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www.optometry.co.uk June 17 2011 vol 51:12 £4.95<br />

optometrytoday<br />

What a nerve!<br />

Read our latest CET: optic nerve anomalies

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June 17 2011 vol 51:12<br />

20 22 44<br />

News<br />

5 Parental ignorance<br />

A new poll has revealed just how many<br />

parents are unaware of the importance of eye<br />

examinations for the under-7’s<br />

6 Consortia get guidance<br />

New eye care commissioning guidance is<br />

launched by NHS Alliance chief executive<br />

Michael Sobanja<br />

7 Trio honoured<br />

Details of those who received recognition<br />

in the optical sector in the Queen’s Birthday<br />

Honours List<br />

8 Comment<br />

In the week that the Government annonced<br />

revised plans for the Health Service in<br />

England, AOP chief executive Bob Hughes<br />

writes on the NHS Future Forum<br />

10 Extra CET credits<br />

Next month’s Independents Day will have<br />

an eve-of-conference mini symposium with<br />

CET points<br />

12 Eye Health Week headlined<br />

The profile of vision <strong>issue</strong>s was raised <strong>this</strong><br />

week by the latest promotion week on the<br />

importance of eye care<br />

Events<br />

27,29 Demystifying dyslexia<br />

A review of last month’s ‘Managing Dyslexia in<br />

your Practice’ course<br />

30-33 BCLA shines in Manchester<br />

Our review of the annual contact lens-focussed<br />

conference and exhibition which took place<br />

last month<br />

Products<br />

20-21 Industry<br />

A major contact lens launch from Sauflon,<br />

sunglasses from Stepper, dry eye solutions<br />

from Bausch & Lomb; plus designer frames<br />

and a new discount scheme from Dunelm<br />

24 Accessories<br />

Ideas to improve your profits Hilco, Dibble<br />

Optical, Caseco and Optipak<br />

Regulars<br />

14 Pre-reg Focus<br />

Nadeem Rob with important information on<br />

OSCEs<br />

18 Q&A<br />

Nick Atkins takes our 20 questions<br />

38 Diary dates<br />

All the latest optical events<br />

News Extras/Background<br />

16-17 AOP secures victory in<br />

field screeners challenge<br />

Background details of the latest defence the<br />

Association has provided<br />

22 Fresh call to improve testing<br />

drivers’ vision<br />

European optical groups claim the UK has<br />

fallen behind along with other EU member<br />

states in its requirements for testing drivers’<br />

eyesight<br />

34 Millions too hard-up to book<br />

New research has found many people are<br />

not attending eye examinations because of<br />

financial pressures<br />

Clinical<br />

36-37 VRICS: Presbyopia &<br />

Ageing Eyes<br />

The picture quiz covers the correction of<br />

presbyopia and identification and management<br />

of ageing eye conditions<br />

40-43 CET: Optic nerve<br />

anomalies<br />

Key advice in the latest part of our referral<br />

refinement course, written by Dr Marcela<br />

Votruba<br />

44-48 CET: Visual factors in<br />

specific learning difficulties<br />

This article, by Lindsay Bater, outlines the results<br />

of a clinical study to determine whether there<br />

were any predictive factors to indicate the<br />

presence of Meares-Irlen syndrome<br />

Classified<br />

51-54 Jobs<br />

All the latest vacancies. Sandwell and West<br />

Birmingham Hospitals are inviting dispensing<br />

optician/ senior optical dispensers for interview<br />

or please see our Jobs section for NHS jobs<br />

55-58 Marketplace<br />

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NEWS<br />

Parents’ ignorance of<br />

kids eye care revealed<br />

NEW EVIDENCE has revealed<br />

that many UK parents are<br />

unaware how important an<br />

eye examination is for their<br />

young child.<br />

A new poll by the<br />

influential Mumsnet forum<br />

involving over one thousand<br />

respondents found the<br />

majority of parents are<br />

concerned about their child’s<br />

eye health, yet only half (49%)<br />

have taken their child for an eye<br />

test with a medical professional,<br />

over and above a developmental<br />

check-up.<br />

Commissioned by the<br />

Childhood Eye Cancer Trust<br />

(CHECT), the survey – conducted<br />

by Mumsnet with parents<br />

of children aged up to six –<br />

revealed most (79%) of those<br />

questioned felt sure their child’s<br />

eyes had been examined as<br />

part of a routine developmental<br />

check. Nevertheless 12% said<br />

they didn’t know if they had<br />

been checked, and a further 9%<br />

were sure that they definitely<br />

hadn’t been checked during<br />

developmental checks.<br />

A total of 49% of parents stated<br />

they had proactively taken their<br />

child for an eye check with either<br />

‘an optician, GP, hospital doctor<br />

or health visitor,’ outside of a<br />

scheduled developmental check.<br />

CHECT undertook the project<br />

to mark the start of National<br />

Eye Health Week and is urging<br />

parents to become more aware of<br />

their child’s eye health.<br />

Online retention<br />

gets thumbs up<br />

FURTHER PROOF that<br />

optometrists and others<br />

professionals are happy to<br />

register online has emerged<br />

<strong>this</strong> week. And the GOC<br />

has reported it is to expand<br />

its electronic retention<br />

procedure to businesses from<br />

2012-2013.<br />

Following the success of the<br />

first year of online registration<br />

reported by the GOC in<br />

April, when almost 95% did<br />

so, a survey conducted by<br />

the optical regualtor has<br />

found that practitioners are<br />

happy with the new online<br />

retention system. Of 885<br />

practitioners replying to<br />

its survey, 86% reported<br />

completing their application<br />

in under 10 minutes, with<br />

80% describing the process<br />

as ‘very easy’ or ‘easy’.<br />

Online retention is also<br />

now available for students,<br />

who have until July 15 to<br />

apply at its website, said<br />

head of registration Philip<br />

Hallam, who also confirmed<br />

that the GOC intends to<br />

introduce the online system<br />

for business registrants<br />

next year.<br />

Of those parents surveyed,<br />

most (61%) had heard of<br />

retinoblastoma, but 89% of<br />

those that were aware of it<br />

(55% overall) didn’t know<br />

much about it and few were<br />

aware of all the signs and<br />

symptoms. Almost two-in-five<br />

(37%) were not aware of the<br />

life-threatening disease at all.<br />

More than three-quarters<br />

(77%) correctly noted that a white<br />

reflection in the pupil is likely to<br />

be a symptom of childhood eye<br />

cancer, while only 12% correctly<br />

said a squint or lazy eye could be<br />

a symptom. Less than half (48%)<br />

correctly thought that a change<br />

in the colour of the iris could<br />

also be a warning sign. One-infive<br />

(19%) incorrectly identified<br />

a red reflection in the pupil as a<br />

symptom of eye cancer.<br />

“Parents appear to be relying<br />

on the media to provide them<br />

with vital information on what<br />

to look out for,“ said a CHECT<br />

spokeswoman, “with 46%<br />

becoming aware of childhood<br />

eye cancer through a national<br />

newspaper or magazine article<br />

and 37% through the internet. Just<br />

4% had heard about it through a<br />

medical professional.”<br />


Thank you to those<br />

who ticked to raise<br />

cash for charity<br />

OPTICAL charity <strong>Optometry</strong> Giving<br />

Sight has praised AOP members<br />

who have collectively donated<br />

more than £4,000 via those who<br />

decided to add a donation to their<br />

annual membership renewal.<br />

Members who ticked ‘Yes’ to<br />

fund <strong>Optometry</strong> Giving Sight<br />

helped refractive error programmes<br />

to support millions who are blind<br />

or visually impaired simply because<br />

they do not have access to an<br />

eye examination and a pair of<br />

spectacles.<br />

“The amount raised was more<br />

than last year which is fantastic”<br />

said Donna Power, UK country<br />

manager. “We are truly grateful<br />

for <strong>this</strong> donation and would like<br />

to thank all of the members for<br />

supporting us, and the AOP for the<br />

continuous support we receive as<br />

their Charity of Choice.”<br />

For every £1 raised, <strong>Optometry</strong><br />

Giving Sight can guarantee at<br />

least 85p goes directly to those<br />

in need. Last year, $US1.2m was<br />

disbursed, which supporting 18<br />

refractive error programmes in 16<br />

countries, enabling 322,189 people<br />

to receive an eye examination and<br />

appropriate eye care in 2010.<br />

Bob Hughes, chief executive of<br />

the AOP, said: “<strong>Optometry</strong> Giving<br />

Sight funded projects are making a<br />

real and sustainable difference to<br />

people who cannot afford glasses,<br />

but cannot function without them,<br />

and I would like to thank our<br />

members for contributing to<br />

<strong>this</strong> work.”<br />

<br />

5<br />

17/06/11 NEWS

NEWS<br />

optometrytoday<br />

JUNE 17 2011<br />

VOLUME 51:12<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 />

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

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

Guidance is launched<br />

for new GP consortia<br />

YESTERDAY (June 16) NHS<br />

Alliance chief executive Michael<br />

Sobanja (pictured) launched<br />

new eye care commissioning<br />

guidance to help GP consortia in<br />

commissioning ‘quality, costeffective<br />

eye care services’ for<br />

patients.<br />

Speaking at the Vision UK<br />

2011 conference he said: “It<br />

is important to have patients<br />

right at the heart of eye care<br />

service commissioning. This<br />

new guidance will assist<br />

commissioners to improve<br />

quality of provision in a<br />

sustainable manner.”<br />

The conference and guidance<br />

are both initiatives of the UK<br />

Vision Strategy, which held its<br />

annual Vision UK event in<br />

London yesterday.<br />

The guidance has been<br />

produced in collaboration with<br />

GPs, ophthalmologists and other<br />

clinicians, and is intended for those<br />

taking a ‘hands-on approach’ to<br />

local commissioning.<br />

It recommends priority areas<br />

and hopes to enable consortia<br />

to: ‘assist in making considerable<br />

cost savings in the short, medium<br />

and longer term; deliver high<br />

quality care through specific<br />

improvements to the patient<br />

journey; create innovative eye<br />

care services tailored to the<br />

needs of local populations; and<br />

to develop sustainable services<br />

through increased collaboration<br />

between commissioners,<br />

clinicians and local communities<br />

The guidance is available as<br />

an online resource at: www.<br />

commissioningforeyecare.org.uk.<br />

FMO briefs on new Bribery Act<br />


and gifts should be guarded<br />

against to avoid any<br />

potential challenge under<br />

the new Bribery Act, a<br />

meeting of the Federation<br />

of Manufacturing Opticians<br />

(FMO) was told last week.<br />

A briefing was given as<br />

part of the FMO’s regional<br />

meeting which took place in<br />

Birmingham and discussed<br />

the implications of the<br />

Bribery Act 2010 which<br />

comes into force on July 1.<br />

An FMO spokeswoman<br />

Glaucoma clarification<br />

THE AUTHORS of our CET article<br />

in June 3 OT (pages 40-44)<br />

have clarified their statement<br />

on prevalence of glaucoma<br />

increasing with age, ‘from about<br />

2% for a patient aged 40-50<br />

years’. “The prevalence varies<br />

according to each study and the<br />

said: “Soon the Optical<br />

Confederation will be<br />

releasing guidance that will<br />

stress the need for optical<br />

practitioners to comply<br />

with existing GOC Code of<br />

Conduct and Professional<br />

Guidelines to minimise risks<br />

or accusations of influencing<br />

clinical judgement.”<br />

Mark Nevin, head of policy<br />

and regulation at the FMO,<br />

FODO, and the ACLM, told<br />

the FMO’s Frames, Lenses<br />

and Equipment Associations<br />

that the Ministry of Justice<br />

population studied,” they state.<br />

“The figure of approximately<br />

2% is used as an average<br />

for glaucoma in the general<br />

population, all ages averaged.<br />

This increases to 5% for those<br />

in their 80s. These figures are<br />

applicable to Caucasians only.<br />

“is not intending to prohibit<br />

normal, honest, business<br />

practice”, but that companies<br />

need to be aware “of any risk<br />

of bribery”.<br />

He also updated FMO<br />

members on the Optical<br />

Confederation’s campaign for<br />

better vision for safer driving<br />

(see also page 22).<br />

In addition, the meeting<br />

discussed specific industry<br />

challenges, with dedicated<br />

optical training for all<br />

levels of employees a major<br />

talking point.<br />

For black populations the figure<br />

is higher with about 5% and<br />

8% depending on studies and<br />

age. This figure is taken as an<br />

average of all populations ages<br />

from several different studies<br />

and is not meant to reference<br />

one particular study.”<br />

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

Trio are recognised in<br />

Queen’s Honours List<br />

INDIVIDUALS FROM optics were<br />

recognised <strong>this</strong> week in the<br />

Queen’s Birthday Honours List.<br />

Frank Norville (pictured),<br />

chairman of the Norville Group,<br />

has been awarded an OBE for<br />

services to manufacturing.<br />

The ‘champion of<br />

manufacturing’, Mr Norville<br />

is well-known for supporting<br />

the development of the UK<br />

manufacturing industry and<br />

also as a supporter of charitable<br />

causes.<br />

Mr Norville told OT: “It was quite<br />

a surprise and a great honour to<br />

receive the news on behalf of all<br />

the colleagues and friends within<br />

the profession, some of whom are<br />

sadly no longer with us.<br />

“Optics is a small but important<br />

industry and it is a great honour<br />

that manufacturing has been<br />

recognised in <strong>this</strong> way.”<br />

As a ‘third-generation’ optics<br />

professional, he says the business<br />

was one he was ‘born into’ and as<br />

well as being chairman of Norville<br />

Group, Mr Norville has held the<br />

titles of chairman of the FMO<br />

and master of the Worshipful<br />

Company of Spectacle Makers.<br />

He puts his own and his<br />

company’s success down to<br />

continuous attention to detail and<br />

developing and embracing new<br />

technology, but has no plans to<br />

rest on his laurels.<br />

“It’s a very exciting time in<br />

manufacturing,” he added, “with<br />

technology developing into<br />

being more compact.”<br />

Chief executive of the FMO,<br />

Malcolm Polley, said the<br />

award was richly deserved,<br />

and added: “Frank’s dedication<br />

and commitment not just to<br />

manufacturing but across the<br />

whole spectrum of optics is<br />

unsurpassed. He continues to<br />

be a fantastic champion of UK<br />

manufacturing.”<br />

Other recipients were Dick<br />

Roberts and Rosie Auld who<br />

both received CBEs for services<br />

to optometry and services to<br />

healthcare, respectively.<br />

Mr Roberts, a self-employed<br />

optometrist, is a fellow of the<br />

College of Optometrists and the<br />

American Academy of <strong>Optometry</strong>.<br />

He was appointed consultant<br />

optometric advisor to the National<br />

Assembly of Wales in 2000, and<br />

was awarded the OBE in the 1998<br />

New Year’s Honours List.<br />

Ms Auld spent six years as chair<br />

of the British and Irish Orthoptic<br />

Society and is currently head<br />

orthoptist/lead clinical tutor at<br />

the Birmingham and Midland<br />

Eye Centre.<br />

Book now for workshops<br />

BOOKINGS are being<br />

taken for practitioners<br />

who are interested<br />

in training to<br />

become ’professional<br />

ambassadors’ for<br />

the Careers in Optics<br />

scheme.<br />

The initiative’s team,<br />

which last month won a<br />

prestigious award for innovation at the National<br />

Recruiter Awards – pictured – aims to raise<br />

awareness of optics as a career option amongst<br />

secondary school and sixth-form pupils.<br />

To ensure all ‘ambassadors’ are well-equipped<br />

to deliver the workshops, the Working<br />

Group running the scheme is offering optical<br />

professionals the chance to attend free-to-<br />

attend workshops<br />

during <strong>this</strong> month<br />

and next.<br />

The workshops<br />

will take place in<br />

London at City<br />

University (June<br />

24), Birmingham<br />

(July 4), and<br />

Manchester<br />

(July 5), with venues for the latter two to be<br />

decided.<br />

Each workshop lasts two hours and<br />

refreshments will be available. However, there<br />

is a limit of 20 places per session so those<br />

who are interested should book now to avoid<br />

disappointment.<br />

• To register email charlotteverity@aop.org.uk<br />


GOC outlines plans<br />

to ‘get tough’ on<br />

illegal sales<br />

The General Optical Council<br />

has published a new protocol<br />

explaining how it will deal with<br />

breaches of the Opticians Act.<br />

The protocol for the investigation<br />

and prosecution of criminal<br />

offences details how the GOC will<br />

deal with individuals and firms it<br />

suspects of breaking the law.<br />

Offences that the Harley<br />

Street-based Council may decide<br />

to prosecute over, include<br />

selling contact lenses without<br />

the involvement of an optician<br />

(including over the internet),<br />

testing sight while unregistered,<br />

falsely claiming to be a registered<br />

optician and selling zero-powered<br />

contact lenses illegally.<br />

GOC director of regulatory<br />

services David Howell said: “We<br />

