AOP advice on safe referral Profile: Brian ... - Optometry Today

AOP advice on safe referral Profile: Brian ... - Optometry Today

AOP advice on safe referral Profile: Brian ... - Optometry Today


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www.optometry.co.uk April 6 2012 vol 52:7 £4.95<br />

optometrytoday live<br />

Journal of the Associati<strong>on</strong> of Optometrists<br />

<strong>Profile</strong>: <strong>Brian</strong><br />

Tompkins<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g> <str<strong>on</strong>g>advice</str<strong>on</strong>g> <strong>on</strong><br />

<strong>safe</strong> <strong>referral</strong><br />

<strong>on</strong>line enewsletter<br />

LOCSU’s<br />

pathway<br />

triumph<br />

L<strong>on</strong>d<strong>on</strong> calling<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g>/SECO therapeutics seminar previewed

Maximise the lens-wearing<br />

experience, maximise success.<br />

New Biofinity ® multifocal is everything you<br />

expect in a c<strong>on</strong>tact lens. CooperVisi<strong>on</strong>’s<br />

Balanced Progressive Technology<br />

delivers excepti<strong>on</strong>al visi<strong>on</strong> at all distances,<br />

while a streamlined fitting approach<br />

means fitting presbyopes just got easier.<br />

And, thanks to CooperVisi<strong>on</strong>’s Aquaform ®<br />

Comfort Science , your multifocal<br />

patients can now enjoy the same benefits<br />

from silic<strong>on</strong>e hydrogel technology as your<br />

Biofinity and Biofinity toric wearers.<br />

Find out more at:<br />


Become our fan <strong>on</strong> Facebook<br />

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

News<br />

5 GOC <strong>on</strong> the move?<br />

Optics’ regulator is to investigate a move<br />

away from its Harley Street base<br />

6 Scottish strategy assessed<br />

Preventing sight loss in Scotland has been<br />

discussed at a high profile c<strong>on</strong>ference<br />

7 Mystery shop at multiples<br />

Branches of Specsavers and Boots Opticians<br />

have been compared in a mystery shop by<br />

The Guardian<br />

8 Comment<br />

The <str<strong>on</strong>g>AOP</str<strong>on</strong>g>’s interim chief executive Richard<br />

Carswell discusses getting the best out of<br />

your OT<br />

10 News Extra<br />

NICE has issued an updated guide <strong>on</strong><br />

commissi<strong>on</strong>ing services for people at risk of<br />

glaucoma across England<br />

Cover story<br />

22-23 Educati<strong>on</strong> Destinati<strong>on</strong><br />

A preview of the lectures at the upcoming<br />

inaugural two-day therapeutics seminar in<br />

L<strong>on</strong>d<strong>on</strong> co-produced by the <str<strong>on</strong>g>AOP</str<strong>on</strong>g> and SECO<br />

Products<br />

20-21 Industry News<br />

Good news for Optix, the FMO discusses<br />

the ec<strong>on</strong>omy, plus new products for David<br />

Thomas C<strong>on</strong>tact Lenses, Signet Armorlite<br />

Europe and OWP<br />

Feature is <strong>on</strong>line<br />

www.optometry.co.uk<br />


Give us a call...<br />

...Steve did!<br />

01793 648607<br />

outsideclinic.com<br />

April 6 2012 vol 52:7<br />

12 20 41<br />

OT (the <str<strong>on</strong>g>AOP</str<strong>on</strong>g> and Ten Alps Publishing) accept no resp<strong>on</strong>sibility for products, goods or services that may be<br />

advertised or referred to. Opini<strong>on</strong>s expressed are not necessarily those of OT, the <str<strong>on</strong>g>AOP</str<strong>on</strong>g> or Ten Alps Publishing<br />

Video is <strong>on</strong>line<br />

<strong>Profile</strong>/<str<strong>on</strong>g>advice</str<strong>on</strong>g><br />

14 <strong>Profile</strong><br />

Flamboyant optometrist <strong>Brian</strong> Tompkins<br />

advises <strong>on</strong> making optics fun<br />

16 A profitable exit<br />

Techniques to help sell a practice<br />

18 Referring <strong>safe</strong>ly<br />

Clinical adviser to <str<strong>on</strong>g>AOP</str<strong>on</strong>g> legal services, Trevor<br />

Warburt<strong>on</strong>, advises <strong>on</strong> reducing risks<br />

36-37 Pathway triumph<br />

LOCSU has developed a new Community<br />

Eye Care Pathway for people with learning<br />

disabilities<br />

Events<br />

24 <strong>Optometry</strong> Tomorrow<br />

A review of the College of Optometrists’ annual<br />

c<strong>on</strong>ference<br />

34 <str<strong>on</strong>g>AOP</str<strong>on</strong>g> Awards/NOC<br />

Update <strong>on</strong> the accolades and a new<br />

beginning for the annual c<strong>on</strong>ference<br />

Regulars<br />

12 Spectator<br />

Biscuit budgets and recycling spectacles<br />

for charity<br />

28 Diary dates<br />

The upcoming optical events<br />

32 Students news<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g> student reps meet at annual forum<br />

Clinical<br />

38-39 VRICS C-18690 O/D<br />

Advanced clinical techniques<br />

Part 1<br />

Optical Coherence Tomography by Ramesh<br />

Sivaraj. The first in this series tests practiti<strong>on</strong>ers’<br />

knowledge of posterior segment OCT of the<br />

macular area<br />

41-44 CET 1: C-18633 O/D<br />

Ophthalmic public health Part 4<br />

Healthy lifestyle equals healthier eyes. Dr Ruth<br />

Hogg discusses how lifestyle changes can help<br />

to reduce the risk of ocular disease<br />

45-49 CET 2: C-18551 O/D<br />

Retinoscopy in infancy<br />

Cycloplegic vs. n<strong>on</strong>-cycloplegic by Fabrizio<br />

B<strong>on</strong>ci and Luigi Lupelli. This article reviews<br />

cycloplegic and n<strong>on</strong>-cycloplegic refracti<strong>on</strong><br />

in infants<br />

Classified<br />

51-52 Jobs<br />

All the latest vacancies<br />

54-58 Marketplace<br />

Your guide to optical products and<br />


MODEL WEARS Ti 2006<br />

titanium<br />

0151 426 3907<br />


GOC c<strong>on</strong>siders office move<br />

Chris D<strong>on</strong>kin<br />

chrisd<strong>on</strong>kin@optometry.co.uk<br />

THE GOC is to investigate a move<br />

away from its Harley Street office<br />

to more modern premises, the<br />

regulator has revealed.<br />

As part of its business plan and<br />

strategic aims for the coming<br />

years, the regulator will look<br />

at the viability of relocating or<br />

collocating to ‘modern fit-forpurpose<br />

offices’.<br />

GOC director of resources,<br />

Jeff Cant, told OT: “As the office<br />

is in a high value locati<strong>on</strong> any<br />

move would have the probable<br />

advantage of helping us to<br />

reduce the costs of our facilities.<br />

A TOTAL of 351 practiti<strong>on</strong>ers<br />

learned about the effects of UV<br />

<strong>on</strong> the eye, different soluti<strong>on</strong>s<br />

and enjoyed a <strong>referral</strong> quiz at<br />

last week’s Johns<strong>on</strong> & Johns<strong>on</strong><br />

Raising the Bar roadshows in<br />

Manchester and L<strong>on</strong>d<strong>on</strong>.<br />

The pair of day-l<strong>on</strong>g events<br />

covered a range of optical issues<br />

with delegates able to collect<br />

CET points from sessi<strong>on</strong>s which<br />

included a fascinating look<br />

at the latest research <strong>on</strong> UV<br />

from professor Minas Cor<strong>on</strong>eo<br />

(pictured).<br />

Delegates learned that many<br />

‘fashi<strong>on</strong>’ sunglasses are ineffective<br />

at protecting the whole eye from<br />

damaging rays and glare and<br />

were advised to c<strong>on</strong>sider eyewear<br />

soluti<strong>on</strong>s with a good all-round<br />

protecti<strong>on</strong>, such as wrap style<br />

“We are fully committed to<br />

maintaining downward pressure<br />

<strong>on</strong> retenti<strong>on</strong> fees and a move<br />

could additi<strong>on</strong>ally enable us<br />

to hold more meetings and<br />

hearings in-house, reducing the<br />

bill for hiring rooms in other<br />

premises. A move to more<br />

modern premises would also<br />

help the team work more<br />

efficiently and effectively.<br />

“We will carry out a thorough<br />

cost-benefit analysis before<br />

any office move proposal is<br />

presented to the council.”<br />

Currently, the GOC is holding<br />

its council meetings at hired<br />

locati<strong>on</strong>s around L<strong>on</strong>d<strong>on</strong> due<br />

to lack of space in its office<br />

during fitness to practise<br />

hearings and other meetings.<br />

Its March council meeting<br />

was held at the Royal Institute<br />

of British Architects, with the<br />

previous <strong>on</strong>e held at the Royal<br />

College of Ophthalmologists,<br />

both a short walk away from<br />

Harley Street.<br />

J&J roadshow hailed a success<br />

frames or c<strong>on</strong>tact lenses offering<br />

UV protecti<strong>on</strong>.<br />

Later in the day professor<br />

Lynd<strong>on</strong> J<strong>on</strong>es discussed the<br />

merits of different types of<br />

soluti<strong>on</strong>s for extended wear<br />

c<strong>on</strong>tact lenses, Philip Morgan<br />

covered c<strong>on</strong>tact lens materials<br />

and Jeff Walline looked at the<br />

opti<strong>on</strong>s available for myopia<br />

c<strong>on</strong>trol.<br />

C<strong>on</strong>cluding the day, professors<br />

J<strong>on</strong>es and Morgan tested the<br />

audience’s skills in diagnosing<br />

c<strong>on</strong>diti<strong>on</strong>s causing red eye in<br />

c<strong>on</strong>tact lens patients.<br />

Head of The Visi<strong>on</strong> Care<br />

Institute, Kamlesh Chauhan, said:<br />

“We were delighted to see so<br />

many delegates at Raising the<br />

Bar. From the feedback we have<br />

received it seems that delegates<br />

really benefited from the<br />

interactive lectures by some of<br />

the top internati<strong>on</strong>al speakers.<br />

“As part of our commitment<br />

to helping eye care<br />

professi<strong>on</strong>als further their<br />

learning, we hope the<br />

success of the roadshows will<br />

encourage colleagues to come<br />

to The Visi<strong>on</strong> Care Institute and<br />

take part in <strong>on</strong>e of the many<br />

new courses we have available<br />

in 2012.”<br />

The series of roadshows will<br />

return in October with guest<br />

speaker professor Nathan Efr<strong>on</strong>.<br />

For more details, visit www.<br />

thevisi<strong>on</strong>careinstitute.co.uk<br />

To comment go to www.optometry.co.uk<br />

NEWS<br />

IN BRIEF<br />

Voucher values<br />

A handy leaflet detailing the<br />

new optical voucher values will<br />

be included for <str<strong>on</strong>g>AOP</str<strong>on</strong>g> members<br />

in the next editi<strong>on</strong> of OT (April<br />

20). NHS voucher values rose<br />

by 2.5% <strong>on</strong> April 1.<br />

OC releases Youth<br />

C<strong>on</strong>tract guidance<br />

The Optical C<strong>on</strong>federati<strong>on</strong><br />

has released guidance <strong>on</strong><br />

Youth C<strong>on</strong>tracts, a £1bn<br />

Government programme<br />

to encourage employers to<br />

train and hire 18-24-yearolds.<br />

The Youth C<strong>on</strong>tract,<br />

launched <strong>on</strong> April 2, c<strong>on</strong>tains<br />

several initiatives including<br />

apprenticeships, work<br />

academies and an employer<br />

incentive payment of up to<br />

£2,275 for full-time roles that<br />

last at least 26 weeks.<br />

For more details, visit<br />

www.dwp.gov.uk/youthc<strong>on</strong>tract<br />

CET correcti<strong>on</strong><br />

OT would like to apologise<br />

for printing the incorrect CET<br />

code with the questi<strong>on</strong>s for<br />

the exam ‘Assessing visual<br />

functi<strong>on</strong>: young children’s<br />

visi<strong>on</strong> part 3’ by Dr Margaret<br />

Woodhouse <strong>on</strong> March 23,<br />

2012. The correct CET code for<br />

this exam is C-18550 O/D.<br />

Bring your display<br />

into focus with the<br />

Number One choice in optical labelling<br />

• Price labels, every kind<br />

and colour<br />

• Lens labels, stock and<br />

bespoke<br />

• C<strong>on</strong>tact lens packaging<br />

labels<br />

• Dummy security sensors<br />

• Coloured oval price<br />

tickets<br />

£58<br />

$89 €55<br />

3 Isis Court, Wyndyke Furl<strong>on</strong>g, Abingd<strong>on</strong> OX14 1DZ<br />

Tel 01235 543993 Fax 01235 532118<br />

www.ewmorris.co.uk sales@ewmorris.co.uk<br />

5<br />

06/04/12 NEWS

6<br />

06/04/12 NEWS<br />

IN BRIEF<br />

Photograph c<strong>on</strong>test<br />

The BCLa is<br />

calling for<br />

submissi<strong>on</strong>s<br />

for its annual<br />

photographic<br />

competiti<strong>on</strong>,<br />

which closes <strong>on</strong> april 27.<br />

professor James Wolffsohn,<br />

a lecturer in the optometry<br />

department at ast<strong>on</strong> University,<br />

will judge the competiti<strong>on</strong><br />

al<strong>on</strong>gside c<strong>on</strong>tact lens expert<br />

andrew Gass<strong>on</strong>.<br />

professor Wolffsohn said: “if you<br />

have taken a photograph of the<br />

anterior eye over the last year that<br />

you are proud of, whether it was<br />

taken with a smart ph<strong>on</strong>e or a<br />

sLr camera, we want you to<br />

share it.”<br />

Last year’s winner was ant<strong>on</strong>io<br />

Calossi (pictured) from italy.<br />

For more informati<strong>on</strong> visit<br />

www.bcla.org.uk<br />

Specsavers launches<br />

<strong>on</strong>line help facility<br />

Specsavers has launched an<br />

interactive <strong>on</strong>line source of<br />

eye care <str<strong>on</strong>g>advice</str<strong>on</strong>g> called<br />

‘Ask the optician’.<br />

Visitors to the multiple’s<br />

website can post a questi<strong>on</strong><br />

which will be answered by a<br />

qualified optometrist ‘within<br />

a few days’ by email, with<br />

selected questi<strong>on</strong>s and<br />

answers appearing <strong>on</strong> the<br />

website.<br />

New JOCEU chairman<br />

Former<br />

president of<br />

aBDo Kevin<br />

Milsom<br />

(pictured)<br />

has been<br />

announced<br />

as the new<br />

chairman of<br />

the Joint optical Committee for<br />

the european Uni<strong>on</strong>, following<br />

three years as vice chair of the<br />

organisati<strong>on</strong>. Cindy Tromans,<br />

former president of the College of<br />

optometrists has been appointed<br />

vice chairman.<br />

NEWS<br />

Impact of Scottish Visi<strong>on</strong><br />

Strategy since 2008 assessed<br />

emily McCormick<br />

emilymccormick@optometry.co.uk<br />

The proGress made at<br />

eradicating preventable sight<br />

loss in scotland since the scottish<br />

Visi<strong>on</strong> strategy was established<br />

in 2008 was assessed at a high<br />

profile c<strong>on</strong>ference last m<strong>on</strong>th.<br />

Despite scotland being seen<br />

as a ‘world leader’ in some<br />

aspects of eye care, with free<br />

eye examinati<strong>on</strong>s introduced in<br />

2006, the number of scots who<br />

are blind or partially sighted is<br />

expected to double over the next<br />

two decades. statistics reveal that<br />

<strong>on</strong>e-in-six hospital appointments<br />

in the country relate to eye<br />

problems.<br />

eye health specialists,<br />

government officials and<br />

Optos CEO Roy Davis wins IoD director award<br />

The CEO of Optos, Roy Davis<br />

has been named ‘Fife and<br />

Central Scotland Regi<strong>on</strong>al<br />

Director of the Year’ at the<br />

annual Institute of Directors<br />

(IoD) Scotland Awards.<br />

Judges selected Mr Davis<br />

CooperVisi<strong>on</strong> extends OGS support<br />

emily McCormick<br />

emilymccormick@optometry.co.uk<br />

CooperVisi<strong>on</strong> has increased<br />

its commitment to support<br />

optometry Giving sight, the<br />

charity has announced.<br />

The c<strong>on</strong>tact lens giant<br />

becomes a platinum sp<strong>on</strong>sor<br />

and pledges its support for two<br />

years, extending its previous Gold<br />

Global sp<strong>on</strong>sorship, which it<br />

announced last year.<br />

president of CooperVisi<strong>on</strong>,<br />

John Weber, said: “This is a very<br />

significant commitment by our<br />

company to an organisati<strong>on</strong><br />

that we believe is having a<br />

substantial impact <strong>on</strong> the delivery<br />

sight loss charities gathered in<br />

stirling to review the strategy’s<br />

progress and to hear from the<br />

country’s health Minister Michael<br />

Mathes<strong>on</strong>, chair of optometry<br />

scotland, peter Cars<strong>on</strong>, and chair<br />

of the scottish eyecare Group, Dr<br />

paul Baines.<br />

Director of the rniB scotland,<br />

John Legg (pictured), said: “The<br />

for the accolade ‘because the<br />

company’s financial performance<br />

and development of innovative<br />

new products, showcased<br />

the strategic directi<strong>on</strong> and<br />

operati<strong>on</strong>al capabilities of an<br />

excellent business leader’.<br />

of sustainable eye care services<br />

in under-served communities<br />

throughout the world.<br />

“as a global company, we<br />

think it makes absolute sense to<br />

actively support a global charity,<br />

especially <strong>on</strong>e which is doing so<br />

much to promote and develop<br />

optometry.”<br />

Clive Miller, Ceo of optometry<br />

Giving sight, added: “This is<br />

To comment go to www.optometry.co.uk<br />

scottish Visi<strong>on</strong> strategy set its<br />

targets high from the outset. But<br />

this review will hear that we have<br />

made tangible advances, and in<br />

some cases, big steps forward.”<br />

he then cited a pilot scheme<br />

by nhs Fife trialling the scottish<br />

Government’s new £6.6m<br />

initiative to build high-tech digital<br />

links between optometrists and<br />

ophthalmology departments over<br />

the next decade and reported<br />

faster <strong>referral</strong>s for patients who<br />

required immediate hospital<br />

attenti<strong>on</strong>.<br />

aop scotland chairman, Kevin<br />

Wallace, said: “optometrists are<br />

perfectly placed and equipped to<br />

provide a preventative approach<br />

to eye care. scotland has provided<br />

a lead to the rest of the UK – but<br />

we can still do more.”<br />

Mr Davis commented: “I am<br />

highly h<strong>on</strong>oured and pleased<br />

to win the award and it is<br />

a testament to the efforts<br />

of our employees that the<br />

company has c<strong>on</strong>tinued to<br />

grow and succeed.”<br />

a huge vote of c<strong>on</strong>fidence in<br />

optometry’s efforts to eliminate<br />

the backlog of uncorrected<br />

refractive error by the year 2020.<br />

“CooperVisi<strong>on</strong>’s support, al<strong>on</strong>g<br />

with that of our existing d<strong>on</strong>ors<br />

and global and nati<strong>on</strong>al sp<strong>on</strong>sors,<br />

will help us to reach more people<br />

in under-served communities<br />

and transform the lives of<br />


Multiples scrutinised in<br />

Guardian mystery shop<br />

Chris D<strong>on</strong>kin<br />

chrisd<strong>on</strong>kin@optometry.co.uk<br />

BranChes oF specsavers<br />

and Boots opticians have<br />

been compared for their deals,<br />

customer service and overall<br />

offerings by The Guardian’s store<br />

Wars secti<strong>on</strong>.<br />

a representative from the<br />

regular column visited the<br />

specsavers and Boots opticians<br />

practices <strong>on</strong> central L<strong>on</strong>d<strong>on</strong>’s<br />

Tottenham Court road <strong>on</strong> March<br />

22 to enquire about two pairs of<br />

frames and analyse the overall<br />

service level.<br />

Though both multiples<br />

fared well in the newspaper’s<br />

c<strong>on</strong>clusi<strong>on</strong>, overall Boots<br />

opticians fared slightly better –<br />

scoring 8/10 while specsavers<br />

was rated 7/10. however in the<br />

<strong>on</strong>line readers poll, 61.8% of<br />

resp<strong>on</strong>dents said they preferred<br />

GOC removes 221<br />

from its registers<br />

FOllOwIng THE final<br />

retenti<strong>on</strong> deadline of March<br />

31, the gOC has removed 93<br />

optometrists, 102 dispensing<br />

opticians and 26 bodies<br />

corporate from its registers.<br />

It is now illegal for those<br />

practiti<strong>on</strong>ers who have not<br />

completed their 2012-13<br />

retenti<strong>on</strong> to practise in the UK.<br />

gOC head of registrati<strong>on</strong>,<br />

Philip Hallam, said: “This year,<br />

as in previous years, the vast<br />

majority of our registrants<br />

applied for retenti<strong>on</strong> <strong>on</strong><br />

time. This underlines to both<br />

the public and the optical<br />

professi<strong>on</strong>s that our registrants<br />

understand the importance of<br />

gOC registrati<strong>on</strong>.<br />

“Only a small number failed<br />

to apply, and they have now<br />

left themselves unable to<br />

practise until they are restored<br />

to our registers.”<br />

specsavers, with 23.9% opting<br />

for Boots opticians and 14.2%<br />

resp<strong>on</strong>ding ‘some<strong>on</strong>e else’.<br />

in the article’s ‘lasting<br />

impressi<strong>on</strong>s’ the reporter said<br />

that specsavers had a ‘good<br />

choice of frames, but i felt<br />

bamboozled by the different<br />

prices <strong>on</strong> offer – despite the clear<br />

price policy’. The article added<br />

that ‘clearly a lot of prices were a<br />

minimum, and it was difficult to<br />

make a meaningful comparis<strong>on</strong>’.<br />

heaLTh MinisTer Lord howe<br />

has been announced as the<br />

headline speaker for the Visi<strong>on</strong><br />

UK 2012 c<strong>on</strong>ference, hosted by<br />

the rniB.<br />

The event, which takes<br />

place at the Queen elizabeth<br />

ii C<strong>on</strong>ference Centre in<br />

Westminster <strong>on</strong> June 12, has the<br />

theme ‘improving outcomes,<br />

increasing value’ and will cover<br />

aspects of eye care in the new<br />

nhs landscape.<br />

as well as Lord howe,<br />

the c<strong>on</strong>ference includes<br />

presentati<strong>on</strong>s from Dr Clare<br />

Gerada, chair of the royal College<br />

of Gps; Dr selwyn hodge, chair of<br />

the Council for the royal society<br />

of public health; nick astbury,<br />

chair of Visi<strong>on</strong> 2020 UK and parul<br />

Desai from the public health<br />

team at Moorfields.<br />

Topics discussed will include<br />

preventable sight loss as a<br />

summing up her Boots<br />

experience, she said: ‘it all<br />

felt a bit old fashi<strong>on</strong>ed, but<br />

outstandingly professi<strong>on</strong>al<br />

n<strong>on</strong>etheless’, and added she<br />

felt staff answered more of her<br />

technical questi<strong>on</strong>s.<br />

Discussing the industry as a<br />

whole, the author c<strong>on</strong>cluded<br />

that: ‘i can’t help but feel the<br />

pressure to make m<strong>on</strong>ey through<br />

expensive designer frames<br />

could be taking priority over the<br />

healthcare message’.<br />

Commenting <strong>on</strong> the report,<br />

a spokesman for specsavers<br />

told oT: “We’re delighted that<br />

specsavers c<strong>on</strong>vincingly topped<br />

the people’s poll with 61.8% of<br />

the vote.”<br />

For the full analysis, visit www.<br />

guardian.co.uk/m<strong>on</strong>eym<strong>on</strong>ey/<br />

poll/2012/mar/23/storewars-specsavers-bootsopticians?newsfeed=true<br />

RNIB reveals line-up<br />

public health priority; improving<br />

community eye care and sight<br />

services and the launch of<br />

‘seeing it my way – a quality and<br />

outcomes framework for blind<br />

and partially sighted people’.<br />

programme director of<br />

the UK Visi<strong>on</strong> strategy, anita<br />

Lightst<strong>on</strong>e, said: “Visi<strong>on</strong> UK 2012<br />

is about improving outcomes<br />

and increasing value. This is an<br />

important challenge for health<br />

and social care professi<strong>on</strong>als<br />

across the UK.<br />

“Those who attend Visi<strong>on</strong><br />

UK 2012 can find out about<br />

how they can meet this goal<br />

by innovating locally to drive<br />

forward the UK Visi<strong>on</strong> strategy<br />

and ultimately improve services<br />

for blind and partially sighted<br />

people.”<br />

For more informati<strong>on</strong> and to<br />

book, visit www.visi<strong>on</strong>2020uk.<br />

org.uk/ukvisi<strong>on</strong>strategy<br />

To comment go to www.optometry.co.uk<br />

NEWS<br />

IN BRIEF<br />

Marath<strong>on</strong> couple<br />

optometrist stephen poundall<br />

of Visi<strong>on</strong> express in norwich<br />

will be joined by his wife Kirsty<br />

(pictured) when they both<br />

take part in the Virgin L<strong>on</strong>d<strong>on</strong><br />

Marath<strong>on</strong> <strong>on</strong> april 22 to raise<br />

m<strong>on</strong>ey for the Childhood eye<br />

Cancer Trust.<br />

it will be Mr pundall’s<br />

first marath<strong>on</strong>, but his wife<br />

has previously completed<br />

marath<strong>on</strong>s in both L<strong>on</strong>d<strong>on</strong><br />

