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optometrytoday<br />

Vote in the<br />

AOP Awards<br />

Read Shelly Bansal’s<br />

presidential address<br />

Prepare for PAC<br />

Spectator<br />

www.optometry.co.uk September 30 2011 vol 51:19 £4.95<br />

Kids’ club<br />

How the children’s eye care campaign<br />

has galvanised practitioners into action

CooperVision Courses<br />

Coming to a city near you<br />

Our industry is constantly evolving. Featuring ‘live patient’ workshops,<br />

a CooperVision Course is your opportunity to learn from highly experienced<br />

clinicians, discover the latest product, clinical and business developments<br />

and earn up to 6 CET points. Reserve your place today.<br />

To fi nd out more including dates/locations and reserve your place,<br />

please visit: www.coopervision-courses.co.uk

Become our fan on Facebook<br />

http://twitter.com/<strong>Optometry</strong><strong>Today</strong><br />

News<br />

6 Sight loss collaboration<br />

Former home secretary David Blunkett will lead<br />

a new collaboration of three charities<br />

7 Tesco figures<br />

The supermarket’s eye care efforts have been<br />

revealed by a supplier<br />

8 Comment<br />

OT’s editor-in-chief David Challinor backs<br />

calls to improve practitioners’ contact lens<br />

communication with patients<br />

10 Research boost<br />

OT launches a new online resource<br />

15 NHS guide<br />

The Optical Confederation has helped eye care<br />

to be included in a guide for the new NHS<br />

Cover story<br />

34-35 Campaign success<br />

Practitioners reveal the results of the<br />

profession’s children’s campaign<br />

Products<br />

20-21 Industry news<br />

Sauflon achieves a world first, Zoobug is flying<br />

the flag and Dibble Optical celebrates its<br />

anniversary plus trading places<br />

42 Vitamins and eye drops<br />

The latest launches to help practitioners make<br />

the most of these opportunities<br />

Feature is online<br />


September 30 2011 vol 51:19<br />

15 20 44<br />

Regulars<br />

22 Prize crossword<br />

Our popular brainteaser<br />

39 Student news<br />

<strong>Optometry</strong> applications remain high, GOC<br />

roadshows for students plus news from<br />

Bradford and Cardiff<br />

Features/interviews<br />

14 Question time<br />

Optometrist and AOP councillor Ean Blair<br />

in the spotlight<br />

18 Scotland update<br />

The challenges facing optometry in the<br />

changing political environment<br />

24-25 Community<br />

Achievement Award<br />

Profiles on those shortlisted for an AOP award<br />

to help you vote<br />

26-27 LOC, ROC or AOC of<br />

the Year<br />

Profiles on those shortlisted for an AOP award<br />

to help you vote<br />

28-29 Supplier of the Year<br />

Profiles on those shortlisted for an AOP award<br />

to help you vote<br />

36-37 BCLA address<br />

BCLA president Shelly Bansal reminds<br />

practitioners of their importance when<br />

prescribing contact lenses<br />

OT (the AOP and Ten Alps Publishing) accept no responsibility for products, goods or services that may be<br />

advertised or referred to. Opinions expressed are not necessarily those of OT, the AOP or Ten Alps Publishing<br />

Video is online<br />

Clinical<br />

40-41 VRICS: C-16925 O/AS/SP/IP<br />

Ocular therapeutics and disease<br />

Part 4. Dr Mhairi Day and Dr Douglas Lyall<br />

complete our series on the investigation and<br />

therapeutic management of ocular diseases<br />

44-48 CET 1: C-16864 O<br />

Referral Refinement<br />

Peripheral retinal degenerations<br />

Part 10. Graham Macalister and Paul Sullivan<br />

look at common peripheral retinal anomalies<br />

which can be encountered, and which pose<br />

risks for retinal detachment. They discuss<br />

whether referral to the HES is needed<br />

49-53 CET 2: C-16942 O/D/CL<br />

Impact of cosmetics on the ocular<br />

surface and contact lens wear<br />

Dr Cameron Hudson reviews current<br />

knowledge about cosmetics and their impact<br />

on patient symptoms and contact lens wear<br />

Classified<br />

55-58 Jobs<br />

All the latest vacancies<br />

59-62 Marketplace<br />

Your guide to optical products and services<br />


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NEWS<br />

FTP cost awards ahead?<br />

DRAFT NEW rules, to govern<br />

fitness to practise cases in the<br />

optical professions, were debated<br />

<strong>this</strong> week by the General Optical<br />

Council.<br />

The debate followed<br />

consultation and further<br />

advice by the Department of<br />

Health after the new rules were<br />

drawn up by the GOC last year<br />

in an effort to speed up the<br />

investigation of complaints.<br />

Four main <strong>issue</strong>s arose for the<br />

council to discuss, although the<br />

consultation process has been<br />

overwhelmingly in favour of the<br />

changes to quicken the process<br />

which is a stressful one for<br />

practitioners involved.<br />

In particular, a proposal in which<br />

the council has provisionally<br />

agreed to introduce a rule<br />

enabling the fitness to practise<br />

committee to order “any party to<br />

the substantive hearing or review<br />

hearing” to pay all, or part, of the<br />

other’s costs was discussed.<br />

According to GOC papers, the<br />

Department of Health view is<br />

that there is no good reason why<br />

health professionals should not<br />

be asked to pay all, or a<br />

contribution to the costs of<br />

the proceedings that their<br />

performance of their duties has<br />

precipitated.<br />

Also a move to change the<br />

process of screening initial<br />

complaints about the fitness<br />

to practise of practitioners – to<br />

prevent cases with insufficient<br />

evidence being directly referred<br />

for future attention – from the<br />

larger investigation committee<br />

to a much smaller duo of case<br />

examiners (one from the sector,<br />

one lay) has met with concern.<br />

Another matter is that of the<br />

drafted five-year time limit to<br />

review an allegation which has<br />

not been referred to the council’s<br />

fitness to practise committee<br />

in the light of new evidence ‘for<br />

the protection of the public’ or<br />

injustice to the practitioner. It has<br />

been claimed that a year limit<br />

would suffice.<br />

Contact lens warning spreads<br />

TRADING SERVICES officers<br />

in the West Midlands<br />

borough of Sandwell are<br />

the latest officials to warn<br />

people that they could be<br />

risking their sight by wearing<br />

illegally sold cosmetic<br />

contact lenses.<br />

The area’s team is working<br />

with the GOC, and the<br />

warning has come after<br />

officers found several shops<br />

in the borough selling the<br />

plano-type lenses.<br />

Sandwell follows trading<br />

standards moves by East<br />

Riding officials in Yorkshire<br />

and Hartlepool to focus on<br />

the problem.<br />

Bob Charnley, Sandwell<br />

Trading Standards deputy<br />

manager said: “My officers<br />

have been working closely<br />

with the General Optician<br />

Council to identify traders in<br />

the borough who are selling<br />

products and provide them<br />

with appropriate advice to<br />

ensure they comply with<br />

the law. So far traders have<br />

Retail women celebrated<br />

The founder of Specsavers<br />

presented the top award<br />

at the annual showcase for<br />

dynamic businesswomen<br />

at the top of the retail<br />

sector last week. Dame<br />

Mary Perkins is pictured<br />

presenting the 2011 Woman of the Year Award to Harriet<br />

Kelsall, managing director of Harriet Kelsall Jewellery Design,<br />

at the 2011 Specsavers Everywoman in Retail Awards. The<br />

event was hosted by TV presenter Gaby Roslin and took place<br />

at The Savoy in London in front of 300 people.<br />

voluntarily removed them<br />

from sale.”<br />

Cabinet member for<br />

neighbourhood services,<br />

councillor Derek Rowley<br />

said: “I would urge people<br />

to only buy cosmetic contact<br />

lenses from authorised<br />

retailers and have them fitted<br />

by a qualified professional.”<br />

Suspect someone of selling<br />

cosmetic contact lenses<br />

illegally? Report them to the<br />

GOC by emailing KGill@<br />

optical.org.<br />


�� ��<br />

Essilor secures<br />

our Elvis man<br />

Lens company Essilor has won<br />

the services of OT’s front cover<br />

‘Elvis Presley’ – aka AOP chairman<br />

David Shannon – in the <strong>Optometry</strong><br />

Giving Sight sealed auction for the<br />

World Sight Day Challenge.<br />

Professional relations manager<br />

of Essilor, Andy Hepworth, told OT:<br />

“We are delighted to have secured<br />

‘Elvis’ for the day. We take part<br />

in the Challenge every year and<br />

<strong>this</strong> will only enhance our other<br />

activities. We will have David<br />

Shannon doing a round of each of<br />

the departments and look forward<br />

to him taking calls on reception.<br />

“Giving back to <strong>this</strong> worthwhile<br />

cause is incredibly important to us,<br />

and if we can create more appeal<br />

internally amongst the staff whilst<br />

transforming many lives through<br />

the gift of vision then we are very<br />

happy to do so.”<br />

Country manager for the charity,<br />

Donna Power, added: “There was a<br />

lot of demand to have the services<br />

of Elvis on World Sight Day, and I<br />

would like to thank every one who<br />

made an offer. Congratulations to<br />

Essilor.”<br />

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5<br />

30/09/11 NEWS

optometrytoday<br />

SEPTEMBER 30 2011<br />

VOLUME 51:19<br />

ISSN 0268-5485<br />


January 1 2009 – December 31 2009<br />

Average Net: 19, 842<br />

UK: 19,308 Other Countries: 895<br />

Editor-in-Chief: David Challinor<br />

T: 020 7549 2071<br />

E: davidchallinor@optometry.co.uk<br />

Deputy Editor:<br />

Robina Moss<br />

T: 020 7549 2072<br />

E: robinamoss@optometry.co.uk<br />

Web Editor:<br />

Emily McCormick<br />

T: 020 7549 2073<br />

E: emilymccormick@optometry.co.uk<br />

Reporter: Chris Donkin<br />

T: 020 7549 2074<br />

E: chrisdonkin@optometry.co.uk<br />

OT Multimedia Editor: Laurence Derbyshire<br />

T: 020 7549 2075<br />

E: laurencederbyshire@optometry.co.uk<br />

Clinical Editor: Dr Navneet Gupta<br />

E: navneetgupta@optometry.co.uk<br />

Multimedia Creative Editor: Ceri Smith-Jaynes<br />

E: Cerismithjaynes@optometry.co.uk<br />

OT Manager: Louise Walpole<br />

T: 020 7549 2077<br />

E: louisewalpole@aop.org.uk<br />

Editorial Office:<br />

2 Woodbridge Street, London, EC1R 0DG<br />

Advertising: Vanya Palczewski<br />

T: 020 7878 2347<br />

E: vanya.palczewski@tenalps.com<br />

Sponsorship: Sunil Singh<br />

T: 020 7878 2327 E: sunil.singh@tenalps.com<br />

Recruitment & Classified: Haley Willmott<br />

T: 020 7878 2313 E: haley.willmott@tenalps.com<br />

CET and bookshop enquiries: Charlotte Verity<br />

T: 020 7549 2076<br />

E: charlotteverity@aop.org.uk<br />

Production: Ten Alps Creative<br />

T: 020 7878 2323 E: gemma.trevillion@tenalps.com<br />

Membership Dept:<br />

2 Woodbridge Street, London, EC1R 0DG<br />

T: 020 7549 2010<br />

W: www.aop.org.uk<br />

Advertising and Production Office<br />

Ten Alps Creative and Ten Alps Media,<br />

Commonwealth House, One New Oxford Street,<br />

High Holborn, London WC1A 1NU<br />

Editorial Advisory Board<br />

Leon Davies, Mark Draper, Polly Dulley, Dan<br />

Ehrlich, Andy Hepworth, Olivia Hunt, Niall Hynes,<br />

Jessica McIsaac, Sonal Rughani, David Ruston,<br />

David Shannon, Gaynor Tromans, David Whitaker,<br />

Andy Yorke<br />

W: www.optometry.co.uk<br />

Published fortnightly for the Association of<br />

Optometrists by Ten Alps Creative<br />

Subscriptions<br />

Alliance Media Limited, Bournehall House,<br />

Bournehall Road, Bushey, Herts, WD23 3YG<br />

T: 020 8950 9117<br />

E: tenalps@alliance-media.co.uk<br />

UK £130, OVERSEAS £175 for 24 <strong>issue</strong>s<br />

FORMER HOME secretary David<br />

Blunkett is to help lead efforts<br />

to prevent blindness by working<br />

for three charities involved in the<br />

sight loss sector.<br />

Action for Blind People, RNIB<br />

and SeeAbility are planning<br />

future collaboration, and have<br />

appointed Mr Blunkett MP, who<br />

has been blind since birth, to act<br />

as an independent chair for their<br />

discussions.<br />

Mr Blunkett will work with<br />

the three CEOs and nominated<br />

trustees from each charity to<br />

ensure that improved sustainable<br />

services for blind and partially<br />

sighted people, including those<br />

with additional disabilities, are<br />

delivered as a result of <strong>this</strong> closer<br />

collaboration.<br />

“These organisations<br />

have taken an impressive<br />

NEWS<br />

Blunkett to lead new<br />

sight loss collaboration<br />

and innovative approach to<br />

improving service delivery<br />

for blind and partially sighted<br />

people,” he said, “including<br />

those with other disabilities<br />

by choosing to work together<br />

and for <strong>this</strong> they should be<br />

commended.<br />

“I’m very pleased to take on<br />

the role of chairing the transition<br />

and giving a little back after years<br />

of supporting from the sidelines.<br />

Helping to explore more effective<br />

use of valuable resources and<br />

lifting the profile of the work<br />

being undertaken, encourages<br />

me to take on the task of getting<br />

everyone to work constructively<br />

together.”<br />

The appointment of Mr<br />

Blunkett begins the initial phase<br />

of the discussions, which is<br />

anticipated to last until October<br />

2012. The desire of the three<br />

organisations to work more<br />

closely together actively supports<br />

the UK Vision Strategy, which<br />

aims to align the objectives<br />

of charities and professional<br />

groupings working in the sight<br />

loss sector.<br />

Stephen Remington, chief<br />

executive of Action for Blind<br />

People, said: “Combining the<br />

resources and expertise of the<br />

three organisations will avoid<br />

duplication of services.”<br />

Nominations for 2012<br />

and 2013 awards<br />

BCLA MEMBERS have until<br />

the first of November to<br />

nominate for the 2013 Medal<br />

Award, which is also the<br />

deadline to apply for its latest<br />

round of research grants, the<br />

association announced <strong>this</strong><br />

week.<br />

The medal is awarded<br />

annually at the BCLA annual<br />

conference and exhibition to<br />

a person who has made an<br />

‘outstanding contribution to<br />

contact lenses’ with the 2012<br />

award set to be presented to<br />

Professor Alan Tomlinson<br />

at next year’s event at the<br />

Birmingham ICC.<br />

This year’s recipient<br />

Professor Mark Willcox<br />

(pictured with BCLA<br />

president Shelly Bansal),<br />

from the University of New<br />

South Wales in Australia,<br />

hailed the award as “a great<br />

honour” and the “pinnacle of<br />

my research career”.<br />

The deadline is also<br />

approaching for the Dallos<br />

Award 2013, an £8,000 grant<br />

for a project which is deemed<br />

Comment on the news via www.optometry.co.uk<br />

likely to further understanding<br />

relating to contact lenses/the<br />

anterior eye.<br />

For less established<br />

researchers, the 2012 Da<br />

Vinci Award recognises<br />

the work of an individual<br />

who has released less than<br />

five papers, and may also<br />

be given in recognition of a<br />

member of staff working in<br />

the manufacture or supply<br />

industry. The winner receives<br />

£1,000 and a full delegate<br />

package for the BCLA’s 2012<br />

ICC event.<br />

All of the forms are<br />

available at www.bcla.org.uk<br />

or by emailing jkelly@<br />


Tesco ‘benefited Galaxy’<br />


eye care efforts have<br />

been revealed in figures<br />

from its supplier, Galaxy<br />

Optical Services.<br />

In figures revealed<br />

by news website www.<br />

thebusinessdesk.com<br />

Galaxy’s turnover grew<br />

6% for the year to<br />

November 2010, from<br />

£38.2m to £40.8m, and its profits<br />

improved from £2.1m to £2.4m.<br />

The article quotes a report<br />

which accompanies the accounts,<br />

in which director and secretary<br />

Jocelyn Morgan states that Galaxy<br />

was pleased with its 12-month<br />

performance and it had met<br />

forecasts. “Sales and profitability<br />

have again increased,” she said,<br />

“following the growth in the<br />

numbers of opticians opened.<br />

The company has also benefited<br />

from full-year sales of opticians<br />

opened in 2009. Significant<br />

investment has been made<br />

in the company’s<br />

manufacturing<br />

systems and<br />

management<br />

information to<br />

support the growth<br />

made by the<br />

business, especially<br />

with the opening<br />

of in-store opticians<br />

across Europe.”<br />

Galaxy stated that it would invest<br />

during <strong>this</strong> year, concentrating on<br />

manufacturing and IT systems.<br />

The company was founded in<br />

1998, carries out a range of<br />

services for Tesco, including<br />

recruiting optometrists, and is<br />

based near Altrincham.<br />

CL giant launches roadshows<br />

CONTACT LENS giant<br />

CooperVision has launched<br />

a new series of roadshows<br />

aimed at demonstrating<br />

simple techniques to<br />

increase the confidence of<br />

practitioners when fitting<br />

multifocal lenses. The<br />

‘CooperVision Courses’ began<br />

<strong>this</strong> month and will make<br />

stops in 14 cities across the<br />

UK by November 2.<br />

The CET-accredited<br />

half-day events include<br />

interactive workshops based<br />

on multifocal fitting, patient<br />

records and communication,<br />

offering delegates the<br />

opportunity to use real-life<br />

subjects to test new fitting<br />

techniques.<br />

Karl Aberdeen,<br />

professional relations<br />

manager at CooperVision,<br />

said: “As part of our strategy<br />

to provide continued<br />

education to practitioners,<br />

we wanted to focus on key<br />

topics that would provide<br />

real value, whilst offering<br />

that all-important practical<br />

element to help practitioners<br />

increase their confidence<br />

levels.”<br />

Spaces are allocated on a<br />

first-come, first-served basis.<br />

To reserve a place, visit<br />

www.coopervision-courses.<br />

co.uk<br />

Robin Banks honoured<br />

AS REPORTED in our last <strong>issue</strong><br />

Robin Banks (pictured right), the<br />

former AOP chairman of finance, was<br />

presented with the Peter Yeo Medal<br />

for his services to the association at<br />

<strong>this</strong> month’s opening ceremony of<br />

the association’s new headquarters.<br />

The medal, presented by Peter’s Yeo’s<br />

widow, Jane, is given to those who have been outstanding in their service to the AOP, and is rarely<br />

awarded. Previous recipients included Ben Lewis and Ian Hunter. The award to Mr Banks was<br />

made for his work on the new headquarters in London and he has been one of the main figures<br />

behind the move. Also pictured are (from left to right), health minister Earl Howe, AOP chief<br />

executive Bob Hughes and Jane Yeo.<br />

News updated regularly at www.optometry.co.uk<br />


Aircrew briefing<br />

The Ministry of Defence is to<br />

host an industry briefing on the<br />

morning of October 18 at RAF<br />

Henlow, in Bedfordshire on the<br />

requirement for a refractive vision<br />

correction service for aircrew.<br />

This will include a prescription<br />

service for ophthalmic lenses,<br />

and the provision of frames,<br />

lenses and contact lenses. The<br />

value of the anticipated four-year<br />

contract will be in the range of<br />

£810,580 to £3,400,000. Further<br />

details are available in a current<br />

advertisement in the OJEU (Official<br />

Journal of the European Union).<br />

The MoD contact for expressions<br />

of interest and attendance at<br />

the briefing is Richard Ireland at<br />

desfast-comrcl4a1@mod.uk or<br />

telephone 0306 798 2917.<br />

Homeless appeal<br />

Homeless charity Crisis is on a<br />

recruitment drive for volunteers<br />

to help run the optical practice<br />

within its London centre over the<br />

Christmas period.<br />

Working in partnership<br />

with Vision Care for Homeless<br />

People, the charity is calling for<br />

optometrists and dispensing<br />

opticians to donate a few hours<br />

of their time. Information on how<br />

to volunteer during December<br />

will go live on the Crisis website<br />

– www.crisis.org.uk – on October<br />

1. The charity is also seeking<br />

donations of new plastic and<br />

metal frames which can be glazed<br />

for those in need over the festive<br />

period. To make a donation email<br />

will@visioncarecharity.org<br />

New learning<br />

Practitioners are invited to a free<br />

London conference hosted by<br />

Replay Learning on November 14.<br />

Booking is now open for the event<br />

at www.drugsandeyehealth.co.uk.<br />

7<br />

30/09/11 NEWS

8<br />

30/09/11 NEWS<br />

NEWS<br />

Historic retinal<br />

stem cell trial<br />


embryonic stem cell<br />

trial will take place at<br />

Moorfields Eye Hospital.<br />

The hospital is hoping<br />

that the trial will help<br />

treatments for people<br />

with retinal blinding<br />

conditions such as<br />

AMD and Stargardt’s disease.<br />

The trial, which was approved by the<br />

Medicines and Healthcare Products Regulatory<br />

Authority last week (September 22), will<br />

investigate the safety of using retinal cells<br />

derived from stem cells to treat people with<br />

advanced Stargardt’s disease.<br />

Retinal surgeon, professor James Bainbridge<br />

– who will conduct the research – said: “There is<br />

real potential that people with blinding disorders<br />

of the retina, including Stargardt’s disease and<br />

age-related macular degeneration, might benefit<br />

in the future from transplantation of retinal cells.<br />

“The ability to regenerate retinal cells from<br />

stem cells in the<br />

laboratory has been<br />

a significant advance<br />

and the opportunity<br />

to help translate such<br />

technology into new<br />

treatments for patients is<br />

hugely exciting. Testing<br />

the safety of retinal cell<br />

transplantation in <strong>this</strong> clinical trial will be an<br />

important step towards achieving <strong>this</strong> aim.”<br />

Head of external relations for the Macular<br />

Disease Society, Cathy Yelf, added: “We are very<br />

pleased that a leading centre such as Moorfields<br />

is participating in <strong>this</strong> work. Although <strong>this</strong> is just<br />

the first stage of the human trials, it is exciting<br />

news and we will be following it with great<br />

interest.<br />

“Macular disease can be devastating at any<br />

age and especially for young people affected by<br />

conditions like Stargardt’s so <strong>this</strong> is a hopeful sign<br />

that progress might one day be possible towards<br />

a therapy for these conditions.”<br />

MP fact-finding at<br />

optical practice<br />

LIZ KENDALL MP (pictured) has become<br />

the latest Member of Parliament to<br />

visit an optical practice to get a better<br />

understanding of eye care. The Labour<br />

MP for Leicester West visited J N Stocks<br />

Associates in the city’s Hinckley Road on<br />

September 23 to find out why regular<br />

eye examinations are so important in<br />

preventing blindness.<br />

She met optometrist Kathryn Harper,<br />

and Sanjeev Patel (pictured right),<br />

consultant optometrist and Leicestershire and Rutland Local Optical Committee<br />

chairman who explained the health benefits of regular eye examinations. Ms Kendall<br />

said: “It is really important that people take good care of their eyesight. If you are aged<br />