take breaches of the Opticians<br />

Act extremely seriously and <strong>this</strong><br />

protocol sets out the action we<br />

will take when we suspect the law<br />

has been broken. This may involve<br />

conducting investigations and<br />

bringing criminal prosecutions in<br />

appropriate cases.<br />

“We have begun to apply<br />

<strong>this</strong> policy, and in several cases<br />

the alleged activity has ceased<br />

following initial contact from us.”<br />

The protocol is available on the<br />

GOC’s website and sets out a faster<br />

process by allowing the registrar<br />

to decide to pursue a prosecution,<br />

instead of a committee as<br />

previously. GOC staff are to attend<br />

the Trading Standards Institute<br />

conference later <strong>this</strong> month, to<br />

raise awareness of the Opticians Act<br />

among trading standards officers.<br />

Anyone who wishes to report a<br />

suspected breach of the Opticians<br />

Act should telephone the GOC on<br />

020 7580 3898 and select option 2.<br />

7<br />

17/06/11 NEWS<br />

News updated regularly at www.optometry.co.uk

NEWS<br />


8<br />

17/06/11 NEWS<br />

Survey reveals public<br />

attitude to eye health<br />

ALMOST a third of people<br />

who haven’t had a sight<br />

test for the last two years<br />

say they ‘don’t think it’s<br />

necessary’ according to<br />

new research. And 50%<br />

state they haven’t visited<br />

an optometrist because ‘I<br />

haven’t experienced any<br />

problems with my eyes’ .<br />

Current public attitudes<br />

to eye care have been<br />

scrutinised as part of a<br />

report released <strong>this</strong> week by the College of<br />

Optometrists. The survey was undertaken by<br />

independent research company FreshMinds,<br />

which heard the views of 4,004 UK adults<br />

aged below 60.<br />

Other popular reasons for not attending an<br />

eye examination among the 716 respondents<br />

who stated they have not had a recent sight<br />

test included: concern about the cost of a<br />

test (20%); the cost of glasses (17%); lack of<br />

free time (20%); ‘it’s just<br />

too much hassle’ (14%);<br />

‘I’m worried they’ll try<br />

and sell me spectacles<br />

even if I don’t need them’<br />

(14%); and a proportion<br />

of people worried about<br />

problems the optometrist<br />

might find (7%).<br />

Further findings<br />

revealed in the report<br />

include that 65% of<br />

people wear some sort<br />

of corrective eyewear, with 62% owning<br />

spectacles and 14% in contact lenses, 11%<br />

had both. Explaining the reason for the<br />

research, president of the College, Dr Cindy<br />

Tromans (pictured), said: “Patients are at the<br />

heart of our work and we commissioned <strong>this</strong><br />

research because, as a public benefit body,<br />

it is important for us to develop a better<br />

understanding of patient attitudes towards<br />

their vision and eye health.”<br />

Successful roadshow<br />

event is now online<br />

ONE of <strong>this</strong> year’s AOP<br />

roadshow events which<br />

helped explain the Making<br />

Accurate Claims in Scotland<br />

publication can now be<br />

viewed online. The Inverness<br />

meeting, filmed earlier <strong>this</strong><br />

year is now available – see<br />

link below.<br />

Kevin Wallace (pictured),<br />

chairman of AOP Scotland,<br />

spoke about claiming GOS fees in Scotland<br />

and gave examples of illustrative cases, as<br />

well as answering questions posed from the<br />

practitioners attending.<br />

Although almost a third of Scottish<br />

practitioners were present at one of the<br />

five roadshows which the AOP ran, there<br />

were still many who were unable to attend<br />

because the distances involved were<br />

just too great. “So”, said<br />

Mr Wallace, “we decided<br />

that filming the event<br />

and making it available<br />

for free on the OT website<br />

would mean that every<br />

practitioner in Scotland was<br />

able get the benefit.<br />

“Furthermore, because<br />

the subject matter is very<br />

relevant to many nonprofessional<br />

staff in practices as well, they<br />

can also access the film.”<br />

Scottish AOP members are reminded<br />

that, if they have questions about GOS<br />

they should contact the AOP office;<br />

richardcarswell@aop.org.uk<br />

The event can be viewed at http://<br />

www.optometry.co.uk/multimedia/viewvideo?id=990437320001<br />


FUTURE?<br />

The NHS Future Forum has just reported<br />

to the Government on the NHS reforms<br />

in England and I am trying to wade<br />

through the five separate documents<br />

published on Monday.<br />

As you would expect, we engaged<br />

with the process and made the case for<br />

optometry and optics. In <strong>this</strong> we are<br />

grateful to Ash Soni, a member of the<br />

Forum and a Croydon pharmacist, who<br />

helped us ensure that our voice was<br />

heard and that our views were taken on<br />

board.<br />

We have backed the Government’s<br />

reforms from the beginning because<br />

they offer real opportunities to improve<br />

eye care provision and of course they<br />

remove the Primary Care Trusts, so<br />

many of which have failed to tackle<br />

eye care <strong>issue</strong>s and have acted so badly<br />

towards practitioners.<br />

There are two big opportunities for<br />

the profession. Influencing the Council<br />

Health and Well Being Boards, and<br />

ensuring that commissioning consortia<br />

see optometry as an essential partner<br />

in reaching eye care commissioning<br />

decisions. The profession is well set<br />

up for <strong>this</strong>, and for once we don’t need<br />

to play catch-up. We have lobbied<br />

tirelessly using the combined resources<br />

of the Optical Confederation, and we<br />

have support for local action in place<br />

through the LOC Support Unit. LOCs<br />

have the opportunity to become an<br />

essential part of health planning and<br />

public health assessment and to make<br />

the case for developing enhanced<br />

services in the community.<br />

In any longer term risk assessment it is<br />

an inescapable conclusion that, if we fail<br />

to take advantage of these opportunities,<br />

we face the very real possibility that a<br />

refusal to adapt will bit by bit impact on<br />

the core business as others move in to<br />

fill the gap.<br />

Bob Hughes, AOP chief executive<br />


Amazing things<br />

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Conditions. Optom Vis Sci 2007; 84(11): 1039-1045. 3. JJVC data on fi le 2011. Randomised, bilateral study for 1 month daily wear with 66 astigmatic spectacle wearers (lapsed wearers and neophytes). 4. JJVC<br />

data on fi le 2010. Class II UV blocking; more than 85% UVA and 99% UVB. UV blocking contact lenses are not substitutes for UV blocking sunglasses as they do not completely cover the eye and surrounding area.<br />

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NEWS<br />

10<br />

17/06/11 NEWS<br />

IN BRIEF<br />

Christie at<br />

CooperVision<br />

Well-known academic Caroline<br />

Christie (pictured) has been<br />

appointed clinical and professional<br />

affairs manger for CooperVision.<br />

She will be responsible for the<br />

clinical and professional profile of<br />

CooperVision in the UK and Ireland.<br />

Sales and marketing director for<br />

the UK and Ireland, Gabor Dozsa<br />

said: “We are delighted to welcome<br />

Caroline to the team and believe<br />

she will be a great asset to the<br />

company. As such a renowned figure<br />

in our industry, her strong lecturing<br />

experience, coupled with her<br />

outstanding clinical and academic<br />

background, will really enable us to<br />

build on our clinical expertise and<br />

training initiatives.”<br />

Optom proud of<br />

MoonWalk<br />

An<br />

optometrist<br />

has walked<br />

over 26 miles<br />

for charity.<br />

Meera Patel<br />

(pictured),<br />

who works at<br />

Specsavers’<br />

Walton on Thames practice, has<br />

raised more than £500 for Walk<br />

The Walk by completing the annual<br />

MoonWalk in Hyde Park. Ms Patel<br />

commented: “The MoonWalk<br />

means so much to me as quite a<br />

few members of my family have<br />

sadly been affected by cancer. I was<br />

joined by my two aunts and it took<br />

us seven hours to complete the 26.2<br />

mile walk. We started at 11.30pm<br />

and didn’t finish until almost 7am<br />

– by that point we were cold and<br />

exhausted but still extremely proud.”<br />

Early arrivals for ID’11<br />

can get extra CET credits<br />

PRACTITIONERS WHO attend a<br />

free ‘mini symposium’ on the eve<br />

of Independents Day can receive<br />

two CET points.<br />

The afternoon event, on<br />

July 3 at the Windmill Village<br />

Hotel, Coventry is open to all<br />

practitioners, regardless of<br />

whether they have booked to<br />

attend Independents Day 24<br />

hours later.<br />

Business lectures include<br />

independent practitioner Simon<br />

Donne discussing his patient<br />

communication tips in his<br />


CONFEDERATION will host<br />

an introductory training and<br />

apprenticeship workshop<br />

which aims to inform<br />

delegates about government<br />

schemes available to help<br />

support optical training next<br />

month.<br />

To be held at FODO’s<br />

headquarters in London on<br />

presentation entitled ‘Contact<br />

Lenses… It’s the way I tell em!’<br />

and Sandi Charlesworth from<br />

Essilor discussing ‘Tuning-up<br />

your business for maximum<br />

performance’. General dispensing<br />

and contact lens CET points will<br />

be provided by Andy Hepworth<br />

(pictured) – ‘Modern Day<br />

Varifocals: Betamax to HD Vision’<br />

and Jonathon Bench – ‘Striking<br />

the right balance of material<br />

properties’ respectively.<br />

Essilor and Johnson & Johnson<br />

Vision Care are sponsors of the<br />

symposium, and in addition<br />

to the presentations, there will<br />

be a small exhibition of both<br />

company’s latest products.<br />

Confederation to hold info<br />

day on support staff training<br />


Care for Homeless People has<br />

received a boost from Topcon.<br />

The instrument supplier has<br />

donated consulting room<br />

equipment for the good<br />

cause’s new London centre in<br />

Shepherd’s Bush, including a<br />

Topcon fundus camera and<br />

Volk lenses. Andrew Yorke<br />

(pictured, with chair of the<br />

charity Elaine Styles), medical<br />

July 6, the one-day event<br />

(10am-3pm) is free to attend<br />

and will focus on training<br />

for optical assistants and<br />

support staff.<br />

Attendees will have the<br />

opportunity to meet training<br />

providers, representatives<br />

from companies already<br />

using the schemes, and<br />

the bodies awarding the<br />

qualifications.<br />

The event will also cover<br />

how practices’ own workplace<br />

training schemes could be<br />

accredited towards nationally<br />

approved modules which<br />

would lead to an assessment<br />

and a nationally recognised<br />

qualification for staff.<br />

To book a place email<br />

karensparrow@aop.org.uk<br />

New kit for homeless<br />

director of Topcon GB, said:<br />

“People are in need in <strong>this</strong><br />

country and, do excuse the<br />

pun, we can’t turn a blind eye.<br />

When we were asked to help<br />

we were happy to do so,<br />

especially as it is here, close<br />

to home.”

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ON<br />

*Based on expected sponsorship coverage, ABC1 women, period March – November 2011 – all Johnson & Johnson Vision Care sponsored programs. Source: Techedge– predicted via the sponsorship module and actual via Advantedge Advantedge.<br />

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NEWS<br />

12<br />

17/06/11 NEWS<br />

IN BRIEF<br />

GOC joins Twitter<br />

Practitioners who want the<br />

up-to-date, inside knowledge on<br />

events at the GOC can now follow<br />

its statements on social networking<br />

facility Twitter. The regulatory body,<br />

which has the username<br />

@GOC_UK joins OT, the Student<br />

AOP, Eye Health Alliance, the College<br />

of Optometrists and a number of<br />

other optics groups who use the<br />

website to inform ‘followers’ on the<br />

latest news and developments.<br />

Students get<br />

smoking insight<br />

Students in the Nottinghamshire<br />

area have been told of the links of<br />

smoking and sight loss – by seeing<br />

themselves as smokers aged 70. The<br />

RNIB’s ‘virtual ageing photo booth’<br />

went to three colleges to coincide<br />

with National Eye Health Week as<br />

part of Nottingham’s Sight Matters<br />

Week. Barbara McLaughlan, RNIB’s<br />

eye health campaigns manager,<br />

said: “Our focus is on younger<br />

people because we want to show<br />

them, in a very tangible way, how<br />

their lifestyle choices may affect<br />

their risk of developing eye disease<br />

in later life.”<br />

OGS donates £2k<br />

Optical charity <strong>Optometry</strong> Giving<br />

Sight has given a £2,000 grant<br />

to enable five Cardiff-based<br />

optometrists and 10 students<br />

to take part in the Romania and<br />

Moldova Vision Project later<br />

<strong>this</strong> summer. The project, which<br />

has been running for nine years<br />

extended into Moldova last year,<br />

and has already provided 10,000<br />

people with vision care. While there,<br />

the Cardiff University students<br />

aim to provide vision care to over<br />

2,000 impoverished people of all<br />

ages; spending time in orphanages,<br />

churches and schools.<br />

Cardiff student Juliet Ashwell, said:<br />

“It’s a very exciting challenge and<br />

we’re grateful for the financial<br />

contribution. It will help us<br />

significantly improve quality of life<br />

for thousands of people.”<br />

Eye Week highlighted<br />

THE EYECARE TRUST used <strong>this</strong><br />

week’s National Eye Health<br />

Week to raise the profile<br />

of vision <strong>issue</strong>s, including<br />

contributing to a vision<br />

supplement in The Guardian<br />

newspaper.<br />

Published in the newspaper<br />

on June 13, the vision and<br />

hearing supplement featured<br />

items on glaucoma, the<br />

importance of regular sight<br />

testing for children and also<br />

covered advances in laser eye<br />

surgery.<br />

Other initiatives by the Trust<br />

include the launch of ‘A guide<br />


and sunglasses company<br />

Fabris Lane has announced it<br />

is looking to expand – and is<br />

actively seeking to purchase an<br />

established optical distribution<br />

business.<br />

Managing director Tim<br />

Downes explained that with a<br />

strong growth in sales the time<br />

is right for the firm to grow to<br />

‘the next level’.<br />

He said: “We believe the<br />

most expedient path is through<br />

to summer eye care’, attending<br />

regional events and producing a<br />

practitioner resource pack.<br />

The resource pack for<br />

optometrists has been produced<br />

in association with one of the<br />

lead sponsors of the Week,<br />

Simplyhealth. It includes: A<br />

poster, pocket guides and a<br />

handbook highlighting ways<br />

of caring for eyes when using<br />

a computer, a door panel for<br />

practices promoting the concept<br />

of affordable eye care, template<br />

press releases and a quiz for<br />

patients.<br />

Chair of the Eyecare Trust,<br />

BOOTS OPTICIANS has launched a campaign to encourage parents<br />

to make sure their children wear adequate sunglasses, and highlight<br />

the dangers of UV. The initiative, launched by the multiple last week,<br />

includes a video made with its celebrity ‘ambassador’ actress Patsy<br />

Kensit (pictured with a child sunglasses wearer) outlining some of<br />

the main <strong>issue</strong>s parents appear unaware of according to a new survey.<br />

The video theme centres on: 80% of UV damage happens by<br />

the age of 18 and that only around half of parents put their children<br />

in sunglasses in sunny weather, compared to 86% who will apply<br />

sun cream in the same weather. It is available to parents on website<br />

youtube, and the multiple also plans to market it to ‘mummy<br />

bloggers’ in the hope they will promote the message in the coming<br />

weeks.<br />

Dharmesh Patel, said: “National<br />

Eye Health Week is an important<br />

event in the optical calendar and<br />

the trust will be working hard<br />

to help lift optics up the public<br />

health agenda with a series of<br />

high profile promotions and<br />

more locally targeted events such<br />

as our attendance at the Ryedale<br />

Sight Support Open Day.”<br />

Packs are currently being<br />

sent out to supporters of the<br />

Trust.For further information<br />

about becoming a Friend of the<br />

Trust contact Melissa Reeds on<br />

0845 129 5001 or email info@<br />

eyecaretrust.org.uk<br />

Fabris now looks to acquire<br />

acquisition and we are looking<br />

to acquire a well respected<br />

company with an established<br />

sales structure, which may also<br />

licence some strong consumer<br />

brands. Being in a cash-positive<br />

position we would fund<br />

any purchase from existing<br />

resources.<br />

“Our customer service<br />

facility, extensive quality<br />

testing laboratories, and<br />

fully integrated EDI and<br />

bespoke stock management<br />

warehousing, which ships<br />

thousands of frames around<br />

the world each day, supports<br />

sales into 35 countries.<br />

“We have the means,<br />

and desire, to bring further<br />

eyewear products to market.”<br />

Actress helps multiple<br />

Geoff Caddick/PA Wire

Do your astigmatic patients<br />

experience fluctuating vision?<br />

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

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

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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.


