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contents features 14.
CET – C-76735 Getting to grips with OCT Part 1 By Prashant Shah and Yashita Shah
CET MCAs – C-76020 Dry eye. Recent evidence surrounding the lack of correlation between signs and symptoms By Clare Hayes
Policy update Year of change ahead By Debbie McGill
In practice On track for 2021 By Antonia Chitty
A DO and proud of it
Business Bites | Eyecare FAQ | OA Corner
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JANUARY 2021 DISPENSING OPTICS
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DISPENSING OPTICS The Professional Journal of the Association of British Dispensing Opticians Volume 36 No 1
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Alexandra Webster MSc PGDipE FBDO CL FHEA FBCLA ABDO CPD, Unit 2, Court Lodge Offices, Godmersham Park, Godmersham, Canterbury, Kent CT4 7DT
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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 HOPE SPRINGS IN 2021 We begin the New Year with the very welcome news that a safe and effective Covid-19 (coronavirus) vaccine is being rolled out in communities across the UK – beginning with those most at risk from the disease. Without doubt, this signifies the beginning of a return to some form of normality for us all. As a profession and industry, we hope to reach a turning point as spring time approaches and to resume a more familiar way of working in the months ahead. Despite the very real challenges that the pandemic has presented, I am very proud of the way that ABDO and its departmental teams – from education, to communication to membership – have maintained a very high level of service to all of our members. We have also been able to make definitive plans for the future. As reported on page 7, this month sees the launch of our 2021 Annual Plan. It is the first publication of its kind for ABDO, and one which we hope will give members a very clear idea of the breadth of service and activities that the Association is involved with. During 2021, we will also be working on a new five-year strategic plan, which we plan to consult widely upon. Your thoughts and views will be most welcome, so do keep an eye on your inbox for ABDO communications. Whatever happens in the coming months, you can be reassured that we will be doing all we can to promote the profession and provide the level of service you rightly expect of your Association.
Sir Anthony Garrett 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
ABDO general secretary
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
JANUARY 2021 DISPENSING OPTICS
OUR MONTHLY COLUMN FROM THE ABDO PRESIDENT JO HOLMES FBDO
A DO and proud of it s we enter a New Year and subscription renewals land in our inboxes, I want to talk to you about the many benefits of your ABDO membership. Making good use of the lifestyle discounts and savings could more than cover the cost of More to membership than you might imagine your yearly subscription – but there is so much more to your membership. To start, there is a range of useful tools to support you in day-to-day practice – from ABDO Advice and Guidelines and key British Standards to, most recently added, Ophthalmic Lens Availability Online. Alongside this, there are patient leaflets to download and hand out, and digital assets for your social media platforms via Eyecare FAQ. Beyond this, you can contact ABDO’s Membership Department and clinical lead when you need professional advice. ABDO is a leading provider of continuing education and training (CET) for dispensing opticians (DOs) and contact lens opticians (CLOs). The ABDO board has pledged to offer at least the minimum General Optical Council CET requirement for members and this has been consistently exceeded. CET is now developing with continuing professional development (CPD) – and CPD resources for all members can be found in the ABDO Professional Development Toolbox. You can access CET in a variety of convenient ways: articles available in Dispensing Optics journal can be completed online in your membership page where you will also find the latest recorded lectures. Visit the ABDO Events section of the website for details of interactive webinars, online discussion-based workshops and national and regional events. ABDO also offers members individual professional indemnity insurance, which covers you personally for any fitness to practise scenarios. As a member, you also benefit from personal legal protection up to the value of £25,000 to cover any employer tribunals. This provides valuable peace of mind if you are ever in difficulties. And remember: ABDO is an HMRCapproved professional body so if you are a UK tax payer, you may be eligible for tax relief on your membership fee. The team at ABDO works continuously in the background ensuring that DOs and CLOs are included in new pathways and legislation, making sure there will always be a place for us within the healthcare system. These are just some of the benefits ABDO offers to maintain and protect your profession: don’t let your membership slip.
DISPENSING OPTICS JANUARY 2021
Nick and Antonia receive the award virtually
ABDO careers campaign wins national award ABDO has won the Best Newcomer award for its Careers in Eyecare campaign from Youth Employment UK (YEUK). The Careers in Eyecare campaign promotes careers across the sector, highlighting the range of clinical, fashion, design, technical and retail roles available. It was launched in 2020, and maximises the use of social media to reach out to young people, parents and careers advisers, and those looking to change career. YEUK made the award at its Annual Impact & Awards Event. There are two awards for employers. Antonia Chitty, ABDO head of communications, and Nick Walsh, ABDO sector skills development officer, received the award on behalf of ABDO at a virtual ceremony. The other award from Youth Friendly Employer of the Year 2020 was won by Coca Cola European Partners. Antonia said: “In a year when very little went to plan, we were thrilled to launch Careers in Eyecare, an online campaign to highlight the wide and varied range of careers available in this field. Receiving this award was massively positive, and we look forward to continuing the campaign and expanding it in 2021. “My thanks go to all the other organisations in the fields of eyecare and eyewear who have helped us make such a good start on the careers hub. We will be developing these partnerships and building further links in 2021,” Antonia added. Nick commented: “We identified YEUK as a key partner for our campaign because of its existing careers hub and the way it ensures that young people have a voice in shaping their activities. It has a huge ready-made audience which is enabling Careers in Eyecare to reach people who may never have considered a career in our sector. “YEUK also has valuable links with government departments. This is an incredibly valuable partnership for ABDO, and it is great that YEUK has recognised ABDO’s commitment to highlighting careers with this award.” The awards were presented by Kirstie Donnelly MBE CEO, City & Guilds, and David Phillips, managing director, City & Guilds and ILM.
NEWS ABDO sets out annual plan ABDO has launched a new Annual Plan for 2021, published on its website in the About Us section. The ABDO Annual Plan for 2021 sets out the wide range of activities that ABDO will be carrying out to continue to support, develop and represent members. ABDO president, Jo Holmes, said: “We know that Covid-19 made 2020 a hugely difficult year for everyone – both personally and professionally. ABDO will continue to support members in dealing with the pandemic’s challenges, while managing the organisation’s finances prudently and hoping that the coming year brings more positive news.”
JANUARY 2021 issues, including via a new Clinical Support Hub • A regular supply of news and information through eNews and Dispensing Optics ABDO will represent the profession by: • Representing members on crosssector bodies and committees to ensure the voices of dispensing opticians (DOs) and contact lens opticians (CLOs) are heard • Working collaboratively with other organisations to promote eye health and the importance of highquality dispensing • Engaging with the General Optical Council (GOC) to influence regulatory developments • Negotiating opportunities for members to develop their roles
Association of British Dispensing Opticians
Serving and safeguarding members’ interests
In the plan, ABDO pledges to support members by providing: • High quality continuing education and training (CET) to support professional development – through articles, webinars, online workshops and, when feasible, regional events • Professional and personalised responses to requests and enquiries • A range of professional qualifications to enable entry to the profession and the expansion of roles • Support to gain accreditations needed to deliver enhanced services • Guidance and tools via the Business Support Hub • Advice and guidance on a wide range of clinical and regulatory
ABDO will build on member development opportunities by: • Reviewing the syllabus for the FBDO Level 6 Diploma in Dispensing Optics and responding to the GOC’s Education Strategic Review once this is concluded • Having a greater focus on providing education and training that supports members’ continuing professional development • Encouraging students to work towards the management and leadership qualifications offered in conjunction with the Chartered Management Institute • Seeking to inspire the next
Eye for an eye
Real-world data for myopia management
Essilor is rolling out a new logo and branding system for its flagship and product brands, including Varilux, Crizal, and Eyezen. “While Essilor will continue to introduce more breakthrough technology in the coming years, we believe it is essential to continue building a strong branding system to execute solid launches and ensure trust from ECPs and confidence from consumers,” said Tim Precious, managing director at Essilor. The company will complete the roll-out of its new branding system by the end of the year.
The largest-ever retrospective study of its kind has found very low complication rates in children who wear soft contact lenses, similar to rates in adults. Adverse event rates in the Retrospective Cohort Study of Safety of Paediatric Soft Contact Lens Wear: the ReCSS Study by Chalmers et al appears in the January 2021 issue of Ophthalmic & Physiological Optics, the journal of the College of Optometrists. The work was initiated to support CooperVision’s regulatory submissions of its MiSight 1 day contact lenses. “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 ground-breaking, multi-year MiSight 1 day clinical study,” said co-author 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. 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.”
generation of DOs through the Careers in Eyecare campaign • Developing a new strategic plan – to take effect in January 2022 – that will set out a positive vision for the future, explain ABDO’s objectives, and demonstrate the benefits members can expect to see Jo added: “As our members’ professional body, we are proud to serve and safeguard the interests of dispensing opticians, contact lens opticians and low vision practitioners, and hope that 2021 proves to be a successful year for all.”
