CCLSNZ 2025: elevating eyecare through collaboration

Regarding the never-ending ‘which-atropine-strength-is-best’ debate, Dr Donaldson said after assessing risks, he starts Caucasian children on 0.01-0.025% and other races on 0.025-0.05%, though recently he’s been tending to start them on the higher doses. Nam said she identifies fast progressors and myopes at risk of high myopia first, refers the ones who don’t make sense or have high signs of pathology, and recommends a “go early, go hard” combination treatment, with the recommended treatment approach based on the patient’s compliance, binocular vision and side-effect profile. Nam and Dr Donaldson ended their talk by stressing that myopia control is a team effort and there’s never any harm getting a second opinion as “it works both ways.”

Christchurch-based optometrist-turned-ophthalmologist Dr Malcolm McKellar then shared a personal journey about his and his patients’ experience with serum eye drops to treat severe dry eye and other corneal issues. He describes serum eye drops to his patients as “compost tea” which fertilises the ocular surface and tends to recommend them to patients with severe ocular surface disease who’ve had little success with other treatments. He’s even devised his own serum-phial opener and drop-delivery tool that sits in the fridge for patients who live with severe arthritis! Overall, there’s no concrete evidence the drops work for all patients, but they have certainly helped some of his and can be “highly effective,” he said. He recommends using them at 25% dilution, with patients reviewed at six weeks and treated for a minimum of three months. But they are expensive and require significant patient education, he said.

Dr Elizabeth Conner then broached the tricky subject of periocular steroids, using a series of cases to illustrate the pros while warning of the cons. Her recommendations include taking a detailed history (ocular and systemic); consider prescribing refills carefully, if at all; and reviewing the cornea carefully with fluorescein staining to check the epithelium. She also reminded us that steroids and contact lenses don’t mix well and they can lead to elevated intraocular pressure. Her excellent talk was a reminder that treating inflammatory anterior segment conditions requires careful monitoring for other sequelae and caution to avoid tipping the balance of pressure.

After morning tea, Nam and Dr Donaldson discussed the safety of ortho-k in myopia management. In their Squid Game-themed talk they reminded us of the need to follow the rules, especially regarding cleanliness, using new (not topped-up) solution and avoiding all tap water as these can cause nasty infections. They also cautioned us to look not just at individual case reports (as these can be emotive) but at the science, since following the rules and providing ortho-k is safer than watching progress and risking vision impairment from myopic complications.

Optometrist Anita Pistorius followed with a wonderful case report on fitting a scleral lens for a patient with nystagmus and keratoconus. She reminded us that sometimes you can be pleasantly surprised in cases that don’t look promising to begin with and the results can be life-changing for both of you! Next up was Dr Hans Vellara’s investigation into a piggyback system for a soft contact lens and a semi-scleral. He found this wasn’t perfect for everyone but could work well for decentred cones when a traditional scleral fitting means choosing between touching the cone or a large bubble in the mid-periphery.

Several overseas specialists made guest appearances in Soojin Nam and Dr Craig Donaldson’s keynote address, courtesy of their onscreen TARDIS, including Dr Ramesh Kekunnaya, head of paediatric ophthalmology, strabismus and neuro-ophthalmology at the LV Prasad Eye Institute in India

Tui Homer built on her popular talk from last year with another set of cases from her rural Wanaka practice, including a patient with “splitty eyes” (aka Terrien marginal peripheral degeneration). Dr Donaldson then returned to end the first half of the conference with an overview of syndromic and pathological myopia, reminding us they are quite common and sometimes hiding in plain sight. He cautioned against the diagnosis of bilateral amblyopia, which is rare in myopes, and that syndromic myopia (most commonly Marfan or Stickler syndrome) often has systemic complications which require management.

Afternoon delights

After lunch, a series of case studies was presented, again emphasising the importance of co-management. Ophthalmologist Dr Mo Ziaei and optometrist Grant Watters described a patient requiring both optometric and surgical assistance to manage his keratoconus. This began with fitting contact lenses, followed by deep anterior lamellar keratoplasty (DALK) and surgical management of post-graft astigmatism, before more lenses were fitted.

Nam then spoke on congenital stationary night blindness (beware a young myope with bilaterally reduced vision), while Dr Donaldson gave us a peek at what it’s like being on call, summarising the cases he encountered in just one week at a busy Sydney hospital. He also reminded us of the need to closely monitor preseptal cellulitis – which is more common than you might think – and to very carefully check any corneal trauma, with a low threshold for getting a second opinion. Globe ruptures and corneal perforations can be subtle but are devastating if missed!

In the final session of the day, we looked at new and developing research. Watters and Professor Jennifer Craig, head of the Ocular Surface Unit at Auckland University, introduced and asked for our help with a survey looking at the different management techniques for anterior blepharitis – a common condition with a varied response to treatment. Nam then covered how both biometry and topography can be helpful in predicting risk and ascertaining how effective myopia management really is.

Optometrist Vicky Wang shared details of how she’d used her CCLS scholarship to benefit her whole team at Te Whatu Ora Auckland, with an educational trip to Corneal Lens Corporation (CLC) in Christchurch. There they learned about the manufacturing and design of custom lenses and what was needed to provide just the right lens for your patient. Wang also shared how the personal mentorship of CLC’s owner and director, the late Graeme Curtis, had encouraged her on her ophthalmic journey and how he will be sorely missed – a sentiment echoed by us all.

A few sponsor talks were scattered throughout the conference: Helen Gleave, Alcon’s senior professional education and development manager ANZ, discussed the surface technologies of the Total 1 lenses; Tauranga optometrist Alex Petty shared his experiences with Bausch + Lomb’s BioTrue lenses, reminding us HyperGel lenses can work well for those patients who are both cost-conscious and require clear vision in demanding environments; CooperVision’s Joe Tanner talked about the four stages of effective myopia management and how MiSight lenses have the longest data duration at almost eight years; and Wellington-based optometrist Andrew Sangster provided some initial thoughts on the Johnson & Johnson Abiliti 1-Day lenses with RingBoost technology – an exciting new lens with centrally +10 to produce as much hyperopic defocus on the foveola as possible.

All that in just one day! Plus a lucky few were able to attend a pre-conference workshop hosted by CLC. Overall, the conference organisers and speakers did an amazing job. As the day ticked by (and the jellybean tower was slowly consumed) we were reminded how collaboration benefits not only our own professional journey but our patient care as well. We are always better together. See you next year!

With additional reporting by Lesley Springall.

Stephanie Mander is a New Zealand-trained optometrist based in Northland. Current CCLS NZ secretary, she has practised in private ophthalmology clinics and in regional optometry practices both in New Zealand and Australia.