Focusing on orthoptics 2022

April 26, 2022 Maddy Scavone

This year’s Orthoptics Australia Annual Conference took place virtually, so I got to enjoy the array of talks during a visit to my hometown of Hobart, with an interactive Slack channel providing an opportunity to engage with other attendees and see the various locations they were joining from.

 

The speakers’ knowledge, the research they shared and their updates on new technology and adaptations emerging from the pandemic was fascinating. Catherine Mancuso, chief orthoptist and manager of diagnostic eye services at The Royal Victoria Eye and Ear Hospital (RVEEH) and Melanie Lai, orthoptic discipline advisor, South Eastern Sydney Local Health District, discussed innovation in orthoptic practice, with the pandemic prompting a rethink in public hospitals when face-to-face appointments were not possible.

 

RVEEH had already implemented telehealth in 2017, without much success with patients, but it was a different story in 2020. Although it’s difficult to run ophthalmic care virtually, RVEEH staff remotely provided assistance to diagnoses in neuro-ophthalmology, including giant cell arteritis (GCA) and idiopathic intracranial hypertension (IIH). The waitlist of patients overdue for review was reduced by 45%, significantly lifting the burden for the hospital. They also ran a rapid diagnostic clinic, consisting of an in-person assessment with an orthoptist, followed by a telehealth appointment with the doctor. This reduced patients’ time spent on site by 47%, compared to the neuro-ophthalmology clinic, where patients sometimes waited several hours to see the doctor.

 

RVEEH paediatric orthoptist Navdeep Kaur discussed setting up orthoptic-led clinics for mild to moderate glaucoma and for screening for neurofibromatosis type 1, which proved a more cost-effective solution than consultant-led clinics. Navdeep’s wonderful presentation also earned her the Orthoptics Australia Paediatric Orthoptics award.

 

Addressing donor cornea shortfall

 

In the session on optimising orthoptic care, Dr Karl Brown from the Centre for Eye Research Australia (CERA) spoke about the work he and his team from the Australian government Medical Research Future Fund-backed BIENCO consortium have been doing with tissue-engineered corneas. Launched in December 2021, BIENCO is a collaboration between the Universities of Sydney, Wollongong and Melbourne, Queensland University of Technology, CERA and the NSW Organ and Tissue Donation Service to develop bioengineered eye tissue to treat corneal blindness.

 

Dr Brown highlighted the fact that keratoplasty has limitations but is the only effective treatment for severe corneal disease, with 12.7 million people globally waiting for a donor cornea and only one in 70 of those having access. He attributed the problem to the significant resources needed to identify donors and collect tissue, the quality of which is variable. The endothelial cell count is further reduced in surgery and continues to reduce over time. BIENCO’s intention is to produce lower cost, higher quality, mass-produced sight-restoring treatments for severe corneal diseases. Tissue engineering has the potential to reduce and eventually eliminate the need for donor tissue while producing a consistent endothelial cell count and eliminating the risk of donor-to-host disease transmission. BIENCO-engineered tissues consist of all corneal tissue layers – epithelium, stroma and endothelium – combined to create a full-thickness cornea. This technology is already supplanting grafts for penetrating and lamellar procedures, so if you happen to examine a patient who has been lucky enough to receive one, it might be a bit of an anti-climax as you will see no difference to a standard corneal graft. However, Dr Brown said it is a much cheaper and more accessible solution with higher quality results and better patient outcomes.

 

The importance of diet

 

Georgia Shaw presented her case study of a young boy with autism who presented to Westmead Children’s Hospital with terrifyingly low levels of vitamin A. He’d been living on a diet of Nutella sandwiches, refusing anything else. He was diagnosed with xerophthalmia, the branch term to describe ocular complications of vitamin A deficiency that presents with symptoms including dry eye, photophobia, epiphora and night blindness. The key takeaways were identifying at-risk populations, including those with avoidant restrictive disorder, a diet limited to one food group, autism spectrum disorder and sensory processing. However, the good news for this little guy was that restoration of vitamin A levels reversed the disease process, demonstrating that early management is essential.

 

Putting children first

 

Day two had a strong focus on paediatric ophthalmology, with sessions covering strabismus and amblyopia, childhood low vision and paediatric practice. South Australia’s Lachlan Knight received the 2022 Emmie Russell Award for his presentation on the ‘The kids are alright: quality of life in children with glaucoma’, the first study to provide an insight into the lived experience from the child’s perspective. He found that younger children may experience fewer quality of life issues than teenage children, who may require additional social and ophthalmic care. His research further explored the quality of life for adults with childhood glaucoma, as well as the caregiver’s experience. These findings show that genetic counselling is valued and should be made available.

 

Lachlan Knight

 

The session on genetics had a strong focus on inherited retinal disease, the patient’s understanding of this and the current pathways for gene therapy and trials currently underway for Usher syndrome (also known as Alström syndrome). Professor Robyn Jamieson discussed Luxturna (voretigene neparvovec), Australia's first gene therapy for inherited retinal disease caused by mutations in both copies of the RPE65 gene, specifically Leber congenital amaurosis. Patients must undergo genetic and clinical testing to establish suitability and if they have sufficient viable retinal cells, she said. She added that phase 2 clinical trials of oral RPB4 antagonists to reduce the amount of vitamin A available to the retinal visual cycle are underway for the treatment of Stargardt disease.

 

Prof Robyn Jamieson

 

Click here to enter text.The last session looked at the efficacy of laser intervention for age-related macular degeneration (AMD). Dr Meri Vukicevic, an orthoptist at Melbourne’s La Trobe University, discussed her study of the long-term use of anti-vascular endothelial growth factor for the treatment of diabetic macular oedema and neovascular AMD. The retrospective study showed that strict adherence to treatment in the first three months may be the critical period for visual gain and to decrease the presence of intra-retinal fluid. Findings also suggest that allowing some subretinal fluid to remain will not affect treatment options.

 

Dr Meri Vukicevic

 

In conclusion

 

From the level of talks and the seamless flow of the event, it was clear that a lot of preparation has been put into this year’s conference by all concerned and I congratulate the Orthoptics Australia team for all their hard work.

 

 

Maddy Scavone is an orthoptist specialising in paediatrics and founder of Speckles, a company focused on children’s vision needs and wants.