Optometry Today August/September 2020

FRONT COVER & SPINE

VERSION

Journal of the Association of Optometrists years

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August/September 2020 Volume 60:07

www.optometry.co.uk

My vision Jesse Dufton Page 39

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August/September 2020 / Volume 60:07

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THE NHS BACKLOG EDITION

THE GROWING QUEUE FOR NHS TREATMENT AND HOW OPTOMETRISTS CAN EASE THE BURDEN ON SECONDARY CARE

/ www.optometry.co.uk

CET SARS-COV-2 and the safety of contact lens wear

Perspectives Patient care at Birmingham and Midland Eye Centre

In practice Hamza Mussa on tackling racism head-on

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Welcome

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ART PRODUCTION Cover: Grant Pearce

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nderstanding what is in the best interests of patients, and putting those needs front and centre, is an approach optometry has learned to excel at. But as the impact of the coronavirus crisis continues to shape and change our profession, the question of how optometry must adapt to provide DQ H HFWLYH VHUYLFH KDV QHYHU EHHQ PRUH SUHVVLQJ Ongoing government funding for the profession is critical, particularly for the practices that operate in deprived areas, serving at-risk communities. The AOP, as part of the Optometric Fees Negotiating Committee (OFNC), challenged the NHS to put forward a proposal on future funding that is fair and workable. Faced with the cost of PPE and infection control measures, and a reduction in the number of patients that can be seen per day, we know some members are ZRQGHULQJ LI WKH\ FDQ D RUG WR SURYLGH 1+6 FDUH The COVID-19 crisis has encouraged communities around the world to stop, think and UHÁHFW ,Q WKLV HGLWLRQ RI OT, AOP member Hamza Mussa talks about the important campaign he has led, encouraging peers to share their experiences of racism and discrimination at work (page 48).

This insight is distressing – but it is a point from which change can happen. The AOP is providing guidance and tools for members over the next few PRQWKV WKDW DGGUHVV WKHVH LVVXHV 2XU FRQÀGHQWLDO Peer Support Line is also available for members and non-members who want to talk.

Providing opportunities to learn and share knowledge has never been more valued. Over the last seven years, 100% Optical has become WKH LQGXVWU\·V ÁDJVKLS HYHQW LQ WKH 8. ² DQG LW LV welcome to hear that it will have the support of IHOORZ SURIHVVLRQDO ERGLHV LQ $V WKH R FLDO partner of the event, the AOP will keep you informed as plans develop.

Of course, planning for the future in such a turbulent world is not easy, but the AOP remains focused on supporting every member. This work will include interrogating the proposals from the GOC for long-term changes to the way RSWRPHWULVWV DUH WUDLQHG LQ WKH 8. <RXU YLHZV and experiences will guide our recommendations.

“The crisis has encouraged communities around the world to stop, think and reflect”

Henrietta Alderman, AOP chief executive

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WELCOME

AUGUST/SEPTEMBER

VERSION

Contents

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33

53 COVER STORY SUBS ART PRODUCTION CLIENT

07-25 SPOTLIGHT

OT investigates

On the ground

The news, insight and analysis Picture this RNIB launches a World Upside Down campaign in July OT reports Five innovations to ease the COVID-19 patient backlog The audit Optics in 16 stories Health and wellbeing Racial inequality in optics and the steps for the sector to take On the ground Views on independent prescribing during the pandemic AOP round-up The guidance from the clinical and SXEOLF D DLUV H[SHUWV Supplier insight The view from contact lens manufacturers

4 www.optometry.co.uk

“I know there are people all over the UK who have done the academic part of the IP qualification but have not been able to do the final practical element” Brian McKeown PAGE 18

27-33 HIT LIST The trends, launches and looks OT focuses on...

OCT and equipment Me and my glasses Twinkle Patel Get the look Clear styles The shortlist The latest launches Behind the brand %ODFNÀQ

August /September 2020

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35-39 PERSPECTIVES Voices from optics and beyond Perspectives Dr Ian Beasley, Dr Waheeda Illahi, Rose Wright My vision Jesse Dufton, rock climber

“Paediatric patients are often frightened by staff in uniform” Dr Waheeda Illahi PAGE 36

8

CET 59-81

39

30 36

Education and training for the eye care practitioner 59 CET welcome 60 Age six – the refractive error milestone?

64 Does body language communicate personality?

68 Severe acute respiratory syndrome coronavirus-2 and contact lens wear 74 Visual impairment, employment and empowerment 78 OCT findings in age-related macular degeneration 80 Optometric management of anterior segment eye disease In this edition of OT, practitioners can test a range of competencies: OPTOMETRISTS // 7 THERAPEUTIC OPTOMETRISTS // 1 DISPENSING OPTICIANS // 4 CONTACT LENS OPTICIANS // 1

xx

43-51 IN PRACTICE Business insight and career development The discussion Negotiating fees as a locum practitioner Pre-reg focus Tamara Hasan, Daniel Chung and Samrina Awan The workshop Domiciliary care advice from AOP councillor, Gordon Ilett How I got here Hamza Mussa on campaigning against racism using Instagram How do I? Tackle unconscious bias Becoming a business owner Farzeen Khan on a new challenge on the Isle of Wight What I have learned University teaching during the lockdown

ONLINE

Cover story

The waiting millions With estimates that the list of patients waiting for treatment could reach 10 million by the end of the year, how can optometrists help to tackle a daunting backlog?

OT video highlight

PLUS: The view from a West Midlands optometry practice

AOP guide to infection control and prevention

PAGE 53–58

Watch the CET video on

www.optometry.co.uk

83-90 JOBS, MARKETPLACE

Contact the OT team with your experiences, observations and lessons from practice today: newsdesk@optometry.co.uk

& SECRET LIFE Jobs How to respond to interviewers’ frequently asked questions I could not live without…

A triage system, the Optopol Revo, and an automatic phoropter Secret life 3UHWW\ %DVUD RQ KHU ÁHGJOLQJ confectionary business

Follow us on Twitter @OptometryToday Like us on Facebook OptometryTodayJournal Follow us on Instagram @optometry_today

August /September 2020

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CONTENTS

CONTENTS

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THIS MONTH VERSION

Spotlight

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08 OT REPORTS

Five innovations to ease the backlog of patients post COVID-19

18 ON THE GROUND

IP optometrists on managing more eye health conditions in the community

22 AOP SUPPORT

The Policy team's renewed focus on optometry training and education

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Upturned world

RNIB

July saw the launch of the Royal National Institute of Blind People's World Upside Down campaign, calling for people to think about the challenges blind and partially sighted people face with the easing of lockdown. Europeâ&#x20AC;&#x2122;s biggest advertising display, the Piccadilly Lights in London, ran upturned displays every hour as a representation of the difficulties people with sight loss are facing.

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August/September 2020/Volume 60:07 Issn 0268-5485 ABC certificate of circulation January 1 2019 â&#x20AC;&#x201C; December 31 2019

SUBS

Editor: John White johnwhite@optometry.co.uk Interim deputy editor: Lucy Miller lucymiller@optometry.co.uk Assistant editor: Selina Powell selinapowell@optometry.co.uk

ART PRODUCTION CLIENT

Senior reporter: Kimberley Young kimberleyyoung@optometry.co.uk Web content and social media executive: Leah Boyle leahboyle@optometry.co.uk Clinical editor: Dr Ian Beasley ianbeasley@optometry.co.uk Clinical editor for multimedia: Ceri Smith-Jaynes cerismithjaynes@optometry.co.uk Video production editor: Laurence Derbyshire laurencederbyshire@optometry.co.uk CET enquiries: 020 7549 2076 CEThelp@optometry.co.uk AOP membership and OT subscription team: AOP, 2 Woodbridge Street, London, EC1R 0DG subscriptions@aop.org.uk

Advertising: Richard Ellacott 020 3771 7242 richard.ellacott@thinkpublishing.co.uk Advertising production: aop@ccmediagroup.co.uk Senior designer: Grant Pearce Account director: Anna Vassallo Executive director: Jackie Scully Published monthly for the Association of Optometrists by Think Capital House, 25 Chapel Street, London NW1 5DH Printed by Acorn Web, Normanton Ind Estate, Loscoe Close, Normanton, West Yorkshire, WF6 1TW All rights in and relating to this publication are expressly reserved.

No part of this publication may be reproduced in any form or by any process without written permission from the AOP or the publisher.

8 www.optometry.co.uk

FIVE INNOVATIONS HELPING TO EASE THE COVID-19 BACKLOG At a time when clinicians are grappling with the best way to tackle waiting lists following the COVID-19 lockdown, innovators have been working in the background to provide new tools and ways of working. )URP XVLQJ DUWLĂ&#x20AC;FLDO LQWHOOLJHQFH WR UHGXFH WKH KXPDQ EXUGHQ RI GLDEHWLF UHWLQRSDWK\ VFUHHQLQJ WR D SODWIRUP WKDW FDQ KRVW VSHFLDOLVW DSSRLQWPHQWV LQ D SDWLHQW¡V OLYLQJ URRP WHFKQRORJ\ KDV WKH SRZHU WR KHOS SDWLHQWV UHFHLYH WKH FDUH WKH\ QHHG ² DQG IDVWHU +RZHYHU VRPH LQQRYDWLRQV GR QRW LQYROYH WKH GHYHORSPHQW RI QHZ WRROV

1

NHS TRUSTS USE ALGORITHMS TO CLEAR WAITING LISTS

Technology that helps NHS hospitals to remotely monitor and effectively triage patients could play a role in reducing the hospital backlog.

Trusts that have signed up for DrDoctor include Nottingham University Hospital, the Christie NHS Foundation Trust in Manchester, and Aneurin Bevan Hospital in Wales.

DrDoctor founder Tom Whicher told Digital

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Health that information collected through DrDoctor suggests there could be 10 million patients on NHS waiting lists by the end of the year â&#x20AC;&#x201C; aligning with the NHS Confederation estimate. â&#x20AC;&#x153;In ophthalmology we are seeing large backlogs, partly because it was a service that was under pressure anyway, but that has been made significantly worse by people not being able to travel in,â&#x20AC;? he said. â&#x20AC;&#x153;This is an opportunity for the health service to re-think how it works.â&#x20AC;?

DrDoctor has provided NHS trusts with flexible appointment management tools and software that sends digital questionnaires to patients who have had appointments delayed or deferred in order to prioritise care.

The company has also developed broadcast messaging for NHS trusts to quickly contact patients to inform them of changes in their care, and demand management technology that triages patients effectively across pathways.

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Pando secure messaging app helps 45,000 UK healthcare workers stay in touch Thousands of UK healthcare workers, including optometrists, are using a messaging app that has been specifically designed for health and social care workers. With more work being completed remotely, the app allows team members to collaborate and safely share information with each other.

Optometrist and Essex Local Optical Committee secretary, Emma Spofforth, told OT that Pando is being used by Mid and South Essex NHS Foundation Trust to communicate with clinicians working in primary care. â&#x20AC;&#x153;Patient images and details can be shared without disclosing

any patient identifiable data.

A full work-up can be assessed by a doctor, who will ask more questions of an optometrist, advise speed of referral or recommend treatment if necessary,â&#x20AC;? she highlighted.

Enhanced communication with secondary care can help to avoid unnecessary hospital visits, she added.

3

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THIS MONTH

SPOTLIGHT

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"We want to create a safe, efficient system for catching up on the backlog" Professor Alicja Rudnicka

CLIENT

During the COVID-19 lockdown, diabetic retinopathy screening was largely paused across the UK. Only particularly high-risk diabetes patients, including

STUDY FINDS AI COULD SAFELY HALVE DIABETIC RETINOPATHY SCREENING WORKLOAD pregnant women, were able to attend screening appointments.

A new study published in the British Journal of Ophthalmology (bit.ly/30F4hhJ) has found that delays in assessing an individualâ&#x20AC;&#x2122;s risk of developing diabetic eye disease could be eased with WKH LQWURGXFWLRQ RI DUWLĂ&#x20AC;FLDO intelligence (AI) technology that lessens the human workload of running a screening programme.

Professor Alicja Rudnicka, from St Georgeâ&#x20AC;&#x2122;s, University of London, told OT that the introduction of the technology had the potential to save the NHS millions of pounds every year. â&#x20AC;&#x153;We want to create a VDIH H FLHQW V\VWHP IRU FDWFKLQJ up on the backlog,â&#x20AC;? she said.

The number of diabetics is rising globally. Professor Rudnicka highlighted that AI could also help to introduce screening for diabetic retinopathy in countries

WELSH IP OPTOMETRISTS REDUCE HOSPITAL REFERRALS A pioneering scheme within Cardiff and Vale University Health Board has helped to reduce referrals into secondary care.

The Independent Prescribing Optometry Service, introduced one day after lockdown on 24 March, saw four optometry practices with IP optometrists provide emergency eye care within the community.

Optometrists at Direct Eyecare (Cardiff), Jones & Jones Optometrists (Barry), Osmond Drake (Penarth) and Davies and Jones Optometrists (Dinas Powys) worked a six day per week rota to reduce the burden on eye

10 www.optometry.co.uk

casualty at University Hospital of Wales during the COVID-19 lockdown.

Of the patients treated through the service, 92% of cases were able to be treated within the community.

IP optometrists shared patient data and images securely through the electronic patient record platform, OpenEyes, with consultants at the University Hospital of Wales.

Head of primary care services at Cardiff and Vale University Health Board, Clare Evans, highlighted that there is potential for national rollout of the service.

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that have not had a system in place previously. â&#x20AC;&#x153;Having this sort of technology might help in developing countries where the infrastructure is not in place to have a labour-intensive, manual grading system.â&#x20AC;?

She added that the AI technology is safe and did not miss any cases of advanced diabetic retinopathy in an evaluation based on 30,000 patients in three NHS diabetic eye screening programmes. The technology had 95.7% accuracy for detecting eye damage that would require specialist referral, and 100% accuracy for moderate to severe non-proliferative and proliferative diabetic retinopathy.

Professor Rudnicka highlighted that real-time implementation of the technology in an existing screening programme would need to take place before it could be rolled out more widely.

5 â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;ve had great feedback from patients who have used this service, particularly those who have shielded who mentioned they felt safer being treated closer to home,â&#x20AC;? she said.

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INDUSTRY SUPPORT

Clinitas

®

a trusted brand for

Inspecs Group has acquired the manufacturing operations of the Norville Group from administrators. The business had entered administration on 3 July.

The retail division of the group, Norville Opticians, was saved in an earlier sale to the Hakim Group.

10 + YEARS REPRO OP

Clinitas dry eye soothing solutions ®

SUBS ART

“Now, more than ever, we can come together as an industry at 100% Optical and tackle the key issues facing optics today” Stuart Burn, chairman of the Federation of Manufacturing Opticians, pledged support for the event, revealing that Optrafair 2020 will not go ahead. The AOP supports 100% Optical as official partner and education provider, with OT the official media partner.

One in five blind and partially sighted people were rationing food during lockdown according to the Royal National Institute of Blind People, which joined with other sight loss charities to highlight the challenges of safely accessing supermarkets amidst altered shop layouts, social distancing and delivery slot limitations.

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NE

Pixabay/Steve Buissinne

CLIENT

• Choose from resealable individual droppers (with 12 hour use) or a multidose soft tip dropper (3 months use from opening) • 0.4% sodium hyaluronate, the highest strength available on the market • Preservative free and contact lens friendly

Clinitas® 0.2% & Clinitas® Multi 0.2% • 0.2% sodium hyaluronate

Altacor has partnered with Adaro Optics to support practices to offer home delivery for its range of products. Group brand manager, Oliver Wooding, told OT: “If there was ever a time ECPs needed to offer patients a home delivery service to obtain their eye products, including our Clinitas eye drops, now is that time.”

Vision Aid Overseas has asked for pledges to keep its core services operating, after the COVID-19 crisis halted its fundraising activities, leaving the charity with a "severe" fundraising shortfall.

• Extends established range Menicon launched its new Toric Calculator to help make fitting lenses simpler. Eye care professionals input a patient’s prescription and receive a suggestion for a starting lens.

Add Comfortear® Lacrisolve® 180 plugs to your dry eye toolkit, when patients need more than dry eye drops.

Contact Altacor for further information.

www.altacor-pharma.com 0118 902 6766 12 www.optometry.co.uk

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Clinitas Soothe® & Clinitas Soothe® Multi

“Lockdown has thrown all my plans out of the window.

I think it very much is going to be a case of flexibility” Kathleen McQuade, owner of Aberfeldy Opticians, spoke to OT for our ‘My Priority’ series, on how she plans to balance running her practice post-COVID with a new baby.

THIS MONTH

SPOTLIGHT THE AUDIT

CLINICAL PROVISION & EYE CARE Pexels/Andrea Piacquadio

The Royal College of Ophthalmologists and the British & Irish Orthoptic Society released advice on the use of vision testing apps for children during COVID-19, urging clinicians to carefully assess novel technology and advise parents of the potential risks and benefits.

“In about 30-40% of patients who are receiving injections in one eye, we can predict with very high specificity whether they will develop wet AMD in their good eye within the next six months” Dr Pearse Keane, consultant ophthalmologist at Moorfields Eye Hospital, on using deep learning to predict the development of wet age-related macular degeneration in a patient’s ‘good eye.’

13.3m

NHS sight tests were carried out in England over the past year (ending March 2020) according to results published

by NHS Digital in its annual round up of GOS activity.

“This won't even scratch the surface of the issues that will be faced by many optical practices as they try to go back to work” Kathy Jones, policy adviser at the AOP, welcomed Government job retention measures, including a £1000 bonus to keep furloughed workers in employment and a training scheme for under-25s, but highlighted that gaps in support still persist.

A report by the Treasury Committee into the economic impact of coronavirus urged the Government to assist those who have missed out on financial support packages following the outbreak of COVID-19, such as limited company directors, self-employed workers and new starters. The report stated: “Over a million people have lost livelihoods while being locked down and locked out of support.”

Getty/z_wei

GUIDANCE & ADVICE

Pixabay/Sabine van Erp

The Optical Confederation’s Domiciliary Eyecare Committee produced guidance on meeting the eye care needs of vulnerable patients in the next stage of the pandemic and called for stakeholders to work with domiciliary care providers to ensure the clinically vulnerable “are not denied the eye and vision care they need in these very challenging times.”

Read more advice from the committee co-chair on page 47.

Boots UK launched a consultation process for restructuring to “mitigate the significant impact” of COVID-19.

The business has seen a reduction in retail sales of 72% for Boots Opticians in the third quarter compared to last year. Proposals include cutting up to 4000 jobs and closing 48 Boots Opticians stores.

“We were operating fairly well for one and a half weeks and suddenly, we had to cancel all our routine appointments and furlough our staff again” Riyaz Jasat, principal optometrist and partner at Evington Eyecare, a Hakim Group practice in southeast Leicester, spoke to OT about returning to restricted services in the local lockdown.

Almost 20,000 patients were seen by optometrists in Wales between March and the end of June. This included 5400 remote consultations, as well as a total of 9500 urgent eye care appointments. Optometry Wales chief executive, Sali Davis, said the data will be used in discussions on eye care reform with the Welsh Government.

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PRACTICE IMPLICATIONS

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A spotlight on equality

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The global focus has been drawn to issues of racial inequality in healthcare and across society. OT outlines the conversation in optics Events over the past few months have shone a light on inequalities across healthcare, society and in the workplace.

Reports have demonstrated the increased COVID-19 risks for those in Black, Asian and Minority Ethnic (BAME) communities, while campaigns and protests have brought issues of racial inequality into the headlines.

“With everything in the news at the moment, you hear about racism – but do we ever take a closer look to home to see if there is racism and bias in our own profession?”

This was a question highlighted by optometrist Hamza Mussa, who leveraged his Instagram account, ‘The Crazy Optom’ (@thecrazyoptom), to explore experiences of racism within optical practices.

Inspired by a friend’s post sharing how she had experienced patients specifically asking to be seen by a white optometrist, Mr Mussa launched a series of polls asking his followers to share their own stories.

Of 895 participants, 82% (or 731 respondents) agreed they had experienced racism in practice.

What many found more shocking, however, were the examples where the patients had still been seen despite racist or discriminatory behaviour.

“Shining a light on it, however hard it is to read, has achieved some good” Hamza Mussa, optometrist

82%

OF RESPONDENTS HAD EXPERIENCED RACISM IN PRACTICE ACCORDING TO A SOCIAL MEDIA POLL OF OPTICAL WORKERS

Asked what had happened after an incident of racist behaviour had been raised to a manager or director, over 80% of respondents said the patient had still been seen, and only 19% said a zero tolerance policy was enforced.

“By saying to the patient, ‘Yes we’ll find somebody else to see you,’ it’s like management going out of their way to please the patient,” Mr Mussa said. The accommodation of this rewards the patient’s behaviour, he suggested.

“Zero tolerance is on the front of it, but it should be enacted in all situations and it shouldn’t be a case that practitioners are embarrassed to need to use that policy, for fear of what management will do,” he added.

Raising the issue with stakeholders across the profession, Mr Mussa outlined a number of recommendations to ensure August /September 2020

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SPOTLIGHT

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THE NUMBERS...

EXPERIENCES OF RACISM IN PRACTICE

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Polls by @thecrazyoptom found 82% of respondents had experienced racism in practice When asked what happened after an incident had been raised with management, 81% said the patient had still been seen The remaining 19% said a zero tolerance policy was enforced A poll by OT found that of 241 respondents, 68% had experienced racism in practice Another 16% said they had witnessed incidents of racist behaviour in practice.

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81%

CLIENT

SAID A PATIENT HAD STILL BEEN SEEN AFTER AN INCIDENT OF RACIST BEHAVIOUR HAD BEEN RAISED WITH MANAGEMENT

racism in practice is properly handled, from retraining at management level, to renewed stances against racism and a confidential reporting process.

“It’s heart-breaking for me. At the same time it’s good to shine a light on it, because this was all there in the first place – it’s not new,” Mr Mussa commented.

“Shining a light on it, however hard it is to read, has achieved some good.”

Calling it a “very troubling issue that needs urgent consideration,” AOP policy adviser, Kathy Jones, explained the AOP plans to publish Dr Mohammed Sattar, the a range of resources GP behind Leed’s primary care for employees and BAME network employers on the points raised.

This will include a reminder of the "legal requirements in respect of equality, diversity and inclusion, and what to do if faced with racism in the workplace,” Ms Jones added.

The conversation followed the publication of a series of reports that revealed that those in BAME groups face a higher risk from COVID-19.

“We all have a story to share of our lived experience, whether in the workplace or as a patient of BAME background”

16 www.optometry.co.uk

In June, NHS England and the NHS Confederation announced the launch of the NHS Race and Health Observatory to investigate the impact of race and ethnicity on people’s health and aimed at improving health outcomes for NHS patients, communities and staff.

“Ethnicity and race have been shown systematically to influence our health, independent of factors such as age, sex and socio-economic status,” NHS chief executive, Sir Simon Stevens commented on the launch, adding that COVID-19 has “injected stark urgency” into the need for more action.

In Leeds, a new primary care network is aiming to address inequalities affecting BAME staff and communities.

“Working in primary care we get to see first-hand how inequalities can lead to issues affecting a person’s health and wellbeing,” explained GP Dr Mohammed Sattar, who spearheaded the network.

“The inequalities have always been there and now they have been scrutinised and laid bare at a national, as well as regional or local level,” Dr Sattar told OT. He added, “We all have a story to share of our lived experience, whether in the workplace or as a patient of BAME background.”

The network is aiming to bring together colleagues from across primary care, including optometrists, to help shape services, with Dr Sattar emphasising the unique insights eye care professionals can bring.

The group also hopes to inspire similar networks across the country. “There is momentum,” Dr Sattar added, “We started a movement and you can too.”

FURTHER READING AND RESOURCES Take a look at the AOP’s employment resources to understand your rights, and how the AOP can support you Read our interview with Hamza Mussa on OT's website and find out more about his work on page 48 If you need a space to talk, the confidential AOP Peer Support Line is available on 0800 870 8401 for a listening ear

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Optics on the ground: independent prescribing

REPRO OP SUBS

Optometrists with further qualifications have been in the spotlight as COVID-19 provides an impetus for optical professionals to manage more conditions in the community. OT talks with IP optometrists about how they have been practising during this time and hears how a second IP cohort has been established at Glasgow Caledonian University in response to the pandemic.

ART PRODUCTION

“In Northern Ireland, GPs and pharmacists are realising what optometrists are able to do” Brian McKeown, Ballymoney, Coleraine and Garvagh, Northern Ireland

CLIENT

I’ve been qualified in independent prescribing since 2013. It is great to have an FP10 prescription pad beside you. It saves a lot of hassle from the patient’s point of view, gives me more job satisfaction and it helps to relieve pressure on secondary care.

During COVID-19, I have been using the prescription pad every day. Before the pandemic, it probably would have averaged a few times a week. It has been so useful to be IP qualified during this time. I have some patients who were at-risk and did not want to be going to hospital. They could come in, be seen, receive a prescription and fill it at the pharmacy within half an hour. For a visit to the hospital, it might take an hour to get there and then there was also the fear of COVID-19.

During lockdown, I had referrals from other optometrists who knew that I was IP-qualified.

Optometrists tend to be seen as competitors with their

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neighbouring practices. It is so refreshing to have a colleague call you and run through a case with you. I have had optometrists from both multiples and independents contact me. In one situation, I had a call from an optometrist in Belfast who had received photos from a patient who was 40 miles away. I am another 40 miles up the road. I looked at the pictures, rang the patient and sent a prescription to a local pharmacy near her. That wouldn’t have happened before the pandemic.

Patients have reacted really positively to the care they have been able to receive. In Northern Ireland, GPs and pharmacists are realising what optometrists are able to do. The demand for the independent prescribing qualification was slowly increasing before COVID-19 and since the pandemic there has been an influx in interest. I think that is because IP optometrists have raised their profile during the pandemic. Some

people may be on furlough and they have been thinking about doing independent prescribing for a long time and the pandemic has given them the opportunity to get involved. Ulster University has seen an increase in demand for the course. There are close to 1000 independent prescribing optometrists in the UK now.

