A Super Sunday Diverse Topics, Talks, and Panels

Opening the one-day event, Andrew McKinnon, CEO, Optometry Australia NSW/ACT, explained that the Super Sunday concept was developed around 13 years ago when Optometry Australia (OA) realised that Sydneysiders were not attending multi-day conferences. It was initially non-stop, with a 10-minute break between each lecture, and food served all day from 8am–6pm.

It was a roaring success!

The event has since been modified to comply with the changing continuing professional development framework, but it’s still a very compact day.

Diverse Presentations

The organising committee always tries to provide a keynote speaker with a difference. This year’s keynote talk, ‘Neurodiversity in our patients, co-workers, and ourselves – making the most of our differences’, was no exception. Delivered by psychiatrist Dr Mark Cross, he stressed the need for us to understand neurodiversity and accept the natural variations between human minds, including those who suffer from conditions such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). He provided a serious yet entertaining talk citing the importance of language in managing and interacting with the neurodiverse, and how to ensure everyone is treated with empathy and respect, including patients, co-workers, and family.

People with such issues want to be treated like everyone else but also have their specific condition addressed. Historically, autism was considered a form of schizophrenia while ADHD was only really defined in the 1990s. ADHD is now one of the most diagnosed conditions and its management is placing an increasing burden on the National Disability Insurance Scheme (NDIS). Self-stigma, trying to be ‘normal’, masking the condition, and the pressure to hide something, can add to the challenges, leading to the person’s inability to deal with the problem unsupported. They often take their frustrations out on family and co-workers, adding greatly to the impact of the problem, Dr Cross explained.

The nature of optometric practice means we come across a spectrum of neurodiverse patients. Our use of bright lights is one issue that can trigger difficulties. Sufferers are often intolerant. Dr Cross told the audience we need to take steps to reduce the intensity and avoid, as far as possible, the use of such bright light sources. Consider timing them toward the end of a consultation – or performing these tests at a second visit, once we’ve established rapport with our patients. The use of symbol test charts instead of traditional Snellen letters is another consideration.

Staff and patients need relaxed spaces with less stimulation. Isolating headphones with enjoyable music aids relaxation for some.

Avoid sarcasm or figurative speech, ‘talking down’ to people or speaking slowly, assuming they don’t understand. Repetitive behaviours can agitate certain people. Issues such as scratching on fabrics or surfaces can trigger sensory overload and nausea.

Humour and making the eye exam fun can help. Avoid invading a person’s body space and avoid touching as far as possible.

Ask staff “what do you need to make your working day more useful?” and have a general conversation with the whole organisation. Talk about the positives and reassure them that there’s no shame. Show empathy, and an understanding of differences, explore and be inclusive.

Dr Cross cited the importance of courage and that above all, we should be kind.

Rapid Fire Research

Rapid-fire research papers presented findings succinctly, delivering the essence, evidence, and important points.

Dr Daniel Tilia showed how some novel design contact lenses based on S.T.O.P. (Spatio Temporal Optical Phase) have optic zones with rotationally asymmetric power and meridional and azimuthally varying power distribution, forming a conoid of Sturm on the retina, which creates a form of stigmatic blur. This may reduce myopic progression.

These novel dynamic designs showed comparable performance to the static design of MiSight, with one design showing aspects of improved subjective visual performance. The efficacy of S.T.O.P. in reducing myopia progression is currently unknown and will be assessed in a randomised, multisite clinical trial.

Dr Jessie Huang-Lung delved into the issues surrounding cataract surgery waitlists in her talk ‘The true cost of hidden waiting times for cataract surgery in Australia’. She showed that around one in three Australians accesses cataract surgery in the public health system. Reducing wait times from 12 to three months would result in 50,679 avoided falls and save AU$6.6 million. There’s a 30% reduction in falls after one eye surgery and a further 50% after the second surgery. Binocularity is a key factor. Delays can lead to depression, more car accidents, restricted driving, and reduced quality of life.

Dr Jim Kokkinakis delivered a novel talk on ‘Skin lipids and their effect on the human tear film’ with compelling infrared imaging technology to demonstrate his key points. The pH of skin is around 4.6 and the pH of the tear film is around 7.6. It is therefore 1,000 times more acidic with Dr Kokkinakis attesting that vinegar in the eye irritates less than skin oil. Skin sebum is made up of many components. Further studies will isolate these components. At this stage in his research, he suspects that polar lipids are the culprits.

