optrafair - Optometry Today

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Four CET
credits
Survey on
visual field
screening
Unveiled at
www.optometry.co.uk March 25 2011 vol 51:6 £4.95
Optrafair
We preview next month’s show

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PLEASE VISIT STAND L40 AT OPTRAFAIR
TO SEE THE FULL COLLECTION.
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optometrytoday
Comment
Who advises the advisors?
AOP clinical advisor Trevor Warburton
discusses a new survey – see pages 42
and 43 – on domiciliary services
News
News
Beatles for Sale
A range of sunglasses utilising the
Fab Four’s images will be launched in
Britain next month
Letters
Your views
Comments from the GOC chief
executive and others
8
Support in Health Bill discussions
The optical sector’s strengths are highlighted
by an MP as the Health Bill continues its
progress at Westminster
5
Become our
fan on Facebook’
7
18
Industry
Show preview
All the fun of the fair
It’s nearly time to visit the NEC
for Optrafair
24
Step into Spring
The new designer range from
Scandinavian Eyewear 20, 21
Optrafair
22
Education, learning and lunch
What to expect at OT Live
next month 36
New research
Survey on visual field screenings
David Craig and Trevor
Warburton report on a new AOP
survey for those working in
domiciliary settings
42-43
http://twitter.com/OptometryToday
Profile
CET
CET
March 25 2011 vol 51:6
7
21
Professor Bruce Evans
The practice owner answers our
20 questions 45
Symptoms of multiple system
atrophy
Dr Richard Armstrong writes in
our ageing vision series 50-54
Intraocular telescopes for macular
degeneration
Brendan Moriarty discusses
this type of treatment 55-58

0151 426 3907
model featured Jaeger London 03
OPTRAFAIR
2011
April 9th - 11th
Stand K.40

NEWS
Health Bill: Support for
optics from MP in discussion
THE IMPORTANCE of optical
services has been highlighted
in the latest discussions on the
Health and Social Care Bill.
Nicky Morgan MP (pictured)
raised concerns about the
commissioning of enhanced eye
care schemes in the Standing
Committee stage of the Bill, and
the optical professions have
welcomed her intervention.
The Loughborough MP
applauded the inclusion of
primary ophthalmic services,
particularly the sight testing
service, within the remit of the
NHS commissioning board.
“It makes sense to utilise
optometric practices to deliver
primary eye care, as they are the
logical partners of hospital-based
ophthalmology,” she said. “That has
been demonstrated with great
success in Wales and Scotland,
where people with eye problems
see their optometrist first, rather
than going to their GPs or to
hospital.”
She commented that in her
constituency, GPs work closely
with opticians and optometrists to
secure “decent treatment”.
“Enhanced eye care services,
such as shared care arrangements
with hospitals and GPs, for pre
and post-operation cataract
assessments and stable glaucoma
management, are currently
commissioned locally. My right
honourable friend the minister
has made it clear that the NHS
commissioning board will devolve
enhanced optometric services
to GP commissioners, and, in the
main, that also makes sense.
“However, optometrists are
concerned about glaucoma
referrals under the NICE guidelines
and community-based acute
services. Managing red eye and
minor eye problems are two
small services that are national
in character and, many believe,
should be commissioned
nationally on the same basis as the
NHS sight test. That would ensure
national coverage and appropriate
protocols and accreditation within
an agreed patient pathway, and
would save money and
transaction costs throughout
the system.”
Speaking for the Optical
Confederation AOP chief executive
Bob Hughes said: “We are very
grateful to Nicky Morgan for
raising these issues in the standing
Committee. She has encapsulated
the main areas where we are
looking to the Government to
seize the opportunity to radically
improve the service and take
pressure off hospital eye clinics.”
Scottish roadshow success
THE AOP ran a week of
roadshows in Scotland based
on the newly issued Making
Accurate Claims booklet
earlier this month. Visiting
Perth, Aberdeen, Edinburgh
and Glasgow, the seminars
saw over 200 people attend
to hear Kevin Wallace
(pictured), author of the
booklet, talk about how the
GOS claiming process works
for Scottish practitioners,
how the regulations
should be interpreted and
give guidance on sample
borderline cases.
The AOP’s Scottish legal
advisers, Brodies, also
attended and gave a talk
and answered questions
regarding the new Protecting
Vulnerable Groups
legislation, which came into
force on February 28.
The roadshows were such
a success that two more are
planned – in Inverness and
Ayr. Further details will be
published in OT as soon as
dates have been confirmed.
�� ��
BRIEFING
Can you help
recover these
stolen items?
OPTOMETRIST DOUGLAS Denny
has turned to the optical press
for help after he was robbed of
his optical instruments, some
which he has used for 40 years.
“I feel as if I have lost an
arm,” he said, telling OT that
the items are of great
sentimental value to him.
The robbery, of Mr Denny’s
brown Samsonite case with
the ‘tools of his trade’ inside,
took place in Portsmouth on
March 18.
“I was going to a concert
and foolishly left the case in the
rear foot well of the car,”
he revealed.
“Stolen were various items
including an Occulus Trial Frame
and two Hamblin diagnostic sets
– ophthalmoscope and streak
retinoscopes – one of which I
had been using since I was a
student 40 years ago.
“You might imagine that
besides being functional
instruments and necessary for
my work as I am now doing
locum work, they are of great
sentimental value too.”
If any reader is offered
them please contact Mr Denny –
01243 572 162 – or the police.
5
25/03/11 NEWS

optometrytoday
MARCH 25 2011
VOLUME 51:6
ISSN 0268-5485
ABC CERTIFICATE OF CIRCULATION
January 1 2009 – December 31 2009
Average Net: 20,203
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Editor-in-Chief: David Challinor
T: 020 7202 8164
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Deputy Editor:
Robina Moss
T: 020 7202 8163
E: robinamoss@optometry.co.uk
Web Editor:
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T: 020 7202 8165
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EFFORTS to dispel ‘the
myths and fears’ regarding
peer review CET was raised
at yesterday’s meeting of
the GOC.
In its previous meeting
the Council had heard
suggestions that the
College of Optometrists
and Local Optical
Committees could help
with the provision peer
review CET.
It has emerged that the GOC’s
head of education and standards
has met with representatives
from the optical bodies to agree
an action plan to increase the
amount of CET available, and
to also increase the take-up of
continuing education among
optical practitioners.
NEWS
GOC hears of efforts to
widen peer review CET
Part of the development
of these aims include using
optical conferences, websites
and journals to inform optical
professionals about peer review
education, and ‘to dispel the
myths and fears surrounding this
type of CET’.
The Council heard that
Linda Kennaugh will produce
a Podcast, and will conduct
interviews on the subject of
peer review CET, and that
the College of Optometrists
will run peer review training
sessions throughout this year.
Also the approval criteria
has been reviewed and
has created a more flexible
framework for activities that
can be approved for peer
review CET points.
In July a workshop will
be held attended by CET
providers to identify ‘remaining
barriers’. The workshop will also
encourage providers produce
more peer review CET.
Yesterday’s meeting also
discussed the GOC’s budget,
which, for 2011-2012, was
expected to be in deficit of
£16,381 after a concerted period
of cost-cutting measures.
Roadshows start Sunday
CONTACT LENS
giant CooperVision
has announced
the return of its
successful ‘Leading
Thinking’ roadshows
which aim to
educate practitioners
about the latest
developments in
clinical practice and
management.
The free-toattend
conference will
make six stops across the
UK throughout March
and April. Starting in
Manchester on Sunday
(March 27), the event
will then head to Cardiff
(March 29), Leeds (March
31), London (April 3),
Birmingham (April 5) and
then returns to London
(April 7).
Delegates will have the
opportunity to hear from
well-known speakers
Professor Noel Brennan, Dr
Philip Morgan (pictured),
Shelly Bansal, Professor
Bruce Evans and Craig
Wilcox.
Key topics covered
during the day-long events,
which have up to eight
CET points available, will
include: Contact lenses
Comment on the news via www.optometry.co.uk
for children; patient
communication; and
corneal demands for
patients of different
ages.
Karl Aberdeen,
professional
relations manager at
CooperVision, said:
“Following positive
feedback from last
year’s roadshow, we
wanted to ensure that
this year was even bigger
and better and continued
to provide genuine value to
attendees in their continued
education and everyday
clinical practice.”
Spaces are limited so
practitioners are urged
to book early to avoid
disappointment. To book visit
www.thejourneyoflife.co.uk,
or telephone 0845 519 3831.

All together now – UK
Beatles Eyewear launch
BEATLES EYEWEAR, the first
optical range bearing the images
of the world’s most famous pop
band, will make their UK debut at
next month’s Optrafair.
The sunglasses collection,
distributed by Dutch company
TOL Brilmonturen, is based on the
group’s 1968 Yellow Submarine
film, and the ten styles, which
come in two colours each (black
and Tortoise brown), are lavishly
illustrated from the animated
feature.
The collection, which is
manufactured by California-based
Revolution Eyewear, was unveiled
at Vision Expo East in New York
last week.
Revolution has signed a license
agreement with Apple Corps
Ltd., the multi-media company
founded by The Beatles, for the
exclusive worldwide rights to
develop certain Beatles’ songs
and imagery for collections
of sunwear and ophthalmic
frames. Gary Martin, president of
Revolution, told US trade paper
Vision Monday (March 9) he was
“honoured” to be involved in
the project, and confirmed his
company is named after one of
the Beatles’ best-known songs.
2010 was ‘best year’ – Marcolin
EYEWEAR GIANT Marcolin
has said that 2010 was the
best yet in its 50-year history.
The Italian business
reported turnover was
€207.7m to December
31, up 15% on 2009, but
a geographic breakdown
revealed Europe lagging
behind other regions (such as
the US, +13.2%) with a 3.9%
Now TOL Brilmonturen
has booked to exhibit at the
Birmingham show after the
surviving Beatles and the widows
of John Lennon and George
Harrison gave their thumbs-up to
the initial range.
“All of the pieces of the Yellow
Submarine line had to get
unanimous acceptance from
Apple Corps board of directors,
which includes Paul McCartney,
Ringo Starr, Olivia Harrison and
Yoko Ono,” said Daan van Driel,
director of TOL Brilmonturen.
“The high standards that Apple
Corps employs, together with
the creativity of the [collection’s]
designer, make these sunglasses
really unique.”
The sunglasses come with a
contemporary front with
artwork from the film on
the inside of the
turnover rise.
Marcolin’s renewal of its Tom
Ford licence from this month to
2022 was said to be important
in terms of the company’s
profitability and turnover,
and was highlighted in the
results. So too its five-year
exclusive licence with Diesel
for sunglasses and spectacle
frames.
temples, and, for the models in
acetate, on the inside of the front
piece. The artwork is covered in a
high-gloss finish and on the outer
side of the temples each model
carries a ‘subdued decoration’ .
“The ten styles are all
contemporary,” said Mr van Driel,
“varying from the famous John
Lennon frame with near round
lenses to stylish black acetate.”
Mr Driel revealed that the
Yellow Submarine was the
debut range for Beatles Eyewear.
“Assuming it has wide market
acceptance, there will be
further collections,” he said. The
collection will be on display at
stand Q53 at Optrafair.
“We are very satisfied with
the record results achieved
in 2010,” said managing
director Massimo Saracchi.
“Our commitment is now to
significantly improve these
results as from 2011, at the
same time validating the
initiatives looking to ensure
new and important growth for
the years to come.”
News updated regularly at www.optometry.co.uk
IN BRIEF
20 year jail term
The trial of Dr Michael Mockovak, the
US laser eye surgery boss featured
in our January 28 edition, has ended
with the surgeon sentenced to 20
years in jail. Dr Mockovak, who cofounded
the Clearly Lasik business,
was found guilty of conspiring to kill
his former business partner. Found
guilty of four of five charges, including
attempted murder and conspiracy
to commit murder against Dr Joseph
King who is Dr Mockovak’s former
brother-in-law, the defendant was
accused of enlisting Russian mobsters
to carry out the crime.
Timing change
The next All Party Parliamentary
Group on Eye Health and Visual
Impairment meeting will take
place earlier than first planned, at
5pm-6pm on Monday (March 28) in
Committee Room 19 at Westminster.
Lord Howe, Parliamentary under
secretary of state for quality at the
Department of Health, will address
the meeting, discussing the Health
and Social Care Bill. To register for the
event, call Philip Chandrapal on 020
7766 4384.
AGMs announced
The annual general meetings of the
AOP and FODO will take place on May
10 at the Novotel St Pancras, London.
The proceedings will start with a
buffet lunch from 12.45pm, followed
by the AGMs, and then a black tie
dinner that evening.
LOC enlists MP
Another MP got behind his local
practice last week with a visit to
discuss issues in the profession and
the Health and Social Care Bill. Henry
Smith, MP for Crawley visited Golding
& Maud where he met owner Mary
Golding and West Sussex LOC chair
Lynn Stacey.
7
25/03/11 NEWS

8
25/03/11 NEWS
NEWS
Ex-director of Sainsbury’s
is new CEO of multiple
VISION EXPRESS
has appointed
former J
Sainsbury
director Jonathan
Lawson as
its new chief
executive
o�cer. The
appointment,
which will take e�ect from May, comes at a
time when the multiple has embarked on a
rebranding of its stores.
Mr Lawson was formerly managing director
of Local Pubs, Greene King plc and before that
retail operations director for the J Sainsbury
convenience division. His retail career has
included working for other leading retail brands
such as Asda and Marks and Spencer.
He said: “I’m very excited to be joining Vision
Express and building on the strengths of this
great brand and the people, who are clearly
very proud of their business. The optical market
is highly competitive and has customers
who demand the very highest levels of value,
service and quality, areas that Vision Express has
focussed on for many years.
“I look forward to meeting their customers
and the team, as well as
learning more about the
business so we can work
together and develop
new ways to drive the
best possible service in
the years ahead.“
It has been reported
that a Vision Express in
Lincolnshire has become
one of the �rst to boast the company’s new
logo following a six-�gure store redesign. The
Scunthorpe branch has undergone a renovation
to mark its 15th anniversary, and, reports The
Grimsby Telegraph (March 14) the work coincides
with a nationwide rebranding of the entire chain.
Owner of the Scunthorpe store, Richard Ogden
told OT: “We were given the opportunity to get
the new branding at the same time as our re�t.
The company has been through several rebrands
in the 15 years since we opened, so it was time to
freshen up.
“Franchise stores are being o�ered the new
logo and branding as and when renovation work
takes place, but I believe the plan is that all ‘VE
owned’ stores are getting the change within the
next 12-18 months,” he added.
Vision Express has more than 320 outlets.
SMC donates £5k to OGS
THE WORSHIPFUL Company of Spectacle
Makers has awarded a £5,000 grant to
Optometry Giving Sight to fund the
development of two optical workshops in
Malawi.
The workshops, which will be used to train
optical personnel in the East African country,
will be located at the Malawi College of Health
and Mzuzu University.
Future optometric technicians will be trained
at the college, and four-year long optometry
course will be introduced at the university.
John Salmon, clerk of the Worshipful
Company of Spectacle Makers, commented:
“We were incorporated in 1629 to direct the
�ght against visual impairment at home. We
are delighted to also support Optometry Giving
Sight’s e�orts to extend that struggle overseas.”
Optometry Giving Sight country manager,
Donna Power (pictured) said: “The
development of these workshops form
an integral part of the overall training
programme for the future of eye care in
Malawi. We are incredibly thankful to the
Worshipful Company of Spectacle Makers,
whose grant will assist in this sustainable and
long-term solution to the lack of accessible
eye care in that African country.”
Comment on the news via www.optometry.co.uk
COMMENT
WHO ADVISES
THE ADVISORS?
Less than 1% of domiciliary
practitioners frequently or always use
an electronic field screener, as the
survey in today’s issue shows. Clearly
it is not part of mainstream domiciliary
practice. The AOP are challenging a
few PCTs who want to enforce this as a
condition of a domiciliary contract.
Increasingly the AOP has to help
with contract compliance disputes or
performance demands which are well
beyond average practice. One example
is a requirement for motility testing in
everyone, or recording a reason why
not. Just another bizarre requirement
which is out of touch with the real
world of optometry.
In most areas, PCTs receive sound
advice about current standards of
practice from optometric advisors, who
do not receive recognition for their
excellent work.
The problem lies with a tiny handful
of advisors who appear not to live in
the real world, unable to differentiate
between basic safe practice, average
standards and their own personal
views. This creates serious problems
for practitioners and for their PCTs who
face unnecessary legal actions.
PCTs assume that the advice they are
getting is appropriate. This minority
is giving their colleagues a bad name.
A desire to improve standards beyond
average is laudable, but it is not a
matter for contract compliance. There
is no training for advisors or defined
common standard and no code of
conduct. The latter is an important
first step and we support the National
Optometric Advisors’ Association in its
efforts to develop such a code.
Trevor Warburton, Clinical Advisor,
AOP Legal Department

If they’re comfortable here,
1,2
they’re comfortable anywhere.
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even when using a computer.
When working at a computer we blink five times less3 , leading to dryer eyes and discomfort.
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flexibility and wettability to ensure patients experience a lens so comfortable they’ll
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Eyes are also shielded by the highest level of UV protection4,5 of any reusable lens.
Talk to your patients today about why ACUVUE ® OASYS ® is the best choice for
computer use.
www.jnjvisioncare.co.uk
1. JJVC Data on File 2006. 84% of patients using the computer more than 25 hours a week agreed strongly/somewhat that ACUVUE ® OASYS ® made them forget they were wearing lenses. N=174. 2. Young G, Riley CM, Chalmers RL, Hunt C. Hydrogel lens comfort in
challenging environments and the effect of refitting with SiH lenses. OVS 2007; 84; 4: 302-308. 3. Patel S, Henderson R, Bradley L et.al. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci, 1991;68:11 888-92. 4. UV absorbing contact lens are
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© Johnson & Johnson Medical Ltd. 2010. Johnson & Johnson Vision Care is part of Johnson & Johnson Medical Ltd.

