Sixties, the Beatles, Paul McCartney in town, Maroon Five came but cancelled, wind and rain, a spectacular gala dinner in the Anglican Cathedral and some great education, that was the 2015 British Contact Lens Association (BCLA) conference, held during May this year in the United Kingdom city of Liverpool and themed ‘Come Together’.
I was a bit worried when I heard that the live orthokeratology fitting was to be conducted on the morning after the Gala Dinner, however I needn’t have been. The lenses may have gone in late, but they went in, and anyway, that’s real life. It was great to see Shelly Bansal, past BCLA President, talking through the expectations and saying relax and don’t make changes too quickly. As he described it, orthoK is a “process”.
The first day of the conference was Myopia Day, which culminated in an interesting and varied panel discussion chaired by Professor Brien Holden. Differences between myopia control practices across regions became very apparent. Professor Pauline Cho from Hong Kong Polytechnic described how orthoK was the main myopia control in her country, contrasting with Australia where around 100 out of 4,500 optometrists practise orthoK. Kate Gifford described some issues in Australia with equipment, as well as high set up costs and non-compliance on follow up. Several UK University lecturers remarked that while it varied between universities, theoretical orthoK was usually taught but seen as specialised. Because of the preregistration year in the UK, where most practical experience is gained in full-time practice, the opportunity to fit orthoK depended very much on the host practice. As Shelly Bansal explained, this was unlikely to occur unless you were in a specialised independent practice.
Prof. Holden asked the panel what parents preferred. Esteemed orthoK and specialist contact lens optometrist from the US, Professor Pat Caroline said that many parents like orthoK because they control the lens going in at night and its removal in the morning, however they worry about what happens during the day. He said current orthoK lenses are, in the main, designed for adult eyes and child specific designs are performing well in research, so watch this space.
By far the most interesting question was what will be happening in 10 years time. There was some discussion about the “outside effect” – are light levels or differences in viewing distances outdoor compared to indoors behind the rise of myopia? Suggestions of short bursts of treatment that have been seen to work in animal models, and treatment in a step wise fashion e.g. pharmacological treatments when a child if four to five years of age; followed by contact lenses, with or without drugs were popular. How might the treatments be delivered: drugs from within contact lenses, semi-rigid overnight orthoK lenses? What role will genetics testing take? While risk algorithms incorporating genetic and environmental factors are likely (as there are now for AMD), how far off is this? The session ended on a comment we are all familiar with: the three ways to slow down myopia are: optical defocus, spending time outdoors and chromatic aberration. The next step is to clarify why these work.
Business Track
BCLA has a reputation for innovative education delivery and this year did not disappoint. Sarah Morgan tweeted a selfie video of her audience, before launching into the dos and don’ts of front of house staff communication.
An important question potential contact lens (CL) wearers will ask, she said, is “how much do CLs cost” because they don’t know what else to ask and they are really saying, “tell me about CLs”. Other good tips are to prepare them for change, so tell them that new products are always on the horizon and put their prescription in context, for example, make them feel special that they are a -3D and they will get new products first.
Sarah was presenting in the business track, an additional education stream that has been welcomed in recent years. Also on the bill was Ross Grant, a UK optometrist with extensive managerial experience gained through practice and in the CL industry. Ross runs Toolbox Training and Consultancy and gave a fascinating talk on management styles. What made a lot of sense was a summary of the characteristics different age groups prefer in their boss.
Coming in fourth and fifth on the list for both the 26–35 and 55 plus age groups were the attributes ‘effective and competent’. However top three for the younger ages was ‘consistency, credit giving and supportive’ while for the older group, ‘honesty, being authentic and fair’ were more important features.
Ross Grant also spoke about situational leadership and described four leadership styles based on different levels of supportive and directive behaviour. It is importance to match the leadership style with a person’s competence and commitment. Consider four people in a large practice as outlined in Figure 1. D4 is less directive than D1, and so requires more directive leadership. What tasks would you assign these staff members and do you agree with the suggestions on how to direct them? Consider the effect if the management style did not suit the person’s competence and commitment.
One important point to remember is that successful management depends on the person’s competence for a particular task and that even if people have high experience they need to be inducted into a new position. So good managers are different things to different people, and adapting your leadership style to the person and the situation is key.
Demodex
To round off, let’s go behind the slit lamp. I must admit I was not sure what all the Demodex hype was about, until I listened to Sarah Farrant, independent UK optometrist and “Dexorcist, mite massacerer”. Ever wondered why those lid scrubs just don’t work for some people? It might not be compliance.
Demodex is a parasitic mite that as you get older, is more often found at the base of the lashes. They appear as “cylindrical dandruff” and are associated with itching and in some cases inflammation due to bacteria they carry. They are 0.3mm in length, with a life cycle of around three weeks, lay 12–15 eggs each and are commonly found on the head. On the eyelid, the eggs are laid in the lash follicle and the mites flow out as they hatch. They are nocturnal, the females territorial and the males nomadic. They tend to be active in spring and summer and symptoms are worse on waking, with cellular debris composed of lipids, dead mites and dead skin cells forming crusts.
To identify them, pull the crust off the last with forceps at high (25-40x) magnification. The demodex tend to crawl back into the follicle so you need to be quick to grab one. Treatment is to reduce the mites, not eliminate them and needs to be done repeatedly and maintained between visits. Sarah uses a Blephex device, a swirling sponge to debride the lashes of the crust, then uses a solution of 100 per cent tea tree oil mixed with macadamia oil (six drops of each) on a cotton bud wiped along the lid. Tea tree oil is toxic to the cornea so must not be used full strength and used with caution. Review is in one to three weeks when retreatment is required for severe cases to kill the hatched mites. Further retreatment is four to six-monthly thereafter; and maintenance between visits is for patients to use tea tree shampoo. Certainly this is a good practice builder.
So that’s it from the BCLA Clinical Conference for two years now as it moves to a biannual schedule and will “come together” again in 2017.
Nicole Carnt graduated from UNSW in Optometry in 1989 and worked in private practice in Australia and the UK before taking a position with the Brien Holden Vision Institute in 1999, where she held a variety of roles, including Principal Investigator on CL clinical trials. While completing a PhD on Epidemiology of CL Related Infection and Inflammation 2008-12, she worked at UNSW in co-supervisory roles of undergraduate and research students, as well as coordinating post-graduate courses and running small group workshops. She is currently a Research Fellow at Save Sight Institute, Sydney, following a two-year placement at Moorfields Eye Hospital, London, funded by the Australian Government.
