With a focus on myopia, dry eye disease, and the ocular surface, the British Contact Lens Association’s (BCLA) flagship conference in Manchester, in the United Kingdom, made a welcome post-COVID return. Excited delegates from around the globe, including Jessica Chi, gathered to hear the latest research from industry-leading experts.
With over 100 speakers, BCLA’s three-day event had a packed itinerary, incorporating keynote lectures, discussion panels, and poster presentations. Additionally, hands-on workshops and live demonstrations were conducted to showcase the latest clinical insights and technology available to practitioners.
caffeine has been found to be correlated with increased tear meniscus height and better Schirmer scores
The conference, held in June, placed a strong emphasis on management of myopia, dry eye disease, and the ocular surface, highlighting the potential to improve patients’ quality of life. In a new initiative for 2023, BCLA introduced micro-credential certificates in four topics: Advanced Contact Lenses, Dry Eye, Myopia Control, and Ocular Health. These certificates were designed to enhance practitioners’ skills and knowledge in specific domains.
One of the many highlights of the conference was keynote speaker Professor Gregory Sawyer, an engineer who had previously participated in the Mars Rover expedition and is now a bioengineer and cancer researcher leading a tribology lab. Tribology is the study of friction, wear, and lubrication, and how surfaces interact. He discussed the delicate, yet complex nature of the tear film and the sheer stress exerted by the eyelid on the ocular surface as it slides over with each blink, travelling some 600 metres a day.
His work demonstrated that corneal epithelial cells sense and respond to pressure and shear deformation, creating a pro-inflammatory response releasing cytokines. There is roughly one nerve ending for every projected corneal epithelial cell, so when the eyelid slides over the cornea, it slides over tissue covered with nerve endings, and protected by the tear film, which is merely 2–5 microns thick. He then explored the challenges imposed once a contact lens is introduced, which is 20–40 times thicker than the tear film.
The ideal contact lens, according to Professor Sawyer, should be like a jellyfish – “soft, wet, and squishy”. However, there also needs to be a balance with regard to modulus for handling and oxygen permeability. He finished the lecture demonstrating the concept of tribology – showing how a cork in a wine bottle cannot come out, however if you can reduce the friction with another surface, in this case a silk pocket square, then the surface of less friction will always move over the surface of the higher friction, et voila, he was able to remove the wine cork from inside the bottle! Informative, engaging, entertaining – the perfect mix of fun-ducation!
Lifestyle and Dry Eye
Experts from The Tear Film and Ocular Surface Society (TFOS) – Professors Jennifer Craig, Fiona Stapleton, Lyndon Jones, James Wolffsohn, and Etty Bitton – presented the latest TFOS workshop, which is ‘Lifestyle Impacts on the Ocular Surface’. These lifestyle challenges could be divided into mental health, social factors, and physical factors, with categories including contact lenses, cosmetics, digital environment, elective medications and procedures, environmental conditions, lifestyle challenges, nutrition, and societal challenges.
Factors that could negatively affect the tear film include depression, anxiety, stress, poor sleep, physical inactivity, and obesity. Fortunately, resting for a fortnight after sleep deprivation reversed observed changes. Smoking and substance use is positively correlated with dry eye, the science for alcohol is inconclusive, and caffeine has been found to be correlated with increased tear meniscus height and better Schirmer scores.
Other factors that can be correlated with dry eye include pollution and poor diet – both for those who are under- and over- nourished. The only diet that has been shown to be beneficial to the ocular surface is the Mediterranean diet as well as having a diet with a higher ratio of Omega-3 to Omega-6, with the ideal ratio being 4:1. The gut microbiome and the use of probiotics and prebiotics have also been found to alleviate dry eye symptoms.
Ocular Surface Stress
The use of contact lenses, in particular noncompliant use, can negatively impact the ocular surface. Non-adherence to replacement schedules, purchasing contact lenses online or from unregulated outlets, and failing to frequent follow-up care are among some of the factors that can lead to contact lens complications.
There are many other factors that can also cause stress on the ocular surface including systemic disease, digital device use, both topical and systemic medications, cosmetics and procedures around the eye, and elective surgery. The findings presented were comprehensive and a great addition to the wealth of information already out there from the extensive work done by TFOS.
Professor Etty Bitton delivered a wonderfully succinct and informative lecture on ocular lubricants, breaking them down into their different categories and explaining their methods of actions. She also spoke about some emerging products, including osmoprotectors such as trehalose and ectoine, while warning against the off-label use of homeopathic substances due to the risk of eye infections. Alarmingly, retinol (vitamin A) has been shown to inhibit cell proliferation, increase cell death, and can lead to meibomian gland atrophy.
The conference dedicated numerous sessions to myopia management – the why and how, and even had a session with patient-reported outcomes, including seeing the myopia contact lens journey through the eyes of Maddy Stickley.
This 12-year-old shared her wonderfully positive experiences with contact lenses – how they not only improved her quality of life, but also arrested her myopic progression.
The latest round of International Myopia Institute (IMI) white paper reports were presented, led by myopia expert Dr Kate Gifford. The newest papers include the pre-myope, adult myope, and young high myopes. They detail the risk factors for the pre-myope, and describe studies for adult myopia as poor because progression in this group is unpredictable. These papers also include the young high myope, i.e., those with more dioptres than years and the intricacies of managing them as they are the most at risk. They may often be associated with visual autism, neurological delay, and reduced best corrected visual acuity, and progression patterns can be different. It is important for this subset to ascertain aetiology, family ocular history, general health, and look for and manage any comorbidities.