10
25/03/11 NEWS
BRIEFING
BCLA to o�er
ophthalmologists
lens training
OPHTHALMOLOGISTS ARE being
given an opportunity to train in
�tting contact lenses during this
year’s BCLA Clinical Conference
Exhibition in Manchester.
A special Training Day for
Medics will run on the Friday of
the exhibition (May 27) to increase
their knowledge of contact lens
�tting, types of lenses and how both
regular and coloured contact lenses
can be used for therapeutic cases.
Former BCLA president Dr
Sarah Janikoun, who will present
‘How to �t the irregular cornea’
at the session, said: “The course
is presented by experienced
ophthalmologists under the aegis
of the BCLA and is the opportunity
to gain hands-on manipulation of
various lens types and take part in
an open, friendly discussion about
contact lens management.”
Meanwhile Shelly Bansal
(pictured below) will be the �rst
BCLA president to hold the o�ce for
two consecutive years following a
change in policy by the Association’s
council in London.
Mr Bansal will remain in o�ce
until May 2012 when he will be
succeeded by president elect
Catharine Chisholm.
“Since my term of o�ce began,
there has been a big drive to widen
BCLA membership and to encourage
new delegates to attend the
conference, “ Mr Bansal commented.
“My ambition now is to build on
these initiatives for BCLA 2012 in
Birmingham. I am therefore truly
honoured that the BCLA council has
elected me as president for a
second term.”
NEWS
ID’11 speakers unveiled
ORGANISERS OF
Independents
Day have released
details of the
speaker line-up for
this year’s event on
July 4, claiming it is
one of the
best yet.
Keynote
speaker will be
Andy Edwards
(pictured) who runs
training, personal
development and coachingbased
events in the UK, Europe
and the Middle East focusing
on sales relationships and
communication. Mr Edwards,
who is managing director and
lead consultant with business
coaching company Nine 5 Three
Ltd will address the event’s
audience with ‘I’ve Upped
my Sales – Now Up Yours!’ He
combines his sales and marketing
experience with a background
in behavioural psychology and
NHS OPTICAL voucher values
in England will be unchanged
again this year to remain
at levels set in 2009, the
Government has announced.
Disappointed with the
decision, chief executive
of the AOP, Bob Hughes
(pictured) said: “We
understand why they’ve
done it and we understand
the economic position
the country is in, but they
[the Government] have to
understand they may be
damaging the service people
rely on.
has written a number of selfpublished
books and regularly
contributes to national magazines
and journals. Mr Edwards trains,
consults and coaches with
household names and brands,
including Barclays, Paul Smith, the
Highways Agency and Stannah.
Other speakers include
Jonathon Bench, an optometrist
and former commercial manager
at D&A/Boots, who will o�er
insight into the multiple sector
and what the larger companies
do well, focussing on what
independents can learn
from them.
Accountant Marc
Bennett has specialist
experience in optics will
discuss tips for minimising
tax liability. Abi Grute is a
dispensing optician and
specialist behavioural
trainer and will discuss
the practice conditions
required for business
improvement.
Nick Atkins co-director of
organiser Proven Track Record,
said: “I am delighted with this
year’s line-up which is one of
the best we have ever compiled.
Independents Day will, once
again, deliver a stimulating and
thought-provoking programme
focussed on strategies to
better cope with the turbulent
conditions independent practices
continue to face.”
For more information go to
www.independentsday.co.uk.
Optical voucher values
remain unchanged
“Some colleagues may say
that’s not a great impact on
my practice, but the fact is
cumulatively we are losing
government money.
“We have to explain why
if things go on like this it
will impact on patients.
Eventually this will e�ect
the ability of the profession
to provide the sight
testing service which the
Government relies on.”
In the review of charges
and vouchers, the cost to
patients of prescriptions,
dental charges and hospitalsupplied
items such as
stockings, wigs and fabrics
were increased.

Getting the
balance right
A major educational event coming soon
The latest unique one-day symposium from THE VISION CARE INSTITUTE arrives this April.
Four expert speakers will offer new insights to help you get the clinical balance right in your
practice with your patients. Places are offered without charge to attendees and because
they’re always very popular it’s best to book now to avoid disappointment.
Date Venue Location
Monday 11th April 2011 Royal College of Physicians London
Wednesday 13th April 2011 Royal Armouries Leeds
Key Themes
• Dry eye management
• The science inside contact lenses
• Compliance: latest insights
FREE TO ATTEND
• UV and the eye: latest research findings
• Getting the balance right with silicone hydrogels
• Current trends and the future of CL practice
THE VISION CARE INSTITUTE is a trademark of Johnson & Johnson Medical Ltd. © Johnson and Johnson Medical Ltd. 2011.
11 CET POINTS
(including distance learning)
education through inspiration
The speakers are:
Dr Jason Nichols is a
faculty member at the Ohio
State University College
of Optometry, where he is
responsible for teaching
coursework on the tear film,
dry eye, corneal physiology
and contact lenses. He has authored over 70
peer-reviewed publications and 130 abstracts on
these topics. He is additionally Editor of Contact
Lens Spectrum and serves on the editorial board
for Eye and Contact Lens. He lectures widely all
around the globe.
Dr Philip Morgan is Director
of Eurolens Research and a
senior lecturer in optometry at
The University of Manchester,
United Kingdom. Philip is vicepresident
of the International
Society for Contact Lens
Research and secretary of the International
Association of Contact Lens Educators. He has
authored over 160 papers, primarily relating to
the clinical performance of contact lenses and the
nature of the UK and international contact lens
markets.
Dr Cris Schnider is Senior
Director, Medical Affairs
for Vistakon, where she
provides medical, clinical and
technical support. She is also
an internationally known
speaker and writer, with
over 14 years experience in the field of contact
lens education and research prior to joining the
industry. She is a diplomat in the American
Academy of Optometry and a member of the
International Society for Contact Lens Research.
Lenora Copper is a senior
research and development
scientist at Vistakon. Her
current research is aimed
at the development of the
next generation of products
that will deliver attributes
beyond vision, comfort and health to wearers.
She has participated in numerous research and
development projects in her 15 years including
the role as technical lead for new silicone
hydrogel materials.
Register now at www.thevisioncareinstitute.co.uk or call 0845 310 5347

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more when it comes to their vision. 1 Bausch + Lomb PureVision ® 2 contact lenses with High Definition
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reducing spherical aberration across the entire power range – offering crisp, clear vision, especially
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1. Results from a global survey across 7 countries, 3,800 vision-corrected consumers aged 15-65. Consumers provided incidence of symptoms (dryness, sensitivity, etc), how impactful, when experienced
and benefits of product features most likely to motivate consumers when it comes to eye health/vision correction products. 2. Data on file. Bausch & Lomb Incorporated
© 2011 Bausch & Lomb Incorporated. ®/ denote trademarks of Bausch & Lomb Incorporated. Other product names/brand names are trademarks of their respective owners.

14
25/03/11 NEWS
IN BRIEF
Independents
get sunglasses
promo help
A MARKETING business aimed to aid
independent opticians has launched
a campaign targeted to help small
practices increase revenue from
prescription sunglasses.
The Independent Marketing
Partnership has unveiled its
promotion called ‘The Sunglasses
Collection’ which tries to push the
bene�ts of wearing good quality
sunglasses to the public.
The campaign’s literature,
designed to be sent with patient
recall letters, explains why patients
should protect their eyes with high
quality, stylish sunglasses available
from their independent practice.
Graham Hutchison, MD of the
Partnership, said there is signi�cant
potential to gain extra sales via
prescription sunglasses.
“But this will only happen if
patients are informed of the bene�ts
of wearing them – and of buying
them from independent practices.
At the moment it is mainly the
multiples who are getting the sales,
but this is only because they actively
promote sunglasses to the public.”
For further details: 020 8224 1595.
NEWS
Deal creates online giant
JAMIE MURRAY WELLS’
Glasses Direct has acquired
Sunglasses Shop, a fellow
online optical group,
establishing Europe’s largest
online eyewear retailer.
Prescription Eyewear
Limited, the parent
company of Glasses Direct,
announced that the two
companies will continue to
operate separately, but the
combined companies boast
more than eight million
unique visitors annually
and sells nearly a quarter of a
million pairs per year. Glasses
Direct is Europe’s largest online
retailer of prescription eyewear
and Sunglasses Shop is the
continent’s largest online
retailer of designer sunglasses.
Kevin Cornils, CEO of Glasses
Direct, said: “Sunglasses Shop
is the clear leader in the
sunglasses market, with an
unbeatable selection of over
8,000 frames, all of which are
carried in-stock and available
for guaranteed next-day
delivery. They have unrivalled
knowledge of performance and
sports sunglasses, and are also
the destination for celebrity
MORE THAN 93% of
practitioners successfully
completed retention for
2011/2012 with the GOC by
the Council’s deadline. In total,
93.8% of registrants applied in
time, a 3% increase compared
to 90.4% last year.
For the �rst time this year
registrants were able to
complete their retention
online using the new ‘MyGOC’
system, which allowed them to
submit the registration in a few
minutes.
news and fashion advice, all
key elements for the sunglasses
market.”
Sunglasses Shop, based
in Southend-on-Sea, has
expanded across Europe
with sites now live in twelve
languages, including French,
German, Italian and Spanish.
Its founder and MD, Daniel
Puddick, said: “Working closely
with the management team
and investors at Glasses
Direct will allow us to greatly
accelerate our plans to
grow our business in the
UK, as well as expand our
European business where we
believe there is tremendous
opportunity. We’re excited
to be part of Prescription
Eyewear Limited, and
we share Glasses Direct’s
entrepreneurial vision to
change the way people
feel about buying
eyewear online.”
Both companies’
websites will continue
to operate as separate
brands, with the combined
businesses will have over
100 employees based in
London, Swindon and
Southend-on-Sea. Glasses
Direct’s existing venture capital
investors – Index Ventures,
Highland Capital Partners and
Acton Capital Partners – all
contributed to support the
transaction.
Sunglasses Shop was
established in 2003 Mr Puddick,
a Central St Martin’s graduate,
and marketing director Dagmara
Alicja Barcz, an ex-innovation
consultant.
The company is based in
London and Swindon and
employs 75 sta�. Glasses Direct
was founded in 2004 by Mr
Murray Wells (pictured) and is
now backed by three leading
European venture capital �rms.
GOC gets 93% response
Philip Hallam, GOC head
of registration, said: “We’re
delighted to see so many
more registrants complete
their retention by the
deadline. We’ve had a lot of
good feedback about the
new online system and it’s
really encouraging to see in
these results that it’s making
retention easier for registrants.
We look forward to rolling the
system out for students and
business registrants over the
coming year.”
Practitioners who have
not yet completed their
registration will now be
required to pay a £20 late
application fee. Those who
have still not applied for
retention by March 31 face
removal from the registers on
April 1.
Maintaining GOC registration
is a legal requirement for
practitioners. If removed from
the registers, practitioners are
unable to practise in the UK
until they have been restored.

Do your astigmatic patients
experience fluctuating vision?
Toric contact lens wearers rub their eyes on average 6 times a day with
89% subsequently experiencing visual disruptions. 1
Over 90% of astigmatic patients would be interested in a solution to the
problem of blurred or hazy vision. 2
Bausch + Lomb’s Toric contact lenses feature the unique Quick Alignment
System which is designed to ensure faster rotational recovery to help
your patients maintain consistently clear vision throughout their day. 3
To find out more, contact your Bausch + Lomb Territory Manager
or call customer services on:
UK: 0845 602 2350 Republic of Ireland: 1800 409 077.
1. Rub Your Eyes Consumer Research Report, Decision Analyst. March 2010. Participants totalled 502 soft contact lens wearers of which 250 were toric wearers. 2. Symptom, Incidence and Needs Survey, Market Probe. December 2009. Participants
totalled 1,642 claimed astigmats. 3. Cairns, G et al. Diff erences in Toric lens performance: Lens Orientation and Orientation Recovery. Presented at American Academy of Optometry, Orlando. November 2009. Two clinical studies were conducted to
evaluate the rotational recovery abilities of two toric lens designs: Quick Alignment System (Bausch & Lomb, Rochester, NY) and Accelerated Stabilization design (AS) (Vistakon, Jacksonville, FL). In Study 1, the Quick Alignment System of PureVision®
Toric (PVT) (Bausch & Lomb) was compared with the AS design of Acuvue Advance for Astigmatism (AAA). In Study 2, the Quick Alignment System of PVT (Bausch & Lomb) was compared with the AS design of Acuvue Oasys for Astigmatism (AOA).
Image represents the eff ect of a 2.25D cylinder mis-rotated by 45° on an eye with 2.25D of astigmatism.
© 2011 Bausch & Lomb Incorporated. ®/ denote trademarks of Bausch & Lomb Incorporated. Other product names/brand names are trademarks of their respective owners.

16
25/03/11 NEWS
BRIEFING
J&J tours with
‘getting the
balance right’
JOHNSON & Johnson is taking its
expertise on the road next month,
sharing contact lens insights and
research in a brief roadshow.
The ‘Getting The Balance Right’
events, to be held in London (April
11) and Leeds (April 13), will hear
from speakers Dr Jason Nichols,
Dr Philip Morgan, Dr Cris Schnider
(pictured) and Lenora Copper
who will o�er practitioners advice
on how they can get the clinical
balance right with contact lenses for
their patients.
A total of
11 CET points
are on o�er
for each of
the free- toattend
and
open-to-all
events, which
are designed to help practitioners
con�dently provide their patients
with the most up-to-date lens
advice. Interactive sessions,
including remote voting, will
encourage the audience to get
involved and the key themes are:
dry eye management; the science
inside contact lenses; compliance:
latest insights; UV and the eye:
latest research �ndings; getting
the balance right with silicone
hydrogels; current trends and the
future of contact lens practice.
David Ruston, director of
professional a�airs for J&J Vision
Care in Western Europe, said: “This
is a unique opportunity for eye care
professionals to learn about the
latest in contact lens research and
have access to some of the industry’s
leading �gures.”
The roadshow will take place at
London’s Royal College of Physicians,
and Leeds’s Royal Armouries.
NEWS
‘New NHS’ is debated
CLINICAL EXCELLENCE, business
tips and an intense debate about
the future of the profession were
the highlights of this week’s wellattended
Optometry Tomorrow
conference in Liverpool.
Over 260 delegates attended
the Aintree Racecourse event,
hosted by the College of
Optometrists, �gures slightly up
from last year’s event in York.
As well as the clinical-led
aspects of the conference, this
year’s programme included
a lively discussion on how
GP commissioning would
a�ect the profession and how
increased training could prepare
practitioners for the ‘new NHS’.
The debate was chaired by
associate editor of the Guardian,
Michael White, and featured
City University Professor John
Lawrenson, GP partner of
Chat�eld Health Centre in South
London, Waqaar Shah, and
optometrist and College treasurer
David Parkins.
Each speaker put forward
their opinions on what the new
primary care landscape may look
DELEGATES HAVE
praised the LOCSU
roadshows for helping over
250 practitioners hone
negotiation skills and learn
more about commissioning.
Feedback left by
practitioners at the events
held across England and
Wales included: ‘Very
supportive,’ ‘informative
day’ and ‘good quality
empathetic speakers’.
Director of operations and
commissioning for LOCSU,
Katrina Venerus, told OT:
“The success of the
roadshows over the past few
weeks has demonstrated
like, and how practitioners can
enhance their role by further
training and working closely
with ophthalmologists.
Mr Shah told delegates of
how existing commissioned
services worked in his area
of Wandsworth for di�erent
aspects of healthcare.
A new innovation to the
conference this year was the
‘newly quali�ed stream’ series of
seminars and workshops.
Sessions included clinical
decision making, slit lamp skills,
legal aspects of practice and
dealing with members of the
public.
Director of education at the
College, Jackie Martin, told OT
the appetite amongst LOCs
and ROCs for training and
development, which can
equip them to deal with
the challenges they face
when negotiating enhanced
services at a local level.
“Following on from the
roadshows we are offering
the importance of the sessions:
“The newly quali�ed stream
was launched to enable us to
o�er additional support to new
College members. We aimed to
help those who have just entered
the register to develop their skills
for practise.
“This year’s newly quali�ed
stream was a pilot but it was well
received and had broad appeal,
even attracting those with more
experience who wished to refresh
their skills in a particular area. We
will monitor feedback and hope
to review and develop the stream
for future years.”
��Pictured is (l-r) John Lawrenson,
Waqaar Shah, Michael White and
David Parkins.
LOCSU roadshows a success
more individualised
development training for
any LOCS/ ROCs who want
to improve their skills to
enable them to negotiate
more successfully with
the NHS. We will also use
some of the key learning
points from the roadshows
to develop the programme
for the National Optometric
Conference in the Autumn.”
Among the speakers
was specialist optometric
adviser from Primary Care
Commissioning, John
Hearnshaw (pictured). For
a full report, visit www.
optometry.co.uk.