Following a recent TV appearance highlighting Demodex in a segment on the ABC show Monsters or Medicine, Associate Professor Maria Markoulli presented an overview of the use of pre- and probiotics in dry eye disease (DED) as one way of controlling inflammation in the body by modulating gut function. Later in the program she presented the very latest in dry eye in her talk ‘What role does nutrition play in dry eye?’

She reviewed the role and correct ratios of Omega 3:6, which are not synthesised in the body, and need to be obtained through ingestion. But she said, increasing the intake of oily fish may also increase mercury intake, which has been shown to increase dry eye. Water intake has not been shown to be protective for dry eye, while alcohol intake was not associated with dry eye, but caffeine intake was beneficial.

In the CSL Seqirus sponsored talk ‘The PERSPECTIVE Study: Insights from a real-world setting’, Professor Fiona Stapleton delved into the research and clinical implications of Cyclosprine A (CsA) 0.1% cationic emulsion (CE) in routine clinical practice. She concluded that topical CsA 0.1% CE is effective from four weeks onward in reducing corneal fluorescein staining and that the effect was maintained to 12 months. Symptoms were the same or improved in around 85% of patients. Challenges remain in the diagnosis of DED and severity staging, but symptom evaluation was helpful.

Professor Tailoi Chan-Ling discussed a recent paper ‘Impact of high-fat Western diet on type 2 diabetes and RPE function’. Her research group was able to demonstrate that diabetic retinopathy can be induced by a Western high fat diet. She illustrated the key features and explained the histological changes with compelling data and imaging showing retinal pigment epithelium (RPE) changes, lipofuscin, degradation of photoreceptors and cellular waste, resulting in marked retinal changes. Based on evidence, we should refrain from high fat diets, lose weight, reduce sugars, eat whole foods, and aim for a Mediterranean or Okinawa diet.

Awards

Prof Chan-Ling delivered the H. Barry Collin Research Medal presentation, ‘My scientific journey and its impact on the understanding and treatment of the three major vascular causes of blindness’. She honoured her mentors and colleagues and summarised her work and current understanding of human retinal vascular and RPE development. She delved deeply into a landmark paper, ‘Pathophysiology, screening, and treatment of retinopathy of prematurity: A multidisciplinary perspective’, illustrating points with remarkable images.

The Optometry Australia NSW/ACT Distinguished Service Award was fittingly awarded to Dr Philip Anderton who has been a stalwart of optometric research and education at the University of New South Wales, and a popular figure in the optometric fraternity. Dr Phil, as he is affectionately known, is credited as being one of the prime movers in getting therapeutics into optometry. His dedication in providing rural eye care over the years and flying to remote regions in his home-built airplane was recognised. His family was there to share in the occasion, including his daughter Joanne Anderton, who published a children’s book The Flying Optometrist, about his flying and rural eye clinics. Dr Anderton recognised his colleagues and made an emotional tribute to his late friend and colleague, Christine Craigie.

More Talks

In her presentation, titled ‘Paranoid or prepared?’, Dr Angelica Ly detailed and demonstrated several artificial intelligence (AI) systems including one that integrates with retinal imaging systems, with high levels of diagnostic accuracy around the 95% level.

She also showed the usefulness of ChatGPT in report writing and how AI can be of benefit in low vision.

Optometrists should arm themselves with the knowledge and skills to effectively interact with AI. In one survey, 71% of practitioners noted they already use or intend to use AI. Some medico-legal, privacy, and moral issues remain but AI is here to stay.

In an ‘Update on paediatric keratoconus: Who do we treat and how?’, Dr John Males provided a brief overview of keratoconus (KC) and discussed issues surrounding corneal cross linking (CXL). When progression is seen, CXL is indicated but Dr Males stressed that not all KC progresses so CXL should not be used in such cases. We should manage related conditions like eye rubbing and allergy. He noted that childhood obesity is associated with KC. He discussed the pros and cons of epithelium-on (less pain but more progression) vs epithelium-off CXL, which in his experience, has better post-treatment vision and greater corneal flattening.