60 or over, a child under the age of 16 or on a low income, you are entitled to free NHS<br />

eye tests, so do go and get yourself checked out.” Her visit was arranged as part of the<br />

Optical Confederation’s campaign to reduce the high level of avoidable sight loss in the<br />

UK. To find out more visit www.opticalconfederation.org.uk<br />

Comment on the news via www.optometry.co.uk<br />




I FIND it hard not to be impressed<br />

by BCLA president Shelly Bansal’s<br />

reasoning about contact lens patients<br />

and the work of practitioners to fulfill<br />

their needs (see pages 36-37). At last<br />

week’s evening address at the Royal<br />

Society of Medicine he impressed me<br />

with his thoughtful argument regarding<br />

the high ‘drop-out’ rate.<br />

With manufacturers champing at<br />

the bit to improve the percentage<br />

of those wearing contact lenses, Mr<br />

Bansal’s argument devotes more<br />

attention to the fact that many<br />

practitioners are not currently<br />

delivering the right communication<br />

in-practice to patients.<br />

“In our practice we spend lots of<br />

time just chatting to our patients,”<br />

he said. “We ask lots of questions to<br />

understand what their expectations<br />

are – if we don’t, we don’t get the<br />

information to meet their needs.”<br />

Mr Bansal also mentioned the<br />

importance of body language and<br />

attention to detail. It reminded me of<br />

our 2011 series on the communications<br />

process in the testing room, authored<br />

by Helena Webb and colleagues from<br />

King’s College London, which will<br />

continue in OT later <strong>this</strong> year.<br />

People often bemoan that<br />

optometrists are not taught business<br />

skills at university, but communicating<br />

well with patients is an important<br />

skill practitioners also need, unless<br />

they get a good grounding in their<br />

pre-reg year. Perhaps it is time to<br />

look into delivering more advice to<br />

new practitioners about the vital, if<br />

rarely discussed, process of how to<br />

communicate better with your patient.<br />

David Challinor, Editor-in-Chief OT

Nearly<br />

700,000<br />

women * will<br />

ACUVUE ®<br />

ACUVUE Brand Contact Lenses<br />


see our message<br />

on<br />


From October to December ACUVUE ®<br />

From October to December ACUVUE<br />

will be sponsoring the very best<br />

US drama premieres<br />

®<br />

will be sponsoring the very best<br />

US drama premieres<br />

Driving astigmatic patients to your practice<br />

www.jnjvisioncare.co.uk<br />

*Based on expected sponsorship coverage, ABC1 women, period October – December 2011 – all Johnson & Johnson Vision Care sponsored programs. Source: TNS – Mediamat July 2011.<br />

ACUVUE ® , ����� ACUVUE ® MOIST ® , ACUVUE ® OASYS ® , HYDRACLEAR ® and LACREON are trademarks of Johnson & Johnson Medical Ltd. © Johnson & Johnson Medical Ltd. 2011.<br />



10<br />

30/09/11 NEWS<br />

IN BRIEF<br />

Optrafair 2013 date<br />

announced<br />

The FMO has announced the<br />

date for the next Optrafair at<br />

Birmingham’s NEC as April 13-15,<br />

2013. This year’s Optrafair attracted<br />

more than 6,600 visitors over its<br />

three days, claimed organisers, up<br />

2% on the 2009 figure.<br />

Abstracts appeal<br />

The European Academy of<br />

<strong>Optometry</strong> and Optics is<br />

appealing for abstracts and<br />

proposals for its 2012 annual<br />

conference in Dublin. Oral and<br />

poster abstracts and proposals<br />

for sessions including clinical<br />

workshops, educational and clinical<br />

case studies, and discussion forums<br />

are being requested in areas<br />

including optometry, dispensing<br />

optics, vision science, optics and<br />

related fields and practice-based<br />

research. For more details visit:<br />

www.eaoo.info/dublin.<br />

Kirk celebrates<br />

Kirk Originals has announced the<br />

launch of a new collection to mark<br />

its 20th anniversary. Following 12<br />

years in development, the Beam<br />

range will be officially launched at<br />

Silmo in Paris <strong>this</strong> weekend.<br />

Optos in OCT deal<br />

Retinal imaging company<br />

Optos has entered into a<br />

conditional agreement to buy the<br />

instrumentation division of OPKO,<br />

which develops, manufactures and<br />

sells OCT devices and ultrasound<br />

scanners. The acquisition will cost<br />

an initial $17.5m with further<br />

royalty payments on future<br />

revenues.<br />

WCO to meet<br />

The World Council of <strong>Optometry</strong>’s<br />

2012 conference will take place in<br />

Chicago in June. Called ‘Advancing<br />

<strong>Optometry</strong> Worldwide’, the threeday<br />

meeting will run alongside the<br />

American Optometric Association’s<br />

‘<strong>Optometry</strong> Meeting’ on June 24-26.<br />

OT HAS launched a new online<br />

research section online which<br />

aims to keep practitioners upto-date<br />

with the latest research<br />

findings in optometry and<br />

ophthalmology.<br />

When visiting the new<br />

‘Research Articles’ page, which<br />

can be found at www.optometry.<br />

co.uk/clinical/research-articles,<br />

users can navigate through<br />

recent research on over a dozen<br />

clinical topics including macular<br />

degeneration, glaucoma, diabetic<br />

retinopathy, cataract, myopia,<br />

retinal detachment and many<br />

more.<br />

By selecting a subject they are<br />

interested in from the list of key<br />

topics, practitioners can browse<br />

NEWS<br />

OT launches research<br />

resource online<br />

a full list of papers exploring the<br />

topic which have been published<br />

via online database Pub Med.<br />

A summary of the article can<br />

be viewed by following the ‘Read<br />

More’ link listed.<br />

Speaking about the new<br />

section, OT clinical editor Navneet<br />

Gupta (picutred), said: “This is a<br />

fantastic new feature which will<br />

help to bridge the gap between<br />

clinical research and clinical<br />

practice.<br />

“With continuing high<br />

demands to improve on<br />

standards of vision care, we at<br />

OT wanted to make it more<br />

accessible for busy practitioners<br />

to find out about the latest<br />

research findings and to keep<br />

them at the forefront of new<br />

clinical developments in the<br />

profession.<br />

“With access to salient<br />

information on a wide range of<br />

topics, we hope practitioners will<br />

find <strong>this</strong> new tool to be of great<br />

benefit in their daily practice.”<br />

Silmo shortlist announced<br />


the annual Silmo<br />

D’Or awards have<br />

announced the<br />

shortlist for the<br />

2011 awards to be<br />

presented during<br />

the Paris event<br />

<strong>this</strong> weekend.<br />

In the headline<br />

category of Optic<br />

Frame, French<br />

brand JF Rey compete against LA<br />

Eyeworks, Gold & Wood, PM Frost<br />

and Vue Dc. The sunglass contest<br />

has a distinctly continental feel<br />

with designs by IC! Berlin, IDC<br />

Lunettes, Face a Face, Gotti and<br />

Vue Dc in the running.<br />

Sports equipment has good<br />

potential next year with London<br />

2012 on the horizon and most<br />

of the nominated Silmo D’Or<br />

designs are currently available<br />

to British practitioners. The<br />

companies contesting <strong>this</strong> award<br />

are Cebe, Julbo, Maui Jim, Logo<br />

and Silhouette’s Adidas arm.<br />

With a large representation<br />

in the technical innovations<br />

categories Essilor has<br />

nominations in the Vision,<br />

Material/Equipment and<br />

Low Vision/Optic Instrument<br />

categories. However, it will<br />

face tough competition from<br />

Transitions Optical, Bolle,<br />

Novacel and Indo for the Vision<br />

award; Nidek, Minima, Opti 3<br />

and Luneau in the Material/<br />

Equipment category; and for<br />

the Low Vision/Optic<br />

Instrument prize,<br />

Medas, Ceciaa, Axos<br />

and Alain Mikli.<br />

The awards are a<br />

tremendous honour<br />

for those companies<br />

involved. International<br />

marketing manager<br />

of Maui Jim, Martijn<br />

Van Eerde, who is<br />

nominated in the<br />

Sport category told OT: “we are<br />

delighted to be nominated for<br />

<strong>this</strong> prestigious award in such<br />

an important market as France.<br />

We will keep our fingers crossed<br />

and hope to take that trophy to<br />

Hawaii!”<br />

Brand manager of Adidas<br />

Eyewear UK, Simon Klima,<br />

commented: “We are extremely<br />

proud of the Evil Eye Halfrim<br />

Pro and to be nominated for the<br />

Silmo D’Or award means a great<br />


DAILIES AquaComfort Plus ®<br />

1<br />

offers superior tear film stability<br />

Pre-lens Non-invasive<br />

15s.<br />

10s.<br />

5s.<br />

0s.<br />

15.4<br />

Help your patients enjoy whatever the day brings<br />

Blink-activated moisture release technology<br />

© CIBA VISION (UK) Ltd, a Novartis company, 2011. 1. Wolffsohn J., Hunt O., Chowdhury A., Objective clinical performance of ‘comfort-enhanced’ daily<br />

disposable soft contact lenses. Contact Lens & Anterior Eye, 2010. Focus, DAILIES, AquaComfort Plus, PLUS, CIBA VISION, the DAILIES logo and the CIBA<br />

VISION logo are trademarks of Novartis AG. ACUVUE is a trademark of Johnson & Johnson Vision Care, Inc. SofLens is a registered trademark of Bausch & Lomb.<br />

14.1<br />

13.4 13.1<br />

8h.<br />

16.3<br />

*<br />

12.4<br />

11.5<br />



Partnering for Success<br />

Independent Practitioner Marc Karbaron talks<br />

about the impact of a new initiative from<br />

CIBA VISION to grow the contact lens market<br />

Marc knows a thing or two about<br />

running a successful optical practice;<br />

he is the Managing Partner of OPTIX at<br />

Broadgate, a family run, independent<br />

practice in the heart of the city of<br />

London. His father Monte set up the<br />

practice almost twenty years ago with<br />

Marc and his brother Stephen. They<br />

were one of the first optical practices<br />

in the area and have built the business<br />

up from one single, ground floor<br />

shop unit to a large, two storey triple<br />

unit with three consulting rooms<br />

servicing London’s financial district,<br />

with a strong reputation in the area<br />

for exceptional customer service. There<br />

is a rule at OPTIX at Broadgate that<br />

the only time staff can use the word<br />

‘no’ is when it is accompanied by a ‘k’<br />

and ‘w’ and followed by, ‘if we do not<br />

know we will find out for you’.<br />

“Building strong relationships is key to<br />

the success of our practice”, explains<br />

Marc, “with both our clients and<br />

the companies that supply us. Our<br />

customers are predominantly bankers,<br />

accountants, lawyers and they are quite<br />

rightly very demanding. We say that<br />

they demand ‘dynamic vision’. They<br />

want the latest innovations and the<br />

best products for their lifestyles. Their<br />

jobs can involve simultaneously looking<br />

at a bank of screens, reading a report<br />

and talking on their mobile phones<br />

and they want products that will fulfill<br />

all those needs. Our clients are the<br />

ultimate multi taskers. Being able to<br />

offer the most innovative products<br />

therefore is crucial for us and so we are<br />

“I congratulate<br />

CIBA VISION on their<br />

new pricing system,<br />

it’s pioneering and very<br />

welcome.”<br />

as demanding with our suppliers as our<br />

customers are of us.”<br />

Given the clientele it’s not surprising<br />

that OPTIX at Broadgate has a very<br />

large contact lens practice and<br />

around 50% of their dispensing space<br />

is given over to sunglasses. Their<br />

customers need vision care solutions<br />

for all aspects of their lives not just the<br />

working environment. The practice’s<br />

relationship with the contact lens<br />

suppliers is therefore very important,<br />

as is the quality of the products the<br />

companies offer.<br />

“How our suppliers deal with us<br />

impacts on our customer service<br />

therefore we expect a combination<br />

of great service, great products<br />

and great trade terms from them”,<br />

explained Marc.<br />

As part of their commitment to grow<br />

the contact lens market in the UK,<br />

CIBA VISION ® has recently announced<br />

a new pricing structure and trade<br />

terms for their customers designed<br />

to recognise the role of practitioners<br />

in actively recommending, fitting,<br />

and providing after care services for<br />

contact lenses. “I congratulate CIBA<br />

VISION on their new pricing system,<br />

it’s pioneering and very welcome”,<br />

commented Marc.<br />

“Which brings me on to products.<br />

It’s no good having great trade terms<br />

if you haven’t got excellent products.<br />

That’s the beauty of CIBA VISION;<br />

their portfolio is one of the best on<br />

the market. The company provides<br />

exceptionally good products for our<br />

range of patients. We are always<br />

hungry for new innovations to offer<br />

our patients and can rely on<br />

CIBA VISION to provide those”,<br />

explained Marc.<br />

He continued, “Many of our patients<br />

wear daily disposable contact lenses.<br />

They are in the office first thing in the<br />

morning until late at night then go<br />

on to social events. The convenience<br />

of wearing a daily disposable is<br />

paramount to these patients. Comfort<br />

is also vital, when we get patients to<br />

give us feedback it is the number one<br />

concern for them.”<br />

For these types of patients the<br />

DAILIES ® family of contact lenses<br />

remain the number one selling<br />

brand across Europe. DAILIES ®

AquaComfort ® Plus, provides superior<br />

comfort upon application 1 and its<br />

timed release moisture technology and<br />

superior tear fi lm stability are essential<br />

for all day comfort 2 .<br />

“I am excited by new products”,<br />

enthuses Marc. “What differentiates<br />

OPTIX at Broadgate from other types<br />

of optical practices is the drive to fi t<br />

the newest, most high tech products<br />

on the market; the products that will<br />

best suit our patients’ needs. And<br />

knowing we can effortlessly bring the<br />

latest products to our patients is very<br />

rewarding.”<br />

CIBA VISION has a rich history of<br />

innovation in bringing new products<br />

to the market including many industry<br />

‘fi rsts’ such as the fi rst company to<br />

develop and commercialise silicone<br />

hydrogel (SiHy) contact lenses, a<br />

material that has been hailed as<br />

the most innovative in history;<br />


The AIR OPTIX ® family of contact lenses<br />

offers a wide variety of parameters to<br />

satisfy the vision correction needs of<br />

virtually every patient. TriComfort TM<br />

technology ensures high breathability,<br />

“For me the added<br />

value of CIBA VISION<br />

products is the way<br />

in which they are<br />

presented to us as a<br />

practice. What I mean is<br />

that we get exceptional<br />

support from the<br />

professional affairs and<br />

sales teams.”<br />

all day comfort and superior deposit<br />

resistance 3<br />

“For me the added value of<br />

CIBA VISION products is is the way in<br />

which which they are presented to us as<br />

a practice. practice. What I mean is that we<br />

get exceptional support from the<br />

professional affairs and sales teams.<br />

Our CIBA VISION Business Development<br />

Manager, Suki Nandra and Regional<br />

Sales Manager Lacy Rasul have taken<br />

every step step over the last few years to<br />

offer the services and help we need<br />

with their products. As a team they are<br />

exceptional and extend a high degree<br />

of empathy to our needs. They always<br />

go that that extra mile mile to offer training, training,<br />

point of sale sale materials, new new campaigns campaigns<br />

that will help drive our business. One One<br />

such campaign is the BIG FIT. I really<br />

like the idea of a localised promotion<br />

that gets our current customers and<br />

new customers to try contact lenses.<br />

And I like the fact that the campaign<br />

is run with strong support from the<br />

CIBA VISION team in terms of materials<br />

and training as well as on the ground<br />

support”.<br />

“Whilst a lot of our clients already wear<br />

contact lenses we always get those<br />

who come in and say I used to wear<br />

contact lenses years ago but stopped<br />

because they weren’t comfortable or<br />

I just couldn’t get on with them. The<br />

BIG FIT is a great opportunity to say<br />

well that was then and <strong>this</strong> is now,<br />

we are a high tech industry and we<br />

have great new products nowadays<br />

that bear little resemblance to contact<br />

lenses of years ago.”<br />

“At the end of the day I want to<br />

promote independent practitioners<br />

as one way to deliver vision care. I<br />

welcome all the support we are getting<br />

from CIBA VISION in terms of the new<br />

pricing system, innovative products as<br />

well as the assistance from the sales<br />

www.cibavision.co.uk<br />

team in achieving <strong>this</strong>. All of these<br />

factors are vital in how we present<br />

ourselves because ultimately the<br />

product we are selling, is us.”<br />


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14<br />

30/09/11 20 QUESTIONS<br />


Question Time – Ean Blair<br />

Ean Blair trained as an optometrist after working as a teacher, then a �nancial adviser. He is<br />

developing his own independent practice, Blair Opticians in Hull, where he is an active member<br />

of the LOC executive and an AOP councillor<br />

How are you?<br />

Very well. Looking forward to a short<br />

break in the Bristol area.<br />

How is business right now?<br />

Continuing to grow steadily.<br />

Have you had any promotions<br />

that were especially<br />

successful?<br />

As a former teacher, I have enjoyed<br />

promoting children’s eye care in local<br />

schools. Screening alone is not enough.<br />

I firmly believe that all children should<br />

have regular comprehensive eye<br />

examinations to ensure early detection<br />

of any problems.<br />

What do you like about<br />

optics?<br />

Making a real difference to people’s<br />

lives in the local community – especially<br />

elderly people and children.<br />

What’s the best thing that’s<br />

happened in the profession<br />

during your time working in<br />

it?<br />

NHS reorganisation. Hopefully it will give<br />

us the opportunity to redefine our role<br />

as healthcare professionals.<br />

Who do you admire in optics?<br />

David Rose, my pre-reg supervisor. An<br />

independent practitioner who taught<br />

me a lot more than how to pass my<br />

PQEs.<br />

Where are your favourite<br />

places that optics has taken<br />

you?<br />

India. I developed a firm friendship with<br />

an Indian ophthalmologist, who invited<br />

me to join him for a family wedding in<br />

the Punjab. A very different experience<br />

than visiting as a tourist.<br />

Are you superstitious?<br />

Absolutely not. If you think you can or you<br />

think you can’t you’re probably right. LUCK<br />

is an acronym for Labouring Under Correct<br />

Knowledge!<br />

If you were granted one wish for<br />

optics what would you wish for?<br />

Recognition of optometrists as skilled<br />

healthcare professionals whose true worth<br />

is reflected in a realistic eye examination<br />

fee.<br />

Do you have a favourite film/<br />

TV show?<br />

2001: A Space Odyssey and Torchwood<br />

(the old series).<br />

Outside of the profession, what<br />

are your hobbies?<br />

I’m a member of a Celidh band, and enjoy<br />

walking and photography.<br />

Sum up your feelings for the<br />

next 12 months in five words.<br />

Moving forward with optimistic<br />

enthusiasm.<br />

Where do you go on holiday?<br />

Mainly in the UK, especially the Scottish<br />

Highlands.<br />

What are your favourite<br />

products in the optical sector?<br />

Eschenbach LVAs.<br />

If you weren’t in the profession<br />

what would you be doing?<br />

Property development.<br />

What’s your favourite singer or<br />

musical group?<br />

The Chieftains.<br />

What do you put your/your<br />

company’s success down to?<br />

Hard work and offering a friendly, personal,<br />

local service.<br />

What’s your favourite season,<br />

and time of year?<br />

Autumn. Perfect for walking and<br />

photography.<br />

Where would spend your<br />

perfect day?<br />

Walking in the Scottish Highlands with<br />

family and friends, followed by a relaxing<br />

pub meal with real ale.<br />

Any final thoughts?<br />

Nil desperandum.


