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www.optometry.co.uk November 25 2011 vol 51:23 £4.95<br />

optometrytoday<br />

Journal of the Association of Optometrists<br />

Four CET<br />

points inside<br />

Profiled: Viewpoint<br />

of York in focus<br />

How you<br />

will benefit<br />

from AOP<br />

Privileges<br />

Student Summit<br />

We feature CooperVision’s new clinical competition

Biofi nity ® multifocal<br />

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November 25 2011 vol 51:23<br />

11 20 36<br />

News<br />

6 Bob Hughes leaves<br />

The AOP pays tribute to its former chief<br />

executive who has left to pursue a new career<br />

7 Cataract crackdown<br />

PCTs have been banned from cost-cutting<br />

measures which have been hitting patients<br />

waiting for cataract surgery<br />

8 Comment<br />

OT’s editor-in-chief David Challinor reflects on<br />

the changes in retail and how events such as<br />

the AOP’s Student Eye Opener Conference are<br />

helping young practitioners prepare better for<br />

their careers<br />

11 VAT loophole to close<br />

Companies undercutting UK suppliers by<br />

selling low-value items from the Channel<br />

Islands will now have to pay VAT<br />

14 New optometry department<br />

Plymouth aims to create something ‘exciting’<br />

it was revealed at the official opening<br />

Cover story<br />

32-33 Magnificent seven<br />

Seven universities took part in CooperVision’s<br />

first-ever student competition and OT’s David<br />

Challinor was one of the judges<br />

Products<br />

20-21 Industry news<br />

‘Eyes heaven’ opens in London and the<br />

Rodenstock Club celebrates its 20th anniversary<br />

plus an important launch from Carl Zeiss Vision<br />

28 Cases for specs and CLs<br />

A look at distinctive cases which can help boost<br />

footfall at the traditionally quiet time in practice<br />

Regulars<br />

24 Letters<br />

Clarification on peripheral retinal degenerations<br />

25 Christmas crossword<br />

Our popular brainteaser<br />

26 Diary dates<br />

Details of the FMO Christmas Lunch and all the<br />

latest optical events<br />

38 Student news<br />

A fully-funded studentship is being offered at<br />

the new optometry department at Plymouth<br />

University plus news from Aston, Glasgow<br />

Caledonian and Cardiff<br />

Events<br />

30-31 AOP Council elections<br />

Information on the important changes in<br />

the upcoming election which features new<br />

constituencies and additional seats<br />

Features<br />

16-17 New benefits scheme<br />

The AOP has launched a privileges scheme for<br />

members which includes savings on holidays,<br />

dining out, car repairs, ‘phone bills, energy and<br />

gifts<br />

34-35 Practice excellence<br />

Optix MD Trevor Rowley has opened a new<br />

practice in York which takes technology and<br />

high-end retail to a new level<br />

Clinical<br />

36-37 VRICS: C-17158 O<br />

Vision assessment in ocular disease<br />

Part 1. Dr Raymond Beirne tests our knowledge<br />

of the assessment of vision and interpretation of<br />

results for different types of ocular diseases<br />

40-43 CET 1: C-17573 O<br />

Referral refinement –<br />

distortion of vision<br />

Part 12. Mark Benson discusses how optometrists<br />

should investigate and manage patient reports of<br />

distorted vision, offering pertinent referral advice<br />

for the most common causes<br />

44-49 CET 2: C-17277 O/AS/SP/IP<br />

Community-based<br />

independent prescribing<br />

Peter Frampton describes his work as an<br />

independent prescriber in community practice,<br />

offering advice on the management of various<br />

conditions<br />

Classified<br />

50-53 Jobs<br />

All the latest vacancies<br />

54-58 Marketplace<br />

Where to buy optical goods and services<br />

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

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

Feature is online<br />

Video is online<br />


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Call for more information or for a demonstration, on: 0121 458 6800

