Wow! What a weekend at the 17th International Cornea and Contact Lens Congress (ICCLC) in Noosa. To say my expectations were blown away would be an understatement. The conference, themed ‘A breath of fresh air’, began with some interesting workshops on a quiet Friday afternoon followed by a casual cocktail party. Saturday was full of insightful sessions and it peaked with a 60s themed dinner, complete with live music that continued throughout the night.
Dr Tom Arnold
The picturesque Peppers Conference Centre in Noosa welcomed optometrists from around the world who attended the 17th ICCLC in October.
Described by optometrist Benjamin Lu as “a gold mine of like-minded contact lens practitioners with a wealth of experience in contact lens fitting”, the event presented new approaches to contact lens management and to growing a contact lens practice. The congress kicked off with workshops followed by an evening to break the ice, allowing delegates to mingle over a few drinks and delicious food, backed by live music. If you were up for it, you could catch a wave and ride the mechanical surfboard. As colleague Tim Grant said, “It was the best conference opening I’ve ever attended”. That’s big coming from someone who’s been to many around the world for decades.
MALFUNCTIONS OF THE IRIS
On day two we heard from leaders in the profession. Auckland’s Professor Charles McGhee shared valuable tips regarding the best options we have to manage malfunctions of the iris. We all know the iris is a structure that controls light entering the eye but what I didn’t realise is that it’s highly vascular too. Malfunctions of the iris from damage or disease cause issues with glare and really affect a patient’s confidence. Management can start with conservative options like tinted spectacles, cosmetic contact lenses or even bespoke colour matched lenses. Sometimes more invasive interventions are warranted.
Floppy iris syndrome post cataract surgery is one cause of malfunction and Prof McGhee advised that some intraocular lenses can help deal with the consequential glare. Other options he described and demonstrated for management of floppy iris syndrome were to stitch the iris back together and even create a pupil.
CCLSA CEO Alan Saks
Sometimes it is only possible to preserve what is left of the iris. Interestingly, an artificial iris can be injected into the anterior chamber to achieve extremely realistic results. This is purely used in complex cases and not for cosmetic purposes.
INTRAOCULAR LENS SURGERY
Auckland’s Dr Sue Ormonde provided practical advice to prepare contact lens wearing patients for intraocular lens (IOL) surgery whether it be for cataracts or refractive reasons. Biometry – axial length, keratometry, corneal shape, corneal thickness and even refraction, needs to be accurate and precise to ensure good patient outcomes. Ideally these patients need to remove their contact lenses, whether they are soft, rigid gas permeable (RGP) or extended wear lenses, to allow the cornea to stabilise. The time it takes can range from just days to months or longer, depending on lens type.
Dr Ormonde’s advice was to put patients into spectacles, soft contact lenses or even leave them un-aided, one eye at a time, to allow the cornea to stabilise prior to taking biometry measurements. Keratoconic patients need to be made aware that biometry is difficult on abnormally shaped corneas and realistic expectations for outcomes should be set. Optometrists are well placed to start conversations about IOL outcomes.
The presence of Dr Ormonde and Prof McGhee was enabled by CCLSNZ.
ACANTHAMOEBA KERATITIS
Ken Bell Medal award winner Don Ezekiel AM with Margaret Lam
Dr Nicole Carnt from Sydney presented on the dangers of Acanthameoba found in water. We all know Acanthamoeba Keratitis is rare, it’s difficult to diagnose and even harder to treat due to its resistance to antibiotics and tough cysts. It relapses 70% of the time in the 12 months from occurrence.
Dr Carnt’s aim is to curb the incidence of Acanthamoeba Keratitis and ensure contact lens wearers are warned of the risks when mixing water with their contact lenses. Her hypothesis is that educating contact lens wearers will improve their safe practices. Through research she has found that a lot of people swim and shower with their contact lenses because they can’t see without them. What was scary was her finding that a few people do use tap water instead of disinfecting solutions to clean their lenses.
Dr Carnt has created (and subsequently updated) a ‘No Water’ sticker designed to warn about the dangers of mixing water with contact lenses. It’s available from the CCLSA and there is a link for patient education (www.cclsa.org.au/tap).
MEIBOMIAN GLAND DYSFUNCTION
A workshop hosted by optometrist Lucille Gergis from Sydney upskilled attendees on assessing and managing meibomian gland dysfunction (MGD) in clinical practice – 86% of dry eye is caused by MGD. Ms Gergis encouraged everyone to get into the habit of checking and, where necessary, expressing the glands on patients. She stressed the importance of educating patients and starting treatment early because you can’t get those glands back from the dead.