I don’t know how all of these students will find their clinical placement. There will be social distancing rules within hospitals for the foreseeable future, which may mean that a student isn’t allowed in the room. It would be great to explore whether an experienced optometrist in a clinic could be a supervisor rather than an ophthalmologist to get more people through the final part of the qualification.

I know there are people all over the UK who have done the academic part of the qualification but have not been able to do the final practical element.

PPE

“The closest dedicated ophthalmology department is 100 miles away, which is at least a four-hour round trip by car” Ian Morris, Wick, Scotland I am an IP optometrist and the store director for Specsavers Wick, which is one of the most northernly practices in mainland UK. From the outset, we were set up as an EETC for NHS Highland as Wick and the surrounding area is in a unique position of being both remote and populated.

When the EETCs were introduced, we were approached by the ophthalmology department to help. We had a teleophthalmology system set up allowing us to live stream our patient assessments to an ophthalmologist if there was something we weren't sure about or needed help on. The closest dedicated ophthalmology department is 100 miles away, which is at least a four-hour round trip by car and even longer with bus or train.

We have also provided help to secondary care by managing the patients that hospitals weren’t able to see due to the restrictions in place. This has included reviewing patients following retinal detachment surgery and trabeculoplasty surgery. We have also completed intraocular pressure reviews and a review of a 97-yearold with herpetic stromal keratitis and corneal thinning. Our team has performed cycloplegic refractions for kids with significantly reduced vision at screening just before lockdown was introduced.

There has been a variety of conditions that I have had to deal with, from more routine conditions like marginal keratitis, uveitis, episcleritis, branch retinal

vein occlusions and lots of foreign body removals from DIY gone wrong, to some potentially sight and life-saving treatments. These included a few suspected giant cell arteritis episodes, a patient with a suspect temporal lobe lesion or stroke, a patient with amaurosis fugax with visible embolism, a few optic neuritis cases and one optic papillitis and an 80-year-old referred directly to accident and emergency with a stroke where she had a complete hemianopia.

During lockdown, we made video calls using a secure system and patients sent photos in advance of any potential appointments. We were able to deal with about half the cases remotely without seeing the patient face-to-face. I gave them advice and prescribed treatments remotely with follow ups to make sure that treatment was helping.

I have seen and learned a lot over the course of the pandemic. I feel that the work is more fulfilling as it seems like we are making more of a difference than ever.

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THIS MONTH

SPOTLIGHT

THIS MONTH VERSION REPRO OP SUBS ART

“Our first 2020 cohort was our largest ever, with more than 100 UK optometrists starting the course in March” Dr Eilidh Martin, Glasgow, Scotland

PRODUCTION CLIENT

I am a lecturer in vision sciences at Glasgow Caledonian University (GCU). My undergraduate teaching focuses on contact lenses and anterior eye. At a postgraduate level, I am the module leader for the first module on the independent prescribing course. I have been working as part of the IP team at GCU for three years now.

We decided to offer a second cohort of places for IP training in 2020 as there was a feeling among staff that optometrists may be more interested in pursuing their IP qualification following the outbreak of COVID-19. This could be due to optometrists having free time on their hands during lockdown or, thinking ahead, that optometrists may well take on an enhanced role in collaboration with the hospital eye service to manage more patients in the community. We had also seen how useful IP optometry was during the lockdown in minimising referrals into hospital.

A discussion took place with NHS Education for Scotland (NES). We have a long-standing,

collaborative relationship with NES and they have been incredibly supportive of our IP course since it started in 2009. NES shared our aspiration to use the current climate to fast-track optometrists and provided funding for a number of Scottish optometrists to commence their training in IP. We were thrilled with the response from optometrists to these extra IP training places, both those eligible for funding and those who were going to selffund. We had applications from roughly four times as many people as there were places available.

Our first 2020 cohort was our largest ever, with more than 100 UK optometrists starting the course in March. This was in place before the pandemic so shows the desire of optometrists to up-skill even before COVID-19.

We have seen the benefits of IP in action during lockdown with the creation of Emergency Eye Treatment Centres (EETCs).

This has allowed IP optometrists to diagnose and manage a wide range of conditions in the community and in hospital. They

have also provided a supporting role to non-IP optometrists. This has prevented unnecessary travel and unnecessary hospital visits.

Going forward, we can only assume that there will be a backlog of patients needing care from the hospital eye service and that this will be an opportunity for optometry to co-manage patients in the community. We have seen the further development of tele ophthalmology in the last few months; this combined with the IP qualification makes for a very exciting future in shared care.

We have had to adapt the course. Normally we welcome the students for two days of faceto-face teaching. This has not been possible during lockdown.

Recorded and narrated lectures have been important in lieu of the face-to-face teaching and to allow flexibility for the students as to when they view materials. We have used different types of software for online peer discussions. We hope to welcome our students back to campus for the practical workshops in the future, in line with the Government’s guidelines.

Get in touch Share your 'On the ground' COVID-19 experiences with the OT team selinapowell@optometry.co.uk

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MEMBER SUPPORT

AOP on your side The AOPâ&#x20AC;&#x2122;s policy team discussâ&#x20AC;Ś education

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The AOPâ&#x20AC;&#x2122;s policy team has been working to secure, and lobby for, support for members throughout the pandemic.

Now, as the profession moves into recovery, it is expected there could be a renewed focus on training and education. ´7KLV LV DQRWKHU DUHD VHULRXVO\ D HFWHG E\ WKH SDQGHPLF with universities moving to remote learning and preUHJ SODFHPHQWV XQGHU WKUHDW Âľ VDLG 7RQ\ 6WD RUG SROLF\ director for the AOP. â&#x20AC;&#x153;But there are also important proposals for long-term strategic changes to the way optometrists are trained in the UK, and we need to make sure those work in our membersâ&#x20AC;&#x2122; interests.â&#x20AC;?

The GOCâ&#x20AC;&#x2122;s Education Strategic Review has been running since 2016 and is in a consultation stage for feedback on a

new framework of requirements for education providers.

The AOP ran a survey in July to gather experiences of pre-reg supervision from recent graduates and supervisors, ZLWK WKH DLP RI VKDULQJ WKH Ă&#x20AC;QGLQJV ZLWK WKH *2& DQG gaining an understanding of how the current system works.

The policy team will be developing the AOPâ&#x20AC;&#x2122;s response to the consultation with the Policy Committee and AOP &RXQFLO 0U 6WD RUG VDLG ´:H KRSH DQG H[SHFW WKDW PDQ\ members will be interested in the proposals, so weâ&#x20AC;&#x2122;ll be encouraging them to feed in views to us.â&#x20AC;?

Members can get in touch on the AOP community forums, and via email at policy@aop.org.uk. For more details, read the full discussion on the OT website.

Supporting members through COVID-19 PRODUCTION

How the AOP has been sharing advice and resources over the past few months Financial and employment

Advice

CLIENT

With general dental services opening from 8 June, the Optometric Fees Negotiating Committee (OFNC) shared the potential implications for optical services in England The OFNC and AOP chairman shared an update on an expanded range of issues that could constitute essential care The AOP voiced its concerns over a video appearing to show a Specsavers practice colleague explaining how they were providing routine care, which would have been in breach of restrictions at the time The Domiciliary Eyecare Committee produced guidance for providing care for vulnerable patients The AOP shared a member email outlining its position on private sight testing following a GOC statement that led to some confusion on providing private care in lockdown After receiving confirmation that practices could provide the full range of GOS services, the AOP shared an update, signposting resources on returning to practice

In June, the AOP wrote to the Treasury for a third time, seeking an urgent response to its emails on the gaps in government support Responding to suggestions that COVID-19 support could cease at the end of June, the OFNC and the AOP raised concerns of a sudden end to support An AOP webinar explored employment law issues facing optometrists in England and Wales, particularly in light of COVID-19 With flexible furlough introduced from July, the AOP updated its guidance and shared a new template letter on the topic In an update on the funding discussions, the OFNC said it had received a â&#x20AC;&#x153;very limited proposalâ&#x20AC;? for temporary funding from NHS England, which it rejected as â&#x20AC;&#x153;inadequate and unworkableâ&#x20AC;?

The OFNC confirmed on 20 July that while negotiations with NHS England over further support were ongoing, previous levels of COVID-19 funding for GOS contractors in England would continue until the end of July

Resources The AOP shared updated FAQs on returning to work, covering the differences in essential eye care in England, Scotland, Wales and Northern Ireland The AOP and OT created guides for members on UV-C disinfection OT worked with the AOP student representative committee to pose key questions and concerns on the impact of COVID-19 to experts across the sector On 16 June, the AOP held a webinar for Scottish members, covering common issues encountered both in everyday practice, and during the COVID-19 crisis The AOP made the Infection Control and Prevention lecture video available to the wider practice team in response to feedback from members Following confirmation that practices in England could resume GOS, the AOP held a webinar to explore the return to routine services in England With locum optometrists facing unique challenges post-lockdown, the AOP held a webinar on negotiating contracts. For more on this, read â&#x20AC;&#x2DC;The Discussionâ&#x20AC;&#x2122; from page 43.

As face coverings became mandatory to wear in shops in England on 24 July, the AOP shared top tips for spectacle wearers to prevent lenses from fogging.

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AOP launches tool to help pre-reg members find placements The Pre-reg Register aims to support members who have lost their placements through the COVID-19 pandemic The AOP has launched the Pre-reg Register to assist pre-registration members looking for a placement.

The tool was launched in response to challenges brought about by the pandemic, with the AOP sharing: â&#x20AC;&#x153;We are aware that as a result of the coronavirus pandemic, some pre-registration students have lost their pre-reg placements.â&#x20AC;?

To help pre-reg optometrists looking for a placement, and those practices looking for a pre-reg, the AOP launched the register where students with active memberships can list their availability.

The register complements the AOPâ&#x20AC;&#x2122;s existing pre-registration vacancy list.

Both the pre-reg register and the vacancy list can be accessed at www.aop.org/students

Getty/invincible_bulldog

REPRO OP

As the focus moves to the future of training, members are encouraged to share their views

AOP EXPERT

Clinical

Policy

Dr Peter Hampson, AOP clinical director

Milo Barnett, public affairs officer

Could you outline some of the financial concerns of practices?

These can be broadly split into two areas: increases to the cost of seeing patients and a decrease in the number of patients that can be safely seen.

Increased costs take the form of personal protective equipment costs and increased infection control measures. The limitations on the number of patients is arguably the biggest challenge.

The reduction in patients has huge implications for practice viability, and in more deprived areas could be catastrophic.

That funding needs to provide support to those that need it most, for example, practices in deprived areas and who serve at-risk communities, such as those who require home visits.

In July, the NHS made a limited proposal that was inadequate and unworkable, and the OFNC wrote to the Secretary of State for Health and Social Care and the Minister for Primary Care.

Many people quite fairly thought the NHS sight test fee was undervalued before COVID-19, now many are wondering if they can afford to provide NHS care.

How has the AOP been working to call for COVID-19 funding?

Funding is discussed with NHS England via the Optometric Fees Negotiating Committee (OFNC), of which the AOP is a member.

We made an argument that funding needs to be provided on an ongoing basis due to the challenges discussed.

What areas you are focused on in for the weeks ahead?

Guidance still needs to be constantly updated in this everchanging world. Continuing to work on the funding challenge will be a main focus until it is resolved. After that, the AOP team has plans for new clinical and policy content.

Could you tell us about the project to share optometrists COVID-19 stories with MPs? It is important to convey what the sector does, and MPs will always talk about doctors and nurses but not optometrists.

When you write to an MP, you don’t want to list a series of technical requests that they don’t understand and probably won’t be interested in. That is why our greatest tool is our members, who are able to demonstrate what they

do on the ground and why it matters. By showing them what their local constituents are up to, it forms a better connection.

What do the stories cover?

The stories we have gathered have ranged from people going beyond the call of duty in delivering spectacles to the elderly on bicycles, to people who have had to think outside the box to help their patients. We are always looking for more.

What do you hope the project will achieve?

We hope to achieve a greater awareness among MPs around what our members do and we intend to form some strong relationships with MPs to enable us to ask questions and table debates in the House of Commons.

neubau-eyewear.com

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AOP EXPERT

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Cautious optimistism

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Contact lens manufacturers share their insight on the effect of COVID-19, and how the patient journey could shift in the future

ART PRODUCTION CLIENT

The coronavirus pandemic has affected all aspects of eye care, and the contact lens segment has not escaped the pressure.

A recent survey by Johnson & Johnson Vision found 43% of patients say they are wearing contact lenses less than before the lockdown.

“There is certainly a significant impact in the short-term,” explained Jakob Sveen, head of Northern Europe and general manager for UK and Ireland, Johnson & Johnson Vision.

With 89% of respondents saying they are likely to return to their normal contact lens wear, however, he added: “We are hopeful that the rebound will come.”

As other markets have opened ahead of the UK, contact lens manufacturers have considered how the recovery could play out.

Chantelle Cook, Alcon general manager, UK and Ireland, has observed that in some European markets they have seen some people “keen to get their lenses fitted.”

Using the phrase “cautiously optimistic” however, Ms Cook pointed to the local lockdown introduced in Leicester as a reason for a conservative approach.

to provide practices the opportunity to build on their knowledge. Speaking to OT, CooperVision's head of professional services, Krupa Patel, said the site has seen over 7000 attendees.

Kamlesh Chauhan, director of professional affairs, UK, Ireland, Nordics and DACH for Johnson & Johnson Vision has seen an “eagerness” from eye care professionals (ECPs) for online learning.

The company has supported more than 2500 ECPs through live training, along with 1200 support staff.

J&J have been running programmes to help get practices back to seeing patients, as well as streamlining the examination without compromising safety and quality. This includes an accredited peer workshop to explore how to welcome patients safely back into practice.

The team are also looking at how it can support ECPs to innovate their practice infrastructure. Calling this “critically important,” Dr Chauhan explained, “Getting home deliveries up and running was a transformational change for some.”

Protecting revenue streams Over the lockdown, subscription models for contact lenses have provided muchneeded income as practices closed their doors and faced restricted services.

Alcon has seen the numbers in its direct-to-patient scheme more than double, Ms Cook told OT. “I think that has been a really big lesson for everyone. Something that is a great service for people can also continue to keep your revenue stream and business afloat.”

A key takeaway from the crisis has been to “never assume business is always going to be fine,” Ms Cook suggested.

“I think it is really important that customers are reflecting on how they protect their businesses, not just for now, but in the future. Who knows what else is around the corner.”

Ms Cook explained the company is focusing on supporting practices to get more of their patients onboard a scheme.

CooperVision’s Ms Patel also noted the “strong business resilience” that contact lenses have offered, particularly for those offering a subscription model.

Direct-to-patient schemes could also offer a positive change to the customer journey. A recent consumer survey from CooperVision found that 78% of contact lens wearers agree their lenses should

Getty/ LaylaBird

78%

Education and idea sharing For some, the lockdown provided an opportunity for professional development and many suppliers launched new webinar content to meet this demand.

CooperVision brought forward the launch of its new eLearning platform

24 www.optometry.co.uk

OF CONTACT LENS WEARERS AGREE THEIR LENSES SHOULD BE DELIVERED TO THEIR HOUSE, RATHER THAN PICKING THEM UP IN-STORE

With new guidance released as practices return to routine services, CooperVision has compiled the key information into a free ‘mini module,’ and over the next few months, the company is reviewing its education plan to offer bite-sized content along with full sessions.

CooperVision is also exploring how it can adapt and tailor its approach for groups such as undergraduates, preregistration optometrists and trainee contact lens opticians.

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Below Menicon launched a virtual Toric Calculator to help practitioners in their initial selection of trial lenses

Reflections on the pandemic Krupa Patel, CooperVision “COVID-19 has challenged practitioners to operate and deliver patient care in ways they never knew before. It’s highlighted the vital role contact lenses play in practice revenue streams, as well as our patients’ lifestyles."

“We have to think about how we are going to bring the practice window, that normally prospective patients would have walked past, into their homes”

Chantelle Cook, Alcon

Dimple Zala, professional affairs manager UK/Ireland and Nordics for Bausch + Lomb, shares how the profession could adapt in the future be delivered to their house, rather than picking them up in-store.

"COVID-19 has shifted the way in which patients receive their contact lenses and we have seen a dramatic increase in the number of shipments sent to patients’ homes on behalf of their practitioners," Ms Patel explained. She suggested this presents an opportunity for practices to leverage subscription schemes and “protect retailer loyalty” while improving the customer journey.

Online shopfront Future approaches in practice could involve greater digital support suggested Neil Retallic, European professional services director for Menicon, including communicating through different channels, such as social media.

He highlighted that during the lockdown, many people were turning to social media as a source of information, and suggests the profession could utilise this to share information or guidance, and help patients to keep connected between appointments.

This has resulted in a desire amongst practices to leverage social media to better communicate with customers.

This is a trend Dimple Zala, professional affairs manager UK/Ireland and Nordics for Bausch + Lomb, believes will grow in the future.

“If you think about the reduction in footfall on the High Street, the fact that the general public may be less comfortable shopping on the High Street now, really the shopfront is now online,

and we have to think about how we are going to bring the practice window, that normally prospective patients would have walked past, into their homes.”

Ms Zala added, “The power of social media is the obvious way forward.”

COVID-19 has accelerated the adoption of online platforms, Ms Zala suggested, commenting: “I think online purchasing is here to stay, which we believe can be a good thing.”

Services such as home deliveries could be a positive step, Ms Zala suggested.

Alongside the established Bausch + Lomb Direct scheme, the company has plans to launch a new e-commerce feature that will enable practices to set up online reordering for their cashpaying patients.

“What this will do is hopefully enable the patient to stay with the practice but give them the freedom of paying as they go for their contact lenses,” Ms Zala said.

J&J has also highlighted the opportunities for the future of the sector.

Mr Sveen commented: “There are early conversations around – what are those green shoots of ideas that we can keep as we come out of recovery that make it a more convenient and much better experience overall for patients?”

However, the relationship between optometrist and patient will still be central, he said: “That engagement is at the heart of what the industry is all about, and that will not change.”

“I have three takeaways. Firstly, it’s important that customers reflect on how they protect their business. Secondly, how do we embrace technology to evolve? Thirdly, I ask that we work together as an industry to support each other."

Dimple Zala, Bausch + Lomb “I have been impressed at how the industry has come together, demonstrating great agility and perseverance through these uncertain times. It has been tough, and it has hit the industry drastically in several ways. There are some positives that can be taken out of this, but there are some real challenges."

Neil Retallic, Menicon “My message to the profession is you are doing a great job already, and you’ve made people feel a lot more comfortable and confident about accessing eye care services and support during these challenging times."

Kamlesh Chauhan, Johnson & Johnson Vision "It is impressive what the industry has achieved in what has been a challenging, unforeseen and unprecedented event. COVID-19 has highlighted the capability and capacity of eye care professionals in the community.

Remember what you do for patients. The impact an ECP can have on a person is immeasurable."

For more on COVID-19 and contact lens wear, read our CET article on page 68.

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Unlocking remote access REPRO OP

BiB Ophthalmic Instruments has highlighted a range of Optopol solutions that can be used from a distance, explaining that Optopol has unlocked parts of its software to allow for the use of remote access systems.

Solutions include Optopol’s REVO OCTs, which are PC-based and so can be operated through remote desktop software to take scans, save and analyse data. The company’s range of PTS Visual Field Analysers can also be used from a distance. www.bibonline.co.uk

FOCUSES ON...

OCT AND EQUIPMENT

SUBS ART PRODUCTION

Hit list

The trends, launches and looks

CLIENT

Evolving expectations Offering flexibility

Canon has highlighted several ways its Canon Xephilio OCT-A1 can be used from a distance. The first option would be to use longer cables, and a wireless keyboard and mouse to operate the device from up to five metres away. The device could also be operated from a tablet, or from another room over the network, using remote desktop software and a video meeting application to communicate with the patient. www.eu.medical.canon

In a recent survey, Zeiss found 74% of customers reported safety as a top priority in the return to a new normal. To support this, Zeiss flagged a number of its instruments that could support a contactless patient experience, including the Visufit 1000. The product offers 3D centration face scanning and a 180 degree view to help get patients the best lenses and frames for their requirements. It also highlights different lens and frame combinations. www.zeiss.co.uk/vision

Reducing contact

Heidelberg Engineering has showcased the benefits of its Spectralis device, noting that the platform can perform several imaging functions, which reduces the need to move a patient to different devices. As the device uses confocal scanning laser ophthalmoscopy to assess the health of the retina, the company said the patient’s eye does not need to be dilated, meaning they can drive to and from the appointment, without the need for someone to accompany them or use public transport. www.heidelbergengineering.co.uk

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LOOK

Q&A ME AND MY GLASSES

Optometrist and lifestyle blogger, Lizzy Yeowart, considers clear styles

SUBS ART PRODUCTION

‘Bocca’ by Face a Face

CLIENT

Twinkle Patel

‘Bocca’ by Face a Face comes in a choice of pearlescent colourways, each as wearable as the next. Light as a feather with architectural detail, this design is a joy to behold.

Face a Face, ‘Bocca’ designeyeweargroup.com

The practice owner and optometrist shares her thoughts on colourful eyewear and the importance of community

1

3

2

4

Once upon a time, I didn’t really think about eyewear shape. But over the last year or two, I have realised that frames with upswept or a cat’s eye style best suit me. They lift my cheekbones, which is only a good thing. My current favourite frames are a pair by White Optics, and the brand Infusion.

I always used to be in black frames. Once I entered independent optometry, I began to look at more colourful frames. After all, I wear colourful clothes, so why shouldn’t I do the same with my JODVVHV" 7KH\ DUH WKH ÀUVW DFFHVVRU\ people see on me. They are an LQWHJUDO SDUW RI FUHDWLQJ WKDW ÀUVW impression. I love reds, yellows and bold pinks.

I have worn spectacles for 30 years. It was my brother who was having problems with his vision, but my parents decided to take me for an eye exam at the same time.

Then I found out I had a problem with my left eye. It just goes to show how important regular eye exams are, even if there are no symptoms.

The impact of COVID-19 has been dramatic. One good thing that came out of the situation was that I had time to become more involved in the community. My practice became an NHS foodbank, I helped with deliveries in the selfisolation group, and I supplied visors to optometrists with the donations going back to creating more PPE.

‘DHP637-1’ by Daniel Hechter

Daniel Hechter revolutionised fashion in the 1960s, taking it to the streets and making it accessible for all.

This flattering soft green cat’s eye is the perfect complement to the trans-seasonal wardrobe.

Daniel Hechter, ‘DHP637-1’ shop.michael-pachleitner-group.com

‘Violet’ by David Green

In a world of mass production and replication, David Green is decidedly different. Inspired by the uniqueness of nature, every creation is a one-off and handcrafted from the finest raw materials.

David Green, ‘Violet’ www.greeneyewear.com

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Sportsi

Into the blue

REPRO OP

Bollé has launched a new sport model, Vulture, which the company suggests is ideal for water sports. The frame is available in a medium fit, features integrated side shields and Thermogrip hydrophilic rubber inserts on the side tips and nose pads. The model benefits from a series of lens treatments, such as Phantom+ that includes a polarising filter to provide extra protection against glare. It also includes anti-fog, hydrophobic and oleophobic (dirt-repelling) treatments. www.bolle.com

SHORTLIST THE LATEST PRODUCT LAUNCHES

SUBS

Spectacles

Fashion forward

ART

Levi Strauss & Co has launched its new eyewear collection in Europe, designed and manufactured in partnership with Safilo Group. The range includes 16 sunglasses and 19 optical frames. Styles range from square models to retro-inspired frames, while colours include a range of blues, inspired by Levi’s denim line, as well as gold and orange mirror lenses and classic black, brown and grey tones. www.safilogroup.com

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Lenses

PRO Tech lenses Bausch + Lomb has announced the European launch of its first extended depth of focus intraocular lens (IOL), LuxSmart, and a new monofocal IOL, LuxGood, both featuring preloaded delivery systems. The products utilise what the company calls “pure refractive optics (PRO) technology,” which it suggests means patients are less likely to experience dysphotopsia.

LuxSmart and LuxGood also feature proprietary acrylic hydrophobic cross-linked copolymer material with an ultraviolet absorber, protecting the eyes against ultraviolet light. www.bauschhealth.com

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Sunglasses

Summer hues Monokel Eyewear has released its Spring/ Summer 2020 collection, with plant-based tortoiseshell and recycled black acetate frames and new seasonal hues including transparent red and deep purples. The collection features a range of twists on the cat’s eye shape with the ‘Moon’ (pictured), ‘Hilma’ and ‘June’ models, while the ‘Otis’ and ‘River’ sunglasses offer lightweight frames and sharp angles. www.monokel-eyewear.com

To feature in OT’s Hit list, contact kimberleyyoung@ optometry.co.uk

Spectaclesi

London luxury Sunglasses brand, Taylor Morris, has launched its first full optical collection in a range inspired by, and named after, South West London. Frames include the Windsor rim SW12, to an optical variant of the classic rollright style, which was one of the first frames the brand designed. As well as being available at the Taylor Morris Space in Notting Hill, the collection is available for practices to stock. The brand also plan to launch a business-to-business platform to simplify the ordering process. www.taylormorriseyewear.com

Materials

Tidal trends Inspecs has created a new sustainable frame for O’Neill, called Wove. The Wove frames are created from recycled ghost fishing nets (those lost or left in the ocean) with mineral and recyclable glass lenses, and touchpoints made of recycled rubber. The hangtag is water-soluble, while the sunglasses case is also made from recycled plastic bottles. www.inspecs.com

Sunglasses

Colour lovers Marcolin has shared a new capsule collection from Guess with music artist J Balvin, inspired by his March album. The Guess x J Balvin Colores collection features three styles including the squared GU8224 (pictured), the rectangular and narrow GU8225, and the feminine cat’s-eye, GU8226. The collection is available in colours including Havana blue acetate and orange crystal acetate, Havana green acetate and green crystal acetate, and Havana amber and light crystal acetate. www.marcolin.com

August /September 2020

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BEHIND NEW THE BRAND WOMEN’S EYEWEAR

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CEO, Nicola Del Din, discusses re-starting manufacturing after COVID-19

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BLACKFIN

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Blackfin's brand is built around three pillars, with the company ethos of authentic Italian production at the heart, as well as respect for those involved in production, for the environment and for the company’s roots Second in the company’s core pillars is its core material, titanium The final pillar reflects the brand’s desire to always be "looking beyond."

