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www.optometry.co.uk December 10 2010 vol 50:24 £4.95<br />

optometrytoday<br />

live<br />

Optics<br />

and IT<br />

surveyed<br />

Fees cut<br />

by GOC<br />

online<br />

enewsletter<br />

A design for life<br />

Introducing our interactive site for 2011

From the Marigold to the Macula<br />

The alternative to the AREDS formula (Age related Eye Disease Study)<br />

With Meso-Zeaxanthin<br />

Before taking Macushield ® supplement<br />

After taking Macushield ® supplement for 1year<br />

Clinical trial shows that 100% of patients, both AMD and<br />

Normal, respond positively to Meso-Zeaxanthin by<br />

increasing their central macular pigment.<br />

Macular pigment is believed to protect<br />

against AMD development due to its light<br />

filtering and antioxidant properties, and we<br />

now have scientific evidence from the<br />

MOST 1 trial, recently published in<br />

CURRENT EYE RESEARCH, that shows<br />

people can significantly increase their<br />

macular pigment level following<br />

supplementation with meso-zeaxanthin,<br />

Lutein and zeaxanthin, as found in<br />

Macushield®. This formula combines<br />

powerful antioxidants that can help protect<br />

eye t<strong>issue</strong> from blue light and free radicals.<br />

It is designed specially to support macular<br />

health.<br />

This graph shows 4 patients (1 normal and 3 AMD), who had<br />

a central dip in their Macular Pigment pre supplementation.<br />

After only 8 weeks, following supplementation containing<br />

Lutein, Meso-Zeaxanthin and Zeaxanthin, all patients were<br />

able to rebuild their pigment profile to normal levels.<br />

What to do next......<br />

www.bondeyeoptical.co.uk<br />

To order a FREE copy of the MOST research paper<br />

or to purchase Macushield Supplements<br />

Call Bondeye: 0121 772 3888 or visit www.bondeyeoptical.co.uk<br />

Alternatively: For up to date research<br />

results and training documents visit:<br />


December 10 2010 vol 50:24<br />

optometrytoday<br />

6<br />

Comment<br />

Christmas Best Wishes<br />

AOP chief executive Bob Hughes appeals<br />

to readers to get involved in their LOC<br />

News<br />

News<br />

Pupils enjoy pilots<br />

School students take part in optometry<br />

workshops which are career building pilots<br />

News<br />

AOP elections<br />

Changes to the Association’s elections<br />

are announced<br />

8<br />

MHRA <strong>issue</strong>s Alert<br />

Certain contact lenses are identified as a<br />

problem by the Medicines Health products<br />

Regulatory Agency 5<br />

6<br />

12<br />

Letters<br />

Response to C retan VA feature<br />

Read Nick Rumney’s letter, and others<br />

too<br />

News extra<br />

Success at Blenheim<br />

Dozens brave the weather to attend the<br />

National Eyecare Group conference at<br />

Churchill’s birthplace<br />

Industry<br />

Colorimetry Down Under<br />

News on promotion for the<br />

technique in Australia<br />

Survey review<br />

20<br />

IT and the independents<br />

We look at the results of <strong>this</strong> year’s Optisoft<br />

IT survey which received hundreds of<br />

responses from practitioners<br />

10<br />

14<br />

20<br />

24<br />

Cover story<br />

Event review<br />

Longleat is great fun<br />

This year’s AOP student conference<br />

as reviewed by a second-year<br />

student<br />

Free CET<br />

36<br />

Web site renewed<br />

January 1 will see the launch of<br />

OT’s new-look web presence 36-37<br />

38-39<br />

Management op tions part 6<br />

Professor Michael Doughty discusses<br />

ocular surface and anterior<br />

segment inflammation 42-49<br />

tv Visit www.optometry.co.uk today

0151 426 3907<br />


LAzER pLUs 4046<br />

Value for money<br />

eyewear for all ages<br />

Comprehensive selection of<br />

styles in metal and acetate<br />

Immediate delivery from stock

NEWS<br />

MHRA <strong>issue</strong>s contact lens alert<br />

voluntary recall of select lots of<br />


recalled nearly half-a-million<br />

boxes of its 1-Day Acuvue TruEye<br />

(narafilcon A) contact lenses<br />

since the summer recall, it has<br />

been reported. The reports<br />

emerged as the Medicines<br />

Healthcare products Regulatory<br />

Agency (MHRA) <strong>issue</strong>d a Medical<br />

Devices Alert on the problem<br />

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

The alert, available on the<br />

MHRA’s website, www.mhra.<br />

gov.uk, stated that lenses from<br />

affected lots can cause stinging<br />

because of higher than expected<br />

levels of decanoic acid. The<br />

affected lots, which have been<br />

manufactured in Ireland, are<br />

those with the first six digits<br />

within the ranges 492237 to<br />

492498, and 502080 to 502269.<br />

It was in August that the<br />

company announced a<br />

1-Day Acuvue TruEye (narafilcon<br />

A) following a limited number<br />

of complaints in which wearers<br />

described unusual pain upon<br />

insertion.<br />

In a statement updated <strong>this</strong><br />

month, a J&J spokesman said:<br />

“The decision to expand the<br />

voluntary recall follows the<br />

company’s extensive review<br />

of its manufacturing process<br />

which identified the potential<br />

for some lenses to have higher<br />

than expected levels of a<br />

processing aid used in 1-Day<br />

Acuvue TruEye (narafilcon A), and<br />

identified a small percentage of<br />

contact lenses in the expanded<br />

lots that do not meet internal<br />

manufacturing requirements.<br />

“Complaint monitoring<br />

indicates no increase in healthrelated<br />

complaints related to <strong>this</strong><br />

Massive deferment of eye<br />

tests, multiple warns<br />

AN ESTIMATED 400,000<br />

people across the UK will<br />

delay scheduled eye tests<br />

until the New Year primarily<br />

because of concerns about<br />

budgets and the cost of<br />

Christmas, Vision Express<br />

has warned.<br />

Omnibus polling for<br />

Vision Express found that<br />

one-in-five people due to<br />

have an eye test <strong>this</strong> side of<br />

Christmas admitted that they<br />

will not be doing so.<br />

Of those opting not to have<br />

a test, 62% said they were<br />

delaying their eye tests until<br />

the New Year due to the cost<br />

of buying replacement lenses<br />

and eye wear.<br />

Of those putting off eye<br />

tests, 22% said that they<br />

didn’t think that their<br />

eyesight had deteriorated<br />

sufficiently to warrant an<br />

examination.<br />

Brian Linnington, brand<br />

strategy director at Vision<br />

Express, said: “As the days<br />

get significantly shorter and<br />

the weather deteriorates, it is<br />

essential that all of us have<br />

optimum eyesight. We’re<br />

very concerned that people<br />

product variation. While these<br />

reports, along with the findings<br />

from the company’s continued<br />

testing indicate a lower<br />

likelihood of the occurrence of<br />

stinging than the earlier recalled<br />

lots, Johnson & Johnson Vision<br />

Care is taking <strong>this</strong> action as a<br />

precaution to provide wearers<br />

with greater confidence that<br />

they will experience the comfort<br />

they expect from 1-Day Acuvue<br />

TruEye (narafilcon A).<br />

“Corrective and preventive<br />

actions have been identified<br />

for sources of variation and<br />

will be implemented prior<br />

to restarting production on<br />

those manufacturing lines that<br />

produced the affected product.<br />

In the interim, 1-Day Acuvue<br />

TruEye (narafilcon A) will<br />

continue to be supplied via<br />

other manufacturing lines.”<br />

are putting off potentially<br />

important eye examinations<br />

at the time of the year when<br />

good eyesight is critical.”<br />

The number of pairs<br />

of new glasses sold in<br />

December typically falls<br />

by around a third during<br />

December according to GfK<br />

data, of the 20 million eye<br />

examinations carried out per<br />

year in the UK.<br />

IN BRIEF<br />

Bonus scheme<br />

launched<br />

Eyeplan has introduced a profit<br />

sharing bonus scheme amongst its<br />

independent member practices.<br />

The first Bonus Bonds have been<br />

awarded to practices which have<br />

100 or more customers signed up<br />

to an Eyeplan scheme. A proportion<br />

of Eyeplan’s profits will be shared<br />

between registered practices for each<br />

Bonus Bond Dividend awarded.<br />

The company has confirmed it will<br />

shortly introduce a discretionary<br />

Bonus Bond scheme based on other<br />

contributions such as recommending<br />

another practice to Eyeplan.<br />

Consultation to end<br />

The Department of Health’s<br />

consultation on proposals to offer<br />

‘greater choice and control’ in the<br />

Health Service for the majority<br />

of NHS funded care will close<br />

on January 14 2011. Healthcare<br />

professionals and the public are<br />

urged to offer their views to the<br />

debate via the Department’s<br />

website and other sources of<br />

contact.<br />

Nystagmus guide<br />

The Nystagmus Network charity<br />

has reprinted a guide which can<br />

be useful for those who work with<br />

children who have the involuntary<br />

movement of the eyes. Early Onset<br />

Nystagmus: A Parents’ Guide is<br />

written by experts at Great Ormond<br />

Street Hospital, and is available by<br />

email at info@nystagmusnet.org or<br />

by telephone 0845 634 2630.<br />

Swedish expansion<br />

Specsavers plans to open a dozen<br />

more outlets in Sweden, the<br />

country’s financial newspaper<br />

Dagens Industri (November 29)<br />

reports. The group entered the<br />

country in 2004.<br />

Best wishes from OT<br />

OT would like to wish all its readers<br />

and contributors a Happy Christmas<br />

and a prosperous New Year.<br />

The fortnightly journal will return<br />

next year, when it celebrates its 50th<br />

birthday, and will reappear with its<br />

first edition of 2011 on January 14.<br />

5<br />

10/12/10 NEWS

optometrytoday<br />

DECEMBER 10 2010<br />

VOLUME 50:24<br />

ISSN 0268-5485<br />


January 1 2009 – December 31 2009<br />

Average Net: 20,203<br />

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

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

T: 020 7202 8164<br />

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

Deputy & Supplements Editor:<br />

Robina Moss<br />

T: 020 7202 8163<br />

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

Web and Ot.tv Editor:<br />

Emily McCormick<br />

T: 020 7202 8165<br />

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

Reporter: Chris Donkin<br />

T: 020 7202 8162<br />

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

Clinical Editor: Dr Navneet Gupta<br />

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

OT Manager: Louise Walpole<br />

T: 020 7401 5330<br />

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

Editorial Office:<br />

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

London SE1 0HL<br />

Advertising: Vanya Palczewski<br />

T: 020 7878 2347<br />

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

Sponsorship: Sunil Singh<br />

T: 020 7878 2327<br />

E: sunil.singh@tenalps.com<br />

Recruitment & Classified: Haley Willmott<br />

T: 020 7878 2313<br />

E: haley.willmott@tenalps.com<br />

CET and bookshop enquiries: Denise Williams<br />

T: 020 7878 2364<br />

E: denise.williams@tenalps.com<br />

Production: Ten Alps Creative<br />

T: 020 7878 2343<br />

E: louise.greenall@tenalps.com<br />

Membership Dept:<br />

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

T: 020 7261 9661<br />

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

Advertising and Production Office<br />

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

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

High Holborn, London WC1A 1NU<br />

Editorial Advisory Board<br />

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

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

Niall Hynes, David Ruston, Gill Robinson, David<br />

Shannon, David Whitaker, Vincent Yong<br />

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

Published fortnightly for the Association of<br />

Optometrists by Ten Alps Creative<br />

Subscriptions<br />

Alliance Media Limited, Bournehall House,<br />

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

T: 020 8950 9117<br />

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

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

A SERIES of workshops<br />

which aim to attract the next<br />

generation of eye health<br />

professionals have been<br />

successfully piloted in seven<br />

schools across the UK.<br />

Organised by a Careers<br />

in Optics Working Group,<br />

representatives from major<br />

High Street practices,<br />

professional bodies and<br />

leading universities teamed<br />

up to highlight sciencerelated<br />

post-16 studies<br />

and career choices in the<br />

classroom.<br />

Co-developed by<br />

education experts<br />

Word&Pictures in partnership<br />

with optometrists and<br />

dispensing opticians, the science<br />

and career roadshows are based<br />

on the idea of ‘Living life in a new<br />

dimension’ and aim to fit in with<br />

the key stage three and four in<br />

the national curriculum.<br />

Students learnt about<br />

illusions, light and sight in a ‘fun,<br />

supportive environment’. They<br />

NEWS<br />

<strong>Optometry</strong> workshops<br />

for pupils are piloted<br />

TO CELEBRATE its new premises<br />

Newcastle-based practice Michael<br />

Afford Optometrists treated its<br />

first-ever patient to a special day.<br />

Mr Afford collected Elsie Wearn<br />

(pictured foreground), who first<br />

attended the business 30 years ago<br />

when it opened, and brought her<br />

to his premises to be first through<br />

the door again. Once at the practice<br />

Ms Wearn was greeted by his team<br />

– including Jill Dickinson, Claire<br />

Litster and Hazel Dalton (pictured,<br />

background) – presented with<br />

flowers and champagne, and her<br />

choice of spectacles, ‘on the house’.<br />

also watched a short 3D film<br />

which aims to encourage them<br />

to think broadly about their<br />

career options.<br />

Chair of the working group,<br />

City University lecturer, David<br />

Thomson said: “The Group aims<br />

to raise awareness of optics as a<br />

career choice in schools and sixth<br />

form colleges. <strong>Optometry</strong><br />

and optics is developing<br />

rapidly and is an exciting<br />

option. We are working to<br />

stimulate further interest in<br />

the profession and to target<br />

specific regions<br />

where recruitment<br />

challenges exist. It was<br />

essential to think creatively<br />

and to develop an<br />

attractive, dynamic<br />

campaign.”<br />

One student at Rochester<br />

Grammar School for Girls<br />

where the workshop has<br />

been piloted said: “I would<br />

definitely recommend<br />

optometry and optics as<br />

a good career choice. I<br />

enjoyed everything about <strong>this</strong><br />

activity, ten out of ten.”<br />

The Working Group will<br />

evaluate the pilot events at a<br />

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

To watch what happened<br />

when the roadshow visited<br />

Burlington Danes Academy go<br />

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

Patient gets red carpet trip

Discounters warned by OFT<br />


prices and deals are being<br />

warned to ensure their prices are<br />

not misleading – or risk facing<br />

action from the Office of Fair<br />

Trading (OFT).<br />

The warning to retail<br />

businesses comes after a market<br />

study into the advertising of<br />

prices, which established that<br />

certain techniques used in<br />

advertising online and in-store<br />

can mislead customers and<br />

potentially break the law.<br />

While not necessarily illegal,<br />

the specific techniques the<br />

OFT highlighted as having the<br />

‘potential to cause harm’ are: ‘drip<br />

pricing’, where compulsory price<br />

increases are added during the<br />

buying process, ‘time-limited<br />

offers’ advertised as ‘must end<br />

today’ and ‘baiting’, where only<br />

THE EYE Health Alliance has<br />

welcomed the Public Health<br />

White Paper, Healthy Lives,<br />

Healthy People saying it hoped<br />

the changes outlined would<br />

‘ensure everyone in their local<br />

community is aware of the<br />

importance of eye health.’<br />

The White Paper outlines<br />

how funds from the overall<br />

NHS budgets will be ringfenced<br />

for spending on public<br />

health, controlled largely by<br />

local authorities, and also<br />

creates the new body Public<br />

Health England.<br />

Head of public affairs for<br />

the alliance, Heather Marshall<br />

said: “The Eye Health Alliance<br />

welcomes the publication of<br />

the Public Health White Paper.<br />

There are 1.8 million people in<br />

the UK living with sight loss,<br />

and <strong>this</strong> figure is set to increase<br />

by 115% to nearly 4 million<br />

people in 2050, largely due to<br />

the ageing population. Much<br />

a small proportion of stock is<br />

available at the advertised price.<br />

Chief executive of the OFT,<br />

John Fingleton, said: “Pricing<br />

practices used in a transparent<br />

and fair manner can provide<br />

customers with a helpful<br />

shortcut to assess whether a<br />

particular offer is a good or bad<br />

deal. However, our research has<br />

highlighted how certain tactics<br />

can be used in a misleading way.<br />

of the high level of avoidable<br />

sight loss could be prevented<br />

through regular sight-testing.<br />

“We’re calling on all those<br />

involved in public health<br />

including the Government,<br />

GP consortia, health care<br />

professionals and especially<br />

local authorities, with their<br />

new public health<br />

responsibilities, to work<br />

together to ensure that<br />

everyone in their local<br />

community is aware of the<br />

importance of eye health and<br />

the need for regular sight tests<br />

and early diagnosis to reduce<br />

<strong>this</strong> public health<br />

time bomb.”<br />

“Misleading pricing is not<br />

only bad for the consumer, it is<br />

also bad for competition, and<br />

creates an uneven playing field<br />

between fair dealing businesses<br />

that stick to the spirit of the<br />

law, and those that push the<br />

boundaries too far.”<br />

Among the businesses<br />

surveyed for the wide-ranging<br />

report were Boots, Specsavers<br />

and Tesco.<br />

Alliance applauds White Paper<br />

Health secretary Andrew<br />

Lansley (pictured) said: “Too<br />

often in the past, public<br />

health budgets have been<br />

raided by the NHS to tackle<br />

deficits. Not any more. The<br />

money will be ringfenced to<br />

be used as it should be – for<br />

preventing ill health.<br />

“People’s health and<br />

wellbeing will be at the heart<br />

of everything local councils<br />

do. It’s nonsense to think that<br />

health can be tackled<br />

on its own.<br />

“Everyone should have<br />

services tailored for them, at<br />

the right times in their<br />

life from the professionals<br />

closest to them. With local<br />

authorities in the driving<br />

seat, supported by the latest<br />

evidence on behaviour<br />

change from Public Health<br />

England, we will start seeing<br />

significant improvements in<br />

the nation’s health.”<br />

IN BRIEF<br />

Theft of £4k’s worth<br />

Police are investing the theft of<br />

almost £4,000 worth of designer<br />

frames from a Salisbury practice.<br />

A man is being sought for the<br />

November 13 theft from Memory<br />

Opticians and police have released a<br />

CCTV image in connection with the<br />

incident, according to the Salisbury<br />

Journal (December 1). Readers<br />

should contact PC Mark Harris if<br />

they have any information on 0845<br />

4087000.<br />

Certificate advice<br />

Members of the AOP have been<br />

advised to tell PCTs their insurance<br />

renewal ends on December 31,<br />

and certificates will be <strong>issue</strong>d<br />

in February. A statement on the<br />

Association’s website said: ‘The AOP<br />

has learnt that some rather overzealous<br />

PCTs are asking optometrists<br />

for copies of their 2011 insurance<br />

certificates already. The AOP advises<br />

that the PCT should be told that the<br />

renewal period for 2011 insurance<br />

does not end until the end of<br />

December and certificates will be<br />

<strong>issue</strong>d in February. In the meantime,<br />

any PCT which is worried about an<br />

optometrist’s insurance can look<br />

up the practitioner on the GOC web<br />

site, www.optical.org. Registration<br />

with the GOC is, to all intents and<br />

purposes, proof of insurance.”<br />

Weather warning<br />

As OT went to press ABDO was<br />

monitoring weather conditions to<br />

decide whether to run its Dispensing<br />

and Contact Lens Examinations<br />

<strong>this</strong> week at Birmingham’s Paragon<br />

Hotel. “We are aware that some<br />

people have theory examinations,”<br />

said a spokesman, “and we sincerely<br />

hope to run our examinations as<br />

normal.”<br />

Apple patent<br />

Computer giant Apple has been<br />