Eye care incorporated<br />

into guide for new NHS<br />

THE OPTICAL Confederation<br />

has been joined by other<br />

bodies from the primary<br />

healthcare sector to release<br />

a document to help local<br />

authorities identify good local<br />

sources of clinical information<br />

in the new NHS. It has been<br />

launched at the major party<br />

conferences, the latest of<br />

which will take place at the<br />

Conservative party conference<br />

in Manchester on Monday<br />

(October 3) with public<br />

health minister Anne Milton<br />

(pictured).<br />

Billed as a guide, the eye<br />

care profession, as well as pharmacy,<br />

dentistry and general medicine, have<br />

produced Engaging with primary<br />

healthcare professionals to improve the<br />

health of the local population’ to help<br />

local decision makers access clinical<br />

advocates and representatives to help<br />

provide services for patients.<br />

With the abolition of PCTs,<br />

contracts for optical and<br />

other primary care sectors<br />

will be held centrally by<br />

the NHS Commissioning<br />

Board from 2013. Soon local<br />

authorities will be working<br />

with health and wellbeing<br />

boards, as well as other local<br />

groups, including professional<br />

networks, representative<br />

committees and clinical<br />

commissioning groups.<br />

The guide sets out an<br />

overall checklist for health<br />

and wellbeing boards, what<br />

they can expect from LOCs and similar<br />

groupings, and how they can make the<br />

best use of local representation.<br />

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15<br />

30/09/11 THE NEW NHS

16<br />

30/09/11 SPECTATOR<br />


IT decision shows local health<br />

solutions are in ascendancy<br />

FOR CLEAR evidence that local solutions are to be the order<br />

of the day for the future of the NHS, we need look no further<br />

than last week’s announcement that the Government is to<br />

accelerate the dismantling of the national programme for<br />

IT. Going the way of seemingly many (overly?) ambitious IT<br />

projects, the initiative introduced by the Labour government<br />

has so far cost the NHS almost £6.5bn – is it any wonder<br />

that efficiency savings are being called for? The approach<br />

to be taken in its absence, according to health secretary<br />

Andrew Lansley (pictured), is to move “to an innovative<br />

new system driven by local decision-making”. Whether<br />

such a change will make it easier, or harder, for optometrists<br />

as primary care contractors, to connect effectively to their<br />

local NHS healthcare networks cannot be known as yet, but<br />

it is likely that <strong>this</strong> change in strategy will work against the<br />

spirit of achieving a consistent solution across the country.<br />

It looks as if we haven’t been<br />

overlooked when it comes to<br />

the introduction of a patient<br />

comment facility on the NHS<br />

Choices website<br />

And while there is a sense of optometry having been left<br />

out when it comes to harnessing the benefits that such<br />

connections might achieve, it looks as if we haven’t been<br />

overlooked when it comes to the introduction of a patient<br />

comment facility on the ‘NHS Choices’ website. Whether<br />

the latter is ‘good news’ remains to be seen.<br />

While on the subject of websites, a recent article in the<br />

doctors’ magazine Pulse reports on the findings of a<br />

Freedom of Information Act request into the website<br />

viewing habits of Department of Health civil servants. It will<br />

come as no surprise that the most viewed website was the<br />

Daily Telegraph (important for civil servants to keep up to<br />

speed with <strong>this</strong> bellwether of Conservative party thinking)<br />

followed closely by visits to Facebook. But what is possibly<br />

more telling are those visits to websites such as match (one<br />

assumes in search of love) and Goldmoney (maybe looking<br />

for ways to stretch DH investment?). However, a connection<br />

with reality is evident in that browsing the jobs pages of the<br />

Guardian and NHS jobs websites also figure highly.<br />

As the political party conference season comes to an end,<br />

the annual flu season is set to begin. On the same day<br />

that chief medical officer Dame Professor Sally Davies<br />

announced the start of <strong>this</strong> year’s round of flu vaccinations,<br />

NHS chief executive Sir David Nicholson has written to<br />

For more comment visit www.optometry.co.uk<br />

NHS colleagues urging active support within the NHS for<br />

promoting the vaccination programme during the winter.<br />

In earlier years, the Department of Health ran a national<br />

advertising campaign for seasonal flu vaccination, and Mr<br />

Lansley drew criticism when <strong>this</strong> was dropped for the first<br />

time in autumn 2010. There are no signs that the campaign<br />

will be reinstated <strong>this</strong> year but the criticism made recently<br />

by the chief medical officer, that frontline health service<br />

staff who did not have the jab were “selfish” as they may<br />

be responsible for infecting patients, indicates that there<br />

is still a very real fear of the potentially devastating effect<br />

of <strong>this</strong> disease. The president of the UK Faculty of Public<br />

Health went even further, saying that staff who did not get<br />

vaccinated against seasonal flu were guilty of “complete<br />

dereliction of duty” and could endanger the lives of at-risk<br />

patients. Fewer than 35% of healthcare workers received<br />

jabs last year, which is well below the levels necessary to<br />

minimise risk and <strong>this</strong> despite potentially fatal H1N1 swine<br />

flu being the predominant strain in circulation. As frontline<br />

workers who will routinely come into contact with ‘at risk’<br />

patients, optometrists and dispensing opticians should<br />

seriously consider whether they should act responsibly by<br />

getting vaccinated. Of course, unless you are one of the 16<br />

million patients eligible for a free jab, you will have to pay for<br />

the privilege of acting responsibly.

EVENTS<br />

Final call for PAC 2011<br />

PRACTITIONERS CAN still reserve<br />

their place at <strong>this</strong> year’s Specsavers’<br />

PAC Conference – open to all optical<br />

practitioners, not just employees of the<br />

multiple – which takes place on Sunday<br />

October 9 at the ICC in Birmingham.<br />

The deadline for pre-booking for the<br />

conference is Thursday, October 6, and<br />

instructions are published at the bottom<br />

of <strong>this</strong> article for those who wish to join<br />

in, and after the deadline, delegates can<br />

turn up and book on the morning of the<br />

conference.<br />

This year’s event focuses on practical<br />

skills, with more workshops and<br />

interactive sessions than previously,<br />

from brushing up on a practitioner’s<br />

Volk and tonometry skills, to<br />

reinvigorating enthusiasm for contact<br />

lens work, to testing dispensing<br />

know-how, or finding out more about<br />

assessing patients for refractive surgery.<br />

PAC chairman Paul Carroll said:<br />

“The PAC Conference is a truly all-<br />

inclusive event – everyone’s welcome<br />

and everything is included in the one<br />

delegate fee.<br />

“This is<br />

our most<br />

ambitious<br />

programme<br />

to date,<br />

ensuring<br />

that busy<br />

professionals<br />

can maximise<br />

their day<br />

with a broad<br />

range of live<br />

CET T and a variety of learning formats.<br />

Not only that, but we’ve pegged the fees<br />

for the last five years, so delegates really<br />

are getting more conference for their<br />

money.”<br />

As well as earning up to a year’s<br />

worth of CET points, delegates will<br />

also have the opportunity to talk to key<br />

industry suppliers and representatives<br />

from invited educational institutions<br />

and professional bodies, as well as catch<br />

up with colleagues from across the<br />

profession.<br />

Conference highlights<br />

Clinical, dispensing and contact lens<br />

lectures, include:<br />

• Recognising the effects of drugs on the<br />

eye – Dr Cindy Tromans<br />

• Sexy eyes – Teifi James,<br />

• Dramatic, traumatic and problematic:<br />

A guide to ocular emergencies – Leon<br />

Au<br />

• The pupil: Into the void – Bill Harvey<br />

• A sight for sore eyes – Jeff Kwartz<br />

• Will a magnifier help? – Stephen<br />

Golding<br />

• It shouldn’t happen to a dispensing<br />

optician – Paul McCarthy<br />

• One step beyond. Fitting the irregular<br />

cornea in practice: tips for the non-<br />

specialist – Dr Clare O’Donnell<br />

• Say goodbye to dry: latest dry eye<br />

management – Caroline Christie<br />

• Diabetes: what the DO needs to know<br />

– Nigel Best<br />

• All eyes on you: a practical approach<br />

to dealing with complaints, claims and<br />

regulation – Berryman Lace Mawer,<br />

solicitors<br />

Workshops<br />

Workshops and interactive<br />

presentations include:<br />

• Volk and contact tonometry (Perkins<br />

and Goldmann)<br />

• ‘Dispensing detectives; practical<br />

problem-solving dispensing workshop,<br />

sponsored by Carl Zeiss Vision UK<br />

• Orbscan topography and assessment<br />

for refractive surgery, sponsored by<br />

Ultralase<br />

• Eye examination plus – contact lens<br />

essentials<br />

Also at the event<br />

The conference features:<br />

• Three specially commissioned<br />

CET quizzes, available in paper-based<br />

format and online<br />

• Student-specific lectures and<br />

workshops for Specsavers trainee<br />

dispensing opticians and pre-reg<br />

optometrists<br />

• A discounted bookstall<br />

• Between six and eight CET credits<br />

for attendance on the day, with a<br />

further six credits available through the<br />

quizzes.<br />

To book<br />

The PAC annual clinical conference is<br />

open to all optical practitioners, not just<br />

Specsavers employees. This year’s event<br />

takes place on Sunday October 9 at the<br />

ICC, Birmingham, from 9am-4.45pm.<br />

Delegate fees are £80 for students and<br />

£120 for qualified practitioners (inc.<br />

VAT), and include a two-course sit-<br />

down meal and all refreshments.<br />

For full programme information and<br />

online booking, visit www.specsavers.<br />

com/pac, email pac@gg.specsavers.com<br />

or telephone 01481 233 674.<br />

17<br />

30/09/11 EVENTS

18<br />

30/09/11 DEVELOPMENTS<br />


Scottish contract tipped<br />

to be left ‘unscathed’<br />

HUGE POLITICAL changes took<br />

place following the Scottish<br />

Parliamentary elections earlier<br />

<strong>this</strong> year. Whereas before, Alex<br />

Salmond’s Scottish National<br />

Party governed as a minority<br />

administration, and therefore needed<br />

the support of other parties to<br />

achieve its legislative ambitions, <strong>this</strong><br />

time it achieved an absolute majority<br />

– 69 MSPs out of a total of 129.<br />

This is a significant change,<br />

because whilst before the election<br />

the SNP government had to cajole<br />

and barter to pass measures through<br />

Parliament, now it can do more or<br />

less as it pleases, within reason.<br />

What <strong>this</strong> will mean for optometry<br />

remains to be seen, with the<br />

government’s legislative programme<br />

to be published <strong>this</strong> autumn.<br />

However, cabinet secretary for<br />

health, Nicola Sturgeon, has publicly<br />

declared on more than one occasion<br />

that NHS spending in Scotland will<br />

be ‘ring-fenced’ and will not be<br />

subject to the same cuts that will fall<br />

elsewhere.<br />

This should mean that the<br />

NHS GOS contract terms north<br />

of the border, together with their<br />

relatively generous remunerative<br />

arrangements, should be unscathed.<br />

But many commentators have<br />

already questioned <strong>this</strong> ambition,<br />

including Robert Black, auditor<br />

general for Scotland, saying that<br />

for Scotland to survive the current<br />

economic crisis the culture of ‘free<br />

universal benefits’ will have to be<br />

re-assessed.<br />

Scotland presently enjoys free care<br />

for elderly people, free bus travel<br />

for those aged 60 or over, free dental<br />

checks, free prescriptions and free<br />

eye examinations for all.<br />

The Scottish government is<br />

committed to some big budget items<br />

outside the health sector which some<br />

see as stretching Scotland’s public<br />

finances to breaking point. Chief<br />

amongst these is the new, additional<br />

road bridge over the Firth of Forth<br />

on which work is expected to start<br />

later <strong>this</strong> year. Estimated costs for<br />

<strong>this</strong> project range between £1.47bn<br />

and £1.62bn.<br />

Against <strong>this</strong> sort of background,<br />

many consider the current spending<br />

regime to be unsustainable, and<br />

representative body <strong>Optometry</strong><br />

Scotland’s efforts are now very<br />

much targeted at protecting what<br />

the profession has achieved so<br />

far rather than pressing for more.<br />

Time will tell whether it will be<br />

successful, but hardly a day passes<br />

without some media comment on<br />

the appropriateness of free universal<br />

benefits and the debate is by no<br />

means won.<br />

Clearly the profession needs<br />

more than ever to keep its crucial<br />

role in maintaining the health<br />

and wellbeing of the nation to the<br />

fore. Other representative bodies<br />

in the health sector are energetic<br />

and dedicated in the competition<br />

for resources and funding, and<br />

optometry needs to ensure its voice<br />

is heard amongst the others. This is<br />

a large part of <strong>Optometry</strong> Scotland’s<br />

remit.<br />

But the AOP in Scotland has its<br />

part to play too. Members are being<br />

encouraged to contact their newly<br />

elected MSPs – many of whom are<br />

‘first-timers’ and new to national<br />

politics – and invite them to visit<br />

their practices and learn about<br />

optometry and its place in the<br />

community.<br />

AOP Scotland chair Kevin Wallace<br />

has led by example, hosting a visit<br />

by his constituency MSP, Colin Keir<br />

(pictured right).<br />

Those wishing to follow his<br />

lead can do so by contacting<br />

AOP Scotland’s political adviser,<br />

Stuart Crawford, who will help<br />

with a briefing pack by emailing<br />

swc@swcrawford.co.uk or via the<br />

telephone on 07957 859067.<br />

There is little doubt that some of<br />

the most effective political lobbying<br />

is that which is carried out at local,<br />

constituency level, with practitioners<br />

engaging with their elected<br />

representatives on their home turf.<br />

Every AOP member in Scotland has a<br />

part to play in ensuring the profession<br />

remains at the forefront of healthcare<br />

in the community and an important<br />

part of the NHS in Scotland.

20<br />

30/09/11 INDUSTRY NEWS<br />



In new roles<br />


a new customer<br />

services manager,<br />

Katie Watts<br />

(pictured right).<br />

With more than 14<br />

years experience in<br />

customer services,<br />

she has implemented<br />

a restructure at the company’s UK headquarters<br />

in Kent, placing the focus ‘firmly on the needs of<br />

practitioners’.<br />

“We have doubled the number of people in<br />

the team and everyone is undertaking the FMO<br />

training programme to enhance their skills,” she<br />

explained. “Our aim is to have knowledgeable<br />

staff who are able to deal with calls swiftly and<br />

accurately, providing levels of customer service<br />

not seen before in the optical industry.”<br />

Ms Watts has already received a positive<br />

response to the changes. “We have listened to<br />

feedback from customers and our own staff, and<br />

the restructure is a great start,” she said. “Now<br />

we need to look at improving all our processes<br />

and procedures to make sure our customers’<br />

experience reflects the quality of our products.”<br />

SAUFLON HAS appointed Sue Cockayne, a<br />

qualified optometrist, as professional services<br />

manager. She has 22 years of optical experience,<br />

having previously worked for Leightons<br />

Opticians as professional services director and<br />

then managing director since 2008. She has a<br />

wealth of experience in retail optics and will<br />

strengthen Sauflon’s professional services<br />

support to both its customers and sales teams<br />

across Europe. She has joined the company as<br />

it introduces Clariti 1day toric and is supporting<br />

the launch plus the launch of a range of new<br />

products over the coming months.<br />


appointed Peg<br />

Achenbach, OD, FAAO<br />

(pictured right) as chief<br />

medical and academic<br />

strategist for professional<br />

services, vision care at<br />

Contamac US. She will<br />

oversee the development<br />

of Contamac’s continuing<br />

education programs with strategic focus in the<br />

specialty contact lens arena. Dr Achenbach was<br />

most recently the senior director, professional<br />

and medical affairs for Johnson & Johnson Vision<br />

Care, Vistakon.<br />

Anniversary success<br />

DIBBLE OPTICAL, the Kent-based<br />

supplier of ophthalmic products, is<br />

celebrating its second anniversary.<br />

The company started trading in<br />

2009, distributing the respected<br />

Breitfeld & Schliekert (B&S) product<br />

range and soon afterwards added<br />

3M LEAP optical adhesives to its<br />

extensive portfolio.<br />

This year the company added<br />

Miraflex paediatric frames, Progear<br />

sports eyewear, Rodenstock<br />

instruments and a new and used<br />

edging machinery range to develop the company’s position as ‘a true one-stop-optical-shop’.<br />

“Like most other companies in these challenging times we have experienced many highs and<br />

lows over the past two years but our strong product range, delivered by friendly and experienced<br />

staff, has made a significant impact,” said managing director Barry Dibble (pictured). “I am<br />

immensly proud of our achievements and I’d like to sincerely thank our loyal customer base for<br />

their support.”<br />

Dibble Optical remains enthusiastic about the future and is currently planning to expand into<br />

larger premises.<br />

� 01634 880885

Reviving<br />

an echo<br />

ØRGREEN, THE innovative Danish<br />

company, is launching 15 new models<br />

in both acetate and titanium at Silmo<br />

in Paris <strong>this</strong> weekend and now also has<br />

weekly news on Facebook.<br />

Pictured are frames from the Echo97<br />

collection which celebrates the birth of<br />

the company with updated retro-modern<br />

frames using the latest techniques. She<br />

is wearing Cassidy 150, a unisex frame<br />

with an acetate top and titanium bottom<br />

which has a marbled effect on the acetate<br />

in toffee and violet. He is wearing Harold<br />

144, inlaid titanium which is popular in<br />

classic black highlighted with a yellow<br />

lining. Email gb@orgreen.co.uk<br />

��07977 431409<br />

An eye on<br />

bookings<br />

SILVER-SURFERS are the largest group<br />

of users booking their appointments<br />

online Northern Ireland independent,<br />

Fergus Bain, has found. He was the<br />

first in Ireland to run the Optix practice<br />

management system which was installed<br />

over four years ago. Since then he has<br />

embraced each new enhancement to<br />

the system in the three-practice group,<br />

Alexander Bain & Murray Opticians.<br />

“We have been running online<br />

appointment booking for three years and<br />

it makes the point to our patients that we<br />

are technically up-to-date,” he said.<br />

“It is very pleasing to come in on a<br />

Monday morning and see 10 new<br />

appointments have been made out-ofhours.”<br />

� 0845 869 8501<br />

Flying<br />

the flag<br />

ZOOBUG IS showcasing the Official London 2012 Sunglass Collection for children to the<br />

international optical sector at Silmo in Paris <strong>this</strong> weekend.<br />

The two official “London 2012” models for two to 12-year-olds are Daisy 2012a, a distinctive<br />

flower-shape design for girls, offered in pink with the Official “London 2012” logo on the<br />

temples and Buzz 2012a, a unisex shape with a subtle wrap shape. It is offered in navy blue for<br />

boys and hot pink for girls.<br />

Offering 100% UV protection, the sunglasses are designed first and foremost to protect<br />

children’s delicate eyes from the sun, and are fitted with UV400 polycarbonate (Category 3)<br />

shatterproof lenses, offering high level optical clarity.<br />

Pictured are the official Team GB sunglasses which were launched earlier <strong>this</strong> month and<br />

which will also be showcased by Zoobug at Silmo.<br />

� 0207 251 8122<br />

A world first<br />

BRITISH CONTACT lens and<br />

solutions manufacturer Sau�on<br />

o�cially launched Clariti 1day<br />

toric, the world’s �rst silicone<br />

hydrogel, daily disposable<br />

toric contact lens, at a sunset<br />

celebration in the high-rise<br />

Tower 42 landmark in the heart<br />

of London earlier <strong>this</strong> month.<br />

The launch of the<br />

‘groundbreaking’ new contact<br />

lens is a milestone for the<br />

Twickenham-based company<br />

and follows its silicone hydrogel<br />

daily disposable lens, clariti<br />

1day which has been highly<br />

successful. Managing director Alan Wells and UK sales director Bradley Wells are pictured at<br />

the launch which was attended by 70 practitioners.<br />

Sau�on has positioned Clariti 1day toric as a premium product that patients can be<br />

upgraded into the latest technology ‘for little or no extra cost’. To encourage patient loyalty,<br />

the new contact lenses are available exclusively to practitioners.<br />

As with Clariti 1day, Clariti 1day toric utilises Sau�on’s patented manufacturing process,<br />

