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contents features 14.
CET – C-77388 Brain tumours in your practice By Lorcan Butler
CET MCAs – C-76574 Customer service: not just for shops By Pamela Robertson
In practice What makes an ideal lens? By Antonia Chitty
In practice Diversity, equality, equity or inclusion? By Antonia Chitty
11. 13. 9.
From the Holmes front
Business Bites | Eyecare FAQ | OA Corner
stay in touch DO Online
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APRIL 2021 DISPENSING OPTICS
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DISPENSING OPTICS The Professional Journal of the Association of British Dispensing Opticians Volume 36 No 4
EDITORIAL STAFF Publisher Editor Email Assistant Editor Email Design and Production Email Admin. Manager Email
Sir Anthony Garrett CBE HonFBDO Nicky Collinson BA (Hons) firstname.lastname@example.org Jane Burnand email@example.com Rosslyn Argent BA (Hons) firstname.lastname@example.org Deanne Gray HonFBDO email@example.com
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0781 2734717 firstname.lastname@example.org www.abdo.org.uk
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Edward Fox FBDO Association of British Dispensing Opticians Godmersham Park, Godmersham, Kent, CT4 7DT
Telephone Email Website
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ABDO CPD Head of CPD
Alexandra Webster MSc PGDipE FBDO CL FHEA FBCLA ABDO CPD, Unit 2, Court Lodge Offices, Godmersham Park, Godmersham, Canterbury, Kent CT4 7DT
01206 734155 firstname.lastname@example.org
CONTINUING EDUCATION REVIEW PANEL Joanne Abbott BSc (Hons) FBDO SMC (Tech) Josie Barlow FBDO CL Keith Cavaye FBDO (Hons) CL FBCLA Andrew Cripps FBDO PG Cert HE FHEA Kim Devlin FBDO (Hons) CL Stephen Freeman BSc (Hons) MCOptom FBDO (Hons) Cert Ed Claire McDonnell FAOI Angela McNamee BSc (Hons) MCOptom FBDO (Hons) CL FBCLA Cert Ed Alex Webster MSc PGDipE FBDO CL FHEA FBCLA Gaynor Whitehouse FBDO (Hons) LVA
DO Dispatches REASONS TO BE HOPEFUL With the arrival of spring, longer hours of daylight and warmer weather, everything seems to be getting better – slowly but surely. Added to this is the imminent reopening of so much of the economy on 12 April. This should not only be welcome news for everyone, both professionally and personally, but is a clear indication that we are hopefully – and finally – coming out of a very long and difficult period for so many. The ABDO Membership Department has remained open and manned throughout the past 12 months of the pandemic. Staff have been on hand, along with colleagues from other departments, to help, support and advise the very large number of members who have been in touch over the past year. It has been a monumental effort, and one which I hope has demonstrated the dedication of the ABDO team to members. Another reason to feel positive is that ABDO president, Jo Holmes, and I met with the new chair of the General Optical Council, Dr Anne Wright, on 4 March. This was an encouraging and positive meeting. Dr Wright has considerable experience of regulatory affairs, as well as extensive knowledge of education and training. Both the president and I hope this will be the start of an improved relationship with our regulatory body.
Sir Anthony Garrett ABDO general secretary
EDITORIAL COMMITTEE Nicky Collinson BA (Hons) Antonia Chitty MA MCOptom MCIPR Alex Webster MSc PGDipE FBDO CL FHEA FBCLA Max Halford FBDO CL Debbie McGill BA (Hons) Sir Anthony Garrett CBE HonFBDO Jo Holmes FBDO DISPENSING OPTICS IS PUBLISHED BY ABDO, Unit 2, Court Lodge Offices, Godmersham Park, Godmersham, Canterbury, Kent CT4 7DT © ABDO: No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means whatever without the written prior permission of the publishers Dispensing Optics welcomes contributions for possible editorial publication. However, contributors warrant to the publishers that they own all rights to illustrations, artwork or photographs submitted and also to copy which is factually accurate and does not infringe any other party’s rights ISSN 0954 3201 AVERAGE CIRCULATION: 8,848 copies (January to June 2020) ABDO Board certification
APRIL 2021 DISPENSING OPTICS
OUR MONTHLY COLUMN FROM THE ABDO PRESIDENT JO HOLMES FBDO
From the Holmes front ESR: a thank you to our members would like to take this opportunity to thank all our members who responded to the General Optical Council (GOC) consultation as part of its Education Strategic Review (ESR). In February, the GOC approved the new standards for Staff tenacity and members’ input qualifications providers and have helped to steer the ESR new outcomes for students that will form the basis of an updated system of optical education. You may recall when the ESR was first launched in 2016, ABDO welcomed it, looking forward to student dispensing opticians (DOs) and optometrists being educated to a high standard and prepared for future roles. Through expert advisory groups, ABDO provided guidance drawn from long-standing experience of providing examinations. Worryingly, some issues raised in those groups were not resolved. Now, though, through the tenacity of ABDO staff and the many responses submitted by members, the GOC has approved new standards for qualifications providers and outcomes for students to achieve in order to register as DOs or optometrists. For DOs, these will be at the same academic level as ABDO’s Level 6 Diploma in Ophthalmic Dispensing, which provides the correct benchmark for entry to the profession. The GOC has responded to ABDO’s call for greater detail in the new outcomes for registration with regard to the clinical skills and knowledge required by newly qualified professionals, and to recognise the distinct roles of DOs and optometrists. The GOC also agreed with ABDO on the need to commission ‘indicative documents’ with additional information on the programme content leading to registration as a DO or optometrist. This will promote consistent high standards of education while still allowing scope for innovation. The costs of these changes is a cause for concern, but ABDO is pleased that the GOC intends to keep its impact assessment up-to-date, its approach to quality assurance consistent and proportionate, and to minimise the burden of regulation. The next step is implementation. Effective engagement with stakeholders will be crucial. ABDO will be working with the GOC to address any issues that arise for the benefit of our members.
Jo Holmes FBDO President of ABDO
DISPENSING OPTICS APRIL 2021
“Immense efforts” during pandemic recognised Members of the optical professions, via their representative bodies, have been recognised for their “immense efforts” in supporting primary eye health care during the pandemic. In a letter co-signed by health and social care, ophthalmic and optical leaders in the UK, dispensing opticians, optometrists and practice support staff have been praised for their “passion and commitment” shown working across all roles throughout the pandemic. Optical professionals were encouraged to “look after their colleagues” as they continued to face “professional dilemmas” as some “may be pushed to the limits of physical and mental endurance”. The letter went on: “...protracted, relentless crises are often much more draining than short intense ones”. ABDO general secretary, Tony Garrett, a co-signatory of the letter, commented: “I am delighted that the dedication of dispensing opticians and their optometry colleagues during the pandemic has been recognised in such a public way. It is encouraging that all nations of the United Kingdom have come together to recognise the vital role that the profession makes.” Read the letter in full on DO Online.
NHS England says ‘No’ NHS England has rejected calls for financial support for those practices struggling with the impact of the third national lockdown. As reported on DO Online last month, the Optometric Fees Negotiating Committee (OFNC) had proposed a targeted safety net scheme to support practices that had seen a drop in GOS activity of 50 per cent or more; along with continued top-up support for domiciliary providers that had continued to struggle to access patients, particularly in care homes. However, on 4 March, NHS England stated that no further financial support would be made available to practices at present. It gave two reasons for this: 1) that its monthly GOS claims data
was showing relatively stable activity in January and February 2021; and 2) that the additional support offered in autumn 2020 to some fixed practices in areas of deprivation was taken up by fewer than 200 practices, “suggesting limited demand for further help”. “We reject both these arguments,” the OFNC stated, “and we know the profession will be aggrieved at this decision. It shows a lack of regard for the small number of practices that still need help, having struggled to continue to meet eyecare needs and provide frontline services throughout the pandemic.” The committee said it was continuing to meet with NHS England to review the impact of the pandemic on activity levels and other data, and to monitor the need for future support for practices for the benefit of patients, the public and the sector.