and paris.<br />

Keeler d<strong>on</strong>ati<strong>on</strong><br />

Ophthalmic instrument<br />

manufacturer Keeler has<br />

d<strong>on</strong>ated ophthalmoscopes<br />

and retinoscopes to Visi<strong>on</strong><br />

Care for Homeless People,<br />

a UK-based charity which<br />

provides free sight tests<br />

and spectacles to homeless<br />

people.<br />

Harinder Paul, CEO and<br />

founder of the charity, said:<br />

“The ophthalmoscopes<br />

and retinoscopes d<strong>on</strong>ated<br />

by Keeler, al<strong>on</strong>g with their<br />

earlier d<strong>on</strong>ati<strong>on</strong> of the<br />

pulsair intellipuff, will help<br />

us deliver the highest level of<br />

comprehensive care to large<br />

numbers of patients.”<br />

New VAO centre<br />

Charity Visi<strong>on</strong> aid overseas<br />

(Vao) has opened its fourth<br />

visi<strong>on</strong> centre in Zambia thanks<br />

to the help of d<strong>on</strong>ati<strong>on</strong>s from<br />

UK practices.<br />

The new Livingst<strong>on</strong>e centre<br />

in the southern province<br />

of the african country took<br />

three weeks to establish, with<br />

volunteers installing a refracti<strong>on</strong><br />

room, diagnostic screening<br />

room, glazing workshop and<br />

dispensing room.<br />

7<br />

06/04/12 NEWS

8<br />

06/04/12 NEWS<br />

NEWS<br />

Sight linked to crashes<br />

Chris D<strong>on</strong>kin<br />

chrisd<strong>on</strong>kin@optometry.co.uk<br />

INSuRANCE COMPANy Royal Sun Alliance<br />

(RSA) has joined the professi<strong>on</strong>’s call to acti<strong>on</strong><br />

<strong>on</strong> drivers’ visi<strong>on</strong> following the release of<br />

statistics reporting a rise in accidents in the<br />

twilight hours at the start of British Summer<br />

Time.<br />

Accident rates between 4pm and 6pm<br />

were around 9% higher <strong>on</strong> the week marking<br />

the start of British Summer Time compared to<br />

the previous three m<strong>on</strong>ths, according to the<br />

RSA’s claims data for last year and 2010.<br />

RSA uK and Western Europe chief<br />

executive, Adrian Brown said: “It’s often when<br />

driving during twilight hours that people<br />

first notice problems with their visi<strong>on</strong>. Just<br />

as an MOT and service is important for<br />

keeping your car <strong>safe</strong>, regular eye tests are<br />

vital to ensure your eyes are roadworthy too.<br />

My <str<strong>on</strong>g>advice</str<strong>on</strong>g> to all drivers is to follow medical<br />

<str<strong>on</strong>g>advice</str<strong>on</strong>g> and have your eyes examined every<br />

couple of years.”<br />

RSA recently launched its fitness to drive<br />

campaign which highlights the dangers of<br />

driving with poor eyesight and calls for: ‘the<br />

current wholly inadequate number plate test<br />

to be scrapped; for all learner drivers to have<br />

their visi<strong>on</strong> tested by a qualified professi<strong>on</strong>al<br />

prior to applying for a provisi<strong>on</strong>al driving<br />

licence and any<strong>on</strong>e renewing their driving<br />

licence to have to prove that they have had an<br />

eye examinati<strong>on</strong> within the last two years.’<br />

Director of operati<strong>on</strong>s at the <str<strong>on</strong>g>AOP</str<strong>on</strong>g>, David<br />

Craig, said: “We all know that the number<br />

plate test is woefully inadequate, both in<br />

itself and because the c<strong>on</strong>diti<strong>on</strong>s in which it<br />

is taken can vary so much. It is encouraging<br />

to see RSA’s initiative and to hear this hard<br />

evidence that visi<strong>on</strong> plays a part in accidents.”<br />

Tax changes welcomed<br />

SMAll BuSINESSES look set to benefit<br />

from tax and finance measures in this year’s<br />

Budget, according to the Forum of Private<br />

Business, but the organisati<strong>on</strong> also warns<br />

that the Government may not have g<strong>on</strong>e<br />

far enough.<br />

The changes outlined by the chancellor<br />

of the exchequer, were welcomed by the<br />

Forum, however, it added that the smallest<br />

firms, such as some independent practices,<br />

must benefit from the new Nati<strong>on</strong>al<br />

loan Guarantee and Business Finance<br />

Partnership schemes.<br />

Chief executive of the Forum, Phil Orford<br />

(pictured), told OT: “The overall verdict is<br />

that there have been some tentative steps<br />

in the right directi<strong>on</strong>, and perhaps the<br />

beginnings of a road map for the future – but<br />

for the next year or two, when many of these<br />

policies kick in – what small businesses and<br />

the ec<strong>on</strong>omy need are c<strong>on</strong>fident strides<br />

forward now. largely, that has not happened<br />

in this Budget.<br />

“We saw nothing <strong>on</strong> reducing the<br />

mounting burden of business rates or fuel<br />

duty via cuts and a real stabiliser to regulate<br />

prices at the pump. These were omissi<strong>on</strong>s<br />

– and while the Government is working to<br />

improve access to funding and bring down<br />

banks’ lending costs by implementing ‘credit<br />

easing’, the Nati<strong>on</strong>al loan Guarantee Scheme,<br />

there are c<strong>on</strong>cerns that the smallest firms in<br />

most need of affordable finance will miss out.<br />

“Further, we called for tax incentives to pave<br />

the way for alternative lenders to compete<br />

more effectively in finance markets dominated<br />

by the big banks, but there was nothing <strong>on</strong><br />

this in the Budget.”<br />

Mr Orford also praised the cut in<br />

corporati<strong>on</strong> tax and added: “The c<strong>on</strong>cept of<br />

merging income tax and Nati<strong>on</strong>al Insurance<br />

is a first step in what looks to be l<strong>on</strong>g overdue<br />

reforms to the tax system for small firms, but<br />

the chancellor could have g<strong>on</strong>e further.”<br />

to comment go to www.optometry.co.uk<br />

commENt<br />

GettING the best<br />

out of YouR ot<br />

OT (formerly <strong>Optometry</strong> <strong>Today</strong>) is a l<strong>on</strong>gstanding<br />

offering to the <str<strong>on</strong>g>AOP</str<strong>on</strong>g>’s members<br />

and the wider optometric community. But<br />

how much is it valued by our members?<br />

Inevitably, <strong>on</strong>ly those who read it are in a<br />

positi<strong>on</strong> to reply. There are rumours that<br />

some recipients even leave the magazine<br />

unopened in its wrapper and never look at<br />

it again. Such a reacti<strong>on</strong> is unfortunate, to<br />

say the least.<br />

Without wishing to blow our own<br />

trumpet too loudly, I think the <str<strong>on</strong>g>AOP</str<strong>on</strong>g> can<br />

<strong>safe</strong>ly say that its magazine c<strong>on</strong>tains<br />

a great deal of interesting and useful<br />

news, informati<strong>on</strong> and expert <str<strong>on</strong>g>advice</str<strong>on</strong>g> for<br />

practiti<strong>on</strong>ers. In fact, the news pages<br />

in this issue have been updated with a<br />

fresher look to get in even more optical<br />

news.<br />

OT is the primary means of<br />

disseminating our <str<strong>on</strong>g>advice</str<strong>on</strong>g> <strong>on</strong> a wide range<br />

of topics. Notice of new regulati<strong>on</strong>s,<br />

CET grants, GOC renewal deadlines – all<br />

appear in OT. Reading the magazine<br />

certainly would have helped the member<br />

who called me last year, having just heard<br />

he had to register his glazing facility with<br />

the Medicines and Healthcare products<br />

Regulatory Agency – more than 10 years<br />

after the event.<br />

Of course, we must not rest <strong>on</strong><br />

our laurels. There is always room for<br />

improvement. From a narrow point of<br />

view, OT needs to do more to inform our<br />

members of the <str<strong>on</strong>g>AOP</str<strong>on</strong>g>’s efforts across a<br />

range of activities. More widely, OT needs<br />

to be more investigative in its reporting.<br />

To be sure, investigati<strong>on</strong>s require a lot of<br />

resources. But we need to have a better<br />

understanding of what is going <strong>on</strong> in our<br />

sector. The livelihood of our members<br />

could depend <strong>on</strong> it.<br />

Richard Carswell<br />

AoP interim chief executive

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live<br />

optometrytoday bookshop<br />

APRIL 6 2012<br />

VoLume 52:7<br />

ISSN 0268-5485<br />


January 1 2011 – December 31 2011<br />

Average Net: 20, 038<br />

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

OT Manager: Louise Walpole<br />

T: 020 7549 2077<br />

E: louisewalpole@aop.org.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 D<strong>on</strong>kin<br />

T: 020 7549 2074<br />

E: chrisd<strong>on</strong>kin@optometry.co.uk<br />

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 />

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

Editorial Office:<br />

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Editorial Advisory Board<br />

Vivian Bush, Le<strong>on</strong> Davies, Camer<strong>on</strong> Huds<strong>on</strong>,<br />

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Hepworth, Olivia Hunt, Niall Hynes, Ceri Smith-<br />

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<strong>on</strong>line enewsletter<br />

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Published fortnightly for the Associati<strong>on</strong> of<br />

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UK £130, OVERSEAS £175 for 24 issues<br />

NICe issues updated support<br />

guide <strong>on</strong> glaucoma services<br />

Emily McCormick<br />

emilymccormick@optometry.co.uk<br />

NICE HAS issued an updated<br />

guide to support the<br />

commissi<strong>on</strong>ing of high quality,<br />

evidence-based services for<br />

people at risk of developing<br />

glaucoma across England.<br />

The document, which is<br />

designed for commissi<strong>on</strong>ers,<br />

looks at commissi<strong>on</strong>ing<br />

services for the <strong>referral</strong>,<br />

diagnosis and m<strong>on</strong>itoring of<br />

those at risk of developing<br />

glaucoma, which is classified<br />

as people with ocular<br />

hypertensi<strong>on</strong> (OHT) and<br />

suspected chr<strong>on</strong>ic open<br />

angle glaucoma (COAG).<br />

However, it does not include<br />

commissi<strong>on</strong>ing services for<br />

people already diagnosed<br />

with COAG. It also provides<br />

support for the commissi<strong>on</strong>ing<br />

of repeat measure and <strong>referral</strong><br />

refinement schemes.<br />

The guide urges<br />

commissi<strong>on</strong>ers to work with<br />

a range of partners, including<br />

clinical commissi<strong>on</strong>ing groups;<br />

health and wellbeing boards;<br />

ophthalmology, optometry<br />

and social care providers and<br />

service users to develop and<br />

deliver the services.<br />

The healthcare guidance<br />

body stressed that, although<br />

the guide draws <strong>on</strong> exisiting<br />

NICE recommendati<strong>on</strong>s, it<br />

doesn’t c<strong>on</strong>stitute formal<br />

guidance and is intended as a<br />

tool to help the NHS improve<br />

patient care through effective<br />

commissi<strong>on</strong>ing.<br />

Dr John Sparrow, c<strong>on</strong>sultant<br />

ophthalmologist at the Bristol<br />

Eye Hospital and chair of the<br />

Topic Expert Group for the<br />

glaucoma quality standard,<br />

said: “The NICE clinical<br />

guideline and accompanying<br />

quality standard <strong>on</strong> glaucoma<br />

provide a blueprint for a<br />

c<strong>on</strong>sistent nati<strong>on</strong>al approach<br />

to managing people with<br />

chr<strong>on</strong>ic open angle glaucoma<br />

VRICS<br />

and the related precursor<br />

c<strong>on</strong>diti<strong>on</strong>s, OHT and suspected<br />

COAG. This guide will ensure<br />

that those resp<strong>on</strong>sible for<br />

commissi<strong>on</strong>ing services for<br />

people at risk of developing sight<br />

loss from glaucoma are able to<br />

do so <strong>on</strong> the basis of the best<br />

available evidence.”<br />

The guide, which was<br />

published last Friday (March 30),<br />

includes a commissi<strong>on</strong>ing and<br />

benchmarking tool which aims<br />

to help users determine the level<br />

of service required locally and<br />

to help identify the potential<br />

savings linked to commissi<strong>on</strong>ing<br />

services for people with OHT<br />

and suspected glaucoma. It also<br />

highlights the current high levels<br />

of unneccessary <strong>referral</strong>s to the<br />

hospital eye service for OHT and<br />

suspected COAG, which could<br />

be reduced through locally<br />

commissi<strong>on</strong>ed schemes.<br />

Optometrist and OT clinical<br />

editor, Dr Navneet Gupta,<br />

commented: “The updated<br />

<str<strong>on</strong>g>advice</str<strong>on</strong>g> from NICE about<br />

improving the commissi<strong>on</strong>ing<br />

of services for people at risk<br />

of developing glaucoma is a<br />

welcome and timely additi<strong>on</strong> to<br />

help ease the burden placed <strong>on</strong><br />

hospital eye services, which was<br />

created after the introducti<strong>on</strong> of<br />

the new <strong>referral</strong> guidelines for<br />

OHT/suspected glaucoma.<br />

“It is pleasing to see that many<br />

areas in England are already<br />

working <strong>on</strong> establishing <strong>referral</strong><br />

refinement schemes for OHT/<br />

To comment go to www.optometry.co.uk<br />

CET<br />

tv<br />

glaucoma, and some schemes<br />

are already active.<br />

“The informati<strong>on</strong> provided in<br />

this updated <str<strong>on</strong>g>advice</str<strong>on</strong>g> from NICE,<br />

however, will go a l<strong>on</strong>g way<br />

to helping those who may be<br />

struggling, or those who have<br />

not yet begun, to implement<br />

such a scheme in their area<br />

by making the process clearer<br />

and helping to ensure that the<br />

scheme is fair for every<strong>on</strong>e<br />

involved, from patients to<br />

practiti<strong>on</strong>ers. At the same time,<br />

it provides a template to be<br />

followed to ensure there are<br />

little nati<strong>on</strong>al variati<strong>on</strong>s in such<br />

schemes.”<br />

David Craig, <str<strong>on</strong>g>AOP</str<strong>on</strong>g> director<br />

of operati<strong>on</strong>s, added: “We<br />

welcome the updated guide<br />

from NICE for commissi<strong>on</strong>ers<br />

<strong>on</strong> providing services for<br />

people at risk of developing<br />

glaucoma. It dem<strong>on</strong>strates<br />

that NICE understands the<br />

value of repeating pressures<br />

and <strong>referral</strong> refinement in<br />

a primary care setting and<br />

that it also understands the<br />

limitati<strong>on</strong>s of GOS. We hope that<br />

commissi<strong>on</strong>ers will now ensure<br />

that these services are provided<br />

to patients wherever they live in<br />

the UK. Of course, optometrists<br />

are very well placed, well trained<br />

and well equipped to offer these<br />

services to their patients; we just<br />

need the funds and a green light.”<br />

• To read the guidance, go to<br />

www.nice.org.uk and search<br />

for ‘cmg44’.

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1. JJVC, data <strong>on</strong> fi le 2010. Physiological resp<strong>on</strong>se of neophytes with a daily disposable silic<strong>on</strong>e hydrogel lens. 1-year prospective randomised, double-masked, parallel group study, results after 12 m<strong>on</strong>ths, n=48. Measures included:<br />

C<strong>on</strong>junctival and limbal hyperaemia, c<strong>on</strong>junctival and corneal staining, papillary c<strong>on</strong>junctivitis and subjective comfort. 2. Corneal oxygen c<strong>on</strong>sumpti<strong>on</strong> was calculated using the method of Brennan, which represents an index of corneal<br />

oxygen metabolism during open eye and thus cellular energy producti<strong>on</strong>. Brennan NA. OVS. 2005 Jun; 82(6):467-72. Brennan N, Morgan P. CLAE 2009; 32(5): 210-254. 3. UV-absorbing c<strong>on</strong>tact lenses do not substitute devices<br />

like sunglasses because the c<strong>on</strong>tact lenses do not cover the entire eye. 4. Veys K & French K. Optician 2006; 231(6050): 16-20. 5. Chamberlain P. CLAE 2009; 32: 220. ACUVUE ® , SEE WHAT COULD BE ® , 1•DAY ACUVUE ® TruEye ® ,<br />

HYDRACLEAR ® and 4 DIMENSIONS OF EYE HEALTH are trademarks of Johns<strong>on</strong> & Johns<strong>on</strong> Medical Ltd. © Johns<strong>on</strong> & Johns<strong>on</strong> Medical Ltd 2012. Johns<strong>on</strong> & Johns<strong>on</strong> Visi<strong>on</strong> Care is part of Johns<strong>on</strong> & Johns<strong>on</strong> Medical Ltd.

12<br />

06/04/12 SPECTATOR<br />


Taking the biscuit<br />

Poor old lansley – despite the recent talk all being about<br />

pasties, petrol queues and ‘granny tax’, he still can’t avoid the<br />

headlines. According to news reports in last week’s nati<strong>on</strong>al<br />

press, he is (allegedly) resp<strong>on</strong>sible for the department of<br />

Health’s biscuit spend, accused by the oppositi<strong>on</strong> of “losing<br />

his grip <strong>on</strong> his own department’s reckless spending”. An<br />

urgent review has been ordered after it was revealed that the<br />

department has, since January 1, spent more than £109,000<br />

<strong>on</strong> “tea and biscuits” for staff and visitors. But surely the<br />

oppositi<strong>on</strong> ought to be c<strong>on</strong>gratulating the beleaguered Health<br />

Secretary for having reduced this bill by over 40% from the<br />

£194,000 spent during the same period when labour was last<br />

in power?<br />

‘real cost of recycled spectacles’ in last m<strong>on</strong>th’s optometry<br />

and Visi<strong>on</strong> Science c<strong>on</strong>cluded that the collecti<strong>on</strong> (by<br />

opticians up and down the land) of recycled spectacles<br />

should be discouraged as a strategy for eliminating<br />

uncorrected refractive error in developing countries as it is<br />

not a cost-saving method of achieving this. At first glance,<br />

the paper appears to be dismissing what is, to the general<br />

public in the UK, <strong>on</strong>e of the most visible activities that the<br />

charity, Visi<strong>on</strong> Aid overseas, undertakes. The paper even<br />

questi<strong>on</strong>s the ethics of practices collecting spectacles as it<br />

may encourage further dispensing sales and infers that the<br />

collecti<strong>on</strong> activity is in some way misleading the c<strong>on</strong>sumer<br />

into purchasing glasses from an optician that supports<br />

charitable activity. reading this, many practiti<strong>on</strong>ers may be<br />

forgiven for thinking that they may as well stop collecting<br />

spectacles, but hold <strong>on</strong> a minute. This very public activity<br />

serves useful purposes bey<strong>on</strong>d the obvious. Firstly, it creates<br />

a visible profile (pictured) and encourages engagement with<br />

the VAo charity from the public and opticians alike. Having<br />

built an associati<strong>on</strong> and relati<strong>on</strong>ship with the charity, many<br />

practiti<strong>on</strong>ers (and their staff) go <strong>on</strong> to engage in fundraising<br />

activities and even to physically support VAo initiatives<br />

<strong>on</strong> the ground in the countries in which they operate.<br />

Sec<strong>on</strong>dly, recycling spectacles does provide a small part<br />

of the soluti<strong>on</strong> to correcting refractive error in developing<br />

countries (although by far the bulk of the answer lies in the<br />

provisi<strong>on</strong> of new, rather than recycled spectacles). However,<br />

the recycling activity could be made more effective with<br />

some small improvements. The oVS paper highlights that the<br />

proporti<strong>on</strong> of recycled spectacles that can be reused is less<br />

than 10% – but this could be improved if there was initial<br />

sorting at the point of collecti<strong>on</strong>, for example, disregarding<br />

all multifocals and critically dismissing any with scratched<br />

lenses, worn or ‘tired’ frames.<br />

Headlines of a more serious note were being made in last<br />

weekend’s Financial Times regarding a potential over-supply<br />

of 20,000 doctors. Most professi<strong>on</strong>s working within the NHS<br />

To comment go to www.optometry.co.uk<br />

are subject to NHS ‘workforce planning’ oversight. It is this<br />

that lay behind the Government’s decisi<strong>on</strong> to open seven new<br />

medical schools just over a decade ago (and has had similar<br />

influence over the opening of new university departments for<br />

dentistry and pharmacy). NHS Employers, the organisati<strong>on</strong><br />

which negotiates NHS staff pay, commented that there is a<br />

need to “get to grips with how the NHS plans its workforce”<br />

thus acknowledging what we have always intuitively<br />

known – that the NHS isn’t very good at workforce planning.<br />

our own sector is, thankfully, not subject to such external<br />

interference (and l<strong>on</strong>g may that c<strong>on</strong>tinue). The cause of the<br />

current c<strong>on</strong>cern, is realisati<strong>on</strong> that by the end of the decade,<br />

the number of junior doctors and medical students qualifying<br />

as c<strong>on</strong>sultants will reach 60,000 compared with 40,000 today<br />

– and there will not be jobs for that many c<strong>on</strong>sultants within<br />

the NHS. Soluti<strong>on</strong>s being c<strong>on</strong>sidered include the creati<strong>on</strong><br />

of ‘sub-c<strong>on</strong>sultant’ posts (at presumably substantially lower<br />

rates of pay) and a ‘managed programme of movement’ for<br />

junior doctors to spend up to three years working elsewhere<br />

in the EU. This may be a soluti<strong>on</strong>, which suits the EU, as<br />

there are high vacancy rates for doctors in eastern European<br />

countries. But what might appeal more to those younger<br />

doctors who become disenchanted with the NHS, are the<br />

lures of warmer climes, they will be aware that it isn’t <strong>on</strong>ly<br />

optometrists who are in str<strong>on</strong>g demand in Australia and<br />

New Zealand.<br />

Picture courtesy of Visi<strong>on</strong> Aid Overseas

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14<br />

06/04/12 <strong>Profile</strong><br />

profile<br />

‘Make it entertaining’<br />

Optometrist, lecturer and entertainer <strong>Brian</strong> Tompkins gives OT his unique outlook <strong>on</strong> optics<br />

