COOKIE Issue 17 - Practice Management Issue

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PRACTICE MANAGEMENT ISSUE

October 2024

cookiemagazine.org

Ob Malope and Dr. Laura Matthews transform nontraditional paths into successful regional optometry practices p10

Letter to Readers

Focus on Progress Enhancing care in dry eye disease and practice management

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his issue of COOKIE Magazine focuses on two significant topics in optometry: Dry eye disease and regional practice management.

We interviewed Ob Malope and Dr. Laura Matthews, who shared their experiences and tips for thriving in regional optometry practices. We also explored the latest developments in dry eye disease treatment, including tailored approaches and new technologies that offer hope to millions. Additionally, we examined how automated contact lens ordering systems are transforming practice management by enhancing efficiency and improving patient experience.

Innovations in equipment for dry eye disease, the latest research, and technological solutions continue to evolve, promising new hope for patients. It's encouraging to see that the World Council of Optometry, in collaboration with industry experts, has developed the Dry Eye Wheel to enhance understanding and management of this condition.

Wherever you practice, the key to sustained success lies in consistently honing your clinical skills.

There are no shortcuts to proficiency—it requires a significant investment of time, money, and resources to learn the latest and most effective techniques and technologies.

Engaging in learning opportunities, such as international conferences and similar events, is essential.

Additionally, keeping up with cutting-edge publications

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COOKIE MAGAZINE | October 2024

and following leading experts online and offline greatly enhances our knowledge base.

Ensuring patient satisfaction is equally important.

A couple of years ago, a local celebrity shared her excitement on TikTok about how I managed her son’s myopia with orthokeratology (Ortho-K). That post garnered around 2 million views, giving my Ortho-K practice a significant boost. However, such endorsements are rare. Most Ortho-K practitioners rely on word-ofmouth; one satisfied patient shares their experience with their circle, leading to a boost in appointments.

In this rapidly evolving field, our mantra is clear: Never stop learning. Remember, knowledge waits for no one.

As always, we hope you enjoy this issue!

Best, Dr. Carmen Abesamis-Dichoso

OD, MAT, FPCO, FIACLE, FBCLA, FAAO

In This Issue...

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Cool Optometry Tailoring Dry Eye Solutions Eye care professionals highlight advances in diagnostic tools and therapies that are at the forefront of DED management

Optics

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Streamlining Lens Ordering Automated systems are revolutionizing the way optometrists manage contact lens orders

Cover Story

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Ob Malope and Dr. Laura Matthews transform nontraditional paths into successful regional optometry practice

Enlightenment

Kudos

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From Tanzania to the World With a focus on public health, Dr. Priya Morjaria is bridging gaps in eye care for underserved populations around the world

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Conference Highlights

Innovation

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A New Era of DED Relief From thermal pulsation therapies to smart contact lenses, groundbreaking innovations for dry eye management promise to enhance treatment outcomes

T ears of Relief Dr. Mahnia Madan’s four-step approach to managing dry eye disease

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From Trauma to Treatment Experts at WCPOS V 2024 outline effective strategies for managing pediatric eye injuries eye injuries Balancing Function and Aesthetics Specialists share groundbreaking breakthroughs in pediatric ocular prosthetics and contact lenses Navigating the Digital OR At ESCRS 2024 iNovation Day, experts discuss the game-changing role of AI and digital technologies in the operating room

COOKIE MAGAZINE | October 2024

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Advisory Board Members

Matt Young CEO & Publisher Gloria D. Gamat Chief Editor Dr. Carmen Abesamis-Dichoso

Dr. Purvi Thomson

Abesamis Eye Care & Contact Lens Center, Manila, Philippines

OCL Vision London, United Kingdom

carmen.dichoso@gmail.com

Purvi@oclvision.com

Mapet Poso Editor Matt Herman Associate Editor Maricel Salvador Graphic Designer

Dr. Li Lian Foo

Dr. Kristie Nguyen

Dr. Feenstra and Associates; Dr. Kristie Nguyen PLLC, Florida, USA

Singapore National Eye Centre (SNEC) Singapore

kristie817@gmail.com

foo.li.lian@singhealth.com.sg

Writers Chow Ee-Tan Diana Truong John Butcher Tan Sher Lynn

Hannah Nguyen COO Travis Plage CFO

Dr. Maria Sampalis

Dr. Monica Chaudhry

Sampalis Eyecare Cranston, Rhode Island, USA

Learn Beyond Vision New Delhi, India

monica.rchaudhry@gmail.com

msampalis@hotmail.com

Society Friends

Ruchi Ranga Society Relations & Conference Manager International Business Development Brandon Winkeler Robert Anderson Sven Mehlitz

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Let's talk! Send us an email at editor@mediamice.com.

To place an advertisement, advertorial, symposium highlight, video, email blast, or other promotion in COOKIE magazine contact sales@mediamice.com

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COOKIE MAGAZINE | October 2024

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Cool Optometry |

DED MANAGEMENT

Tailoring Dry Eye Solutions Eye care professionals highlight advances in diagnostic tools and therapies that are at the forefront

of DED management

by John Butcher

Tailored approaches to dry eye disease (DED) treatment are becoming the norm, with eye care specialists utilizing advanced technologies to create personalized care plans. Not to mention, patients now have access to various contact lens options designed for DED management. These developments not only enhance the understanding of dry eye but also open new avenues for relief, offering hope to those who struggle with this common condition.

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hile there remains no cure for dry eye condition, advances in technology and treatments offer hope to millions who suffer from it. According to eye care professionals, new ophthalmology equipment allows for more accurate diagnoses, while recently developed treatments have proven effective in combating symptoms. Additionally, there is an increasing understanding

of how overall health impacts the condition, along with greater awareness of the effects of contact lenses.

The importance of accurate diagnosis “Thorough investigation and examination to determine the correct dry eye diagnosis is crucial

for establishing the most suitable treatment options,” opened Mr. Connan Tam, director of the Dry Eye Centre in London, United Kingdom.

Once an accurate diagnosis has been made, technological advances also offer better options for treating the condition. “It is important to identify where the patient falls on the spectrum of dry eye to determine whether to recommend treatment for aqueous deficiency, evaporative dry eye, or both,” he said.

“It is important to identify where the patient falls on the spectrum of dry eye to determine whether to recommend treatment for aqueous deficiency, evaporative dry eye, or both.”

— Mr. Connan Tam

According to Mr. Tam, there are now numerous devices that can aid in diagnosing dry eye more accurately, including meibography using infrared capture. “It is a very important

COOKIE MAGAZINE | October 2024

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Cool Optometry |

DED MANAGEMENT

technique that enables us to visualize the meibomian gland structure,” he continued.

Tailored approaches to dry eye treatment Mr. Alisdair Buchanan, who leads Buchanan Optometrists practice in Kent, United Kingdom, noted that advances in diagnosis—such as tear film analysis, meibomian gland imaging, and new diagnostic tools— also help develop treatment plans tailored to individual patients.

Dr. Branka Marjanovic, consultant ophthalmologist and oculoplastic surgeon at Moorfields Eye Hospital, London, highlighted that another emerging trend in dry eye diagnosis is the use of biometrics and artificial intelligence (AI) to personalize treatment plans.

Introduced a little over 10 years ago, intense pulsed light therapy (IPL) for the treatment of dry eye has also seen significant advances over the years.

“IPL therapy has become a leading treatment of choice for meibomian gland dysfunction and rosacearelated dry eye,” said Dr. Marjanovic.

“This therapy delivers broadband, non-coherent light to the skin surrounding the eyes, typically using wavelengths between 560 nm and 1200 nm.”

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Mr. Tam explained that there are several mechanisms by which this technology operates. “With the correct wavelength and fluency, IPL can obliterate the abnormal superficial blood vessels on the skin’s surface that developed due to inflammation. This restricts the delivery of inflammatory markers to the eyelid margin,” he said.

“The light itself has a photobiomodulation effect, increasing anti-inflammatory markers and inhibiting pro-inflammatory markers to reduce lid margin and ocular surface inflammation.

Photobiomodulation also boosts the energy of the mitochondria in the meibomian gland cells to improve their function,” he added.

A more recent development in dry eye treatment is low-level light therapy (LLLT), which concentrates wavelengths towards the red and near-infrared spectrum to deliver photobiomodulation deeper into the skin surface.

“This treatment option has become an excellent alternative and even adjunct therapy to IPL,” confirmed Mr. Tam.

Innovative therapies for dry eye relief According to Mr. Buchanan, intense restricted pulsed light (IRPL) and

COOKIE MAGAZINE | October 2024

Blephasteam masks have also shown significant promise in managing dry eye. Emerging treatments—such as new in-practice cleaning procedures using okra-based products for eyelid cleaning and amniotic membrane contact lenses designed for severe cases of dry eye—also show promise.

“These lenses, made from amniotic tissue, promote ocular surface healing, offering relief in extreme cases,” he said. “Additionally, practitioners should also consider prescribing makeup products specifically formulated for dry eye patients to reduce further irritation.”

While light-based therapy has proven effective for dry eye, it also reduces reliance on traditional treatments such as oral antibiotics, which can affect gut health.

“We are becoming increasingly aware of the role that gut health plays in systemic inflammatory control and dry eye,” said Mr. Tam. “It is preferable to avoid oral antibiotics when possible to prevent disrupting the normal gut flora.”