Corneal discussion panel
Treatments include warm compresses at 40°C for at least five minutes but eight minutes is ideal. Blephasteam has been shown to warm the eyelids better than warm compresses, especially the lower lid. New technologies available, including intense pulsed light therapy (IPL) and LipiFlow, aim to provide huge amounts of improvement in meibomian gland function lasting months.
UNDERSTANDING OUR OBLIGATIONS
Luke Arundel from Optometry Australia had plenty of useful tips to help us better understand optometrists’ obligations to patients. His advice included:
- Take a proper history, educate and inform patients and ensure they understand instructions given,
- Document everything – no records means no evidence,
- Implement and use a proper recall system,
- Do not become ‘friends’ with your patients – maintain a professional relationship,
- Do not post and share patient testimonials,
- Optometrists are not able to use the word ‘specialist’ to describe their services but can use descriptors such as “working primarily in…” or “has a substantial interest in…”, and
- Minimise the risk of complaints by communicating pros and cons, risks and benefits of treatment strategies upfront.
PRACTICE AND REPUTATION BUILDING
Keynote speaker Tom Arnold (America) brought ICCLC to a close with an engaging and broad ranging lecture covering contact lens complications, social media and practice success.
Tom built his practice over many years with an emphasis on training and involving staff.
Dr Laura Downie
Consequently, his staff pre-screen patients and do preliminary testing, put lenses into patients’ eyes, and in the process can predetermine whether the fitting is too flat or steep in RGP lenses and make adjustments accordingly before the optometrist has a final look. Tom’s staff also discuss insertion and removal of lenses with patients, and manage fees, follow ups and lens warranties.
As well as involving his staff at this integral level, Tom schedules his practice days to maximise efficiency and effectiveness. He has days dedicated to particular types of lenses, so he will fit orthokeratology on one day, sclerals on another etc.
Tom also shared the secrets to building his reputation at a professional level. Over many years he spent time getting to know corneal and cataract surgeons with whom he manages patients. Additionally, he took time to get to know optometrists who don’t do RGPs so he could become a valuable asset to them and their patients. Then he strengthened this network by doing the little things that matter: sending reports back to doctors, other optometrists and health professionals etc.
Tom encouraged us to do the same, but most of all he urged us to share our skills and knowledge. He finished by sharing photos of patients he’s personally helped which brought tears to my eyes, as I was reminded of why we practise – it’s for the patients and it changes their lives forever.
COLOUR, CRAZINESS AND LIFE
By the time Saturday came to an end, we were ready to let our hair down. The theme for the congress dinner, with live entertainment, was ‘the 60s’ and so I wiggled into an afro wig and colourful outfit and headed out in search of all the new friends I’d made over the past few days.
The event was incredible – everyone was so dressed up that they were hardly recognisable. I never knew the 60’s was so full of colour, craziness and life – we partied all night!
AN UNFORGETTABLE EXPERIENCE
ICCLC comes with multiple benefits for practitioners and students alike as Pooja Coffey, Alexandra Combe, Wes Butler and Louise Bhindi – final year students from Flinders University – were keen to point out.
The group said “We were blown away by the incredible and informative speakers, some who had travelled halfway around the world to attend the conference. We had the opportunity to learn about new advancements in specialty contact lenses, biometry in myopia control and dry eye management, as well as developing a deeper understanding of dry eye diagnosis and pathophysiology, interpreting corneal topography and fitting multifocal contact lenses.
“The warm and welcoming nature of all those attending, from new graduates to industry leaders, made this event one to remember. It was an incredible experience to be able to learn from experts in the field while also having a fun time in what can only be described as a party in paradise!”
For experienced optometrist Benjamin Lu, ICCLC was a chance to reconnect and remind himself of the support that is available. “Oftentimes you’re stuck in your consult room feeling alone in dealing with tough cases, but it was great to rub shoulders with the best and realise you’re just one among many who have gone through this before, and that people are more than willing to lend a helping hand.”
I’m eagerly looking forward to the next one and so is everyone else – make sure you don’t miss out!
The 18th ICCLC will take place early in 2021 and will be themed ‘The Hitchhikers’ Guide to Cornea & Contact Lenses’.
Shon Prasad is an optometrist who graduated from Queensland University of Technology in 2016. He works at OPSM Kawana Waters and Stafford.
