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www.optometry.co.uk June 3 2011 vol 51:11 £4.95<br />

optometrytoday<br />

Eye contact in<br />

consultations<br />

Back to School<br />

campaign<br />

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A place in the sun<br />

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Become our fan on Facebook’<br />

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


June 3 2011 vol 51:11<br />

Photo by Phil Weedon/BCLA<br />

6 30<br />

News<br />

5 Glare opportunities<br />

Global study shows practitioners could<br />

benefit from tackling patients’ symptoms<br />

6 Contact lenses ‘drive growth’<br />

Sales of contact lenses rose last year but the<br />

frames market dropped according to new<br />

figures<br />

7 Eye Health Week<br />

Details of the annual focus on eye care<br />

later <strong>this</strong> month<br />

8 Comment<br />

OT editor-in-chief David Challinor asks if a<br />

‘maybe’ approach to pay rises in practices<br />

might benefit business<br />

10 Tints ‘give relief’<br />

New research on precision tinted lenses<br />

shows they can help migraine sufferers<br />

12 New resource<br />

A website has been launched which shows<br />

how donations to the Central (LOC) Fund are<br />

used for the benefit of the whole profession<br />

14 GOC recruiting<br />

The regulatory body is seeking a new lay<br />

member<br />

Cover story<br />

30-31 Sunglasses<br />

A look at the latest styles and trends<br />

Events<br />

6 BCLA 2011<br />

Reaction from newcomers to the annual<br />

conference<br />

28 OT Live<br />

An optometrist gives her verdict on the CET<br />

programme<br />

Products<br />

20-21 Industry news<br />

New launches from Silhouette, Charmant<br />

and Bausch & Lomb plus a major boost for<br />

Jai Kudo and new technology from Shamir<br />

UK<br />

Regulars<br />

22 Spectator<br />

A review on the future of the High Street seeks<br />

to create diverse town centres<br />

32 Crossword<br />

This month’s prize competition<br />

36 Diary dates<br />

All the latest optical events for the summer<br />

39 Student news<br />

Celebrations for Glasgow Caledonian and<br />

Anglia Ruskin plus an OSCE refresher course at<br />

Bradford<br />

Features/interviews<br />

16-18 Improving communication<br />

Part 2 on the importance of eye contact and<br />

gaze in optometry consultations<br />

24 Children’s eyecare<br />

Why the profession’s campaign is vital for every<br />

child<br />

27 Compliance update<br />

Advice from the AOP on the the latest<br />

developments on contract compliance<br />

inspections<br />

Clinical<br />

34-35 VRICS: Presbyopia<br />

& Ageing Eyes<br />

This covers the correction of presbyopia and<br />

identification and management of ageing eye<br />

conditions<br />

40-44 CET: Optimising<br />

glaucoma referral<br />

Key advice on how to recognise possible<br />

cases of glaucoma, for referral to specialist<br />

practitioners, through presentation of case<br />

studies<br />

45-48 CET: Optometric<br />

management of dry eye<br />

This article outlines the role of the optometrist<br />

in the conservative management of dry eye,<br />

namely through treatment with artificial tear<br />

substitutes and eyelid therapy<br />

Classified<br />

50-54 Jobs<br />

All the latest vacancies. The Outside Clinic<br />

continues to grow and is looking for employed<br />

and locum opticians<br />

55-58 Marketplace<br />

CBS offering frame package deals from £1.25<br />

Feature is online<br />

Video is online<br />



0151 426 3907<br />



JUNIOR<br />


HE WEARS 2064<br />


A NEW global study of people patients who experienced<br />

using vision correction has<br />

the symptoms found each<br />

found that halos and glare<br />

bothersome (84% and 89% for<br />

remain commonplace.<br />

halo and glare, respectively).<br />

The Needs, Symptoms,<br />

·<br />

Spherical aberration, which can<br />

Incidence, Global Eye Health contribute to irregularities in the<br />

Trends (NSIGHT) study surveyed visual system, can create halos and<br />

3,800 spectacles and contact glare. Spherical aberration is a type<br />

lens-corrected wearers, from 15 of image blur caused by light rays<br />

to 65 years of age, from seven striking the lens periphery where<br />

different countries (the UK, as they are bent too much – over<br />

well as China, Korea, Japan, refracted – compared with rays<br />

France, Italy and the United coming through the centre of<br />

States) to better understand the lens.<br />

the eye-related symptoms<br />

Loughborough-based<br />

that vision-corrected patients optometrist, Nick Dash, said:<br />

experience.<br />

“It is important for eye care<br />

The study found:<br />

professionals to discuss vision<br />

·<br />

About half of the spectacle in low-light situations with their<br />

and contact lens wearers<br />

patients to ensure solutions<br />

surveyed reported suffering from are identified for patients<br />

the symptoms of halos (52% experiencing halos and glare.”<br />

and 56%, respectively) and glare The study findings indicate<br />

(47% and 50%, respectively) that the severity of symptoms<br />

more than three times a week. associated with halos and glare<br />

· More than four out of five is sufficient enough to impact on<br />

NEWS<br />

Glare study shows<br />

‘opportunities’<br />

Falls awareness<br />

to focus on sight<br />

THIS<br />

YEAR’S Falls<br />

Awareness<br />

Week will<br />

focus on the<br />

link between<br />

reduced<br />

vision and<br />

falls. Events highlighting<br />

the annual week from June<br />

20-24 will be held across<br />

the country with the aim of<br />

informing older people about<br />

the simple steps they can take<br />

to reduce their risk of falls,<br />

such as having an eye test.<br />

Helena Herklots, services<br />

director at Age<br />

UK, said: “There<br />

are a number<br />

of things that<br />

professionals<br />

can do to help<br />

prevent falls;<br />

simply ensuring<br />

older people have regular<br />

eye tests and are wearing the<br />

right prescription glasses will<br />

help with balance, making<br />

them feel as confident as<br />

possible.”<br />

To find out how to host an<br />

event visit www.ageuk.org.<br />

uk/fallsweek.<br />

patient satisfaction with prescribed<br />

vision correction methods.<br />

Coupled with how ‘bothersome’<br />

patients tended to find the<br />

symptoms, about 90% of these<br />

patients (90% for halos, 91% for<br />

glares) reported having either<br />

no solution or one that was<br />

unsatisfactory. Moreover, the same<br />

rate of these patients (89% for<br />

halos, 87% for glares) expressed<br />

an interest in an intervention that<br />

more adequately addressed the<br />

symptoms.<br />

Carla Mack, global medical<br />

affairs director for Bausch & Lomb,<br />

which commissioned the report,<br />

said the company believes there<br />

was opportunities for eye care<br />

professionals to address these<br />

common symptoms with their<br />

patients. “Some spectacle designs<br />

as well as aspheric contact lenses<br />

may help patients achieve optimal<br />

visual correction with no halos or<br />

glare,” she claimed.<br />

The study was conducted by<br />

independent market research<br />

firm, Market Probe: Europe.<br />

Additional analyses from the data<br />

obtained in NSIGHT is expected to<br />

appear in optometry journals and<br />

professional congresses later<br />

<strong>this</strong> year.<br />

<br />


MIDO moves to<br />

new days<br />

Organisers of MIDO have<br />

announced that next year’s show<br />

will start on Sunday March 11 and<br />

end on Tuesday March 13, moving<br />

away from its traditional Friday to<br />

Sunday scheduling.<br />

The change comes following<br />

feedback collected at <strong>this</strong> year’s<br />

event, which showed that many<br />

delegates and exhibitors would<br />

prefer two weekdays, according<br />

to MIDO vice president, Cirillo<br />

Marcolin (pictured).<br />

He added: “We came up with<br />

what we think is a very good<br />

answer – two of the three days of<br />

(the 2012) MIDO are on consecutive<br />

days when many Italian opticians<br />

are not working. Sunday and then<br />

Monday, a day on which stores are<br />

closed in many regions of Italy and<br />

in some other European countries.<br />

We think that <strong>this</strong> will meet the<br />

needs of our reference public and<br />

will help in the decision to visit our<br />

exhibition.<br />

“We are confident that these<br />

considerations will please many of<br />

our stakeholders and fulfil our main<br />

mission of organising an event at<br />

the service of the sector.”<br />

5<br />

03/06/11 NEWS

NEWS<br />

optometrytoday<br />

JUNE 3 2011<br />

VOLUME 51:11<br />

ISSN 0268-5485<br />


January 1 2009 – December 31 2009<br />

Average Net: 20,203<br />

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

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

T: 020 7202 8164<br />

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

Deputy Editor:<br />

Robina Moss<br />

T: 020 7202 8163<br />

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

Web Editor:<br />

Emily McCormick<br />

T: 020 7202 8165<br />

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

Reporter: Chris Donkin<br />

T: 020 7202 8162<br />

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

OT Multimedia Editor: Laurence Derbyshire<br />

T: 020 7401 5310<br />

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

Clinical Editor: Dr Navneet Gupta<br />

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

OT Manager: Louise Walpole<br />

T: 020 7401 5330<br />

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

Editorial Office:<br />

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

London SE1 0HL<br />

Advertising: Vanya Palczewski<br />

T: 020 7878 2347<br />

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

Sponsorship: Sunil Singh<br />

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

Recruitment & Classified: Haley Willmott<br />

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

CET and bookshop enquiries: Charlotte Verity<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 />