NEWS<br />

Contact lenses rich with<br />

info are nearer to reality<br />

THE DREAM of contact lenses<br />

providing wearers with digital<br />

images and information in front<br />

of their eyes came a step closer<br />

<strong>this</strong> week.<br />

A study reported that<br />

researchers constructed a<br />

computerised contact lens and<br />

demonstrated its safety by testing<br />

it on live eyes, with no signs of any<br />

adverse side effects.<br />

At the moment, the contact<br />

lens device – which was tested<br />

on rabbits – contains only a single<br />

pixel but the researchers see <strong>this</strong><br />

as a ‘proof-of-concept’<br />

for producing lenses with multiple<br />

pixels which could be used to<br />

display short emails and text<br />

messages before a wearer’s eyes.<br />

The device could overlay<br />

computer-generated visual<br />

information, say developers, and<br />

be of use in gaming devices and<br />

navigation systems. It could also<br />

be linked to biosensors in the<br />

user’s body to provide information<br />

on glucose levels.<br />

The contact lens, created by<br />

researchers at the University<br />

of Washington, USA, and Aalto<br />

University, Finland, consisted<br />

of an antenna to gather power<br />

sent out by an external source,<br />

as well as an integrated circuit<br />

to store <strong>this</strong> energy and transfer<br />

it to a transparent sapphire chip<br />

containing a single blue LED.<br />

One major problem the<br />

researchers had to overcome was<br />

the fact that the human eye, with<br />

its minimum focal distance of<br />

several centimetres, cannot resolve<br />

objects on a contact lens. Any<br />

information projected on to the<br />

lens would probably appear blurry.<br />

To combat <strong>this</strong>, the researchers<br />

incorporated a set of Fresnel lenses<br />

JMW 20 feet tall<br />

into the device. Much thinner and<br />

flatter than conventional lenses,<br />

they were used to focus the<br />

projected image on to the retina.<br />

After demonstrating the<br />

operation and safety of the<br />

lens, the researchers state that<br />

significant improvements are<br />

necessary to produce fully<br />

functional, remotely-powered,<br />

high-resolution displays. For<br />

instance, the device could be<br />

wirelessly powered in free space<br />

from approximately one metre<br />

away, but <strong>this</strong> was reduced to<br />

about two centimetres when<br />

placed on the rabbits eye.<br />

Co-author of the study, Professor<br />

Babak Parviz, of the University<br />

of Washington’s department of<br />

electrical engineering, said:<br />

“We need to improve the antenna<br />

design and the associated<br />

matching network and optimise<br />

the transmission frequency to<br />

achieve an overall improvement<br />

in the range of wireless power<br />

transmission.<br />

“Our next goal, however, is to<br />

incorporate some predetermined<br />

text in the contact lens.”<br />

The study was published in the<br />

Institute of Physics publication,<br />

Journal of Micromechanics and<br />

Microengineering.<br />

IN BRIEF<br />

Tribute to lecturer<br />

Dr Gary Baker, pictured, the<br />

senior lecturer at City University’s<br />

Department of <strong>Optometry</strong> and<br />

Visual Science, has died. He was<br />

59. Read the tribute to him from<br />

his colleague, Ron Douglas, on<br />

page 14.<br />

Barbour Eyewear<br />

launch<br />

The new Barbour Eyewear<br />

collection was launched by Norville<br />

Eyewear last week. The high profile<br />

launch took place at London’s<br />

Sloane Club and will be featured in<br />

our next edition.<br />

Jailed for theft<br />

A 24-year-old man who stole<br />

thousands of pounds worth of<br />

designer glasses has been jailed<br />

for 20 months. Ahmed Ebrahimi<br />

forced entry into Boots Opticians in<br />

Croydon late on August 8, and took<br />

£87,733 worth of stock, reported<br />

www.<strong>this</strong>islocallondon.co.uk.<br />

5<br />

25/11/11 NEWS<br />

Bring your display<br />

into focus with the<br />

Number One choice in optical labelling<br />

JAMIE MURRAY WELLS, founder of Glasses Direct, is one of the<br />

entrepreneurs featured in promotional 20-foot high images<br />

outside Queen’s banker Coutts in London’s Strand. His image<br />

was part of the bank’s celebration of Global Entrepreneurship<br />

Week. The Coutts caption for Mr Wells, who is pictured alongside<br />

the founder of Coffee Republic Sahar Hashemi, reads: ‘Jamie<br />

took on conventional opticians in a great example of using the<br />

Web to disrupt traditional ways of doing business…’<br />

• Price labels, every kind<br />

and colour<br />

• Lens labels, stock and<br />

bespoke<br />

• Contact lens packaging<br />

labels<br />

• Dummy security sensors<br />

• Coloured oval price<br />

tickets<br />

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

Tel 01235 543993 Fax 01235 532118<br />

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

News updated regularly at www.optometry.co.uk

optometrytoday<br />

NOVEMBER 25 2011<br />

Volume 51:23<br />

ISSN 0268-5485<br />


January 1 2009 – December 31 2009<br />

Average Net: 19, 842<br />

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

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

T: 020 7549 2071<br />

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

Deputy Editor:<br />

Robina Moss<br />

T: 020 7549 2072<br />

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

Web Editor:<br />

Emily McCormick<br />

T: 020 7549 2073<br />

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

online<br />

Reporter: Chris Donkin<br />

T: 020 7549 2074<br />

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

OT Multimedia Editor: Laurence Derbyshire<br />

T: 020 7549 2075<br />

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

Clinical Editor: Dr Navneet Gupta<br />

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

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

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

OT Manager: Louise Walpole<br />

T: 020 7549 2077<br />

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

Editorial Office:<br />

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

Advertising: Vanya Palczewski<br />

T: 020 7878 2347<br />

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

Sponsorship: Sunil Singh<br />

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

CET and bookshop enquiries: Charlotte Verity<br />

T: 020 7549 2076<br />

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

Production: Ten Alps Creative<br />

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

Membership Dept:<br />

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

T: 020 7549 2010<br />

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

Advertising and Production Office<br />

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

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

High Holborn, London WC1A 1NU<br />

Editorial Advisory Board<br />

Leon Davies, Cameron Hudson, Polly Dulley, Dan<br />

Ehrlich, Andy Hepworth, Olivia Hunt, Niall Hynes,<br />

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

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

Andy Yorke<br />

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

Published fortnightly for the Association of<br />

Optometrists by Ten Alps Creative<br />

Subscriptions<br />

Alliance Media Limited, Bournehall House,<br />

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

T: 020 8950 9117<br />

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

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

NEWS<br />

Bob Hughes has left the<br />

live<br />

bookshop<br />

AOP to pursue new career<br />

AOP chairman David Shannon<br />

paid tribute to his achievements:<br />

“Bob has contributed to the<br />

success of the AOP over nearly<br />

seven years. During his time<br />

as CEO, Bob has raised our<br />

profile and that of optometry<br />

significantly in Parliament and<br />

with the public. He has been<br />

central to enewsletter<br />

the development of<br />

much closer working relationships<br />

with the other optical bodies<br />

and especially FODO; a move<br />

which created the Optical<br />

Confederation.<br />

“The AOP now has a substantial<br />

new property that will enable<br />

us to increase our services to<br />

members within an attractive<br />

working environment, and will<br />

also help us contain running costs<br />

VRICS<br />

well into the future.<br />

“We are a more powerful<br />

national lobbying force than we<br />

have ever been, as well as being<br />

able to operate effectively locally<br />

through the LOC Support Unit<br />

which Bob pioneered and helped<br />

to build. The profession speaks<br />

with a much stronger voice now<br />

and we are grateful for his work<br />

and his enthusiasm. We wish him<br />

well for the future.<br />

“The AOP has not yet<br />

appointed a successor; Richard<br />

Carswell, deputy chief executive,<br />

will head the AOP while a<br />

successor is recruited. Richard<br />

has been with the AOP for<br />

many years and is widely known<br />

and respected throughout the<br />

profession.”<br />

Bob Hughes said: “I am<br />

proud to leave the AOP with<br />

increased capabilities to promote<br />

optometry, with friends in all<br />

political parties and the NHS<br />

administration, and a first class<br />

defence team able to stand<br />

alongside individual optometrists<br />

as they come under attack.”<br />

Space flights have an<br />

impact on astronauts’ eyes<br />

A NASA study has<br />

concluded that lengthy<br />

space flights can cause<br />

a number of changes<br />

in astronauts’ visual<br />

systems, with some<br />

problems appearing<br />

to persist long after<br />

the astronauts have<br />

returned to Earth.<br />

The study team,<br />

which included a<br />

number of ophthalmologists,<br />

was reported in the journal<br />

Ophthalmology.<br />

The researchers studied<br />

seven astronauts, all of<br />

whom were about age 50<br />

and had spent at least six<br />

continuous months in space.<br />

All reported that their vision<br />

became blurry, to varying<br />

degrees, while on the space<br />

station. Vision changes<br />

usually began around six<br />

weeks into the mission and<br />

persisted in some astronauts<br />

for months after their return<br />

to Earth. Researchers agreed<br />

that the eye abnormalities<br />

appear to be unrelated to<br />

launch or re-entry, since they<br />

occurred only in astronauts<br />

who spent extended<br />

time in microgravity.<br />

In-depth examination<br />

of the seven astronauts<br />

revealed several<br />

abnormalities. All of<br />

the subjects had one or<br />

more of the following<br />

changes in the t<strong>issue</strong>s,<br />

fluids, nerves and other<br />

structures in the back<br />

of the eye:<br />

• Flattening of the back of<br />

the eyeball (five subjects);<br />

• Folds in the choroid, the<br />

vascular t<strong>issue</strong> behind the<br />

retina, which is the light<br />

sensitive area in the back of<br />

the eye (five subjects); and<br />

• Excess fluid around and<br />

presumed swelling of the<br />

optic nerve (five subjects).<br />

CET<br />

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

PCTs banned from<br />

capping cataract ops<br />

Health Secretary Andrew<br />

Lansley (pictured) has banned<br />

PCTs from cutting costs by<br />

enforcing minimum waiting<br />

times and capping the operation<br />

numbers for procedures such as<br />

cataracts surgery – which some<br />

PCTs have reportedly been using<br />

as a way to save money.<br />

PCTs have until March to<br />

remove any arbitrary rationing,<br />

and, following the deadline,<br />

all decisions which ‘impact on<br />

patient choice’ will be made at<br />

PCT Board level. The rules will<br />

not apply to new commissioning<br />

groups.<br />

The move comes following an<br />

investigation by the Co-operation<br />

and Competition Panel into<br />

any instances where PCTs were<br />

limiting patient choice or not<br />

acting in the best interests of the<br />

taxpayer.<br />

Announcing the measure,<br />

Mr Lansley said: “This is just the<br />

beginning of a range of measures<br />

we hope to introduce to make<br />

the NHS truly patient focused. I<br />

want a health service that works<br />

around patients – not the other<br />

way around.<br />

“PCTs have to manage<br />

resources carefully but they must<br />

do so without restricting patient<br />

choice. That’s why I am taking<br />

firm action today and banning<br />

these unfair measures imposed<br />

on patients.”<br />

RNIB eye health campaigns<br />

manager, Clara Eaglen, applauded<br />

the move. “RNIB welcomes the<br />

commitment by the secretary of<br />

state for health to end minimum<br />

waiting times and arbitrary caps<br />

on surgery, “ she said. “Both these<br />

problems were highlighted<br />

earlier <strong>this</strong> year in a joint report<br />

from RNIB and the Royal College<br />

of Ophthalmology on access to<br />

cataract surgery.<br />

“However it is far from<br />

clear whether the measures<br />

announced will provide a<br />

solution.”<br />

Commenting on the measure,<br />

head of commissioning policy<br />

for the PCT Network, Elizabeth<br />

Wade, said: “NHS commissioners<br />

should ensure decisions about<br />

changes to local services that<br />

might reduce or delay access<br />

to care are not arbitrary, but are<br />

based on careful deliberation<br />

of the available evidence and<br />

likely impact on patients. Where<br />

there is poor commissioning<br />

practice, we should not support<br />

it. Nobody wants decisions on<br />

patient care taken in an arbitrary<br />

fashion purely based on cost.”<br />

Advanced ordering software<br />

Rodenstock has<br />

introduced an advance<br />

ordering system which<br />

enables practitioners to track<br />

orders 24 hours a day.<br />

WinFit Reference’s online<br />

software allows users to<br />

input orders directly without<br />

relaying information to a third<br />

party, therefore reducing the<br />

risk of error. Practitioners can then<br />

monitor the production of their<br />

order using the system’s real-time<br />

tracking function.<br />

The programme can be<br />

connected to multiple computers<br />

in a practice and also links to<br />

Rodenstock’s dispensing software.<br />

A 3D online calculation module<br />

can be used as an interactive<br />

demonstration tool which shows<br />

exact base curve, shape and<br />

substance at any point on the<br />

finished lens.<br />

Debbie Bathgate,<br />

Rodenstock lens product<br />

manager, said: “We are already<br />

receiving excellent feedback<br />

about the new system which is<br />

designed to make efficient use<br />

of opticians’ time. Everything is<br />

recorded and information can<br />

be accessed at any time.<br />

“While ‘phone, fax and<br />

written orders are still available,<br />

we hope that WinFit Reference<br />

will be a welcome development<br />

and be less time-consuming. Our<br />

WinFit Reference team is on hand<br />

to offer advice and assistance<br />

when needed.”<br />


Health village 2<br />

Chemist Lloyds pharmacy is to open<br />

a second ‘Health Village’, which<br />

includes an opticians, following the<br />

first of the concept which opened in<br />

London’s Brent Cross. The second is at<br />

Thurrock, Essex, and will be unveiled<br />

in December, the website reports<br />

www.retailgazette.co.uk<br />

Expanded recall<br />

CooperVision has expanded its global<br />

recall of its branded Avaira toric and<br />

Avaira sphere contact lenses. The<br />

recall was initiated due to the level<br />

of a residue on certain Avaira lenses,<br />

and the company has said there have<br />

been reports of wearers experiencing<br />

hazy vision and unusual discomfort.<br />

A website – www.coopervision.com/<br />

international-recall/gb – has more<br />

details.<br />

Pub ruling<br />

A Norwich pub has won the right<br />

to have tables and chairs outside<br />

its premises, despite the protests<br />

of a practice manager who claimed<br />

drinkers nearby posed a nuisance to<br />

his patients. Moss & Leakey’s David<br />

Foskett objected but a committee<br />

from Norwich City Council granted<br />

the owners of The Murderers pub<br />

permission to retain its outside<br />

tables and chairs after a number<br />

of nearby businesses said the<br />

pub brought business to the area,<br />

reported www.eveningnews24.co.uk<br />

Optos buoyant<br />

Sales are soaring at retina imaging<br />

business Optos, the Scottish<br />

company has reported. Pre-tax<br />

profits for the year to September 30<br />

were up 73% to £14m, and revenues<br />

rose by 35% to £91m.<br />

Name change call<br />

A Northampton practice owner<br />

has started a campaign to have<br />

part of the town centre renamed<br />

‘Eastgate’, it has been reported. John<br />

Sheinman, of Sheinman Opticians,<br />

is aiming for the historic origin of<br />

the area where his outlet is situated,<br />

to be recognised.<br />

7<br />

25/11/11 NEWS<br />

News updated regularly at www.optometry.co.uk

NEWS<br />

comment<br />

GOC posts healthy<br />

financial quarter<br />

8<br />

25/11/11 NEWS<br />

THE GOC is seeking to<br />

press ahead to maintain a<br />

‘downward pressure’ on its<br />

Low Income Fee, a meeting<br />

of the council heard <strong>this</strong><br />

week.<br />

A paper tabled by Jeff<br />

Cant, the GOC’s director of<br />

resources, reviewed a healthy<br />

financial quarter for the<br />

council. He reminded those<br />

at Thursday’s Harley Street<br />

meeting that 12 months ago<br />

the council had agreed a 20% reduction in<br />

fees for the year April 1, 2011-2012 to £270. It<br />

also was agreed at that point that fees would<br />

have to increase to £274 from April 1, 2012,<br />

assuming the rate of inflation was at 4%.<br />

Mr Cant stated that it was good to report<br />

that saving in costs in a number of efficiency<br />

measures – including a ‘significant redu ction’<br />

in the use of costly legal advice – of £250,000<br />

is expected in the year despite inflation<br />

running at over 5% and a reduction in income<br />

into the GOC’s coffers of around £150,000,<br />

with the introduction of the Low Income Fee,<br />

which he called ‘an excellent outcome’.<br />

For 2012-2013 “we are fully committed<br />

to deliver <strong>this</strong>,” he said, “and to seek<br />

further economies from our Invest to<br />

Save programme to enable us to maintain<br />

Next week’s meeting<br />

of the All Party<br />

Parliamentary Group<br />

on Eye Health and<br />

Visual Impairment<br />

will hear from<br />

health minister Earl<br />

Howe, one of the<br />

leading figures in the<br />

government’s team<br />

aiming to change the<br />

NHS.<br />

The meeting, which will take place on<br />

December 1 in Committee Room 1 at the<br />

downward pressure on<br />

the fee in future years”.<br />

He invited the<br />

council to reaffirm its<br />

commitment, and that of<br />

the GOC staff, to seek ways<br />

of getting the best value<br />

from the budget available,<br />

‘driving out inefficiencies<br />

and delivering on its aim<br />

to provide high quality<br />

public protection’.<br />

The cumulative spend<br />

for the year to September 30 of £2.1m is<br />

£390,000 (16%) below budget.<br />

This was predominantly due to:<br />

· Lower than anticipated Fitness to Practise<br />

case charges largely due to the increase in<br />

work carried out in-house and the impact of<br />

re-negotiated fees to cap case costs which<br />

have been dependent upon the nature of<br />

cases and work completed by law firms<br />

·Criminal prosecution cases have increasingly<br />

been resourced in-house, reducing the need<br />

to employ law firms<br />

· Lower than anticipated spend on<br />

consultancy within the CEO’s office budget<br />

to improve the policy formulation and<br />

governance processes<br />

· Greater cost awareness and focus on<br />

achieving efficiency gains across all budgets.<br />

Earl Howe speaks to APPG<br />

House of Lords, will start<br />

at 4pm. It is expected<br />

that the meeting will<br />

provide the group<br />

with an opportunity to<br />

discuss with Earl Howe<br />

the proposed changes<br />

to the NHS, in particular<br />

Public Health Indicators<br />

and the need for an Eye<br />

Health Indicator.<br />

The RNIB and the<br />

College of Optometrists provide the<br />

secretariat for the group.<br />

What’s their<br />

Viewpoint?<br />

It’s encouraging to read the profile<br />

of Trevor Rowley’s newly opened<br />

practice, Viewpoint, which is featured<br />

on pages 34-35.<br />

Early indications for the upmarket<br />

store are good, reinforcing the belief<br />

that if you can spot an opportunity<br />

in the market, and sense an audience<br />

is there for a certain type of product<br />

or service, sometimes success and<br />

everything else can follow.<br />

It seems eons ago, but when I first<br />

wrote about the retail sector for a living<br />

back in the late 1980s it felt there was<br />

a lot more money available to invest<br />

in the High Street generally, if not the<br />

experimentation and niche areas we<br />

see today.<br />

I can’t help but also think of the<br />

excellent clinical presentations I<br />

witnessed recently at the CooperVision<br />

student summit. Although optometry<br />

degrees deliver the expertise working<br />

in practice requires, being retail<br />

savvy is often picked up during a<br />

practitioner’s career.<br />

A few years ago there was little or<br />

no wider help for optometry students<br />

heading towards their first professional<br />

role. That is now changing, notably<br />

because of events such as the AOP<br />

Student Eye Opener Conference.<br />

This weekend’s event, as it has done<br />

for the last few years, will provide a<br />

good networking opportunity for those<br />

students who attend, and will also be<br />

useful for delegates to hear the latest on<br />

what employers expect in the early part<br />

of a practitioner’s career.<br />

Who knows what success stories will<br />

emerge from the latest Center Parcs<br />

audience in the future.<br />

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

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

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question time<br />

Francesca Marchetti<br />

AOP councillor and self-employed optometrist Francesca Marchetti works in both independents and<br />

multiples. She also practises at the Midland Eye Institute and is a College of Optometrists’ councillor<br />

10<br />

25/11/11 QUESTION TIME<br />

How are you?
<br />

I’m fine. Work’s very busy, enjoyable, in<br />

particular the diversity of my work in<br />

practice, as a councillor and a presenter.<br />

What do you like about<br />

working in optics?<br />

I like absolutely everything, it’s as simple<br />

as that. From all sides: the clinical area, the<br />

fashion part, the people, the healthcare<br />

element.<br />

What’s the best thing that’s<br />

happened in the profession<br />

during your time working in it?<br />

Compulsory CET. The great and the<br />

good always did CET, but those isolated<br />

practitioners didn’t realise they needed<br />

to do it. It’s great for networking and<br />

socialising and building the profession.<br />

Who do you admire in the<br />

sector?<br />

I wouldn’t pick out any individual, just to<br />

say every good, hard-working enthusiastic<br />

optometrist.<br />

Where are your favourite<br />

places in the world that optics<br />

has taken you?<br />

Very close to home. In fact, Glasgow, where<br />

I grew up. And also the House of Commons<br />

as an AOP councillor and College of<br />

Optometrists councillor.<br />

Are you supersitious?<br />

Slightly. I always throw salt over my left<br />

shoulder. Never walk under a ladder.<br />

What instrument could you not<br />

do without?<br />

Without a shadow of a doubt my Hamblin<br />

Streak Ret’ bought for me by my father<br />

for my 21st birthday. It’s never needed<br />

servicing, apart from new bulbs.<br />

If you were granted one wish<br />

for the profession what would<br />

you wish for?<br />

Increased recognition of what we do as<br />

optometrists, both in the clinical sector<br />

and public sector. And having adequate<br />

remuneration.<br />

Do you have a favourite film<br />

or TV show<br />

La vita è bella (Life is Beautiful), the film.<br />

Outside the profession, what<br />

are your hobbies?<br />

I love cooking – I’ve been on Ready,<br />

Steady, Cook. Also running and skiing.<br />

Sum up your feelings for the<br />

next 12 months in five words.<br />

No complacency, exciting, challenging,<br />

positive.<br />

Where do you go on holiday?<br />

Barga, Italy where my family originates<br />

from.<br />

What are your favourite<br />

products in the optical sector?<br />

Blephaclean and Blephasol treatment for<br />

blepharitis. They’re lovely products to sell<br />

to women.<br />

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

what would you be doing?<br />

A life coach, and presenter.<br />

What’s your favourite singer or<br />

musical group?<br />

Frank Sinatra, childhood memories of<br />

listening to his music with mum and dad<br />

at home.<br />

What do you put your success<br />

down to?<br />

The fact I’ve been open-minded to change<br />

and adapted.<br />

What’s your favourite time of<br />

year?<br />

Summer. I love outdoor living and the<br />

more light hours the season brings.<br />

Where would you spend your<br />

perfect day?<br />

Having a long, lazy lunch in my garden<br />

with friends and family.<br />

Any final thoughts?<br />

Let’s move forward and look ahead,<br />

embracing the challenges and turning<br />

them into opportunities.<br />

Question Time<br />

Would you like to take our questions<br />

and be involved in our regular Question<br />

Time series? If so please write to David<br />

Challinor, editor-in-chief of <strong>Optometry</strong><br />

<strong>Today</strong> by email at davidchallinor@<br />

optometry.co.uk, or by post to: Question<br />

Time, <strong>Optometry</strong> <strong>Today</strong>, 2 Woodbridge<br />

Street, London EC1R ODG including<br />

your contact details and availability.<br />

Please be able to answer our questions<br />

by telephone or email, and to provide a<br />

good quality photograph of yourself.

Govt closes VAT loophole<br />

NEWS<br />

Companies undercutting<br />

UK suppliers by selling lowvalue<br />

goods such as contact<br />

lens solutions from the Channel<br />

Islands using the tax loophole the<br />

Low Value Consignment Relief<br />

will now have to pay VAT, the<br />

government has announced.<br />

The loophole closure is to<br />

ensure there is no unfair tax<br />

advantage as a result of trading<br />

through – or from – the Channel<br />

Islands compared to the rest of<br />

the UK.<br />

In the 2011 Budget, the<br />

threshold for goods to qualify for<br />

the Relief was lowered from £18<br />

to £15, a measure which took<br />

effect on November 1. This rate will<br />

continue until it is abolished from<br />

the beginning of April.<br />

Explaining the reasoning behind<br />

the policy change, exchequer<br />

secretary to the Treasury, David<br />

Gauke, said: “These reforms<br />

will ensure that UK companies,<br />

especially small and medium sized<br />

enterprises, can compete on a<br />

level playing field with those larger<br />

companies with the resources to<br />

set up operations in the Channel<br />

Islands. By making these changes,<br />

we are striking the best possible<br />

balance between the costs of<br />

collecting small amounts of VAT<br />

and protecting the interests of UK<br />

taxpayers and businesses.”<br />

BCLA president, Shelly Bansal<br />

(pictured), welcomed the move,<br />

adding: “It remains to be seen<br />

whether the change will lead to<br />

a ‘fairer’ market for contact lenses<br />

and care products, however, it<br />

will undoubtedly affect those<br />

companies that have used <strong>this</strong> VAT<br />

loophole to ship contact lenses<br />

and related products from the<br />

Channel Islands via their online<br />

businesses.<br />

“Some may choose to absorb<br />

the VAT costs within their<br />

businesses, while others may<br />

choose to increase their product<br />

costs and/or close any distribution<br />

businesses on the islands.”<br />

11<br />

College presents its diplomas<br />

Three hundred newly qualified<br />

optometrists celebrated collecting<br />

their College of Optometrists<br />

diplomas in front of 700 onlookers<br />

at the graduation ceremony at<br />

Westminster Central Hall, London.<br />

As well as the presentation of<br />

its diplomas, the College also uses<br />

the ceremony to recognise those<br />

who have made an outstanding<br />

contribution to optometry locally,<br />

nationally and internationally.<br />

Anita Lightstone, John Adrian<br />

Macdonald Jennings, Norbert<br />

Cohn, Donald Cameron and<br />

Colin Fowler all received Life<br />

Fellowships with Peng Tee Khaw<br />

being elected to the Honorary<br />

Fellowship of the College, in<br />

recognition of his outstanding<br />

contribution to the optometric<br />

profession.<br />

College president Dr Cindy<br />

Tromans told those receiving<br />

the qualifications: “<strong>Today</strong> you are<br />

beginning your career and we are,<br />

rightly, celebrating <strong>this</strong> milestone.<br />

But you must continue to develop<br />

your skills, your knowledge and<br />

your understanding throughout<br />

your professional life.<br />

“Since I qualified in 1986, there<br />

have been many developments<br />

in the profession. The increased<br />

pace of science and technology<br />

will mean that the changes<br />

during your career are likely to be<br />

even more profound.”<br />

25/11/11 NEWS<br />

FMO warns about allowance<br />

Practice managers and<br />

owners are being warned<br />

by the FMO to take note<br />

of next April’s changes in<br />

Capital Allowance, which<br />

include a reduction in annual<br />

investment allowance from<br />

£100,000 to £25,000.<br />

Businesses considering<br />

making large purchases such<br />

as new technology, cars or<br />

equipment have been urged<br />

by the Federation to consider<br />

the tax implications of doing<br />

so before April 6, especially<br />

if their financial year ends in<br />

March or April.<br />

FMO auditor, Irving Goldin,<br />

told OT: “Even if your year<br />

end is not March or April you<br />

might be better off making<br />

business purchases before<br />

April as the reduction in<br />

the allowance will be time<br />

apportioned in accordance<br />

with your financial year end.”<br />

He also warned of a small<br />

reduction, by 2%, of the<br />

depreciation allowances –<br />

which can include old assets<br />

that are brought forward.<br />

Companies are advised to<br />

discuss details, especially of<br />

hire purchase agreements,<br />

with their accountants.<br />

Mr Goldin added: “With<br />

some careful planning, the<br />

rules for capital allowances<br />

can be maximised.”

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NEWS<br />

14<br />

25/11/11 NEWS<br />


Dr Gary Baker<br />

It is with great sadness that I report<br />

the death of Dr Gary Baker, aged 59,<br />

a senior lecturer in the Department<br />

of <strong>Optometry</strong> & Visual Science, City<br />

University, writes Ron Douglas,<br />

Professor of Visual Science and<br />

deputy head of the department .<br />

I first met Gary on the rugby<br />

field almost 40 years ago when we<br />

were both undergraduates at the<br />

University of Sussex. After obtaining<br />

a BSc in Experimental Psychology<br />

in 1976, he also gained an MSc in<br />

Neurophysiology in 1981 and a PhD<br />

from London Guildhall University on<br />

‘the gustatory system of cypinoid<br />

fish’ in 1987.<br />

He spent 12 years in the<br />

world-leading laboratories at<br />

the University of Oxford, and two<br />

years with Michael Stryker at<br />

the University of California, San<br />

Francisco. During <strong>this</strong> time he<br />

cemented his own international<br />

reputation where his work, in<br />

particular on the organisation and<br />

development of the mammalian<br />

retinal pathways, and on changes in<br />

conduction velocity along individual<br />

nerve axons remain gold-standards<br />

in their fields.<br />

He joined our Department<br />

in 1999 and soon acquired a<br />

reputation as an inspiring teacher<br />

of ocular and visual anatomy and<br />

function. He was enormously<br />

popular among our students, being<br />

a frequent nominee for University<br />

Teaching Prizes voted for by the<br />

student body, which he deservedly<br />

won two years ago.<br />

Gary also made significant<br />

contributions to the running of the<br />

undergraduate and postgraduate<br />

programmes. He took on the<br />

difficult roles of BSc <strong>Optometry</strong><br />

Programme Director in 2004, later<br />

transferring his energies to the<br />

task of coordinating the widening<br />

of student participation via the<br />

Foundation Degree in Ophthalmic<br />

Dispensing run in collaboration<br />

with City & Islington College.<br />

He is deeply missed by<br />

colleagues and students alike.<br />

He leaves Maxine, his wife, and<br />

two daughters, Bonny and Holly.<br />

Plymouth aims to create<br />

something ‘exciting’<br />

THE new optometry<br />

programme at Plymouth<br />

University was officially opened<br />

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

The department, which<br />

enrolled 36 first-year students<br />

in September, is the ninth to<br />

offer a BSc (Hons) degree in<br />

optometry across the UK.<br />

Local practitioners, LOC and<br />

PCT insiders, as well as optical<br />

industry representatives, attended<br />

the launch and toured the newly<br />

built state-of-the-art laboratories<br />

based in the institution’s School of<br />

Health Professions.<br />

Pictures by Plymouth University<br />

The FMO has honoured its<br />

former representative on the<br />

BSI standards panel, Derek<br />

McLaren by awarding an annual<br />

prize bearing his name to the<br />

highest student in the ABDO final<br />

qualifying exam.<br />

The Derek McLaren Memorial<br />

Prize was presented to the<br />

winning student at the ABDO<br />

graduation and Prize Giving<br />

The course was established after<br />

the university’s vice chancellor<br />

Wendy Purcell spoke to a regional<br />

director from Specsavers by<br />

chance during a flight. Plans were<br />

quickly put into motion and by<br />

ceremony in Canterbury<br />

Cathedral on November 23 by<br />

Mr McLaren’s widow Christine.<br />

“Derek would have been very<br />

humbled, but also extremely<br />

honoured, by <strong>this</strong> award in his<br />

memory as optics was his life,”<br />

she said. “He started his optical<br />

career in the profession and later<br />

moved to the industry, so <strong>this</strong><br />

award, combining the FMO and<br />

June the university had gained<br />

provisional approval for the<br />

programme from the GOC.<br />

Acknowledging the support<br />

of FODO, Specsavers and<br />

the College of Optometrists,<br />

Dean of the Faculty of Health,<br />

Education and Society,<br />

Professor Richard Stevenson<br />

said: “This celebratory event<br />

is a huge milestone in the<br />

journey of optometry at Plymouth.<br />

It’s a statement that optometry<br />

at Plymouth is here. Our doors<br />

are open and we hope to create<br />

something hugely exciting.”<br />

Derek McLaren honoured<br />

Pop star Max George from boy<br />

band The Wanted was crowned<br />

‘Celebrity Wearer of the Year’<br />

at Specsavers’ Spectacle Wearer<br />

of the Year awards last week<br />

(November 15).<br />

The annual event, hosted by<br />

‘fashion guru’ Gok Wan and<br />

actress Kara Tointon, marked<br />

the 15th year of the awards<br />

and was held at the Boiler<br />

House in Battersea Power<br />

Station, London.<br />

Following a six-month<br />

country-wide search for the<br />

‘Spectacle Wearer of the Year<br />

2011’, Lucie Stevenson from<br />

Falkirk, Scotland (pictured)<br />

was revealed as the overall<br />

winner, receiving a 12-month<br />

ABDO ticks all the boxes and is<br />

most appropriate. “<br />

Mr McLaren died in August.<br />

Pop star shows specs appeal<br />

modeling contract with MOT<br />

Models, as well as a Caribbean<br />

holiday for two.<br />

A total of £10,000 was<br />

raised for anti-bullying<br />

charity Kidscape through the<br />

competition and an auction on<br />

the evening.<br />

Other awards went to<br />

Diversity dance member Perri<br />

Kiely for ‘Best Newcomer’ and<br />

past Strictly Come Dancing<br />

contestant Nancy Dell’Olio for<br />

‘Glamorous Glasses Wearer’.<br />

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

enefits<br />

Big discounts available<br />

with AOP Privileges<br />

16 28<br />

08/04/11 25/11/11 COVER AOP PRIVILeGES<br />

STORY<br />

AOP members can now recoup a large amount of their<br />

membership fees through savings on everything from phone<br />

bills to family holidays, thanks to a brand new privileges<br />

scheme launched by the Association.<br />

In tight economic times it makes sound financial sense to<br />

save money wherever possible and the exclusive discount<br />

secured by the AOP, in association with benefits company<br />

Parliament Hill Ltd, will help members make savings in all<br />

areas of their lives.<br />

“It is a great opportunity for AOP<br />

members to make big savings”<br />

Discounts available include: 5% discount on supermarket<br />

shopping; savings on home telephone lines and broadband<br />

through Shebang; lower rates on gym membership at outlets<br />

across the country with an Incorpore membership; access<br />

to an exclusive price comparison website which can help<br />

members save on energy bills; training course savings and<br />

even website design.<br />

For practitioners looking to take a well-earned break from<br />

work, company Superbreak offers London Theatre breaks<br />

including a stay at a London hotel and tickets to see top<br />

West End shows.<br />

The AOP has also secured discounts with several more<br />

relaxing destinations including breaks available with<br />

CottageStayUK, a company which offers holidays in a<br />

variety of relaxing rural locations not just in the UK, but<br />

also France and Italy.<br />

A choice of thousands of family holidays are also<br />

available for practitioners looking to take the children away,<br />

with an online discount of 8% available on holidays with<br />

Thomas Cook.<br />

Practice managers and owners can access discounts to help<br />

them invest in business solutions such as: 45% off all Microsoft<br />

Desktop Applications Training, including Word, Excel, and<br />

PowerPoint using QA training solutions; SiteWizard offers a<br />

30% reduction on its low cost website and eCommerce solution<br />

provider; AOP Privileges members also receive 20% off annual<br />

stationery and office supplies bills through the Buying Support<br />

Agency.<br />

As well as these deals, the scheme offers Cashback Gift Cards<br />

which can be topped up with money and can be<br />

spent at major retailers and offer between 5% and 15% cashback<br />

when used for everyday purchases from the likes of Marks &<br />

Spencer, ASDA, Sainsbury’s, Boots, Comet, Top Shop and B&Q.<br />

Director of Parliament Hill Ltd, Andrew Holden told<br />

OT: “In tough economic times every penny counts and<br />

that is why AOP Privileges has been created. These offers are<br />

only available to select user groups so they are not available<br />

to the public, which means it is a great opportunity for AOP<br />

members to make big savings.”<br />

Available exclusively to members and their families,<br />

AOP Privileges is easy to access, simply click on the ‘members<br />

benefits’ area of the AOP website at www.aop.org.uk then click<br />

‘AOP Privileges’ from the menu.

