The Greatest Show In Orthokeratology

The Orthokeratology Society of Oceania (OSO) biennial conference, held on the Gold Coast in September, has been several years in the making, after being repeatedly postponed and delayed due to the COVID-19 pandemic. As such, it had been five years since the previous OSO conference, and the first opportunity for colleagues across Australia in the orthokeratology and myopia management space to meet each other face-to-face in a large-scale industry event since the pandemic.

Over the past five years, myopia management has emerged in the forefront of optometric practice and preventative eye care, led by the global rise of childhood myopia, increased awareness of the risks of myopia, and increased available intervention options. With ‘The New Frontiers’ as its central theme, this conference pushed the envelope in presenting the latest research and evidence in myopia management and myopia prevention. New and emerging evidence in how optical interventions work to modulate axial elongation in a myopic eye help us to understand how orthokeratology (OK) lenses can be customised to improve myopia control outcomes, how potential new designs in soft contact lens options may work, and the effectiveness of combining optical interventions with atropine.

This OSO conference featured an impressive line-up of international speakers of the highest calibre, including esteemed professors Langis Michaud, David Berntsen, James Wolffsohn, and Mark Bullimore. The conference experience was enhanced with an event app to provide delegates with up-todate information of the conference agenda, a live event stream, and easy session check-in with QR codes to log CPD hours.

ABERRATIONS IN OK

Day one began with lectures on aberrations in orthokeratology. Professor Berntsen spoke on how aberrations from OK treatment affect quality of vision and quality of life. This was followed by a lecture by Perth-based optometrist Gavin Swartz, a PhD candidate in this area, to help explain the complex topic of aberrations in a more understandable way. Induced positive spherical aberrations with OK are now understood to be one of the likely mechanisms in how OK treatment slows myopia progression.

Prof Michaud spoke on customising myopia treatments for better patient outcomes and presented challenging cases in myopia management. Based on the clinical treatment protocol developed from the Montreal Experience at the Montreal School of Optometry Clinic in Canada, he recommended setting more aggressive treatment targets for younger myopic children, those of Asian ethnicity, and patients with longer baseline axial length. Binocular vision assessment is important and vision training might be necessary for some children before commencing myopia management. He also suggested nutrition, childhood obesity, and sugar intake as potential risk factors for myopia development. Customising the design of OK lenses to induce greater amounts of peripheral myopic defocus within the pupil zone is key to optimising retardation of axial elongation with orthokeratology.

DRY EYE

Subcommittee chair of the TFOS DEWS II report, Prof Wolffsohn, presented on the diagnosis and management of dry eye disease. Dry eye is an increasingly important part of myopia management, given that many of the interventions involve wearing contact lenses. Meibomian gland dysfunction is also correlated with the increased amount of screen time in children, teenagers, and young adults. Preserved eye drop formulations, including compounded atropine, may increase the risk of dry eye in the long term.

While children are often asymptomatic of dry eyes, treatment is indicated if clinical signs are observed. Prof Wolffsohn also later updated the audience on the latest from the International Myopia Institute (IMI) White Papers, now into its third series, which expanded into less researched populations such as paediatric patients with high myopia, and young adults with myopia progression.

SETTING THE STANDARD

Delegates enjoyed an entertaining overview, by Professor Bullimore, of the latest evidence for why practitioners around the world need to embrace myopia management. He believes that Australian and New Zealand optometrists will lead the world in setting a new standard in the management of myopia, through our wide scope of practice, practitioner education and knowledge, social media engagement, and raising public awareness.

He suggested a series of ‘Aussie Rules’ for myopia management, including identifying children at risk of myopia onset, starting management promptly, administering best, evidence-based interventions for all young myopes and setting treatment goals, with the target of eradicating higher levels of myopia and reducing the risk of myopia-related eye disease in the population.

NEW RESEARCH AND ENTERTAINING LECTURES

Always-popular guest speakers at OSO conferences, Associate Professor Patrick Caroline and Randy Kojima also took to the stage on day one. Assoc Prof Caroline presented some intriguing research that theorised the foveola – the central part of the fovea – may be responsible for 90% of the retinal signals that produce a myopia control effect, rather than the peripheral retina as commonly believed. Mr Kojima spoke about findings from the VOLTZ study, comparing OK treatment zone size with myopia control efficacy; 5mm BOZD OK lenses, which create greater aberrations, were found to result in significantly slower eye growth than conventional 6mm BOZD lenses after one year.

