Optometry Today December 2020/January 2021

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December 2020/January 2021 Volume 60:09

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How we live now

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Rethinking the role of the UK’s High Street

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CET Visual challenges associated with driving

Perspectives Managing the COVID-19 second wave in hospital

In practice The shifting attitudes towards e-commerce

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Journal of the Association of Optometrists

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Welcome

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or all of us in optometry and beyond, this past year has been dominated by the enormous challenges presented by the COVID-19 pandemic. We hope you and your families are well. On behalf of everyone at the AOP, thank you for your ongoing membership.

Throughout 2020, the AOP has continued to do everything we can to provide the support, protection and representation you expect from us.

In March we set up our online coronavirus information hub, so members can easily find all our specialist employment law, clinical and regulatory advice and guidance relating to the pandemic. The hub is updated frequently as we respond to rapidly changing government and NHS guidance.

We have developed specialist webinars to help members adapt to the new reality of clinical practice during COVID-19. We also adapted our planned events programme so it could be delivered online, enabling thousands of members to continue their education, training and professional development during lockdown.

We have worked along with other UK optometry bodies, as part of the Optometric Fees Negotiating Committee, to negotiate better NHS support for optical practices in England during the pandemic, and we have asked for members’ input via surveys and consultation responses to help us influence decisions about the future of our profession on your behalf.

We know our members place great value on the peace of mind the insurance cover and our legal defence provide, along with the news, features and CET in OT. These will, of course, continue to be a core part of our offering, alongside the many other benefits which are provided as standard to all our members.

As a member, you will have received the renewals pack with further information about any action you need to take to renew your membership. I hope you will remain a valued member of the AOP into 2021 – and look forward to updating you on the Association’s plans for next year.

“Throughout 2020, the AOP has continued to do everything we can to provide the support, protection and representation members expect from us”

Mike George, AOP chairman

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Welcome

DECEMBER 2020/JANUARY 2021

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Contents 59

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07-25 SPOTLIGHT

Spotlight

Making the mainstream

The news in digest Picture this Competitive edge in slit lamp imaging OT reports Three ways that a COVID-19 vaccine could affect optometry, plus Honey Rose receives GOC suspension order The audit The month in 16 stories Industry outlook Turbulent times for labs 100% Optical preview Bringing the profession together Clinical roundup Insights from the AOP’s hospital optometry virtual event series Supplier insight The impact of OCT rollout AOP member support Responding to the GOC’s Education Strategic Review

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“Post-lockdown, I think OCT has come into its own, and I would have struggled personally with not having an OCT in practice” Martin Memory, optometrist PAGE 22

29-34 HIT LIST

The trends, launches and looks OT focuses on...

Dry eye tools and products Me and my glasses Sunny Cords founder, Flo Kemp Get the look Eyewear and accessory brands to watch The shortlist This edition’s selection Behind the brand Essilor

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35-39 PERSPECTIVES

Voices from optics and beyond Perspectives Dr Cindy Tromans, the Birmingham & Midlands Eye Centre team My vision Lee Morris

“The burden of responsibility I felt towards optometrists who were redeployed to COVID-19 wards will always stay with me” Dr Waheeda illahi, PAGE 36

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Inside

A GUIDE FOR EVERY PRACTICE

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CET 65-91 Education and training for the eye care practitioner 65 CET welcome 66 The visual challenges associated with driving 72 Light for sight 77 Scleral lenses: dealing with a game-changer 82 21st century low vision care: apps and accessibility 88 Measurement devices for dispensing 90 Visual fields in neuro-ophthalmic disease In this edition of OT, practitioners can test a range of competencies: OPTOMETRISTS // 5 DISPENSING OPTICIANS // 4 CONTACT LENS OPTICIANS // 1

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41-58 IN PRACTICE

Business insight and career development In conversation Inviting patients to experience contact lenses The discussion OT explores the realities of e-commerce in a COVID-19 world How I got here Sarah Arnold’s career view The workshop Booking interpreters for appointments Pre-reg focus Emily Mather and Peter Grant Becoming a business owner The importance of a support system What I have learned Baird Optometrists on opening their second practice

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ONLINE

Cover story

High Street horizons Masks, socially distanced queues and hand sanitising stations have all become part of the experience on High Streets across the country. OT asks experts for a health check on the economic pulse of the UK – and what this could mean for optometry PLUS: optical businesses from across the UK share their predictions for the future of the High Street PAGE 59–64

92-98 JOBS, MARKETPLACE

OT video highlights

Self-performed visual field tests for glaucoma patients Watch the video on

www.optometry.co.uk Contact the OT team with your experiences, observations and lessons from practice today: newsdesk@optometry.co.uk Follow us on Twitter @OptometryToday

I cannot live without ”The Government’s PPE portal,” writes Nevin Govindasami Secret life Sarita Harrar’s dog walking sideline

Like us on Facebook OptometryTodayJournal Follow us on Instagram @optometry_today

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Contents

CONTENTS

Picture This VERSION

Spotlight

REPRO OP

08 OT REPORTS

How a COVID-19 vaccine could affect optometry, and Honey Rose FTP case decided

21 CLINICAL ROUND-UP

Using technology to optimise AMD services, and AI funding for retinal imaging company

24 AOP SUPPORT

Changes to AOP Council and the AOP responds to the Education Strategic Review

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PICTURE THIS ART PRODUCTION Mel Yeneralski, Cambridge University Hospitals, United Kingdom

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Capturing a winner This photograph of silicon oil bubbles by Cambridge University Hospital ophthalmic photographer Mel Yeneralski took first place in Haag-Streit's 2020 Slit Lamp Imaging competition. From more than 300 entries, 12 finalists were selected. Second place went to John McCormick, with third place awarded to Eva Steffen.

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THREE WAYS A COVID-19 VACCINE COULD AFFECT OPTOMETRY

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December 2020/January 2021 Volume 60:09 Issn 0268-5485 ABC certificate of circulation 1 January 2019 – 31 December 2019

During the first UK lockdown, the prospect of a COVID-19 vaccine provided a glimmer of hope

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

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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 bimonthly 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.

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At times, an effective vaccine, and the return to a semblance of normality, seemed like a distant possibility.

Then in November the announcement that Pfizer/ BioNTech had developed a safe and effective vaccine brought this hope closer to reality. Later in the month, promising results were announced separately by Moderna and University of Oxford/AstraZeneca.

In December, the MHRA authorised the emergency use of the Pfizer/BioNTech vaccine in the UK. What will these developments mean for the optical workforce and their patients? OT outlines three ways a COVID-19 vaccine could affect optometry.

OPTOMETRISTS MAY ASSIST WITH VACCINE DELIVERY PROGRAMME While the announcement of an effective vaccine is promising news, the practical challenges of delivering an immunisation programme to the UK population are significant.

The extra burden

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of administering vaccines comes at a time when NHS staff and resources are stretched as a result of the pandemic.

The Government is exploring how different healthcare workers might potentially assist in the delivery of COVID-19 vaccines.

In November, NHS England asked for expressions of interest in Cheshire and Merseyside as well as Lancashire and South Cumbria from optometrists interested in assisting with mass vaccinations.

Scottish therapeutic optometrist and dispensing optician, Dr Scott Mackie, told OT that a group of Lanarkshire optometrists had received training from

nurse practitioners on how to deliver injections – with the potential for some optometrists to assist in the delivery of COVID-19 vaccines in the future.

The optical workforce in Scotland has recently been asked to play a greater role in vaccinations after flu vaccinations were not included in a new GP contract.

HOSPITAL OPTOMETRISTS AMONG NHS WORKERS TO RECEIVE VACCINE AS A PRIORITY Interim Government advice on priority groups for a COVID-19 vaccine include NHS workers as well as care home staff and social workers.

OT understands that hospital optometrists will be among NHS staff who receive the COVID-19 vaccine as a priority.

At the time of writing, it was not clear whether community optometrists offering NHS care would receive the COVID-19 vaccine ahead of the general population.

In November, the NHS outlined an intention for designated sites within each primary care network to deliver a minimum of 975 vaccine doses each week.

The letter to general practice teams and clinical commissioning groups stated: “Designated sites will need to be able to deliver a vaccination service seven days per week including bank holidays between 8am and 8pm if vaccine supply allows.”

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PRACTICE FOOTFALL MAY INCREASE IF ROLLOUT IS SUCCESSFUL If carried out effectively, mass immunisation of the UK population could reduce the transmission of COVID-19 and allow the Government to ease restrictions on retail and other sectors designed to stem the spread of the virus.

Older age groups, who are more susceptible to becoming severely unwell from the illness, may feel more comfortable travelling to the High Street to seek eye care.

Currently the Government plans to undertake a phased rollout of COVID-19 vaccinations, with those aged 50 and older to receive the inoculation before the rest of the population.

Wolf Eyewear director, Tom Wolfenden, highlighted that a vaccine could help to reassure patients. “For opticians, a vaccine would mean more confidence for patients coming into practice that the environment is safe,” he said.

Edinburgh optometrist, Michael O'Kane, shared his view that the

development of a vaccine would help with the recovery from the economic recession in the UK. “I think it will be wonderful to see the world return to a more normal, social place and people won’t feel so isolated and lonely,” he observed.

Mr O'Kane noted that there will still be a need for masks and shielding among those who are unable to take the vaccine for medical reasons, with the potential need for separate clinics for those who are not immunised.

“I also think there will be a changed mindset about social interactions and physical contact – maybe handshaking of patients as you greet them will be gone for good,” he highlighted.

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OT Reports

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OPTOMETRIST HONEY ROSE RECEIVES NINE-MONTH SUSPENSION ORDER A practitioner whose gross negligence manslaughter conviction was quashed in 2017 has been suspended by the General Optical Council

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Optometrist Honey Rose, whose gross negligence manslaughter conviction was overturned, has received a nine-month suspension order from the General Optical Council (GOC). The fitness to practise case ran over 34 days in July, August and November, with the hearing conducted by video link due to social distancing restrictions because of the pandemic.

The committee’s decision on 12 November was a significant milestone in the proceedings against Ms Rose, who has not practised as an optometrist for seven years.

CLIENT

UPS & DOWNS

Speaking with OT after the decision, Ms Rose described the result as a “real relief. All that stress has gone and I can set it behind me now.”

Ms Rose expressed her gratitude for the support offered by the AOP during the fitness to practise hearing.

“Without them, I don’t think I would have made it this far,” she said.

“You can trust that they will be with you throughout your career – during the ups and downs. They will support you during all of the hard times.”

The hearing related to the provision of eye care by Ms Rose to two children, Patient A and Patient B, at the Upper Brook Street branch of Boots Opticians in Ipswich.

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Patient A received a sight test conducted by Ms Rose in February 2012 and died from swelling of the brain on 13 July 2012.

The fitness to practise committee determined that Ms Rose failed to carry out an adequate internal eye examination on Patient A and viewed the wrong retinal image. There were also associated record keeping failures. The committee concluded that Ms Rose’s acts and omissions amounted to misconduct.

On the question of impairment, the committee found that Ms Rose had remedied the specific clinical failings identified and she was fit to practise “from a personal perspective.”

However, the committee found that the registrant’s fitness to practise was impaired on public interest grounds.

MITIGATING FACTORS

Speaking at the hearing, fitness to practise chair Graham White highlighted that the committee did not consider the departure from the relevant professional standards to be sufficiently serious to warrant erasure from the register.

“Erasure is a sanction of last resort and should be reserved for the category of cases where there is no other means of preserving the wider public interest,” he said.

Mitigating factors taken into account by the committee included that the registrant’s failings were “spontaneous and momentary” and Ms Rose had demonstrated a commitment

to returning to practise by keeping her knowledge and skills up to date.

Mr White highlighted the committee’s view that, within the context of her professional career, Ms Rose’s failings were an isolated event.

The committee determined that there was no ongoing risk to public safety.

"All that stress has gone and I can set it behind me now" Optometrist, Honey Rose AOP legal director, Ella Franci, told OT: “It has been a long and difficult process for our member, Ms Rose, but ultimately we feel that it is a good result for her and the AOP’s legal team. Ms Rose’s account of what happened was accepted, and she was found to have sufficiently remedied any past misconduct identified by the FTP Committee. Although disappointed to remain suspended for nine months, Ms Rose is looking forward to returning to the profession she loves, with the ongoing support of the AOP.” Ms Franci continued: “This is a tragic case which has been devastating for all concerned and our deepest sympathies go to the patient’s family for their loss.”

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OT REPORTS

In the next edition OT's exclusive interview with Honey Rose, plus insight and learnings from the AOP legal team

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“The idea of mixing curiosity about other students or professionals, coupled with the feeling that professionals should all know they are not alone, and we are ‘all in this together’ seemed like a beautiful concept” Clare Gaba, head of marketing and communications for Louis Stone, on the company’s social media campaign to share the pandemic experiences of optometry professionals.

Bollé has launched a new augmented reality filter on Instagram, enabling customers to ‘try on and try out’ its Phantom lens, RYFT helmet and Nevada goggles. The AR experience aims to support practices and retailers to boost sales and consumer interactions, supported by communication plans and merchandising tools.

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of respondents in a Johnson & Johnson Vision Survey of 1002 UK adults admitted to putting off sight tests because they felt their vision had not changed. While respondents saw an eye exam as important for their health, there was a “disconnect” in how they prioritised their own eye care.

CooperVision has launched its Brilliant Futures Myopia Management Programme, featuring its MiSight 1 day contact lenses. Brilliant Futures introduces a new professional accreditation programme to equip practitioners to initiate and develop a myopia management practice, along with practice tools. A messaging portal linking patients to practitioners is also in development.

The Macular Society is extending its telephone befriending programme in Yorkshire and the North East after receiving a £10,000 grant from the Coronavirus Community Support Fund. It is hoped that extending the programme will provide further support for those facing loneliness due to COVID-19.

OrCam Technologies and Starkey, a hearing technology company, have partnered to pair their artificial intelligence technologies to provide a holistic solution to people with hearing and vision loss. When paired, the audio from the OrCam MyEye device will be streamed wirelessly to the Livio Edge AI hearing aids.

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Observe and measure all the main structures and surfaces of the eye

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More than just an OCT

Inspecs has conditionally agreed to acquire the equity interests in German eyewear group Eschenbach for approximately €94.85 million (£84.7 million). The acquisition would enable Inspecs to expand its global reach, particularly in Germany and the USA, broaden the company’s customer reach and strengthen its brand portfolio, Inspecs CEO, Robin Totterman shared, adding that the deal would “propel Inspecs to a new high.”

Audit

SPOTLIGHT

Optegra

“From the name ‘dry eye’, it seems very simple, but it can... significantly impact a patient’s quality of life”

Dr Tugce Ipek on her PhD research project, through which, with the support of Optegra and a European Union research grant, she developed a new in vitro model of dry eye to determine what stage of cataract surgery may induce or exacerbate dry eye. Read more online.

900m

could be affected by blindness and sight impairment by 2050, according to a study by Anglia Ruskin University. The study, which is not yet peer reviewed, estimated that blindness and severe vision impairment could more than double by 2050 – up from 338 million.

Mr Paulo Stanga, consultant ophthalmologist and vitreoretinal surgeon at the London Vision Clinic, spoke to OT about a study investigating the potential of using gene therapy to treat dry age-related macular degeneration (AMD). It is hoped the research will provide insight into how dry AMD develops, while gene therapy aims to avoid the need for monthly or bi-monthly intravitreal injections with a one-off surgery.

Watch the video at: youtube.com/

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THE AUDIT

SCIENCE AND VISION

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PROFESSIONAL SUPPORT

An expert working group has been established to review the performance of community eye care in Scotland. Chaired by Julie Mosgrove, vice-chair of Optometry Scotland, the review will assess the impact of universal entitlement to eye care in Scotland and the performance of community optometry services before and after the pandemic. The group is set to produce a report with recommendations for consideration by the Scottish Government in early January.

7.9m

attendances were recorded in ophthalmology in 2019-2020 according to NHS Digital data.

This was an increase from 7.8 million in 2018-2019 and makes it the busiest outpatient speciality for the third year running.

The General Optical Council (GOC) launched a public consultation to gather views on the content and impact of its Coronavirus (COVID-19) statements and how these should apply in the future. The statements were published to “remove unnecessary regulatory barriers, clarify certain areas of practice and reinforce existing guidance” to support registrants delivering care during the pandemic. The current statements remain in place pending the outcome of the consultation, with a review set for 31 January 2021.

IN PRACTICE

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Dr Gunnar Schmidtmann, lecturer in optometry at the University of Plymouth, has published Clinical Vision Science: A Concise Guide to Numbers, Laws and Formulas as a userfriendly guide to help students and clinicians quickly find key information for optical practice.

“Adapting to the ‘new normal’ has been strange, so it will be good for students to have a break” Hina Patel, AOP student representative and optometry student at the University of Bradford, spoke to OT on the Government’s guidance for students returning home at the end of term. While welcoming the guidance, many highlighted the practical challenges of the plans.

Anthony Josephson, optometrist and owner of Maskell + Josephson Optometrists, told OT of his conflicted feelings over the second lockdown in England, particularly the impact it would have on local businesses. He said: “A High Street is only as good as the businesses that trade there. With every lost business and vacant unit, a little bit of the soul that makes up the town dies.”

Read more on the impact of COVID-19 on the High Street from page 59.

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INDUSTRY OUTLOOK

Turbulent times for independent labs

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COVID-19 has dealt a blow to optical manufacturers. OT spoke to Preston Everard on the closure of Kentoptic and the underlying challenges facing labs

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On 23 September, it was announced that the manufacturing opticians, Kentoptic, would not be reopening after its closure due to the pandemic. The announcement marked the second independent lab to close its doors during the coronavirus (COVID-19) crisis. The Norville Group entered administration in July, before being bought by Inspecs.

The COVID-19 crisis has exacerbated challenges that existed for many independent manufacturers, from a shrinking market to technological developments. Preston Everard, executive manager of Kentoptic, gave OT his insights.

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Over the last 15 years, we have seen the multiple optician groups grow substantially, and as a consequence, the independent market decline. Our customer base was also declining due to closure or retirements. As an independent lab, this meant our work and opportunities to attain work had also diminished.

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As independent practices see a reduction in footfall, and therefore a reduction in profit, there are only three things a practice can do: increase prices, increase footfall, or reduce overheads. Over the years we had seen customers asking for bigger discounts, and when we could not discount further, our customers would have no option but to go directly to the supplier. It was a typical catch-22: our clients needed to save money, but we could no longer afford to do their work. No one is at fault; it is just the way the marketplace has gone.

Technology has also played a part. Remote edging is greatly improved and boasts a first-time fit rate of over 90%. This facility is being offered to opticians at very reasonable prices, and in some cases, depending on spend,

is supplied free. Lens edging machinery has become easier to operate and is more accurate. It can be an expensive option compared to remote edging, but it offers almost total control to the optometrist.

COVID-19 was the worst thing to happen to Kentoptic and many other businesses and its devastating effect was compounded by the time of year it hit. We could not afford to remain open and the only option was to shut down the factory and furlough the staff. When June came, we questioned whether to open again. A decision was made to remain closed. Significant factors influencing this decision were that we had no way of knowing what the working environment would look like, and the costs involved of restarting.

Both branded and independent labs are vitally important for the future of optics. Independent manufacturers can offer a unique level of service, due to a choice of products, or their proximity to their customers. They have a limitless toolbox of products to choose from. There may be a small cost involved in supporting your local lab, but if you want choice, healthy competition and a vibrant industry in the future, you need both options available.

Support your local lab as much as you can. As an independent practice, you understand the issues of competing against a wellorganised, well-funded multiple group. As an independent lab, we have exactly the same issues that you do.

For more on the challenges facing independent labs, visit www.aop.org.uk/ot/industry/equipment-and-suppliers

THE NUMBERS:

CHANGING WORKPLACE PRIORITIES

56%

A survey by Talentshed of over 400 optometrists found that priorities in the workplace have changed due to coronavirus (COVID-19)

81%

of optometrists said physical working conditions are now more important due to COVID-19

77%

of optometrists felt job stability is now more important

65% of optometrists rated salary as more important

of optometrists say what is most important in a role has changed due to COVID-19

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Industry Outlook

SPOTLIGHT

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100% OPTICAL

Bringing the profession together PRODUCTION

Nathan Garnett, show director of 100% Optical, speaks to OT about the show’s new dates, the potential changes ahead, and celebrating the profession after a year of challenge

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After a year in which events and trade shows have been postponed or cancelled due to restrictions aiming to reduce the spread of coronavirus (COVID-19), event organisers are looking tentatively ahead to 2021.

Organisers behind 100% Optical announced the event will be taking place from 8-10 May instead of its typical January dates to ensure the optical sector will be able to meet in 2021.

The move followed confirmation from the UK Prime Minister in September that the restart date for exhibitions and conferences would be delayed.

Discussing the industry response to the new dates, 100% Optical show director, Nathan Garnett, told OT: “The reaction was very positive. It allows people to plan with a bit more certainty. We feel much more confident about the May dates, and so does the venue.”

The AOP has supported 100% Optical as official partner and education provider since the launch of the event, while OT is the official media partner.

On the release of the new dates, Henrietta Alderman, chief executive of the AOP said the exhibition would offer members and the wider profession a “much needed opportunity to meet 16 www.optometry.co.uk

and network with colleagues, friends and suppliers,” as well as take in the “highly-valued world-class education programme facilitated by the AOP.” Exhibitor attendance for the show is on track to be at similar levels to 2020.

The gap in the events calendar through 2020 has brought challenges for optical suppliers, who have been unable to meet both existing and new customers.

“I think there will also be a real buzz about the place - the joy of people being able to reconnect with colleagues and suppliers” Nathan Garnett, 100% Optical show director “With practices so busy, suppliers have been struggling to meet with customers, so it puts more onus on the show to be that place where they can meet their customers,” Mr Garnett suggested.

“There is only so much you can do online, and there is a place for virtual – we have been running virtual ‘meet-thebuyer’ events – but I think the trade show comes into its own in that regard.”

The 2021 event may look a little different for a number of reasons, but particularly with the presence of the

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Federation of Manufacturing Opticians (FMO) due at the event.

This follows an agreement announced over summer that Media 10 would take over the ownership of the Optrafair event brand from 2021, with the FMO announcing its support for 100% Optical.

Speaking to OT about the agreement, Mr Garnett said that the additional presence of the FMO at the show “will only strengthen our offering.”

While a relief that the agreement was finalised this year in such a challenging period for the industry, Mr Garnett did point out that the plan had already been in the works.

“We wanted, what we will still have come May, a big unifying event that will bring everything together, and that everyone knows they can put their faith

in and get behind. Perhaps it will be quite a poignant time to hold the event, as hopefully by May we will be on a road to recovery and able to see a way through this. Having everybody there pulling in the same direction would have been vital,” Mr Garnett added.

While, at the time of writing, it is still too early to tell what to expect from exhibitors at the show, Mr Garnett shared: “From talking to equipment suppliers, we know there has been a need and a desire to update equipment

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SPOTLIGHT because of the situation, so we expect that to be a strong part of the show.”

He added: “The eyewear side of the industry has had a really tough year, as everyone has, but we would expect there are some stored up new products to share with the market.”

As for attending the show itself, Mr Garnett emphasised that visitors can expect a “very safe environment.”

“That is probably our biggest frustration through this period – the events industry has not been able to demonstrate what we know we can do very safely,” he shared.

The event will have a registration system and will be able to accommodate the NHS Test and Trace. Sanitation systems and signage will be visible features, and stands will be designed to have space for social distancing.

The ExCel Centre itself became an NHS Nightingale hospital during the spring lockdown. As a result, the venue has invested in ensuring a safe environment and has developed its own safety principles, including social

Exhibitor outlooks OT caught up with exhibitors preparing for 100% Optical With industry events cancelled throughout 2020, how has your business felt the effects?

Scope marketing events manager, James Kelly (JK): Like most with events cancelled, there have been some effects. We have pivoted well as an organisation in ensuring our customers are still hearing from us. That might just be a quick chat to see how people are doing or offering virtual events and training.

Kirk & Kirk managing director, Jason Kirk (JKI): Buying patterns have become smoother across the year, rather than having peaks and troughs built around trade shows.

Unexpectedly, our sales increased dramatically since the return after the initial lockdown, perhaps because optometrists were not waiting for trade shows. Every inch of every

distancing measures, cleaning regimes and training.

Bringing together the industry for what could be the first time in over a year, Mr Garnett expects the show will offer a joyful environment. He said: “I think there will also be a real buzz about the place – the joy of people being able to reconnect with colleagues and suppliers.”

“We are working with the AOP on developing what is always a highly sought-after programme, which we hope to start sharing with visitors in the first quarter of 2021,” Mr Garnett added, recommending visitors make their plans early.

shelf needs to perform successfully for the retailer.

‘Playing safe’ with frame selection is a risk and so optometrists are being pushed to make decisions outside of the trade show calendar.

William Morris founder and creator, Robert William Morris (RM): Inevitably it will have an impact. What is difficult to judge at the moment is how big of an impact because, like a lot of companies, we are working very hard with our existing customer base or distributors abroad to make sure they get product. The main thing we’re going to have missed is new business from the shows where we would normally pick up some new markets.