Another treatment trend to consider is regenerative medicine, such as stem cell therapy, according to Dr. Marjanovic. “Research into stem cell therapy for regenerating damaged tear glands or repairing ocular surface damage could offer long-term solutions for chronic dry eye,” she said.

Contributors New medications and therapies are also being developed, including drugs that target specific pathways involved in the development of dry eye, she said. Additionally, remote monitoring, which provides real-time data to healthcare providers, enables them to adjust treatments more effectively.

Dry eye and contact lenses According to Mr. Tam, while treatments have improved, the options offered by contact lenses have also advanced. Wearing contact lenses can have multiple negative impacts on dry eye, including disrupting tear film function and altering the normal blink reflex, which can exacerbate the condition.

With these issues in mind, Mr. Tam added, it is important for people with dry eye to carefully consider their choice of contact lenses, as the lens material plays an important role in their comfort and effectiveness.

Hydrogels with high water content can provide comfort during the first few hours of wear. As the day progresses, however, the water in the lenses evaporates. “The dehydrated lens can in turn draw water from the tear film, which further increases symptoms of dry eye,” he said.

Silicone hydrogel lenses provide better oxygen transmissibility, but their higher modulus level can add friction between the lid-lens as well as corneal-lens interaction. This can increase contact lens discomfort and aggravate dry eye symptoms, he added.

“Newer materials have been designed with better stability and improved wetting agents to increase surface wettability, reduce friction, and enhance resistance to dehydration.

These lenses have been shown to perform better in individuals with dry eye,” Mr. Tam continued.

“Lens wear modality is also an important factor to consider when choosing a lens,” he added. He noted that longer-wear lenses require cleaning and disinfection to prevent infection, which can introduce preservatives and cleaning agents

onto the ocular surface, potentially irritating the sensitive eye.

“Daily disposable lenses are the preferred modality for dry eye patients as they are packaged in blister packs with preservative-free solution,” he explained.

When the eye cannot tolerate conventional contact lenses due to severe dry eye, Mr. Tam recommends scleral lenses—larger-diameter rigid lenses that rest on the sclera while vaulting over the cornea, ensuring no contact with the corneal surface.

The lens is filled with a nonpreserved saline solution, creating a liquid reservoir that bathes the corneal surface and provides optimal hydration.

“A well-fitted scleral lens will have minimal or no movement, thereby reducing friction on the ocular surface. Visual correction with a scleral lens can be superior, especially in cases of irregular corneal surfaces. In chronic and severe dry eye, there may still be some discomfort experienced due to the lens-lid interaction, but scleral lenses can help minimize the bulk of the pain caused by corneal contact experienced with conventional lenses,” Mr. Tam explained.

A multifaceted approach to DED management The future of dry eye management looks promising, with ongoing advances in technology and lens materials, allowing for more focused and targeted treatments and providing patients with better choices between contact lenses and spectacles.

“As practitioners, we must not simply jump on the latest trend as a wonder cure,” said Mr. Buchanan. “What I have learned after many years of using the latest technologies is that treatments require a multifaceted approach, often taking time to resolve and requiring at least a couple of visits.”

Mr. Connan Tam is the director of the Dry Eye Centre in London, United Kingdom (www.dryeyecentre. co.uk), which was established in 2013 and has more than 10 years of experience in intense pulsed light therapy. He holds dual qualifications as both an orthoptist and optometrist, specializing in pediatric eye care, as well as complex contact lens fitting and dry eye management. connantam@dryeyecentre.co.uk

Mr. Alisdair Buchanan leads the award-winning Buchanan Optometrists practice in Kent, United Kingdom. His clinic won the Optician Award for ‘Technology Practice of the Year’ and ‘Independent Practice of the Year’ in 2023-2024. His expertise in dry eye management, combined with the adoption of cuttingedge technologies, has positioned his practice at the forefront of advanced eye care. info@optometrists.co.uk

Dr. Branka Marjanovic is a leading consultant ophthalmic and oculoplastic surgeon based at Moorfields Eye Hospital London. She graduated from Guy’s and St. Thomas’ Medical School, University of London, over 20 years ago, later specializing in oculoplastic surgery at Moorfields Eye Hospital. She has contributed research to a range of medical journals and is a member of various prestigious ophthalmic organizations, including The British Oculoplastic Surgery Society.

Additionally, Dr. Marjanovic also serves as a joint divisional director for Moorfields North and is actively engaged in teaching and training medical professionals.

Her specialty interests include blepharitis, dry and watery eye treatments, eyelid inflammatory conditions, blepharoplasty, surgery for correction of droopy eyelids (ptosis), eyelid augmentation for ectropion, entropion, precision removal of periocular eyelid lesions, and anti-wrinkle injections for cosmetic and medical indications (blepharospasm). www.drbrankamarjanovic.com

COOKIE MAGAZINE | October 2024

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Optics | CONTACT LENSES

Streamlining Lens Ordering Automated systems are revolutionizing the way optometrists manage contact lens orders by John Butcher Dr. Ian Whipple is among the practitioners who have embraced automated contact lens ordering software, simplifying the process for the staff and patients. With features like direct access to electronic medical records and automated reminders, the system enhances accuracy and satisfaction, marking a significant shift in contact lens management.

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ontact lenses have long been a staple stream of business for many optometrists. However, traditional ordering methods can be time-consuming and occasionally result in inaccuracies.

Simplifying the ordering process According to Dr. Ian Whipple, owner and optometrist at Vision Source of Farr West and South Ogden, Utah, USA, the introduction of automated contact lens ordering software has changed this landscape—bringing with it greater efficiency and satisfaction for both patients and opticians alike.

“Before using this software, our opticians had to manually enter contact lens information—such as Rx and lens base curves/diameters— into our distributor’s order page. This process was time-consuming and led to occasional transcription errors, resulting in returns of inaccurately ordered contact lens boxes,” he told COOKIE Magazine.

Switching to an automated system has made the task “ridiculously easy,” he said, allowing staff members to pull up contact lens information directly from the company’s electronic medical records system and submit orders directly to their distributor with the click of a button.

“The system has improved customer satisfaction, allowing for quicker,

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easier, and more accurate ordering system of new lenses,” added Dr. Whipple.

The process has also been a hit among the company’s staff, making their job less complicated with fewer margins for error. “They love being able to order with one click instead of spending time navigating another website to order manually. The extra five minutes saved can now be spent on other office tasks,” he enthused.

of the company counter, they do not come without issues.

One challenge, according to Dr. Whipple, was that every contact lens had to be uniformly noted within the system so that CLX could recognize the name and product details necessary to generate an accurate order.

“For example, a My Day daily disposable contact lens might have been originally entered in our system as ‘My Day Sphere,’ but we needed to change its name to ‘My Day daily disposable’ for CLX to recognize it.

We probably spent less than three hours of staff time setting up this process,” he said.

Overall, however, the system has been a great boost to the business, according to Dr. Whipple. “Any time we have the opportunity to automate a process in our office, we see improvements in efficiency and accuracy. We’ve definitely realized this with our integrated contact lens ordering system, CLX,” he concluded.

Contributor

A seamless integration Vision Source embraced CLX (EssilorLuxottica; Paris, France) early on, impressed by its features. One notable feature is the automated email and text reminders sent to customers who don’t order an annual supply of lenses on their original reorder date. These reminders direct them to the online ordering portal, allowing them to obtain the remaining lenses needed for their annual supply.

“These lenses are ordered directly through CLX and come from our distributor. To the patient, it appears as if they're ordering directly from our office. We keep the revenue, and patients don't have to shop around,” explained Dr. Whipple.

Navigating system setup and challenges While automated contact lens ordering systems can significantly enhance satisfaction on both sides

COOKIE MAGAZINE | October 2024

Dr. Ian Whipple is the owner and optometrist at Vision Source of Farr West and Vision Source of South Ogden.

He graduated from Utah State University and received his Doctor of Optometry at The Ohio State University. In 2019, Dr. Whipple received the Best Practices Award, recognizing his commitment to excellence in eye care. His primary clinical focuses include specialty contact lenses, dry eye management, and advanced macular degeneration care. A regular contributor to Review of Optometric Business, Dr. Whipple also practices aesthetic optometry, offering services like lid lump/bump removals and Botox injections.

He and his wife, Taunya, are the parents of two children, Grant and Gwen. He is a passionate musician who plays the piano and guitar and enjoys jamming with his bands.

He is also an avid runner and rock climber. iwhipple@gmail.com

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Cover Story

Ob Malope and Dr. Laura Matthews transform nontraditional paths into successful regional optometry practices

by Diana Truong

As more optometrists trade the hustle of city life for the tranquility of rural living, they find that running a regional practice brings its own unique set of challenges and rewards.

Two seasoned experts—each with distinct perspectives— shared their tips and tricks for thriving in a regional optometry practice, revealing how embracing a slower pace of life can lead to unexpected opportunities for growth and community impact.

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COOKIE MAGAZINE | October 2024

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n the world of optometry, success often hinges on adaptability and connection with the community.

Ob Malope and Dr. Laura Matthews exemplify this principle through their unique journeys into regional practice. From mastering the business side of optometry to prioritizing quality over quantity, both optometrists showcase the profound impact they can have in underserved areas.

