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In this edition of Advances in Eyecare we hear from three experts about developments in maintaining ocular health. The speakers discuss their fields of research as applicable to optometric practice.

Dr Nicole Carnt outlines the nature of Acanthamoeba keratitis, its causes, diagnosis, management and avoidance. There is some discussion of why there has been an increase in incidence in some UK areas in the last year.

Prof Niall Strang looks at the latest views on the use of low-dose atropine in the slowing of myopic progression and the likely potential this may have for the future for UK-based practitioners in myopia therapy.

Dr Tariq Aslam looks at the review of the Royal College of Ophthalmologists (RCO) guidelines for the screening for retinal disease due to the systemic use of chloroquine and hydroxychloroquine and how the optometrist may be usefully involved in the multidisciplinary approach to future screening and monitoring.

Last published: December 2019

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    • 1.1.1 Understand the nature of Acanthamoeba keratitis, its diagnosis and management.

    • 2.1.2 Understand the current recommendations for the screening of chloroquine and hydroxychloroquine toxicity.

    • 2.5.3 Understand the evidence base relating to the use of atropine in myopia therapy and so be better able to advise patients on the outcomes so far indicated by published research.

    • 3.1.3 Understand the latest imaging techniques available to detect maculopathic changes due to systemic drugs such as chloroquine before significant vision impact is established.

    • 5.2.1 Understand the risk of Acanthamoeba keratitis with soft contact lens wear and how to best advise the patient to avoid it.

    • 6.1.7 Understand the nature of Acanthamoeba keratitis, its diagnosis and management.

    • 6.1.15 Understand the potential adverse ocular effects of systemic chloroquine and hydroxychloroquine use and how these may be best screened for under the latest RCO guidelines.

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      Dr Nicole Carnt and David Cartwright

      Acanthamoeba keratitis is a rare eye infection caused by a water-borne microorganism, Acanthamoeba, which infects the cornea. The disease is rare but has a strong association with soft contact lens wear. Since 2011, there has been a threefold increase of the infection in South-East England. In this interview, David Cartwright speaks to Dr Nicole Carnt, at the University of New South Wales Sydney, to find out what the reasons are for the increased incidence in the UK and what this means for optometrists.

      • References

      •  Arshad M, Carnt N, Tan J et al. (2019) Water Exposure and the Risk of Contact Lens-Related Disease. Cornea. DOI: 10.1097/ICO.0000000000001898

         Carnt N, Hoffman J, Verma S et al. (2018) Acanthamoeba keratitis: confirmation of UK outbreak and a prospective case-control study identifying contributing risk factors. BJOphthalmol. DOI: 10.1136/bjophthalmol-2018-312544

         Carnt N, Stapleton F. (2016). Strategies for the prevention of contact lens-related Acanthamoeba keratitis: a review. Ophthalmic Physiol Opt. 36(2):77-92

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      Professor Niall Strang and Abeeda Khatoon

      Myopia is a cause of sight loss reaching epidemic proportions around the globe. For most people with low to moderate myopia the main implications are refractive, but for those classed as having high myopia (-6.00DS or more) there is an increased risk of ocular pathology. For these patients, a number of possible interventions have been looked at, including the use of low-dose atropine. In this interview, Abeeda Khatoon speaks to Professor Niall Strang at Glasgow Caledonian University to find out how this intervention works and its availability in the UK.

      • References

      • Chia A, Chua WH, Cheung YB, et al. (2012). Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology 119:347–54

        Chia A, Lu QS, Tan D. (2016). Five-year clinical trial on atropine for the treatment of myopia 2: Myopia control with atropine 0.01% eyedrops. Ophthalmology. 123:391–9

        Harvey W. The return of atropine. Optician, 05.10.2018, p17

        Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050, Ophthalmology, May 2016 Volume 123, Issue 5, Pages 1036–1042

        Loughman J, Flitcroft DI. (2016). The acceptability and visual impact of 0.01% atropine in a Caucasian population. Br J Ophthalmol. Nov;100(11):1525-1529. doi: 10.1136/bjophthalmol-2015-307861. Epub 2016 Feb 22

        Pei-Chang Wu et al. Update in myopia and treatment strategy of atropine use in myopia control. Nature, June 2018, doi.org/10.1038/s41433-018-0139-7

        Tideman JWL, et al. (2018) Axial length growth and the risk of developing myopia in European children. Acta Ophthalmol. 96: 301–309

        Yam JC et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019 Jan;126(1):113-124

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      Dr Sharon Blackford and Dr Tariq Aslam

      In 2018, the RCO released new guidelines on screening for hydroxychloroquine and chloroquine retinopathy. This was in response to an increase in the use of the drugs, drugs that for a long time have been known to have significant ocular side effects. The new guidelines make specific recommendations on the techniques and timing of baseline and follow-up screening tests. To understand the importance of these drugs, dermatologist Dr Sharon Blackford provides a background summary on their clinical use. Following this, ophthalmologist Dr Tariq Aslam explains the new guidelines and how they will work in practice.

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      • DOCET would like to thank the following for their contribution to this programme:

        Acanthamoeba

        • Dr Nicole Carnt, Research optometrist, specialising in anterior eye
        • David Cartwright, Chair of National Eye Health Week

        Atropine

        • Professor Niall Strang, Senior Lecturer at Glasgow Caledonian University, currently involved in myopia therapy research
        • Abeeda Khatoon, postgraduate optometrist at Glasgow Caledonian University

        Hydroxychloroquine

        • Dr Sharon Blackford, Consultant Dermatologist, Singleton Hospital, NHS Wales
        • Dr Tariq Aslam, Consultant Ophthalmologist, Manchester

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