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

T: 020 7261 9661<br />

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

Advertising and Production Office<br />

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

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

High Holborn, London WC1A 1NU<br />

Editorial Advisory Board<br />

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

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

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

Whitaker, Vincent Yong<br />

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

Published fortnightly for the Association of<br />

Optometrists by Ten Alps Creative<br />

Subscriptions<br />

Alliance Media Limited, Bournehall House,<br />

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

T: 020 8950 9117<br />

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

Next generation praises<br />

record-breaking BCLA<br />

NEW DELEGATES given free<br />

places to <strong>this</strong> year’s BCLA<br />

clinical conference and<br />

exhibition described the event<br />

as “informative and excellent<br />

for networking” and vowed to<br />

recommend it to colleagues<br />

for next year.<br />

A record numbers of<br />

delegates attended <strong>this</strong><br />

year’s event at the Manchester<br />

Central conference centre, which<br />

ran from Thursday to Sunday<br />

last week. Final figures confirm<br />

that there were a total of 1,186<br />

delegates, of which 98 attended<br />

just the free exhibition.<br />

BCLA president Shelly Bansal<br />

said he was delighted by both<br />

the attendance and the feedback<br />

from new delegates. He told OT:<br />

“It (the conference) has been<br />

excellent. The new delegates<br />

say they are pleasantly surprised<br />

to realise that the BCLA is not a<br />

clique, it’s for every practitioner,<br />

no matter what their skillset. They<br />

seem to have really enjoyed it.<br />

They’ve seen we’re just everyday<br />

people and they can be a part of<br />

<strong>this</strong>. We want them to be a part<br />

of <strong>this</strong>.”<br />

For the first time <strong>this</strong> year,<br />

free spaces at the conference<br />

and the Bollywood-themed gala<br />

dinner were made available to<br />

some new delegates, together<br />

with a personal meet-and-greet<br />

breakfast with Mr Bansal on<br />

Sunday.<br />

Addressing the newcomers,<br />

Mr Bansal said: “The BCLA is not<br />

a club for the best practitioners,<br />

it’s not a club for the novices,<br />

it’s a club for everyone. We want<br />

to break the myth that we’re an<br />

outdated organisation for contact<br />

lens specialists.”<br />

At the breakfast, new delegate<br />

Sarabdip Ryatt, owner of Ryatt<br />

Optometrists in Loughborough,<br />

told OT he had been tempted to<br />

attend because of the offer of a<br />

free place: “I’ve been meaning<br />

to come to the BCLA conference<br />

for a long time,” he said. “The free<br />

places are excellent, you get<br />

to find out exactly what it’s like<br />

being a member.”<br />

Ravi Vaid, clinical support<br />

colleague at Boots Opticians<br />

in Greater London added: “It’s<br />

been great. Really informative.<br />

In the past we (myself and<br />

colleagues) didn’t really know<br />

what the conference offered,<br />

but now we do, I’d definitely<br />

recommend it.”<br />

Another first-time delegate<br />

Simon Lefever, CLO for<br />

Specsavers, Barrow-in-Furness,<br />

praised the community<br />

spirit he found among other<br />

new delegates – who were<br />

identifiable by the yellow stripe<br />

on their badges.<br />

“It’s quite nice. Most of the new<br />

delegates seem to be here on<br />

their own so between lectures<br />

and in the exhibition everyone’s<br />

really friendly and wants to chat,”<br />

he said.<br />

Next year’s event will take<br />

place away from a Bank Holiday<br />

weekend, on May 24-27 at the<br />

new Birmingham venue for the<br />

association, the ICC.<br />

• For more on <strong>this</strong> year’s BCLA see<br />

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

Contact lenses ‘drive growth’<br />

SALES OF contact lenses<br />

and care products arose<br />

almost 5% in value for the<br />

last year according to GfK<br />

Retail and Technology UK,<br />

while the frames market<br />

continued to fall.<br />

Comparing figures for<br />

the first quarter of 2011 to<br />

those from the same period<br />

in 2010, sales of contact<br />

lenses were up 4.9%, adding<br />

£6m, despite the number of<br />

fittings being down 0.9%<br />

Photo by Phil Weedon/BCLA<br />

year-on-year.<br />

The report shows frames<br />

as being the only segment<br />

of the UK optics market<br />

down in both volume and<br />

value. Volume dropped 3%<br />

to 3.16 million units and in<br />

value by 2%, which meant a<br />

slight increase in the average<br />

frames dispense to £68.10.<br />

Women’s frames now make<br />

up 44% of the market with<br />

men’s sales contributing<br />

35.2%.<br />

The figures also show a<br />

shift from lower price points<br />

towards the mid and highend.<br />

In the first quarter of<br />

2010, glasses sales valued as<br />

lower than £75 accounted for<br />

45.1% of the market, whereas<br />

current figures show <strong>this</strong> has<br />

fallen to 42.1%. The luxury<br />

segment of the market (above<br />

£220) now accounts for nearly<br />

5% of all sales in value.<br />

For a detailed report visit<br />

www.gfkrt.com/uk<br />

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

DO complaint leads to<br />

advert being banned<br />

A COMPLAINT from a<br />

dispensing optician has led<br />

to a national press advert by<br />

Specsavers being banned<br />

by the ASA (the Advertising<br />

Standards Authority).<br />

The advert was headlined:<br />

“Some opticians charge<br />

extra for digital retinal<br />

photography. At Specsavers,<br />

we don’t”. Text underneath<br />

stated: “Many opticians charge<br />

for using the latest optical<br />

technology. You pay once for<br />

your ‘normal’ eye test, then<br />

pay again for digital retinal<br />

photography, a sophisticated<br />

process that uses a digital<br />

camera to take a picture of the<br />

back of your eye and help your<br />

optician monitor the health<br />

of your eyes ... We also believe<br />

that as many people as possible<br />

should have access to <strong>this</strong> new<br />

technology, so digital retinal<br />

photography is now available in<br />

590 of our stores”.<br />

The DO challenged whether<br />

the advert misleadingly implied<br />

that digital retinal photography<br />

was the latest technology,<br />

because he understood “that it<br />

had been superseded by Spectral<br />

Domain Optical Coherence<br />

Tomography”.<br />

Specsavers told the ASA that<br />

Digital Retinal Photography (DRP)<br />

and Spectral Domain Optical<br />

Coherence Tomography (SDOCT)<br />

were completely separate<br />

technologies.<br />

Specsavers also explained that<br />

the technology for OCT was first<br />

introduced over more than 20<br />

years ago and disagreed with<br />

the complainant that it had been<br />

recently introduced.<br />

However, the ASA<br />

decided the advert had<br />

breached its ‘misleading<br />

advertising’ and<br />

‘substantiation’ rules, and<br />

said it must not appear<br />

again in its current form.<br />

A Specsavers spokesman<br />

told OT: “This was a<br />

single complaint by one<br />

dispensing optician,<br />

based on an interpretation of<br />

the word ‘latest’. It was upheld,<br />

after some quibbling over the<br />

dates when various technologies<br />

were introduced, but that does<br />

not take away from the fact<br />

that Specsavers provides a<br />

sophisticated, nationwide digital<br />

imaging capability as part of the<br />

standard eye test.<br />

“At Specsavers if you are<br />

over 40, or your optician<br />

recommends it, then digital<br />

retinal photography comes at no<br />

extra cost. It not only provides an<br />

in-depth eye examination, with a<br />

detailed record, it also can – and<br />

does – save lives.”<br />

First woman president<br />

THE WORLD Council of <strong>Optometry</strong><br />

(WCO) has welcomed its first<br />

female president, Tone Garaas-<br />

Maurdalen (pictured) at its latest<br />

meeting in Puerto Rico. Ms Garaas-<br />

Maurdalen takes over the role from<br />

George Woo, who has recently<br />

completed his two-year term. Ms<br />

Garaas-Maurdalen said: “It is a real<br />

honour to be the first female WCO<br />

president and I look forward to continuing the<br />

important work the WCO does for the profession<br />

worldwide. WCO has always been an important<br />

unifying voice and catalyst for international<br />

projects and services. I am delighted to be able<br />

to ensure that it continues to meet the future<br />

needs of the optometric<br />

profession and the public<br />

around the globe.”<br />

Her career highlights<br />

include working as<br />

professional affairs<br />

manager at CIBA Vision<br />

for Nordic countries,<br />

working in private practice<br />

and holding the position<br />

of executive director of the Norwegian<br />

Optometric Association. Other appointments<br />

at the meeting include the UK’s Bob Chappell<br />

becoming chair of the legislation, registration<br />

and standards committee, and Canadian<br />

Susan Cooper being made president elect.<br />


Eye Health Week -<br />

final preparations<br />

Last minute preparations are being<br />

made for <strong>this</strong> month’s National Eye<br />

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

Readers are being urged by<br />

its organisers – a cross-sector<br />

grouping which aims to raise public<br />

awareness of the importance of eye<br />

health and the need for regular eye<br />

examinations – to get involved in<br />

10 days’ time and tell their patients<br />

and the wider community about<br />

how vital eye care is.<br />

To do <strong>this</strong> go to the campaign’s<br />

website at www.visionmatters.<br />

org.uk/<br />

The event will be helped by two<br />

eye care charities which are putting<br />

their weight behind the promotion.<br />

SeeAbility<br />

is urging the<br />

public to<br />

have an eye<br />

test during<br />

National Eye<br />

Health Week<br />

with the help<br />

of food writer and cook Clarissa<br />

Dixon-Wright (pictured). She<br />

said: “Having faced the terrifying<br />

experience of sight loss with<br />

cataracts, I know how important it<br />

is to have regular eye tests. Without<br />

early intervention, I could have<br />

lost my sight. I am delighted to<br />

support SeeAbility during National<br />

Eye Health Week. I do hope it<br />

will resonate with the public and<br />

encourage people to look after<br />

their eyes and have them tested<br />

regularly.”<br />

SeeAbility, formerly the Royal<br />

School for the Blind, supports<br />

people with a visual impairment<br />

and multiple disabilities. Fight for<br />

Sight has also joined National Eye<br />

Health Week, as a lead sponsor.<br />

The charity, whose mission is<br />

to support research into the<br />

prevention and treatment of<br />

blindness and eye disease, will<br />

use National Eye Health Week as<br />

a platform to launch ‘Carrots’ – its<br />

first fundraising nightwalk which<br />

will take in London landmarks on<br />

September 23.<br />

7<br />

03/06/11 NEWS<br />

News updated regularly at www.optometry.co.uk

NEWS<br />


8<br />

03/06/11 NEWS<br />

Optometrist found<br />

to be fit to practise<br />

A GOC panel has decided<br />

that an optometrist who<br />

failed to immediately<br />

refer a patient showing<br />

symptoms of a potential<br />

retinal detachment does<br />

not have his fitness to<br />

practise impaired.<br />

The fitness to practise<br />

committee, chaired by<br />

Margaret Wall, found that,<br />

although optometrist<br />

Roger Staite was guilty of<br />

misconduct it was a ‘quite<br />

uncharacteristic lapse on<br />

the part of a competent<br />

and conscientious<br />

practitioner who has<br />

given great service to the public over many years.’<br />

Mr Staite, who practised for 42 years, admitted<br />

allegations that he: failed to perform a dilated<br />

examination of the patient’s retina during an<br />

examination in February 2009; did not refer<br />

her as an emergency on the same day to an<br />

ophthalmic unit or seek any advice on such a<br />

referral; and in a further consultation – less than<br />

a week later – he referred her to a GP rather than<br />

an ophthalmic specialist.<br />

The practitioner has now retired, but Ms Wall<br />

confirmed that ‘had he remained in practise<br />

the committee would not<br />

have felt there was a risk of<br />

repetition.’<br />

During the case, Ms<br />

Wall said the panel was<br />

“impressed by the way he has<br />

questioned himself rigorously<br />

over these matters. He has<br />

clearly agonised over the<br />

lapses of judgement he has<br />

made (and) co-operated fully<br />

with the GOC’s investigation<br />

and willingly came to the<br />

hearing to give evidence.’”<br />

Although not used by the<br />

defendant to try and excuse<br />

himself, there was found to<br />

be an ‘administrative failing’<br />

which meant the results of a visual field test<br />

examination were not immediately available<br />

during the first assessment.<br />

Ms Wall added: “This failing helps to explain,<br />

but not excuse, the misconduct that took place<br />

in relation to <strong>this</strong> patient. It is important for<br />

members of the profession to remember that<br />

delegation of tests to unqualified staff does not<br />

absolve them of professional responsibility.’’<br />

The GOC concluded Mr Staite’s fitness to<br />

practise is not impaired and has not <strong>issue</strong>d a<br />

warning for the misconduct charge.<br />

Moorfields charity launched<br />


Widdecombe launched the new<br />

Moorfields Eye Charity at the<br />

hospital last week (pictured).<br />

The charity is to help to provide<br />

services and improvements that<br />

cannot be achieved within the<br />

limits of normal NHS funding. Its<br />

aims include to support hospital<br />

improvements, fund research,<br />

purchase new equipment,<br />

support ophthalmic teaching<br />

and training, improve the ‘patient<br />

environment’ and generally enhance<br />

services to patients.<br />

Cutting the ribbon Ms Widdecombe<br />

said: “Moorfields strives to make<br />

advances in the field of eye care<br />

and, no matter what government<br />

is in place, it<br />

will never be possible to fund<br />

them all.<br />

“This new charity will help<br />

support Moorfields in taking<br />

<strong>this</strong> work forward and to keep<br />

producing ground-breaking work.<br />

It is an honour to be launching the<br />

charity and I can only encourage<br />

people to support it over the<br />

coming years.”<br />

For more information on the Moorfields<br />

Eye Charity, visit: www.moorfields.nhs.uk<br />



RECENTLY I heard that a practice<br />

employer was facing something of a<br />

revolt by his receptionist and optical<br />

assistant over their hopes to get a<br />

bigger pay rise, and one which would<br />

keep pace with inflation.<br />

Before many of you fellow managers<br />

out there cry ‘in the current economic<br />

environment? They’d be lucky!’ I’d<br />

ask is there room for something of a<br />

negotiation?<br />

One area which our sector constantly<br />

debates is the necessity to get new<br />

patients to grow an optical business.<br />

Some practices produce a plethora of<br />

leaflets etc, while others use special offer<br />

boards outside their outlets to attract<br />

new people in. But in <strong>this</strong> day and age,<br />

isn’t it time to be somewhat more direct?<br />

What I mean is that I’m constantly<br />

approached by those representing<br />

charitable causes – or ‘chuggers’ as<br />

they’re also known – but I for one<br />

would find it refreshing to find a<br />

representative of an opticians asking<br />

me directly whether I have had an eye<br />

examination of late.<br />

And who better to do <strong>this</strong> than the<br />

very personable and ‘people friendly’<br />

receptionists and other public-facing<br />

staff that practices employ? If carried<br />

out to some success surely wouldn’t<br />

that be worth negotiating towards a<br />

payrise, rather than a blanket ‘no’?<br />

I do understand that business is very<br />

difficult out there, and that <strong>this</strong> would<br />

mean discussing an extension of an<br />

employee’s role, which can be difficult<br />

too. But in a month where we mark<br />

National Eye Health Week isn’t more<br />

proactive approaches like <strong>this</strong> worth<br />

a try?<br />

David Challinor, Editor-in-Chief OT<br />

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

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NEWS<br />

10<br />

03/06/11 NEWS<br />


Decia Griffiths MCSP,<br />

BSc(Hons), FCOptom<br />

The death has been reported of<br />

former practitioner Decia Griffiths<br />

who graduated in Ophthalmic Optics<br />

from City University. She was 83.<br />

Her optometrist daughter and<br />

Huddersfield practice owner, Stella<br />

Griffiths, writes: “My mother and<br />

my family are steeped in both optics<br />

and politics. My father, Will Griffiths<br />

FBOA, MP, came from Manchester, and<br />

trained as an ophthalmic optician in<br />

the 1930s, when he also joined the<br />

Labour Party. He was elected as an<br />

MP in his home city in 1945.<br />

Passionate about health<br />

provision for the public, he became<br />

Parliamentary Private Secretary<br />

to NHS founder Aneurin Bevan,<br />

was closely involved with the<br />

establishment of the Health Service<br />

in 1948, and was also a founder of<br />

the Opticians Act of 1958.<br />

Decia Griffiths was raised<br />

in Blackpool also with politics<br />

in the blood. She trained as a<br />

physiotherapist and married Will<br />

Griffiths having met him at a Labour<br />

Party dance. They moved to London<br />

and encouraged by her husband,<br />

Decia went to City University and<br />

graduated in Ophthalmic Optics in<br />

1970.<br />

Will and Decia were in practice,<br />

both in London and Manchester, and<br />

Decia continued as an optometrist<br />

until 1998.”<br />

Lis Thomas<br />

Wales-based optometrist and practice<br />

owner Lis Thomas, 45, has died.<br />

<strong>Optometry</strong> Wales said that she ran<br />

her practice Thomas Opticians, in<br />

Margaret Street, Ammanford,<br />

for 15 years and died “suddenly<br />

and unexpectedly during a recent<br />

Bank Holiday and will be missed by<br />

colleagues and family”.<br />

Tints ‘give migraine relief’<br />

NEW RESEARCH on precision<br />

tinted lenses has claimed they<br />

can offer relief to migraine<br />

sufferers. The study, which<br />

involved a UK-based team, may<br />

provide a breakthrough for<br />

patients hitherto considered<br />

untreatable.<br />

Precision tinted lenses have<br />

been used to help poor readers,<br />

and are used for migraine<br />

sufferers, but the science behind<br />

their effects has been unclear.<br />

The study published in<br />

Cephalalgia (May 26), uses<br />

functional magnetic resonance<br />

imaging (fMRI) for the first time<br />

to suggest a neurological basis<br />

for these visual remedies. It<br />

shows how coloured glasses,<br />

tuned to each migraine sufferer,<br />

work by normalising activity in<br />

the brain. The researchers saw<br />

specific abnormal brain activity –<br />

hyperactivation – when migraine<br />

sufferers saw intense patterns.<br />

The tinted lenses considerably<br />

reduced the effect.<br />


Tom Davies has increased its<br />

Chinese-based production<br />

workforce by 22% to meet<br />

a growing demand for its<br />

ready-to-wear collection<br />

and bespoke and couture<br />

spectacles and sunglasses.<br />

To celebrate progress,<br />

the brand invited a team<br />

of international opticians<br />

to tour the facilities and<br />

take part in an inaugural<br />

four-day advanced training<br />

programme inside the<br />

workshop in Shenzhen.<br />

A dozen opticians visited<br />

the production departments<br />

and newly renovated<br />

The team, from Michigan State<br />

University and the University of<br />

Michigan, US, and the University<br />

of Essex, homed in on specific<br />

visual stimuli known to trigger<br />

migraines and which may also<br />

cause seizures in those with<br />

photosensitive epilepsy.<br />

Before the brain imaging<br />

took place, participants were<br />

tested and prescribed precision<br />

ophthalmic tints (POTs) with an<br />

Intuitive Colorimeter. Previous<br />

studies have suggested that<br />

some 42% of migraine with aura<br />

sufferers saw their migraine<br />

frequency halved on days when<br />

they wore POTs.<br />

The researchers used the<br />

Colorimeter to illuminate text<br />

with coloured light, manipulating<br />

hue and saturation at constant<br />

luminance. For each test<br />

participant, <strong>this</strong> gave an optimal<br />

hue and saturation (chromaticity)<br />

of light that led to the greatest<br />

comfort, reducing perceptual<br />

distortion. The test subjects then<br />

viewed stressful striped patterns<br />

illuminated with their optimal<br />

coloured light settings to screen<br />

for efficacy. The researchers used<br />

the readings to generate both<br />

effective POTs for each migraine<br />

sufferer and also two other pairs<br />

of grey and coloured lenses<br />

with slightly different properties<br />

as controls. Eleven patients<br />

who frequently suffered from<br />

migraine enrolled in the fMRI<br />

study. Each patient was paired<br />

with a migraine-free control,<br />

who was also tested with that<br />

patient’s three sets of lenses.<br />

Although patients reported<br />

some relief using all of the lenses<br />

(by around 40%), the POT lenses<br />

had a significant effect when<br />

viewing the stressful stripes<br />

(70% discomfort reduction).<br />

Both control and migraine<br />

patients responded similarly to<br />

the non-stressful stripe patterns,<br />

and in these cases, all three<br />

lenses made no difference to<br />

the result.<br />

Workforce increased<br />

ground floor. They observed<br />

the intricate production<br />

processes developed by<br />

Mr Davies, from the initial<br />

design and engineering<br />

process to the final quality<br />

control procedures at the<br />

end. They also took part in<br />

workshops on key stages of<br />

production, including rim<br />

wire forming, sandblasting<br />

and hand polishing, with<br />

each visitor able to oversee<br />

the production of frames<br />

that they had ordered for<br />

their own customers.

Manufaktur<br />

Anything but standard.<br />

Unusual requests need<br />

unusual solutions. Therefore,<br />

the Rodenstock Manufaktur<br />

Team is your number one<br />

contact partner for all special<br />

lenses requirements.<br />

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NEWS<br />

12<br />

03/06/11 NEWS<br />

IN BRIEF<br />

Don’t miss AOP<br />

Awards deadline<br />

The deadline is fast approaching<br />

for nominations for the AOP’s<br />

new awards, with the winners<br />

nominated and voted for by the<br />

profession itself. The winners<br />

will receive their accolade at a<br />

prestigious and fun annual awards<br />

ceremony in November.<br />

We all know a group,<br />

organisation, individual or students<br />

(picture from the AOP student<br />

conference) that deserve to be<br />

recognised for their contribution<br />

to optics, so here’s your chance to<br />

thank them for their efforts, but<br />

hurry as all nominations must be<br />

received by June 30.<br />

The entries will be whittled<br />

down by an internal judging panel<br />

to a shortlist of three finalists<br />

per category. The finalists will be<br />

published in OT and readers asked<br />

to vote for the winners. Everyone<br />

who is shortlisted will be invited<br />

to attend the National Optometric<br />

Conference on November 3, where<br />

the winners will be announced.<br />

The conference and ceremony<br />

will be at Chesford Grange, a<br />

luxurious hotel set in 17 acres of<br />

private grounds in the Warwickshire<br />

countryside.<br />

Nominating is easy, just visit<br />

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

enter your nomination. Alternatively<br />

post it to: AOP Awards, AOP, 61<br />

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

You will need to provide<br />

contact details for yourself and the<br />

nominee/s, as well as between<br />

200-500 words describing why you<br />

feel <strong>this</strong> person or group should<br />

be nominated. There should be<br />

evidence of true effectiveness<br />

related to the award criteria. Full<br />

details are on the website.<br />

Central Fund launches<br />

new website resource<br />

A NEW website has<br />

been launched which<br />

gives more details of<br />

how the voluntary<br />

levy from eye health<br />

professionals supports<br />

projects benefitting<br />

the whole profession.<br />

The new site, www.<br />

centralfund.org.uk,<br />

has been established<br />

by the Central (LOC)<br />

Fund, giving details of both<br />

current and past projects, as well<br />

as initiatives which have been set<br />

up thanks to generous voluntary<br />

contributions from optical<br />

professionals.<br />

Keith Chapple, a representative<br />

of the Central (LOC) Fund said:<br />

“We are very grateful for the<br />

optical profession’s generosity<br />

enabling us to regularly fund a<br />

wealth of projects including eye<br />

health campaigns and literature.<br />

Although we are acutely aware<br />

of the financial pressures faced<br />

by LOCs, we hope some may<br />

consider making a one-off<br />

donation as they complete their<br />

end of financial year accounts.”<br />

Readers can contact the Central<br />

Fund treasurer Roy Brackley via<br />

the new website.<br />

The Central (LOC) Fund collects<br />

money by voluntary levy and<br />

donations from optometrists<br />

and LOCs. It distributes the<br />

donations in the form of grants<br />

to organisations and individual<br />

applicants for “<strong>issue</strong>s and projects<br />

that will be of benefit to<br />

the whole profession”.<br />

Georgina Gordon,<br />

head of the LOC<br />

Support Unit, has left<br />

the LOCSU to explore<br />

opportunities outside<br />

of the organisation. A<br />

spokeswoman for the<br />

Unit said: “Georgina was<br />

the first head of LOCSU,<br />

and brought to the role<br />

a wealth of expertise in clinical<br />

and general management gained<br />

from board level positions in a<br />

number of major organisations.<br />

We thank her for her valued<br />

contribution to the work of the<br />

LOC Support Unit and we wish<br />

her well in her future career.”<br />

The acting head of LOCSU<br />

is Richard Carswell at the AOP<br />

(pictured at a LOCSU training<br />

day) and the director of<br />

operations and commissioning<br />

is Katrina Venerus.<br />

Independent duo expands<br />


is looking forward to<br />

expanding their business<br />

with the opening of a<br />

second practice in the<br />

county. Optometrist Jan<br />

Goodwin and Sarah Edge,<br />

dispensing optician, have<br />

now bought the former<br />

Gnosall Optometrists in Gnosall, following the<br />

retirement of Peter Mincher-Lockett.<br />

The duo bought Mr Mincher-Lockett’s Stafford<br />

practice in 2006, and have made significant<br />

changes, including extending into neighbouring<br />

premises, and a total refurbishment, as well as<br />

investing in some new kit. Both practices will<br />

now be known as Mincher-Lockett Opticians.<br />

“We are thrilled to be opening a second<br />

practice,” said Ms Edge.<br />

“When we started<br />

out, we made it part<br />

of our commitment to<br />

continually improve<br />

the quality of the eye<br />

care we provide, and<br />

we are already looking<br />

at investing in new<br />

equipment for the Gnosall practice.”<br />

New services will include macular pigment<br />

screening and NHS diabetic screening, and the<br />

new owners are also planning to introduce a<br />

wider range of frames and contact lenses, along<br />

with new equipment.<br />

“Using more modern equipment improves the<br />

efficiency, quality and the range of the testing<br />

we can do,” said Ms Goodwin.

