- Email: [email protected]
Hard Times
Contact Lens & Anterior Eye 36 (2013) e1–e15
Contents lists available at ScienceDirect
Contact Lens & Anterior Eye journal homepage: www.elsevier.com/locate/clae
Abstracts of the 2013 BCLA Annual Clinical Conference, Manchester, UK
Oral Presentations Diabetes - Front and back Bill Harvey E-mail address: [email protected]. The incidence rates for diabetes and the strong association with sight loss make it a major challenge for all eye care practitioners. Understanding the risk factors, markers and various manifestations of the disease are essential for clinical practice. The traditional two type model of the disease will be explained along with variations suggesting a spectrum of disease model. This talk outlines the nature of the various manifestations of the illness, explains the various markers indicating stability of control that are useful to assess the status of any individual patient (including the HbA1c value), and describes the various non-retinal signs of the disease, including corneal and collagenic, lenticular, vascular perfusion and motility concerns. It will conclude with some general advice eye care practitioners should be ready to offer their patients.
apeutic response in patients with diabetic and other peripheral neuropathies.” http://dx.doi.org/10.1016/j.clae.2013.08.006 BCLA – Vision of the future Shelly Bansal, Nicky Collinson (BCLA Communications Consultant & Web Editor) 2012-13 has been a very exciting year for the BCLA as we put the wheels in motion for some fantastic new developments. At the heart of these is a re-ignition of the BCLA brand, along with a brand new website. We have invested heavily in these new projects, and in some detailed research to give us more insight into our members and conference delegates – and those who have yet to experience BCLA membership. Find out what’s in store for the exciting times that lay ahead for the BCLA. http://dx.doi.org/10.1016/j.clae.2013.08.007
http://dx.doi.org/10.1016/j.clae.2013.08.005
Determining success in myopia control strategies
Corneal confocal microscopy: Beyond corneal defects! Translational studies in diabetes and neurology
Ed Mallen E-mail address: [email protected].
Mitra Tavakoli E-mail address: [email protected]. Diabetic neuropathy, the most common cause of peripheral neuropathy in the world, causes substantial morbidity and increases mortality. It is diagnosed by “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes” and may occur in 50% to 90% of patients depending on the criteria used for diagnosis. Conventional techniques of electrophysiology and quantitative sensory testing along with an assessment of neurological disability offer a relatively robust means of identifying neuropathy. However, there are major shortcomings when these criteria are employed to define therapeutic efficacy in clinical intervention trials. The ophthalmic technique of corneal confocal microscopy has been shown to be an ideal surrogate endpoint for diabetic neuropathy. Over the past 8 years we have pioneered the use of corneal confocal microscopy (CCM) as a sensitive test for detecting early nerve damage, staging the severity of neuropathy and establishing repair of nerves in diabetic patients. These findings have changed the paradigm for diagnosing, following progression and assessing ther-
1367-0484/$ – see front matter
This talk will discuss the potential mechanisms for controlling myopia progression. It will cover the ways in which the effectiveness of myopia control procedures can be monitored. The theoretical aspects that underpin the myopic control strategies currently being attempted will be covered, before handing over to other presenters for detailed material on specific methods of myopia control (including custom soft lens fitting and rigid lens methods). The talk will also touch on pharmacological methods of myopia control. http://dx.doi.org/10.1016/j.clae.2013.08.008 Hard Times Jacinto Santodomingo-Rubido, Trusit Dave E-mail address: [email protected] (J. SantodomingoRubido). The prevalence of myopia has increased substantially in recent decades and has approached 20–50% and 60–80% in the West and far East Asia, respectively. Worldwide, the condition is considered
e2
Abstracts / Contact Lens & Anterior Eye 36 (2013) e1–e15
to be the leading cause of visual impairment. Therefore, finding effective treatment options for the control of myopia progression in children is both appealing and demanding. Several treatment therapies, including pharmaceutical agents; bifocal & multifocal spectacle lenses, and conventional, single vision GP & soft contact lenses have been used with relatively modest success to reduce myopia progression. Overall, most therapies have either limited treatment benefits or there are professional issues with regard to long-term prescribing of pharmaceutical agents. Recently, modern orthokeratology has been shown to be effective in slowing myopia progression in children. The authors will present the latest findings on the efficacy of orthokeratology for the control of myopia progression; how long the myopia control effect lasts; predictors of myopia; the optimal time to initiate treatment, defining acceptable clinic outcomes in ortho-k treatment for myopia control, and why should ortho-k be used as a treatment for myopia control over soft contact lenses. http://dx.doi.org/10.1016/j.clae.2013.08.009 Multifocal orthokeratology associated with rapid shortening of vitreous chamber depth in eyes of myopic children Martin Loertscher E-mail address: [email protected]. Purpose: We investigated short-term changes in peripheral refraction and on-axis ocular biometry associated with a novel procedure, multifocal orthokeratology (MOK). MOK lenses mould a controlled multifocal