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www.optometry.co.uk May 20 vol 51:10 £4.95<br />

optometrytoday<br />

Boots’<br />

results<br />

Frames in<br />

focus<br />

Children’s<br />

eye care profile<br />

The thoughts of a<br />

Super coach<br />

Frank Dick speaks ahead of his BCLA speech


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Become our fan on Facebook’<br />

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

May 20 2011 vol 51:10<br />

CONTENTS<br />

6 24<br />

News<br />

5 Driver’s vision highlighted<br />

New campaign for managers of<br />

commercial vehicle fleets<br />

6 Boots’ like-for-likes lower<br />

Boots Opticians like-for-like sales are 2.4%<br />

lower for the year to December 31<br />

7 Did Scotland get it right?<br />

A new study will look into the effects of<br />

Scotland’s enhanced eye care services<br />

8 Comment<br />

AOP chief executive Bob Hughes on the<br />

benefits of US-UK optical relationships<br />

10 Call for evidence<br />

The RNIB wants your experiences on<br />

cataract care<br />

14 Eye Bus wins victory<br />

Optometrist Jane Fisher writes of her efforts to<br />

bring optometric services to rural Dorset<br />

News Extra<br />

30 Sector’s project lands top<br />

honour<br />

Optics scheme collects recruitment award<br />

Cover story<br />

40-41 Frank Dick<br />

We talk to the ‘coaches coach’ before his<br />

appearance at the BCLA conference<br />

Events<br />

16,18 BCLA 2011<br />

Our preview of the BCLA conference<br />

26 Falls and vision linked<br />

Optical practitioners are invited to take part in<br />

National Falls Week, which will take place next<br />

month<br />

39 Early Bird extended<br />

Independents Day extends its ‘Early-Bird’ ticket<br />

price offer<br />

Products<br />

20-21 Industry news<br />

Rodenstock launches new models in the<br />

Alfred Dunhill collection<br />

22, 24 Fantastic frames<br />

The latest fasion looks in our latest pictorial<br />

guide<br />

Regulars<br />

28 20 Questions<br />

This <strong>issue</strong> practice owner Mike Broadhurst<br />

answers our 20 questions<br />

42 Pre-reg focus<br />

Jane Macnaughton on the objective structured<br />

clinical examination<br />

49 Diary dates<br />

All the latest optical events from now into<br />

next month<br />

Features/interviews<br />

35 Polly Dulley<br />

The leader of the children’s campaign on eye<br />

care speaks to OT<br />

50 Dr Joe Ellis<br />

President of the American Optometric<br />

Association gave an address at the AOP agm<br />

Clinical<br />

46-47 VRICS: Paediatric<br />

<strong>Optometry</strong> Part 2<br />

Take our visual quiz with part 2 of our series<br />

covering paediatric care compiled by<br />

optometrist Dr Bruce Evans<br />

52-56 CET: Assessment and<br />

management of AMD<br />

Part 4 of our referral refinement series by Dr<br />

Alison Binns from Cardiff University<br />

57-60 CET: Dealing with<br />

patient anxiety<br />

Cardiff University optometrist and lecturer Dr<br />

Helen Court writes about <strong>this</strong> important and<br />

complex subject<br />

CET video:<br />

An introduction to Domiciliary eye care<br />

Classified<br />

48 Jobs<br />

All the latest vacancies. Optical Express is<br />

looking for sports vision optometrists<br />

52 Marketplace<br />

Optisoft offer software from £50 per month.<br />

Feature is online<br />

Feature is online (video)<br />

www.optometry.co.uk


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NEWS<br />

New vision campaign<br />

targets vehicle fleets<br />

MANAGERS OF commercial<br />

vehicle fleets are being called<br />

on to ensure their company<br />

drivers have regular eye<br />

examinations in a new<br />

campaign.<br />

The Fleet Safety Forum,<br />

a division of the road safety<br />

charity Brake, has launched<br />

the Look Sharp promotion<br />

in a sponsorship deal with<br />

Boots Opticians. A poster and<br />

e-guidance campaign pack is<br />

available to managers, alerting<br />

drivers and managers to the<br />

importance of regular eyesight<br />

tests. The poster aims to help<br />

fleet managers get the message<br />

across to drivers that it is vital<br />

to have a sight test every two<br />

years to ensure they can see<br />

hazards on the roads. And the<br />

e-guidance material discusses<br />

eyesight problems, and gives<br />

guidance on what action can be<br />

taken to prevent them among<br />

drivers.<br />

The Fleet Safety Forum stated<br />

that every year in the UK alone<br />

an estimated 12.5 million people<br />

who need a test do not have<br />

one, and one-in-six drivers<br />

cannot see well enough to pass<br />

the basic eyesight test.<br />

Brake’s marketing manager<br />

EAOO awards<br />

fellowships<br />

AOP<br />

EDUCATION<br />

advisor and<br />

Vision Aid<br />

Overseas<br />

(VAO)<br />

supporter<br />

Karen<br />

Sparrow (left) has been<br />

awarded a fellowship by<br />

the European Academy of<br />

<strong>Optometry</strong> and Optics for her<br />

contribution to the charity.<br />

College of Optometrists chief<br />

executive Bryony Pawinska<br />

(third from right) was also<br />

awarded a fellowship, for<br />

her work in developing the<br />

European Academy and the<br />

optometric profession. The<br />

fellowships<br />

were formally<br />

awarded at an<br />

EAOO meeting<br />

in Prague earlier<br />

<strong>this</strong> month.<br />

Ms Sparrow<br />

was awarded<br />

the accolade by president<br />

Feike Grit in ‘recognition<br />

of her major contribution<br />

to VAO at administrative,<br />

clinical leadership and<br />

strategic levels, and for her<br />

work to enhance the delivery<br />

and quality of optometric<br />

care in the UK and overseas.’<br />

Ms Sparrow has been an<br />

active supporter of VAO for<br />

six years.<br />

Caroline Perry said:<br />

“Fleet managers must<br />

address the <strong>issue</strong><br />

internally and consider<br />

their drivers’ eyesight as<br />

part of their wider fleet<br />

safety strategy. Being an<br />

experienced and skilled<br />

driver is meaningless if a<br />

driver is unable to spot<br />

hazards due to poor<br />

vision.”<br />

The Look Sharp campaign<br />

pack is available for free to the<br />

first 50 companies who order it.<br />

Thereafter it costs £7.45 plus p&p.<br />

The pack is also provided free of<br />

charge to members of Brake’s<br />

Fleet Safety Forum, the charity’s<br />

not-for-profit service which<br />

aims to help companies stop<br />

accidents through better road risk<br />

management.<br />

<br />

BRIEFING<br />

Independent wins<br />

business award<br />

Independent opticians Haine<br />

& Smith has been named as a<br />

winner at the Wiltshire Business of<br />

the Year Awards.<br />

The<br />

opticians,<br />

which has 19<br />

practices across<br />

the region,<br />

scooped the<br />

award in the<br />

‘Customer & Staff Care’ category of<br />

the annual awards.<br />

The ceremony took place at the<br />

Four Pillars Hotel, Cotswold Water<br />

Park on May 12.<br />

Partner Giles Smith, pictured<br />

at the awards, said: “We are<br />

delighted to win <strong>this</strong> award which<br />

recognises the dedication of our<br />

staff to achieving excellence in<br />

service within a competitive<br />

marketplace.”<br />

Senior partner, Barry Smith<br />

added: “With hundreds of entries<br />

for each category from all over<br />

the county, we are very proud to<br />

have won.”<br />

5<br />

20/05/11 NEWS


NEWS<br />

optometrytoday<br />

MAY 20 2011<br />

VOLUME 51:10<br />

ISSN 0268-5485<br />

ABC CERTIFICATE OF CIRCULATION<br />

January 1 2009 – December 31 2009<br />

Average Net: 20,203<br />

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

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

T: 020 7202 8164<br />

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

Deputy Editor:<br />

Robina Moss<br />

T: 020 7202 8163<br />

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

Web Editor:<br />

Emily McCormick<br />

T: 020 7202 8165<br />

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

Reporter: Chris Donkin<br />

T: 020 7202 8162<br />

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

OT Multimedia Editor: Laurence Derbyshire<br />

T: 020 7401 5310<br />

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

Clinical Editor: Dr Navneet Gupta<br />

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

OT Manager: Louise Walpole<br />

T: 020 7401 5330<br />

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

Editorial Office:<br />

<strong>Optometry</strong> <strong>Today</strong>, 61 Southwark Street,<br />

London SE1 0HL<br />

Advertising: Vanya Palczewski<br />

T: 020 7878 2347<br />

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

Sponsorship: Sunil Singh<br />

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

Recruitment & Classified: Haley Willmott<br />

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

CET and bookshop enquiries: Denise Williams<br />

T: 020 7878 2364 E: denise.williams@tenalps.com<br />

Production: Ten Alps Creative<br />

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

Membership Dept:<br />

61 Southwark Street, London SE1 0HL<br />

T: 020 7261 9661<br />

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

Advertising and Production Office<br />

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

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

High Holborn, London WC1A 1NU<br />

Editorial Advisory Board<br />

Duncan Counter, Leon Davies, Mark Draper,<br />

Polly Dulley, Dan Ehrlich, Andy Hepworth, Niall<br />

Hynes, David Ruston, David Shannon, David<br />

Whitaker, Vincent Yong<br />

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

Published fortnightly for the Association of<br />

Optometrists by Ten Alps Creative<br />

Subscriptions<br />

Alliance Media Limited, Bournehall House,<br />

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

T: 020 8950 9117<br />

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

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

Boots revenue up but<br />

like-for-like sales fall<br />

BOOTS OPTICIANS’<br />

revenue improved<br />

by 2.8% in the year<br />

to March 31 which<br />

included a full-year of<br />

sales from Dollond &<br />

Aitchison. However,<br />

the optical chain saw<br />

its like-for-like revenue<br />

from owned practices<br />

decrease by 2.4%, and<br />

warned that the immediate<br />

future would be difficult due to<br />

‘subdued’ consumer demand,<br />

coupled with the government’s<br />

continuing to constrain spending<br />

on health services.<br />

The fall in like-for-like sales was<br />

due to a decline in the optical<br />

market and its highly competitive<br />

High Street environment, Alliance<br />

Boots said on Monday (May 16).<br />

These factors particularly<br />

hit those practices still trading<br />

as D&A, the business stated.<br />

Nevertheless, trading profit<br />

increased as a result of the cost<br />

synergies from the merger of<br />

the multiples, which arose from<br />

Boots’ purchase of the longstanding<br />

opticians name in<br />

May 2009, and the subsequent<br />

integration of D&A.<br />

Further cost savings are on<br />

track to be delivered in the<br />

All aboard for an<br />

eye examination<br />

SOUTH WEST-based<br />

optometrist Jane Fisher is<br />

pictured on her ‘Eye Bus’<br />

following a ruling that she<br />

can continue her mobile eye<br />

care service after a tribunal<br />

hearing with Dorset PCT. She<br />

was helped by the AOP’s legal<br />

team. Read her story <strong>this</strong><br />

<strong>issue</strong> on page 14.<br />

coming year.<br />

George Fairweather,<br />

Alliance Boots group<br />

finance director,<br />

reported that Boots<br />

Opticians had made<br />

£329m in revenue<br />

for the year, and told<br />

the results press<br />

conference that it had<br />

“largely completed<br />

the rebranding of D&A”, with<br />

the result nearly 500 outlets<br />

now trading as Boots Opticians,<br />

with the balance of those not<br />

yet rebranded being mainly<br />

franchised practices. He also<br />

claimed that its new patient offer<br />

was proving popular with the<br />

public.<br />

At the year-end the company<br />

had 656 optical practices,<br />

including 192 franchises.<br />

AOP takes to the High Road<br />

THE AOP is hosting two further<br />

free-to-attend seminars in<br />

Scotland about the Making<br />

Accurate Claims booklet,<br />

following the popularity of four<br />

roadshows it held in February.<br />

The aim of the new seminars<br />

is to ensure that practitioners get<br />

every opportunity to get to grips<br />

with the new regulations and<br />

receive answers to any questions<br />

they may have about general or<br />

specific cases from the author of<br />

the publication, Kevin Wallace.<br />

The AOP councillor, AOC chair<br />

and optometric adviser will talk<br />

about what practitioners need<br />

to do in order to practise safely<br />

and avoid any difficulties with<br />

their health board and Counter<br />

Fraud Services.<br />

The seminars are suitable<br />

for optometrists, dispensing<br />

opticians and support staff, and<br />

will take place in Ayr (May 31) and<br />

Inverness (June 1). There will be<br />

refreshments from 6.30 pm with<br />

the session starting at 7.30pm with<br />

a finish at 9.30pm.<br />

Contact Linda Marriott at<br />

the AOP to book via email<br />

lindamarriott@aop.org.uk or call<br />

her on 020 7202 8166.<br />

Comment on the news via www.optometry.co.uk


Study will ask ‘did<br />

Scotland get it right?’<br />

A UNIVERSITY is to probe<br />

whether Scotland’s<br />

population benefitted from<br />

the introduction of free eye<br />

examinations to the public.<br />

University of Aberdeen<br />

researchers will examine<br />

the success of offering<br />

eye care services free in<br />

Scotland, which followed<br />

the March 2004 review of<br />

eye care services by the<br />

Holyrood government. The review<br />

culminated in the introduction<br />

north of the border of free eye<br />

examinations from April 1, 2006.<br />

A team of economists from the<br />

university, led by Dr Alexandros<br />

Zangelidis, will investigate the<br />

success of the policy, which<br />

aimed to encourage a wider<br />

use of optometry services and<br />

to ensure that the majority of<br />

the population benefitted from<br />

regular eye examinations.<br />

It was also argued that there<br />

would be a reduction in waiting<br />

times and lists for patients who<br />

require referrals to hospital eye<br />

services due to more people<br />

being seen in the community,<br />

thereby reducing the risk of late<br />

diagnoses and ensuring quicker<br />

treatment.<br />

Dr Zangelidis said: “In the<br />

past the optometrists were<br />

considerably underutilised. With<br />

the introduction of the free<br />

eye care policy in Scotland <strong>this</strong><br />

has changed. Since April 2006,<br />

the High Street optometrists<br />

became the first contact point<br />

for eye patients. Now they do not<br />

simply provide a sight test, but a<br />

thorough eye examination that<br />

enables them to detect eye and<br />

other health-related problems<br />

like glaucoma, macular<br />

degeneration, diabetes and<br />

other conditions.”<br />

The year-long project,<br />

funded by the Chief<br />

Scientist Office, aims to<br />

establish the degree to<br />

which the stated objectives<br />

of the policy of free eye<br />

care in Scotland have<br />

been met and to examine<br />

people’s response, both as<br />

eye care patients and consumers.<br />

Specifically, the researchers will<br />

explore whether more people<br />

have had their eyes examined<br />

after the introduction of the<br />

policy, whether individuals from<br />

certain socio-economic groups<br />

responded more, and if patients’<br />

spending on related eye care<br />

goods like spectacles changed.<br />

The project will run from July<br />

2011 to July 2012 and is funded<br />

by a grant of £43,034.<br />

For more information visit<br />

www.abdn.ac.uk<br />

• See also column on <strong>this</strong> page.<br />

Coup for careers team<br />

THE CAREERS in Optics<br />

team are pictured<br />

celebrating their win at<br />

the Recruiter Awards for<br />

Excellence 2011 ceremony,<br />

which was held at London’s<br />

Gloucester House Hotel on<br />

May 11. Formed to raise<br />

awareness of optics as a<br />

career option amongst<br />

secondary school and<br />

sixth-form pupils, the<br />

scheme carried off the award for “Innovation<br />

in Recruitment”. It beat off competition from<br />

other finalists, which included the Royal Bank<br />

of Scotland, Accenture, Adidas, Atkins and<br />

Network Rail. One<br />

of the team, Karen<br />

Sparrow, AOP<br />

education adviser,<br />

said: “We were up<br />

against some big<br />

players with multimillion<br />

pound<br />

budgets so to<br />

have our scheme<br />

recognised was<br />

amazing – we<br />

really were ‘giant killers’ as someone texted<br />

back to us when we let everyone know:<br />

David to their Goliaths.” For more details<br />

and reaction to the award turn to page 30.<br />

IN BRIEF<br />