Eight top ways to earn back the cost of your AOP membership<br />

1. Get an 8% discount online on thousands of holidays<br />

from over 100 tour operators with the Thomas Cook<br />

Holiday Club.<br />

2. A Gourmet Society dining card can offer you<br />

2-for-1 dining or 25% off your bill including drinks.<br />

Choose from over 4,500 leading restaurants including<br />

some Michelin-starred establishments. A national<br />

Gourmet Society membership for 12 months has an<br />

RRP of £69.95, but AOP members can get a 14-month<br />

membership for just £24.95.<br />

3. CottageStayUK is the UK’s leading cottage short<br />

break member benefit, with fantastic cottage discounts<br />

across the UK, France and Italy. AOP members receive<br />

10% off all year round prices and special offers.<br />

4. Vehicle Servicing Manager (VSM) uses the UK’s<br />

largest network of independent garages to deliver<br />

average savings of 30%, on all your car servicing and<br />

repair requirements. With VSM you can also save 20%<br />

on the cost of your next MOT.*<br />

5. AOP members have access to exclusive mobile<br />

‘phone contracts through Shebang, which is one of the<br />

country’s largest retailers of mobile phones. Members<br />

have access to all the latest network tariffs and handsets.<br />

6. Member Energy’s new free energy price comparison<br />

service will help you find the cheapest gas and electricity<br />

suppliers in your area. The average saving for members is<br />

currently £237* for dual fuel.<br />

7. Cashback Gift Cards is an exciting new way of making<br />

the most of your money! Earn cash back of between 5%<br />

and 15% on everyday purchases from major retailers<br />

including M&S, ASDA, Sainsbury’s, Boots, Comet,<br />

Debenhams, Topshop, B&Q and many more.<br />

8. Get beautiful<br />

flowers and gifts<br />

at amazing<br />

discounted<br />

prices<br />

delivered<br />

direct<br />

to your<br />

door with<br />

Flowers<br />

Direct, using the<br />

10% AOP discount.<br />

17<br />

25/11/11 AOP PRIVILeGES<br />

Example savings available<br />

from AOP Privileges<br />

• Save a minimum of £50 and as much as £250 on gym membership<br />

• Save £33.60* with Superbreak on staying at a three star central<br />

London hotel, including breakfast, with two top class adult tickets to<br />

see Grease the musical on a Saturday evening<br />

• Save £143.50* with CottagStayUK for seven nights at Knowle Farm<br />

Cottage near Bude, Cornwall<br />

• Save £187.20* with Thomas Cook on a seven night holiday for four<br />

to Turkey<br />

• Save £129.87* on an Excel level four course through QA<br />

• Save £179.98* + VAT on a five page website design and launch with<br />

SiteWizard<br />

*Terms and conditions apply. See the website for further details. VSM not available in Northern Ireland. Member Energy available for households in<br />

England, Scotland and Wales (mainland only). Member Energy average saving calculated using figures taken from November 2010 until April 2011.<br />

Other savings used illustrative. AOP Privileges is managed on behalf of the AOP by Parliament Hill Ltd of 127 Cheapside, London, EC2V 6BT. Neither<br />

are part of the same group as a provider.


Leading the Way with New Fits<br />

Hayley Wainer, owner of City Opticians Hawkes & Wainer in Leadenhall Market describes<br />

how embracing new technology and innovation is integral to a successful practice.<br />

Based in the historic Leadenhall Market<br />

(Diagon Alley in the Harry Potter films)<br />

Hawkes & Wainer have seen their fair<br />

share of changes over the years having<br />

been established in the City of London<br />

since 1919. They embrace change and<br />

actively seek new and better ways to<br />

run their business so that Hawkes &<br />

Wainer can remain a thriving practice.<br />

We asked Optometrist and owner<br />

Hayley Wainer about some of the<br />

initiatives that have helped her and her<br />

team to maintain a successful practice.<br />

Wainer explains: “To survive in business,<br />

particularly in the City, you need to<br />

be flexible. Our patient population<br />

is predominantly in the insurance<br />

business and associated industries. Our<br />

challenge is dealing with discerning<br />

individuals who not only demand a first<br />

class service from us but as they spend<br />

their working lives negotiating it’s in<br />

their nature to request the best deal<br />

possible. For that reason we run a very<br />

flexible fee structure, which delivers<br />

exactly what our patients are looking<br />

for. Flexibility is particularly important<br />

for our contact lens business. My father<br />

Ivan, the figurehead of our practice,<br />

has been fitting contact lenses for over<br />

forty years and they are integral to<br />

our business. I would say that during<br />

“I have felt for some time<br />

now that CIBA VISION<br />

is really supporting<br />

independent practitioners,<br />

which is a key factor in<br />

our success”<br />

these difficult economic times our<br />

contact lens business has continued to<br />

grow thereby allowing us to continue<br />

to invest in the clinical care we offer.<br />

Certainly the support we have received<br />

from CIBA VISION over the past few<br />

years has played a large part in that.”<br />

With such a challenging patient<br />

population we wanted to know what<br />

Hawkes & Wainer has done to maintain<br />

a successful contact lens business and<br />

explore the role that CIBA VISION has<br />

played in <strong>this</strong>.<br />

“I have felt for some time now that<br />

CIBA VISION is really supporting<br />

independent practitioners, which is a<br />

key factor in our success”, said Wainer.<br />

“For example the new trade terms<br />

for the new products that have been<br />

launched over the past few years; it<br />

all helps independent practitioners<br />

to grow and maintain their business.<br />

Furthermore, the educational<br />

initiatives that the company has<br />

introduced over the past few years<br />

have been excellent. I have been lucky<br />

enough to attend the MBA part 2,<br />

which I found to be incredibly helpful<br />

and thought provoking and have<br />

now implemented a great deal of<br />

<strong>this</strong> into our daily practice. We have<br />

had some fantastic sessions from the<br />

CIBA VISION Practice Academy, where<br />

qualified eyecare professionals have<br />

carried out staff training at Hawkes &<br />

Wainer and I have also attended many<br />

roadshows at which I have gained<br />

a tremendous amount of clinical &<br />

business knowledge that I have then<br />

been able to apply in my practice.”<br />

Hawkes & Wainer recently ran a<br />

Big Fit promotional day, which is<br />

the latest campaign offering from<br />

CIBA VISION. “What a great idea”,<br />

enthused Wainer, “It is so important<br />

to keep attracting new customers.<br />

Inevitably we lose some patients when<br />

they move away from the Leadenhall<br />

Market area so we need initiatives<br />

such as the Big Fit to replace them.<br />

The help we got from CIBA VISION<br />

in setting <strong>this</strong> up was fantastic. The<br />

company provided all the supporting

www.cibavision.co.uk<br />

What Can A Big Fit Day Do For Your Practice?<br />

Help your practice engage with more people and the benefits of contact<br />

lenses<br />

Encourage them to experience clear vision without glasses<br />

Help your practice grow in patient numbers and revenue<br />

Big Fit days have resulted in up to 35 contact lens trials<br />

To find out how your practice could benefit from a Big Fit event<br />

contact your local CIBA VISION Business Development Manager.<br />

literature and they even organised the<br />

promotional team who handed out<br />

leaflets and encouraged customers to<br />

come into the practice and try contact<br />

lenses. All in all setting <strong>this</strong> up was very<br />

easy and stress free. The day itself went<br />

well and we found it to be an effective<br />

way to increase new contact lens fits.”<br />

As technology advances and healthier,<br />

more comfortable lenses come on to<br />

the market practitioners have a duty<br />

of care to ensure that their patients<br />

are in the best possible contact lenses<br />

for their needs; something that is<br />

very important to the Hawkes &<br />

Wainer team. They are a big contact<br />

lens practice and have a lot of pre<br />

“The new trade terms<br />

from CIBA VISION are very<br />

fair and very transparent.<br />

I feel like someone has<br />

finally taken notice of the<br />

independent practitioner.”<br />

and early presbyopes in the practice<br />

and are currently fitting a significant<br />

number of them with AIR OPTIX ®<br />

AQUA MULTIFOCAL – even existing<br />

daily disposable lens wearers. “These<br />

are demanding patients who were<br />

committed to their daily lenses but<br />

are now absolutely delighted with<br />


lenses. They are happy because I have<br />

preserved their binocularity and they<br />

can read. Remembering that our<br />

patient population is predominantly<br />

involved in the insurance world, <strong>this</strong><br />

is incredibly important for them. The<br />

comfort level is also excellent from<br />

morning right through to night-time.<br />

Quite simply our presbyopic patients<br />

love these lenses. New fits are vital to<br />

our business and something that we<br />

are always looking out for.”<br />

Have the new trade terms from<br />

CIBA VISION had an impact on the<br />

practice? This is a new initiative from<br />

the company designed to grow the<br />

whole contact lens market. The new<br />

pricing system recognises the role of<br />

independent practitioners in actively<br />

recommending, fitting, and providing<br />

after care services for contact lenses.<br />

In brief, all CIBA VISION customers<br />

who fit contact lenses will qualify for a<br />

fitting discount of 8%, customers who<br />

actively promote CIBA VISION contact<br />

lenses and utilise the company’s EASI<br />

online ordering scheme will qualify<br />

for an additional 3% discounts. The<br />

system has been designed to be<br />

transparent and fair.<br />

“The new trade terms from<br />

CIBA VISION are very fair and very<br />

transparent. I feel like someone has<br />

finally taken notice of the independent<br />

practitioner. It’s very refreshing for a<br />

company to offer single practices such<br />

as ours these kinds of discounts. We<br />

are a large practice but haven’t always<br />

qualified for such discounts. This fairer<br />

system helps us to be as competitive<br />

as possible.”<br />

© CIBA VISION (UK) Ltd, a Novartis company, 2011. AIR OPTIX, the AIR OPTIX logo, CIBA VISION and the CIBA VISION logo are trademarks of Novartis AG.


20<br />

25/11/11 INDUSTRY NEWS<br />

News update<br />

Limited edition<br />

for Christmas<br />

Rimless eyewear<br />

manufacturer,<br />

Silhouette, has<br />

launched a limited<br />

edition Crystal<br />

Glamour eyewear<br />

model which will<br />

be available in<br />

time for Christmas<br />

but only by special<br />

request and for a short time only. Crystal<br />

Glamour is part of the company’s successful<br />

Crystal Collection which was launched earlier in<br />

the year. The accessory eyewear is designed to<br />

attract attention at any festive gathering as it is<br />

strewn with delicate fine cut crystals, including<br />

on the lightly tinted lenses themselves. Each<br />

of the 38 faceted crystals on each lens is set<br />

individually by hand, making each piece<br />

unique.<br />

Crystal Glamour is intended to be the first in<br />

a series of festive, special edition collector items<br />

from Silhouette. Each will be made to order.<br />

& 0208 987 2434<br />

Boost for lab<br />

The quality<br />

management<br />

standard ISO9001<br />

has been achieved<br />

by Tant Laboratories<br />

which it believes<br />

will help drive up<br />

efficiency and win new business. The project<br />

involved 12 months of preparation looking at all<br />

Tant’s internal procedures.<br />

Lenstec Group MD, Nigel Castle, said: “It’s a<br />

fantastic achievement for Tant to achieve ISO<br />

accreditation that provides a consistent base<br />

for improving the process flow through the<br />

laboratory. Tant Labs has recently undertaken<br />

robot production investments and training<br />

programmes to support <strong>this</strong> achievement.<br />

“We find our customers support our<br />

investment in achieving recognised standards<br />

that keep us in the forefront for producing<br />

consistent quality.”<br />

The company has a new All-In-One<br />

Catalogue out which includes a promotion for<br />

Trivex and Emporium kids frames.<br />

& 01279 653 785<br />

20 years of benefits<br />

Rodenstock Club is celebrating its 20th anniversary<br />

by offering independent opticians even more reasons to<br />

join the popular frames loyalty initiative.<br />

The Club was founded in 1991 solely for<br />

independents, and has evolved to provide a unique<br />

portfolio of products as well as rewards package. The<br />

benefits for being a Rodenstock Club member include<br />

contributions to local advertising, branded open days,<br />

loyalty bonuses, annual training and early<br />

bird promotions.<br />

Members receive full marketing support<br />

to increase their sales and attract new<br />

customers. It includes direct marketing,<br />

advertising templates, public relations,<br />

product imagery and point of sale<br />

merchandise.<br />

Members are also eligible for the annual<br />

awards, <strong>this</strong> year taking place at the recently<br />

refurbished Savoy in London. The award<br />

winners will join Rodenstock in Florence to<br />

experience the renowned club hospitality.<br />

& 01474 325555

‘Eyes heaven’<br />

launched in<br />

London<br />

High fashion, handmade frames<br />

company Cutler and Gross has launched<br />

a bespoke frames service by opening<br />

The Museum above its Knightsbridge<br />

store, featuring a permanent display of<br />

1,000 of its iconic frames and sunglasses.<br />

The Museum’s Lacquered Room in total<br />

houses over 4,000 frames and sunglasses,<br />

dating from 1969 to the present day.<br />

Despite the economy, the company’s<br />

turnover is up 50% <strong>this</strong> year, on top of the<br />

50% increase last year and as part of the<br />

expansion, an additional workshop was<br />

bought in Italy.<br />

Bespoke service<br />

The bespoke service was officially<br />

launched at an exclusive event for 120 of<br />

the national fashion press, which included<br />

OT’s Robina Moss and various film crews.<br />

The shop at 16 Knightsbridge Green is just<br />

behind Burberry’s flagship store and was<br />

specially decorated in keeping with the<br />

theme of the last collection, Hong Kong<br />

Love Story (pictured left).<br />

The bespoke service opens up the<br />

service previously used by celebrities and<br />

pop stars but is available by appointment<br />

only. An eyewear stylist helps clients<br />

select a frame from one of the archive<br />

designs or choose a unique style, colour<br />

and material combination to create<br />

their own one-off eyewear. Colours can<br />

be matched to a customer’s clothing<br />

and there are even acetate frames<br />

incorporating newsprint and lace.<br />

“The Museum really is eyes heaven,”<br />

said chief executive Majid Mohammadi.<br />

“There are no limitations on what we<br />

can do. We have the biggest collection<br />

of glasses to choose from and if a client<br />

wants something else we can still do<br />

it. We can give them exactly what they<br />

want.”<br />

The launch event was held after recent<br />

Fashion Weeks and the company’s new<br />

biannual magazine was handed out. It can<br />

be viewed online at www.cutlerandgross.<br />

com and is part of an initiative to<br />

educate clients about the brand and the<br />

craftsmanship behind the frames.<br />

& 020 7581 2250<br />

Greater precision<br />

Carl Zeiss Vision believes it has raised the<br />

bar even higher for precision refraction and<br />

centration as the newly launched i.Profiler<br />

plus and i.Terminal 2 systems are said to<br />

be achieving a new level of excellence for<br />

individualised precision lenses.<br />

i.Profiler plus and i.Terminal 2 (pictured)<br />

lay the ideal foundation for generating the<br />

most individualised vision profile available<br />

from Zeiss. All the measurements are then<br />

incorporated into the company’s precision<br />

lenses ensuring they reflect the wearer’s<br />

personal vision profile.<br />

Measurement is said to reach new<br />

heights of precision, speed and ease of use<br />

for a fast processing time with increased<br />

sales and satisfied patients.<br />

i.Profilerplus combines an autorefractor,<br />

keratometer, aberrometer and corneal<br />

topography in a single system. In about 30 seconds the i.Profilerplus system analyses all<br />

parameters needed for the use of lenses featuring i.Scription technology with accuracy to the<br />

nearest 1/100 dioptre.<br />

After including i.Scription technology in their product offering, eye care professionals have<br />

been recording an average increase of 27% in their lens sales revenue, and of 15% in the<br />

number of lenses sold.<br />

With the i.Terminal 2 centration system in addition to refraction, precise centration data<br />

ensures optimal adaptation of the lenses to the eyes of the wearer. Both systems are also the<br />

winners of the 2011 reddot design award.<br />

& 0845 300 7788<br />

Three for the kids<br />

There are nine new frames in the three Actman Junior ranges, which are designed to<br />

appeal to fashionable youngsters, reflecting the latest grown-up look but keeping a colourful<br />

character. The emphasis is on affordable, robust design with frames that ‘are cool for kids and<br />

kind on the pocket’. Cookie is a bold acetate full rim for girls. It is offered in ‘shocking’ pink<br />

and blue with the slightly more understated colours of light pink and purple available for a<br />

subtler look and also tortoiseshell for a more grown up look.<br />

Teddy is a full rim metal boys’ frame available in a dark red, dark blue with highlights of<br />

lime green and a reddish brown with cream detail. Jellybean is a unisex metal frame. It has<br />

the look of a stylish supra but keeps the stability needed for a robust child’s frame by still<br />

maintaining a full rim metal.<br />

& 0151 526 2626<br />

21<br />


22<br />

25/11/11 SPECTATOR<br />


‘Every little helps’ as chancellor<br />

removes VAT exemption<br />

In the same week that the government announced its<br />

plans to remove (rather than simply reduce as previously<br />

announced) VAT exemption for low value goods – otherwise<br />

know as ‘consignment relief’ (LVCR) imported from the<br />

Channel Islands – any cost-conscious contact lens wearer<br />

who is also considering the possibility of cosmetic surgery<br />

may also find that VAT has just been added to that bill also.<br />

Some cosmetic procedures are exempt from VAT if their main<br />

purpose is the protection, maintenance or restoration<br />

of health, but updated guidance from HM Revenue &<br />

Customs (HMRC), makes it clear that patients will only avoid<br />

paying the tax if they have been diagnosed with a medical<br />

condition. There are reports that HMRC anticipates <strong>this</strong><br />

will raise a further £500m in tax every year, dwarfing the<br />

anticipated recovery of £200m a year through the abolition<br />

of LVCR. For the impoverished chancellor, it may be a case<br />

‘every little helps’, and encouragement for the government<br />

to search out further examples of apparently lax taxation<br />

arrangements.<br />

Foraging for savings wherever they can be made is evidently<br />

symptomatic of the economic climate, as were the headlines<br />

in the last edition of OT of: ‘AOP resists fee pressures,’<br />

and ‘Challenging market affects Boots Opticians.’ We will<br />

encounter daily<br />

examples of<br />

the impact of<br />

the economy<br />

on both our<br />

professional<br />

and personal<br />

lives for the<br />

foreseeable<br />

future, so it was<br />

all the more<br />

encouraging<br />

to read about<br />

the positive<br />

messages being<br />

presented to<br />

the sector at the<br />

recent NOC,<br />

by those from outside the profession. Of course, at times like<br />

these, the sector needs to work together to prepare for the<br />

upturn which will eventually come – a quote often attributed<br />

to Sir Richard Branson applies here – “in good times fortunes<br />

are made; in tough times empires are built”. Virgin Money’s<br />

recent acquisition of Northern Rock is evidence that he has<br />

the confidence to follow his conviction, and so should our<br />

sector, as, according to one of the NOC keynote speakers:<br />

“You hold more power than you realise.”<br />

Mainline Optical Connections Ltd<br />

are a company with a focus on<br />

small equipment and consumables.<br />

Ordering could never be simpler<br />

you can order online from our<br />

website, use our Freefax number<br />

or over the telephone from our<br />

friendly and helpful staff. For<br />

online ordering simply browse<br />

our website to find the products<br />

you need and place an order.<br />

View our special offers page for<br />

products at amazing discounted prices!<br />

Just scan<br />

the QR to<br />

find out<br />

more!<br />



www.mainline-opticalconnections.co.uk<br />

Phone: 01377 257752<br />

The Royal College of Nursing chose last weekend to fire a<br />

broadside at the government by claiming that changes in the<br />

NHS will result in 56,000 job losses among doctors, nurses,<br />

midwives and other NHS staff. Accepting that the RCN may<br />

have presented an unbalanced argument, it is inevitable,<br />

with approximately 70% of the NHS budget being spent on<br />

staffing, that staff will be affected by efficiency gains. But it<br />

is not the case that every job removed will result in a worse<br />

outcome for patients (official government figures show that<br />

while the number of managers will be reduced by 13%,<br />

the equivalent fall for nursing staff is likely to be nearer to<br />

1%). And if the stress of the process causes some to seek<br />

support from an understanding GP that they may be signed<br />

off as long-term sick, then that too is about to become more<br />

difficult if the findings of a government-backed review, due<br />

to be published <strong>this</strong> week, are implemented. Arguing that<br />

people should be signed off for long-term sickness by an<br />

independent assessment service and not GPs, co-author of the<br />

report, Professor Carol Black said the current system was not<br />

working for anyone. While a spokesman for the Department of<br />

Work and Pensions offered: “The economy loses £15bn in lost<br />

economic output each year due to sickness absence and we<br />

cannot continue to foot <strong>this</strong> bill.” No doubt the chancellor has<br />