Dr Kah Ooi Tan and Jong-Mei Khew, from nthalmic Technologies, presented practitioner perspectives of myopia control. Their research, which to date has involved 90 practitioner interviews across Asia, has explored the potential barriers and determinants in offering myopia management in practice. They found treatment cost was a major barrier, which is less of an issue for the developed Western countries. Other factors included confidence in prescribing and knowing which treatment to prescribe. In China alone there are 60 different types of myopia control lenses. They stressed the need for strategic advocacy and professional education to advance patient care in Asia.
The final keynote presentation was by Dr Frank Schaeffel, biologist and physicist, and head of The IOB Myopia Research Group in Basel, on the topic of ‘Visual cues for emmetropisation and mechanisms of myopia control’.
He showed that myopic progression can occur without the optic nerve – that all the cues are occurring in the retina. The retina can detect signs of defocus, even in poor retinal images. He demonstrated various studies where they presented defocused videos altered by photoshop and showed that even after 30 minutes’ deprivation, myopia could be induced. Dr Schaeffel spoke of factors such as choroidal thickness changes and the impact this has on allowing the retina to inhibit eye growth in positive defocus.
The BCLA Irving Fatt Memorial Lecture was presented by Dr Sonia Trave-Huarte, who spoke on how treatment studies can support evidence-based dry eye practice. Her PhD surveyed a whopping 1,316 eye care practitioners across 51 countries.
The Da Vinci Award presentation was given by Rabia Mobeen who presented on how dendritic cells’ response to immediate soft contact lens wear is impacted by their physical contact with nerves in the human corneal epithelium. She showed that dendritic cells that are in physical contact with nerves gain longer dendrites as they are activated for antigen-capture activity.
Fakhruddin Barodawala won the BCLA poster competition for his smartphone based placido disc attachment. This was a 3D printed attachment that was found to be comparable to corneal topography for detecting keratoconus and low tear film break-up time. It has potential to be a portable, inexpensive screening device.
Sharon Flora was named the winner of the Dry Eye Practitioner of the Year Award, sponsored by Scope, while Kathryn Webber received the Myopia Management Practitioner of the Year Award, sponsored by CooperVision.
Martin Rubenstein was Hospital Optometry Practitioner of the Year while the BCLA Industry Award was given to CooperVision’s Project Sunflower team in recognition of its work to combat the reliance upon single use plastics in the contact lens industry.
Some other pearls of wisdom presented at the conference included;
• Sin Wan Cheung studied the effect of orthokeratology on meibomian glands, following patients over two years. He found no significant difference between the study and controls.
• Meibomian gland dysfunction is a strong predictor for contact lens discomfort; in the study, observing meibomian gland images alone can predict 68% of symptoms.
• Success of contact lenses is driven by practitioner attitude; reactive = 10%; proactive = 26%, and the offer of a simple trial = 36% success.
• Dropout continues to be the reason that stunts contact lens market growth. Half of patients discontinue in the first two months, often due to handling. However, for established wearers, discomfort is the number one reason for contact lens dropout. These patients are silently suffering; 82% of patients are annoyed or frustrated by contact lens discomfort, 84% have compensating behaviours, and 73% fail to tell their eye care practitioners.
Novel Treatments and Lenses
Presenters at the BCLA conference discussed some novel treatments and lenses yet to hit Australia, including the Johnson and Johnson Acuvue Oasys Max 1-day, which incorporates TearStable technology to reduce evaporation by two times. With an OptiBlue Light Filter that filters 60% of blue-violet light to minimise light scatter, it is targeted at adults who spend 13+ hours on digital devices per day, a 35% increase since 2019.
Omnilens was also presented. This novel amniotic membrane, embedded into a bandage contact lens, was shown to increase corneal nerve fibre length and density, and decrease dry eye disease by 62.5% at six months.
Professor Eric Papas presented the BCLA Medal address ‘How football, luck, and good people saved me from the golf course’. Prof Papas spoke of the path he had taken along his career, and of the wonderful research and innovations he had been a part of, including the invention of the silicone hydrogel contact lens. He graciously expressed respect for those around him who had mentored him and inspired him. Informative, entertaining, and inspirational, Prof Papas is ever the gentleman – he could not have been more deserving of the great honour.
Of course, BCLA is not all work and no play as could be seen at the Gala Dinner held at the Imperial War Museum, and in the lively trade fair which even comprised an air hockey table with some animated contests!
This year welcomed 33 new Fellows of the BCLA, and 25 long-standing Fellows were honoured for 15 years of continuous commitment. At the BCLA Annual General Meeting, outgoing president Neil Retallic handed over the reins to Rakesh Kapoor.
Mr Kapoor will lead BCLA Asia, to be held in Chengdu province in China next Spring. Andy Yorke, former BCLA president was named an honorary life member.
BCLA represents a wonderful opportunity for practitioners down under to witness a global view of the latest research in contact lenses and anterior eye. Conveniently held in our winter and their summer, delegates enjoyed proximity to many other wonderful summer destinations.
Jessica Chi is the director of Eyetech Optometrists, an independent specialty contact lens practice in Melbourne. She is the current Victorian, and a past national President of the Cornea and Contact Lens Society, and an invited speaker at meetings throughout Australia and beyond. She is a clinical supervisor at the University of Melbourne, a member of Optometry Victoria Optometric Sector Advisory Group and a Fellow of the Australian College of Optometry, the British Contact Lens Association, and the International Academy of Orthokeratology and Myopia Control.