AquaGen which has a highly wettable lens surface combined with a low modulus and high<br />

water content for ‘exceptional comfort’. The new toric lens is available in all minus powers,<br />

plano to -6.00 (0.25 steps) and -6.50 to -8.00 (0.50 steps) with 2 cylinders, -0.75 and -1.25 at<br />

axes of 20, 70, 90, 110, 160 and 180 degrees.<br />

� 0208 322 4222<br />

21<br />


22<br />

30/09/11 CROSSWORD<br />


Autumn crossword<br />

This <strong>issue</strong> we continue our popular crossword series. So why not enter our competition before the<br />

closure date October 23, 2011. The winner will receive £50 in Marks & Spencer vouchers<br />

Name:<br />

Address:<br />

HLM Luxury<br />

Our latest lensmeter offers the<br />

best in design technology as well<br />

as accurate measurement and<br />

ease of use.<br />

�� Tilting Screen allowing<br />

best definition when<br />

viewed<br />

�� 1 Touch +/- Cyl<br />

display button<br />

�� UV Measurement<br />

�� PD Measurement<br />

�� Auto Progressive<br />

Recognition<br />

�� Thermal Printer<br />

Two years<br />

interest free<br />

with Two years<br />

parts & labour<br />

warranty.<br />

Offer Ends<br />

September 2011<br />



www.mainline-opticalconnections.co.uk<br />

Phone: 01377 257752<br />

ACROSS<br />

1. Translucent mineral (9)<br />

8. He wrote Three Men in a<br />

Boat (6,1,6)<br />

11. Organised body of soldiers (4)<br />

12. Early ecclesiastical tax (5)<br />

13. Official account (4)<br />

16. Declare approval of (7)<br />

17. Dick’s name for a currant<br />

pudding (7)<br />

18. Weapon from France (7)<br />

20. Childish term for a slavish<br />

imitator (4-3)<br />

21. Short journey (4)<br />

22. Monetary unit of Iraq (5)<br />

23. Open tart (4)<br />

26. Small principality between<br />

Austria and Switzerland (13)<br />

27. The world’s largest island (9)<br />

DOWN<br />

2. King of the jungle (4)<br />

�<br />

3. House maintained by an<br />

apiarist (7)<br />

4. Ambulance service –<br />

commemorated its centenary in<br />

1987 (2,5)<br />

5. British nobleman (4)<br />

6. Early Poet Laureate (5,3,5)<br />

7. Liquid in which an embryo is<br />

suspended (8,5)<br />

9. Daughter of Henry VIII (5,4)<br />

10. British Prime Minister<br />

1868-74 (9)<br />

14. Airmen’s popular term for<br />

the ocean (5)<br />

15. Symbolic flower (5)<br />

19. Scottish order of<br />

Knighthood (7)<br />

20. Tunnel vision first seen in 1802<br />

(7)<br />

24. Term of reference for the Central<br />

Council of Physical Recreation<br />

(Initials) (4)<br />

25. Light sub-machine gun (4)<br />

Send entries to OT Autumn Crossword, 2 Woodbridge Street, London EC1R 0DG by October 23, 2011. You can now enter OT’s Crossword competition online at<br />

www.optometry.co.uk.<br />

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OT CET Video<br />

C-17248 O/AS/SP/IP: When too much<br />

therapeutics is not nearly enough!<br />

Presenter: Peter Frampton<br />

Therapeutic prescribing can be a daunting prospect for<br />

many practitioners. In <strong>this</strong> video, Peter Frampton aims to<br />

encourage practitioners to take up independent<br />

prescribing. He discusses the barriers and benefits of<br />

offering therapeutic services for patients, secondary eye<br />

care services and practitioners themselves, as well as<br />

offering advice on how to become part of a multi-<br />

disciplinary team, working with ophthalmologists to<br />

manage patients in primary care settings. He also provides<br />

examples of the types of cases that can be managed<br />

therapeutically in optometric practice.<br />

You must be logged in to the website before you can watch<br />

<strong>this</strong> video and take the exam.<br />

A hint button is now available for each question and will<br />

take you<br />

to the section of the video that relates to the question.<br />

The closing date for MCQ submissions will be November<br />

30 2011 and the points will be uploaded to CET optics<br />

10 days later.<br />


24<br />

30/09/11 AOP AWARDS 2011<br />


Community Achievement<br />

Award – the shortlist<br />

McCandless Opticians<br />

Alan McCandless and his practice team have been working<br />

hard to help children’s eye care in their local community.<br />

McCandless Opticians, which is based in Ballyclare, co<br />

Antrim, Northern Ireland, is now involved with five schools<br />

and is notable for inviting its community to visit the practice<br />

for an open day to give people a taste of the services it offers.<br />

Initially, the practice proactively contacted its local<br />

primary school to take an active part in the school’s<br />

Christmas fair, which it did. Its involvement proved to be<br />

a huge success as it gave dispensing information, a range<br />

of children’s frames and coloured lenses, and arranged fun<br />

activities to engage the children.<br />

Owner optometrist Mr McCandless says: “We wanted to get<br />

more involved in the community. I grew up here so I know<br />

many parents and kids. From talking to the local teachers<br />

there seemed to be a lot children slipping ‘through the net’<br />

in regard to eye care, so we thought raised awareness would<br />

help.”<br />

The success of <strong>this</strong> led on to more activities with the<br />

local community, including involvement in the town’s May<br />

fair, promoting National Eye Health Week before its most<br />

successful promotion to date which was a ‘design a poster’<br />

competition.<br />

Umarfarouq Jussab<br />

Principal optometrist at St Peter’s Eye Clinic, Leicester,<br />

Umarfarouq Jussab prides himself on delivering eye care from<br />

his community practices amid stiff competition.<br />

“I only started my independent group of practices from<br />

scratch less than five years ago in the Midlands,” he says.“I<br />

knew that I would be facing a very competitive environment.<br />

However, I still went ahead, pursuing my dream to own and<br />

build my own practice and have a unique approach to my<br />

patients.”<br />

Previously, Mr Jussab had spotted a tumour behind the eyes<br />

of a six-month-old infant shortly after qualifying, and been<br />

featured in the local press.“This gave me a certain amount of<br />

fame, but also confidence,” he says, “having only qualified not<br />

long before and being new in the area. The publicity brought<br />

the practice recognition, as well as giving my professional<br />

acumen a boost.”<br />

After discovering someone ‘sleeping rough’ outside his<br />

practice who happened to complain about his vision, Mr<br />

Jussab decided to get involved in voluntary work. “I started<br />

by giving my professional skills to help homeless people and<br />

work one afternoon a week at a day centre,” he says. “It’s<br />

amazing how vision can change someone’s life.”<br />

A local health centre contacted him and now Mr Jussab is an<br />

active member of a stakeholder group of health professionals<br />

To vote now visit www.optometry.co.uk/awards<br />

Five schools helped design practice window material,<br />

illustrating the importance of looking after sight. The contest<br />

drew a huge response with over 800 entries, and the winning<br />

posters were professionally printed to display in the practice<br />

window as a ‘back to school’ campaign last month.<br />

Mr McCandless says: “We got a bike donated and bought an<br />

iPod as prizes. The kids embraced it brilliantly, we received<br />

hundreds of entries.”<br />

The practice is now a key campaigner in raising awareness of<br />

eye health amongst the people of Ballyclare and further afield.<br />

in Leicester providing healthcare to homeless people on a<br />

voluntary basis.“In giving <strong>this</strong> service I was Leicester’s only<br />

homeless eye care service provider, and was nominated by<br />

public vote for the GEM Awards 2010 led by the Leicester’s<br />

PCT. To my surprise I achieved the most votes to win the<br />

Primary Care Award 2010 for the services I provide, with over<br />

20 nominations.”<br />

Mr Jussab also provides eye care to the mental health<br />

community, is proactive with children’s eye care and arranges<br />

for school visits, and is active with the local media, promoting<br />

vision awareness.

Chaaban Zeiban<br />

Lebanese-born Chaaban Zeiban came to the UK aged 17 to<br />

learn English, and quickly decided to complete his education<br />

in <strong>this</strong> country. Self-supporting his studies, he studied in<br />

the evening to achieve a combined degree in biochemistry,<br />

chemistry and physiology at Aston University, switching to<br />

optometry in 1976.<br />

Combining what he calls ‘a love for business and<br />

optometry’ has seen Mr Zeiban utilise many novel ideas to<br />

help patients and the profession.<br />

His innovative screening programmes for young children<br />

won him the UK NatWest Award for Innovation and New<br />

Ideas, and overall winner of New Business Development,<br />

netting him £7,000 in prize money in the process.<br />

In his area of Tamworth, Staffordshire, Mr Zeiban has<br />

visited several school in the locality, and sponsors an antibullying<br />

campaign for pupils, encouraging glasses with a<br />

themed promotion called ‘Why wear a blur when you can<br />

wear a smile’ which includes activities, games, and fashion<br />

shows involving frames and contact lenses. He is also<br />

involved in open days for parents and their children, GPs and<br />

teachers and helps them witness the use of technology in eye<br />

care.<br />

His in-practice training series includes the titles ‘Customer<br />

care – ignore at your own peril’, ‘Turn a child into a family’,<br />

‘Commodities that we take for granted’, ‘Promote yourself;<br />

shout louder’ and ‘walk with your customer and learn’.<br />

Mr Zeiban has lectured and written articles, both nationally<br />

and internationally, on contact lenses, dyslexia and academic<br />

Keep up-to-date with the latest<br />

optical news, features, events and<br />

CET by signing up to receive OT ’ s<br />

weekly E-newsletter. It is sent out to<br />

over 5,900 people every Thursday.<br />

Sign up today at www.optometry.<br />

co.uk/newsletter-sign-up<br />

AOP a member of the Charity partner<br />

skills disorders, nystagmus and contact lenses, children<br />

and contact lenses, and visual dysfunction in galactocaemia<br />

children.<br />

He has held several roles in his optometric career, including<br />

visiting lecturer for the ophthalmic foundation degree at<br />

Nottingham College, course director of CET training at<br />

Healthtalk International, and working as a hospital optometrist<br />

at the Sir Robert Peel Hospital, Tamworth and Victoria<br />

Hospital in Lichfield.<br />

All three shortlisted are worthy winners. Vote for the community<br />

Achievement Award at www.optometry.co.uk/awards or send your<br />

vote to AOP Awards, 2 Woodbridge Street, London, EC1R 0DG.<br />

Results will be announced at the NOC in November and also in OT,<br />

following the event.<br />

Sign up to OT ’s free<br />

weekly E-Newsletter<br />

25 25<br />

30/09/11 AOP AWARDS 2011

26<br />

30/09/11 AOP AWARDS 2011<br />

LOC, ROC or AOC of the Year<br />

The committee that has done the most to promote and enhance the reputation of optics in its area<br />

Central Mersey LOC<br />

Strength in numbers is very much the ethos of Central Mersey<br />

LOC, which was formed in 2007 from members of the former<br />

North Cheshire LOC and St Helens and Knowsley LOC.<br />

As one large LOC covering three different PCTs, the extensive<br />

skillset of committee members has been used to enhance<br />

relationships with the three local health authorities and has<br />

secured a number of enhanced services.<br />

Now averaging almost 20 members per meeting, the LOC has<br />

gone from strength to strength since its formation but is not<br />

resting on its laurels, as between meetings an executive steering<br />

group analyses progress.<br />

Because of its size, when negotiating for local contracts,<br />

the committee can claim to represent a greater number of<br />

practitioners and, because it deals with different PCTs,<br />

members of the LOC have greater experience in securing<br />

contracts.<br />

Chair of the committee, Bob Wilkes (pictured) told OT:<br />

“We wanted to get as many people involved as possible, and<br />

because we’re able to draw on a larger pool, we’ve managed to<br />

get more people involved and so can represent more practices.”<br />

Optometrists lucky enough to be based in Central Mersey<br />

have praised the hard work of the committee which – in<br />

order to serve each area’s best interests – has appointed a<br />

Staffordshire LOC<br />


Supportive and proactive, Staffordshire LOC has been praised<br />

for making its area a pleasure to work in for optometrists across<br />

the county.<br />

Thanks to the team’s hard work, shared care programmes,<br />

are now available in acute eye, post-cataract examinations,<br />

glaucoma referral refinement/full co-management, adnexal and<br />

ongoing cataract and paediatric schemes.<br />

Chair of the committee Malcolm Gray (pictured, with a<br />

patient) told OT: “What we’ve done is to try and help move<br />

more and more work into primary care, then help develop that<br />

care so that patients who can be managed in the community<br />

are. It’s something we’ve worked very hard on and we’ll<br />

continue to do that.”<br />

Their hard work with ophthalmologists, GPs and the local<br />

PCTs has been well received, both within the profession and<br />

with the public who have reaped the benefits of being treated<br />

locally.<br />

Having been chair of the committee for over 25 years, Mr<br />

Gray has seen many changes in the profession which he, and<br />

his colleagues, have done an excellent job in keeping updated<br />

with, whether clinical or technical.<br />

Whereas a large number of LOCs concentrate solely on<br />

furthering the profession from the inside, <strong>this</strong> group has also<br />

made an effort to impact on the public’s knowledge. The LOC<br />

To vote now visit www.optometry.co.uk/awards<br />

representative to deal with optometrists in a variety of<br />

locations. Thanks to the hard work of the LOC, each PCT<br />

area now has diabetic screening and general direct referral,<br />

as well as individual areas having cataract referral and<br />

glaucoma schemes in place. As well as commissioning<br />

expertise, the LOC offers a variety of clinical workshops and<br />

CET events throughout the year. Respected by local health<br />

commissioners and practitioners alike, Central Mersey LOC<br />

has done wonders for the profession in its area since its<br />

formation.<br />

chair presents an advice slot on local radio and the LOC’s<br />

website is one of the few which has a public section.<br />

It features sections on common eye conditions, eye<br />

examinations, diabetes and the eye, eye care, FAQs and careers<br />

information for people considering a career in the profession.<br />

Few organisations have has such a dramatic effect on eye<br />

care in their area. Staffordshire LOC is respected throughout<br />

its region and is a very popular nomination for <strong>this</strong> award.

Wirral LOC<br />

Respected by local practitioners for forging excellent relations<br />

with decision-makers at its local PCT, Wirral LOC has done a<br />

tremendous amount to promote the reputation of the industry<br />

and the optometrists it serves.<br />

Inspired by a visit to the NOC and LOCSU advice, <strong>this</strong><br />

modern LOC has increased its representation on local health<br />

committees such as those on ophthalmology modernisation and<br />

paediatric eye care, which has, in turn, increased the level of<br />

interest and enthusiasm among members.<br />

Wirral LOC secretary David McGowan (pictured) told<br />

OT he was delighted that the committee’s hard work had<br />

improved eye care services for local people and has been<br />

embraced so widely by local members. “What we’ve done is<br />

quite an achievement, we have worked very closely with local<br />

ophthalmologists and PCTs to deliver a service to local people<br />

that we can be proud of.<br />

“We were very keen to be involved in services which we<br />

believed we could improve.”<br />

Having used the Wales <strong>Optometry</strong> Postgraduate Education<br />

Centre (WOPEC) to accredit its schemes, local ophthalmologists<br />

and PCT members were enthusiastic to deal with the optical<br />

group, seeing the value that its proposals could offer.<br />

The committee now has excellent links with local decision-<br />

makers, who feel confident enough to deal with the LOC<br />

directly, so much so, that the deputy director of the PCT has<br />

attended LOC meetings and worked to produce new services<br />

with service level agreements.<br />

The road hasn’t been easy but thanks to the determination of<br />

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the chair Fred Howard and the rest of the team, the LOC has<br />

made real progress, putting it in an excellent position to retain<br />

and add more enhanced services in the new NHS landscape.<br />

All three LOCs have done an outstanding amount to forward<br />

the profession in their area, but only one can win. Vote for the<br />

candidate you think most deserving at www.optometry.co.uk/<br />

awards/loc-roc-aoc-of-the-year or send your vote to: AOP<br />

Awards, AOP, 2 Woodbridge Street, London, EC1R 0DG. Results<br />

will be announced at the NOC in November and also in OT<br />

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27<br />

30/09/11 AOP AWARDS 2011

28<br />

30/09/11 AOP AWARDS 2011<br />


Supplier of the Year<br />

Advancing eye care through a relationship with optical practices<br />

Josie Barlow, UltraVision<br />

The practitioner testimonials on the UltraVision website<br />

and the glowing comments in the AOP Award nominations<br />

illustrate the high regard that Josie Barlow is held in by the<br />

profession and patients alike. The clinical services advisor<br />

(SMC (Tech) FBDO CL) has been at the contact lens innovator<br />

for the last five years.<br />

“My role is basically troubleshooting, giving the practitioners<br />

options on how they can help their patients,” she told OT. “I<br />

particularly help independents to develop their specialist side,<br />

to differentiate, which is a vital thing to be doing in the present<br />

economic climate.”<br />

Ms Barlow visits practices and hospital clinics showing<br />

them how to fit contact lenses on the more complex patients.<br />

She also advises the company’s distributors in France, Spain,<br />

Germany and even South Africa.<br />

She helps to run workshops in practices, particularly with<br />

the KeraSoft contact lenses for irregular corneas. “I basically<br />

offer tailor-made help, even bespoke training for their more<br />

challenging patients,” she explained.<br />

Ms Barlow has been in optics for 23 years but originally<br />

planned to become a mechanic until she helped a neighbour<br />

who made spectacles in his laboratory. She enjoyed it so much<br />

that she funded a course to become a qualified technician<br />

Brian Halliday, Essilor<br />

Brian Halliday of Essilor has worked in optics for over<br />

25 years and was nominated for the AOP Award by an<br />

independent practice which he helped to target the quality<br />

end of the market to differentiate itself from the multiples,<br />

resulting in significant growth.<br />

Mr Halliday’s in-practice training, plus marketing and<br />

promotions support, were particularly singled out and he<br />

was also praised for his hands-on approach at the practice’s<br />

open day.<br />

Training is his particular passion. “By providing training<br />

on new technologies, I’m not only advancing eye care but<br />

helping my customers to grow their business,” he said.<br />

He believes that patients deserve the opportunity to wear<br />

the best possible optical correction. Recently training on<br />

personalised lenses has been in demand. “Quite a few of<br />

my customers want to differentiate themselves and consider<br />

personalised lenses as a great way to achieve <strong>this</strong>,” he said.<br />

“What I really love is the satisfaction of being able to<br />

make a real difference to a customer’s business. Through a<br />

combination of relationship-building, delivering training and<br />

working with the most innovative products, I have watched<br />

businesses flourish.<br />

“A few simple tried and tested changes are sometimes all it<br />

takes and my customers really do appreciate <strong>this</strong>, particularly<br />

To vote now visit www.optometry.co.uk/awards<br />

and worked at Vision Express as a master technician. She<br />

funded a DO course and then a contact lens course, working<br />

for Vision Express and Boots Opticians. Her role followed a<br />

similar one at Cantor & Nissell.<br />

“I did other jobs early on but always came back to optics,”<br />

she said. “I get to use all of my key skills and not a lot of<br />

practitioners can say that. I get a lot of job satisfaction. We get<br />

a lot of patient feedback and I’ve even had them hug me in<br />

gratitude. They are so grateful and what we do is really life<br />

changing.”<br />

when they can wow their patients by enhancing their quality<br />

of vision.”<br />

Mr Halliday likes to treat practitioners the way he would<br />

want to be treated. “I know what it’s like to be on their side of<br />

the dispensing table,” he said. “I like them to know that I care<br />

about their business and their patients and I’m always willing<br />

to help if a problem arises.”

