NEWS, INFORMATION AND EDUCATION FOR OPTICIANS
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News Focus CLEAR: Tip of the tech iceberg
CET – C-77616 Myopia progression and management By Tina Arbon-Black
CET MCAs – C-76735 Getting to grips with OCT Part 1 By Prashant Shah and Yashita Shah
BCLA preview Tune in for live global event
In practice A vision for contact lenses By Antonia Chitty
Minding our MECS and CUES By Max Halford
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MAY 2021 DISPENSING OPTICS
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DISPENSING OPTICS The Professional Journal of the Association of British Dispensing Opticians Volume 36 No 5
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A WELCOME SURPRISE This year’s GOS settlement, announced last month by the Department of Health and Social Care, was certainly a very welcome surprise. After five consecutive years of no increase at all, it would not have been surprising if the same had happened this year. The fact that we received an increase of 1.9 per cent in the GOS sight test fee – rising to £21.71 from the current £21.31 – is therefore very welcome indeed, especially when you consider the wider fiscal restrictions currently in place. Although this is quite clearly a modest increase, and goes nowhere near in making up for what has been lost over many years, it is at least a very positive sign. I am certain that the extremely professional way in which the optical sector has responded to the challenges of the Covid-19 pandemic, and the way that eyecare practitioners the length and breadth of the country are continuing to provide outstanding care to patients, contributed to this settlement. The profession now needs to capitalise upon this small win. Instead of complaining about the past, and holding on to historic grievances, we should concentrate on proving the continued and evolving value of primary eyecare practice on the High Street. ABDO will be at the forefront of this drive – ensuring that our members have their voices shared and, most importantly, heard.
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
MAY 2021 DISPENSING OPTICS
OUR MONTHLY COLUMN FROM THE ABDO PRESIDENT JO HOLMES FBDO
From the Holmes front UV and sunspecs for kids s we step into spring and summer, and as the public is becoming more and more aware of age-related macular degeneration (AMD) and the potential relationship to ultraviolet radiation (UVR) exposure, we need to We must make time to explain UVR risks revisit our training and how we address this issue in practice. The ABDO board has asked for clear guidance on UV protection for children for our members, and simply there is no right or wrong answer. But that doesn’t mean there is justification in doing nothing. We need to be protecting children from UVR exposure; as dispensing opticians and as General Optical Council registrants we have a duty of care to this age group who are a legally protected group of patients. Therefore, it is important that we make the time within practice to explain the risks of UVR exposure to the parents and guardians of children who do not wear spectacles – as well as provide all the options for those who do. As we know, children without a prescription will outnumber their spectacle wearing peers. Having plenty of choice of plano sun specs on display will encourage parents and children to take up the offer of eye protection and hear this essential advice. At the moment, research is ambiguous and contradictory with regards to UVR exposure and cataractogenesis and AMD development in later life. Every child’s case will be different, as lifestyles, ametropia, ocular history and future aspirations will reflect and affect your decisions. But it does mean tinting spectacles and supplying a UV inhibitor should always be considered. It is essential to record the reason for the tint or UV inhibitor. If you have supplied a tint between one and 80 per cent, it is vital to differentiate between UV400 and 100 per cent UV blocking. I cannot guide you on what tint or UV protection is recommended, as each child’s needs and situation is different, but you must always record and explain your recommendation as an essential part of the paediatric record.
Jo Holmes FBDO President of ABDO
DISPENSING OPTICS MAY 2021
INSPIRING THE NEXT GENERATION
Boost for careers campaign ABDO’s award-winning Careers in Eyecare campaign has two new sponsors: Specsavers and Stepper UK. Lucy Knock, Specsavers early careers manager, commented: “Specsavers is delighted to work with ABDO on the Careers in Eyecare campaign, which we hope will inspire more young people to become opticians. “We’re keen on sharing the hidden secrets of the fantastic opportunities we have in our industry and, in particular, our role as STEM employers – for people who love science and technology, but also want to work in a caring environment. We look forward to sharing all the amazing ways we change people’s lives with a career in eyecare.” Peter Reeve, managing director of Stepper UK, said: “Stepper is supporting Careers in Eyecare so we can work together with parents, schools and careers advisers to let more young people know about the amazing range of roles available in design and manufacture of eyewear, with career routes available for those who like engineering, craft and design – as well as those who are interested in science, technology and healthcare.” Nick Walsh, ABDO sector skills development officer, said: “Support from these great, forward-thinking sponsors helps us to increase the range of help and resources that we can offer to students, teachers and careers advisers. We look forward to working with them and any other companies who would like to become sponsors too.” Find out more about the campaign on the ABDO website.
Board elections open Four places on the ABDO board are open for election, and members are now invited to submit their nominations. Three places are held by members entitled to seek re-election. They are Julie Lees, Garry Kousoulou and Brenda Rennie. The fourth seat is held by Kevin Milsom, who will step down after serving a full term. This year, any person seeking election should complete a candidate form and include details of their six nominators. Nominators should then individually complete and sign the separate nomination form. Both forms can be found on the ABDO website here, and should be completed by 10am on Friday 18 June. Email Jane Burnand at firstname.lastname@example.org or call her on 0207 2985102 with any questions.
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CooperVision acquires No7 No7 Contact Lenses has become part of the CooperVision Specialty EyeCare Group, after its acquisition for an undisclosed sum. “No7 Contact Lenses has been our partner for several years in the UK while expanding its business,” said Juan Carlos Aragón, president of CooperVision Specialty EyeCare. “The acquisition will enable us to directly offer more of our products through Juan Carlos Aragón No7’s wellestablished channels, while expanding access to their designs. In tandem, the agreement should further accelerate the development of myopia management solutions in the UK.” Ashley Pepper, managing director of No7 Contact Lenses, said: “We have great respect for CooperVision and have enjoyed a strong working relationship with its specialty eyecare team. [The acquisition] will help us have an even greater impact on the eyecare professionals who prescribe our contact lenses, and the adults and children whose vision and lives are made better because of them.”
NEW PACKAGING ACROSS THE RANGE
Toric lens powers extended Menicon’s daily disposable toric contact lens, Miru 1day Flat Pack, is now available in plus powers of up to +2.00D in 0.25D steps. Kevin Mitchell, managing director of Menicon UK, said: “Until now, the choice for long-sighted patients with astigmatism has been limited, and we are excited to bring this product to the UK contact lens market.” The lens features Smart Fit technology, and is available in the same new packaging design recently unveiled across the Miru
1day Flat Pack range with colours reflecting changing light from dawn to dusk. Its SmartTouch packaging is just 1mm thick, ensuring the inner surface of the lens remains hygienic during application because the patient only touches the outer surface. The packaging also uses significantly less raw materials and is recyclable. Menicon’s online toric calculator has been updated to include the new plus powers for Miru 1day Flat Pack Toric. It also offers an e-learning module. For more contact lens product news, turn to our Product Spotlight on page 16.
Savings for spring conference Readers of Dispensing Optics have until 31 May to take advantage of two special discount codes when registering for the British Contact Lens Association’s (BCLA) spring and autumn virtual conferences. The Association’s spring meeting on 13-14 June will be its first-ever livestreamed clinical conference and exhibition. “Covid-19 guidelines mean this year’s event cannot be held in person, but the BCLA moved swiftly to switch to an online-only platform – with livestreaming across multiple time zones around the world ensuring a truly global audience,” said BCLA chief executive, Luke Stevens-Burt. Turn to page 25 for details of the conference and special offers.
DISPENSING OPTICS MAY 2021
Quick and Handyrefract
Handy refraction tool Developed by dispensing optician, Chris Boyde, the new Handyrefract is now available from BIB Ophthalmic Instruments. Handyrefract is a low cost, hand-held, lightweight and sturdy binocular trial lens holder. A hand-held arm, positioned for either the dispensing optician or patient to hold, adjoins with two sprung fully rotational front cells with axis markings left and right providing quick and easy lens insertion. Both sprung cells can be removed for cleaning if required. “Ideal for demonstrating a spectacle prescription, reading Adds and over-refractions, Handyrefract is also useful for introducing cyls over spherical contact lenses,” said a spokesperson from BIB.
SLOWS PROGRESSION BY
Slow their myopia, not their ambition. Introducing the Brilliant Futures™ Myopia Management Programme with MiSight® 1 day contact lenses, clinically proven to reduce the rate of myopia progression by 59% and axial length by 52% in children.1 Make a difference to your young myopes’ lives now and you can help protect their vision of the future.2 To ﬁnd out more and begin your myopia management journey visit coopervision.co.uk 1. Chamberlain P et al A 3-year Randomized Clinical Trial of MiSight® Lenses for Myopia Control. Optom Vis Sci 2019;96:556–567. Over a 3 year period, MiSight® 1 day reduced myopia progression on average by 59% compared to a single vision contact lens. 2. Tideman JW, Snabel MC, Tedja MS, et al. Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol. 2016;134:1355-1363.
MAY 2021 Public confidence remains high
OFNC CHAIR, GORDON ILETT
New OFNC chair states priorities The new chair of the Optometric Fees Negotiating Committee (OFNC), Gordon Ilett, has said the Committee’s top priorities for the coming year would continue to be supporting the optical sector through the pandemic, and pressing for a fairer level of GOS sight test fee and grants. He has also thanked outgoing chair, Paul Carroll, for the leadership he has provided throughout the Covid-19 crisis. Gordon said: “GOS contractors throughout England have worked incredibly hard to keep providing care to their patients, even in the early stages of the pandemic when remote care was key in the absence of PPE. “Even now some practices are still facing financial challenges because of the restrictions introduced at the start of 2021, and we will keep making the case for additional targeted support where necessary. We encourage GOS contractors to keep us informed of the challenges they are facing. “It is also a top priority for the OFNC to keep pushing for a proper increase to the GOS sight test fee, which has been so badly eroded by rising costs and inflation in recent years,” added Gordon. Read more on this story on DO Online.
Myopia control alliance Johnson & Johnson Vision and Menicon are to strategically collaborate on the development and manufacture of contact lenses to manage the progression of myopia in children.
DISPENSING OPTICS MAY 2021
The latest public perceptions research from the General Optical Council (GOC) has revealed an 11 per cent increase in the number of respondents who would consult an ‘optician’ first if they woke up with an eye problem. The survey also revealed that more people than before considered opticians to be solely a healthcare service. More than 2,000 members of the public responded to an online survey as part of the 2021 research. Ninety-seven per cent of respondent said they were satisfied with the measures that were in place
during their last optician visit to protect them from coronavirus. Marcus Dye, GOC acting director of strategy, said: “We’re extremely pleased to see that confidence in the professions remains high, especially during the Covid19 pandemic. We’d like to thank our registrants for their hard work during these difficult times to ensure the public could still receive eyecare and feel safe doing so. It’s also positive to see that the perception of opticians as a healthcare service has increased to over a third, and more respondents than ever say they would speak to an optician first if they had an eye problem.” Access the report here.
AR-DRIVEN MOJO LENS
AR smart contact lens collaboration Mojo Vision, which describes itself as ‘the invisible computing company’, and Menicon have entered into a joint development agreement for the Mojo Lens smart contact lens. Using augmented reality (AR), the Mojo Lens is said to be able to overlay images, symbols and text on users’ natural field of vision without obstructing their view, restricting mobility or hindering social interactions. Through the agreement, Mojo and Menicon will conduct a series of feasibility studies, applying Menicon’s experience in gas permeable lens R&D and manufacturing to Mojo’s smart contact lens microelectronics, systems integration and consumer products innovation. Areas of collaboration will centre around contact lens materials, cleaning and fitting. “Our development agreement with Menicon is a significant step forward for Mojo and Mojo Lens,” said Drew Perkins, CEO and co-founder of Mojo Vision. “While we continue making progress in developing our smart contact lens technology, our collaboration with Menicon will provide us valuable insights that can accelerate our progress.”
