NEWS, INFORMATION AND EDUCATION FOR OPTICIANS
contents features 12.
CET – C-76826 Getting to grips with OCT Part 2 By Prashant Shah and Yashita Shah
CET MCAs – C-76110 Triage in the new normal By Alexandra Webster and Professor Christine Purslow
In practice PPE tips and techniques By Antonia Chitty
A DO and proud of it
Business Bites | Eyecare FAQ | OA Corner
Jobs & Notices
stay in touch DO Online
DO Twitter ABDO Facebook ABDO Twitter
FC – Nick Howard in practice: page 22
FEBRUARY 2021 DISPENSING OPTICS
BECAUSE EVERY EYE IS DIFFERENT:
B.I.G. VISION FOR ALL ÂŽ
Experience the sharpest possible vision with progressive lenses made from a complete biometric eye model.
For more information on how Rodenstock can help you, then please contact your Regional Lens Manager or Customer Service T: 01474 531112 E: firstname.lastname@example.org
DISPENSING OPTICS The Professional Journal of the Association of British Dispensing Opticians Volume 36 No 2
EDITORIAL STAFF Publisher Editor Email Assistant Editor Email Design and Production Email Admin. Manager Email
Sir Anthony Garrett CBE HonFBDO Nicky Collinson BA (Hons) email@example.com Jane Burnand firstname.lastname@example.org Rosslyn Argent BA (Hons) email@example.com Deanne Gray HonFBDO firstname.lastname@example.org
EDITORIAL/ADVERTISING Telephone Email Website
0781 2734717 email@example.com www.abdo.org.uk
SUBSCRIPTIONS UK Overseas
£150 £175, including postage
Edward Fox FBDO Association of British Dispensing Opticians Godmersham Park, Godmersham, Kent, CT4 7DT
Telephone Email Website
01227 733911 firstname.lastname@example.org www.abdo.org.uk
ABDO CPD Head of CPD
Alexandra Webster MSc PGDipE FBDO CL FHEA FBCLA ABDO CPD, Unit 2, Court Lodge Offices, Godmersham Park, Godmersham, Canterbury, Kent CT4 7DT
01206 734155 email@example.com
CONTINUING EDUCATION REVIEW PANEL Joanne Abbott BSc (Hons) FBDO SMC (Tech) Josie Barlow FBDO CL Keith Cavaye FBDO (Hons) CL FBCLA Andrew Cripps FBDO PG Cert HE FHEA Kim Devlin FBDO (Hons) CL Stephen Freeman BSc (Hons) MCOptom FBDO (Hons) Cert Ed Claire McDonnell FAOI Angela McNamee BSc (Hons) MCOptom FBDO (Hons) CL FBCLA Cert Ed Alex Webster MSc PGDipE FBDO CL FHEA FBCLA Gaynor Whitehouse FBDO (Hons) LVA
DO Dispatches STRESSES AND STRAINS The new variant of the coronovirus, which hit the country at the end of last year, has put the sector under even greater pressure than during the first lockdown. Despite the roll-out of approved vaccines to all optical practice staff and locums, which is very welcome indeed, many practices are facing additional financial strains. This pressure is, in part, due to the understandable drop-off in eyecare appointments – adding to a backlog of patients requiring routine eyecare. One knock-on effect of this is more and more patients turning to the internet for their eyewear and contact lenses. This is far from ideal, and the sector’s professional bodies – including ABDO – must collectively grip this challenge to promote professional, face-to-face eyecare in the months ahead. Promoting the profession is a top priority for the ABDO board and staff – and I do hope this has been made clear in our recently-published 2021 Annual Plan. It will also be at the heart of our new Strategic Plan, which is currently being developed to be rolled out from the beginning of 2022. Despite everything, we have much to look forward to – and so planning for a post-pandemic world is at the centre of our development work. The ABDO team, as always, welcomes the views of members on how we should plan for the future. Contact details for all board members and staff can be found on the ABDO website. We look forward to hearing from you.
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
FEBRUARY 2021 DISPENSING OPTICS
OUR MONTHLY COLUMN FROM THE ABDO PRESIDENT JO HOLMES FBDO
A DO and proud of it Eyecare in lockdown had hoped that this month I would be able to write my column without mentioning the ‘C’ word, but unfortunately we aren’t there yet. On 14 January, the College of Optometrists hosted a webinar for the We have all worked hard profession to support to minimise risk delivery of eyecare during another UK lockdown. Debbie McGill, our head of policy, represented ABDO at the meeting, where she highlighted that: “In line with all other frontline healthcare providers and their specific remits, it is the responsibility of the governments and optical profession in each nation to continue to deliver eyecare in line with the basic principles of such; to maintain eye health, prevent, treat, manage eye problems and disease, treat eye injuries, and provide spectacles and contact lenses”. It is important for us to balance how we do this by triaging the provision of routine care, to prioritise clinical need, in line with the threat of Covid-19, whilst some of us are still getting through the backlog we acquired during the last year. The profession is doing a great job, which is borne out by there being no increase in transmission amongst us – with patients accessing eyecare or other frontline health care services. This is because we have all embraced new ways of working by increasing our infection prevention and control, using personal protective equipment (PPE) and adapting our practices to socially distance in communal areas, and so on. I’d like to take this opportunity to commend the entire optical profession throughout the UK for its dedication in doing this. That said, it is unfortunate that a minority of employers from all different businesses, both multiple and independent practice owners, are not considering the ethical side to what they are excepting of their staff, by not adhering to guidance on best practice at this time, which all representative bodies have provided to support them and their employees. I understand the fear and pressures from working on the frontline. It hasn’t been easy, and working all day in PPE has taken a bit of getting used to, but with the vaccine roll-out well underway, this is the beginning of the end. So hang on in there – and please remember that everyone is in the same storm but not in the same boat. Be considerate and kind. Stay safe, take care.
DISPENSING OPTICS FEBRUARY 2021
E-learning course leads to recognised qualification
ABDO management course eligibility extended The ABDO Level 5 Management & Leadership (MLT) qualification is now available to everyone working within the optical industry. The ABDO MLT turns any informal learning into a recognised qualification through a course of study and assessment. The training courses are accredited by the Chartered Management Institute (CMI), which also assesses and awards the qualification. ABDO members have been taking part in the training and qualifications since launch in April 2020, with 29 students studying towards diplomas and certificates. Students say that the courses are relevant, resources are easy to locate and use, tutors are easy to contact and respond in a timely fashion with the relevant information, and the courses are good value for money. All students said they would recommend the courses to others. Mark Turner, who is studying for the diploma, commented: “I never realised there were so many tools and theories, which can help you in developing, managing and leading individuals. I’d advise always to try and stretch yourself a little: this course offers just that and will be useful to anyone who is already in a similar role or looking to further their career. The tutoring has been very productive: the tutors will check, guide and give constructive feedback on your work. I’d absolutely recommend this course to others.” Nick Walsh, ABDO sector skills development officer, said: “These courses from ABDO are the ideal next step for any manager, whether you are just starting out or looking to formalise knowledge and experience gained in practice. “As a manager, you need to make time for your own development: this will improve the success of the business, the effectiveness of the team and the morale of the team as well as bringing benefits to your career.” The qualification awarded by CMI is well recognised. Students become members of the CMI and gain access to the support and materials that it offers, including the ManagementDirect online resource. It is an ideal way for employers to develop existing managers and train up those aspiring to a role in management. ABDO MLT is entirely via e-learning and, with the support of a tutor, removes the need for time away from the business to complete study. The qualification can be completed at either a diploma or certificate level. Find out more on the ABDO website.
NEWS New clinical role South Wales dispensing optician, Christina Verallo, has been appointed as a member of the ABDO National Clinical Committee (NCC). Currently on maternity leave, Christina works in practice part-time in Bridgend. She represents the profession on her regional optical committee, is an ABDO local lead for South East Wales, and ABDO representative for Optometry Wales. She is also enrolled on the ABDO contact lens course. “I applied for the ABDO NCC role because I believe that change is on the horizon for primary eyecare,” Christina told Dispensing Optics. “The roles of the DO and CLO are going to evolve, and I wanted to be a part of that change. “I hope that my enthusiasm for optics as well as my passion for Christina Verallo the future at graduation roles of DOs shines through in the coming months, and that I am able to help secure changes and progression for us all in the future,” she added.
ABDO College trustees appointed ABDO College has welcomed three new trustees: Les Thomas, Claire Walsh and Helen Wilkinson. Les Thomas, a former ABDO College student, is learning and development specialist for dispensing opticians and contact lens opticians at Boots Opticians. He is also an ABDO practical examiner and practice visitor. He replaces Angela McNamee, who completed her term as a trustee last month. Claire Walsh has been an ABDO College tutor for the past nine years. Helen Wilkinson is a locum dispensing optician, and was one of the first graduates of the ABDO College/Canterbury Christchurch BSc (Hons) programme. She has been an ABDO College tutor for 11 years and is currently a senior tutor. Claire and Helen will replace Kim Devlin and John Hardman, who will be retiring as trustees in July.
