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www.optometry.co.uk March 23 2012 vol 52:6 £4.95<br />

optometrytoday<br />

Journal of the Association of Optometrists<br />

live<br />

GOC role<br />

questioned<br />

NOC 2012<br />

launched<br />

online<br />

enewsletter Six new<br />

CET points<br />

The young ones<br />

Focus on kids’ frames and new action group

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March 23 2012 vol 52:6<br />

30 36 45<br />

News<br />

5 Screening boost<br />

Key bodies across the optical sector have<br />

joined forces to help improve children’s vision<br />

screening<br />

6 Driving call<br />

Fresh calls have emerged for older drivers to<br />

be made more aware of eyesight <strong>issue</strong>s<br />

7 ‘Good progress’<br />

The AOP Board of Directors has decided on<br />

a change at the top ‘in view of the good<br />

progress being made’<br />

8 Comment<br />

The AOP’s interim chief executive Richard<br />

Carswell asks if optometrists have anything to<br />

be grateful for?<br />

12 News Extra<br />

The Law Commission report into health<br />

regulation could mean big changes for the<br />

GOC<br />

Cover story<br />

30-31 Children’s eyewear<br />

With the Easter holidays fast approaching,<br />

OT looks at the latest children’s frames and<br />

sunglasses on offer<br />

Products<br />

36-37 Industry news<br />

A new brochure and MIDO success for Dunelm,<br />

new frames from International Eyewear, plus a<br />

special App from Hoya and also Trading Places<br />

Profile/advice<br />

18 Profile<br />

AOP director Alison McClune looks to the future<br />

of the association and AOP Scotland<br />

26 Children reminder<br />

Practitioners are being urged to highlight<br />

youngsters’ eye health as the Easter break nears<br />

34 Pension reforms<br />

New rules for employers are set to take place,<br />

starting <strong>this</strong> year and there will be a direct cost<br />

Events<br />

20 NOC launched<br />

What delegates can expect from <strong>this</strong> year’s<br />

conference which LOCSU is offering every LOC/<br />

ROC a free place for<br />

22-23 Education Destination<br />

A preview of the two-day seminar in London<br />

next month co-produced by SECO and the AOP<br />

40 Diary dates<br />

The upcoming optical events<br />

Regulars<br />

14,16 Business<br />

Tips on creating a winning team and a strong<br />

practice<br />

28 Pre-reg focus<br />

Advice on conquering Stage 2 exams<br />

32 OT crossword<br />

Our popular monthly prize competition<br />

Clinical<br />

42-43 VRICS: C-18426 O/D<br />

Vision assessment in ocular<br />

disease Part 4<br />

By Dr Raymond Beirne. The last in our popular<br />

series on vision assessment techniques in<br />

ocular disease<br />

45-48 CET 1: C-18550 O/D<br />

Young children’s vision Part 3<br />

Dr Margaret Woodhouse continues her series<br />

by discussing how best to examine young<br />

children, offering key points for conducting<br />

procedures<br />

49-53 CET 2: C-18459 O/D/CL<br />

Ocular allergy and contact<br />

lens wear<br />

This article discusses the optometric<br />

management strategies to maintain successful<br />

contact lens wear in ocular allergic conditions.<br />

Classified<br />

54-57 Jobs<br />

All the latest vacancies<br />

58-62 Marketplace<br />

Your guide to optical products and<br />

services<br />

Give us a call...<br />

...Steve did!<br />

01793 648607<br />

outsideclinic.com<br />

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

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

Cover image courtesy of Zoobug<br />

Feature is online<br />

Video is online<br />


901003 60<br />

Elizabeth Hurley<br />

Sales force telephone numbers:<br />

North West, North Wales & West Midlands Ryan James 07827 894734<br />

North East and Scotland Stephen Raine 07827 894731<br />

South West and South Wales Jamie Lee 07827 894732<br />

South East and East Anglia Hannah Cawte 07827 894733<br />

Telephone: 0121 585 6565<br />


NEWS<br />

Action taken for kids<br />

Key representative bodies<br />

across the optical sector have<br />

joined forces to help improve<br />

children’s vision screening across<br />

the UK.<br />

The new UK Vision Strategy<br />

Action Group aims to support<br />

commissioners in the<br />

implementation of school entry<br />

vision screening for children<br />

across the UK.<br />

The group consists of<br />

representatives from the Optical<br />

Confederation, the College of<br />

Optometrists, the RNIB, the Royal<br />

College of Nursing, the Royal<br />

College of Ophthalmologists<br />

Paediatric Sub-Committee,<br />

the British and Irish Orthoptics<br />

Society, and the Institute of Child<br />

Health and Vision Checks.<br />

Supporting the UK National<br />

Screening Committee (NSC)<br />

policy which recommends that all<br />

children aged four to five-yearsold<br />

have their vision checked<br />

in an orthoptic-led service, the<br />

Action Group will work together<br />

to launch recommendations to<br />

aid commissioners in getting the<br />

NSC’s policy implemented.<br />

Programme director of the UK<br />

Vision Strategy, Anita Lightstone<br />

(pictured), said: “Although recent<br />

high profile surveys indicate<br />

that many children are being<br />

screened, we still need to speak<br />

with a single voice to persuade<br />

commissioners to meet their<br />

responsibilities to all children.”<br />

AOP director of operations,<br />

David Craig, added: “As we know<br />

through our ‘Back to school’<br />

children’s campaign – too many<br />

young people are still missing<br />

out on vital eye care. Recent<br />

statistics report that one in<br />

10 Primary Care Trusts do not<br />

arrange vision screening for<br />

children starting school – <strong>this</strong><br />

must change. The AOP actively<br />

supports the Action Group’s<br />

work to persuade commissioners<br />

to meet their responsibilities to<br />

all children.”<br />

Free eye tests achieve aim<br />

Free eye tests in Scotland<br />

have been hailed a success by<br />

economists at the University<br />

of Aberdeen who have<br />

concluded the policy has<br />

closed the ‘health gap in eye<br />

care between those living<br />

north and south of the border’.<br />

However, the study also<br />

found that the uptake of<br />

optometry services remained<br />

low in poorer households.<br />

The research team, led by<br />

Dr Alexandros Zangelidis<br />

(pictured), used data from<br />

the British Household<br />

Panel Survey and business<br />

records from a multi-branch<br />

private ophthalmic optician<br />

company to assess uptake of<br />

services and any demographic<br />

divisions.<br />

Dr Zangelidis said: “All<br />

evidence, using different<br />

indicators, points in the same<br />

direction – people in Scotland<br />

responded positively to the<br />

free eye care policy. The<br />

figures indicate a rise in the<br />

number of people in Scotland<br />

having their eyes examined<br />

after the introduction of the<br />

policy in April 2006.”<br />

The results also revealed<br />

that wealthier households<br />

were more likely to have an<br />

eye test, both before and after<br />

the policy was introduced.<br />

Commenting on the results,<br />

chair of AOP Scotland, Kevin<br />

Wallace, told OT: “We are<br />

pleased to hear that <strong>this</strong> study<br />

shows that the comprehensive<br />

eye examination funded by<br />

the Scottish Government is<br />

encouraging more people to<br />

visit their optometrist, which<br />

will have a positive impact on<br />

the eye health of the nation.<br />

“The public are becoming<br />

more aware of the benefits of<br />

regular eye examinations to<br />

detect problems early making<br />

them much easier to treat.”<br />

IN BRIEF<br />

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• Price labels, every kind<br />

and colour<br />

• Lens labels, stock and<br />

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• Contact lens packaging<br />

