Latest Trends in Myopia Management, Prof Mark Bullimore (USA)
In recent years, effective optical and pharmaceutical therapies have been developed and validated that can slow myopia by meaningful amounts. Likewise, the prevalence of myopia is increasing and its role in uncorrectable visual impairment has become clear—around one third of all uncorrectable visual impairment can be attributed to myopia. High quality evidence continues to emerge from rigorous clinical trials with multiple years of data, good retention of subjects, concurrent controls or placebo, masking (when possible), and objective outcome measures: optical biometry and cycloplegic auto-refraction. Quality of vision is good and safety is satisfactory. Thus, practitioners have a growing portfolio of therapies that allow them to tailor management to a child’s lifestyle and address safety concerns.
The Genetic Architecture of Myopia : The Born in Bradford Study, Dr Neema Ghorbani Mojarrad (UK)
Myopia is a complex refractive error, with both genetic and environmental influences. Understanding the genetic structure of myopia is useful as it can allow us to understand the different biological mechanisms involved, as well as estimating the predisposition that people have towards becoming myopic. Born in Bradford is a large children’s study, with one of the most diverse cohorts in the UK, consisting of children aged between 12-14 years old. Previous vision data has been collected, along with genetic data from the children and their parents. Because of its diverse nature, this cohort would allow for the discovery of new genetic associations, along with the ability to investigate children’s visual development during a critical period.
In this talk, the genetic influences of myopia will be described and explained, along with what we currently understand about the performing genetic prediction for myopia. Results for preliminary genetic analyses for refractive error and myopia in the Born in Bradford dataset will also be shown, with differences between the different major ethnicities in the sample.
Fit is Everything – Frame and Lens Positioning in Myopia Management, Dr Alicia Thompson (UK)
Myopia control spectacle lenses, along with any type of spectacle refractive correction or intervention is only effective if the frame that holds the lenses is at the correct position in front of the eye and is comfortable and safe for the wearer.
For all patient groups being able to see clearly from an effective dispense is extremely important in daily life, however, for paediatric patients it is potentially life-changing as a successful intervention or correction can impact on their long-term vision, educational achievement, career opportunities and social development.
The majority of paediatric frames are produced as a smaller version of an adult design and while they may hold cosmetic appeal with the use of designer brands and popular characters, the resultant fit is often far from satisfactory in terms of holding the lens in a stable and appropriate position as well as lacking the ability to physically adjust the frame to fit a child’s face.
Achieving both stability and comfort from these small adult frames is unlikely as the parameters of a young child’s face are not that of a small adult. For example, from birth the wide, flat and relatively low position of the nasal bearing surface dictates the same wide, flat and low bridge requirements in a spectacle frame design. Dispensing a small adult frame results in the bridge sitting too high with little or no contact causing the frame to slide forward until it finds anchorage, usually at the nasal bulb. This element alone can cause the child to look over the top rim of their frames, an all-too-common sight.
This session will explore facial development and the various facial parameters that should be considered when designing spectacle frames for children based on a recent anthropometrical study. Three-dimensional stereophotogrammetry was employed to capture images in a rapid, non-invasive manner. Fifteen paediatric facial measurements associated with spectacle frame parameters were measured using custom software in a sample of 1349 images of children observing differences in gender, ethnicity and Down’s syndrome.
Myopia Management: the Opportunity and the Imperative, Dr Kate Gifford (Australia)
Myopia management has been declared as standard of care for children with myopia, which requires the optometrist to discuss risk factors, review regularly and take active steps to prescribe treatments which slow myopia progression. The past handful of years has seen enormous growth in the research support and industry innovations for myopia control treatment. In this lecture, an overview of the clinical imperative for myopia management will be provided, translating the science into guidelines for patient care. Then, steps to take in setting up practice systems and training the team will be detailed, along with resources to support marketing and communication with parents and patients.