NEWS GOS sight test fee increase “a small step” For the first time since 2015, the Department of Health and Social Care has agreed an increase in GOS sight test fees. Effective from 1 April 2021, the GOS sight test fee will increase by 1.9 per cent – rising to £21.71 from the current £21.31. For domiciliary sight tests, the additional fees become £38.27 for the first and second test, and £9.58 for the third and subsequent tests. The GOS CET allowance and the preregistration supervisors’ grant for 2021/22 will also increase by 1.9 per cent. CET payments will increase to £584 for CET undertaken in 2020, and claimable in a window from 1 July to 31 October 2021,
APRIL 2021 and the grant to pre-registration supervisors will increase to £3,762. Though welcomed by the Optometric Fees Negotiating Committee (OFNC), the GOS sight test increase has been viewed as still falling short. The fees for GOS sight tests in England were last increased in April 2015 by one per cent. Since then, the sector has seen five consecutive years with no fee increase, while contractors’ costs have continued to rise. The OFNC had pressed for urgent action to address the widening gap between NHS sight test fees and inflation, and the relative underfunding of primary eyecare compared to other NHS care. Paul Carroll, OFNC chair, said: “The 1.9 per cent increase, welcome though it is, does not fully address the erosion of GOS fees by inflation in recent years. “After five years without any increase
Prompt for CET points ABDO’s head of CPD, Alex Webster, is urging members to ensure they are on track to achieve all of their CET requirements by the end of the current cycle on 31 December 2021. Alex told DO: “We have been made aware by the General Optical Council [GOC] that by February, more than half of dispensing opticians were not where they should be at that point in the CET cycle. “Given that we only have another eight months before the GOC shuts down its current CET scheme and replaces it with a new system, there is a very real danger that members will find themselves caught out. If they don’t complete their full quota of 36 CET points and other scheme requirements, they will be neither be able
ONLINE CET WIDELY AVAILABLE to continue with their registration nor to practise.” Alex is encouraging members to first log in to the My GOC portal and check what remaining requirements they have.
Book now for student revision event ABDO has opened bookings for its 2021 revision event for student dispensing opticians, taking place on 11, 12 and 13 May. Now in its sixth year, the event aims to help students revise with the support of expert tuition from ABDO practical examiners over a three-day online event. Tuesday 11 May will cover all sections of Unit 2 (PQE practical) including the PQP and case records, while Wednesday 12 and Thursday 13 May will cover all
sections of Unit 12 (FQE practical) including case records. Alicia Thompson, ABDO’s director of professional examinations, said: “We are pleased to be able to run this event online, giving students access to great expertise. Every tutor is a current and experienced ABDO practical examiner. “The online format, successfully received last year, allows delegates to join any of the lectures they choose as well as access open question time at
to reflect the rising costs of care, a 1.9 per cent increase in GOS fees now will understandably disappoint a loyal and hard-working sector, which has gone the extra mile in keeping eyecare services running over the past year when hospital care was often just not available. “Nevertheless, we take it as a signal that the government and NHS England have at last understood the value of primary eyecare – and the need to move towards fairer treatment of GOS contractors in the future. “We hope this is the first small step on a journey to a properly funded national sight-testing infrastructure to help meet growing eye health need, focus on prevention and deliver more care outside hospital closer to home,” Paul concluded. Read the OFNC’s full response on ABDO’s England policy page.
Then to visit the ABDO website to see what free CET is available to complete – including interactive webinars and discussion-based workshops – as well as to log in to CET Online to access any uncompleted MCQs for Dispensing Optics CET articles and access CET recorded lectures. “It is also worth spending some time researching what other CET providers are offering in terms of free and paid-for CET,” Alex added. ABDO has negotiated a member discount of 25 per cent on an annual subscription to CETpoints.com for the remainder of the current CET cycle. Find out more on DO Online. Members who would like further support, or who have any concerns about fulfilling their CET requirements, can email the ABDO CPD Department at email@example.com or call 01206 734155.
the end of each revision session. There will also be access to the recording of most of the event for those who may want to revisit the sections prior to their examinations.” The event is tailored to the 2015 Level 6 Diploma in Ophthalmic Dispensing. Revision will be delivered through lectures, video demonstrations, peer discussion and open questions. The event is free of charge and open to all PQE and FQE student members. For more information and to book, visit the ABDO website. APRIL 2021 DISPENSING OPTICS
NEWS Takeover approved – with caveats
THE LATE BERNARD MAITENAZ
The European Commission (EC) has approved the proposed acquisition of GrandVision by EssilorLuxottica, subject to conditions, including the divestment of around 350 stores in three countries. The decision follows an in-depth investigation of the proposed acquisition focusing on competition concerns, which involved feedback from more than 4,300 opticians throughout Europe. The three countries where competition issues were of particular concern were Italy, Belgium and the Netherlands. As such, the GrandOptical chain and its 35 stores in Belgium will be sold without the brand name. In Italy, 174 stores will be divested including the entire EssilorLuxottica’s VistaSi chain together with 72 stores from the ‘GrandVision by’ chain. In the Netherlands, 142 stores from the EyeWish chain, along with the brand name, will be sold. EssilorLuxottica stated that the outcome of the proposed transaction was still dependant on the sign off from competition authorities in Chile and Turkey, as well as the decisions regarding ongoing litigations. EssilorLuxottica is also set to acquire the Walman network of 35 optical labs in the US.
©Essilor Heritage all rights reserved
Tributes paid to lens pioneer Tributes have been paid to Bernard Maitenaz, the inventor of Essilor Varilux progressive lenses who passed away in February at the age of 94. One of the most iconic figures in the optical industry, Bernard Maitenaz was one of the founders of the Essilor Group in 1972. From the early 1980s, he headed up the company overseeing a period of major international growth. Paul du Saillant, chairman and CEO of Essilor International, said: “A true pioneer and inventor at heart, Bernard will also be remembered for the values with which he led Essilor between 1981 and 1991, and which he promoted within Valoptec throughout his more than 70-year career. Without him and the invention of the Varilux progressive lens, the optical industry and Essilor would not be what they are today.” Read a tribute to Bernard by ABDO’s Elaine Grisdale on DO Online.
Rolling out eco frame boxes Stepper UK will progressively roll out recyclable delivery boxes for individual frames this year. The boxes are created from a single piece of self-fastening cardboard, minimising the space required during storage and transit. “Improving total responsibility through the supply chain is a conscious
DISPENSING OPTICS APRIL 2021
Save the date for eye health week This year’s National Eye Health Week (NEHW) will take place between 20 and 26 September. The week will encourage the public to be ‘eye aware’, inspiring greater up-take of routine eye examinations and highlighting the role healthy lifestyles play in preventing avoidable sight loss. Last year, Google searches around ‘eye health’ peaking during the week-long campaign – up more than 20 per cent on the next highest point in the year – the organisation reported. According to independent consumer research, 74 per cent of those who saw, heard or read advice about eye health during the NEHW 2020 said it had prompted them to act. David Cartwright, chair of Eye Health UK, said: “National Eye Health Week is an important occasion for optics and has
ambition of Stepper Eyewear,” said Peter Reeve, Stepper UK managing director. “We are committed to delivering the best eyewear in a way that balances the needs of good vison and wearer comfort, whilst being sensitive to our impact on the environment and aware of the social impact of our organisation.” To learn more about Stepper’s ongoing commitment to the environment, download its ‘Responsibility’ document from its website homepage.
Campaign materials being planned huge potential for the sector to come together to create a premier health event. We’re urging everyone with an interest in vision and eye health to get involved.” Register at www.visionmatters.org.uk
NEW RECYCLABLE FRAME BOXES
DISPENSING OPTICS I APR2021 Licence agreement renewed
NEW FILA EYEWEAR SUN STYLES
Kodak lens brand to be phased out EMNUK, an Essilor Group company, is to restructure its site in Quedgeley, Gloucester, and withdraw the Kodak brand from its lens offer to independent practitioners in the UK and Ireland by the end of Q3 2021.
De Rigo and Fila Luxembourg have renewed their licensing agreement for the design, production and distribution of Fila-branded prescription frames and sunglasses in EMEA, the Americas, Australia and New Zealand. “We are particularly proud of this renewal that further confirms the longstanding and solid relationship between our companies, which began 25 years ago with the launch of the first ever Fila Eyewear collection,” said Michele Aracri, CEO of De Rigo Vision. Sports and fashion-inspired Fila Eyewear recorded a nine per cent growth in global sales in 2020, driven in particular by business in Europe and the Americas.
Brian Deegan, EMNUK managing director, said: “We are proposing a significant change to our operations, in what are challenging times. Our group’s commitment to independent High Street ECPs remains as strong as ever with continued investment in brands which offer differentiation, in addition to continuing investment at our larger sites.
Catalogue debut Positive Impact has launched its first catalogue to help independents differentiate and to highlight its expanding range of products and services. The catalogue, which includes the company’s latest launches, has been distributed to 600 independent practices, and is available as a flipbook at www.positiveimpact.co.uk
“We are communicating our proposals to restructure with the Independent Kodak Lens Vision Centres partners we supply in the UK, and likewise will support them through any changes that may affect them,” Brian added. The company added it was in consultation with around 40 staff at the site whose jobs are at risk.
PROFESSOR LIZZY OSTLER
New education lead for College The College of Optometrists has appointed Professor Lizzy Ostler as its new director of education. Professor Ostler joins the College from the University of Brighton where she was Professor of Chemical Biology conducting world-leading research on the remediation and reversal of age-related degenerative processes. She said: “I look forward to working with the College’s education team and UK-wide stakeholders to develop and deliver a high quality ongoing educational experience for student and practising optometrists to ensure the profession is equipped to meet future challenges.”