Flamboyant, excitable, engaging<br />

and off-the-wall are all statements<br />

you’re likely to hear if lucky enough to<br />

catch <strong>on</strong>e of brian tompkins’ lectures<br />

<strong>on</strong> the c<strong>on</strong>ference circuit this year,<br />

but there’s more to him than just an<br />

optometrist with an unusual dress<br />

sense, he’s a shrewd practice owner<br />

who most of all wants to promote<br />

that optics can, and should, be fun.<br />

“How boring is it sitting in a<br />

darkened room all day saying <strong>on</strong>e<br />

or two?,” he asks. “it bores any<strong>on</strong>e,<br />

it must do. i think you need to<br />

take what can be a massively fun<br />

professi<strong>on</strong> and take it to the next<br />

level. Sure, we can help visi<strong>on</strong>, we can<br />

give people frames, but let’s enjoy it. Do a<br />

dry eye clinic, do sports visi<strong>on</strong>, whatever<br />

it might be, just do something different,<br />

d<strong>on</strong>’t be a refracti<strong>on</strong> machine.”<br />

He believes in dazzling his patients with<br />

‘a bit of theatre’ in the c<strong>on</strong>sulting room:<br />

“We, as optometrists, are <strong>on</strong> stage in fr<strong>on</strong>t<br />

of every single patient. that <strong>on</strong>e-to-<strong>on</strong>e<br />

stage is where we perform our art to<br />

the best we can. it’s all about making it<br />

entertaining, make them smile, know<br />

what you’re doing and take some m<strong>on</strong>ey<br />

at the end of it. make life fun.”<br />

Breaking the mould<br />

Straight from leaving university, mr<br />

tompkins knew he wanted to break the<br />

mould in optics and recommends any<br />

student qualifying now who is looking for<br />

a bit of variety and fun in their career to<br />

attempt a similar path to him and find an<br />

inspirati<strong>on</strong>al mentor.<br />

“i’d tell any<strong>on</strong>e to get working in an<br />

independent, try not to become part<br />

of the corporate machine, d<strong>on</strong>’t be put<br />

<strong>on</strong> to a c<strong>on</strong>veyor belt where you have<br />

no choice but to become a refracti<strong>on</strong><br />

machine.<br />

“at the end of the day, unless you<br />

have some form of interest in it (your<br />

professi<strong>on</strong>) and actually enjoy what you<br />

do, then there’s no point doing it.<br />

“What was the whole point in<br />

becoming an optometrist? try and find<br />

something to hook your interest to get<br />

in there and then try and find a mentor.<br />

When i look at how i got through i realise<br />

i worked with some seriously, seriously<br />

nice people who were really interested<br />

in their job and really took it to the next<br />

level.<br />

“try your best to be different and<br />

try to be unique. Something that<br />

takes you above that level of boring.<br />

it’s difficult, you need to get some<br />

lucky breaks al<strong>on</strong>g the way but it’s<br />

the way to get through.”<br />

Embrace 2012<br />

He believes that it’s imperative for<br />

every<strong>on</strong>e to keep abreast of modern<br />

technology. “if you d<strong>on</strong>’t use it (as a<br />

business) you w<strong>on</strong>’t survive – and<br />

make sure you charge for it,” he<br />

warns. “it denigrates our professi<strong>on</strong><br />

by saying we’ll take a photo but we<br />

w<strong>on</strong>’t charge for it. i d<strong>on</strong>’t charge for<br />

taking the (retinal) photo, i charge<br />

for spending my time telling them about<br />

what they’ve got, explaining it to them – i<br />

do a bit of theatre, ‘here is your eye, here<br />

are the workings of your eye’, then a few<br />

educati<strong>on</strong>al bits telling them what’s going<br />

<strong>on</strong>. that’s what i feel we should all be<br />

doing.”<br />

With a schedule filled with lecture<br />

spots at major c<strong>on</strong>ferences and a full<br />

appointment book, mr tompkins is<br />

certainly going to have another busy<br />

spring, but he has no intenti<strong>on</strong> of slowing<br />

down or – shudder at the thought –<br />

retiring.<br />

“Having just had a massive refurb at a<br />

time when some of my friends are retiring<br />

i just d<strong>on</strong>’t see myself retiring, i have too<br />

much fun. Why retire from something i<br />

have fun doing? What am i going to do,<br />

sit at home, dig the garden? that’s not my<br />

bag. this professi<strong>on</strong> has treated me very<br />

well, i see great people <strong>on</strong> a regular basis,<br />

classically Saturday mornings are like a big<br />

café when i get people from a different<br />

part of the country coming to visit, i d<strong>on</strong>’t<br />

want to lose that.”<br />

An extended versi<strong>on</strong> of this<br />

interview is available <strong>on</strong>line at<br />


16<br />

06/04/12 VAluATIoNs<br />

ADVICE<br />

Make sure your exit<br />

is a profitable <strong>on</strong>e<br />

In the final article of our two part series, director of RA Valuati<strong>on</strong> Services Mark Ridout discusses<br />

techniques to help sell a business for a good price<br />


owners should have<br />

an exit strategy in<br />

mind. This may<br />

simply be a ‘wish<br />

list’ reflecting the<br />

owner’s desires, or<br />

it could comprise<br />

part of a detailed<br />

formal business<br />

plan.<br />

Either way,<br />

an exit strategy<br />

should, ideally, be<br />

planned at least<br />

three years ahead<br />

if a satisfactory<br />

valuati<strong>on</strong> and<br />

successful transfer/<br />

sale are to be<br />

achieved. If you feel you haven’t got the experience, or the<br />

time, to develop a plan, hire a c<strong>on</strong>sultant or some<strong>on</strong>e who can<br />

help you – it will almost certainly be a sound investment.<br />

Preparing your business for sale<br />

There are many things to do, most of them simple, if you<br />

are planning to put your practice <strong>on</strong> the open market. For<br />

example, you must ensure that the physical appearance is up<br />

to scratch, as with selling a house, so called ‘kerb appeal’ is<br />

vitally important.<br />

“As with selling a house, so<br />

called ‘kerb appeal’ is vitally<br />

important”<br />

When a homeowner wants to sell their house, they may<br />

paint it, fix up a couple of things that needed to have been<br />

d<strong>on</strong>e during the last few years, and polish the taps. Simple,<br />

obvious, but unarguably effective. It is the same for practice<br />

owners, they can improve the value of their practice by<br />

making a few changes. First impressi<strong>on</strong>s count and can be the<br />

difference between a successful, or unsuccessful, sale.<br />

Be realistic about the value of your practice<br />

D<strong>on</strong>’t underestimate the value of your business but do be<br />

realistic. Bear in mind that prudent would-be buyers are<br />

increasingly<br />

commissi<strong>on</strong>ing<br />

an independent<br />

valuati<strong>on</strong> to<br />

ensure they are<br />

paying no more<br />

than a realistic<br />

and fair price.<br />

They are well<br />

aware that some<br />

practices have<br />

declined in value<br />

over the last<br />

couple of years<br />

and may drop<br />

further still. They<br />

will recognise<br />

an over-priced<br />

practice for what<br />

it is.<br />

Take <str<strong>on</strong>g>advice</str<strong>on</strong>g> from a professi<strong>on</strong>al valuer familiar with<br />

the industry – never use guesswork. Whether you are a<br />

purchaser or a vendor, a specialist valuer could save or make<br />

you c<strong>on</strong>siderable m<strong>on</strong>ey.<br />

Be a professi<strong>on</strong>al manager as well as a<br />

professi<strong>on</strong>al practiti<strong>on</strong>er<br />

C<strong>on</strong>centrate <strong>on</strong> the points listed in the previous article (OT<br />

February 24, 2012) and above. Enlist professi<strong>on</strong>al help to<br />

organise and plan. Listen to the experts. Most importantly,<br />

be prepared with clear, up-to-date accounts showing an<br />

attractive and well documented track record of profitable<br />

growth. Like the homeowner, polish and a fresh coat of<br />

paint will help with the kerb appeal. But remember that<br />

the bank will want to see that the potential buyer can pay<br />

back the loan. Ultimately, it all comes down to profit. Get<br />

all of the above right and the financial figures will speak for<br />

themselves.<br />

• RA Valuati<strong>on</strong> Services Limited is the <str<strong>on</strong>g>AOP</str<strong>on</strong>g>’s sole accredited<br />

practice valuati<strong>on</strong> specialist. In additi<strong>on</strong> to RA’s exclusive<br />

discount <strong>on</strong> practice valuati<strong>on</strong>s to <str<strong>on</strong>g>AOP</str<strong>on</strong>g> members, for a<br />

limited time, RA is also offering a Practice Market Appraisal<br />

Guide for small practices – ie, with a turnover less than<br />

£100,000 – priced at <strong>on</strong>ly £350+VAT. See its website www.<br />

RAValuati<strong>on</strong>Services.com/<str<strong>on</strong>g>AOP</str<strong>on</strong>g> or c<strong>on</strong>tact them either by<br />

teleph<strong>on</strong>e <strong>on</strong> 01425 402402 or email info@RAValuati<strong>on</strong>s.com

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1. OPTOMETRY AND VISION SCIENCE; 2008, 85(2), 82-88, 2. INVEST OPHTHALMOLOGY VISION SCIENCE; 2009, 46, E-ABSTRACT 1703, 3. OPHTHALMIC PHYSIOLOGY OPT; 2006, 26, 362-71, 4. PROGR RET EYE RES; 2002, 21, 225-40.<br />


18<br />

06/04/12 STAYING SAFE<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g>ADVICE<br />

Referring <strong>safe</strong>ly<br />

Clinical adviser to <str<strong>on</strong>g>AOP</str<strong>on</strong>g> legal services, Trevor Warburt<strong>on</strong> advises <strong>on</strong> reducing risk<br />

SOME ISSUES just keep cropping up in<br />

cases that pass through the <str<strong>on</strong>g>AOP</str<strong>on</strong>g>’s legal<br />

department.<br />

GPs d<strong>on</strong>’t do urgent<br />

D<strong>on</strong>’t send a <strong>referral</strong> to the GP with the<br />

expectati<strong>on</strong> that it will be dealt with<br />

urgently, whatever you write in your<br />

letter. Unless you are prepared to follow<br />

up with a ph<strong>on</strong>e call to the GP to ensure<br />

acti<strong>on</strong> is taken, and then to the patient<br />

to ensure it happened, d<strong>on</strong>’t rely <strong>on</strong><br />

the GP. You do not relieve yourself of<br />

resp<strong>on</strong>sibility or liability by referring to<br />

the GP if that <strong>referral</strong> pathway is later<br />

deemed inappropriate.<br />

If you have a patient with urgent<br />

pathology in your c<strong>on</strong>sulting room, then<br />

you want them out and into the right<br />

hands as so<strong>on</strong> as possible.<br />

Use the right pathway<br />

If you have a dedicated local pathway for wet AMD, then make<br />

sure you use it. If there is a pathway and you use an alternative<br />

route, then you run the risk of delaying, and being accused<br />

of delaying, the <strong>referral</strong>. If you are asked to fax the <strong>referral</strong>,<br />

‘ph<strong>on</strong>e afterwards and check it was received. My staff now do<br />

this as routine, and then make a note of the c<strong>on</strong>firmati<strong>on</strong> <strong>on</strong><br />

the record. Remember, you are resp<strong>on</strong>sible for the <strong>referral</strong>. The<br />

c<strong>on</strong>tractor has a duty to ensure you are aware of the correct<br />

<strong>referral</strong> pathways, but you can’t blame them if you d<strong>on</strong>’t know.<br />

Emergencies<br />

If you have a dedicated eye casualty, then use it. Sometimes<br />

they w<strong>on</strong>’t accept patient walk-ins without a <strong>referral</strong> – mine<br />

w<strong>on</strong>’t. So when some<strong>on</strong>e walks in and tells your recepti<strong>on</strong>ist<br />

they have new floaters and you have no free appointments, you<br />

may need to direct them to A&E. It’s best to try and direct them<br />

to an A&E in a hospital with an ophthalmology department, so<br />

the expertise will be <strong>on</strong> call if required.<br />

When referring to casualty, give the patient your <strong>referral</strong> note<br />

to take with them, or fax it in advance. If you ring to make the<br />

patient an urgent appointment, ask who you are speaking to<br />

and make a note of the name <strong>on</strong> the record. If they say they<br />

will ‘ph<strong>on</strong>e the patient to make the appointment, check with<br />

the patient that this has happened and d<strong>on</strong>’t leave it more than<br />

a day to do so.<br />

Other procedures<br />

If you decide other procedures are required as a part of the<br />

sight test, eg, visual fields not performed in advance, then they<br />

need to be carried out before the sight test is<br />

deemed complete.<br />

If you find, for example, that there is a field<br />

defect, you might then refer, or repeat the<br />

field test. In the latter case, you have reached<br />

a c<strong>on</strong>clusi<strong>on</strong> to the test and are referring to<br />

yourself for an enhanced service, regardless of<br />

whether this is funded by the NHS, the patient<br />

or yourself.<br />

Locums<br />

It can be particularly difficult requesting repeat<br />

tests as an occasi<strong>on</strong>al, or <strong>on</strong>e-off, locum. A<br />

regular cause of difficulty is where a locum has<br />

requested repeat tests and these were either<br />

not carried out by the practice, or they were<br />

carried out but no <strong>on</strong>e looked at the results. To<br />

stay <strong>safe</strong>, a locum should do two things; first,<br />

they should refer these repeat tests, in writing,<br />

to another optometrist within the practice and<br />

note this <strong>on</strong> the record. Sec<strong>on</strong>dly, they should<br />

keep a log of any requested repeat tests and<br />

any urgent <strong>referral</strong>s, and check that these have been dealt with<br />

– either when next in the practice or by ‘ph<strong>on</strong>ing to check.<br />

Look back at records and photos<br />

D<strong>on</strong>’t forget to look at the history. Check back to ensure the C:D<br />

ratio you have observed is in line with previous observati<strong>on</strong>s.<br />

If you take photos, compare them with previous <strong>on</strong>es. For C:D<br />

ratios compare oldest and newest. It’s embarrassing to take<br />

pictures and discover later that you missed an obvious change<br />

because you didn’t look back. It should go without saying that<br />

you must not take and store fundus images that you do not<br />

examine. It may sound obvious, but it has happened and, sadly,<br />

there was very obvious pathology visible which was missed<br />

with the ophthalmoscope.<br />

Fail<strong>safe</strong> procedures<br />

If you are suspicious about a field, or any other abnormality,<br />

and have booked a repeat test, you need to have procedures<br />

in place to deal with the patient who does not turn up. If they<br />

later develop a c<strong>on</strong>diti<strong>on</strong>, you will need to show that you at<br />

least tried to follow up. Make notes of DNAs <strong>on</strong> the record and<br />

‘ph<strong>on</strong>e and make another appointment. If all else fails, write a<br />

<strong>referral</strong> letter <strong>on</strong> the basis of your original tests and send it to<br />

the patient with a covering letter asking them to take it to their<br />

GP. Remember that, at this point, you d<strong>on</strong>’t actually have the<br />

patient’s permissi<strong>on</strong> to write direct to their GP. Staying <strong>safe</strong><br />

is a mix of comm<strong>on</strong> sense and ensuring that you have fail<strong>safe</strong><br />

procedures so patients d<strong>on</strong>’t fall through the net. It is worth<br />

reviewing practice systems to ensure they are fit for purpose.

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6 Prince Road, Kings Nort<strong>on</strong> Business Centre, Birmingham B30 3HB<br />

**Offer valid in April/May 2012, Not to be used in c<strong>on</strong>juncti<strong>on</strong> with any other offer. Subject to availability,E&OE

20<br />

06/04/12 INDUSTRY NEWS<br />



New products<br />

for DTCL<br />

DaviD Thomas C<strong>on</strong>tact Lenses (DTCL) this week<br />

began offering a new C2 multifocal silic<strong>on</strong>e hydrogel<br />

c<strong>on</strong>tact lens from Precilens, a leader in the specialty<br />

c<strong>on</strong>tact lens market in France. The Northampt<strong>on</strong>based<br />

DTCL has also taken over the marketing and<br />

distributi<strong>on</strong> of solocare aqua all-in-<strong>on</strong>e soluti<strong>on</strong> for<br />

soft lenses in the UK and ireland.<br />

Precilens CEo, Pierre Pitance, said: “The C2<br />

multifocal c<strong>on</strong>tact lens is the latest achievement in<br />

Precilens’ 30 years legacy in presbyopia. Precilens<br />

was the inventor of the first soft progressive c<strong>on</strong>tact<br />

lens in the 1980s. it has, since then, put presbyopia at<br />

the heart of its R and D process.”<br />

The C2 multifocal is a moulded m<strong>on</strong>thly lens with<br />

an optical design formed of two stabilised z<strong>on</strong>es, a<br />

near visi<strong>on</strong> z<strong>on</strong>e in the centre and a distance visi<strong>on</strong><br />

z<strong>on</strong>e at the periphery of the lens. Combined with a<br />

progressive intermediate z<strong>on</strong>e inbetween, the design<br />

is said to offer enhanced depth of focus.<br />

ophthalmology experts and optometry specialist<br />

organisati<strong>on</strong>s have shown interest in the latest<br />

Precilens product developments. am<strong>on</strong>g them is<br />

the Jenvis Research institute, based in Germany<br />

and cooperating with the optometry department<br />

of Jena University, Germany, which will c<strong>on</strong>duct a<br />

comparative multi-centre study led at a European<br />

level by Dr sebastian marx.<br />

in the UK and ireland, the study will involve<br />

Dr shehzad Naroo, who will explain further the<br />

methodology and c<strong>on</strong>clusi<strong>on</strong>s at a podium sessi<strong>on</strong><br />

during the next<br />

BCLa Clinical<br />

C<strong>on</strong>ference and<br />

Exhibiti<strong>on</strong>.<br />

The moulded<br />

m<strong>on</strong>thly multifocal<br />

silic<strong>on</strong>e hydrogel<br />

c<strong>on</strong>tact lens will<br />

be exhibited at the<br />

c<strong>on</strong>ference next<br />

m<strong>on</strong>th.<br />

& 01604<br />

646216<br />

Optix news is good<br />

The OpTIx two-day user group meeting last week<br />

attracted almost 170 independent practiti<strong>on</strong>ers,<br />

a rise of nearly 40 <strong>on</strong> the previous year. They were<br />

entertained at the event dinner by BBC TV and radio<br />

journalist John Sergeant, who is pictured with Optix<br />

directors Trevor Rowley, Andrew harris<strong>on</strong> and John<br />

Regan at the Champagne recepti<strong>on</strong> at Carden park<br />

near Chester.<br />

Mr Rowley gave a workshop emphasising the new<br />

features in the Optix business management system,<br />

especially a marketing module described as an “immensely powerful tool”. he also previewed<br />

some of the new features coming in the next versi<strong>on</strong> of the software, including hTML emails,<br />

which will give independents the ability to put images and signatures into their emails.<br />

The new hybrid mail integrati<strong>on</strong>, “essentially a remote printing system” for recall letters proved<br />

especially popular am<strong>on</strong>g the delegates.<br />

“with the announcement of the increased 50p charge for sec<strong>on</strong>d class letters, our new<br />

integrated mail processing system is very timely, enabling independents to send letters for as little<br />

as 37.5p, fully inclusive of postage, paper, printing, and envelope,” Mr Rowley told OT’s Robina<br />

Moss at the event. “what makes our new system unique is that we print <strong>on</strong> ultra-high quality<br />

120gsm paper using start-of-the-art digital printers. It can save an independent thousands of<br />

pounds each year.”<br />

& 01904 606611

Gok goes<br />

more retro<br />

TV sTyle guru gok Wan has launched<br />

13 new styles to his popular gW by<br />

gok Wan glasses, which build <strong>on</strong> the<br />

retro-inspired look of the original range,<br />

launched in February last year.<br />

“My inspirati<strong>on</strong> for this sec<strong>on</strong>d<br />

collecti<strong>on</strong> came from the 1940s and<br />

1950s,” he told OT’s robina Moss at the<br />

press launch in l<strong>on</strong>d<strong>on</strong>. “I was interested<br />

in the Hollywood look but what the stars<br />

of that era might wear off screen when<br />

they were not <strong>on</strong> camera.<br />

“My first collecti<strong>on</strong> covered a wide<br />

range of style and colours to test the<br />

market and see what people like. It’s still<br />

selling well but this range is more refined.<br />

It’s designed to be workable, wearable<br />

and versatile. There are cat’s eye shapes<br />

for women and TV styles for men.”<br />

All glasses in the range are sold at<br />

specsavers and cost £99 which includes<br />

single visi<strong>on</strong> Pentax lenses and scratch<br />

resistant coating as standard.<br />

Fog freedom<br />



Signet THE Armorlite NEW TECHNOLOGY europe AGAINST has secured<br />

FOG<br />

an exclusive agreement to offer Kodak<br />

lenses with optiFog to patients through<br />

the Kodak lens Visi<strong>on</strong> Centre network.<br />

optiFog is a new generati<strong>on</strong> of lenses<br />

with an exclusive anti-fog top layer<br />

plus glare reducti<strong>on</strong>, protecti<strong>on</strong> against<br />

scratches, dust repellence and ease of<br />

cleaning. optiFog is targeted at wearers<br />

who suffer from fog issues in everyday life<br />

with temperature changes such as while<br />

cooking, exercising or playing sport.<br />

Practiti<strong>on</strong>ers wanting to find out more<br />

about how they could join the centres are<br />

asked to teleph<strong>on</strong>e Hilary King.<br />

& 07917 061391<br />

© Essilor Internati<strong>on</strong>al – RCS Créteil 712 049 618 – May 2011. © Optifog TM is a trademark of Essilor Internati<strong>on</strong>al. © Essilor ® is a registered trademark of Essilor Internati<strong>on</strong>al. Kodak and the Kodak trade dress are trademarks of Kodak used under license by Signet Armorlite, Inc.<br />

Gang of four<br />

AwARD-wINNINg<br />

frames company Owp<br />

has launched four<br />

sophisticated women’s<br />

models, 1358, 1359, 1360<br />

and 2128. The Danish<br />

company is encouraging<br />

women to think of their<br />

glasses as accessories, as<br />

they would shoes, bags<br />

or jewellery, and as part<br />

of the initiative the new<br />

frames are available with<br />

fitting necklaces while<br />

stocks last.<br />

Using a new kind of<br />

technology, acetate<br />

partially encases the<br />

stainless steel temples<br />

in decorative patterns.<br />

william Morris is the UK<br />

distributor.<br />

& 01279 600 042<br />

Talking business<br />

OVeR 70 representatives from the optical<br />

industry heard about ‘the best means of<br />

driving the UK ec<strong>on</strong>omy forwards’ from<br />

Britain’s top business leader and new director<br />

general of the Institute of Directors (IoD),<br />

Sim<strong>on</strong> walker, pictured with FMO chairman<br />

John C<strong>on</strong>way (left).<br />

“This industry is a great example of Britain’s<br />

strengths in advanced manufacturing and<br />

there are clearly major opportunities across<br />

the sector,” he said at the latest FMO meeting, held at the AOp’s new headquarters in L<strong>on</strong>d<strong>on</strong>.<br />

Mr walker’s presentati<strong>on</strong> was followed by a questi<strong>on</strong> and answer sessi<strong>on</strong>, with optical industry<br />

bosses keen to hear his views <strong>on</strong> banking issues, salaries, government interventi<strong>on</strong> and the way<br />

forward for business.<br />

“The missing link is c<strong>on</strong>fidence,” he told them. “A survey of 1,000 IoD members revealed that<br />

companies were much more c<strong>on</strong>fident about their own prospects than they were for the wider<br />

ec<strong>on</strong>omy. The tantalising prospect is that if, and when, c<strong>on</strong>fidence does return, expenditure plans<br />

could be dusted down and put into acti<strong>on</strong> relatively quickly. But if business is to have c<strong>on</strong>fidence<br />

in Britain, Britain needs to have c<strong>on</strong>fidence in business.”<br />

he stressed the need to improve leadership in business and company directorship by<br />

highlighting the IoD’s Chartered Director Qualificati<strong>on</strong>, which the FMO chairman, John C<strong>on</strong>way<br />

holds.<br />

Companies represented at the FMO meeting included Rodenstock, C<strong>on</strong>tinental eyewear,<br />