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I have some important firsthand<br />

advice on your OSCEs<br />

14<br />

17/06/11 PRE-REG FOCUS<br />

AND SO the end begins; it’s almost<br />

time to take those last steps to<br />

become fully qualifed, writes<br />

optometrist Nadeem Rob (pictured)<br />

as he reflects on taking his OSCE.<br />

You may not choose to believe me<br />

but the hardest part was over when<br />

you passed your Stage 2. The only<br />

obstacle left that stands in your way<br />

now are 60 minutes of practical<br />

exams.<br />

Here are my tips to making it<br />

through the OSCEs.<br />

Obvious<br />

Be obvious. Try not to over<br />

complicate things and keep things<br />

simple. This is not always as easy as<br />

it sounds, but complicating things<br />

will only get you in a muddle and<br />

confuse the examiner beyond their<br />

tolerance. This tip comes in handy with<br />

stations like data interpretation. To start off,<br />

just say what you see or hear. If it’s a field<br />

plot, describe through the data logically<br />

as you normally would. If you’ve taken<br />

everything in over your pre-registration<br />

period, while describing through the data<br />

you will get that ‘light bulb’ moment.<br />

Smart<br />

Be smart. It’s an exam with clinical cases.<br />

The potential for the type of patient is<br />

endless but being smart in your revision<br />

can make all the difference. Know your<br />

more common disorders inside out as<br />

more often than not it will be one of these.<br />

Remember, the exams are in place to see if<br />

you are competent in everyday practice.<br />

Ideally you should be able to diagnosis<br />

everything, but realistically that’s<br />

impossible. If you haven’t a clue, make<br />

an intuitive suggestion. Any answer is<br />

better than no answer.<br />

Confident<br />

Be confident. By oozing <strong>this</strong> you will<br />

instil confidence in your patient and<br />

conseqently your examiner. No patient<br />

wants a bumbling, sweaty palmed<br />

practitioner looking after their eyes.<br />

Naturally nerves will kick in, but have a<br />

certain degree of confidence in yourself<br />

and your training. The past year has<br />

effectively been a dress rehearsal for<br />

these individual stations. Now it’s time<br />

to step up.<br />

Efficient<br />

Be efficient. This allows you to look<br />

and sound like you know what you’re<br />

talking about. Remember you have<br />

five minutes for each station and <strong>this</strong><br />

time will race by. When you’re running<br />

through data or doing a history and<br />

symptoms, be ready to be flexible<br />

and adapt to whatever gets thrown<br />

at you. Practice explaining different<br />

disorders in simple everyday terms to<br />

your non-optometry related friends.<br />

This is much more difficult than it<br />

sounds and I would advise everyone<br />

to have a rough script ready for each<br />

problem as your patient actors will<br />

ask you about anything that is even a<br />

little technical.<br />

Success lies in the preparation.<br />

Revising for the OSCE can be difficult.<br />

My last piece of advice is to make up<br />

a group of case studies of your own.<br />

Choose certain disorders and write<br />

down what you think a patient would<br />

say in their history and symptoms. Then<br />

come up with signs that you would see<br />

in patients with these disorders. Follow<br />

that up with possible investigations<br />

which are relevant to the disease and<br />

a list of differential diagnoses. Finally,<br />

finish with your possible management<br />

decisions which should include the<br />

correct referral if required or a recall date.<br />

By logically breaking down each disorder<br />

you can efficiently recall them during a<br />

station.<br />

But remember; be Obvious, Smart,<br />

Confident, and Efficient – my version of<br />

the OSCEs.<br />

Good Luck.<br />

• Keep up-to-date with all things prereg<br />

related on the new student AOP<br />

website at www.studentaop.org.uk/<br />


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16<br />

17/06/11 BACKGROUND<br />

AOP secures<br />

victory in field<br />

screeners<br />

challenge<br />

THE AOP initiated a Judicial<br />

Review over a decision by a<br />

number of PCTs in the south<br />

west to refuse a contract to an<br />

optometrist who did not have a<br />

portable electronic visual field<br />

screener to use on domiciliary<br />

visits.<br />

However, since the legal<br />

challenge, the PCTs involved have<br />

withdrawn their requirement and<br />

the AOP has therefore withdrawn<br />

the Judicial Review proceedings.<br />

Devon-based optometrist and<br />

AOP member, James Faverty,<br />

was refused a domiciliary contract by Devon PCT because<br />

he did not possess a mobile electronic visual field screener<br />

(eVFS). Mr Faverty approached the AOP for advice and<br />

the Association immediately protested to the PCT, on the<br />

grounds that there was no contractual requirement for a<br />

domiciliary provider to possess or use an eVFS.<br />

Three-month deadline<br />

Devon PCT acted on behalf of several other PCTs in the area<br />

– Cornwall and the Isles of Scilly, Somerset, Bristol, Dorset,<br />

North Somerset, Torbay and Plymouth – in the matter of the<br />

contract application and, with the exception of Bristol, then<br />

acted together to write<br />

to all practitioners on<br />

their lists, requiring<br />

those who carry out<br />

domiciliary visits to<br />

ensure they had eVFSs,<br />

giving them a threemonth<br />

deadline to<br />

acquire one if they did<br />

not possess one. This<br />

was despite the fact<br />

they knew that Devon<br />

PCT was in discussion<br />

with the AOP over the<br />

legality of its actions<br />

with respect to Mr<br />

Faverty.<br />

AOP director of<br />

legal services, Gerda Goldinger (pictured) stated: “This was a<br />

hugely inflammatory course of action for the PCTs to take. The<br />

AOP’s legal challenge had been made, yet they tried to force a<br />

large number of practitioners to purchase portable electronic<br />

visual field screeners by a deadline that would fall before any<br />

judicial proceedings could be heard, let alone decided. They<br />

knew full well that, if the legality of their decision was not<br />

upheld, those practitioners would have spent their money on<br />

unnecessary equipment; yet they went ahead regardless.”<br />

The AOP carried out a poll of practitioners in the south west<br />

“This is clear evidence that peer<br />

practice… is that eVFSs are not<br />

used routinely”<br />

and was able to confirm that few practitioners had portable<br />

eVFSs – just over 10% – and less than 3% actually used one<br />

while carrying out a domiciliary visit. Ms Goldinger reasoned:<br />

“This is clear evidence that peer practice – which is the<br />

standard by which optometrists will be judged – is that eVFSs<br />

are not used routinely.”<br />

Consequently, the AOP launched a Judicial Review of<br />

the decision by the PCTs to make <strong>this</strong> unreasonable<br />

requirement of practitioners. In order to further build its<br />

case, the AOP consulted its members across England and<br />

Wales. In a survey reported in OT (March 25 pages 42-43),<br />

practitioners stated they did not have such equipment and<br />

that the vast majority of their patients would be unable to<br />

undertake the test.<br />

To nominate for the AOP Awards go to www.optometry.co.uk/awards

667<br />

practitioners<br />

responded<br />

In total, 667<br />

practitioners<br />

responded to the<br />

survey saying<br />

they carried out<br />

domiciliary visits;<br />

and only 18% of<br />

them said that they<br />

had access to an<br />

eVFS. Of those,<br />

77% stated they<br />

“rarely or never”<br />

take it with them<br />

to a domiciliary<br />

visit. Of those<br />

who take the eVFS<br />

with them, only 6% said they use it “always or frequently”,<br />

with 94% using it “rarely or never”. In other words, of 667<br />

domiciliary practitioners, only five take an eVFS with them<br />

and use it frequently – less than 1% of those who undertake<br />

domiciliary visits.<br />

“This was the AOP doing what<br />

it does best – battling for its<br />

members”<br />

Additionally, half of the practitioners felt that just 10% or<br />

fewer of their patients were capable of completing such a test<br />

meaningfully.<br />

Furthermore, the action taken by the PCTs was likely to<br />

lower the level of patient care. Only 3.4% of practitioners<br />

said they would be prepared to buy an eVFS, whilst 58%<br />

said they would stop doing domiciliary visits altogether if<br />

one was required. As Trevor Warburton (pictured left), the<br />

AOP legal department’s clinical adviser and a practice owner<br />

based in Stockport, pointed out: “Taking action that could<br />

result in almost 60% of domiciliary test providers giving up<br />

visits was hardly likely to improve the eye care provided to a<br />

vulnerable sector of the community.”<br />

Expressing his gratitude to the practitioners who<br />

responded to the survey, David Craig, AOP director<br />

of operations, (pictured above) said: “The number of<br />

optometrists who responded was fantastic and played a<br />

really big part in enabling us to establish that the peer view<br />

backed up our position. So we are really grateful to all those<br />

who helped – their contribution has had a genuine role<br />

in protecting the profession from creeping regulation and<br />

legislation.<br />

“All of us at the AOP were moved also by the expressions<br />

of support that we received from practitioners all over the<br />

country – some of whom did not do visits themselves but<br />

recognised and supported our fight to protect their colleagues<br />

from unjust and foolish regulation.<br />

“This was the AOP doing what it does best – battling<br />

for its members.”<br />

Reflecting on the situation, Mr Faverty commented:<br />

“It would have been much less stressful to just purchase<br />

the eVFS, but after much soul searching I felt it was an<br />

unreasonable requirement. I also wanted to fight the potential<br />

precedent of local guidelines superseding those established<br />

nationally.”<br />

In the meantime, the PCTs involved have stated they<br />

intend to consult about eVFSs and said their “guidance”<br />

continues to advise the use of eVFSs. The AOP notes that <strong>this</strong><br />

guidance quotes extensively from the College guidance for<br />

the routine eye examination and not at all from the guidance<br />

on domiciliary eye examinations.<br />

The Association is happy to have guidance <strong>issue</strong>d for<br />

domiciliary eye exams and indeed, the Domiciliary Eyecare<br />

Committee have done so. However, eVFSs are “gold<br />

standard” and not a mandatory requirement. Mr Warburton<br />

added that the AOP looks forward to seeing the PCTs’<br />

consultation process – and even hopes that the AOP can<br />

contribute.<br />

The AOP is currently considering whether practitioners<br />

who have bought equipment unnecessarily, as a result of the<br />

requirement <strong>issue</strong>d by the PCTs, may have legal grounds to<br />

request compensation from the PCT.<br />

Mr Faverty added: “I would encourage any practitioner<br />

who feels its PCT or optometric advisor is imposing<br />

unreasonable regulations or guidelines to contact their LOC<br />

and the AOP for advice.<br />

“The support I received from the AOP was fantastic and I<br />

wish to thank them again for all their help.”<br />

• This article appeared on our website, www.optometry.<br />

co.uk earlier <strong>this</strong> month.<br />

17<br />

17/06/11 BACKGROUND<br />

To nominate for the AOP Awards go to www.optometry.co.uk/awards


20 Questions – Nick Atkins<br />

The Independents Day organiser Nick Atkins is the latest to take our Q&A<br />

18<br />

17/06/11 20 QUESTIONS<br />

How are you?<br />

Well and busy. Trying to keep up with my<br />

various business interests, in particular<br />

preparations for Independents Day.<br />

What can delegates expect<br />

from Independents Day?<br />

This year David (Goad) and I have<br />

introduced some new initiatives including<br />

a free-to-attend Title Sponsor Mini-<br />

Symposium on the Sunday before ID, that<br />

is open to all independents regardless of<br />

ID attendance. There are new interactive<br />

Skills Workshops on how to practice<br />

PR, better merchandise, increase sales<br />

through more effective communication.<br />

How is business generally?<br />

I must say that my businesses are very<br />

buoyant. Positive Impact, the contract<br />

sales company I set-up with Maxine<br />

Green continues to bring in new clients.<br />

And following success using the model<br />

sending professional colleagues to deliver<br />

over 4,000 in-practice training sessions on<br />

behalf of a couple of clients, we launched<br />

our own service for independent practices<br />

at Optrafair.<br />

What do you like about<br />

working in optics?<br />

The people I have met and friends I’ve<br />

made in the last 30 years.<br />

What’s the best thing that’s<br />

happened in the optics during<br />

your time working in it?<br />

Scrapping of the free eye exam for all. It<br />

made everyone focus on what we offer<br />

and working harder to promote<br />

it through the delivery of even better<br />

eye care.<br />

Who do you admire in the<br />

sector?<br />

Whilst perhaps not the most popular<br />

choice, I’m sure, I have to say Specsavers.<br />

Whether you like what they do or not it<br />

is impossible to argue that the general<br />

public is far more aware of the need for<br />

our profession as a result of what they<br />

have done in the last 20 years. Who<br />

would have thought that an optician’s<br />

advertising strap-line would become<br />

such common parlance.<br />

Where are your favourite<br />

places in the world that optics<br />

has taken you?<br />

Kula Lumpa as an ABDO Contact Lens<br />

Practical Examiner.<br />

Are you superstitious?<br />

No. I never buy a lottery ticket as I believe<br />

the only way to wealth is to earn it!<br />

If you were granted one wish<br />

for the profession what would<br />

you wish for?<br />

That we continue to work together as<br />

one ‘optical’ profession to make people<br />

truly value the excellent service we<br />

provide. And that starts with every<br />

individual practitioner acting as an<br />

ambassador for our profession every day<br />

Do you have a favourite film?<br />

I’ve always loved sci-fi films and so it<br />

must be Independence Day.<br />

What are your hobbies?<br />

Watching Portsmouth FC, mountain<br />

biking, music gigging and, rarely these<br />

days, trying to improve my drumming.<br />

Sum up your feelings for the<br />

next 12 months in five words.<br />

The future is bright – that’s only four!<br />

Where do you go on holiday?<br />

I love the UK as its beauty is right on the<br />

door-step.<br />

What are your favourite<br />

products in the optical sector?<br />

Multi-purpose contact lens solutions.<br />

Their formulations are more complex<br />

than many drugs and the importance<br />

of their role in safe contact lens wear<br />

should never be underestimated.<br />

If you weren’t in optics what<br />

would you be doing?<br />

Not sure, as with a father who was a DO, I<br />

think it was prewritten. But when I retire I<br />

want to be a volunteer forest ranger!<br />

What’s your favourite singer<br />

or musical group?<br />

I’m an old punk rocker and I’m looking<br />

forward to Kings of Leon, Foo Fighters<br />

and Kasabian at the Isle of Wight Festival.<br />

What do you put down your<br />

success down to?<br />

Nothing but a bit of imagination and<br />

good old fashioned hard work.<br />

Favourite time of year?<br />

Autumn – a gloriously beautiful and<br />

uniquely English time of year.<br />

Your perfect day?<br />

Probably out on my bike in the heart of<br />

the countryside.<br />

Any final thoughts?<br />

Real difficulties can be overcome,<br />

it’s only imaginary ones that are<br />



Live: June & July<br />

Want to maximise your business?<br />

Then join leading business consultants<br />

and participate in an interactive<br />

discussion, debate and live Q&A session<br />

from the comfort of your home!<br />

Ahead of the game: The benefits of professional<br />

fees based pricing.<br />

Shelly Bansal, 7pm, Monday, 20th June 2011<br />

Make it happen: A step by step guide to<br />

professional fees based pricing.<br />

Martin Russ, 7pm, Monday, 11th July 2011<br />

Open to Eyecare Professional throughout the UK and Ireland. Interested delegates are invited to visit<br />

www.cibavisionacademy.co.uk<br />

© CIBA VISION (UK) Ltd, a Novartis company, 2011. The Fit for Life logo, CIBA VISION and the CIBA VISION logo are trademarks of Novartis AG.