How has the outbreak of coronavirus affected Blackfin?

During the lockdown in Italy, we stopped manufacturing from the second half of March and resumed in midApril. The warehouse and customer service remained operational as the industry was exempt from closing; glasses are considered a medical device. Commercial activity resumed in May, but we had to wait until the end of July to see activity restart in earnest.

What new products should customers be aware of?

We have recently launched a new line of optical frames, Blackfin Razor. Made from 1mm titanium sheet, the styles are crafted using special micromechanical processes we custom-engineered for these frames. It’s a step forward in our research and development.

What are the company’s plans for the next 12 months?

I always think positively, but I’m also realistic. The lockdown dramatically affected business all over the world. We suffered, and had to review our business plan, but our company is totally independent and we can trust in our financial stability. This is why we decided to present the new Autumn/Winter collection in July. We want to spread a positive message to our clients.

Clockwise from top: As operations began again following the pandemic, Blackin launched its 'Timeless Memories' campaign video; CEO, Nicola Del Din; the new 'Annie' frame from the Blackfin Razor collection

STYLE

NOTES For each publication, OT columnist, Lizzy Yeowart, considers a dispensing scenario.

This edition: a 55-year-old on a walking 'staycation'

Top of the tech

‘Spark’ by Julbo is a must-have for walkers who want a single pair of elegant, high-performance photochromic sunglasses. A technical bridge and sides make sure they stay in place.

Julbo, ‘Spark,’ www.julbo.com

Lizzy says "The most protective sunglasses are wraparound, opaque styles that protect the eyes from incidental ambient light entering from the side.

Rubberised ear and nose pieces make the frames more secure."

Feel the curve

The Bollé Boxton rubber Tortoise Pool prescription sunglasses can correct up to -8.00/+ 6.00 spheres and 4 dioptres of cyl.

Wraparound recalibration software ensures the prescription is altered to account for the curve.

Bollé, ‘Boxton,’ www.bolle.com

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Perspectives Voices from optics and beyond

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It is difficult to look far ahead with certainty, but professional support from the AOP is constant

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FULVLV XQIROGHG $ PLQL PHOWGRZQ E\ \RXUV WUXO\ was averted and instead I and the team have VHW DERXW DGDSWLQJ WKH education programme for the virtual world.

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OT has played a key part in supporting 0\ ÂśĂ&#x20AC;UVW¡ WULS WR WKH SXE VHUYHG DV DQRWKHU PHPEHUV WKURXJK LWV &(7 R HULQJ DV ZHOO LV LWV H[DPSOH RI WKH EUDYH EXW EL]DUUH QHZ ZRUOG around-the-clock coverage of the news. In this ZH QRZ LQKDELW $SSUHKHQVLYHO\ KDQGLQJ RYHU edition alone we have seven GOC competencies contact details, sanitising hands and traversing covered for optometrists, including an DQ HODERUDWH RQH ZD\ V\VWHP ² DQG DOO GRQH WR article on severe acute respiratory syndrome get my paws on a pint of shandy and a packet of FRURQDYLUXV DQG FRQWDFW OHQV ZHDU E\ -DVSUHHW KP dry roasted.

Sajjan (page 68). ,W LV GL FXOW WR ORRN WRR IDU DKHDG A growing archive ZLWK FHUWDLQW\ EXW WKH $23 VWDQGV ,W VHHPV OLNH DQ DJH VLQFH WKH $23 â&#x20AC;&#x153;I have UHDG\ WR VXSSRUW RXU PHPEHUV LQ R FHV ZHUH DEUXSWO\ FORVHG witnessed the coming weeks and months at the point of lockdown. meticulous plans for whatever the future may hold. $GPLWWHGO\ WKHUH ZHUH D :KDW GRHV FRQWLQXH DOEHLW couple of punch-drunk delivery of face-to-face GL HUHQWO\ LV WKH SODQQLQJ days as we all scurried to education in 2020 being SURFHVV IRU WKH Ă DJVKLS HYHQW construct workstations in torn into everLQ WKH $23¡V FDOHQGDU IRU disused corners of home. smaller shredsâ&#x20AC;?

2SWLFDO 7KH QHZV Nevertheless, almost without that the FMO and Media 10 have SDXVH WKH YDULRXV WHDPV VHW DERXW joined forces to support a show that HQVXULQJ ZH ZHUH DEOH WR SURYLGH EULQJV WKH ZKROH VHFWRU WRJHWKHU HDFK LPPHGLDWH VXSSRUW WR PHPEHUV GXULQJ \HDU LV ZHOFRPH $V WKH R FLDO SDUWQHU WR WKH the coronavirus crisis, including a 20% reduction event, and the provider of education, we will RQ IHHV IRU 8. SUDFWLVLQJ PHPEHUV DW WKH HDUOLHVW EH ZRUNLQJ KDUG WR VXSSRUW DQG JXLGH WKH opportunity. profession in what is a transformed landscape. ,Q P\ UROH DV KHDG RI HGXFDWLRQ DW WKH $23 ,¡YH ZLWQHVVHG PHWLFXORXV SODQV IRU GHOLYHU\ RI IDFH WR IDFH HGXFDWLRQ LQ EHLQJ WRUQ Dr Ian Beasley is clinical editor of OT and head into ever-smaller shreds as the COVID-19 of education at the AOP

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August /September 2020

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What is your view?

Email OT with your comments newsdesk@ optometry.co.uk Journal of the Association of Optometrists years

ÂŁ9.95

August/September 2020 Volume 60:07

www.optometry.co.uk

My vision Jesse Dufton Page 39

Page xx

THE GROWING QUEUE FOR NHS TREATMENT AND HOW OPTOMETRISTS CAN EASE THE BURDEN ON SECONDARY CARE

CET SARS-COV-2 and the safety of contact lens wear

Perspectives Patient care at Birmingham and Midland Eye Centre

In practice Hamza Mussa on tackling racism head-on

Page 68

Page 36

Page 48

Coronavirus support

Visit the AOPâ&#x20AC;&#x2122;s dedicated section for members online www.aop.org.uk/ coronavirus

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Our hospital services have continued to evolve at Birmingham and Midland Eye Centre Dr Waheeda Illahi

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he recovery phase for ophthalmology, optometric, orthoptic and diagnostic services started at the Birmingham and Midland Eye Centre (BMEC) in mid-May 2020.

The number of in-patients with coronavirus (COVID-19) stabilised and the Government changed the message from â&#x20AC;&#x2DC;Stay home. Protect the NHS. Save livesâ&#x20AC;&#x2122; to â&#x20AC;&#x2DC;Stay Alert. Control the virusâ&#x20AC;&#x2122; and the easing of national lockdown began.

There continues to be a variation in the delivery of ophthalmology services throughout the UK. Some hospital departments are starting to build on the skeleton service cover they provided during the pandemic. Others continue WR VX HU IURP VWD UHGHSOR\PHQW DQG DUH RQO\ DEOH WR R HU PLQLPDO VHUYLFHV As a tertiary service, BMEC needed to support â&#x20AC;&#x153;This has not been urgent services and develop an easy transition. plans to restore and deliver During the early weeks moderate and routine of the COVID-19 ophthalmic services. As of 8 July, we are seven crisis, the multitude of weeks into the recovery unknowns and a lack phase, with most telephone of specific government and virtual consultations guidance for hospitalreplaced by face-to-face based care resulted in a attendances. breakdown of normal This has not been an easy transition. During the early service deliveryâ&#x20AC;? weeks of the COVID-19 crisis, the multitude of unknowns and a lack of VSHFLĂ&#x20AC;F JRYHUQPHQW JXLGDQFH IRU KRVSLWDO EDVHG care resulted in a breakdown of normal service delivery. The level of service we were expected to provide as service leads was ever-changing. ,W ZDV GL FXOW WR PDQDJH VWD FRQFHUQV DQG expectations as they made comparisons with colleagues working in other hospitals and the community who had vastly reduced workloads My priorities OT speaks to the or were working from home.

profession about practice post COVID-19 www.optometry. co.uk/coronavirus

Redeployment experience As discussed in our previous article in OT, as the pandemic developed, both locally and nationally,

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doctors, nurses, optometrists, orthoptists and other allied health care professionals were UH GHSOR\HG WR EDFNĂ&#x20AC;OO RWKHU FOLQLFDO UROHV HQDEOLQJ QXUVLQJ DQG PHGLFDO VWD WR PRYH WR frontline care.

The fear and anxiety of the early days when WKH UH GHSOR\HG VWD GLG QRW NQRZ ZKDW OHYHO of exposure they would have to COVID-19positive patients, and whether they would have adequate PPE, was overwhelmingly outweighed by their willingness to help the greater cause.

Optometrists and orthoptists moved to non-ophthalmic outpatient specialities and wards, having to adapt to working within GL HUHQW PXOWL GLVFLSOLQDU\ WHDPV LQ YHU\ GL HUHQW UROHV Optometrists worked on in-patient wards providing communication links between patients, family members and other healthcare professionals. They played a vital role at a time where there was, and still continues to be, national restrictions on relatives visiting.

Patientsâ&#x20AC;&#x2122; relatives were greatly appreciative of the service. Some of the orthoptic team remain on re-deployment to the Breast service, acting as patient chaperones. These re-deployments, ZKLOH GL FXOW IRU XV DV VHUYLFH OHDGV WR PDQDJH KDYH JLYHQ VWD OLIH VNLOOV WKDW ZLOO KDYH D VLJQLĂ&#x20AC;FDQW EHQHĂ&#x20AC;W WR WKHP DV FOLQLFLDQV Managing the challenges Compliance with social distancing rules remains the biggest challenge; it seriously limits the number of outpatients that can be accommodated in our hospital. The reduction of the social distancing rule to one metre has given us the potential to increase our activity.

,Q DGGLWLRQ ZH VWLOO KDYH VWD UH GHSOR\HG shielding or restricted to non-patient contact roles. Throughput needs to increase to manage the backlog of patients and the expected surge of referrals from GPs and community optometric practices.

Specialist services such as our paediatric electrophysiology and genetics services have resumed, and we are about to resume clinical trials.

Our services are diagnostic and therapeutic, and as such do not easily lend themselves to telephone and video assessment. The challenge remains to think of innovative methods of delivery, balancing patient and VWD VDIHW\ ZLWKRXW FRPSURPLVLQJ FOLQLFDO care.

Personal protective equipment guidance KDV FKDQJHG VLJQLĂ&#x20AC;FDQWO\ RYHU WKH FRXUVH RI WKH SDQGHPLF ZLWK KRVSLWDO VWD R FLDOO\ informed that face masks were not required in the early stages of the pandemic unless VWD ZHUH ZRUNLQJ GLUHFWO\ ZLWK &29,' positive patients, to the current guidance that makes face masks/coverings mandatory for DOO VWD FOLQLFDO DQG QRQ FOLQLFDO 5HGXFLQJ WKH minimum social distance emphasised the need for adequate facial coverings, particularly in ophthalmology.

A path to the new normal 3DWLHQWV DWWHQGLQJ RXU 7UXVW DUH R HUHG IDFH masks at the point of entry into the hospital. &OLQLFDO VWD PXVW ZHDU DSSURSULDWH 33( including surgical face mask, face shield or goggles, apron and gloves, at all times.

Additional protection in the form of a Perspex VKLHOG KDV EHHQ Ă&#x20AC;WWHG WR DOO VOLW ODPSV LQ OLQH ZLWK JXLGDQFH IURP WKH 5R\DO &ROOHJH RI Ophthalmologists.

Our Trust has agreed to provide KN95 face masks, which we believe are necessary for close diagnostic examination such as paediatric examination.

There are practical challenges that arise from WKH XVH RI 33( 6XUJLFDO IDFH PDVNV GR QRW Ă&#x20AC;W tightly to the face. Adjacent surfaces, such as goggles or face shields, steam up and make H[DPLQDWLRQ YHU\ GL FXOW

Optometrists have also complained about distorted retinoscopy UHĂ H[HV XVLQJ JRJJOHV or face shields. Contact OHQV Ă&#x20AC;WWLQJ FDQ EH FKDOOHQJLQJ when wearing gloves, with contact lens removal being SDUWLFXODUO\ GL FXOW Paediatric patients in particular are often frightened E\ VWD LQ XQLIRUP DQG WKH addition of face mask, gloves and goggles heightens the level of fear. We have all been issued with badges to wear over our PPE that show patients what our face actually looks like.

It is likely that face masks and other PPE being used currently in ophthalmology will become a permanent feature of a post COVID-19 world, as community immunity does not exist now or in the foreseeable future.

In addition to changes in clinical services, the replacement for meetings has been provided by software such as WebEx, Microsoft Teams and Zoom. This has been a positive outcome from the pandemic; there are distinct advantages in holding meetings and webinars remotely, and it greatly reduces the need to increase our carbon footprint E\ WUDYHOOLQJ RU WKH WLPH VSHQW Ă&#x20AC;QGLQJ meeting and conference rooms. However, it is challenging to be able to contribute to a group discussion. You are required to wave your hand to draw attention to yourself or ZDLW IRU \RXU WXUQ PDNLQJ LW GL FXOW WR provide constructive criticism. And the loss of networking opportunities has changed the interaction needed in multi-disciplinary teams such as ours.

Our hospital services continue to evolve â&#x20AC;&#x201C; as we do with them. But we are open for business and encourage all of the community optometrists in our catchment area to refer patients through the normal pathways including urgent and routine.

Dr Waheeda Illahi is head of optometry services at the Birmingham and Midland Eye Centre. The article is co-authored Rosie Auld CBE, head of orthoptic services, and Dr Peter Good, consultant neurophysiologist.

December 2020 2017 August /September

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It was the hardest of all my redeployment roles â&#x20AC;&#x201C; but the experience has diversified my skills and knowledge Rose Wright

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work as head of optometry and orthoptics at the Shrewsbury and Telford Hospitals NHS Trust. During the COVID-19 pandemic, while retaining my responsibilities in my substantive role, I was part-redeployed to support other departments in their response to the pandemic.

Redeployment has grown both my network of FRQWDFWV DQG GLYHUVLĂ&#x20AC;HG P\ KHDOWKFDUH NQRZOHGJH and skillset. I have a much better knowledge of PPE and a greater appreciation of the complexity involved in keeping people as safe as possible, while providing data to aid the ongoing management of the pandemic. I look forward to returning to my ophthalmology clinics soon with my new and improved email address book.

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â&#x20AC;&#x153;I fitted visitors with FFP3s so that they could visit their relatives in ITU. This would always be an emotional timeâ&#x20AC;?

Roseâ&#x20AC;&#x2122;s top tips Read Roseâ&#x20AC;&#x2122;s eight steps for safe practice in a hospital setting online www.optometry. co.uk/coronavirus

My four redeployment roles Door triage Back in April and May, members of ophthalmology â&#x20AC;&#x201C; including doctors, orthoptists and optometrists â&#x20AC;&#x201C; rotated door shifts at the buildingâ&#x20AC;&#x2122;s entrance ZKLOH KHDOWKFDUH DVVLVWDQWV DQG VWD nurses were needed on the wards. It was fun â&#x20AC;&#x201C; you felt like you were really on the front line and helping to protect patients, colleagues and visitors.

Hood training 6WD ZKR IDLOHG WR Ă&#x20AC;W ))3 UHVSLUDWRU PDVNV EXW were required to enter red zones in the hospital â&#x20AC;&#x201C; that is, high risk areas containing isolated infectious patients â&#x20AC;&#x201C; or carry out aerosol generating procedures, have to wear PAPR units with helmet headtops. These are colloquially known as â&#x20AC;&#x2DC;hoods.â&#x20AC;&#x2122; 6WD QHHG XVHU WUDLQLQJ EHIRUH WKH\ XVH D KRRG IRU WKH Ă&#x20AC;UVW WLPH DV WKH\ QHHG WR XQGHUVWDQG KRZ WKH unit works, what the automated warning signals mean, and what action to take if the signal sounds.

The hood stock was controlled by the theatre team. It was good to be exposed to another world, consisting of conversations about major surgeries and intensive care. I have the utmost respect for the team as they are the main team that care for the critically ill COVID-19 patients.

38 www.optometry.co.uk

FFP3 fit testing ))3 UHVSLUDWRUV DUH QHJDWLYH SUHVVXUH GHYLFHV ZRUQ WR SURWHFW VWD RU YLVLWRUV LQ UHG ]RQHV LQ hospitals. They need to be worn with adherence WR PDQXIDFWXUHU LQVWUXFWLRQV 7KH\ PXVW EH Ă&#x20AC;W tested and donned correctly. The straps that go over the wearerâ&#x20AC;&#x2122;s head must not be crossed. The ZHDUHU SHUIRUPV D Ă&#x20AC;W WHVW WR HQVXUH WKH PDVN KDV sealed correctly on the face each time they don an ))3 EXW WKLV LV QRW DQ DGHTXDWH UHSODFHPHQW IRU D Ă&#x20AC;W WHVW )LW WHVWV FDQ EH GRQH VXEMHFWLYHO\ E\ WDVWH D TXDOLWDWLYH Ă&#x20AC;W WHVW RU REMHFWLYHO\ XVLQJ DPELHQW SDUWLFOH FRXQW D TXDQWLWDWLYH Ă&#x20AC;W WHVW , DORQJ with several orthoptists, was trained to perform D TXDOLWDWLYH Ă&#x20AC;W WHVW VXEMHFWLYHO\ XVLQJ %LWUH[ D bitter tasting chemical. The wearer was tested in a controlled environment performing several timed actions. If they could taste the Bitrex, the mask GLG QRW Ă&#x20AC;W DQG DQ DOWHUQDWLYH PDVN RU D 3$35 unit/â&#x20AC;&#x2DC;hoodâ&#x20AC;&#x2122; was recommended. , DOVR Ă&#x20AC;WWHG YLVLWRUV ZLWK ))3 V VR WKDW WKH\ could visit their relatives in the ITU. This would always be an emotional time.

Tactical commander in the incident room This was an impressive title â&#x20AC;&#x201C; and the hardest of all my redeployment roles. I had previously wondered how the daily statistics on COVID-19 tests and deaths arrived onto the internet. As a tactical commander, I compiled data from several emails and databases and uploaded them to Government websites.

The information relating to COVID-19 patients ZDV UHWULHYHG IURP DP DQG ZDV XSORDGHG WR D FRPSOLFDWHG IRUP E\ DP DQG VXEPLWWHG IRU approval. I worked with a loggist and strategic commander. We also had a minute-taker at the peak of the infections. Together we ran the Trustâ&#x20AC;&#x2122;s incident room. The news was on permanently in the room in case of a national incident. Other data, such as PPE stock levels, would be escalated if required.

The whiteboards were full of tasks and data, which would be updated throughout the day.

I never thought I would be sending so many emails to the chief executive. If you needed information from someone, you would email them with a time deadline â&#x20AC;&#x201C; I think I may adopt this strategy into normal practice. I also realised that if I rang my department from the incident URRP P\ FDOOHU ,' KDG TXLWH DQ RPLQRXV H HFW Rose Wright is head of optometry and orthoptics at the Shrewsbury and Telford Hospitals NHS Trust

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â&#x20AC;&#x153;You develop a sixth sense about which is the right way to goâ&#x20AC;?

Jesse Dufton

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&OLPEHUV XVXDOO\ FDOO WKH PRVW GL FXOW VHFWLRQ RI he more you know about what is involved in a route a crux. The crux on the Old Man of Hoy was climbing, the more people are surprised about GHĂ&#x20AC;QLWHO\ WKH &R Q 3LWFK 2QFH \RX KDYH GRQH WKDW what Iâ&#x20AC;&#x2122;m doing. Members of the general public are like, â&#x20AC;&#x2DC;Wow, he is climbing up a rock.â&#x20AC;&#x2122; But those who LW LV WKH PRVW GL FXOW ELW RYHU , KDG WKDW IHHOLQJ RI know more about what is involved are like, â&#x20AC;&#x2DC;Oh Godâ&#x20AC;Śâ&#x20AC;&#x2122; HQMR\PHQW DQG UHOD[DWLRQ IURP WKH VWDUW RI WKH Ă&#x20AC;QDO pitch, the open book corner. It is the best rock quality , DP QRW WKH Ă&#x20AC;UVW EOLQG FOLPEHU WR FOLPE WKH 2OG at that point. I could enjoy the moment.

0DQ RI +R\ EXW , DP WKH Ă&#x20AC;UVW EOLQG SHUVRQ WR OHDG LW 0\ GDG WRRN PH XS P\ Ă&#x20AC;UVW WUDG >WUDGLWLRQDO Climbers climb in pairs, one leader and one seconder.

FOLPELQJ@ URXWH ZKHQ , ZDV WZR DQG , OHG P\ Ă&#x20AC;UVW Leading is far more demanding than following, and route outside when so climbers prize leading I was 11. Climbing is highly. something that I have You canâ&#x20AC;&#x2122;t totally always done and it is eliminate the fear but you a big part of my life. need to learn to function My parents always while you are still scared. encouraged me. The Climbers are always quite fact that my eyes didnâ&#x20AC;&#x2122;t understated. You can be work properly was never â&#x20AC;&#x2DC;mildly perturbedâ&#x20AC;&#x2122; about a thing for them. Iâ&#x20AC;&#x2122;m the fact that it is 10 metres grateful that they didnâ&#x20AC;&#x2122;t since your last piece of wrap me in cotton wool. gear but if you totally let I have rod cone that dominate you then the dystrophy. When I was outcome isnâ&#x20AC;&#x2122;t good. You born, I had 20% of central have to press on and keep vision and no peripheral the fear genie in the bottle. â&#x20AC;&#x153;With the right attitude and with vision. The analogy I use Whoever your climbing for my vision is to imagine partner is, you trust them planning, you would be amazed with your life â&#x20AC;&#x201C; literally. at what you can still do with sight lossâ&#x20AC;? you are looking down a drinking straw and there is Molly and I have been VL[ OD\HUV RI FOLQJ Ă&#x20AC;OP VWUHWFKHG RYHU WKH HQG climbing for over 10 years together. We have done 3DUW RI WKH UHDVRQ WKDW , GHFLGHG WR PDNH Climbing more than 1000 routes. As a consequence, when she is Blind is that if my story can help a younger version of guiding me, she knows how I climb. She can almost me or the parents of a younger version of me, then it read my mind. She will be looking up at me as I am on is worth it. With the right attitude and with planning, the wall, see me slightly twitch my right ankle and she will know that means that I need to move my right foot you would be amazed at what you can still do with sight loss. and she will just tell me where to put it.

Climbing is not for everyone, but that doesnâ&#x20AC;&#x2122;t mean There was a section on the Old Man of Hoy where you canâ&#x20AC;&#x2122;t learn to play an instrument or some other Molly couldnâ&#x20AC;&#x2122;t see me. It is technically quite easy, but challenge that might seem improbable at the outset. there is that worry about what happens if you go the If you can work out what the challenges are going wrong way. Because I have been doing this for so long, to be in advance and then work out problem solving you develop a sixth sense about which is the right way methods to address those challenges, then that is half to go. If you come across lichen, then you are probably the battle.

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Patient leaflets The AOP has produced a series of downloadable eye condition leaflets www.aop.org.uk/patients

Jesse Dufton, 34, is a rock climber and patent engineer. His journey to becoming the first blind person to lead climb the Old Man of Hoy is captured in Alastair Leeâ&#x20AC;&#x2122;s award-winning documentary Climbing Blind (available on BBC iPlayer).

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REPRO OP

45 Pre-reg focus SUBS

This yearâ&#x20AC;&#x2122;s pre-reg contributors reflect on how COVID-19 changed the course of their year

47 The workshop

Gordon Ilett on best practice when offering domiciliary care to patients who are still shielding

48 How I got here

Hamza Mussa, aka The Crazy Optom, on slit lamp photography and campaining for change

PRODUCTION CLIENT

Negotiating fees as a locum Isle of Wight-based locum optometrist, Rebecca Rushton, and learning and development consultant, Trevor Bibic, discuss how locums can up their negotiation game in a post-lockdown world

Getty/Kubkoo

D

ecreased availability of work and downward pressure on rates are just two of the issues that locums have faced in recent months. Fees have the potential to vary wildly, depending on location and SUDFWLFH FDVK Ă RZ $GGHG WR this is a new conversation

around supply of personal protective equipment (PPE), and the safety of practices that locums are walking into.

The good news is that, as a locum, the answers to these challenges are within reach â&#x20AC;&#x201C; for those who have the skills to negotiate.

From discovering optics by accident in Nepal to owning a practice on the Isle of Wight

than the optom in the next room.â&#x20AC;?

Trevor Bibic, a learning and development consultant, thinks that if you believe the fee youâ&#x20AC;&#x2122;re asking for is fair, it will â&#x20AC;&#x153;come across in your communication. You should be so clear on the value and EHQHĂ&#x20AC;WV WKDW \RX EULQJ WKDW youâ&#x20AC;&#x2122;re shocked by a low R HU DQG IHHO FRQĂ&#x20AC;GHQW DQG UHDG\ WR FRXQWHU WKDW R HU Âľ He recommends building up the â&#x20AC;&#x153;library of EHQHĂ&#x20AC;WV WKDW \RX EULQJ WR organisations as you go.

Donâ&#x20AC;&#x2122;t stop with the handful you might pick up today â&#x20AC;&#x201C; keep going.â&#x20AC;?

ART

THE DISCUSSION

50 Business ownership

Communicating value

When negotiating, the experts emphasise, locums need to be aware of the value their skills hold.

Otherwise, it is going to be hard to secure the appropriate rates.