GG Vivvi C2<br />

INTERNATIONALeyewear<br />

The Eschenbach Group Telephone: 0121 585 6565

NEWS<br />

14<br />

03/06/11 NEWS<br />

IN BRIEF<br />

Police presentation<br />

<strong>Optometry</strong> Wales has delivered<br />

a presentation to South Wales<br />

police officers about vision and<br />

driving. The presentation, which<br />

has been delivered in England and<br />

some European Countries, was<br />

created by FODO’s head of policy<br />

and regulation, Mark Nevin. A<br />

spokeswoman for OW said that<br />

feedback has been positive, and<br />

that other stakeholders present<br />

have asked OW to deliver the<br />

presentation within their own<br />

organisations.<br />

New WCSM director<br />

The Worshipful Company of<br />

Spectacle Makers (WCSM) has<br />

announced the appointment of<br />

Adele Williams (pictured above)<br />

as its qualifications director.<br />

Responsible for the further<br />

development and marketing of<br />

WCSM qualifications, <strong>this</strong> will<br />

include the expansion of its current<br />

range of examination-based<br />

qualifications and the introduction<br />

of new ones with an emphasis<br />

on work-based assessment. Ms<br />

Williams has worked for a number<br />

of years as a lecturer in education,<br />

and for the last seven years, she has<br />

been a senior manager in Awarding<br />

Bodies, working with employers to<br />

develop qualifications, particularly<br />

in the health sector.<br />

Smart multiple<br />

Staff from Specsavers have a new<br />

look from <strong>this</strong> week after two big<br />

names in fashion – Gok Wan and<br />

Jeff Banks – worked together to<br />

help redesign the optical group’s<br />

uniforms. The 20-piece capsule<br />

collection, known as iWear, was<br />

rolled out across the UK and Ireland<br />

with all staff wearing it from <strong>this</strong><br />

month.<br />

Ultralase ahead by 5%<br />

LASER EYE surgery company<br />

Ultralase has announced a<br />

5% growth in revenue for<br />

the last full year.<br />

Revenue increased to<br />

£42.3m in 2010, compared<br />

to £40.3m in 2009, with its<br />

core business of refractive<br />

surgery showing a sales rise<br />

of 8%.<br />

Chief executive of<br />

Ultralase, Tony Veverka<br />

(pictured) said: “Whilst market<br />

conditions remain challenging,<br />

our latest figures are a clear<br />

indication that the group<br />

continues to increase market<br />

share. Our performance yearon-year<br />

and in the context<br />

of our competitors, remains<br />

strong and is testimony to our<br />

growth strategy and continued<br />

investment in our clinical<br />

team and advanced<br />

technology.<br />

“This year sees us<br />

celebrate our 20th year<br />

and we are delighted that<br />

the outlook is promising.<br />

With 31 clinics in the UK<br />

and Ireland and a series<br />

of new clinic openings<br />

planned <strong>this</strong> year, we are<br />

well positioned to achieve<br />

further gains in market<br />

share within the industry.”<br />

The company also said that<br />

99.1% of its patients in 2010<br />

achieved vision ‘of driving<br />

standard or better’.<br />

New lay member sought<br />

THE GOC has launched its<br />

search for a new lay member<br />

through the Appointments<br />

Commission.<br />

In the advertisement on<br />

the Commission’s website,<br />

the Council says it is looking<br />

for a candidate who can:<br />

“demonstrate senior level<br />

experience in patient safety<br />

or advocacy, or public<br />

involvement” and is “able<br />

to articulate the interests<br />

of service users who are<br />

especially vulnerable, either<br />

because of income or other<br />

circumstance, or because<br />

of their complex optical<br />

requirements”.<br />

Talking about the<br />

importance of attracting a<br />

forward-thinking member,<br />

THE OPTOMETRIC adviser for<br />

the College of Optometrists<br />

has been appointed to the<br />

National Association of<br />

Primary Care’s council. The<br />

council, of which Susan<br />

Blakeney is now a member,<br />

chair of the GOC, Anna<br />

Bradley (pictured) said:<br />

“Our vision is to lead the<br />

way in professional health<br />

regulation. There are going<br />

to be some significant<br />

challenges in healthcare<br />

regulation over the next few<br />

years and the Council and<br />

staff are very focused on<br />

identifying and addressing<br />

is a national not-for-profit<br />

body. Ms Blakeney said: “It is<br />

a membership organisation<br />

for those involved in, or with<br />

an interest in, a primary<br />

care led NHS. It has three<br />

core aims – to promote the<br />

these challenges proactively.<br />

“We have made an<br />

important start strengthening<br />

the organisation and<br />

modernising some of our<br />

practices. We have been<br />

laying the foundations, but<br />

there is plenty more to do<br />

and we are looking to<br />

enhance our team for the next<br />

phase of work.”<br />

Applications must be<br />

received by June 16 with<br />

interviews taking place in<br />

late July. Remuneration is<br />

in the region of £12,000 per<br />

annum for around three days<br />

commitment each month.<br />

Those interested can apply<br />

through the website: www.<br />

appointments.co.uk using<br />

reference DH0251.<br />

National role for adviser<br />

highest possible quality in the<br />

delivery of primary care services<br />

for patients; to support the<br />

effective introduction of GP<br />

commissioning and to support<br />

the development of clinical<br />


Silhouette | valid until 12.2011<br />

©<br />


A WOMAN’S<br />

PASSION.<br />




Eye contact and gaze in<br />

optometry consultations<br />

16 28<br />

08/04/11 03/06/11 COVER COMMUNICATING<br />

STORY<br />

Researchers at the Department of Management Helena Webb and Dirk vom Lehn at King’s College<br />

London report from a project about communication in optometry consultation. In <strong>this</strong> the second<br />

part of their series – the first published by OT on April 8 – they describe the importance of eye<br />

contact and gaze<br />

IN OUR research we video-record optometry consultations<br />

in order to observe and analyse the communication that<br />

occurs between optometrists and patients. Using videorecordings<br />

enables us to capture both verbal and nonverbal<br />

forms of interaction and we can then develop an<br />

advanced understanding of how communication takes<br />

place in the consultation. In <strong>this</strong> article we highlight<br />

the connections between talk and non-verbal<br />

elements such as eye contact and body movement<br />

and discuss their implications for practice.<br />

Across healthcare fields, surveys of patient<br />

satisfaction regularly highlight the importance<br />

of eye contact. Patients often complain that their<br />

practitioners spend much of the encounter looking<br />

through medical records, at the computer screen<br />

etc rather than making eye contact and that as a<br />

consequence they do not feel properly listened to.<br />

Communication skills’ guidance for practitioners<br />

therefore frequently emphasises the importance of<br />

maintaining eye contact in order to establish rapport,<br />

demonstrate empathy and ultimately to enhance<br />

patient satisfaction. We can add that as well as<br />

affecting satisfaction; the presence or absence of<br />

eye contact can influence the way in which<br />

communication in the consultation unfolds.<br />

Example 1 in our data shows a transcript<br />

of a brief segment of history-taking in a<br />

standard eye examination. The videostill<br />

images illustrate the physical<br />

positions of the optometrist and patient<br />

throughout <strong>this</strong> segment. The patient<br />

is looking towards the optometrist<br />

and the optometrist is turned<br />

towards her desk writing<br />

on the record card.<br />

We have added some extra<br />

markings in the transcript<br />

(used as standard in our<br />

method, Conversation<br />

Analysis) to highlight<br />

something noticeable about<br />

<strong>this</strong> interaction. Although<br />

the optometrist elicits the<br />

necessary information from<br />

the patient, the conversation

etween them appears<br />

Example 1<br />

‘stilted’ rather than smoothflowing.<br />

The frequent<br />

silences - shown by the<br />

numbers in brackets in<br />

the transcript- contribute<br />

to <strong>this</strong> stilted feel, in<br />

particular those that seem<br />

to delay a response, such<br />

as in line 2 following the<br />

optometrist’s question<br />

about computers and<br />

in line 8 before the<br />

optometrist acknowledges<br />

the patient’s comment<br />

about television. There<br />

is also an overlap of talk<br />

and a mismatch of topics.<br />

In line 5 the patient<br />

begins speaking and the<br />

optometrist also begins<br />

to speak in overlap with<br />

her (<strong>this</strong> is shown by the<br />

square brackets in adjacent<br />

lines of the transcript).<br />

The patient stops shortly<br />

after the optometrist begins<br />

her question, answers the<br />

question in line 7 and then goes back to her original comment<br />

about television.<br />

Delays, overlaps and topic mismatches can occur in<br />

conversation for various reasons. In <strong>this</strong> instance we suggest<br />

that they are connected to the absence of eye contact between<br />

optometrist and patient. This is because eye contact, or more<br />

generally looking at another person during conversation,<br />

functions as an important resource to aid communication<br />

during face-to-face encounters. Looking at someone whilst<br />

he/she speaks to me displays that I am listening, allows<br />

me to notice any gestures the speaker is making and which<br />

may convey important information, and also enables me to<br />

discern when that person is about to stop talking so that I can<br />

take my ‘turn’. Meanwhile, by looking at me the speaker is<br />

able to monitor my expression for signs that I may not have<br />

understood, am in disagreement etc. Maintaining eye contact<br />

“Eye contact and gaze are crucial<br />

interactional resources that can<br />

aid the flow of communication”<br />

and gaze helps us to be actively involved in the interaction<br />

and where <strong>this</strong> does not occur – as in example 1 – a stilted,<br />

non-flowing conversation can result.<br />

The resources provided by eye contact and gaze can be<br />

particularly important in interactions where those involved<br />

do not know each other well – such as in consultations<br />

between a healthcare practitioner and patient. Ironically, these<br />

are occasions in which eye contact is frequently withdrawn as<br />

the practitioner turns towards the record form, examination<br />

equipment etc. We<br />

have already observed<br />

that the absence of eye<br />

contact can disrupt<br />

the flow of interaction.<br />

Additionally, patients<br />

sometimes pursue<br />

eye contact when the<br />

practitioner’s gaze is<br />

elsewhere. Example<br />

2 occurs at the start<br />

of the consultation.<br />

The patient is<br />

sitting next to the<br />

optometrist’s desk<br />

and the optometrist<br />

is turned towards<br />

her as she asks about<br />

the existence of any<br />

problems. The patient<br />

replies ‘no’ in line 3<br />

and then goes on to<br />

describe how she does<br />

not wear her glasses<br />

all the time. During<br />

<strong>this</strong> description the<br />

optometrist turns to<br />

her computer and<br />

begins typing, withdrawing eye contact. There follows a 1.6<br />

second silence during which the patient changes her body<br />

position. As shown by the video-stills in the transcript, she<br />

moves her entire body sideways towards the optometrist.<br />

This makes her significantly closer, positions her within<br />

the optometrist’s field of vision and makes it easier for the<br />

optometrist to return the patient’s gaze. In fact it ‘requests’<br />

that she does so by making it clear that patient is looking<br />

at her. As the patient describes feeling sick in lines 6-8 the<br />

optometrist does in fact look over to her.<br />

The pursuit of a return of gaze through body movements<br />

or other actions is a widely-observed phenomenon across<br />

communication studies. This is not to suggest that people do<br />

<strong>this</strong> in a pre-meditated way, but rather that <strong>this</strong> is another<br />

‘seen but unnoticed’ interactional resource that all of us<br />

deploy, often even without realising it. In our analysis we<br />

notice that patients typically perform such actions when<br />

they are about to reveal some information that can be<br />

considered important. In example 2, the patient’s change<br />

of body position comes just before she reveals that she<br />

can’t wear her glasses without feeling sick, a potentially<br />

significant symptom. In our final example the patient delays<br />

revealing the exact nature of a problem until the optometrist<br />

has turned around to face her.<br />

The optometrist is sitting at his desk facing away from<br />

the patient and preparing the record form. As with example<br />

1, <strong>this</strong> physical position prevents eye contact and we can<br />

observe that the conversation is slowed down with silences.<br />

In line 1 the patient says that her eyes have got worse and<br />

the optometrist invites further information by asking ‘what’s<br />

been happening?’. The patient answers in line 6 with a<br />

17<br />



Example 2 Example 3<br />

18 28<br />

08/04/11 03/06/11 COVER COMMUNICATING<br />

STORY<br />

short, ambiguous response, ‘driving’. After ‘okay’ from the<br />

optometrist she does not continue with her problem report<br />

but asks a question of her own in line 10, ‘you know?’. The<br />

optometrist does not answer but turns his head to look at her<br />

for the first time in <strong>this</strong> sequence. In the silence at line 11 he<br />

begins moving his chair round to face her with the record<br />

form on his lap. It is at <strong>this</strong> point that the patient provides<br />

a more complete description of her problem – that she can’t<br />

see distances (line 12). This description has been delayed<br />

until the optometrist is in a position where he can see as well<br />

as hear her and eye contact is possible (although the patient<br />

herself is looking down in line 12). The delay of talk provides<br />

a different kind of resource to ensure important information<br />

is delivered at a point when eye contact is possible.<br />

These three examples illustrate patterns across our data<br />

and display the close connection between talk in optometry<br />

consultations and non-verbal elements such as gaze, eye<br />

contact and body movements. These patterns have practical<br />

implications that optometrists may wish to consider.<br />

Firstly, whilst eye contact is often linked to patient<br />

satisfaction <strong>this</strong> is not the only role it plays in the<br />

consultation. Eye contact and gaze are crucial interactional<br />

resources that can aid the flow of communication. The<br />

withdrawal of eye contact by the optometrist can lead to<br />

disruptions, and patients may perform actions that pursue<br />

the return of the optometrist’s gaze or delay reporting certain<br />

information until eye contact becomes possible. It is therefore<br />

useful for optometrists to reflect on how far they maintain or<br />

withdraw eye contact during their consultations.<br />

Of course many practitioners will point out that<br />

maintaining eye contact would be ideal but that time<br />

limitations sometimes make it to necessary to withdraw<br />

gaze in order to make notes or prepare equipment etc<br />

whilst conversation is taking place. Given these practical<br />

constraints it is also useful to reflect on which moments in<br />

the consultation particularly benefit from the maintenance of<br />

gaze. We have shown that eye contact is important when the<br />

patient is delivering key information about his/her symptoms<br />

so it is worthwhile avoiding other activities at <strong>this</strong> point, or<br />

at least to combine them with frequent looks towards the<br />

patient. For similar reasons maintaining eye contact is also<br />

important when the optometrist is delivering key information<br />

in the form of a diagnosis and management advice. A further<br />

point to consider is that whilst withdrawing gaze to carry out<br />

other activities appears to save time, it may well result in the<br />

kind of delays seen in examples 1 and 3 and in fact slow the<br />

consultation down rather than speed it up.<br />

Finally, the layout of the consultation room can help or<br />

hinder the maintenance of eye contact. Looking again at<br />

example 1 we can see that when the optometrist faces her<br />

desk she has no opportunity for eye contact and would<br />

need to change her body position to a large extent to see<br />

the patient’s face. This in fact happens during example 3,<br />

in which the optometrist first looks over his shoulder at<br />

the patient and then moves his chair round to face her. By<br />

contrast, in example 2 the positioning of the optometrist’s<br />

desk and patient’s chair next to each other means that the<br />

optometrist can transfer gaze between the patient and the<br />

computer via a much smaller movement. So the physical<br />

layout of the room can have significant consequences for<br />

communication in the consultation.<br />

The connections between verbal and non-verbal elements of<br />

interaction are integral to communication in the consultation.<br />

Any consideration of ‘communication skills’ needs to include<br />

attention to eye contact, gaze and body movement. This article<br />

has illustrated some key points for such consideration.


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20<br />

03/06/11 INDUSTRY NEWS<br />

The Charmant Group, the global specialist in<br />

high-value titanium eyewear, has launched<br />

a new collection for men, “ad lib” which<br />

combines fashion and comfort.<br />

Inspired by the word and attitude derived<br />

from the Latin, “ad libitum”, which means<br />

“be free” or “as you like”, young fashionconscious<br />

spectacle wearers can choose and<br />

wear the “ad lib” frame in a more casual and<br />

individualistic manner, suiting their lifestyle<br />

and circumstances.<br />

With a touch of the latest trends for young<br />

men, the new models are inspired by cars<br />

and home interiors. Edges and slits have been<br />

used in the frame structure with a threedimensional<br />

approach.<br />

Colours for “ad lib” men are vibrant and<br />

individualistic. The dual colouring on the metal<br />

or layered acetate, utilised using a carving<br />

technique, provides a contrast of colours.<br />

Frame AB3108U (pictured top) is an urban<br />

inspired half rim style. The wearer’s personality<br />

is reflected by the frame’s modern structure<br />

of a milled titanium front, individualistic<br />

temples with the three rhythmic bevel slits and<br />

masculine dual colours. It is offered in black/<br />

orange and black/green as well as brown, dark<br />

grey and white.<br />

The “ad lib” icon has been put on the end<br />

tips. The unique hinge function ensures a<br />

wearing comfort for <strong>this</strong> particular style,<br />

despite the temple form.<br />

Frame AB3112U (pictured middle) is a<br />

modern remixing of vintage acetate frames<br />

with the carving on the layered acetate and the<br />

selection of colours giving it a fresh look. It is<br />

offered in brown, green, orange and yellow.<br />

Frame AB3110U (pictured above) has a<br />

touch of oversized styling. It is offered in black,<br />

brown, dark and light grey as well as silver.<br />

020 8992 9911<br />

Pack for travel<br />

BAUSCH & LOMB’S Biotrue Flight Pack is now<br />

available in the UK and Ireland, offering contact<br />

lens wearers the benefits of the multi-purpose<br />

solution in a convenient size in time for the main<br />

summer holidays.<br />

Each flight pack contains two 60ml bottles of<br />

Biotrue, a clear plastic zip bag, two lens cases and<br />

care instructions, making it easier for contact lens<br />

wearers to keep their lenses clean and healthy<br />

when travelling for work or pleasure.<br />

The solution is bio-inspired to work like the<br />

eyes to help contact lenses stay moist for up to 20<br />

hours.<br />

“The flight pack offers eye care practitioners<br />

the opportunity to increase their sales by providing their customers with on-the-go lens care at<br />

the busiest time of year for travel products,” said Nichola Menzel, professional relations manager,<br />

Bausch & Lomb Northern Europe Vision Care.<br />

“Bausch & Lomb recognises that when people are travelling they want to minimise the size and<br />

number of bottles and liquids they are carrying, especially when flying.”<br />

Biotrue was developed following intensive studies on how the eye naturally works. It is<br />

formulated to work like the eyes with three bio-inspired innovations. It matches the PH of healthy<br />

tears, utilises a lubricant found in eyes and keeps certain beneficial tear proteins active. The<br />

solution also exceeds the FDA/ISO stand-alone procedure for disinfecting products.<br />

0845 602 2350

Making<br />

waves<br />

SILHOUETTE, THE world’s leading rimless<br />

brand, has joined the fashion trend for<br />

a return to colour with its new ‘Colour<br />

Waves’ eyewear collection, featuring zesty<br />

colours and graphics.<br />

The collection is up to 80% handmade<br />

in Austria and comprises six frameless<br />

models which extenuate the wearer’s<br />

features, complemented by the arms<br />

available in the colours, Sweet Honey,<br />

Fresh Green, Power Red and Cool Blue.<br />

For the more reserved are the colour<br />

combinations of Trendy Grey and Young<br />

Pink, which emphasise the graphics and<br />

wave optics of the arms but look different,<br />

depending on the perspective.<br />

“Particularly when the light shines<br />

from a certain angle on the ultra light<br />

SPX temple arms and illuminates the<br />

strong colours, Colour Waves comes alive<br />

transforming from eyewear into a fashion<br />

statement,” said Silhouette brand director<br />

Andreas Aschauer Martinelli.<br />

020 8987 8899<br />

New market<br />

unmasked<br />


the UK’s<br />

largest online<br />

contact lenses<br />

retailer, has<br />

expanded into<br />

the Italian<br />

market with<br />

the launch of<br />

GetLenses.it.<br />

The move is in response to rapidly<br />

growing demand in Italy and builds on<br />

the company’s success in the UK and<br />

Ireland, where the business is growing at<br />

around 20% per year. The London and<br />

York-based company has sales of £6m<br />

a year and 100,000 customers. Around<br />

75-80% of sales come from repeat<br />

customers.<br />

“A less crowded marketplace, with<br />

fewer competitors, made sense for our<br />

first foray into mainland Europe,” MD<br />

Michael Kraftman told OT.<br />

Eyes on<br />

exports<br />

JAI KUDO designer eyewear company<br />

has been recognised as one of Britain’s<br />

best performing exporters, with an annual<br />

international growth in sales of 62.51%.<br />

In <strong>this</strong> year’s International Track 100<br />

published in The Sunday Times, Jai Kudo/<br />

Pure Technology ranked at number 71.<br />

The league table ranks Britain’s private<br />

companies with the fastest-growing<br />

international sales over the last two years.<br />

“We are delighted to feature in the<br />

list,” said Jai Kudo’s executive managing director, Jamie Holoran. “Given the ever increasing<br />

competitiveness of the UK optical market, we have opted in recent years to concentrate on<br />

developing market share further afield. I’m pleased to say that the reaction to our products<br />

has been extremely encouraging.”<br />

Jai Kudo is based in Hertfordshire and represented in more than 30 countries, with sales<br />

from North America and Europe contributing to around half of last year’s turnover. Large<br />

deals with overseas clients in America have further boosted international sales from £1.9m in<br />