Have your say EMAIL THE EDITOR firstname.lastname@example.org WRITE TO Dispensing Optics, Unit 2, Court Lodge Offices, Godmersham Park, Godmersham, Canterbury, Kent CT4 7DT FOLLOW DO ON TWITTER @DO_OnlineUK
Dear Editor I’d like to express my concerns and complain about Dispensing Optics (DO) moving online only. I remain to be convinced that online magazines are read and shared like a hard copy, which is presumably why other magazines either remained in print or have now returned to print after a temporary break during lockdown. My complaint is that, as a member, I have yet to receive any e-communications regarding this fact. I’ve now been advised that this is because many years ago I opted out of ABDO emails because they weren’t pertinent to me – not being in practice anymore. I never intended to opt out of receiving DO. Common sense would say that all those in my position should have been communicated with. I wonder how many other members aren’t seeing DO due to spam filters, overloaded in-boxes, because they opted out of emails (but never to receiving DO) or a combination of these and other factors? When I was on the ABDO board, the challenge was always membership engagement and I’m sure that is still as much of a challenge today. Reducing the circulation and visibility of DO is a shortsighted decision that will further disconnect members from the Association. In my view, the board has got this seriously wrong. In these difficult times, communication with members needs to be upweighted and not downgraded. It is a well acknowledged marketing truism that companies who continue to invest in marketing come through challenging times more successfully and in better shape than those who cut back/stop marketing to save money. There is also an argument that in the absence of live events, companies still need to engage with customers and keep their brands in the front of their minds by other means, and journal advertising is a likely beneficiary of this. Those competitors who are in print seem to be proof of this with adverts appearing from suppliers not previously known to spend marketing budget in this way.
In the case of DO, I do understand it going online for a few months, but not for a prolonged period. As such, I implore ABDO to urgently return to physical copies in order to best encourage members to read, contributors to be heard and advertisers to get proper exposure and thus ROI. Nick Atkins FBDO (Hons) CL Co-director, Positive Impact
Editor’s reply In the printed issue of June 2020, we informed members that from the July 2020 issue we would be going digital for a temporary period. At the time of writing, DO Online has had 36,147 page views since July 2020. There have been 38,163 opens on the dedicated bi-monthly DO e-newsletter, with 8,264 links clicked. There has also been a total of 91,070 views and clicks on the PDF of the journal and the Issuu flip-through version. When members opt out of e-communications, by default they opt out of emails about DO. At present, there is no option to unsubscribe from one type of e-communications from ABDO and keep another; there is not the capacity to maintain lists in that way. This system also gives people the chance to re-subscribe if they have unsubscribed by mistake. Communications with members has been increased since the beginning of the pandemic, and there has been a significant uptick in traffic to the website compared to the same period last year. Similarly, there has been a significant increase in communications to members via email, which members have very much appreciated. This has been borne out by excellent open and click rates – a year-onyear increase in ABDO’s already excellent engagement rate. Since going online only, advertising bookings for DO have continued and we have welcomed new advertiser bookings since the beginning of the pandemic – both in the journal and on DO Online. The ABDO board is committed to DO returning to print as soon as it is practical to do so.
FEBRUARY 2021 DISPENSING OPTICS
NEWS Measures enable safe practice, reiterates ABDO As the prioritised programme for the vaccination of primary care workers rolls out, including to all optical practice staff and locums, ABDO has reiterated to members that there is currently no evidence of increased transmission of Covid-19 amongst those accessing or delivering frontline healthcare services. “The increase in infection prevention and control and the use of personal protective equipment within optical practices enables the safe delivery of care,” said ABDO head of policy, Debbie McGill. “At the current time, and under new lockdown restrictions announced on Monday 4 January, ABDO’s advice to members is to continue to provide needs and symptoms-led primary eyecare, in line with all other primary healthcare services, prioritising essential and urgent care whilst providing routine care where it is safe and clinically appropriate to do so,” Debbie continued. “In relation to patient safety, ABDO supports clinicians being able to manage their patients’ eyecare using their clinical judgement. However, members are encouraged to refer to their government’s eyecare lead’s advice.” Discussions about financial support continue. Please refer to the ABDO Covid-19 guidance page for the latest updates. Turn to page 24 to read Richard Rawlinson’s experience of being part of the vaccination roll-out programme.
New myopia guide published Following a year of collaboration with leading optometric organisations in the USA and Singapore, Johnson & Johnson Vision has published a new set of recommendations for eyecare professionals to assess, monitor and treat myopia in children. According to the company, the guide ‘In managing myopia: a clinical response to the growing epidemic’ adds to the “collective awareness, research and understanding of myopia and provides a research-based
DISPENSING OPTICS FEBRUARY 2021
Sustaining new business
Cases made with recycled plastic
Optoplast, which celebrates its 75th anniversary this year, is offering a new eco collection of cases and cloths called Optoplast Sustain. The range is crafted from recyled polyethylene terephthalate, a widely used recycled plastic. Each case and cloth is named after a coral reef. For example, our photograph shows the Palancar case named after the Palancar Reef, part of the Arrecifes de Cozumel National Park. Find out more about the collection on the new-look Optoplast website, which now features online ordering and personalisation.
Shapes of Water Neubau Eyewear has launched its first collection as an independent label. The Water collection is the first of a new series of sun and ophthalmic lines inspired by nature’s elements. It consists of three bio-based NaturalPX models – Adam, Barbara and Robin – made using seeds of the castor oil plant. The styles come in muted colour tones including teal matte, midnight tortoise, mint tortoise and khaki matte, while the minimalist shapes include angular Adam, rounded Robin and cat-eye Barbara. Subsequent collections will be named Air, Fire and Earth. And by using bio-based materials like NaturalPX and Natural3D, along with resource-efficient production methods, Neubau is once again emphasising its own pioneering spirit.
Model Barbara in teal matte
rationale for how and why we need to prioritise the eye health of children”. Key points within the guide are to consider offering children an eye examination between the ages of six and 12 months, at least once between the ages of three and five years, and then annually until age 17. Identifying and treating myopia as early as possible is also deemed to be critical to slowing progression, along with monitoring progression by measuring axial length. The new recommendations to help slow the progression of myopia are a great step forward for our children,” said Ken
Focus on protecting children’s vision Tong, president of the Singapore Optometry Association. Download the guide here.
DISPENSING OPTICS I FEB2021 Soft lens wear safe, says study The largest-ever retrospective study of its kind, published in Ophthalmic & Physiological Optics, has found low complication rates in children who wear soft contact lenses, similar to rates in adults. The so-called ReCSS study was initiated to support CooperVision’s regulatory submissions of MiSight 1 day contact lenses, and measured the rate of adverse events in children prescribed soft contact lenses before they turned 13 to establish wearing safety among that age group. “ReCSS is the most extensive compilation of ‘real-world’ data supporting safety of soft contact lens wear in children, complementing the effectiveness research from our groundbreaking, multi-year MiSight 1 day clinical study,” said John McNally, CooperVision senior director of clinical research. “Practitioners will appreciate the fact that the study included a range of eyecare practice types and locations, and a variety of soft contact lens brands, modalities and designs,” continued John. “Parents should be even more confident in embracing the benefits of a soft contact lens-based approach to myopia management, by knowing that the study evaluated the safety of contact lenses in children of the same age range as their own.”
Global consensus in the press A new global consensus report from the British Contact Lens Association (BCLA), to be published next month, aims to deliver evidence-based guidance to eyecare professionals on all aspects of prescribing and fitting contact lenses. The Contact Lens Evidence-based Academic Reports (CLEAR) will be
Contact lenses that deliver
sight-threatening eye disease. This will help us to identify people who would benefit from more frequent monitoring to detect early changes, since early treatment is known to improve clinical outcomes. “In the longer term, this research will provide us with a greater understanding of the biological mechanisms that cause myopia, which will aid the development of new treatments or lifestyle changes for myopia that are more effective than those currently available.” This is a three-year project with researchers hoping to have optimised a genetic test for high myopia in the next couple of years.
Italian company Safilens has launched the first in a new family of contact lenses called Delivery developed in partnership with the Veneto Eye Bank Foundation – a European leader in the research, transplant and treatment of ocular diseases. Delivery Tyro is the first product in the new family, and features biological functions designed to release tyrosine: an amino acid that helps normalise ocular development. “Because it is a natural substance, tyrosine has an extremely low level of toxicity and is constantly present in the blood,” explained Dr Diego Ponzin, medical director of the Foundation. “It crosses the natural barriers – for example, the blood-brain barrier – that often inhibit the penetration of drugs. “Recent research has revealed that dopamine plays a key role in proper development of eye anatomy. Thus, by releasing tyrosine, there will be a higher concentration of dopamine in the blood or in the structures of the eye,” added Dr Ponzin. By using an exclusive manufacturing process patented by Safilens, Delivery contact lenses are also enriched with natural substances, like Lachryceuticals, hyaluronic acid, and TSP – a natural polymer extracted from tamarind seeds. The lenses will be launched in the UK next month.
published in the March issue of the BCLA journal, Contact Lens & Anterior Eye (CLAE). It will feature 10 overview papers, each compiled by a panel chaired by internationally renowned experts. Topics will include: anatomy and physiology of the anterior eye, speciality lenses, orthokeratology, contact lens complications, future applications and evidence-based contact lens practice. Executive chair of CLEAR, Professor James Wolffsohn, said: “Putting together
these reports has been an amazing journey of discovery, bringing together gems of evidence to inform clinical practice, identifying areas where further research is needed, and determining where there are opportunities for new innovations from industry. We look forward to disseminating the findings globally as soon as the reports are published.” Non BCLA members will be able to access the report by subscribing to CLAE via the Elsevier site.