Optoplast Actman and Dibble Optical. After a networking buffet lunch, FMO members divided<br />

into their industry-specific frame, lens and equipment focus groups to discuss current trading<br />

c<strong>on</strong>diti<strong>on</strong>s. Any companies wishing to know more about The FMO and attend the next regi<strong>on</strong>al<br />

meeting <strong>on</strong> October 16 are asked to email Sandie Fisher at sfisher@fmo.co.uk<br />

21<br />


22 28<br />

06/04/12 <str<strong>on</strong>g>AOP</str<strong>on</strong>g>/SECO SEMINAR<br />


Countdown to optics’<br />

L<strong>on</strong>d<strong>on</strong> 2012 seminar<br />

The <str<strong>on</strong>g>AOP</str<strong>on</strong>g>’s new c<strong>on</strong>ference facilities will be buzzing at the end of this m<strong>on</strong>th for the two-day<br />

seminar <strong>on</strong> therapeutics – L<strong>on</strong>d<strong>on</strong> 2012 Educati<strong>on</strong> Destinati<strong>on</strong>. It will also have an internati<strong>on</strong>al<br />

feel, with an Australian additi<strong>on</strong> to the multi-nati<strong>on</strong>al list of delegates flying in to join the main UK<br />

c<strong>on</strong>tingent. OT’s clinical editor Navneet Gupta looks at the packed programme<br />

Day 1<br />

Going the distance: clinical insights into<br />

glaucoma diagnosis<br />

Clarity over what many practiti<strong>on</strong>ers c<strong>on</strong>sider to be a grey<br />

area in optometry, establishing the diagnosis of glaucoma, will<br />

be offered at the seminar by Dr Murray Fingeret, chief of the<br />

optometry secti<strong>on</strong> in the Department of Veterans Administrati<strong>on</strong><br />

in the New York Harbor Health Care System and a clinical<br />

professor at the State University of New York. Dr Fingeret will<br />

discuss the different tests to use (t<strong>on</strong>ometry, the latest in optic<br />

nerve analysis/imaging, visual fields and g<strong>on</strong>ioscopy) and how<br />

each is incorporated, al<strong>on</strong>g with the patient’s history into the<br />

decisi<strong>on</strong> making process. The c<strong>on</strong>cept of using multiple tests<br />

to corroborate whether glaucoma is present is more important<br />

today, especially given the wealth of technology available.<br />

Peak performance: evidence-based prescribing<br />

in an optometric setting<br />

Professor John Lawrens<strong>on</strong>, chair in clinical visual science at<br />

City University, played a pivotal part in acquiring prescribing<br />

rights for UK optometrists and the development of educati<strong>on</strong>al<br />

curricula for this speciality. In this presentati<strong>on</strong>, he will<br />

c<strong>on</strong>sider the evidence base for treatment effectiveness and<br />

how to balance likely benefits, and possible harms, when<br />

c<strong>on</strong>sidering prescribing. He will highlight the systematic<br />

approach to use through various examples, displaying how<br />

this can be incorporated into day-to-day clinical decisi<strong>on</strong><br />

making.<br />

Because you’re worth a gold medal – why<br />

investment in therapeutic training is a must<br />

The number of experienced qualified optometrist independent<br />

prescribers (IP) joining the specialist register has now<br />

reached 150 and the UK has become the first country of the<br />

EU to reach level four of the World Council of <strong>Optometry</strong><br />

framework. Nicholas Rumney, who is in full-time private<br />

practice in Hereford with BBR <strong>Optometry</strong>, a standard setting<br />

(ISO9000 and IiP) award-winning independent practice, will

highlight the benefits of undertaking therapeutic training. He<br />

will update delegates <strong>on</strong> the development and enacting of<br />

therapeutic capability am<strong>on</strong>g optometrists in other countries<br />

too.<br />

Team GB vs Team USA – the Big Debate: care<br />

regimes both sides of the p<strong>on</strong>d<br />

Great Britain and the USA will go head-to-head in what is<br />

anticipated to be a lively debate where top clinicians will<br />

discuss the therapeutic management of a variety of diseases,<br />

and will compare and c<strong>on</strong>trast the modalities available in<br />

both countries. Dr Fingeret, professor Lawrens<strong>on</strong> and Mr<br />

Rumney will be joined by Dr Paul Ajamian, centre director<br />

of Omni Eye Services of Atlanta, USA, the first optometric<br />

co-management centre in the USA. A truly internati<strong>on</strong>al<br />

perspective <strong>on</strong> disease management which will hopefully<br />

whet the appetite for optometrists to join the growing<br />

community of therapeutic prescribers.<br />

Carrying the torch? Working in community<br />

ophthalmology<br />

If the Big Debate wasn’t treat enough, the next presentati<strong>on</strong><br />

by Jane Bell, an independent prescribing optometrist with<br />

over 30 years’ experience, a director of the <str<strong>on</strong>g>AOP</str<strong>on</strong>g> and chair of<br />

the Optical C<strong>on</strong>federati<strong>on</strong> primary care committee, is sure<br />

to put the icing <strong>on</strong> the cake by describing how to utilise IP<br />

in a community ophthalmology service. She will provide<br />

informati<strong>on</strong> about commissi<strong>on</strong>ing similar services in different<br />

parts of the country and will take attendees <strong>on</strong> a journey<br />

through a typical ‘day in the life of an IP practiti<strong>on</strong>er’. Her<br />

presentati<strong>on</strong> will include some fascinating case studies to<br />

really show what optometrists are capable of.<br />

Day 2<br />

Going for gold: my favourite cases<br />

As the event heads into the home straight, Dr Ajamian will<br />

present a number of timely and challenging cases which<br />

are likely to be encountered in optometric practice. He<br />

will dem<strong>on</strong>strate how to manage them through the latest<br />

pharmacology and technology.<br />

Sprint or marath<strong>on</strong>? 21st century glaucoma<br />

therapy<br />

To update practiti<strong>on</strong>ers <strong>on</strong> the latest developments, Dr<br />

Fingeret will describe new glaucoma treatments, juxtaposing<br />

therapy today with where therapy may be in the foreseeable<br />

future. The c<strong>on</strong>cept of risk will be described, as well as new<br />

medical and surgical interventi<strong>on</strong>s.<br />

Could OCT be a gamemaker in optometric<br />

practice? A hands-<strong>on</strong> guide<br />

Optical Coherence Tomography (OCT) has revoluti<strong>on</strong>ised<br />

the diagnosis and management of several ocular diseases,<br />

including age-related macular degenerati<strong>on</strong> and diabetic<br />

maculopathy. In this presentati<strong>on</strong>, Dr Fingeret and Mr<br />

Rumney will talk about this fascinating imaging technology<br />

and how it allows layer-by-layer assessment of the retina and<br />

optic nerve. The instrument’s excellent resoluti<strong>on</strong> allows<br />

features to be recognised which previously were not visible,<br />

and this has notable clinical applicati<strong>on</strong>s for detecting and<br />

managing both glaucoma and retinal c<strong>on</strong>diti<strong>on</strong>s.<br />

The winning difference: modern-day<br />

cataract care<br />

As the two-day event nears the finishing line, Dr Ajamian<br />

will provide optometrists with the fundamentals of how to<br />

co-manage cataract surgery patients, looking at the important<br />

aspects of pre and post-operative care of patients.<br />

If the clinical programme wasn’t enough to entice you,<br />

then the accompanying social events, including a L<strong>on</strong>d<strong>on</strong><br />

City Bus Tour, afterno<strong>on</strong> tea at The Ritz and the L<strong>on</strong>d<strong>on</strong> Eye<br />

Experience, are sure to make for an enjoyable educati<strong>on</strong>al<br />

event.<br />

The L<strong>on</strong>d<strong>on</strong> 2012 Educati<strong>on</strong> Destinati<strong>on</strong> runs from April<br />

29-30 and provides a valuable opportunity for qualified<br />

optometrists to gain specialist IP points and for those just<br />

starting to take an interest in this field, it offers guidance and<br />

knowledge in a growing field of optometry. Fourteen COPE<br />

and GOC Specialist (IP) and general optometry points have<br />

been applied for, as well as DO points where applicable.<br />

For more informati<strong>on</strong>, please visit www.eiseverywhere.<br />

com/ehome/31864/50766/<br />

Alc<strong>on</strong> Pharmaceutical is the headline sp<strong>on</strong>sor for the event and<br />

urges interested optometrists to attend. “Alc<strong>on</strong> is pleased to be<br />

the patr<strong>on</strong> sp<strong>on</strong>sor to the inaugural <str<strong>on</strong>g>AOP</str<strong>on</strong>g>/SECO Therapeutics<br />

Seminar. In recent years, we have been delighted to see the<br />

growing interest of the professi<strong>on</strong> in fulfilling many of the<br />

unmet needs in patient care through therapeutics,” said Dam<strong>on</strong><br />

Cooke, Alc<strong>on</strong> Pharmaceutical, business unit head, UK and<br />

Ireland. “As a world leader in eye care, Alc<strong>on</strong> is keen to promote<br />

and support optometrists in their professi<strong>on</strong>al development.<br />

We hope that many more optometrists will choose to attend<br />

what promises to be a pi<strong>on</strong>eering and stimulating event.”<br />

23<br />

06/04/12 <str<strong>on</strong>g>AOP</str<strong>on</strong>g>/SECO SEMINAR

24<br />


EVENTS<br />

CET by the seaside<br />

Annual <strong>Optometry</strong> Tomorrow c<strong>on</strong>ference attracts record numbers, OT reports<br />

More than 270 practiti<strong>on</strong>ers flocked to the sunny south coast<br />

for the College of optometrists’ annual optometry tomorrow<br />

c<strong>on</strong>ference last m<strong>on</strong>th.<br />

held in Bright<strong>on</strong> for the sec<strong>on</strong>d time in the event’s history,<br />

the Cet packed two-day event offered over 45 lectures,<br />

seminars and workshops, which focused <strong>on</strong> ‘hot topics’ such<br />

as aMD treatment, independent prescribing and business<br />

skills. and, with this year’s lectures assigned under the themes:<br />

‘therapeutics’, ‘research’, ‘CPD’ and ‘refresher’, delegates could<br />

easily select the sessi<strong>on</strong>s of most interest to them.<br />

optometrist rob hogan’s (pictured<br />

left) seminar <strong>on</strong> appraisals –<br />

‘appraisals – I’m an optometrist... get<br />

me out of here’ – drew a full crowd,<br />

highlighting practiti<strong>on</strong>ers’ desire to<br />

learn more about improving their<br />

business management skills, which Mr<br />

hogan commented is not taught at<br />

university.<br />

navigating his audience, delegates were identified as<br />

‘employees who receive appraisals’, ‘employees who carry out<br />

appraisals’ or ‘employers performing appraisals’, whilst all had<br />

the comm<strong>on</strong> interest of wanting to find out the ‘right way’ to<br />

appraise and be appraised.<br />

During the sessi<strong>on</strong>, which gave delegates an overview of how<br />

appraisals can lead to a more efficient business, managers were<br />

encouraged to hold appraisals and staff were urged not to be<br />

intimidated by them as “generally the people who are doing the<br />

appraisals d<strong>on</strong>’t feel c<strong>on</strong>fident either”.<br />

the newly appointed College treasurer explained: “appraisals<br />

are necessary for developing people and improving the<br />

company. they are a way of m<strong>on</strong>itoring the standards that you<br />

are trying to achieve for your business.”<br />

offering listeners a variety of ways to carry out appraisals, from<br />

assignment and task led assessments to psychometric tests, Mr<br />

hogan, advised: “Whatever template you use for your appraisals,<br />

the important thing is to give people notice of this type of thing.<br />

agree a time and get the envir<strong>on</strong>ment right. It shouldn’t be<br />

d<strong>on</strong>e in a coffee room with people walking in and out; that isn’t<br />

fair to anybody. the c<strong>on</strong>sulting room is the classic place to hold<br />

appraisals.”<br />

other tips included: create an acti<strong>on</strong> plan for future objectives<br />

and meet regularly to discuss progress; agree any necessary<br />

support and development; close positively and write up<br />

feedback.<br />

he underlined the importance of both parties preparing for<br />

the appraisal, as well as returning to the feedback regularly:<br />

“You need to prepare, and prepare well, and that’s both parties’<br />

resp<strong>on</strong>sibility.”<br />

an important point which Mr hogan warned about was<br />

the salary aspect often associated with appraisals. he said:<br />

“Pers<strong>on</strong>ally, I d<strong>on</strong>’t think salary should be the reas<strong>on</strong> you are<br />

performing an appraisal, but if previous targets have been met<br />

and your business is doing well you should reward staff.”<br />

he later added: “I think if your business wants to be seen<br />

as ethical, caring and moral, everybody should see a similar<br />

percentage increase in their salary if your business is able to<br />

afford it.”<br />

elsewhere at the c<strong>on</strong>ference, optometrist rakesh Kapoor<br />

(pictured above) discussed how regular clinical audits could<br />

help increase the quality of patient care and prevent ‘trouble’<br />

occurring.<br />

Despite clinical audits being “generally feared by most<br />

practiti<strong>on</strong>ers”, Mr Kapoor drew <strong>on</strong> his own experience to reveal:<br />

“In the l<strong>on</strong>g run you find that morale does improve when you do<br />

such audits.”<br />

explaining the benefits of establishing regular clinical audits<br />

in practice, the visiting lecturer at ast<strong>on</strong>, anglia ruskin and City<br />

universities, and GoC FtP committee member, said: “It can have<br />

a substantial improvement in the quality of services to patients<br />

and users; in an audit we can make things better, we can see<br />

where our weaknesses are and where to improve.”<br />

he added: “It prevents problems re-occurring and reduces<br />

the chance of litigati<strong>on</strong> and disciplinary acti<strong>on</strong>, which is very<br />

important.”<br />

other elements of practice which audits can help improve<br />

include: better utilisati<strong>on</strong> of resources, reducing risk, improving<br />

effectiveness of care and better access to care.<br />

• optometry tomorrow 2013 will take place <strong>on</strong> March 17-18<br />

in nottingham.

Mobile: 07799 685779 www.advancedeyecareresearch.co.uk<br />

Ast<strong>on</strong> Court, Kingsmead Business Park,<br />

High Wycombe, Buckinghamshire HP11 1LA<br />

Teleph<strong>on</strong>e: 01494 616038<br />

Fax: 01494 616001<br />

C<strong>on</strong>tact:<br />

Mr. Chris Jamies<strong>on</strong><br />

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PEG 400 is a water soluble, n<strong>on</strong>-i<strong>on</strong>ic,<br />

hydrophilic lubricating demulcent whose<br />

viscosity is not affected by the presence of<br />

electrolytes. The additi<strong>on</strong> of PEG 400 to<br />

hyalur<strong>on</strong>ic acid increases the water retenti<strong>on</strong><br />

and tear film residence time.<br />

• Rehydrati<strong>on</strong> of soft c<strong>on</strong>tact lenses

26<br />

06/04/12 BOOK REVIEW<br />

2012 c<strong>on</strong>ference<br />

M<strong>on</strong>day April 23rd 2012<br />

Hilt<strong>on</strong> East Midlands Airport Hotel<br />

Change a childs<br />

future...<br />

Up to 60% of children have the<br />

pre-disposing signs to simple Dyslexia.<br />

More children than ever are leaving primary<br />

school unable to read or write<br />

– a coincidence?<br />

PROGRAMME includes:<br />

The childrens eye care initiative - Polly Dulley<br />

The cumulative effect of prescripti<strong>on</strong> & colour <strong>on</strong><br />

eye-tracking and reading performance<br />

- Chris Coakley<br />

Underachieving, academically able children<br />

- Michael Gilsenan<br />

Irlen tints and the Schoolvisi<strong>on</strong> assessment<br />

of dyslexic patients - Olha Lac<br />

Reading speed, migraines and coloured<br />

c<strong>on</strong>tact lenses - Alexandra Cook<br />

The principles of visual psychology<br />

- Geraint Griffiths<br />

Learning difficulties and ametropia<br />

- Damaris Anders<strong>on</strong><br />

Gaining recogniti<strong>on</strong> for the Schoolvisi<strong>on</strong> Practice<br />

- Umar Jussab<br />

Schoolvisi<strong>on</strong> workshop<br />


Dinner, live entertainment & awards<br />

(Package price available, inc. accommodati<strong>on</strong>)<br />


www.schoolvisi<strong>on</strong>.org.uk<br />

Or Ph<strong>on</strong>e: 0116 2363113<br />

REVIEW<br />

Normal Binocular Visi<strong>on</strong> – Theory, Investigati<strong>on</strong> and<br />

Practical Aspects. Optometrist Zuzana Freidin reviews<br />

the latest book by David Stidwell and Robert Fletcher,<br />

published by Wiley-Blackwell<br />

IF YOU ever w<strong>on</strong>dered as a student why<br />

there were so many books and articles <strong>on</strong><br />

binocular visi<strong>on</strong>, you were not al<strong>on</strong>e. Many<br />

books c<strong>on</strong>tain a welter of informati<strong>on</strong><br />

about normal and abnormal c<strong>on</strong>diti<strong>on</strong>s,<br />

and treatments, making it difficult, if not<br />

c<strong>on</strong>fusing, for the reader to pull together<br />

the whole picture, let al<strong>on</strong>e grasp how<br />

the different parts fit together.<br />

As its name Normal Binocular Visi<strong>on</strong><br />

indicates, the aim is to help the reader<br />



NORMAL<br />


VISION<br />



understand the c<strong>on</strong>cepts and structure of normal binocular visi<strong>on</strong>. The<br />

authors have decided to leave out anomalies and their management,<br />

and to just c<strong>on</strong>centrate <strong>on</strong> presenting a complete overview of normal<br />

binocular visi<strong>on</strong>. They felt that the student who understood normal<br />

binocularity would be better able to study its abnormalities as the next<br />

step.<br />

The structure and sequence of the topics shows that the authors<br />

have extensive interest, dedicati<strong>on</strong> and experience teaching.<br />

The 12 chapters of the book are divided into three categories:<br />

1. The development and characteristics of binocular visi<strong>on</strong><br />

2. The effects of errors in binocular motor c<strong>on</strong>trol and in sensory fusi<strong>on</strong><br />

of the two images<br />

3. The assessment of binocular visi<strong>on</strong> parameters.<br />

To illustrate the points and explanati<strong>on</strong>s in the text, the<br />

authors explain the c<strong>on</strong>cepts, anatomy, acti<strong>on</strong>s, experiments and<br />

measurements graphically, using copious black and white and some<br />

colour diagrams, photographs and drawings. The short revisi<strong>on</strong> quizzes<br />

at the end of each chapter require filling in missing word/s. There are<br />

six appendices, <strong>on</strong>e of which provides explanati<strong>on</strong>s of when and why<br />

different terms are applied to a c<strong>on</strong>diti<strong>on</strong>, eg, tropia/strabismus/squint.<br />

Another appendix describes simple experiments which are quite easy<br />

and fun to do, aiding the reader further in comprehensi<strong>on</strong> of the topic.<br />

The glossary of terms acts as a handy summary of the text.<br />

Although written for students of optometry and psychology,<br />

students of ophthalmology will also find the topic easier to grasp<br />

through the study of this book.<br />

For those who have already l<strong>on</strong>g delighted in the subject, the book<br />

provides many clear insights and new takes <strong>on</strong> some of the areas<br />

discussed, as well as an opportunity to catch up <strong>on</strong> new c<strong>on</strong>cepts and<br />

understanding of its aspects.<br />

This book is definitely a must for all who want to, or need to,<br />

understand how normal binocular visi<strong>on</strong> works; and it should be a<br />

recommended standard study text.<br />

• Zuzana Freidin is an employed optometrist, working in Cambridge,<br />

who also supervises students in clinics <strong>on</strong>ce a week at Anglia Ruskin<br />

University. Ms Freidin qualified at City University and has an interest in<br />

binocular visi<strong>on</strong> having taught the subject abroad.<br />

RRP £42.99 OT Foyles <strong>on</strong>line bookshop price £38.69 (10% off).<br />

Visit www.optometry.co.uk/bookshop and click <strong>on</strong> the Foyles<br />


Now<br />

with<br />

Epsom Downs 30th April<br />

Start Finish Lecture<br />

Speaker<br />

6.55 7.00 Welcome Ian Berry<br />

7.00 7.20 OCT interpretati<strong>on</strong> - Learning how<br />

to describe what you see<br />

7.20 7.40 Keynote address: Offer patients<br />

more with OCT technology<br />

7.40 8.00 Management of wet AMD, the<br />

evolving role of Optometrists<br />

8.00 8.20 Multi-modality fundus imaging and<br />

simultaneous SD-OCT<br />

Bill Harvey,<br />

City University<br />

Romana Hashim,<br />

Optometrist<br />

Dr Femi Adekunle<br />

Novartis<br />

Ian Berry<br />

8.20 8.40 Can you afford not to have an OCT? Sim<strong>on</strong> Wardle,<br />

Performance Finance<br />

Chester Racecourse 2nd May<br />

Start Finish Lecture Speaker<br />

6.55 7.00 Welcome Ian Berry<br />

7.00 7.20 OCT interpretati<strong>on</strong> - Learning how<br />

to describe what you see<br />

Chris Mody<br />

7.20 7.40 Keynote address: Offer patients Niall O‘Kane,<br />

more with OCT technology Optometrist<br />

7.40 8.00 Management of wet AMD, the Dr Femi Adekunle<br />

evolving role of Optometrists Novartis<br />

8.00 8.20 Multi-modality fundus imaging and<br />

simultaneous SD-OCT<br />

Martin L<strong>on</strong>g<br />

8.20 8.40 Can you afford not to have an OCT? Sim<strong>on</strong> Wardle,<br />

Performance Finance<br />

Buffet available at 6.30pm Free to attend<br />

To book your FREE place visit: http://is.gd/horsesforcourses<br />

www.heidelbergengineering.co.uk 01442 345372<br />

Warwick Racecourse 1st May<br />

Start Finish Lecture Speaker<br />

6.55 7.00 Welcome Ian Berry<br />

7.00 7.20 OCT interpretati<strong>on</strong> - Learning how<br />

to describe what you see<br />

7.20 7.40 Keynote address: Offer patients<br />

more with OCT technology<br />

7.40 8.00 Management of wet AMD, the<br />

evolving role of Optometrists<br />

8.00 8.20 Multi-modality fundus imaging<br />

and simultaneous SD-OCT<br />

Chris Mody<br />

Daniel Hardiman-<br />

McCartney, Optometrist<br />

Dr Femi Adekunle<br />

Novartis<br />

Martin L<strong>on</strong>g<br />

8.20 8.40 Can you afford not to have an OCT? Sim<strong>on</strong> Wardle,<br />

Performance Finance<br />

Hamilt<strong>on</strong> Park Racecourse 3rd May<br />

Start Finish Lecture Speaker<br />

6.55 7.00 Welcome Ian Berry<br />

7.00 7.20 OCT interpretati<strong>on</strong> - Learning how<br />

to describe what you see<br />

Chris Mody<br />

7.20 7.40 Keynote address: Offer patients<br />

more with OCT technology<br />

7.40 8.00 Management of wet AMD, the<br />

evolving role of Optometrists<br />

8.00 8.20 Multi-modality fundus imaging and<br />

simultaneous SD-OCT<br />

Alice McTrusty<br />

Optometrist<br />

Dr Femi Adekunle<br />

Novartis<br />

Ian Berry<br />

8.20 8.40 Can you afford not to have an OCT? Sim<strong>on</strong> Wardle,<br />