granted a patent for a projection<br />

system that can enable multiple<br />

viewers to simultaneously view 3D<br />

images without the need for 3D<br />

glasses.<br />

7<br />

10/12/10 NEWS

8<br />

10/12/10 NEWS<br />

neWS<br />

GOC cuts retention<br />

fees for 2011-12<br />

THE GOC has announced that its retention<br />

fees for 2011-12 will be £270 for all fullyqualified<br />

registrants and bodies corporate.<br />

‘Subject to unforeseen circumstances’ the<br />

council intends to hold retention fees level<br />

for a period of three years, based on a lower<br />

budget forecast. Based on current forecasts,<br />

the Harley Street-based organisation plans to<br />

absorb inflationary rises, the increase in VAT,<br />

and the forthcoming levy by the Council for<br />

Healthcare Regulatory Excellence (CHRE).<br />

A spokeswoman for the council<br />

commented that the last two years have been<br />

expensive ones for the GOC. “In the current<br />

economic climate we are particularly mindful<br />

about reducing costs and passing these<br />

savings on to our registrants.<br />

“Alongside a continual focus on cost<br />

savings, we have been improving our<br />

performance, recognised and commended<br />

by the CHRE. Our ‘Invest to save’ schemes are<br />

beginning to bear fruit: the first phase of our<br />

organisational restructure has taken place, and<br />

our online retention system is about to go<br />

live. We are now in a position to take forward<br />

a longer-term plan which will create a stable<br />

and resilient organisation.”<br />

Anna Bradley, GOC chair, said: “We have<br />

listened specifically to our registrants and<br />

their professional bodies, and are also<br />

introducing a low income fee of £170<br />

for registrants whose income is less than<br />

£12,000. We believe it’s critical in these<br />

difficult economic times to encourage highly<br />

professional dispensing opticians to stay<br />

on the registers, and <strong>this</strong> underlines our<br />

commitment to protecting the public.”<br />

Satjit Singh, chief executive and registrar,<br />

added: “We have taken the initiative,<br />

scrutinised costs, and made some bold<br />

decisions which will benefit registrants whilst<br />

continuing to promote good eye care.”<br />

The decision has drawn approval from<br />

professional leaders as a step in the right<br />

direction. Go to www.optometry.co.uk for<br />

more reaction.<br />

Parcs promotion rewards<br />

24 independent winners<br />

STAFFORD-BASED optometrist Jan<br />

Goodwin is looking forward to a trip<br />

to Center Parcs with her family, thanks<br />

to a Hoya Lens promotion, which saw<br />

24 independent practice winners<br />

throughout the UK. Ms Goodwin is<br />

pictured receiving her vouchers from<br />

Hoya area sales manager, Paul Esp.<br />

“It is a great prize and I will probably<br />

be taking my husband and two children<br />

to the Lake District once the weather<br />

improves. We are all very keen on<br />

archery which we should be able to<br />

enjoy,” she said.<br />

Her practice, Mincher-Lockett<br />

Opticians, qualified for the prize through<br />

the promotion for the iD FreeForm<br />

progressives with Hi-Vision LongLife<br />

coatings. Mr Esp said: “The promotion<br />

was a great way to highlight the<br />

combination of the new lens technology<br />

and the internationally acclaimed coating<br />

which is bringing high levels of customer<br />

satisfaction, particularly amongst patients<br />

who have had tolerance <strong>issue</strong>s in the<br />

past.”<br />

comment<br />

A ChristmAs messAGe<br />

And A new YeAr wish<br />

Our third student conference was just<br />

fantastic. Double the number of students<br />

and a real buzz from enthusiastic and<br />

focussed young people determined to<br />

learn everything they can about their<br />

chosen profession. They showed equal<br />

determination on the dance floor – but<br />

that is a different story. What happens in<br />

Longleat, stays in Longleat. (Hopefully<br />

that applies to the video of me dancing to<br />

YMCA!).<br />

It is stating the obvious to say that<br />

2011 will see changes for optometry<br />

and optics. Scotland and Wales have<br />

elections, with the potential for policy<br />

shifts on the delivery of eye care. In<br />

Northern Ireland, negotiations for a new<br />

contract will come to a head. In England<br />

we will engage with the National<br />

Commissioning Board and seek a better<br />

way of agreeing and remunerating<br />

enhanced services and a reduction<br />

in peaked cap bureaucracy. I have a<br />

Christmas message for PCT staff. Before<br />

you sign off yet another unreasonable<br />

demand on practices, could you just<br />

possibly read the contract? Consulting<br />

QCs, especially out of hours, to fight<br />

fatuous alleged contract breaches is very<br />

expensive, and when we threaten legal<br />

action it never goes down well. Reading<br />

and understanding the GOS contract<br />

would be so much cheaper and much<br />

less stressful.<br />

Change is all around us. The bits are<br />

being thrown in the air and who knows<br />

where it will all land? What we know<br />

is that the future of the profession in<br />

largely in the hands of your LOC, AOC or<br />

ROC. Across the UK, local decisions will<br />

dictate how we expand and grow. If I<br />

may suggest a New Year’s resolution it is,<br />

get involved. Join your LOC. The future<br />

of your profession may just depend on it.<br />

Bob hughes, AOP chief executive<br />


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Gratifying to see VA charts<br />

My colleague, Catherine<br />

big vision charts they are mostly<br />

a logMAR chart over the same<br />

such is eminently suitable for<br />

Chisholm, is to be congratulated<br />

for blind people and they need<br />

range would run 6/19 [0.5], 6/15<br />

refraction.<br />

on tackling a difficult subject,<br />

to be big !” – and have integrated<br />

[0.4], 6/12 [0.3], 6/9.5[0.2], 6/7.5<br />

I do make one plea. However<br />

explaining visual acuity to<br />

them into my routine practice,<br />

[0.1], 6/6 [0.0], 6/4.8 [-0.1], 6/3.8<br />

scientifically sound logMAR may<br />

10<br />

ophthalmologists, and European<br />

ophthalmologists at that (Cretan<br />

conference is host to VA focus,<br />

OT November 26). My apologies<br />

for being a little facetious but<br />

as logMAR and its common use<br />

teaching and a good few low<br />

vision schemes up and down<br />

the country. It is gratifying to see<br />

that most display type VA charts<br />

use logMAR ratings notably<br />

the leading UK exponent the<br />

[-0.2], 6/3 [-0.3]. This is nine levels<br />

as opposed to just five (or at<br />

best six). I did wonder if Professor<br />

Spileers meant the inclusion<br />

of additional lines around the<br />

6/6 line on some Snellen charts<br />

be, it is not intuitive in<br />

the way that the Snellen fraction<br />

is. Now that hospitals are<br />

using logMAR, the situation is<br />

complicated by the use of that<br />

decimal term; what optometrist,<br />

in clinical research for over 35<br />

Thomson chart.<br />

but as 6/6 is below what most<br />

or ophthalmologist knows that<br />

years grew out of optometry<br />

I do wish to highlight the<br />

consider normal acuity, <strong>this</strong><br />

0.3 logMAR is 6/12, for one thing<br />

(Ian Bailey’s seminal paper<br />

point made at the conference<br />

appears unlikely.<br />

but at what distance was it<br />

being in 1976) it has really taken<br />

by Professor Werner Spileers; he<br />

There is good argument<br />

measured (clearly stated in the<br />

far too long to permeate into<br />

is quoted as saying “establishing<br />

(Westheimer, 1979) that the<br />

Snellen fraction).<br />

10/12/10 LETTERS<br />

mainstream hospital practice,<br />

particularly for the critical<br />

<strong>issue</strong>s of VA in amblyopia<br />

management.<br />

Twenty years ago I struggled<br />

through airports and customs<br />

with large Bailey-Lovie charts,<br />

the refractive endpoint<br />

sometimes benefits from the<br />

additional lines for above<br />

average acuity provided by the<br />

Snellen chart”. I have never<br />

been aware of such lines, most<br />

Snellen charts adopting a<br />

logMAR spacing is too fine as<br />

there is significant potential<br />

for overlap and end points<br />

of refraction might include<br />

additional letters accurately<br />

read on the next line,<br />

nevertheless it is, very roughly<br />

I fundamentally believe<br />

that in routine, non-research<br />

clinical practice we should<br />

use only logMAR scaling and<br />

logMAR charts but use the<br />

Snellen fraction to denote<br />

the value.<br />

arguing all the way for free<br />

sequence of 6/18, 6/12, 6/9, 6/6,<br />

speaking, a scale of just<br />

freight – “yes of course they are<br />

6/5 and possibly 6/4 whereas<br />

noticeable difference and as<br />

Nick Rumney via email, Hereford<br />

<br />

What’s in a name?<br />

I recently resigned from College membership and I received a letter<br />

acknowledging <strong>this</strong>. It referred to my years of service to the ophthalmic<br />

optical profession. This was certainly the profession I joined 30 years<br />

ago but having changed the letters after my name several times, I really<br />

believed I had finally become an optometrist! Still what does it matter?<br />

What’s in a name? A name that means absolutely nothing to the average<br />

person in the street. It’s what you do and how you do it that matters.<br />

When I joined the profession I had a very clear idea of my role and<br />

my place in the medical and commercial worlds. I leave a profession<br />

unsure of its identity, a profession which has sold its soul to big business.<br />

Optometrists do a great job but are manipulated by a force with far<br />

more clout than any professional body. Thank you for allowing me to<br />

keep my certificate. I was under the impression that I had worked for it,<br />

but again I was mistaken.<br />

Esther Brodie, Worthing<br />

Ready-readers should be restricted<br />

As a 92-year-old retired optometrist I<br />

was interested to read the Which Report<br />

(November 12 OT). Two or three years<br />

ago I tried to start some research to<br />

find the percentage of cases referred by<br />

optometrists of pathologies found during a<br />

routine examination, and also tried to get<br />

RNIB and the GOC to use their influence<br />

to have ready-readers restricted in some<br />

way. Perhaps something along the lines<br />

of sales of these devices should only be<br />

made on production of proof that an eye<br />

examination had been done within the<br />

previous two years?<br />

I have realised since I retired that my<br />

prescribing of spectacles for reading only<br />

could have been improved, for those<br />

people who had never had a problem with<br />

their vision until presbyopia arose. I now<br />

think that small, or maybe larger cyls.<br />

could be left out and a pair of equal power<br />

spheres supplied. I remember many times<br />

when patients had complained about<br />

distortions, I suggested that the brain had<br />

to re-adjust to the prescription.<br />

Frank J Fox, via email<br />

OT Letters, 61 Southwark Street, London SE1 0HL 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.

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NEWS<br />

12<br />

10/12/10 NEWS<br />

IN BRIEF<br />

Thank you<br />

reviewers<br />

OT would like to thank its article<br />

reviewers for <strong>this</strong> year. Those<br />

who contributed were Dr William<br />

McIlhagga (University of Bradford),<br />

Dr Juhyun Park (Lancaster),<br />

Professor Bruce Evans (Institute of<br />

<strong>Optometry</strong>, London),<br />

Dr Vik Sharma (London<br />

Ophthalmology Centre), Professor<br />

David Edgar (City University), Dr Edi<br />

Osuobeni (Anglia Ruskin University),<br />

Professor David Elliott (University<br />

of Bradford), and Aston’s Dr Mark<br />

Dunne, Dr Chris Smith, Dr Frank<br />

Eperjesi, Dr Leon Davies.<br />

Sale completed<br />

HAL Holdings has completed the<br />

sale of the 60 strong Optifashion to<br />

Luxottica Retail Australia, according<br />

to ADP News (November 26). The<br />

chain, a rival to Specsavers Down<br />

Under, generates annual revenue of<br />

AUD30m.<br />

US educator<br />

The American Health Assistance<br />

Foundation has launched a new<br />

educational website, Children’s<br />

Corner for Macular Degeneration,<br />

which aims to teach children about<br />

the degenerative disease through<br />

stories, interactive games and other<br />

activities. The site can be viewed at<br />

www.childrenscorner.org<br />

African aid<br />

Two global vision charities are<br />

joining forces to provide access<br />

to vitally needed eye care in the<br />

Gambia. Sightsavers and OneSight<br />

have announced a three-year<br />

partnership starting in 2011 to<br />

reach 80,000 patients with<br />

sustainable vision care. It is<br />

estimated 163, 000 Gambians<br />

need spectacles every year.<br />

Christmas donation<br />

Cantor & Nissel has announced it is<br />

sending a donation to RP Fighting<br />

Blindness instead of sending<br />

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

Growth of IT surveyed<br />

INDEPENDENTS ARE embracing<br />

IT as never before, according to<br />

<strong>this</strong> year’s Optisoft survey.<br />

The survey, which gathered<br />

over 350 responses, is reviewed<br />

in detail on pages 24 and 26,<br />

and shows a shift towards using<br />

patient reminders, GOS forms and<br />

other areas being controlled by a<br />

practice’s IT system.<br />

Keith Sheers (pictured), Optisoft<br />

managing director, commented:<br />

“Around a third of the practices<br />

responding to the survey <strong>this</strong><br />

year said they would be going<br />

paperless in every possible area<br />

in the near future.”<br />

General Ophthalmic Services<br />

forms are now being processed<br />

Changes to AOP elections<br />

THE AOP Board, with the<br />

backing of its Council, has<br />

agreed that from 2012, all<br />

Council representatives<br />

will be elected from nine<br />

geographical constituencies<br />

– six in England plus<br />

representation from Northern<br />

Ireland, Scotland and Wales.<br />

The Board believes that<br />

<strong>this</strong> will have the effect of<br />

increasing competition for<br />

electronically within the practice<br />

by 23%, and a further 38% of<br />

practices surveyed expected<br />

<strong>this</strong> to become the norm in the<br />

“near future”. Although just 6%<br />

of practices are sending forms<br />

places as all elections will be<br />

for a number of places all up<br />

for election at the same time.<br />

Rule changes to facilitate <strong>this</strong><br />

will be brought before the<br />

AGM in London on May 10.<br />

The new Council elections<br />

will be introduced in 2012,<br />

and thereafter a third of the<br />

constituencies will hold<br />

elections every year. To<br />

facilitate <strong>this</strong>, the Board has<br />

electronically at present, <strong>this</strong><br />

is expected to grow by 35% in<br />

the near future, following the<br />

practice of many multiples.<br />

“The speeding up of payment<br />

and improvement in cash flow,<br />

thanks to the later cut off date<br />

for electronic submissions, is<br />

a great plus on <strong>this</strong> aspect of<br />

paperless communication,” said<br />

Mr Sheers. “It also ensures that<br />

the form is filled out correctly,<br />

with an acceptance or rejection<br />

notice normally arriving while<br />

the patient is still at the practice,<br />

allowing any discrepancies to be<br />

rectified immediately – another<br />

reason why the take up is so<br />

good.”<br />

decided not to hold Council<br />

elections next year, so<br />

existing Councillors will all<br />

continue in office until the<br />

elections in 2012.<br />

Following representations<br />

from a number of members,<br />

the Board has agreed to<br />

revert to first-past-the-post,<br />

having experimented with<br />

single transferrable votes<br />

over the last three years.<br />

Exhibitors get good advice<br />

EXHIBITORS FOR next year’s<br />

Optrafair have been given<br />

valuable tips on how to get<br />

the best out of the show from<br />

experts at the FMO’s masterclass,<br />

including pre-show promotion,<br />

setting realistic targets and<br />

following up leads.<br />

Managing director of Answers<br />

Training International, Simon<br />

Naudi, explained to delegates<br />

the importance of marketing<br />

their stand pre-show and the<br />

need to brief staff on how to deal<br />

with customers: “Be clear of the<br />

objectives for the whole team,” he<br />

said, “no company needs people<br />

there who are just giving away<br />

brochures. First impressions count<br />

and you have 12 seconds to<br />

create that first impression<br />

with visitors. Of <strong>this</strong> 7% will be<br />

achieved through words, 38%<br />

through tone and 55% through<br />

body language.”<br />

Mr Naudi added: “Remember<br />

that activity over the three days<br />

of the show equates to only a<br />

small total of the results, and<br />

that the team should be planning<br />

follow-up activity with names,<br />

email addresses and telephone<br />



Blenheim Palace success may<br />

see NEG run event in 2011<br />

14<br />

10/12/10 NEWS EXTRA<br />

A NEW CET conference for independents was<br />

hailed a success after over 100 practitioners<br />

travelled in freezing weather to attend from<br />

across the UK last week.<br />

The inaugural conference by the National<br />

Eyecare Group (NEG), was held at what has<br />

to be a unique venue for optics: Blenheim<br />

Palace, birthplace of Winston Churchill and<br />

home of the eleventh Duke and Duchess of<br />

Marlborough.<br />

The theme was ‘Building for success’ and<br />

the conference in Oxford was deemed such<br />

a success that there are already plans to<br />

hold similar events in future. NEG business<br />

development manager, Phil Mullins said: “We<br />

were delighted with the support shown by<br />

all the members and suppliers who came<br />

to Blenheim, despite the exceedingly cold<br />

weather. We very much hope to repeat the<br />

conference in 2011.”<br />

The event offered five CET points, a poster<br />

trail and a prize draw. A well-supported<br />

exhibition was held in the palace’s Orangery<br />

(pictured).<br />

Entertaining optometrist Andy Clark<br />

presented the keynote lecture, ‘The Expert’s<br />

Edge’, looking at areas where independent<br />

practice could be positioned as a centre of<br />

excellence. He highlighted that dry eye is on<br />

the increase yet few practitioners charge for a<br />

specialist appointment. Other opportunities<br />

were dyslexia, fashion, sports vision, contact<br />

lenses, sunglasses, eye nutrition and eye<br />

health.<br />

To gauge a market he recommended<br />

looking under Google for how many searches<br />

the topics generated. He recommended six<br />

ways of how an independent could find ‘their<br />

edge’: know your market, find a winning<br />

niche, sell what the market wants to buy in<br />

the ways it wants to buy it, be excellent and<br />

be different but stressed “above all, don’t risk<br />

the business”.<br />

Before becoming an expert he<br />

recommended a practice owner consider:<br />

Who in the practice could do it? Could it be<br />

systemised? Did it require big changes? What<br />

percentage of the budget would they commit<br />

to promote it? More information can be found<br />

on the website www.practicebuilding.co.uk<br />

Bournemouth-based optometrist Craig<br />

Wilcox focused on patient communication.<br />

“We have a really great job, we get to change<br />

people’s lives,” he told delegates, but added<br />

that complaints to the Optical Consumer<br />

Complaints Service were rising because of<br />

poor communication.<br />

He urged practitioners to “be there in<br />

the moment” and warned that patients<br />

immediately pick up if a practitioner is<br />

stressed. Lower pitched voices and slow<br />

speech convey authority and inspire<br />

confidence, he said. He urged practitioners to<br />

smile and to use the patient’s name a lot.<br />

When discussing spectacles, he suggested<br />

never referring to “a spare pair” but instead use<br />

“emergency pair”. He recommended the use<br />

of “fees” not “payments” and for them to be<br />

separated from products.<br />

He said to never mention problems when<br />

saying goodbye but instead to ask the patient:<br />

“Is there anything else you’d like to ask me?”<br />

Patient literature or another appointment<br />

could then tackle any <strong>issue</strong>s. “Behind every<br />

obstacle there is an unperceived opportunity,”<br />

he concluded.<br />

Hugh Greenway, MD of Reed Learning,<br />

encouraged independents to learn for free<br />

from the Internet. “Become your own teacher,”<br />

he said. He suggested asking Google how<br />

to use Google which could save time when<br />

searching, and recommended independents<br />

to use YouTube, and also the bookmarking<br />

website www.delicious.com.