Funding for myopia gene test Researchers in Wales are developing a genetic test to identify people with high myopia who are most at risk of permanent damage to their eyesight and may thus benefit from more frequent monitoring. The test may also help to identify children who are most at risk of developing high myopia. Funded by Fight for Sight, in partnership with Welsh government through Health and Care Research Wales, a team at Cardiff University, led by Professor Jeremy Guggenheim, will harness existing information from the UK Biobank – a study investigating the role of genetics and lifestyle in determining the health and wellbeing of 500,000 UK citizens – to explore what genes may cause a predisposition to high myopia. Professor Guggenheim said: “Our aim for this project is not only to determine what children are at risk of developing high myopia, but also to be able to identify those who are at above-average risk of
Biological functions aid ocular health
PROFESSOR JEREMY GUGGENHEIM
FEBRUARY 2021 DISPENSING OPTICS
Accelerated refraction with precise accuracy
Essilor’s new Vision-R700 phoropter
The new Vision-R700 phoropter from Essilor has been designed to deliver faster, socially-distanced refraction without compromising quality. The technology, which can be operated from seven metres away, incorporates a multiple increment algorithm and a series of patient specific smart programs incorporating Essilor’s new Digital Infinite Refraction process. The latter automatically compensates for the effect that any change in sphere, cylinder and axis has on one of the other dimensions. This, in turn, shortens the test to just three minutes to give an exact 0.25D refraction. Essilor Instruments director, Paul Cumber, said: “Until now, the only way to shorten the traditional procedure of bracketing sphere, cylinder and axis independently was by cutting crucial steps. This leads to bigger variances and an estimation of the prescription. Using the phoropter will help practices obtain repeatable results to eliminate the discrepancy you can get with a traditional subjective refraction.”
Tools of the trade Efficiency and accuracy are of the essence with it comes to in-practice tools. The instruments showcased this month are among some of the newest available to ensure your patients are on the right clinical path when it comes to vision correction and long-term eye health care...
Speedier OCT scanning with enhanced functions
Enhanced diagnostics with the iVue80
Haag-Streit UK has launched in the UK its new iVue80 SD-OCT, which offers 80,000 A-scans per second. Said to be three times faster than the original model, the system features new scan options and functions along with a wider field of view. The iVue80 offers retina, glaucoma and anterior segment scanning as standard, quantifying the thickness of the retina nerve fibre layer (RNFL), ganglion cell complex (CCT) and cornea. It also tracks change and predicts trends in RNFL and ganglion CCT, and precisely measures angles to aid in disease diagnosis. With its streamlined interface and slit lamp style design, the system displays a 12x9mm view of the retina during acquisition. The optional addition of the iCam12 allows the user to upgrade to the iFusion80. The ability to simultaneously perform high-resolution fundus and external photography enables the OCT image to be overlaid with the fundus photo. This, says the company, aids in the diagnosis of the patient, by enhancing any suspected abnormalities.
Tonometer with myriad features and benefits
The ORA G3 and 7CR auto tonometer from Reichert 10
DISPENSING OPTICS FEBRUARY 2021
Grafton Optical is encouraging practitioners to look at the potential cost savings that could be made by switching to the Ocular Response Analyser (ORA) G3. The ORA G3 and 7CR (Corneal Response) auto tonometer from Reichert is said by the company to offer “substantial cost savings versus all other methods of tonometry”. It enables practices to offer ‘drop free clinics’ by eradicating the need for drops, dilation, prisms, disposables or consumables. It offers accurate readings by way of its Waveform Reliability Score, which requires minimal training to achieve fast, objective results independent of the operator. The combined devices also feature corneal compensated intraocular pressure, which Grafton states as being proven to be less influenced by corneal properties than Goldmann or other methods of tonometry.
Finally, the ORA G3 is said to be the only device capable of measuring corneal hysteresis (CH), shown to be a significant risk factor for glaucoma development and progression. The NICE MedTech Innovation Briefing on the use of the ORA G3 to measure CH can be viewed here.
Mastering myopia management Using the Oculus Myopia Master in practice could help eyecare practitioners to better diagnose, manage and monitor myopia – believes UK distributor, the Birmingham Optical Group. The Oculus Myopia Master combines autorefraction, keratometry and optical biometry in a “simple-to-use, automated and sleek looking device”. Importantly, the device includes questionnaires to gather relevant data, such as the patient’s ethnicity (and that of their parents), the refractive state of both parents, the patient’s refractive history, their lifestyle and more. Using this data, along with measured results, allows the device to produce a prognosis for the patient. After follow-up visits, the patient’s Myopia Profile can be viewed to validate the therapies being used and help the eyecare practitioner to manage the patient accordingly. “Reports are available for the patient and their parents,” explained Jason Higginbotham, managing director of FYEye and consultant to Birmingham Optical. “This all helps the practitioner to plan management, engage the family, motivate them and ensure they return regularly for follow-up appointments. “The Myopia Master helps to improve clinical outcomes for your patients, drive new revenue to your practice plus it increases patient footfall and patient loyalty,” Jason added.
The Oculus Myopia Master Next month’s Product Spotlight is on spring/summer eyewear. Please email email@example.com with any editorial and/or advertising enquiries.
CET COMPETENCIES COVERED DISPENSING OPTICIANS Communication, Standards of Practice, Ocular Abnormalities OPTOMETRISTS Standards of Practice, Ocular Disease
Getting to grips with OCT Part 2 By Prashant Shah BSc(Hons) MCOptom PGDipOphth DipClinOptom and Yashita Shah BSc(Hons) PGDipOphth
n Part 1 of this article (Dispensing Optics January 2021), we discussed the history of optical coherence tomography (OCT), its benefits, limitations and application in practice. Normal features of the retinal anatomy and scans were also described. As the use of OCT increases in optometry, it will become imperative that all staff members – from optometrists to dispensing opticians (DOs) – understand its use and application in practice to recognise eye conditions and manage patients accordingly. As DOs are well placed in the optical setting to take scans, their role is vital in bringing any abnormal scans to the attention of the optometrist during the initial screening. In Part 2, we will focus on some common conditions seen in practice, where OCT is useful in diagnosis and management. Each eye condition will not be discussed in extensive detail, though the reader can refer to the references and reading list if they wish for more information.
I This CET has been approved for one point by the GOC. It is open to all FBDO members, and associate member optometrists. The multiple-choice questions (MCQs) for this month’s CET are available online only, to comply with the GOC’s Good Practice Guidance for this type of CET. Insert your answers to the six MCQs online at www.abdo.org.uk. After member login, go into the secure membership portal and CET Online will be found on the L menu. Questions will be presented in random order. Please ensure that your email address and GOC number are up-todate. The pass mark is 60 per cent. The answers will appear in the June 2021 issue of Dispensing Optics. The closing date is 7 May 2021.
VITREOMACULAR TRACTION AND POSTERIOR VITREOUS DETACHMENT A posterior vitreous detachment (PVD) occurs when the vitreous gel shrinks and
liquifies. It can then detach from the retina at points of vitreoretinal adhesion, which are the peripheral retina, macula and optic nerve. The symptoms of PVD can be flashing lights, floaters, shadows, cobwebs or a ‘veil’ in the vision. While the majority of PVDs occur without complications, potential complications include retinal tears, retinal detachments, macular holes and epiretinal membranes. The incidence of PVD is known to increase with age1, and risk factors associated with earlier onset of PVD include high myopia, ocular trauma, ocular surgery, aphakia, intraocular inflammation, diabetes and postmenopausal women2. Vitreomacular traction (VMT) occurs when there is persistent vitreous attachment at the central macula following an incomplete PVD, causing traction and macular distortion. Vitreomacular adherence remains at the centre of the macula while there is adjacent vitreoretinal separation. The clinical picture in VMT is variable, with symptoms ranging from mild blurring and distortion to severe decrease in visual acuity and distortion3. If the patient is relatively asymptomatic and VMT is a chance finding, they should be advised to self-monitor with an Amsler grid and be reviewed sooner to
PLAN YOUR CET TODAY
C-76826 Approved for one CET Point
DISPENSING OPTICS FEBRUARY 2021
For all the latest CET available from ABDO visit the Events section of the ABDO website. Here you will able to see the latest online interactive CET sessions available for booking. Online sessions include discussion-based workshops, a great way to learn in a small group of your peers. Online discussion sessions are available for all professional roles and are approved for three CET points. New sessions will be added regularly. Additionally, we continue to host our monthly CET webinar series featuring a range of topics and speakers. Each CET webinar will be approved for one interactive CET point.
Figure 1. OCT of a right vitreomacular traction (note: on infrared fundus images: infrared light is absorbed by intraretinal, sub-retinal and sub RPE fluid. Fluid appears as a darker region on the infrared image. OCTs taken along green arrow) see if spontaneous resolution or progression occurs. Spontaneous resolution of VMT occurs in approximately 50 per cent of cases4. Figure 1 represents the OCT scan of a 70-year-old female attending with symptoms of intermittent visual disturbance in the right eye for one week. Right visual acuity was 6/7.5 with slight central distortion reported on the Amsler chart. As seen on Figure 1, the infrared fundus image appears normal. The OCT B-scan shows the posterior vitreous face attached to the inner retina at the fovea. The vitreous face is a thin hyperreflective band, which has separated from the retina adjacent to the fovea but is gripping on the fovea centrally. Due to this traction, two cystic spaces are visible. Since the outer retina and ellipsoid zone at the fovea have remained intact, the patient has maintained relatively good visual acuity. VMT can be subtle and difficult to detect on ophthalmoscopy, especially in the early stages. Therefore, without an OCT in practice, VMT would not have been identified as the cause of the patientâ€™s symptoms. The patient would
probably have been referred as she had unexplained symptoms; instead, having an OCT allowed the optometrist to effectively manage this in practice by explaining the condition to the patient, giving reassurance and monitoring on a regular basis. An Amsler chart was issued to the patient for self-monitoring, with advice to seek urgent attention if symptoms worsened. The VMT resolved within six months into a complete PVD without any residual traction on the fovea, and the patientâ€™s visual acuity returned to 6/6.