spotted <strong>this</strong> one as well.<br />

For more comment visit www.optometry.co.uk


Sponsored by<br />

Clarification on retinal degenerations<br />

24<br />

25/11/11 LETTERS<br />

Re the article on Peripheral Retinal<br />

Degenerations (OT September 30, p44-<br />

48), with all due respect to the authors of<br />

<strong>this</strong> article, I would be grateful if you could<br />

clarify the section on CHRPE and FAP. In<br />

the article it states that ‘When CHRPE are<br />

found in groups, known as bear tracks, it<br />

is worth.........in case they are a sign of rare<br />

inherited condition of the bowel known<br />

as FAP’. I wonder if you could research/<br />

clarify <strong>this</strong> for me because I had previously<br />

understood that multiple CHRPE in the<br />

same area of the fundus (bear tracks)<br />

were not usually suspicious (look at<br />

http://www.opticianonline.net/assets/<br />

getAsset.aspx?ItemID=1921). However,<br />

multiple bilateral (spread out/isolated in position) CHRPE or<br />

atypically shaped (especially fish shaped or oval), and those with<br />

a depigmented halo, were the ones to ask about family history<br />

of gastrointestinal problems. This is the newest article I can find<br />

regarding CHRPE:<br />

Optical Coherence Tomography of Retinal and Choroidal Tumors,<br />

Emil Anthony T. Say, Sanket U. Shah, Sandor Ferenczy, and Carol L.<br />

Shields http://ukpmc.ac.uk/articles/PMC3145171/ <br />

Having spent time Googling the literature seems to be somewhat<br />

contradictory. I would be really grateful if you could shed some light<br />

on <strong>this</strong> as I am now rather confused! As CHRPE are such a common<br />

finding I think it’s important to have a clear understanding. A couple<br />

of years ago one of the DOCET CET quarterly review CD’s covered<br />

<strong>this</strong> topic but of course I can’t find it!<br />

Rachael Smith, optometrist<br />

Graham Macalister, optometrist at Moorfields Eye Hospital, replies:<br />

Thank you for your enquiry, we are glad to have the opportunity<br />

to expand a little on the topic of CHRPE. The vast majority of these<br />

pigmented lesions are innocuous and do<br />

not require referral. Typically they occur as a<br />

solitary lesion in one eye. There is a variant in<br />

which multiple lesions are grouped together<br />

in clusters giving the impression of paw prints<br />

(Bear tracks). These are usually confined to one<br />

quadrant and are present in only one eye. Bear<br />

track CHRPE do not warrant referral. However<br />

suspicion should be roused when there are<br />

multiple CHRPE-like lesions which have a<br />

haphazard distribution with no grouping. These<br />

could be pigmented ocular fundus lesions of<br />

familial adenomatous polyposis (POFLs)1 and<br />

since they are associated with an inherited form<br />

of colon cancer referral would be warranted.<br />

They sometimes have an atypical shape such as<br />

pisciform (fish tail) or fusiform (spindle), but the<br />

diagnostic criteria with the highest specificity/<br />

sensitivity for POFLs includes the detection of<br />

at least four small pigmented lesions, or two lesions of which one<br />

is large (>25% of disc area)2. Also the presence of multiple bilateral<br />

lesions appears to be a highly specific marker for POFLs (95–100%<br />

specificity) 3. Remember that CHRPE are very common and POFLs<br />

are very uncommon. Optometrists should feel free to refer any<br />

pigmented lesion that they are not sure about, but a good guideline<br />

would be to monitor CHRPE without referral unless they meet all of<br />

these three criteria:<br />

• multiple (4 or more)<br />

• Not in groups (ie not bear track)<br />

• Bilateral<br />

References<br />

1. Coleman P, Barnard S. Congenital hypertrophy of the retinal<br />

pigment epithelium: prevalence and ocular features in the optometric<br />

population. Ophthalmic and Physiological Optics. 2007 27 (6),<br />

547–555<br />

2. Tiret, A, Taiel-Sartral, M, Tiret, E, et al. Diagnostic value of fundus<br />

examination in familial adenomatous polyposis. Br J Ophthalmol<br />

1998;81: 755–758.<br />

3. Morton, DG, Gibson, J, Macdonald, F, et al. Role of congenital<br />

hypertrophy of the retinal pigment epithelium in the predicitve<br />

diagnosis of familial adenomatous polyposis. Br J Surg 1992;79:<br />

689–693.<br />

OT Letters, 2 Woodbridge Street, London EC1R 0DG E: davidchallinor@optometry.co.uk The Editor reserves the right to edit letters and points out that the views expressed may not be those of the journal.


Christmas crossword<br />

This <strong>issue</strong> we continue our popular crossword series. So why not enter our competition before<br />

the closing date of December 30, 2011. The winner will receive £50 in Marks & Spencer vouchers<br />

Name:<br />

Address:<br />

across<br />

1. Parasitic plant which<br />

encourages closeness between<br />

couples! (9)<br />

8. Encouraging start – but fails<br />

to maintain impetus! (5,2,3,3)<br />

11. Distressing teenage<br />

affliction (4)<br />

12. Musical term (5)<br />

13. Singing voice (4)<br />

16. Streamlined engine<br />

cover (7)<br />

17. Expanse of treeless<br />

grassland (7)<br />

18. Part of a vehicle’s cargo<br />

from which revenue is<br />

obtained (3-4)<br />

20. A model of its kind (7)<br />

21. London district (4)<br />

22. Type of terrier (5)<br />

23. Spoken word (4)<br />

26. Clear evidence of<br />

autumn (7,6)<br />

27. Railway compartments for<br />

passengers (9)<br />

down<br />

2. Abbreviate date (4)<br />

3. Following closely behind (7)<br />

4. Competition applicants (7)<br />

5. Not closed (4)<br />

6. In the distance (1,4,3,5)<br />

7. Roman designation of<br />

the A5 (7,6)<br />

9. Ceremonial parade (5,4)<br />

10. Energy conversion<br />

unit (5,4)<br />

14. Smaller version (5)<br />

15. Relating to birds (5)<br />

19. Assists the person<br />

washing-up (7)<br />

20. Decorative leaves (7)<br />

24. Appeal (4)<br />

25. Lacking colour (4)<br />

25<br />

25/11/11 CROSSWORD<br />

Send entries to OT Christmas Crossword, 2 Woodbridge Street, London EC1R 0DG by December 30, 2011. You can now enter OT’s Crossword competition<br />

online at www.optometry.co.uk.


26<br />

25/11/11 DIARY DATES<br />

Book now for FMO meal<br />

FMO members and their guests can once again enjoy a fun Christmas<br />

lunch <strong>this</strong> year, organised by the Federation on December 15 at the<br />

Paddington Hilton Hotel in Central London.<br />

To capture the event a series of photographs will be taken of those<br />

who form the FMO’s individual sector Frame, Lens and Equipment<br />

Focus Groups.<br />

Prior to the lunch, at 1pm, its AGM will be held. For more details,<br />

contact: 020 7298 5123 or sfisher@fmo.co.uk.<br />

NEW… 7 WOPEC, School of <strong>Optometry</strong><br />

and Vision Sciences, Cardiff University,<br />

Maindy Road, Cardiff, New accreditation<br />

PEARS/WEHE Winter 2011 SEE ABOVE<br />

NEW… 12 Northern Optometric Society,<br />

Manchester Conference Centre, Manchester<br />

Eye surgery lecture SEE ABOVE<br />

NEW… 13 WOPEC, School of <strong>Optometry</strong><br />

and Vision Sciences, Cardiff University,<br />

Maindy Road, Cardiff, WLVS practical<br />

training day two SEE ABOVE<br />

14 UltraVision, Head Office, Leighton<br />

Buzzard, Bedfordshire, KeraSoft IC<br />

workshop and fitting techniques<br />

(workshop@ultravision.co.uk)<br />

NEW… 15 FMO, The Hilton Hotel,<br />

Paddington, London, Christmas Lunch<br />

(www.fmo.co.uk)<br />


9 Lancashire Optical Society, Swallow<br />

Hotel, Preston, Glaucoma management in<br />

secondary care (janelbarker@yahoo.co.uk)<br />

NEW… 15-16 Eyecare 3000, Hilton Hotel,<br />

Glasgow, Annual conference run by Replay<br />

Learning (www.eyecare3000.com)<br />

NEW… 16 Warwickshire AOP, The Venture<br />

Centre, University of Warwick Science<br />

Park, Coventry, Therapeutic treatment<br />

of the anterior segment lecture (susan@<br />

susanrbowers.co.uk)<br />

NEW… 23 Northern Optometric Society,<br />

Manchester Conference Centre, Manchester,<br />

Current and evolving treatments for diabetic<br />

retinopathy SEE ABOVE<br />

30 BCLA, 76 Portland Place, London, Evening<br />

meeting (events@bcla.org.uk)<br />


NEW… 6 Northern Optometric Society,<br />

Manchester Conference Centre, Manchester,<br />

Onocology lecture SEE ABOVE<br />

NEW… 6 Nottingham and Derby Optical,<br />

Wolloughby Hall, Nottingham University<br />

Park Campus, Nottingham, Visual field loss<br />

lecture (NDOS@live.com)<br />


NEW… 28 Northern Optometric Society,<br />

Manchester Conference Centre, Manchester,<br />

Contact lens comfort lecture (www.<br />

northernoptom.com)<br />


NEW… 4 Wales <strong>Optometry</strong> Postgraduate<br />

Eductaion Centre (WOPAC), School of<br />

<strong>Optometry</strong> and Vision Sciences, Cardiff<br />

University, Maindy Road, Cardiff, Disk<br />

dilemmas (http://www.wopec.co.uk/events)<br />

NEW… 6 NEOS, Holiday Inn Express,<br />

Waterloo Square, St James Boulevard,<br />

Newcastle Upon Tyne, Electronic eyes for the<br />

blind (neosoptoms@hotmail.co.uk)<br />

NEW… 6 North London AOP, City University,<br />

Northampton Square, London EC1, Flashes<br />

and floaters (stevedross10@hotmail.com)<br />

NEW… 7 College of Optometrists, Ramada<br />

Plaza Gatwick, South East regional event<br />

(www.college-optometrists.org/southeast)<br />

NEW… 9 Northern Optometric Society,<br />

Manchester Conference Centre, Manchester,<br />

Peer review session SEE ABOVE<br />

NEW… 10 NEOS, Holiday Inn Express,<br />

Waterloo Square, St James Boulevard,<br />

Newcastle Upon Tyne, LASER lecture SEE<br />

ABOVE<br />

13-15 Opti ’12, New Munich Trade Fair<br />

Centre, Munich, Germany (www.optimunich.com)<br />

NEW… 7 NEOS, Holiday Inn Express, Waterloo<br />

Square, St James Boulevard, Newcastle Upon<br />

Tyne, Glaucoma management SEE ABOVE<br />

13 Lancashire Optical Society, Swallow<br />

Hotel, Preston, Modern management of<br />

keratoconus and irregular corneas<br />


NEW… 20 Northern Optometric Society,<br />

Manchester Conference Centre, Manchester,<br />

Allergy lecture SEE ABOVE<br />

briot Hi res optom 2day.indd 1 26/10/2011 15:46<br />

See more events at www.optometry.co.uk/events

2012<br />

36th BCLA<br />

Clinical Conference & Exhibition<br />


Competing for<br />

Excellence<br />

Conference<br />

24 – 27 May 2012<br />

Exhibition<br />

25 – 27 May 2012<br />

The one event you cannot afford to miss!<br />

• Renowned international speakers<br />

• More than 40 CET points<br />

• Programme tailored to your needs<br />

• UK’s largest FREE contact lens industry exhibition<br />

Registration opens in January 2012<br />

Save over £100 on your delegate fee –<br />

become a member of the BCLA today.<br />

Be part of the BCLA Clinical<br />

Conference - inviting<br />

submissions now for:<br />

• Papers/Posters/Abstracts<br />

(Deadline: 13 January 2012)<br />

• Photographic Competition<br />

(Deadline: 27 April 2012)<br />

Visit www.bcla.org.uk<br />

to find out how you can get involved<br />

Book your<br />

place by<br />

9 March 2012 to<br />

receive the early<br />

bird discount.<br />

Follow us on<br />

and<br />

Patron Platinum Gold<br />

Abbott Medical Optics<br />

<strong>Optometry</strong> <strong>Today</strong><br />

Sauflon<br />

Topcon<br />

British Contact Lens Association, 7/8 Market Place, London, W1W 8AG, UK<br />

+44(0)207 580 6661 +44(0)207 580 6669 events@bcla.org.uk www.bcla.org.uk<br />



Case in<br />

point<br />

28<br />

25/11/11 ACCESSORIES<br />

Distinctive cases for spectacles and contact lenses<br />

can help boost footfall and profits at the traditionally<br />

quiet time in the practice which is fast approaching.<br />

Robina Moss looks at the latest on offer to give your<br />

patients an unusual Christmas stocking filler idea<br />

Christmas<br />

CL cases<br />

Optipak, a UK<br />

designer of<br />

contact lens cases,<br />

has introduced a<br />

range of new fashion<br />

themed contact lens<br />

cases and Christmas<br />

themed cases<br />

(pictured). The attractive<br />

compact displays each<br />

hold 12 cases and are<br />

designed for counter top<br />

retailing. Made from premium<br />

plastic the cases come with<br />

rubber washers to give a leak proof<br />

seal. To see the range visit www.optipak.co.uk<br />

& 0208 322 4210<br />

On-trend coverings<br />

New in Dunelm’s cases <strong>this</strong> year are on-trend denim coverings, as well as<br />

an array of print patterns including everything from flags<br />

(pictured) stars, hearts and polka dots to the more unusual<br />

Wellington boots, cupcakes, animal prints and nautical<br />

themes.<br />

“We also offer various free accessory packages when<br />

ordering frames from our Janet Reger, John Rocha and<br />

Paul Costelloe designer ranges,” said Dunelm director Peter<br />

Beaumont. “With Paul Costelloe, consumers take away not<br />

only their new designer frames, but a tasteful brown leather<br />

case and purple cloth, all packaged in a<br />

specially designed gift bag featuring one of<br />

the designer’s own unique sketches.”<br />

To view the ranges, visit www.<br />

dunelmoptical.co.uk.<br />

& 01388 420420<br />

Bespoke options<br />

The new ‘J65’ case (pictured) is one of a new series of<br />

colourful cases that Caseco has introduced which can be<br />

viewed on www.caseco.co.uk. There is a wide range of<br />

models available for all ages. The company also provides a<br />

range of bespoke options on cases, microfibre cloths and<br />

lens cleaning liquids.<br />

“In <strong>this</strong> difficult business environment, our customers have<br />

appreciated the innovation and colour range of our bespoke<br />

options,” said MD Peter Wood. “They may be a necessary<br />

purchase but we can use creative ways to ensure these<br />

products have a marketing impact.”<br />

& 01580 890111<br />

Cute and FDA-approved<br />

Optisafe offers FDA-approved 3D contact lens cases in<br />

six cute animal shapes – froggy (pictured), piggy, hippo,<br />

elephant, fish and bear. They are easily identified left and<br />

right screw top cases which come individually wrapped in<br />

poly bags. They are suitable for storing all contact lenses<br />

and carry the CE marking of conformity (Medical<br />

Devices Directives 93/42 EEC). To see the range visit<br />

www.optisafe.co.uk<br />

& 07703 174560

No.1 for<br />

UK’s support for<br />

“Visionace ®<br />

tablets<br />

help to maintain my<br />

eye health and vision”<br />

“I like to take Cardioace ®<br />

nutrient tablets to help<br />

maintain my heart health.”<br />

Help your customers maintain all<br />

round health and vitality, plus eye<br />

and heart health with Vitabiotics.<br />

Visionace ®<br />

is a comprehensive, research<br />

based nutritional supplement designed to<br />

support all round health and vitality, with<br />

specific nutrients to help support eye<br />

health and vision such as Vitamin A,<br />

Zinc and Riboflavin. Visionace ®<br />

Plus dual<br />

pack provides the benefits of Visionace ®<br />

Original, plus more.<br />

Cardioace ® advanced formula includes<br />

vitamins, minerals and antioxidants, plus<br />

vitamin B1 to help maintain a healthy heart.<br />

Cardioace ®<br />

Plus also contains 1.3g of<br />

phytosterols to help maintain a healthy<br />

cholesterol level.<br />

Recommended by leading UK optometrists<br />

Expert nutrition to help maintain heart health<br />

Visionace ® Plus Omega-3 Visionace ® Original Cardioace ® Original<br />

Cardioace ® Plus Sterols<br />

ADCARVISOTP10-11<br />

For further information please contact<br />

Vitabiotics on 020 8955 2662 or<br />

visit www.vitabiotics.com<br />

Vitamin supplements may benefit those with<br />

nutritionally inadequate diets.<br />

40<br />


EVENTS<br />

AOP Council elections<br />

THE AOP will shortly be holding its elections for AOP<br />

councillors to serve on Council from May 2012.<br />

All AOP members are entitled to stand for election,<br />

optometrist members to represent optometrists.<br />

30 28<br />

08/04/11 25/11/11 COVER COUNCIL STORY ELECTIONS<br />

New constituencies<br />

From 2012, optometrists will be elected to represent<br />

geographical constituencies. Previously, some optometrists<br />

represented members through geographical constituencies<br />

and others through modes of practice (employed and selfemployed<br />

optometrists). Councillors elected in 2012 to<br />

represent geographical constituencies will continue to<br />

represent the interests of members as employed and selfemployed<br />

optometrists.<br />

From 2012, the geographical constituencies will be larger<br />

than the previous constituencies and represented by more<br />

than one councillor. Previously each constituency was<br />

represented by one councillor. Voting optometrist members<br />

of the Association, including hospital optometrists, each have<br />

one geographical constituency in which they vote to elect<br />

representatives to Council.<br />

To represent a geographical constituency a candidate must<br />

be nominated, seconded and elected by optometrist members<br />

who are entitled to vote in that geographical constituency.<br />

Councillors representing geographical constituencies need not<br />

represent the constituency in which they are entitled to vote.<br />

The changes to constituencies were adopted by the AOP<br />

Board of Directors in January 2011.<br />

The table below shows the new geographical constituencies<br />

and the number of AOP members who will be elected to<br />

represent each constituency.<br />

The chart on page 31 sets out the postcodes which<br />

fall within each constituency. Members have previously<br />

Councillors<br />

Constituency<br />

5 East of England & East Midlands<br />

5 London<br />

5 North West England<br />

5 South East Coast & South Central England<br />

nominated their geographical constituencies according<br />

to where they lived or worked. These were allocated to<br />

constituencies on the AOP membership database by postcode.<br />

For the 2012 elections, the postcodes have been transferred<br />

to each member’s new constituency. Each member’s new<br />

constituency was set out on the AOP Membership Renewal<br />

Notice which was sent to all members recently. Members<br />

should check that their new constituency is their chosen<br />

geographical constituency according to where they live or<br />

work and, if the information is incorrect, to amend it on the<br />

AOP website in accordance with the guidance below.<br />

Additional seats on Council<br />

In addition to the elected optometrists on Council, a<br />

dispensing optician member is elected to represent dispensing<br />

opticians. Dispensing opticians do not have a geographical<br />

constituency. A further five members are appointed to<br />

Council, one each to represent the following members:<br />

hospital optometrists, academic optometrists, newly qualified<br />

optometrists, pre-registration optometrists and undergraduate<br />

student optometrists.<br />

5 South West England & West Midlands<br />

5 Yorkshire & Humber & North East England<br />

2 Northern Ireland<br />

4 Scotland<br />

3 Wales<br />

Transitional arrangements<br />

In May 2012, all elected seats on Council will be due for<br />

election. Following the elections in 2012, in order to establish<br />

the working of the new Council there will be no elections<br />

in 2013. Thereafter one third of the seats on Council will<br />

be elected annually by rotation. On August 12, 2011, AOP<br />

Chairman, David Shannon, drew lots for the geographical<br />

constituencies which will be elected by rotation from 2014.