Peter Menziuso, global president, Johnson & Johnson Vision Care, said: “Our collaboration with Menicon marks another step forward to bring a portfolio of differentiated products to help manage the progression of myopia in children, as we work towards our vision of helping the world see better, connect better, live better.”
As part of the collaboration, Menicon will develop and manufacture the contact lenses to help manage the progression of myopia in children. Johnson & Johnson Vision will focus on expanding availability of these lenses around the world. Learn more about future myopia control projects at www.jnjvisionpro.com/seemyopia
A key feature of the 2021 programme will include findings from the ground-breaking
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2019 OPTICIAN OF THE YEAR, ANDREW KEIRL
Last call for nominations Brand ambassador, Katarina Johnson-Thompson
21-day contact lens retention challenge Johnson & Johnson Vision has launched a new patient support programme designed to reduce contact lens drop-out. The Acuvue 21 Day Challenge will give patients who enroll on a contact lens trial access to a range of content and tips over a three-week period. Jakob Sveen, managing director Northern Europe and general manager UK and Ireland, Johnson & Johnson Vision, said: “The purpose of the programme is to extend the positive experience patients have with their optician by providing support after they leave the practice, improving the likelihood that they build confidence in contact lenses and complete their trial. For eyecare practitioners, the hope is that we help reduce patient dropouts and build long-term loyalty.” Acuvue brand ambassador Katarina Johnson-Thompson, world champion heptathlete, said: “For me, the key thing to success for most things in life is the combination of motivation, perseverance and support. That’s the great thing about the Acuvue 21 Day Challenge. Participants will have help and guidance throughout the first 21 days, and access to top tips when you need them.” Patients can sign up on the Acuvue website when they start a new trial with Acuvue brand contact lenses. There is also the chance to win a year’s supply of contact lenses. In-practice resources are available to support the campaign, including a digital toolkit and e-learning training modules for staff.
DISPENSING OPTICS MAY 2021
There’s still time to submit nominations for the 2021 International Opticians Association (IOA) Silmo International Optician of the Year Award, which recognises the importance of the optician in the optical business. IOA president, Fiona Anderson, said: “The calibre of previous entrants and winners has been astonishing, and we hope this year continues to highlight the skills and talents of opticians from around the world. We eagerly await this year’s entrants and are excited to review the applications from outstanding opticians worldwide.” The winner will be announced at Silmo Paris 2021 in September, and enjoy a trip to Silmo Paris 2022. Find out more, and how to nominate by 7 May, at www.ioassn.org/award
New course leader at Anglia Ruskin Dr Jarrod Hollis has taken over from senior lecturer Liam Kite as course leader for the BSc Ophthalmic Dispensing at Anglia Ruskin University (ARU). A practising optometrist, Dr Jarrod specialises in the visual assessment of people with neuropsychological and perceptual impairments of vision. Holding degrees in both cognitive psychology and optometry, his doctoral thesis considered
picture recognition, and the pathways involved in linking the visual representations to those required for speech production. He has a long history of teaching adults in further and higher education, and is a fellow of advanced higher education. Dr Jarrod said: “Liam has been involved with this course since its first presentation at the university many years ago, and as such is our resident expert for ABDO dispensing. Liam’s experience is irreplaceable and in this respect, he will continue to have a significant role in the management of the course.”
Student success story at Bradford Bradford College has announced that all of its initial intake of advanced entry students from the Specsavers BTEC Level 4 Certificate in Optical Dispensing have been successful in all of their preliminary assessments. Students who have already achieved the Level 4 BTEC Certificate are able to enter the Bradford College part-time Foundation Degree in Ophthalmic Dispensing in the second year, allowing them to potentially graduate in two years’ time. Dean Dunning, programme leader for the FdSc Ophthalmic Dispensing, said: “We are absolutely thrilled that all of our advanced entry students this year have
“Remarkable” progress of advanced entry students done so well so far. Their progress has been nothing short of remarkable. Read our special feature on DO Online.
DISPENSING OPTICS I MAY2021 Benefits link for OSA members
Unveiling of myopia lens results
All members of the Optical Suppliers Association (OSA) and their employees are now eligible to join the ABDO benefits programme. The programme provides an array of health and lifestyle benefits from discounts in High Street stores to lower insurance rates, reduced gym memberships and more. OSA chairman, Stuart Burn, said: “There has never been a more important time to focus on wellbeing and by collaborating with ABDO, we have delivered our members’ employees with an exceptional array of benefits and discounts.” ABDO general secretary, Tony Garrett, commented: “There has always been a close link between dispensing opticians in practice and our partners in industry, who provide both equipment and products. I hope that this initiative will be the start of a new and even closer working relationship.”
Essilor will unveil pivotal two-year clinical trial results of its Stellest spectacle lens for myopia control at the Annual Meeting of the Association for Research in Vision and Ophthalmology in China on 6 May. The two-year results will demonstrate that Essilor Stellest lenses slow down myopia progression by 67 per cent on average, when compared to single vision lenses, when worn at least 12 hours a day.
Cameo appearance The latest Cameo styles from Continental Eyewear includes two models for men and two for women in a range of colourways. Model Serena (pictured) is a metal oval frame featuring subtle diamante detailing alongside contrasting tips. Serena comes in Blue, Pink and Rose Gold. The Cameo collection is created
The results will also show that after the first year, the eye growth of nine out of 10 children wearing Essilor Stellest lenses was similar or slower than nonmyopic children; and that two out of three children who wore the lenses did not need a prescription change after the first year. Grita Loebsack, Essilor International group chief marketing officer, said: “These exciting results have already amazed leading global myopia experts, and illustrate that Essilor’s mission and commitment to tackle myopia remains stronger than ever today.
in-house and includes both metals and plastics, appealing to a wide range of wearers from teens to adults.
Cameo Serena in Pink
NEWS Women with sensory loss suffer more Women who suffer from vision, hearing or dual sensory loss are more than twice as likely to report depression and anxiety as men who experience the same issues, according to a new study by Anglia Ruskin University (ARU). The research, published in the International Journal of Geriatric Psychiatry, looked at survey data from the Spanish National Health Survey of more than 23,000 adults, where participants had self-reported whether they had suffered depression or anxiety, and whether they experienced vision, hearing or dual (both vision and hearing) sensory impairment. Across the whole sample, the prevalence of depression and anxiety was between two and 2.56 higher in women compared to men. Women with dual sensory impairment were almost threeand-a-half times more likely to report depression or anxiety than those who did not have any impairments, while men with dual sensory impairment were more than two-and-a-half times more likely to experience depression, and almost twice as likely to report anxiety than those with no impairment. Lead author Professor Shahina Pardhan, director of the Vision and Eye Research Institute at ARU, said: “This [study] highlights the importance of interventions to address vision and hearing loss, especially in women. Some sensory loss is preventable or treatable, and clearly these issues are taking their toll not just on physical health, but mental health too.”
MAY 2021 Anti-virus coating first Zeiss Vision Care’s new DuraVision AntiVirus Platinum UV coating is said to kill 99.9 per cent of viruses and bacteria. It is the company’s first lens coating with anti-viral and anti-bacterial properties, utilising nano silver technology integrated into its structure. The coating also offers full UV protection in all clear plastic Zeiss lenses (excluding CT25, S728 and Aphal RS 22). “Tough, easy to clean, and with full UV protection included as standard, these lenses beautifully combine innovative
Tough on viruses and bacteria technology, with all the quality you’d expect from Zeiss,” said a company spokesperson.
Topography-guided fitting tool CooperVision Specialty EyeCare has launched Paragon CRT Software – a topography-guided tool aimed at simplifying the fitting process for first-time CRT and CRT Dual Axis contact lens prescribers. The software enables practitioners to change lens parameters, assess fluorescein patterns of different lenses on the same patient, and see simulated lens changes on a patients’ eye prior to ordering warranty exchanges. In addition, practitioners can upload patient topography maps and customise CRT and CRT Dual Axis lenses for each patient. The software is available to download at ecp.paragonvision.com/software
CET offer reminder Don’t forget: ABDO has negotiated a member discount of 25 per cent on an annual subscription to CETpoints.com for the remainder of the CET cycle ending on 31 December 2021. Members can register at CETpoints.com and complete their first CET course for free. Those who then purchase a subscription can use the code ABD21BX25 to save £40 on the normal 12month cost. The subscription will run for a calendar year from the sign-up date, with full access to all learning during that period. When using the discount code, the user’s name will be shared with ABDO for the sole purpose of verifying ABDO membership.
DISPENSING OPTICS MAY 2021
VICTORIA BECKHAM EYEWEAR VB222S
Oversized 70s inspired edit Elegance and a sense of understated ease runs through the latest Victoria Beckham Eyewear collection from Marchon. The new edit of 16 styles combines inspiration from quintessential oversized 70s shapes with contemporary design details. Premium materials are married with delicate details and sharp, strong silhouettes. The custom seasonal palette sees warm shades of sage, rust and honey sit alongside faux tortoiseshell and horn textures, gold and silver, plus the unexpected addition of a bright azure blue. Key styles include the Peaked Metal Rimless, the Faceted Rectangular and a new optical variation on the signature Navigator silhouette, featuring a unique hammered effect along the upper rim and details in tones of gold and blush.
NEWS FOCUS CLEAR REPORTS
Tip of the tech iceberg “Incredible advancements” in contact lens applications are on their way, experts predict… newly-published paper has been described as representing one of the most comprehensive reviews of advancements to come in contact lenses. It describes applications well beyond refractive error correction – from disease diagnostics and drug delivery to spectral filtering. ‘Contact lens technologies of the future’ by Professor Lyndon Jones and colleagues is published in Contact Lens & Anterior Eye (CLAE), the peer review journal of the British Contact Lens Association (BCLA). It joins nine other papers printed in a special edition as part of the BCLA-led Contact Lens Evidencebased Academic Reports (CLEAR) series. Commenting on future applications, Professor Jones, director of the Centre for Ocular Research and Education (CORE) and the paper’s lead author, said: “There are a range of diverse technologies that are shaping the future of contact lenses, in some cases already showing their potential in late-stage development initiatives and even commercially-available products. “Novel biomaterials, nanotechnology progress, unique optical designs, biosensing discoveries, antibacterial agents and even battery miniaturisation and power transfer are coalescing like never before. The next several years will see incredible advancements and growth for an expanded contact lens category.”
microfabrication, theranostic lenses would release appropriate therapeutics based on continuous monitoring inputs, replacing more invasive procedures, state the authors.
DISEASE DIAGNOSES AND MONITORING With more than 500 references, the paper explores several areas in which innovations are anticipated to make an impact. The presence of biomarkers in the tear film will give rise to diagnostic contact lenses to help detect and monitor systemic and ocular diseases, including diabetes, cancer and dry eye disease, the authors suggest. Integrated circuit progress may give rise to in-lens intraocular pressure monitoring for glaucoma, and even retinal vasculature imaging for early detection of diseases such as hypertension, stroke and diabetes.