What will it mean for the industry to meet in 2021?

Transitions category manager, Carly Rocyn-Jones (CR): We are disappointed that we have not been able to showcase our exciting new tools at many events this year. This means 100% Optical 2021 will be extra

THE HYBRID EVENT Discussing the potential effects that COVID-19 could have on how future events may look, Mr Garnett suggested that technology will play a greater role.

He said: “In May, there will still be some optometrists who can’t come for a variety of reasons, such as if they are continuing to shield, and we don’t want them to miss out.”

The event organisers are working to consider how aspects of the show could be presented virtually, alongside the physical elements of the event.

“One of the unintended benefits of this could be that we actually increase our audience, because we could introduce the show to people who have never been before and give them a virtual taster,” Mr Garnett observed.

There will be a careful balance to be struck, Mr Garnett added, with the concern that people could be becoming “screen weary” from the shift to virtual content through 2020.

“The key for us will be about making it engaging and valuable,” he emphasised.

The team plan to make the catwalk show as accessible as possible, for example, running more live shows, but also livestreaming one for viewers to experience virtually.

exciting for us; a chance to reconnect with the industry whilst showcasing further innovations for the photochromic category.

JK: As great as virtual events are, in that you can reach out to a wider market and speak to people through a video call or chat function, it is still not the same as a face-to-face meeting. The opportunity to demo or put a product in a customer or potential customer’s hand is invaluable.

JKI: Trade shows are a great opportunity to create cohesion and strength through co-operation between all of the different sectors of independent optics. We are all facing similar challenges and we need to work together to secure our future.

RM: On a personal level, it will be crucial to celebrate getting through COVID-19 and being able to come together again as an industry and reconnect on a business, but also a personal level. I think it would be a huge relief and we should treat it as a celebration.

What can readers expect from you at 100% Optical?

CR: Delegates can expect to learn about the latest innovations in the photochromic category from Transitions.

JK: I have an idea of what Scope will be sharing but, as May is a long way away, readers will just have to come by the stand and see what we are doing.

We launched a few new products this year so it will be interesting to see how they are received by attendees.

JKI: Kirk & Kirk will be releasing new launches regularly throughout the year. We have new shapes and colours planned every couple of months, so we expect to have something new to excite and inspire our clients and prospective clients at the show.

RM: Certainly new products from William Morris if the timing is right. I think the main focus for us would be a celebration of coming back together, and of getting back to some kind of normality.

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Safio advertorial

Advertorial brought to you by VERSION REPRO OP SUBS

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ART

Safilo has launched a new digital B2B platform to provide opticians with all the necessary tools to succeed, from the most innovative eyewear product catalogue to the most advanced e-commerce and omnichannel solutions.

The platform, You&Safilo, is part of Safilo’s customer-facing digital shift, which include the go-live of a new customer relationship management system, and is proof of how customer satisfaction and customer loyalty are and will continue to be a key priority for the company.

PRODUCTION CLIENT

SIMPLE & INTUITIVE TOOLS Recently launched in the United Kingdom, You&Safilo is a high-performance and userfriendly digital platform, including features that opticians have indicated as priorities for them and their consumers. With this new B2B platform, Safilo is strengthening its support for opticians, simplifying the process from ordering to after-sales management within a new site. It is an easy-touse, simple and complete tool which enables users to navigate Safilo’s catalogue, facilitating the order process of glasses and spare parts with clear product descriptions and intuitive order tools.

The first release is the starting point of this journey: using an agile framework, the new B2B platform will be improved continuously with new functionality from Safilo.

“At Safilo, we are accelerating our digital transformation projects, working to be at the forefront of seizing the opportunities of the digital business. We strive to provide our customers with optimal conditions so they can offer our final consumers the best possible experience, therefore we created an even more functional and user-friendly B2B platform.

Our priority was to deliver the highest quality of service possible for our business partners: we have started from their feedback to make sure that the platform is perfectly aligned with their needs.”

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For more information, visit: www.youandsafilo.com

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GLAUCOMA

Gene therapy for glaucoma

Clinical round-up

REPRO OP

OT’s Selina Powell reviews the latest clinical news and research papers How technology can help to future-proof a wet AMD service

SUBS ART PRODUCTION iStock / Getty Images Plus

CLIENT

Hospital optometrists heard how technology can be used to optimise wet age-related macular degeneration services during a webinar organised by the AOP in November.

Moorfields Eye Hospital retinal and cataract consultant, Dawn Sim, discussed how home vision tests, home monitoring, virtual imaging clinics, and video consultations can be used to improve intravitreal injection clinic flow and capacity.

Her presentation, on 10 November, was part of a month-long series of AOP virtual events for hospital optometrists and allied professionals.

Professor Sim highlighted that it is important to consider the purpose that innovation is being used for when improving a service, rather than starting with a platform and adapting the workflow to it.

“What do you want as an outcome for this effort? Find the right thing that fits into that,” she emphasised. “Technology is replaceable but a robust process that

integrates this technology into your service will allow you to thrive,” Ms Sim shared with her virtual audience.

The ophthalmic surgeon explained to attendees that Moorfields Eye Hospital staff saw around 20,000 patients through video consultations between the beginning of the March lockdown and October.

Of these patients, four out of five did not require further face-to-face care.

Video consultations were used to teach AMD patients how to monitor their vision at home, with 243 patients receiving training during the initial UK lockdown.

The home vision testing technology flagged at-risk patients, who were then offered face-to-face appointments.

FUNDING TO DEPLOY AI IN HEALTHCARE Optos technology uses a machine Optos has received funding from a learning algorithm to assess the retina for partnership that aims to accelerate the the presence of diabetic retinopathy or testing and evaluation of promising diabetic macular oedema. It produces a artificial intelligence (AI) technologies report in around one minute, identifying within the NHS. whether a patient The Fife-based retinal should be referred to imaging technology “Being selected eye care specialist. company received for this award is a anRob Kennedy, Optos funding through the huge achievement” chief executive officer, AI in Health and Care said: “Being selected Award programme. for this award is a huge achievement for Optos will use the grant to fund a all the team." study exploring if automated grading is Other projects funded through the clinically and cost effective for the NHS scheme include technology to analyse Diabetic Eye Screening Programme. breast cancer screening scans, assess The work will be supported by emergency stroke patients, and a Moorfields Eye Hospital, researchers wearable patch to detect irregular from Queen’s University Belfast and heartbeats. software provider, InHealth.

NEWS

University of Bristol researchers have highlighted the potential of gene therapy in treating glaucoma.

Writing in Molecular Therapy, scientists described how CRISPR gene editing was used to inactivate a gene in the ciliary body of the eye, decreasing intraocular pressure.

Visiting senior research fellow at Bristol Medical School, Dr Colin Chu, said the team hoped to advance towards clinical trials of the therapy in the near future.

“If it's successful it could allow a long-term treatment of glaucoma with a single eye injection, " Dr Chu explained.

Wu et al.

DOI: 10.1016/j.ymthe.2019.12.012 HEALTH

Corneal cells act as potential COVID-19 entry point

Researchers have identified cells in the body that are likely to act as initial infection points for the COVID-19 virus.

Writing in Nature Medicine, scientists described how they had examined cells from the lung, nasal cavity, eye, gut, heart, kidney and liver for the presence of two key entry proteins.

Both proteins were found in high levels within the mucus-producing goblet cells and ciliated cells in the nose.

The proteins were also found in the cells of the cornea and the lining of the intestine.

Sungnak et al.

DOI: 10.1038/s41591-020-0868-6 CONTACT LENSES

Application of spider silk in contact lens manufacture

An antifungal and antibacterial biomaterial that fosters wound healing could lead to the creation of new contact lenses.

Described in Materials Today, the nanostructured biomaterial is based on spider silk proteins.

At the same time as repelling bacteria and fungi, the material encourages the adhesion and proliferation of human cells.

The technology has potential applications for preventing the formation of biofilms on medical devices, such as prosthetics, medical implants, contact lenses, and catheters.

Kumari et al.

DOI: 10.1016/j.mattod.2020.06.009

December 2020/January 2021

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CLINICAL

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SPOTLIGHT

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SUPPLIER INSIGHT ART

Making the mainstream

PRODUCTION

OT spoke to OCT manufacturers and suppliers on the fast-paced development and roll-out of the technology, and the implications of COVID-19

CLIENT

The development and roll-out of optical coherence tomography (OCT) has been continuing at pace, growing to become a key part of many practices, offering both clinical and business benefits.

For many, the OCT device has been a key tool in navigating eye care during the coronavirus (COVID-19) pandemic.

Emily Malbon, head of UK marketing and education at Heidelberg Engineering UK, described the development of OCT technology over the past two to three years as “extremely fast-paced.”

Devices are becoming faster, with everincreasing A-scans per second, as well as additional diagnostic functionality, such as OCT angiography imaging, she said.

While roll-out of the technology has been steady, the company has seen a surge in enquires from practices who are considering replacing their first OCT with the Heidelberg Spectralis.

Topcon has also seen OCT become “firmly a mainstream clinical tool.” The

“Many optometrists have been using OCT for more than five years and are very experienced” Emily Malbon, head of marketing and education, Heidelberg Engineering UK 22 www.optometry.co.uk

company suggested there are many reasons for this, including technological developments to optimise ease of use, speed up capture and facilitate delegation In addition, Topcon noted that the changes in patient demographic, with an ageing and growing population, coupled with the practice-building opportunities afforded by shared care, and the increased delegation of eye care from secondary to primary eye care, has fuelled the growth of OCT. Andrew Yorke, managing director for Topcon Great Britain Medical, said: “We have found OCT sales continue to be extremely buoyant,” adding that in the few months following the first lockdown the company had been busy “installing, training and educating our customers in the extensive benefits of their new OCTs.’” “The current trends remain the same and the outlook for OCT in all market segments in the coming months looks very encouraging,” Mr Yorke added.

The company particularly saw interest grow for its DRI OCT Triton due to the device’s ability to image through cataracts and better examine the choroid.

Gareth Steer, vice president of sales for Optos Europe, meanwhile, suggested that the increased need to provide the safest possible environment, while delivering the best standard of eye care, has further increased demand for OCT.

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Boosting confidence A key challenge when introducing OCT into practice is to become comfortable with seeing the retina “in a completely new way,” Mr Steer commented.

Optos’ webinars and CET events aim to help customers familiarise themselves with the technology, including reviewing and interpreting pathology, while online forums enable practitioners to discuss images and share knowledge.

“Peer-to-peer support is a huge part of the integration process as the use of OCT grows,” Mr Steer commented, adding that through the forums, optometrists regularly “work together to further improve patient care.”

Over the six years Heidelberg Engineering’s Academy has been delivering OCT education, the company has seen a shift in confidence.

“When we began, we found that most optometrists were complete beginners and we focussed on delivering the basics to build their confidence,” Ms Malbon said. “Fast forward to 2020, and now we notice a mix of ability. Many optometrists have been using OCT for five or more years and are very experienced, while others are just beginning their journey.”

Education, typically CET-accredited, now needs to cover both the basics and more advanced interpretation of data. This initial training is key to determining how

Getty/microgen; Optos

REPRO OP

The company’s devices offer a combined use of OCT and optomap retinal imaging, to provide a range of images and clinical information, allowing practitioners to maintain a safe distance.

“Having a combined device also reduces the length of time needed for the complete examination as well as saving precious space within the practice, as it essentially provides two devices in one,” Mr Steer said. “The device design also allows for simple and effective cleaning between appointments.”

“It is still a daunting prospect starting out in OCT interpretation but there is plenty of support and no one is expected to be an expert from day one” Dr Catharine Chisholm, global director of education and training, Topcon Healthcare quickly and successfully the equipment is integrated into practice, Ms Malbon said.

While using the devices can be generally “very easy,” and people without clinical background can be trained to take images competently, Ms Malbon highlighted that “evaluating OCT images requires a sound knowledge of the anatomy and physiology of the visual system.”

Key to this, Ms Malbon noted, is the ability to "consistently recognise or monitor abnormalities, establish urgency of referral and provide ophthalmologists with good quality information.”

It is also important to have the buyin from everybody in the practice, Ms Malbon suggests. “Taking the time to train non-clinical staff so they understand that the practice is serious about eye health and looking for early diagnosis of a wider range of eye conditions will put the practice on the road to success.”

Topcon has also seen confidence increasing, helped by more success stories and discussions on the clinical value of OCT, as well as a growing range of educational opportunities.

Dr Catharine Chisholm, global director of education and training for Topcon Healthcare told OT: “It is still a daunting prospect starting out in OCT interpretation

but there is plenty of support and no one is expected to be an expert from day one.”

Support through training, conferences and online forums help to break down learning barriers. Topcon Healthcare University offers e-learning courses for clinicians and support staff, and plans to introduce courses for front of house staff in presenting the OCT to patients.

Considering some of the challenges in introducing OCT, Topcon noted that some devices can be tricky to use, with a long learning curve associated with aspects such as joystick control and focusing, with image quality critical for analysis.

The Maestro2 was designed to overcome these issues, the company has suggested, as a plug-and-play device that would allow anyone to capture a quality image, with the optional OCT angiography also fully automated. Taking away the variability introduced by the operator is valuable in terms of time and clinical decision making, Topcon said.

The impact of COVID-19 In a webinar exploring the challenges practices faced in returning to business after the spring lockdown, Optos found that 74% of optometrists surveyed had found it challenging to implement new protocols and communicate the changes to patients. However, practitioners reported that utilising technology had helped to ease the process.

The company has seen interest in its OCT and optomap technologies accelerate as a result of the pandemic.

“We know that some patients and practitioners were understandably somewhat nervous about starting eye examinations again, following the easing of lockdown restrictions,” Mr Steer said, highlighting that the OCT and optomap

Ian Jarvis, principal optometrist of independent practice, Jarvis Optometrist “The challenging thing about OCT is that it is a completely different way of looking at people’s retinas. It was a bit of a voyage of discovery early on, but there is a lot more support now. Having an OCT helps in clinical decision making and reducing patient contact time, which was something we were nervous about at the start of lockdown. There is still a view that OCT is a business expense. We see it as an income generator. We offer it to everyone – that way we can charge a relatively low fee and widen access. Having said that, you have to educate your patients. They have to know you are not selling them something; you are providing an enhanced service because you believe that is a good thing to do.”

Martin Memory, director and optometrist, Memory Opticians, a Hakim Group practice “OCT allows us to see the kind of structures of the eye in the sort of detail that we had only ever seen in textbooks. It was challenging and exciting at the same time.

Post-lockdown, I think it has come into its own, and I would have struggled personally with not having an OCT in practice.

We’ve not really been able to use direct ophthalmoscopy because we would have to get too close to clients. Now, everybody will be put onto an OCT machine, though we might not perform the full gamut. There is an element of being apprehensive about new technology, but the more familiar you are with it, the more you use it, the more intuitive it becomes, and the better you interpret what you are doing. It is here to stay and is something for the future.”

technologies had helped provide the confidence “that this can be done safely and effectively.”

Topcon has seen demand for devices offering easy-clean benefits and helping to reduce infection risks associated with traditional posterior segment imaging.

A new remote tablet control for the Maestro2 and other automated Topcon devices has also supported practices.

Demand has extended beyond OCT scanning, as the company has seen requests for guidance on using the peripheral photograph and mosaic function. To further increase patient confidence, a Maestro-specific breath shield is also under development.

Considering the impact COVID-19 has had on the development and roll-out of OCT, Ms Malbon shared that she expects to see a small delay.

“Cancellation of ophthalmic exhibitions globally in 2020 has meant manufacturers have nowhere to launch or show a new product or technology,” she said, adding that OCT roll-out was delayed during the height of the spring lockdown.

“Once we were out of the full lockdown situation, we noticed that roll-out is perhaps even being accelerated by those wishing to utilise the government bounceback loan to invest in a new OCT.”

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Suppliers

SPOTLIGHT

AOP Update VERSION

MEMBER SUPPORT

AOP on your side

Read the full consultation response and survey findings: shorturl.at/cmKMX

Education Strategic Review: the AOP responds REPRO OP

The AOP published key concerns in response to the GOC’s education proposals

SUBS ART

The AOP published its response to the General Optical Council’s (GOC) Education Strategic Review (ESR), with the association sharing “significant concerns” over the proposals for the future education and training of optometrists.

The feedback concerns the GOC’s revised draft Outcomes and Standards for optical education, and the Quality Assurance and Enhancement Method.

The AOP’s response argues that the GOC “must do much more to manage the risks created by the ESR” in order to ensure the proposals can be implemented safely and will enable optometry education that is fit for purpose.

The AOP also published the results of two member surveys into experiences of pre-registration supervision, finding that while over half of trainees felt the support they received was adequate or more than adequate, 45.5% of pre-reg trainees surveyed found it to be “sometimes adequate and sometimes less than adequate,” or “less than adequate most of the time.”

Meanwhile, a survey of supervisors revealed that 54% felt the support they are given to supervise trainees was less than adequate some of the time, or most of the time.

The AOP highlighted that the experiences revealed through the survey demonstrate a need to establish that any changes are properly funded, to ensure that “newly qualified optometrists are safe and ready to face the challenges of a fast-changing profession.”

Supporting members through COVID-19

AOP Council elections confirmed for 2021

How the AOP has been delivering advice and resources in October and November

CLIENT

The AOP, the College of Optometrists and the Optometry Schools Council, released a joint statement outlining concerns over how education providers would be funded to deliver the General Optical Council’s proposed education framework As the Department for Health and Social Care encouraged practices with an NHS contract to continue registering for the PPE portal, the AOP shared guidance on how to use the portal and PPE in practice After hearing of placements being withdrawn or delayed, the AOP launched a survey for AOP student and pre-registration members regarding pre-registration placements in 2020 The AOP published its response to the General Optical Council’s Education Strategic Review (ESR) consultation The AOP published the findings of member surveys with current or recent pre-reg trainees and supervisors, to feed into the GOC's ESR consultation response Following the introduction of a second lockdown, the AOP confirmed with NHS England that optical practices in England would be able to remain open for services including routine sight tests.

The AOP partnered with Johnson & Johnson Vision to deliver a series of webinars and peer discussions for locum optometrists Welcoming new student members, the AOP provided a variety of resources for first years The AOP launched its new SMS/text remindeer service for members The AOP published its 2020 Annual report, offering a summary of the association’s work last year and including messages from AOP chief executive, Henrietta Alderman and chairman, Mike George Key headlines of the 2020 Annual Report included the launch of the AOP locum register, influencing developments in optometry education, and the AOP’s first policy manifesto. Read more from the report online: https://bit.ly/36nRm6B Ahead of the clocks changing, the AOP launched its ‘Don’t swerve a sight test’ campaign to highlight the challenges of driving in the dark and regular sight tests Throughout November, the AOP hosted a virtual hospital optometry series, including four webinars and two peer discussions.

These were held in place of the Hospital Optometrists Annual Conference which could not be held due to COVID-19 In December, the AOP continued its wellbeing content with a webinar, sponsored

by Johnson & Johnson Vision, exploring the links between mood and food.

Financial and employment

The Optometric Fees Negotiating Committee (OFNC) clarified the issue of support payments in October after concerns were raised The AOP updated its guidance in response to changes to the Government’s employment support schemes The OFNC confirmed COVID-19 funding would be available for certain providers through 2020, with discussions over reimbursing PPE expenses also held

Shutterstock

PRODUCTION

The AOP updated guidance for members in England as the country moved to COVID-19 alert level 4, with guidance covering routine care and appointment times

24 www.optometry.co.uk

Nominations will open in February after a delay in 2020

Resources

Advice

The AOP Council elections will be held in 2021, following a pause in 2020 due to the challenges posed to members by the coronavirus pandemic.

“This pause gave us the opportunity to look again at the structure of our Council and we are making some changes in 2021,” the AOP explained, adding that these changes will “ensure our Council continues to represent the sector and the diversity of our membership.”

In the 2021 elections, all Councillors in every geographical constituency will step down. As well as vacancies for elected positions, there will be up to 15 vacancies for designated positions, which will be chosen by appointment.

Members will be updated on the new opportunities ahead of the opening of nominations in February with voting to take place in March.

Following the introduction of a second lockdown in England, the OFNC sought urgent discussions with NHS England over the implications for practices, including ongoing funding support The AOP updated members on major changes announced by the Government to the furlough scheme, which has been extended to 31 March 2021, in light of the second lockdown Following a change in legislation to written statements of employment, the AOP updated its template employment contracts.

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AOP EXPERT

AOP EXPERT

Jacqueline May

Saqib Ahmad

Policy officer

Policy officer

REPRO OP SUBS

What have been key areas of focus for you in 2020?

A focus for me has been bringing different groups of members together to explore what is happening and how the AOP can help. A highlight has been hearing about our student members’ experiences. They have shown such a mature and thoughtful approach in really difficult circumstances. Another was holding the first virtual AOP Council meeting, which worked better than we expected and was welcomed by Council members who can find it timeconsuming to travel to London for meetings.

ART PRODUCTION

Getty: Eakkasit Nimprasert

What will be a focus for you in the year ahead?

We are hoping to complete the 2021 AOP Council elections smoothly after the 2020 round was cancelled because of the impact of the pandemic on members. We are also hoping that there will be more time to return to forward-thinking work, as well as reacting to events.

Could you share a key takeaway from the challenges of 2020?

I have been learning all over again that good policy development is based on engagement and evidence – even while having to act more quickly than usual.

What have been key areas of focus for you in 2020?

The General Optical Council (GOC) has continued work on changes to the optical education system. We’ve tried to help members understand and influence things despite the circumstances. Universities, as well as optical practices, have faced massive challenges in operating safely during COVID and that is why we think it will be in everyone’s interest if the GOC makes sure its proposals are financially viable, and can be safely delivered, before they go ahead.

Could you share a key takeaway for you from 2020?

Change can come around a lot more quickly than we think. We’ve seen things that were slowly evolving, suddenly accelerate during the pandemic – from working at home, to buying online. This

could have a big impact on the High Streets where many of our members work. Some change has been positive, like the development of the new urgent eye care service in England in response to the pandemic, using the skills of community optometry in a long overdue way. We need to embed the positive, manage the risks and adapt to change.

CLIENT

What will be a focus for you in the year ahead?

Unpredictability will continue to be a theme, we will need to keep reminding ourselves of how resilient we have been. We will need to keep pushing decision makers from Government and the GOC to ensure the sector and our members get support that is fair and reflects their important healthcare roles in society.

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AOP Update

SPOTLIGHT

VERSION

Improving compliance

REPRO OP

TearRestore is aiming to simplify the treatment of dry eye through warm compresses with the launch of its open-eye reusable heat packs.

Using warm compresses can be time-consuming, which the company suggested can affect compliance.

To address this, the TearRestore heat packs target the meibomian glands, while still allowing the users to see throughout the treatment. The product is available for optometrists and practitioners through an online portal, as an affiliate or through distribution partners. www.tearrestore.com

FOCUSES ON...

DRY EYE

SUBS ART PRODUCTION

Hit list

The trends, launches and looks

CLIENT

A suite of tools

Topcon has introduced its Myah tool in Europe, aiming to support practices in growing myopia and dry eye services.

In addition to tools supporting myopia management, the device incorporates a suite of dry eye assessment tools, including non-invasive Tear Break-up Time, Meibomian gland imaging with the area of loss analysis, tear meniscus height analysis, blink analysis, real fluorescein imaging and video acquisition, and video review of anterior corneal aberrations between blinks. The Myah device recently won the 2020 Silmo D’Or Award in the Material/Equipment category. www.topconmyah.com

Improving symptoms

Positive Impact has highlighted its punctal plugs as an effective strategy for reducing tear drainage and helping improve dry eye symptoms. The company offers two types of plug: The Silicone Punctal Plug Parasol, which is available in four sizes and features a non-dilating design, and The Painless Plug.

Maxine Green, managing director for Positive Impact, highlighted that punctal occlusion can be an effective strategy for contact lens induced dry eye. www.positiveimpact.co.uk

Broadening service

Essilor has taken on sole distribution of the IDRA dry eye diagnostic tool by SBM Sistemi. The device performs a full assessment of the ocular surface, through a series of tests including assessing the quality of tears and analysis of the meibomian glands, in order to classify the type of dry eye disease. The company suggests the IDRA could be used alongside Essilor’s TearStim Dry Eye treatment for a complete diagnosis and treatment service for patients with meibomian gland dysfunction. www.essilor.co.uk

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Hitlist

HIT LIST

VERSION

GET THE

REPRO OP

Q&A ME AND MY GLASSES

LOOK Optometrist and lifestyle blogger, Lizzy Yeowart, goes in search of eyewear and accessory brands to watch in 2021

SUBS ART

‘Stay Wild’ by Caron

PRODUCTION

Caron Kraitt has over 20 years’ experience in optical design and launched eponymous brand, Caron, in July. Her collection is inspired by modern women who celebrate femininity, beauty, strength and independence.

Caron, ‘Stay WIld’ caroneyewear.com

CLIENT

Flo Kemp

The founder of Sunny Cords discusses playing with styles – and the impact of COVID-19

1

3

2

4

Some women have a shoe addiction; I have a sunglasses addiction.