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AOP elections<br />

are extended<br />

AOP members who have not yet<br />

voted in <strong>this</strong> year’s council elections<br />

have until April 5 to cast their vote.<br />

Those who are yet to vote will<br />

receive a letter in the post from the<br />

Electoral Reform Services early next<br />

week telling them of how to vote<br />

before the April 5 extended deadline.<br />

For more details on the elections,<br />

visit www.aop.org.uk.about-theaop/council-elections<br />

Business workshop<br />

The AOP has joined forces with<br />

Myers La Roche to host a workshop<br />

aimed at helping practitioners<br />

increase practice sales and profits.<br />

The event will be held at the<br />

AOP headquarters, London on May<br />

21 from 4pm. The workshop will<br />

cover topics such as, how to attract<br />

new patients to the practice and<br />

how to increase conversion rates<br />

and dispensing values. For more<br />

information and to book visit,<br />

www.aop.org.uk<br />

New OGS committee<br />

chair named<br />

Optometrist Nick Rumney has been<br />

named chair of <strong>Optometry</strong> Giving<br />

Sight’s UK National Committee.<br />

Awareness Week<br />

confirmed<br />

Organisers of National Eye Health<br />

Week have confirmed that the<br />

annual vision awareness week<br />

will be held on September 17-23.<br />

• Dummy security sensors<br />

• Coloured oval price<br />

tickets<br />

3 Isis Court, Wyndyke Furlong, Abingdon OX14 1DZ<br />

Tel 01235 543993 Fax 01235 532118<br />

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

5<br />

23/03/12 NEWS<br />

News updated regularly at www.optometry.co.uk

NEWS<br />

optometrytoday<br />

MARCH 23 2012<br />

Volume 52:6<br />

ISSN 0268-5485<br />


January 1 2011 – December 31 2011<br />

Average Net: 20, 038<br />

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

OT Manager: Louise Walpole<br />

T: 020 7549 2077<br />

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

Deputy Editor:<br />

Robina Moss<br />

T: 020 7549 2072<br />

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

Web Editor:<br />

Emily McCormick<br />

online<br />

T: 020 7549 2073<br />

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

Reporter: Chris Donkin<br />

T: 020 7549 2074<br />

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

Multimedia Editor: Laurence Derbyshire<br />

T: 020 7549 2075<br />

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

Clinical Editor: Dr Navneet Gupta<br />

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

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

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

Editorial Office:<br />

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

Advertising: Vanya Palczewski<br />

T: 020 7878 2347<br />

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

Sponsorship: Sunil Singh<br />

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

CET and bookshop enquiries: Charlotte Verity<br />

T: 020 7549 2076<br />

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

Production: Ten Alps Creative<br />

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

Membership Dept:<br />

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

T: 020 7549 2010<br />

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

Advertising and Production Office<br />

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

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

High Holborn, London WC1A 1NU<br />

Editorial Advisory Board<br />

Vivian Bush, Leon Davies, Cameron Hudson,<br />

Polly Dulley, Dan Ehrlich, Navneet Gupta, Andy<br />

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

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

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

Whitaker, Andy Yorke<br />

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

Published fortnightly for the Association of<br />

Optometrists by Ten Alps Creative<br />

Subscriptions<br />

Alliance Media Limited, Bournehall House,<br />

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

T: 020 8950 9117<br />

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

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

Safety of older drivers<br />

bookshop<br />

live<br />

under investigation<br />

Fresh calls have emerged<br />

enewsletter<br />

The UK Vision Strategy and<br />

RNIB have been given grants<br />

of around £200,000 each in a<br />

£6.8m Department of Health<br />

initiative to ‘test and develop<br />

innovative approaches to<br />

health and wellbeing’.<br />

Cross-sector initiative the<br />

UK Vision Strategy has been<br />

given up to £230,000 to fund<br />

and support three clinical<br />

commissioning groups<br />

in England to design and<br />

evaluate sight loss services;<br />

while the RNIB will use its<br />

grant, of up to £200,000, to<br />

train volunteers and those<br />

who work in eye clinics to<br />

VRICS<br />

for elderly drivers to be made<br />

more aware of eyesight <strong>issue</strong>s<br />

following a new report on older<br />

drivers by the Parliamentary<br />

Advisory Council for Transport<br />

Safety.<br />

The report looks into ways<br />

older people can use transport<br />

more safely including ensuring<br />

that they are safe when driving,<br />

recommending regular eye<br />

tests and suggesting that<br />

optometrists should be ‘ alert<br />

to fitness to drive <strong>issue</strong>s’, along<br />

with pharmacists.<br />

It adds that self-regulation<br />

of a person’s own ability to<br />

drive, including if they meet<br />

eyesight requirements should<br />

be the subject of further study<br />

‘assessing the link between selfregulation<br />

and crash risk’.<br />

The advisory council report<br />

adds: ‘health care providers<br />

should be better supported so<br />

that they can become more<br />

effective in giving advice on both<br />

physical and mental fitness to<br />

drive.’<br />

The AOP’s professional<br />

adviser, Geoff Roberson told<br />

OT: “This report highlights<br />

many of the <strong>issue</strong>s relating to<br />

vision and driving the Optical<br />

Confederation has been<br />

lobbying about for some time;<br />

that drivers should be more<br />

aware of vision related driving<br />

<strong>issue</strong>s, act to ensure their own<br />

safety and the safety of other<br />

road users, make sure they have<br />

regular vision checks and wear<br />

their prescribed spectacles.”<br />

Sight care causes given<br />

share of £6.8m fund<br />

provide support for those<br />

with sight loss when they<br />

are first diagnosed.<br />

The charity confirmed<br />

that training will be across<br />

150 different locations and<br />

the funding will also enable<br />

it to set up a peer support<br />

network for the newly<br />

trained volunteers.<br />

Head of evidence and<br />

service impact at the RNIB<br />

Philippa Simkiss told OT:<br />

“Being told you are losing<br />

your sight or have lost your<br />

sight can be extremely<br />

traumatic. It’s vital that<br />

people are offered the<br />

appropriate, and joined up,<br />

support and services from<br />

the point of diagnosis. This<br />

funding will enable RNIB<br />

to increase the support we<br />

offer.”<br />

Programme director of<br />

UK Vision Strategy, Anita<br />

Lightstone, added: “We<br />

are delighted to receive<br />

<strong>this</strong> funding boost. It<br />

will enable us to put our<br />

commissioning eye care<br />

guidance into action<br />

by supporting clinical<br />

commissioners to design and<br />

deliver effective eye care and<br />

sight loss services.”<br />

CET<br />

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

NEWS<br />

Role change as AOP<br />

makes good progress<br />

The AOP’s Board of Directors<br />

has confirmed the association’s<br />

acting chief executive Richard<br />

Carswell in the post of interim<br />

chief executive until 2013.<br />

The decision was made at<br />

the Board meeting last week:<br />

“in view of the good progress<br />

being made in developing the<br />

association’s strategy for the<br />

foreseeable future”.<br />

The Board’s working party on<br />

recruiting a permanent chief<br />

executive has begun its work,<br />

and the association will be<br />

advertising the post later <strong>this</strong><br />

year. Mr Carswell will participate<br />

in the process of recruiting the<br />

new chief executive and ensuring<br />

a smooth transition. The intention<br />

is that the new chief executive<br />

will deliver on the association’s<br />

Looking to move jobs?<br />

Upload your CV to OT’s CV Uploader<br />

and let employers search for you<br />

For more information visit<br />

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

Looking to move jobs?<br />

The chief executive of the FMO,<br />

Malcolm<br />

co.uk/newsletter-<br />

Polley (pictured), has<br />

been admitted to the livery of the<br />

sign-up<br />

Worshipful Company of Spectacle<br />

Makers, probably the oldest<br />

optical organisation in the world<br />

which was incorporated by Royal<br />

vision and strategy from next year<br />

onwards.<br />

“It is important that the<br />

association has a period of<br />

Upload your CV to OT’s CV Uploader and let<br />

employers search for you<br />

Charter in 1629, following his<br />

broad career in optics.<br />

Mr Polley is perhaps best<br />

known for leading the Optrafair<br />

team which stages the largest<br />

UK optical show, held biennially.<br />

He is also the manufacturing<br />

industry representative for the<br />

Optical Confederation, bringing a<br />

wealth of industry experience and<br />

knowledge to the role.<br />

He started his optical life with<br />

Clifford Brown Opticians in central<br />

London on the dispensing side,<br />

and after 11 years moved to the<br />

Norville Group in Gloucester.<br />

As sales and marketing director<br />

there, he led the team for many<br />

years and was actively involved in<br />

both the frame and lens side of<br />

the Norville business.<br />

He was chairman of the FMO<br />

stability in which to develop<br />

our plans to improve services<br />

to members,” Mr Carswell<br />

told OT.<br />

“With the profession facing<br />

huge challenges, it is time to<br />

look outwards and consider<br />

the wider needs of the<br />

association and its members.”<br />

Mr Carswell took over the<br />

day-to-day running of the<br />

association when the then<br />

chief executive, Bob Hughes<br />

left the AOP in November. He<br />

was deputy chief executive<br />

for many years and is also<br />

the association’s head of<br />

regulatory affairs, advising<br />

AOP members needing help<br />

in their dealings with PCTs,<br />

Health Boards and the GOS<br />

contract.<br />

New honour for Optrafair leader<br />

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

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

optical news, features and CET<br />

Sign-up to OT’s<br />

weekly e-newsletter<br />

at www.optometry<br />

from 2004-6 and then became<br />

chief executive in 2006. Plans<br />

are already well underway for<br />

Optrafair 2013, which will be<br />

held at The NEC, Birmingham,<br />

from April 13-15 next year.<br />

Sign-up to OT’s<br />

weekly e-newsletter<br />

at www.optometry<br />

co.uk/newslettersign-up<br />

IN BRIEF<br />

Optom torch bearers<br />

Two optometrists have been chosen<br />

as ‘inspirational people’ who will<br />

carry the Olympic Flame as it travels<br />

across the UK.<br />

Dr Zahra<br />

Jessa (pictured)<br />

works in<br />

independent<br />

practice in<br />

London. She<br />

also does<br />

refraction and low vision work and<br />

some extended role clinics, working<br />

at the Action for Blind Low Vision<br />

clinics at Judd Street, London, part<br />

of the RNIB. She is a liveryman of the<br />

Worshipful Company of Spectacle<br />

Makers and was awarded the<br />

professional of the year accolade at<br />

the Asian Women of Achievement<br />

Awards in 2010.<br />

Elaine Styles<br />

(pictured) is the<br />

chair of the Vision<br />

Care for Homeless<br />

OT’s dedicated jobs hub provides People charity advice<br />

on writing a successful CV which and encourages cover letter<br />

optometrists to volunteer their<br />

services to enable it to offer free sight<br />

care and free prescription glasses to<br />

‘the most excluded in the UK’. The<br />

announcement of her Olympic role<br />

was made during afternoon tea at<br />

the House of Lords on Tuesday led<br />

by charity patron Lord Filkin CBE.<br />

The event highlighted that it is the<br />

only charity which runs free weekly<br />

eye clinics for the homeless in three<br />

Visit www.optometry.co.uk/jobs/job-tips locations in the UK. today<br />

Sent out to over 6,500<br />

professionals every Thursday<br />

7<br />

23/03/12 NEWS<br />

News updated regularly at www.optometry.co.uk

NEWS<br />

comment<br />

Retention figures up<br />

8<br />

23/03/12 NEWS<br />

More than 94% of<br />

registrants successfully<br />

applied for retention by<br />

the March 15 deadline,<br />

the GOC has confirmed.<br />

In total 94.9%<br />

completed their 2012/13<br />

retention on time,<br />

marking a 1.1% increase<br />

from last year’s 93.8%.<br />

Online retention for optical businesses was<br />

introduced <strong>this</strong> year, whilst optometrists and<br />

dispensing opticians were able to renew online<br />

for the first time last year.<br />

Philip Hallam, GOC head of registration, said:<br />

“Online retention has made the process of<br />

renewing GOC registration quicker and easier<br />

for our registrants. <strong>Today</strong>’s (March 16) figures<br />

show that last year’s improved application rate<br />

was not a one-off. We’re delighted that fewer<br />

registrants are putting their careers at risk by not<br />

applying on time.<br />

“Missing the GOC retention deadline is<br />

serious. Those registrants who have not yet<br />

applied now face an additional late fee, and if<br />

they have still not applied<br />

by March 31 they will be<br />

removed from the Opticians<br />

Registers. They should apply<br />

for retention immediately<br />

to ensure they can practise<br />

during 2012/13.”<br />

Those who missed the<br />

March 15 deadline will now<br />

be required to pay a £20 late application fee,<br />

taking the cost of retention to £280. Registrants<br />

who fail to apply by March 31 will be removed<br />

from the registers on April 1, leaving them<br />

unable to practise in the UK.<br />

David Craig, aoP director of operations, said:<br />

“I’m delighted to see the figure for retention<br />

is higher <strong>this</strong> year than last. Some of those<br />

not renewing will be retiring; and we wish<br />

those practitioners a happy and well-deserved<br />

retirement. But practitioners who intend to<br />

continue to practise must get their renewal<br />

completed before the deadline. The trouble<br />

caused by failing to meet the timetable will<br />

cause significant problems to those who<br />

miss the boat.”<br />

Boost for Welsh services<br />

The Welsh Government<br />

has made over £750,000<br />

available to buy fundus<br />

cameras for hospital eye<br />

services (HES) across the<br />

country.<br />

A total of 18 cameras<br />

will be purchased by the<br />

six Local Health Boards in<br />

Wales with a HES, which<br />

will help them meet the<br />

Welsh Government’s programme to<br />

establish ophthalmic diagnostic and<br />

treatment centres across Wales.<br />

Health minister Lesley Griffiths<br />

said: “Using the latest technology<br />

delivers wider benefits to the NHS. It is<br />

estimated an ophthalmologist using a<br />

fundus camera will see 10 patients for<br />

the cost of seeing one patient. Nurses,<br />

technicians and orthoptists using the<br />

camera will support a consultant-led<br />

virtual clinic, freeing up the consultant<br />

to see more patients.”<br />

<strong>Optometry</strong> Wales<br />

chairman Mike George<br />

(pictured) added: “We<br />

are fully supportive of<br />

<strong>this</strong> commitment from<br />

Welsh Government<br />

and are pleased that<br />

it will ensure that<br />

the Government<br />

endorsed ‘focus on<br />

ophthalmology’<br />

pathways are adhered to.<br />

“<strong>Optometry</strong> Wales is committed<br />

to enabling early detection and<br />

treatment. We believe that <strong>this</strong><br />

funding will mean that we are<br />

working closer to a seamless<br />

integration of primary and secondary<br />

care colleagues working together for<br />

the benefit of the patient.”<br />

• The Welsh Government has also<br />

announced a rise in NHS Voucher<br />

Values by an average of 2.5% from<br />

April 1.<br />

Grateful for what?<br />

HAVE OPTOMETRISTS anything to<br />

be grateful for? At a time of declining<br />

salaries, it is possible to think that<br />

there is little to celebrate. Yet,<br />

anecdotal evidence suggests that the<br />

sector is doing relatively well, given<br />

the current economic climate.<br />

Of course, the sector’s performance<br />

is variable, depending on the area of<br />

an optometric practice and the local<br />

competition. Having just returned<br />

from the north west of England, I<br />

am surprised how busy some local<br />

practices are. But there are other parts<br />

of the country where some independent<br />

practices are struggling to make ends<br />

meet. The burden of low NHS fees and<br />

alternative dispensing outlets make the<br />

dilemma all the crueller: keep private<br />

fees low and hope for higher sales; or<br />

increase private fees and introduce fees<br />

for supplementary procedures offered<br />

to GOS patients?<br />

It is worrying that dispensing<br />

opticians wanting refracting rights<br />

are pinning their hopes on the Law<br />

Commission’s review (see page 12). Do<br />

they not realise that there is a danger of<br />

the whole edifice crashing down, once<br />

a future reincarnation of Lord Rugby<br />

gets his teeth into the Opticians Act.<br />

Should we be grateful, for instance,<br />

for the regulation of contact lenses in<br />

<strong>this</strong> country?<br />

The British system is not perfect.<br />

Can we be sure that all Internet<br />

suppliers of contact lenses in <strong>this</strong><br />

country only dispense against a valid<br />

specification? Frankly, I don’t know.<br />

While the system seems to work to the<br />

benefit of the public, the jury is still out<br />

on whether it works to the benefit of<br />

the profession.<br />

Richard Carswell,<br />

AOP interim chief executive<br />

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

education through inspiration<br />

Raising The Bar<br />

Clinical Roadshow<br />

The latest educational roadshow from THE VISION CARE INSTITUTE® arrives<br />

<strong>this</strong> March, helping you and your staff drive higher clinical standards in practice<br />

to benefit your patients.<br />

A one-day programme<br />

We have brought together top international speakers who are experts in their<br />

field to share their latest research and clinical pearls, and help you raise the<br />

clinical bar in your practice. These include:<br />

• Professor Minas Coroneo<br />

• Professor Lyndon Jones<br />

• Dr Philip Morgan<br />

• Associate Professor Jeffrey Walline<br />

From the latest on UV, to current thinking on Myopia Control, Contact Lens<br />

Materials and How Contact Lens Solutions Interact with the Eye, we have<br />

an exciting programme of interactive lectures in store. Due to the success of<br />

previous roadshows we urge you to reserve your place today.<br />

The speakers are:<br />

Professor Minas Coroneo<br />

is Chairman of The Department of<br />

Ophthalmology, University of New<br />

South Wales and Prince of Wales<br />

Hospital. He was involved in the<br />

development of Trypan Blue as an<br />

ocular dye and is currently exploring<br />

uses of <strong>this</strong> dye in corneal surgery.<br />

He oversees the Hospital’s largest rural and indigenous<br />

health program, largest outpatient department and<br />

surgical training program. His research interests include<br />

development of a bionic eye and UV damage to the eye.<br />

He is author and co-author of approximately 140 papers,<br />

chapters in books, letters to editors, reports and theses.<br />

Professor Lyndon Jones<br />

is a Professor at the School of<br />

<strong>Optometry</strong> and Director of the Centre<br />

for Contact Lens Research at the<br />

University of Waterloo. He graduated<br />

in <strong>Optometry</strong> from the University of<br />

Wales in 1985 and gained his PhD<br />

from the Biomaterials Research<br />

Unit at Aston University, Birmingham, UK in 1998. He is a<br />

Fellow of the American Academy of <strong>Optometry</strong> and is a<br />

Diplomate in Cornea and Contact Lenses. He is a Topical<br />

Editor for <strong>Optometry</strong> & Vision Science and the current Chair<br />

of the Research Committee of the American Academy<br />

of <strong>Optometry</strong>. He has authored over 250 refereed and<br />

professional papers, one text-book and given over 600 invited<br />

lectures at conferences worldwide in over 30 countries.<br />

Dr Philip Morgan is Director of<br />

Eurolens Research and a senior<br />

lecturer in optometry at The<br />

University of Manchester, UK. Philip<br />

is vice-president of the International<br />

Society for Contact Lens Research<br />

and secretary of the International<br />

Association of Contact Lens Educators.<br />

He has authored over 160 papers, primarily relating to the<br />

clinical performance of contact lenses and the nature of the<br />

UK and international contact lens markets.<br />

Dates and Venues 2012<br />

Wednesday 28th March<br />

Thursday 29th March<br />

fREE TO<br />

ATTENd<br />

Bridgewater Hall, Manchester<br />

Royal College of Physicians, London<br />

9<br />


Associate Professor<br />

Jeffrey Walline<br />

is an Associate Professor at The<br />

Ohio State University College of<br />

<strong>Optometry</strong>. He received his Doctor<br />

of <strong>Optometry</strong> degree from the<br />

University of California, Berkeley<br />

School of <strong>Optometry</strong> and his Master’s<br />

degree and PhD degree from The Ohio State University<br />

College of <strong>Optometry</strong>. Dr Walline teaches Vision of Children<br />

and Specialty Contact Lenses to optometry students, and<br />

he is a clinical instructor in the Contact Lens, Binocular<br />

Vision and Pediatrics, and Primary Care Services at the OSU<br />

College of <strong>Optometry</strong>.<br />

Don’t delay, book today.<br />

Register now at www.thevisioncareinstitute.co.uk or call 0845 310 5347.<br />

THE VISION CARE INSTITUTE® and education through inspiration are trademarks of Johnson & Johnson Medical Ltd. © Johnson and Johnson Medical Ltd. 2012.

NEWS<br />

10<br />

23/03/12 NEWS<br />


‘Professional’ frames<br />

theft warning<br />

The managing director of an<br />

independent practice has warned<br />

fellow practitioners to beware of a<br />

‘professional thief’ who stole 21<br />

pairs of designer glasses from the<br />

practice by slipping them into his<br />

sleeve.<br />

MD of Clamp Optometrists in<br />

Cambridge, Daniel Hardiman-<br />

McCartney, told OT that CCTV<br />

showed the man dropping pairs of<br />

rimless Lindberg frames down his<br />

right sleeve and filling the gaps in<br />

the shelves with surrounding stock<br />

to avoid detection.<br />

He added: “I am completely<br />

shocked by the audacity of <strong>this</strong> theft,<br />

it was clearly planned and they<br />

knew exactly what they wanted,<br />

as an independent optician to lose<br />

the amount of stock in the current<br />

economic climate is a very bitter<br />

pill, although I am very grateful<br />

no one was hurt during the incident.”<br />

Sunny side up, but frame<br />

sales stall the market<br />

Sunglass sales showed a rise<br />

of almost 10% in 2011 compared<br />

to the previous 12 months, new<br />

statistics from research company<br />

GfK Retail and Technology UK<br />

have revealed, with contact lenses<br />

‘driving the market’ while frame<br />

sales fell.<br />

The figures reveal that over<br />

586,000 pairs of sunglasses were<br />

sold in the UK, with independents<br />

showing a 4% rise and multiples<br />

recording an 11.5% boost (a 9.9%<br />

rise overall). Women’s sunglasses<br />

proved to be the strongest<br />

performers over the 12 month<br />

period with sales value up 8.9%,<br />

while men’s and unisex styles<br />

saw a value decline of 7.6% and<br />

7.1% respectively. Although both<br />

plastic and metal designs showed<br />

growth, plastic outperformed the<br />

market by 5.9%.<br />

GfK’s figures also provided good<br />

news for the contact lens sector<br />

describing it as the ‘key driver in<br />

the optics market’ with a value of<br />

£458m in the last year. The report<br />

concludes that the main drivers of<br />

<strong>this</strong> growth were in the multifocal<br />

and daily toric modalities with<br />

a rise of 12.4% and 18.7% yearon-year<br />

respectively. The toric<br />

segment now accounts for 19.8%<br />

of disposable lens value sales.<br />

The retail outlook for the year<br />

wasn’t all good news though,<br />

with the frames market falling<br />

4% in value and 2.7% in volume,<br />

dragging the optics market into<br />

an overall decline for the year.<br />

The only sector of the frames<br />

market to show growth was the<br />

relatively small premium end,<br />

which showed a boost of 25% on<br />

2010 figures.<br />

Account manager at GfK,<br />

Paul York, told OT: “The decline<br />

suggests hard pressed consumers<br />

have been increasingly looking to<br />

reduce expenditure in the frames<br />

category, the methods available<br />

to do <strong>this</strong> being either delaying<br />

purchases or buying a cheaper<br />

product.”<br />

The College reveals<br />

its new president<br />

Optometrist Kamlesh<br />

Chauhan was named as<br />

president of the College of<br />

Optometrists on Monday<br />

(March 19).<br />

The official handover from<br />

outgoing president, Dr Cindy<br />

Tromans took place during the<br />

College’s AGM in Brighton.<br />

Speaking about his<br />

appointment to the new role,<br />

Dr Chauhan, said: “I am<br />

proud to be the new president,<br />

and I look forward to building<br />

on the excellent work the<br />

College and Cindy have done in<br />

bringing eye care professionals<br />

together to provide a more<br />

integrated approach to patient<br />

care.”<br />

Dr Tromans added: “Having<br />

worked closely with Kamlesh<br />

over the past two years, I am<br />

delighted that he will be<br />

taking over from me.”<br />

Optometrist David Parkins<br />

becomes vice president having<br />

been treasurer of the College<br />

for five years, while Rob<br />

Hogan replaces Mr Parkins as<br />

treasurer.<br />

Win a Vitabiotics hamper<br />

Vitabiotics is offering OT readers<br />

the chance to win a deluxe hamper<br />

worth over £100 full of goodies<br />

suitable for the whole family.<br />

To be in with a chance of<br />

winning the hamper, which<br />

includes products from the<br />

Wellwoman, Wellman and Wellkid<br />

range, all you have to do is answer<br />

the following question:<br />

Visionace includes which of<br />

the following nutrients?<br />

a. Bilberry<br />

b. Cranberry<br />

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Need a hint? Visit www.<br />

visionace.com<br />

Submit your answer via email<br />

to louisewalpole@aop.org.uk by<br />

midnight on April 1, 2012, with<br />

the subject heading ‘Hamper’.<br />

Please note that your details<br />

will be passed onto Vitabiotics<br />

who will draw out the winner.<br />

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

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Regulators under scrutiny<br />

The Law Commission report into health regulation could mean big changes for the GOC<br />

12<br />

23/03/12 LAW<br />

The repeal of the Opticians Act,<br />

an end to student registration, and<br />

the reform of the GOC’s power to<br />

register bodies corporate and fund<br />

a consumer complaints service are<br />

all very real possibilities of the Law<br />

Commission’s current review into<br />

health regulation in the UK.<br />

The consultation paper, released<br />

by the Commission on March 1,<br />

follows a thorough investigation<br />

into the inner-workings of the<br />

GOC and the nine other health<br />

and social care regulatory bodies<br />

in the UK, with the ultimate aim<br />

of establishing a ‘streamlined,<br />

transparent and responsive system’<br />

to regulation.<br />

Tim Spencer Lane, a lawyer<br />

working on the report for the Law<br />

Commission, explained to OT what<br />

the consultation could mean for<br />

the GOC: “The review covers all<br />

aspects of the GOC’s functions<br />

– registration, the approval of<br />

education, standards for practice,<br />

and fitness to practise – and so its<br />

potential impact is substantial.<br />

Opticians Act<br />

“The first main change would<br />

be the repeal of the Opticians<br />

Act 1989 (and all the rules and<br />

regulations made under it) and its<br />

replacement by a single Act which<br />

would cover all 10 health and<br />

social care regulators.<br />

“The second main change<br />

would be that, under our<br />

proposals, the GOC would be<br />

given broad powers to make its<br />

own rules – which would not<br />

have to be approved by the Privy<br />

Council. We think <strong>this</strong> will give the<br />

GOC greater flexibility to develop<br />

and keep its systems of regulation<br />

up-to-date in order to reflect the<br />

changing circumstances of the<br />

profession.<br />

“The third main change would<br />

“Under our proposals the GOC<br />

would be given broad powers to<br />

make its own rules”<br />

be that all the powers of the<br />

regulators would be the same. For<br />

example, at the moment some of<br />

the regulators (such as the GMC)<br />

have powers to introduce systems<br />

of case managers while others<br />

(such as the GOC) do not. Under<br />

our proposals all the regulators<br />

would have the same powers to<br />

make rules on such matters if they<br />

wish to do so.”<br />

He added that there were<br />

several other points which could<br />

change the role of the GOC,<br />

including an investigation into<br />

whether student registration<br />

was still necessary given that the<br />

GOC is the only health regulator<br />

with a compulsory register for<br />

undergraduates.<br />

Also under review is the<br />

GOC’s power to register bodies<br />

corporate – which is also unique<br />

to the GOC – and whether the<br />

regulator’s power to fund a<br />

consumer complaints service<br />

should be retained.<br />

A section especially relevant<br />

given the current debate around<br />

refraction training for DOs is the<br />

review of ‘protected functions’<br />

such as refraction. Mr Spencer<br />

Lane added: “We are also<br />

reviewing the use of protected<br />

titles and protected functions<br />

under the new legal framework<br />

and whether some of these<br />

could be reviewed, one such<br />

area that has been suggested to<br />

us is the area of refraction and<br />

whether <strong>this</strong> should continue<br />

to be restricted to doctors and<br />

optometrists only.”<br />

Chief executive and registrar<br />

of the GOC, Samantha Peters,<br />

said that the regulator welcomed<br />

the review. She told OT: “The<br />

Law Commission review will be<br />

extremely important in shaping<br />

the future regulation of all UK<br />

healthcare professionals.<br />

“We welcome its full and<br />

comprehensive nature and<br />

the tremendous opportunity it<br />

provides to ensure that healthcare<br />

regulators’ legal framework is bestplaced<br />

to protect the public.”<br />

Striking a balance<br />

“I encourage everyone across<br />

optics to engage with the Law<br />

Commission throughout the<br />

consultation process, “ she added,<br />

“Any new legislation must strike<br />

the right balance between<br />

consistency and flexibility in<br />

healthcare regulation. It should<br />

also ensure that any new freedoms<br />

for regulators are balanced by the<br />

right accountability.<br />

“This can only be achieved<br />

with extensive stakeholder input,<br />

so both the GOC and the Law<br />

Commission strongly welcome the<br />

input of the optical professions<br />

and the wider public.”<br />

The consultation closes at the<br />

end of May. The full document is<br />

available at www.lawcom.gov.uk<br />

The review has examined<br />

the work and scope of the<br />

GOC as well as the other<br />

health and social care<br />

regulators:<br />

• General Chiropractic<br />

Council<br />

• General Dental Council<br />

• General Medical Council<br />

• General Osteopathic<br />

Council<br />

• General Pharmaceutical<br />

Council<br />

• General Social Care Council<br />

• Health Professions Council<br />

• Nursing and Midwifery<br />

Council<br />

• Pharmaceutical Society of<br />

Northern Ireland.<br />

It also extends to include<br />

the regulator of the other<br />

regulators, the Council<br />

for Healthcare Regulatory<br />

Excellence.<br />

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

Business<br />

Create a winning team<br />

and a strong practice<br />

OT’s Chris Donkin picks up some business tips at J&J’s latest Practice Made Perfect roadshow<br />

14<br />

23/03/12 ROADSHOW<br />

Positioning a practice to make the most of the local<br />

market and building a strong team are vital to attract new<br />

patients and retain existing ones, according to experts at the<br />

latest roadshow organised by Johnson & Johnson<br />

Vision Care.<br />

Presented by optometrist and practice consultant, Peter<br />

Ivins, and BCLA president and practice owner, Shelly<br />

Bansal, the Practice Made Perfect (PMP) roadshow has<br />

toured the country over the last month, sharing business<br />

building advice with managers and owners.<br />

First in the spotlight was Mr Ivins, who encouraged<br />

delegates to study their demographic and create a clear<br />

vision and mission statement to attract those people.<br />

“Are you trying to attract the right sort of person?” he<br />

asked the audience. “Have a look at who’s in your area. It<br />

may well be you’ve got absolutely no wealthy achievers in<br />

the particular area that you work in, so it’s not very sensible<br />

to become a practice with very high prices and designer<br />

frames – because that’s not the market you’ve got, you might<br />

actually be playing in the wrong space.<br />

“Before you start doing anything, understand where you<br />

are right now and where you want to be. Once you know<br />

that then it’s a good idea to have a mission statement for<br />

your practice.”<br />

Describing the importance of a clear, simple ‘non-cheesy’<br />

mission statement, he added: “It defines what your practice<br />

is all about, it’s your USP. A document that lets your staff<br />

know how they should function and maybe it also lets<br />

patients know why they should deal with you. It should be<br />

very simple and patient focused.<br />

“It’s a good start because it says ‘<strong>this</strong> is what I do, <strong>this</strong> is<br />

the space I’m in and I know what my practice is all about.’<br />

“Once you’ve got that mission statement and your<br />

place in the market everything you do must support that<br />

statement right down to the look of the stationery, your<br />

uniforms, the look of your signage and the frame ranges.”<br />

Building a bond<br />

Following an exercise in creating a mission statement,<br />

which Mr Ivins (pictured left) told delegates should be<br />

a long, carefully thought out procedure in practice, he<br />

described the importance of patient loyalty.<br />

He added that a great way to create a bond was to be in<br />

touch with patients ‘more than once every two years’, but<br />

warned that the way people communicate is changing with<br />

social media becoming more and more prevalent.<br />

“Social media is something that you are going to have to<br />

engage with whether you like it or not,” he told the gathered<br />

managers and owners. “Ask for email addresses, get them to<br />

write them down by having a form and ask them to fill it in,<br />

I guarantee that <strong>this</strong> way almost everyone will give you both<br />