AI to Monitor and Predict Myopia Progression, Dr Li Lian Foo (Singapore)
Our study aims to identify children at risk of developing high myopia for timely assessment and intervention, preventing myopia progression and complications in adulthood through the development of a deep learning system (DLS). Using a school-based cohort in Singapore comprising of 998 children (aged 6-12 years old), we trained and performed primary validation of the DLS using 7456 baseline fundus images of 1878 eyes and external validation using an independent test dataset with 821 baseline fundus images of 189 eyes together with clinical data (age, gender, race, parental myopia and baseline spherical equivalent (SE)). We derived three distinct algorithms – image, clinical and mix (image + clinical) models to predict high myopia development (SE ≤ -6.00 dioptre) during teenage years (5 years later, age 11-17). Model performance was evaluated using area under the receiver operating curve (AUC). Our image models (Primary dataset AUC 0.93-0.95; Test dataset 0.91-0.93), clinical models (Primary dataset AUC 0.90-0.97; Test dataset 0.93-0.94) and mix (image + clinical) models (Primary dataset AUC 0.97; Test dataset 0.97-0.98) achieve clinically acceptable performance. The addition of 1 year SE progression variable had minimal impact on the DLS performance (clinical model AUC 0.98 versus 0.97 in primary dataset, 0.97 versus 0.94 in test dataset; mixed model AUC 0.99 versus 0.97 in primary dataset, 0.95 versus 0.98 in test dataset). Our DLS allows prediction of the development of high myopia by teenage years amongst school-going children. This has potential utility as a clinical-decision support tool to identify “at-risk” children for early intervention.
Repeated Low Level Light Therapy: An Alternative Myopia Control Strategy, Prof Mingguang He (Australia)
Repeated low-level red-light therapy has been proposed as a new method to control myopia progression. It is delivered by an at-home desktop device, emitting red light through semiconductor laser diode, under parental supervision. This lecture will present the most up-to-date information on the treatment, evidence on clinical efficacy and safety, as well as possible mechanism of the therapy.
Potential Environment-Based Strategies for Myopia Prevention and Control (AEIR Eye Hospital study) Professor Weizhong LAN (China)
Rapid increase of myopia prevalence in the past decades indicates environment plays a significant role in myopia pathogenesis. Modifiable factors of environment might include outdoor time, viewing time/distance/pattern of nearwork, light intensity, spatial frequency spectrum of viewing field, etc. The talk will discuss the attempts to modify these environmental factors for myopia prevention and control.
The Changing World of Low Vision?, Helen Whitaker (Canada)
Sight loss is a major challenge around the world, both to the individual in terms of reduction of quality of life and independence and to society at large in terms of loss of income generation, costs of care and costs of (re)habilitation. Most causes of sight loss have age as the main risk factor. Increased life expectancy has led to sight loss having a greater prevalence in an increasingly digitised and communication-based world where visual input is the key to full participation.
Traditional approaches to low vision assessment have included the assessment of a patient’s visual needs and expectations (commonest disabilities include difficulties in reading, mobility, face recognition, domestic and work/hobby tasks), assessment of the best corrected acuities and the prescribing of optical magnification and non-optical contrast and locational assistance. Such assistance has optical limitations (field of view, distortion, adaptation challenges, limited target enhancement and so on).
The advent and wide availability of electronic systems capable of easy-to-use target presentation and adaptation (e-readers such as Kindles) and target capture and enhancement (tablets and smartphones with cameras or dedicated apps) has clearly demonstrated that many patients currently using or about to be prescribed traditional optical aids will benefit from (and indeed prefer) to use the electronic system instead. This is usually related to better image enhancement options, ease of use, portability, accessibility and increasingly, cost (might use hardware the patient already owns.
The development of dedicated systems (adaptive rather than the assistive adaptation of tablets and smartphones) has continued apace recently, from desktop and portable image/video magnification systems (EVES), electronic reading and OCR systems, to the very latest head-worn visor systems able to combine image and text recognition software, image enhancement, augmentation or even VR capability, and support this with audio/vibrational inputs. Add to this the options of Wi-Fi linkage and access to the internet, and such a device might be proposed as a highly sophisticated remedy for sensory deficit.