20<br />

17/06/11 INDUSTRY NEWS<br />

Partners in signs<br />

Optimed celebrated an industry partnership<br />

with Topcon GB, one of the UK’s leading<br />

manufacturers and suppliers of ophthalmic<br />

instruments, OCTs, fundus cameras, practice<br />

management software and accessories at the<br />

BCLA clinical conference and exhibition in<br />

Manchester.<br />

Topcon will provide Optimed’s i-Vue waiting<br />

area display signage (pictured above) primarily<br />

for all 3D OCT purchases within the UK and<br />

Ireland and CAPTIV8 chair-side education and<br />

marketing software (pictured below) will be<br />

offered fully integrated as part of Topcon’s new<br />

I-Clarity practice management software.<br />

Topcon’s medical director, Andy Yorke, said:<br />

“The added value to our after sales customer<br />

support package will be very much enhanced<br />

by the i-Vue software package and will provide<br />

a fantastic patient information platform when<br />

introducing OCT for the first time into clinical<br />

practice.<br />

“The option to add CAPTIV8 to our new<br />

PMS software, I-Clarity, will add an extremely<br />

unique and dynamic additive software platform<br />

to our package, which will enhance practice<br />

development and profitability.”<br />

CAPTIV8 is a marketing and communications<br />

tool, which gives the practitioner the ability to<br />

draw over film during chair-side consultations.<br />

All the animations can be shared and viewed by<br />

the patient at home.<br />

Optimed director, Dr Trusit Dave said:“I<br />

believe that the combination of Topcon’s<br />

amazing technology and our state-of-theart<br />

communication software will mean that<br />

practitioners now have the ability to successfully<br />

promote devices like OCT to their patients and<br />

fully underscores Topcon’s commitment to<br />

offering ‘not just OCT’ but the ability to make OCT<br />

a worthwhile investment in practice”.<br />

02476 444118<br />

• Interview on www.optometry.co.uk<br />

Targeted dry eyes<br />

relief<br />

BAUSCH & LOMB launched three new<br />

innovative formulations of its Artelac<br />

range of dry eye solutions at the BCLA<br />

conference in Manchester, targeting<br />

patients’ specific needs and age ranges.<br />

Artelac Splash, Artelac Rebalance and<br />

Artelac Nighttime Gel are designed to<br />

manage the symptoms for dry eye by stabilising the tear film to break the dry eye cycle.<br />

Instant relief for environmentally dry eyes is offered by Artelac Splash, (pictured) a preservativefree<br />

eye drop containing the natural lubricant hyaluronic acid (HA). It is designed for those with<br />

dry eyes caused by computer use, lifestyle, air-controlled environments, a lack of blinking and dry,<br />

windy outdoor environments. It is available in single-dose units for convenience and in packs of<br />

30 or 60. Artelac Rebalance is a combination of tear film stabilising agents to help older patients<br />

with chronic tear dysfunction and is said to offer long-lasting relief with no blurring effect. The<br />

inclusion of mineral nutrients naturally found in healthy tears and vitamin B12 supplement<br />

the tear film to promote a healthy ocular environment where epithelial cells can begin to heal<br />

themselves. For patients with lipid deficiency, an inability to close their eyelids, or those with<br />

more severe chronic dry eye symptoms, Artelac Nighttime Gel seals in moisture for additional<br />

protection, and it is designed for those needing a little more relief.<br />

0845 602 2350

Stepping<br />

into the sun<br />

FRAMES COMPANY Stepper has launched<br />

its first sunglasses collection at the BCLA<br />

clinical conference and exhibition.<br />

The new sunglass range is fully<br />

glazeable and is designed to give<br />

prescription spectacles wearers the<br />

look of fashion sunglasses but with the<br />

fit, comfort and style that Stepper is<br />

known for.<br />

There are 10 sunglasses in the new<br />

range, each available in two colours,<br />

some with intricate jewels and diamante<br />

detailing on the arms.<br />

01732 375975<br />

Software offer<br />

extended<br />

ORASIS, which launched its new<br />

contact lens and clinical modules at<br />

Optrafair, has extended its special offers<br />

until the end of <strong>this</strong> month, including<br />

free data transfer and the buy-one-getone-free<br />

module.<br />

Director Linus Mason, felt that, after<br />

talking to one practice owner who hadn’t<br />

even opened his ‘bags’ from Optrafair,<br />

decision makers needed a bit more time<br />

“to gather all their information on the<br />

numerous systems available for the<br />

optical market”.<br />

The Midlands-based company believes<br />

that the Orasis system is very easy to use<br />

due to its ‘uncluttered’ screen. “Using<br />

the latest technology, <strong>this</strong> non Web-based<br />

system will make a real difference to the<br />

independent practice,” said Mr Mason.<br />

Anyone interested in the Optrafair<br />

offers, or a demonstration, can email<br />

sales@orasisnet.co.uk or view the<br />

website www.orasisnet.co.uk.<br />

01527 834740<br />

World-first in torics<br />

BRITISH contact lens and solutions<br />

manufacturer Sauflon has launched<br />

Clariti 1day toric – the world’s first<br />

silicone hydrogel daily disposable<br />

toric contact lens. It will be available<br />

exclusively to eye care professionals<br />

to encourage patient loyalty.<br />

The launch at the BCLA clinical<br />

conference and exhibition follows the launch in 2009 of the award-winning silicone hydrogel<br />

daily disposable lens, Clariti 1day. It has been very successful, enabling practitioners to upgrade<br />

their patients from older technology, allowing them to wear their lenses for longer, whilst<br />

improving ocular health. Sauflon has positioned Clariti 1day toric as a premium product which<br />

patients can be upgraded into for little, or no, extra cost. “We are very proud to be launching<br />

the world’s first silicone hydrogel daily disposable toric lens,” said Sauflon’s UK sales director,<br />

Bradley Wells. “This unique lens will enable eye care professionals to fit their astigmatic patients<br />

with the safest modality and the healthiest material and improve end of day comfort. The<br />

product’s positioning allows for an easy upgrade from the older conventional hydrogel lenses<br />

into Clariti 1day toric, leading to improved end of day comfort and greater patient retention.”<br />

As with Clariti 1day, the new toric lens uses Sauflon’s patented manufacturing process,<br />

AquaGen, for a highly wettable lens surface combined with low modulus and high water<br />

content for added comfort. Clariti 1day toric is available in all minus powers, plano to -6.00<br />

(0.25 steps) and -6.50 to -8.00 (0.50 steps) with 2 cylinders, -0.75 and -1.25 at axis of 90 and 180,<br />

and 20 degrees either side.<br />

020 8322 4222<br />

Feminine touch added<br />

DUNELM OPTICAL has launched a new collection from top designer John Rocha which<br />

steers away from his usual unisex style, instead focusing on embellishment inspired by his<br />

jewellery collections. The new feminine range has six styles with detailed sides and temples,<br />

made up of floral, diamante and cut out patterns on classic brown, white and black frames.<br />

The styles range from delicate minimal frames to bold retro designs.<br />

Alongside the launch, Dunelm has also introduced a John Rocha gold membership<br />

scheme, which runs until August 31 and works on a volume discount basis. Customers who<br />

purchase 10 or more John Rocha frames will receive a 10% discount, and those who buy 30<br />

or more will receive a 20% discount. They will also automatically become<br />

gold members and be in with the chance of winning four tickets to<br />

visit London Fashion Week next year.<br />

Dunelm director, Peter Beaumont, said:<br />

“It’s fantastic to see a female-focused<br />

collection from John Rocha <strong>this</strong><br />

season. We’ve seen jewellery<br />

inspired designs really<br />

take off over the<br />

past year, and<br />

these latest<br />

styles put<br />

the Rocha<br />

optical<br />

range<br />

at the<br />

forefront of<br />

that.”<br />

01388 420420<br />

21<br />



22<br />

17/06/11 DRIVERS’ VISION<br />

Fresh call for<br />

UK to improve<br />

testing drivers’<br />

eyesight<br />

A NEW REPORT has found that the UK<br />

lags behind other European countries<br />

in its requirements for testing drivers’<br />

eyesight.<br />

The report, by optical sector groups<br />


highlights substantial variation in the<br />

assessment of drivers’ vision across<br />

Europe, and recommends that member<br />

states – including the UK – act to better<br />

assess drivers’ vision.<br />

While many European countries have<br />

good systems in place to assess all drivers’<br />

vision, the report notes that the UK and a<br />

small number of other countries continue<br />

to rely on what many consider to be<br />

an outdated assessment of vision – the<br />

‘Licence Plate Test’ – which is thought<br />

not to be consistent with the underlying<br />

standards.<br />

Among the proposals put forward by<br />

the UK government in its consultation<br />

response, is to retain the Licence Plate<br />

Test for car and motorcycle drivers and<br />

to lower the current eyesight standard<br />

by reducing the distance at which the<br />

licence plate is read. In addition, the UK,<br />

along with France, Germany and four<br />

other countries, has no requirement<br />

for ongoing assessment of vision for<br />

these drivers, which is seen as a missed<br />

opportunity to improve road safety.<br />

The report also recommends that the<br />

European Commission press the member<br />

states that are dragging their feet to<br />

implement better screening of drivers’<br />

vision before issuing a first licence, and<br />

when renewing a driving licence.<br />

With the EU committed to halving<br />

road deaths across the European Union<br />

by 2020, the aim is to achieve <strong>this</strong> by<br />

legislative means that changes driver<br />

behaviour, as well as raising the technical<br />

standards of vehicles and improving road<br />

designs. The visual requirements to drive<br />

safely in European law are currently being<br />

implemented by EU members states,<br />

including the UK, which lately launched a<br />

consultation on the matter.<br />

On behalf of the Optical Confederation<br />

Jayne Rawlinson said: “The UK is at the<br />

bottom of the league when it comes to<br />

assessing drivers’ eyesight. We have been<br />

working to achieve better vision for safer<br />

driving in the UK and greatly value the<br />

support we have received from other<br />

road safety groups. We hope the UK<br />

Government will use <strong>this</strong> opportunity to<br />

ensure everyone drives with good vision.”<br />

Mark Nevin, spokesman for ECOO<br />

said: “The European Commission should<br />

be alert to those member states that<br />

are dragging their feet and refusing to<br />

implement appropriate assessments of<br />

vision, before issuing a first licence and<br />

during the driving career. Given that<br />

90% of sensory information when driving<br />

comes from vision, and poor vision<br />

impacts on driving performance, <strong>this</strong><br />

must be an area with potential to deliver<br />

improvements in road safety.”<br />

• The Report can be found online at:<br />


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Accessorising<br />

your profits<br />

24<br />

17/06/11 ACCESSOSRIES<br />

From novelty contact lens and spectacle cases to prescription goggles<br />

and much more, offering useful accessories in your practice can help<br />

boost add on sales and increase profits. OT looks at what’s on offer<br />

Optipak<br />

Optipak is offering the child and young at heart adult contact lens wearers<br />

amongst your patients a ‘fun and practical’ way to keep their contact<br />

lenses safe – the 3D contact lens case (pictured).<br />

Ideal for storing and carrying lenses around in when on the<br />

go, the case comes with an accompanying keyring attachment,<br />

whilst its 3D design makes it easy to identify between the right and<br />

left contacts. The case is available in a number of quirky animal characters<br />

including a Duck, Fish, Turtle, Ladybird and Dolphin, as well as an Eye Ball.<br />

0208 322 4210<br />

Dibble Optical<br />

Having launched its latest accessories catalogue just last<br />

month, Dibble Optical has a wide variety of new and useful<br />

products on offer.<br />

As the largest supplier of prescription swimming goggles<br />

and diving masks in the UK ,the company has launched<br />

several new models to supplement its Optiswim and Tusa<br />

View collections. Pictured is the 945901 children’s swimming<br />

goggle, which have a power range of +6.0 to -7.0D and come<br />

with a multi-purpose case that spectacle<br />

wearers can use to store their<br />

frames whilst swimming as<br />

standard.<br />

01634<br />

880885<br />

Hilco<br />

It’s very important for independent practices to build a long-lasting relationship<br />

with their patients in order to retain them and increasing brand awareness is one<br />

way <strong>this</strong> can be achieved. Offering practice owners a simple way to do <strong>this</strong> is<br />

Hilco with its personalised spectacle cases and lens cleaners.<br />

Practice information, such as the name, address and telephone number, can<br />

now be printed on several of the company’s popular case styles. Personalisation<br />

is offered free of charge, with the information available to be printed in black or<br />

white text, on the inside or outside of the case – silver or gold text can be printed<br />

on the outside also. A minimum order of 100 applies.<br />

In addition to being able to offer customisation on Hilco’s lens cleaning sprays,<br />

a new bottle design with a focus on colour has been introduced. The compact<br />

