Exploring the Matrix of Ocular Health: ICCLC 2024

Put together by the Cornea and Contact Lens Society of Australia (CCLSA), this year’s exceptional three-day program featured lectures and workshops presented by international and Australian clinicians and researchers.

Reflecting on The Matrix theme of the conference, I was reminded of the words of Morpheus: “I’m going to show them a world where anything is possible”. This perfectly captures how the exciting advancements in our field are turning what once seemed impossibilities into new realities.

Optimising Ocular Surface Management

Saturday’s lectures kicked off with keynote speaker Dr Peter Pham – a chemist, entrepreneur, and practising ophthalmologist from Houston, Texas. Dr Pham impressed the audience with his chemistry expertise and lively presentation style. He challenged us to rethink the concept that preservatives in eye products are inherently harmful and to consider the important ways they can be helpful.

Brisbane-based optometrist and lecturer David Foresto was also a keynote speaker at the conference. He discussed ocular surface management in one of his talks, emphasising the importance of managing ocular allergies effectively to prevent scarring. He encouraged optometrists to think beyond prescribing cold compresses, Zaditen (ketotifen hydrogen fumarate) and Patanol (olopatadine) when treating highly atopic patients, and consider referral to allergy specialists for severe cases. Mr Foresto is renowned for his engaging speaking style and had the audience laughing out loud with his jokes.

Associate Professor Katrina Schmid from Queensland University of Technology (QUT) educated audiences on the effects of ultraviolet (UV) radiation on the corneal epithelium, a highly relevant topic for Australians. Her research shows that chronic UV exposure is linked to significant reductions in epithelial cell density, and monitoring corneal epithelial morphology could be valuable in assessing ocular surface health.1

The National President of the CCLSA, Martin Robinson (Tasmania), has extensive experience managing dry eye disease and is passionate about sharing his expertise with others. In his presentation, Mr Robinson offered practical tips for managing dry eye patients and discussed intriguing cases from his independent optometry practice in Hobart.

Fresh Approaches to Dry Eye Disease

Dry eye is a complex multifactorial disease that affects millions of people worldwide. Mark Koszek (Sydney) presented fascinating case studies of dry eye patients with neuropathic pain. He explained how damage to corneal nerves can result in dysfunction, and cause pain from stimuli that are usually non-painful. Patients suffering from neuropathic corneal pain often do not respond to standard dry eye treatments and might benefit from a referral to a pain specialist through their general practitioner.

On a similar note, Dr Katie Edwards from QUT discussed how neuropathic corneal pain can be associated with autoimmune conditions and chronic pain syndromes.

Dr Edwards shared her research using non-invasive in vivo corneal confocal microscopy to visualise corneal nerves,² and the potential for these methods to help diagnose patients with associated systemic conditions.

Dr Azadeh Tavakoli from University of New South Wales (UNSW) discussed her recent publication on the impact of probiotics and prebiotics in dry eye disease.³ Her study highlights the significant role of the gut microbiome in regulating low-grade chronic inflammation throughout the body. The findings suggest that oral probiotics and prebiotics could be beneficial in managing dry eye, potentially reducing symptoms and stabilising clinical signs.

In his second lecture, Dr Pham explained the remarkable chemistry of polysaccharides and their ability to alleviate pain. His own Zocular ophthalmic products contain polysaccharides extracted from okra plants, which provide patients with rapid relief from discomfort and help decrease eyelid inflammation. These products are available as both an in-office treatment (Zest) and a home therapy (ZocuFoam), designed for patients suffering from blepharitis and ocular surface disease.

The Matrix of Myopia Management

As always, myopia management was a key focus at the conference. Ophthalmologist Dr Craig Donaldson and optometrist SooJin Nam, both from Sydney, spoke about the impending myopia epidemic and stressed the critical need for early intervention with effective myopia control treatments. They revisited landmark studies to support evidence-based practices, all while humorously dressed as Neo from The Matrix. Their presentation also featured fun video cameos from several leading researchers in the field of myopia.

Dr Emma Gillies (Sydney) encouraged optometrists to broaden their perspective beyond randomised controlled trials (RCTs) when evaluating myopia control data. Real-world data can offer insights into treatments in the everyday context and reflect a more diverse patient population than the specific criteria of RCTs. She discussed the results of three independent retrospective studies,^4-6 all reaching a similar conclusion about the effectiveness of NaturalVue Multifocal contact lenses in slowing myopia progression in children. These studies demonstrate that real-world results can be both consistent and reliable.

Supporting The Next Generation

The CCLSA strives to cater to all skill levels at its conference, from beginners to experts. This year, it invited expressions of interest for the CCLSA Contact Lens Mentorship Program, which pairs seasoned optometrists with emerging practitioners to share expertise and provide guidance. Mentor Gavin Swartz, a lecturer and researcher at University of Western Australia, and James Devereaux from Brisbane, a mentee, shared their experiences with the program, highlighting the mutual benefits gained from both perspectives.

I had the honour of speaking on ‘Getting started with specialty contact lenses’. My presentation focussed on directing attendees to useful online resources, identifying who they can reach out to for support, and providing practical advice. I aimed to encourage novice practitioners to delve into the world of complex contact lenses with confidence and curiosity.

