Optometry Australia’s first ever national virtual conference in late June provided optometrists with an exceptional opportunity to connect and learn from the comfort of their own homes. With live and recorded webinars offering a total of 22 CPD points, a cock tail party and even an interactive song that summed up the state of the profession right now, this was an event not to miss, even if there were a few technical glitches to navigate along the way.
Over 2,200 optometrists from Australia, New Zealand, the Asia Pacific, the US and Europe registered to attend Optometry Virtually Connected (OVC), which provided diverse, high quality educational content non-stop from the afternoon of Friday 26 June through to Sunday 28 June.
Hosted by Optometry Australia (OA), the conference was cleverly programmed to allow maximum flexibility for attendees with live ‘one-off ’ CPD and exhibitor webinars spread across the three days, along with ‘on demand’ pre-recorded sessions that optometrists could dive into at leisure.
ongoing use of triage questions to minimise contact with potentially infected patients was useful
Topics ranged from traditional clinical lectures on age related macular degeneration and myopia through to interpretation of optical coherence tomography, innovative lens dispensing technology, legal and CPD compliance, effective communication strategies and cultural safety. As you’d expect, there was a healthy smattering of references to COVID-19 – both in terms of clinical and patient management.
On average 900 delegates attended each live CPD webcast, 230 viewed each on-demand CPD webcast, and 417 delegates attended each supplier CPD session hosted on the Optometry Virtually Connected platform.
Over 300 delegates attended the virtual welcome cocktail function, taking the opportunity to catch up with colleagues and to view the launch of We are here, a highly motivational song written by Optometry Australia’s own Sophie Koh in collaboration with producer Robin Waters and sung by Ms Koh with contributions from members.
Optometry Australia Chief Clinical Officer Luke Arundel referred to data from a recent Lancet study to discuss new evidence on the effectiveness of face masks, eye protection and physical distancing to protect healthcare workers and people in the community from infection. He mentioned the World Health Organisation had revised its mask advice in early June to suggest, in areas with known or suspected community transmission (or intense outbreaks of COVID-19), that health workers should continuously wear a medical mask throughout their entire shift. For the local context he referenced advice from the Australian Department of Health, updated this month, stating health care workers do not always have to use PPE (Personal Protective Equipment), but were recommended to do so if caring for a patient with confirmed or suspected COVID-19. He stressed that ongoing use of triage questions to minimise contact with potentially infected patients was useful and that, where possible, confirmed cases with COVID-19 requiring urgent ophthalmic care are referred to centres more appropriately equipped to deal with these cases.
Mr Arundel encouraged optometrists to make their own informed choice on PPE after reviewing the evidence presented on the OA COVID-19 (PPE section) online, and considering both their personal situation and (perhaps most importantly at the moment) location. Mr Arundel spoke about specific precautions that can be taken when using clinical equipment in practice. He also alerted attendees to the increased number of cyberattacks on health care providers during the COVID-19 pandemic. Over three face to face zoom sessions across the weekend and through an online chat function, the Optometry Australia member support team also assisted with a wide range of professional services and clinical questions. Infection control queries were the most popular topic over the weekend.
KIDS AND CONTACT LENSES: MYTH BUSTING
Optometrist and mivision contributor Jessica Chi successfully and humorously busted six myths surrounding the prescribing of contact lenses (CLs) for children.
While acknowledging that prescribing CLs for young patients often causes anxiety not just for children, but also their parents and even their optometrists, Ms Chi assured delegates that children are great candidates and, while some may not be ready for them, they are never too young – newborns with congenital cataracts, for example, can and do wear CLs. Managing the parents of babies and children with CLs can be the greatest challenge.
“Fitting a baby is easy – they’re little, they’re weaker than you and they forgive and forget quickly,” said Ms Chi, though she advised that ideally, it is a two person job.
Referring to the three year CLAY study, which involved thousands of children, Ms Chi assured attendees that young children, up to age 14, are at much lower risk of infiltrative events and infection. “Children are used to following instructions and have a routine, but as they get into teenage years their appetite for risk increases – they’re more willing to challenge authority, more likely to party and not go home, and they don’t have great CL hygiene,” she said. “Contact lenses are actually really safe, provided the patient is compliant.”
Many parents believe their children can’t be trusted with CLs because they lose or break their spectacles. However, specs are usually lost or broken because they are on and off – whereas once CLs are in, they’re usually in for the day.