Expert presenters from Australia and New Zealand completed the dense lecture program. Innovative Eye Care optometrist Pooja Bhindi presented on the principles of fitting OK for astigmatism; Dr Gavin Boneham reminded us that OK is not just for children for myopia control and that many adults also benefit from the freedom of night time vision correction that OK brings; Alex Petty presented case studies on fitting OK for post-laser refractive surgery corneas; Kathleen Watt updated us on the safety of OK amid several reported cases of Acanthamoeba keratitis; Professor Scott Read presented new evidence on how measuring the choroid might be involved in myopia management; and Dr Pauline Kang spoke on the clinical protocols of the UNSW Myopia Clinic.

A PACKED PROGRAM

The conference catered for both beginners in orthokeratology and seasoned practitioners looking to further their skills in this specialty lens area. The OrthoK Beginners’ Bootcamp, run by members of the OSO Committee, provided essential knowledge and training to practitioners just getting started in orthokeratology, focussing on the fundamentals of capturing corneal topography correctly, patient selection, lens designs, safety, and the practical aspects of fitting OK on patients.

As always, sponsors are an important and valued part of the conference. Trade stands were popular among attendees as they mingled with suppliers showcasing new treatment products, technologies, and instruments. There was keen interest in the incredible, full-volume 3D imaging capabilities of the new Cylite Hyperparallel optical coherence tomographer, developed here in Australia. Platinum sponsors had the opportunity to give a five-minute ‘firetalk’ presentation to delegates.

Interactive workshops, held on the Friday and Saturday afternoons, were particularly popular, with practitioners keen for detailed learning in a small group setting. Provided by platinum and gold sponsors including CooperVision, CLCA/ VTI Vision, Designs For Vision, Innovative Contacts, Medmont, Menicon, ZEISS, Cylite and Good Optical, these workshops delved more deeply into topics covering customising OK lens designs, troubleshooting, corneal topography tips and tricks, advanced OK case studies, dry eye treatment, scleral lens fitting, and myopia management with soft contact lenses and spectacle lenses.

The conference also recognised the achievements of nine candidates who recently completed their journey to attain the International Academy Certification in Myopia Management (IACMM), a new qualification with a rigorous examination process for members seeking to practise myopia management at the highest level.

SUNDAY SESSIONS

The third day of the conference opened with a brand-new initiative called ‘Speed Dating with the Speakers’. In this innovative, interactive close-and-personal experience that proved to be a hit, our line-up of conference speakers each sat with delegates at their table for an intimate question and answer discussion around their areas of expertise, rotating between tables every five minutes.

The focus of the Sunday program was scleral lenses, another specialty lens area that many OK practitioners are involved in, to improve the vision and quality of life of patients with keratoconus and other irregular corneal conditions. Australian experts in scleral lenses, Damien Fisher, Professor Stephen Vincent, and Lachlan Hoy led the presentations, alongside a pre-recorded lecture beamed in by Dr Eef Van Der Worp from the Netherlands. We heard clinical presentations and arguments for when scleral lenses are ideal for patients with complex corneas, and when they might not always be the answer.

THE GREATEST SHOW

The dinner extravaganza on the Saturday night, themed the ‘The Greatest Show’, was a spectacular experience that its attendees will never forget. OSO conferences are well known for the social aspect and taking dinners to the extreme, and this was no exception. A carnival atmosphere, a ringmaster, attendees dressed up for the occasion, and wild games were fuelled by a deep competitive spirit between tables to win the ultimate prize. At its finale, OSO committee members performed a rendition on stage, inspired by the theme song from Hugh Jackman’s The Greatest Showman, to raptures of applause from the audience. For a few hours, this seemed like the greatest show indeed and our guests from America tell us there is nothing like it at conferences back home.

Putting together a successful large conference like this is no easy feat. OSO President Dr Boneham and Secretary Celia Bloxsom, along with the rest of the OSO committee, did an incredible job, through countless hours of work as volunteers of the organisation, to make this complex logistics exercise possible. It’s been a pleasure to be part of it. As Australasia’s premier myopia management and orthokeratology meeting, the impressive depth and scope of the lectures and workshops helped make this OSO conference a big success. Our guest presenters praised the meeting’s high level of discussion, the warmth they received, and friendships formed, while delegates enjoyed the relaxed atmosphere, organisation, visual aesthetics, well-curated content, and practical learnings to take back into their practices. It is pleasing to receive such overwhelmingly positive feedback from all those who enjoyed the conference.

It had been a long time between drinks. But it was definitely worth the wait.

Dr Philip Cheng B.Optom GCOT IACMM FAOMC is the clinical director of The Myopia Clinic in Melbourne. He has a particular interest in myopia management and orthokeratology. Dr Cheng is a Fellow of the International Academy of Orthokeratology and Myopia Control and a Committee Board Member of OSO.