A therapeutic focus

It’s amazing what you learn from people who practise optometry in different countries, and this is what always makes Education Destination such a special conference.

Each year, the Southeastern Congress of Optometry International (SECO) can be relied upon to bring world-class speakers, and Dr Eric Schmidt, founder of Omni Eye Specialists, was no exception to this. Add to the mix the best of British therapeutic optometrists, academics, ophthalmologists and industry experts, and you have a compelling weekend of education.

Dr Schmidt opened the programme with an overview of iritis, revealing his management of some complicated clinical presentations, explaining “the more posterior the inflammation, the more likely a [systemic] cause will be found.”

The event then split into two streams, one for therapeutic optometrists and the other aimed at those considering therapeutic qualification. Independent prescriber Jane Bell and University of Bradford lecturer Dr Andrew Logan, showed us the path to therapeutics and where it might lead, with a discussion about university courses, arranging your clinical placement and what to expect from the final assessment. The take home message? Get to know the College of Optometrists’ clinical management guidelines early on in your training.

Later, Dr Schmidt showed us his current methods for treating severe dry eye disease, creating autologous serum tear drops by centrifuging the patient’s own blood to produce a serum rich in platelets and growth factors, in order to promote healing. It seems Restasis (cyclosporine 0.05%) is widely used in the US to treat inflammatory dry eye with good results, although it can take months to make a difference. He also showed us how he uses an amniotic membrane to shield a damaged cornea, allowing rejuvenation of the corneal surface.

"Acanthamoeba keratitis is often a case of missed diagnosis or mis-diagnosis. It does not always show in culture or with confocal microscopy, and it does not always hurt as much as I previously believed"

Studies using functional MRI (fMRI) have identified a region of the brain which responds strongly to faces but not other objects. Dr Andrew Logan talked about research concerning the neurological condition prosopagnosia (face-blindness) and the dreadful social consequences. Imagine being unable to recognise a family member because they have changed their jacket. It’s incredibly helpful to these patients if optometrists wear name badges.

Scott Hau, a principal optometrist and research associate at Moorfields Eye Hospital, explained that Acanthamoeba keratitis is often a case of missed diagnosis or mis-diagnosis. Acanthamoeba keratitis can masquerade as a herpes infection because it can produce dendritic lesions in the cornea. It does not always show in culture or with confocal microscopy, and it does not always hurt as much as I previously believed.

The infection may be quite rare, but it is a life-changing event when it happens. Furry taps in hard water areas increase the likelihood of infection, and Mr Hau said that patient education is paramount on the danger of tap water and contact lenses.

Dr Schmidt closed the conference with a discussion about glaucoma management and using optical coherence tomography in diagnosis. He described a definite trend towards earlier selective laser trabeculoplasty (SLT) in the US. He explained that some drops work better than others to control the intraocular pressure spike during the night and urged clinicians to stress the importance of compliance to their patients.

London Education Destination is an event organised by the AOP in partnership with SECO International, an educational organisation based in Atlanta, US. The 2016 event will take place in October.