Scots study: Early<br />

results from pilot<br />

The research which has been<br />

announced in Scotland – see<br />

main story <strong>this</strong> page – has already<br />

started. Aberdeen University’s<br />

researchers have conducted an<br />

exploratory pilot study that has<br />

investigated the effect of the policy<br />

on summary measures of eye test<br />

activity.<br />

This indicates that since 2006,<br />

at least one third of the population<br />

of Scotland has had an eye<br />

examination and the proportion of<br />

the Scottish population having an<br />

eye examination increased from<br />

31.5% in 2008 to 33.4% in 2009,<br />

and to 34.2% in 2010.<br />

Dr Alexandros Zangelidis<br />

(pictured) commented: “These<br />

statistics point to some interesting<br />

changes in the demand for eye tests<br />

after the policy was introduced in<br />

Scotland.<br />

“The analysis proposed in <strong>this</strong><br />

research will help identify the early<br />

effects of the new policy, as well<br />

as other factors that may affect<br />

individual’s likelihood of having an<br />

eye test.<br />

“In the face of the current fiscal<br />

tightening, it becomes even more<br />

important to ensure that resources<br />

are used more efficiently by<br />

targeting resources towards those<br />

who need it most or who are least<br />

likely to utilise services, thereby<br />

also reducing health inequalities.<br />

“The results of <strong>this</strong> study are<br />

expected to help in prioritising<br />

government health expenditure in<br />

relation to free eye examinations in<br />

Scotland.”<br />

The researchers will use data<br />

from a large private ophthalmic<br />

optician company, operating<br />

primarily in the north east of<br />

Scotland, and data from the British<br />

Household Panel Survey.<br />

7<br />

20/05/11 NEWS<br />

News updated regularly at www.optometry.co.uk


8<br />

20/05/11 NEWS<br />

NEWS<br />

President to breakfast<br />

PRESIDENT<br />

OF the BCLA,<br />

Shelly Bansal,<br />

will welcome<br />

150 first-time<br />

delegates to<br />

the association’s<br />

annual clinical<br />

conference and<br />

exhibition at a<br />

breakfast hosted<br />

for them on the<br />

Sunday of the<br />

event.<br />

In a short<br />

presentation to the attendees on May 29, Mr<br />

Bansal will talk about the association’s future<br />

development, the annual clinical conference<br />

and exhibition, and his vision for the future.<br />

“It will be a great pleasure to personally<br />

greet our first-time delegates,” Mr Bansal said.<br />

“Sharing ideas and discussing the challenges<br />

that lie ahead over a hearty breakfast<br />

following an evening of partying at our<br />

Bollywood themed gala dinner will be a great<br />

start to the final day.”<br />

This year the association offered a freeweekend<br />

conference package to the first<br />

150 practitioners<br />

to sign up who<br />

hadn’t attended<br />

the show before.<br />

Speaking about<br />

the conference’s<br />

educational<br />

programme which<br />

is currently being<br />

put together<br />

by the BCLA’s<br />

conference<br />

scientific<br />

committee,<br />

the president<br />

added: “From clinical spotlights and sponsors’<br />

showcases to clinical presentations and<br />

workshops, there is something to ‘float the<br />

boat’ of every delegate – from the novice<br />

through to the expert, from the clinically<br />

minded to the academic, and whether they<br />

work as an independent or with a multiple.”<br />

Practitioners who have not pre-booked but<br />

wish to attend can register on the day at the<br />

conference.<br />

• The 2011 BCLA clinical conference and<br />

exhibition will be held at the Manchester<br />

Central Convention Complex on May 26-29.<br />

Practitioners up by 4%<br />

THE NUMBER<br />

of ophthalmic<br />

practitioners<br />

in England has<br />

increased by<br />

almost 4% during<br />

the 12 months to<br />

December, NHS<br />

statistics have<br />

revealed.<br />

According to<br />

the new data, at<br />

the end of 2010 there were 10,409 active<br />

ophthalmic practitioners, 386 more than<br />

2009 – which represents a 3.9% rise and<br />

means there are 20.1 practitioners per<br />

100,000 of the population.<br />

In Wales there was a much sharper<br />

increase with the number of practitioners<br />

reaching 756, a rise<br />

of 6.3%, increasing<br />

the ratio per 100,000<br />

of the population to<br />

25.2.<br />

The data,<br />

released by the NHS<br />

Information Centre,<br />

covers practising<br />

optometrists and<br />

ophthalmic medical<br />

practitioners in<br />

England and Wales. Over the last 10 years,<br />

the research shows a steady trend towards<br />

a complete gender balance in the industry,<br />

last year in England 50.6% were male –<br />

compared to 59.3% 10 years ago. In Wales<br />

the breakdown was 52% male, down from<br />

59.8% 10 years ago.<br />

COMMENT<br />

NEVER MIND THE PRICE<br />

TAG?<br />

Our AOP council meeting benefitted<br />

from the presence of Dr Joe Ellis OD,<br />

President of the American Optometric<br />

Association, our opposite numbers in the<br />

USA.<br />

Joe flew over to be with us, and<br />

contributed to our discussions<br />

throughout the day. His insights allowed<br />

us to compare our approaches to dayto-day<br />

<strong>issue</strong>s. For instance Joe now<br />

has a clearer appreciation of the over<br />

regulation and interference that can<br />

accompany government-led health care.<br />

A timely lesson as they move into what<br />

they call “Obama-care”.<br />

UK optometry can learn a great<br />

deal from the USA. For instance,<br />

financial incentives to pressurise<br />

optometrists into selling new specs to<br />

every patient are illegal in the US. They<br />

recognise that it is inappropriate and<br />

reflects badly on a clinical profession.<br />

In saying <strong>this</strong>, we all recognise that the<br />

large majority of practice income comes<br />

from spectacle and contact lens sales,<br />

but there is an important line between<br />

helping patients understand the value of<br />

high tech lenses etc, and just maximising<br />

sales, come what may. Of course<br />

optometry and optics is not unique<br />

here, and we all know that hospital<br />

consultants are not beyond manipulating<br />

waiting lists to boost their private<br />

practice income.<br />

The price tag really does matter, and<br />

destroying confidence in the profession<br />

is too high a price to pay for short term<br />

advantage and profit. Jessie J’s wonderful<br />

song lyric “Never mind the price tag”<br />

is not a slogan that commands respect<br />

for a clinical profession or works in the<br />

interest of patients. Incentive-based pay<br />

is designed to skew the profession’s<br />

judgement and we should seek an end<br />

to it.<br />

Bob Hughes, AOP chief executive<br />

bobhughes@aop.org.uk


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NEWS<br />

10<br />

20/05/11 NEWS<br />

IN BRIEF<br />

Specs billionaire<br />

Co-founder of Specsavers, Dame<br />

Mary Perkins has become Britain’s<br />

first female self-made billionaire,<br />

The Sunday Times Rich List<br />

has revealed. According to the<br />

newspaper’s latest list, which was<br />

published on May 8, Ms Perkins and<br />

her family are worth an estimated<br />

£1.15bn.<br />

Taking the plunge<br />

AOP education adviser Karen<br />

Sparrow (centre) has abseiled down<br />

an Essex water tower for charity<br />

Vision Aid Overseas. Ms Sparrow,<br />

along with DO Lee Davis and OO<br />

David Dickson lowered themselves<br />

down the 110ft Veolia Water Tower,<br />

in Harlow Tye raising £700 in the<br />

process. Ms Sparrow told OT: “It was<br />

a bit daunting climbing up the steps<br />

and ladders to the top but the views<br />

over Essex were incredible. The drop<br />

was OK – the most difficult bit was<br />

stepping over the edge. Once we<br />

were abseiling though it was great<br />

and Lee and I managed to chat<br />

on the way down and wave at the<br />

crowd below. Having done it once<br />

I might even be persuaded to have<br />

another go next year.”<br />

Call for cataract clues<br />

A CALL for information<br />

to investigate<br />

anecdotal evidence<br />

suggesting PCTs are<br />

introducing policies<br />

to restrict access to<br />

cataract surgery has<br />

been made.<br />

The Royal<br />

National Institute<br />

of Blind People has<br />

announced it is seeking evidence<br />

from health professionals<br />

to establish ‘the extent of the<br />

problem’.<br />

With the support of The Royal<br />

College of Ophthalmologists, the<br />

RNIB is gathering information<br />

about policies on cataract surgery<br />

currently in place, and evidence of<br />

what patients actually experience<br />

at hospital eye clinics.<br />

A RNIB spokeswoman said: “An<br />

increasing number of patients<br />

are reporting that their cataract<br />

Trio develop system<br />

operations are delayed or<br />

have been refused. RNIB<br />

would like to hear from eye<br />

health professionals if any of<br />

your patients are affected by<br />

<strong>this</strong> <strong>issue</strong>.”<br />

The team is looking, in<br />

particular, as to whether<br />

practitioners have<br />

encountered any situations<br />

where a patient has been<br />

disadvantaged because of<br />

restrictions on cataract surgery. The<br />

charity is also looking for patients<br />

who would be willing to share their<br />

experiences with RNIB. To respond<br />

call 0207 391 2055 or email:<br />

Campaigns@rnib.org.uk<br />

THE UPTAKE of flat screen displays within the consulting<br />

room has reached an estimated 70% of UK practices,<br />

Professor David Thomson, founder of Thomson Software<br />

Solutions and Professor of <strong>Optometry</strong> and Vision<br />

Sciences at City University, believes.<br />

The fast progress has led to a professional<br />

collaboration between Nidek diagnostic technology,<br />

Optix Practice Management Software and Thomson test<br />

charts. The trio have together created a fully integrated<br />

eye examination system. Professor Thomson (pictured<br />

left) explained: “All three systems are working seamlessly so there is no need to re-enter data. The<br />

Thomson Software controls the test chart and the computerised Nidek refractor head allows us to<br />

make more comparisons, at greater speed and so the results are likely to be more precise. There is<br />

greater control over the exact positioning, which is particularly valuable for astigmatic patients.”<br />

Also pictured are Optix’s MD Trevor Rowley, and Chris Tyler, Birmingham Optical’s group CEO.<br />

Bad Payers’ event<br />

The FMO has announced details of<br />

its Summer Meeting, to be held at<br />

the NEC, Birmingham, on June 8.<br />

In the morning session individual<br />

FMO group associations for eyewear,<br />

lenses and equipment will meet<br />

to discuss their sector. There will<br />

then be a more general forum<br />

in the afternoon discussing new<br />

developments, industry regulation,<br />

trends and the Bad Payers’ List. For<br />

more information, email sfisher@<br />

fmo.co.uk.<br />

Still time to be a friend<br />

WITH LESS than a month to<br />

go before <strong>this</strong> year’s National<br />

Eye Health Week (June 13-19)<br />

organisers have made a final<br />

appeal to practitioners to get<br />

involved.<br />

The Week is a cross-sector<br />

initiative aiming to raise public<br />

awareness of the importance<br />

of eye health and the need for<br />

regular sight tests.<br />

Publicity materials include<br />

posters, leaflets, stickers<br />

and balloons and are now<br />

available for Friends of the<br />

Week to order online at www.<br />

visionmatters.org.uk. Other<br />

resources available to Friends<br />

of the Week include access to<br />

the official campaign logo for<br />

use in publicity materials and<br />

inclusion on the National Eye<br />

Health Week website www.<br />

visionmatters.org.uk<br />

Last year over 300<br />

organisations got involved and<br />

already involved <strong>this</strong> year are<br />

‘gold sponsor’ Tesco Opticians,<br />

as well as optical chains<br />

Specsavers and Haine & Smith.


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BACKGROUND<br />

Eye Bus wins victory<br />

14<br />

20/05/11 BACKGROUND<br />

Optometrist Jane Fisher (pictured) describes how the AOP helped her and rurally-based mobile eye<br />

care service continue in practice<br />

MY OWN county of Dorset, like other<br />

rural areas, lacks a regular bus service<br />

and other local amenities . Many<br />

patients I would normally see in my job<br />

in a High Street chain optician premises<br />

would have had some kind of <strong>issue</strong><br />

getting to their appointment or had to<br />

drive some considerable distance.<br />

Some time ago I had an idea which<br />

was not only to become my own boss,<br />

but to enable more people in the area<br />

in which I live to get access to good<br />

quality optometric care within their local<br />

community.<br />

The concept was to equip and fit<br />

out a low floor 15-seat minibus and be<br />

able to take to rural villages miles from<br />

a town and test eyes for part of a day. I<br />

would be able to see up to five patients<br />

per location. I would have one member<br />

of staff to man the reception desk and I<br />

would test and dispense.<br />

When I first approached my PCT with<br />

<strong>this</strong> idea back in January 2010, I had<br />

some very positive feedback. They looked<br />

forward to my application. So, I started<br />

looking for equipment and submitted<br />

my application in May 2010. I waited for<br />

a response from the PCT whilst I bought<br />

and equipped the bus.<br />

I first contacted the AOP in July last<br />

year when I explained the situation and<br />

enquired when I could reasonably expect<br />

a response. The association’s deputy chief<br />

executive Richard Carswell contacted the<br />

PCT in writing on my behalf insisting on a<br />

rapid response.<br />

I launched the Eye Bus at the<br />

beginning of August 2010, still without<br />

an NHS contract, so I tested eligible<br />

people for free. It took until September<br />

23 to receive a letter from the PCT. It was<br />

a letter of refusal. The letter explained we<br />

had been turned down for a mandatory<br />

GOS contract over the word ‘premises’.<br />

The wonderful AOP legal team then<br />

got involved. I had conversations with<br />

Steven King, deputy head of legal<br />

services, in the run-up to our Dorset<br />

PCT internal appeal hearing on October<br />

12. When I met him for the first time<br />

he made me feel at ease and explained<br />

what would be likely to occur. I was very<br />

nervous, so it was great to have such<br />

support. Unfortunately the appeal failed.<br />

It was felt we offered no new evidence<br />

even though we gave them examples<br />

of case law where ‘mobile’ was defined<br />

as ‘premises’. The PCT was insistent that<br />

the word premises meant ‘fixed premises’<br />

and couldn’t incorporate ‘mobile’. It also<br />

stated that as I didn’t visit patients in their<br />

homes, I couldn’t be included under the<br />

supplementary list either.<br />

The Eye Bus was still testing eligible<br />

patients for free some eight months<br />

later. Not an easy overhead for a small<br />

business to continue to cover.<br />

As advised by the PCT, the next step<br />

was to appeal to the Tribunal Service.<br />

Our initial hearing date was for February<br />

10 2011. However <strong>this</strong> was postponed<br />

until April 27.<br />

At the hearing I had the support of my<br />

husband, Mr King, trainee solicitor Funmi<br />

Jones and the AOP’s barrister David<br />

Pievsky. The judge seemed very evenhanded<br />

and impartial, and he kept to<br />

the point of whether the term premises<br />

means fixed or could incorporate a<br />

mobile testing vehicle. Mr Pievsky<br />

argued that the Government did not<br />

explicitly set out to exclude The Eye Bus.<br />

Mr King telephoned on May 4 and<br />

gave us me the news that we had been<br />

successful in arguing that a bus does<br />

constitute ‘premises’ for the purpose<br />

of GOS regulation. I was so happy and<br />

massively relieved. Both Mr King and<br />

myself are now in discussion with the PCT<br />

to get a contract in place.<br />

It has been an epic struggle to get an<br />

answer to the simple question of whether<br />

a bus can be classed as ‘premises’ under<br />

the GOS regulations . Without the help<br />

and expertise of the AOP Legal Team I<br />

would never have been able to get <strong>this</strong><br />

result.<br />

Over the past few months I believe<br />

I have spoken to, or emailed, most of<br />

the members of the AOP legal team<br />

they have always been very supportive,<br />

prompt in replying to any concerns I have<br />

had and have kept me up-to-date with<br />

any relevant information. If you ever have<br />

any <strong>issue</strong>, not necessary as big as mine,<br />

they are always available and easy to<br />

discuss <strong>issue</strong>s with.