BEYOND SMART LENSES
Enhancements will extend beyond 'smart' manifestations Ocular disease treatment and management may likewise benefit from progress in fluid dynamics, materials science and microelectronics. Dehydration-resistant materials combined with electro-osmotic flow and reactive oxygen species-scavenging materials – when integrated into lenses – could offer alternative dry eye disease therapies. Liquid crystal cells could replicate the functionality of the pupil and iris arrangement, autonomously filtering incoming light to overcome physiological defects, it is posited. Further, embedded and tunable spectral filtering has the potential to mitigate colour vision deficiencies. Drug-delivering contact lenses may offer more accurate dosing versus traditional eye drops, the authors continue, increasing the residence time of a drug on the ocular surface – with less exposure to elements such as blinking and non-productive conjunctival absorption, reducing the many known side-effects of drugs. Delivery might come from in vitro uptake and release, the paper reports, incorporation of drug-containing nanoparticles into contact lens materials during the manufacturing process, and even molecular imprinting to imbue polymers with memory characteristics that aid dispensation. These techniques and related advancements could open up opportunities for contact lenses as theranostics, the multi-disciplinary medical field that combines therapeutics with diagnostics. Uniting sensing technology and
While ‘smart’ contact lenses have become associated with on-eye headsup displays, the authors put forward the view that optical enhancements extend well beyond these manifestations. Customised optics could address aberrated eyes, with the front surface of a lens shaped to specifically reduce measured aberrations based on each person’s unique corneal shape. Embedded microelectronics might constantly monitor corneal gaze direction, controlling optical elements to address presbyopia in real time. Myopia control lenses are slowing axial growth in children, responding to one of the most pressing issues in eye health today. And optical and digital display discoveries hold the potential for assisting people who suffer from low vision – and then extend to the general population to replace or supplement traditional screens. The paper concludes with an overview of packaging and storage case material and design developments, which may offer improved hygiene and reduced wearer-induced contamination. Joining Professor Jones as one of the paper’s 14 authors is Chau-Minh Phan, a research assistant professor with CORE. Six other CORE scientists contributed to the BCLA CLEAR reports series, serving as co-authors on papers regarding anatomy and physiology, complications, evidence-based practice, and the effect of lens materials and design. CLAE editor in chief, Dr Shehzad Naroo, said: “The CLEAR reports are a unique achievement from all those involved, especially the chair, vice chair and panel chairs. They represent the benchmark of the current knowledge base, that will be useful for practitioners, students, researchers and industry colleagues for years to come.” MAY 2021 DISPENSING OPTICS
Raising the bar for toric multifocals
More than 200,000 prescription options available
New Biofinity toric multifocal contact lenses are the latest addition to CooperVision’s flagship Biofinity family of lenses – combining the designs of Biofinity toric and Biofinity multifocal. Like all Biofinity silicone hydrogels, Biofinity toric multifocal features CooperVision’s Aquaform Technology for “superb breathability and higher moisture content to keep eyes comfortable and healthy”. The lenses combine CooperVision’s Optimised Toric Lens Geometry and Balanced Progressive technologies. The former provides uniform horizontal iso-thickness, an optimised ballast band design, a large toric optical zone, and a smooth continuous surface; while the latter offers multiple zones of vision correction optimised for each sphere and add power, with the option of fitting a centre distance or centre near lens. “Correcting for astigmatism and presbyopia in a single contact lens is complex, and through our partnerships with eyecare professionals, we have come to understand the challenges associated with fitting toric multifocal lenses,” commented Krupa Patel, head of professional services for CooperVision UK and Ireland. “With Biofinity toric multifocal, all of that has changed; our advanced optical design and effective fitting guide have raised the bar.”
In the zone
It’s all go in the contact lens sector this month as we shine a spotlight on six new product innovations...
New lenses with AR-powered support programme
Addressing contact lens drop-out with AR Alcon has launched its Precision1 daily disposable silicone hydrogel contact lens in both sphere and toric options. The lens features Alcon’s proprietary SmartSurface technology, described as: “a permanent, micro-thin, high-performance layer of moisture at the lens surface that helps support a stable tear film to deliver lasting visual performance from morning to night”. A patient support programme, powered by augmented reality (AR), has also been introduced to work alongside eyecare practitioners. Accessible when scanning the contact lens pack or QR code via a smartphone, the AR support programme is aimed at: those who have never tried contact lenses; those who are trying Precision1 for the first time; and wearers whose lenses are not meeting their needs. It contains four key areas: Fact Not Fiction; Learning Lab; Precision1 Lowdown; and Rock Your Lenses. “We are delighted to offer a daily disposable contact lens for consumers who have a busy lifestyle and expect long-lasting comfort and precise vision; and we want their wearing experience to be memorable,” said Chantelle Cook, vision care franchise head and country manager for Alcon UK and Ireland.
Lens family expanded for astigmatic presbyopes
Seamless vision in all three zones 16
DISPENSING OPTICS MAY 2021
Bausch + Lomb has launched its new Ultra Multifocal for Astigmatism contact lens, further expanding its Ultra monthly reusable contact lens family. The contact lens incorporates the company’s Moisture Seal Technology, while combining 3-Zone Progressive Design and OpticAlign Design, to meet the needs of astigmatic presbyopic patients. In phase one data analysis, the company found that the 3-Zone Progressive Design provided “seamless vision near, far and in-between”.
In addition, a company stabilisation study found that the OpticAlign Design provided ≤5˚ rotation on 95 per cent of patients. A fitting guide of trial lenses is available.
Preparing to come into full bloom Menicon is gearing up for the launch of its new Menicon Bloom Myopia Control Management System in the second half of 2021. Designed for all children who have shown signs of myopia progression, the system will have three components: 1) night and day lens products specifically for myopia management; 2) treatment plans and/or protocols to fully support eyecare practitioners (ECPs) throughout the fitting process and beyond; and 3) a two-part monitoring system consisting of software for ECPs and an app to enhance communication between practitioners and patients. Gill Narramore, UK sales manager for Menicon’s speciality lens division, told Dispensing Optics: “Contact lens innovations continue to drive welcome progress in this regard, but this is not the whole story when it comes to effective management of myopia in children. “We believe that ongoing communication between the children, their parents or guardians, and the eyecare practitioner is paramount. The Bloom app will deliver this with ease, improving compliance and safety throughout the myopia treatment programme.”
New myopia control system on its way
Xtended focus on healthier lifestyles Described as “a new silicone hydrogel contact lens for healthier lifestyles”, Mark’ennovy’s new monthly Xtensa SiHy lens is said to provide excellent vision, eye health and comfort. The silicone hydrogel material has a Dk/t of 119 for “outstanding” oxygen transmissibility, along with a Class 1 UV filter – blocking 90 per cent of UVA and 99 per cent of UVB rays. The lens also features a hyaluronic acid-infused outer surface to promote a comfortable, all-day wearing experience. Available in spherical, toric and multifocal geometries, Xtensa SiHy provides a generous range of options for myopia, hyperopia, astigmatism and presbyopia. Complimentary trial lenses are available from the company. Mark’ennovy has also upgraded its Saphir Rx silicone hydrogel material with a Class 1 UV filter and blue visibility tint. Saphir Rx provides a complete range of base curves, diameters and powers to ensure the most precise contact lens fit.
UV-blocking lenses for eye health and comfort
Built-in personalisation for presbyopes July will see the UK launch of Johnson and Johnson Vision’s new Acuvue Oasys Multifocal with Pupil Optimised Design following its recent CE mark approval. The lens includes the same Pupil Optimised Design technology currently available in 1-Day Acuvue Moist Multifocal, and follows the same fitting process. Now available in both reusable and daily disposable modalities, Pupil Optimised Design is said to provide built-in personalisation for better visual performance. “Although there are 50 million presbyopia patients over the age of 45 across the EMEA region who are open to wearing contact lenses, fewer than 10 per cent of this group are currently wearing a multifocal contact lens to correct the condition,” said Sandra Rasche, area vice president, Europe, Middle East and Africa, Vision Care, Johnson & Johnson Medical. “Acuvue Oasys Multifocal with Pupil Optimised Design will offer an exciting solution for these patients, using a blend of technologies for better comfort and clearer vision at all distances.” Next month’s Product Spotlight will focus on children’s eyewear. For editorial and advertising opportunities email email@example.com
Due to launch in the UK in July MAY 2021 DISPENSING OPTICS
CET COMPETENCIES COVERED DISPENSING OPTICIANS Standards of Practice, Optical Appliances, Contact Lenses CONTACT LENS OPTICIANS Standards of Practice, Verification and Identification, Contact Lenses OPTOMETRISTS Standards of Practice, Optical Appliances
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-to-date. The pass mark is 60 per cent. The answers will appear in the September 2021 issue of Dispensing Optics. The closing date is 7 August 2021.
Myopia progression and management By Tina Arbon Black BSc (Hons), FBDO CL esearch into halting the progression of myopia has been on the optical agenda for several decades. The author recollects that during the 1980s, hospital eye departments and progressive optometrists routinely prescribed executive bifocals, typically with a +2.50 add, set with the segment bisecting the pupil, in order to halt the progression of ‘juvenile stress myopia’. A lack of evidence and a GOS system illfitted to paying for ‘experimental’ treatments meant that this practice fell by the wayside. However, interest in myopia has never gone away – and has come to the fore in the last decade.
Evidence suggests that myopia is reaching epidemic proportions with predictions that 49.8 per cent of the world’s population will be myopic by 2050, with 9.8 per cent having high myopia (standardised to spherical equivalent of -5.00D and greater) with consequences of serious pathology including retinal detachment, myopic maculopathy, glaucoma and cataract1. Clearly, reducing myopic progression is important to relieve the public health burden and improve quality of life for myopes; slowing myopia by 1.00D can reduce myopic maculopathy by 40 per cent2. This article aims to give an insight into current thinking regarding myopia, existing
Figure 1. Corrected eye with retinal image focussed at the fovea
PLAN YOUR CET TODAY
C-77616 Approved for one CET Point
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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.
Figure 2. Peripheral image in focus with eye growth interventions and some new spectacle and contact lens designs that have been gaining interest. Dispensing opticians, contact lens opticians and optometrists have an exciting opportunity to play a part in myopia management, and now more than at any other time evaluating and understanding evidence is essential. General Optical Council registrants’ responsibilities are very clear within the standards of practice for optometrists and dispensing opticians: 3.1, 3.1.4, 3.3 and 5.33, so with evidence mounting of this growing problem it is not an option to just say nothing – hoping someone else will.
CURRENT OPINION ON MYOPIA PROGRESSION Today, causes of myopia still generate much debate and research. It is clear there is a link between genetics, environmental and now optical factors like eye shape and off axis refraction4,5.
Heritability of myopia is between 60 and 80 per cent6 and children of two myopic parents having a greater risk of developing myopia than children of one myopic parent7. Current thinking is that eye growth is visually guided with relative peripheral retinal refraction playing a more significant role than foveal refraction in driving eye growth5,8,9. Figure 1 shows that even though a corrected eye with retinal image focused at the fovea, the peripheral image plane is behind the retina creating hyperopic defocus and stimulating horizontal axial elongation. Eye growth continues until the peripheral image is in focus (Figure 2) and the foveal image becomes myopic. By creating peripheral myopic defocus, the stimulus for eye growth is discouraged. The foveal image must remain in focus allowing full visual development, avoiding amblyopia. Figure 3 shows a peripheral
myopic defocus image plane and in-focus foveal image. Measuring peripheral refraction and eye lengths in myopic children that took part in the bifocal lenses in near-sighted kids (BLINK) study, found more hyperopic relative peripheral error in the horizontal meridian and more myopic relative peripheral error in the vertical10. Both vertical and horizontal axial lengths were shorter compared to the central area, and the more foveal myopia the more relative peripheral hyperopia horizontally and less relative peripheral myopia vertically. Simply: the greater the myopia, the steeper the retinal profile. A study of 18 to 30-year-olds found steeper retinas in East Asian populations compared to Caucasians when viewed with increased myopia prevalence in East Asia retinal shape could indicate development of myopia11. Children from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) study were found to show relative peripheral hyperopia one year before myopia onset in Caucasian children, and three years before in Asian children. This supports the theory that relative peripheral hyperopia is a driver not an effect of myopia12. Contradictory evidence from Atchison et al 13 (Chinese children aged seven years and aged 14 years) found that when myopia developed, relative peripheral refraction was myopic not hyperopic as expected. This makes the point that spectacle lenses inducing relative peripheral myopia would be unsuccessful. Clearly, more research is needed to understand the dominating factors driving myopia progression.