Performance Finance<br />

These educati<strong>on</strong>al Roadshows look at all aspects of OCT and how this can dovetail into your practice, allowing you to offer your patients<br />

a more comprehensive examinati<strong>on</strong> and become more profi table.<br />

Learn from the experience of our Keynote Speakers. Find out more about the Wet AMD opportunity with Novartis. Discover a creative way<br />

of fi nancing OCT technology. Experience how easy the SPECTRALIS OCT is to use, even <strong>on</strong> the most diffi cult patients.<br />

Anticipated fi nish time 9pm.<br />

Worth<br />

1 CET Point<br />

Be certain Stay Ahead to back of the The right Field horse With

28<br />

06/04/12 DIARY DATES<br />

APRIL<br />

12 No 7 C<strong>on</strong>tact Lenses, Sidney Little Road,<br />

Hastings, Future proof c<strong>on</strong>tact lenses (www.<br />

no7c<strong>on</strong>tactlenses.com)<br />

NEW… 16 TMR, venue c<strong>on</strong>firmed <strong>on</strong><br />

applicati<strong>on</strong>, Newcastle up<strong>on</strong> Tyne, Optical<br />

assistant/recepti<strong>on</strong>ist course <strong>on</strong>e (info@tmr.<br />

co.uk)<br />

16 Warwickshire <str<strong>on</strong>g>AOP</str<strong>on</strong>g>, The Venture Centre,<br />

University of Warwick Science Park, Coventry,<br />

Casualty lecture (susan@susanrbowers.co.uk)<br />

16 University of Warwick, Coventry,<br />

Ophthalmic imaging course begins (www.<br />

warwick.ac.uk)<br />

NEW… 16 Hospital of St John and St<br />

Elizabeth, 60 Grove End Road, L<strong>on</strong>d<strong>on</strong>, NW8,<br />

Internati<strong>on</strong>al development in optometry<br />

lecture (www.hje.org.uk)<br />

NEW… 17 TMR, venue c<strong>on</strong>firmed <strong>on</strong><br />

applicati<strong>on</strong>, Newcastle up<strong>on</strong> Tyne, Optical<br />

assistant/eecepti<strong>on</strong>ist course two SEE ABOVE<br />

17 Optos, Hilt<strong>on</strong> Eust<strong>on</strong>, L<strong>on</strong>d<strong>on</strong>, WC1H, Optos<br />

Dayt<strong>on</strong>a and OCT roadshow (www.optos.com/<br />

register)<br />

17 J&J, The Visi<strong>on</strong> Care Institute,<br />

Pinewood, Berkshire, Presbyopia and its<br />

management with c<strong>on</strong>tact lenses (www.<br />

thevisi<strong>on</strong>careinstitute.co.uk)<br />


Improve your imaging skills<br />

The University of Warwick’s ophthalmic imaging postgraduate certificate<br />

module begins this m<strong>on</strong>th with students being given an understanding<br />

of the c<strong>on</strong>cepts and theories surrounding the issue.<br />

There will also be a practical secti<strong>on</strong> to the course, which includes an<br />

advanced understanding of the processing, compressi<strong>on</strong> and storage of<br />

digital imaging.<br />

For more details <strong>on</strong> this and other courses available, including June’s<br />

Diabetes and the Eye module, visit www.warwick.ac.uk<br />

18 Optos, Hilt<strong>on</strong> Stansted Airport, Essex,<br />

Optos Dayt<strong>on</strong>a and OCT roadshow SEE<br />

ABOVE<br />

NEW… 18 TMR, venue c<strong>on</strong>firmed<br />

<strong>on</strong> applicati<strong>on</strong>, Newcastle up<strong>on</strong> Tyne,<br />

Commercial dispensing SEE ABOVE<br />

18 No 7 C<strong>on</strong>tact Lenses, Sidney Little<br />

Road, Hastings, Ortho K and topography<br />

day SEE ABOVE<br />

19 Optos, Radiss<strong>on</strong> Blu, Bristol, Optos<br />

Dayt<strong>on</strong>a and OCT roadshow SEE ABOVE<br />

NEW… 19 TMR, venue c<strong>on</strong>firmed <strong>on</strong><br />

applicati<strong>on</strong>, Newcastle up<strong>on</strong> Tyne, Optical<br />

management and marketing SEE ABOVE<br />

20-22 EAOO, Dublin, Ireland, Annual<br />

c<strong>on</strong>ference (www.eaoo.info)<br />

21 WOPEC/<strong>Optometry</strong> Wales, Cardiff<br />

University, Cardiff, Welsh Nati<strong>on</strong>al<br />

Optometric C<strong>on</strong>ference (www.wopec.<br />

co.uk)<br />

23 UltraVisi<strong>on</strong>, Commerce Way, Leight<strong>on</strong><br />

Buzzard, Bedfordshire, Interactive<br />

workshops (workshop@ultravisi<strong>on</strong>.co.uk)<br />

24 SBK Healthcare, The Hatt<strong>on</strong>,<br />

Farringd<strong>on</strong>, Managing change in your<br />

ophthalmology service course (www.<br />

sbk-healthcare.com)<br />

25 Optos, Hilt<strong>on</strong> Manchester Airport,<br />

Manchester, Optos Dayt<strong>on</strong>a and OCT<br />

roadshow SEE ABOVE<br />

NEW… 25 Toolbox Training and<br />

C<strong>on</strong>sultancy, Belfast, Northern Ireland,<br />

Business in practice sessi<strong>on</strong> (www.<br />

toolbox.ch/course)<br />

25-26 J&J, The Visi<strong>on</strong> Care Institute,<br />

Pinewood, Berkshire, Returning to work<br />

c<strong>on</strong>fident and refreshed SEE ABOVE<br />

26 Optos, Hilt<strong>on</strong> Newcastle Gateshead,<br />

Newcastle up<strong>on</strong> Tyne, Optos Dayt<strong>on</strong>a and<br />

OCT roadshow SEE ABOVE<br />

27 J&J, The Visi<strong>on</strong> Care Institute,<br />

Pinewood, Berkshire, Presbyopia and its<br />

management with c<strong>on</strong>tact lenses SEE<br />

ABOVE<br />

27 No 7 C<strong>on</strong>tact Lenses, Sidney Little<br />

Road, C<strong>on</strong>tact lenses – it’s everybody’s<br />

business SEE ABOVE<br />

29-30, <str<strong>on</strong>g>AOP</str<strong>on</strong>g>, 2 Woodbridge Street,<br />

L<strong>on</strong>d<strong>on</strong>, EC1R, L<strong>on</strong>d<strong>on</strong> 2012 Educati<strong>on</strong><br />

destinati<strong>on</strong> (www.aop.org.uk)<br />

MAY<br />

10 No 7 C<strong>on</strong>tact Lenses, Sidney Little<br />

Road, Improve your c<strong>on</strong>tact lens<br />

c<strong>on</strong>fidence SEE ABOVE<br />

13 WOPEC, Anglia Ruskin University,<br />

Cambridgeshire, G<strong>on</strong>ioscopy event<br />

(mackens@cardiff.ac.uk)<br />

NEW… 14 Hospital of St John and St<br />

Elizabeth, 60 Grove End Road, L<strong>on</strong>d<strong>on</strong>,<br />

NW8, All things retinal lecture SEE ABOVE<br />

14 Macular Disease Society, Edinburgh,<br />

Top doctors roadshow (help@<br />

maculardisease.org)<br />

14 No 7 C<strong>on</strong>tact Lenses, Sidney Little<br />

Road, Hastings, Fitting presbyopic<br />

c<strong>on</strong>tact lenses SEE ABOVE<br />

15 Macular Disease Society, Belfast, Top<br />

doctors roadshow SEE ABOVE<br />

NEW… 16 NIOS, Templet<strong>on</strong> Hotel,<br />

Templepatrick, Co Antrim, C<strong>on</strong>tact lens<br />

day (lizgillespie.nios@btopenworld.com)<br />

NEW… 21 <str<strong>on</strong>g>AOP</str<strong>on</strong>g> and Myers La Roche,<br />

2 Woodbridge Street, L<strong>on</strong>d<strong>on</strong>, EC1R,<br />

How to increase sales at your practice<br />

workshop SEE ABOVE<br />

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

21 Warwickshire <str<strong>on</strong>g>AOP</str<strong>on</strong>g>, The Venture Centre,<br />

University of Warwick Science Park,<br />

Coventry, Myopia c<strong>on</strong>trol lecture SEE ABOVE<br />

21-22 J&J, The Visi<strong>on</strong> Care Institute,<br />

Pinewood, Berkshire, Healthy eyes and<br />

healthy practices and managing the<br />

astigmatic patient combined course SEE<br />

ABOVE<br />

NEW… 23 Kent and Medway LOC, Russell<br />

Hotel, Boxley Road, Maidst<strong>on</strong>e, Kent, AGM<br />

and lecture (davidflacey@aol.com)<br />

24 Macular Disease Society, Manchester,<br />

Top doctors roadshow SEE ABOVE<br />

24-27 BCLA, ICC, Birmingham, Annual<br />

Clinical C<strong>on</strong>ference and Exhibiti<strong>on</strong> (www.<br />

bcla.org.uk)<br />

29 ABDO Golf Society, Moseley Golf Club,<br />

Birmingham, Challenge Cup (m.stokes67@<br />

ntlworld.com)<br />

NEW… 29 Bexley, Bromley and Greenwich<br />

LOC, Charlt<strong>on</strong> Athletic FC, The Valley,<br />

L<strong>on</strong>d<strong>on</strong>, SE7, AGM and lecture <strong>on</strong> laser<br />

refractive surgery (davidflacey@aol.com)<br />

JUNE<br />

NEW… 11 Hospital of St John and St<br />

Elizabeth, 60 Grove End Road, L<strong>on</strong>d<strong>on</strong>, NW8,<br />

Paediatric optometry lecture SEE ABOVE<br />

12 Hampshire LOC, Chilworth Manor,<br />

Southampt<strong>on</strong>, AGM and CET event<br />

(www.hampshireloc.org.uk)<br />

NEW… 12 Visi<strong>on</strong> UK 2012, Queen Elizabeth<br />

II C<strong>on</strong>ference Centre, Broad Sanctuary,<br />

L<strong>on</strong>d<strong>on</strong> SW1P (www.visi<strong>on</strong>2020uk.org.uk)<br />

14 Macular Disease Society, Newcastle,<br />

Top doctors roadshow SEE ABOVE<br />

18-19 J&J, The Visi<strong>on</strong> Care Institute,<br />

Pinewood, Berkshire, Returning to work<br />

c<strong>on</strong>fident and refreshed SEE ABOVE<br />

19 Carl Zeiss Educati<strong>on</strong>, Manchester,<br />

OCT course (www.zeiss.co.uk)<br />

NEW… 19 Macular Disease Society,<br />

Inverness, Top doctors roadshow SEE ABOVE<br />

NEW… 20 Carl Zeiss Educati<strong>on</strong>,<br />

Manchester, Visual fields course SEE ABOVE<br />

NEW… 25 University of Warwick, Coventry,<br />

Postgraduate certificate course begins<br />


ADVISTRADE12-03-12<br />



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30<br />

06/04/12 <str<strong>on</strong>g>AOP</str<strong>on</strong>g> MEMBER BENEFITS<br />

UPDATE<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g> Member Benefits<br />

– debt collecti<strong>on</strong> tips<br />

The Office of Fair Trading (OFT) has recently published its updated Debt Collecti<strong>on</strong> Guidance.<br />

OT asked L<strong>on</strong>d<strong>on</strong> House Services to provide an overview of what the changes to the guidance<br />

could mean to <str<strong>on</strong>g>AOP</str<strong>on</strong>g> members. The company is an <str<strong>on</strong>g>AOP</str<strong>on</strong>g>-endorsed service provider<br />

“The updaTed guidance sets out the standards<br />

expected of all businesses engaging in the<br />

recovery of c<strong>on</strong>sumer credit debts, including<br />

banks, law firms and tracing agents as well<br />

as traditi<strong>on</strong>al debt collectors,” L<strong>on</strong>d<strong>on</strong><br />

house Services’ regi<strong>on</strong>al partner, John<br />

Whitewood, told OT. “It also sets out<br />

specific business practices which the OFT<br />

c<strong>on</strong>siders to be unfair or improper, such as<br />

using Facebook and Twitter and other social<br />

networking sites to c<strong>on</strong>tact debtors, as well<br />

as c<strong>on</strong>tacting debtors at unreas<strong>on</strong>able<br />

times, or at inappropriate locati<strong>on</strong>s,<br />

for example when they are a<br />

patient in hospital.”<br />

In summary, the guidance:<br />

• Warns against misuse<br />

of c<strong>on</strong>tinuous payment<br />

authority to recover debts,<br />

such as making recurring<br />

attempts to recover a single<br />

repayment<br />

• highlights the resp<strong>on</strong>sibilities<br />

of all parties involved in the<br />

debt recovery process,<br />

including creditors, for<br />

the quality and level<br />

of informati<strong>on</strong> they<br />

maintain and exchange<br />

with others, in order to avoid the wr<strong>on</strong>g pers<strong>on</strong> being pursued<br />

for a debt<br />

• provides greater clarity <strong>on</strong> the OFT’s positi<strong>on</strong> <strong>on</strong> issues such as<br />

reas<strong>on</strong>ably queried and disputed debt and statute-barred debt<br />

• Makes debt recovery businesses aware that they should<br />

adopt appropriate practices and procedures for dealing with<br />

particularly vulnerable debtors.<br />

Clear standards<br />

The OFT’s director of c<strong>on</strong>sumer credit, david Fisher said: “In the<br />

present ec<strong>on</strong>omic climate, with many people, including those<br />

who may be particularly vulnerable, in financial difficulties, this<br />

updated guidance makes clear the standards the OFT expects of<br />

all businesses involved in debt recovery.”<br />

The guidance also states that, when communicating with<br />

debtors, businesses must make sure that all communicati<strong>on</strong> is<br />

clear, accurate and d<strong>on</strong>e so in a transparent, truthful, and fair<br />

manner. You must not mislead your legal positi<strong>on</strong> with regards<br />

to debts and the recovery of those debts. Businesses should not<br />

engage in physical or psychological harassment of debtors, or<br />

third parties. unfair methods of recovery are not accepted and<br />

those visiting debtors must not act in a threatening or unclear<br />

manner and charges associated with debt collecti<strong>on</strong> must not<br />

be levied inappropriately.<br />

having clear and appropriate processes in place with a view<br />

to ensuring customer data is accurate and adequate is essential<br />

to ensure all reas<strong>on</strong>able steps are taken to <strong>on</strong>ly c<strong>on</strong>tact actual<br />

debtors and valid debts are pursued for payment.<br />

L<strong>on</strong>d<strong>on</strong> house Services provides aOp members help to

manage debt recovery issues. These services include debt<br />

collecti<strong>on</strong> and supplying credit status checks <strong>on</strong> individuals<br />

and companies, as well as financial c<strong>on</strong>sultancy.<br />

• If you are an aOp member and would like to c<strong>on</strong>tact<br />

L<strong>on</strong>d<strong>on</strong> house Services, call 01934 863 616 or email John<br />

Whitewood at taunt<strong>on</strong>@lh-services.co.uk<br />

L<strong>on</strong>d<strong>on</strong> house is fully regulated and a member of the<br />

Credit Services associati<strong>on</strong>. The company has offices<br />

throughout the uK and operates both <strong>on</strong> a pan-european<br />

and internati<strong>on</strong>al basis.<br />

These are a few basic things to remember if you are<br />

recovering debts. In the guidance, ‘Debt collecti<strong>on</strong>, OFT<br />

guidance for all businesses engaged in the recovery<br />

of c<strong>on</strong>sumer credit debts’, there are a number of<br />

overarching principles of c<strong>on</strong>sumer protecti<strong>on</strong> and<br />

fair business practice which apply to all debt recovery<br />

activities:<br />

In general terms, businesses should:<br />

• Treat debtors fairly – debtors should not be subjected<br />

to aggressive practices, inappropriate coerci<strong>on</strong>, or<br />

c<strong>on</strong>duct which is deceitful, oppressive, unfair or<br />

improper, whether unlawful or not<br />

• Be transparent in their dealings with debtors and<br />

others – informati<strong>on</strong> provided should be clear and<br />

should not be c<strong>on</strong>fusing or misleading<br />

• Exercise forbearance and c<strong>on</strong>siderati<strong>on</strong> – in particular<br />

towards debtors experiencing difficulty – we would<br />

expect businesses to work with debtors with a view to<br />

providing them with reas<strong>on</strong>able time and opportunity<br />

to repay debts and, where appropriate, to signpost them<br />

to sources of free independent debt <str<strong>on</strong>g>advice</str<strong>on</strong>g><br />

• Act proporti<strong>on</strong>ately when seeking to recover debts,<br />

taking into account debtors’ circumstances – acti<strong>on</strong>s<br />

taken in respect of arrears or default should give proper<br />

c<strong>on</strong>siderati<strong>on</strong> to available opti<strong>on</strong>s and the likely effect<br />

of such acti<strong>on</strong>s <strong>on</strong> the debtor (taking account of the<br />

informati<strong>on</strong> available to the business at that time)<br />

• Establish and implement clear, effective and<br />

appropriate policies and procedures for engaging with<br />

debtors and other relevant parties, including having<br />

appropriate mechanisms for resp<strong>on</strong>ding to reas<strong>on</strong>ably<br />

queried and disputed debt (and other) complaints<br />

• Establish and implement clear, appropriate and<br />

effective policies and procedures for identifying and<br />

dealing with particularly vulnerable debtors.<br />

<strong>Optometry</strong> <strong>Today</strong> April 280x90mm:Layout 1 29/3/12 12:46 Pag<br />

Diabetic Eye Disease<br />

(City & Guilds Certificate in Diabetic<br />

Retinopathy Unit 302)<br />

1st – 2nd May 2012<br />

This module will provide optometrists with the ability to identify<br />

clear diagnostic criteria, <strong>referral</strong> guidelines and informati<strong>on</strong><br />

regarding different modes of treatment following the in-depth<br />

analysis of presenting features. The course will include<br />

face-to-face teaching with e-learning.<br />

Speakers will include:<br />

Miss Gillian Vafidis<br />

Dr Byki Huntjens<br />

Dr Rachel North<br />

C<strong>on</strong>tact Lens Practice<br />

13th – 15th June 2012<br />

This module has been devised to enable optometrists to<br />

deal more c<strong>on</strong>fidently and effectively with the management of<br />

c<strong>on</strong>tact lens patients in the community and will include fitting<br />

c<strong>on</strong>tact lenses in patients requiring therapeutic lenses, those<br />

with pathological dry eye, high prescripti<strong>on</strong>s and following<br />

surgical procedures.<br />

Speakers will include:<br />

Ms Caroline Christie<br />

Ms Lynne Speedwell<br />

Mr Daniel Ehrlich<br />

Glaucoma<br />

16th – 18th July 2012<br />

This module will provide optometrists with the ability to<br />

gain comprehensive theoretical and practical knowledge<br />

of the glaucomas. The course is accredited by the College<br />

of Optometrists and forms the Professi<strong>on</strong>al Certificate<br />

in Glaucoma.<br />

Speakers will include:<br />

Mr Gus Gazzard<br />

Mr John Salm<strong>on</strong><br />

Mr Andrew Scott<br />

Mr Rizwan Malik<br />

Each module costs £730 (plus £80 exam fee for Glaucoma).<br />

CET points will be available. Completi<strong>on</strong> of the examinati<strong>on</strong> that<br />

follows each module will enable accumulati<strong>on</strong> of postgraduate<br />

credits which can be used towards a Postgraduate Certificate,<br />

Diploma or MSc in Clinical <strong>Optometry</strong>.<br />

To apply, please c<strong>on</strong>tact Rita Kaur <strong>on</strong> 020 7040 3934<br />

or rita.kaur.1@city.ac.uk<br />

www.city.ac.uk/pgoptometry<br />

31<br />

06/04/12 <str<strong>on</strong>g>AOP</str<strong>on</strong>g> MEMBER BENEFITS

32<br />

06/04/12 STUDENT NEWS<br />


Glasgow wins Optics cup<br />

STUDENTS FROM Glasgow Caled<strong>on</strong>ian<br />

University arose victorious to be named<br />

winners of Opfest 2012.<br />

Hosted by Ast<strong>on</strong> University <strong>on</strong> March<br />

9-10, the cross-university sporting event<br />

was attended by representatives from<br />

seven of the nine optometry schools<br />

across the UK.<br />

Glasgow’s win sees them secure the<br />

Optics Cup from Bradford University,<br />

who have w<strong>on</strong> since the competiti<strong>on</strong><br />

was re-established three years ago.<br />

The annual ‘sports day’ opened with a<br />

sports-themed fancy dress night <strong>on</strong> the<br />

Friday (March 9), before students kicked<br />

off the tournament with a game of tug of<br />

war the following morning. Other sports<br />

held throughout the day included,<br />

football, volleyball, netball and<br />

dodgeball. In the evening students met<br />

for an ‘Around the world in 80 dishes’<br />

themed dinner and Awards cerem<strong>on</strong>y.<br />

To read a full account of the event<br />

by organiser Jeff Clarke, visit www.<br />

studentaop.org.uk<br />

Having a Ball at Ulster University<br />


University of Ulster held their annual<br />

Eyeball last m<strong>on</strong>th and raised £360 for<br />

the Mozambique Eyecare Project, in<br />

associati<strong>on</strong> with OGS. Hosted <strong>on</strong> March<br />

9 at The Galgorm Manor, Ballymena, the<br />

event gave students the opportunity to<br />

raise m<strong>on</strong>ey for charity.<br />

In the lead up to the Ball, students<br />

raised funds through a bake sale, a<br />

night out in Belfast and a raffle.<br />

Third-year undergraduate Edna Kelly<br />

was drawn as the winner of the raffle,<br />

taking home a full Keeler student set<br />

d<strong>on</strong>ated by Ulster Anaesthetics.<br />

For more informati<strong>on</strong> <strong>on</strong> the<br />

Mozambique Eyecare Project, visit<br />

www.mozeyecare.org<br />

Ast<strong>on</strong> holds CL fair for students<br />

A NUMBER of major c<strong>on</strong>tact lens companies<br />

attended Ast<strong>on</strong> University’s C<strong>on</strong>tact Lens Fair, taking<br />

the opportunity to talk to optometry students about<br />

their products. During the fair, each business was<br />

invited to give a 30-minute presentati<strong>on</strong> to the 130<br />

undergraduates who attended, providing delegates<br />

with an overview of the company, the products they<br />

offer, and what they have ‘in the pipeline’.<br />

• Pictured is CooperVisi<strong>on</strong>’s Mark Chatham<br />

presenting student Anisa Graham with a pair of<br />

headph<strong>on</strong>es after she correctly answered the<br />

c<strong>on</strong>tact lens company’s student quiz competiti<strong>on</strong>.<br />

Sp<strong>on</strong>sored by<br />

Dining in the dark<br />

THE OPTOMETRY undergraduates named as<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g> reps for the 2012-13 academic year met in<br />

L<strong>on</strong>d<strong>on</strong> last m<strong>on</strong>th at the annual student forum.<br />

Hosted by the Associati<strong>on</strong> at its Clerkenwell<br />

headquarters, students had the opportunity<br />

to get to know each other, discuss various<br />

student benefits and talk about what more the<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g> could do for students. The day-l<strong>on</strong>g event<br />

closed with dinner at Dans Le Noir, a restaurant<br />

where you dine in the dark and are served by<br />

blind or partially sight waiters.<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g> director, Ed Bickerstaffe, said: “We had yet<br />

another group of very enthusiastic optometry<br />

undergraduates brought together to share ideas<br />

for university events, as well as discuss nati<strong>on</strong>al<br />

charity fundraising plans. Each year we build the<br />

<str<strong>on</strong>g>AOP</str<strong>on</strong>g>’s support for students, taking <strong>on</strong> feedback<br />

from the forum <strong>on</strong> subjects such as web<br />

c<strong>on</strong>tent and the Eye Opener c<strong>on</strong>ference.<br />

“The university reps are there for you<br />

[students] as well, so please get to know them<br />

and use them to feedback any ideas to the <str<strong>on</strong>g>AOP</str<strong>on</strong>g><br />

