ABDO Clinical Conference 2024
Enhancing practical dispensing skills
Providing four rotating CPD skills workshops on paediatric dispensing and acute eyecare for dispensing opticians (DOs), alongside a visual recognition test (VRT) and sponsors’ exhibition, the ABDO Clinical Conference practical days, held on 6 and 7 October at the ABDO National Resource Centre (NRC), formed part of a new-for-2024 hybrid education event incorporating webinars, online peer reviews and Journal Club sessions.
As online conference education continues through November and December, ABDO members have been given the chance to gain up to 24 interactive CPD points before the end of the current three-year cycle – 14 of which could be gained from the NRC practical days. Each of the four skills workshops were approved for three interactive CPD points – with an extra two points available on successful completion of the VRT.
DOs have the technology
Harnessing in-practice technology
The importance of thoroughly triaging the acute eyecare patient was the starting point for the ‘Acute eyecare and technology‘ CPD workshop. This session was curated by Topcon with a supporting introduction from the company’s clinical affairs manager, Danielle Lee. It was facilitated by Alex Webster, ABDO head of CPD, and extended services contact lens optician (CLO), Diane Nash.
Prior to commencing the workshop, Alex pointed out that a customisable triage form was available for ABDO members to download from the ABDO website, which could assist in managing the patient and making a referral along the correct clinical pathway.
Alex went on to discuss the different technologies that were available to support patients presenting in primary eyecare practice with an acute eyecare issue – namely fundus photography, optical coherence tomography (OCT) and slit lamp biomicroscopy. Participants were encouraged to consider the practice team’s scope of practice to support the use of these instruments for acute eyecare.
A key benefit of fundus photography, Danielle explained, was to help the clinician educate the patient through instantly-generated images. The use of ‘true colour’ imagery was useful for differentiating pathologies, while red-free images facilitated better observation of superficial lesions and some vascular abnormalities within the retina and surrounding tissue.
Near infra-red imaging used longer light wavelengths to produce a better vessel-to-background contrast and was suitable for detecting sub-retinal pathologies in the choroid, explained Danielle. Autofluorescence was also beneficial in identifying changes to damaged cells and optic nerve head drusen. Danielle encouraged delegates to familiarise themselves with all the pre-sets on the instrumentation available to them in practice.
Turning to OCT, Danielle outlined the basic fundamentals of the technology, which provided an ultrasound to help diagnose and manage diseases of the retina, optic nerve and cornea. It was important to utilise all the scans available on the practice OCT, she insisted, including 3D macular scans. The latter was important for myopic patients, while utilising the Van Herrick technique of measuring the size of the anterior chamber angle to assess for glaucoma risk could also be valuable.
Solving acute eyecare mysteries
Recent advances in OCT were discussed including swept source and spectral domain OCT for greater scanning depths, and how this could assist with pathology triaging; for example, in signs of wet age-related macular degeneration, retinal detachment and sub-retinal haemorrhaging. How to navigate the OCT and use OCT angiography were also discussed.
Moving on to slit lamp biomicroscopy, Danielle reminded delegates about its importance for patient education. She outlined how different filters worked; for example, the blue filter could be used with fluorescein to stain any areas of corneal damage or a foreign body. Danielle also highlighted the value of the slit lamp’s smart capture and movie functions.
During the ensuing workshop, delegates looked at three real-life patient cases on an OCT, including a ‘red flag’ case of 39-year-old high myope female presenting with flashes and floaters. They then discussed in groups potential diagnoses to support a referral. Alex reminded delegates to always check their local referral pathway for guidance on next steps, and that DOs were not only able to refer – they had a duty to do so. She also urged members to “record everything”.
Acute eyecare detectives
Taking the visual recognition test
The ‘Acute eyecare mysteries‘ workshop saw delegates turn sleuth as they worked together using their clinical knowledge, skills and NRC equipment to identify underlying eye conditions and suggest management and/or referral strategies.
Led by ABDO clinical lead, Max Halford, with ABDO facilitators and regional leads Abi Crutcher, Millie Fellows and Amy Seaman acting as patients from real-life cases encountered by DOs in practice, delegates investigated using clues, images, a triage form as well as a QR code linking to the ABDO Clinical Hub.
With the facilitators acting as real-life patients might, delegates were reminded to use all the tools available to them to consider their line of questioning, and how they would go on to manage the patient depending on their professional role and scope of practice.