TERMINOLOGY AND CLASSIFICATION
Figure 3. Eye corrected with peripheral myopic defocus
After a meeting in 2015 between the World Health Organisation (WHO) and the Brien Holden Vision Institute (BHVI) on myopia and high myopia, the International Myopia Institute (IMI) was formed as the global burden of myopia and its sight-threatening complications were clearly evident. The IMI consists of experts from around the world who created a series of white papers and clinical summaries (free to access) to aid eyecare practitioners, governments educators and the general public understanding of myopia. MAY 2021 DISPENSING OPTICS
CET MYOPIA MERMINOLOGY Myopia
A condition where the spherical equivalent refractive error is ≤-0.50D with relaxed accommodation
A condition where the spherical equivalent refractive error is ≤-0.50D and >-6.00D with relaxed accommodation
A condition where the spherical equivalent refractive error is ≤-6.00D with relaxed accommodation
A condition where structural changes in the posterior segment of the eye are caused by the excessive axial elongation associated with myopia such as; myopic maculopathy, posterior staphyloma (irregular configuration of the retina due to scleral thinning and bulging from excessive elongation), and high myopia associated optic neuropathy
Myopia due to excessive axial elongation of the eye
Myopia due to the cornea and/or the crystalline lens
Myopia due to a specific cause for example a drug, corneal disease or systemic clinical syndrome which is not a known population risk factor for development of myopia
Refractive status of the eye ≤+0.75D and >-0.50D in children where age, refraction and considered risk factors show a likelihood of future myopia development to warrant preventative interventions
Table 1. Myopia terminology Table 1 explains the definitions and classifications of myopia set out by the IMI to create consistency. Note: high myopia is now defined as ≤ -6.00D using mathematically valid descriptors, meaning more myopic than -6.00D14.
EXISTING INTERVENTIONS: EVIDENCE AND EFFECTIVENESS Time spent outdoors Time outdoors is an area of extensive research, which has shown to protect against myopia onset but not myopia progression in subjects who were already myopic15. Forty minutes of daily outdoor activity provided a relative 23 per cent reduction in myopia incidence among sixyear-old children in China16. Unsurprisingly, lockdown restrictions during the Covid-19 pandemic have impacted on the amount of time spent outdoors. A recently published prospective cross-sectional study found the prevalence of myopia was 3x higher in children aged six years, 2x higher for children aged seven years and 1.4x higher for children aged eight years compared to previous years17. Interestingly Huang et al in 202018 found that ensuring working distances of >30cm for near work, stopping every 30 minutes then having time outdoors, decreased myopia progression and prevalence.
Pharmacological interventions Evidence from Chua et al19 (ATOM1 phase
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one study) showed atropine one per cent concentration produced a 77 per cent reduction in myopia progression over two years. During a one-year cessation of atropine, participants were followed and a considerable myopic progression (rebound effect) was observed comparable to the control group at two years, negating the effectiveness of the treatment20. Due to the rebound effect and other potential side-effects (mydriasis, reduced accommodation, potential glare, near vison blur, allergic conjunctivitis) lower concentrations were studied. Chia, Lu and Tan21 (Atom2 phase three study) found 0.01 per cent atropine concentration proved effective – with a 50 per cent reduction in myopic progression over five years with fewer side-effects. There are still many unanswered questions regarding the use of atropine, which is not currently licensed in the UK for myopia control. These include: the cellular and pharmacological process; whether the sclera, choroid or retina is the location which impedes myopic progression; concentration; treatment duration; drug holidays; and safety of long-term use22.
evidence is contradictory. In a systematic review, Logan and Wolffsohn25 found that most evidence showed an increase in myopic progression compared to full correction. Current clinical guidance supports myopes being fully corrected. A randomised clinical trial conducted by Gwiazda et al26 involved 462 children using Varilux comfort (+2.00D add) compared to single vision lenses. The trial achieved a reduction in myopic progression of 0.20D, and an axial length reduction 0.11mm. Disappointingly, these results were clinically insignificant. The treatment effects of progressive power lenses have shown to be greatest in the initial six to 12 months, but diminish in later intervals. The reasons for this are unknown, however, accommodation adaption may be a factor27. Bifocal lenses – more effective results have been found using two executive bifocal (+1.50 Add) designs, one with no prism and one incorporating 3Δ base in at near. Myopic progression was reduced by 39% and 51% respectively over 3 years, compared to single vision lenses. The prismatic lenses had a greater effect for children with low lag of accommodation28.
Contact lens wear
Under correction of myopes, giving rise to foveal myopic defocus potentially diminishing myopic progression stimulus, initially showed success in animal studies23,24. However, in humans the
With conventional soft multifocal contact lenses, centre distance lenses do provide some reduction in myopic progression (43 per cent) and axial elongation (36 per cent) as recorded by Walline et al29 (Blink
been found with atropine and OK42,43. However, cessation of Misight 1 day lens wear over a one-year period found no rebound effect44. This concurs with the opinion that intervention by altering retinal image profile is a more natural, less invasive approach unlike pharmacological interventions45. Accommodative and binocular functions showed no changes in the MASS study46.
Key points: FIGURE 4. ONGOING TRIALS ARE YIELDING POSITIVE RESULTS
randomised clinical trial). The results are similar to a previous meta-analysis with a 25-50 per cent reduction in myopic progression30. Reverse geometry high DK rigid gas permeable contact lens designs, which reshape the cornea when worn overnight to reduce myopic refraction, were originally designed to eliminate need for vision correction during the day. Orthokeratology (OK) lenses have now been shown to be successful in myopia management. Results of a two-year randomised clinical trial found axial elongation slowed by 43 per cent, compared to single vision spectacles, with greatest results in the first six months31. This concurs with metaanalysis results from Sun et al32. The OK lens design creates a steepening in the mid-peripheral corneal zone, creating myopic defocus. The amount of myopic defocus created is believed to be dependent upon the degree of centrally corrected myopia33. OK lenses require exact specialist fitting. It should also be noted that the risk of microbial keratitis is considered similar to other overnight wear modalities34. Rebound effects have been observed with this method of intervention35, although there is a lack of robust comparable data.
COMMERCIAL SOFT CONTACT LENS DESIGNS MiSight 1 day MiSight 1 day (CooperVision) (Figure 4) is a dual focus soft daily disposable contact lens with a central distance correction zone (3.36mm) surrounded by a treatment zone, creating 2.00D myopic defocus zone (+2.00D add). This alternating pattern is then repeated36,37 When viewing a distant object, the
distance correction zone is focused on the retina and the myopic defocus treatment zone in front of the retina, which is consistent for near vsion with accommodation. Full lens specifications can be found on the CooperVision UK practitioner website.
Evidence for myopia management A multicentre trial being conducted in Portugal, England, Singapore and Canada is ongoing with results that appear very promising. This is a randomised, doublemasked clinical trial being conducted over three years among 144 children aged eight to 13 years old38 – with one group wearing MiSight 1 day lens and the other group Proclear 1 day. Changes in cycloplegic refraction measured by autorefractor recorded as spherical equivalent refraction over three years showed a 59 per cent reduction in myopic progression for those wearing the Misight 1 day lens, and a 52 per cent reduction in axial length measured in mm. Weekday wearing times were around 13 hours, with weekends 12 hours worn over 6.5 days per week. Results from a parallel group – the MiSight Assessment Study Spain (MASS)39 two-year randomised clinical trial – compared MiSight 1 day to single vision spectacles and found lower results: a 39.32 per cent reduction in myopic progression and a 36.04 per cent reduced axial elongation. It was noted that 86-87 per cent were Caucasian children, whereas many other myopia intervention studies only include Asian subjects. The multicentre study showed myopia progression consistent across population groups within the study38 differing from existing evidence where progression has been linked with ethnicity40,41. The ‘rebound effect’ when treatment stops is an issue of concern, which has
• Multicentre, double-masked randomised controlled trial over three years • Children aged eight to 13 years • Study is ongoing so further results will provide even more information • Evidence relating to ethnicity and myopic progression • This study did not include any children with high myopia (no participants over -5.00D) • Fifty-nine per cent reduction in myopic progression and 52 per cent reduction in axial elongation
NaturalVue Mutlifocal 1 day NaturalVue Multifocal 1 day (NVMF) (Visioneering Technologies) is an extended depth of focus (centre distance) simultaneous vision multifocal contact lens. The lens design features Neurofocus Optics technology (a patented aspheric design) which rapidly increases relative plus power from the central zone inducing a virtual pinhole effect48. The non-conical, aspheric surface design creates a smooth power distribution. Full lens specifications can be found on Visioneering Technologies’ UK practitioner website.
Evidence for myopia management Cooper et al48 conducted a retrospective case series analysis (report on a series of patients with an intervention that was studied) of 32 patients aged six to 19 years fitted in 10 practices across America with NVMF lenses between March 2015 and August 2016 (Table 2). This research method does not have a separate control group like randomised clinical trials, making assessment of a single variable difficult. The study created a starting point from previous spectacle refraction and time interval (months) until initial visit. MAY 2021 DISPENSING OPTICS
CET METHOD OF CORRECTION PRIOR TO NATURALVUE LENS Spectacles (type of lens not specified)
Single vision spherical contact lenses
Multifocal soft contact lenses
3% date OK ceased not specified
Table 2. NaturalVue Multifocal study, prior methods of correction The monthly progression figure was annualised, forming the basis of using each participant as their own control. Inclusion criteria was by practitioner clinical judgement where -0.50D of refractive myopic progression was evident compared to previous examination. It is not clear if cycloplegic refraction was undertaken. Subjects were seen approximately every six months. Progression was recorded and divided by the number of months since the previous visit, then again annualised with each eye analysed separately. The time NVMF lenses were worn varied from six to 25 months with an ‘average’ of 10.94 months. However, eight (25 per cent) children only wore the lenses for six months, and two children (6.2 per cent) wore them for 24 months. Daily wearing times were not specified. The data shows that for 75 per cent of children, myopia progression completely stopped. For 6.25 per cent of children, refraction actually regressed; 90.6 per cent of the children showed a 70 per cent or greater reduction in myopia progression. Care needs to be taken when interpreting these results, as the use of percentages could lead to confusion. For example, it states that 1.56 per cent of 32 children showed an increase, which relates to half of one child, or one eye. Annualised myopic progression rates were calculated from the initial visit.
FIGURE 5. HOYA MIYOSMART LENS
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Unfortunately, full baseline refractive assessment details were not given – but appear not to include use of cycloplegics, or if refraction methods differed across the 10 practices. No axial length measurements were given. The study itself acknowledges that retrospective case series analysis lacks the scrutiny of double-masked randomised controlled clinical trials, and interpreting these results must be considered alongside that fact that no topography or axial length measurements were taken. A recent product focus article in Optician magazine, ‘A common sense approach to myopia management’, mentions new clinical data involving a larger case sample (153) – but this data seems unpublished as yet49. Standardised refraction protocols would have improved both reliability and validity of the study. Case studies provide real world evidence and clearly MVMF worked for these patients. Presentation of the data implies this intervention is very effective, although the results need to be considered alongside the limitations of this study method.