High Street “infiltration” of online retailer Online contact lens retailer Vision Direct has gone into partnership with UK optical group David Clulow, which is operated by Luxottica Retail UK. The collaboration will see Vision Direct’s online contact lens customers offered a free eye examination at David Clulow practices as well as an extra discount on contact lenses purchased online. The online retailer has been growing its infrastructure within Europe over the last 10 years, with acquisitions across the continent and establishing warehouses in Spain and the Netherlands. The company said it was now aiming to maximise its offering by “infiltrating the High Street”. “Thanks to our new partnership with Vision Direct, we are able to expand our offers and combine the powers of the High Street and the online world,” said Stefano Melani, general manager of Luxottica Retail UK.
DISPENSING OPTICS APRIL 2021
Design director, Roland Keplinger, presenting the new collection
Virtual showroom opens its doors The ongoing pandemic has seen Silhouette accelerate its digital transformation programme, with the launch of its first-ever virtual showroom. The new virtual space showcases the Austrian manufacturer’s premium eyewear brands, from its latest Sun 2021 collection to its bespoke Atelier service, allowing customers the luxury of a personal tour from the comfort of their own practice. By invitation, one-to-one live consultations with Silhouette business managers will be complemented by the
opportunity to browse look-books, view corporate videos about company history, innovations and approaches to sustainability, and discover more about 100% Silhouette, the all-in-one lens, frame and service package. The showroom also links up to Silhouette’s new Virtual Try-On tool, which transforms the user’s screen into a virtual mirror to explore different shapes and styles. “It’s never been so easy for our business partners to digitally immerse in the Silhouette brand environment to explore our latest premium products,” said Silhouette CMO, Michael Schmied. “And with one-on-one consultations, it’s a tailored overall service.”
Double-bridged aviator, Golding
Inspired by British icons Walter & Herbert have launched four new models for 2021, two optical and two sun. Inspired by their English heritage, these Made in England frames are named after English icons such as engineer and racing driver, Beatrice Shilling, the novelist, William Golding, mathematician Hertha Ayrton, and composer William Walton. The Walter & Herbert collection is available exclusively from Continental Eyewear, part of the Millmead Group. Our photograph shows Golding in C2 Storm Grey.
DISPENSING OPTICS I APR2021 Sustainable materials move Safilo has announced the introduction of Eastman Acetate Renew and Eastman Tritan Renew in its sunglass and optical products. Both products are part of a broad portfolio of sustainable resins now offered at scale by Eastman, a global specialty materials provider and pioneer in molecular recycling. Safilo will debut Eastman Tritan Renew with proprietary brand Polaroid in January 2022, and then roll out the two materials across its brand portfolio for both sun and ophthalmic frames.
Diving into the seasons ahead Marcolin has released its autumn/winter 2021 collections, with new styles across the Adidas Originals, Adidas Sport, Guess Eyewear and Moncler Lunettes ranges.
Clear, durable and BPA-free, Eastman Tritan Renew is a co-polyester made of 50 per cent certified recycled content – achieved by allocating the recycled waste plastic to Eastman Renew materials using a mass balance process certified by International Sustainability and Carbon Certification. Eastman Acetate Renew is composed of 60 per cent bio-based and 40 per cent certified recycled content, by the same process. In 2020, Safilo introduced Econyl regenerated nylon in its Tommy Jeans eyewear line in partnership with Aquafil, and developed the first eyewear style made with ocean waste plastic for the Ocean Cleanup.
POLAROID 2021 STYLE
Our photograph shows Moncler Lunettes model ML0202_01A, inspired by the world of scuba diving. The frame features a unique construction that ensure maximum impact resistance and comfort, enriched with adaptable nose pads and a large logo on the sides.
APRIL 2021 DISPENSING OPTICS
Photochromic with dynamic polarisation Now available from Norville 20/20 is Transitions XTRActive Polarised – the first lens with a variable polarisation photochromic element. The lens is a combination of two photochromic technologies: new XTRActive and variable polarisation. This means the lens is clear when not activated, but becomes a dark grey polarised lens with 90 per cent polarisation efficiency when fully activated. The lenses are designed to benefit all spectacle wearers, but especially people with higher light sensitivity and those who spend more time outdoors. They are available in semi-finished spherical blanks in optical materials with 1.50, 1.60, 1.67 refractive indices, and 1.586 polycarbonate. XTRActive Polarised has a residual grey 90 per cent LTF tint when unactivated, darkening in the car and polarised in its darkened state; it achieves 92 per cent polarising efficiency in its darkest state at 38˚C. XTRActive Polarised is a UV activated and temperature dependent photochromic.
One lens: two photochromic technologies
Through the looking glass From a new dimension in photochromic technology, to evidence-based innovations in paediatric myopia management, this month we shine a spotlight on the spectacle lens sector...
Multi-tasking lens for multi-tasking people
Young adults experiencing tired eyes
In a poll of 2,000 UK 18 to 24-year-olds working from home (WFH) when they’d normally be in an office, 60 per cent of respondents said they were multi-tasking more. The OnePoll survey, taken in January 2021 on behalf of Zeiss Vision Care UK and Ireland, also revealed that 51 per cent of respondents were experiencing tired eyes; alongside headaches (42 per cent), back pain (42 per cent) and an issue with their clarity of vision when switching between devices (37 per cent). “Multi-tasking is playing an ever-increasing role in our daily lives,” said Lindsay Filmer, marketing director at Zeiss Vision Care UK and Ireland. “This survey tells us the extent to which this is happening, but also that there are perceived issues here with people’s optical and physical health which concerns us. Increased attention to connected devices triggers new patterns of eye movement, which can also affect body position as you adjust your posture and head angle, causing discomfort in the places that our respondents have seen - eyes, head, back and neck. “Zeiss SmartLife lenses are the ultimate, precision multi-tasking lens, which takes these issues into account, allowing for clearer vision when shifting focus near and far, from screen to street,” Lindsay concluded.
Smart solution for childhood myopia
Hoya’s MiyoSmart myopia management lenses 12
DISPENSING OPTICS APRIL 2021
Hoya’s newly-launched MiyoSmart lens with patented DIMS technology is indicated for the management of myopia in children of all ages. Developed in collaboration with the Hong Kong Polytechnic University, the lens features Hoya’s award-winning Defocus Incorporated Multiple Segments (DIMS) technology.
Results from a two-year randomised clinical trial conducted in Hong Kong demonstrated that children wearing DIMS spectacle lenses had a reduction of 60 per cent of their myopia progression compared to those wearing single vision lenses. DIMS technology creates a myopic defocus effect, which is said to slow myopia progression and axial elongation in myopic children. MiyoSmart incorporates this technology into a lens that features a lowmaintenance multi-coating and UV protection. Andrew Sanders, professional services director at Hoya UK, said: “The introduction of such an effective treatment only emphasises Hoya’s innovatory stance within the optical industry and we truly can’t wait to see the difference it will make.” Training is available to eyecare professionals who plan to dispense the lens.
Is it time to think BIGger? BIG – or Biometric Intelligent Glasses – from Rodenstock utilise the company’s DNEye Scanner to provide a complete and individualised set of measurements. Each patient’s eyes can be measured to create a unique biometric eye model to base their calculations on, and create lenses that match to the micrometre. The DNEye scanner not only offers practitioners a quick, socially distanced way to capture measurements, it can also be used as an autorefractor, pachymeter, corneal topographer, gonioscope and aberrometer. “The ability to order BIG lenses and provide patients with the most accurate vision possible is exclusive to Rodenstock customers and their patients,” said a spokesperson. BIG is a result of the very ethos of the company that hasn’t changed since its foundation almost 145 years ago: “Everyone should be able to fully exploit 100 per cent of their personal vision potential,” Josef Rodenstock, 1877. To share this philosophy, and find out how BIG and Rodenstock can support your practice and patients, contact Rodenstock using this link.
BIG lenses are created using Rodenstock’s DNEye Scanner
Taking lens personalisation to new levels Seiko Optical’s new premium progressive lens – Seiko Brilliance – is said to feature a unique combination of innovative technologies. “With the introduction of the personal design selector, the lens design is tailored precisely to the wearer’s needs, alongside the additional elements of individualisation to the wearer’s selected frame and facial features,” said a spokesperson. Seiko Brilliance aims to provide eyecare practitioners with a progressive lens they can feel confident to recommend, with little or no adaptation issues, and high performance across the visual areas.
A multi-faceted lens choice for presbyopes
New complete glazed frame and lens package Jai Kudo Lenses, in association with Continental Eyewear, is now offering customers the option of glazed frame and lens packages. “With frames, lenses and a state-of-the-art glazing lab all under one roof, we are perfectly positioned to deliver an unbeatable service,” said a spokesperson. “Our complete glazed package includes a wide range of lens options and coatings such as our unique Honeycomb lenses, Drivesense driving lenses, and our Wideview Confidence Superior lens using Camber technology.” The brands included within the package range from high-quality titanium eyewear by Reykjavik Eyes Black Label, to the Walter & Herbert Made in England collection and the popular Lazer and Lazer Junior ranges. Next month’s Product Spotlight will focus on contact lens products.
