of the clinical diagnosis of retinal detachment highlighting that patient history and pupil dilation are crucial considerations and that a non mydriatic retinal photograph is unacceptable.

Associate Professor Huynor told the conference that in 2014, the most common method of treating retinal detachment is vitrectomy followed by scleral buckling and pneumatic retinoplexy. The lecture concluded with an informative discussion on diabetic retinopathy and macula oedema.

Key points regarding macula oedema were a new classification – central vs. non-central; that an OCT was required for diagnosis; that laser now has a limited role and intra vitreal anti-VEGF is far superior for central involvement.

Speaker: Dr. Andrew Apel

Topic: The Anterior Segment Guide

Dr. Apel gave an informative lecture regarding all aspects of the anterior eye, introducing the acronym PEDALO: Pain, Epithelial defect, Discharge, Anterior chamber reaction, Location, Oedema.

Dr. Apel gave practical information on the treatment of corneal ulcers for both contact lens wearers and non contact lens wearers, with the take-home message being: If it gets worse, REFER.

The lecture continued with treatment of marginal keratitis, filamentary keratitis and adenoviral conjunctivitis. Giant Papillary Conjunctivitis was renamed as Contact Lens Papillary Conjunctivitis (CLPC) and treatment with antihistamines and mast cell stabilisers was discussed as well as the suggestion of the use of a short course of steroids (seven to 10 days).

Dr. Apel stressed the importance of ensuring that patients be made aware that the disease can take up to six months to fix. The lecture concluded with a relevant discussion on kerataconus and collagen cross linking.

Speaker: Prof. Jonathan G. Crowston

Topic: Glaucoma Risk Factors

Professor Crowston began his informative lecture on Normal Tension Glaucoma, with the startling fact that 80 per cent of patients with glaucoma have IOP less than 21mmhg.

Professor Crowston listed the five risk factors for glaucoma:

1. Dysregulation of blood flow

2. Sleep apnoea

3. Low CSF (cerebral spine fluid) pressure

4. A compromised autoimmune system

5. Myopia or mitochondrial dysfunction.

Professor Crowston stressed the dynamic nature of IOP, and that looking at the optic nerve head is critical.

He also spoke about Flammer Syndrome, a disease that affects young females, and its link with normal tension glaucoma, as well as non-glaucomatous diseases such as Anterior Ischaemic Optic Neuropathy and the genetic eye diseases – Leber’s Optic Neuropathy and Autosomal Dominant Optic Neuropathy.

Speaker: Assoc. Prof. Michael Coote

Topic: Looking at the Optic Disc

Associate Professor Coote is well known for his GONE (Glaucomatous Optic Neuropathy Evaluation) study and introduced conference participants to the purpose of the study, which began six years ago and the website www.gone-project.com.

He outlined some well-known glaucoma studies including OHTS (the Ocular Hypertension Treatment Study) and reiterated that 50 per cent of glaucoma patients have intraocular pressure within the normal range.

Assoc. Prof. Coote stressed the many non-linear relationships in glaucoma including cup/disc ratio, axonal loss and visual field loss. He also explained how crucial optic disc assessment was.

Assoc. Prof. Coote detailed the aspects of the optic nerve, which must be considered including disc size, disc shape, tilt, peri papillary atrophy, cup/disc ratio, depth, the retinal nerve fibre layer and haemorrhages.

All in all a very thought provoking lecture.

Speaker: Dr. Charles Su

Topic: Danger Areas Outside the Globe

This presentation made the audience sit up and listen…. simple clinical presentations are not what they appear to be!

Lumps and bumps

Dr. Su advocated not just looking at something but actually palpating it. Does the lesion appear fixed or is it moveable? He stressed the importance of not knowing vs not looking!

Watery eyes

Dr. Su said it may not be simple… Test for facial weakness by asking the patient to close their eyes. Checking facial nerves is important and is often overlooked.

Swelling and puffiness

We need to check more widely. Is there globe malposition? Always consider the other eye. He concluded the lecture stressing that when looking outside the globe four factors need to be considered:

1. Globe displacement

2. Nerve dysfunction

3. Mechanical dysfunction

4. Palpation

Speaker: Dr. Shish Lal

Topic: the Anterior Segment:

What Not to Miss

Dr. Lal opened the lecture by defining the “black swan event” and reminded the audience that as practitioners we must be vigilant. There are serious events that mimic benign ones, and serious conditions that are time critical. He advised the audience that if a condition is not improving they:

• need to revisit the case and look at the possibility of a different diagnosis;
• reconsider the course of disease;
• review the treatment being provided;
• listen to their intuition.

Dr. Lal then proceeded to discuss some unusual conditions including Carotid Cavernous Fistula, which is defined by a unilateral red eye and very prominent corkscrew vessel. He also discussed Third Cranial Nerve Palsy, advising it should be treated as an emergency if the pupil was involved, pain was a prominent symptom, or the patient was over the age of 50.

He also advised that for Severe Ocular Trauma with an open globe to never use a pad but always a clear shield.

His discussion on Ocular Surface Squamous Neoplasia also included interesting comment on the fact that 8 per cent of iris nevi convert to melanoma in a 15-year follow up, and then concluded the lecture with a detailed discussion on the differential diagnosis of scleritis and episcleritis.

Speaker: Prof. Nathan Efron

Topic: Rethinking Contact Lens Aftercare

Prof. Efron is regarded as one of the foremost speakers in the world on contact lenses. It was prudent that the organisers of the conference once again placed him at the end of the conference immediately following afternoon tea because most delegates stayed to hear him.

Prof. Efron bounced onto the stage and had us all thinking about the importance of daily disposables and monthly replacements which make up 94 per cent of the overall contact lens market.

He highlighted that daily disposables are 12 times safer than reusable lenses…a startling statistic and one to take note of when advising patients.

Although contact lens fitting is not included in Medicare Prof. Efron said the two business models he’d suggest are:

1. An all-inclusive annual fee

2. Fee per service

He highlighted the pros and cons of these models but stressed that clinical considerations must drive profitability.

Next year the Specsavers Clinical Conference will be on Sunday 13 September… “bigger in scale and more points available!”

Helen Brown is an optometrist with 25 years of clinical practice experience. She has been a Director of the Specsavers practice in Randwick NSW for the past four years.