their email and their phone number.<br />

“If a new patient comes in have a pre-test questionnaire<br />

and make that be part of it – if it’s an existing patient have<br />

a questionnaire that says ‘we have some very valuable data<br />

that we hold for you, we want to check it’s correct’ – print it<br />

out and get them to check it for you.”<br />

He added that social media is a good, cheap marketing<br />

tool and a Web presence is a must. Although he<br />

recommended a marketing budget of three percent of<br />

practice turnover, he also gave some examples of small<br />

things which can be done that can make a big difference<br />

such as having up-to-date patient leaflets and using point<br />

Continues on page 16

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16<br />

23/03/12 ROADSHOW<br />

of sale materials for items such as contact lenses which<br />

are often overlooked when arranging the dispensing and<br />

waiting room areas.<br />

“Before you start doing anything,<br />

understand where you are right<br />

now and where you want to be”<br />

“You get people in your practice who aren’t patients,” Mr<br />

Ivins said. “Some that are existing spectacle wearers who<br />

might want to talk about things like contact lenses – so ask<br />

them and make it easy for them.<br />

“If you’re going to do that (encourage sales and<br />

promotions in practice) you need to train your staff,<br />

everybody in the team has to be engaged, it’s a good idea to<br />

have incentives. It’s also a good idea to have targets like the<br />

number of trials per day or per week.”<br />

Team building<br />

Following on inspiring discussion on loyalty, Mr Bansal<br />

(pictured above with Mr Ivins) took to the microphone to<br />

explain the value of team work in creating a high standard<br />

customer journey, because he believes ‘satisfied’ is not a<br />

good enough level any more, patients must leave feeling<br />

‘wowed’.<br />

“There’s great value in building a high performance team<br />

and we can all do it if we really want to,” he told delegates.<br />

“So the next thing you can do when you’ve set your goals<br />

is look at your team – and I don’t mean to go and pick at<br />

them – look at what people’s strengths and weaknesses are.<br />

Look at how they can develop. Look at the team as a whole<br />

– who’s dropping the baton? Who needs coaching? Who<br />

needs to be told ‘we do <strong>this</strong> with every patient’?<br />

“Look at the team properly so you can create the<br />

‘complete customer journey’, think about the staff – Jessie<br />

who sits in the backroom may be fantastic with all the<br />

books, you never pay an invoice a day early or day late and<br />

you never pay any more or any less than you should.<br />

“These are great strengths, but unfortunately at lunch<br />

Jessie has to work at the front desk and she’s not very<br />

good at dealing with customers. This puts the rest of the<br />

team under pressure. It’s not Jessie’s fault it’s our fault as<br />

managers because we’ve not trained her.”<br />

Mr Bansal added that a mission statement is an excellent<br />

way to focus the team and give them an idea of the team<br />

goal.<br />

“It really upsets me when I talk to staff and they say<br />

‘I’m just the receptionist, I’m just the DO or I’m just the<br />

optometrist’, it’s the whole team that makes (the practice)<br />

work and that can only work well if we all know where we<br />

are, and that all starts with training together.<br />

“When we practice we make mistakes, but learn from<br />

them. When we make mistakes what do we do? Go away<br />

and practice some more.<br />

“Developing the team starts from the beginning with<br />

an induction programme for every single member of<br />

staff outlining the core competencies in the practice, the<br />

minimum standards that are a ‘must’ for your practice and<br />

the space that you are in.<br />

“The difficulty is that you will probably have a member<br />

of staff who has been there since eternity, we all call them<br />

‘dragons’ and it’s difficult because they ‘know everything<br />

already’.”<br />

For these ‘dragons’ he recommends: “The way to engage<br />

them is to say ‘<strong>this</strong> is a new format we are using for all<br />

new staff and to protect you we have created a minimum<br />

standard’. We know you do all of these things but if I don’t<br />

have <strong>this</strong> paperwork in place the person who starts might<br />

not, which might compromise you.”<br />

For more business tips and advice, visit the business<br />

section of the OT website on www.optometry.co.uk/<br />

business<br />

Boost your skills at an upcoming<br />

roadshow<br />

Following the initial series of PMP<br />

roadshows, practitioners looking for<br />

tips on how to boost their business<br />

can take advantage of further events<br />

later <strong>this</strong> year, also arranged by J&J.<br />

Looking at the themes of the PMP<br />

sessions in more depth will be a twoday<br />

follow-up event at The Vision Care<br />

Institute in Pinewood which is open to all practitioners, not just<br />

whose who attended the original series of events. The contact<br />

lens company added that a repeat of the original roadshow<br />

was likely to be arranged for later in the year.<br />

In addition, the Raising the Bar clinical roadshow goes on<br />

a UK tour in mid-October following its two events in London<br />

and Manchester on March 28 and 29. Headlined by renowned<br />

international speaker Nathan Efron (pictured), the event covers<br />

how to ‘drive higher clinical standards to benefit patients’.<br />

For further details as they become available check OT Diary<br />

and the online Events page, as well as on<br />



Available<br />

April 2012<br />


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profile<br />

Boosting specs appeal<br />

Continuing the OT series looking at how the AOP is developing, Robina Moss talks to AOP director<br />

Alison McClune who feels her role is to speak out for the majority of ‘ordinary’ optometrists<br />

18<br />

23/03/12 Profile<br />

“At the end of the day<br />

the vast majority of our<br />

patients come to us<br />

for specs, to help them<br />

see better and I’m very<br />

proud of that role,” she<br />

explained. “Yes the health<br />

checks are a valuable<br />

part of our work but the<br />

public perception of us is<br />

in that vision correction<br />

role. We have to shout<br />

about it as much as the<br />

extended role. We need<br />

to be equally proud of<br />

that to instil pride into<br />

those who have just<br />

qualified.<br />

“Optometrists always want to do a<br />

good job for their patients and for a<br />

fair wage but many don’t necessarily<br />

want to do the progressive work such<br />

as glaucoma pathways. Many just want<br />

to do a job they can be proud of as a<br />

professional and as an individual. To go<br />

home at the end of the day proud of<br />

what they’ve achieved. I don’t always feel<br />

we fill that gap and I like to think that’s<br />

where I come in. I’m a voice for those<br />

optometrists. That’s what I think I bring to<br />

the table and to the AOP.”<br />

Ms McClune has been an AOP director<br />

since 2007 and an AOP councillor for 12<br />

years. She qualified as an optometrist<br />

from Glasgow Caledonian University in<br />

1992 and works as a locum at various<br />

practices in the Glasgow area. She is<br />

also chairman of the AOP membership<br />

committee.<br />

“The AOP does provide an awful lot of<br />

services, not just legal and defence. We<br />

want to highlight the work that we do to<br />

emphasise that support is just a phone<br />

call away,” she told OT in London amid a<br />

hectic meetings schedule.<br />

The committee looks at all aspects of<br />

the services for members such as the<br />

membership benefits package offered.<br />

“We also provide help for students,<br />

supporting the work that the AOP’s<br />

education adviser Karen Sparrow does,”<br />

she added. “And we support the College/<br />

AOP Benevolent Fund which works for<br />

optometrists and their families.”<br />

Ms McClune worked with the Children’s<br />

Eye Health Campaign, which she is<br />

enthusiastic about as an optometrist and a<br />

mother of two.<br />

Boost<br />

Looking to the future, the AOP generally<br />

is aiming to boost its communications<br />

with members. “The new council elections<br />

<strong>this</strong> month are on a more geographical<br />

basis and there will be a push for getting<br />

out more in the locality for face-to-face<br />

meetings. We will also be looking at how<br />

we communicate through OT and also<br />

electronically through Blink,” she said.<br />

Ms McClune began working as a locum<br />

as there was no permanent position with<br />

the company she was working for at<br />

that time but found that she enjoyed the<br />

variation. “I enjoyed working in<br />

different practices and different<br />

modes of practice,” she said.<br />

As a Scottish councillor, she<br />

has seen the changes to GOS in<br />

Scotland which came about in<br />

2006 as a result of devolution,<br />

and the AOP lobbying of the<br />

Scottish Executive.<br />

“AOP ‘Making Accurate<br />

Claims’ roadshows, headed by<br />

AOP Scotland chairman, Kevin<br />

Wallace, ran in 2011 to ensure<br />

our members had a chance to<br />

ask any regulation questions<br />

directly,” she explained. “There<br />

was also the presence of the<br />

AOP legal team at the recent Eyecare<br />

3000 event in Glasgow. AOP Scotland<br />

continues to keep a keen eye on political<br />

developments, and is now considering,<br />

carefully, the impact independence may<br />

have on AOP and Scottish optometry as<br />

a whole.<br />

“We are aiming to ‘beef up’ the AOP<br />

service to members in Scotland so that<br />

they don’t feel that for legal and defence<br />

they have to contact the AOP in London.<br />

It will be nice for AOP members in<br />

Scotland to hear a Scottish voice when<br />

they ring up.”<br />

AOP Scotland is aiming to enhance<br />

and reinforce its presence in Scotland.<br />

“We want to provide more support on<br />

a hands-on basis, on a more practical<br />

level, having the right people available<br />

if people are having <strong>issue</strong>s with Health<br />

Boards or the GOC,” she added.<br />

“When the new AOP council is<br />

established we will look at the way<br />

forward for better representation of our<br />

Scottish members. We want to see our<br />

role increasing in Scotland to create more<br />

local support. I look forward to playing<br />

my part in that.”

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NOC to provide vital<br />

support from LOCSU<br />

OT goes behind the scenes to find out what delegates can expect from <strong>this</strong> year’s National Optical<br />

Conference (NOC) in Birmingham in October<br />

20<br />

23/03/12 PREVIEW<br />

The NOC is a conference primarily aimed at Local/Regional<br />

Optical Committees (LOCs/ROCs), optometrists, dispensing<br />

opticians and optometric advisers. This year the annual event<br />

will take place on October 18-19, at the Hilton Metropole,<br />

Birmingham.<br />

Director of operations and commissioning at LOCSU, Katrina<br />

Venerus, feels strongly that every LOC and ROC should be<br />

represented at the NOC 2012. She explained: “Once again<br />

LOCSU will be offering every LOC and ROC one free place<br />

at the NOC 2012. For anyone that hasn’t yet had the chance<br />

to attend, the NOC is a fantastic opportunity to hear from<br />

nationally renowned speakers on areas ranging from eye care<br />

pathways and NHS reforms, to peer discussion, public health<br />

and the ability to connect with fellow members in workshops,<br />

discussion forums or over a coffee. This event is increasingly<br />

seen as important to some of the most senior influential<br />

figures in the NHS and beyond. NOC 2011 attracted nationally<br />

renowned speakers, such as Helen Hirst, programme director<br />

for primary care commissioning at the NHS Commissioning<br />

Board, and Samantha Peters, chief executive of the General<br />

Optical Council.”<br />

Ms Venerus added: “I know, from the outstanding feedback<br />

given by delegates for the NOC 2011, that people also found<br />

the chance to hear about some of the success stories taking<br />

place across the country really beneficial when developing, or<br />

improving, the way they negotiate and deliver local eye care<br />

services in their own region.”<br />

Explaining why it was critical that the 2012 NOC’s<br />

programme represents the interests of LOCs and ROCs, Ms<br />

Venerus highlighted feedback received from a recent survey<br />

carried out by LOCSU to find out what would be most useful<br />

to members. Out of the 61 committees which responded:<br />

• 93% said that they wanted a keynote address on the national<br />

perspective on the NHS reforms<br />

• 84% wanted a session on local professional networks<br />

• 84% wanted to hear from other LOCs/ROCs presenting<br />

evidence and outcomes from successful local services.<br />

“The best NOC I’ve been to yet. A great black<br />

tie event and both days of conference were<br />

excellent. I left feeling very positive”<br />

Comment from LOCSU NOC survey 2011<br />

With LOCSU offering a free place for every LOC/ROC<br />

committee again <strong>this</strong> year, practitioners are urged to put<br />

the NOC 2012 in their diary. OT will publish updates on<br />

the conference programme in the journal and online over<br />

the coming months, and readers considering attending are<br />

encouraged to register their interest by emailing NOC2012@<br />

locsu.co.uk<br />

Situated just 10 minutes from Birmingham International<br />

Airport, the Hilton Metropole, Birmingham is one of the UK’s<br />

largest conference hotels. Located on the site of the NEC, it has<br />

good transport links to the city centre. It also boasts a fullyequipped<br />

LivingWell Health Club and heated indoor swimming<br />

pool for delegates who find they have some ‘downtime’.<br />

The NOC 2012 will offer delegates an expansive exhibition<br />

and offers excellent opportunities for companies which want<br />

to reach key decision-makers in the development of local<br />

eye health services across England and Wales. In addition to<br />

exhibiting at the event, companies can also pick from a<br />

variety of sponsorship packages – for details contact Steve<br />

Grice at the Redactive Media Group on steve.grice@redactive.<br />

co.uk or 020 7880 6220.


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EVENTS<br />

AOP education adviser, Karen Sparrow reveals the expertise of the high-calibre practitioners who<br />

will speak at ‘Education Destination’ on April 29-30 at the association’s headquarters in London<br />

22 28<br />

08/04/11 23/03/12 CET EVENT<br />

NEXT MONTH’S therapeutics-focused event, ‘London 2012<br />

Education Destination’, will bring together key speakers from<br />

both sides of the Atlantic, mixing American experts with<br />

homegrown UK talent.<br />

Co-produced by SECO and the AOP, the two-day seminar<br />

will be held at the AOP’s headquarters in London (April<br />

29-30), featuring lectures from Dr Murray Fingeret, Dr Paul<br />

Ajamian, Nick Rumney, professor John Lawrenson and Jane<br />

Bell.<br />

Speaking about why the ‘Education Destination’ is a must<br />

attend event, Ms Bell said: “I think it is important for UK<br />

On the American team is Dr<br />

Murray Fingeret who is known<br />

for his glaucoma expertise and<br />

has been active in glaucoma care<br />

in the USA for many years. His<br />

current responsibilities include<br />

chief of the optometry section<br />

in the Department of Veterans<br />

Administration in New York and he is<br />

a clinical professor at the State University of New York’s College<br />

of <strong>Optometry</strong>. He is also a Fellow of the American Academy<br />

of <strong>Optometry</strong>, the National Academies of Practice and the<br />

American Glaucoma Society, and sits on the Board of Directors<br />

of the Glaucoma Foundation which funds groundbreaking<br />

research into glaucoma and educates the public about the<br />

disease and the importance of early detection.<br />

Dr Fingeret has a long involvement with changing clinical<br />

practice in the USA, lobbying, debating and advising the<br />

optometric profession at the highest levels, including the<br />

US Administration. He is a member of the medical eye care<br />

committee, American Optometric Association. He is also a<br />

founding member and past-president of the Optometric<br />

Glaucoma Society, and currently its executive vice-president.<br />

Amongst a number of awards for his work in the field of<br />

optometry, Dr Fingeret is a recipient of the 2008 Distinguished<br />

Service Award from the Optometric Glaucoma Society, the<br />

2005 Carel C. Koch Memorial Medal from the American<br />

Academy of <strong>Optometry</strong>, the 1996 Otsuka Glaucoma Educators<br />

Award from the American Academy of <strong>Optometry</strong> and 1999<br />

AMSUS Federal Service Optometrist of the Year award.<br />

optometrists with an interest in optometric prescribing to<br />

have the opportunity to attend an event that focuses on ocular<br />

therapeutics.<br />

“It is particularly relevant at <strong>this</strong> point in time as we<br />

gradually increase the number of independent prescribing<br />

optometrists in the UK. One of the greatest challenges for us is<br />

to find a suitable placement in which to practise our hard-won<br />

and recently-acquired prescribing status.”<br />

Geoff Roberson, clinical adviser to the AOP, echoes Ms<br />

Bell’s enthusiasm for extending our skills into therapeutics.<br />

“Expanding scope of practice and developing the range<br />

Paul Ajamian was instrumental in<br />

starting the Omni Center in 1982, the<br />

first Optometric Co-Management<br />

Center in the country and hence<br />

pioneered co-management in the<br />

United States, allowing patients<br />

to be referred by their local<br />

optometrist directly to the Omni<br />

Eye Services Centers for secondary and tertiary care, such<br />

as same day cataract surgery. His team of optometrists and<br />

ophthalmologists provide improved access to affordable eye<br />

care for patients as an extension of optometric practice. Since<br />

1984 he has served as center director of Omni Eye Services<br />

of Atlanta. He serves as general chairman of the education<br />

committee for SECO International, which sees him co-ordinate<br />

the optometry education programme at the event each year<br />

for around 9,000 delegates, the largest CE optometric event in<br />

the States.<br />

Ian Cameron, an independent optometrist from Edinburgh,<br />

spent two weeks working with Paul at the Omni Centre in<br />

Atlanta a few years ago. “Anything that would end up in an eye<br />

hospital in <strong>this</strong> country is dealt with in <strong>this</strong> multi disciplinary<br />

eye care centre. Specialist ophthalmologists run clinics<br />

supported by a huge team of optometrists and support staff<br />

seeing around 100 patients per clinic. Dr Ajamian himself deals<br />

with anterior eye disease cases with a team of juniors working<br />

up patients for him to examine and treat.<br />

There seemed to be nothing they couldn’t deal with inhouse:<br />

from retinal surgery and cataract to intractable uveitis<br />

and microbial keratitis. This is a very impressive operation.”

of services offered is important for both the profession<br />

and individual practitioners,” he said. “We must all<br />

keep moving forward. Much hard work has gone into<br />

obtaining prescribing rights for optometrists and we must<br />

not squander <strong>this</strong>, nor waste the opportunity current<br />

developments in healthcare provision in the UK present to<br />

us. A move into therapeutic practice can provide an ideal<br />

opportunity to embrace all of these opportunities, enhance<br />

the services we can offer to our patients and increase our job<br />

satisfaction. This course provides an ideal starting point for<br />

those who are interested and a chance to meet and talk to<br />

colleagues from the US who are already taking advantage of<br />

their prescribing status.”<br />

London 2012 Education Destination, supported by<br />

Topcon, will be held on April 29-30 at the AOP headquarters<br />

in London. It aims to provide a valuable opportunity for<br />

optometrists to gain specialist IP points, and for those<br />

just taking their first tentative steps into managed care<br />

and expanded clinical pathways to gain guidance and<br />

knowledge in a growing field of optometry. Fourteen COPE<br />

and GOC specialist (IP) and general optometry points have<br />

been applied for, as well as points for DOs where applicable.<br />

The event has already attracted international bookings from<br />

the USA, Russia, Australia and Greece so practitioners are<br />

urged to book soon to avoid disappointment.<br />

For more information about the programme, speakers,<br />

social events and booking visit: www.eiseverywhere.com/<br />

ehome/31864/50766/<br />

Also on the home team is Professor<br />

John Lawrenson who, following a<br />

first degree in biochemistry at Cardiff<br />

University, studied optometry at<br />

Aston University and graduated with<br />

a first-class honours degree. After a<br />

pre-registration year at Moorfields<br />

Eye Hospital professor Lawrenson<br />

undertook postgraduate research at City University London,<br />

receiving his PhD in 1992. He went on to complete a postdoctoral<br />

research fellowship in Neuroscience at University<br />

College London and subsequently returned to join the<br />

academic staff at City University where he currently holds a<br />

chair in Clinical Visual Science.<br />

Professor Lawrenson’s research interests lie in the fields<br />

of ocular therapeutics and ophthalmic service delivery.<br />

Consequently, he is director of the Ophthalmic Public Health<br />

research group at City University.<br />

Professor Lawrenson was extensively involved in acquiring<br />

prescribing rights for UK optometrists and the development<br />

of educational curricula for <strong>this</strong> speciality. He is has also been<br />

involved in the production of a number of resources to support<br />

therapeutic prescribers.<br />

23<br />

23/03/12 CET EVENT<br />

For ‘Team GB’ we have optometrist<br />

Nick Rumney, who currently works<br />

in full-time private practice at BBR<br />

<strong>Optometry</strong>, Hereford, a standard setting<br />

(ISO9000 & IiP) and award-winning<br />

independent practice. He is a clinical<br />

advisor and consultant to Topcon, as<br />

well as a visiting lecturer at Manchester University and visiting<br />

research fellow at Aston University.<br />

BBR <strong>Optometry</strong> was the first UK practice to install a Topcon<br />

3D-OCT and My Rumney now has over two years experience<br />

of utilising it in High Street practice. Mr Rumney has published<br />

over 40 papers in optometric journals, including OT, and<br />

even the odd letter in the BMJ and Eye. He is an optometrist<br />

member of Eyecampus, a multi-disciplinary group created by<br />

Pfizer to promote and deliver high standards in CE to eye care<br />

professions. He has been a fellow of the American Academy of<br />

<strong>Optometry</strong> (AAO) since 1995 and in 2008 was appointed to the<br />

International Admissions Committee for the AAO. Mr Rumney is<br />

a fellow of the BCLA and has recently joined IACLE. In 2011 he<br />

completed the didactic and clinical placement components of<br />

independent prescribing.<br />

Finally, to reflect grass-roots<br />

therapeutics in the UK, Jane Bell will<br />

also speak at the two-day event. She<br />

is a self-employed optometrist with<br />

over 30 years experience in different<br />

types of practice including multiple,<br />

hospital, health centre, independent<br />

optometry owned and dispensing<br />

owned practices. She provides a Primary Care Ophthalmology<br />

Service within a Medical Centre, initially established by PCT<br />

commissioners in 2002. This groundbreaking service has since<br />

survived two procurement processes with the backing of<br />

local ophthalmologists, GPs and PCT managers, resulting in<br />

expansion of the service so that patients are referred from a<br />

larger number of GP practices. They are about to become a<br />

provider through NHS ‘Choose & Book’.<br />

Ms Bell attained the College of Optometrists’ Diploma in<br />

Therapeutics, Additional Supply, in July 2006 and Independent<br />

Prescribing in July 2010. She is currently a director of the AOP<br />

and chair of the Optical Confederation primary care committee.<br />

She began working for the LOC Support Unit in January 2008<br />

and is now a LOCSU adviser.


