A highly educational presentation by Associate Professor Elaine Chong, Director of the Department of Ophthalmology at The Royal Melbourne Hospital, proved to be the perfect way to kick off the 2021 annual Specsavers Clinical Conference.
The short sharp event in Melbourne CBD attracted 100 people to the venue and a further 900 attendees on line, validating the fresh new approach that Specsavers is taking to conferencing.
How good to be out and about again at a live conference!
Those who attended the first hybrid session in Specsavers’ 2021 Clinical Conference Series were treated to an entertaining lecture by A/Prof Chong who focussed delegates’ attention on a new treatment for Fuch’s endothelial corneal dystrophy which does not involve corneal transplant. Descemet’s stripping only / Descemetorhexis without endothelial keratoplasty (DWEK) has been shown to successfully improve visual acuity in the early to intermediate stage of the disease.
Several approaches to corneal transplant have been used to treat Fuch’s dystrophy, from penetrating keratoplasty (PK) which is a full thickness donor corneal transplant, through to endothelial keratoplasty (EK) which can be either Descemet stripping endothelial keratoplasty (DSAEK) using about one fifth of a donated cornea (~100um), or Descemet membrane endothelial keratoplasty (DMEK), using an even thinner layer of donor tissue (~10um) to replace the diseased tissue.
Interestingly, DWEK was discovered accidentally; impressively, small studies like one led by A/Prof Chong are evidencing its success
Typically, when treating Fuch’s Dystrophy with EK, the thinner and smaller the tissue transplanted, the better the resultant visual acuity and contrast sensitivity, and the longer the transplant is likely to survive. However the thinner the donor tissue, the more technically challenging the procedure, necessitating a bigger learning curve. Most recently, DWEK has been discovered as an alternative to corneal transplantation. Essentially, this approach involves removing the sick/ diseased part of the cornea then allowing the endothelium to repair itself. This process of repair can be encouraged, if necessary, with the administration of Ripasudil ROCK inhibitors, available under special scheme in Melbourne.
Not every patient is given ROCK inhibitors because some will experience side effects. Not every patient is suitable for the DWEK approach – candidates must have enough peripheral endothelial cells to migrate centrally – and even then success is not guaranteed. However, if unsuccessful, they can go on to have a DMEK corneal transplant.
In other words, says A/Prof Chong, patients can try DWEK first and if it doesn’t work, they will have lost nothing except time. On the flip side, if it is successful, they will avoid the need for more complex corneal transplant surgery. This is a positive because, as A/Prof Chong pointed out, there are many issues with donor tissue rejection and the procedure often has to be repeated after 15 or 20 years. Additionally, there is a greater chance of rejection with every subsequent transplant.
Interestingly, DWEK was discovered accidentally; impressively, small studies like one led by A/Prof Chong are evidencing its success.
“Our study is still actively recruiting. So far, 80% were successful and 20% went on to require transplant,” she said, adding that she is currently enrolling participants for an extension of the study, which aims to answer questions including why some patients won’t respond to the procedure, how different surgical techniques used can impact outcomes, and the potential frequency and duration for treatment with Rock inhibitors.
A/Prof Chong asked optometrists to refer appropriate patients with Fuch’s dystrophy to participate in the study. “Suitable patients are those who want to improve their vision, and are happy to accept DMEK if the more experimental DWEK fails,” she said.
If you have interested patients, you can contact A/Prof Chong via email: elaine@ irissurgery.com.au or firstname.lastname@example.org.
RED FLAGS IN CORNEAL TRANSPLANT
Returning to the topic of corneal transplants, A/Prof Chong said optometrists need to be aware of the red flags that indicate a likely transplant failure.
Patients who have undergone corneal transplant and are at risk of transplant failure include those who present with poor visual acuity, photophobia, a high number of previous transplants, and a history of HSK/VZV/atopy; glaucoma surgery; or uveitis (especially cytomegalovirus).
Patients who are at high and imminent risk of failure are those who present with broken sutures and inflammation. Patients with keratic precipitates (KP) and anterior chamber cells must be referred very quickly as this indicates rejection. Patients with corneal oedema and vascularisation should also be referred urgently.
AMBITIONS DRIVING SPECSAVERS
At the conference, Dr Ben Ashby, Specsavers ANZ Director of Optometry, took the opportunity to update optometrists on the group’s achievements and its five year ambitions for patient care, career development, partnerships and business growth.
Stating that, “our people are our greatest asset”, Dr Ashby advised that in April, Readers Digest recognised Specsavers Australia and New Zealand as the ‘Most Trusted Optometrist’ brand in 2021, for the second year running. He said over the next five years, Specsavers will focus on developing more business opportunities for its future clinical leaders and aims to be looking after an additional one million patients, 70,000 with treatable eye disease.
Having completed the roll-out of optical coherence tomography across Australia and New Zealand, and partnered with Oculo for seamless referrals and data capture, Specsavers is now piloting the use of artificial intelligence and clinical decision support software in its practices to support continuous improvement and earlier diagnosis in the most common causes of avoidable blindness – age related macular degeneration, glaucoma and diabetic retinopathy. Additionally, Specsavers is working with Topcon to explore the potential of smart refraction technology, which Dr Ashby said could “remove much of the mechanical process of refraction from the consult room”, freeing optometrists to “spend more time with their patient that is focused on improving vision and protection of sight”.
FREE TO ALL OPTOMETRISTS
This was the first event within the 2021 Specsavers Clinical Conference program which will comprise a blend of hybrid and virtual events throughout the year. In 2020, the clinical conference was entirely virtual due to the pandemic, which was well received, however Dr Ashby said his team had also been asked for opportunities to network after a year of limited face-to-face events.
The series will include a range of virtual presentations, panel discussions and interactive webinars on topics ranging from glaucoma diagnosis and comanagement, to diabetic retinopathy screening, therapeutic management, KeepSight updates and more. Events are free and open to all optometrists, students and industry professionals across Australia and New Zealand. All events are eligible for both Australian CPD hours (including therapeutic hours) and New Zealand CD and General Points.