EPIRETINAL MEMBRANE An epiretinal membrane (ERM) is a sheet of fibrous tissue that forms in between the vitreous face and the internal limiting membrane of the retina. The clinical appearance of ERM can vary depending on its thickness and associated retinal traction. A thin translucent membrane is often referred to as cellophane maculopathy, and is seen on fundus examination as an irregular light reflex or sheen over the macula. As the membrane thickens and contracts, it creates retinal folds which is known as macular pucker5. Unlike cellophane maculopathy, where
vision remains relatively unaffected, macular pucker typically causes reduction in vision to 6/12 or worse, with associated metamorphopsia5,6. In severe cases, ERM is associated with retinal thickening and oedema. PVD has a critical role in the pathogenesis of an ERM5. ERM can be a precursor to VMT and subsequent pathologies such as macular and lamellar holes. Other causes for ERM development include retinal surgery, retinal vascular disease, intraocular inflammation and ocular trauma. Asymptomatic patients do not require referral and can be managed by regular monitoring with OCT and an Amsler chart. Patients with reduced acuity can be routinely referred to an ophthalmologist for vitrectomy and an ERM peel. The visual outcome following surgery varies depending on preoperative visual acuity, with improved visual outcome achieved in patients who had a better initial acuity6. In some cases, it can take up to one year for the visual acuity to settle down following surgery. Figure 2 shows the right fundus and OCT of a 68-year-old female who attended with symptoms of mild distortion when reading. Visual acuity measured as RE 6/7.5, N6 and LE 6/6, N5. Amsler showed slight paracentral distortion and no scotomas. The infrared fundus image displays mild retinal wrinkling. Overall, the macula still has a concave profile as shown on the OCT B-scan, however, there is a hyperreflective line on the inner retinal surface which is the ERM (depicted by a red arrow on Figure 2). The ILM/RNFL are not smooth and straight; this is the retinal wrinkling. As the inner and outer retinal layers are still intact, relatively good visual acuity has been maintained. The patient was reassured and given an Amsler chart to use for self-monitoring regularly with advice to seek urgent attention if symptoms worsened. When a patient presents with distorted central vision, OCT can be used to differentiate between conditions such as age-related macular degeneration (AMD), VMT and ERM.
CYSTOID MACULA OEDEMA Figure 2. OCT of a right epiretinal membrane
Cystoid macula oedema (CMO) is a painless central loss of vision occurring in FEBRUARY 2021 DISPENSING OPTICS
Figure 3. OCT of a right cystoid macula oedema a variety of conditions such as uveitis, retinal vein occlusions, diabetic retinopathy and most commonly following cataract extraction7-9. Post-cataract CMO typically occurs four to six weeks after surgery, although it can occur months or years later7. Patients usually present with a drop in vision after initially having had a good post-operative visual outcome. Occasionally, the patient may report mild ocular discomfort or photophobia. There may be a slight red eye, mild anterior chamber activity and an absent or irregular macular reflex on ophthalmoscopy depending on the severity of the oedema. Very mild cases tend to resolve without intervention within a few weeks, although persistent or severe cases can take up to several months to resolve even with treatment8. Common treatments are topical steroids in combination with non-steroidal anti-inflammatory drugs to manage or prevent CMO10. It is important to recognise that the cause of CMO in post-cataract patients may not be due to surgery alone, especially if there are co-existing conditions such as diabetes or hypertension. Therefore, it is essential to examine the fundus for other clinical signs and consider differential diagnosis, as the management for
pseudophakic CMO will be different from that for macular oedema due to diabetes or vein occlusion7,8. Figure 3 shows the right OCT scan of a 70-year-old patient who presented for a routine eye examination following recent uneventful bilateral cataract extractions. He did not have any relevant general health issues and was not taking any regular medications. He was essentially asymptomatic, reporting only difficulty reading at near (a typical symptom post-op), which was thought to be likely due to the fact that he needed new prescription spectacles. Good distance vision was reported, and he had begun driving again since having the cataract operation. Visual acuities were RE 6/18, N10. LE 6/7.5, N5. Binocularly 6/7.5, N5. He reported distortion on the Amsler chart with the right eye but not with the left eye. The infrared fundus image shows irregular macula surface with ridges. Loss of the normal concave foveal profile is demonstrated on the OCT B-scan as well as an increased macular thickness. The vitreous face is still attached at the fovea, but there are medium to large intraretinal cysts, which are hypo-reflective and the fluid within the cysts are not casting shadows.
Figure 4. Right central serous retinopathy at presentation
DISPENSING OPTICS FEBRUARY 2021
The cysts are primarily within the outer nuclear and plexiform layers – this wouldn’t have been detected by ophthalmoscopy. The ellipsoid zone at the fovea has been disrupted leading to reduced visual acuity. The patient was consequently referred to the hospital eye service (HES) for treatment. Previously, CMO was diagnosed when vision loss was accompanied by cystoid spaces identified on ophthalmoscopy or detected with fluorescein angiography. In cases where the macula looks normal, but the vision is reduced, OCT allows the cystoid spaces in the neurosensory layer to be visualised effortlessly and CMO to be detected more frequently.
CENTRAL SEROUS RETINOPATHY Central serous retinopathy (CSR) is characterised by detachment of the neurosensory retina from the retinal pigment epithelium (RPE), classically affecting young to middle-aged men with a Type A personality11. CSR can be aggravated by stress, untreated hypertension, high alcohol intake and corticosteroid use12. The exact cause of CSR is unknown – although it has been linked with increased choroidal vascular and RPE permeability13. Differential diagnosis of CSR includes choroidal neovascularisation/exudative AMD and serous RPE detachment (PED). Typical symptoms of CSR include unilateral blurred vision/distortion and the patient may describe a dark spot in the middle of their vision. A hyperopic shift in prescription may be found due to the retinal elevation from the oedema. Spontaneous resolution and absorption of fluid occurs in most cases of CSR within three to six months, with vision returning to normal or nearnormal. However, recurrence can occur in up to 50 per cent of cases1,12. Treatment of prolonged or chronic CSR is commonly with laser or photodynamic therapy (PDT)13. Figure 4 shows a 32-year-old emmetropic male who presented with complaints of blurred vision for the past three months. His symptoms appeared to be worse when looking at a VDU screen. He was a trader working for a top investment bank in the UK. His unaided vision was 6/12 in the right eye and 6/6 in the left. A +1.00DS refraction was found
Figure 5. The same patient as Figure 4 attended three months later with resolution of central serous retinopathy in the right eye, improving the visual acuity to 6/7.5 – and a plano result was found in the left eye. Amsler testing revealed central distortion in the right eye only; the left eye appeared normal. The infrared fundus image shows a round grey lesion at the macula and the OCT shows a well-defined serous detachment of the neuroretina from RPE. The space between the neuroretina and RPE is hypo-reflective, indicating the presence of serous fluid as it does not cast a shadow on the retina below. There is no intraretinal or sub RPE-fluid. The condition was explained to the patient and reassurance given. Despite being aware that the hyperopic refractive shift was due to the subretinal fluid, which would improve as the fluid resolved, the patient insisted on having a spectacle prescription. Against recommendation, a spectacle prescription was dispensed – in this case as a temporary measure to allow the patient to carry on working more comfortably. An Amsler was also issued for self-monitoring with advice to return sooner if symptoms worsened. A further review was arranged three months later to monitor his progress (see Figure 5) at which point the vision in the right eye had improved to 6/7.5. The OCT
Figure 6. OCT of a right macula hole
foveal profile in Figure 5 appears more normal. There is considerably less subretinal fluid, and the neuroretina and RPE have nearly re-joined corresponding to the improved vision. The infrared fundus image shows a smaller grey lesion than Figure 4. OCT allowed the CSR to be easily visualised, and excluded other potential causes.
FULL THICKNESS MACULAR HOLE A true macular hole is a well-defined oval or circular lesion with loss of all inner and outer retinal layers, visible as a red punched out hole on ophthalmoscopy. It is typically seen in females in the sixth or seventh decade of life and most likely to develop in response to persistent VMT, although it can also occur in high myopes or following blunt ocular trauma14. Symptoms typically are gradual and unilateral, causing central blurred vision or distortion. Patients may complain of difficulty with close work or watching TV. They may also describe a dark spot in the centre of their vision. These symptoms will vary depending on the size and depth of the macular hole. Often patients are asymptomatic as the fellow ‘good’ eye compensates, and so they may only
notice it as a chance finding when the fellow eye is closed. Full thickness lesions can be treated surgically with vitrectomy, ILM peel and insertion of a gas bubble to seal the macular hole. Following this procedure, patients are often instructed to posture face down for a number of days. Success rates for this procedure are high with closure achieved in around 90 per cent of cases15 and an improvement in visual acuity in 79-95 per cent of patients16. Prompt referral to a vitreoretinal surgeon is thus essential as earlier intervention will have a better prognosis. A lamellar hole differs from a full thickness macular hole in that the outer retinal layers are unaffected; interestingly on ophthalmoscopy it also appears as a well-defined round circular lesion17-19. It characteristically has an irregular shape, with an intraretinal split but an intact photoreceptor layer on OCT. While visual acuity can be good, patients often report distortion, however, referral is not usually indicated, as surgery is unlikely to improve vision18. Figure 6 illustrates a 78-year-old asymptomatic female who attended for a routine eye examination. She had previously had bilateral cataract surgery and was currently taking medications for rheumatoid arthritis. Her visual acuities on presentation were 6/60, N48 in the right eye (with no further improvement using a pinhole) and 6/7.5, N5 in the left eye. A red, well-defined round hole was visible on ophthalmoscopy in the right eye, however, the patient reported a negative response to the Watzke-Allen test as well as on Amsler. The infrared fundus image demonstrates a clear, round punched out hole at the macula. The OCT B-scan confirmed a full thickness macular hole with no inner and outer retina at the fovea. The foveal profile was completely lost and there were large intraretinal cystic spaces, which were hypo-reflective. The RPE was intact but the ellipsoid zone and ELM were absent. There was also hyper-reflectivity of the choroid centrally, known as a window defect. This patient was referred urgently to the HES (to be seen within two weeks) to increase surgical success of macula closure. She returned three months later following surgery and her visual acuity had improved to 6/9.5. FEBRUARY 2021 DISPENSING OPTICS
CET optometrists are crucial in monitoring the condition and disease progression in the patient. Where vision appears to be deteriorating, OCT can help to differentiate between those who need fast-track referral, and those who do not require any intervention.
