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www.optometry.co.uk February 28 2014 vol 54:4 ÂŁ4.95

Manchester Royal Eye Hospital bicentenary

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CONTENTS

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February 28 2014 vol 54:4

5 GOC consults on illegal practice

Regulator announces plans to tackle misuse of protected titles and unregulated supply of CLs online

6 Cells discovery

Chemical compounds which allow other cells in the eye to act as photoreceptors are discovered

7 Dua layer glaucoma link

Researchers say corneal layer plays key role in draining fluid from the eye

8 Taking sight seriously

A hard-hitting health campaign is calling on the UK to take sight seriously

10 News extra

The LOC Support Unit is not making a legal challenge over the DVLA vision testing services contract

12 AOP comment

Henrietta Alderman relects on optometry’s newest fixture, 100% Optical

Regulars

16 Pre-reg focus 18 Letters 57 Diary dates 58 Crossword Cover: Courtesy of Media 10. Photographer Theo Cohen

Feature is online

Cover story

Business

OT reviews 100% Optical, London’s first annual, international trade show

Changes to workplace pension law mean that employers need to give their workers access to a workplace scheme

30 100% Optical

34 Capturing the clinical

OT reports on the impressive line-up of clinical speakers who presented at 100% Optical

Fashion

14 Shades of yesteryear

OT looks at the sunglass fashions for 2014 to help practitioners prepare for the season ahead

Interviews/Profiles

20 Manchester Royal Eye Hospital bicentenary

This October, the MREH celebrates 200 years of delivering eye care

24 Fighting for sight

OT speaks to Michele Acton, chief executive of Fight for Sight

40 Pensions update

Clinical

47 Clinical editor’s corner

Dr Ian Beasley ensures that the CET in this edition offers something for practitioners from all disciplines

48 Blepharitis, but not as you know it (C-35258) 53 Retinal haemorrhages: cases in ophthalmology (C-35268)

Classified 59 Jobs

The latest optical vacancies

62 Marketplace Your guide to optical products and services

28 Drops reminder

OT finds out about an app which has been developed to increase patient compliance of eye drops

Reviews/Previews

38 UK academy first

What is believed to be the first training academy from a UK equipment company has been officially launched

www.optometry.co.uk

Audiologist vacancies nationwide

www.outsideclinic.co.uk

28/02/14 CONTENTS

News/Comment

48

20

14

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NEWS

Ryan O’Hare ryano’hare@optometry.co.uk

THE GENERAL Optical Council (GOC) has announced that it has launched a consultation into tackling illegal practice, with a focus on the misuse of protected titles and the unregulated supply of contact lenses on the internet. The announcement was made at the recent council meeting in London (February 12), and the strategy is based upon research commissioned last year around the risk to the public from such practises. Alistair Bridge, the GOC’s director of policy and communications, said: “One of the biggest problems we face is the illegal supply of contact lenses from websites overseas.”

With the many online traders registered outside of the UK, and outside of the regulator’s jurisdiction, Gareth Hadley, chair of the GOC, stated that a “more creative and proactive approach” is needed to tackle the problem. Proposals put forward include promoting public awareness and a voluntary code of practice for online suppliers to help consumers to identify suppliers who follow good practice. “This will involve helping the public understand the benefits of choosing a supplier that provides first-rate clinical advice and aftercare,” said Mr Bridge.

The council said that it plans to work closely with optical bodies, manufacturers, consumer groups, and regulatory and enforcement bodies, such as Trading Standards. The consultation is expected to run until the end of May. David Craig, director of policy for the AOP, said: “The AOP is delighted to see the GOC is looking to prioritise its work on controlling illegal practice. Registrants work to high standards of practice and it is important that patients should be able to expect the same standards wherever they access their eye care and eyewear.” The GOC also announced that it has appointed Nockolds Solicitors as independent mediators for consumer complaints, with effect from April 1.

Hertfordshire to submit A UNIVERSITY in the south east of England which is seeking to introduce a four-year optometry course has confirmed that it will have developed a programme to submit to the GOC for accreditation by the end of March. If approved, the University of Hertfordshire would become the 10th UK-based institution to offer optometry as a degree. The programme requires accreditation by the regulator before it can be established. During the process, the GOC decides whether or not the course meets its defined set of standards and, if so, provides accreditation. The plan has drawn much criticism from within the profession, with a ‘Stop Hertfordshire’ petition gaining more than 2,500 signatures.

Speaking to OT, the organiser confirmed that the petition would be submitted to universities and science minister, David Willetts, and the GOC imminently. It will also be sent to the Department of Health’s Jeremy Hunt and Lord Howe. Speaking about establishing the petition, the organiser, who wishes to remain anonymous, told OT: “I established the petition because this potential new school affects everyone in the profession. The petition has given the profession a platform for its grievances to be heard. “The support that it has attracted is proof that my concerns related to the launch of a new optometry school are shared among optometrists all across the country. These concerns are shared by many.” A spokesperson for the

institution told OT: “The University of Hertfordshire is working with the GOC to develop a programme in line with the requirements for accreditation and we intend to make a formal submission for accreditation in March.”

100% fantastic A total of 5,483 (ABC audit pending) people attended the inaugural 100% Optical trade show at the ExCeL Exhibition Centre in London last week (February 16–18). The three-day event combined an exhibition of over 200 stands with a comprehensive lecture programme of 90 hours of education, offering 101 CET points. The OT team has reviewed the show, including its clinical content, in more detail from page 30. A round-up of the event’s business seminars and the latest launches will feature in the next edition (March 14).

Multivitamins could reduce cataract risk

New research from the US suggests that men who take a daily multivitamin could reduce their risk of cataract. The study looked at 12,641 men, aged 50 or older who took either a multivitamin or placebo every day, from 1997 to 2011. Researchers found 73 fewer cases of cataract in the multivitamin group, a risk reduction of 9% versus placebo. The multivitamin group also had a slight increase in risk of AMD, although this was not found to be statistically significant. The results are published in the journal Ophthalmology.

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5

28/02/14 NEWS

GOC consultation into illegal practice launches

IN BRIEF


NEWS IN BRIEF

Singing for charity

28/02/14 NEWS

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A group of Specsavers employees has teamed up and are using their voices to raise funds for East Anglia’s Children’s Hospices. Employees from the multiple in Thetford have recorded a song entitled I can count on you, which is due to be released on iTunes on Monday (March 3). The song is by indie band DryStoneWalls and features backing vocals from the Specsavers team. All proceeds raised from the single will be donated to the children’s charity, which provides care for children with lifethreatening conditions.

David Pyle tribute

The General Optical Council has paid tribute to former council member David Pyle who died recently following a battle with cancer. Mr Pyle was a member of the GOC’s education committee. His involvement with the regulator spanned 16 years, after he was initially appointed as an education visitor in June 1997. Alongside his role as an education visitor, Mr Pyle was also an education adviser to ABDO and chaired its examination board until 2002, when he was appointed as a lay member of the GOC council – a position he held until 2010.

Keith Edwards memorial

A memorial will be held in London next month for optometrist Professor Keith Edwards who died in Florida on January 25, aged 61. The event will be at held Apothecaries Hall on Blackfriars Lane, on March 21. A reception will be hosted from 12.30pm, with the memorial afterwards. Those who wish to attend are asked to inform Professor Edward’s brother, Barry Edwards, on 01424 211 007 or i_teeth@yahoo.co.uk

Chemical ‘switch’ turns cells into photoreceptors Ryan O’Hare ryano’hare@optometry.co.uk

RESEARCHERS IN the US have discovered chemical compounds which allow other cells in the eye to act as photoreceptors in mice. The discovery could pave the way for treatments for conditions where loss of photoreceptors plays a key role, such as retinitis pigmentosa and age-related macular degeneration (AMD). In degenerative eye conditions the outermost layer of the retina containing the photosensitive rods and cones wastes away, but the other layers, including the nerve cells which connect to the brain, often remain intact.

This means that these retinal nerve cells, or ganglion cells, are no longer receiving any signals which they can pass on to the brain to process. Now researchers at the University of California, Berkley, have developed one chemical compound in particular, called DENAQ, which allows the ganglion cells themselves to become sensitive to white light. Unlike previous photoswitch chemicals discovered by the group, which required high doses of ultraviolet light, DENAQ confers phostosensitivity at intensities similar to daylight. The compound only works when the rods and cones of the retinal photopigment layer

have already died, as this causes electrophysiological changes in to the ganglion cells. Just one injection of DENAQ into the eyes of mice was enough to allow light sensitivity for several days. Further testing is required to assess the safety of this class of compounds, but the selective nature of DENAQ is a desirable characteristic for vision-restoring treatments. Dr Richard Kramer, who led the research, said: “It will take several more years, but if safety can be established, these compounds might be useful for restoring light sensitivity to blind humans. How close they can come to re-establishing normal vision remains to be seen.”

NICE recommends Eylea THE NATIONAL Institute for Health and Care Excellence (NICE) has recommended Eylea (aflibercept) for patients with macular oedema following central retinal vein occlusion (CRVO). The final guidance comes after announcements at the end of last year. The Final Appraisal Determination from NICE means that the treatment is now recommended for

patients in England and Wales with the condition. CRVO occurs when the main vein supplying the retina is blocked and leads to a leak of fluid beneath the retina. If left untreated it can result in the loss of central vision. Administered as an injection into the eye, aflibercept works by interfering with the protein messengers involved in the growth of new blood

vessels (angiogenesis). These messenger proteins cause inflammation which plays a role in CRVO-related macular oedema. Moin Mohamed, a consultant ophthalmologist at St Thomas’ Hospital in London, said: “[Having Eylea] available... is an important step forward in the management of this debilitating condition.”

Charity announces grants A UK charity supporting research into nystagmus is accepting applications for the first of two new grants. The first grant, which has been established by the Nystagmus Network, is worth £15,000 and has a closing date of April 30. The second grant, which is expected to open for applications this summer,

is worth £10,000 and will close on August 31. Applications are being sought for projects which aim to “improve the lives of people affected by nystagmus and/or expand on the existing knowledge and understanding of the condition.” The charity confirmed that the new grants are in addition to the £6,000 small grants scheme

To comment go to www.optometry.co.uk

which it introduced in 2013. The Network will also continue its partnership with Fight for Sight’s Carrots NightWalk, which sees its £7,500 contribution doubled into a £15,000 grant for nystagmus research. To apply for the new grant, email John Sanders – john.sanders@nystagmusnet.org – to request an application form.


NEWS

Ryan O’Hare ryano’hare@optometry.co.uk

A LAYER of the cornea which was discovered last year may play a key role in draining fluid from the eye, according to researchers. The findings could provide new insight into glaucoma, the underlying cause of which is a lack of fluid drainage, which leads to a build up of pressure inside the eye. Fluid drains from the eye through the trabecular meshwork, a sieve-like network of connective protein and cells at the edge of the cornea.

New online Master courses NHS EDUCATION for Scotland (NES) Optometry is working with partners to develop a new online Master’s course in Global Public Health. The course would be run by the University of Edinburgh, which is currently running a survey to assess demand for the course. Donald Cameron, optometry programme director of NES, said: “NES Optometry is committed to developing a continuum of education for those involved in optics. This programme will complement the excellent progress we have already made in this field.” Two part-time, flexible courses designed in collaboration with the University of Edinburgh and the Royal College of Surgeons of Edinburgh will also launch this September. Information on the new courses can be found at http://bit.ly/Hej0G6.

Now, scientists have found that the Dua layer contributes directly to the structure of this network. The layer of tissue was discovered last year by researchers at the University of Nottingham, led by Professor Harminder Dua (pictured). Using

electron microscopy, the team at Nottingham looked at donor eyes to study the layer and the surrounding microanatomy in more detail. They found that the collagen scaffold of the Dua layer extends into the trabecular meshwork, so adding to its structure. Professor Dua said: “Many surgeons who perform lamellar corneal transplants recognise this layer as an important part of the surgical anatomy of the cornea. This new finding... could have significance beyond corneal surgery.” The research is published in the British Journal of Ophthalmology.

UK motorists admit to poor vision MORE THAN a third of UK drivers admitted that they could not see properly when they drive, when questioned in a survey. A surprising 36% of 1,571 drivers told the survey for Sight Care, a support network for independent opticians, that their eyesight was not at an acceptable standard when they were driving. A quarter admitted that they could not see well when driving at night and 11% revealed that their daytime vision was ‘blurry’ when they were in their cars. In terms of new drivers, 5% of those surveyed by the independent market research company, Opinion Matters, admitted that they had struggled to see the registration plate during the brief eyesight assessment which was part of their driving test. Chief executive of Sight Care, Paul Surridge (pictured), said: “The figures speak for themselves.

Nearly 3,000 people are killed or injured every year in car accidents caused because of poor eyesight. This is tragic, especially considering how easy it is to book an eye test and get most vision problems sorted out.” “Our survey shows that more than a third of people admit that their vision isn’t good enough when they are driving. This is pretty shocking when you consider what the consequences could be. We are urging everyone who feels the same to get in touch with their local independent optician and get their eyesight tested as soon as possible.”

To comment go to www.optometry.co.uk

IN BRIEF

New BP genes

Researchers at Queen Mary, University of London have discovered 11 new gene variants associated with high blood pressure and heart disease. The findings could help researchers to better understand the genetic basis of hypertension and to develop treatments for associated conditions, such as hypertensive retinopathy. The international study looked at more than 87,000 people, searching for genetic variations associated with high blood pressure traits. Professor Patricia Munroe, of Queen Mary, said: “Discovering these new genetic variants provides vital insight into how the body regulates blood pressure.”

Animal testing

The Government has launched its delivery plan to cut the number of animals used in scientific research in the UK. The strategy (announced on February 7) to replace, refine and reduce the number of animals used in experimentation (known as ‘the 3Rs’) aims to encourage scientists to use alternatives wherever possible. Universities and science minister, David Willetts, said: “Animals are only used when there are no suitable alternatives. But the results we get from research can transform lives and pave the way for new and ground breaking medical advances.”

Actress speaks on AMD Dame Judi Dench has spoken publicly about the impact agerelated macular degeneration is having on her life. The 79-year-old Hollywood actress, best known for her role as ‘M’ in the James Bond movies, revealed in 2012 that she suffered from the condition. In a recent interview, the star revealed that she can no longer see well enough to read film scripts. Speaking to Hollywood Reporter, she said: “I can’t read anymore. I can’t paint like I used to.”

7

28/02/14 NEWS

s ‘Dua layer’ could be linked to glaucoma, study finds


NEWS EXTRA

National media campaign on taking sight seriously Robina Moss robinamoss@optometry.co.uk

281/02/14 NEWS

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VISION EXPRESS is calling on the UK to take sight seriously with the launch of a hardhitting health campaign. Underpinned by research, the initiative signals towards a worsening outlook for the nation’s eye health, despite sight loss being one of the public’s biggest fears. Named Vision: Taken seriously, the campaign was shown on primetime television on Saturday (February 22), and is in the national press highlighting the importance of vision care through educational adverts. Behind the campaign are UK research findings which report that 85% of adults admit to having problems with their vision and that 40% have noticed deterioration in their vision and have done nothing about it. The new campaign is the result of an almost one-year study by the multiple. Vision Express CEO, Jonathan Lawson, said: “We don’t want to scaremonger, but the joviality around eye health has got to stop. Just over half of adults in the UK only visit an optician every five years, with 8% never having had a sight test. The statistics are shocking and we need people to sit up and take notice.”

Mr Lawson added: “At Vision Express, we have over 100 types of test, so we can detect serious conditions such as high cholesterol, high blood pressure, diabetes and increased risk of stroke. None of these conditions are a laughing matter, yet we see vision care constantly trivialised. We are urging people to start taking sight seriously.” Research also shows that free NHS child eye test rates hit a 10-year low last year. Pictured is five-year-old Matilda Darling who features in the campaign after surgery for a large brain tumour, the signs of which were detected by pre-registration optometrist Manpreet Bahra, pictured left, at Vision Express Brent Cross in November. The campaign was first broadcast during Dancing On Ice on ITV on Saturday.

Double success for OW OPTOMETRY WALES (OW) has announced two successes in the campaign to improve eye care in Wales and raise the profile of the profession. The evaluation report by Public Health Wales on the national community pharmacy public health campaign, Look after your eyes, has highlighted the success of joint professional working between community pharmacy and optometry. During the month-long initiative last July, pharmacies across Wales gave people using medicines for eye conditions a medicines use review and reminded them about the importance of having sight tests. Pharmacy staff also spoke about the importance of having a sight test when people enquired about eye health, or were purchasing sunglasses or contact lens solutions. The Eye Health Campaign Report said: “The campaign received favourable

media coverage, with reports suggesting that inter-professional working between optometrists and pharmacists may have improved as a result of the campaign.” OW chief executive, Sali Davis, told OT: “Optometry Wales was delighted to support this innovative and collaborative way of working with colleagues in pharmacy to provide the best quality of care to the patient that can be accessed closer to home, in a community setting.” In another boost for OW, the Welsh Government has announced the launch of a new eye care website as part of its Together for health: eye health care delivery plan for Wales 2013-2018. The website, www.eyecare.wales.nhs.uk, has a search facility which will help people find their nearest optometrists who have undergone additional training to be able to offer enhanced eye care services.