surface on the central cornea. Methods: Thirty children (10-14 years, mean refraction: −2.71 ± 0.76 D) were fitted with a conventional orthokeratology (OK) lens in one eye and an MOK lens in the fellow eye (randomly assigned). We measured peripheral refractions (every 5◦ out to 35◦ , nasal and temporal) and on-axis biometry (Haag Streit Lenstar LS900) with masking, before lens-fitting (pre-fit) and after a satisfactory fit had been established (post-fit). Results: The mean period between pre and post-fit measures was 26 ± 18 days. Over this time, both eyes developed the same myopic relative peripheral refractions and equal visual acuity. In eyes fitted with MOK lenses there were also significant reductions in vitreous chamber depth (VCD: −0.057 ± 0.02 mm, P = 0.004) and internal axial length (IAL: posterior cornea to anterior sclera: −0.051 ± 0.01 mm, P = 0.013) and an increase in choroidal thickness (CHR: +0.023 ± 0.006 mm, P = 0.001). Eyes fitted with OK lenses showed no significant changes in axial dimensions. Conclusion: We found a rapid reduction in VCD and IAL, accompanied by an increase in choroidal thickness with MOK lens wear, but no significant short-term changes in axial eye dimensions with OK lenses. These findings suggest that the rapid on-axis changes are not caused by refractive changes in the peripheral retina, but rather by the simultaneous myopic defocus in the central retina produced by the MOK lens
myopia control, the strategies employed to control the progression of myopia and the outcomes with each of these strategies. http://dx.doi.org/10.1016/j.clae.2013.08.011 Therapeutics post IP - preparing the peace dividend Nick Rumney E-mail address: [email protected]. IP Optometry has been a reality since 2009 and there are 200 IP optometrists scattered piecemeal amongst the HES, primary care and occasionally in academia. So what’s next? Are we truly independant and autonomous or are we over regulated. Is becoming IP promoted widely enough or is it being presented as, and perceived as, a step too far for most optometrists? Within 5 years of getting IP in Victoria, Australia (closer to us clinically than the USA) over 80% of registered optometrists became therapeutically licensed. In context that would be close to 10,000 in the UK? Why is the perceived lack of remuneration a red herring and why are we content to fit lenses then expect others (A&E?) to pick up the pieces? Will our future role in refractive management demand IP or will we lose the chance? This presentation will inspire you to ignore the doomsayers and ne’er do wells and embrace IP. http://dx.doi.org/10.1016/j.clae.2013.08.012 Contact lens related keratitis: Acute presentation and management options: The Manchester Royal Eye Hospital Acute Services experience Leon Au E-mail address: [email protected]. A prospective study on the initial assessment and further management of patients with Contact Lens related keratitis presenting to the Acute Services at Manchester Royal Eye Hospital.. Other points which will be highlighted are 1. Referral protocols when a patient with Contact lens related keratitis presents to an optometrist 2. How soon would a patient with contact lens related keratitis need to be seen by an ophthalmologist 3. Initial assessment and further management. 4. What type of contact lens related keratitis are referred to a corneal subspecialist 5. What type of contact lenses is more likely to cause contact lens related keratitis according to The Manchester Royal Eye Hospital Experience. 6. How long does it usually take for full resolution 7. Best advice to patients to try and avoid contact lens related keratitis http://dx.doi.org/10.1016/j.clae.2013.08.013
http://dx.doi.org/10.1016/j.clae.2013.08.010 Acanthamoeba keratitis Myopia control - what is the best way forward? Brien Holden E-mail address: [email protected]. To stem the rising burden of myopia world-wide, interventions are needed to correct as well as control the progression of myopia. Over the years, there have been optical and pharmaceutical strategies that have attempted to control the progression of myopia. This lecture will bring the practitioner up to date on the theories for
Florence Malet E-mail address: fl[email protected]. Acanthamoeba is free living amoeba. It is responsible for a relatively ‘newly ‘discovered (1973) corneal infection which primarily occurs in contact lens wearers (85% of cases versus 15% non CLW). It is a potentially devastating ocular infection. The disease has become more recognisable in recent years and today a clinical diagnosis is generally achieved at an earlier stage. Acanthamoeba keratitis is
Contents lists available at ScienceDirect
Contact Lens & Anterior Eye journal homepage: www.elsevier.com/locate/clae
Abstracts of the 2013 BCLA Annual Clinical Conference, Manchester, UK
Oral Presentations Diabetes - Front and back Bill Harvey E-mail address: [email protected]. The incidence rates for diabetes and the strong association with sight loss make it a major challenge for all eye care practitioners. Understanding the risk factors, markers and various manifestations of the disease are essential for clinical practice. The traditional two type model of the disease will be explained along with variations suggesting a spectrum of disease model. This talk outlines the nature of the various manifestations of the illness, explains the various markers indicating stability of control that are useful to assess the status of any individual patient (including the HbA1c value), and describes the various non-retinal signs of the disease, including corneal and collagenic, lenticular, vascular perfusion and motility concerns. It will conclude with some general advice eye care practitioners should be ready to offer their patients.