Contact lens experts also shared their clinical pearls and discussed intriguing cases. James Simpson (Canberra) outlined his approach to managing challenging cases and simplifying complex contact lens fitting. David Foresto returned to the stage to provide practical tips for advancing contact lens skills, from prescribing prosthetic soft contact lenses for scarred corneas to incorporating aspheric designs to minimise aberrations.

Current Innovations in Contact Lenses

Seasoned contact lens practitioners explored various options for managing presbyopia. David Stephensen (Brisbane) encouraged the audience to consider fitting multifocal rigid gas permeable lenses (RGPs), drawing on his personal experience of wearing them. Meanwhile, Hirdesh Nair from Johnson and Johnson Vision Care introduced the Acuvue Oasys Max 1-Day Multifocal lens, and Gold Coast optometrist Celia Bloxsom shared her insights from prescribing these lenses for both her patients and herself.

Incorporating wavefront aberrometry into contact lens fitting is growing in popularity, allowing optometrists to correct higher-order aberrations and provide even better vision for patients. Toowoomba optometrist Hugh Bradshaw demonstrated significant reductions in aberrations by using aspheric designs in RGPs. Gavin Swartz, who is currently completing his PhD exploring the impacts of higher-order aberrations in irregular corneas, explained how imaging and biometry can enhance the contact lens fitting process for these patients.

Dr Damien Fisher from QUT, who also serves as the Queensland Chapter President of the CCLSA, discussed his recent publication on scleral lens-induced corneal oedema. The study investigated how different fluid reservoir thicknesses influence corneal oedema and compared the findings to theoretical models.7 It revealed that both central and peripheral oedema increased with medium and high reservoir thicknesses, aligning with a model without limbal metabolic support. This research offers the first comprehensive analysis of the impact of scleral lens wear on peripheral corneal oedema.

The poster sessions were well-attended in the exhibition area, where delegates interacted with industry professionals and colleagues, and eyed out the fantastic equipment on display.

Beyond The Matrix: A Time for Celebration

Associate Professor Tony Phillips from Flinders University received the prestigious Kenneth W. Bell Medal. During his lecture, he shared stories of three significant milestones from his distinguished career. His accomplishments include co-editing all six editions of the textbook Contact Lenses (Elsevier), publishing over 50 articles and research papers, and earning a Churchill Fellowship in 1992 to study contact lenses for aphakic newborns. In 2013, he was appointed Associate Professor and Head of Contact Lens Teaching in the new optometry course at Flinders University, in South Australia.

Timothy Grant received the CCLSA Brien Holden Memorial Award and captivated the audience with his lecture on the development of silicone hydrogel contact lenses. His distinguished career spans academia, corporate research and development, sales, marketing, and management, including his role as Executive Director of Clinical and Regulatory Affairs for the team behind the world’s first silicone hydrogel lens, Focus Night and Day.

In classic ICCLC fashion, Saturday night featured an unforgettable Matrix-themed gala dinner, showcasing the CCLSA’s dedication to both high-quality education and hosting an exceptional costume party. Attendees enjoyed live music, delicious food, and great company, while mivision added extra excitement with a 360-photo booth for capturing Matrix-style slow-motion videos. If you haven’t yet had the pleasure of attending an ICCLC, be sure to join us for the next one in 2026.

Rachael Kwok BVisSci MOptom completed her Masters of Optometry at Queensland University of Technology (QUT) in 2016. Through her diverse experiences working in public health, ophthalmology, and private practice, she has developed a keen interest in complex contact lens fitting and myopia control. Currently, she works as a supervising optometrist at the QUT Optometry Clinic while pursuing a PhD on the topic of telehealth and its potential for enhancing optometric service delivery. She is a member of Optometry Australia and the Cornea and Contact Lens Society of Australia.

References

1. Bhattacharya P, Schmid K, et al. (2023). Corneal epithelial cell density is reduced in young adults with conjunctival ultraviolet autofluorescence. Cornea. 2024 Jun 1; 43(6):693-701. doi: 10.1097/ICO.0000000000003389.
   2. Colorado LH, Edwards K, Bazan HE, et al. (2020). In vivo immune cell dynamics in the human cornea. Experimental eye research. 2020;199:108168. doi: 10.1016/j.exer.2020.108168.
   3. Tavakoli A, Markoulli M, Papas E, Flanagan J. The impact of probiotics and prebiotics on dry eye disease signs and symptoms. J Clin Med. 2022 Aug 20;11(16):4889. doi: 10.3390/jcm11164889.
   4. NaturalVue monotherapy subgroup analysis from the CAMP study (The Clinical Algorithm for Myopia Progression) conducted by Treehouse Eyes.
   5. Lederman CR, Edward S. Myopia control with extended depth of focus multifocal contact lenses, Harkness Eye Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY (Presented as a POSTER at the 2023 American Association for Pediatric Ophthalmology and Strabismus 48th Annual Meeting, 29 March–2 April 2023).
   6. Cooper J, O’Connor B, Aller T, et al. Reduction of myopic progression using a multifocal soft contact lens: a retrospective cohort study. Clin Ophthalmol. 2022;16:2145-2155.
   7. Iqbal A, Fisher D, et al. Central and peripheral scleral lens-induced corneal oedema. Ophthalmic and Physiological Optics. 2023 Aug 25;44(4):792-800. doi: 10.1111/opo.13221.