1. East of England & East Midlands: AL, CB, CM, CO, DE, IP, LE, LN, LU, MK, NG, NN, NR, PE, SG, SS, WD<br />

2. London: BR, CR, DA, E, EC, EN, HA, IG, N, NW, RM, SE, SM, SW, TW, UB, W, WC<br />

3. North West England: BB, BL, CA, CH1-4, CH>8, CW, FY, IM, L, LA, M, OL, PR, SK, WA, WN<br />

4. South East Coast & South Central England: BN, CT, GU, HP, KT, ME, OX, PO, RG, RH, SL, SO, TN<br />

5. South West England & West Midlands: B, BA, BH, BS, CV, DT, DY, EX, GL, GY, HR, JE, PL, SN, SP, ST, SY1-8, SY11-15, TA, TF, TQ, TR,<br />

WR, WS, WV<br />

6. Yorkshire and The Humber & North East England: BD, DH, DL, DN, HD, HG, HU, HX, LS, NE, S, SR, TS, WF, YO<br />

7. Northern Ireland: BT<br />

8. Scotland: AB, DD, DG, EH, FK, G, HS, IV, KA, KW, KY, ML, PA, PH, TD, ZE<br />

9. Wales: CF, CH5-8, LD, LL, NP, SA, SY9-10, SY>15<br />

31<br />

These are: 2014: East of England and East Midlands, London,<br />

Northern Ireland; 2015: North West England, South East<br />

Coast and South Central England, Scotland; 2016: South<br />

West England and West Midlands, Yorkshire, Humberside<br />

and North East England, Wales. The dispensing opticians’<br />

representative will next be due for election in 2013. New<br />

student representatives will be appointed in 2012 and the<br />

other appointments will next be made in 2013.<br />

2012 eleCTiONs<br />

The elections for seats on the AOP Council will be conducted<br />

between December 2011 and May 2012.<br />

In accordance with the byelaws, to elect the new Council,<br />

the period of service of all current elected AOP councillors<br />

will terminate at the annual general meeting in 2012.<br />

Councillors elected to represent the new constituencies will<br />

take their seats on Council following the AGM in 2012.<br />

All AOP members entitled to stand for election to Council<br />

may do so.<br />

Council nominations for 2012<br />

1. In December, guidance and a nomination form, in pdf<br />

format, will be put on the AOP’s website and emailed to<br />

AOP members whose email the association has. Members<br />

who wish to receive a paper copy should contact Steven King<br />

(contact details right).<br />

2. A reminder about the election nomination process<br />

and timetable will be published in OT and e-mailed to<br />

members in Blink and <strong>Optometry</strong> <strong>Today</strong> in January 2012.<br />

3. Members who wish to stand for election to the Council<br />

in May 2012 must return the duly completed nomination<br />

form to the AOP before 12 noon on January 27, 2012.<br />

Updating your voting constituency<br />

Optometrist members have only one constituency, a<br />

geographical constituency which has been allocated<br />

according to the postcode of each member’s mailing address.<br />

Please visit the AOP website, www.aop.org.uk, to check your<br />

constituency is correct. To do <strong>this</strong> click on “Members’ Area”.<br />

There log in via the “Secure Area Login” page. If you need<br />

to register before logging in, do so by following the links on<br />

the page. Once you have logged in to the secure area, click<br />

on “Update My Details”. You will find your geographical<br />

constituency under “Mailing Information” where, if your<br />

constituency is incorrect, you can change to the correct<br />

constituency by selecting either “Home” or “Business” as<br />

appropriate. While visiting the website, please take the<br />

opportunity to review the contact details, especially the<br />

email address the association has for you, and update them<br />

if necessary.<br />

If you are unable to check the website yourself or have noone<br />

to do it on your behalf, please contact the Membership<br />

Department (email membership@aop.org.uk or telephone<br />

020 7549 2010), AOP staff will check the website and make<br />

any necessary changes for you.<br />

Geographical constituencies must be updated before<br />

January 20, 2012 to ensure that you will be sent the correct<br />

constituency ballot form which will be prepared at the end<br />

of January.<br />

2012 election timetable<br />

Following the close of nominations on January 27, the 2012 election<br />

timetable will be as follows:<br />

January 27 Notify candidates if they have been returned<br />

unopposed. Request personal details and election addresses from<br />

candidates in constituencies where elections will be held. Closing<br />

date: February 17.<br />

March 2 Electoral Reform Services will e-mail voting instructions to<br />

members in constituencies in which elections are being held. Voting<br />

will be conducted over the Internet. Elections close on March 23.<br />

March 23 Inform candidates of the results. Send new councillors<br />

forms for self-nomination for the Board elections. Forms to be<br />

returned by April 6.<br />

April 6 Despatch voting papers for the elections to the Board of<br />

Directors. Elections to the Board close on April 20. (Councillors<br />

may not serve on the Board of Directors during their first year on<br />

Council.)<br />

April 20 Notify councillors of the outcome of the Board elections.<br />

May 15-16 Annual General Meeting and Council meeting.<br />

Further information about the elections and appointments to<br />

Council and the role and duties of AOP councillors is available on<br />

the AOP website or from Steven King (e-mail: stevenking@aop.org.<br />

uk; telephone: 020-75 49 20 18).<br />



Magnificent seven<br />

32 28<br />

This autumn saw the launch<br />

of CooperVision’s first-ever<br />

student summit competition.<br />

It involved reaearch studies<br />

from seven universities, and<br />

David Challinor – who was<br />

part of the judging panel –<br />

reports<br />

08/04/11 25/11/11 COVER STUDENT STORY SUMMIT<br />

IT WAS an unseasonally warm day<br />

on the south coast when lecturers and<br />

students representing seven universities<br />

travelled to CooperVision’s plant<br />

near Southampton to contest the first<br />

‘student summit’.<br />

The competition was the brainchild of<br />

the contact lens company’s professional<br />

relations manager Karl Aberdeen, who<br />

introduced the day, which included a<br />

tour of the business, networking meals<br />

and social activities.<br />

But it was the students’ contact lensrelated<br />

presentations that took centre<br />

stage. Each university team gave its<br />

presentation before a team of judges<br />

from the universities and optical press.<br />

Bradford University’s student duo<br />

of Pat Frils and Barney Norris presented<br />

their work on Peripheral Refraction in<br />

Soft Contact Lenses early in the day.<br />

From their research, the pair<br />

concluded that different soft lens<br />

designs can produce significantly<br />

different peripheral refractions,<br />

with some lenses appearing to give<br />

a relatively hyperopic peripheral<br />

refraction.<br />

Their work was well-received, though<br />

they agreed more research was needed<br />

in <strong>this</strong> area.<br />

Aston’s Steve Wright and Maryam<br />

Mousavi discussed Oxygen Saturation<br />

in the Limbal Region at Baseline and<br />

During Contact Lens Wear. From their<br />

study of 25 people aged 18-61, they<br />

found no effect due to age or sex, with<br />

short-term contact lens wear providing<br />

little effect, however some regional<br />

differences in oxygenation were<br />

concluded.<br />

Cardiff’s Katie Demery outlined her<br />

work, Investigating Visual Performance<br />

of Cosmetic Contact Lenses, using<br />

examples from popular culture before<br />

discussing her research which involved<br />

10 subjects. She found that comfort<br />

levels were severely reduced with<br />

cosmetic contact lenses, and though<br />

vision was unaffected clinically one of<br />

her subjects complained of an ‘annoying<br />

orange glow’ in the periphery. She also<br />

noted that, in terms of corneal thickness,

The panel decided that Bradford’s Pat Frils<br />

and Barney Norris should collect the prize...<br />

there was significantly more central and<br />

inferior swelling with cosmetic lenses.<br />

Importantly she concluded that<br />

unregulated supply of cosmetic contact<br />

lenses could have serious implications<br />

for patient ocular health.<br />

The University of Ulster’s Owen<br />

Coyles led a presentation on Non-<br />

Invasive Measurement of Tear Meniscus<br />

Height (TMH) and Tear Break-Up<br />

Time (NITBUT). In his research, he<br />

found no significant correlation found<br />

between NITBUT and lower lid tear<br />

meniscus, height (LTMH). Therefore, it<br />

cannot be assumed that an individual<br />

with a larger tear volume indicated<br />

by the presence of a large lower tear<br />

meniscus will have a more stable tear<br />

film and yield a longer NITBUT and<br />

vice versa. However, a highly variable<br />

nature of tear film stability giving<br />

large differences in NITBUT between<br />

individuals and when taking multiple<br />

recordings at the timed intervals is, in<br />

his opinion, due largely to variations in<br />

individual’s vertical palpebral aperture<br />

and tear component production.<br />

Glasgow Caledonian University’s<br />

Lesley Thom spoke of The Cornea in<br />

Diabetes Mellitus, looking at how the<br />

cornea is affected by diabetes and how<br />

important is <strong>this</strong> in contact lens wear.<br />

Using OCT equipment she concluded<br />

there was a slight increase in CCT (and<br />

IOP). Also, some trends which are<br />

appearing in the analysis of research<br />

work currently in progress included a<br />

slight decrease in ECD (especially in CL<br />

wear); increased COV of cell size, and<br />

lower percentage of hexagonal cells.<br />

City’s Chloe Waterton discussed<br />

Factors Influencing the Fit and<br />

Selection of Contact Lenses for<br />

Presbyopic Patients in Practice in<br />

her presentation. In her research, she<br />

surveyed 42 presbyopic patients ranging<br />

from 47 years to 71, divided them<br />

equally into multifocal, monovision and<br />

single vision.<br />

Her conclusions included that it is<br />

not in the patient’s best interest to have<br />

one multifocal design, and that cost is<br />

not readily a negative factor if the lens<br />

works out well for the patient in terms<br />

of comfort and vision. Also that the<br />

correction of presbyopia in contact lens<br />

wearers should be treated on a ‘case-bycase’<br />

basis, but success was dependent<br />

on patient motivation, and the patient’s<br />

expectations must be managed by the<br />

practitioner.<br />

The final presentation was from the<br />

University of Manchester students<br />

Sundeep Kaur and Smaira Fazil. They<br />

had carried out an investigation of the<br />

sensitivity of the marginal and tarsal<br />

conjunctiva in soft contact lens wearers<br />

and non-contact lens wearers. One<br />

of its aims was to map the sensitivity<br />

of the cornea, limbus, palpebral<br />

conjunctiva and marginal conjunctiva<br />

in soft contact lens wearers and noncontact<br />

lens wearers. The pair studied<br />

20 subjects – 10 contact lens wearers<br />

and 10 non-wearers – and in terms<br />

of aeshesiometry, results found no<br />

difference between the groups, though<br />

with a trend towards less lid margin/<br />

wiper sensitivity in contact lens<br />

wearers. The pair said their research<br />

warrented further investigation with a<br />

larger sample size.<br />

After a lengthy and detailed<br />

discussion by the judges it was decided<br />

that Bradford’s Pat Frils and Barney<br />

Norris should collect the winner’s prize<br />

for their work, Peripheral Refraction in<br />

Soft Contact Lenses.<br />

After the presentations, the<br />

celebration continued with a sailing<br />

tour of Portsmouth’s historic docks,<br />

and then a meal at one of the city’s<br />

most lively restaurants.<br />

Other participants<br />

included:<br />

University Lecturers<br />

Dr Rebekka Hietmar – Aston University<br />

Dr Catharine Chisholm – Bradford<br />

University<br />

Arnold Cochrane – University of<br />

Ulster<br />

Dr Graeme Kennedy – Glasgow<br />

Caledonian University<br />

Dr Katharine Evans – Cardiff University<br />

Caroline Christie – City University<br />

Judges on the panel
<br />

Dr Rebekka Hietmar – Aston<br />

University<br />

Dr Catharine Chisholm – Bradford<br />

University<br />

Arnold Cochrane – University of<br />

Ulster<br />

Dr Graeme Kennedy – Glasgow<br />

Caledonian University<br />

Dr Katharine Evans – Cardiff University<br />

David Challinor – <strong>Optometry</strong> <strong>Today</strong><br />

33<br />



Viewpoint of<br />

excellence<br />

Optix MD Trevor Rowley has opened a new practice in York city centre which takes technology<br />

to a new level and surpasses what you would expect of an optometric software pioneer, believes<br />

OT’s Robina Moss who attended the official opening<br />

34 28<br />

08/04/11 25/11/11 VIEWPOINTORY<br />


The new practice in Feasegate is called Viewpoint and is<br />

the first UK centre of excellence for Nidek featuring the latest<br />

technology from the company in its prescreening and consulting<br />

rooms.<br />

The practice has the world’s first new Nidek AFC-330 Fundus<br />

camera, which is approved for diabetic retinopathy screening<br />

and is virtually operator-free. It also has the new Nidek OPD<br />

Scan III which introduces a new technology to the market which<br />

it is believed ‘will revolutionise a practice and the clinical<br />

information available to the optometrist’. Within 60 seconds it<br />

can take nine measurements from both eyes including a night<br />

vision assessment. There is also a Nidek RS-3000 OCT and<br />

the three consulting rooms each have Nidek RT-5100 Auto<br />

Phoropters linked to the new Thomson 3D Xpert Chart.<br />

Viewpoint is also a showroom to illustrate what Optix software<br />

can achieve in practice and is an ‘eyewear ambassador’ for<br />

Boucheron frames from Paris. Such is the calibre of the retail<br />

space that Cartier unusually supported the new practice.<br />

The business has been relocated from a narrow building<br />

nearby which had the practice on four floors. Mr<br />

Rowley (pictured) has had a practice in York since<br />

1985 and wanted to expand into larger premises<br />

when the lease ran out. Viewpoint now has 15<br />

staff with a new optometrist and dispensing<br />

optician currently being recruited.<br />

The new practice was a former Halfords<br />

which was completely renovated to<br />

offer a large retail space all on one floor.<br />

The attention to detail is inspiring with<br />

marble, backlit Onyx on the walls to<br />

highlight the designer frames with<br />

lighting controlled from the reception<br />

desk.<br />

There is also Smart glass which goes<br />

opaque when it senses movement, thus<br />

ensuring privacy for patients in the<br />

clinic behind the reception area and<br />

customers in the prestige area. iPads<br />

have been installed with a special App<br />

to show with a slide of the fingertips<br />

when a consulting room is in use. Even<br />

the patient’s toilet has real stone on the<br />

walls and would not look out of place<br />

in a five-star hotel.

35<br />

“I know some will be shocked that we bought six iPads at £800-£900 each<br />

to use as signage but it makes the right statement of what we’re about...”<br />

25/11/11 PROFILE<br />

“It’s all about creating the right impression,” explained Mr<br />

Rowley. “I know some will be shocked that we bought six<br />

iPads at a cost of £800-£900 each just to use as signage but it<br />

makes the right statement of what we’re about. Our ethos is<br />

uncompromising excellence in everything. We’re going for the<br />

‘wow’ factor and I’m proud to say that we’ve achieved it.”<br />

Visitors to the official opening agreed. “It’s the finest<br />

practice in Europe, that’s why we chose it as our first UK<br />

centre of excellence,” said Chris Tyler, CEO of Nidek UK. “It’s<br />

simply outstanding for the customer journey, from the range<br />

of frames through to the use of lighting to display them. It has<br />

great footfall and enables us to showcase our technology in<br />

the ideal retail environment.”<br />

Viewpoint financial controller Andrew Harrison explained:<br />

“We’ve spent well in excess of £700,000 on the new practice<br />

but it’s quality not quantity which counts. The quality of the<br />

eye examination is already spreading by word of mouth. We<br />

can already see that it’s swiftly paying back, with the average<br />

dispense around £600.”<br />

The practice is situated in a fashionable shopping area near<br />

the famous York Minster. Tourism is York’s biggest industry<br />

and visitors from abroad have already purchased frames<br />

at the practice to have glazed when they return home. The<br />

practice has also benefited from people who visit York on a<br />

regular basis. It opens on a Sunday, has a wide catchment<br />

area and has been a particular hit with women who can buy<br />

the latest high-end frame without having to travel to London.<br />

The frames collections are impressive and include Cartier,<br />

Lindberg bespoke frames and Ørgreen. There is also Gold &<br />

Wood, Porsche Design, Martin & Martin, Tom Davies bespoke<br />

and the Blac exclusive range from Denmark. There are Tom<br />

Ford frames, gotti from Switzerland, Paul Smith, Lafont and<br />

an entry range from Jimmy Choo with frames from £170. The<br />

most expensive frames retail at around £2,500. At the official<br />

opening representatives from Oliver Peoples, Maui Jim and<br />

Fred attended to show the new ranges for next year. The<br />

lenses offered include Rodenstock, Zeiss and Nikon.<br />

“This is high-end retail,” explained Mr Rowley. “We have<br />

arranged specialist staff training to help the staff move from<br />

contact lenses to selling high end frames.”<br />

The newest member of staff is DO Michael Blenkisop who<br />

has grown up in optics as his parents and his sister all work in<br />

the sector. So what attracted him to the new practice?<br />

“I was attracted by the uniqueness of the offering,” he said.<br />

“There’s a real buzz about the place and I love that we offer<br />

the best eye care and eye wear.”<br />

The practice is an inspiration but there were lessons learned<br />

along the way for other practice owners. “You have to have it<br />

very clear in your mind what you want even with excellent<br />

shopfitters such as we had,” said Mr Rowley. “You have to<br />

be there all the time as they don’t see <strong>issue</strong>s in the same way.<br />

Even though they were passionate about the job at the end of<br />

the day they are not opticians and it is all about the details.”<br />

And his advice for other practitioners considering a new<br />

practice? “It’s all about making a statement. Decide what the<br />

market needs in your area and just go for it,” he said.