JANUARY 2021 DISPENSING OPTICS
NEWS GOC launches FtP bulletin The General Optical Council (GOC) has launched FtP Focus, a new learning bulletin for registrants on the Fitness to Practise (FtP) process. The bulletin, to be published quarterly, will provide insights into the types of concerns the regulator receives and how it assesses them. The launch edition focuses on triage, the first stage of the process, and includes case studies,
JANUARY 2021 reflection points and tips. It also highlights relevant standards and CET, and includes insights from the Optical Consumer Complaints Service. Dionne Spence, director of casework and resolutions, said: “Through conversations with practitioners, students and businesses who have either gone through the FtP process themselves or have heard about it through others, we became aware that there is a lot of work we can do to dispel some of the myths around FtP and also
provide valuable insight into how we approach concerns when they are raised. “Even though many registrants will not have any involvement with FtP, we know that the fear of ever receiving a notification from us can be overwhelming and we hope we can do something about that. The reality is we only receive initial concerns about less than one per cent of our registrants, which shows the high quality care the majority of our registrants deliver,” added Dionne. Read our new series – OCCS Insights – in the features section of DO Online.
LIGHT-HEARTED SCENARIOS FEATURE
NEW DIRECT CHANNEL
Eco-brand flies solo Winter contact lens boost Formed in 2016, the Neubau Eyewear brand utilises environmentallyconscious production processes. And from the start of this month, it will operate independently from Silhouette International. “As an independent company, Neubau Eyewear will focus more fully on sustainable, trendsetting products distributed through its own sales and marketing channels and through selective business partnerships,” Silhouette International stated. The frames will continue being made in Austria at the two production locations operated by Silhouette International.
CooperVision is running a winter consumer campaign – titled ‘@home@play’ – to bring contact lens wearers back into the fold. According to its own research, contact lens sales in April 2020 dipped by around seven per cent on the previous year, with a third of contact lens wearers reducing frequency of wear because they were “giving their eyes a break”. Some 29 per cent hadn’t worn their contact lenses as usual as they only needed them for socialising, the company reported, with 28 per cent saying they only needed their lenses for work or other activities. Running via Facebook, Instagram and digital display advertising throughout the winter, the campaign features light-hearted scenarios, contrasting staying in with going out. Lapsed wearers will be encouraged to contact their ‘optician’ via the online CooperVision store locator. Doug Bainer, CooperVision country manager for the UK and Ireland, said: “This is a really exciting campaign, not just for us here at CooperVision, but for the contact lens category as a whole. Contact lenses offer people the freedom to do so many different things; we wanted the campaign to acknowledge this and showcase how this period of restriction is making us discover new ways of finding freedom in our everyday lives.”
Kick-start for independents
providing the resources needed to grow their business while offering meaningful employment experience to unemployed 16 to 24-year-olds. SightCare and Insight Optical Training will bring together independent practices from across the country and apply for placements on their behalf. This means independents won’t be restricted by the requirements for a minimum of 30 placements per employer. John French, SightCare Group CEO,
SightCare Services and Insight Optical Training have come together to help independent practices access the government’s £2bn Kickstart Scheme – designed to rebuild the economy and support young people into work. The new partnership allows smaller firms to take advantage of the scheme,
DISPENSING OPTICS JANUARY 2021
said: “We will help independent optical employers to advertise and recruit, and deal with all the cumbersome admin, including payroll. We will provide support to the young person, so that they are ready for work and fully prepared for their next steps once the placement is complete. This is all at zero cost to the employer.” Independent practices in England, Scotland and Wales can register at www.sightcare.co.uk/kickstart-scheme
Chronos Optimise workﬂow, grow your practice, with guided binocular refraction. It’s time to change, without Compromise. Chronos offers binocular autorefraction, keratometry measurements and visual acuity with subjective testing. Enjoy the convenience of automated binocular refraction, with Chronos.
VISIT tphc.io/reinventrefraction for more information.
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NEWS Eyewear au naturel
Climbing the career ladder From optical assistant (OA) to store director and qualified dispensing optician (DO), Laura Stallerbrass was made redundant twice in six months before finding her “dream job” at her local Specsavers. After a run of bad luck in different job roles, Laura applied to be an OA at Specsavers in Forfar, Scotland, in 2010. Despite having no experience, she quickly progressed to store supervisor. After several more promotions, she became practice manager then decided to study to become a DO. Whilst continuing to work in practice, Laura completed her second degree at Anglia Ruskin University – and in just three years was a qualified DO as well as manager. Through Specsavers’ Pathway programme, she then became a joint venture partner and is now at the helm of a successful store alongside optometrist Blair Michie. Laura said: “It’s sometimes hard to believe how I ended up as an [dispensing] optician and director of a Specsavers store, as I have changed my career choice many times before I joined here. It was particularly difficult being made redundant twice in six months, but in hindsight it was meant to be...”
Myopia control collaboration Essilor International has teamed up with Australia-based myopia educational company, Myopia Profile, to develop specific educational content to increase primary eyecare practitioners’ knowledge and skills in prescribing spectacle lenses to young children. Content will be housed on MyopiaProfile.com and shared across
DISPENSING OPTICS JANUARY 2021
Pioneer of the world’s first hemp fibre eyewear, Edinburgh-based Hemp Eyewear has created a new frame using organic hemp combined with turmeric. Turmeric is one of a range of natural pigments used in the collection, from blueberries to beetroot. “We wanted to push the boundaries of our sustainable technology and develop exciting new combinations,” said Sam Whitten, founder of Hemp Eyewear. “Turmeric was the perfect choice for a bright, vibrant colour with a positive impact on the planet.” Founded in 2016, Hemp Eyewear is 100 per cent natural and vegan, with each frame handmade in Edinburgh using organic hemp grown in France. The
OCT expedites infection diagnosis, study finds Optical coherence tomography (OCT) in optometric practice can aid the diagnosis of corneal infections, reducing the risk of sight loss and helping patients’ vision return to its pre-infection level, a new study has found. The study, led by the University of Southampton, examined 45 patients with bacterial keratitis using OCT. The researchers also examined features of cytokines, proteins emitted from cells, in the patients’ tears to determine whether this was also an effective technique for assessing the inflammatory response. The results, published in Nature Scientific Reports, showed that both techniques could rapidly distinguish between gram-negative and gram-positive
multiple platforms. It will also cover getting started in myopia management, clinical communication, and understanding the latest research. Myopia Profile was founded in 2016 by optometrist husband-and-wife Drs Paul Gifford and Kate Gifford. Its public awareness arm, MyKidsVision.org, provides information on myopia risk factors, how-to video guides, and social media platforms for parents to learn more about childhood myopia and treatment options.
Eyewear created using hemp fibre collection includes prescription eyewear and sunglasses and each style comes with a hemp box, pouch and cloth. There is also a custom service, allowing personalised name engraving and choice of shape, lens and frame colours.
infections. As gram-negative infections present a higher risk to vision, this could help clinicians prescribe the right antibiotics straight away and reduce the impact of antimicrobial resistance if the wrong treatment was applied, the researchers argued. The study also showed that faster application of topical steroids, such as prednisolone, could reduce the inflammatory response. Dr Parwez Hossain, associate professor of ophthalmology at the university, said: “Our findings...show that treatment could start within 72 hours of the symptoms presenting themselves to give the best chance of full visual recovery in patients with suspected bacterial keratitis. OCT, or examination of a patient’s cytokine features in clinics, makes this possible; this should be the basis for a larger-scale clinical evaluation of this approach to treat a significant global health problem.”
DR KATE GIFFORD
DISPENSING OPTICS I JAN2021 Tackling children’s vision problems Essilor is sponsoring a new eye health initiative, Villa Vision, run by the Foundation of Premier League football club, Aston Villa, and has pledged to provide corrective lenses to all children identified with vision problems. It has donated and fitted a mobile eyecare van with optical equipment to perform full eye examinations and to help spread the message of good eye health. The Villa Vision van will tour schools and local community venues across Birmingham, reaching out to several hundred children each term through interactive lessons, educational materials and vision screening.
