Eric Papas PhD, MCOptom, DCLP

Eric Papas is Executive Director of Research & Development at the Vision Co-operative Research Centre, Sydney, Australia. He originates from England where he obtained degrees in physics and optometry, before spending several years in specialist contact lens practice. Most of his subsequent career has been devoted to research and he has managed clinical research groups for corporations such as Hydron and Allergan. His latest role involves supervision of a range of vision correction projects that are either government funded or run in direct collaboration with industrial partners. Currently, his major research interests are the tear film, ocular surface sensation and vascular behaviour.

Highlights of the BCLA Conference

On May 24th this year, the British Contact Lens Association held its 26th Clinical Conference and Exhibition. Over 600 delegates from around the world attended the 3 day conference at the Birmingham Metropole Hotel.

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Lyndon Jones from the School of Optometry at Waterloo discussed the impact of novel materials on contact lens practice. The most obvious success of these materials, he said, was the elimination of edema related problems. This did not, however mean that there were no remaining clinical complications to be dealt with. Inflammatory corneal events and responses related to the mechanical characteristics of the lenses were still present. Improving performance even further beyond current standards required attention to several factors, one of which was improved wettabillity. Pointing out that in vitro measures of wettability did not provide the clinician with a meaningful indicator of in vivo performance, he suggested that lipid uptake may pose a greater problem for Silicone Hydrogel lenses than conventional ones. This can result in the appearance of white spots on the lens surface and he proposed that an increased replacement frequency would be indicated in such cases. Other advances that he sees as important for the future are the introduction of antibacterial lenses to overcome the risks of corneal infection and improvements in production quality. If this also resulted in cheaper lenses, then that would be particularly well received he said. Referring to the phenomenon of mucin balls, he departed slightly from the general held view that these features can be safely ignored. He advocated a cautious approach and suggests that it might be prudent to mange severe cases by removing lenses more frequently.

Another researcher from the University of Waterloo, Kathy Dumbleton, continued the theme of clinical experience with SiH lenses by reporting the results of clinical trials conducted under her supervision. Striking evidence of the improved physiological result possible was provided by her data showing that corneal neovascularisation did not occur with subjects wearing SiH lenses. Discussing the issue of fitting subjects with the Focus Night and Day lens she noted that only 2% of subjects did not achieve a successful fit with either of the two available base curves. Overall slightly better comfort was achieved with the steeper fittings.

Australian researcher Noel Brennan related the results of a study looking at the effect of age on susceptibility of subjects to develop adverse responses during SiH wear. His findings showed that younger wearers are more likely to experience problems than their more mature counterparts. He advocated that this risk factor should be considered when fitting and counseling potential patients.

Ken Polse summarized the results of research conducted at Berkeley into the ways in which tear exchange can be improved beneath soft contact lenses. Using a variety of techniques, both clinical and mathematical, his group conclude that among the methods effective in increasing tear flow, lens fenestration and size reduction have a place.
Exploring the theme of ocular discomfort. Eric Papas from the Co-operative Research Centre for Eye Research and Technology at the University of New South Wales in Sydney discussed the way in which the cornea responds to stimulation. Rather than being simply a pain detector, it is becoming clear that this tissue is capable of exhibiting a range of responses to an array of different stimuli. Thus the sensation perceived during contact lens wear or in dry eye, is due to the combined responses of several receptors at sites scattered across the cornea and conjunctiva.

The wider use of imaging techniques in clinical practice was advocated by James Wolffsohn from Aston University. Apart from the benefits of more accurate record keeping, he pointed out that automated methods of measuring clinical conditions such as hyperaemia and fluorescein staining were possible. These methods have benefits in terms of objectivity and consistency.

Nathan Efron from UMIST in Manchester reported the results of a study looking at whether training helps observers to make more reliable judgements of clinical conditions. His data suggested that both trained and untrained observers would essentially arrive at the same answer, though the latter show greater variability. In any given situation this is likely to mean that the chances of making an erroneous decision are reduced by the training process.

The issue of vCJD and the possibility of its transmission by contact lenses was discussed by Roger Buckley. While the risks are low compared to those related to blood exchanges, they cannot be entirely discounted. Effective disinfection of reusable lenses is rendered extremely difficult due to the robust nature of the prions responsible for the disease.
Arthur Ho from the CRC for Eye Research and Technology, reiterated the dangers of ultra violet light from an ocular perspective. He pointed out that UV rays can be focussed by the cornea onto its periphery, leading to the formation of pterygia. Both UV blocking contact lenses and, in particular, wrap-around sunglasses were effective in providing protection, he said.

Also from CRCERT Brien Holden ended the conference with a striking and inspiring note. Resplendent in evening dress he urged the audience to take the opportunities offered by developing technologies. The possibilities for providing high standards of visual correction to all individuals throughout the world had never been more available. It is incumbent on all members of the “eye business” to work together in ensuring that all people can achieve their full visual potential, irrespective of geography or economic conditions.