With 42 therapeutic points on offer, WAVE 2017, at the Rendezvous Hotel in Scarborough, Perth, was rich in content. Workshops and lectures complemented everyday optometry and introduced new clinical ideas, which could shape the practice of optometry in the future. The annual conference attracted delegates from around Australia and as far as Singapore and New Zealand.
WAVE 2017 is renowned for its workshops and this year was no different with topics that included ‘Inter-professional collaboration’ presented by Simon Hanna; ‘Indirect ophthalmoscopy with scleral indentation’ by Dr. Vignesh Raja; ‘Developing your dry eye practice’ with Rebecca Li and Damon Ezekiel and ‘Scleral lens fitting’ with David Stephensen.
Mr. Hanna’s workshop on inter-professional collaboration highlighted the importance of teamwork and communication between practitioners, of knowing each other’s scope of practice and knowing who to refer to for best patient outcomes. Pharmacist Dr. Fei Sim addressed the delegation about inter-professional collaboration from a pharmacist’s perspective and highlighted the benefits of optom-pharmacist partnerships. The use of Telehealth Medicare items 10945-10948 was discussed, along with the new MBS items for retinal photography, the latter providing opportunities for optometrists to partner with GPs by arranging private commercial fees for reading/grading retinal images.
The scleral contact lens workshop by David Stephensen touched on the basics of a scleral lens fitting process, non-optical applications and complications. Meanwhile, a hands-on dry eye workshop enabled delegates to experience first-hand, the benefits of using the meibograph, IPL laser and the Blephex brush, to help grow their dry eye practice.
a hands-on dry eye workshop enabled delegates to experience first-hand, the benefits of using the meibograph, IPL laser and the Blephex brush
Aqueous Deficient Dry Eye
Mark Koszek delivered an in-depth presentation on aqueous deficient dry eye (ADDE) diagnosis and management. His first key point was to recognise ‘at risk’ patients by analysing gender, age, medications and systemic diseases. Studies showed that ADDE was higher in women and prevalence increased with age. Diagnostic tests were discussed and a common misconception about reduced tear breakup time (TBUT) was pointed out. “TBUT is not a specific indicator of meibomian gland dysfunction (MGD), patients with aqueous deficiency dry eye also have a reduced TBUT,” said Mr. Koszek. Treatment options included lubricants (preservative free), topical steroids, nutrition, cyclosporin, mini-sclerals and punctal plugs.
Diabetes and the Role of Optometry
Our role in the management of patients with diabetes is increasing and with the advent of new imaging technology, we can make informed clinical decisions about patient management. Amira Howari challenged us to take it a step further by developing a greater understanding of the disease and the patient’s personal circumstance. She reminded us to ask key questions such as the patient’s diabetes type; age of onset; medication; specialists involved in their care; their HbA1c levels; fasting blood sugar levels; and if they are stable, questions about their diet; their last diabetic retinopathy (DR) check; and how often they see their GP. Ms. Howari said this would help build the patient profile and gain an insight into whether they have their disease under control and their risk of developing diabetic retinopathy in the near future. Different treatment modalities for DR were discussed and compared (laser vs. anti-VEGF).
Glaucoma and visual field tests were covered in depth by Jack Phu and Mark Koszec. Mr. Koszec spoke about the ganglion cell layer and its analysis in glaucoma and disease progression, including the use of the 10-2 visual field tests in early ganglion cell damage in glaucoma and its role in disease progression. A study done by Grillo L et al showed that about half the patients who showed damage in retinal ganglion cell layer were missed on 24-2 testing.
Jack Phu helped us explore further the visual field indices and their usefulness in different disease processes. He reminded us about the common misconception of structure loss being manifest before functional loss. This certainly isn’t true for all diseases, especially retrograde diseases.
Professor William Morgan talked about the trans laminar pressure gradient between intraocular pressure (IOP) and cerebrospinal fluid pressure (CSFp) and its implications in glaucoma. High translaminar pressure gradient (TLPG) was seen in high IOP glaucoma and was shown to reduce axoplasmic flow. CSFp thus was an important component in glaucoma, however measuring it is the challenge.
Adrian Bell and Andrew Hogan discussed paediatric optometry, including therapeutics and amblyopia. Among key points for amblyopia was that studies show the ‘critical period’ doesn’t end at the age of eight. There have been improvements in many amblyopes later on in life. This is where perceptual learning plays a role in training the less plastic brain to make fine discriminations over time in older patients.
Dr. Antony Clarke’s lecture on myopia control highlighted the ATOM1 and ATOM2 studies that showed myopia progression reduces by 80 per cent with 1 per cent atropine as opposed to 68 per cent with 0.01 per cent atropine. However, after ceasing the drops after two years, the rebound was much greater with high dose atropine compared to low dose. Studies have shown that OrthoK and low dose atropine can be used together for myopia control as well.
Dr. Chandra Balaratnasingam spoke about the importance of choroidal neovascularisation subtyping in age-related macular degeneration as it has a major influence on visual prognosis and anti-VEGF treatment schedules. When it comes to anti-VEGF therapy, less is more, mainly because of the recent studies showing the increased risk of glaucoma and geographic atrophy with anti-VEGF use.
In 2018 WAVE will take place from 11–12 August in Perth, WA.
Early Career Optometry Lecture Series
The Early Career Optometry group, led by David Hsu, held a lecture series on the evening of Friday 11 August, ahead of WAVE. Designed specifically for early career optometrists, topics ranged from minimally invasive glaucoma surgery (MIGS) to paediatrics, depression and anxiety. Within an intimate setting, delegates had one on one access to leading presenters in their profession.
Dr. Antony Clarke highlighted the advent of MIGS to reduce the frequency of glaucoma drops in order to save the health dollar. Simon Hanna spoke about different organisations the Association is involved with, and how they can benefit optometrists and patients. He also provided an update on driving standards. Adrien Bell discussed key tips to engage with paediatric patients, among them, undertaking the Howell-Dwyer test first with a six base down prism over the right eye. Steve Leslie spoke on depression and anxiety and how medication can affect ocular health and the binocular system of the patient.
It was an evening packed with clinical and profession-related lectures, which aimed to empower early career optometrists in their day-to-day practice as well as leading them into the future of optometry.
Roxanne Medhora completed a Bachelor of Science in Biomedical Science (2010) and a Bachelor of Optometry (with Honours) in 2014 at the University of Auckland in New Zealand. She works with Abernethy Owens optometrists, one of the largest and longstanding independent practices in Western Australia.