Sheldon Tessler, Rodenstock<br />

A passion for good customer service and bags of enthusiasm<br />

have earned Sheldon Tessler from Rodenstock the nominations<br />

from grateful customers and a place on the shortlist for the<br />

AOP’s Supplier Award.<br />

Mr Tessler has been Rodenstock’s area sales manager for the<br />

South-West for three years. He drives 60,000 miles a year on<br />

average, looking after customers in a huge area which takes<br />

in Gloucestershire, South Wales, Oxfordshire, Berkshire and<br />

Hampshire right down to Devon and Cornwall.<br />

Like most northerners, the effervescent Mancunian prides<br />

himself on “telling it as it is” which is clearly appreciated by<br />

his customers. “I firmly believe in honesty and integrity,” he<br />

said. “I would never tell customers anything which wasn’t true.<br />

I like to treat everyone with respect. My customers are more<br />

like friends now. It’s all about building a rapport.”<br />

Mr Tessler has been selling frames for 14 years, previously at<br />

Safilo where he helped launch Yves St Laurent frames, and also<br />

at Filos where he dealt with Vivienne Westwood frames.<br />

He clearly loves his role. “I present the frames but also<br />

represent Rodenstock as a company,” he said. “Should there<br />

be a query I try to get it resolved as quickly as possible but<br />

I have great technical support from my colleagues. I have<br />

seen optometrists and DOs literally open-mouthed at the<br />

presentations on the technology that is now available. We have<br />

moved so far forward, particularly on the lens side. It’s amazing<br />

what can be achieved now and that’s where the independent’s<br />

strength lies.”<br />

Mr Tessler was nominated for the award for going the extra<br />

AOP a member of the Charity partner<br />

mile for the practitioners he supports, even helping out in the<br />

practice when necessary and supporting practice events. “It’s<br />

true that if they are busy I will help them by talking to patients<br />

if there is no one else available. I will help the practitioner to<br />

sell the frames by putting them on faces,” he explained. “The<br />

first 30 seconds are crucial when a potential customer comes<br />

through the door.”<br />

All three suppliers are greatly appreciated by their customers<br />

and all are worthy winners. Vote for the supplier you think the<br />

most deserving at www.optometry.co.uk/awards/supplier-award<br />

or send your vote to AOP Awards, 2 Woodbridge Street, London,<br />

EC1R 0DG. Results will be announced at the NOC in November<br />

and also in OT, following the event.<br />

29<br />

30/09/11 AOP AWARDS 2011

30<br />

30/09/11 DIARY DATES<br />


��An eye opening experience<br />

With the new university term upon us, it is a good time for students<br />

to consider booking their place at the Student AOP’s Eye Opener<br />

conference on November 3 and 4.<br />

Returning to Center Parcs Longleat for the second successive year,<br />

the event is highly regarded among students – the conference is fun,<br />

educational and gives a real insight into delegates’ future as optical<br />

professionals.<br />

Travel is provided from the major universities and during<br />

the weekend students will be given vital careers advice, enjoy<br />

competitions, prizes, forums and the always popular Eye Ball event.<br />

Last year’s event sold out so early booking is essential at www.<br />

studentaop.org.uk<br />


3 Northern Optometric Society, Manchester<br />

Conference Centre, Manchester, Retinal all<br />

sorts lecture (www.northernoptom.com)<br />

NEW… 3 Nottingham and Derby Optical,<br />

Wolloughby Hall, Nottingham University<br />

Park Campus, Nottingham, Visual stress and<br />

colourimetry lecture (ndos@live.com)<br />

3 Sight Care, Hilton, Leeds City Hotel,<br />

Neville Street, Leeds, Regional meeting<br />

(www.sightcare.co.uk)<br />

4 NEOS, Holiday Inn Express,<br />

Waterloo Square, St James Boulevard,<br />

Newcastle Upon Tyne, Recent advances<br />

in corneal transplant<br />

(neosoptoms@hotmail.co.uk)<br />

4 Sight Care, Newcastle Marriott<br />

Metrocentre, Metrocentre, Gateshead,<br />

Regional meeting SEE ABOVE<br />

4 North London AOP, Moorfields Eye<br />

Hospital, London, CET meeting on<br />

paediatrics<br />

(stevedross10@hotmail.com)<br />

5 Sight Care, Stirling Management<br />

Centre, University of Stirling,<br />

Stirlingshire, Regional meeting SEE<br />

ABOVE<br />

6 CooperVision, Hotel Russell,<br />

Bloonsbury, London, Roadshow,<br />

(www.coopervision.com)<br />

6 Sight Care, Hilton Manchester Airport,<br />

Outwood Lane, Manchester, Regional<br />

meeting SEE ABOVE<br />

NEW… 7 C3Rs, Ramada Heathrow<br />

Hotel, 745 Bath Road, Middlesex,<br />

Training day (kate@c3rs.co.uk)<br />

7 Yorkshire Optical Society, University<br />

of Bradford, Performance sun lenses<br />

trilogy lecture (madhouse37@hotmail.<br />

co.uk)<br />

7 Spectrum Thea, Aston University,<br />

Aston Triangle, Brimingham,<br />

The Dry Eye Project<br />

(www.spectrum-thea.co.uk)<br />

7-8 Heidelberg Engineering, Balmoral<br />

Hotel, Scotland, International<br />

spectralis symposium (www.<br />

heidelbergengineering.com)<br />

Have you got your copy?<br />

<strong>Download</strong> our whole catalogue<br />

or select sections from our new website<br />

visit:- www.bibonline.co.uk<br />

or call 01438 740823<br />

E-mail: sales@bibonline.co.uk Tel: 01438 740823 web: www.bibonline.co.uk UK wide<br />

support<br />

See more events at www.optometry.co.uk/events<br />

7-9 Association for Independent<br />

<strong>Optometry</strong>, Kilworth House Hotel,<br />

Leicestershire (secretary@afio.co.uk)<br />

9 Specsavers, ICC, Birmingham, PAC<br />

Conference (pac@gg.specsavers.com)<br />

10 Lancashire Optical Society, Swallow<br />

Hotel, Preston, Ocular emergencies and<br />

injuries (janelbarker@yahoo.co.uk)<br />

NEW… 10 Sight Care, Leicester<br />

Marriott, Grove Park, Enderbury,<br />

Leicester, Regional meeting<br />


11 Carl Zeiss, Hilton London Stansted,<br />

Round Coppice Road, Stansted, OCT<br />

lecture (kflavelle@zeiss.co.uk)<br />

NEW… 11 Topcon, Cardiff University,<br />

Cardiff, OCT roadshow (medical@topcon.<br />

co.uk)<br />

NEW… 11 Sight Care, Menzies<br />

Cambridge Hotel, Bar Hill, Cambridge,<br />

Regional meeting SEE ABOVE<br />

NEW… 12 Topcon, University of<br />

Bradford, Yorkshire, OCT roadshow<br />


12 Carl Zeiss, Hilton London Stansted,<br />

Round Coppice Road, Stansted, Essex,<br />

Optical biometry lecture<br />


NEW… 12 Sight Care, Copthorpe Hotel,<br />

Slough, Berkshire, Regional meeting<br />



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34<br />

30/09/11 CHILDREN’S CAMPAIGN<br />


It’s for the kids – OC’s<br />

campaign a success<br />

Optometrists nationwide answered the call to get involved in the profession’s initiative<br />

WITH RECENT statistics revealing that one in 10 PCTs do<br />

not arrange any vision screening for children starting school,<br />

the Optical Confederation <strong>this</strong> summer urged optometrists to<br />

promote the importance of children having sight tests in their<br />

local community, building on its inaugral ‘Back to School’<br />

campaign in 2010.<br />

The AOP, on behalf of the Confederation, also targeted more<br />

than 230 school nurse managers across the UK asking them<br />

to disseminate the ‘sight test message’ to their colleagues and<br />

encourage schools and parents to consider children’s eye<br />

care as part of their routine in preparing for the year ahead<br />

at school. More than 10,000 optometrists were encouraged to<br />

display campaign posters in their practices, give a school talk<br />

and build relationships with their local media. A free online<br />

resource pack was available to any practitioner wishing to<br />

take part (www.aop.org.uk/childrenseyehealth).<br />

“This is a very handy ‘DIY’ campaign. I am suggesting that posters<br />

are put up in schools and the pack is <strong>issue</strong>d to every school nurse”<br />

school nurse manager<br />

The Confederation sees <strong>this</strong> campaign, not only as a means<br />

to promote an important public eye health message, but also a<br />

great practice-building opportunity for local optometrists, and<br />

many agreed. Harsh Shah of Eyewise Opticians, Hillingdon,<br />

London, said: “This campaign has given my practice a high<br />

profile in the local community and has brought a steady<br />

stream of new referrals to the practice. Going out to the<br />

schools and organising a class visit to my practice has also<br />

How practitioners got involved<br />

Suffolk optometrist ran advertising campaign<br />

Spectacular Opticians in Newmarket, Suffolk, used<br />

the campaign resource pack to develop a series of<br />

promotional advertising campaigns and also had<br />

a stand at a local summer fair in Cambridgeshire,<br />

which was heavily oriented towards youth groups.<br />

Martin Gibbs, director of clinical services at the<br />

practice, said: “One child’s mother said that she had<br />

booked sight tests for her children based on an<br />

advert that we ran in the paper but she was sure<br />

that the majority of the mums in the school did not<br />

know that it was important to get their children’s<br />

eyes tested.<br />

“Promising progress has been made as a result<br />

of our campaigning but there is still a long way to<br />

go. There is still a widely held belief amongst parents<br />

that surely their children’s eyes must be okay if they<br />

seem to be able to see properly.”

I used the<br />

presentations<br />

and/or handouts<br />

– 4.65% Other – 11.63%<br />

I contacted<br />

my local<br />

school –<br />

13.95%<br />

I printed out the<br />

parents information<br />

leaflet - 11.63%<br />

I signed up<br />

to the national<br />

register of school<br />

volunteers –<br />

11.63%<br />

I displayed the<br />

poster in my<br />

practice window<br />

– 25.5%<br />

I used the resource<br />

pack – 13.95%<br />

I sent the press<br />

release to my local<br />

media – 6.98%<br />

The results of the survey showing how practitioners got involved<br />

added variety to my daily work and provided an equally<br />

rewarding experience.”<br />

Paul McDonald, of Wilson, Wilson and Hancock Opticians<br />

(practices across East Sussex), and a member of East Sussex<br />

LOC commented: “It was very easy and fun (to give a school<br />

talk), and the children were very receptive with some good<br />

probing questions, such as ‘is what my mum says true that if I<br />

watch too much TV my eyes will go square?’”<br />

“Well done to the AOP; an<br />

important <strong>issue</strong> that needs to be<br />

addressed” J Coleman, N. Ireland<br />

While time constraints and demands, particularly on small<br />

businesses, are more prevalent than ever, a survey carried<br />

out by the Confederation found that just under a third of<br />

respondents got involved in the campaign <strong>this</strong> year. For an<br />

initiative in its infancy, <strong>this</strong> should be seen as a success but<br />

there is more work to be done if the future aim for a children’s<br />

sight test to become synonymous with buying a new uniform<br />

on the ‘back to school’ checklist is to happen. Encouragingly,<br />

of those who responded, 25% displayed a poster in their<br />

practice and 14% contacted their local school.<br />

How practitioners got involved<br />

McCandless of N. Ireland ran a competition<br />

Alan McCandless, of McCandless Opticians, Ballyclare,<br />

Northern Ireland, said: “One of the ways we took part<br />

in the campaign involved working with local schools<br />

on a ‘design a poster’ competition where the children<br />

designed posters to display in our practice. The<br />

schools really got on board with <strong>this</strong> and we received<br />

more than 800 entries!<br />

“I think as a result of our work to date we have really<br />

increased awareness locally. The teachers have had<br />

assemblies and talks with the children about their<br />

eyes and are much more aware of looking for vision<br />

problems with children and relaying that information<br />

to the parents.<br />

“Just as importantly, we’ve had a lot of fun doing all<br />

these things and have gained some extra children,<br />

parents and teachers as new patients too.”<br />

“Your emails could not have come at a better time. I have an<br />

appointment with a local school (at their invitation) to discuss<br />

providing a service within the school aimed at those pupils’ parents<br />

who can’t take their children to a High Street optometrist”<br />

D.P, Blackpool<br />

Steven Hislop, partner at The Opticians at Marchmont<br />

in Edinburgh, decided to source ‘outside help’ in engaging<br />

with local schools. He is now working with his local MSP,<br />

Ian Murray, who is contacting local schools on his behalf<br />

as part of a promotional week in November at his practice.<br />

Mr Hislop told OT: “A motion has also been raised in the<br />

Scottish Parliament to highlight the lack of vision testing on<br />

children.”<br />

Across the UK, a number of practices gained local press<br />

coverage over the summer, while Polly Dulley, chair of the<br />

Optical Confederation’s children’s committee, appeared<br />

on ITV’s Daybreak programme, promoting the message<br />

nationally to thousands of viewers.<br />

The AOP is already planning for 2012 and will take<br />

on board comments from the survey such as ‘contact the<br />

SureStart children’s centres’, ‘send out more materials’ and<br />

‘contact the schools directly’. Practitioners’ involvement is<br />

key to the campaign’s success – unfortunately there is no<br />

budget to ‘run a TV campaign’ as one respondent suggested<br />

– but <strong>this</strong> year’s many success stories demonstrate how<br />

practitioners can be a vital part of spreading the message<br />

to the wider public. To get involved, or to share comments,<br />

email childrenseyecare@aop.org.uk or telephone Anne<br />

Grenyer, AOP PR manager, on 020 7549 2063 or Lou Devine,<br />

marketing and communications manager, on 020 7549 2064.<br />

35<br />


36 28<br />

30/09/11 BCLA ADDRESS<br />


Black holes, revelations<br />

and expectations<br />

BCLA president Shelly Bansal used his presidential<br />

address to remind practitioners of their importance<br />

when prescribing contact lenses<br />

‘‘<br />

TONIGHT I want to talk to you about super massive<br />

black holes, expectations and revelations. I also will<br />

speak to you about NSIGHT, which is a groundbreaking<br />

study which Bausch & Lomb has had<br />

conducted with 3,800 vision correction patients.<br />

Sometimes, when you’re in independent practice you<br />

think you’re in cloud cuckoo land with your thoughts,<br />

but <strong>this</strong> study reinforced what I believed to be true.<br />

We are freedom fighters<br />

A key aspect of our practice is that we are very strong<br />

in contact lens wearers, with a low attrition rate, which<br />

is not ‘the norm’ for a practice like ours.<br />

I think it’s fair to say that we are freedom fighters in<br />

our practice – we liberate our patients, give them real<br />

freedom, the freedom from spectacles. I still think it’s<br />

true that kids get labelled at school as geeks or book<br />

worms, and you find as soon as you fit very young<br />

people, or older people for that matter, with contact<br />

lenses, you give them a new lease of life.<br />

Every one of you has seen that in practice, giving<br />

someone a new lease of life through eye care is one of<br />

the most rewarding aspect of our profession. We make<br />

life-changing moments for our patients all the time –<br />

can you think of another profession that does that?<br />

In our practice, patients buy into our services and<br />

care, it’s like a liberation. As a team, we want to deliver<br />

that promise, we have a passion for it, it’s our success.<br />

We spend the first 10-15 minutes just chatting to<br />

a patient, no equipment, no testing sight. We ask<br />

lots of questions to understand what<br />

their expectations about contact<br />

lenses are, and patients<br />

are involved in the<br />

decision-making<br />

process.<br />

So it’s all about<br />

communication<br />

– listening,<br />

asking the right<br />

questions and<br />

body language.<br />

So do you<br />

know what

the biggest black hole in our business? Do you think it’s the<br />

Internet? No, it’s not at all.<br />

It is in fact drop-outs. It’s true; those patients collectively<br />

represent the super massive black holes in our profession.<br />

That’s how I’d like you to think of drop-outs, as big black holes<br />

in your practice.<br />

Figures show that there are as many people dropping out of<br />

contact lenses as joining (as new wearers), and I can’t think of<br />

another profession that would accept the kind of rate of attrition<br />

that we have in our sector.<br />

�<br />

“What are we going to do about<br />

contact lens drop-outs?”<br />

Let’s say the average patient spends about £20 a month on<br />

contact lenses, and all told they’re generating £15k profit –<br />

however, if you suffer 30% in drop-outs, that’s costing you<br />

£5,000 per 100 patients, around £50 per patient. That’s a<br />

massive amount, don’t you think?<br />

Given that drop-outs have a massive impact on your business,<br />

the big question I ask is what are we as professionals doing<br />

about <strong>this</strong>? Who of you out there actually measures <strong>this</strong>?<br />

The big thing about losing money through drop-outs is that it<br />

counters a practitioner being proactive. If you’re content (with a<br />

high rate of drop-outs) I see no reason for you to invest in<br />

staff or equipment, it’s simply not worth your while.<br />

So what’s going wrong? At the heart of <strong>this</strong> I think there’s<br />

miscommunication going on.<br />

The patient has high expectations after seeing a glossy<br />

lifestyle ad which is appealing to their lifestyle, and wants<br />

to wear contact lenses. These adverts appeal to the patient’s<br />

emotional values. But the miscommunication happens<br />

because, typically, the average practitioner doesn’t talk to their<br />

patients in that way, and these adverts appeal to the patient’s<br />

emotional values.<br />

Patients don’t ask because, as was found in J&J research, the<br />

reason many patients don’t wear contact lenses is that they feel<br />

if they were suitable the practitioner would have told them.<br />

They only ask about contact lenses because they see an advert<br />

which appeals to their emotional values.<br />

Permission<br />

Following pre-examination fact-finding and an eye examination,<br />

you must ask the patient: ‘Is it alright that we go through the<br />

results of the examination with you?’ This is important as it<br />

gives you the permission to discuss every option. You have an<br />

opportunity to reset their expectations.<br />

If your wearer is disappointed and the contact lens falls below<br />

their expectations, is it better that the patient is disappointed at<br />

the practice or later when they’re at home or elsewhere?<br />

And so if you reset the expectations of the patient the chances<br />

are that they will come back and be happy with the results and<br />

those who exceed expectations will feel like they are ‘winners’,<br />

and will stay a contact lens wearer – it’s all about making the<br />

right recommendation.<br />

Don’t give a ‘wishy-washy’ recommendation. Sometimes we<br />

don’t direct the patient to where we want them to go, we don’t<br />

properly finish the job we started.<br />

At the end of the recommendation make sure you ask ‘are<br />

you happy?’ It’s another opportunity for the patient to say ‘I’m<br />

not happy’ or ‘yes, you’ve got it spot on’, and then you need<br />

to prepare your patient for what happens next, using language<br />

which is appropriate for the personality type of the patient.<br />

You need to say to the patient ‘you need to come back and<br />

tell me whether or not my recommendation worked’.<br />

And also constantly re-engage them, by asking ‘I need you<br />

to tell me how <strong>this</strong> recommendation is working?’ Tell them to<br />

come back in a week’s time to tell you the result of the promise<br />

that you made. So say to them: ‘I want you to put <strong>this</strong> in the<br />