An opportunity of<br />

Olympic proportions?<br />

Next <strong>issue</strong>’s supplement on sport discusses the opportunities London 2012 may offer your practice<br />

24<br />

23/03/12 Sport eyewear<br />

AFTER MUCH anticipation, and<br />

trepidation in some quarters, the London<br />

Olympics are almost upon us – but how<br />

can the world’s top athletes descending<br />

on the Capital help the average optical<br />

practitioner?<br />

With the inevitable interest drummed<br />

up in the events showcased, many<br />

patients are likely to consider taking up a<br />

new sport or outdoor pursuit for the first<br />

time, and others who are already taking<br />

part may be inspired to increase their<br />

performance level and often performance<br />

eyewear can help them achieve <strong>this</strong><br />

objective.<br />

The opportunities afforded by sport<br />

and performance eyewear are interesting<br />

in terms of varying everyday practice,<br />

providing patient satisfaction and can<br />

also be potentially very lucrative – with<br />

a small investment in increasing staff’s<br />

knowledge on the latest technology<br />

there is a possibility of making your<br />

practice specialised or at the very least<br />

providing a USP.<br />

The next <strong>issue</strong> of OT features a 20-page<br />

supplement on sports and performance<br />

eyewear, with details on how certain<br />

types of lenses and frames can enhance<br />

the performance of your patients, as well<br />

as the bottom line of your practice.<br />

Enthusiasts are more than willing to<br />

invest in the latest shoes, clothing and<br />

equipment to improve performance, so<br />

why not a pair of sports frames or contact<br />

lenses, which could enhance their<br />

performance further?<br />

In fact, not only can the correct<br />

eyewear sometimes help performance, in<br />

many Olympic events protective eyewear<br />

is a prerequisite whether the player needs<br />

vision correction or not. Activities such as<br />

archery, swimming, cycling and shooting<br />

all require participants to wear some form<br />

of specialist eyewear.<br />

Although training is available for those<br />

who want to specialise in sports vision<br />

in practice, having a few sports frames in<br />

stock could tempt the amateur runner,<br />

cyclist or archer to try and improve<br />

their performance using prescription or<br />

protective specialist eyewear.<br />

Often patients don’t even consider<br />

contact lenses or specialist eyewear<br />

because they are simply unaware of the<br />

benefits. A little knowledge can go a<br />

long way and who better to impart that<br />

information than staff at your practice?<br />

Many of your existing patients already<br />

run, swim, play football, tennis, golf or<br />

squash – the list is endless – and with a<br />

couple of simple questions when they<br />

arrive, you may uncover a pastime which<br />

the right type of eyewear can enhance<br />

their enjoyment and experience of.<br />

Make sure you check the next <strong>issue</strong><br />

of OT for your guide to sport, and<br />

performance eyewear, it could make a big<br />

difference to your business.


Headline<br />

sponsor:<br />

Awards<br />

2012<br />

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

Category sponsors:<br />

Nominations must be received by May 31, 2012.

update<br />

Kids’ vision reminder<br />

26 28<br />

23/03/12 children’s eye health<br />

Recent statistics report that<br />

one-in-10 Primary Care Trusts do not<br />

arrange vision screening for children<br />

starting school. As the Easter holiday<br />

nears, it is a good time to remind<br />

parents about the importance of<br />

children’s eye health.<br />

For some children, having a sight<br />

test could be the difference between<br />

being confident or withdrawn socially,<br />

to being disruptive or doing well<br />

academically. For 10-year-old Sophie Gadner (pictured),<br />

having a sight test and being prescribed spectacles resulted<br />

in improved school grades. Sophie’s mother, Yvonne Gadner,<br />

explained: “I first took Sophie to the optician when she was<br />

eight-years-old after her school recommended it because she<br />

had been disruptive in class. They recommended a sight test<br />

and a dyslexia test. Before <strong>this</strong>, I had no idea what the right age<br />

was to have a child’s sight tested.”<br />

After being prescribed spectacles to correct her vision,<br />

Ms Gadner noticed a number of changes in her daughter’s<br />

academic achievements. “Since being prescribed glasses,<br />

Sophie is more interested in reading,” she<br />

said. “She’s finding her class work easier<br />

and her grades have improved which is<br />

great.<br />

“Visiting the optometrist has been a<br />

positive experience all round.”<br />

Ms Gadner and Sophie aren’t alone.<br />

Mother Melanie Wisher took her daughter<br />

Emily to the optometrist when she started<br />

school and a teacher expressed concern.<br />

Ms Wisher said: “The optometrist said<br />

Emily’s vision was quite bad and potentially she may never be<br />

able to drive, which really hit home. I was concerned it would<br />

impact on her life decisions, not just her learning at school<br />

and development, but also later in life. If <strong>this</strong> had been picked<br />

up earlier, my feeling is that she would have been able to<br />

read before she went to school, which would have helped her<br />

educational and social development.”<br />

A free online campaign resource pack is available to<br />

all practitioners, which includes information leaflets for<br />

parents, template letters for schools and a poster. For more<br />

information, visit www.aop.org.uk/childrenseyehealth<br />

Optical Leads<br />

(Six vacancies across England)<br />

The potential to increase the number of local eyecare services commissioned by the NHS in England<br />

is significant and Local Optical Committees (LOCs) have expressed a need for hands-on support from<br />

professionally trained negotiators in writing and presenting business cases to local commissioners.<br />

For 2012-14, we are seeking to appoint six Optical Leads whose role will be primarily focussed on<br />

working with and on behalf of LOCs to maximise the opportunities to expand local eyecare services.<br />

About LOCSU<br />

Our purpose is to support<br />

Local and Regional Optical<br />

Committees to increase the<br />

role of optometrists and<br />

opticians in delivering high<br />

quality eyecare services in<br />

the community.<br />

About You<br />

You will need to demonstrate a good understanding of the sector and have a real passion for<br />

developing business cases and negotiating with commissioners. You will need to be available for<br />

a minimum of eight days per month.<br />

We welcome applications from experienced and enthusiastic individuals from all parts of the<br />

optical sector. Job description and application form can be downloaded from our website<br />

www.locsu.co.uk<br />

A competitive daily rate is offered in addition to the opportunity to work with some of the top<br />

influencers in the optical sector.<br />

Closing date for receipt of applications is 5pm, Friday 20th April 2012.<br />

Short-listed applicants will be invited to attend an interview in London on either<br />

Wednesday 9th May or Thursday 10th May 2012.<br />

For an informal discussion about the role, please contact Katrina Venerus,<br />

Director of Operations and Commissioning at LOCSU at katrinavenerus@locsu.co.uk<br />

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23/03/12 PRE-REG FOCUS<br />

“CONGRATULATIONS. If you have reached<br />

<strong>this</strong> stage. You have been judged<br />

competent in 75 different areas, so give<br />

yourself a pat on the back and know you<br />

are ready to take on Stage 2,” writes Optical<br />

Express newly-qualified optometrist Amar-<br />

Kaash Gandecha (pictured).<br />

“Stage 2 can be looked at as a<br />

‘condensed’ version of all of your previous<br />

visits, purely designed to skim over some<br />

of what you have already been deemed<br />

competent on, and to get a second<br />

opinion on your skills and knowledge<br />

from a different assessor. The feel of Stage<br />

2 will probably be more formal than your<br />

previous visits because you haven’t had<br />

a chance to build any rapport with your<br />

new assessor.<br />

The visit consists of three parts – the<br />

first of which is the assessment of a<br />

routine eye exam on a presbyopic patient<br />

in 45 minutes. Although <strong>this</strong> is what<br />

you do every day, there are some subtle<br />

differences:<br />

• Tonometry and fields are not required,<br />

and the use of an auto-refractor is<br />

prohibited<br />

• The patient’s current spectacles,<br />

prescription or VA will not be made<br />

available to you<br />

• You must use the College recording<br />

sheet.<br />

It is important that you familiarise<br />

yourself with the College recording sheet<br />

and consult with your supervisor on how<br />

exactly to record your findings on the<br />

sheet. Practice using the record card on<br />

every patient you examine at least three<br />

weeks prior to your assessment to ensure<br />

your recording is seamless on the day. It<br />

may also have been a while since your<br />

supervisor sat in on an eye test with you<br />

and you may have picked up a few bad<br />

habits, so try and arrange <strong>this</strong>. I gave some<br />

helpful hints and tips for your routine eye<br />

exam in a previous article (OT, October 14,<br />

2011) and it is worth looking at <strong>this</strong> again.<br />

Next, you will be given 40 minutes to<br />

perform a soft contact lens fitting and<br />

aftercare (approximately 20 minutes for<br />

each). For the fitting section you will<br />

be given K readings, spectacle Rx and<br />

visual acuity for one of the patient’s eyes,<br />

along with a fitting scenario ie, patient<br />

motivation and wearing time. You can<br />

assume that all other slit lamp findings are<br />

normal and the patient is suitable to be<br />

fitted with contact lenses. You must then<br />

take pre-fitting measurements, make an<br />

appropriate first lens selection and insert<br />

the lens into the patient’s eye:<br />

• Know your contact lens materials. You<br />

should recommend a silicone hydrogel<br />

lens for longer wearing schedules<br />

• If the assessor bypasses the usual time<br />

allowed for the lens to settle into the eye<br />

due to time constraints, be aware that the<br />

fit will appear flatter than if it was allowed<br />

settling time<br />

• Assess the fit and suggest any<br />

modifications<br />

• All fitting information, along with your<br />

final lens specification (brand/type,<br />

base curve, diameter and Rx), should be<br />

recorded on the College recording sheet<br />

• You must remove the lens and check the<br />

cornea of the patient.<br />

For the aftercare, you are to assume<br />

that the patient is new to the practice and<br />

has booked for an aftercare appointment.<br />

You must take a relevant history and<br />

symptoms, perform an over-refraction,<br />

assess the lens fit, carry out an anterior<br />

eye slit lamp examination, including<br />

tear assessment, and finally, advise the<br />

patient on your findings, along with<br />

an appropriate recall date – again, all<br />

recorded on the College recording<br />

sheet. The assessment of over-arching<br />

competencies through a review of patient<br />

episode records is the final part of the<br />

assessment:<br />

• The assessor will sample at least two<br />

patient episodes from each of the six<br />

competency groups. Ensure that all of<br />

your patient records are easily accessible in<br />

your room, and arranged by competency,<br />

in order to ensure fluency during the<br />

assessment<br />

• The assessor will always use field plots<br />

and images – these won’t be anything out<br />

of the ordinary so be aware of common<br />

conditions. Take time methodically<br />

studying and describing what you are<br />

looking at before jumping straight into a<br />

diagnosis<br />

• You will be heavily scrutinised on how<br />

you manage patients when presented<br />

with a scenario, so know when and when<br />

not to refer, and be aware of local and<br />

national protocol on referral urgency.<br />

Don’t be nervous, be organised and<br />

hard-working in your preparation and<br />

practice your routine.<br />

Good luck.

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Program highlights include:<br />

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Mini me frames on trend<br />

With the Easter holidays just around the corner, OT<br />

looks at what new children’s frames are on offer<br />

30<br />

23/03/12 CHILDREN’S FRAMES<br />

Bollé<br />

Bollé’s sunglasses collection for kids – Bollé Kids – is based on the same<br />

properties as Bollé’s adult range, the sunglasses manufacturer tells OT –<br />

‘protection, technology, quality and style’.<br />

The Prince frame (pictured in shiny blue with smoke lenses), like all Bollé Kids<br />

sunglasses, is designed to be flexible and lightweight so that the sunglasses<br />

stay on, keeping the child’s eyes protected on long sunny days.<br />

The frames, suitable for seven to 10-year-olds, have polycarbonate moulded<br />

lenses with a carboglass coating, and are scratch and impact resistant,<br />

designed to withstand even the most active of children.<br />

Exceeding the industry standard with 100% UVA/UVB protection, parents<br />

can be assured that their child’s eyes will remain protected when wearing the<br />

sunglasses.<br />

& 020 8391 4700<br />

Continental<br />

Eyewear<br />

Recent introductions to Continental<br />

Eyewear’s Lazer Junior children’s<br />

eyewear collection are the 2078<br />

model for girls (pictured) and the<br />

2080 frame for boys.<br />

The current Lazer Junior collection<br />

consists of over 30 styles, with each model<br />

available in three or four colours.<br />

Sales and marketing director, Neal Grimason, told OT: “We are constantly releasing new styles as we are very aware of the increased frequency of<br />

visits a child makes to their optician.” Both of the new metal frames have detailed sides with a different design used on each colour frame available.<br />

This aims to allow wearers to have two frames with the same shape front but an overall different appearance. Mr Grimason added: “Recent years<br />

has seen a dramatic improvement in the appearance of children’s frames both from a style viewpoint and the use of colour. It is evident that<br />

children are discerning in their taste in eyewear and very aware of what they want.”<br />

& 0151 426 3907<br />

Orange Eyewear<br />

Orange Eyewear’s Junior range aims to offer ‘value’<br />

frames for children and teenagers in a variety of<br />

fashionable colours. The stainless steel frames, which<br />

have acetate sides, are available in sizes from 44 to 50 and<br />

come with child-friendly spring hinges.<br />

Catering for boys and girls, pictured is the ORK 106 in<br />

black, which is available in sizes 48-17 and 51-17, and in<br />

the colours gun and purple.<br />

& 0161 773 5555

Brulimar<br />

Brulimar will launch kids collections under its Lee Cooper and<br />

Pineapple eyewear brands. The introduction of the children’s<br />

ranges for boys and girls retrospectively follows the popularity of<br />

the company’s adult frames for both brands.<br />

With a combined total of more than 30 new frames released<br />

on the market, both ranges will ‘tap into the trend for adultstyle<br />

frames, with a focus on sleek and stylish eye shapes and<br />

sophisticated, modern temples’, Brulimar confirmed.<br />

The 16 Lee Cooper designs for boys include aviator-shaped<br />

frames (pictured below) and denim-inspired colours, whilst the 15<br />

new Pineapple frames for girls (pictured above) range from vibrant<br />

florals to animal-print temples.<br />

Managing director of Brulimar, Howard Librae, said: “Pineapple<br />

Eyewear has experienced phenomenal popularity since we<br />

launched the adult range in 2010. By incorporating state-of-the-art<br />

eyewear materials with such a well-loved London brand we are<br />

expecting fierce demand across the UK and Europe.”<br />

& 0845 130 1415<br />

Zoobug<br />

Children’s eyewear specialist Zoobug’s spring 2012 optical<br />

collection is retro-inspired and features a broad choice of metal<br />

and acetate frames for boys and girls alike.<br />

Updating popular designs and introducing new styles, the<br />

optical frames range is suitable for children aged two-12 years.<br />

Drawing inspiration from the vintage trend popular amongst<br />

adults, whilst staying true to the British brand’s ‘innovative’ and<br />

‘child-friendly’ frames, stripes and marbling effects have been<br />

introduced for boys, and laser engraving and crystals for girls.<br />

Director of Zoobug, Julie Diem Le, explained: “The frames<br />

in my new optical collection are inspired by the vintage<br />

trend, but I have interpreted them so the shapes are perfectly<br />

adapted to small faces.<br />

“Zoobug’s approach to fashion is always exciting, and we<br />

love to serve up super stylish frames for kids. But that’s not all.<br />

This collection is designed in the best interests of the child, in<br />

terms of the durability, ease of wear and overall comfort with<br />

new end tips and well designed nose bridges.”<br />

Iconic to Zoobug is its original ‘Daisy’ frame (pictured) which<br />

has received an update with jewel tones. The acetate frame has<br />

been cut ‘to make <strong>this</strong> style even more fun’, says the company.<br />

New sizes for the frame, which is available in pale pink, purple,<br />

raspberry and red, include 40-17 and 43-17<br />

New for boys is the ‘Stomp’ frame which Zoobug describes as<br />

evoking a retro feel. Available in green, blue, red and beige, the<br />

acetate stripe model comes in sizes 43-16 and 46-16.<br />

& 0207 251 8122<br />

Dunelm<br />

Dunelm’s WhizKids range grows by 11 <strong>this</strong> season, with new<br />

optical frames reflecting the adult trend for all things retro.<br />

The new optical styles include chunky frames with deep sides in<br />

bright colours, floral, polkadot and mosaic designs for girls, and<br />

football and fish details for boys.<br />

The latest additions to the collection mean that the range now<br />

totals 67 optical frames and 39 sun frames.<br />

Pictured is the WhizKids Seneca spectacles model which reflects<br />

the two-tone design which is popular <strong>this</strong> season. Red and cream<br />

in colour with star pattern sides, the frame is already proving to be<br />

a bestseller in the new range, Dunelm confirmed.<br />

Aiming to ‘offer something for all’, a selection of plain plastic and metal frames<br />

in more subtle, muted colours are also available for the ‘more conservative customer’.<br />

Speaking about the changing children’s frame market, director of Dunelm, Peter Beaumont, said: “Shapes are unashamedly big and bold, with<br />

children embracing them and wearing them very much as a fashion accessory, rather than seeing them as something to be embarrassed about.<br />

This is a testament to how far the category has come – children’s optical frames have lost that old stigma almost entirely because of the vast<br />

improvement in style.”<br />

& 01388 420420<br />

31<br />



March crossword<br />

Try your luck in our popular crossword competition for the chance to win £50 in shopping vouchers<br />

