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www.optometry.co.uk July 30 42010 £4.95 www.optometry.co.uk May 2012vol vol50:15 52:9 £4.95

optometrytoday

Journal of the Association of Optometrists

live GOC’S CET changes revealed

online

LOCSU: The year enewsletter ahead

BCLA in focus Birmingham ICC conference previewed


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CONTENTS

Become our fan on Facebook

May 4 2012 vol 52:9

http://twitter.com/OptometryToday

16 News

Profile/advice

An optometrist facing allegations of misconduct has been deemed fit to practise

Plans for a busy year following the release of LOCSU’s 2012-2015 strategic plan

5 GOC case

48

28 Clinical

42-43 VRICS: C-18783 O/D Advanced clinical techniques part 2

16 LOCSU looks ahead

6 Postal blow

25 Quality in Optometry update

Gonioscopy and tonometry by Thomas Ressiniotis and Maged Nessim. The second article in this series tests our knowledge of gonioscopy and tonometry techniques

7 Student sponsorship

36 Profile

44-47 CET 1: C-18848 O/D Ophthalmic public health part 5

The massive rise in postal costs this week will hit practices

The College of Optometrists will sponsor international optometry students during their pre-reg period

How the new Practitioner Checklist can help during a contract compliance visit AOP director Vivian Bush talks about the evolution of the association

Health promotion: from knowledge to action. Dr Ruth Hogg discusses how to put health promotion into practice more effectively

Events

8 Comment

The AOP’s interim chief executive Richard Carswell discusses why the independence of optometry as a clinical activity is under threat

48-53 CET 2: C-18803 O/D Ocular mycoses

26 NOC

Booking for the National Optical Conference has now opened

Infection of the eye by fungi. Dr Richard Armstrong and Maryam Mousavi discuss the most common ocular mycoses, the importance of fungal contamination of materials in contact with the eye and methods of treatment

32 Independents Day

10 News Extra

Details of the enhanced CET scheme for optometrists and dispensing opticians which comes into effect in January

A preview of the annual event which this year features a symposium sharing real patients’ thoughts and experiences of independent practice

Classified

Cover story

34 Diary dates

54-57 Jobs

20-21 BCLA preview

All the latest vacancies

The upcoming optical events for this month

OT looks at the highlights of the upcoming contact lens conference and exhibition

58-62 Marketplace

Regulars

Your guide to optical products and services

30 Student news

Products

CooperVision has announced the launch of its Summer Research Scholarship plus news from Cardiff and Plymouth universities

28-29 Industry news

New frames launched by JK London, children’s frames from International Eyewear and a presbyopia breakthrough from Sauflon, plus role changes at two instrument companies

14 Spectator

Give us a call... ...Rachael did!

01793 648607

Could regional pay proposals for NHS staff impact on the GOS fee?

outsideclinic.com

OT (the AOP and Ten Alps Publishing) accept no responsibility for products, goods or services that may be advertised or referred to. Opinions expressed are not necessarily those of OT, the AOP or Ten Alps Publishing

Feature is online

05_May 4th OT EP Rachael 2.indd 1

Video is online

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27/04/2012 11:03


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NEWS Emily McCormick emilymccormick@optometry.co.uk

AN OPTOMETRIST facing allegations of misconduct has been deemed fit to practise by a GOC hearing. Elizabeth Dawson was working as a pre-registration at Specsavers, in Brighouse, West Yorkshire in July 2008, when she was accused of failing to ask her supervisor for advice in relation to a patient who presented with a retinal detachment. During the proceedings Ms Dawson was represented by the AOP, which had instructed Ian Stern QC to present its case on behalf of its member. Hearing the case, the fitness to practise committee acknowledged that whether the Council proved if Ms Dawson failed to approach her supervisor, Gareth Hart, would be key. It was claimed that neither

parties could clearly recollect the events of the day, however, whilst Ms Dawson claimed to always take abnormal visual field test results to her supervisor, Mr Hart said if shown such abnormal test results, he would have asked for more information, noted the adverse signs and symptoms and referred the patient to hospital urgently. However, with evidence from that patient stating she was asked to wait in reception while Ms Dawson went elsewhere, the committee concluded that it was more likely than not that Ms Dawson did go to Mr Hart for

advice and consequently found her not guilty. Welcoming the decision, solicitor at the AOP, Ella Power said: “This case raises important questions for the profession about the adjudication of student optometrists. We are extremely pleased for Elizabeth that the central allegation of misconduct at a time when she was undertaking training as an optometrist was not made out and that she can now put this matter behind her. We wish her all the best for the future.” Ms Dawson told OT: “This positive result has lifted an enormous weight from my shoulders, and has been a very long time coming. The help and support from the AOP and Mr Stern has been a huge comfort during this stressful time. Thanks to all their hard work, I am now able to look forward to my future as an optometrist.”

Concerns over AMD drug THE MACULAR Disease Society has called on the Government to urgently resolve the row over which drug should be used for treating wet AMD after the makers of one treatment announced it is seeking a judicial review against a cluster of PCTs for using an alternative, unlicenced drug. The charity added it ‘regrets’ that the drug company is taking the PCT cluster to court and wants ministers to instruct NICE to hold an appraisal of the unlicensed drug, Avastin, for use in a range of eye diseases. The appeal comes following Novartis’ announcement that it has filed for a Judicial Review into the policy of Southampton, Hampshire, Isle of Wight and Portsmouth PCT, for using Avastin rather than its licensed alternative Lucentis. Novartis added that it is ‘concerned that the recent wet

AMD policy is asking patients and clinicians to save the NHS money by using an unlicensed medicine to treat wet AMD’ and ‘Novartis is worried that the principle of patient safety is being undermined by the current policy’. Chief executive of the Macular Disease Society, Helen Jackman, told OT: “Many retinal specialists are satisfied that Avastin is as safe and effective as the approved drug Lucentis, others are not. “NICE is the organisation best placed to resolve these issues, although we accept it cannot do so alone as its remit does not include safety and so it needs the expertise of the MHRA as well. “There needs to be a national solution to these uncertainties. If Avastin is not as safe as Lucentis no-one should be using it. If it is as good perhaps everyone should be using it. If doctors and other experts cannot agree on which drug to use it is not reasonable to

expect a patient to decide and we have doubts patients would have the issues properly explained. “A court would decide whether the PCTs’ decision was correct from a legal or procedural point of view. Many of the issues of safety will remain unanswered and the uncertainty will go on.”

To comment go to www.optometry.co.uk

IN BRIEF

Report online

The AOP annual report 2012 is now available to view on the Association’s website. Fully downloadable and printable, this year’s document features a number of interactive elements including the ability to view an image gallery of the AOP’s new offices and click straight through to the elements of most interest. To view the report, visit http:// annualreport2012.aop.org.uk/

5

London workshop

An additional glaucoma lecture and training workshop has been organised by the South East London QIPP Glaucoma Repeat Measures and Referral Project. The evening event will run on May 9 at King’s College Hospital from 7pm. To book, visit www.locsu.co.uk

Training session The latest ambassador training event for the Careers in Optics initiative will take place in Cardiff on May 17. Once trained, ambassadors can facilitate workshops in secondary schools to build links in the local community and help promote optical careers to pupils. For more information or to register, email ambassadors@ newdimensionsinoptics.org

04/05/12 NEWS

Optom fitness not impaired


NEWS IN BRIEF

Patients given money saving tips

04/05/12 NEWS

6

Consumer advice website moneysavingexpert.com has launched a ‘cheap contact lens finder’ where users can enter their usual brand, type and lens to discover which online retailer offers the cheapest lenses. The new feature sits above its top 15 pieces of advice for ‘cutting contact lens costs’, which includes tips on the patient’s legal right to their prescription, advice to consider own brand lenses and direct debit schemes. It also outlines the importance of being careful when ordering from overseas and the need for aftercare.

Nominate for the Rodenstock Awards

Rodenstock has announced the launch of its 2012 Club Awards which aim to recognise independent opticians for their loyalty and support to the manufacturer. Practices from across the UK will compete in a number of categories including Impression Lenses, Lifestyle Lenses, ColorMatic IQ Lenses, Dunhill eyewear, Porsche Design eyewear and Rodenstock eyewear. The competition closes on November 30, with winning practices announced at an awards ceremony at The Landmark in London on December 18. This year winners will enjoy a trip to Prague.

EAOO fellowships

Four UK optometrists have been awarded Fellowships to the European Academy of Optometry and Optics (EAOO). Recipients Paul Murphy, Shehzad Naroo, David Parkins and Rakesh Kapoor received their certificates at the EAOO annual conference in Dublin last month. The Fellows can now use letters FEAOO after their name.

Postal rises hit practices Chris Donkin chrisdonkin@optometry.co.uk

PRACTICES MAILING out newsletters, promotional leaflets and appointment reminders have been hit by Royal Mail’s massive rise in postal costs, where the prices of a standard second class letter have risen by over a third to 50p (from 36p) with the first class cost jumping to 60p (from 46p). Although the per-letter rises may appear small, the fees soon add up and can eat into the profit margins of practices, which is why the AOP’s director of operations, David Craig (pictured) is urging practitioners to consider cheaper options when contacting their patients. He told OT: “Optometric practices have always been big customers of the Post Office, with most practices sending

out reminders and referral letters via snail mail, so the increase in charges will hit hard. “This must be a great incentive for more of our communications with patients to go via email and text messaging. These media provide very cost-effective ways of getting in touch with your patients – often in a way that is

easier for them to use as well as cheaper for you.” The rise in postal costs will effect everyone, including the AOP, and with this in mind Mr Craig appealed to AOP members to ensure their details are up to date so the Association can move an increased amount of its communications to email and SMS. He added: “The AOP continues to look towards moving communications online or via email or SMS where practicable; it promises to save costs and therefore keep membership fees down. It’s just so that we can keep in touch – we promise not to deluge you with spam.” To change your details, visit www.aop.org.uk or email changes to membership@aop. org.uk For more information on the increase in postal charges, visit www.postoffice.co.uk

Practitioners flock to Education Destination OVER 65 delegates attended therapeutics event Education Destination at the AOP offices in Woodbridge Street, central London last weekend (April 29-30). Organised by the AOP

and SECO, the event was the first major conference and exhibition held by the AOP in its new state-of-the-art building. The two-day meeting featured internationally

renowned speakers Dr Murray Fingeret and Dr Paul Ajamian and UK professionals professor John Lawrenson, Nick Rumney and Jane Bell. A full review will appear in the next issue of OT.

Black & Lizars eyes expansion Chris Donkin chrisdonkin@optometry.co.uk

SCOTTISH-BASED independent Black & Lizars is currently in takeover talks with 10 practices and, in the longer-term, bosses believe there is room for 150 outlets across the UK, chief executive Mark Ross has revealed in an interview with The Herald newspaper. The independent, which already owns 22 practices in Scotland and one in Northern

Ireland, is initially looking at opening in ‘strategic towns’ such as St Andrews, Inverness and Dunblane, Mr Ross told the

To comment go to www.optometry.co.uk

newspaper, with the aim of doubling the chain in size by 2015. He added that in ‘due course’ the company would also look at further acquisitions outside of Scotland. The full interview is available on The Herald‘s website at www. heraldscotland.com/ business/company-news/ black-and-lizars-boss-eyeingup-acquisitions.17370308


NEWS

Emily McCormick emilymccormick@optometry.co.uk

THE COLLEGE of Optometrists will sponsor international optometry students during their pre-reg period, allowing them to complete their studies in the UK, the body has announced. The news comes following joint working across the sector by optical bodies, the GOC, universities and employers after a new ruling from the UK Border Agency meant that non EEA international students studying optometry in the UK would be unable to complete their pre-reg period in the country once they had graduated. The issue arose due to a minimum wage restriction stipulated in the new visa regulations which is higher than the current rate of pay for the pre-reg period.

Cardiff plays host to AOP The AOP will hold its AGM at the Marriott Hotel in Cardiff on May 15, the Association has confirmed. Key speakers during the event include Dick Roberts, chief optometric adviser to the Welsh Government, and representatives from retail and technology market analysis group GfK. FODO, the ACLM and the Benevolent Fund will all host their AGMs alongside the AOP’s meeting at the same venue. AOP interim chief executive, Richard Carswell, said: “I invite all members of the Association to attend not only our AGM but also the other meetings before and after. We will have the benefit of some very interesting speakers.”

Jackie Martin, director of education at the College, said: “In our discussions with UK universities, it became clear that an urgent solution was needed to migrate the impact of recent changes to the UK Border Agency rules. With the support of the British Universities Committee of Optometry (BUCO), Universities UK and the Department of Health, we are pleased to be able to provide a solution.” Responding to the news, AOP education advisor, Karen Sparrow, told OT: “I am delighted

that international students can now concentrate on their final exams and graduation, and that the College has taken on the role of sponsor. This will come as a relief to many international students who have lived with this uncertainty for a number of months.” The College will now apply for a licence from the UK Border Agency, allowing it to issue Certificates of Sponsorship under the Tier 5 Government Authorised Exchange. Glenn Tomison, chair of the Joint Visa Working Group, commented: “This is great news for those students caught by this change and also for the sector and our universities. It once again shows what the Optical Confederation, the College and universities can achieve when they work together.”

ECOO accreditation scheme confirmed ECOO WILL introduce an accreditation scheme which allows institutions to opt out of all, or part of, the European Diploma of Optometry, the Council confirmed at its conference in Dublin last month. The accreditation scheme, which has already been piloted in Switzerland, Norway and the Czech Republic and was developed by Bob Chappell and Adrian Jennings, aims to allow European teaching institutions to benchmark their qualifications against the diploma. Although the diploma is tipped as the ‘gold standard’ of optometry, due to the high costs of taking the exams very few professionals have signed up in the past. During the three-day conference, details of the Council’s

plans to establish a European Standard on optometric and optical services were discussed. In the absence of an official standard, a working group, chaired by AOP councillor and vice chair of ECOO, Julie-Anne Little, was established. During the group’s first meeting, the scope of guidelines for the standard, as well as a common understanding for terminology and content was agreed. Once decided, it is hoped that the guidelines will ‘serve as a template for optometrists and opticians to deliver clinically safe and effective primary eye care services to patients in the community’. Draft standards are now in development and the working group will meet again next month.

To comment go to www.optometry.co.uk

Charity challenge

Optometrist and chair of Vision Care for Homeless People, Elaine Styles (pictured right) will cycle from Land’s End to John O’Groats to raise funds for the charity next month. Ms Styles aims to raise £1,000 by completing the 900-mile journey – enough to keep all four of the charity’s clinics running for two weeks. To make a donation, visit www.virginmoneygiving. com/elainemcknight

Optos in best of British exhibition

Retinal imaging company Optos has been selected to take part in an exhibition demonstrating the ‘very best of British manufacturing’, this summer. The Scottish-based firm will feature in the UK Government’s ‘Make it in Great Britain’ show at the Science Museum, London, during the Olympic and Paralympic Games. Optos will showcase its latest products and aim to educate visitors about the benefits and value of manufacturing in the UK. CEO of Optos, Roy Davis, said: “We’re delighted that we are going to be a part of the Make it in Great Britain exhibition, and feel very proud to be representing the manufacturing industry.”

Online resource LOCSU has unveiled a new online resource to share evidence and information on ophthalmic public health. Useful for NHS commissioners, health and well being boards, eye health professionals, providers, public health experts and academics, the Ophthalmic Public Health Network is available at www. networks.nhs.uk/nhs-networks/ ophthalmic-public-health-network

7

04/05/12 NEWS

The College to sponsor international students

IN BRIEF


COMMENT

NEWS

Mystery shop poll on cheap glasses

04/05/12 NEWS

8

SUPERMARKET OPTICIANS were found to offer better overall frames on a £70 budget than some branches of multiples, a Daily Mail mystery shop concluded last week. With a total budget of £70, reporter Vincent Graff, from the online version of the national newspaper, visited outlets of Specsavers, Vision Express, Asda Opticians, Tesco Opticians and Boots Opticians to have an eye test and buy a pair of glasses. The lenses and frames were then examined by Dr Sneh Khemka, a former eye surgeon at Moorfields. According to Dr Khemka, none of the lenses were made to the ‘perfect prescription’ given by the practitioner (which the author frequently refers to in error as an ophthalmologist), though the discrepancies were ‘not large enough to greatly affect vision.’ However, despite this criticism, the reviews were largely positive with overall scores of (out of 10): Vision Express: 5, Specsavers: 6.5, Boots: 7, Tesco: 7 and Asda: 8.5. Dr Khemka concluded he was ‘pleasantly surprised by the good quality of some of the frames’ adding, ‘The Tesco and Asda frames stand out as excellent, and most of the other ones are fine. Spectacle frames are very often a complete rip-off. You can buy them for £30 or £40, but they’d sell for £300 if they had a designer label.’ He goes on to warn readers: ‘What this experiment has shown is that the vast

INDEPENDENT OPTOMETRY?

majority of glasses-wearers can get a very good pair of spectacles for £70, and there’s no point in spending much more.’ Delighted with his firm’s rating, Ed Ashley, optical buying manager at Asda, told OT: “We’re thrilled to have topped the leader board with an overall rating of 8.5 out of 10. We pride ourselves on giving our customers a great shopping experience.” AOP director of operations, David Craig, was critical of the article’s portrayal of the profession. He told OT: “Once again our sector is under attack. These ‘surveys’ regularly crop up with the same old story: that the public are being ripped off by opticians. The fact that the journalist does not know the difference between an optometrist and an ophthalmologist sums it up: poor journalism following a pre-set agenda.”