Key Points
What patient pathways are currently in place for managing patients with Low Vision?
What new models are being explored within Canada ?
What are the different types of modern alternatives to traditional optical low vision aids?
How can patients be helped with adapting widely used existing technology?
How can we educate ourselves to utilize every available free resource for patients?
What is the Vision for managing Low Vision?
Eyecare Professionals Role in Reducing Fall Risks in Older People, Ass Prof Alex Black (Australia)
Falls occur in about one third of older people living independently in the community every year. This can lead to significant physical, psychological and financial costs to the individual and the community. While the risk factors for falls in older people are multifactorial, visual impairment is considered to be an important contributing factor. The visual system provides one of the key sensory inputs for the control of balance, and assists in the identification of obstacles and hazards to guide appropriate navigation planning and accurate stepping.
This presentation will provide eyecare professionals with a current overview of the importance of vision in preventing falls, along with recommendations regarding how to best manage their older patients to minimise the risk of falls. Participants will be given practical, evidence based advice regarding prescribing for high-risk fallers, guidelines for prescribing large changes in refractive error, and considerations when prescribing following cataract surgery.
Sports Vision – Improving Patient Performance, Michelle Beach (UK)
Sport and exercise should be a fundamental part of our everyday lives. Particularly today, following COVID-19 and with a huge increase in diabetes, vascular disease and myopia globally, Eye Care Professionals should be encouraging their patients to see sport as an essential part of our health and well-being. But, in reality, how many Optometrists are regularly factoring this into their patient examination and dispense? Arguably, not enough.
All sporting decisions are made from visual cues and could mean the difference between; a win or a lose, a precise tackle or a penalty, safety or injury. Sports Vision goes far beyond understanding what you can see on a letter chart. It takes an in-depth look into the aspects of your vision that matter most when playing sport, including the speed and accuracy of focus, eye dominance, the stability of your visual system, and peripheral awareness - offering a total view of the efficiency of your vision. The ‘Sports Vision Assessment’ involves a multi-faceted approach of binocular harmony, eye health, psychology and a great relationship between the Optometrist, Dispensing Optician and athlete.
This presentation will address the key elements of a Sports Vision Assessment, including the multiple steps involved when screening a team and translating this into a written team report. This presentation will draw on and discuss an array of case studies involving elite athletes as well as an understanding of how to help the “normal patient” - bringing Sports Vision to your practice.
Occupational Dispensing – Eddie’s New Prescription Fiona Anderson (UK)
Improving Quality of Life for People Living with Dementia Through Patient Centered Care, Elaine Grisdale (UK)
Every 3 seconds, somewhere in the world, someone develops dementia (Alzheimer’s Disease International). This presentation is about understanding dementia better and developing initiatives to be able to serve our patients well. As primary care actors it is important that we are aware of the best ways to manage the eyecare needs of people living with the condition. We should be interested professionally but one day, the information in this talk may be of value personally as well. The chances are that we know someone with dementia. That person may be a relative, a friend, a colleague or more probably a patient.
Worldwide, the population of people aged 60 years and over is predicted to double by 2050 (United Nations, 2017). The population increase, coupled with an increasing prevalence of dementia suggests that the > 60 demographic, seeking eye-care services in the future, risks being affected by this shift. Worldwide, there are 50 Million cases (Alzheimer’s Disease International, 2020) leading the World Health Organisation (WHO) to describe dementia as “one of the major health challenges of a generation” (WHO, 2015).
In Singapore, an estimated 10% of the population who are 60 years and above, are living with dementia. In the Well-being of the Singapore Elderly (WiSE) nationwide study, the prevalence of dementia was found to be 30,000 in 2010 with predictions to increase to 53,000 in 2020 and 92,000 in 2030 due to the rapidly ageing population.