35ml bottles come in blue, green, yellow and clear.<br />

01453 761 900<br />

Caseco<br />

Casco has introduced a wide variety of new spectacle cases,<br />

from the larger hard top to the small more feminine<br />

cases and soft wallets.<br />

The ECURVEMAX-sparcle (pictured) is a<br />

large case suitable for bigger frames and<br />

sunglasses and has a ‘sparkly’ finish.<br />

Whilst the J5-spot is a soft touch<br />

‘fun, tactile and sophisticated’<br />

case featuring polka dots.<br />

Casco also supplies a<br />

colourful, soft wallet case<br />

which comes with a microfibre<br />

cloth and is available in six colours.<br />

01580 890111

This independent optician grew<br />

his practices by 18% last year<br />

– you can do the same with <strong>this</strong><br />

FREE practice marketing book<br />

Claim your FREE paperback copy of a<br />

new book on opticians marketing<br />

A<br />

new book that was officially launched at Optrafair<br />

earlier <strong>this</strong> year reveals how any independent<br />

optician can achieve double digit growth in<br />

their practice over the next 12 months.<br />

“It’s Time to Fight Back” has been written<br />

by Richard Pakey FBDO, and looks at the<br />

need to focus on 12 key practice growth and<br />

marketing areas.<br />

Richard is the successful owner of two independent<br />

practices in Essex and Hertfordshire.<br />

He is also behind an exciting business<br />

called Independent Practice Growth UK.<br />

Together with an experienced team of<br />

writers, web experts and marketers, he’s<br />

working closely with a number of optoms,<br />

helping them grow their business.<br />

Richard said: “It’s been an unbelievably<br />

tough couple of years to be an independent<br />

optician.<br />

“The multiples are successfully using a<br />

mix of marketing methods that are becoming increasingly<br />

aggressive. In most cases they are targeting each<br />

other but of course independents are being caught in<br />

the crossfire, affecting revenues.<br />

“The economy continues to be depressed with no upturn<br />

in sight, meaning people are continuing to put off<br />

eye tests.<br />

“And to top it all off, the glasses websites have added<br />

further pressure and continued to speed up the commoditisation<br />

of the market, by encouraging the dreaded<br />

‘prescription-only’ client.”<br />

SUCCESS: Richard<br />

Pakey FBDO says it’s<br />

time to fight back<br />

against the recession<br />

and the multiples<br />

Despite these crippling challenges, Richard is surprisingly<br />

upbeat about the opportunities for the independent<br />

sector.<br />

He said: “I’ve seen my two practices grow by 18%<br />

over the last year.<br />

“I’m no better an optician than most, but<br />

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EVENTS<br />

Demystifying<br />

dyslexia<br />

Optometrist Kate McMahon writes about last<br />

month’s course aimed to help demystify dyslexia<br />


latest course on<br />

‘Managing Dyslexia<br />

in Your Practice’ was<br />

well-attended by<br />

practitioners.<br />

The Watford-based<br />

event, which took<br />

place at the town’s<br />

Ramada Jarvis Hotel,<br />

followed the success of a similar day-long event at the Hilton<br />

Hotel, Birmingham in February. A total of seven CET points<br />

were available at the day-long event, which again included<br />

C3Rs training for participants.<br />

C3Rs is a new company using The Versatile Trackograph<br />

system, a patented, easy-to-use, system to benefit those with<br />

reading difficulties.<br />

27<br />

17/06/11 DYSLEXIA DAY<br />

Dyspraxia used to be called the<br />

‘clumsy child syndrome’<br />

Its holistic approach is user friendly and ‘practice building’,<br />

and the aim of the system to make reading fun, enjoyable and<br />

to remove the stress.<br />

The day was divided up into lectures in the morning, based<br />

on ‘Recognition, Research & Resolution’, and a workshop in<br />

the afternoon.<br />

The lectures covered an introduction to dyslexia, visual<br />

stress and associated conditions, some of which, like<br />

dyspraxia, are closely linked to dyslexia.<br />

Dyspraxia used to be called the ‘clumsy child syndrome’<br />

and indicates co-ordination difficulties. Helping to overcome<br />

these difficulties forms the basis of associated sports vision<br />

exercises.<br />

Continued on page 29

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EVENTS<br />

Continued from page 27<br />

Computer Vision Syndrome<br />

(CVS) was also covered and<br />

included how the Vistamesh<br />

lens has had a dramatic effect<br />

for a number of patients<br />

suffering visual stress.<br />

This was followed by an indepth<br />

look at anatomy, effects<br />

of light, facts and figures,<br />

solutions and getting started. It<br />

included up-to-date research,<br />

and the facts and figures to<br />

empower practitioners enabling<br />

them to answer questions<br />

and have a greater understanding of their dyslexic<br />

patients and their concerned families.<br />

Case histories were also reviewed, giving an insight into<br />

how we can work with colleagues and make a difference to<br />

young lives. For instance, one family was said to be grateful<br />

for ‘getting their son back’, and, with regards to another<br />

patient, a mother said she was ‘over the moon’ that her<br />

daughter was now out of special needs.<br />

The morning session concluded with a presentation by<br />

Raglan Sanders, an education expert, on the best ways<br />

to approach schools. A schools pack was provided to all<br />

delegates to aid their introduction to headteachers, teachers<br />

and SENCOs (Special Educational Needs Coordinators).<br />

The day’s workshop session began with an overview<br />

about prescribing and various binocular vision techniques<br />

and exercises followed by an<br />

introduction to Sports Vision and<br />

Colour Vision.<br />

A DVD which demonstrated<br />

how to use the C3Rs system,<br />

before a ‘hands-on’ session using<br />

the Versatile Trackograph system.<br />

Vision screening<br />

C3Rs also provides a Business<br />

Model, and appointment times<br />

and all charges are merely<br />

suggestions and entirely at the<br />

discretion of the practitioner,<br />

but form a helpful guide to the<br />

possibilities. A register of practitioners on the C3Rs web site<br />

is being complied and there is a follow-up programme in<br />

place.<br />

The demise of the children’s vision screening programme<br />

in schools has left a vacuum that the optical profession is<br />

ideally placed to fill.<br />

Both the optical and national press have noted with<br />

concern children’s vision and literacy levels. This new<br />

approach of C3Rs can benefit patient and practice alike by<br />

raising practice profile, providing increased job satisfaction,<br />

offering a new career path – especially for dispensing<br />

opticians – and at the same time providing a much needed<br />

service in the community.<br />

• For further information go to the C3Rs website<br />

www.c3rs.co.uk/default.aspx<br />

29<br />


REVIEW<br />

BCLA’s variety on<br />

show in Manchester<br />

OT Clinical Editor Dr Navneet Gupta and AOP Education Advisor Karen Sparrow report on <strong>this</strong><br />

year’s clinical conference and exhibition<br />

30 28<br />

Photo by Elliott Franks/BCLA<br />

Photo by Phil Weedon/BCLA<br />

08/04/11 17/06/11 COVER BCLA 2011 STORY<br />

Photo by Elliott Franks/BCLA<br />

WHILE THE red half of Manchester had its attention fixed<br />

firmly on Wembley Stadium for the European Champions<br />

League final, the focus of the contact lens world was on the<br />

city’s Central Convention Complex as it played host to the<br />

35th BCLA annual clinical conference and exhibition.<br />

Recent years have seen a gradual increase in the variety<br />

of topics on offer and <strong>this</strong> year’s event crossed borders into<br />

optometric and therapeutic areas to capture a wider audience.<br />

So, for example, for the first-time, a selection of lectures<br />

also carried COPE accreditation for international delegates.<br />

With sponsor showcases, hands-on clinical workshops, a<br />

motivational presentation from Dr Frank Dick OBE (pictured<br />

top left), and a Bollywood-themed gala dinner to boot, <strong>this</strong><br />

year’s meeting certainly offered something for everyone.<br />

Oxygen<br />

The importance of oxygen for successful contact lens wear<br />

has taken centre stage at many BCLA meetings, and <strong>this</strong><br />

year’s event proved to be no exception. Professors Desmond<br />

Fonn, Nathan Efron, Noel Brennan, James Wolffsohn and<br />

Brien Holden debated on a very confusing <strong>issue</strong>, each in turn<br />

presenting compelling and varied arguments as to whether<br />

the problem of oxygen has been solved.<br />

Having re-analysed the original Holden-Mertz data,<br />

Professor Fonn suggested that a Dk/t in excess of 350 may<br />

be required for 0% corneal swelling with extended wear<br />

(EW) contact lenses. In contrast, Professor Efron suggested<br />

that a Dk/t as low as 50 is sufficient, based on assessment of<br />

oxygen flux ie, how much oxygen is actually consumed by<br />

the cornea. Indeed, the law of diminishing returns indicates<br />

that there is an upper limit as to how much oxygen the cornea<br />

can actually use, such that any further increase in oxygen<br />

availability has little benefit; Professor Efron suggested that<br />

<strong>this</strong> plateau is reached at a Dk/t of 50.<br />

Professor Brennan (pictured, page 32) suggested that Dk/t is<br />

of little use now, since <strong>this</strong> metric does not allow comparison<br />

between different contact lenses and, more importantly, to the<br />

no lens situation. Furthermore, he alluded to the possibility<br />

that a minimum Dk/t of infinity may be required, since the<br />

original Holden-Mertz data follows an asymptotic curve.<br />

Professor Brennan also endorsed measurement of the cornea’s<br />

oxygen consumption as a more useful metric, but pointed out<br />

that current assessments are based on inaccurate models that<br />

require many assumptions. Despite the development of new<br />

methods to assess corneal oxygen consumption, presented by<br />

Professor Wolffsohn, the panel’s views were well summarised

y Professor Holden, who explained that the advent of<br />

silicone hydrogel lenses has in many ways solved the problem<br />

of oxygen but that other complications have arisen, with<br />

attention now deviating towards areas such as maximising<br />

comfort and enhancing the efficacy of cleaning regimens.<br />

Comfort<br />

Professor Brennan continued the theme of contact lens<br />

comfort in his next presentation. It was surprising to learn<br />

that 49% of patients who drop out of contact lens wear do<br />

so due to poor comfort, whilst 9% do so due to dry eye. Poor<br />

comfort is multi-factorial but a key contributor is friction<br />

between the lens surface and the upper palpebral conjunctiva<br />

(on blinking), as hilariously illustrated by the US political<br />

video Dick Cheney vs. Nancy Pelosi: The Blink-Off, from the<br />

TV show David Letterman (a must-see on YouTube); basic<br />

calculations reveal that when blinking, the eyelids travel<br />

approximately 42km in a single year and <strong>this</strong> can lead to<br />

lid wiper epitheliopathy, which can contribute to reduced<br />

comfort during contact lens wear. Research presented by<br />

Professor Brennan confirmed that there are subjective<br />

differences in comfort between different types of contact<br />

lenses, and that <strong>this</strong> is not due to the material or Dk/t, but<br />

due to the modulus and coefficient of friction. This confirms<br />

the importance of lens surface interactions in the eye, and the<br />

need to manage conditions that may affect <strong>this</strong> eg, meibomian<br />

gland dysfunction.<br />

New technologies such as iPhone<br />

apps or contact lens cases with<br />

date displays need to be embraced<br />

Daniela Nosch (pictured below) took a patient-orientated<br />

approach to the topic of comfort, looking at whether<br />

patient compliance could be an <strong>issue</strong>. Many patients fail to<br />

adhere to manufacturers’ and practitioners’ instructions for<br />

cleaning lenses and cases and for replacing lenses, and it<br />

was proposed that new technologies such as iPhone apps or<br />

contact lens cases with date displays need to be embraced to<br />

improve compliance and comfort. Ms Nosch also discussed<br />

the importance of improving the quality of the tear film by<br />

recommending artificial tears / re-wetting drops, avoidance of<br />

preservatives, avoiding environmental triggers (eg, smoke and<br />

air conditioning), and even taking nutritional supplements<br />

(eg, omega-3 fatty acids), which can help to reduce ocular<br />

inflammation and increase tear production. Ms Nosch<br />

also emphasised the practitioner’s role in ensuring patient<br />

compliance, by providing information in writing, discussing<br />

the benefits of compliance, and managing expectations.<br />

including motion after-effects, the Zollner illusion, the Ponzo<br />

illusion, and size constancy, and although well-explained<br />

some audience participation and less busy slides would have<br />

helped to bring some real fun to the occasion.<br />

Glaucoma and the anterior segment<br />

Although unusual for a contact lens conference, a half-day<br />

session on glaucoma was very informative and very well<br />

presented by Professor John Flanagan. He began by describing<br />

the risk factors for glaucoma and how each of these forms<br />

stressors that are thought to cause glaucoma. The effects<br />

of these on the structure/function relationship were then<br />

discussed, before Professor Flanagan described how diagnosis<br />

of glaucoma could be improved by considering gonioscopy,<br />

central corneal thickness (CCT) measurements, phasing IOP<br />

measurements, and ocular perfusion pressure; it is known that<br />

IOP increases at night whilst a good sleeper will have a greater<br />

dip in blood pressure, leading to nocturnal hypotension, both<br />

of which increase the risk for glaucoma – if these could be<br />

measured for an individual, the risk of glaucoma can then<br />

be better evaluated. A new contact lens device has been<br />

developed for <strong>this</strong> purpose but in order to obtain accurate<br />

measurements, the lens must stick to the cornea and not<br />

move – not the most ideal situation for overnight contact lens<br />

wear! As expected, the device is not suitable for use but an<br />

alternative scleral device is currently being investigated.<br />

Anterior segment pathogens<br />

If the audience was slightly bewildered by a glaucoma lecture<br />

during a contact lens conference, they were in for a further<br />

twist when the session was “gate-crashed” by a lecture on<br />

anterior segment pathogens by Dr Lisa Keay. Concentrating<br />

on microbial keratitis, Dr Keay looked at the consequences of<br />

<strong>this</strong> devastating corneal condition, most commonly associated<br />

with EW contact lenses, before embarking on a detailed tour<br />

of the variants, including differential diagnosis of: (i) fungal<br />

keratitis, particularly relevant due to the contact lens solutionrelated<br />

outbreak of Fusarium Keratitis in 2005-2006; (ii)<br />

acanthamoeba keratitis, which causes pain out of proportion<br />

with the symptoms and is particularly relevant due to its<br />

association with a contact lens solution; and (iii) other types<br />

31<br />

17/06/11 BCLA 2011<br />

Visual illusions<br />

The Albion lecture delivered by Professor Will Ayliffe<br />

promised much with the title of “Fun with Visual Illusions”.<br />

He began with a brief look at how visual illusions come to<br />

be, discussing how the brain makes errors in interpretation<br />

by filling in gaps within the visual scene through “topdown”<br />

cortical processing. Professor Ayliffe then took the<br />

audience through a variety of different visual illusions,<br />

Photo by Phil Weedon/BCLA

REVIEW<br />

32 28<br />

08/04/11 17/06/11 COVER BCLA 2011 STORY<br />

of keratitis including<br />

those caused by Herpes<br />

Simplex, Pseudomonas,<br />

and Noccardia (rare in<br />

the UK).<br />

Visual fields<br />

analysis<br />

The session went back<br />

on track when Professor<br />

Flanagan took to the<br />

stage again to deliver a<br />

presentation on visual<br />

fields analysis, in which<br />

he offered six key pearls:<br />

(i) do the right test –<br />

fast strategies look for<br />

normality so if you suspect a defect then conduct a standard<br />

strategy to detect it; (ii) the patient is not automated so<br />

remember to keep them attentive with continual reassurance;<br />

(iii) assess the reliability – false positive errors are more<br />

important than false negative and even fixation errors,<br />

particularly since the latter can arise if the camera is not<br />

working properly; (iv) assess the statistical indices – focal,<br />

hemifield and general defects can be ascertained from these<br />

whilst progression over time can also be monitored; (v)<br />

beware learning effects – it is not wise to refer on the first<br />

or second field test result, as the defect may not be real;<br />

remember that a normal field plot can never be faked; (vi)<br />

use the right equipment – standard automated perimetry<br />

detects functional loss after a significant amount of structural<br />

damage has occurred, so consider methods that could lead<br />

to earlier detection, such as Frequency Doubling Technology<br />

(FDT), Short Wavelength Automated Perimetry (SWAP), the<br />

Heidelberg Retinal Tomograph (HRT) and the new Heidelberg<br />

Edge Perimeter, the latter two of which provide structural and<br />

functional data.<br />

Photo by Elliott Franks/BCLA<br />

Photo by Phil Weedon/BCLA<br />

Corneal<br />

dystrophies<br />

Professor Ayliffe’s<br />

discussion of corneal<br />

dystrophies followed a<br />

similar format to his take<br />

on visual illusions. It<br />

was interesting to learn<br />

more about commonly<br />

encountered dystrophies<br />

such as Meesman’s,<br />

Recurrent Erosion, Reiss-<br />

Buckler, Granular, Fuch’s<br />

and Lattice dystrophies,<br />

although less time spent<br />

on rarer dystrophies,<br />

including some that have<br />

only been reported in 4 or 5 families in the world, would have<br />

been preferred, especially since Professor Ayliffe proclaimed<br />

“you will never see <strong>this</strong> in your career!”<br />

Scientific round-up<br />

Amongst the many scientific research sessions was a<br />

section dedicated to presbyopia, updating delegates on<br />

current contact lens practice. Contact lens prescribing has<br />

changed very little over the past 20 years, with distance<br />

contact lenses and reading spectacles still being the most<br />

popular choice (60%), whereas the previously popular<br />

monovision correction is now losing out to modern<br />

multifocal contact lenses, with a direct swap in popularity<br />

(30%). Multifocal contact lenses such as the Proclear EP<br />

have positive effects in reducing asthenopia in emerging<br />

and pre-presbyopes, without significantly affecting visual<br />

clarity. Indeed, subjective satisfaction with multifocal lenses<br />

appears to out-weigh corresponding poorer objective visual<br />

performance, but it is still advisable to trial all available<br />

options to find one that works best for the individual. It was<br />

also fascinating to learn about the latest progress in surgical<br />

presbyopia correction, including the use of liquid crystals<br />

and biocompatible materials that could replace the natural<br />

crystalline lens.<br />

There is a possible application for<br />

silver-infused contact lenses, which<br />

do not affect the natural biota<br />

Another scientific research session concentrated on contact<br />

lens care systems. Many lens/solution combinations can lead<br />

to corneal staining (SICS) and it was shown that peroxidebased<br />

systems minimise <strong>this</strong> whilst certain lens surface<br />

treatments (such as that used on the Acuvue Advance lenses)<br />

are also associated with reduced staining. Lens cleaning<br />

could be enhanced by dual disinfection solutions eg, those<br />

containing Polyquad and Aloxidine, whilst there is a possible<br />

application for silver-infused contact lenses, which do not<br />

affect the natural biota of the eye. In addition to lens cleaning,

case cleaning considerations are equally important and it<br />

was shown that although vibrating contact lens cases do not<br />

reduce cholesterol deposition, the most effective current<br />

method of cleaning a case and reducing biofilm production is<br />

to rinse and rub with a finger, then wipe with a t<strong>issue</strong> before<br />