2007 to £4.9m in 2009.<br />

“Although, like everybody, we are hopeful of an improving economy domestically, I would<br />

envisage us continuing to drive sales forward in the European territories where we have<br />

made the greatest gain,” said Mr Holoran.<br />

020 8732 9600<br />

As-Worn Technology<br />

SHAMIR UK <strong>this</strong> week launched the upgrade of Smart Single Vision, with As-Worn<br />

Technology. It is aimed at providing single vision patients with the personal fit they need “to<br />

experience crisp, clear uncompromised vision”.<br />

The technology is an innovation in the personalisation process, which fine-tunes a<br />

patient’s prescription by calculating three distinct measurements – back vertex distance (the<br />

distance between the lens and the eye), pantoscopic tilt (the angle at which the frame sits on<br />

the patient’s face) and panoramic angle (the angle of the frame itself).<br />

Submitting the three measurements, along with the patient’s Rx, allows Shamir’s Presciptor<br />

software to adjust the prescribed Rx to “better suit the patient as they wear the frame on<br />

their face”.<br />

The upgrade also offers an advantage to patients due to its aspheric/atoric rear surface<br />

which means the lens can be lighter, due to decreased centre thickness, and for high plus<br />

patients, an aspheric/atoric lens means better clarity because of minimised off-centre errors.<br />

The design is produced consistently in all materials, which means single vision patients can<br />

have multiple pairs of Smart Single Vision<br />

As Worn in various materials, switching<br />

from pair to pair without adjustment time.<br />

“We offer the most superior progressive<br />

lens solutions on the market and we<br />

wanted to extend <strong>this</strong> commitment to<br />

superiority to the single vision market as<br />

well,” said Shamir UK general manager,<br />

Phil Bareham.<br />

01954 785100<br />

21<br />



Mary to the retail rescue<br />

for diverse town centres<br />

22<br />

03/06/11 SPECTATOR<br />

THE PRIME Minister has announced that Mary Portas<br />

(pictured) has been appointed to lead a “no nonsense”<br />

review into the future of the High Street to “help us to<br />

create vibrant and diverse town centres.” A couple of the<br />

items in the shopping list contained in the objectives of<br />

the review are for her to advise on how to: ‘prevent the<br />

proliferation of “clone towns”’, and, ‘to increase the number<br />

of small and independent retailers’. One could speculate<br />

whether, with the relatively fresh memory of riots in Bristol<br />

against the presence of the leading supermarket brand, <strong>this</strong><br />

latest initiative is politically motivated.<br />

However, the aim is clearly laudable as variety, choice<br />

and the regular refreshing of our town and city centres<br />

benefits us all. But before we all become dewy-eyed with<br />

nostalgia, we must be realistic – support for variety does<br />

not mean defending mediocrity. Tired and weak businesses,<br />

no matter how quaint or once loved, will go – they simply<br />

have no future on the modern High Street. Equally certain<br />

is that strong innovative businesses, including optometrists<br />

and opticians, will survive. But as in Bristol, where the<br />

Cheltenham Road Tesco Express store re-opened last week<br />

(May 24) there should be no doubt that the supermarkets<br />

will continue to grow and over time will come to dominate<br />

all the markets in which they are active – including optics.<br />

Towards the end of last year, the Department of Health<br />

was indicating that by April 2014, GPs would have to<br />

have reduced unscheduled admissions to hospital (by<br />

patients with long term conditions) by 20%. But GPs aren’t<br />

being allowed to take their time working towards <strong>this</strong> target,<br />

with an article in last week’s Pulse magazine revealing<br />

that PCTs and healthboards have set their own target of an<br />

average of a 15% reduction by the end of <strong>this</strong> financial year<br />

alone.<br />

That’s not all – average reductions of over 30% in A&E<br />

attendance are also being targeted. Against <strong>this</strong> background,<br />

Stephen Dorrell, chairman of the Commons health select<br />

committee, has spoken out with his view that the solution<br />

to achieving the unprecedented levels of savings required,<br />

lies not in simply more competition, but in proper<br />

integration. GP magazine reported his comments to an<br />

audience at the King’s Fund last week, where he argued<br />

that better service integration across the health sector<br />

rather than simply delivering services in ‘silos’ was the<br />

answer: “If we are going to rise to the challenge we face,<br />

we now have the urgent, drop-dead requirement to deliver<br />

a degree of integration that we have talked about but never<br />

succeeded in delivering.” Which is why, as the primary care<br />

practitioner group for community eye care, our profession<br />

must form part of <strong>this</strong> solution.<br />

Review to advise on how to<br />

‘increase the number of small<br />

and independent retailers’<br />

According to a report published in last week’s Barrister<br />

Magazine, medical negligence claims against GPs increased<br />

by 20% in 2010 when compared to the previous year.<br />

Although delayed or incorrect diagnosis formed the basis of<br />

the majority of the claims, the second most common category<br />

was ‘failure to refer.’ While there is no suggestion that<br />

pressure to reduce referral rates has had an influence (rather<br />

it is suggested that the increasing availability of ‘no win no<br />

fee’ arrangements may play a part), there is no doubt that <strong>this</strong><br />

has potential to create a friction between the need to control<br />

budgets and the need to ensure that all those who require<br />

onward referral are so directed. With the prevalence of ocular<br />

problems on the average GP patient appointment list, there<br />

is much that primary care optometry can do to support their<br />

local GPs with both sides of <strong>this</strong> difficult equation.<br />

For more comment visit www.optometry.co.uk

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A clear vision for every child<br />

24<br />

03/06/11 CAMPAIGN<br />

IN SEPTEMBER, almost 500,000<br />

five-year-olds will start school.<br />

Their ability to learn will<br />

certainly be affected by their<br />

ability to see, and for many,<br />

no-one will know how well they<br />

can see. Just 53% of children in<br />

the UK have had any form of eye<br />

examination and in September,<br />

it is estimated that one million<br />

children will return to school<br />

with an undiagnosed vision<br />

problem.<br />

The UK is way behind the<br />

rest of Europe in the number of children who have regular<br />

eye examinations and the proportion of children who wear<br />

vision correction. In France, it is part of the summer back to<br />

school routine to book children in for an eye exam. In the US<br />

state of Kentucky, it is the law that every child must have a<br />

comprehensive eye examination before they are allowed to<br />

start school.<br />

The UK Government has recommended that all four-yearolds<br />

should have orthoptist-led vision screening. However,<br />

with less than 1,000 orthoptists in the UK, it is an impossible<br />

task. Add to the lack of man-power the fact that it’s entirely at<br />

the discretion of individual PCTs whether they commission<br />

any form of vision screening or not, and it’s easy to see why<br />

vision screening does not work effectively.<br />

However, most parents still assume that their child will<br />

have their vision checked at school, regardless of whether <strong>this</strong><br />

actually happens or not. Vision screening, when it is done, is<br />

designed to pick up amblyopia. It probably won’t pick up low<br />

to moderate refractive error or binocular vision anomalies and<br />

certainly does not assess the health of the eyes.<br />

Optometrists in community practice are qualified to<br />

examine the eyes of all children, paid for by the NHS. Isn’t<br />

it time that our profession started to blow its own trumpet<br />

and let parents know that we are here to provide that very<br />

important service? Children’s eyes change over time and so<br />

it is important to examine children’s eyes regularly over the<br />

years, as they grow. This, in<br />

turn, can be a great practice<br />

builder. One child’s vision<br />

problems solved by you can<br />

lead to an entire family of new,<br />

loyal patients for your practice.<br />

Back to School<br />

The Children’s Eyecare<br />

Initiative aims to improve<br />

awareness of the need for eye<br />

examinations for all children<br />

among parents, teachers and<br />

healthcare workers in schools.<br />

The 2011 campaign has a ‘Back to School’ theme, including<br />

a new poster which we would like to see displayed, not only<br />

in schools, but also in High Streets up and down the country.<br />

The AOP will be sending out a resource pack <strong>this</strong> month,<br />

including the campaign poster to download, a template press<br />

release and tips for generating local media coverage. The<br />

association will be also sending out the poster, along with<br />

other downloadable resources, to primary schools throughout<br />

the UK via school nurse managers.<br />

Get talking<br />

The AOP will be compiling a list of all interested<br />

optometrists and dispensing opticians who would be<br />

prepared to visit schools to give talks in assemblies,<br />

to children in class, or to members of staff or parents.<br />

Commenting on school talks, Polly Dulley, chair of the<br />

Children’s Eyecare Initiative, said: “I’ve been doing <strong>this</strong><br />

myself for many years and can testify just how good <strong>this</strong> is<br />

for your profile in the community. It never ceases to amaze<br />

me how receptive both children and staff can be when I visit<br />

the school with a member of my team to talk about eyes.<br />

We’ve had a stall at Health Week in one school, had a ‘drop<br />

in for a chat’ session at an evening for new parents, as well as<br />

giving talks to individual classes to help them with their Key<br />

Stage 1 and 2 curriculum.”<br />

The Children’s Eyecare Initiative aims to support<br />

colleagues to get up to speed in seeing children. A range<br />

of resources have been produced, from a top tips guide, to<br />

myth-busting in children’s eye care and practice leaflets for<br />

parents. In addition, many of the larger CET providers are<br />

currently offering courses as well as distance learning on<br />

children’s eye care.<br />

An information pack will be sent out <strong>this</strong> month with<br />

everything you need to get involved with <strong>this</strong> year’s ‘Back<br />

to School’ campaign. If you would like to volunteer to visit<br />

schools in your area, and to be included on the national<br />

register, please send your details (including your practice<br />

address) to childrenseyecare@aop.org.uk<br />

For more information, visit the website: www.aop.org.uk/<br />

childrenseyehealth or email childrenseyecare@aop.org.uk

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upper face surgery<br />

Request an Information Pack at:<br />

0800 0148 321<br />

info@upliftnetwork.com<br />

www.upliftnetwork.com<br />

1. Mintel Oxygen, June 2010. 2 and 3. Key Note Cosmetic Surgery Market Report 2010

ADVICE<br />

Update on<br />

compliance<br />

Trevor Warburton reports on the latest<br />

developments regarding PCC<br />

IT IS now two years<br />

since the pro-forma was<br />

introduced with a list of<br />

relevant inspection points<br />

and questions to assist PCTs<br />

and optometric advisors<br />

on contract compliance<br />

inspections and so Primary<br />

Care Commissioning<br />

has been revising it, in<br />

consultation with the<br />

National Optometric<br />

Advisors’ Association and<br />

the Optical Confederation.<br />

In some cases, the changes<br />

reflect variations in the<br />

contract, such as the requirement to offer a choice of<br />

practitioner where possible, whilst others relate to changes in<br />

guidance, such as the College Guidelines on Infection Control.<br />

On record keeping, final visual acuity has been separated<br />

from unaided VA, or VA in current spectacles. C:D ratio is<br />

mentioned in ophthalmoscopy, along with a question to<br />

note whether any further comments have been made under<br />

the heading of ophthalmoscopy. There is a specific note that<br />

electronic records should be backed up regularly and the<br />

backup kept separately and securely, though <strong>this</strong> has been<br />

advice within Quality in <strong>Optometry</strong> (QiO) from the start.<br />

Contract compliance is about ensuring a basic and safe<br />

standard of practice that complies with the contract and the<br />

law. It isn’t about requiring best practice, or even typical<br />

practice, but ensuring patient safety. The practitioner may<br />

endanger themselves if their record keeping is poor, but the<br />

contractual concern is whether it endangers the patient.<br />

Improving standards beyond <strong>this</strong> is a matter of education and<br />

peer practice, not contract inspections.<br />

Other new items include a check on whether it is possible<br />

for the optometrist to make a confidential telephone call to,<br />

or regarding, a patient, for instance to refer urgently, and<br />

whether computer terminals in public places are safe and<br />

secure – access restricted when no member of staff is present<br />

and the screen not observable by passing patients.<br />

For any practice which is already fully compliant with<br />

Level 1 of QiO, these changes will be minor. Nevertheless,<br />

work to update QiO and its accompanying audit tools to<br />

match the new pro-forma has already commenced. Any<br />

questions relating to contract compliance should be directed<br />

to Richard Carswell at the AOP.<br />

• Full article can be read on www.optometry.co.uk<br />

27<br />

03/06/11 ADVICE

EVENTS<br />

‘Thrilling and valuable’<br />

Optometrist Vicky O’Connor describes the OT Live CET offering at Optrafair<br />

28<br />

03/06/11 OT LIVE 2011<br />

THIS YEAR’S Optrafair<br />

highlight for many clinicians<br />

was the OT Live CET<br />

programme. The format of an<br />

open-air main lecture arena<br />

provided a fantastic setting<br />

for some thrilling lectures,<br />

allowing all participants to<br />

soak up the atmosphere of<br />

the surrounding exhibition<br />

while gaining some valuable<br />

education. The variety of age<br />

and specialities amongst the<br />

delegates in the audience at any<br />

one moment highlighted the<br />

wide range of people the setting enabled speakers to reach.<br />

Saturday’s lectures in the main arena included an<br />

emotive talk by ophthalmologist Brendan Moriarty, and<br />

optometrist and independent prescriber Peter Frampton on<br />

the importance of the provision of eye care in both the UK<br />

and developing countries. They compelled us to get on board<br />

with such projects, even within our own local communities.<br />

Optometrists Dan Rosser and Dr John Wild opened<br />

our eyes to the latest updates on glaucoma diagnosis and<br />

management. Meanwhile, in the satellite arena, optometrist<br />

Peter Charlesworth (pictured) advised on the most important<br />

aspects of children’s eye care for community practitioners,<br />

including the somewhat trickier aspects of paediatric<br />

dispensing.<br />

Karen Sparrow, educational adviser to the AOP, shared<br />

a few tricks of the trade with employed optometrists,<br />

mentoring on how best to communicate with our employers,<br />

colleagues and even our patients, key skills to a good working<br />

environment.<br />

Sunday offered a packed schedule, with an emphasis<br />

on the new toy in town, OCT. Simon Browning and David<br />

Samuel shed some light on the fear that can be the peripheral<br />

retina, its imaging and the value of the latest version of the<br />

Optomap when doing<br />

so. Mike Potts and Craig<br />

McArthur tackled the<br />

hot topic of macular<br />

pigment and the use of<br />

dietary supplements in<br />

daily practice. Andrew<br />

Blaikie and Cliff Williams<br />

rounded up the session<br />

with a perfect example<br />

of how the use of OCT<br />

in everyday practice<br />

can not only offer a<br />

more comprehensive<br />

eye examination,<br />

but is a key factor<br />

in the consolidation<br />

of accurate clinical<br />

decision-making<br />

with sound business<br />

development.<br />

Ophthalmologists<br />

Paulo Stanga and<br />

Praveen Patel and<br />

optometrists Nick<br />

Rumney and Brian<br />

Tompkins (never one<br />

to disappoint) captured<br />

the audience with an enthusiastic, hugely engaging and<br />

practical approach to optimising our HES referrals, optimal<br />

patient selection when playing with our new toys and<br />

considering the greater use and value of these in our daily<br />

practice. It was a truly engaging session and hugely popular<br />

among the attendees.<br />

“Many made the journey<br />

especially for <strong>this</strong> session”<br />

On Monday the main arena opened its doors to preregistration<br />

optometrists. Optometrists Professor Steve<br />

Parrish and Dr Anna Kwartz from Innovative Optical<br />

Training dispelled the myths surrounding the OSCE exams,<br />

combined with a round-up of the most important aspects of<br />

ocular pathology. This feature has become a favourite among<br />

pre-registration students with many making the journey<br />

especially for <strong>this</strong> session. However, it wasn’t just student<br />

optometrists who were catered for. The satellite arena was<br />

a hub of activity as the Worshipful Company of Spectacle<br />

Makers’ Education Trust provided a revision course for the<br />

level four optical technician’s qualification.<br />

For those of us who spend the majority of our day sitting in<br />

a darkened testing room, the OT Live poster quiz provided a<br />

great opportunity to gain some well needed exercise as well<br />

as some extra CET points.<br />

OT Live provided a full and comprehensive programme of<br />

CET that was both inspiring and reflective of our professional<br />

abilities. The take home message was undoubtedly one of<br />

encouragement, pride and confidence in the services that<br />

we as a profession can provide for the public, the potential<br />

for growth and development despite the current climate and<br />

excitement for the possibilities that lie before us. This is one<br />

optometrist who is already on countdown for what the next<br />

OT Live offering will bring.<br />

For more events see www.optometry.co.uk



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to their vision. 1 Bausch + Lomb PureVision ® 2 contact lenses with High Definition Optics offer a solution. The High<br />

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range – offering crisp, clear vision, especially in low light conditions. And because they are amongst the thinnest on the<br />

market today 2 , PureVision ® 2 HD contact lenses allow exceptional breathability and comfort, keeping your patients’ eyes<br />

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1. Results from a global survey across 7 countries, 3,800 vision-corrected consumers aged 15-65. Consumers provided incidence of symptoms (dryness, sensitivity, etc), how impactful,<br />

when experienced, and benefits of product features most likely to motivate consumers when it comes to eye health/vision correction products. 2. Data on file. Bausch & Lomb Incorporated.<br />

© 2011 Bausch & Lomb Incorporated. ®/ denote trademarks of Bausch & Lomb Incorporated. Other product names/brand names are trademarks of their respective owners.