NEWS<br />

Companies dig deep for WSD<br />

16<br />

10/12/10 NEWS<br />

CONTACT LENS giant CIBA Vision<br />

has raised more than £2,000 for<br />

<strong>this</strong> year’s World Sight Day. And<br />

lens company Essilor also helped,<br />

raising £1,000.<br />

By taking on the 2011<br />

Challenge, employees at CIBA’s<br />

headquarters in Southampton<br />

dressed in school uniform and<br />

participated in an awareness<br />

exercise which tested their<br />

knowledge on low vision and<br />

sight loss. A bake sale, quizzes<br />

and karaoke were also held,<br />

and a team of employees even<br />

completed the Great South Run.<br />

Roger Lopez, managing<br />

director of CIBA Vision UK and<br />

Ireland, said: “The World Sight Day<br />

Challenge is extremely important<br />

to everyone at CIBA Vision.<br />

“All of our activities are about<br />

Donna Power (second from the right) receives Essilor’s contribution<br />

raising funds to provide healthy<br />

vision to as many people in the<br />

world as possible, which in turn<br />

offers a better life in general.”<br />

The money will be divided<br />

equally between <strong>Optometry</strong><br />

Giving Sight and Vision Aid<br />

Overseas.<br />

Donna Power, country<br />

Boxes of best wishes<br />

Staff from contact lens manufacturer<br />

UltraVision collected 75 shoeboxes<br />

filled with gifts <strong>this</strong> year for Operation<br />

Christmas Child, run by international<br />

relief organisation Samaritan’s Purse<br />

UK. They will be donated to the Asian<br />

republic of Kyrgyzstan. UltraVision’s<br />

despatch manager, Julie Oldfield,<br />

pictured, who organises the collection,<br />

commented it was 12 more boxes than<br />

last year. “This is fantastic”, she said.<br />

“This year’s boxes will be distributed<br />

in Kyrgyzstan to a lot of very excited<br />

children.”<br />

manager for <strong>Optometry</strong> Giving<br />

Sight, said: “This is an incredible<br />

contribution. Not only did CIBA<br />

Vision raise record funds, but<br />

they also utilised their entire<br />

sales force to help register<br />

practices to take part across the<br />

UK, and we are so thankful for<br />

their considerable support.”<br />

Essilor has raised £1,000 by<br />

also taking on the World Sight<br />

Day Challenge <strong>this</strong> year. Staff at<br />

the lens manufacturer’s branch<br />

in Bristol held a ‘wacky costume<br />

day’ at work and hosted a raffle<br />

which saw prizes from an iPod<br />

Nano to annual leave days up<br />

for grabs. On the day executive<br />

management staff could also<br />

be seen providing a waitering<br />

service in the staff canteen.<br />

The money will also be divided<br />

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

and Vision Aid Overseas.<br />

Ms Power added: “The amount<br />

raised <strong>this</strong> year was absolutely<br />

incredible. They took the time to<br />

think about how best to appeal<br />

to their staff and have a great<br />

time, whilst maximising the<br />


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NEWS<br />

New assessment centre aims to<br />

support teaching and research<br />

18<br />

10/12/10 NEWS<br />

ANGLIA RUSKIN University’s<br />

Department of Vision & Hearing<br />

Sciences has opened a new vision<br />

testing and assessment facility.<br />

It aims to support teaching and<br />

research in optometry and the<br />

vision sciences, and has the<br />

potential to provide specialist<br />

vision testing services to<br />

patients from near its locality in<br />

Cambridge.<br />

The Evelyn Trust Anglia Vision<br />

Suite, which attracted over<br />

£78,000 worth of funding through<br />

the departmental research group,<br />

Anglia Vision Research, provides<br />

the software and instrumentation<br />

that will allow vision assessment<br />

of a specialised nature that is<br />

not normally found in routine<br />

optometric examinations.<br />

It has electrophysiological<br />

(L:R) Dr John Siderov, head of department, with colleagues from the Evelyn<br />

Trust, Adrian Frost and Catherine Thomas, officially opening the new Evelyn<br />

Trust Anglia Vision Assessment Suite<br />

equipment for non-invasive,<br />

objective assessment of normal<br />

and diseased retinas and<br />

the optic nerve pathway to<br />

visual cortex, in children and<br />

adults. Also psychophysical<br />

testing will allow for further<br />

specialised visual assessment<br />

as well as a complete colour<br />

vision assessment in children<br />

and adults, which, the university<br />

says, is a unique facility in the<br />

Cambridgeshire region.<br />

The suite will also provide<br />

enhanced teaching and research<br />

possibilities for undergraduate<br />

optometry students and<br />

postgraduate vision science<br />

research students, as well as<br />

seeding for new research projects<br />

by vision scientists.<br />

The Evelyn Trust Anglia Vision<br />

Suite has been funded by a grant<br />

from the Evelyn Trust which<br />

supports medical research and<br />

healthcare in Cambridge, and the<br />

surrounding area.<br />

Head of department Dr John<br />

Siderov said the university was<br />

“extremely pleased and grateful”<br />

to be awarded the grant.<br />

Anglia Ruskin is one of the<br />

largest universities in the East<br />

of England with a student<br />

population of 30,000, and also<br />

hosts its University Eye Clinic, one<br />

of the largest facilities of its kind<br />

in the region.<br />

Warburton elected<br />

PAST<br />


of the AOP,<br />

Trevor<br />

Warburton<br />

(centre) has<br />

been elected<br />

for Life<br />

Fellowship to<br />

the College of<br />

Optometrists in recognition<br />

for the ‘outstanding<br />

contribution he has made<br />

to clinical practice in the<br />

profession’.<br />

Mr Warburton accepted<br />

his award at the College’s<br />

Diploma Ceremony when<br />

195 newly qualified<br />

optometrists were welcomed<br />

into the profession. Also<br />

pictured (right) David<br />

MacVeigh, who introduced<br />

the award, and College<br />

president<br />

Cindy<br />

Tromans<br />

(left). The<br />

optometrist’s<br />

Life<br />

Fellowship<br />

marked his<br />

third from<br />

the College<br />

having already received a<br />

Foundation Fellowship as<br />

well as one for submission<br />

by portfolio two years ago.<br />

Optometrist and senior<br />

lecturer at Aston University,<br />

Dr Leon Davies was also<br />

present at the ceremony<br />

which took place at<br />

Westminster Central Hall,<br />

London to accept The<br />

Neil Charman Medal for<br />

outstanding post-doctoral<br />


DK8073 C1<br />

2011 advance previews now available<br />

INTERNATIONALeyewear<br />

The Eschenbach Group<br />

To arrange an appointment<br />

please call: 0121 585 6565



HOYA HAS appointed Joanne Copeland,<br />

pictured, as regional training manager for the<br />

South. She has worked in practice for several<br />

years and is now visiting practices to train<br />

dispensing opticians, optometrists and support<br />

staff in the benefits of dispensing premium<br />

lenses.<br />

20<br />

10/12/10 INDUSTRY NEWS<br />

The training, which takes about an hour,<br />

includes the use of the Hoyalux iD Comparison<br />

Display which compares conventional lenses<br />

with Hoya’s latest iD FreeForm technology. For<br />

details, email j.copeland@hoya.co.uk<br />

BAUSCH &<br />

LOMB has<br />

named Charl<br />

van Zyl,<br />

pictured, as<br />

corporate vice<br />

president and<br />

commercial<br />

leader, Europe,<br />

Middle East and<br />

Africa (EMEA).<br />

This is a new<br />

role and Mr van<br />

Zyl will lead the company’s cross-functional,<br />

EMEA operations team. He will also have direct<br />

commercial responsibility for B&L’s emerging<br />

markets in the region. He will be based in Zug,<br />

Switzerland.<br />

Mr van Zyl joined Bausch & Lomb in 2009,<br />

serving as vice president, EMEA, for the<br />

company’s pharmaceuticals business. In recent<br />

months he has taken on additional region-wide<br />

responsibilities.<br />

Before joining the company, he was chief<br />

executive officer for Jado Technologies, a<br />

German biotechnology firm. From 2004 to 2007<br />

he held positions at Novartis Pharma AG as head<br />

of marketing and sales, pharma Europe, and<br />

head of global marketing, ophthalmics.<br />

Earlier in his career he held multiple positions<br />

with Eli Lilly & Co, with responsibilities spanning<br />

across Europe, Japan, the United States and<br />

Latin America.<br />

Color-ing happy<br />

Down Under<br />

COLORIMETRY AND the Intuitive Colorimeter MK3 from<br />

Cerium Optical Products of Kent have been successfully<br />

promoted Down Under for helping dyslexics and<br />

migraine sufferers.<br />

There was a surge in colorimetry practitioners last<br />

year following a series of lectures organised on behalf<br />

of the International Institute of Colorimetry, based in<br />

London and sponsored by Cerium. Recently there was a<br />

clamor for more information following articles in Australian vision journals and optometrist<br />

Professor Bruce Evans, pictured, travelled from the UK to Australia to give lectures at two<br />

universities and a college there. He was well-known, as a number of leading academics had been<br />

contemporaries of his at Aston University. The lectures centred on using colorimetry in practice,<br />

the treatment of specific learning difficulties and the added benefits to the practice overall.<br />

Several colorimeters were purchased by interested optometrists and some even made the<br />

journey of 3,000 miles from Perth in Western Australia.<br />

International Institute of Colorimetry spokeswoman, Christine Fitzmaurice told OT that the<br />

plan now was to organise a lecture tour in Australia next summer. She believes that once the<br />

use of colorimetry is more embedded, it will quickly become a significant tool in aiding specific<br />

reading problems and migraine there. “Australian vision professionals are open to new ideas and<br />

the colorimeter offers a unique and efficient opportunity to help some children who are failing<br />

educationally as well as some migraine sufferers,” she said.<br />

01580 765211

Blue Bay<br />

dreaming<br />

The new Blue Bay collection of optical<br />

frames and sunglasses from Safilo has<br />

been designed for a young market with<br />

a mix of pop colours and the slogan ‘For<br />

dreamers only.’<br />

The oval-shaped acetate Blue Bay<br />

model 812, pictured, has high-impact<br />

colours, such as cyclamen and wisteria,<br />

white with red as well as red, white and<br />

navy, navy and green, black, white and<br />

yellow plus aubergine and orange.<br />

The new PR campaign features<br />

strong-impact graphic patterns<br />

with linear geometries for boys<br />

and romantic, pastel-shade flower<br />

decorations for girls.<br />

& 01423 520 203<br />

Go bug-eyed<br />

over PoS<br />

Children’s eyewear specialist<br />

Zoobug has launched a new range<br />

of striking point-of-sale materials to<br />

accompany its new collections launched<br />

at silmo.<br />

The materials include an 18-piece<br />

tray, with Zoobug logo, a matching<br />

six-piece stand, window posters and a<br />

counter card featuring a boy wearing<br />

Zoobug optical frames or sunglasses.<br />

They are available with all minimum<br />

orders of 24 pieces.<br />

new colourful hard cases for<br />

spectacles or sunglasses will be<br />

available to order from February. They<br />

will come complete with microfibre<br />

“bug” lens cloth.<br />

& 020 7251 8122<br />

Lazer<br />

sharp<br />

fashion<br />

tHe lazer Junior collection from<br />

Continental eyewear has been<br />

proving increasingly popular<br />

recently as spectacles have<br />

become a “must have” fashion<br />

item for youngsters. the range<br />

features metal and plastic designs<br />

and combinations of both.<br />

one of the best sellers is a<br />

frame that was launched just<br />

three months ago, model 2074.<br />

it appeals to both girls and boys<br />

and is available in four colours, black, burgundy, gunmetal<br />

and lavender. the sides are differently patterned in the different colours so that if the child<br />

returns to the practice and wishes to have the same frame they can, but with a totally different<br />

look. the frame is available from stock for immediate delivery.<br />

& 0151 426 3907<br />

New Year, new lenses<br />

BBGR’s AnAteo Progressive lens range receives a full makeover in January. In addition to<br />

the established Anateo design, a new short-corridor version, Anateo Mini, will be introduced,<br />

offering a minimum fitting height of 14mm.<br />

Anateo Mio will replace Anateo PdM as the flagship in BBGR’s portfolio. Winner of the<br />

2010 silmo d’or gold award, Anateo Mio is said to add a new dimension to personalised<br />

progressive lenses by integrating an extra parameter into its design, the natural reading<br />

distance.<br />

<strong>this</strong> fourth parameter builds upon the individualisation offered by the current Anateo<br />

family of lenses. they are designed to optimise the various lens zones according to the<br />

shape of the eye (Anateo), the shape of the frame, the thickness of the lens and the wearing<br />

conditions (Anateo PdM). In another new addition to the company’s range, trivex will be<br />

available in all Anateo<br />

lens designs from<br />

January 5.<br />

BBGR has also<br />

developed eyetab,<br />

a unique measuring<br />

device “to allow<br />

simple, precise<br />

and professional<br />

measuring of the<br />

natural reading<br />

distance”.<br />

& 0844 880 1349<br />

21<br />



Christmas crossword<br />

This <strong>issue</strong> we continue our monthly crossword series. So why not<br />

enter our competition before the closure date. The winner will<br />

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

22<br />

10/12/10 CROSSWORD<br />

across<br />

1. First full length animated Disney movie (4,5)<br />

8. South London tube station (7,6)<br />

11. One part of a whole (4)<br />

12. Step (5)<br />

13. Small needle case (4)<br />

16. Protruding balustrade (7)<br />

17. Type of screwdriver (7)<br />

18. Offered for finding criminals (7)<br />

20. Missing from work (7)<br />

21. Leave out (4)<br />

22. Large beaver-like rodent (5)<br />

23. Norwegian capital (4)<br />

26. Festive season (9,4)<br />

27. Type of marrow (9)<br />

down<br />

2. Home for the high flying set (4)<br />

3. Rich (7)<br />

4. More joyful (7)<br />

5. Where the shop takings are kept (4)<br />

6. One of the first Americans who invented<br />

flight (7,6)<br />

7. Refreshing drink after work (6,3,4)<br />

9. Scottish city (9)<br />

10. Parasitic plant brought indoors at<br />

Christmas (9)<br />

14. French river (5)<br />

15. Store safely in a secure place, informal; (5)<br />

19. Petrol driven cycle (7)<br />

20. Placate someone (7)<br />

24. Disposable pen (4)<br />

25. Leave as it is (typeface) (4)<br />

name:<br />

address:<br />

Send entries to OT, Christmas Crossword, 61 Southwark Street, London SE1 0HL to arrive<br />

no later than January 10 2011.

