The award-winning hotel pool allowed patrons to swim with the fish, but it was the deep dive into various eye conditions and diseases that was keeping optometrists captivated during Specsavers’ 13th and biggest clinical conference yet.
The old saying goes that you should never work with children or animals.
But Dr Rushmia Karim would disagree, especially regarding the former, and she offered plenty of tips and tricks for eyecare professionals at the 2024 Specsavers Clinical Conference (SCC), should those professionals be called upon to bend a knee and look a fidgety young patient in the eye.
Dr Karim, a New South Wales paediatric ophthalmologist, was one of more than 20 eye care professionals sharing their expertise at the annual Specsavers event, this year hosted on the Gold Coast on September 14-15.
More than 400 optometrists attended in person and participated in a range of sessions on the main stage and fringe talks over the two days, with another 450-plus watching online from around Australia and New Zealand. This year’s conference also included eight on-demand talks available for optometrists to view at a time that suits them.
Subjects included paediatrics, neuro-ophthalmology, posterior eye conditions, anterior eye therapeutics and inflammatory eye disease, covering many conditions that optometrists might encounter in their practices, the tools and techniques they might use, and the treatments they could adopt.
As well as Dr Karim, other key speakers included Dr Brendan Cronin, corneal and anterior segment surgeon, and director of education at the Queensland Eye Institute, who focused on dry eye treatments in an entertaining, balloon-filled presentation; Associate Professor Chameen Samarawickrama, a consultant eye surgeon and clinician-scientist who spoke on the complexities of diagnosing and treating watery red eye; and Dr Brian Ang, whose presentation on proactive glaucoma care covered the impacts of lifestyle, diet and stress on the debilitating condition.
All of the presentations over the two days and the on-demand talks provided insight and practical knowledge to continually develop optometrists’ clinical knowledge, contributing up to 20 hours of CPD content.
The conference weekend kicked off with an uplifting update on Specsavers’ impact in the eye health sector, by the company’s clinical services director for ANZ, Dr Ben Ashby.
He opened his presentation by reflecting back to 2020, and Specsavers’ aim to reduce rates of avoidable blindness across Australia and New Zealand.
“We felt that an industry standard of probably 60 to 70% of people with avoidable blindness being detected wasn’t good enough, that a 50% undiagnosed rate for glaucoma wasn’t what we should deliver in this country, and that diabetes as the leading cause of blindness in the working age was unacceptable,” he said.
“We set ourselves the ambitious goal to get to a 95% detection rate of avoidable blindness, and . . . incredibly, we are already at 92%.”
Because of this relentless focus, Specsavers optometrists are now detecting diseases and conditions that could lead to avoidable blindness in more than 130,000 people each year.
In addition, over the past five years, more than 215,000 cases of glaucoma have been detected in Specsavers practices in Australia and New Zealand.
“We are now at the amazing point that 93% of all glaucoma cases are being picked up in our stores.” Over the past 12 months, more than 5 million people had trusted Specsavers with their eye care, with more than 3,500,000 of those Aussies and Kiwis receiving vision correction to help them “live better lives with better sight”.
Dr Ashby also shared some impressive data from KeepSight, the program Specsavers has been a founding partner of alongside the Department of Health and Diabetes Australia, which reminds people with diabetes to keep up regular visits to check their eye health – “because the biggest risk factor for losing your sight through diabetes is not attending regular appointments”.
“It is working,” he said. “Specsavers optometrists have registered over one million visits for their patients living with diabetes. Reminders sent out by KeepSight have increased the return rate by 20%.”
That meant that, over the last 12 months, Specsavers optometrists had found more than 20,000 cases of advanced diabetic retinopathy that needed treatment by ophthalmologists.
Meanwhile, Dr Ashby said the company had launched its Early Career Optometry (ECO) program in 2023, with 100 optometrists having already been through the program. Following conversations with graduates, the Professional Development team identified the opportunity to add the ECO program to continue supporting optometrists beyond the initial two-year Graduate Program. Next year, Specsavers will pilot the Senior Optometrist role as an extension of the ECO program, leveraging the expertise of experienced practitioners as mentors, further supporting optometrists throughout their career.
And dry eye disease would have a heightened focus in Specsavers stores, he said.
