Drs David Ng and Rushmia Karim presenting.
Vision Eye Institute (VEI) recently hosted its first major CPD meeting, since the COVID pandemic, for optometrists, optometry students, general practitioners, and Sydney Eye Hospital Fellows. The evening, held at Establishment in Sydney, also kicked off the celebration of the Institute’s 10-year anniversary performing small incision lenticule extraction (SMILE) surgery, with over 8,000 procedures now completed by VEI surgeons.
Approximately 100 optometrists gathered to hear presentations from a distinguished panel of experts, comprising Dr Rushmia Karim, Dr David Ng, Professor Colin Chan, Dr Simon Chen, Dr Michael Wei, and Associate Professor Michael Lawless. The event showcased the latest advancements in refractive and cataract surgery and highlighted VEI’s commitment to ongoing professional education and collaboration with the optometric community.
NEURO-OPHTHALMOLOGY
Dr Karim, who practises at Chatswood and Tuggerah Lakes, presented two case studies, emphasising the importance of trusting one’s instincts and seeking second opinions when something seems amiss. She highlighted the value of “phoning a friend” – consulting colleagues or specialists when faced with unclear diagnoses. Dr Karim stressed, “If you’re sort of worried, you’ve got a gut feeling that something’s not quite right, there’s no harm in asking a friend.” She demonstrated how collaboration and persistence led to correct diagnoses in complex cases, including an orbital lesion and a late-onset dystrophy. Dr Karim concluded by reassuring optometrists that “no one is going to get upset if you over test”.
RED EYE PATIENTS
Dr Ng, a general ophthalmologist and cataract surgeon practising at Chatswood and Drummoyne, presented a framework for assessing red eye patients to optometrists. He emphasised the importance of first determining if the patient is a contact lens (CL) wearer, and if they are, determining their wear behaviour (duration / sharing etc) highlighting three main concerns that can be associated with CL wear: microbial keratitis, CL intolerance, and dry eyes. For non-contact lens wearers, Dr Ng stressed the importance of distinguishing between conjunctival and ciliary injection.
He outlined three common causes of conjunctival injection: allergic, bacterial, and viral conjunctivitis. Dr Ng advised looking for follicles or papillae under the eyelids to help differentiate between these conditions. He also discussed more serious conditions like iritis, acute angle closure, and penetrating eye injuries.
Dr Ng provided practical advice on treatments, such as using preservative-free eye drops for dry eyes and emphasised the importance of proper dosage for viral keratitis treatment. He stated, “Five times a day, four times a day, it doesn’t cut it, it doesn’t work. There is not enough absorption for the virus to be cleared.”
Throughout his presentation, Dr Ng stressed the need for a thorough examination and logical stepby- step assessment to ensure accurate diagnosis and appropriate treatment for red eye patients.
RETINAL DISEASE
Dr Chen, a renowned retinal and cataract surgeon, practising in Bondi Junction, Chatswood, and Drummoyne, presented on surgical complications of high myopia. He highlighted the challenges and management strategies for myopic traction maculopathy, a condition common in highly myopic eyes.
Dr Chen spoke about the importance of recognising myopic traction maculopathy, which can present with foveal detachment and macular schisis on optical coherence tomography (OCT) scanning. He noted, “I’ve seen numerous highly myopic Asian patients (including multiple optometrists) in Sydney with this condition.”
The presentation covered various management options, including monitoring or vitrectomy surgery. Dr Chen discussed the potential benefits of surgical intervention in advanced cases, stating, “If the retinoschisis progresses to involve the entire macula, and a foveal detachment develops, then surgery should be considered before a macular hole develops.”
He also discussed the complexities of cataract surgery in highly myopic eyes, including the potential need for custom-made intraocular lenses, which can take up to eight weeks to have manufactured overseas, and whether patients should be directed to posture post-surgery (this will often depend on the individual).
The talk provided valuable insights for optometrists in identifying and managing high myopia complications, stressing the importance of timely referral and intervention.
Dr Wei, a retinal specialist and cataract surgeon practising in Bondi Junction and Hurstville, presented on emerging treatments for geographic atrophy (GA). He highlighted the significant impact of GA on patients’ quality of life and introduced complement inhibitors as promising new therapies.
Dr Wei discussed pegcetacoplan (Syfovre, Apellis Pharmaceuticals, Inc.), which recently received approval from the United States Food and Drug Administration for treating GA secondary to agerelated macular degeneration (AMD). Approval for its use in Australia, by the Therapeutic Goods Administration (TGA), is anticipated later this year. He presented data from clinical trials showing a 20% reduction in GA growth with monthly injections over 24 months.
The presentation highlighted the need for early detection and imaging in GA management. Dr Wei stated, “It’s important to start identifying and imaging these lesions early to establish a baseline.”
During a discussion with Dr Chen, both specialists expressed caution about the new treatments. Dr Chen noted that although TGA approval is highly likely, “there’s still a significant risk it doesn’t get PBS (Pharmaceutical Benefits Scheme) approval”, which would result in potential cost barriers for patients.
Dr Wei acknowledged safety concerns, particularly the increased risk of neovascular AMD with treatment. He suggested, “If I were to start, I’d use it every other month rather than monthly due to the lower risk of onset neovascular AMD”.
Both specialists stressed the importance of balancing benefits and risks when considering these new treatments for GA patients.
LASER REFRACTIVE SURGERY
Assoc Prof Lawless, a pioneer in refractive surgery who practises at Bondi Junction, Chatswood, and Hurstville, traced the development of SMILE from its conceptualisation in 2004, sharing personal insights over the past decade.
Highlighting technological advancements, he said the most recent release by ZEISS, the VisuMax 800, has significantly improved SMILE’s speed and efficacy, and reduced the risk of complications.
His presentation covered improvements in refractive outcomes, with tighter results achieved using newer devices. Assoc Prof Lawless also discussed recent innovations like cyclorotation compensation and the ability to perform hyperopic SMILE.
He said SMILE’s advantages, including larger effective optical zones, faster visual recovery, and lower enhancement rates in 2024, have led to him using this technology in 50% of refractive cases. “This is definitely going to go to 70, 75% of cases in the next year or so,” he predicted, signalling SMILE’s growing prominence in refractive surgery.
Prof Chan, an expert in vision correction procedures who practises at Bondi Junction and Chatswood, addressed optometrists on navigating challenges in refractive surgery. He focussed on scenarios where refractive targets are not achieved, causing anxiety for patients and practitioners.
Prof Chan spoke about the need to ensure patients are educated regarding known inaccuracies in laser surgery. He uses a normal bell distribution curve (along with some analogies from everyday life) to explain that “95% of surgeries go according to plan, 5% would go not according to plan, and 1% clearly do not go according to plan at all”.
He discussed factors affecting refractive outcomes, including prolonged healing times and “tricksters” like intraocular pressure and ocular surface issues. Prof Chan stressed the importance of patience, stating, “The hardest thing to do… is to help patients to wait and sit on their hands and do nothing” until their vision stabilises.
Regarding ocular surface problems, Prof Chan noted, “The big one… is ocular surface disease. So that can be a combination of dry eye disease which we know happens after laser.”
He also touched on refractive lens exchange, cautioning about performing it on younger patients: “I usually will not do a refractive lens exchange on patients until they’re in their mid-50s and beyond unless they’ve got a very high prescription.”
The evening concluded with the promise of more live CPD activities for optometrists and further events to celebrate the 10th anniversary of using SMILE at Vision Eye Institute.