Opti leads the way into<br />

2011 with global brands<br />

NEWS<br />


brands will be seen at the<br />

curtain-raiser to Europe’s<br />

optical trade fa ir calendar in<br />

Munich next month.<br />

Opti ’11 will present over<br />

400 exhibitors plus special<br />

areas of interest to visitors,<br />

when it opens for three days<br />

on January 28 at the New<br />

Munich Trade Fair Centre.<br />

Next year the show has<br />

attracted names such as Luxottica,<br />

Marcolin, Charmant and Alain Mikli.<br />

“With the participation of these frame<br />

manufacturers, the list of key players will<br />

be even longer and more international<br />

than in 2010,” said Dieter Dohr, CEO and<br />

president of organiser, GHM Gesellschaft<br />

für Handwerksmessen mbH.<br />

“Once again more than 430<br />

companies are expected in Munich from<br />

all areas of the industry to exhibit their<br />

lenses, frames, contact lenses and low<br />

vision products. Our goal with Opti is<br />

to cover the full spectrum of optics and<br />

eyewear, for the benefit of our exhibitors<br />

and visitors.”<br />

British-based exhibitors<br />

William Morris, Tom Davies<br />

and Booth & Bruce will mix<br />

with optical heavyweights<br />

such as Safilo, Zeiss and<br />

Hoya on the exhibition floor.<br />

January’s show will<br />

also have a new lecture<br />

programme, where latest<br />

technologies and marketing<br />

concepts are explained<br />

– with a simultaneous<br />

translation in English, a feature that was<br />

introduced at <strong>this</strong> year’s event.<br />

In addition to lectures, Opti has also<br />

introduced a new ‘Walk of Frame’ billed<br />

as ‘a parade of innovations’, and alumni<br />

table discussion.<br />

For more information go to<br />

www.opti-munich.com<br />

23<br />

10/12/10 NEWS

REVIEW<br />

Use of IT is growing rapidly<br />

within UK independents<br />

24<br />

10/12/10 IT IN PRACTICE<br />


Revealing not just<br />

advance of<br />

a desire for efficiency<br />

electronic<br />

but also a move to<br />

communication<br />

slash postage costs,<br />

in High Street<br />

more than 20% of<br />

optics is<br />

practices are now<br />

highlighted by<br />

sending reminders,<br />

the 2010 Optisoft<br />

orders and payments<br />

Survey of IT in<br />

electronically.<br />

independent<br />

Practice predictions<br />

practices. This<br />

see another 33%<br />

year’s annual<br />

expecting to use<br />

report reveals<br />

<strong>this</strong> means of<br />

a strong shift<br />

communication in<br />

towards patient<br />

the “near future” (see<br />

Use of integrated equipment in practice (Optisoft survey)<br />

reminders, GOS<br />

tables). At the same<br />

forms, diagnostics integration and ordering being controlled time fax and post usage is expected to decrease by 15%.<br />

via the practice IT system.<br />

Optisoft managing director, Keith Sheers said: “With<br />

Broadband with email is now almost universal, with the some already ordering goods at home via the Internet, most<br />

uptake being twice as much as expected from last year’s practitioners see that <strong>this</strong> is the future for all aspects of<br />

survey, as practitioners realise that it is fundamental to their business life. Around a third of the practices responding<br />

business and patients, and suppliers demand <strong>this</strong> means of to the survey <strong>this</strong> year said they would be going paperless<br />

communication.<br />

in every possible area in the near future, recognising the<br />

The use of Internet search engines in looking for businesses fact that the technology is proven, saves staff time, is more<br />

has not been ignored by the profession with 87% of the 360 efficient and cuts costs, especially in the current economic<br />

responding practices now having a website.<br />

climate.”<br />

GOS forms are now being processed electronically within<br />

the practice by 23%, and a further 38% of practices surveyed<br />

expected <strong>this</strong> to become the norm, also in the “near future”.<br />

Although the survey found just 6% of practices are sending<br />

forms electronically now, <strong>this</strong> is expected to grow by 35% in<br />

the future, following the practice of many multiples.<br />

“The speeding up of payments and improvements in<br />

cash flow, thanks to the later cut-off date for electronic<br />

submissions, is a great plus on <strong>this</strong> aspect of paperless<br />

communication,” said Mr Sheers. “It also ensures that<br />

the form is filled out correctly, with an acceptance or<br />

rejection notice normally arriving while the patient is still<br />

at the practice, allowing any discrepancies to be rectified<br />

immediately – another reason why the take-up is so good.”<br />

Almost half of practices – 48% – are now using online lens<br />

catalogues from the major lens suppliers, with a dramatic<br />

23% growth over last year’s survey.<br />

“Lens catalogues are now supplied with practice<br />

management and lab ordering systems,” said Mr Sheers.<br />

“This helps to speed up the lens selection process and<br />

reduces any mistakes made during the dispensing process.<br />

Many practices also like the option of prompting preferred<br />

lens options for their dispensers. Our survey reveals a<br />

predicted 20% increase in the use of online catalogues in the<br />

Continued on page 26


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1. GFK market value share data weekly/monthly multifocal soft contact lenses Sept/Oct 2010.<br />

2. GFK fit audit New fits Q3 2010. 3. amongst emerging presbyopes. 4. subjective ratings<br />

from emerging presbyopes on a scale of 0 to 100, with 100 being excellent satisfaction.<br />

5. Rappon J, Bergenske P. AIR OPTIX AQUA MULTIFOCAL contact lenses in practice. Contact<br />

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© CIBA VISION (UK) Ltd, a Novartis company, 2010. AIR OPTIX, the AIR OPTIX logo,<br />

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

REVIEW<br />

26<br />

10/12/10 IT IN PRACTICE<br />

near future.”<br />

Frame catalogues,<br />

which need refreshing<br />

frequently, lend<br />

themselves well to<br />

being online due to the<br />

seasonal changes and<br />

39% of practices are now<br />

using these.<br />

Just 2% of respondents<br />

to the survey are still<br />

functioning without any<br />

kind of computer system,<br />

and the use of hardware<br />

revealed an interesting Above: Use of IT functions in optics (Optisoft survey)<br />

“It is most likely that<br />

the current economic<br />

climate is making<br />

practitioners realise that<br />

they need to keep a close<br />

eye on their profitability<br />

and the factors which<br />

affect <strong>this</strong>,” added Mr<br />

Sheers.<br />

In much the same vein,<br />

some 35% of respondents<br />

were part of a buying<br />

group, enabling them to<br />

negotiate more attractive<br />

pricing.<br />

trend away from “clone”<br />

computers – which are<br />

often unable to compete<br />

on the service of the<br />

bigger manufacturers –<br />

towards a greater uptake<br />

of Hewlett Packard and<br />

Apple which is expected<br />

to continue. Overall<br />

winner in hardware<br />

was Hewlett Packard at<br />

41%, and Apple on 9%<br />

The growth of<br />

integration between<br />

optical equipment and<br />

practice management<br />

system was significant<br />

as practices realise that<br />

to remain competitive<br />

they must invest in<br />

equipment, particularly<br />

as the multiples<br />

promote a more<br />

comprehensive eye<br />

but expected to grow by<br />

examination as the norm<br />

Above: Use of on-line catalogues, 2009 v. 2010 (Optisoft survey)<br />

19% in the near future.<br />

in TV advertising.<br />

Support of practice management systems seems to be<br />

shifting towards one provider for hardware, software and<br />

support, as demonstrated by 48% of respondents. The use of<br />

a local IT man has fallen by 4%, a trend which is expected to<br />

continue as practices prefer to have a single point of reference<br />

for more sophisticated systems.<br />

Fundus cameras were revealed to be the most popular item<br />

of equipment, used by 40% of those surveyed and with 56%<br />

expecting to have <strong>this</strong> technology “in the near future”. Slit<br />

lamps and field screeners followed at 33% with at least a 10%<br />

increase expected.<br />

OCT was significant with 8% of respondents claiming to<br />

The use of generic software revealed some interesting<br />

have <strong>this</strong> technology but with an additional 21% expecting<br />

results with current usage revealed as 94% for word<br />

to make <strong>this</strong> investment soon, showing a marked shift from<br />

processing, 93% email and 42% desktop publishing, with a<br />

last year’s survey when the number of OCTs in practice was<br />

10% increase expected soon.<br />

negligible.<br />

Most interesting was the monitoring of business activity,<br />

Marketing was also a focus for the survey with 28%<br />

with 81% using a spreadsheet, and monthly-managed<br />

using a video dispensing system, with <strong>this</strong> expected to rise<br />

accounts and benchmarking, or Key Performance Indicators,<br />

dramatically to 49% soon; 40% have a practice newsletter and<br />

increasing by 10% from last year to 39%.<br />

<strong>this</strong> is expected to rise to 65%; 37% use direct mail and <strong>this</strong><br />

is expected to rise to 60%, and, most dramatically with 13%<br />

currently using email marketing, <strong>this</strong> is expected to rise to<br />

62% soon.<br />

In terms of IT spend, 62% spent less than £5,000 in the<br />

past three years; 14% spent between £5,000 to £8,000 in the<br />

past three years and 17% spent more than £8,000, with the<br />

remaining 7% declining to comment.<br />

The respondents were revealed to make up a good regional<br />

representation of the UK in the survey, and are based in the<br />

following areas: 13% East Anglia; 13% Midlands; 13% north<br />

east; 10% Scotland; 9% Central Southern; 8% south west; 7%<br />

south east; 5% Wales; and 4% Northern Ireland.<br />

The 2010 Optisoft Survey of Independent Practices<br />

is published by the York-based company. For more details<br />

contact Optisoft via www.optisoft.co.uk



provides better vision for driving *1<br />

The No.1 fitted multifocal contact lens<br />

by UK practitioners 2<br />

*Compared to monovision, based on subjective ratings by emerging presbyopes 1. CIBA VISION data on file 2008. 2. GfK data Q2 2010.<br />

© CIBA VISION (UK) Ltd, a Novartis Company, 2010. AIR OPTIX, the AIR OPTIX logo, CIBA VISION and the CIBA VISION logo are trademarks of Novartis AG.


Explain, maintain, retain<br />

We conclude the Best Practice 10 series with Mike Broadhurst’s views on retaining patients<br />

28<br />

15/01/10 10/12/10 INTEVIEW<br />


NOTHING HELPS to focus the mind better than realising that<br />

you’ve got something wrong and it is going to cost you dearly.<br />

This happens throughout life – that’s how we learn. Most of<br />

the pain associated with <strong>this</strong> is frustrating but short-lived.<br />

Many of these incidents become distant memories as life,<br />

work, children take over our thoughts. However, the longterm<br />

effect of losing a patient’s loyalty becomes a long-term<br />

cost – loss of annual income from them, their family and their<br />

recommendations.<br />

Many years ago a patient returned to me after an absence of<br />

three years. She had gone to her friend’s practitioner and had<br />

been refitted with one of the “newer GP materials”. Her friend<br />

had been told of the benefits of <strong>this</strong> wonderful new material,<br />

had been refitted and was thrilled with the results.<br />

My patient had been “disappointed” that I had not offered<br />

the opportunity of having a trial with <strong>this</strong> “new” product and<br />

had followed her friend. On her return to me I was mortified.<br />

For the previous four years our practice had been in the top<br />

10 practices in the UK for fitting <strong>this</strong> material – I just hadn’t<br />

thought to talk about it to all of my patients.<br />

This was one of my very first lessons in how I should<br />

improve communication of new products to patients. I’ll<br />

never know how much <strong>this</strong> episode cost my practice but I<br />

don’t want it to happen again.<br />

Communication with our patients regarding all new<br />

product types, innovations in the optical world, and thoughts<br />

on where the contact lens world is moving should be<br />

considered at contact lens appointments.<br />

The most appropriate type of contact lens for each person<br />

should be discussed with the patient so that the decision to<br />

try a particular lens is a collaboration.<br />

Explaining why a particular lens type is selected for initial<br />

fitting is vital in ensuring the patient’s best interests have<br />

been considered. Being realistic around patient expectations<br />

is important, as promising all-day wear to every wearer is<br />

much harder to attain than majority day wear to most. The<br />

benefits of spectacle wear for evenings/weekends not only<br />

ensures that patients keep in touch with the visual challenges<br />

sometimes experienced with spectacles, but it makes it easier<br />

to manage occasional use around any contact lens <strong>issue</strong>s.<br />

It also keeps the patient in touch with how up-to-date their<br />

spectacle correction is – both optical and cosmetic.<br />

Contact lens checks should become contact lens reviews –<br />

an opportunity to assess a patient’s needs, both current and<br />

future.<br />

I know some contact lens practitioners who try a new<br />

contact lens product on a patient every time s/he attends.<br />

Personally, I prefer to tell them about all new products<br />

whether currently available in their prescription or not. Soft,<br />

daily/monthly lenses for astigmatism (in most prescriptions)<br />

were pie in the sky not too long ago. Yet now we have a<br />

plethora of lens types available to us. Tell patients about<br />

what “excites” you in <strong>this</strong> ever changing market – multifocals<br />

that work, astigmatic lenses that don’t rotate, extended wear,<br />

silicon hydrogels, or combinations of all of the above.<br />

Managing patient expectations is obviously very important<br />

at the initial contact lens fitting – understanding the patient’s<br />

lifestyle is equally important in ongoing care of contact lens<br />

wearers. Don’t be afraid to offer any patient the chance to try<br />

a new lens/material/solution, but only if there is a tangible<br />

benefit that can be seen by the wearer. The benefits of silicon<br />

hydrogel are well-known to most practitioners, but if moving<br />

to <strong>this</strong> type of lens causes the patient a different problem they<br />

believe “I can’t wear <strong>this</strong> lens as long” compared to “these<br />

will keep my eyes healthier for longer”.<br />

If <strong>this</strong> is the case consider if the patient needs to move<br />

towards silicon hydrogel or may <strong>this</strong> patient benefit from<br />

delaying the change until the next generation of design is<br />

launched?<br />

The more a patient visits a practice, the more opportunities<br />

s/he has of seeing your new range of sunspecs for the summer,<br />

tinted cosmetic lenses near Christmas or simply the new<br />

range of spectacle frames that become more appealing every<br />

year. Uninformed patients can often be the most dissatisfied<br />

and the first to go to mail order or an internet supplier of<br />

products.<br />

Patients who are satisfied their practitioner is<br />

knowledgeable, engaging and clinically competent are more<br />

likely to remain loyal. Up-to-date leaflets help to reassure<br />

the patient that their practitioner is using current lens types<br />

and materials and confident handling of the patient in the<br />

consulting room enforces <strong>this</strong>.<br />

Retaining current patients is much more cost-effective than<br />

trying to attract new ones. Communication, practitioner skills<br />

and knowledge maintain and retain patients for life, which is<br />

so vital for your business.<br />

Mike Broadhurst is an optometrist with three practices in<br />

the north west. Secretary of North & West Lancs LOC, he is<br />

optometric advisor to three PCTs, and Director of <strong>Optometry</strong><br />

Support Services Ltd www.optomss.co.uk


Sponsored by<br />

30<br />

10/12/10 PRE-REG FOCUS<br />

Magnification explained: Part 2<br />

Director of Clearview Training, Jane Mcnaughton, concludes her discussion on magnification<br />

Why +4.00D?<br />

Magnification is merely a comparison of the old<br />

object distance to the new object distance. For<br />

example, if we cannot see the number plate<br />

of a car, we move up closer to it, the retinal<br />

image size increasing all of the time. If a patient<br />

moves in towards the television by half the<br />

total distance then the image of the television,<br />

or the retinal image size, will increase by a<br />

factor of two. This is termed relative distance<br />

magnification: Magnification = Old object<br />

distance / New object distance.<br />

When establishing near magnification, as<br />

in the above method, we call the old object<br />

distance 25cm. By everyone choosing to use<br />

the same distance as their starting point, we can<br />

all be talking from the same hymn sheet. This<br />

starting point is called Unit Magnification. For<br />

example, if a patient needed to bring the print<br />

in to 12.5cm in order for it to be seen, then the<br />

retinal image size is 2x larger than it was when it<br />

had been held at 25cm: M = 25/12.5 = x2.<br />

What the lenses do is to merely focus the<br />

retinal image of the object at the given distance,<br />

in <strong>this</strong> case a +4.00D addition for a 25cm<br />

working distance, and a +8.00D addition for<br />

a 12.5cm working distance. Alternatively, the<br />

patient may wish to use their accommodative<br />

effort, if they have it. Thus it is typical for a visually<br />

impaired child to hold text very close to achieve<br />

‘magnification’ of the print or object.<br />

From the above equation, and on the<br />

assumption that 25cm is the conventional ‘old’<br />

object distance, we derive the magnification<br />

formula, M = F/4: +4.00D @ 25cm 1x (by<br />

convention); +8.00D @ 12cm 2x; +10.00D@<br />

10cm 2.5x; and+20.00D @ 5cm 5x etc. From <strong>this</strong><br />

we can call the +4.00D add or ‘unit magnification.’<br />

Each successive addition of another 4 dioptres<br />

adds another unit of magnification.<br />

From a practical viewpoint, <strong>this</strong> method<br />

quickly establishes the estimated magnification<br />

a patient will require to see an object of a given<br />

size, most typically, the printed text (see box<br />

below).<br />

This acuity reserve is calculated as the ratio<br />

of the target acuity to the patient’s threshold<br />

acuity (with a device). For sustained reading<br />

tasks, <strong>this</strong> ratio has been estimated to be<br />

between 2:1 and 3:1. For example, if a patient<br />

needs to be able to read newsprint successfully,<br />

(N8 approx.), then we need to consider enough<br />

magnification for him or her to be able to read<br />

at least N4 or better. If the patient is given<br />

an aid with which he can only achieve N8,<br />

then it is less likely that reading newsprint will<br />

be sustained for any length of time and the<br />

outcome will be deemed less successful.<br />

However, for survival or spot reading, an<br />

acuity reserve of 1:1 is all that is considered<br />

necessary, and a patient can have a magnifier<br />

that allows him or her to work close to<br />

threshold. Usually in such cases, giving<br />

an unnecessarily strong magnifier would<br />

compromise the patient’s field of view and<br />

further reduce the working distance of the task.<br />

One advantage of using <strong>this</strong> step-by-step<br />

method is that for each additional unit of<br />

magnification added in the trial frame, the<br />

patient should see an improvement, which<br />

helps in restoring confidence. Nevertheless,<br />

<br />

+3.00/-1.00×165 = 6/24+2 +4.00/-1.25×180 = 6/60<br />

LogMAR 0.54 LogMAR 1.00<br />

Add +2.75 = N10@ 30cm Add +2.75 = N24@32cm<br />

Add+4.00 = N6@ 25cm Add +4.00 =N24@ 25cm<br />

Add+6.00 = N5 fair @ 17cm<br />

Add+8.00 = N5 well @ 12cm<br />

<br />

<br />

complained that the short working distance was<br />

<br />

<br />

there are many patients who resist the close<br />

working distance that each additional lens<br />

brings, and <strong>this</strong> could indicate a challenge if a<br />

spectacle magnifier is to be prescribed.<br />

It is also worth mentioning that patients with<br />

a recent central scotoma often do not show<br />

an improvement with each addition. This may<br />

indicate the need for eccentric viewing training.<br />

The above method describes the minimum<br />

magnification required to view a high contrast<br />

near acuity test card, of pre-determined size.<br />

However, the amount of magnification that is<br />

prescribed will depend upon other factors:<br />

<br />

<br />

<br />

During the previous ‘work-up’, the minimum<br />

magnification required for a patient to reach<br />

the target acuity has been estimated. Whilst <strong>this</strong><br />

minimum amount of magnification may be all<br />

that is necessary to look at a washing machine<br />

dial or a can label, it is not possible to work at or<br />

on <strong>this</strong> threshold for sustained or fluent reading<br />

tasks, such as reading the newspaper or a novel.<br />

For sustained reading, more magnification will<br />

be required than what has previously been<br />

estimated. In other words, the patients will keep<br />

a degree of acuity in reserve.<br />

<br />

more tolerant of the shorter working distances<br />

<br />

N5 (approx a +6.00D or +8.00D lens) is the power<br />

<br />

<br />

<br />

near VA

optometrytoday<br />

Clinical performance of<br />

‘comfort-enhanced’ daily<br />

disposable soft contact lenses<br />

Online article<br />

The latest clinical article to appear online<br />

James Wolffsohn, Olivia Hunt, Ashok Chowdhury<br />

Over the last 10 years much has been written<br />

about discomfort amongst contact lens wearers,<br />

particularly at the end of the day, and that <strong>this</strong><br />

contributes to some patients dropping out of<br />

lens wear each year. There have been several<br />

studies to support <strong>this</strong> assertion. Discomfort,<br />

particularly towards the end of the day, is a major<br />

cause of contact lens discontinuation. Dry eye<br />

symptoms are the most common complaint,<br />

with over 70% of wearers reporting symptoms<br />

late in the day, and approximately one third<br />

of these discontinue lens wear as a result.<br />

About the Authors<br />

James Wolffsohn is the deputy Dean of Life and Health Sciences at Aston<br />

University and a Professor of <strong>Optometry</strong>. Olivia Hunt is the Principal Clinician of<br />

the <strong>Optometry</strong> Clinics at Aston University and final year tutor. Ashok Chowdhury<br />

is a Clinical Instructor in the <strong>Optometry</strong> Clinics and a lecturer at Aston University.<br />