Locum optometrist Rebecca Rushton believes that thereâ&#x20AC;&#x2122;s a taboo around pay. She says: â&#x20AC;&#x153;In this country, itâ&#x20AC;&#x2122;s not the done thing to discuss earnings with colleagues and it can EH YHU\ GL FXOW WR NQRZ your monetary value. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;ve undervalued myself in the past and LW¡V IUXVWUDWLQJ WR Ă&#x20AC;QG RXW that youâ&#x20AC;&#x2122;re getting paid VLJQLĂ&#x20AC;FDQWO\ OHVV

Identifying practice need

Mr Bibic explains that, when negotiating, people tend to stop after stating the advantages they will bring.

To move the conversation on, locums should ask: â&#x20AC;&#x153;Why does this person actually care about that?â&#x20AC;?

Donâ&#x20AC;&#x2122;t just describe the advantages, Mr Bibic advises, but also think about what this allows the practice owner to do.

Mr Bibic uses the example of being an independent prescriber, meaning â&#x20AC;&#x153;I can treat patients without referring to the hospital, and this makes things more convenient.â&#x20AC;?

August /September 2020

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In practice

Business insight and career development

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IN PRACTICE DISCUSSION, 2

and Iâ&#x20AC;&#x2122;m ok with that,â&#x20AC;? she says. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m not ok with rates being kept low when business is steady again.â&#x20AC;?

She adds: â&#x20AC;&#x153;I try to give and get as much information as possible to HQVXUH D JRRG Ă&#x20AC;W EHWZHHQ myself and the practice. Iâ&#x20AC;&#x2122;m not afraid to decline work that I think might not be a JRRG Ă&#x20AC;W Âľ

SUBS ART

Renegotiating contracts

PRODUCTION CLIENT

He adds: â&#x20AC;&#x153;Where you have that additional skill in your practice, youâ&#x20AC;&#x2122;re going to encourage more people to come. That increases your competitive advantage. Now itâ&#x20AC;&#x2122;s going to be harder for me, as the practice owner, to bargain you down, because youâ&#x20AC;&#x2122;ll EULQJ PH VRPH VLJQLĂ&#x20AC;FDQW EHQHĂ&#x20AC;WV DQG \RX¡YH WKRXJKW about what my needs are.â&#x20AC;?

Ms Rushton agrees: â&#x20AC;&#x153;This year Iâ&#x20AC;&#x2122;ve decided to state my interest in anterior eye,â&#x20AC;? she says. â&#x20AC;&#x153;If a client focuses on refractive surgery, contact lenses or dry eyes then I know that Iâ&#x20AC;&#x2122;m the optometrist for them.â&#x20AC;?

How to prepare

So, how do you prepare?

The experts told OT that you need to have a good sense of what is fair, what youâ&#x20AC;&#x2122;re aiming for, and what is most important to you. At the moment, this might be a guaranteed stock of PPE provided by the practice.

Mr Bibic points out that the

44 www.optometry.co.uk

more you can help them with that challenge, the easier it is going to be to justify your rate. â&#x20AC;&#x153;If they are uncertain about how to handle PPE with locums, you can say, â&#x20AC;&#x2DC;well, Iâ&#x20AC;&#x2122;ve got some great ideas for this, and Iâ&#x20AC;&#x2122;d be happy to discuss them further with youâ&#x20AC;Śâ&#x20AC;&#x2122; â&#x20AC;&#x153;That sense that youâ&#x20AC;&#x2122;re working with them on a solution is going to mean that itâ&#x20AC;&#x2122;s easier for you to explain why youâ&#x20AC;&#x2122;re worth more money, and easier for them to accept that theyâ&#x20AC;&#x2122;re going to pay a bit more for somebody whoâ&#x20AC;&#x2122;s engaged and proactive,â&#x20AC;? he said.

Ms Rushton agrees that, at the moment â&#x20AC;&#x153;money isnâ&#x20AC;&#x2122;t everything. Sometimes negotiating testing times, or someone to do pre-testing, might be more important.â&#x20AC;?

Ms Rushton and Mr Bibic note locums should think about how long they want to spend on the negotiation.

Their advice is to put time aside and set ground rules, ask the practice owner how much time they will have to talk on a certain day at a certain time â&#x20AC;&#x201C; and change it if itâ&#x20AC;&#x2122;s not going to be long enough â&#x20AC;&#x201C; and make sure they know what information will be needed.

What if, despite all this, walking away with no agreement is the only option? Ahead of the discussion, Mr Bibic advises thinking about alternative plans. This is a powerful preparation tool.

Ms Rushton isnâ&#x20AC;&#x2122;t afraid of standing her ground. â&#x20AC;&#x153;I accept that rates may be lower as volume is lower,

â&#x20AC;&#x153;Focus on the most you can give and the most you can get for yourself, rather than how quickly you can reach a financial agreementâ&#x20AC;?

Trevor Bibic

Ms Rushton and Mr Bibic agree that, while reviewing contracts with existing clients might be awkward, itâ&#x20AC;&#x2122;s vital that the relationship is treated as an evolving process. There can be value for both sides in having the discussion, and it can make the relationship DQG VHUYLFH R HUHG VWURQJHU Itâ&#x20AC;&#x2122;s important to ask open questions and address the required changes.

Locums with experience in the practice have an advantage, Mr Bibic says.

If theyâ&#x20AC;&#x2122;re renegotiating, circumstances have likely changed. Itâ&#x20AC;&#x2122;s reasonable to point this out, and ask how things could be adjusted in terms of contract or pay.

0V 5XVKWRQ LV FRQĂ&#x20AC;GHQW about the future. â&#x20AC;&#x153;This is the time to prove how invaluable you are, and to remember that everybody is trying to get used to an ever-changing landscape so ZH DOO QHHG WR EH Ă H[LEOH Âľ she says. â&#x20AC;&#x153;This is equally true for employees, locums and business owners. Now is a great time to develop strong relationships. I hope that a lot of good can come IURP WKLV GL FXOW WLPH Ultimately, know your value and always be the best version of yourself.â&#x20AC;?

Getty/Irina_Strelnikova

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THE DISCUSSION

August /September 2020

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PRE-REG FOCUS

REPRO OP

â&#x20AC;&#x153;This is your year for self-developmentâ&#x20AC;?

OT skills guidesI OT has developed a range of short video skills guides to aid students in their studies www.aop.org.uk/ otskillsguides

This yearâ&#x20AC;&#x2122;s pre-reg contributors, Samrina Awan, Tamara Hasan and Daniel Chung, on how COVID-19 upended their year and what theyâ&#x20AC;&#x2122;ve learned along the way

SUBS ART PRODUCTION CLIENT

Did your choice of pre-reg placement work well for you?

Daniel Chung: I think in

What have the unexpected events of this year taught you for the long-term?

TH: I have learned to take

Is there anything that you wish you knew before your pre-reg that you know now?

TH: I wish I knew what was

order to know where you wish to work in the future, you need to try all settings and Iâ&#x20AC;&#x2122;m glad I started in a multiple. The support provided has been fantastic, and working with colleagues DFURVV GL HUHQW VWRUHV DQG meeting fellow pre-regs made the process easier.

Samrina Awan: Moving from an independent to a multiple was one of the best decisions , PDGH , WKRURXJKO\ HQMR\ the busy environment. It is also great knowing that there are pre-regs in the neighbouring stores, with whom I can discuss case scenarios. We can use each other for additional revision.

Tamara Hasan: I am happy that I made the choice to do my pre-reg in hospital as it has shown me how varied a hospital career can be. It has been rewarding to be taught by expert supervisors, and , KDYH HQMR\HG GHOYLQJ LQWR more specialist services â&#x20AC;&#x201C; particularly learning about complex contact lenses and low vision.

each day as it comes and to live in the present. Before COVID-19, working Monday to Friday, it could be hard Ă&#x20AC;QGLQJ WKH HQMR\PHQW LQ WKH work when Iâ&#x20AC;&#x2122;d had a stressful or mundane day or week.

Now that Iâ&#x20AC;&#x2122;ve had time away, Iâ&#x20AC;&#x2122;ve had time for things I wouldnâ&#x20AC;&#x2122;t have in the past and I have been able to appreciate the little things.

I hope what I have learned from this experience is to never let a day go to waste.

DC: When setting goals, I have learned not to worry if I donâ&#x20AC;&#x2122;t achieve them.

Make use of any time you KDYH DQG XVH LW H FLHQWO\ Keep in touch with those around you. Youâ&#x20AC;&#x2122;re never DORQH LQ WKLV MRXUQH\

to come halfway through, so that I wouldnâ&#x20AC;&#x2122;t panic about getting to July OSCEs on time. This has made me realise that it is not the â&#x20AC;&#x2DC;prereg yearâ&#x20AC;&#x2122; but the â&#x20AC;&#x2DC;pre-reg period,â&#x20AC;&#x2122; and even without the pandemic, everyone works at GL HUHQW SDFHV 7KH SUHVVXUH to get through competencies made me stress more and not HQMR\ LW DV , RXJKW WR KDYH done. It really doesnâ&#x20AC;&#x2122;t matter whether I qualify in July or September or even beyond ² LW LV QRW D UHĂ HFWLRQ RI P\ ability as an optometrist.

DC: Fortunately, I was well informed by others before pre-reg and knew what to expect. I found that most things you simply learn along the way. Keeping on

â&#x20AC;&#x153;It is not the pre-reg year, but the pre-reg period even without the pandemic, everyone works at different pacesâ&#x20AC;?

Tamara Hasan

top of things is a consistent component in pre-reg advice, and though you may think youâ&#x20AC;&#x2122;re prepared for it, when youâ&#x20AC;&#x2122;re working, commuting and caring for yourself, LW FDQ EH GL FXOW WR JHW into a routine. This is only something I got the hang of after working and studying for a while.

What are you most excited about for the next 12 months?

SA: Iâ&#x20AC;&#x2122;m looking forward to

qualifying and passing my assessments. I hope to test in busy clinics and build upon my knowledge and clinical skills as the year progresses.

DC: After a long time waiting to progress on the scheme, I cannot wait to qualify and start expanding my knowledge. Iâ&#x20AC;&#x2122;m very interested in myopia control and really look forward to developments and SDUWLFLSDWLQJ LQ GL HUHQW treatment areas.

TH: I am excited for the day that I can say I am a fully TXDOLĂ&#x20AC;HG RSWRPHWULVW $OO the hard work and patience through these current times ZLOO KDYH SDLG R

Our contributorsâ&#x20AC;&#x2122; five tips for those starting their pre-reg 1 Prepare before you start. Go over your routine and questions, and understand why you are using a technique 2 Read the Scheme for Registration Handbook and familiarise yourself ZLWK WKH FRPSHWHQFLHV \RX QHHG WR Ă&#x20AC;QG

3 Take advantage of resources. Your supervisor, other optoms, courses, support sites, Instagram pages â&#x20AC;&#x201C; theyâ&#x20AC;&#x2122;ll all expand your knowledge 4 Never compare yourself to others.

If youâ&#x20AC;&#x2122;re slower than your

colleagues, thatâ&#x20AC;&#x2122;s ok. We all get there in the end 5 Donâ&#x20AC;&#x2122;t put pressure on yourself.

This is your year for learning, so HQMR\ LW QR PDWWHU KRZ ORQJ LW WDNHV â&#x20AC;&#x201C; COVID-19 has taught us that.

August /September 2020

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THE WORKSHOP

ART

Domiciliary care post-lockdown Every issue, OT poses a scenario from a practitioner.

Here, we look at providing domiciliary care to patients who have continued to shield

PRODUCTION

The scenario

CLIENT

Julie, practice owner â&#x20AC;&#x153;I am a practice owner with a number of patients who are older and vulnerable. A lot of them are choosing to continue shielding after government guidance changed on 1 August. I want to hear about the precautions that I should take when providing domiciliary care to these patients, and what particular behaviours I should instruct my staff to follow. Can you help?â&#x20AC;?

The advice Gordon Ilett, AOP board member and co-chair of the Optical Confederation Domiciliary Eyecare Committee

Getty/JDawnInk

I

ndividuals, particularly older adults, who are unable to leave home unaided owing to physical or mental illness or disability, or who are still shielding from COVID-19, are potentially at higher risk of eye disease and vision problems than the general population. Vision and eye health problems exacerbate WKH H HFWV RI LVRODWLRQ and impact on other serious conditions, such as

cognitive impairment and dementia.

Advice on shielding in England has changed in recent weeks, and may change again in response to local risk levels. The provision of eye care will need to be responsive to these changes, based on local public health advice and clinical judgement about risk DQG EHQHĂ&#x20AC;WV Risk and need

The group that was advised to shield throughout the COVID-19 lockdown included the 2.5 million SHRSOH ZKR ZHUH FODVVLĂ&#x20AC;HG as â&#x20AC;&#x153;clinically extremely vulnerable.â&#x20AC;? These individuals are most at risk of eye disease, visual problems and sight loss, which are in turn correlated

with falls, loneliness, isolation and loss of cognitive function. All of these factors are exacerbated by loss of social contact with family, friends and carers.

The virus will be around for some time; possibly for the whole lifetime of some vulnerable patients. This means that the balance of risk has now shifted towards meeting each individualâ&#x20AC;&#x2122;s eye care needs based on the principles of informed consent and respecting protected characteristics of each patient. The goal now is to preserve sight and independence and ensure no-one is denied the care they need when this can be provided safely.

Basic principles

In managing the patient, you should respond to needs LGHQWLĂ&#x20AC;HG E\ WKHP D FDUHU another clinician or social worker. Care provided should continue to observe social distancing guidelines where possible, and should consist only of clinically necessary tests to minimise examination time.

You should clearly record and date all the information shared during the appointment, and share with care coordinators, GPs and other authorised persons and caregivers if required.

A risk assessment for each individual patient, and any other people who may be at risk of infection, should be completed. Upto-date advice from the College of Optometrists and ABDO should be followed, especially in

respect of rigorous infection control and the wearing and disposal of personal protective equipment (PPE).

The appointment should be planned with the patient or their care co-ordinator at the safest possible time for them. If needed, you should liaise with the local ophthalmology department so that care can be completed in a single visit.

Preparing your staff

You should ensure that any VWD SHUIRUPLQJ GRPLFLOLDU\ eye care are fully able to comply with the above.

They should also check and comply with self-isolation advice on a daily basis, and before visiting any patient. $OO VWD VKRXOG KDYH equipment for rigorous infection control and use of PPE (and have been trained in its use), clean uniforms daily, bare forearms, and awareness that they need to disinfect equipment and devices at each use. <RX PD\ Ă&#x20AC;QG LW KHOSIXO WR SURYLGH WUDLQLQJ IRU VWD VR they know how to perform a risk assessment at each location, for example how to enter and exit with minimal FRQWDFW ZLWK Ă&#x20AC;[WXUHV RU RWKHU people. You should check that they feel comfortable ending a visit if they have concerns about a patientâ&#x20AC;&#x2122;s health, or their own.

6WD PHPEHUV VKRXOG EH limited to one per vehicle, and only one should attend a domiciliary visit. You should make sure you collaborate with individuals and care homes to minimise the number of visits needed.

â&#x20AC;&#x153;We know that the virus will be around for some time, and possibly for the whole lifetime of some vulnerable patientsâ&#x20AC;?

August /September 2020

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IN PRACTICE PRE REG

IN PRACTICE

REPRO OP SUBS ART

â&#x20AC;&#x153;Many people have experienced racism in practiceâ&#x20AC;?

PRODUCTION

Hamza Mussa tells OT about campaigning against racism via Instagram and his commitment to professional development I studied at Aston University, graduating in 2016. I did

CLIENT

P\ SUH UHJ DW 6SHFVDYHUV LQ .HQGDO FRPSOHWHG WKH 26&(V in July 2017, and Iâ&#x20AC;&#x2122;ve been in Kendal ever since. We have two stores, so we bounce between the two.

I do see a lot of pathology.

Because we are quite rural, we JHW D JRRG PL[ RI SDWLHQWV ,W¡V not as fast-paced as city work, but it allows you variety so \RX FDQ OHDUQ RQ WKH MRE I also do professional DGYDQFHPHQW ZRUN ,¡YH been to Manchester and Bradford to speak to second year students and to do DVVHVVPHQW FHQWUHV IRU WKH VXPPHU SODFHPHQW VFKHPH Iâ&#x20AC;&#x2122;ve been up and down the FRXQWU\ ² %LUPLQJKDP London, Glasgow â&#x20AC;&#x201C; to do prereg courses within Specsavers,

which include pre-reg inductions, and contact lens and pathology courses.

I set up The Crazy Optom on Instagram because I wanted to follow ophthalmology and optometry accounts that werenâ&#x20AC;&#x2122;t on my main page. Seeing real cases and

presentations is the best learning tool. You can learn WKH WKHRU\ EXW WKH Ă&#x20AC;UVW WLPH \RX VHH DQ DQWHULRU FKDPEHU reaction, tobacco dust or Schaferâ&#x20AC;&#x2122;s sign in the vitreous, it clicks.

7RZDUGV WKH HQG RI P\ SUH UHJ , VWDUWHG VKDULQJ LPDJHV The accountâ&#x20AC;&#x2122;s following grew RUJDQLFDOO\ 7KH Ă&#x20AC;UVW \HDU ZDV only 1000 to 2000 followers, with posts here and there.

Year two was a really big ERRP ,W ZDV JURZLQJ DW RQH

â&#x20AC;&#x153;My Plan B?â&#x20AC;? ,I KDGQ¡W JRQH LQWR RSWRPHWU\ , ZRXOG KDYH VZDSSHG P\ GDUN URRP DQG VOLW ODPS IRU P\ 6/5 DQG VXLWFDVH DQG PDGH D FDUHHU RXW RI P\ SDVVLRQ IRU SKRWRJUDSK\

48 www.optometry.co.uk

Photography has been a longstanding passion of mine. Iâ&#x20AC;&#x2122;ve always found

capturing interesting. With RSWRPHWU\ LW EHFDPH PRUH like, â&#x20AC;&#x153;Ok, this is a learning experience.â&#x20AC;? &HOOV DQG Ă DUH LQ WKH DQWHULRU FKDPEHU LV RQH WKLQJ thatâ&#x20AC;&#x2122;s very hard to explain to patients, and to teach colleagues to look for, without EHLQJ DEOH WR VKRZ WKHP , was able to capture a really JRRG YLGHR RQ LW VR PXFK VR that recently it was used in a SDWLHQW LQIRUPDWLRQ YLGHR IRU *UHDW 2UPRQG 6WUHHW +RVSLWDO Itâ&#x20AC;&#x2122;s used in the childhood XYHLWLV SDWLHQW LQIRUPDWLRQ video, which is really cool and incredibly rewarding.

Recently, a friend posted about her experience of racism within optometry. It

PDGH PH WKLQN ´$FWXDOO\ Iâ&#x20AC;&#x2122;ve experienced this too.â&#x20AC;? ,W EUDQFKHG RXW IURP WKHUH LQWR WKH Ă&#x20AC;UVW SROO DVNLQJ KRZ PDQ\ SHRSOH KDG H[SHULHQFHG UDFLVP LQ SUDFWLFH 6DGO\ WKH VWRULHV ZHUH RYHUZKHOPLQJ The key issue is not necessarily the experience of UDFLVP , WKLQN ZKDW LV PRUH shocking and heart-breaking is the way itâ&#x20AC;&#x2122;s handled. I think LW¡V WKDW DFFHSWHG QRUP WKDW WKH SDWLHQW VWLOO FRPHV Ă&#x20AC;UVW

â&#x20AC;&#x153;No amount of business should ever come before staff or patient welfareâ&#x20AC;?

HYHQ ZLWK UDFLVP :H QHHG WR urgently change that.

I got in contact with Optometry Today WKH $23 DQG DOO WKH ELJ FRPSDQLHV :H had a great response. Thereâ&#x20AC;&#x2122;s a lot of work to do: getting SHRSOH WR VSHDN XS PRUH JHWWLQJ PRUH VROLG DFWLRQV LQ WKH 3UDFWLFH &RGH RI &RQGXFW and getting businesses to have a renewed stance, especially ZKHQ LW FRPHV WR WXUQLQJ WKDW SDWLHQW DZD\ 1R DPRXQW RI EXVLQHVV VKRXOG FRPH EHIRUH VWD RU SDWLHQW ZHOIDUH I am only four years into my career. Itâ&#x20AC;&#x2122;s funny when I hear

it out loud because it feels OLNH D ORW ORQJHU 6RPHWLPHV optics can feel like dog \HDUV &XUUHQWO\ ,¡P GRLQJ P\ SURIHVVLRQDO FHUWLĂ&#x20AC;FDWH LQ PHGLFDO UHWLQD DW &LW\ 8QLYHUVLW\ ,¡P KRSLQJ WR JR RQ WR GR P\ SURIHVVLRQDO FHUWLĂ&#x20AC;FDWH LQ JODXFRPD DQG WKHQ P\ LQGHSHQGHQW SUHVFULELQJ TXDOLĂ&#x20AC;FDWLRQ ,¡P DOVR JRLQJ WKURXJK WKH Specsavers pathway process. ,W¡V DQ DVSLUDWLRQ RI PLQH WR KDYH P\ RZQ SUDFWLFH $W WKH VDPH WLPH , ZDQW to get involved with hospital work. My passion lies in the pathology side of the SURIHVVLRQ , VSHQW WLPH shadowing on urgent eye care units, and the work always IDVFLQDWHG PH Get in touch Share your career journey with OT. Email lucymiller@ optometry.co.uk

August /September 2020

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IN PRACTICE BUSINESS OWNER

VERSION

HOW I GOT HERE

point, by 1000 followers a PRQWK ,W KLW MXVW EHIRUH 'HFHPEHU WKDW \HDU :H¡UH RQ MXVW RYHU QRZ ,W¡V EHHQ D UHPDUNDEOH growth. It was never about IROORZHUV RU VRFLDO PHGLD presence, it was purely a KREE\ 1RW VR PXFK WR WHDFK SHRSOH EXW PRUH VKDULQJ interesting cases that I FDPH DFURVV 'RLQJ WKLV ZH realise how varied visual presentation can be.

HDI

IN PRACTICE VERSION

HOW DO I...

REPRO OP

Tackle unconscious bias in practice?

Learn more Watch the AOP's webinar with Russell providing an introduction to unconscious bias www.aop.org.uk/eventsand-education

Russell Thomas, director and senior consultant at the Diversity Trust, on how practices can fight unconscious bias and foster a culture of learning that works for everyone

SUBS

P

ART

eople think that they're being attacked, but bias is a natural thing that exists.

To address it you need to get an understanding of your upbringing, your education, what messages you have received from the media, your friends, and your parents. It's important to explore all of that, before we can get an understanding of where other people might be coming from.

PRODUCTION

Identify your own bias CLIENT

Identifying those biases gives \RX WKH Ă&#x20AC;UVW RSSRUWXQLW\ to deal with them. At the unconscious bias stage, and the stereotype stage, things haven't cemented so much in your mind that you can't challenge them. But if they go unchecked, they develop into prejudice and discrimination, which is much harder to change. Our unconscious bias plays a role in reinforcing stereotypes and prejudices.

Do the Harvard Implicit Bias Test, so you understand what your biases are, and can better identify other people's.

7KDW V WKH Ă&#x20AC;UVW WKLQJ UDLVLQJ those unconscious biases to the forefront of our minds and starting to tackle them.

of yourself?â&#x20AC;? You don't QHFHVVDULO\ NQRZ WKDW Ă&#x20AC;UVW RI all. You might think about it and realise, â&#x20AC;&#x153;That person is exactly the way I would be.â&#x20AC;?

It's up to other people to call you out on those things.

Get to know people from different backgrounds

There are two positives to this. One is that you get to see how much like you people are, which means you're less likely to be biased. But also, you get to understand them a lot better.

In terms of policies and procedures, this is where it crosses over with indirect discrimination. Indirect discrimination is the unintended consequences of a policy, procedure or culture WKDW KDYH D QHJDWLYH H HFW on a protected characteristic.

Because it's unintended, when we're writing policies and procedures we may not know that we're being biased. That can have a disproportionate H HFW RQ LQGLYLGXDOV Do an equality impact assessment

For any decision you're making, ask people from GL HUHQW EDFNJURXQGV ZKDW

Three steps to success Understand the impact of the biases on people Have logical methods to keep yourself in check Keep on top of it â&#x20AC;&#x201C; complacency is dangerous their view is on this particular policy from their perspective, and see whether they're picking up something that you're not.

If you haven't got people in the organisation, look externally. Look to customers, look to other companies. Say, â&#x20AC;&#x153;Can you look at this? Is this discriminatory in any way?

Is this biased in any way?

Is it gendered all the way through?â&#x20AC;?

Create a â&#x20AC;&#x2DC;no blame cultureâ&#x20AC;&#x2122;

See your organisation as a learning organisation, with every interaction as an opportunity to grow. Try to foster a culture where you encourage people to have GL FXOW FRQYHUVDWLRQV LQ D respectful manner.

When you have those conversations, you're open to

Getty/Olha Khorimarko

Consider interviews

So, I'm an interviewer, and I really like a candidate. It should be the responsibility of someone to ask, â&#x20AC;&#x153;Do you think you like that person because they remind you

â&#x20AC;&#x153;People think that they're being attacked, but bias is a natural thing that existsâ&#x20AC;?

criticism. You're saying, â&#x20AC;&#x153;we'll give it a go, we'll try and talk about racism, we'll try and talk about sexual orientation.

I don't know enough about it.

But we're going to try.â&#x20AC;? If we don't talk about issues, they become taboo. We need to talk about them.

When you come in with an open mind, it makes it easier to start those conversations, and allow them to take place LQ \RXU RUJDQLVDWLRQ 6WD need to be prepared that, when they talk, they will be challenged.

Instil key behaviours

We talk about allies and how, when you hear a situation that you disapprove of, you can challenge these things. Quite often there's false consensus that it's ok to speak in a certain way. Nobody challenges you, so you can behave in that way.

You don't have to think about certain things.

There's an opportunity there, if someone says something that's stereotypical, for you to challenge them.

6D\ ´:KHUH GRHV WKDW FRPH from?â&#x20AC;? Be an active bystander, an active ally to equality and diversity, rather than being complicit and inadvertently creating a negative culture in the workplace.

By doing that you're also telling everyone else in the workplace that this is the culture we want to create.

It's ok if we challenge unwanted behaviour.