18
25/03/11 LETTERS
�
With reference to your news
I have just read with great
interest the possibility
of lowering the visual
requirements for drivers
in the UK (OT News and
Newsletter, February 11).
I would just like to relate
to you our experiences in
Tanzania. Within the Road
Traffic Act of the United
Republic of Tanzania,
standards were agreed
for vision for drivers.
Unfortunately these were
LETTERS
article about Anglia Ruskin
University in Optometry Today
(February 25), I wanted to clarify
the GOC’s position.
We have in fact granted
provisional approval to the
university for a new ophthalmic
dispensing foundation degree
which leads to direct registration.
Full approval status does not
occur until we are satisfied that
the new programme has been
implemented as proposed and is
deemed to meet the standards
required by the GOC.
This process involves a series
of quality assurance visits to
be conducted over the next
three years, when the panel will
satisfy itself that any conditions
applied during this time are met
and that the course has been
appropriately delivered for each
of the three years.
Provisional approval can be
withdrawn at any time if the
panel is not satisfied with what is
being delivered or if conditions
are not met.
Sponsored by
GOC clarifies university position
What is classed as ‘discrimination’?
What is the definition of ‘discrimination’?
Under the PEARS scheme in Wales I have an obligation to see a
patient that is suffering with recent onset of ocular symptoms that
same day or in the next available clinic.
However, if a patient that is housebound and unable to attend
the practice unaccompanied contacts me with the same symptoms
(flashing lights and floaters for example) I must give the health
African difficulties on the road
not being implemented, with
the result that road accidents
were resulting in a severe
loss of life.
The Tanzania Optometric
Association took up the
cause and designed vision
screening certificates and, by
getting them approved by the
licence issuing authorities,
helped to make visual
screening by an optometrists
compulsory before the
issuing or the renewal of
We have written to
Anglia Ruskin to ensure
that any future publicity
surrounding the provisional
approval is appropriately
worded.
Satjit Singh, Chief executive and
registrar, General Optical Council,
Harley Street, London
authority 48 hours written notice before going out to see them.
Is this classed as discrimination? I will let you decide.
I really cannot see any benefit in this requirement to give such
notice. It increases the administrative work of both the practice
and the health authority but ultimately it is the housebound
patient that suffers.
Nick Maydew BScMCOptom, Bridgend
driving licenses.
The screening certificates
were launched in 2002
and initially faced much
opposition. But with the
support of the Ministry of
Health and Social Welfare we
have made the screening an
acceptable part of the process
of obtaining a driving license.
As licenses are renewed every
three years, drivers are being
screened regularly. We have
picked up quite a few high
myopes driving public service
vehicles without correction
and as an association we
believe we are making a
difference to road safety.
Optometrists can play a
significant role in public
health and maintaining good
visual standards for drivers is
a potentially positive role for
the optometrists.
Rajeshwari Sagar (Mrs), BSc MBCOptom
president, Tanzania Optometric
Association
Can you help create some magic for kids?
I would like to ask your readers to help a good cause dedicated to
creating ‘magical’ gardens at children’s hospices across the UK. They can
do this by holding fundraising tea parties at their practices to help our
charity – Greenfingers – with its projects.
A ‘Care for Tea’ pack to help with organising a tea party event can
be sent electronically, via info@greenfingerscharity.org.uk or through
the post to anyone who would like to take part.
Deborah Skillicorn, director of marketing and fundraising, Greenfingers
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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20
25/03/11 INDUSTRY NEWS
INDUSTRYNEWS
TRADING PLACES
Silhouette UK
has appointed
Christopher
Cox (pictured)
as managing
director. He
was UK sales
and marketing
manager from
2001 to 2003. He is very well known, having over
20 years experience and sales success in the UK
optical industry.
Birmingham
Optical Group,
UK and Ireland
distributor
of Nidek and
Oculus and a
principal supplier
of instruments
and machines
to the profession, has a renewed focus to
enhance its client service and after sales care
this year. To deliver this, it has enhanced its
senior management team and created two new
business development director positions. Andrew
Brandi (pictured) and Justin Annett will head up
the independent sector and medical divisions
respectively.
Mr Brandi, business development director for
the independent division, has the responsibility
to grow relationships with the independent
sector and emphasis the after sales care to
practices seeking a stronger partnership with
their suppliers. He has over 24 years’ experience
serving both the optical and medical business
sectors and joins from Buchmann UK where he
was managing director. He has also held senior
positions at Topcon, Tinsley Medical Instruments
and Keeler.
Justin Annett, business development director
for the medical division, has over 10 years’
experience in the healthcare industry and played
a pivotal role in launching and building the
brand reputation of private eye hospital business
Optegra. He was also previously a regional
business manager at Ultralase.
Both directors will be joining the senior
management team of CEO Chris Tyler and MD
Neil Townsend at Birmingham Optical Group’s
25th year at Optrafair.
Former D&A and Boots Opticians contact lens
category manager, Jonathon Bench has joined
forces with in-practice sales and training
company, Positive Impact. He will provide
consultancy for the company’s clients.
Helping to C-Spex
ACP SOFTWARE has launched C-Spex software which is designed to be a �exible answer to enable
patients to see how they look in new frames when they have removed their glasses. The company
will be exhibiting at Optrafair on stand D65. The software can be loaded onto a practice’s present
PC or laptop and linked to a high-de�nition USB webcam. Alternatively, a new all-in-one PC with
touchscreen can be used for the maximum e�ect but “at a much lower cost than current units”.
The computer or laptop can be placed on a dispensing table, wall mounted or portable, making it
suitable for domiciliary work.
“After extensive testing we have developed a great practice builder, a method of increasing
dispensing values and a great talking point,” said optometrist Alan Bellamy, who helped form ACP
Software. He has two independent practices in the Midlands and was a dispensing optician before
re-training as an optometrist. The premier package, a new all-in-one touchscreen PC, HD webcam,
remote unit and C-Spex software, costs under £1000. If the practice uses an existing computer
then only the software, a webcam and remote control unit is needed which costs “far less”.
“We are o�ering a free 28 day trial of the software,” said Mr Bellamy. “It can be downloaded from
our website www.c-spex.com or we can supply a disc.”
� 01780 483894

Power
of pink
SCANDINAVIAN EYEWEAR has launched
the new Spring optical collection from
designer Efva Attling which features
six styles in acetate and metal. The
designer’s favourite is model 8512
Beverly in pink (pictured). It is inspired
by 1950s America and is also o�ered in
black and grey.
“Allowing men to be men and women
to be fabulously feminine, as in the 1950s
and 60s continues to be bang on trend
for Spring and Summer,” said Efva Attling.
“For people who want to re�ect this in
their eyewear, there are several strong
candidates in this collection.”
Other styles include Twisted, a
feminine Hollywood-inspired style with
soft round shapes and a twisted frame,
Rolf which has a strong masculine
feel and Rickey, which is more unisex.
Those who like Ms Attling’s eyewear
for its jewellery-like feel might like
Spikes, which has a diamante pattern.
For more information visit www.
scandinavianeyewear.
��0800 376 1050
Doctor is in
THE BIB Group has added
to its service division,
Optical Doctor, upholstery
repairs as a new service
for UK optical practices.
Recognising the need for a national reupholstery
service specifically for patient
chairs, BiB has signed an agreement
with Ecomaster which has over 10 years
experience providing the specialist
service to market-leading blue chip
brands nationally and internationally.
CEO of the BiB Group, Tim Baker, said:
“Ecomaster offers the perfect solution for
fast, efficient, professional onsite repairs.
As well as being unsightly, cracked or
split, chair coverings can, in extreme
cases, lead to cross contamination
and also fail an NHS inspection. It
is now possible to make savings by
refurbishment rather than replacement.”
For further information email enquiries
to service@opticaldoctor.co.uk
�� 01438 740823
250 new
choices
INTERNATIONAL EYEWEAR has launched
its new Spring/Summer brochure featuring
its largest ever collection of frames for
independents. It illustrates 250 new
models, which have been added across all
ranges.
The new ‘shining star’ of the company’s
product portfolio is Gorgeous Girls, an
exclusive 18-piece collection of frames
for girls aged �ve to 15 at a�ordable
prices. Other featured brands include the
Eschenbach product ranges, including
designer brands Marc O’Polo, Humphrey’s,
Brendel and the technically advanced
TITAN�ex. The established ranges such as
Hero, Zo�ani, Episode, Puccini, Star Wars and Eyestu� are also included.
MD Mark Hobson said: “International Eyewear has once again been able to provide
outstanding value throughout its ranges without compromising innovation, style or quality even
in entry-level ranges. Once again the ever popular OK and Azzuri ranges also feature, with many
opticians �nding these frames top of their best sellers list.”
The brochure is designed to be user-friendly and a useful reference tool.
� 0121 585 6565
Climb in dispensing
HOYA PNX 1.53, a tough,
durable and safe option
for children’s lenses,
has enjoyed a 40%
increase in dispensing
since a two-year antibreakage
guarantee was
introduced by Hoya.
The company believes
it is an ideal introductory
lens material and brings
peace of mind for
dispensers due to its
100% built-in UV protection and high impact resistance, as it can withstand a one kilogram
steel ball dropped at 1.20 metres.
“This is the most shock resistant material available for lenses and is great for active lifestyle
patients,” said Hoya Lens UK’s product manager, Steve Roberts, FBDO. “Being ultra lightweight
it is ideal for rimless and supra styles, and not just for children. Many dispensers are seeing
that selecting this lens, which is three times stronger than a standard option, saves a lot of
problems.”
Hoya PNX 1.53 is produced in the UK and is available in a choice of Hoya lens designs and
with a range of coatings, tints and Transitions options.
� 0845 3300 984
21
25/03/11 INDUSTRY NEWS

22
25/03/11 SHOW PREVIEW
OPTRAFAIR
All the fun
of the fair
IT’S ALMOST here. Once every two
years the UK optical profession gets
its chance to gather at Birmingham’s
NEC for Optrafair to see what’s new
and what’s relevant for their respective
businesses.
This year’s show promises to be an
important one for companies looking
to climb away from the economic
difficulties of the past two or three years
and improve their profitability.
Around 200 exhibitors of all shapes and
sizes will be present, all aiming to grab
the attention of the wide variety of visitors
Optrafair attracts. Over the next few pages
we will preview what some of them will be
bringing to the event.
No doubt some exhibitors will highlight tempting
money-off promotions or other kind of offers, such as
prize draw competitions, available during the three days
of the show. And there will be numerous new ranges and
collections on display for the spring and summer months.
In addition to the exhibition, our education event OT Live has
expanded – further details of the subjects up for discussion are
featured on page 36.
“Around 200 exhibitors of all
shapes and sizes will be present”
Show organisers will host a poster trail, a display on
the history of Optrafair, and new for 2011, a contact lens
pavilion.
For those interested in designer wear there is the show’s
‘Fashion Quarter’ which offers visitors the chance to view the
latest displays from manufacturers of designer frames, fashion,
sports and children’s eyewear. Attendees are also invited to
enjoy the refreshments provided at the Quarter’s champagne
and cocktail bars.
With the fashion theme in mind, the OptraAwards
competition will take place highlighting new designs for
fashion frames.
The show also promises some free-to-attend seminars to help
individuals build their business, improve consumer satisfaction
and keep abreast of the latest technological advances and
product innovations.
The next Optrafair won’t
come round until 2013 – so,
if you mean to go, spare some
time for what might be a
valuable journey.

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24
25/03/11 SHOW PREVIEW
OPTRAFAIR
Show
business
Optrafair gives optics the chance to really
put on a show to help UK practices boost
their business. OT’s Robina Moss looks at
some of the new frame launches set to
inspire practitioners and patients alike.
Jai Kudo
Jai Kudo is celebrating its 10th anniversary at Optrafair and will be promoting the two current
frame collections of Jai Kudo and JK London on stand FQ20 plus Wideview Signature lenses.
The debut Jai Kudo frame collection was launched 10 years ago at the 2001 show. The di�usion
line JK London was launched in 2008 for the younger age group. Ten years on and both brands
continue ‘to go from strength to strength’. In March 2010, the company expanded and relocated
to new premises in Elstree, Hertfordshire. There are plans for a new brand later in the year.
Dunelm
Optical
Dunelm Optical will be exclusively
previewing range additions
from its 2011 brochure at this
year’s Optrafair. All ranges will be
showcased on stand M40 in Hall
20, with a total of 150 new styles
from the likes of Paul Costelloe,
Janet Reger, and John Rocha’s
designer collections, to Dunelm’s
own Julian Beaumont, Retro, and
Whiz Kids ranges. Dunelm will also
showcase its popular cases and
accessories range.
Orange Eyewear
Orange Eyewear is launching a new designer collection for independents
at this year’s Optrafair from internationally renowned women’s clothing
line, CC. Fronted by actress Jane Seymour (pictured), the new frames
complement CC classic clothing which is available in 232 stores across
the UK.
Orange Eyewear will be on stands FQ12 and FQ16 and will also unveil
new models from its own label, Orange. In addition, there will be new
designs from French fashion label, Guy Laroche. The latest models from
the Été collection, which incorporate beautiful pheasant feathers, will
also be on show.
Caseco
Caseco, featured on the OT cover, will showcase all its ranges
and latest models on stand N20. Brands featured will be JF
Rey, Boz, Henry Jullien, Öga, Koali, Derapage, Shoc, Julbo and
Hello Kitty eyewear. New will be Levi’s Eyewear and the o�cial
launch of Pinfeel 2, a series of titanium models utilising the
Pinfeel patented rimless glazing system. Julbo will show its
sunglasses including ranges for children and teenagers, and
will be introducing ‘RX-Trem’, its Silmo d’Or award winning
freeform glazing system.

C A N Y O U
S E E T H I S I N
Y O U R P R A C T I C E ?
Visit us at stand O50
The new 200Dx ultra-widefield imaging system gives you the ability
to see more. Use the power of early detection to protect your patients‘
vision and overall health. Your vision is our focus.
For details of our Optrafair programme
please go to www.optos.com
New business models and ownership options for all systems!
optos.com
© 2011 Optos. All rights reserved. Optos is a registered trademark and 200Dx is a trademark of Optos plc. P/N 453001v1

26
25/03/11 SHOW PREVIEW
International
Eyewear
International Eyewear is launching
Gorgeous Girls, a new designer range
for girls. Designed to appeal to young
fashionistas between the ages of �ve and
12, the debut collection of nine models on
stand L40 has drawn its inspiration from
catwalk trends and features diamantes,
designer detailing and Italian acetate
materials.
For a limited period, International
Eyewear is o�ering a free designer display
unit with the purchase of any eight frames
from the range. All frames are accessorised
with a stylish pink handbag-style case.
In creating the collection, extensive and
planned market research was carried out
involving focus groups and consultation
with dispensing opticians.
OPTRAFAIR
Rodenstock
Rodenstock will be debuting Merecedes Benz frames on stand O40 plus new models from
dunhill, Porsche Design and uvex as well as presenting new correction spectacles, marking
a new direction for Rodenstock. This year, besides a special rimless frames concept, the
presentation mainly focuses on the women’s frames, which are characterised by sophisticated
design, high-quality materials and details.
Continental Eyewear
A henna tattooist/face painter for the children plus a prize draw and pen freebies are some of
the attractions on Continental’s stand K40. Customers will be greeted with a familiar face when
they walk on the stand as all the sales team will be present and there will be a comfortable
seating area to rest weary legs.
The latest fashions from Jaeger will be displayed on two mannequins together with a
selection of Jaeger fashion accessories. There will be a plethora of new frames on display in
each range – from the ‘excellent value for money’ Lazer collection to up-to-the minute geek
chic models.
ProDesign
Axiom is a new line under the ProDesign
name, exhibiting on stand H15. “Axiom”
means a self-evident truth and this is a
‘no-nonsense collection’ with integrated
technical solutions, that the viewer can
see and instantly realise how they work.
ProDesign has used a new technology
called PVD, which is said to make it nearly
impossible for the colour of the temples to peel. It is a delicate and time-consuming process
but the company feels that the results are fully worth it. There are four di�erent shapes in
models 6901-04, each o�ered in four colours.
Inspecs
Inspecs will showcase its new luxurious collection of pure titanium frames for women on stand
Q5O. Sheer titanium is a new collection of handcrafted frames, designed to be lightweight yet
chic. They include mother of pearl �nishes and are designed using TR90 Grillamid temples.