AOP call for councillors PRACTITIONERS IN the south of England who want to help shape the profession are being encouraged to put their names forward to be considered for the AOP Council. Following the Council elections last month, there are three seats available in the South East Coast and South Central England constituency. The Association’s board is keen to fill the roles with practitioners who live, work or have strong connections to the area covering postcodes: BN, CT, GU, HP, KT, ME, OX, PO, RG, RH, SL, SO and TN. Information about the role is available on the AOP website, under the ‘About the AOP’ section. Alternatively, members who are interested can contact Steven King on 020 7549 2018 or email stevenking@aop.org.uk

Initial expressions of interest are requested before May 11, with the AOP board then selecting successful candidates. If you are interested in serving on the AOP Council email Steven King with your name, AOP membership number and a statement of no more than 150 words outlining your experience, which will help serve the AOP and the profession. AOP director of operations, David Craig, told OT: “We are very keen to get new blood onto Council; we need new ideas, fresh energy and a willingness to challenge. “The other councillors are ordinary practitioners from all kinds of backgrounds, so don’t feel intimidated.”

IT IS a common understanding that independent optometry and optics are under threat. How could anybody argue against such a proposition, when they survey the High Street and see the number of multiple optical outlets, let alone the supermarkets? Conflicting figures are often bandied about when calculating the multiples’ share of sight tests and turnover. Whatever the true figures, the share is undoubtedly formidable and represents an apparently irreversible trend. On the other hand, it is sometimes difficult to define exactly what an independent is. Is it a single optometric/ optical practice? A group of three or more? The debate is potentially endless. And how do we judge the franchisees who nevertheless carry a multiple’s logo? Not everything is as black and white as it appears. But one thing is certain: the independence of optometry as a clinical activity is under threat. Restricted testing times and imposed conversion rates: the controversies are all too familiar to OT’s readers. But it is not simply the dilemma of finding the right balance between unrestricted clinical practice and competing commercial pressures (as I have written before). It is the degradation of a proud profession which is at stake. Lucky him or her who can afford the professional satisfaction of carrying out a thorough eye examination. Not all of their colleagues can, or are allowed, to. No, it is not a matter of pointing the figure at any particular branch of the sector. The malaise is more fundamental than that. Richard Carswell, AOP interim chief executive

tTo read and comment on this piece online, visit the ‘Blog’ section at www. optometry.co.uk. Alternatively, you can post your views to OT, 2 Woodbridge Street, London, EC1R 0DG.

To comment go to www.optometry.co.uk


Sunscreen: On UV-blocking contacts: In Your patients: Happy

There is a growing awareness of the issues associated with UV – such as the depletion of the ozone layer – and therefore the need for UV protection. As for skin, UV damage to the eyes is cumulative and can cause a wide range of conditions, such as pingueculae, pterygia and cortical cataracts.1

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UV absorbing contact lenses are not substitutes for devices like UV-blocking sunglasses as they do not completely cover the eye or the surrounding area. 1. A Special Issue: Ultraviolet Radiation and Its Effects on the Eye. Eye & Contact Lens (2011); 37(4): 167 – 272. 2. UV Consumer Insights Survey, November 2011, online questionnaire with 18-45 year-old soft CL wearers (UK, n=400; Poland, n=300) and CL considerers (Poland, n=302). ® ® ® ® ACUVUE®, SEE WHAT COULD BE® TruEye® MOIST®, ACUVUE® , ACUVUE® ADVANCE® and LACREON® are registered trademarks of Johnson & Johnson Medical Ltd. © Johnson & Johnson Medical Ltd. 2012.

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16/04/2012 17:08


NEWS EXTRA

‘Enhanced’ CET is coming Robina Moss

optometrytoday MAY 4 2012 VOLUME 52:9 ISSN 0268-5485 ABC CERTIFICATE OF CIRCULATION January 1 2011 – December 31 2011 Average Net: 20, 038 UK: 19,308 Other Countries: 895 OT Manager: Louise Walpole T: 020 7549 2077 E: louisewalpole@aop.org.uk Deputy Editor: Robina Moss T: 020 7549 2072 E: robinamoss@optometry.co.uk Web Editor: Emily McCormick T: 020 7549 2073 E: emilymccormick@optometry.co.uk Multimedia Editor: Laurence Derbyshire T: 020 7549 2075 E: laurencederbyshire@optometry.co.uk Clinical Editor: Dr Navneet Gupta E: navneetgupta@optometry.co.uk Multimedia Creative Editor: Ceri Smith-Jaynes E: Cerismithjaynes@optometry.co.uk Editorial Office: 2 Woodbridge Street, London, EC1R 0DG Advertising: Vanya Palczewski T: 020 7878 2347 E: vanya.palczewski@tenalps.com Sponsorship: Sunil Singh T: 020 7878 2327 E: sunil.singh@tenalps.com AOP Awards and NOC sponsorship: Steve Grice T: 020 78806220 E: steve.grice@redactive.co.uk CET and bookshop enquiries: Charlotte Verity T: 020 7549 2076 E: charlotteverity@aop.org.uk

online

Production: Ten Alps Creative T: 020 7878 2323 E: gemma.trevillion@tenalps.com Membership Dept: 2 Woodbridge Street, London, EC1R 0DG T: 020 7549 2010 W: www.aop.org.uk Advertising and Production Office Ten Alps Creative and Ten Alps Media, Commonwealth House, One New Oxford Street, High Holborn, London WC1A 1NU Editorial Advisory Board Vivian Bush, Leon Davies, Cameron Hudson, Polly Dulley, Dan Ehrlich, Navneet Gupta, Andy Hepworth, Olivia Hunt, Niall Hynes, Ceri SmithJaynes, Gaumaya Gurung, Sonal Rughani, David Ruston, David Shannon, Gaynor Tromans, David Whitaker, Andy Yorke W: www.optometry.co.uk Published fortnightly for the Association of Optometrists by Ten Alps Creative Subscriptions Abacus eMedia, Bournehall House, Bournehall Road, Bushey, Herts, WD23 3YG T: 020 8950 9117 E: stelios.kontos@abacusemedia.com UK £130, OVERSEAS £175 for 24 issues

robinamoss@optometry.co.uk

live

ENHANCED CET for optometrists and dispensing opticians will come into effect in January 2013. At the GOC meeting in London last week the regulator used a draft independent research report from Europe Economics to satisfy itself that the council’s enhanced CET scheme is ‘fit for purpose’. Under the enhanced scheme, enewsletter a minimum of 36 CET points per cycle must be accrued, with at least six points earned each year and points must be gained across all competency areas. At least 50% of a practitioner’s points must be gained through ‘interactive’ learning meaning an 18 point cap on text-based distance learning. Optometrists and contact lens opticians must attend one peer discussion session per cycle, worth two points. The three-month shortfall period will no longer be automatic but reserved for registrants with ‘exceptional circumstances’ and must be applied for in advance of the points shortfall. If CET is incomplete, the practitioner will have to earn all of the missing points and pay a fee to regain entry onto the register. The report to the GOC noted that the requirement to undertake peer discussion (pictured) and an increased proportion of interactive CET would ‘deliver the intended benefit of addressing the contextual risks associated with professionally isolated, out of touch or disengaged practitioners’. The expectation that registrants achieve a minimum of six points per year throughout the CET cycle would ‘reduce the current risk that practitioners undertake short intense periods of learning with long periods of no learning’. The report added that the removal of an automatic right to a shortfall period would result

bookshop

CET

tv in VRICS registrants who have failed their CET, and are therefore not fit to practise, being removed from the register much earlier. It concluded that the requirement to conduct CET across a range of competencies, another change to the current system, would ‘result in optometrists undertaking learning in the diagnosis and management of ocular disease, beneficial in tackling the risks around glaucoma and retinal detachment’. Chief executive and registrar Samantha Peters said: “By implementing our changes, we believe that CET will be a proportionate mechanism to ensure our registrants have the necessary skills, experience and knowledge to remain fit to practise.” The GOC also decided to reject plans to introduce a UKwide Clinical Skills Assessment (CSA), which would have been conducted every six years and cost the profession over £6m. It had been proposed as a way of requiring registrants to practically demonstrate they were up-to-date in certain key areas of practice. The aim was for workshops where registrants would demonstrate basic practical competencies to trained assessors. The draft independent report noted that the costs of establishing the CSA scheme would not be justified. The research used the model operating in Scotland and Wales for the assessment of practitioners undertaking NHS commissioned services. The research concluded that for the GOC to develop and operate an

To comment go to www.optometry.co.uk

assessment across the UK would be £1.48m, with additional costs associated with remediation activity of £408,000. The total cost to the profession, taking into account time out of practice for registrants to prepare and attend, was estimated at £6.25m. The research considered data from the Scottish scheme, which showed that only 5% of practitioners failed at their first assessment and of those who took a second attempt, only five practitioners failed again. To reach the tipping point where costs and benefits were considered to be equal, the assessment would need to identify 11-17 practitioners across the UK who were ‘sufficiently incompetent that they posed a risk to the public’. The council concluded that, given the risk-research findings and fitness to practise data, that level of risk did not exist. The research also considered benefits associated with the prevention of harm, measured by QALY (quality adjusted life years) a recognised measure used by NICE and within the NHS to provide a monetary value for harm to a patient. Using this, 11% of registrants would need to be sufficiently incompetent as to misdiagnose or mismanage all new cases of glaucoma or retinal detachment occurring during a year, to argue the case for establishing a national system of Clinical Skills Assessment. OT will be covering all the changes in CET in the coming months

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OBITUARY

Tony Sabell: Master craftsman Colleague and friend Jacqui Lamb remembers Tony Sabell, who sadly died last month

04/05/12 TONY SABELL

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IT IS difficult to do justice to someone who has helped and inspired so many people throughout his 86 years. Tony Sabell: teacher, lecturer, inventor and master craftsman – qualified as an ophthalmic optician in 1946 and two years later in 1948 he went on to specialise in contact lenses when only scleral lenses were available. After gaining experience both in general optometry as well as contact lens practice, he began working at Aston University (College of Advanced Technology as it was known then). Soon he was a full-time lecturer in optics and indeed, ended up co-running the whole department. Tony spent 25 years at Aston University, changing the face of optometry in Britain, developing the original correspondence course into a fulltime three year honours degree,

pre-reg year and qualifying exams. He believed passionately in the professionalism of ophthalmic optics and was integral in the development of today’s optometrist. After retiring from Aston, Tony began contact lens clinics in three major Birmingham hospitals – Birmingham Eye Hospital, Birmingham Children’s Hospital and Selly Oak Hospital. He specialised in hand-made PMMA scleral lenses, made from alginate moulds of the eye. It was there I had the absolute pleasure of working with him. Our clinics were massively busy. Tony was technical adviser, expert clinician and master craftsman to our hospital optometry team. He was never too busy, nor too exhausted to give advice or to do ‘yet another’ adjustment when it was needed. He took lenses and

eye casts back to his workshop at home to spend hours making shells for the following week. His handmade inventions were invaluable and spread through our department, with books featuring chapters written by him on our shelves. Tony finally retired from our hospital when he was 80. He slipped away in his sleep

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whilst sat in his favourite armchair in front of his television on April 16. Our thoughts and love go to his wife Rhona and his three children and their families. Ian Sabell (Tony’s son) said they have already had so many lovely comments and anecdotes about Tony from his friends, students and patients that he is setting up a website where people can share their memories.


NEWS EXTRA

DOCET releases glaucoma DVD

incidence, associations and risk factors; assessment, examination and investigation (in two parts); appropriate referral and management; and credits. Included in the footage is a run-down of the common risk factors for the condition including age, intraocular pressure, race and family history and also includes prevalence statistics for each risk factor. DOCET training adviser, Philippa Shaw, said: “There is often some anxiety and

uncertainty among practitioners about the management of patients at risk of developing glaucoma, particularly following recent changes in guidelines for managing patients at risk of glaucoma, yet we know that currently around half of all cases go undetected. “Optometrists play a vital role in identifying patients at risk and this new DOCET training resource aims to help them manage and refer their patients appropriately.” Other contributors to the film include optometrist consultant

at Manchester Royal Eye Hospital, Dr Robert Harper (pictured); glaucoma specialist optometrist at Howie & Tickner Optometrists, John Tickner; consultant glaucoma specialist at Manchester Royal Eye Hospital, Leon Au; and professor of clinical optometry at City University, professor John Lawrenson. The new release goes alongside DOCET’s previous productions, which include AMD, which was a runner-up in last year’s AOP Award for Best Educational Video, Optometry and Ethnicity and Dementia & Optometry, which are all available on DOCET’s website. DOCET’s new DVD is currently being distributed by post and is also available online for all optometrists registered with the GOC. For more information, visit www.docet.info

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04/05/12 NEWS

DOCET HAS released a new CET training film to keep optometrists abreast of the latest information on glaucoma. The latest resource aims to: define the different types of glaucoma and risk factors involved; give clear advice and information on appropriate investigation and examination techniques and explain the management; referral and treatment of glaucoma. Presented by Miranda Krestovnikoff, who also featured in DOCET’s 2011 AMD DVD, the film offers two CET points for optometrists who complete all of the MCQs. The 45 minute film is divided into eight chapters to allow practitioners to take the CET in sections: Introduction; definition and classification, pathophysiology of glaucoma;


SPECTATOR

Could pay proposals hit sight test fees? 04/05/12 SPECTATOR

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ANOTHER MONTH has gone by, but Andrew Lansley continues to create headlines – this time with his reported support for the proposal to introduce ‘regional pay’, whereby NHS staff working in poorer parts of the country are paid less, with the assumption being that the cost of living is proportionately lower. Possibly a more positive way of looking at this is that staff working in richer, and potentially more expensive, parts of the country, would be paid more – but either way, unintended consequences are bound to emerge from such a proposal. In some respects this arrangement would better reflect the dynamics of the real-world employment market, however, it could equally act to reinforce the economic divide between poorer and richer geographic areas. At the same time, it is in some of the poorest areas that healthcare needs are at their greatest and financial disincentives are more likely to discourage staff from choosing to move to these areas and accordingly skills shortages will arise and service levels suffer. Potentially worrying from the perspective of the optical sector should this proposal come to fruition, is whether it would have any impact on GOS sight test fees. The introduction of regional variations in sight test fees doesn’t bear thinking about. In addition to the above, it would create a logistical nightmare. The proposal document suggests setting a national basic pay rate at a “minimum level necessary” and paying additional supplements in particular areas, and in that may lay our salvation. Surely the Department of Health could not seriously propose that the current GOS fee is anything other than at the absolute minimum? There will be many on this side of the debate who would argue that the GOS fee in fact fell below this minimum level many years ago and is only able to remain viable through a continuance of the market cross-subsidy. While on the subject of GOS fees, it is worth noting the comment by the chief dental officer (CDO) regarding the planned uplift at the end of April in the fees paid to dentists. This is in line with the same increase for GPs and, of course, at odds with the lack of an equivalent increase for optometrists. In his letter, the CDO describes this as “an expenses uplift of 0.5%, largely to fund pay increases for practice staff earning less than £21,000 a year, again in line with the Government’s public sector pay policy”. The same justification was offered to set the context for the 0.5% uplift for GPs. One wonders then, why the Department of Health appears oblivious to the essential support role of many optical practice staff in enabling the delivery of GOS, and the fact that many will be earning less than £21,000 per year.

At last week’s quarterly meeting, the GOC considered research evidence for and against the possible introduction of a six yearly clinical skills assessment for optometrists and dispensing opticians, and concluded that this would not be a proportionate approach to addressing potential risks associated with clinical practise. A sensible conclusion appears to have been reached, but that this was discussed, points to the reality that the concept of revalidation for healthcare professionals is still very much a work in progress. The GMC is still adding to the final design of the process for revalidation of doctors, due to be introduced imminently. The latest tweaks to one component have now been revealed – doctors will be expected to seek feedback from colleagues and patients and demonstrate that they have reflected on that feedback. But the research evidence presented regarding this proposal concludes that for ‘reliable’ results, a doctor will need to obtain feedback from a minimum of 15 colleagues, which, it is argued, will be difficult, if not impossible, for most. In addition to inviting ratings from their colleagues, doctors will then be required to self-assess themselves on matters such as clinical knowledge and honesty. While we can learn much from the other healthcare professions, thank goodness our own profession is not unthinkingly following in the footsteps of the doctors on this one – far better to seek our own evidence and our own solutions.

