What's New in Ophthalmology and Optometry

Advances are happening in all sub-specialties of ophthalmology and optometry. Treatments are also changing. In order that specialists can stay abreast of some of the developments outside their sub-specialty, 15 minute presentations were given on a variety topics at the Save Sight Society conference held recently in Auckland, and Eye Institute's Dr Peter Hadden was one of them.

What’s new in neuro-ophthalmology...

Although neuro-ophthalmic disease remains largely defined by clinical course, advances in neuro-imaging have added a lot to both the understanding of these diseases and the investigative repertoire. Acute imaging for third palsy and Horner syndrome was used as a basis to discuss a ‘what, when and by who’ approach. When ordering imaging, clinicians need to have a clear understanding of which scan and in what time frame it is needed – keeping in mind what hardware they have at their disposable, and the relative skill set of their local radiology service. (Dr Brett Gaskin)

What’s new in oculoplastics...

1) The use of Rituximab (a monoclonal antibody) in thyroid eye disease, 2) new information on the natural history of lymphomas which are a common orbital tumour, and 3) the use of vibration to lessen pain when injecting local anaesthetics. (Dr Stephen Ng)

What’s new in ocular oncology...

The importance of diagnosing melanoma early, before it had time to metastasise was discussed. The suspicious features that should make one alert to the possibility of melanoma, include thickness, fluid under the retina, symptoms (eg blurred vision or flashes), orange pigment and margin at or near the disc. A useful mnemonic to remember these suspicious features is ‘to find small ocular melanoma’. (Dr Peter Hadden - Eye Institute)

What’s new in contact lenses...

SynergEyes hybrid lenses are now available in a wide range of RGP base curves for keratoconus, astigmatism and irregular corneas. They are a great troubleshooter for keratoconus RGP and semi-scleral non-adapt patients and monocular irregular corneal conditions. CooperVision tailormade silicone hydrogel lenses now come in an impressive range of parameters, including multifocals for astigmatism. Rose K International, and parent company Menicon, have developed the Rose K2XN, designed specifically for steep nipple cones, which will soon be available in the excellent Menicon-Z material. After a cautious start, Orthokeratology (OK) contact lenses are now gaining traction in New Zealand, as research evidence strengthens about its effectiveness in myopia control. OK lenses can now also correct significant corneal astigmatism and hyperopia/presbyopia. (Grant Watters)

What’s new in retinopathy of prematurity...

Retinopathy of prematurity (ROP) continues to be a leading cause of preventable blindness affecting children in both developed and developing countries. Adoption of the new screening and treatment guideline and use of digital retinal photography (Retcam) for ROP screening significantly improved the accuracy of ROP diagnosis and treatment outcome. Laser photocoagulation of avascular retina remains the preferred choice of treatment for advanced ROP with plus diseases. Recent introduction of intravitreal Avastin injection in selective cases of advanced ROP proved to be effective in arresting progression of ROP. (Dr Shuan Dal)

What’s new in paediatric ophthalmology...

The treatment of capillary haemangioma has been much improved by the discovery that mostly they respond to systemic beta blockers, a treatment which is generally safe to use in children. The management of amblyopia in children now has a substantial evidence base thanks to the efforts of the Paediatric Eye Disease Investigator Group. There are now many studies that can guide us on what treatments are reasonable and how successful they are likely to be. (Dr John Dickson)

What’s new in ocular genetics?...

In ocular genetics new tools are assisting phenotyping, such as fundus autofluorescence which may often help to discriminate between different types of maculopathy. Genetic analysis has advanced rapidly with next generation sequencing, and now the ability to sequence all the genes encoding proteins – the ‘exome’ – within 12 months over 15 new genes have been elucidated with this technology – the price is rapidly dropping with the aim that it may become a clinically feasible tool. Many gene specific and gene related therapies are also on the horizon. The NZ database for inherited retinal diseases is well established with over 200 patients and families enrolled, and will allow us to tap into the diagnostic and therapeutic advances when they are available. (Dr Andrea Vincent)

What’s new in dry eye...

The latest developments in clinical dry eye evaluation include the use of the TearLab osmometer for diagnosing dry eye, and the RPS InflammaDry Detector for identifying raised levels of inflammation in ocular surface disease. In response to the recent evidence showing that excessive evaporation contributes more to dry eye than aqueous deficiency – most often as a result of MGD – there have been significant advances in the techniques available for evaluating and managing lipid deficiency such as the LipiView and LipiFlow instruments from TearScience, as well as the development of exciting new artificial tear products incorporating lipid components. (Dr Jennifer Craig)

What’s new in uveitis?...

New medications are changing treatment options for patients with severe uveitis, and old medicines are being delivered in different ways. Subconjunctival injections of long-acting steroid (triamcinolone acetonide) are increasingly used in management of non-necrotising anterior scleritis, and 97% of patients have a good therapeutic response. Biological agents, such as the anti-tumour necrosis factor alpha medications infliximab and adaliumab, can produce dramatic and rapid improvement in control of refractory uveitis. Side effects can be severe but they may be sight-saving in certain conditions. (Dr Jo Sims)

What’s new in VR surgery...

Three recent advances have resulted in safer and more efficient vitreoretinal surgery; high vitrectomy cut rates of 5,000 cuts per minute available with the Alcon Constellation and Bausch + Lomb’s Stellaris PC, the new Zeiss Resight posterior segment viewing system offers significant advantages over alternative viewing systems, and the intraocular dye Brilliant Blue G used in macular surgery is a safe alternative to indocyanine green. (Dr Andrew Thompson)

What’s new with RANZCO...

Chair of the NZ branch of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Dr Derek Sherwood took the opportunity to address colleagues as this year there had not been a NZ branch meeting. He said the Save Sight Society has a great role in funding ophthalmic research in NZ and providing education which it does through donations, subscriptions, industry sponsorship and regular contributions from RANZCO.

Dr Mike O’Rourke was thanked for the work he had put into the organisation over the past two years as chair of the NZ branch. Since Susi Tegen was appointed as CEO of RANZCO, she has been providing an enormous amount of support to NZ. This has led to the appointment of Cameron McIver as branch policy advisor, providing a much needed presence for the College in Wellington.