VRICS<br />

Visual Recognition<br />

and Identification<br />

of Clinical Signs<br />

Sponsored by<br />

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

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

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

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

Vision Assessment in Ocular Disease Part 1<br />

Course Code: C-17158 O<br />

Dr Raymond Beirne, BSc (Hons), MCOptom, PhD<br />

About the author<br />

Dr Raymond Beirne is an optometrist and lecturer at the University of Ulster. He is responsible for<br />

the Advanced Examination Techniques undergraduate module and his main research interest is<br />

visual function in the ageing eye and ocular disease.<br />

36<br />

1. When assessing the optic nerve head of a patient with the visual<br />

field defect shown in Image A, which of the following is the most likely<br />

appearance to be found?<br />

a) C:D ratio of 0.6, ISNT rule obeyed<br />

b) C:D ratio of 0.6 with significant superior neuro-retinal rim loss<br />

c) C:D ratio of 0.6 with significant inferior neuro-retinal rim loss<br />

d) C:D ratio of 0.6 with nasal neuro-retinal rim loss<br />

25/11/11 VRICS<br />

A<br />

2. Which of the following techniques is LEAST likely to improve the early<br />

detection of the visual field defect shown in Image A?<br />

a) Frequency doubling technology<br />

b) Short-wavelength automated perimetry<br />

c) Optical coherence tomography<br />

d) Heidelberg Edge Perimeter<br />

3. Which of the following statements about the colour vision test shown in<br />

Image B is FALSE?<br />

a) It is a colour arrangement test<br />

b) It can detect protan, deutan and tritan colour vision defects<br />

c) It can reliably differentiate between dichromats and anomalous trichromats<br />

d) The test uses 85 different coloured caps<br />

B<br />

C<br />

4. Which of the following options BEST describes the result shown in Image<br />

B?<br />

a) Normal<br />

b) Protan defect<br />

c) Deutan defect<br />

d) Tritan defect<br />

5. Image C shows the VA and contrast sensitivity results of a patient with<br />

early nuclear sclerotic cataract in their right eye. If the VA test was carried<br />

out at 4 metres what is the patient’s logMAR VA?<br />

a) 0.20<br />

b) 0.08<br />

c) 0.32<br />

d) 0.38<br />

6. Which of the following statements about the contrast sensitivity test<br />

used to obtain the results in Image C is true?<br />

a) The patient should wear their habitual reading prescription for <strong>this</strong> test<br />

b) The result is the lowest triplet where one of the three letters in a triplet is read<br />

correctly<br />

c) The contrast sensitivity score is based on Weber contrast<br />

d) A working distance of two metres should be used<br />

Presbyopia and Its Management with Contact Lenses<br />

25th November and 12th December 2011

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

Sponsored by<br />

IMPORTANT INFORMATION: Under the new Vantage rules, all OT CET points awarded will be uploaded to its website by us.<br />

All participants must confirm these results on www.cetoptics.com so that they can move their points from the “Pending Points record” into<br />

their “Final CET points record”. Full instructions on how to do <strong>this</strong> are available on their website. The closing date for <strong>this</strong> examination is<br />

January 27 2012. cet points for <strong>this</strong> exam will be uploaded to Vantage on February 6 2012.<br />

2 FREE CET Points<br />

Approved for Optometrists<br />

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Dispensing Opticians<br />

✗<br />

References to aid completion of the exam:<br />

Q1 & Q2: http://webeye.ophth.uiowa.edu/ips/PerimetryHistory/index.htm<br />

Q3 & Q4: Formankiewicz, M (2009). Assessment of Colour Vision: Colour Vision Part 2.<br />

OT, 23rd October<br />

Q5 & Q6: http://www.scribd.com/doc/59085894/Pelli-Robson-ETDRS-Score-Sheet-Instructions<br />

Q7 & Q8: Hancock, S (2008). Clinical Decision Making I: Visual Field Interpretation. OT, 11th July<br />

Q9 & Q10: Binns, A (2011). Assessment & Management of AMD: Referral Refinement Part 4.<br />

OT, 20th May.<br />

Q11 & Q12: http://webvision.med.utah.edu/book/part-viii-gabac-receptors/psychophysics-of-vision/<br />

7. Which of the following statements about the test result shown in<br />

Image D is FAlse?<br />

a) The results could account for overall depression in sensitivity due to cataract or<br />

pupil miosis<br />

b) The results are for a patient’s right eye<br />

c) The results could account for a retinal cause as the midlines are not respected<br />

d) The results are reliable<br />

37<br />

D<br />

8. Which of the following is the most likely cause of the test result<br />

shown in Image D?<br />

a) Cataract<br />

b) Lid ptosis<br />

c) Glaucoma<br />

d) Patient fatigue<br />

9. Which of the following best describes the appearance of the test result<br />

shown in Image E?<br />

a) Metamorphopsia<br />

b) Hemianopia<br />

c) Paracentral scotoma<br />

d) Central scotoma<br />

25/11/11 VRICS<br />

E<br />

F<br />

10. Which of the following assessments would be LEAST useful to<br />

conduct when investigating the cause of the test result shown in<br />

Image E?<br />

a) Binocular indirect ophthalmoscopy of the macula<br />

b) Monocular visual acuity<br />

c) Monocular contrast sensitivity<br />

d) Confrontation visual fields<br />

11. Image F illustrates which of the following psychophysical methods<br />

that can be used for obtaining a visual sensitivity threshold?<br />

a) Descending method of limits<br />

b) Bayesian staircase method<br />

c) Fixed step size staircase method<br />

d) Ascending method of limits<br />

12. In a clinical context, which of the following statements about<br />

the psychophysical method used for obtaining the visual sensitivity<br />

threshold illustrated in Image F is FAlse?<br />

a) This method is completely free from errors of habituation and anticipation<br />

b) The threshold can be measured as the average of several reversal points<br />

c) This method is faster at estimating threshold than the method of constant stimuli<br />

d) When used in perimetry, starting stimuli are visible to the observer<br />

For more information on all our courses, please visit:<br />



Sponsored by<br />

38<br />

25/11/11 STUDENT NEWS<br />

‘Blinded’ to mark WSD<br />

An optometry student spent 24<br />

hours ‘blind’ to mark <strong>this</strong> year’s World<br />

Sight Day last month.<br />

Wearing special eyewear to block out<br />

light, Aston University undergraduate<br />

Jeff Clarke tried to carry on with his<br />

day-to-day routine such as attending<br />

lectures, going to the library and making<br />

dinner.<br />

Relying on his classmates to direct<br />

him around campus, Mr Clarke had to<br />

A Halloween party is the latest event<br />

organised by optometry undergraduates at<br />

Glasgow Caledonian University to raise money<br />

for their forthcoming Eye Ball.<br />

The students (pictured) raised £368 through<br />

ticket sales for the event which was held at a<br />

local student venue in Glasgow’s city centre.<br />

Costumes on the night included Where’s<br />

Wally?, Minnie Mouse, the cast of the Wizard of<br />

Oz, Cruella Deville and many more.<br />

New department seeks PhD student<br />

The newly opened optometry department at Plymouth University is<br />

seeking a PhD student for a fully-funded studentship starting early<br />

next year. The three-year fixed term research project will be based on<br />

the ‘post-operative assessment of modern intraocular lens designs and<br />

the assessment of the biomechanics of the anterior eye’.<br />

The successful candidate would have the unique opportunity to get<br />

quickly adapt to avoid injury and mess<br />

whilst eating.<br />

Third-year and AOP council student<br />

rep, Mr Clarke said: “It was a very<br />

challenging day as I had taken for<br />

granted how much I rely on my vision.<br />

I quickly realised it was going to be a<br />

long and difficult day when I woke up<br />

and couldn’t check my emails or text<br />

messages.<br />

“Throughout the day, I was amazed to<br />

hear how many people were inspired by<br />

our event and who mentioned that they<br />

had never realised how much they take<br />

for granted their sight until they saw us<br />

stumbling around the campus.”<br />

A pub quiz organised by the<br />

university’s Optics Society marked the<br />

annual day and helped raise money for<br />

the cause.<br />

Combined the events raised more than<br />

£200, which will be divided between<br />

<strong>Optometry</strong> Giving Sight and Vision Aid<br />

Overseas.<br />

Essilor awards Cardiff Prize<br />

Cardiff optometry students Robin Clayton and Daniel McGhee have<br />

been named <strong>this</strong> year’s recipients of the ‘Essilor Prize’.<br />

Whilst Mr Clayton received the award for best performance in<br />

dispensing in the second year, Mr McGhee was awarded the prize for the<br />

same unit in the third year.<br />

Pictured is Mr Clayton (pictured right) being presented with the award<br />

from Essilor professional relations manager Andy Hepworth (left) and head<br />

of optometry and vision science professor Tim Wess (centre).<br />

Hair-raising<br />

Halloween party<br />

involved with a new optometry programme, have access to stateof-the-art<br />

research facilities and could attend conferences overseas.<br />

Applicants must hold a first or 2:1 degree in optometry and be able<br />

to start in January or April, 2012. For further information on the<br />

opportunity telephone Phillip Buckhurst on 01752 588884. The deadline<br />

for applications is December 1.

OT CET Video<br />

C-17876 O/D/CL: The Tear<br />

Film in Contact Lens Wear<br />

The cause of dry eye is multi-factorial and can<br />

affect contact lens wear resulting in drop-out.<br />

However, newer contact lens materials are<br />

available to help practitioners reduce dry eye<br />

symptoms by lubricating the eye during<br />

contact lens wear. In <strong>this</strong> video, learn about<br />

the difference between these materials and<br />

which performed the best in a recent trial<br />

undertaken by Professor James Wolffsohn of<br />

Aston University.<br />

You must be logged in to the OT website before you can<br />

watch <strong>this</strong> video and take the exam.<br />

A hint button is now available for each question and will<br />

take you to the section of the video that relates to the<br />

question.<br />

The closing date for MCQ submissions is December<br />

31 2011. Points will be uploaded to CET Optics up to<br />

10 days later.<br />





& TRAINING<br />


Approved for: Optometrists<br />

4<br />

Dispensing Opticians ✗<br />

OT CET content supports <strong>Optometry</strong> Giving Sight<br />

Having trouble signing in to take an exam?<br />

View CET FAQ Go to www.optometry.co.uk<br />

40<br />

25/11/11 CET<br />

Distortion of Vision<br />

to<br />

Referral REFINEMENT Part 12 C-17573 O<br />

Mark Benson, MB, ChB, MSc, FRCS, FRCOphth<br />

Metamorphopsia, or distortion of vision, is an important visual symptom,<br />

particularly if it is the chief reason for a patient seeking optometric<br />

assessment. It often indicates serious underlying pathology, and it always<br />

demands thorough history-taking and examination. There are many causes<br />

of visual distortion, but in most cases with underlying ocular pathology<br />

the problem is in the macula. This article discusses the more common<br />

causes of such symptoms, including epiretinal membrane, macular hole,<br />

age-related macular degeneration (AMD), non-AMD choroidal neovascular<br />

membranes, central serous retinopathy (CSR) and vascular maculopathies.<br />

Epiretinal Membrane<br />

An epiretinal membrane (ERM) may be<br />

thought of as a delicate sheet of glial<br />

“scar” t<strong>issue</strong> that has formed on the<br />

surface of the retina in response to some<br />

sort of retinal upset. By far the most<br />

common cause is posterior vitreous<br />

detachment (PVD), which probably<br />

causes slight trauma of the retinal<br />

surface, not in itself sufficient to lead to<br />

symptoms. A healing response ensues,<br />

with the formation of a glial membrane.<br />

Like any scar t<strong>issue</strong> <strong>this</strong> then contracts,<br />

Figure 1<br />

“Punched-out” appearance of full-thickness<br />

macular hole, with surrounding sub-retinal fluid<br />

leading to a wrinkling of the retinal<br />

surface. This anatomical distortion of<br />

the retina, usually involving the macula,<br />

may then produce distortion of vision.<br />

In some cases the anatomical change is<br />

associated with a pathophysiological<br />

effect leading to associated waterlogging,<br />

or oedema, of the macula<br />

with further worsening of vision.<br />

Sometimes an ERM may be a sequel<br />

to previous retinal vascular occlusion,<br />

or retinal laser treatment or surgery.<br />

Macular Hole<br />

For reasons that have yet to be<br />

established, macular hole is much more<br />

common in females than in males.<br />

Unlike ERM, most are not associated<br />

with PVD. Indeed, it is the nonseparation<br />

of a contracting vitreous<br />

face, leading to tangential traction<br />

across the fovea that is thought to be<br />

the cause of the condition. Initially<br />

<strong>this</strong> traction produces a detachment<br />

of the fovea – known by the misnomer<br />

stage I macular hole. The vitreous may<br />

separate at <strong>this</strong> stage to give a PVD,<br />

but if not, then the fovea may dehisce<br />

For the latest CET visit www.optometry.co.uk/cet<br />

give a small hole – the stage II fullthickness<br />

macular hole (FTMH). Over<br />

time <strong>this</strong> hole enlarges, and there is<br />

often seepage of fluid beneath the rim of<br />

the hole to give the classic appearance<br />

of the “punched-out” FTMH (stage III)<br />

(Figure 1). Eventually the vitreous may<br />

separate to give a PVD, a stage known<br />

as stage IV FTMH. Note that there is<br />

no loss of retinal t<strong>issue</strong>, and the hole<br />

hardly ever leads to retinal detachment<br />

(but can in high myopes). Central vision<br />

usually settles at around 3/60-6/60<br />

acuity in an untreated case, and in 10%<br />

of people the condition is bilateral.<br />

Age-Related Macular<br />

Degeneration (AMD)<br />

Referral refinement of AMD has been<br />

discussed previously in <strong>this</strong> series (see<br />

OT May 6 2011 and May 20 2011) and<br />

it is probably the most important of<br />

the causes of distortion because it is<br />

increasingly common and can often be<br />

treated. The condition is more common<br />

with advancing age. In its “dry” form it is a<br />

degeneration affecting Bruch’s membrane<br />

and the retinal pigment epithelium<br />

(RPE), with secondary changes in the<br />

retina. The subject may have noticed a<br />

preceding slight reduction in vision,<br />

with difficulty in making out detail,<br />

and poor reading vision in conditions of<br />

reduced illumination. These symptoms<br />

Figure 2<br />

Myopic fundus with pigmented juxtafoveal<br />

choroidal new vessels

elate to the “dry” degenerative changes.<br />

As Bruch’s membrane is compromised,<br />

blood vessels may grow through from<br />

the choroid to directly underlie the<br />

retina, particularly beneath the central<br />

macula. These vessels are fenestrated,<br />

and thus leak fluid, which pools<br />

beneath the macula and penetrates into<br />

41<br />

it. This is “wet” AMD. As the macula<br />

is lifted the vision becomes distorted.<br />

The new vessels proliferate beneath<br />

the elevated retina and spread out,<br />

gradually being replaced by “scar”<br />

t<strong>issue</strong>. The vessels may bleed, and <strong>this</strong><br />

Figure 3<br />

Angioid streaks with parafoveal scar from choroidal<br />

new vessels.<br />

Figure 4<br />

Scattered hypo- and hyper-pigmented lesions of<br />

presumed ocular histoplasmosis syndrome<br />

may result not only in sub- and intraretinal<br />

haemorrhage, but occasionally in<br />

breakthrough bleeding into the vitreous.<br />

Increasingly, those affected by AMD<br />

are becoming aware that distortion of<br />

vision may herald the onset of the wet<br />

form of the condition. Note, however,<br />

that dry AMD may also cause some<br />

distortion. This is usually mild, and<br />

fairly static, unlike wet AMD where the<br />

distortion worsens almost day-by-day.<br />

Non-AMD Choroidal<br />

Neovascular Membranes<br />

and PIC scattered foci of inflammation<br />

occur, resulting in the characteristic<br />

appearance of these conditions, with<br />

sub-retinal hypo-and hyper-pigmented<br />

lesions (Figure 3). Blunt ocular trauma<br />

may lead to large, curvilinear breaks<br />

in Bruch’s membrane, which may be<br />

complicated at a later date by the growth<br />

of CNV. Angioid streaks is a hereditary<br />

condition resulting in a degeneration<br />

of Bruch’s membrane and the RPE. It is<br />

named thus because the resulting breaks<br />

in Bruch’s membrane resemble blood<br />

vessels on cursory examination (Figure 4).<br />

bilaterality even when there have been<br />

no subjective symptoms from that eye.<br />

Vascular Maculopathies<br />

There are many vascular abnormalities<br />

of the fundus that may affect the<br />

macula, but those most often<br />

seen in optometric practice are:<br />

• Diabetic maculopathy<br />

• Branch retinal vein occlusion<br />

• Central retinal vein occlusion<br />

Diabetic maculopathy is one of the<br />

chief causes of visual loss in people<br />

with diabetes and a common cause<br />

25/11/11 CET<br />

Although AMD is by far the most<br />

common cause of choroidal new<br />

vessels (CNV), there are many<br />

Central Serous Retinopathy<br />

(CSR)<br />

of sight impairment registration.<br />

Retinal vein occlusions are a relatively<br />

common cause of sudden visual loss<br />

other underlying aetiologies that<br />

In stark contrast to macular hole, <strong>this</strong><br />

in one eye. In all of these conditions<br />

may lead to <strong>this</strong> same end-point:<br />

condition is much more common (20x)<br />

macular oedema may ensue. In the<br />

• Myopia (Figure 2)<br />

in males than females. It typically affects<br />

case of diabetic maculopathy there is<br />

• Sub-retinal inflammatory conditions<br />

a younger age group, most commonly<br />

usually evidence of retinopathy, in the<br />

e.g. presumed ocular histoplasmosis<br />

in the third and fourth decades. Those<br />

form of microaneurysms, flame-shaped<br />

syndrome (POHS) (Figure 3), punctate<br />

affected by CSR may have several or<br />

haemorrhages, so-called cotton wool<br />

inner choroidopathy (PIC)<br />

many episodes, so the subject may<br />

spots, and exudates. In the case of<br />

• Trauma<br />

report previous episodes of distortion.<br />

retinal vein occlusion there are scattered<br />

• Angioid streaks (Figure 4)<br />

The pathophysiology of the condition<br />

flame-shaped haemorrhages, and larger<br />

• Idiopathic CNV<br />

is not fully understood, but it seems to<br />

blot haemorrhages, sometimes with<br />

The common factor with these<br />

be related to a temporary breakdown in<br />

cotton wool spots. The distribution of<br />

conditions is compromise of Bruch’s<br />

those mechanisms that control fluid flow<br />

the haemorrhage is in one quadrant of<br />

membrane and <strong>this</strong> is what allows<br />

across the retina, such that fluid pools<br />

the fundus, in one hemisphere, or in all<br />

new vessels to grow into a sub-retinal<br />

beneath the retina. There are usually<br />

quadrants, for branch, hemi- and central<br />

position. In some myopes, breaks in<br />

associated pigmentary changes in the RPE<br />

retinal vein occlusions respectively.<br />

Bruch’s membrane may be seen on<br />

(Figure 5), and subtle RPE abnormalities<br />

It is unusual for distortion to be<br />

fundoscopy as “lacquer cracks”. In POHS<br />

in the fellow eye may indicate<br />

the presenting symptom for these<br />

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42<br />

25/11/11 CET<br />

maculopathies, even when macular<br />

oedema is demonstrable, and indeed<br />

distortion may be a minor symptom<br />

for the patient, if present at all. It is<br />

not uncommon, however, for patients<br />

with macular oedema to complain of<br />

micropsia. This occurs because the<br />

macular oedema effectively spreads<br />

the photoreceptors further apart, and<br />

the image is hence seen as smaller. The<br />

opposite effect sometimes occurs with the<br />

surface-wrinkling maculopathy of ERM.<br />

Taking the history<br />

Not surprisingly, the symptoms of<br />

distortion and reduced VA tend to go<br />

together. If there is distortion, then that<br />

is often described by the patient as their<br />

chief complaint. Sometimes, however,<br />

it is only mentioned as a symptom after<br />

some prodding. If the symptom is not<br />

offered by the patient, but they complain<br />

of reduced central vision or other<br />

central visual abnormality, then you<br />

should ask if their vision is distorted.<br />

If there is a scotoma, is it absolute,<br />

or can the patient see “through” it?<br />

It is important to ask about the duration<br />

of the symptom: distortion that has been<br />

present for twelve months is unlikely<br />

to require same-day assessment. It is<br />

also important to determine the degree<br />

of recent change in the symptom. As<br />

mentioned above, fairly static distortion<br />

of a mild degree is not infrequently<br />

present in dry AMD, whereas the wet<br />

form of the condition, in the acute stage,<br />

often produces distortion which can<br />

be seen to worsen day by day. This is<br />

also true of CNV of other aetiologies.<br />

The distortion of macular hole and<br />

of ERM usually reaches a steady<br />

state, with VA of about 6/60-3/60 in<br />

macular hole, and better than <strong>this</strong> in<br />

ERM. Is there a history of previous<br />

visual distortion? If so, particularly<br />

in a young to middle-aged male, then<br />

<strong>this</strong> is strongly suggestive of CSR.<br />

Figure 5<br />

Central serous retinopathy (CSR)<br />

Is there a history of previous visual<br />

loss weeks, months or even years<br />

prior to the distortion? The patient<br />

may describe the sectorial visual<br />

field disturbance associated with a<br />

previous retinal vein occlusion; or<br />

they may volunteer the information<br />

that they have had such an event.<br />

Note the age of the patient,<br />

and ask if they have diabetes. Is<br />

there a history of ocular trauma?<br />

Examination<br />

The VA may give some clue to the<br />

aetiology in stable distortion, with<br />

macular hole typically around 6/60 to<br />

3/60, and ERM 6/9 to 6/24 (there are<br />

exceptions, of course, and note that VA<br />

in ERM is likely to steadily worsen before<br />

stabilising); note whether the patient<br />

uses eccentric fixation, or has to “search”<br />

for the letters. Is the patient myopic?<br />

There may be no clinical signs in the<br />

anterior segment, although a history<br />

of ocular trauma may be corroborated<br />

by pupillary sphincter ruptures,<br />

lens subluxation, or phacodonesis.<br />

In people with diabetes, and those<br />

with suspected previous vascular<br />

occlusion, you should examine the<br />

iris carefully for evidence of rubeosis<br />

iridis prior to dilatation of the pupil.<br />

It is unwise to venture an opinion on<br />

the macula without first dilating the<br />

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pupil. Before focussing on the macula<br />

