The Power of a Prosthesis

A prosthetic contact lens can make all the difference to a patient’s appearance, self-confidence, and the ability to fit into society. Recently, our optometrist Jess spent Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia with Sight for All. While there, she saw a variety of patients, including MC, who she was able to fit with a prosthetic soft contact lens. You can read more in Jess's article on Mivision's Mipatient.

Interview with our optometrist Jess on www.girl.com.au

Jessica Chi Sight for All Interview

Asia is home to two thirds of the 1.4 million blind children in the world

Asia is home to two thirds of the 1.4 million blind children in the world. What's more alarming is that the main cause of blindness in developing countries are cataract, hence clouding of the lens in the eye, of which most cases can be prevented with the right care. 

As an SFA Visionary, Jessica travelled to Cambodia to train local ophthalmologists to properly rehabilitate children after cataract surgery and other ocular conditions. 
 

Interview with Jessica Chi

Question: Currently, what is a typical day like for you, in your clinic? 

Jessica Chi: My clinic is a small independent optometry practice located in Carlton, Melbourne. My day would start by catching up with my wonderful staff as we prepare for the day. I would see a broad range of patients, from your simple spectacle checks, to ocular disease management to fitting, and reviewing complex contact lens patient. 

Aside from seeing patients, there's the usual admin, ordering and checking off spectacle and contact lens jobs, and general running of the business. The days are generally busy, and they pass very quickly, but I love it. We are really fortunate to have a great team and also have genuinely lovely patients. 

 

Question: What is Sight For All? 

Jessica ChiSight For All is a not-for-profit eye healthcare charity that raises funds to deliver projects free of charge to developing countries. Through research, education and necessary equipment, Sight For All works to deliver comprehensive, evidence-based and quality eye health care in developing countries. The aim is to reduce vision impairment and blindness, which in turn can break the cycle of poverty. 

An example is the project I just returned from in Cambodia. This specific mission was part of a two-year educational project aiming to reduce avoidable blindness among children in Cambodia through specialty contact lens training. This also extended to speciality contact lens fits for conditions, such as irregular cornea that require contact lenses as they cannot be corrected by spectacle, as well as prosthetic contact lens fitting to people with scarred or disfigured eyes. 

What a lot of people don't know is that contact lenses are by far the best means of rehabilitation for vision conditions, and sometimes are the only option for these patients. By training Cambodian paediatric ophthalmologists and optometrists, we're hoping to reduce avoidable blindness caused by cataract surgery and corneal conditions. 


Question: What inspired you to donate your time to Sight For All? 

Jessica Chi: Being short sighted myself from the age of 8, I understand the importance of sight, and what it is like to not have it. In fact, blindness and vision impairment can significantly reduce a person's quality of life and can even lead to an early death. 

285 million people in the world are vision impaired and 90% of these live in developing countries. Sadly, the main causes of blindness in developing countries can often be prevented or treated with the right care. 

What stood out for me with Sight For All's mission compared to other charity organisations is that they work towards a sustainable solution. This is done through providing local ophthalmologists and optometrists with the training and infrastructure they need to provide eye care for their communities, which is essential for reducing blindness in the long run. 

I was fortunate enough to be part of a project in Vietnam in 2014 – where I had the opportunity to teach a team at the Vietnam Institute of Ophthalmology in Hanoi. 

Words cannot describe how rewarding that week was. One in particular was watching a 10-month child see for the first time – he had had his cataracts removed but had not been able to obtain spectacles at such a high prescription and had still been essentially blind. 

He had been unsettled and unhappy and the second we put contact lenses into his eyes, he just stared, in awe. What really struck me in that moment was that we had the opportunity to do this for one child, but Sight For All was creating the skills so this could go on to help countless other patients. 


Question: How do you hope to fight avoidable blindness among children in developing countries? 

Jessica Chi: I believe providing sustainable eye care through an educational approach is key. 

Sight For All's approach of training local ophthalmologists, optometrists and nurses in developing countries to provide eye care for their local communities makes complete sense to me. They call this the 'teach a man to fish model", which essentially means to give the community the necessary equipment and skills to be self-sufficient and enable proper eye care. 

What was special about this project is that this hospital – the Khmer Soviet Friendship Hospital – had been set up to be a teaching hospital. 

During a recent presentation by Sight For All Chairman Dr James Muecke, he said that his mission was to make us Visionaries redundant. I think this is such a noble cause and more importantly, a sustainable one. 

