Dec 2015

Packed conference for Eye Institute
Eye Institute’s 11th Annual Scientific Conference
was another record-breaker with more than 320
optometrists and, for the first time, dispensing
opticians and support staff attending.
The inaugural, parallel dispensing opticians and
support staff conference (see separate story) filled its
room at Auckland’s Waipuna Hotel and Conference
Centre, while the main auditorium rippled with life as
optometrists attended a series of sharp, 15-minute
sessions from the Institute’s ophthalmologists and
special guest, Margaret Lam, of theeyecarecompany,
award-winning Sydney-based practices and specialist
contact lens (CL) provider.
The exhibitors’ hall and refreshment area also
teemed with life during the breaks as sponsors (see
box) caught up with all the news about the New
Zealand optical scene and delegates discussed the
new products on offer.
CL nous to grow your practice
Lam, who’s also state president of the Cornea
and Contact Lens Society of Australia, kicked off
the proceedings with an update on keratoconus
management, explaining that it is challenging to
get right, but also rewarding. “Patients literally have
sight restored they thought they had lost,” she said.
This was the first of three talks Lam gave through
the day, all designed to show how important and
rewarding (financially, personally and for patients)
it can be if optometrists develop expertise in
speciality CL management.
Her presentation, From little things, big things
grow–practice growth strategies, summarised a
number of case studies showing what a difference
optometrists can make to their patients with better
CL understanding and how that can boost referrals,
increase loyalty and so grow your practice.
In her Ocular therapeutics and contact lenses–
two peas in a pod talk, Lam provided a case study
on microbial keratitis, and gave some insight on
how to spot it. This included: sore, irritated eyes
during waking hours; round focal central corneal
lesion with indistinct, roundish borders with
positive NaFl staining; photophobia; lid oedema;
profuse epiphora; diffuse extensive conjunctival
hyperaemia; and worsening or non-improvement
of symptoms after the patient stops wearing CLs.
Tina Gao, Renita Martis, Nafisa Slaimankhel and Teresa Hsu
Treatment is with topical antibiotic and/or referral
to an ophthalmologist.
Drugs side effects, cataract surgery and AMD
The first of Eye Institute’s ophthalmologists to
take the floor was Dr Shanu Subbiah who outlined
possible ocular side effects of commonly prescribed
systemic medications. This is especially important
for older patients, he said, who are often prescribed
several drugs simultaneously which together can
throw up any number of side-effects.
The number of drugs that can cause ocular side
effects is enormous, said Subbiah. More common
ones, however, include: hydroxychloroquine
(Plaquenil) used to treat malaria and certain autoimmune
diseases, which can cause retinal toxicity
and is often characterised by the “flying saucer sign”;
bisphosphonates, used for osteoporosis, which can
cause a range of “-itis’s” including conjunctivitis,
uveitis, episcleritis and scleritis, but these should get
better if the patient stops taking the drugs; fingolimod
(Gilenya) for multiple sclerosis, which cause macular
oedema in about 1% of cases; and sildenafil (Viagra),
the infamous little blue pill that can cause users to see
everything with a blue tint (cyanopsia).
Later in the day Subbiah tackled Cataract surgery
in the presence of retinal disease, explaining how
one influences the other, and concluding that
patients shouldn’t hesitate to remove cataracts if
they have AMD (age-related macular degeneration)
as it’s often essential to allow the continued
management of their retinal disease.
DED and spotting retinal detachment
Dr Peter Hadden provided an overview of
Amy Royal, Chloe Lovell and Angeline Ng
diabetic eye disease, the extent of the problem
in New Zealand and how it damages the retinal
vasculature causing macular oedema. At minimum,
diabetics should be screened every two years; those
with mild diabetic retinopathy (microaneurysms,
a few dot and blot haemorrhages and mild lipid
exudates) should be reviewed every six months
to a year, while moderate to severe patients
(more extensive changes, plus any venous loops,
beading or other vascular abnormalities) should
be “semi-urgently” referred to an ophthalmologist.
Treatment is by intravitreal injections, usually
with Avastin as Eylea is still too expensive in New
Zealand, he said.
Hadden’s other session on the peripheral retina,
discussed what was important when doing a retinal
examination and what wasn’t. When it comes to
increasing the risk of retinal detachment, benign findings
include cystoid degeneration, paving stone or cobblestone
degeneration, reticular pigmentary degeneration,
equatorial drusen and choroidal or pigmentary
degeneration. Things optometrists should be on the
lookout for, however, include lattice degeneration, snail
tracks (which may be a variant on lattice degeneration),
retinoschisis, retinal tags, horseshoe tears and snowflake
vitreoretinal degeneration.
PDS and glaucoma myths
Professor Helen Danesh-Meyer discussed
pigment dispersion syndrome (PDS), which can
lead to pigmentary glaucoma when pigment cells
slough off from the back of the iris and float
around in the aqueous humour. Those who get it
tend to be young, caucasian myopes, usually male.
Optometrists should identify patients who are
Gary Crowley, David Roberts and Diane Pearson
A surprised Maryanne Dransfield, former publisher of
NZ Optics (now editor-at-large), receives flowers from
Eye Institute’s Dr Trevor Gray to say thank you for her
dedication to the NZ industry over the past 35+ years
“actively dispersing pigment or have blurred vision
during exercise” and monitor them carefully as it
can lead to glaucoma and retinal detachment.
Prior to lunch, Danesh-Meyer also tackled normal
pressure glaucoma, stressing the term needs to
be killed off once and for all as it “is a meaningless
statistical construct that has done more to confuse the
diagnosis and management of primary open-angle
glaucoma than it ever did to enhance it.”
Typical intraocular pressures (IOPs) can vary from
day to day, at night and when we lie flat, she said.
“IOP is a risk factor that varies in importance for
each individual person.”
Scleritis clues, marginal keratitis and laser
review
Dr Peter Ring explained how scleritis can be a
sign for all sorts ailments, including auto-immune
and metabolic disorders and a variety of bacterial
infections. Symptoms include moderate to
severe pain, often deep and boring, and waking
the patient in the morning; redness of the eye;
CONTINUED ON P18
Looking forward to seeing you
for bigger and better next year at our half day workshops on Saturday 5th of Nov
and our Sunday conference on 6th Nov 2016
December 2015
NEW ZEALAND OPTICS
5
December 2015.indd 5
19-Nov-15 3:26:53 PM