From student to consultant Ob Malope’s journey into optometry was more than just about understanding eye health—it was about mastering the business of running a practice. As a young optometry student in South Africa, Malope quickly noticed that while academic and clinical skills were emphasized, the business side of optometry was often overlooked.

"Regional optometry practices in Africa face challenges with managing the constant patient flow."

- Ob Malope

Determined to fill that gap, Malope worked for top optometry practices across South Africa, sometimes offering his services for free to learn the ropes. By 2019, after years of hands-on experience in both franchise and independent practices, as well as stints in contact lens and lens manufacturing, Malope launched his own optometry consulting business. Today, he’s not only a consultant but also an educator and writer, providing innovative solutions for optometrists across Africa.

A nontraditional route Dr. Laura Matthews’ path to optometry was anything but typical.

At 31, when many people are settling into their careers, this New Zealander took a leap and went back to school, earning her Bachelor of Optometry (BOptom) degree from the University

of Auckland at 37. Her story isn’t just about late-blooming ambition— it’s about finding opportunities in unexpected places.

After moving from Auckland to Townsville, Australia, with her partner and newborn son, Dr. Matthews found herself drawn to the slower pace and affordability of life in the new location.

When her son started school, fate intervened. A local optometrist was retiring, and she seized the opportunity to take over the practice.

What started as a financial decision turned into a fulfilling career move, allowing her to build a thriving practice in a community that quickly became home.

A balancing act In regional areas, the dynamics of supply and demand for optometry services can differ significantly from

those in urban centers. According to Malope, “General optometry services in urban areas have been on the decline. Patients would rather go online to get the eye care they need.”

In rural settings, however, it's entirely a different story. With fewer optometrists in these regions, patients often flock to local practices, driving demand for in-person services. “There is growth in general optometry services in remote areas,” Malope noted.

Dr. Matthews experienced firsthand how patient loyalty can flourish in regional communities. When she took over a long-established practice, she inherited not only her predecessor’s patients but also their children and grandchildren. “The guy I took over from had patients for decades, along with their families,” Dr. Matthews shared.

COOKIE MAGAZINE | October 2024

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Cover Story

But building trust in a close-knit community wasn’t easy. “I had to prove myself to people who had only ever seen Bernie [her predecessor],” she said. “That first year was slow, but now we are exceptionally busy.” With a growing client base and patients spreading the word, her practice is now booked out two weeks in advance.

Efficiency becomes essential with a constant flow of patients.

Malope stressed the importance of technology in streamlining operations. In Africa, digital tools like Nevada Cloud (Sunridge Park, South Africa) have been game changers.

"Regional optometry practices in Africa face challenges with managing the constant patient flow," Malope explained. "Nevada Cloud uses AI to process patient data efficiently. It is accessible and cost-effective."

For Dr. Matthews, maintaining a tight schedule is essential to managing her busy practice. She stressed the importance of patient punctuality. "If you turn up 20 minutes late, my front staff will let you know that I can’t see you right away. We can rebook you in three weeks," she said.

While this strict scheduling helps maintain order, it also means she has to manage emergency cases with care. "I keep a couple of slots open for urgent appointments, but it’s easy to burn out," she admitted. Dr. Matthews has found balance by embracing a four-day workweek, which she credits for her continued success and wellbeing. "The four-day workweek is the only reason I’m still functioning at a high level," she shared.

Quality over quantity In regional optometry, quality trumps quantity. Patients in rural Africa often travel long distances for care, so providing comprehensive services during each visit is critical. As Malope put it, "People are traveling from far away to access your services. They can’t come regularly, so you have to make sure you cover everything in one visit."

For Dr. Matthews, prioritizing quality is the cornerstone of her practice.

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She ensures each patient gets enough time and attention, even while running on a tight schedule. “I focus on quality, not quantity,” she asserted.

This personal touch extends to communication—Dr. Matthews prefers to keep things "old school," handling patient testing herself and taking the time to communicate clearly. “I feel they’re more likely to buy from me if I’ve explained in detail why they need these glasses or contact lenses,” she said.

Malope also noted the importance of involving patients in the decisionmaking process but emphasized that good communication starts with trust. "You cannot have open communication if you haven't built trust, and you can only build trust if you genuinely care," he asserted.

Trust is everything Building trust in a regional optometry practice goes beyond providing good care—it requires a deep connection with the community. In rural African areas, relationships matter.

According to Malope, the first step is speaking the same language, both literally and figuratively. “People in rural communities speak completely different languages, so you have to consider that when you implement solutions. You literally have to entrench yourself in the community,” Malope shared.

Respect is key, and one of the quickest ways to earn it is by learning the local language. “When you're speaking like them and telling them how you care... it makes it easier for them to trust,” Malope continued.

Clear communication is equally important, particularly when patients travel long distances to your practice.

Being upfront about their needs and the costs involved builds the patient’s confidence in you and increases the likelihood of return visits.

In these close-knit areas, trust is often built through local leaders.

“If the local leaders trust you, the rest of the community will also trust

COOKIE MAGAZINE | October 2024

you,” Malope emphasized. This trust isn’t just about offering medical services—it’s about understanding and respecting traditional health practices. “There’s a lot of traditional health in remote areas, and you have to find that balance,” he added.

Trust can spread like wildfire in these communities. “If you help one person, word spreads quickly,” Malope observed. “For every one person you help, 10 more will come.”

This ripple effect can transform your practice into a trusted pillar of the community—so long as you’re willing to think outside the box and deliver on your promises. The rewards are immense, both in patient loyalty and the satisfaction of making a real difference.

However, trust is delicate. Dr. Matthews warns that a single dissatisfied patient can spread word fast. “If you piss off one person, they’re going to talk,” she cautioned.

"I've seen other optometry clinics here get a bad reputation, and people just turn their backs."

A team effort The significance of well-trained and motivated staff in a regional optometry practice cannot be overstated. Dr. Matthews emphasized the pivotal role her front staff play.

"My front staff work WITH me. I just want to make that clear," she explained. "If I didn't have them, there's no way that I would be as busy as I am. The front staff are just as important as me." This collaborative spirit ensures that patients receive consistent care and attention, reinforcing her practice’s reputation in the community.

Training is a cornerstone of this collaboration. Dr. Matthews is proactive in developing her staff’s skills. "If I find the right person and they want to, I'd be happy to pay for them to do their dispensing certificate," she said. "I think it’s important. I want people to know what they’re doing." This commitment to education not only enhances the quality of service but also fosters a knowledgeable team that can better assist patients.

Contributors Malope also highlighted the growing importance of accessible training resources. "During the pandemic, a lot of companies built learning platforms that became open, easily accessible, and free of charge to the industry. Today’s media has allowed us to communicate with even the most remote positions," he added.

This makes training materials more accessible than ever and bridges gaps that previously existed due to geographic isolation.

With the support of these modern learning tools and a commitment to staff development, regional practices can ensure their teams are wellprepared to deliver exceptional care.

Bridging the tech gap In regional optometry practices, the use of technology can be both a blessing and a challenge. Dr. Matthews emphasized the importance of advanced equipment. “I believe every clinic should have an optical coherence tomography (OCT),” she asserted. Her OCT is five years old, and she noted that newer models offer even greater capabilities. “There’s no reason why every clinic shouldn’t have them,” she added.

Additionally, Dr. Matthews highlighted the necessity of a topographer, particularly in areas with a high prevalence of conditions like keratoconus. “It makes my load a whole lot easier,” she explained. “And it’s also good for when I refer patients to an ophthalmologist.”

However, not all practices are equipped with the space needed for an extensive array of technology. Dr. Matthews candidly admitted, “There are things that I would like, but I don’t have room for all of the stuff.”

This limitation can impact the range of services offered, even in wellestablished practices.

In contrast, the technology gap in remote areas of Africa is often more about access than space. “The biggest challenge of the majority of optometrists working in regional areas is the fact that they don’t have access to quality products and solutions,” Malope explained. In these

regions, companies sometimes overlook the value of doing business due to logistical constraints.

This lack of access leaves optometrists frustrated, as they are unable to provide the necessary care for their patients. “Patients often present at a late stage, expecting solutions that are not readily available,” Malope said. This can create a difficult situation where managing patient expectations becomes an additional challenge.

Efforts to bridge this gap are underway. Malope highlighted the work of Eyefrica Media (Durham, North Carolina), which has facilitated greater collaboration and awareness among companies like CooperVision.

“CooperVision is teaming up with Eyefrica Media to devise a program for optometry schools across the continent,” he noted. This initiative aims to improve access to essential products and solutions in remote areas by leveraging the outreach programs of optometry schools.

As regional practices continue to navigate these technological challenges, finding creative solutions and fostering collaboration will be key to advancing patient care and service delivery.

Navigating patient care and business needs At the end of the day, managing a regional optometry practice is a delicate balance of patient care, community engagement, and business acumen. While the challenges are unique—from staffing shortages to technological limitations—so too are the rewards.

Both Malope and Dr. Matthews demonstrate that success in these settings stems from adaptability, a commitment to quality, and building trust within tight-knit communities.

By embracing these principles, regional optometrists can not only thrive but also make a lasting impact, shaping the future of optometry in underserved areas.

Ob Malope is a dynamic, award-winning leader in the healthcare industry who has made significant strides in championing and pioneering innovative products and solutions.