More than 1,500 frame choices available APRIL 2021 DISPENSING OPTICS
CET COMPETENCIES COVERED DISPENSING OPTICIANS Communication, Standards of Practice, Ocular Abnormalities OPTOMETRISTS Communication, Standards of Practice, Ocular Disease
Brain tumours in your practice By Lorcan Butler MCOptom, Prof Cert Paed Eye Care
espite being widely considered rare, brain tumours are responsible for more deaths of children and younger people than any other type of cancer1. Brain tumours are divided into primary and secondary, adult and paediatric. Primary tumours are those that originate within the brain itself; secondary brain tumours originate from elsewhere and metastasize in the brain (lung and breast being the most common sites). They are classified as low grade I-II or high grade III-IV. Nearly 12,000 people in the UK will be diagnosed with a primary brain tumour each year, that’s 31 per day. Approximately 4,000 more will have secondaries that have spread from cancers in other parts of their body1. Some 62 per cent of children who survive a brain tumour are left with a life altering, long-term disability2. Tumours of the central nervous system and intracranial tumours are the ninth biggest cancer killer in the UK, and the largest cancer killer of children3. Although primary brain tumours represent only three per cent of all cancers, they result in the most life years lost of any cancer3. Approximately 60 per cent of brain tumour diagnoses comes from self-
D This CET has been approved for one point by the GOC. It is open to all FBDO members, and associate member optometrists. The multiple-choice questions (MCQs) for this month’s CET are available online only, to comply with the GOC’s Good Practice Guidance for this type of CET. Insert your answers to the six MCQs online at www.abdo.org.uk. After member login, go into the secure membership portal and CET Online will be found on the L menu. Questions will be presented in random order. Please ensure that your email address and GOC number are up-todate. The pass mark is 60 per cent. The answers will appear in the August 2021 issue of Dispensing Optics. The closing date is 9 July 2021.
referral to Accident & Emergency (A&E). This means there is a high percentage of patients who have advanced disease at diagnosis4. The most common age range for brain tumours in adults is 50 years and above, and the risk increases with each decade (Figure 1). The peak age of presentation is between 60 and 79 years5. Optometrists and dispensing opticians are a touchpoint for diagnosis, as some brain tumours do have ocular presentations that prompt the visit. Approximately 28 per cent of adults with a brain tumour report a visual impairment7, which increases up to 39 per cent in children8. Therefore, it is imperative as primary care practitioners that all General Optical Council (GOC) registrants are able to detect subtle signs and symptoms of a brain tumour quite confidently. This equates to a quicker referral, accurate diagnosis and timely treatment. Having a dispensing optician and/or a practice manager who is cognisant of some of these presenting signs and symptoms will help screen the importance of appointments being symptom-led, and patients being triaged appropriately. What could initially start as a telephone conversation for a routine appointment may need to be escalated to a more urgent assessment, or even a referral to a general practitioner (GP) or even A&E.
PLAN YOUR CET TODAY
C-77388 Approved for one CET Point
DISPENSING OPTICS APRIL 2021
For all the latest CET available from ABDO visit the Events section of the ABDO website. Here you will able to see the latest online interactive CET sessions available for booking. Online sessions include discussion-based workshops, a great way to learn in a small group of your peers. Online discussion sessions are available for all professional roles and are approved for three CET points. New sessions will be added regularly. Additionally, we continue to host our monthly CET webinar series featuring a range of topics and speakers. Each CET webinar will be approved for one interactive CET point.
• Appear to increase in severity over preceding weeks New headaches presentation in patients over 50 years of age would be a cause for concern. Also, a new style of headache that is more severe, happening more frequently, and/or not being stopped by painkillers, etc, should warrant further investigation by the patient’s GP.
Figure 1: Average number of new cases per year and age-specific incidence rates per 100,000 population, UK, 2015-20176 (image courtesy of Cancer Research UK)
RISK FACTORS FOR BRAIN TUMOURS Common risk factors include: • Age • Leukaemia • Neurofibramatosis • Previous episode of lung and/or breast cancer • Lifestyle: smoking/alcohol • Family history of a brain tumour Neurofibromatosis (NF) is a rare genetic disorder that causes typically benign tumours to form on nerve tissue. There are three different types: type 1, 2 and 3. An NF type 1 tumour can develop anywhere in the nervous system, including the brain, spinal cord and nerves. It is usually diagnosed in childhood or early adulthood and affects approximately one in 3,500 people worldwide. Lisch nodules on the iris are an ocular characteristic9 (Figure 2).
SYMPTOMS OF BRAIN TUMOURS These can be broken down into:
Figure 2: Lisch nodules (credit: Dimitrios Malamos. https://commons.wikimedia. org/w/index.php?curid=45193921)
non-vision-related symptoms; and vision related symptoms.
Non-vision-related symptoms Non-vision-related symptoms of a brain tumour include: a) headaches; b) seizures; c) vomiting; and d) cognitive changes.
a) Headaches Headaches are not often the main primary presenting symptom in brain tumours. It has been reported that that only two to 16 per cent of patients have isolated headaches as the sole symptom of a brain tumour10. When we talk about headaches, we talk about headaches in addition to something else, a term that GPs call ‘headache plus’ concept, i.e. headaches plus behavioural changes (depression, anxiety, loss of inhibition), headaches plus excessive sleeping, etc. However, in very specific cases such as papilloedema, the headaches are a presenting feature in approximately 60 to 70 per cent of cases11 (Figure 3). Papilloedema headaches tend to: • Be worse upon waking and when lying down in bed • Be strong enough to wake you from your sleep • Be associated with nausea and vomiting, sometimes projectile vomiting • Be worse with valsalva-based movements, e.g. coughing, sneezing and bending down to tie a shoelace
Seizures are the most common first symptom that lead to a brain tumour diagnosis in adults. When people hear the term seizure, they often think of convulsive seizures. This is where the person loses consciousness, their body goes stiff and they fall to the floor with their limbs jerking. However, this type of seizure (known as a tonic-clonic seizure) is rarely associated with brain tumours. There are many other types of seizures. The type of seizure most commonly noted with brain tumours is called a focal (or partial) seizure. Focal seizures affect only one part of the brain and can affect movement and/or the level of consciousness or awareness. The symptoms of a focal seizure include: • Feeling a bit strange or absent (spaced out). The person may not even notice this sort of seizure themselves, it may be recognised by a partner/spouse • Unusual smell or taste, like burning toast • Feeling of not being able to speak despite being fully conscious • Numbness or tingling sensation • Visual disturbance, such as coloured or flashing lights • Hallucinations (seeing something that isn’t there)
Figure 3. Headaches are a presenting feature in 60-70 per cent of cases of papilloedema APRIL 2021 DISPENSING OPTICS
CET acquired diplopia; c) anisocoria; d) papilloedema; and e) nystagmus.
Box 1: Triage questions for transient visual obscurations
a) Changes in vision Transient visual obscurations (TVOs) tend to be reported as the ‘dimming’ or ‘greying out’ of vision, which may be fleeting in duration lasting one to three seconds. Patients usually find it difficult to isolate if it is unilateral or bilateral in nature12. Sometime people may not even mention it all. However, if it was suspected that the patient was describing other symptoms listed in this article, it may be worthwhile going back and through some very specific questions establish if TVOs have been experienced by this person. Box 1 looks at triage questions for transient visual obscurations.
Have you ever experienced a sudden loss of vision in one eye? Transient visual obscurations (TVOs) are very short lasting one to two seconds. Patient may not offer this information, however, if probed they may admit to experiencing this phenomenon. The typical loss of vision would be not just partial loss, but total visual field loss in one eye.
Do you every get moments when the vision goes dim or grey? These tend to be the two words associated with TVOs – a ‘greying out’ or ‘dimming’ of the vision.
All seizures should be fully investigated by a GP or A&E.
d) Cognitive changes
b) Newly acquired diplopia
This can be first noted by a family member/partner.
This could be where the patient, or the patient’s partner, describes this to you face-to-face or over the phone. If one of their eyes is turned in towards their nose, this would be a cranial nerve VI palsy. The CN VI is the longest of the
c) Vomiting Vomiting is usually first thing in the morning and may, or may not, be associated with nausea. It is usually projectile in nature.
Vision-related symptoms Vision-related changes of a brain tumour include: a) changes in vision; b) newly
Box 2: Diplopia triage questioning for DOs and CLOs When triaging a patient, what further questions could you ask specifically relating to the diplopia?
with cataracts, keratoconus, irregular astigmatism, and macular distortion.