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EVENTS<br />

The BCLA presents<br />

illusion and education<br />

With anticipation mounting for <strong>this</strong> year’s BCLA, OT looks at the highlights awaiting delegates<br />

16 28<br />

20/05/11 BCLA PREVIEW<br />

AFTER THE success of last year’s Birmingham event, <strong>this</strong><br />

year the BCLA Clincal Conference and Exhibition returns to<br />

the Manchester Central convention centre – which has been<br />

refurbished since its 2009 event.<br />

The educational content starts on Thursday (May 26) with<br />

the exhibition running from Friday until Sunday. The theme<br />

of <strong>this</strong> year’s conference is ‘learn today – practice tomorrow’<br />

and will focus on education for all.<br />

New features <strong>this</strong> year include a non-clinical lecture on<br />

Thursday evening about visual illusions, free exhibitor<br />

sessions in the exhibition pavilion, dedicated workshops for<br />

those new or returning to contact lens practise and a firstever<br />

session on corneal dystrophies.<br />

Education, education, education<br />

The education on Thursday morning is led by the topic of<br />

presbyopia with a clinical spotlight chaired by Shehzad<br />

Naroo opening the conference in the Exchange Auditorium.<br />

The afternoon features a keynote address by US lecturer Jo<br />

Bonnano, from Indiana University School of <strong>Optometry</strong>, on:<br />

‘The Oxygen Story’ – a theme that continues throughout the<br />

afternoon.<br />

Running simultaneously from<br />

11am in the other main theatre –<br />

The Exchange Hall – is a session<br />

on myopia and orthokeratology,<br />

featuring the Irving Fatt Memorial<br />

Lecture by research paper author<br />

Jacinto Santodomingo, followed by<br />

an afternoon session discussing a<br />

scientific paper on presbyopia.<br />

Friday’s educational offering is<br />

focussed on increasing compliance<br />

with the morning session in the<br />

main hall – featuring University of Waterloo, Canada,<br />

scientist Kathy Dumbleton (pictured) presenting her keynote<br />

lecture – and the afternoon session in the other theatre<br />

discussing the subject. Later in the day practitioners can see<br />

the BCLA’s first keynote lecture on corneal dystrophies by<br />

William Ayliffe.<br />

Comfort is the opening <strong>issue</strong> on Saturday in the Exchange<br />

Auditorium culminating in the BCLA Medal Address<br />

by Australian researcher Mark Willcox – while in the<br />

other main hall, delegates can discover new papers in the<br />

Scientific Paper Session.<br />

The afternoon features a clinical spotlight on myopia<br />

control.<br />

Sunday’s schedule is a real mix and includes Lisa<br />

Continued on page 18


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EVENTS<br />

18 28<br />

08/04/11 20/05/11 COVER BCLA PREVIEW STORY<br />

Keay’s keynote on ‘Healthy and safe contact lens wear,’ top<br />

competitive tips for practice, the hot topics session and new<br />

research papers.<br />

There are a variety of workshops available to book separately<br />

on the first three days, with Saturday also featuring the special<br />

training day for medics.<br />

Several special presentations by sponsors will also be<br />

available with CIBA Vision presenting Thursday’s Patron<br />

Sponsor’s Showcase and lunch on ‘Change patients’ lives<br />

and grow your practice’ and Friday’s Patron’s Presentation<br />

discussion on: ‘What matters in contact lens wear? The<br />

importance of tear film.’<br />

Friday sees Johnson & Johnson Vision Care’s Patron<br />

Showcase on ‘Clear your view: Insights and answers for<br />

astigmats’ with the contact lens manufacturer also presenting<br />

the results of its clinical study into its TruEye product in the<br />

Saturday Patron’s Presentation.<br />

CooperVision presents its showcase on Friday and its<br />

Platinum Sponsors Presentation on: ‘Why some practices<br />

are so successful fitting soft multifocal lenses’ after lunch on<br />

Saturday.<br />

Alcon presents its Sponsor’s Presentation on Thursday<br />

afternoon and its showcase on Saturday.<br />

Break out the Bhangra moves<br />

BCLA 2011 is not all about learning though, with a fun and<br />

varied series of social events available throughout the<br />

weekend so delegates can catch up with colleagues and<br />

contacts, and make some new ones.<br />

Saturday night sees the annual gala dinner, which is sure<br />

to have a taste of the East about it, given the Bollywood<br />

theme and professional Bhangra dancers, who will perform<br />

throughout the evening. Tickets for the gala dinner are<br />

not included in the delegate package and must be bought<br />

separately. To book, visit the BCLA website or telephone 020<br />

7580 6661. Any remaining tickets will be available at the<br />

exhibition. The party is then open to everyone at 11pm.<br />

There are plenty of free events available over the weekend<br />

including a fun lecture on visual illusions by keynote William<br />

Ayliffe, explaining how they ‘mess with our minds’ using<br />

examples from art history and images especially for the<br />

occasion. This is preceded by BCLA welcome drinks and is<br />

open to everyone.<br />

This year’s Friday night patron’s event is hosted by Johnson<br />

& Johnson Vision Care and features inspiring motivational<br />

lecturer Frank Dick MBE, sharing his words of wisdom<br />

followed by a dinner. OT spoke to Mr Dick about his<br />

forthcoming session and impressive career, see pages 40 and<br />

41 for the full interview.<br />

William Ayliffe explains how<br />

visual illusions ‘mess with our<br />

minds’<br />

Accompanying persons can learn more about their<br />

surroundings in Friday’s Crafty Arty Manchester Talk,<br />

discussing the recent history of the city and on Saturday the<br />

Crafty Arty Manchester Walk takes them on a two-hour tour<br />

from 11am. Both events are free and registration is available<br />

onsite.<br />

On the final morning of the exhibition BCLA president<br />

Shelly Bansal will present the first ‘New Delegates Breakfast’<br />

for first-time visitors.<br />

Northern exposure<br />

Practitioners without tickets for the conference are still<br />

welcome at the exhibition, with contact lens companies,<br />

instrument manufacturers and distributers all on hand to<br />

showcase their latest products and innovations.<br />

For those who missed out on Optrafair, the BCLA exhibition<br />

provides a chance to discover some of the new innovations<br />

launched at the NEC event, including the much talked-about<br />

new OCTs from the likes of Topcon. There will be plenty<br />

of special offers available at the show including some great<br />

deals from the OT bookshop, which will have all of the latest<br />

textbooks available on-stand and to order for home delivery.<br />

Also <strong>this</strong> year, for the first time, exhibitors and sponsors<br />

will run half-hour product and educational sessions in a<br />

pavilion in the main hall of the venue.


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INDUSTRYNEWS<br />

BCLA SHOWCASE<br />

20<br />

20/05/11 INDUSTRY NEWS<br />

HAAG-STREIT<br />

UK will be<br />

showcasing<br />

two new<br />

products at<br />

the BCLA<br />

conference in<br />

Manchester<br />

next week –<br />

the DRS non-mydriatic retinal imaging camera<br />

(pictured above) and the Perkins Mk3 hand-held<br />

applanation tonometer (pictured below). The<br />

new DRS, fully-automated, retinal camera has<br />

been designed to maximise patient flow, without<br />

compromising on image quality. The compact,<br />

ergonomic design features an integrated PC with<br />

an intuitive touch screen interface that requires<br />

minimal operator training. It has a 160GB hard<br />

drive, enabling the storage of thousands<br />

of images, and the low-power LED flash helps<br />

patient comfort.<br />

The DRS supports single or multiple field<br />

acquisition, providing seven different standards<br />

within a 45° field. Single-button operation<br />

enables the DRS to automatically detect the<br />

patient, self-align to the patient’s eye, focus on<br />

the retina, adjust the flash level then capture<br />

and store a high-quality image in less than 30<br />

seconds per eye.<br />

Images can be stored directly onto the DRS<br />

system or a USB memory stick, printed, or<br />

transmitted to another PC or network via the<br />

integrated Wi-Fi and Ethernet connection.<br />

Initially unveiled at Optrafair last month,<br />

the product attracted much attention, due to<br />

its competitive price point and functionality.<br />

Haag-Streit UK is anticipating that it will be<br />

as popular at the BCLA event. The new Perkins<br />

Mk3 hand-held applanation tonometer will<br />

also be showcased. The product is designed and<br />

produced by Haag-Streit UK and has an improved<br />

ergonomic hand-held design, an integrated<br />

rechargeable battery and enhanced internal LED<br />

illumination.<br />

Like its predecessors, the Mk3 can utilise<br />

either reusable Goldmann tonometer prisms<br />

or Tonosafe disposable applanation prisms to<br />

minimise the risk of patient<br />

cross-contamination.<br />

Haag-Streit UK will<br />

additionally exhibit<br />

the popular Goldmann<br />

digital tonometer and the<br />

Heidelberg Spectralis OCT<br />

at the BCLA exhibition on<br />

stand 77.<br />

01279 414969<br />

Three in one<br />

RODENSTOCK HAS launched new<br />

models in the Alfred Dunhill collection.<br />

The British men’s luxury brand has<br />

been extended for both the correction<br />

frames and sunglasses (pictured in<br />

classic black and white).<br />

The men’s spectacles are divided<br />

into three lines: dunhill Club, dunhill<br />

Classic and dunhill Ultimate. dunhill<br />

Club includes correction frames<br />

made of titanium and acetate as well<br />

as sunglasses made of acetate or<br />

alternatively, a combination of titanium<br />

and polyamide.<br />

“Timeless, consistent, finest quality” are the definition of the dunhill Classic line. The spectacles<br />

have luxurious decorative elements such as a diamond-cut surface on the temples or lacquered<br />

bar bridges. High-quality materials are used such as titanium as well as exotic rosewood and<br />

ebony.<br />

With a dynamic design and clear lines, dunhill Ultimate line is targeted at the man “who has<br />

many demands on his eyewear”. Different surfaces and carbon fibre that have been worked into<br />

rubber, as well as curved lenses with striking angular edges, emphasise the innovative luxury<br />

brand.<br />

Classically masculine colours dominate in all three lines, different shades of brown and grey, as<br />

well as Havana, black and gun. All models are available in three colours and come in a box with<br />

a matching case, a cleaning cloth, an Alfred Dunhill booklet plus a guarantee card.<br />

01474 325555


Offer to<br />

upgrade<br />

Hoya is offering a free upgrade of its<br />

Amplitude progressive to Amplitude<br />

TrueForm, the company’s latest digital<br />

progressive lens, until July 31. The<br />

company believes the offer would be<br />

of interest to presbyopes who look for<br />

technological innovation but are on a<br />

limited budget.<br />

Bringing improved interaction<br />

between the distance and near portions,<br />

the freeform surfaced lens is said to offer<br />

great flexibility for dispensing, with two<br />

corridor lengths of 11mm and 15mm.<br />

“Amplitude TrueForm brings a smooth<br />

interaction between the distance and<br />

near portions, with easy adaptation<br />

and wide functional viewing zones,”<br />

said Steve Roberts, FBDO, Hoya Lens<br />

UK product manager. “It is designed to<br />

fit into a wide range of frame styles – a<br />

dispenser’s delight.”<br />

& 0845 3300 984<br />

Daring<br />

the spirit<br />

Next generation<br />

app is launched<br />

Essilor has launched its second generation Vision Test app which is available on<br />

iPhone, iPod Touch, iPad and Andriod phones with the aim of driving eye test footfall into<br />

independent Varilux Consultant Opticians.<br />

The interactive app features new improved modules and, as with version one, each test<br />

has a pass or fail mode and users with results of less than 100% are advised that their vision<br />

could be improved through optical correction and a full eye examination is recommended.<br />

Using the app, users can search immediately for their nearest Varilux Consultant Optician<br />

by entering their postcode, or through GPS based on their current location.<br />

Since the app was launched last July, it has received over one million downloads. It is<br />

currently being<br />

advertised on<br />

Facebook and is<br />

still counted as the<br />

number one<br />

medical app.<br />

Essilor highlighted<br />

that The Vision Test<br />

app is just one way<br />

that the company<br />

continues to support<br />

independent<br />

practitioners by<br />

directing footfall<br />

directly to their<br />

practices.<br />

& 01454 417100<br />

21<br />

20/05/11 INDUSTRY NEWS<br />

Exclusive colours<br />

These new Giorgio Armani sunglasses<br />

from Safilo (above) are inspired by the<br />

models worn by pilots and explorers.<br />

The rounded shape in <strong>this</strong> model, GA<br />

859/S, features a double nose-bridge,<br />

gooseneck nose pads and visible rivets.<br />

The colour range is moderately period<br />

and plays with mellow contrasts, such<br />

as spotted Havana with light blue lenses,<br />

light Havana with ochre lenses, dark<br />

Havana with brown/grey lenses and<br />

black with grey lenses.<br />

& 01423 520303<br />

ProDesign’s new Essential collection features two feminine shapes, each available in<br />

a choice of six colours. The colour combinations of the acetate temples are exclusive to<br />

the popular Danish company.<br />

ProDesign is doing its own colour<br />

combinations instead of working<br />

with pre-manufactured acetate<br />

sheets.<br />

The classic monotone of the<br />

frame fronts makes them unisex<br />

to look at but the design of the<br />

powerful colour combinations on<br />

the temples, takes the frames in a<br />

more feminine direction. For<br />

more information visit<br />

www.prodesigndenmark.com<br />

& 0845 1082 469


FRAMES<br />

Fantastic fashion<br />

Retro shapes have never been so popular but frame companies at Optrafair last month took the<br />

trend to a whole new level and also showed that there are alternatives. Robina Moss reports<br />

22<br />

20/05/11 FRAMES<br />

Silhouette<br />

There are six models in the new<br />

Silhouette collection “Action<br />

Style” released <strong>this</strong> month. The<br />

frames for both men and women<br />

are created mainly by hand in<br />

Austria. The colour combinations,<br />

Black-Red Rally and Purple Race<br />

are sporty, while the White-Gold<br />

Contrast and Black Mood convey<br />

subtle everyday elegance and<br />

wearers of Brown-Gold Harmony<br />

and Grey-Black Shadow Love<br />

are said to “love uncomplicated<br />

independence”.<br />

020 8987 8899<br />

International Eyewear<br />

One of International Eyewear’s “definite product favourites” from Optrafair<br />

was frame EP148 (pictured). The retro-inspired frame manages to combine<br />

the stand out feel that vintage styling provides, but with the modern twist<br />

of subtle detailing and an exciting colour palette. Designed to appeal to<br />

“stylish women of all ages”, the beautifully crafted frame is said to be perfect<br />

for both single vision and progressive lenses.<br />

0121 585 6565<br />

EuroVisie<br />

Worldwide<br />

Exotic themes and colours are<br />

featured in the latest You’S<br />

collection of Dutch designs<br />

from EuroVisie Worldwide.<br />

The frames are now sold in<br />

more than 60 countries and<br />

were successfully shown at<br />

Optrafair. This season’s prints<br />

have flowers, butterflies,<br />

bows, naive drawings and<br />

landscapes. Model You’S<br />

824 (pictured) is proving a<br />

popular choice.<br />

0800 0467 353<br />

Inspecs<br />

To tie-in with the 2011 fashion clothing line, Inspecs is<br />

offering a range of Manish Arora Optical pieces for Summer.<br />

The new collection for women is designed “to enhance high<br />

style without adding years”. Lightweight frame MNO-L01-004<br />

(pictured) is a typical example of the next phase of Manish’s<br />

work, understated but lavish colouration. For a limited time,<br />

each frame sale receives a special edition Manish bangle, handcrafted<br />

from glossy pressed acetate, coordinating with the<br />

candy colours and exotic reptile skin textures featured in the<br />

eyewear collection.<br />

01225 717000<br />

Continued on page 24


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FRAMES<br />

Zuma London<br />

The first Titanium Supra range from Zuma is the Saville<br />

range, known for combining understated sophistication<br />

with a high level of comfort due to the ultra lightweight<br />

properties of the materials used. The collection consists<br />

of three models, for men, women and unisex. Each model<br />

is available in three colour combinations.<br />

020 3176 4210<br />

24<br />

20/05/11 FRAMES<br />

Dunelm<br />

Large shapes, diamante studded temples, embellished<br />

sides and classic colours have been the prominent features<br />

of previous Celine Dion ranges for Dunelm and the latest<br />

range additions are no exception. CD 7059A (pictured)<br />

illustrates the attention to details.<br />

01388 420420<br />

Caseco<br />

Koali’s new concept ‘Vanilla’ takes a fresh look at floral motifs using transparency<br />

and a wide variety of colours to create a range of wearable frames for women.<br />

The delicate flower of the vanilla orchid is the inspiration behind the new<br />

frame available from Caseco. The temple is composed of three layers of<br />

different coloured acetate, cut to let light in and show the imprinted, stylised<br />

stalks of the vanilla motif. The concept is available full-rim with nylon and acetate,<br />

or metal, and also offers a metal fronted supra version.<br />

01580 890111<br />

The Eyewear Company<br />

The Eyewear Company at Optrafair won second prize in the Female Opthalmic<br />

award category with The Vanni Suede frame model V1084 and has now<br />

launched another award winner. The Stratos line which won the “Gran Prix<br />

Eyewear of the Year’ in Tokyo has launched some new designs for 2011.<br />

Stratos is all-acetate, formed by stratifying different colours and thicknesses.<br />

The frames are fashioned out of strips of multicolour acetates and combined<br />

with plain-coloured plastic, or single-colour patterns combined with Havana<br />

browns, finished in both transparent and opaque. There are nine models for<br />

men and women.<br />

01453 761 900


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© CIBA VISION (UK) Ltd, a Novartis company, 2011. The Practice Academy logo, Academy for Eyecare Excellence logo,<br />

CIBA VISION and the CIBA VISION logo are trademarks of Novartis AG.