For more news visit www.optometry.co.uk


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LOCSU

Planning ahead Following the release of LOCSU’s 2012-2015 strategic plan, OT’s Emily McCormick speaks to the Unit’s director of operations and commissioning, Katrina Venerus about the busy year ahead

04/05/12 KATRINA VENERUS

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KATRINA VENERUS (pictured) has been at the reins of LOCSU for over a year and under her guidance the Unit has been knuckling down, producing new pathways, introducing optical leads and widening the scope of the NOC to encompass the entire profession – in a nutshell, working towards meeting its strategic aim of increasing the role of optometrists and dispensing opticians in providing primary eye care services. Having been onboard since the Unit’s inception five years ago, Ms Venerus initially began as an ‘associate’, working three days a month in an advisory role. An optometrist by profession, Ms Venerus has a wealth of experience across the sector, and until recently owned her own independent practice. “I’ve worked in all sorts of practices over the years, from independent to multiple, and being a clinical manager for a large practice; so I’ve been around the different houses if you like,” she reveals. It is an expertise she can utilise when advising LOCs and ROCs on winning enhanced services and convincing PCTs of the untapped skillset they have in optometrists and dispensing opticians locally.

This year and beyond LOCSU marked a milestone with the publication of its first three-year strategic plan (2012-2015) last month, in which it pledges to ‘support and enable LOCs and ROCs to negotiate and deliver primary eye care services at a local level’. “It is important for LOCs to understand that they can get as little or as much advice and support as they want from LOCSU,” Ms Venerus explains. “It’s about making sure that practitioners can get amongst commissioners and are prepared to do the ‘selling job’,” she adds. As well as help from the Unit always

being just a phone call away, the role of optical leads was established last year. With 10 practitioners appointed for a 12 month period, their purpose was to “bring LOCs together to share ideas and network with each other,” the LOCSU director explains. “It might not seem like rocket science to you and I that it’s a good idea to talk to each other, but when you are busy and working very much in isolation, it’s hard to create and maintain those relationships.”

service that a commissioner is interested in, the optical lead in the right location will go in and spend time working with the LOC and commissioners.” She confirms that LOCSU is looking to appoint six optical leads in June to implement this support. Discussing the process of getting an enhanced service commissioned, Ms Venerus points out that: “Before we get to the meeting and selling point with commissioners, it’s about LOCSU having up-to-date business templates that LOCs can use, and before that the right pathways.” Both are essential tools for LOCs/ROCs hoping to be successful in an enhanced service bid which is set out in the Unit’s aims ‘to be a source of support and good quality advice for committees’. Hot on the heels of introducing its eighth pathway last month – Community Eyecare Pathway for Adults and Children with Learning Disabilities – a ninth is already in the pipeline. “We are now looking at stable glaucoma monitoring because, when commissioners are looking for opportunities that can be delivered in the community, if you have

“It’s about making sure practitioners can get amongst commissioners and do the selling job” Initially appointed for a year due to the changing NHS structure, the next optical leads are expected to take up a refocused role for a two-year period. “Feedback told us that a lot of individuals don’t have the time to jump to meetings when requested by PCTs, or complete unexpected work when a response to something is required the following day,” Ms Venerus tells OT. “So in year two, the optical leads will be concentrating on an area to area basis, whereby when an LOC has an opportunity for an enhanced

people with the right qualifications, this is a simple one,” Ms Venerus explains. But with the College currently updating its guidance this is a pathway that has been put on the backburner. However, LOCSU does more than communicate, and with a five strong team, the Unit is able to educate practitioners and network with commissioners to get the best deal for practitioners. Continued on page 18


LOCSU practices it’s very common that, due perhaps to systems breaking down, when there’s bits of paper to be submitted it doesn’t always go to plan.” She adds: “And, from the point of view of the LOC presenting this service as an opportunity to the PCT, if it can wrap the IT into it at the start then the benefits of it to the commissioner are very clear.”

Still to come

04/05/12 KATRINA VENERUS

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Supporting Ms Venerus is Gill Brabner, director of education and training, who is currently focused on developing leadership training and development workshops to arm LOCs with the skills they need to win the battle and get a service commissioned. While communications manager Jenny Manchester has the combined role of communicating with LOCs and ROCs, as well as ‘getting the wider messages about the LOCSU out there’. Office manager Jacque Hudson is always on-hand in the office to ensure all questions are answered too. “Enquires can range from a very simple question about whether a constitution is the most up-to-date one, to ‘I’ve been issued with the specification for a service, does it look right?’, and Jacque makes sure everyone gets an answer,” Ms Venerus says. Also on the team as executive chair is Alan Tinger, who has been onboard since the Unit’s early days and has a wealth of experience in the optical sector.

Continued support Keen to point out that the Unit doesn’t desert LOCs once they have won a commissioning battle, Ms Venerus clarifies that support continues through to data collection. “Data is at the core of enhanced services. Once an LOC or ROC has successfully negotiated an enhanced service and an agreement has been reached it will need to capture a range of

data to show the outcomes of the service and prove its success. Many PCTs will ask for this data too,” the optometrist explains, “especially if they are only piloting the scheme.” As a result, the Unit has developed OptoManager, a Web-based IT system which allows practitioners working on an enhanced service to log all the required data with ease. “OptoManager has been established to fit the enhanced services pathways so that a practice can enter the key clinical data related to that specific patient episode, instead of handwriting it,” she says. “Users will be asked to verify a few things and then the data is automatically saved into a secure Web-based platform and out of the other side comes monthly reports and invoices for commissioners, based on a practice’s activity.” A pilot of the system which ran in Stockport saw OptoManager used for a glaucoma repeat readings enhanced service. After being funded for a year by LOCSU, it was labelled a success and has since been taken up by NHS Stockport. The OptoManager system now developed specifically for use in cataract pathways is also already being used in Stockport, with a platform for PEARS now underway. Proud of the system, Ms Venerus explains: “A clear advantage to a business owner is that, when they’ve pressed a button in terms of finishing that record, that’s their payment submission. In

A ‘secret weapon’ currently in development that the Unit hopes will help LOCs/ROCs win the enhanced services battle is an atlas map which will highlight all of the enhanced services that have been commissioned across England and Wales. “This will allow LOCs to say to a commissioner ‘look, it’s not just one or two areas providing this service, it’s all of these’,” Ms Venerus explains. “It will hopefully work by adding pressure on commissioners.” More than just a map, when users drill down they will be able to find details about the outcomes ‘and successes’ the services in each area have had. “It will also allow us to put LOCs/ROCs in touch with each other more easily because we can see at a glance who is doing what they are trying to do.” A very hands-on leader, Ms Venerus likes to attend LOC/ROC AGMs whenever possible. “It gives me the opportunity to meet people from both the LOC and normally the local PCT also. I can learn about their experiences, good and bad, first-hand and sometimes seeing the way one committee has been successful can give me ideas on how the action they have taken can be used by others,” she says. And when Ms Venerus is not busy meeting LOCs she’s ‘out there at ground level’ networking in a bid to spread the word about the wider role optometrists and dispensing opticians can play in the NHS. “It’s difficult to get wider engagement and more awareness of what the possibilities are for optometrists and opticians,” she says. But if anyone can do it, practitioners should be convinced, it’s Ms Venerus and the LOCSU team.


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EVENTS

BCLA rides into the wild West Midlands OT’s Chris Donkin discovers what’s on offer at this year’s BCLA Conference and Exhibition

04/05/12 COVER STORY

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BILLY THE Kid, Jesse James and Doc Holliday – all names synonymous with the American ‘Wild West’ – and they will soon be joined by Sheriff Shelly Bansal as the BCLA struts its way into Birmingham later this month. Held at the ICC on May 24-27, the conference features high profile speakers, an exhibition showcasing the latest innovations from companies in the sector and a packed social programme, including a ‘Wild, Wild West’ themed gala dinner on the Saturday night. The first day of the conference will be mainly educational, with the exhibition running May 25-27, alongside the programme of lectures from internationally-renowned speakers and workshops. Following the loosely-based Olympic theme of ‘Competing for excellence’, the lecture programme covers a variety of topics based on contact lenses and the anterior eye. With over 20 CET points available from the lecture programme alone, the conference offers excellent opportunities to learn, network and have a bit of fun at the same time.

Stock up on CET Keynote lecture ‘Success with presbyopia’ opens the main clinical content of the exhibition on the Thursday, presented

by associate professors of optometry at the Pacific University College of Optometry, Mark Andre and Patrick Caroline. Later in the day the attention turns to lids with the BCLA’s first foray into sessions on skin and the eye lids. The keynote lecture of the session is presented by professor Richard Collin, a consultant ophthalmic surgeon billed by the association as ‘The King of Lids’, who is a leading expert in oculoplastic surgery, working in Harley Street and for Moorfields Eye Hospital. Thursday’s lecture programme ends with two award winners as Da Vinci Award winner Charles White discusses ‘controlled release of comfort molecules from silicone hydrogel contact lenses through the use of molecular implanting’, followed by Dallos Award winner, Dr Paul Gifford, with his presentation on what multifocal contact lenses offer over single vision. ‘Anterior eye and nutrition – implications for contact lens practice’ is the subject of Friday morning’s keynote by Dr Stuart Richer – chief of optometry at the DVA Medical Center in Chicago. Later in the day, professor Alan Tomlinson presents his Medal Address on dry eye in contact lens wear.

“When else will you get the chance to dress up as Calamity Jane, Woody or John Wayne?” Friday is also the conference’s Training for Medics morning which will run alongside the main lecture programme and is designed for medics and ophthalmologists who are keen to develop their practical contact lens fitting skills. Saturday features the Irving Fatt Memorial Lecture ‘The effect of exercise on the cornea and contact lens wear’ by BCLA fellow, Dr Martin Cardall and comes as part of a morning session filled with lectures on contact lenses and sport. The educational content ends on the Sunday with a debate between Mr Bansal’s past president’s team and Dr Catherine Chisholm’s president’s team, chaired by Sarah Morgan and entitled ‘A question of contact lenses’. Alongside the main lecture programme, delegates can attend many CET-accredited workshops and seminars on other subjects.


Entertainment

BCLA president Shelly Bansal told OT what the BCLA conference offers practitioners: “Once again, the BCLA will be going in ‘all guns blazing’ to stage a memorable conference and exhibition which provides exceptional value in so many ways. With the world’s leading academics, authorities, speakers and exhibitors coming together to share their knowledge and expertise, delegates will leave this year’s conference armed to the hilt with the latest contact lensrelated learning and products ready to fight off the effects of the recession. “The Wild West will be coming to the Midlands this year at our Wild, Wild, West themed gala dinner where the good, the bad and the ugly will be on show. When else will you get the chance to dress up as Calamity Jane, Woody or John Wayne? Or better still a Red Indian!”

What’s on show? In the exhibition area, major companies in the sector will showcase their latest products including CIBA Vision and Alcon who are exhibiting together for the first time; Sauflon celebrates its new launch – the Clariti 1day multifocal – with a Champagne reception; Bausch & Lomb promotes its latest lens, the PureVision2 for Astigmatism with High Definition Optics; Johnson & Johnson Vision Care focuses on its practitioner support offering and UV; CooperVision presents its Biofinity range and UltraVision introduces its new cosmetic and prosthetic range. As well as showcasing the latest releases, the OT Bookshop is also offering several delegate deals, including the CET Shared Care Series, consisting of nine books for £1 each, or £5 for the set. A Guide to Building a Successful Practice is reduced to £10. Also in the exhibition hall, Optometry Giving Sight will hold a raffle for practitioners who sign up to support the charity, with a Neitz Ophthalmoscope worth £300 on offer for the winner. Due to its popularity last year, the Exhibitor’s Pavilion will also make a return at this year’s BCLA, where companies can exhibit their innovations. For further information and to book your place, visit www.bcla.org.uk

BCLA Clinical Conference and Exhibition Dates: May 24-27 Venue: ICC Birmingham, Broad Street, Birmingham, B1 2EA Transport: Easily accessible from the M1, M5, M6, M6 toll, M40 and M42; also close to Birmingham New Street Station and eight miles away from Birmingham International Airport Accommodation: Close to Birmingham city centre hotels, visit www.bclainbirmingham2012.com for a list of those with special rates.

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04/05/12 COVER STORY

Whereas the BCLA’s previous Birmingham venue of choice, the Hilton Metropole was quite a distance from the city centre, the ICC is in the heart of the city, a short walk from Birmingham New Street Station and the Bullring shopping centre. With such a central location, all of the restaurants, bars and entertainment of England’s second city are on hand. Delegates are encouraged to attend a variety of networking and fun social events during the conference with BCLA welcome drinks available after the lecture programme on the Thursday night. Friday brings the complimentary patron’s event where Johnson & Johnson has arranged for blind adventurer Miles Hilton-Barber to give delegates a fascinating motivational speech and discuss his many achievements, which include being the first blind pilot to undertake a 55-day 21,000 kilometre microlight flight from London to Sydney. Saturday brings the much-anticipated gala dinner and its ‘Wild, Wild, West’ theme with the BCLA encouraging people in its guide to: ‘Saddle up cowboys, cowgirls and Indians and get ready to party’. For those who don’t fancy breaking out the leather chaps black tie or lounge suits are also an option. The event takes place at The New Bingley Hall, Hockly, a short coach journey from the conference hotels. Tickets for the gala dinner must be bought in advance, with seating allocated at the BCLA stand during the exhibition. Once again this year, the Association has organised activities for people accompanying delegates with a ‘Welcome to Birmingham Big Brum’ talk on Friday which reveals the history of the city and outlines some of the tourist attractions available in the local area. The following day brings a canal tour illustrating 200 years of Birmingham’s history.


AWARDS

AOP Awards 2012 – Student of the Year Do you know a student who deserves to be recognised for their contribution?

04/05/12 AOP AWARDS

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LAST YEAR, Student of the Year was sponsored by Specsavers which is again supporting this year’s category. To qualify for the award, the student needs to be an undergraduate and fit the following criteria: Have ‘demonstrated initiative, interest and energy in improving their fellow students participation in, and awareness of, optometric issues and activities’. If you know someone who fits the bill, nominate them now. Nominating is easy and will take you no more than a few minutes. Go to www.optometry.co.uk/awards and click on the ‘Nominate Now’ link next to the selected category. Alternatively, post your nomination, remembering to include the nomination category name, to: AOP Awards (Category), The AOP, 2 Woodbridge Street, London, EC1R 0DG. You will need to provide contact details for yourself and the nominee, plus an explanation of why the person deserves to be included in this category. Student of the Year 2011 winner, Fares Hatoum (pictured left), was nominated for revolutionising the University of Bradford’s Optics Society, BOOSA, and for his part in organising the 2011 Opfest. Mr Hatoum showed a determination to increase the student experience for all. A strong Optics Society is recognised as being vital in enhancing learning, making friends and helping students in the first year adapt to a new city. “I noticed in my first year the Society was failing people,” Mr Hatoum told OT. “The name alone was a problem; the majority of our students are not drinkers so they were being put off as Headline sponsor

they perceived the Society to be based around alcohol. When I started it was really weak to be honest. “So we decided to arrange alcoholfree events to include everybody. I felt we needed to encourage everyone in the first year at least to be a part of it. It’s important to be inclusive – especially in optics which I believe is a small world and networking is very important.” As a result of his efforts, the Society became more and more popular with the general consensus being that 2010 was the Society’s finest. Among his other achievements, Mr Hatoum was instrumental in his university hosting, and winning, Opfest, an inter-university sports challenge against other institutions offering optical courses. Due to the impressive way he arranged the event in 2011, he was on the 2012 committee for the event which was hosted by Aston University. Mr Hatoum was also a student

rep for the AOP and was involved in organising a cycle ride in aid of Vision Aid Overseas and Optometry Giving Sight. The larger-than-life character is sure to be a well-known face in the profession for years to come. When OT asked Mr Hatoum what he thought about the AOP Awards ceremony, he said: “Going to the Awards ceremony was great to socialise and get to know more people. I think it brought these bright and great individuals to the spotlight. It was nice to share the stories with everybody in the profession, so hopefully it will inspire others to do the same.” If Mr Hatoum’s story sounds similar to your own or someone you know, nominate now. Visit www.optometry.co.uk/awards to view all 16 AOP Award 2012 categories. All nominations must be received by May 31, 2012. Any nominations received after this date will not be considered.