To see the complete article, log on to<br />



Get back into the<br />

training groove<br />

Education and entertainment with a twist of tartan will be the<br />

flavour of the month in January as practitioners make their way<br />

to Glasgow Marriott for Eyecare 3000 on the 16th and 17th.<br />

Up to 16 CET points will be available over the two days as<br />

delegates can take their pick from a wide-ranging program of<br />

lectures and workshops tailored to fit a variety interests and<br />

specialisms.<br />

It’s not all education though. Socialising and dancing will be<br />

in abundance with a drinks reception on the evening of the<br />

15th, Sunday brings the dinner dance with a disco, the Scott<br />

Mackie Dancers and the sounds of the Paul McKenna Band.<br />

For more information see www.eyecare3000.com<br />

34<br />

10/12/10 DIARY DATES<br />

Alan Robertson, Glasgow: Scotland with Style<br />

DECEMBER 2010<br />

10 FMO, Hilton Hotel, Paddington, London,<br />

W2, ‘Christmas lunch’ (sfisher@fmo.co.uk)<br />

JANUARY 2011<br />

11 NEOS, The Harvey Suite, Ravensdene Lodge<br />

Hotel, 55 Consett Road, Lobley Hill, Gateshead,<br />

‘Acute red eye’ 7.15pm (simonraw44@hotmail.<br />

com)<br />

16-17 Eyecare 3000, Marriott Hotel, Glasgow,<br />

‘Annual conference’ CET points available<br />

(www.eyecare3000.com)<br />

17 Lancashire Optical Society, Swallow Hotel,<br />

Preston, ‘Photochromic lenses; the new<br />

standard lens’ (ruthcuth@btinternet.com)<br />

24 LOCSU, AOP offices, 61 Southwark Street,<br />

London, ‘Regional training roadshow’<br />

(cameronmitchell@locsu.co.uk)<br />

26 Wessex Optical Society, Circle Bath<br />

Hospital, ‘Vascular disease and the eye’<br />

6.45 pm, 1 CET point on offer (Samantha.<br />

sousa@circlepartnership.co.uk)<br />

27 LOCSU, Radisson Blu Hotel, Queensway,<br />

Birmingham, ‘Regional training roadshow’<br />


31 LOCSU, Salomons Centre, Broomhill Road,<br />

Tunbridge Wells, ‘Regional training roadshow’<br />


FEBRUARY 2011<br />

1 NEOS, The Harvey Suite, Ravensdene Lodge<br />

Hotel, 55 Consett Road, Lobley Hill, Gateshead,<br />

‘Dots, blots and haemorrhages. A guide to<br />

medical retinal problems’ 7.15pm SEE ABOVE<br />

2-3 J&J, The Vision Care Institute,<br />

Pinewood, Berkshire, ‘Returning to work<br />

confident and refreshed’ two day course,<br />

18 CET points (www.thevisioncareinstitute.<br />

co.uk)<br />

3 LOCSU, Ramada Piccadilly, Portland<br />

Street, Manchester, M1 4PH, ‘Regional<br />

training roadshow’ SEE ABOVE<br />

NEW… 6 Eyecare 3000, Hilton Hotel,<br />

Belfast, 6 CET points on offer SEE ABOVE<br />

6 Glasgow Caledonian University and NHS<br />

Education for Scotland, Dundee, venue<br />

TBC ‘Communication skills in optometry’<br />

(Karen.reid@gcal.ac.uk)<br />

7 LOCSU, Maunsel House, North Newton,<br />

Somerset, ‘Regional training roadshow’<br />


10 LOCSU, Winchester Royal Hotel, St Peter<br />

Street, Hampshire, Winchester, ‘Regional<br />

training roadshow’ SEE ABOVE<br />

14 LOCSU, Belfry, Mellor’s Way,<br />

Nottingham, ‘Regional training roadshow’<br />


14 Lancashire Optical Society, Swallow<br />

Hotel, Preston, ‘Surgeons’ choice’<br />

(ruthcuth@btinternet.com)<br />

15 BCLA, 76 Portland Place, London,<br />

‘Scientific evening meeting’ (www.bcla.<br />

org.uk)<br />

17 LOCSU, Menzies Hotel, Barr Hill,<br />

Cambridge, ‘Regional training roadshow’<br />


28 LOCSU, Copthorne Hotel, The Close,<br />

Quayside, Newcastle, ‘Regional training<br />

roadshow’ SEE ABOVE<br />

MARCH 2011<br />

NEW… 2-6 SECO, Georgia World Congress<br />

Center, Atlanta, USA (www.seco2011.com)<br />

3 LOCSU, Park Plaza, Boar Lane, Leeds,<br />

Yorkshire, ‘Regional training roadshow’<br />


NEW… 4-6 MIDO, Fieramilano, Milan, Italy<br />

(www.mido.com)<br />

7 LOCSU, WOPEC, Cardiff University, Cardiff,<br />

‘Regional training roadshow’ SEE ABOVE<br />

9 South Staffs Optical Society, Cannock Cricket<br />

and Hockey Club, Church Lane, Hatherton,<br />

Cannock, ‘The OCT in practice’ with buffet,<br />

6.30pm (suecutts@talk21.com)<br />

10 LOCSU, Lion’s Quay, Moreton Mt Weston<br />

Rhyn, Oswestry, Shropshire, ‘Regional training<br />

roadshow’ SEE ABOVE<br />

14 Glasgow Caledonian University and NHS<br />

Education for Scotland, Inverness, venue<br />

TBC ‘Binocular vision and additional exam<br />

techniques’ SEE ABOVE<br />

14 Lancashire Optical Society, Swallow Hotel,<br />

Preston, ‘Lutein and Zeaxanthin for protection<br />

against AMD: fact or fiction?’ (ruthcuth@<br />

btinternet.com)<br />

NEW… 20-21 College of Optometrists,<br />

Aintree Racecourse, Liverpool, Merseyside, L9<br />

5AS, ‘<strong>Optometry</strong> tomorrow 2011’<br />

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

NEW… 28 Maui Jim, Brooklands Hotel,<br />

Weybridge, ‘CET party – training with the<br />

Hawaiian twist’ free but places are limited<br />

(0800 980 1770)<br />

NEW… 29 Maui Jim, Aztec Hotel, Bristol,<br />

‘CET party – training with the Hawaiian<br />

twist’ free but places are limited SEE ABOVE<br />

NEW… 30 Maui Jim, National Motorcycle<br />

Museum, Birmingham, ‘CET party – training<br />

with the Hawaiian twist’ free but places are<br />

limited SEE ABOVE<br />

NEW… 31 Maui Jim, Hilton Hotel,<br />

Manchester, ‘CET party – training with the<br />

Hawaiian twist’ free but places are limited<br />


APRIL 2011<br />

NEW… 1 Maui Jim, Holiday Inn,<br />

Bloomsbury, London, ‘CET party – training<br />

with the Hawaiian twist’ free but places are<br />

limited SEE ABOVE<br />

NEW… 4 Maui Jim, Morrison Hotel, Dublin,<br />

‘CET party – training with the Hawaiian<br />

twist’ free but places are limited SEE ABOVE<br />

NEW… 6 South Staffs Optical Society,<br />

Cannock Cricket and Hockey Club, Church<br />

Lane, Hatherton, Cannock, ‘Contact lens<br />

complications’ with buffet, 6.30pm SEE<br />

ABOVE<br />

NEW… 9-11 Optrafair, Birmingham NEC<br />

(FMO: 020 7298 5123)<br />

NEW… 14 BCLA, 76 Portland Place,<br />

London, ‘Scientific evening meeting’<br />


6 CET<br />

credits<br />

available<br />

Ot.tv Guide<br />

PAC Conference coverage<br />

In association with Specsavers, Ot.tv is delighted to bring you a selection of<br />

lectures filmed at the 2010 PAC Conference. For those who were not able to<br />

attend, or for any delegates wishing to recap, we have three CET accredited<br />

lectures available to view online at www.optometry.co.uk.<br />

The lectures available are:<br />

• Peripheral retinal degenerations: Dr William L. Jones looks at common retinal<br />

lesions that are encountered in the peripheral fundus, providing advice about<br />

techniques for examining the retinal periphery and distinguishing between sightthreatening<br />

and non-sight threatening degenerations.<br />

• Silicone hydrogels – are we there yet?: Paul Chamberlain<br />

examines silicone hydrogel contact lenses, advising on the<br />

successful fitting of these lenses, reporting on various related research studies<br />

and providing an overview of potential complications of wear. This lecture is<br />

sponsored by Sauflon.<br />

• Visualising the end result: Paul McCarthy discusses the best approach to<br />

take when optimising the cosmetic and optical performance of spectacle lenses,<br />

including consideration of lens thickness calculations, frame choices and the<br />

design of free-form lenses.<br />

Each of these 3 videos are accompanied by 12 MCQs, with 6 CET points available in total<br />

for Optometrists, 4 available for Dispensing Opticians and 2 points for Contact Lens<br />

Opticians.<br />




A New Year, a new start –<br />

OT launches new website<br />

Whilst everyone is welcoming in the New Year next month, OT ‘s online presence will go live with a<br />

new re-designed website. Emily McCormick reports<br />

36<br />

10/12/10 WEBSITE LAUNCH<br />

TO BE launched on January 1, 2011, the<br />

improved website has been designed<br />

to offer its average 18,000 a month<br />

users a more simplified way to access<br />

educational materials and keep abreast<br />

of the latest optical developments.<br />

The redesigned website makes<br />

everything from taking CET exams and<br />

finding archived clinical articles, to<br />

buying optical products and discovering<br />

a new job much easier.<br />

Regular readers will not only notice<br />

that some areas have been renamed but<br />

that functionalities across the board<br />

have been widely enhanced.<br />

Users are encouraged to register<br />

with OT online to take advantage of<br />

a number of features, which are only<br />

available to those who register. For<br />

instance, when completing the few<br />

easy steps that are required to register<br />

with the website, users will be asked to<br />

highlight their professional interests.<br />

By doing so, any new content which is<br />

published on optometry.co.uk since a<br />

user has last visited will be tagged and<br />

highlighted to them in the ‘My Tagged<br />

Items’ box when they return.<br />

Marketplace<br />

Arguably, the<br />

section which<br />

has undergone<br />

the biggest<br />

transformation<br />

is Marketplace<br />

(previously<br />

known as<br />

Where to Buy).<br />

Unrecognisable<br />

as the listing<br />

service which is<br />

currently used,<br />

the area will<br />

offer sellers a<br />

visually more<br />

enticable way<br />

to promote their<br />

products and will be easier for buyers to<br />

locate what they are looking for.<br />

Advanced searching options will<br />

see potential buyers able to search<br />

using keyword, category and location<br />

options. When searching, users will<br />

find that entries include a lot more<br />

information to help them make the right<br />

purchase choice. When selling on OT<br />

Marketplace, companies are encouraged<br />

to upload product pictures, company<br />

catalogues and details of their latest<br />

offers. In a bid to provide users with the<br />

best possible service, sellers advertising<br />

on the site will also be able to update<br />

their information.<br />

Jobs<br />

Previously<br />

known as<br />

‘Recruitment’,<br />

the renamed<br />

‘Jobs’ section<br />

has been<br />

designed to<br />

operate as<br />

much more<br />

than a simple<br />

job searching<br />

tool. The site<br />

can now be<br />

utilised by<br />

both those<br />

searching<br />

for their<br />

next optical<br />

position and by companies seeking to<br />

fill vacancies.<br />

An invaluable Job Tips hub,<br />

populated with information to help<br />

professionals search for their next<br />

career move, will help users produce<br />

a job winning CV and cover letter, as<br />

well as warn them about the pitfalls to<br />

avoid. Just as importantly, it is free to<br />

use.<br />

When you have written your CV and<br />

are ready to begin your job search, we<br />

urge you to upload your CV to the site<br />

using our ‘CV Uploader’ facility where<br />

a wide range of optical companies can<br />

view your CV when considering any<br />

vacancies they may have open.<br />

When advertising on OT Jobs,<br />

employers – from the small independent<br />

to the large multiple – are encouraged to<br />

upload a profile of their business for job<br />

seekers to browse and learn more about<br />

their potential employer.<br />

Focusing on the needs of the<br />

employer, we have responded to<br />

requests to make placing an advert for<br />

a vacancy quicker and easier, and will<br />

allow companies to book online going<br />

forward.<br />

Furthermore, the ‘Jobs’ site is still<br />

a job search tool at its core. What<br />

readers will notice, however, is that<br />

searching for that elusive position<br />

has been made a lot easier. As well<br />

as a general keyword search being in<br />

place, a new advanced search option<br />

allows job seekers to search for specific<br />

roles, specify salary desirability and<br />

view vacancies within a specified mile<br />

radius from their home. And, to make<br />

the job search process as hassle-free as<br />

possible, users who find a job that takes<br />

their fancy can<br />

save it in ‘My<br />

Favourites’<br />

where it can<br />

easily be found<br />

when they<br />

return to the<br />

site – if you<br />

register of<br />

course!<br />

Events<br />

As an area<br />

which is<br />

equally utilised<br />

by users to<br />

advertise an<br />

event as by

those looking for events to attend,<br />

the event section will undergo some<br />

massive developments.<br />

Presently the oT website solely<br />

displays details of events via a calendar<br />

tool. excitingly, from January, visitors<br />

to the site will be able to additionally<br />

see events highlighted in both list<br />

and map formats. Whilst the newly<br />

introduced list format aims to provide<br />

users with an easy to read overview of<br />

each month’s events, the map view tool<br />

allows users to search for events within<br />

a specific area range. by simply typing<br />

in a postcode and the distance you are<br />

willing to travel from that postcode,<br />

the tool will highlight all events taking<br />

place within that radius.<br />

As always, users wishing to advertise<br />

anything from an LoC meeting or a<br />

CeT conference will be able to submit<br />

an event online. However, when doing<br />

so the information required from them<br />

will be a lot more specific. In requesting<br />

details such the venue, including the<br />

address and postcode, users trying to<br />

located meetings close to home can do<br />

so with ease.<br />

Users registered on the oT website<br />

can also save any event that they find<br />

of interest to their ‘My Favourites’<br />

where it will remain in the easy<br />

locatable box anytime they return to the<br />

site until they delete it.<br />

Multimedia<br />

During the site’s revamping process<br />

oT’s online television station, ot.tv<br />

has been renamed. From launch ot.tv<br />

will become defunct, with all videos<br />

– news, features and events – being<br />

located under the new umbrella,<br />

‘Multimedia’. Responding to feedback<br />

from oT readers, the decision was made<br />

to merge the two platforms in order to<br />

ease access and make the content easier<br />

to find and watch.<br />

As always users will be able to submit<br />

their comments on any video they have<br />

watched, with previous comments<br />

being displayed underneath each<br />

video. However, users will also be able<br />

to rate a video using the site’s newly<br />

established star rating system. Readers<br />

and users alike will be pleased to hear<br />

that news and feature content on the<br />

site will be separated going forward.<br />

Viewed in mirroring formats, users can<br />

comment, rate and add any news or<br />

feature story<br />

to their ‘My<br />

Favourites’.<br />

CET<br />

As the most<br />

viewed page<br />

on the oT<br />

website,<br />

developers<br />

have worked<br />

hard to<br />

maintain the<br />

functions<br />

that users<br />

said they<br />

liked, such<br />

as having a<br />

PDF of all exam articles available on<br />

the CeT landing page, and added a<br />

number of new functionalities to make<br />

the process easier and clearer. Along<br />

the exam journey practitioners will find<br />

prompting instructions, will have the<br />

ability to skip to and from questions,<br />

save and return to an exam later, and<br />

see recommendations for books – and<br />

in the future events which they can<br />

attend – relating to the topic area.<br />

The correct answers for each exam<br />

will now be automatically emailed once<br />

the exam has closed to everyone who<br />

sits the exam. As will a certificate for<br />

all those who pass an exam.<br />

A new personal Grade book can be<br />

used by practitioners to track their<br />

progress on oT CeT exams. It is also<br />

where users can easily see which exams<br />

they have passed or failed and how<br />

many points they have collected.<br />

Coming Soon<br />

Practitioners using oT’s CeT site<br />

after launch will notice that we have<br />

included a ‘Your Learning outcomes’<br />

box within the Grade book.<br />

This section is designed to allow oT<br />

CeT users to record their reflective<br />

learning comments as they take an<br />

exam, be it CeT, VRICS or CeT Video.<br />

This facility is in development and<br />

is only available as a text box in your<br />

Grade book until March 2011. This text<br />

box will allow you to record all of your<br />

combined learning outcomes, however<br />

as from March we will introduce <strong>this</strong><br />

function to each exam enabling you<br />

to link your reflective learning to the<br />

relevant exam which will show on your<br />

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March. A new Personal Development<br />