EVENTS<br />

Falls and sight link stressed<br />

26<br />

20/05/11 EVENTS<br />

AGE UK has announced details<br />

of its Falls Awareness Week<br />

2011 for next month, which will<br />

focus on the connection between<br />

reduced vision and falls. Optical<br />

practitioners and other health<br />

professionals can get involved<br />

by organising events during the<br />

promotional five days – which<br />

will run from June 20-24 – and<br />

it is hoped <strong>this</strong> will encourage<br />

older people to go for eye<br />

examinations and wear appropriate vision correction.<br />

The connection between falls and sight loss was highlighted<br />

earlier <strong>this</strong> month by the health minister Earl Howe as a<br />

concern for the Health Service and one that impacts on<br />

hospital capacity.<br />

Next month’s Falls Awareness Week is being organised by<br />

the charity formed out of the 2009 merger of Age Concern<br />

and Help the Aged. It will promote activities and projects that<br />

help to prevent falls in later life – from letting people know<br />

how important regular eye tests are, to “giving an elderly<br />

person’s walking stick an MOT”, and information on strength<br />

and balance exercises.<br />

Helena Herklots, services<br />

director at Age UK, said: “It<br />

is not just falls themselves<br />

that have an impact on older<br />

people’s lives – the fear of<br />

falling can have a devastating<br />

effect on their confidence,<br />

limiting daily activities and<br />

reducing independence. There<br />

are however a number of things<br />

that professionals can do simply<br />

ensuring older people have<br />

regular eye tests and are wearing the right prescription glasses<br />

will help with balance, making them feel as confident as<br />

possible.”<br />

A spokeswoman for Age UK said that the Week is an<br />

opportunity for Age UK to encourage people to find out more<br />

about falls prevention and to take part in local activities to<br />

reduce their risk of falling. “Last year, over 1,200 events took<br />

place around the UK; <strong>this</strong> year, Age UK is asking professionals<br />

to get involved and help older people to ‘Watch Your Step’<br />

and encourage them to attend activities which help reduce the<br />

risk of falling.” For more about how to host a local event, call<br />

0800 169 87 87 or visit www.ageuk.org.uk/fallsweek.


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PROFILE<br />

20 questions – Mike Broadhurst<br />

Mike Broadhurst owns Broadhurst Optometrists, based in Preston, Blackpool and Lytham<br />

28<br />

20/05/11 20 QUESTIONS<br />

How are you?<br />

Great. Looking forward to a busy week<br />

keeping on top of things before a week’s<br />

skiing in Kaprun, Austria with my wife,<br />

Teresa<br />

How is business right now?<br />

Busy. After a lot of cancellations in<br />

December due to poor weather many of<br />

these patients were re-booked into our<br />

January diary, which is historically quieter.<br />

Have you had any promotions<br />

that were especially successful?<br />

Our most successful promotion has been<br />

the introduction of our Direct Debit<br />

schemes, from professional service plans to<br />

savings schemes. We now have well over<br />

a thousand Direct Debits being paid in<br />

monthly.<br />

What do you like about optics?<br />

The patient contact, the exciting new<br />

products and the opportunities that are<br />

constantly available to us.<br />

What’s the best thing that’s<br />

happened in the profession<br />

during your time working in it?<br />

The Optomap Retinal Imaging System<br />

and the good relationships we have built<br />

up with five local PCTs to develop locally<br />

commissioned services.<br />

Who do you admire in optics?<br />

Donald Cameron for inspiring me to charge<br />

realistic professional fees and our business<br />

development manager, Lynsey Arguello,<br />

who’s energy and enthusiasm continues to<br />

drive our business forward.<br />

Where are your favourite places<br />

that optics has taken you?<br />

When I worked for Kelvin Contact Lenses<br />

in the early 70’s, I spent a considerable<br />

amount of my time driving around the Lake<br />

District. Although I have been to several<br />

European cities, the Lakeland Fells are a<br />

magical place and easily accessible.<br />

Are you superstitious?<br />

No<br />

If you were granted one wish for<br />

optics what would you wish for?<br />

That primary care organisations realised the<br />

full potential available to them, to provide a<br />

fully integrated service to the public.<br />

Do you have a favourite TV<br />

show?<br />

Currently, The Good Wife and Formula 1,<br />

but 24 has to be the most gripping series I<br />

have ever watched.<br />

Outside of the profession, what<br />

are your hobbies?<br />

Yoga, fell walking and cycling. I’m about<br />

to do the Coast to Coast cycle ride with<br />

my 17-year old daughter for Vision Aid<br />

Overseas and Asthma UK. If anyone would<br />

like to support us please go to http://www.<br />

justgiving.com/mandsc2cvao<br />

Sum up your feelings for the<br />

next 12 months in five words.<br />

Optimistic, excited, must keep focused.<br />

Where do you go on holiday?<br />

In Summer: Gozo, a small island north west<br />

of Malta. It is hot sunny and we manage<br />

lots of yoga and relaxing. In Winter: Skiing<br />

in Europe.<br />

What are your favourite<br />

products in the optical sector?<br />

The Air Optix range of silicon hydrogel<br />

contact lenses from CIBA Vision.<br />

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

what would you be doing?<br />

Nothing else was ever an option. I loved<br />

optics when I entered the profession and<br />

have even more enthusiasm for it now.<br />

Who’s your favourite singer?<br />

Ellie Goulding and Jamie Cullum come a<br />

close joint second behind my daughter<br />

Sarah, who has the most amazing voice.<br />

What do you put down your/<br />

your company’s success to?<br />

Personal vision, enthusiasm, having the<br />

right staff who make every patient feel<br />

valued, and creating new opportunities<br />

from challenging circumstances.<br />

What’s your favourite season,<br />

and time of year?<br />

Autumn. The visual beauty of the Lake<br />

District in October takes some beating.<br />

Where would spend your perfect<br />

day?<br />

On the track of the London velodrome<br />

just ahead of Chris Hoy!, Or on the top of<br />

Haystacks in the Lake District.<br />

Any final thoughts?<br />

Optics has presented me with many<br />

opportunities and challenges. It’s important<br />

to be focused on the opportunities rather<br />

than legged up by any setbacks.


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NEWS EXTRA<br />

Optics scheme collects<br />

top recruitment honour<br />

30<br />

20/05/11 NEWS EXTRA<br />

THE CAREERS in Optics<br />

Working Group, which was<br />

established to raise awareness<br />

of optics as a career option<br />

among secondary school<br />

and sixth-form pupils, has<br />

won a prestigious award for<br />

“Innovation in Recruitment”.<br />

The cross-sector<br />

initiative was recognised<br />

at the Recruiter Awards for<br />

Excellence 2011 which was<br />

held at London’s Gloucester<br />

House Hotel on Wednesday<br />

May 11.<br />

The Working Group joined<br />

forces with educational experts, Words&Pictures to develop a<br />

‘fast-paced’ workshop based around the concept of ‘living life<br />

in a new dimension’. Utilising the popularity of 3D, during the<br />

workshops, students learnt about illusions, light and sight in a<br />

fun, supportive and engaging environment. They also watched<br />

a 3D film that encouraged them to think broadly about their<br />

future career options.<br />

Talking about the award, chair of the Careers in Optics<br />

Working Group and City University lecturer, Professor David<br />

Thomson, said: “This is a fantastic achievement. This award<br />

acknowledges excellence and recognises those who embrace<br />

forward-thinking ideas. To receive <strong>this</strong> recognition from<br />

professional recruiters is<br />

testimony to the quality of the<br />

Group’s work.<br />

“To attract the very best<br />

young people into optometry<br />

and optics we needed a<br />

fresh approach which would<br />

capture the imaginations of<br />

students at a time when they<br />

are thinking about their career.<br />

All the evidence is that we<br />

have achieved <strong>this</strong> and it is<br />

great to get <strong>this</strong> endorsement<br />

from the industry.<br />

“I am really proud of the<br />

way that the whole optical<br />

sector has got behind <strong>this</strong> initiative and <strong>this</strong> success is a<br />

real tribute to the hard work of the Working Group and the<br />

creativity of Words&Pictures.”<br />

The judges agreed that the Group’s campaign showed ‘real<br />

innovation, technology and investment in the grass roots,<br />

with the long-term plan of attracting future recruits into the<br />

industry a real step forward’.<br />

Other finalists in the same category were the Royal Bank of<br />

Scotland, Accenture, Adidas, Atkins and Network Rail.<br />

If you are interested in becoming an optical ambassador and<br />

carrying out workshops in a school in your local area contact<br />

newdimension@college-optometrists.org


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INTERVIEW<br />

Campaigning for kids<br />

With <strong>this</strong> year’s children’s eye care campaign under way, Polly Dulley, chair of its advisory panel,<br />

spoke to David Challinor<br />

“IT’S A bit of a love-hate thing<br />

seeing children,” Polly Dulley says,<br />

“it’s a bit like Marmite: either you<br />

love seeing kids or you hate seeing<br />

kids and that’s usually to do with<br />

a practitioner’s confidence and<br />

experience.”<br />

The Epping-based optometrist<br />

is talking to me about <strong>this</strong> year’s<br />

Optical Confederation campaign<br />

to highlight children’s eye care, a<br />

topic on which many now believe<br />

urgent action is required. “Every<br />

practitioner has their strengths and<br />

weaknesses. There’s nothing wrong<br />

with people who don’t want to see<br />

kids, but we should be encouraging<br />

parents to take their children to see<br />

an optometrist who enjoys seeing<br />

them.”<br />

And with <strong>this</strong> year’s promotion<br />

being targeted to a wider audience<br />

than 2010’s, with a new poster campaign at the forefront of the<br />

message, there’s every chance it will.<br />

Ms Dulley is just the right person you’d wish to examine<br />

your eyes when young. At ease with kids of all ages, she is<br />

passionate about the subject and only last week she was one<br />

of the people at the AOP agm pressing health minister Lord<br />

Howe for more action to help children’s vision.<br />

But back to <strong>this</strong> year’s campaign, which she chairs, and has<br />

new material.<br />

“Last year we sent the poster to head teachers to engage<br />

education, which worked very well,” she says, “but <strong>this</strong> year<br />

we want the poster to be positioned in more public places <strong>this</strong><br />

time so parents can think about it at other times than just in<br />

the school playground.”<br />

There are hopes that the message will get viewed in High<br />

Street stores, and campaigners have been speaking to the<br />

Independent School Wear Association so it could be part of<br />

the annual Back to School push for parents to get their kids<br />

ready for September (and mid-August in Scotland). There are<br />

also plans for a campaign pack of publicity materials to be<br />

made available electronically.<br />

This year the campaign hopes to better measure its<br />

successes. “Last year we got a very positive response – many<br />

schools really joined in, with one I remember with a ‘spectacle<br />

wall’ where everyone who wore glasses had had their photo<br />

taken and they’d really embraced it. What we weren’t able to<br />

do was measure successes like these.”<br />

What is needed for the campaign, and children’s eye care<br />

in general, is a tipping point, a<br />

breakthrough moment when many<br />

more parents sit up and take notice.<br />

The reasons for urgent action are<br />

oft-mentioned in optical circles –<br />

the need to examine early due to<br />

the risk of amblyopia, the paucity<br />

of orthoptists, the limitations<br />

regionally of what vision screening<br />

there is, and the screening itself<br />

which is often left to school<br />

nurses – and has led to a situation<br />

virtually unheard of by the general<br />

public, but deeply worrying to<br />

those in-the-know.<br />

Polly Dulley’s patients know<br />

about it and children represent a<br />

remarkable 25%-30% of her patient<br />

base. “I’m a very patient woman<br />

when it comes to other people’s<br />

children!” grins the mother of two<br />

teenage boys. In all seriousness, her<br />

practice staff, including husband and fellow optometrist Tim<br />

are all incredibly enthusiastic about children’s eye care, but it<br />

is Ms Dulley who examines the very young.<br />

“I think all children, from babes-in-arms to stroppy<br />

teenagers, should have eye examinations and thankfully<br />

I have the background from hospital work to be confident<br />

and competent to do that. Though all optometrists are<br />

qualified to see children, the very young and those who have<br />

learning disabilities present particular challenges that not all<br />

optometrists will feel comfortable dealing with. “Nevertheless<br />

I’ve worked hard over the years to find the skills whatever<br />

their age, and whatever their ability to communicate at the<br />

level required, to get the best from the child.”<br />

As to the very young she advises ‘mums feel confident<br />

taking their baby to another parent’ and that her success is<br />

about having the skills by ‘just being a mum and knowing<br />

what will relax a two-year-old, compared to a nine-year-old’.<br />

We talk about further about children’s eye care, and my<br />

idea – pushed in May 6’s Comment – of practices ‘adopting a<br />

school’, which is something she applauds, and will consider.<br />

I thank her for that and wish the campaign well.<br />

The next day I spot a class of primary school children<br />

walking on an outing, no doubt to one of London’s historic<br />

landmarks, and passing where Ms Dulley and I have said our<br />

farewells. It suddenly strikes me that, quite possibly, there<br />

is a child in that class getting through his or her day with<br />

uncorrected vision difficulties. And that it is up to the ‘grownups’<br />

from whatever walk of life to help change <strong>this</strong>.<br />

35<br />

20/05/11 INTERVIEW


EVENTS<br />

Plans for first optometry<br />

summer school are revealed<br />

36<br />

20/05/11 SUMMER SCHOOL<br />

Aston University has revealed it is<br />

planning its first-ever optometry<br />

summer school for <strong>this</strong> year.<br />

The university optometry<br />

summer school will run from July<br />

18 to August 5 2011, and it is<br />

open to optometrists, opticians,<br />

and other optical professionals.<br />

It is aimed to help practitioners<br />

develop new skills and learn<br />

techniques they can use in their<br />

work.<br />

“It is a truly unique way to gain<br />

CET for optoms, opticians and<br />

others,” said Dr Shehzad Naroo, senior<br />

lecturer at Aston’s School of Life and<br />

Health Sciences. “The Aston University<br />

<strong>Optometry</strong> summer school will run<br />

from July to August 2011, and is open to<br />

optometrists, opticians, ophthalmologists,<br />

orthoptists, ophthalmic nurses and<br />

technicians who wish to learn techniques<br />

that they can take into their own practice<br />

environments.”<br />

Continuing education and training<br />

points will be available for<br />

optometrists and opticians<br />

where possible, with up to 10<br />

UK CET credits available per day.<br />

Mr Naroo said that advanced<br />

techniques will be taught<br />

in seminars and dedicated<br />

workshops with “plenty of<br />

hands-on opportunities”.<br />

Students about to start their<br />

final year of study may benefit<br />

from particular classes, he said,<br />

and wish to come along to gain<br />

additional experience.<br />

“Delegates can attend for one, two,<br />

or three weeks, or just one day,” said<br />

Mr Naroo. “Delegates attending for<br />

full weeks are able to stay on campus<br />

accommodation at a reduced rate.”


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EVENTS<br />

ID ‘11 Early-Bird<br />

prices extended<br />

THE ORGANISER of<br />

Independents Day, Proven<br />

Track Record (PTR), has<br />

announced that its ‘Early-<br />

Bird’ discounts for the<br />

event will be extended to<br />

May 31.<br />

PTR co-director, David<br />

Goad, said: “We realise<br />

that with all the recent<br />

public holidays many<br />

people are behind with<br />

plans for later in the year.<br />

So Nick (Atkins, pictured) and I have decided to support the<br />

people who have supported us so loyally over the years with<br />

an extra couple of weeks to benefit from the best prices.”<br />

Prices for past delegates who are also Varilux Consultant<br />

Opticians start at £109.<br />

PTR has also announced that Johnson & Johnson Vision<br />

Care has provided former DO John Hotowka (pictured below),<br />

who bills himself as the Laughter Dinner Speaker, as the guest<br />

speaker at <strong>this</strong> year’s Independents Night dinner.<br />

For seven years, in the 1980s, he was ‘an optician by day<br />

and magician by night’, performing magic to the diners in<br />

the restaurants of Bradford. Mr Hotowka is a fellow of the<br />

Professional Speaking Association and a member of the Magic<br />

Circle. He is also a member of The Mile High Card Trick Club<br />

– open solely to those who have performed card tricks on a<br />

Boeing 747 in mid flight. He has also motivated audiences at<br />

the top of the Berlin Telecom Tower, on a container ship in<br />

the middle of the Atlantic, and whilst travelling at speed on<br />

the Orient Express. A sought after speaker on the corporate<br />

circuit and popular in education, he helps young people to<br />

develop entrepreneurial and life skills.<br />

Mr Atkins said: “I’m sure John will be a big hit with our<br />

colleagues joining us for dinner. Independents Night will<br />

once again provide a great opportunity for delegates to meet,<br />

network, share ideas and simply enjoy the company of likeminded<br />

peers.<br />

“But most of all,<br />

Independents Night really<br />

does support the whole ethos<br />

David (Goad) and I had from<br />

the earliest inception of<br />

Independents Day – that in<br />

addition to all the educational<br />

and business benefits, it<br />

should be fun.”<br />

For more information and<br />

to book at the best prices visit<br />

www.independentsday.co.uk<br />

by May 31.<br />

39<br />

20/05/11 EVENTS


INTERVIEW<br />

Going for gold in the<br />

contact lens business<br />

Frank Dick has been called ‘the coaches coach’ after a phenomenal career which saw him lead<br />