With over 13 years of experience in the optometry sector, Malope has held a variety of roles, including optometrist, sales representative, and business owner, gaining a broad and deep understanding of the industry. Known for his fresh, relevant, and solution-oriented business approach, Malope is not afraid to challenge the status quo, and his passion for developing and transforming optometry businesses is evident in his work. As a speaker, author, and strategist, Malope currently serves as the managing director of Visionstryt, a business management and service consulting firm that focuses on aligning the academic, clinical, and business aspects of optometry. He is also the co-founder of Eyefrica Media, a platform that enhances collaboration within the African optometry community, and Activyt, further expanding his influence in the field. hello@obmalope.com Dr. Laura Matthews After spending her 20s exploring the world, representing New Zealand as an amateur boxer, and performing stunts on television and film sets, Dr. Laura Matthews’ life took an unexpected turn when she failed the eye examination required to become a police officer. That moment shifted her path entirely, leading her to pursue a career in optometry at the University of Auckland. Graduating in 2017 with first-class honors, Dr. Matthews now owns and operates Bernie Lanigan Optometrist (part of The Optical Company) in Townsville, Queensland, Australia. Her passion for ocular pathology and specialty contact lenses has become a focal point of her practice. Beyond her professional achievements, Dr. Matthews is also a mother of two and has developed a newfound love for Brazilian jiu-jitsu, which keeps her grounded and energized.

While her decision to move to a regional area has proven fulfilling, the only thing she truly misses from her previous lifestyle is surfing. laura.matthews@lanigans.com.au

COOKIE MAGAZINE | October 2024

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Kudos |

WOMEN IN OPTOMETRY

From Tanzania to the World

With a focus on public health, Dr. Priya Morjaria is bridging gaps in eye care for underserved populations around the world

by Chow Ee-Tan

Growing up in a small Tanzanian town, Dr. Priya Morjaria experienced firsthand the struggles of limited access to eye care, which ignited her passion for public health. Now a leading figure in global eye health initiatives, she’s dedicated to improving services for low- and middle-income countries.

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COOKIE MAGAZINE | October 2024

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r. Priya Morjaria, assistant professor at the London School of Hygiene and Tropical Medicine (LSHTM), practiced community and hospital optometry for three years before pursuing an MSc in Public Health for Eye Care at LSHTM. She then joined the International Centre for Eye Health (ICEH) as a researcher and later on completed her PhD with a focus on the effectiveness and efficiency of school eye health services.

Today, Dr. Morjaria co-chairs the School Eye Health Working Group at the International Agency for the Prevention of Blindness and serves

she added. By then, she realized that her true passion was in research rather than clinical practice.

Tracking children’s eye health After completing her PhD, she joined Peek Vision, a social enterprise focused on providing sustainable access to eye care in Africa and South Asia. Over the years, her role has evolved, and she is currently the head of Global Programme Design.

on the World Council of Optometry’s (WCO’s) board of directors as the public health committee chair.

“I grew up in East Africa as a thirdgeneration Indian in a small town called Tabora in northwest Tanzania, living with my grandparents, parents, uncle, aunt, and cousins,” shared Dr. Morjaria. It was a small town with a close-knit community where everyone knew everyone,” she recalled. She later attended an international school in Dar-es-Salaam before moving to the United Kingdom for university—where she now calls home.

A life-long journey begins

her family had to travel long distances to replace her glasses— which broke easily. “They were made of glass, and I really didn’t like wearing them,” recalled Dr. Morjaria. “I was teased and bullied, often told nobody that would want to marry a ‘four eyes!’”

Her decision to pursue optometry was influenced by two significant While considering a career as a events in her childhood. “My clinical optometrist, Dr. Morjaria also grandfather went blind after a wanted to improve access to eye care cataract surgery that went wrong and for people in low- and middle-income later developed countries. Leaving glaucoma,” she a well-respected “My grandfather shared. “I have job with a went blind after a vivid memories reasonable salary of him fumbling was a risk, but she cataract surgery around the house, chose to pursue that went wrong trying to get on an MSc in Public with his daily life.

Health instead. and later developed Additionally, I was glaucoma.” diagnosed with “A few months high myopia by into my program, the age of five. My teachers wrote to I realized I really enjoyed learning my parents, telling them that I was about public health principles and not paying attention in class and the importance of evidence-based even labeled me as ‘stupid’. One day, service delivery. But I had no idea I tripped over the teacher’s dog that how to turn that into a career until my used to wander into the classroom.

MSc dissertation supervisor, Prof.

It turned out I simply couldn’t see Clare Gilbert, saw the potential in clearly!” me and mentored me,” Dr. Morjaria shared. “Working on various research At the time, access to refraction and projects at ICEH exposed me to optometry services was limited, and different countries and experiences,”

“During my PhD, I met Peek’s founder, Andrew Bastawrous, who was eager to implement some of the work that had been done in Kenya focused on tracking children with eye health issues to ensure they receive the care and services they require,” she said. “I wanted to build on the research in Kenya and explore whether educating parents, teachers, children, and their peers would encourage those in need of eye care to follow through with referrals and treatment. Using the software developed by Peek, we tracked these children throughout their journey and sent voice/SMS reminders to parents about their children’s needs. This became the second clinical trial as a part of my PhD,” she shared.

Dr. Morjaria now works closely with the Partnerships and Programmes teams, bringing together the relationships and networks she has fostered over the years with the public health and the clinical standards necessary for effective program designs.

Bridging academia and practice The year 2017 was particularly memorable for Dr. Morjaria, as she was awarded the prestigious Paul Berman Young Leader Award by the WCO. “I was very honored to be recognized as an ‘expert’ in the field. At that time, there weren’t many optometrists who were both in the academia and also worked in the program field—and that meant I was able to bring both perspectives to important conversations,” she shared. “At the time, I was also trying to find my place in the sector and

COOKIE MAGAZINE | October 2024

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Kudos |

WOMEN IN OPTOMETRY

exploring how I could best contribute to the field of global eye health.”

Indeed, Dr. Morjaria has made school eye health a key focus in her work.

Over the past few years, she has been developing and validating a tool from Peek, called School Eye Health Rapid Assessment (SEHRA).

strategy and the global agenda, including supporting the successful Optometry Program for Advocacy and Leadership (OPAL), which fosters future leaders in optometry worldwide.

Despite a successful career at a relatively young age, Dr. Morjaria acknowledges the challenges and barriers she faced along the way.

“I realized that while school eye health programs are regularly “I am a woman of “When I started in implemented Indian origin who globally, there are grew up in East this field, I didn’t significant gaps in Africa,” she said. realize how gender, standardization “When I started and sustainability. in this field, I ethnicity, and age This tool, didn’t realize how combined meant I developed in gender, ethnicity, had to work extra collaboration and age combined with the sector, meant I had to hard to have my has been work extra hard voice heard or to be implemented in to have my voice taken seriously.”

India, Pakistan, heard or to be Liberia, and taken seriously,” South Africa. We she shared. “I are also planning a national SEHRA in have sat at many meetings where Uganda,” she elaborated. my opinions went unrecognized until someone else echoed the same “The tool consists of two modules: idea. I know this may sound The first investigates environmental cliché, but these experiences factors and the readiness of a are more common than we location to implement a school eye realize, and it’s an issue we health (SEH) program, while the haven’t learned to address,” she second gauges the magnitude of added. eye health needs among children.

By integrating these modules, we “Now, as a mother to a seven-monthensure that the planned program old son, it’s even more challenging. will be tailored and suitable to Like any mother, I want to set an the environment and address its example for him and show that his specific needs. Too often, school mummy is strong and confident, but eye health initiatives focus solely on that’s not always easy. I have noticed refractive errors, neglecting other eye the subtle perception changes conditions in children,” she explained. when you attend a meeting with a baby or have a crying infant in the background during a call,” she shared.

Breaking barriers and

navigating challenges

One of Dr. Morjaria’s key leadership roles is serving as chair of the Public Health Committee at the World Council of Optometry. In this position, she works with other optometrists dedicated to public health, advocating for its crucial role in the wider agenda of preventing avoidable blindness and strengthening health systems. As chair, she works alongside regional representatives and committee members on projects that align with the WCO

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Dr. Morjaria believes we still have a long way to go in fully understanding the challenges and barriers faced by women in the workplace, particularly those from minority ethnic backgrounds and younger generations. “On the other hand, I understand the intersectionality of the different factors in many work situations and appreciate the various cultural and language nuances that come into play in many work situations,” she said.

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Dr. Morjaria admitted she never fully understood the importance of a worklife balance until she welcomed her baby earlier this year.

“I am guilty of not maintaining a worklife balance for a very long time. But now I consciously plan and make time for it to be the best version for my son. I love running—I have completed four marathons and hope to do a few more, although it feels very challenging at the moment. I also love reading and spending time outdoors,” she enthused.

Small changes, big impact “Looking back, if I hadn’t had access to an eye test and a pair of glasses at five, I wouldn’t be where I am today,” concluded Dr. Morjaria. “I firmly believe we’re where we are for a reason. So, during difficult times, I remind myself that I am here to make a contribution—however small it is, in the hopes of changing a life.”

Contributor Dr. Priya Morjaria has over 15 years of experience in public health. Before joining the London School of Hygiene and Tropical Medicine (LSHTM) to pursue her interest in public health full-time, she practiced both hospital and community optometry. She completed her MSc in Public Health for Eye Care at LSHTM and earned a PhD with a focus on the effectiveness and efficiency of school eye health services. Currently, she is an assistant professor at LSHTM and has worked on eye health research and programs in over 22 countries.