Is it there all the time? Does it affect both eyes or one eye? Most people don’t know the answer to this question. You are trying to differentiate between monocular and binocular diplopia. Ask the patient to close one eye at a time, or put their hand over one eye at a time. If the diplopia disappears, this would be a sign of binocular diplopia, which in turn would suggest conditions of a vasculopathic (high blood pressure, high cholesterol, diabetes), neurogenic (CN paresis/palsy), or compressive nature (space occupying lesion). Monocular diplopia is often found
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You are trying to discover if the diplopia is physiological or pathological. It’s natural as we age to lose tone of the eye muscles and, when we are tired, the muscles begin to relax to their habitual state. This may give rise to a decompensating phoria, breaking down into a tropia. Constant diplopia would exclude this.
Did it begin gradually or suddenly? Gradually would be sign of a progressive condition like a brain tumour, while suddenly would be more vasculopathic in nature.
Are the images side-by-side or one on top of the other? You are trying to find out which muscles are affected. Horizontal side-by-side would indicate the muscles that move the eyes left and right: the lateral and medial rectus muscles. Images on top of each other would indicate the muscles responsible for moving the eyes up and down.
What makes it better or worse? Usually, closing one eye will get rid of the two images. The patient will have to tilt or turn their head in one direction to minimise or negate the doubling images. Looking in the distance will be much harder than near if there is a CN VI palsy.
cranial nerves from its origin in the Pons to its point of attachment. Tumours can be insidious in developing and wrap themselves around the nerve itself, restricting its movement. This would lead to a horizontal diplopia, which is worse for distance than it is for reading. This needs urgent referral to A&E for ophthalmological and neurological investigation12. Box 2 covers the types of questions that dispensing opticians and contact lens opticians could ask, specifically relating to diplopia, when triaging a patient.
c) Pupil involvement/anisocoria A relative afferent pupillary defect (RAPD) would not be present in the early stages of a brain tumour, but may be present in the later stages as the optic nerve function is affected. Anisocoria is where there is a marked difference in the size of the pupils. One will be larger or smaller than the other. It may be longstanding in nature or it may be of a sudden onset. A sudden onset anisocoria noticed by the practitioner, family member, and/or partner, should warrant further investigations. It may be more vasculopathic in origin, such as a tear in the Internal carotid artery, but it should warrant immediate assessment.
d) Papilloedema Papilloedema is a bilateral swelling of the optic discs due to high intracranial pressure (ICP), one cause of which is a brain tumour. It can sometime be unilateral but that is quite rare. Eighty per cent of cases of ICP tend to be linked to a condition called idiopathic intracranial hypertension (IIH). This used to be referred as benign IIH, but its classification has changed due to its life-threatening severity. IIH is usually found in young woman of child bearing age with a slightly higher than normal BMI. Other causes of raised ICP could be a space occupying lesion (brain tumour), venous sinus thrombosis (blood clot) or meningitis. Box 3 looks at triage questions for DOs and CLOs related to headaches.
e) Nystagmus Usually, nystagmus comes under two different classifications – either
Box 3: Triage questions for headaches Are these headaches normal for you, or are they getting worse? Most people have a typical headaches profile/presentation. What we are trying to establish is whether it is increasing in frequency and severity. People who say it is much worse than before, often experience severe vomiting whether with or without nausea.
Are the headaches worse at any time during the day? Papilloedema headaches are usually present upon waking, and may even be strong enough to wake the patient up from their sleep.
Does the headache begin to get better when you get up and move around? A papilloedema headache is typically worse when lying down, as there is a build-up of cerebrospinal fluid (CSF) that can’t drain, and a secondary increase in intracranial pressure. As the patient moves around, and the CSF is able to drain and the ICP decreases, the headache eases.
congenital or acquired. It can be either a primary sign of a brain tumour or secondary adverse drug reaction (ADR) due to the medication prescribed after surgery. Seizures would tend to be a feature of brain tumour diagnosis journey in approximately 30 per cent of cases14. Anti-epilepsy or anti-convulsant medication may be given post-surgery, and one of the known side-effects of these medications is that they may cause nystagmus15.
HEADSMART The Headsmart campaign was launched by the Brain Tumour Charity in association with the University of Nottingham in 2013, to increase the awareness of the signs and symptoms of brain tumours among healthcare practitioners and allied health practitioners involved in the care of children. It resulted in reducing the referral times for paediatric brain tumours from 13 weeks to six-and-a-half weeks, just by knowing typical signs to watch out for. Headsmart is still a very important and active campaign currently used by the Royal College of General Practitioners as a clinical toolkit for the detection of pediatric brain tumors.
CONCLUSIONS There are certain ‘red flag’ signs and symptoms that dispensing opticians and contact lens opticians need to be aware of in normal day-to-day practice, that may require urgent referral to either an optometrist, a GP or even A&E for suspect brain tumour. It is very difficult to list all the signs and symptoms of a brain tumour, but hopefully this article will better inform the eye care practitioner of specific symptoms that, if heard on the shop floor or on a telephone booking enquiry, should be addressed immediately. LORCAN BUTLER is a dispensing optician and optometrist with the Brain Tumour Charity. In his role as optical engagement manager, he educates the UK optical community of the importance of the sector being part of the referral process for further investigation for suspect brain tumours.
REFERENCES 1. Cancer Research UK. Brain, other CNS and intracranial tumours statistics. Available at: https://www.cancerresearchuk.org/ health-professional/cancer-statistics/ statistics-by-cancer-type/brainother-cns-and-intracranial-tumours APRIL 2021 DISPENSING OPTICS
CET 2. Macedoni-Luksic, M. Long term sequelae in children treated for brain tumours: impairments, disability, and handicap. Pediatr. Hematol. Oncol. 2003;20:89-101. 3. Cancer Research UK. Data and statistics. Available at: https://www. cancerresearchuk.org/healthprofessional/data-and-statistics 4. NICE. Brain Tumours (primary) and brain mestases in adults NICE guideline [NG99]. 2018. Available at: https:// www.nice.org.uk/guidance/ng99 5. Kernick DP et al. Imaging patients with suspected brain tumour: guidance for primary care. Br. J. Gen Pract. 2008;58 (557):880-885. DOI: https://doi.org/ 10.3399/bjgp08X376203 6. Cancer Research UK. Brain, other CNS and intracrainial tumours incidence by age. Available at: https://www.cancer researchuk.org/health-professional/ cancer-statistics/statistics-bycancer-type/brain-other-cns-and-
intracranial-tumours/incidence# heading-One 7. The Brain Tumour Charity. Losing myself: the reality of life with a brain tumour. 2015. Available at: https://www.thebraintumourcharity. org/about-us/our-publications/ losing-myself-reality-life-braintumour/ 8. The Brain Tumour Charity: Losing my place: the reality of childhood with a brain tumour, 2015. Available at: https://www.thebraintumourcharity. org/about-us/our-publications/ losing-my-place-reality-childhoodbrain-tumour/ 9. Cockey E and Ullrich NJ. Neurofibromatosis type-1 associated brain tumours. Journal of Rare Diseases Research and Treatment 2016;1(2):11-16. 10. Kernick D and Hamilton W. Clinical features of primary brain tumours: a case-control study electronic primary
care records. Br. J. Gen. Pract. 2007;57 (542):695-9. 11. Grant R. Overview. Brain tumour diagnosis and management/Royal College of Physician guidelines. J. Neurol. Neurosurg. Psychiatry 2004 Jun;75(Suppl 2):ii18–ii23. 12. Seova N et al. Papilloedema in patients with brain tumours, NeuroOphthalmology 2009;33:100-105 13. Rucker JC (2012) Diplopia, Third Nerve Palsies, and Sixth Nerve Palsies. In: Roos K. (eds) Emergency Neurology. Springer, Boston, MA. https://doi.org/10.1007/978-0-38788585-8_6 14. Liigant A et al. Seizure disorders in patients with brain tumours. Eur. Neurol. 2001;45:46-51. 15. Rowe FJ et al. Interventions for eye movement disorders due to acquired brain injury (protocol). Cochrane Database Syst. Rev. 2018 Mar;2018(3): CD011290.
Multiple choice answers Customer service: Not just for shops By Pamela Robertson MSc BSc (Hons) DipTp IP MCOptom C-76574 – published December 2020 Six of the following questions were presented online to entrants to comply with the General Optical Council’s best practice specifications for this type of CET. Which of the following has been offered as a definition of customer service? a. The provision of service to customers during a purchase b. The provision of service to a customer leading to a sale and the purchase itself c. The provision of service to a customer before, during and after a purchase. d. None of the above c is the correct answer. Customer service plays a vital role in any business. Any contact with a purchaser at any point leading up to the sale, whether it be face-to-face or virtual, influences the buyer. Good customer service post purchase will determine how the buyer thinks of the company and product bought, and influences their buying behaviour next time.
DISPENSING OPTICS APRIL 2021
What is a key factor in delivering good customer service? a. Well paid staff b. Low prices c. Giving the purchaser everything they ask for d. Managing patient expectations d is the correct answer. All of the possible answers could be considered important to some patients in their own way, but none of them will make the difference unless a practice manages the patient’s expectations. This means that if something is promised at a cost, time or mode then that is what must be delivered at a minimum. This also relates to communication with patients. Open and honest communications are important if something goes wrong but also give the practice the opportunity to ‘shout’ about something that goes better than planned.