Figure 7. OCT scan showing wet AMD. The red stars indicate sub-retinal fluid which is hypo-reflective. The yellow arrow points to the CNVM which appears hyper-reflective Unusually, this case did not present with any symptoms or positive reports on clinical tests that we would have expected the patient to respond to. Having an OCT in practice allowed the confirmation of a full thickness macula hole and prompt referral.
AGE-RELATED MACULAR DEGENERATION Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the western world in patients over 65 years of age20. Half of all sight impaired or severely sight impaired registrations in the UK are due to AMD21. Optometrists are seeing this condition more regularly in practice due to an ageing population. Patients are also more conscious of the disease as there is a greater public health awareness of AMD. AMD can be classified into two categories: dry and wet.
Dry AMD The ‘dry’ form is the most common type, accounting for approximately 90 per cent of AMD cases in the UK1,22. The key
features of dry AMD condition are drusen and RPE changes. Drusen are discrete yellow deposits of lipid and protein located between Bruch’s membrane and the RPE that are a result of degenerative change22. Hard drusen are small, have sharply defined edges and appear as hyper-reflective RPE elevations on an OCT scan, whereas soft drusen have less defined edges and appear as large, rounded RPE elevations on OCT23. A large number of drusen is an increased risk factor for later stages of dry AMD23. Symptoms of dry AMD tend to be gradual, ranging from no symptoms to mild vision change and slight distortion to severe central vision loss. Atrophic AMD is a term given to a more severe form of central vision loss due to RPE and photoreceptor degeneration. This is visible on OCT as retinal and RPE thinning, which can be localised or confluent. Choroidal hyperreflectivity is also present in the corresponding area of retinal thinning22. Currently, there is no treatment available for dry AMD1,22 and, therefore,
Figure 8. Drusen as seen in dry AMD on an OCT scan
DISPENSING OPTICS FEBRUARY 2021
Wet AMD (also known as exudative or neovascular) accounts for approximately 10 per cent of AMD cases. It is characterised by the development of a choroidal neovascular membrane (CNVM)22 which is a collection of new blood vessels from the choroid that can remain under the RPE or break through Bruch’s into the subretinal space (see Figure 7). These blood vessels are thin, fragile and more prone to rupture, leaking blood and fluid into the sub-RPE, sub-retinal or intra-retinal spaces. CNVM appears on OCT as hyper-reflective areas in front of, or beneath, the RPE. Symptoms of wet AMD are usually unilateral, sudden and profound vision loss and distortion. Patients may report a dark patch or spot in their central vision. Fortunately, treatment is available for wet AMD and patients can be managed through fast-track referral pathways to minimise the risk of visual loss. The treatment is aimed at clearing the fluid and shrinking the CNVM using a course of anti-VEGF intravitreal injections24. Figure 8 shows the right OCT of an 80-year-old female who presented for an eye examination complaining of difficulty reading at near. Her last eye examination was 10 years ago, at which point she had just had bilateral cataract surgery. Her symptoms were worse in poorer lighting. The new spectacle refraction corrected her visual acuities to 6/15, N10 in the right eye and 6/9.5, N6 in the left. Binocularly, she achieved 6/9.5, N6. In the infrared image, multiple round discrete lesions at the macula (i.e. drusen) can be seen. The OCT B-scan highlights the drusen as focal hyperreflective RPE elevations, giving it a ‘lumpy bumpy’ appearance in contrast to a normally smooth straight line. The foveal contour is still concave but there is a possible interruption of the ellipsoid zone accounting for the reduced vision. The scan verified dry AMD and ruled out wet AMD. The patient was subsequently
Figure 9. Optic nerve scans right and left unfolded in panoramic view has a double hump feature/twin peaks. The peaks are the thicker superior and inferior nerve fibre bundles. If these become damaged in glaucoma, an asymmetry develops between the superior and inferior nerve bundles
Figure 10. Ganglion cell thickness maps for the right and left eye
counselled, issued with a new spectacle prescription as well as an Amsler chart, and advised to return as soon as possible if she experienced any new or changed symptoms. She was also advised of the importance of having regular annual eye examinations. In older patients, where the fundus can be harder to examine due to miotic pupils or media opacities, OCT allows the macula to be assessed more accurately, aiding in the early detection of wet AMD and helping to maximise the patientâ€™s chance of retaining good functional vision for longer. Another benefit is that OCT can help differentiate between the dry and wet forms, allowing more accurate and appropriate referrals, speeding referral urgency and avoiding unnecessary referrals to the HES.
Glaucoma is a group of optic neuropathies resulting in damage to the optic nerve and causing vision loss. Primary open angle glaucoma (POAG) is the most common form of glaucoma, characterised by raised intra-ocular pressure (IOP), leading to progressive death of the retinal ganglion cells and consequently irreversible blindness25. Risk factors include increasing age, positive family history of glaucoma and Afro-Caribbean ethnicity26. Optometrists are important in glaucoma detection, as in the early stages the condition is asymptomatic. Until recently, the diagnosis of glaucoma was based on the appearance of the optic disc, IOP measurement, visual fields and slit lamp exam. Glaucoma detection and progression over time can be monitored by OCT objective analysis of the optic nerve head, retinal nerve fibre layer (NFL) and ganglion cell layer at the macula25,27. Damage or loss of the ganglion cell layer at the macula can precede visual field loss, and can be an early sign of glaucoma. OCT analysis should always be used in conjunction with other test results in glaucoma screening. Figures 9 and 10 show the OCT maps of the retinal NFL at the optic nerves, and ganglion cell layer at the maculae of a 60year-old male who presented for his routine annual examination. He was asymptomatic and had a mother with glaucoma. His best corrected visual acuities were 6/6 right and left. IOP measurements were 21mmHg in both eyes. The anterior chamber angle was open and visual fields were full in each eye. The data in both maps is compared to age-matched normal. The NFL and rim of tissue at the optic nerve follows the ISNT rule (thickest inferiorly, then superiorly, then nasally and thinnest temporally). If this rule is broken, this could suggest NFL loss and possibly glaucoma. In this case, both OCT scans appeared within normal limits. The patient was reassured and recommended to continue his annual eye examinations with OCT imaging due to the positive family history of glaucoma to monitor any changes over time. Angle-closure glaucoma is a less common form of glaucoma. It is caused by narrowing and blockage of the anterior chamber angle, resulting in raised IOP. FEBRUARY 2021 DISPENSING OPTICS
CET This can be chronic or acute. The acute form develops very quickly and requires immediate medical attention. The symptoms of angle closure glaucoma include a red painful eye, headache, blurred vision, nausea and haloes around lights. OCT imaging of the anterior chamber angle can be useful in assessing the risk of angle closure and detecting change in chronic cases.
CONCLUSION OCT has become an indispensable diagnostic and management tool in optometry and, as such, dispensing opticians will eventually grow to be an integral part of its use. Using OCT will enhance discovery of ocular abnormalities that may not have otherwise been visible on ophthalmoscopy. Some of these abnormalities may be clinically significant and appropriate management can therefore be undertaken promptly. PRASHANT SHAH is an optometrist with more than 15 years of clinical experience. He holds postgraduate diplomas in ophthalmology and clinical optometry. Prashant is a regular contributor of CET articles and has had work published in the journals of both the College of Optometrists and Association of Optometrists. YASHITA SHAH is an experienced optometrist working in independent practice where OCT is routinely used. She holds a postgraduate diploma in ophthalmology and has a keen interest in orthokeratology and dry eye.
REFERENCES 1. Hiscox R. Discover what lies beneath. Optometry Today 2014;C-36203:40-43. 2. Bottós J, Elizalde J, Arevalo JF et al. Vitreomacular traction syndrome. J. Ophthalmic. Vis. Res. 2012;7(2):148‐161. 3. Amoaku W, Cackett P, Tyagi A et al. Redesigning services for the management of vitreomacular traction and macular hole. Eye 2014;28 Suppl.1: S1-10. 4. Garcia-Layana A, Garcia-Arumi J, Ruiz-Moreno JM et al. A review of current management of vitreomacular traction and macula hole. Journal of Ophthalmology 2015; 80964 14 pages, 2015. https://doi.org/10.1155/2015/ 809640
DISPENSING OPTICS FEBRUARY 2021
5. Stevenson W, Prospero Ponce CM, Agarwal DR et al. Epiretinal membrane: optical coherence tomography-based diagnosis and classification. Clin. Ophthalmol. 2016;10:527‐534. 6. Dawson SR, Shunmugam M, Williamson TH. Visual acuity outcomes following surgery for idiopathic epiretinal membrane: an analysis of data from 2001 to 2011. Eye 2014;28(2): 219-24. 7. Rotsos TG, Moschos MM. Cystoid macular edema. Clin. Ophthalmol. 2008; 2(4):919‐930. 8. Grzybowski A, Sikorski BL, Ascaso FJ et al. Pseudophakic cystoid macular edema: update 2016. Clin. Interv. Aging 2016;11:1221‐1229. 9. Flach AJ. The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans. Am. Ophthalmol. 1998;96: 557-634. 10. NICE. Cataracts in adults: management. NICE guideline [NG77] Published date: 26 October 2017. Post-operative assessment. https://www.nice.org.uk/guidance/ ng77/chapter/Recommendations# postoperative-assessment. See section 1.8.7 and 1.8.8 [Accessed 18 May 2020]. 11. Yannuzzi LA. Type A behavior and central serous chorioretinopathy. Trans. Am. Ophthalmol. Soc. 1986;84: 799-845. 12. Wang M, Munch IC, Hasler PW et al. Central serous chorioretinopathy. Acta. Ophthalmologica. 2008;86(2): 126-45. 13. Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinopathy: an update on pathogenesis and treatment. Eye 2010;24(12):1743-56. 14. Ezra E. Idiopathic full thickness macular hole: natural history and pathogenesis. British Journal of Ophthalmology 2001; 85:102-9. 15. Zhao PP, Wang S, Liu N et al. A review of surgical outcomes and advances for macular holes. J. Ophthalmol. 2018; 2018:7389412. 16. Stainer L. Macular conditions. Part 1. Optician 2014; C35606. 17. Chen JC and Lee LR. Clinical spectrum of lamellar macular defects including pseudoholes and pseudocysts defined by optical coherence tomography. Br. J. Ophthalmol. 2008;92(10):1342-1346.