Her work has been recognized by the World Council of Optometry with the 2017 Paul Berman Young Leader Award. She is also a Fellow of the College of Optometrists and the European Academy of Optometry and Optics, as well as the head of Global Programmes at Peek Vision. Additionally, she is the chair of the Public Health Committee at the World Council of Optometry. priya.morjaria@lshtm.ac.uk

Industry Update

Aldeyra Therapeutics Resubmits Reproxalap NDA for DED Treatment

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ldeyra Therapeutics, Inc., a biotechnology company devoted to discovering and developing innovative therapies designed to treat immune-mediated and metabolic diseases, recently announced the resubmission of a New Drug Application (NDA) to the US Food and Drug Administration (FDA) for topical ocular reproxalap, an investigational new drug candidate for the treatment of signs and symptoms of dry eye disease (DED).

The resubmission includes previously disclosed positive results from a recently completed DED symptom trial requested by the FDA following review of the previously submitted NDA, as well as a draft label reflecting acute activity in reducing dry eye symptoms in a dry eye chamber trial, chronic activity in reducing dry eye symptoms in a field trial, and acute activity in reducing ocular redness in two dry eye chamber trials.

“If approved, reproxalap would have the potential to be the first dry eye disease therapy for chronic use with pivotal data demonstrating acute activity in reducing dry eye symptoms and ocular redness, two characteristics of dry eye disease of primary importance to patients,” said

Todd C. Brady, Aldeyra’s president and chief executive officer.

In August 2024, Aldeyra announced the achievement of the primary endpoint in a Phase 3 randomized, double-masked, vehiclecontrolled dry eye chamber clinical trial of reproxalap in patients with dry eye disease.

Reproxalap was statistically superior to the vehicle for the prespecified primary endpoint of ocular discomfort (P=0.004), an FDA-accepted symptom of dry eye disease. To Aldeyra’s knowledge, the results represented the first positive Phase 3 clinical trial in a dry eye chamber with a symptom as a primary endpoint, and Aldeyra believes that results are supportive of the potential rapid clinical effect of reproxalap on reducing the ocular discomfort associated with dry eye disease.

The Prescription Drug User Fee Act target guidelines for NDA resubmissions include acknowledgment of acceptance for review within 30 days of submission and completion of submission review within six months.

For more information, visit aldeyra.com.

COOKIE MAGAZINE | October 2024

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Innovation |

DED TREATMENT

A New Era of DED Relief From thermal pulsation therapies to smart contact lenses, groundbreaking innovations for dry eye management promise to enhance treatment

by Tan Sher Lynn outcomes Dry eye disease (DED) is a multifactorial condition affecting millions of individuals worldwide. With its increasing prevalence, especially in modern digital societies, more patients are experiencing symptoms that significantly impact their quality of life. Dr. Carmen Abesamis-Dichoso shared her insights on the causes, evolving understanding, and treatment landscape of this prevalent condition.

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r. Abesamis-Dichoso, a seasoned optometrist from the Philippines with over 34 years of practice, highlighted the primary causes of dry eye disease as a combination of different factors.

“Aging, lifestyle, the digital world, and health issues requiring medications affect the ocular surface,” she

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explained. The impact on quality of life can be significant, with patients experiencing negative effects on visual function, activities, and work productivity. “Severe DED symptoms had a greater impact on vision-related quality of life and work productivity,” she continued.

In her private practice, Dr. AbesamisDichoso reported that 40% to 50% of her patients present with symptomatic DED, emphasizing the condition's widespread nature.

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Treatment innovations Among the breakthroughs in DED treatment, thermal pulsation therapies like LipiFlow® (Johnson & Johnson; Ontario, Canada) have shown significant promise for managing dry eye caused by meibomian gland dysfunction (MGD).

Dr. Abesamis-Dichoso shared that randomized clinical trials conducted in 2021 indicated “significant positive changes” in various metrics, including the Standard Patient Evaluation of Eyelid Disease (SPEED), Meibomian Gland Yielding Secretion Scores (MGYSS), and Meibomian Gland Yielding Liquid Secretion (MGYLS).

She noted that regenerative therapies are also emerging as a vital part of the treatment landscape for moderate to severe dry eye.

She emphasized the effectiveness of cryopreserved amniotic membrane (CAM) treatments, stating, “CAM has demonstrated an improved ocular surface and decrease in the severity of dry eye for moderate to severe condition that doesn’t respond to topical artificial tears, cyclosporine-A, antibiotics, and steroids—even to those who required repeated treatment to complete healing.

Apart from discomfort during CAM placement, there were no adverse events. This therapy shows promising results through the recovery of ocular surface health with a reduction in signs and symptoms,” she explained.

Meanwhile, the advent of smart contact lenses represents an exciting understanding the multifactorial frontier in dry eye management. nature of dry eye, healthcare Dr. Abesamisproviders can Dichoso said that tailor treatment "Treating dry eye the system uses plans that address electroosmotic the underlying disease can vary flow (EOF), which causes, whether according to causes the liquid through lifestyle the practitioner’s to flow when a modifications, voltage is applied advanced preference; the tools across a charged therapies, or available in their surface. collaborative care with other health toolkit, which largely “In this case, a professionals. depend on the area current applied of practice; legal to a hydrogel Future causes fluid to regulations; the skills perspectives flow upwards developed through from the patient’s Looking ahead, Dr. temporary tear Abesamis-Dichoso years of practice; reservoir behind anticipates and the resources the lower eyelid significant available.” to the eye’s developments surface. However, in DED further research is needed to develop treatment over the next improved self-moisturizing contact decade. "Treating dry eye lenses that are tougher and capable disease can vary according to of operating at smaller currents,” she the practitioner’s preference; said. the tools available in their toolkit, which largely depend on the area of practice; legal regulations; A multifactorial disease the skills developed through years Over the years, the understanding of practice; and the resources of dry eye disease has dramatically available,” she explained. evolved, observed Dr. AbesamisDichoso. “I have witnessed the “Since there is a wide range of factors prevalence and incidence of dry to consider before one can offer the eye increasing rapidly not only in best treatment, accurate diagnosis the aging population but also in the is critical,” she stressed. “There has younger generation.” to be a standard of care that will benefit the patient at the end of the She mentioned that the Tear Film & day without necessarily investing in Ocular Society (TFOS) has redefined expensive tools and equipment. Most dry eye as a ‘multifactorial disease,’ dry eye conditions encountered in emphasizing the loss of homeostasis practice fall in the mild to moderate of the tear film. This reclassification category, which can be diagnosed by has prompted collaboration among simple questionnaires and managed industry leaders, scientists, and with lifestyle modification, such as allied health professionals to delve the World Council of Optometry Dry deeper into the causes of tear film Eye Wheel.” instability and available technologies for improvement.

She noted that the World Council of Optometry has collaborated with Additionally, this comprehensive view industry leaders such as Alcon to of dry eye disease has significant introduce the Dry Eye Wheel. implications for treatment. It encourages practitioners to adopt "The Dry Eye Wheel is structured a more holistic approach that around three core components: considers all potential contributing Mitigation, measurement, and factors rather than focusing solely management. It categorizes dry on tear replacement therapies. By eye into simple, intermediate, and

advanced stages, represented by concentric rings. Additionally, the mitigation and measurement aspects are further broken down, enabling optometrists to consider various factors related to ocular health, general health, and patient lifestyle," she explained.

As our understanding of dry eye disease deepens, integrating innovative treatments and holistic approaches is becoming essential.

The rise of advanced technologies, such as thermal pulsation therapy and regenerative treatments, offers new hope for patients. Continued research and patient-centered care will lead to better management strategies, ensuring healthier eyes and improved quality of life.

Contributor Dr. Carmen AbesamisDichoso earned her Doctor of Optometry in 1989 and her Master of Arts in Teaching in 2001 from the Central Colleges of the Philippines. She specializes in special contact lens design for keratoconus, children and high astigmatism, and visual assessment for individuals with mental challenges, autism, ADHD, cerebral palsy and learning disabilities. Practicing orthokeratology since 2005, she has had a private practice at Medical Plaza Makati since 1998.

She was named Outstanding Optometrist of the Year in 2017 by the Optometric Association of the Philippines. Currently, she chairs the International Affairs Committee of the Optometric Association of the Philippines and holds roles such as director of Special Olympics Opening Eyes in the Philippines and program manager of the Vision Screening Program. Dr. AbesamisDichoso is a fellow of the American Academy of Optometry, a founding fellow of the Philippine College of Optometrists, a fellow of the International Association of Contact Lens Educators and holds positions with the Asia-Pacific Council of Optometry. carmen.dichoso@gmail.com

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Enlightenment |

DED MANAGEMENT

Tears of Relief 1

from practical approaches to current treatment options and best practices to enhance patient outcomes.

Dr. Mahnia Madan’s four-step approach to managing dry eye disease

by Diana Truong

Dry eye disease (DED) may seem simple at first glance, but managing it effectively requires more than just treating surface symptoms. With an increasing number of patients seeking relief, understanding the complexities of this condition is crucial for effective treatment.

Understand the root cause

DED is rarely just about dry eyes.

It often stems from a variety of lifestyle habits and systemic health conditions, making it essential to uncover the root cause for effective treatment.