<strong>on</strong> improvements we can make to our services.”<br />

This year’s reps are: S<strong>on</strong>am Ruparelia (Anglia<br />

Ruskin University); Niloufar Ahmadpour (Ast<strong>on</strong><br />

University); Dan Varcoe (University of Bradford);<br />

Alis<strong>on</strong> Fletcher (Cardiff University); Sasha<br />

Junega (City University); Gemma Hill (Glasgow<br />

Caled<strong>on</strong>ian University); Neema Ghorbani<br />

(University of Manchester); Avi S<strong>on</strong>d (Plymouth<br />

University); and Louise Cagney (University of<br />

Ulster). The OT student rep is Ast<strong>on</strong> University’s<br />

Gaumaya Gurung.<br />

To read a full account of the forum authored<br />

by Mr Varcoe, visit www.studentaop.org.uk

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Better Sight for a Better Life

34<br />

06/04/12 AWARDS AND NOC<br />

UPDATE<br />

Make your nominati<strong>on</strong><br />

The <str<strong>on</strong>g>AOP</str<strong>on</strong>g> Awards are your chance to nominate those who should be recognised for their work<br />

The nominaTi<strong>on</strong>s for this year’s aoP awards are starting to<br />

come in, so act now and submit your nominati<strong>on</strong>s. D<strong>on</strong>’t leave<br />

it until it’s too late. These are unique awards within the industry<br />

because the recipients are nominated by their peers and voted<br />

for by the professi<strong>on</strong>. The nine 2011 categories received a total of<br />

nearly 6,000 votes, with 28,000 page hits <strong>on</strong> the awards secti<strong>on</strong><br />

of the oT website last year.<br />

The aoP awards headline sp<strong>on</strong>sor has been c<strong>on</strong>firmed as<br />

CooperVisi<strong>on</strong>, which is also the category sp<strong>on</strong>sor of the C<strong>on</strong>tact<br />

Lens Practiti<strong>on</strong>er award. The c<strong>on</strong>tact lens company’s UK and<br />

ireland marketing manager, Rob healey, said: “The aoP awards<br />

proved a great success last year and it was fantastic to be a part<br />

of them in their launch year. To dem<strong>on</strong>strate CooperVisi<strong>on</strong>’s<br />

support further, we are delighted to be the awards headline<br />

sp<strong>on</strong>sor and look forward to an even more successful and<br />

entertaining evening.<br />

“With the promoti<strong>on</strong> of these awards coming earlier in the<br />

year, it is sure to provide a lot of high calibre nominati<strong>on</strong>s, and<br />

with that in mind, we are pleased to sp<strong>on</strong>sor the C<strong>on</strong>tact Lens<br />

Practiti<strong>on</strong>er of the Year award.”<br />

To nominate, visit www.optometry.co.uk/awards and click<br />

<strong>on</strong> the desired category. alternatively, post your nominati<strong>on</strong>,<br />

remembering to include the nominati<strong>on</strong> category name, to: aoP<br />

awards (Category), The aoP, 2 Woodbridge street, L<strong>on</strong>d<strong>on</strong>, eC1R<br />

0DG. You will need to provide c<strong>on</strong>tact details for yourself and<br />

the nominee/s, plus an explanati<strong>on</strong> of why that pers<strong>on</strong> or group<br />

deserves to be included for the category selected.<br />

All nominati<strong>on</strong>s must be received by May 31, 2012. Any<br />

nominati<strong>on</strong>s received after this date will not be c<strong>on</strong>sidered.<br />

All shortlisted nominati<strong>on</strong>s will be voted for by OT readers,<br />

except for the Lecturer Award and Lifetime Achievement Award.<br />

Winners of these categories will be decided by a panel of judges.<br />

NOC 2012: A new beginning<br />


importance to the entire<br />

optical sector of raising the<br />

profile of local community<br />

eye care services, the NOC<br />

2012 will have a new name.<br />

Organised by<br />

the <str<strong>on</strong>g>AOP</str<strong>on</strong>g> <strong>on</strong> behalf of<br />

LOCSU and the Optical<br />

C<strong>on</strong>federati<strong>on</strong>, the<br />

event, previously known as the Nati<strong>on</strong>al Optometric<br />

C<strong>on</strong>ference, will be renamed the Nati<strong>on</strong>al Optical<br />

C<strong>on</strong>ference from this year. The change in name<br />

reflects the increasing c<strong>on</strong>tributi<strong>on</strong> made by eye care<br />

professi<strong>on</strong>als from across the sector in the development<br />

of local eye care services throughout England and Wales.<br />

It also represents a new phase for the event.<br />

As well as being the annual highlight for Local and<br />

Regi<strong>on</strong>al Optical Committee members, the NOC 2012<br />

is a great opportunity for people to learn how the NHS<br />

reforms will change the way eye health services will be<br />

delivered in the coming years. David Craig (pictured),<br />

director of operati<strong>on</strong>s at the <str<strong>on</strong>g>AOP</str<strong>on</strong>g>, said: “The c<strong>on</strong>ference<br />

is the <strong>on</strong>ly forum for our sector to get together and<br />

discuss the politics and the practicalities of practice.<br />

Dispensing opticians and, indeed lay people, can be<br />

c<strong>on</strong>tractors, so it is right that the title of the c<strong>on</strong>ference<br />

recognises the c<strong>on</strong>tributi<strong>on</strong>s that can come from all<br />

secti<strong>on</strong>s of our community.<br />

“The NOC has always been open to all who want to<br />

attend. Its name should reflect that inclusivity, so that<br />

not <strong>on</strong>ly are people able to attend, but they should feel<br />

welcomed and their c<strong>on</strong>tributi<strong>on</strong>s valued.”<br />

Whether you are simply interested in, or are already<br />

heavily involved in, redesigning local eye care<br />

services, the NOC is your chance to learn about the<br />

latest developments from highly regarded nati<strong>on</strong>ally<br />

renowned speakers. It is also a chance to network,<br />

as well as celebrate the success of LOCs and ROCs in<br />

making services work well in so many areas to the<br />

benefit of thousands of patients. The NOC 2012 will<br />

be held <strong>on</strong> October 18-19, at the Hilt<strong>on</strong> Metropole,<br />

Birmingham. Programme details and booking<br />

arrangements are being finalised, but if you want to<br />

register your interest, email your details to NOC2012@<br />

locsu.co.uk or visit www.locsu.co.uk<br />

For an extended versi<strong>on</strong> of this article, visit www.<br />



Category sp<strong>on</strong>sors:<br />

Headline<br />

sp<strong>on</strong>sor:<br />

Awards<br />

2012<br />

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

Nominati<strong>on</strong>s must be received by May 31, 2012.

36 28<br />

06/04/12 LOCSU PATHWAY<br />


Learning disabilities<br />

pathway introduced<br />

PEOPLE WITH learning<br />

disabilities are 10 times more<br />

likely to have eye problems, yet<br />

they are less likely than the rest<br />

of the populati<strong>on</strong> to have access<br />

to the right care at the right time<br />

(statistics from the RNIB report).<br />

Despite this, many adults with<br />

learning disabilities have never<br />

had a sight test.<br />

Recognising the need to<br />

improve access to eye care<br />

services for people with learning disabilities, LOCSU has<br />

developed a new Community Eye Care Pathway.<br />

The pathway is based <strong>on</strong> successful learning disability<br />

services provided by community optometrists in a number<br />

of areas in England. It has been developed in partnership<br />

with Mencap and SeeAbility to ensure that the proposal<br />

fully reflects the needs of people with learning disabilities.<br />

Katrina Venerus (pictured above), LOCSU director of<br />

operati<strong>on</strong>s and commissi<strong>on</strong>ing, said: “This pathway will<br />

help LOCs to make the case to commissi<strong>on</strong>ers and increase<br />

eye care provisi<strong>on</strong> for this vulnerable group in our society –<br />

often ‘unseen’ in terms of health provisi<strong>on</strong>.”<br />

People with learning disabilities might not attend an<br />

opticians for an eye examinati<strong>on</strong> for a number of reas<strong>on</strong>s.<br />

First, neither themselves or their carer could be aware of any<br />

visi<strong>on</strong> impairment. Sec<strong>on</strong>d, they may be reluctant to attend<br />

a practice through fear of the process, or their carer may feel<br />

they would be unable to participate or read the letters <strong>on</strong> the<br />

letter chart.<br />

Experience has shown that a sight test for a patient with<br />

moderate to severe learning disabilities will require at least<br />

45 minutes, al<strong>on</strong>gside subsequent visits, before the patient is<br />

comfortable with the testing envir<strong>on</strong>ment, or the practiti<strong>on</strong>er<br />

is satisfied that the sight test has been fully completed. In<br />

this case an enhanced service is needed to ensure adequate<br />

time can be allocated for the sight test and the preparati<strong>on</strong><br />

and reporting that is involved.<br />

Optometrist and chair of Bexley, Bromley and Greenwich<br />

LOC, Gord<strong>on</strong> Ilett – who has a special interest in examining<br />

patients with learning disabilities – said: “The opportunities<br />

for optometrists presented by the adopti<strong>on</strong> of the LOCSU<br />

pathway includes engagement with other professi<strong>on</strong>als<br />

involved in providing for this group of people, and l<strong>on</strong>ger<br />

appointment times for patients with complex needs, allowing<br />

optometrists to communicate effectively with patients and<br />

carers.”<br />

Paula Spinks-Chamberlin, director of SeeAbility’s<br />

specialist services, added: “Our research shows that there<br />

are an estimated <strong>on</strong>e milli<strong>on</strong> adults in the UK with learning<br />

disabilities. They are 10 times more likely than the rest of

“This pathway will help LOCs to make the case to commissi<strong>on</strong>ers and<br />

increase eye care provisi<strong>on</strong> for this vulnerable group in our society –<br />

often ‘unseen’ in terms of health provisi<strong>on</strong>”<br />

Katrina Venerus, LOCSU director of operati<strong>on</strong>s and commissi<strong>on</strong>ing<br />

the populati<strong>on</strong> to be blind or partially sighted, and six out<br />

of 10 will need glasses, and people with severe or profound<br />

learning disabilities are the most likely to have serious sight<br />

problems.<br />

“SeeAbility welcomes the launch of this local pathway.”<br />

Head of campaigns and policy at Mencap, David<br />

C<strong>on</strong>gd<strong>on</strong>, commented: “The LOCSU pathway has a vitally<br />

important role to play in improving the eye health of people<br />

with a learning disability and is a key tool to making sure<br />

that more people access the services that they need.<br />

“The eye health comp<strong>on</strong>ent of annual health checks<br />

for people with a learning disability also provides an<br />

opportunity to help identify problems with people’s<br />

eyesight and ensure they are referred to appropriate<br />

services.”<br />

For more informati<strong>on</strong>, visit www.locsu.co.uk<br />

How more time can benefit<br />

patients with a learning<br />

disability – an example<br />

Jimmy has Down’s syndrome and severe learning disabilities, with<br />

no verbal communicati<strong>on</strong>. He lived with his parents until they<br />

became too infirm to look after him and c<strong>on</strong>sequently, moved<br />

into a small group home. He had always been very lively and his<br />

idea of mischief was to drink every<strong>on</strong>e’s tea if they put their cup<br />

down, or to run and hide behind supermarket displays when out<br />

shopping with his carers.<br />

Jimmy started to become withdrawn and was worried or<br />

became agitated if left <strong>on</strong> his own. He no l<strong>on</strong>ger ‘stole’ tea and<br />

would shuffle rather than walking c<strong>on</strong>fidently. When he first<br />

attended for an eye examinati<strong>on</strong> he refused to open his eyes, and<br />

the whole appointment was spent chatting to him and his carer<br />

and drinking tea. A further appointment was made and, despite<br />

minimal cooperati<strong>on</strong>, it was quickly established that he had dense<br />

cataracts in both eyes. A <strong>referral</strong> was made to a sympathetic<br />

ophthalmologist, explaining the changes in Jimmy’s behaviour<br />

and his reluctance to cooperate with examinati<strong>on</strong> procedures.<br />

Following surgery, the practice received a letter from the<br />

hospital which stated: ‘Despite the inability to obtain any formal<br />

visual acuity, surgery was successful, and we assume Jimmy can<br />

see well as he is back to his old ways, drinking other people’s tea<br />

and ran off and hid during a supermarket visit. Please see and<br />

refract if possible’.<br />

Jimmy c<strong>on</strong>tinues to attend regular sight tests and his<br />

cooperati<strong>on</strong> is gradually improving. His functi<strong>on</strong>al visi<strong>on</strong> is good<br />

and he enjoys life to the full.<br />

Benefits of the pathway<br />

The pathway gives LOCs the basis for a proposal to tailor the<br />

delivery of sight tests to meet the needs of people with learning<br />

disabilities in their local area.<br />

The benefits of the pathway are that it allows:<br />

• People with more complex learning disabilities to access<br />

NHS eye care services (eg, a sight test and any necessary visual<br />

correcti<strong>on</strong>) in a community setting like every<strong>on</strong>e else<br />

• More time to familiarise patients and their carer with the<br />

procedures and equipment during the sight test and also gives<br />

time for repeat visits to complete procedures where needed<br />

• Better preparati<strong>on</strong> for patients through linked specialist<br />

informati<strong>on</strong>, provided by SeeAbility, minimising stress for patients<br />

• Easily understood feedback from optometrists to the patient,<br />

regarding sight test results, using SeeAbility’s ‘Feedback from the<br />

optometrist about my eye test’ form.<br />

37<br />


38<br />

06/04/12 VRICS<br />

VRICS<br />

Visual Recogniti<strong>on</strong><br />

and identificati<strong>on</strong><br />

of clinical signs<br />

Sp<strong>on</strong>sored by<br />

readers are encouraged to discuss the cases in this Free vrics with their colleagues, c<strong>on</strong>duct simple<br />

internet searches, and use the references provided to complete the multiple choice questi<strong>on</strong>s (mcqs).<br />

Please note that there is <strong>on</strong>ly <strong>on</strong>e correct answer for each mcq. complete the vrics test <strong>on</strong>line at<br />

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

A<br />

AdvAnced clinicAl Techniques PArT 1: OPTicAl<br />

cOherence TOmOgrAPhy<br />

cOurse cOde: c-18690 O/d<br />

1. What macular anomaly is mOsT likely to be present in the<br />

scan shown in image A?<br />

a. Central serous chorioretinopathy<br />

b. Wet age-related macular degenerati<strong>on</strong><br />

c. Macular hole<br />

d. Macular oedema<br />

2. When does a patient with the c<strong>on</strong>diti<strong>on</strong> shown in image A<br />

need to see an ophthalmologist?<br />

a. No <strong>referral</strong> is required, m<strong>on</strong>itor routinely every year<br />

b. Refer if a patient has been symptomatic for under 1 year<br />

c. Refer if a patient has been symptomatic for at least 1 year<br />

d. Refer <strong>on</strong>ly if a patient has bilateral presentati<strong>on</strong><br />

3. how is the c<strong>on</strong>diti<strong>on</strong> shown in image A treated?<br />

a. Observati<strong>on</strong> <strong>on</strong>ly, no treatment is c<strong>on</strong>ducted<br />

b. Pneumoretinopexy<br />

c. Focal laser photocoagulati<strong>on</strong><br />

d. Vitrectomy with gas infusi<strong>on</strong><br />

ramesh sivaraj, ms, dnB, Frcs ed Ophthalmology<br />

Ramesh Sivaraj is a c<strong>on</strong>sultant ophthalmologist & clinical lead for diabetic retinopathy at the Heart<br />

of England NHS Foundati<strong>on</strong> Trust. After completing specialist training in Birmingham he took an<br />

advanced Medical Retinal & Uvea Fellowship at Moorfields Eye Hospital. His special interests are<br />

age-related macular disease, diabetic retinopathy, retinal vascular disease and uveitis.<br />

4. What macular anomaly is mOsT likely to be present in the scan<br />

shown in image B?<br />

a. Diabetic macular oedema<br />

b. Vitreo-macular adhesi<strong>on</strong>/tracti<strong>on</strong><br />

c. Macular hole<br />

d. Dry age-related macular degenerati<strong>on</strong><br />

5. Which of the following clinical features will be present <strong>on</strong><br />

ophthalmoscopic fundus examinati<strong>on</strong> of a patient with the<br />

c<strong>on</strong>diti<strong>on</strong> shown in image B?<br />

a. Macular haemorrhages<br />

b. Macular microaneursyms<br />

c. Retinal striae<br />

d. N<strong>on</strong>e of the above<br />

6. When does a patient with the c<strong>on</strong>diti<strong>on</strong> shown in image B<br />

need to see an ophthalmologist?<br />

a. Refer <strong>on</strong>ly if the patient is symptomatic<br />

b. Refer even if a patient is asymptomatic<br />

c. Refer <strong>on</strong>ly if the VA is worse than 6/60<br />

d. No <strong>referral</strong> is required as it always resolves itself<br />

Astigmatism: potential is all around you. Maximise it!<br />

9th July 2012<br />

2198 VRICS Banner 420x30_ASTIGMATISM v4.indd 1 29/03/2012 14:05<br />


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imPOrTAnT inFOrmATiOn: Under the new Vantage rules, all OT CET points awarded will be uploaded to its website by us.<br />

All participants must c<strong>on</strong>firm these results <strong>on</strong> www.cetoptics.com so that they can move their points from the “Pending Points record” into<br />

their “Final CET points record”. Full instructi<strong>on</strong>s <strong>on</strong> how to do this are available <strong>on</strong> their website. The closing date for this examinati<strong>on</strong> is<br />

June 1 2012. ceT points for this exam will be uploaded to vantage <strong>on</strong> June 11 2012.<br />

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references to aid completi<strong>on</strong> of the exam:<br />

Q1, Q2 & Q3: http://www.ncbi.nlm.nih.gov/pubmed/7852702<br />

Q4, Q5, & Q6: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162296/?tool=pubmed<br />

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4<br />

Q7, Q8 & Q9: http://www.patient.co.uk/doctor/Macular-Oedema.htm<br />

Q10, Q11 & Q12: Binns A (2011) Assessment & Management of AMD: Referral Refinement Part 4,<br />

OT, May 20.<br />

LARGER SCALE IMAGES ARE AVAILABLE ON THE OT WEBSITE (Simply click <strong>on</strong> the image when completing the exam <strong>on</strong>line)<br />

c d<br />

7.What macular anomaly is mOsT likely to be present in the scan<br />

shown in image c?<br />

a. Focal diabetic macular oedema<br />

b. Diffuse diabetic macular oedema<br />

c. Wet age-related macular degenerati<strong>on</strong><br />

d. Central serous chorioretinopathy<br />

8. Which of the following factors can influence the c<strong>on</strong>diti<strong>on</strong><br />

shown in image c?<br />

a. Durati<strong>on</strong> of diabetes<br />

b. Systemic diabetes c<strong>on</strong>trol<br />

c. High cholesterol<br />

d. All of the above<br />

9. What is the mOsT appropriate treatment for the c<strong>on</strong>diti<strong>on</strong><br />

shown in image c?<br />

a. Observati<strong>on</strong> <strong>on</strong>ly, no treatment is required<br />

b. Laser photocoagulati<strong>on</strong><br />

c. Anti-VEGF intra-vitreal injecti<strong>on</strong>s<br />

d. Vitrectomy<br />

10. What macular anomaly is mOsT likely to be present in the<br />

scan shown in image d?<br />

a. Diabetic macular oedema<br />

b. Wet age-related macular degenerati<strong>on</strong><br />

c. Evolving macular hole<br />

d. Cystoid macular oedema<br />

11. What clinical signs and symptoms are likely to be associated<br />

with the c<strong>on</strong>diti<strong>on</strong> shown in image d?<br />

a. Macular exudates<br />

b. Recent <strong>on</strong>set distorti<strong>on</strong> of central visi<strong>on</strong><br />

c. Macular haemorrhage<br />

d. All of the above<br />

12. What is the mOsT appropriate course of acti<strong>on</strong> to take for the<br />

c<strong>on</strong>diti<strong>on</strong> shown in image d?<br />

a. Refer to an ophthalmologist urgently if VA is better than 6/96<br />

b. Refer to an ophthalmologist urgently regardless of VA<br />

c. Refer to an ophthalmologist routinely<br />

d. Referral is not required, m<strong>on</strong>itor in practice yearly<br />

2198 VRICS Banner 420x30_ASTIGMATISM v4.indd 2 29/03/2012 14:05<br />

39<br />

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Femtosec<strong>on</strong>d laser<br />

cataract surgery<br />

C-18628 O/D<br />

Publicati<strong>on</strong> date March 23 2012 Closing date May 22 2012<br />

Over 300,000 cataract operati<strong>on</strong>s are performed in the UK each year. Lasers play a major part in<br />

eye care, but until now cataract surgery has always been performed using traditi<strong>on</strong>al surgical<br />

instruments, relying <strong>on</strong> the skill of the surge<strong>on</strong>. Laser Cataract Surgery offers <strong>safe</strong>r, quicker and<br />

improved outcomes by eliminating the potential for human error in performing delicate parts<br />

of the procedure that may lead to complicati<strong>on</strong>s and loss of optimum visual functi<strong>on</strong>. This video<br />

details how the femtosec<strong>on</strong>d laser can be used for accurate capsulorhexis, lens fragmentati<strong>on</strong><br />

and corneal incisi<strong>on</strong> and compares this to c<strong>on</strong>venti<strong>on</strong>al methods.<br />

Sp<strong>on</strong>sored by<br />

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Healthy lifestyle equals<br />

healthier eyes<br />

OPHTHalmIC PublIC HEalTH PaRT 4 C-18633 O/D<br />

Dr Ruth Hogg, bSc, PhD, mCOptom<br />

Age-related sight loss is a major public health c<strong>on</strong>cern given the increasingly<br />

aged populati<strong>on</strong> and due to changes in demographics in most Western<br />

societies. People in the UK are living nearly 30 years l<strong>on</strong>ger now compared<br />

with 100 years ago and increases in life expectancy are c<strong>on</strong>tinuing at a rate<br />

of approximately four m<strong>on</strong>ths per year. Major advances in the treatment<br />

of c<strong>on</strong>diti<strong>on</strong>s such as heart disease and cancer are enabling people to live<br />

l<strong>on</strong>g enough to develop classical degenerative c<strong>on</strong>diti<strong>on</strong>s associated with<br />

ageing, such as Alzheimer’s disease, cataract and age-related macular<br />

degenerati<strong>on</strong> (AMD). This article discusses the important relati<strong>on</strong>ship<br />

between lifestyle and ocular disease and it is hoped that eye care practiti<strong>on</strong>ers<br />

are encouraged to promote healthy living am<strong>on</strong>gst their patients.<br />

major threats to visi<strong>on</strong> with<br />

ageing<br />

The main causes of visual impairment<br />

in those aged 75 years and over in the<br />

UK were identified by a large study<br />

of over 14,500 people from general<br />

practices. 1 Surprisingly, the principal<br />

cause of visual loss was uncorrected<br />

refractive error. Other causes of visual<br />

impairment (binocular VA of less<br />

than 6/18) and sight loss identified<br />

were AMD (52.9%), cataract (35.9%),<br />

glaucoma (11.6%), myopic degenerati<strong>on</strong><br />

(4.2%) and diabetic eye disease (3.4%).<br />

All of these, with the excepti<strong>on</strong> of<br />

myopic degenerati<strong>on</strong>, share a degree of<br />

similarity in their underlying aetiology<br />

in that oxidative stress is known to<br />

play a significant role. Oxidative stress<br />

results from an imbalance between the<br />

producti<strong>on</strong> of reactive oxygen species<br />

(ROS) and the human body’s ability to<br />

detoxify them or repair the resulting<br />

damage. Smoking, obesity, and a<br />

poor diet are known to increase the<br />

amount of oxidative stress in the body.<br />

Inflammati<strong>on</strong> is also an important<br />

factor in AMD and diabetic eye disease,<br />

with smoking, obesity, lack of physical<br />

activity and poor diet also known to lead<br />

to an increase in inflammatory mediators<br />

that can lead to disease development.<br />

All of these diseases have a n<strong>on</strong>modifiable<br />

genetic comp<strong>on</strong>ent so<br />

some people will be more predisposed<br />

to experiencing them than others.<br />

However, the priority is to reduce the<br />

modifiable risk factors as much as<br />

possible, as a means of either preventing,<br />

or delaying, the <strong>on</strong>set of disease.<br />

lifestyle and eye disease<br />

amD<br />

Oxidative stress is c<strong>on</strong>sidered a major<br />

pathogenic mechanism in the human<br />

body and is thought to play a pivotal role<br />

in the development of AMD. The retina<br />

is particularly susceptible to oxidative<br />

stress due to its high oxygen utilisati<strong>on</strong>,<br />

the presence of photosensitisers such as<br />

rhodopsin and exposure to intense light<br />

c<strong>on</strong>diti<strong>on</strong>s. Comp<strong>on</strong>ents of the retina,<br />