In my younger years, I bought them all the time. Recently my buying attitude has changed.

Focusing on sustainability and making more conscious decisions, I want to purchase quality over quantity. I allow myself to buy one new pair a year. I can really get excited about this yearly purchase.

I’ve been wearing spectacles for six years.

I was in a car with my best friend and I remember her reading a sign out loud. I was looking at it and it was all blurry.

I realised that I couldn’t see what she saw while she was sitting next to me. I remember this being a very strange feeling. The next day I went to the optometrist and I’ve been wearing spectacles since.

When we look at people, our brain automatically classifies them into certain ‘types.’ Our brain does this within one millisecond by registering and judging a person’s hair, clothing and eyewear. What I like about eyewear is that you can play around with what ‘type’ of person you want to be, even if it is just for the day, simply by choosing which pair of glasses to wear.

We had a real setback in terms of turnover in April, when the lockdown had just started, but we were lucky this impact only lasted a month. We have now introduced the ‘Mask chain’ to simplify people’s lives in a stylish way.

Had you asked us in early 2020, we would never have thought that we would be launching a product related to face masks.

‘Lorcan’ by GOTD

GOTD (Glasses of The Day) is a new British eyewear brand established by optometrist Shivani Sharma. The ‘Lorcan’ is composed of a lightweight wood with ethically sourced recycled acetate backing.

GOTD, ‘Lorcan’ gotd.co.uk

‘Anima’ chain by Coti Vision

Chains for spectacles were not famed for their style acumen – until Nancy Gries and Julie Hawkins turned them into a super-sized and utterly fabulous accessory with their York-based brand, Coti Vision.

Get involved.

Coti Vision, ‘Anima’ glasses chain, cotivision.com

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MMG

HIT LIST

VERSION

Sports

Sustainable ski-wear

REPRO OP

Spektrum has launched a collection of sustainable ski goggles, made up of 64% biomaterials. The ‘Östra’ goggles use impactresistant, anti-shatter lens technology and feature a wide field of vision. An air flow lens system keeps goggles fog-free, while the lenses have also been glazed with an anti-scratch coating and a multi-layer mirror finish with 100% UV protection. The collection includes four models including the ‘Östra White Line’ (pictured). www.spektrumsports.com

SHORTLIST THE LATEST PRODUCT LAUNCHES

SUBS ART

Spectacles

Perfect fit PRODUCTION CLIENT

Kirk & Kirk has launched two new models specifically designed to suit larger heads, following requests from optometrists and consumers.

The ‘Angus’ and ‘Guy’ (pictured) frames come in eye sizes 59 and 60 and are created from the brand’s own grade of acrylic, making the frames lightweight. The frames are available in 10 colours from the Centena collection. www.kirkandkirk.com

Remote consultationi

Virtual triage

Contact lenses

Simplifying first-time fits

Menicon has launched a second version of its digital calculator, offering a new tool to support eye care professionals in prescribing monthly multifocal lenses. The calculator aims to provide a “starting point” to help increase the chances of first fit success. The resource can be viewed on any digital device. www.menicon.co.uk/professional/calculator

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Optonet has released a first version of its tool for remote consultation, in a project funded by Innovate UK. The CE class I medical device software is designed for the assessment of visual function. The Optonet Vision Unit features an interactive triage questionnaire based on visual and eye-related symptoms, as well as a tool for the remote display of vision charts on the patient’s computer or tablet. www.eyespace-eyewear.co.uk

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

Spectacles

Northern lights

Reykjavik Eyes has launched its new Rimless Tech collection, developed in partnership with Jai Kudo Lenses. The collection offers a twist on the traditional rimless style with a silicone band surrounding the lens rim to add a “pop of colour.” The collection features four models including: ‘Sirus’ a round frame; ‘Andres,’ which comes in colours inspired by the glaciers of Iceland; ‘Alexis’ (pictured), which offers a small, geometric design; and ‘Erik,’ in a rectangular shape and subtle colourways. www.reykjavikeyes.com/black-label

Sunglassesi

Shaping up

Eyewear brand, Okia, has launched a new version of its ‘Reshape’ frame, made of recycled PET material from plastic bottles.

The ‘Reshape 3.0’ features an upgrade of the sustainable material launched in 2019. The models in the new collection are thinner and ultralight, also featuring flexible temples. The company has extended the colour range with a selection of vibrant, shiny, milky, and crystal tones in Havana shades. www.reshapeeyewear.com Glazing

Feel-good factor

The Prison Optician Trust, an organisation providing eye care within prisons as well as running training programmes to support prisoners to gain skills in spectacle making, has established a new service for optical practices.

Liberty Glasses currently offers acetate frames including brands such as Battatura and Jack & Francis, which are glazed with prescription lenses by prisoners through the programme. The organisation hopes to launch its own brand of frames in 2021 to support the creation of more jobs for ex-offenders. www.prisonopticians.org/liberty-glasses

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Shortlist

HIT LIST

BTB

HIT LIST VERSION REPRO OP

Q&A BEHIND THE BRAND

ESSILOR SUBS

Managing director, Tim Precious, on supporting independent practices

ART

ESSILOR

1 PRODUCTION

2 3

//

Clockwise from left: The Varilux Comfort Max launched this autumn; Tim Precious, managing director

What was Essilor’s latest product launch and what makes it stand out?

Essilor invented the first varifocal lens in 1959 The company reinvests around £200m of profit every year into research to provide solutions to evolving vision challenges

CLIENT

Essilor is the largest employer in Thornbury and has been based there over 46 years, as has its longest-serving member of staff.

Varilux Comfort Max launched in October and is our first lens to be designed for postural flexibility to adjust to the wearer’s natural postures. This makes the lens ideal for emerging presbyopes and first-time varifocal wearers. The lens stretches the ‘useful vision zone’ by up to 46% to help wearers see naturally without having to struggle to find the right gaze direction or posture.

How has Essilor been supporting independent practices through COVID-19?

It has been a challenging time for independent High Street practices. We remained open for emergency orders and put key pieces of equipment on deferred payment terms. At practice level, we created 10,000 safe practice packs which included window and floor stickers and distributed personal protective equipment free of charge. We developed digital assets for practices to help them attract new customers to their stores. Now, more than ever, eye care professionals (ECPs) need to be visible online as well as off to capture new patients.

What are the company’s main ambitions for the next 12 months?

We will continue to adapt to the current climate and to the needs of ECPs. We have seen that demand patterns have changed a little and, if anything, independents have been seeing a new, younger demographic that needs to be nurtured as well as the need to continually provide the best solutions to existing patients.

STYLE

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

This edition: eyewear brands for young wearers with a flat bridge

Erin’s World Frames

Erin’s World Frames aim to improve the sight and quality of life for individuals with Down Syndrome by providing a custom frame to meet their unique needs, specially formatted to fit individuals with low bridges.

Erin’s World Frames, ‘EW 06’ www.erinsworldframes.com

34 www.optometry.co.uk

Lizzy says "Erin’s World and Tomato Glasses are standout options. Both eyewear brands were established by parents who couldn’t find eyewear to suit the needs of their own children, and decided to address the issue head-on."

Tomato Glasses

Tomato Glasses cater for a child’s small head and flat bridge. The frames are flexible, lightweight, have adjustable side lengths and nose pad heights, and come with a detachable headband strap as standard.

Tomato Glasses, ‘TJBC6’ www.tomatoglassesuk.com

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Perspectives VERSION REPRO OP

Perspectives Voices from optics and beyond

SUBS

The value of eye care is evident, but is the profession empowered to play a full role as a primary eye care giver?

ART

Dr Cindy Tromans

PRODUCTION

W

CLIENT

ith an ageing population, changes in lifestyle and an increase in eye diseases triggered by non-communicable diseases such as diabetes, the global demand for eye care is set to increase. The World Health Organization already estimates there are at least 2.2 billion people around the world who suffer from vision impairment.

In the UK, it is estimated that 4.5% of the population suffers from some type of vision loss.

How will health systems cope with this increase in the demand in eye care services? What are some of the essential steps we can take now in order to prevent avoidable sight loss and ensure patients receive the quality eye care they need?

Sadly, as a result of the COVID pandemic, we have already seen what can happen. This summer, it was calculated that at least 10,000 people were at risk of suffering irreversible sight loss due to missed or delayed care during lockdown as hospitals reduced their outpatient and elective activity substantially. Hospitals now face a backlog which will further delay care.

A unique snapshot With COVID-19, there has been a gradual recognition that opticians and optometrists could contribute to taking some of the pressure off health systems and ensure continuity of eye care. This proved that the first port of call for any eye problems can and should be optical practices – for example, the introduction of the COVID-19 Urgent Eyecare Service (CUES) in England – and also highlighted the value of the eye care workforce operating at the top of their competencies and the benefits of upskilling.

This recognition has been felt across the whole of What is your view?

Europe, as reported by national associations of Email OT with optometry and optics in a survey conducted by your comments the European Council of Optometry and Optics newsdesk@ (ECOO). But is the profession empowered to optometry.co.uk play its full role as primary care givers?

Elements of this answer are contained in the latest edition of the ECOO Blue Book, How we live now which provides a unique snapshot of the state of optometry and optics across Europe and contains data on the number and size of the profession in each country, the status, and scope of practice of the profession, its role in public health, and the education and training provided.

While there are several differences between countries, the scope of practice is evolving.

In some countries, professionals can use diagnostic drugs and others have gained or are in the process of gaining recognition of their optometric professions, which in most instances is considered a health profession. Countries are also moving towards developing a “The only way therapeutic scope of practice. forward to cope The Blue Book also shows consistency with the increase over the years in the number of optical in demand for professionals in Europe and a steady eye care will be number of students graduating every year with the various qualifications. It to invest in a is anticipated that, per year, more than well-educated 6500 students complete their qualification and skilled in optics and 4630 students complete workforce” their qualification in optometry. This is encouraging, as education complemented by professional practice guidelines ensure that the care is delivered to a high standard.

The only way forward to cope with the increase in demand for eye care will be to invest in a well-educated and skilled workforce that can ensure timely diagnosis of eye conditions and access to care. Opticians and optometrists are eager to play their full role in strengthening eye care to improve access, and to adapt and respond to rapidly changing population needs.

Journal of the Association of Optometrists £9.95

December 2020/January 2021 Volume 60:09

www.optometry.co.uk

Rethinking the role of the UK’s High Street

CET Visual challenges associated with driving

Perspectives Managing the COVID-19 second wave in hospital

In practice The shifting attitudes towards e-commerce

Page 66

Page 36

Page 45

Dr Cindy Tromans is ECOO’s immediate pastpresident, and head of optometry services at Manchester Royal Eye Hospital

December 2020/January December 2021 2017

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A MEMBER OF THE SEED GROUP

years

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VERSION REPRO OP

“A second wave, a second lockdown, a second call for re-deployment”

SUBS

Dr Waheeda Illahi, Rosie Auld, Dr Emma Berrow and Dr Peter Good

T

ART PRODUCTION CLIENT

he year 2020 will be remembered by generations to come as the year that an illness originating in Wuhan, China spread around the world, killing millions of people.

As a large supra-regional specialist ophthalmology service, we believe that the Birmingham and Midland Eye Centre is a barometer of how ophthalmology services are being impacted by this pandemic.

Community optometric practices were adapting to the new normal and had resumed business, regaining patient confidence. But in the autumn, we were all plunged once again into the second wave of the pandemic.

“The recovery On 4 November, NHS England process feels like went onto the highest incident level a precarious 4. Sandwell and Birmingham saw admissions rising rapidly and infection sandcastle we rates reaching very high levels. The aim have tentatively the four-week national lockdown, built, which may of which commenced on 5 November, is easily be swept to reduce the transmission of the virus, away by the but the current message from our Trust second wave” remains: ‘business as usual.’

More advice OT insight for the profession practising during COVID-19 www.optometry. co.uk/coronavirus

Recovery phase Over the last six months, the optometry department, orthoptic services and the visual function department have moved from a telephone-based service, to a gradual reintroduction of face-to-face consultations. The Trust’s aims were to return to 100% activity, including diagnostic and therapeutic procedures.

Our teams have worked hard to support the recovery of services, while donning PPE and adhering to strict cleaning procedures between face-to-face consultations. We continue to use telephone consultations for patients who require low vision aid follow up.

NHS England and NHS Improvement have developed an Eye Care Restoration Roadmap for 2020–21 with five opportunities to transform local systems by implementing: 1. Integrated eye care pathways across primary, secondary and community care

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Dr Waheeda Illahi on... courage “I will remember 2020 as the most challenging year so far in my career to be leading a service and representing my profession in one of the busiest hospitals in the UK. The terrible burden of responsibility I felt towards optometrists who were redeployed to COVID-19 wards will always stay with me. My colleagues’ courage, dedication and sheer hard work has been a humbling experience for me. On a personal level, I share the guilt felt by many parents who worked during the pandemic and whose children had to attend school during the most difficult of times. I feel more than ever that it is an honour and a privilege to serve in the NHS.”

2. Risk stratification and fail-safe processes to reduce harm 3. Remote consultations for all appointments where possible and safe 4. Virtual diagnostic clinics for all appointments where possible and safe 5. Patient-initiated follow up care.

The restoration process will mean a huge change across acute and primary eye care services and will require significant service re-design.

Sandwell & West Birmingham (SWBH) NHS Trust is currently working with neighbouring Trusts, community optometric services and private providers in the Black Country to see how services can be delivered. This is an exciting opportunity to develop an integrated eye care model for our patients.

Second lockdown, second redeployment As heads of service (HoS) in the hospital, we had been dreading the looming second wave and the catastrophic effect it would have on our recovery plans. We have previously discussed the array of responsibilities that optometrists, orthoptists, ophthalmic technicians and vision scientists have had during their re-deployment roles as the first wave of the pandemic struck, but during this second wave we had been hopeful that our services would be spared as so much progress has been made in our recovery plans.

Much to our despair, we have been informed that optometrists and orthoptists will again be re-deployed and, as HoS, we need to prepare our teams. Unlike in the past, where all the services were required to contribute towards re-deployment, trainee ophthalmologists will not be re-deployed to prevent disruption to their training.

The recovery process feels like a precarious sandcastle we have tentatively built, which may easily be swept away by the second wave.

With the second surge now in hand, there is uncertainty as to what is to come. As teams, we built resilience after the first COVID-19 surge. Although there are tools provided to help staff with mental wellness, many staff feel apprehensive about the future.

During the second wave we are not keen on re-deployment, but are well aware of the need to ‘step up’ to support the Trust in its response to COVID-19.

Education and training Unfortunately, due to the ongoing pandemic, difficult decisions had to be made regarding training placements. This included independent prescriber trainees, approximately 20–25 graduate optometrists attending for their two-week pre-registration hospital placements, and four four-week undergraduate orthoptist clinical placements. The visual function department supports the NHS England Scientist Training Programme. This year, students have been unable to attend the department due to social distancing restrictions and small electrodiagnostic rooms.

We are mindful of the significant impact the reduction in clinical placements has on the development of the ophthalmic workforce, and we need to think about how to address this going forward, with the added responsibility of caring for pre and post registration visitors in addition to our own staff.

Despite the second lockdown, patient attendance remains high. There is a need to balance capacity against social distancing in already limited clinical space. We have tried to solve this issue by asking patients to attend alone, and to arrive just prior to their appointment time. Fortunately, the weather has been good this summer as patients have been asked to queue outside the hospital until their appointment time.

As winter comes, we will need to relook at how to accommodate our patient numbers within finite spaces.

Getty/sesame

Dr Emma Berrow on... patients “As I am sure it has been for many, this year has been difficult, but with the resilience and camaraderie of colleagues, we have pulled together to do the best for our patients.

Now there is the possibility of a vaccine imminently, this has boosted moral and gives hope for 2021.”

Rosie Auld on... the challenges ahead “Virtual review might be the answer to certain aspects of ophthalmic care, but in our specialities – optometry, orthoptics and visual function – we have to maintain face-to-face services as so much of our interventions are quantitative, allowing us and other members of the multi-disciplinary team to make diagnoses and formulate management and treatment plans. We need to reflect on the effect on patient care since the start of the pandemic, and use research and audit evidence to evolve services that minimise the risk to existing and new patients.”

As HoS, we are concerned that highly specialist services such as referrals for electrodiagnostic tests from tertiary providers have reduced this year as fewer patients visit their ophthalmologists. This could lead to an overwhelming demand for services in the future as these referrals eventually filter through.

The visual function team have seen a surge in cases of malignancy. During the first lockdown, one patient missed an appointment in our medical retina service and with his optometrist.

When he presented recently, he was found to have a large choroidal “The restoration metastases and neurological signs process will mean suggesting cerebral involvement. He a huge change had previously had testicular cancer across acute and and was noted to have a small choroidal primary eye care lesion by his optometrist late in 2019. services and will There is no doubt that it is not just Long COVID that will have a lasting require significant impact on our patients, but delays in service re-design” referral, review and treatment will result in loss of sight and in some cases loss of life. It is vital that we take an innovative approach to service delivery to ensure that essential ophthalmic services are retained and that we continue to deliver safe and effective patient care.

Dr Waheeda Illahi is a consultant optometrist and head of optometry services, Rosie Auld CBE is head of orthoptic services, Dr Emma Berrow is consultant ophthalmic electrophysiologist and head of visual function, and Dr Peter Good is a consultant neurophysiologist at the Birmingham & Midland Eye Centre

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Perspectives

PERSPECTIVES

VERSION

MY VISION

REPRO OP

“It has given me a new lease of life” Lee Morris

SUBS

E

ART PRODUCTION Manchester Royal Eye Hospital

CLIENT

Before the operation, I had pretty much no nighttime ver since I was born, I’ve lived with retinitis vision at all. When light levels were low, I really did pigmentosa. I was around eight years old when I struggle. I had 10% vision in each eye in good light. I was diagnosed. use a cane when I am out and about. I have a clock that As a baby, when I looked at toys, I would hold them reads the time and there are knobbly bits on my cooker. up to the light. That is what prompted my parents into At work I have an enlarged monitor. As time has thinking that there was something not quite right with gone on, even doing simple tasks like washing dishes my eyes. has become a struggle. I work for a travel company in I’ve been a patient of Manchester Royal Eye Hospital after-sales and for nearly 40 years. the treatment will During that time, definitely improve there hasn’t been my working life. any treatment At the moment, available. Every I am on reduced time I went in, duties at work it was a case of because there are being told that certain systems they can’t really do that I couldn’t use anything because a on the terminal at treatment had work because of not been the condition. It developed. As causes eye strain, soon as the gene with my eyes therapy came up, aching and my I thought, ‘Wow, vision becoming that’s amazing. worse.

Let’s do it.’

My eyes not In October 2019, having to work as I received an email hard as they have from Moorfields been doing is going to improve explaining that this new form of “They said, ‘Do you not my life a lot. It has been a treatment might need to think about it?’ But massive worry for me for a very be authorised on the NHS. I had thought about it, and I long time.

There were certain clinics that were wanted it done” I was ecstatic when I found going to be allocated the drug so out I was eligible. When I found they could perform the procedure. out how much it cost per eye, I thought, ‘Good on the I got a couple of phone calls after that from genetic counselling inviting me to go in. I did all of the eligibility NHS’. They said, ‘Do you not need to think about it?’

But I had thought about it, and I wanted it done. tests to make sure I was eligible for the treatment on I have seen improvements in my vision since the New Years’ Eve. operation. It has made me a bit more optimistic about After that, I waited to find out when they would do the operation. I pretty much made the decision there and my future. I’ve suffered with depression and anxiety before and it has given me a nicer outlook on things in then once I was told that I was eligible. I said, ‘Yes, I will the future. It has given me a new lease of life. go ahead with it.’

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

Lee Morris, 39, from Chorley, was one of the first patients in the UK to receive NHS-funded Luxturna treatment at Manchester Royal Eye Hospital. The gene therapy helps children and adults with retinal dystrophies caused by a fault in the RPE65 gene.

December 2020/January 2021

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My Vision

PERSPECTIVES

jjv

IN CONVERSATION VERSION REPRO OP SUBS ART

RE-ENGAGING THE CONTACT LENS CURIOUS

PRODUCTION CLIENT Grant Pearce; Shutterstock

With patient interactions evolving as a result of COVID-19, OT speaks to experts and optometrists at Johnson & Johnson Vision on how practices can invite patients to experience contact lenses OT: What steps has J&J Vision taken this autumn to support eye care professionals (ECPs)?

James Haden: We have been

Could you tell OT about the Acuvue® 21 Day Challenge and the inspiration behind it?

JH: We are very excited to be

working closely with ECPs to help in whatever way we can, whether it is better understanding patient needs, or how to blend virtual and physical appointments. We are critically challenging our own approach as to how we can best engage, retain and nurture contact lens wearers as we know the reality is that the marketplace will never be the same again.

introducing a new programme for contact lens patients in the New Year. The Acuvue® 21 Day Challenge is a new behaviour change programme designed to enhance the patient experience with contact lenses from first fit to successful, ongoing use.

Starting when patients sign up for a contact lens trial, the programme delivers a range of content directly to their inbox across a three-week period.

"WE WANT TO PARTNER WITH PRACTICES TO BUILD A STRONG AND EFFECTIVE SUPPORT PROGRAMME FOR ALL CONTACT LENS TRIALISTS" James Haden, marketing director for Johnson & Johnson Vision UK

December 2020/January 2021

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VERSION

STRENGTHENING THE PATIENT RELATIONSHIP

PATIENT & PRACTITIONER REASSURANCE

REPRO OP

Sarah Long, contact lens optician and professional affairs consultant for Johnson & Johnson Vision, on supporting first-time contact lens wearers

SUBS ART

There has been a lot of change. I am a locum, so during lockdown I haven't been working in practice and I've missed my patients.

But I have found it rewarding to be able to support fellow clinicians, through my role for Johnson & Johnson, in navigating the new challenges.

PRODUCTION CLIENT

We are identifying new ways patients benefit from could benefit wearing contact lenses as lifestyles have changed. While there has been a decline for some people in frequency of contact lens wear, others are wearing them more often for exercise or video calls. I think that is probably where we can change our game in how we introduce contact lenses, asking about changes in their lifestyle and if they would like to try a new or different lens. Patients having tired eyes from an increase in screen-time may benefit from trying a different lens – one that is more able to retain moisture, for example.

A lot of patients are nervous when they are first trying contact lenses. I think that the Acuvue® 21 Day Challenge will be a way you can hold your patient’s hand through those tentative first weeks. I see so many patients in practice who have put off trying contact lenses for years. What they get with the Acuvue® 21 Day Challenge is like an additional safety net. I think that where there will be patients who are in two minds about contact lenses, it will give them the extra push they need to give it a try.

If somebody is having a contact lens teach, I'm very mindful about checking the patient is confident before they leave, especially as a locum, if you are not back in that practice to see that patient for their follow up. I think that with the Acuvue® 21 Day Challenge, I would have the reassurance that the patient was getting a certain level of support.

The challenges of COVID-19 have made us fast forward the way that we work as an industry. I think it has also highlighted the level of clinical care we provide, with the personal protective equipment that practitioners are wearing, I think it highlights to patients that it is a health environment. I think that is a positive thing.

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The purpose of the programme is to augment the in-store experience, helping contact lens patients by providing support after they leave the practice, and improving our collective chance of converting a first-time trialist to a confident and loyal contact lens wearer.

Part of the inspiration behind the Acuvue® 21 Day Challenge is that we know it takes time to form a new habit. There are plenty of proven case studies, from exercise, to smoking cessation, which demonstrate that providing useful, timely content and positive nudges can make a big difference when people want to make a change. So we are focusing on those first few critical weeks for contact lens trialists.

How does the Acuvue® 21 Day Challenge help ECPs to engage with patients?

JH: Throughout the three

weeks, we want to partner with practices to build a strong and effective support programme for all contact lens trialists, always ensuring the practitioner is at the heart of the relationship.

The Acuvue® 21 Day Challenge is an additional resource to provide to patients, so that they feel they have a little extra support outside of the practice.

From the moment a patient leaves a practice excited to start their contact lens trial, they will start receiving content that can help guide them from the comfort of their own home, should they need that extra level of support.

Kamlesh Chauhan, director of professional affairs, UK, Ireland, Nordics and DACH for Johnson & Johnson Vision, on adapting approaches It has been impressive to see how quickly ECPs adapted to continue supporting their patients through lockdown.

A lot of practitioners offered consultations over the phone for contact lens wearers and set them up with direct debit schemes so they could continue receiving their contact lenses. This not only helped from a patient care perspective, but also helped strengthen relationships.

One practitioner I know was even offering Zoom calls with her patients to help provide guidance on application and removal of contact lenses.

Practices that are able to re-engage both with current contact lens wearers and recent dropouts have an opportunity to strengthen their patient database and drive business recovery. We want to help ECPs create a sustainable and efficient practice which optimises quality time with patients – which ultimately is what really matters.

JJV

IN CONVERSATION

BUILDING GOOD CONTACT LENS HABITS How would J&J Vision like to see practices use the Acuvue® 21 Day Challenge?