COMMENT FEELING THE FLOOD IT WON’T have escaped anyone’s notice that 2014 has started on a damp note. The Met Office’s statistics for the start of the year show that parts of the UK had their wettest January since 1910 – and this marker was hit with three days left in the month to go. For a swathe of the country, from East Devon to Kent and inland across parts of the Midlands, the rainfall for the month was a wellington boot-grabbing double the average. As part of an attempt to respond to the impact of the widespread flooding, the Government has announced a new business support scheme worth up to £10m, which will provide hardship funding for small and medium enterprises. The Government expects the average payment to be around £2,500 per business, and the fund will be administered by local authorities which will have discretion on the maximum payments given. For those practices affected, a free helpline is available: 0300 456 3565. If your practice has been caught in the floods, get in touch with OT to share your story. Elsewhere in this edition, OT visits the Manchester Royal Eye Hospital to learn about its plans to celebrate 200 years in eye care (page 20), plus chief executive of Fight for Sight, Michele Acton, tells OT about the charity’s ambitions to invest £20m in research by 2017 (page 24). We also find out about changes to workplace pension law, which mean that employers need to give their employees access to a workplace pension scheme (page 40). Following the successful launch of 100% Optical last week – see the first installment of our two-part review, including clinical highlights from the seminar programme, on page 30 – March sees the gauge go up a notch in the optical conference calendar. Over the next couple of editions, look out for reviews from Milan’s Mido, the Sight Care Conference in Birmingham, Fresh Eyes (codelivered by the College of Optometrists and the AOP) and Optometry Tomorrow in York, and SECO in the US, not forgetting ABDO’s conference and exhibition in Kenilworth. And then in April… John White, OT managing editor johnwhite@optometry.co.uk

To comment go to www.optometry.co.uk


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NEWS EXTRA optometrytoday

Journal of the Association of Optometrists

FEBRUARY 28 2014 VOLUME 54:4 ISSN 0268-5485 ABC CERTIFICATE OF CIRCULATION January 1 2012 – December 31 2012 Average Net: 20,575 UK: 19,726, Other Countries: 849

LOCSU abandons legal battle over DVLA contract live

bookshop

CET

Robina Moss

robinamoss@optometry.co.uk

Managing Editor: John White T: 020 7549 2071 E: johnwhite@optometry.co.uk

28/02/14 NEWS EXTRA

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tv

THE LOC Support Unit (LOCSU) has announced that it will not Deputy Editor: Robina Moss be making a legal challenge T: 020 online 7549 2072 enewsletter VRICS over the DVLA vision testing E: robinamoss@optometry.co.uk Assistant Editor: Ryan O’Hare services contract. T: 020 7549 2078 The DVLA confirmed to OT E: ryano’hare@optometry.co.uk earlier this month that it was Web Editor: Emily McCormick the agency’s intention to award T: 020 7549 2073 the contract to Specsavers E: emilymccormick@optometry.co.uk Opticians. Multimedia Editorial and Production Assistant: Jack Cochrane LOCSU chairman, Alan Tinger T: 020 7549 2074 (pictured right), said: “The E: jackcochrane@optometry.co.uk DVLA has made it clear to us “If we had pitched at a level to win the bid, Clinical Editor: Ian Beasley that our bid was the highest E: ianbeasley@optometry.co.uk it would have ended up with practitioners scorer in terms of quality and Multimedia Editor: Laurence Derbyshire by implication therefore we lost being remunerated substantially less than T: 020 7549 2075 out on price. E: laurencederbyshire@optometry.co.uk they currently are for the service” “We do not know the price Multimedia Creative Editor: Ceri Smith-Jaynes E: cerismithjaynes@optometry.co.uk LOCSU’s decision not to make for the courtesy and willingness the winning bidder tendered the legal challenge is the right to communicate during the but it is clear to us that if we Advertising and sponsorship: Vanya Palczewski T: 020 7878 2347 one. Careful examination of extended ‘standstill’ period which had pitched at a level to win E: vanya.palczewski@tenalps.com the process and diligent work could not be faulted. I have, the bid, it would have ended Jobs and marketplace: Haley Willmot directly with DVLA has enabled however, made crystal clear the up with practitioners being T: 020 7657 1805 the LOCSU team to reach its feelings of those who currently remunerated substantially less E: haley.willmot@tenalps.com conclusion fully understanding provide the service, and indeed a than they currently are for the CET enquiries: the issues. The unit took legal most effective service convenient service. T: 020 7549 2076 E: CEThelp@optometry.co.uk advice on both the EU and for drivers. “Hindsight is a wonderful Bookshop enquiries: Kudzai Muronzi Competition Law aspects.” “My letter concluded: ‘Whilst thing and no doubt after the T: 020 7549 2012 Mr Grocott added: “Winning not originally intended by event some might say ‘anything E: kudzaimuronzi@aop.org.uk the bid is still an option since the DVLA, this has reached a would have been better than Production: Ten Alps Creative there is a continuation of the regrettable and destabilising nothing.’ However, that was T: 020 7878 2323 ‘standstill’ period. My view conclusion for the UK optical certainly not the mood at the E: gemma.trevillion@tenalps.com continues to be that a LOCSU sector, the repercussions of time of the bid, and bidding AOP Membership Dept: win would be in the best which will be felt for a long too low to be viable for many AOP, 2 Woodbridge Street, London, EC1R 0DG T: 020 7549 2010 interests of the sector and we time and may well be a tipping would not have been in the W: www.aop.org.uk should continue to hope that point for driving any other interests of those affected, or Advertising and Production Office: will be the outcome.” competition out of the market to the long-term viability of the Ten Alps Creative, Commonwealth House, One Mr Tinger said last week: “I the detriment of the DVLA in the sector.” New Oxford Street, High Holborn, London am satisfied that we have left future.’” The LOCSU bid was WC1A 1NU no stone unturned throughout Specsavers has said that it supported by the Optical Editorial Advisory Board: the extended ‘standstill’ period will not comment until the Confederation, Optometry Mohammed Abid, Vivian Bush, Leon Davies, to seek grounds for a legal ‘standstill’ period is over and Scotland and Optometry Wales. Cameron Hudson, Polly Dulley, Dan Ehrlich, Andy Hepworth, Olivia Hunt, Niall Hynes, Ceri challenge and I pay tribute to it has heard officially from the It was based on delivering a Smith-Jaynes, Vicky O’Connor, Sonal Rughani, the extended LOCSU team for all DVLA. managed network of optical David Ruston, David Shannon, Bryony Stather, they have done in the very best A DVLA spokeswoman told practices and optometrists Gaynor Tromans, David Whitaker, Andy Yorke. OT on Tuesday: “As is standard interests of the sector.” across England, Scotland and Website: www.optometry.co.uk practice, we have extended the Mr Tinger continued: “I have Wales. Published fortnightly for the Association of standstill period of the vision written at length to the assistant Optical Confederation Optometrists by Ten Alps Creative testing contract in order to director (commercial) at the chairman, Don Grocott Subscriptions: respond to a query. The current DVLA, who is responsible to the (pictured far right), told OT Abacus eMedia, Bournehall House, Bournehall Road, Bushey, Herts, WD23 3YG standstill period will end at DVLA board for the conduct of on Wednesday (February T: 020 8950 9117 midnight on March 4.” the tender. I have thanked him 26): “It is quite certain that E: tenalps@alliance-media.co.uk UK £130, OVERSEAS £175 for 24 issues

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COMMENT

The future is bright for 100% Optical 28/02/14 AOP COMMENT

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The AOP’s chief executive, Henrietta Alderman, reflects on optometry’s newest fixture, 100% Optical FOR THREE days last week, ExCeL London was home to a new, exciting and innovative optical event. The atmosphere over the whole weekend was upbeat as thousands of visitors, exhibitors, lecturers and students mingled, enjoying the hugely successful collaboration between exhibition giant Media 10, and the event’s official partners, the AOP and OT. Months of hard work had gone in to planning every element of the show, from the unique layout to the worldclass CET. The overwhelmingly positive feedback we have received proves that this attention to detail and focus on the visitor experience resulted in a show which really delivered the VIP treatment, particularly to AOP members. Over 90 hours of free education was definitely a highlight of the event, with a fantastic line-up of speakers covering topics across all practitioner specialisms, including optometrists, dispensing opticians, contact lens opticians and independent prescribers. The programme, which was finely

“The AOP is pleased to have been partnered with this new event, which looks set for a bright future” crafted by the AOP’s head of professional development, Karen Sparrow, included high calibre international keynote speakers, alongside interactive sessions and workshops, all of which attracted large audiences throughout the show. Professor Brien Holden spoke about the challenges of myopia to a sold-out main stage. Afterwards, reflecting on 100% Optical, he said: “It is a great and very impressive meeting with superb organisation.” With AOP members describing the CET programme as “a valuable and enjoyable learning experience,” and thanking the AOP for the “standard of speakers,” it is clear that this collaboration between Media

10 and the AOP really delivered a high quality education event to the benefit of many of our members. The large AOP stand was the hub of the show, and it was fantastic to see so many members using the VIP area to catch up with colleagues and chat to AOP employees. The AOP inhouse legal team was kept busy over the three days giving advice and answering members’ queries, really making the most of this valuable opportunity to meet so many AOP members face to face. There was a lot of interest in the AOP’s Independent Practice Support services, as well as the AOP Image Library and Children’s Campaign, and the communications team received some great feedback on how to develop and grow the services which are regularly used by thousands of our members. The launch of this year’s AOP Awards was an added attraction on the stand, and the nominations received were a great start to the event, which will be held in October. The AOP Awards celebrate some of the outstanding optical achievements of the past 12 months, so if you haven’t already, please consider nominating yourself or a colleague. The show’s fresh approach combined industry-leading innovators, worldclass CET and an exciting approach to the visitor experience. The AOP is pleased to have been partnered with this new event, which looks set for a bright future. Following the event, we are collating the feedback, which will contribute to the plans already underway to make 100% Optical 2015 even more of a success.


CET ROADSHOWS 2014

Book your place now

AOP Peer Review Roadshow

AOP Legal Roadshow Building on the success of the legal roadshow in Scotland in 2013, a further series will run across the rest of the UK in 2014. ‘A guide to staying on the right side of the law (and the GOC)’, these educational events will raise the awareness of factors that could affect a practitioner’s professional conduct and registration. These evening events are CET approved for four interactive points.

EVENTS ARE FRE E TO AOP MEMBE RS

The AOP hosted a popular series of regional peer discussion groups across the UK last year and these have been extended into 2014 to visit locations not previously offered. These are approved for three interactive Peer Review CET points.

Inverness Oct 7

Glasgow Oct 8

Middlesbrough May 12 Belfast Apr 8 Belfast Oct 15 St Asaph Apr 9

Manchester May 21 Sheffield May 7 Norwich Mar 20

Nottingham May 20

Birmingham Apr 30 Oxford Apr 29

London Apr 2

Cardiff Nov 4

Book your place! • A fee of £60 is charged to non-members •Places are limited – early booking is recommended

Exeter Mar 6 Exeter Nov 18

Maidstone Mar 5 Maidstone Oct 14

Book online at www.aop.org.uk


FASHION

Shades of yesteryear 28/02/14 SUNGLASSES

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The vintage vibe is a strong theme in sunglasses for summer 2014. OT ’s Robina Moss reviews the latest launches to help practitioners prepare for the new season

Delivering a dozen

CONTINENTAL EYEWEAR has launched 12 sunglasses in the contemporary Jaeger London collection (pictured is Jaeger London Sun 1401). The styles are all glazeable and are offered in a mix of plastic and metal designs. The new sunglasses are supplied with a case and a microfibre cloth. www.continental-eyewear.com

Over 100 styles debuting

DUNELM OPTICAL will debut over 100 new sunglasses across a number of its different ranges at Mido this weekend (March 1–3). Satisfying the continued demand for vintage shapes and styles, there are plenty of references to the 1960s and 1970s with large feline fronts and chunky butterfly silhouettes (JR Sun 33) across the female Janet Reger, Retro and Sunset collections (pictured is Sunset+ 365). For men, aviator style frames with double brows are a big look this summer (Sunset 361), while metals are a must in angular squares and rectangles (PC Sun 21). Dunelm Optical director, Peter Beaumont, told OT: “The new collection celebrates all that is great about British sun eyewear this year. And with another hot summer predicted, we’re confident the new frames will prove best sellers, so much so we’re offering discounted prices across all the new sun collections if opticians order before April 1 for delivery any time.” www.dunelmoptical.co.uk

Originals thinking

ADIDAS ORIGINALS has launched five new sunglasses for spring/ summer 2014. ‘Melbourne’ (pictured below) is contemporary while ‘Malibu’ fuses matt and shiny surfaces, alongside hard and soft lines, described as “the perfect beach meets street frame.” ‘San Diego’ offers full coloured frames or colour-blocked styling while ‘Copenhagen’ and ‘Amsterdam’ both incorporate smooth joinery detailing to create a sleek outline. www.adidas.com/eyewear


High fashion focus

MENRAD HAS launched six new sunglass styles in the spring/summer 2014 eyewear collection of Joop! Mirrored lenses, neon colours and transparency styles are the trends of the international brand for the coming season. Managing director of Menrad UK, Chris Beal, told OT: “The importance of sunglasses within our portfolio continues to grow. They are now a must-have accessory which also allows the wearer to make a strong personal statement. “Sunglasses from our Joop! Jaguar, Morgan, Davidoff and L’Wren Scott collections extend our brand message into this arena, with definitive, stylish and very much on-trend propositions, linking fashion trends and brand ethos.” www.menrad.com

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Driving in a 70’s revival 28/02/14 SUNGLASSES

IN 1978 the legendary P’8479 sunglasses, known as the ‘Yoko Ono sunglasses,’ after she wore them on the cover of Rolling Stone magazine, were launched and are still one of the most recognisable models from Porsche Design Eyewear. As part of the Porsche Design Iconics series, Rodenstock is launching two highly anticipated successor models, P’8576 and P’8577 (pictured right). Both are a reinterpretation of the classic design, with elements such as the visible screws in the lenses and the singular temple design. 01474 325555

Cool styles for kids

CC-ing the sun

ORANGE EYEWEAR has launched a capsule sunglasses collection for its successful range, CC Eyewear. Fronted by the actress, Jane Seymour, who appears on point-ofsale materials, the range was exhibited at 100% Optical last week. Managing director of Orange Eyewear, Hanna Nussbaum, told OT: “CC Eyewear continues to go from strength-to-strength. We’re delighted to be enhancing the ever-popular collection with this capsule sunglasses range, exclusive to the independent sector, which allows women to wear beautiful CC designs come rain or shine.” The five contemporary styles are designed to complement the ophthalmic range. Pictured above is ‘Sicily’ CCS05 (size 58 x 17). www.orange-eyewear.co.uk

ZOOBUG LONDON launched its new sunglass styles for children at 100% Optical last week. The unisex wayfarer-inspired ZB sunglasses are now available in new colours, inspired by the 1950s and 1960s (pictured below top). The company also launched its circular Sunny design (pictured below bottom) with a new catwalk look python print finish. It is offered in two colours, baby blue or pale pink. A new edition of the Zoobug classic sunglass style Daisy was also shown in pearl. www.zoobug.com


CET PRE-REGFOCUS CONTINUING EDUCATION & TRAINING

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Pre-registration Dan Varcoe (pictured), how secure thistocase leavea the door open or with special needs, shares may be advice nervous.on In to quiet activities optometrist, (eg, puzzles and pre-registration placement with anConsider independent allowing children to visit the have another member of staff join you. colouring) rather than allowing children practice before their first appointment, It is advisable to continue to apply stage of their WORKING IN independent practice can Conclusion to meet the staff and see the room active items. Remember that children to other practices rather than wait for a university career. provide many benefits to a pre-reg. order from to successfully testPractices children, the examination will take place. In may being away from a where response a particular one. If a practice Someresent of these maydragged include freedom, it may be necessary to purchase tests There are children’s books about eye toy corner to have an of eye examination. decides to take in the next area may already be accepting in terms of their choice product designed forposition the ageand group. available Think about the equipment display in tests applications for a pre-reg on a student at so consider loaning a specifically recommendations, an abilityon to speak Of equal importance is the attitude book at the time the parent makes the your examination room. Is it unfamiliar awaiting a reply could hinder a student’s an early stage of directly to the person who owns the all staff, the practice environment chances of another placement. Some practitioners create of and scary? Is makes it computerised and their studies they business and decisions on a highly appointment. the approaches taken to make An interview at an independent may also able especially for children. and regular basis, and a loyal patient ownbe leaflets attractive to inquisitive fingers?base Can you their practice gives a student the chance to the entire experience child-friendly. to support their whichunnecessary trusts the practice with their eye a Staff training may be needed as not place equipment behind education, has as a natural rapport with meet directly with someone who they are care andCan may allow a pre-reg observe everyone screen? you replace your to information likely to be working with, and is likely to well as possibly holiday work. In About some rare conditions. the author thatpaid all members of staff posters with children’s pictures? children. Ensureoffer be their pre-reg supervisor too. It is also a addition, early applications give students Any student who would like to Arrange your appointment book to are familiar with child protection issues Maggie Woodhouse is senior lecturer great opportunity to find out plenty of opportunity to meet for an apply for a pre-reg placement at anto give and local protocols (see the College of at the School of Optometrymore and about Vision avoid unnecessary waiting and the practice. interview at a convenient time which fits independent practice may believe that it flexibility. Some practitioners like to Optometrists’ guidelines on examining Sciences, Cardiff University, where she During an interview, students may in with university. will be an arduous and on-going task. It reserve one whole session per week for the younger child and consider studying specialises in paediatric optometry. expect questions which relate to their Some independent practices may can be. There are many practices across children. For older children, reserving the e-learning module on safeguarding She runs the Special Assessment career aspirations, patient manner, how not advertise an available position until the UK and it is impossible for students which caters for patients of all after-school appointments can be useful. children provided by DOCET). It is Clinic, they might deal with certain situations, students are in their final year, yet if a to apply to them all, especially when ages with disabilities. Her particular practice to ensure that a child is areas in which When the appointment is made, it may be good they are confident, and practice already has a student’s CV on file completing their studies. are they visual witharea keen. member of staff. interests helpful to discuss parental concerns and never possibly areas thinkdevelopment they will need in it showsalone that they My view is that some independent children with Down’s syndrome and the extends to theletter examination; determine whether extendedbetter or second This so A great covering and CV is ensure support. They could be asked anything, practices will suit anan individual impact of visual defects on education. that a parent or guardian comes into appointment might be needed. Remember they should expect the unexpected. essential to ensuring an application is not than others. This can be due to a number examination room the child. to during the examination It is also good practice for students to forgotten. The letter mustwith be tailored to of allow factorstime including location, speciality, to the attend interviews with some relevant may not always be possible eg, a References explain what is going toequipment. happen and after This the practice which a student is applying level of supervision and questions, which shows that they are to and should be addressed parent may need to take to a the distracting See These practices must take priority in a www.optometry.co.uk/ the examination to discuss the outcome interested. practiceoutside, manager,oror an the older owner,child by name. student’s However, may clinical. Click on the article title and with bothapplication the childefforts. and the parent(s). sibling However, students to should be mindful Personally, I would not they should not be the only practicesthose not want the parent torecommend accompany them. then on ‘references’ download. Some children, particularly not to put all of their eggs in the sending generic applications as they are which they apply for. independent basket, and to apply to the easy to spot. At the moment, anyone applying for After an application, students may want multiples and hospitals too, ensuring they an independent pre-reg placement meet the18,appropriate follow up their written communication will likelyNOTE be making most PLEASE There is only one applications correct answer. All CET isto now FREE. Enter online. Please complete online by midnight on May 2012 – You willdeadlines. be unable to submit exams after this date. Answers to the module will be published on www.optometry.co.uk/cet/exam-archive. CET points for these exams willof bestudents uploaded to Vantage While a number may not with a telephone call. This ensures that speculatively to see if employment is on May 28, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates end up securing their ideal placement, the application has been received, available, rather than answering to job c) Uses a flashing colourful target they should give themselves as good 1. Diagnosing congenital vision defect inshows early childhood they are interested, and allows adverts. Some aadverts cancolour be found d) Uses a large target has the following benefits EXCEPT: a chance of gaining employment as a brief conversation with the recipient. ata)various times of treated the year, however, The defect can be 3. Success in eye health examination of aThe young childimportant may be improved b) Teachers can understand a child’s colour choice in artwork possible. most thing isifnot During any conversation, a student students have to consider that their c) Inappropriate career plans can be avoided the practitioner: the type of practice, but the quality of may want to reiterate their availability future employer may not even be a) Asks the child to sit as still as possible for as long as it takes d) Alternatives to colour coding can be used support a student will to gain experienceb)inAsks practice astowell the child keep looking atsupervision an interestingand picture on the wall, no matter looking for a pre-reg until their what 2. Measuring eye movements in children more receive during the year, as this is what as be convenient times to meet with the application drops through the door. is likely to c) Uses a slit-lamp and a Volk lens successful if the practitioner: helpintervals ensure that the year passes practice owner, based on university Students begin applying for d) Examines sections of the eyes inwill separate a) Moves thecan target very slowly 4. Practice preparation may include all of the following b) Avoids distracting the child by speaking with minimal stress. EXCEPT: commitments. independent pre-reg placements at any to become excited by playing with

