British Contact Lens Association

29 November 2011

A total of 250 members of British Contact Lens Association (BCLA) earned up to four contact lens CET points each at the Association’s 8th Pioneers Conference, held at the Royal Society of Medicine in London on 23 November.

A free half-day CET event for BCLA members only, who may bring one guest each to the evening Pioneers Lecture, this year’s Pioneers Conference featured a special commemorative presentation to mark the 50th anniversary of the invention of soft contact lenses. Other sessions focused on keratoconus management and practice matters, while the 8th Pioneers Lecture, entitled, ‘Beyond the corneal borders’, was delivered by renowned contact lens educator and researcher, Dr Eef van der Worp (pictured right).

Nigel Burnett Hodd, Honorary Pioneers Conference Organiser, commented: “This year's Pioneers Conference felt like the best ever. With Eef's help, and some great speakers, we had the perfect balance of topics pertaining to everyday practice yet of interest to all BCLA disciplines.

“The day would not be possible as a free membership benefit if it was not for the generosity and enthusiasm of our eight educational sponsors – the BCLA, CIBA Vision, CooperVision, David Thomas Contact Lenses, Johnson & Johnson Vision Care, No7 Contact Lenses, Sauflon and Topcon – and time donated by the speakers,” continued Mr Burnett Hodd. “The sponsors willingly turned out on the day to run their stands and were rewarded with 250 enthusiastic Pioneers delegates. As organiser, I was thrilled with the turnout and the enthusiastic response from an eager audience. I hope to do just as well in 2012 and would appreciate any topic suggestions from BCLA members.”

Conference report

Kicking off the conference were Tim Bowden and Andrew Gasson with their talk, ‘Soft contact lenses: the first 50 years’. From where it all began – on Christmas Eve 1961 when Professor Otto Wichterle built a machine using a meccano set, a bicycle dynamo and a bell transformer to create the world’s first contact lens on Christmas Day – the speakers compared packaging, patient instructions, lenses, care solutions and clinical problems from the 1960s and 70s with their modern equivalents. Although lenses from the 1970s improved comfort, explained Tim, they created new clinical problems – such as giant pupillary conjunctivitis and microbial keratitis. One of the main things we had learnt over the past 50 years was that there is no one lens for everyone, they concluded.

The first speaker in a session entitled, ‘Focus on keratoconus et al’ was Dr Bruce Allan, Consultant Surgeon at Moorfields Eye Hospital, who outlined the latest approaches to managing keratoconus – which he said affected one in every 2,000 people worldwide. The aim was to stop people from travelling down the clinical pathway, through shape stabilisation and visual rehabilitation. No intervention was risk free and the redefinition of pathways for treating keratoconus remained incomplete, said Dr Allan. Funding was an issue for corneal collagen cross-linking (CXL), despite evidence that it worked.

Next, Consultant Ophthalmic Surgeon, David O’Brart, spoke in more depth about CXL and other treatments. He cited his recent study with colleagues at St Thomas’ Hospital, London, published in the British Journal of Ophthalmology, which concluded that CXL appeared to be an effective and safe modality to halt the progression of keratoconus. The future, predicted Mr O’Brart, would see accelerated CXL with higher doses of UV but for a shorter period, CXL without UVA, and bullous keratopathy and corneal melts to treat keratoconus. “CXL is safe, effective and should be considered for any patient – and it should be on the NHS now,” concluded Mr O’Brart.

Dr Sheraz Daya, Director and Consultant at Queen Victoria Hospital and Founder and Medical Director of Centre for Sight, London, followed this up by looking at when to operate and with what procedure. Dr Daya gave an overview of new procedures to treat keratoconus, such as Intacs and Ferrar rings. Corneal grafts could be delayed and avoided if we could indentify and treat keratoconus earlier, concluded Dr Daya.

The final speaker in this session was 8th Pioneers Lecturer, Dr Eef van der Worp, who focused on contact lens options for the irregular cornea. He explained that 10-25 per cent of patients would eventually need surgery, but that contact lenses would always be required before or after. “Surgery can be prevented by using our lens arsenal,” he said. This included soft lenses, piggyback and hybrid lenses, and RGPs, which were the best option. Scleral lenses were the future of fitting the keratoconic eye, concluded Dr van der Worp. A discussion followed during which the issues of treatment funding, and routine optometric screening of younger patients for keratoconus, were raised.

Many take-home pearls were relayed during the conference’s Practice Matters session, with speakers Craig Wilcox, Dr Katharine Evans (pictured right with delegates), Ian Cameron, Keith Cavaye and Sarah Morgan touching on patient communication, empowering support staff, rules and regulations, practice profitability and predicting successful contact lens wearers. In her talk, Dr Evans advised delegates to promote compliance not just in terms of infection risk, but in terms of comfort, and to consider the implications of a healthy tear film and lipid layer on contact lens wear success.

The audience heard from BCLA Council member, Keith Cavaye, that practitioners were obliged to inform patients of the risks of microbial keratitis with extended wear lenses, and that aftercare appointments should be carried out every 12 months. In terms of verifying patient specifications with internet suppliers, Mr Cavaye told delegates that a simple ‘yes’ or ‘no’ would suffice. A lively debate followed, including whether optical assistants should be delegated tasks such as teaching lens insertion and removal, as advocated by staff development consultant, Sarah Morgan.

The evening session began with a Pioneers Update by Tim Bowden, after which Dr Eef van der Worp shared his expert knowledge on scleral lenses in his Pioneers Lecture, ‘Beyond the corneal borders’. Dr van der Worp explained the findings of the Pacific University Scleral Shape Study, which found that the shape of the limbus and the anterior sclera was frequently tangential rather than curved – and that most eyes were non-rotationally symmetrical in nature beyond the corneal borders. This may call for non-rotationally symmetrical lenses, such as toric and quadrant specific lenses, he told delegates.

“There is a bright future for scleral lenses if we become confident about fitting them or referring our patients to someone who can,” concluded Dr van der Worp.
 
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