A leading cause of DED is MGD, where the glands lining the eyelids become clogged with thick oils or cells. But the issue can run deeper.

"Conditions like Sjögren's syndrome, rheumatoid arthritis, or lupus are common genetic causes," explained Dr. Madan. These inflammatory diseases interfere with the body's ability to produce tears, resulting in chronic dry eye. "Patients with diabetes, high blood pressure, or even sleep apnea can also experience dry eye as a consequence of their condition," she added.

Medications, too, play a role in exacerbating dry eye symptoms.

Antihistamines, diuretics, and blood pressure medications can all reduce tear production. "Patients on these medications, especially those with diabetes or hypertension, are often slower to heal and more prone to dry eye," Dr. Madan pointed out.

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patient walks into your office, blinking excessively, rubbing their eyes, and complaining of persistent discomfort. Their eyes are red, their vision slightly blurred, and the itching seems relentless. You know the symptoms all too well—this is a classic case of DED. But while the signs may seem straightforward, the underlying causes and effective management are anything but simple.

DED demands more than just a bottle of over-the-counter eye drops.

As optometrists, you’re not just treating symptoms, you’re navigating

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a complex landscape of ocular surface disease, meibomian gland dysfunction (MGD), environmental triggers, and even systemic health factors. Each patient presents a unique puzzle, requiring a tailored approach to uncover and address the root causes of their discomfort.

One expert who has mastered this delicate balance is Dr. Mahnia Madan, an optometrist based in Canada, where she spends 80% of her day managing dry eye patients. Her expertise offers valuable insights into how to navigate DED management—

COOKIE MAGAZINE | October 2024

Pinpointing the underlying cause of a patient’s dry eye is the critical first step. Whether it’s therapeutic expression for MGD or collaborating with healthcare providers to address autoimmune-related inflammation, the goal is to move beyond alleviating symptoms and target the core issue.

first-line 2 Implement treatments The next step toward managing DED begins with simple lifestyle modifications and basic treatments.

Tweaking the patient’s environment; adjusting their diet; reviewing medications; and incorporating ocular lubricants, lid hygiene, and warm compresses are all part of this initial approach.

Small adjustments in daily habits can make a big impact. For instance, humidifiers can help patients exposed to dry conditions. Screen time is another significant factor.

"Many patients aren't aware that staring at screens all day can cause dry eye," Dr. Madan said. Encouraging patients to follow the 20-20-20 rule— taking a 20-second break every 20 minutes to look at something 20 feet away—can reduce strain and dryness.

Nutrition and overall wellness also play a key role. Dr. Madan emphasized the importance of a balanced diet rich in anti-inflammatory foods and adequate hydration. “Believe it or not, your eyeballs are not on a stick— they’re part of the body,” she said.

“So managing overall health with a well-balanced diet is going to be supportive of good eye health.”

For contact lens wearers and those who use makeup, proper eyelid hygiene is essential. “I always remind my patients to take their makeup off at night and avoid sleeping in contact lenses,” Dr. Madan advised.

This helps prevent irritation and reduces the risk of complications like blepharitis.

Consistent lid hygiene is also key in managing MGD. However, Dr. Madan noted that adherence can be challenging. "Lid hygiene adds a ton of value, but the consistency of doing it is often an issue," she said.

In-office treatments can provide more thorough cleaning and an opportunity for optometrists to educate patients.

Artificial tears are another effective treatment for mild DED. “They are effective, easy to use, and have very few side effects,” said Dr. Madan.

However, for patients with moderate to severe DED, artificial tears may not address the root cause. “If a patient has more moderate to severe dry eye, they might use a lot of artificial tears, which can become expensive, but still not solve the underlying problem."

Understanding when artificial tears alone are enough and when further intervention is needed is essential. Dr. Madan emphasized the importance of monitoring patients closely. If symptoms persist or

worsen, it may be time to explore more advanced treatments.

your patients 4 Show you care

advanced 3 Explore therapies

Ultimately, the heart of effective DED management lies not just in the treatments optometrists offer, but in the rapport they build with their patients. “Tell them that you really care about their disease because it can have such a big impact on their life,” advised Dr. Madan.

For patients whose symptoms persist, non-preserved ocular lubricants, tear conservation techniques like punctal occlusion, and overnight treatments such as ointments can offer relief. In-office procedures like meibomian gland expression and prescription antiinflammatory agents are also key tools in managing more stubborn cases.

One highly effective therapy is thermal pulsation with devices like LipiFlow® (Johnson & Johnson Vision; California, United States) and TearCare® (Sight Sciences; California, United States). These technologies use heat and pressure to unblock the meibomian glands, enhancing oil flow and improving tear stability. “There are numerous studies showing that thermal pulsation can effectively reduce meibomian plugs and enhance gland function,” shared Dr. Madan.

For those requiring more intensive care, oral secretagogues, and serum eye drops promote healing and tear production, while specialty contact lenses provide a protective barrier for the ocular surface.

Advanced treatments like topical corticosteroids, amniotic membrane grafts, and surgical punctal occlusion are reserved for severe cases of DED that don’t respond to other therapies.

Newer treatments like intense pulsed light (IPL) therapy have emerged as a powerful tool in addressing the inflammatory aspects of DED, especially in patients with MGD. “IPL is valuable because it addresses various aspects of dry eye disease, providing anti-inflammatory effects and promoting healing,” said Dr. Madan. Low-level light therapy (LLLT), while less intense than IPL, offers similar benefits. "Both IPL and LLLT can have significant roles in managing the multifactorial nature of dry eye," she added.

Whether it’s discomfort with contact lenses, fluctuating vision, or postsurgical dissatisfaction, recognizing the multifaceted nature of DED creates a foundation of trust and understanding. By showing genuine care and taking the time to explain the gravity of this chronic condition, optometrists empower patients to take their treatment seriously. In the end, it’s this connection that makes all the difference, turning what can feel like an overwhelming journey into a collaborative, supportive process for long-term eye health.

Contributor Dr. Mahnia Madan is a graduate of the Pacific University College of Optometry in Oregon, USA. She did her residency in ocular disease and surgical co-management at the Eye Center of Texas in Houston. Dr. Madan is a fellow of the American Academy of Optometry and has lectured on the management of ocular diseases across North America.

She practices in Vancouver, BC, focusing on the use of innovative treatments for advanced dry eye diseases, such as platelet-rich plasma (PRP) and intense pulse light (IPL). She and her team developed the technique to make PRP eye drops in her Vancouver clinic. She also currently serves as vice president for the BC Doctors of Optometry in British Columbia, Canada. @Dr.Mahnia.Madan www.vancouvereyedr.ca

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Conference Highlights |

WCPOS V 2024

From Trauma to Treatment Experts at WCPOS V 2024 outline effective strategies for managing pediatric eye injuries

by Tan Sher Lynn

Leading experts discuss the complexities of pediatric ocular trauma, emphasizing the importance of early diagnosis and tailored treatment approaches. This comprehensive overview highlights key risks, preventive measures, and innovative surgical techniques to optimize visual outcomes for affected children.

She highlighted that more injuries occur at home than in school or outdoors, with closed globe injuries predominating the cases.

Additionally, there is a high risk of refractive error, amblyopia, and a poor visual prognosis associated with penetrating eye injuries in young children.

In conclusion, she offered suggestions for prevention, including adult supervision during playtime, especially with toys that have projectile components; educating parents about hazards in the home; mandating the use of sports protective eyewear; and enforcing restrictions on airguns and fireworks.

Use of stent in canaliculi repair Presenting on pediatric eyelid trauma, Dr. Jamalia Rahmat (Malaysia) emphasized that the goal of trauma reconstruction is to restore normal function as much as possible. Knowledge of the anatomic path of canaliculus is crucial, and magnification with the microscope or surgical loupe can aid in identifying the medial cut end of the lacerated canaliculus.

“The use of stents in canaliculi repair helps keep the tissue together and makes suturing much easier. It also facilitates mucosal healing of the anastomosed canalicular and prevents canalicular obstruction or stenosis,” she said.

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cular trauma involves injuries to the eye and surrounding structures, presenting unique challenges in evaluation, management, and longterm outcomes in children. At the 5th World Congress of Paediatric Ophthalmology & Strabismus (WCPOS V 2024), held recently in Kuala Lumpur, Malaysia, experts from various parts of the world shared their expertise in preserving visual function and addressing potential complications.

Risks and prevention First on the podium was Dr. Inez Wong (Singapore), who presented on

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the epidemiology and mechanisms of pediatric ocular trauma. She noted that every year, 160,000 to 280,000 children below 15 years old are hospitalized for ocular trauma.

At the severe end of the spectrum, 21% to 24% of these cases involve penetrating globe injuries.1 “There is a bimodal distribution among preschool children and teenagers, with males at the highest risk of injury,” said Dr. Wong. This is attributed to the development of fine and gross motor skills in younger children and participation in sports or risky behaviors among older adolescents.

COOKIE MAGAZINE | October 2024

She stressed that all canalicular cuts should be repaired, noting that delayed repair (up to 48-72 hours) is not necessarily a bad thing if it allows for a more experienced surgeon, a more controlled situation, less edema, and better visualization. A monocanalicular stent is easier to handle than a bicanalicular stent.

