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In this edition of Advances in Eyecare we hear from four experts about their fields of research as applicable to optometric practice:

  • Dr Deacon Harle and Paddy Gunn discuss the use of selective laser trabeculoplasty as an alternative to topical drug management of glaucoma and ocular hypertension. They clarify what it is, how it is done and who can do it.
  • Dr Shelby Temple describes the latest technique for macular pigment assessment and the implications for its use in community practice eye health screening.
  • Dr Keyur Patel explains the use of intense pulsed light (IPL) treatment for persistent and chronic lid margin disease.

Last published: April 2020

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    • 1.1.2 Understand the use of selective laser trabeculoplasty as a means of managing POAG and ocular hypertension.

    • 1.1.2 Understand the use of high energy light impulse therapy for management of lid margin disease.

    • 2.5.3 Understand the evidence base relating to pros and cons of laser versus pharmaceutical management of glaucoma so as better be able to advise patients.

    • 3.1.3 Understand the latest clinical techniques for assessing retinal and macular structure related to macular pigment density.

    • 6.1.1 Understand the association between the levels of macular pigment and macular degeneration.

    • 6.1.11 Understand the use of high energy light impulse therapy in the treatment of chronic lid margin disease.

    • 6.1.11 Understand the use of selective laser trabeculoplasty as a means of managing POAG and ocular hypertension.

    • 7.1.1 Understand the current legality of specialist and IP optometrists in developing skills for laser therapy of conditions such as glaucoma, both in the hospital setting and in future in community practice.

      View only 'Topic 2'

      Paddy Gunn and Dr Deacon Harle

      The lowering of intraocular pressure (IOP) is the mainstay treatment for primary open angle-glaucoma and slows down further progression of the disease. Many patients present with raised IOP but without optic nerve damage and this is termed ocular hypertension. Many ocular hypertensives convert to glaucoma, and so lowering their IOP helps reduce the risk of the disease establishing. Recently published LiGHT study suggests that the use of a laser treatment, selective laser trabeculoplasty (SLT), may replace the need for on-going use of IOP-lowering drops. In this interview, we speak to Dr Deacon Harle and Patrick Gunn to find out more about the SLT technique, and what it means for optometrists.

      • References

      • Cantor L, Katz L, Cheng J, et al. (2008) Economic evaluation of medication, laser trabeculoplasty and filtering surgeries in treating patients with glaucoma in the US. Curr Med Res Opin  24(10), pp 2905-2918

        Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. (2018) Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre randomised controlled trial: design and methodology. Br J Ophthalmol 102(5), pp 593–598

      • Harvey B (2019) Selective laser trabeculoplasty. Optician (3), pp 25-31

        Hutnick C et al. (2019) Selective Laser Trabeculoplasty versus Argon Laser Trabeculoplasty in Glaucoma Patients Treated Previously with 360 degree Selective Laser Trabeculoplasty – A Randomized, Single-Blind, Equivalence Clinical Trial. Ophthalmology 126, pp 223-232

        Jha B, Bhartiya S, Sharma R et al. (2012) Selective Laser. Trabeculoplasty: An Overview. Journal of Current Glaucoma Practice 6(2), 79-90

        Nguyen D, Khan A, Hickley N (2015) Glaucoma – part 4: surgical management. Optician, 0.07

        Samples JR et al. (2011) Laser Trabeculoplasty for Open-Angle Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology  118, pp 2296–2302

        Wong M et al. (2015) Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Survey of Ophthalmology 60, 36-50

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      Dr Shelby Temple

      Macular pigments absorb shorter wavelength visible light, act as anti-oxidants and reduce degenerative processes. They may also play a role in vision: specifically contrast sensitivity and glare reduction. Accurate measurement of the pigments is useful clinically as a means of assessing macular protection, especially in those susceptible to degeneration. In this interview, we speak to Dr Shelby Temple about a new macular pigment screening tool that has been recently developed at Bristol University.

      • References

      • Arunkumar R et al. (2018) What do we know about the macular pigment in AMD: the past, the present, and the future. Eye 32(5), pp 992-1004
         

        Bone R, Landrum J (1992) Distribution of macular pigment components, zeaxanthin and lutein, in human retina. Methods Enzymol 213, pp 360–6

        Fletcher A et al. (2017) Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future. Ophthalmology 124 (12), pp 1753-1763

        Fletcher A et al. (2008) Sunlight exposure, antioxidants, and age-related macular degeneration. Archives of Ophthalmology 126(10), pp 1396-1403

        Loughman J, Davison P, Nolan J et al. (2010) Macular pigment and its contribution to visual performance and experience. J Optom3, pp 74–90

        Modenese A, Gobba F (2019) Macular degeneration and occupational risk factors: a systematic review. International Archives of Occupational and Environmental Health 92(1), pp 1-11

        Sui G et al. (2013) Is sunlight exposure a risk factor for age-related macular degeneration? A systematic review and meta-analysis. British Journal of Ophthalmology 97(4), pp 389-394

        Temple S, Roberts N, Misson G (2019) ‘Haidinger’s brushes elicited at varying degrees of polarization rapidly and easily assesses total macular pigmentation’. Journal of the Optical Society of America A vol 36, pp B123-B131

        Trieschmann M, van Kuijk F, Alexander R et al. (2008) Macular pigment in the human retina: histological evaluation of localization and distribution. Eye (Lond) 22, pp 132–7

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      Dr Keyur Patel

      The eyelids are an essential component of maintaining a healthy tear film and treatment of eyelids is often part of a management strategy for dry eye disease.  One long-established technique for dry eye disease treatment involves the use of warm compression, although more recently, controlled abrasion has also been used as part of a management strategy. To understand the importance of a more recent treatment option, Dr Keyur Patel explains how the use of very high energy impulses on the eyelids can help treat dry eye disease.

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

        Scanning laser trabeculoplasty for optometrists

        • Dr Deacon Harle, IP specialist registered optometrist, Community ophthalmology lead in West Kent
        • Patrick Gunn, Principal Optometrist for Education and Training at the Manchester Royal Eye Hospital

        Macular pigment screening

        • Dr Shelby Temple, Visual neuroscientist and Honorary Researcher at the University of Bristol, Chief Science Officer at Azul Optics

        High intensity impulse therapy for eyelids

        • Dr Keyur Patel, Director Tompkins Knight and Son Optometrists

      View only 'Topic 6'

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