Hot styles for<br />

the summer<br />

30<br />

03/06/11 SUNGLASSES<br />

International<br />

Eyewear<br />

This year’s signature ladies piece from<br />

International Eyewear in its Ocean Blue<br />

collection is the style 9086 (pictured).<br />

While still retaining the trendy<br />

oversized eye shape, it has been<br />

designed not to be too large to avoid<br />

dominating the face and also to be<br />

‘dispenser friendly’ due to its suitability<br />

for prescription lenses.<br />

0121 585 6529<br />

From big and bold to rimless and retro, the latest sunglasses<br />

can add to any look your patients want to go for <strong>this</strong><br />

summer. OT looks at some of the new designs on offer.<br />

Rodenstock<br />

Rodenstock has increased the number of designs in its<br />

Wimbledon collection for 2011. Using the success of the classic<br />

English summer tournament as a marketing platform, the new<br />

designs are backed and modelled by former champion Boris<br />

Becker (pictured wearing model 9938).<br />

The whole collection is available with a choice of plastic<br />

plano, single vision, bifocal, and varifocal lens options.<br />

01474 325 555<br />

<br />

Brulimar<br />

Bringing some rock and roll to summer 2011<br />

is the new collection from the ‘godfather of<br />

tattoos’ Ed Hardy, distributed by Brulimar.<br />

The brand will be well known to younger<br />

patients through its clothing range, which<br />

has featured on popular TV shows Jersey<br />

Shore and The Real Orange County.<br />

The high-end range is available in male and<br />

female designs. Pictured is the EHS044 Live to<br />

Ride frame.<br />

0845 130 1415<br />

Dunelm<br />

Retro is the buzz-word for many<br />

fashionistas again <strong>this</strong> year.<br />

With <strong>this</strong> in mind, Dunelm’s latest<br />

sunglass looks back to the trends<br />

of yesteryear with the Lennon<br />

inspired Retro Sun 65, available in<br />

classic tortoiseshell. The rounded<br />

lens shape is marketed as being<br />

‘the favoured shape of the year<br />

for the in-crowd’.<br />

01388 420 420

Caseco<br />

Aimed at the brand-aware customer the Levi’s<br />

Eyewear’s new sunglass collection, distributed by<br />

Caseco, plays on the recognisable features of the<br />

fashion label.<br />

Technical details incorporated in the designs<br />

include rivets and denim-inspired finishes, as<br />

well as the Levi brand name and logo. Pictured is<br />

the LS5039, which is available in four colours.<br />

01580 890 111<br />

Luxottica<br />

Released <strong>this</strong> month, Ray-Ban –<br />

distributed by Luxottica – presents<br />

a new take on its classic aviator and<br />

caravan styles with Light Ray RB 3460<br />

and RB 3461 (pictured). Both designs can<br />

be sold with a kit of three interchangeable<br />

lenses so wearers can change their ‘look’<br />

each day to suit their mood or outfit.<br />

0845 034 8843<br />

Maui Jim<br />

New for the summer, the Lani from Maui<br />

Jim is a feminine, mid-size square frame<br />

which merges Maui Jim’s exclusive lens<br />

technology with a stylish, beach-side look<br />

The design is available in several colour<br />

combinations including Tokyo Tortoise<br />

and black (pictured).<br />

0800 980 1770<br />

31<br />

03/06/11 SUNGLASSES<br />

Silhouette<br />

The sunglass designs of the Silhouette’s Crystal<br />

Collection (modelled by Helena Christiansen) feature<br />

tints for a ‘cosmopolitan look’. As well as being<br />

fashionable, they are designed to provide ‘clear vision<br />

and glare-free sight in every situation to facilitate<br />

the highest level of relaxation and intelligent sun<br />

protection for the eyes.’<br />

020 8987 8899<br />

Inspecs<br />

The Layback design (pictured) is part of the Animal Sun 2011 range,<br />

distributed by Inspecs, which has a heavy retro influence with 70s<br />

eyeshapes, double-bridge aviators and ‘preppy-geek’ acetate.<br />

Surf-flavours also feature in the wide-ranging collection for 2011 with<br />

hot pink, aqua and fresh lime coloured frames all available.<br />

01225 717 000


32<br />

03/06/11 CROSSWORD<br />

June crossword<br />

This <strong>issue</strong> we continue our monthly crossword<br />

series. So why not enter our competition<br />

before the closure date, July 1. The winner will<br />

receive £50 in Marks & Spencer vouchers.<br />

ACROSS<br />

1. Take a ‘Cooks Tour’! (3.3.6)<br />

7. Girl’s name (5)<br />

8. Neutralising agent (7)<br />

11. Transfers to a large computer<br />

system (7)<br />

12. Staff manning an aircraft (3-4)<br />

13. ----- Previn, musician and<br />

conductor (5)<br />

14. Upset over the barrow-boys<br />

turnover! (9)<br />

16. Away from the main stream<br />

(9)<br />

19. Surplus to requirements (5)<br />

21. Melancholy verse (7)<br />

23. Chris -------, former athlete and<br />

sports journalist (7)<br />

24. Condiment (7)<br />

25. Racket (5)<br />

26. Good looking, colloquially<br />

(4,2,3,3)<br />

DOWN<br />

1. Prepared a horse for riding (7)<br />

2. Give out (7)<br />

3. Given unfair advantage in the<br />

race (4-5)<br />

4. Organisation for Soldiers, Sailors<br />

and Air Force members (5) (init.)<br />

5. James ------- (well known for his<br />

work with Pink Floyd) (7)<br />

6. Interval for a ‘commercial’ (7,5)<br />

9. ----- Bruni, former model and<br />

First Lady of France (5)<br />

10. Money wasted, colloquially<br />

(4,3,5)<br />

15. Country seat for a Judge! (4,5)<br />

17. Cockeyed way to teach a<br />

twister! (5) (anag.)<br />

18. Heavy (7)<br />

19. Where the ‘bucket and spade’<br />

brigade prefer to be beside! (7)<br />

20. One who exhibits physical<br />

prowess (7)<br />

22. Castrated chicken (5)<br />

Name:<br />

Address:<br />

Send entries to OT, June Crossword, 61 Southwark Street, London<br />

SE1 0HL to arrive by July 1, 2011. You can now enter the crossword<br />

competition online at www.optometry.co.uk.

Do your astigmatic patients<br />

experience fluctuating vision?<br />

Toric contact lens wearers rub their eyes on average 6 times a day with<br />

89% subsequently experiencing visual disruptions. 1<br />

Over 90% of astigmatic patients would be interested in a solution to the<br />

problem of blurred or hazy vision. 2<br />

Bausch + Lomb’s Toric contact lenses feature the unique Quick Alignment<br />

System which is designed to ensure faster rotational recovery to help<br />

your patients maintain consistently clear vision throughout their day. 3<br />

To find out more, contact your Bausch + Lomb Territory Manager<br />

or call customer services on:<br />

UK: 0845 602 2350 Republic of Ireland: 1800 409 077.<br />

1. Rub Your Eyes Consumer Research Report, Decision Analyst. March 2010. Participants totalled 502 soft contact lens wearers of which 250 were toric wearers. 2. Symptom, Incidence and Needs Survey, Market Probe. December 2009. Participants<br />

totalled 1,642 claimed astigmats. 3. Cairns, G et al. Diff erences in Toric lens performance: Lens Orientation and Orientation Recovery. Presented at American Academy of <strong>Optometry</strong>, Orlando. November 2009. Two clinical studies were conducted to<br />

evaluate the rotational recovery abilities of two toric lens designs: Quick Alignment System (Bausch & Lomb, Rochester, NY) and Accelerated Stabilization design (AS) (Vistakon, Jacksonville, FL). In Study 1, the Quick Alignment System of PureVision®<br />

Toric (PVT) (Bausch & Lomb) was compared with the AS design of Acuvue Advance for Astigmatism (AAA). In Study 2, the Quick Alignment System of PVT (Bausch & Lomb) was compared with the AS design of Acuvue Oasys for Astigmatism (AOA).<br />

Image represents the eff ect of a 2.25D cylinder mis-rotated by 45° on an eye with 2.25D of astigmatism.<br />

© 2011 Bausch & Lomb Incorporated. ®/ denote trademarks of Bausch & Lomb Incorporated. Other product names/brand names are trademarks of their respective owners.

VRICS<br />




Sponsored by<br />

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

and answering the Multiple Choice Questions (MCQs) using the associated images. Please note that there is only<br />

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

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

Presbyopia & Ageing Eyes<br />

COURSE CODE: C-16279 O/D/CL<br />

Dr Navneet Gupta BSc (Hons) PhD MCOptom FBCLA<br />

Acknowledgements<br />

The author would like to thank the International Association of Contact Lens Educators, Dr Chris<br />

Purslow (Cardiff University), Mohammed Muhtaseb (Singleton Hospital, Swansea) and Louise<br />

O’Toole (Mater Private Hospital, Dublin) for providing images for <strong>this</strong> VRICS.<br />

34<br />

1. Which of the following statements about the measurement shown in Image<br />

A is FALSE?<br />

a) It can be better visualised by instillation of sodium fluorescein and illuminating with a cobalt<br />

blue filter<br />

b) A value of 0.1mm at the temporal aspect and 0.35mm at the centre is considered normal<br />

c) The regularity of the measurement can be affected by blepharitis<br />

d) It can be affected by environmental factors such as air conditioning and humidity<br />

03/06/11 VRICS<br />

A<br />

2. Considering the measurement shown in Image A alone, which of the<br />

following statements is LEAST appropriate when fitting contact lenses for a<br />

60-year-old patient?<br />

a) “Comfort enhancing” contact lenses ought to be selected if the measurement is low<br />

b) Rigid gas permeable contact lenses are the lens of choice if the measurement is low<br />

c) Contact lens re-wetting drops can be prescribed if the patient is symptomatic<br />

d) The patient should be advised to minimise their wearing time if they are symptomatic<br />

3. A 58-year-old patient with the condition shown in Image B is interested in<br />

wearing contact lenses. Which of the following considerations is TRUE?<br />

a) This condition will disrupt the tear film making them unsuitable for contact lens wear<br />

b) This condition will disrupt their vision making them unsuitable for contact lens wear<br />

c) This condition indicates a soft contact lens with a thin edge should be selected<br />

d) This condition precludes the fitting of alternating design bifocal contact lenses<br />

B<br />

C<br />

4. For the patient in Question 3 and with the condition shown in Image B,<br />

which of the following statements is FALSE?<br />

a) A soft contact lens with ultraviolet (UV) filter should be fitted<br />

b) A soft photochromic contact lens should be fitted<br />

c) The use of wrap-around sunglasses should be recommended<br />

d) The use of ocular lubricants should be recommended if needed<br />

5. A 54-year-old patient has the spectacle refraction shown in Image C.<br />

Which of the following contact lens options would be the MOST<br />

appropriate to select initially?<br />

a) PureVision Multifocal, High Add for both eyes<br />

b) Air Optix Multifocal, High Add for the right eye, Medium Add for the left eye<br />

c) Proclear Multifocal, Add of +1.50DS, D lens in the right eye, N lens in the left eye<br />

d) Acuvue Oasys Multifocal, with an Add of +1.25DS for both eyes<br />

6. If the patient in Question 5 and with the spectacle refraction shown in Image<br />

C decides to opt for monovision correction, which of the following would be the<br />

MOST appropriate lens powers to select initially?<br />

a) +2.25DS for the right eye, +1.25DS for the left eye<br />

b) +2.25DS for the right eye, +2.75DS for the left eye<br />

c) +3.75DS for the right eye, +1.25DS for the left eye<br />

d) +3.75DS for the right eye, +2.75DS for the left eye

Sponsored by<br />

CONFUSED ABOUT CET REQUIREMENTS? www.cetoptics.com/cetusers/faqs/<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<br />

record” into their “Final CET points record”. Full instructions on how to do <strong>this</strong> are available on their website.<br />

The closing date for <strong>this</strong> examination is July 29 2011. CET points for <strong>this</strong> exam will be uploaded to Vantage on August 1 2011.<br />


<br />

Approved for Optometrists Approved for DOs Approved for CLPs<br />

<br />

<br />

About the author<br />

Dr Navneet Gupta is an optometrist with special interest in presbyopia, an<br />

Assessor for the College of Optometrists Scheme for Registration and is the<br />

Clinical Editor for <strong>Optometry</strong> <strong>Today</strong>. He completed his PhD investigating<br />

“Functional Near Vision Assessment in Presbyopia” from Aston University.<br />

Associated reading:<br />

1. Gasson & Morris (2010) The Contact Lens Manual<br />

(4th Ed), Butterworth-Heinemann<br />

2. Efron, N (2010) Contact Lens Practice,<br />

Butterworth-Heinemann<br />

3. O’Toole, L (2010) Management & Investigation of Retinal<br />

Conditions, <strong>Optometry</strong> <strong>Today</strong>, May 7 2010<br />

4. Goes, FJ (2009) Multifocal IOLs, McGraw-Hill<br />

7. Which of the following statements about the intraocular lens (IOL)<br />

shown in Image D is TRUE?<br />

a) This IOL uses diffractive zones to create simultaneous vision<br />

b) This IOL uses adopization to create simultaneous vision<br />

c) This IOL uses alternating refractive zones to create simultaneous vision<br />

d) This IOL combines diffractive and refractive zones to create simultaneous vision<br />

35<br />

D<br />

8. When assessing the visual function of a patient implanted bilaterally with the<br />

intraocular lenses (IOL) shown in Image D, which of the following is FALSE?<br />

a) High contrast VA will be reduced by a greater degree than low contrast VA<br />

b) Measurement of binocular VA is more informative than the individual VA of each eye<br />

c) A near spectacle addition can be prescribed for those patients who require it<br />

d) Patient satisfaction with their VA is more important than acheiving a VA of 6/5<br />

9. Which of the following is NOT thought to be a risk factor for the condition<br />

shown in Image E?<br />

a) Hypertension<br />

b) Female gender<br />

c) Obesity<br />

d) African-Caribbean race<br />

03/06/11 VRICS<br />

E<br />

F<br />

10. If a person presents with the condition shown in Image E and has a visual<br />

acuity (VA) of 6/18, which of the following is the MOST appropriate course of<br />

action to take?<br />

a) Routine review in 1 year with advice on ocular nutrition / supplements and UV protection<br />

b) Routine referral to be seen at the hospital eye service within 2 months<br />

c) “Soon” referral to be seen at the hospital eye service within 4 weeks<br />

d) Urgent referral to be seen at the hospital eye service within 1-2 days<br />

11. What is the vertical differential prism that a person with the spectacle<br />

refraction and lenses shown in Image F is likely to experience, at the near vision<br />

point (NVP)?<br />

a) 2.25∆ Base Down RE<br />

b) 2.25∆ Base Up RE<br />

c) 3.75∆ Base Down RE<br />

d) 3.75∆ Base Up RE<br />

12. For the patient in Question 11 and Image F, which of the following would be the<br />

LEAST appropriate method of vision correction?<br />

a) Executive style bifocal lenses<br />

b) Prism controlled bifocal lenses<br />

c) Round segment bifocal lenses with different segment sizes<br />

d) Fresnel lenses


36<br />

03/06/11 DIARY DATES<br />

<br />

Explore new AMD approaches<br />

Next month practitioners have the opportunity to gain a greater<br />

The famous setting of Aintree racecourse plays host to <strong>this</strong> year’s<br />

College understanding of Optometrists of the latest conference, diagnostic, see below therapeutic and preventative<br />

heathcare approaches to treating AMD – all in the historic<br />

surroundings of Cambridge.<br />

AMD for Optometrists 2011, held on July 12, has been awarded<br />

eight CET points and will take place at the picturesque Downing<br />

College at the city’s famous university. Lecture topics include:<br />

‘Diagnosis on AMD and different types’, ‘Epidemiology and the<br />

risk factors of AMD’, ‘Role of nutrition in AMD’, ‘Trials of macular<br />

carotenoids’ and ‘Should optometrists always refer patients to an<br />

ophthalmologists?’ The day will conclude with a question and<br />

answer session with experts.<br />

For more information on the event and to book, visit the website:<br />

www.amdforoptometrists.org<br />

JUNE<br />

6 NES, Macdonald Rusacks Hotel, Pilmour<br />

Links, St Andrews, Fife, Developing<br />

optometric skills (www.nes.replaylearning.<br />

com/clinical-skills)<br />

7 North London AOP, Moorfields Eye<br />

Hospital, London, EC1V, CET meeting<br />

(stevedross10@hotmail.com)<br />

8 FMO, Birmingham NEC, West Midlands,<br />

summer meeting including discussions<br />

on the economic situation and industry<br />

training (sfisher@fmo.co.uk)<br />

13, 14, 15, 16, 17 J&J, The Vision Care<br />

Institute, Pinewood, Wokingham, OSCE<br />

preparation one-day courses (www.<br />

thevisioncareinstitute.co.uk)<br />

14 Hampshire LOC, Chilworth Manor,<br />

Chilworth, Southampton, demonstration<br />

of OCT, AGM and CET lecture (www.<br />

hampshireloc.org.uk)<br />

15 UltraVision, Head Office, Leighton<br />

Buzzard, Bedfordshire, ‘KeraSoft IC<br />

Workshop’ workshop and fitting techniques<br />

(workshop@ultravision.co.uk)<br />

16 RNIB, Queen Elizabeth II Conference<br />

Centre, Westminster, London, SW1P, Vision<br />

UK 2011 featuring Techshare (www.rnib.<br />

org.uk)<br />

20-21 J&J, The Vision Care Institute,<br />

Pinewood, Wokingham, ‘Returning to work<br />

confident and refreshed’ two-day course<br />


21-22 SBK Healthcare Events, Maple House,<br />

Birmingham, 2011 ophthalmology series<br />

(bookings@sbk-healthcare.co.uk)<br />

28 The Scottish Optical Golfing Society,<br />

Glenbervie, Falkirk, second annual outing<br />

(haddington@montgomeryoptometrists.<br />

co.uk)<br />

NEW… 29 East Sussex LOC, Venue TBC,<br />

Halland, Annual contact lens day, RSVP<br />

(jackie.oxley@googlemail.com)<br />

30-1 (July) Innovatove Sclerals Ltd, 73<br />

Railway Street, Hertford, Introduction to<br />

scleral lens practice (www.sclerals.com)<br />

JULY<br />

4 Independents Day, National Motorcycle<br />

Museum, Birmingham (www.<br />

independentsday.co.uk)<br />

12 NES, The Beardmore Hotel, Clydebank,<br />

Glasgow, Developing optometric skills<br />


9 NES, The Marriott Hotel, 500 Argyle<br />

Street, Glasgow, Developing optometric<br />

skills SEE ABOVE<br />

12 Downing College, University<br />

of Cambridge, Cambridge, AMD<br />

for optometrists 2011 (www.<br />

amdforoptometrists.org)<br />

20 UltraVision, Head Office, Leighton<br />

Buzzard, Bedfordshire, ‘KeraSoft IC<br />

Workshop’ workshop and fitting<br />

techniques SEE ABOVE<br />

AUGUST<br />

17 UltraVision, Head Office, Leighton<br />

Buzzard, Bedfordshire, ‘KeraSoft IC<br />

Workshop’ workshop and fitting<br />

techniques SEE ABOVE<br />

22, 23, 24, 25 J&J, The Vision Care<br />

Institute, Pinewood, Wokingham,<br />

OSCE preparation one-day courses<br />



NEW… 1 NES, Ettrick Riverside, Dunsdale<br />

Road, Selkirk, Developing optometric skills<br />


7 The Scottish Optical Golfing Society,<br />

Ladybank, Fife, final annual outing<br />


NEW… 12 NES, Kingsmills Hotel,<br />

Culcabock Road, Inverness, Developing<br />

optometric skills SEE ABOVE<br />

See more events at www.optometry.co.uk/events




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The pre-corneal tear film comprises three layers: the mucin layer,<br />

produced by the conjunctival goblet cells, which binds mucin to<br />

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which provides nutrition and flushes and cleanses the eye; and<br />

the lipid (oily) layer which impedes tear film evaporation. All three<br />

are essential to maintain tear film stability. When contact lenses<br />

are applied to the eye they separate the tear film producing<br />

a pre lens tear film and a post lens tear film. This disruption<br />

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Unlike traditional contact lenses, DAILIES PLUS *<br />

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during blinking, DAILIES PLUS * contact lenses use blinkactivated<br />