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Figure 1<br />

Early posterior subcapsular cataract (courtesy of<br />

Prof David Elliot & K<strong>on</strong>rad Pesudovs)<br />

such as photoreceptor outer segments,<br />

by virtue of their high polyunsaturated<br />

fatty acid c<strong>on</strong>tent, are particularly<br />

vulnerable to oxidative damage resulting<br />

in the formati<strong>on</strong> of lipid peroxides.<br />

Diet<br />

Various aspects of diet have been<br />

associated with a risk of AMD. Several<br />

epidemiologic studies and clinical<br />

trials have dem<strong>on</strong>strated that diets high<br />

in antioxidant nutrients (vitamins C<br />

and E, carotenoids such as lutein and<br />

zeaxanthin, and fruit and vegetables<br />

rich in these nutrients) or zinc, are<br />

associated with a decreased occurrence<br />

of AMD, 2 while a high dietary intake<br />

of fat is associated with a higher<br />

prevalence or incidence of early,<br />

or late stage, AMD. 3 Higher intakes<br />

of fish or omega-3 fatty acids were<br />

associated with lower rates of AMD. 3<br />

Other dietary characteristics such as<br />

eating foods with a low-glycaemic<br />

index, or overall diet quality, as<br />

characterised by a ‘healthy eating<br />

score’, 4 have also been reported to be<br />

important in reducing risk. Data from<br />

a l<strong>on</strong>gitudinal study of approximately<br />

10,000 women in the USA showed that<br />

those with the highest “healthy eating<br />

scores” compared to those with the<br />

lowest, had 46% lower odds for early<br />

41<br />

06/04/12 CET

42<br />

06/04/12 CET<br />



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AMD, emphasising the importance<br />

of ensuring the entire diet is<br />

appropriate as opposed to just<br />

specific nutrients. Also of note is<br />

a recent report from the Rotterdam<br />

study, 5 which stratified risk <strong>on</strong> the<br />

basis of both genotype and diet<br />

and found that risk of AMD for<br />

those with the high-risk genotypes<br />

could be reduced significantly<br />

by intake of zinc, antioxidants<br />

and omega-3 fatty acids. This<br />

suggests it is important to advise<br />

patients with a family history<br />

of AMD <strong>on</strong> good dietary intake.<br />

Exercise<br />

Very few studies have reported<br />

specifically <strong>on</strong> the relati<strong>on</strong>ship<br />

between AMD and physical<br />

activity. The Beaver Dam Eye<br />

Study found, within their 15-year<br />

follow-up study, that exercise three or<br />

more times per week or walking several<br />

blocks each day reduced the incidence<br />

of neovascular AMD, 6 while the Nati<strong>on</strong>al<br />

Runners Health Study found that those<br />

who undertook higher doses of vigorous<br />

exercise had a significantly lower risk<br />

of AMD. 7 Recently, a study in the USA<br />

reported that women in the highest<br />

quintile, compared with those in the<br />

lowest quintile for physical activity, had<br />

54% lower odds for early AMD. 8 Although<br />

more data is required to c<strong>on</strong>firm these<br />

associati<strong>on</strong>s, it is known that increasing<br />

physical activity is an effective method<br />

of improving cardiovascular health.<br />

body mass index<br />

Many studies have investigated the<br />

relati<strong>on</strong>ship between body mass index<br />

(BMI) and AMD. A recent meta-analysis<br />

of prospective studies evaluating clinical<br />

risk factors found an adverse risk for<br />

late AMD when being overweight/<br />

obese. 9 Data from a populati<strong>on</strong>-based<br />

cohort study in Australia showed that<br />

OT CET c<strong>on</strong>tent supports <strong>Optometry</strong> Giving Sight<br />

Figure 2<br />

Cortical cataract (courtesy of prof David Elliot and Dr K<strong>on</strong>rad Pesudovs)<br />

middle-aged people who lost 3% or<br />

more of their waist:hip ratio over time<br />

had 29% lower odds of any form of<br />

AMD, while the beneficial impact of<br />

reducing waist:hip ratio for those who<br />

were obese was even more dramatic<br />

(59% lower odds of developing AMD). 10<br />

Smoking<br />

Cigarette smoking has been shown to<br />

markedly influence the risk of progressi<strong>on</strong><br />

to neovascular AMD, with a four-fold<br />

increase in prevalence reported. 11 The<br />

incidence of AMD is also higher in pastsmokers<br />

and a dose-resp<strong>on</strong>se relati<strong>on</strong>ship<br />

has been observed with current smokers,<br />

who are at substantially higher risk<br />

than past-smokers. However, statistical<br />

modelling has shown that cessati<strong>on</strong> of<br />

smoking results in an average reducti<strong>on</strong> in<br />

risk of AMD by 6.7% after <strong>on</strong>e year, and<br />

a further 5% reducti<strong>on</strong> after five years of<br />

cessati<strong>on</strong>, 12 c<strong>on</strong>firming that even stopping<br />

smoking later in life can have a significant<br />

impact in reducing the risk of AMD.<br />

Cataract<br />

Oxidative stress is clearly involved in the<br />

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aetiology of age-related cataract<br />

development and therefore,<br />

many of the associati<strong>on</strong>s mirror<br />

those found with AMD, albeit<br />

usually being less str<strong>on</strong>g.<br />

Diet<br />

Some of the studies that have<br />

evaluated the relati<strong>on</strong>ship<br />

between AMD and nutriti<strong>on</strong><br />

have also looked into<br />

associati<strong>on</strong>s with cataract.<br />

A review article13 c<strong>on</strong>cluded<br />

that data from observati<strong>on</strong>al<br />

studies appears to suggest a<br />

beneficial effect of vitamin C<br />

and E intake in reducing the<br />

risk of cataract, while results<br />

from randomised c<strong>on</strong>trolled<br />

trials were inc<strong>on</strong>sistent.<br />

Exercise<br />

Physical activity is not c<strong>on</strong>sidered a<br />

recognised risk factor for cataract. 14<br />

body mass index<br />

Several studies have reported an<br />

associati<strong>on</strong> of increased risk of posterior<br />

subcapsular (Figure 1) and cortical (Figure<br />

2) cataracts with higher BMI. 14 However,<br />

the relati<strong>on</strong>ship with nuclear cataract is<br />

less clear (for a full review see Asbell et al. 14 )<br />

Smoking<br />

Smoking is c<strong>on</strong>sidered a significant<br />

risk factor for the development of<br />

nuclear cataract, with the research<br />

literature dem<strong>on</strong>strating a clear dose<br />

resp<strong>on</strong>se. 14 Smoking is also associated<br />

with posterior subscapsular cataract<br />

and cortical cataract, although the<br />

relati<strong>on</strong>ships are not as str<strong>on</strong>g. 14<br />

Diabetic retinopathy<br />

Diet<br />

The maintenance of good blood sugar<br />

c<strong>on</strong>trol for people with type 1 and type<br />

2 diabetes is a major priority, as stability<br />

and c<strong>on</strong>trol is related to decreased risk<br />

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of developing diabetic<br />

complicati<strong>on</strong>s including<br />

retinopathy or maculopathy.<br />

General guidelines for diet<br />

should be provided by a<br />

patient’s GP or diabetic<br />

specialist, and usually<br />

include reducti<strong>on</strong> in the<br />

intake of carbohydrates,<br />

preferential intake of<br />

complex carbohydrates<br />

and low glycaemic index<br />

foods, restricted intake of<br />

sugar, high intake of fibre,<br />

lower intake of saturated<br />

fats and lower intake of salt.<br />

Elderly people with type 2<br />

diabetes in particular often<br />

struggle with the change in<br />

dietary pattern required after diagnosis.<br />

So it is worthwhile reinforcing these<br />

messages during the eye examinati<strong>on</strong><br />

and, in particular, if retinopathy or<br />

maculopathy is apparent (Figure 3).<br />

Reports in the research literature15 also<br />

suggest that dietary supplementati<strong>on</strong><br />

with certain micro-nutrients such as<br />

chromium, isoflav<strong>on</strong>es with soy proteins,<br />

and vitamin E, may be beneficial,<br />

although most studies investigating<br />

this are quite small and therefore lack<br />

statistical power to make firm inferences.<br />

Exercise<br />

Increasing physical activity is a<br />

well-accepted method for primary<br />

preventi<strong>on</strong> of developing type 2<br />

diabetes and indeed the increasingly<br />

sedentary lifestyle adopted in both<br />

Western and Asian countries alike are<br />

causing c<strong>on</strong>cern of increasing diabetes<br />

prevalence of epidemic proporti<strong>on</strong>s.<br />

Across the world governments and<br />

public health practiti<strong>on</strong>ers are attempting<br />

various strategies for increasing activity<br />

in different age groups. It is increasingly<br />

appreciated that greater levels of<br />

physical activity may also be important<br />

for preventing diabetic complicati<strong>on</strong>s<br />

Figure 3<br />

Diabetic retinopathy (courtesy of prof Rachel North)<br />

by improving glycated haemoglobin, an<br />

important biomarker of diabetes severity,<br />

even in the absence of weight loss. 16<br />

body mass index<br />

Obesity is str<strong>on</strong>gly related to the<br />

development of type 2 diabetes and<br />

usually a priority within the medical<br />

management of this c<strong>on</strong>diti<strong>on</strong> is<br />

weight reducti<strong>on</strong>. However, within<br />

public health literature it is widely<br />

recognised that l<strong>on</strong>g-term weight loss<br />

is very difficult to achieve. A metaanalysis<br />

has reported that diet plus<br />

exercise rather than diet al<strong>on</strong>e is better<br />

for achieving goals, although weight<br />

regain is comm<strong>on</strong> with both strategies. 17<br />

Smoking<br />

Smoking is an accepted independent<br />

and modifiable risk factor for the<br />

development of type 2 diabetes and<br />

hence diabetic eye disease. A recent<br />

large cohort study dem<strong>on</strong>strated that, 12<br />

years after smoking cessati<strong>on</strong>, a pers<strong>on</strong>’s<br />

risk level can return to normal even if<br />

this is typically accompanied by weight<br />

gain, which inherently increases the<br />

risk of type 2 diabetes. The data showed<br />

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an increased risk of diabetes<br />

for approximately three years<br />

after smoking cessati<strong>on</strong>,<br />

before a fall in risk occurred. 18<br />

Therefore, the l<strong>on</strong>g-term<br />

benefits of smoking cessati<strong>on</strong><br />

far outweigh the weight<br />

gain risk in the shorter term.<br />

Glaucoma<br />

Diet<br />

Oxidative stress and the<br />

formati<strong>on</strong> of reactive oxygen<br />

species are known to play<br />

a significant role in the<br />

development of primary open<br />

angle glaucoma (POAG). 19<br />

However, some studies20,21 have reported decreased risk<br />

of POAG associated with<br />

higher vitamin E intake and increased<br />

servings of kale and carrots. One study<br />

reported increased risk of POAG with<br />

a higher intake of vitamin C. 21 These<br />

inc<strong>on</strong>sistent results suggest preliminary<br />

evidence that glaucoma may be related<br />

to dietary intake but more research is<br />

needed to clarify the relati<strong>on</strong>ships. 22<br />

Exercise<br />

Very few studies have focused <strong>on</strong> the<br />

relati<strong>on</strong>ship between glaucoma and<br />

physical activity. Overall, exercise<br />

appears to have a beneficial effect in<br />

reducing the risk of POAG, although in<br />

most studies the sample sizes were too<br />

small to be able to make firm inferences.<br />

In additi<strong>on</strong>, n<strong>on</strong>e of the studies provided<br />

sufficient informati<strong>on</strong> to enable <str<strong>on</strong>g>advice</str<strong>on</strong>g><br />

to be compiled regarding the optimal<br />

level of exercise, the durati<strong>on</strong>, or type of,<br />

exercise, and whether a pers<strong>on</strong>’s initial<br />

fitness level or degree of exhausti<strong>on</strong><br />

impacted the final outcome. 22 Two<br />

of the studies that reported a drop in<br />

intraocular pressure (IOP) following a<br />

period of aerobic training showed that<br />

the effect may dissipate when exercise<br />

is stopped; in <strong>on</strong>e study, IOP levels<br />

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returned to their original level three weeks<br />

after the training program was stopped. 22<br />

body mass index<br />

Glaucoma is related to BMI and obesity<br />

due to its relati<strong>on</strong>ships with hypertensi<strong>on</strong>,<br />

diabetes and insulin resistance, which are<br />

all known to be linked to higher BMI. It is<br />

thought that obesity may increase blood<br />

viscosity and episcleral venous pressure<br />

and also damage aqueous flow from the<br />

eye, thereby increasing the likelihood of<br />

glaucoma development. 22 Despite reports<br />

from various epidemiological studies<br />

linking glaucoma to obesity, a literature<br />

review c<strong>on</strong>cluded that, although<br />

evidence exists for a link between higher<br />

BMI and high IOP, the link between<br />

glaucomatous optic neuropathy is less<br />

clear due to numerous c<strong>on</strong>founding<br />

factors complicating the associati<strong>on</strong>s. 23<br />

Smoking<br />

It is well known that smoking increases<br />

the risk of vascular disease and, given<br />

the likely vascular aetiology of POAG<br />

(disrupted optic nerve head blood flow),<br />

smoking is also thought to be related to<br />

POAG. However, a recent meta-analysis<br />

OT CET c<strong>on</strong>tent supports <strong>Optometry</strong> Giving Sight<br />

of all of the existing studies showed<br />

no associati<strong>on</strong> between glaucoma<br />

and either current, or past, smoking. 24<br />

C<strong>on</strong>clusi<strong>on</strong><br />

This article has shown that adopti<strong>on</strong> of<br />

general principles of a healthy lifestyle<br />

(stopping smoking, maintaining a normal<br />

BMI, taking regular exercise, and eating<br />

fruit and vegetables) have the potential<br />

to prevent or delay the <strong>on</strong>set of the major<br />

threats to sight in the elderly. During the<br />

eye examinati<strong>on</strong>, eye care practiti<strong>on</strong>ers<br />

as public health professi<strong>on</strong>als should<br />

take every opportunity to reinforce<br />

the link between healthy lifestyle and<br />

maintaining healthy eyes. In particular,<br />

patients at high risk, for example those<br />

module questi<strong>on</strong>s Course code: C-18633 O/D<br />

1. all of the following are related to oxidative stress EXCEPT:<br />

a) Age-related macular degenerati<strong>on</strong><br />

b) Myopic degenerati<strong>on</strong><br />

c) Cataract<br />

d) Glaucoma<br />

2. all of the following are reas<strong>on</strong>s why the retina is sensitive to<br />

oxidative stress EXCEPT:<br />

a) The presence of photosensitisers such as rhodopsin<br />

b) High oxygen utilizati<strong>on</strong><br />

c) Exposure to intense light c<strong>on</strong>diti<strong>on</strong>s<br />

d) High polyunsaturated fatty acid c<strong>on</strong>tent of the retinal pigment<br />

epithelium cells<br />

3. People with a family history of amD should be advised to eat:<br />

a) High glycaemic index foods<br />

b) Foods high in omega-3 fatty acids<br />

c) Foods low in Lutein and zeaxanthin<br />

d) A high fat diet<br />

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with a family history of AMD, diabetes or<br />

glaucoma, should be str<strong>on</strong>gly encouraged<br />

to c<strong>on</strong>sider their lifestyle if wanting to<br />

reduce the risk of, or delay, developing<br />

similar problems. As the visual loss<br />

associated with AMD, cataract, diabetic<br />

eye disease and glaucoma is known<br />

to have substantial pers<strong>on</strong>al, social<br />

and ec<strong>on</strong>omic costs, delaying <strong>on</strong>set by<br />

even a few years is a worthy objective.<br />

about the author<br />

Dr Ruth Hogg is a lecturer at the Centre<br />

for Visi<strong>on</strong> and Vascular Science at<br />

Queen’s University Belfast. She qualified<br />

as an optometrist in 2000 from the<br />

University of Ulster and was awarded<br />

a PhD from Queen’s University Belfast<br />

in 2005. Her research is focused <strong>on</strong><br />

the early detecti<strong>on</strong> and preventi<strong>on</strong> of<br />

advanced AMD, and through this she is<br />

also involved in working with the RNIB<br />

to promote ophthalmic public health.<br />

References<br />

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

clinical. Click <strong>on</strong> the article title and then<br />

<strong>on</strong> ‘references’ to download.<br />

PlEaSE NOTE There is <strong>on</strong>ly <strong>on</strong>e correct answer. all CET is now FREE. Enter <strong>on</strong>line. Please complete <strong>on</strong>line by midnight <strong>on</strong> may 4, 2012 – You will be unable to submit<br />

exams after this date. answers to the module will be published <strong>on</strong> www.optometry.co.uk/cet/exam-archive. CET points for these exams will be uploaded to Vantage<br />

<strong>on</strong> may 14, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates<br />

4. based <strong>on</strong> current scientific evidence, what <str<strong>on</strong>g>advice</str<strong>on</strong>g> should NOT be<br />

offered to a patient with a family history of glaucoma and IOP of<br />

22mmHg, in order to prevent or delay developing the same c<strong>on</strong>diti<strong>on</strong>?<br />

a) Stop smoking<br />

b) Increased and prol<strong>on</strong>ged physical activity<br />

c) Maintain a healthy BMI<br />

d) Eat foods rich in vitamin C<br />

5. Which of the following should a patient with type 2 diabetes NOT do?<br />

a) Restrict their intake of sugar<br />

b) Decrease their intake of low glycaemic index foods<br />

c) Lower their intake of salt<br />

d) Increase their intake of fibre<br />

6. Increasing physical activity can be encouraged to prevent or delay:<br />

a) Diabetes and AMD<br />

b) AMD and cataract<br />

c) Myopic degenerati<strong>on</strong> and diabetes<br />

d) Cataract and myopic degenerati<strong>on</strong><br />

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& TRAINING<br />


Approved for: Optometrists 4<br />

Dispensing Opticians 4<br />

OT CET c<strong>on</strong>tent supports <strong>Optometry</strong> Giving Sight<br />

Retinoscopy in infancy:<br />

cycloplegic versus n<strong>on</strong>-cycloplegic<br />

C-18551 O/D<br />

Fabrizio B<strong>on</strong>ci, Dip. Optom (ITA), MCOptom<br />

Luigi Lupelli, Dip. Optom (ITA), FAILAC, FIACLE, FBCLA<br />

The assessment of refractive status in very young children is often<br />

not c<strong>on</strong>ducted in the same manner as for adult patients. In particular,<br />

the child’s age, their co-operati<strong>on</strong> and dynamic refractive status will be<br />

key factors which influence the accuracy of refracti<strong>on</strong>. For this reas<strong>on</strong>,<br />

it is often necessary to choose procedures which inhibit or minimise<br />

accommodative activity. This can be achieved by fogging with positive<br />

lenses or rousing the t<strong>on</strong>ic (resting) accommodati<strong>on</strong> (dry refracti<strong>on</strong>),<br />

or with pharmacological agents (wet refracti<strong>on</strong>). This review article<br />

compares the two approaches, focusing <strong>on</strong> the retinoscopy techniques.<br />

Dry retinoscopy<br />

Static retinoscopy<br />

The patient views a distance target (foursix<br />

metres) so that accommodati<strong>on</strong> is<br />

presumed to be static and in a relaxed<br />

c<strong>on</strong>diti<strong>on</strong>. The fixating eye (c<strong>on</strong>tralateral<br />

to the <strong>on</strong>e being examined) should be<br />

adequately “fogged” with a positive lens<br />

(resulting in an “against” movement seen<br />

<strong>on</strong> the retinoscopy swipe). 1 For children,<br />

maintaining fixati<strong>on</strong> at this distance<br />

can be difficult and new computerised<br />

test charts generally provide dynamic<br />

and more interesting targets to view<br />

than a standard spotlight (Figure 1)<br />

to help with this. It is also possible<br />

to download a number of videoclips,<br />

especially carto<strong>on</strong>s, with different<br />

animati<strong>on</strong>s. Practiti<strong>on</strong>ers should also<br />

c<strong>on</strong>sider not using a phoropter or trial<br />

frame when c<strong>on</strong>ducting retinoscopy<br />

<strong>on</strong> a very young child, as this can be<br />

intimidating for the child. It is preferable<br />

to use single trial lenses or a lens rack.<br />

Speed during retinoscopy is essential<br />

when performing this technique in<br />

young children, especially as they<br />

maintain fixati<strong>on</strong> <strong>on</strong>ly for very short<br />

periods of time. In cases of fluctuati<strong>on</strong> of<br />

accommodati<strong>on</strong>, the practiti<strong>on</strong>er should<br />

Figure 1<br />

Examples of exciting targets presented by computerised test charts during retinoscopy. Different face<br />

expressi<strong>on</strong>s allow to the practiti<strong>on</strong>er to talk to the child to maintain attenti<strong>on</strong> <strong>on</strong> the target (Courtesy of<br />

Thoms<strong>on</strong> Software Soluti<strong>on</strong>s, UK)<br />

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follow the “with” movement, ignoring the<br />

occasi<strong>on</strong>al “against” movements seen.<br />

Yeotikar et al. 2 evaluated the difference<br />

in refractive error in n<strong>on</strong>-strabismic<br />

children between the ages of seven years<br />

and 16 years, using static retinoscopy<br />

under two c<strong>on</strong>diti<strong>on</strong>s – first by fogging<br />

the c<strong>on</strong>tralateral eye with a positive<br />

lens and sec<strong>on</strong>d with cycloplegia using<br />

cyclopentolate 1%. The study found<br />

that the average difference in refractive<br />

error between these two c<strong>on</strong>diti<strong>on</strong>s<br />

was <strong>on</strong>ly 0.29DS more hypermetropic<br />

with cyclopentolate, highlighting the<br />

accurate results that can be obtained<br />

when there is adequate accommodative<br />

c<strong>on</strong>trol during static retinoscopy.<br />

Furthermore, Chan and Edward3 suggested a calculati<strong>on</strong> which can be<br />

used to match the dry retinoscopy result<br />

to that which would be obtained using<br />

cyclopentolate 1%, in children between<br />

three and a half to five years of age. The<br />

astigmatic comp<strong>on</strong>ent is kept the same<br />

whilst the spherical comp<strong>on</strong>ent found<br />

in both meridians is multiplied by 1.45<br />

and a value of 0.39D is added. However,<br />

this depends <strong>on</strong> an accurate static<br />

retinoscopy result having been obtained.<br />

Mohindra retinoscopy<br />

The Mohindra technique, also known<br />

as near retinoscopy or near m<strong>on</strong>ocular<br />

retinoscopy, carries the main advantage<br />

of being child-friendly and requiring less<br />

co-operati<strong>on</strong> from the child. 4 In this case,<br />

the stimulus is the dimmed light source<br />

of the retinoscope in a darkened room.<br />

The darkness of the room will facilitate<br />

the child to keep their attenti<strong>on</strong> <strong>on</strong> the<br />

retinoscope’s light. The retinoscope<br />

is held at a distance of 50cm (errors in<br />

distance are not clinically relevant),<br />

with hand-held trial lenses used to find<br />

the neutral point. The accommodati<strong>on</strong><br />

activity during the examinati<strong>on</strong> is small<br />

and the same in both eyes. It is important<br />

during the examinati<strong>on</strong> to keep the light<br />

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& TRAINING<br />


Approved for: Optometrists 4 Dispensing Opticians 4<br />

of the retinoscope <strong>on</strong> the child’s pupil<br />

(to see the retinal reflex) for <strong>on</strong>ly a short<br />

period of time so as not to stimulate<br />

accommodati<strong>on</strong>; subsequently the<br />

optometrist’s attenti<strong>on</strong> should be focused<br />

<strong>on</strong> the pupil, watching for maximum<br />

dilati<strong>on</strong> (indicating no accommodati<strong>on</strong>). 5<br />