18. Witkin AJ, Ko TH, Fujimoto JG, et al. Redefining lamellar holes and the vitreomacular interface: an ultrahighresolution optical coherence tomography study. Ophthalmology. 2006;113:388-97. 19. Haouchine B, Massin P, Tadayoni R, et al. Diagnosis of macular pseudoholes and lamellar macular holes by optical coherence tomography. Am. J. Ophthalmol. 2004;138:732-9. 20. Klein R, Wang Q, Klein B E et al. The relationship of age-related maculopathy, cataract, and glaucoma to visual acuity. Invest. Ophthalmol. Vis. Sci. 1995;36:182-191. 21. Owen CG, Jarrar Z, Wormald R et al. The estimated prevalence and incidence of late stage age related macular degeneration in the UK. Br. J. Ophthalmol. 2012;96(5):752-6. 22. Ambati J, Fowler BJ. Mechanisms of age-related macular degeneration. Neuron. 2012;75(1):26‐39. 23. Klein R, Cruickshanks KJ, Nash SD et al. The prevalence of age-related macular degeneration and associated risk factors. Arch. Ophthalmol. 2010;128: 750-758. 24. Gale RP, Mahmood S, Devonport H et al. Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service. Eye 2019; 33:1-21. 25. Mansouri K, Leite MT, Medeiros FA et al. Assessment of rates of structural change in glaucoma using imaging technologies. Eye 2011;25:269-77. 26. TCollege of Optometrists. Glaucoma (primary open angle) (POAG). https://www.college-optometrists. org/guidance/clinical-managementguidelines/glaucoma-primary-openangle-poag-.html [Accessed 18 May 2020]. 27. Sung KR, Wollstein G, Kim NR, et al. Macular assessment using optical coherence tomography for glaucoma diagnosis. Br. J. Ophthalmol. 2012;96 (12):1452‐1455.
SUGGESTED FURTHER READING 1. Yoshimura N and Hangai M. OCT Atlas. Tokyo: Igaku-Shin Ltd; 2012. https://media.heidelbergengineering. com/downloads/ebooks/OCT-AtlasHangai_EN.pdf 2. Bille JF. High resolution imaging in
microscopy and ophthalmology. Switzerland: Springer Nature Switzerland AG; 2019. https://link.springer.com/content/ pdf/10.1007%2F978-3-030-166380.pdf
3. Rougier MB, Delyfer MN, Korobelnik JF. OCT and Retina. France: Laboratoires Thea and Carl Zeiss Meditec. https:// www.laboratoires-thea.com/medias/ oct_and_retina_thea_website.pdf 4. Adams NA. Atlas of OCT: Retinal Anatomy
in Health and Pathology. Independently published UK; 2013.
ACKNOWLEDGEMENT Figures 1-6 and 8-10 are reproduced courtesy of Heidelberg Engineering.
Multiple choice answers Triage in the new normal By Alexandra Webster MSc, PGDipE, FBDO CL, FHEA, FBCLA and Professor Christine Purslow PhD, MCOptom, FBCLA C-76110 â€“ published October 2020 Six of the following questions were presented online to entrants to comply with the General Optical Councilâ€™s best practice specifications for this type of CET. Personal protective equipment (PPE) is now routinely used in optical practice post Covid-19. Recommended PPE for this setting consists of: a. gloves, apron and scrubs b. gloves, apron, mask and eye/face protection c. apron, scrubs and mask d. mask, gloves and protective desk screen b is the correct answer. Public Health England suggests single use disposable gloves, single use disposable apron, fluid resistant surgical mask and eye/face protection. More information can be found at: Public Health England. Recommended PPE for primary, outpatient, community, and social care by setting, NHS and independent sector. April 2020. Available at: https://www.gov.uk/government/publications/wuhannovel-coronavirus-infection-prevention-andcontrol/covid-19-personal-protective-equipment-ppe During lockdown, concerns have arisen about the reduction in patients being seen face-to-face in secondary care and the potential backlog of patients with new pathologies requiring intervention. Estimates state the reductions to be: a. b. c. d.
25-37 per cent 45-60 per cent 65-87 per cent 85-99 per cent
c is the correct answer. In June 2020, the Macular Society stated that three of the UKs largest ophthalmology clinics had reported between a 65 and 87 per cent drop in new referrals in the first month of the coronavirus outbreak, compared to the same period in the previous year. Further information can be found at: Macular Society. Patients urged to seek treatment, before it is too late. 19 June 2020. Available at: https://www.macularsociety.org/news/ patients-urged-seek-treatment-it-too-late Triage has become a vital part of service delivery in optical practice. Triage is defined as: a. triage directs the patient to the most appropriate source of help, quickly and efficiently b. triage saves time and saves bothering the optometrist/optician c. triage directs the patient to the most appropriate optical professional d. triage allows the non-urgent patients access to the care they need a is the correct answer. Triage allows optical practices to provide satisfactory and effective patient care and directs the patient to the most appropriate clinician either in the practice or refers onward to a specialist. More information on triage can be found at: Dunn S. Triaging: reassurance, CLO, optometrist, or ophthalmologist? Dispensing Optics. March 2020. FEBRUARY 2021 DISPENSING OPTICS
MCAs Blepharitis may present as a non-urgent red eye in a triage. Distinguishing features of blepharitis include: a. marked redness, itchy and photophobia b. red-rimmed eyes, burning and mucopurulent discharge c. marked redness, photophobia and history of a recent cold d. burning, red-rimmed eyes and crusts around the eyelashes d is the correct answer. Patients with blepharitis often present with red-rimmed eyes and crusts around the eyelashes, which may be accompanied by a burning sensation and a possible history of dry eye. Which of the following patient pathways should be chosen if ‘red flags’, such as reduced vision and/haloes around lights, are uncovered during a red-eye triage? a. Refer the patient as an urgent referral to see their GP b. Reassure the patient that the condition is self-limiting c. Refer the patient urgently to see an optometrist or, if not available, to see specialist care on the same day d. Book the next available face-to-face appointment at the practice c is the correct answer. The presence of one or more red flags with a red-eye requires urgent same day referral to an optometrist or specialist care. Local protocols should be adhered to. General Data Protection Regulations (GDPR) impacts on all aspects of optical practice. How can GDPR be maintained whilst conducting telephone and/or video triage? a. Establish at the outset who you are speaking with by asking the patient name/address/date of birth, etc b. All patients must be triaged via video so you can see them c. Ask the patient to provide their NHS number d. Record the conversation and keep it on file a is the correct answer. It is essential practices conducting remote triage have all GDPR protocols in place, and team members involved in triage have the skills and knowledge to ensure GDPR is maintained. Additional security questions such as address, date of birth etc, are extra security checks. More information can be found at: Royal College of Nursing. Remote consultations guidance under Covid-19 restrictions. 4 May 2020. Available at: https://www.rcn.org.uk/professional-development/ publications/rcn-remote-consultations-guidanceunder-covid-19-restrictions-pub-009256 If a patient has a hearing or cognitive impairment, remote triage may be more difficult for them due to their impairment. How might we enable such a patient to access services?
a. These patients would be better to attend the practice for a face-to face triage b. These patients will need to be seen in a hospital setting c. These patients will have to wait until the pandemic is over before they can be seen d. These patients can consent to a third party to be present during the call d is the correct answer. Provided the patient can consent to a third party being present on the call, and all attendees are documented on patient file as having attended, then triage can be done adhering to GDPR and General Optical Council (GOC) regulations. More information can be found at: Royal College of Nursing. Remote consultations guidance under Covid-19 restrictions. 4 May 2020. Available at: https://www.rcn.org.uk/professional-development/ publications/rcn-remote-consultations-guidanceunder-covid-19-restrictions-pub-009256 When triaging patients remotely, we must try to help in all instances. Positive outcomes for patients are paramount. When triaging a ‘red eye’ we must: a. only triage our own patients b. triage appropriately and consider local protocols c. arrange to see all patients for a face-to-face appointment regardless of symptoms described d. advise all patients that they should go to A&E b is the correct answer. Appropriate triage allows us to appraise what is required, and who the patient will need to see. Flow charts and professional body advice aids decision making and timely care. All interactions with any patient should be documented and stored within their practice held notes and remote consultations are no different. Which of the following would be an acceptable method of capturing any remote consultation? a. Note bullet points of the conversation on a post- it note and add it to the patient records b. Inform the optometrist of what was discussed c. Add a full transcript to the patient records, or a recording of the encounter which is then deleted from the device involved in the capture d. Ask the patient to tell the optometrist when they attend their face-to-face appointment c is the correct answer. All patient interactions should be recorded on patient notes regardless of how they take place. GOC Standards of Practice state that all registrants must: “Maintain clear, legible and contemporaneous patient records which are accessible for all those involved in the patient’s care”. See: https://standards.optical.org/ standards/maintain-adequate-patient-records
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.