When it comes to fitting children with CLs, Ms Chi said studies have indicated total chair time is only five to fifteen minutes more for kids than older patients. The difference is usually from insertion and removal, which is a task that can be delegated. Additionally, she said any standard CL will fit a child by the time they are three years old as the eye’s diameter is almost fully formed by two years of age and corneal curvature is almost fully formed by age three. “Kids’ eyes are often more suitable for CLs than adults as they usually have more stable tear films,” she added. The practice benefits of fitting a child with CLs are long-lasting thanks to building loyalty, repeat business, and word of mouth.
Finally Ms Chi reported studies that have shown that children who are fitted with CLs accelerate academically, physically, socially and emotionally. Reflecting on her own childhood, she said being fitted with contact lenses made an enormous difference to her self-esteem, her confidence, and indeed, her life.
However, she said it is important to find a balance. There is no point in pressuring a child who does not feel comfortable wearing CLs as they will become traumatised and it may be years before you get another chance to offer them.
“Talk to the child and involve the parent rather than talking to the parent and involving the child. Find the things they hate about wearing glasses… let them touch and feel a CL, show them the CL in your own eye and demonstrate taking it out and putting it back on, tell them what you’re about to do when doing the initial fitting. Make the unfamiliar familar. Get the closest possible lens for them from the first fitting – they won’t tolerate multiple fittings. And offer lots of reassurance.
“Bribery will get you everywhere – it’s really important – it doesn’t work on young babies, but when kids get older (and stronger!), that’s when it’s useful,” she said with humour, cautioning that you should always check with the parents first.
Philip Cheng, optometrist and Director of the Myopia Clinic Melbourne in Victoria, spoke about the use of orthokeratology (OK) and multifocal soft contact lenses to manage myopia – a refractive and progressive condition caused by axial elongation.
A myope himself, he said as optometrists “we have a duty of care to look after our patients’ eyes to the best of our ability” and “there is no safe level of myopia – for every one dioptre increase, we increase the risk of myopic maculopathy by 67%; whereas for every one dioptre reduced, we lower the risk of myopic maculopathy by 40%.”
The most effective optical interventions to slow refractive change and axial elongation are OK, multifocal soft contact lenses, and DIMS spectacle lenses. Less effective are multifocal/PAL spectacle lenses. Low-dose atropine eye drops (0.025-0.05% being more effective than 0.01%) can also be used, but correction of vision is still required. Optical interventions, which provide both vision correction and myopia control benefits, should be considered as a first-line treatment.
“Our job is to educate parents about what myopia is, the implications, and offer the options so they can make an informed decision for their children,” Dr Cheng told around 800 optometrists who attended the webinar.
Mr Cheng recommended that children diagnosed with myopia commence myopia control treatment as early as possible because every dioptre counts.
“Eye growth is greater at a younger age, if you delay treatment until a patient is in their teens, you miss the best opportunity to slow their eye elongation – they may have progressed to a high level of myopia already, which also makes OK more challenging to fit.
“OK works by re-shaping the front surface of the eye during sleep – it slows progression indirectly by creating an optical effect on the back of the eye. By changing the focusing of light in the peripheral retina, this sends a stop signal for eye elongation.”
Mr Cheng said corneal topography is critical to success with OK – for the initial assessment, lens design and assessment of treatment outcomes. Well fitted OK lenses can achieve 40–50% reduction in myopia in one night, but every cornea is different. “Give patients the expectation that their vision will improve day-by-day, and stabilise at around one week,” he said, adding that even with treatment, myopia progression may still occur. “Reducing progression by half is a good outcome; children at genetic risk and fast progressors may require more than one treatment, and adding atropine to OK can enhance treatment outcomes in these cases. We’re not necessarily aiming for 6/6 vision – we aim to achieve good functional unaided vision for the patient.”
Visual acuity alone is not a meaningful measure when assessing the success of OK in slowing the progression of myopia, as progression can be masked by variations in treatment effect. The Gold Standard is to accurately measure and track axial elongation over time during OK treatment (Mr Cheng uses a Zeiss IOLMaster 500). He said patients should be warned to expect to see haloes as a result of changes to peripheral vision, particularly at the start of treatment. Teenagers can be slower to adapt to visual changes than younger children.