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AWARDS

AOP increases its categories New Awards for 2012 include Optical Assistant of the Year. Nominations wanted

B st

Versi

04/05/12 AOP AWARDS

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WITH THE huge success of the AOP Awards last year, the Association has decided to increase the number of categories this year to 16. These additional categories include Specialist Practice of the Year, Contact Lens Practitioner of the Year, Optical Assistant of the Year and Optical Bravery Award. Sponsoring the new Optical Assistant of the Year category is Johnson & Johnson Vision Care.“J&J is proud to be sponsoring the Optical Assistant of the Year at the AOP Awards,” says the contact lens company’s director of professional affairs UK and Ireland, Marcella McParland. “This year we launched Support 360 and in June will launch Practice Made Perfect online modules, both of which are dedicated to supporting practice success and improving the training which support staff receive. We are delighted to acknowledge staff who put best practice into play every day. We would like to encourage all employers to nominate and reward an optical assistant who is on the front line and truly puts their customer, the patient, first.” Has your optical assistant gone above and beyond their role in helping your customers? Do you have a story where your optical assistant has acted remarkably in an emergency? If you are, or know, an optical assistant who has done a lot to promote and expand the role of optics, or who has brought the benefits of optics to a wider audience, you should nominate now. Nominating is easy and will take no more than a few minutes. Visit www.optometry.co.uk/awards and click on Headline sponsor

the ‘Nominate Now’ option next to your desired category. Alternatively, post your nomination, remembering to include the nomination category name, to: AOP Awards (Category), The AOP, 2 Woodbridge Street, London, EC1R 0DG. Last year nearly 6,000 individuals voted for their favourite shortlisted nominee to win an Award. Act now to make sure your choice is among those being voted for. Nominations will be accepted until May 31, before a shortlist of three per category is decided by an internal judging panel. The finalists will be published in OT and readers asked to vote for the winners. The exception to this process is the Lecturer Award, where all nominations which fit the criteria will be voted for by OT readers and the winner decided by a judging panel from the three who poll the most votes. Without your nomination the group, organisation or individual will not receive the recognition they deserve for their contribution to optics. All shortlisted nominees will be invited, along with a guest of their choice, to attend the AOP Awards black tie ceremony dinner where the winners will be announced. The dinner will take place on October 18 during the National Optical Conference (NOC). Visit www.optometry.co.uk/awards to view all 16 AOP Award 2012 categories. All nominations must be received by May 31, 2012. Any nominations received after this date will not be considered.

Category sponsors

Shared Passion for Healthy Vision and Better Life

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To nominate visit www.optometry.co.uk/awards Brand identity standards

Version 4.0 | July 1, 2011

Version 4.0 | July 1, 2011


UPDATE

QiO for practitioners Practitioner checklist How many practitioners are aware that their GOS contractor has a contractual obligation to ensure that they are familiar with local referral pathways? Or that they have an obligation to ensure that their performers keep adequate records? The contract says (clause 30.2), “The Contractor shall… secure the fulfilment of any duty imposed on a tester of sight…” And yet – aren’t those also the obligations of any competent professional? There are many similar instances; if the contractor has a policy on the handling of data (as they should), then they should ensure that anyone acting as a performer in the practice, however briefly, is aware of the content. Equally, a performer should be aware of the requirements of safe handling of data. It’s a mutual requirement; the performer should know these things, but the contractor needs to know that the performer knows, and may need to demonstrate that to the authorities

during a contract compliance visit. QiO now has the answer, with the new Practitioner Checklist. This has taken from the national contract compliance framework the elements with which a GOS practitioner should be familiar. The usual QiO help and links to resources back up every question and the practitioner can tick off their knowledge. Add in the practice’s own policies and the resulting checklist can be printed off and provided to a contractor as a demonstration of the required knowledge. Different checklists can be saved by those who work in a variety of practices. This is also a valuable resource for those new to GOS such as students, pre-registration optometrists and those returning to work. It gathers into one place most of the information needed to work within GOS. To start, create an account at www. qualityinoptometry.co.uk Anyone can do so, it isn’t just for contractors.

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04/05/12 UPDATE

OPTOMETRIST, AOP legal adviser and Quality in Optometry (QiO) working group chair, Trevor Warburton tells OT how QiO is for practitioners as well as contractors. QiO is constantly being updated to keep pace with changing regulation and documentation. Level 1 precisely matches the latest version (8.2) of the Primary Care Commissioning (PCC) contract compliance framework. It seems likely that this will be the framework adopted by the National Commissioning Board from April 2013, so whether your area currently uses the PCC framework or not (most do), it will be doing so next year. QiO can be used to check GOS contract compliance, for clinical governance in enhanced services, to audit records, to demonstrate compliance with infection control and information governance procedures and now, by practitioners to confirm their knowledge of GOS. Scan the above QR code to go straight to the website.


NOC

‘Getting Connected’ with NOC keynote speaker 04/05/12 NOC KEYNOTE SPEAKER

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IN THE last edition of OT, LOCSU explained what delegates could expect from this year’s conference. Over the next few months, OT will feature more about the conference speakers and details from the programme. One of the keynote lectures ‘Get networked, get connected’ will be given by Edna Robinson, managing director of the Clinical Commissioning Community Programme and founder of NHS Networks. OT caught up with Ms Robinson to find out why she thinks ‘Getting connected’ in the new NHS is so important for eye care professionals.

What are your responsibilities in terms of the new NHS reforms? “In my background, having held various chief executive positions in the NHS and from founding NHS Networks 10 years ago, I have believed passionately in a democratic NHS where people can make their voices heard. In terms of the NHS reforms, this means that my work is to connect the voices of GPs to the professional institutions, such as the British Medical Association and the Royal Colleges. One of the main ways I do this is through a ‘soft’ intelligence monthly report sent to David Nicholson, chief executive of the NHS, and Andrew Lansley MP, secretary of state for health, which collates the views of people throughout the NHS – from individual interviews to going to events and listening to the views on the NHS Network. My NOC presentation will look at how eye health professionals can become more connected into the new NHS landscape.”

What do you think the characteristics of an effective or successful network are? “Networks often start with enthusiasm

Booking for the NOC 2012 has now opened Event: National Optical Conference (NOC) Date: October 18 – 19 Venue: Hilton Metropole, Birmingham Visit www.locsu.co.uk to book and view the draft programme Costs are as follows: For an NOC resident delegate, the cost is £540 (including VAT). For an NOC resident spouse/partner, the cost is £140 (including VAT). For a non-resident NOC delegate, the cost is £330 (including VAT). but need – more importantly than money – people and time to make them sustainable and work over the longterm. It is absolutely critical that they are not hierarchical to ensure that people feel satisfied that their views are heard. Always valuable, they bring particular benefits to people working at a time of transition. “

In a nutshell what does ‘Getting connected’ actually mean? “People feeling that their voices are heard. When speaking at the NOC, I will make it clear that I want to hear from the delegates about their thoughts, concerns and experiences. I hope as many of them as possible take the chance to ‘get connected’ and come along.” Katrina Venerus, LOCSU director of

operations and commisioning, told OT: “LOCSU will once again be supporting Local and Regional Optical Committees and each will receive one place free of charge. Costs have been kept the same for a second year running. All costs for resident delegates include accommodation and food for a two night stay starting on the evening of October 17. Also, included in the ticket is an invitation to attend the formal black tie AOP Awards dinner on the Thursday evening. This is an opportunity to celebrate the achievements of the profession over the past year.” To book a place visit www.locsu.co.uk where you can find the confirmed programme as it stands and a link to the e-booking form. Gold sponsor


INDUSTRYNEWS TRADING PLACES

Instrumenting role changes

04/05/12 INDUSTRY NEWS

28 MAINLINE INSTRUMENTS has promoted Adrian Richards (pictured right) to medical sales director. He was previously the medical sales manager. MD Simon Hawkins (pictured left) said: “In Adrian’s five years with Mainline, he has demonstrated a drive and determination to offer excellent service to our customers. “Adrian has been directly involved with establishing the icare tonometer as a reliable and reputable method of measuring IOP in the UK optical community. With new products appearing from icare Finland, which utilise the established rebound technology of the icare tonometer, Adrian is sure to have a busy time ahead of him. I look forward to continuing our working relationship as Adrian continues to grow our business.” KEELER HAS appointed Keith Watson (pictured) as its new sales and marketing director. He was previously sales and marketing director at Halma’s sister company Hanovia, where he implemented major changes to the sales organisation and helped increase sales revenues by 35%. He was also sales director of Arun Technology, a pioneer in miniature optical spectrometers, in the UK before spending 10 years in Hong Kong and China where he was managing director of Spectro Analytical (Asia Pacific) and general manager of Martek Marine. “I am delighted to join a manufacturing company with such a strong global brand and background in healthcare and optics,” he said. “Keeler has performed exceptionally in recent years and I look forward to continuing and improving the growth strategies that have contributed to this success.” After gaining a chemistry degree from Exeter University, Mr Watson spent several years in industrial chemistry before pursuing a career in instrumentation sales.

A first presbyopia J Kfor London

SAUFLON HAS launched clariti 1day multifocal, the world’s first silicone hydrogel, daily disposable contact lens for presbyopia. It follows in the footsteps of clariti 1day toric, the world’s first silicone hydrogel daily disposable lens for astigmatism and the award-winning clariti 1day. Sauflon has positioned clariti 1day multifocal as a product that patients can be easily upgraded into at an affordable price. The company is proud that all its products are exclusively available to eye care JK London’s professionals only to encourage patient loyalty to the practice. summer The clariti 1day range is now available in sphere, toric and 2012 multifocal designs to enable practitioners to offer a silicone hydrogel daily disposable lens ‘to meet every patient’s lifestyle and vision needs’. As with clariti 1day sphere and toric, the new lens utilises Sauflon’s patented manufacturing process, AquaGen. It ensures a highly wettable lens surface, which combined with the low modulus and high water content, maximises biocompatibility with the ocular surface to boost comfort. Clariti 1day multifocal is available in all powers +5.00 to -6.00 (0.25 steps), with low and high adds, correcting a wide range of adds. Diagnostics are available.

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JK LONDON’s summer 2012 collection for the street savvy 16-24 year old has styles named after London locations and features a ‘Lookbook’ brochure for customers (pictured). With patterns all the rage on the London catwalk, the Park Lane model for men taps into the trend with criss-cross digi prints in black and white monochrome, blue and brown. The women’s version has Africainspired animal prints in purple, grey and brown and a retro shape. Brompton Road and Crystal Palace, male and female models respectively, have ultrathin, flat matt metal for a minimalist look. Brompton Road is offered in traditionally masculine black, brown and grey whereas Crystal Palace is offered in purple with pink, red with stone and black with gold. The Streatham model for boys features the ever popular 1970’s aviator shape in black, navy and tortoiseshell. The Dalston model for girls looks back to the 1980’s with an oversized teardrop shape. It is offered in translucent peach, tortoiseshell and black.

Fun of the fair INTERNATIONAL EYEWEAR has a new circus-inspired look for its Eyestuff Kids range. A combination of current cinema trends and book releases are the inspiration. Celebration is a key theme, with the upcoming Jubilee and Olympic events. Through the ground breaking circus style photo shoot, the company has unleashed a new direction for the Eyestuff brand. The refreshed Eyestuff collection incorporates three new models, Eyestuff Tickle, Sketch and Muddle, all featuring TR90 technological advancements, to help keep the company at the forefront of the children’s optical market. Eye-catching styles and vibrant colour fusions are designed to attract children of all ages. For a limited time, practitioners buying any 12 frames from the Eyestuff collection can receive a free promotional package complete with a four-piece display stand, showcard and A1 poster.

0121 585 6565

Display your patriotism

Stepping out with ooh la la

WILLIAM MORRIS London is offering its customers the chance to tap into the national spirit this summer and demonstrate their patriotism and love of all things English. The independent designer frames company has 300 sets of William Morris London window banners on offer as part of its celebrations for The Queen’s 60 years on the throne. The window display banner is a limited edition and interested customers are urged to apply to the company as soon as possible.

THE PARIS COMPANY Face à Face has made a limited edition launch of its sexy Bocca art piece as sunglasses, complete with red shoes on the arms The launch comes after “the fantastic feedback” at the last Silmo show and “numerous requests” since the optical trade exhibition in Paris. The sunglasses are inspired by the surrealist sofa by Salvador Dalí which was shaped after the lips of the sex symbol actress Mae West. The Bocca sunglasses are designed to pay tribute to “glamour and femininity”. There are two styles, in black and red, but only 200 of each available. Each frame is numbered and comes with a certificate.

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For details visit www.faceaface-paris.com

29

04/05/12 INDUSTRY NEWS

Looking to London


STUDENTNEWS

2012 scholarship launched

04/05/12 STUDENT NEWS

30

CONTACT LENS giant CooperVision has announced the launch of its 2012 Summer Research Scholarship. Following the success of the inaugural programme last year, the company is now seeking applications, with UK optometry universities invited to nominate their high-achieving, second year students to participate in the scheme. The student/s representing each university will then conduct a six-week project on a contact lens-based topic of their choice. Successful applicants will attend a National Student Summit at CooperVision’s UK headquarters in September, with the winner being invited to the 2013 BCLA clinical conference and exhibition on a full delegate package. At the summit, candidates will have the opportunity to present the findings of their project, competing for the ‘CooperVision Student of the Year’ title. Bradford University’s Pat Friis (pictured right), joint winner of last year’s Scholarship, told OT: “Every aspect of the project and the event provided invaluable experience for our careers to come and was also great fun. It was a real insight to see the manufacturing and distribution facilities CooperVision has and great to meet everybody involved. I can’t recommend the scholarship highly enough to those in the year below me on the course and will be encouraging anyone with an interest in research in the future to take part.”

BiB donates to Plymouth THE BiB Group has donated a 22-inch anti-glare, positive polarisation LCD chart system to the optometry department at the University of Plymouth. The Pola Vista Vision allows users to create a bespoke acuity and refraction assessment with charts from around the world. Included with the device is a colour touch screen tablet controller which doubles as a near vision acuity solution. Pictured is CEO of the BiB Group, Tim Baker, with University of Plymouth optometry lecturer, Kiki Soteri. Mr Baker believes it is important for the students to use the latest technologies which are available. Ms Soteri commented: “With this donation of the Pola Vista Vision, BiB Ophthalmic Instruments leads the way for stakeholders in the industry who recognise the potential scope of their role in the future progress of the optometry profession. We are grateful to Tim Baker for contributing to the experimental learning opportunity which optometry with Plymouth University offers.”

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Undergrads climb to fundraise OPTOMETRY STUDENTS at Cardiff University have joined forces with visually impaired young people to climb the Welsh Pen y Fan mountain to raise awareness of visual impairment. A team of undergraduates and members of UCAN Productions – an organisation which works with visually impaired children – plan to complete the four-mile walk which will take them 2,907ft above sea level next month. The charity climb aims to raise money to help staff and students in the University’s optometry department provide free sight tests and spectacles to people in Moldova. The School travels to the Eastern European country to perform free eye tests and dispense glasses every July. Dr Tom Margin, a reader in the School who was involved in the walk, commented: “The trip is part of an established project within the School, which has been running 11 years and has already reached out to over 12,500 people who were in desperate need of spectacles. Any spectacles required are given free of charge so this year £3,300 needs to be raised to cover these costs, with the intention of sight testing over 1,500 impoverished people in areas where sight tests would normally be completely unavailable.” Donations can be made, via a cheque, to ‘Returning Vision Moldova 2012’ and sent to Helen Peregrine at the School of Optometry and Vision Sciences, Cardiff University, CF24 4LU.


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EVENTS

See the patient’s view Independents Day (ID12) will include a symposium sharing real patients’ thoughts and experiences of independent practice. Robina Moss reports

04/05/12 EVENTS

32 28

OVER THE past seven years Independents Day has built up a reputation as one of the key events in the optical calendar for those in independent practice. This year’s event, on Monday July 9, at The National Motorcycle Museum in Birmingham, aims to get to the heart of how independents differentiate themselves from the multiples which is seen as ever more essential to thrive in the present economy. Heightened service levels and developing lasting relationships with patients will be the focus. The conference will be looking at all the close encounters which make up the ‘patient journey’ but in a refreshing change from the conventional conference model, will also hear what patients think about the independent sector’s offering. ID12 will be devoted to examining the relationship between patients and practitioners, largely from a patient’s eye view. A symposium will have real patients’ thoughts, and experiences from a combination of focus group research and mystery shopping, commissioned by the conference organiser, Proven Track Record (PTR) and shared via Forum Theatre. It will look at the numerous interactions a patient has with various members of the practice team during the customer journey and how these can be improved. “We have tried to improve on our already successful concept with yet more innovation and, in my opinion, this is the most exciting main programme we’ve ever put together,” said PTR co-director, David Goad. “We promise a stimulating, thoughtprovoking and interactive programme. This, along with some useful CET, is all designed to ensure practices maximise their investment in taking valuable time out of their businesses.”

Speakers PTR has brought together some eminent speakers to support the two interactive patient sessions. Professor Darren Shickle (pictured), from the University of Leeds, is a leader in the

field of ophthalmic public health and, as part of his current eye research, he analyses data on the uptake of NHS-funded eye tests to explore health inequalities. He will discuss the results of his research, conducted through focus groups and prompted by a low-uptake of NHS-funded eye examinations in the Leeds area. He told OT: “Although people are entitled to free eye tests, some choose not to because they don’t trust that their optometrist isn’t going to sell them something they don’t need. In my experience, optometrists are highly trained, the problem is they do not have the chance to use most of their skills.”