Key points: • Real world evidence • Children aged six to 19 years • Small number of participants
• No control group • Consistency across practices regarding refraction not discussed • Cycloplegic refraction not specified • No axial length measurements
COMMERCIAL SPECTACLE LENS DESIGNS Hoya Miyosmart lens Launched in the UK in February 2021, the Hoya Miyosmart spectacle lens has gained considerable interest. Development started from the defocus incorporated soft contact (DISC) lens; a simultaneous vision correction with central clear distance zone and a 50:50 ratio of (2.50D) myopic defocus zones50. Myopia progression has been shown to reduce by 58 per cent when the lenses are worn for at least seven hours; time worn or ‘dose’ of myopia management was linked to the effect. This concept was applied to spectacle lenses by defocus incorporated multiple segments (DIMS) technology – as not everyone is suitable for contact lens wear51. Miyosmart is a simultaneous vision lens consisting of a hexagonal central distance zone surrounded by a ring of micro lens segments (lenslets) creating 3.50D of myopic defocus (+3.50D add) so there is optical defocus in all regions of the lens51. Lenslets are very discreet, and only visible if the lens is tilted and a light source is used to show the multiple segments by reflection (Figure 5). Full lens specifications can be obtained on request from Hoya.
Evidence for myopia management Lam et al51 conducted a two-year, doublemasked, randomised controlled trial of Chinese children aged eight to 13 years; one group wore a single vision lens and the other group wore the DIMS lens. It was accepted that while it was difficult to differentiate single vision and DIMS lenses, some children may have identified the multiple segments but no adaption difficulties were noted. Changes in cycloplegic refraction measured by autorefractor were recorded as spherical equivalent refraction, and showed 52 per cent less myopia progression in the DIMS group over 24 months. The greatest effect was seen in the first six months. Axial length growth was measured in millimetres (mm) and showed a 62 per cent reduction in the DIMS group
Figure 6. Practitioners must educate patients and parents about myopia management options compared to the single vision group; 21.5 per cent of children wearing the DIMS lens had no myopia progression over two years compared to 7.4 per cent in the single vision control group. Constant wear of spectacles was achieved in both subject groups (around 15 hours). To determine if the DIMS lens had any effect on visual function, a further study was conducted. This showed no significant differences between children who wore the DIMS lens compared to those in single vision lenses, although it was accepted that further studies were required covering a longer time period52. Changes in relative peripheral refraction (RPR) of children wearing DIMS showed a decrease in hyperopic RPR in contrast to the single vision group, where it increased. Also, it was concluded that using a lens that induced peripheral myopic defocus slowed myopia progression and altered the overall retinal shape53.
Key points: • Double masked randomised controlled trial • Children aged eight to 13 years • Study is ongoing so further results will provide even more information • Population studied was Chinese children, therefore the effect in differing ethnicities will need further research • This study did not include any children with high myopia (no participants over -5.00D) • Fifty-two per cent reduction in myopic progression and 60 per cent reduction in axial elongation
Stellest spectacle lenses In July 2020, Essilor launched its Stellast spectacle lens for myopia management in the Wenzhou Medical University Eye Hospital, China. In September 2020, the company reported that interim findings after one year of an ongoing clinical trial showed more than a 60 per cent slowdown in myopia progression on average, when compared to children wearing single vision lenses. The trial also showed that axial elongation was prevented in 28 per cent of children. Described as using highly aspherical lenslet target (HALT) technology – the lens features a central distance zone with aspherical lenslets spread on 11 rings ensuring visual signals are always in front of the retina, following the retinal profile54.
SightGlass Vision DOT lenses In February 2021, CooperCompanies and EssilorLuxottica entered into a joint venture agreement to accelerate the commercialisation of SightGlass Vision spectacle lenses, designed to reduce myopia progression in children. SightGlass Vision Diffusion Optics Technology (DOT) lenses are said to modulate peripheral contrast with no impact to on-axis vision; contrast modulation is quantified and controlled, and the amount of contrast reduction is not vergence dependent55. In June 2020, DOT lenses received CE mark declaration, allowing market growth across the EU, UK and other EEA countries.
Evidence suggests myopia progression can be slowed signifcantly by spectacle lenses and contact lenses, creating relative peripheral myopic defocus. Being able to offer spectacles and contact lenses for the management of myopia progression provides an exciting opportunity for eyecare practitioners – but mechanisms of myopia progression are clearly extremely complex and questions still remain: • How much peripheral myopic defocus reduces growth stimulus? • What is the minimum dose/ treatment time? • Is peripheral hyperopic defocus the primary factor in myopic progression? With many questions remaining and new products being trialled, following the evidence is essential. Combined with this opportunity is an obligation and responsibility to educate patients and parents. Presenting evidence with accuracy and clarity is essential so that clear consent and informed choice is achieved. At present, it needs to be remembered that no intervention/ treatment is 100 per cent effective and research is still ongoing. Equally, practitioners who fail to offer myopia management options, or fail to inform young myopes and their parents of the risks of myopia progression and the different treatments available, may be failing to observe the first duty of any regstered optician: to act in the patient’s best interests at all times. It should also be mentioned where products and treatment strategies are not licensed for myopia management and used ‘off licence’, failure to ensure full patient awareness and understanding could become subject to investigation by the General Optical Council. References for this article are published with the online version in the ABDO CET portal. TINA ARBON BLACK is co-founder of accredited CET provider, Orbita Black. She is an ABDO practical examiner, practice visitor, auditor, assessor and theory exam script marker, and a distance learning tutor for ABDO College. In 2019, she graduated from Canterbury Christ Church University with a first class honours in Vision Science. MAY 2021 DISPENSING OPTICS
Multiple choice answers Getting to grips with OCT Part 1 By Prashant Shah BSc(Hons) MCOptom PGDipOphth DipClinOptom and Yashita Shah BSc(Hons) PGDipOphth. C-76735 – published January 2021 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 one of these statements is true? a. The beam splitter in an interferometer produces two equal beams called the refractive beam and the reflective beam b. A-scans are stacked together to form a threedimensional image c. Two wave sources are coherent if their frequency and waveform are identical and their phase difference is constant d. Pupil dilation is essential to obtain good quality imaging of the retina c is the correct answer. Low coherence interferometry is the underlying principle of optical coherence tomography. In the Spectral/Fourier Domain OCT system, interference patterns are measured by a spectrometer as a function of: a. wavelength b. frequency c. time d. signal to noise ratio b is the correct answer. This is the most common system, the reference mirror being kept stationary. It is an improvement over Time Domain OCT where the reference mirror was moveable and interference patterns were produced as a function of time. With reference to the structure of the retina, which one of these statements is false? a. The pigment epithelium consists of a single layer of cells between the nerve fibre layer and the vitreous humour b. The outer plexiform layer is between the inner and outer nuclear layers c. The outer regions of the retina are closest to the choroid d. The nerve fibre layer is next to the ganglion cell layer a is the correct answer. The pigment epithelium layer is between the choroid and photoreceptor layer. Which one of the following will appear hyper-reflective on an OCT scan? a. Vitreous humour b. Inner nuclear layer c. Ganglion cell layer d. Exudates
d is the correct answer. OCT shows that exudates are located specifically in or adjacent to the outer plexiform layer, which would not be so obvious in ophthalmoscopy. Which one of these statements is not correct? a. Quicker scanning speeds reduce the effects of eye movement b. Swept Source OCT produces less light scattering and consequently better image resolution c. Both spectral-domain and swept-source devices have been used to describe the microvascular morphology of choroidal neovascularisation d. Spectral Domain OCT is the best system for image clarity where media opacities are present d is the correct answer. OCT parameters are affected by ocular media opacity because of changes in signal strength. Cortical cataracts have the most significant effect followed by posterior subcapsular opacities. Improved signal-to-noise ratio and much quicker scanning speeds make the swept source system preferable to spectral domain. Retinal blood vessels appear hyper-reflective and cast shadows on an OCT scan because: a. the vessels are considered to be optically empty b. they block the infra-red section of the spectrum c. they mimic layers with cell nuclei d. there is no fluorescein present b is the correct answer. By analysing the difference between the reference and measurement beam interference patterns, a photosensitive detector can create an image, the quality of which depends on the intensity and depth of light from the measurement beam. OCT images of the optic disc can be used for: a. monitoring suspected glaucoma cases b. visual field analysis c. assessing hyporeflective pigment epithelium undulations d. fine tuning visual acuity a is the correct answer. OCT gives us a wealth of data to work with, providing structural information about many parts of the retina and optic nerve head including the lamina cribrosa. This data needs to be viewed in conjunction with other tests and results in order to form a diagnosis.
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.
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PREVIEW BCLA VIRTUAL CONFERENCE
Tune in for live global event yecare professionals around the world will be able to tune in to exclusive, live-streamed lectures as part of the British Contact Lens Association’s (BCLA) first-ever virtual clinical conference and exhibition – on 13 and 14 June. The meeting will deliver the latest innovations and clinical insights, with world-class speakers on all areas of contact lenses and ocular surface health. “Our virtual spring conference promises to be a truly global event to remember, featuring a host of passionate speakers who can inspire eyecare professionals to make a real difference to patients’ lives,” said BCLA chief executive, Luke Stevens-Burt. Among the highlights of the programme will be: a 30-hour scientific programme; an introduction to the BCLA Contact Lens Evidence-based Academic Reports (CLEAR); new ‘Visit my clinic’ sessions; industry-sponsored ‘Powered by…’ sessions; papers and poster showcases; the 2021 BCLA Medal, Da Vinci and Dallos awards; Irving Fatt Memorial Lecture; ‘Beat the Brains’ pub quiz; and a virtual exhibition with networking opportunities.
SEEING THINGS CLEARLY The highlight of the programme will be a once-in-a-lifetime opportunity to hear all lead CLEAR authors present their
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findings. The culmination of a global project almost two years in the making, CLEAR is a 302-page document with contributions from 102 eyecare professionals. CLEAR lead author Professor Lyndon Jones will explore the opportunities available to make the most of modern technology and maximise the potential of contact lenses, ensuring they are seen as a device that offers so much more than vision correction (see News Focus, page 15). By reviewing the physiological and anatomical changes that may occur while wearing contact lenses, Professor Philip Morgan will provide eyecare practitioners with a better understanding of the key clinical learnings for modern contact lens practice. Professor Morgan’s session will consolidate clinical research information about the various physiological and anatomical changes that may result from wearing contact lenses, taking an anatomy-centric approach covering changes to the lids and adnexa, the conjunctival regions and the various layers of the cornea. He will present ‘subclinical’ changes rather than those which are symptomatic – or generally considered as ‘adverse events’. Professor Fiona Stapleton will summarise the best available evidence for the classification, epidemiology, pathophysiology and management of contact lens complications. She will consider complications from an aetiological perspective to help practitioners determine the most appropriate management strategy. Key signs and symptoms underlying major groups of complications will be described to support the decision-making process. Meanwhile, Kathryn Richdale will review the ways in which contact lens optics can be measured and manipulated to compensate for refractive error, optimise retinal image quality, allow the presbyopic wearer to see at multiple viewing distances, and control how the juvenile eye grows.
LIVE STREAMING PACKAGE 40% off with code: ABDO21 Recommended for existing BCLA members (all categories), enjoy online access to the live stream of the main lecture track at both the spring and autumn 2021 virtual conferences. Interactive CET points are available for online sessions attended, with access to the virtual exhibition – plus the opportunity to attend an online workshop/peer review sessions.