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Tel: 01625 618816 Fax: 01625 619959

28
25/03/11 SHOW PREVIEW
OPTRAFAIR
The IT factor
Practice management software has developed apace since the last Optrafair. This year’s event
provides the perfect opportunity for practitioners to �nd out how to make their business more
pro�table. OT looks at the new developments and the people behind them.
Optix
Optix is an innovative practice management system developed
by optometrist Trevor Rowley (pictured) and has more than
doubled its customer base since the last Optrafair. On stand H70
the company will show that features include fully integrated
electronic ordering from Essilor, Hoya, Nidek and Rodenstock along
with electronic GOS submissions and integration with leading
technology companies including Nidek and Thomson software.
Optix includes an innovative business Intelligence system.
See20/20
Sales and marketing director Paul Houston (pictured) is aiming to
bring the ‘wow’ factor to Optrafair with the debut of See20/20’s
major upgrade of its practice management system. The company
has invested over half-a-million pounds in a major upgrade,
with its new dispensing, ordering and insurance module being
unveiled on Stand F50. The software features state-of-the-art
advancements in dispensing with seamless integration to
SpesCare insurance, clinical notes and a major revamp of
patient recall.
Over 300 practices and organisations across the UK now use
the See20/20 system and Merseyside’s Silverberg Opticians,
Rawlings Opticians of Surrey and Hampshire, and Gwynns
Opticians of South Wales are among the �rst to use the
enhanced software.

For astigmats, even a simple head tilt can
cause lens rotation and blurred vision.
ACUVUE ® has the answer.
Four stabilisation zones deliver clear and stable vision throughout the day regardless
of head 1 or eye 2,3 movements of your patients, no matter how active their lifestyle may be.
ACUVUE ® OASYS ® material with HYDRACLEAR ® Plus technology delivers a unique
combination of UV protection4 , smoothness, breathability, flexibility and wettability. 5
To see for yourself, visit www.jnjvisioncare.co.uk
Studies compared vision performances between ACUVUE ® OASYS ® for ASTIGMATISM and PureVision ® Toric, Proclear ® Toric & Air Optix ® for astigmatism. 1. McIlraith R, Young G, Hunt C. Toric lens orientation and visual acuity in non-standard conditions. CLAE 2010; 33 (1): 23-26. 2. Chamberlain P et
al. A vision chart to quantify disturbances in acuity during wear of toric contact lenses. Optom Vis Sci 2008; E-abstract 85079. 3. Zikos G et al. Rotational Stability of Toric Soft Contact Lenses During Natural Viewing Conditions. Optom Vis Sci 2007; 84 (11): 1039–1045. 4. Class 1 UV Block: 96% UVA;
100% UVB; UV absorbing contact lens are not substitute for UV-blocking sunglasses as they do not completely cover the eye and the surrounding area. 5. JJVC Data on File 2010. All other companies brand names mentioned herein are the trademarks of their respective owners.
ACUVUE ® , ACUVUE ® OASYS ® , HYDRACLEAR ® and SEE WHAT COULD BE are trademarks of Johnson & Johnson Medical Ltd. © Johnson & Johnson Medical Ltd. 2011.

30
25/03/11 SHOW PREVIEW
OPTRAFAIR
Ocuco
Ocuco will be having a draw for
an iPad 2 on its stand H50, and
o�ering a free iPad 2 with all
purchases of £10,000 and over. The
latest version of its ‘world leading’
practice management system,
Acuitas will be demonstrated. It
has had over 1500 installations in
practices worldwide and the latest
improvements in SMS technology,
business intelligence KPI reporting
and direct debit processing will be
on show. New innovations such as electronic GOS 3 submission will also be available to view.
Acuitas integrates with almost all clinical diagnostic equipment, providing enhanced value for
money for those planning on purchasing an OCT or Fundus camera at the show. Ocuco will be
running presentations for independents in a room in the NEC adjacent to the main show. For
details visit the stand.
Opticabase
Opticabase exhibited for the �rst time at
Optrafair 2009 and the “fantastic response”
has inspired director and practice owner
Michael Prais (pictured) to exhibit again
this year.
Opticabase was designed “by opticians
for opticians” and now has over 200
practices using it. There are a variety of
low cost, packages available, from the
reception program to a full dispensing
package. A domiciliary package is also
available. Many new features have been added including SMS and email messaging,
on-line tutorials and one-click lens ordering.
The various software packages will be available to view at Stand SB40 along with free
trial CDs to take away.
Mr Prais has been working with NHS Connecting for Health on the electronic submission
of all GOS forms.
Orasis
The MD of Orasis Practice Management Software, Linus
Mason, (pictured) is particularly close to the profession –
he married a quali�ed DO he met through his work with
independents and they now have two young sons.
The work began in 1995 to create a modern,
comprehensive practice management system ‘developed
with opticians for opticians’ to provide a complete solution
whatever the size of the optical business.
The system’s main purpose is to help improve practice
performance. Orasis uses the latest technology to ensure
a reliable system which aims to deliver fast performance
and a stable environment that is not web-based, a huge
advantage when reliant upon quick entry. A demonstration
and show o�ers will be on the stand C50.

Income
protection
important asset
- the ability to earn a living!
Protect your most
AOP
Members
receive 20% off
your first 3 years
contributions!
“The one protection policy every working
adult in the UK does need is the very one
most of us don’t have - income protection”
Which Consumer website 2011
Come and visit us on the AOP stand (T20) at Optrafair
Could you pay the bills if you were too ill to work?
PG can cover you from the first day that you can’t work due to illness or accident,
until either you recover or turn 65.
As a Friendly Society specialising in the Healthcare profession since 1928, we
don’t have outside shareholders but return any surplus to our members.
For more details visit our website or call us today, on:
Freephone: 0800 146307 www.pgprotects.co.uk/aop
Pharmaceutical & General Provident Society Ltd, trading as PG
Registered Office: 11 Parkway, Porters Wood, St. Albans, Hertfordshire AL3 6PA. Tel: 01727 840095 www.pgprotects.co.uk Incorporated in the United Kingdom
under the Friendly Societies Act 1992. Authorised and regulated by the Financial Services Authority, Registered Number 110023.

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DON’T MISS SPECSAVERS’ EVENTS AT ‘OPTRAFAIR’
During ‘OptraFair’ Specsavers will be running a number of events which are free to attend as follows:
• Relocation Down Under
Running Saturday 9th April, Sunday 10th April and Monday 11th April
Duration one hour, starting 10am; 1pm; 3pm
• Opportunities in Spain
Running Saturday 9th April, Sunday 10th April and Monday 11th April
Duration 30 minutes, starting 12pm
• OCANZ explained
Running Saturday 9th April, Sunday 10th April and Monday 11th April
Duration 30 minutes, starting 11.30am; 2.30pm; 4.30pm
• Funding of Business Acquisition –
featuring Ken Braddock, Senior Franchise Manager of HSBC.
Running Sunday 10th April only
Duration one hour, starting 12pm; 3pm
There is no limit to the number of events you can attend so for more information
and to book a place, please call 01695 554200.
Details await you at http://jobs.specsavers.co.uk

34 28
25/03/11 SHOW PREVIEW
OPTRAFAIR
Enter the Tonometry Zone
HANDS-ON demonstrations and
comparisons between different
manufacturers of OCT, retinal
technology, hand-held gadgets
and dispensing systems will
be key attractions for Optrafair
visitors next month.
April’s show will provide
attendees with a renewed look at
what’s new and what has been
developed from international
suppliers.
“Optrafair is the opportunity
to see what is available,” said
Ron Wright, BiB managing
director, whose company will be
promoting a range of products
including its generic Anyview
dispensing and measuring system.
“We have exhibited for the past
five shows and always chase up our
manufacturers so there are always
enticing deals at the show.”
Birmingham Optical Group will be
showcasing its inspiring ‘Practice of the
Future’ which includes a contemporary
refraction unit plus new anterior
imaging solutions, innovations in pre
screening and a link from the Nidek
Auto-Phoropter to the Test Chart 2000.
Also to be featured is a new Oculus
Keratograph, a Tear Film map which
demonstrates tear break up time and
OxiMap simulating contact lens oxygen
permeability.
The company’s partnerships with
Nidek and Oculus will see new
technologies displayed, including the
Nidek Retinal Screeners – the Nidek RS-
3000 OCT with Anterior Segment and
Normative database.
Carlton, will be promoting the Canon
brand, particularly the Canon CR-2
non-myd camera, Optopol imaging,
and perimetry and refraction furniture
solutions.
“Optrafair is the opportunity to
see what is available… ”
“In response to the ever-growing
demand for portability, we now offer a
hand-held autorefractor, a hand-held
non-myd retinal camera, a range of
hand-held tonometers, a hand-held
pachymeter, and a hand-held slit lamp,”
said Krysten Williams, Carlton sales and
marketing manager.
“Visitors can explore the benefits of
the Optopol Spectral OCT combined
with retinal imaging, consider a Pascal
Dynamic Contour Tonometer for the
most accurate IOP independent of
corneal thickness, try the hand-held
Tonopen AVIA applanation tonometer,
and compare the new Takagi Soft Non-
Contact Tonometer and the new Canon
non-contact Tonometer/Pachymeter.”
Rodenstock’s ophthalmic instrument
range is coming back to the UK market
at the show, via Dibble Optical. MD
Barry Dibble said: “This German brand
of high quality refraction, measurement
and diagnostic technology has a
pedigree going back more than 100
years and has been a popular choice
with ophthalmic professionals. The
new product range has been expertly
redeveloped and represents technology
at the leading edge of innovation and
clinical excellence, all with a two year
warranty.”
The Optovue OCT (IVUE and RTVUE)
complete with 3D, Gangling Cell
Complex, Retina, Glaucoma and Cornea
modules will be a highlight at Grafton
Optical’s stand. Also promoted will be
computerised test charts, complete with
For more features go to www.optometry.co.uk/features
iMac and LCD monitors,
along with the Pachymeter
from DGH, and the portable
hand-held Pachmate. The
new non-Mydriatic Camera,
complete with eyescape digital
capture software, which can be
paired up with the Ivue OCT,
will be demonstrated too.
Keeler will be exhibiting its
hand-held ophthalmoscopes
and retinoscopes, lithium
charger upgrade kits, new
digital Volk lenses, and for
domiciliary visits, its Portable
Slit Lamp.
The company’s ‘Tonometry
Zone’ will display the new Pulsair
Desktop, the space-saving wall-mounted
Pulsair intelliPuff, and for the Slit
Lamp, the Keeler Applanation
Tonometer.
Visitors to the Optos stand will get
the chance to have their retinal image
taken on the new 200D ultra widefield
retinal imaging device. Capturing up to
200° of the retina in one image without
mydriasis, it is an upgrade to the P200,
the technology behind the optomap
retinal exam. Its enhanced image
quality and integrated software tools
will be a key promotion for the
company at Optrafair.
Andrew Yorke, director of medical
at Topcon GB, said its presence at the
exhibition will show the company’s
commitment to the “technical revolution
in optometric instrumentation”.
“Practitioners will be able to see
the growing impact of OCT on dayto-day
optometric practice and the
benefits that are being delivered to
practitioner and patient alike. Our
ability to see beneath the surface and
detect disease much earlier will change
the way we practice now, and in the
future. This will strengthen the clinical
ability of all practitioners and present
a huge opportunity to create clinical
differentiation.”

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36
25/03/11 SHOW PREVIEW
OPTRAFAIR
OT Live expands at 2011
OPTRAFAIR WILL once again feature the
popular OT Live educational series. This
year the OT Live Arena has the addition
of a second smaller Satellite Arena site
to give visitors even more choice.
Looking forward to the event, AOP
education advisor Karen Sparrow said:
“The new format of education at 2009’s
Optrafair was well received by delegates
and sponsors alike. It’s great to be back
in 2011 with a bigger programme,
more choice and fantastic support from
industry sponsors.”
On Saturday April 9 there will be
lectures on retinal disease, intraocular
telescopes for macular degeneration,
therapeutics, glaucoma, OCT, peripheral
retinal imaging, and children’s eye
care. There will also be presentations
on helping practitioners with
communications skills both with their
colleagues and customers.
On Sunday April 10, OT Live headline
sponsor Topcon will be providing an
update on the developments in OCT.
Delegates attending this and other
sessions in the middle of the day will be
given a complementary lunch to enjoy
during the presentation.
Also on Sunday you can listen to
lectures about lifestyle dispensing,
‘drivewear’, contact lens materials and
solutions, refractive lens exchange,
vitreoretinal surgery, OCT and peripheral
retinal imaging. In addition to these CET
lectures, the Optical Confederation will
give you the chance to �nd out how to
be involved in its new career initiative
– New Dimensions in Optics. Also the
Worshipful Company of Spectacle Makers
Education Trust is running a taster session
on the level 2 courses for optical support
sta� and technicians.
Rounding o� the show on Monday
April 11 there will be a series of
specialised half-day sessions.
Pre-registration students can attend an
OSCE preparation and ocular pathology
course for just £39 aimed at helping
them prepare for their imminent �nal
assessments (see also page 60 of this
issue). There is also a ‘Careers Ambassador
Experience’, provided by the Optical
Confederation, for anyone interested
in taking the initiative into their local
schools.
To book, visit www.otlive.co.uk

S O F T W A R E W I T H V I S I O N
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Visit Optimed
at Optrafair
Try some healthy (and not so healthy) ocular cocktails at the Optimed Booth (stand E80)!
Enjoy Brian’s cocktails and let our resident experts take you through innovative technology to set your
practice apart. Whether you want to engage patients in the waiting area (with i-Vue), increase sales & and
retain patients (using CAPTIV8) or simply make your website standout from the rest (ANIM8) there’s a
patient communication platform for your business.
®
(waiting area) (chairside communication) (animations in your website)
Great animations in your waiting area
with captions, narration, live weather
and news! Also, the ability to ‘push’
content updates from your home direct
to your display system!
®
iPad Ready
Increase dispense values using draw
over video. Retain patients by emailing
ACTUAL videos to the home. Increase
patient recommendations to your
practice by allowing patients to share
content with friends and family.
®
Captivate, engage and inform visitors
to your website with amazing quality
animations fully equipped with
voiceover and captions in over
10 languages.
Email: info@optimed.co.uk Web: www.optimed.co.uk
TM

OPTRAFAIR
Career chances
to see at NEC
VISITORS TO next month’s Optrafair will have a range of
professional opportunities to explore.
The exhibition will see Specsavers Professional
Recruitment showcasing the latest career options available
across the UK and overseas for those considering working for
one of the sector’s most recognisable names.
“Whether you are looking for employed or self-employed
careers,” said a spokesman for the company, “Specsavers
believes in providing the right opportunity for everyone and
this is your chance to find out more. A visit to the Specsavers
exhibition stand will include advice on vacancies, career
development opportunities and tips for joining the Specsavers
family.”
Visitors who are interested in running their own practice
can learn more about the Joint Venture Partner programme
and discuss current opportunities. Those looking further
afield can ask about Joint Venture Partner openings in
Australia and New Zealand.
As well as expert advice from the recruitment team, there
will be a series of seminars focused on funding for business
partnerships. Keynote speakers include Ken Braddock, senior
franchise manager at HSBC.
Senior members of the Specsavers team will also present
the multiple’s success story in Australia and New Zealand,
where Specsavers has become a major player in both
countries in a little over two years, with 300 stores open and
sales that are projected to surpass $400m in 2010/11.
The presentations will also show the comprehensive
immigration and relocation packages available to retailers,
dispensers and optometrists who qualify for the low cost Joint
Venture programmes in both countries, as well as case studies
of those who have made a new life and new business for
themselves ‘Down Under’.
For more information on Specsavers at Optrafair 2011, or
to book an appointment with one of the company’s team, call
David Markham on 01695 554200.
39
25/03/11 SHOW PREVIEW

40
25/03/11 VRICS
VRICS
VISUAL RECOGNITION
AND IDENTIFICATION
OF CLINICAL SIGNS
Sponsored by
This FREE VRICS test should be completed online by clicking on the “VRICS Test” button at http://www.otcet.
co.uk/ and answering the Multiple Choice Questions (MCQs) using the associated images. Please note that
there is only one correct answer for each MCQ. Successful completion will result in two CET points. VRICS
regularly appears in Optometry Today.
Contact lens aftercare & complications 2
COURSE CODE: C-15794 O/D/CL
A
B
C
Dr Shehzad Naroo BSc (Hons)
MSc PhD MCOptom FIACLE
FAAO FBCLA
1. Image A reveals what was found underneath a soft contact lens,
in the eye of a regular wearer. Which of the following is likely to be a
symptom that will be experienced?
a) Lacrimation that is worse upon lens insertion
b) Lacrimation that is worse upon lens removal
c) Dull aching pain throughout lens wear
d) Photophobia throughout lens wear
2. Which of the following is an indicated slit lamp technique for the
person in Question 1 and the �nding shown in Image A?
a) Direct illumination with parallelepiped
b) Retroillumination using the iris
c) Sodium �uorescein staining assessment
d) All of the above
3. Which of the following statements about the technique shown in
Image B is TRUE?
a) It aids visualisation of palpebral conjunctival redness
b) It aids visualisation of bulbar conjunctival redness
c) It aids visualisation of the lid attachment of a RGP contact lens
d) It aids visualisation of a dislodged/split soft contact lens
4. For the patient in Question 3, which of the following stains/dyes
should be used in conjunction with the technique shown in Image B?
a) Rose Bengal
b) Sodium Fluorescein
c) Alcian Blue
d) Lissamine Green
5. The power of the lens shown in Image C was initially selected as
LE: -2.50/-1.25x180 to match the patient’s spectacle prescription.
Based on the �nding shown in Image C, what is the CORRECT lens
power to order?
a) -2.50/-1.25x20
b) -2.50/-1.25x160
c) -2.50/-1.25x90
d) -2.50/-1.25x180
6. Which one of the following is NOT a design typically used for the
type of lens shown in Image C?
a) Front surface toric
b) Back surface toric
c) Toric periphery
d) Bi-toric