“For a long time, we’ve been aware that 30% of the patients in our store are suffering with some form of dry eye.
“We’ve started the IPL pilot and it’s currently live in three stores in Australia, with an additional six stores joining the pilot by the end of the year. We will continue the IPL pilot into next year, as it is a great, affordable long-term treatment for our patients with dry eye.”
Another key focus was the Trusted Expert Series (TES), which supports Specsavers’ network of 1,500 optometrists to understand the importance of effective communication in establishing relationships with their patients to achieve the best health outcomes. In the year ahead, TES will focus on enhancing the communication skills of both optometrists and dispensers, to help build trust and better understand patients’ lifestyles for the best possible clinical recommendations.
Speaking of trust, Dr Ashby also made a special mention to thank all Specsavers optometrists who helped Specsavers to be named Most Trusted Optometrist for the fifth year running by Reader’s Digest Magazine. He also called out the commitment and achievements of more than 500 recent graduates and early career optometrists who have chosen to build a career at Specsavers.
It’s not always child’s play
Dr Karim admits that paediatric ophthalmology can be “daunting”. “Sometimes my heart sinks when I see a whole room full of children,” said
the former head of the Paediatric Eye Service at Britain’s Prince Charles Eye Unit, part of the Royal Berkshire Hospital Trust.
“Children are unpredictable. You’re worried if you miss anything, don’t really see the back of the eye, don’t really get that script correct.”
Her advice was to go back to “first principles and simplicity”.
“You don’t really have to go into depth in every single clinical consultation, but there’s a few things that will give you a good clue as to whether this is a ‘red-flag’ patient or someone just needing a standard assessment.”
That included asking the right questions: Was the child born full-term? Had they been immunised? Were they there because mum’s gone for an eye test and brought in their child, or were they in for a specific problem?
Other questions could include medications the child was on, what they were eating and drinking, and their bladder and bowel movements.
As much as a full room of children might be daunting, Dr Karim liked to observe children in the clinic, especially when they didn’t know she was looking.
“I can be a bit of a stalker: are the children in the clinic playing, are they watching Bluey, what’s their visual behaviour when they think you are not watching them?”
And she reminded the audience that they had a duty of care to report signs of abuse and non-accidental injuries, which should be reported to GPs and other authorities.
Examination was all about “toys, toys, toys. Have as many things as possible in your toolbox”.
One of her favourites was a wind-up mouse, which kept the child stimulated and allowed her to watch the fixing and the following of the toy.
“But use toys that don’t make a sound because sometimes the child will track the noise, not the vision.”
Visual charts could also be a challenge.
Dr Karim said some charts could be 30-40 years old and not appropriate for modern children, and less formal charts were fine to use.
Often, parents were harder to deal with than their children, she said. She advised careful counselling of parent expectations.
“Parents love surgery; half of my clinic is talking them out of surgery,” she said.
That included when children presented with amblyopia, for which the treatment was usually a mixture of patching and glasses.
“I start children in glasses first, get them used to it. Then I can introduce patching.”
Atropine was also an excellent treatment, especially if the child was not keen on patching.
And parental supervision was “the key to compliance; it will make the world of difference. Tell them it’s a marathon, not a sprint.”
Impact of good lifestyle choices, and a little saffron
Dr Brian Ang, a Melbourne glaucoma specialist and co-founder of Nutravision, told the conference about the influence of holistic lifestyle choices on the progression of glaucoma, an area rarely discussed.
He felt optometrists could play a key role in coaching patients along their “eye health journey”.
His “five pillars” would help patients address and manage the risk of the debilitating eye condition
They included a focus on physical activity, stress management, restorative sleep, diet and nutrition, and what he termed neuroprotection.
“Exercise is good for your eyes,” said Dr Ang. “Between 35 and 40 minutes of aerobic exercise each day can improve blood flow, reduce pressure, and slow vision field loss.”
Strength training and yoga were also recommended, although he cautioned that people should breathe out during exertion to avoid pressure build-up around the eyes, and some yoga positions could have a similar affect.
“Mental stress can be overlooked for its impact on glaucoma,” he said.
Between 45 and 60 minutes of daily meditation was shown to reduce eye pressure by up to 25%. Also, deep breathing exercises: “Three times daily, 6 breaths a minute, 5 seconds in and 5 seconds out.”