August /September 2020

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Investing in a new challenge

PRODUCTION

Farzeen Khan on her journey from discovering optometry accidentally in Nepal to running her own practice on the Isle of Wight

A

CLIENT

fter graduating in chemistry, with a post-graduate diploma in computer programming, in 1994 I married an ophthalmologist and we moved to a village in Nepal where he worked in a hospital run by an American charity. In the absence of anything to do, I started to read my husbandâ&#x20AC;&#x2122;s books and became hooked on optics. Thatâ&#x20AC;&#x2122;s really when my career started. I began working in the same hospital as my husband, pre-testing cataract patients. We moved to Saudi Arabia, then settled in the UK in 1999. When my daughter was two, I applied for a job at a multiple. I began working as a frame stylist in 2002, with a plan to become a dispensing optician (DO).

my own ideas; I knew in the back of my mind I could do better if the opportunity came about. As luck would have it, a family friend was looking to UHWLUH DQG WKH\ R HUHG PH WKH opportunity to buy a practice, which I did in 2017.

Initial challenges

There were naturally a few teething problems.

Everything was on paper records, with nothing backed up on computers.

Coming from a multiple, where everything was done digitally, going back to paper records was challenging. I wanted to modernise the outlook and set up social media channels and a website as well as advertising the practice locally. I also updated the branding, so it

Making the decision

After 15 years and with two grown-up children, it was time to invest in my own project. I had always wanted to be able to give more to my patientsâ&#x20AC;&#x2122; care and implement

50 www.optometry.co.uk

â&#x20AC;&#x153;I knew in the back of my mind that I could do better if the opportunity came aboutâ&#x20AC;?

A supportive community

I joined Hakim Group in EXW , Ă&#x20AC;UVW PHW ,PUDQ Hakim many years ago when I was a DO, so I knew about the group and had read articles about them in magazines. I came over to Hakim Group HQ and the energy and enthusiasm of the team was infectious.

I knew instantly it was the right decision to join, allowing my business to grow with the support of a larger group. The culture was the decision maker for me â&#x20AC;&#x201C; I know I can pick up the phone at any time and someone is there to assist me.

The practice â&#x20AC;&#x2DC;Buddiesâ&#x20AC;&#x2122; are our support system, guiding us along the way. The whole package gives us the FRQĂ&#x20AC;GHQFH WR GR ZKDW ZH GR and do it well.

THE PATH TO PRACTICE OWNERSHIP DEMYSTIFIED How was the business affected by COVID-19?

We went into remote working to provide emergency and essential care. That involved triaging patients over the phone and delivering glasses, contacts, and solutions. We also worked with another Hakim Group practice on the island to support each other. I have repaired glasses for patients in front of their houses as they were unable to leave home. It was challenging, but I enjoyed doing my share for the community.

It was also a huge learning curve.

What do you most like about being a practice owner?

I have the freedom to give the service in the way I would like to be treated myself. Eye care, customer service and aftercare are my main priorities. My vision is to provide a unique service and to create an experience for our patients.

What are your top tips for buying a business?

Look at what you have to offer and ask yourself: â&#x20AC;&#x2DC;is it unique to the market?â&#x20AC;&#x2122; See if there is a place available for you in the market and try to differentiate.

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BECOMING A BUSINESS OWNER

looked more contemporary.

Those aspects were really enjoyable to work on.

I have learned that if you move too fast in implementing changes, it FDQ EHFRPH GL FXOW WR NHHS up. The focus was to settle in and then implement small changes in the day-to-day running of the business that were lacking before. I started implementing processes to make the clinics and overall EXVLQHVV UXQ PRUH H FLHQWO\ We had a lot of training VHVVLRQV IRU VWD LQ WKH Ă&#x20AC;UVW few months, with brand reps from various frame, lens, contact lens, solutions and sunglasses manufacturers. I updated the frame selections to introduce new brands WKDW UHĂ HFWHG RXU SDWLHQW base. Weâ&#x20AC;&#x2122;ve also introduced stronger window displays and planned promotions to drive footfall.

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Getty/venimo

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WHAT I HAVE LEARNED

ART

“The approach to learning has completely flipped”

PRODUCTION

Dr Rakhee Shah, lecturer at City, University of London, second-year student Sabrina Choudhury, and final-year student, Bilal Hassan, share how the optometry course adapted to COVID-19 What impact did COVID-19 have on teaching?

Dr Rakhee Shah (RS): The

CLIENT

week before lockdown, our university made the decision that face-to-face teaching needed to stop and any remaining teaching, where feasible, needed to move RQOLQH , WHDFK ÀQDO \HDU clinical and professional practice and my assessments all take place in April and May. Normally I would have had objective structured clinical examinations (OSCEs) at the university, which account for 50% of the module mark, and the remaining 50% comes from a two-hour unseen exam.

We were unable to run the OSCEs and so we had to redesign the end of year assessment to consider all of the outstanding learning

outcomes for the module.

As it was now an open book assessment, I created a mixture of ethical and scenario-based questions to ensure students weren’t regurgitating lecture materials.

What have been the most challenging aspects of adapting the course?

RS: The biggest challenge

has been that the situation changes so rapidly, you don’t know whether the changes you’re putting in now will be valid by the time you need to use them.

When lockdown began, we had so much to do in such a short space of time and had to ensure we met the requirements of the university and professional bodies.

“The situation changes so rapidly, you don’t know whether the changes you’re putting in now will be valid by the time you need to use them”

Dr Rakhee Shah, lecturer at City, University of London

What considerations has this experience given you for the future of the course?

RS: As an optometrist, it

made me question why we don’t teach certain clinical skills earlier. We tend to focus on indirect ophthalmoscopy, for example, from towards the end of the second year and into the third. Now we are considering teaching this earlier on. Perhaps skills that require students to be further away from the patient should be taught earlier, so they are more embedded by the time students come to their later years.

How did remote learning compare to normal classes?

Sabrina Choudhury (SC):

The approach to learning KDV FRPSOHWHO\ ÁLSSHG $V assessments were open book, we had the luxury of looking back through our notes but we also had to ensure that we had a deep understanding of the content.

7KH EHQHÀW RI WKLV ZDV that assessments were still challenging.

Bilal Hassan (BH): My peers

and I felt that the cancellation of the scheduled OSCEs was not in our best interests in the long-term, as these would have given us some much-needed experience for the College assessments in pre-registration. However, we did sit a mock assessment back in December.

I was surprised while WDNLQJ WKH ÀUVW RQOLQH H[DP as to how much application there was. Over time the exams became easier as I adapted to the new format.

I felt the style of exams was good as they were real scenarios that we may experience in our future lives as optometrists.

What were the positives and challenges?

SC: /HFWXUHUV R HUHG SOHQW\

of support. However, remote learning meant communicating through email and explaining a concern or question is often more easily done in person.

Online learning also meant that we were unable to practise techniques that will be needed for our careers. I feel like we haven’t used a retinoscope or slit lamp in a long, long time.

BH: Remote learning meant

we could pause and rewatch sections of the lectures if something did not make sense to us. The open book exams also tested our ability to apply our knowledge, however the format meant a lot of time was spent searching for information.

How do you feel about the next academic year?

SC: Easing back into student

life may be challenging and GL HUHQW WR ZKDW ZH DUH XVHG to, so this may be hard at ÀUVW EXW , DP FRQÀGHQW WKDW with time, we will all settle into the new normal.

Share your story Get in touch if you would like to share your experience with OT kimberleyyoung@optometry.co.uk

August /September 2020

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IN PRACTICE WIHL

IN PRACTICE

VERSION

Rethinking glaucoma

REPRO OP

Glaukos’ microscopic implant iStent inject® W

SUBS ART CLIENT

500K+

OVER

PRODUCTION

Around 500,000 people in the UK are currently diagnosed with glaucoma, and optometrists have a key role in its identification and treatment. The key opportunity is the identification of glaucoma at an early stage, and allowing the patient to benefit from alternative treatments to eye drops. Establishing effective referral pathways for those diagnosed with mild to moderate glaucoma would ensure they receive the best care possible from early intervention.

Trabecular micro-bypass surgery with iStent inject® W

iStent®, iStent inject® and iStent inject® W devices have been implanted globally

If used correctly they can work, but human error added to side effects such as discomfort, redness and stinging in the eyes can lead to inaccurate dosage. Many patients are also older, so the issue of forgetting to administer the drops is also a factor in ineffective treatment. Studies show that more than 90% of patients are non-adherent to medications, and nearly 50% stop taking them before six months.1

COMPLIANCE ISSUES WITH EYE DROPS At the moment, the majority of patients are currently using eye drops to treat their glaucoma, but the problem of compliance is a major issue. Eye drops need to be used on a daily AN ALTERNATIVE basis, but many patients find Trabecular micro-bypass them difficult to administer. surgery with iStent

inject® W involves implanting two small surgical-grade titanium stents designed to bypass the trabecular meshwork, the area of greatest resistance to aqueous humor outflow and therefore designed to increase drainage through Schlemm’s canal, thus lowering intraocular pressure.2 HOW ISTENT® INJECT W WORKS Implanted during cataract surgery or as a separate procedure, the device comprises a hand-held

injector capable of implanting two 0.36mm heparin-coated titanium stents via a single corneal entry point.

EFFICACY Over 500,000 iStent®, iStent inject® and iStent inject® W devices have been implanted globally.3 Clinical studies show that patients experience a reduction in reliance on topical glaucoma medications.4 To date, there are more than five years of published efficacy and safety data for iStent inject, and more than 150 peer reviewed published studies on iStent technologies.3 NICE approval was granted for iStent inject in 2017.

Glaukos®, iStent®, inject® and inject® W are registered trademarks For further information: www.glaukos.com/en-uk

References

1. Nordstrom BL. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol. 2005; 140:598-596 2. Neuhann TH. Trabecular micro-bypass stent implantation during small-incision cataract surgery for open angle glaucoma or ocular hypertension: Long-term results. J.Cataract Refract Surg. 2015; 41: 2664-2671 3. Data on file 4. Voskanyan L, GarcIa-Feijo O J, Belda J, Fea A, Jünemann A, Baudouin C. “Prospective, unmasked evaluation of the iStent inject® System for open-angle glaucoma: Synergy trial”. ADV Ther 2014; 31:189-201

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GLAUKOS ADVERTORIAL, 1

Advertorial brought to you by

VERSION REPRO OP

THE WAITING MILLI NS

SUBS

The NHS Confederation has estimated that the list of patients waiting for treatment could reach 10,000,000 by the end of the year. How can optometrists help to tackle a daunting backlog? OT investigates

ART PRODUCTION CLIENT

M

W

I

hen she became worried about her left eye at the height of a global pandemic, Jennifer Slater turned to the same institution that has helped to

L

L

keep her world in focus since VKH Ă&#x20AC;UVW DWWHQGHG 0RRUĂ&#x20AC;HOGV Eye Hospital more than six decades ago with Fuchs dystrophy. But this time the DSSRLQWPHQW ZDV D GL HUHQW

I

O

experience. Instead of travelling WR D à XRUHVFHQWO\ OLW ZDLWLQJ URRP 0V 6ODWHU¡V DSSRLQWPHQW was a click, rather than a tube journey, away. $ FOLQLFLDQ REVHUYHG 0V August /September 2020

BLACK YELLOW MAGENTA CYAN

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THE BACKLOG

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Slaterâ&#x20AC;&#x2122;s eye, asked her questions and emailed a prescription to her local pharmacist. â&#x20AC;&#x153;I felt like I was in the clinic. It made me feel so much better knowing someone could not only talk to me but see me,â&#x20AC;? she said.

Ms Slater is one of 600 patients HDFK ZHHN DFFHVVLQJ 0RRUĂ&#x20AC;HOGV¡ services through video appointments.

With social distancing requirements reducing the capacity of many clinics by close to half, remote care is becoming an increasingly important way of tackling a growing NHS backlog.

Attend Anywhere, the video consultation platform used by 0RRUĂ&#x20AC;HOGV ZDV XVHG IRU DURXQG 1000 video consultations each day across the UK and Ireland before the outbreak of COVID-19.

Now 20,000 patients are seen daily through the technology â&#x20AC;&#x201C; a number that is continuing to rise.

CLIENT

Radical and rapid change

Enhanced use of video consulting technology is just one way that 0RRUĂ&#x20AC;HOGV (\H +RVSLWDO KDV adapted to the challenges posed by the pandemic. Deputy head RI RSWRPHWU\ DW 0RRUĂ&#x20AC;HOGV DQG AOP Councillor, Dr Vijay Anand, highlighted his desire for the momentum of change to continue as core services resume. â&#x20AC;&#x153;Everybody knows there is pressure on the NHS, and ophthalmology is the highest outpatient specialty. I think it

â&#x20AC;&#x153;It would be a real shame if we don't change after learning what we are capable ofâ&#x20AC;?

54 www.optometry.co.uk

with calls following lockdown would be a real shame if we donâ&#x20AC;&#x2122;t as many patients had routine change after learning what we are appointments cancelled. capable of,â&#x20AC;? Dr Anand added.

Optometrists were involved in Analysis shared with the NHS taking around 5000 calls between Confederation estimates that April and the beginning of July, the NHS wait list could reach providing reassurance to patients 10,000,000 by the end of the year and redirecting queries away from or possibly higher if there is a medical colleagues. second wave of COVID-19 in the While many core optometry DEVHQFH RI D YDFFLQH RU H HFWLYH services were paused during treatments. Data published in lockdown, Dr Anand and October last year by NHS Digital his colleagues came up with reveals that ophthalmology innovative ways to continue to recorded the highest number of care for patients â&#x20AC;&#x201C; albeit from a annual outpatient appointments distance. in 2019, with 7.8 million patients Optometrists provided 1300 attending â&#x20AC;&#x201C; 200,000 more low vision and 3000 contact lens appointments than the next consultations over the phone. closest specialty. â&#x20AC;&#x153;People were grateful for that After lockdown was introduced, because they felt that they werenâ&#x20AC;&#x2122;t Dr Anand was part of a team just lost in this system where they that worked out how the skillset werenâ&#x20AC;&#x2122;t going to be seen RI 0RRUĂ&#x20AC;HOGV again. It reassured optometrists and them and 20 dispensing LGHQWLĂ&#x20AC;HG WKRVH opticians could patients who be utilised we will bring within a EDFN Ă&#x20AC;UVW DV radically Within Moorfields alone, we open up and rapidly it is estimated that 40,000 services,â&#x20AC;? Dr transformed glaucoma patients had Anand said. model of their appointments cancelled during 6WD ZLWKLQ providing lockdown the optometry eye care. department The usual devised a home network of 32 vision testing chart. Low 0RRUĂ&#x20AC;HOGV (\H +RVSLWDO vision patients were sent letter sites was reduced to eight, charts and pieces of string in with some nursing and medical various lengths in order to get VWD UHGHSOR\HG WR DLG WKH a crude measurement of visual COVID-19 response.

Optometrists alternated between acuity. Optometrists would direct the patients on how to use this providing patientfacing and remote care on a weekly during telephone consultations and were able to reassure patients EDVLV 7KH\ ZHUH SURĂ&#x20AC;OHG WR DVVLVW about any change in their visual in face-to-face clinics for high-risk acuity. Reading cards helped to patients within glaucoma, medical MXGJH ZKDW VWUHQJWK RI PDJQLĂ&#x20AC;HU retina, accident and emergency a patient needed and these would and urgent care services. then be posted out.

During remote working shifts, â&#x20AC;&#x153;A large proportion of the low RSWRPHWULVWV VWD HG D SUH H[LVWLQJ vision patients were shielding due helpline that was â&#x20AC;&#x153;inundatedâ&#x20AC;?

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40,000

to their age or health conditions.

They werenâ&#x20AC;&#x2122;t able to have the usual support from relatives to aid with activities of daily living, such as reading letters. Continuing to provide a low vision service to these patients meant they were able to continue with their day-today lives,â&#x20AC;? Dr Anand shared.

Streamlined thinking

:LWKLQ 0RRUĂ&#x20AC;HOGV DORQH LW LV estimated that 40,000 glaucoma patients had their appointments cancelled during lockdown while 2000 cataract operations were either delayed or cancelled.

In order to address this backlog, WKH ZD\ WKDW FDUH LV R HUHG LV changing across all sub-specialities.

Within glaucoma care, more patients will go through a virtual pathway. Dr Anand said that these reviews tended to be conducted by ophthalmologists before COVID-19, but more optometrists are now undergoing training to conduct virtual reviews.

Previously, between 80 to 90% of patients within the keratoconus monitoring clinic would be seen face-to-face. That could change to 30% of patients following the COVID-19 outbreak and lockdown, with the remainder of patients reviewed virtually. â&#x20AC;&#x153;Patients would attend for

a visual acuity measurement followed by corneal topography, anterior segment OCT and corneal hysteresis carried out by an optical assistant,â&#x20AC;? Dr Anand said. â&#x20AC;&#x153;That information would be reviewed by an optometrist who would make the clinical decision on the stability of the patient's condition,â&#x20AC;? Dr Anand shared.

Cataract services could also become more streamlined, with a larger proportion of care R HUHG UHPRWHO\ Dr Anand, who has worked within the cataract service for 16 years, highlighted that within a typical 25-minute face-to-face appointment the majority of time is spent detailing the risks and EHQHĂ&#x20AC;WV RI FDWDUDFW VXUJHU\ DQG a far smaller portion is spent conducting a physical examination of the eye. â&#x20AC;&#x153;With the massive backlog of patients you could probably manage more patients with phone call consultations; establishing whether they want to have the surgery, how much of a risk they are in terms of COVID-19 and how much surgical risk there is, and discuss refractive planning before they even step into the hospital building,â&#x20AC;? he elaborated.

Dr Anand also believes there will be more opportunities to work with optometrists in the community to manage patients.

He added that, following the outbreak of COVID-19, patients have become more forgiving of healthcare services working in GL HUHQW ZD\V â&#x20AC;&#x153;In any sub-speciality there are lots of patients who have annual check ups. Many of these patients will be stable but still require monitoring due to the nature of their condition. Before the pandemic, many of these patients would still want to be seen in

a face-to-face clinical setting.

However, with new ways of working, and the involvement of community optometrists, many of these patients could be GLVFKDUJHG WR D GL HUHQW PRGHO of care,â&#x20AC;? Dr Anand observed. â&#x20AC;&#x153;We could move these patients into primary care optometry with optometrists referring the patients back into secondary care if there is a change in the patientâ&#x20AC;&#x2122;s condition.

That is the kind of thing that the profession as a whole should be striving for.â&#x20AC;?

Adapt and thrive

Initially, Dr Anand had hesitations DERXW KRZ VWD ZRXOG UHDFW WR the rapid transformation of their working life.

How would colleagues adapt to homeworking â&#x20AC;&#x201C; a concept that was largely alien to optometry in preCOVID-19 times? Would they be comfortable working in unfamiliar roles? Would optometrists who needed to stay at home, because of health conditions or at-risk family members, feel isolated from the rest of their team?

However, Dr Anand emphasised that the optometrists working at 0RRUĂ&#x20AC;HOGV KDYH EHHQ ´DEVROXWHO\ brilliant.â&#x20AC;? â&#x20AC;&#x153;They have really shown that you can put them in any situation and they adapt and thrive. They havenâ&#x20AC;&#x2122;t complained. Everybody KDV KDG WKH DWWLWXGH Âś7KDW¡V Ă&#x20AC;QH , will do whatever you need me to doâ&#x20AC;&#x2122;,â&#x20AC;? Dr Anand said.

Asked by OT whether he has KDG D FKDQFH WR SDXVH DQG UHĂ HFW as routine services resume, Dr Anand highlighted that there is still much work to be done. â&#x20AC;&#x153;In six months, when we look back on this, we will say, â&#x20AC;&#x2DC;I canâ&#x20AC;&#x2122;t believe that we actually did WKDW¡ Âľ KH UHĂ HFWHG ´,W KDV EHHQ D completely unprecedented time.â&#x20AC;?

August /September 2020

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91OPTAUG20127.pgs 28.07.2020 17:58

FEATURE, 2

THE BACKLOG

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“FEAR OF OVERCROWDED CLINICS HAS LED MANY PATIENTS TO REFUSE TREATMENT”

ART

Macular Society chief executive, Cathy Yelf, describes how patients living with macular disease have been affected by the COVID-19 pandemic and lockdown

C PRODUCTION CLIENT

OVID-19 presented thousands of macular disease patients with an impossible choice – should they follow government advice to stay at home to save their life or keep their hospital appointment and save their sight? The Macular Society Advice Line took many calls in the early days of lockdown from people in tears at the awful choice they had to make.

Fear is a common companion of people whose sight is at risk.

Now they also faced the fear of COVID-19; on the public transport they relied on to get to the clinic and back as well as

56 www.optometry.co.uk

at what they imagined awaited them at the clinic itself; the usual overcrowded waiting areas, the teeming cafes and corridors.

And then there is the loneliness.

Far too often people with sight loss are isolated and lonely. Now social distancing meant they had to face coronavirus while EHLQJ HYHQ PRUH FXW R 7KH impact on the wellbeing of many people was devastating. Calls to our advice line rose But many hospitals report a 15% but the length of calls was 50% did not attend rate in AMD 20% greater because our advisers patients – unheard of in normal were dealing with so much times. We do not know how distress. Our counselling service many new patients have gone saw its busiest month on record in June.

Fear of “Fear is a common overcrowded companion of people whose clinics has led sight is at risk. Now they also many patients to refuse treatment, faced the fear of COVID-19” even though undiagnosed and so untreated hospitals have worked so hard during these weeks of lockdown to create a safe environment and and closed optometry practices. cancelled all but the most urgent Some clinics have reported 70% appointments. fewer new referrals than normal.

Patients who did attend COVID-19 may well have caused reported that the waiting rooms a great deal of unnecessary sight were quieter than they had loss. ever imagined they could be.

The NHS must now re7KH 33( ZDV ÀUVW UDWH DQG WKH engineer ophthalmology appointments quick and slick. outpatient departments to meet They posted on our social media the circumstances of COVID-19 sites, encouraging and reassuring and post-COVID times. Clinics others it was safe to go.

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MISSING PATIENTS

WHAT THE NUMBERS REVEAL

72% ZHUH DOUHDG\ Ă&#x20AC;QGLQJ LW KDUG or impossible, to meet demand in medical retina and other specialties.

Some innovative ideas are gaining momentum in the slipstream of COVID-19 and in some ways that may help push forward reforms that are needed to create capacity in the system.

These include accelerating the introduction of virtual clinics for follow up and monitoring, the development of home monitoring apps and, who knows, maybe even improved links between community optometry and ophthalmology so that more patients can be monitored and followed up closer to home.

All of these have the potential to deliver better visual outcomes for patients and for that they will be grateful. But patients are more than a pair of maculae and they still have real, human needs even in a virtual world.

Will anyone listen to their fears, recognise their depression and anxiety, reassure them their hallucinations donâ&#x20AC;&#x2122;t mean they are going mad, signpost them to the other services they need?

We recognise the need to create a system that can deliver basic treatments to rising numbers of eye patient, but the new world must still put the patient, not the process, at the heart of care.

The drop in wet-AMD referrals in April 2020 across Moorfields Eye Hospital, Kingâ&#x20AC;&#x2122;s College London Hospital, University Hospital Southampton and Whipps Cross Hospital compared to April 2019

186

It is estimated that at least 186 patients will suffer severe sight impairment in England as a result of lower wet-AMD referral rates across the single month of April 2020

10,000 The percentage drop in accident and emergency attendance in England in April 2020 â&#x20AC;&#x201C; the lowest level since records began

The number of people at risk of irreversible damage to their sight as a result of missed care during lockdown in England, Scotland and Wales

A+E

56%

August /September 2020

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91OPTAUG20128.pgs 29.07.2020 14:39

FEATURE, 3

THE BACKLOG

FEATURE, 4

THE BACKLOG VERSION REPRO OP

Steve Wright, West Midlands SUBS ART

THE VIEW FROM PRACTICE

PRODUCTION

â&#x20AC;&#x153;I saw four elderly patients with suspected wet-AMD in the first week after lockdown.

Normally we see one every few monthsâ&#x20AC;?

CLIENT

D

uring lockdown, Steve Wright kept his West Midlands independent optometry practice open for emergency appointments but did not receive many calls. ,Q WKH Ă&#x20AC;UVW ZHHN RI UHWXUQLQJ to practice following the easing of restrictions, the optometrist and director of Malcolm Gray Optometrists saw as many patients with suspected macular disease as he would usually see in a year. â&#x20AC;&#x153;I saw four elderly patients with suspected wet-AMD LQ WKH Ă&#x20AC;UVW ZHHN DIWHU ORFNGRZQ Normally, we see one every few months. When I referred these patients, the hospital co-ordinator told me that she had been inundated that week with wetAMD referrals,â&#x20AC;? he added.

Mr Wright told OT that it appeared that some patients had delayed getting in touch with their optometrist during the lockdown period. â&#x20AC;&#x153;Hopefully we are able to get these patients seen in time

58 www.optometry.co.uk

to save their vision, but I wonder how many people are out there with symptoms that need to be seen and managed before itâ&#x20AC;&#x2122;s too late,â&#x20AC;? Mr Wright emphasised.

A large proportion of the patients who attend the West Midlands practice, which has operated in the community for four decades, are aged 60 and older.

Mr Wright highlighted that hesitations about contacting an optometrist for advice on eye health concerns could be leading to vision loss. â&#x20AC;&#x153;The message needs to be that if anyone has symptoms with their vision, they should seek out professional advice over the telephone immediately and, if necessary, face-to-face,â&#x20AC;? he said. â&#x20AC;&#x153;As a profession we are able to help patients maintain healthy vision and, in the event of V\PSWRPV D HFWLQJ YLVLRQ ZH FDQ KHOS SDWLHQWV Ă&#x20AC;QG WKH right solution.â&#x20AC;?

â&#x20AC;&#x153;Hopefully we are able to get these patients seen in time to save their visionâ&#x20AC;?

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CET

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Education and training for the eye care practitioner

August/September 2020

PRODUCTION

In this issue 60/ Age six – the refractive error milestone?