Hitting milestones Zeiss Vision Care UK has reported a number of key milestones as part of an over-arching Green, Safe, Responsible project, combining more than 250 initiatives worldwide into a single global programme. At Zeiss Vision Care UK, no water is used for lens cutting. In the entire process of making Zeiss lenses, less than five litres
The Optometry School at Aston University is partnering the initiative to share its clinical and research expertise. It will collect data from the eye screenings to conduct research into myopia to provide evidence-based eyecare. Andy Hepworth, professional relations manager at Essilor, said: “When Aston University approached us about the project, we knew instantly that we wanted to help make it a success. It’s a natural fit with our Vision for Life social impact fund and helps us strive towards our mission to improve lives, by improving sight.” Villa Vision project manager and optometrist, Nikhil Sonpal, said: “Having this support from Essilor really gives the project the opportunity to fulfil its
ambition to successfully raise awareness of the importance of eye health and serve the needs of the local community.” Andy is pictured (far left) with (from left): Leon Davies, head of the Optometry School at Aston University, Guy Rippon, head of the Aston Villa Foundation, and Nikhil Sonpal.
of water are used per day, while all lens cuttings are recycled. The company has changed to plain brown packaging, which uses 40 per cent less carbon dioxide than white bleached card, while its laboratory machines are powered by one industrial air compressor – meaning they have 33 per cent lower energy use than individually powered cutting machines. All paper and card is FSC accredited, and the links on the company’s printing are
now vegetable oil based. They have also removed the single-use plastic from their guarantee tags and changed the coating to be compostable. Zeiss Vision Care‘s yearly waste reduction is now equal to the weight of 2.5 million plastic bags – and its lens packaging has been reduced to save 68 tonnes of paper each year. The company, founded 130 years ago, has pledged to achieve carbon neutral energy consumption by 2022.
Aston Villa Vision van
Eyewear retrospective at 50-year milestone
Celebrating 50 years with Stepper’s SI-20073
As Stepper Eyewear passes 50 years of creating comfortable and stylish quality frames, Hans Stepper has revisited some of his earliest styles. As part of the Stepper Eyewear First Collection, the retro and distinctive SI-20073 is now available in a selection of 21st century colour options. “Reopening the design book and approaching classic models with the accumulated knowledge, skills and – most importantly – advanced materials and manufacturing, presents an excellent opportunity not only to reinvent the past, but to make it even better,” explained Hans. In its original carnation, the SI-20073 was already considered ‘retro’, reflecting even earlier classic frame designs. “A good design is always a good design, and this style is evergreen,” added Hans.
New year, new products As we launch our new Product Spotlight series for 2021, we take in a selection of new releases in a range of different categories.... Refraction “reinvented” with all-in-one device Delegation facilitation with Topcon Chronos
Topcon Healthcare is celebrating the European launch of its “revolutionary” Chronos Automated Binocular Refraction System with SightPilot guided refraction software. Topcon Chronos combines autorefraction, keratometry and subjective refraction, reducing the number of conventional refraction lanes and additional refractometers needed. “Simply put, Topcon Chronos reinvents refraction,” said John Trefethen, global VP of marketing and product design for Topcon Healthcare. “This revolutionary all-in-one system saves time and space and allows eyecare providers to delegate the refraction process and grow their practice. This technology changes the game forever, and we are thrilled to bring it to fruition.”
Prima styles pay homage to iconic ballet
Silhouette Bolshoi Grace model 8181
For the new 2021 sun season, Silhouette is launching the Bolshoi Grace collection, which pays homage to the world-renowned Bolshoi Theatre in Moscow. The styles have been designed to evoke the essence of a graceful ballerina, where lightness meets strength and flexibility. There are two distinct models: a cat-eye (model 8180) and a butterfly (model 8181). The space between the ring and the lens with a six base curve enhances the uniqueness of the design. The intricate, adjustable sides feature 23-carat gold in several layers, while the colour matches the classic precious metal tones of the frames, available in both shiny and matte surface finishes. Distinctive cut-outs on the sides echo the designs of the fronts, emphasising the styles’ lightness and sophistication.
Radiating elegance and glamour Luxury Zoffani model ZF3113 12
DISPENSING OPTICS JANUARY 2021
The latest styles from luxury eyewear range Zoffani from International Eyewear radiate elegance, glamour and femininity.
“Showstopping” model ZF3113 is an ultra-glamorous acetate style with its barrel shaped side trims encrusted with lavish Swarovski crystals for ultimate indulgence. “Sophisticated striation in rich brown and grey hues provide premium finesse and quintessential Zoffani luxury,” the company stated.
“Game-changing” anti-fog lens cloth Help patients keep their lenses fog-free with the new Free-From Fog lens cloth from Grafton Optical. Designed by optical professionals, the cloth is free from damaging solvents, and is said to keep lenses clear for at least 12 hours. FreeFrom Fog dry cloths can be used on all types of optical lenses, including cameras and those with special coatings and treatments, and each can be used up to 200 times. The cloths come in boxes of 25 pieces and can be found in Grafton’s online shop. The company stated: “Grafton Optical are excited to launch FreeFrom Fog. [It] has launched to very positive reviews and is already being hailed as a huge game-changer for glasses wearers.”
Demystifying lenses with Free-From Fog
New tool for dry eye relief Hycosan Shield is a new addition to the Hycosan range of dry eye solutions from Scope. Locking moisture in with a single, rapidly spreading drop, Hycosan Shield is said to work fast to alleviate sensations of evaporative dry eye disease and meibomian gland dysfunction. Its single ingredient drop replaces the lipid layer and prevents moisture from the aqueous layer evaporating. Shield’s lightweight drop also acts to keep harmful environmental matter out and can be used as often as required, the company added. The recent launch was supported by a digital-first multi-touchpoint consumer educational campaign. “We are investing behind the launch with a strong PR and social initiative designed to reach our target consumers when they are thinking about their eye health,” commented Leah Donnelly, UK brand manager for Hycosan Shield.
Locking moisture in
Sporty, lightweight and timeless Reflecting the brand’s spirit, the new Moncler Lunettes collection from Marcolin stays true to the distinctive three themes featured in previous collections. Firstly Sport, which showcases heritage-inspired frames designed for mountain and city wear alike; secondly Duvet, iconic eyewear that includes puffy-effect styles, crafted with an exclusive thermoforming technique that makes their structure extremely lightweight. Timeless is the third theme, which includes classic and retro-inspired shapes. Every style is made unique by distinctive details: rounded or rubber tips for extra grip and comfort, a tricolour metal logo and branded nose pads.
Modern take on classic rimless The Millmead Group’s Reykjavik Eyes Rimless Tech collection, produced in collaboration with Jai Kudo Lenses, is a modern take on the classic rimless style. All four styles, each available in three colours, feature a silicone band around the lens rim adding a pop of colour whilst defining the shape of the lens. Using screwless technology, each model is designed in lightweight titanium with silicone end tips and riveted heads. “The partnership with Jai Kudo Lenses harnesses their expertise to craft and glaze the styles to an extremely high level,” the company stated, “giving opticians the confidence to know their glazed Rimless Tech frame will be returned in the best condition.” Next month's Product Spotlight will feature practice instrumentation. To submit editorial or book a Product Spotlight Showcase, email email@example.com
Moncler ski mask model ML0130
Rimlesy Tech model Alexis JANUARY 2021 DISPENSING OPTICS
CET COMPETENCIES COVERED DISPENSING OPTICIANS Standards of Practice, Methods of Ocular Examination OPTOMETRISTS Standards of Practice, Methods of Ocular Examination
Getting to grips with OCT Part 1 By Prashant Shah BSc(Hons) MCOptom PGDipOphth DipClinOptom and Yashita Shah BSc(Hons) PGDipOphth ptical coherence tomography (OCT) is a quick, non-contact, non-invasive and reliable imaging technique, which has transformed ophthalmology and optometry practice. OCT provides both qualitative and quantitative (thickness and volume) analysis of the optic disc, macula and retina – and can be used to evaluate the anterior segment of the eye. It uses low coherence interferometry to produce a 3D image of the retina and can be performed with or without pupil dilation. OCT has been commercially available since 19961. As its use is increasing in primary eyecare settings, this article explores the benefits, limitations and history of OCT and its applications in practice.
O 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 May 2021 issue of Dispensing Optics. The closing date is 9 April 2021.
APPLICATION OF OCT IN PRACTICE OCT is currently being used for research, screening, diagnosing and monitoring pathology of the macula, retinal nerve fibre layer, optic nerve and anterior segment. It can be used to quantify structures and lesions and monitor progression over time. Treatment planning and response to treatment is another feature of OCT use; for example, if patients need additional therapy, OCT imaging can assist in clinical decision making.
Anterior segment OCT has a wide variety of clinical applications, including diagnosing and managing conditions such as ocular surface disease, keratoconus, corneal dystrophies and glaucoma. Other uses are for anterior chamber angle assessment, central corneal thickness measurement and contact lens assessment2,3. One of the more recent developments in OCT technology is OCT angiography. It is used to visualise the retinal and choroidal vasculature, which is useful in conditions such as diabetic retinopathy4. Unlike fluorescein angiography and indocyanine green angiography, it does not require the injection of contrast dye – so it is particularly beneficial in cases when a patient may have an allergy to the dye or in those with severe renal impairment4. This article focuses primarily on OCT application for common eye conditions encountered in everyday clinical practice. Therefore, anterior segment OCT and OCT angiography will not be discussed further as it is beyond the scope of this article.
ROLE OF A DISPENSING OPTICIAN As more optical practices are utilising OCT, optical assistants and dispensing opticians may be requested to take OCT images as part of the initial screening – as well as to promote the service to
PLAN YOUR CET TODAY
C-76735 Approved for one CET Point
DISPENSING OPTICS JANUARY 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.