CONFERENCE PLUS PACKAGE 20% off with code: ABDO21 Available to non-BCLA members only, enjoy online access to the live stream of the main lecture track at both the spring and autumn 2021 virtual conferences. Interactive CET points are available for the sessions attended with access to the virtual exhibition – plus the opportunity to attend an online workshop/peer review sessions. For added value, take advantage of BCLA member benefits until 30 November 2021. These codes are valid until 31 May 2021. Terms and conditions apply: visit bcla.org.uk
“The BCLA CLEAR initiative will set the standard to which researchers and eyecare professionals will refer for the latest information in the field, and will highlight potential opportunities for future research,” said Luke. “It provides evidence-based guidance on all aspects of prescribing and fitting contact lenses as part of a concerted drive to provide the best possible patient care.” To book a place for the inaugural BCLA virtual conference and exhibition in June, and make the most of the special offers (see box copy), visit www.bcla.org.uk MAY 2021 DISPENSING OPTICS
IN PRACTICE – CONTACT LENSES ANTONIA CHITTY
A vision for contact lenses he world of contact lenses is constantly changing. In this article, we speak to a range of eyecare practitioners (ECPs) about their vision for the future of contact lenses – and discover how some are putting this into practice now. We are seeing rapid growth in the number of contact lens companies launching myopia control contact lenses. Josie Barlow, a qualified contact lens optician (CLO), is professional services manager at Menicon. She says: “I expect we will see more developments within the myopia control sector, with the introduction of new contact lens designs and technologies in all modalities. These could include combined therapy options with effective tools to monitor and ensure treatments are successful.” CLO Debbie Hopkins, professional services consultant at UltraVision, sees extended depth of focus (EDOF) lenses as the development patients have been waiting for. She explains: As [the Brien Holden Vision Institute design] EDOF does not utilise dedicated areas of high or low power, the design allows for flexibility in lens centration and pupil sizes, which leads to a simpler fitting routine and more consistent patient vision. Ultimately, this translates to reduced chair time and happier patients.” From its feedback survey of ECPs and their patients, as well as optical academics trialling EDOF, UltraVision found that the common response was: “I have never had such good near vision with any previous multifocal type lens”. Phil Thompson is professional services lead at Positive Impact and another supporter of EDOF. Also a qualified CLO, Phil says: “NaturalVue contact lenses [Visioneering Technologies] use a rapid, continuous and uninterrupted relative plus power in the periphery to create a virtual pinhole which, in turn, creates the extended depth of focus. It means these lenses can be fitted in a similar way to single vision distance lenses.
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EYE PRINT PROSTHETICS CREATES BESPOKE SCLERAL LENSES
“NaturalVue give clear vison from distance to near with everything in between,” continues Phil. “They are also the only contact lens licenced for both presbyopia and myopia. The lack of ghosting due the EDOF design means both children and presbyopes are genuinely pleased with the vision – and the statistics around myopia management are impressive too. “Coming down the road as another opportunity with EDOF lenses is SynergEyes iD [SynergEyes],” Phil explains. “These lenses will be available in single vison and, excitingly, the Brien Holden Vision Institute EDOF design. Slightly different from the NaturalVue design, SynergEyes iD uses a unique power profile that is non-periodic and non-monotonic. Unique combinations of higher order aberrations are utilised to elongate the patient’s depth of focus, for clearer vision at near, intermediate and distance. “Whilst this lens is initially only licenced for presbyopia, it can be used ‘off licence’ for myopia. Due to the rigid central portion, it will correct corneal astigmatism up to 6.00DC without the need for a toric lens,” adds Phil.
CUSTOM LENSES AND SCANNING Personalisation is a key trend across a range of sectors, and it has the potential to transform contact lens prescribing too. Award-winning optometrist Brian Tompkins is a leading UK contact lens specialist and a past president of the
British Contact Lens Association. His practice makes cutting edge contact lens technology one of its specialisms. TK&S Optometrists is the only licensed UK practice to offer Eye Print Prosthetics. Eye Print utilises a system where instead of being multi-processed, the mould is sent to the lab and scanned in 3D – linked directly to the lathes. Brian explains: “Eye Print utilises impressions, or scans, of the ocular surface to design specialised scleral contact lenses that match the shape of each individual eye. This highly customised fit results in greater stability of the lens, improving comfort for many patients. We are using it for any and every ectasia – keratoconus, pellucid, trauma, scarring, post laser ectasia, post laser or neuropathic dry eye, for dry eye patients who find no other lens working.” Brian also uses the Eaglet Eye – Eye Surface Profiler (ESP). He says: “What has become the ‘go to’ for the scleral fitting principle is the empirical scan to fit. Like a topographer, the Eaglet Eye ESP maps the cornea, but what makes it unique is that it maps the sclera out to 22-23mm. This lets us know what will happen at the edge of a lens. “We are now also working with the Eye Print ScanFitPro,” Brian continues. “The scan is sent to Colorado and within a week, we receive a custom-made prescription lens which fits like a glove. Scan fit lenses take longer to manufacture, but what you get is a bespoke, non-returnable fingerprint of the eye.”
This improved system has worked well over the last year, as Brian explains: “We are being told to minimise visits, and to keep people out of practice. A fit with an ‘off-the-shelf’ lens can take several visits. Now, we take a scan and get first fit success; although sometimes the prescription needs a tweak.”
DRY EYE AND AFTERCARE Dry eye is an ongoing problem for some patients, but contact lenses can provide a solution. Brian highlights the new range of lenses coming through with clever surface properties. He says: “Lenses such as those from Safilens have mucomimetic properties, and the Alcon Total1 water gradient lens concept uses a silicone hydrogel core with a six-micron surface layer transition zone to transform the surface into water. This is incredibly important and can make even plano lens patients feel more comfortable. We want to bust the myth that dry eye patients can’t wear contact lenses. Choosing the right one will soothe the eye.” Alongside the different lenses on offer and developments in lens technology, it is important to consider how contact lens aftercare is delivered. The past year has seen a shift due to Covid-19, resulting in more remote care for contact lens wearers. Alex Stewart, a dispensing optician and contact lens manager at Specsavers in Huntingdon, Cambridgeshire, says: “Whilst remote reviews are not suitable for everyone, there have been patients where Covid-19 has made me re-evaluate whether a remote alternative is suitable. This has saved them a trip, which is safer but also much more convenient. With such a competitive online market, I think having alternative options to safely keep our patients happy and healthy is a good thing if used in the right way.” The pandemic has also made some practitioners look at how the practice is financed. More may be considering a shift to care plans to protect their cashflow, something which has already happened at TKS Optometrists. Brian explains: “All our contact lens patients are on a care plan. We have had a policy of zero ‘pay as you go’ contact lens patients for more than 15 years, and this has benefitted us during lockdown as our direct debits have continued.” The practice has continued to support these patients throughout lockdown by email and online. “We have offered a lot of video consultations and believe that in the longer term, we will do more using AOS Telemed Software. With patients coming from further afield, this is especially beneficial.”
Alex Stewart has re-evaluated his approach to aftercare
COMPLIANCE AND ECO PACKAGING Patient compliance is a key issue, particularly if one considers the possibility of more remote care and consultations. Josie Barlow remarks: “We hope to see further developments in consumer driven innovations, such as our Smart Touch technology and tools to ensure better patient compliance. This is of even greater importance given the situation we have found ourselves in with Covid-19, which will continue to impact patient interaction long-term. Some upcoming products and services from Menicon will include tools to help with patient monitoring and communication.” Diba Choudhury, professional affairs manager at Alcon, reports that patient drop-out remains a key issue to address. She says: “The most cited reasons for drop-out are consistent across many reviews: comfort, vision and handling. New Alcon Precision1 contact lenses are designed with the drop-out challenge in mind, offering excellent comfort, vision and handling. Designed to support a stable tear film, these lenses feature SmartSurface Technology, a water surface inspired by the water gradient technology of Alcon Dailies Total1 lenses.”
Brian Tompkins predicts a rise in empirical lens fittings
Designed to work alongside eyecare practitioners, Alcon’s patient programme supports new and existing contact lens wearers at the touch of a button. Diba explains: “Accessible when scanning the contact lens pack or QR code via a smartphone, the wearer is transported into an immersive experience where they are supported on key areas like how to apply and remove their lenses, myth busting, and hints and tips for successful contact lens wear.” A growing number of patients and practitioners are also prioritising the environment. Chris Boyde is a CLO with Boots Opticians in Surrey and suggests: “By encouraging patients into full-time daily disposables, we are responsible for consigning a lot of plastic to landfill. It would be good to see more thought going in to addressing this.” Josie Barlow responds: “Menicon already offers eco-friendly packaging with our DD flat pack contact lens and we hope that this will be expanded in the future to reduce waste in the disposable contact lens market.”
SCIENCE FICTION BECOMING FACT Looking to the future, there are many exciting developments underway in the field of contact lenses. Brian Tompkins believes that “the future is the best possible surface qualities in every soft lens capable. The more choice of lenses you have, the more capabilities of fitting you have. Don’t say someone isn’t suitable for contact lenses – instead, extend the ranges you offer.” Brian also sees the empirical nature of fitting developing in the future, “with better scanners and fewer trial lenses, so the lens is virtually spot on at first attempt. The more knowledge we have of lid tension and anatomy, pingueculae, scleral anatomy and so on, the better any lens choice will be – with increased firstfit success and less chance of drop-out.” Josie Barlow predicts that “collaborations with technology partners will become more commonplace. Combining augmented reality with contact lens wear is no longer science fiction, but becoming a reality. I think it is a very exciting time to be in optics – and particularly in the realm of contact lenses – with new designs and options for patients and practitioners now and in the future.” ANTONIA CHITTY PHD, MCOPTOM, MCIPR, MPRCA is ABDO head of communications and author of 20 books on business, health and special needs. MAY 2021 DISPENSING OPTICS
IN PRACTICE – MECS AND CUES MAX HALFORD
Minding our MECS and CUES t seems like only yesterday that there was a flurry of activity, and a clarion call for all patients with minor eye conditions to be seen in High Street practice, to relieve the burden on the hospital eye service (HES). In actual fact, what we now refer to as ‘minor eye conditions services’ (MECS) had been established long before then – with schemes up and running in both Wales and Sheffield as far back as the early 2000s. By rights, we should have celebrated the 20th anniversary of the introduction of ‘MECS’ in 2020. This would have been the moment to look back and reflect upon the evolution of extended primary eyecare services, the patient care they provide, and ABDO’s more recent involvement in providing accredited MECS training to contact lens opticians (CLOs).
EVOLVING CONCEPT OF CARE The concept of accredited primary care practitioners delivering eyecare close to patients’ homes is a universal one. In Wales the launch of the Wales Eye Care Initiative in May 2002 brought together the primary eyecare acute referral scheme (PEARS) and an enhanced examination for groups at risk of developing eye disease. The PEARS scheme, developed as a pilot by optometric practices in the Vale of Glamorgan, enabled optometrists to become the first point of contact for acute eye conditions in primary care, allowing them to manage a range of nonsight-threatening conditions and alleviate pressures on GPs. Referral routes to the HES were simultaneously revised, with direct referral from optometrist to the HES becoming standard across Wales. In Scotland, the ‘supplementary examination’ was introduced in April 2006. Delivered as part of Scotland’s enhanced GOS system, this provides an enhanced payment to the optometrist to enable them to care for patients with ‘emergency eye issues’ – including
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Sarah Farrant, Somerset LOC chair blurred or reduced vision, flashes and floaters, red eye or eye pain. And in Somerset, the acute community eyecare service for Somerset (ACES) was launched in 2009. Sarah Farrant, chair of Somerset Local Optical Committee, said: “The ACES service was inspired by what was happening in Wales with PEARS. We recognised the potential value in the service for patients, GPs, hospitals and practitioners alike – particularly in a rural county where easy access to services is key.” So by the second decade of the 21st century, momentum had gathered, and data was becoming available to show how these services were performing. Data was also available to demonstrate the difference such services could make to patients in a given locality.