Sarah L Morgan BSc (Hons), MCOptom, MPhil, FAAO, FBCLA

64/ Does body language communicate personality?

CLIENT

Andrew Cole MSc

Age six – the refractive error milestone? page 60

Course code: C-75850 Course code: C-75357

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“While vision screening may be offered to some pre-school children, even for those that are screened, refractive status is not typically included in screening assessments. Once a child has started school, an ad hoc ‘examine whenever complaints occur’ is generally the approach. This reactive approach leaves a percentage of children with amblyopia undiagnosed.”

Sarah L Morgan

Does body language communicate personality? page 64 “It is possible to misread non-verbal communication.

The most powerful and pervasive problems here are confirmation bias and the primacy effect (we pay attention to what we saw and thought first).

These biases can lead us to quickly interpret behaviour but still be far off the mark.

Think about a time when someone’s behaviour could also have been accurately explained by the situations in which it occurred.”

Andrew Cole

August /September 2020

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www.optometry.co.uk

VERSION

Age six â&#x20AC;&#x201C; the refractive error milestone?

REPRO OP

Sarah L Morgan BSc (Hons), MCOptom, MPhil, FAAO, FBCLA SUBS

This article outlines the implications of refractive status at a key milestone in a childâ&#x20AC;&#x2122;s visual development, particularly in the context of myopia.

ART

a strabismus has been missed, or their reduced vision in one eye was not picked up during screening) putting the child at threat of partial sight, or worse, if they later lose their functioning eye from trauma or a pathological FDXVH 7KH EHQHĂ&#x20AC;WV RI D FRPSUHKHQVLYH H\H H[DPLQDWLRQ at this key refractive milestone at age six should not be underestimated by optometrists and parents.6

Optometrists Dispensing opticians

PRODUCTION

Introduction

CLIENT

In 2015, the World Health Organisation (WHO) placed myopia on the world health agenda.1 One of the chief concerns is the future burden both to the patient and also the economic health costs of myopia-related pathologies, such as myopic macular degeneration.

From an epidemiological standpoint, the prevalence of myopia has been growing rapidly around the world and, for patients in their late teens, over 90% in East Asia and 31% in Australia have myopia.1 While the prevalence of myopia in UK white children is lower than in East Asian countries where most children leaving school are myopic, DOPRVW RQH LQ Ă&#x20AC;YH WHHQDJHUV LQ WKH 8. LV P\RSLF DQG WKLV is predicted to increase.2 Given that the age of onset of myopia typically occurs between six and 14 years of age, this article proposes that a full optometric examination at age six is the best opportunity to assess the individual risk of future myopia â&#x20AC;&#x201C; in advance of the onset.

1 CET POINT

Current practice When seeing children for eye examinations, there DSSHDUV WR EH QR Ă&#x20AC;UP ÂśFDOO WR DFWLRQ¡ JLYHQ WR SDUHQWV when compared with other key milestones in the growth stages of a child, for example, height and weight tracking of children, immunisations, or dental checks.7â&#x20AC;&#x201C;9 Most parents assume that their childrenâ&#x20AC;&#x2122;s eyes have been checked via other healthcare professionals,10 perhaps by a paediatrician at birth, a health visitor, school vision screening and during visits to the family doctor â&#x20AC;&#x201C; a tacit â&#x20AC;&#x2DC;someone will let me know if there is anything wrong.â&#x20AC;&#x2122; Of course, these healthcare professionals are unlikely to be

Figure 1

Background It is common sense that a child with undiagnosed (and FRUUHFWDEOH SRRU YLVLRQ VKRXOG EH LGHQWLĂ&#x20AC;HG VR WKH\ do not miss out educationally (see Figure 1 RU VX HU GHWULPHQWDO H HFWV WR WKHLU VRFLDO GHYHORSPHQW ZLWK SRWHQWLDOO\ ORQJ ODVWLQJ H HFWV LQWR DGXOWKRRG VXFK as reducing their career opportunities.3 While vision VFUHHQLQJ PD\ EH R HUHG WR VRPH SUH VFKRRO FKLOGUHQ even for those that are screened, refractive status is not typically included in screening assessments.4 Once a child has started school, an ad hoc â&#x20AC;&#x2DC;examine whenever complaints occurâ&#x20AC;&#x2122; is generally the current approach.5 This reactive approach not only risks myopic children going undetected â&#x20AC;&#x2DC;until they complainâ&#x20AC;&#x2122; (or perhaps someone else notices they have a vision problem), it also leaves a percentage of children with amblyopia undiagnosed (if

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Figure 1 Comparison of a classroom scene through the eyes of an emmetrope (left) and an uncorrected myope (right)

experts in the eye and vision and it is doubtful that they will have checked the refractive status of the child.

Given the above, taking a child for a routine eye examination is not on the checklist for the majority of parents, and not even those for whom it should or could be, for instance, parents with a history of squint/ DPEO\RSLD VLJQLĂ&#x20AC;FDQW UHIUDFWLYH HUURU 10 Parents respond well to key milestone advice,10 the simplicity of which helps to cut through their busy lives and brings into sharp focus key healthcare checks. It is interesting to note that dental information discusses the consequences of tooth decay in terms of number of school days missed due to pain and treatment, so there is a glaring opportunity for optometry to provide information on the countless hours of lessons â&#x20AC;&#x2DC;missedâ&#x20AC;&#x2122; simply by not being able to see in the classroom. A similar argument can be made for extracurricular activities such as sport or music.

Figure 2

Figure 2 Children learning their letters in school

It is hoped that the majority of children in the amblyopia/ KLJK UHIUDFWLYH HUURU JURXSV ZLOO KDYH EHHQ LGHQWLĂ&#x20AC;HG LQ earlier checks, but the silent onset of myopia is frequently not on the radar. Myopia is insidious in its onset, often going unnoticed until the child or someone else notices there may be a vision problem, and optometry is wellpositioned to identify those children at risk ahead of the onset. Various educational, communicative and clinical IDFWRUV VXJJHVW WKDW WKH ODWHVW SRLQW LQ FKLOGKRRG IRU D Ă&#x20AC;UVW eye examination is age six.

in their teens or sooner,6 and examining children at this key milestone along with a careful explanation of the Ă&#x20AC;QGLQJV DQG OLNHO\ IXWXUH FKDQJHV DQG H[DPLQDWLRQ intervals represents a very useful guide for parents.

Zadnik et al state: â&#x20AC;&#x153;Children examined in grade one (age six years) with less than +0.75D of hyperopia are at increased risk for developing myopia. This predictive model should enable clinicians and scientists to evaluate the risk for myopia in a child using simple, feasible measures.â&#x20AC;?6 Furthermore, research has shown that the age of myopia onset is a predictor for high myopia in later childhood.11

Reliability of refractive error at age six 5HIUDFWLYH HUURU FDQ FKDQJH GUDPDWLFDOO\ RYHU WKH Ă&#x20AC;UVW Ă&#x20AC;YH \HDUV RI OLIH VR WKH UHVXOWV GHWHUPLQHG DURXQG DJH six more clearly inform the future vision correction needs of the child.6 Beyond a small subset (5â&#x20AC;&#x201C;10%) of the paediatric population with known risk factors,5 examinations for the majority occur by â&#x20AC;&#x2DC;chanceâ&#x20AC;&#x2122; rather than a scheduled ocular health initiative. However, for children who have not been examined before six years of age, this represents the best â&#x20AC;&#x2DC;fall backâ&#x20AC;&#x2122; time to refractively assess children. The refractive status at this age is the best single predictor of the risk of a child developing myopia

Letter recognition Once a child starts school, one key focus is learning to read. While letter recognition is not an essential component of visual acuity measurement in a child (see Figure 2), research has shown that this is much improved by age six compared with children who are LQ WKHLU Ă&#x20AC;UVW \HDU RI VFKRRO 12 Seeing a child at age six versus DJH IRXU WR Ă&#x20AC;YH SURYLGHV WKH RSWRPHWULVW ZLWK PRUH FRQĂ&#x20AC;GHQFH LQ WKHLU VXEMHFWLYH HYDOXDWLRQ DV ZHOO DV JLYLQJ FOHDU HYLGHQFH RI YLVXDO GL FXOWLHV WR WKH parent attending the examination with their child; this latter point is commonly underappreciated.

Six is the magic number

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Paediatrics, refraction & myopia

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Opportunity to communicate and educate (\H FDUH SURIHVVLRQDOV DUH H[WUHPHO\ IDPLOLDU ZLWK myopia whereas non-myopic parents of the newly diagnosed myopic child are unlikely to understand the full implications of the condition. Parents rarely know what myopia is, so are even less likely to be aware of the way in which myopia typically progresses. Additionally, where one lay person may have some sense of refractive error running in families, another will not have made any connection.13 In a survey of myopic parents with children aged eight to 15 years, nearly 50% had not considered that their child could also become myopic.13 It is vital that optometrists appreciate this huge educational gulf between their knowledge and that of the parent (and child). Parents deserve to be carefully informed and educated both when a child requires a refractive correction or if a correction is likely to be required in the near future. Such conversations are not straightforward and are made much easier if the possibility of a need for refractive correction has been predicted at an earlier examination.

If no such forecast has been made previously â&#x20AC;&#x201C; as in the case of a reactive approach to optometric care for school age children â&#x20AC;&#x201C; the parental discussion is generally one of explaining bad news. Many parents see a need for vision correction as disadvantageous for their child. There are several pieces of bad news the optometrist must deliver, along with some negative responses: Bad news 1. Your child cannot see as well as they once did 2. Your child has myopia 3. Your child needs to wear glasses to see clearly 4. Your child will need to be examined again soon (a further visit) 5. Your child will likely need a stronger prescription next time 6. Your childâ&#x20AC;&#x2122;s myopia will continue to worsen as they grow 7. Your child will be dependent on vision correction for the rest of their life 8. Probably unsaid: your child is at increased risk of myopic pathology with age.

Negative responses 1. Parents may feel â&#x20AC;&#x2DC;guiltyâ&#x20AC;&#x2122; that they did not notice the vision problem sooner 2. Parents may not â&#x20AC;&#x2DC;trustâ&#x20AC;&#x2122; the outcome of the examination HYHQ LI WKH FKLOG PRVW GHĂ&#x20AC;QLWHO\ LV P\RSLF DQG UHTXLUHV spectacles) â&#x20AC;&#x201C; especially if the parent has not noticed the child has a problem or the child has no complaints

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3. Subsequent examinations typically require â&#x20AC;&#x2DC;strongerâ&#x20AC;&#x2122; prescriptions, which, if not carefully discussed ahead of time, can cause parents to worry that wearing the spectacles is making their childâ&#x20AC;&#x2122;s eyes worse.

3UHVFULELQJ IRU WKH Ă&#x20AC;UVW WLPH IRU D FKLOG ZLWK P\RSLD LV QRW XQFRPPRQ IRU WKH RSWRPHWULVW EXW LW LV RIWHQ D ÂśĂ&#x20AC;UVW¡ for the parent (and certainly for the child). It is worth FRQVLGHULQJ KRZ GL HUHQW WKLV FRXOG EH KDG WKH FKLOG attended for a previous eye examination. Such a child might show low levels of hyperopia, the best single predictor of their individual future risk of myopia. At this visit, the optometrist would have the opportunity to discuss what is then only a â&#x20AC;&#x2DC;possibilityâ&#x20AC;&#x2122; of their child becoming myopic â&#x20AC;&#x201C; no prescription for spectacles would EH QHFHVVDU\ RQ WKDW Ă&#x20AC;UVW RFFDVLRQ ( HFWLYHO\ WKH QHZV DW WKH Ă&#x20AC;UVW H[DPLQDWLRQ LV ODUJHO\ SRVLWLYH IRU WKH WLPH EHLQJ with the only â&#x20AC;&#x2DC;prescriptionâ&#x20AC;&#x2122; being to advise the parents to encourage their child to spend more time outdoors.

The parent (and child) can be counselled on signs that relate to increasing myopia, and what everyday tests the parent and child can watch out for, such as checking they can read the subtitles on the television at a certain distance or the digital clock on a kitchen appliance. Discussions can be had with members of the family to consider if this is something that might be familial in origin, and of course, other siblings and relatives can be considered (and examined). There is also the opportunity to mention future possibilities such as myopia management options, including contact lenses.

All of these points are much easier to discuss, and for the parent to listen to and process, at a time when there is not abject panic that a child now needs spectacles along with the parental guilt of wondering for how long their FKLOG KDV EHHQ VX HULQJ IURP SRRU YLVLRQ 7KH RXWFRPH of the initial examination at age six also informs both the optometrist and the parents about the recommended schedule for future examinations.

A school age child is typically brought for a comprehensive eye examination if something or someone has caused the parent to react Child complains of blurry vision/ cannot see Child complains of tired eyes Parent has concerns that their child may have a vision problem School screening test has recommended an eye examination Child tried a friendâ&#x20AC;&#x2122;s spectacles on and said they could see better Childâ&#x20AC;&#x2122;s teacher has some concerns about vision or educational progress Parentâ&#x20AC;&#x2122;s optometrist has recommended to bring the child in to be examined.

Conclusion

Acknowledgement

One of the primary objectives of an eye care professional is to correct refractive error in order that a child can attain the best visual acuity possible.

Having the opportunity to examine a child who may be at risk of uncorrected refractive error is key, and a clear message to parents of when, by whom and where to have their child seen is vital.

The current approach is â&#x20AC;&#x2DC;openâ&#x20AC;&#x2122; at best and moving â&#x20AC;&#x2DC;an eye examination at age sixâ&#x20AC;&#x2122; to the â&#x20AC;&#x2DC;must doâ&#x20AC;&#x2122; list of key milestones in the childâ&#x20AC;&#x2122;s developmental healthcare plan is a great opportunity to put optometric care and management on the parental checklist.

A child at risk of developing myopia, if seen at this key ocular milestone, provides a valuable moment in time for both the child and the parents. An initial examination where no action is required, is a positive experience all round; this places the optometrist in a good position to counsel both the child and the parent(s) on the future possibility of a change in vision, dependent on how their eyes develop as the child grows, and allows them all to be on the lookout for visual changes. Just as examining a pre-presbyope gives the optometrist the opportunity to discuss presbyopia and forewarn the patient about these impending changes, a child at known risk of myopia can also be pre-handled in this way promoting a trusted relationship for the years ahead. Should WKH FKLOG IXOĂ&#x20AC;O WKHVH VWDWLVWLFDOO\ SUHGLFWDEOH FKDQJHV not only will the parent (and possibly even the child) KDYH ZLWQHVVHG Ă&#x20AC;UVW KDQG WKH FKDQJHV RYHU WLPH they are able to bring the child to see the optometrist DW WKH HDUOLHVW RSSRUWXQLW\ VR WKH Ă&#x20AC;UVW SUHVFULSWLRQ can be given and further conversations around the future management of the progression of the myopia discussed. No parent wants their child to miss out, but without proactive advice and direction, they remain ignorant.

It is important to educate all parents about key milestones in the visual development of their FKLOG 7KH\ FDQ EH UHDVVXUHG DERXW WKH VFLHQWLĂ&#x20AC;F predictability of myopia, which helps them realise the importance of bringing their child to be examined and refractive error measured to assess their potential to develop myopia â&#x20AC;&#x201C; initiating this discussion with myopic parents is a good place to start.

Children deserve the opportunity to â&#x20AC;&#x2DC;see the best they can seeâ&#x20AC;&#x2122; so that they can â&#x20AC;&#x2DC;be the best they can beâ&#x20AC;&#x2122; during their early yearsâ&#x20AC;&#x2122; education right through to secondary school and beyond.

This article was supported by a grant from CooperVision.

CET

Exam questions and references Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 30 October 2020. You will be unable to submit exams after this date. Please note that when taking an exam, the MCQs may require practitioners to apply additional knowledge that has not been covered in the CET article. CET points will be uploaded to the GOC within 10 working days. Visit www. optometry.co.uk, and click on the â&#x20AC;&#x2DC;Related CET articleâ&#x20AC;&#x2122; title to view the article and â&#x20AC;&#x2DC;referencesâ&#x20AC;&#x2122; in full.

About the author Q Sarah Morgan is an optometrist and has worked in clinical research at The University of Manchester where she gained her MPhil.

She continues to lecture and lead clinical sessions and holds the post of Vision Sciences Fellow. Her business consultancy includes a wide portfolio of projects including staff development and training, advising professional organisations, and healthcare communication initiatives for manufacturers in the UK, Europe and globally. Sarah has lectured extensively across Europe, North America, South Africa, Hong Kong, Australia and New Zealand. She is a Fellow of the American Academy of Optometry and the British Contact Lens Association.

Course code: C-75850 Deadline: 30 October 2020

Learning objectives Q Be able to explain to parents about the implications of their childâ&#x20AC;&#x2122;s refractive status (Group 1.2.4) Q Be aware of key refraction milestones for children (Group 7.1.3) Q Be able to explain to parents about the implications of their childâ&#x20AC;&#x2122;s refractive status (Group 1.2.4)

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Does body language communicate personality?

REPRO OP

Andrew Cole MSc SUBS

This article discusses ways to ensure that practitioners are able to communicate effectively with patients to help them address their fears, anxieties and concerns.

ART

Optometrists Dispensing opticians

PRODUCTION

Introduction

CLIENT

There is an ongoing debate within psychology about nonverbal communication and what it tells us about people. Many claims are made but the science remains unclear. What we do know from research is that the way ZH LQWHUSUHW VRPHRQH¡V ERG\ ODQJXDJH LQĂ XHQFHV RXU response to it.1â&#x20AC;&#x201C;4 We may feel drawn towards someone or feel more or less comfortable in their presence. We anticipate our response and work out what to say or do next. The more able we become at interpreting nonverbal communication, the more capable we become at understanding social interaction; this makes us more emotionally intelligent because we are more self-aware and aware of others.

What if it were possible to say that body language Ă&#x20AC;WWHG D SDWWHUQ WKDW ZRXOG DOORZ XV WR FRQĂ&#x20AC;GHQWO\ describe someoneâ&#x20AC;&#x2122;s personality and perhaps predict what they might do next? Imagine how useful that would be as a starting point when we met someone? Imagine how important that could be in clinical practice?

6FLHQWLĂ&#x20AC;F VWXG\ LQWR QRQYHUEDO FRPPXQLFDWLRQ LV not new and has been an important aspect of trying to understand how we develop skills in recognising and understanding each other.1 We know that: There is a universal ability to decode emotion from facial expressions We need very little time to make relatively accurate conclusions about personality traits We need only limited information to do this.

This â&#x20AC;&#x2DC;thin slicingâ&#x20AC;&#x2122; to make judgements about people FDQ EH FULWLFDO WR VRFLDO VXFFHVV DQG LQĂ XHQFHV KRZ we remember people later on. Our conclusions about someone might also prove more accurate than we might suppose, giving support to those times when we felt we knew what would happen or what someone would say.2â&#x20AC;&#x201C;5

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1 CET POINT

But in what ways are we describing someoneâ&#x20AC;&#x2122;s personality when we try and explain their behaviour?

And what is â&#x20AC;&#x2DC;personalityâ&#x20AC;&#x2122; anyway? Personality can be described as â&#x20AC;&#x2DC;the things going on inside people that explain their behaviour.â&#x20AC;&#x2122; This behaviour is comprised of distinct interpersonal characteristics that others would use to describe someone in various situations.6 A shorthand for describing behaviour as personality certainly has a heritage, from Greek philosopher +LSSRFUDWHV ZKRVH ZRUG ÂśWHPSHUDPHQW¡ ZH VWLOO XVH today) to more modern concepts of describing people in terms of their openness, conscientiousness, extraversion, DJUHHDEOHQHVV DQG VWDELOLW\ RU KRZ GRPLQDQW LQĂ XHQWLDO steady or compliant people are in social situations. :KLOH DQ\ VFLHQWLĂ&#x20AC;F FODLP QHHGV WR EH FULWLFDOO\ HYDOXDWHG LI ZH EULQJ WRJHWKHU DOO RI WKH GL HUHQW WKHRULHV about body language and personality, there are some general and often predictable trends. We tend to describe people as: More or less energetic and proactive, slow or methodical More or less impulsive or unpredictable 0RUH RU OHVV PRWLYDWHG ZLWK GL HULQJ PRRGV DQG energy levels Either driven, expressive, analytical, or simply friendly and amiable.

It is possible to make limited but fairly reliable inferences about personality from the observable behaviour of other people. In this way, some communication traits that we REVHUYH LQ RWKHUV ZLOO GHPRQVWUDWH GL HUHQW SHUVRQDOLW\ traits. We can use this information to more accurately respond to others and by doing so, become more responsive to them.

With recent advances in neuroscience, some studies also suggest that the old phrase â&#x20AC;&#x2DC;seeing is believingâ&#x20AC;&#x2122; might also hold something for us in terms of developing our emotional intelligence. By seeing and responding in kind, we develop skills in self-awareness and awareness of others.7â&#x20AC;&#x201C;16 It is, of course, possible to misread non-verbal communication. The most powerful and pervasive SUREOHPV KHUH DUH FRQĂ&#x20AC;UPDWLRQ ELDV ZH VHH ZKDW ZH

H[SHFW WR VHH DQG WKH SULPDF\ H HFW ZH SD\ DWWHQWLRQ WR ZKDW ZH VDZ DQG WKRXJKW Ă&#x20AC;UVW 7KHVH ELDVHV FDQ OHDG XV WR TXLFNO\ LQWHUSUHW EHKDYLRXU EXW VWLOO EH IDU R WKH PDUN Think about a time when someoneâ&#x20AC;&#x2122;s behaviour could also have been accurately explained by the situation in which it occurred. Perhaps an unsettled patient who was unhappy with the service they received. We might describe them as a complainer and imagine they are like WKLV LQ JHQHUDO DQG FDOO WKHP GLVDJUHHDEOH RU ZRUVH

7KLV W\SH RI ELDV LV GL FXOW WR DYRLG GRLQJ DV ZH PDNH judgements about people to assess whether we will have either a positive or negative response about them. Some research tells us that simply the way a speaker uses their hands indicates how engaging and charismatic we think they are.17â&#x20AC;&#x201C;21

CET

tend to be direct in their communications and make deliberate decisions based on consideration of the purpose and the goal.

Get-things-going style People of the get-things-going style usually appear energetic. They tend to be animated and lively in their gestures and are expressive, enthusiastic and engaging. They can be persuasive and prefer to make consensual decisions.

Behind-the-scenes style People with a behind-the-scenes style have a quiet and UHĂ HFWLYH GHPHDQRXU 7KH\ KDYH D TXLHW XQDVVXPLQJ quality to their interactions with others, appear rather patient and prefer to make consultative decisions.

Interaction styles In 2011, the leading personality theorist, Linda Berens, set out an integrated model of personality that draws upon UHVHDUFK DFURVV WKH GL HUHQW WUDGLWLRQV RI SHUVRQDOLW\ 22â&#x20AC;&#x201C;24 She describes distinct patterns of behaviour that we might expect to see with certain personality types. The key point that Berens makes is the association between the drives people have and how they behave in response to those drives to get their needs met. Berens calls these GULYHV ÂśLQWHUDFWLRQ VW\OHV¡ see Table 1, page 66). Each style has particular talents with some characteristic body language traits to accompany them.

In-charge style People with an in-charge style appear energetic, fast paced and determined. They inspire others to follow their lead. They seem in control, straightforward in their communications with a key characteristic being how decisive they look.

Laban movement analysis If â&#x20AC;&#x153;personality is an unbroken series of successful gesturesâ&#x20AC;?25 then the work of Rudolf von Laban, an LQĂ XHQWLDO GDQFH PRYHPHQW WKHRULVW ² 26 EURXJKW WKLV GHĂ&#x20AC;QLWLRQ WR OLIH WKURXJK KLV ´EDVLF H RUWVÂľ ² PRYHPHQWV WKDW DFWRUV DQG GDQFHUV OHDUQ WR physically convey intentions and emotions.

Laban emphasised that the energies associated with emotions and intentions could be made visible by FRPELQLQJ EDVLF H RUWV WRJHWKHU WR Ă RDW WKUXVW SXQFK JOLGH VODVK GDE ZULQJ Ă LFN RU SUHVV ,PDJLQH Ă RDWLQJ into your consulting room, gliding across on your chair to reach something, and dabbing a lens with a cloth.

What might this convey to your patient? Contrast this with thrusting your chair underneath your desk, Ă LFNLQJ WKURXJK \RXU SDSHUZRUN DQG SXQFKLQJ LQ GDWD onto the computer. What is this saying to your patient?

Applying to practice Chart-the-course style Those with a chart-the-course style appear quiet. Their energy tends to be very intense and focused. They exhibit a calm demeanour with little use of gestures or excitability. This lack of motion masks the intensity that is nonetheless felt by others. They usually seem reserved,

Back to our model of personality â&#x20AC;&#x201C; interaction styles.

Think of these four styles as possessing some of the movements outlined above more than others and WKDW VRPH RI /DEDQ¡V EDVLF H RUWV DUH PRUH OLNHO\ WR be associated with an individual interaction style.

Movement can now be thought of as an expression of

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Communication

VERSION REPRO OP

Table 1 Berensâ&#x20AC;&#x2122; interaction styles model

SUBS

Chart-the-course

Get-things-going

Behind-the-scenes

Core drive

Urgent need to accomplish in a timely manner

Pressing need to anticipate and have points of reference

Urgent need to involve others and be involved

Pressing need to integrate and consider many sources

Aim

Get an achievable result

Get a desired result

Get an embraced result

Get the best result possible

Core belief

It is worth the risk to go ahead and act or decide

It is worth the effort and time to think ahead to reach the goal

It is worth the energy to involve everyone and get them to want to

It is worth the time to integrate and reconcile many inputs

Talents

Supervise Mobilise resources Mentor Execute actions

Devise a plan Illuminate Give guidance Monitor progress

Facilitate Make preparations Share insights Explore options

Support others Define specifications Clarify values and issues Produce

Energy

Determined Push against

Focused Move away from

Engaging Move toward

Calmly open Move with

Stressors

Feel out of control Nothing being accomplished

Not knowing what is likely to happen Donâ&#x20AC;&#x2122;t see progress

Not being a part of what is going on Feeling disliked or not accepted

Not enough input or credit Pressed to decide too quickly

Stress response

Fight Push against

Flight Move away from

Flurry Move toward

Freeze Move with

ART

In-charge

PRODUCTION CLIENT

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66 www.optometry.co.uk

August /September 2020

BLACK YELLOW MAGENTA CYAN

Know anyone like that? Which one are you?

