Delegates from around the country enjoyed presentations and workshops covering a wide range of topics from paediatric to geriatric eye care at the Australian Vision Convention in Brisbane.
The Australian Vision Convention, at the Brisbane Exhibition Centre in April, kicked off with a breakfast lecture describing a new tool to identify the vision behaviour of patients, and in doing so, prescribe a personalised lens.
Sebastian Fricker, who leads Essilor R & D’s Lens Design team in France, presented the lecture, and explained the process by which his company developed, with the aid of motion capture, a ‘pseudo reading’ task to determine a reader’s behaviour (including posture, head and eye movement).
I don’t want vision to be the reason why someone isn’t successful in their sport
By creating data sets of the reading behaviour of multiple patients, then measuring the individual data for a patient captured via this pseudo reading task, (a tablet records the values using a special ‘clip’ on the patient’s chosen frame as they track a large blue dot in the way they would text), Mr. Fricker said it is possible to personalise the spectacle lens.
David Foresto delivered a fascinating presentation on paediatric red eye, beginning by describing the many different types of conjunctivitis. He said, “if any paediatric conjunctivitis lasts more than four weeks, it is important to consider chlamydial conjunctivitis, which is a concern because the cause is typically sexual abuse. Chlamydial conjunctivitis is a notifiable disease and pathology needs to be taken. Furthermore, the broader issue of the child’s safety is paramount.” Mr. Foresto said, “it is important to speak to the child’s GP and ensure the child is seen by the GP. Additionally, it may be considered wise not to alert the parent to the suspected diagnosis as, if they are the perpetrator, it is likely they will not want the disease to be discovered and therefore may not be compliant with the GP referral.”
The topic of discussion moved from paediatric red eye to geriatric red eye with a presentation on demodex mites by Dr. Ieuan Rees. He said all adults have some mites, but when we see blepharitis with lash collarettes, we know there is likely to be an infestation of the demodex mite.
“Given their prevalence, it’s astounding that we pay such little attention to them,” Dr. Rees said. Described as “microscopic creepy crawlies that can be found in your eye lids,” he said, the symptoms – itching, blurring, red lids, even tear film instability and toxicity – are often misdiagnosed as an ocular allergy. The difference is the symptoms are worse at night and failure to respond to conventional lid hygiene. Treatment is long and uncomfortable, involving specifically formulated blephadex products, repeated over time. Additionally, bed linen needs to be hot washed, pillows and make up thrown away, hair washed with tea-tree shampoo, and the patient’s partner checked for infestation. Women are usually more enthusiastic to have this condition treated than men.
In acknowledgement of the Commonwealth Games, held “just down the highway” on the Gold Coast, Professor Graham Erickson from the Pacific University College of Optometry, USA, delivered several presentations on the visual performance of elite athletes – a topic he said is not well enough covered at optometry school.
“Good vision, with excellent experience, coaching and training gives you an advantage in sport,” he said. “I don’t want vision to be the reason why someone isn’t successful in their sport,” he said.
Prof. Erickson said competitive athletes have better perceptual mechanisms than the majority of the population; i.e. visual acuity, contrast sensitivity, dynamic visual acuity, ocular alignment, stereopsis, accommodative function, vergence function, ocular motor function and peripheral function.
He highlighted the importance of choosing the most useful tests when working with athletes – rather than a Snellen Chart for example, Landolt rings will test for sensitivity to gaps in visual information.
Today there are an increasing number of virtual reality and digital screen tools that are suitable to assess and refine athletes’ peripheral awareness/reaction, speed of object recognition and decision making, as well as, hand:eye; foot:eye; balance:eye coordination etc. Some of these instruments alleviate the need to invest in multiple pieces of equipment and some offer useful comparisons of a patient’s results against a databank of other athletes. He said more work needs to be done to develop and standardise specific tests.
PSYCHOLOGY OF CONTACT LENSES
David Foresto highlighted the positive psychological impact that contact lenses can have on patients. He recommended asking patients with high prescriptions or significant vision loss whether they feel like they’re missing out on anything in life. Using the examples of a woman who won’t take her kids to the beach anymore because she can’t supervise them in the water, a patient who avoids long flights, and another who doesn’t watch movie’s at night in fear of falling asleep while wearing scleral contact lenses, Mr. Foresto drew attention to the issue. It’s also important to ask patients not just what they like about their new contact lenses, but also what they don’t like. “There are often solutions to prevent anxiety and achieve an even better wearer outcome,” he said.