British athletics in its 1980s golden era. Now a motivational speaker, David Challinor met him<br />

ahead of his appearence at BCLA 2011<br />

40 28<br />

08/04/11 20/05/11 COVER FRANK STORY DICK<br />

AT THE agreed hour and place, I<br />

spot Frank Dick quietly reading<br />

in the hotel lounge while all<br />

around younger guests are glued<br />

to their lap tops and mobiles.<br />

‘Little do they know…’ I think<br />

as I head towards him, ‘he’s<br />

helped the gold medal winners<br />

to greatness, Coe, Ovett, Daley<br />

Thompson….’<br />

As we greet each other and a<br />

quieter corner to talk, it strikes<br />

me here is someone that could<br />

coach anyone in the room to<br />

perform better. Nevertheless,<br />

we’re here to talk about his<br />

appearance at next week’s BCLA<br />

conference, courtesy of Johnson &<br />

Johnson Vision Care, and how he<br />

became what he is.<br />

Why athletics? I ask.<br />

“It was triggered by a broadcast<br />

on the radio,” he says, fixing me<br />

with his steely blue eyes, “and it<br />

was the one moment in my life<br />

which switched everything on.<br />

“I was listening to a legendary race between Chris<br />

Chatterway and Vladimir Kuts when Chatterway broke the<br />

world record for the 5,000m. I remember running out of my<br />

home in Edinburgh,” he says, breaking into a smile at the<br />

vividness of the memory, “down the stairs, round the block,<br />

dipping at the lamp posts, pretending I was winning races. I<br />

think it was then that I decided to do sport after that.”<br />

Moments like <strong>this</strong> 1954 race and others form precious<br />

links in his life, which now, decades on, seem wonderous to<br />

him. He’s embarrassed to admit that at school he failed every<br />

science exam.<br />

However, he entered Loughborough university to do PE and<br />

maths, but ‘fell in love’ with the embryonic shoots of sports<br />

science. “Nowadays one of the biggest selling sports science<br />

books at universities is Sports Training Principles,” he grins,<br />

speaking of one of his books. “I’m not mentioning that to brag<br />

or anything, but isn’t it an extrodinary thing that you go <strong>this</strong><br />

or that way in life because something does or doesn’t click at<br />

school, or you are given the right teacher at the right time.”<br />

Fortunately for Britain’s top athletes, Frank Dick was<br />

there at the right moment – but it may never have happened.<br />

He might well have ended<br />

up as a PE teacher but for his<br />

fascination of coaching in sport,<br />

which helped take him to the<br />

University of Oregon in the US<br />

which is a renowned place for<br />

breeding sporting excellence.<br />

There he met its head of<br />

track and field Bill Bowerman<br />

who inspired him further – not<br />

surprising, given the fact that<br />

from Bowerman’s ideas came a<br />

running shoe that was a topseller<br />

in the 1960s and became<br />

the platform for the most iconic<br />

footwear designs of the company<br />

the Oregon coach helped to found<br />

– Nike.<br />

Mr Dick speaks of that time<br />

and his fascination in almost<br />

obsessional tones. “Then I would<br />

just want to get near coaches<br />

when they were working, so I’d<br />

travel just to see what they were<br />

saying, what they were doing,<br />

and thinking,” he says.<br />

“This was long before sporting event tourism,” he smiles, and<br />

jokes, “it was an early form of stalking, albeit in a nice way.<br />

“I give you an example: I went to Budapest in 1966 to see the<br />

European Championships with a friend just to stand outside<br />

the warm-up area and listen to the coaches and watch them and<br />

find out where they were going for a beer in the evening, then<br />

go and listen to them.<br />

“You could always read what athletes did, but you couldn’t<br />

understand how coaches thought or why they made their<br />

decisions unless you were actually with them.”<br />

It wasn’t long afterwards that just before Mr Dick was about to<br />

travel to do a fellowship at the University of British Columbia<br />

that he heard from a contact that Scotland’s athletics coach was<br />

leaving, and he applied for the job ‘for a laugh’, and duly got it.<br />

“So many things happen in your life you wonder whether<br />

it truly is fate,” he says, looking back. “I had to get a coaching<br />

qualification, and they said ‘we’ll wait for you’ which was good.<br />

You’ve got to have faith in people and when you’re recruiting<br />

you get a gut feeling and you have to go for it.”<br />

So he stayed in Scotland and was happy coaching that<br />

nation’s athletes until he was told that a prospective GB director


41<br />

of coaching position might well end up directing his role in<br />

ways and judgements he didn’t want. So he decided to apply<br />

for <strong>this</strong> broader role, and again got the job.<br />

“So you see two accidents shaped me really,” he says,<br />

“there isn’t one way to leadership, it’s how you live your life,<br />

what you decide to do.”<br />

He had to pick British athletics up from a disasterous poor<br />

result at the 1976 Olympics where a Brendon Foster bronze<br />

was virtually Great Britain’s only placing of note. Mr Dick is<br />

modest about what was achieved after <strong>this</strong>. “I got lucky with<br />

good coaches and the athletes,” he says, “for my part, I could<br />

see a pathway where we could go towards.”<br />

“As leaders and managers we’ve<br />

got to be more like coaches and<br />

less like cops...”<br />

The rest is, indeed, history, with the Great Britain team<br />

succeeding at the 1980 Games – Mr Dick helping to inspire<br />

Coe, Ovett and Thompson to a famous trio of golds.<br />

But, I ask, how do you coach widely different and<br />

conflicting personalities like Seb Coe and Steve Ovett?<br />

In giving his answer, Mr Dick remembers how he calculated<br />

success for the GB team at the Athletics’ European Cup,<br />

challenging East German and Soviet Union dominance.<br />

He drew the athletes together and asked each of them to<br />

gain an extra team point than he had calculated they were<br />

capable of.<br />

“ ‘If you are worth one point out of eight maximum’, I said,<br />

‘and you can get that to two, it gives us just the same step up<br />

the mountain to victory as if you were worth 5 points and get<br />

6’ – and as for an athlete who was worth 8 points I warned<br />

‘don’t give me a 7’.”<br />

When victory was secured, he tells me with a smile,<br />

he drew them all together to see how deep an effect his<br />

motivational efforts had had, and chastied the team for only<br />

winning by four and a half points. Mr Dick: “ ‘Who’s to<br />

blame’, I asked, and all of them raised their hands!” Each<br />

knew their point made the difference.<br />

He will doubtless give a much broader motivational<br />

message when he appears at the BCLA on May 27, outlining<br />

how being a coach can help in business and leadership.<br />

He remains passionate that the profession of coaching is<br />

undervalued and should be given more respect – like many<br />

optical professionals believe their respective professions are<br />

undervalued – and uses the maxim that a coach prepares<br />

people for sport but also through sport for a better life. So<br />

in developing a team, it’s not only for business but for their<br />

life. Definitely the right man for the sporting talents of Boris<br />

Becker, Katarina Witt and others he has coached, he adds<br />

“Whether you are in your arena on your own or as part of a<br />

team, you need to feel your own motivation, not someone<br />

else’s. Motivation is not something off the shelf, it’s personal.”<br />

Familiar with the business of optics, Mr Dick has spoken to<br />

staff of optical multiples before and calls the sector ‘a terrific<br />

industry’, and hopes he can change the BCLA audience’s<br />

professional lives for the better.<br />

But how do you, I ask, make the commuters I had travelled<br />

into London with that morning, many who are bored and<br />

unhappy in their jobs, more motivated. “As a practice<br />

manager you have to be aware of all the different roles of<br />

those in the outlet,” he says, “and as leaders and managers<br />

we’ve got to be more like coaches and less like cops.”<br />

He admires other leaders and coaches, the two he mentions<br />

happen to be like him, Scottish, including Manchester<br />

United’s Alex Ferguson (“it was Alex who was one of the first<br />

football managers, when at Aberdeen, to make sure his players<br />

had a dedicated club cafeteria, rather than letting them run<br />

round to the greasy spoon”), and businessman Tom Hunter<br />

(“I hear he has monthly meetings with technology savvy<br />

teenagers in which he asks them ‘What can you tell me?’. I<br />

think that’s impressive”).<br />

As to future business, Mr Dick predicts that managers need<br />

to have in place a social media strategy very quickly if they<br />

are to survive, and believes that it is significant that today<br />

young people take most of their opinions from social media,<br />

rather than newspapers.<br />

The interview, which has overrun, draws to a close, and<br />

the memory I leave with is of someone who still has much<br />

coaching to impart to people from all walks of life. I’m<br />

sure his appearance at the BCLA conference will be worth<br />

attending.<br />

• Frank Dick will present ‘Get a Clear Advantage’, courtesy of<br />

Johnson & Johnson Vision Care, at the BCLA’S Patron’s Event<br />

which starts at 6.45pm on May 27 in the Exchange<br />

Hall, Manchester Central.<br />

20/05/11 frank dick


PRE-REGFOCUS<br />

Sponsored by<br />

Advice as the OSCE’s near<br />

42<br />

20/05/11 PRE-REG FOCUS<br />

THE COLLEGE introduced the<br />

OSCE’s a few years back as a<br />

forward move to a system of<br />

pre-registration examinations<br />

that were seen to be less biased,<br />

impartial and non-discriminatory,<br />

writes Clearview Training director,<br />

Jane Macnaughton.<br />

The OSCE’s are not a new<br />

concept by any means. The<br />

College has closely studied OSCE’s<br />

already in place with allied health<br />

professions, such as medicine,<br />

and adapted them for optometry.<br />

The term objective in <strong>this</strong> setting<br />

means that the exams are designed to<br />

move away from subjective vivas. There<br />

is almost no examiner interaction and<br />

each examiner is there to ensure you<br />

complete the test in a safe and orderly<br />

manner before marking the station when<br />

you exit. What <strong>this</strong> means is that you must<br />

focus on your interaction with the patient<br />

instead.<br />

Preparation<br />

In achieving the Stage 2 pass,<br />

trainees have been assessed in all<br />

core competencies by experienced<br />

assessors. So the OSCE’s are, if you like, a<br />

check test to validate those results.<br />

The most common question trainees<br />

ask is ‘where do I start?’. There are four<br />

key areas of focus that I would<br />

recommend you cover, all of<br />

which contain significant pass/fail<br />

criteria: Investigation; Interpretation;<br />

Management; and Communication.<br />

Investigation<br />

This is where you may be asked to<br />

demonstrate a technique. Here the<br />

examiner will mark you on how well<br />

you use the equipment, how you<br />

communicate with the patient, and how<br />

you explain the test. For example – use<br />

of an Amsler Chart. You may be asked<br />

to use <strong>this</strong> technique on a patient. But<br />

before you pick up the chart take a step<br />

back and think. What should you do first<br />

? Check if the patient requires a near<br />

correction – ask them to wear it; what<br />

working distance should you hold the<br />

chart? – is there a tape measure? If so, use<br />

it; which chart is the most appropriate to<br />

use for the presenting complaint (there<br />

are several) – select the correct one;<br />

what lighting should you use? – is there a<br />

lamp on the table?; if so, use it.; and how<br />

do you explain the test to the patient?<br />

The way you set up and perform a<br />

test will give the examiner information<br />

on whether or not you understand the<br />

purpose of that test.<br />

Selective attention and the invisible<br />

gorilla<br />

Candidates who are so focused on one<br />

thing may miss the obvious. This is<br />

called selective attention. A well-known<br />

experiment, available to watch on You<br />

Tube illustrates <strong>this</strong> beautifully (simply<br />

Google: ‘selective attention test’). You are<br />

asked to watch a short film of two teams<br />

of three basketball players. One team are<br />

wearing white and the other team are<br />

wearing black. You are asked to count<br />

how many passes the white team<br />

make to each other. The viewer<br />

will focus so closely on the white<br />

team that nine times out of 10,<br />

they will not see the man in a<br />

gorilla suit walking into the room,<br />

waving and then walking out<br />

again.<br />

A colleague and I set up a<br />

cubicle to ‘test’ <strong>this</strong> theory.<br />

Students were asked to select the<br />

most appropriate Amsler chart<br />

for the presenting condition and<br />

perform the technique accurately.<br />

Everything they needed was on the table,<br />

including a tape measure, which is critical<br />

to set the correct working distance of the<br />

test plates. However, not one person used<br />

the tape measure. Each student was so<br />

focused on choosing the correct Amsler<br />

that they failed to see the tape measure.<br />

So, take a look at everything in the room.<br />

Try to see the whole picture.<br />

Interpretation<br />

Some stations may ask you to look at<br />

the data presented, and perhaps make a<br />

judgement call. For example, you may be<br />

asked to interpret a prescription, make<br />

an order or communicate the data to a<br />

patient. When you are presented with<br />

a page of information work through<br />

it logically, there may be red herrings.<br />

For example, if you are given a fundus<br />

photograph don’t go straight for the<br />

obvious lesion in the centre. Start at the<br />

disc, work your way our along the vessels<br />

etc. Did you see the melanoma in the far<br />

periphery? Another invisible gorilla just<br />

waiting to be overlooked.<br />

• To read the rest of <strong>this</strong> article, which<br />

covers management and communication<br />

tips for the OSCEs, visit www.optometry.<br />

co.uk


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2011-077-52766


ONLINE<br />

Helping you take the<br />

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The OT website has a variety of free tools to assist optical professionals who are looking for a new<br />

job. Here’s some of the ways we can help…<br />

44<br />

20/05/11 ONLINE<br />

IT CAN be difficult to know where<br />

to start when you first embark on<br />

searching for a new job so why not<br />

head to OT’s dedicated online Job<br />

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

jobs/job-tips for lots of free advice,<br />

and to find out about the latest<br />

vacancies first.<br />

Tips and templates for<br />

writing a cover letter<br />

and CV<br />

Cover letters and CVs can come in<br />

all styles and writing them from<br />

scratch can be a daunting prospect.<br />

To help you along in the process, OT has compiled a series of<br />

cover letter examples and built a CV template to follow and<br />

we also have lots of tips on what to avoid when writing your<br />

CV, so make sure you take a look before you start writing.<br />

All documents can be downloaded as PDFs for you to keep<br />

in a handy place and refer back to during your job search.<br />

CV Uploader<br />

Once you have a CV, why not upload it for free to OT’s ‘CV<br />

Uploader’ facility which can be viewed by a wide range of<br />

optical companies and let<br />

potential employers search<br />

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Job Alerts<br />

Sign up to OT’s personalised<br />

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vacancies relevant first.<br />

Once you have logged in to<br />

the website and clicked onto<br />

the Jobs homepage, perform a<br />

job search by selecting search<br />

criteria and click ‘Submit’<br />

(pictured). This will produce a<br />

list of all current job vacancies<br />

which match your criteria. Remember to select ‘Save <strong>this</strong><br />

search as a Site Alert’. By clicking on the link (highlighted)<br />

you will be taken to the ‘Site Alerts’ section of your profile,<br />

enter the name of the alert then select ‘Weekly Digest Email’<br />

from the ‘Alert Type’ dropdown box, and, finally, click ‘Submit<br />

Changes’. From then on OT will send you a weekly email<br />

containing any new vacancies which are relevant to you.<br />

• Visit www.optometry.co.uk/jobs/job-tips to get more help<br />

and advice on finding your next job.