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Exam questions Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 30 October 2020. You will be unable to submit exams after this date. Please note that when taking an exam, the MCQs may require practitioners to apply additional knowledge that has not been covered in the related CET article.

CET points will be uploaded to the GOC within 10 working days. You will then need to log into your CET portfolio by clicking on â&#x20AC;&#x2DC;MyGOCâ&#x20AC;&#x2122; on the GOC website (www.optical.org) to confirm your points.

References Visit www.optometry.co.uk, and click on the â&#x20AC;&#x2DC;Related CET articleâ&#x20AC;&#x2122; title to view the article and accompanying â&#x20AC;&#x2DC;referencesâ&#x20AC;&#x2122; in full.

About the author Q Andrew Cole is a business psychologist with over 20 yearsâ&#x20AC;&#x2122; experience in people development, assessment and experimental learning. He has led talent management and training for well-known high street names and consults in the optical sector on individual and team performance. He also teaches communication skills to optometry undergraduate students at Aston University.

Course code: C-75357 Deadline: 30 October 2020

Learning objectives Q Be able to make effective use and interpretation of body language when communicating with patients (Group 2.2.1) Q Be able to make effective use and interpretation of body language when communicating with patients (Group 2.2.1)

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Communication

VERSION

Severe acute respiratory syndrome coronavirus-2 and contact lens wear

REPRO OP

Jaspreet Sajjan B(Optom)Hons, MCOptom, ProfCert MedRet SUBS

This article is designed to help practitioners make informed management decisions regarding the safety of contact lens wear in patients with respect to the novel coronavirus.

ART

Optometrists Dispensing opticians

PRODUCTION

Contact lens opticians

Introduction CLIENT

The novel coronavirus, referred to as severe acute respiratory syndrome coronavirus-2 (SARS-COV-2), is a highly contagious virus which can cause a severe respiratory disease known as COVID-19.1 As of 18 July

1 CET POINT

Figure 1

2020, there have been nearly 15m cases of coronavirus and almost 610,000 deaths globally. In the UK, the number of cases is approaching 300,000 with over 45,000 deaths to date.2 The main symptoms of SARS-COV-2 include a high temperature, a new, continuous cough, and a loss or change to sense of smell or taste. Most people with coronoavirus have at least one of these symptoms.3 While most people have mild symptoms, others are at higher risk of severe illness, such as the elderly, and people with serious underlying medical conditions such as heart disease, diabetes, and lung disease.4 Coronavirus is spread via direct contact through aerosols produced by coughing, sneezing, talking, or indirect contact between contaminated surfaces and mucosal surfaces (mouth, nose, and eyes).5 SARS-COV-2 has been known to infect cells via angiotensin converting enzyme 2 (ACE2) receptors,1 which are found in many human tissues, such as the lungs, heart, kidney, and gastrointestinal tissues. The SARS-COV-2 virus consists of three glycoproteins that are attached to the envelope of the virus, one of which, known as the spike protein, has a KLJK DÂ?QLW\ IRU $&( 5 A cell surface protease called TMPRSS2, facilitates the release of viral RNA into the human cell, upon binding of the virus spike protein to ACE2;6 this causes viral reduplication and further infection as illustrated in Figure 1.

Emerging evidence 1 ACE2

HUMAN CELL

3

2 TMPRSS2 CELL SURFACE ASSOCIATED PROTEASE

RNA

Figure 1 Diagrammatic representation of viral reduplication in human tissues containing ACE2. 1 = Spike protein binds to ACE2 receptor; 2 = TMPRSS2 primes the spike protein to allow; 3 = SARS-COV-2 viral RNA to enter the human cell

68 www.optometry.co.uk

August /September 2020

BLACK YELLOW MAGENTA CYAN

In a short space of time, there have been many publications around the recent coronavirus outbreak, to enable better understanding of the disease process and any associated ocular implications. From an ocular point of view, SARS-COV-2 has been known to cause conjunctivitis, anterior uveitis, retinitis, and optic neuritis in animals,5 and so it may be possible for the same to occur in humans. In order to ascertain the safety status of contact lens (CL) wear during the pandemic, a summary of the main studies, guidance and reports is provided here.

Report one Figure 2 (page 70) details a timeline of events for a

Table 1 Study findings in patients who tested positive for COVID-199 Study findings

No. of patients with finding

Chemosis symptom

8

Epiphora symptom

7

Secretion symptom

7

Conjunctival hyperaemia symptom

3

Positive nasopharyngeal swab for COVID-19

11

Positive nasopharyngeal and conjunctival swab for COVID-19

2

Covid-19 positive patients with ocular findings consistent with conjunctivitis Moderate cases = Fever and respiratory symptoms

4 (out of 12)

Severe cases = Dyspnea, blood oxygen saturation ≤ 93%, ratio of partial pressure of arterial oxygen: fraction of oxygen inspiration ≤ 300

2 (out of 12)

CET

with conjunctivitis (see Table 1). The authors concluded that ocular transmission of SARSCOV-2 is possible despite VWXG\ UHVXOWV ÀQGLQJ D low prevalence of COVID-19 in tears. The study also found ocular abnormalities secondary to COVID-19 occurred more in severe cases.

Report four A letter to the editor of the Lancet described how a patient (pneumonia Critical cases = Respiratory failure/shock, multiple organ failure/ 6 (out of 12) expert) developed dysfunction COVID-19 during an inspection of facilities in 63-year-old female patient who developed conjunctivitis Wuhan, China.10 He wore an N95 face mask but had no secondary to COVID-19. The virus was detected in the eye protection and subsequently developed red eyes patient’s ocular swab days after it was no longer followed by pneumonia. This report demonstrates the detectable in the nasal swab. The study concluded that possibility of ocular transmission of COVID-19 and RFXODU ÁXLGV RI 6$56 &29 LQIHFWHG SDWLHQWV PD\ rules out the respiratory tract as the only SARS-COV-2 contain the virus, which could be a potential source transmission route. The authors highlighted the of infection.7 importance of protective eyewear when examining patients.

Report two A timeline of events for a healthy 29-year-old female Report five patient who developed conjunctivitis as the main This prospective interventional case series study presenting symptom of COVID-19 is summarised in collected the tear and conjunctival secretions of 30 Figure 3 (page 70).8 While report one illustrated that patients diagnosed with the novel coronavirus conjunctivitis may be present in SARS-COV-2 patients, pneumonia (NCP) for viral culture and reversethis case demonstrates that conjunctivitis can be a transcription polymerase chain reaction (RT-PCR) presenting symptom of SARS-COV-2. assay.11 The results of the study, conducted at a hospital in Zheijang, China, are shown in Figure 4 (page 70).

The authors concluded that the risk of ocular Report three transmission is low, as viral RNA was only found in This study investigated ocular manifestations and viral tear and conjunctival secretions of one patient; prevalence in the conjunctiva of patients with COVID-19 however, the possibility of ocular transmission should in Hubei province, China.9 Almost a third (12 out of 38 SDWLHQWV ZLWK &29,' KDG RFXODU ÀQGLQJV FRQVLVWHQW not be ignored. Further study is required to determine

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91OPTAUG20135.pgs 29.07.2020 09:47

CET 3, 1

Contact lenses & systemic disease

VERSION REPRO OP

Figure 2

SUBS

JAN 23 2020

JAN 28 2020

Travel from Wuhan, China to Italy

Symptoms begin

JAN 29 2020

Admitted to hospital: - Non-productive cough - Sore throat - Bilateral conjunctivitis

FEB 1 2020

Tests positive for COVID-19: - Fever - Nausea, vomiting

FEB 13 2020 Conjunctivitis improves

FEB 18 2020 Resolution of conjunctivitis

Figure 2 Timeline of COVID-19 symptoms for 63-year-old female patient8 ART

Figure 3

FEB 29 2020

PRODUCTION

Travels home to Canada after one month in Philippines

MAR 1 2020

MAR 3 2020 - Photophobia + - RE mucous discharge - Sore and swollen eyelid - Conjunctival injection - Follicles - Pseudodendrite x1 - Subepithelial infiltrates x8

Presenting symptoms: - RE conjunctivitis - Rhinorrhoea - Nasal congestion

MAR 5 2020

MAR 6 2020

Worsening symptoms: - Conjunctival injection, pain, irritation - Tender pre-auricular node

Persistently worsening symptoms: - Cervical lymphadenopathy - RE VA drops to 6/10, PH 6/9 - RE follicular conjunctivitis - Subepithelial infiltrates >50

Impression: epidemic keratoconjunctivitis

Impression: herpetic keratoconjunctivitis Treatment: T Valaciclovir 500mg PO TID, G Moxifloxacillin QID RE

CLIENT

Figure 3 Timeline of COVID-19 symptoms for 29-year-old female patient6

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70 www.optometry.co.uk

MAR 8 2020 Tests positive for COVID-19

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Figure 4

29 patients = 96.67% No ocular signs or symptoms No viral RNA detected in tear and conjunctival secretions of patients with severe or common type of SARS-COV-2 without conjunctivitis

1 patient = 3.33% Conjunctival congestion Aqueous secretion Viral conjunctivitis No severe fever or respiratory symptoms Viral RNA found in tear and conjunctival secretions with conjunctivitis

Figure 4 Results of tear and conjunctival secretions of 30 COVID-19 positive patients4

August /September 2020

BLACK YELLOW MAGENTA CYAN

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Figure 5 DIRECT CONTACT

Person-to-person coughing, sneezing, talking

Contaminated ocular surface

Possible risk of SARS-COV-2 being transferred to CL surface

Fingers contaminated upon CL removal

Virus transfers to CL case CL solution contaminated

CET

Touching contaminated surface then touching mucous membranes, eyes, nose, mouth

INDIRECT CONTACT

Figure 5 A pathway for infection spread for CL wearers

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SARS-COV-2 and CL wear 7KH &HQWHUV IRU 'LVHDVH &RQWURO DQG 3UHYHQWLRQ &'& DORQJVLGH RSWRPHWU\ UHJXODWLQJ DQG JRYHUQLQJ ERGLHV ZRUOGZLGH ²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ÁX OLNH RU &29,' V\PSWRPV &/ ZHDUHUV VKRXOG VHHN DGYLFH IURP WKHLU H\HFDUH SURYLGHU DQG LPPHGLDWHO\ GLVFRQWLQXH &/ ZHDU 3DWLHQWV VKRXOG QRW VOHHS LQ WKHLU &/V XQOHVV DGYLVHG LW LV VDIH WR GR VR E\ DQ H\HFDUH SURIHVVLRQDO 5XEELQJ WKH &/ GXULQJ WKH FOHDQLQJ SURFHVV LV YHU\ LPSRUWDQW 5 DV &/ FOHDQLQJ ZLOO SUHYHQW WKH YLUXV WUDQVIHUULQJ WR WKH H\H +\GURJHQ SHUR[LGH EDVHG V\VWHPV IRU FOHDQLQJ GLVLQIHFWLQJ DQG VWRULQJ &/V VKRXOG EH H HFWLYH DJDLQVW 6$56 &29 7KHUH LV FXUUHQWO\ LQVX FLHQW VFLHQWLÀF HYLGHQFH DERXW WKH H FDF\ RI RWKHU GLVLQIHFWLRQ PHWKRGV VXFK DV PXOWLSXUSRVH VROXWLRQ

Contact lens advice for the COVID positive patient &29,' SRVLWLYH &/ ZHDUHUV VKRXOG IROORZ WKH DGYLFH RXWOLQHG EHORZ 5

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CET 3, 2

Contact lenses & systemic disease

CET 3, 3 VERSION

About the author Q Jaspreet Sajjan is a specialist optometrist at Leicester Royal Infirmary. She has nine years’ experience in hospital optometry and has a wide range of clinical interests including medical retina and uveitis.

REPRO OP SUBS ART

Stop CL wear Immediately dispose of any CL worn at the time of symptoms/diagnosis and practise thorough hand hygiene afterwards Discard all CL solutions, ocular lubricants and CL cases during the above time Revert to spectacle wear When fully recovered, recommence with brand new CLs, solutions and CL case.

Additionally, the practitioner may advise a CL wearer to temporarily stop CL wear if they are in the same household as someone with COVID-19 symptoms, until they recover.14

Summary It is safe for CL wear to continue in healthy in CL wearers, if they are compliant with CL and hand hygiene and general adherence is optimal Always consider ocular transmission of SARS-COV-2 as a cause of viral conjunctivitis In COVID-19 positive cases, CL wear should be strictly prohibited. All CLs, CL cases and solutions must be disposed of, only returning to CL wear after approval from an eyecare provider Thorough hand washing and hygiene is imperative with CL wear Current best practice regarding CLs is still applicable.

Advice for practitioners PRODUCTION CLIENT

Practitioners should be aware of their local clinical care facilities while access to primary eye care is limited. In order to reduce the impact and likelihood of CL-related complications requiring medical attention, practitioners could advise patients to reduce CL wear time while at home during the pandemic, eliminate sleeping in CLs (where successful insertion and removal has been documented) or consider changing patients to daily GLVSRVDEOH OHQVHV 7KLV LV HVSHFLDOO\ EHQHÀFLDO IRU KLJK risk immunocompromised patients. Additionally, practitioners should use alcohol-based disinfectants before and after each patient consultation in the interest of infection control. The College of Optometrists has advised practitioners to keep time spent on slit lamp and other close examinations to a minimum safe level.21 The Centre for Ocular Research and Education (CORE) has published an information poster for CL wearers during the pandemic, which can be displayed in practice waiting areas.22

indirect viral contact causing potential ocular infection, as well as a theoretical risk of the virus being transferred by hand to the eye and CL during insertion and removal.13 Practitioners should always be aware of the pathway for infection spread for CL wearers as illustrated in Figure 5.

Exam questions and references

Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 30 October 2020. You will be unable to submit exams after this date. Please note that when taking an exam, the MCQs may require practitioners to apply additional knowledge that has not been covered in the related CET article. CET points will be uploaded to the GOC within 10 working days. You will then need to log into the GOC website (www.optical.org) to confirm your points. Visit www.optometry.co.uk, and click on the ‘Related CET article’ title to view the article and accompanying ‘references’ in full.

Conclusion SARS-COV-2 has been found to be present on ocular surfaces and isolated in tears of symptomatic patients,5 and so it may be wise to assume that COVID-19 can be transmitted from the ocular surface and tears. Therefore, practitioners should exercise caution when advising a COVID positive patient on CL wear.

As SARS-COV-2 is very recent, we do not yet have a full understanding on the way it interacts with CLs. Further study in this area is needed to elucidate: The ability of SARS-COV-2 to adhere to CL surfaces 7KH H FDF\ RI &/ GLVLQIHFWDQWV DJDLQVW 6$56 &29 The interaction of SARS-COV-2 on CL materials :KHWKHU WKH WHDU ÀOP SOD\V D SURWHFWLYH UROH DJDLQVW SARS-COV-2.

There is always a theoretical risk of direct and

72 www.optometry.co.uk

Course code: C-75882 Deadline: 30 October 2020

Learning objectives Q Be able to promote safe contact lens wear for patients during the COVID-19 pandemic (Group 5.2.1) Q Be able to promote safe contact lens wear for patients during the COVID-19 pandemic (Group 5.2.2) Q Be able to promote safe contact lens wear for patients during the COVID-19 pandemic (Group 5.4.2)

August /September 2020

BLACK YELLOW MAGENTA CYAN

91OPTAUG20137.pgs 29.07.2020 09:48

Composite ad opage

VERSION REPRO OP SUBS ART PRODUCTION CLIENT

BLACK YELLOW MAGENTA CYAN

91OPTAUG20168.pgs 29.07.2020 15:35

VERSION

Visual impairment, employment and empowerment

REPRO OP

Cirta Tooth BSc, Prof Cert LV, Higher Cert LV, Prof Cert Paed Eye Care SUBS

This article describes the impact of visual impairment in the workplace and the role that practitioners can play in helping these patients

ART

Optometrists Dispensing opticians

PRODUCTION

Introduction

CLIENT

In the year 2010, just over 600 people of working age were newly registered for severe sight impairment (SSI) or sight impairment (SI) in Scotland.1 For many years, the leading cause of SSI in working age adults was diabetic retinopathy (DRP)/maculopathy, but this has now become the second leading cause of blindness after inherited retinal disease in England and Wales according to data from 2010.2 However, the Royal National Institute for Blind People (RNIB) states that DRP/maculopathy remains the leading cause of â&#x20AC;&#x2DC;avoidable sight lossâ&#x20AC;&#x2122; among the working age population in the UK.3 Sight loss has an immediate impact on employment.

In 2015, around one in four registered (SI or SSI) people in the working age population were in paid employment, compared to around three in four in the general population.4 SI and SSI people of working age DUH VLJQLĂ&#x20AC;FDQWO\ PRUH OLNHO\ WR UHFHLYH KRXVLQJ DQG FRXQFLO WD[ EHQHĂ&#x20AC;W 5 and twice as likely to be living in a household with an income of less than ÂŁ300 a week.

Why are visually impaired people under-represented in the workplace? It has been reported that 27% of nonTable 1 Clinical findings for case one

LogMAR distance vision

R 1.00 improved to 0.80 with correction L 0.80 improved to 0.50 with correction Binocular 0.80

Reading (unaided, no improvement with correction)

R N20 L N12 Binocular N12

74 www.optometry.co.uk

August /September 2020

BLACK YELLOW MAGENTA CYAN

1 CET

working registered people left their last job due to the onset of sight loss or deterioration of sight. However, more people would stay in employment with the right support.6 Receiving specialist vision rehabilitation VXSSRUW LPSURYHV FRQĂ&#x20AC;GHQFH DQG LQGHSHQGHQFH DQG aids in the acquisition of new skills.7 ,Q WKLV DUWLFOH GLÂ&#x20AC;HUHQW VFHQDULRV ZLOO EH GLVFXVVHG WR LOOXVWUDWH KRZ YLVXDO LPSDLUPHQW FDQ DÂ&#x20AC;HFW HPSOR\PHQW and what positive steps can be made to support people of working age.

POINT

Case one: diabetic eye disease 7KLV Ă&#x20AC;UVW FDVH GHPRQVWUDWHV WKH HÂ&#x20AC;HFW RI VXGGHQ visual loss in adults of working age, in this scenario due to diabetic eye disease. Table 1 summarises the clinical details.

A sudden drop in vision could mean that the day-to-day work duties either have to be adapted or changed and in some cases a patient may not be able to continue in the role that they are employed for. Sudden involuntary unemployment can lead to depression, anxiety,8 and fear,9 and this is exactly what this patient is experiencing.

In this case, the patient works freelance, which means that there is a sudden loss of income for him.

The low vision practitioner needs to be equipped to deal with both the emotional stress and employment issues. $OWKRXJK VRPH SUDFWLFDO VXSSRUW FDQ EH RÂ&#x20AC;HUHG LQ terms of optical aids, there is a much wider issue here WKDW GHPDQGV LQSXW IURP PDQ\ GLÂ&#x20AC;HUHQW DJHQFLHV Some of the issues will be discussed here.

In this scenario, driving a car is an essential part of the job and also the ability to see small details closeup. As both of these skills are now compromised, the patient has decided to take unpaid leave. As many SHRSOH LQ WKH 8. KDYH OLPLWHG Ă&#x20AC;QDQFLDO UHVHUYHV 10 this VFHQDULR FDQ OHDG WR VLJQLĂ&#x20AC;FDQW GLVWUHVV :LWK PRQH\ running out at the end of the month, this patient is worried about not being able to pay his rent. :KDW Ă&#x20AC;QDQFLDO VXSSRUW LV DYDLODEOH" +RZ FDQ WKLV patient be supported in the workplace?

Distance vision and driving This patient is undergoing intravitreal treatment for maculopathy. Once the condition has settled, refraction will need to be repeated in order to establish if driving can be resumed. In the meantime, the patient is advised not to drive as his vision is unstable and below driving standards.

Near vision In the workplace, this patient felt that the use of PDJQLĂ&#x20AC;HUV ZDV XQDFFHSWDEOH IRU YDULRXV UHDVRQV ,Q the authorâ&#x20AC;&#x2122;s experience, patients often cite that they do not want to be perceived as someone with a visual impairment. Unfortunately, the stigma associated with the use of low vision aids still exists and a better understanding of visual impairment within general society and the workplace may reduce this stigma.11 It ZDV GHFLGHG WR IRFXV RQ SUHVFULELQJ PDJQLĂ&#x20AC;HUV IRU WKH home situation during this visit and perhaps consider adaptations in the workplace at a later date. A dome PDJQLĂ&#x20AC;HU SURYLGHV HQRXJK PDJQLĂ&#x20AC;FDWLRQ IRU Ă XHQW reading tasks, allowing an acuity reserve of 2:1.12 For reading labels and instructions with small print and poor FRQWUDVW DQ LOOXPLQDWHG KDQG PDJQLĂ&#x20AC;HU IRU H[DPSOH RI DURXQG [ PDJQLĂ&#x20AC;FDWLRQ LV D JRRG RSWLRQ )RU SDWLHQWV with access to a smartphone, assistive technology can be explored. Simple advice can be given during the consultation. For further support the practitioner can refer to local technology sessions for the visually impaired.

Work The Equality Act 2010 protects employees with a disability,13 and it is helpful to be familiar with referral pathways to provide the right employment support. In this case, a same-day referral was made, and options were discussed to support this patient in the workplace. It is worth referring to the nearest eye FOLQLF OLDLVRQ R FHU (&/2 DV WKH\ RIWHQ R­HU VDPH GD\ DVVHVVPHQW DQG DGYLFH ,Q WKLV FDVH WKH (&/2 DUUDQJHG D EHQHĂ&#x20AC;WV FKHFN IRU ORQJ WHUP Ă&#x20AC;QDQFLDO VXSSRUW DQG tactile stickers to highlight dials and switches.

CET

Diabetes control Good glycaemic control is important to prevent further visual loss. It is, therefore, important to address this issue and make sure that the patient is able to manage their medication. For instance, audio or large display glucose meters can be obtained.

This case scenario demonstrates that positive changes can be made to support a patient with their HPSOR\PHQW DQG Ă&#x20AC;QDQFHV +RZHYHU LW LV XQUHDOLVWLF to expect changes to be made overnight and, therefore, some time is needed to set realistic goals and expectations. One also needs to consider the HPRWLRQDO LPSDFW DQG R­HU ORZ YLVLRQ DLGV DW D WLPH when the patient is ready to accept interventions of this type.

Case two: cerebral palsy This second scenario is an example of a patient who has had to cope with ups and downs in employment and has made some positive changes to improve his work situation. A man of working age presents to the hospital eye service (HES) with a history of cerebral SDOV\ &3 ZLWK OHIW KHPLSOHJLD Table 2 shows the UHOHYDQW FOLQLFDO Ă&#x20AC;QGLQJV RI WKLV YLVLW

Table 2 Clinical findings for case two

LogMAR distance vision (no significant refractive error)

R Hand movements L 1.10

Reading (unaided, no improvement with correction)

R N20 L N12

Eye movements and binocular vision

Large constant left exotropia Nystagmus with null point in extreme left gaze

Registration status

Severely sight impaired

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91OPTAUG20153.pgs 27.07.2020 13:31

CET 4, 1

Low vision & pathology

VERSION REPRO OP SUBS ART PRODUCTION CLIENT

+H KDG EHHQ LQ D MRE ZKHUH KH IHOW XQZHOFRPH ZLWK KLV GLVDELOLW\ IRU PDQ\ \HDUV GHVSLWH DFWXDOO\ EHLQJ DEOH WR GR WKH MRE XVLQJ D WHOHVFRSLF DLG 5HSRUWV RI WKLV W\SH ZKHUH LQGLYLGXDOV KDYH XQVDWLVIDFWRU\ ZRUN experiences can lead to them eventually giving up.14 Although the Equality Act 2010 sets out to protect people with SI or SSI in the workplace, the reality is WKDW VRPH SHRSOH FDQ Ă&#x20AC;QG LW GLÂ&#x160;FXOW WR IXQFWLRQ LQ employment. The unemployment rate in young people with CP and average intelligence, is higher than in the JHQHUDO SRSXODWLRQ ZKLOH RI SHRSOH ZLWK &3 LQ employment have experienced situational or health barriers.15 'HVSLWH WKHVH EDUULHUV WKH SDWLHQW LQ WKLV FDVH GHFLGHG WR JHW IXUWKHU HGXFDWLRQ ZLWK D YLHZ WR DFKLHYLQJ PRUH VDWLVI\LQJ MRE SURVSHFWV 6LQFH WDNLQJ WKLV SURDFWLYH DSSURDFK IRU WKH SDVW IHZ \HDUV KH KDV been working in a new environment where he is valued and appreciated. +H KDV EHHQ XVLQJ D [ VSHFWDFOH PRXQWHG OHIW PRQRFXODU WHOHVFRSH IRU PDQ\ \HDUV DQG KH Ă&#x20AC;QGV WKLV H[WUHPHO\ XVHIXO ,W KDV WKH ULJKW DPRXQW RI PDJQLĂ&#x20AC;FDWLRQ IRU ZKDW KH QHHGV WR VHH DQG LW KDV D Ă H[LEOH ZRUNLQJ GLVWDQFH ZLWKRXW WKH QHHG WR KROG D PDJQLĂ&#x20AC;HU ZKLFK LV LGHDO ZLWK KLV KHPLSOHJLD $GDSWDWLRQ to a distance telescope is enhanced when the user XQGHUVWDQGV WKH EHQHĂ&#x20AC;WV DQG UHVWULFWLRQV RI WKH GHYLFH DV seen in this case.16 Although this patient had tried various other low vision aids over the years, the telescopic aid UHPDLQHG WKH EHVW RSWLRQ $ QHZ WHOHVFRSLF DLG ZDV Ă&#x20AC;WWHG IRU WKH ULJKW H\H XVLQJ D IRFXVDEOH .HSOHULDQ V\VWHP PRXQWHG LQWR D V\VWHP IUDPH R HULQJ PDJQLĂ&#x20AC;FDWLRQ RI 4.2x and 5x at distance and near, respectively (see Figure 1

This case shows that a patient with CP, who had negative experiences in employment, could overcome these barriers due to his own perseverance and LQLWLDWLYH FRPELQHG ZLWK WKH ULJKW VXSSRUW )RU VRPH SDWLHQWV PRUH VXSSRUW LV QHHGHG DQG UHIHUUDO WR RWKHU DJHQFLHV VXFK DV WKH 51,% RU $FFHVV WR :RUN VHUYLFHV PD\ EH UHTXLUHG 7KH\ FDQ R HU VXSSRUW LQ WKH FXUUHQW ZRUNSODFH RU H[SORUH GL HUHQW FDUHHU SDWKZD\V education and training.