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in individuals’ profiles. Newsletters<br />

currently available include news and<br />

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in the near future. Signing up to our<br />

e-newsletter service can lead to big<br />

benefits for those who are for example<br />

job hunting, as they will receive<br />

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37<br />


REVIEW<br />

38<br />

10/12/10 EYE OPENER<br />

Snow and success for 2010<br />

Eye Opener student conference<br />

Second-year Anglia Ruskin undergraduate, Julie Polczyk reports on <strong>this</strong> year’s sold-out AOP event<br />

AS 190-plus optometry undergraduates arrived at Center Parcs<br />

in Longleat for the third annual AOP Student Conference they<br />

were greeted by a picturesque Winter Wonderland – with real<br />

snow included – and it was clear to see from their faces that<br />

the weekend was going to be a hit.<br />

For the first time in the conference’s history representatives<br />

from all eight optometry universities attended, with another<br />

50 eager students vying for a place on a waiting list. In<br />

fact, the buzz from the conference had spread so far that<br />

undergraduate Ryan Gustas from the School of <strong>Optometry</strong> at<br />

Indiana University travelled from America for the occasion.<br />

Since it’s birth three years ago the two-day meeting has<br />

grown and grown, with a bigger exhibition, more sponsors<br />

and even more activities <strong>this</strong> year.<br />

Kicking off the ‘educational’ side of proceedings, students<br />

were treated to a whistle stop tour of the various career<br />

options available to them upon qualifying.<br />

Different pathways<br />

Perhaps the most obvious option of joining a multiple<br />

was covered by Paul Richie, a regional manager for Boots<br />

Opticians, who spoke about working in a High Street practice<br />

and the possible career progression it offers. Whilst not<br />

discounting the independent route, David Shannon, AOP<br />

chairman, was on hand to talk about the freedom afforded<br />

by the autonomy of independent practice. However, he was<br />

mindful of the difficulties in being up against the ‘multiples’<br />

and the challenges that <strong>this</strong> might present.<br />

The pathway into hospital optometry proved popular, with<br />

more than 80% of the crowd saying they were interested in<br />

securing a place in the competitive field. Consequently, when<br />

Nadeem Rob, a hospital pre-reg graduate himself, took to the<br />

stage and strongly encouraged delegates to explore the field<br />

he had their full attention. He explained: “You don’t need<br />

to be the highest qualified graduate for a hospital pre-reg<br />

placement, but you do have to be the right sort of person. And<br />

if I can do it, so can you.”<br />

Mr Rob’s talk certainly seemed to spark a lot of interest<br />

amongst the undergraduates, with most of the subsequent<br />

question-and-answer session directed towards him.<br />

However, academia shouldn’t be discounted as University<br />

of Bradford lecturer Dr Catharine Chisholm pointed out when<br />

she spoke about the full gambit of challenges open to the<br />

optometrist with an interest in research, as well as the benefits<br />

of foreign travel.<br />

Campaigning on behalf of domiciliary optometry was AOP<br />

counsellor Ed Bickerstaffe, who was a domiciliary optometrist<br />

himself. Whilst Mr Bickerstaffe was enthusiastic about the<br />

area in which he works, he advised students that it is most<br />

definitely a route to consider for the future rather than directly<br />

after the pre-reg period as it is prudent to get some experience<br />

of working in practice first. “You may well be out there on<br />

your own, with no colleague next door to ask for a second<br />

opinion,” he warned.<br />

As the first ‘Circuit Training’ session began students<br />

breathed a sigh of relief that thankfully it did not involve<br />

push-ups and sit-ups, but instead was eight 15-minute<br />

problem solving workshops. Students got stuck into the<br />

practical workshops on toric contact lens fitting, experiments<br />

in behavioural optometry, ophthalmoscopy and OCT, and

39<br />

there was even a workshop from Lloyds TsB on how to write<br />

a business plan.<br />

An ‘Ask the Employers what is it really like’ Q&A perked<br />

students up before lunch and they took full advantage of<br />

the opportunity to grill recruitment staff from ‘the big four’<br />

– Boots Opticians, specsavers, Vision Express and Optical<br />

Express – with some pithy questioning certainly putting them<br />

on the spot.<br />

Inspirational talk<br />

In between learning delegates took the opportunity to<br />

explore the exhibition which included representatives from<br />

conference sponsors Optical Express, Vision Express, Boots<br />

Opticians, specsavers, Buchmann, Keeler, CIBA Vision,<br />

Johnson & Johnson, and Lloyds TsB. Charities Vision Aid<br />

Overseas, <strong>Optometry</strong> Giving sight and the RNIB were also<br />

present.<br />

“Anything is possible if you are<br />

willing to take risks...”<br />

Keeping true to the promise of fully demystifying the<br />

pre-reg year, it was AOP education advisor Karen sparrow<br />

who had the job of explaining the pitfalls of sorting out a<br />

pre-registration placement. And providing students with<br />

vital tips about the OsCE, head of education at the College of<br />

Optometrists, Jackie Martin’s speech was keenly listened to<br />

by all.<br />

Optometrist and entrepreneur, Imran Hakim closed the<br />

first day of the conference with what delegates called an<br />

‘inspirational’ talk on the possibilities outside of optometry.<br />

Mr Hakim described his iTeddy journey and his belief that<br />

“you should never stop dreaming”. Although a qualified<br />

optometrist his life has taken a different path to that<br />

envisaged by most students as the usual career progression,<br />

showing that anything is possible if “you are willing to take<br />

risks and make mistakes,” he said.<br />

Despite early snowfall and plummeting sub-zero<br />

temperatures, students braved the walk through Longleat<br />

Forest to saturday night’s Gala Dinner. They arrived peeling<br />

off layers of scarves, hats, gloves, wellies and Uggs, to reveal<br />

glamorous party dresses and smart suits for the annual AOP<br />

Eyeball.<br />

At the Ball – during which the dancing hardly stopped –<br />

Bradford students were named winners of the first AOP Film<br />

and Television Award (AFTA) for their amusing film ‘show<br />

me your fovea’ which can be watched at http://bit.ly/hB5ga4<br />

Coming back next year<br />

With a few blurry eyes in sight, double act Dr Anna Kwartz<br />

and Professor steve Parrish, directors of IOT, opened lectures<br />

on the final day of the conference. students quickly livened<br />

up though, as the duo’s talk was full of useful information on<br />

planning your pre-reg and advice on the right questions to<br />

be asking when faced with a placement proposal – the two<br />

inflatable CIBA Vision eye people props may have helped<br />

<strong>this</strong> too.<br />

A delegate at last year’s conference, pre-reg optometrist<br />

Ellen Fletcher, returned to host a Q&A session about life as a<br />

pre-reg. students fired question after question at Ms Fletcher<br />

knowing what a good opportunity it was to have someone<br />

speaking from first-hand experience about the period.<br />

The conference certainly proved to be a hit amongst<br />

students, speakers, sponsors and exhibitors alike. First-year<br />

Anglia Ruskin undergraduate, Natalie Keates told OT: “I think<br />

the conference has been really interesting and I’ve learnt how<br />

to apply for my pre-reg and what to expect when I get there.<br />

“I’ll definitely be coming next year, and in my third-year<br />

if I can too.”<br />

Ms Kwartz said: “We really enjoyed it and were very<br />

impressed at how beautifully organised the whole event was,<br />

All the delegates were clearly getting a lot out of the day.”<br />

senior lecturer at Cardiff, Dr Christine Purslow added:<br />

“Well done everyone – my students were buzzing with<br />

news of it all.”<br />

10/12/10 EYE OPENER

VRICS<br />




The following FREE Visual Recognition and Identification of Clinical Signs (VRICS) test should be<br />

completed online by clicking on the VRICS test button at www.otcet.co.uk. Respondents should<br />

use the six images/photos to answer the12 associated Multiple Choice Questions (MCQ). Please<br />

note that there is only one correct answer for each MCQ. Successful completion of the VRICS test<br />

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

40<br />

10/12/10 VRICS<br />

Diabetes and the Eye 2: Diagnosis and Management<br />

COURSE CODE: C-15140 O/D Professor Rachel North<br />

A<br />

1. The Hess plot shown in Image A was measured in a patient with<br />

Diabetes Mellitus (DM). Which of the following statements regarding<br />

<strong>this</strong> result is FALSE?<br />

a) The patient will complain of horizontal diplopia<br />

b) This defect occurs more frequently in patients with Type 2 DM than<br />

Type 1 DM.<br />

c) The patient will exhibit a convergent squint<br />

d) The patient will have a bilateral ptosis<br />

2. Which of the following statements regarding the management of the<br />

condition in Image A and the patient in Question 1 is FALSE?<br />

a) Treatment with botulinum injection is an option<br />

b) Corrective strabismus surgery may be required<br />

c) Prismatic correction is a treatment option<br />

d) Intervention is always required in such cases<br />

3. Which of the following statements about the condition shown in<br />

Image B is FALSE?<br />

a) This condition can cause increased intraocular pressure (IOP)<br />

b) The condition represents normal dilated iris blood vessels<br />

c) This condition is associated with fibrous t<strong>issue</strong> formation<br />

d) This condition is treated by pan-retinal photocoagulation<br />

B<br />

4. What is the MOST appropriate grade of diabetic retinopathy that<br />

would be associated with the condition shown in Image B, according<br />

to the National Screening Committee?<br />

a) P0<br />

b) R1<br />

c) U<br />

d) R3<br />

5. Which technique has been used to obtain the picture shown in<br />

Image C?<br />

a) Fluorecein angiograhy<br />

b) Red free fundus photography<br />

c) Optomap imaging<br />

d) Optical conherence tomography<br />

C<br />

6. What is the MOST appropriate grade of diabetic retinopathy that<br />

would be associated with the condition shown in Image C, according to<br />

the National Screening Committee?<br />

a) R1<br />

b) R2<br />

c) R3<br />

d) P


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All participants must confirm these results on www.cetoptics.com so that they can move their points from the “Pending Points record” into their “Final CET points record”. Full instructions on how to do <strong>this</strong><br />

are available on their website.<br />

About the author<br />

Professor Rachel North is an optometrist at the School of <strong>Optometry</strong> & Vision<br />

Sciences, Cardiff University. Areas of research interest include the investigation<br />

of functional and structural changes in Diabetes Mellitus and Glaucoma, using<br />

psychophysical, electrophysiological and digital imaging techniques.<br />

Associated Reading:<br />

1. www.retinalscreening.nhs.uk<br />

2. Louise O’Toole (2009) Features of diabetic retinopathy<br />

and grading protocol. <strong>Optometry</strong> <strong>Today</strong> February 13<br />

3. Brinda Muthusamy (2009) Diabetes: Indications for<br />

treatment. <strong>Optometry</strong> <strong>Today</strong> March 13<br />

4. Rachel North (2009) Monitoring and controlling<br />

diabetes. <strong>Optometry</strong> <strong>Today</strong> April 10<br />

5. Shaheen Shah (2009) Non-retinal complications<br />

of diabetes mellitus. <strong>Optometry</strong> <strong>Today</strong> May 8<br />

7. Which of the following statements regarding the lesions X and Y<br />

shown in Image D is TRUE?<br />

a) These are pre-retinal haemorrhages that have occurred due to rupture<br />

of new vessels<br />

b) They are commonly seen in Type 2 DM<br />

c) These findings are indicative of an anoxic retina<br />

d) These are vitreous haemorrhages<br />

41<br />

D<br />

8. Which of the following is NOT an indicated management strategy<br />

for the lesion labelled as X in Image D?<br />

a) Vitrectomy<br />

b) Pan-retinal laser photocoagulation<br />

c) Prescription of oral systemic steroids<br />

d) More efficient systemic glycaemic control<br />

9. A patient with the macular condition shown in Image E has a visual<br />

acuity of 6/18. Which of the following statements about <strong>this</strong> condition<br />

is FALSE?<br />

a) It is more common in patients with Type 1 DM<br />

b) It occurs due to capillary drop out<br />

c) It is associated with cotton wool spots<br />

d) It has a good prognosis for resolution<br />

10/12/10 VRICS<br />

E<br />

10. Which of the following statements about the condition shown in<br />

Image E is TRUE?<br />

a) Vitrectomy should be performed<br />

b) Intra-vitreal steroid injections should be given<br />

c) Fluorescein angiography will show areas of retinal non-perfusion<br />

d) Pan-retinal photocoagulation should be performed<br />

11. Which of the following statements about the condition shown in<br />

Image F is FALSE?<br />

a) It is non-recurrent<br />

b) It can cause ptosis<br />

c) It is associated with Type 1 DM<br />

d) It is usually due to hypercholesterolemia<br />

12. Which of the following is NOT an indicated management strategy<br />

for the condition shown in Image F?<br />

a) Cryotherapy<br />

b) Surgical excision<br />

c) Carbon dioxide laser treatment<br />

d) Chemical cauterization eg, with trichloroacetic acid, for deep lesions<br />

F<br />

Acknowledgements<br />

The author would like to thank the All Wales Diabetic Retinopathy Screening Service, Optos Plc, and<br />

the Media Resources Centre of the University Hospital of Wales , for providing images for <strong>this</strong> VRICS.



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10/12/10 CET<br />


Ocular surface and anterior<br />

segment inflammation<br />

COURSE CODE: C-15087 O/AS/SP/IP<br />

Professor Michael J. Doughty, PhD<br />

In <strong>this</strong> final article of <strong>this</strong> series, the management of a range of fairly<br />

common mild-to-moderate inflammatory conditions of the anterior<br />

segment is discussed. Many of these conditions, such as complex cases<br />

of blepharitis, blepharoconjunctivitis, limbal and peripheral corneal<br />

infiltrates, non-perforating abrasions, and foreign bodies, can present<br />

to and be managed by an optometrist, especially those with additional<br />

supply (AS) therapeutic qualifications. Pharmacological options range from<br />

artificial tears and lubricants to topical analgesics and the therapeutic use<br />