20/04/12 28/02/14 CET PRE-REG

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Module questions Course code: C-18705 O/D

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Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates


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LETTERS Driving away business

28/02/14 LETTERS

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Dear OT, I am writing concerning the intention of the DVLA to give the contract for drivers’ field screening and visual assessments to a large multinational, thereby cutting out independent opticians. Drivers in rural and more inaccessible areas will be inconvenienced by not being able to use their more local opticians. In my area the trip to the nearest Specsavers involves a journey of 50 miles each way with inconvenient and expensive parking. Anyone who has had their licence withdrawn would face an arduous two-hour bus journey, each way, on infrequent buses. For independent opticians it removes a relatively minor source of revenue but sends a signal reinforcing national advertising that only a large chain can be trusted, even the Government does not think that independents (small businesses) are up to the job. It gives a positive marketing opportunity to the contractor while removing it from independents – if you have to come here for this, why not have a sight test and get your glasses here as well? It appears that yet again the Government wants to attack small businesses via death by a thousand cuts, rather than support them as it claims to. This at the cost of unnecessarily disadvantaging the populations of rural areas. It would be interesting to know exactly what the savings to the taxpayer are over LOCSU’s bid and indeed the situation up to now. This involves taxpayers’ money in a contract by a government department, so all the details should be transparent and in the public arena. John Dean-Perrin, optometrist, Aberdeenshire

This is a lot more than just which equipment platform to choose; it is about being able to interpret the images, manipulate and store data, build a seamless and efficient patient journey and also being able to commercialise the process – in other words, to do it profitably. In this competitive age of optics, the concept of ‘survival of the fittest’ still holds true, and by investing in technology and using it as a way of differentiating your practice it can also be a powerful practice builder. I was very impressed by the show, the organisation, the venue and its layout. Overall, the show was superb, a great debut from 100% Optical. It’s great that there’s been such great feedback about London but come on folks, we can’t have two London shows going forward. Let’s hope common sense prevails and those who know who they are can get together and produce one great London show. Peter Ivins, optometrist, Glasgow

Your chance to have your say… 1

An impressive show Dear OT, I attended two lectures on clinical Darwinism in glaucoma care in the equipment hub at 100% Optical. It went really well, with good attendance at both sessions. The lecture highlighted the changes in technology that allow optometrists not only to accurately diagnose and refer patients, but also to get involved in the treatment and management of glaucoma.

Send a letter via email to jackcochrane@optometry.co.uk

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OT reserves the right to edit letters and points out that the views expressed may not be those of the magazine or the AOP

Have your say. Email jackcochrane@optometry.co.uk


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PROFILE

Two centuries of eye care This October, the Manchester Royal Eye Hospital celebrates 200 years of delivering eye care in the north of England. OT ’s Ryan O’Hare went to meet consultants Nick Jones and Cindy Tromans to find out more

28/02/14 MREH BICENTENARY

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ON OCTOBER 21, 1814, on the now defunct public holiday of Trafalgar day, a surgeon from Leeds established one of the oldest dedicated eye hospitals in the world, in the city of Manchester. Since then the hospital has moved sites multiple times, been bombed by German World War II planes, seen the birth of the NHS, welcomed royalty, and witnessed fundamental clinical advances along the way. Today, just eight months shy of its bicentenary, the Manchester Royal Eye Hospital (MREH) serves more than 200,000 patients a year, and even received a visit from The Queen in 2012 – an impressive feat given its humble beginnings. “It started off as a little room in a house, with an eye surgeon going in twice a week,” explained Nick Jones, a consultant eye surgeon at the MREH. After more than 30 years working at the hospital, he is well versed in its history, so much so that he is writing a book for the upcoming bicentenary. The theme for the celebrations is ‘then and now.’ Poring over a collection of old documents, Mr Jones picks out just a few items of interest from the hospital’s past – including an invoice for ‘228 leeches’ scrawled in a ledger dated December 4, 1829. Such relics are dotted about the hospital, and those walking the corridors may stumble upon a display case containing an antiquated reading chart, which displays a passage from an old book printed in ever decreasing font size. “The old charts required people to read words, but the proportion of illiteracy in Manchester then was around 30%, so it wasn’t that easy to tell how well they saw,” said Mr Jones.

progressed since its doors first opened, you only need to look to something as commonplace as cataract surgery. Up until the mid-1800s visitors would have witnessed nightmarish scenes in the operating theatre, with patients being forcibly pinned down to the table while the surgeon made the cuts. With no anaesthetic to numb the eye or to send them under, patients had little choice; behave or go blind. Certainly not a procedure for the faint-hearted. Thankfully, by the 1850s the advent of anaesthesia had resigned such practices to the history books. “Nowadays patients are still awake,” said Mr Jones, “but very well anaesthetised and find the procedure not as unpleasant as they were expecting.” From a “very long list” of medical advances which have shaped modern ophthalmic and optometric practice, Mr Jones picks out antibiotics as a key. “A hundred years ago, an audit of cataract surgery showed that one in 10 patients developed severe infection afterwards,” he said, explaining that the risk today has dropped to one in 1,000. “We’re able to do much more for the average patient, and patients have more options available to them.”

Multidisciplinary approach Today, the labyrinth of specialist eye clinics and consultation rooms within the MREH are equipped with cutting edge imaging equipment, and 21st century pharmaceutical products. But those connected with the hospital in its modern form are keen to reiterate that one of its greatest strengths is its interdisciplinary approach to treating patients, with the wide scope of optical specialities supporting each other to lead patient care. “I think one of the special things about Manchester is the way that we all work together,” said Cindy Tromans. As a consultant optometrist at the hospital, and past president of the College of Optometrists, Dr Tromans has seen her team of

Then and now In order to see just how far treatment at the hospital has

Continued on page 22


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PROFILE

28/02/14 PEEK MREH BICENTENARY 15/11/13

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optometrists more than triple in the last 20 years, from eight to 27. “We’ve really pushed multidisciplinary team working, and have made a real success of that,” she added. “You have other professions like optometrists, orthoptists and nurses working as part of larger teams. For example, the nurses lead services at the emergency eye centre, the optometrists are heavily involved in the management of glaucoma and macular [conditions], and orthoptists are becoming more involved in managing neuro-ophthalmology problems. So I think that’s where we will certainly stand apart from many other hospitals.” Adding context, Mr Jones explained: “Ophthalmologists’ attitude historically was exclusively to expect support from other professions, but not direct intervention. I think it’s true to say that this has been diluted and improved upon more here than other hospitals.” “It’s about trying to improve the patient experience,” added Ms Tromans. “It’s important that they get seen by the most appropriate person with the skills to manage them in a timely manner.”

Celebrating two centuries Although the hospital’s 200th anniversary does not fall until October, the bicentenary celebrations are already underway, with a number of events planned throughout the year. Plans are being finalised for a permanent display to be installed in the hospital’s bustling open plan atrium, depicting key moments from its history and showcasing the technological and clinical advancements in eye care. In June, the hospital will celebrate the clinical research achievements with a four-day academic conference – with three parallel sessions which will see over 100 speakers and 150 abstracts for presentation. “It will be a gathering of old friends together with new science and hopefully a good professional meeting,” said Mr Jones. And, to mark the bicentenary itself, on October 21, all but the emergency services will be suspended for an open

day for hundreds of guests, as well as to allow academic tours of the hospitals’ facilities. Undergraduates and sixth form students will be able to tour the departments, see videos of surgery, and get first-hand experience of the advanced equipment used to treat patients at the hospital today.

Clinical research Research remains at the heart of clinical progress, and the MREH is well placed as a centre for research and development. “There are innovations here that are different [from] anywhere else,” said Mr Jones, referring to the bionic eye implants using implanted chips to detect and conduct signals to the retina. “[Manchester] is the only hospital in the UK doing it,” he added. “We have a very high grade genetics unit for identifying genes in children with serious eye problems... it’s fair to say that our genetics and paediatric teams are leading in Europe with that,” said Mr Jones, pointing to the genetic research being carried out at across the hospitals. In addition, there are currently between 20 and 30 active clinical trials being run at the MREH, with data being used to develop and test new drug treatments.

“There are innovations here that are different [from] anywhere else” With over 400 staff – including ophthalmologists, optometrists, nurses, orthoptists and dispensing opticians – the hospital is a draw for eye health professionals, both regionally and nationwide. “People want to work here,” said Dr Tromans. “The cutting edge research and leadership means that we’re able to attract a high calibre of optometrists who want to work in the department.”

Staying connected “Our colleagues can liaise with other specialists,” said Mr Jones, explaining the advantage of such a setting over the other historic eye institutions in the UK. Despite the high calibre of research, they are freestanding and lack the interconnectivity of the staff at the Manchester hospitals. Connected directly to St Mary’s Hospital on one side and the Manchester Royal Infirmary on the other, the location of the MREH facilitates communication, allowing eye health practitioners to seek opinion from other departments, and to have their opinions sought. “We are part of one of the largest medical campuses in Europe,” he added. As the hospital approaches its bicentenary, it is clear that the staff take great pride in its status, and the dedicated team of eye health specialists will continue to serve the community, keeping patients at the centre. “We are so generously provided by funds from patients who are grateful for what we have done, and that has enhanced what we are able to do enormously,” said Mr Jones. “Some of that,” he adds, “we can use to fund research. We think leading that research is very important, as vision loss is very high on most people’s list of crucial medical developments.”


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INTERVIEW

Fighting for sight OT ’s Emily McCormick speaks to the chief executive of Fight for Sight, Michele Acton, about the charity’s ambitions to invest £20m in research in the five years to 2017 made the two charities quite unique in their focus, which remains true today. With both charities operating on a small scale, the trustees recognised the potential impact they could have together and consequently joined forces, believing that a national charity dedicated to funding sight loss research was required. “The merger has certainly brought benefits in terms of the amount of research that we can fund,” Ms Acton told OT, revealing that, while the combined income of the charities before they merged was under £2m, it has now doubled. Today, Fight for Sight is funding research at 28 different universities and hospitals around the UK, with just under 100 different research projects currently being funded.

28/02/14 FIGHT FOR SIGHT

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FOUNDED IN 1965, Fight for Sight has grown to become the UK’s main charity funding sight loss research. However, with the ability to fund only one-in-six applications for research grants, the charity is on a drive to raise awareness and boost funds in order to expand on its vital research programme. Under the leadership of Michele Acton (pictured on page 26), who joined as chief executive in late 2006, the charity has pledged to invest £20m into new research grants during a five-year period between 2012 to 2017. This commitment is identified as pivotal in order to help the charity achieve the goals set out in its five-year strategic plan – the second under Ms Acton’s lead. These goals seek to find new ways of preventing, detecting, treating, and even, reversing sight loss. They also include improving people’s understanding of sight loss and providing information to those affected.

In the beginning Established 49 years ago by the first ophthalmic pathologist in the UK, Professor Norman Ashton, the charity’s main aim has remained the same: to fund research into eye disease. Today, Fight for Sight is formed by two charities which merged in 2005 – Fight for Sight and the IRIS Fund (formerly known as the Prevention of Blindness Research Fund). Having been founded, coincidently, in the same year, both organisations solely operated to fund eye-related research in London. While the IRIS Fund was based south of the river at the Royal Eye Hospital in Southwark, before subsequently moving to St Thomas’ Hospital, Fight for Sight operated north of the river at the Institute of Ophthalmology. Although a number of sight loss charities operate in the sector, Ms Acton rightly points out that almost all exist to provide services, support and information to people who are blind and partially sighted, rather than fund research. This

Strategy mission Currently, in the midst of its current five-year plan, which enters year three in April, the charity is working from a 2012–2017 strategic prospective. Last year the charity committed £3.5m into new research grants, and “we hope to do the same this year,” Ms Acton told OT. But in order to reach its aim of £20m by 2017, whereby a pledge of £4m annually is required, “we are going to have to increase our income to make this happen. We’ve been planning our fundraising strategy to support this and help from our supporters is as important as ever,” she admitted. Fight for Sight’s goals are not just based on what it seeks to achieve as a charity, but also on what its supporters wish to be explored. “We want to make sure that what we are really doing is what our supporters want us to do,” commented Ms Acton. As a result, last year Fight for Sight led a consultation in partnership with the James Lind Alliance and other partners including the College of Optometrists, the Royal College of Ophthalmologists and the NIHR Biomedical Centre for Ophthalmology. Under the title, the Sight Loss and Vision Priority Setting Partnership, the consultation focused on what people who have experience of sight loss and different eye diseases, patients and eye health professionals really want research to address. Having surveyed 2,220 people to ask what research should be prioritised, the final report was launched last October at the House of Lords. “We know that our supporters will want us to fund certain things, and a lot of our supporters are people who are affected by different sight conditions, so it seemed very sensible to do the consultation,” said Ms Acton.

Continued on page 26


INTERVIEW

28/02/14 PEEK FIGHT FOR SIGHT 15/11/13

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With responses covering over 100 different eye diseases, Ms Acton explained that “it was a complicated consultation, as other priority-setting exercises usually cover only one condition.” In the short-term, the priority-setting partnership will help the charity focus on what matters most to its supporters. In the long-term, Fight for Sight will use the findings to identify the priorities that are most important to people and which are failing to attract funding. Then, Ms Acton explained: “If there are top research priorities for people that are simply failing to attract research funding, we will go out there and stimulate that research.” “We will, down the line, look to put out calls to researchers saying that we want research proposals to address these priorities,” she added.

Fundraising focus As the charity’s flagship fundraising initiative, Fight for Sight’s Carrots NightWalks will expand into two new cities this year. “We will be going to Bristol and Oxford this September, turning the cities orange,” Ms Acton said with a smile, adding that expansion into the new cities is paired with growth for the existing walks. All of the walks will take place during National Eye Health Week in September. Having launched in London in 2011, the annual walks bring together people living with sight loss, eye health professionals and charity supporters to complete a six or 15-mile route to raise funds for eye research. The initiative has grown year-on-year, raising more than £300,000 over its three-year history. Fight for Sight has developed a series of partnerships with fellow charities, allowing them to buy places on the walks, with the money raised being earmarked for research in the area which concerns them. “We are working on new partnerships for the Carrots NightWalk this year,” Ms Acton revealed, with two new charities expected to come on board imminently. Discussing how fundraising aids the charity in meeting its wider goals, Ms Acton admitted: “It’s a very competitive charity marketplace and there are lots of good causes competing for people’s pounds. We have to be smart and put our case across.” One way of doing this is by encouraging corporate partnerships like the recent relationship with the Bio Industry Association (BIA) having been selected as its charity of the year. “We really want to capitalise on this over the next 12 months,” said Ms Acton. “It will give us the opportunity to profile eye research and highlight the importance of eye research to many, many companies across the UK. The BIA’s recent gala dinner helped to raise over £30K for Fight for Sight and played a crucial role in raising awareness for the charity.”

“There is so much more which could be done with additional funds” directly funded by the charity, include: a new genetic test to identify congenital cataract; a study which concluded that a link between developing AMD and Alzheimer’s does not exist; and the identification of genetic markers for keratoconus. In addition, researchers were successful in using similar technology to inkjet printers to print retinal cells. Although preliminary, it is hoped that this may lead to the production of cell grafts which could have potential positive implications for a wide range of diseases which affect the retina. Success in 2014 shows no sign of slowing, with the publication of the initial results of the first gene-replacement clinical trial for choroideremia, which surpassed the expectations of researchers leading the study, gaining national press coverage in January. “We clearly started the year well,” said Ms Acton, “with the results from the choroideremia trials being published in The Lancet. And, while we did not fund the trial itself, we did support the preliminary work, without which the trial couldn’t have been done.” Referring to where she hopes the charity will be by 2017, Ms Acton concluded: “We hope to have taken each of our goals, whether it’s about prevention or detection, understanding causes, or developing new treatments, and be able to point to very real examples of where Fight for Sight funding has absolutely made a difference.” While Fight for Sight’s achievements over the last 12 months may be impressive, Ms Acton is confident that these can be built on with further funding. “Like most charities, we have a budget for grants which we have to operate within and that sadly means that we have to turn down many good quality research projects due to lack of funds,” she said. “There is so much more which could be done with additional funds.” I will certainly be signing up for this year’s Carrots NightWalk to help raise funds. Will you?