Sponsored by
CONFUSED ABOUT CET REQUIREMENTS? www.cetoptics.com/cetusers/faqs/
IMPORTANT INFORMATION: Under the new Vantage rules, all OT CET points awarded will be uploaded to its website by us.
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record” into their “Final CET points record”. Full instructions on how to do this are available on their website.
The closing date for this examination is May 6 2011. CET points for this exam will be uploaded to Vantage on May 16 2011.
2 FREE CET POINTS
��
Approved for Optometrists Approved for DOs Approved for CLPs
About the author
Dr Shehzad Naroo is senior lecturer at Aston University, Birmingham, where he
teaches contact lenses, anterior eye and therapeutics. He is also the global vicepresident
of the International Association of Contact Lens Educators (IACLE),
and editor-in-chief for the journal Contact Lens & Anterior Eye.
D
E
F
�
��
Associated reading:
1. The Contact Lens Manual: A practical guide to �tting
(fourth edition) by Andrew Gasson and Judith A. Morris
2. Eye Essentials: Rigid Gas-Permeable Lens Fitting by
Ngaire Franklin, Elsevier Health Sciences, 2006
3. Corneal Topography by Amar Agarwal, Elizabeth A.
(FRW) Davis, Anshan, 2009
4. Contact Lens Practice by Nathan Efron Butterworth-
Heinemann, March 2010
7. Which type of contact lens modality is MOST commonly
associated with the complication shown in Image D?
a) Hydrogel monthly disposable lenses worn daily
b) Silicone hydrogel lenses worn daily
c) Silicone hydrogel lenses worn as continuous wear
d) Rigid gas permeable lenses worn daily
8. What is the MOST appropriate management option for the
complication shown in Image D?
a) Change from a multipurpose to hydrogen peroxide cleaning regime
b) Reduce the daily lens wearing time
c) Cease contact lens wear completely
d) No management required. Continue lens wear as now
9. Which of the following is the MOST likely cause of the corneal
complication shown in Image E?
a) Overwear of hydrogel contact lenses
b) Overwear of rigid gas permeable lenses
c) Protein deposits on a hydrogel contact lens
d) A �at �tting hydrogel contact lens
10. Which of the following techniques BEST reveals the location
of the corneal complication shown in Image E?
a) Specular re�ection
b) Sclerotic scatter
c) Retroillumination
d) Indirect illumination
11. Which of the following is the MOST likely problem in the right
eye of a regular contact lens wearer, as found by the technique
shown in Image F?
a) Keratoglobus
b) Pellucid marginal degeneration
c) Corneal warpage
d) Orthokeratology
12. Which of the following would NOT be useful for di�erentiating
the condition shown in Image F from Keratoconus?
a) Review the refraction periodically
b) Measure the corneal pachymetry
c) Review the corneal topography periodically
d) Measure the spherical aberration
41
25/03/11 VRICS

42 28 By David Craig and Trevor Warburton
15/01/10 25/03/11 INTEVIEW
NEW DATA
RESEARCH
New survey on visual
�eld screening in the
domiciliary setting
CONTRACTORS PROVIDING General Ophthalmic Services
have to provide appropriate equipment and, in the standard
fixed-site situation, appropriate premises. Exactly what this
means is open to a fair amount of interpretation. Many of
the background requirements such as Health and Safety and
Data Governance are dealt with in Quality in Optometry and
in the Primary Care Commissioning contract compliance
inspection form. However, some aspects of equipment
requirements are vague and there is no definition within
the Opticians’ Act or regulations to help. Visual fields
are a case in point, since the testing of visual fields is not
mentioned at all in legislation or regulation, only “other
such examinations as appear to be necessary”.
So, for guidance on what is required in the domiciliary
setting, we must look to advice from the optical
representative bodies via their advisory committee, and
on guidance from the College of Optometrists. However,
the key factor in such cases is what actually happens in
practice. The courts and the GOC both use the standard of
the average, competent practitioner as a yardstick to judge
whether particular actions are reasonable.
It is generally accepted that a threshold-controlled visual
field screener is the instrument of choice in a practice
setting. It is much less clear in the domiciliary setting.
Visual fields tests require considerable concentration and
take some time to complete, and the eligible populations are
very different. The Primary Ophthalmic Regulations 2008
state the requirements for eligibility for a domiciliary sight
test as being “…unable to leave [their place of residence]
unaccompanied because of physical or mental illness or
disability.” Practitioners report that visual fields are difficult
or impossible on many of their domiciliary patients and
even portable electronic threshold-controlled field screeners
(eVFAs) are large and bulky pieces of equipment to add to
the already considerable volume of kit transported from site
to site.
A small handful of PCTs have begun to require contractors
providing domiciliary services to possess a portable
electronic threshold-controlled field screener. The basis for
this requirement is unclear but the reality is that anything
not mentioned in legislation or regulation can only be
required if it represents peer practice. The AOP has been
supporting members placed in this position and, as part of
the evidence gathering, undertook a survey of members in
England and Wales. The survey was conducted online and
a link was sent to all members for whom the AOP has an
email address. This was 6,366 of the 8,107 members in those
regions. There were 667 responses from practitioners who
undertake domiciliary visits.
“The survey response is likely to
represent the views of a signi�cant
percentage of those practitioners
involved in providing home visits”
It is difficult to be certain how many practitioners
undertake domiciliary visits, or even how many contractors
hold contracts to do so as there is no central register of
For more business articles go to www.optometry.co.uk/business

contractors. there
were 12.5 million
sight tests in England
and Wales in the year
ending March 31
2010, and these were
delivered by 11,768
optometrists and 44
oMps. in total, 3.4%
of these tests were
domiciliary tests,
or about 425,000.
it is unlikely that
more that a third
of practitioners
participate in home
visits, and the true
figure is probably
more like a quarter.
thus the survey
response is likely to represent the views of a significant
percentage of those practitioners involved in providing
home visits.
of the 667 who indicated that they undertake home visits,
18.3% say they have access to an electronic threshold
controlled field screener. it is even more revealing to look
at the underlying practice of this subset. of those who have
access to such a screener, 22.5% take it on a visit frequently
or always, whilst 77.5% take it rarely or never.
Looking at the even smaller subset of those who always
take an evFa with them, 9% use it frequently or always,
whilst 91% use it rarely or never.
to put it another way, of the 667 respondents, just five
always or frequently take and always or frequently use an
evFa on visits.
so what do practitioners use for testing visual fields?
not surprisingly, confrontation is the most popular choice,
with 86% indicating it is the method they would normally
use to check visual
fields. of those who use
Tests other than confrontation
confrontation, 34% also
use some other means of
checking the visual field,
though not necessarily on
every occasion. a total of
50% have some means
other than confrontation
of checking the fields.
Most popular of the rest
is the red dot test, with
128 users, followed
by damato with 91.
a further 16 roll up a
Bjerrum screen and take
it with them, whilst 11
mention amsler charts.
the latter may not be
a true reflection of the
usage of an amsler chart as it was not offered as an option
but relied on respondents entering it as a choice under
“other”.
practitioners were asked what proportion of their
domiciliary patients they felt would be capable, physically
and mentally, of taking a meaningful visual field test. the
responses were invited to answer in 10% bands. Half of the
respondents felt that 10% or fewer of their patients would
be capable. Just 3.5% felt that over half their patients would
manage such tests.
Finally, domiciliary practitioners were asked what they
would do if required to purchase a portable electronic
threshold-controlled field screener in order to maintain their
domiciliary visiting contract. only 3.4% said they would be
prepared to purchase one, while 58% said that they would
stop doing home visits. Clearly these would be the smaller
contractors, since the larger national companies often have
evFas available, though usually these are shared within an
area and so are frequently not available to the practitioner
at the time of the sight test. However, it is these smaller
contractors who do a lot of the visits to individuals in their
own homes, as opposed to larger residential or nursing
homes.
it would seem that a policy of requiring portable evFas
for additional service contracts is not in line with the
current practice of the majority of domiciliary practitioners
and is likely to result in a drastic reduction in the
availability of sight tests to patients in their own home.
david Craig is director of operations at the aop. trevor
Warburton is an aop director and clinical advisor to aop
Legal services.
For other business articles go to www.optometry.co.uk/business
43
25/03/11 NEW DATA

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45
25/03/11 20 QUESTIONS
How are you?
Medium rare.
PROFILE
20 Questions – Bruce Evans
Professor Bruce Evans took over at Brentwood independent Cole Martin Tregaskis in 1996 after
working there since 1988
How is business right now?
The practice is very busy and January was a
record month for new patients.
Have you had any promotions
that were especially successful?
No! Part of our USP is that we don’t do
promotions or do anything to lead our
patients to think that our main reason for
existing it to make money from them. Of
course, we need to earn a living, but our
main motivation for going to work each
day is to preserve, enhance and improve
eyesight.
Why do you like about optics?
Optometry is a wonderful job since it
combines so many pluses: The job satisfaction
of being a healthcare practitioner, knowing
that you are helping people.
What’s the best thing that’s
happened in the profession
during your time working in it?
It is di�cult to say and many would say
things like imaging, OCT, or disposable
contact lenses. But I think that the best
thing to happen is the development of the
Intuitive Colorimeter by Professor Arnold
Wilkins.
Who do you admire in optics?
I have had the pleasure of working with
people like Neville Drasdo, David Edgar, David
Thomson and Judith Morris, and I have learnt
a huge amount from them.
Where are your favourite places
that optics has taken you?
Sierra Leone (with Vision Aid Overseas), and
recently lecturing in Australia.
Are you superstitious?
No.
If you were granted one wish for
optics what would you wish for?
That my colleagues who work for
employers that advertise “free sight tests”
realise that they devalue their profession
and themselves. Each day we make choices.
We choose who we work for and in so
doing we choose the activities that we
support. We should choose carefully.
Do you have a favourite TV
show?
No.
Outside of the profession, what
are your hobbies?
Anything to do with water. Typically, sailing,
windsur�ng, scuba diving and kayaking.
Sum up your feelings for the
next 12 months.
Mixed.
Where do you go on holiday?
At the moment, West Wales because that is
where my boat is at present. Also, wherever I
am invited to lecture.
What are your favourite products
in the optical sector?
Any contact lenses that are easy for children
to wear. They can be so liberating.
If you weren’t in the profession
what would you be doing?
In the Royal Navy or Merchant Navy.
What’s your favourite singer or
musical group?
I have such wide tastes that I could not name
a favourite.
What do you put down your/your
company’s success to?
The whole team, past and present, that has
built a reputation for placing patient care at
the heart of everything we do.
What’s your favourite season,
and time of year?
Summer.
Where would spend your perfect
day?
Sailing with the family, reading or writing
an optometric article, and then cooking a
barbecue on the beach.
Any �nal thoughts?
That optometry is interesting and ful�lling.
If you don’t �nd it so, then you need to do it
in a di�erent place and in a di�erent way.

optometrytoday
COMPETITION
Win a £500 shopping spree
WITH OUR Optrafair draw fast approaching, this issue is
your last chance to enter our Mystery Year contest online
or by post.
As part of our anniversary celebrations, we are giving
one lucky reader £500 worth of shopping vouchers for the
store or website of their choice.
All you have to do to get an entry in our prize draw is
to tell us which year the advertisement appeared below in
OT. Last issue’s Mystery Year, which featured a ‘Goodies’
inspired frame came from 1973. Congratulations to all
who were correct, you each get an entry into our prize
draw.
This issue’s controversial Mystery Year image comes
from the year Celine Dion won the Eurovision Song
Contest for Switzerland.
To enter simply guess the Mystery Year and send the
answer, along with your contact details to: Mystery Year
(March 25), Optometry Today, 61 Southwark Street,
London, SE1 0HL.
For full terms and conditions or to enter online, see
www.optometry.co.uk
Looking back
optometrytoday
Throughout the year in OT we’ll be sharing some of the best
letters we’ve received over the years. This week, we look
back to the controversy surrounding this week’s Mystery
Year image.
Sir – So sex comes to Optometry Today. I suppose it had
to, sooner or later. All glossy trade magazines eventually
succumb. It appears Rodenstock now advocate the end of
boring old spectacle cases, chains and cords in favour of more
exciting, though less protective and more uncomfortable
means for holding spectacles when they are not in use. Well
this may be all right for sun-worshipping women but is it
going to be followed by ideas for shades-wearing beach-boys?
I would like to propose a series of front covers depicting
hunks modeling brief swimming apparel, each with a
spectacle frame tucked in or hooked over his trunks.
Looking forward, with baited breath and pent up
excitement the forthcoming issues of ‘Optometitlation Today’
– A Hampshire-lady-optometrist (April 23).
Sir – I note with a modicum of amusement the fuss over the
Rodenstock cover. The only letter that realised we were now
in the 80s was that of a ‘Hampshire lady optometrist’.
I have looked again and again at that cover for any stimulation
hoping, perhaps, that I could save my subscription to
Playboy. Could we have a full-length photograph of the lady
soon, preferably without the sunspecs? – Reg Herson, Hove
(May 21).
Sir – I have resisted (until now) rising to the bait cleverly laid
for us by your collective correspondents to our ‘sexist’ front
cover advertisement.
As with most things in life, the letters demonstrated
admirably the diverse opinions which exist in all professions,
and who optometrists in particular are such an interesting
mixture to deal with.
To all of your readers, whether ‘prima-donna’ or ‘light
hearted humourist’ on behalf of Rodenstock UK, may I just
say it was a ‘boob’ which will not be repeated. – Chris Hunt,
MD – Rodenstock UK (June 4).
47
25/03/11 MYSTERY YEAR

OT CET Video
C 15893/O D: An Introduction to
Optical Coherence Tomography
This video aims to provide an introduction to the technology of Optical
Coherence Tomography (OCT) for both Optometrists and Dispensing Opticians.
The video is split into three segments:
In part one, Dr Leon Davies (Senior Lecturer, Aston University) provides an
overview of the theory behind Optical Coherence Tomography, including
details of how the scans are generated, the differences between time domain
and spectral domain systems and tips for interpreting OCT scans.
In the second segment, optometrist Nick Rumney discusses the clinical use of
OCT in optometric practice, including advising when to use the technology, the
appearance of commonly presenting abnormalities and details a series of case
studies based on his experiences with OCT.
Finally, optometrist Nicola Haig-Brown describes her experience of owning
an OCT machine, including discussing the impact OCT has had on her practice.
The video is one hour in length and is accompanied by 12 MCQs accredited
with 2 free CET points for Optometrists and Dispensing Opticians.
You must be logged in to the website before you can watch this video
and take the exam.
A hint button is now available for each question and will take you
to the section of the video that relates to the question.
The closing date for MCQ submissions will be April 30, 2011.
SPONSORED BY
www.optometry.co.uk