Swept source based Narrow line width
Reference mirror Sample
Broad-band light source
sweeping light source
1-D detector Mirror image
Interference signal (FD) Intensity (arb.)
+z 0 Depth (mm)
Figure 1. Upper left shows the optical set up of SD-OCT and upper right shows SS-OCT. SD-OCT uses a spectrometer to separate wavelengths, whereas SS-OCT uses a light source which sweeps the wavelength in time. Bottom left of the image is the interference signal produced (FD). Bottom right of the image is the A-scan produced using Fourier Transformation (FFT) of the interference pattern/signal. Sample: Object of interest such as the retina (figure taken from: Drexler W, et al. Optical coherence tomography today: speed, contrast, and multimodality. J. Biomed Opt. 2014;19(7):071412)
patients and the general public before the sight test takes place. Whilst it is beyond the scope of a dispensing optician to interpret and analyse images in detail, it is advantageous for them to have some background knowledge of the retinal anatomy and to be able to recognise a normal scan from an abnormal one, thereby allowing them to flag any concerns directly to the optometrist. A basic understanding will also enable the dispensing optician to understand and relate patient symptoms to the OCT scan results.
BENEFITS OF OCT There are clear benefits to having an OCT in practice: • It has a high degree of sensitivity and specificity in detecting ocular pathology5-10, such as early stage primary open angle glaucoma or pathology not immediately visible on ophthalmoscopy such as cystoid macula oedema. Early pathology detection leads to better clinical decision making and prognosis for the patient • False positive referrals can be avoided, giving the optometrist more confidence in managing patients. It also allows referral
refinement so that the patient can be seen by the hospital eye service within the appropriate time scale • Optometrists who become confident in interpreting and analysing images can become involved in shared care schemes, which expands the scope of their clinical work and builds relationships with other healthcare workers • All-in-one devices, which incorporate retinal imaging with OCT, save space and time. They allow practitioners to compare a lesion on the OCT image to that on the fundus image • Patients appreciate and like new technology as this makes them feel that they are having a more thorough test. It also allows them to become more involved in their management and gain a better understanding of their eyes
HISTORY AND SCIENCE BEHIND OCT Low coherence interferometry is the underlying principle for all OCT designs1-2, 11-13 as shown in Figure 1. A laser diode (broad band light source in spectral domain OCT or sweeping light source in swept source OCT) emits low
coherent near infrared light (840nm) that travels to an interferometer. Here, the beam of light is split into two equal parts by a beam splitter (BS): one part travels through the ocular media to the retina (known as the measurement beam); and the other part travels to a reference mirror (known as the reference beam). The difference between the reflected light from the tissue being imaged and the light from the reference mirror, interact to produce an interference pattern, which is converted into a signal by a photosensitive detector (I-D detector or photodetector). These interference patterns give information about the intensity and depth of the reflected light from the measurement beam11-13. Fourier transformation (FFT) converts the interference pattern/signal into an Ascan. A-scans are stacked together either in a line or circle to form a 2D cross-sectional B-scan. B-scans can be stacked together to form a 3D image. Optical surfaces absorb, reflect and transmit the infrared signal. Differences in refractive index and scattering properties of the various different retinal layers produce the contrast on the images, which resemble a histological section. Tissue structures are represented in greyscale or in colour. Digital processing corrects eye movements and digital smoothing techniques are used to further reduce image noise11. Time domain OCT (TD-OCT) was the earliest system used, where a moveable reference mirror produced interference patterns as a function of time. It wasn’t ideal because the scanning speed was very slow at approximately 400 A-scans per second and it gave a poor resolution of 10 to 15 microns1,2,13. This led to the evolution of the second generation system: spectral/Fourier domain OCT (SD-OCT) which was demonstrated in 20031,2,13 (Figure 1, upper left image). Most OCT machines used in current practice are of this type. A spectrometer measures the interference patterns as a function of frequency whilst the reference mirror is kept stationary. The whole A-scan is generated at once based on Fourier transformation of the interference patterns1,2. Scanning speeds are significantly improved to approximately 50,000 A-scans per second therefore JANUARY 2021 DISPENSING OPTICS
Figure 2. A high resolution macula B-scan showing the 13 retinal layers and the various cells which make up the retina (image courtesy of Heidelberg Engineering) reducing scanning time. SD-OCT also has better resolution of images (3μm to 6μm) and improved visualisation of the retinal layers. The latest technology in OCT is swept source (SS-OCT) (Figure 1, upper right image). Here a sweeping, tuneable laser light source with a wavelength of 1050nm is used and interference output is measured as a function of time. The scanning speeds are considerably quicker – at approximately 100,000 A-scans per second – and larger areas can also be scanned in a single turn. The high imaging speed allows highresolution images (approximately 5μm) to be obtained while reducing the negative effect of the patient’s eye movements on scan quality. Signal-tonoise ratio is vastly improved13,14. The longer wavelength enhances the ability to image deeper ocular structures such as the choroid. SS-OCT can provide clearer images in patients with media opacities compared to conventional SD-OCT due to less light scattering13,14. Despite these advantages, SS-OCT is not commonly found in widespread optometric practice due to the high purchase cost of the machine.
LIMITATIONS OF OCT The following factors must be taken into consideration when analysing OCT images as they can affect the quality of the scan: • High prescription and axial length can affect accuracy
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• Poor signal strength: due to media opacities, ocular surface disease, miotic pupils, reduced tear film quality and motion artefacts • It is important to consider whether boundaries defined by the software have been placed correctly, otherwise thickness measurements may not be accurate and poorly centred scans may also make the statistical analysis inaccurate • Frequent blinking, tremors, nystagmus
RETINAL ANATOMY AND IMAGE INTERPRETATION OCT images represent an in vivo histology of the retina. Before they can be interpreted and analysed, it is important to understand the normal chorioretinal anatomy and what a normal OCT scan looks like. Only then can abnormal scans be detected. Figure 2 shows a high resolution OCT macula B-scan highlighting 13 layers of the retina including the choroid. Retinal anatomy can be complicated to understand. It is simpler to divide it into two zones: the inner retina and the outer retina. The top part of a B-scan is the inner retina, which lies closest to the vitreous humour. The inner retina consists of the internal limiting membrane through to the external limiting membrane (ILM, RNFL, GCL, IPL, INL, OPL, ONL, ELM). The vascular supply of the inner retina is from the central retinal artery; its largest
capillaries are innermost and its smallest capillaries outermost at the level of the INL and IPL15,16. These are usually the first to leak in diabetic eye disease. The outer retina is closest to the choroid (bottom of B-scan) and consists of the photoreceptor layers through to the choroid (PR, RPE, Bruch’s membrane, choriocapillaris and choroidal stroma). The outer retina is avascular and gets its oxygen and nutrient supply from the choroid17. Another way to understand retinal anatomy is to divide it into the neurosensory retina and the RPE/Bruch’s membrane complex. The neurosensory retina is classified from the ILM to the photoreceptor level. This layer is responsible for converting light into electrical signals, which are then sent to the occipital lobe in the brain for analysis and image construction. The neurosensory retina has high metabolic activity18. The RPE is a single layer of cells between the photoreceptors and choroid. Its three main functions are: to keep the neuroretina and sub retinal space dry by pumping out water; to prevent glare by using melanin to absorb excess light; and to remove waste products from photoreceptors to the choroid as well as moving oxygen and nutrients from the choroid to photoreceptors19. The photoreceptors and RPE have a very close relationship and any damage to or loss of these layers can result in poor vision20,21. Bruch’s membrane is a multi-layered structure, which allows the exchange of metabolic waste products, oxygen, nutrients and fluids between the RPE and choroid. Several factors such as age, gender and ethnicity can affect macular thickness22-24. The thinnest part of the macula is the fovea. The average central macular thickness is approximately 200 to 230 microns22-24. Being aware of this value enables the clinician to determine any abnormalities and potential concerns. Thickness values are usually shown on normative data plots/thickness map plots.
COLOUR SCAN VERSUS GREY SCALE SCAN The various layers on a grey scale B-scan appear as either bright (hyper-reflective) or dark (hypo-reflective) bands depending on whether the layer is reflecting or absorbing light (Figures 2
Figure 3. A high resolution macula grey scale B-scan on the right side of the image. Left image is the fundus and OCT was taken along the green line Annotate: Ellipsoid zone (red arrow), area under fovea (blue arrow), retinal BV (purple arrow), RNFL (yellow star), macula (white circle) (image courtesy of Heidelberg Engineering) and 3). In a colour OCT scan, the warm colours indicate high reflectivity (red, yellow, white) and the cooler colours (green and blue) indicate low reflectivity (Figure 4). Grey scale resolution tends to be better and is more widely used for image interpretation.