Looking to the future Citing the charity’s achievements in 2013, the list is vast and requires Ms Acton to pause for breath in the process. Research developments which made headlines, under projects

Fight for Sight is the winner of the AOP Awards 2013 Charity of the Year. For further information, visit www.fightforsight.org.uk


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INTERVIEW

28/02/14 EYE DROPS APP

28

Drops reminder OT ’s Emily McCormick speaks to Tony Cowburn, director of Medication Planning, a company which has developed an app to help increase patients’ compliance of eye drops

IT IS well-known that the compliance of patients who are prescribed eye drops as a treatment option is low. When speaking to patients, reasons for non-compliance can range from a failure to administer properly, or, perhaps most commonly, simply forgetting. This was true for Tony Cowburn, director of Medication Planning and the brains behind the app, when he found himself prescribed eye drops following a series of eye operations. “After the operations, I found it difficult to remember which drops I

was meant to take and when,” Mr Cowburn admitted. As a result, the product development engineer devised a spreadsheet to aid him in managing his treatment. With positive feedback about the spreadsheet from the surgeon who treated him at University Hospital Southampton, it was two years later when apps were coming to the fore that he decided to develop the spreadsheet into an app, dubbed ‘Eye-Drops.’ Speaking about ‘Eye-Drops,’ Mr Cowburn explained: “It’s really simple and I knew instantly that it would be very useful to people who were in a similar situation to what I was at the time.” However, with app development not being his forte, he joined forces with a software developer, Martin West, now fellow director of Medical Planning. Released onto iTunes 18 months ago for a download fee of £2.99, the pair have decided to offer the app free of charge, with immediate effect. Explaining the move, Mr Cowburn told OT: “While feedback has been extremely positive from those who have downloaded and used the app, we have

opted to offer it free of charge because opening the app up to a wider audience will offer a number of benefits.” Addressing the reasons why, he added: “Firstly, it is a useful app which we are proud of and would like everyone who needs to take eye drops to be able to take advantage of it.” Other reasons include the potential it has to capture important compliance data and the ability to host i-adverts if circulation is boosted.

The app Simple in nature, the app works by raising alarms for users to prompt them to administer their medication. Once downloaded, patients can search and select the eye drop medication they are using, as well as the number of days they require treatment and for which eye. Using that information, an alarm will be triggered, reminding the patient every time an eye drop is due to be used. It will also record when a patient has adhered to their medication, allowing them to check compliance at a later date. Users can select their prescription from a list of more than 100 commonly


consistently have on you.” He added: “It’s annoyingly good at reminding you that it is time to take the drops and it’s almost impossible not to do it right.”

Data benefits

29

28/02/14 EYE DROPS APP

prescribed eye drop medications which are stored in the database. However, they can also input additional medications which may not be listed, eye drop-related or otherwise. “Often those who take eye drops,” Mr Cowburn said, “are older people who have other

Mr Cowburn is excited about the potential wide-reaching benefits data capture could bring once a larger uptake for the app is achieved. While he is not referring to personal data capture, the director explained that a Universal Unique Identifier (UUID), which exists on every phone, is able to capture the information stored on the app by each user and direct it back to the company’s database. This provides the potential for meaningful trend analysis, exploring which brands are used, when compliance becomes an issue and who for. Analysing this data would be beneficial for both pharmaceutical companies and medical staff,

“It’s annoyingly good at reminding you that it is time to take the drops and it’s almost impossible not to do it right” medication to take too. Therefore we felt it was important to allow them to add, for example, their blood pressure tablets.” Large fonts and a speech mode have also been included to support visually impaired users. Explaining the reasoning, Mr Cowburn said: “In the early days of developing the app, we realised that many people who are prescribed eye drops do not have very good eyesight and, therefore, we felt it was important to offer a speech option.” When activated, a voice command will override the alarm option, with the reminder, dose and eye requirements spoken aloud to the user instead. Talking about the benefits that the app brings, Mr Cowburn said: “The difference is that it is automatic. People always have their phone with them, it never leaves their side, so if you have to administer a drop six times daily, your phone is the one thing that you will

Mr Cowburn explained. While the former would gain an insight into the medication which is being prescribed by doctors, the latter would be able to see how compliance changes when using ‘Eye-Drops’ as an aid.

Company future Since ‘Eye-Drops’ was initially launched, the company has been busy working on a number of other apps which it hopes will reach market in due course. These build on the basis of ‘Eye-Drops’, utilising the technology to aid compliance in people being treated for different conditions, such as TB and mental health conditions. Mr Cowburn concluded: “This time next year, I would hope that some of these other apps will have come to fruition for the specific group which we have been working with.” To download the app, visit http://bit.ly/1h62963

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100% OPTICAL

‘100% fantastic’ OT reviews 100% Optical, London’s first annual, international optical show

28/02/14 SHOW ROUNDUP

30 28

A TOTAL of 5,483 (ABC audit pending) people attended the inaugural 100% Optical trade show which was held at the ExCeL Exhibition Centre last week (February 16–18). The three-day event combined an exhibition of more than 180 companies, with a comprehensive lecture programme of 90 hours of education. A popular catwalk show, which regularly drew in a large crowd, was hosted daily in the fashion hub. A total of 101 CET points were available across the AOP-provided education programme, with 100 suitable for optometrists, 94 for dispensing opticians, 22 for contact lens opticians and 23 for independent prescribers. Of the seminars which ran simultaneously from five stages, 59 hours of CET-accredited lectures were held. Chief executive of the AOP, Henrietta Alderman, told OT: “100% Optical has been a great success, bringing together

world class CET with industry-leading innovators. Our members have enjoyed a VIP show experience that delivered a fresh approach to optics. “Our education programme was a sellout success, with 101 CET points on offer throughout the show. With exhibitors already booking stands for next year’s event, we are delighted that 100% Optical has become one of the leading events of the optical calendar.” Delegates attending the show comprised optometrists, dispensing opticians and industry professionals. In addition, organisers reported that more than 250 buyers attended the show from companies such as Specsavers, Vision Express, Leightons Opticians and Harvey Nichols. AOP member Lynne Fernandes, who attended the event, said: “The show has a well-designed layout and interesting and exciting exhibitors. I would recommend anyone in the world of optics to come to

100% Optical.” Feedback from exhibitors has been as equally positive. Reflecting on the show, Robert Morris, founder of William Morris Eyewear, said: “100% fantastic.” “100% brings the European feel to London. I’m delighted that we decided to exhibit, we will definitely be back next year,” he added. UK manager for ophthalmic solutions at Zeiss, Rob Lyon, commented: “What a vibrant show with a strong footfall. 100% Optical marries well with our objectives.” Lee Newton, CEO of Media 10, the company which organised the show, said: “This event has been spectacular – we have taken a strong industry and launched an exhibition which will transform the UK optical market. “The feedback from exhibitors has been overwhelming. London needed a worldclass optical event and we have given them exactly that. We have shown that B2B events can have the wow factor.”


ATTENDANCE

BY COUNTRY

87 13%

%

UK

INDIVIDUAL SEMINAR

ROW points

CET ON OFFER TOTAL POINTS = 103

3,766 BOOKINGS

90

HOURS OF CET/CPD

AVAILABLE

immediately felt a buzz and a welcome from the optical community. That gave us a mandate and the encouragement to pursue our idea of creating a new, well designed, well curated, exciting annual event in a world class London venue. Now the industry is event at the ExCeL. We saw over 5,300 professionals, assembled 200 interesting and varied stands, amassed a staggering 90 hours of education, and attracted star South Africa, Holland and Israel, to name but a few. We had backing from key industry

and our media partner, Optometry

59 AVAILABLE

ATTENDEES Independent opticians 60% Manufacturers 8% Multiple opticians 7%

Distributors of optical products 6% Others 19%

31

buzzing again after a fantastic three-day

and unswerving support from the AOP

BY SECTOR

IP = 23

in February 2013, we

people with huge credibility and respect,

HOURS OF CET

CLO = 22

launched 100% Optical

international speakers from Australia,

Optom = 103

DO = 96

WHEN MEDIA 10

Today. We owe a massive thank you to all of those who put their faith in this project. I won’t name them all, for fear of leaving someone out – but I do have to mention the AOP’s Karen Sparrow, who worked tirelessly to create a brilliant CET programme which was so well received. So, believe it or not, thoughts have already turned to 2015 – and the exciting thing is that we have done so much groundwork now, that next year the event will certainly be bigger and better. It’s exciting to have so much positive feedback and suggestions for 2015 (please keep them coming by the way). Watch this space; as 100% Optical develops, it will get better and better, fulfilling your needs and delivering the type of trade event the profession deserves. We felt we could bring something of real value to the industry, and by working together, we have made a fantastic start. Now we have something we can really build on. See you in February 2015. Nathan Garnett 100% Optical event director

28/02/14 100% OPTICAL

100% Optical in numbers

Looking back...


100% OPTICAL

And the verdict is…? OT hears from delegates, speakers and exhibitors about their highlights from the first ever 100% Optical show in London

Buyers’ delight

“Impressive… I like [the event], it’s got a good vibe, and it feels different. I am looking for niche products from companies like The Eyewear Company, and ProDesign Denmark.” Paul Gallivan, dispensing optician, Leigh-on-Sea

32 20

28/02/14 FEEDBACK

“I think the event is absolutely brilliant. The venue is really great – lots of space and lots of things to see. There seems to be a nice mixture of commercial and clinical, which is what we need.” Mike Killpartrick, optometrist, Bristol

“We have come from West Wales to try and see as much as possible in one go. The unusual elements of frame design have definitely been a high point. It’s been brilliant.” Celia Vlismas, optometrist, Crymych

“It’s a really nice venue, with different sections clearly marked out. There are lots of fashions on display, offering something different for people. This includes Feb31st – the texture of wooden frames is very nice – and Andy Wolf’s dramatic eyewear. I will definitely be back for the show next year.” Julia Fisher, dispensing optician, Welwyn Garden City “I am very impressed… We are here looking at frame ranges, and optical lenses. We go to Silmo and Mido – so it is good to have all of these brands under one roof in the UK. I am here for high quality products, people like ProDesign Denmark and British brand, Cutler and Gross. I have also seen quite a few brands I have not seen before and am interested to look at.” Arminder Singh Panesar, Bristol

Knockout seminars

“The quality of the lectures is very high, and I am really impressed to see that 100% Optical is not only focusing on British issues, but is also “This really is the highlight of my career focusing on global issues.” and, for once, I am asprogrammes near to speechless Professor Kovin Naidoo, global director ofas theI ever International for Eyecare Education get. ICentre would like to thank those

who took the trouble to nominate me and vote for me.” Lecturer Award: Liam Kite

“It is probably the most interesting meeting I have been to in quite some time. The organisation has been fantastic, and I think there is a buzz in the hall that augers well for the future.” Professor Brien Holden, Brien Holden Institute “My impression of the show is that it is immense. I think the clinical programme was absolutely fantastic. I have been to many lectures which I have been enjoying, and I learnt a lot. I really loved the myopia control session – a very important topic to all of us in the optical industry. I love London – I am going in to town tonight.” Dr Eef van de Worp, associate researcher at the University of Maastricht “I wanted to get CET points and I thought the programme looked interesting and made me think it is worth coming all the way from Portugal to attend the event. Since I got here, it has been absolutely brilliant. Not only have I got points, but I have learnt things. Even after 40 years in practice, I can still learn.” Roy Carpenter, optometrist, Cavoeira, Portugal


nd .

“The show is very exciting for us. In terms of the concept, there are all of the elements to go to make a practice. There is an exciting programme going on, and we are excited to be here. We’ll definitely be back next year.” Safilens

The exhibitor experience

“The event has gone very well. It is great to be surrounded by so many companies, and great to meet current and potential customers around the London area.” Moorfields Pharmaceuticals “We really like 100% Optical. It has a vibrant atmosphere and it’s a great venue. In the first hour, we have taken quite a few leads.” Carl Zeiss “SeeAbility has really enjoyed coming to 100% Optical. We have been impressed by the size of the exhibition – it has been a really positive experience for us.” Seeability

The AOP on hand “The AOP members lounge is great. It is good to have somewhere to meet the AOP team, talk to them about any problems you might have, and to have somewhere to sit down and rest your feet. Plus the tea and coffee is a bonus on top of all of that.” Roy Carpenter, optometrist, Cavoeira, Portugal

That London fashion feeling “I wanted to support a ‘vibrant ‘ London fashion eyewear show, and [100% Optical] really has those elements. I have been to other shows like Mido and Silmo and they are always very energetic. This event has definitely delivered, really making optometry cool, because it is about fashion as well as the welfare element. Exhibitor highlights include the Hoet 3D frame, which is an amazing technical innovation – really pushing the boundaries. I also like Feb31st’s new wooden frames. New concepts, things that are different, things that are broadening our minds as to what eyewear is, are great, and hopefully this will trickle down to the public and they will really get behind being proud of their eyewear. London is the centre of fashion, but eyewear has never taken up the fashion mantle before.” Brenda McKernan, optometrist, London

33

Student support “100% Optical is a fantastic event for students to attend. It is a great networking opportunity in a fun environment, and as an optometry student I found the sessions particularly useful. The sessions I attended were both informative and interactive. My personal favourite was the session about myopia progression by Professor Ed Mallen. His enthusiasm for the topic made for an engaging lecture. The exhibitors were all very friendly and there were plenty of opportunities to ask questions one-on-one with a number of different optics companies. Overall, I had a great time at 100% Optical and I look forward to attending next year.” Melissa Ramsey, optometry student, University of Bradford

28/02/14 FEEDBACK

“The show has been fantastic. We love 100% Optical; it’s absolutely what the UK’s needed for a long time. We can see it’s a long-term investment, a long-term strategy – but for sure we’ll be back next year. The organisers of the show are a pleasure to work with, and they are very ambitious.” William Morris

“Exhibiting at 100% Optical is a no-brainer for us: it’s a London show, and we are a London company. I think the industry has been calling out for a London show for quite a while, and we are excited to be here at something, which is fresh and new, and on our doorstep.” No7 Contact Lenses


100% OPTICAL

28/02/14 CLINICAL ROUNDUP

34 28

Capturing the clinical An impressive line-up of clinical speakers presented over the three days of 100% Optical. OT ’s Jack Cochrane and Ryan O’Hare look back at some of the highlights THE AOP-delivered programme of CET accredited education seminars on offer at the first 100% Optical trade show saw speakers cover a wide range of important topics.

Understanding the senses Visitors to the main stage were treated to a talk on perception by Professor Charles Spence, entitled How your senses interact and where vision fits in. Professor Spence, of the University of Oxford, highlighted the large areas of neural landscape given over to visual processing in comparison to the other senses, and described how the effect of visual dominance can be so powerful that it can override the other senses influencing what we hear and even taste. Speaking to OT, Professor Spence commented: “Our senses are more integrated than people realise…so there is an opportunity to make up for sensory loss through a better utilisation of the other senses.”

Halting myopia in its tracks Drawing a large crowd to the main stage, Professor Brien Holden delivered his presentation on the Challenge of myopia. He explained that “53% of visual impairment worldwide is associated with refractive error,” resulting in over $200bn (USD) in lost productivity. Professor Holden presented evidence that high myopia increases the risk of vision loss and blindness through

significantly increasing the risk of retinal pathology, glaucoma and cataracts. Targeting children with the condition to slow the rate of progression, and therefore reducing the long-term health impacts, is key to tackling the issue he said. Professor Holden told OT: “Over the years we haven’t taken a lot of interest in controlling myopia, and you’ll find many optometrists with children whose myopia has progressed from minus one, to minus two and minus three, who now think ‘maybe I should have done something about it.’” Professor Ed Mallen also spoke about myopia control on the closing day of the event. Echoing Professor Holden’s sentiment that the problem is ‘creeping westward,’ with increased prevalence in Europe and the US. He highlighted the links between the laboratory and the consulting room, explaining how low dose atropine, multifocal lenses and orthoK are just a few of the methods showing promise in treating myopia, and so potentially avoiding further longterm complications.

Advances in technology Eye surgeon and corneal expert at Moorfields Eye Hospital, Romesh Angunawela, talked delegates through how technological advances are changing the way in which corneal laser refractive surgery is carried out in the UK. “The technology is really unbelievable now. It’s amazing


what we can do,” he said. With modern femtosecond lasers able to deliver up to 1,400 pulses per second, some corrective procedures can be over in a matter of seconds. “Large (clinical) studies have shown that up to 96% of patients are happy with laser surgery,” Mr Angunawela told the audience, “but there are problems.” He explained to delegates that one in every 1,000 patients may succumb to infection, dry eye or develop heavy scarring of the cornea after the procedure. “When a patient develops a problem, that becomes our problem,” he asserted. Mr Angunawela went on to describe how small changes can affect how quickly a patient recovers from the procedure, such as changing the angle of the laser incision, which can encourage the repair of nerves severed during the procedure.

Current OCT technology is limited to a depth of 2mm, but advances to laser technology are allowing for depths of up to 40mm. Vertical-cavity surface emitting lasers (VCSEL) can provide a scan of the entire eye, allowing clinicians to “drill down” to any area they want to view in greater detail. The session also provided an opportunity for delegates to look at case studies. Practitioners were able to study OCT images to make diagnoses and potential treatment plans for patients, under the direction of Christopher Mody, clinical programme director for Heidelberg Engineering.

“Over the years we haven’t taken a lot of interest in controlling myopia, and you’ll find many optometrists with children whose myopia has progressed... who now think ‘maybe I should have done something about it’”

OCT benefits NIHR clinical lecturer, Pearse Keane, from Moorfields Eye Hospital in London, spoke to delegates about Optical Coherence Tomography (OCT), explaining how technological advancements are providing images of the interior eye with greater levels of detail. Highlighting the importance of the technique as a diagnostic tool, Mr Keane informed the audience that Moorfields is carrying out over 1,000 OCT scans a week. “You cannot call yourself a retinal specialist if you don’t have access to OCT imaging,” he said. Since OCT was first described in the journal Science in 1991, it has become a mainstay for retinal imaging.