real world, your world, and tell me how it works.’<br />

Why would a patient even want to go to the Internet (for<br />

their lenses) when they’re being treated like <strong>this</strong>?<br />

Recall<br />

And the next important stage is recall, and ask them how<br />

they’d like to receive the recall – by email, by ‘phone, by<br />

letter, what method? Personalise it. The patient is not going<br />

elsewhere, as nobody else is inviting them in.<br />

In B&L’s NSIGHT study, although two-in-three wearers were<br />

happy with their lenses, one-in-three contact lens wearers were<br />

not happy with their lenses. Although its results reinforced<br />

my own thoughts, I was surprised when ‘vision’ was judged<br />

the most important aspect of contact lens wear by those in<br />

the sample. I always thought ‘comfort’ would be ranked most<br />

highly.<br />

Overall, the NSIGHT study shows that one-in-four wearers<br />

are dissatisfied which is not good enough in my book. Some of<br />

you might be surprised that the study shows how good we are<br />

at fitting young people. But then there is a drop – why?<br />

�<br />

“Nine-out-of-ten patients do not<br />

want to get rid of their lenses”<br />

The truth of the matter is that nine-out-of-ten do not want<br />

to get rid of their lenses, so our patients are desperate for their<br />

lenses but we lose them. In conclusion it’s about managing<br />

expectation. Do it well, everything else can be alright. That’s<br />

the area I think we can really improve upon, we can help<br />

our patients to choose the best type of contact lens for them,<br />

personalising our care and service to their needs, increase our<br />

patients satisfaction by understanding what ‘ticks their boxes’<br />

and setting their expectations realistically and correctly.<br />

The NSIGHT study does reinforce a lot of things we’ve not<br />

wanted to accept is the truth and gives a lot of evidence of what<br />

we can do for our patients. To finish, we can’t afford to have<br />

one-in-three patients as drop-outs, it costs our practices a lot<br />

of money. There is a great joy in watching happy lens patients<br />

growing up and becoming adults and you can say ‘I had an<br />

impact on that person’s vision correction at a specific<br />

time’ and that’s worth a lot more than money in the till.<br />

37<br />


38<br />

30/09/11 NHS CHOICES<br />

ADVICE<br />

Confederation advises<br />

on managing the Web<br />

THE OPTICAL Confederation (OC)<br />

has released guidance on best<br />

practice for managing practice<br />

profiles on NHS Choices, a service<br />

which allows optometrists to<br />

showcase the services they offer and<br />

also allows patients to feedback on<br />

the care they receive.<br />

Following a meeting with the<br />

Department of Health, NHS Choices<br />

team and the Optometric Fees Review<br />

Committee, the Confederation has<br />

developed a document which is<br />

currently being <strong>issue</strong>d to members<br />

and will be available online.<br />

In the meeting it was agreed that<br />

practices could manage profiles<br />

themselves and have a right of reply<br />

to all feedback left by patients. All<br />

practices offering NHS services will<br />

be included and will be contacted<br />

by their PCT with access details<br />

for the site. It is expected that most<br />

will be contacted in October and the<br />

feedback section will not ‘go live’<br />

until the majority are able to access<br />

their page.<br />

OC guidance advocates responding<br />

to all comments, whether positive<br />

or negative. It states: ‘In the case<br />

of positive comments, <strong>this</strong> shows<br />

your appreciation that the patient<br />

has taken the time and trouble to<br />

send comments and reinforces your<br />

relationship with them.<br />

‘Negative comments can be more<br />

difficult to deal with. Practices are<br />

advised never to respond hastily<br />

and always respond in moderate<br />

terms recognising that if the patient<br />

thinks they have had a problem,<br />

then they have an <strong>issue</strong> that needs<br />

to be acknowledged (even if they are<br />

mistaken). Encouraging the patient to<br />

return to the practice and discuss the<br />

<strong>issue</strong> is always good practice.’<br />

However, the website<br />

administrators have confirmed that<br />

libellous, offensive and unsuitable<br />

����������<br />

��������������������������������<br />

comments will be moderated before<br />

they appear and any names of<br />

individual staff will be deleted.<br />

The AOP’s professional adviser,<br />

Geoff Robeson, added that it is in<br />

practitioners best interests to take<br />

an active role in their NHS Choices<br />

profile: “So that they can ensure<br />

that the information about<br />

their practice is correct, use the<br />

opportunity to promote the services<br />

they offer, respond positively to<br />

criticism but correct incorrect<br />

comments or misunderstandings,<br />

and use the feedback to improve<br />

their public face.”<br />

�������������������������� �������������������������<br />

������������������������� ���������������������<br />

����������������������������� ����������������������<br />


Sponsored by<br />

Applications remain high<br />

ENROLMENT ON optometry courses<br />

across the UK has remained strong<br />

ahead of the rising tuition fees next year.<br />

Enrolling optometry students for the<br />

first time was Plymouth University,<br />

which reported to have received twice<br />

as many applications as it has spaces,<br />

with 75 applicants vying for its 36<br />

places. Both applications and enrolment<br />

at Anglia Ruskin for the 2011/12<br />

academic year have risen, admissions<br />

tutor, Ebi Osuobeni told OT. A total<br />

of 532 applications were received and<br />

67 accepted <strong>this</strong> year, compared to<br />

471 in 2010 with 55 enrolling. Whilst<br />

applications received for Cardiff’s<br />

course were unchanged at around 500,<br />

Undergrads test in Romania<br />

A GROUP of Cardiff University optometry<br />

students tested the eyes of over 1,000 people<br />

during a four-day mobile clinic in Romania.<br />

The annual trip, which is now in its ninth<br />

year, is sponsored by the Wiseman Memorial<br />

Fund.<br />

Visiting a new area in the south-west of<br />

Romania where the majority of patients had<br />

never seen an optometrist before, the project<br />

included five optometry undergraduates and<br />

two opticians.<br />

Final year student Juliet Ashwell (pictured),<br />

who tested during the trip, said: “It was a<br />

very rewarding experience as we saw a lot<br />

THIS AUTUMN the GOC will embark on a<br />

series of roadshows, making stops at every<br />

institution which offers a GOC-approved<br />

course in optometry and dispensing optics.<br />

Through the events, staff from the optical<br />

regulator aim to highlight the importance of<br />

student registration and explain the council’s<br />


the number of undergraduates enrolled<br />

rose slightly from 89 to 95.<br />

A total of 74 students will begin on<br />

Manchester’s optometry degree <strong>this</strong><br />

year, which has been whittled down<br />

from 525 applications. With over 180<br />

applications to study at Ulster, 30<br />

students were accepted for <strong>this</strong> year,<br />

although a ‘couple’ of requests to defer<br />

were received. This is up by three on<br />

the university’s 2010 uptake.<br />

Taking on 100 new students from<br />

roughly 600 applicants is Bradford.<br />

Whilst City is welcoming 108 new<br />

students from its 975 applicants,<br />

compared to 103 in 2010 from 886<br />

applications.<br />

of difficult cases, systemic disease and high<br />

refractive error. I had a patient who had<br />

papilloedema which in the UK would lead to<br />

an emergency hospital referral but in rural<br />

Romania there was nothing they could do<br />

which was very upsetting.”<br />

GOC on uni and college tour<br />

work to first-year students.<br />

The College of Optometrists hosts a similar<br />

series of events annually. The optical body<br />

has already made stops at City, Manchester,<br />

Aston and Cardiff Universities, with events at<br />

Bradford and Ulster Universities scheduled for<br />

next month.<br />

Bradford trio completes<br />

its Challenge<br />

A BRADFORD optometry trio has successfully<br />

completed a 750-mile bike ride to raise money for<br />

the World Sight Day Challenge.<br />

After a gruelling eight days, cyclists Fares<br />

Hatoum, OT student rep Jessica MacIsaac and<br />

Abubakr Patel crossed the finishing line at Cardiff<br />

University, having raised around £1,500 to date.<br />

Setting off on September 13 from Glasgow<br />

Caledonian University, the undergraduates made<br />

stops at Bradford, Manchester, Aston, Anglia and<br />

City Universities before reaching the finishing line.<br />

Along the route they were joined by Bradford<br />

University reader in physiological optics, Ed<br />

Mallen.<br />

Speaking about the journey, Mr Patel said:<br />

“We wanted to do something optometry related<br />

to raise a good amount of money and help those<br />

less fortunate with visual impairment. We all cycle<br />

anyway so we thought, lets do something we<br />

enjoy and raise money at the same time.”<br />

Ms MacIsaac added: “Now more people know<br />

about (the ride) we hope that it will become an<br />

annual event.”<br />

This year’s World Sight Day Challenge takes<br />

place on October 13, with funds raised divided<br />

equally between <strong>Optometry</strong> Giving Sight and<br />

Vision Aid Overseas.<br />

You can still sponsor the students at www.<br />

justgiving.com/Optoms-Cycling-for-Sight<br />

39<br />


40<br />

30/09/11 VRICS<br />

VRICS<br />





COURSE CODE: 16925 O/AS/SP/IP<br />

Dr Mhairi Day BSc (Hons), MCOptom, PhD<br />

Dr Douglas Lyall, MBChB MRCOphth<br />

A<br />

Sponsored by<br />

This FREE VRICS test should be completed online by clicking on the “VRICS Test” button at http://www.otcet.co.uk/<br />

and answering the Multiple Choice Questions (MCQs) using the associated images. Please note that there is only<br />

one correct answer for each MCQ. The associated reading list provides useful help for completing the MCQS.<br />

Successful completion will result in two CET points. VRICS regularly appears in <strong>Optometry</strong> <strong>Today</strong>.<br />

1. A patient presents with chronically irritated eyes and on<br />

investigation you observe the signs shown in Image A. Which one of<br />

the following statements about Image A is FALSE?<br />

a) It shows extensive super�cial punctate corneal staining<br />

b) It shows a geographic corneal ulcer<br />

c) It shows a thin/broken-up tear �lm<br />

d) It shows an irregular corneal light re�ex<br />

2. Which of the following is NOT likely to be associated with the<br />

appearance shown in Image A?<br />

a) A tear break-up time of 30 seconds<br />

b) A low tear meniscus / prism height<br />

c) Meibomian gland dysfunction<br />

d) Bilateral presentation<br />

3. Which of the following is NOT likely to bene�t the patient in<br />

Question 1 and with the appearance shown in Image A?<br />

a) Application of arti�cial tears, four times a day or when needed<br />

b) Application of ocular lubricants, before bed and during the day if needed<br />

c) Fitting of punctal occlusion plugs<br />

d) Referral for lid tightening surgery<br />

About the author<br />

Dr Mhairi Day is an optometrist and lecturer at Glasgow Caledonian University (GCU). She is<br />

responsible for the Introduction to Ocular Disease and Clinical Ophthalmology undergraduate<br />

modules and is involved in the delivery of the postgraduate ocular therapeutics course at GCU.<br />

Dr Douglas Lyall is a specialty registrar in ophthalmology at Gartnavel General Hospital, Glasgow<br />

and is an Honorary Clinical Research Fellow at NHS Ayrshire and Arran. The authors wish to thank<br />

Gartnavel General Hospital ophthalmology department for providing images for <strong>this</strong> VRICS.<br />

B<br />

4. Which of the following features is evident in Image B?<br />

a) Scleritis<br />

b) Chemosis<br />

c) Posterior synechia<br />

d) Iris nodules<br />

5. Which of the following symptoms is MOST likely to be reported by<br />

a patient with the condition shown in Image B?<br />

a) Itching<br />

b) Deep, boring pain<br />

c) Sudden onset of reduced vision<br />

d) Headaches<br />

6. The patient with the condition shown in Image B reports that a<br />

foreign substance touched the eye a couple of hours previously.<br />

Which of the following is NOT a suitable treatment option for <strong>this</strong><br />

patient?<br />

a) Topical mast cell stabilisers<br />

b) Cold compresses<br />

c) Topical eye wash<br />

d) Reassurance that it should resolve spontaneously within a few<br />

hours or a day

CONFUSED ABOUT CET REQUIREMENTS? www.cetoptics.com/cetusers/faqs/<br />

Sponsored by<br />

IMPORTANT INFORMATION: Under the new Vantage rules, all OT CET points awarded will be uploaded to its website by us.<br />

All participants must con�rm these results on www.cetoptics.com so that they can move their points from the “Pending Points record” into<br />

their “Final CET points record”. Full instructions on how to do <strong>this</strong> are available on their website. The closing date for <strong>this</strong> examination is<br />

25th November 2011. CET points for <strong>this</strong> exam will be uploaded to Vantage on December 5 2011.<br />


��<br />

Approved for Optometrists AS SP IP<br />

Associated readings:<br />

1. Kanski JJ (2011) Clinical Ophthalmology: A Systematic Approach: Expert Consult, 7th edition,<br />

Elsevier<br />

2. Ehlers JP et al. (2008). The Wills Eye Manual: O�ce and Emergency Room Diagnosis and<br />

Treatment of Eye Disease. 5th Edition Lippincott Williams & Wilkins<br />

C<br />

�<br />

��<br />

7. Which of the following features is shown in Image C?<br />

a) Keratic precipitates<br />

b) Cells in the anterior chamber/aqueous<br />

c) Fuchs endothelial dystrophy<br />

d) A regularly shaped pupil<br />

��<br />

8. Which of the following features is NOT likely to be associated with<br />

the presentation of the condition shown in Image C?<br />

a) Sudden onset<br />

b) Aqueous �are<br />

c) Posterior synechiae<br />

d) Raised intra-ocular pressure<br />

9. The patient shown in Image C has had the condition at least twice<br />

before within the last three months and has been treated by an<br />

Independent Prescribing optometrist each time. What is the MOST<br />

suitable management at <strong>this</strong> point?<br />

a) Treatment by an additional supply optometrist<br />

b) Further treatment by an Independent Prescribing optometrist<br />

c) Treatment by a GP<br />

d) Treatment by an ophthalmologist<br />

3. The College of Optometrists Clinical Management Guidelines (http://www.college-optometrists.<br />

org/en/professional-standards/clinical_management_guidelines/index.cfm)<br />

4. British National Formulary (BNF) (http://bnf.org/bnf/index.htm)<br />

D<br />

10. Which one of the following features is shown in Image D?<br />

a) Vogt’s limbal girdle<br />

b) Pigmented anterior angle<br />

c) Narrow anterior angle<br />

d) Neovascularisation at the trabecular meshwork<br />

11. When performing the technique shown in Image D, which of<br />

the following statements is FALSE?<br />

a) The name, concentration, batch number and expiry date of the<br />

anaesthetic used should be recorded<br />

b) The time of day that the procedure was performed should be recorded<br />

c) The most posterior structure that is visible should be recorded<br />

d) The result is normally recorded as a grade on a scale of 0 (closed) to<br />

4 (open)<br />

12. Which one of the following statements about the technique<br />

shown in Image D is TRUE?<br />

a) The best way to visualise the position of iris insertion is to use a<br />

di�use beam<br />

b) This technique should be conducted on all patients diagnosed with<br />

glaucoma at every visit<br />

c) This technique may be useful when investigating patients who have<br />

had a central retinal vein occlusion or proliferative diabetic retinopathy<br />

d) Van Herrick’s technique is a suitable substitute for <strong>this</strong><br />

41<br />

30/09/11 VRICS

42<br />

30/09/11 PRODUCTS<br />


Vitamins and eye drops<br />

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0208 955 2662.<br />

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The pleasant-tasting<br />

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dose is one sachet dissolved in half a cup of cold water. Telephone<br />

0845 521 1290.



To be held at Chesford Grange Kenilworth, Warwickshire<br />

5 TH – 6 TH NOVEMBER 2011<br />

Programme includes<br />

� �������� ����� ������ � ������� �������� � ����������� ��������<br />

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���� �� ��������������������� �� �������� Andrew Tompkin, <strong>Optometry</strong> Department,<br />

St Paul’s Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP<br />

Supported by:<br />

� Braemar Finance<br />

� Cardiff University<br />

� Cantor & Nissel<br />

� Carl Zeiss UK Ltd<br />

� Cerium Optical<br />

� David Thomas CL Ltd<br />

� Grafton Optical<br />

� Haag-Streit UK<br />

� Hanson Instruments<br />

� IGA<br />

� Keeler<br />

� Mainline Instruments<br />

� Macuvision<br />

� No7 Contact Lenses<br />

� Northern Lenses<br />

� Novartis UK Ltd<br />

� Optima Low Vision<br />

� Optisoft<br />

Tel 0151 706 3900/3901 Fax 0151 706 5846<br />

E-mail aptompkin@tompkin.org.uk<br />

� <strong>Optometry</strong> Giving Sight<br />

� OT Bookshop<br />

� Swisslens<br />

� Topcon UK<br />

� Ultravision<br />

� Warwick Medical School<br />

� Webstar

44<br />

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& TRAINING<br />


Approved for: Optometrists �� Dispensing Opticians ��<br />

Peripheral retinal<br />

degenerations<br />


Graham Macalister, PhD, FCOptom, DCLP, Dip Tp (IP)<br />

Paul Sullivan, MD, FRCS, FRCOphth<br />

This article examines retinal degenerations and congenital anomalies which<br />

the optometrist may encounter in the periphery of an asymptomatic patient.<br />

The key identifying features are described and for each condition, the<br />

following questions are asked: Is it a risk factor for retinal detachment (RD)? Is<br />

prophylactic treatment required? Does it warrant referral? If so, should it be<br />

urgent or routine? If referral is not warranted, is more frequent monitoring<br />

by the optometrist required? What advice should be given to the patient?<br />

Peripheral retinal<br />

degenerations and retinal<br />

detachment<br />

The increasing adoption of indirect<br />

ophthalmoscopy techniques means<br />

that optometrists are routinely looking<br />

further into the retinal periphery. Imaging<br />

instruments, such as the Optomap,<br />

have also increased access to <strong>this</strong> area.<br />

Optometrists, therefore, need to be aware<br />

of the significance of the conditions<br />

that are increasingly likely to be found.<br />

In order to decide if a given peripheral<br />

retinal degeneration is a risk factor<br />

for RD, we must first consider how a<br />

detachment arises. Rhegmatogenous<br />

retinal detachments (RRD) are the most<br />

common and occur when fluid in the<br />

vitreous cavity passes through tears<br />

or holes in the neurosensory retina<br />

and separates it from the underlying<br />

retinal pigment epithelium (RPE).<br />

Detachment becomes more likely if the<br />

break in the neurosensory retina is held<br />

open by ongoing vitreoretinal traction,<br />

encouraging liquid vitreous that has been<br />

mobilised by saccadic eye movements to<br />

pass through the open break. 1 Therefore,<br />

OT CET content supports <strong>Optometry</strong> Giving Sight<br />

if a peripheral retinal degeneration is<br />

to be considered a risk factor for RRD<br />

then it must predispose the formation<br />

of breaks, either through enhanced<br />

attachment between the vitreous cortex<br />

and the neurosensory retina and/or a<br />

weakness of the neurosensory retina<br />

itself. Furthermore it is only those<br />

conditions that affect the inner retina<br />

and its interface with the vitreous,<br />

that are likely to be rhegmatogenous.<br />

Conditions that affect the outer retina<br />

are unlikely to be a risk factor for RD.<br />

Conditions that affect the outer<br />

retina<br />

Pavingstone<br />

Also known as cobblestone degeneration,<br />

<strong>this</strong> condition is present in about 25%<br />

of the population and appears as well<br />

defined yellow white patches between<br />

the equator and the ora serrata. It is<br />

characterised by the absence of the outer<br />

layers of the retina, in particular the<br />

choroid, which permits an uninterrupted<br />

view of the sclera. Sometimes large<br />

blood vessels can also be seen through<br />

<strong>this</strong> window giving the impression of a<br />

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View CET FAQ Go to www.optometry.co.uk<br />

Figure 1<br />

Pavingstone degeneration (also known as<br />

cobblestone) (Image courtesy of Dr HD Riley and<br />

the Indiana University School of <strong>Optometry</strong>, USA)<br />

well-defined red stripe over the white<br />

background of the sclera (Figure 1). It<br />

is possible that Pavingstone defects are<br />

present from birth and should not be<br />

considered a degeneration at all. Although<br />

these lesions have a striking hole-like<br />

appearance, the defect is in the outer<br />

retina, leaving the inner layers intact with<br />

no predisposition to break formation.<br />

CHRPE<br />

Congenital Hypertrophy of the Retinal<br />

Pigment Epithelium (CHRPE) is a<br />

common benign lesion. It is present at<br />

birth and is not a degenerative condition.<br />

It is a flat round or oval lesion, which is<br />

dark grey or black in colour and up to<br />

three disc diameters in size. It is darker<br />

and more well-defined than a choroidal<br />

naevus because it is more superficial and<br />

therefore there is less retinal t<strong>issue</strong> to<br />

dull the appearance and soften the edges.<br />

It is an outer retina change and does<br />

not affect the vitreo-retinal interface;<br />

therefore it does not predispose to retinal<br />

detachment. When CHRPE lesions<br />

occur in groups, known as bear tracks<br />

(Figure 2a), it is worth asking the patient<br />

if there is a family history of gastro-<br />

intestinal problems, in case they are a<br />

sign of rare inherited condition of the

owel known as Familial Adenomatous<br />

Polyposis. Individual CHRPE lesions<br />

can lose pigment over time, altering<br />

the uniform appearance and making<br />

recognition more difficult. Some lesions<br />

may become almost totally de-pigmented<br />

with only a thin rim of residual pigment<br />

remaining at the edge, giving the<br />

false impression of a hole (Figure 2b).<br />

Reticular degeneration<br />

Reticular pigmentary degeneration (also<br />

known as honeycomb degeneration) is a<br />

relatively common finding in the peripheral<br />

fundi of older patients. It is characterised<br />

by a fine network of pigmentation<br />

and has no clinical significance.<br />

Peripheral drusen<br />

Optometrists are familiar with drusen<br />

that form at the posterior pole in<br />

those affected by age-related macular<br />

degeneration (AMD). Similar clusters of<br />

pale yellow lesions can be found near<br />

the equator of the eye in elderly patients<br />

(Figure 3). They are not a risk factor for<br />

detachment and do not require referral.<br />

Conditions that affect the inner<br />

retina<br />

White without pressure<br />

White without pressure refers to<br />

geographic areas of whiteness in the<br />

peripheral retina that are not caused<br />

by scleral indentation. It is an optical<br />

phenomenon probably related to increased<br />

density of collagen fibrils at the interface<br />

with the retina. It occurs in 30% of normal<br />

eyes and is usually bilateral. There are<br />

reports that traction-induced giant retinal<br />

tears will follow the posterior border<br />

of an area of white without pressure.<br />

This does not mean that white without<br />

pressure caused the tear, but it may have<br />

determined the route that the tear took.<br />

It is now believed that white without<br />

pressure it is not a risk factor for RRD and<br />

there is no need for referral. However,<br />

Figure 2<br />

Congenital Hypertrophy of Retinal Pigment Epithelium (CHRPE) (a) a group or “bear track”, (b)<br />

de-pigmented CHRPE with a thin rim of pigment remaining at the edge<br />

optometrists should be aware that white<br />

without pressure can sometimes give<br />

the false impression of a retinal break.<br />

A true defect in the neurosensory retina<br />

will allow the red choroidal reflex to<br />

appear brighter in the area of the defect<br />

as compared to the adjacent fundus.<br />

A similar, but misleading appearance,<br />

can occur when an area of seemingly<br />

white retina entirely encloses the retina<br />

with the normal orange red colouration.<br />

Microcystoid degeneration<br />

Microcystoid degeneration consists of<br />

small vesicles set in an area of greyish<br />

white retina near the ora serrata. It<br />

is present in all eyes and, although<br />

it increases in extent with age, it is<br />

not directly responsible for break<br />

formation. However, the cysts may<br />

give rise to the formation of splits<br />

between the layers of the neurosensory<br />

retina, producing retinoschisis.<br />

Retinoschisis<br />

In the age-related form of retinoschisis,<br />

cystoid spaces coalesce to form<br />

mucopolysaccharide-filled cavities that<br />

cause the inner retina to separate from<br />

the outer retina (Figure 4). This splitting<br />

of the neurosensory retina is present in<br />

7% of the population over 40 years of<br />

age and occurs almost exclusively in<br />

hypermetropes, most commonly in the<br />

inferior temporal quadrant and often in<br />

both eyes. There is total loss of function in<br />

the affected area, resulting in an absolute<br />

scotoma, but there is no threat to sight<br />

because, unlike a retinal detachment,<br />

a retinoschisis does not progress from<br />

the periphery towards the macula.<br />

With retinoschisis, it is rare to see RPE<br />

changes, whereas in retinal detachments<br />

these changes are relatively common.<br />

There is generally no flow of liquid<br />

from the vitreous into the schisis<br />

cavity, which means that it appears as<br />

a smooth bulge that does not change<br />

shape or position with eye movements.<br />

Figure 3<br />

Peripheral retinal drusen<br />

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45<br />

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46<br />

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Approved for: Optometrists �� Dispensing Opticians ��<br />

