Dr Stephen Best welcomed the pre-dominantly shore-based crowd of optometrists to Auckland Eye’s second Insight seminar, held at the company’s new North Shore premises in Takapuna on 16 May, while Drs Dean Corbett and Archie McGeorge were the evening’s presenters.
ERM and floater problems
Dr McGeorge kicked-off the seminar with a talk on epiretinal membranes (ERMs or macular pucker) and associated issues like flashes and floaters. Most flashes and floaters aren’t a problem, he said, however, they could be symptoms of something more serious, like a torn retina. Optometrists need to be able to distinguish between harmless ones and those indicating an underlying condition. Patients experiencing flashes and floaters in combination with a new horse-shoe retinal tear or vitreous haemorrhage need to been seen urgently. Non-symptomatic cases, with occurrences of atrophic retinal holes (often associated with lattice degeneration) should be referred, but are less urgent.
Similarly, ERMs often don’t require treatment, only causing problems when they’re either too thick or too contracted. When mild, with little or no effect on the patient’s vision, Dr McGeorge recommended checking the patient every three to four months. In more severe cases, ERM surgery may be necessary to remove the membrane to tackle vision loss. Optometrists shouldn’t wait too long to treat ERM, however, as vision lost can’t be fully restored, he said. Post-ERM surgery, vision is often blurred and it can take two to three weeks to regain pre-op vision as the tissue recovers. Vision can sometimes continue to improve over months, up to a year after surgery.
Laser and lens options
Dr Dean Corbett’s sometimes amusing presentation encouraged optometrists to keep their cool and their humour in clinical situations. He showed two videos - one of a guy who could almost pop his eyeballs and an intriguing game of football where all the players were kitted out with a pair of binoculars as their only form of vision.
As for lens options in lens replacement surgery (a better term than cataract surgery), he discussed a number of new technologies, including the Tecnis Symfony extended depth-of-focus intraocular lens (IOL); IC-8 small aperture IOL, a new class of optics useful for highly-aberrated corneas; and the Harmoni two-part modular IOL from Clarivista Medical, a first-of-its-kind lens still undergoing feasibility trials. Having seen too many cases where patients opted for multifocal lenses and ended up with night vision trouble and halo effects, he also said he was now an advocate for monofocal or EDOF (such as Symfony) lenses.
SMILE (small incision lenticule extraction) is Auckland Eye’s preferred laser procedure for vision correction surgery, with nearly 100% of patients opting for it and less than 1% needing a second procedure. The real beauty of the procedure, said Dr Corbett, is it keeps the cornea near intact.
Dr Corbett also touched on a trial Auckland Eye is currently running on MIGS (minimally invasive glaucoma surgery) with a zero-complication rate to date.
CPAC to monovision
Some time was also devoted to the new Clinical Priority Assessment Criteria (CPAC) tools and their advantages for optometrists (see story in NZ Optics’ June issue). Dr Corbett is chair of the CPAC Steering Group. Claire McDonald from McDonald Adams Optometrists, said she finds the tools quite useful for assessing a patient’s condition and helping them form a more realistic expectation of what can be done.
Closing the seminar, Dr Corbett invited Grant Dabb from Orewa Optics to talk about his experience of monovision laser surgery. Dabb said it’s the best vision he has ever had. But both pointed out the importance of conducting a proper trial with contact lenses before going ahead with monovision surgery. The optometrist has a crucial role to play in this, said Dr Corbett.
Dr Stephen Best ended the evening with a raffle rewarding two lucky guests with a bottle of wine and an annual subscription of NZ Optics!
Auckland Eye’s next educational event will be at Orakei Bay, 231 Orakei Rd, Remuera on 17 October from 5.30-9:00pm
Written by - New Zealand Optics