however, examine the vitreous (see<br />

OT October 28 2011). A PVD is likely<br />

in ERM and unlikely in macular hole.<br />

Examination of the macula at the slitlamp<br />

with the hand-held condensing<br />

lens (e.g. 90D or 78D) allows stereoscopic<br />

assessment of macular elevation. Look<br />

for the signs of degenerative AMD<br />

(drusen and pigmentary changes). Can<br />

you discern a sub-retinal membrane? Is<br />

there sub-retinal blood? Look for lacquer<br />

cracks in a myopic patient; these can be<br />

very subtle (Figure 2). Can you see the<br />

sub-retinal, vessel-like abnormalities<br />

radiating from the disc that are typical<br />

of angioid streaks (Figure 3)? With <strong>this</strong><br />

condition, the RPE often has a stippled<br />

or granular appearance. Can you see<br />

the scattered, well-demarcated, hypoand<br />

hyperpigmented lesions of PIC or<br />

POHS (Figure 4)? In the latter the lesions<br />

are often scattered in the peripheral<br />

fundus, particularly inferiorly. Can<br />

you see the classic “punched-out”<br />

appearance of a macular hole, which<br />

is usually surrounded by a “halo” of<br />

slightly elevated retina (Figure 1)? Does<br />

the macula have the sheen of an ERM,<br />

possibly with corrugations of the retinal<br />

surface? Do you see the scattered flame<br />

haemorrhages of a retinal vein occlusion<br />

(Figure 6), or the microaneurysms, flameshaped<br />

haemorrhages, cotton-wool spots<br />

and exudates of diabetic retinopathy?<br />

Optical coherence tomography (OCT)<br />

is a useful ancillary investigation in<br />

these cases. It is non-invasive, and<br />

provides a cross-sectional “picture” of<br />

the macula, which aids in confirming<br />

the presence of an abnormality<br />

and in making the diagnosis.<br />

Management<br />

Of the causes of metamorphopsia<br />

discussed above, it is CNV that demands<br />

the most urgent management. The drugs<br />

Lucentis and Avastin have proved very

effective in the treatment of CNV<br />

then referral need not be urgent. State<br />

with various underlying aetiologies,<br />

on the referral that the diagnosis is<br />

but if good vision is to be salvaged or<br />

ERM because, as for macular hole, <strong>this</strong><br />

retained, then the CNV must be treated<br />

will help to ensure that the patient<br />

in its early stages. This is because the<br />

is directed to a vitreo-retinal clinic.<br />

membrane usually grows rapidly, and as<br />

When patients are counselled<br />

it does so it tends to form a layer of subretinal<br />

scar t<strong>issue</strong> which permanently<br />

regarding macular conditions some<br />

will baulk at the idea of surgery,<br />

43<br />

separates the overlying retina from<br />

particularly if they are elderly. It should<br />

the underlying RPE and choroid.<br />

be pointed out to them that age is rarely<br />

Furthermore, the passage of fluid into<br />

a contraindication to vitreo-retinal<br />

the retinal substance causes a disruption<br />

surgery, which is increasingly carried<br />

of its normal cellular architecture<br />

which has physiological consequences.<br />

Hence, patients with CNV should be<br />

referred urgently for assessment and<br />

treatment. Same-day assessment via an<br />

ophthalmic emergency is not usually<br />

necessary, provided the optometrist<br />

has established a rapid written referral<br />

route (e.g. via fax) to a rapid-access<br />

macula or retinal clinic. 1 Since referrals<br />

to secondary care may be screened by<br />

non-medical personnel, you should<br />

state clearly on the referral that the<br />

patient has distortion of vision and<br />

that you suspect CNV, or wet AMD.<br />

If you are unable to refer directly<br />

to a clinic providing rapid access<br />

for these cases, then referral to the<br />

ophthalmic emergency service may be<br />

necessary to ensure prompt treatment.<br />

If the diagnosis seems to be CSR<br />

(e.g. distortion with moderately<br />

reduced vision, with no evidence<br />

of CNV or sub-retinal blood, and no<br />

pre-disposing condition for CNV, in<br />

a young or middle-aged patient) then<br />

there is little urgency. This condition<br />

is often self-limiting, and generally<br />

the first step in management is to<br />

allow a period of several months for<br />

<strong>this</strong> to occur, before active treatment<br />

Figure 6<br />

Central retinal vein occlusion<br />

diabetic retinopathy or retinal vein<br />

occlusion should be treated promptly.<br />

These patients should be referred<br />

urgently, but same-day assessment<br />

is not necessary. Again, it helps to<br />

indicate on the referral that diabetic<br />

or retinal vascular disease is present.<br />

Macular holes require a surgical<br />

treatment, and it is known that the<br />

shorter the history, the greater the<br />

chance of a successful outcome from<br />

surgery. However, on the scale of vitreoretinal<br />

urgency these patients would<br />

generally be placed in the “moderate”<br />

category, with a wait of weeks to months<br />

for surgery on the NHS. 2 There is little<br />

to be gained, therefore, from sameday<br />

ophthalmological assessment.<br />

They should be referred as urgent,<br />

with the referral indicating that the<br />

diagnosis appears to be macular hole.<br />

Epiretinal membranes pass through<br />

stages in their development: they form<br />

as delicate glial sheets then go through a<br />

contractile phase before remaining fairly<br />

static, although macular oedema may<br />

evolve. The vast majority of ERMs seen<br />

in optometric practice are in <strong>this</strong> third<br />

out under local anaesthetic on a daysurgery<br />

basis. The patient may still<br />

have many years ahead of them, and<br />

they cannot be sure that the “good” eye<br />

will remain in good health: a time may<br />

come when they rely on the currently<br />

“bad” eye. Furthermore, the retina<br />

is relatively intolerant of anatomical<br />

and physiological disturbance, and<br />

with retinal conditions in general,<br />

the sooner they are treated the greater<br />

the chance of a satisfactory outcome.<br />

The results of surgery for ERM, and<br />

particularly for macular hole, are very<br />

good nowadays, but early intervention<br />

is important. It is no good for the patient<br />

if they decline referral for surgery and<br />

then change their mind five years later<br />

because the “bad” eye has become<br />

the best prospect for useful vision!<br />

About the author<br />

Mark Benson is a director of the<br />

Midland Eye Institute, and consultant<br />

ophthalmic surgeon to the Heart of<br />

England NHS Trust for whom he runs<br />

retinal and cataract services. He is<br />

senior clinical lecturer to the University<br />

of Birmingham, a section editor for the<br />

journal Eye, and an examiner for the<br />

Royal College of Ophthalmologists.<br />

25/11/11 CET<br />

is considered. Of course, if there<br />

is doubt about <strong>this</strong> diagnosis, and<br />

stage: they have stabilized. Hence, when<br />

you are counselling patients, you can<br />

References<br />

you feel CNV could be present, then<br />

tell them that it is very likely that their<br />

See<br />

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

you should refer urgently as above.<br />

symptoms will not worsen significantly.<br />

clinical/index. Click on the article title<br />

Macular oedema secondary to<br />

If you are confident of the diagnosis<br />

and then download “references”.<br />

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25/11/11 CET<br />

Community-based<br />

Independent<br />

Prescribing<br />

Course Code C-17277 O/AS/SP/IP<br />

Peter Frampton MSc, FCOptom, BAppSc(Optom) (AUS), DipTp(AS),<br />

DipTp(SP), DipTp(IP)<br />

Community-based independent prescribing (IP) optometrists tend to<br />

work in isolation, an intimidating concept. However, for IP to impact on<br />

commissioning consortia by saving money whilst improving access to care,<br />

promptness of care, and appropriateness of care, the services need to be<br />

driven from a community perspective. Optometrists need to be the GPs of<br />

community eye care. Based on audit results of IP activity of the author, <strong>this</strong><br />

article highlights the role of IP in community practice, with the hope that <strong>this</strong><br />

will encourage much greater uptake in these qualifications by optometrists.<br />

The College of Optometrists¹ states that<br />

practitioners ‘must only ever prescribe<br />

within your level of experience and<br />

competence’. This means that whilst<br />

some IP practitioners will feel confident<br />

in diagnosing and treating conditions,<br />

others will feel more comfortable with<br />

monitoring already diagnosed cases,<br />

Figure 1<br />

Total acute presentations of cases requiring IP intervention over a 12-month period. KEY: SLK = superior<br />

limbic keratitis; BCC = basal cell carcinoma; EBMD = epithelial basement membrane dystrophy<br />

eg, glaucoma and those with ocular<br />

hypertension. Indeed, practitioners<br />

should always practice within their<br />

own capabilities and confidence levels.<br />

Audit results<br />

Over the 12 month period from June<br />

2010 to June 2011, the author’s practice<br />

therapeutically managed on average<br />

about 3 cases per day. Audit results<br />

during <strong>this</strong> period are shown in Figure<br />

1, which displays the total breakdown<br />

of acute or unplanned presentations<br />

that required IP intervention. Only<br />

cases requiring IP ability were included<br />

in the audit. Many presentations were<br />

manageable under core competency<br />

levels of skills eg, mild seasonal and<br />

perennial allergic conjunctivitis and<br />

dry eye, and were not included in<br />

these figures. Tear deficient dry eye<br />

conditions were only included when<br />

requiring Sjogren investigations or<br />

prescription only medications (POMs).<br />

Figure 2 displays the breakdown<br />

of patients investigated/managed for<br />

glaucoma. Patients with glaucoma<br />

were only included if they were<br />

not under routine HES care, were<br />

stable and discharged to our care,<br />

or patients not yet diagnosed and<br />

under regular review for progression<br />

or ocular hypertension (OHT).<br />

All assessments carry private charges.<br />

Northumberland does not have a shared<br />

care scheme for acute presentations and<br />

apart from in-house information and<br />

reactive education of the healthcare<br />

community via GP reports, there is no<br />

advertising of IP services. Regardless,<br />

the practice receives regular referrals<br />

from GPs, who are aware of the private<br />

charges, as well as pharmacies and selfreferrals.<br />

Patients not prepared to pay<br />

the fees are directed to the HES. The<br />

data presented must be considered a<br />

very conservative estimate of the total<br />

level of activity possible within the<br />

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community, if official Care Trust funded<br />

and promoted services were provided.<br />

Bacterial keratitis<br />

Treating suspect bacterial keratitis<br />

within the community, and without<br />

access to laboratory facilities and<br />

cultures, is controversial. Ray-<br />

Chaudhuri² states that suspect<br />

bacterial keratitis requires a corneal<br />

scrape and culture. There are no<br />

exclusion criteria. However, of the five<br />

cases of suspected bacterial keratitis<br />

that the author referred to the HES,<br />

four were treated empirically with<br />

ofloxacin, without cultures; all four<br />

were treated intensively, indicating<br />

infective (bacterial) keratitis was<br />

suspected. The fifth patient, a contact<br />

lens wearer with no history of trauma,<br />

referred with a central corneal lesion<br />

was diagnosed at the HES as having<br />

a corneal abrasion and treated with<br />

chloramphenicol. Only at the 24 hour<br />

review appointment was bacterial<br />

keratitis diagnosed, the patient<br />

hospitalised and treated with fortified<br />

antibiotics and cultures taken. Why the<br />

conflict in approach? Culture yields as<br />

low as 63% have been reported,³ while<br />

over 80% of ulcers respond well to<br />

empirical broad-spectrum treatment. 4<br />

Significant predictive factors for<br />

treatment success or failure are lesion<br />

size, promptness of presentation,<br />

the patient’s age, co-existing corneal<br />

pathology and use of topical steroids. 4<br />

A general reduction in immune<br />

competence would also contribute.<br />

It is further suggested that young<br />

patients with small ulcers should<br />

respond well with empirical treatment<br />

and would be unlikely to be culture<br />

positive. Conversely, older patients<br />

(>60 years) with large ulcers (>5mm)<br />

are at 5.5x greater risk of primary<br />

treatment failure. It has also been<br />

suggested that resistance is unlikely<br />

Figure 2<br />

Management of patients diagnosed with glaucoma by IP optometrists. KEY: PDSi = pigment dispersion<br />

syndrome; PD = pseudoexfoliative glaucoma; NTG = normal tension glaucoma; OHT = ocular<br />

hypertension; COAG = chronic open angle glaucoma; AACG = acute angle closure glaucoma<br />

with community-acquired keratitis. 5<br />

Many of these observations have been<br />

amalgamated into the objective ‘1, 2, 3’<br />

guidelines, which suggest that bacterial<br />

keratitis presentations showing ≤1+<br />

cells in the anterior chamber, being<br />

≤2mm in size and with a lesion edge<br />

≥3mm from the cornea centre are<br />

not potentially sight threatening,<br />

are unlikely to be culture positive,<br />

and so could reasonably be treated<br />

empirically with a fluoroquinolone. 6<br />

Clinical decisions should be<br />

made based on severity, symptoms,<br />

compliance and ease of access to<br />

laboratory facilities. If a decision<br />

to treat empirically is taken it must<br />

reflect each individual presentation<br />

and the practitioner’s confidence;<br />

the ‘1, 2, 3’ guidelines lend objective<br />

support for such decisions. Certainly<br />

all cases of suspect bacterial keratitis<br />

managed by the author’s practice<br />

have been treated successfully.<br />

When prescribing antibiotics, one<br />

must also be wary of inappropriate<br />

use, which falls into two categories:<br />

incorrect diagnosis and subtherapeutic<br />

dosing.³ An intensive<br />

therapeutic strategy, with initial<br />

loading dose and subsequent hourly<br />

daytime dosage and nocturnal cover,<br />

is instigated whenever bacterial<br />

keratitis is suspected within the<br />

practice; the potential risk with subtherapeutic<br />

dosing is too high. In<br />

the case of marginal keratitis, <strong>this</strong> is<br />

always treated more conservatively<br />

with polyfax qid; steroids are not<br />

considered necessary in all cases.<br />

Viral keratitis<br />

GOC guidelines 7 state: ‘Independent<br />

prescribers take responsibility<br />

for the clinical assessment of the<br />

patient, establish a diagnosis and<br />

determine the clinical management<br />

required, (including prescribing<br />

45<br />

25/11/11 CET<br />

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I. Ocular Symptoms<br />

(at least one)<br />

II. Oral Symptoms<br />

(at least one)<br />

III. Ocular Signs<br />

(at least one)<br />

IV. Histopathology<br />

V. Oral Signs<br />

(at least one)<br />

VI. Auto-antibodies<br />

(at least one)<br />

Primary Sjogren’s<br />

syndrome diagnosis<br />

Secondary Sjogren’s<br />

syndrome diagnosis<br />

where necessary).’ Implicitly the<br />

choice of treatment is contingent<br />

on correct diagnosis. If we cannot<br />

diagnose we should not be allowed<br />

to treat. Regardless, the College of<br />

Optometrists’ Clinical Management<br />

Guidelines prepared for IP optometrists 8<br />

recommend that no treatment should<br />

be instigated by the optometrist for<br />

Dry eyes >3 months<br />

Foreign body sensation in the eyes<br />

Use of artificial tears >3x per day<br />

Dry mouth >3 months<br />

Recurrent or persistently swollen salivary glands as an<br />

adult<br />

Drink liquids to swallow dry foods<br />

Schirmer’s test, (without anesthesia) ≤5 mm/5 mins.<br />

(Substitute less uncomfortable Phenol red thread test)<br />

Positive vital dye staining (van Bijsterveld ≥4)<br />

(Substitute lissamine green)<br />

In minor salivary glands, focal lymphocytic sialoadenitis<br />

with a focus score of 1, defined as a number of<br />

lymphocytic foci per 4mm of glandular t<strong>issue</strong><br />

Unstimulated whole salivary flow (≤1.5 mL in 15 mins.)<br />

Abnormal parotid sialography<br />

Abnormal salivary scintigraphy<br />

Anti-SSA (Ro) or Anti-SSB (La) or both<br />

a. Any 4 of the 6 criteria, must include either item IV<br />

(Histopathology) or VI (Auto-antibodies/Serology)<br />

b. Any 3 of the 4 objective criteria (III, IV, V, VI)<br />

In patients with a potentially associated disease (for<br />

instance, another well defined connective t<strong>issue</strong><br />

disorder), the presence of item I or item II plus any 2 from<br />

among items III, IV and V<br />

Table 1<br />

Revised International Classification Criteria for Sjogren’s Syndrome. Adapted from Vitali et al. 14<br />

new presentations of viral (Herpes<br />

Simplex) keratitis ‘because <strong>this</strong> could<br />

make confirmation of the diagnosis by<br />

the ophthalmologist more difficult’.<br />

Herpes Simplex Keratitis isolated to<br />

the epithelium is confidently treated<br />

within the practice with topical<br />

aciclovir 5 times per day for 10 days.<br />

Presentations with interstitial and<br />

inflammatory components are more<br />

likely to be referred, as they usually<br />

require chronic care and fall beyond<br />

the financial scope of a private<br />

practice. However, prophylactic<br />

systemic aciclovir has been prescribed<br />

for patients with previously<br />

treated Herpes Zoster Keratitis.<br />

Sjogren’s syndrome<br />

Sjogren’s syndrome is classically<br />

under-diagnosed, with delays of up to<br />

11 years reported. 9,10 Jonsson et al. 10<br />

also suggest that the delay in diagnosis<br />

is, in part, due to a lack of awareness<br />

of the disease among health care<br />

professionals. Optometrists should<br />

have access to objective and subjective<br />

techniques to improve sensitivity and<br />

specificity of diagnosis. The sicca<br />

symptoms cause significant quality<br />

of life morbidity, 11 as well as a range<br />

of more significant co-morbidities,<br />

some life threatening. 9,10 Significant<br />

morbidities directly attributable to<br />

dry eyes and mouth can include<br />

mouth sores, malnutrition, oral<br />

candidiasis, sleep disruption with<br />

secondary fibromyalgia, accelerated<br />

dental caries, bacterial conjunctivitis,<br />

corneal ulceration and vision loss. 12<br />

There is no single infallible test for<br />

Sjogren’s syndrome; 13 diagnosis must<br />

assess ocular and salivary components<br />

as well as differentiate between<br />

primary and secondary disease.<br />

Vitali et al. 14 presented the ‘Revised<br />

International Classification Criteria for<br />

Sjogren’s Syndrome’, which is a 6-item<br />

criteria set with demonstrated value<br />

as a diagnostic tool (Table 1). Items<br />

I to III can be readily incorporated<br />

into routine optometric practice.<br />

The Sjogren’s Classification protocol<br />

was considered necessary for 22<br />

patients in the author’s practice. Two<br />

were referred to secondary care for<br />

a full work-up with salivary gland<br />

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iopsies, two were co-managed with<br />