MAKING AN IMPACT LOCALLY An oft-quoted study in relation to MECS commissioning is by Konstantakopoulou et al of the Centre for Public Health Research, School of Health Sciences, City University, London1. This study, designed
to evaluate a minor eye conditions scheme delivered by community optometrists, is of particular interest as it compares data from two neighbouring London boroughs. The first borough, Lambeth and Lewisham, introduced MECS in April 2013, whilst its neighbouring borough of Southwark decided at the time not to commission the service. This meant that data, such as GP referrals, hospital activity and patient satisfaction, could be compared between the two boroughs. The researchers also looked at data for Lambeth and Lewisham before and after the introduction of MECS, to gain deeper insights into its impact. The conclusion was that: “The Lambeth and Lewisham MECS demonstrates clinical effectiveness, reduction in hospital attendances and high patient satisfaction, and represents a successful collaboration between commissioners, local HES units and primary healthcare providers”. By 2016, 30 per cent of clinical commissioning groups (CCGs) had commissioned a MECS scheme, which were already showing significant benefits. National data reported that more than 80 per cent of patients with a minor eye condition were being managed by community optometrists, releasing capacity from other services such as GPs and the HES2. The push was on and, within the primary eyecare sector, it was hoped that a tipping point would be reached in 2017 – with more CCGs with a MECS scheme in place than without one.
BLAZING A NEW TRAIL Around this time, a working group of experienced practitioners was being established within ABDO. Working with colleagues from the Wales Optometry Postgraduate Education Centre (WOPEC) and the Local Optical Committee Support Unit (LOCSU), they explored the possibility of CLOs undertaking the WOPEC MECS and glaucoma modules that optometrists complete. The course
content would remain unchanged, with the CLOs delivering care to patients presenting with anterior eye problems, or delivering Goldmann applanation tonometry (GAT) as part of a glaucoma repeat measures (GRM) service. The ABDO Extended Services course launched in November 2018 and the online, flexible nature of the learning, coupled with content that for many practitioners was new and fascinating, meant there was an immediate uptake of 100 CLOs applying for the free codes to undertake the 11 modules. The first ABDO Extended Services Day was held at Aston University’s College of Health and Life Sciences on 21 May 2018. It was an immediate success. Practitioners attended a series of lectures, covering topics including acute red eye, and practical workshops on GAT technique and foreign body removal. The scene was set for the first CLOs to become accredited after successfully passing their objective structured clinical examination (OSCE) later that summer.
EXCELLING AT THE OSCES For the candidates who arrived at the newly acquired – and not yet officially opened – ABDO National Resource Centre on 29 August 2018, a daunting day lay ahead. Certainly, there was a fear of the unknown: no CLOs had ever sat an extended services OSCE. There was also the additional responsibility of knowing that they were being seen within the profession as ‘trailblazers’ for a new era. The role of dispensing opticians in extended primary care services was about to be made official – hopefully. The seven stations of an OSCE are designed to assess both the candidate’s
ABDO repeated this accreditation cycle in 2019 and partially in 2020. We now have more than 50 ESCLOs fully accredited and working in the community, another 40 plus waiting to sit their final OSCE this spring and summer, and more than 300 others who have applied for the free codes to undertake the WOPEC online training modules.
WHERE ARE WE NOW?
TESTING NEW SKILLS DURING THE OSCES
understanding and their practical skills. Rotating through different rooms at the NRC, each one is a five-minute episode, varying from a ‘Referral and management’ station, to one where the candidate is required to take the intraocular pressures of an actor patient using GAT. The total time, including preparation between stations, is around one hour – and so by late afternoon the event had finished. We then waited anxiously for the results to come back from WOPEC. Within a week, it was clear the OSCEs had been a tremendous success. Feedback from the assessors at the event was unequivocal: the candidates not only demonstrated some outstanding practical skills but their communication skills were described as ‘above average’ for OSCE events. All of the candidates passed, and officially became accredited extended services CLOs (ESCLOs).
Book now for next Extended Services Day Bookings are now open for the next ABDO Extended Services Day (ESD) to be held at the National Resource Centre (NRC) in Birmingham on 7 June 2021. The event will be preceded by a webinar at 7pm on 17 May. Bookings and payments for the ESD can be made here. Access details for the webinar element will be forward to all candidates with confirmed bookings prior to the event. It is conditional that CLO registrants have successfully completed all the WOPEC online modules in both MECS and GRM. For details of the free online ABDO/WOPEC modules, contact ABDO clinical lead, Max Halford, by emailing firstname.lastname@example.org The summer WOPEC OSCE will take place on 19 July 2021 at the ABDO NRC. This is open to all candidates who have successfully completed the ABDO ESD. Register with WOPEC here. Please note: booking requires registration with WOPEC on the above link, and registration and payment with ABDO here.
Last year, the pandemic meant that access to eyecare was severely restricted in many areas. In response to this, a new service was introduced: the Covid-19 urgent eyecare service (CUES). This service not only allows our ESCLOs to participate in the delivery of urgent eyecare, but calls upon the skills of DOs and CLOs to work to support patient care. Many DOs are supporting their ESCLO and optometrist colleagues in triage and, as the General Optical Council has stated: “Uncertain times mean that our registrants may be called upon to work at the limits of their scope of practice”. ACES, PEARS, MECS and CUES have one thing in common: they offer care to patients at a time and place that suits them, delivered by highly skilled and accredited eyecare practitioners. But we must continue to evolve from those early days of the 21st century. CUES was designed during a pandemic but with an eye to a Covid-19 free future where urgent eyecare is delivered locally, away from an overburdened secondary care or GP surgery. It will evolve, expand and become even more virtual in its delivery. It will require more accredited ESCLOs to become involved – both in its delivery and design – and ABDO will continue to support and offer training and accreditation opportunities to members who wish to become involved. Read this month’s Jottings by Rebekah Fielding (page 30) to hear how she progressed from optical assistant to ESCLO. MAX HALFORD FBDO CL is ABDO clinical lead. He is an ESCLO, WOPEC assessor, and clinical governance and performance lead to a MECS scheme in the South West of England.
REFERENCES 1. Konstantakopoulou E, Edgar DF, Harper R et al. Evaluation of a minor eye conditions scheme delivered by community optometrists. BMJ Open 2016;6:e011832. doi: 10.1136/bmjopen2016-011832 2. LOCSU data on file 2016. MAY 2021 DISPENSING OPTICS
JOTTINGS REBEKAH FIELDING
From OA to MECS CLO s soon as I qualified as a dispensing optician back in August 2011, I pretty much immediately started looking for my next challenge. I had always enjoyed contact lenses, being a full-time wearer myself, and was already looking after the contact lens side of the business, ordering lenses, doing teaches and setting up direct debits. So when one of my directors, Tim, approached me with the idea of training to qualify as a contact lens optician (CLO) through ABDO College, I jumped at the chance. The contact lens course would be more intense than the FBDO course, with assignments sent in every week and one-week residentials when needed. A quick chat with my other half later that day, and I was all signed up. I loved the anatomy side of the course, groaned over the physics, and had post-it notes with various maths formula stuck all over the house. My husband always knew when I was revising for exams, as our walls and doors turned yellow. The theory side of the contact lens course takes a year to complete, with exams at the end. It’s then up to you when to take the practical exams – but the recommendation is to wait at least six months. This allows you time to build up your case records (remember those from the DO course?) and spread the exams out a little. I was well supported through my studies and exams by my optometrist mentors, Anthony, Elizabeth and Jon, and by the ABDO College lecturers. Theories done, practicals done – including one set of resits – and I qualified in September 2013. I love the challenge of seeing patients in the contact lens clinic. First-time wearers are still my absolute favourite. The rush you get from giving someone their vision back, and taking away from them the often restrictive vison of spectacles is amazing.
WIDENING SCOPE OF PRACTICE One bouncy baby girl later and I found myself itching for a new challenge. Minor eye conditions services (MECS) had been around for a while but it soon became possible for CLOs to complete the course, and be able to manage anterior eye conditions. I also liked the idea of more anatomy-based work and how it would complement my contact lens clinic. MECS was already having a positive effect on the practice. Patients who wouldn’t normally come to us were now doing so because their current practice didn’t provide the service. Patients who normally had to wait a week or more to been seen by their GP could be seen within 48 hours.
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REBEKAH IN PRACTICE
Many of the conditions presenting were ones I was already familiar with. Prior to qualifying as MECS accredited, I had always been frustrated to see a subconjunctival haemorrhage, ask the patient if they wore contact lenses, and be told no. At this point, I could advise them as a DO on the ‘shop floor’ but couldn’t use the slit lamp to have a proper look as it was out of my scope. Prior to undertaking my MECS training with ABDO, I completed the same 11 modules on the Wales Optometry Postgraduate Centre (WOPEC) website as the optometrists. The modules included four on glaucoma, two on age-related macular degeneration, and one each on corneal conditions and foreign bodies, dry eye disease, flashes, floaters and detachments, red eye, and sudden loss of vision. This often involved a dictionary as lectures would assume knowledge of certain techniques or anatomy well used in optometry but not in dispensing optics. Once I had completed the online WOPEC modules, I attended an ABDO Extended Services Day at the National Resource Centre (NRC) in Birmingham where we covered Goldmann applanation tonometry (GAT), Van Hericks and foreign body removal, among others practical skills. Scraping glitter off a fake cornea with a hypodermic needle was one of the highlights. The experience and support from the ABDO lecturers was second to none. There was no such thing as a stupid question, lots of useful answers and a great opportunity to catch up with other CLOs – because certainly in my area we are a rare breed. I then went on to sit my objective structured clinical examination (OSCE), also at the ABDO NRC, where I was tested on the skills I had learnt during the Extended Services Day, as well as on what to do in certain situations. Exams, especially practical ones, are always nerve wracking but the examiners at each station did their best to put us at ease and enable us to pass.
So on Monday 16 March 2020, I took my OSCEs; on Monday 23 March 2020, I found out I’d qualified; and on Tuesday 24 March 2020 the whole world changed – and I subsequently went on furlough.
BRAVE NEW WORLD To prepare for returning to a ‘brave new world’ of practice last August, I needed to be ready for the Covid-19 urgent eyecare service (CUES). This involved making sure my Safeguarding for Adults and Children Level 2 was up-to-date. The Safeguarding for Adults, however, was only available through an optometrist affiliated link and not accessible for CLOs. Luckily, one of my directors, Jon, was able to sort it out – but it was a reminder that this is a road less taken and there are likely to be similar challenges ahead. [See box copy.] Returning to practice after four months on furlough was interesting. There were huge changes to our working practice. A full clean down of the room in between patients, masks, aprons, gloves, sanitiser; all now part of normal everyday life but at the time, so unknown. Getting back to fitting contact lenses was challenging without adding in a very newly qualified skill set. CUES, along with the government furlough scheme, helped stop redundancies and store closures. The skeleton staff of an optometrist and a dispensing optician kept the business afloat, and showed our patients that we were still there for their eyecare needs – as with all other practices which remained open. I will be forever grateful to those staff who continued to work throughout the pandemic. Slowly, CUES appointments began to appear in my clinic. These included for conditions such as subconjunctival haemorrhages, corneal abrasions, ulcers, dry eye, conjunctivitis, blepharitis, chalazion and episcleritis. I have done Van Herricks before checking intraocular pressures, and administrated dilation drops for a colleague to help streamline their clinic. As yet, I have not performed GAT as restrictions allowing us to do so have only just been lifted. Overall, patients have been very appreciative and glad to be seen locally instead of having to go to the hospital, especially in the middle of a pandemic. A lady with a large subconjunctival haemorrhage summed it up when she said: “I struggle to come out of the house at the moment. If I were told to go to the hospital, I probably wouldn’t have, but I would have worried that it was something serious. To be able to come here puts my mind at rest, and allows me to take what I feel is a small risk, rather than a large one.”