Going in as a volunteer to see patients is great for those patients, however once we leave, the rest requiring care will be neglected. Sight For All is about training speciality eye care and having the specialists train future generations of specialists, so quality eye care becomes more accessible and blindness reduces. 


Question: Can you tell us about your recent trip to Cambodia? 

Jessica Chi: My recent trip to Cambodia was part of Sight For All's Optometry Education Program, which aims to provide training to paediatric ophthalmologists and refractionists in developing countries. 

Sight For All conducted an evaluation of the provision of optometry services at the Khmer Soviet Friendship Hospital (KSFH) in Phnom Penh, and found that there was limited capacity to treat infants born with congenital cataracts which must be removed, resulting in aphakia, the absence of the lens of the eye, and suggested the establishment of a contact lens training course at KSFH. 


The idea is to send one Australian optometrist – such as myself – with expertise in contact lens prescribing to spend a week every few months in the local clinic, providing hands-on training. 

My recent trip was the fifth in my group of contact lens Visionaries. The week was spent providing workshops and lectures to further the specialty contact lens knowledge of this team. We also saw patients, discussed their options and treatment plans. 

The hospital has become a constantly evolving place. The building I was in did not exist for the previous Visionaries' visits. The specialty training and the equipment and resources are constantly developing. 


Question: What did you do in Cambodia? 

Jessica Chi: As a specialist, I spent time in the clinic conducting comprehensive one-on-one training with Dr Kheng Sok, one of the first Paediatric Ophthalmologists as well as Mr Kith Koeung, a refractionist at KSFH. The idea is to provide enough tools for the trained personnel to be able to train their own colleagues at KSFH. 

We reviewed patients that had been prescribed contact lenses by the previous visits and saw new patients and discussed their management. 

One patient during the week really stood out. An eight-year-old boy who had managed to find some ammunition and set it off by accident, causing traumatic cataracts in both eyes, shrapnel in his corneas as well as the loss of his right hand. He had been fitted with a contact lens and I asked his carer what it meant to him. 

She said that prior to the contact lens, being an active (and cheeky!) boy, he was constantly covered in bruises and cuts as he couldn't see. Now he had the contact lenses, accidents were much less frequent. When I asked him what it meant, he said that before the contact lens, he couldn't play soccer. Now he has the contact lens, he can see the ball. 

It was an absolute delight working with Kheng and Kith. They were bright, eager to learn and were extremely accommodating to me. 

Overall it was a fantastic week. 


To learn more about Sight For All, visit https://sightforall.org/ 

https://www.girl.com.au/jessica-chi-sight-for-all-interview.htm
Interview by Brooke Hunter

'WHAT INSPIRES ME TO TEACH'

My experiences as a teaching clinician at the University of Melbourne 

Last week, I was asked to speak at the University of Melbourne Eyecare Clinician’s end of year cocktails. I was asked to speak on how I inspire students, and I have to admit, I was a little nervous as those who remember me as a student would recall that I was not the best student... I was disenchanted and bored. If there could have been a prize for the person most likely to leave optometry I probably would have won it. I saw optometry as repetitive and uni-dimensional and I envisaged a career in a small dark room.

Optometry didn’t really make any sense to me until we began clinical practice, and this was largely influenced by my clinical supervisors. I really enjoyed the patient interaction, and I learnt the nuances of managing patients, and discovered there was more than one way to practice.

During clinical visits to rural optometrists I was able to witness the appreciation and respect that patients had for their optometrists, and the pride and enjoyment that it brought them. I soon came to realise that optometry is what you make it, and learnt that the more you put in, the more you get back.

There was one particular visiting practitioner that I particularly admired, and I was lucky enough to score a graduate position with him. He became my teacher and my mentor. He encouraged me to develop myself professionally and supported me the entire way. Without his support, and with him pushing me, and the support of many others along the way, there is no way I would be standing here in front of you. I feel very lucky to have entered this profession, one that is so generous and so kind, and so open.

Earlier this year I had two encounters with a couple of recent grads.

One referred a patient to me, and wrote an impeccable referral letter. The letter was detailed, yet only included the relevant information. Reading the letter, it was evident that she had managed the patient perfectly. She had used therapeutic agents appropriately, and only when these could not provide sustained improvement, she referred him to me for contact lens fitting. When I saw the patient, he was well informed as she had done all the ground work for me.

This instance stood out to me because of her excellent management and communication, even though she was only a very recent grad. She wasn’t afraid to use therapeutics and she used them appropriately.

