In Contact - April 2004
11th ICLC ? Cypress Lakes
Although attendance figures were way down at the 11th ICLC meeting, it was still a great meeting. In fact a number of delegates commented that lower numbers actually meant better networking and a more intimate meeting. Content and speakers were, as expected, top quality. Although our NZ model of NZSCLP meetings is moving toward a more clinical style, the majority of presentations at the ICLC were of a more academic bent. For many delegates that was fine. There were however some excellent clinical presentations. We certainly heard a lot of leading edge stuff and were presented with new and future technologies and alternative ways of doing things.
O2: Enough Already?
Research is pointing toward a need for ever higher levels of Dk. New and future products are indeed delivering the goods. The Menicon Z RGP got a lot of mentions as a high Dk design - with advanced surface, optics and design. 100Dk materials are now really the de facto standard. New materials are now around with superior wetting angles and Dk in the 125 to 200 range. One example, recommended by an independent US based RGP manufacturer, was the Contamac Optimum range. They offer a 125 Dk lens with a remarkable 6? degree wetting angle with UV block and a range of tints. I haven?t tried it yet but CLC promises we?ll have some blanks very soon.
As I've often said, for more than twenty years, always aim for the highest level of O2 transmission that you can. I've had a few colleagues disagree with me on this but today it seems target Dk is well over 100 units and in fact now seems to be in the 125 to 300 unit range. Again we were told HEMA is not good enough, nor are low Dk RGPs.
MK, OK and EW.
MK [Microbial Keratitis] incidence, although dramatically reduced, can still occur and it's not all oxygen related. It seems for pseudomonas to penetrate the cornea the physical presence of a contact lens is still an issue as merely inducing hypoxia with reduced oxygen levels [as with nitrogen goggles] does not make the cornea as vulnerable as in the case of a lens on the eye. We heard about complex issues and how spectacular technology can actually trace the path of a microbe into the cornea in a form of ?raft?. Technology in practice is also evolving at an ever increasing pace. It was both interesting and great to hear that the Australian developed Medmont Topographer is now the instrument of choice for local and US based Ortho-K [OK] and CL specialists. They rate it very highly. This is impressive considering that some of these contact lens gurus have access to all the leading instruments and are indeed consultants to some of the alternative topographer manufacturers. For us downunderdwellers the Medmont is incredible value. The downside is that there is apparently such demand for the E300 that buyers now have to wait months for supply. There was a lot of coverage of OK and many great presentations. Australian OK specialists are certainly at the leading edge and enthusiastic promoters and unselfish teachers. I felt it was given more coverage than its current or potential market penetration would justify and I am still not convinced It's a modality I personally wish to practice. Among other things, the dramatic epithelial thinning, as demonstrated, concerns me.
When performed with enthusiasm, commitment, skill, precision and quality care it appears to work very well and is an excellent practice builder, even in kids. There were however some alarming statistics from Asia where it seems there are way too many red eyes, infections, complications and even a few MKs. Research seemed to indicate that there were multiple reasons for this which included poor fitting, design, materials and manufacture. Hygiene and aftercare were also mentioned along with other lesser factors.
The danger of this is that when the press gets hold of this ?bad news? it bags all forms of OK. We know how bad press killed old style EW. Modern OK means overnight wear and thus it could also reflect poorly on the new style of Si-Hy EW.?
Of course that was another topic well covered. Although there was not much news, experience of five years and more tells us that risk of serious complications are less than for refractive surgery. We do however need to be ever vigilant and through proper care and management prevent or pre-empt serious problems. As we suspected early on, CLPC or GPC is a problem and CLPU and MK are still a risk. Although rare they still can occur. We know regular aftercare, compliance and a thorough examination of the cornea, including lid eversion, are paramount.
The Market
As usual ?market penetration? of contact lenses was well debated and in fact nothing has really changed. The Aussies [≈5%] still hate the fact that NZ [≈9%] has double penetration as far as contact lens usage is concerned. It also appears that no matter what the marketers do, these figures are pretty static. For those that were paranoid that LASER refractive surgery would kill optometric practice, they can feel a little more relaxed in that only 1% of Americans have had LASER refractive surgery and it seems that it is not growing either. It would appear that the pool of prospective patients is not only smaller but is limited to roughly those people between around 21 to the late thirties. After that Presbyopia is an issue and some surgeons reckon it should not be preformed on people over 60 as their eyes respond differently - nor under-21 - due to issues of progression and so on. So you can put away the Prozac and get out the old slit lamp. One respected Kiwi surgeon also mentioned that when he is ?qualifying? prospective LASIK patients by asking if they have tried Si-Hy EW, by far the majority state that their practitioner never offered or discussed that alternative with them. Even if he suggests that they try it most are not interested as by that stage they are already committed, in their own minds, to go ahead with LASIK and just say ?Where do I sign?.?
For proactive practitioners, the take home message is offer your patients all the options, particularly EW, before they are prostrate under the LASER gun.
Earlier I mentioned the technological leaps us practitioners are faced with. Checking out the technology being used and developed by researchers is frankly awesome. Watching videos of leucocytes migrating from conjunctival vessels, through the limbus - like a column of marching soldiers - to ?exposed? stroma at LASIK flap junctions was awesome, as were a host of other technological, measuring and imaging tools.
The ?true? accommodating IOL is also showing promise but hurry please, my arms are getting ever shorter!
Unfortunately space limitations this month do not allow me to mention all the names of the great speakers we heard, nor discuss many other issues covered, but in time I will make a point of highlighting and featuring some of their work and publications.
Thanks
Likewise I cannot personally thank all the presenters, sponsors and organisers. However, and I think I can speak on behalf of the majority of Kiwi delegates and most others, we had a great meeting that ran pretty smoothly and as always we were treated to the renowned Aussie hospitality, great food and environment. Trevor Gray, officiating in his role as President of the NZSCLP and Charles McGhee ? the only NZ based presenter - kept the flag flying. Even though there were less than 20 Kiwis present, we were still around 17% of paying delegates.
Much learning was achieved, not to mention networking and interaction with industry. We saw good friends and colleagues, made many new ones and met some truly great people. Of course a lot of fun was had. As it should.?
Work hard, play hard.
Thanks to all involved. We know how much hard work goes into putting together a meeting of this calibre.
Home Town Advantage
I'm a lucky guy. I get to go to great conferences, have a great practice and colleagues and it seems if my current home team are not performing, then my former home team steps up to the plate.
Have you seen the super 12 log? Go Bulls! Likewise Shumy?s had a great start to the F1 season.
Cheers
For more information or any comments email Alan at incontact@optom.co.nz.