DISPENSING OPTICS FEBRUARY 2021
REGION UPDATE – MIDLANDS AND EAST OF ENGLAND RICHARD RAWLINSON
Could be worth a shot? s I write this month’s update, the UK Covid-19 vaccination programme is in full swing. It will be no mean feat to deliver tens of millions of doses to protect everyone from a virus – and its subsequent mutations – that has changed our lives beyond all recognition. Even back in November, as the first vaccines were seeking approval, it was apparent there would be a huge demand on NHS staff to deliver the doses. Combine this with an upsurge in hospital admissions and it soon became very apparent that support would be needed if the NHS were to move at pace and push back against the rise in infections. During the latter part of December, I was invited to volunteer and support the launch of one of the first vaccination programmes in Manchester. Whilst my clinical qualification would have allowed me to complete additional training to administer vaccinations, I chose to support the oversight of patient recovery as a non-clinical volunteer. I registered and completed e-learning for healthcare modules relating to anaphylaxis and basic life support, and was registered to use electronic patient management systems.
AIDING THE VACCINATION ROLL-OUT Whilst we should all be available to support eyecare services whenever we can, if you are currently not working, or working part-time, you might be in a position to consider supporting the vaccination roll-out programme. The Department for Health and Social Care recently changed the law to allow a wider group of staff to undertake training to deliver vaccines. This includes many allied health professionals, healthcare scientists and dental staff, as well as other individuals with appropriate first aid training, who are able to undertake additional comprehensive training; so opportunities for flexible, paid roles are open to lots of people. Therefore, DOs registered with the General Optical Council can apply and support the vaccination programme in England via https://vaccine-jobs.nhsp.uk/index.html. The sorts of roles available include the following... Covid Vaccination Programme Vaccinator: • Configuration of their vaccination station • Administration of the vaccine • Disposal of clinical waste and change of PPE as per national guidelines • Adherence to infection control practices between individuals Covid-19 Vaccination Programme – Registered Healthcare Professional (immunisations)
RICHARD RAWLINSON AT THE VACCINATION CENTRE
• Assisting with the configuration of the vaccination pod and vaccination station • Conducting clinical assessments • The review of complex medical histories and potential adverse reactions • Preparation of the vaccine prior to administration by the immunisers using aseptic technique • Ensuring the best possible clinical outcomes by using up-to-date skills and adhering to evidencebased policies and procedures COVID-19 Vaccination programme – RHCP Clinical Supervisor (immunisations) • Delivery of a safe immunisation service, assisting to influence and facilitate change within the setting and service areas • The supervision of clinical assessment prior to vaccination • Supporting the reviews of complex medical histories and potential adverse reactions and offering specialist advice as needed • The supervision of the configuration of the vaccination pod and vaccination station within the mass vaccination delivery model • The clinical supervision of safe vaccination delivery • The supervision of drawing up and preparation of the vaccine prior to administration and ensuring that each activity is recorded • Ensuring the best possible clinical outcomes by using up-to-date skills and adhering to evidencebased policies and procedures From personal perspective, volunteering to support the vaccination programme was an incredibly rewarding experience – and I would encourage anyone to participate if the opportunity arises. RICHARD RAWLINSON FBDO is ABDO regional lead for the North of England, Midlands and East of England, director of Primary Eyecare Services, LOCSU optical lead, a GOC case examiner, member of the UK Domiciliary Eyecare Committee and trustee of Vision Aid Oversees. FEBRUARY 2021 DISPENSING OPTICS
IN PRACTICE – PPE ANTONIA CHITTY
PPE tips and techniques t’s coming up for a year of wearing personal protective equipment (PPE), and we have all learnt plenty about how to make PPE effective whilst ensuring comfortable wear all day. In this article, you can find out how other dispensing opticians (DOs) and contact lens opticians (CLOs) make PPE work for them. Nick Howard is a speciality CLO at Burnley Hospital, Blackburn Hospital and in independent practice. Nick’s multiple roles provide him with extensive experience of PPE best practice across a range of settings. He says: “For day-to-day practice I now wear an apron, gloves, mask and visor and use a breath shield on the slit lamp.” Nick changes his apron on a patientby-patient basis, in keeping with government guidelines for healthcare practitioners working at less than two metres in a non-Covid ward. Working in a hospital, Nick has had useful input on infection prevention and control (IPC). He explains: “Even pre-Covid, there was a chart by every hospital wash basin outlining all of the stages of washing your hands. And in private practice I was using protective gloves and face masks prior to Covid-19 as we were using Blephex to treat blepharitis.” Nick experienced Covid-19 himself early on in the pandemic. He recalls: “The necessity for the PPE was driven home when I caught the disease back in April. At the time, we weren’t seeing patients and doing everything remotely. I live by myself, so I hadn’t caught it at home. This virus is clearly easy to catch – I now have a crusade for maximum safety.” Nick wears hospital scrubs both in the hospital and in independent practice. He explains: “The rationale for scrubs is that it is easy to put in a bag. We change at work in the morning and in the evening. Scrubs can go straight into the washer at 60 degrees. At this moment in time, I think every practitioner should do this. It’s one of the most practical things to
DISPENSING OPTICS FEBRUARY 2021
Nick Howard in full PPE at the slit lamp come out of Covid-19. The scrubs have short sleeves, which leave you clean beneath the elbow; this has been compulsory in hospitals, along with rules against wearing watches and jewellery bar a wedding ring. This makes it easier to wash thoroughly, including your forearms and wrists.” With regard to masks, Nick says: “I work on the understanding that there are
PPE AND THE ENVIRONMENT While the rapid increase in the use of PPE throughout 2020 was essential, there are environmental implications of this change, which should not be ignored. ABDO vice president, Daryl Newsome, is an independent practitioner and chair of the Association’s National Clinical Committee (NCC). He says: “The use of PPE in 2021 is anticipated as being 40 per cent greater than in 2019. So far, little has been done to make the production of PPE environmentally friendly. Much more has been done to address sustainable solid waste management so we can dispose of used PPE in an appropriate manner.
three entry points – nose, mouth and eyes – which need to be covered all of the time. I also use microporous tape at the top of the mask, which stops my spectacles from steaming up as well as improving the fit. My advice is to wear the mask high and press the reinforced part hard onto your cheeks.” Nick has also settled on a protective visor with a foam band across the forehead. He says: “I’ve tried protective goggles, similar to industrial goggles, but I like the style with a band on the forehead as I can keep it on even when using a slit lamp. It means my eyepieces don’t steam up.” When using the slit lamp, Nick has tried out different breath shields. He says: “It’s not clear what is the ideal size for a breath shield. The only thing I have seen is that it should be as big as practical while allowing you to get your arms around it. In hospital, I have added a larger screen over the one that the slit lamp came fitted with, in conjunction with a visor and a mask. “The instruction from the hospital is to wear gloves,” Nick explains, “which applies to everyone in the ophthalmology department. And, of course, to wash your
“The Covid-19 pandemic has taken our attention away from the United Nations 17 sustainable development goals, and we must refocus in 2021 to address solid waste management globally. The DARYL NEWSOME NCC has a working group looking at this and other problems of plastic waste within the optical sector, and hopes to host a summit within the sector to discuss this and plan for a greener future.”
hands first. It is important not to let the gloves lull you into a false sense of security. Wash your hands then put gloves on, and don’t touch your eyes, nose or mouth. “It can be harder to get contact lenses onto the eye with gloves on, but gloves make it easier to remove lenses. The gloves need to be the smallest size you can get to achieve a tight fit – but this makes it hard to get them on after washing your hands. We spend a lot of time drying our hands with paper towels.” Nick also has a tip which he picked up from a colleague in the Far East: “The coronavirus is heavy, it falls down. Your footwear should be wipeable. I use slipons only to avoid handling laces.” The correct PPE has also been accompanied by changes in practice. “We now offer video tutorials for contact lens tuition, and limit time in close proximity to 15 minute sessions,” Nick explains. “We obviously ensure patients can handle the lenses safely before allowing them to take them home. I use the video slit lamp and corneal topographer more in practice. And we have a strict time regime; if I can’t fit them in within the timescale, I have to stop and rebook as we can’t have people in the waiting rooms for any length of time. They shouldn’t even meet whilst entering and leaving. “One plus point has been that the hospital has put me in a different room so I can open the window to ventilate in between patients,” Nick continues. “The correct use of PPE has become automatic. We have been taught about donning and doffing. One of the nurses showed me how to remove the apron correctly – off the neck, let it fall onto your lap covering the disposable gloves, and drop it into the bin. It is now absolutely routine.” If you’re interested in how other practitioners are using PPE, read on for tips on masks, handcare, what to wear and PPE disposal.
2a and b. Abbie Wogin wears homemade ‘ear savers’ to hold her mask in place my short-cut beard had been rubbing against my mask and slowly loosening the fibres over each session through talking with patients. Since discovering this, I’ve started shaving and am a lot more comfortable now.” Phoebe Tingley, optical assistant at Taylor-West and Co, suggests: “I have found that using a silicone ear saver that goes round the back of your head is much more comfortable than having the straps on your ears all day – especially with glasses and long hair.” CLO Adele Peacock splits her time between hospital clinics and locum practice in a multiple. She has this piece of advice: “I use micropore tape to tape the top of the mask over my nose; it stops the slit lamp and my specs steaming up.” DO Jamie L. Wogin works at Daybell & Choo in Sheffield and has created his own design of ear saver. He explains: “We
sewed two buttons onto a strip of elastic to make ours. The strip is worn at the base of the hairline below the ears. This angles the mask down and creates a better seal between the mask and the face, reducing any chance of breath escaping upwards. The specs should be worn on top of the nasal part of the mask to keep the mask from moving. Obviously these ‘ear-savers’ are machine washable too. I have a clean one each day as part of the clothing guidelines for Covid-19.”