air-drying face down.<br />

Save the best ‘til last<br />

The BCLA certainly saved the best ‘til last. Just when<br />

delegates were flagging after four days of lectures and<br />

networking, the BCLA brought attendees an X-Factor-style<br />

finale entitled ‘The Great Debate: Ten Top Tips for Clinical<br />

and Practice Success’. Of course, the Simon Cowell seat<br />

on the judging panel was taken by Professor Brien Holden,<br />

flanked by BCLA vice president Dr Catharine Chisholm and<br />

BCLA president Shelley Bansal. The stage was set with ten<br />

empty seats. First up was Jayne Schofield, who gamely set the<br />

ball rolling in the few minutes allocated to each presenter.<br />

She faced the judges bravely before Dr Phil Morgan took<br />

to the stage. Dr Morgan’s power-point shimmered with<br />

Mac special effects but that didn’t save him from Professor<br />

Holden’s sharp comments. Professor Desmond Fonn received<br />

a kinder response from the judges, although his 1970’s dress<br />

sense was called into question, as was Professor Efron’s<br />

bow-tie. Dr Craig Woods forgot his microphone and then<br />

put on spectacles for his contact lens presentation … which<br />

unsurprisingly lost him favour and marks with the judges!<br />

One of the highlights was Dr Kathy Dumbleton breaking<br />

into song, with acknowledgements to Paul McCartney<br />

Photo by Elliott Franks/BCLA<br />

for ‘Yesterday’, as she urged patients to change their<br />

lenses regularly. Professor Lyndon Jones recommended a<br />

compliance sheet for patients, before giving the floor to<br />

Professor Charles McMonnies who recommended a blink<br />

instruction guide. Jonathan Walker was the penultimate<br />

presenter and managed to get in a jibe about the cricket<br />

before the stage was taken over by ‘The Edutainer’ Brian<br />

Tompkins who prescribed fun with helium balloons and a<br />

gold jacket, the latter of which he later discarded to reveal his<br />

take home message across his t-shirt. The judges held their<br />

nerve and marked in the manner of Strictly Come Dancing,<br />

out of 10, with Professor Jones and Professor Efron (pictured<br />

above) trying to share the ‘trophy’ to a round of applause.<br />

33<br />

17/06/11 BCLA 2011


Millions are too hard-up<br />

to book an appointment<br />

National Eye Health Week has provided some revealing new figures<br />

34<br />

17/06/11 NEW DATA<br />

THIS WEEK’S National Eye Health Week emphasised that<br />

financial pressures are having a real impact on the nation’s<br />

eye health.<br />

New YouGov research released to mark the start of the<br />

Week estimates that millions of adults in Britain currently<br />

do not attend regular eye examinations – at least once every<br />

two years – because they believe they cannot afford to. A<br />

total of 13% of those questioned for the research, 2,042<br />

adults during May 11-13, said they were too hard-up to<br />

make an appointment.<br />

With the UK economy still in difficulty, the survey<br />

found that people are economising on <strong>this</strong> type of essential<br />

purchase, and not just treats and luxuries. More than fourout-of-ten<br />

(43%) of the population are currently risking<br />

their sight and their health by not attending regular sight<br />

tests. Although more than nine-out-of-ten people know<br />

about the wider health benefits of eye examinations,<br />

<strong>this</strong> knowledge does not result in people visiting their<br />

optometrist.<br />

The research also revealed that for women, cost is even<br />

more of a barrier to good eye health, as over a third of women<br />

(34%) have put off buying new spectacles or contact lenses<br />

because they thought they could not afford it.<br />

David Scott-Ralphs, chairman of National Eye Health Week,<br />

said: “This is a massive public health <strong>issue</strong>.<br />

“Many people do understand the importance of a sight test,<br />

but there is great concern that they are still avoiding having<br />

one, often citing cost grounds. Many people qualify for a free<br />

NHS sight test and may also qualify for help with the cost of<br />

spectacles or contact lenses.”<br />

Supporters and sponsors of the Week agreed that eye<br />

examination is vital for the nation’s health.<br />

Anna Turvey, superintendent optician at Tesco Opticians,<br />

said: “We perform free eye examinations for customers, many<br />

of whom decide on a whim to have an eye check because they<br />

happen to be in a store for another reason.<br />

“Some customers have turned out to have a significant<br />

condition such as high blood pressure – and in some cases<br />

tumours – that would otherwise not have been diagnosed.”<br />

Michele Acton, chief executive of Fight for Sight, said:<br />

“Regular eye tests are so important not only for picking up<br />

early signs of eye disease but also for identifying other health<br />

conditions. Many people wait until they experience problems<br />

with their vision before they go for sight tests but sadly <strong>this</strong><br />

can be too late. With conditions such as glaucoma, by the<br />

time symptoms become apparent, permanent damage to the<br />

eye has already occurred.”<br />

National Eye Health Week started on June 13 with events<br />

around the country.<br />

The YouGov survey was carried out online, and its figures<br />

are weighted and are representative of all British adults aged<br />

18 or over.

A one-day CET conference for optometrists on<br />

Age-related Macular Degeneration (AMD)<br />

July 12th 2011, Downing College, University of Cambridge, Cambridge, UK<br />

1 day on AMD<br />

8 CET Points<br />

July 12th 2011<br />

Help reduce the risk of people developing <strong>this</strong> debilitating condition by learning about the diagnosis and<br />

monitoring of AMD. This one-day update from leading specialists aims to give you the tools you need in<br />

order to recognise cases that warrant onward referral.<br />

Speakers:<br />

Professor Stephen Beatty, Dr John Nolan, Professor David Thurnham, Dr James Loughman<br />

Diagnosis of AMD and the<br />

different types<br />

Epidemiology and risk factors of<br />

AMD<br />

Role of nutrition in AMD<br />

Measuring macular pigment in<br />

patients with and without AMD<br />

Trials of macular carotenoids in<br />

patients with and without AMD<br />

What to do following detection of<br />

AMD signs and symptoms: should<br />

optometrists always refer patients<br />

to an ophthalmologist?<br />

Registration fee: £200 per delegate<br />

Course fee is inclusive of lunch and refreshments<br />

For more information, contact us on:<br />

info@amdforoptometrists.org or call 01223 234193

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

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 />

36<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 />

17/06/11 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

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<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 />

37<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 />

17/06/11 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


12 NES, The Beardmore Hotel, Clydebank,<br />

Glasgow, Developing optometric skills (www.<br />

nes.replaylearning.com/clinical-skills)<br />

22-24 International Conference on<br />

Ophthalmic Photography, Venue TBC, Oxford<br />

(www.icopmeeting.org)<br />

38<br />

17/06/11 DIARY DATES<br />

Optics hits the bright lights<br />

With the UK optics conference season almost ended practitioners<br />

The famous setting of Aintree racecourse plays host to <strong>this</strong> year’s<br />

College can start of Optometrists considering the conference, possibility see of below visiting one of the many<br />

overseas exhibitions in the autumn.<br />

One of the biggest and brightest conferences and exhibitions, just<br />

crying out for a holiday-education combination, is Vision Expo West<br />

in Las Vegas on September 21-24.<br />

Last year’s event featured lectures on the revelation of exclusive<br />

research as well as a high profile exhibition – where you were sure to<br />

bump into the occasional celebrity, at the many launches.<br />

Full speaker details are still to be confirmed, more details will be<br />

revealed as they are available at www.visionexpowest.com<br />

JUNE<br />

20-21 J&J, The Vision Care Institute,<br />

Pinewood, Wokingham, ‘Returning to work<br />

confident and refreshed’ two-day course<br />

(www.thevisioncareinstitute.co.uk)<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 />

Falkirk, second annual outing (haddington@<br />

montgomeryoptometrists.co.uk)<br />

29 East Sussex LOC, Venue TBC, Halland,<br />

Annual contact lens day, RSVP to (jackie.<br />

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 Downing College, University of Cambridge,<br />

Cambridge, AMD for optometrists 2011 (www.<br />

amdforoptometrists.org)<br />

20 UltraVision, Head Office, Leighton<br />

Buzzard, Bedfordshire, KeraSoft IC Workshop<br />

(workshop@ultravision.co.uk)<br />

AUGUST<br />

17 UltraVision, Head Office, Leighton Buzzard,<br />

Bedfordshire, KeraSoft IC workshop and fitting<br />

techniques SEE ABOVE<br />

22, 23, 24, 25 J&J, The Vision Care Institute,<br />

Pinewood, Wokingham, OSCE preparation<br />

one-day courses SEE ABOVE<br />


1 NES, Ettrick Riverside, Dunsdale Road,<br />

Selkirk, Developing optometric skills SEE<br />

ABOVE<br />

7 The Scottish Optical Golfing Society,<br />

Ladybank, Fife, final annual outing<br />


NEW… 12 NES, Kingsmills Hotel, Culcabock<br />

Road, Inverness, Developing optometric skills<br />


14 BCLA, Royal Society of Medicine, London,<br />

presidential address (events@bcla.org.uk)<br />

21 UltraVision, Head Office, Leighton Buzzard,<br />

Bedfordshire, KeraSoft IC workshop and fitting<br />

techniques SEE ABOVE<br />

NEW… 25-26 BABO, Oxford University,<br />

college TBC, Oxfordshire, Annual conference<br />

and 20th anniversary celebration (www.<br />

babo.co.uk)<br />

NEW… 29-2 (October) Silmo, Paris Nord<br />

Villepinte exhibition center, Paris, France<br />

(www.silmoparis.com)<br />


NEW… 19 UltraVision, Head Office,<br />

Leighton Buzzard, Bedfordshire, KeraSoft IC<br />

workshop and fitting techniques<br />


NEW… 22 Nystagmus Network, Harrow,<br />

north-west London, open day (0845 634<br />

2630)<br />


NEW… 3-4 National Optometric<br />

Conference, Chesford Grange Hotel,<br />

Kenilworth, Warwickshire (www.aop.org.uk)<br />

NEW… 5-6 Hospital Optometrists 37th<br />

Annual Conference, Chesford Grange Hotel,<br />

Kenilworth, Warwickshire SEE ABOVE<br />

NEW… 16 UltraVision, Head Office,<br />

Leighton Buzzard, Bedfordshire, ‘KeraSoft IC<br />

Workshop’ workshop and fitting techniques<br />


NEW… 25-27 AOP Student Eye Opener<br />

Conference, Center Parcs Longleat Forest,<br />

Warminster, Wiltshire SEE ABOVE<br />

See more events at www.optometry.co.uk/events


Assistants get improved<br />

training within Scotland<br />

AS THE Worshipful Company of Spectacle<br />

Makers (WCSM) announces the first set of<br />

results for its Certificate in Optical Care,<br />

the chief optometrist at NHS Education<br />

for Scotland (NES) has said that the new<br />

examination marks a “change in attitude”<br />

in Scotland.<br />

“Optical assistants are a key part<br />

of healthcare delivery,” said Donald<br />

Cameron (pictured), the programme<br />

director for optometry at NES, the<br />

education and training body of NHS<br />

Scotland. “This new course encourages<br />

everyone within the profession to think<br />

more carefully about these roles.<br />

“It’s a change in attitude, it’s gearing<br />

up for the future. Ultimately, we want to put in place an<br />

educational structure that enables optical assistants with<br />

few or no academic qualifications to develop themselves,<br />

and for some of them to go on and study for a professional<br />

qualification.”<br />

The Certificate in Optical Care, which was launched by the<br />

WCSM in 2010, is designed for optical assistants working<br />

under the General Ophthalmic Service in Scotland. Full<br />

funding is provided by NES, and the qualification is approved<br />

at Level 5 by the Scottish Qualifications Authority. The next<br />

course begins in August 2011.<br />

The five-month programme combines distance learning with<br />

three one-day workshops held at Stirling Management Centre,<br />

part of the University of Stirling.<br />

Debbie Gigg, the WCSM’s training<br />

director, said: “The blended learning<br />

approach makes a big difference to the<br />

students’ understanding of the topics<br />

and their retention. The workshops are<br />

hands-on, a chance for optical assistants to<br />

get together, use relevant equipment, ask<br />

questions and prepare for the examination.<br />

“In terms of professional development,<br />

it gives students the opportunity to obtain<br />

confidence and recognition for the role<br />

that they are performing. It has been the<br />

case that once one person in a practice<br />

started the course – and could see the<br />

benefits – their colleagues showed<br />

interest in doing it too.”<br />

A total of 27 candidates passed the inaugural examination,<br />

which was held in March. A further 10 candidates who failed<br />

a small number of units were due to resit those individual<br />

sections in June. An official WCSM award ceremony will be<br />

held on September 14 at the Royal College of Surgeons in<br />

Edinburgh, where successful candidates will be presented with<br />

their certificates by Michael Barton, the master of the WCSM.<br />

Enrolment is now underway for the 2011/12 course.<br />

The one-day workshops will be held in August, October<br />

and January, and the examination, which can be taken by<br />

e-assessment or as a written paper, will be held at the end of<br />

February 2012. Further information – including details of the<br />

full funding support available from NES – can be obtained<br />

from the WCSM at training@spectaclemakers.com.<br />

39<br />




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40<br />

Optic nerve<br />

anomalies<br />


17/06/11 CET<br />

Dr Marcela Votruba, BM, BCh, MA, FRCOphth, PhD<br />

Optic nerve anomalies are commonly seen in optometric practice and<br />

practitioners must be able to differentiate acquired anomalies from those that are<br />

characteristically congenital in origin. Indeed, acquired optic nerve anomalies are<br />

likely to require fast and effective referral to the hospital eye service (HES), whereas<br />

anomalies of congenital origin simply require detection and monitoring. This article<br />

aims to help practitioners to distinguish between acquired and congenital optic<br />

nerve anomalies, in order to improve appropriate detection and referral of cases.<br />

Clinical features<br />

The normal anatomy of the optic nerve sets<br />

the parameters for the clinical appearance<br />

of optic nerve anomalies, and the following<br />

features are specifically pertinent. The<br />

normal optic disc is approximately<br />

1.5mm in diameter, and is located 10-<br />

15° from fixation, nasally, slightly above<br />

the horizontal meridian. It carries 1.2<br />

million nerve fibres from retinal ganglion<br />

cells (RGCs). There is a rigid scleral<br />

opening and a collagenous cribriform<br />

plate. Myelination is normal beyond<br />

the cribriform plate. The sub-arachnoid<br />

space begins as the nerve exits the eye.<br />

The post-laminar optic nerve is 3-4mm in<br />

diameter. The normal blood supply is via<br />

Figure 1<br />

Normal optic disc appearance<br />

the two posterior ciliary arteries from the<br />

ophthalmic artery, which divide into 15-20<br />

short posterior ciliary arteries. The central<br />

retinal artery penetrates the optic nerve<br />

12mm posterior to the cribriform plate.<br />

Clinical investigations<br />

The importance of being able to distinguish<br />

the normal optic disc and its associated<br />

cup (Figure 1) from physiological cupping<br />

(Figure 2) on one hand, and frank pathology<br />

on the other, should be emphasised. This<br />

article does not intend to delve into the<br />

detection of glaucomatous optic discs, as<br />

<strong>this</strong> has been dealt with elsewhere in <strong>this</strong><br />

series (see <strong>Optometry</strong> <strong>Today</strong>, June 3 2011).<br />