HYPER-REFLECTIVE LAYERS AND LESIONS The RNFL, inner and outer plexiform layers, ELM, inner segment photoreceptor layer, RPE/Bruch’s complex, blood, exudates and pigment clumps will all appear hyper-reflective on an OCT scan. Blood and exudates, although appearing hyper-reflective, can themselves cast shadows on the scan below their location as they block the infrared light signal. Shadows are always cast downwards as the infrared light comes from the front of the eye down to the retina.
HYPO-REFLECTIVE LAYERS AND LESIONS The ganglion cell layer, layers with cell nuclei such as the inner and outer nuclear
layer, and the outer segment photoreceptor layer all appear hypo-reflective on an OCT scan. The vitreous humour and serous fluid also appear hypo-reflective. A point worth noting is that serous fluid, unlike blood or exudates, does not cast a shadow on the retina below its location. This is because fluid is clear and therefore does not block the infrared light falling on the retina. Fluid can be: intra-retinal, when it is located above the photoreceptors; sub-retinal, which forms below the photoreceptors but above the RPE; or sub-RPE, when it forms below the RPE. Key signs to be aware of when assessing the OCT B-scan images: • The photoreceptor inner segment/ outer segment junction (also known as the photoreceptor inner segment ellipsoid zone) is clearly visible on OCT (indicated by the red arrow in Figure 3). A well-defined, hyperreflective ellipsoid zone indicates good visual acuity and good photoreceptor function. Disruption of this zone represents
Figure 4. A high resolution macula colour B-scan of the same eye as Figure 3. Warm colours indicate hyper-reflectivity and cooler colours hypo-reflectivity. Grey scale OCT scans show layer detail better (image courtesy of Heidelberg Engineering)
photoreceptor damage and a corresponding drop in a patient’s visual acuity25,26 • The outer segments of cones under the foveal pit are longer and narrower than any other part of the retina. Due to a high concentration of cones in this region, the centre under the foveal pit appears slightly raised (indicated by the blue arrow in Figure 3). This is a normal physiological finding and is required for good visual acuity27-29 • The retinal nerve fibre layer is thickest nasally and thinner temporally. The thicker side represents the collection of nerve fibres from the macula to the optic nerve (indicated by the yellow star in Figure 3) • The retinal blood vessels are highly reflective and cast a shadow through the whole OCT section because they block the infrared signal (indicated by the purple arrows in Figure 3) • The vitreous humour is 98 per cent water and two per cent collagen. Since it is optically empty, it appears hypo-reflective on an OCT scan. Vitreous floaters, if present, will appear hyper-reflective in the vitreous cavity. However, if they are large enough they can cast a shadow through the whole retina • If the choroid appears illuminated, it means less infrared light has been absorbed by the neurosensory retina and RPE. Effectively a reverse shadow is produced, for example, in advanced dry macula degeneration OCT is extremely useful in differentiating features that have similar retinal appearances: for example, drusen and exudates, both of which are yellow retinal lesions. On an OCT scan, however, they are easily differentiated by their location. Drusen are photoreceptor waste products, which accumulate at the level of the Bruch’s membrane/RPE. They appear as focal, hyper-reflective RPE elevations. Exudates are lipid residues which have leaked from damaged inner retinal blood capillaries and are located in or adjacent to the OPL. All OCT instruments are able to image and assess the optic nerve head, RNFL thickness and ganglion cell layer at JANUARY 2021 DISPENSING OPTICS
CET the macula, which can be useful as part of glaucoma detection and monitoring. Algorithms compare RNFL thickness and ganglion cell values to stored, agematched, normative databases. This allows areas of increased or decreased thickness to be identified and monitored for any changes over time.
EVALUATING OCT IMAGES Normal variations in OCT images and data are crucial to understand in order to help differentiate normal from abnormal scans. OCT scans should always be interpreted in conjunction with other examination results: history and symptoms, visual acuity, intraocular pressures, visual fields and fundus exam. Using a systematic and structured approach when assessing the OCT image will help to ensure the scan is of good quality and that potential pathology is flagged.
Assess the scan quality There is usually a colour coded scale from 0 to 10 displayed. Seven and above indicates a good quality scan and this can be indicated by a green colour. Points to note: Is there a good laminar structure? Can the inner and outer retina be identified? Is there a good signal to noise-ratio?
Assess the overall scan profile and appearance The overall normal retina profile at the macula has a slightly concave appearance (Figures 2 and 3). If the concavity or adjacent convexity is exaggerated then the profile would be abnormal. The scan profile will change depending on where it is placed in the eye. Points to note: Does it look like a reasonably good image? Does it look normal or not?
Assess the structure and layers of the retina for any abnormalities or changes It is important to assess the preretinal/epi-retinal layers, intra-retinal layers, and sub- neurosensory retina and sub-RPE for any abnormal changes. OCT has become an essential part of an optometrist’s toolkit assisting in better detection, diagnosis and management of various ocular conditions. Dispensing opticians are well placed in the optical setting to take good quality OCT scans and to recognise
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common ocular conditions. A good understanding of the retinal anatomy is vital for this. In the second article next month, we will look at case studies where OCT scans were used in the diagnosis and management of various ocular conditions. Specific signs and features of each condition will be discussed. 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. Fujimoto J, Swanson E. The development, commercialization, and impact of optical coherence tomography. Invest Ophthalmol. Vis Sci. 2016;57(9):OCT1‐OCT13. 2. Ang M, Baskaran M, Werkmeister RM et al. Anterior segment optical coherence tomography. Progress in Retinal and Eye Research. 2018;66: 132-156. 3. Vincent S J, Alonso-Caneiro D, Collins M J. Optical coherence tomography and scleral contact lenses: clinical and research applications. Clinical and Experimental Optometry. 2019;102(3): 224-241. 4. Gao SS, Jia Y, Zhang M et al. Optical coherence tomography angiography. Invest. Ophthalmol. Vis Sci. 2016;57: OCT27–OCT36. 5. Al-Mujaini A, Wali UK, Azeem S. Optical coherence tomography: clinical applications in medical practice. Oman Med. J. 2013;28(2): 86‐91. 6. Bengtsson B, Andersson S, Heijl A. Performance of time-domain and spectral-domain optical coherence tomography for glaucoma screening. Acta Ophthalmol. 2012;90(4):310‐315. 7. Flores‐Rodríguez P, Gili P, Martín‐Ríos MD. Sensitivity and specificity of
time‐domain and spectral‐domain optical coherence tomography in differentiating optic nerve head drusen and optic disc oedema. Ophthalmic Physiol. Opt. 2012; 32:213–221. 8. Goatman KA. A reference standard for the measurement of macular oedema. Br. J. Ophthalmol. 2006;90(9): 1197‐1202. 9. Tomidokoro A, Hangai M, Yoshimura N et al. Sensitivity and specificity of thickness measurements of macular ganglion cell layer and ganglion cell complex using spectral-domain OCT for diagnosis of preperimetric or early glaucoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):216. 10. Chang RT, Knight OJ, Feuer WJ et al. Sensitivity and specificity of timedomain versus spectral-domain optical coherence tomography in diagnosing early to moderate glaucoma. Ophthalmology. 2009;116 (12):2294-2299. 11. Hiscox R. Discover what lies beneath. Optometry Today 2014;C-36203:40-43. 12. Guedes V, Schuman JS, Hertzmark E et al. Optical coherence tomography measurement of macular and nerve fiber layer thickness in normal and glaucomatous human eyes. Ophthalmology 2003;110:177-189. 13. Popescu DP, Choo-Smith LP, Flueraru C, et al. Optical coherence tomography: fundamental principles, instrumental designs and biomedical applications. Biophys. Rev. 2011;3(3):155. 14. Kishi S. Impact of swept source optical coherence tomography on ophthalmology. Taiwan Journal of Ophthalmology 2016; 6(2):58-68. 15. Hiscox R. Blood supply to the retina. Optometry Today 2016;C-52874. 16. Oyster CW. Blood supply and drainage. In: Farley P (ed). The Human Eye Structure and Function. USA: Sinauer Associates Inc, 1999; Chapter 6: p275-277. 17. Oyster CW. Blood supply and drainage. In: Farley P (ed). The Human Eye Structure and Function. USA: Sinauer Associates Inc, 1999; Chapter 6: p269-275. 18. Oyster CW. Retina I: Photoreceptors and functional organisation. In: Farley P (ed). The Human Eye Structure and Function. USA: Sinauer Associates Inc, 1999; Chapter 13: p549-557. 19. Oyster CW. Retina I: Photoreceptors
and functional organisation. In: Farley P (ed). The Human Eye Structure and Function. USA: Sinauer Associates Inc, 1999; Chapter 13: p579-585. 20. Strauss O. The retinal pigment epithelium in visual function. Physiol. Rev. 2005;85:845-881 21. Oyster CW. Retina I: Photoreceptors and functional organisation. In: Farley P (ed). The Human Eye Structure and Function. USA: Sinauer Associates Inc, 1999; Chapter 13: p545-557. 22. Grover S, Murthy RK, Brar VS et al. Comparison of retinal thickness in normal eyes using Stratus and Spectralis optical coherence tomography. Invest. Ophthalmol. Vis. Sci. 2010;51(5):2644-2647. 23. Song WK, Lee SC, Lee ES et al. Macular thickness variations with sex, age, and axial length in healthy subjects: A spectral domain optical coherence tomography study. Invest. Ophthalmol. Vis. Sci. 2010;51(8):3913-3918. 24. Chan A, Duker JS, Ko TH et al. Normal macular thickness measurements in
healthy eyes using Stratus optical coherence tomography. Arch. Ophthalmol. 2006;124(2):193‐198. 25. Turgut B, Demir T. The new landmarks, findings and signs in optical coherence tomography. New Front. Ophthalmol. 2016;2(3):131-136. Acta Ophthalmol. 2012;90(4):310‐315. 26. Tao LW, Wu Z, Guymer R et al. Ellipsoid zone on optical coherence tomography: a review. Clinical and Experimental Ophthalmology 2016; 44: 422-430. 27. Purves D, Augustine GJ, Fitzpatrick D et al. Anatomical distribution of rods and cones. In: Purves D, Augustine GJ, Fitzpatrick D, et al (eds). Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK10848/ 28. Oyster CW. Retina III: Regional variation and spatial organisation. In: Farley P (ed). The Human Eye Structure and Function. USA: Sinauer Associates Inc, 1999; Chapter 15: p660-661. 29. Hiscox R. What you should know about
OCT assessment – Part 1. Optician. October 2014.