He also recommended 7-9 hours of sleep each night, but “don’t sleep with the affected eye facing downward into the pillow”.
There was some bad news for coffee and alcohol drinkers.
While fresh food and vegetables had been shown to lower the risk of glaucoma by up to 79%, and vitamins A, C and E, Omega-3 fatty acids also helped, the results were mixed for what we drank.
Hot tea could reduce the risk by up to 74%, but caffeine was shown to increase eye pressure by 1-6 mmHg. And more than two cups a day could increase the likelihood of glaucoma fourfold.
Alcohol could reduce eye pressure temporarily, but over the long-term, alcohol increased glaucoma risk, even at intake levels below the current UK and US guidelines.
Neuroprotection was also a key factor, said Dr Ang.
That covered pressure-independent mechanisms for glaucoma progression, including vascular factors that could reduce blood flow through the body and eyes, cellular factors such as mitochondrial dysfunction and axonal degeneration, and even external factors such as UV light exposure and mental stress.
He said there was no medical consensus or specific guidelines on neuroprotection, but he believed protocols and proactive glaucoma care that emphasised a healthier, holistic lifestyle, supported by vitamins and botanical supplements like nicotinamide (vitamin B3), methylcobalamin (active vitamin B12), saffron, bilberry, and gingko biloba could help reduce risk and vision loss.
Case studies had shown an improvement for people following the neuroprotection protocol, he said.
“Start the protocols early – don’t wait until it’s advanced, don’t consider it a last resort in attempt to delay surgery.
“And don’t forget regular monitoring; early detection equals early intervention equals better outcomes.
“Optometrists can be the coach along their patients’ eye health journey.”
Why it’s good to talk
On the Sunday, Ms Acyel Al-Alosi and Ms Virginia Carlton, from Specsavers’ Clinical Performance team, issued an entertaining challenge to attendees to lift their communication in order to build greater trust with patients.
They said those in the venue and online had learnt a great deal over the two days of the conference.
“But if you don’t know how to communicate it and your patients don’t trust you – how can you improve their sight?.”
Better communication saved time, it allowed the optometrist to focus on the patient and improved follow through with recommendations.
It led to more accurate diagnoses, better outcomes for patients and less risk of treatments failing.
The pair used role play to demonstrate how asking the right questions and using language that was less clinical and more appropriate for the patient could build more trust and lead to compliance and better outcomes, for the optometrist and the patient.
“That means getting more detail about the person’s day, their work duties and how they use their eyes,” they said.
“Stronger communicators can dive into their patients’ concerns.” Appropriate language was important too. “Use words that have meaning for your patients. Many people think of their vision in terms how well they can drive, watch TV, read a book, rather than being long- or short-sighted.
“So, a recommendation that these glasses will improve your distance vision does not have the same impact as these glasses will improve your driving and watching TV will be more comfortable.”
Using more relatable language would support patient compliance and follow-through.
In the decision-making process, it was important to obtain a mutual agreement with the patient.
“Find common ground to respond to their unique needs.
“Use inclusive language, use words that have meaning to them, and use your expertise – ‘let’s walk through what our best options are’.”
Optometrists who took a more patient-centric approach were more likely to meet expectations and have higher patient and job satisfaction.
This was about “what kind of optometrist do you want to be”, they said.
“Do you want to be one that is proactive and can adapt to meet your patients’ needs?
“Or do you want to be one who, because the word ‘optometrist’ is on the door, it’s the patients who automatically understands and trusts them?
TOP PERFORMERS:
Specsavers has announced its winners of the Doug Perkins Medal and Dame Mary Perkins Award for 2024 at its annual clinical conference on the Gold Coast.
Stores in Port Lincoln, South Australia, and Blenheim in New Zealand were awarded the Doug Perkins Medal, acknowledging stores “that consistently upheld the highest standards of clinical excellence”.
The 2024 Dame Mary Perkins Award was presented to two optometrists who demonstrated “an exceptional commitment to patient care, going above and beyond to make a positive difference”.
They were Ms Sarshia Hua, from Specsavers Toowong, in Queensland, and Mr Kevin Chen from Specsavers Mt Wellington, in New Zealand.
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