The clinical features of optic<br />

nerve disease generally are relatively<br />

circumscribed. Firstly, the symptoms<br />

depend on the underlying condition, but<br />

generally there is poor vision. There is<br />

rarely, if ever, any pain. The signs of optic<br />

nerve dysfunction are reflected in reduced<br />

visual acuity (VA), both for near and<br />

distance and there may also be diminished<br />

sensitivity to light brightness and colour<br />

vision anomaly (or dyschromatopsia),<br />

which may be red-green or blue-yellow<br />

in nature. Testing of the pupil reactions<br />

Figure 2<br />

Appearance of physiological cupping<br />

may reveal a relative afferent pupillary<br />

defect (RAPD) whilst visual field<br />

defects may be documented, including<br />

(typically) central scotoma, centrocaecal<br />

scotoma, altitudinal defects or nerve fibre<br />

bundle defects. Special investigations,<br />

such as imaging of the visual pathways<br />

by computerised tomography (CT)<br />

scan or by magnetic resonance<br />

imaging (MRI) scan are invaluable<br />

to exclude additional underlying<br />

pathology. Electrophysiology, including<br />

visually evoked potentials (VEPs), is<br />

diagnostically useful in revealing which<br />

part of the visual pathway is affected.<br />

Acquired nerve anomalies<br />

Acquired disorders of the optic nerve<br />

include anterior ischaemic optic<br />

neuropathy (AION), optic neuritis,<br />

papilloedema (swelling of the optic<br />

nerve head secondary to raised<br />

intracranial pressure), toxic optic<br />

neuropathies, tumours of the optic<br />

nerve, and genetic optic neuropathies<br />

(such as Leber’s hereditary optic<br />

neuropathy and autosomal dominant<br />

optic atrophy), and, of course, glaucoma.<br />

Disc swelling (whether unilateral or<br />

bilateral) and optic atrophy will not be<br />

dealt with here in detail. The commonest<br />

causes for disc swelling are papilloedema<br />

itself, papillitis and neuro-retinitis and<br />

AION, as well as infiltration of the optic<br />

nerve. A unilateral or bilateral swollen<br />

disc should always be referred urgently

to the HES, as <strong>this</strong> may have a potentially<br />

life-threatening cause. Ultimately, optic<br />

atrophy or disc pallor results from these<br />

conditions. However, the detection of a<br />

pale disc or optic atrophy may also suggest<br />

a range of other diagnoses, such as postoptic<br />

neuritis, compressive optic atrophy<br />

(due to tumours affecting the optic nerve<br />

or visual pathway), and hereditary optic<br />

atrophies (eg, Leber’s hereditary optic<br />

neuropathy and dominant optic atrophy).<br />

Optic nerve anomalies are important to<br />

clinical practice because it is vital for the<br />

practitioner to be confident in distinguishing<br />

between congenital structural anomalies<br />

from acquired and potentially treatable<br />

conditions, such as papilloedema. Whilst<br />

the conditions discussed here are generally<br />

rare, they may result in visual symptoms<br />

Congenital optic nerve<br />

anomalies<br />

These may be divided into those<br />

without systemic associations and those<br />

with associated systemic features. 1<br />

Congenital optic nerve anomalies<br />

without systemic associations include<br />

tilted disc, disc drusen, optic disc pit<br />

and myelinated nerve fibres. Those with<br />

systemic associations include optic<br />

disc coloboma (including the morning<br />

glory anomaly), optic disc hypoplasia,<br />

megalopapilla,<br />

peripapillary<br />

staphyloma, and optic disc dysplasia.<br />

Tilted disc<br />

The VA is typically normal in <strong>this</strong><br />

common, bilateral condition, which is<br />

frequently associated with myopia and<br />

distinguishes it from a visual field defect<br />

that is due to chiasmal compression.<br />

Disc drusen<br />

Disc drusen are calcified deposits<br />

within the optic nerve head. Disc<br />

drusen are not common (less than 2%<br />

of the population) and when they do<br />

occur they are generally bilateral (75%).<br />

Familial cases have been reported.<br />

Rare associations include retinitis<br />

pigmentosa (RP) and angioid streaks.<br />

The VA is typically normal, unless<br />

complications occur, such as choroidal<br />

neovascularization or peripapillary<br />

haemorrhage. The clinical features<br />

include an absent cup and the appearance<br />

of pink/yellow or waxy, pearl-like,<br />

indistinct lumps on the disc margin<br />

41<br />

17/06/11 CET<br />

or even poor vision, and thus are of<br />

high astigmatism. The appearance is<br />

(Figure 4). Disc drusen may be under the<br />

importance to the practising optometrist.<br />

that of a small disc, which is commonly<br />

disc surface (Figure 5) or penetrating it.<br />

It is desirable to emphasise here the<br />

oval, and is due to the oblique angle<br />

They frequently start out in childhood<br />

importance of accurate and educated<br />

at which the optic nerve enters the<br />

deep in the optic nerve and later emerge<br />

history-taking in the assessment of these<br />

globe. This gives rise to an appearance<br />

to be more superficial. There is no dilation<br />

individuals. In the conditions described<br />

which is easily confused with disc<br />

of the veins or obscuration of the vessels.<br />

here there may be a family history in a<br />

swelling (Figure 3). Most commonly<br />

Disc drusen display autofluoresce,<br />

good proportion of cases and it is important<br />

a nasal defect of the optic disc may<br />

but there is no leakage on fluorescein<br />

to include <strong>this</strong> in the assessment. In<br />

be seen, with hypopigmentation<br />

angiography. They are also seen on CT<br />

addition, and even of greater importance,<br />

of the inferonasal retina, and these<br />

scans because they contain calcium. They<br />

there are systemic features in some of<br />

individuals may have a supero-<br />

may be easily visualised on an ultrasound<br />

the conditions, and patients may not be<br />

temporal visual field defect 2 that does<br />

of the eye. This allows them to be<br />

aware of their relevance or significance.<br />

not observe the vertical midline, which<br />

distinguished from papilloedema, which<br />

Figure 3<br />

Tilted disc appearance<br />

Figure 4<br />

Pink/yellow or waxy, pearl-like, indistinct lumps on<br />

the disc margin in optic nerve head drusen<br />

Figure 5<br />

Optic nerve head drusen under the surface



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been advocated as alternative surgical<br />

management for such complications.<br />

Myelinated nerve fibres<br />

Normal myelination in the human<br />

visual pathways is completed by nine<br />

42<br />

17/06/11 CET<br />

Figure 6<br />

Optic disc pit (courtesy of Professor JE Morgan)<br />

is a very important distinction to make. 3<br />

Optic disc pit<br />

Optic disc pits are uncommon and generally<br />

unilateral. 4 The disc is often larger than in<br />

an unaffected eye, and it contains an oval<br />

or round pit. The pit is usually inferotemporal<br />

in position (Figure 6). The VA is<br />

typically normal. However, complications<br />

are sometimes seen in cases with optic<br />

disc pits. Pits have been associated with<br />

glaucoma, 5 whilst other complications<br />

include macular detachment, especially if<br />

the pit is centred on the maculo-papullar<br />

bundle. This occurs in approximately<br />

50% of eyes with pits and <strong>this</strong> may then<br />

eventually give rise to oedema or a central<br />

serous retinopathy-like appearance, which<br />

will reduce the central VA. However,<br />

there may be spontaneous resolution of<br />

<strong>this</strong> state. Argon laser photocoagulation<br />

or photodynamic therapy (PDT) may<br />

have some potential benefit if treatment<br />

is needed for such cases, although largescale<br />

clinical trials are currently clearly<br />

lacking in the evidence base. Vitrectomy<br />

and internal membrane peeling has<br />

months of gestation. It starts at the lateral<br />

geniculate body and moves towards the<br />

lamina cribrosa. However, sometimes the<br />

myelination spreads onto the surface of<br />

the retina, starting from the optic disc and<br />

spreading variably onto the retina. Thus the<br />

appearance of myelinated nerve fibres may<br />

follow one of three patterns: 6 isolated in the<br />

periphery, or peripapillary, or extensively<br />

around the disc (Figure 7). Recently,<br />

retinal vascular abnormalities have been<br />

reported with myelinated nerve fibres. 7<br />

Occasionally a visual field defect may be<br />

documented in patients with myelinated<br />

nerve fibres (specifically an enlarged blind<br />

spot), but it is usually inconsequential and<br />

asymptomatic. The VA is typically normal.<br />

Optic disc coloboma<br />

Optic disc coloboma is rare and may<br />

be unilateral or bilateral. It is usually<br />

sporadic, but may occasionally be<br />

inherited. In almost all cases, the VA<br />

is decreased. The optic disc has a large<br />

excavated area (Figure 8) and there<br />

is often a superior visual field defect.<br />

A coloboma is a defect resulting<br />

from malclosure of the foetal cleft.<br />

The foetal fissure of optic cup usually<br />

lies inferiorly and normally it closes<br />

between five to seven weeks of gestation.<br />

Defects in <strong>this</strong> process cause coloboma.<br />

Systemic associations of optic disc<br />

coloboma include central nervous system<br />

(CNS) malformations, cysts, chromosomal<br />

abnormalities (Trisomy 13 and Trisomy<br />

22 (cat-eye syndrome)) and CHARGE<br />

(coloboma, heart defects, choanal<br />

atresia, retarded mental development,<br />

Figure 8<br />

Coloboma of the optic nerve head<br />

actually a variant of coloboma. 9 This is<br />

very rare and usually unilateral. The<br />

VA is typically decreased and the optic<br />

disc appears very large with a funnel<br />

shaped excavation; there may also be<br />

glial t<strong>issue</strong> in the base (Figure 9). The<br />

characteristic appearance results from<br />

spoke-like emerging blood vessels from<br />

the optic disc. There may be a surrounding<br />

chorioretinal pigmentary disturbance<br />

pattern too. 10 Serous detachment of the<br />

retina may be seen in approximately<br />

30% of cases. The morning glory disc<br />

anomaly may be associated with midfacial<br />

anomalies, such as hypertelorism,<br />

nasal malformations and cleft palate. 11<br />

Optic nerve hypoplasia<br />

Optic nerve hypoplasia is rare and may<br />

be unilateral or bilateral. 12 The VA is<br />

variably reduced, and in severe cases<br />

is devastatingly affected. Visual field<br />

examination reveals a range of potential<br />

defects including arcuate defects,<br />

altitudinal defects, centrocaecal scotomas,<br />

or bitemporal or binasal defects. The<br />

appearance of the optic disc is small and<br />

Figure 7<br />

Myelinated nerve fibres<br />

genital and ear abnormalities). 8<br />

Other rare syndromes include the<br />

morning glory disc anomaly, which is<br />

Figure 9<br />

Morning glory disc anomaly

often grey-pink and of variable size (Figure<br />

10). There may be small optic nerve canals<br />

and in severe cases loss of the foveal reflex,<br />

due to loss of perifoveal retinal t<strong>issue</strong>. 13<br />

The causes of optic nerve hypoplasia are<br />

still largely unknown in most patients, but<br />

may include the use of drugs (for example,<br />

anti-epileptics or even LSD) and alcohol<br />

in pregnancy and maternal diabetes.<br />

Optic nerve hypoplasia is associated with<br />

septo-optic dysplasia, in which there is an<br />

absence of the midline septum pellucidum<br />

and agenesis of the corpus callosum. These<br />

patients may have endocrine anomalies,<br />

which lead to low height and growth<br />

retardation, unless they are diagnosed<br />

early and receive growth hormone<br />

or other endocrine supplementation.<br />

Mutations in the genes HESX1, SOX2,<br />

SOX3 and OTX2 have been implicated. 14<br />

Megalopapilla<br />

This condition presents with an unusually<br />

huge optic disc, with horizontal or<br />

vertical disc diameters of over 2mm. It<br />

is a rare condition and may merge with<br />

the diagnosis of coloboma or morning<br />

glory disc anomaly in some cases.<br />

Peripapillary staphyloma<br />

This anomaly appears as a normal<br />

disc with peripapillary excavation<br />

and is associated with high myopia.<br />

Summary<br />

Congenital anomalies of the optic disc are<br />

either confined to the ocular structures<br />

alone or associated with systemic features.<br />

Those without systemic associations<br />

include tilted disc, disc drusen, optic<br />

disc pit and myelinated nerve fibres.<br />

Those with systemic associations are<br />

optic disc coloboma and the morning<br />

glory disc anomaly, optic disc hypoplasia,<br />

megalopapilla, peripapillary staphyloma<br />

and optic disc dysplasia or hypoplasia.<br />

Conclusion<br />

Accurate history taking and examination<br />

readily reveal the key clinical features<br />

required for the diagnosis of the<br />

conditions discussed in <strong>this</strong> article.<br />

Referral in the absence of previous<br />

investigation is important, due to the<br />

presence of systemic associations, which<br />

require additional medical investigation<br />

and may require intervention.<br />

By and large, supportive measures,<br />

including refraction and low vision<br />

services, may be required for most<br />

patients whose visual function is affected.<br />

However, as a number of the conditions<br />

Figure 10<br />

Optic disc hypoplasia<br />

affect children and have an impact on<br />

visual function during education, there<br />

is a need for a high level of awareness<br />

and referral to the appropriate hospital<br />

eye service and social services.<br />

About the author<br />

Marcela Votruba is an honorary consultant<br />

at the University Hospital of Wales Eye<br />

Department, Cardiff, and a senior lecturer<br />

at Cardiff University’s School of <strong>Optometry</strong><br />

& Vision Sciences. Her specialist interests<br />

are in genetic eye disease and optic<br />

neuropathy. She is currently programme<br />

secretary of the European Association<br />

for Vision & Eye Research (EVER).<br />

References<br />

See http://www.optometry.co.uk<br />

clinical/index. Click on the article title<br />

and then download "references".<br />

43<br />

17/06/11 CET<br />

Module questions<br />

Course code: C-16562 O/D<br />

1. Which of the following is associated with tilted discs?<br />

a) Reduced vision<br />

b) Papilloeadema<br />

c) Visual field defect observing the midline<br />

d) Astigmatism<br />

2. Which of the following statements about optic disc<br />

drusen is TRUE?<br />

a) They are common, being found in 75% of the population<br />

b) They display leakage on fluorescein angiography<br />

c) They are visible on a CT scan as calcification<br />

d) They are mostly unilateral<br />

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4. Which of the following statements about colobomas of the optic<br />

nerve is TRUE?<br />

a) They require OCT for their clinical diagnosis<br />

b) They arise from the mal-closure of the foetal fissure<br />

c) They are not associated with systemic conditions<br />

d) They always occur alongside iris coloboma<br />

5. Which of the following statements about optic nerve hypoplasia is TRUE?<br />

a) It has been associated with maternal alcohol ingestion<br />

b) It rarely leads to poor vision<br />

c) It is associated with hand anomalies<br />

d) It has not been found to have a genetic cause<br />

3. Which of the following statements about optic disc<br />

pits is TRUE?<br />

a) VA is always reduced<br />

b) They must be treated by PDT<br />

c) They have been associated with glaucoma<br />

d) They are usually supero-nasal<br />

6. Which of the following statements about optic nerve anomalies is FALSE?<br />

a) They may have systemic associations<br />

b) There may be positive family history<br />

c) Acquired anomalies ultimately lead to optic atrophy<br />

d) They all require emergency referral to the HES



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44<br />

17/06/11 CET<br />

Visual factors in specific<br />

learning difficulties<br />

COURSE CODE C-16499 O/D<br />

Lindsay Bater, BSc, MPhil, FCOptom, DipCL<br />

This article reports the results of a clinical study that aimed to determine<br />

