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The 8th conference of the Orthokeratology Society of Oceania was held on the Gold Coast, Australia, from the 9th to the 11th of July 2010.
Unlike other conferences this was held in mid winter. Not the best time to visit a beach side holiday destination like the Gold Coast however, this did not stop interest. A record number of 160 registrants attended. This was the largest attendance ever experienced at this conference. The previous record was 120.
The timetable for the entire weekend promised something for everyone, ranging from beginners classes to advanced fitters discussion groups.
The first day covered clinicial aspects of this modality. We welcomed John Mountford back on the podium, after having had a break for a few years. His style was as refreshing as ever and the content covered the current 'hot topics' of orthokeratology. He feels the peripheral retina model plays a significant role in myopia progression. It is his belief that optometrists will over time become more and more involved in managing myopia progression. He discussed how orthokeratology has been proven to control myopia progression and that it has the best risk-benefit ratio of all the methods available. His opinion was that it will be a significant technique to be used in the battle against myopia. Other topics covered on the day were the use of orthokeratology to treat astigmatism and hyperopia.
The second day had a high calibre line-up of presentations by various academics, researchers and practitioners.
Helen Swarbrick began the day reporting on her very positive results from her orthokeratology and myopia control study. It compared myopia progression in children, who wore an Ortho-k lens in one eye at night time, and an RGP lens in the other during the day. This combination of lenses was worn over a period of 6 months. At 6 months the lenses were swapped over to the other eye. The study used axial length measurement to determine myopia progression.
The eye that wore the orthokeratology lens experienced an initial shortening of the axial length, while the other eye, wearing an RGP lens, lengthened. This shortening of the axial length was thought to be due to choroidal thickening which has been found to occur when a myopic stimulus is removed. Interestingly, when the crossover occurred, the eye which had shortened lengthened again while the other eyes axial length shortened. These results were highly significant, Helen's conclusions were that orthokeratology, in the short term (6 months) slows the progression of myopia. She could not predict, or say, what would happen over the long term.
Jeff Walline presented a great summary of the history of myopia control and research, including bifocals, atropine, pirenzipine, gas permeables and orthokeratology. The most effective means was atropine; however, the risks associated with this outweigh the benefits. An interesting result found in the atropine studies was that myopia progression was stopped for the first year however after one year myopia progression continued at the same rate as the control group.
Orthokeratology has been shown to slow progression by approximately 50%, making it the next most effective treatment after atropine. Unlike atropine, and other treatments such as bifocals, the effect that orthokeratology treatment had on myopia continued after one year, giving Jeff the grounds for the opinion that orthokeratology is the best modality for myopia control.
Mark Bullimore presented on the risk of infection when using orthokeratology found in the results of his post FDA study.
It appears that the risk of infection is slightly less that overnight extended wear with soft contact lenses. One has to alert patients to this when fitting Ortho-k. As with all contact lens modalities, compliance with lens care is major issue.
There was an interesting presentation by Michael Collins from Queensland University of Technology. He discussed the role of optics and other factors involved in myopia progression. He proposed three models for myopia progression, one being peripheral retinal image shell, the second spherical aberration and the third a lag in accommodation. We had a further presentation by students in the ROK Group investigating peripheral refraction and astigmatism.
The quality of the lectures was extremely high, and the lecturers, attendees and sponsors all commented on how much they learnt and enjoyed the conference. Unlike other conferences where optometrists come along to accumulate points, it has always been the case at this conference that participants were keen to learn. The quality of the lecture program and the rest of the conference reflected well on the organising committee headed by Celia Bloxsom.
The conference showed the increasing interest in orthokeratology as a technique to be used in the forefront in Optometry's battle against myopia progression.
The 8th Congress of the Orthokeratology
Society of Oceania (OSO), held recently on the Gold
Coast, had great support from NZ optometrists who joined
their Australian colleagues to spend three days listening
to a myriad of topics associated with Orthokeratology
(OK).
The 25 New Zealand optometrists who attended were not
disappointed, as they heard from both industry experts
and newcomers to OK practice. Sessions were varied ranging
from beginner classes to advanced fitter discussion
groups and included topics on OK and astigmatism, myopia
control, kids and OK, infections, topography, OK and
hyperopia, OK101 and even what not to do with OK.
A highlight of the event was a presentation by Associate
Professor Helen Swarbrick that focussed on the latest
research on myopia control from the ROK study group
at the University of NSW (a full report of the results
will be in the next issue of NZ Optics). The ROK group,
of which Helen is head of, is one of the world’s
leading OK research groups. Gavin Boneham, president
of the OSO, welcomed everyone to the event and gave
an overview of what was current in the world of OK and
what the future holds. “OK is an interesting technology
for a practitioner to be involved in and it challenges
you everyday,” he said. “I’ve been
doing it for about 15 years and there is always something
new that turns up. It’s also a great addition
to a practice and provides a different focus for the
optometrist that is very rewarding. “Research
in OK is also diversifying with more and more serious
research being done. This can only contribute to the
promotion of OK as a realistic and effective option
for refractive correction. The results that are coming
out of studies, particularly to do with myopia, will
no doubt attract interest and in turn the public’s
awareness of OK as a relevant and safe alternative.”