32<br />

23/03/12 CROSSWORD<br />

Name:<br />

Address:<br />

A5 lanscape_Layout 1 20/02/2012 15:19 Page 1<br />

across<br />

1. Association of British<br />

Dispensing ------ (9)<br />

8. War-time security official (3-4, 6)<br />

11. Vegetarian food (4)<br />

12. Thrillers’ author, ----- Francis (5)<br />

13. Admired for brave deeds (4)<br />

16. Pressed into trousers (7)<br />

17. Casual summer footwear (7)<br />

18. Formation initially seen on<br />

RADAR (7)<br />

20. Bantu weapon (7)<br />

21. Food, commonly known as (4)<br />

22. Cable carrier (5)<br />

23. Ash, elm etc. (4)<br />

26. High ranking Naval officer at<br />

the Battle of Trafalgar (7,6)<br />

27. Sentry-go (5,4)<br />

down<br />

2. Place where ships can dock (4)<br />

3. Frozen tapering pieces of ice (7)<br />

4. Moving towards the centre (7)<br />

5. Average, typical or standard (4)<br />

6. Length of a boxing match (7,6)<br />

7. British Military commander, died<br />

at Khartoum (7,6)<br />

9. Accusation of guilt (2,1,6)<br />

10. Join in a secret agreement to<br />

do something wrong or illegal (9)<br />

14. Yoga posture (5)<br />

15. Mediterranean plant type (5)<br />

19. Salubrious region of London (7)<br />

20. Decorated (7)<br />

24. ‘God’, a religious epic by Victor<br />

Hugo (4)<br />

25. Ink blemish (4)<br />

Send entries to OT March Crossword, 2 Woodbridge Street, London EC1R<br />

0DG by April 16, 2012. You can enter OT’s Crossword competition online<br />

at www.optometry.co.uk. The winner of OT’s January Crossword was<br />

optometrist Ken Forster from Kendal, Cumbria. He wins a £50 Marks &<br />

Spencer shopping voucher.<br />

OCANZ Applicants Practical Skills Training Course<br />

Tuesday 29th May 2012<br />

An intensive 1-day practical skills training course hosted by Aston University <strong>Optometry</strong> Department,<br />

for UK optometrists undertaking the OCANZ examinations in 2012.<br />

Delegates will benefit from working in small groups whilst gaining supervised clinical experience in the<br />

following areas:<br />

• Contact tonometry<br />

• Gonioscopy<br />

• Head mounted and slitlamp BIO<br />

• Binocular vision assessment<br />

Course fee £450 per delegate. For further information, please email optometrycpd@aston.ac.uk<br />

or visit http://www1.aston.ac.uk/lhs/cpd/courses/optometry/<br />


Achieve your goals<br />

Exmouth Rowing Club 8K Regatta 2011<br />

Steve, Super Optom<br />

Give us a call...<br />

...Steve did!<br />

Call and speak to Jim Gilbert today: 01793 648607 email: jim@outsideclinic.com

ADVICE<br />

Employers should act<br />

now on pension reform<br />

New rules for employers are set to take place starting <strong>this</strong> year, OT asked Rachel O’Donoghue,<br />

director of Buzzacott, financial planning to explain some of the changes<br />

34<br />

23/03/12 PENSION REFORM<br />


provision will be<br />

revolutionised by key<br />

reforms introduced in the<br />

Pension Act 2008. The<br />

changes take effect from<br />

2012 and will affect all<br />

UK employers, whether<br />

companies or not-for-profit<br />

organisations.<br />

Government estimates<br />

suggest that around seven<br />

million people are undersaving<br />

for retirement. As a<br />

result, the pensions reforms<br />

place the onus on employers to ensure that individuals save<br />

for retirement.<br />

For the first time, all employers will automatically have<br />

to enrol all eligible employees into a workplace pension<br />

scheme which meets or exceeds certain legal standards. In<br />

addition, all employers will be required to pay into a pension<br />

scheme on behalf of employees. Employers will have to<br />

comply with the new legislation, even if they already offer a<br />

pension scheme to employees.<br />

“There will be a direct cost to all<br />

employers”<br />

a qualifying pension scheme,<br />

<strong>this</strong> can be an employer’s<br />

existing pension scheme as<br />

long as it meets the minimum<br />

criteria. Alternatively, there<br />

is an option to use the new<br />

workplace pension scheme; the<br />

National Employment Savings<br />

Trust (NEST).<br />

Qualifying schemes offer<br />

a more comprehensive and<br />

flexible pension arrangement<br />

than NEST, potentially offering<br />

a greater range of investment<br />

options, higher levels of<br />

permitted contributions and possibly no up-front charge on<br />

contributions.<br />

NEST aims to provide a basic, low cost pension scheme<br />

and is generally targeted at organisations that employ low-tomoderate<br />

earners and do not have, or do not wish to use, their<br />

own qualifying scheme for all employees.<br />

Charges will be applied to cover the set-up costs for NEST.<br />

In addition, there will be an ongoing administration and<br />

investment management charges.<br />

Buzzacott is a financial planning firm company which<br />

recently ran seminars on the changes. To contact a member of<br />

its financial planning team email enquiries@buzzacott.co.uk.<br />

For more information visit www.buzzacott.co.uk<br />

The new regulations will be rolled out between 2012<br />

and 2017; the date companies will be affected from is<br />

dependent on the size of their largest PAYE scheme, with<br />

those employing fewer than 50 people in their largest PAYE<br />

scheme given more time to prepare.<br />

Costs involved<br />

There will be a direct cost to all employers in the form of a<br />

compulsory pension contribution for all eligible employees –<br />

a minimum of three per cent of their ‘qualifying earnings’ by<br />

the end of the phasing-in period. Complying with the autoenrolment<br />

rules may also place a considerable administrative<br />

burden on employers.<br />

Employers must ensure pension contributions are paid into<br />

Positive steps employers should take<br />

1. Identify the likely cost impact (both of contribution and<br />

implementation)<br />

2. Consider the options available for mitigating the costs<br />

3. Phase in contributions over a number of years<br />

4. Consider whether any existing pension schemes meet<br />

the criteria<br />

5. Investigate how any existing pension schemes can be<br />

improved/amended<br />

6. Prepare for the administration requirements<br />

7. Review the opportunity to create a National Insurance<br />

saving that could be used to further reward employees, or<br />

help fund the cost of increased contributions<br />

This article is prepared to keep readers abreast of current developments, but is not intended to be a comprehensive statement of law or current practice. Professional<br />

advice should be taken in light of your personal circumstances before any action is taken or refrained from. No liability is accepted for the opinions it contains, or<br />

for any errors or omissions. Buzzacott Financial Planning is the trading name of Buzzacott Financial Services Limited, registered office is 130 Wood Street, London,<br />

EC2V 6DL. Authorised and regulated by the Financial Services Authority © Buzzacott Financial Services Limited December 2011. All rights reserved.

A guide to: i-vue<br />

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Content Driven Digital Signage<br />

Educate and Entertain your patients in the waiting<br />

area to promote your products and services.<br />

Fed-up of those old, tired<br />

magazines in the waiting<br />

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energise your practice<br />

with modern technology<br />

that doesn’t cost the earth?<br />

It’s time you<br />

looked at i-Vue…<br />

Engage patients in the waiting area with i-Vue. Only i-Vue uses CAPTIV8 3D animations that have been meticulously<br />

developed to add a real WOW to your practice by delivering content that will help grow your practice.<br />

Amazing Content<br />

i-Vue includes a full library of the highest quality 3D animations.<br />

With content covering everything from frames, lenses, contact<br />

lenses, eye diseases and surgery there’s something for everyone.<br />

Not only that, your i-Vue subscription includes<br />

ALL new animations (developed approximately monthly).<br />

Live updates!<br />

i-Vue allows you to easily create playlists and add personalised<br />

messages. What’s really amazing is that you can do <strong>this</strong> from any<br />

web browser and your i-Vue/s will update automatically!<br />

All at an affordable monthly cost<br />

<br />

www.optimed.co.uk<br />

Tel: +44 (0) 2476 444 118<br />

Email: info@optimed.co.uk


Trading places<br />

In new roles<br />

Optix Software has expanded its support<br />

team to eight, with two new appointments to its<br />

York-based offices. Optix support desk manager,<br />

Lee Atkinson, (pictured left) explained that the<br />

continual growth of the number of practices<br />

using the business management software had<br />

inevitably led to more support resources being<br />

required.<br />

36<br />

23/03/12 INDUSTRY NEWS<br />

“The queries we receive from our customers<br />

range vastly in terms of their experience of IT<br />

<strong>issue</strong>s and skills,” he said. “We simply enjoy<br />

supporting and advising them all on how to gain<br />

the most benefit from our system. With the face<br />

to face training they receive, and our annual<br />

conference, we get to know all of our customers<br />

personally, which is important to us, even those<br />

in Trinidad.”<br />

Adam Eamonson (pictured centre) joins the<br />

company with experience in marketing, IT and<br />

customer service. Anthony Holdsworth (pictured<br />

right) has much experience in customer support<br />

within the retail industry and with bespoke<br />

software.<br />

The Optix annual user group meeting is next<br />

week on March 27 and 28 at Carden Park, near<br />

Chester. The after dinner speaker is broadcaster<br />

and journalist John Sergeant.<br />

GetLenses, the UK’s<br />

largest online contact<br />

lenses retailer, has<br />

appointed Ashley<br />

Mealor (pictured) as<br />

marketing director. He<br />

is based in the London<br />

office and has over 12<br />

years’ experience in<br />

the marketing sector,<br />

having held positions<br />

within major brands such as O2, Betfair and<br />

British Airways.<br />

His role will include continuing to grow the<br />

company’s 30% online market share in the<br />

UK, while also implementing new marketing<br />

strategies within Europe, following the retailer’s<br />

recent rapid expansion into Ireland, Italy and<br />

Holland. The company has sales of over £8m and<br />

100,000 active customers.<br />

Changing image<br />

HeIDelberg eNgINeeRINg has launched<br />

MultiColor Scanning Laser Imaging as ‘a new<br />

dimension in multi-modality fundus imaging’<br />

with the Spectralis product family. Some UK<br />

optometrists are using the Spectralis system<br />

which is said to be the only one which allows<br />

them to choose the imaging modules they<br />

require and offers simultaneous OCT with all<br />

models.<br />

Heidelberg, based in Hertfordshire, is taking<br />

over the distribution of its products from<br />

Haag-Streit UK on April 1 and there will be<br />

‘a big push’ into optometry afterwards.<br />

The new imaging modality was unveiled at<br />

the World Ophthalmology Congress in Abu<br />

Dhabi. “The combination of MultiColor fundus<br />

imaging and SD-OCT in a single device elevates the Spectralis multi-modality platform to a new<br />

level of diagnostic power,” said Kester Nahen, VP of global marketing and business development.<br />

For information on the complete range of modular SD-OCT and visual fields visit the website<br />

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

& 01442 345370

In the pink<br />

after MIDO<br />

Dunelm Optical has unveiled its<br />

new collections in the latest 2012<br />

catalogue, after previewing the new<br />

styles at MIDO in Milan earlier <strong>this</strong><br />

month.<br />

There are almost 800 optical and<br />

sun frames featured in total with<br />

140 new collections from renowned<br />

international designers Janet Reger,<br />

Paul Costelloe and John Rocha. There<br />

is also a wide selection of own-brand<br />

styles, including Julian Beaumont,<br />

(pictured left is JB752 ), Retro,<br />

Chantelle and Whiz Kids.<br />

Dunelm director, Peter Beaumont,<br />

said: “This year we’ve really excelled in<br />

the style stakes with our new frames<br />

and we genuinely believe there is<br />

something to suit every taste, and<br />

pocket, in the new brochure.<br />

“We opened up seven new countries<br />

in Milan <strong>this</strong> year and doubled the<br />

orders we did last year, so we are, of<br />

course, thrilled. The show itself was<br />

busier than it has been in a few years<br />

which was encouraging news for the<br />

industry as a whole.”<br />

& 01388 420420<br />

OT industry<br />

news online<br />

OT’s industry pages have proved so<br />

popular that we’ve now introduced a<br />

separate section on the OT website to<br />

give practitioners more in depth news<br />

on the latest product innovations and<br />

launches.<br />

Go to www.optometry.co.uk to help<br />

keep you at the cutting edge of optics<br />

and to boost your business.<br />

Optical companies: you can reach<br />

your customers in a new and exciting<br />

way. To be involved simply email<br />

your press releases and pictures to<br />

OT deputy editor Robina Moss at<br />

robinamoss@optometry.co.uk or write<br />

to her at 2 Woodbridge Street, London,<br />

EC1R 0DG.<br />

Three of<br />

a kind<br />

INTeRNaTIONal eYewear has launched three new TR90 models – Eyestuff Tickle, Sketch and<br />

Muddle which are designed to appeal to children between the ages of four and 12.<br />

The frames feature the technologically advanced TR90 material and a grown-up eye shape,<br />

which remains suitable for children’s prescriptions. The Swiss TR90 material is good to use for<br />

children, as it is flexible, durable, lightweight and resistant to perspiration. An adjustment wire in<br />

the temple tips, alongside a quirky elliptical tip shape, adds interest and practicality.<br />

A stand out frame within the new collection is Muddle, a full rim combination model with cute<br />

temple designs. It is available in a size of 45-17-130 in three vivid colour options of juicy orange,<br />

flamingo pink and bonza brown (pictured).<br />

Extensive and carefully planned market research was carried out by the company in creating<br />

the new models. It included organising focus groups, consulting local dispensers and drawing on<br />

the in-depth knowledge gained over the years creating the popular Eyestuff kids’ collection.<br />

To celebrate <strong>this</strong> launch, Eyestuff is also offering a display package for any independent<br />

optician looking for ‘all the fun of the fair’ within their practice.<br />

& 0121 585 6565<br />

New App<br />

for orders<br />

Hoya has launched the Hoyanet App which is<br />

designed to free up practice managers from being<br />

tied to the practice by enabling them to keep in<br />

touch with the laboratories and lens supplier and<br />

track the progress of Hoya orders, even when they are<br />

miles away.<br />

The App is free to download and already being used by<br />

more than 60 customers who can keep up to date with lens<br />

releases and check the status of orders at the tap of a finger.<br />

The App also enables them to also switch from one practice<br />

account to another, without needing to log in and out.<br />

“It is now easier than ever to focus on the key <strong>issue</strong>s<br />

which keep the customers coming back,” said Hoya<br />

sales support manager, Carl Pearson.<br />

The new App is compatible with iPhone 3GS,<br />

iPhone 4 and iPads. Details are available<br />

from the Apple App Store or by emailing<br />

supportingyou@hoya.co.uk<br />

& 0845 3300 984<br />

37<br />


Minimal<br />

operator training<br />

required<br />

Free image<br />

viewing via a<br />

web browser on<br />

a tablet or PC<br />

Easy-to-use<br />

intuitive<br />

touch screen<br />

The DRS non-mydriatic retinal camera . . .<br />

*<br />

all of <strong>this</strong> for just £9,995<br />

The fully-automated DRS nonmydriatic<br />

retinal camera has been<br />

designed to maximise patient flow<br />

without compromising on image<br />

quality.<br />

Minimal operator training<br />

Its compact, ergonomic design<br />

features an integrated PC with an<br />

easy-to-use intuitive touch screen<br />

and requires minimal operator<br />

training.<br />

Acquisition of the posterior and<br />

anterior segment<br />

It offers automatic (or manual)<br />

acquisition of the posterior and<br />

anterior segment, providing<br />

alignment throughout the live image.<br />

It supports single or multi-field<br />

acquisition protocols, providing seven<br />

different standardised 45° fields.<br />

Automatic mosaic composition is<br />

supported and the DRS also boasts<br />

measuring tools such as; area vessel<br />

calliper and relation ‘cup-to-disc’.<br />

Images in just 30 seconds per eye<br />

The DRS automatically senses the<br />

patient, self-aligns to the target eye,<br />

focuses the retina, adjusts the flash<br />

level and captures the image – all in<br />

less than 30 seconds.<br />

Haag-Streit, a name you can trust<br />

The DRS is supplied and supported<br />

by Haag-Streit, so quality, accuracy<br />

and reliability are assured.<br />

Key features & benefits<br />

• Approved by the UK National<br />

Screening Committee for use in<br />

the NHS Diabetic Eye Screening<br />

Programme<br />

• Stereo mode, with 3D viewer<br />

• Captures both eyes in one minute<br />

• Automatic (or manual) acquisition<br />

of the posterior and anterior<br />

segment<br />

• Minimal operator training required<br />

• Easy-to-use intuitive touch-screen<br />

• Integrated PC with 160Gb hard<br />

drive<br />

• Wi-Fi and ethernet connection.<br />

For further information on the DRS non-mydriatic retinal camera, please<br />

telephone us on (01279) 456255, email drs@haag-streit-uk.com or<br />

alternatively, visit www.haagstreituk.com/drs<br />

* Excludes VAT and table<br />

(01279) 456255<br />

drs@haag-streit-uk.com<br />

Follow us on Twitter @HS_UK

update<br />

AOP Member Benefits<br />

– Cashback Gift Cards<br />

AOP Privileges is a free membership benefits package which has been put together with the goal<br />

of saving members’ time and money. The ‘Cashback Gift Cards’ scheme is just one of the benefits<br />

offered to AOP members. OT explains how it works<br />

39<br />

the AOP membership<br />

‘Cashback Gift Cards’ scheme<br />

is designed to help with<br />

household budgeting and<br />

saving money.<br />

To qualify for <strong>this</strong> free<br />

service, AOP members are<br />

required to register by visiting the ‘Cashback Gift Cards’<br />

website www.aop.org.uk click on member-services/memberbenefits/aopprivileges.<br />

Every time you load money onto a<br />

retailer’s reloadable card you could earn up to 15% cashback.<br />

Some AOP members are already using the benefit and<br />

saving on a monthly basis. One example is a member who<br />

spent £5,000 in B&Q and earned £400 back in one fell swoop.<br />

Another member earned £304.50 last year, mainly through<br />

grocery shopping for the family. When asked what she spent it<br />

on she simply said ‘me’.<br />

Just decide how much money you want to spend with each<br />

retailer every week or month and load your budget onto the<br />

gift cards. The cashback you generate can be easily transferred<br />

to any of your cards, meaning that the cashback you earn<br />

in one store can be spent in another. You will also still earn<br />

on other loyalty schemes you use such as Nectar, Boots<br />

Advantage and the Costa Coffee Club.<br />

For example, if you do your grocery shopping at ASDA,<br />

you would select an ASDA Gift Card to stretch your budget.<br />

If you typically spent £250 per month, you would earn<br />

£130.50* net ‘cashback’ per year. This can then be spent on<br />

the family’s weekly shop.<br />

Saving for an occasion or a big expense? Why not<br />

accumulate your cashback and when you are ready you can<br />

load it onto a card from any of the retailers in the scheme. For<br />

example, you can load the cashback onto a B&Q card to put it<br />

towards a DIY project. You could buy Christmas presents or<br />

even update your wardrobe.<br />

Why not use the online, interactive savings calculator to find<br />

out how much you could potentially save by using ‘Cashback<br />

Gift Cards’? Simply enter your estimated ‘spending per month’<br />

for the categories shown online and then click the ‘calculate<br />

savings’ button to see your savings.<br />

‘Cashback Gift Cards’ charge £1 per month membership fee,<br />

but as <strong>this</strong> is taken from the ‘cashback’ you earn, membership<br />

is effectively free.<br />

Here’s how it works in five easy steps:<br />

1. Begin by visiting the Cashback Gift Cards website www.<br />

aop.org.uk click on member-services/member-benefits/<br />

aopprivileges<br />

2. Sign up to register (<strong>this</strong> only takes a couple of minutes)<br />

3. To qualify for <strong>this</strong> member benefit deal, you must enter the<br />

reference code: AOPO<br />

4. A username and password will be emailed to you<br />

immediately<br />

5. You can then login to your account<br />

Once logged in you can choose which card you would like<br />

to have sent to you from a range of your favourite stores.<br />

Choose from Topshop, Topman, B&Q, Boots, M&S, ASDA,<br />

Comet, Debenhams and many more. Once your cards have<br />

arrived in the post you can return to the site time and time<br />

again to load them ready for use.<br />

Cashback will be added to your account every time you load<br />

a card.<br />

23/03/12 AOP PRIVILEGES<br />

• Terms and conditions apply. See website for further details. Example<br />

used is illustrative. Example base charges included in net saving. AOP<br />

Privileges is managed on behalf of the AOP by Parliament Hill Ltd of<br />

Floor 3, 127 Cheapside, London, EC2V 6BT. Neither Parliament Hill


Speakers for London 2012 Education Destination<br />

Paul C. Ajamian, OD FAAO US SPEAKER<br />

Jane Bell, FCOptom DipTp(IP)<br />

Murray Fingeret, OD FAAO US SPEAKER<br />

John Lawrenson, PhD MCOptom<br />

Nicholas Rumney, FCOptom FAAO<br />

April 29 th & 30 th<br />

The Association of Optometrists, in partnership with SECO International, are proud to be hosting a<br />

2-day CET/COPE program focusing on therapeutics and optometrist prescribing. This program also<br />

offers social events and group tours.<br />

This will be the first CET event in the Association of Optometrists' prestigious new central London<br />

headquarters and education venue. The event will focus on optometry as a specialist area with sessions<br />

targeted at therapeutics, prescribing rights and the contrasts between UK and US patient care pathways.<br />


