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SRC 2016: Crowded House

There were pluses and minuses about the new look Southern Regional Congress, which took place at the Pullman and Mercure Hotel in Melbourne in early March. In the main, the view was positive and the outlook for 2017 optimistic… with a few lumps and bumps ironed out, the feeling is that next year’s SRC will be the profession’s flagship CPD event once more.

Pete Haydon, CEO of Optometry Victoria, always knew that moving SRC from Melbourne’s expansive and very expensive exhibition centre to a hotel and convention centre in nearby Albert Park would be a challenge. However, he said, the move was essential to boost declining delegate numbers, better manage member’s money and reinvigorate the event.

He certainly achieved that target, with a significant increase in delegate numbers year on year (from 814 in 2015 to more than 870 in 2016) resulting in SRC bursting at the seams on the Saturday in particular. The high delegate count certainly tested the venue’s capacity and the strain on the Pullman will drive further change ahead of 2017.

“We are delighted with the numbers SRC attracted, and with the high quality of the education program and the trade expo, which had strong traffic and an amazing energy,” said Mr. Haydon. “We had a fantastic careers expo – 120 students attended and with representatives from right across the profession exhibiting, we were able to show them all the opportunities available across optometry.” Mr. Haydon said the Congress dinner on Saturday night was “the best in years” with a great band and packed dance floor.

While we know that
the natural tear blink rate is 10–33 per min, when we add the influence of technology the blink rate is 60
per cent less when in front of a computer or digital device…

Mr. Haydon acknowledged that Saturday’s over-crowded lecture theatres were problematic and had a flow-on effect when it came to moving people around the venue and catering. He said his team was able to increase seating for Sunday lectures and make logistical changes which meant everyone “didn’t need to breathe in and out at the same time”. Additionally, he said the venue has a great deal of potential to expand the size of lecture theatres to ensure delegate’s comfort in the future.

“Overcrowding, both in the lecture theatres and at the catering stations on Saturday was a real disappointment because it compromised the comfort and experience of our delegates,” said Mr. Haydon. “While we were able to respond and improve the amenity significantly on Sunday, I acknowledged to those attending that we would only be able to make partial fixes on the fly. We will be undertaking a thorough review of what happened operationally and making changes for next year to ensure SRC remains the flagship CPD event for optometry in Australia.”

Contact Lenses Today and Into the Future

At the Alcon breakfast, optometrist Margaret Lam kick-started SRC 2016 with a presentation on contact lens prescribing. Before asking the bigger question, ‘Are we optimising our prescribing?’ Ms. Lam ventured into the future with an enticing overview of developments that are shaping the future of contact lens technology.

Among these is a glaucoma monitoring contact lens being developed in collaboration by Google X labs in Switzerland and Alcon; a solar power assisted living contact lens under development at the University of Washington, fitted with transparent light emitting diodes, that will give an overlay of information on-demand; and the telescopic contact lens to treat people with retinal pathology, macular degeneration. This lens would give the wearer normal unmagnified vision as well as vision magnified to 2.8 times with the blink of an eye.

Ms. Lam went on to talk about existing contact lens wear experiences. She said the universal drop rate was two out of every three existing contact lens wearers, highlighting the main reasons as being dryness and discomfort levels associated with this dryness.

This led into a discussion on the changing ocular environment due to consumers’ addiction to technology, which was resulting in an increasing incidence of dry eye.

“While we know that the natural tear blink rate is 10–33 per min, when we add the influence of technology the blink rate is 60 per cent less when in front of a computer or digital device – less than four times per minute – and that influences negatively on tear film stability, inducing dryness and discomfort. This means we have to be mindful of the type of contact lenses we prescribe and highlights we need to choose what we prescribe carefully to ensure patients do not drop out of CL wear and make sure we prescribe the best lenses at our disposal. This means keeping up-to-date with technological advances and revolutionary products such as Dailies total one. That’s how you can meaningfully improve the patients’ quality of life,” said Ms. Lam.

HB Colin Medal

Professor Nathan Efron AC delivered the H. Barry Colin medal lecture on the topic ‘Is contact lens wear inflammatory?’ He said the question of contact lenses being inflammatory goes back to the first paper published on contact lenses by August Muller, a 20-year-old medical student who wrote about his own experiment to correct his 14 diopters of myopia by fitting a glass scleral lens to the eye.

Professor Efron told the audience that he had been asking this question since 1985, and now felt he could answer it. In a high energy and entertaining presentation, he listed in Latin, the “five cardinal signs” of inflammation: rubor (redness) calor (heat), tumor (swelling), dolor (pain / discomfort) and functio laesa (loss of function). He concluded that contact lens wear is indeed inflammatory, but added “it’s a good thing!”