Case three: macular disease 7KLV VFHQDULR LV DQ H[DPSOH RI D ZRUNLQJ DJH SDWLHQW ZKR KDV DGDSWHG WR GHWHULRUDWLRQ RI YLVLRQ RYHU many years. The patient initially had visual impairment LQ RQH H\H ZKLFK ZDV VRRQ IROORZHG E\ YLVLRQ ORVV

76 www.optometry.co.uk

August /September 2020

BLACK YELLOW MAGENTA CYAN

Figure 1

Figure 1 Focusable Keplerian telescope. Image courtesy of Associated Optical

in the other eye; this caused problems in her work situation as she needed to see very small details, including written manuscripts. However, she didnâ&#x20AC;&#x2122;t LGHQWLI\ KHUVHOI DV EHLQJ YLVXDOO\ LPSDLUHG 'HQLDO is a common initial reaction to visual impairment17 and, throughout this stage, patients tend to resist WKH XVH RI PDJQLĂ&#x20AC;HUV 7KH ZD\ WKH GLDJQRVLV LV FRPPXQLFDWHG FDQ D HFW KRZ WKH SDWLHQW ZLOO UHDFW 18 so it is important to take time to explain the condition and answer any questions the patient may have. A positive initial consultation tends to lead to better DFFHSWDQFH DQG D JRRG UDSSRUW ZKLFK LV HVVHQWLDO IRU RSWLPDO PDQDJHPHQW RI WKHVH SDWLHQWV ,Q WKLV FDVH D VLPSOH SDLU RI KLJK DGG VSHFWDFOHV ZDV VXÂ&#x160;FLHQW WR FRPSHQVDWH IRU WKH SDWLHQW¡V UHGXFHG DFXLW\ +RZHYHU DV KHU YLVLRQ GHWHULRUDWHG RYHU WLPH D GL HUHQW solution was needed. At this stage, the patient was in D WUDQVLWLRQ IURP FRQVLGHULQJ KHUVHOI DV EHLQJ VLJKWHG WR LGHQWLI\LQJ DV YLVXDOO\ LPSDLUHG WKLV LV WKH SRLQW at which patients typically start to accept the need IRU FRPSHQVDWLRQ VWUDWHJLHV DQG LQWHUYHQWLRQV VXFK DV PDJQLĂ&#x20AC;HUV 19 They start to recognise that assistive GHYLFHV DQG DGDSWLYH OLIHVW\OH FKDQJHV SURPRWH LQGHSHQGHQFH DQG FRPSHWHQFH DV ZHOO DV VDIHW\ 7KH SDWLHQW ZDV QRZ UHDG\ WR UHTXHVW DQ DVVHVVPHQW IURP Access to Work in order to make some changes in the workplace, such as better lighting and extra time to complete tasks. She was issued with an electronic SRFNHW PDJQLĂ&#x20AC;HU WR HQDEOH KHU WR VHH PDQXVFULSWV )RU FHUWDLQ WDVNV WKH XVH RI PDJQLĂ&#x20AC;HUV DQG WHOHVFRSLF aids worked very well. When her vision deteriorated IXUWKHU KLJKHU PDJQLĂ&#x20AC;FDWLRQ DLGV DQG D &&79 ZHUH

issued to enable her to continue to work. She also started to use voice recognition and audio technology in her workplace. When it was no longer possible to deal with written manuscripts, she was moved to a GL HUHQW UROH ZKHUH VKH FRXOG IXQFWLRQ EHWWHU ZLWK KHU YLVXDO LPSDLUPHQW ,Q RUGHU IRU KHU WR JHW WR WKH ZRUNSODFH VKH ZDV UHIHUUHG WR WKH 51,% IRU PRELOLW\ WUDLQLQJ DQG WHFKQRORJ\ VHVVLRQV WR IDPLOLDULVH KHUVHOI with navigation apps.

As can be seen in this case, deteriorating sight FRQVWDQWO\ FKDQJHV WKH QHHGV RI WKH SDWLHQW DQG QHZ adaptations and devices need to be considered at each VWHS $ JRRG UHODWLRQVKLS DQG FRQWLQXLW\ RI FDUH LV HVVHQWLDO WR PHHW WKH HYROYLQJ QHHGV RI SDWLHQWV ZLWK deteriorating vision.

CET

References

Visit www.optometry.co.uk, and click on the â&#x20AC;&#x2DC;Related CET articleâ&#x20AC;&#x2122; title to view the article and accompanying â&#x20AC;&#x2DC;referencesâ&#x20AC;&#x2122; in full.

About the author Q Cirta Tooth is an optometrist with a special interest in visual impairment. After several years working in community optometry, she is now primarily based in a hospital setting where she works in paediatric, macular, and low vision clinics. She has developed strong relationships with healthcare professionals, local support groups and voluntary organisations.

She recently completed postgraduate education in low vision and paediatric optometry. She is involved in teaching optometrists, orthoptists, ophthalmologists, paediatricians, QTVIs, RNIB staff and postgraduate students.

Conclusion These cases have shown that the low vision practitioner can play an important role to support visually impaired patients in the workplace. However, PRUH FDQ EH GRQH ZLWK EHWWHU VXSSRUW IURP WKH government to reduce the stigma attached to sight ORVV DV ZHOO DV SURYLVLRQ RI VSHFLDOLVW HGXFDWLRQ DQG resources to support patients in the workplace. Jamie +HSEXUQ 063 IRU %XVLQHVV )DLU :RUN DQG 6NLOOV KDV DQQRXQFHG ¶$ )DLUHU 6FRWODQG IRU 'LVDEOHG 3HRSOH Employment Action Plan,â&#x20AC;&#x2122; in which he commits to achieve the ambition to at least halve the disability employment gap over the next 20 years. The Scottish Parliament holds â&#x20AC;&#x2DC;Visual Impairment Cross Party *URXS· PHHWLQJV LQ ZKLFK HPSOR\PHQW LVVXHV IRU WKLV particular group are among the topics discussed; this LV HQFRXUDJLQJ QHZV IRU SHRSOH ZKR KDYH ORVW RU DUH LQ GDQJHU RI ORVLQJ WKHLU MRE DV ZHOO DV IRU WKRVH ZKR DUH unemployed due to sight loss.

Exam questions Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk.

Please complete online by midnight on 30 October 2020.

You will be unable to submit exams after this date.

Please note that when taking an exam, the MCQs may require practitioners to apply additional knowledge that has not been covered in the related CET article.

CET points will be uploaded to the GOC within 10 working days. You will then need to log into your CET portfolio by clicking on â&#x20AC;&#x2DC;MyGOCâ&#x20AC;&#x2122; on the GOC website (www.optical.org) to confirm your points.

Course code: C-75444 Deadline: 30 October 2020

Learning objectives Q Be able to identify and respond to patientsâ&#x20AC;&#x2122; fears, anxieties and concerns about their visual welfare in the workplace (Group 1.1.3) Q Be able to direct patients with visual impairment to services that can support them in the workplace (Group 2.10.1) Q Be able to provide advice on optical and non-optical interventions to support the needs of patients with visual impairment in the workplace (Group 4.2.1) Q Be able to identify and respond to patientsâ&#x20AC;&#x2122; fears, anxieties and concerns about their visual welfare in the workplace (Group 1.1.3) Q Be able to direct patients with visual impairment to services that can support them in the workplace (Group 2.10.1) Q Be able to provide advice on optical and non-optical interventions to support the needs of patients with visual impairment in the workplace (Group 6.3.1)

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91OPTAUG20154.pgs 28.07.2020 18:29

CET 4, 2

Low vision & pathology

VRICS VERSION REPRO OP

OCT findings in age-related macular degeneration

1 CET POINT

Dr Daniel Epshtein OD, FAAO SUBS

In this feature, readers are invited to review the OCT images and answer the accompanying questions using additional resources where required.

ART

Optometrists Image B

Image A

PRODUCTION CLIENT

An asymptomatic 77-year-old male patient presents for his routine annual examination. A macular OCT was acquired.

01 a) b) c) d)

This OCT image depicts: Exudates Drusen Haemorrhage Cystoid macular oedema

02 What is the expected vision based on this retinal OCT? a) 6/6 to 6/12 b) 6/24 to 6/36 c) 6/60 d) Worse than 6/60 03 What does the hyper-reflective band denoted by the red marker represent? a) Ellipsoid zone b) Photoreceptor zone c) Retinal pigment epithelium d) Outer nuclear layer

78 www.optometry.co.uk

August /September 2020

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An 87-year-old female patient presents complaining of progressively worsening vision in both eyes over the past six years. The right OCT image is presented here.

04 Which term best describes the findings?

D &RQĂ XHQW GUXVHQ b) Disciform scarring c) Geographic atrophy d) Active choroidal neovascularisation 05 What does the hyper-reflective band denoted by the blue marker represent? a) Outer plexiform layer b) Ganglion cell layer c) External limiting membrane d) Bruchâ&#x20AC;&#x2122;s membrane 06 What does the hyper-reflective zone denoted by the red marker represent? a) Increased signal intensity of the choroid due to loss of overlying structures b) Choroidal neovascularisation c) Disciform scarring d) Drusen

Image C

VRICS

Image D

An 82-year-old female patient presents complaining of blur in her right eye for the past month or two. She had a good outcome from cataract surgery three years prior. Best corrected visual acuity in this eye is 6/30.

07 Which term best describes the OCT finding?

D &RQÁXHQW GUXVHQ b) Disciform scarring c) Geographic atrophy d) Active choroidal neovascularisation 08 The area denoted by the red marker represents: a) Drusen b) Exudate F 6XEUHWLQDO ÁXLG d) Choroidal neovascular membrane 09 The area denoted by the blue marker represents: a) Drusen b) Exudate F 6XEUHWLQDO ÁXLG d) Choroidal neovascular membrane

About the author Q Dr Daniel Epshtein currently practices in a hospitalbased ophthalmology practice at Mount Sinai St Luke’s in New York City. Previously, he held a position in a high-volume multispecialty practice where he supervised optometry students as an adjunct assistant clinical professor of the SUNY College of Optometry. Dr Epshtein’s research focuses on using the latest ophthalmic imaging technologies to elucidate ocular disease processes and to help simplify equivocal clinical diagnoses.

Exam questions Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 30 October 2020.

You will be unable to submit exams after this date.

An 85-year-old female patient presents for review of her agerelated macular degeneration having received several injections in her left eye. Her best corrected vision in this eye is 6/12. The 2&7 DQJLRJUDSK\ LV DQ HQ IDFH UHSUHVHQWDWLRQ RI WKH EORRG ÁRZ between the pink dotted lines in the structural OCT. 10 Which term best describes this condition?

D &RQÁXHQW GUXVHQ b) Geographic atrophy c) Non-exudative choroidal neovascularisation d) Exudative choroidal neovascularisation 11 The fern-like pattern denoted by the red marker on the OCT angiography image represents: a) A disciform scar b) A choroidal neovascular membrane c) Exudation d) Outer retinal tubules 12 a) b) c) d)

The lesion is most likely to: Convert to exudative choroidal neovascularisation Convert to a disciform scar Convert to drusen Convert to geographic atrophy

Course code: C-75619 Deadline: 30 October 2020

Learning objectives Q Be able to interpret OCT scans of the macula (Group 3.1.3) Q Be able to identify retinal abnormalities and understand the implications for the patient (Group 6.1.5)

August /September 2020

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VRICS 1, 1

AMD, low vision & OCT

VRICS VERSION REPRO OP

Optometric management of anterior segment eye disease

1 CET POINT

Dr Sandeep Kaur Dhallu BSc, PhD, MCOptom, FBCLA SUBS

This feature requires the practitioner to consider signs, symptoms and management options for a range of anterior segment conditions accessing additional resources where necessary to answer the questions.

ART

Optometrists

Therapeutic optometrists

Contact lens opticians Image B

PRODUCTION

Images courtesy of Johnson & Johnson Institute

Image A

CLIENT

A 30-year-old patient presents for a routine check with the signs shown in the image 01 What is the most likely diagnosis? a) Orbital cellulitis b) Chalazion c) Meibomian gland dysfunction d) Chronic blepharitis 02 Which of the following is not a recommended management option for this condition? a) Lid hygiene measures b) Using warm compresses, either wet to loosen crusts or dry to melt meibum c) Ganciclovir 0.15% antiviral gel d) Advise the patient to avoid cosmetics, especially Weye liner and mascara 03 Which of the following signs and symptoms is least likely to be associated with this condition? a) Transient blurred vision b) Ocular discomfort c) Photophobia d) Blepharospasm

80 www.optometry.co.uk

August /September 2020

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A patient with chronic blepharitis presents with a recurrent, red, light sensitive, painful and watery eye for the last few days.

She has recently overcome an upper respiratory tract infection.

Fluorescein staining reveals the signs shown in the image 04 What is this presentation most likely to be? a) Anterior uveitis b) Marginal keratitis c) Microbial keratitis d) Dry eye 05 Which of the following is not a recommended management option? a) Ocular lubricants for symptomatic relief and systemic analgesic if required b) Antibiotic drops or ointment alongside steroid GURSV WR UHGXFH DQ\ LQÁDPPDWLRQ c) Advise regular lid hygiene d) Emergency referral to an ophthalmologist 06 Which of the following would be a possible differential diagnosis? a) Terrien’s marginal degeneration b) Marginal herpes simplex keratitis c) Mooren’s ulcer d) All of these options

Image C

A patient attends for contact lens aftercare with the following sign seen during lid eversion 07 Which of the following symptoms would you least expect the patient to complain of? a) Itchiness b) Burning sensation c) Mucous discharge d) Pain on eye movement 08 Which of the following is not a predisposing risk factor for this condition? a) Mechanical trauma from long-term-wear of ocular prostheses b) History of atopy F &RQMXQFWLYDO LQÁDPPDWRU\ FRQGLWLRQ DVVRFLDWHG ZLWK ZHDULQJ SRRUO\ ÀWWHG VRIW FRQWDFW OHQVHV d) Age 09 The patient has worn the same brand of soft monthly silicone hydrogel contact lenses for the past 10 years. What would the most appropriate management in this case? a) Switch to daily disposable lenses b) Continue with the same lenses and wearing time F 5HÀW ZLWK 5*3 OHQVHV d) Permanently discontinue lens wear

About the author Q Dr Sandeep Kaur Dhallu is a lecturer at the University of Hertfordshire following a previous role as a research fellow at Aston University. Prior to that she worked within clinical research at Moorfields Eye Hospital. Dr Dhallu was recently awarded a fellowship from the British Contact Lens Association.

Exam questions Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 30 October 2020.

You will be unable to submit exams after this date.

VRICS

Image D

A 40-year-old patient attends the practice complaining of a red right eye since the evening before. She reports mild discomfort, no discharge and mentions that similar episodes occur every six to eight weeks 10 What is the most likely diagnosis? a) Scleritis b) Episcleritis c) Conjunctivitis d) Anterior uveitis 11 Which of the following is not an appropriate treatment option for the condition shown?

D $UWLÀFLDO WHDUV IRU V\PSWRPDWLF UHOLHI LI UHTXLUHG b) Cold compress for symptomatic relief if required c) Investigation for underlying systemic disease d) Topical antibiotics 12 Which of the following is commonly associated with this condition?

D &HOOV DQG ÁDUH LQ WKH DQWHULRU FKDPEHU b) Blanching of the blood vessels with phenylephrine 10% c) Reduced visual acuity d) Exudative retinal detachment

Course code: C-75577 Deadline: 30 October 2020

Learning objectives Q Be able to identify a range of anterior segment conditions (Group 6.1.5) Q Be able to determine the appropriate treatment options for a range of anterior segment conditions (Group 1.1.2) Q Be able to identify a range of anterior segment conditions during contact lens aftercare (Group 5.4.1)

August /September 2020

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VRICS 2, 1

Anterior segment

Northern Lenses

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JOBS VERSION REPRO OP

Jobs

www.aop.org.uk/ot/jobs

SUBS

INSIDER ADVICE

TOP TIPS FOR FREQUENTLY ASKED QUESTIONS AT INTERVIEW

ART

Michelle Hiseman, career counsellor at CV Writers, looks at how best to prepare for and answer frequently asked questions 1. Tell me about yourself

PRODUCTION CLIENT

Alternative versions are, “Talk me through your CV” or “What’s your story?” Often in an opening question, interviewers are not looking for your life history or a re-run of the information on your CV. The answer needs to be a summary of your career highlights, key achievements, motivation for this career, training, interests, volunteer work and languages spoken. Also, be prepared for “Describe yourself in three words” and “How do others describe you?”

From the moment you decide to apply for a new job, remember:

focus on aspects such as lack of career progression, geographical distance or a company restructure. Keep the reason brief then move on to why the position you are interviewing for has piqued your interest.

4. What are your weaknesses?

Alternative versions are, “What aspects do you need to improve on?” Or “What are you not good at?” These questions WHVW \RXU DELOLW\ WR VHOI UHÁHFW $YRLG traits such as being a perfectionist or work-alcoholic and do not mention core skills required for the role. Talk in 2. Why are you interested in terms of ‘areas of development,’ or what this position? you are not comfortable with rather Avoid giving a generic answer. Mention than using the word what aspects of this ‘weakness’ in your company and role “Mention what aspects and turn it into appeal to you. Do of this company and role answer a positive statement. their values and ethos appeal to you. Do their For example, “I’m match your own? not keen on giving Does the organisation values and ethos match presentations, R HU RSSRUWXQLWLHV IRU your own?” however, I took a the career progression you are looking for? If you can’t think of training course last year and was given good feedback about my style.” Prepare any reasons, ask yourself if you should two or three ‘weaknesses,’ because it is be applying for the role. not uncommon for the interviewer to ask for more than one.

3. Why are you leaving your

current job?

This is an alternative to the second question above. This is not the time to be critical of your current boss or organisation. Stay professional and

BONUS TIP: Remember the three Rs

5. What are your strengths?

An alternative could be, “What are you good at?” You need to focus on a IHZ VSHFLÀF VWUHQJWKV WKDW DUH UHODWHG

Research Before you write your CV and make the application, research the role and the organisation thoroughly. The most important document is the job description, particularly the person specification. These outline the skills, competencies and attributes which are important to the role. The company website gives you a useful insight into their values, culture, news and career progression.

Relevance Always put yourself in the shoes of the employer and think about what they are looking for. Tailor your application and interview answers accordingly. Choose examples to use in your interview that showcase your skills which match their criteria.

Always keep in mind the culture, values and vision of the organisation.

Rehearse Practise your interview answers out loud. Ask a trusted friend or career coach to give you honest feedback on your performance. Go through your own job description and CV and practice talking through each aspect. Focus on key messages rather than learning a verbatim script. An over-rehearsed answer will not come across well – you need to be able to adapt your answers to the actual questions asked.

to the role, and back each one up with an appropriate achievement or short H[DPSOH %H FRQÀGHQW DQG UHOD[HG DERXW your strengths and avoid boasting or being arrogant.

CV Writers offers career counselling and interview coaching, as well as support with CVs, LinkedIn profiles and cover letters. They also provide a free CV review service via their website www.cv-writers.org.uk

August /September 2020

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Marketplace 1

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REPRO OP

Services and products for the practitioner

SUBS

RESPONDING TO THE COVID-19 LOCKDOWN

ART

Three optometrists tell OT about the products and systems that have enabled them to adapt to an unprecedented situation

PRODUCTION CLIENT

I couldn’t live without… a COVID-19 triaging system Nikki Sharma, Cambridge “We have introduced a colour-coded triaging system to help us identify patients who require urgent/essential eye care and those who need remote care consultations. Once an appointment is booked, my colleagues contact the patient to ask the relevant COVID-19 questions and triage them. The colour of the slot in the diary is altered from green (pre-triaged) to blue (triaged), making it easier to identify patients who need to be contacted. When the patient attends their appointment, they are asked the COVID-19 questions again.

The triage form is handed to me prior to the appointment. This is useful as I can highlight the patients who need extra FDUH 7KH LQLWLDO WULDJH IRUP ZDV ÀOOHG with numerous questions and required an extensive phone conversation, however after some rejigging we have been able to create a form which is still thorough, but more concise and less time consuming. Working together on all of the new processes, including the triaging system, we’ve shown what we are capable of.”

I couldn’t live without… an Optopol Revo FC Simon Rose, Essex and London “I saw the Optopol Revo at 100% Optical. Having had OCT for the last 15 years, I ZDV RQH RI WKH ÀUVW LQ WKH 8. ZLWK WKH RTVue. I realised I needed to update,

I COUL NOT LI D W ITHO V E UT...

“We have introduced a colour-coded triaging system to help us identify patients who require urgent/essential eye care and those who need remote care consultations” Nikki Sharma

and the Optopol Revo was the one for me. When I received the machine it was working excellently, but I struggled initially to get used to the semi-automated mode, which is necessary to use on high myopes and on certain other specialist scans. After getting used to the semi-automated mode, I started to enjoy using it, and found it

an absolute pleasure to get accurate images and managed to train up all the VWD WR XVH LW 7KH %LRPHWU\ VRIWZDUH axial length package has changed the way that I deal with young myopes and think about myopia management.

“Lockdown changed the game for me. In practice I had to continue to work throughout, helping local GPs and eye units cope with urgent, emergency and essential cases around minor eye care services (MECS) in the Hackney and Ilford areas. The Revo came into its own when I realised I could fully control it from another consulting room, allowing me to shield vulnerable elderly patients who had sudden vision loss.

“The angiography software addition has proved invaluable in sorting out the wet from the dry AMDs. The Revo is now my main weapon, and not having to get close to patients but still giving them a thorough examination where needed is simple. I love it and can't wait for the topography add on.”

In the future I know I won’t be able to live without… the automatic phoropter Mohamed Kasmani, Feltham “I've ordered an automatic phoropter, so I don't have to be leaning so close to patients. I don't have to worry about cleaning lenses and so on, because I can get in one unit. Doing the test previously wasn't easy – I've had to disinfect all the lenses that I've been using, putting them onto one side. I'm quite meticulous, and quite neurotic about wanting to keep the whole environment nice and clean and safe.

It’s important for us to have that level of understanding that we want to get through this in the best way possible.

If it’s the case that we have to invest in keeping our patients safe, then why not?

We need to bring eye care into the 21st century.”

August /September 2020

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MARKETPLACE ICLW

VERSION

Marketplace

VERSION

MY T SECRE ...

S LI F E A

My secret life

REPRO OP

Do you have a hobby to share with readers?

Get in touch with selinapowell@ optometry.co.uk

SUBS ART PRODUCTION

Optometrist Pretty Basra on how a fledgling sweet business gave her back a sense of purpose during lockdown

CLIENT

â&#x20AC;&#x153;There is an element of nostalgia with sweets. They take you back to childhoodâ&#x20AC;?

90 www.optometry.co.uk

T

he practice where I work, Edwards and Walker Opticians, closed during lockdown. It was quite hard on my mental health. I was wondering what I would do Ă&#x20AC;QDQFLDOO\ DQG KRZ ORQJ WKH situation would go on for.

One evening on a Zoom call, one of my family members mentioned that she had ordered a box of sweets for a Friday movie night. I started thinking, â&#x20AC;&#x2DC;I love sweets and I love to be creative. I could do that.â&#x20AC;&#x2122; I thought it would be a little project.

That same night I set up a social media account and posted an order with a wholesaler. I said to my husband, â&#x20AC;&#x2DC;As long as I make what Iâ&#x20AC;&#x2122;ve put in, Iâ&#x20AC;&#x2122;m happy.â&#x20AC;&#x2122; I wasnâ&#x20AC;&#x2122;t expecting 10â&#x20AC;&#x201C;15 orders a day. I would go into practice and see emergency patients and then in the evening I would be working on the sweet business.

When I go out to deliver orders, I often strike up a conversation with the people like I would do in the testing room.

The looks on some peopleâ&#x20AC;&#x2122;s faces

when theyâ&#x20AC;&#x2122;re not expecting a delivery are absolutely brilliant. Especially when it is for a little kid and they come to the door, there is that feelgood factor.

I would say I sent out well RYHU RUGHUV LQ P\ Ă&#x20AC;UVW VL[ weeks of operating. I see it as a bit of a challenge to see how fast I can get at packing orders.

Iâ&#x20AC;&#x2122;ve asked my husband to time me. I have begun to be quite arty with the presentation. For the end user, they are probably not bothered about whether the eggs are next to the cherry lips but the colourways matter to me. It is quite therapeutic.

There is an element of nostalgia with sweets. They take you back to childhood.

We lived in a terraced house when I was young and I would negotiate how many sweets I could buy when my mother sent me to the corner shop for milk. She might JLYH PH Ă&#x20AC;YH RU WHQ SHQFH It was such a big decision choosing the right sweets. The shopkeeper would look at me wondering why I was standing there taking so long.

I keep saying to my husband, â&#x20AC;&#x2DC;I think this is it now, the orders will stop,â&#x20AC;&#x2122; but people keep on getting in touch. The experience has been gobsmacking. The minute WKH EXVLQHVV WRRN R , IHOW my shoulders relax. I had a purpose again.

August /September 2020

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LAST WORD- SECRET LIFE

LAST WORD

AOP House ad

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