SUGGESTED FURTHER READING Yoshimura N, Hangai M. OCT Atlas. Tokyo: Igaku-Shin Ltd; 2012. Available at: https://media.heidelberg engineering.com/downloads/ebooks/ OCT-Atlas-Hangai_EN.pdf Bille JF. High resolution imaging in microscopy and ophthalmology. Switzerland: Springer Nature Switzerland AG; 2019. Available at: https://link.springer.com/ content/pdf/10.1007%2F978-3-03016638-0.pdf Rougier MB, Delyfer MN, Korobelnik JF. OCT and Retina. France: Laboratoires Thea and Carl Zeiss Meditec. Available at: https://www.laboratoires thea.com/medias/oct_and_retina_thea_ website.pdf Oyster CW. The Human Eye Structure and Function. USA: Sinauer Associates Inc; 1999.
Multiple choice answers Dry eye. Recent evidence surrounding the lack of correlation between signs and symptoms. By Clare Hayes FBDO CL SFHEA C-76020 – published September 2020 Six of the following questions were presented online to entrants to comply with the General Optical Council’s best practice specifications for this type of CET. Research suggests a large proportion of the population are affected by Dry Eye Disease (DED). The global reported prevalence is: a. between 20-30 per cent b. between 25-35 per cent c. between 5-15 per cent d. between 5-75 per cent d is the correct answer. It is suggested in the Dry Eye Workshop II 2017 (DEWS II) that global prevalence is between five and 75 per cent. Further information can be found at TFOS DEWS II report executive summary. The Ocular Surface 15:802-812.
The term homeostasis describes: a. a stable equilibrium between interdependent elements b. an interruption in production of the tears c. an unstable equilibrium between interdependent elements d. an overproduction of the tears a is the correct answer. Homeostasis is the tendency towards a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes. Further information can be found at: https://www.tearfilm.org/public/TFOSDEWSIIExecutive.pdf (Section 2). JANUARY 2021 DISPENSING OPTICS
MCAs Which is not a generally accepted clinical sign of dry eye disease (DED)? a. Reduced tear break up time b. Corneal and/or conjunctival staining c. General discomfort d. Lid wiper epitheliopathy c is the correct answer. General discomfort is a symptom that patients may experience and report to their Eyecare Practitioner. More information can be found at: Ridder W, Tomlinson A, Huang J, Li J. Impaired visual performance in patients with dry eye. The Ocular Surface 2011;9(11):42-54. Lid wiper epitheliopathy (LWE) has also been highlighted as a sign of DED. Which sentence is correct? a. The lid wiper is responsible for tear production b. The lid wiper is responsible for spreading the tears across the ocular surface c. The lid wiper covers the whole of the eyelid d. The lid wiper encourages the production of mucous in the tears b is the correct answer. The lid wiper is responsible for spreading the tears across the ocular surface. Further information can be found at: https://iovs.arvojournals. org/article.aspx?articleid=2678073 Patient questionnaires can be used by ECPs as an aid to diagnosis and management of DED. The most commonly used questionnaire in practice, The Ocular Surface Disease Index (OSDI), uses questions that focus on vision and lifestyle. How many questions does it ask? a. Ten b. Fifteen c. Twelve d. Eight c is the correct answer. The questionnaire uses 12 questions that focus on vision and lifestyle and asks the patient to score each statement from ‘none of the time’ (1) to ‘all of the time’ (4) and then uses a formula to generate an overall mark from 0 to 100. Further information can be found at: McMonnies, C. Measurement of symptoms pre and post treatment of dry eye syndromes. Optometry and Vision Science 2016;93(11):1431-1437. In 2018, Ngo et al investigated what is often believed to be the two largest potential contributing factors to DED. What are these two factors? a. Age and smoking b. Age and Sex c. Sex and injury d. Smoking and Injury b is the correct answer. In September 2018, Ngo et al published results of a small sample study of 20 symptomatic and 20 non symptomatic women. Further information can be found at: Ngo W, Srinivasan S, Jones L.
A comparison of dry eye diagnostic tests between symptomatic and asymptomatic age-matched females. Eye & Contact Lens 2018;44:110-114. The research carried out in 2017 by Vehof et al suggests that study participants with Sjögren’s syndrome showed lower subjective OSDI scores than the signs would suggest. Which statement best describes Sjögren’s syndrome? a. Sjögren’s is a disease of the eyes b. Sjögren’s is a disease of the saliva glands c. Sjögren’s is a life limiting disease d. Sjögren’s is an auto immune disorder d is the correct answer. Sjögren’s syndrome is classified as an autoimmune disorder, one of a large group of conditions that occur when the immune system attacks the body’s own tissues and organs. In Sjögren’s syndrome, the immune system primarily attacks the glands that produce tears (the lacrimal glands) and saliva (the salivary glands), impairing the glands’ ability to secrete these fluids. Further information can be found at: https://www.nhs.uk/conditions/sjogrens-syndrome/ DED classification is helpful and aids ECPs in the diagnosis and treatment of DED. The TFOS DEWS II report introduces three main classifications to aid management. What are the three classifications? a. Aqueous deficient, mixed and evaporative b. Aqueous deficient, evaporative and Sjögrens c. Evaporative, mixed and non – Sjögrens d. Sjögren’s, aqueous deficient and mixed a is the correct answer. DEWS II provides the following table to aid in the classification. However, DEWS II also report that the classification of DED are not mutually exclusive and exist on a continuum with the patient possibly moving between classifications and having overlap. More information can be found at: https://www.tearfilm.org/ public/TFOSDEWSII-Executive.pdf Which two indicators are suggested as the most reliable indicators of dry eye? a. Reduced visual acuity and reduced tear break up time b. Tear osmolarity and Lid wiper c. Corneal and conjunctival staining d. Poor quality meibum and reduced contrast sensitivity b is the correct answer. The literature pre-DEWS II and DEWS II itself would seem to indicate that tear osmolarity and the lid wiper are the most reliable indicators of dry eye and may provide the missing piece to link signs and symptoms. Further information can be found at: Sullivan B. Challenges in using signs and symptoms to evaluate new biomarkers of dry eye disease. The Ocular Surface 2014;12(1):2-9; and Efron N, Brennan N, Morgan P, Wilson T. Lid wiper epitheliopathy. Progress in Retinal and Eye Research 2016;55:140-174.
Participants are advised that the GOC’s Enhanced CET Principles and Requirements v4 document states that for text article CET questions: “A proportion of the questions should require the application of existing professional knowledge to determine the answer”. This can include personal research online, or following up the article references.
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POLICY UPDATE – OUTLOOK FOR 2021 DEBBIE MCGILL
Year of change ahead ell, that didn’t go to plan. 2020: the year we shelved our objectives and prioritised supporting our members and the wider profession through such unprecedented times, and when the most used words in my working world were: “You’re on mute”. Without doubt, 2020 was a year that impacted everyone in a variety of ways – and continues to do so. For those who have lost loved ones, my sincere condolences; to those who have lost jobs and those who are just getting through the day, ABDO is here for you. Please remember: it is good to talk and our membership team is here to help you, or to signpost you to those who can. So do give them a call to discuss any issues you might be having. At the time of writing this update, the UK is in a tiered lockdown with many areas experiencing different levels of restrictions. However, all optical practices are permitted to remain open to deliver eyecare regardless of the tier level they are in. Recently, I have been involved in meetings throughout the UK in relation to the primary care Covid-19 vaccine delivery plan. There have been two sides to these discussions: one was regarding the use of optical practices as primary care settings where patients could receive their vaccines; and the other was the hope (and expectation) that optical professionals and their staff would be at the head of the queue to be vaccinated in their roles as frontline primary care workers. At a recent meeting in England, we were informed that optical practices would not be used to deliver the vaccine – but that optometrists and dispensing opticians could register their interest in getting involved in the sites that would be used. At the time of writing, the options were still being discussed in the other countries. However, it is hoped that by the time of publication, a vaccination programme for frontline primary eyecare practitioners and their staff will have been confirmed.