ADULT SAFEGUARDING TRAINING Members who are practising within MECS or CUES schemes are required to hold a Level 2 Adult Safeguarding qualification, and there may be other work-based circumstances where this is also a requirement. ABDO is currently working with NHS England on the development of an Adult Safeguarding Adults Level 2 course, as part of a programme of education for dispensing opticians who will be delivering services in special schools. When completed, the Adult
WORKING AS A TEAM I love the variation my day brings: a mix of in-person and telephone contact lens consultations, contact lens clinical queries and troubleshooting, and online and in-person CUES and MECS. Thankfully, in those first few months back in practice, no patients needed to be refered to hospital; although there were a few knocks on the door to my (very patient) colleagues for a second opinion, or help putting the information on the Opera referral system. As an accredited CLO, I am able to perform CUES and MECS if there is an accredited optometrist in the practice. This is not for hand-holding or because our qualification means less. It is purely in case what appears to be an anterior eye issue, turns out to be a posterior eye issue. The patient can then be referred straight to the optometrist on site, so they aren’t kept waiting. Good triaging and telemed calls should keep this to a minimum; and I have not yet had this situation arise. I hope that soon we will be able to perform MECS and CUES even if there is not an accredited optometrist on site, even if it’s just for emergencies. It is rare to have a lone CLO working in the practice, but there may be times when the accredited optometrist is sick and a non-accredited locum steps in. Or it’s the end of the day and the CLO may be the only clinical person there. Patient care will always come first but, at the end of the day, we are providing a service and it’s only right we should be reimbursed for it. It’s always important to me that I can help patients whenever I can – especially during the pandemic. My optometrist colleagues are put under more and more pressure from local GP surgeries, pharmacies and hospitals. As CUES and MECS become more well known, the phrase ‘just see your optician’ is both great and frustrating all at the same time. When I look back over my career and what I’ve achieved since walking into that small Specsavers practice in Stourport all those years ago, a few phrases spring to mind: ‘Not just an optical assistant’; ‘Not just a dispensing optician’; and now ‘Not just a contact lens optician’. The more MECS and CUES accredited CLOs we have to help lighten the load, the better for our patients and professions. It also shows that as clinicians we have the required knowledge and expertise to manage the anterior eye alongside our optometrist colleagues. We are, after all, working side by side as one team. REBEKAH FIELDING FBDO (HONS) CL is a MECS and CUES accredited contact lens optician at Specsavers based at Kidderminster.
Safeguarding course will be available to for all members to complete. ABDO’s current recommendation is to purchase Reed’s Safeguarding Adults Level 2 – Online Training Course – NHS Health & Care – CPD Accredited. Designed specifically for healthcare practitioners, this two-hour course costs £19.99 and covers the major principles and legislation. At the end of the course, there is a mandatory assessment and a printable certificate is available upon successful completion. Please note: ABDO cannot provide technical support or funding for this course. MAY 2021 DISPENSING OPTICS
REGION UPDATE – SCOTLAND BRENDA RENNIE
Working across the sectors ost practice staff in Scotland have now had both doses of a Covid-19 vaccine. If you have not yet received yours, nor been contacted by local primary care teams or health boards to make arrangements, please contact them direct. ABDO’s Scotland regional team are working hard to represent our dispensing optician (DO) profession by working collaboratively with other organisations to promote our delivery of evolving eye health care – including refraction as a delegated function, vaccines and the importance of high quality dispensing. We are engaging with cross-sector bodies and committees to establish the progression of DOs and contact lens opticians (CLOs) in primary care to ensure their voices are heard. Do log on to our next Scottish policy meeting to hear these updates direct from ABDO head of policy, Debbie McGill. You will also be able to provide comments and ask any questions. Please contact me for further details. Glasgow Caledonian University has restarted its course in ophthalmic dispensing as the profession seeks to attract new recruits. ABDO welcomes this news, as do local students, to maintain consistency in the supply of DOs in Scotland.
SHARED GLAUCOMA CARE Our team have been working with Optometry Scotland and supporting some of the exciting changes made in the last year, such as the roll-out of glaucoma shared care. This has successfully reduced the burden on secondary care, with suitable patients being discharged from hospital and managed in local practice. Stage 1 glaucoma patients are being managed within the practice with any relevant changes being forwarded to the hospital. There is no contract with the practice, as this scheme currently operates similar to the postcataract examinations. Therefore, all optometrists are asked to participate and the patient can then choose which practice they would like to attend. This has been useful, especially when lockdown movement restrictions were in place. If you cannot offer a patient an appointment within a reasonable time frame, the patient can choose another practice. If a patient has Stage 2 glaucoma, they are being managed in allocated practices with field machines provided by the hospital for continuity. NES Optometry is providing and delivering a programme of accredited
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education and training in glaucoma management to allow independent prescribing optometrists in Scotland to manage these discharged patients in the community. This is being funded by the Scottish government. Some of the Scotland regional team have been supporting the ABDO CPD Department with online sessions to help members gain their required CET points. Capacity has been expanded for online discussion-based sessions to accommodate up to 40 members when possible. There is a recorded lecture specifically for CLOs covering the verification and identification competency, as this can be difficult for some members to obtain. Find distance learning articles and recorded lectures on the ABDO website. So far this year, we have provided live CET via Zoom with three peer discussions titled, ‘Complex not complicated’ in February, along with a discussion workshop on ‘Interdisciplinary working to support patient care’. These were well received, and all delegates gained three CET points for each session. ABDO would like to thank NES for its continued support and are hoping to return to face-to-face delivery next year.
AOC REPRESENTATION Members in certain areas, who usually attend their area optical committee (AOC) meetings in person, have now transferred to digital meetings. This helps DOs to build up representation within optical circles, as we play a vital role in practice settings. In some areas, DOs now have voting rights and some have even progressed to become AOC chair. This is great news as it gives DOs a louder voice within these groups. If you attend your AOC and would like to make us aware of any relevant local changes, please get in touch by email so I may share ABDO’s national policy objectives with you too. If you have never attended an AOC meeting but would like to, I can put you in touch with the relevant person. Debbie McGill is in regular communication with all policy leads throughout the UK to support members through the pandemic as safely as possible, as well as maintaining the delivery of care. Members looking for individual support on any matter are encouraged to contact ABDO’s Membership Services team in the first instance on 01227 733 911/ 01227 733 912. BRENDA RENNIE FBDO is ABDO regional lead in Scotland. Email email@example.com
OA CORNER PART 5
SOCIAL MEDIA TIPS: DON’T FORGET TO ‘BE SOCIAL’
OUR AMAZING EYES
ften companies forget that social media is all about actually being social. Take time to ‘like’ comments, reply to them, and interact with your followers. Don’t be afraid to jump in on conversations on Twitter or like your followers’ pictures on Instagram and leave a comment. They will stop interacting if you don’t interact back. Time is precious – but if you want your social media to flourish then you need to build the time in your working day. It doesn’t have to take long, and your team members could take turns to respond. On Eyecare FAQ in May, we will be covering contact lenses, sunglasses and congenital eye disease. Find Q&As on more eyecare and eyewear topics on Eyecare FAQ. You can also find EyecareFAQ on Facebook, Twitter, Pinterest and Instagram.
In this month’s Optical Assistant (OA) Corner, Sue Deal asks: what do I need to know about eyes and how we see? The eye and the visual system are amazing, with more than 100 million rod cells and six million cone cells present in the retina alone. These cells send light signals via the optic nerve along the visual pathway and to the visual cortex in the brain. Learn more about the visual system and the functions of different structures of the eye, including the cornea, crystalline lens, iris, vitreous humour, aqueous humour and its role in the onset of glaucoma. Read OA Corner Part 5 in full on DO Online – and find out what makes our eyes so extraordinary.
REVITALISING YOUR CONTACT LENS BUSINESS With Mintel* reporting that the contact lens market declined by an estimated 19 per cent in 2020, now could be the time to look at how you approach this important part of your patient offer. One way to develop your contact lens practice is to increase the number of patients you talk to about occasional use. For each patient you need to find the occasion when spectacles are a pain. Ask about their hobbies, their work and if they go to the gym – and how their specs are for that particular activity. This gives you a way to start a conversation about contact lenses. Do you discuss contact lenses with every patient? It may be time to alter your way of thinking and give contact lenses equal prominence, rather than assuming specs are the first choice. Contact lens patients will need both specs and contact lenses, and generally are loyal, returning patients. These are all reasons to ensure that contact lenses and spectacles as options for vision correction are proactively mentioned where appropriate.
Another area where your practice may be missing out is children and contact lenses. With increasing evidence showing the benefits of contact lenses for myopia control, parents and children may be motivated by reducing the progression of myopia. They may also like the idea that their child can play games and sports without specs. Offer the option of contact lenses, explore the parents’ and child’s interests and beliefs about contact lenses, and you can help them develop a better understanding of why they are a good option and how they can help. Presbyopes offer a similar chance to increase the scope of your contact lens practice. We now have a range of multifocal products that work better than anything we have had in the past. Presbyopic contact lens wearers are loyal too. A good opening question to start a conversation about contact lenses could be: “Tell me when your glasses annoy you”. It might be going out in the rain or playing golf. You could then say: “Well, there’s something you can do about that”. Another friendly introductory question might be to ask about any events they have coming up. People may be interested in contact lenses for their own wedding anniversary or their child’s wedding. *Mintel, Optical Good Retailing UK, March 2021 MAY 2021 DISPENSING OPTICS
ABDO Board Elections 2021 Four places on the ABDO board are open for election, and members are now invited to submit their nominations.
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 firstname.lastname@example.org
Three places are held by members entitled to seek re-election. They are Julie Lees, Garry Kousoulou and Brenda Rennie. The fourth seat is held by Kevin Milsom, who will step down after serving a full term. This year, any person seeking election should complete a candidate form and include details of their six nominators. Nominators should then individually complete and sign the separate nomination form. Both forms can be found on the ABDO website here, and should be completed by 10am on Friday 18 June. Email Jane Burnand at email@example.com or call her on 0207 2985102 with any questions.
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.
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Contact Lenses What’s your next step in optics?
The ABDO College Contact Lens Certificate course is an ideal opportunity for you to further your career by specialising in contact lenses. It leads to the ABDO Level 6 Certificate in Contact Lens Practice qualification, enabling you to join on the General Optical Council specialty register for contact lens dispensing.
Course features • A minimum one year course commencing in September 2021 • Two separate weeks block release at Godmersham • Block release accommodation can be provided
Entry requirements • ABDO Fellowship Diploma and GOC registration. Existing students may also apply subject to successfully passing the Final Qualifying Exams immediately preceding the start of the course • Qualified, registered optometrists and ophthalmologists are also eligible to enrol
For more details and to apply: visit www.abdocollege.org.uk call 01227 738 829 (Option 1) or email firstname.lastname@example.org 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