After months of planning and anticipation, O=MEGA 19 has been and gone with tremendous success. Brought together by Optometry Victoria South Australia (O V/SA) and the Optical Distributors and Manufacturers Association (ODMA), the huge biennial event replaced SRC and ODMA19.
In its inaugural year, we didn’t know quite what to expect of O=MEGA19. Held at the Melbourne Convention and Exhibition Centre, O=MEGA19 boasted two streams of local and international speakers as well as a huge trade show with everything you could think of relating to eye care and eyewear. Masterclass sessions were held for both new and experienced dispensers, meaning that throughout the weekend, there was something for the whole team.
A great take home pearl was not to use beta blockers in patients with normal tension glaucoma – due to high prevalence of concurrent vascular issues, beta blockers may hinder rather than help
Excitement was in the air on day one, with busy lecture streams and eager faces ready to absorb clinical insights and updates about the latest in technology and research.
The conference boasted a trade show area larger than ever before, with new splashes of fun and colour from eyewear brands. This ranged from the newest technological advances in optical coherence tomography and widefield imaging through to hula dancers and lei’s on the award winning Maui Jim stand. There was a wide range of frame exhibitors, making O=MEGA19 an ideal opportunity to consider new ranges which may not currently be available at your practice. The Bausch + Lomb Knowledge Centre stage drew crowds in the trade arena, hosting talks which appealed to both optometrists and optical dispensers. Kathy Allen from Dewings Accountants was a highlight with her talk, What is your practice really worth? detailing the calculation of a practice’s market value as well as options for succession planning.
At the end of a Saturday of insightful lectures, attendees were given a chance to network over much appreciated drinks and canapes. This was a chance to meet lots of new and familiar faces, and snap a photo at the Eyes Right Optical photobooth.
Below are some of the highlights from lectures across the three days, for those who missed out:
CASE STUDIES FROM AROUND VICTORIA
Always popular, the case studies from around Victoria session kicked off with three early career optometrists sharing their interesting and complex patients. Victor Liu discussed a case of Fuch’s endothelial dystrophy, leading to a Descemet’s stripping automated endothelial keratoplasty (DSAEK). This resulted in an excellent visual outcome for the patient for five years, however the patient then returned with significant corneal oedema and fibrosis of the transplant, and had to undergo a secondary Descemet’s stripping endothelial keratoplasty (DSEK). Secondary DSAEK results are surprisingly similar to primary DSAEK results: at six months post operation, 94% of patients achieve a best corrected visual acuity of 6/12 or better.
Karina Sinclair presented a case study detailing advanced pseudoexfoliative glaucoma, which led to a painful bullous keratopathy and a blind eye. This was managed with an extended wear bandage contact lens with prophylactic antibiotic cover.
Katrina Yap covered acute epidemic keratoconjunctivitis, followed by recurrent subepithelial infiltrates. She noted that steroids are required to ease the symptomatic infiltrates, but in patients that have a steroid response, cyclosporin A can be considered. The aim, whether steroids or cyclosporin is used, is to find the lowest dose that keeps the subepithelial infiltrates asymptomatic.
WHY ARE OLDER EYES AT GREATER RISK OF GLAUCOMA?
Associate Professor Bang Bui wasted no time diving into his explanations in a quest to answer why intraocular pressure (IOP) does not affect the progression of glaucoma in some, but has a dramatic affect in others, particularly the elderly. As we age, we lose ganglion cells. Because our receptive field decreases with this loss, the remaining ganglion cells upregulate their sensitivity to light, working harder to compensate for this loss, and are more prone to oxidative stress and damage.
In patients with a long history of elevated blood pressure, atherosclerosis decreases the lumen size of the ophthalmic artery, thus limiting oxygen perfusion. A/Prof Bang also noted our ganglion cells lose their flexibility as we get older. Younger eyes can flex with increased ocular pressure, whereas older eyes, whose ganglion cells cannot bend, are compressed by the force of the IOP. It is believed that African American’s are at a greater risk of glaucoma as their ganglion cells stiffen more than other ethnicities. Studies show that mice who were exercised were better able to tolerate increases in IOPs, whether it be from increased brain derived neurotrophic factors or increased mitochondrial function. Therefore great modifiable risk factors to consider, to prevent glaucoma, are weight control, exercise and diet.
TROPIAS: UNDERSTANDING WHEN TO REFER
The plenary theatre was busy with attendees keen to listen to Dr Lionel Kowal and understand when to refer, and when to monitor people with tropias. Infantile esotropia, in the first six months of life, can mimic a sixth nerve palsy, so must be referred urgently before the medial rectus tightens. Dr Kowal noted the best way to refer urgently is to ensure there is a phonecall and handover to reception staff, with a follow up call later in the day. Infantile exotropia must also be referred onwards, but children with an intermittent or alternating exotropia can be treated with minus therapy and monitored.