For more information visit www.aop.org.uk<br />

Produced by


NEW… 18 Optos, Hilton Stansted Airport,<br />

Essex, Optos Daytona and OCT roadshow<br />


18 No 7 Contact Lenses, Sidney Little Road,<br />

Hastings, Ortho K and topography day SEE<br />

ABOVE<br />

NEW… 19 Optos, Radisson Blu, Bristol,<br />

Optos Daytona and OCT roadshow SEE<br />

ABOVE<br />

MAY<br />

NEW… 10 No 7 Contact Lenses, Sidney<br />

Little Road, Improve your contact lens<br />

confidence (www.no7contactlenses.com)<br />

NEW… 13 WOPEC, Anglia Ruskin<br />

University, Cambridgeshire, Gonioscopy<br />

event (mackens@cardiff.ac.uk)<br />

NEW… 14 Macular Disease Society,<br />

Edinburgh, Top doctors roadshow (help@<br />

maculardisease.org)<br />

Cardiff University hosts WNOC<br />

Practitioners in Wales have the opportunity to learn about<br />

optometry and the law, rocs, public health and a variety of clinical<br />

topics at the Welsh National Optometric Conference (Wnoc) next<br />

month.<br />

Organised by WOPEC and <strong>Optometry</strong> Wales, the conference takes<br />

place on Saturday April 21 at Cardiff University’s School of <strong>Optometry</strong><br />

and Vision Sciences with a black-tie dinner held in the evening at the<br />

near-by Radisson Blu Hotel.<br />

Tickets for the cet-accredited event are still available from the website<br />

www.wopec.co.uk<br />

MARCH<br />

27 J&J, The Vision Care Institute, Pinewood,<br />

Berkshire, Managing the astigmatic patient<br />

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

3 NEOS, Holiday Inn Express, Waterloo Square,<br />

St James Boulevard, Newcastle upon Tyne,<br />

The eye in systemic disease (neosoptoms@<br />

hotmail.co.uk)<br />

20-22 EAOO, Dublin, Ireland, Annual<br />

conference (www.eaoo.info)<br />

NEW… 21 WOPEC/<strong>Optometry</strong> Wales,<br />

Cardiff University, Cardiff, Welsh National<br />

Optometric Conference<br />

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

23 Ultravision, Commerce Way, Leighton<br />

Buzzard, Bedfordshire, Interactive<br />

workshops SEE ABOVE<br />

NEW… 24 Kensington, Chelsea and<br />

Westminster Local Optical Committee, The<br />

Chapel, Chapel Street, London, NW1, AGM<br />

(kcw.loc@gmail.com)<br />

24 SBK Healthcare, The Hatton,<br />

Farringdon, Managing change in your<br />

ophthalmology service course (www.sbkhealthcare.com)<br />

NEW… 14 No 7 Contact Lenses, Sidney<br />

Little Road, Hastings, Fitting presbyopic<br />

contact lenses SEE ABOVE<br />

NEW… 15 Macular Disease Society,<br />

Belfast, Top doctors roadshow SEE ABOVE<br />

NEW… 21 Warwickshire AOP, The Venture<br />

Centre, University of Warwick Science Park,<br />

Coventry, Myopia control lecture SEE ABOVE<br />

NEW… 21-22 J&J, The Vision Care<br />

Institute, Pinewood, Berkshire, Healthy<br />

eyes and healthy practices and managing<br />

the astigmatic patient, combined course<br />


NEW… 24 Macular Disease Society,<br />

Manchester, Top doctors roadshow SEE<br />

ABOVE<br />

41<br />

23/03/12 DIARY DATES<br />

28 North Yorkshire LOC, National<br />

Railway Museum, York, CET day (www.<br />

northyorkshireloc.co.uk)<br />

3 No 7 Contact Lenses, Sidney Little Road,<br />

Hastings, Next generation hybrids (www.<br />

no7contactlenses.com)<br />

NEW… 25 Optos, Hilton Manchester<br />

Airport, Manchester, Optos Daytona and<br />

OCT roadshow SEE ABOVE<br />

NEW… 24-27 BCLA, ICC, Birmingham,<br />

Annual clinical conference and exhibition<br />


28 UltraVision, Commerce Way, Leighton<br />

Buzzard, Bedfordshire, Interactive workshops<br />

(workshop@ultravision.co.uk)<br />

12 No 7 Contact Lenses, Sidney Little Road,<br />

Hastings, Future proof contact lenses SEE<br />

ABOVE<br />

25-26 J&J, The Vision Care Institute,<br />

Pinewood, Berkshire, Returning to work<br />

confident and refreshed SEE ABOVE<br />

NEW… 29 ABDO Golf Society, Moseley<br />

Golf Club, Birmingham, Challenge Cup<br />

(m.stokes67@ntlworld.com)<br />

28 BCLA, 76 Portland Place, London, Evening<br />

meeting (www.bcla.org.uk)<br />

28 ABDO, Shamir Head Office, Shamir Bridge<br />

House, Saxon Way, Bar Hill, Cambridge, Area 4<br />

CET meeting (abdoarea4@gmail.com)<br />

29 Nidek, Aston University, Birmingham,<br />

Pentacam users day (www.nidek.co.uk)<br />

APRIL<br />

2 Nottingham and Derby Optical Society,<br />

Wolloughby Hall, Nottingham University Park<br />

Campus, Nottingham, Complex dispensing<br />

lecture (NDOS@live.com)<br />

16 Warwickshire AOP, The Venture Centre,<br />

University of Warwick Science Park, Coventry,<br />

Casualty lecture (susan@susanrbowers.co.uk)<br />

16 University of Warwick, Coventry,<br />

Ophthalmic imaging course begins (www.<br />

warwick.ac.uk)<br />

NEW… 17 Optos, Hilton Euston, London,<br />

WC1H, Optos Daytona and OCT roadshow<br />

(www.optos.com/register)<br />

17 J&J, The Vision Care Institute, Pinewood,<br />

Berkshire, Presbyopia and its management<br />

with contact lenses SEE ABOVE<br />

NEW… 26 Optos, Hilton Newcastle<br />

Gateshead, Newcastle upon Tyne, Optos<br />

Daytona and OCT roadshow SEE ABOVE<br />

27 J&J, The Vision Care Institute, Pinewood,<br />

Berkshire, Presbyopia and its management<br />

with contact lenses SEE ABOVE<br />

27 No 7 Contact Lenses, Sidney Little Road,<br />

Contact lenses – it’s everybody’s business<br />


29-30, AOP, 2 Woodbridge Street, London,<br />

EC1R, Education destination with SECO<br />

(www.aop.org.uk)<br />

JUNE<br />

NEW… 12 Hampshire LOC, Chilworth<br />

Manor, Southampton, AGM and CET event<br />

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

NEW… 14 Macular Disease Society,<br />

Newcastle, Top doctors roadshow SEE<br />

ABOVE<br />

NEW… 18-19 J&J, The Vision Care<br />

Institute, Pinewood, Berkshire, Returning<br />

to work confident and refreshed SEE ABOVE<br />

NEW… 19 Carl Zeiss Education,<br />

Manchester, OCT course SEE ABOVE<br />

Place your event on OT’s diary dates section – for free. If you have any diary dates which you would like to publicise, please don’t hesitate to contact us. OT goes to every registered optometrist and<br />

dispensing optician in the UK. Send full details for inclusion in the next <strong>issue</strong> before March 27 to Chris Donkin by emailing chrisdonkin@optometry.co.uk or call him on 020 7549 2074. NEW...denotes <strong>this</strong><br />

event that has not been printed in Diary Dates previously. You can place your event on our website, also for free, click on www.optometry.co.uk for more details.

VRICS<br />

Visual Recognition<br />

and Identification<br />

of Clinical Signs<br />

Sponsored by<br />

Readers are encouraged to discuss the cases in <strong>this</strong> FREE VRICS with their colleagues, conduct simple<br />

Internet searches, and use the references provided to complete the Multiple Choice Questions (MCQs).<br />

Please note that there is only one correct answer for each MCQ. Complete the VRICS test online at<br />

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

Vision Assessment in Ocular Disease Part 4<br />

Course Code: C-18426 O/D<br />

Dr Raymond Beirne, BSc (Hons), MCOptom, PhD<br />

About the author<br />

Dr Raymond Beirne is an optometrist and lecturer at the University of Ulster where he teaches<br />

on the BSc (Hons) <strong>Optometry</strong> course and the fully online distance learning MSc in Clinical Visual<br />

Science. His main research interest is visual function in the ageing eye and ocular disease.<br />

42<br />

1. Which visual field test strategy has been used to acquire the results<br />

shown in Image A?<br />

a) Swedish interactive threshold algorithm strategy<br />

b) Supra-threshold screening strategy<br />

c) Zippy adaptive threshold algorithm strategy<br />

d) Single intensity screening strategy<br />

23/03/12 VRICS<br />

A<br />

2. For which of the following clinical scenarios is it NOT appropriate to use<br />

the test results shown in Image A to help make a final clinical decision in<br />

optometric practice?<br />

a) If a patient is complaining of headaches<br />

b) If a patient has normal IOP but has optic discs that are suspicious of glaucoma<br />

c) If a patient wishes to know if they are suitable to drive a car<br />

d) If a patient appears to have tilted discs on Volk lens examination<br />

3. Which of the following visual function tests would be LEAST useful in<br />

assessing a patient with the fundus appearance shown in Image B?<br />

a) Amsler Grid<br />

b) Photostress recovery time<br />

c) Preferential hyperacuity perimetry<br />

d) Stereopsis<br />

B<br />

4. Which of the following could increase the risk of vision loss in a patient<br />

with the fundus appearance shown in Image B?<br />

a) If the patient is a smoker<br />

b) If the patient has suffered choroidal neovascularisation in the fellow eye<br />

c) If the patient has had previous cataract surgery carried out on <strong>this</strong> eye<br />

d) All of the above<br />

5. Which of the following statements about the test results shown in<br />

Image C is true?<br />

a) The patient has essential anisocoria<br />

b) There is damage to the parasympathetic innervation to the right eye<br />

c) There is damage to the sympathetic innervation to the left eye<br />

d) There is a total afferent pupil defect in the left eye<br />

C<br />

6. Which of the following signs would suggest a recent onset Adie’s pupil if<br />

a 40-year-old female presents with the test results shown in Image C?<br />

a) Relative afferent pupil defect<br />

b) Very slow near pupillary reaction in the affected eye<br />

c) Ptosis on the affected side<br />

d) Iris heterochromia<br />

Astigmatism: potential is all around you. Maximise it!<br />

27th March and 9th July 2012<br />

2358 VRICS Banner 420x30_ASTIGMATISM.indd 1 12/03/2012 10:20

CONFUSED ABOUT CET REQUIREMENTS? www.cetoptics.com/cetusers/faqs/<br />

Sponsored by<br />

IMPORTANT INFORMATION: Under the new Vantage rules, all OT CET points awarded will be uploaded to its website by us.<br />

All participants must confirm these results on www.cetoptics.com so that they can move their points from the “Pending Points record” into<br />

their “Final CET points record”. Full instructions on how to do <strong>this</strong> are available on their website. The closing date for <strong>this</strong> examination is<br />

May 4 2012. CET points for <strong>this</strong> exam will be uploaded to Vantage on May 14 2012.<br />

2 Free cet Points<br />

Approved for Optometrists<br />

4<br />

Dispensing Opticians<br />

4<br />

References to aid completion of the exam:<br />

Q5 & Q6: Bremner, FD (2000). Pupil Abnormalities OT, 7th April.<br />

Q1 & Q2: Hancock, S (2008). Clinical Decision Making I: Visual Field Interpretation. OT, 11th July Q7 & Q8: http://webeye.ophth.uiowa.edu/ips/perimetryhistory/FDP/index.htm<br />

Q3 & Q4: Binns, A (2011). Assessment and Management of AMD: Referral Refinement Part 4. Q9 & Q10: www.contrastsensitivity.net/csc.html<br />

OT, 20th May.<br />

Q11 & Q12: www.scribd.com/doc/59085894/Pelli-Robson-ETDRS-Score-Sheet-Instructions<br />

LARGER SCALE IMAGES ARE AVAILABLE ON THE OT WEBSITE (Simply click on the image when completing the exam online)<br />

7. For which of the following clinical scenarios is it LEAST appropriate to<br />

conduct the test shown in Image D?<br />

a) If you suspect that a patient has a branch retinal vein occlusion<br />

b) If you suspect visual field loss due to hydroxychloroquine toxicity<br />

c) If you suspect that a patient has anterior ischaemic optic neuropathy<br />

d) If you suspect that a patient has a glaucomatous optic disc<br />

43<br />

D<br />

8. Which of the following statements about the visual field defect shown<br />

in Image D is FALSE?<br />

a) It could be described as being altitudinal<br />

b) It shows an absolute scotoma in the superior field<br />

c) It respects the horizontal mid-line<br />

d) The plot is unreliable due to fixation errors<br />

9. Which one of the following statements about the test and results shown<br />

in Image E is true?<br />

a) It uses a 6-alternate forced choice psychophysical method<br />

b) It is a letter based contrast sensitivity test<br />

c) Both eyes have abnormal contrast sensitivity at moderate spatial frequencies<br />

d) It indicates that both eyes should have similar high contrast visual acuity values<br />

23/03/12 VRICS<br />

E<br />

10. Which other clinical test can provide additional information about the<br />

right-hand side of the graph shown in Image E?<br />

a) Mars contrast sensitivity test<br />

b) Regan test chart<br />

c) Pelli-Robson contrast sensitivity test<br />

d) Melbourne edge contrast sensitivity test<br />

11. What would be the equivalent Snellen distance VA for the left eye of<br />

the patient whose clinical data is shown in Image F?<br />

a) 6/60<br />

b) 6/24<br />

c) 6/12<br />

d) 6/6<br />

F<br />

12. Which one of the following statements about the contrast sensitivity<br />

data shown in Image F is true?<br />

a) There is severe loss in both eyes<br />

b) There is severe loss in the right eye and normal results in the left eye<br />

c) There is moderate loss in both eyes<br />

d) There is severe loss in the right eye and moderate loss in the left eye<br />

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2358 VRICS Banner 420x30_ASTIGMATISM.indd 2 12/03/2012 10:20

You must be logged in to the CET section of the OT website before you can watch <strong>this</strong> video and take the exam. A hint button is now available for each<br />

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uploaded to CET Optics up to 10 days later.<br />

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Assessing visual function I<br />

Young childREN’s visION PART 3 C-18550 O/D<br />

Dr Margaret Woodhouse, BSc (Hons), PhD, MCOptom<br />

Assessing visual functions in young children can often be perceived as being<br />

challenging. This article looks at how practitioners might ensure that each<br />

test is successful by making simple modifications to procedures and by<br />

choosing ability-appropriate tests. The author does not suggest that the<br />

practitioner examine a child in the order described in the article; choosing<br />

the order of test procedures will be covered in the next article of <strong>this</strong> series.<br />

Distance visual acuity<br />

There are a number of tests available and it<br />

is worth investing in a variety. Those based<br />

on logMAR principles are advantageous.<br />

At the very least, practitioners should<br />

use tests which offer the same task at all<br />

acuity levels, and have equal steps in<br />

acuity. Ideally, norms and repeatability<br />

(the variation in score for the same patient<br />

tested on two occasions) data should be<br />

available, as <strong>this</strong> enables the practitioner<br />

to recognise a change in visual function.<br />

For example, if a child’s acuity on a<br />

second examination is different by an<br />

amount less than the repeatability of the<br />

test, then the likelihood is that there has<br />

been no real change. If the difference is<br />

greater than the repeatability, you can<br />

be more confident that VA has changed.<br />

Figure 1<br />

From the position of Joshua’s eyes it is easy to<br />

predict that the picture on the Cardiff Acuity Test<br />

card is at the bottom. Picture courtesy of Mike<br />

O’Carroll<br />

Preferential-looking<br />

For very young children, tests based on<br />

preferential looking (PL) are the most<br />

reliable. Teller (available in the US) or<br />

Keeler Acuity Cards (in the UK) use black/<br />

white grating targets placed within one<br />

half of a grey card. These are suitable for<br />

infants under 12 months of age. Beyond<br />

the first year, children find gratings rather<br />

boring and it becomes difficult to hold<br />

their attention. The pictures used in<br />

the Cardiff Acuity Test are much more<br />

attention-grabbing and are suitable for<br />

the toddler age group. Each picture is<br />

made up of a black/white outline and<br />

is positioned at the top or bottom of a<br />

grey card. The average brightness of the<br />

black/white target matches the midgrey<br />

of the background, so that when the<br />

target (grating or picture) is beyond the<br />

acuity limit, it is invisible against the<br />

background. Thus, if a child reliably looks<br />

towards the target, the practitioner can<br />

assume that it is within the acuity limit,<br />

but if the same child then fails to look<br />

towards a finer target, the practitioner<br />

can assume that the acuity limit has been<br />

exceeded. The crucial element in the use<br />

of PL is objectivity. The practitioner must<br />

NOT know the position of the target.<br />

For the Teller/Keeler Cards,<br />

practitioners should ‘twirl’ each card<br />

before presentation, whilst for the Cardiff<br />

Acuity Test the three cards available for<br />

each acuity level should be shuffled. Begin<br />

with a large, easily visible target. Attract<br />

the child’s attention straight ahead and<br />

then quickly present the card. For Teller/<br />

Keeler Cards, look at the child through the<br />

peephole; for the Cardiff Acuity Test, look<br />

around the edge of the card held at your<br />

eye level. Note the child’s eye movement<br />

and estimate the position of the target<br />

(Figure 1). Check your decision; if you are<br />

correct, repeat at the same acuity level.<br />

If you score two out of two correct, then<br />

move to a finer acuity level. If you make a<br />

wrong guess on one occasion, move back<br />

to a larger target. The end point is the finest<br />

acuity for which you have scored two out<br />

of two correct. As with any procedure,<br />

once you are skilled, short cuts are possible<br />

and advisable to avoid the child becoming<br />

bored. Indeed, practitioners need to be<br />

quick, as the child may have looked at the<br />

target and then looked away before you<br />

are in position. For both types of PL test,<br />

repeatability and norms are available. 1,2<br />

PL, by its nature, is a resolution task<br />

and does not involve crowding. It does,<br />

therefore, tend to give a better acuity result<br />

than a recognition task and can miss subtle<br />

differences in acuity between the two<br />

eyes, which might indicate amblyopia. 3<br />

It is, therefore, important to perform an<br />

optotype test with crowding, when a child<br />

is old enough. Remember, however, that<br />

if you are monitoring a child over time,<br />

acuity may well appear to drop when a<br />

different test is introduced; in <strong>this</strong> instance<br />

there may be an argument for using both.<br />

Kay Pictures<br />

Kay Pictures are the most commonly used<br />

optotype test for young children in the<br />

UK. These use pictures determined by<br />

a research study to be the most readily<br />

recognised by young children. 4 The<br />

range of tests provides flexibility, as there<br />

is a single-target and a crowded-target<br />

version (both logMAR based), and both<br />

come with a matching card for children<br />

45<br />

23/03/12 CET<br />

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who are not yet ready to name out loud<br />