“We promise a stimulating, thought-provoking and interactive programme” Supporting speakers include psychologist Dr Fiona Fylan, currently the principal examiner in communication for ABDO. Speaking at her third Independents Day, she will use her past research in optics to present ‘What your patients think about you’. Energetic business consultant and performance coach Carmen Lester (pictured) has delivered customer journey/ mystery shop programmes, via interactive workshops, throughout the UK and Europe. As a serial spectacle and contact lens buyer, she is perfectly placed to pose the question, ‘So you think you’re good… eh?’ Co-director of PTR, Nick Atkins said: “Independents Day will, once again, deliver a stimulating and thoughtprovoking programme but with additional interactivity as delegates respond to the feedback of patients about how their experience of our services can be improved.” In response to delegate feedback, the conference has moved

Continued on page 34


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EVENTS away from being a source of CET points over the past few years to focus on more commercial matters. However, as the 2012 event covers how a practice interacts and communicates with its patients, this year’s main programme will offer CET points. In a change from recent years there is no specific track for optical assistants as the main programme is equally as relevant to them as it is to the professional team. The 40-company strong exhibition is always popular with proactive business owners looking to find new products and services, which can help grow their business, and this year there is even more time allocated to meet with suppliers.

04/05/12 COVER EVENTSSTORY 08/04/11

34

Independents Night The successful networking dinner is on the Sunday evening, July 8. Independents Night is a dinner, bed and breakfast package which offers an opportunity for delegates to arrive on the Sunday prior to the conference and enjoy dinner with like-minded practitioners, plus networking with sponsors and exhibitors. Sponsored by Johnson & Johnson Vision Care, Independents Night guests will be entertained by physiologist professor Greg Whyte, a former double Olympian and modern pentathlete. He is perhaps better known for his training and mentoring

of celebrities such as David Walliams and Eddie Izzard in their swimming and running marathons and, most recently, comedian John Bishop in his ‘Week of Hell’, on behalf of Sports Relief. He will give a perspective into what it means to succeed in any challenge.

New for 2012 Recognising the tough economic climate, PTR has come up with a number of initiatives to help keep the cost of attendance down. Most prices are lower than 2011, with the best prices available for bookings made before May 13. To encourage more practices to bring the team along there’s a new practice team price for a block booking of three delegates. To encourage more owners to bring another two members of the team along, the practice team price starts at £279 (£93 per person) before May 13. All companies exhibiting this year have delegate discount vouchers to give away to their customers. Voucher values start at £10 from tabletop exhibitors and go up to £30 from title sponsors. Delegates can redeem up to £30 worth of vouchers, in any mix of denominations, against each place booked. For more information visit www.independentsday.co.uk where the ‘early-bird’ prices are available until May 13.

DIARY DATES MAY 10 No 7 Contact Lenses, Sidney Little Road, Improve your contact lens confidence (www. no7contactlenses.com)

13 WOPEC, Anglia Ruskin University, Cambridgeshire, Gonioscopy event (mackens@ cardiff.ac.uk)

14 Hospital of St John and St Elizabeth, 60 Grove End Road, London, NW8, All things retinal lecture (www.hje.org.uk)

21 AOP and Myers La Roche, 2 Woodbridge 29 ABDO Golf Society, Moseley Golf Club, Street, London, EC1R, How to increase sales at your practice workshop (www. aop.org.uk)

21 Warwickshire AOP, The Venture Centre, University of Warwick Science Park, Coventry, Myopia control lecture (susan@ susanrbowers.co.uk) 21-22 J&J, The Vision Care Institute,

doctors roadshow (help@maculardisease.org)

Pinewood, Berkshire, Healthy eyes and healthy practices and managing the astigmatic patient combined course (www.thevisioncareinstitute.co.uk)

14 No 7 Contact Lenses, Sidney Little Road, Hastings, Fitting presbyopic contact lenses SEE ABOVE

23 Kent & Medway LOC, Russell Hotel, Boxley Road, Maidstone, Kent, AGM and lecture (davidflacey@aol.com)

15 Macular Disease Society, Belfast, Top doctors roadshow SEE ABOVE

NEW… 24 Leeds LOC, The Village Hall, Headingley, CET event and AGM (barrettann@hotmail.co.uk)

14 Macular Disease Society, Edinburgh, Top

16 NIOS, Templeton Hotel, Templepatrick, Co Antrim, Contact lens day (lizgillespie.nios@ btopenworld.com) NEW… 17 Careers in Optics, Cardiff, Ambassador training event (ambassadors@ newdimensionsinoptics.org)

Birmingham, Challenge cup (m.stokes67@ ntlworld.com)

29 Bexley, Bromley & Greenwich LOC, Charlton Athletic FC, The Valley, London, SE7, AGM and lecture on laser refractive surgery (davidflacey@aol.com)

14 Macular Disease Society, Newcastle, Top doctors roadshow SEE ABOVE 17-19 Sportvision, Thistle St Albans, Hertfordshire, Sportvision diploma course (www.schoolvision.org.uk)

18-19 J&J, The Vision Care Institute, Pinewood,

Returning to work confident SEE ABOVE JUNE 10-12 Schoolvision, Harpenden House Hotel, 19 Carl Zeiss Education, Manchester, OCT course (http://tiny.cc/zeducation) Harpenden, Schoolvision diploma course (www.schoolvision.org.uk) 19 Macular Disease Society, Inverness, Top doctors roadshow SEE ABOVE 11 Hospital of St John and St Elizabeth, 60 Grove End Road, London, NW8, Paediatric NEW… 19 Bradford School of Optometry and optometry lecture SEE ABOVE Vision Science, West Yorkshire, OSCE refresher course (c.l.viner@bradford.ac.uk) 12 North London AOP, Clinical Tutorial Complex, Moorfields Eye Hospital, City Road, 20 Carl Zeiss Education, Manchester, Visual London, EC1V, Glaucoma lecture (www. fields course SEE ABOVE nlao.org.uk)

24 Macular Disease Society, Manchester, Top doctors roadshow SEE ABOVE

12 Hampshire LOC, Chilworth Manor, Southampton, AGM and CET event (www. hampshireloc.org.uk)

25 University of Warwick, Coventry, Postgraduate certificate course begins (www.warwick.ac.uk)

24-27 BCLA, ICC, Birmingham, Annual

12 Vision UK 2012, Queen Elizabeth II

27-28 J&J, The Vision Care Institute, Pinewood,

clinical conference and exhibition (www. bcla.org.uk)

Conference Centre, Broad Sanctuary, London SW1P (www.vision2020uk.org.uk)

Berkshire, Healthy practices and managing the astigmatic patient combined course SEE ABOVE


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PROFILE

Being on Board AOP director Vivian Bush talks about the evolution of the AOP and his responsibilities on the board

04/05/12 VIVIAN BUSH

36

WHEN OT speaks to Vivian Bush (pictured) he has just emerged from an AOP finance sub committee meeting. It has covered every detail of the accounts, down to discussing the impact of a rise in postage costs and how this could affect the Association. “The AOP,” he explains,“is a growing business with a big balance sheet, but every component of expenditure matters. A rise of £10,000 per year in postage costs may not seem a lot, but £10,000 is 20 full subscriptions and we can’t afford to take that for granted.” “We [the AOP] may formally be titled ‘not for profit’, but being business-like is a fundamental requirement. Okay, we don’t have shareholders in the formal sense, but our membership has the ultimate say in how we are run and what they want to see happening. These are tough times and they rightly expect us to be careful in how we spend their subscriptions,” the Yorkshireman adds. Mr Bush has been an AOP director for eight years and an AOP councillor since 1988. He is also chairman of OT’s management committee, which scrutinises all aspects of the journal’s production. “Someone’s got to be able to go to the board and report what’s happening, sometimes what isn’t happening, and what the tentative plans are in each area of the Association,” he says. Talking about his involvement in OT, Mr Bush explains: “The journal is slightly different from some of the other board roles. It is an easily identifiable cost centre with its own balance sheet. What we have to do with OT is continue producing a high quality journal which must evolve, like the organisation, and be revenue positive. At the same time we must maintain the integrity of the journal and its credibility.” In 2010 the AOP took the leap into property ownership through the purchase of its Farringdon headquarters, moving in August last year. The optometrist reveals that, as a City University graduate, he is now back in familiar territory, having studied and lived just a few hundred yards away from the new premises. “We looked at a lot of freeholds over a long period of time and moving to this area was, without doubt, a wise decision.” His view is confirmed by a recent article in The Telegraph labelling EC1 as an up-and-coming area for creative media, technology and fashion companies. The AOP has owned its own footprint in London in the past – with offices in Blackfriars Road until 1997 – before taking the decision to rent in Elephant and Castle, and later Southwark Street. There are many benefits that come with ownership, the business-minded independent explains: “We’ll see some capital

appreciation through this purchase and there’s scope for generating some extra income from maximising efficient use of the building.” With members at the heart of the Association’s actions, Mr Bush is certain that they will reap the benefits from the purchase of the building, and the eventual savings which will be seen through no longer paying rent. “It’s our intention to plough savings back for the benefit of members. For example, the Association wants to avoid continual rises in subscription rates. We can’t guarantee immediate reductions, but it is our intention to be able to use our asset base to create savings for the membership.”

An independent life Having completed his pre-reg with R Woodfall Opticians in South London, Mr Bush, a fifth generation optometrist, returned to his family practices after qualifying, joining his father and grandfather. For six years the three generations all worked together, which he describes as ‘quite an experience’. He now owns two independent practices in Hull and East Yorkshire and still practises pretty much full-time. Once back in the North, Mr Bush began attending LOC meetings and has been chairman of the East Yorkshire LOC for 10 years. It was this early involvement in the LOC that led him to meet AOP chairman George Wheatcroft, who taught Mr Bush about the work of the AOP and “to some extent promoted my involvement with the Association”. Entering his 25th year on Council after recently being reelected, Mr Bush reflects on how the Association has evolved over the years. “My perspective has changed a great deal. It used to be about fighting for issues such as the inadequate sight test fee, which I used to be more angry rather than realistic about. “These days my principal concerns are twofold; there’s the changing demographics of the profession and then our profile as the guardians of the nation’s eyesight. For all that the public values their vision, optometry is insufficiently recognised. There’s a huge amount of work to be done to make us synonymous with sight.” Confirming that the AOP is actively discussing how it can evolve its work, he adds: “The AOP must continue to evolve and it doesn’t require any major direction changes, as what we do is essentially very good. It’s about a process of evolution and recognising, for example, that the largest identifiable groups are no longer a bunch of independents but probably a collective of staff working for Boots, Specsavers, Vision Express and Optical Express. What can we do for them and what do they need of us?”


2012

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Key note speakers BCLA Medallist – Professor Alan Tomlinson (UK) Irving Fatt Memorial Lecturer – Dr Martin Cardell (UK) Professor Mark Andre (USA) Professor Patrick Caroline (USA) Professor Richard Collin (UK) Dr Stuart Richer (USA) For more information on the speakers and programme visit www.bcla.org.uk

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REVIEW Ophthalmic Dictionary and Vocabulary Builder for Eye Care Professionals, 4th by Harold A Stein, Raymond M Stein, Melvin I Freeman and John S Massare

04/05/12 BOOK REVIEW

38

NEWLY QUALIFIED optometrist Amar-Kaash Gandecha provides a review for OT on the fourth edition. The first thing that strikes you about this book is that it does not follow this traditional A-Z format. Instead, it is logically arranged into different sections, each covering an important aspect of ophthalmology. The first section covers ‘basic science’, which is further sub-divided into topics such as anatomy, physiology and genetics. Interestingly, rather than jumping in and just giving a list of words with one-line definitions, the authors have chosen to give a small introduction to each sub-section, cleverly linking ophthalmological terms together in order to introduce the more commonly used words in the section. For example, part of the introduction to the ocular tumours section, says ‘Xanthelasma (Greek xanthas, “yellow,” and elasmos, “a metal plate”), are yellowish fatty deposits that arise from blood vessels and may be associated with high cholesterol levels. A papilloma is a benign epithelial outgrowth over a fibrovascular cone. It may be pedunculated (hanging with a stalk) or sessile (broad-based). Hemangiomas (Greek haima, “blood”, and angioma, “tumor of vessel”) are growths of blood vessels and may be benign or malignant.’ Colour pictures of these particular conditions are also given, amongst many others throughout the book. These small introductions justify the use of ‘vocabulary builder’ in the title of the book, because it allows it to be a text which can be read as opposed to being a simple “lookup” reference tool like most dictionaries; it therefore cements ideas and produces a real sense of understanding. As the authors state: ‘your attitude towards words will change – you will be curious about them.’ My only criticism of these introductions would be the constant reference to the origin of words (Latin/Greek etc.), which, in my opinion, is irrelevant information for the majority of practitioners. Other sections of the book include ‘refraction, spectacles and contact lenses’, ‘disorders of the eye’, ‘surgery of the eye’ and ‘ophthalmic tests, devices and imaging’. As you can tell from these titles, the book isn’t specifically aimed at one group of people (eg, optometrists), but rather everyone who is within the ophthalmic profession. This can be seen in both a good and bad way, in that it includes almost any word that an optometrist would want to know about, but sometimes also includes terms that would probably never be used in optometric practice. New to the fourth edition was a chapter on refractive surgery, which I found particularly interesting, as this is a field I am currently training in. If you are only looking for a handy reference guide to use when you hear a term that you are unfamiliar with, this could still be the book for you, as the first section is divided into a cross reference in an alphabetical dictionary format, which gives the page number of the definition you are looking for. This will then direct you to the

definition of the word, which will be alphabetically grouped with words that are of a similar topic, hence encouraging further reading and understanding of a topic. The definitions are concise and to the point, for example, Ring scotoma, in the Spectacles section, is defined as ‘A ring of blind area in a high-plus lens created by the prismatic effect from the thick centre to the thin edge.’ As a newly qualified optometrist, I personally feel I would have found this book very useful during both my time at university and my preregistration period, as it would have been a concise way of taking in certain topics and definitions, rather than trawling through a number of resources to obtain the same information. I think it is also a very useful vocabulary builder for those who have recently entered the profession and a handy book of reference for those who have more experience within the field. RRP £33 OT Foyles online bookshop price £29.70 (10% off). Visit www.optometry.co.uk/bookshop and click on the Foyles link.

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C-18628 O/D Publication date March 23 2012 Closing date May 22 2012 Over 300,000 cataract operations are performed in the UK each year. Lasers play a major part in eye care, but until now cataract surgery has always been performed using traditional surgical instruments, relying on the skill of the surgeon. Laser Cataract Surgery offers safer, quicker and improved outcomes by eliminating the potential for human error in performing delicate parts of the procedure that may lead to complications and loss of optimum visual function. This video details how the femtosecond laser can be used for accurate capsulorhexis, lens fragmentation and corneal incision and compares this to conventional methods. Sponsored by

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LETTERS

AMD supplement concern studies such as these can be used to Dear editor, CET promote any imaginable treatment I WRITE to express my concern 1 FREE CET POINT strategy as being ‘effective’ and are with your CET article entitled symptomatic of the ‘it worked for me’ ‘Dietary macular carotenoid Dietary macular carotenoid school of thought supplements and drusen supplements and drusen Such thinking has the damaging resolution’ published in the resolution Figure 1 The different types of free-radicals generated from 48 COURSE CODE C-17541 O effect of encouraging practitioners oxygen November 9, 2011 issue of OT, to assume that a correlation is course code C-17541. the same thing as a causation. The article concludes by None of this would matter if the strongly encouraging clinicians supplements were free at the point to recommend dietary of use and proven to have no other supplements to their AMD side effects. Sadly this is not the patients. However, evidence case. Granted, there does appear that the considerable cost of to be converging evidence that these supplements is justified, What happens at the macula in the ingestion of certain substances is flimsy at best. In their AMD? can affect AMD progression but article, the authors cite the it is far from clear that expensive AREDs Study as evidence for Macular pigment supplements are superior to simply supplements slowing the rate increasing the intake of leafy green of AMD progression. However, vegetables, omega-3 fatty acids ect. the findings of this study have Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates Given that such dietary changes been repeatedly criticised for have an established beneficial effect failing to report a negative result on a variety of other conditions (in one subgroup of patients The authors also cite evidence from two such as cardiovascular disease, shouldn’t we dietary supplementation had no effect case studies which appear to show some be advising our patients along these lines, whatsoever) whilst reporting positive drusen resolution following a programme rather than promoting the purchasing of effects in a different subgroup [1, 2, 3]. of dietary supplements, but where is the supplements? Granted, the results of AREDS 2 may evidence that the supplements themselves provide practitioners with more robust caused any change in the patient’s visual Dr James Heron, Bradford School of Optometry and information in this area, but why preface function or fundus appearance? Case Vision Science its findings before they are published? CONTINUING EDUCATION & TRAINING

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15

Shamina Asif, BSc (Hons), MCOptom, Dr John Nolan, BSc (Hons), PhD

If you have a patient whose visual acuity (VA) is decreasing year by year due

04/05/12 LETTERS

09/12/11 CET

40

lipid-containing residues of lysosomal digestion). Of note, the accumulation of

to age-related macular degeneration (AMD) and the hospital eye service

lipofuscin within the RPE cells increases

(HES) has told them that ‘nothing can be done’, what advice would you give

as a result of incomplete digestion of

to the patient? In addition to discussing lifestyle changes such as smoking

oxidatively

cessation, ultraviolet (UV) protection and accessing low vision services, if appropriate, how many practitioners actively recommend the use of dietary

supplements? Hopefully, by the end of this article, many more will understand the potential that nutritional supplements offer for this eye condition.