JH: We aim to partner

How can practices get involved with the challenge?

JH: All practices are welcome

with ECPs to provide the Acuvue® 21 Day Challenge as an additional resource for patients. The programme will include a range of resources, including a takehome kit as well as practical tips and information delivered throughout the 21 days – all with the aim of helping patients to overcome any fears and develop confidence in their lenses.

and encouraged to sign up for the Acuvue® 21 Day Challenge. From February, ECPs can reach out to their Acuvue® Account Manager and they will be provided with a suite of marketing materials for the programme. When a patient is fitted with new Acuvue® contact lenses, they will be able to sign up for the challenge through our website.

THE PATIENT PERSPECTIVE

Monal Shah, optometrist and professional affairs consultant for Johnson & Johnson Vision, on encouraging contact lens confidence The past few months have been a challenging time, but it's also brought about an opportunity to review how we do things in practice. It has highlighted the importance of a patientcentred approach to provide the best clinical care, which has given me a greater level of satisfaction.

I realised how adaptable and resilient we are as a profession and this makes me optimistic about our future.

Matt Gurr, 28 Contact lens wearer for 13 years “When you first start wearing contact lenses, the idea of putting something on your eye is a little strange. I remember my first fitting and learning those techniques that are now second nature. I had some issues with dryness, which made it a bit uncomfortable, so I tried a few different brands which was helpful. I think it just takes a bit of persistence and practice.

“In the initial lockdown, while I was at home and not seeing people as often, I found myself staying in my glasses slightly more. Over the summer when I could meet friends more, I found my contact lens wear was mostly back to its normal level.

“Wearing contact lenses suits my lifestyle. I wear them while cycling and running, and I typically wear them to work or when seeing friends.”

I think early on many patients were concerned about the safety of contact lens wear during the pandemic, though we were able to reassure our patients that there is no scientific evidence to suggest an increased risk. It has been a great time to reinforce compliance amongst existing wearers in regard to following the recommended contact lens care and replacement schedule.

Beverley Harlow, 64 Contact lens wearer for 45 years “When I started wearing contact lenses, it was just so nice not to have glasses on all the time and I preferred how they looked. I think my vision is better with contact lenses, particularly as I have astigmatism, so once contact lenses were developed that could take account of that, it was much better.

“My routine of wearing contact lenses hasn’t really changed over this year. They are just part of my everyday.

I put my contact lenses on before I clean my teeth in the morning, and I take them out before I clean my teeth at night. The only difference during lockdown was that I couldn’t have my check-up at the opticians, but I have not had any issues and have been booked in since.”

Forming a new habit takes time, and occasionally, patients can lose motivation. But by getting new contact lens wearers to sign up to the Acuvue® 21 Day Challenge, we will be helping them with a reinforced commitment to build good habits, routines, and confidence. I think it is a great opportunity and is going to be really useful for patients.

The early stages of contact lens wear are crucial to long-term success, satisfaction and compliance. The Acuvue® 21 Day Challenge will help provide contact lens trialists with more support beyond the consulting room, from tips on application and removal, to safe contact lens care. The content will also prompt frequency of wear, as there are so many activities where contact lenses can offer patients flexibility and freedom.

One positive outcome from the past couple of months has been the possibility of remote consultations. It has been valuable in being able to identify if the patient's needs and care can be managed remotely, to help maintain social distancing for the patient and the practice team and you can still bring the patient in if needed. I wonder if that will influence how we continue to practice beyond this period.

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Discussion VERSION REPRO OP

In practice 49 How I got here

SUBS

Optometrist Sarah Arnold on a family business with 150 years of unbroken history to celebrate

51 The workshop

How to organise and pay for an interpreter, and the circumstances in which you might need one

ART PRODUCTION CLIENT

“Businesses that thrive are those that adapt to shifts in consumer behaviour” How can practices go about ensuring the clinical aspect of their service if their business is increasingly taking place online? OT asked multiples and independents for their thoughts

Getty/JuliaSim

he events of 2020 have accelerated the shift in optical retail towards e-commerce in an unprecedented way. With practices across the UK closed to all but urgent and

53 Pre-reg focus

The challenge of having a pre-reg delayed, and what graduate Emily Mather is doing in the meantime

online as well as in practice would find themselves better able to weather the storm than others.

So, can lessons be taken from those who had already invested in e-commerce tools, or managed to incorporate them during the lockdown? OT spoke to multiples and independents to see how their businesses fared, and what advice they can offer others looking to integrate e-commerce into their practices’ offerings.

THE DISCUSSION

T

Business insight and career development

essential work for months, many found themselves without the reliable income stream that they’d usually get from frame sales. It was perhaps inevitable that those with the ability to sell

Making the decision

Specsavers, which launched its e-commerce platform before the initial UK lockdown was announced, believes that the move online “was probably always going to happen – it was just when and how.”

Chris Carter, the multiple’s trading director, told OT: “Specsavers has been selling contact lenses online for a while now, so extending the offering to glasses was the natural progression, reflecting the way some customers want to shop.

We chose to launch an e-commerce platform to give customers access to a more complete Specsavers service – online as well as in stores.”

Independents are also embracing this opportunity.

Mark Preston, head of digital

55 Business ownership

Two business owners on what they’ve learnt from this year, and what they’d tell those starting out

“It’s about assisting the patient at all touch points, ensuring that the online and instore experiences complement each other” Mark Preston, head of digital at Hakim Group

at Hakim Group, told OT how the pandemic sped up the digitalisation of the group’s offering, “adapting to e-commerce and omnichannel is part of an ongoing strategy.”

Mr Preston said: “There was a real focus on this in the early weeks of the pandemic due to customers being unable to leave their homes. A new page was integrated onto each practice’s personalised website, supported by social media promotions, which allowed patients to remotely purchase an exclusive selection of frames, which could be then delivered to their door.”

Setting up

For Valarie Jerome, establishing an e-commerce offering during the pandemic was essential: she’d only opened her practice at the beginning

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of the year, and needed to solidify her customer base.

Dr Jerome told OT: “It’s something that I’ve tried to teach myself. During lockdown I began to watch a series of Facebook Lives that were put on by Small Business Saturday UK, teaching small businesses how to use e-commerce to take their business online.”

She added: “I had to learn how to pivot and how to adapt my business. I began doing virtual consultations, then I put all my products online and developed my shop. I spent probably 24 hours trying to teach myself how to use Shopify.”

Creating an e-commerce offering was a matter of survival, she believes: “Had I not been in that position, I wouldn’t have forced myself to do it. But I needed to have some kind of income to be able to know that my business could survive after lockdown. Had I not been in such a fight or flight mode, I would never have done it.”

Chris Carter told OT that his biggest concern was creating a great online customer experience, so their in-store standards could be reflected digitally.

Mr Carter explained: “If we look at product browsing in-store, customers are guided and advised by highly trained colleagues who help them find the right

frames for them. To help simulate this online, we offer services like virtual try-on and aim to provide the best product browsing and frame selection experience.”

What about clinical considerations, in terms of ensuring the right products for the right conditions?

“Customers are asked to name their local store, and the store helps with questions about purchase, checking pupil distance, the fit of new glasses, returns or aftercare,” Mr Carter told OT. This link between the customer’s usual store and the online experience allows for a level of personal service that could be lost otherwise.

Combining digitalisation within in-store experience

Lesley Gregory, head of digital at Vision Express, told OT that “free life-long service, access to in-store adjustments, and a 60-day guarantee” enable customers to find the service they need in whatever form is easiest for them. It’s something the multiple calls an “omnichannel optical retailing experience.”

This approach is something that the Hakim Group has prioritised too.

Mark Preston explained how remote consultations became a key part of the offering of Hakim practices during lockdown: “Clinical

“I needed to have some kind of income to be able to know that my business could survive” Valarie Jerome, independent optometrist

46 www.optometry.co.uk

“Customers are putting their trust in digital transactions at an all-time high” Chris Carter, trading director at Specsavers

care and the personalised touch are still at the heart of the transactions through the practice website.”

“After a patient places an order, they receive a video call from a member of that practice team who provides them with a personalised consultation to discuss their prescription and any other special requirements they may have,” he added.

“Professional eye care expertise remains a key factor in the process, and therefore a strong omnichannel presence is the best way to deal with changing patient habits. It’s about assisting the patient at all touch points, ensuring that the online and in-store experiences complement each other,” he told OT.

Realising the limitations

Perfectly placed independents

E-commerce cannot solve all the challenges that a practice might be facing, and it shouldn’t be seen as a golden ticket to survival – even during a pandemic.

Chris Carter explained how Specsavers keeps the balance in check: “Clinical excellence and customer eye care remain top priorities, and this can only be delivered through our stores,” he told OT. He added: “We only offer e-commerce to customers with a valid, single vision prescription within specific sphere limits. Any complex orders are halted before the customers submits their order and they are directed to stores, where a more comprehensive service can be offered.”

Mr Preston agrees: “Whilst we have seen increased activity towards e-commerce in the optical space, accelerated by COVID-19, the reality is that prescription eyewear is still an assisted purchase. It’s unlikely to completely replace the instore experience.

For Valarie Jerome, the impact of e-commerce has been clear: with an online booking system, a website, and shops on Facebook and Instagram, she is now selling to customers in locations she never would have reached otherwise.

She estimates that 60% of her customers found her via social media.

Mark Preston believes independents are perfectly placed to prioritise high levels of care alongside an online service.

He told OT: “The agility and attitude to adapt from all our practices has been remarkable, particularly through lockdown. Many practice team members hand-delivered straight to the doors of patients who needed an emergency pair of glasses, or to those selfisolating and unable to leave their house.”

He added: “Although our independent practices are changing the way some of their business is done, patient care and wellbeing remains the priority.”

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“My parents have got a photograph of me sitting at our first computer, trying to sort out the database”

you like to apply?” That’s how I ended up back in the UK. It wasn’t in the plan. But since 1997, I have been here.

My brother is a dispensing optician, and I work for him.

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HOW I GOT HERE PRODUCTION

“I don’t let grass grow beneath my feet”

CLIENT

Hampshire-based optometrist, Sarah Arnold, tells OT about the 150-year history of her family practice We have three practices.

I work in the one in Petersfield, in the South Downs. It’s typical commuter belt: an affluent town, but with pockets of poverty. In terms of patients, we get all sorts, from people wanting bespoke spectacles to those wanting budget options.

The first practice opened in about 1860, in Kent.

They moved to Southsea, in Portsmouth, in 1870, so that’s where we start the clock. My grandfather then moved to Petersfield in 1927. It’s been a long time, unbroken.

When I was three or four, I idolised my dad and grandfather. They were my heroes. They ran a clinic on a Thursday evening, and if I was really good, I could go along and see them at

the end of clinic. When you’re four years old, and your grandpa takes out a glass eye from his pocket, you’ve got two options.

Either you think, “Wow, that’s amazing,” or you run.

I thought it was great.

The thought of being able to look into somebody’s eyes with a light – I just thought, that’s what I want to do. I never deviated, my whole life. It was in my blood.

When I was 14, I started as a Saturday girl.

I cleaned, polished frames, made tea, and stamped NHS forms. At 16, I was answering the phone, making appointments, and taking on responsibility in reception. By the time I was 18, I was doing optical assistant work and helping

with computerisation. It seems like such a long time ago. My parents have got a photograph of me sitting at our first computer, trying to sort out the database.

I had lots of jobs when I was 18. I worked for the practice in the holidays and on Saturdays, worked in two or three pubs, did my A-Levels, and then went to City University pretty much straightaway.

I graduated in 1993 and went to Bristol Eye Hospital to do my pre-reg. I helped

fit contact lenses for babies who had had their cataracts removed. You could only get the lens in when the baby was asleep. Often, you were juggling a breastfeeding mum, and a contact lens, and a sleeping baby. It was a really great place to work.

Afterwards, I went to the West Country and worked for a group of independents called Batemans for a few years. Then my husband’s career took us to Australia.

I couldn’t work out there, so I did some volunteering and observation at the Vision Eye Institute in Melbourne.

We stayed less than a year, because he was offered a job in Southampton.

I rang home and said, “Don’t come to Australia, we’re coming home.” My mum said, “I’ve just put an advert in Optometry Today for an optometrist. Would

He is the owner of the other two practices, and helps run the Petersfield practice.

I’ve had a lot of experience.

I haven’t got very many letters after my name because I’ve been busy raising a family. Work-life balance was really important; raising the children. They’re both at university now.

Every few years I’ve had a pre-reg. I love helping

with hands-on education they don’t get elsewhere.

I enjoy teaching for the love of teaching, but I also like people to be informed.

Over lockdown, I helped to produce webinars for the Nystagmus Network. We’ve just done ‘What to expect in a High Street optometrist,’ when you’ve been discharged from the hospital system.

I’m doing some expert witness training too. I don’t let grass grow under my feet. You can have a portfolio career and be an optometrist.

There’s so much to learn. My grandfather would be beside himself if he could see what we can see in a human eye now. It’s incredible.

Working with my dad has been a career highlight.

He is an amazing man. He just had a brain like a planet.

I learned so much working with him. Not many people get to do that.

Get in touch Share your career journey with OT. Email lucymiller@ optometry.co.uk

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IN PRACTICE

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Contact lenses for younger patients

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A GUIDE FOR EVERY PRACTICE Continuing professional development

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Welcome DR IAN BEASLEY

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OT’s guide to contact lenses for younger patients for the whole practice team

ART

“I can recall many instances where contact lenses have made a life-changing difference to children”

PRODUCTION CLIENT

ontact lens patients are the lifeblood for many practices. They provide a steady revenue stream for the business and are the ‘regulars’ that help to build the community feel within the practice. In my experience, the familiar faces of these contact lens wearers are usually perched on the shoulders of adults rather than children, which begs the question: are we doing enough to proactively offer contact lenses to our younger patients?

In most cases, the short answer is probably ‘no.‘ Yet, given the vast range of product options we now have available, literally at the end of our fingertips, surely there has never been a better time to expand the contact lens offering to youngsters.

As a dad to two teenagers, I can understand why parents (and to some extent practitioners) may be reluctant for their precious cherubs to start poking their eyes with a grubby index finger. But are we making assumptions about the risks of children wearing contact lenses? And, have we considered the benefits that contact lenses can bring to the active, savvy, image conscious youth?

In my experience of fitting children with contact lenses, I am frequently taken aback at how well they seem to get on with the task in hand, often creating a lot less fuss than, shall we say, men of a certain age. I can recall many instances where contact lenses have made a lifechanging difference to children, either by helping with their confidence or allowing them to embrace boisterous activities.

Despite the success stories of children enjoying the freedom that contact lenses bring, we should always be Dr Ian Beasley mindful that they require a level of responsibility. is an optometrist, Taking all of the above into account, the content within researcher, clinical editor this guide shares tips for growing contact lens uptake of Optometry Today, and among children, highlighting the benefits and risks of head of education for the Association of Optometrists wear, along with tips to help make the process a smooth and successful one.

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Contact lenses CPD

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Inside 04 Introducing contact lenses to kids How to open the contact lens conversation 06 Cases from practice Experiences of fitting children with contact lenses in High Street independent practice 08 Application and removal without the tears and tantrums Getting younger patients to successfully handle their contact lenses 10 Seeing the benefits How contact lenses can improve the quality of life for young wearers 12 On the front line A staff nurse's guide to carrying out a contact lens teach 13 Refraction changes in children Outlining how refraction changes during childhood 14 Are contact lenses safe for children?

The track record of contact lens safety in young wearers 15 Your resources guide Contact lens resources for patients and parents

CPD

MEETING YOUR TEAM’S CPD NEEDS

What you will learn

Getty/Halfpoint Images

Contact lenses form an integral part of the daily routine for most practices, and optical assistants are a key component in managing the many touchpoints that are required for these patients. From scheduling aftercares, ordering replacement lenses and teaching patients how to handle and care for their lenses, the tasks are numerous. This guide will help the reader to identify the opportunities to deliver the benefits of contact lenses to younger wearers. Our experts offer guidance on how to start the conversation with potential patients, as well as recognise the scenarios where they can be a useful alternative to spectacle correction. Insight from research will help to put the risks and benefits of contact lens wear in children into context, and provide advice on how best to manage the needs of these patients – and, of course, their parents.

•

How to open up the conversation

•

Recognise scenarios for contact lens wear

Drawing insight from the research

Did you know...?

Myopia is more common in children when one or both parents have myopia as well

Four simple tips for every practice team Get the most out of OT’s CPD guide. Consider these scenarios as a team to test your skills and knowledge: 1. Think of six different scenarios where contact lenses could improve the quality of life for children 2. Take a look through the appointment diary over the next week and identify some of the younger patients where you think contact lenses would be of benefit to them. Talk to your optometrist about potential contact lens options that would meet the needs of these children 3. Try striking up the conversation with parents and their children about trying contact lenses, using the insight this guide provides on the risks and benefits 4. Try out the vision simulator detailed on page 15 to get a feel for what a patient’s uncorrected vision is like at different levels of myopia. Then think about how this might affect children taking part in activities where it is impractical to wear glasses safely.

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Welcome

Contact lenses for younger patients

CPD module sponsored by

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Introducing contact lenses to kids KEITH TEMPANY & INDIE GREWAL

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Sharing tips on starting the contact lens conversation with children and their parents

ART PRODUCTION CLIENT

here are many good reasons that contact lenses should be offered to all patients irrespective of age because of the positive impact they can have on quality of life. This is especially the case for children. Indeed, a study comparing children and teenagers who had been contact lens wearers for 10 years or more concluded that age should not be the deciding factor in whether or not to offer contact lenses.

Despite the obvious benefits of contact lenses, as well as the advancement in materials and designs, a survey by the College of Optometrists showed that only 0.4% of practitioners recommend contact lenses as a primary method of vision correction for those under eight years old, 1.4 % for eight to nine year olds, 7.1% for 10–12 year olds and 24.1% for 13–14 year olds.

For successful introduction of contact lenses to paediatric patients, it is important to lead the conversation with specific benefits for the individual using examples of where contact lenses can be better than spectacles – for example, playing sports. Other key insights from research can be shared which show that youngsters feel their physical appearance, sporting prowess and social acceptance improves with contact lens wear. It is also a sad reality that spectacle wearing children are 35% more likely to be bullied than those who don’t wear them.

Parents and children will have many misconceptions about being fitted with contact lenses at a young age, so it is important to allay their fears. Research published in 2017 showed that the risk of serious infection in paediatric contact lens

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wearers is no higher than in adults. In fact, in the younger age group of eight to 11 year olds, it is significantly less, which is probably due to better compliance and parental supervision. It is worth bearing in mind that many parents may have been fitted with contact lenses themselves in their mid to late teens or early adulthood due to the limited availability of contact lens prescriptions, materials or designs. Therefore, they may not be aware of product advancements that

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make contact lenses suitable for children.

Virtually all kids believe that anything applied to the eye hurts. As with all dealings with younger patients, use language which is appropriate for their level of maturity, keeping things easy for them to understand using simple analogies. If they’ve not held a lens before then give them a trial lens to feel – you could make it a game by asking them if they think it will be hard or soft, wet or dry, slippery or sticky; this can instantly

Daily disposables will usually be the first 'DLO\ GLVSRVDEOHV ZLOO XVXDOO\ EH WKH ÂżUVW choice for children as this minimises the risk of FKRLFH IRU FKLOGUHQ DV WKLV PLQLPLVHV WKH ULVN RI serious complications, especially as it removes VHULRXV FRPSOLFDWLRQV HVSHFLDOO\ DV LW UHPRYHV potential problems of poor case hygiene SRWHQWLDO SUREOHPV RI SRRU FDVH K\JLHQH

Kids

Contact lenses for younger patients

CPD

3DUHQWV DQG FKLOGUHQ ZLOO KDYH PDQ\ Parents and children will have many misconceptions about being fitted PLVFRQFHSWLRQV DERXW EHLQJ ÂżWWHG with contact lenses at a young age, ZLWK FRQWDFW OHQVHV DW D \RXQJ DJH so it is important to allay their fears VR LW LV LPSRUWDQW WR DOOD\ WKHLU IHDUV

take away initial fears that the lenses might be uncomfortable. It can be useful to say that the lens has so much water in it that it will feel like a drop of rain that will just float on the eye. If the parents are lens wearers and are willing to show the child how they pop their lenses in and out this will also help.

If there is any hesitancy to proceed, ask them to go home and think of 10 things that would be better to do in contact lenses than in spectacles. They

could get the whole family involved in this project and go through the list with them at the next appointment.

Daily disposables will usually be the first choice for children as this minimises the risk of serious complications, especially as it removes potential problems of poor case hygiene. The cost of daily disposables can be presented as ‘price per wear calculation,’ which allows parents to consider part-time options for wear, perhaps for particular activities.

In clinical practice, the authors have had great success in the ‘all day comfort trial.’ The child is able to trial contact lenses for a half or whole day, while remaining within the locality of their practice. This enables the patient to experience what life would be like wearing contact lenses for sport, a day out and as an alternative method of vision correction.

The first mention of contact lenses can be just to sow the seed, but do remember to follow up at the next appointment or with a phone call a little while later. Both authors have seen life-changing differences that contact lenses can bring about for youngsters, benefitting the wearer, the parents and the practice.

Keith Tempany

Indie Grewal

is a multiple awardwinning contact lens practitioner and former president of the BCLA

is a qualified dispensing optician and optometrist and current president of the BCLA

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Cases from practice CERI SMITH-JAYNES

SUBS

Experiences of fitting children with contact lenses in High Street independent practice

ART

Case one

PRODUCTION

This little girl was nine years old when she first came to my colleague for contact lenses. Despite his deft touch and wealth of experience, they got no further than getting one gas permeable lens on an eye.

Four years on, this self-conscious teenager with a lazy eye wore thick, hyperopic spectacles and walked with her head lowered, hiding behind her fringe:

CLIENT

Refraction RE +6.00/-2.00 x 10

VA 6/24

LE +5.75/-1.75 x 170

VA 6/6

With the passing of time, more soft contact lens options for hyperopes with astigmatism had become available so I fitted her with CooperVision Biofinity torics. She suffered from severe insomnia, so I was particularly keen to use a highly breathable silicone hydrogel material in order to minimise the risk if she accidentally napped in the lenses or wore them late into the night. The lenses sat straight and stable and she managed application and removal herself with a relatively short tutorial.

She continued wear successfully for a couple of years and the effect on her self-esteem was delightful to see. However, in 2019, she said the vision had become variable and her eyes were itching. When asked about her wearing time, she said she wore them daily for about 16 hours. She had purchased some +1.00D reading glasses from a supermarket and was

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She suffered from severe insomnia, so I was particularly keen to use a highly breathable silicone hydrogel material in order to minimise the risk if she accidentally napped in the lenses or wore them late into the night using them at her computer (note: legally, these are not to be sold to under 16s).

The back of her eyelids had become a little lumpy, indicating allergy.

It was late Spring, so I decided to treat her for hayfever by prescribing olopatadine eye drops, a combined antihistamine and mast cell stabiliser.

These are dosed twice a day, making them advantageous for contact lens wearers compared to over-the-counter alternatives because you can put them in 20 minutes before applying lenses and again after taking them out.

I brought her in for a cycloplegic refraction as she hadn’t done this since she was little and she did turn out to be more hyperopic, so I adjusted her contact lens prescription accordingly, allowing her to ditch the ready readers.

The fitting of the lenses still appeared stable and the surfaces clean. The unstable vision could have been a tired child struggling

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with undercorrected hyperopia or the rough surface on the back of the eyelids moving the lenses about as they dried out at the end of a long day. It’s difficult to know when you change two factors at once. Still, she did report back that she had stopped using the reading glasses and her eyes were feeling somewhat better.

Case two An eight-year-old boy came with his foster parents for a sight test. He was already moderately myopic, so we had a conversation about the possibilities of myopia control. A year later, his myopia had progressed by a dioptre in each eye.

Refraction RE -5.00/-0.75 x 5 LE -4.00/-0.75 x 10

VA 6/6 VA 6/6

Although we didn’t know his family history, I was concerned about the increasing myopia as his eyeballs grew longer because this can increase the risk of eye disease later in life. He was a good swimmer and attended his local club. Together, with his foster parents, we decided to try EyeDream orthokeratology (ortho-k). This meant he’d be able to wear the rigid lenses overnight, remove them for cleaning and storing in the morning and spend the day free to jump in the pool. The lifestyle advantages were obvious and, without making promises, there was a chance it could slow his myopia progression.

He tolerated the fitting of the lenses

CPD Ceri’s view…

remarkably well and managed to apply and remove them himself a few times. I asked him to wear the lenses that night and booked him in first thing in the morning, still wearing them. I checked they weren’t stuck to his cornea and then he removed them in the test room. After just one night his cornea had partially flattened (see Figure 1). I wasn’t expecting his myopia to be fully corrected in one night but, on removing the lenses, he could read some of the letter chart and refraction was less than -2.00D in each eye. After two weeks, we did have to alter the fit of the lenses

to help them sit more centrally and to correct his myopia more effectively.

The second set of lenses proved effective – he could read the board at school without glasses or contact lenses – and he wore the lenses successfully for the next year.