of cycloplegics; the latter are more likely to be utilised by optometrists<br />

trained to independent prescriber (IP) level, as highlighted later.<br />

Aetiology of ocular surface and<br />

anterior segment inflammation<br />

The sub-epithelial connective t<strong>issue</strong><br />

(parenchyma) usually contains<br />

inflammatory cells, including additional<br />

white blood cells (eg, macrophages) that<br />

have initially non-specifically migrated<br />

from the dilated capillaries into the<br />

conjunctival t<strong>issue</strong> in response to the<br />

inflammatory stimulus, followed later<br />

by specifically recruited white blood<br />

cells (eg, polymorphonuclear leucocytes<br />

- PMNs) that migrate to the region where<br />

the foreign antigens are located. 1,2 These<br />

cell types, especially the former, along<br />

with mast cells, can release inflammatory<br />

mediators from granules in the cells.<br />

These non-specific mediators include<br />

histamine and certain prostaglandins.<br />

As inflammation develops, the natural<br />

cell complement of the conjunctiva and<br />

peripheral cornea becomes affected and,<br />

in turn, these cells also provide a source<br />

of further inflammatory mediators mostly<br />

of the prostaglandin type (see later).<br />

When a generalised inflammatory<br />

response of the anterior segment<br />

develops, a patient is likely to report<br />

some type of ocular discomfort,<br />

including foreign body sensation,<br />

which can progress to a dulled pain<br />

feeling that may also be associated<br />

with a progressive development of<br />

photophobia. In rare cases far more<br />

substantial pain can develop, especially<br />

as associated with eye movement,<br />

because of the generally inflamed t<strong>issue</strong>,<br />

which includes the extraocular muscles<br />

and their connective t<strong>issue</strong> sheaths.<br />

Part of the general discomfort is caused<br />

by general or localised vasodilatation<br />

and t<strong>issue</strong> oedema that accompanies<br />

the inflammation. For the most part, in<br />

the majority of cases of anterior segment<br />

inflammation, the t<strong>issue</strong> oedema is<br />

superficial and associated with blood<br />

vessels close to the conjunctival surface,<br />

whether <strong>this</strong> is at bulbar, palpebral or<br />

fornical regions, or a combination of<br />

these. This can often result in the patient<br />

wanting to rub their eyes and actually<br />

worsening any redness and puffiness of<br />

the conjunctiva and lid margins. Overall,<br />

these responses are all inflammatory<br />

in nature, but can be associated with<br />

bacteria or carry the risk of being infected.<br />

The redness can, however, be more<br />

localised to a certain region of the<br />

ocular surface (bulbar or palpebral<br />

conjunctiva) and <strong>this</strong> forms the basis<br />

(in part) of a differential diagnosis for<br />

the various conditions. Vasodilatation<br />

of the more superficial vasculature<br />

across the bulbar conjunctiva should<br />

be self-evident (especially if assessed<br />

by slit-lamp biomicroscopy), but any<br />

concern that deeper lying blood vessels<br />

have been affected (ie, as in scleritis)<br />

could be checked with a simple<br />

‘blanching’ test, ie, instil phenylephrine<br />

2.5% eye drops and assess the<br />

extent of clearing of the hyperaemia.<br />

Conditions such as contact lens<br />

associated papillary conjunctivitis<br />

(CLPC) are well defined by the<br />

terminology, ie, the inflammation is<br />

clearly associated with papillae, which<br />

are located across the tarsal surface<br />

and associated with localised regions<br />

of thickening (hyperplasia) of the<br />

conjunctival epithelium. The progression<br />

of the inflammation and thus the increase<br />

in the grade of CLPC 3 could therefore

e localised to the hyperplastic<br />

regions, and while <strong>this</strong> has not been<br />

well-documented in systematic<br />

studies, it is likely associated with<br />

increased risk of discrete focal<br />

‘staining’ with sodium fluorescein<br />

(NaFl) across the tarsal plate. In<br />

related conditions such as vernal<br />

keratoconjunctivitis (VKC) or atopic<br />

keratoconjunctivitis patients with<br />

conjunctival or corneal conditions,<br />

the hyperplasia is so substantial<br />

that the ‘hardened’ focal regions of<br />

the palpebral surface are sufficient<br />

to essentially cause mechanical<br />

damage to the corneal epithelium<br />

and a central or more peripheral<br />

‘shield’ ulcer can develop. 4-6<br />

Accompanying the CLPC can be<br />

an aggregation of white blood cells under<br />

and/or within the palpebral conjunctiva<br />

(whereas the normal, non-inflamed<br />

palpebral conjunctiva and parenchyma<br />

should contain few, if any, white blood<br />

cells). Illustrated in Figure 1 is a high<br />

magnification electron micrograph from a<br />

rabbit with mild follicular conjunctivitis, 1<br />

where a presumed PMN (white arrow) and<br />

macrophages (black arrows) are found<br />

in abundance. A likely consequence<br />

of the presence of these inflammatory<br />

cells is an alteration of the goblet cells<br />

and their secretions of mucous. As<br />

a result, in some cases of ‘follicular’<br />

conjunctivitis, and more especially in<br />

VKC, it is entirely possible that a thick<br />

‘mucoid’ discharge may line the furrows<br />

or groves between papillae and follicles,<br />

and also be present at the lower fornix.<br />

Such aggregates of white blood<br />

cells may also invade the superficial<br />

epithelium of the limbus and even the<br />

peripheral cornea, having migrated from<br />

the peri-limbal vascular arcade. As with<br />

the conjunctival epithelium (Figure.<br />

1), the corneal epithelium cells will<br />

become increasingly disorganised by the<br />

presence of extra cells (ie, the invading<br />

macrophages and even PMNs). This has<br />

a very important consequence since a<br />

cluster of white blood cells will distort<br />

the superficial (squamous) cell layers and<br />

the immediately underlying intermediate<br />

Figure 1<br />

Transmission electron micrograph of the palpebral<br />

conjunctiva, to show the presence of goblet cells<br />

with slightly heterogeneous paler-staining granules<br />

associated with the presence of white blood<br />

cells (marked by white and black arrows) within<br />

and under the conjunctiva. Copyright Australian<br />

Association of Optometrists. Reproduced from<br />

Doughty and Bergmanson 2<br />

(wing) cells, so progressively disrupting<br />

the tight junctions between superficial<br />

epithelial cells. In early stages of an<br />

inflammatory response affecting the<br />

limbus and/or peripheral cornea, the<br />

surface may not be ‘broken’, ie, the<br />

white blood cell infiltrates are under<br />

the surface. However, at some stage,<br />

the surface may be breached as in<br />

some cases of limbitis associated with<br />

reaction to contact lens care solutions,<br />

in contact lens associated peripheral<br />

‘ulcers’ (CLPU) (OT, November 12<br />

2010), or a range of other inflammatory<br />

conditions affecting the limbus. 4-6<br />

The focal inflammation may also be<br />

a reaction to microorganisms and/or<br />

their metabolic products, eg, to bacterial<br />

toxins (see later), or in later stages of<br />

epidemic keratoconjunctivitis (EKC)<br />

associated with adenoviral infections.<br />

The infiltrates, usually more easily seen<br />

in the peripheral cornea, have a circular<br />

shape reflecting aggregation around<br />

a focal site where the stimulus<br />

for white blood cell migration is<br />

located (Figure 2). In conditions<br />

such as VKC, the aggregates can<br />

become sufficiently dense to be<br />

evident as raised limbal nodules.<br />

Any infiltrate cluster can result in a<br />

compromise of the surface barrier and<br />

the net result is discrete regions of<br />

NaFl ‘staining’ (Figure 2). Whenever<br />

there is a break in the surface, no<br />

matter how small, there will be<br />

continued migration of white blood<br />

cells to that location (see later). In<br />

management of these inflammations,<br />

the goal is both to reduce the<br />

aggregation of white blood cells and<br />

promote their removal, and to regain<br />

the integrity of the ocular surface<br />

barriers especially across the cornea.<br />

There are several relevant College<br />

of Optometrists Clinical Management<br />

Guidelines (CMGs) that should be<br />

consulted, namely ‘CL-associated<br />

papillary conjunctivitis’, ‘Keratitis – CLassociated<br />

infiltrative’, and ‘Keratitis –<br />

marginal’, ‘Ocular Rosacea’, ‘Episcleritis’,<br />

‘Corneal abrasion’ and ‘Recurrent<br />

corneal epithelial erosion syndrome’.<br />

Pharmacology of antiinflammatory<br />

drugs and<br />

options for optometrists<br />

Anti-inflammatory drug treatment, for<br />

the types of conditions outlined above,<br />

are mainly directed towards controlling<br />

the inflammatory response, but also<br />

promoting wound healing. In general<br />

terms, macrophages underpin the<br />

initial inflammatory response and then<br />

are largely responsible for removing<br />

(by phagocytosis) those secondarily<br />

recruited PMN leukocytes so as to end<br />

the inflammatory reaction. The latter is<br />

especially important in cases of recurrent<br />

corneal erosion syndrome (see later)<br />

where the failure to completely re-heal<br />

the epithelial surface drives a recurrent<br />

cycle of recruitment of inflammatory<br />

cells that re-disrupt the epithelial barrier.<br />

The prostaglandins that drive the<br />

inflammatory response are derived from<br />

43<br />

10/12/10 CET



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Figure 2<br />

Limbal epithelium infiltrates of white blood cells,<br />

also extending just into peripheral cornea, arising<br />

from an inflammatory response to a contact lens<br />

care solution. Image courtesy of the Bausch & Lomb<br />

picture library [www.bausch.com/en_US/ecp/<br />

resources/image_libary].<br />

cell membrane phospholipids, both<br />

externally and internally. A sequence<br />

of enzyme-mediated reactions results<br />

in the release of a pro-inflammatory<br />

precursor molecule, a ‘lipid autoacid’<br />

called arachidonic acid (a type of<br />

unsaturated fatty acid), with a cell<br />

membrane-associated phospholipase A2<br />

enzyme being a notable activity. This<br />

enzyme activity is indirectly regulated<br />

by natural immune modulators such<br />

as glucocorticosteroids and can be<br />

inhibited by exogeneous cortisosteroids<br />

used as anti-inflammatory drugs. 7,8 The<br />

mechanism of inhibition, by drugs such<br />

as hydrocortisone and prednisolone,<br />

is complex; both are used as eye drops.<br />

It involves both that the corticosteroid<br />

binds to the affected cells and be<br />

translocated to the cell nucleus, and that<br />

there is an elaboration of an intracellular<br />

peptide messenger called lipocortin-1.<br />

If the inflammatory response is not<br />

blocked at <strong>this</strong> level by exogenous<br />

corticosteroids, then continuing activity<br />

of phospholipase A2 results in more and<br />

more arachidonic acid being produced to<br />

start an inflammatory cascade involving<br />

cycloxygenase COX-1 and COX-2<br />

enzymes. 8,9 In normal t<strong>issue</strong>s, there will<br />

always be some COX-1 activity to convert<br />

arachidonic acid into pro-inflammatory<br />

prostaglandins, but <strong>this</strong> conversion<br />

is augmented by an inducible COX-2<br />

(ie, higher levels of enzyme produced<br />

in chronically inflamed t<strong>issue</strong>s) that<br />

will produce the same or other proinflammatory<br />

prostaglandins. All of<br />

these cyclooxygenase activities can<br />

be inhibited by aspirin-like drugs, the<br />

Non-Steroidal-Anti-Inflammatory Drugs<br />

(NSAIDs). The NSAID most relevant<br />

to management of anterior segment<br />

inflammation is diclofenac eye drops.<br />

In more recent years, increasing<br />

attention is being given to other natural<br />

pro-inflammatory biochemical pathways<br />

and anti-inflammatory mechanisms<br />

involving ‘protective lipid mediators’. 2<br />

There are three aspects of these that<br />

deserve consideration for future<br />

therapeutic options. The first of these is<br />

the enzyme lipoxygenase (specifically<br />

LOX-15) that is present in the epithelia,<br />

and generates both an anti-inflammatory<br />

and ‘pro-inflammatory resolving’<br />

prostaglandin-like molecules such as<br />

lipoxin A4. The lipoxin pathway is<br />

considered important in inflammation<br />

and epithelial resurfacing control. Other<br />

unsaturated fatty acid-type products<br />

from <strong>this</strong> pathway such as 12(S)- and<br />

15(S)-HETE have been shown in animal<br />

models to be substantially elevated<br />

following continuous wear of contact<br />

lenses, associated with development<br />

of inflammatory cornea oedema and<br />

corneal neovascularisation. 10 A set of<br />

other lipoxin pathway-related molecules<br />

are peptides such as the resolvins, which<br />

have been reported in animal studies to<br />

reduce the severity of experimentallyinduced<br />

ocular surface inflammation. 11<br />

The resolvins are derived more from<br />

another polyunsaturated fatty acid<br />

(PUFA) which has received considerable<br />

attention in relation to inflammation of<br />

the ocular surface and the Meibomian<br />

glands, namely the omega-3 compound<br />

docosahexaenoic acid (DHA). 2,12<br />

Contact lens wear-related<br />

papillary conjunctivitis and<br />

related conditions<br />

As noted in the previous article<br />

(OT, November 12 2010), the ideal<br />

management of CLPC involves<br />

discontinuation of contact lens wear<br />

followed by a four-times-daily (QDS)<br />

regimen of a mast cell stabilizer such<br />

as sodium cromoglicate. 13-16 The logic of<br />

such a treatment might be questioned<br />

since sodium cromoglicate is not<br />

considered to have any constitutive<br />

anti-inflammatory activity; the removal<br />

of the stimulus to inflammation should<br />

help and better results might be obtained<br />

with other mast cell stabilisers/antieosinophil<br />

drugs such as lodoxamide or<br />

nedocromil sodium (both available to AS<br />

optometrists). The treatment, whilst the<br />

patient has stopped lens wear, should be<br />

continued until the eyelid inner surface<br />

is quiet and any ‘staining’ of papillae is<br />

reversed. 13,14 Depending on severity, most<br />

resolution should take two to four weeks,<br />

after which the dosing could be reduced<br />

to TDS or BDS for a further two to three<br />

weeks to ensure complete resolution. 14,16<br />

This approach should work for mild<br />

to moderate CLPC, but more severe<br />

cases of GPC (with notable conjunctival<br />

hyperplasia) may require a short<br />

period topical corticosteroid treatment.<br />

This would require referral to an IP<br />

optometrist (preferably one specialising<br />

in conta ct lenses) or an ophthalmologist.<br />

The topical corticosteroid therapy should<br />

reduce conjunctival vessel leakiness<br />

within a few hours, 17 reduce PMN<br />

leukocyte recruitment and migration<br />

into the conjunctiva (extravasation), 18,19<br />

and reduce any further elaboration<br />

and secretion of other inflammatory<br />

mediators by the leukocytes. 20 A short<br />

term topical ocular corticosteroid<br />

regimen (eg, prednisolone 0.5% or 1%<br />

gtt, QDS, for two to three weeks) may be<br />

beneficial in substantial cases of GPC, as<br />

opposed to CLPC, associated with soft<br />

lens wear. 21 By current perspectives,<br />

regular lens replacement, improved<br />

lens hygiene and patient education are<br />

considered the mainstay of preventing<br />

CLPC/GPC from developing in the first<br />

place, 22 but a short course of topical<br />

ocular corticosteroids can be used simply<br />

to manage discomfort, photophobia

and also improve appearance by<br />

reducing conjunctival hypaeremia. 23<br />

Long-term and/or extended wear of<br />

contact lenses may result in marginal<br />

keratitis, which is a mild-to-moderate<br />

inflammatory response that is often<br />

refractory to management. While the<br />

tarsal plate may not show an exaggerated<br />

reaction, such inflammatory reactions<br />

now likely include a hardening of<br />

the palpebral conjunctival infiltrates.<br />

Corneal infiltrates and even larger deep<br />

stromal infiltrates, as opposed to small<br />

and localized peri-limbal infiltrates, can<br />

also develop. 3,16,24,25 Such conditions are<br />

less likely to be acute in presentation but<br />

progressive. A further extension of such<br />

reactions may be the development of<br />

neovascularization or deeper infiltrates<br />

(in the palpebral conjunctiva, corneal<br />

epithelium or stroma) both of which are<br />

the clear signs of an extended recruitment<br />

of inflammatory cells in response to<br />

persistent irritation. It is likely that<br />

any patient with such infiltrates will<br />

show low grade corneal and bulbar<br />

conjunctival staining with NaFl. The<br />

presence of just a mild inflammation,<br />

as might be expected in many cases of<br />

contact lens wear-associated superior<br />

epithelial arcuate lesions (SEALs), can<br />

likely be managed without corticosteroids<br />

(ie, discontinue lens wear). The more<br />

substantial cases are likely accompanied<br />

by notable peri-limbal reaction, the<br />

presence of neovascularisation, perilimbal<br />

or peripheral corneal infiltrates<br />

with an accompanying anterior<br />

chamber reaction. For these, along with<br />

stopping contact lens wear for several<br />

weeks, an aggressive but carefully<br />

monitored treatment with topical ocular<br />

corticosteroids may well be needed. 16,24<br />

Similarly cautious use of topical<br />

ocular corticosteroids might also be<br />

appropriate to help manage the initial<br />

gross inflammatory response in contact<br />

lens associated acute red eye (CLARE),<br />

concurrently with intensive antibiotic<br />

coverage. Some might argue that it<br />

is best to discontinue lens wear and<br />

let the eye quieten down on its own,<br />

Figure 3<br />

Presumed angular blepharo-conjunctivitis caused by Staphylococcus sp. Associated with slight limbic<br />

reaction and peripheral corneal infiltrates. Figure courtesy of Gartnavel Hospital Eye Department, Glasgow.<br />

but the presence of t<strong>issue</strong> oedema<br />

and substantial peripheral infiltrates<br />

may need the judicious use of strong<br />

anti-inflammatory drugs such as<br />

corticosteroids. Patience is required<br />

in monitoring such patients to decide<br />

on the most appropriate intervention.<br />

A case can be made that substantial<br />

signs of inflammation need to verified<br />

and carefully documented before<br />

corticosteroid use is justified. The<br />

efficacy of the topical corticosteroid<br />

therapy should be assessed with the<br />

expectation of reduced symptoms and<br />

biomicroscopy performed to confirm<br />

the reduction of oedema, quieting of<br />

the vasculature, reduction in infiltrates<br />

and anterior chamber reaction. 26 The<br />

infiltrates should be examined (and<br />

graded) to check for resolution. 27 For<br />

contact lens wearers, it can be noted<br />

that the removal of the offending contact<br />

lens in itself should reduce most of the<br />

exogenous inflammatory stimulus and<br />

so the steroid therapy is really to arrest<br />

the further development of inflammatory<br />

cell recruitment and to promote recovery.<br />

Contact lens wear might be reconsidered<br />

after a suitable abstention (eg, a few weeks<br />

after cessation of corticosteroid therapy).<br />

Overall, the same principles for use<br />

and follow-up of corticosteroids would<br />

apply for cases of non-specific keratitis<br />

associated with limbal inflammation<br />

in the absence of contact lens wear, ie,<br />

more substantial cases of limbitis or<br />

superficial (punctuate) limbal keratitis<br />

including those associated with<br />

VKC, 4,5 or atopic keratoconjunctivitis. 6<br />

Marginal keratitis in the<br />

absence of contact lens wear<br />

As noted earlier, non-infectious<br />

inflammatory conditions such as VKC<br />

can be associated with marginal keratitis<br />

and can even progress to substantial<br />

corneal epithelial problems such as noninfectious<br />

(shield) ulceration. There<br />

is another cause of marginal keratitis<br />

that has an association with infectioncausing<br />

bacteria but is not necessarily<br />

infected. Such a condition used to be<br />

referred to as a ‘sterile inflammation’,<br />

now recognised to be a rather special<br />

inflammatory response to toxins secreted<br />

by bacteria eg, from certain strains of<br />

Staphylococcus aureus, S. epidermidis or<br />

the Propionibacterium acnes associated<br />

with rosacea and related conditions. 28,29<br />

These spread from the eyelid margins via<br />

the tear film to the edge of the cornea,<br />

and can result in additional marginal<br />

infiltration and even ulceration of the<br />

superficial corneal epithelium at the<br />

45<br />

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limbus, 30-33 which will likely show<br />