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gradually released during the day. DAILIES PLUS*<br />

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Stable Tear Film<br />

Tear film break up<br />

Tear film stability is essential for good visual acuity,<br />

comfort and contact lens-wearing success.<br />


Proven cushioning lubricant hydroxy-propyl methylcellulose<br />

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wetting agent polyethylene glycol (PEG) coats the lens and binds<br />

with polyvinyl alcohol (PVA) supporting its moisture release<br />

throughout the day to provide improved wettability to the end<br />

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Enhanced Timed Release Moisture Technology<br />

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*DAILIES® PLUSTM is the abbreviated name for DAILIES® AquaComfort PlusTM 1. Wolffsohn J., Hunt O., Chowdhury A., Objective clinical performance of ‘comfort-enhanced’ daily disposable<br />

soft contact lenses. Contact Lens & Anterior Eye, 2010. 2. CIBA VISION data on file, 2007. Focus, DAILIES, AquaComfort Plus, PLUS, CIBA VISION, the DAILIES logo and the CIBA VISION logo are<br />

trademarks of Novartis AG. ACUVUE and MOIST are trademarks of Johnson & Johnson Vision Care, Inc. Soflens is a trademark of Bausch & Lomb, Inc. ©2011 CIBA VISION AG, a Novartis AG Company<br />




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optometry<br />

undergraduates<br />

from Glasgow<br />

Caledonian<br />

University<br />

celebrated their<br />

forthcoming<br />

graduation with<br />

an end of year ball late last month.<br />

A total of 88 students and staff gathered at<br />

the Macdonald Forest Hills hotel in Aberfoyle<br />

to mark the end of their degree studies before<br />

they go on to prepare for their pre-reg period.<br />

Organised by student Laura Telford with the<br />

help of some fellow coursemates, the evening<br />

began with a three-course sit down meal<br />

followed by lively Ceilidh dancing.<br />


Graduation celebrations<br />

Whilst the optometry boys embraced their<br />

Scottish roots and donned kilts, the girls<br />

OPTOMETRY AND dispensing<br />

students at Anglia Ruskin<br />

University have raised more<br />

than £700 for Cambridge<br />

charity Camsight and also<br />

Vision Aid Overseas.<br />

The money was raised<br />

through the school’s annual<br />

charity ball which was<br />

organised by Anglia Ruskin<br />

Optics Society and <strong>this</strong> year<br />

had a masquerade theme.<br />

Over 100 undergraduates attended the<br />

event which was held at the Doubletree by<br />

Hilton Hotel in Cambridge. Entertainment<br />

included a harp player, a drumming solo<br />

performance and a magician.<br />

During the evening, organisers also hosted<br />

a raffle, with prizes such as a Nintendo Wii, a<br />

embraced the<br />

opportunity<br />

to dress up<br />

(pictured).<br />

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

lecturer Mhairi<br />

Day, who<br />

attended the<br />

event and has<br />

taught the students over the last four years,<br />

told OT: “It was a fantastic night in a beautiful<br />

location with an intelligent and lovely group<br />

of our fourth year students.<br />

“As a new lecturer a few years ago,<br />

they were the first years that I taught and<br />

I feel extremely proud (and a little old!)<br />

seeing them flourish into aspiring pre-reg<br />

optometrists.”<br />

The students’ graduation ceremony will be<br />

held at Glasgow Concert Hall on June 29.<br />

Having a ball for charities<br />

garra rufa fish pedicure<br />

and massage, and a volk<br />

lens from Keeler up for<br />

grabs.<br />

A spokesperson for the<br />

society said: “We would<br />

like to thank Specsavers<br />

and Boots Opticians<br />

for their extremely<br />

generous donation to<br />

the society and to all<br />

the other companies that helped with raffle<br />

contributions.”<br />

Pictured left to right are Optics Society<br />

members: Karan Sharma (vice president), Hafsa<br />

Okhai (events organiser), Fatema Ebrahimji<br />

(secretary), Pretesh Patel (events organiser),<br />

Priya Katira (treasurer), and Samnika Kalsi<br />

(president).<br />

Sponsored by<br />

Hoya supports<br />

Ethiopian DOs<br />

HOYA LENS UK has provided a group of<br />

dispensing optician students in Ethiopia with<br />

their first “tools of the trade”.<br />

Supported by Vision Aid Overseas (VAO), the<br />

second year students are studying at<br />

Hawassa University Hospital, 200 miles south of<br />

Addis Ababa. Hoya contributed PD rulers, lens<br />

cleaning products and other support materials.<br />

Dispensing optician David Hollander, who<br />

practises in Surrey and is part of the VAO team,<br />

said: “This is the first group of students to<br />

be trained at <strong>this</strong> university in the southern<br />

part of the country. Serving some 60 million<br />

people, which is around three quarters of<br />

the population, it is very rewarding as we are<br />

helping them to build a basis so that they<br />

become self-sufficient in eye care.”<br />

Bradford hosts<br />

OSCE refresher<br />

THE SCHOOL of <strong>Optometry</strong> and Vision<br />

Science at the University of Bradford<br />

will host an OSCE refresher course for<br />

pre-registration students <strong>this</strong> month.<br />

The course, which is scheduled to<br />

run from 10am-4.30pm on June 14,<br />

aims to give pre-registration students<br />

the opportunity to experience a<br />

variety of OSCE situations under exam<br />

conditions and receive feedback on their<br />

performance.<br />

A group session outlining how to<br />

prepare for the OSCE format of the Final<br />

Assessment will also be held.<br />

The course costs £200. For more<br />

information email Catherine Viner on<br />

c.l.viner@bradford.ac.uk.<br />

39<br />




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Optimising<br />

glaucoma referral<br />

40<br />


03/06/11 CET<br />

Lisa Cowan BSc (Hons) MCOptom, Sikander S Sidiki, BSc, MBChB,<br />

FRCOphth<br />

The first Independent Prescribing (IP) optometrists have now qualified, enabling<br />

an expanded role for practitioners in the care of patients with glaucoma.<br />

However, glaucoma is a difficult disease to detect in the first place, and yet is<br />

one that requires early detection for improved prognosis. This article therefore<br />

aims to provide key advice on how to recognise possible cases of glaucoma,<br />

for referral to specialist practitioners, through presentation of case studies.<br />