Which of the following statements about communication is correct? a. Can be in person, telephone, post, email or ‘virtual’ b. Good and timely communication can build loyalty c. A patient should be able to state how they wish to be communicated with d. All of the above d is the correct answer. Good communication is important to excellent customer services – and done well, this can build loyalty. The contact should be timely and appropriate to the audience. Technology gives practices lots of ways to communicate, and the current Covid situation has made us all explore new ways off connecting with each other. A customer savvy practice can make use of those things. However, owing to GDPR, we have an obligation to ask our patients how they wish us to communicate with them, and ensure that is the method used for them. Which of the following is not a benefit to customer service of operating an appointment only policy? a. This can weed out those not wishing to buy new spectacles b. It allows Covid triaging questions to be done remotely prior to the visit c. Lifestyle questioning can be done remotely, meaning the examination can be tailored to the patient d. Dispensing needs can be discussed with the patient in their own environment a is the correct answer. Whilst it may be desirable to prioritise patients wishing to be dispensed from a commercial point of view, this does not benefit the patient and could be negatively viewed in terms of patient care. Appointment-only policies allow for in-practice time to be minimised for the patient but maximised in terms of what can be achieved. If triaging, lifestyle and needs questions are asked whilst patient is at home and unhurried, it is possible that more information will be provided. However, it is certain that by the time the patient arrives in the consulting room, time can be cut down and focused directly on the already known needs. Which of the following statements is false? a. A phone call to a patient the day before their appointment may say to the patient – we care about your safety b. A phone call from the practice can ‘set the scene’ for the patient’s visit if they have not been seen recently c. Practice initiated contact with a patient shows that they have not been forgotten about, even if they cannot be seen immediately d. With everyone wearing masks, eye contact and body language are not important d is the correct answer. Masks make facial expressions more difficult to read, meaning eye contact and positive body language become more important. A smile may not be visible but it is still seen in the eyes. The
other answers are all true as they reflect how good communication can make the patient feel safe and valued. Which of the following may not make a patient feel safe in your practice in the Covid world? a. Asking a patient to sanitise their hands b. By all staff wearing a face mask and appropriate PPE c. Offering an extended appointment d. Barriers at the reception desk. c is the correct answer. Answers a, b and d are recognised ways of working in a practice for patient and staff safety. Offering an extended appointment to some patients may have been a very good idea in the past, but this is not something we can do now due to safety implications. If the patient needs more time spent with them then it is currently the norm to book a continuation appointment another day. What is the purpose of a ‘practice wow’? a. To make the patient feel appreciated b. To make the patient feel welcome c. To encourage repeat business d. All of the above d is the correct answer. A ‘practice wow’ should have the effect of making a patient feel valued and wanted. All of this is aimed to encourage repeat business, loyalty and, hopefully, word of mouth advertising. Which of the following is not a customer service benefit of appointment only dispensing? a. The patient gets dedicated one on one time b. A targeted selection of frames can be offered based on needs discussion c. Average order value may be increased d. The patient has a quiet space and time to discuss needs and try on frames with privacy c is the correct answer. There is anecdotal evidence to suggest that average dispensing values and second pair purchases increase, and this is definitely a benefit to the practice but it is not a benefit to the patient. Appointmentonly dispensings limit those in the dispensing area so offer a more private and personal experience for the patient. It is easier for the patient to explain needs and, sometimes, cost barriers and then for the practitioner to understand those needs and offer appropriate options. Which of the following statements is false? a. A patient can be contacted by any means the practice wish b. Recommendations for products should be based on wants and needs not latest technology c. Patient feedback should be welcomed and actively sought d. Complaint procedures are a requirement for all practices a is the correct answer. GDPR means that a person has the right to be able to choose how and why they can be contacted by a business. Going outside of this could have serious implications for that business.
Participants are advised that the GOC’s Enhanced CET Principles and Requirements v4 document states that for text article CET questions: “A proportion of the questions should require the application of existing professional knowledge to determine the answer”. This can include personal research online, or following up the article references.
APRIL 2021 DISPENSING OPTICS
IN PRACTICE – SPECTACLE LENSES ANTONIA CHITTY
What makes an ideal lens? atients and practitioners alike are all, at times, in search of one thing: the ideal lens. What this lens is may differ for each person, but in this article we look at current and future lens technologies and how they are bringing us closer to the ideal lens. Meeting the patient’s needs is at the heart of what a dispensing optician (DO) does, but the patient seldom appreciates the technical developments required to do so. People want their lenses to do everything: to work seamlessly for distance, intermediate and near. They may want something that offers a dark tint outside, which fades to nothing indoors, and swiftly adapts for every shift in brightness in between. And of course the lens will be thin, light and suit whatever frame they choose. Russell Bickle is general manager at Shamir and a qualified DO. He says: “Nowadays patients want lenses that fit and enhance their lifestyle, not just correct their vision. We can see this through the uptake in lens products such as Transitions Style Colours and Autograph Urban, which allow for dynamic progressive lens wear. I think also patients want products that have
This comment should be taken in context with the level of patient knowledge about lenses. For many patients, a pair of spectacles is a grudge purchase, and may be an unwelcome indicator that they are getting older. DOs need to share their passion and enthusiasm for lenses, along with their knowledge of the latest technical developments and how these will benefit the patient. Only in this way will patients appreciate what they are paying for.
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TECHNOLOGIES AS DRIVERS
DOs can inspire patients with lifestyle lens choices more benefits built in, such as blue light protection. This expectation is starting to become the norm and is almost standard in premium products now.” Julian Wiles, founder owner of Performance Lenses and country manager UK and Ireland for Younger Optics, believes that the only real driver of lens developments until the advent of digital surfacing was refractive index. He explains: “The 1.74 index lens is now 20 years old – and digital surfacing is creating new opportunities much faster. New technology drives most growth industries, and optics should be no exception.” Thinking about the patient perspective, Julian continues: “When you ask most people how to improve their spectacles, the first thing they say is ‘cheaper’ and then maybe ‘lighter’. We need to think about how we can combine the available technologies with what people actually want. My ideal lens will not be your ideal lens.”
When looking at new developments in lens design and technology, Julian says: “At the heart of Younger Optics’ development philosophy is an attempt to answer three simple questions before any idea even gets to the drawing board: is the idea a true technological development?; is it an intelligent combination of existing technologies?; and is it specifically targeted and marketed? A fourth question might be: does it add value?” Understanding these questions can help the DO in practice assess material promoting new lenses, and can ensure that the practice manager or owner makes good decisions on whether to
offer a new lens. Julian adds: “Protecting vision is also a key role of the lens, protecting the eye from glare, impact and ‘blue light’”. Russell identifies artificial intelligence (AI) as a significant driver for change in lens technology. He says: “AI has made a big difference; the data gives us the ability to evaluate designs much faster and reach a refined, product tested result for patients much more quickly. We can change designs as habits change, and offer a faster roll-out of new design concepts.” The Covid-19 pandemic has also changed Shamir’s offering. Russell continues: “Since the start of the pandemic, products that were already available have taken on much greater importance. For example, our Glacier Plus anti-fog lens coating was previously sold for sports products; it then became something that healthcare professionals and then the public at large were looking for.” Julian identifies Camber technology as one of the key steps forward in lens design in recent years. Developed by Younger Optics in partnership with IOT, Camber lenses are now being offered by a growing number of independent laboratories, most of whom market Camber lenses under a house brand of digital lens designs. “This needs both digital surfacing and personalised measurements to succeed,” says Julian.
LENS PERSONALISATION It is interesting to consider the role of personalisation from both a technical and psychological perspective. Technically, it is harder to create a personalised lens, but developments in recent years have put this into the reach of every practice. Psychologically, a personalised lens is a winner for building patient relationships. Communicate the technical advances and personal benefits well, explain how a lens is made specifically for each patient, and you will have a loyal patient who returns. Individualisation of a lens offers multiple benefits to a practice, not least because, according to Julian, it will differentiate the practice. He explains: “For the recipient of the lens, it offers a wider field of view, sharper distance, wider near and intermediate regions and less distortion. Taking care of a wider range of measurements, and explaining why you are doing so as you go along, will differentiate you from a retailer or online store. On the other hand, if the public don’t have the value explained, all they have to compare on is price.
MYOPIA CONTROL LENSES SUCH AS HOYA MIYOSMART OFFER EXCITING POSSIBILITIES
“Lifestyle and convenience is built into every product that we buy,” continues Julian, “and the question is how we make this apply to spectacle lenses. It’s not just about technology, but how you communicate it. “How and when do you talk to your patients? Is it once every two years when they need a reminder? Or do you drop them an email once a month, not selling, but just with something of interest about optics. This is an ideal chance to tell people about new technology and warm them up to it before their next visit.