As for suturing the canicular tissue, Dr. Rahmat said, “Direct suturing that is not done properly may cause problems such as increased scarring and stenosis. All you need to do is purse the string around the canicular to hold the stent in place, which should be good enough. Maintain the stent for at least six weeks, and

then assess functional success postoperatively.”

Repairing globe rupture

inflammation and other sequelae can also adversely affect visual outcomes in the amblyogenic age group. That’s why it’s important to tackle the cataract early,” he stressed.

Speaking on globe rupture, Dr. Naomi Tan (United Kingdom) stressed the He noted that accurate intraocular importance of taking an accurate lens (IOL) power calculations history from the child or a witness to are challenging, and the debate establish the likelihood of an open continues regarding primary versus globe injury. High-risk mechanisms secondary IOL implantation. include high-force blunt injury, high-velocity To obtain optimal projectiles, sharp “Be extremely careful outcomes in objects, foreign such cases, he when examining bodies, and emphasized that contamination. awake patients, have preoperative ultrasound a low threshold for Dr. Tan explained (USG) is crucial examination under that while for assessing assessing the condition anesthesia and presenting of the posterior primary repair, and visual acuity (VA) segment and the is important, posterior capsule. be aware of occult it should not Biometry should injuries.” overly influence be performed - Dr. Naomi Tan management on the same decisions in eye whenever children. Studies have shown possible. Meanwhile, the staging of no difference in presenting primary IOL implantation depends on acuity between closed and open whether the injury involves an open or globe injuries in this population. closed globe.

Additionally, adult studies have indicated that patients with no light “Always stain the anterior capsule for perception can recover. better management, and be wary of the vitreous and the unstable bag,” he She emphasized that the surgical added. principles to follow when repairing a globe rupture in children include Furthermore, Prof. Sukhija advised applying minimal pressure on the performing a posterior primary globe, providing maximum exposure, capsulorhexis (PPC) due to the high opposing identifiable edges, and incidence of visual axis opacification preserving viable tissue. This can (VAO) in children. He also suggested be achieved with sutures, glue, or that posterior optic capture can tectonic grafts. prevent iris capture and synechiae formation, while intracameral steroids “Be extremely careful when can help reduce inflammation. examining awake patients, have a low threshold for examination under Management of anesthesia and primary repair, and strabismus following be aware of occult injuries,” she trauma cautioned.

According to Dr. Rasheena Bansal (India), strabismus can develop in Strategies for managing children following orbital or ocular traumatic cataracts trauma, although such cases are Next, Prof. Jaspreet Sukhija (India) less common compared to other offered tips for addressing traumatic causes. This condition can manifest cataracts. “Traumatic injury to as both restrictive and paralytic. the lens can involve other ocular Approximately 5% to 10% of children structures, increasing the complexity who experience significant trauma of surgery. The increased incidence of develop strabismus.2

She explained that trauma can lead to strabismus due to the direct leash effect (caused by accessory scar tissue between the globe and the orbital wall, or a tight extraocular muscle) or the reverse leash effect (where the muscle is fixed to the globe due to scarring or suturing), restricting muscle mobility.

Regarding treatment, Dr. Bansal recommended initially opting for a conservative approach involving non-surgical methods such as patching, prisms, and vision therapy.

“Surgical intervention is indicated when misalignment persists despite non-surgical efforts, when there is significant deviation affecting vision and quality of life, when double vision persists despite treatment, or when functional amblyopia develops due to vision loss in one eye. Surgical options include recession/resection, transposition, and adjustable suture techniques,” she said.

In conclusion, Dr. Bansal emphasized the importance of early diagnosis and treatment. “It is important to intervene early depending on the severity of the trauma, so that we can maximize the visual outcome and prognosis. Every case requires a different approach based on clinical presentation,” she said.

References 1. Abbott J, Shah P. The epidemiology and etiology of pediatric ocular trauma. Surv Ophthalmol. 2013;58(5):476-485.

2. Bhate M, Adewara B, Bothra N. Strabismus in pediatric orbital wall fractures. Indian J Ophthalmol. 2023;71(3):973-976.

Editor’s Note The 75th World Congress of Paediatric Ophthalmology & Strabismus (WCPOS V 2024) was held from July 11 to 13 in Kuala Lumpur, Malaysia. Reporting for this article took place during the event.

A version of this article was first published on cookiemagazine.org.

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Conference Highlights |

WCPOS V 2024

Balancing Function and Aesthetics

Specialists share breakthroughs in pediatric ocular prosthetics and contact lenses

by Diana Truong

At the recently held 5th World Congress of Paediatric Ophthalmology & Strabismus (WCPOS V 2024) in Kuala Lumpur, Malaysia, experts shared the latest breakthroughs in pediatric ocular prostheses and contact lenses, emphasizing the intricate balance between medical efficacy and patient comfort.

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rom Dr. Tarjani Dave’s (India) innovative approaches to ocular prosthetics, which blend cuttingedge techniques with cosmetic finesse, to Mr. Vimal Mehra’s (India) insights into custom-made anophthalmic prostheses, the focus was clearly on personalized solutions that enhance both appearance and quality of life.

The discussions extended to Dr. Devakani Suresh Kumar’s (UAE) detailed exploration of contact lens fitting for complex corneal conditions and Dr. Matjaž Mihelčič’s (Slovenia) work on managing nystagmus with rigid gas-permeable (RGP) lenses.

Concluding the symposium, Dr. Neha Prashant (India) emphasized the vital role of empathetic communication with young patients, reminding us that successful treatment goes hand in hand with compassionate care.

Prosthetic aesthetics Dr. Tarjani Dave’s lecture on the aesthetics of ocular and orbital prosthetics delved into implant complications and cosmetic solutions.

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She highlighted her innovative techniques and treatments that ensure not just functional, but aesthetically pleasing outcomes for her young patients.

Unfortunately, implant complications do happen with prosthetics for the eye, including early and delayed implant exposures. “If exposure is seen in the initial post-op period, it’s largely an infection or tension on the wound,” she noted. For delayed exposures, which can occur years after surgery, Dr. Dave attributed these to a T cell-mediated immune response. “You will have to treat the patient by removing and replacing the implant,” she said.

Dr. Dave also touched on the issue of implant migration, which has become more noticeable with the introduction of the sclera petals method. “Between the ‘sclera petals,’ the implant can move and migrate outside the intraconal space,” she explained. The solution isn’t simply replacing the implant, as it will likely migrate again.

Instead, Dr. Dave recommends placing a

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second, customized implant to block the quadrant of migration.1 One particularly interesting topic was the management of periimplant cysts, which often present as proptosis of the prosthetic eye.

Dr. Dave stressed the importance of ruling out intraocular tumors before treatment. If it isn’t due to a tumor, she suggested simple aspiration followed by sclerotherapy.2 Addressing post-enucleation socket syndrome, Dr. Dave described various volume correction techniques, such as secondary implants, dermis fat grafts, and filler injections, along with lower eyelid tightening and ptosis correction.

Anophthalmic prostheses Continuing with the theme of aesthetic and functional solutions, Mr. Vimal Mehra, director of Mehra’s Ocular Prosthetics (Thane, India), shed light on managing anophthalmic sockets in pediatric patients.

One of the primary solutions is the creation of a custom prosthesis.

These are meticulously crafted to match the patient’s other eye, providing both aesthetic and functional benefits.

Another approach involves the use of serial, custom-made conformers, which expand progressively larger to maintain the socket’s shape and apply gentle pressure to help the orbit expand, promoting appropriate facial growth.

Mr. Mehra concluded with a message on the importance of early intervention. “Management of congenital anophthalmos should be initiated as soon as possible after birth,” he said. “The first few years of life is a critical period for potential growth of the orbit, and the absence of the globe can negatively affect this development.”

Corneal contact lenses The importance of custom solutions was echoed in the lecture by Dr. Devakani Suresh Kumar (UAE), who gave a detailed exploration of

contact lens fitting post-penetrating keratoplasty (PKP) and for managing pediatric keratoconus.

Dr. Kumar began by emphasizing the importance of allowing the cornea to fully heal and stabilize before considering contact lens fitting.

“Ensure that all sutures are removed if applicable, as they can affect the corneal shape,” she advised.

She pointed out that scleral lenses require more care, making rigid corneal lenses a better choice for most children.

Dr. Kumar then turned to contact lenses for pediatric keratoconus management:

“Checking for endothelial cell health is important,” she noted. Monitoring for keratic precipitates and corneal vascularization is also key to assessing the risk of rejection.

• Glasses or contact lenses for those with a normal corneal shape.

• GP lens optics for an irregular corneal shape.

• Smaller diameter GP lenses for mild-to-moderate irregularities.

• Larger diameter GP lenses, such as scleral designs, for significant irregularities.

• Cross-linking can halt the progression of early-stage keratoconus.

• Hybrid, piggyback, or scleral lenses for moderate-stage keratoconus, with impression scleral lenses reserved for rare cases.

• Severe stages may necessitate a corneal transplant.

When it comes to choosing the right contact lens post-PKP, corneal topography plays a pivotal role. Dr. Kumar shared her recommendations for various lens designs based on specific corneal conditions:

“High DK GP lenses are always recommended,” she concluded, highlighting their importance in providing adequate oxygen permeability for healthy corneal function.

• Traditional RGP lenses for normal topography and high-risk transplants with low endothelial cell counts.