and interspersing easy targets with hard<br />

(Figure 2). Many children with speech<br />

ones will be needed. Never end with the<br />

delay use Makaton or SignAlong, both<br />

‘failed’ level. For every child, always return<br />

being simple signing systems that aid<br />

to an easy level – let the last thing the child<br />

development of language. Each of the<br />

remembers be getting the answer right.<br />

pictures in the Kay test has a sign that<br />

For adult patients, VA is typically<br />

46<br />

can be easily learned by a practitioner.<br />

Norms for the test are available in the<br />

measured several times; monocular<br />

and binocular, with and without old<br />

research section of the supplier’s website.<br />

and new correction, adding up to nine<br />

acuity tests. It would be a rare child who<br />

Lea Symbols<br />

tolerates repeating a test so many times.<br />

These tests use four symbols that have the<br />

Therefore, practitioners should prioritise<br />

advantage of ‘blurring’ to a similar shape<br />

the main VA measurements required eg,<br />

at threshold. Thus, guessing is difficult and<br />

if amblyopia is suspected, monocular<br />

23/03/12 CET<br />

the end-point is sharper than for pictures<br />

or letters. The tests come in a variety of<br />

formats, and logMAR crowded versions<br />

are available, although norms appear to be<br />

published only for uncrowded versions. 5<br />

Letter Acuity Charts<br />

Older children will, of course, be ready<br />

to use a letter chart. However, a full chart<br />

can be daunting since the child reading<br />

the top line will be aware of all the other<br />

lines below waiting to be tackled. Much<br />

more child friendly is the Keeler logMAR<br />

Crowded test, which presents only one<br />

line at a time (in uncrowded and crowded<br />

versions). It also has a matching card for<br />

children unsure of letter naming, and<br />

norms are available 6,7 (note that when the<br />

test was first developed it was described<br />

in literature as ‘Glasgow Acuity Cards’).<br />

Although the Kay Pictures and Keeler tests<br />

appear similar on cursory examination,<br />

they are calibrated for different distances;<br />

the Kay Pictures test is calibrated in<br />

Snellen terms for six metres and in logMAR<br />

for three metres, while the Keeler test is<br />

calibrated in both for three metres. Thus<br />

the acuity level labelled 6/12 is twice the<br />

size in the Kay test as it is in the Keeler test.<br />

Figure 2<br />

The Kay Picture Test (crowded version)<br />

particular variation (such as matching,<br />

signing). Secondly, record the distance<br />

at which the test was conducted, since<br />

in refractive error and visual impairing<br />

conditions such as nystagmus, VA may<br />

vary with distance; it is not acceptable<br />

to convert an acuity score eg, 3/12 is not<br />

necessarily the same as 6/24. Thirdly, note<br />

which eye was tested first for monocular<br />

acuity, and fourthly, record the confidence<br />

with which you measured acuity. This<br />

allows an apparent difference in acuity<br />

next (or last) time to be put into context.<br />

If a child is very nervous or distracted,<br />

<strong>this</strong> may affect the acuity measured.<br />

When VA is measured, it is usual<br />

to begin with an easy target and move<br />

progressively to more difficult levels, until<br />

the patient cannot read any more ie, in<br />

order to determine what a patient can see,<br />

we have to determine what they cannot<br />

see – we force the patient to fail. For some<br />

children <strong>this</strong> technique is fine; children<br />

can be very competitive and some love<br />

to show how clever they are. For other<br />

acuity is clearly important, but is there<br />

a need to measure binocularly? If the<br />

child wears glasses constantly, is there<br />

a need to measure uncorrected acuity?<br />

When measuring monocular VA, use<br />

a variety of occluding items as some<br />

children may tolerate a sticky patch, others<br />

their mother’s hand, whilst others might<br />

prefer to wear a pair of spectacles with one<br />

opaque lens. If a child objects to continued<br />

occlusion, swapping between eyes at each<br />

acuity level can be successful and becomes<br />

fun as everyone tries to remember which<br />

eye comes next. While measuring acuity,<br />

never take your eyes off the child. They<br />

can peek very quickly around an occluder.<br />

Never scold a child who does <strong>this</strong> – he/<br />

she is simply trying to do what you are<br />

asking, which is to name the picture or<br />

letter. It may be that they don’t even realise<br />

they are doing it with the ‘wrong eye’.<br />

Near visual acuity<br />

In the UK, near acuity is usually assessed<br />

by a reading task and the result recorded by<br />

print size. Reading charts aimed at children<br />

are available, but the most well known<br />

(using text from Peter Rabbit and Thomas<br />

the Tank Engine) require such a high<br />

children, the technique is less successful,<br />

reading age that any child who can read<br />

Measuring acuity<br />

particularly for those with special needs or<br />

them should also be able to read the adult<br />

For any acuity test, it is essential to<br />

who are used to failing, as the test simply<br />

versionThe Maclure test offers text graded<br />

record four things in addition to the<br />

reinforces their poor self-esteem. For these<br />

by age so that a child can be offered a task<br />

score. Firstly, note the test used and any<br />

children, lots of praise should be offered<br />

appropriate to their reading ability. Because<br />

Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates

acuity, <strong>this</strong> may be very close. The same<br />

advice regarding test procedures for VA<br />

should be followed for CS testing too.<br />

Refraction<br />

Conventional refraction techniques involve<br />

Figure 3<br />

The Cardiff Contrast Test<br />

the task is so dissimilar to distance acuity<br />

charts, reading acuity cannot be compared<br />

with, or predicted from, distance acuity.<br />

For children not yet reading, a near<br />

Kay Pictures card (Figure 2) or the<br />

Cardiff Near Test (the latter is not PL but<br />

a naming or matching test) can be used.<br />

These two tests are calibrated for Snellen<br />

or logMAR acuity. As they are similar<br />

in construction to distance tests, they<br />

allow a comparison between distance<br />

and near acuity. They do not allow the<br />

prediction of text enlargement for reading<br />

in a child with visual impairment.<br />

Contrast sensitivity<br />

Contrast sensitivity (CS) measurement<br />

forms an important part of adult low vision<br />

assessment and the same would apply for a<br />

child with (suspected) visual impairment.<br />

It may also be useful in the assessment of a<br />

child with special needs and with binocular<br />

vision problems such as amblyopia. There<br />

are fewer tests available for CS than for<br />

VA, but nevertheless a very wide age<br />

range can be assessed. The most common<br />

chart for older, able, children is the Pelli-<br />

Robson letter chart, for which adult norms<br />

exist. 8 For younger children, the Cardiff<br />

Contrast Test (Figure 3) can be used as a<br />

naming, signing or PL test, and norms are<br />

available in the manual. Some children<br />

with special needs may respond better to<br />

static retinoscopy with accommodation<br />

controlled by distance fixation and<br />

fogging lenses, followed by refinement<br />

with subjective routine. Only the oldest<br />

children will be able to participate in a<br />

subjective routine. In general, younger<br />

children will answer a question by telling<br />

you what they think is the right answer<br />

(after all, <strong>this</strong> is what they are trained to<br />

do in school). A question to which there<br />

is no obvious answer (“which is better,<br />

one or two?”) is totally bewildering to a<br />

child and so practitioners must rely on<br />

objective techniques instead. An article<br />

in the next <strong>issue</strong> of OT will discuss the<br />

use of cycloplegia and non-cycloplegic<br />

(Mohindra) techniques in more detail, but<br />

some general pointers are offered here.<br />

When using Mohindra retinoscopy,<br />

practitioners should remember that some<br />

children are afraid of the dark. As such, lower<br />

the lights slowly, and once in the dark keep<br />

talking to reassure the child. When using a<br />

cycloplegic method, talk to the child about<br />

drops beforehand and show their drops<br />

going into a doll’s or teddy’s eyes. Don’t<br />

tell the child that they won’t hurt, because<br />

they will, and you will lose the child’s<br />

trust. Use terms like ‘sting’ or ‘fizz’ and do<br />

tell the child how brave they are once the<br />

drops are in. Insert the drops as quickly<br />

as you can. Do not prolong the anxiety.<br />

Wearing a trial frame restricts the field<br />

of vision, which can be frightening for a<br />

child. As such, keep a hand-held mirror<br />

nearby so that the child can see him/<br />

Figure 4<br />

Ellie doesn’t mind wearing the trial frame briefly<br />

trial frame, which may only be essential<br />

for measuring cyl axis. A later article will<br />

discuss the interpretation of refractive<br />

findings and guidelines for prescribing.<br />

Accommodation<br />

Accommodation may be the most<br />

neglected aspect of children’s vision,<br />

since it is easy to assume that children<br />

have ample and active accommodation.<br />

Recent studies have shown that the<br />

majority of children with Down’s<br />

syndrome 10 and cerebral palsy 11 have<br />

defective accommodative responses,<br />

even when distance refractive errors<br />

are fully corrected. The prevalence of<br />

accommodative disorders among typical<br />

young children appears unreported.<br />

Accommodation is quick and easy<br />

to measure and, given that children<br />

spend much more time looking at<br />

near objects than far, must provide<br />

important information about a child’s<br />

ability to overcome hypermetropia<br />

and perform prolonged schoolwork.<br />

Dynamic retinoscopy is a reliable<br />

objective means of determining accuracy<br />

of accommodation, and a modified version<br />

of the Nott technique has been validated<br />

and norms established. 12 The technique is<br />

illustrated in Figure 5. The child, wearing<br />

a distance correction if prescribed, attends<br />

47<br />

23/03/12 CET<br />

the smiling face in the Hiding Heidi test. 9<br />

herself before the lights go out, to take<br />

to a detailed target set at a known distance.<br />

CS should be measured at low<br />

away that fear (Figure 4). Remember that<br />

The instrument depicted in Figure 5 is<br />

spatial frequencies and therefore the<br />

trial frames are uncomfortable so consider<br />

the UC-Cube, which has various self-<br />

test should be placed at a distance for<br />

holding spherical and cylindrical lenses<br />

illuminated targets and is calibrated for two<br />

which the targets are well within the<br />

manually for each eye instead. Minimise<br />

distances, 20cm and 25cm. Use the shorter<br />

child’s acuity limit; for a child with poor<br />

the time that the child needs to wear the<br />

distance for younger children. Since<br />

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distance refractive errors are corrected, the<br />

practitioner need examine only one eye, in<br />

one meridian. Begin with the retinoscope<br />

alongside the target, with the child telling<br />

you about the picture (or with the parent<br />

pointing to the picture to hold attention).<br />

If a child is accommodating accurately,<br />

the reflex will be neutral. A ‘with’ reflex<br />

indicates under-accommodation and<br />

an ‘against’ reflex over-accommodation.<br />

Leave the target in place and move away<br />

from or towards the child to find neutral<br />

– <strong>this</strong> is the point to which the child is<br />

actually accommodating. A neutral point<br />

beyond the norms (shown on the UC-<br />

Cube rule) indicates an accommodative<br />

anomaly. This may suggest a binocular<br />

problem deserving further evaluation,<br />

or an accommodative spasm or deficit.<br />

Dynamic retinoscopy as described<br />

above does not measure amplitude of<br />

accommodation, the function typically<br />

measured in adults. Young children do<br />

not understand the concept of blur so a<br />

push-up method is inappropriate. The<br />

reverse of <strong>this</strong>, a push-down method, can<br />

children and by making simple changes<br />

to established procedures, the interested<br />

practitioner can quickly gain skills in<br />

examining even the youngest child. The<br />

next article will continue <strong>this</strong> discussion by<br />

looking at other aspects of visual function.<br />

48<br />

Figure 5<br />

The UC-Cube in use for dynamic retinoscopy<br />

About the author<br />

Maggie Woodhouse is a senior lecturer<br />

at the School of <strong>Optometry</strong> and Vision<br />

Sciences, Cardiff University, where she<br />

specialises in paediatric optometry. She<br />

runs the Special Assessment Clinic,<br />

which caters for patients of all ages with<br />

disabilities. Her particular interests are<br />

visual development in children with<br />

Down’s syndrome and the impact of<br />

visual defects on education. The author<br />

has a financial interest in the Cardiff<br />

Acuity Test, the Cardiff Contrast Test,<br />

the Cardiff Near Test and the UC-Cube.<br />

sometimes be used, whereby a target with<br />

very fine detail (letters or pictures) is first<br />

deliberately placed too close to the child<br />

and then slowly moved away; the child is<br />

asked to name the letters or targets as soon<br />

as they can see them. This technique will<br />

slightly under-estimate the amplitude, as<br />

there will be a reaction time delay between<br />

the targets becoming clear and the moment<br />

the child names them. Nevertheless, it<br />

will provide a subjective measure as well<br />

as allowing the practitioner to note the<br />

child’s ability to maintain convergence.<br />

23/03/12 CET<br />

References<br />

Conclusion<br />

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

clinical. Click on the article title and then<br />

on ‘references’ to download.<br />

By investing in a few tests developed for<br />

Module questions Course code: C-18446 O/D<br />

PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on April 20, 2012 – You will be unable to<br />

submit exams after <strong>this</strong> date. Answers to the module will be published on www.optometry.co.uk/cet/exam-archive. CET points for these exams will be uploaded to<br />

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1. All of the following describe the repeatability of a test, EXCEPT:<br />

a) The practitioner’s confidence in the result noted on the second occasion<br />

b) The difference in test result that would mean a clinically significant<br />

change<br />

c) The average difference in results between two measures taken under<br />

the same conditions<br />

d) The practitioner’s confidence that visual function has changed over time<br />

2. The correct procedure for measuring acuity by the Cardiff Acuity<br />

Test includes:<br />

a) Ensuring pictures in successive presentations are at opposite ends of<br />

the card<br />

b) Noting the position of the picture then quickly presenting the card to<br />

the child<br />

c) Going back to a larger target if the examiner cannot tell the picture<br />

position<br />

d) Moving the card closer to the child until he or she looks at the picture<br />

3. An acuity test that incorporates crowding is preferable because:<br />

a) Uncrowded tests are likely to give a poorer acuity score<br />

b) The task is equal at every acuity level<br />

c) Crowding improves the repeatability of the test<br />

d) It is more likely to detect small interocular differences<br />

4. All of the following could explain a reduction in acuity at a second test<br />

of a child, EXCEPT:<br />

a) A different test was used on the second occasion<br />

b) The child may have peeked over the occluder on the second occasion<br />

c) The child is more distracted on the second occasion<br />

d) A refractive error may have increased by the second occasion<br />

5. In Nott dynamic retinoscopy:<br />

a) A neutral reflex indicates normal accommodation<br />

b) A ‘with’ movement indicates the child is accommodating to a point between<br />

the retinoscope and the target<br />

c) An ‘against’ movement means the practitioner should move closer to find<br />

neutral<br />

d) Accurate accommodation is indicated by a change from “with” to “against”<br />

within a 5cm range<br />

6. Making an eye examination child-friendly may include all of the<br />

following, EXCEPT:<br />

a) Using a trial frame for a limited time only<br />

b) Repeating a test several times so that the child becomes familiar with it<br />

c) Alternating between eyes during an acuity test<br />

d) Using a recognition task to measure amplitude of accommodation<br />

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Ocular allergy and<br />

contact lens wear<br />

C-18459 O/D/CL<br />

Paramdeep Singh Bilkhu, BSc (Hons), MCOptom<br />

Dr Shehzad A Naroo, BSc (Hons), MSc, PhD MCOptom, FBCLA<br />

Prof James S Wolffsohn, BSc (Hons), MBA, PhD, MCOptom, FBCLA<br />

Allergy is a condition where the body produces an over-reaction or<br />

hypersensitivity to normally harmless substances known as allergens. The<br />

prevalence of allergy in Europe is between 15% and 20% 1 and is expected<br />

to increase with estimates up to 50% by 2015. 2,3 Although genetics play an<br />

important role in susceptibility, the increase in prevalence is reported to be<br />

the result of modern lifestyle, 4 being associated with improved hygiene 5<br />

and increased antibiotic use. 6 Environmental factors such as increased air<br />

pollution, climate change and increased planting and importation of allergenic<br />

plant species may also be involved. 7,8,9 Of those who suffer from allergy,<br />

approximately 20% experience a form of ocular allergy. 10 This article discusses<br />

optometric management strategies that can be employed to maintain<br />

successful contact lens wear in patients who have allergic eye conditions.<br />

Ocular allergy includes a group of distinct<br />

clinical entities, typically associated<br />

with the conjunctiva, and includes<br />

seasonal allergic conjunctivitis (SAC),<br />

perennial allergic conjunctivitis (PAC),<br />

vernal keratoconjunctivitis (VKC), atopic<br />

keratoconjunctivitis (AKC) and giant<br />

papillary conjunctivitis (GPC). 11,12,13 Other<br />

allergic eye conditions include contact<br />

allergy to topical medication, such as<br />

anti-glaucoma agents, 14,15 and microbial<br />

allergy, such as phlyctenulosis caused<br />

by hypersensitivity to tuberculoprotein. 16<br />

The most common form of ocular allergy<br />

is SAC (90% of cases) followed by PAC<br />

(5% of cases). 12 Together with GPC,<br />

which is frequently associated with<br />

contact lens wear, SAC and PAC are most<br />

likely to be encountered in optometric<br />

practice. VKC and AKC are rare and often<br />

managed in the hospital eye service due<br />

to their sight-threatening potential. 11<br />

In the UK, the prevalence of ocular<br />

allergy in patients attending optometric<br />

practice has been estimated at 8%. 17 Due<br />

to the increasing prevalence of allergies as<br />

a whole, a significant proportion of the 3.6<br />

million contact lens wearers in the UK 18<br />

have ocular allergies, which has been found<br />

to be a common cause of drop out from<br />

contact lens wear. 19 In addition, patients<br />

with existing seasonal allergies had five<br />

times increased risk of developing ocular<br />

symptoms during contact lens wear. 20<br />

Thus, it is important for practitioners<br />

to identify these conditions in order to<br />

manage them more appropriately with<br />

respect to maintaining contact lens wear. 21<br />

Seasonal and perennial allergic<br />

conjunctivitis<br />

SAC occurs on a seasonal basis and is<br />

often triggered by exposure to grass,<br />

tree and weed pollens but can also be<br />

caused by outdoor moulds, all of which<br />

peak at different times of the year. 12,22<br />

SAC may exist alone or accompany<br />

seasonal rhinoconjunctivitis (hay fever),<br />

Figure 1<br />

Allergic conjunctivitis. Courtesy of Professor<br />

Michael Doughty, Glasgow Caledonian University<br />

which involves both nasal and ocular<br />

symptoms. 12 The signs and symptoms of<br />

SAC usually develop gradually but can<br />

also occur suddenly following exposure to<br />

the offending allergen; the severity is often<br />

associated with pollen counts. 11,23 Signs<br />

and symptoms include itching, tearing,<br />

eyelid oedema, chemosis (conjunctival<br />

oedema) (Figure 1) and sometimes a<br />

papillary reaction. 11,12,23 PAC can occur all<br />

year round and is caused by house dust<br />

mites, insects, animal dander and indoor<br />

moulds. 22 The signs and symptoms of<br />

PAC are similar to SAC but are usually<br />

milder and have seasonal exacerbations<br />

in severity. 24 Despite SAC and PAC being<br />

relatively mild forms of ocular allergy, they<br />

can significantly impact on an individual’s<br />

quality of life eg, reduced school<br />

performance and work productivity. 25,26,27<br />

The economic impact can be profound,<br />

with SAC estimated to cost £124 per<br />

year for someone in employment. 26<br />

The pathophysiology of both SAC<br />

and PAC is an IgE-mast cell mediated<br />

hypersensitivity reaction. 22 It is triggered<br />

by exposure to the allergen, leading to a<br />

series of complex immunological events;<br />

these are coordinated by a variety of<br />

inflammatory mediators with the mast<br />

cell playing a central role. 28,29 The allergen<br />

reacts with specific IgE antibodies bound<br />

to the surface of a sensitised mast cell,<br />

causing linkage of the IgE molecules<br />

and resulting in an influx of calcium<br />

49<br />

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50<br />

Allergen<br />

Pollen and outdoor<br />

moulds<br />

House dust mites<br />

Avoidance Strategies<br />

• Minimise outdoor activities when symptoms are known to develop<br />

• Plan outdoor activities by monitoring pollen levels using TV, the Internet and radio<br />

• Wear close fitting sunglasses and avoid rubbing eyes when outdoors<br />

• Wash hands after being outdoors and wash hair regularly before sleeping<br />

• When indoors, close windows and doors leading outside<br />

• Use air conditioning, circulate air internally and close windows when in a vehicle<br />

• Wash bedding regularly (temperatures at least 60⁰C)<br />

• Damp dust and vacuum entire house weekly<br />

• Regularly clean curtains, upholster carpets and any areas that may gather dust<br />

• Reduce humidity to 30-50% in the home with a de-humidifier<br />

23/03/12 CET<br />

Figure 2<br />

Pollen attached to a contact lens surface (image<br />

from a confocal scanner)<br />

ions into the mast cell. This initiates<br />

mast cell degranulation, releasing preformed<br />

inflammatory mediators such as<br />

histamine, which causes the signs and<br />

symptoms of allergic conjunctivitis. 22,29<br />

The hypersensitivity reaction is divided<br />

into two phases; 30,31 the early phase<br />

described above occurs immediately<br />

and lasts clinically for 20-30 minutes, 32<br />

whilst the late phase may occur 3 to 12<br />

hours after the initial reaction 30 and<br />

symptoms can last up to 24 hours. 22,31 The<br />

late phase is characterised by sustained<br />

mast cell activity, production of newly<br />

formed inflammatory mediators derived<br />

from arachidonic acid, and infiltration<br />

of leukocytes and Th2-lymphocytes at<br />

the site of inflammation. 22,28 The yearround<br />

signs and symptoms of PAC are<br />

caused by chronic mast cell activation<br />

and Th2-lymphocyte infiltration. 22,32<br />

The primary aim of treatment in<br />

SAC and PAC is to avoid exposure<br />

to the allergen through avoidance<br />

strategies 33-38 (Table 1). However, <strong>this</strong> is<br />

not always possible and people must<br />

then seek therapeutic strategies instead.<br />

Allergic conjunctivitis and<br />

contact lens wear<br />

Contact lens wearers who suffer from<br />

allergic conjunctivitis are often managed<br />

by temporarily ceasing lens wear, as the<br />

Animal dander<br />

• Avoid contact with animals<br />

• Remove pets from home or do not keep at all<br />

• Regularly vacuum and clean entire home<br />

• Wash hands and clothes, avoid rubbing eyes or nose after contact with animals<br />