apeutic response in patients with diabetic and other peripheral neuropathies.” http://dx.doi.org/10.1016/j.clae.2013.08.006 BCLA – Vision of the future Shelly Bansal, Nicky Collinson (BCLA Communications Consultant & Web Editor) 2012-13 has been a very exciting year for the BCLA as we put the wheels in motion for some fantastic new developments. At the heart of these is a re-ignition of the BCLA brand, along with a brand new website. We have invested heavily in these new projects, and in some detailed research to give us more insight into our members and conference delegates – and those who have yet to experience BCLA membership. Find out what’s in store for the exciting times that lay ahead for the BCLA. http://dx.doi.org/10.1016/j.clae.2013.08.007
http://dx.doi.org/10.1016/j.clae.2013.08.005
Determining success in myopia control strategies
Corneal confocal microscopy: Beyond corneal defects! Translational studies in diabetes and neurology
Ed Mallen E-mail address: [email protected].
Mitra Tavakoli E-mail address: [email protected]. Diabetic neuropathy, the most common cause of peripheral neuropathy in the world, causes substantial morbidity and increases mortality. It is diagnosed by “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes” and may occur in 50% to 90% of patients depending on the criteria used for diagnosis. Conventional techniques of electrophysiology and quantitative sensory testing along with an assessment of neurological disability offer a relatively robust means of identifying neuropathy. However, there are major shortcomings when these criteria are employed to define therapeutic efficacy in clinical intervention trials. The ophthalmic technique of corneal confocal microscopy has been shown to be an ideal surrogate endpoint for diabetic neuropathy. Over the past 8 years we have pioneered the use of corneal confocal microscopy (CCM) as a sensitive test for detecting early nerve damage, staging the severity of neuropathy and establishing repair of nerves in diabetic patients. These findings have changed the paradigm for diagnosing, following progression and assessing ther-
1367-0484/$ – see front matter
This talk will discuss the potential mechanisms for controlling myopia progression. It will cover the ways in which the effectiveness of myopia control procedures can be monitored. The theoretical aspects that underpin the myopic control strategies currently being attempted will be covered, before handing over to other presenters for detailed material on specific methods of myopia control (including custom soft lens fitting and rigid lens methods). The talk will also touch on pharmacological methods of myopia control. http://dx.doi.org/10.1016/j.clae.2013.08.008 Hard Times Jacinto Santodomingo-Rubido, Trusit Dave E-mail address: [email protected] (J. SantodomingoRubido). The prevalence of myopia has increased substantially in recent decades and has approached 20–50% and 60–80% in the West and far East Asia, respectively. Worldwide, the condition is considered
e2
Abstracts / Contact Lens & Anterior Eye 36 (2013) e1–e15
to be the leading cause of visual impairment. Therefore, finding effective treatment options for the control of myopia progression in children is both appealing and demanding. Several treatment therapies, including pharmaceutical agents; bifocal & multifocal spectacle lenses, and conventional, single vision GP & soft contact lenses have been used with relatively modest success to reduce myopia progression. Overall, most therapies have either limited treatment benefits or there are professional issues with regard to long-term prescribing of pharmaceutical agents. Recently, modern orthokeratology has been shown to be effective in slowing myopia progression in children. The authors will present the latest findings on the efficacy of orthokeratology for the control of myopia progression; how long the myopia control effect lasts; predictors of myopia; the optimal time to initiate treatment, defining acceptable clinic outcomes in ortho-k treatment for myopia control, and why should ortho-k be used as a treatment for myopia control over soft contact lenses. http://dx.doi.org/10.1016/j.clae.2013.08.009 Multifocal orthokeratology associated with rapid shortening of vitreous chamber depth in eyes of myopic children Martin Loertscher E-mail address: [email protected]. Purpose: We investigated short-term changes in peripheral refraction and on-axis ocular biometry associated with a novel procedure, multifocal orthokeratology (MOK). MOK lenses mould a controlled multifocal surface on the central cornea. Methods: Thirty children (10-14 years, mean refraction: −2.71 ± 0.76 D) were fitted with a conventional orthokeratology (OK) lens in one eye and an MOK lens in the fellow eye (randomly assigned). We measured peripheral refractions (every 5◦ out to 35◦ , nasal and temporal) and on-axis biometry (Haag Streit Lenstar LS900) with masking, before lens-fitting (pre-fit) and after a satisfactory fit had been established (post-fit). Results: The mean period between pre and post-fit measures was 26 ± 18 days. Over this time, both eyes developed the same myopic relative peripheral refractions and equal visual acuity. In eyes fitted with MOK lenses there were also significant reductions in vitreous chamber depth (VCD: −0.057 ± 0.02 mm, P = 0.004) and internal axial length (IAL: posterior cornea to anterior sclera: −0.051 ± 0.01 mm, P = 0.013) and an increase in choroidal thickness (CHR: +0.023 ± 0.006 mm, P = 0.001). Eyes fitted with OK lenses showed no significant changes in axial dimensions. Conclusion: We found a rapid reduction in VCD and IAL, accompanied by an increase in choroidal thickness with MOK lens wear, but no significant short-term changes in axial eye dimensions with OK lenses. These findings suggest that the rapid on-axis changes are not caused by refractive changes in the peripheral retina, but rather by the simultaneous myopic defocus in the central retina produced by the MOK lens
myopia control, the strategies employed to control the progression of myopia and the outcomes with each of these strategies. http://dx.doi.org/10.1016/j.clae.2013.08.011 Therapeutics post IP - preparing the peace dividend Nick Rumney E-mail address: [email protected]. IP Optometry has been a reality since 2009 and there are 200 IP optometrists scattered piecemeal amongst the HES, primary care and occasionally in academia. So what’s next? Are we truly independant and autonomous or are we over regulated. Is becoming IP promoted widely enough or is it being presented as, and perceived as, a step too far for most optometrists? Within 5 years of getting IP in Victoria, Australia (closer to us clinically than the USA) over 80% of registered optometrists became therapeutically licensed. In context that would be close to 10,000 in the UK? Why is the perceived lack of remuneration a red herring and why are we content to fit lenses then expect others (A&E?) to pick up the pieces? Will our future role in refractive management demand IP or will we lose the chance? This presentation will inspire you to ignore the doomsayers and ne’er do wells and embrace IP. http://dx.doi.org/10.1016/j.clae.2013.08.012 Contact lens related keratitis: Acute presentation and management options: The Manchester Royal Eye Hospital Acute Services experience Leon Au E-mail address: [email protected]. A prospective study on the initial assessment and further management of patients with Contact Lens related keratitis presenting to the Acute Services at Manchester Royal Eye Hospital.. Other points which will be highlighted are 1. Referral protocols when a patient with Contact lens related keratitis presents to an optometrist 2. How soon would a patient with contact lens related keratitis need to be seen by an ophthalmologist 3. Initial assessment and further management. 4. What type of contact lens related keratitis are referred to a corneal subspecialist 5. What type of contact lenses is more likely to cause contact lens related keratitis according to The Manchester Royal Eye Hospital Experience. 6. How long does it usually take for full resolution 7. Best advice to patients to try and avoid contact lens related keratitis http://dx.doi.org/10.1016/j.clae.2013.08.013
http://dx.doi.org/10.1016/j.clae.2013.08.010 Acanthamoeba keratitis Myopia control - what is the best way forward? Brien Holden E-mail address: [email protected]. To stem the rising burden of myopia world-wide, interventions are needed to correct as well as control the progression of myopia. Over the years, there have been optical and pharmaceutical strategies that have attempted to control the progression of myopia. This lecture will bring the practitioner up to date on the theories for
Florence Malet E-mail address: fl[email protected]. Acanthamoeba is free living amoeba. It is responsible for a relatively ‘newly ‘discovered (1973) corneal infection which primarily occurs in contact lens wearers (85% of cases versus 15% non CLW). It is a potentially devastating ocular infection. The disease has become more recognisable in recent years and today a clinical diagnosis is generally achieved at an earlier stage. Acanthamoeba keratitis is