In the area of glaucoma and ocular<br />

hypertension (OHT), evidence-based<br />

guidelines such as those produced by<br />

NICE 1 and the College of Optometrists 2<br />

provide a valuable framework upon<br />

which to base diagnosis and management<br />

decisions. Some patients fall easily into<br />

pre-defined categories, and the decision<br />

Figure 1<br />

Inferior notching of the neuro-retinal rim<br />

to treat is relatively straightforward<br />

eg, patients with IOP of 35mmHg. In<br />

other patients, it is apparent that no<br />

treatment is required, and the patient<br />

can either be discharged, or monitored<br />

without treatment eg, low risk OHT<br />

with IOP of 23mmHg, healthy discs,<br />

full visual fields, and central corneal<br />

thickness (CCT) greater than 590µm. 1<br />

There are a significant number of cases<br />

however, which do not fit into distinct<br />

categories, and these are perhaps the<br />

cases that test our diagnostic skills most.<br />

The development of prostaglandin<br />

analogues has introduced a very safe,<br />

effective treatment to reduce IOP. This<br />

may suggest that the best policy in these<br />

equivocal cases is to “err on the side of<br />

caution” when managing such patients.<br />

However, many patients find using eye<br />

drops, even if only once a day, to be<br />

disruptive to their everyday life, stressful<br />

and physically demanding. Long-term<br />

use of glaucoma medications, particularly<br />

those containing preservatives, may have<br />

an impact on the health of the ocular<br />

surface and cause symptoms such as<br />

discomfort and dryness. 3,4 Patients are<br />

Figure 2<br />

Nasal cupping with nasalisation of blood vessels<br />

sometimes anxious about remembering to<br />

instil their drops, or about whether they<br />

can physically manage to do so. Many<br />

patients are elderly and have physical or<br />

mental disabilities such as arthritis and<br />

dementia. Glaucoma treatment, which is<br />

usually life-long, also has a significant<br />

financial impact on the patient and/<br />

or the NHS in terms of prescription<br />

charges. So treatment for glaucoma,<br />

whilst generally well tolerated, safe and<br />

effective, is not without its problems.<br />

Primary Open Angle Glaucoma<br />

(POAG)<br />

POAG, and particularly normal tension<br />

glaucoma (NTG), are generally slowly<br />

progressive diseases, and a diagnosis is<br />

often made on the basis of detecting a<br />

change in one or other parameter. By <strong>this</strong><br />

definition, more than one visit would<br />

be required to make a diagnosis. In<br />

practice, it is often possible to diagnose<br />

glaucoma on a single visit, as there has<br />

been sufficient change already to clearly<br />

differentiate the eye from normal. Signs<br />

that may indicate a pathological process<br />

include: (i) focal changes in the neuroretinal<br />

rim eg, notching or focal thinning<br />

(Figure 1) (ii) acquired pits of the optic<br />

nerve (iii) blood vessel signs such as<br />

baring and nasalisation of vessels (Figure

and parameters such as mean deviation<br />

patient’s lifetime”. 8 It has been shown<br />

(MD) and pattern standard deviation<br />

that a significant proportion of cases of<br />

(PSD) can be analysed sequentially using<br />

NTG do not progress significantly, even<br />

sophisticated software to determine<br />

without treatment. 9 It seems reasonable<br />

rates of progression; 5,6 a simple plot<br />

then to suggest that slowly progressive<br />

of MD against time and the age of the<br />

glaucoma in elderly patients does not<br />

patient provides a useful insight into<br />

the rate of progression for an individual<br />

always require treatment. Of course,<br />

<strong>this</strong> does not imply discriminating<br />

41<br />

patient, and can lead to a change in<br />

against patients based on age, but<br />

patient management in some cases.<br />

rather recommends taking a holistic<br />

The prevalence of glaucoma increases<br />

view, considering all the available<br />

with age, from about 2% for a patient<br />

information, and involving the patient<br />

Figure 3<br />

Peri-papillary atrophy<br />

2), and (iv) peri-papillary atrophy<br />

(Figure 3); if these signs are associated<br />

with corresponding visual field defects,<br />

the likelihood of glaucoma increases.<br />

In many cases though, it is not<br />

immediately clear whether an optic<br />

disc is physiologically unusual, or if it<br />

is pathologically damaged. In addition,<br />

it is not possible to assess the rate of<br />

progression on the basis of a single<br />

visit – even if the optic disc appearance<br />

and visual field plots are typical of<br />

glaucoma, isolated results form only a<br />

snapshot of the disease process at one<br />

point in time. IOP may give a clue as to<br />

the likely rate of change but part of the<br />

diagnostic process involves watching<br />

carefully for any evidence of change<br />

aged 40-50 years, to 5% for a patient over<br />

70 years, in a Caucasian population. 7 The<br />

European Glaucoma Society suggests<br />

that the aim of glaucoma treatment<br />

is to “maintain the patient’s visual<br />

function and related quality of life, at<br />

a sustainable cost”. 8 It also states that<br />

“the aim of treatment need not be no<br />

progression at all, but a reduction of rate<br />

of progression to such a level that quality<br />

of vision is not endangered during the<br />

in the decision making process. This<br />

takes account of many factors, in<br />

addition to the patient’s age, including<br />

severity of glaucoma at presentation,<br />

family history (including severity,<br />

progression and age of onset for family<br />

members with glaucoma), ethnic origin,<br />

CCT, and other risk factors for NTG such<br />

as migraine and disc haemorrhage. 9<br />

Of course, deciding not to treat a<br />

patient at the first visit does not mean<br />

that they will never be treated; the<br />

decision to treat or not depends on<br />

monitoring the rate of progression<br />

for each patient individually. It can<br />

be something that evolves over time,<br />

and not treating does not equate to<br />

doing nothing. The patient should be<br />

monitored at regular intervals, and the<br />

management plan changed accordingly.<br />

03/06/11 CET<br />

over time, which indicates an active<br />

disease process. When looking for these<br />

changes, there are a variety of techniques<br />

available. Serial photography of the<br />

optic disc (ideally stereoscopic images)<br />

can show changes in the neuro-retinal<br />

rim and position of blood vessels on<br />

the disc, as well as revealing retinal<br />

nerve fibre layer defects that are often<br />

Case Study A<br />

A 91-year-old female patient was<br />

diagnosed with early to moderate NTG<br />

in her right eye and early NTG in her<br />

left eye. IOP was 18mmHg in the<br />

right eye and 16mmHg in the left eye.<br />

Phasing revealed no significant diurnal<br />

variation in IOP. Due to her advanced<br />

more apparent on photographs than<br />

age, normal IOP and likelihood of slow<br />

on slit lamp examination. Imaging<br />

techniques such as OCT can allow<br />

sequential analysis of the nerve fibre<br />

layer, and measures changes in retinal<br />

nerve fibre layer thickness, which can<br />

indicate progression. Visual field plots<br />

Figure 4<br />

Progression of visual field defects in Patient A. Top<br />

panels were measured at diagnosis, bottom panels<br />

were measured 6 months after diagnosis, with no<br />

treatment conducted during <strong>this</strong> time<br />

progression, as well as her personal<br />

preference to avoid using eye drops, it<br />

was decided not to treat the patient but<br />

to monitor her on a 6-monthly basis. If<br />

there were any evidence of progression<br />

in optic disc appearance and/or visual



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42<br />

03/06/11 CET<br />

Figure 5<br />

Deep glaucomatous cupping and thinning of the<br />

inferior neuro-retinal rim in Patient B<br />

fields, <strong>this</strong> management plan would be<br />

reconsidered. At the first 6-monthly<br />

review, the optic discs appeared similar<br />

but visual fields showed an increasing<br />

glaucomatous defect in both eyes (Figure<br />

4) and IOP, while still normal, was higher<br />

than at the initial visit (RE=20mmHg<br />

LE=19mmHg). Based on <strong>this</strong> change<br />

in clinical picture, the decision was<br />

made to commence treatment and<br />

the patient was happy with <strong>this</strong>.<br />

Case Study B<br />

An 81-year-old female patient was<br />

diagnosed with early NTG with IOP of<br />

16mmHg in the right eye and 15mmHg<br />

in the left eye. The appearance of the<br />

left optic disc is shown in Figure 5;<br />

glaucomatous cupping is present with<br />

a very thin inferior neuro-retinal rim.<br />

After some discussion, it was agreed<br />

that she would be monitored, without<br />

treatment, but <strong>this</strong> management plan<br />

would be re-assessed if there were a<br />

change in the clinical findings. To date,<br />

<strong>this</strong> patient has been monitored for 4<br />

years, with no evidence of progression<br />

of the visual field defect (Figure 6).<br />

Referral<br />

In the cases of patients A and B, NTG<br />

Figure 6<br />

Stable visual field defects for Patient B, measured in April 2010<br />

was diagnosed and the decision not to<br />

treat was made by, or in conjunction<br />

with, a consultant ophthalmologist.<br />

NICE guidelines state that practitioners<br />

should “refer people with suspected<br />

optic nerve damage or repeatable visual<br />

field defect(s), or both, to a consultant<br />

ophthalmologist for consideration of a<br />

definitive diagnosis and formulation<br />

of a management plan”. 1 As such,<br />

appropriate management in primary<br />

optometric care would be to refer<br />

these patients to ophthalmology,<br />

even if it was felt that they might not<br />

require treatment. Indeed, in some<br />

cases of NTG, it may be necessary<br />

to arrange neurological imaging<br />

to rule out more sinister causes of<br />

optic neuropathy, and <strong>this</strong> would<br />

require an ophthalmological opinion.<br />

Once the diagnosis has been<br />

confirmed, there may be instances<br />

where it is possible to refer the patient<br />

back to their own optometrist for<br />

follow-up care, with the option to<br />

refer back to ophthalmology available<br />

to the practitioner if there is a change.<br />

The NICE guidelines state that people<br />

with a diagnosis of OHT, chronic open<br />

angle glaucoma (COAG) or suspected<br />

COAG should be monitored and treated<br />

by a trained healthcare professional<br />

who has all of the following: 1<br />

• a specialist qualification (when not<br />

working under the supervision of a<br />

consultant ophthalmologist)<br />

• relevant experience<br />

• ability to detect a change in clinical<br />

status.<br />

Monitoring and treatment of people<br />

with OHT, suspected COAG and<br />

established COAG should be carried out<br />

by healthcare professionals trained to<br />

make relevant management decisions.<br />

Monitoring (but not treatment) of<br />

people with a confirmed diagnosis<br />

of OHT or suspected COAG who<br />

have an established management<br />

plan can be carried out by a suitably<br />

trained healthcare professional with<br />

the relevant skills and ability to<br />

detect a change in clinical status.<br />

Much of the above is open to<br />

interpretation though, and the<br />

definition of “supervision” in <strong>this</strong><br />

context has recently been clarified<br />

by the Joint Group on NICE<br />

Glaucoma Guidelines. 10 Advice on the<br />

interpretation and implementation<br />

of NICE guidelines by optometrists

has also been <strong>issue</strong>d by the AOP, and<br />

the LOC Support Unit (LOCSU). 11<br />

Referral refinement<br />

Of course, not all patients need to be<br />

referred to ophthalmology, and the<br />

community optometrist has the oftendifficult<br />

task of deciding which patients<br />

to refer. Some cases are clear and referral<br />

is obviously indicated (eg, clearly<br />

glaucomatous optic nerve head with<br />

definite thinning or absence of neuroretinal<br />

rim (Figure 7). There are other<br />

cases where observation is all that is<br />

required (eg, large physiological cupping<br />

with healthy neuro-retinal rims and no<br />

additional risk factors for glaucoma). As<br />

ever, the difficulty is the patient who falls<br />

somewhere in between these two groups.<br />

An audit of the authors’ hospital<br />

glaucoma clinic in 2006 revealed the<br />

outcomes of referrals received; 37%<br />

had some form of glaucoma (including<br />

POAG, narrow angle glaucoma, NTG,<br />

and secondary glaucoma eg, pigment<br />

dispersion glaucoma), 16% had OHT, 28%<br />

had no evidence of glaucoma or OHT and<br />

19% were diagnosed as glaucoma suspect.<br />

A diagnosis of glaucoma suspect was<br />

perceived risk include IOP, CD ratio,<br />

disc size, CCT, family history, myopia,<br />

ethnicity and vascular risk factors<br />

such as diabetes. Risk calculators are<br />

available but are limited by the number<br />

of factors that they can account for and<br />

by the studies on which they are based.<br />

As such, while they may be useful, they<br />

should not be considered a substitute<br />

for clinical judgement and experience.<br />

It is important to note that low CCT<br />

is a risk factor independent of IOP and<br />

corrected IOP. Although correction<br />

factors for IOP taking into account<br />

CCT have been suggested, opinion as<br />

to the validity of these varies as other<br />

corneal biomechanical factors such as<br />

corneal hysteresis have been suggested<br />

to influence IOP measurement much<br />

more than CCT. 12,13 The OHT treatment<br />

study identified CCT as the single most<br />

important risk factor for conversion to<br />

glaucoma, but did not make any attempt<br />

to “correct” IOP. 14 Other reasons for<br />

the association between low CCT and<br />

glaucoma have been hypothesized, but<br />

not proven e.g. low CCT may indicate<br />

a difference in structural properties of<br />

the eye, which could pre-dispose to<br />

glaucoma, such as a thinner retinal nerve<br />

fibre layer, or lamina cribrosa. 15 These<br />

are interesting areas of research, which<br />

may shed further light on the diagnosis<br />

of glaucoma and OHT in the future.<br />

If a glaucoma suspect is reviewed<br />

after 6 months or one year, there are<br />

essentially two possible outcomes:<br />

1. Progression of the optic disc cupping<br />

and/or visual field defect – referral<br />

to the HES can then be made, ideally<br />

with disc images and visual fields to<br />

illustrate progression. This gives the<br />

HES clinician a great deal of information<br />

upon which to base their diagnosis,<br />

management and treatment plan.<br />

2. No progression of the optic disc<br />

cupping and/or visual field defect is<br />

identified – the practitioner and patient<br />

can be reassured that there is still no<br />

evidence of glaucoma, and if there is<br />

any glaucomatous progression, it is<br />

proceeding at such a slow rate that it<br />

would be likely to be picked up by regular<br />

6-monthly or annual reviews. Referral to<br />

the HES could then be made for treatment<br />

if necessary. Once again, if the patient<br />

does need to be referred for treatment,<br />

both the patient and the clinician<br />

43<br />

03/06/11 CET<br />

made if it was not possible on the first<br />

visit to diagnose the patient as either<br />

normal or glaucomatous, so further<br />

follow-up was arranged. Examples of<br />

suspect disc appearances include cup<br />

to disc (CD) ratio >0.5, disc-cupping<br />

asymmetry between the eyes, ISNT<br />

negative discs, and baring of blood<br />

vessels. Discs may also be considered<br />

suspicious if they are difficult to<br />

interpret, with shallow cupping, sloping<br />

neuro-retinal rims or if they are tilted.<br />

Community optometrists with<br />

appropriate skills and equipment could<br />

follow-up some glaucoma suspects<br />

who are considered at low risk of<br />

developing glaucoma, without the need<br />

for referral to the hospital eye service<br />

(HES). Factors that will influence <strong>this</strong><br />

Figure 7<br />

Clear glaucomatous disc with absent inferior<br />

neuro-retinal rim<br />

Figure 8<br />

Suspicious optic disc cupping



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44<br />

03/06/11 CET<br />

who examines them will be greatly<br />

helped by the additional information<br />

available from the referring optometrist.<br />

Of course, the level of skill and<br />

training in glaucoma will vary between<br />

optometrists, and some will be more<br />

confident in assessing glaucomatous<br />

changes in patients than others. If the<br />

optometrist does not feel comfortable<br />

observing the patient over time,<br />

then they should refer to the HES.<br />

Case Study C<br />

A 49-year-old man was diagnosed as a<br />

glaucoma suspect due to a suspicious<br />

optic disc appearance, which was not<br />

clearly glaucomatous, but neither was it<br />

clearly normal. CD ratio was 0.8 in both<br />

eyes (Figure 8) with no focal thinning,<br />

disc height was 2.2mm in both eyes, and<br />

IOP was consistently normal in both eyes<br />

(RE=15mmHg and LE=14mmHg). He has<br />

now been reviewed for four years with no<br />

evidence of any change in the optic disc<br />

appearance. Visual fields remain full,<br />

and his IOP has remained within normal<br />

limits throughout <strong>this</strong> time. It is likely<br />

that he will be discharged back to the care<br />

of his own optometrist in the near future.<br />

Scotland<br />

In Scotland, community optometrists<br />

have the equipment and resources to<br />

examine glaucoma suspects fully under<br />

General Ophthalmic Services (GOS),<br />

and some have additional equipment<br />

and skills to perform techniques such as<br />

gonioscopy and pachymetry. In addition<br />

the GOS contract allows community<br />

optometrists to be funded to perform<br />

additional tests such as contact tonometry,<br />

repeat visual field tests, and facilitates<br />

early recalls, which may be required in<br />

the management of glaucoma suspects.<br />

It also ensures that when patients are<br />

referred on to the HES, the clinician<br />

receiving the referral should have a<br />

wealth of useful additional information,<br />

such as repeat threshold visual fields<br />

and contact tonometry, which helps the<br />

diagnostic process and to prioritise the<br />

urgency of the out-patient appointment.<br />

Summary<br />

Optometrists, both in hospital practice<br />

and in the community, have an<br />

important role to play in the detection,<br />

diagnosis and follow-up of glaucoma.<br />

The advent of IP status is likely to allow<br />

us to develop <strong>this</strong> role further over the<br />

coming years, as we move further away<br />

from a “detection of abnormality” role,<br />

and continue to develop our skills in<br />

diagnosis and management of disease.<br />

About the authors<br />

Lisa Cowan is a specialist optometrist<br />

at the Southern General Hospital and<br />

New Victoria Hospital, Glasgow, and<br />

lead glaucoma practitioner in the<br />

shared care glaucoma service. Sikander<br />

Sidiki is a consultant ophthalmologist<br />

at Southern General Hospital and<br />

Gartnavel General Hospital, Glasgow.<br />

References<br />

See http://www.optometry.co.uk<br />

clinical/index. Click on the article title<br />

and then download "references".<br />

Module questions<br />

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Course code: C-16277 O/D<br />

1. Which of the following is NOT a risk factor for primary<br />

open angle glaucoma?<br />

a) Increasing patient age<br />

b) Hypermetropia<br />

c) Low CCT<br />

d) Family history of glaucoma<br />

2. Prevalence of glaucoma in patients aged 40-50 years is<br />

approximately:<br />

a) 0.1%<br />

b) 2.0%<br />

c) 5.0%<br />

d) 8.0%<br />

3. Which of the following is NOT a requirement for<br />

healthcare professionals monitoring patients with OHT,<br />

COAG, or suspected COAG, according to NICE guidance?<br />

a) A specialist qualification if working independently<br />

b) Relevant experience<br />

c) Independent prescriber status<br />

d) Ability to detect a change in clinical status<br />

4. Which of the following was identified by the Ocular Hypertension<br />

Treatment Study as the single most important risk factor for conversion<br />

to glaucoma?<br />

a) Low CCT<br />

b) Myopia<br />

c) Family history<br />

d) Peri-papillary atrophy<br />

5. For a myopic patient with optic disc cupping of RE: 0.6 ISNT obeyed,<br />

LE: 0.4 ISNT obeyed, IOP of 21mmHg in both eyes, and no visual field<br />

defect, what is the most appropriate course of action?<br />

a) Refer to HES routinely<br />

b) Refer to HES urgently<br />

c) Repeat the visual fields test<br />

d) Monitor annually<br />

6. In the author’s 2006 audit of glaucoma referrals, what percentage of<br />

patients was diagnosed with some form of glaucoma?<br />

a)12%<br />

b) 28%<br />

c) 37%<br />

d) 74%



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Optometric<br />

management of dry eye<br />

COURSE CODE C-16461 O/D<br />

Samantha McGinnigle BSc (Hons), MCOptom, Dr Frank Eperjesi BSc<br />

(Hons), PhD, MCOptom, Dip Orth, FAAO, MHEA, PGCertHE, MBA Dr<br />

Shehzad Naroo BSc (Hons), MSc, PhD, MCOptom, FIACLE, FAAO, FBCLA<br />

Dry eye has been defined by The Dry Eye Workshop (DEWS) as ‘a multifactorial<br />

disease of the tears and ocular surface that results in symptoms of discomfort,<br />

visual disturbance and tear film instability, with potential damage to the<br />

ocular surface. It is accompanied by increased osmolarity of the tear film<br />

and inflammation of the ocular surface’. 1 This article outlines the role of<br />

the optometrist in the conservative management of dry eye, namely<br />

through treatment with artificial tear substitutes and eyelid therapy.<br />

There are three steps towards<br />

treating dry eye, according to a recent<br />

European Ocular Surface Workshop: 2<br />

1. Patient education, monitoring the<br />

eyelid environment, use of artificial<br />

tear substitutes and eyelid therapy.<br />

2. Addition of temporary antiinflammatory<br />

agents, temporary punctual<br />

occlusion, secretagogue administration.<br />

3. Use of autologous serum<br />

and amniotic membranes.<br />

This article concentrates on the first<br />

step of <strong>this</strong> treatment paradigm, but<br />

first considers the risk factors that lead<br />

to a patient suffering from dry eye.<br />

Risk factors for dry eye<br />

The ocular surface functions as a<br />

complex unit which includes the surface<br />

t<strong>issue</strong>s, secretory glands, eyelids and<br />

nasolacrimal outflow channels, all<br />

linked via the neural reflex arcs which<br />

collectively form the lacrimal function<br />

unit. This interdependent unit is further<br />

supported by an intact nervous system<br />

and hormones, particularly systemic<br />

androgen. There is constant feedback from<br />

neural receptors to maintain the finely<br />

balanced homeostasis and if any aspect<br />

of <strong>this</strong> complex system is compromised<br />

then the structure and function is<br />

affected. 3 Regardless of which element<br />

causes the ocular signs or symptoms, all<br />

dry eye conditions share the common<br />

features. These include an unstable tear<br />

film between blinks, increased osmolarity<br />

and inflammation. 4 Ocular irritation and<br />

visual disturbance can pose significant<br />

problems for patients with dry eye 5 and<br />

the debilitating effects of dry eye have<br />

been rated as similar to those of moderate<br />

angina in quality-of life surveys. 6<br />

Researchers have found that 52% of<br />

contact lens wearers, 23% of spectacle<br />

wearers and 7% of clinical emmetropes<br />

self-report dry eye in optometric<br />

practice. 7 Increased age, female gender,<br />

medication, connective t<strong>issue</strong> disease,<br />

radiation therapy and LASIK/refractive<br />

excimer laser surgery are proven factors<br />

for dry eye. 1 Environmental stresses at<br />

the workplace (particularly prolonged<br />

VDU use) or during recreational<br />

activities can also initiate or exacerbate<br />

dry eye. 8 Allergic and inflammatory<br />

ocular surface conditions can have a<br />

destabilising effect on the tear film 9 and<br />

smoking interferes with the lipid layer. 10<br />

Meibomian gland dysfunction (MGD)<br />

is a major cause of evaporative dry<br />

eye 11 and in a prospective study of<br />

patients seeking an eye examination<br />

because of ‘ocular discomfort’ or<br />

‘irritation,’ there was a diagnosis of<br />

posterior blepharitis in 24% of cases and<br />

anterior blepharitis in 12% of cases. 12<br />

45<br />

03/06/11 CET<br />

Figure 1<br />

Different causes of ocular irritation<br />

Presentation of dry eye<br />

The patient may complain of ocular<br />

irritation, grittiness, burning, foreign<br />

body sensation, blurred vision,<br />

photophobia or possibly just general



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“A fluid is defined as a substance that undergoes continuous deformation when<br />

subjected to shear stress. The resistance of the fluid to <strong>this</strong> deformation is<br />

measured in terms of the fluid property called viscosity.<br />

Newtonian fluids have a constant viscosity at a given temperature and the viscosity<br />

is independent of changes in shear stress.<br />

Non-Newtonian fluids have a variable viscosity at a constant temperature and the<br />

viscosity also varies with the rate of shear of the liquid, ie, with increased stress the<br />

viscosity decreases.”<br />

Figure 2<br />

Definition of a fluid<br />

discomfort, particularly in the evening. 13<br />

There is, however, a lack of association<br />

between symptoms and the severity of dry<br />

eye, although validated questionnaires,<br />

such as The Ocular Surface Disease<br />

Index can be helpful in consolidating<br />

evidence towards a correct diagnosis. 13-16<br />

Indeed, there are many different<br />

causes of ocular irritation (Figure 1),<br />

several of which can cause similar<br />

symptoms, making differentiation of the<br />

underlying cause all the more difficult.<br />

The patient may exhibit signs of<br />

arthritis (poor mobility, joint deformity),<br />

acne rosacea, red eyes, lid problems,<br />

abnormal blink patterns, incomplete<br />

blinking and reflex epiphora. Signs<br />

may include reduced inferior tear prism<br />

height, a reduced tear break up time,<br />

staining of the cornea with fluorescein<br />

and conjunctiva with lissamine green,<br />

lid parallel and conjunctival folds<br />

(LIPCOF) and reduced corneal sensitivity<br />

(standardised grading scales for<br />

parameters are available in the Diagnostic<br />

Methodology Subcommittee Report 1 ).<br />

In terms of anterior blepharitis there<br />

may be crusts or flakes on the eyelashes,<br />

the lids may be stuck together in the<br />

morning and be accompanied by red eyes<br />

or eyelids; with posterior blepharitis there<br />

may be a change in meibomian gland<br />

secretions, meibomian gland plugs, lid<br />

telangiectasias, a frothy tear film, aqueous<br />

tear deficiency and excess lipid deposits. 17<br />

Composition and role of the<br />

tear film<br />

The tear film provides a smooth optical<br />

surface and protects the corneal surface<br />

by flushing away debris, bacteriostasis,<br />

maintaining epithelial hydration and<br />

acting as a lubricant to prevent the<br />

eyelid rubbing the surface on blinking.<br />

Studies have shown the tear film to<br />

be made up of a lipid layer overlying<br />

a mucoaqueous layer containing<br />

both gel-forming and transmembrane<br />

mucins. The lipid layer is secreted by<br />

the meibomian glands and is thought<br />

to reduce evaporation and maintain<br />

the smooth surface by interacting with<br />

lipid-binding proteins such as lipocalin<br />

in the aqueous phase. The stability of<br />

the tear film relies on adequate lipids<br />

being present to carry in water, lower the<br />

surface tension and combine with other<br />

tear components to create a highly non-<br />

Newtonian viscous liquid (Figure 2). 18<br />

Within the aqueous layer, the soluble<br />

mucins secreted by goblet cells and<br />

lacrimal gland acini are thought to serve<br />

a variety of purposes. They are moved<br />

through the aqueous during the forces<br />

of blinking and protect the surface of<br />

the eye via debris removal and the<br />

harbouring of defence molecules secreted<br />

by the lacrimal glands. The membrane<br />

associated mucins expressed by the<br />

stratified surface epithelia also protect the<br />

eye, forming a dense barrier to prevent the<br />

entry of pathogens. They allow the lids to<br />

glide over the surface due to the anionic<br />

character of all mucins, so when the<br />

soluble mucins pass over the membrane<br />

bound mucins their charges force the<br />

molecules apart, preventing adherence. 19<br />

Composition of tear<br />

supplements<br />

Aqueous artificial tears<br />

Cellulose derivatives are water soluble,<br />

viscoelastic polysaccharides with a low<br />

molecular weight, which exhibit emollient,<br />

cohesive (film-forming) properties. They<br />

do not generally blur vision (with the<br />

exception of methylcellulose) and are<br />

useful for mild or transient symptoms.<br />

The solutions are absorbed by the corneal<br />

epithelium, so there is a short ‘bathing<br />

‘period and only temporary relief. They<br />

can be formulated with electrolytes as a<br />

hypotonic solution. Hypromellose can<br />

cause crusting of lids and so care must be<br />

taken not to confuse <strong>this</strong> with blepharitis. 20<br />

Polyvinyl alcohols are water soluble<br />

synthetic polymers. Their viscolysing and<br />

surfactant action is helpful in patients with<br />

mucin deficiencies and at a concentration<br />

of 1.4% have the same surface tension as<br />

normal tears. They do not blur vision but<br />

have a short ocular surface retention time.<br />

They do not mix well with other products.<br />

Lipids<br />

Phospholipids occur naturally in the tear<br />

film and have surfactant properties as well<br />

as a role in surface monolayer formation.<br />

Commercial products are now available<br />

to deliver phosphatidylcholine (the major<br />

phospholipid) via a stable liposome,<br />

which can be sprayed onto the closed<br />

lid and migrate from there to combine<br />

with the tear film. Improvements in the<br />

lid margins have also been found with<br />

these products making them especially<br />

useful in the management of blepharitis. 21<br />

Viscoelastics<br />

Sodium hyaluronate is a

mucopolysaccharide<br />

with<br />

high viscosity, good ocular<br />

surface retention time and is<br />

beneficial to wound healing.<br />

Studies have shown an<br />

improvement in damaged<br />

ocular surface epithelium<br />

after using <strong>this</strong> product. 22<br />

Carbomers are synthetic<br />

polymers with high viscosity<br />

and good ocular surface<br />

retention time, but they tend<br />

to sting and blur vision.<br />

Carbomer 980 is a gel with<br />

thixotropic<br />

(reversible)<br />

properties; during blinking<br />

it liquefies, then reforms<br />

to a gel rather than being<br />

eliminated. 23,24 This means<br />

that fewer instillations are<br />

required and the eye has less<br />

exposure to benzalkonium<br />

chloride, which reduces the<br />

risk of developing allergies<br />

for the patient. These types<br />

of therapies benefit patients<br />

who have lipid, mucin and<br />

aqueous tear deficiencies.<br />

Povidones<br />

(polyvinyl<br />

pyrrolidones) are synthetic<br />

polymers of differing chain<br />

lengths and molecular weights.<br />

They act as surfactants and<br />

in higher concentrations<br />

increase the viscosity of solutions. They<br />

are useful for mucin deficiencies and<br />

can be co-formulated with electrolytes. 25<br />

Hydroxypropyl guar (guar gum)<br />

is a mucomimetic agent which has<br />

been shown to be more effective than<br />

carboxymethylcellulose in reducing<br />

the signs and symptoms of dry eye. 26<br />

Ointments<br />

Aqueous<br />

artificial tears<br />

Paraffin ointments have a long retention<br />

time and should only be used at night<br />

before sleep due to their detrimental<br />

effect on vision. They should be used<br />

as an adjunct to daytime artificial<br />

Active ingredient<br />

Hypromellose<br />

Carboxymethylcellulose<br />

Poyvinyl alcohol<br />

Polvinyl alcohol with povidone<br />

Product brand name<br />

Tears Naturale<br />

Isopto Plain<br />

Artelac SDU<br />

Optive<br />

Sno Tears<br />

Liquifilm Tears<br />

Hypotears<br />

Liquifilm<br />

Refresh<br />

Clinitas Ultra<br />

Ocutect (povidone)<br />

Liposomes Liposome spray Tears Again<br />

Optrex Actimist Eye Spray<br />

Viscoelastics Sodium hyaluronate Optrex Dry Eye Drops<br />

Blink Revitalising Drops<br />

Sainsburys Dry Eye Drops<br />

Clinitas Soothe, Clinitas Soothe<br />

Ocular<br />

lubricants<br />

Carbomer 940<br />

Carbomer 980<br />

Hydroxypropyl guar<br />

Tamarind seed polysaccharide<br />

and hyaluronic acid<br />

Liquid paraffin<br />

White soft paraffin<br />

Yellow soft paraffin<br />

Geltears*<br />

Viscotears*<br />

Liposic*<br />

Clinitas Hydrate<br />

Viscotears<br />

Systane<br />

Rohto Dry Eye Relief<br />

Rohto daily dose<br />

Lacri-Lube<br />

Lubri-Tears<br />

Simple Eye Ointment<br />

Lubrifilm<br />

Table 1<br />

Artificial tear availability. All solutions are preserved with Benzalkonium<br />

chloride with the exception of those highlighted with an asterisk (*), which use<br />