“It’s worth correcting some patients’ vision at night because they might be up – or worried they’ll need to get up to feed the baby, respond to an alarm etc… In the future I think extended wear will take off again because our visual demands are changing – we watch movies at night, check our phone for emails first thing in the morning,” he said.
MYOPIA CONTROL INCLUDING ORTHOK
The prevalence of myopia among Australian 12 year olds has doubled between 2005 and 2011, and the age of onset has come down. “As optometrists,” Mark Hinds stated, “we have a responsibility to look after vision for these children… we can’t halt myopia, but we can try to control or slow it.”
In his experience, orthoK is the most effective control for myopia. “OrthoK has become my gold standard, achieving an average reduction in myopia progression of +/- 45 per cent.” Although more invasive than spectacle lenses, Mr. Hinds said orthoK treats the eyes all day and, for most patients, his strategy is 10 days wearing the lenses followed by a 10 day break. He advises his patients that it takes about 10 days to reach full power change to allow a realistic timeline for the patient. “Obviously, refractive error change and success is expected far before this time,” said Mr. Hinds.
“The number of specifically designed myopia control lens options is growing and it’s probably the most technically nuanced option (for treatment), so you do need to upskill,” he said. “Poorly fitted lenses or non-compliance can result in corneal damage, however, when the project is done well, the price is justifiable and it may be less costly for the patient than prescribing daily contact lenses… Alternative options, which are now available, are daily disposable myopia control specific contact lenses and even custom made distance centred hybrid lenses from SynergEyes. Now is the time to get involved with myopia control as there is a wave of patients to help.”
For optometrists looking to upskill on complex contact lens skills, he recommended the OSO conference from 5 –7 October.
IMPACT OF BACTERIA
A presentation on the intestinal microbiome by optometrist Julie Newport highlighted the role of bacteria for general health and specifically, eye health. Ms. Newport said, “bacteria have a much greater impact on our healthcare than previously realised, including our eye care… Internal flora have everything to do with what’s going on with our immune and endocrine systems and both of these have an impact on what’s going on with our eyes.” Probiotics could be recommended to patients after a course of antibiotics, which strip the intestine of microbial cells. They may also be useful for patients who are unable to take Omega 3. Ms. Newport said she often advises patients to see a dietician or conduct their own research before taking probiotics. Michael Mosley’s website, Clever Guts, is a patient friendly resource.
PAEDIATRIC EYE HEALTH
Tina Huynh presented on paediatric testing, emphasising the need to be fully aware of visual acuity and refractive error norms when working with children. She explored different testing procedures according to age group and offered “tips and tricks” for building trust and rapport. She said “fun activities” to test stereoacuity, motility, and NPC prior to testing for visual acuity, help to build on the patient’s sense of trust.
Adrian Bell presented strategies for managing paediatric patients with learning disabilities. Often children with learning disabilities will have some visual issues too. He said it is important to, “confine yourself to vision, prescribe as required and don’t worry about the label the child arrives with”. He said when testing, behavioural signs of discomfort and inefficiency (facial expressions, body movement or a child who says ‘ouch’ etc.) will indicate that a child is finding the test difficult. Mr. Bell said if in doubt, use Medicare item 10905 to refer to an optometrist with a special interest in paediatric care.
OPTICAL DISPENSING PROGRAM
An optical dispensing program, sponsored by Rodenstock, attracted a solid audience eager to learn about the many nuanced lens technologies available today. Steven Daras (TAFE NSW) referred to his personal experience with Office lenses to demonstrate the visual benefits for computer use as opposed to just using progressive lenses.
He encouraged dispensers to educate patients about their options. “Tell your patients what’s available and let them make their decision,” he said. He spoke about digital assistance lenses for people up to the age of around 40, who tend to use more than one screen at a time (e.g. a television and a smart phone). He cautioned, “this lens should not be given to early presbyopes – it is not a progressive lens; it’s simply to take the stress off the accommodation”.
Helen Venturato presented on dispensing to optimise sports performance. She said this is not an area of advice that should be reserved for elite sports people – any person who enjoys playing sport will want to maximise their performance. By asking about the sport a patient plays and the condition in which they play, as well as understanding the mandatory requirements surrounding eyewear in the game, it’s possible to prescribe lenses that will enhance their activity. Ms Venturato said at a time when obesity is on the rise and diabetes type 2 is becoming an epidemic, we don’t want to be putting barriers in the way of people playing sport by not giving them the ideal eyewear.
Mid-way through the conference, a cocktail party, complete with band, at the Queensland Art Gallery, provided optometrists, exhibitors, presenters and organisers with the perfect opportunity to let their hair down.
In April 2019, AVC will return to the Gold Coast.