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Sound bytes from academy 2017, Chicago

The four-day American Acady of Optometry Annual (AAOA) National Meeting is an opportunity to welcome new fellows, share research and clinical insights, and catch-up with old friends. This year, the event was held at McCormick Place, Chicago. The education programme was intensive and diverse, with attendees given the choice of up to 16 concurrent workshops, sinars or symposiums at any given time.Acupuncture for myopia control?In ‘OD Scrabble: Scientific Evidence vs Pseudoscience in Clinical Care’, Drs Agustin Gonzalez and Joseph Pizzimenti discussed how to take an evidence-based approach to delivering clinical care when being presented with apparent pseudoscience.Pizzimenti recounted an encounter with a patient from out of state who reported that she had been getting acupuncture for myopia control and asked him whether he could continue to provide her with this service.{{quote-A:R-W:450-Q: 10 calories from broccoli does not equal 10 calories from cake. }}Although taken aback, rather than dismissing her request Pizzimenti told her that he didn’t know much about it and would do some research into the area. Surprising himself, he found that significant studies had been conducted into the method – though results were so far inconclusive – and even went as far as calling local acupuncturists to enquire about the procedure.In the end, the patient didn’t get what she wanted, but the story was a sound rinder that being a good scientist means keeping an open mind to investigation, rather than shutting down ideas or approaches that se novel or far-fetched.Clinical decision makingA team from Hadassah Acadic College, Israel presented a poster about ‘The Effect of Clinical Experience on the Assessment of VaKE’. VaKE, which stands for Values and Knowledge Education, was developed by scientists from Salzburg University and is based on dilma discussions as a way to increase self-awareness and apply values in real life.{{image2-a:r-w:400}}An example in the clinical setting could be that an elderly patient has borderline VA for driving – do you sign off on his form or not? In this particular program VaKE was trialled with a group of experienced optometrists and a group of optometry students in order to find out how it could be better applied to the clinical curriculum or customised as continuing education for those already in the workforce.The duo suggested that introducing VaKE into optometry education at an earlier stage could allow students to be prepared for clinical dilmas, such as the ones posed above. In doing so, they asserted it would improve self-awareness during clinical decision-making, regardless of the optometrist’s experience. However, for those who did have some prior clinical experience, it was considered valuable to introduce more complex and challenging topics for th to explore.Microbiome and SGLT2 inhibitorsDrs Paul Chous and Jeffrey Gerson gave a concise update on the latest research in diabetes and its clinical managent. Their discussion on the way the human microbiome digests our food was an interesting takeaway.According to Chous and Gerson, 10 calories from broccoli does not equal 10 calories from cake, because the way our gut interacts with these its is very different, and it’s these interactions that may be partly responsible for insulin resistance.{{quote-A:L-W:450-Q: 10 minutes of walking after eating reduces the blood glucose level by more than 20% }}Regarding diabetes medication, the duo discussed SGLT2 inhibitors, also known as ‘flozins’, which concentrate sugars in glucose, keep the blood sugar level stable and apparently reduce cardiovascular events and death. Many of these drugs have not yet been FDA approved for diabetes managent, but the speakers revealed that at least some patients were already using th off-label.Some other interesting facts they threw out to the audience included; compared to a 30 minute walk before any meal, 10 minutes of walking after eating reduces the blood glucose level by more than 20%; sitting is the new smoking – prolonged sitting for longer than 30 minutes has negative effects on your health; and, consumption of burnt meat increases your risk of advanced AMD, Type II diabetes and death, so rather than using the barbecue, grill or fry-pan, you’re safer broiling or stewing your beef.Dehydrated amniotic mbranesAustralian ophthalmologists sometimes apply amniotic mbranes in certain procedures like pterygium surgery. However, optometrists in the US also have access to th and they are being used increasingly in situations where previously, the practitioner may have chosen a bandage contact lens.In their ‘Grand Rounds of the Anterior Segment’ presentation, Drs Nicholas Colatrella and Jeffrey Varanelli donstrated via video its use in treatment for recurrent corneal erosion. The doctors applied it onto the cornea following epithelial debrident, but before application with a bandage contact lens.The combination of an amniotic mbrane is used in conjunction with a bandage contact lens as studies have shown that using both promotes faster re-ephithalisation of the cornea. It is also thought to reduce the chances of recurrent corneal erosion.Representatives from multiple companies had samples on show in the exhibit hall.Magic leapIn his presentation on ‘Vision Rehabilitation with Wearable Display Technology’, Dr Jerome Legerton introduced the audience to the concept of the fourth and fifth dimensions of light.{{quote-A:R-W:450-Q: Sitting is the new smoking – prolonged sitting for longer than 30 minutes has negative effects on your health }}These components of the ‘light field’, are the phenomenon being used by companies such as Magic Leap to generate image overlays on top of the real world in their yet-to-be-released virtual retinal display headset.Despite having no products on the market, the company has a current estimated worth of US$4.5 billion (AU$5.84 b) according to Forbes.Pillars of practiceDr Nicholas Despotidis gave an engaging presentation on setting good foundations for private practice, in which he described a private practice as being held up by “pillars”.In his analogy, spectacle and contact lens sales are brittle pillars, because barriers to entry are low, competition is high and you have to compete on cost, while he also described medical optometry as being a brittle pillar, because reimbursent for general consultations is low.Despotidis explained that in both cases there was a need to increase volume in order to increase revenue, which turned some optometrists towards a mantra of “the busier you are, the more money you can make.” However, an unfortunate reality of this philosophy is that often, “the busier you are, the worse your care.”Therefore, according to Despotidis, the question is how can an optometrist make more money, while increasing the time they can spend with each patient? The answer – provide services which patients can’t get elsewhere, such as myopia control, vision therapy, learning related vision probls, special needs, head trauma rehabilitation, dry eye therapy and specialty contact lens.{{quote-A:L-W:450-Q: Consumption of burnt meat increases your risk of advanced AMD, Type II diabetes and death }}Despotidis isn’t just doing one of these at his practice – he has a partner and four associates at his clinic, and they are providing all of these services, making th a patient’s first choice when they are seeking any specialised care. Additionally, Despotidis talked about targeting the relevant patients to relevant services. Using myopia control as an example, he spoke about how to determine when to think about intervention. Besides a child’s age and level of myopia, he discussed selecting through the parent, i.e. ‘who is going to be motivated and interested in this treatment?’It is the parents who are overachievers, the parents who phasise scholastic achievent, guilty parents who blame thselves for passing on their own myopia genes and the parents who view myopia as a disease whose children respond best to treatment.Brain injury rehabilitationIt was fascinating to hear about the work Dr Tina Aldana does with the US military in Germany. The Landstuhl Regional Medical Centre is an overseas hospital for the US military in active service in both Europe and Africa.Aldana works in an interdisciplinary team there with a neurologist, occupational therapist, physiotherapist, psychologist and behavioural specialist in the traumatic brain injury rehabilitation department.Besides discussing the vision therapy she uses in her work, Aldana also described the common challenges she faces in her job. This included how to make patients notice their own reduced visual spatial awareness, their reduced visual efficiency and mismatch between focal and ambient visual processing, and the amplified effects these have on the work of active servicen. Her role donstrates the greater applications optometry can have in healthcare at large.