MARCH
NEW… 27 CooperVision, The Lowry Hotel,
Manchester, ‘Leading thinking conferences’
(www.journeyo�ife.co.uk)
28 Maui Jim, Brooklands Hotel, Weybridge,
‘CET party – training with the Hawaiian twist’
free but places are limited (0800 980 1770)
29 Maui Jim, Aztec Hotel, Bristol, ‘CET party
– training with the Hawaiian twist’ free but
places are limited SEE ABOVE
NEW… 29 CooperVision, The Celtic
Manor Resort, Newport, ‘Leading thinking
conferences’ SEE ABOVE
29 Pinpoint Scotland, Postgraduate Centre,
Leighton Hospital, ‘Retinal imaging course’
(Maureen.broomhall@mcht.nhs.uk)
29 BABO, Lesley Arkin Optometrist,
Co�eridge Close, Stony Stratford, Milton
Keynes, ‘Peer review day’ (arkin@eyecare-mk.
co.uk)
30 BABO, Keith Holland & Associates, 27 St
George’s Road, Cheltenham, ‘Peer review
day’ (clare@keithholland.co.uk)
30 Norfolk and Norwich LOC, The Oaklands,
Norwich, ‘AMD part two,’ 6.45pm (caron.
willard@novartis.com)
30 Maui Jim, National Motorcycle Museum,
Birmingham, ‘CET party – training with the
Hawaiian twist’ free but places are limited
SEE ABOVE
31 BABO, John Glover Optometrists, 45
Compsall Road, Romiley, Stockport, ‘Peer
review day’ (john@parkvision.co.uk)
NEW… 31 CooperVision, Oulton Hall, Leeds,
‘Leading thinking conferences’ SEE ABOVE
31 Maui Jim, Hilton Hotel, Manchester
Airport, ‘CET party – training with the
Hawaiian twist’ free but places are limited
SEE ABOVE
APRIL
1 Maui Jim, Holiday Inn, Bloomsbury, London,
‘CET party – training with the Hawaiian twist’
free but places are limited SEE ABOVE
1 International Institute of Colorimetry,
University of Ulster Conference Centre, ‘One
day colorimetry training session’ (info@
colorimetryinstitute.org)
NEW… 3 CooperVision, 195 Piccadilly,
London, W1J, ‘Leading thinking conferences’
SEE ABOVE
4 Maui Jim, Morrison Hotel, Dublin, ‘CET party
– training with the Hawaiian twist’ free but
places are limited SEE ABOVE
NEW… 4 Nottingham and Derby Optical
Society, The Village Hall, Chilwell, ‘Eye
casualty services’ (ndos@live.com)
NEW… 5 North London AOP, Moor�elds Eye
Hospital, London, EC1V, ‘Lecture congenital
colour de�ciencies’ (stevedross10@hotmail.
com)
DIARYDATES
Party your way to points
Both optometrists and DOs can say ‘aloha’ to CET, earned in
a fun and lively environment with Maui Jim’s series of CET
parties, which are being held around the country between
March 28 and April 4.
Traditional Hawaiian entertainment will be provided on the
night as well as a bu�et and, of course, the lectures explaining
polarised light and the technical bene�ts of the companies
lenses.
Places are limited, so booking is essential on: sales.uk@
mauijim.com
NEW… 5 Hampshire and IOW LOC and
East Hants West Sussex AOP branch, Dame
Judith Professional Centre, Sundridge Close,
Cosham, ‘Corneal grafting and corneal
dystrophies’ (ronald.rabbetts@virgin.net)
NEW… 5 CooperVision, Crowne Plaza Hotel,
Birmingham NEC, Pendugo Way, ‘Leading
thinking conferences’ SEE ABOVE
6 South Sta�s Optical Society, Cannock
Cricket and Hockey Club, Cannock, ‘Contact
lens complications’, 6.30pm (suecutts@
talk21.com)
NEW… 7 CooperVision, The Institute of
Engineering and Technology, London, WC2R,
‘Leading thinking conferences’ SEE ABOVE
9-11 Optrafair, Birmingham NEC (FMO: 020
7298 5123)
NEW… 11 J&J, The Vision Care
Institute, Pinewood, Wokingham,
‘Managing the astigmatic patient’ (www.
thevisioncareinstitute.co.uk)
NEW… 12 J&J, The Vision Care Institute,
Pinewood, Wokingham, ‘Healthy eyes and
healthy practices’ SEE ABOVE
14 BCLA, 76 Portland Place, London,
‘Scienti�c evening meeting’ SEE ABOVE
NEW… 20 UltraVision, Head O�ce, Leighton
Buzzard, Bedfordshire, ‘KeraSoft IC workshop’
workshop and �tting techniques (workshop@
ultravision.co.uk)
MAY
NEW… 6-8 European Academy of
Optometry and Optics, Prague, Czech
Republic, ‘Annual conference’ (info@eaoo.
info)
NEW… 9 J&J, The Vision Care Institute,
Pinewood, Wokingham, ‘Healthy eyes and
healthy practices’ SEE ABOVE
NEW… 10 J&J, The Vision Care Institute,
Pinewood, Wokingham, ‘Managing the
astigmatic patient’ SEE ABOVE
NEW… 11 NIOS, Templeton Hotel,
Templepatrick, County Antrim, ‘Contact lens
day’ (lizgillespie.nios@btopenworld.com)
NEW… 18 South Sta�s Optical Society,
Cannock Cricket and Hockey Club, Church
Lane, Hatherton, Cannock, ‘AGM’ with bu�et,
6.30pm SEE ABOVE
NEW… 18-19 J&J, The Vision Care Institute,
Pinewood, Wokingham, ‘Returning to work
con�dent and refreshed’ SEE ABOVE
NEW… 18 ABDO, 199 Gloucester Terrace,
London, W2 ‘President’s consultation day’
(jburnand@abdolondon.org.uk)
NEW… 18 UltraVision, Head O�ce,
Leighton Buzzard, Bedfordshire, ‘KeraSoft IC
workshop’ workshop and �tting techniques
(workshop@ultravision.co.uk)
NEW… 23 Sportvision, Walkers Stadium,
Leicester, ‘Sportfair’ (www.sportvision.co.uk)
49
25/03/11 DIARY DATES

50
25/03/11 CET
CET CONTINUING
EDUCATION
& TRAINING
1 FREE CET POINT
Approved for: Optometrists �� Dispensing Opticians ��
OT CET content supports Optometry Giving Sight
Visual Signs & Symptoms
of Multiple System
Atrophy
AGEING VISION PART 6 COURSE CODE: C-15734 O
Dr Richard A. Armstrong BSc DPhil
In this �nal article on ageing vision, the visual features of Multiple System
Atrophy (MSA) are discussed and described. Previous articles in the series
have shown how systemic ageing changes, particularly those a�ecting
the brain, can have signi�cant detrimental e�ects on vision. MSA is a rare
movement disorder and a member of a group of neurodegenerative diseases,
which include Parkinson’s disease (PD) and progressive supranuclear palsy
(PSP), and are referred to as the ‘Parkinsonian syndromes’. Although primarily
a neurological disorder, patients with MSA may also develop visual signs
and symptoms that could be useful in di�erential diagnosis. In addition,
the eye care practitioner may contribute to the management of visual
problems of patients with MSA and therefore help to improve quality of life.
Visual signs and symptoms
Several of the brain areas affected in
MSA may be involved in visual function
(Figure 1) including areas of the
cerebral cortex, striatum, midbrain, and
cerebellum. A variety of visual problems
have been reported in patients with
MSA, involving these brain areas, and
the major signs and symptoms identified
to date are summarised in Table 1.
Primary vision
There is little detailed information
concerning changes in visual acuity
(VA) in MSA. Patients with PD and
PSP, however, will often complain of
poor vision especially as the disease
progresses, and this is also possible in
MSA. In PD, vision has been reported
to be blurred in response to coloured
stimuli, 1 with reduced colour fusion
times, 2 which indicates the acuity of
perception of monochromatic contours.
There is little evidence however,
that colour vision itself is affected in
MSA. Consistent with this suggestion,
abnormal visual evoked potentials
(VEP) using coloured stimuli have not
been reported in MSA. 3 There have
been few studies of visual field defects
in patients with any of the Parkinsonian
syndromes, a reflection of the specific
difficulties of conducting such tests
in patients with a movement disorder.
Eye movement
Eye movement problems are an
important aspect of the Parkinsonian
syndromes in general. For example,
spontaneous and voluntary eyelid
mobility are often abnormal in PSP
but are usually less affected in PD
and MSA. 4 Abnormal ocular fixation,
however, may occur in a significant
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proportion of patients with MSA. 5
In a patient with MSA where a
combination of olivopontocerebellar
atrophy and striato-nigral degeneration
was present, the typical impairments
of eye movement characteristic of
PD were evident, viz., abnormal eye
movements, 6 in combination with
a vertical optokinetic nystagmus. 7
However, smooth pursuit and saccadic
movements in the vertical direction were
only slightly affected. In a recent study
of oculomotor function in thirty patients
with MSA, 8 excessive square-wave jerks
were observed in 21 of the patients, a
mild supranuclear gaze palsy in eight
patients, a gaze-evoked nystagmus in
12 patients, a positioning down-beat
nystagmus in 10 out of 25 patients,
mild-moderate saccadic hypometria
in 22 patients, impaired smooth
pursuit movements in 28 patients, and
reduced vestibulo-ocular reflex (VOR)
suppression in 16 out of 24 patients.
The VOR is a reflex eye movement
that stabilizes images on the retina
during movements of the head. This is
achieved by the central nervous system,
which induces an eye movement in
the opposite direction to that of the
head. It can be tested by the ‘rapid
head impulse test’ in which the head
is rapidly moved to the side. Normally
the eyes will remain looking in the same
direction but in diseases such as MSA,
no compensatory eye movement may
be apparent. The ‘gain’ of the VOR is
the ratio of the change in eye angle to
head angle during a head turn. If the
gain is impaired (ratio not equal to
unity), head movements result in image
motion on the retina and blurred vision.
The gain of the VOR in the dark may be
cancelled by fixation. Both patients with
MSA and PSP show this cancellation
compared with both normal subjects
and patients with PD, 5 which could
be related to cerebellar dysfunction.

Hence, eye movement problems
and especially those related
to oculomotor dysfunction are
likely to be an important feature
of MSA. Nevertheless, many of
the visual signs and symptoms
associated with eye movement
are controversial and may not
occur in all patients. Hence, some
authors believe that oculomotor
anomalies are not present in MSA
consistently enough to make them
useful in differential diagnosis. 9
Pupil reactivity
Examination of the pupil
reactions is an opportunity to
detect disturbances in autonomic
innervation of the eye, a likely
feature of MSA. 10 Infra-red
pupillography can be used to
measure pupil diameter in the
light and dark, the light reflex
response, and pupil reactions
associated with the administration
of pharmacological agents. 10 In a
study of pupil reactivity in MSA,
about a quarter of patients tested
had abnormal pupil reactions
and in the majority, the defects were
bilateral and symmetrical. Pupil
defects were not usually apparent to
the patients themselves or to their
physicians. In addition, in normal
subjects, pupil size will often increase in
response to stress but no such change is
apparent in MSA. 11 Horner’s syndrome
(abnormally small pupil diameter) has
rarely been observed in neuropathies
such as MSA, although such a change
has been reported in one case. 12
Psychophysics
Contrast sensitivity (CS) is affected in
PD at least in a proportion of patients 13,14
but there is little evidence to date
for an effect in MSA. Visual spatial
contrast threshold and suprathreshold
Figure 1
The major brain areas a�ected in multiple system atrophy (MSA) which may be involved in visual function:
Basal ganglia (BG), Cerebellum (CB), Inferior olive (ION), Locus caeruleus (LC), Motor cortex (MC), Premotor
cortex (PMC), Pontine nuclei (PT), Spinal cord (SC), Substantia nigra (SN), Thalamus (Th)
contrast match to high-contrast sine-
wave gratings have been compared in
patients with PD and MSA to normal
control subjects. 15 The response
of patients with PD was reduced
compared with the controls but this
was not the case in patients with MSA.
Visual evoked potentials
Evoked responses to motor stimuli have
been reported to be normal in MSA. 16
Similarly, although significant effects
on the electroretinogram (ERG) and
VEP have been found in PD and PSP,
the results reported in MSA are more
controversial. For example, the pattern
reversal ERG to a coloured stimulus
(ChPERG) was recorded in both PD and
MSA. 3 Although reduced amplitude and
increased latency of evoked components
were observed in PD, especially when a
blue-yellow horizontal grating was used
as a stimulus, no such effects were seen
in MSA. 3 Similarly, using a horizontal
sinusoidal grating, there were no effects
on the VEP in MSA although effects
were demonstrated in PD. 17 Significantly
less impairment has also been observed
in MSA to a full-field flash stimulus
compared to PD and PSP. 18 Nevertheless,
in some studies, VEP abnormalities have
been reported in patients with MSA,
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of event-related potentials in MSA,
which elicit the ‘P300’ evoked response,
believed to reflect orientation, attention,
stimulus evaluation, and memory. These
evoked responses may be associated
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Ocular aspect Change in MSA References
Primary vision Little evidence at present for defects in acuity, colour vision, or
with no detectable differences between
the MSA-C and MSA-P subtypes. 16
Event-related evoked potentials
There have been a number of studies
visual �elds
Eyelid mobility Spontaneous and voluntary eyelid mobility normal VallSole et al., 1991
Fixation Abnormal in many patients Rascol et al., 1991
Square-wave jerks Present in a signi�cant proportion of patients Anderson et al., 2008
Supranuclear gaze palsy Mild defect in some patients Anderson et al., 2008
Nystagmus Gaze-evoked nystagmus in a proportion of patient Anderson et al., 2008
Saccadic hypometria Mild to moderate Anderson et al., 2008
Smooth pursuit
movement
Impaired in a signi�cant number of patients Anderson et al., 2008
VOR Reduced suppression in a proportion of patients Anderson et al., 2008
Pupil reactivity Abnormal pupils in many patients
No response due to stress
-
Kuruda et al.,
Contrast sensitivity No evidence for impairment van Elst et al., 1997
Evoked potentials Normal motor-evoked potentials
Normal chromatic PERG
VEP defects controversial
Abnormal event-related potentials
in some patients (P300)
1998
Abele et al., 2001
Sartucci et al., 2006
Delalande et al., 1998
Delalande et al., 1998
Wang et al., 2000
Sleep disorder iREM in many patients Turner, 2002
Reading speed Mildly a�ected Sachin et al., 2008
Visual hallucinations Rare, unrelated to medication Kumbler and
Kornhuber, 2002
Table 1
Visual changes in Multiple System Atrophy (MSA). Abbreviations: iREM = idiopathic rapid eye movement sleep disorder, PERG = pattern elctroretinogram, VEP =
Visual evoked responses, VOR = Vestibulo-ocular re�ex
with neural activity in the temporal
lobe, pre-frontal lobe, limbic system,
and thalamus. 19 In one of the first
studies of event-related potentials in
MSA, 20 it was observed that the P300,