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This FREE VRICS test should be completed online by clicking on the “VRICS Test” button at http://www.otcet.co.uk/<br />

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one correct answer for each MCQ. The associated reading list provides useful help for completing the MCQS.<br />

Successful completion will result in two CET points. VRICS regularly appears in <strong>Optometry</strong> <strong>Today</strong>.<br />

Paediatric <strong>Optometry</strong> Part 2<br />

COURSE CODE: C-16234 O/D/CL<br />

Professor Bruce JW Evans BSc PhD<br />

FCOptom DipCLP DipOrth FAAO FBCLA<br />

46<br />

20/05/11 VRICS<br />

A<br />

1. What is the MOST likely diagnosis for the condition shown<br />

in Image A?<br />

a) Right lateral rectus palsy<br />

b) Left lateral rectus palsy<br />

c) Left Duane’s syndrome<br />

d) Left Brown’s syndrome<br />

2. What is the MOST appropriate action to take for the<br />

condition shown in Image A if the patient is asymptomatic<br />

and says there has been no change since infancy when it was<br />

investigated in the hospital eye service?<br />

a) No action required. Monitor and review routinely in two years<br />

b) Prescribe near point of convergence exercises<br />

c) Refer to ophthalmology routinely<br />

d) Refer to ophthalmology as an emergency<br />

3. What is the MOST appropriate action to take if the condition<br />

shown in Image A is observed in a six-year-old child and<br />

their parent says that it had always been present but never<br />

investigated?<br />

a) Prescribe bifocal spectacle lenses for constant wear<br />

b) Prescribe negative lenses to induce accommodative convergence<br />

c) Refer to ophthalmology because the condition is likely to worsen<br />

and requires surgery<br />

d) Refer to ophthalmology because the condition may be associated<br />

with ocular/systemic pathology<br />

B<br />

4. A cycloplegic refraction at a six-year-old child’s first eye<br />

examination yielded the clinical information shown in Image B.<br />

What is the most likely diagnosis?<br />

a) Strabismic amblyopia<br />

b) Bilateral amblyopia<br />

c) Anisometropic amblyopia<br />

d) Iatrogenic amblyopia<br />

5. For the patient in Q4 and based on the information in Image B,<br />

what is the MOST appropriate management approach?<br />

a) Prescribe refractive correction, monitor every three months, begin<br />

part-time occlusion if VA doesn’t improve<br />

b) Prescribe no refractive correction, monitor every three months, begin<br />

full-time occlusion immediately<br />

c) Prescribe refractive correction, monitor every six months, begin<br />

full-time occlusion immediately<br />

d) None of the above<br />

6. If fitting contact lenses for the patient in Q4 and with the<br />

clinical information in Image B, which of the following statements<br />

is TRUE?<br />

a) Contact lenses should not be prescribed until the patient becomes an<br />

adult<br />

b) Contact lenses are contra-indicated for <strong>this</strong> patient due to the VA<br />

c) Full-time occlusion will be required if contact lenses are worn instead<br />

of spectacles<br />

d) Aniseikonia will be reduced with contact lenses compared with<br />

spectacles


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<br />

About the author<br />

Professor Bruce Evans is a practising optometrist who has been involved in clinical research in<br />

many areas of optometric practice for over 20 years. He is director of research at the Institute of<br />

<strong>Optometry</strong> and a visiting professor to City University and to London South Bank University where<br />

he is involved in the Doctor of <strong>Optometry</strong> programme.<br />

Associated Reading<br />

1. Allen, Evans & Wilkins. (2010) Vision and reading difficulties, Ten Alps Media, London.<br />

2. DeRespinis et al. (1993) Duane’s retraction syndrome. Surv.Ophthalmol. 38:257-288.<br />

3. Evans. (2007) Pickwell’s Binocular Vision Anomalies, Elsevier, Oxford.<br />

4. Wilkins et al. (1994) Ophthal.Physiol.Opt. 14:365-370.<br />

8. Based on the information given in Image C, what is the<br />

MOST likely clinical diagnosis?<br />

a) Visual conversion reaction (hysterical reaction)<br />

b) Meares-Irlen syndrome (visual stress)<br />

c) Accommodative insufficiency<br />

d) All of the above<br />

47<br />

9. For the patient in Image C, which of the following<br />

statements is TRUE?<br />

a) Spectacles should be worn for schoolwork and the required colour<br />

checked every year<br />

b) The condition can only be corrected with spectacles and not with<br />

contact lenses<br />

c) Soft monthly disposable contact lenses are the preferred correction<br />

option<br />

d) The precision tinted lenses are likely to cure dyslexia<br />

20/05/11 VRICS<br />

C<br />

10. What is the name and purpose of the test being<br />

conducted in Image D?<br />

a) Von Graefe’s test of dissociated heterophoria<br />

b) Cover-uncover test for heterotropia<br />

c) Prism bar test for fusional reserves<br />

d) Fixation disparity test for aligning prism<br />

11. When conducting the test shown in Image D, which of<br />

the following statements is FALSE?<br />

a) It should be conducted with the patient wearing their habitual<br />

refractive correction<br />

b) The test can be performed at near only, not at distance<br />

c) The near working distance should be consistent with the patient’s<br />

habitual working distance<br />

d) The convergent fusional reserves are measured using base out<br />

prisms<br />

D<br />

7. For the patient in Image C, which of the following additional<br />

tests should be conducted in order to aid the clinical diagnosis?<br />

a) Aligning prism (fixation disparity)<br />

b) Accommodative lead/lag (dynamic retinoscopy)<br />

c) Accommodative convergence / accommodation ratio<br />

d) All of the above<br />

12. If the test in Image D reveals a low value when testing<br />

with Base Out prism, and there is a marked near exophoria,<br />

which of the following would be the LEAST appropriate<br />

treatment?<br />

a) Eye exercises<br />

b) Prescription of Base In prism<br />

c) Prescription of negative spectacle lenses<br />

d) Prescription of bifocal spectacle lenses


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DIARYDATES<br />

<br />

MAY<br />

23 Scotlens, Tron Theatre, Trongate, Glasgow,<br />

Contact lens training day (01506 844 272)<br />

NEW... 31 AOP, Fairfield House Hotel, 12<br />

Fairfield Road, Ayr, regulations roadshow<br />

(lindamarriott@aop.org.uk)<br />

Get on your bike to ID 2011<br />

Independents looking to improve their business strategy and<br />

increase sales will have a variety of lectures to help them at the July<br />

4 Independents Day in Birmingham.<br />

Returning to its regular location of the Motorcycle Museum, <strong>this</strong><br />

year’s schedule includes lectures on improving sales, marketing,<br />

using social media in your business and an ‘optical assistants track’<br />

presented by Sarah Morgan.<br />

Limited places are also available on a series of workshops – priced<br />

at £10 each and covering topics: Doing your own practice PR,<br />

merchandising your practice, communication, and making the most<br />

out of VAT rules.<br />

Tickets are now available from www.independentsday.co.uk with<br />

an ‘early bird’ discount until May 31.<br />

23 Sportvision, Walkers Staduim, Leicester,<br />

‘Sportfair’ (www.sportvision.co.uk)<br />

23 TMR, Holiday Inn, Oxford Street, London,<br />

Optical assistant/receptionist course one<br />

(info@tmr.co.uk)<br />

24 TMR, Holiday Inn, London, Optical<br />

assistant/receptionist course two SEE ABOVE<br />

24-26 Vision-X, Dubai International<br />

Convention Centre, UAE (www.vision-x.ae)<br />

25 TMR, Holiday Inn, Oxford Street, London,<br />

Commercial dispensing SEE ABOVE<br />

25 Royal College of Ophthalmologists, The<br />

ICC, Birmingham, Allied professions day<br />

(events@rcophth.ac.uk)<br />

26 TMR, Holiday Inn, Oxford Street, London,<br />

Optical management and marketing SEE<br />

ABOVE<br />

26-29 BCLA, Manchester Central Convention<br />

Complex, Manchester, BCLA conference and<br />

exhibition (events@bcla.org.uk)<br />

JUNE<br />

NEW... 1 AOP, The Kingsmills Hotel, Culcabock<br />

Road, Inverness, regulations roadshow SEE<br />

ABOVE<br />

6 NES, Macdonald Rusacks Hotel,<br />

Pilmour Links, St Andrews, Fife, Developing<br />

optometric skills (www.nes.replaylearning.<br />

com/clinical-skills)<br />

7 North London AOP, Moorfields Eye Hospital,<br />

London, EC1V, CET meeting (stevedross10@<br />

hotmail.com)<br />

NEW… 8 FMO, Birmingham NEC, West<br />

Midlands, summer meeting (sfisher@fmo.<br />

co.uk)<br />

13-17 J&J, The Vision Care Institute,<br />

Pinewood, Wokingham, OSCE preparation<br />

one-day courses (www.thevisioncare<br />

institute.co.uk)<br />

14 Hampshire LOC, Chilworth Manor,<br />

Chilworth, Southampton, Demonstration<br />

of OCT, AGM and CET lecture (www.<br />

hampshireloc.org.uk)<br />

49<br />

20/05/11 DIARY DATES


50 28<br />

08/04/11 20/05/11 COVER DR JOE STORY ELLIS<br />

GLOBAL<br />

State of the union<br />

At the AOP agm Dr Joe Ellis OD, president of the American Optometric Association, gave an<br />

overview of the progress of optometry in the US and in his home state<br />

‘‘<br />

functions carried out at a central location, it allows us to be<br />

I practice in a town in Kentucky with a<br />

population of 5,000 people. I’m also involved<br />

in something considered rather unique, which<br />

is what we call a ‘business practice consortium’, with 12<br />

other ODs and two ophthalmologists. We remain independent<br />

practitioners but we collectively have a central business office<br />

that runs our [corporate] operations. A number of years ago<br />

we were all practising very well, but the business side of our<br />

practice was doing very poorly. Now, with all the business<br />

more efficient in our business practices, and we’ve had that<br />

model for about 12 years.<br />

This model has additionally helped us to be ready for the<br />

healthcare reform changes going on in the US. Healthcare<br />

in the US is big business, and it’s actually nearly 20% of the<br />

US’s GDP (gross domestic product). So we had to learn to be<br />

good business individuals over time, and we’ve been very<br />

successful in that model.<br />

We have 36,000 optometrists in the US in 6,500<br />

communities, and in many of those communities we’re the<br />

only form of eye care provision.<br />

“Looking to the UK, it’s very<br />

important that optometry is<br />

present ‘at the table’ during the<br />

process of change in the NHS...”<br />

In the past decades, US states have passed laws to extend<br />

our scope of practice. But we have a lot more work to do to<br />

make our scope of practice uniform across the country.<br />

Looking to the UK, it’s very important that optometry is<br />

present at the table [of decision makers] during the process<br />

of change in the NHS – back in 1966 in the US the House of<br />

Delegates voted not to include optometry in the Medicare<br />

programme, and it took us 20 years for optometry to be<br />

included in that system. Being involved in the Medicare<br />

programme was huge for optometry in the States because it<br />

allowed us to become part of the [wider] medical eye care<br />

system in the US.<br />

We’re very proud of our recent Bill in Kentucky, Better<br />

Access to Quality Eyecare, which extends our scope of<br />

practice. One of the things which is exciting is the ability to<br />

use laser therapy, and other eye care procedures. My state is<br />

very rural, and patients would have to travel many miles to<br />

have treatments, but in many cases they can now visit their<br />

local optometrist to have procedures, as well as diagnosis and<br />

follow-up care.<br />

We had built key personal relationships in the state over 20<br />

years and managed to pass the Bill in record time in two weeks.<br />

We were the focus of much media attention because of the how<br />

the Bill passed so quickly, due to the fact that we were wellprepared,<br />

ready to go when we got a window of opportunity.<br />

What will the Bill produce in future? I can’t tell you, but<br />

our board will be able to do what is in the best<br />

interests for citizens in Kentucky, and ‘step up to<br />

the plate’ to provide more and different kinds of<br />

primary eye care in the future.


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your move and much more besides. We can also assist those wishing to spend a short time working<br />

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But you don’t have to go all the way ‘down under’ to find out how it works – from 26th-29th May our<br />

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To find out more about the opportunity that awaits you ‘down under’ or to book in for a chat with<br />

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CET CONTINUING<br />

EDUCATION<br />

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View CET FAQ Go to www.optometry.co.uk<br />

52<br />

20/05/11 CET<br />

Assessment and<br />

management of AMD<br />

REFERRAL REFINEMENT PART 4 COURSE CODE: C-16276 O/D<br />

Dr Alison Binns, BSc (Hons), PhD, MCOptom<br />

The previous article in <strong>this</strong> series outlined the key features of age-related macular<br />

degeneration (AMD), a condition that is responsible for more than half of all<br />

registrations as sight-impaired or severely sight-impaired in the UK. 1 A review<br />

of treatments showed that medical intervention is currently only available<br />

for those with the active, wet form of the disease. Although those with early<br />

AMD (also known as age-related maculopathy - ARM), dry AMD (geographic<br />

atrophy), and end stage wet AMD are not responsive to current medical<br />

treatments, they still present at optometric practices requiring management.<br />

This article provides an overview of the optometric assessment of patients with<br />

suspected ARM and AMD, and appropriate management of these patients.<br />

Clinical Assessment of ARM<br />

and AMD<br />

Diagnosis and monitoring of AMD in the<br />

clinic has historically been based on the<br />

assessment of visual acuity (VA), Amsler<br />

chart, and fundus examination of retinal<br />

signs. Fundus examination in recent<br />

years has expanded to include not only<br />

direct and indirect ophthalmoscopy,<br />

but also imaging techniques such as<br />

(stereo) fundus photography and optical<br />

coherence tomography (OCT). Intraretinal<br />

or sub-retinal fluid accumulation<br />

or sub-retinal pigment epithelium (RPE)<br />

neovascular membranes will cause a<br />

raised area of the retina, which may not<br />

be immediately appreciated without a<br />

three dimensional view of the fundus.<br />

Binocular indirect ophthalmoscopy<br />

(Volk or BIO headset) and stereo<br />

fundus photography provide a means<br />

of accurately identifying elevations of<br />

the retina. OCT, which provides a crosssectional<br />

view of the retinal layers, not<br />

only allows the clinician to identify<br />

raised or thickened areas of the retina,<br />

but also allows some visualisation of the<br />

nature of the material that is causing the<br />

elevation. For example, Figure 1 shows<br />

a serous pigment epithelial detachment<br />

(PED), where the fluid under the RPE<br />

is seen as black due to its low relative<br />

optical reflectivity, whilst Figure 2 shows<br />

a fibrovascular membrane, where the<br />

hyper-reflective material underlying the<br />

RPE is clearly visible on the tomogram.<br />

Furthermore, the local elevations of<br />

the RPE caused by drusen are also<br />

apparent on an OCT image (Figure 3).<br />

When a patient is referred to the<br />

hospital with suspected wet AMD,<br />

fluorescein angiography is carried out<br />

as a standard procedure to confirm<br />

the presence and type of choroidal<br />

neovascularisation.<br />

Fluorescein<br />

angiography is also an important<br />

tool in differentiating between<br />

neovascularisation<br />

attributable<br />

to AMD and that caused by other<br />

conditions such as myopia and<br />

birdshot choroidopathy, which may<br />

require different treatment strategies. 2<br />

VA is often relatively unaffected in<br />

early AMD, but there is evidence to<br />

suggest deficits in other aspects of visual<br />

function when fundus changes are still<br />

mild. Reduced sensitivity to flicker 3<br />

and elevated cone and rod thresholds 4<br />

have been reported in individuals<br />

with ARM before marked VA loss has<br />

occurred. There is substantial evidence<br />

that the rod and cone adaptation are<br />

also delayed in very early macular<br />

disease. 5,6 The macular photostress test<br />

is one way that cone adaptation may<br />

be assessed quickly and easily in the<br />

Figure 1<br />

Fundus photograph (left) and OCT image (right) of serous PED. Black arrow indicates location of OCT scan.<br />

Note the bright band of OCT image corresponding to the RPE (marked with a green arrow) shows domeshaped<br />

elevation with accumulation of fluid beneath, seen as a dark region due to its low relative optical<br />

reflectivity. Images courtesy of Ashley Wood, Cardiff University


clinic. Margrain and Thomson 7 found<br />

the technique to be most repeatable<br />

after exposure of the macula to an<br />

ophthalmoscope light for 30 seconds,<br />

followed by assessment of the time taken<br />

for VA to return to within one line of its<br />

pre-bleach level. Their data suggest that<br />

a healthy 60-year-old person should<br />

have a recovery time of less than about<br />

60 seconds, and that any delay beyond<br />

<strong>this</strong> may be considered abnormal.<br />

There is also evidence that patients<br />

who are at higher risk of developing<br />

choroidal neovascularisation will<br />

have more marked delays on the<br />

macular photostress test. 8 This may<br />

provide a useful adjunct to the Amsler<br />

chart, which is commonly used to<br />

look for central visual distortions in<br />

patients at risk of wet AMD (Figure 4).<br />

Optometric management of<br />

ARM and AMD<br />

Age-related maculopathy<br />

On identifying drusen or pigmentary<br />

changes in the retina, a key role of<br />

the optometrist is to exclude the<br />

possibility of neovascular changes<br />

through thorough fundus examination<br />

and checking for marked central visual<br />

field distortions using the Amsler chart<br />

(bearing in mind that drusen may<br />

themselves cause small distortions).<br />

These patients should be referred for<br />

urgent ophthalmological assessment<br />

if they have noticed a sudden onset<br />

of blurring or distortion of the central<br />

vision. Not all patients with drusen will<br />

imminently develop severe visual loss<br />

(one study observed that nine out of 49<br />

patients with bilateral drusen developed<br />

severe sight loss in at least one eye<br />

over a period of about five years). 9<br />

However, patients should be made<br />

aware of the risks of developing late<br />

AMD and the symptoms of wet AMD.<br />

Patients with risk factors for developing<br />

choroidal neovascularisation (eg, lots of<br />

Figure 2<br />

Fundus photograph (left) and OCT image (right) of choroidal neovascular membrane resulting in PED.<br />