Problem patients How to handle reluctant or challenging patients was also a theme at the event, with two presentations on the kind of patients that can move practitioners “out of

their comfort zone.” In his talk Eye care: not a man in sight, Dr Ian Banks, visiting professor in men’s health at the Institute of Nursing and Health Research at the University of Ulster, discussed the challenges of getting men to make use of optical services. Drawing on evidence drawn from many healthcare sectors, Dr Banks painted a picture of how half of the population access (or rather do not access) healthcare. One shocking statistic, which drew gasps of surprise from the audience, was that the average woman in the UK is diagnosed with diabetes within one year of symptoms appearing, usually by a GP, while for men, the average is 10 years, with a diagnosis usually being made by an optometrist examining a badly damaged eye. Stating that “men deflect important health issues,” Dr

28/02/14 CLINICAL ROUNDUP

35


100% OPTICAL Capturing the mood OT ’s clinical editor, Ian Beasley, discusses his highlights of 100% Optical

28/02/14 CLINICAL ROUNDUP

36 28 Banks described how men suffer from a lack of general health education, which results in them becoming a major drain on NHS resources as they ignore health issues. Attendees were also given advice on how to manage another challenging group of patients – children. In her lecture Children’s vision: getting it right for the child patient Dr Margaret Woodhouse, senior lecturer at the School of Optometry & Vision Sciences, Cardiff University and a specialist in paediatric optometry, illustrated why vision tests are so important for children – and rewarding for optometrists. Discussing the importance of early testing of young patients, Dr Woodhouse (pictured centre, page 34) pointed out that uncorrected refractive error can have a significant impact on a child’s education, explaining: “Earlier correction of defects means better learning.” Advising optometrists to try to see the eye examination from “the child’s point of view,” Dr Woodhouse recommended crouching down to get a ‘child’s eye view’ of their practice, asking ‘how does the practice look?’ and, importantly, ‘is there equipment around I don’t want them to play with?’ Dr Woodhouse also recommended that optometrists with young patients examine their local child protection policy and take basic steps such as not seeing them without the presence of another adult. However, in among advice on techniques and precautions, Dr Woodhouse explained to OT that there is an upside of treating younger patients: “Testing young patients is not the scary process some practitioners think it is; if you get into the right mindset it’s the most fun thing you can do in optometry.”

It’s not always easy to translate the sense of atmosphere at events onto the written page, without resorting to the trite use of words such as ‘buzz’ and ‘vibe’. Nevertheless, capturing the successful elements of the inaugural 100% Optical event is not difficult. Of significant appeal to the throng of attendees was no doubt the impressive provision of CET across all three days. With headline speakers from the academic world giving latest research insight, and leading figures from the clinical sphere providing expert advice of direct relevance to modern practice, there was certainly plenty on offer for all. The event flowed seamlessly with education streams across four platforms, a reflection of the meticulous planning undertaken months in advance. The seminars were punchy, relevant and succinct, ensuring that practitioners were not just there for a bland accrual of requisite CET points.

“The event flowed seamlessly with education streams across four platforms” A standout session on day two was the assured delivery by colleagues, Peter Ivins and Craig McArthur, taking a retrospective view as optometrists qualifying in disparate eras. Gone are the days when practitioners were armed with nothing more that a direct ophthalmoscope, and a Bjerrum screen; those entering the profession today have an abundance of technology at their disposal, including video slit lamps, automated visual fields, fundus cameras, OCT, with the list lengthening year-on-year. The duo gave a compelling case for practitioners to make steps to acquire the latest technology on offer. They outlined a successful model to support its use in a modern clinical environment for the dual benefit of improved patient care and business longevity. The true mood of this spectacular event may not have been captured in this short piece. Perhaps the only way to really see what the industry’s freshest event has to offer is to go along next year. As the thousands of visitors strolled away from the exhibition, fed, watered and with a glut of CET points safely under their belt, it was all too easy to forget that the entire event was absolutely free!


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REVIEW

UK academy first What is believed to be the first training academy from a UK equipment company has been officially launched. OT ’s Robina Moss reports on the opening ceremony

28/02/14 HEIDELBERG ACADEMY

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THE HEIDELBERG Academy was officially launched earlier this month (February 14) at an opening ceremony of the OCT specialist’s new UK head office and training centre, in Hemel Hempstead. The Mayor of Dacorum, Councillor Penny Hearn, toasted the ‘centre of excellence’ with an audience of leading UK optometrists and ophthalmologists, glaucoma specialists and members of the Press, including OT. Company founder, Christopher Schoess, travelled from Germany to attend the event and celebrate the success of the technology company, which became an independent supplier two years ago. A surprise came when Mr Schoess promoted well-known UK general manager, Krysten Williams, to director in front of the 40 guests at the event. He said the UK operation was one to be admired and emulated.

Growth Outlining Heidelberg Engineering’s international growth during the past 23 years, Mr Schoess highlighted that Spectralis technology is now being used in more than 100 countries. He added that the company generated £90m of sales last year and now had 250 employees. He highlighted that the Spectralis is being used on the international space station to monitor astronauts for any changes in the optic nerve, as part of research into long periods spent in space. Ms Williams said that the opening of the Heidelberg Academy demonstrated the company’s commitment to the early diagnosis of disease. She added: “It highlights that in the UK we have 100 people a day who start to lose their vision but through early detection and careful monitoring, one in two cases could be avoided. The Spectralis detects

Pictured at the event left to right are: Mr Mody, Professor Crabb, Mr Priel and Ms Williams the smallest change, with more than five times the accuracy of even its closest competitor.” She continued: “We have made this technology affordable and networked to provide good connectivity to other systems. We are committed to education and to supporting our faculty members to provide better levels of patient care.” Ms Williams later told OT: “We are very proud of this new academy and believe we are the first equipment company in the UK to open a training academy. Education is a key part of what we do at Heidelberg and this will enable us to do more.”

“Education is a key part of what we do” The theme was expounded by the company’s clinical programme manager, Christopher Mody. He said: “Heidelberg has a commitment to education and training which is unrivalled. We work very closely with the professional bodies and are developing new means of delivering education, not just through our Retinal Faculty and Glaucoma Faculty but also with valuable Peer Discussions.” The keynote speakers at the launch were Professor David Crabb from City University London and Ethan

Priel, founder and director of the ophthalmology department at the MOR Institute, Israel. Professor Crabb’s lecture, Disease progression in glaucoma, reflected his longstanding interest in imaging and laboratory measurement techniques, particularly relating to perimetry and visual fields. “When does the disease start to impact on reading, on finding something on a supermarket shelf, on mobility, and particularly on driving?” he asked. Stressing the importance of establishing the measurement of binocular vision loss, he said his team had examined hand eye coordination and used hazard perception challenges, taken from the UK driving licence test. Used in conjunction with eye tracking technology to monitor fixations and saccades, the research had led to the view that patients with glaucoma make more, but smaller, saccades than those without glaucoma and that more research was needed in this field. Mr Priel, who has devoted his career to the study of ophthalmic imaging techniques, highlighted the importance of examining the periphery, particularly in relation to diagnosing Coats’ disease. Details of the company’s 2014 educational programme can be found at www.heidelbergengineering.co.uk


Watt a great idea


BUSINESS

The need to comply Changes to workplace pension law mean that employers need to give their workers access to a workplace pension scheme which meets certain legal standards. Adam Bernstein investigates

28/02/14 PENSIONS

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THANKS TO improvements in living standards, technology and radical advances in healthcare, we are all living longer. That is the good news. The bad news is that, with great expectations of pensions, yet poorer returns, pension investors may well be very disappointed with life in their old age. According to the UK’s Office for National Statistics, men born in the UK in 1985 have a life expectancy of 86 years. For those born in 2013, that life expectancy had risen to 91 years; however, it is projected to be not far off of 94 years for those born in 2035. The problems created by the interaction of longevity and the State rolling back what it can pay for means that the Government is forcing the employer and employee pension relationship to change. According to Heather Chandler, a partner in the pensions team at Shoosmiths LLP, the Government has, for some time, been concerned that not enough people are saving enough for their retirement – preferring instead to rely on the State, or just “live for today.” She added that many larger employers offer their employees membership of an occupational pension scheme, and pay contributions into that scheme on behalf of those who join. However, there has previously been no legal requirement to do so and the costs associated with having an occupational pension scheme have deterred many smaller employers. Instead, where required, they have perhaps “designated” a stakeholder pension scheme into which no employer contributions had to be made. Take-up of stakeholder pension schemes by employees has traditionally been very low. “The Government has therefore moved from the concept of employees choosing to join a pension scheme to one of automatic enrolment,” explained Ms Chandler. She added: “Since October 2012, larger businesses have been required to automatically enrol eligible employees into a pension scheme and pay a minimum level of pension contributions for each employee. By February 2018, every

employer, no matter how small, will be subject to the same obligations.” Graham Vidler, the director of communications and engagement at the National Employment Savings Trust (Nest), a low-cost pensions auto-enroller run by the Government, echoes Ms Chandler’s comments. He said: “Workplace pension law has changed, which means employers need to give their workers access to a workplace pension scheme which meets certain legal standards.” He believes that over the next five years more than 1.2 million employers and up to 11 million workers will be automatically enrolled into a pension scheme.

“Ignorance of the duties is no defence” Staging dates Explaining further, Ms Chandler added: “Generally speaking, employers with between 50 and 249 employees will have staging dates (to join auto-enrolment) between April 2014 and April 2015. Employers with fewer than 50 employees will be subject to the requirements between April 2015 and April 2017. New businesses have staging dates at the end of the timetable.”

Continued on page 42


OT full page keep calm_Layout 1 19/02/2014 13:56 Page 1

KEEP CALM YOU WON’T BE PUFFED www.main-line.co.uk


BUSINESS

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Recent research from Nest in Nest insight highlighted that a number of employers staging in 2014 are not prepared. Mr Vidler said: “We found that only 23% of employers staging between February and July 2014 had both confirmed the provider they are using and have done everything else they needed to do in order to be ready to comply.” There is one saving grace though – practices can use a threemonth postponement period to avoid automatically enrolling employees who leave the business shortly after joining (such as temporary workers). This should also help practices align their obligations with existing administrative and payroll processes. The Pensions Regulator will notify every business of its staging dates. Following their staging date, they must register with the Regulator and penalties will follow from noncompliance.

Not everyone is covered Those covered by the auto-enrolment legislation include permanent, fixed-term and temporary employees, as well as agency workers. Self-employed people will not be subject to the requirements. Employees already enrolled into a qualifying scheme through their workplace will remain in that scheme and the duty of auto-enrolment will not apply in respect of them. Mr Vidler explains that only practices which operate as a sole trader and who do not employ anybody else, are unaffected by the changes. “However,” he added, “sole traders may decide to take advantage of a scheme like Nest so that they can put something away for the future, while getting tax relief.” Ms Chandler explained that workers fall into different categories, depending on age and earnings, and the obligations on employers differ accordingly. “Employees between the age of 22 and state pension age, who earn over the income tax threshold (£9,440 in the 2013/2014 tax year), are ‘eligible jobholders’ who must be automatically enrolled into a scheme

at the staging date (or one later joining the business). The employer is required to pay contributions into the pension scheme in respect of these employees.” Ms Chandler added: “However, those earning below the income tax threshold but above the lower earnings limit, and those earning above the lower earnings limit but who do not meet the age criteria, will be able to opt into the scheme, should they wish, and the employer must also pay contributions for these employees if they do opt in.” She highlighted that practices need to be aware of their obligations to provide certain information to all employees. For employees earning under the lower earnings limit, there is no requirement on the employer to contribute but the employer must arrange access to a pension scheme and facilitate employee contributions (say through the existing payroll systems) if the employee requests it. In terms of the optical profession, the NHS offers pension services to employees. But James Davenport,

“A practice can use an existing occupational or personal pension scheme, set up a new scheme or enrol employees in Nest” communications and stakeholder relations manager in the Customer Insight and Communications Team at the NHS Business Services Authority, said: “The only opticians who can access the NHS pension scheme are those who work directly for NHS organisations (such as those at the Manchester Royal Eye Hospital) and ophthalmic practitioners.” He added that these practitioners, if they have previously opted-out of the NHS pensions scheme but remain eligible for scheme membership, will be automatically re-enrolled in the NHS pensions scheme at the next staging date. In contrast, private practices will have to set up their own pension schemes explained Mr Davenport. He added: “ECPs who work for private companies such as Specsavers do not have access to the NHS pension scheme. While Specsavers may be undertaking an NHS contract to provide eye tests, its employees are subject to the pension arrangements of that company, not the NHS.” Information on NHS auto-enrolment is at www.nhsbsa.nhs.uk/Pensions/ 4094.aspx.

What if employees do not want to be enrolled? Clearly there will be some employees who, for whatever reason, do not want to be part of a practice automatic enrolment pension scheme. For them the process demands that they must first be automatically enrolled into the scheme before being allowed to opt out. They must then be automatically re-enrolled every three years.

Continued on page 44


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BUSINESS What practice employers should do next? • Practices must identify their staging date (the Pensions Regulator will write 12 months beforehand) • The next step is to review the workforce to identify categories of employees and the duties owed to each • Practices should make additional checks on any contractors, or agency staff, to see whether they fall within the requirements • Decide what sort of scheme the practice will operate, and if an existing scheme is to be used, make sure it meets the

44 28

necessary requirements, making amendments if required •Take advice as appropriate and make use of free resources such as the Pensions Regulator’s website • If a new scheme is required, review pension provider options in the market. Be aware that providers will be inundated

28/02/14 PENSIONS

with small businesses as more and more hit their staging dates, so build in plenty of time to work within providers’ timescales • Discuss with payroll providers how the changes can be accommodated within existing systems • Budget for the increased cost of paying employee contributions • Prepare employee communications (template documents are available on the Pensions Regulator’s website) • Keep records to prove compliance with auto-enrolment duties • Note that the auto-enrolment requirements continue beyond the initial staging date – new members of staff will need to be auto-enrolled on joining employment, and existing staff may fall within the requirements on a change in age or earnings • Use software wherever possible to automate the monitoring process.

Finding a scheme to join With the background established, the question turns to the pragmatic implementation of the new system and there are a number of options available. A practice can use an existing occupational or personal pension scheme if it meets certain statutory requirements, set up a new scheme or enrol employees in Nest. Mr Vidler explained that Nest was set-up by the Government specifically for automatic enrolment and operates on a not-for-profit basis. It is the only pension scheme to have a service obligation which means that Nest is open to every single employer. He warned, however, that any scheme used for automatic enrolment must comply with legal minimum standards set out by the Government. As already mentioned, many small businesses will have previously been subject to the requirement to provide access for staff to a stakeholder pension scheme. This requirement has now been removed, although employers may continue to use existing stakeholder schemes for

auto-enrolment purposes, if they meet certain quality requirements. Ms Chandler said: “If businesses want to use an existing scheme, they should check the regulator’s guidance or seek legal advice on whether it meets the quality requirements.” The guidance is available at http://bit.ly/1etn3fY.

The costs Regardless of the type of scheme chosen, employers must make minimum contributions into the scheme in respect of each employee. These minimum contributions are being phased in gradually, but by 2018, a total of 8% of an employee’s qualifying earnings over a 12-month period must be paid in, at least 3% of which must come from the employer and 1% from tax relief. Naturally there are costs for the administration of pensions and charges will involve a percentage of each contribution and annual management fees for employers who use Nest. Other pension providers will also impose charges. “For smaller employers the comparative costs of automatic enrolment could be substantial and will need to be budgeted for,” Ms Chandler warned.

Talk to others It should go without saying that the changes will have an impact on business systems generally, most notably payroll and the administration involved in taking on new staff. Practices will need to liaise with the human resources department in larger organisations, or whoever is managing the process internally in smaller companies, as well as payroll providers, pension providers, and financial and legal advisers, if appropriate. Practices will also need to communicate with employees at the appropriate times.

Employee safeguards Ms Chandler is keen to stress that there are certain


Non-compliance is not an option

Start soon All businesses, but especially small businesses, will need to make various changes in order to deal with the introduction of the auto-enrolment legislation. Drawing upon her experience, Ms Chandler warned: “Administrative tasks will need to be allocated, with valuable staff time devoted to the issue, third party providers approached, systems changed and extra costs budgeted for.” She said that taking action sooner rather than later would help ensure that a business is well prepared for a smooth transition when the time comes to enrol staff. Mr Vidler said that time is of the essence. He added: “The largest employers took around a year to get ready for automatic enrolment, obviously they had more workers to enrol but they were also more likely to have an in-house specialist team which was able to help. With dedicated HR, payroll, communications, IT and pension specialists, they had a head start which some smaller employers may not have.” He is recommending nine to 12 months to make sure businesses meet their new legal duties. However, practices would be well advised to plan ahead to ensure that their systems can cope with the changes, and to allow time to work with pension providers who may impose their own conditions, or timescales, or may indeed decline further business at some point before 2018. The Pensions Regulator (www.thepensionsregulator.gov.uk) suggests businesses allow 12–18 months to prepare for auto-enrolment.

Information www.nestpensions.org.uk www.thepensionsregulator.gov.uk

45

28/02/14 PENSIONS

safeguards imposed by the legislation to protect employees: “Businesses must not encourage employees to opt out of a scheme and must not treat workers unfairly, or dismiss them for a reason relating to membership of an auto-enrolment scheme. In addition, businesses must not screen job applicants on the basis of how likely they are to opt in or out of the pension scheme.” The warnings are clear.

For businesses that get it wrong the Pensions Regulator will generally work with them to ensure compliance. “However,” as Ms Chandler was keen to point out, “ignorance of the duties is no defence and can result in a statutory notice directing businesses to comply.” She added that there is a fixed penalty of £400 for non-compliance with the statutory notice and there are other financial penalties, including escalating penalty notices of £50 to £10,000 a day, depending on employee numbers. She warned: “The Regulator has stated that it will pursue penalties through the courts if necessary and will prosecute employers for deliberate and wilful failure to comply.” There seems to be reason and common sense built into the system. Ms Chandler believes that, while the penalties for non-compliance may seem substantial, the Regulator will only use them for persistent offenders, or if there has been deliberate and wilful ignorance of the duties. She concluded: “So long as you make efforts to comply, you should not find yourself on the receiving end. For smaller employers, working with a good pension provider/advisers, and early planning, is key to ensuring compliance.”