In that year, his myopia was unchanged in his right eye and had progressed by just half a dioptre in his left eye. His lenses were updated to correct this. This little boy seemed to be flourishing and it was satisfying to be able to help him do well with his competitive swimming.

"I have to remind myself not to underestimate children. They’re generally more adaptable than the average adult and they are used to taking instruction, making some children ideal contact lens patients. I find age is a poor indicator of how successful they will be with contact lenses."

He tolerated the fitting of the lenses remarkably well and managed to apply and remove them himself a few times

Figure 1 Topography images mapping the curves of patient’s left cornea before (left) and after (right) wearing his ortho-k lenses for a night. After wear, the centre of the cornea has been flattened, shown by the central green area. The red-orange area shows the part of the cornea which is more curved

Ceri Smith-Jaynes is an IP-qualified optometrist and OT clinical multimedia editor

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Cases from practice

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Application and removal

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without the tears and tantrums KEITH TEMPANY

ART

It’s not what you do…

PRODUCTION CLIENT

‘Kids are not small adults’ is a well coined phrase and never truer than when it comes to the contact lens application and removal session.

Having said that, the core instruction content is the same for children as it is for adults. In either case, it is true that a thorough teach will generally lead to a successful contact lens wearer.

I tend to refer to these sessions as handling and hygiene appointments as it’s not just about getting the lens on and off of the eye. The first step is to try and break down any barriers and build a rapport, for instance, by chatting about what sports they like, if they have any pets, to make them comfortable as they are likely to be apprehensive. The language that you use should be determined by the maturity of the patient, so make it simple enough for them to understand and follow while taking time to repeat key points. Young ones can be encouraged to bring along their favourite cuddly toy to give them confidence.

If they haven’t had a lens on eye at this point, let them feel a trial lens to remove any fear that it will be uncomfortable. Ask if they have any concerns from the outset and deal with these before continuing. In the author’s experience, the time required at the handling and hygiene visit for children is about the same as an adult; sometimes a six-year-old will be successful in one appointment whereas some adults may need multiple visits.

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Getty/LightFieldStudios

SUBS

Experiences of getting younger patients to successfully handle their contact lenses

The pandemic effect With COVID-19 in mind, it is worth taking steps to limit face-to-face contact time where possible: ● Ensure patients take advantage of online resources to learn in advance how to handle and care for their lenses (see page 15) ● Advise patients to practise some of the techniques shown in the online tutorials, such as holding their eyelids ● Get the patient to gently touch the white of their eye with a clean, dry finger so they can familiarise themselves with the sensation ● Be prepared to run a series of shorter teaching sessions rather than expecting the patient to master the technique in a single sitting – manage expectations in advance in this regard to avoid disappointment.

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CPD

The first step is to try and break down any barriers and build a rapport, for instance, by chatting about what sports they like, if they have any pets, to make them comfortable as they are likely to be apprehensive” …It’s how you do it Ideally the space that you use should be quiet, well-lit and with the mirror at a suitable height for the patient. Have everything you need to hand including a checklist of the main points to cover.

Try to limit the audience to one parent or carer to reduce any distractions.

Cleanliness cannot be stressed enough and make a point of explaining the importance of good hand hygiene, including why drying is as important as washing.

‘No tap water’ stickers available from the BCLA to mark the lens boxes ‘right’ and ‘left’ is a good way to remind them.

Demonstrate how to tell if the lens is inside out or not and how to inspect the lens for damage or foreign objects.

It is useful for the patient to watch someone else, such as their parent or a practice team member, apply and remove a lens before they try. Then coach them how to apply and remove the lenses themselves. Be prepared to adapt the technique if the patient is struggling and work with them to find an approach that works best for them.

If they are having difficulties, ask them to put a lens on their cuddly toy’s eye (if they’ve brought one) or even on your eye – it is amazing how gentle they can be. Remember: don’t press

or criticise but offer encouragement as small increments are usually the way forward, for the first lens on eye at least. The second lens is usually applied much quicker. It is always a good idea to repeat the process to rule out any flukes.

The instructions for lens and case hygiene is the same as for adults. However, after explaining and demonstrating the process, get the child to show you with a trial lens so that you can iron out any misunderstandings before they take the lenses home.

The instructions for lens and case hygiene is the same as for adults. However, after explaining and demonstrating the process, get the child to show you with a trial lens so that you can iron out any misunderstandings before they take the lenses home

An informed consent form should be read and signed by both the parent or carer and the patient. It should, therefore, be written in a concise, easy to understand language and include a check list of what has been covered during the appointment, wearing schedule, modality and application and removal techniques, with links to online resources. It should also give advice on what to do and where to go if they have any problems. Asking the child to sign it should reinforce the significance of the instructions and how important it is to be compliant.

It is vital to remember that good compliance is crucial for safe and successful contact lens wear. To help monitor this, the author uses separate pictures of each stage of the process.

At the aftercare appointments, these are placed in a pile and the patient is asked to put them in the correct order.

Time for take away After a successful session, book an aftercare appointment and ensure that the patient has enough lenses and solutions for the intervening period. Ask the patient to wear the lenses to the aftercare appointment having had them on eye for at least a couple of hours. Finally, just confirm that the patient is happy to take the lenses on the day or if they would prefer another run through to build confidence.

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Application

Contact lenses for younger patients

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Seeing the benefits KRUPA PATEL

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How contact lenses can improve the quality of life for young wearers

ART PRODUCTION CLIENT

eedback from young patients tells us that contact lenses give them a sense of freedom to do the activities that they want to do, to not have to think twice about what they are doing, and to be themselves. These benefits can be appreciated regardless of age, for instance, being able to fully embrace any physical activity – from jumping on a trampoline to playing football – without the restriction of spectacles. Several studies have explored the impact that spectacles and contact lenses can have on a child’s quality of life; let’s take a look at these below.

F

Improving self-perception Contact lenses often improve a child’s view of themselves, including their physical appearance, sporting ability, and acceptance among friends. This is supported by the ACHIEVE study, which randomly assigned 484 children (aged eight to 12 years) to wear either spectacles or contact lenses for three years. The aspect of self-perception that contact lenses improved the most was that of physical appearance, which interestingly improved even if the child did not mind wearing spectacles.

It is not surprising, therefore, that contact lenses can significantly improve the quality of life of children and teenagers. The Contact Lenses in Paediatrics (CLIP) study refitted 169 children and teens (aged eight to 12 and 13 to 17 years, respectively) from spectacles to contact lenses for three months of wear and examined quality of life using a questionnaire. On average,

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the children and teenagers were wearing their contact lenses for about 11 hours per day. Quality of life significantly increased over the three months with 71% of children and 79% of teenagers preferring their contact lenses over spectacles. Taking this into account, practitioners can be confident that contact lenses are as beneficial for the quality of life of children as they are for their teenage patients, since the two age groups experienced improvements in the same aspects and to the same degree.

Improvements in quality of life were

Contact lenses CPD

Practitioners can be confident that contact lenses are as beneficial for the quality of life of children as they are for their teenage patients, since the two age groups experienced improvements in the same aspects and to the same degree

CPD

make being active more enjoyable by providing a better visual experience than spectacles. Unlike spectacles, contact lenses provide clear vision across the whole visual field and remain stable on the eye while running, providing stable vision. Additionally, contact lenses don’t fog up like spectacle lenses. The CLIP study reported that about 60% of children and teens felt that their sporting performance was improved by contact lenses.

Easy to apply

not affected by age, gender, ethnicity, satisfaction with spectacles, family use of contact lenses, or refractive error.

In addition, contact lenses are far more convenient than spectacles for playing sports. Contact lenses give kids the freedom to be active instead of worrying about breaking their spectacles and causing a related eye injury. The CLIP study found that, after a contact lens fitting, the proportion of children and teens failing to use vision correction during sports dropped from 21% to just 4%. Equally, contact lenses may

A two-year trial with MiSight® 1 day contact lenses also reported significant improvements in quality of life compared to spectacles. The study gave a questionnaire to 74 children fitted with either MiSight® 1 day or singlevision spectacles. Children who wore MiSight® 1 day lenses gave significantly higher ratings than spectacles wearers for symptoms, appearance, satisfaction, effect on activities and peer perceptions.

Children can be just as capable as adults at wearing and handling contact lenses; they are fast learners and, after a little time, wearing contact lenses can become second nature. A three-year trial of MiSight® 1 day lenses reported that, on average, children wore contact lenses for over six and a half days per week for 13 hours per day during the week and 12 hours per day at the weekend. Furthermore, throughout the three years, nearly all children reported that they did not notice or only

Krupa’s view…

“There are multiple, significant benefits of contact lens wear for children and young people. I encourage readers to put themselves in the shoes of younger patients attending for their eye examinations and ensure they, alongside their parents/carers, are informed of all the available options for their active lifestyles.”

sometimes noticed their contact lenses.

For most children, they found it easy to apply contact lenses within a month of starting and almost all children found lens removal easy from the first week of wear.

CooperVision would like to acknowledge and thank Nathan Greenaway at Visioncare Research Limited for their support with this article.

Krupa Patel is head of professional services for CooperVision UK & Ireland

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Benefits

Contact lenses for younger patients

Front line VERSION REPRO OP

On the front line JODIE PENDLEBURY

ART

What’s your role?

PRODUCTION

I’m a staff nurse based in paediatric ophthalmology at Alder Hey Children’s NHS Trust in Liverpool.

I test visions, carry out visual field testing, OCT imaging and run a nurse-led watery eye clinic. But my favourite part is teaching children and parents how to apply and remove contact lenses.

CLIENT

Getty/monstArrr_

SUBS

A staff nurse's guide to carrying out a contact lens teach

How long have you been involved in contact lens work?

I have worked in the department for 11 years and have been involved in contact lens teaching for at least nine of those. I remember our lead optometrist at the time approaching me and asking if it was something I would like to get involved in. I jumped at the chance. It is something I love doing and it can be so rewarding.

Jodie’s top tips for a successful teach

What have you found most challenging about this aspect of your role?

We don’t just see local children; sometimes they come from Wales, the Isle of Man or even further afield.

This becomes slightly harder to manage as they aren’t just down the road if they encounter a problem with the lenses.

I try and plan a teaching session to coincide with one of their other appointments, allowing plenty of time for the discussion/questions and if they need a break in between, so that they feel well prepared and confident handling the contact lenses.

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Allow plenty of time for teaching, remembering that multiple sessions may be necessary Be clear about the importance of hand hygiene and contact lens care Remember to talk them through it all; it’s important they feel comfortable to alleviate anxiety Encourage the patient to use a mirror and lean over a desk so that any unsuccessful attempts will be caught Keep solution, saline and a box of tissues to hand while teaching Once the contact lenses are in, encourage the patient to go for a short break to allow them time to settle

The top lashes often get in the way; try to teach the patient to get a good grip of them to make application easier Tell the patient to keep their glasses, a contact lens case and small bottle of solution in their school bag in case of any problems Be explicit about no swimming or showering in contact lenses and to avoid tap water coming into contact with the lenses by making sure their hands are completely dry before handling them Don’t let the patient take their lenses home until you are confident that they know what they are doing.

Jodie Pendlebury is a staff nurse at Alder Hey Children's NHS Trust, Liverpool

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VERSION

Refraction

REPRO OP

changes in children

CPD

PROFESSOR NICOLA LOGAN SUBS

Outlining how refraction changes during childhood

ART PRODUCTION CLIENT

ost infants have a significant refractive error at birth, with the majority having hyperopia (longsightedness).

The level of hyperopia decreases during infancy and early childhood, with most children retaining a low level of hyperopia by the time they are six years of age. Children can easily compensate for this normal level of hyperopia with their natural focussing ability and rarely need correcting with spectacles during this time. By the time children reach secondary school age, they will have often naturally out-grown their hyperopia; however, some won't and will still require vision correction with glasses or contact lenses.

M

What happens if the eye over-grows?

The eye grows rapidly in early childhood with an increase in axial length from approximately 18mm at birth to around 22mm by the age of three years. To offset this growth in the eye, a compensatory mechanism by the other parts of eye exists, such as thinning of the crystalline lens and flattening of the cornea. If the eye grows too long and the other ocular components are unable to compensate then the child can develop myopia. It is a gradual process with many children unaware of myopia onset until they start to experience difficulty with seeing the whiteboard at school.

Commonly, myopia is due to a longer axial length and typically develops during school years, with progression of myopia occurring from onset to late teenage years. However, some people

develop myopia in later teenage years or early adulthood. The younger the age of onset of myopia, the greater the amount of myopia progression and rate of axial length growth.

Myopia is more common in children when one or both parents have myopia, although there is increasing evidence that today’s lifestyles, such as less time spent outdoors, are also influencing the

development of the condition.

As most young children are not aware if they have a problem with their eyes or if myopia has developed, parents should be advised to have their children’s eyes examined at least before they start school and then on a regular basis. Awareness that a low level of hyperopia is the norm at six years of age is important, and that children who are already plano at that age have a higher risk of developing myopia by the time they get to teenage years. This, alongside family history of myopia and a lifestyle with limited outdoor time should be considered as risk factors for development of myopia in children.

Myopia is more common in children when one or both parents have myopia, although there is increasing evidence that today’s lifestyles are also influencing the development of the condition

Professor Nicola Logan is a myopia researcher based at Aston University

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Refraction

Contact lenses for younger patients

Safety VERSION REPRO OP

Are contact lenses safe for children?

KRUPA PATEL

SUBS

The track record of contact lens safety in young wearers

ART PRODUCTION CLIENT

n OT’s guide, we have seen why children benefit from wearing contact lenses. But are they a suitable option for these youngsters? In fact, there is mounting evidence to suggest that children can safely wear soft contact lenses as long as they are worn and cared for properly. It is rare for children or young people to have clinical complications with their lens wear and these seem to occur less frequently than in older wearers. This was shown in a recent analysis of six clinical studies, which reported no serious or significant complications in children during a total of 816 years of contact lens wear across the wearer group.

In a three-year clinical study where children wore contact lenses for myopia management, there were no reported serious or significant eye complications among 144 young participants.

A further clinical study examined the patient records of 3,500 soft contact lens wearers from as young as eight years old. Very few problems were reported among the younger wearers (aged eight to 12 years), despite the large number of patient records analysed.

To help report the figures in a meaningful way, the results were standardised to the number of complications for every 10,000 years of lens wear. The overall findings showed that contact lens complications were notably lower in young children than in other age groups, which may be due to an improved level of compliance. The rate of reported complications was just 97 per 10,000 years of wear in young

I

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Contact lens complications were notably &RQWDFW OHQV FRPSOLFDWLRQV ZHUH QRWDEO\ lower in young children than in other age ORZHU LQ \RXQJ FKLOGUHQ WKDQ LQ RWKHU DJH groups, which may be due to an improved JURXSV ZKLFK PD\ EH GXH WR DQ LPSURYHG level of compliance OHYHO RI FRPSOLDQFH children (aged eight to 12 years), 335 per 10,000 years in teenagers (aged 13 to 17 years), and 463 per 10,000 years in adults (aged 18 and older). Anecdotal evidence suggests that the differences in these age groups may be due to parents supervising younger children, who may also be better at taking instructions than their older teenage counterparts.

Studies have also reported other positive eye health-related findings, in addition to low levels of contact lens complications. This includes that contact lenses are no more likely than spectacles to cause meaningful increases in myopia or lengthening of the eyeball.

Additionally, the evidence indicates that contact lens wearers who are fitted as children or as teenagers, can continue to successfully wear contact lenses for years to come. In summary, practice teams can confidently recommend contact lenses for younger patients and give them the opportunity to experience freedom from wearing spectacles.

CooperVision would like to acknowledge and thank Nathan Greenaway at Visioncare Research Limited for their support with this article.

STANDARDISED DATA ON CONTACT LENS WEAR

97

reported complications per 10,000 years of wear in young children (aged eight to 12 years)

335

PER 10,000 YEARS IN TEENAGERS (AGED 13 TO 17 YEARS)

463

per 10,000 years in adults (aged 18 and older)

Contact lenses CPD

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VERSION REPRO OP

Your resources guide CERI SMITH-JAYNES

SUBS

Contact lens resources for patients and parents

ART

WEBSITES

PRODUCTION CLIENT

My Kids Vision is an informative website developed by optometrists, Dr Kate Gifford and Dr Paul Gifford, the team behind the helpful Myopia Profile website and Facebook group.

My Kids Vision provides a plethora of ‘how-to guides’ for children and parents on contact lens related topics, including application and removal, lens cleaning, ortho-k and managing myopia. www.mykidsvision.org/en-us/Home/ HowToGuides The International Myopia Institute website is a useful reference for those parents interested in research papers on myopia control. www.myopiainstitute.org

LEAFLETS

SUPPORT FROM CONTACT LENS MANUFACTURERS Contact lens coach by CooperVision features application and removal videos and step-by-step guides, along with FAQs and tips for new contact lens wearers. There is good emphasis on the dangers of water and contact lenses. coopervision.co.uk/ contactlenscoach CooperVision’s MiSight® 1 day website also features a vision simulator, so parents can get an idea of how uncorrected myopia can affect their child at school. coopervision.co.uk/eye-health-andvision/childhood-short-sightedness/ myopia-simulator

AOP members can download free copies of patient leaflets on Advice for soft contact lens wearers and Advice for rigid contact lens wearers. www.aop.org.uk/advice-and-support/forpatients/contact-lenses

The Acuvue website has some useful, clear guidance for new contact lens wearers, including tips for sticking to a regular replacement schedule. www.acuvue.co.uk/contact-lens-care/ new-wearer-guide For children suitable for orthokeratology, No7 Contact Lenses Eyedream website is a good place to start. The website gives introductory information and patient stories, including a go-karting eightyear-old and features an optician finder. www.eyedreamlenses.com/children

VIDEOS

In OT’s video, Myopia management – balancing the possible and impossible, Dr Nicola Logan outlines the evidence base and discuss the current and emerging options available for practitioners to offer to patients with progressing myopia, and Dr Peter Hampson discusses the steps that practitioners should take to ensure they manage the expectations of parents and patients. www.aop.org.uk/ot/cet/2020/07/09/myopiamanagement-balancing-the-possible-andimpossible/article

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Resources

Contact lenses for younger patients

VERSION REPRO OP

SOMALI

URDU

THE WORKSHOP SUBS

Who pays for an interpreter?

ART

Every issue, OT poses a scenario from a practitioner.

This edition, what you need to know about booking interpreters for appointments

The scenario PRODUCTION

Emma, practice manager “I have a patient with hearing difficulties booked in for an appointment in two weeks time. I’m new to managing a practice and haven’t handled this situation before. I wondered what provisions I might need to take, and what financial implications there might be?”

CLIENT

The advice Sue Clark, clinical consultant at the Optical Consumer Complaints Service (OCCS)

Getty/Pavlo Stavnichuk

C

lear communication is essential when discussing eye health. But what’s the answer when communication is limited due to a language barrier or patient disability?

Interpreters can provide a channel of communication where it is limited between patient and optician.

This can be crucial when discussing aspects of care. There are financial implications, however. Who pays depends on context.

Catering for those with disabilities

The Equality Act 2010 requires that all service

providers make ‘reasonable adjustments’ when it comes to services for people with disabilities, in order to ensure that they are not given a substantial disadvantage.

Approximately 11 million people in the UK are deaf or hard of hearing, and there are 151,000 British Sign Language users. A patient who is deaf can be described as having a disability. They are therefore protected under the Equality Act, requiring reasonable adjustments to be considered.

Reasonable adjustments refer to changes that can be made in order to cater for a person’s disabilities.

These changes only need to be made if it is reasonable to do so; for example, if the changes are necessary

to communicate important information between patient and optician, and are affordable and practicable.

If an optician does not fulfil their duty to make reasonable adjustments, and has no valid excuse as to why these adjustments could not be made, the Equality Act deems this unlawful discrimination. Patients can ask the optometrist to make these changes, and can make a discrimination claim if they refuse.

Is an interpreter a reasonable adjustment?

The Act states that service users should not have to pay for reasonable adjustments.

Therefore, the optometrist must decide whether an interpreter qualifies, and arrange funding if so.

Whether an interpreter counts as a reasonable adjustment depends on a number of factors, including cost. On average, interpreters cost around £15 per hour, so a reasonable adjustment in this case may be to book patients on a day that an interpreter is working in the practice.

If an interpreter is too costly (for example, if there are no local interpreters and therefore travel expenses must also be considered) then it may not qualify as a reasonable adjustment. In this case, the optometrist should seek alternative methods for providing accessible information for patients.

What about public funding?

The NHS Accessible Information Standard Guidance for Community

“Clear communication with patients is essential when discussing matters concerning eye health”

Optical Practices states that NHS service users should receive information in a suitable format. The Standard is a legal requirement that applies to needs that relate to a learning disability, sensory loss or other impairment – not those who may require language translation.

The guidance, last updated in July 2016, says that the NHS does not provide financial support for implementation of the Standard, implying that interpreters must be funded by the provider.

The Standard suggests, however, that some support may be available on a caseby-case basis locally: “Where it is concluded that using a communication support professional is a reasonable adjustment, and where the patient is NHS funded, you may wish to contact your local area team and/ or commissioner to find out what support they can offer.”

Both private and publicly funded optical practices are likely to have to provide their own funding for an interpreter’s services if this is necessary, in order to cater to patients’ disabilities in line with the Equality Act. If it is not possible to finance these services, alternative arrangements must be made to ensure that information is accessible to those who require support.

Alternatives can range from providing written material to allowing a patient to bring a friend or family member to their appointment.

Sufficient alternative communication methods should alleviate the need for an interpreter, allowing an optical practice to provide cost-effective support for patients where needed.

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Workshop

ARABIC

IN PRACTICE

VERSION

PRE-REG FOCUS

REPRO OP

“I’m so excited to start the next part of my career”

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

Manchester graduate, Emily Mather, had her pre-reg placement at Moorfields delayed as a result of COVID-19. Here, she tells OT why she is grateful for the extra time at home

SUBS

M ART PRODUCTION CLIENT

y placement at Moorfields was delayed because of the uncertainty surrounding COVID-19. I know that Moorfields want to give pre-regs the best possible training, support and experience, and so they pushed the start date back to allow them to do so.

At first, I felt upset that I wasn’t going to be starting sooner. But I soon realised this delay is only going to be beneficial for me. They’ve also extended the length of the contract so I get to spend more time at the hospital, which is great. It would be so easy to get so upset about the change of plan, but I really tried hard to think of the positives to the situation and realise a lot of it is beyond anyone’s control.

Due to COVID-19, I ended up moving home from university and back in with

Peter says…

my parents. I’m from a little village in West Yorkshire, so I was so excited to move to London and experience the big city. However, this time at home has been wonderful, and I’ve got to spend a lot of time with my family that I wouldn’t otherwise have had. I think it’s made me appreciate the countryside and where I’m from a lot more, and I know I’ll miss it once I move.

In the meantime, I have a job as an online shopping picker in the supermarket.

This has been hard work given the pandemic, but the job has taught me a lot of resilience and I’ve also gained more experience with the general public – any experience is invaluable for a clinician. I also sometimes work nights for overtime and end up doing 16-hour shifts, which is crazy.

At the moment I’m just

The first weeks of my prereg have been… tiring but rewarding. I have gone from seeing one or two patients a week at university to four patients a day in practice.

Although I have had to adjust to the increased testing, it has allowed me to carry out over 50 sight tests in the first two months of my pre-reg.

This has provided me with invaluable experience, such as testing children for the first time, seeing a range of pathology, and writing several referral letters.

reading through some of my notes from university and trying to keep up my knowledge before starting pre-reg. It’s difficult because I don’t want to feel like I’ve forgotten everything over this extended break, but I don’t want to overwhelm myself and stress about constantly revising. I know a lot of the practical side of

what I enjoy. I really can’t wait to start working with the public again and helping people in any way I can.

I can’t wait to receive the training from Moorfields and I’m so excited to start the next part of my career in optometry. I’m also excited to start finding my feet and working out where I’d like my career to take me.

“My tutors at university would be reminding me not to forget my anatomy, so I’m trying desperately hard not to” things will come back to me once I start practising again.

My tutors at university would be reminding me not to forget my anatomy, so I’m trying desperately hard not to.

I’m most excited for the fresh start in a new place and to get back to doing

The most important thing I’ve learnt so far is… how to manage a variety of people. Every individual has a unique personality, and it is up to me to address their concerns and meet their needs to the best of my ability, within my limits of competence and to ensure the patient comes away feeling satisfied.

What I’m enjoying most about independent practice is… managing each patient throughout

Though COVID-19 completely changed my plans, I’m really grateful for the past eight months.

I have met some great people and learnt a lot of new skills. Hopefully my experiences over this time will be beneficial to my pre-reg.

their entire appointment.

From the moment I am handed their record card at reception, right up to dispensing their new spectacles at the end of their visit, I am involved in every part of their journey in the practice, including any additional tests or follow-ups required.

