Returning from a pandemic-induced hiatus, the Cornea & Contact Lens Society of Australia’s International Cornea and Contact Lens Congress (CCLSA ICCLC) took over Darling Harbour for its 18th instalment. The ICCLC never fails to impress, each year assembling an outstanding line-up of presenters from both clinical practice and research fields. Attendees were entertained again this y ear with another creative conference theme, A Hitchhiker’s Guide to Cornea and Contact Lenses, reinforcing CCLSA’s reputation for providing high quality education in a fun and welcoming environment.
KERATITIS AND OCULAR SURFACE DISEASE
A Hitchhiker’s Guide to Cornea and Contact lenses kicked off with Professors Fiona Stapleton and Stephanie Watson discussing keratitis and ocular surface disease (OSD). On multiple occasions throughout the weekend, we were fortunate to hear from these esteemed professors, both international leaders in clinical research for these diseases.
Professor Stapleton enlightened the audience with her knowledge of corneal infection and inflammation. We were reminded of the importance of hand hygiene, as failure to wash hands prior to contact lens handling equates to a 50% increased risk of an infectious event. We also learned that infectious keratitis is not exclusive to the central cornea as some textbooks may tell us, hence we must stay vigilant when differentiating infectious keratitis from inflammatory keratitis.
Professor Watson walked through countless diagnostic pearls when managing OSD, notably discussing chronic ocular surface pain in patients with disproportionate dry eye symptoms. These patients are notoriously difficult to manage as they are often unresponsive to conventional treatments. Multidisciplinary psychological management and emotional support can be effective alternative treatments that are possibly underutilised in optometric practice.
The first session of the ICCLC, dense with clinical research, was neatly concluded by Damon Ezekiel, reiterating the important role that contact lens practitioners play in providing evidence-based care for the management of their patients.
Acanthomoeba was a hot topic this year, as it continues to challenge contact lens practitioners globally. Who better to lead the discussion than Scientia Associate Professor Nicole Carnt, research expert in corneal infection risk management. We revisited her work surrounding high risk contact lens behaviours, notably the relationship between tap water and acanthamoeba infection. As we know, acanthomoeba is notoriously elusive. Up to 50% of cases involving this sneaky masquerader are misdiagnosed. Hari Peguda added to the conversation with his fascinating research to develop a novel method for rapidly isolating and identifying acanthamoeba without culture, with the aim of reducing misdiagnosis.
UPCOMING DRY EYE RESEARCH
It has been a big year for research in the cornea and contact lens field, and we were fortunate to have those leading the way share their latest findings at the ICCLC. A thriving area of research within this broader topic is dry eye diagnosis and management. This work is rapidly providing practitioners with solutions to the many challenges presented in clinical practice.
Dr Ngozi Chidi-Egboka covered paediatric dry eye symptomatology and the reduction in blink rate during screen time in children. This was a good reminder for practitioners to familiarise themselves with the World Health Organization’s recommendations for early childhood screen time; no screen time for children under the age of one, and no more than one hour for children under five.
With a growing number of practitioners using meibomian gland imaging in practice, Fatima Iqbal identified the need to quantify our findings when performing meibography. She presented impressive research on the hallmark features of dry eye disease, including reduced distal meibomian gland width, increased gland spacing and reduced total gland orifices.
Quantum dot imaging is being explored in many medical fields; whereby biological markers are used to visualise difficult to isolate tissues. Sidra Sarwat shared current findings on how these biological markers can be applied to help visualise tear film layers.
Associate Professor Laura Downie wowed the audience with her ADMiER project, presenting slow motion footage of ‘tear stretching’. ADMiER or acoustically driven microfluidic extensional rheometry, can visualise a single droplet of the tear film responding to sound waves, to help subcategorise dry eye with high sensitivity and specificity. I look forward to seeing how these new technologies will revolutionise the diagnosis and management of dry eye in the future.
Unsurprisingly, the impact of coronavirus on contact lens practice has featured heavily in recent publications. Both Dr Parthu Kalaiselvan and Dr Vinod Massedupally addressed the research they have been conducting with respect to coronavirus adhesion to contact lens materials and how to minimise transmission risk when handling and fitting contact lenses.