AMD is now the leading cause of

experiences with health professionals

blindness

world1

at the time of diagnosis because “they

and its prevalence is likely to rise

were not treated as a person”, making it

as a consequence of increasing life

more difficult to adapt to the condition.

in

the

western

expectancy.2 Indeed, in 1933 just 6% of

The

the registered population in England and

people were given more information

authors

believe

that

if

these

Wales had ‘senile macular degeneration’

about the disease and the potential

compared to nearly 50% in 1990.3 In the

prevention/treatment options for AMD,

UK, approximately 30,000 people are

they would be more likely to adjust to

registered blind or partially sighted every

their situation, and it would enable

year, half of whom will have AMD. With

them to deal with the condition and

respect to the visually consequential

ultimately have a better quality of life.

stage of the disease, it has been estimated

function

is

In

turn,

irradiated with light of an appropriate

wavelength, emits an electron, thereby generating

reactive

oxygen

species

(ROS). This provokes further oxidative injury.

Of

interest,

ROS

production

(and, therefore, oxidative injury) peaks

at the macula, where AMD manifests.4 Unfortunately there is no treatment

that can restore vision in the dry, nonexudative form of AMD. For this reason

there is a lot of interest in trying to prevent the disease from developing

in the first place. Risk factors such as age, gender, family history (we now know the genes responsible for AMD), colour

and

examples

of

refractive

error

non-modifiable

are

risk

factors for AMD.6 However, there are

degraded,

The appearance of yellow-white lesions

the ability to read, drive a car, and

called drusen is usually the first clinical

even recognise familiar faces can be

manifestation

lost. Many studies have shown that

comprises a photoreceptor and axon-

the quality of life of these patients is

containing neurosensory layer with an

significantly diminished, and patients

underlying single-layer retinal pigment

lose their social independence.4 Indeed,

epithelium (RPE). The function of the RPE

it was reported that over 60% of people

is to nurture and remove waste products

who were told ‘nothing can be done

from the neurosensory retina. AMD is

Macular pigment is yellow in colour and

about your macular disease’ suffered

characterised by loss of photoreceptors

is housed in the fovea, where we have

from anxiety and/or depression, and

and by RPE cell dysfunction, the latter

sharpest VA and colour appreciation

54 out of 1,421 people reported feeling

being largely attributable to an age-related

(it is found in the inner retinal layers

suicidal.5 The same study found that

accumulation

(yellow-

and the fibres of Henley).7,8 It is made

most patients reported unsatisfactory

brown pigment granules representing

up of three carotenoids (from a total of

OT ASKED the author of the article to comment on Mr Heron’s letter. He said: “In response to the statement ‘that considerable cost of these supplements is justified is flimsy at best‘ “that is inaccurate.’ In regards to the scientific evidence, we agree that case studies are a weak source of evidence, but that does not mean that their findings should be ignored. Over two decades of research has been conducted which questions and challenges the important hypothesis about the role of antioxidants for AMD and vision. The clear message is that, although appropriately weighted attention should be accorded to higher levels of evidence, the totality of available data should be appraised in an attempt to inform professional practice.

macular

photoreceptor

membranes.

chromophore, a compound which, when

all

suffer from visual problems due to AMD.

damaged

segment

this yellow pigment then acts as a

iris

that 6-8% of people aged over 75 years If

outer

of

of

AMD.

The

lipofuscin

retina

many modifiable risk factors that can

be controlled, which forms the basis of preventative can

take.

measures

an

individual

Importantly,

smoking

cessation and diet are two important modifiable

risk

factors

for

In this context, the literature demonstrates that supplementation with the macular carotenoids is probably the best means of fortifying the anti-oxidant defences of the macula, thus putatively reducing the risk of AMD and/or its progression. We accept that there is not concrete evidence; however, many important treatments and preventions also lack conclusive evidence, but the totality of the evidence is in favour of treatment/ prevention. The facts are that, while a healthy diet is a must and should be recommended to all patients, some individuals cannot achieve enrichment of the macular antioxidants by diet alone. Therefore, in some cases, there is a clear role for supplements. The obvious cases are patients with AMD

AMD.

or at high risk of developing this disease. It is important, therefore, that healthcare professionals inform their patients of all available evidence, giving them (the patient) the opportunity to decide whether supplements are feasible or not. Indeed, European directive supports the role of supplements for AMD (see publication in Nutrition by Biesalska et al. 26th Hohenheim Consensus Conference, September 11, 2010 Scientific substantiation of health claims: evidence-based nutrition Nutrition 2011 Oct;27(10 Suppl):S1-20. Epub 2011 Jun 23.). Just quoting the AREDS study is not sufficient any more (this intervention did not contain the macular carotenoids) as much more focused trials have been conducted and published highlighting the importance

Have your say, email louisewalpole@aop.org.uk


Dr John M Nolan, Fulbright Scholar

OT’S CLINICAL editor, Navneet Gupta also commented: “My own view is that supplements are of value to older patients at risk of AMD. I agree that there is, as yet,

no concrete evidence to support the link between supplements and AMD, but taking supplements (even as multi-vitamins if not ones containing specific ocular pigments) are of benefit to general health. Indeed, many patients in general will not, and do not, have a diet which is sufficient to meet the daily recommended nutrient intake, whether this is due to dislike of such food or otherwise. As such, I do feel that a supplement of some sort is a very feasible option for such patients. Optometrists have a wider public health role to play in helping patients to maintain healthy eyes, and there is a general wide understanding that this is largely achievable through maintaining a healthy diet. As such, if supplements are able to aid this process, why not recommend them? Not doing so on the grounds of cost is not an adequate reason I feel, and patients should not be “kept in the dark� about these options on these grounds. Whether

the cost is acceptable or not is for the patient to decide, not the optometrist. As with all “commercial� optometric recommendations, the optometrist should make suitable recommendations and provide information for each individual patient, and then let the patient decide. I agree that advice to patients must be communicated effectively. The authors have clearly stated that the effect is only a possibility and contributes to the evidence, and that further research evidence is required. How this translates to optometric advice to a patient is not addressed in the article, as that was not the aim, but the article does indicate that optometrists need to consider the evidence and make appropriate informed recommendations to patients regarding supplements and other lifestyle changes.� Navneet Gupta, OT clinical editor

Your chance to have your say OT really wants to hear your point of view. Whether you agree, disagree or have a personal experience related to anything we have published in the magazine or relating to optics, OT wants to hear from you. You can opt to remain

anonymous if you would prefer, just let us know. Contacting us is easy, either send an email to louisewalpole@aop.org.uk or by post to AOP, OT Letters, 2 Woodbridge Street, London, EC1R 0DG.

The editor reserves the right to edit letters and points out that the views expressed may not be those of the journal

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Write to: OT Letters, Optometry Today, AOP, 2 Woodbridge Street, London, EC1R 0DG

41

04/05/12 LETTERS

and potential of the macular carotenoids for protecting and improving vision. As for the cost-effectiveness of antioxidants, in addition to the above discussed body of evidence, it is now well accepted that there is a cost benefit of supplements for AMD. A publication by Rein DB et al found that “compared with no therapy, vitamin therapy yielded a costeffectiveness ratio of $21,387 per QALY (quality-adjusted life year) gained and lowered the percentage of patients with AMD who ever developed visual impairment in the better-seeing eye from 7.0% to 5.6% (Rein DB, et al. Ophthalmology. 2007 Jul;114(7):1319-26).�


VRICS

VISUAL RECOGNITION AND IDENTIFICATION OF CLINICAL SIGNS

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Readers are encouraged to discuss the cases in this FREE VRICS with their colleagues, conduct simple Internet searches, and use the references provided to complete the Multiple Choice Questions (MCQs). Please note that there is only one correct answer for each MCQ. Complete the VRICS test online at www.optometry.co.uk/cet/exams

ADVANCED CLINICAL TECHNIQUES PART 2: GONIOSCOPY AND TONOMETRY COURSE CODE C-18783 O/D Mr Thomas Ressiniotis, MB BS, MRCOphth, FRCSEd(Ophth), MD Mr Maged Nessim, MB ChB, PgDip Med Ethics & Law, FRCSEd(Ophth)

04/05/12 VRICS

42

Thomas Ressiniotis is a consultant ophthalmologist with a special interest in glaucoma and cataract surgery. He was awarded a Medical Doctorate for his work on glaucoma genetics by the University of Newcastle upon Tyne and he completed a glaucoma fellowship in Moorfields Eye Hospital. Maged Nessim is a consultant ophthalmologist with specialist interest in glaucoma and small incision cataract surgery. He completed two glaucoma fellowships at Moorfields Eye hospital, and Birmingham and Midland Eye Centre. He teaches ophthalmology to medical students at the University of Birmingham.

A

B

1.Which of the following structures is NOT visible in Image A? a) Schwalbe’s line b) Trabecular meshwork c) Scleral spur d) Ciliary processes

2. Which of the following events is LEAST likely to result in the observation of pigmentation of the structures shown in Image A?

4. Which of the following MOST accurately describes the finding in Image B? a) Neovascularisation of the anterior angle b) Van Herrick’s grade 0: closed angle c) Anterior angle recession d) Schaffer’s angle 45 degrees

5. When performing the technique shown in Image B, which of the following statements is FALSE?

a) Pigment dispersion syndrome b) Following peripheral laser iridotomy c) Neovascular glaucoma d) Ocular injury

a) Use a slit lamp magnification of 40x b) Use an optic section illumination beam c) Place the illumination beam 60° from the observation system d) Place the illumination beam just inside the limbus

3. Which of the following tests is the LEAST appropriate alternative technique to that shown in Image A?

6. Which of the following eye drops should NOT be instilled if the finding shown in Image B is observed?

a) Ultrasound biomicroscopy b) Anterior segment OCT c) Van Herrick’s slit lamp technique d) Heidelberg Retinal Tomography

a) Tropicamide b) Beta-blockers c) Pilocarpine d) Carbonic anhydrase inhibitors

a) Tropicamide

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Sponsored by CONFUSED ABOUT CET REQUIREMENTS? www.cetoptics.com/cetusers/faqs/ IMPORTANT INFORMATION: Under the new Vantage rules, all OT CET points awarded will be uploaded to its website by us. All participants must confirm these results on www.cetoptics.com so that they can move their points from the “Pending Points record” into their “Final CET points record”. Full instructions on how to do this are available on their website. The closing date for this examination is June 29 2012. CET points for this exam will be uploaded to Vantage on July 9 2012.

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References to aid completion of the exam: Q1, Q2, Q3: http://www.pacificu.edu/optometry/ce/courses/21171/gonioscopypg1.cfm#intro Q4, Q5, Q6: http://www.academy.org.uk/tutorials/gonio.htm

Q7, Q8, Q9: http://www.agingeye.net/mainnews/glaucomapachymetry.php Q10, Q11, Q12: http://eyewiki.aao.org/IOP_and_Tonometry

LARGER SCALE IMAGES ARE AVAILABLE ON THE OT WEBSITE (Simply click on the image when completing the exam online) 43

a) Central corneal rigidity b) Central corneal curvature c) Central corneal thickness d) Intraocular pressure

C

04/05/12 VRICS

b) Beta-blockers 7. Which of the following can be measured using the instrument shown in Image C?

D

10. Which of the following is the CORRECT interpretation of the test shown in Image D?

8. Which of the following values obtained using the instrument shown in Image C would represent an approximate average for the general population? a) 500µm b) 550µm c) 600nm d) 7.80mm

9. Which of the following statements about the measurement obtained using the technique shown in Image C is FALSE? a) This provides an important predictor of the development of glaucoma b) This is a contact technique and there are no non-contact techniques available c) The measurement is an important consideration for corneal laser refractive surgery d) Research studies suggest that values obtained are typically higher in Caucasians

a) The current alignment is correct for the correct reading to be taken b) The current alignment under-estimates the correct reading c) The current alignment over-estimates the correct reading d) The current position is off-centre so the correct reading cannot be taken

11. Which of the following is NOT a potential source of error during the procedure shown in Image D? a) Presence of high corneal astigmatism b) Valsalva manoeuvre c) Anterior chamber depth d) Finger pressure on the eye

12. Which of the following factors does NOT influence the measurement obtained using the technique shown in Image D? a) Amount of fluorescein instilled into the eye b) Central corneal thickness c) Patient positioning (upright or supine) d) Non-linear readings on calibration checks

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Dispensing Opticians

Health promotion: from knowledge to action

healthy. A key distinguishing feature of interventions within this tier of the pyramid is that someone would have to expend considerable effort not to benefit from them. An example is fluoridation

OPHTHALMIC PUBLIC HEALTH PART 5 C-18848 O/D 44

of drinking water,3 while others include the provision of clean water and air,

Dr Ruth Hogg, BSc, PhD, MCOptom

improvements in vehicle design and

Throughout this series of articles, the authors have highlighted the

road layout and the design of towns

crucial role which optometrists can play in ophthalmic public health,

and cities which promotes physical

such as increasing awareness of risks of

activity by encouraging the use of public

sight loss, the diagnosis of

transport, walking and cycling rather

serious systemic illnesses during routine sight tests, and educating

than driving. In the UK, a more recent

04/05/12 CET

patients on the links between lifestyle choices and eye health. This

example would be the introduction of

final article in the series will deal with the practicalities of putting this

smoking restrictions in public buildings

information into use within the context of health promotion theory.

and commercial premises. From an

Health promotion

(see OT, January 13, 2012), health is

Health promotion has been described

multi-factorial

as “the process of enabling people to

approaches can be used to promote it

increase control over, and to improve,

and various theoretical models have

their health”1 and is a key component

been used to depict the impact of

of public health. It is concerned with

different types of interventions. A recent

the strong links which exist between

model from the Centre

a person, their environment and their

Control and

health. It concentrates on the population

has five tiers3 (Figure 2) and illustrates

as a whole rather than just those at high

the contrast between working at a

risk of a particular disease and aims to

large scale in the case of a population

enable people to take control over, and

level

responsibility for, their health. The

those that are targeted at individuals.

main concepts of public health were

At

set out formally in 1986 in the Ottawa

the

Charter.2 It contained five key areas for

those

action: 1. building healthy public policy

aimed

at

2. creating supportive environments

the

socioeconomic

3.

strengthening

determinants of disease.

4.

developing

community

intervention, the

base

pyramid

of

of

be the provision of free

community participation in the success

eye tests to those on

of interventions. These five components

financial benefits who

can be reduced to three areas of action

may otherwise not have

to make it easier to see how they

their eyes tested due

could be put into practice: 1. Health

to economic hardship.

Education

Improvement

The next tier involves

3. Advocacy for policy change. This

changing the context

HESIAD

be

for health in order to

applied to different situations (Figure 1).

make an individual’s

As discussed in a previous article

default

framework

can

easily

screening of vision by school nurses would be examples of modulating the context to make default decisions healthy. The

third

interventions

tier

represents

which

involve

those either

once-only or infrequent application, and do not require on-going clinical care. This is a transition point within the model as we move from reaching people collectively to reaching them as individuals and therefore tends to have less impact. Examples include

Health Promotion

addressing

also

Service

to

of free eye tests for children and the

are

interventions

care, an example would

2.

Disease

compared

5. re-orientating health services. It importance

for

different

Prevention in the USA

In the context of vision

the

skills,

many

and

reaffirmed

personal

action

and

optometric point of view the provision

choices

Health Education

Service Improvement

Advocacy

Glaucoma focused Health Promotion

Material directed towards individuals, families and communities. Information such as who is at risk of Glaucoma, the importance of regular eye tests, family history information, symptoms and information about the condition and its treatment.

Improvement to quality and quantity of services. Making eye tests more convenient and accessible. Providing free eye tests for those at high risk.

Sight related charities and professional organisations ensuring ophthalmic public health is kept on the policy agenda. Removal of barriers or inequalities in accessing health care

Figure 1 The HESIAD framework for health promotion applied to glaucoma sight loss prevention. Adapted from Practical Health Promotion by Hubley and Copeman (2008 Wiley and Sons)

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situations or predict how change takes

immunisation and smoking cessation represented by the forth tier and include on-going programmes which aim to prevent chronic disease such as diabetes and cardiovascular disease. Although it is known that these have the impact to reduce disability and mortality, they can be limited in their impact due to inaccessibility,

poor

adherence

adherence is particularly problematic in those conditions that are asymptomatic. Glaucoma treatment would fall into this category as sight loss is minimised through monitoring

and

medication,

whilst non-adherence to the use of eye drops as instructed is well recognised, as patients don’t immediately experience the consequences of not using them. The fifth tier represents counselling and

educational

interventions

and

contains the notions most frequently associated with the concept of health promotion,

yet

these

are

Counselling & Education

Increasing personal motivation needed

Clinical Intervention Long-lasting protective intervention

generally

accepted as the least effective type of intervention.4 Within the USA, obesity levels continue to rise despite over two thirds of those categorised as being obese being counselled regarding their weight and diet by a health care provider.3

place in individuals, communities, organisations and societies. Without a theory, an expensive intervention may address the wrong issue or only impact a proportion of the variables needed to alter for a change to occur.

