In Contact - May 2005
Art & Science
A book review in Optometry and Vision Science, February 2005, recently caught my eye. The Fine Art of Prescribing Glasses - Without Making a Spectacle of Yourself, 3rd edition, authored by Benjamin Milder and Melvin M Rubin was reviewed by well known international optometric personality James E Sheedy. Based at OSU, Dr Sheedy is also very much involved in writing and optometry and runs various optometric websites including some dealing with computer vision syndrome and is also active on optometric discussion boards. He also knows a thing or two about the long-lost art and science of progressive spectacle lenses.
Why don't we have lectures on such things at NZ Optometric Conferences? It seems many practitioners want some real optometry, and are tiring of presentation after presentation on glaucoma and path. For this reason it appears many are heading overseas for broader-based CE?
Maybe we need to attend some ADONZ conferences to get more CPD on the fine art of spectacle prescribing?
The authors themselves are no slouches when it comes to track record in writing.
Benjamin Milder has written not only in the eye arena but also poetry and short stories. He even hosts a website dedicated to Tolkien!
Melvin Rubin too has a fine writing pedigree with at least six textbooks to his credit, a background in optometry and ophthalmology and thus a broad range of knowledge on the subject of spectacle prescribing.
As you would have seen from the link, the text consists of some twenty two chapters covering all the major topics and as Jim Sheedy points out, they write in a ?unique, conversational and easy to read? style and understand that behaviour, psychology, patient expectations [and dissatisfaction] play a major role in adaptation to and acceptance of spectacles. Apart from skill and experience, bedside manner and personality are also critical issues, on the part of the prescriber. Are these qualities largely overlooked these days in academic selection criteria for optometry students around the world?
Indeed with the dumbing down of the art of optometry in favour of the science and medical aspects we are seeing a change in younger optometrist?s attitudes toward spectacle prescribing. We see this too in the field of contact lenses where many recent graduates appear to have a significant lack of many practical aspects of contact lenses.
CPD
The relative absence of younger optometrists seemed quite obvious at the recent NZSCLP contact lens conference in Napier. A great pity.
That said there was however a broad spread of delegates, many of who commented on how much they enjoyed the new format of lectures and workshops. We all enjoyed the interaction with optometric, ophthalmology and industry colleagues.
Recent press showed around 50% of recent grads take off to other countries, mostly Oz and UK. We only had a ?baker?s dozen? left in NZ, from the recent batch. One would think that at least a few from recent years would have some interest in contact lenses? One certainly has to deal with CLs in everyday practice.
Great patient care does require continuing development.
Fortunately at least two of our younger optoms showed passion and skill and presented excellent lectures on Orthokeratology [Nisha Jeyaseelan] and Large Diameter RGPs [Richard Johnson] - outperforming many local and overseas speakers in the speaker ratings.
A great effort.
Overall the top slots were taken by ?locals? - the first time I can recall that the top rating was not taken by a visiting contact lens keynote speaker?
Charles McGhee achieved the top score with his talk on Infective Keratitis. Optometrists managed 2nd place, just 1% behind, with a combined presentation in which Mark Andre?, Pat Caroline, Des Fonn and I, participated. This model of presenting cases in a quiz style followed by ?open forum? discussion and management is something we will continue to build on. It was interesting to note how different the solutions to such problems can be. While some suggest ?go smaller and steeper? others within our group suggested ?bigger and flatter?!
You know what they say about guys who drive Big cars and punt Big lenses...
It was great to get input from the audience with skilled clinicians like Paul Rose, John Mountford et al, also contributing positively.
Seven of the top ten slots went to local ophthalmologists and optometrists with two overseas optometrists rounding out the ?top ten? as follows: McGhee, Saks et al, Gray, McGhee, McGhee, McKellar, Caroline, Ormonde, Andre` and Corbett. It was all very close with the top six all within 2%!
I won?t go into much detail on the presentations as this is being covered elsewhere in this issue. It appears that Keratoconus, MK, IK, Therapeutics, Allergy, RGPs, and new technologies, rated highly. Clinical care was an important aspect.
One of the most important take home points I noted was that Daily Disposables [DD] are around 20X safer than silicone hydrogel extended wear [SHEW] as far as MK is concerned and backs-up what I have been promoting in this column for many years.