It made me proud.. proud of the student, proud to be part of a teaching team that helped to educate this optometrist, and proud to be from an institution which produces optometrists of this calibre. 

The other was a letter – a heartfelt letter thanking me for advice I had given. It took me by surprise because I vaguely remembered casual chats with this student, but I had no idea she had taken it so much to heart. This touched me and made me realise how even small gestures can have a large impact on our students, to help build them up and give them confidence in their future careers.

So I’ve told you what inspires me – the educators & mentors I’ve had before me and the students who have flourished into practitioners and have become my colleagues.

But I was asked to talk about techniques that I use to ‘inspire’ the students. That part is simple. Be the clinician, the optometrist, the professional that they would want to be. 

Kids & Contact Lenses

Often when I present contact lenses as an option to parents, they may be hesitant and ask whether their child is old enough, and whether it is safe or necessary. Contact lenses are a fantastic option to adolescents, and I believe that we should offer these to all our kids requiring refractive correction.

We are all well aware of the optical benefits of contact lenses – including reduced peripheral distortion, wider field of view, and of course there are the practical benefits such as less chance of slipping or coming off in challenging situations, less susceptibility to fogging and becoming soiled with sweat, rain, dust, etc. These benefits of contact lenses provide patients with convenience and comfort, especially in sporting and leisure activities where spectacles are a nuisance or even a hindrance.

For many adolescents, contact lens wear may provide greater self-esteem and vision related quality of life, 1-4 particuarly those with high prescriptions where spectacles can be thick and unsightly. Spectacles can be uncomfortable and may be impractical for activities such as sport and there is often a stigma associated with wearing spectacles as they may face teasing from other children with name calling such as ‘four-eyes’ and ‘nerd.’ Many will improve confidence and performance in sporting activities and in schooling, particularly when refractive correction is avoided due to discomfort, inconvenience or ridicule from spectacles.

Many believe that contact lenses are not safe for adolescents, however studies have shown that children of all ages are able to wear contact lenses without complications provided they are compliant.4-5 From my own clinical experience, I find that adolescents are often the most compliant of my patients, as adolescents are accustomed to routine and following instructions. They are less likely to stray from the prescribed regime, especially when under the supervision of an adult.

Some parents may argue that their child is too irresponsible for contact lenses as they often lose or break their spectacles.  However, arguably, these are some of these patients that are best suited to contact lenses. Spectacles are rarely lost when worn full time – they usually are lost or broken when taken on and off or when they are not worn at all. Adolescents will resist wearing spectacles due to the limitations, discomfort or teasing they can cause. Thus, adolescents who are highly resistant to spectacle wear are often the most motivated to wear contact lenses as it more attractive than wearing spectacles, and for certain patients contact lenses can be the difference to being uncorrected to fully corrected.

There are many other benefits of contact lenses specific to certain lenses including UV protection (which is important in the Australian sun!), to being able to correct ocular conditions that spectacles are not suitable for such as keratoconus, post-ocular trauma, aphakia, or extreme refractive states. They may also reduce photophobia in cases of albinism, aniridia, polycoria, etc.

As a practitioner, one of the greatest benefits of contact lenses is the ability to retard myopia with certain modalities. Recently there has been much discussion on this epidemic, as prevalence and degrees of myopia has been growing rapidly throughout the world6. Studies have shown that contact lenses have been a safe and effective method for retarding the rate of progression of myopia with ortho-keratology7-8 and soft bifocal contact lenses9 compared to spectacles or no correction. Contact lenses are often the preferred method for these patients and their parents as the side effect of contact lens wear for myopia progression is clear comfortable vision! Myopia progression is not only important to keep children from requiring thick heavy spectacles, but for reducing the risk of ocular conditions such as retinal detachment, myopic maculopathy and glaucoma which are associated with myopia. 6

Contact lens fitting to children and teens can be extremely rewarding, not just for the patient but also for the practitioner. Speaking from personal experience, prescription of contact lenses to these young patients has been one of the most rewarding parts of practice to me.

Some practitioners may be resistant to prescribing contact lenses because of the perceived increased chair time required to fit contact lenses. Studies have shown that whilst the time to complete a new contact lens fit for a patient may be slightly longer in a younger patient, most of increased time is in the insertion and removal training4. In a busy practice, chair time is valuable, however insertion and removal training can be delegated to front of house staff, meaning less disruption to a busy appointment book. Personally, I find these patients some of some of my most loyal patients, and adolescent contact lens fitting has been a fantastic practice builder.