Peter Grant is a pre-registration optometrist at Julian Davies Opticians in St Mellons, South Wales

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Pre reg

IN PRACTICE

Glaukos advertorial

Advertorial brought to you by VERSION REPRO OP

ISTENT INJECT® AND TRABECULAR MICRO-BYPASS SURGERY

SUBS

This article will address some questions patients may ask when contemplating modern glaucoma treatment such as trabecular micro-bypass surgery. The answers are facilitated with help from the Glaukos technical team and experience at Queen Victoria Hospital (QVH), East Grinstead, West Sussex, which is a centre of excellence for glaucoma surgery headed by consultant Mr Gok Ratnarajan, assisted by Specialist optometrist, Shruti Malde.

ART PRODUCTION

Is iStent inject® safe going through airport security?

A: Yes. It is not required to notify airport security with regards to an implanted iStent inject® as the device is not expected to set off security scanning machines. You may proceed normally with airport scanning machines.

CLIENT

Is it safe to have MRI scan?

A: Yes. Magnetic resonance imaging (MRI) forms detailed images of any part of the body by using the body’s natural magnetic properties. Although pacemakers, metal clips, and metal valves can be dangerous in MRI scanners because of potential movement within a magnetic field. iStent inject® are magnetic resonance (MR) conditional. This means that the device is conditioned to work properly in an MRI environment under specified MRI scan parameters which are provided in the product labelling.

Can iStent inject® dislodge?

A: It is unlikely as evidenced by iStent inject® clinical studies, but possible. Like most implants in the eye, there is some degree of healing and scarring that is typically seen after a few weeks to months. This secures the implant in place in the same way the intraocular lens (IOL) is secured in the eye after cataract surgery. Once it has healed, it is unlikely that the stent will dislodge from the trabecular meshwork.

Can you exercise and go to the gym after the insertion of iStent inject®?

A: Advice following iStent inject® implantation is the same as post-operative care following any ocular surgery like cataract surgery, where strenuous physical activity, lifting weights or bending down should be avoided for about 2 weeks while healing is taking place. Following clearance from a healthcare professional, there is no known contraindication for physical activity.

Can the iStent inject® become blocked?

A: It is coated with heparin to promote flow of aqueous and reduce the risk of blockage. Your surgeon will confirm the position of the iStent inject® and its patency at your post-operative visit.

BLACK YELLOW MAGENTA CYAN

HOW DOES TRABECULAR MICRO-BYPASS SURGERY WORK? Trabecular micro-bypass surgery with iStent inject® involves implanting two small surgical-grade titanium stents to bypass the trabecular meshwork, the area of greatest resistance to aqueous humor outflow and increase drainage through Schlemm’s canal, thus lowering intraocular pressure. iStent inject surgery has an excellent safety profile and is usually performed under local anaesthesia. The surgery is very elegantly combined with, and has a safety profile similar to, cataract surgery. iStent inject® might be an alternate to eyedrops for those patients unable to tolerate or use drops adequately at the time of cataract surgery. Following surgery, many patients find it improves their quality of life with a large number needing fewer eye drops or none at all, whilst at the same time controlling their glaucoma progression.

For more information iStent inject® and Trabecular micro-bypass surgery, go to www.glaukos.com/en-uk

91OPTDEC20162.pgs 02.12.2020 16:27

BBO

IN PRACTICE VERSION

BECOMING A BUSINESS OWNER REPRO OP SUBS

“This year has highlighted the importance of having a support system” Two practice owners speak about the challenges of 2020, and offer their advice for those just starting out

ART

ELLIS LEATHERBARROW, Cooper and Leatherbarrow, North Yorkshire and County Durham PRODUCTION CLIENT

Cooper and Leatherbarrow has been a family business throughout the generations, which makes working here even more special.

The original business was established in 1902 by Ernest Cooper and became Cooper and Leatherbarrow Opticians after my grandfather joined him in 1913. My father took the reins in the late 1950s, and then I became the managing director in 1996 after joining in 1981.

The pandemic has brought home the value of having a diverse practice. There were many practices across the country that were closed or working remotely, but we actually stayed open with our Darlington and Richmond practices staffed but with a locked-door

policy. As part of our local Minor Eye Care Service (MECS) scheme we were getting patients sent by local GPs, NHS 111, and ophthalmology.

Because of the reputation we have established over the years, we were kept quite busy. As our normal function of sight testing and dispensing spectacles was basically suspended for three months, all of the above actually helped to keep the business ticking over during that challenging period.

Having a diverse practice was hugely beneficial during that time, as you can reallocate manpower and resources as necessary.

This year has also highlighted the importance of having a support system.

As a solo independent, actually having the whole support from the back-office team at Hakim Group has

been a huge benefit. Having that effective and collective backing, as well as having access to individuals to bounce ideas off, and who can throw ideas back at you is extremely useful.

This year has really reinforced that.

My main words of advice for anyone becoming a business owner, especially following this year, is to be prepared for the unexpected.

ADAM MATTHEWS, Matthews Opticians and Hearing Care, Cornwall

Being an independent has meant that we can excel at providing better customer service and quality products, and spend more time with patients. In Cornwall, I think patients connect really well with the idea of being independent, as they like to shop local.

That was demonstrated after the initial lockdown, as we have been tremendously busy. I think there has been a shift in focus to support small businesses.

Prior to furlough being introduced and before the first lockdown, there was a lot of uncertainty. Clinics just dropped off a cliff, especially as so many of our patients are over 60 and were shielding. Very quickly, I had to adapt to think about the longevity of the business, which was not something I’d ever really had to think about before.

It meant I had to have more challenging conversations, regarding staffing and HR. We had

to look closely at new guidelines, and make sure we were finding the right sources of information.

That meant there was a requirement for a lot more communication, so those skills have certainly had to be honed. Understandably, everyone was concerned, with worries about finance and safety. I’ve learned a lot about reaching conclusions that satisfy staff, the business and everyone involved.

What has been reaffirmed during this time is my belief that patients value the experience on the High Street. I think that’s been proven this year as opticians are still going strong through lockdown, especially at a time when other businesses on the High Street are really struggling.

That’s obviously testament to the fact that people still want to come back for the quality service and the professional advice.

The challenge that I have faced, and that a lot of business owners will face, is of how to balance creating a warm and welcoming environment in a postCOVID world, where the High Street experience – of PPE, social distancing and having your temperature checked – is harsh. I think we’ve overcome that well here. That should definitely be a priority for any new business owner.

Get in touch Share your practice ownership journey with OT. Email lucymiller@optometry.co.uk

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WIHL

IN PRACTICE VERSION

too sure how we would get on working together, but so far it has been great. The fact that there is always someone there to share decisions and problem solve with is a big bonus. I think our patients and staff quite enjoy the husband and wife banter.

WHAT I HAVE LEARNED

REPRO OP SUBS

“Local services are more important than ever” Husband and wife team at Baird Optometrists, Andrew and Fiona Baird, on pursuing their dream of opening their second practice

ART

What will the changes of COVID-19 mean for the High Street?

AB: It is the perfect time for

You opened your first practice in 2011, during a recession. What did the experience teach you?

Andrew Baird (AB):

PRODUCTION CLIENT

Recession or not, opening your first business is a huge learning curve. You learn to ask questions and get used to feeling stupid. It takes time and patience to build from nothing and there were days when I would panic about being quiet. I wouldn’t say I have learned not to panic, but I am more accepting that there are ups and downs – and sometimes it is worth enjoying the quiet times because you will miss them when you are rushed off your feet.

What made you open your new practice despite the challenges of COVID-19?

AB: I have been keen to

open a second practice for a few years and we had been looking for the right opportunity. Lockdown gave us time to discuss our options and we felt more confident in our decision.

Yes, COVID-19 will make life more difficult, but eye care isn’t going to become any less important. We feel our role will grow as we pick up the overflow from secondary care services.

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local independent opticians to attract commuters who are no longer travelling into the cities. In our Callander practice, we have seen a significant increase in new patients since lockdown.

With more people working from home, local services are more important than ever.

On the downside, with restaurants closed, there is less footfall on the High Street, which has a negative impact on us.

As a new practice, you want people to notice that you are there. Despite the challenges that we’ve faced, there is a big opportunity for independent practices like ours to make a good recovery post COVID-19, but we need to focus on showing our new patients what we are capable of and ensuring we see them returning for years to come.

“There is something special about seeing your name on a High Street you walked up and down growing up”

Why did you decide to offer tele-ophthalmology?

AB: We signed up to

tele-ophthalmology at the end of 2019. We used this while working in the local emergency eye care treatment centre and have built stronger relationships with the Falkirk Eye Clinic.

We see tele-ophthalmology as an essential piece of kit for the new practice.

Treating patients in the community is going to be increasingly important as we move forward, and we see this as the obvious way to achieve this.

What made you open your second practice this year?

Fiona Baird (FB): After

working part-time while bringing up our sons, I had started to look at pushing myself professionally and exploring new challenges.

When COVID-19 hit, it threw me out of my comfort zone and made me realise you only get one shot at life.

Knowing how passionate we are about optometry and patient care, it seemed like the logical next step. In a strange way, I think it was COVID-19 that pushed us to just go for it.

How does it feel to run the business as a team?

FB: Andrew and I have

always complemented each other’s strengths. I wasn’t

What have you learned about owning a practice in the years since the Callander site opened?

FB: Be yourself, value your

staff, value every patient and enjoy your work. The rest will follow.

How will the new practice utilise technology?

FB: The fact that we did a

shop fit from the bare walls out meant that we could ensure all the necessary data points were exactly where we needed them.

Having a great practice software system in XeyeX means that we are paperfree and efficient from day one. Investing in the latest technology from Topcon also gives us the best start on providing the most advanced tests.

What are you looking forward to in establishing the Dunblane practice?

FB: Being the best clinician

and employer that I can be.

There is something special about seeing your name on a business in a High Street that you walked up and down hundreds of times growing up. After loving being a wife, mum, and dog walker for over a decade, I can’t wait to show my boys what else I am capable of.

Get in touch Share your career journey with OT. Email kimberleyyoung@ optometry.co.uk

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The future

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From deserted city centres, to the rise of home working and online sales, the pandemic has changed how people work, socialise and shop. At the close of a year that no one saw coming, OT looks ahead at what might be to come for the economic pulse of UK communities December 2020/January 2021

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he glittery festive decorations are the same, the jingles serenading shoppers come from an unchanged playlist and the flavours of the seasonal hot drinks continue to reliably mimic the smell of a spice cupboard being tidied.

But the UK High Street reflected in shop windows this December will be markedly changed from this time last year, when COVID-19 was limited to a handful of reported cases in China.

Masks, socially distanced queues and hand sanitising stations have all become as much of the Christmas shopping experience as garish knitwear. Much uncertainty remains about what shape the High Street will take in 2021, with the growth of online sales and many workers shopping closer to where they live – leaving traditionally buzzing urban centres quiet.

London architect and Mayor’s Design Advocate, Holly Lewis, highlighted that traditionally there was a worry about the underperformance of smaller centres.

“That has completely flipped. All of those bigger centres where people once came together to compare prices for items such as clothes and electronics – they are now all empty,” she emphasised.

ADAPTING & FLEXING While the impact on local business from COVID-19 and Government measures to control it has been dramatic, Ms Lewis is quick to point out that throughout history High Streets have had to adapt to changing circumstances – from the introduction of shopping centres to the growth of online sales.

“High Streets are constantly adapting and flexing. That is what is good about them. The format is equipped to respond well to the things that are going on in the neighbourhood around them. I am sure that will continue,” she said.

The change in working lifestyles 60 www.optometry.co.uk

creates opportunities for smaller High Streets to serve populations working from home.

Ms Lewis observed that businesses that are able to provide services that are specific to the local community are the ones that will thrive.

“One of the things that we have always felt about High Streets in our architect practice is that they HOLLY LEWIS need to be really highly tailored to their individual locality. What “There is value is brilliant about them is that they can completely respond to the in the baker community and the demographic knowing your that is living around them,” she name if you are shared. a lonely older With a growth in online sales following the March lockdown, person or the will the High Street of the future guy in the news be located within the neat tiles of kiosk being a computer keyboard? Ms Lewis able to give emphasised that the social aspects of High Streets are often undervalued, directions to with research showing that up to half someone who of people in these locations are not is lost” there to go shopping.

“They are there to meet friends, conducted online – more than double to go to work, to catch transport or the pre-pandemic level of online nonto go out for a walk and be in the food sales, which was 30% for April hubbub of other people,” she shared.

2019. By August, as stores began to “There is value in the baker open, the share of non-food online knowing your name if you are a sales had dropped to 40%. lonely older person or the guy in “We think it is going to stabilise the news kiosk being able to give at around 40% for the year, which directions to someone who is lost. means a 10-percentage point All of those things are difficult to increase. It is a much bigger increase put into graphs and spread sheets than we think would have happened but they are an important aspect of if the pandemic did not occur,” Dr what High Streets offer,” Ms Lewis Danila observed. emphasised.

A second retail trend observed British Retail Consortium following the pandemic was the economist, Dr Liliana Danila, told polarisation of sales. Electronics, OT that many of the patterns being DIY and furniture sales experienced observed following the outbreak a surge in sales to the extent where of COVID-19 are an acceleration of some businesses could not keep up existing trends. with demand, while other retailers “They are now happening at a saw a steep drop off in purchases. much faster pace than we would “People have spent a lot on the have thought. In particular, online comfort of their own house but they sales have grown much faster than spent very little on expected,” she said. some categories, such For example, at the as clothing, jewelry height of the UKand beauty. The wide lockdown in pandemic has split April, 69.9% of nonretail into a sector food sales were

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of two stories,” Dr Danila shared.

She added that the wider economic impact of the pandemic in the UK will affect household spending.

“There might be quite a significant increase in unemployment which will have an impact on spend, especially spend on non-essential goods,” Dr Danila said.

CHANGING HABITS The fact that people could only purchase certain products online in April and May has also prompted a change in spending habits. Some consumers picked up an enduring online grocery shopping routine while others made their very first online purchases.

“There were people who had never bought online, especially in the older demographic. Once they realised that it is quite a convenient way to purchase certain goods, they will stick to those patterns,” Dr Danila highlighted.

The shift to online sales has resulted in an increasing number of businesses offering an enhanced in-store experience. From barber shops with a barista to sports stores that use virtual reality to simulate a

Optics on the Ground: views from Scotland's High Streets Colin Pettinger Practice locations: Inverness, Golspie and Dingwall "Whilst the retail sector has bounced back fairly well, hospitality and tourism are a mainstay of the Highland economy and they have been decimated by lockdown and ongoing restrictions. Lower numbers of national and international tourists are apparent and the older members of the local population remain cautious about venturing into public areas in the context of the current rising number of cases. Because the hospitality sector is so dominant here, the knockon effects of lockdown can be felt even in community optometry.

Proprietors of guest houses and bed and breakfast establishments would often book eye examinations in the autumn and indulge in a healthy retail spend following a successful season. This year, many such patients consider themselves fortunate if they remain in business at all; some delaying updating their spectacles for reasons of financial hardship, or even delaying booking at all."

Michael O’Kane Practice location: Edinburgh "Unfortunately, there have been a lot of closures on the High Street.

I don’t think it’s sunk into the public mindset as much as the 2008 crash did. It feels like there’s more businesses going under now than did back then. To add to this, Edinburgh city council have expanded the pavements to allow more social distancing, but a side effect of this is to remove on-street parking which has affected a lot of neighbouring business. I’m sorry to say that I think many High Street businesses will struggle and what would be considered luxuries might not have a secure future. Most people have become more accustomed to online shopping and many people like to look in-person at a product but will often go home and buy online. That buying behaviour isn’t going keep these brick and mortar businesses that are acting as showrooms open."

Ian Morris Practice location: Wick "There has been an increasing number of tourists in the area, which is where a lot of the High Street make their money. There is a delicate balancing act between welcoming the extra trade and local fear of the possibility that tourists coming from areas with higher virus numbers may bring the virus and spread it in the remote location. A big change is the town post office closing which has caused uproar locally. A mobile service has been introduced and they are looking for a new postmaster or postmistress to take over."

Alistair Duff Practice location: Ayrshire "So far, our High Street has had minimal shop closures due to our practices being located in market towns. People seem to be shopping locally more than before so it’s quite often we see a socially distanced queue outside the butcher or the bakers. This is great to see; the community supporting local independent shops. With many officebased workers working from home, we have seen a rise in them attending during the week rather than Saturdays or our late night."

DR LILIANA DANILA

To read the full reflections of OT's On the Ground contributors online, visit www.aop.org.uk/ot/in-practice/practitioner-stories

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mountain top for those trying on ski gear, businesses are coaxing customers away from their homes with added services.

“A decade ago, people would go to different stores to browse and then they might buy something. These days, people will go to a store to pick up something that they know the store has. Not only are we buying more online, but the purpose of the store visit has changed,” Dr Danila observed.

Within this changing dynamic, Dr Danila shares the example of an electronics shop where no transactions are made but customers can try out the latest product releases.

While this shift was occurring before the pandemic, Dr Danila highlighted that a unique trend has been the rise of locally-focused retail.

“We have seen that stores in highly dense neighborhoods have done better during the pandemic than before because people spend more time locally. Some retailers have started capitalising on this,” she said.

For example, Dunelm launched a series of stores in a smaller format featuring products that are the most popular in that particular area.

Hotel Chocolat launched its first

PROFESSOR SARAH HALL

outlet store with a 100-space car park for those who are hesitant about taking public transport, and Pret a Manger launched a hot drink subscription scheme.

Primark, which does not have an online presence, has focused on showing that stores are safe.

In addition to sanitising stations and dividers at the tills, they have installed more tills to eliminate queues.

RETAIL ROULETTE Dr Danila emphasised that the pandemic has prompted “resilience, innovation and very fast change” among businesses.

“It is a guessing game for retailers right now. It sounds good to say, ‘We are going to have experiential retail,’ but when it comes to the practical side of things, there are so many avenues that retailers can go down.

Which one is going to be successful is really trial and error,” she observed.

Dr Danila predicts that the shift in working patterns will be a trend that outlasts the immediate impact of the pandemic. Like Ms Lewis, Dr Danila highlighted the social and community value of High Streets.

“It appears that there is an increasing awareness about the fact that some stores are at the risk of disappearing,” she said.

Aside from the pandemic, High Street businesses are also grappling with the implications of Brexit when the transition period ends on 31 December.

Professor of Economic Geography at the University of Nottingham, Sarah Hall, has argued for more attention to be paid to the High Street when observing the economic impact of leaving the EU. “Often economists talk at the national level or maybe the

“London has dominated our economy from at least the 1980s onwards. It is quite striking when you look at the growth of suburban commuter belts as opposed to city centres” 62 www.optometry.co.uk

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regional level – they say the hit to the UK economy from Brexit might be this. What you really need to understand is how that affects existing local economies. They are the economies we interact with,” she highlighted.

“If you go to your local High Street and you see more stores shut, that immediately tells you something about what is going on in the economy in a way that, if you read in a newspaper that GDP was down 9%, that doesn’t feel so real.”

She observed that sections of the High Street that rely on migrant labour may face challenges following the end of the transition period.

“Quite a lot of the High Street relies on relatively low paid work – particularly the hospitality sector.

They wouldn’t be able to attract migrant labour to come and do that work if the salary was below the proposed threshold of £25,600 per annum,” Professor Hall added.

While this may not directly affect optometry practices, it could result in a drop in footfall.

Professor Hall described the shift in people shopping closer to home as a “distinctive trend” following the pandemic.

“London has dominated our economy from at least the 1980s onwards. It is quite striking when you look at the growth of suburban commuter belts as opposed to city centres,” she said.

As well as fewer people commuting to the city for office jobs, people have also linked the trend to perceptions of safety. Professor Hall believes that office workers will continue to follow a blended pattern of working, moving forward from the pandemic.

“I don’t think we will stay working completely online but neither do I think we are likely to see the wholesale return to offices. That is crucial for the High Street,” she said.

If the shift in retail activity to smaller centres continues, Professor Hall highlighted that this may influence decisions about where to locate optometry practices.

THE VIEW FROM PRACTICE Optical professionals from across the UK describe how local businesses are faring – and share their predictions for the future of the High Street

W

hen independent prescribing optometrist, Dr John Gurney, travelled to a UK conference in February, people were talking over tea and biscuits about an unusual condition emerging from China.

The Aylesford-based practitioner told OT that he was not too concerned at the time.

“Everybody thought it might be like SARS or the bird flu, which petered out. How wrong we were,” Dr Gurney said.

Eight months later in October, it has become second nature for Dr Gurney to wear a mask and a visor and, in the interests of safety, patients are turned away if they turn up early for an appointment.

“Before COVID, we might have made them a cup of tea while they were sitting there. It’s a shame because that was a nice thing, but it is no good sitting there having a nice chit-chat and then finding out they have ended up in hospital on a ventilator,” Dr Gurney said.

Every High Street in the UK has felt the ramifications of the pandemic. The drop in footfall has created a significant challenge for the traditional business model underpinning optometry, with social distancing limiting the number of patients who can be seen.

Some practices in smaller centres and market towns have seen a boost in trade with customers working from home and supporting local businesses.

Dr Gurney told OT that his practice had a backlog of routine appointments following the March lockdown.

“There seems to be pent up demand. Sales have increased in terms of the average spend but there are fewer people coming through the practice,” he said.

The Acute Primary Care Ophthalmology Service (APCOS) that Dr Gurney is involved in has experienced an increase in demand following the pandemic, with accident and emergency departments signposting patients with eye problems to APCOS. The service is also helping to ease the burden on secondary care by helping to manage patients with wet age-related macular degeneration.

“Before the pandemic, if you stood in a hospital wet AMD clinic there would be a hundred people sitting in the waiting room crammed together.

You can’t do that now but all these patients still have to be seen. If they are seen in a community setting like ours, it is a lot safer than seeing them in a hospital,” Dr Gurney emphasised.

A silver lining of the processes brought in following the outbreak of COVID-19 is that Dr Gurney has not caught a single cold. In a normal year, seeing patients all day and with his children at school, he might catch five or six.

“The hygiene processes are stricter and patients don’t come in if they have a cough or a temperature. I wouldn’t have any problem with wearing a mask while dealing with patients until the end of my career,” he shared.

Head of business development at the Hakim Group, Luke Wren, told OT that most practices within the group are

“We remain positive and absolutely believe that COVID won't be with us forever. We want to make sure the steps we take today set us up well for a stronger future” Luke Wren

booked up “well into the future” with social distancing limiting the number of daily appointments that can be offered. However, among the patients who do come through the practice, there is an intent to buy.

“Average order values are a lot higher, showing that generally people have got money to spend due to reduced mobility within the general population. Sales of multiple pairs, spare pair sales and sunglasses sales are all up, so all the usual trends we track are positive,” he said.

Mr Wren noted that while footfall had dropped across all sectors, city centres are finding the situation more challenging than smaller towns.

“People’s shopping behaviour has changed in the sense that they are staying more local, as opposed to travelling into busy city centres.”

In terms of remaining profitable during the pandemic, many Hakim Group practices are investing in the digital experiences of patients.

Mr Wren highlighted that there were three different approaches that could be taken by the business in response to the pandemic – to do nothing, to scale back spending,

LUKE WREN

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or to invest in practices, people and technology despite the uncertainty.

The Hakim Group ultimately chose the latter.

“We remain positive and absolutely believe that COVID won't be with us forever. We want to make sure the steps we take today set us up well for a stronger future,” Mr Wren said.

Chief executive of Leightons Opticians, Ryan Leighton, told OT that he has noticed a shift in shoppers supporting local independent businesses with an uptick in the number of new customers visiting his practice.

He has also noticed that customers seem to have more spending power with average transaction values rising.

“Clearly this pandemic has been a test for all businesses and all sectors, and I'm mindful that our sector is more resilient than others,” he said.

CLIENT

“It wouldn’t be unusual for people pre-lockdown to use services such as an opticians close to their office, which they could visit during their lunchbreak or after work.

But now people are staying closer to home” Royston Bayfield

“From a business performance perspective, I am very satisfied with our recovery so far,” Mr Leighton added. The focus for Leightons Opticians over the coming months is developing the patient experience, providing training and support to teams and investing in new clinical equipment as well as practice re-fits.

Mr Leighton also acknowledged the impact of the increasing influence of online retail.

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“Whilst serving our patients with the highest levels of clinical care and quality in practice, we also need to be able to provide the convenience and added-value service from a connected omnichannel experience,” he said.

Founder and chief executive of Bayfields Opticians and Audiologists, Royston Bayfield, highlighted that the High Street has evolved significantly over the past decade.

“The current COVID-19 pandemic with its associated lockdowns and restrictions has accelerated changes as people have had to adapt the way they live, work, shop and socialise,” he said.

The company’s 20 practices across the UK are based in towns, with practices benefitting from shifting working patterns resulting in more people working from home during the week.

“It wouldn’t be unusual for people pre-lockdown to use services such as an opticians close to their office, which they could visit during their lunchbreak or after work. But now people are staying closer to home,” Mr Bayfield shared.

He added that there are opportunities for practices located in smaller centres.

“It’s expected that a lot of employers will continue to encourage their teams to work remotely for some or most of the time after the pandemic, so I think we’ll see smaller towns thrive as they support their local communities,” Mr Bayfield said.