I fit the majority of spherical patients with Dailies, and by far the majority of my patients are in either DDs or daily wear lenses [high water or si-hy] and when I do occasionally fit SHEW I always promote the 6 night, ?Sunday Lens? philosophy: Where lenses are removed, cleaned and disinfected at least once a week, with at least one night without lenses in situ.
Around 40% of the society membership attended. Many commented positively on the clinical presentations, workshops and venue. Most of the exhibitors and sponsors also seemed pleased.
Many delegates commented that they'd prefer lectures and workshops to be presented in unique time-slots, so as to avoid having to choose between concurrent choices. I also dislike conferences with concurrent sessions as one would sometimes like to attend two excellent options running in the same time slot.
The problem is however that if a conference is run over a week, attendance is poor as It's hard to leave one?s practice and suffer a week of lost turnover.
CPD is expensive. Someone has to pay for it.
On the other hand, three-day, ?long-weekend? conferences do not leave much time for a full lecture programme, workshops, time to visit the exhibitors, activities, breaks, dinners and so on.
Once again It's a question of compromise and balance?
The Napier meeting was also a milestone in that we finally achieved a name change. Back in 1999 when a name change was proposed it was rejected. Contrarily, it now appears to suit the winds of change in optometry and significantly some who opposed it six years ago, actually supported it this time. So the mouthful that was the NZSCLP, is now no more and replaced by the Cornea and Contact Lens Society [CCLS] or officially the Cornea and Contact Lens Society of New Zealand Incorporated.
We also have a new look website.
Congratulations to CCLS President, Trevor Gray for a nice, modern, clean site. Trevor created the basic ?look?. Thanks also to Richard Johnson, Nisha Jeyaseelan and Mike Gale for their input. It certainly needed a new look as the site we created in ?99 had aged.
Web design moves fast.
Grant Watters, often referred to in Auckland as ?a visitor from Hawke?s Bay?, was conference chair and did his home town proud with an excellent meeting. Thanks to the local organisers for some great apr?s CPD food and fun.
After many years, dare we say a decade or two of service to Contact Lenses in NZ, Mr Watties has stepped down from council, as has Dave Robinson. Both have served at least two terms on council and both are former Presidents of the Society.
Thanks guys, you?ll be missed.
Fortunately they were replaced by excellent people in the form of Kevin O?Connor and Richard Johnson. Kevin has been on council before and has experience in putting on great conferences - Wairakei 2003, and Blenheim 2001 - as well as skills in other areas. Richard, as mentioned, is a great presenter with skill and passion for contact lenses and is involved in complex contact lens work at APH and also teaches at the DOVS in Auckland. His abilities will be a great asset, as has already been shown by his work on the new CCLS website.
Welcome.
It was great seeing so many like-minded individuals at the meeting, who share a camaraderie and passion for providing the best patient care. Once again the Society proved that optometry and ophthalmology can work together and in fact relations between the professions in NZ continue to flourish.
Long may it last, as I am told that in the US and elsewhere, such inter-professional relationships are at an all time low, with optometrists being banished from some US ophthalmology meetings, after years of attendance.
A great thank you to all the speakers, sponsors, exhibitors, delegates and organisers for an excellent meeting.
Myopia
The current dramas in NZ Optometric politics were not apparent during the meeting although some private discussions did take place over a few beers. There certainly do appear to be a number of people rather unhappy with all the ridiculous politicking and some overseas guys couldn?t believe that older professionals and some immigrant optoms were being retrospectively ?forced out.? They asked ?What about grandfathering?
Indeed.
I have been informed that one of the greats of NZ optometry had a retirement party in Auckland during April. For a leader in optometry, with an excellent reputation, who?s devoted decades to education, CPD, advancing optometric standards and been at the forefront of professional patient care, all I can say is that it saddens me to see the myopic nature of the current registration criteria.
Skill and experience can in many cases lead to better outcomes than all the mydriatics and BIOs in the world, in the wrong hands.
When will they realise this?
Too late?
I am not alone in my views on this matter.
For more information or any comments email Alan at incontact@optom.co.nz.