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25/02/2014 12:26


CET

CONTINUING EDUCATION & TRAINING

Clinical editor’s corner Not everyone could take advantage of the spectacular programme of education on offer at 100% Optical. But fear not, readers can still keep ahead of the game by completing the CET in this issue from the comfort of their favourite armchair. With engaging content for practitioners from all disciplines, it’s the perfect opportunity to tick off a few of those allimportant competencies.

Ian Beasley

Expires in days

C-35258

Blepharitis, but not as you know it

Expires in days

C-34991

Low vision Part 1 – not just AMD

days

Retinal haemorrhages – cases in ophthalmology

CET MULTIMEDIA

Expires in

28 days

C-34583/C-34450

The future of cataract surgery This lecture takes a look at modern cataract surgery, from patient history and symptoms to co-existing ocular pathology, along with the use of femtosecond lasers and advanced intraocular lens implants.

Low vision specialist, Kevin McNally provides images to test the practitioner’s knowledge on optical and non-optical aids for visual impairment.

Next edition

Expires in

Optometrist turned ophthalmology registrar, Imran Jawaid, along with consultant ophthalmologist Moneesh Patel, explore cases of retinal haemorrhage presenting in secondary care and discusses their clinical significance for practitioners.

How much do you really know about blepharitis? This back-tobasics guide by IP optometrists, Gillian Brice and Ian Cameron, provides useful information on the management of blepharitis.

VRICS PAGE 42 42

C-35268

CET 2 PAGE 53 28

A look ahead to the next issue promises a fresh approach to communication in practice. A further installment of low vision images is provided to test the visual recognition skill of practitioners and the section is completed with intraocular pressure measurement and instrumentation.

CET events in March

5 The AOP, Village Hotel, Castle View, Forstal Road, Sandling, Maidstone ME14 3AQ The AOP Legal Roadshow (www.aop.org.uk/events) 6 The AOP, Gipsy Hill Hotel, Gipsy Hill Lane, Pinhoe EX1 3RN The AOP Legal Roadshow (www.aop.org.uk/events)

For the latest CET visit www.optometry.co.uk/cet

28/02/14 CET & VRICS

CET 1 PAGE 48 28

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CET

CONTINUING EDUCATION & TRAINING

1 CET POINT

Blepharitis, but not as you know it Gillian Bruce MCOptom, DipTP(IP) and Ian Cameron MCOptom, DipCLP, DipTP(IP), FBCLA 48

28/02/14 CET

This straight-talking article provides the reader with a clear understanding of how to investigate and diagnose lid margin disease. It offers useful tips on managing eyelid disease that will save the practitioner time, delight patients, and provide a welcome boost for business.

Course code: C-35258 | Deadline: March 28, 2014 Learning objectives To be able to explain to patients about the implications of lid margin disease (Group 1.2.4) To be able to recognise the signs and symptoms of lid margin disease and manage the patient accordingly (Group 6.1.4)

Learning objectives To be able to explain to patients about the implications of lid margin disease (Group 1.2.4) To be able to recognise the signs and symptoms of lid margin disease and manage the patient accordingly (Group 8.1.1)

Learning objectives To be able to explain to patients about the implications of lid margin disease (Group 1.2.4)

Learning objectives To be able to understand the natural progress of blepharitis and assess its severity (Group 1.1.1) To be able to consider the treatment options for blepharitis (Group 2.1.6)

About the authors Gillian Bruce and Ian Cameron are independent prescriber (IP) optometrists with experience in managing anterior eye conditions. Based in a leading UK practice, specialising in contact lens and anterior eye conditions, they are responsible for delivering the Lothian hospital contact lens service. Ms Bruce has lectured nationally on the topic of blepharitis and lid margin disease.


Introduction

Classification of lid disease The eyelids are inextricably linked with dry eye, and suffer from a host of inflammatory conditions and other factors that affect comfort and vision. The chronic, symptomatic nature of these conditions means that they are a persistent problem for patients and an ongoing challenge for practitioners. Despite the frequency with which it presents in practice, blepharitis is still a condition that is poorly understood. Simply classifying it can be baffling, with many conflicting and inconsistent terms in use. The first step to a clearer knowledge of the murky world of lid disease is to understand its relationship to anatomy.

Anatomy The eyelids contain three types of secretory gland, which are important when considering lid disease. The meibomian gland and the Gland of Zeis are both sebaceous types, with the Gland of Moll, a type of sweat gland, being the third (see Figure 1). Sebaceous glands are small, oil-producing glands usually attached to hair follicles, found in abundance on the face and scalp. The fatty, oily substance that they release is called sebum, which acts to lubricate and waterproof the skin and provide some protection against bacteria. It is helpful to consider the eyelid as having an anterior and posterior portion; anteriorly consisting of the subcutaneous skin, eyelash and glands of Zeis and Moll; posteriorly, the tarsal conjunctiva and the tarsal plate housing the meibomian glands. There are approximately 30–40 meibomian glands in the upper lid and 15–20 in the lower lid, which are responsible for producing meibum, a unique type of sebum. Meibum is composed mainly of lipids along with proteins,

Orbicularis oculi

Posterior lid disease

Meibomian gland

Skin Gland of moll

Tarsal conjunctiva

The natural course of posterior lid disease may be considered in stages (see Figure 2):

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Stages 1–3 Gland of zeis

Anterior

Posterior

Figure 1 Anatomy of the eyelids both of which play important roles in the pre-corneal tear film. The nervous supply to the meibomian glands are controlled by the autonomic nervous system and meibum production is controlled by both neuronal and hormonal factors. Meibum, along with lesser contributions from glands of Zeis and Moll, forms the thin, outermost lipid layer of the pre-corneal tear film, the function of which may be summarised as: • Providing a smooth optical surface for the cornea at the air-lipid interface • Reducing evaporation of the tear film • Enhancing the stability of the tear film • Enhancing spreading of the tear film • Preventing spillover of tears from the lid margin • Preventing contamination of the tear film by sebum • Sealing the apposing lid margins during sleep.1

Considered simply, the tear film can be disrupted by either low production of meibum (hyposecretion) or excessive amounts of poor quality meibum (hypersecretion). Hyposecretion can be due to a physical obstruction of the ducts by keratinised epithelium or by reduced meibum production influenced by hormone levels, age, contact lens wear, and medication including: retinoids for acne, antidepressants, antihistamines, along with post-menopausal treatments.1 Hypersecretory changes are commonly linked to dermatitis, acne rosacea and atopic disease. The quantity and quality of the lipids produced may be observed by expressing the gland contents. Gentle digital pressure to the centre of the lower lid for a few seconds during a routine slit lamp exam should cause an oily layer of clear or light straw-coloured meibum to be expressed. If nothing comes out of the Sub-clinical changes to meibum

Altered tear film

A spectrum condition It is important to consider lid disease as a spectrum condition ranging from the mildest sub-clinical forms, with sequelae leading to full-blown scarred, inflamed lids. The severity of symptoms in each case will vary, with patients presenting to the clinician at any stage of the disease. Having classified the lid as having anterior and posterior portions, lid disease may be grouped in a similar way with posterior lid disease, frequently termed meibomian gland dysfunction (MGD), and anterior lid margin

Signs and/or symptoms of ocular irritation

Clinically apparent inflammation

Structural lid changes

Ocular surface disease

Figure 2 The sequelae of posterior lid margin disease

For the latest CET visit www.optometry.co.uk/cet

28/02/14 CET

In the good old days of CET, when the multiplechoice questions were the only part of the article a practitioner read, simply putting ‘blepharitis management’ in the title would be a guaranteed way to attract attention. Surely there could not be anything in the article that you did not know already – a point in the bag. Think again. CET has been ‘enhanced’ and now it is time to do the same with the practitioner’s understanding and management of lid margin disease.

disease, each of which will be considered in turn.


CET

CONTINUING EDUCATION & TRAINING

1 CET POINT

28/02/14 CET

50

glands, you can safely diagnose hyposecretion of the meibomian glands. In hypersecretion, the meibum is thicker and opaque with a more yellow colour. Simple assessment of the tears can also be a useful diagnostic tool. Reduced tear break-up time (TBUT) (<10 seconds) suggests a lack of meibum, while frothy tears are characteristic of hypersecretory posterior lid margin disease. When hypo- or hypersecretion are seen, the patient has already progressed to Stage 2 posterior lid disease. Left untreated, this abnormal secretion will deteriorate and eventually lead to symptoms of ocular irritation such as foreign body sensation, epiphora, glare, tired eyes and excessive blinking, caused by a poor quality tear film.

Stage 4: inflammation A poor tear film and stagnant lipids provide an optimum environment for inflammation and infection. The stagnant material becomes a growth medium for bacteria that can seep into the deeper tissue layers of the eyelid, causing inflammation. A poor tear film and corresponding dry eye cause inflammation of the ocular surface and there is some evidence that changes in lipid composition in the tear film releases pro-inflammatory mediators.2 At this stage, with inflammation becoming

Figure 3 Staphyloccocal blepharitis clinically apparent, it may be termed posterior blepharitis. Telangiectasia (capillary dilation) of the posterior lid margin is one of the major diagnostic signs of inflammation, but the meibomian glands also begin to be visibly affected with solidified plugs of opaque meibum, clogging the openings with waxy mounds protruding from blocked glands.

Stage 5: structural change Although the patient may be asymptomatic, left unchecked, low-grade chronic inflammation of the posterior lid margin takes it toll and eventually causes structural change. Conjunctivalisation is a reliable sign of chronic inflammation, where the posterior conjunctiva

Symptoms

Signs

Eyelids stuck together on waking

Madarosis (loss of eye lashes)

Itchiness

Trichiasis (misdirected eye lashes)

Glare

Poliosis (white lashes)

Blurred vision

Telangiectasia Conjunctival injection Lid margin hypertrophy Lid scarring

Table 1 Characteristics of anterior lid margin disease

trespasses over the mucocutaneous junction, causing a fluffy scalloped edge which is visible at the tear meniscus. Meibomian gland drop out (ceasing to function) and pitting or scarring of the lid margin may be seen. The tarsal plate acts like a skeleton for the lid so deformity of the meibomian glands will result in structural change to the lid and conjunctiva. This undermines the role of the lid margin in providing support for the tear meniscus and may allow unwanted substances to contact the ocular surface.

Stage 6: ocular surface disease A poorly performing eyelid eventually leads to ocular surface disease. Chronic inflammation and structural changes affect the integrity of the ocular surface and serious problems, such as marginal keratitis and corneal neovascularisation may follow. Such changes take many years of neglect to develop, so often patients with more severe lid problems are elderly and likely to be referred for cataract and other surgeries. Devastating surgical outcomes, including endophthalmitis are associated with lid disease and a compromised ocular surface.3

Anterior lid margin disease Anterior lid margin disease originates from the eyelashes and debris in this area is a characteristic in the early stages of this condition. The features of anterior lid margin disease are summarised in Table 1. As with posterior disease, anterior conditions have a spectrum of severity where chronic inflammation will result in structural changes and eventually ocular surface disease. Given their proximity, chronic inflammation of either the anterior or posterior lid margin will â&#x20AC;&#x2DC;spill overâ&#x20AC;&#x2122; and begin to affect the fellow margin. The characteristics of the lash debris are a key differentiator in identifying the cause.


Staphylococcus are part of the commensal flora of the eyelid about 75% of the time, becoming problematic only if a there is a hypersensitivity reaction to either the bacteria itself, or its toxins, waste products and enzymes. Staphylococcal debris and white blood cells form yellow, brittle fibrinous scales at the lash base (see Figure 3). They may form into distinctive rings or pyramids of debris around the lash base, called collarettes.

Figure 4 Demodex mite infestation Demodex mite infestation Demodex mites are found on the human body in or near hair follicles, including the eyelids (see Figure 4). They feed on skin cells, oils and hormones and exist in two forms, Demodex folliculorum at the lashes and Demodex brevis in the meibomian glands.4 The prevalence of the mites increases with age and poor hygiene and are strongly associated with symptoms of ocular discomfort. Demodex infestation forms a distinctive ‘greasy sleeve’-type collar around the lashes. A demodex mite is about half the diameter of a grain of table salt and is, therefore, extremely difficult to see even at the slit lamp.4

Seborrhoea Certain dermatological conditions, such as seborrhoeic dermatitis, rosacea and eczema carry an increased risk of anterior lid margin disease. Seborrhoea (a skin condition caused by excess production of sebum) is present in around 5% of the population. Scaly and greasy material collects along the lashes and sticks the lashes together in greasy clumps (see Figure 5). The skin around the eyelashes often looks greasy.

disconnect between practitioner and patient in terms of stressing the importance of managing the condition. Even the most enthusiastic practitioner can become jaded with lid disease but the chronic nature of the condition is of utmost concern to the long-suffering patient who may be blighted by symptoms of irritation and visual impairment, leading to frustration and even depression. Failure to manage lid disease appropriately can result in cessation of contact lens wear, delays to ocular surgery, avoidable referrals into secondary care and patients can become disillusioned with the care from their eye care practitioner. Needless to say, a more complete approach to eyelid health is required:

Screening To allow for early intervention, patients should be screened. Taking a thorough history bearing in mind risk factors and looking for external clues from the patient’s appearance. Risk factors include duration of contact lens wear, dry eye disease, hormonal conditions, acne rosacea, psoriasis, seborrhoeic dermatitis, atopic history and hypertension.5

Management

Treatment

Expert consensus universally recommends lid hygiene as the management of choice, but if the treatment is so simple, why is lid disease so poorly managed? The fundamental reason is poor patient compliance. Lid disease is poorly understood by patients, ill communicated by the optometrist and the commonly recommended treatments (sodium bicarbonate, salt water, baby shampoo, flannels) are laborious and long-term. Further, the burden of maintaining treatment falls to the patient and there can be a fundamental

Omega-3 essential fatty acids (EFA) directly improve the lipid composition of the meibum as well as having anti-inflammatory properties, unlike omega-6, which is pro inflammatory. Omega-3 and 6 compete for the same conversion sites in the body; therefore, improving the ratio of 3:6 is the aim. The omega-3 EFAs critical for wellness and disease prevention in humans are eicosapentanoic acid (EPA) and docosahexanoic acid (DHA). These are found in fish oils and are converted more effectively by the body than alphalinolenic

acid (ALA), found in flaxseed oil, nuts, seeds and dark leafy vegetables. In general, patients will be more compliant with therapies that are easily managed in daily life. However, it is important to realise that the presentation and content of the advice may infer the seriousness of the condition. With this in mind, recommending kitchen cupboard ingredients as the therapeutic agent of choice is, perhaps, not the required approach. There is scant evidence to suggest pre-made products have superior efficacy to homemade remedies and any form of lid hygiene is better than no lid hygiene, although anecdotally, patients respond well to using purpose-designed products to treat lid disease.

Warm compress therapy Warming the lash debris will ease removal, while warming the meibomian glands will aid expression. The meibum from normal subjects becomes liquid at 28–32°C, but the melting point is approximately 35°C for MGD patients. This means that warm compress therapy needs to be at a precise and constant temperature,6 something not easily done with a warm flannel at home. Custom-made devices such as Eyebags are simple to use, safe, effective and affordably priced. A novel moist heat, lid-warming device, Blephasteam, is also available for home use.

Massage Thirty seconds of massage should be used to physically express the contents of the glands after warming them. Applying gentle pressure from the root of the gland to the duct, repeating the process a number of times and advising patients that it is normal to experience a smearing effect on vision. Meibum expression is a sign of progress that the glands are expelling unhealthy secretions.

Cleaning In addition to removing secretions, cleaning can provide antibacterial and antiinflammatory cover. Making a homemade cleaning solution is time-consuming and involves appropriate dilution to be safe. There are a number of convenient products now available in the form of solutions, gels and impregnated cleaning pads.

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Staphyloccocal infection


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Tea tree is highly effective in the removal of demodex mites. Guidelines suggest that demodex can be killed by daily lid scrub with 50% tea tree oil with 50% mineral oil (commonly called ‘liquid paraffin’ in the UK) but this should be undertaken only by experienced practitioners as such preparations are toxic to the ocular surface.7 Preparations such as Cliradex and Ocusoft treatment kits for direct use on the lashes are not readily available in the UK, with lack of evidence to support the efficacy of the lower concentrations of tea tree oil in these products. Local herbalists may be able to provide a safe preparation of tea tree that can be used on the lashes. Tea tree shampoos and facial soaps for the face and scalp are widely available and readily recommended by some ophthalmologists but the low concentrations of tea tree oil in these products means their efficacy is no better than a basic lid hygiene regime.

Lubrication After cleaning it is beneficial to restore the tear film by instilling an artificial tear. A non-preserved formulation should be recommended for safe long-term use.

Figure 5 Seborrhoeic blepharitis potent anti-inflammatories that inhibit the production of bacterial lipases and alter the consistency of meibomian oils. Oral antibiotics can be prescribed by independent prescribing optometrists or in conjunction with a GP for the treatment of more significant disease, pre-surgically, or in systemic conditions such as acne rosacea. Such treatment needs to be continued for a number of months and topical applications can be used for more significant inflammation. In seborrhoeic conditions, medicated shampoos are recommended. Lid hygiene should be performed twicedaily for the ‘treatment period’ (usually a fortnight) and then may be reduced to daily or less frequently for maintenance, under supervision of the optometrist.

Medication If staphylococcal infection is present then a topical antibiotic ointment such as 1% Chloramphenicol can be used on the lid margin. Systemic tetracycline antibiotics, for example, Oxytetracycline or Doxycycline, are

Communication The key to success with all treatment is good communication with the patient. Other members of staff, trained in lid hygiene procedures, can reinforce verbal

communication from the optometrist. Written information consolidates the advice given in the consulting room and hopefully prevents patients straying to friends or the internet for their information. Information leaflets can be obtained from the College of Optometrists, or can be written by practitioners to reflect their choice of treatment regimes. It is helpful to issue patients with a ‘lid management care plan’, to clarify the diagnosis to the patient, allowing them to understand the cause of their symptoms and engage in treatment. It details each stage of the cleaning regime and the required frequency of treatment and follow up. Asking the patient to grade symptoms over a number of months of treatment, reaffirms the long-term nature of the regime. Lid care/pre-surgery packs of products can be put together with relevant information to further reduce complications for the patient and encourage repeat sales of cleaning and lubricating products for the practice. These packs can be recommended to every patient prior to referral for cataract surgery.