Case one – ‘Once bitten, twice shy’ – involved a 47-year-old female patient presenting with sore, mildly red and irritated eyes. She had also recently returned from holiday where she had been bitten by an insect close to her eye; the latter turning out to be a ‘red herring’. The diagnosis was determined as dry eye – and Max reminded delegates that its treatment and management was well within the DO’s scope of practice and that the ABDO Clinical Hub had a Focus on Dry Eye section which could be used as a ‘refresher’.
Case two – ‘A jaw-dropping experience’ – was based on a real-life 76-year-old male patient who had entered the practice and told the receptionist that they were about to visit the pharmacy to obtain some DeepHeat gel for a recent onset pain/ache in their shoulders. He had attended to ask about some recent blurriness, and transient loss of vision the night before.
As the only registrant in the practice at that time, the DO intervened and referred the patient directly to A&E – possibly saving their sight. The condition proved to be giant cell arteritis. Again, Max emphasised the need to use a triage form and follow a logical step-by-step process.
Case three – ‘Connie and Sophia’ – involved a mother (Connie) entering the practice to ask about her daughter (Sophia) who had been suffering from sore, red, watery eyes for nearly a month. She had tried pharmacist-recommended eye drops to no avail and then GP-prescribed chloramphenicol for the past week but with no improvement. Connie’s request was for stronger drops for Sophia.
It transpired that Sophia had a missed case of viral conjunctivitis, which should be possible to detect via the use of a triage form and referral to ABDO’s Advice and Guidelines. However, Max also reminded participants that in cases where the patient wasn’t present, it would be useful to ask to see photographs, and that certain procedures should be followed in terms of patient data protection.
Peer learning support
The final case – ‘Were in but they won’t come out’ – involved a parent presenting with their daughter, who had inserted cosmetic contact lenses purchased online – but now couldn’t get them out. She also wanted advice on whether she could sue the online supplier.
This was clearly a case of where a DO would be able to help avoid a trip to A&E, and raised the question of who was responsible for raising awareness of the risks of buying contact lenses online. The case also allowed for further discussion on scope of practice, which could change through further education and training; for example CLOs who go on to become minor eye conditions service (MECS) CLOs.
Max reminded delegates that they were all capable of inserting and removing a contact lens, and to refresh their skills and knowledge if necessary. He added that ABDO also had a duty to keep members’ skills and knowledge up-to-date; as evidenced by the newly-updated FBDO syllabus. He concluded the workshop by sharing the fact that 70-80 per cent of patients who came into a MECS practice with an acute eyecare issue stayed within the primary eyecare service – without the need for onward referral into secondary care.
Paediatric frame fitting
In the ‘Understanding frame fitting for children‘ skills workshop led by Dr Alicia Thompson, ABDO director of research and professional development, delegates were provided with evidence-based paediatric facial data to further understand how children’s faces developed; and how age, ethnicity and/or special characteristics could influence the facial features that interacted with spectacles.
Using anatomically accurate paediatric model heads, participants were then tasked with translating facial measurements into bespoke cardboard spectacle frames – with support from ABDO facilitators Dean Dunning, Miranda Richardson, Cheryl Hill and Jo Newsome.
In outlining the differences between children and adult facial characteristics, Dr Thompson discussed their differing needs and the importance of patient communication. She highlighted the result of poorly-fitting frames, such as inaccurate effective power, and the potential problems this could cause to the child’s vision and overall development.
Frames that were based on a small adult design were completely incorrect in their parameters for a child’s development, Dr Thompson stated, and would inevitably slide down the child’s nose to find anchorage; often resulting in the child looking over the top of their frames. This could affect their learning in the classroom and their behaviour, as well as their social learning and development.
Poorly-fitting paediatric frames also posed a risk to the child in that their myopia development pathway could be compromised as a result of an effective power change due to slippage; with under-corrected myopia linked to an acceleration in myopia progression. They might also cause tissue or structural damage to the child’s head and face, Dr Thompson added, such as causing permanent tramline marks, which are often observed in adult patients.
Bespoke cardboard spectacles completed
Delegates next set about creating bespoke cardboard frames using measurement tools, with a reminder that it wasn’t recommended to use a ruler with children because it couldn’t measure a negative crest height (the vertical distance from a horizontal intersecting the lower limbus to the crest of the bearing surface of the nose). It was crucial to understand children’s crest height when it came to paediatric dispensing, Dr Thompson explained. Other key measurements were bridge projection, head and temple width, and length to bend.