Following the pandemic, there have been practical changes in some of the towns that Bayfields practices are located in, with roads becoming pedestrianised, pavements made larger, one-way routes introduced for walking around, and parking fees reduced or waived.

Working beside councils and local government, businesses have a role to play in making sure that consumers feel safe when visiting the town centre, Mr Bayfield emphasised.“Consumers want

more reassurance now when they’re visiting the High Street, and I expect a lot of the new ways of operating will continue into the future,” he elaborated.

“Whether it’s businesses highlighting their health and safety procedures, or town centres being more accommodating to pedestrians and cyclists, there are some positives we can take which will improve people’s experiences overall of visiting their local High Street,” Mr Bayfield observed.

The OutsideClinic, which employs 80 domiciliary optometrists across England, Scotland and Wales, has seen demand increase for its services following the pandemic.

“Many vulnerable patients who have previously chosen to be taken to High Street practices by relatives or friends are now electing to be seen at home in order to reduce potential exposure,” director of professional services, Nick Wingate, highlighted.

Speaking with OT as Northern Ireland entered lockdown in October, optometrist Sam Baird highlighted that the closure of hotels, pubs and restaurants looked set to empty the streets around his practices in Glengormley, Dundonald, Dromore, and Lisburn.

“Confidence amongst patients about the whole COVID-19 situation is low with job insecurity and social isolation being the commonest concerns shared by patients,” Mr Baird said.

“Regarding our own business prospects, we are confident the service we provide is very much needed and we do have a future.

However, uncertainty is the dominant feature in our contingency planning,” he highlighted.

Mr Baird emphasised that the end of the Brexit transition period brought an “extra paperwork nightmare” for optometry practices in Northern Ireland.

“We have to give customs a list of all our UK mainland suppliers in advance of Brexit,” he said.

“Never has there been so much paperwork for little or no return.”

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Education and training for the eye care practitioner

December 2020/ January 2021

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In this issue

Light for sight, page 72

66/ The visual challenges associated with driving Howard Collins BSc (Hons), MCOptom, Paul Hopkins BSc (Hons), MCOptom, Professor Leon Davies PhD, FCOptom, FAAO, SFHEA

CLIENT

72/ Light for sight

David Elks BSc (Hons), MCOptom

77/ Scleral lenses: dealing with a game-changer Francesco Viviano MSc

82/ 21st century low vision care: apps and accessibility

Dr Michael Crossland PhD, MCOptom, DipRVI

88/ Measurement devices for dispensing Jim Cox FBDO

90/ Visual fields in neuro-ophthalmic disease Dr Daniel Epshtein OD, FAAO

Course code: C-76336

Course code: C-76471

Course code: C-76501

Course code: C-76564

Course code: C-76290

“For the practitioner, the most useful aspect of the path of light energy from the light to the eye is the illuminance. It is easily measured with a light meter sometimes called a lux meter, as illuminance (the amount of light falling on an area) is measured in lux.

When measuring with a light meter it needs to be placed on the surface the patient is looking at, being careful not to cast a shadow on the meter as this will produce quite marked errors.”

David Elks

Course code: C-76296

Competency tracker In this edition of OT, practitioners can test a range of competencies:

Optometrists Dispensing opticians Contact lens opticians CET exams in this edition are available online from 12 December 2020

Scleral lenses: dealing with a game-changer, page 77 “One hot topic in scleral lenses (SLs) research is the possibility that their use may lead to an increase in intraocular pressure (IOP). Evidence appears to be equivocal with several studies showing that an IOP increase arises from SL use, while others conclude that no difference occurs between pre-wear IOP measurements with post-wear measurements.

Further investigation is needed to better address the effects of SL wear.”

Francesco Viviano

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The visual challenges associated with driving Howard Collins BSc (Hons), MCOptom, Paul Hopkins BSc (Hons), MCOptom and Professor Leon Davies PhD, FCOptom, FAAO, SFHEA

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This article explores the visual challenges that patients face when driving in suboptimal conditions and outlines potential solutions.

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Introduction

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Driving is by far the most popular means of transport in the UK1 and for many people is essential in maintaining independence and improving quality of life.2,3 Data from the Driver and Vehicle Licensing Agency (DVLA) (Great Britain) and the Driver and Vehicle Agency (DVA) (Northern Ireland) show that there are around 42.2 million licence holders in the UK,4,5 although this may not accurately reflect the amount of active drivers.

The DVLA suggest that more robust figures can be found in the National Travel Survey detailing patterns of travel in England,1 which show that 75% of the population aged 17 years and over hold a driving licence.

Applied across the UK,6 there are likely to be around 39.6 million licence holders of which the vast majority will be actively driving.

Drivers in the UK must meet the minimum eyesight requirements put in place by the DVLA/DVA summarised in Table 1.7 It is incumbent upon eye care professionals to be familiar with these standards so that they can properly advise patients about corrective eyewear, reporting ocular/medical conditions to the DVLA or if necessary, driving cessation.

Obtaining or renewing a Group 1 (standard car) licence does not require an eye examination, with the onus on the individual to report any ocular or medical conditions that may affect their fitness to drive. For some common eye problems, for example, cataract, the DVLA need not be informed provided vision standards are still met. Other conditions, such as glaucoma, macular degeneration and diabetic retinopathy, do not require notification if only one eye is affected, though progression to the second eye does require notification regardless of disease severity or visual capability. In addition, health conditions such as sudden onset dizziness and vertigo, which may be

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presenting symptoms in an eye examination, require the DVLA to be notified and cessation of driving until the symptoms are controlled. A full list of ocular and health conditions which may impact fitness to drive is available from the DVLA.8 While the driving standards set out the legal requirements, the visual challenges that drivers face are more complex in the real world. Numerous factors may affect visual acuity (VA), and a person’s ability to ‘see’ differs depending on the environment they are in. Driving is visually and cognitively demanding and becomes more problematic when conditions are not optimal.9–11 In this article we look at some of the challenges that drivers experience and the possible solutions. This is not an exhaustive list, and the key is to identify the specific issues affecting your patient in order to advise them appropriately.

Driving challenges

Low illumination Night driving is a challenging task and a disproportionate amount (approximately 42%) of fatal accidents occur in the hours of darkness12 despite only 25% of driven miles being undertaken in the same period.13 Although the reasons for the elevation in fatalities are likely to be multifactorial, including alcohol consumption14–16 and fatigue,14,17 visual factors play a major role in night driving accident statistics.15,18,19 Most night driving takes place under conditions of mesopic illumination20 (0.01–3 cd/m2) where contrast sensitivity (CS) and VA are both reduced,21–23 and pupil enlargement causes blur through reduced depth of focus,24 increased high-order aberrations25 or interference from media opacities.26,27 CS is particularly important; although studies have shown that it is a better predictor of night driving performance and accident involvement than photopic VA,28,29 it is rarely measured during routine eye examinations.30 For older drivers, issues of low illumination may be compounded by the natural age related decline in CS,31,32 accompanied by increased prevalence of cataract33,34 and glaucoma,35,36 which can

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Table 1 Summary of the current UK vision driving standards Licence type

Visual acuity

Visual fields

Group 1 Standard car and motorcycle licence

Number plate made after 1 Sept 2001 at 20m and binocular VA of 6/12 (0.5) (with correction if needed)

At least 120° horizontal with at least 50° left and right.

No significant defect within 20° of fixation above or below horizontal (Esterman field test)

Group 2 Bus and lorry drivers

VA at least 6/7.5 (0.8) in the better eye, at least 6/60 (0.1) in the worse eye.

Spectacles may be used, power no greater than +8D in any meridian of either lens. No limit for contact lenses

At least 160° uninterrupted on the horizontal plane. Extension at least 70° right and left. Extension at least 30° above and below horizontal.

No significant defect within 70° left and right or within 30° above and below horizontal. No defect present within central 30° radius

both negatively affect CS.37,38 There is good evidence to suggest that cataract surgery improves CS28,39 and reduces the subsequent risk of accident involvement.40,41 This is important as patients may present with ‘real world’ visual problems that are not apparent from conventional acuity measures, as good VA does not necessarily translate to good CS in the presence of even mild ocular pathology.37,38,42–44 Low CS in a symptomatic patient with good VA may help make the case for early cataract extraction and, therefore, its measurement can be beneficial as an addition to the routine eye examination of such patients.

Night myopia Night myopia is a temporary phenomenon caused by the tonic or resting level of accommodation shifting towards myopia under conditions of darkness in the absence of a visual cue.20,45 It has been suggested that a modified refraction may be of benefit for night driving46 and some lens manufacturers incorporate extra minus into their night driving lenses. However, this approach is potentially problematic for a number of reasons: 1 Accommodation naturally varies even in consistent levels of darkness47 and lighting conditions are unlikely to remain constant across an entire journey20

Other requirements

No other impairment of visual function.

No glare sensitivity, contrast sensitivity loss or impairment of twilight vision

2 Levels of night myopia vary significantly between patients45,48,49 3 UK road luminance levels generally fall within the mid to high mesopic range,50 (even when lit by headlights alone),51 where accommodation fluctuations are comparable to those under photopic illumination.45,48 It may, therefore, be preferable to explore other strategies for improving night-time vision, for example, through wavefront guided refraction and appropriate lens and coating choices, as detailed later in this article.

Glare Another visual challenge for drivers arises from glare and dazzle (see Figure 1, page 68), either through low sun during the day, or from car headlights at night. Glare can be described as causing discomfort or disability, although both issues may be present simultaneously. Discomfort glare usually occurs due to very bright light sources and describes the subjective experience of an individual. It may not impact visual performance but can cause headaches and eyestrain, particularly after prolonged exposure, and may influence driving behaviour.52 However, disability glare does impact visual performance, generally manifesting

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Dispensing & driving

VERSION REPRO OP

with the figure of 46% from a 2014 survey.74 Visual correction to meet the challenges of driving can be provided both with spectacles and contact lenses.

However, unfortunately many drivers choose not to wear such correction for driving, even though it improves their vision.75 Among the reasons given by patients for this potentially dangerous disconnect include not feeling comfortable in their spectacles and unclear guidance regarding wearing visual correction for driving.75 This highlights three important factors: 1. The need for optometrists to ask pertinent questions during the case history regarding driving and the use of visual correction 2. Clarity of advice to the patient regarding wearing correction for driving. An uncorrected VA of 6/12 is the

Figure 1

SUBS ART

Figure 1 Example night driving scene showing glare from headlights

The most common driving and vision challenge for optometrists is providing suitable correction for patients to meet driving standards. Estimates show that 74% of the population wear vision correction or have had refractive surgery to improve their vision.66 Using this information alongside data on refractive error prevalence and its effects on vision,67–73 the authors suggest approximately 49% of drivers are likely to require visual correction to meet the driving standard, which is largely in agreement

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Object point at infinity Object point at infinity

CLIENT

Meeting the challenge

Figure 2

Object point at infinity

PRODUCTION

as a reduction in CS (even though VA may remain unaffected)53 which can significantly impact driving performance.52,54–56 Disability glare can arise both from the sun during the day and at night from headlights. Glare from the sun is obviously dependent on time of day and ambient weather conditions, but has great potential to impact road safety.55,57 For night driving, xenon high intensity discharge (HID) and light-emitting diode (LED) headlamps, which are brighter and provide more road illumination compared to tungsten-halogen lamps,58,59 can positively affect driver performance.29 However, the increased brightness also leads to elevated levels of discomfort and disability glare for other drivers.58,60,61 Importantly, the effects of glare disproportionately affect older drivers.62 Recent analysis of road collision data for the UK showed that drivers over 60 years of age were twice as likely to have headlight or sunlight dazzle as contributing factors to road traffic accidents.63 This largely stems from increased light scatter due to ocular media changes, either through natural ageing64,65 or cataract.28,37,39 Therefore, it is particularly important to recommend visual correction solutions with the capacity to reduce glare for these patients.

Exam room vision

Pupil blocks highorder aberrations

A Refraction affected by high-order aberrations Low-light vision

B

High-order aberration modification

Refraction optimised for high-order aberrations

Figure 2 Effect of pupil size and correction optimised for high-order aberrations on the retinal image

C

CET

Figure 3

night driving vision.

Further enhancements to vision come from freeform lenses which allow individual lens customisation77 and can offer subjective Standard PAL design Example driving PAL design improvements in vision Yellow: required clear area Larger distance and intermediate to spectacle wearers,78 for driving zones to meet the visual challenge potentially improving of driving Red: areas of surface astigmatism visual performance for affecting clear vision both single vision (SV) lenses and progressive addition lenses (PALs).

Figure 3 PAL designs to meet the specific challenges of driving Regardless of the minimum standard of vision for driving and patients type of lens, patients must be advised of the need should be advised of the potential risks of driving for adaptation to a new prescription prior to driving, without correction, particularly at night75 particularly at night. Any refractive or spectacle lens 3. The need for good advice and careful selection of changes can lead to perceived distortions, image frames and lenses in order to encourage compliance movement and dizziness, all of which could affect safe with spectacle wear and driving with optimum vision. driving. Even if a patient’s refractive change does not The first step in optimising visual performance when warrant new spectacles, it is important to examine their driving is to ensure that the refraction is accurate and up lenses for signs of wear and tear, as scratched lenses to date. may reduce VA79 and can produce disability glare through light scatter; this has important implications Advances in refraction technology involve the use of for night driving80 and patients should, therefore, be wavefront aberrometers, in conjunction with a standard advised accordingly. subjective refraction. The concept is to generate a more accurate prescription which compensates for highLens choices order aberrations induced by variation in pupil size, The choice of lenses for driving is particularly important thus providing optimal vision across a wider range as gaze continually shifts between the road, signposts, of luminance levels (see Figure 2). A recent study of spectacle lenses made using such technology showed mirrors and car instrumentation.10,81 Maintaining clarity across as much of the lens as possible is, therefore, vital subjective improvements in vision under low light for driver comfort and safety. levels,76 which may translate to improvements in Table 2 Data from BS EN ISO 12312-1:2013+A1:2015 showing the categorisation of sunglass filters82 Filter category

Description

Range of luminance transmittance in the visible spectral range

Driving suitability

0 1

Clear or very light tint

From over 80% to 100%

Light tint

From over 43% to 80%

2

Medium tint

From over 18% to 43%

3

Dark tint

From over 8% to 18%

Suitable for road use and driving* *Sunglass filters with a luminous transmittance of less than 75% should not be used for driving in twilight or at night

4

Very dark tint

From over 3% to 8%

Not suitable for driving at any time of the day

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VERSION REPRO OP

Figure 4

SUBS ART

Figure 4 Different colour temperatures of LED, and halogen headlights when compared side by side

PRODUCTION CLIENT

For presbyopes, lens manufacturers have developed PALs to meet the specific visual challenges of driving.

These lenses are often designed to enable optimal peripheral vision and comfortable vision while viewing a vehicle’s instrumentation binnacles, by adopting wide distance and intermediate zones (see Figure 3). However, if these designs neglect to optimise the spectacle near zone, patients may encounter visual problems when reading day to day. As such, it is important that any spectacle appliance designed for driving also ensures that reading performance is not impaired.

Tints for glare Many people wear some form of tinted lens to combat glare. However, tints for driving need to conform to certain standards82 and cannot be too dark (see Table 2). Category 4 lenses are not suitable for driving at any time of the day and so care must be taken that prescription lenses are not tinted too deeply, or that patients purchasing category 4 sunglasses, for example, for skiing, are advised against driving in them. The same British Standard also specifies that for driving in twilight or at night, tinted lenses must have a luminance transmission of at least 75% and this is particularly pertinent in relation to the ready availability of so called ‘night driving’ spectacles.

These are usually yellow tinted lenses, which claim to improve contrast and reduce glare when driving at night. However, a recent study using commercially available night driving spectacles showed that yellow tinted lenses do not benefit drivers for object recognition at night in the presence or absence of headlight glare.83 The use of any tint in lenses will reduce the amount of light that is able to reach the eye and reduced luminance can have a negative impact on driver performance.19 Advice from the College of Optometrists,84 ABDO85 and also the Highway

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Code86 recommends having no tints on lenses for night driving, but both the College of Optometrists and ABDO recommend the use of anti-reflective (AR) coatings to reduce headlight glare.84,85 For daytime driving, tinted lenses can prove very useful in cutting down sun glare and the College of Optometrists recommend that drivers keep a pair in the car for use when needed.87 Tinted lenses are available in a number of different designs which have their own benefits and limitations.

Standard solid tints are relatively cheap for patients and provide useful protection against discomfort glare.88 However, a graduated tint may allow a clearer view of the dashboard and instrumentation.

Light reflected from wet roads, car windscreens and even buildings can be a source of disability glare. Much of this reflected light is polarised along a particular plane – that is to say, horizontally for horizontal surfaces such as a road. Polarised lenses have their filters oriented vertically to cut out horizontally polarised light and are, therefore, the only lenses that reduce disability glare and dazzle, while also providing relief from brightness discomfort. They have also been shown to improve CS and reaction times in daylight driving conditions, which may have particular relevance for drivers with cataracts.89 One potential issue with polarised lenses may arise from in-car digital displays using an LCD screen, as these devices can appear dim or black due to their use of linear polarised filters. Newer devices are attempting to negate this problem through the use of more advanced screen technologies.

As these types of tinted lenses are generally additional to a clear pair of spectacles, some patients may opt for photochromic lenses as an ‘all-in-one’ solution. However, car windscreens absorb UV light and patients should be advised (regardless of the manufacturer’s photochromic design) that the lenses will not go as dark in the car as they do outside and as such a solid tint may be a better option for driving.

Anti-reflective coatings for driving AR coatings reduce glare by decreasing light scatter from the spectacle lenses themselves. They have particular relevance to night driving as they have been shown to reduce symptoms of glare90,91 and improve objective measures of CS in the presence of glare.92,93 AR coatings have developed significantly since their invention in 1935 by Olexander Smakula while working for ZEISS and recent designs aim to provide superior anti-glare performance for driving at night. This has largely been necessitated by the popularity of xenon

CET

About the authors n Howard Collins is an optometrist with over 15 years’ clinical experience. He has worked in high street practice and has delivered clinical teaching for the optometry degree programmes at both Bradford and Aston Universities. He is currently in the final stages of writing up his PhD thesis at Bradford University while working on a collaborative research project with Aston University and ZEISS Vision Care. n Paul Hopkins is an optometrist and professional services manager at Carl Zeiss Vision UK, Ltd. After

HID and LED headlamps which, relative to halogen headlamps, have increased brightness alongside a spectral transmission that is shifted towards the blue end of the visible light spectrum (see Figure 4). This higher level of short-wavelength light may increase discomfort glare for other drivers,60,94–96 possibly due to increased photophobia97 or scatter98 for light in this part of the spectrum. In order to minimise the effects of discomfort glare from these types of headlamps, an AR coating which actively attenuates the transmission of shorter wavelength light while maintaining transmission across the rest of the spectrum is required, and some lens manufacturers include this on their driving specific lenses.

Conclusion

Driving is an important part of life for millions and improves quality of life, particularly for older people.

Recent advances in lens and coating designs mean that eye care practitioners are well placed to provide solutions for some of the most common visual problems reported by drivers which can lead to driving cessation.

Careful selection of lenses alongside improved refractive techniques mean that spectacles can be manufactured to provide optimal visual performance for driving both in the day and at night by reducing glare and improving VA and CS. An important part of increasing compliance with spectacle wear is clarity in the advice that optometrists provide to patients by emphasising the importance of optimal vision for driving, even if they meet the minimum standard for vision without correction.

Taken together, these measures should instil greater patient confidence in their eyewear, thus improving spectacle wear compliance, and enabling patients to maintain their independence while reducing their risk of accidents.

achieving a DipHE with distinction in ophthalmic dispensing with management from Bradford College, Paul graduated from the University of Bradford in 2005 with a degree in optometry. n Leon Davies is professor of optometry and physiological optics and head of the school of optometry at Aston University. He is a liveryman of the Worshipful Company of Spectacle Makers, editor-in-chief of Optometry in Practice and vice president of the College of Optometrists.

Exam questions and references

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

This CET will expire on the 28 December 2020 for points to be allocated to the current year of the cycle. It will reopen on 1 January 2021 and expire on 5 March 2021 for those that want points allocated in 2021. 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 ‘MyGOC’ on 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.

Course code: C-76336 Deadline: 28 December 2020 / 5 March 2021

Learning objectives n Be able to provide appropriate advice on coatings and tints to mitigate the visual challenges faced by drivers (Group 4.1.5) n Recognise the visual challenges that patients face when driving in suboptimal conditions and be able to outline potential solutions (Group 4.1.4)

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Dispensing & driving

VERSION

Light for sight

REPRO OP

David Elks BSc (Hons), MCOptom SUBS

This article discusses lighting in the home and how it relates to the performance measured in practice – and includes a methodology for assessment in a domiciliary environment along with ideas on how to improve illumination.

ART

Understanding the terminology

Optometrists Dispensing opticians

PRODUCTION

Introduction

CLIENT

In practice, there are some situations where improved lighting is the only easy way to increase visibility. Dry age-related macular degeneration (AMD), untreatable cataract, corneal opacities and even multifocal contact lenses are all cases where improving the illumination on an object can raise the visual acuity (VA) to an adequate level, for example, the difference between seeing N5 and N8.

Optometrists and low vision practitioners are in a unique position to comment on how to use light to improve vision by changing different aspects of lighting.

However, in order to make informed changes to lighting, a basic understanding of lighting terminology and photometry is important.

Figure 1

1

CET

POINT

A common area of confusion is that the part of the light fitting producing the light is called a ‘lamp’ by lighting engineers, but it is commonly called a bulb by the layperson. ‘Luminaire’ is the technical term given to what is commonly called a lamp shade.

The path of light from a light source into an eye is defined in photometry by a series of specific terms.

Unfortunately, in common English these terms are used interchangeably so in order to interpret the data given for lamps we need to understand the meaning.

In photometry, different terms are used for the various aspects of the path of the photons of light from the light source to the observer’s eye (see Figure 1):1 Luminous intensity describes the path of light and defines the amount of light produced by a light source in candelas The luminous intensity of the source that is transmitted in one direction is termed luminous flux and measured in lumens The amount of luminous flux that shines on an area is called the illuminance measured in lux The illuminance level on the object viewed by a standard eye after being reflected off the surface is called luminance and is measured in nits.

Assessing the environment Luminance

Luminous intensity Luminous flux

Illuminance

Figure 1 Photometry terminology related to a real scene

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For the practitioner, the most useful of these aspects of the path of light energy from the light to the eye is the illuminance. It is easily measured with a light meter sometimes called a lux meter, as illuminance (the amount of light falling on an area) is measured in lux. When measuring with a light meter it needs to be placed on the surface the patient is looking at, being careful not to cast a shadow on the meter as this will produce quite marked errors.

Light meters can be purchased online or an app can be downloaded on a mobile phone. While these apps may lack accuracy, they are good enough to measure relative improvements, for example, those made by placing a reading light closer to the page.

A code for illuminating engineers has lists of the

Table 1 Standard services illumination measured at 85cm above the floor

the number of lights in a room, lighting engineers look at the décor and size of the room as well as the service illuminance. When a house is new, the lighting will correspond with the SSI; however, over time things often change, for example, replacing a fluorescent tube with an array of spotlights producing the same luminous flux. This spotlight array produces more shadow, which in a kitchen will result in obvious problems, especially for the visually impaired and is a situation worth considering when changing lamp types.

Room

Lux

Office

500

Consulting rooms

300

Test chart near

500

Lounge

150

Stairs

150

Kitchen

300

Examination couch hospital

1000

Making changes

Operating theatre table

10,000

One limitation to the SSI is that a 60-year-old patient needs three times more light than a 20-year-old.4 Therefore, many patients over 60 years of age who have no ocular pathology will need more light than provided by standard house lighting design. Those who are 65 years or older may need 450–600 lux for tasks where a 40-year-old requires only 300-500 lux.2 The points below show how we can improve the illuminance: Changing the décor of the room by lightening the walls and ceiling will improve the luminance received by the eye and improve visibility Moving the light closer by using a reading light or localised task lighting. We all remember that the inverse square law means that halving the distance the light is from the object increases the illuminance by four times. But the inverse square law applies to point sources, that is to say, if the distance from the source is less than 10 times the diameter of the source, it does not apply.1 Nevertheless, moving a 5cm diameter light close to the page to under 50cm still improves the lighting level. Table 2 shows the illuminance of a 60W general lighting source (GLS) at varying distances Changing the lamp (light bulb) for one that has greater efficacy (see Table 3, page 75).5–7 The greater efficacy of light emitting diode (LED) lamps compared to incandescent ones means that for the same wattage a light fitting will produce more light with an LED lamp compared to an incandescent

Table 2 Illuminance levels for a 60W General Lighting Service (GLS) lamp (nominal 800 lumen output) at different heights Height (cm)

Lux

140

30

120

50

100

80

80

120

60

210

40

390

20

1200

illuminance levels required for various situations;2,3 these are called Standard Service Illuminances (SSI).

Some useful ones are given in Table 1 taken as being on a surface 85cm above the floor. Taking the measurement on a surface above the floor negates problems with lamps in the ceiling being at different heights above the surface. If we just looked at a lamp’s luminous intensity in lumens to predict the amount of light on a surface it would need to allow for the ceiling height every time.