John Mountford, who is well known as an authority on
OK, gave an introduction to OK – OK101 –
covering the history in regards to its development,
lens design, the personalities involved in this lens
specialty and its benefits.
Attendees were divided into two groups for some of
the sessions over the three days depending upon their
experience with OK, thus ensuring that everyone got
the most out of the meeting. Each group considered the
subject of topography, an essential element for OK practice.
Beginners analysed corneal topography maps and were
given an understanding of how to extract the information
required to fit OK lenses and follow up different OK
lens designs. Randy Kojima, director of technical affairs
for Precision Technology Services/BE Enterprises (a
GP manufacturing company in Canada) covered important
topographical considerations prior to fit and evaluation
of outcomes post wear, along with the more advanced
concepts for capture and analysis available with topography.
In the beginner sessions newcomer to OK, New Zealand
optometrist Jagrut Lallu, provided an extremely useful
session on ‘My first year in OK’ that covered
clinical tips, experiences with his first patients,
incorporating OK into a practice and his marketing experience
in his first year of practising the specialty. Jagrut
also provided some tips that weren’t all necessarily
clinical. He commented that patient selection is also
very important and that by identifying a personality
type and knowing how to communicate to that type will
dictate to a certain extent the information that is
wanted and provided. Skepticism among patients is also
quite common and knowing how to handle these queries
is helpful.
On the clinical side he commented that screening for
tear film anomalies is critical, along with quality
maps, sags and patient education in regards to explaining
how the procedure works. “By explaining to patients
how the procedure works and that it’s the tears
working with the lens that change the shape of the front
window of their eye, they seem really relieved that
the lens doesn’t actually press on the eye. “The
best advice I’ve ever received was from John Mountford
when he told me to ‘keep it as simple as you can,
take the certain cases that are a ‘sure thing’
and do 50 of them before you branch out’.”
Jagrut, combined with fellow optometrist Celia Bloxsom
who provided a frank and entertaining look at ‘what
not to do with OK’. With 10 years experience in
fitting OK lenses, instead of focusing on the success
she has had, Celia detailed her unsuccessful patients.
Looking at these patients retrospectively Celia showed
that by analysing the initial data correctly can help
predict the success of OK fitting before beginning and
save some embarrassing situations.
Whilst Jagrut and Celia provided some very useful advice
and tips for newcomers to OK, John Mountford continued
with the more experienced practitioners covering those
areas of OK that cause the greatest degree of frustration,
such as predictability, common fitting problems and
the question of myopia control. By reviewing literature
and highlighting some of the current unknowns of OK,
John compared the fitting philosophies to the actual
outcomes of some cases. All this aimed towards assisting
the practitioner in understanding these issues and devising
strategies to limit the number of unsuccessful patients.
A detailed look at OK and astigmatism and OK and hyperopia
was covered in the following sessions with a range of
practitioners and industry representatives giving informative
presentations on some of the common yet challenging
OK cases. Analysis of the pre-treatment and post- wear
responses as well as the solutions for these challenging
cases were also discussed.
A lively panel discussion concluded the sessions for
the first day and delegates then had the opportunity
to catch up with colleagues over a few refreshments.
Presentations on day two looked at the science of OK
with in-depth discussions on myopia, kids and OK, infections
and multifocal OK. Along with Helen Swarbrick’s
ROK group myopia study update, another highlight for
the day was Jeffrey Walline’s presentation on
working with kids in OK. Jeffrey gave practical techniques
and troubleshooting tips for OK and children, all aimed
at giving practitioners greater confidence in using
this modality for those that would most benefit from
the treatment, being young progressing myopes.
Mark Bullimore presented on the risk of infection when
using OK that were found in the results of his post
FDA study, and it appears that the risk of infection
is slightly less than that of overnight extended wear
with soft contact lenses. Patients fitted with OK should
be alerted to this and as with all contact lens modalities,
compliance with lens care is major issue.
Day three allowed for company representatives to provide
product information from their various businesses in
relation to OK, namely lenses and specialist equipment
such as topographers. A panel discussion followed that
allowed attendees to query these technologies and hear
directly from the manufacturer. Proceedings ended with
the OSO’s innaugral Lifetime Achievement Award
being presented to OK pioneer, John Mountford. This
most deserved honour was awarded in appreciation for
the great contribution John has made, not only in OK
research
but also for his tireless contribution to the OSO for
more than a decade.
The quality of the lectures was extremely high, and
the lecturers, attendees and sponsors all commented
on how much they learnt and enjoyed the conference.
“The quality of the lecture programme and the
rest of the conference reflected well on the organising
committee headed by Celia Bloxsom,” said Gavin.
“The conference showed the increasing interest
in OK as a technique to be used at the forefront of
optometry’s battle against myopia progression.”
With the number of optometrists specialising in OK
growing, the congress offers a great opportunity to
gain a further understanding of the treatment and as
it covers the experience spectrum it’s a must
attend event for those with an interest in this speciality.
The OSO Congress is a biennal event, and the next meeting
is currently planned for the Gold Coast 2012. If you
would like more information about the society or OK,
please contact Jagrut, jagrutlallu@gmail.com,
or navigate to the website, www.osa.net.au
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