With greater availability of contact lenses and huge advances in technology and expansion of parameters, now is better than any time to be prescribing our adolescents with contact lenses.

 

- Jessica Chi

Connecting Eyes To Life

The 15th International Cornea and Contact Lens Congress held over two and a half days at the beautiful QT hotel on the Gold Coast brought together 36 speakers packaged into eight themes. It was a fantastic success.

The International Cornea and Contact lens Congress represents over 30 years of bringing some of the leading minds in the field of cornea and contact lens together under one roof to share and further our knowledge and experience.

The theme of the conference was ‘Connecting Eyes to Life.’ The conference committee, chaired by David Stephensen, Margaret Lam and myself, meticulously pieced together a conference which covered everything from the latest research and advances in contact lens technology and corneal surgery, dry eye management, myopia control, the state of contact lens practice, practice building and more…!

 

WORLD EXPERTS

The official opening was preceded by three one hour master classes on Friday afternoon and a welcome reception/cocktail party which were all very well-attended. Johnson and Johnson sponsored a breakfast session with international expert Noel Brennan who is famed for his work on oxygen flux amongst other research. He began his thought provocative session by taking an audience poll, asking what the contact lens of first choice was. The audience response was almost unanimously ‘silicone hydrogel.’ He then presented his case that silicone hydrogels were not all they were cracked up to be and that perhaps oxygen is not the ‘answer.’ Noel repeated the same poll at the end of the session, and obviously his session had had an impact on half the audience who now responded ‘unsure.’ 

The official preceding kicked off with the presentation of the Kenneth W. Bell Award to Professor Nathan Efron. The Kenneth W. Bell award is in recognition of decades of work that Ken Bell dedicated to the CCLSA as its treasurer, and is awarded biannually to a CCLSA member for distinguished contributions to the cornea and contact lens field. Nathan delivered a brilliant address questioning why we recommend annual contact lens after-care. He presented his review of the literature of the risk factors associated with each lens modality, and gave his evidence-based argument for his recommended contact lens after-care.

At the end of his speech, a humbled and gracious Nathan thanked the CCLSA for giving him his start, and said he was very grateful as a PhD student for a $3,500 research grant awarded to him in his early days.

Such a brilliant start to the conference, with two of the most internationally acclaimed Australian researchers in the contact lens field challenging our beliefs, and we had not even reached the first morning tea! This set the tone for the fast paced, thought-provoking sessions over the next two days.

 

Dry Eye… so Dry!

Dry eye is a topic which has always been considered… well... dry. Historically it has been poorly understood and poorly managed. Professor Jennifer Craig of the University of Auckland, who is also the vice chair of the Tear Film and Ocular Surface Society (TFOS), the conglomerate of the leading experts in this field worldwide headed the session on dry eye.

In a whirlwind 40 minutes, she managed to summarise the different techniques of diagnosis and management of dry eye. Our population is ageing, our patient’s eyes’ are drying, however their future (and ours) is anything but dry with so many advances in our understanding as well as in technology to manage this condition.

 

The Myopia Epidemic

Professor Pauline Cho, hailing from Hong Kong Polytechnic University delivered an equally succinct and definitive lecture on the myopia epidemic, and methods to control it. She showed us that we need to stop thinking of myopia as a refractive condition, but as the disease that it is. Myopia is a huge burden on our society, and with increasing prevalence and severity, is one of the leading causes of vision loss throughout the world. Thankfully, with the help of researchers like Pauline, we can help patients maintain normal vision.

 

SURGICAL MANAGEMENT

We had a fantastic contingency from our corneal ophthalmological friends, with Dr. Jonathon Shaw nutting out when to flap, zap, or implant, with the help of SMILE, FLEX or ReLex in his great update on refractive surgery. Dr. Peter Beckingsale gave a fantastic lecture on the good, the bad, and the ugly of the surgical management of keratoconus.

PK, LK, EK, SALK, DALK, DSEK, DSAEK, DMEK, whaaaaaaaat?? What’s the difference and what does it all mean? Thankfully the CCLSA employed Dr. Brendan Cronin to explain all these abbreviations in a straightforward manner like only a Queenslander could.

 

Defunct Corneas

Other highlights were the corneal limbal stem cell transplantation lecture from Dr. Stephanie Watson, which shows brilliant promise for patients with defunct corneas, and Gen X-er David Stephensen giving us his perspective on Gen X and presbyopic contact lenses, which was especially fascinating as it came from both the perspective of practitioner and patient i.e. David himself.