The ensuing discussion enabled delegates to review how to select suitable frame designs for their paediatric patients, and how this related to frame measurements. Adjustments to support the child’s needs, such as children with hearing aids, was also considered. Communication and the patient journey were discussed, and how the practice could adapt to better support paediatric patients and their careers. This could include a changed tone of voice, not displaying paediatric frames, activities for children, instructions on frame care and maintenance, and addressing any emotional concerns the child and/or carer might have.
The final touches
In ‘The final touches‘ skills workshop, designed and led by Cheryl Hill, ABDO CPD learning manager, delegates rotated around three stations: specialist paediatric frame fitting, pad insertion to an acetate frame, and ptosis props. Facilitators for this session were Dean Dunning, Miranda Richardson, Dr Thompson, Jo Newsome and Rob Barrow.
In the specialist frame fitting rotation, delegates were reminded how to increase the angle of let back by filing, to aid paediatric frame fitting. Following on from Dr Thompson’s session, where it was found that children have a wider head width than adults, this vital adjustment allowed for appropriate frame fitting delegates learned.
Participants were then provided with a variety of speciality paediatric frames – including Tomato Glasses, SeeCreatures, Erin’s World and StarFit – and tasked with fitting them to the paediatric heads. This allowed delegates to learn about the special features these frame ranges have integrated into their design, to better fit the children they see in practice.
During the pad insertion rotation, delegates were shown how to modify a fixed pad bridge into a pad on arms bridge; this was done by safely removing the fixed pad and drilling the back surface to allow the pad arm to be inserted. Such frame modifications opens up more frame choice to children who would like an acetate frame but due to their facial anatomy struggle to find one which fits appropriately, delegates learned.
Working out the finishing touches
Ptosis props are used to raise drooping eyelids, commonly known as a ptosis, which can be congenital or acquired from trauma for instance. This final rotation was supported by demonstration kits supplied Spec-Care of Exeter, and the company’s founder, DO Rob Barrow.
Delegates learnt that ptosis props had the potential to significantly improve patients’ quality of life – and if uncorrected the condition could lead to psychological effects or safety and wellbeing concerns. They also gained practical experience in measuring and fitting ptosis props, learning about their various mechanical qualities and how their appropriate use could alleviate the condition.
“Enjoyable and excellent day”
As well as gaining an extra CPD point via a visual recognition test and discussion on ‘Measurements and pathology‘, members could also catch up with suppliers at the exhibition – supported by EssilorLuxottica and Hoya Lens UK as Platinum Sponsors, and CentroStyle, Coopervision, Mark’ennovy, Menicon, Millmead Optical Group, Ocucuo, Seiko Optical UK, Stepper and Topcon as Gold Sponsors.
Commenting afterwards, Alex Webster, ABDO head of CPD, said: “It was fabulous to see so many ABDO members at the NRC for our hybrid clinical conference practical days. The enthusiasm for learning and engagement people showed in all the CPD sessions was brilliant to experience. We are really grateful to all our sponsors who exhibited over the two days, and who have supported ABDO to provide education to our members across the whole hybrid conference programme.”
Alistair Bridge, ABDO CEO, said: “I’d like to thank everyone who was involved in making this year’s ABDO Clinical Conference such a successful and well-organised event. I was really impressed by how enthusiastic and engaged the members attending the practical days were, in both the workshops and exhibition. I hope that members who have taken part in this year’s new hybrid clinical conference have enjoyed this addition to our core CPD programme.”
Sunday delegate, Karen Burnett, DO and practice manager, told Dispensing Optics: “I found the day educational, insightful and so enjoyable. The organisation was excellent, the workshops were informative, educational and entertaining and kept us all engaged. A huge thank you to both the organisers and sponsors for such a well-executed and interesting day.”
Other comments from delegates included: “It was an informative and engaging day. The ocular mysteries in clinic set-up were great.”; “This was probably the best CDP event that I have attended in a long time. Very relevant to my job”; “It was very well planned out”; “Very informative and will definitely inform my future practice”; “Fantastic – really enjoyed myself and learnt loads”.
ABDO Clinical Conference 2024 education continues into November and December with online peer review and Journal Club workshops. Visit the ABDO Events pages for details of how to join.