The procedure should be carried out<br />

with <strong>on</strong>e eye occluded, preferably by the<br />

parent, while the other eye is evaluated.<br />

However, Wess<strong>on</strong> et al. 6 c<strong>on</strong>firmed that<br />

there is no substantial difference in the<br />

result if binocular fixati<strong>on</strong> is allowed<br />

(Figure 2); indeed this can be useful if the<br />

infant is resistant and becomes agitated<br />

with occlusi<strong>on</strong>. Several people advocate<br />

neutralisati<strong>on</strong> of the two principal<br />

meridians of the eye separately, using<br />

loose spherical trial lenses. However,<br />

Saunders and Westall7 c<strong>on</strong>firmed that<br />

the accuracy of the technique can<br />

be improved using a combinati<strong>on</strong> of<br />

spherical and cylindrical lenses instead.<br />

Once the retinoscopy result is obtained,<br />

the refractive error was originally<br />

calculated by adding -1.25DS to the<br />

gross finding. 8,9 Saunders and Westall7 have reported that the accuracy can be<br />

improved if -0.75DS is added instead,<br />

for children aged between zero to two<br />

years, and -1.00DS added for those<br />

children over two years of age. They<br />

also affirmed that the result achieved<br />

by the Mohindra procedure in children<br />

between six m<strong>on</strong>ths and four years of<br />

age is similar to wet retinoscopy (using<br />

cyclopentolate 1% – see later), with<br />

a difference of <strong>on</strong>ly 0.50DS. Others<br />

have reported similar results, 10 and<br />

certainly no differences greater than<br />

1.00DS, 11 whilst similar results were<br />

also obtained for children with Down’s<br />

syndrome12 and even in adults. 13<br />

The Mohindra technique is useful for<br />

practiti<strong>on</strong>ers in Europe who are not<br />

permitted to used cycloplegic agents, 14<br />

whilst there are benefits for c<strong>on</strong>ducting<br />

frequent follow-up assessments without<br />

OT CET c<strong>on</strong>tent supports <strong>Optometry</strong> Giving Sight<br />

Figure 2<br />

Mohindra retinoscopy. Hand-held trial lenses are<br />

placed in fr<strong>on</strong>t of both eyes whilst the child fixates<br />

the retinoscope light. The procedure should be run<br />

in darkened room (the high level of room light in<br />

this image was for photographic purposes <strong>on</strong>ly)<br />

repeated use of cycloplegic agents. 15<br />

One must remember, however, that the<br />

accuracy of results will naturally depend<br />

<strong>on</strong> the practiti<strong>on</strong>er’s experience. 16<br />

Cycloplegic agents<br />

C<strong>on</strong>trol of accommodati<strong>on</strong> in children<br />

of pre-school age is more comm<strong>on</strong>ly<br />

achieved by pharmacological means,<br />

using cycloplegic agents such as<br />

cyclopentolate and tropicamide; atropine<br />

can <strong>on</strong>ly be used by therapeutically<br />

qualified practiti<strong>on</strong>ers. All of these drugs<br />

are muscarinic receptor blockers, thus<br />

they work by blocking the muscarinic<br />

receptors in the ciliary body, which<br />

in turn prevents accommodati<strong>on</strong>.<br />

A mydriatic effect is c<strong>on</strong>currently<br />

achieved by inhibiting muscarinic<br />

stimulati<strong>on</strong> of the iris sphincter muscle.<br />

An ideal cycloplegic would have no<br />

ocular and systemic adverse effects.<br />

Also, it should produce a rapid <strong>on</strong>set of<br />

cycloplegia, blocking accommodati<strong>on</strong><br />

completely for an adequate period<br />

of time, before swiftly restoring<br />

accommodative ability. 17 Several<br />

studies have reported both ocular<br />

and systemic side effects (especially<br />

using atropine) in those children who<br />

have had a cycloplegic refracti<strong>on</strong>,<br />

in additi<strong>on</strong> to expected mydriasis<br />

and cycloplegia, as detailed later. 18<br />

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Drug selecti<strong>on</strong> and instillati<strong>on</strong><br />

Cycloplegia is an invasive technique<br />

which can be uncomfortable, or even<br />

distressing, for the child. This is notably<br />

so because the acidic pH of the cycloplegic<br />

agent leads to stinging <strong>on</strong> instillati<strong>on</strong>.<br />

Some practiti<strong>on</strong>ers advocate the use of a<br />

local anaesthetic prior to instillati<strong>on</strong> of<br />

the cycloplegic agent; proxymetacaine<br />

0.5% is the drug of choice as it stings less<br />

than other topical anaesthetics. However,<br />

this is not always recommended due to<br />

the risks associated with an anaesthetised<br />

cornea. To facilitate the applicati<strong>on</strong><br />

of cycloplegics, cyclopentolate has<br />

been instilled in spray form <strong>on</strong>to the<br />

eyelashes and the closed upper lid. 19<br />

Practiti<strong>on</strong>ers should also be c<strong>on</strong>scious<br />

of their instillati<strong>on</strong> technique, since<br />

different degrees of cycloplegia between<br />

the eyes can occur, especially if the<br />

child does not keep their eyes open wide<br />

enough and/or if there is significant postinstillati<strong>on</strong><br />

tearing (which is very likely).<br />

As such, practiti<strong>on</strong>ers can opt to instil<br />

the higher c<strong>on</strong>centrati<strong>on</strong> of cycloplegic<br />

agent and/or instil further drops if<br />

regular review (eg, periodic measurement<br />

of the amplitude of accommodati<strong>on</strong>)<br />

reveals differing levels of cycloplegia.<br />

Differences in the main cycloplegic<br />

agents are summarised in Table 1. The<br />

optometrist should select an appropriate<br />

agent c<strong>on</strong>sidering factors such as the<br />

patient’s age and whether they have<br />

dark, or light coloured, irides. Adequate<br />

cycloplegic effect could be achieved<br />

with tropicamide in a teenage patient<br />

suspected of having latent hypermetropia,<br />

for example, whereas cyclopentolate<br />

is likely to be required for an infant<br />

suspected of having an accommodative<br />

esotropia. Those with light coloured<br />

irides may exhibit an increased resp<strong>on</strong>se<br />

to drugs as compared with darkly<br />

pigmented irides, and therefore a lower<br />

c<strong>on</strong>centrati<strong>on</strong>/dose ought to be selected.<br />

Overdose of cycloplegic agent has to<br />

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e avoided in children with Down’s<br />

syndrome or those affected by cerebral<br />

palsy, trisomy 13 and 18, and other<br />

central nervous system (CNS) disorders.<br />

This is because toxicity increases in<br />

these people, especially children, which<br />

causes stimulati<strong>on</strong> of the medulla<br />

and the cerebral centres, leading to<br />

hallucinogenic effects similar to those<br />

caused by LSD drugs. 20,21 These reacti<strong>on</strong>s<br />

generally occur within 20-30 minutes<br />

after administrati<strong>on</strong>. 22 Tropicamide<br />

1% should be c<strong>on</strong>sidered in these<br />

children as opposed to cyclopentolate.<br />

Cyclopentolate<br />

Cyclopentolate 0.5% or 1.0% is<br />

comm<strong>on</strong>ly used by practiti<strong>on</strong>ers as<br />

the cycloplegic agent of choice for<br />

paediatric examinati<strong>on</strong>s. The cycloplegia<br />

achieved is not too deep, as compared<br />

with atropine, but it is quicker in<br />

<strong>on</strong>set, often achieved after 30 minutes<br />

from its administrati<strong>on</strong>. Recovery of<br />

accommodati<strong>on</strong> is typically between six-<br />

12 hours after instillati<strong>on</strong> whilst mydriasis<br />

resolves by 24 hours after instillati<strong>on</strong>.<br />

Although full cycloplegia is achieved<br />

with atropine, the cycloplegic refractive<br />

results obtained with cyclopentolate<br />

are comparable in “normals”, 23 high<br />

hypermetropic children24,25 and also<br />

those children with strabismus. 26,27<br />

For children under the age of three<br />

m<strong>on</strong>ths, it is advised that two drops of<br />

cyclopentolate 0.5% are used as opposed<br />

to 1%. 28 This is becasue drug absorpti<strong>on</strong><br />

through the c<strong>on</strong>junctival epithelium and<br />

skin is more rapid in infants compared<br />

to adults, 29,30 due to immature metabolic<br />

enzyme systems in ne<strong>on</strong>ates and young<br />

children, which may prol<strong>on</strong>g the effects<br />

of the drug. 31,32 The main side effects<br />

of cyclopentolate include incoherent<br />

speech, hallucinati<strong>on</strong>s and disorientati<strong>on</strong>,<br />

psychosis and visual disturbances. 33,34<br />

Tropicamide<br />

This is an anti-muscarinic drug<br />

with short-lasting effect <strong>on</strong> the pupil<br />

(mydriasis) and <strong>on</strong> accommodati<strong>on</strong><br />

(cycloplegia) at the 1% c<strong>on</strong>centrati<strong>on</strong>.<br />

Although tropicamide is mostly used for<br />

mydriasis, to examine the optical media<br />

and the ocular fundus, several studies<br />

have suggested that this drug can be used<br />

for a cycloplegic effect. 35 In particular,<br />

it is a cycloplegic agent that can at least<br />

detect latent hypermetropia, for example<br />

in school children, teenagers and those<br />

in their early 20s, with otherwise normal<br />

refractive status and/or with moderate<br />

hypermetropia, 36 as well as for children<br />

during the post-natal period. 37 In adult<br />

patients undergoing refractive surgery, a<br />

study showed no significant difference<br />

in cycloplegic refracti<strong>on</strong> between<br />

tropicamide 1% and cyclopentolate<br />

1%. 38 In the same patients, however,<br />

the study showed that cyclopentolate<br />

was more effective than tropicamide<br />

in reducing accommodative amplitude<br />

in adult myopes (near-point testing).<br />

Atropine sulphate<br />

This is a natural alkaloid extracted<br />

from the deadly nightshade (Atropa<br />

bellad<strong>on</strong>na) plant. Its administrati<strong>on</strong><br />

is justified in children of pre-verbal<br />

age or when other cycloplegic agents<br />

fail to produce a satisfactory level of<br />

cycloplegia. Atropine is administrated<br />

three times a day during the three days<br />

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Mydriasis Cycloplegia<br />

Agent C<strong>on</strong>centrati<strong>on</strong> Max effect Recovery<br />

time<br />

Max<br />

effect<br />

Recovery<br />

time<br />

Atropine 0.5-3.0% 1-2 hours 7-12 days 60-180 min 6-12 days<br />

Cyclopentolate 0.5-2.0% 30-60 min. 1 days 25-75 min 6-12 hours<br />

Tropicamide 0.5-1.0% 20-40 min 6 hours 20-35 min 4-6 hours<br />

Homatropine 2.0-5.0% 40-60 min. 1-3 days 30-60 min 1-3 days<br />

Scopolamine 0.25% 20-30 min 3-7 days 30-60 min 3-7 days<br />

Table 1<br />

Cycloplegic and mydriatic effects am<strong>on</strong>gst the main cycloplegic drugs used in optometric practice<br />

before the eye examinati<strong>on</strong>. Associated<br />

mydriasis decreases in two weeks after<br />

the refractive examinati<strong>on</strong>. This drug is an<br />

antag<strong>on</strong>ist of the muscarinic acetylcholine<br />

receptors, thus it dampens mediati<strong>on</strong> of<br />

the parasympathetic nervous system. As<br />

a result, systemic absorpti<strong>on</strong> of atropine<br />

can lead to difficulties with swallowing<br />

food (opposed effects of the vagus nerve),<br />

inhibiti<strong>on</strong> of the salivary glands leading<br />

to a dry mouth, and reducti<strong>on</strong> of sweating.<br />

Atropine can also increase firing of the<br />

sino-atrial node (SA) and c<strong>on</strong>ducti<strong>on</strong><br />

through the atrio-ventricular node (AV)<br />

of the heart, leading to tachycardia. It<br />

also decreases br<strong>on</strong>chial secreti<strong>on</strong>s,<br />

which can make breathing difficult.<br />

Other side effects that have been reported<br />

include dizziness, nausea and sensati<strong>on</strong><br />

of being unbalanced and allergic<br />

reacti<strong>on</strong>s of the eyelids and c<strong>on</strong>junctiva.<br />

Atropine is able to pass through the<br />

blood-cerebral-barrier and alter the state<br />

of c<strong>on</strong>sciousness of the child. Therefore,<br />

in order to minimise the systemic<br />

absorpti<strong>on</strong> of atropine, the practiti<strong>on</strong>er<br />

can gently press the punctum of both eyes<br />

and keep the patient’s head tilted back.<br />

A recent study39 compared the<br />

cycloplegic efficacy of homatropine 2%<br />

and atropine 1% in children between the<br />

ages of four and 10 years by retinoscopy<br />

and automated refracti<strong>on</strong>. As expected,<br />

the study reported that homatropine<br />

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& TRAINING<br />


Approved for: Optometrists 4 Dispensing Opticians 4<br />

produced a significantly lesser cycloplegic<br />

effect than atropine, with residual<br />

accommodati<strong>on</strong> being greater (1.80±0.40D<br />

with atropine vs 3.10±0.50D with<br />

homatropine; p

factors for binocular visi<strong>on</strong> anomalies<br />

the refracti<strong>on</strong> should be performed<br />

under cycloplegia. Tropicamide seems<br />

to be as effective as cyclopentolate<br />

for measurement of refractive error<br />

in most n<strong>on</strong>-strabismic infants,<br />

particularly at the 1% c<strong>on</strong>centrati<strong>on</strong>, so<br />

it should be c<strong>on</strong>sidered more often in<br />

paediatric eye care in order to reduce<br />

the possibility of adverse reacti<strong>on</strong>s.<br />

Module questi<strong>on</strong>s Course code: C-18551 O/D<br />

PLEASE NOTE There is <strong>on</strong>ly <strong>on</strong>e correct answer. All CET is now FREE. Enter <strong>on</strong>line. Please complete <strong>on</strong>line by midnight <strong>on</strong> May 4, 2012 – You will be unable to submit<br />

exams after this date. Answers to the module will be published <strong>on</strong> www.optometry.co.uk/cet/exam-archive. CET points for these exams will be uploaded to Vantage<br />

<strong>on</strong> May 14, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates<br />

1. Which of the following statements is TRUE?<br />

a) Atropine produces cycloplegia within 2-3 hours and recovery of<br />

accommodati<strong>on</strong> in 2 days<br />

b) Cyclopentolate produces cycloplegia within 30 minutes and<br />

recovery of accommodati<strong>on</strong> in 12 hours<br />

c) Homatropine produces cycloplegia in 20-30 minutes and recovery of<br />

accommodati<strong>on</strong> in 24 hours<br />

d) All of the above<br />

2. Which pharmacological agent should be c<strong>on</strong>sidered in a child<br />

with Down’s syndrome?<br />

a) Atropine<br />

b) Homatropine<br />

c) Cyclpentolate<br />

d) Tropicamide<br />

3. When should Mohindra’s retinoscopy technique be<br />

performed?<br />

a) In all children<br />

b) Only in children aged 7-10 years<br />

c) Only in young children with moderate astigmatism<br />

d) In pre-verbal children<br />

Where there is suspici<strong>on</strong> of a binocular<br />

visi<strong>on</strong> anomaly, cyclopentolate<br />

should be the agent of choice.<br />

About the authors<br />

Fabrizio B<strong>on</strong>ci is an optometrist and<br />

clinical research fellow at the divisi<strong>on</strong><br />

of clinical neuroscience and mental<br />

health, Imperial College, L<strong>on</strong>d<strong>on</strong>, and<br />

the Faculty of Medicine, Charing Cross<br />

4. How should Mohindra’s retinoscopy technique be performed?<br />

a) In darkness, fixati<strong>on</strong> being <strong>on</strong> the retinoscope light, using hand held lenses<br />

b) In room lighting, fixati<strong>on</strong> being <strong>on</strong> a high c<strong>on</strong>trast target at the retinoscope mirror<br />

c) In darkness, fixati<strong>on</strong> being <strong>on</strong> a spotlight at 6 metres, using hand held lenses<br />

d) In room light, fixati<strong>on</strong> being <strong>on</strong> a high c<strong>on</strong>trast target at 6 metres, under<br />

cycloplegia<br />

5. Which of the following statements regarding cycloplegic refracti<strong>on</strong> is<br />

TRUE?<br />

a) It should be c<strong>on</strong>sidered in children with high hypermetropia or strabismus<br />

b) It should be c<strong>on</strong>sidered in every child at every sight test<br />

c) Atropine is the cycloplegic of choice for a 5-year-old child<br />

d) Objective automated refracti<strong>on</strong> should be used for prescribing decisi<strong>on</strong>s<br />

6. Which of the following is NOT a side effect of cyclopentolate?<br />

a) Incoherent speech<br />

b) Hallucinati<strong>on</strong>s<br />

c) Mydriasis<br />

d) C<strong>on</strong>junctival hyperaemia<br />

For the latest CET visit www.optometry.co.uk/cet<br />

Hospital, L<strong>on</strong>d<strong>on</strong>. Luigi Lupelli is an<br />

optometrist, professor in c<strong>on</strong>tact lenses<br />

at the Faculty of Science, Department<br />

of Physics, (Optics and <strong>Optometry</strong>)<br />

at the University of Roma Tre, Italy.<br />

References<br />

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

clinical. Click <strong>on</strong> the article title and<br />

then <strong>on</strong> ‘references’ to download.<br />

49<br />

06/04/12 CET

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Register today at www.bcla.org.uk<br />

Save over £100 <strong>on</strong> your delegate fee –<br />

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Be part of the BCLA Clinical C<strong>on</strong>ference - inviting<br />

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JOBS<br />


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We are looking for an Optometrist for<br />

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The job involves all aspects of optometry<br />

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Bristol, Lincoln, Scunthorpe, Grimsby,<br />

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Weekends are your time - we w<strong>on</strong>’t ask you to give these up!<br />

To discuss positi<strong>on</strong>s in your area call Jim for a c<strong>on</strong>fi dential chat<br />

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Part time<br />

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practise cv to<br />

info@ spexopticians.co.uk<br />

or call 01200 423704<br />

Band 8a £38,851 - £46,621 per annum<br />

37.5 hrs Ref: 427-2012DJ100<br />

We are seeking to appoint a Head Optometrist resp<strong>on</strong>sible for the<br />

delivery of <strong>Optometry</strong> services within the Ophthalmology department<br />

at Royal United Hospital, Bath. You will be working as part of a<br />

multidisciplinary team of six C<strong>on</strong>sultant Ophthalmologists with<br />

a range of specialist interests, Orthoptists and Nursing teams.<br />

You will c<strong>on</strong>tinue to develop the service providing a broad range of<br />

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refracti<strong>on</strong>, c<strong>on</strong>tact lenses, low visi<strong>on</strong> assessment, glaucoma shared care<br />

and Age Related Macular Degenerati<strong>on</strong> (lucentis). You will be managing<br />

your own complex case load and have significant experience within<br />

hospital eye services. You will also be resp<strong>on</strong>sible for the <strong>on</strong>going<br />

development of the service in order to both manage the increasing<br />

demands and to work with key stakeholders in order to establish efficient<br />

and high quality patient pathways.<br />

This post is ideal for some<strong>on</strong>e with excellent interpers<strong>on</strong>al and<br />

communicati<strong>on</strong> skills, team focus, initiative and the ability to deliver<br />

a high standard of patient care.<br />

If you require any further informati<strong>on</strong> regarding this post or to arrange<br />

an informal visit please c<strong>on</strong>tact Sarah Canning, Head of <strong>Optometry</strong> <strong>on</strong><br />

01225 824609.<br />

The Royal United Hospital Bath NHS Trust is working towards equality<br />

and diversity and welcomes applicants from all secti<strong>on</strong>s of the community.<br />

We also promote flexible working to help staff achieve a healthy work<br />

life balance.<br />

Closing date: 22 April 2012.<br />

For full details of our current vacancies, an insight into working life<br />

at the RUH and to apply, visit: www.ruh.nhs.uk or teleph<strong>on</strong>e:<br />

01225 821142 (24 hour).<br />

We welcome applicati<strong>on</strong>s from all secti<strong>on</strong>s of the community.<br />

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<strong>on</strong>line enewsletter<br />

For more vacancies<br />

check <strong>on</strong>line<br />

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Linklaters Optometrists<br />

live<br />

CET<br />

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Opticians (Sevenoaks) have<br />

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busy, dynamic practices.<br />

VRICS<br />

Experienced Optical Assistant or DO<br />

required in Nottingham practice to cover<br />

holidays <strong>on</strong> Sundays.<br />

CET<br />

Part Time Optometrist<br />

required for Nottingham practice Sundays +<br />

2 weekday Domicilliary/Practice.<br />

VRICS<br />

Please apply with a C.V to Jigna Teli<br />

j.teli@linklaterwarren.co.uk<br />

www.linklaterwarren.co.uk<br />

tv<br />

C<strong>on</strong>tact: optometristuk@gmail.com<br />

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Do You Share Our<br />

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You can’t teach excellent customer service – we believe it’s in your genes.<br />

Our delivery of patient care may seem a little old fashi<strong>on</strong>ed, but it allows<br />

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Our approach is centred <strong>on</strong> three simple words: Time, Care and Quality.<br />

Simple words, but not always easy to deliver in practice.<br />

And when you’ve been in optics as l<strong>on</strong>g as we have it<br />

becomes sec<strong>on</strong>d nature.<br />

We currently have vacancies for people passi<strong>on</strong>ate<br />

about optics so, if you share our passi<strong>on</strong>, we’d like<br />

to hear from you.<br />

Optometrists<br />

Essex<br />

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All positi<strong>on</strong>s come with excepti<strong>on</strong>al salaries,<br />

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twitter.com/RaynerOpticians<br />

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rayneropticians.co.uk<br />

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Speakers for L<strong>on</strong>d<strong>on</strong> 2012 Educati<strong>on</strong> Destinati<strong>on</strong><br />

Paul C. Ajamian, OD FAAO US SPEAKER<br />

Jane Bell, FCOptom DipTp(IP)<br />

Murray Fingeret, OD FAAO US SPEAKER<br />

April 29th & 30th April 29 The Associati<strong>on</strong> of Optometrists, in partnership with SECO Internati<strong>on</strong>al, are proud to be hosting a<br />

2-day CET/COPE program focusing <strong>on</strong> therapeutics and optometrist prescribing. This program also<br />

offers social events and group tours.<br />

th & 30th This will be the first CET event in the Associati<strong>on</strong> of Optometrists' prestigious new central L<strong>on</strong>d<strong>on</strong><br />

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targeted at therapeutics, prescribing rights and the c<strong>on</strong>trasts between UK and US patient care pathways.<br />


John Lawrens<strong>on</strong>, PhD MCOptom<br />

Nicholas Rumney, FCOptom FAAO<br />

For more informati<strong>on</strong> visit www.aop.org.uk<br />

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