OA Chief Clinical Officer, Associate Professor Luke Arundel delivered ‘Get your black belt in optometry self-defence’. He noted that hacking, cybercrime, and ransomware is on the rise. Cybercrime is costing AU$29 billion a year: It can cost you $40,000 to get back to ‘normal’ if you get nailed! Always have secure, current backups.
He went on to discuss clinical self-defence, noting that clear and precise communication is critical. Always advise patients to inform you if they notice any changes in their vision or eye health.

Record negative and positive findings and grade conditions. Inform patients and discuss and record steps to reduce risk. Follow up on referrals and recalls, and keep records of such interaction, Associate Professor Arundel advised.
Dr Richard Johnson delivered a comprehensive talk on ‘The optometric diagnosis and management of uveitis’, including pearls, detailed diagnostics, and evidence-based treatment options. He noted that 8% of cases seen in a hospital clinic were for uveitis. Most occurred in the 20–50 age bracket. Cases outside of this range raise red flags. We should fully investigate all new cases. A plastoid aqueous means the ciliary body is shutting down and there is no production of aqueous; no convection currents lead to stagnated cells. He classified signs, stages, and grading, illustrated with images and useful slit lamp techniques. Optical coherence tomography (OCT) is a useful tool for identifying related posterior vitritis by showing white cell presence anterior to retina.

Panel Sessions

In one of these interesting panels, titled ‘Two-way Street: Working with GPs for the best outcomes of patients with diabetes’, Drs Paula Katalinic, Michelle Crockett, Lilly Psomadelis, Dom Willson, and Jessie Huang-Lung discussed better ways to communicate and interact.

Dealing effectively with diverse population groups and demographics was highlighted, as were financial considerations. Medicare has not kept up and does not fit well with current population models. We have around 1.3 million diabetics in Australia and it is more prevalent in males.

The pandemic may have affected outcomes due to delayed diagnosis/treatment. There’s a crisis in general practice with GP shortages in rural and remote areas and certain areas of cities. Patients are more complex, ageing, and there are increasing co-morbidity issues. Western Sydney was highlighted as a diabetic hotspot. In such challenging areas, emergency departments routinely do HbA1c tests. There are perceived cost issues surrounding necessary eye care and a general lack of understanding: 50% of people said they’d see a GP first if they had an eye problem. Co-management between optometrists and GPs is important for diabetic care. No feedback can be frustrating, and optometrists mentioned they’d like to know what the latest HbA1c readings are, or what medication the patient is taking.

Although report writing is ideal, it contributes to burnout. ChatGPT-assisted report writing can reduce the burden. A form letter, tick boxes or dictation are also time saving options.

The second panel, ‘Hot topics: Practising to your therapeutic limit’ included Drs Dom Willson, Michael Yapp, William Trinh, Margaret Lam, and Mark Koszek.

The importance of clarity in prescribing compounded atropine was cited. Make sure it is 0.1% compounded, not off the shelf 1%.

An ulcer threatening to perforate or cause long-term central scarring might need referral to ophthalmology.

However, there are socioeconomic benefits of optometrists managing things as far as possible.

GPs also learn from optometry: Specific diagnosis, ideal therapeutic management, and observation with sit lamp imaging and OCT is beneficial. It was also noted that working closely with GPs can aid the prescribing of oral antibiotics and antivirals. Shared care with fellow optometrists is also important. Provide a mobile phone number for emergency contact.

Dr James Wong explored ‘Cardiovascular disease and the eye’, noting the need for an accurate clinical history. A thorough clinical examination utilising multimodal imaging aids diagnosis. We should identify ophthalmic manifestations of systemic diseases and be aware of cardiovascular medications that affect the eyes.

Dr Yapp kept the audience engaged in the talk with his interactive quiz-style closing presentation, ‘Is it serious?

Yeah…Nah…Anterior Eye interactive case studies to hone your diagnostic skills’. Images were presented for a variety of rare and not so rare conditions. Delegates discussed differential diagnosis amongst themselves. Prizes were handed out to the winners. He repeatedly stressed the importance of understanding anatomy to make the correct diagnosis, and provided some useful references to further investigate such conditions.

Super Sunday – supported by Good Optical, CSL Seqirus, and ProVision – was, by all accounts, a resounding success.