• Large diameter, reverse geometry designs for flat central topography.

• Larger diameter lenses (10-12 mm) with a back optic zone diameter (8.50-9.00 mm) for proud graft topography.

• Reverse geometry lenses for oblate or plateau grafts and steepened corneas peripheral to the graft-host junction.

• Custom soft contact lenses, both spherical and toric, for tilted grafts.

• Soft lenses for those intolerant to other lens types.

• Scleral and hybrid lenses for almost all corneas.

Silencing nystagmus

A thorough assessment of the patient’s visual acuity is essential, alongside corneal topography to map surface irregularities and measure curvature. Dr. Kumar highlighted the need to document any new haze or scarring, as well as the stromal condition, including scarring, haze, edema, or signs of rejection.

“Large diameter RGPs are the best options for PKPs,” Dr. Kumar emphasized, noting that rigid corneal lenses are also suitable for early keratoconus, as children can often manage these lenses on their own.

Transitioning from corneal health to motion disorders, Dr. Matjaž Mihelčič, CEO of INOVA Vision Lab (Radovljica, Slovenia), shared about the use of RGP contact lenses for silencing nystagmus in children.

He discussed the ideal candidates for RGP lenses, highlighting children with high ametropia, high astigmatism, and irregular corneas. For nystagmus specifically, Dr. Mihelčič recommended RGP lenses for those with small amplitude and higher frequency nystagmus.

However, not all children are suitable candidates for RGP lenses, including “those that have [large angle] squints because of the centering of the lens, and those who have adopted extreme low point positions of gaze or postures.” He did not advise RGP lenses for children with larger visual field defects or deep amblyopia.

Dr. Mihelčič explained how RGP lenses help manage nystagmus through several mechanisms: Haptic biofeedback, optical image stabilization, and optical zone diameter alignment.

Connecting with young eyes Effective treatment involves not only technical expertise but also strong communication skills, as highlighted by Dr. Neha Prashant (India). She suggested creating a comfortable, engaging, and empathetic environment for children and recommended toys and playing music to make the clinical setting less intimidating.

Involving children in age-appropriate decisions can significantly boost their autonomy and confidence.

This approach fosters a strong emotional connection when combined with empathizing with the child’s emotions, asking open-ended questions, and reflecting on their responses.

Dr. Prashant also stressed the importance of customizing the approach to each patient. Paying attention to nonverbal cues such as eye contact, body language, and facial expressions can provide insight into a child’s emotions and comfort level.

References 1. Dave TV, Tiple S, Vempati S, et al. Low-cost three-dimensional printed orbital templateassisted patient-specific implants for the correction of spherical orbital implant migration.

Indian J Ophthalmol. 2018;66(11):1600-1607.

2. Dave T, Taneja S, Tiple S, et al. Conjunctival retention cysts: Outcomes of aspiration and sclerotherapy with sodium tetradecyl sulfate. Ophthalmic Plast Reconstr Surg.

2019;35(2):165-169.

Editor’s Note The 75th World Congress of Paediatric Ophthalmology & Strabismus (WCPOS V 2024) was held from July 11 to 13 in Kuala Lumpur, Malaysia. Reporting for this article took place during the event. A version of this article was first published on cookiemagazine.org.

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Conference Highlights |

ESCRS 2024

Navigating the Digital OR At ESCRS 2024 iNovation Day, experts discuss the game-changing role of AI and digital technologies in the operating room Tan Sher Lynn

During iNovation® Day at the 42nd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2024), prominent figures in ophthalmology shed light on the transformative impact of digital technologies in the operating room (OR).

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o kickstart the session, Dr. Roger Zaldivar (Argentina) emphasized the importance of data integration for improving efficiency and saving time. However, he acknowledged the challenges of managing increasing amounts of data from various sources, which can lead to time constraints and potential errors. Despite these challenges, he believes that digital processes will ultimately enhance efficiency, reduce

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mistakes, and improve predictive accuracy in outcomes.

Dr. Cathleen McCabe (USA) echoed this sentiment, highlighting the importance of improved visualization for better OR outcomes. She discussed how enhanced visual feedback could refine procedures such as capsule access and overall situational awareness during surgery. Dr. McCabe stressed the

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concept of the "digital OR," which encompasses the automation and digitization of data across the surgical workflow. This includes advanced instrumentation like 3D visualization devices and the integration of data and images throughout procedures, aiming to optimize data aggregation and application.

The pros and cons of digital ecosystems The panel also explored the advantages and challenges of digital ecosystems. Dr. Seba Leoni (Switzerland), another panelist, pointed out that digital technologies have been instrumental in reducing variability in cataract surgery. He emphasized that digital connectivity, from preoperative planning to intraoperative guidance, significantly reduces transcription errors and enhances surgical outcomes.

"One of the key advantages of this digital connectivity is the ability to capture input from measurement devices into a smart planner. This enables interconnectivity between devices and integration with picture archiving and communication system (PACS) and electronic health record (EHR) systems. As transcription errors are a leading cause of refractive error, this connectivity

minimizes the number of manual steps and entries required from nurses and staff. Once the data is aggregated into the planner, technologies like the Smart Cataract DX we’re launching at the ESCRS, facilitate easy access to advanced formulas, impacting outcomes and streamlining data transfer from the clinic to the operating room,” he explained.

Artificial intelligence’s (AI’s) role in the digital OR was another key topic. The discussion highlighted how AI-driven tools, like those embedded in modern devices, can optimize surgical settings and enhance astigmatism management. AI not only aids in real-time decision-making but also supports postoperative analysis, leading to more informed and effective future procedures.

“AI can seem like such a big concept.

AI sounds like magic and it’s a little bit scary, but it's really just big data analysis,” said Dr. McCabe. “The more data we have coming in, the better we can anticipate achieving our outcomes, and the more significant those small steps of improvement will be. So, I think the real focus should be not only on integration but also on ensuring that the user experience is absolutely seamless,” she added.

Dr. McCabe also addressed the impact of these advancements on training. She noted that digital mentors and haptic feedback systems could vastly improve the training of new surgeons. By providing trainees with extensive virtual practice and feedback, these technologies promise to accelerate skill acquisition and enhance surgical proficiency.

Emerging digital solutions in eye care The session also included presentations on cutting-edge digital solutions set to revolutionize eye care in the near future.

CEO and co-founder Ran Yam of NovaSight (Tel Aviv, Israel), provider of pediatric digital vision care solutions, highlighted his company’s product TrackSightTM — a software

as a service (SaaS) solution utilizing computer monitors’ embedded webcams to perform eye-tracking designed to run on any device.

Myopia prevention is achieved by blurring the peripheral area of the screen while keeping the center of vision clear according to the momentary gaze position.

“TrackSight stimulates both myopic contrast reduction and myopic blur into the digital space. If you look away from the center of vision, you will notice slight degradation of the image which is protecting the vision of children throughout childhood on any device using our technology, even delaying the onset of myopia,” he said.

Next, Dimitri Chernyak from Intelon Optics (Massachusetts, USA) presented BOSSTM, an advanced imaging technology that utilizes noncontact, point-by-point measurement techniques based on Brillouin scattering principles.

By harnessing light energy to measure reverberations at varying tissue depths, BOSS provides critical insights into the structural composition of ocular tissues. He emphasized that this innovative approach addresses unmet needs in multiple areas, including the early diagnosis of corneal diseases like keratoconus, screening and treatment customization for refractive surgery, customization of arcuate keratotomy (AK) and limbal relaxing incisions (LRIs) for cataract surgery, presbyopia drug discovery, and the early detection of progressive myopia.

Meanwhile, Dr. John C. Berestka of Lightfield Medical (Minnesota, USA) addressed the limitations of the traditional slit lamp, which has long been the cornerstone of ophthalmology. He noted that it requires both the doctor and patient to be physically present at the same time, the exam is analog and fleeting, and the doctor must rely on memory to document the findings in the medical record.

“Our solution is Captura. We’ve taken high-speed computational

photography to design a brandnew ophthalmic instrument where a technician with minimal training can capture the exam for the doctor.

The doctor can review the images and explore them using intuitive gestures, preview the exam before seeing the patient, or use the images to explain the technology. For the first time, we have true telemedicine in ophthalmology,” he said. This cuttingedge imaging system is set to be launched in 2026.

Lastly, Phil Norris from machineMD (Bern, Switzerland) introduced neos®, the world’s first neuroophthalmoscope designed for quick and efficient assessment of the visual field, pupil reactions, eye alignment, and movement.

Combining proprietary software and consumer hardware, neos is intuitive, precise, and scalable—making clinical workflow more efficient.

“We achieve this with a virtual reality (VR) headset worn by the patient.

The device utilizes high-frequency eye tracking to analyze ocular movements and responses to stimuli.

This system is scalable, enabling data interoperability through a powerbased system,” Mr. Norris said.

From vision to reality All in all, the advancements and integration of digital technologies and AI in the OR emphasize a pivotal shift towards a more interconnected and technologically advanced field of ophthalmology.

As these technologies continue to evolve, they hold great promise in improving workflow efficiency, reducing errors, and enhancing treatment outcomes.

Editor’s Note Reporting for this story took place at the 42nd Congress of the European Society of Cataract and Refractive Surgery (ESCRS 2024), held from September 6 to 10 in Barcelona, Spain.

A version of this article was first published on cakemagazine.org.

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