Cetrimide. Italics indicate single dose, unpreserved preparations<br />

tears and are particularly useful in the<br />

treatment of recurrent epithelial erosion.<br />

Table 1 summaries the various artificial<br />

tear supplements that are available and<br />

also provides examples of products<br />

that can be recommended to patients.<br />

Management strategies<br />

It is important to manage blepharitis; both<br />

anterior and posterior blepharitis need<br />

to be treated, as if left untreated it can<br />

progress, causing significant discomfort<br />

and possibly scarring. Conservative<br />

management of anterior blepharitis<br />

includes lid hygiene; lid scrubs using<br />

dilute baby shampoo (10:1)<br />

or commercial products eg,<br />

Ocusoft Lid Scrub Eyelid<br />

Cleanser (Cynacon/ Ocusoft),<br />

TheraTears Sterilid (Advanced<br />

Vision Research), in addition<br />

to aqueous artificial tears.<br />

This has been shown to be<br />

an effective combination and<br />

should mitigate the need<br />

for additional antibiotic<br />

therapy if adhered to. 27<br />

Posterior<br />

blepharitis<br />

requires heat above body<br />

temperature to melt the<br />

inspissated secretions. A wash<br />

cloth soaked with warm water<br />

(40-45°C) for 3-10 minutes<br />

has been shown to increase<br />

the tear film lipid layer<br />

and improve tear quality. 28<br />

Lid massage should be<br />

performed immediately after<br />

to help the flow of meibum.<br />

Artificial tears or liposomal<br />

sprays are also beneficial.<br />

With mild, transient dry<br />

eye, the logical progression<br />

regarding artificial tears<br />

is to try the least viscous<br />

formulations first, as these<br />

cause the least symptoms ie,<br />

stinging and blurred vision,<br />

so the patient is more likely<br />

to be compliant. The recommended dose<br />

for most artificial tears is one to two<br />

drops applied three to four times a day.<br />

For patients who have difficulty inserting<br />

drops, devices are available to help and for<br />

those who don’t like putting drops in their<br />

eye, the spray offers a useful alternative.<br />

With more moderate cases of dry eye,<br />

patients may be more willing to accept<br />

the slight stinging on insertion and initial<br />

blurring of more viscous formulations<br />

to gain relief from their symptoms.<br />

The most widely used preservative in<br />

artificial tears is benzalkonium chloride<br />

47<br />

03/06/11 CET



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48<br />

0.01% which can destabilise the tear film<br />

and have cytotoxic effects. 29 Patients<br />

requiring the application of tear substitutes<br />

more than four times a day should<br />

therefore be advised to use unpreserved<br />

formulations. There is, however, an<br />

increased cost and also compliance <strong>issue</strong>s,<br />

due to the fact that the patient has to<br />

carry sufficient vials when not at home. 30<br />

Conclusion<br />

There are many products available to<br />

lubricate the eye for patients who suffer<br />

from symptoms indicative of dry eye.<br />

However, due to the significant variation<br />

in both formulation and viscosity of these<br />

products, it can be very difficult for the<br />

patient to choose the most appropriate<br />

preparation. The optometrist can<br />

provide useful guidance to help with<br />

these choices, as some may involve<br />

considerable expense. It is interesting,<br />

however, that the DEWS report has<br />

found a ‘prominent apparent placebo<br />

effect’ in most clinical trials evaluating<br />

topical therapy for dry eye disease, 1<br />

so perhaps the key to management is<br />

as simple as encouraging compliance!<br />

About the authors<br />

Samantha McGinnigle is an<br />

optometrist, post-graduate and<br />

Clinical Demonstrator at Aston<br />

University. Frank Eperjesi is<br />

Head of <strong>Optometry</strong> at Aston<br />

University. Shehzad Naroo is a<br />

Senior Lecturer at Aston University.<br />

References<br />

See http://www.optometry.co.uk<br />

clinical/index. Click on the article<br />

title and then download “references”.<br />

03/06/11 CET<br />

Module questions<br />

Course code: C-16461 O/D<br />

1. According to the Dry Eye Workshop, which of the following is a<br />

sign of dry eye?<br />

a) Decreased osmolarity of the tear film<br />

b) Inflammation of the ocular surface<br />

c) Punctal occlusion<br />

d) Increased corneal sensitivity<br />

PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight<br />

on July 1 2011 - You will be unable to submit exams after <strong>this</strong> date – answers to the module will be published on<br />

www.optometry.co.uk. CET points for these exams will be uploaded to Vantage on July 11 2011.<br />

4. Which product is MOST helpful in patients with evaporative<br />

dry eye?<br />

a) Hypromellose<br />

b) Geltears<br />

c) Liquifilm<br />

d) Tears Again<br />

2. In the tear film, which of the following is a function of soluble<br />

mucins?<br />

a) They produce defence molecules against bacteria<br />

b) They form the optically smooth surface of the tears<br />

c) They reduce the stability of the tear film<br />

d) They allow the lids to glide over the ocular surface<br />

3. Which of the following components of tear supplements has the<br />

highest viscosity?<br />

a) Methylcellulose<br />

b) Polyvinyl alcohol<br />

c) Carboxymethylcellulose<br />

d) Carbomer 980<br />

5. What is the BEST option for a patient with dry eyes and surface<br />

staining, who needs to administer artificial tears more than four<br />

times a day?<br />

a) Liposome spray<br />

b) Hypromellose<br />

c) Unpreserved saline<br />

d) Unpreserved Clinitas Soothe<br />

6. Which of the following statements about blepharitis is FALSE?<br />

a) Warm compress requires heat in excess of 50°C<br />

b) Liposomal sprays can improve tear quality<br />

c) Antibiotic therapy may be required in severe cases<br />

d) If left untreated, it can possibly lead to scarring

OT CET Video<br />

C-14091 O/D: An Introduction<br />

to Domiciliary Eye Care<br />

Written and presented by Dawn Roberts (Joint Chair, Domiciliary Eye care<br />

Committee), <strong>this</strong> video aims to provide a two-part introduction to domiciliary<br />

Eye care for optometrists and dispensing opticians who are considering<br />

working in <strong>this</strong> rewarding area of practice. Topics covered include: the need<br />

for a domiciliary service, patient eligibility, regulations and recommended<br />

equipment.<br />

Part 1 details the changing age demographics of the UK, regulations and<br />

eligibility for domiciliary services and questions whether the needs of all<br />

patients unable to leave their homes are currently being met.<br />

Part 2 offers advice about modifications to the typical sight test routine,<br />

record keeping, domiciliary working environments and aftercare services.<br />

This video is sponsored by Healthcall Optical.<br />

This video features 12 MCQs that have been accredited with 2 CET points and<br />

are GOC approved for Optometrists and Dispensing Opticians.<br />

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

and take the exam.<br />

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

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

The closing date for MCQ submissions<br />

will be June 30, 2011 and the points<br />

will be uploaded to CET optics 10<br />

days later.<br />



Creating a Brighter Outlook<br />

A New Decade for Independent Success<br />

Economic storm clouds clearing<br />

With all the negative media coverage about the economy, business owners might be forgiven for falling into a deep<br />

depression about their future. Independents Day 2011 intends to blow away all the doom and gloom. Top business<br />

people will offer their best advice to help break out of the current doldrums to create a brighter outlook.<br />

Brighter, clearer spells in July<br />

Independents Day continues to shine as a top-class<br />

business programme and so much more:<br />

• Independents Night networking dinner (3rd July)<br />

• Optical Assistants Programme<br />

• Sponsors CET Lectures<br />

• Over 40 supplier strong exhibition<br />

NEW<br />

• Skills Workshops<br />

• Title Sponsors Mini-Symposium (Sunday PM, free entry for all)<br />



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Continental Eyewear Seiko Topcon<br />

Bausch + Lomb AEL Partners<br />


<strong>Optometry</strong> <strong>Today</strong><br />

Long-term high’s expected<br />

Come to Birmingham in the summer where <strong>this</strong> year’s<br />

programme is forecast to deliver perfect conditions for<br />

you and your practice team, with seasonal highs that<br />

are predicted to last well into the autumn and winter.<br />

For more information and to book<br />

Visit: www.independentsday.co.uk

JOBS<br />

To place an advertisement call 020 7878 2313<br />

or email haley.willmott@tenalps.com<br />



required to work for a minimum of<br />

one (1) year in the Island of<br />


Interested candidates please forward<br />

an updated Curriculum Vitae, to:-<br />

Ferreira Optical Limited, P.O. Box 894,<br />

Port of Spain, Trinidad, W.I.<br />

Tel: (868) 623-3472<br />

Fax: (868) 623-3473<br />

E-mail: hro@ferreiraoptical.com<br />

Website: www.ferreiraoptical.com<br />

www.cardiff.ac.uk/jobs<br />

Lecturer (Part-time)<br />

Wales <strong>Optometry</strong> Postgraduate Education Centre<br />

(WOPEC)<br />

Cardiff School of <strong>Optometry</strong> and Vision Sciences<br />

The purpose of <strong>this</strong> post will be to develop and deliver high-quality taught courses<br />

at postgraduate level and to enhance the international reach of the School<br />

through postgraduate teaching.<br />

You will require registration with the General Optical Council and you will be<br />

expected to have post-qualifying clinical experience.<br />

Through Wales <strong>Optometry</strong> Postgraduate Education Centre (WOPEC), the<br />

School of <strong>Optometry</strong> and Vision Sciences has been working with the Welsh<br />

Assembly Government, Primary Care Trusts (PCTs), Local Health Boards (LHBs)<br />

and <strong>Optometry</strong> Bodies to provide postgraduate training and accreditation to<br />

optometrists in Wales and England. You will work with the highly motivated team<br />

in WOPEC to help develop and deliver a flexible portfolio of taught postgraduate<br />

courses for UK and overseas optometrists. This post is fixed-term for 2 years.<br />

Hours: 22.5 per week<br />

Salary: £29972 - £35788 per annum, pro-rata for hours worked.<br />

Informal enquiries can be made to Barbara Ryan or Nik Sheen on<br />

+ 44 (0) 29 2087 0794.<br />

For an application pack and details of all our vacancies, visit<br />

www.cardiff.ac.uk/jobs. Alternatively email vacancies@cardiff.ac.uk<br />

or telephone + 44 (0) 29 2087 4017 quoting vacancy number 270.<br />

Closing date: Friday, 24 June 2011.<br />

51<br />

03/06/11 JOBS<br />

Glaucoma Optometrist<br />

Opportunities<br />

Hillingdon, Kingston, Midlands, North-West<br />

& Nationwide<br />

Newmedica is a dynamic, innovative UK healthcare company<br />

delivering a network of high quality, optometrist-led glaucoma<br />

monitoring units across the UK. We partner with the NHS to safely<br />

and effectively deliver specialist clinical eye care services to our<br />

patients, both in fixed and mobile settings.<br />

We currently require optometrists to work in our clinics in<br />

Hillingdon, Kingston, the Midlands and the North-West. However,<br />

we are also interested in hearing frm Optometrists nationwide and<br />

from those with experience in other sub-specialties.<br />

If you enjoy leading a small team to deliver high quality patient<br />

care smoothly and efficiently, we would be delighted to hear from<br />

you. Clinical experience is preferred, however full training will be<br />

provided. We will consider applicants who wish to work on either a<br />

permanent or a locum basis.<br />

Salaries are competitive, and are commensurate with skills and<br />

experience.<br />

To apply, please send your CV to Ben Gaehl at<br />

ben.gaehl@newmedica.co.uk<br />

www.newmedica.info<br />

Currently recruiting a Regional<br />

Account Manager for Essilor UK Ltd<br />

in the south central area.<br />

You will be responsible for managing<br />

existing accounts together with new<br />

business sales in the independent<br />

optical market.<br />

Previous Area Sales experience or a<br />

D.O qualification is essential.<br />

Excellent salary and package (including<br />

Company car and pension) on offer.<br />

For more details call John Williams<br />

on 0121 4550774.<br />

Email – john@jonesoptical.co.uk<br />

www.jonesoptical.co.uk<br />

URN 880866

JOBS<br />

To place an advertisement call 020 7878 2313<br />

or email haley.willmott@tenalps.com<br />

Shared Care Department, Bristol Eye Hospital<br />

Optometrist/Shared Care Practitioner<br />

Band 7, plus 17% recruitment and retention premium<br />

(£30,460 - £40,157 plus 17% RRP) Ref: 387-S-118<br />

Two new positions for full time Optometrists have become available in the Shared Care<br />

Department at Bristol Eye Hospital. The main initial responsibility of these posts is<br />

provision of ongoing care for patients with glaucoma, with subsequent participation in<br />

retinal and/or anterior segment clinics.<br />

Optometrist<br />

Ely and surrounding areas<br />

Independent, modern and friendly practice<br />

1 – 5 days per week (to suit)<br />

Newly qualified welcome<br />

Please contact:<br />

shona@spectacularopticians.co.uk<br />

Telephone: 01638 561 972<br />

52 50<br />

You will be GOC registered and have substantial post-registration experience. Evidence of<br />

extended role practice or a strong background knowledge appropriate to glaucoma care<br />

would be advantageous, although neither are pre-requisites for the position.<br />

17/09/10 03/06/11 RECRUITMENT<br />

JOBS<br />

Bristol Eye Hospital is a teaching hospital providing a wide range of ophthalmic care to<br />

people in the Bristol area and across the south west of England. The Optometric Shared<br />

Care Department is well established and integrated into the multidisciplinary environment<br />

of the hospital, providing clinical management of patients with glaucoma, retinal disease<br />

and patients presenting acutely to eye casualty.<br />

Informal enquiries regarding <strong>this</strong> position are encouraged. For further information please<br />

contact Dr Paul GD Spry, Optometrist Consultant, Bristol Eye Hospital, Lower Maudlin<br />

Street, Bristol BS1 2LX, Tel 0117 342 4652 (direct) or 0117 342 3812 (messages) or<br />

email paul.spry@uhbristol.nhs.uk<br />

For further details, or to apply please visit www.uhbristol.nhs.uk/working-at-the-trust.html<br />

Closing date for applications: Thursday June 30th 2011.<br />

Interview date: Tuesday July 19th 2011.<br />

An equal<br />

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optometrytoday<br />

Boost your chances of<br />

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Call 020 7878 2313<br />

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Optician/Optical Assistant/Manager<br />

Enthusiastic, friendly, committed fully<br />

qualified DO/OA required for prestigious, busy,<br />

independent practice in Cambridge.<br />

Benefits include:<br />

• Good Salary (according to qualifications & experience)<br />

• Friendly working environment<br />

• Full support staff<br />

• Full or part time considered<br />

• Hours 9-5.30 1 hour for lunch<br />

Please contact Martin on: 07788 772334 or<br />

Email: HR_Optician@yahoo.co.uk<br />

optometrytoday<br />

More jobs visit<br />

www.optometry.<br />

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Vision Care for Homeless<br />

People (Charity no: 1118076)<br />

Vision Care for Homeless People is a charity setup<br />

to provide eye-care services to homeless and<br />

other vulnerable people in an accessible and friendly<br />

environment in which they feel safe, welcome and<br />

comfortable.<br />

We have recently expanded our services in the London<br />

area and are subsequently looking for a Clinic Manager<br />

who will manage 3 Vision Care for Homeless People<br />

clinics in the London area, ensuring all VCHP policies and<br />

live<br />

bookshop<br />

procedures are being adhered to, that all stock levels CET<br />

are maintained and equipment is working correctly, to<br />

administer all clinic paperwork including mail and to assist<br />

with volunteer management and communication.<br />

The position is on a part-time basis, 2 days per month.<br />

For a full job-description and application details please<br />

email: info@visioncarecharity.org<br />

enewsletter VRICS<br />


JOBS<br />

To place an advertisement call 020 7878 2313<br />

or email haley.willmott@tenalps.com<br />

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All areas & Offi ce Based M4 corridor<br />

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Nationwide<br />


Nationwide<br />

Days still available to book, please visit<br />

www.outsideclinic.com/careerslocum.html<br />

or contact Jim Gilbert for more details.<br />

03/06/11 JOBS<br />

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For all the latest vacancies please visit<br />

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tel: 01793 648607 - email: jim@outsideclinic.com<br />

follow us on<br />


JOBS<br />

To place an advertisement call 020 7878 2313<br />

or email haley.willmott@tenalps.com<br />

Super<br />

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Cornwall, Sussex,<br />

Norfolk, Kent<br />

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Opportunities Nationwide<br />

Call Jim on 01793 648607 or visit www.outsideclinic.com<br />

54 50<br />

17/09/10 03/06/11 RECRUITMENT<br />

JOBS<br />

R01 OT Strip.indd 1 27/5/11 13:32:53<br />

Ninewells Hospital, Dundee<br />

Surgical Directorate<br />

Ophthalmology Department<br />

Optometrist Specialist Band 7<br />

Salary Scale £30,460 - £40,157 per annum<br />

The main duties for <strong>this</strong> job are paediatric, post-op cataract, vitreous, low visual<br />

aid and macular (including using an OCT) clinics. There will also be opportunities<br />

for teaching and research.<br />

You must hold General Optical Council registration and have post-registration<br />

experience. As you may be required to work anywhere throughout Tayside and<br />

NE Fife, the ability to travel is essential.<br />

Informal enquiries and visits are welcomed. Please contact Dr Kathryn Weed,<br />

Optometrist Consultant on 01382 632348.<br />

22.5 hours per week.<br />

To request an application pack please email: recruitment.tayside@nhs.net<br />

(quoting Ref – D/JM/61 in the subject box).<br />

Short-listed applicants will be contacted by email. Please check your emails regularly.<br />

Closing date for receipt of completed application forms: Friday 24th June 2011.<br />

Interviews are scheduled for Friday 8th July 2011 (Afternoon).<br />

NHS Tayside is committed to equality and diversity and welcomes applicants from all sections<br />

of the community.<br />

Advertise your job vacancy in OT magazine<br />

and reach 25,794 optical professionals and<br />

online at www.optometry.co.uk and reach<br />

an average of 14,506 unique<br />

visitors per month.*<br />

*Google analytics March 2011<br />

For more details contact Haley Willmott on<br />

0207 878 2313 or email<br />

haley.willmott@optometry.co.uk<br />

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