Conclusion The ageing population will only continue to deliver more lid disease and with that more potential for loyal patients who will need and value continued care from the dedicated practitioner. Treating lid disease is clinically interesting, of lasting benefit to patients and provides a revenue stream for the practice.  

MORE INFORMATION References Visit www.optometry.co.uk/clinical, click on the article title and then on ‘references’ to download. Exam questions Under the new enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk/cet/exams. Please complete online by midnight on March 28, 2014. You will be unable to submit exams after this date. Answers will be published on www.optometry.co.uk/cet/exam-archive and CET points will be uploaded to the GOC every two weeks. You will then need to log into your CET portfolio by clicking on ‘MyGOC’ on the GOC website (www.optical.org) to confirm your points. Reflective learning Having completed this CET exam, consider whether you feel more confident in your clinical skills – how will you change the way you practice? How will you use this information to improve your work for patient benefit?


CET

CONTINUING EDUCATION & TRAINING

1 CET POINT

Retinal haemorrhages: cases in ophthalmology Imran Jawaid and Moneesh Patel explore cases of retinal haemorrhages seen within secondary eye care services, relating these findings to basic anatomy. They present the clinical features of each case and guide the practitioner to appropriate management.

Course code: C-35268 | Deadline: March 28, 2014 Learning objectives To be able to obtain relevant history from patients presenting with retinal haemorrhage (Group 1.1.1) To be able to refer patients with appropriate urgency as reflected by clinical presentation (Group 2.2.6) To be able to recognise the systemic implications of retinal haemorrhages (Group 6.1.13)

Learning objectives To be able to discuss the significance of ocular findings in relation to systemic disease (Group 1.2.3) To be able to understand the systemic implications of retinal haemorrhages (Group 8.1.4)

Learning objectives To be able to understand the natural progress of retinal haemorrhages and assess severity of different presentations (Group 1.1.1) To be able to identify the nature, severity and significance of the different types of retinal haemorrhage that present in practice (Group 2.1.4)

About the authors Imran Jawaid qualified formerly as an optometrist and is now a specialist registrar in ophthalmology. Moneesh Patel is a consultant ophthalmologist specialising in medical retina and uveitis.

For the latest CET visit www.optometry.co.uk/cet

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Imran Jawaid BSc (Hons), MBChB (Hons) and Moneesh Patel MBChB, FRCOphth


CET

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1 CET POINT Introduction

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The discovery of retinal haemorrhages upon routine optometric examination is a common reason for referral into secondary eye care services. Optometrists often refer such patients urgently to the medical retina clinic or their local eye casualty. However, a closer look at the retinal picture may enable better understanding of the likely aetiology, allowing for the correct investigations to be requested and the promptness of referral to be considered more diligently. The individual cases presented in this article will guide the practitioner to the appropriate management of retinal haemorrhages in routine practice. Prior to this, an overview of relevant anatomy is given.

Blood supply to the retina The retina is highly metabolic and its blood supply reflects this. Branches from the central retinal artery supply the inner two-thirds of the retina and the choroidal circulation supplies the outer third. The central retinal artery divides into superior and inferior branches from which the nasal and temporal branches are derived. Functionally, these are end-arteries, which means there is insufficient collateral circulation to supply retinal tissue should these arteries become occluded. The temporal arcades approximate the macula region and within this area the central foveal avascular zone contains outer retinal layers only. The blood supply to

Figure 1 Flame-shaped haemorrhages superotemporal and infero-temporal to the optic disc

the foveal area is derived from the underlying choroidal circulation. The post-arteriole retinal capillaries can be found in the nerve fibre layer, whereas the pre-venular capillaries are found a little deeper – in the inner nuclear layer, with communication between these two plexuses.

Retinal haemorrhages: morphological categories Subhyaloid/pre-retinal haemorrhage Subhyaloid haemorrhages are found between the inner limiting membrane and the posterior hyaloid face. A pre-retinal haemorrhage is located between the inner limiting membrane and nerve fibre layer.1 Both bleeds mask the underlying vessels making it difficult to differentiate between the two. Although there are several terms for such bleeds, including D-shaped or boat-shaped haemorrhages, the aetiologies are identical and so these terms may be used interchangeably. Such haemorrhages have a crescent shape which demarcates the limit of the posterior vitreous detachment. The aetiology is commonly neovascularisation or complicated posterior vitreous detachment. Another common cause is a valsalva manoeuvre and so a careful history is helpful. Patients should be warned not to strain or exert themselves physically as there is a risk of penetration into the vitreous gel.

Flame-shaped haemorrhages Flame-shaped haemorrhages are found in the nerve fibre layer with the axons of ganglion cells shaping the blood to reflect this characteristic appearance (see Figure 1).1 Commonly, these haemorrhages result from hypertension, thus, blood pressure assessment is paramount when encountering this finding. Other causes of flame-shaped haemorrhages include retinal vein occlusion, anterior ischaemic optic neuropathy, and disc swelling, amongst others. An isolated finding of a flame-shaped haemorrhage at the margin of a non-swollen optic disc raises the

Figure 2 Flame-shaped haemorrhages with pale centres suspicion of normal tension glaucoma. This is a marker for the site of future nerve fibre damage and corresponding visual field loss. The location should be accurately documented and further investigations performed.

Haemorrhages with pale centres Such retinal haemorrhages are eponymously termed Roth spots after Swiss pathologist, Moritz Roth (see Figure 2). He first described this type of haemorrhage in 1872 for patients with severe bacteraemia. In 1878, a German pathologist, Moritz Litten, coined the term Roth spots for these retinal haemorrhages and found them to be present in 80% of patients with sub-acute bacterial endocarditis.2 There may be a serious underlying cause for such haemorrhages and so a careful systemic history is necessary. Causes of Roth spots include: • Sub-acute bacterial endocarditis • Leukaemia • Anaemia • Anoxia • Carbon monoxide poisoning • Hypertensive retinopathy • Pre-eclampsia • Diabetic retinopathy • Neonatal birth trauma • Shaken baby syndrome.


Dot and blot haemorrhages

these tests, should be requested. Importantly, if there are features of ocular inflammation, peri-vascular changes, optic nerve concerns, non-refractive visual loss, alongside retinal dot haemorrhages, a discussion with the on-call ophthalmology doctor is essential for appropriate management.

Case 2 Figure 3 Scattered dot and blot haemorrhages

not missed? As always, examination must begin at the front of the eye, ensuring there are no Sub-retinal haemorrhage features of ocular inflammation, for example: These haemorrhages arise between the neuroconjunctival injection, keratic precipitates, cells, sensory retina and retinal pigment epithelium posterior synechiae, iris transillumination defects (RPE).1 They are dark in colour and the retinal or raised intraocular pressure. Findings of this vasculature is clearly visible above (retinal type may suggest the presence of systemic capillaries are not found any deeper than the inflammatory diseases/infections and indicate inner nuclear/outer plexiform layer). There are no that a more careful look at the fundal picture is firm adhesions in this space and so the bleed can required through a dilated pupil, also noting the be large in area and variable in shape. Sub-RPE presence or absence of vitritis. bleeds (between RPE and Bruchâ&#x20AC;&#x2122;s membrane of Optic nerve head swelling or pallor should the choroid) have a more confined arrangement also be discounted as this could suggest as there are tight junctions between RPE cells.1 alternate pathology, such as a vein occlusion By far the most common cause of such bleeds or hypertensive retinopathy. The retinal vessels is choroidal neovascularisation with such should be examined carefully, noting the haemorrhages found at the posterior pole (see presence or absence of any arteritis or phlebitis Figure 4, page 56). Other causes include trauma, that would suggest infective or inflammatory tumours and retinal angiomas. disease. The optometrist should also observe any arterio-venous nipping or copper/silver wiring Case studies suggesting hypertensive retinopathy. With the By working through specific cases, the absence of all of these findings the differentials importance of a logical and comprehensive are narrowed somewhat pointing to diabetic approach towards retinal haemorrhages can be retinopathy, slow flow retinopathy and ocular demonstrated. As a general rule, bilateral retinal ischaemic syndrome, although in the latter abnormalities, although possibly asymmetric, scenario the patient would have other point towards an underlying systemic disease. symptoms such as ocular ache and anterior segment signs would also be present. If the patient is symptomatic for diabetes Case 1 (polyuria, polydipsia, weight loss) then they At a routine eye examination a 55-yearshould see their practice nurse or GP for an old asymptomatic man was found to have urgent fasting glucose and HbA1c test. No scattered dot haemorrhages throughout all onward ophthalmic referral would be indicated four quadrants in both eyes. His visual acuity and the patient would be seen by the diabetic was 6/6 in each eye. His past medical history includes hypercholestorlaemia and hypertension, retinopathy screening service. However, if the patient were asymptomatic, a prudent approach controlled with Simvastatin and Ramipril, would be to ask the GP to review the patient to respectively. assess cardiovascular risk factors. Optometrists At first glance, this case is typical of should ask the GP to consider a full blood count, background diabetic retinopathy. However, ESR, fasting glucose, lipid profile looking for how can the practitioner be sure? What are the diabetes and hyperviscosity. An outpatient salient points practitioners need to consider in ophthalmology appointment, in addition to order to be confident that other diagnoses are

An eight-year-old boy presents for a routine examination. There are no ophthalmic symptoms and the mother tells you that he has an appointment with his GP the following week as he has been having recurrent infections and is also losing weight. On dilated fundal examination he has widespread flame haemorrhages with pale centres. Clinically, the fundal findings are not difficult to observe, with flame-shaped haemorrhages with yellowish centres scattered in all four quadrants. The reason for this appearance has been the cause of much debate in the literature, however, it is likely that rupture of capillaries followed by adhesion of platelets and the formation of a platelet-fibrin complex gives rise to the white centre.2 Unless managed appropriately, the underlying cause can be life threatening. When encountering asymptomatic pathology it is prudent to step back and start from the history again. It is essential to ask about symptoms of fever, rash, weight loss, tiredness, and shortness of breath. Then look for signs of anaemia in the conjunctiva. As optometrists you will not be expected to perform a general physical examination but any grossly abnormal signs such as a widespread rash can be easily noted. The diagnosis here is likely to be leukaemia or lymphoma and the reasons for the symptoms are due to a fall in red cells (tiredness, shortness of breath), effective white cells (recurrent infections) and platelets (petechial rash). If this patient were to wait until he sees his GP, this will lead to avoidable, potentially life-threatening delay. Therefore, such patients should be referred urgently to the ophthalmologist oncall who can liaise with the paediatric team to arrange further tests. Retinal haemorrhages found in a child always warrant further investigation. If there is no convincing history, physical abuse must be a consideration and urgently liaise with the on-call ophthalmologist or GP for advice.

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These arise from the slightly deeper, prevenular, capillaries. The compact middle layers of the retina give rise to the dot and blot-like appearance of these haemorrhages.1 Often there is associated oedema and may give rise to diminished acuity if the macula is involved. Blot haemorrhages are often larger and darker (see Figure 3). These findings should alert the examiner to search for other features of ocular ischaemia, namely, venous changes, cotton wool spots and neovascularisation.


CET

CONTINUING EDUCATION & TRAINING

1 CET POINT Case 3

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A 76-year-old woman presents with a sudden loss of central vision in her right eye. Visual acuity is 6/60 in the right eye and 6/12 in the left eye. Fundal examination reveals a large sub-retinal haemorrhage at the macula in the right eye, with evidence of confluent drusen in the left eye. The aetiology here is most likely to be choroidal neovascular membrane. It is essential to conduct a thorough examination of the posterior pole in the fellow eye to look for features of macular degeneration. This will help confirm the likely diagnosis and also to exclude any subtle features of exudative macular degeneration in the fellow eye. In accordance with NICE guidance, this patient should be seen within two weeks and most hospitals run a rapid access macular service for such patients. It is important to discuss cessation of smoking where indicated, offer dietary advice and issue an Amsler chart to allow the patient to check for distortion in the fellow eye. Alternatively, if this patient presented to you following trauma and there was a large sub-retinal haemorrhage, which may not be at the posterior pole, the case should be discussed and reviewed by the ophthalmologist on-call. Globe integrity must be assessed for these patients. The eye should not be manipulated and the practitioner should not try too hard to obtain intra-ocular pressure recordings for these patients. A shield can be provided, if available, until they are seen within the secondary care service.

Case 4 A 60-year-old man with a 20-year history of Type II insulin-dependent diabetes mellitus attends for a routine eye check. He has not attended the retinopathy screening service for 10 years. His corrected visual acuity is 6/6 in

Figure 4 Large sub-retinal haemorrhage – note normal vasculature over haemorrhage. Reproduced with permission from eyerounds. org and the University of Iowa both eyes and there are no anterior segment signs. Dilated fundoscopy reveals dark blot haemorrhages in all four quadrants, with venous changes in three quadrants in both eyes. There is no macular oedema. However, there is a preretinal haemorrhage in the right eye. The diagnosis here is proliferative diabetic retinopathy in the right eye and very severe pre-proliferative diabetic retinopathy in the left eye. However, to differentiate between mild, moderate, severe or very severe pre-proliferative retinopathy all four quadrants must be examined to build up a picture. The Airlie House criteria are helpful in this respect and were used in the Early Treatment of Diabetic Retinopathy Study (ETDRS). In brief, a 4:2:1 rule can be used; this refers to severe retinal haemorrhages in four quadrants, venous changes in two quadrants and extensive intra-retinal microvascular abnormalities (IRMA) in one quadrant. If any one of these changes is present it is classified as severe pre-proliferative retinopathy and if two or more are present then very severe preproliferative diabetic retinopathy. In those with severe changes there is a 50% likelihood of proliferative retinopathy at one year, increasing to 75% chance of proliferative retinopathy at five years.3

Initial instinct in this case would be to pass the patient to secondary care. However, there are a few immediate problems, which require careful consideration. Firstly, the patient has not engaged with services, therefore, referring via the GP may lead to a failure to attend. The patient may eventually attend when they lose vision from a vitreous haemorrhage, or a tractional retinal detachment, but by then the opportunity for prevention of these serious outcomes will have been missed. Therefore, urgent PRP laser is needed and a same day appointment may be possible if the details of the situation are discussed in full with the ophthalmologist on-call. Further, a letter should be sent to the GP highlighting the nature of this patient’s eye disease. Ideally, this would trigger a review of the patient’s blood pressure, lipid profile, HbA1C and medications. It may be helpful to point out in the letter, the targets from a retinopathy point of view. Namely, a systolic blood pressure of less than or equal to 130mmHg in established retinopathy, consideration of an ACE inhibitor, a personalised HbA1c – normally between 48 and 58mmol/mol, statins and fibrates.4 Optometrists are not expected to be versed in the prescribing requirements for these drugs. However, as part of the diabetic team in the community, emphasising these targets to the patient’s GP may help prevent sight loss.

Conclusion The cases above have been chosen to illustrate the need to take a structured approach to retinal findings. Of course, this is not a complete discussion on retinal haemorrhages but provides general tips and rules to help guide management and investigation. The cases discussed in this article illustrate the pivotal role that optometrists play in effective patient eye care.

MORE INFORMATION References Visit www.optometry.co.uk/clinical, click on the article title and then on ‘references’ to download. Exam questions Under the new enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk/cet/exams. Please complete online by midnight on March 28, 2014. You will be unable to submit exams after this date. Answers will be published on www.optometry.co.uk/cet/exam-archive and CET points will be uploaded to the GOC every two weeks. You will then need to log into your CET portfolio by clicking on ‘MyGOC’ on the GOC website (www.optical.org) to confirm your points. Reflective learning Having completed this CET exam, consider whether you feel more confident in your clinical skills – how will you change the way you practice? How will you use this information to improve your work for patient benefit?