In typical ICCLC fashion, a full day of lectures and workshops was completed with a memorable themed gala dinner. For those with a taste for quality live music, and a desire to dress as Elton John, this event was not to be missed!
MYOPIA MANAGEMENT MASTERCLASS
To kickstart day two, Dr Oliver Woo passionately opened the floor for fellow myopia experts to share pointers on how to manage the world’s growing burden of myopia. Dr Pauline Kang extensively covered the ‘when, how and why’ of myopia management and Pooja Bhindi provided an expert guide to fitting and troubleshooting orthokeratology patients. Dr Kathleen Watt calmed the nerves of those who worry about contact lens complications in children. Attendees learnt that although the rate of inflammatory complications in children is not too dissimilar from that of adult wearers, we must be vigilant with young adults and children, as they are more likely to engage in at-risk contact lens behaviours.
ENHANCING DRY EYE DIAGNOSIS AND MANAGEMENT
Dry eye, by definition is multifactorial, as highlighted by Martin Robinson when reinforcing the importance of correct identification, isolation, and treatment of individual factors of dry eye pathogenesis. The memorable acronym, BEISTO (bugs/bacteria, enzymes, inflammation, stasis, temperature and obstruction) will be of great use when tackling stubborn cases of dry eye disease. The ICCLC was also privileged to hear from Professor Nicholas Rumney from the United Kingdom, who shared some clinical pearls for managing dry eye in contact lens patients.
ADVANCED SCLERAL LENS
The ICCLC did not slow down for one moment, with the final day featuring presentations from the most brilliant minds in scleral lens practice and research.
Dr Damien Fisher and Associate Professor Steve Vincent covered the physiological impacts of scleral lenses. Intraocular pressure spikes have been a focal point of discussion in recent years, with concerns that scleral lenses compress common aqueous outflow pathways. After reviewing the literature, they have concluded that intraocular pressure elevation is perhaps much less of a concern than once thought.
Lachlan Hoy gave a masterclass on how to perfect a scleral lens fit, accounting for scleral toricity and lens flexure to ensure optimal lens centration. We also caught a glimpse of the future therapeutic use for scleral contact lenses, with evidence of well-fitting lenses facilitating unexpected healing of advanced corneal scarring. After discussing just how advanced rigid lens technology has become, Richard Vojlay reminded us not to forget the basics of corneal lens fitting, to avoid turning a simple lens fit into an unnecessarily complex one.
David Stephensen piqued our interest late in the day with the prospect of using our knowledge of wavefront error to optimise visual quality in contact lens fitting.
PUSHING THE SCOPE
In our efforts to expand the scope of practice, several new therapeutic agents have become available to us, for example, Muro 128 sodium chloride ointment, Lifitegrast topical LFA-1 antagonist, and AmnioTek sutureless amniotic membranes. TGA approval for novel therapies takes considerable time, often creating a barrier to treatments. Dr Margaret Lam introduced the Special Access Scheme and how to use yet to be approved pharmaceutical treatments.
Literature outlining emerging clinical interventions often excludes patients with comorbidities from selection criteria. Professor Watson returned to the lectern to remind us of the power that clinical registries have to enhance our understanding of eye disease clinical outcomes. There are currently several patient registries to which practitioners can contribute for many eye diseases, such as keratoconus and dry eye. To be involved, find more information at https://savesightregistries.org.
As always, this year’s ICCLC was a hub for optometry’s most passionate and motivated professionals to share experiences, accumulate knowledge and celebrate achievements. I extend my gratitude to the Cornea & Contact Lens Society of Australia and those involved in the organisation of this inspiring, memorable and wonderful event. Their tireless work to ensure the weekend ran seamlessly was evident. For those interested in pushing themselves, their practice and the scope of the profession, the ICCLC should not be missed when it returns in 2024.
Wes Butler is an optometrist with Custom Eye Care, Cooks Hill, New South Wales. Mr Butler’s professional interests include paediatric and behavioural optometry, low vision and contact lens care, including for orthokeratology. He is a member of Optometry Australia, the Australasian College of Behavioural Optometrists the Cornea & Contact Lens Society, and the Orthokeratology Society of Oceania.
Hero image: Professor Stephanie Watson