elicited using visual stimuli, could be
recorded even when a severe motor
disability was present. Reaction times
to rare target stimuli were significantly
decreased in PD and MSA compared
with PSP. 19 Kamitani 21 studied event
related potentials in MSA-C and MSA-P.
No significant change was found in the
latency of the N1 or N2 components in
either subtype of the disease suggesting
that the early stages of visual processing
were preserved in MSA. Nevertheless,
the P3a peak was more difficult to
distinguish and there were decreases in
amplitude of the response in both MSA
subtypes. By contrast, the P3b component
was only affected in the MSA-C subtype
and exhibited both increased latency and
reduced amplitude. The reduced size of
the pons, claustrum, perisylvian area and
the deep cerebral gray matter in MSA
may be responsible for these responses.
Complex visual functions
Speech abnormalities are common in
all of the Parkinsonian syndromes and
in MSA, and there is often a mixed
dysarthria (problems in articulating
speech) with ataxic and spastic
elements. 22 Maximum phonation time
and reading speed are also affected
in MSA but to a lesser extent than in
PSP. 22 There is also ‘idiopathic rapid eye
movement’ (iREM) disorder (abnormal
behaviour during sleep accompanied
with rapid eye movements) in MSA,
which probably results from neuronal
losses in the pigmented monoaminergic
nuclei such as the locus caeruleus and
substantia nigra. 23 So common is this
type of disorder in the Parkinsonian
syndromes generally, that the presence
of iREM is often regarded as a strong
indicator that a patient may be
developing a Parkinsonian-type disorder.
Visual hallucinations, unrelated to
medication, are rare in MSA however,
compared with the other Parkinsonian
syndromes, and especially in PD.
Di�erential diagnosis
The Parkinsonian syndromes often
exhibit overlapping signs and symptoms
and therefore, can be very difficult to
diagnose correctly. Hence, there is the
question of whether visual symptoms
can help in the clinical diagnosis of
these disorders. A summary of the most
useful visual features in differential
diagnosis is shown in Table 2. Patients
with MSA often exhibit a combination
of extrapyramidal, cerebellar,
pyramidal, and autonomic dysfunction
signs, many of which can also be seen
in other Parkinsonian disorders. The
presence of visual hallucinations,
unrelated to medication, however,
are rare in MSA and their presence
can often exclude MSA as a possible
diagnosis. 24 In addition, there is greater
retinal pathology in PD, which results
in significant defects in CS, and in the
early components of the VEP, which are
also not likely to be seen in MSA. Colour
VEPs are also affected in PD but not in
MSA. 3 Where defects in the VEP are
seen in MSA, they will normally involve
event-related evoked potentials such as
the P300. 19,20 Additional features that
may be helpful in differential diagnosis
include fixation, which is abnormal in a
significant proportion of PSP and MSA
cases but less so in PD, 5 eyelid mobility
which is abnormal in PSP but more
likely to be normal in PD and MSA, 4
and the slowing of saccadic movements
especially in the vertical direction
which occurs most significantly in PSP. 25
Anderson et al. 8 have recently
published a list of ‘red flag’ criteria that
are strongly suggestive of a diagnosis of
MSA and include excessive square-wave
jerks, mild to moderate hypometria of
saccades, impaired VOR, and nystagmus.
By contrast, if clinically slow saccades
are present together with a moderate to
severe vertical gaze palsy, the diagnosis
is more likely to be one of the other
Parkinsonian syndromes such as PSP.
Discussion and conclusions
Middle-aged to elderly patients who have
not been diagnosed with MSA may exhibit
visual signs and symptoms suggestive of
a Parkinsonian-type disorder. The most
important of these signs are related to
the primary defects of the disease, viz.,
extrapyramidal, cerebellar, pyramidal,
and autonomic dysfunction. The
most important visual signs include
oculomotor dysfunction and pupil
reactivity, but with relatively preserved
primary vision. Hence, a patient with
unexplained signs of this type should be
referred for neurological examination.
Nevertheless, the exact presentation of
MSA is highly variable and patients can
be visually asymptomatic. It is difficult
to separate MSA from other disorders
with Parkinsonism such as PD and
PSP especially before visual symptoms
become apparent. If ocular signs and
symptoms are present, then they may aid
differential diagnosis. Atypical features
of MSA include slowing of saccades,
presence of vertical gaze palsy, and
absence of square-wave jerks. Particularly
useful in separating MSA from other
Parkinsonian syndromes is the presence
in the former of excessive square-wave
jerks, mild to moderate hypometria of
saccades, impaired VOR, and nystagmus.
Patients who have been diagnosed
with MSA may develop a range of
visual problems during the course of the
disease. Visual deficits in Parkinsonian-
type syndromes are often important
in influencing overall motor function.
Hence, identifying and correcting the
visual problems of a patient with MSA as
far as possible can significantly improve
quality of life. Clinical examination
requires sensitivity to the physical
and mental state of the patient and the
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problems involved in the Parkinsonian
syndromes have been described in
detail by Naylor. 26 In addition, some
of the visual problems may be adverse
reactions to treatment. Side effects
may occur relatively rapidly at the
beginning of, or after a change in, drug
treatment, but can also occur after a long
latent period. It is important that those
symptoms due to adverse reactions are
distinguished from those due to the
disease process itself. If ocular side
effects are identified in a patient with
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MSA and become severe, then it is
essential that these be monitored and the
patient referred back to their physician
for further clinical assessment.
About the author
Syndrome
Richard Armstrong was educated
at King’s College London and St.
Catherine’s College Oxford. He has
been a lecturer in Botany, Microbiology,
Ecology, Neuroscience, and Optometry
during his 34 years at Aston University.
His research interests include the
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Feature MSA PD PSP
Eyelid mobility Normal Normal Eyelid opening apraxia
Saccadic eye
movements
Mild-moderate
hypometria
Normal Abnormal, slow
Vertical gaze palsy Rare Rare Present
Fixation Abnormal Normal Abnormal
Square-wave jerks Frequent Present Present
Contrast sensitivity Normal (?) Abnormal
(high to intermediate
frequencies)
VEP (early) Normal Abnormal Normal
VEP (colour) Normal Abnormal ?
VEP (P300) Increased L
Reduced A
Visual hallucinations Rare, unrelated to
medication
?
?
Common Rare
?
Increased L
Reduced A
VOR Impaired gain Normal Impaired gain
Nystagmus Various present Abnormal OKN Abnormal OKN
Table 2
Summary of features that can be used to provide a di�erential diagnosis of ‘parkinsonian’ syndromes (MSA = Multiple system atrophy, PD = Parkinson’s disease,
PSP = Progressive supranuclear palsy) based on visual signs and symptoms. A = Amplitude, L = Latency, VEP = Visual evoked potential, VOR = Vestibulo-ocular
re�ex, OKN = Optokinetic nystagmus, ? indicates no reliable data known to the author
neuropathology of neurodegenerative
diseases with special reference to vision
and the visual system. He also has a
particular interest in the application
of statistical methods in research.
References
See http://www.optometry.co.uk
clinical/index. Click on the article
title and then download "references".
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Intraocular Telescopes
For Macular
Degeneration
COURSE CODE C-15909 O/D
Brendan J Moriarty MA (Cantab), MBBChir, FRCS, FRCOphth, MD.
Age related macular degeneration (AMD) is the leading cause of blindness in the
population above 65 years of age in the western world. 1 In the UK, 3.7% of people
over 75 years old and 14% of those over 90 years of age have visual impairment
attributable to AMD. 2 The central scotoma arising from AMD also limits most
daily living activities resulting in dependency, depression and impaired quality
of life. 3,4 The demographics of our societies would indicate that this problem will
signi�cantly increase every decade, with an estimated 54% increase in the over
75 years age-group in the next 25 years. 2 This article describes an innovative
and promising method of vision correction for those with AMD, the intraocular
implantation of telescopes, which could in the future become commonplace.
A number of treatments are available or
are being developed for the treatment
of neovascular (‘wet’) AMD, including
intra-vitreal anti-vascular endothelial
growth factor (anti-VEGF) injections.
However, wet AMD only constitutes
10-15% of cases of AMD. In contrast
‘dry’ AMD constitutes 85-90% with
limited treatment options available; 5
most notably, this typically involves
advice on increased dietary intake of
anti-oxidants through healthy eating
and supplementation with lutein- and
zeaxanthin-containing vitamins, and
protection of the eyes from ultraviolet
(UV) and blue-light radiation with
sunglasses. Those of you familiar with
low visual aid clinics will attest to the
frustration and despair that patients
with dry AMD experience in an attempt
to regain their reading and navigation
ability. Therefore, it is fitting that
intraocular telescope implantation
�
offers a promising hope for the future.
Optical principles
Intraocular telescopes are most commonly
based on the Galilean telescopic system
(Figure 1), whereby a high minus powered
bi-concave eye piece lens is combined
with a high positive powered bi-convex
objective lens, to produce a magnified,
erect, virtual image. Magnification of such
systems approximates to the dioptric
ratio of the eye piece lens to the objective
lens. In the Implantable Miniature
Telescope (IMT) the magnification is
between 2.2x and 3x. 6 The Intraocular
Lens for Visually Impaired Persons
(IOLVIP) has a magnification of 1.3x
with “a small prismatic effect due to
misalignment (planned) of the IOLs”. 7
Once a patient receives an intraocular
telescope implant, the post-operative
refraction is influenced by the separation
of the two lenses. This is fixed in
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the IMT system and in the IOLVIP
system, particularly in hyperopes,
this can give rise to high (5.00-
7.00DS) degrees of residual hyperopia.
The IMT
The IMT (Figure 2) consists of a quartz
tube that houses two wide angle micro-
lenses. The diameter of the IMT is
3.6mm and the length is 4.4mm with
a carrier haptic of 13.5mm diameter.
The IMT recently completed a two-year
trial study that included 28 centres, 6
and has received FDA approval. In this
study, 206 patients were enrolled and
174 were analysed at two years after
implantation. The study mandated the
IMT to be implanted in the worse eye of
the patient and it was found that the best-
corrected visual acuity (VA) improved
by three lines (doubling of the visual
angle) in over 60% of patients, and by 5
lines of acuity in nearly 20% of patients.
There were initial concerns from
ophthalmologists about corneal
endothelial cell loss, and this was
reported to be 25% cell loss at one year
following implantation. However, this
cell loss does not appear to be cumulative
with only 2.4% additional loss reported
between years 1 and 2. 6 This endothelial
cell loss is largely due to the wide
incision required for implantation;
it is much longer than an incision
made for phacoemulsification cataract
extraction (2.8mm) or an extracapsular
cataract extraction (7–10mm).
By necessity, this system causes
a restriction in visual field of about
25% loss. As such, at present it is
recommended that the IMT only be
used in the worst eye of a patient, in
order to enhance reading ability. The
better eye is left as a navigational eye.
The IMT is currently completing
mandatory “pre-marketing” assessment
and the author has been invited to
collaborate with the FDA and the
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Figure 1
The Galilean telescopic system
manufacturers when introducing
the IMT to the UK in 2011. Further
outcomes data will also, hopefully, be
obtained and published in the future,
but it is already clear that the outcomes
with the IMT look very promising.
The IOLVIP
The IOLVIP typically comprises lenses
of power +53D as the anterior optic
and -64D as the posterior optic. It is a
lower magnification system than the
IMT but incorporates a “prismatic”
effect, thereby diverting the image onto
a preferred retinal locus (PRL), which is
a point on the retina that is away from a
macular area affected by AMD (Figure 3).
Pre-operatively the PRL is determined
using a simulator (Figure 4), which
Figure 2
Implantable Miniature Telescope
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�
allows an assessment of the likely visual
improvement that will be obtained. In the
IOLVIP system, the prismatic simulator is
placed in a trial frame over the optimal
distance vision refraction. The simulator
is rotated to determine the point at
which visual improvement is maximal.
This tells the surgeon which way to
orientate the IOLs during the operation.
The author introduced implantation
of the IOLVIP in the UK in 2007 and at
six months noted that 89% of patients
had doubled their distance vision (pre-
operative distance VA was logMAR 1.52
whilst post-operative distance VA was
logMAR 0.69) (Figure 5). 8 In addition,
the visual outcomes predicted by the
simulator closely reflected the actual
visual outcome. Indeed, in some patients
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the outcomes were better than predicted
by the simulator, because of extraction of
the lens opacity at the time of surgery. This
predictability of outcome carries many
benefits. Principally, the patient and the
surgeon can determine with substantial
confidence the likely outcome prior to
surgery, whilst also giving the patient
and their family a realistic prognosis.
The outcomes observed by the author in
his own work are similar to the outcomes
observed elsewhere. In the Milan study
group 7 the pre-operative distance VA
was logMAR 1.30 whilst post-operatively
this improved to logMAR 0.72. In the
Valencia study group 9 the pre-operative
distance VA was reported to be logMAR
1.37 and this improved post-operatively
to logMAR 0.68. Longer term follow-
up at 18 months post-operatively has
revealed that in some patients the
initial improvement in VA was lost,
due to advancement of AMD and
corneal decompensation. 10 Indeed, this
highlights the importance of making all
patients aware of the risks and that there
is no guarantee of a long-term, sustainable
improvement in VA. Furthermore, it
is important to counsel patients and
communicate to them and their families
that surgery does not prevent AMD, it
merely compensates for it for a period
of time. Otherwise, it can be distressing
for these patients if at a later stage they

Figure 3
The Intraocular Lens for Visually Impaired
Persons (IOLVIP)
find that their initial improvement in
vision has declined thereafter. It is
also important to clarify to patients
that there will be substantial induced
hyperopia post-operatively; indeed,
the research reported above has clearly
noted misgivings about post-operative
hyperopia within patient groups. 7,8,9,10
Note that it is important to assess
visual function in terms of logMAR
acuity as opposed to traditional Snellen
acuity, due to design flaws in the latter
that may over-estimate true VA. Indeed,
logMAR charts such as the Bailey-Lovie
chart are advantageous in that task
difficulty remains consistent across all
levels of acuity, with equal number of
optotypes presented per line, and there
Figure 4
The IOLVIP simulator
is a regular logarithmic progression of
acuity such that each line is a scaled
version of the preceding line, allowing
each individual letter to contribute to
the VA measure, increasing the accuracy.
CE marking
The IOLVIP and IMT have CE marks and
are supported by NICE Guidelines (IPG
272). Only the IMT has FDA approval.
Although the telescopes are CE marked
and have NICE guidelines with regard
to audit, funding for surgery on the
NHS is unpredictable. The author has
been successful on many occasions in
presenting patients to their Primary
Care Trusts as “special circumstances”.
Indeed, lately the approval for NHS
funded surgery has become rare.
Interestingly, it is likely that the IMT
may be approved by Medicare in the
USA, which perhaps indicates a more
sympathetic appreciation of the enhanced
quality of life that the device offers.
Top ten tips
Patients that may be deemed suitable for
implantation of intraocular telescopes
have a lot to gain by undergoing the
procedure. It is important however to
consider the following factors and advice,
in order to optimise the possible outcomes:
1) Patient selection is all important. It
is the author’s experience that visual
outcomes are dependent on the extent of
AMD. As a rule of thumb, good outcomes
can only be expected with less than 2
disc diameters (DD) of AMD (Figure 6).
2) Patients need to be highly
motivated with a clearly defined
PRL for eccentric fixation.
3) This procedure does not have a
“wow” factor, and it is important
not to mislead patients to expect an
outcome that is akin to the change
people may experience following
routine cataract extraction or corneal
laser refractive surgery for refractive
error correction. Visual improvement
can be slow and needs encouragement.
4) Some patients with moderate AMD
alongside cataract may benefit from
cataract extraction alone. However,
cataract surgery in advanced
AMD is generally of limited value.
5) Optometric input is vital in helping
with patient selection and post-
operative refraction. In general terms,
the author advises patients to have
separate distance and reading glasses
for one year post-operatively. Ancillary
devices eg, Eschenbach magnifiers,
can still be used if required. The
author works in conjunction with an
experienced low vision aid optometrist
in his clinics to ensure optimal post-
operative visual function can be gained.
6) Patients need to be counselled
carefully about visual expectations.
The author generally only discusses
surgery with patients who show at
least 3 lines improvement with a
simulator. Advising patients that their
AMD is too far advanced for surgery
can often be met with great dismay
and requires sympathetic counselling.
7) Great dismay can be encountered
when vision improves for a time and
then regresses due to advancement of
AMD, after surgery. It is important for the
surgeon to emphasise that the surgery
does not delay the advancement of AMD
but it merely reduces its visual impact
for an unpredictable period of time.
8) Both IOLVIP and IMT telescopic
systems have a rehabilitation programme
that is directed by the surgeon/
optometrist. The author finds these
of limited value since if a patient has
well established eccentric fixation
they do not need to be taught how
to utilise it; for those that do not
eccentrically fixate, the rehabilitation
program may be of some use though.
9) The family input is vital. The author
usually insists on as many family
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Post op distance vision (logMAR)
members being present at the assessment
and follow-up appointments as possible.
They can see the visual improvement
afforded by the simulator and thereby
aid counselling of the patient about the
expected visual outcomes. Indeed, they
can avoid the patient getting “carried
away” with perceptions of “miracles”.
10) Surgeons and optometrists need
to advise patients with honesty and
Pre op distance vision (logMAR)
Figure 5
Improvement in distance VA with implantation of the IOLVIP
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integrity. These patients may have had a
harrowing time in the past and surgery
is a “last chance saloon” for many. They
need careful selection and counselling.
Future Developments
Figure 6
Best prognosis with the IOLVIP and IMT is if the AMD is less than 2DD in size
Two new ‘telescopic’ systems are
currently undergoing trials for improving
visual function in AMD and the outcomes
of these are awaited in anticipation.
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The Lipshitz Macular Implant (LMI)
uses a Cassegrain (Newtonian)
telescopic system and magnifies the
central image using a concave mirror
system. The Nu-lens system is a
sulcus fixated IOL that can reportedly
provide 10-14D of accommodation.
It was originally designed for use in
cataract surgery for the correction of
presbyopia, but it has clear possibilities
for use in patients with AMD too.
We all eagerly await the potential
improvements afforded by gene therapy
and stem cell therapy too. While
much research in this field shows great
promise, we may have to wait many
more years yet before this becomes
a distinct clinical treatment option.
About the author
Brendan Moriarty trained in medicine at
the Middlesex Hospital in London and
gained his FRCS in 1984. He then worked
as fellow and medical director for Project
Orbis, the internationally renowned
flying eye hospital. He became Fellow in
glaucoma at Moorfields Eye Hospital in
1987 and he is now head of glaucoma at
Leighton Hospital, Crewe. His expertise
in intraocular telescope surgery has been
recognised by his role as Special Advisor
to NICE. He was awarded “Best Original
Work” by the American Academy in
2008. He consults privately at The
Prospect Eye Clinic in Altrincham but
does not accept paid consultancies with
industry; his fees have been donated
to the Save the Children Fund. He has
no financial interests in the products
discussed. Visit www.prospecteyeclinic.
com for more information about
ophthalmic techniques and procedures.
References
See http://www.optometry.co.uk/
clinical/index. Click on the article
title and then download “references.”