DIARYDATES THE ATTENDANCE for the ABDO Conference and Exhibition is shaping up to be the Association’s best yet, the general secretary, Anthony Garrett, told OT at 100% Optical last week. The conference is on March 30–31 at Chesford Grange Hotel, Kenilworth, Warwickshire. As well as CET lectures and workshops, it includes a pre-conference golf tournament and a gala dinner (pictured). For more information and to book, visit www.abdo.org.uk/events

MARCH 3 Sight Care Group, Hilton Birmingham Metropole, National Exhibition Centre, Birmingham, West Midlands B40 1PP. Sight Care Conference 2014 (www.sightcare.co.uk)

3 Nottingham and Derby Optical Society, The Toby Carvery, Derby Road, Wollaton, Nottingham NG8 2NR. I-BIT study with Nic Herbison and Daisy MacKeith (www.ndos.org.uk)

4 North East Optics Society, Jurys Inn Hotel, Scotswood Road, Newcastle upon Tyne NE3 4AD. Lecture Medical retina review (simonraw44@hotmail.com) 4 BCLA, BCLA Head Office,
 7/8 Market Place, 
London 
W1W 8AG. Business workshop You’re a good contact lens practitioner: how’s your business? (www.bcla.org.uk/events)

4 BCLA, Alcon Academy, Park View, Riverside Way, Watchmoor Park, Camberley, Surrey GU15 3YL. ‘BCLA to go’ Peer Discussion (www.bcla.org.uk/events)

10 North Yorkshire and South Durham AOP, St George Hotel, Durham Tees Valley Airport, Darlington, County Durham DL2 1RH. March lecture, Pearls and pitfalls in oculoplastics (sarahwest987@virginmedia.com)

AOP EVENTS

Resort, Coldra Woods, 
The Usk Valley,
 Newport
, South Wales 
NP18 1HQ. CET contact lens course (www.coopervision.co.uk/courses)

NEW… 12 CooperVision, Ageas Bowl, Botley Road, West End, Southampton, Hampshire SO30 3XH. CET contact lens course (www.coopervision.co.uk/courses) NEW… 12 No7 Contact Lenses, Holiday Inn Express, Aberford Road, Oulton, Woodlesford, Leeds LS26 8EJ. Ortho-K 2014 Roadshow (www.no7contactlenses.com)

MARCH 5 The AOP, Village Hotel, Castle View, Forstal Road, Sandling, Maidstone, Kent, ME14 3AQ. The AOP Legal Roadshow (www.aop.org.uk/events)

6 The AOP, Gipsy Hill Hotel, Gipsy Hill Lane, Exeter, Devon EX1 3RN. The AOP Legal Roadshow (www.aop.org.uk/events)

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16–17 The AOP and the College of Optometrists, York Racecourse, North Yorkshire YO23 1EX. Fresh Eyes conference for newly qualified optometrists (www.fresheyesconference.org)

NEW… 13 CooperVision, Twickenham Stadium, 200 Whitton Road, Twickenham TW2 7BA. CET contact lens course (www.coopervision.co.uk/courses)

20 The AOP, Best Western Brook Hotel,

NEW… 13 Sandwell LOC, Bethel Convention Centre, Kelvin Way, West Bromwich B70 7JW. AGM (pghampson@gmail.com)

2 Barnard Road, Norwich, Norfolk NR5 9JB. AOP Peer Review Roadshow (www.aop.org.uk/events) APRIL

NEW… 10 Lancashire Optical Society,

NEW… 14 International Institute of

8 The AOP, Wellington Park Hotel, 21

Conference Centre, Brockholes Nature Reserve, Junction 31, M6 Samlesbury, Preston PR5 0AG. Lecture Sexually transmitted diseases and the eye (janelbarker@yahoo.co.uk)

Colorimetry, Aston University Conference Centre, Aston University, The Aston Triangle, Birmingham B4 7ET. Colorimetry in Vision and Education Conference (www.colorimetryinstitute.org)

Malone Road, Belfast, County Antrim BT9 6RU. The AOP Legal Roadshow (www.aop.org.uk/events)

NEW… 10 BCLA, BCLA Head Office,


16–17 The College of Optometrists, York

7/8 Market Place, 
London 
W1W 8AG. ‘BCLA to go’ Peer Discussion (www.bcla.org.uk/events)

Racecourse, Knavesmire Road, York YO23 1EX. Optometry Tomorrow 2014 conference (www.college-optometrists.org)

Booking for AOP events opened last month and some are already full so practitioners are advised to book as soon as possible to avoid disappointment.

Publicise your event for free through OT magazine and online at www.optometry.co.uk. Simply send FULL details before March 6, 2014 by emailing robinamoss@optometry.co.uk or write to Robina Moss, OT deputy editor, 2 Woodbridge Street, London EC1R 0DG. Please check you have included where and when the event is being held plus who it is organised by and the booking information. Please let us know if anything changes with your event.

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28/02/14 DIARY DATES

ABDO event ‘best yet’

NEW… 11 CooperVision, The Celtic Manor


COMPETITION FEBRUARY CROSSWORD BRAINTEASER 1

2

3

4

5

6 9

8

7

10

ACROSS

DOWN

1. Seeing two (6, 6)

1. Apparent when smiling (7)

7. Computer communication

2. Modernised (7)

device (5) 12

11

13

14

8. Singing nymph of the Rhine (7)

4. Price or cost (5)

11. How some hymns are sung

5. Spreads out (7)

(2, 5)

15

12. Blake ------- (7)

58 16

17

18

19

20

3. Paper clearly protected (9)

6. Dry eye measurement (8, 4) 9. Tempting ruler of 8 across

13. Pondered (5) 14. Cherished (9)

anag. (5) 10. Illegal stockmarket trading

16. Ecstatically enthusiastic (9) 26

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21

22

23

25

24

26

(7, 5)

19. Set of two (1, 4)

15. Moving staircase (9)

21.It might start “EFP TOZ LPED”

17. She recorded the album 21 (5)

(3, 4)

18. Clinically clean (7)

23. Carousel riders? (7)

19. Portugal’s holiday coast (7)

24. Back up for Gladys (3, 4)

20. Specialist place of study (7)

25. Calorie crammed cake (5)

22. Elephant’s long teeth (5)

26. Light operation (5, 7)

Name: Address: Send entries to OT February Crossword, 2 Woodbridge Street, London EC1R 0DG by March 19, 2014. You can enter OT ’s Crossword competition online at www.optometry.co.uk/crossword. The winner of OT ’s January crossword is Andrew Astle, who completed the quiz online and wins a £50 M&S giftcard.

Clinic Hire

Vision Sciences Clinical Facilities Putting your needs at the centre of everything

For courses that require clinical or lecture facilities then our venue may fit your requirements. We can hire one or multiple clinics, either with individual or multiple examination bays. We can also offer classroom and lecture theatre facilities. We offer full examination equipment and can host conferences, teaching courses/workshops and examinations for all optical professions.

To make a booking or for informal enquiries and price details please email e.a.bartlam@aston.ac.uk or call 0121 204 4104


To place an advertisement call 020 7657 1805 or email haley.willmott@tenalps.com

Long-established Independent practice in busy market town requires an enthusiastic Optometrist

Super Optometrist

(full or part-time) to join 4 current OO’s. We are an ethical /progressive practice involved in many local shared care programs. We have 3D OCT, Fundus camera, video slit-lamp and air-con’d rooms. We have an in-house workshop and full support staff including Dispensing Optician. We offer 30-minute appointments, a four and a half day week and do not set targets. A future partnership is possible, if desired. Apply in writing with full CV to:- Geoff Cummings e-mail; geoff@newbold-opticians.co.uk B.Newbold(Newcastle)Ltd. 34, Ironmarket, Newcastle, Staffs ST5 1RP

East Yorkshire, Cambridgeshire, Devon, Lincolnshire

Travelling to visit patients in their home setting to provide domiciliary general ophthalmic services.

Dispensing Optician North London and Scotland

Please contact Jim on 01793 648607 or email jim@outsideclinic.com.

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Dispensing Optician Optometrists urgently needed in Yorkshire, London and the South West Contact MITCH on 0121 451 2707 or sign up now at www.teamlocum.co.uk

Team Locum is an Employment Agency

Reach over 20,575 potential candidates by advertising your vacancy with OT. Call Haley Willmott on 020 7657 1805 or email on haley.willmott@ tenalps.com

South Cheshire, A full time qualified Dispensing Optician is required who loves working in an independent practice. We are looking for a DO/manager who is passionate about their job and loves to help people. Personality and skill are the key. Glazing experience would be an advantage. Competitive salary. Call Keith for more info 07936 898 640 Or email cooperkr@me.com with your CV.

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28/02/14 JOBS

JOBS

Full or Part time Optometrist bookshop live required Boots Opticians Franchise CET in lovely sunny Elgin, Morayshire. Busy, progressive practice with lots of pathology. OCT onsite, Fundus cameras in each test room. No hard sales, minimum 30-35 min testing. £35,000 – £46,000 per year depending on candidate. enewsletter VRICS Contact Lloyd Griffiths to discuss further 07447 462 997 or lloyd.griffiths@nhs.net

OPTOMETRISTS Are you looking for a new challange? Then join our team. We are looking for clinically minded optometrists to work in our diabetic retinal clinics in Kings Lynn, Ely, Bury St Edmunds and Haverhill. Full training will be provided and no previous experience is necessary, but good skills using slit lamp biomicroscopy is an advantage. The role is for one or more days per week, part time or self employed options available. For more information call Niall on 07791 322 344 or email your CV to eos.clinic@nhs.net

HARROW, MIDDLESEX OPTOMETRIST

Full time including Saturdays Want to be part of vibrant professional team & enjoy your work? We are a high profile independent practice with the latest clinical equipment. In addition to core optometry services we provide a range a specialist services which differentiates our practice from the competition. We are a clinically focussed practice and the position would suit a forward thinking optometrist interested in providing the best care to their patients Contact Sachin or Dipesh at jobs@parkerandhammond.co.uk or 020 8422 1269

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Up to 15 interactive CET points available

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Highlights • keynote lecture from Professor Bruce Evans • peer discussion session • range of expert presentations • hands-on and interactive sessions • up to 15 interactive CET points available.

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To place an advertisement call 020 7657 1805 or email haley.willmott@tenalps.com

School of Health Sciences Manager, Optical Appliance Testing Service (OATS) One year fixed term contract Full Time (35 hours per week) £41,242 to £49,216

Faculty of Health, Education and Society

The Optical Appliance Testing Service (OATS) is an independent service which provides assessment of sunglasses, prescription spectacles and ready-to-wear reading glasses. The service is housed within The School of Health Sciences. We are seeking to recruit someone who will take over the current business activity and develop plans to increase that activity. You will lead the delivery of the testing service, maintaining current customer relationships and identifying potential new customers, ensuring the work of the Centre meets required standard and needs You will have a first degree in Optometry, Optics or Physical/ Engineering Sciences or equivalent work experience in the Ophthalmic Optics industry. With the ability to think creatively, you will have strong written and oral communication skills and a commitment to achieving results. For an informal discussion about the role please email H.Obstfeld@city.ac.uk. For further information and to apply go to: www.city.ac.uk/ about/working-at-city Closing date: Sunday, 2nd March 2014 Academic excellence for business and the professions

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TEACH WITH PLYMOUTH UNIVERSITY

live

Reach over 20,575 potential candidates by online enewsletter advertising your vacancy with OT. Call Haley Willmott on 020 7657 1805 or email on haley.willmott@tenalps.com

School of Health Professions The School of Health Professions at Plymouth University, launched a new, innovative Optometry Programme in Sept 2011, and our well-equipped Centre for Eye Care Excellence (CEE) provides the training and clinical experience for final year students and a base for undergraduate research projects.

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Clinical Lead Optometrist £31,644 to £45,053 pa – Grade 7/8 Ref: A3653 We wish to appoint an enthusiastic Optometrist with suitable experience of working in an undergraduate setting, to lead our clinical teaching at the CEE. This position will provide a unique opportunity to combine teaching, supervision and clinical practice in a full-time position. You will also be responsible for co-ordinating the training and development of the other clinical supervisors that work in CEE, as well as providing a comprehensive range of eye care services during specified periods. Organising and maintaining comprehensive and accurate records of student achievement and competencies will be a key element of the role You will be registered with the General Optical Council, and will have an interest in clinical and educational aspects of the profession. Continued engagement with optometry practice is an essential part of this role and you will be the named individual responsible for maintaining the GOS contract the clinic has with the NHS. The Clinical Lead Optometrist is supported by a Practice Manager and a Deputy Clinical Lead (Dispensing Optician).

Dispensing Optician (Deputy Clinical Lead) bookshop £31,644 to £36,661 pa – Grade 7 CET

Ref: A3654 We wish to appoint an enthusiastic Dispensing Optician to support our clinical teaching at the CEE. This position will provide a unique opportunity to combine teaching, dispensing supervision and clinical practice in a full-time position. You will also be the nominated Deputy Clinical Lead and support the Clinical Lead Optometrist in co-ordinating the training and development of the other clinical supervisors that work in CEE, as well as contributing to the provision of a comprehensive range of eye care services during specified periods. You will also support the Clinical Lead in the organisation and VRICS maintenance of records of student achievement and competencies and to work with the Practice Manager to develop the business potential of CEE. Registration with the General Optical Council is essential. For more information on these exciting and unique opportunities, please contact Dr Luisa Simo on 01752 588881 or email Luisa.simo@plymouth.ac.uk

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These are full-time positions working 37 hours per week available on a permanent basis. Clearance from the Criminal Records Bureau will be required for this position. To apply, please visit www.plymouth.ac.uk/jobs Closing date: 12 midnight, Sunday 9 March 2014. Plymouth University is committed to an inclusive culture and respecting diversity, and welcomes applications from all sections of the community. The University holds a Bronze Athena SWAN Award which recognises commitment to advancing women’s career in STEMM academia

28/02/14 JOBS

JOBS


MARKETPLACE Accountants

To place an advertisement call 020 7 657 1805 or email haley.willmott@tenalps.com

Computer Systems

Buying Groups

28/02/14 MARKETPLACE

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Cases

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cases eyewear accessories lens care readers microfibre Tel 01580 890111 sales@caseco.co.uk www.caseco.co.uk

Reach over 20,575 potential candidates by advertising your vacancy with OT. To advertise call Haley Willmott on 020 7657 1805

Please call Haley Willmott 020 7657 1805 We don o â&#x20AC;&#x2122;tt sell ou our in nte t lllig gentt b bu usine esss man nage gement ge nt syst stem m, it sim im mply y se ells ittself.

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To place an advertisement call 020 7 657 1805 or email haley.willmott@tenalps.com

Computer Systems

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Looking to sell anything from a second-hand piece of equipment to your practice. Advertise in OT and reach 20,575 potential buyers. Please call Haley Willmott on 020 7657 1805

Finance

caseco

Tel 01580 890111 Fax 01580 890118 sales@caseco.co.uk www.caseco.co.uk

Please call Haley Willmott 020 7657 1805

Reach over 20,575 potential candidates by advertising your vacancy with OT. To advertise call Haley Willmott on 020 7657 1805

28/02/14 MARKETPLACE

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MARKETPLACE

Instruments

Hot Compress

Thousands of people are already regularly using the EyeBag for the treatment of MGD and for the relief of the following conditions: n Blepharitis n Evaporative Dry Eye Syndrome n Eyelid cysts and styes n Contact lens dry eye

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n Post laser dry eye n Eye irritation and grittiness n Burning discomfort

Reichert Non Contact Tonometers LCD ClearChart Frastema Combi units Eyescape / Retinal imaging Shin Nippon Slit Lamps & Tonometers

EyeBags available through your wholesaler or contact us direct info@eyebags.com www.eyebags.com

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To place an advertisement call 020 7 657 1805 or email haley.willmott@tenalps.com

Oasis Punctum Plugs Pre-owned equipment

Glazing

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Visit graftonoptical.com for more details on all our products & services. Grafton Optical Company Limited, Crown Hall, The Crescent,Watford,Herts, WD18 OQW T: 01923 233980 E: sales@graftonoptical.com

To advertise call Haley Willmott 020 7657 1805

digital test chart

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Looking to sell anything from a secondhand piece of equipment to your practice. Advertise in OT and reach 20,575 potential buyers. Call Haley Willmott 020 7657 1805

To advertise call Haley Willmott 020 7657 1805

*Snellen *Logmar *E and C Charts *Childrens tests *Ishihara, images, and much more The complete test chart with a 22” LCD and 8” tablet controller

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Making it better, easier and affordable

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Instruments

Buy & Sell Your Equipment

Buy or Sell New & Used Instruments, Supples and Practice Fittings Save

Machinery & Consumables

Specialist and first class suppliers to the optical industry

Advertise any items for free with our no Sale no Fee policy Why not visit our website and see what’s on offer today or call 01257 230430 WANTED! Surplus Instruments urgently required - Buyers waiting BEST PRICES PAID

New, used & refurbished equipment Lens coating, edging and surfacing machinery Finance and trade-ins available Dispensing & laboratory consumables at affordable prices On site maintenance & rapid response engineer service Personal and efficient aftersales care

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For more information Phone: +44 (0) 161 926 8844

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To place an advertisement call 020 7 657 1805 or email haley.willmott@tenalps.com

Practice For Sale

Practice for Sale!

Ideally suited for the independent optician looking for a cheap way into ownership of an established practice. Southampton City Centre • 410 tests • £75K gross sales • Price £25K

For more information call 07970 849505

Looking to sell anything from a second-hand piece of equipment to your practice. Advertise in OT and reach 20,575 potential buyers. Please call Haley Willmott 020 7657 1805

Retirement sale Optometric practice established over 30 years in West Sussex. Turnover £263,000, large car park, two consulting rooms. Further details contact

sussexoptometry@hotmail.co.uk

Practice Fittings

To advertise call Haley Willmott 020 7657 1805

14/02/14 MARKETPLACE

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MARKETPLACE

To place an advertisement call 020 7 657 1805 or email haley.willmott@tenalps.com

Practice Fittings

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VISIT OUR NEW WEBSITE www.barnesdesignltd.com Create an outstanding practice for your patients contact us today for a FREE CONSULTATION 14/02/14 MARKETPLACE

Telephone: 01253 400 970 | Email: enquiries@barnesdesignltd.com

Lynx IDG – creating the ultimate custom practice interiors for 30 years

 Limited edition Lynx IDG T-shirt with every R & D consultation – call now on 0800 387 287 Tel: +44 (0)161 367 9628 • Fax: +44 (0)161 366 1810 • Freephone: 0800 387 287 Email: info@lynxidg.com Web: www.lynxidg.com facebook.com/lynx.idg @lynxidg


Endorsed services

www.aop.org.uk/member-services Accountancy and Tax Returns Service

Aon PracticeShield Insurance

AOP Credit Card

Credit and Debit Card Processing

www.twdaccounts.co.uk 0161 480 7717

www.aop.org.uk 0845 608 5084

www.aop.org.uk 0800 028 2440

www.aop.org.uk 0800 731 8921

Criminal Records Bureau (CRB) Checks

Debt Collection; Status Enquiries; Financial Consultancy

Finance for Buying a Practice or Buying into a Practice

Income Protection Plan

www.cbscreening.co.uk 01443 799 905

www.londonhouse international.com 01934 863 616

www.aop.org.uk 07764 287 837

www.pgmutual.co.uk 0800 146 307

Insurance: Household, Motor and Travel

Online Bookkeeping

Personal and Business Loans

Practice Development: Business Planning, Marketing

www.endsleigh.co.uk 0800 028 3571

www.arithmo.co.uk 0161 968 7395

www.premlease.co.uk 01635 876 624

www.myerslaroche.co.uk 0161 929 8389

Practice Valuation

Private Medical Cover and Vehicle Breakdown Recovery

www.ravaluationservices.com 01425 402 402

www.hmca.co.uk/aop.htm 01423 866 985

The Association of Optometrists is authorised and regulated by the Financial Conduct Authority because of the financial services benefits which we offer to our members through affinity partners. We do not provide financial advice or any assurance as to the suitability of the financial services offered by our partner firms. Please seek independent financial advice if in doubt as to the suitability of any financial product. For further details, please see www.aop.org.uk.


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Optometry Today February 28 2014