The Dementia Awareness Monitor in the UK (Alzheimer’s Research UK) revealed that more than half (52%) of the UK public know someone who has been diagnosed with dementia.
Dementia is an umbrella term for different diseases which result in a loss of cognitive function, leading to an erosion of everyday thinking skills and sometimes memory (Alzheimer’s Association, 2021). The loss in brain function usually happens in later life for a variety of reasons, although it is not classed as age-related. This means that the numbers of people with dementia seeking help in ophthalmic practice, not only for simple refractive error but also for age related ocular pathologies, will increase. Optical professionals can help improve the quality of life of people living with dementia and this presentation will help with initiatives.
Primary Care in Optometry – International Update and Future Perspectives, Dr Cindy Tromans (UK)
In 2019 the World Health Organisation published the World Report on Vision which sets out the scale of world wide visual impairment and the significant inequities that exist with access to vision care.
In this presentation I will cover the highlights of the report and what conditions can be effectively managed in primary care. I will discuss the opportunities and challenges for delivering primary care optometry including recognition and legislation of optometry as an autonomous primary health care profession.
Future perspectives will include integrated eye and the impact of digital health on primary eye care delivery.
Ageing Well with Good Eyesight: See Well Think Better, CUI Wen Juan (Singapore)
Longevity is traditionally considered a blessing. However, many people associate it with aging, and with it, vision and health problems that become a burden.
How can optometrists help people, regardless of age, to change their perspective of aging, preserve sight that enhances quality of life and give timely intervention against avoidable blindness?
This talk will highlight how the community-sited optometrist can be empowered to play this important role.
Big Data and Artificial Intelligence in Optics, Grant Hannaford, (Australia)
Ophthalmic optics has long been an area in which developments in computational techniques have found rapid applications. This talk examines core concepts and techniques in the application of big data to models implementing machine learning and artificial intelligence. From a foundation of linear regression and iterative models we discuss general cases which demonstrate a common pathway used in machine learning. This process is then developed in the context firstly of lens design optimisation, then postural integration into lens design, and the incorporation of large biometric data sets into normative sets for the application of biometric data to lens designs. Finally we will discuss some of the risks contained in the implementation of machine learning in lens design, and some of the legal and ethical framework surrounding these techniques and applications.
In this presentation the registrants will achieve the following learning outcomes:
- The core principles behind iterative machine learning models
- Observe the structure of a sample machine learning model in a medical application
- Develop an understanding of the scale of available data sets and the inability of traditional linear regression statistical modelling to provide usable outcomes
- Sample applications of AI and machine learning in lens design optimisation from industry examples
- Sample applications of AI and machine learning in the application of postural and gaze modelling into lens design
- Demonstrate the application of AI and machine learning in the development of refractive error and biometric normative models
- Observe the application of these models to lens designs
- Appreciate the pitfalls in constantly updating data from AI and potential data skew and drift from outliers due to poor data
- Discuss the legal requirements for output verification and some examples of legal frameworks controlling applications of AI and machine learning in the ophthalmic lens industry
Developing Patient Loyalty in a Professional Way, Steven Caunter (NZ)
Paediatric Prescription Analysis, Fiona Anderson (UK)
The Optical Shop of the Future, Jean Philippe Sayag (France)
Size Matters – Taking Measurements for a Hand Made Frame, Dr Alicia Thompson (UK)
Creating a Sustainable Optometry Practice, Elaine Grisdale (UK)
In this fast-paced session, Elaine Grisdale (UK) of the Association of British Dispensing Opticians will take you through why the climate crisis means there is a compelling call for every optician and optometrist to make changes in their practice, and how to do this. You will learn more about the background to the current climate issues, and how to make a plan to lower your practice carbon emissions, looking at issues including waste, procurement, travel and utilities. This talk will help you to involve all the practice staff, and be packed with useful resources to help you make a change.
New Frame Materials and Their Eco-Credentials, James Conway (UK)
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