as punctuate localised staining with<br />

NaFl. This is more likely to occur<br />

when there is a hypersensitivity<br />

to the toxins, and would be<br />

a limbitis or superior limbic<br />

keratoconjunctivitis (SLK) with<br />

an indirect infectious aetiology.<br />

Such toxins can also be a cause of<br />

peripheral infiltrates in a contact<br />

lens wearer that may be mistaken<br />

for peripheral infectious ulcers.<br />

They can progress, if not managed<br />

carefully, to the development<br />

of severe corneal ulceration.<br />

That the condition is largely<br />

inflammatory in nature can be<br />

established by the nature of the<br />

signs that can include notable ‘angular’<br />

blepharitis (Figure 3) associated with<br />

both a limbal inflammatory reaction<br />

and peripheral corneal infiltrates.<br />

If the signs indicate infection (ie,<br />

the presence of some mucopurulent<br />

discharge as opposed to simply<br />

excessive lacrimation), then antibiotic<br />

treatment would be appropriate, eg,<br />

with chloramphenicol or even fusidic<br />

acid viscous eye drops. 32,34 Good eyelid<br />

margin hygiene should also reduce the<br />

recurrence of the condition, but recurrent<br />

and stubborn inflammatory episodes<br />

may also need topical corticosteroid<br />

treatment (eg, prednisolone 0.5% QDS<br />

for a few days) to generally quieten the<br />

eye, reduce lacrimation and photophobia<br />

as well as reduce further development<br />

of corneal infiltrates .27,30,35 As an<br />

inflammatory condition, some limbitis<br />

cases may respond to topical mast cell<br />

stabilizers (eg, regular use of sodium<br />

cromoglicate over one month). 31 Adjunct<br />

measures could also include the use of<br />

dark sunglasses, as well as the as-needed<br />

use of artificial tears to promote comfort.<br />

Other conditions where marginal<br />

infiltrates can occur include sequelae<br />

following adenoviral infections. In some<br />

cases it may prove difficult to distinguish<br />

between infiltrates being associated with<br />

bacterial toxins or a similar immunemediated<br />

response to the virus in<br />

Figure 4<br />

Plot to illustrate relative effects of use of a surface<br />

analgesic (diclofenac eyedrops; blue line; data from<br />

Aragona et al. 44 ) as compared to a topical ocular<br />

anaesthetic (oxybuprocaine eyedrops; red line;<br />

data from Naase et al. 45 ) on the touch sensitivity of<br />

the corneal surface to a nylon filament.<br />

epidemic keratoconjunctivitis (EKC),<br />

ie, the former could also be spread from<br />

one eye to the other and even between<br />

individuals if peri-ocular and facial<br />

hygiene were poor. Notwithstanding,<br />

if substantial infiltrates are seen to be<br />

developing then judicious use of topical<br />

corticosteroids is again appropriate.<br />

Non-perforating foreign body<br />

injury and trauma to the<br />

anterior eye<br />

Abrasions or other forms of nonpenetrating<br />

foreign body injury to the<br />

cornea or conjunctiva will likely elicit<br />

initial pain followed by considerable<br />

discomfort associated with an<br />

inflammatory response. In contact lens<br />

wearers, <strong>this</strong> could be caused by grit<br />

under the lens or a fingernail during<br />

lens insertion or removal. As recognised<br />

many years ago, as long as there is<br />

an open “wound” (ie, an epithelial<br />

defect), macrophage and then leukocyte<br />

recruitment is likely to continue. 36 The<br />

sooner a superficial wound resurfaces,<br />

the faster the secondary recovery<br />

stage of the inflammation (see later).<br />

In A&E as well as in optometric<br />

practice, coverage with an antibiotic<br />

will likely be considered appropriate,<br />

eg, chloramphenicol eye ointment<br />

or fusidic acid viscous eye drops. 37<br />

Substantial eyelid patching is no<br />

longer recommended. 38,39 Patients<br />

need to be instructed to continue<br />

the antibiotic coverage for a few<br />

days, whether <strong>this</strong> be QDS for<br />

chloramphenicol or BDS for fusidic<br />

acid. In many cases, however,<br />

infection is not apparent nor does it<br />

develop but the antibiotic coverage<br />

is a sensible precautionary measure.<br />

Since the abrasion can be rather<br />

painful, systemic analgesics are often<br />

required. Lesser presentations can often<br />

be managed with the patient’s preferred<br />

systemic analgesic but there is only<br />

limited data from organised trials as to<br />

whether an oral NSAID (eg, ibuprofen 400<br />

mg, TDS) is sufficient or whether patients<br />

would be better managed with an NSAIDnarcotic<br />

combination (eg, paracetamol<br />

500 mg with codeine or dihydrocodeine 7<br />

to 8 mg QDS); these options are available<br />

as P Medicines in the UK, for use by adults<br />

(not children less than 12 years of age).<br />

AS and IP-trained optometrists can<br />

also access the same topical NSAIDanalgesic<br />

preparation as used in some<br />

A&E departments, namely diclofenac<br />

sodium eye drops. This is available<br />

in unit-dose form as PoM Voltarol<br />

Ophtha. The successful use of eye drops<br />

containing an NSAID in the management<br />

of corneal abrasions has been reported<br />

in organised trails, with the key effect<br />

being improved patient comfort through<br />

reduced blepharospasm from the<br />

analgesic activity (Figure 4). 40,41 This<br />

surface analgesia is different from surface<br />

anaesthesia, ie, the patients are still able<br />

to sense a foreign body (or similar) and<br />

feel if anything touches their eye. A single<br />

use of a topical ocular anaesthetic may<br />

well be a necessity to allow a patient’s<br />

eye to be opened and examined after an<br />

abrasion or foreign body injury, but is not<br />

to be used as a means of controlling pain

in the longer term. 9,43 While (sadly)<br />

<strong>this</strong> is still sometimes done (either by<br />

a health care professional prescribing<br />

the eye drops, or self-initiated by a<br />

patient after ‘stealing’ a bottle of the<br />

‘magic’ eye drops from the attending<br />

health care professional), the selfuse<br />

of a topical anaesthetic can<br />

result in such devastating corneal<br />

problems that a transplant is needed.<br />

Thus there is an important<br />

distinction between surface<br />

analgesia and anaesthesia which<br />

can be assessed by measuring the<br />

mechanical (touch) sensitivity of the<br />

cornea with the nylon filament of a<br />

Cochet-Bonnet aesthesiometer, 44 the<br />

longer the filament length (in mm)<br />

that can be detected, the greater the<br />

sensitivity. Similar results would<br />

be expected if a dry Q-tip or wisp<br />

of soft t<strong>issue</strong> paper were touched to<br />

the eye. As shown in Figure 4, even<br />

repeated use (four drops repeated at<br />

five min intervals) of diclofenac 0.1%<br />

eye drops would not be expected to<br />

reduce touch sensitivity by more than<br />

25% in a normal eye, while a single<br />

drop of topical anaesthetic should<br />

essentially remove corneal touch<br />

sensitivity within five min or less. 45<br />

The usually recommended use<br />

of diclofenac for corneal abrasions<br />

would likely be to instil two or more<br />

drops prior to the antibiotic, with the<br />

patient being supplied with a few<br />

more single dose units (eg, one or two<br />

packs of 5) to repeat the treatment<br />

over the next two to three days on a<br />

QDS basis. It would likely be better<br />

to recommend such regular use to<br />

ensure good antibiotic coverage,<br />

rather than reducing to BDS (as<br />

might be acceptable for adequate<br />

analgesia). Even much longer-term<br />

use of topical ocular NSAIDs (eg, as<br />

a routine post-operative treatment<br />

for several weeks after cataract<br />

surgery) has not been reported<br />

to produce much more surface<br />

analgesia to that shown in Figure 4.<br />

The main <strong>issue</strong>s in following-up<br />

management of abrasions, especially<br />

of the cornea, are to consider how well<br />

the wound is healing (with appropriate<br />

NaFl staining assessments). Many<br />

mechanical wounds should show good<br />

signs of healing within 24 hours and if<br />

<strong>this</strong> does not occur then the eye should be<br />

considered at risk for recurrent episodes<br />

of un-healing and re-healing, a condition<br />

now usually referred to as recurrent<br />

corneal epithelial erosion syndrome.<br />

A series of deep and centrally located<br />

abrasions from a paper edge cut are show<br />

n in Figure 5. The abrasion may also be<br />

geographic (ie, covering a large area).<br />

Some will advocate routine short-term<br />

management of substantial abrasions with<br />

a large diameter ‘bandage’ soft contact<br />

lens, 46,47 although such patients need to<br />

monitored carefully for lens adhesion<br />

or other complications. 48 The bandage<br />

lens can be of the daily disposable type<br />

so avoiding any <strong>issue</strong>s in lens care and<br />

disinfection. 49 Bandage (soft contact)<br />

lenses have been used concurrently with<br />

an NSAID such as diclofenac (preferably<br />

in its unit-dose preservative-free form,<br />

PoM Voltarol Ophtha), 50,51 and may also<br />

be used with antibiotics (eg, Minims<br />

chloramphenicol) on a BDS basis. 52<br />

Either of such treatments need to be<br />

carefully monitored by regular follow-up.<br />

The logic behind use of a bandage lens,<br />

with or without adjunct medications that<br />

could even include topical corticosteroid<br />

therapies, 53,54 is to promote re-adherence<br />

of the lifted edges of the epithelium<br />

and so facilitate spreading of dividing<br />

Figure 5<br />

Substantial central corneal abrasion from paper<br />

edge. Image courtesy of the Bausch & Lomb picture<br />

library [www.bausch.com/en_US/ecp/resources/<br />

image_libary].<br />

epithelial cells across the abraded<br />

region. The use of a bandage lens may, in<br />

itself, reduce the dull discomfort (pain)<br />

of the abrasion so making additional<br />

topical analgesia unnecessary (although<br />

systemic analgesics may still be<br />

wanted). Eyelid movement across lifted<br />

edges of an abrasion may exacerbate<br />

<strong>this</strong> and/or the non-wetting surface of<br />

the lesion may adhere to the overlying<br />

palpebral conjunctiva (which is likely<br />

to be inflamed due to the response to<br />

the abrasion). The latter may result in<br />

well-known characteristic symptoms<br />

that should alert the patient (as well<br />

as the optometrist) that recurrent<br />

erosion is a problem; the symptoms<br />

typically involve sudden-onset ‘sharp’<br />

pain in the affected eye on waking or<br />

even during sleep as the movement<br />

of the lids detaches the epithelium. 55<br />

Other symptoms will include tearing,<br />

photophobia and blurred vision as the<br />

eye responds to the re-wounding of<br />

the corneal (or conjunctival) surface.<br />

Once recurrent erosion episodes have<br />

started, it may take many weeks,<br />

months or even years to resolve. 48<br />

Current opinion on the mainstay<br />

of management of recurrent erosion<br />

syndromes is to keep the eye well<br />

lubricated, day and night. 56 This<br />

involves use of preservative-free<br />

simple artificial tears (as needed) and<br />

application of a preservative-free bland<br />

ointment (eg, P Lacrilube or P Simple<br />

Eye Ointment) prior to retiring to bed<br />

for as long as it takes such that a<br />

re-current episode does not occur.<br />

Patients should be reviewed<br />

regularly (eg, once a month) to<br />

assess the condition of the corneal<br />

epithelium and the epithelial<br />

interface with the corneal stroma<br />

for any signs of disturbance,<br />

breaks or inflammation. This<br />

inflammation could extend<br />

to the corneal endothelium<br />

(eg, as pseudoguttata) or even be<br />

evident in the anterior chamber as<br />

flare and even cells as the bloodocular<br />

barrier is compromised by<br />

ongoing development of inflammation.<br />

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Figure 6<br />

Mild localised reddening of conjunctiva and<br />

episcleral t<strong>issue</strong> of unknown aetiology. The slight<br />

mucous accumulation at the inferior fornix should<br />

be noted as well. Figure provided Courtesy of<br />

Gartnavel Hospital Eye Department, Glasgow.<br />

Therapeutic use of mydriatic/<br />

cycloplegics<br />

Over many years of largely ad-hoc<br />

and anecdotal evidence, it has become<br />

customary to provide a special sort of<br />

palliative therapy for cases of corneal<br />

abrasions and foreign bodies. This<br />

has involved the use of a mydriatic/<br />

cycloplegic. Its use could also be<br />

considered in the immediate aftermath<br />

of a recurrent erosion episode. It is<br />

a controversial <strong>issue</strong> with different<br />

arguments being presented as to whether<br />

it serves to reduce reactive miosis (ie,<br />

relieve pupil spasm that can occur with<br />

substantial release of prostaglandins into<br />

the anterior chamber following activation<br />

of the innate immune response) and/or<br />

ciliary (body) spasm, or whether the use of<br />

the cycloplegia serves to reduce ongoing<br />

cell-mediated inflammation by beneficial<br />

reduction of blood flow in the uveal and<br />

iris vasculature. In either case, anecdotal<br />

accounts indicate that photophobia<br />

could be reduced as well if there really<br />

was an inflammatory response. An<br />

equally important <strong>issue</strong> is more one of<br />

preventing sequelae from substantial<br />

intraocular inflammation and whether the<br />

immediate use of a cycloplegic/mydriatic<br />

will reduce the risk of iris adhesions to<br />

the crystalline lens that could ultimately<br />

develop into posterior synechiae.<br />

Traditional cycloplegics included<br />

atropine (eg, 0.5% or 1% eye drops used<br />

BDS, or 1% ointment applied prior to<br />

pressure patching) and homatropine (2%<br />

or 5% administered at least BDS). Both<br />

would be expected to exert extended<br />

‘therapeutic’ effects on the iris and ciliary<br />

body (along with similarly prolonged<br />

effects on vision due to substantial<br />

mydriasis and cycloplegia) and both of<br />

these are available to AS optometrists.<br />

However, the non-therapeutically trained<br />

optometrist can only access the shorteracting<br />

cyclopentolate for <strong>this</strong> purpose and<br />

so the frequency of instillation may need<br />

to be increased to TDS, or even QDS in<br />

substantial abrasions and/or those with<br />

darkly pigmented irides, for example.<br />

Other inflammations of the<br />

anterior segment<br />

There are numerous other commonly<br />

occurring inflammatory conditions<br />

of the anterior segment that may<br />

present to optometrists. These<br />

include cases of chronic allergic<br />

conjunctivitis unresponsive to routine<br />

treatments (OT, November 12 2010),<br />

advanced presentations of VKC (again<br />

unresponsive to mast cell stabilizer<br />

treatments), ocular rosacea, episcleritis<br />

(of various aetiologies) and, of course,<br />

intraocular inflammations of the<br />

anterior segment associated with the<br />

iris and anterior uvea. It will sometimes<br />

be a dilemma to assess the cause of<br />

such problems (Figure 6) and there<br />

is likely no substitute for seeing such<br />

conditions on a regular basis to establish<br />

a diagnosis and be able to manage them<br />

on a long-term basis. For any patient<br />

with recurrent or chronic inflammatory<br />

conditions of the anterior segment, two<br />

other <strong>issue</strong>s also need to be considered;<br />

namely whether their condition is the<br />

result of an allergic reaction to ocular<br />

or peri-ocular pharmaceuticals or<br />

products (eg, follicular conjunctivitis),<br />

and whether <strong>this</strong> is the result of an<br />

interaction with other (systemic)<br />

medications (including those for any<br />

other form of allergic condition), which<br />

will need to be carefully reviewed.<br />

As noted earlier, any ‘red eye’ with<br />

an inflammatory aetiology (including<br />

episcleritis) will likely respond in the<br />

short term to being kept adequately<br />

lubricated (to offset the effects of<br />

persistent lacrimation) and some<br />

comfort be realized with the judicious<br />

use of a topical ocular decongestant<br />

(eg, naphazoline eye drops). Antiallergy<br />

drops (eg, mast cell stabilizers)<br />

might also have been tried in cases<br />

where allergy is a factor. All of these<br />

conditions can however progress to the<br />

stage where routine use of topical ocular<br />

corticosteroids is needed and sometimes<br />

on a chronic basis. 7,57 Such therapeutic<br />

options are available to IP optometrists<br />

where safe and effective management<br />

of these conditions can be realised.<br />

Summary<br />

A range of fairly common mild-tomoderate<br />

inflammatory conditions of<br />

the anterior segment can present to<br />

optometrists. Many of these conditions<br />

can be managed by optometrists,<br />

especially those with AS and IP<br />

qualifications, and can include more<br />

complex cases of blepharitis and<br />

blepharoconjunctivitis, limbal and<br />

peripheral corneal infiltrates and nonperforating<br />

abrasions and foreign bodies.<br />

Pharmacological options range from<br />

artificial tears and ocular lubricants, to<br />

mast cell stabilisers, topical analgesics<br />

(NSAIDs) and the therapeutic uses of<br />

cycloplegic drugs such as cyclopentolate.<br />

About the Author<br />

Professor Doughty has been teaching<br />

ocular pharmacology, as well as many<br />

aspects of ocular physiology and eye<br />

disease, for over 25 years and authored<br />

books on the subject. He has held the<br />

post of research professor at Glasgow-<br />

Caledonian University, Department<br />

of Vision Sciences, since 1995.<br />

References<br />

See www.optometry.co.uk and search<br />


Module questions<br />

Course code: C-15087 O/AS/SP/IP<br />

1. For anterior segment inflammation, the phenylephrine test:<br />

(a) should indicate if pupil dilation is excessive<br />

(b) should provide an indication of how deep any dilated vessels are<br />

(c) will only work if dilute (0.125%) solutions are used<br />

(d) should be carried out for every patient presenting with a red eye<br />

2. In limbal or peripheral corneal infiltrates, the ocular surface:<br />

(a) can be breached as white blood cells emigrate through the epithelia<br />

(b) will rarely stain with fluorescein because the leukocytes stop <strong>this</strong> occurring<br />

(c) will only be affected if neovascularization is also present<br />

(d) is unlikely to show any signs of vasodilation<br />

3. Which of the following drugs acts as an indirect inhibitor of<br />

phospholipase A2 enzyme?<br />

(a) sodium cromoglicate<br />

(b) naphazoline<br />

(c) diclofenac<br />

(d) hydrocortisone<br />

4. Which of the following daily doses of lodoxamide eye drops would<br />

be commonly recommended to treat grade 2 CLPC?<br />

(a) As needed with or without contact lens wear<br />

(b) BDS whilst continuing contact lens wear<br />

(c) QDS after discontinuing lens wear<br />

(d) QDS whilst continuing lens wear<br />

5. Toxins associated with development of marginal keratitis come from<br />

which organisms?<br />

(a) Staphylococcus aureus<br />

(b) Staphylococcus epidermidis<br />

(c) Propionibacterium acnes<br />

(d) Any of the above<br />

6. For stubborn and recurrent cases of marginal blepharitis, which of<br />

the following treatments can be considered?<br />

(a) prednisolone 0.5% eye drops QDS for a few days<br />

(b) artificial tears as needed for comfort<br />

(c) sodium cromoglicate eye drops for a month<br />

(d) all of the above<br />

7. The following therapeutic drugs are available to additional supply<br />

optometrists EXCEPT:<br />

(a) nedocromil sodium<br />

(b) prednisolone phosphate<br />

(c) diclofenac sodium<br />

(d) cyclopentolate<br />

8. Which of the following statements about superficial limbal keratitis<br />

is TRUE?<br />

(a) It can result from inflammatory reactions to contact lens care solutions<br />

(b) It can be seen in some chronic cases of vernal keratoconjunctivitis<br />

(c) It can be observed in some patients with atopic skin conditions<br />

(d) All of the above<br />

9. Which of the following would be a suitable narcotic analgesic for<br />

optometric use in cases of corneal foreign body injuries?<br />

(a) ibuprofen<br />

(b) dihydrocodeine<br />

(c) diclofenac<br />

(d) aspirin<br />

10. Which of the following statements about pharmacologically-induced<br />

topical ocular analgesia is TRUE?<br />

(a) It would reduce corneal sensitivity to touch by up to 25%<br />

(b) It would remove a patient’s ability to sense further contact or abrasion<br />

from a foreign body<br />

(c) It would promote eyelid closure as a protective (relaxing) mechanism<br />

(d) It would produce equivalent effects to repeated use of oxybuprocaine or<br />

proxymetacaine<br />

11. Which of the following would be a routinely recommended dose for<br />

diclofenac after a corneal abrasion?<br />

(a) QDS for 2 days with or without antibiotic coverage<br />

(b) A single use of the eye drop once only, followed by chloramphenicol for 1 day<br />

(c) As needed over the following 2 to 3 weeks<br />

(d) Every hour for the first day, then reduce gradually<br />

12. Which of the following statements is about the use of cyclopentolate 1%<br />

following a non-penetrating foreign body injury to the eye is TRUE?<br />

(a) Only a single drop is usually used because it is a strong cycloplegic<br />

(b) Dosing may need to be rather frequent (QDS) to obtained the desired effect<br />

(c) The drug may induce an unwanted ciliary spasm<br />

(d) Its effects would be routinely expected to be at least as good as using atropine<br />

49<br />

10/12/10 CET<br />

PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on January 12 2011 - You will be unable to submit<br />

exams after <strong>this</strong> date – answers to the module will be published on www.optometry.co.uk

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