Changing the context Socio economic factors

and

failure to attend appointments. Non-

careful

Increasing population impact

Health promotion theories Health promotion theories fall into two

Figure 2 The Health Impact Pyramid adapted from Frieden3

categories, namely explanatory theory

the base of the pyramid where political

spread through communities, while

will and policy change is required,

the main aim of explanatory theory is

whereas individual optometrists will

to describe why a problem exists eg,

be engaged towards the top of the

why obesity is increasing or why those

triangle improving patient education

from deprived backgrounds are less

regarding reducing the risk of sight loss.

likely to have their eyes tested despite

and change theory. Change theory focuses on how ideas and behaviours

the NHS voucher system covering the

Putting health promotion into practice

costs. It attempts to draw together all of the important factors such as personal,

While this current series of articles has

environmental,

covered many of the key public health

economic and behavioural elements of

messages which optometrists may wish

the problem. Examples of explanatory

to pass on to patients (Figure 3) it may take

theories

are

cultural,

social,

described

below.

time and thought as to how to incorporate these messages into your conversation

The stages of change model

and daily practise. Most tend to approach

This

this issue from a pragmatic perspective

represent ordered categories along a

comprises

five

stages

which

and design strategies and actions based

continuum of motivation to change

approaches

on either methods that they have seen

a particular problem behaviour. It is

are often the only option and when

used elsewhere, or from what they

sometimes referred to as the trans-

applied

repeatedly

personally think should work. A health

theoretical model.7 Smoking cessation

may have significant impact. In 2011

promotion professional, however, would

provides a straightforward example,

the Department of Health in the UK

design their intervention based on an

which is relevant for patients who wish

launched an initiative called “Making

appropriate health promotion theory

to reduce the risk of developing age-

every contact count” to enable staff in all

or model. While this may appear time

related macular degeneration (AMD).

parts of the health service to encourage

consuming and dull compared to moving

1. Pre-contemplation (not ready) –

a healthy lifestyle and address issues

straight to action, it is known that theory

at this stage, the patient has no plans

such as weight and smoking, no matter

is important to ensure the efficient and

to stop smoking in the near future.

what the context of the appointment

effective planning of health promotion

They may, or may not, feel they have

Nevertheless

educational

consistently

and

was. The website includes a worthwhile

interventions and to provide a form of

a problem and often in this stage

e-learning course.5 As optometrists, it is

evidence to monitor the success of a

they underestimate the advantages

obvious that there are different points of

programme; indeed, it has been shown

and overestimate the disadvantages

entry within the hierarchy for action. The

that processes based on theory are more

of

professional bodies and vision-related

likely to succeed. In the context of public

2. Contemplation (getting ready) –

charities may be the most active towards

health, theories are used to either explain

the patient recognises their behaviour

5

45

6

changing

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their

behaviour

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programmes. Clinical interventions are


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UÊ*iÀViˆÛi`ÊÃÕÃVi«ÌˆLˆˆÌÞ°ÊœÀÊ>Ê«iÀÜ˜Ê to attend a screening test or examination for an asymptomatic disease they must believe their health is in jeopardy eg, in diabetic retinopathy (DR) screening UÊ*iÀViˆÛi`Ê ÃiÀˆœÕØiÃÃ°Ê /…iÊ `ˆÃi>ÃiÊ must be believed to be sufficiently

46

serious in order to warrant the costs involved in adopting the behaviour to be justified eg, sight loss and the implications of this for occupational reasons (eg, if the patient drives for a living), in complicated, proliferative

04/05/12 CET

DR that requires treatment with laser UÊ*iÀViˆÛi`ÊLi˜iwÌÃÊ>˜`Ê`ˆÃ>`Û>˜Ì>}iÃ°Ê The benefits which stem from adopting the costs

behaviour and

must

outweigh

inconvenience

the

involved

eg, prevention of sight loss versus

Figure 3 Key ophthalmic public health messages across the lifespan

the

inconvenience

screening

is problematic and may plan to stop

the concept of “relapse” which is

smoking within six months. They weigh

not a stage but a return from action

up the pros and the cons and may see

or maintenance to an earlier stage.

the benefits of adopting a healthier

In applying this model to advising

lifestyle. However, apathy can prevent

patients to stop smoking, it is clear that

them from moving forward to taking

a “one size fits all” approach may not be

action and procrastination takes over

effective, eg, if your patient was at the

and

of

attending

bearing

pupil

dilation for a few hours afterwards Uʈ˜>ÞÊ

̅iÊ

“cue

action”

to

undertake

the

«iÀÜ˜Ê to

ÀiViˆÛiÃÊ make

behaviour

eg,

them an

invitation letter is received, or they read

an

article

in

a

newspaper.

3. Preparation (ready) – the patient may

pre-contemplation stage there would

The theory of planned behaviour

plan to stop smoking in the next 30 days

be no point referring them to a smoking

This is a variant of the health belief model

and may have taken small steps towards

cessation

they

developed by Ajzen and Fishbein9 and

the goal such as telling their friends and

would need more information regarding

focuses on people’s intentions to change.

family of their intentions. This stage

the health and ocular consequences of

It is based on a belief that behaviour can

is also characterised by fear of failure

continuing to smoke to encourage them

be predicted by intentions, which are

stops

to move to the next stage. Conversely,

based on attitudes. It goes deeper into

hard

outlining the dangers of smoking to

a person’s motivations than the health

and

someone who is in the preparation stage

belief model. Important factors include:

commitments

would be less effective than providing

beliefs regarding the consequences of

the

encouragement

peer

behaviour change, the importance of

support to reduce their fear of failure.

the goal, the opinions of “significant

4.

Action

smoking to

keep

and

the

patient

needs

to

moving

strengthen 5.

their

Maintenance

succeeds

in

work

forward –

smoking

patient cessation

service

and

and

instead

possibly

others” in their lives and their level of

and works hard to prevent relapse. If

the patient

maintenance

can

stage

stay in the

long

enough,

The health belief model

motivation to conform. A public health

This was first developed in the 1950s

intervention using this model may administer questionnaires to find out

to

have

by scientists attempting to explain why

where

they

people attended for x-ray examinations

a person’s belief about a health issue,

have zero temptation and are very

for

to

and the other aspects of the model, and

unlikely

again.

predict health behaviour through the

then these could be reassessed after the

also

interaction of the following beliefs:8

intervention (eg, an advertising campaign

they

can

reached

Within

be

considered

“termination”, to this

start model

smoking there

is

tuberculosis.

It

attempted

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or counselling session); a change of

realm of drug and alcohol education.

being addressed and a way of evaluating

intention within the questionnaire would

The power and utility of health behaviour

the impact. Health promotion has

indicate the success of the intervention.

models is hopefully now evident as

come a long way theoretically since

they enable us to answer important

its

The health action model

questions

charter

This was developed by Tones and

people successfully adopt risk-reducing

opportunity to play a key role in the

Tilford.10 It emphasises the importance of

behaviours and provide insights into how

prevention of sight loss by successfully

identity and self-esteem as key mediating

best to plan and evaluate optometric, as

implementing

factors for motivating behaviour change.

well as general, healthcare schemes.

why

and

how

formal

origins

and

in

the

optometrists

the

Otawa

have

the

principles.

About the author

appearance, intelligence and physical

Conclusion

skills, an awareness of how others view

This final article has highlighted the

Centre for Vision and Vascular Science

them and the ability to make choices that

process

knowledge

at Queen’s University, Belfast. She

go against the flow of the group. Factors

regarding sight loss prevention into

qualified as an optometrist in 2000

upon which behaviour change depends

practice

the

from the University of Ulster and was

include: 1. self-esteem, as those with a

multiple levels at which interventions

awarded a PhD from Queen’s University,

high level of self-esteem are considered to

can be applied. Despite the efficacy of an

Belfast in 2005. Her research is focused

have greater ability to change a behaviour

intervention declining as you move from

on the early detection and prevention of

2. skills and strategies to resist peer

population level to individual level,

advanced AMD, and through this she is

group pressure 3. an assessment of

individual level interventions are easiest

also involved in working with the RNIB

the pros and cons of change, and 4.

to apply and tend to be less political and

to promote ophthalmic public health.

motivation to conform. Factors two

controversial, and therefore frequently

to four are considered important to

the easiest to implement.3 Planning a

References

translate intention into action. This

health promotion intervention should

See www.optometry.co.uk/clinical.

model has been used predominantly

ideally

Click on the article title and then on

with children and young people in the

model to enable the correct problem

of

47

Dr Ruth Hogg is a lecturer at the putting

and

has

include

a

our

demonstrated

health

behaviour

‘references’ to download.

Module questions Course code C-18848 O/D PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on June 1, 2012 – You will 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 will be uploaded to Vantage on June 11, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates

1. Which of the following correctly describes increasing population impact of health promotion in the Centre for Disease Control model? a) Socioeconomic factors, education and counselling, changing the context, clinical intervention b) Changing the context, long-lasting preventative intervention, clinical intervention, socioeconomic factors c) Education and counselling, clinical intervention, changing the context, socioeconomic factors d) Education and counselling, socioeconomic factors, long-lasting preventative intervention 2. Which of the following correctly describes increasing need for personal motivation in the Centre for Disease Control model? a) Clinical intervention, changing the context, socioeconomic factors, longlasting preventative intervention b) Socioeconomic factors, changing the context, clinical intervention, education and counselling c) Socioeconomic factors, education and counselling, changing the context, clinical intervention d) Changing the context, clinical intervention, education and counselling, socioeconomic factors

3. Which of the following is NOT an advantage of using a health behaviour model when planning a public health intervention? a) Improves the efficiency b) Improves the effectiveness c) Provides a method of evaluating success d) Reduces costs 4. The theory of planned behaviour focuses mainly on: a) Intentions b) Beliefs regarding the health condition c) Self-esteem d) Continuum of motivation 5. The stages of change model focuses mainly on: a) Perceived susceptibility b) Beliefs regarding the health condition c) Self-esteem d) Continuum of motivation 6. A key component of the health belief model is: a) Perceived susceptibility b) Beliefs regarding the health condition c) Self-esteem d) Continuum of motivation

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regarding


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Ocular mycoses: infection of the eye by fungi C-18803 O/D

04/05/12 CET

48

Dr Richard A Armstrong, BSc, DPhil Maryam Mousavi, RO (Canada) The surface of the eye is rich in nutrients and supports a variety of microorganisms, including bacteria and fungi.1-4 Fungi are a diverse group of organisms, ranging from microscopic unicellular entities to large multicellular forms.5 Although not as common as bacteria or viruses as a cause of eye infection, a large number of fungal species have been associated with the eye.6 Several species are known to cause eye infections (ocular mycoses), which may even be life-threatening.6,7 This article discusses the most common ocular mycoses, the importance of fungal contamination of materials in contact with the eye, and the methods of treatment.

Figure 1 Cells of Candida albicans, a dimorphic fungus showing unicellular and filamentous forms lipases,

proteinases,

and

oxidases.

These compounds are associated with the ability of fungi to penetrate and macerate many substrates, including the materials of contact lenses. These enzymes also enable fungi to overcome some of the host defences, including mucous-covered or keratin-containing

Ocular mycoses are being reported with

begins with the spore. Spore size and

barriers, to break down components

increasing frequency as a consequence

method of dispersal vary widely with

of the immune system, and to disrupt

of

species.

potential

new

and

improved

diagnostic

Some

spores

are

actively

microbial

competitors.

techniques. In addition, there has been

motile while those associated with eye

an increase in the number of immuno-

infections are often relatively small

Types of fungi in eye infection

suppressed patients in the population

(<5 m in diameter) and are dispersed

Many thousands of fungal species

eg those who are HIV positive or

passively by the wind. Individuals can

have been described and the majority

receiving

or

potentially be exposed to great numbers

can be classified into four major

chemotherapy, who may be increasingly

of fungal spores in the normal course

groups: basidiomycetes, ascomycetes,

susceptible

of their lives. Hence, the incidence

phycomycetes, and fungi imperfecti.

of fungal infection is often correlated

Estimates of the number of fungi

with frequency of spore exposure.

implicated in eye infections range

Fungi are eukaryotic organisms, ie

Composting material, eg poorly stored

from

they are characterised by the presence

animal fodder, may contain up to 170,000

genera

of a cell membrane, which encloses

fungal spores from potential pathogens

35 genera.9 Members of all the major

the organelle. The genome is located

per gram of material. Bird droppings

groups are involved. The unicellular

in the nucleus and mitochondria are

can also be rich sources of both spores

yeast

responsible

production,

and living cells of fungal pathogens.

is a basidiomycete and a pathogen

while vesicles and golgi apparatus

Germination of fungal spores, including

characteristic of immunocompromised

package

cellular

those associated with eye infection, will

patients. By contrast, the majority

constituents. Carbohydrates, such as

occur within 24 hours after deposition

of yeast-like fungi, such as Candida

trehalose, are stored within fungal cells

if temperature and moisture conditions

albicans (Figure 1) are members of

and the cell wall itself is composed

are

fungal

ascomycetes. Also classified within

of unique components such as chitin.

growth may take a number of forms,

the ascomycetes is the common eye-

Hence, although sometimes classified

eg unicellular, as in the yeast Candida

associated fungus genus Aspergillus

with

plants,

fungi

are

unique

(Figure 1), or filamentous, as associated

(Figure 2), which is abundant in many

and

distinct

group

of

organisms.

with most fungal species (Figure 2).

environments

Associated with filamentous growth

hospitals.

Growth and reproduction

is the production of many enzymes,

produce enormous numbers of spores

Fungal growth and infection frequently

eg

and are an important cause of allergies

radiation to

treatment

ocular

mycoses.4

Fungal cells

for and

energy

transport

a

favourable.

amylases,

Subsequent

cellulases,

esterases,

60 8

species

representing

30

to 105 species representing

Cryptococcus,

for

worldwide,

Species

of

example,

including Aspergillus

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and lung infection. Some of the simplest

Conjunctiva

fungi, eg species of Mucor, are classified

Fungal infection of the conjunctiva

within

of

is relatively rare. In children and

this group have high growth rates and

young adults, however, infection by

produce enormous numbers of aerial

Leptothrix

spores which can cause eye infections.

conjunctivitis, characterised by yellow

By contrast with the other groups, they

or grey areas under the epithelium.

possess a limited number of enzymes,

This condition does not usually lead

Members

which restricts them to simple substrates; as such they are often termed ‘sugar fungi’. Another group of fungi associated with the eye are the ‘dematiaceous’ fungi. This group includes a number of genera characterised by dark pigmentation of the hyphae. At least 20 species from 11 genera are

implicated

Curvularia,

and

including

Bipolaris,

Exophiala.

Finally,

organisms of uncertain classification, such as the common fungal-like aquatic organism

Pythium

insidiosum,

may

also be involved in eye infection.

unilateral

the fungus Sporotrichum resulting in the formation of small, yellow, and sometimes ulcerating, nodules on the

agricultural communities. In Ahvaz, Iran, 11 of 172 swabs taken from patients attending hospital were positive Cladosporium

being the commonest genus recorded,

conjunctiva, while in Rhinosporidium infection,

yellow

are

formed,

into

tumours.

to

pink

nodules

which

may

develop

Candida,

Aspergillus

and Trichophyton species can also cause conjunctivitis, with or without involvement of adjacent areas of skin.

followed by Drechselera, Alternaria,

Diagnosis of ocular mycoses Diagnosis of a fungal eye infection involves the recognition of typical clinical features, followed by direct microscopic observation of fungi in scrapes or biopsy samples. Any fungi isolated by these methods can then be cultured and identified. Further histopathology, immunohistochemistry, and DNA-based tests may be necessary to confirm a diagnosis of a specific fungal infection.