Black arrow indicates location of OCT scan. Note disruption of RPE on OCT image, and reflective material<br />

beneath (red arrow). Images courtesy of Ashley Wood, Cardiff University<br />

large soft and confluent drusen and/or<br />

focal hyperpigmentation, or wet AMD<br />

in the fellow eye) should be monitored<br />

particularly closely. Amsler charts<br />

may be given to patients to take home<br />

so that they can check for distortions<br />

in their vision on a daily basis. It is<br />

important that the patient understands<br />

how to carry out the test (for example,<br />

the importance of checking each eye<br />

separately), and it is also vital that<br />

they understand the need for prompt<br />

assessment should any changes<br />

in their vision become apparent.<br />

The optometrist should consider<br />

giving advice to patients with ARM<br />

about lifestyle changes which may<br />

reduce their risk of developing<br />

advanced AMD. Epidemiological 10<br />

and longitudinal 11 studies have<br />

consistently reported that smoking is<br />

the strongest modifiable risk factor for<br />

the development of late AMD, which<br />

gives a firm basis for recommending<br />

that patients with ARM stop smoking.<br />

Some population-based studies have<br />

indicated that increased light exposure,<br />

especially to short wavelength (blue)<br />

light, may also be a risk factor for<br />

AMD. 12-17 Although <strong>this</strong> finding has<br />

not been universal, 18,19 it may be wise<br />

to advise individuals at risk of AMD<br />

and those with early fundus changes<br />

to wear protective sunglasses when<br />

outdoors, especially on bright days.<br />

Other nominated modifiable risk factors<br />

such as elevated body mass index<br />

(BMI), lack of physical activity and<br />

excessive alcohol consumption are less<br />

consistently significant across studies. 20<br />

Nutritional supplements<br />

The efficacy of nutritional supplements<br />

in preventing or delaying the onset of<br />

late AMD has been a matter of some<br />

debate. The first large randomised<br />

controlled trial of the benefits of<br />

supplementation for people with early<br />

ARM was the Age-Related Eye Disease<br />

Study (AREDS). 21 This study reported<br />

a 28% risk reduction in progression<br />

from intermediate to late AMD over five<br />

years in people taking a combination of<br />

zinc plus antioxidants (high dosage of<br />

vitamins C, E and beta carotene). There<br />

was evidence of a beneficial effect in<br />

those who had at least one large druse,<br />

multiple intermediate sized drusen,<br />

parafoveal geographic atrophy in one or<br />

both eyes, or unilateral advanced AMD<br />

(individuals with only small drusen<br />

did not benefit). There is, therefore, a<br />

strong case for recommending vitamin<br />

supplements conforming to the AREDS<br />

formulation for people who fall into<br />

<strong>this</strong> ‘intermediate AMD’ category.<br />

53<br />

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regular fish and green, leafy vegetables<br />

in their diet is a reasonable precaution<br />

to take, but it should be noted that<br />

the protective effect cannot be fully<br />

determined until large, randomised<br />

controlled trials have been carried out.<br />

54<br />

20/05/11 CET<br />

Figure 3<br />

Fundus photograph (left) and OCT image (right) of drusen. Black arrow indicates location of OCT scan. Note<br />

bright band of OCT image corresponding to RPE (marked with a green arrow) is raised by underlying drusen<br />

(red arrows). Images courtesy of Ashley Wood, Cardiff University<br />

Contraindications for the AREDS<br />

supplements include smoking, anaemia<br />

and Alzheimer’s disease. 20 Some<br />

supplements that are currently available<br />

commercially lack beta carotene and so<br />

are less hazardous to current smokers.<br />

However, there is less rigorous<br />

evidence available regarding the efficacy<br />

of such non-AREDS formulations.<br />

Evidence for the beneficial effects<br />

of other dietary factors is less robust.<br />

Omega-3 long chain polyunsaturated<br />

fatty acids are required to maintain<br />

healthy photoreceptor outer segments,<br />

and may be associated with preventing<br />

oxidative, inflammatory and age-related<br />

damage to the retina. Oily fish such as<br />

salmon and tuna are rich in omega-3<br />

fatty acids, and other sources include<br />

nuts, seeds and olive oil. A recent<br />

systematic review of nine studies that<br />

had<br />

evaluated<br />

the benefits of<br />

omega-3<br />

fatty<br />

acid intake (and<br />

included a total<br />

of 88,974 people)<br />

found that a high<br />

dietary<br />

intake<br />

of omega-3 was<br />

associated<br />

with<br />

a 38% reduction<br />

in the risk of<br />

d e v e l o p i n g<br />

advanced AMD. 22 There was also an<br />

apparent decrease in the risk of early<br />

AMD with regular fish consumption.<br />

The carotenoids lutein and<br />

zeaxanthin, which are the main<br />

constituents of macular pigment, have<br />

also been the subject of much interest<br />

given their protective antioxidant<br />

and short wavelength absorption<br />

characteristics. Large epidemiological<br />

studies have found a reduced incidence<br />

of intermediate and advanced AMD<br />

in those individuals with the highest<br />

dietary intake of these dietary factors,<br />

suggesting that they may indeed have<br />

a protective effect in individuals<br />

predisposed to AMD. 23 Green, leafy<br />

vegetables such as kale and spinach<br />

are a particularly good source of<br />

these carotenoids. On the basis of the<br />

evidence, advising patients to include<br />

Wet AMD<br />

Figure 4<br />

Image showing the Amsler chart as it may be perceived by a patient with distortions due to wet AMD.<br />

Images courtesy of National Eye Institute, National Institute of Health<br />

Patients who require urgent referral<br />

to the hospital eye service (HES) by<br />

the optometrist are those who present<br />

with newly developed wet AMD. These<br />

patients are at risk of rapid development<br />

of visual loss, and are also the patients<br />

who could potentially benefit from<br />

medical intervention, particularly<br />

the anti-VEGF therapy ranibizumab<br />

(‘Lucentis’; Novartis Pharma AG,<br />

Switzerland and Genentech, California).<br />

There are guidelines provided by the<br />

College of Optometrists for referral of<br />

AMD cases, but these were published<br />

in 2005, pre-dating the widespread use<br />

of therapies based on growth factor<br />

inhibitors. 24,25 Other referral guidelines<br />

have been published since, for example<br />

by Novartis, with specific reference to<br />

anti-VEGF treatments. 26 The key features<br />

of these documents are the same; newly<br />

developed wet AMD warrants urgent<br />

attention by an ophthalmologist. Delayed<br />

treatment for wet AMD has been strongly<br />

associated with a poorer visual outcome,<br />

so time is of the essence. 27 Some health<br />

authorities now employ a direct referral<br />

scheme for these patients,<br />

for example hospitals in<br />

Wales use an AMD direct<br />

referral pad, adapted<br />

from the Thames Valley<br />

Macular Group Referral<br />

Pad, which allows urgent<br />

and direct referral straight<br />

to the local macular<br />

specialist. In a different<br />

scheme,<br />

Manchester<br />

Royal Eye Hospital<br />

runs an optometry-led


fast-access direct referral clinic, in<br />

which optometrists and GPs may refer<br />

patients directly to a referral refinement<br />

optometrist, who can then re-direct<br />

either to the retinal specialist clinic<br />

for treatment, or to alternative clinics/<br />

discharge. 24 It is of great importance<br />

that all optometrists familiarise<br />

themselves with the local protocols for<br />

normal referrals and fast track referrals.<br />

Signs and symptoms of wet AMD<br />

requiring urgent treatment are<br />

summarised in Table 1. The key retinal<br />

features are: intra-retinal/sub-retinal<br />

or sub-RPE haemorrhage, the presence<br />

of exudates (which suggests leakage<br />

from the vessels, indicating a need<br />

for urgent treatment), intra-retinal or<br />

sub-retinal fluid, PED, raised central<br />

retina, and/or visible neovascular<br />

membrane (often seen as a greenish<br />

or greyish lesion). Functional changes<br />

include metamorphopsia, recent onset<br />

blurred central vision, VA loss and<br />

uniocular hyperopic shift. Clinical<br />

trials suggest that baseline VA does not<br />

influence the outcome of ranibizumab<br />

treatment within the range of 6/12 to<br />

6/48, and NICE guidelines support<br />

medical intervention if presenting VA<br />

is within the range of 6/12 to 6/96. 2<br />

Advanced AMD<br />

When AMD has advanced to a stage<br />

where VA is markedly reduced (to less<br />

than 6/96), as a result of geographic<br />

atrophy or advanced wet AMD including<br />

fibrosis or disciform scarring, treatment<br />

is unlikely to result in a positive<br />

outcome. 2 These patients should still be<br />

referred to the HES on a non-urgent basis<br />

for assessment of the fellow eye, and also<br />

to determine whether they may benefit<br />

from other services available. A low<br />

vision assessment, visual impairment<br />

counselling and/or registration as sight<br />

impaired or severely sight impaired may<br />

be appropriate. If they have only early<br />

changes in the fellow eye, provision<br />

of an Amsler grid for self-assessment,<br />

and advice on lifestyle changes<br />

should also be given (eg, stopping<br />

smoking, nutritional supplements).<br />

For patients with an AMD-related<br />

visual impairment who are not<br />

amenable to treatment, the optometrist<br />

can also give useful advice on<br />

household modifications that may help<br />

with performance of daily activities.<br />

Generally increased lighting levels,<br />

with directional lighting when reading,<br />

can be particularly beneficial. Advice<br />

on improving contrast can also be<br />

helpful, for example suggesting that<br />

the patient use a thick black felt tip<br />

pen when writing. Later articles in <strong>this</strong><br />

55<br />

20/05/11 CET<br />

Fundus Features Functional Status Optometric Action<br />

Dry ARM<br />

• Drusen (several small hard drusen are<br />

considered a normal ageing change)<br />

• Focal Hyperpigmentation<br />

• Slight distortion on Amsler grid,<br />

corresponding to location of drusen<br />

• Gradual reduction in VA<br />

Monitor, advise on lifestyle<br />

changes (eg, stopping smoking<br />

and nutritional supplements)<br />

and provide Amsler grid for selfassessment.<br />

Wet AMD<br />

(Suitable<br />

for<br />

Treatment)<br />

• Haemorrhage (sub-RPE, sub-retinal, intraretinal)<br />

• Exudates (requires urgent referral as it is a<br />

sign of leakage from new vessels)<br />

• Visible retinal elevation<br />

• Sub-retinal fluid or pigment epithelial<br />

detachment<br />

• Sub-retinal neovascular membrane may be<br />

seen as greenish grey lesion<br />

• Presence of markedly distorted,<br />

blurred, or absent lines on Amsler grid<br />

• Recent onset marked reduction in VA<br />

(6/12 to 6/96)<br />

• Hyperopic shift in Rx<br />

REFER URGENTLY<br />

(via rapid access referral route if<br />

available locally)<br />

Advanced<br />

AMD<br />

• Geographic atrophy<br />

• Disciform scar<br />

• Extensive exudates, haemorrhage, fibrosis,<br />

macular elevation<br />

• Central scotoma on Amsler chart<br />

• VA reduced to below 6/96<br />

Refer non-urgently to assess<br />

fellow eye, and consider LVA<br />

assessment and training, visual<br />

impairment counselling and<br />

registration.<br />

Table 1<br />

Summary of the clinical features of ARM, wet AMD and advanced AMD, and appropriate action for optometrists


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56<br />

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series will look at the management of<br />

patients with low vision at greater depth.<br />

Summary<br />

Patients with active wet (neovascular)<br />

AMD require urgent medical treatment to<br />

prevent rapid visual loss occurring. It is<br />

important that all optometrists are aware<br />

of the urgent referral pathway for these<br />

patients in their area. Those individuals<br />

with early AMD may benefit from<br />

guidance about modifiable risk factors,<br />

particularly with respect to smoking and<br />

the potential positive effect of dietary<br />

supplements. Even if the presence of<br />

wet AMD has been excluded, advice on<br />

monitoring for symptoms of choroidal<br />

neovascularisation and the provision of<br />

Amsler charts is advisable, especially<br />

for those patients with risk factors for<br />

development of wet AMD (such as<br />

choroidal neovascularisation in the fellow<br />

eye, or lots of large soft and confluent<br />

drusen or focal hyperpigmentation of<br />

the retina). Patients with end stage AMD<br />

(geographic atrophy/disciform scarring)<br />

should be referred non-urgently to check<br />

the status of the fellow eye, and for low<br />

vision aid provision and training, or<br />

registration as sight impaired or severely<br />

sight impaired. As new treatments<br />

become available, referral guidelines<br />

are likely to be reviewed in the future.<br />

Five key points to remember:<br />

• Patients with early AMD should<br />

be thoroughly examined to exclude<br />

possibility of wet AMD and given<br />

an Amsler chart to self-monitor.<br />

• Stopping smoking, taking AREDS<br />

formulation dietary supplements<br />

(to non-smoking patients only),<br />

and the use of sunglasses on bright<br />

days should be recommended.<br />

• If a patient has any signs of wet AMD<br />

(Table 1), has noticed a sudden onset<br />

of blurring or distortion of the central<br />

vision, or shows marked distortion<br />

on the Amsler grid, refer urgently<br />

for ophthalmological assessment.<br />

• Referral pathways vary between<br />

areas, and it is important for all<br />

optometrists to know their local system.<br />

• When AMD has advanced to endstage<br />

disciform scarring or geographic<br />

atrophy, refer non-urgently for low<br />

vision assessment and evaluation of the<br />

fellow eye. Advise on the importance<br />

of improving lighting and contrast.<br />

About the author<br />

Dr Alison Binns is an optometrist<br />

and a lecturer at the School of<br />

<strong>Optometry</strong> and Vision Sciences, Cardiff<br />

University. Her main research interests<br />

include the early detection and monitoring<br />

of age-related macular degeneration and<br />

electrophysiology of the visual system.<br />

References<br />

See http://www.optometry.co.uk<br />

clinical/index. Click on the article title<br />

and then download "references".<br />

Module questions<br />

PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight<br />

on June 17 2011 - You will be unable to submit exams after <strong>this</strong> date – answers to the module will be published on<br />

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Course code: C-16276 O/D<br />

1) Which of the following is NOT an advantage of OCT when<br />

assessing AMD?<br />

a) It allows visualisation of changes to different retinal layers<br />

b) It helps differentiation between different types of PED<br />

c) It allows differential diagnosis of classic and occult choroidal<br />

neovascularisation<br />

d) It helps to identify areas of retinal thickening due to oedema<br />

2) The ‘macular photostress test’ provides a rapid<br />

assessment of:<br />

a) Speed of cone adaptation<br />

b) Speed of rod adaptation<br />

c) Cone absolute threshold<br />

d) Rod absolute threshold<br />

3) If a patient presents with bilateral soft drusen in the<br />

macular area and VA of 6/6 in both eyes, what is the MOST<br />

appropriate course of action?<br />

a) Refer for urgent ophthalmological assessment<br />

b) Advise on lifestyle changes and monitor<br />

c) Refer for non-urgent ophthalmological assessment<br />

d) Refer for low vision assessment<br />

4) If a patient presents with recent loss of central vision in their right<br />

eye, accompanied by haemorrhage and oedema in the macular region,<br />

and the best VA is 6/36, what is the MOST appropriate course of action?<br />

a) Refer for urgent ophthalmological assessment<br />

b) Advise on lifestyle changes and monitor<br />

c) Refer for non-urgent ophthalmological assessment<br />

d) Refer for low vision assessment<br />

5) Which of the following statements about dietary supplements for<br />

AMD is TRUE?<br />

a) Low dose vitamin C and E taken daily reduces risk of progression from early to<br />

late AMD<br />

b) High dose vitamin C and E and beta carotene plus zinc taken daily reduces risk<br />

of developing early AMD within five years, in healthy individuals<br />

c) High dose vitamin C and E and beta carotene plus zinc taken daily reduces risk<br />

of progression from intermediate to late AMD within five years<br />

d) High dose vitamin C and E and beta carotene plus zinc taken daily reduces risk<br />

of further visual loss in those patients with bilateral wet AMD<br />

6) Which of the following statements about the referral of patients with<br />

wet AMD is FALSE?<br />

a) Urgent referral is only necessary if VA is poorer than 6/18<br />

b) Urgent referral is not necessary if VA is poorer than 6/96<br />

c) Sudden onset report of central scotoma should be referred urgently<br />

d) Sudden onset report of blurred central vision should be referred urgently even<br />

in the absence of choroidal neovascularisation


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Dealing with<br />

patient anxiety<br />

COURSE CODE C-16352 O/D/CL<br />

Dr Helen Court, BSc (Hons), PhD, FHEA<br />

A positive eye examination outcome is not solely based upon an<br />

optometrists’ clinical ability but also on whether the patient has their<br />

expectations fulfilled. It is well-established that there are a number of<br />

patient factors that will drive overall consultation success. These include<br />

the level of patient attention, ability to recall information, satisfaction and<br />

patient willingness to comply with advice. 1-3 When any of these patient<br />

factors are compromised there is a risk of negative consequences. For<br />

example, patients who don’t comply with contact lens hygiene advice<br />

heighten the risk of contact lens complications. 4 It is likely that patient<br />

anxiety plays a significant role here and <strong>this</strong> article aims to address some of<br />

these <strong>issue</strong>s and suggests ways to minimise the potential negative effects.<br />

Healthcare research demonstrates<br />

that anxiety is related to a reduction<br />

in patient attention, recall and<br />

compliance. 2,5,6 Furthermore, it<br />

creates a barrier to effective patientpractitioner<br />

communication 7 and<br />

can contribute to wasted healthcare<br />

resources due to non-attendance of<br />

appointments 8,9 and, in other cases,<br />

excessive unnecessary utilisation of<br />

healthcare services. 10,11 Recent research<br />

has confirmed that there is a significant<br />

relationship between patient anxiety<br />

and lower levels of satisfaction following<br />

eye examinations. 12 Dissatisfied patients<br />

are problematic to practice because they<br />

make more complaints, 13 costing practices<br />

both time and money. Of concern is that<br />

up to 25% of patients attending optometric<br />

practice are anxious. 14 In light of <strong>this</strong> it<br />

is helpful for optometrists to be aware of<br />

the <strong>issue</strong>s surrounding patient anxiety.<br />

Figure 1<br />

Spielberger’s trait-state conceptual framework of anxiety (adapted from Spielberger 16 )<br />