Diabetes Management

Dr. Nandor Jaross spoke about the burden of diabetes on the individual, and the role optometrists have in preventing its escalation and the onset of diabetic eye disease.

He said studies had shown that it takes an hour or two every day for people with type 1 or type 2 diabetes to manage their disease – to do their finger pricks, see their cardiologist, endocrinologist, nephrologist, sleep physician, ophthalmologist, optometrist etc.

Dr. Jaross said diet and exercise remains a major problem in our communities and went on to give examples of diabetic patients who had changed their lifestyle, in the process losing 30kg. One of his patients with type 2 diabetes could stop using insulin and controlled her blood sugar with lifestyle and dietary modification.

“Yes diabetes, especially impaired glucose tolerance, is reversible to a certain extent,” said Dr. Jaross, urging optometrists to encourage their patients at risk of or living with diabetes, to change their lifestyle.

Additionally, he said it was important for optometrists to encourage patients to take control of their diabetes by explaining the benefits good blood sugar control brings – both in avoiding high HbA1c and daily fluctuations. “Similarly, they need to make patients aware of the benefits a blood pressure below 130/80 brings. In the UKPDS, a simple measure of achieving good blood pressure control decreased the progression of diabetic eye disease by about a third over a seven year period and decreased diabetes-related mortality to the same extent. Every diabetic eye review should include a blood pressure check regardless of where it eventuates,” said Dr. Jaross.

“Every week in my clinics I have patients who have a blood pressure of 200 over something – these people have no place in an eye clinic, these patients have to go as an emergency to their local GP… these patients are at risk of stroke and heart attack.”

Quoting the American Journal of Ophthalmology he said, “the input that allied health professionals including optometry can give to the preservation of sight for these patients should not be underestimated… I don’t think we are doing it – there are not many optometrists these days who have the courage or desire or take the time to measure the blood pressure, and / or discuss the importance of systemic management of diabetic eye disease in detail with their patients”.

He said everyone who has a 20-year history with type I diabetes has some sign of diabetic retinopathy, and 60 per cent of patients with type II diabetes after 20 years has some diabetic eye disease. However, with monitoring, systemic management and ophthalmological treatment, vision could be saved.

Dr. Jaross said, “the bottom line, the most important factor is to prevent diabetes with lifestyle modification (primary prevention) and to slow down disease progression by systemic management (secondary prevention) and to save sight by systemic and ophthalmological management (tertiary prevention).

Ultra-Widefield Imaging

Consultant ophthalmologist Dr. Shanel Sharma spoke to delegates about the clinical advantages of ultra-widefield imaging, in particular the Optos, “the only one that expands out to 200 degrees”.

“Fundus fluorescein angiography enables me to perceive and see more of the retina and the pathology going on in the retina… areas I would never have been able to see using the standard fundus photography system with angiography – so pathology that was previously hidden I can now see,” she said.

Dr. Sharma went on to speak spoke about an 86-year-old patient who presented complaining of dry eye. Examination using Fundus fluorescein angiography enabled her to identify a large retinal tear. She said being able to use the Optos to show her patient the tear assisted with patient education about the desired treatment, with gaining patient consent and managing the patient as best as possible.

Anterior Eye

Dr. Nathan Lighthizer, in Australia for SRC from the United States, and Associate Professor Mark Roth were two highlights of SRC, particularly when they teamed up for an entertaining rapid fire session on anterior eye – the perfect antidote to a delicious Sunday lunch.

The team spoke about the potential to diagnose epidemic keratoconjunctivitis (EKC) including palpation of pre-auricular nodes then went to speak about more obvious physical signs. Discussion of EKC treatment included in-office povidine-iodine lavage and the use of steroids if corneal sub-epithelial infiltrates developed.

Dr. Lighthizer highlighted the 18–24 day cycle of this virus, broken into seven days of red eye, seven days of an immune response and seven days of resolution. He said that if not properly recognised and treated early during the first week, the virus will likely have run its course by the second week of EKC and then you are left dealing with the inflammatory stage. Assoc. Prof. Roth said this is why there is such a proliferation of EKC. “There is a period of incubation and (the patient doesn’t) have symptoms or signs – you don’t have a red eye or feel something is wrong, but you’re shedding the virus,” he said.

Dr. Lighthizer said according to the literature, 80 per cent of EKC patients have corneal involvement, although in practice, optometrists might not see this.