Figure 4<br />

Retinoschisis<br />

It is possible for breaks to occur, which<br />

could then trigger a retinal detachment<br />

(detachment of the neurosensory retina<br />

from the RPE), but <strong>this</strong> only happens<br />

in 0.05% of cases; 2 there is no need for<br />

prophylactic treatment of retinoschisis.<br />

Optometrists who suspect a<br />

OT CET content supports <strong>Optometry</strong> Giving Sight<br />

Figure 5<br />

Atrophic round hole. Note that the retinal break<br />

appears redder than the surrounding retina because<br />

of the unobstructed view of the choroid<br />

retinoschisis in an asymptomatic<br />

patient should refer on a routine basis<br />

Retinoschisis Rhegmatogenous Retinal detachment<br />

Split within the neurosensory retina Neurosensory retina separates from RPE<br />

Smooth, shiny Rippled, irregular<br />

Stationary on eye movement Drifts or undulates with eye movements<br />

No flashes or floaters Flashes, floaters, cobwebs<br />

Bilateral usually Rarely bilateral simultaneously<br />

7% of population >40 years 0.1% of population<br />

70% hypermetropes Myopes over-represented<br />

Stable absolute scotoma Progressive relative scotoma<br />

No breaks Break present (may be difficult to locate)<br />

No tobacco dust Tobacco dust<br />

Infero-temporal commonest Superior-temporal commonest<br />

No pigment disturbance Pigment disturbance possible if chronic<br />

No spread, innocuous Sub-retinal fluid spreads, can threaten macula<br />

Routine referral to confirm diagnosis Urgent referral for treatment<br />

Table 1<br />

Comparison between the characteristics of retinoschisis and rhegmatogenous retinal detachment<br />

and then monitor annually if the diagnosis is confirmed. The contrasting<br />

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Figure 6<br />

Operculated tear. The operculum remains stuck to<br />

the posterior vitreous cortex, which in <strong>this</strong> case has<br />

not detached very far from the retina. Shrinkage<br />

means that the operculum appears smaller than<br />

the break that it used to occupy (Image courtesy<br />

of Dr HD Riley and the Indiana University School of<br />

<strong>Optometry</strong>, USA)<br />

characteristics of retinoschisis and RRD<br />

are shown in Table 1. In particular it<br />

is wise to keep to the advice “never<br />

diagnose retinoschisis in a myope”.<br />

Atrophic round holes<br />

Atrophic round holes (Figure 5) are not<br />

caused by posterior vitreous detachment<br />

(PVD) or by blunt trauma. It is most<br />

likely that they are caused by chronic<br />

atrophy related to vascular changes.<br />

They are generally round or oval in<br />

shape and are referred to as atrophic<br />

round holes to distinguish them from<br />

the U shape tears caused by vitreous<br />

traction. Any break in the attached retina<br />

appears redder than the surrounding<br />

t<strong>issue</strong> because of the unobstructed<br />

view of the choriocapillaris. Note that<br />

a peripheral retinal haemorrhage will<br />

have irregular margins as it diffuses<br />

into the surrounding t<strong>issue</strong>, whereas<br />

a hole has perfectly smooth borders.<br />

The incidence is not related to age and<br />

atrophic holes are seen in the young.<br />

Many holes are associated with myopia<br />

or lattice degeneration (see later). Some

atrophic holes are surrounded by a<br />

small area of subretinal fluid (SRF).<br />

These have not progressed to a full<br />

clinical detachment because there is<br />

no vitreous traction to encourage flow<br />

through the break. In <strong>this</strong> situation the<br />

RPE is able to pump all the liquefied<br />

vitreous into the choroid, with the<br />

exception of the immediate zone<br />

around the break. A ring of reactive<br />

hyperpigmentation at the border of the<br />

SRF indicates chronicity and stability.<br />

Very rarely an asymptomatic (no flashes<br />

or floaters) atrophic hole can slowly<br />

progress to a clinical detachment.<br />

Where there is a detachment in a<br />

young myope with no PVD, the most<br />

likely cause is an atrophic hole.<br />

Although atrophic round holes can<br />

potentially lead to a detachment <strong>this</strong><br />

is extremely rare 3,4,5 and they do not<br />

Feature Atrophic hole Operculated<br />

tear<br />

Shape Round or oval Round with disc shape<br />

operculum floating<br />

above the break<br />

Vitreous traction None Traction formed the<br />

break but is absent<br />

after the operculum<br />

has separated<br />

Figure 7<br />

Flap tear (also known as horseshoe tear or U tear).<br />

Note that the apex of the tear always points towards<br />

the posterior pole<br />

require treatment and there is no need<br />

for referral. It is therefore important to<br />

be able to distinguish atrophic round<br />

holes from retinal tears, which do require<br />

urgent referral (see Table 2). It is useful to<br />

refer to a break that results from focal loss<br />

Flap tear<br />

U shape with central<br />

flap<br />

Usually continuous<br />

traction<br />

Location Far periphery Far to mid periphery Far to mid periphery<br />

Retinal or vitreous<br />

haemorrhages<br />

Symptoms<br />

(flashes, floaters)<br />

Never Rarely Often<br />

Never (unless<br />

clinically significant<br />

RD occurs)<br />

Possible in traction<br />

phase (or if clinically<br />

significant RD occurs)<br />

Incidence of RD Rare 1/6 8 (much less if<br />

asymptomatic)<br />

Prophylactic<br />

treatment of<br />

break<br />

Never (for exceptions<br />

see lattice)<br />

Frequent in traction<br />

phase (or if clinically<br />

significant RD occurs)<br />

1/3 8<br />

Rarely Always<br />

Referral No Routine (unless<br />

significant sub-retinal<br />

fluid)<br />

Immediate to A&E<br />

Table 2<br />

The features of atrophic round holes are contrasted with those of operculated tears and flap tears<br />

of t<strong>issue</strong> due to atrophy as a “hole”, while<br />

a break induced by vitreous traction is<br />

described as a “tear”. Unfortunately <strong>this</strong><br />

convention is frequently ignored and the<br />

two terms are used interchangeably. In an<br />

operuclated tear (Figure 6), the traction<br />

separates a small plug of neurosensory<br />

retina from the surrounding retina. This<br />

is known as the operculum and it can<br />

be seen as a grey disc-shape floater lying<br />

over the area of the tear. It remains stuck<br />

to the vitreous cortex and moves with it<br />

on eye movements. Shrinkage means that<br />

it appears slightly smaller than the break<br />

that it previously occupied. Operculated<br />

tears are also round and the best way of<br />

distinguishing them from atrophic round<br />

holes is the presence of the disc-shaped<br />

floater. Flap tears (Figure 7) produce<br />

U or V shape breaks with the apex of<br />

the flap pulled into the vitreous cavity<br />

but still attached at the anterior border<br />

of the tear. Thus the apex of the flap<br />

always points towards the posterior pole.<br />

Lattice degeneration<br />

Lattice retinal degeneration is a common<br />

peripheral condition that is present in 8%<br />

of eyes, but is more common in myopes.<br />

It develops in early adulthood rather<br />

than in old age. It has several different<br />

ophthalmoscopic presentations, which<br />

have previously been described as separate<br />

conditions. The classic appearance is a<br />

crusty, circumferentially oriented oval<br />

patch that appears layered on the surface<br />

of the retina. Sometimes there is excess<br />

pigment and sometimes fine white lines<br />

(sclerosed vessels) criss-cross the patch<br />

of degeneration giving rise to the lattice<br />

appearance. One variant is characterised<br />

by tightly packed “snowflakes” that<br />

produce a glistening appearance, which<br />

has been described as “snailtrack<br />

degeneration”. Histopathology reveals<br />

retinal thinning and sometimes small<br />

atrophic holes will be evident, which<br />

can lead to asymptomatic localised<br />

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47<br />

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48<br />

30/09/11 CET<br />

retinal detachment as described above. 6<br />

The vitreous overlying the area<br />

of lattice is liquefied, but there is<br />

exaggerated vitreoretinal attachment<br />

along its margin. It is <strong>this</strong> combination<br />

(thin retina, strong vitreous attachment<br />

and a reservoir of liquefied vitreous)<br />

that makes lattice degeneration a risk<br />

factor for tractional tears following<br />

PVD. However, <strong>this</strong> does not mean<br />

that all areas of lattice should receive<br />

prophylactic laser treatment. Although<br />

lattice degeneration is a risk factor for<br />

RRD, the majority of these patients do<br />

not develop a detachment. Only 1%<br />

of eyes with lattice changes suffered<br />

RRD in a 10-year follow up period 7<br />

and it was concluded that prophylactic<br />

treatment should be discontinued.<br />

Furthermore, treatment may not<br />

always prevent detachment because<br />

new breaks can occur in areas not<br />

visibly affected by lattice. Referral for<br />

lattice, even in the presence of atrophic<br />

round holes, is therefore not required.<br />

Optometric considerations<br />



& TRAINING<br />


Approved for: Optometrists �� Dispensing Opticians ��<br />

It may seem to be a contradiction that<br />

Peripheral<br />

degeneration<br />

Risk factor for<br />

RRD?<br />

OT CET content supports <strong>Optometry</strong> Giving Sight<br />

lesions such as atrophic round holes and<br />

lattice degeneration can be risk factors<br />

for RRD, yet they do not warrant referral.<br />

Laser retinopexy is routinely applied to<br />

retinal tears or detachments and is very<br />

effective at preventing visual loss. Why<br />

is it not used on those peripheral retinal<br />

degenerations that can theoretically<br />

lead to a detachment? It is important<br />

to understand that it is not always<br />

appropriate, or even feasible, to attempt<br />

to reduce a disease risk by prophylactic<br />

treatment. There are two reasons why <strong>this</strong><br />

is not done for peripheral degenerations.<br />

Firstly, the incidence of RRD secondary<br />

to lattice or atrophic holes is extremely<br />

low. Secondly, when prophylactic<br />

treatment of peripheral degenerations<br />

was undertaken in the past, the results<br />

did not show overall that it was effective<br />

in preventing detachment. This was<br />

confirmed by a Cochrane review, 9<br />

which is now widely accepted by<br />

ophthalmologists. Laser retinopexy is,<br />

therefore, not applied prophylactically<br />

to peripheral retinal degenerations. One<br />

possible exception is when there is a<br />

history of detachment, associated with<br />

Action<br />

Pavingstone No None required<br />

CHRPE No None required<br />

Reticular No None required<br />

Peripheral drusen No None required<br />

WWP No None required<br />

Microcystoid No None required<br />

Retinoschisis Very rare progression Refer routinely for confirmation of<br />

diagnosis. Then monitor annually<br />

Atrophic round holes Very rare Retinal detachment warning. Monitor<br />

annually<br />

Lattice Very rare Retinal detachment warning. Monitor<br />

annually<br />

Table 3<br />

Summary of peripheral retinal lesions and actions required<br />

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lattice degeneration, in the fellow eye.<br />

What should optometrists tell the<br />

patient when they identify a risk factor<br />

for retinal detachment? They should<br />

tell the patient that retinal detachment<br />

is a rare condition and that even<br />

though features in their eyes have<br />

been identified that make <strong>this</strong> slightly<br />

more likely, the risk is still not high.<br />

The symptoms of a retinal break or<br />

detachment should be described and the<br />

patient told to seek advice immediately<br />

if they should occur. Emphasise that<br />

only sudden changes in floaters are<br />

significant. Nervous myopes should be<br />

discouraged from trying to constantly<br />

monitor their floaters for a small increase<br />

in numbers. It is also important to stress<br />

that there is no need to modify lifestyle,<br />

pastimes or sport. The myth that women<br />

can suffer RD as a result of the strains of<br />

child birth is totally without foundation.<br />

It can be seen from Table 3 that the<br />

only peripheral retinal degeneration<br />

that requires referral is retinoschisis.<br />

Where there is doubt about the correct<br />

differential diagnoses then it is always<br />

wise to refer on the basis that it is the<br />

most serious condition. Thus, if an area<br />

of elevated retina has some features<br />

of retinoschisis but some that would<br />

suggest detachment then referral would<br />

have to be urgent. Treatment is required<br />

for retinal tears and detachment and<br />

referral refinement for these conditions<br />

will be considered in more detail<br />

in the next article in <strong>this</strong> series.<br />

About the authors<br />

Graham Macalister is a specialist<br />

optometrist at Moorfields Eye Hospital.<br />

Paul Sullivan is a vitreo retinal<br />

consultant at Moorfields Eye Hospital,<br />

where he is the director of education.<br />

References<br />

See http://www.optometryco.uk<br />

clinical/index. Click on the article title<br />

and then download “references”.



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OT CET content supports <strong>Optometry</strong> Giving Sight<br />

� ��<br />

Impact of cosmetics on the<br />

ocular surface and contact<br />

lens wear<br />

COURSE CODE C-16942 O/D/CL<br />

Dr Cameron Hudson, BSc (Hons), PhD, MCOptom<br />

Cosmetics such as mascara and eyeliner contain a range of ingredients<br />

including pigments, oils, waxes and preservatives, and their site of<br />

application brings these substances close to, and even in direct contact<br />

with, the lashes, the ocular surface and surrounding t<strong>issue</strong>s. The e�ect of<br />

these substances on the ocular surface, including the tear �lm and cornea ,<br />

is not well understood and the impact of cosmetics contaminating contact<br />

lenses has similarly received little attention to date. Whilst all cosmetics<br />

undergo rigorous testing before being made available to consumers, there<br />

have been a number of undesirable e�ects of cosmetics and toiletries<br />

described in the literature. This article reviews current knowledge about<br />

cosmetics and their impact on patient symptoms and contact lens wear.<br />

The cosmetics industry has undergone<br />

another record breaking year with higher<br />

revenues than ever being generated. In<br />

addition, in <strong>this</strong> ‘recession resistance’,<br />

the cosmetics industry has seen changes<br />

in the demographics of consumers<br />

purchasing these products; according to<br />

the market research company The NPD<br />

Group Inc., the average age that a female<br />

began using beauty products was 17<br />

years in 2005, compared with 13.7 years<br />

today. 1 There has also been an increase<br />

in the number of ‘age-defying’ products<br />

and hence the cosmetics industry<br />

appears set on ‘beautifying’ consumers<br />

well into their later years of life. Whilst<br />

the predominant users of cosmetics and<br />

eye make-up are female, increasingly<br />

more males than in previous years<br />

have begun using cosmetic products,<br />

especially those for the face and eyes.<br />

Cosmetics and the eye<br />

It is estimated that approximately 70%<br />

of women wear cosmetic products for<br />

use around the eyes. Cosmetics are<br />

commonly applied to the lid areas, the<br />

lashes and also with close proximity<br />

to the meibomian gland ducts on the<br />

lid margin (Figure 1). During recent<br />

years, eye make-up manufacturers<br />

have promoted their products based on<br />

their ability to resist fading, smudging<br />

or wearing off over time, which<br />

consequentially makes removal of these<br />

products more difficult. Often branded<br />

as “waterproof”, these cosmetics<br />

contain oil, wax or silicone-based<br />

agents to aid resistance to the effects of<br />

tears and perspiration. Currently there<br />

are no published papers that report on<br />

the effects of tear contamination by eye<br />

make-up on the normal function and<br />

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Figure 1<br />

Contamination of upper lid margin by eye makeup<br />

applied to the lower lid margin (courtesy of<br />

Alison Ng – Cardiff University)<br />

physiology of the tear film. Practitioners<br />

will be familiar with seeing many tiny<br />

particles of make-up material floating<br />

in the tear film of some of their patients<br />

when viewed using a slit lamp (Figure 2).<br />

The migration of cosmetic products<br />

(mascara) onto the ocular surface has<br />

been investigated recently. Goto and<br />

co-workers 2 observed relatively large<br />

amounts of migration of cosmetic<br />

eye products onto the ocular surface<br />

after just 30 minutes of application,<br />

especially amongst those who applied<br />

their cosmetics close to or onto the<br />

eyelash line. However, studies that<br />

report on complications associated<br />

with cosmetic use implicate potential<br />

changes to ocular physiology that<br />

affect the tear film and which warrants<br />

further investigation. Previous findings<br />

have linked the use of make-up with<br />

meibomian gland dysfunction (MGD). 3<br />

The impact of cosmetic products<br />

adhering to a contact lens during wear<br />

has also received very little attention<br />

to date and the precise effects on<br />

vision, dry eye symptoms and contact<br />

lens tolerance is poorly understood.<br />

Cosmetics and contact lenses<br />

Patients who combine the use of eye<br />

cosmetics and contact lenses are<br />

more likely to expose their lenses to a<br />

relatively oil-rich environment during<br />

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50<br />

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Approved for: Optometrists �� Dispensing opticians � CLPs<br />

wear. 4 Differences in the ability<br />

of different lens materials,<br />

particularly silicone hydrogels,<br />

to resist oil/lipid deposition<br />

have been reported previously. 5<br />

The effects of contact lens<br />

deposition/spoilation include<br />

changes to the physical and/<br />

or chemical characteristics of<br />

the lens surface 6 and changes<br />

to the clinical performance of<br />

the lens including discomfort<br />

during wear and adverse<br />

events. 7,8 Amongst monthly<br />

disposable lenses, several<br />

studies have highlighted the<br />

relative resistance of the silicone<br />

hydrogel material Lotrafilcon<br />

B (Air Optix Aqua, Ciba Vision) to<br />

lipid deposits over other commercially<br />

available silicone hydrogel lens types, in<br />

both in vitro and in vivo investigations. 5,9<br />

This may, at least in part, be attributable<br />

to the plasma surface treatment feature<br />

of the lens, which resists binding of<br />

foreign substances including lipid. The<br />

plasma surface treatment of Lotrafilcon B<br />

has also demonstrated utility in resisting<br />

lens deformation, which has been shown<br />

to occur to other types of re-usable lenses<br />

when exposed to, and contaminated<br />

by, oil-based eye make-up removers. 4<br />

Contamination of contact lenses<br />

in the eyes has been shown to<br />

occur by several routes, including:<br />

1. The case – where eye cosmetic<br />

ingredients blend with tear fluid<br />

2. The hands – that have<br />

previously been exposed to<br />

make-up or cleansing products<br />

3. Direct adherence onto the<br />

lens surface during wear, either during<br />

application of make-up or by make-<br />

up floating freely in the tear film<br />

In the case of point 2 above, hand<br />

creams that contain an abundance of<br />

lipids such as cholesterol, mineral oil<br />

and glycerine appear to readily adhere<br />

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��<br />

Figure 2<br />

Cosmetic ‘glitter’ contaminants suspended in precorneal<br />

tear film (courtesy of Alison Ng – Cardiff<br />

University)<br />

to silicone hydrogel lenses. 4 It has been<br />

shown that <strong>this</strong> can cause the contact<br />

lens to swell and become brittle, making<br />

the surface of the lens more prone to<br />

scratching. 4 Therefore thorough washing<br />

of hands prior to lens application<br />

and removal is strongly advised.<br />

Current legislation<br />

According to European Union law<br />

directive 93/35/EEC, a cosmetic product<br />

must not cause damage to human health<br />

when applied in normal or reasonably<br />

foreseeable conditions of use. 10 Whilst<br />

rigorous testing of cosmetic products<br />

occurs before they are brought to market,<br />

there are many undesirable effects<br />

of cosmetics that may exist at mild<br />

levels across a particular user group.<br />

An undesirable effect of a cosmetic<br />

product is defined as a harmful reaction<br />

attributable to its normal or reasonably<br />

foreseeable use. However, the knowledge<br />

of undesirable effects at the population<br />

level is limited by the absence of formal<br />

and reliable reporting systems, which<br />

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generally results in under-<br />