The nature of anxiety<br />

In the early 20th Century, Watson and<br />

Morgan 15 presented the original model<br />

for classical conditioning. The basic<br />

theory is that when an initial neutral<br />

and non-anxiety provoking event<br />

(unconditioned stimulus) is paired with<br />

an aversive experience, then an anxiety<br />

response ensues (unconditioned<br />

response). Subsequently, <strong>this</strong> anxiety<br />

response becomes associated with<br />

the aversive experience, and the<br />

unconditioned stimulus then is able to<br />

produce the anxiety reaction. However,<br />

such theories do not explain why some<br />

people are more prone to anxiety than<br />

others. This <strong>issue</strong> was considered by<br />

Spielberger 16 who presented a popular<br />

conceptual framework whereby he<br />

differentiated the concepts of ‘trait’ and<br />

‘state’ anxiety. It is a more complicated<br />

model than simple conditioning; rather<br />

it involves integration between anxiety<br />

proneness (trait anxiety), past learning<br />

and memory, and sensory and cognitive<br />

feedback (Figure 1). This is now a widely<br />

accepted theory forming the basis of<br />

many studies measuring anxiety. 17<br />

Within Spielberger’s anxiety model,<br />

trait anxiety is described as a stable<br />

personality trait, whereas, state anxiety<br />

is a transient experience caused by<br />

a specific perceived threat. Threats<br />

within healthcare are subjective<br />

and determined by the patient’s<br />

thoughts and expectations. If a patient<br />

determines that a situation will lead to<br />

personal negative outcomes, <strong>this</strong> will<br />

be identified as a ‘threat’. Considering<br />

that eyesight is the most valued<br />

sense, 18 any perceived threat is likely<br />

to result in anxiety. For example,<br />

discomfort of clinical procedures,<br />

detection of eye disease and adapting<br />

to spectacles have all been identified<br />

as patient concerns. 14,19-21 The ‘threats’<br />

perceived by patients may vary between<br />

individuals, but all will result in anxiety.<br />

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Which patients are more likely to<br />

be anxious?<br />

Understanding which patients attending<br />

for an eye examination are more likely to be<br />

anxious can help optometrists identify those<br />

who may be more at risk of poor attention,<br />

recall and compliance. Recently, a study<br />

sought to identify which factors predict<br />

patient state anxiety levels in optometric<br />

practice. 22 A total of 366 patients were<br />

asked to complete a questionnaire prior to<br />

their eye examination. The questionnaire<br />

measured state anxiety, trait anxiety and<br />

outcome expectancies. Interestingly, the<br />

results of the study showed that age,<br />

gender, duration since last eye exam and<br />

the reason for appointment were not related<br />

to high anxiety levels. This suggests that<br />

optometrists cannot assume that anxiety is<br />

reserved for one ‘type’ of patient eg, elderly<br />

people. Rather, trait anxiety, expecting<br />

‘bad news’ and being a non-spectacle<br />

wearer were all independent predictors<br />

of increased state anxiety (Table 1). How<br />

these findings apply to clinical practice<br />

is summarised in the following sections.<br />

High anxiety personality types<br />

Trait anxiety is a stable personality trait<br />

which is normally distributed within<br />

the population. 17 However, there are<br />

also smaller groups of people within the<br />

population who have lower and higher<br />

than average trait anxiety levels. Therefore,<br />

the finding that trait anxiety predicts state<br />

anxiety, suggests that there will always<br />

be a group of patients who attend for eye<br />

examinations with high levels of anxiety.<br />

Patients who expect ‘bad news’<br />

It is well reported within other areas of<br />

healthcare that the expectancy of receiving<br />

bad news is a cause of patient anxiety. 23,24<br />

Furthermore, the expectation of ‘bad news’<br />

can stop patients initially articulating their<br />

concerns. 7 Most optometrists have probably<br />

experienced <strong>this</strong> in practice eg, a patient<br />

who had revealed no concerns at the start<br />

of the examination wants reassurance<br />

after a fundus examination that they<br />

‘don’t have a cataract’. This is a common<br />

patient anxiety which is driven by a fear of<br />

‘going blind’. Indeed, the levels of anxiety<br />

associated with losing sight should not be<br />

underestimated. This is demonstrated by<br />

the high levels of anxiety and depression<br />

recorded in patients with low vision. 25<br />

However, optometrists should be aware<br />

that the definition of ‘bad news’ will be<br />

unique to each patient and is not only<br />

related to detection of pathology eg,<br />

identification of a colour vision deficiency<br />

may be insignificant to some individuals,<br />

but devastating for an aspiring pilot.<br />

This highlights the importance of<br />

developing good communication and<br />

rapport with each patient in order to<br />

elicit patient priorities and concerns.<br />

Patients who don’t wear<br />

spectacles<br />

Patients who do not wear spectacles are<br />

more likely to be anxious. One reason<br />

for <strong>this</strong> could be that spectacle wearers<br />

are more familiar with the optometric<br />

experience and as such are more<br />

Non-standardised<br />

Coefficients<br />

B<br />

SE<br />

relaxed. However, a further explanation<br />

may be that patients perceive wearing<br />

spectacles as a ‘threat’. Anecdotal reports<br />

suggest that patients are concerned about<br />

adaption to spectacle wear and the possible<br />

changes to personal appearance. 14,19,21 This<br />

reiterates the importance of identifying<br />

and addressing patient concerns as a<br />

mechanism to reduce patient anxiety.<br />

When are patients anxious<br />

during the consultation?<br />

In addition to understanding which<br />

patients attending practice are most<br />

likely to be anxious, it is also helpful for<br />

the optometrist to know if there are any<br />

specific events during the consultation<br />

that patients find particularly stressful.<br />

To date, only two studies have<br />

investigated patient anxiety during<br />

routine eye examinations and contact<br />

lens fitting. 26,27 Both studies measured<br />

changes in skin conductance (Figure 2), to<br />

assess arousal, which is the physiological<br />

correlate of anxiety. It is based upon the<br />

principle that sweat ducts fill, producing<br />

a more conductive path through the<br />

skin when a person is aroused (the<br />

same principle as a lie detector test). 27<br />

Standardised<br />

Coefficients ß<br />

Trait anxiety 0.278 0.046 0.354 0.000*<br />

Patient/practitioner<br />

relationship:<br />

embarrassment<br />

Possible outcomes (bad<br />

news)<br />

Patient/practitioner<br />

relationship: autonomy<br />

-0.260 0.150 -0.101 0.085<br />

-0.331 0.121 -0.145 0.007*<br />

-0.095 0.150 -0.036 0.529<br />

Physical discomfort -0.074 0.155 -0.024 0.633<br />

Perceived practitioner -0.121 0.204 -0.032 0.555<br />

skills<br />

Spectacle wearer 0.373 0.148 0.122 0.012*<br />

Routine appointment 0.210 0.213 0.087 0.325<br />

Problem appointment 0.044 0.239 0.016 0.853<br />

Emergency appointment -0.526 0.366 -0.083 0.152<br />

Table 1<br />

Multiple linear regression results for the predictors of state anxiety in optometric practice (*significant at<br />

p=0.05) (reproduced from Court et al. 22 )<br />

p


eveal a more fundamental patient concern.<br />

Namely that patients place substantial<br />

value upon good communication with<br />

the optometrist. This is a well-recognised<br />

patient concern within medicine. In<br />

that context, when patients do not feel<br />

Figure 3<br />

Change in mean skin conductance during an<br />

initial contact lens fitting consultation (n=35).<br />

Each point is the mean skin conductance level<br />

obtained from all subjects at key points during<br />

the consultation (reproduced with permission<br />

from Court et al. 26 )<br />

The results of the first study indicated<br />

that patient anxiety levels are not constant<br />

during eye examinations. However, the<br />

specific parts of the eye examination that<br />

make people anxious were difficult to<br />

identify for various reasons (including<br />

a small sample of patients and a<br />

variety of “reasons for visit” for the eye<br />

examination). In a following study, skin<br />

conductance was measured on a larger<br />

group (35 patients) attending practice<br />

for an initial contact lens fit ie, a specific<br />

type of examination/“reason for visit”. 26<br />

This clearly revealed that anxiety levels<br />

are significantly raised at four points of<br />

the consultation: history and symptoms,<br />

contact lens insertion, contact lens<br />

removal and patient advice (Figure 3).<br />

understood by the practitioner, feel out<br />

of control, or do not have their questions<br />

answered, they are less satisfied with the<br />

consultation. 32,33 Communication between<br />

patients and practitioners is a dynamic<br />

and complex process. Considering <strong>this</strong>,<br />

perhaps it is not surprising that patients<br />

show heightened states of anxiety<br />

during these points of the consultation.<br />

These findings are clinically significant<br />

as there is an increased risk of poor<br />

patient attention and recall of what the<br />

optometrist has said. 2,6 For <strong>this</strong> reason<br />

optometrists should not assume that the<br />

patient will remember key information<br />

explained to them during the consultation.<br />

Anxiety during contact lens insertion and<br />

removal<br />

Patient anxiety levels increase when the<br />

optometrist tells a patient “I am now<br />

going to select a contact lens and place it<br />

into your eye”. 26 It is well understood that<br />

the expectation of pain evokes an anxiety<br />

response. 34 However, it is interesting<br />

that <strong>this</strong> heightened state of anxiety<br />

is not maintained upon insertion (or<br />

Figure 2<br />

Application of physiological sensors to the<br />

patient’s fingers to measure level of arousal (the<br />

physiological correlate of anxiety)<br />

patient relax. This will help minimise<br />

the negative effects of anxiety eg, poor<br />

attention and recall. Communication<br />

style and provision of written<br />

information are perhaps two of the most<br />

effective methods to manage anxiety.<br />

Communicate effectively<br />

In order to reduce patient anxiety,<br />

it is essential that the practitioner<br />

identifies the specific ‘threat’ or concern<br />

perceived by the patient. Once <strong>this</strong><br />

has been elicited the optometrist can<br />

communicate information in a clear and<br />

realistic way to the patient and there is an<br />

increased potential for clinical success. 38<br />

At the close of the consultation, the<br />

patient-centred strategy involves the<br />

practitioner initiating a discussion with<br />

the patient to involve them in the decision<br />

making. Patients who feel that they have<br />

59<br />

20/05/11 CET<br />

Anxiety during ‘communicative interaction’<br />

removal) of a second contact lens. 26 This<br />

been involved in their management are<br />

Communicative interaction relates to two<br />

may be because experiencing the event<br />

often more likely to comply with advice.<br />

specific periods during the consultation:<br />

once gave the patients a more accurate<br />

The discussion also allows the practitioner<br />

during history and symptoms-taking<br />

“expectancy”, resulting in a reduction<br />

to check patient understanding<br />

and when offering advice at the end of<br />

of anxiety. Many patients avoid trying<br />

and hence avoid poor compliance.<br />

the consultation. For a patient, dialogue<br />

contact lenses because they are anxious<br />

with a ‘professional’ can be an anxiety-<br />

about having a contact lens in their eye. 3<br />

Provide written information<br />

provoking situation, causing some<br />

However, these results indicate that<br />

It may be beneficial for optometrists to<br />

people to feel embarrassed or silly<br />

after the patient has experienced the<br />

consider providing written materials<br />

(social anxiety). 28,29 Often, the desire to<br />

event once, they are less anxious about<br />

and repeating advice to patients, which<br />

make a good impression further fuels<br />

having the second contact lens inserted.<br />

are techniques used in medical practice<br />

anxiety. 30,31 When the optometrist gives<br />

advice to the patient, there can again be<br />

How to minimise patient anxiety<br />

to improve clinical success. 39,40 Written<br />

information can help reduce anxiety<br />

heightened arousal due to social anxiety.<br />

Identifying potentially anxious patients<br />

by creating accurate expectancies.<br />

However, the heightened anxiety during<br />

is important and allows optometrists<br />

For example, after identifying the<br />

dialogue with the optometrist may also<br />

to modify their routine to help the<br />

misconceptions about wearing contact


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60<br />

lenses, the optometrist could provide<br />

written information to be taken away.<br />

This allows the patient to read and<br />

think about trying contact lenses<br />

in a more relaxed environment.<br />

Written information can also be<br />

used to assist with patient recall. This<br />

is especially useful when discussing<br />

pathology. Optometrists should<br />

never assume that the patient will<br />

remember what they have been told<br />

during an examination, especially if<br />

the patient is anxious. Providing a<br />

leaflet or simply writing the condition<br />

on a piece of paper is a simple way<br />

to ensure the patient remembers and<br />

understands what has been discussed.<br />

Summary<br />

This article has shown how anxiety is<br />

a feature of every optometric practice.<br />

Seeking to understand and explore<br />

patient concerns will assist in improving<br />

outcomes, satisfaction and compliance.<br />

About the author<br />

Dr Helen Court is an optometrist and<br />

lecturer at Cardiff University. Her research<br />

interests include patient-practitioner<br />

communication, anxiety and low vision. The<br />

author acknowledges Cardiff University and<br />

Bausch & Lomb who co-funded the research.<br />

References<br />

See http://www.optometry.co.uk<br />

clinical/index. Click on the article title<br />

and then download “references”.<br />

20/05/11 CET<br />

Module questions<br />

Course code: C-16352 O/D/CL<br />

1. Which of the following has been associated with anxiety?<br />

a) Increased patient satisfaction<br />

b) Increased patient compliance<br />

c) Decreased patient recall<br />

d) All of the above<br />

2. Which of the following statements is TRUE?<br />

a) State anxiety is a stable personality trait<br />

b) Anxiety theories suggest that past experiences and conditioning are<br />

responsible for trait anxiety levels<br />

c) State anxiety is related to anxiety proneness, sensory and cognitive<br />

feedback<br />

d) Every patient has the same trait anxiety level<br />

PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight<br />

on June 17 2011 - You will be unable to submit exams after <strong>this</strong> date – answers to the module will be published on<br />

www.optometry.co.uk. CET points for these exams will be uploaded to Vantage on June 27 2011.<br />

4. Skin conductance recordings show that patients experience<br />

heightened levels of anxiety:<br />

a) When the practitioner removes a contact lens<br />

b) When the practitioner touches the eye<br />

c) During all clinical procedures<br />

d) All of the above<br />

5. Which of the following communication techniques have been<br />

shown to help reduce anxiety?<br />

a) Using a practitioner-centred consultation style<br />

b) Using ‘we’ rather than ‘I’ (plural pronouns)<br />

c) Using closed questions<br />

d) Speaking quietly<br />

3. Why might a patient be anxious when talking to an optometrist?<br />

a) They want to create a ‘good impression’<br />

b) They want to maintain control over the conversation<br />

c) They want to be understood<br />

d) All of the above<br />

6. Which of the following statements about the provision of written<br />

information to anxious patients is FALSE?<br />

a) It is useful for addressing contact lens misconceptions<br />

b) It should always be presented in leaflet format<br />

c) It helps modify outcome expectancies<br />

d) It can assist with patient recall and compliance


OT CET Video<br />

C-14091 O/D: An Introduction<br />

to Domiciliary Eye Care<br />

Written and presented by Dawn Roberts (Joint Chair, Domiciliary Eye care<br />

Committee), <strong>this</strong> video aims to provide a two-part introduction to domiciliary<br />

Eye care for optometrists and dispensing opticians who are considering<br />

working in <strong>this</strong> rewarding area of practice. Topics covered include: the need<br />

for a domiciliary service, patient eligibility, regulations and recommended<br />

equipment.<br />

Part 1 details the changing age demographics of the UK, regulations and<br />

eligibility for domiciliary services and questions whether the needs of all<br />

patients unable to leave their homes are currently being met.<br />

Part 2 offers advice about modifications to the typical sight test routine,<br />

record keeping, domiciliary working environments and aftercare services.<br />

This video is sponsored by Healthcall Optical.<br />

This video features 12 MCQs that have been accredited with 2 CET points and<br />

are GOC approved for Optometrists and Dispensing Opticians.<br />

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

and take the exam.<br />

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

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

The closing date for MCQ submissions<br />

will be June 30, 2011 and the points<br />

will be uploaded to CET optics 10<br />

days later.<br />

SPONSORED BY<br />

www.optometry.co.uk


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when experienced, and benefits of product features most likely to motivate consumers when it comes to eye health/vision correction products. 2. Data on file. Bausch & Lomb Incorporated.<br />

© 2011 Bausch & Lomb Incorporated. ®/ denote trademarks of Bausch & Lomb Incorporated. Other product names/brand names are trademarks of their respective owners.

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