Table 1<br />

Allergen avoidance measures for seasonal and perennial allergic conjunctivitis<br />

causative allergen(s) might attach to the<br />

surface of the lens (Figure 2) and prolong<br />

exposure to the ocular surface (and<br />

therefore increase signs and symptoms of<br />

allergic conjunctivitis). 12,39,40 Furthermore,<br />

it is not normally advisable for contact<br />

lens wearers to apply topical anti-allergic<br />

medications with the lenses in situ, as<br />

they may bind to the lens matrix and cause<br />

toxicity reactions with continued wear. 40<br />

Although <strong>this</strong> is less of an <strong>issue</strong> with daily<br />

disposable contact lenses, modern topical<br />

anti-allergic medications have now<br />

been designed to be applicable during<br />

contact lens wear, in mild to moderate<br />

cases of allergic conjunctivitis, owing<br />

to twice daily dosage. In fact, Brodsky<br />

et al. 41 demonstrated increased wearing<br />

time and contact lens comfort after<br />

instillation of olopatadine hydrochloride<br />

0.1% before contact lens insertion<br />

compared to a placebo in patients with<br />

allergic conjunctivitis. Likewise, Nichols<br />

et al. 42 showed significantly increased<br />

total and comfortable wearing times<br />

following instillation of epinastine<br />

hydrochloride 0.05% prior to contact<br />

lens insertion, compared with re-wetting<br />

drops alone, in patients with a history of<br />

allergic conjunctivitis and contact lens<br />

intolerance during the allergy season.<br />

Unless other t<strong>issue</strong>s (such as the nose<br />

and throat), are involved in the allergic<br />

reaction, systemic anti-histamines<br />

should be avoided as they may cause<br />

drying of mucous membranes (including<br />

the conjunctiva), which can exacerbate<br />

ocular symptoms and reduce the<br />

removal of allergens by tear flushing. 43<br />

Contact lens wearers who suffer from<br />

ocular allergy symptoms might also<br />

benefit from increased lens replacement<br />

frequency and strict compliance with rub<br />

and rinse cleaning regimes to minimise<br />

exposure to allergens on the lens<br />

surface. 20,40 The use of daily disposable<br />

lenses would be beneficial, as they<br />

maximise replacement frequency and<br />

eliminate the need for lens maintenance.<br />

Indeed, one study 44 reported that 67% of<br />

patients found improved comfort with<br />

daily disposable contact lenses compared<br />

with only 18% of patients using a fresh<br />

pair of their habitual reusable lenses.<br />

There was also associated reduction<br />

in bulbar and palpebral hyperaemia,<br />

corneal staining and lid roughness. 44<br />

Wolffsohn and Emberlin compared two<br />

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daily disposable contact lenses (one with<br />

variation between signs and symptoms. 50<br />

enhanced lubricating agents) to each other<br />

Although contact lens chemistry plays an<br />

and to no lens wear using a conjunctival<br />

important role in surface deposition (type<br />

allergen challenge test, in patients with<br />

and extent), there is no correlation between<br />

confirmed systemic and ocular allergy to<br />

<strong>this</strong> and CLGPC severity. 51,54,55 Porazinski<br />

grass pollen. 45 They found that the severity<br />

and Donshik 55 found no significant<br />

of “burning” and “stinging” symptoms<br />

were significantly reduced with the lens<br />

containing the enhanced lubricating<br />

agent. 45 The duration of symptoms was<br />

also shorter (by 1.7-2.0x) with lens wear<br />

compared to allergen exposure of the naked<br />

eye. 45 Signs of bulbar hyperaemia, corneal<br />

and conjunctival staining and palpebral<br />

conjunctival roughness were significantly<br />

reduced with contact lens wear compared<br />

to no lens wear, suggesting that lenses<br />

provide a barrier effect to allergen<br />

exposure. In addition, limbal and palpebral<br />

conjunctival redness were significantly<br />

lower with the lenses containing the<br />

enhanced lubricating agent, suggesting<br />

that lubrication of the ocular surface<br />

further limits the allergic reaction. 45 Based<br />

on <strong>this</strong> evidence, the majority of patients<br />

with allergy or allergic conjunctivitis<br />

can remain in their contact lenses,<br />

particularly if they are daily disposables<br />

or contain enhanced lubricating agents.<br />

If symptoms persist, topical antiallergic<br />

medications with twice daily<br />

dosing (olopatadine hydrochloride 0.1%,<br />

epinastine hydrochloride 0.05% or<br />

nedocromil sodium 2%) can be prescribed<br />

(by the patient’s GP or by optometrists with<br />

therapeutic qualifications) to allow patients<br />

to continue contact lens wear. 21 The drops<br />

must be inserted when the lenses are not<br />

on the ocular surface. Where the contact<br />

lens wearer still remains symptomatic,<br />

temporarily ceasing wear and initiating<br />

topical (and systemic when necessary)<br />

anti-allergic medication is necessary<br />

until signs and symptoms resolve.<br />

Figure 3<br />

Contact lens associated Giant Papillary<br />

Conjunctivitis. Courtesy of Andrew Gasson, London<br />

variety of aetiologies associated with<br />

mechanical irritation of the palpebral<br />

conjunctiva, such as in contact lens wear,<br />

exposed sutures and ocular prostheses. 46,47<br />

Existing allergic (atopic) conditions are a<br />

risk factor for GPC, particularly seasonal<br />

allergies, 48 whilst elevated serum levels<br />

of IgE have also been found in 44% of<br />

patients with GPC. 49 The severity of<br />

signs tends to be greater too, but <strong>this</strong><br />

was not found to have a bearing on the<br />

patient’s ability to wear contact lenses. 50<br />

Contact lens associated Giant Papillary<br />

Conjunctivitis<br />

GPC is predominantly encountered in<br />

contact lens wear, occurring with any type<br />

of contact lens but being more common<br />

with soft lenses (85% of cases) than<br />

hard lenses. 47,51 Contact lens associated<br />

GPC (CLGPC) is usually bilateral and<br />

characterised by the presence of giant<br />

papillae (0.3-1.0mm in diameter) and<br />

hyperaemia on the superior palpebral<br />

conjunctiva (Figure 3), excessive contact<br />

lens movement and intolerance, increased<br />

mucous production and symptoms such as<br />

burning, itching and irritation. 47,52 CLGPC<br />

is often the result of mechanical irritation<br />

to the superior palpebral plate due to<br />

poor contact lens design and fitting and/<br />

difference in signs and symptoms of CLGPC<br />

between FDA type I (low water content,<br />

non-ionic) and type IV (high water content,<br />

ionic) materials even though the latter<br />

is more prone to surface deposits. 56,57,58<br />

Indeed, <strong>this</strong> could be because the deposits<br />

are formed of inflammatory cells in the<br />

allergic response itself. 54 It is, therefore,<br />

reasonable to advise patients to cease<br />

contact lens wear, regardless of the material,<br />

to remove the offending cause of CLGPC.<br />

There is, however, variation in the<br />

incidence of CLGPC with different contact<br />

lens materials, wear modality, replacement<br />

frequency and cleaning regime. 47,55,59<br />

Continued use of old lenses and poor lens<br />

care are risk factors for the onset of CLGPC<br />

symptoms. 59 Hence, contact lens cleaning<br />

(rub and rinse) and disinfection is strongly<br />

advised to minimise surface deposit<br />

build-up in reusable lenses, whilst the<br />

addition of enzymatic treatment once or<br />

twice weekly might also be necessary. 47,50<br />

Refitting patients who experience CLGPC<br />

to new lenses of the same material offers<br />

some success in reducing the recurrence<br />

of CLGPC (61-66%), but greater success<br />

(77-95%) can be achieved by changing the<br />

lens material or increasing replacement<br />

frequency. 50,55,60,61 Refitting patients from<br />

HEMA to a RGP lens can reduce the<br />

recurrence of CLGPC by 80%; 50 the latter<br />

has been attributed to the smaller diameter<br />

of RGP lenses, which reduces the area in<br />

contact with the palpebral conjunctiva<br />

for mechanical irritation and exposure to<br />

surface deposits. 53 RGP lenses are also easier<br />

to clean and therefore there is less build-up<br />

51<br />

23/03/12 CET<br />

Giant Papillary Conjunctivitis<br />

(GPC)<br />

or an immunological response to protein<br />

deposits on the lens surface. 51,53 CLGPC has<br />

been classified into four different stages<br />

of deposits compared with soft lenses. 50,53<br />

Discontinuation of contact lens wear<br />

usually brings about resolution of CLGPC<br />

GPC is a form of ocular allergy with a<br />

(Table 2) 52 but there may be considerable<br />

within four weeks for moderate signs and<br />

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CLGPC Stage Symptoms Signs Treatment Options<br />

52<br />

1 • Occasional itching after lens<br />

removal<br />

• Minimal mucous discharge in<br />

the morning<br />

• Normal tarsal papillae<br />

• Minimal to mild conjunctival hyperaemia<br />

• Some contact lens surface deposition<br />

• Increase replacement frequency<br />

• Encourage strict cleaning (rub and rinse) and<br />

disinfection<br />

• Introduce hydrogen peroxide cleaning and unpreserved<br />

saline if unresponsive<br />

• Consider changing lens polymer or switching to daily<br />

disposable lenses<br />

2 • Itching<br />

• Increased lens awareness /<br />

decreased lens tolerance<br />

• Increased mucous discharge<br />

• Increased size of papillae, some over 0.3mm<br />

diameter<br />

• Mild conjunctival hyperaemia and thickening<br />

• Contact lens surface deposition<br />

• As for stage 1, but introduce enzymatic cleaning (onetwo<br />

times a week) for frequent replacement lenses<br />

• Mild blurring of vision<br />

23/03/12 CET<br />

3 • Increased mucous discharge<br />

• Increased lens awareness<br />

• Excessive lens movement<br />

• Blurred and fluctuating vision<br />

upon blinking<br />

4 • Complete lens intolerance<br />

• Excessive lens movement and<br />

decentration<br />

• Mucous may cause eyelids to<br />

• Tarsal papillae increase in size (>0.3mm) and<br />

number<br />

• Marked conjunctival hyperaemia and thickening<br />

• Scarring and staining of papillae apices<br />

• Contact lens deposition<br />

• Large papillae (coalescence)<br />

• Papillae apices scarred, flattened, and stained<br />

• Contact lens surface becomes deposited soon<br />

after insertion<br />

• Cease lens wear, monitor until symptoms, corneal<br />

staining, inflammation, and papillae resolve (four weeks)<br />

• Initiate use of 2% sodium cromoglicate (one drop four<br />

times daily)<br />

• Refit with RGP lenses<br />

• As for stage 3, but refit with either daily disposable or<br />

RGP lenses<br />

stick together in the morning<br />

Cases resistant<br />

to above<br />

treatment<br />

• Cease lens wear, initiate pharmacological treatment with sodium cromoglicate (one drop four times a day) and monitor until signs and symptoms<br />

have resolved<br />

• Papillae may not reduce in size, but hyperaemia and inflammation must resolve<br />

• Referral to an appropriate practitioner for advanced pharmacological therapy<br />

• Treat as stage 4 when appropriate<br />

Table 2<br />

Classification and treatment of contact lens associated Giant Papillary Conjunctivitis (modified from Allansmith et al. 54 )<br />

symptoms, but may take longer for severe<br />

cases. The papillary signs may persist<br />

unchanged or may reduce in diameter<br />

slowly for a considerable length of time.<br />

Contact lens wear may continue when<br />

symptoms resolve, provided the cornea<br />

is not compromised (ie no staining)<br />

and the eye is free of inflammation. 47,50<br />

As such, it is advisable for patients<br />

to be refitted from their current type<br />

of contact lens after a period of lens<br />

wear cessation, and <strong>this</strong> is reportedly<br />

more successful (94%) at preventing<br />

recurrence of CLGPC than refitting<br />

during an episode of CLGPC (78%). 50<br />

The use of topical ocular medication<br />

to modulate the inflammatory response<br />

in CLGPC is usually reserved for cases<br />

resistant to conventional management<br />

(as described above). This involves the<br />

use of mast cell stabilisers eg, sodium<br />

cromoglicate. 47,50,62 Approximately 75%<br />

of patients with moderate to severe<br />

CLGPC who do not respond to standard<br />

treatment can continue with contact<br />

lens wear after treatment with 2% or 4%<br />

sodium cromolyn following a period of<br />

lens wear cessation. 59,60,63 In the UK, 2%<br />

sodium cromoglicate is available to nontherapeutically<br />

trained optometrists in a<br />

pack size of 10ml and given the supporting<br />

literature it can be used to treat resistant<br />

CLGPC in normal contact lens practice.<br />

The non-steroidal anti-inflammatory drug<br />

(NSAID) suprofen 1% used four times<br />

daily has also demonstrated efficacy in<br />

treating CLGPC, 64 but <strong>this</strong> is not available<br />

in the UK. The steroid loteprednol<br />

etabonate has also demonstrated efficacy<br />

in treating the signs and symptoms<br />

of CLGPC in several randomised<br />

controlled trials. 65,66,67,68 However, the<br />

use of steroids by optometrists requires<br />

further therapeutic training to at least<br />

supplementary prescribing level<br />

and careful monitoring, owing to the<br />

potential risk of cataract and increase<br />

in IOP, which may lead to glaucoma<br />

with long-term or prolonged use. 69,70,71<br />

Summary<br />

Ocular allergy is a common cause of<br />

contact lens wear drop out, and its<br />

prevalence is increasing. However,<br />

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identification of the major subtypes of<br />

ocular allergy – seasonal and perennial<br />

allergic conjunctivitis and giant papillary<br />

conjunctivitis – and appropriate<br />

management by changing the contact<br />

lens type, material, replacement<br />

frequency and cleaning regime, allows<br />

successful contact lens wear in the<br />

majority of these patients. The use of<br />

topical anti-allergic medications may be<br />

required alongside temporarily ceasing<br />

lens wear followed by altering lens type<br />

and wearing pattern, when symptoms<br />

persist, but <strong>this</strong> is only required in severe<br />

cases and those with corneal involvement.<br />

of Contact Lens Educators. Professor<br />

James Wolffsohn is deputy executive<br />

Dean for Life and Health Sciences<br />

at Aston University, teaching and<br />

researching in the field of the anterior<br />

eye. He is also a past president of the<br />

British Contact Lens Association.<br />

About the authors<br />

Paramdeep Singh Bilkhu is an optometrist<br />

and PhD student researching ocular<br />

allergy and dry eye disease management<br />

at Aston University. Dr Shehzad Naroo<br />

is a senior lecturer at Aston University,<br />

teaching anterior eye topics. He is also<br />

president of the International Association<br />

References<br />

53<br />

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then on ‘references’ to download.<br />

Module questions Course code: C-18459 O/D/CL<br />

PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on April 20, 2012 – You will be unable to<br />

submit exams after <strong>this</strong> date. Answers to the module will be published on www.optometry.co.uk/cet/exam-archive. CET points for these exams will be uploaded to<br />

Vantage on April 30, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates<br />

1. The first line of treatment of seasonal and perennial allergic<br />

conjunctivitis in contact lens wearers is to:<br />

a) Cease contact lens wear<br />

b) Avoid exposure to the allergen<br />

c) Use a mast cell stabiliser when the symptoms occur<br />

d) Use an anti-histamine when the symptoms occur<br />

2. In the UK, the prevalence of ocular allergy in patients<br />

attending optometric practice is approximately:<br />

a) 3%<br />

b) 8%<br />

c) 15%<br />

d) 20%<br />

3. Topical anti-allergic medications should:<br />

a) Not be used in contact lens wearers<br />

b) Only be prescribed by independent prescribing optometrists<br />

c) Be applied on the contact lenses in situ to ensure slow release<br />

d) Be applied when contact lenses are not in place on the eye<br />

4. Enhanced lubricating daily disposable lenses:<br />

a) Should not be worn by patients with ocular allergies<br />

b) Offer a barrier effect to allergens unlike other contact lenses<br />

c) Offer additional allergen flushing to reduce signs more than other contact lenses<br />

d) Reduce the duration of ocular allergy symptoms more than other contact lenses<br />

5. Refitting patients from HEMA to RGP contact lenses, reduces GPC by<br />

approximately:<br />

a) 20%<br />

b) 40%<br />

c) 60%<br />

d) 80%<br />

6. Patients with moderate to severe CLGPC who do not respond to standard<br />

treatment should:<br />

a) Cease contact lens wear permanently<br />

b) Be able to wear their current lenses successfully after a break<br />

c) Be treated with 2% or 4% sodium cromolyn and maintain contact lens wear<br />

d) Be treated with 2% or 4% sodium cromolyn following a period of lens wear cessation<br />

23/03/12 CET<br />

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To discuss positions in your area call Jim for a confi dential chat<br />

on 01793 648607 or jim@outsideclinic.com.<br />

For more vacancies<br />

check online<br />

www.outsideclinic.com<br />

54<br />

23/03/12 JOBS<br />


Fixed Term 12 months Ref: D1- 461<br />

Trainee Band 5 (75%) - £20,117 p.a. inc.<br />

37.5 hours per week<br />

We are delighted to announce an opportunity for pre registered dispensing opticians to<br />

work in the <strong>Optometry</strong> Department. This is the largest department of its type in the UK. The<br />

department provides a comprehensive optometric support service, low vision service,<br />

contact lens service, spectacle dispensing service and optometric extended role. We play a<br />

major role in the training of ophthalmic professional staff and we have laboratories for<br />

spectacle glazing, lens surfacing and contact lens manufacturing.<br />

Moorfields Eye Hospital is a post-graduate teaching hospital of international acclaim,<br />

dedicated to excellence in patient care, training and research. Our main site is in the heart of<br />

London, at City Road, but we have a large and growing number of interdisciplinary<br />

outreach centres at which optometric services are provided.<br />

The successful applicants will undertake varied work, including dispensing of high<br />

prescriptions and specialist devices, for children and adults as well as glazing. You will be<br />

working alongside our team of experienced dispensing opticians and receive complete<br />

supervision at all times.<br />

Applicants must be registered with the GOC as a Student Dispensing Optician. We are<br />

looking for enthusiastic applicants who have excellent verbal & written communication<br />

skills, have a keen attention to detail, an ability to work under pressure, show initiative, are<br />

reliable, flexible, calm & helpful, a team player and keen to learn.<br />

Please call 020 7566 2023 for informal enquiries and ask for Dan Ehrlich, Head of <strong>Optometry</strong>,<br />

or Tony Charman, head of Spectacle Dispensing & Manufacturing.<br />

To apply for <strong>this</strong> post please apply online at www.jobs.nhs.uk CV’s will not be accepted in<br />

application for <strong>this</strong> post, it is essential that applicants complete the online application<br />

form in full.<br />

The Human Resources Department can be contacted on 020 7566 2981.<br />

Closing date for receipt of application forms:<br />

Saturday 7th April 2012<br />

Working Towards Equality of Opportunity<br />


Band 7, plus 17% recruitment and retention premium<br />

(£30,460-£40,157 plus 17% RRP)<br />

Two positions for Optometrists have become available in the Shared Care<br />

Department at Bristol Eye Hospital.<br />

One post is full time (37.5 hours/wk), and is focussed on work in the retinal<br />

service, specifically in provision of care to patients with age-related macular<br />

degeneration (AMD).<br />

The other post is part time (22.5 hours/wk), and includes work in the retinal<br />

service (AMD; diabetes) and also post-operative assessment of patients who<br />

have undergone cataract extraction.<br />

Both positions may include work in other abnormal ocular conditions.<br />

The post-holders will be GOC registered and have substantial post-registration<br />

experience. Evidence of extended role practice or hospital eye service<br />

optometry would be advantageous, although neither are pre-requisites for the<br />

position.<br />

Informal enquiries regarding <strong>this</strong> position are encouraged. For further<br />

information please contact Dr Paul GD Spry, Optometrist Consultant/Head<br />

of Shared Care, Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX,<br />

telephone 0117 342 1438 (direct) or 0117 342 1437 (messages) or email<br />

paul.spry@uhbristol.nhs.uk<br />

To apply for these vacancies please visit our website<br />

www.uhbristol.nhs.uk/work-for-us/<br />

Shared Care Optometrist (part time) ref: 387-S-257<br />

Retinal Shared Care Optometrist (full time) ref: 387-S-259<br />

Closing date for applications: Friday April 27th 2012.<br />

Interview date: Afternoon of Tuesday May 29th 2012.<br />

An equal<br />

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Optometrists &<br />

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CaLL Catherine on 0121 451 2707<br />

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Require Optometrist<br />

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Full-time DISPENSER<br />

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Please send CV to Ian Underwood at<br />

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team Locum is an employment agency<br />

Enthusiastic clinically minded<br />

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Achieve new<br />

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Owning and running your own practice has always been a key goal for ambitious professionals and<br />

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Due to our continuing success, we’re increasing the number of our practices throughout the UK.<br />

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Further details await you at http://jobs.specsavers.co.uk





More roadshows coming soon<br />

If you missed out on a place on the roadshows in March and April, don’t worry more dates will be<br />

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AOP members<br />

SAVE 20% for 3 years.<br />

* Employment Support Allowance is £67.50<br />

a week. DWP Website, January 2012<br />

call<br />

0800 146 307<br />

visit<br />

pgmutual.co.uk<br />

PG Mutual is the trading name of Pharmaceutical & General<br />

Provident Society Ltd. Incorporated in the United Kingdom<br />

under the Friendly Societies Act 1992, Registered Number 462F.<br />

Authorised and regulated by the Financial Services Authority,<br />

Registered Number 110023.

DAILIES AquaComfort Plus ® for<br />

Superior tear film stability1<br />

and reduced ocular allergy symptoms 2<br />

Blink, Refresh, Enjoy<br />

* Terms and conditions apply, full details are available from CIBA VISION. References: 1. Wolffsohn J., Hunt O., Chowdhury A., (2010) Objective clinical performance of ‘comfort-enhanced’ daily disposable.<br />

2. Stiegemeier MJ, Fahmy M, Thomas S. Beating back SAC. Optometric Management. 2008; 43(9): 84-85. © CIBA VISION (UK) Ltd, a Novartis company, 2012. DAILIES AquaComfort Plus, DAILIES<br />

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

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