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Module questions
Course code: C-15734 O
OT CET content supports Optometry Giving Sight
1. Which of the following statements regarding the primary aspects of
vision in MSA is FALSE?
(a) Poor vision is likely to be observed in MSA
(b) Blurred vision in response to coloured stimuli has been reported in Parkinsons’s
disease
(c) Abnormal VEP to coloured stimuli have been reported in MSA
(d) The degree to which visual �elds may be a�ected in MSA is largely unknown
2. Which of the following features occurs in a signi�cant proportion of
MSA patients?
(a) Abnormal �xation
(b) Abnormal eyelid mobility
(c) Abnormal vertical saccadic eye movements
(d) Abnormal vertical smooth pursuit movements
3. Which of the following VEP abnormalities have been reported in MSA?
(a) Motor evoked responses
(b) ERG
(c) Pattern-reversal VEP
(d) Event-related VEP
4. Which of the following statements regarding complex visual
functions in MSA is FALSE?
(a) Speech abnormalities are common in MSA
(b) A mixed dysarthria with ataxic and spastic elements may be present in MSA
(c) Reading speed is a�ected to a greater extent in MSA compared with PSP
(d) Idiopathic rapid eye movement (iREM) disorder is present in MSA
5. Which of the following statements regarding the di�erential
diagnosis of MSA is TRUE?
(a) Visual hallucinations are common in MSA
(b) There is greater retinal pathology in MSA compared with PD
(c) The early components of the VEP are signi�cantly a�ected in MSA
(d) Fixation is abnormal in a signi�cant proportion of MSA patients compared
with PD
6. Which of the following is NOT a ‘red �ag’ criterion for the
identi�cation of MSA?
(a) Excessive square-wave jerks
(b) Impaired vestibulo-ocular re�ex (VOR)
(c) Moderate to severe vertical gaze palsy
(d) Nystagmus
Having trouble signing in to take an exam?
View CET FAQ Go to www.optometry.co.uk
PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight
on April 22 2011 - You will be unable to submit exams after this date – answers to the module will be published on
www.optometry.co.uk. CET points for these exams will be uploaded to Vantage on May 2 2011 .
Course code: C-15909 O/D
1. Which of the following statements about intraocular telescopes is
TRUE?
a) They are an alternative to anti-VEGF treatment
b) They produce a magni�ed, erect image
c) They use a Newtonian telescopic system
d) They are suitable for most cases of AMD
2. Which of the following statements about the Implantable
Miniature Telescope (IMT) is TRUE?
a) It incorporates a prism
b) It is suitable for the better eye
c) It magni�es by between 2.2x and 3x
d) It can cause progressive corneal epithelial cell loss
3. Which of the following statements about the IOLVIP is TRUE?
a) It incorporates a 3x magni�cation with a prismatic e�ect
b) It has FDA approval
c) It induces hyperopia
d) It is as e�ective as cataract surgery in advanced AMD
4. Favourable outcomes with the use of intraocular telescopes may be
seen with which of the following?
a) Cataracts
b) Less than 1 disc diameter of AMD
c) Recent onset dry AMD
d) Unilateral cases of AMD
5. Which of the following statements about post-operative
rehabilitation is TRUE?
a) It is essential in all cases
b) It is of great value in advanced disease
c) It is often not necessary in patients with well established eccentric �xation
d) It requires continued monitoring
6. Which of the following statements about intraocular telescope
surgery is TRUE?
a) It causes advancement of AMD
b) It can delay AMD
c) It has no e�ect on progress of AMD
d) It induces glaucoma
59
25/03/11 CET

60
25/03/11 PRE-REG FOCUS
PRE-REGFOCUS
THE AOP will hold its �rst OSCE session
for pre-reg trainees at Optrafair (NEC,
Birmingham, April 9-11). The pre-reg OSCE
Preparation & Ocular Pathology course will
run in the morning on April 11.
As all trainees know, the OSCEs now
form a fundamental part of the scheme for
registration and they are their �nal hurdle
before trainees are able to join the GOC
register, writes Professor Steve Parrish and Dr
Anna Kwartz, directors of Innovative Optical
Training Limited (IOT), who will deliver the
three-hour session.
OSCE stands for Objective Structured
Clinical Examination. This method of
assessment was introduced by the College
of Optometrists into the Scheme for
Registration in the summer of 2010. The
exam involves a series of 5 minute stations
designed to test di�erent aspects of the
syllabus. The aim of OSCEs, which have
previously been used in other disciplines
such as medicine and nursing since 1975,
is to remove some of the examiner and
patient-based traditionally associated with
conventional forms of clinical examination.
The recent inclusion of OSCEs in the
qualifying examinations for optometrists
means that there is not yet an archive of
information which has been established over
several years to draw on. Consequently, for
some candidates, there is an understandable
degree of uncertainty about what will
be involved. As a result, the timing of the
training course at OT Live is ideal as many
trainees will be attempting the exam in the
summer of this year.
The session will focus on skills which
will be invaluable for OSCE candidates. For
example, history taking and formulating
a di�erential diagnosis. Whilst these are
Sponsored by
AOP schedules timely OSCE
training course for Optrafair
Pictured: Dr Anna Kwartz speaking at the
2010 AOP student conference.
skills in which all trainees are probably very
experienced in, the course will also focus
on exam technique and highlight vital
OSCE skills.
In addition, typical pitfalls of the OSCE will
be highlighted – together with avoidance
strategies. There will also be a question and
answer session, where trainees will be able to
ask any questions – no matter how simple –
they have about the OSCE. This component
is particularly important because, in the
past, trainees often used to turn to their
supervisors with queries about the qualifying
exams, but now their supervisor’s exam
experience is not necessarily relevant to
the OSCE.
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have been providing pre-reg training for
over 15 years. They are longstanding College
examiners and assessors for both Stage 1
Pictured: Professor Steven Parrish speaking
at the 2010 AOP student conference.
and Stage 2, and can provide a wealth of
experience to help candidates prepare for the
challenges which lie ahead. IOT is recognised
as an ‘approved supplier’ by the Association
of Optometrists and the two organisations
have previously worked together to provide
courses designed to support trainees at this
critical time in their education.
OT Live returns to Optrafair for a second
year, o�ering visitors to the three-day event
the opportunity to learn and gain CET points.
Session aimed at students, optometrists and
dispensing opticians will run throughout
the show.
The course costs £39. To book a place
on the course visit, www.otlive.co.uk
and then telephone Tracy Symons on
020 7787 1119 to make your payment.

Introduction
Having crisp, clear vision from
waking until bedtime without
experiencing fluctuations in visual
clarity is important to contact
lens wearers. For patients with
astigmatism, achieving this
goal may be more difficult,
especially when the amount of
astigmatism is relatively low (less
than 1.00 DC). These patients
are sometimes treated with
spherical lenses, resulting in less
than optimal vision correction.
For those who are wearing toric
lenses, other circumstances
affect vision such as eye rubbing
and the rotational stability of the
contact lens.
Advertisement Feature
Rotational Stability and Eye Rubbing
in Toric Contact Lens Wear
Gerard Cairns, PhD, MCOptom
In a global study of vision corrected patients,
quality of vision and vision that is as close
to natural as possible were the two most
important needs of astigmatic patients when
selecting eye-related products. 1 Of the 1,624
patients with astigmatism who completed the
survey, 46.5% reported they suffer from blurry
or hazy vision; many of whom (87%) find it
bothersome. These patients report that they
do not have a complete satisfactory solution to
the symptoms but are very interested in finding
one. 1 As 70% of these astigmatic patients
reported going to their ECP for information
concerning eye health and vision correction,
it is the role of the ECP to select the best
modality for their patients with astigmatism. 1 In
many cases, soft toric contact lenses are the
optimal choice; however there are factors that
need to be considered when selecting the best
lens brand.
Eye Rubbing and Rotational Issues
with Soft Toric Contact Lens Wear
Although many advances have been made in
toric contact lens development, lens rotation
continues to affect vision and can occur when
the patient blinks or rubs their eyes. 2 According
to a recent survey of 502 patients between 18
and 44 years of age (toric and spherical lens
wearers), contact lens wearers regularly rub
their eyes and do so for varying reasons. 3 The
most frequent causes of eye rubbing include
itchy eyes, tired eyes, and debris under the
lens (Figure 1). 3 The study reported that 87%
of toric lens wearing patients rub their eyes
approximately 6.3 times per day while wearing
contact lenses, and do so more frequently than
spherical lens wearing patients. 3
Eye rubbing can have visual consequences
for contact lens wearers. Toric lens wearers
note their contact lenses spontaneous move
and then need time to settle into place. 3
Clinically, this manifests as visual disturbances,
Figure 1: Most frequent causes of eye rubbing with toric contact lens wear. 3
Debris under lens
Eyes are itchy
When tired
When heat/AC/fan blows on face
Contact lenses have moved
Allergies are bothersome
evidenced by the fact that 77% of toric lens
wearing patients in this survey experienced
fluctuating, changing, or blurred vision after
rubbing their eyes. Approximately 1/3 of toric
lens wearers say it can take up to 30 seconds
for their vision to normalize. 3 Fluctuating vision
is most bothersome during certain activities,
such as when driving, looking at a computer
screen, or when something is felt on or under
the lens (Figure 2). 3
Stability Is Key to Managing Visual
Fluctuations with Toric Lenses
To best manage fluctuations in vision with toric
lens wear, it is important to prescribe a contact
lens with the ability to return to the primary
gaze orientation following rotation. Rotational
recovery refers to how quickly a lens returns
to the desired orientation following disruption,
such as from eye rubbing. 2
Each lens manufacturer of toric contact
lenses utilises a different lens stabilization
design, which can impact the stability of the
0% 5% 10% 15% 20% 25% 30%
Percentage of Patients
22%
23%
24%
24%
29%
29%
35%
www.academyofvisioncare.co.uk
www.academyofvisioncare.com

lens Several stabilization designs are used
to increase stability and rotational recovery
ability of soft toric contact lenses (Table 1).
In a study by Cairns (2010), the rotational
stability of two different lens stabilization
designs was evaluated. 2 Results showed that
when compared to lenses that utilized an
Accelerated Stabilization Design, the Quick
Alignment System design demonstrated
superior mean rotational recovery and greater
rotational recovery to within 10° of primary
gaze orientation within one minute. Lens
stabilization design can have an impact on
vision correction achieved, and is one more
factor to consider when recommending a toric
contact lens for astigmatic patients.
Conclusion
Soft toric contact lens wearers are highly
motivated by the promise of faster rotational
recovery of their lenses. 3 Many wish their
ECP would prescribe a lens that recovers
faster after rubbing their eyes. 3 Therefore,
when choosing the most appropriate soft
toric contact lens for astigmatic patients,
rotational stability needs to be considered.
Practitioners can reduce the incidence
of rotational issues by prescribing a lens
with demonstrated rotational recovery and
stability. Selecting a lens that utilizes Quick
Table 1: Lens Designs Used by Toric Soft Contact Lenses to Promote Stability and Rotational Recovery
Design How it Works
Quick Alignment System The inferior portion of the contact lens has more ballast and a
360-degree comfort chamfer reduces mass at the base of the
lens to help equalize the thickness around the lens periphery. A
refined optic zone helps minimize variations in vertical thickness
profile with power by adjusting the anterior and posterior optic
zone diameters
The balanced thickness profile stabilizes the lens through
dynamic and static forces of the eye lids during a blink and
open lid positions.
Accelerated Stabilization
Design
Figure 2: Occasions when toric lens wearing patients find fluctuating vision bothersome. 3
When driving
When looking at the computer
When something is felt on or under the lens
When tired
When eyes are itchy
When contact lenses have moved
The design utilizes four active zones near the midperiphery
of the lens to help minimize lens rotation. These stabilization
zones have a thicker profile compared to the rest of the lens.
The stabilization zones are designed to be located within the
interpalpebral aperture.
Thin zones at the top and bottom of the lenses allow pressure
from the eyelids to stabilize the lens by hindering its rotation.
Advertisement Feature
0% 5% 10% 15% 20% 25% 30% 35% 40%
Percentage of Patients
Alignment System stabilization has been
shown to have superior rotational recovery
when compared to the Accelerated
Stabilisation design.
References
25%
27%
29%
33%
37%
37%
1. Market Probe Europe. Needs, Symptoms, Incidence, Global
eye Health Trends (NSIGHT) Study. December 2009.
2. Cairns G. Rotational stability of silicone hydrogel toric contact
lenses. Optician. Jan 8, 2010:26-28.
3. Gillmeister E. Decision Analyst. Rub Your Eyes Consumer
Research. March 2010.
© Bausch & Lomb Inc 2011. /® denote trademarks of
Bausch & Lomb Incorporated.
All other brand names remain the trademarks of their
respective companies.
www.academyofvisioncare.co.uk
www.academyofvisioncare.com

64 50
17/09/10 25/03/11 RECRUITMENT
JOBS
JOBS
RAY0937 Recruitment Ad March_135x196 21/03/2011 15:58 Page 1
To place an advertisement call 020 7878 2313
or email haley.willmott@tenalps.com
Traditional
Rayner is now in it’s 101st year and has its eyes firmly focussed on the future.
Few wholly UK owned optical groups have been around as long as us – and there
isn’t much about optics we don’t know.
On our retail optics side, we hold an enviable collection of strong and respected
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Join us and you’ll be working as part of a dynamic organisation which has diverse
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If you’d like to join us as we start our second century, please contact us by letter
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All positions come with exceptional salaries,
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Lowndes House, The Bury,
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Email: working@rayner.com

JOBS
To place an advertisement call 020 7878 2313
or email haley.willmott@tenalps.com
Visit us at Optrafair - stand number H40
Look into the Magical Eye and see the magic for yourself!
Fill out a form on the day telling us what you see and
you’ll be entered into one of our daily competitions!
For the latest vacancies please visit
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Optometry Support
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Contact Jim Gilbert for more details:
tel: 01793 648607
email: jim@outsideclinic.com

66
25/03/11 JOBS
Nigel Burnett Hodd
JOBS
“Come along and discover the
magic of The Outside Clinic
at Optrafair stand H40”
requires a full time optometric
colleague at his SiDcup Practice,
Full Supporting Staff,
Comprehensive Salary Package.
Brief career resume to;
Chris@bhjenkins.fsnet.co.uk or
in writing to Miss Chris Jenkins,
Burnett Hodd And Jenkins
55 High Street Sidcup, Kent DA14 6ED
To place an advertisement call 020 7878 2313
or email haley.willmott@tenalps.com
Super
Optom
Cornwall, Kent,
Norfolk, Suffolk
Call Jim on 01793 648607 or visit www.outsideclinic.com
An exciting opportunity has arisen
to join a family owned practice in
Milngavie, north of Glasgow. We are
seeking a full time qualified Dispensing
Optician or Optical Assistant with several
years experience. Your focus will be
on providing the highest standard of
customer service. Please email CV to
alan@alanarnotteyecare.co.uk
Technical Advisors &
Dispensing Opticians
OXFORD
OPTOMETRIST and a DISPENSING
OPTICIAN required
A unique opportunity to join part of a highly
professional team, in a busy independent practice
in Oxford, established in 1923. Serving the local
community, as well as Oxford NHS trusts, Oxford
University and Oxford Brookes University.
We focus on providing the highest possible
standards of eye care to every patient.
Applicants must be friendly and patient focused
but also commercially minded.
Our Practice is equipped with the latest
instruments and provides a comfortable, friendly
working environment.
Please apply with full CV to:
James Whittenbury, Gardiners Opticians (Oxford)
Ltd, 5 Manor Buildings, Osler Road, Headington.
Oxford. OX3 7RA
or eyes@gardinersopticians.co.uk
live
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Head Offi ce,
Wiltshire
R01 OT Strip.indd 1 18/3/11 11:50:21
Award winning independent practice in Bournemouth, working primarily
in the luxury eyewear market, require a dynamic, well presented locum
optometrist with excellent client communication skills for 2-3 days a
month. Please send C.V. to Margaret Barnaby, Barnabys Opticians Ltd,
152 Charminster Road, Bournemouth. BH8 8UU. No agencies.
Visit our website www.homerton.nhs.uk/workforus
Directorate of General & Emergency Medicine
Retinal Screening Department
Optometrist
Band 6: £30,566 - £40,406 pa. Inc. pro rata
One year fixed-term
We are looking for an optometrist to work for one half-day
session per week grading retinal images as part of our busy and
friendly diabetes eye screening service, working alongside other
professionals in the diabetes team.
Practical knowledge of diabetic eye disease and some knowledge
of the national screening scheme is needed. Full training in the use
of specialised grading software, and in grading skills, will be given.
For further information and/or to arrange an informal visit
please contact James Beckett, Programme Manager,
email: james.beckett@homerton.nhs.uk
For an application pack please visit our website
www.homerton.nhs.uk/workforus and apply online quoting
the reference 293-10637.
Closing date: 8 April 2011.
Visit our website www.homerton.nhs.uk/workforus
The Trust welcomes applications from candidates wishing
to job share, with or without job share partners.
Committed to Equal Opportunities.
MedicsPro
Ophthalmic Recruitment
Visit us at stand P75
Optrafair 9th -11th April
NEC Birmingham
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For more jobs visit
www.optometry.co.uk/jobs
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• Therapeutics
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• All newly qualified
candidates welcome
Contact maria@medicspro.com
Call now on 0208 506 6745
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• Vat (Including Partial Exemption)
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MARKETPLACE
Grafton Optical
Visit us
at Optrafair
Stand No:E+F 20
Optovue OCT, DGH Pachmate
Reichert Non Contact Tonometers
LCD ClearChart
Frastema Combi units
Eyescape / Retinal imaging
Shin Nippon Slit Lamps & Tonometers
Oasis Punctum Plugs
Pre-owned equipment
Reliable competitive servicing
Visit graftonoptical.com for more details on all
our products and services.
Grafton Optical Company Limited
Crown Hall, The Crescent
T: 01923 233980
Watford, Hertfordshire
E-mail: sales@graftonoptical.com
WD18 OQW
Tel : 01527 501077
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Instruments
Lenses
To place an advertisement call
020 7878 2313 or email haley.willmott@tenalps.com
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Optom today advert .indd 1 26/01/2011 10:33
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25/03/11 MARKETPLACE
online enewsletter

70
25/03/11 MARKETPLACE
MARKETPLACE
Invest in a sales driven Store Graphics interior
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35 th BCLA
CLINICAL CONFERENCE & EXHIBITION
2011
Manchester Central
Conference 26-29 May 2011 | Exhibition
27-29 May 2011
LEARN TODAY PRACTICE TOMORROW
REGISTRATION
NOW OPEN
www.bcla.org.uk
NEW for 2011
n Clinical spotlight on Anti-Myopia
n Clinical workshops
n Corneal dystrophy session
n General health & contact lenses
n Sessions for those new and
returning to contact lenses
n Free Exhibition
Not a member of the BCLA? Join today and save over £100 on your delegate fee
Join our Facebook group ‘BCLA 2011’
Patron - New Delegates Platinum - New Delegates Gold - New Delegates Gold
British Contact Lens Association, 7/8 Market Place, London, W1W 8AG I T:+44(0)207 580 6661 I F:+44(0)207 580 6669 | Email: conf@bcla.org.uk
Pantone 549 EC (C60 M8 Y9 K21)
Bausch + Lomb
Topcon
AMO
Optometry Today