VACCINATION PROGRAMME DISCUSSIONS ARE ONGOING
PROJECTS BACK ON TRACK With the Covid-19 situation stabilising, I have been able to pick up where I hit pause in March. I have resumed conversations with optical government funding representatives to engage in discussions with DOCET to enable dispensing and contact lens opticians access to funding for CET. In England, the special schools project has resumed and part of this will be to deliver training to all professionals involved. We are looking to access adult safeguarding training and education on treating learning disabled and autistic patients through DOCET, which already has these courses available, and to save costs. If you are a dispensing optician working in England within the vicinity of a special school, and would be interested in getting involved, please contact me direct. Also in England, work is continuing in relation to the Ophthalmology Restoration and Transformation Programme, which we are engaged with. This project will explore how optical primary care can support and enable change to be delivered. The Welsh government is currently consulting with the optical profession and stakeholders on its review of the delivery of eye health care. This will increase opportunities for the roles of the profession to evolve, and utilise
primary care optical practices to their full potential. It is hopeful that in Scotland, we will be able to achieve NHS listing of dispensing opticians, enabling them to contribute more to what is already offered within optical practices. Another priority for Scotland is the national low vision project. Similar discussions about how eyecare can be delivered more efficiently are being had in Northern Ireland, and we are optimistic that this will provide further opportunities for our members here too. There is so much potential for 2021 to be the year of change, and to increase the eye health care delivered by optical primary care providers throughout the UK. We certainly have a plan where dispensing and contact lens opticians can support this, based on what they can – and are – already delivering. This includes high quality dispensing, paediatric eyecare, contact lens care, low vision services, to name a few. There is scope to develop all primary care optical professionals’ roles in line with patient need/demand – and if 2020 has taught us one thing, it is the benefit of upskilling the profession. We know our members are keen to maintain and develop what they deliver, and will embrace change with enthusiasm – as they always do. DEBBIE MCGILL is ABDO head of policy. Email firstname.lastname@example.org JANUARY 2021 DISPENSING OPTICS
IN PRACTICE – BUSINESS PLANNING ANTONIA CHITTY
On track for 2021 managing a practice, training to become a CLO or even an optometrist – not forgetting the opportunity to be your own boss.”
lanning for 2021 is fraught with difficulty, whether you are an optical assistant, student, business owner or manager. We are in the midst of a pandemic the like of which has not been seen this century. Optical practices were limited in what they could offer for a significant part of 2020, and the knock-on effects will impact upon business flow this year and into next. In this article, you can learn about goal setting for you and your business, and discover how one practice owner/manager is aiming for success regardless.
CAREER CHALLENGES If you are working in practice, you may have plans for your career. But for many people, plans had to be put on hold in 2020 as businesses faced financial constraints and staff were furloughed. January is a great time to revisit your plans, address barriers that stopped you last year, and work out how you will take the next steps in your career. Take some time when you have a quiet half an hour to picture where you could be in five years’ time. Do you see yourself at the front of the practice, working as a managing dispensing optician (DO), ensuring that staff work together as a team to deliver a great customer experience? Or are you in a clinical role as a DO, contact lens optician (CLO) or optometrist? Perhaps you are happiest with pliers and frame heater in hand, adjusting a great pair of frames that suit the patient, confident that they will walk out of your practice feeling like a million dollars? Having that clear vision can really help you to work out the small steps you need to take to achieve your goals, and give you something to work towards when times are tough. Kevin Gutsell is a tutor for ABDO College and has helped students succeed in their careers over many years. He says: “One problem faced by current students mid-way through their studies
DISPENSING OPTICS JANUARY 2021
Are you happiest with pliers and frame heater in hand? is if they discover they are about to be made redundant.” Whatever barriers you face right now, Kevin advises: “Stay calm and construct a plan of action. Support for students at work or in college is there and often it is just a matter of asking for help. Your supervisors, the college team and the ABDO Membership Department can all be a source of help. And don’t forget to talk to your fellow students. It can be hard not to be worried or anxious about the course or employment. Life is different and often difficult at the moment and, at times, it seems that people are very busy, but generally I find people do have time to listen and to be as helpful as they can.” If you need to find a new job unexpectedly, check out ABDO’s bimonthly Vacancies eNews and look for jobs on DO Online. Kevin adds: “Use social media in a positive way to ‘sell’ yourself. Message local opticians and follow this up after a week. I suggest not to send your CV at this stage although you should have this up-to-date and ready. Engage with other students you will have met at college, and register with agencies in the sector.” Kevin concludes: “Training to become a DO is a great idea. This can lead to
Having goals is key to business success. It is all too easy to allow your practice to drift, but goals ensure that you steer the business in the direction you want. If you are finding it hard to know what are achievable and realistic goals for 2021, read on. As well as being optically qualified, David Samuel has a marketing degree and an MBA from Reading Management Unit. He is now a full-time leadership and business coach. He says: “If I was setting goals for an optical practice this year, my first goal would be around my team. One of my favourite models is where you grade your team on knowledge and engagement and work out a strategy for each person. You need to consider how you develop people who are both engaged and knowledgeable; what do you do about those who are neither, those with a lot of knowledge but less engagement, and so on. Thinking in this way can help you work with your team to set personal goals.” David continues: “My second goal would be around delegation. What can you delegate to your team to reduce your own workload so you can focus on working on
You can look for peer groups within optics, such as SightCare or the National Eyecare Group, or networking groups such as those run by the Federation of Small Businesses. David adds: “I run a group which stretches from Forfar to Salisbury to Denmark. Members can share ideas without worrying if they are competing. We meet fortnightly on Zoom, alternating between evenings or early mornings, and members stay in touch continually between meetings.”
Look out for jobs on DO Online the business rather than in the business? One of the best tools I have seen suggests that you grade your ‘to do’ list as A, B, C, and D. Each month, you focus on As, and delegate Ds. If you repeat this each month, you are working on the top quarter where your skills are most needed. And the stuff in the middle will rise in importance or drop so you can delegate it.” If you are struggling to develop key performance indicators (KPIs) based on an atypical 2020, David suggests: “Develop forward looking KPIs. Don’t look at what you did last year – instead work out what to do now to generate revenue. For example, look at how many people come in after one, two and three reminders. Apply that to people who have just come in and you can project how many people you will be seeing in two
years’ time, giving you the chance to plan activities to build on that. And, most importantly, think how best to treat your patients so more of them come back. It is worth doing a proper cash flow plan, with ‘worst’, ‘best’ and ‘most likely’ case scenarios, so you can track performance.” Developing your business on your own can be hard, and with 2021 shaping up to be as challenging as 2020, it is worth looking at how you are supported as a business owner or manager. David suggests: “If you are struggling, find a peer group. The other day I spoke with someone who runs a £2m business who has had to make a lot of changes since Covid-19. He’s a new MD, cash is tight, so we sat together and talked about the challenges. At the end he said, ‘I feel a thousand times better for having talked about it.’”
“PEER SUPPORT REALLY HELPED ME”
Jay says: “SightCare set up peer support groups during lockdown. I met online with four or five other practice owners, every fortnight for an hour. It helped me discover my concerns were other people’s concerns too. I feel these sessions encouraged me to communicate better with my team who were on furlough. It really helped my team knowing they were still involved, even at a distance, and it helped us to plan reopening, as they weren’t in the dark.” After a few months that group disbanded, and Jay joined SightCare Premium. He says: “I saw the value in closeness with other practitioners. This is better than what I had in lockdown as I also have a one-to-one with a mentor, which makes a significant difference. I now have someone I’m accountable to.
Jay Patel is an optometrist and director of Martin Reynolds Opticians in Bishop Stortford. He has discovered the benefits of mentoring and peer support since the first lockdown in March 2020, and has continued to get valuable support since then.
Check out ABDO’s mentor matching service, which aims to help you with career growth and development by strategically matching those who are looking for knowledge or advice with suitable mentors. Sightcare Premium includes membership of a Premium Peer Group – a group of like-minded business owners committed to help each other and a dedicated business coach to question your thinking, hold you to account and critique your plans. The National Eyecare Group (NEG) runs its NEG Business Club in partnership with Practice Building, offering free basic membership for NEG members. Visit the Growth section of ABDO’s Business Support Hub to find resources on business development and goal setting. And check out the Leadership section for more on mentoring and career development. ANTONIA CHITTY BSC (HONS), MA, MCOPTOM, MCIPR is ABDO head of communications and author of 20 books on business, health and special needs.