Sports vision training{{image3-a:l-w:300}}Former consultant for Nike and current optometrist for the Pacific University College Sports Team, Dr Fraser Horn, gave a broad introduction to sports vision training and devices currently available on the market. He began his presentation by discussing his experience working with college athletes to improve their reaction times using ball toss games, before moving on to blur interpretation using Gabor images – which have apparently also been used in studies with the Israeli Air Force to improve visual acuity.Horn also detailed the latest sports vision testing systs from both the optometric and sports industries, the ‘Quiet Eye’ phenomenon exhibited by top-class athletes, and strobe-light training and strobe glasses, which are already being used by the military.Quiet Eye is a technique that researchers have reported improves outcomes in multiple and varied tasks that require human visual attention – especially under pressure. The prise of the technique is simple; before performing the action, people who utilise the technique focus their gaze on the salient aspects of their goal, usually for a few seconds beforehand, and then maintain that focus during the action.By using eye-tracking technology, researchers have discovered that those who enjoy the most success using this technique are able to lock onto the relevant stimulus at the exact right time, which is typically the few hundred milliseconds before, during and after the movent. Sports scientists have also found that ‘Quiet Eye’ can be trained, and it is having erging applications beyond sports in high-precision vocations such as surgery and the military.Finally, Horn explained the application of existing sports vision training methods in neuroplasticity work, e.g. in concussion rehabilitation or for ageing adults. It was a fantastic primer on an area of the industry that gets little exposure in Australia.


Low-vision drivers{{image4-a:r-w:300}}Faculty from the Ohio State University gave a four-part presentation on low-vision drivers, incorporating research on crash-risk, population level data and case studies. The latter included discussion of a patient with early Alzheimer’s disease who met visual acuity and visual field standards for licence renewal, but had significantly affected results for perceptual tests such as the clock-drawing test and trail-making test.In this scenario, as the patient had failed the perceptual tests the optometrist felt that he was not safe to be on the road, and was compelled to talk to the patient about “retirent from driving.” The speaker mentioned that while it may be difficult to have this conversation with older patients, sometimes it actually takes the burden off family mbers who have similar concerns about a patient’s fitness to drive. Therefore, having the doctor confirm this makes it easier for the family too.Another scenario was a patient with albinism who had gone through the bioptic telescope training program and had driven on a conditional licence for some time, but was in a recent accident due to a glare event. Both highlighted the role of frequently under-utilised optometric tests and the need to work closely with low-vision patients to understand their goals and how they can be best met.

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