Another Successful Education Day for Eye Institute
Eye Institute’s annual conference was as popular as ever with over 200 optometrists registering for the one day event held at the Owen G Glenn Building, University of Auckland Business School on Sunday November 7.
In opening the conference Dr Trevor Gray thanked the more than 200 attendees and the sponsors for their support, especially Alcon for their platinum plus sponsorship.
“My colleagues and I have put together an exciting programme and one of the highlights for all of us is bringing you our keynote speaker, and your colleague, Laurence O’Connell who has many pearls to share with us,” said Dr Gray.
Optometrist Laurence O’Connell’s first session considered the place of technology in optometry. He pointedly stated that technology is an adjunct to, and not a replacement of careful examination and clinical judgment.
“We are the primary eye care practitioners, yet there is an unequal level of qualification across the profession,” said Laurence. “Most older, more experienced practitioners are not therapeutically qualified and the younger optometrists are better trained, but the demands of corporate optometry can add a challenging dimension to maintaining the highest standards of clinical practice."
Laurence then addressed examination skills specifically with regard to the two big pathologies that practitioners have a duty to find or evaluate as part of the opportunistic examination, irrespective of the patients presenting symptom; glaucoma and maculopathy.
“It is more beneficial for your patient, and your surgeon, if you further refine your findings using the vast array of clinical tools and skills at your disposal,” commented Laurence. “Your poor old surgeon mate is already frazzled by dealing with genuine disease; she or he does not want to backstop your laziness and incompetence.”
This session was a great prelude to Laurence’s later session on the contents of a practitioner’s toolbox, what they are for and how to make them work for you in clinical practice.
Dr Adam Watson spoke on the clinical outcomes of Keraring corneal implants for keratoconus. He presented data from his series of over 50 Keraring treatments that showed average improvement in UCVA of 3.1 lines and 1.5 lines in BSCVA, translating to a percentage of 80% achieving 6/12 or better with spectacle correction. He commented that they have a place earlier in the disease process for best effect and improvement of functional vision.
Dr Peter Ring’s first presentation looked at the difference between conjunctivitis occurring in children and adults and the therapeutic management of it.
“An obstructed nasolacrimal duct at birth occurs in 30% of infants,” said Dr Ring. “About 5% go on to become symptomatic within the first few weeks of life with a watery eye/s and mucoid discharge. Some 90% of these children’s symptoms/signs spontaneously resolve during the first year of life when the nasolacrimal duct canalises naturally.”
Management is necessary with the appropriate massage of the nasolacrimal duct to keep it empty of mucous.
Dr Peter Hadden spoke on the therapeutic care of patients who had undergone vitreoretinal surgery. He said post operative care is an important component of such surgery, as all intraocular surgery causes a mild uveitis and refractive changes and the therapeutic and optical management of these changes is vital to ensure best results. Other possible complications of post-operative therapeutic treatment include raised intraocular pressure from steroids, allergic reactions and preservative toxicity.
In discussing how visual fields remain an essential diagnostic tool for optometry, Dr Nick Mantell outlined how the presenting history and clinical examination remain fundamental in making diagnoses for ocular conditions.
“Often features from the history and examination give an indication of the likely diagnosis,” said Dr Mantell. “Auxiliary investigations are also very important and there are aspects of the history and clinical examination which will indicate a visual field is required. Although some of these conditions are relatively rare they are often vision and in some cases life threatening.”
Professor Charles McGhee’s presentation outlined the aspects of ocular chemical injuries and how they should be managed. He said acute chemical injuries occur in both the household and in the workplace and are relatively common and vary from relatively trivial to blinding in nature. Of key importance is appropriate acute management within the first 30 minutes. Integral to emergency treatment is copious irrigation commenced immediately at the scene of the incident, which should be ongoing for 1-2 hours.
Dr Simon Dean’s session was on the foreign body in the eye (FBI). Recognising a corneal foreign body, he said is usually not difficult, but sometimes the removal can be. The first step is to do a focused history yet the FBI will usually be forthcoming however awareness of the high speed FBI from hammering metal, firearms etc that may be intraocular.
Dr Trevor Gray reviewed optometric shared-care of ICLs and the lessons learnt after 550+ ICLs. He said this technology has proven to be the most impactful technology to which he has been exposed to. He said the positive impact of ICLs upon valued aspects of patients’ lives is particularly noticeable for the high myopic astigmats who enjoy the added magnification over their previous glasses and contact lens correction. He said ICLs have also proven their role in patients who have mild stable keratoconus or pellucid marginal degeneration. He provided some pre and postoperative consideration that would be useful from the shared-care prospective.