STRATEGIES FOR SOLVING EPIPHORA
How often are you left feeling frustrated because you are unable to help a patient with persistent low grade epiphora? Keynote speaker Dr Jordan Keith had many great pearls to share. For example, conjunctival chalasis not only causes tear overflow, but results in exposure of the conjunctival folds, causing persistent inflammation. The conjunctival folds can also plug the puncta, further contributing to epiphora. Dr Keith explained that those with floppy eyelid syndrome often have eyelashes that point downwards and encouraged all to really manipulate the lids to look for easy eversion. Floppy eyelid syndrome can be treated with moisture chamber goggles or eye masks that can also fit on c-pap machines. He also described a variation of the Jones Test; minutes after instillation of NaFl, ask yourself if the NaFl has all drained away or is the dye persisting in the lacrimal caruncle area in one eye more than the other?
Keynote speaker Dr Danica Marrelli provided a series of engaging and clinically relevant lectures over the three days. The glaucoma grab bag, or glaucoma toolbox noted the topical agents available for optometrists to prescribe, and the key contraindications to keep in mind. Dr Marrelli noted that there is not one key rule of thumb when setting a target IOP, as this is dependent on the stage of the disease as well as the level of IOP, family history, monocular status, other optic nerve, medical disease, and life expectancy. She detailed the best way to manage IOP, with two flowcharts – the key consideration is to see if the initial glaucoma drop is having a therapeutic effect. If it is, and the target pressure is not being reached, then an additional topical drop should be added. However, if the initial medication is not having a therapeutic effect, it is best to monitor for more time in that class of drug. If this is not effective, switch the class of drug being administered. A great take home pearl was not to use beta blockers in patients with normal tension glaucoma – due to a high prevalence of concurrent vascular issues, beta blockers may hinder rather than help.
CORNEAL DISEASE, INFECTIVE KERATITIS AND RECURRENT CORNEAL EROSION SYNDROME
By the time Sunday afternoon lectures come around, there can be some fatigue in the room, however this was not the case with fascinating anterior eye photos from Dr Georgia Cleary. She noted that pathogens in bacterial keratitis are mostly gram positive, with 82% being measured at the Royal Eye and Ear Hospital in 2014. Considering this, tobramycin, which has no gram negative cover, is not recommended. Instead, first line treatment is Ofloxacin Q1H day and night, with consideration of a topical steroid after 48 hours if the culture is positive with a sensitive organism and/or if there is significant clinical improvement.
COMPLICATIONS OF SCLERAL CONTACT LENSES
Gavin O’Callaghan gave a very informative lecture, mainly focused on complications to watch out for when fitting scleral lenses. Scleral lenses can be game changers for people with irregular corneal surfaces, grafts and dry eye. The key issues to watch out for when fitting them are higher order aberrations, midday fogging, conjunctival obstacles and corneal oedema. It may be possible to avoid issues by maximising best fit using high Dk/t materials, improving scleral alignment by specifying quadrant zones and using microvaults, trying preservative free solutions and addressing any concurrent meibomian gland dysfunction. Although these lenses can be fantastic for corneal graft patients, there is increased risk of complications due to hypoxic stress, neovascularisation, corneal edema and high suction pressure.
ADVANCES IN OCT
Nick Rumney presented a great lecture on the workings of swept-source optical coherence tomography (OCT), which penetrates much deeper into the retinal/ choroidal layers than our regular fourierdomain OCTs at 100,000 scans per second. He showed detailed images of the whole eye, vitreous and exciting analysis systems to show where to search for a visual field defect ie, when to perform 10-2 vs. 24-2 to really pick up early defects. The system tracks the same area four times and records things that move, thus detecting movement of the red blood cells.
A breakout session deviating from the two streams to discuss KeepSight was absolutely packed!
KeepSight is a new program led by Diabetes Australia and Vision 2020, funded both publicly and privately, and being evaluated by the Centre for Eye Research Australia. Alarming statistics were presented indicating that currently 280 Australians are being diagnosed with diabetes per day! Associate Professor Peter van Wijngaarden discussed his experience witnessing the contrast in the mild amount of retinopathy seen at his time in the UK where there is a well implemented diabetic screening and recall program, versus the high numbers and high severity of patients sitting in his chair in Australia. The issue seems to be that only 50% of people in Australia get their eyes checked at their recommended intervals.
KeepSight is another way to try to stop people falling through the cracks of recall systems. Increased awareness and a cross check of patient attendance will help reduce the avoidable vision loss in diabetic retinopathy. KeepSight will also give more data to study trends of retinopathy and give our Associations a greater rallying power at government level.
So what can we say about the biggest eye care and eyewear event in Australia? After three days of intensive lectures, catching up with new and familiar faces, and multiple visits to the trade show, we can say that we were both impressed and slightly exhausted! In an industry overwhelmed with continuing education options, O=MEGA proved itself to be something unique and not to be missed in 2021.
Katrina Yap enjoys private practice in the northern suburbs of Melbourne and is also a clinical teaching instructor at the University of Melbourne Eyecare. Katrina is a committee member of Early Career Optometrists Victoria and the Cornea and Contact Lens Society of Victoria. In 2018, she was appointed to the Optometry Council of Australia and New Zealand board.
Kate Weller graduated from Flinders University in 2014, and currently practices in central regional Victoria. She has special interests in dry eye management and behavioural optometry.