Hand care Keith Dickinson says: “After suffering problems with my fingers with the constant ‘off with one pair of gloves and on with another’ scenario, I now use Neutrogena Norwegian formula at least twice every day and my problems have been solved. I know it sounds like a corny commercial but it does help.”
What to wear Adele Peacock wears scrubs at work. “I change when I get there,” she says, “and before I leave. It means I’m confident I’m not bringing the virus home with me. I’ve made my own scrubs in different colour combinations and it is a revelation in comfort and ease of wear. Who wants to wash their nice dry clean only dresses daily?”
PPE disposal Michelle Hamilton, DO at Specsavers Greenock, advises: “When taking off your apron, roll it up and hold it in one hand. Remove your glove, rolling apron into glove and repeat with the other hand. This compacts the waste into smaller bundles and makes the ‘doff off room’ look tidier too.”
PRACTICAL TIPS FOR PPE Mask wearing CLO Keith Dickinson says: “When using the proprietary surgical face masks, twisting the loop so that the bottom part goes over the top of your ear and vice versa helps manage the steaming up of your specs.” David Knight, lead optometrist at Visioncall, says: “I’d been getting a very sore nose from loose mask fibres being in contact over a session. It turns out that
Adele Peacock in her scrubs
ANTONIA CHITTY BSC (HONS), MA, MCOPTOM, MCIPR is ABDO head of communications and author of 20 books on business, health and special needs. FEBRUARY 2021 DISPENSING OPTICS
JOTTINGS NANCY HUNTER
Have passport, will travel he 30th anniversary of my career in optics, which began at Dollond & Aitchison in Chichester, occurred in 2018. After 30 very happy years in my chosen profession, I made a promise to myself that I would explore new avenues. So in January 2018, I did just that. Brave you might say – or short-sighted perhaps. How did it all turn out? Read on to find out... Cast your mind back to your student days. I spent mine at City & East London College. All the big names were there; Mo Jalie and Jo Underwood to name but two. I clearly remember my first lecture about how axial length determines ametropia, delivered by Trevor White. However, the highlight of my studies were the visual optics lectures taught by Mr Pipe of Pipe & Rapley fame. Surprisingly, it was these early positive experiences that shaped my next move. I knew I wanted to stay within my chosen path of eyecare, so I signed up to the NHS jobs website. They say fortune favours the brave so perhaps fate intervened when I saw a job advertised with Care UK, one of the largest providers of cataract surgery in the UK. The role was to carry out biometry measurements for cataract patients. These determine which artificial lens replaces the cloudy crystalline lens; it has a lot to do with axial length funnily enough. Most DOs are pretty interested in lenses and I am no exception, so I applied immediately. What a great opportunity this was to transfer my existing skills to a new setting. As Emma Knowles suggests in her Prospects article (2019), Make a career change, “challenging yourself by putting your skills to use in a different setting is one of the common motivators for career changers”.
EXPANDED CLINICAL SKILLS Although some might say this was a retrograde career step, it has paid dividends by introducing me to a hospital setting. This is quite an education in itself, and very different from optical retail. I have learnt so much about infection control, patient dignity and confidentiality, not to mention the rigours of a clinical routine. Through my work in hospital eye units, my knowledge and compliance in issues relating to clinical governance has increased tenfold, which has been a revelation,
DISPENSING OPTICS FEBRUARY 2021
especially when coming from a sector where the Care Quality Commission has no jurisdiction. I am now part of the diagnostics team at Optegra, a designated private eye hospital. I have certainly broadened my clinical experience. I’ve measured intraocular pressures as low as one and as high as 65; photographed full depth macular holes; seen a cataract so advanced it was visible to the naked eye; and observed ptosis surgery, basal cell carcinomas and endstage glaucoma to name just a few.
COMING FULL CIRCLE But the story doesn’t end there. An important part of my career development as a DO was when I became a supervisor for student DOs. If you’ve never done this, I can’t recommend it highly enough. Not only can you be an invaluable ally to your student, being a supervisor re-invigorates your own interest in your subject and re-engages your academic mind. This led to a role as a professional development tutor, looking after a small cohort of students. Little did I know that this path would facilitate my next career change in 2019. My supervisory experience encouraged me to apply for a part-time, hourly paid role, lecturing in dispensing and ophthalmic lenses at Portsmouth University. I was recruited to teach my favourite subject, and so began another steep learning curve. I am now part of the vision science team at Portsmouth University, whilst continuing my work at Optegra. I split my time between these two roles – one complementing and informing the other. In such uncertain times, I can feel optimistic about my employment options. One final thought: as a new student of optics in 1988, I remember what a strange and foreign language optics seemed at first. And yet, understanding this rather niche language has given me a passport to other optical fields and enriched my working life. If you have any similar experiences to share or have any questions to ask, I am contactable at my Portsmouth University address – firstname.lastname@example.org NANCY HUNTER FBDO is diagnostic technician at Optegra Eye Health Care, and lecturer in vision science at the University of Portsmouth.
OA CORNER PART 2
SOCIAL MEDIA TIPS: BE CONSISTENT
TAKE-HOME TIPS FOR GREAT COMMUNICATION Communication is key to every role in practice – but optical assistants (OAs) are particularly important as they can make someone feel at ease when they walk into the practice. In OA Corner Part 2, Sue Deal reminds us that while some patients might be excited about choosing new spectacles, others can be nervous or anxious. Sue has some top tips to help you spot if someone is concerned, and make them feel at ease. For example, an anxious patient will have a worried expression, or be biting their lower lip. The anxious patient may also look everywhere but in your A great first impression will help build trust eyes. To reassure and relax them, speak in a calm, quiet and confident tone. A neat and tidy appearance will also help create trust in your abilities from the outset. For additional tips on how to understand a patient’s body language, and use your own to create the right impression and help them feel at ease, read OA Corner Part 2 in full on DO Online.
he key to good social media content is to be consistent. If you are using multiple platforms, try to use the same user names, logo and business information. Post regularly. If you can’t post every day, then make it every other day – but don’t leave weeks or months between posts. If your accounts seem inactive, people won’t follow/like your account. You can schedule on both Twitter and Facebook directly or use third party apps such as Buffer to schedule content on Twitter, Facebook, Instagram, LinkedIn and Pinterest. Why not use the EyecareFAQ graphics and information on your social media account? They are available to share free of charge as a benefit of ABDO membership here. In February, we will be covering the eye test, optical equipment and low vision. Find Q&As on more eyecare and eyewear topics here www.abdo.org.uk/information-for-the-public/eyecarefaq
Congratulations to our December Competition Corner winner: Carley Jones.
30-60-90 DAY PLANS: USES AND BENEFITS Every business and job role can benefit from a 30-6090 day plan, which is a document used to set goals and strategise. All employees should be working towards the same company-driven goals, so the plan should align with overall company success. Starting a new job is exciting and invigorating, but it can also be an anxious time and a little overwhelming. Creating a goal-driven plan can help you adjust to your new position quickly and effectively. 30-60-90 day plans are great tools for an effective start to a new position.
USES Uses for a 30-60-90 day plan may include: • New job: 30-60-90 day plans are a great way to productively use your time to learn about your new job and begin working. These plans are most often associated with beginning a new job • Project: 30-60-90 day plans can help create an actionable project template. They are useful in dividing a project into manageable tasks
• Performance review: 30-60-90 day plans can be implemented following a performance review. Take the constructive feedback you received and create a 30-60-90 day plan to meet your end goal
BENEFITS There are many benefits and uses for a 30-60-90 day plan including the following: • Focus: Creating a clear focus for your first 90 days of a project or role ensures that your daily actions will be productive. • Goal-setting: - Learning goals - Performance goals - Personal goals • Success: Your line manager will see that you are capable of self-management and achieving goals. This indicates that you are an employee worthy of development The full article can be found in the Features section of DO Online. FEBRUARY 2021 DISPENSING OPTICS
Are you passionate about a career in eyecare? ABDO is working with Youth Employment UK to promote careers in eyecare.
FINANCE AND ADVICE
NETWORKING AND EDUCATION
If you are age 18-25 and would be willing to talk about your job and your career, please email email@example.com
To place an advert, telephone 0781 273 4717 or email firstname.lastname@example.org. Booking deadline for the March issue is Friday 5 February. Special rate for ABDO members. Visit DO Online to place your online jobs vacancies, as well as practices for sale
DISPENSING OPTICS FEBRUARY 2021
Fellowship Dispensing Diploma (FBDO) Develop your career and learn while you earn Want to become a dispensing optician? ABDO College offers you the chance to combine online learning with in practice experience and block release. The course: Leads to a registerable FBDO qualification. Has a proven track record of success with consistently high theory and practical exam results. Gives you a platform to advance your career.
Entry requirements Level 4 or above GCSE in English, mathematics, science and two other subjects, including evidence of recent learning (Grade C pre-2017). You must be working in practice as a trainee dispensing optician for a minimum of 30 hours per week and have the support of your employer. For more details and to apply: visit www.abdocollege.org.uk call 01227 738 829 (Option 1) or email email@example.com Applications close: 30th July 2021
KEEPING EXCELLENCE IN YOUR SIGHTS
FINANCE AND ADVICE
NETWORKING AND EDUCATION
The monthly journal of the Association of British Dispensing Opticians