the GP, and five were considered to<br />

be suffering from keratoconjunctivitis<br />

sicca (KCS), but all had reports sent<br />

Corneal abrasions & foreign<br />

bodies<br />

Twelve cases of foreign body removal<br />

or corneal abrasions were managed in<br />

is treated independently in the<br />

practice; the primary consideration<br />

is the patient’s best interests.<br />

The author has managed four specific<br />

to GPs or Rheumatologists. Milder<br />

the practice. One patient with blunt<br />

cases of glaucoma in community<br />

cases are managed within the practice<br />

penetrating foreign body trauma<br />

practice. One of these was an 81-year-old<br />

typically with hyaluronates and<br />

mucolytics; steroids have not been<br />

employed as yet. Included in the group<br />

of patients with dry eye are some<br />

cases of Bell’s Palsy, which were comanaged<br />

with the GP who prescribed<br />

systemic steroids, and lagophthalmos.<br />

presented with positive Seidel sign;<br />

the patient was referred immediately to<br />

the HES, who were notified prior to the<br />

patient’s arrival. Other blunt traumas<br />

included one who was managed with<br />

Ibuprofen and another who required<br />

referral for a magnetic resonance<br />

gentleman with advanced age-related<br />

macular degeneration (AMD), with<br />

logMAR visual acuity of 1.6 and who<br />

had obvious glaucomatous optic nerve<br />

head cupping. Concerned about the<br />

political ramifications, the glaucoma<br />

consultant at the local hospital was<br />

47<br />

imaging (MRI) scan and was found<br />

contacted and the clinical management<br />

Inflammatory conditions<br />

A significant number of inflammatory<br />

conditions were treated by the<br />

author’s practice; iritis, episcleritis,<br />

limbitis, pinguecultitis, vernal<br />

keratoconjunctivitis (VKC), atopic<br />

keratoconjunctivitis (AKC) and<br />

seasonal and perennial conjunctivitis.<br />

Iritis was the most significant<br />

condition encountered and was<br />

managed using a specific procedure<br />

whereby repeated instillation of<br />

2.5% or 10% phenylephrine was<br />

conducted to break synechiae. This<br />

was in direct response to the clinical<br />

experience gained from dealing<br />

with acute iritis and exemplified the<br />

need to constantly re-assess practice<br />

performance. Mandatory is a dilated<br />

fundus examination of both eyes to<br />

ensure the inflammation is limited to<br />

the anterior chamber and, of course,<br />

monitoring for steroid responders.<br />

A number of unidentified<br />

inflammatory episodes were also<br />

treated by the author’s practice. All<br />

to be suffering from concussion; no<br />

treatment was given to <strong>this</strong> patient.<br />

Three cases of eye drop toxicity<br />

were also encountered. One patient<br />

took many months to regain<br />

their visual clarity but all were<br />

managed with patient education.<br />

Infective conditions<br />

The five cases of blepharitis included<br />

in the audit were serious and chronic<br />

enough to require systemic antibiotics<br />

(100mg doxycycline for 6 weeks).<br />

A severe case of conjunctivitis was<br />

also observed, diagnosed as angular<br />

(Moraxella) conjunctivitis, which has<br />

an appearance in the lateral canthi and<br />

can easily be mistaken for episcleritis;<br />

significantly however, the conjunctivitis<br />

was bilateral and there was some<br />

associated blepharitis and discharge<br />

indicative of an infective aetiology.<br />

All cases of pre-septal cellulitis were<br />

successfully treated with 250mg<br />

amoxicillin after ensuring that there<br />

was no history of allergy to penicillins.<br />

plan explained prior to treatment. The<br />

proposal to treat to protect peripheral<br />

vision was positively received, reenforcing<br />

the author’s confidence<br />

while enhancing inter-professional<br />

communication and co-operation.<br />

The author has also prescribed<br />

medication for patients with ocular<br />

hypertension and chronic open<br />

angle glaucoma (COAG); all were<br />

elderly and patient mobility and<br />

limited access to eye care at the<br />

HES was a prime consideration.<br />

Intervening with non-compliant<br />

patients has been necessary on several<br />

occasions. The most significant was on<br />

Christmas Eve 2010; an elderly patient<br />

with a blind left eye and COAG in the<br />

right eye. With no medication list he<br />

simply knew he had three eye drops<br />

but had stopped using one. Intraocular<br />

pressure (IOP) in the right eye was<br />

40mmHg (Goldmann applanation<br />

tonometry - GAT). The HES was<br />

contacted and <strong>this</strong> conversation<br />

revealed that the gentleman was<br />

25/11/11 CET<br />

were successfully managed and<br />

although a definitive diagnosis is not<br />

Glaucoma<br />

supposed to be instilling atropine and<br />

predforte into the blind eye for ocular<br />

always evident, <strong>this</strong> highlighted the<br />

There is ongoing debate as to<br />

comfort and xalatan in the right eye. It<br />

confidence needed in differentiating<br />

whether IP qualifications should<br />

transpired that the patient had stopped<br />

an external inflammatory event from<br />

permit the diagnosis and treatment<br />

taking the xalatan but to compensate<br />

an infective; where a practitioner<br />

of glaucoma independently. Despite<br />

was putting the predforte into his<br />

does not possess <strong>this</strong> confidence,<br />

<strong>this</strong> debate, or its ultimate outcome,<br />

right eye. The author confirmed with<br />

referral to ophthalmology is advised.<br />

within specific constraints glaucoma<br />

the ophthalmologist that he would re-<br />

For the latest CET visit www.optometry.co.uk/cet



& TRAINING<br />


OT CET content supports <strong>Optometry</strong> Giving Sight<br />

Approved for: Optometrists 4 AS Points 4 SP Points 4 IP Points 4<br />

Having trouble signing in to take an exam?<br />

View CET FAQ Go to www.optometry.co.uk<br />

enforce the treatment modalities with<br />

can be compared to HES treatment.<br />

of care to be quantified but not the<br />

the patient, by stopping the patient from<br />

Text books and the College of<br />

specificity. A diagnosis must be<br />

instilling predforte in the right eye, and<br />

Optometrists’ Clinical Management<br />

considered the best hypothesis.<br />

48<br />

25/11/11 CET<br />

immediately re-prescribing xalatan. The<br />

author ensured that the GP was aware so<br />

that he/she could provide ongoing repeat<br />

prescriptions. Upon review a few weeks<br />

later, IOP in the right eye was 18mmHg.<br />

Patients that were referred by the<br />

practice for closable angles all had<br />

iridotomies or cataract extraction.<br />

One patient was referred for<br />

progressive normal tension glaucoma<br />

(NTG) but <strong>this</strong> was not confirmed<br />

and the patient was discharged.<br />

Referral for suspect COAG was<br />

confirmed in all but one case. This<br />

patient had been monitored for some<br />

time and while the diagnosis of frank<br />

COAG was not confirmed, the patient<br />

has not been discharged from HES<br />

and is being monitored. This rather<br />

reflects the dislocation of optometry<br />

and ophthalmology. The patient had<br />

been monitored in the community<br />

for several years and was referred<br />

with a high suspicion of progressive<br />

neuropathy. However the HES will base<br />

Guidelines 8 outline treatment<br />

strategies but doses and schedules<br />

are not usually specified. Reviewing<br />

HES treatment modalities will help<br />

but several invaluable web resources<br />

are available. Indispensable are the<br />

electronic British National Formulary<br />

(BNF) 15 and e-medicines; 16 both are<br />

current and evidence-based resources.<br />

Importantly e-medicines outlines<br />

medical management for specific<br />

ocular conditions, listing drugs,<br />

doses, schedules and common adverse<br />

drug reactions. Both web resources<br />

require registration but are free. Indepth<br />

information for specific drugs<br />

is listed in their Summary of Product<br />

Characteristics (SPCs) obtainable from<br />

Electronic Medicines Compendium. 17<br />

Reflective practice has led to significant<br />

modification of clinical practice.<br />

Introduction of generic information<br />

leaflets with medication names, dosages,<br />

schedules and potential adverse reactions<br />

All episodes need to be monitored<br />

until resolution but the accuracy of<br />

the diagnosis cannot be confirmed.<br />

Optometrists need to work to their<br />

own clinical confidence, which only<br />

comes with experience. Good relations<br />

with ophthalmology are important<br />

and reasonable and ingenuous<br />

enquiries are invariably well received.<br />

Rapport with ophthalmology is a<br />

great support and it is always worth<br />

confirming with consultants that they<br />

do not mind being contacted directly;<br />

HES clinics, particularly glaucoma<br />

clinics, are overloaded and direct<br />

communication and referral is an<br />

area where primary and secondary<br />

care can work together, benefiting all.<br />

Peer reviews are invaluable too.<br />

The small quorum of Northumberland<br />

based IP practitioners meet quarterly<br />

to discuss cases and the mix of<br />

community and hospital based<br />

optometrists brings a breadth of<br />

experience to the discussions. The<br />

any diagnosis on its own data collation.<br />

can be readily printed, allowing a<br />

practice protocol for managing iritis<br />

The patients not referred for<br />

clinical receptionist to re-enforce patient<br />

can be attributed to the advice given<br />

ocular hypertension were found to<br />

education and improving compliance.<br />

by hospital based IP optometrists<br />

comfortably fall outside the treatment<br />

guidelines based on age and central<br />

corneal thickness (CCT) and in the<br />

absence of any signs of frank glaucoma.<br />

Discussion<br />

An essential process for IP practitioners,<br />

and highly recommended for all<br />

optometrists too, is the instigation of<br />

an outcome audit system ensuring<br />

every patient is followed-up. Whether<br />

managed solely by the optometrist,<br />

co-managed with the GP or referred<br />

to the HES, every episode must<br />

represent a learning experience. A<br />

Another response to clinical<br />

experience was the introduction of<br />

a practice dispensary. Best practice<br />

would recommend prescribing via a<br />

second party, guaranteeing a double<br />

check. The practice dispensary was<br />

introduced because, especially on<br />

Saturdays, patients are not always able<br />

to obtain the drugs required promptly<br />

from local pharmacies; 24 hours or<br />

even 36 hours may elapse. Drugs<br />

stocked include aciclovir, predforte,<br />

fluorometholone (FML), olopatadine,<br />

ofloxacin, and diclofenac eye drops.<br />

About the author<br />

Peter Frampton studied optometry<br />

in Brisbane, Australia, and moved to<br />

Britain in 1986. He attained a Masters<br />

Degree in Ocular Therapeutics<br />

from Bradford University and has<br />

Additional Supply, Supplementary<br />

Prescribing and Independent<br />

Prescribing qualifications. He has<br />

recently been made a Fellow<br />

of the College of Optometrists.<br />

References<br />

diagnosis and management plan<br />

If dispensed the author’s practice<br />

See<br />

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

should be prepared which, if not<br />

charge a private prescription cost.<br />

clinical/index. Click on the article<br />

personally managed to resolution,<br />

Outcome audit allows sensitivity<br />

title and then download “references”.<br />

Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates

Module questions<br />

PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on<br />

December 23 2011 – You will be unable to submit exams after <strong>this</strong> date – answers to the module will be published on<br />

www.optometry.co.uk. CET points for these exams will be uploaded to Vantage on January 2 2012.<br />

Course code: C-17573 O<br />

1. Epiretinal membrane:<br />

a) May be caused by previous retinal vein occlusion<br />

b) Causes continuous worsening of vision due to distortion<br />

c) Is always present when a PVD has occurred<br />

d) Requires treatment in the vast majority of cases<br />

2. Which of the following statements about a full-thickness<br />

macular hole is TRUE?<br />

a) It can be excluded if a PVD is present<br />

b) It does not occur in males<br />

c) It does not lead to retinal detachment<br />

d) It may reduce central vision to 3/60<br />

3. Age-related macular degeneration:<br />

a) Is always in the “wet” form if distortion is present<br />

b) Is characterized by retinal wrinkling<br />

c) Requires urgent assessment if distortion has been present for 2 weeks<br />

d) Can always be treated with Lucentis or Avastin<br />

Course code: C-17277 O/AS/SP/IP<br />

1. Which of the following statements is FALSE? IP optometrists:<br />

a) Must only prescribe within their level of experience and competence<br />

b) Must take responsibility for clinical assessment, diagnosis and management,<br />

prescribing where necessary<br />

c) Must contractually adhere to the College of Optometrists’ Clinical<br />

Management Guidelines<br />

d) Must lodge an interest in acute eye care, glaucoma or both<br />

2. Considering the factors that affect treatment of bacterial keratitis,<br />

which one of the following lists is INCORRECT?<br />

a) Patient age, immunocompetence, general health<br />

b) Steroid use, co-existing corneal pathology, gender<br />

c) Size of the lesion, promptness of presentation, location of lesion<br />

d) Hospital vs. community infection, therapeutic dosage level, patient<br />

compliance<br />

3. Which of the following statements regarding the classification<br />

criteria for Sjogren’s Syndrome is TRUE?<br />

a) Item I or II plus two from Items III, IV,V, and VI indicates secondary Sjogren’s<br />

4. Central serous retinopathy:<br />

a) Usually have some pigmentary changes in the RPE<br />

b) Only occurs in males<br />

c) Requires urgent treatment<br />

d) Is now usually treated with Lucentis or Avastin<br />

5. Choroidal new vessels (CNV):<br />

a) Resemble lacquer cracks<br />

b) Can give rise to presumed ocular histoplasmosis syndrome (POHS)<br />

c) Are the chief cause of angioid streaks<br />

d) May result from compromise of Bruch’s membrane in a variety of conditions<br />

6. Which of the following statements about distortion of vision is TRUE?<br />

a) It often denotes serious underlying eye disease<br />

b) It often demands urgent assessment in a secondary care setting<br />

c) It may be best managed surgically, even in patients of advanced age<br />

d) All of the above<br />

b) Any 4 items, as long as IV or VI are included, indicates primary Sjogren’s<br />

c) Sensitivity & specificity of referral can be improved if optometrists assess 4 of the 6 items<br />

d) Phenol red thread is quicker but less comfortable than Schirmer strips<br />

4. Which of the following is LEAST useful for obtaining information on drug doses and<br />

adverse reactions?<br />

a) Text books<br />

b) E-medicine papers for the condition diagnosed<br />

c) The SPCs of individual drugs from electronic medicines compendium<br />

d) Most up-to-date BNF<br />

5. Vital processes to incorporate into community practices include:<br />

a) Outcome audits<br />

b) Peer reviews<br />

c) Modification based on local needs and experience<br />

d) All of the above<br />

6. Which combination of ocular condition and treatment is CORRECT?<br />

a) Blepharitis: day 1 loading dose of 100mg bid then 100mg doxycycline 1x daily for 6 weeks<br />

b) Herpes Simplex Keratitis (Epithelial): 3% aciclovir ointment 5x daily for 10 days<br />

c) Preseptal Cellulitis: 250mg amoxycillin every 8 hours for 10 days<br />

d) All of the above<br />

49<br />

25/11/11 CET

JOBS<br />

To place an advertisement call 020 7878 2347<br />

or email vanya.palczewski@tenalps.com<br />

Super OptOmS - Hampshire, Dorset & Sussex<br />

Call Jim on:<br />

01793 648607<br />

or visit: outsideclinic.com<br />

mObile OptiCal aDviSOrS - Warwickshire & West London<br />

COmmerCial SuppOrt - M4 Corridor<br />

(qualified DO to work within professional services dept)<br />

50<br />

25/11/11 jobs<br />

David Austen <strong>Optometry</strong><br />

25th Nov OT Strip.indd 1 18/11/2011 16:09<br />

45-46 Church Gate • Loughborough • LE11 1UE<br />

www.austenoptometrists.co.uk<br />

Part-time Optometrist required - Our practice<br />

consists of 4 Optometrists with 1 Dispensing<br />

Optician and 7 clinical assistants. We have the latest<br />

equipment including OCT, Optomap, slit-lamp digital<br />

imaging, topographer, colorimeter, pachymeter etc.<br />

All Optometrists have full professional freedom and<br />

contribute to the running of the practice. Further<br />

courses and training will be arranged if required.<br />

Contact: Matthew Austen MSc BSc(Hons)<br />

Phone: 01509 263881 (day)<br />

01509 672584 (evening)<br />

mausten@austenoptometrists.co.uk<br />

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For a busy independent practice,<br />

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Full support staff<br />

Comprehensive salary package<br />

Please apply to Crozier Collinson<br />

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tv<br />

Diabetes Eye Screening Service<br />

Optometrist and Diabetes<br />

Eye Screening Primary Grader<br />

Band 6: £30,633 - £40,406 pa inc pro rata<br />

One year fixed term<br />

This post is based at Homerton University Hospital NHS<br />

Foundation Trust<br />

We are looking for optometrists to work for one half-day session per<br />

week grading retinal images as part of our busy and friendly diabetes<br />

eye screening service, working alongside other professionals in the<br />

diabetes team.<br />

Practical knowledge of diabetic eye disease and some knowledge<br />

of the national screening scheme is needed. Full training in the use<br />

of specialised grading software, and in grading skills, will be given<br />

to the successful candidate.<br />

For further information and/or to arrange an informal visit<br />

please contact: James Beckett, Programme Manager, email:<br />

james.beckett@homerton.nhs.uk<br />

For an application pack please visit our website<br />

www.homerton.nhs.uk/workforus and apply online quoting<br />

the reference 293-10743<br />

Closing date: 9 December 2011.<br />

Visit our website www.homerton.nhs.uk/workforus<br />

tv<br />

The Trust welcomes applications from candidates wishing to<br />

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To advertise your vacancy online or in<br />

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Palczewski on 020 7878 2347 or<br />



Doug & Dame Mary Perkins<br />







From 8th December to 11th December there will be full day and evening events held in Manchester and London.<br />

You will be able to find out more about how you can join Specsavers in Australia & New Zealand, hear some success<br />

stories, meet a partner who has already left the UK and now owns a share of a successful store in Australia and<br />

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You need to be a Retailer, Dispensing Optician or Optician and be experienced in working in a<br />

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To register your interest in booking a place for your meeting simply email<br />

anz.opportunities@specsavers.com or call Jerry Dunn on 07799 581 281.<br />

We welcome enquiries from everyone and value diversity in our workforce.

Looking for your<br />

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56<br />

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4586-<strong>Optometry</strong> <strong>Today</strong> Advert.indd 1 26/09/2011 10:59<br />

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5430 Aon Optomotrist ad 59 x 60mm_Layout 1 02/11/<br />

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As an optometrist you qualify for<br />

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Special terms available to members of the<br />

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Applicants must be 21 or over<br />

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SW-1836-OPTOMETRIST PRESS AD 60mmx59mm.indd 1 14/10/11 16:05:35

A once-a-day Meso-Zeaxanthin supplement<br />

Trust the Science...<br />

New scientific research, published in one of the top peer-reviewed eye<br />

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3. MacuShield ® can uniquely enrich central macular<br />

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MacuShield ®<br />

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For more scientific research... Web: www.macushield.com Phone: 0044 (0) 1564 711154 Email: sales@macuvision.co.uk<br />

1. Connolly, E. E., et al. (2011). Supplementation with all three macular carotenoids: response, stability and safety. IOVS, 11-8025.<br />

2. Li, B., Ahmed, F., Bernstein, P. (2010). Studies on the singlet oxygen scavenging… Arch Biochem Biophys, 504 p.56-60.<br />

3. Connolly, E. E, et al. (2010). Augmentation of Macular Pigment following supplementation… Current Eye Res, 35 (4) p.335-351.

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