Mr Cheng believes multifocal soft contact lenses for myopia management are ideal for practitioners who don’t fit OK; for patients who are not ideal candidates for OK because their myopia is too high or too low, or their eye shape is not suitable, those who won’t tolerate the hardness of RGP lenses, or have questionable hygiene/compliance. He recommends treatments for myopia continue until a child has completed all study – at school and at university – to ensure they maximise outcomes as progression can still occur into the early 20s. Adults can continue to wear OK or multifocal contact lenses, and some prefer to do so.
“Myopia is such a multifactorial condition that we need to look at every individual and tailor the treatment plan to reduce risk of progression as much as possible,” he concluded.
Optical coherence tomography (OCT) has transformed the way we diagnose and manage diseases and is rapidly adopted by many optometric practices in Australia. Pauline Xu and Sophia Zhang, clinicians from Centre for Eye Health, shared some of their best tips and clinical pearls on how to interpret OCT and use it to aid differential diagnosis and management of macular pathologies.
The presentation kicked off with a refresher in OCT interpretation. A systemic approach was introduced: step one is to survey the foveal contour; step two is to examine the reflectivity of the retina layers; step three is to look for abnormal lesions. Lesions such as haemorrhages, pigments, and hard exudates will show hyperreflectivity, while optically empty lesions, such as fluid, will show hypo-reflectivity. Step four is to scrutinise for tissue loss. It was highlighted that inner retina loss and outer retina loss can stem from different disease processes. Step five is to assess the quantitative result such as the macular thickness map.
The second section of the presentation focused on three cases series. The aim of this session was to demonstrate the practical benefits and deployment of OCT in the differentiation of macular pathology.
Visual acuity alone is not a meaningful measure when assessing the success of OK in slowing the progression of myopia, as progression can be masked…
The first case series focused on developing practical OCT techniques to differentiate drusen that occur in age related macular degeneration from other types of macular pathology. It also highlighted the features of drusen subtypes as well as the distinction from the common mimickers of drusen. The second case series demonstrated the various types of pigment epithelial detachments (PED), highlighting the importance of assessing the internal reflectivity on OCT. The natural history and prognosis of each individual type and its effect on management was also addressed. The last case series explored different mechanisms behind the intraretinal hypo-reflective spaces and their respective management plans.
Rodenstock maximised its presence as an Optometry Virtually Connected exhibitor by offering two live webinars, which between them attracted around 700 practitioners.
Nicola Peaper, Rodenstock’s National Sales and Professional Services Manager, said the message she emphasised during both webinars and in the exhibition booth, was that using technology to personalise lenses derives significant benefits for both patients and practices.
“When prescribing single vision lenses we need to differentiate ourselves by selling better quality than a patient can pick up from their local petrol station or pharmacy. My first presentation explored the options for doing this and how optometrists can talk to patients about quality single vision lenses to ensure they understand the benefits.
Ms Peaper’s second webinar was on Rodenstock’s B.I.G. – or Biometric Intelligent Glasses system. “This presents a paradigm shift in producing progressive lenses, based on thousands of unique measurements of an individual’s eyes, and optometrists were keen to understand the technology and ask some indepth questions,” Ms Peaper said. “You can personalise single vision lens offerings by using different technologies, but B.I.G is about as tailored as you can get at the moment,” she added.
Ms Peaper said having a strong presence at Optometry Virtually Connected “was well worth the investment” both in terms of attendance at the lectures and people visiting the booth.
“There are merits to both virtual and physical tradeshows. Some people love coming onto stands at physical conferences and they’re comfortable asking questions, but there are always a lot of people who shy away because they are concerned about being accosted. The virtual show allowed people to visit, download brochures and freely ask questions – we were really pleased with the interactions. Going forward we will be very happy to attend both physical and virtual events.”
ONWARDS AND UPWARDS
OA’s President Darrel Baker said the Association was delighted with feedback from the event.
“Feedback has been terrific,” he said.
“Optometry Virtually Connected represents a new way of delivering a multi-day conference and trade exhibition utilising technology that is just beginning to gain traction globally. We are pleased to be at the forefront of bringing this type of event to the optometry sector in our region. As this becomes more widespread, I’m sure we’ll see rapid changes in the technology around these virtual conferences.
“Driven by the needs of our members, we are anticipating holding a second event as this innovative online platform enables delegates to maintain patient appointments and to meet personal commitments within a highly flexible learning environment.”