Dr Watson discussed superior limbic keratoconjunctivitis (SLK) and emphasised that it is a condition easily mistaken for dry eye, whereas, recognition and appropriate treatment may save many years of frustration and discomfort.
Dr Mantell looked at the management of post-LASIK diffuse lamellar keratitis (DLK) and infectious keratitis and how important it is to differentiate between the two. He also discussed what to be aware of, when to refer back, supportive treatment and what to look for. He also looked at the four stages of DLK.
Laurence presented on why an OCT will become an important part of the office examination suite.
“The OCT is a game-changing modality which has become an essential ophthalmic tool, but has yet to gain widespread traction in the optometric community. It has revolutionised the way we examine the macula and optic nerve head and is now the gold standard for detecting the presence of macular pathology, but fluorescein angiography and retinal photography remain the primary techniques to detect the cause of lesions identified by OCT.”
Dr Peter Hadden looked at the therapeutic and ophthalmic management of an unusual case of mild posterior uveitis. The case discussed a patient who had presented on varying occasions with not only uveitis but cataract, glaucoma and retinal problems; the local optometrist had been closely involved in the care of the patient, given that they lived a significant distance from Auckland in an area with no local ophthalmologist.
Dr Gray continued with a look at what’s new in the therapeutic shared-care of cataract surgery.
“Safety, safety, and safety is the driving force behind evolving changes in perioperative cataract surgery therapeutics. Optometrists involved in the shared-care of cataract patients will note an increasing use of Voltaren drops (NSAID) combined with steroid drops such as Pred Forte or Maxidex, in the peri-operative period as the combination has been proven to reduce the risk of cystoid macular oedema.”
Laurence then presented his last session that discussed how topography, photography and field analysers enhance a practitioners diagnostic skills, and how evidencebased medicine is particularly relevant for diagnoses but that it must be based largely on clinical observations.
“There are three diagnostic skills levels. Know what you know, know what you don’t know and don’t know what you don’t know. The latter is particularly problematic for the patient because there are possible health consequences. Therefore having more tools to gather evidence and assist in building the jigsaw helps lower the risk of under or missed diagnoses.”
Laurence referenced the close working relationship that Professor Molteno of Dunedin Hospital has with optometrists in the south, and how his philosophy is very patient based and inclusive of the whole health system so that serious eye disease ends up being diagnosed in the community and treated in the hospital where it belongs.
“Professor Molteno has written very positively of the skills of optometrists compared to general practitioners in this regard,” said Laurence. “The reasons we can make advanced diagnostic decisions is because we share the same diagnostic tools used in ophthalmology. We also use these technologies differently and in some instances better.”
Dr Tony Morris looked at 20 years of laser vision correction and discussed the development of the excimer laser and the commercialisation of this technology with Marguerite Macdonald performing PRK on the first patient in 1988. He also discussed new directions in laser vision correction both with femtosecond lasers and excimers but considers conventional LASIK will be the procedure of choice for the future. He provided an introduction to Keraflex which utilises thermo-biomechanics together with rapid cross linking to treat abnormal shaped corneas such as Keratoconus.
Professor McGhee then covered the aetiology and management of infective keratitis, in particular bacterial keratitis with a strong emphasis on therapeutics. He looked at the risk factors, diagnostic criteria, methods to identify organisms and the use of antibiotic duotherapy versus monotherapy. He emphasized the need to identify the infective organisms, which are often poly-microbial, as paramount in best-practice.
Professor Helen Danesh- Meyer presented on the importance of having an in-depth understanding of the side effects of various glaucoma medications, how to identify them how to manage them.
Dr Ring’s session on ‘what is this lump on my eyelid?’ dealt with the therapeutic and surgical management of the common meibomian cyst or chalazion along with the differential diagnosis of several other diseases that may manifest as ‘lumps’.
Dr Dean then considered the assessment and management of retrobulbar haemorrhage.
Prof Danesh-Meyer continued with a session focusing on the common toxic optic neuropathy, including phosphodiesterase inhibitors, amiodarone, ethambutol and several other newer causes of toxic optic neuropathy that have been identified.
The final presentation of the day was a particular highlight with Prof McGhee donning his TV show presenters hat for his session ‘who wants to be an anterior segment expert?’
Based on the internationally popular ‘who wants to be a millionaire’ format it had the appropriate music and visuals and audience participation. Utlising a large series of casebased questions, and a handpoll he tested the audience’s knowledge, diagnostic skill, management and appropriate therapeutic approaches for the busy clinical optometrist. It was fun, informative, educational and great entertainment.
It was another informative and popular day of education with optometrists from all over the country attending. The dates for 2011 events have also been set so mark in your diaries May 10 and August 2 for seminars and November 6 for the conference.
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