“What makes an ideal lens is a lot more than technology,” Julian Wiles “When you use technology to design bespoke eyewear and your practice becomes a destination, then you can say you’ve built something powerful. You’ve built your brand. What makes an ideal lens is a lot more than technology. What makes an ideal lens is something for which people are prepared to pay for, and which serves the business model. Those people must come back quickly, buy multiple pairs and bring their friends.”
LENSES OF THE FUTURE When we look into the future, what might the ultimate ideal lens offer? I raised this question on the Opticians on Facebook group, interested to see what vision a peer group could offer. There is a lot of excitement about myopia management lenses, such as the newly-launched Hoya Miyosmart (see Product Spotlight page 12), with one member mentioning the possibility of a
lens to reverse myopia in the future. Others highlighted the scope for intelligent lenses, which adapt from distance to near and back in the blink of an eye, and which immediately adapt to varying light conditions. There might also be developments in plastics to allow greater scratch resistance, and a higher refractive index without significant chromatic aberration. There was also the suggestion of a “Bluetooth enabled lens which allows the wearer to read emails, social media posts and so on, without the need for an Apple Watch”. There is a more sinister side to the intelligent lens that needs to be considered: will it record where you are, who you are with, and what you are looking at? More realistically, every lens designer is working towards the perfect balance between optics and cosmetics, and multifocals with little or no peripheral distortion. Russell suggests coatings as another area for development: “Alongside more and more computing power and advanced modelling being used to really improve designs, I think we may see some real advances with lens coatings in the coming two years,” he predicts. “A number of manufacturers have had a similar coating range for a little while now, and I think there is room for something to really change how a coating can improve visual performance.” The ideal lens is still very much an individual preference, but every DO would like a lens to meet every patient’s needs. Russell concludes: “DOs want a choice of lenses that are simple to dispense, but that they know will exceed their patients’ expectations.” ANTONIA CHITTY PHD, MCOPTOM, MCIPR, MPRCA is ABDO head of communications and author of 20 books on business, health and special needs. APRIL 2021 DISPENSING OPTICS
IN PRACTICE – EQUALITY ANTONIA CHITTY
Diversity, equality, equity or inclusion? here is a growing focus on diversity and inclusion in the workplace – but what does this really mean? Diversity refers to demographic differences of a group – often at team or organisational level. Often, diversity references protected characteristics in UK law: age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex and sexual orientation1. A diverse workplace will include people from a range of backgrounds across these protected characteristics, in proportion to the local population.
EQUALITY OR EQUITY? In order for your practice to become a diverse workplace, you may need to look at how you recruit staff. Understanding the difference between equality and equity will help you consider how you do this. Equality means each individual or group of people is given the same rights, resources or opportunities. The 2010 Equality Act in the UK protects those with protected characteristics from direct and indirect discrimination in the workplace. Equity recognises that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome. Treating everyone equally has shortcomings when the playing field is not level. An equitybased approach emphasises that everyone should not be treated the same, but according to their own needs. There is a well-known image, originally drawn by Craig Froehle (Figure 1), which some have used and adapted to illustrate equality and equity. It shows three people of different height behind a fence, trying to watch a ball game. The fence blocks the views of the two shorter people. If they are each given a box to stand on, the tallest person can still see
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Figure 1: Craig Froehle’s original equality and equity image (reproduced with permission) well, the person of middle height can now see the game, but the shortest can’t. However, if the tall person remains standing on the ground, and the shortest person gets two boxes, they can all see the game. Think about what ‘boxes’ you might need to provide to encourage people in underrepresented groups to apply for work within your practice. This could include looking at media which reaches out to specific groups as a place to advertise vacancies. What other ideas could you come up with to ensure equity of access to work?
Development: “An inclusive workplace culture allows all people to thrive at work, regardless of their background, identity or circumstance”. Now is the time to try to develop understanding within your senior team of how you can make your workplace more inclusive. At individual level, being able to access and succeed in work, regardless of background and circumstance, is a basic tenet of equality, which employers have a responsibility to champion2. There is a growing body of research, which shows that this is not just the right thing to do, it also benefits the economy. Research shows that participation of women in state-level labour markets is linked to wage increases for all3, and that full representation of BAME individuals in the labour market would reap benefits to the tune of £24bn in the UK4. For this to happen, the workplace needs to be an inclusive environment where every employee can perform to the best of their ability and achieve their full potential. Make time today to consider how your practice can become more diverse and inclusive.
INCLUSION FOR ALL While increasing the number of people from minority groups in your workplace is a good start, you also need to think about how to make the workplace inclusive for all. Inclusion means respecting and valuing everyone’s contribution, as well as creating a workplace within which they feel comfortable and able to contribute fully. Inclusion is often defined as the extent to which everyone at work, regardless of their background, identity or circumstance, feels valued, accepted and supported to succeed at work. It is critical to gather data to understand whether there are barriers to equal progression within a workplace, for example. Without good data you may feel everything is going well, and be unaware of unconscious biases. According to the Chartered Institute of Personnel and
REFERENCES 1. Equality and Human Rights Commission. Protected characteristics. Available at: https://www.equalityhumanrights. com/en/equality-act/protectedcharacteristics 2. CIPD. Building inclusive workplaces. 2019 Available at: https://www.cipd.co.uk/ Images/building-inclusive-workplacesreport-sept-2019_tcm18-64154.pdf 3. Weinsten M. When more women join the workforce, wages rise – including for men. Harvard Business Review 2018. Available at: https://hbr.org/2018/01/whenmore-women-join-the-workforcewages-rise-including-for-men 4. BEIS Analysis (2016). Available at: https://www.gov.statistics/bmeindividuals-in-the-labour-marketanalysis-of-full-representation
REGION UPDATE – NORTH OF ENGLAND RICHARD RAWLINSON
Get to know your LOC his month’s region update will focus on local optical committees (LOCs) in the North of England region, and the ABDO local leads actively involved with them. Firstly, it is worth recapping on the makeup and functions of an LOC. LOCs are statutory bodies established within the NHS to represent the interests of NHS GOS contractors and NHS optical practitioners within a geographical area. As prescribed by law, the activities of an LOC may include: • Informing, advising and negotiating with NHS England regional teams and statutory NHS commissioning bodies (for example, clinical commissioning groups) on matters affecting, or liable to affect, local contractors and local performers, including, but not limited to: º The efficient administration and payment of remuneration in relation to primary ophthalmic services º The introduction and implementation of any local extended primary eyecare services or community eyecare services º The terms and conditions upon which any local extended primary eyecare services or community eyecare services are provided and performed º Hospital eye services, in so far as they affect primary ophthalmic services º Complaints against local contractors and local performers in respect of primary ophthalmic services, local extended primary eyecare services or community eyecare services in the area for which the committee is formed LOCs are funded through a statutory levy on NHS eye examinations; and supported by the Local Optical Committee Support Unit (LOCSU). Elected committee members must either be a local NHS GOS contractor (or nominated representative) or a local NHS performer (optometrist). In addition, the LOC model constitution states that each LOC should ensure at least one dispensing optician, who is not a contractor, is properly included in its membership by means of co-option. So, importantly, dispensing opticians can be actively involved with their LOC and offer to support wider eyecare development.
CHAMPIONING THE DO ROLE Within the North of England ABDO regional team, a number of local leads are actively involved with their LOC. Jill Umpleby is a member of Cheshire LOC. She says: “Familiarity with all of the acronyms took a while to learn but once I got up to speed, I found being the only dispensing optician on the committee highly rewarding and constructive.”