“Mentoring has also helped my personal development,” Jay continues. “We look at things like managing my concerns, my time, how to deal with conflict, leadership skills. As professionals, we aren’t trained in these things and having a mentor helps me put things into perspective. I’ve had my practice for 13 years, and always thought I could manage it well – but it’s not just about that, it’s about the team, about lifestyle. We used to live to work, now we work to live.” Jay has also used the sessions to set goals for his business. He says: “In 2021, I aim to increase my staffing levels: we are a small team and could afford one or two more members. If all goes well, I hope to have a shop fit. I want to improve the team spirit even more, and get a better work-life balance for all of us.” JANUARY 2021 DISPENSING OPTICS
REGION UPDATE – SOUTH OF ENGLAND STUART PELL
All in this together irstly, I would like to wish everyone a happy New Year. Let’s hope 2021 brings us out of the pandemic and into prosperous times ahead. I write this article late into the second national lockdown and, unlike during the first wave, I have been lucky enough to work all the way through this time – with all the required safety procedures in place to protect the workplace, staff and patients alike. Returning to work meant challenges for all in terms of permanent masks and visors, often causing communication problems. The constant steaming up of optical equipment has led to innovative ways to keep lenses and eyepieces warm. The never-ending cleansing process has taken its toll – and often after long days returning from work, I have felt mentally and physically exhausted. But our patients have been delighted that we’ve been open and able to service their eye, spectacle and contact lens needs. From speaking with ABDO members and local leads, it’s clear that not all dispensing opticians have been able to remain in employment. Many are working reduced days and this brings its own stresses – both financially and mentally. I would urge any ABDO member, who may be struggling, to contact the Membership Department where we have a fantastic support structure in place whatever your circumstances or needs. On a more positive note, the lockdown has enabled new methods of communication – none more so than the recent online ABDO Consultation Day, which was very well attended. In the south region, we have been busy over the past six months with regular Zoom updates enabling local leads to quickly feed information back to the local optical community. Information from the ground has also been fed back to ABDO, where we are always open and happy to help no matter how big or small the issue. Following our national Zoom update that was available to all members, I have now opened my UK South regular Zoom updates to all ABDO members and urge you to contact me by email for details. All members are most welcome to come and chat with colleagues and discuss recent optical matters.
LOCAL PERSPECTIVE Local lead Grace Haine is a dispensing optician and practice owner in Dorset. She explains how she’s been coping through the pandemic: “Initially, it was a bit of a shock to the system, as I thought Boris was going to stick to his guns and go for herd immunity. Then suddenly it was all change and everything was shut down. My employed optometrist was on the shielding list, so I immediately knew I would be without cover. I was back in practice within a week of the first lockdown
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Stuart in practice commencing, so that we could offer a telephone triage service. We did many frame repairs in the first couple of months, and initially I personally delivered replacement contact lenses to patients’ homes. “There was a large amount of information coming in from all sides, so it was a matter of sorting through all the missives from NHS England, the Association of Optometrists, ABDO and locally to make sense of it. “ABDO was very quick to set up regular online meetings to keep us local leads up-to-date with the latest guidance, and I had the same within the Local Optical Committee Support Unit. I tried to pass on as much information as possible within our local network of contacts, but with many practices closing completely it was challenging. “My practice has remained operational throughout so we were able to offer more care as restrictions gradually eased, and I completed my ABDO Covid-19 risk assessments as we went along. “Personally, the worst worry for me has been the time it has taken for the interim average GOS payments to be agreed and then paid to us. That was a financial worry that was agreed so much more quickly in Wales and Scotland. However, I know all parties involved on our side were doing their best. “I am lucky because I have developed a network of optical contacts, and I could not have come through these strange times without them and my team at work. I think that that’s one of the most important lessons I have learnt through this: not to isolate yourself as an independent practice. Get involved and active in your professional bodies online and, when possible again, in person. You will receive as much help as you give, and it will help to keep you sane and smiling,” Grace concluded. STUART PELL FBDO CL SMC (TECH) is ABDO regional lead for the South of England.
OA CORNER PART 1
SOCIAL MEDIA TIPS: DON’T RUN BEFORE YOU WALK
YOUR PATHWAY TO A REWARDING NEW CAREER
f you are limited for time, or are starting out with social media for your practice, choose one platform and build that up before you move on to the next. It is better to have one brilliant account than three mediocre accounts. Forty-five million people use Facebook in the UK – so Facebook is a great place to start. Why not use ABDO’s EyecareFAQ graphics and information on your social media account? They are available from the ABDO website to share free of charge as a benefit of your membership. In EyecareFAQ this month, we will be covering Healthy You, Healthy Eyes, Food and Eye Health and Colour Vison. Find Q&As on more topics in the Information for the public section of the ABDO website. Don’t forget: you can find EyecareFAQ on Facebook, Twitter, Pinterest and Instagram too.
The role of an optical assistant (OA) is an exciting and varied one. It can be rewarding, challenging and incredibly interesting, with no two days the same. If you’re an OA, or are thinking of becoming one, don’t miss our NEW MONTHLY SERIES on DO Online, written by Sue Deal FBDO R, packed with useful tips and resources for OAs who want to extend their knowledge. Sue will also help new OAs understand more about the role. In OA Corner Part 1: Becoming an optical assistant, published in the features section of DO Online, learn about the qualities you need to be an OA, training courses, how to develop your skills, and further career opportunities. In Part 2 next month, Sue will explore how great communication skills can help you in your role – whether you’re a receptionist or an OA. Discover more about the OA role via our Youth Employment UK Careers in Eyecare Hub.
OAs give a warm welcome and help patients choose the right products Congratulations to our November Competition Corner winner: Aimie Watson.
FIVE REASONS TO USE STRUCTURED MANAGEMENT TRAINING 1. Better employee engagement Giving feedback is a skill of successful leaders. Through management training, managers can learn effective ways of providing feedback to motivate and increase the skills levels of their team members.
2. Better productivity Well-trained managers are able to set realistic goals, develop strategic work plans and make good decisions quickly. Structured training will teach managers how to understand and learn about their team members, to obtain the best results from each individual.
3. Effective management style Management training teaches managers to review their styles of management and assess and understand the effectiveness of it within the business. This enables managers to understand how they can lead their teams in the most effective way, with the end result being a motivated and productive team with minimum conflict.
4. Improved staff retention There can also be benefit in training your managers in the form of a ripple effect. Improving the outcomes of
training delivered to the team, it can boost morale and staff loyalty. By investing in management training, you can retain your people and reduce recruitment costs.
5. Better decision making Management training teaches leaders how to identify and minimise risk, use data effectively and identify the best possible solutions that benefit the business on the whole. Decision-making skills can be improved through training, e.g. how to reframe a problem and make evidence-based decisions. Visit the ABDO Business Support Hub for more information about the ABDO Level 5 courses in Management & Leadership. Applications for the next intake are now open. ABDO members receive a discounted rate compared to non-members. JANUARY 2021 DISPENSING OPTICS
Are you passionate about a career in eyecare? ABDO is working with Youth Employment UK to promote careers in eyecare. If you are age 18-25 and would be willing to talk about your job and your career, please email email@example.com
To place an advert, telephone 0781 273 4717 or email firstname.lastname@example.org. Booking deadline for the February issue is Friday 8 January. Special rate for ABDO members. Visit DO Online to place your online jobs vacancies, as well as practices for sale
DISPENSING OPTICS JANUARY 2021
A CL PP O LIC SI A N T G IO SO N O S N
Grow your practice, develop your team ABDO College offers great courses to help your staff develop Optical Assistant This course is designed for all support staff working in optics, from entry level to those who want to develop skills and knowledge gained in practice. The course offers an introduction to formal learning for students in the area of optics to help them progress in their optical career and educational pathway. It will help staff to contribute more in practice and increase the range of skills they have to support professional staff and answer patient queries.
Staff will develop knowledge of lenses, frames, contact lenses and optical roles, adding to their confidence and knowledge. • Learn online • Complete practice based tasks • Individual tutor support • Optional repairs and pre-screening workshop • Continuous assessment – no examinations • No previous qualifications required • Gives access to year 1 of the FBDO diploma • Lasts 25 weeks • Cost: £795
Why ABDO College? • A proven track record since 2001 • A range of courses to suit your needs • Dedicated and experienced academic staff • Friendly and supportive learning environment • Consistently high theory and practical examination results • Flexible payment plans • Helpful course tutors For more details and to apply: visit www.abdocollege.org.uk call 01227 738 829 (Option 1) or email email@example.com
Applications close 11 January 2021
KEEPING EXCELLENCE IN YOUR SIGHTS
The monthly journal of the Association of British Dispensing Opticians