Of course my word count won’t allow me to write of all the lectures and I thank all the wonderful speakers who had me captive the entire weekend, however, I will say the overall ‘vibe’ I witnessed from the speakers was the genuine excitement and passion in their fields. Our speakers really engaged with the theme, “Connecting Eyes to Life,” all relating their presentations to the end goal – the patient.

 

The Industry Exhibition

The Industry Exhibition was well represented by Diamond sponsors Alcon, Johnson and Johnson and Cooper Vision and Gold sponsor Abbott Medical Optical as well as many other exhibitors.

 

FUN-DUCATION

It wasn’t just all work and no play, with the CCLSA – definitely no way. The CCLSA culminated with the ‘I’-themed Gala dinner. It was incredible fun, with impressive dancing, the highlight being an intense battle of boys versus girls with NSW CCLSA president Margaret Lam taking down Alan Saks in a near unanimous defeat of David versus
Goliath proportions.

 

I’ve attended many conferences in my time as an optometrist, and this one is hands down my favourite. I may be a little biased; however, this group to me represents some of the most passionate optometrists and researchers in our industry, where the focus is entirely on learning and sharing, and where CPD points are not a drawcard but merely a bonus. What I love most about this group is how generous they are with their experience, their knowledge and their time. There is an overwhelming sense of camaraderie, passion, and belief in what we do. I feel very fortunate to have spent the weekend rubbing shoulders with some of the heroes in our industry such as Noel Brennan, Nathan Efron, Pauline Cho, Jennifer Craig, Alan Saks, as well as many of the up and coming stars who will go on to carry our profession into greatness.

The conference was the culmination of over a year of the hard work of the committee, headed by Dorothy Carlborg, David Stephensen, Margaret Lam and myself. The two and a half days went by in a flash, and at the end of it all, we were spent.

Was it worth it? Absolutely.

See you all at the 16th International Cornea and Contact Lens Congress.

 

- Jessica Chi

As She Dreamed It

Just prior to her thirtieth birthday, Jess Chi fulfilled a goal: to own her own practice. Jess, who graduated from the University of Melbourne in 2007, is now the director Eyetech Optometrists, an independent practice based in Carlton with a strong emphasis on contact lenses. She took over last year from founder Russell Lowe.
“I feel at home,” she says. “It doesn’t even feel like work.”
Jess is a self-confessed contact lens nerd. Her passion for contacts dates back to when she was shy teenage girl who hid behind her glasses. Contact lenses helped her to open up, and she became enchanted. She was proactive in discovering the latest contact lens technology, and even instructed her mother to switch optometrists as her optometrist was not keeping up to date.
“I knew all the contact lenses then on the market in high school, years before I even began Optometry,” says Jess.
Choosing a uni career pathway, Jess knew she wanted a career in health, and optometry seemed the obvious choice.
“I hated going to the dentist,” Jess says, “but I always enjoyed going to the optometrist. I wanted a career where as a practitioner, people actually liked coming to see me.”
‘Contact lenses’ was easily the subject Jess enjoyed the most at university. She was lucky enough to secure a graduate job with Richard Lindsay, a well known contact lens practitioner whose practice is among those who have set the pace for contact lens work in Melbourne. Her enthusiasm and excitement for contact lenses was obvious, and it was this that landed her the job.
Here, under the close mentorship of Richard Lindsay, she learnt anything and everything about specialty contact lens fitting and management of the anterior eye – from basic contact lens fitting to complicated rigid, hybrid, mini-scleral and ortho-keratology fits for all conditions including keratoconus, post-surgical and paediatric aphakia. Most of the topics were taught in university, however students were lucky to see these patients in clinical training, so it was a steep learning curve for Jess, but one she embraced wholeheartedly.
Jess says her interest has given her access to collegiate world: you meet another contact lens practitioner, says Jess, and you form an “instant bond”. She notes the group of optometrists practising largely or mostly in contacts are also cooperative and happy to share information and refer patients.
In fact, she never thought she would love her profession as she did. “My friends refer to me as the annoying one that actually loves their job.”
After several years in her graduate job, it was time to branch out, and she was keen to expand her skills and experiences. She considered whether an industry position would for her. But she realised she loved the patients, and the knowledge of the positive impact she could make in their lives and she knew she wanted to continue being a hands-on clinical practitioner. She realised she wanted own practice, and after discussing this with colleagues, she was pointed in the direction of Russell Lowe and Eyetech.


This story was originally written by Kristy Machon and first published in April 2015’s edition of Scope, the bimonthly magazine of Optometry Victoria.