NHS NORTH WEST
NHS NORTH EAST & YORKSHIRE
Ashton, Leigh & Wigan LOC Bolton LOC Manchester LOC Salford & Trafford LOC GM East LOC East Lancashire LOC Central Mersey LOC Liverpool LOC Sefton LOC Wirral LOC Cheshire LOC Cumbria LOC Northumberland Tyne & Wear LOC Durham LOC Tees LOC North Yorkshire LOC Bradford LOC Leeds LOC Calderdale & Kirklees LOC Wakefield LOC East Yorkshire LOC North & NE Lincs LOC Sheffield LOC Rotherham & Barnsley LOC Doncaster & Bassetlaw LOC North West Lancashire & Morecambe Bay LOC
Figure 1. LOCs in the North of England ABDO region Through her LOC, Jill took part in an Atrial Fibrillation Pilot at her practice. She explains: “Taking part in the pilot has been very interesting, and has resulted in our practice referring more than 10 per cent of patients examined to their GP for further tests. In addition, being a member of my LOC has allowed me to complete the LOCSU Leadership Skills for Optical Professionals postgraduate module.” ABDO local lead, Lynda Matthias, is supporting North Yorkshire LOC, while Eleanor Mace, Sarah Pencott and Lesley Oglethorpe are all playing an integral role at Northumberland Tyne & Wear LOC. Sheffield LOC is supported by Amy Seaman and East Patel, and Cheryl Swindells is championing the role of dispensing opticians at Bradford LOC. Figure 1 shows all of the 26 LOCs in the North of England ABDO region. As an ABDO regional lead, I am always keen to hear from DO contractors who are on their LOC or any members who are keen to get involved locally. Email me direct at firstname.lastname@example.org Further information about LOCs can be found in the LOCSU guidance document, Model LOC constitution. RICHARD RAWLINSON FBDO is ABDO regional lead for the North of England, Midlands and East of England. He is LOCSU optical lead, and a trustee of Vision Aid Overseas. APRIL 2021 DISPENSING OPTICS
JOTTINGS ELAINE GRISDALE
It’s never too late to improve and develop ockdown has been many things to many people but for me, especially in the early weeks and months, it was a time for some soul searching and reflection. I’ve been very fortunate in my career and had a lot of opportunities – but one thing that had always bugged me deep down was that I didn’t have a degree. As I proudly watched my daughter graduate from university during lockdown, and then gain a place to study for her Master’s, I became the only person in my family to have never been to university. Although I am really proud of my FBDO qualification and its Level 6 status, I felt it was time to push myself further. It wasn’t just about the kudos of having a degree, or to make up for time lost; I reasoned that having a degree would stand me in good stead if I ever left optics. No matter how many transferable skills I had from 35 years in optics and senior management, I risked being sidelined without one. So with my best foot forward, I enrolled on the ABDO College/Canterbury Christ Church University BSc in Vision Science in September 2020. I also thought that studying alongside my daughter might be a good bonding experience. She did, however, wonder why on earth I would put myself through the student experience at 57 years of age with an already established career. One reason was that I didn’t want to be left behind by younger colleagues who had taken this route and were excelling in academic specialties. A positive spin-off was that, very quickly, I noticed the process helping me improve and develop my critical thinking skills. So what exactly did I sign up for?
BURNING THE CANDLES The course involves studying two modules every four to five months, with six in total. I got a head start by tapping into the lectures early on to get used to the independent learning. This allowed me to settle into researching and writing in more academic terms at my own pace. As work commitments piled up, hitting the coursework submission deadline dates was a little stressful. I had many late nights, and was often up until one or two o’clock in the morning trying to research, write within the guidelines and structure my ideas. Because I’m a slow reader, and have not fully developed my essential scanning skills, I found that reading took up more time than it probably should have. Personally, I found it quite challenging to simultaneously read speedily, and pull out the pertinent points to remember for later use.
DISPENSING OPTICS APRIL 2021
Even though I passed both modules in the first part of the course, I did a lot better in the topic that I preferred and was more interested in. This was ‘Understanding evidence-based practice’, and I enjoyed dissecting and critically reviewing a study regarding spectacles purchased online. I learned a lot from the process and was able to use the evidence I had found, and arguments I had constructed, in some professional meetings. It really proved to me that further education can benefit your professional life, and be very rewarding. It has certainly inspired me to push on with the second part of the course.
“The time for action is now. It’s never too late to do something,” Antoine de Saint Exupery As I write this Jottings, I have just spent a wonderfully warm and sunny weekend sat inside behind my computer trying to catch up. I fear this may be a sign of things to come. The next two modules are on, ‘Principles of contact lenses’ and ‘Independent study’. I have not yet bonded with the contact lens module, although I am warming to the subject I have chosen. And though I love the independent study topic, I have changed the title of my focus topic what seems like a hundred times. Apparently this is common and part of the critical process. I’m hoping that with a bit of spring cleaning in my notes, and in my head, it will work out fine in the end. Overall, I am finding studying for my degree a very enjoyable experience. The tutors are very supportive and come back to you with sage advice if you choose to reach out. I have met some great people of all ages – and everyone seems to be enjoying the sense of achievement the course is providing. We all have our “eye on the prize”. Personally, I wish I had enrolled sooner. If you are seeking a new challenge, I’d definitely encourage looking at what the course entails and considering it. It’s never too late to improve and develop. Details of all courses can be found on the ABDO College website. ELAINE GRISDALE FBDO FAAO FEAOO is ABDO head of professional services and international development, and director of development for the International Opticians Association.
OA CORNER PART 4
SOCIAL MEDIA TIPS: USE GOOD QUALITY IMAGES
here is nothing worse than a grainy or blurry image appearing on a social media account. Either take a good quality photograph yourself, or source one. Use plenty of light when taking your own photo; products look best captured with a white background. If taking staff photos then natural light looks best. When searching for a stock photo, check you have permission to use it. You cannot just use any image you find on the internet; you may find yourself with a copyright issue. Pixabay and Unsplash are great sites for copyright free images. The EyecareFAQ section of the ABDO website also has a large selection of graphics that members can use free of charge. In April, we are covering spectacle lenses, nystagmus and eye diseases of old age. Find Q&As on more topics in the Information for the public section.
Bifocals have become less popular over recent years, as progressive power lenses have become more sophisticated in design – and fit better with modern life for most people. There are, however, occasions when bifocals are the best option. Bifocals consist of two prescriptions: traditionally distance at the top of the lens and reading at the bottom. Sometimes they can be useful as an occupational lens design, for example, with intermediate in the top part of the lens to focus on a computer screen, and a closer reading area at the bottom. Bifocals come in different shapes and sizes, ranging from an e-line bifocal that occupies the entire width of the lens, to a small round 15mm segment. Read the full article on DO Online to find out more about the different types of bifocal, and who they might suit.
Bifocal lenses can be tailored for specific sports
DO YOUR OWN PR Why invest your spare time in PR? The short answer is that it’s a low cost way to promote your business. Independent media coverage builds your business’s credibility and influence, and it extends your reach in a way you could not do yourself.
Here are five quick wins for planning your practice PR: 1. Who do you want to reach, and how will you reach them? Your first step is to think about the people you would like to attract to your practice. What do they read; what do they watch or listen to? 2. What stories make the news? Look at your choice of local media and analyse what they are covering. Seek out slots where experts are interviewed. What ‘hook’ is used to start each interview. Timely and newsworthy stories are most likely to get coverage. 3. How do you tell your story? Writing a press release can sound daunting but it’s not complicated. You really just need to email a named contact with the ‘who,
what, where, when, why and how’ of your story. Finish with the action you would like people to take: ‘call into John Smith Opticians on Saturday to take part’, and your email is ready to send. 4. How do you sell your story? Go back to your list of contacts, and put the content you have written into a quick, personalised email. Do use their name. Get to the story quickly without lengthy preamble and, if you have their number, follow up the next day with a quick call. Be ready to supply photographs or be interviewed straight away: the press needs to move fast to stay timely. 5. How do you capitalise on press coverage? Getting media coverage is only the start. If you have coverage, link to it via practice social media. Put it on your website, print it out and display it in the practice. Look for national events related to eyecare and make sure you let your press contacts know you are available for expert comment. Find out more in the Marketing section of the ABDO Business Support Hub. APRIL 2021 DISPENSING OPTICS
Is your practice going greener? Are you passionate about a career in eyecare? ABDO is working with Youth Employment UK to promote careers in eyecare. If you are age 18-25 and would be willing to talk about your job and your career, please email email@example.com
ABDO wants to hear from you Do you have any environmentally friendly or ethical initiatives in your practice? As part of ABDO’s ongoing campaign to support the profession and industry in implementing greener practices and processes, we are looking to compile a portfolio of case studies. If you would like to get involved, please get in touch with Antonia Chitty, ABDO head of communications, by emailing firstname.lastname@example.org
Visit DO Online Jobs Vacancies to place your recruitment adverts – or search for new opportunities. Your advert will reach some 8,000 ABDO members via eNews direct, making DO Online one of the most cost-effective platforms for DO recruitment. Vacancies are also promoted through ABDO’s active social media channels. Special reduced rate for ABDO members.
DISPENSING OPTICS APRIL 2021
LY JU TH 30
Degree or Diploma? Choose the course for you Diploma If you want to further your career in optics and learn while you earn, ABDO College offers you two great courses in ophthalmic dispensing. Both courses allow you to: Study online and learn new skills to use in practice Attend block release, experience college life and make great friendships Learn from dedicated and experienced academic staff Be supported by helpful course tutors.
A three-year diploma course in ophthalmic dispensing – leading to the ABDO Level 6 FBDO qualification.
In most cases, student finance is available to those undertaking the degree.
For more details and to apply:
A two-year Foundation Degree course followed by a third year BSc Degree course in ophthalmic dispensing – leading to BSc (Hons) and the ABDO Level 6 FBDO qualifications. Earning a degree is an opportunity to: Develop knowledge and expertise in a subject you enjoy Build transferrable skills in communication, leadership and problem solving Improve your career prospects
visit www.abdocollege.org.uk call 01227 738 829 (Option 1) or email email@example.com Applications close: 30th July 2021
KEEPING EXCELLENCE IN YOUR SIGHTS
FINANCE AND ADVICE
NETWORKING AND EDUCATION
The monthly journal of the Association of British Dispensing Opticians