Normal ocular mycoflora

Fusarium, yeasts,

Epicoccum

viz.,

albicans,

and

Cryptococcus,

and

Rhodotorula

three

Cornea

Candida

Common precipitating events for fungal

rubra.

infection of the cornea (keratomycosis

11

or fungal keratitis) include surgical

Ocular mycoses

trauma, contaminated contact lenses and

The major eye infections caused by

alterations in lacrimal secretion.12 This

fungi

1

condition constitutes one of the more

and described in the sections below.

serious eye infections. Keratomycosis

and

summarised

in

Table

is a chronic condition, beginning as a structures

grey-coloured, superficial necrosis of

The most important fungi to affect

the cornea with a dull dry surface and

the

and

surrounded by a sharp yellow line.

flaking

The condition may be accompanied

Eyelids

and

eyelids

Microsporum,

associated are

Trichophyton

which

cause

There have been few studies investigating

skin lesions that become inflamed.

by

fungal infection of the eye. One study10

Particularly notable is T. schoenleini,

in the anterior chamber and iritis.

recorded the presence of fungi on the

which develops as a raised, crusted area

Perforation of the cornea is rare, but

surface of the eye in 2.9% of healthy

around the eyelashes. The tear glands

if it occurs, the fungus may invade

individuals,

pain,

corneal

infiltrates,

pus

higher

and associated canals may be infected

the uvea, vitreous body, and retina.

in older people. Most of the species

by Aspergillus fumigatus or A. flavus

The most common species involved

recorded

and

(‘dacryocystitus’) causing obstruction of

in

likely to have been transmitted by aerial

the nasolacrimal duct. Patients exhibit

fumigatus, followed by members of

contamination, but some pathogenic

epiphora (running over of tears) and

the Mucoraceae.13 Fusarium may also

species were also found; Penicillium

a black discoid elevated area on the

be an important cause, with this being

species was the most commonly isolated.

lower lid. The species of Leptothrix,

the most common cause of infectious

In areas of the world with lower socio-

Sporotrichum, and Rhinospiridium are

fungal keratitis in elderly patients

economic status and poorer hygiene,

also known to invade the lacrimal sac.

in Brazil14 and in China.15 Pythium

incidence

were

being

non-pathogenic

49

Conjunctivitis can also be caused by

association with the eye, especially in

fungi,

a

considerable infiltration by blood cells.

fungi are found more frequently in

pathogenic

cause

to ulceration, although there may be

Figure 2 Aspergillus, a common filamentous fungus to attack the eye, produces enormous numbers of spores and the reproductive spore-bearing structures are clearly visible

for

may

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keratomycosis

is

Aspergillus

04/05/12 CET

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insidiosum can also cause keratitis

responds well to treatment, especially be caused by fungi, especially Candida.

in tropical and temperate regions.16,17

with azoles and surgery should only

A more general infection of the anterior

Fungal

be

structures of the eye is often referred to

keratitis

is

relatively

rare

necessary

in

advanced

cases.

among contact lens wearers but in a

04/05/12 CET

50

as ‘endophthalmitis’. Recently, a case

recent outbreak of Fusarium keratitis

Sclera

of a 70-year-old male was reported with

in the USA, 283 out of 695 identified

The sclera is rarely affected by fungal

anterior

cases were contact lens wearers.18 In

infection. However, scleral ulceration

intraocular lens implantation. A ‘fluffy

the UK, the British Ophthalmologic

caused

fungal-like growth’ was observed, which

Surveillance

reported in HIV positive individuals.23 In was ultimately identified as the fungus

Unit

identified

0.32

by

Cryptococcus

has

been

endophthalmitis

following

cases of fungal keratitis per year and

addition, the first case of ‘sclerokeratitis’ Paecilomyces

in 56% of these cases, Candida was

ie

the only fungus isolated.19,20 However,

area of corneal infiltrate, caused by reported as a cause of endophthalmitis.26

filamentous fungi are more common,

the

fungus

especially in males following trauma.

has

been

scleral

necrosis

adjacent

Metarrhyium reported

in

Recent studies also suggest that species

to

variotii.25

Species

of

an Cephalosporium have been occasionally

anisopliae, Australia.24 Vitreous body Inflammatory reactions within the vitreous can result in liquefaction, opacification and

of Alternaria and Paecilomyces can

Uvea

cause

frequent replacement contact lenses

Infection of the iris, ciliary body and shrinkage, the tissue ultimately becoming choroid by fungi, causing uveitis, is necrotic.4 A fungal infection of the vitreous

and who use a multipurpose cleaning

relatively

solution.21

are

organisms

involved

observed, especially in contact lens

fumigatus

and

although

localised. The most common organisms

wearers, mycological assessment should

Coccidiodes may also be implicated.

involved are the species of Aspergillus,

always be performed.

An endogenous chronic uveitis can also Cephalosporium, Fusarium, and Candida.

keratitis

If

in

patients

corneal

22

wearing

infiltrates

Fungal keratitis

rare.

The

most are

Candida,

frequent progresses more slowly than a bacterial infection and is more likely to remain

Aspergillus

Region of the eye

Fungal infections

Lids, Lacrimal apparatus

Ringworm associated with Microsporum and Trichophyton. Eyelid lesions may be caused by Cryptococcus, Candida, and Sporotrichum Inflammation of lacrimal gland by Aspergillus, Leptothrix, Sporotrichum, and Rhinospiridium

Conjunctiva

Conjunctivitis caused by Leptothrix, Sporotrichum, Candida, Trichophyton, Aspergillis Ulcerating nodules by Rhinosporidium

Cornea

Keratomycosis caused by Aspergillus and Fusarium, Alternaria, Cephalosporium (Acremonium), Dematiaceous fungi and Pythium insidiosum

Sclera

Cryptococcus, Metarrhyium anispliae

Uvea

Uveitis caused by Aspergillus and Candida, and Coccidiodes. Rare cases caused by Paecilomyces sp. and Cephalosporium

Vitreous

Abscess caused by Aspergillus, Cephalosporium, Fusarium and Candida

Retina

Candida retinitis in immuno-compromised patients Local lesions caused by Cryptococcus

Optic disc, optic nerve

Papillitis and optic neuritis caused by Phycomycetes and Cryptococcus

Orbit

Invasive aspergillosis in HIV infection, mucormycosis, Pythium insidiosum

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Retina

infection of the eye (most probably

Retinitis attributable to Candida may

caused by C. albicans, C. parapsilosis, C.

occur in patients with a debilitating

glabrata, or C. guillermondi). The result

systemic disease, especially if they are or

also

receiving

immunosuppressant

Localised

lesions

Cryptococcus

may be a uveitis and endophthalmitis,

chemotherapy caused

may

which

drugs.

also

can

lead

Contamination

by

to

of

blindness.

donor

corneas

preserved by organ culture may also

occur.

be a potential problem. In one study,

51

three out of 1,134 culture media from

by members of the Phycomycetes

Figure 3 Fungal filaments growing on the surface of a contact lens. Fungi are able to penetrate and macerate substrates including the materials used to make contact lenses

and

Fungal contamination

The optic nerve can be affected by infections spreading from the eye, orbit or brain, resulting in optic neuritis. Optic neuritis can be caused the

yeast

Cryptococcus.

The ubiquitous nature of fungi means that

Orbit

they

frequently

contaminate

donor by

corneas

fungi.

were

However,

contaminated treatment

of

donor eyes with 10% betadine (1% povidine-iodine) solution significantly reduced

microbial

especially

the

growth

fungus

and

Candida.36

Treatment of ocular fungal infections

orbit

cosmetics, skin lotions, and ocular

comprise a small minority of orbital

medical materials. For example, fungi

two

infections (‘orbital cellulitis’) but can

were present in approximately 10%

(eg amphotericin-B) and azoles (eg

have a devastating effect on ocular

of tested cosmetic products shared by

econazole and fluconazole) (Table 2).

function.

the public.31 Of these, 3.9% contained

The mode of action of polyenes and

cytology can help to make an early

fungal

azoles are markedly different, although

definitive diagnosis of this condition.

Contamination of contact lenses by

Most fungal invaders of the orbit are

fungi (Figure 3) is usually regarded as

opportunistic saprophytes. In some

negligible, but is being increasingly

Polyenes

patients infected with HIV, an invasive

observed.

bacterium

Polyenes bind directly to the unique

infection, caused by Aspergillus, may

Haemophilus influenzae can be isolated

fungal sterol ergosterol and compromise

occur. Sinonasal ‘aspergillosis’ with

in large numbers from patients wearing

membrane

extension to the orbit often exhibits

disposable

six-night

is effective against Candida but may

a relentless progression and can lead

extended wear schedule, fungi were

penetrate ocular tissues poorly.37 This

to total loss of vision.27 In addition,

present in much smaller numbers.32

substance and its solubilising agent can

infection of the orbit by Mucor

In addition, in a separate study of

actually be toxic to the eye. Natamycin

(‘Mucormycosis’) may be associated

hydrogel contact lenses33 bacteria were

is

Fungal

infections

27

of

the

Fine needle aspiration

28

or

opportunistic

Whereas

lenses

pathogens.

the

on

a

Antifungal agents are classified into major

both

groups,

disrupt

better

viz.,

membrane

function.

tolerated

polyenes

function.

Amphotericin-B

and

actually

This

isolated from 38% of lenses tested,

penetrates the cornea quite effectively

condition occurs most commonly

but no fungi were found. However,

after topical application. The range of

in immunosuppressed children and

background infections of the cornea

activity of natamycin is controversial,

the patient may present with blurred

are a complication of photorefractive

but it is often the treatment of choice

vision, orbital pain, and eye movement

keratectomy.34 Some of these cases can

in

problems

be traced to the wearing of a disposable

filamentous fungal keratitis. Although

addition, two aggressive cases of

contact

natamycin is too toxic to be used

orbital cellulitis have occurred in

overnight. The fungus involved was

intravenously,

the USA, associated with Pythium

believed to be a species of Aspergillus

be used by this method for orbital

insidiosum.30 Chronic inflammation

(most probably A. fumigatus). Ocular

infections

of the orbit, possibly associated with

problems may also occur in patients fed

fungi, can also be observed in a few

intravenously through feeding lines;35

Azoles

cases and is usually of unknown cause.

24% of such patients developed Candida

Azoles

with diabetic ketoacidosis.

29

(ophthalmoplegia).

In

lens

worn

post-operatively

many

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countries,

amphotericin-B

and

bind

especially

for

to

for

can

endophthalmitis.

cytochrome

P-450

04/05/12 CET

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resulting

in

a

azoles.

Several

mechanisms

of

and

miconazole

decrease in synthesis of ergosterol

also

used

intravenously,

and an increase in permeability of

absorbed levels are usually too low

modification

the membrane. All azoles, with the

for treatment of systemic mycoses.

pathways by the fungus, modification of

exception

depress

Fluconazole is probably the azole of

enzymes to reduce the binding of azoles

the activity of the immune system.

choice for intravenous use, achieving

to fungal components, and increased

Several compounds have been used

high levels of penetration of ocular

efficiency of removal of the azole within

including thiabendazole, itraconazole,

tissues within a few hours of a single

fungal cells. Although resistance to

clotrimazole, miconazole, ketoconazole,

dose.41

amphotericin-B has been reported, it

fluconazole and econazole.38 Several

analogue

new azoles are also becoming available

approved for use in USA in 2006.

It

treatment for life-threatening conditions

eg isavaconazole, ravaconazole and

can be applied as an oral suspension

and more severe ophthalmic infections.

altaconazole.

of

fluconazole,

are

Posaconazole, of

a

but

structural

itraconazole,

was 42

resistance have been identified including of

sterol

synthesis

continues to be the most important

effective

and can be administered even if the

against Candida, although econazole

patient has poor renal function. It is

Conclusions

is more effective against filamentous

therefore, useful in high-risk patients,

Fungi are ubiquitous organisms that can

fungi. Azoles are widely used in the

with rare or resistant fungi, or if the

be found in association with healthy

form of drops since they exhibit good

patient cannot tolerate other anti-

eyes. The incidence of actual fungal

penetration of ocular tissues. They are

fungals. In some cases, combination

eye infection, however, is relatively

well tolerated, although econazole,

therapy

B

low compared with that attributable

miconazole and ketoconazole have

eye

sub-conjuctival

to viruses and bacteria. Nevertheless,

been reported to irritate eyes in some

injection of fluconazole) may be more

fungal infection of the eye is increasing,

cases.

efficient

most

39,40

Most

been

have

to

Econazole

Itraconazole, thiabendazole,

(topical

drops at

amphotericin

and treating

keratomycosis

notably

by

the

species

of

are

compared with eye drops alone.43

Fusarium, Aspergillus, Candida, and

ocular

Resistance to anti-fungal agents has

dematiaceous fungi. At present, there

tissue following oral administration.

been growing in recent years, especially

are a limited number of compounds

ketoconazole absorbed

and

fluconazole

significantly

by

Agent

Effective against

Administration

Side effects

Amphotericin-B

Candida

Topical, IVA

Impaired renal

Natamycin

Broad spectrum

Topical

IVA toxic

Thiabendazole

Candida

Topical, oral

None reported

Clotrimazole

Candida

Topical

None reported

Miconazole

Broad spectrum

Topical, IVA but not in UK

Eye irritant

Ketoconazole

Broad spectrum

Topical, oral

Eye irritant

Econazole

Filamentous fungi

Topical

Eye irritant

Fluconazole

Candida

Topical, IVA

None reported

Posaconazole

Broad spectrum

Oral

None reported

Itraconazole

Aspergillus keratitis

Oral

Gastro-intestinal problems

Table 2 Treatment of ocular mycoses (IVA = intravenous administration) Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates


available to control ocular mycoses.

been a lecturer in botany, microbiology,

optician

Natamycin is often first choice for

ecology, neuroscience, and optometry

Canada. She conducts charity work

filamentous

working

in

Vancouver,

and

during his 36 years at Aston University.

supporting eye hospitals in less

topical amphotericin-B for Candida

His research interests include the

developed countries. Through this

keratitis.

keratitis

of

neuropathology of neurodegenerative

she

the behaviour of ocular fungi will be

diseases, with special reference to

interest in fungal infections of the

essential in future, together with the

vision and the visual system. He also has

eye as they are a growing problem

development of new anti-fungal agents.

a particular interest in the application

in

Continued

monitoring

of statistical methods in research.

About the authors Richard

Armstrong

was

educated

has

less

developed

a

developed

Maryam Mousavi is a third year

References

undergraduate

See www.optometry.co.uk/

at King’s College London and St

programme

at

Catherine’s College, Oxford. He has

Previously

she

on

the

Aston was

optometry University.

a

registered

particular

countries.

53

clinical. Click on the article title and then on ‘references’ to download.

Module questions Course code: C-18803 O/D PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on June 1, 2012 – You will 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 will be uploaded to Vantage on June 11, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates

1. The yeast Candida is a cause of which major ocular infection? a) Conjunctivitis b) Endogenous uveitis c) Retinitis d) Optic neuritis

4. The most important fungi to affect the eyelids is: a) Microsporum b) Candida c) Cryptococcus d) Aspergillus

2. Trauma to the cornea may be followed by infection caused by: a) Aspergillus b) Candida c) Fusarium d) Cryptococcus

5. Regarding keratomycosis: a) Surgery is indicated in all cases b) The least common cause is Aspergillus fumigatus c) Surgical trauma is a possible risk factor d) It does not respond well to treatment by azoles

3. In the normal ocular flora of healthy individuals: a) Fungi are a normal constituent in most cases b) Most species of fungi in the conjunctiva are pathogenic c) Species of Penicillium are the most common fungi to be isolated d) Yeasts may be the most common in less developed countries

6. Considering fungal infections of the orbit: a) They are a very common cause of orbital infections b) Most fungal invaders are opportunistic saprophytes c) They do not occur in immuno-supressed patients d) They are normally asymptomatic

04/05/12 CET

fungal


JOBS

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Territory Sales Manager/s (Sales Ambassadors) Competitive salary package

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46

54

Locations available: North: based around Manchester South East: Based around Essex/Hertfordshire Sight Care is a not-for-profit business and product resource group for UK independent opticians. In addition to a comprehensive range of business services including our national PR campaign www. eyelovelocal.co.uk aimed at encouraging consumers to visit independents in their local community, we market an exclusive collection of spectacle frames and accessories to member practices.

We wish to appoint two very special Territory Sales Managers. In addition to selling our exclusive frame collections and accessories to member practices, you will also act as an Ambassador for the group encouraging members to take full advantage of the support services available. Further, you will have responsibility for generating new members on a large geographic territory where occasional overnight stays will be necessary. We seek dynamic individuals that can demonstrate success in selling frame collections, or other products or services to the independent sector. The role may also suit a dispensing optician keen to take on the challenge of territory sales. You will be highly organised, an excellent communicator, self-motivated, confident, and have a natural ability to develop strong relationships with practice owners and their teams. Importantly, a real desire to achieve tangible results in all you do. If you believe you meet the criteria and would like to apply for one of the positions, only then forward a CV and a covering letter stating why you should be considered for an interview. Please state your current remuneration package and the territory of your choice. Applications should either be emailed to paulsurridge@sightcare.co.uk or by post to Paul Surridge, Chief Executive, Sight Care Group, Bakers Yard, Pardown, Oakley, Hampshire RG23 7DY


22/3/10

09:17

Page

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Glaucoma Optometrist Opportunity

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We are currently looking for optometrists to work in our North Lincolnshire and Coventry clinics. However, due to our rapid growth, we are also interested in hearing from optometrists nationwide, particularly those in Swindon, Bristol and Kingston.

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If you enjoy leading a small team to deliver high quality patient care smoothly and efficiently, we would be delighted to hear from you. A combination of clinical and managerial experience is preferred. This is a full-time post, however applications for part-time positions will also be considered.

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Job ad March 10

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A fantastic full/part time opportunity to join a modern, independent practice in beautiful WETHERBY, West Yorkshire

The prestigious and independently established, Concept Eye Clinic group, (Newcastle & Sunderland) invites applications from:

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