reporting. Guidance from<br />

the European Cosmetics<br />

Association (COLIPA)<br />

advises that both consumers<br />

and health care professionals<br />

have a role to play in<br />

reporting of undesirable<br />

effects. With respect to<br />

eye care, practitioners<br />

would be justified in<br />

reporting undesirable<br />

effects, including but<br />

not limited to, irritant or<br />

allergic conditions affecting<br />

the skin, eyes or mouth.<br />

Guidelines from COLIPA<br />

suggest that each individual<br />

cosmetics company should have its own<br />

processes for managing and following<br />

up on each undesirable effect received.<br />

Implications for practitioners<br />

It is possible that cosmetics could play<br />

a role in dry eye, tear film instability,<br />

lacrimal gland dysfunction, dermatitis/<br />

hypersensitivity, allergy, infection and<br />

contact lens intolerance. Whilst toxic and<br />

serious undesirable effects associated<br />

with cosmetics are generally eliminated<br />

before the product comes to market, mild<br />

undesirable effects may go undetected<br />

and unreported. As the following<br />

examples describe, cosmetics can be<br />

responsible for a number of undesirable<br />

effects, which practitioners may be<br />

familiar with managing but may not<br />

necessarily attribute to a particular type<br />

of cosmetic or its normal use/application.<br />

Mascara<br />

The corneal surface is exposed to<br />

contamination by a wide range of cosmetic<br />

products, for example, hair spray, eye<br />

liner, eye shadow, blusher, foundation,<br />

make-up remover to name just a few.<br />

The precise effect of these products<br />

either individually or in combination is<br />

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extremely difficult for scientists<br />

and clinicians to determine. There<br />

are several reported cases where<br />

patients have exhibited reactions<br />

such as contact dermatitis and<br />

loss of eye lashes following<br />

application of mascara. 11-13 Such<br />

reactions appear to be more<br />

common when using products<br />

such as tinting mascara, especially<br />

those containing the ingredients<br />

Para-phenylenediamine<br />

(PPD) or shellac. 11-13<br />

In theory, all pigmented make-<br />

up products may contain metal<br />

allergens including nickel.<br />

Eyelid dermatitis has also previously<br />

been observed amongst patients with<br />

nickel allergic dermatitis following<br />

exposure to mascara and eye shadow. 14<br />

In addition to relatively acute<br />

conditions such as dermatitis, other<br />

long-term associations have been<br />

reported. These include infectious<br />

keratitis, pigmented conjunctival<br />

lesions and a rare case of canalicular<br />

obstruction caused by a mascara-<br />

laden dacryolith 15 or rheum (Figure 3).<br />

The ocular surface, mascara and microbes<br />

Whilst relatively rare and typically of low<br />

severity, bacterial infections of the ocular<br />

surface are more prevalent amongst<br />

contact lens wearers than non-contact<br />

lens wearers. 16 Soft contact lenses are<br />

implicated in half of all bacterial corneal<br />

infections, and bacterial infection often<br />

occurs with combined contact lens<br />

wear and cosmetics. 16 When mascara<br />

and contact lenses are worn at the same<br />

time, the bacterial flora around the eye<br />

may be increased. Therefore the control<br />

of bacterial growth in the mascara tube<br />

is important to minimise the risk of<br />

infection. Manufacturers of cosmetics<br />

use preservatives to keep cosmetics free<br />

of microbial contaminants. However,<br />

the personal hygiene of the wearer<br />

Figure 3<br />

Mascara laden rheum (courtesy of Alison Ng –<br />

Cardiff University)<br />

has been implicated in how well<br />

mascara tubes resist colonisation. 17<br />

The efficacy of mascara preservatives<br />

in resisting colonisation has also been<br />

investigated previously. One study<br />

group concluded that preservatives<br />

in a range of brands of mascara were<br />

inadequate at preventing colonisation<br />

of staphylococcus epidermis and<br />

pseudomonas aeruginosa organisms. 17<br />

This same study observed that six<br />

out of seven cases of pseudomonas<br />

corneal infection occurred<br />

secondary to scratching the cornea<br />

with a mascara applicator brush. 17<br />

The repeated use of mascara by<br />

multiple users, for example at cosmetics<br />

counters, creates greater exposure of<br />

microbial contamination to mascara<br />

tube contents. Even the repeated use<br />

of mascara by a single user has the<br />

same effect, albeit at a slower rate.<br />

To avoid infection associated with<br />

contamination of mascara, historically<br />

it has been recommended that mascara<br />

is replaced every six months for non-<br />

contact lens wearers and every three-<br />

four months for contact lens wearers. 18,19<br />

However, more recent evidence suggests<br />

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that both contact lens wearers<br />

and non-contact lens wearers<br />

should replace their mascara<br />

after three months. 20 The<br />

reality perhaps is that most<br />

people will not replace their<br />

mascara until it is gone. Some<br />

patients will even add water or<br />

saliva to make their make-up<br />

last longer, which introduces<br />

further risk of contamination. 18<br />

Other guidance for wearers<br />

of make-up include: 21<br />

• Not sharing cosmetics<br />

• R e p l a c i n g<br />

cosmetics after infections<br />

• Not using an old applicator<br />

with a new container of cosmetics<br />

• Applying contact lenses before<br />

make-up<br />

A survey conducted by the University<br />

of Alabama showed the reported<br />

range of cosmetic age was anywhere<br />

between six months and five years. 22<br />

The investigators also reported<br />

that 37% of mascara tubes tested<br />

positive for microbial contamination.<br />

A study by Pack and co workers 20<br />

concluded that ‘even though infection<br />

attributable to mascara contamination<br />

is rarely documented, it likely occurs’.<br />

Often in a busy clinical environment,<br />

treating the infection is of greater<br />

concern (for practitioners) than<br />

determining the source of the infection.’ 20<br />

Impact on dry eye/discomfort symptoms<br />

Clinical signs of ocular surface disorders<br />

are not always present with patient-<br />

reported symptoms, hence it is likely<br />

that many patients who experience<br />

dry eye/discomfort symptoms (both for<br />

contact lens wearers and non-wearers)<br />

may only have marginal dry eye and<br />

therefore do not have a pronounced<br />

tear film disorder or ocular surface<br />

pathology. Detection of dry eye/<br />

discomfort by clinical means produces<br />

51<br />

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a smaller prevalence than found by the<br />

use of specially constructed patient<br />

questionnaires. For example, a study<br />

by Caffery and co-workers23 identified<br />

clinical signs of dry eye amongst 13%<br />

of a population of contact lens wearers.<br />

However, a specially formulated dry eye<br />

questionnaire detected dry eye symptoms<br />

in 50.1% of the same study group. 23<br />

Whilst questionnaires are a sensitive<br />

means to detect dry eye and discomfort<br />

symptoms, they can often be seen as<br />

cumbersome in clinical practice. In<br />

search of a simple means to identify<br />

such symptoms, Michel Guillon and<br />

Cecile Maissa proposed a series of<br />

questions that can be incorporated into<br />

a primary care routine examination to<br />

permit more effective identification. 24<br />

These simple questions were derived<br />

from a large study involving over 800<br />

patients (502 non-contact lens wearers<br />

and 309 non-contact lens wearers) that<br />

sought to identify (a) the prevalence<br />

of symptoms, (b) the severity of<br />

symptoms, (c) the type of symptoms<br />

(e.g. burning, dryness, scratchiness,<br />

soreness), and (d) analysis of<br />

environments predisposing symptoms. 24<br />

The study observed a higher<br />

prevalence of dry eye/discomfort<br />

symptoms amongst contact lens wearers<br />

than non-wearers, but the most common<br />

type of symptom experienced by the<br />

two groups was different. Contact lens<br />

wearers were more likely to describe<br />

their symptoms (according to the<br />

McMonnies dry eye questionnaire) 25<br />

in terms of dryness whereas non-lens<br />

wearers are more likely to describe<br />

their symptoms in terms of soreness.<br />

Amongst contact lens wearers<br />

who were symptomatic, 26%<br />

experienced symptoms at times<br />

when they were wearing make-<br />

up. 24 Amongst non-contact lens<br />

wearers who were symptomatic,<br />

64% experienced symptoms at times<br />

when they were wearing make-up. 24<br />

Another observation made by<br />

<strong>this</strong> study was the high proportion<br />

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of subjects who were symptomatic<br />

when using moisturisers (81% of<br />

symptomatic contact lens wearers and<br />

84% of symptomatic non-wearers).<br />

However, the authors do not comment<br />

whether <strong>this</strong> observation was due to<br />

contamination of the ocular surface by<br />

the moisturiser products or whether<br />

individuals who use/require moisturiser<br />

(e.g. to treat dry skin) may be more<br />

susceptible to dry eye/discomfort<br />

symptoms. This study demonstrates that<br />

the propensity of make-up sensitivity<br />

amongst those experiencing dry eye/<br />

discomfort is common to both contact<br />

lens wearers and non-wearers and that<br />

the importance of asking patients about<br />

the use of make-up products in clinical<br />

practice should not be underestimated. 24<br />

Despite contact lens wearers having a<br />

greater propensity to report symptoms<br />

of ocular discomfort than non-wearers,<br />

the association between eye make-<br />

up use and dry eye symptomology is<br />

common to both groups of individuals.<br />

For practitioners, deciding which lens<br />

material and/or lens wear modality is<br />

best suited to a patient who uses eye<br />

make-up has important consequences<br />

regarding how likely that patient<br />

is to develop related symptoms.<br />

Re-useable silicone hydrogel contact<br />

lenses that incorporate a plasma surface<br />

treatment demonstrate better resistance<br />

to lipid deposition under normal contact<br />

lens wear conditions, specifically<br />

Lotrafilcon B. 5 In addition, Lotrafilcon B<br />

lenses appear to demonstrate resistance<br />

to physical changes in the lens structure<br />

when exposed to common contaminants<br />

found in cosmetic products. 4<br />

One may assume that the surfactants<br />

in lens care products may, at least<br />

in part, be successful in removing<br />

cosmetic contaminants from lenses<br />

during cleaning. To date there are<br />

no studies that have investigated the<br />

ability of the various lens care products<br />

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to remove cosmetic contaminants from<br />

lenses. However, even during normal<br />

conditions of wear (without the effects<br />

make-up contamination) significant<br />

amounts of lipid and protein deposits<br />

have been shown to remain on lenses<br />

even after lens cleaning. 26, 27 Thus<br />

repeated exposure of re-useable lenses<br />

to cosmetic contaminants may be<br />

responsible for a cumulative reduction<br />

in lens performance over-time despite<br />

daily cleaning. Based on <strong>this</strong> logic, one<br />

may also assume that daily disposable<br />

lenses may also help to eliminate any<br />

decline in lens performance over time<br />

as a result of <strong>this</strong> form of contamination.<br />

Conclusion<br />

Whilst the precise association between<br />

cosmetic eye products and patient<br />

symptoms may be extremely difficult<br />

to determine, the association produces<br />

a high index of suspicion that warrants<br />

further investigation. The impact of<br />

eye make-up contamination of contact<br />

lenses may have effects that compromise<br />

the performance, physical properties<br />

and physical structure of the lens. For<br />

example, the use of eye make-up is strongly<br />

associated with dry eye/discomfort<br />

symptoms. Practitioners should<br />

therefore be wary of the contribution of<br />

cosmetics to marginal dry eye/discomfort<br />

symptoms in clinical practice and make<br />

appropriate recommendations to patients.<br />

About the author<br />

Dr Cameron Hudson is an optometrist<br />

and head of professional affairs for<br />

Ciba Vision UK and Ireland. He is<br />

responsible for professional training<br />

and education in the field of contact<br />

lenses and current clinical best practice.<br />

References<br />

See http://www.optometry.co.uk<br />

clinical/index. Click on the article title<br />

and then download “references”.<br />

Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates

Module questions<br />

Course code: C-16864 O<br />

1. Which of the following statements about white without pressure<br />

is TRUE?<br />

a) It represents an area of increased vitreoretinal attachment<br />

b) It is a risk factor for retinal detachment<br />

c) It requires “soon referral” to confirm the diagnosis<br />

d) It requires no action<br />

2. Which of the following statements about retinoschisis is TRUE?<br />

a) It requires “soon referral” because of the risk of progression to retinal<br />

detachment<br />

b) It is more common in hypermetropes<br />

c) A relative field defect will be present<br />

d) Shifting fluid causes its position to change if the patient is examined<br />

lying down<br />

3. Which of the following statements about atrophic round holes is<br />

TRUE?<br />

a) They are caused when vitreous traction detaches a circular area of retina<br />

b) They always require referral because they can progress to a detachment<br />

c) They appear more red than the surrounding retina<br />

d)They are more common in hypermetropes<br />

4. Which of the following statements about lattice degeneration is<br />

TRUE?<br />

a) Retinal detachment develops in 8% of patients<br />

b) It is most common after the age of 60 years<br />

c) Referral is not required<br />

d) The white lines visible in lattice represent traction<br />

5. Which of the following statements about CHRPE is FALSE?<br />

a) It is not a retinal degeneration<br />

b) Its appearance always remains stable throughout life<br />

c) It appears to have more well defined borders than a choroidal naevus<br />

d) Multiple CHRPE can be associated with an inherited bowel condition<br />

6. Which of the following statements about retinal degenerations is<br />

TRUE?<br />

a) Patients with lattice degeneration should be advised to give up body<br />

contact sports<br />

b) Women should be counselled about the risk of retinal detachment<br />

during childbirth<br />

c) Pavingstone degeneration is characterised by defects in the outer retina<br />

making it a risk factor for retinal detachment<br />

d) The only peripheral retinal degeneration that may require referral is<br />

retinoschisis<br />

PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by<br />

midnight on October 28, 2011 – You will be unable to submit exams after <strong>this</strong> date – answers to the module will be<br />

published on www.optometry.co.uk. CET points for these exams will be uploaded to Vantage on November 7, 2011.<br />

Course code: C-16942 O/D/CL<br />

For the latest CET visit www.optometry.co.uk/cet<br />

1. According to market research, what is the current average age that<br />

females begin using cosmetics?<br />

a. 10.9 years<br />

b. 13.7 years<br />

c. 15.2 years<br />

d. 17.0 years<br />

2. The silicone hydrogel contact lens material Lotrafilcon B<br />

demonstrates resistance to deposits owing to which of the following<br />

features?<br />

a. Plasma surface treatment<br />

b. Embedded wetting agents<br />

c. High water content<br />

d. Packaging saline additive<br />

3. Investigators from the University of Alabama discovered microbial<br />

contamination in what percentage of mascara tubes?<br />

a. 25%<br />

b. 32%<br />

c. 37%<br />

d. 45%<br />

4. An association between dryness symptoms and make-up use was<br />

found in what proportion of non-contact lens wearing patients?<br />

a. 19%<br />

b. 26%<br />

c. 53%<br />

d. 64%<br />

5. Contact lens contamination by make-up and/or make-up remover<br />

can cause which of the following?<br />

a. Compromise to the performance of the lens<br />

b. Changes to the physical structure of a lens<br />

c. Changes to the physical properties of the lens<br />

d. All of the above<br />

6. Which of the following is the LEAST appropriate option to select<br />

for a contact lens wearer experiencing an undesirable effect from<br />

ocular cosmetics?<br />

a. Fitting a daily disposable contact lens<br />

b. Fitting a lens with a surface treatment that resists spoilation<br />

c. Use of a hydrogen peroxide cleaning regimen<br />

d. Fitting a RGP contact lens<br />

53<br />

30/09/11 CET

National Optometric<br />

Conference 2011<br />

What does Clinically-led Commissioning mean for us?<br />

Your chance to hear some of the leading architects behind the NHS<br />

reforms – to help you get eye health firmly on the map.<br />

Keynote speakers confirmed so far:<br />

• Dame Barbara Hakin, National Managing Director of<br />

Commissioning Development<br />

Barbara Hakin is responsible for the design of the new<br />

NHS commissioning framework for England, making her<br />

presentation a must attend event for anyone who wants<br />

eye health at the heart of commissioning in their region.<br />

• Dr Niti Pall, Clinical Lead, NHS Sandwell<br />

• Samantha Peters, Registrar and Chief Executive,<br />

General Optical Council<br />

• Dr Sue Gregory, Deputy Chief Dental Officer,<br />

Department of Health<br />

• Dr Simon Barnard, Director of Ocular Medicine,<br />

Institute of <strong>Optometry</strong><br />

NOC is your opportunity to:<br />

• hear from leading health opinion formers on the<br />

opportunities to shape the eye health agenda for<br />

your region<br />

• discover how peer review can support<br />

contractors and performers and earn CET points*<br />

at the same time *(Awaiting CET accreditation)<br />

• find out the latest news about LOCSU at LOCSU’s AGM<br />

• learn about the latest market developments from<br />

companies who will be exhibiting at the conference<br />

• find out the winners of the AOP Awards 2011<br />

This is your chance to share knowledge and best practice with colleagues<br />

from around the country.<br />

National Optometric Conference 2011, Chesford Grange Hotel,<br />

near Warwick. Dates: 3rd-4th November 2011<br />

Costs:<br />

• NOC Resident (£540 incl VAT)<br />

• You can bring your Spouse/ Partner<br />

(£140 incl VAT)<br />

• NOC Non Resident (£330 incl VAT)<br />

LOCSU will fund the cost of one delegate per LOC and<br />

ROC - why not take advantage of <strong>this</strong> offer and bring a<br />

colleague, who may not have visited before, with you?<br />

You can book online or download a form at<br />

http://www.aop.org.uk/noc2011<br />

Kindly sponsored by Hanson Instruments<br />

Established in 1996 we are an independent supplier of new, ex demo<br />

& quality refurbished <strong>Optometry</strong> equipment. We also buy used<br />

equipment across the UK. Call us today on; 01527 501077 or visit our<br />

website; www.hansoninstruments.co.uk


WISDOM...<br />

Here at Specsavers we have an absolute commitment to the value of Dispensing Opticians in<br />

our practices.<br />

Right now, nearly 400 student Dispensing Opticians are being sponsored by a Specsavers store<br />

and they will ultimately join the 810 registered Dispensing Opticians that we employ here in<br />

the UK - and that’s not including the professionals who have joined our businesses in Australia<br />

and New Zealand!<br />

We believe that achieving excellence in Dispensing is at the very heart of our future.<br />

If you feel the same and you are a student or fully qualifi ed Dispensing Optician, call<br />

SRS on 01566 880950 or seek us out online.<br />

Details await you at http://jobs.specsavers.co.uk

ecruiting across<br />

all departments<br />

Join us for career progression as we<br />

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The Outside Clinic is the only company that<br />

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For all the latest vacancies please visit<br />

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Contact Jim Gilbert for more details:<br />

tel: 01793 648607 - email: jim@outsideclinic.com

When we say we’ll offer more, we mean it.<br />

We’re looking for qualified Optometrists to deliver total satisfaction to our customers. You’ll offer our customers<br />

recommendations to the highest professional and ethical standards (something our customers have come to expect<br />

from us). You’ll also use your knowledge to effectively identify customer needs and recommend eyewear and eye<br />

care solutions accordingly.<br />

We’ll offer you a truly fresh perspective here at Vision Express and we think you’ll love our culture too. Passionate<br />

about our products, service and customers, we’ll give you all the tools you need to be the best in the business.<br />

As a key member of our team, we’ll also invest a serious amount of time and money in your ongoing training and<br />

development.<br />

We’re currently looking for Optometrists in the following locations:<br />

� �������� � ��������� � ������� � ���� � ���������<br />

� ������ � ����� � ����������� � ����������� � ����������<br />

We’re also looking for mobile Optometrists in the ����� ���� and ����� ��������� areas.<br />

Thanks to a truly individual package of benefits, when we say we’ll offer more, we mean it.<br />

To find out more, or apply, visit visionexpresscareers.com or contact Jo Cantrill in the Recruitment team 0115 9882061.<br />

All calls will be treated in confidence.

58<br />

30/09/11 JOBS<br />

For more details contact Jim<br />

on 01793 648607 or visit<br />

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