whether there were any predictive factors to indicate the presence<br />

of Meares-Irlen syndrome (also known as visual stress or MISViS)<br />

and therefore whether such factors can help to identify which<br />

patients would benefit from receiving precision tinted lenses (PTLs).<br />

A secondary goal was to investigate whether PTLs bring about a<br />

greater improvement in reading performance than coloured overlays.<br />

The effect of using coloured overlays<br />

or PTLs to help patients with specific<br />

learning difficulties (SpLD) or MISViS<br />

is already well-documented. 1 The<br />

mechanism as to how the tint works is<br />

not fully understood but it is theorised<br />

to be related to hyper-excitability of<br />

the visual cortex. 2,3 A clinical sign of<br />

<strong>this</strong> is a sensitivity to striped patterns 4<br />

(pattern glare - PG) and such tests may<br />

have potential in helping to diagnose<br />

the condition. 5-9 Certain patterns<br />

can provoke some degree of visual<br />

discomfort, 10 and <strong>this</strong> discomfort can<br />

be associated with headaches. 11,12<br />

Some people, however, are affected<br />

more severely resulting in migraines or<br />

difficulties with reading. 13 One study<br />

found that a significant degree of MISViS<br />

affects about 12.5% of the general<br />

population and 31% of those people with<br />

dyslexia. 14 As such, it would be useful<br />

to predict the likelihood of MISViS and<br />

the effects of treatment with coloured<br />

overlays and/or PTLs. Particular factors<br />

considered in <strong>this</strong> study were age, sex,<br />

visual acuity (VA), ocular dominance,<br />

binocular vision, stereoacuity,<br />

accommodation,<br />

convergence,<br />

refraction, and fixation disparity.<br />

Method<br />

The clinical records of 244 patients<br />

were retrospectively studied. All<br />

patients had been referred to and were<br />

examined at the same optometric<br />

practice to investigate the possibility<br />

of reading difficulties due to MISViS.<br />

Referrals were received from a variety<br />

of professionals including school<br />

special needs teachers, disability<br />

officers from tertiary colleges,<br />

optometric colleagues, orthoptic<br />

colleagues, or through self-referral.<br />

The clinical protocol followed for<br />

visual assessment was that described by<br />

Lightstone and Evans 15 and as suggested<br />

following an extensive clinical audit by<br />

Evans et al. 16 The clinical protocol has<br />

recently been elaborated upon in a book<br />

by Allen et al. 17 Typically, patients had<br />

a full optometric examination, which<br />

included retinoscopy and subjective<br />

refraction. The eyes were examined<br />

to exclude any pathology that would<br />

require referral. The binocular vision<br />

status was assessed by a variety of<br />

tests; the ocular motor balance was<br />

determined with a cover test, motility<br />

was performed, accommodation and<br />

near point of convergence (NPC) were<br />

Figure 1<br />

Using the Intuitive coloured overlays<br />

determined using a RAF push-up<br />

rule, stereoacuity was measured using<br />

the Lang Stereo test card and fixation<br />

disparity was measured using the<br />

near Mallett Unit. 18 Fixation disparity<br />

assessment particularly included a<br />

report of whether the patient observed<br />

any movement of the nonius markers;<br />

the presence of movement but no<br />

misalignment indicated binocular<br />

instability. Ocular dominance was<br />

determined by the sighting/pointing<br />

method and colour vision was<br />

assessed using the Isihara plates.<br />

PG was assessed using the Institute<br />

of <strong>Optometry</strong> (IoO) PG Test. 8 The test<br />

involves presentation of three cards,<br />

each with a horizontal grating of either<br />

0.5, 3 or 12 cycles per degree (cpd).<br />

Patients who are prone to visual stress<br />

find the 3cpd grating uncomfortable<br />

and report distortions of the grating;<br />

such patients were recorded as positive<br />

for PG. Positive PG was also recorded if<br />

the difference between the results of the<br />

3cpd and 12cpd cards was greater than 1.<br />

All patients then had an overlay<br />

assessment using the intuitive overlays

Vision Assessment<br />

MISViS<br />

(n = 82)<br />

(Figure 1). 1 Patients’ preference for<br />

overlays was noted and their rate of<br />

reading with and without the overlay<br />

was determined using the Wilkins rate<br />

of reading test; 19 an improvement in<br />

the rate of reading by 5% or more, or<br />

if the patient felt “more comfortable”,<br />

were indications to prescribe the<br />

coloured overlay. Thereafter, patients<br />

who felt an improvement with the<br />

coloured overlay were then assessed for<br />

PTLs using the Intuitive Colorimeter;<br />

patients who felt no improvement with<br />

the use of the overlay did not have<br />

follow-up colorimetry assessment. The<br />

procedure for colorimetry followed<br />

that described by Wilkins. 21 Once<br />

the subject has determined the most<br />

suitable hue and saturation for the<br />

lenses, they are ordered either in plano<br />

form or, if required, with the patient’s<br />

refractive correction; if there was a<br />

clinically significant refractive error,<br />

Non-MISViS<br />

(n = 144)<br />

Significance<br />

NPC (cm) 7.8 ± 3.0 7.1 ± 2.9 t=0.05<br />

p=0.40<br />

Stereoacuity (seconds of arc) 538 ± 67 544 ± 129 U=5904<br />

p=0.50<br />

Amplitude of Accommodation<br />

(D)<br />

7.4 ± 2.5 9.8 ± 3.0 t=7.75<br />




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Filter<br />

Colour<br />

Proportion<br />

Preferring <strong>this</strong><br />

Colour (%)<br />

Mean Rate of<br />

Reading Without<br />

Filter (wpm)<br />

Mean Rate of<br />

Reading With<br />

Filter (wpm)<br />

Change in<br />

Rate of<br />

Reading (%)<br />

Significance<br />

t<br />

p<br />

Yellow 18.8 65.6 73.3 11.7 4.15

There was no significant difference<br />

in NPC, stereoacuity, binocular vision,<br />

ocular dominance and fixation disparity<br />

between patients with MISViS and those<br />

without. These findings, which are<br />

all assessments of binocular function,<br />

suggest that binocularity is not a major<br />

factor in predicting reading difficulties.<br />

Indeed, a large proportion of people<br />

without MISViS had a fixation disparity,<br />

which suggests that <strong>this</strong> may be a<br />

correlate of MISViS but not necessarily<br />

causal of it. Furthermore, patients<br />

remarked that the nonius markers on<br />

the Mallett Unit were moving or were<br />

intermittently suppressed, which may<br />

be a consequence of the perceptual<br />

instability that results from MISViS,<br />

rather than a binocular vision anomaly<br />

per se, since these participants<br />

did not typically have other signs<br />

of binocular vision anomalies.<br />

Accommodation<br />

It was found in <strong>this</strong> study that patients<br />

with MISViS had significantly lower<br />

levels of accommodation than those<br />

without MISViS. This supports previous<br />

reports that poor accommodation is<br />

a factor in reading difficulties. 23-25<br />

However, it is suggested that reduced<br />

accommodation is a correlate of MISViS<br />

and not necessarily causal of it. 23-25<br />

The levels of accommodation<br />

observed in <strong>this</strong> study were below<br />

the norms expected. According to<br />

Hofstetter, 26 accommodation ranges<br />

from 17.0D in 4-year-olds to 4.0D<br />

in 50-year-olds. However, when<br />

comparing a control group with<br />

a group of patients with dyslexia,<br />

Buzelli 27 found accommodation was<br />

slightly higher in those with dyslexia<br />

compared to those without, a finding<br />

at odds with the present study.<br />

Allen et al., 28 in their controlled<br />

study, have shown that in patients<br />

with MISViS the use of coloured<br />

overlays improves their rate of reading.<br />

In addition, using a remote eccentric<br />

photorefractor and viewing a cross on a<br />

background, they also showed that when<br />

the chromaticity of the background<br />

matched the overlay, the accommodative<br />

lag was reduced in the study group<br />

compared to the control group.<br />

Pattern glare test<br />

It has been shown that people with PG<br />

display hyper-excitability of the visual<br />

cortex 12 and <strong>this</strong> is the strongest visual<br />

correlate of MISViS. 29,30 The results of the<br />

present study confirm <strong>this</strong> finding, since<br />

PG was significantly more prevalent<br />

in patients with MISViS compared to<br />

those without. The results of <strong>this</strong> study<br />

also revealed, however, that a large<br />

proportion of people without MISViS<br />

also experienced PG (n=64/244). This<br />

would seem to indicate that whilst the<br />

presence of PG is associated with the<br />

supply of PTLs, it may not necessarily<br />

confirm that PTLs are required.<br />

Certainly a negative response on the<br />

PG test suggests that it is less likely that<br />

patients will benefit from PTLs, which<br />

can be a useful indicator to the clinician.<br />

Coloured overlays<br />

The use of overlays resulted in an<br />

improvement in the rate of reading<br />

compared to without the overlays, and<br />

<strong>this</strong> was significant in all cases apart<br />

from purple and grey. This matches the<br />

findings of previous studies. 31-34 The<br />

majority of subjects chose a colour in<br />

the yellow-blue part of the spectrum,<br />

with yellow being the most popular; <strong>this</strong><br />

is likely to reflect the fact that the eye is<br />

more receptive to images along the blue/<br />

yellow axis of the chromaticity graph. 35<br />

However, the greatest improvement<br />

in rate of reading was achieved with<br />

the rose overlay. This finding is in<br />

keeping with Wilkins et al. 36 Indeed,<br />

in their study using coloured light<br />

as opposed to coloured filters, the<br />

majority of subjects preferred blue or<br />

green light, but there was considerable<br />

variability and the optimal colour was<br />

highly specific to each individual. 36<br />

In the present study, the lowest<br />

improvements in rate of reading<br />

were achieved with the purple and<br />

grey overlays. Patients who selected<br />

these colours also had the fastest<br />

rate of reading without an overlay,<br />

which suggests that the degree of<br />

difficulty was lower in the first place.<br />

It is interesting to speculate whether,<br />

in a classroom situation, using coloured<br />

paper (not white) would benefit poorer<br />

readers. With the increased use of white<br />

boards in schools, undiagnosed visual<br />

stress may cause reading problems.<br />

Indeed, although the present study<br />

was a retrospective clinical analysis,<br />

previous prospective double-masked<br />

randomised controlled trials 1,37 indicate<br />

that the benefit from coloured filters<br />

cannot be solely due to a placebo effect.<br />

Rate of reading<br />

Using the criteria that PTLs would<br />

only be supplied if patients showed a<br />

long-term benefit to overlays, 39.3%<br />

of patients seen in <strong>this</strong> study received<br />

PTLs. The rate of reading with PTLs<br />

was significantly improved compared<br />

with coloured overlays, spectacles<br />

(refractive correction only) and with<br />

no refractive correction or filter.<br />

Previous studies 1,16,38 have shown that<br />

PTLs provide benefit to patients with<br />

MISViS, with Wilkins et al. 39 reporting<br />

a 25% increase in the rate of reading<br />

in 5% of children given overlays.<br />

Correction of refractive error<br />

alone did not produce a significant<br />

improvement in the rate of reading<br />

and therefore, in the absence of any<br />

clinically significant refractive error,<br />

each patient should be assessed<br />

individually to determine whether<br />

47<br />

17/06/11 CET



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48<br />

there is any benefit in the supply<br />

of spectacles to help with reading.<br />

Conclusion<br />

This study has identified that age, sex,<br />

accommodation and the presence of<br />

pattern glare are significant factors<br />

to consider for MISViS. The absence<br />

of pattern glare suggests that it is<br />

less likely that a patient will need<br />

precision tinted lenses. Binocularity<br />

did not appear to be a major factor.<br />

Coloured overlays can help to improve<br />

rates of reading, but the greatest<br />

improvement is achieved with PTLs.<br />

About the author<br />

Lindsay Bater graduated in 1978<br />

from City University, London. He<br />

was awarded an MPhil in 1982 and<br />

DipCL in 1986. After qualifying he<br />

spent two years at the Department of<br />

Ophthalmology, University of Otago,<br />

Dunedin in New Zealand. On returning<br />

to the UK he moved to Swansea where<br />

he and his wife run three practices. The<br />

author would like to thank Professor<br />

Bruce Evans for his encouragement<br />

and guidance in producing <strong>this</strong><br />

article and Dr Alan Dobbins for his<br />

assistance in the statistical analysis.<br />

References<br />

See http://www.optometry.co.uk<br />

clinical/index. Click on the article title<br />

and then download “references”.<br />

17/06/11 CET<br />

Module questions<br />

Course code: C-16499 O/D<br />

1. What proportion of the general population can be affected<br />

by MISViS (Meares/Irlen syndrome or Visual stress)?<br />

a) 10.5% of the general population<br />

b) 12.5% of the general population<br />

c) 15% of the general population<br />

d) 17.5% of the general population<br />

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4. Which coloured overlay produced the greatest improvement<br />

in the rate of reading?<br />

a) Aqua<br />

b) Pink<br />

c) Lime green<br />

d) Rose<br />

2. The presence of pattern glare is reported as positive if:<br />

a) The number of distortions on the mid frequency grating is less than 3<br />

b) The number of distortions on the mid frequency grating is 3 or more<br />

c) The number of distortions on the high frequency grating is less than 3<br />

d) There is no difference in number of distortions between plate 2 & 3<br />

3. Which of the following statements about accommodation in<br />

learning difficulties is TRUE?<br />

a) Poor accommodation is usually associated with reading difficulties<br />

b) The amplitude is generally lower than normal<br />

c) It is a correlate of MISViS, not necessarily causal<br />

d) All of the above<br />

5. Which of the following statements about pattern glare is TRUE?<br />

a) It is always present in MISViS<br />

b) It is never present in MISViS<br />

c) It is a cause of MISViS<br />

d) It is correlated to MISViS but is not causal of it<br />

6. What was the improvement in the mean rate of reading with PTLs<br />

compared with no correction or filter, in <strong>this</strong> study?<br />

a) 10%<br />

b) 25%<br />

c) 43%<br />

d) 75%

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To place an advertisement call 020 7878 2313<br />

or email haley.willmott@tenalps.com<br />

Traditional<br />

Rayner is now in it’s 101st year and has its eyes firmly focussed on the future.<br />

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Established 1910. Join in 2011.<br />

51<br />

Contact Lens Opticians<br />

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Lowndes House, The Bury,<br />

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Email: working@rayner.com<br />

17/06/11 JOBS<br />

Sandwell & West Birmingham Hospitals NHS Trust is one of the<br />

largest teaching Trusts in the UK. With a reputation for excellence<br />

we provide high quality care from 3 hospitals, and are working<br />

towards Foundation Trust Status.<br />

Dispensing Optician/Senior<br />

Optical Dispenser<br />

Band 5<br />

Ref: 381-SB-0164<br />

An exciting opportunity has arisen to work in the <strong>Optometry</strong> Department<br />

at the Birmingham & Midland Eye Centre.<br />

As a qualified Dispensing Optician/Senior Optical Dispenser working<br />

in the Department, you will be solely in charge of the day-to-day<br />

management of the newly refurbished Optical Dispensary, reporting to<br />

the Head of <strong>Optometry</strong>. This position requires the demonstration of strong<br />

organisational skills and the ability to work on your own, initiative as well<br />

as interacting with the rest of the <strong>Optometry</strong> Department. You will be<br />

expected to perform both routine and complex dispenses, arrange their<br />

own appointments, place orders, manage stock control, and maintain the<br />

general good order of the Dispensary.<br />

Previous hospital dispensing experience will be very useful although not<br />

essential. You will need to have a positive disposition and be an excellent<br />

communicator, with a genuine enthusiasm for Dispensing to provide a full<br />

and comprehensive Dispensing service for the Birmingham & Eye Centre.<br />

All informal enquiries to Dr Waheeda Illahi, Head of <strong>Optometry</strong> on<br />

0121 507 6727.<br />

Closing date: 3rd July 2011. Interview date: 20th July 2011.<br />

Please apply on-line at our website www.swbh.nhs.uk<br />


Please note that we are unable to contact all applicants after the<br />

shortlisting stage due to cost implications. Therefore, if you have not<br />

heard from us within three weeks of the closing date, please assume<br />

that you have not been successful on <strong>this</strong> occasion.<br />

The Trust is committed to equality of opportunity and is a no<br />

smoking organisation.<br />

www.swbh.nhs.uk<br />

Optometrist - Cardiff<br />

(1 permanent post; also some locum cover required)<br />

DO/Trainee DO; Optical Assistants<br />

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Flexible working hours can be considered.<br />

Please apply in confidence by email to<br />

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JOBS<br />

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17/09/10 17/06/11 RECRUITMENT<br />

JOBS<br />

Specsavers Opticians<br />

Portadown Northern Ireland • Permanent<br />

position for Optometrist • 3-4 days per<br />

week• Salary dependent on experience<br />

Contact Michael or John on 028 3835 0400<br />


Full/Part Time – Experienced, Locum Dispensing Optician<br />

Enthusiastic,friendly,committed fully qualified DO required for<br />

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• Good Salary (according to qualifications<br />

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• Friendly working environment<br />

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• Full or part time considered<br />

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Please contact Martin on: 07788 772334 or<br />

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Banbury, Oxfordshire<br />

D.O. Assistant Manager<br />

Harrold Opticians is a family run group<br />

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We are seeking a D.O or nearly qualified<br />

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Contact Helen 07855094342 0r 01295 266326<br />

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Sign up to OT<br />

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optometrytoday<br />

Research Fellow<br />

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Cambridge Ref: 000046<br />

Fixed-term contract for 6 months (with possibility of extension)<br />

Hours negotiable (full-time/part-time)<br />

£29,972 - £34,745 p.a. pro rata<br />

Our vibrant, modern University has ambitious plans for its future.<br />

Our two main campuses in Cambridge and Chelmsford are being<br />

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higher education in the East of England.<br />

An excellent opportunity has arisen for a Post-Doctoral Research Fellow<br />

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interdisciplinary research environment across different departments and<br />

faculties. In the last Research Assessment Exercise, RAE2008, we<br />

attained excellence in 55% of our research with 5% graded as world<br />

class. We have a number of successful partnerships with the NHS,<br />

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The successful candidate will work on a collaborative project with<br />

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A relevant PhD in optometry or gait analysis is required.<br />

Closing date: 01 July 2011.<br />

For further details and to apply please visit our website<br />

www.anglia.ac.uk. If you have any queries please<br />

contact our recruitment team on 0845 196 4927<br />

or email jobs@anglia.ac.uk<br />

We value diversity at<br />

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17/06/11 JOBS<br />

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To place an advertisement call 020 7878 2313<br />

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See better. Feel better. Work better.<br />

54 50<br />

17/09/10 17/06/11 RECRUITMENT<br />

JOBS<br />

Joint Venture Partners (Established Business Opportunities – Nationwide)<br />

The hard work and commercial acumen of our Joint Venture Partners, along with our state-of-the-art equipment and<br />

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We currently have opportunities available in the following locations:<br />

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To find out more please contact Chris Braddock on 0115 988 2139 or email chris.braddock@visionexpress.com.


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