In doing this, we would in effect be calculating the illuminance in any case. SSI are regarded to be adequate for a 40-year-old with ‘normal’ eyesight.3 To calculate

CET

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CET 2

Low vision

VERSION REPRO OP SUBS ART PRODUCTION CLIENT

one. To decide what is Figure 2 the most appropriate lamp to use, a knowledge of different lamp characteristics is required. These are detailed in Tables 3 and 4 (page 78) and illustrated in Figure 2.

Figure 2 shows how the components of lamps have changed over time, from A B C D E F G a GLS to the latest LEDs. An LED E is shown with Compact LED LED the cover removed to show Incandescent Latest LED fluorescents (no cover) pearl the elements. Most lamps Tungsten halogen have an option to have a frosted outer cover or # 60W 32W 14W 14W 10W 10W 7W pearl appearance like LED F. Pearl bulbs help reduce # Watts to give 800 lumens approx reflections and hence glare.

As we are only changing Figure 2 Evolution of different lamp types the lamp and all the other is reflected light or glare from lights on the edge of the factors are the same, the luminous flux delivered from a visual field. Luminaries (lampshades) can cut down glare. set light fitting is proportional to the illuminance on the For glare outdoors, a hat with a brim and/or sunglasses task. For example, to increase the illumination from 50 lux are effective. This strategy can also be used indoors as a produced by a 60W GLS to 100 lux we could use a 100W last resort if the patient is facing a window or glare source GLS or a 64W tungsten halogen lamp (see Table 3).

More efficient lights can change the appearance of and refuses to change the layout of the room, although colours in a room even though when viewing the light, it the tint will of course reduce the luminance the eye looks ‘white’; this can make a room feel colder or warmer receives. Other options are vertical blinds which can be than it was originally. The way a lamp shows colours is angled to mask some of the glare from the window. specified in two ways: Routine for indoor lighting assessment ‘Colour appearance’ specified by the correlated colour In some areas, community low vision aid (LVA) schemes temperature (CCT). This is the temperature a standard can include a visit to the patient’s home who is referred light source (a theoretical one called a black body to the scheme. The three Bs is a helpful approach when radiator) would be to give the same colour as the light. assisting patients with low vision. The first two Bs, Up to 3300K is classified as ‘warm,’ 3300K to 5300K as ‘bigger’ and ‘bolder,’ are assessed in clinic with the ‘intermediate’ and over 5300K as ‘cool.’ Many lamps potential maximised using LVAs, a careful refraction and with high efficacy tend to give a colder feeling to a reading of black-on-white text. The third B, ‘brighter,’ room ‘Colour rendering’ is the ability the light gives to an can be checked in the patient’s own environment. From observer to identify colours correctly and is rated by a the clinic measurements we can establish what level of colour rendering index (CRI). These values are graded vision the LVA should provide in optimum conditions. by the Chartered Institution of Building Services The aim of the domiciliary visit is to ensure the optimum Engineers (CIBSE) where 1 is best, 1A and 1B are good, vision level is achieved in the home. A generic check list grade 2 is moderate, grade 3 is poor and typically used of the steps that can be taken to assess a patient’s lighting in store areas and Grade 4 is often monochromatic like provision in their home is given below: sodium yellow streetlights (see Table 4).2,3 1 On the patient’s doorstep use a light meter to take a It is important to remember that increasing the reading in lux of the illumination on a clipboard at 85– illumination on the task can cause glare, especially if there 100cm off the ground. Also record a description of the

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sky, for example, overcast, rainy, blue sky, night-time, as this gives an indication as to how much glare or light is provided by windows in the lighting results that are recorded inside the house later 2 In the house, analyse the room in which the patient uses their LVA and make a sketch noting the direction the windows are facing using a magnetic compass. Note the position of light fittings and type of lamps. A good tip to help analyse the types is to look at the reflection of the light in the surface of your watch or trial case prism as this cuts down the glare.

Holding the watch or prism above a light means you can analyse the lamps in an uplighter without having to stand on a chair. Ask the patient to use their LVA and measure the illumination on the work surface where they are using it. Finally, note where the client is sitting in the room in relation to all the lighting. Using the data obtained from this part of the assessment helps to address the following aspects in turn: The direction a window is facing matters as the sun moves in an arc from the east to the south and on to set in the west; this means that a window can be a glare source at different times of the day so advising the patient on where to sit in the room and when is relevant. Also, it can be used to decide if vertical blinds are a worthwhile investment The illumination on a work surface for a partially sighted patient needs to be 500 to 1000 lux.1 To increase the lighting to 1000 lux on the work surface, localised lighting is the best method as this helps to control the glare that these light levels can produce. It is almost impossible to achieve 1000 lux by upgrading ceiling lighting because of the inverse square law. However, daylight on a bright day might achieve as much as 1500 lux.

Fortunately, LVAs with internal lights easily solve the problem of poor light levels, so are a good idea if a domiciliary assessment is not possible

CET

Do bear in mind that spectacles with a high addition will need a reading light or light from a window to be most effective. To increase the background lighting illumination to the order of 300 to 500 lux on the work surface, old incandescent lamps might need to be changed for compact fluorescents or energy saving bulbs. As such lamps produce more light per watt than a GLS, this enables us to fit higher light output lamps and still draw less power from the light fitting than that needed for the original lamp. For example, a light fitting taking a 60W incandescent bulb could be replaced with a 150W equivalent energy saving bulb drawing about 20W. Remember that too much light shining can cause glare so often 100 to 300 lux is sufficient from general lighting with localised lighting used to bring up the level to 500 to 1000 lux Consider if getting the patient to change the chair they sit in, or in extreme cases, changing the room lay out will improve the lighting level on their work area 3 Next, take a look at the kitchen. This is often a place where LVAs are not as useful except for looking at dials. So, it is important to try to improve lighting and contrast – for example, using white chopping boards on a black work top can improve the overall reflectance of the kitchen. The fashion in modern kitchens is for multiple small lamps either as tungsten halogen or LED spotlights and this creates lots of shadows. The shadows they produce on work tops are often a problem. To check this, place a pen upright in a lump of Blu Tack on the worktop and then count the shadows off the pen. This gives a good idea of modelling and highlights the problem to the patient. To remove the shadows, localised lighting can be used either under cupboards or by using a portable daylight lamp on the work top. In extreme cases suggesting a fluorescent tube to be fitted in the kitchen is the best solution. In kitchens that already

Table 3 Showing the equivalent power of common incandescent lamps to other types Lamp type

GLS

Tungsten halogen

Compact fluorescent

Light emitting diode (LED)

60W equivalent minimum 800 lumen

60W

32W

14W

10W

75W equivalent minimum 1100 lumen

75W

44W

19W

15W

100W equivalent minimum 1600 lumen

100W

64W

26W

19W

150W equivalent minimum 2400 lumen

150W

96W

41W

26W

200W equivalent minimum 3100 lumen

200W

124W

62W

30W

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CET 2

Low vision

CET 2 VERSION REPRO OP

Table 4 Showing general lamp data GLS

Tungsten halogen

Low pressure mercury lamp (fluorescent)

Compact fluorescent

LED

Efficacy = Lumens/watt

14–18L/W

25L/W

65–110L/W

46–75L/W

100L/W

Power output range

40–2000W

30–2000W

20–125W

9–32W

3–15W

Colour appearance Correlated colour temperature (CCT)

Warm 2700k

Warm 2900k

Warm-cool 27,000–6500k

Warm-cool 2700–6500k

Warm-cool 2700–7000k

Colour rendering groups Colour rendering index CRI

1 90–100

1 90-100

1–3 75–95

1 90

1B 85–90

Lamp life Relative lifespan versus GLS

1000–2000 hours

2000–4000 hours 2

15,000–20,000 hours 20

6000–15,000 hours 15

10,000-25,000 hours 25

SUBS

Lamp type

ART PRODUCTION CLIENT

have fluorescent tubes do remember that the brightness of fluorescent tubes drops off dramatically (after about 15000 hours), which is long before they stop working, so changing tubes that are over eight years old is a good idea. Visible grey bands at the ends of the tube are a sign they need changing 4 Lastly, check the staircase. Older energy saving lights can take a long time to ‘warm up’ and should be changed to lamps which give full light output straight away, for example, LEDs. Ensuring there are no trip hazards is also essential. Putting marks on the skirting board to highlight where a step is rather than putting tape on the step itself is a sensible suggestion.

Conclusion

There are a few final points to consider. Having access to a light meter is not essential – if the room looks dull to you, then from experience, it is dull. Likewise, if you forget to take a compass, then ask the patient where and when the sun shines into the room. Remember that north-facing windows do not get direct sun very often and hence these rooms are often duller. Lastly, do remind patients they may need to put the lights on even during the day.

Exam questions and references

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

This CET will expire on the 28 December 2020 for points to be allocated to the current year of the cycle. It will reopen on 1 January 2021 and expire on 5 March 2021 for those that want points allocated in 2021. You will be unable to submit exams after this date.

76 www.optometry.co.uk

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 ‘MyGOC’ on the GOC website (www.optical.org) to confirm your points.

About the author n David Elks graduated from Bradford University in 1984 with a BSc (Hons) in ophthalmic optics. He has an interest in low vision and has worked as a community optometrist since 1990.

Course code: C-76471 Deadline: 28 December 2020 / 5 March 2021

Learning objectives n Be able to undertake a lighting assessment as part of visual task analysis (Group 4.1.4) n Be able to assess patients with impaired visual function and advise on improving lighting and managing sources of glare (Group 7.1.5) n Be able to undertake a lighting assessment as part of visual task analysis (Group 4.2.1) n Be able to assess patients with impaired visual function and advise on improving lighting and managing sources of glare (Group 6.3.2)

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91OPTDEC20141.pgs 01.12.2020 11:02

CET

VERSION

Scleral lenses: dealing with a game-changer

REPRO OP

1

CET

Francesco Viviano MSc

POINT

SUBS

In this CET article, scientific evidence will be combined with clinical experience in order to outline best practice when fitting scleral contact lenses.

ART

Optometrists Dispensing opticians

PRODUCTION

Dispensing opticians

Introduction

CLIENT

Since the late 1880s, when the first scleral lens (SL) saw the light thanks to Müller, Fick and Kalt, there have been numerous improvements in the field of large-diameter contact lenses (CLs).1,2 Earlier SLs were characterised by poor reproducibility and made of oxygen-impermeable materials, such as glass and polymethylmethacrylate (PMMA).1,2 Those two factors, combined with the advent of soft CLs in 1959, relegated SLs to the shelf at the end of the 1970s.1,2 A turning point for SLs was the advent of rigid gas-permeable (RGP) materials, first introduced in 1983 by Donald Ezekiel.3 More recently, the new information obtained about the anterior scleral shape,4–7 improvements in SL manufacturing8 and the recent introduction of RGP materials with more than 200Dk units, have led to a renewed interest in SLs.2,4,8–10 In a recent survey, SL modality correction represented about 28% of the entire RGP market, a two percent increase on 201910 and a five percent increase on 2018.11

Scleral lenses: who, when, why?

SLs are large-diameter RGP CLs designed to completely vault the cornea and limbus while resting entirely on the conjunctiva overlying the sclera.4,12 In 2013, the Scleral Lens Education Society (SLS) introduced an internationally recognised SL classification and nomenclature based on the area of bearing on the ocular surface (OS).12,13 As a result, SLs are defined as mini-scleral CLs if they are up to 6mm larger than the horizontal visible iris diameter (HVID) and large

scleral CLs if they are more than 6mm larger than the HVID.12,13 Fadel et al reported 62 indications for SL wear14 and, among them, the most common ones are irregular corneas (74%) and OS diseases (16%).15 Furthermore, the use of SLs reduce the need for corneal transplant by 73% in severe keratoconus16 and significantly improves vision-related quality of life in patients with this condition.17 SLs have unique features such as trapping a fluid reservoir between its back surface and the anterior surface of the eye, a defined central post-lens tear thickness (PoLTT) that allows easy masking of irregular astigmatism as well as keeping the OS protected and continuously hydrated.4 In addition, the crisp vision provided by the wide optical zone typical of SLs can lead to a dramatic improvement in corrected vision, especially when fitting irregular corneas.4 The large total diameter (TD) of SLs ensures they stay both centred and stable on the eye and the fact they land only on the sclera, which is less sensitive than the cornea,18 allows for extremely comfortable lens wear.4 Although SL also have disadvantages, such as high cost and manipulation difficulties due to their large size (the main reason for SL dropout),17,19 these specialty lenses are often a game-changer for patients who use them.

Preliminary considerations

SL fitting can be performed using a slit lamp, a diagnostic SL fitting set, along with a trial frame and loose lenses or a phoropter.4 The majority of SLs are fitted using the trial-and-error method and rely on the use of diagnostic SL fitting sets.4 Other options, such as empirical fitting or impression moulding techniques can also be used for SL fitting4 where the latter method should be adopted especially in extreme cases of deformed eyes or severe irregular scleral profile.

SL use in patients with low endothelial cell density (ECD) should be carefully addressed.14 A minimal numerical ECD of 400–700 cells/mm2 is considered necessary for maintaining both corneal health and

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Figure 1

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Figure 1 Evaluation of PoLTT through a slit lamp optic section that shows an ideal pre-settling condition CLIENT

transparency and lower ECD values could lead to corneal oedema, and as such, is an important contraindication to their use.14 Particular attention should be given to patients who have undergone corneal transplantation because these compromised corneas require close monitoring for signs of neovascularisation, corneal hypoxia or transplant rejection.14 The use of hyper-Dk RGP materials, reducing wearing times, and allowing more tear exchange by adding fenestration holes or scleral channels to the lens should be considered when fitting these patients with SLs.4,14 One hot topic in SL research is the possibility that their use may lead to an increase in intraocular pressure (IOP).20 Evidence appears to be equivocal with several studies showing that an IOP increase arises from SL use21–23 while others conclude that no difference occurs between pre-wear and post-wear IOP measurements.24 Further investigations are needed in order to better address the effects of SL wear on IOP, especially when fitting patients that are at risk of glaucoma.25

Let’s start vaulting

In order to proceed with fitting, the first step is to define the TD of the initial trial SL;4,26,27 this is generally taken to be 4 to 5mm larger than the HVID.28 Accurate HVID measurements can be obtained through the use of handheld rulers or by using the corneal topographer’s caliper tool.29

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After selecting the TD of the trial SL, its depth should be defined. SL depth is often described in terms of sagittal height (SH) rather than radius of curvature.4 The SH refers to the distance from the chord midpoint (TD) to the central curvature of the SL.30 In order to form a fluid reservoir between the SL and the cornea, the SL must have a greater SH than the eye on which it will be applied.4,13 It is possible to obtain information regarding the SH of the eye through use of scleral topographers31,32 or anterior segment optical coherence tomography (AS-OCT) instruments.33 Most corneal topographers are able to provide corneal SH measurements at a chord value of 10mm, to which the desired amount of PoLTT and an extra amount of 2000µm, defined as sag factor, can be added in order to allow the eye care practitioner (ECP) to obtain a prediction of the SH required for a 15mm trial SL.34 If it is necessary to use a SL with a TD different to 15mm, 400µm must be subtracted or added to the calculated SH for every 1mm of reduction or increase in SL size, respectively.35 Once both TD and SH values of the first trial SL have been defined, it comes the time to apply the lens on the eye; this can be achieved by using a large plunger or the three-finger approach, where the middle finger, index finger and thumb are used to create a tripod stand for SL application.36 Prior to the insertion of the SL, its concave portion must be filled with non-preserved saline solution and the patient should be instructed to lower their head so that the face is parallel to the floor.36,37 Adding sodium fluorescein (NaFl) into the saline reservoir before the insertion of the SL will allow the ECP to better visualise the PoLTT during the assessment of the fit.4 At this point, the practitioner needs to hold both the upper and lower lids wide open and slowly bring the SL close to the eye until it is correctly inserted.36 It must always be checked that no air bubbles are present under the SL, and if seen, the lens should be removed and the process repeated.4 A small plunger is often used for SL removal.36 Finally, it must be made clear that, when handling CLs, the use of tap water should be strictly avoided37 and that closed-eye SL wear appears to be clinically unsafe.38

The cornerstones of a good SL fit As a general rule, three fundamental aspects must be assessed during SL fitting: apical clearance; limbal clearance; and scleral landing zone.4,26 It is suggested to use the ‘inside-out’ method, in other words, to evaluate SL fitting by analysing the apical clearance first and then assess other areas of the SL until reaching the periphery.39

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PoLTT will be reduced by 29% after eight hours of SL wear50 and this phenomenon mainly occurs during the first four hours.51 Despite a significant change in PoLTT, no statistically significant changes occur in refractive correction after SL settlement.52 After SL settling occurs, the optimal PoLTT should not be less than 100μm53 and not exceed 200µm40 over the most elevated portion of the cornea and it should be as symmetric as possible in order to avoid areas Figure 2 Symmetrical SL placed over an eye with significant scleral toricity of excessive clearance in peripheral regions of the The apical clearance optical zone.4 In order to improve PoLTT shape, some SL designs can modify their BOZR without altering After applying the SL to the eye, allow it to settle for 20 SLs’ SH: flattening/steepening the BOZR by 0.5mm to 30 minutes before proceeding with the apical clearance will increase/decrease the peripheral PoLTT (around assessment.4 Estimation of the central PoLTT can be performed using AS-OCT40 or with a slit lamp beam by 4.5 to 5mm from the centre of the SL) by about 100µm. using a narrow optic section of white light.4,39 If using the It must be remembered that changing the BOZR of the slit lamp method, the known central SL thickness (or the SL requires the lens BVP to be modified according to one of the cornea) should be compared with the central the well-known FAP-SAM rule (flat add plus/steep PoLTT by placing the light beam at an angle of 45° with add minus). respect to the slit lamp observation system. By doing this, the central PoLTT should be equal to the central SL The limbal clearance thickness (see Figure 1).4,39 As with apical clearance, the limbal clearance can be Excessive amounts of PoLTT can induce hypoxic assessed in the same manner.4,26,39 It is important to avoid compression of the limbal stem cells because complications,39,42 impair SL stability43 and reduce both visual acuity (VA) and comfort during SL wear.44 A low they are responsible for maintaining the integrity of the PoLTT can compromise ocular integrity by causing corneal epithelium and preventing the migration corneal and/or limbal touch and/or stain.45 of conjunctival epithelial cells onto the corneal Midday fogging is a common SL complication that surface.54 46 Optimal post-settling limbal clearance is considered is defined as the cloudiness or haziness of the PoLTT to fall between 50µm55 and 100µm.4 Excessive limbal and occurs in 20% to 33% of SL wearers.47 The PoLTT is clearance can pull perilimbal conjunctival tissue significantly associated with the presence of post-lens between the SL and the corneal limbus (conjunctival tear film fogging: Postnikoff et al reported that for every prolapse).55,56 Furthermore, inserting the SL with too 50um PoLTT increase, there are 2.24 times higher odds of 48 much force can create suction forces under the lens and experiencing midday fogging.

It must be considered that the PoLTT will be reduced increase prolapse risk;56 this condition will not cause short-term serious complications and can be fixed by during SL wear compared to the initial measurement lowering the limbal clearance55,56 and/or by revisiting because of the SL settling phenomenon as the SL landing the patient’s SL handling.56 zone sinks into the soft conjunctival tissue.49 As a result, Figure 2

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Figure 3

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Figure 3 Steep scleral landing zone that is causing conjunctival blanching

When evaluating limbal clearance, if areas of limbal touch greater than 180° are present, a modification of the limbal zone is mandatory. If these areas are less than 180°, ask the patient look in the opposite direction from the zone that presents limbal touch, that is to say, the patient should look in the temporal direction if a limbal touch is noticed on the nasal side. By doing this, if the touch disappears, the limbal clearance is adequate and no geometric modifications of the SL are needed; however, if touch is still present then the SL must be modified. If in doubt, check for post-settling limbal conjunctival staining in these limbal zones after SL removal and, if this occurs, increase SL limbal clearance by at least 50µm or try to increase SL TD. The landing zone Just like the cornea, the sclera can also exhibit flat (most elevated) and curved (less elevated) meridians, and this can be easily detected by using cobalt blue light and sodium fluorescein and a symmetrical SL over an eye that presents scleral toricity.57 This SL will cause blanching of the conjunctival vessels along the flattest meridian of the sclera, while the tear exchange should be appreciated under the edge of the landing zone of the SL over the steepest meridian of the sclera (see Figure 2).58 When evaluating SL alignment, the use of lissamine

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green would be preferred over sodium fluorescein because it provides better contrast over the white sclera.58 DeNaeyer et al revealed that a spherical scleral shape is only present in 5.7% of cases while a regular toric scleral shape pattern is present in 28.6% with an asymmetrical scleral shape being the most common (40.7%).7 In the latter case, quadrant specific SL designs are needed in order to obtain proper alignment of the SL landing zone to the scleral profile.59 The scleral landing zone must be analysed in the primary gaze position and along nasal, temporal, superior and inferior quadrants.4,26,39 If an edge lift arises in one of these four scleral zones, it can be fixed by steepening the landing zone of the SL. On the other hand, if compression of the conjunctival blood vessels occurs (see Figure 3), the scleral portion of the SL must be flattened.4,26,39,55 Consider increasing SL size if there is a very large area of bearing on the landing zone in order to better distribute the weight of the SL across the sclera, but keep in mind that the larger the lens, the greater the amount of scleral toricity that needs to be corrected.6 Focal elevation along the scleral portion of the SL can be overcome in different ways, such as TD reduction, notching of the SL edge, adding a small vaulting area to accommodate the obstacle, or by performing an

impression of the eye in order to obtain an extremely customised SL.60 An inadequately aligned SL will decentre downwards and this may lead to redness and limbal congestion; the PoLTT will look like a base-down prism and the inferior edge of the SL may dig in to the conjunctiva.45 In this case, if pushing the lens up leads to a more symmetrical PoLTT shape, the remedy may be to increase the toricity of the scleral landing zone by steepening the vertical meridian of the SL. If edge lift is noticed all along one meridian, it is recommended to try a SL with a toric periphery of approximately 100/150µm and then moving in 100µm steps if required. When a SL with a toric periphery is on the eye, note the lens markings and then rotate the lens with the fingers; if it rotates back into place this means that there is scleral toricity and that using a SL with toric periphery is the right choice.59

One last step: over-refraction

Once apical clearance, limbal clearance and scleral landing zone have been determined, the fit should be considered almost done and an overrefraction must be performed.4 In order to aid the patient’s VA throughout the SL settling period, it is possible to apply a soft CL (with a power near to that noted during over-refraction) over the top of the diagnostic SL;61 this will allow the patient to see properly while the SL settles on the eye or could be useful to let the patient try out monovision.

If an astigmatic correction is needed, a SL with a front toric option should be used but lens flexure should be assessed first by performing keratometry or topography over the SL while the patient is wearing it. The presence of toricity (with defined steep and flat meridians) on the front surface of the SL of >0.50D having a flat axis corresponding to the axis of the over-refraction indicates SL flexure. This lens flexure could be reduced by increasing SL central thickness or by using a SL with a toric periphery, in order to decrease SL pressure along the meridian of flexure.4,39,55

A good fit is half the battle

After SL dispensing, a proper aftercare schedule must be defined and it is recommended to have a minimum follow-up period for this specialty lens fitting at one week, after one month, and then every six months.

During each follow-up visit, post-settling apical clearance must always be checked without removing the lenses and then ocular surface integrity must be assessed upon lens removal with any complications addressed accordingly.4,26,39

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Conclusion

Fitting SLs can be rewarding for both the ECP and their patients. Taking on specialty CL fitting allows the ECP to diversify their skill set and offer a broader range of solutions to solve more challenging clinical cases in practice.

Exam questions and references

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

This CET will expire on the 28 December 2020 for points to be allocated to the current year of the cycle. It will reopen on 1 January 2021 and expire on 5 March 2021 for those that want points allocated in 2021. 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 ‘MyGOC’ on 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.

About the author n Francesco Viviano obtained his bachelor’s degree in optometry and optics at Roma Tre University in 2014 and completed a master’s degree in optometry and vision at Complutense University of Madrid in 2018. Mr Viviano currently works as a professional services consultant at Medlac Srl. His primary interests include specialty contact lenses, keratoconus and myopia control.

Course code: C-76501 Deadline: 28 December 2020 / 5 March 2021

Learning objectives n Be aware of the indications for, and the steps that need to be taken, to successfully fit scleral contact lenses (Group 5.3.3) n Be aware of the indications for, and the steps that need to be taken, to successfully fit scleral contact lenses (Group 5.1.2) n Be aware of the indications for, and the steps that need to be taken, to successfully fit scleral contact lenses (Group 5.1.2)

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21st century low vision care: apps and accessibility

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Dr Michael Crossland PhD, MCOptom, DipRVI SUBS

This article gives an overview of some of the accessibility options and apps used by people with vision impairment to make their lives easier.

ART

Optometrists Dispensing opticians

PRODUCTION

Introduction

CLIENT

Karen is a 38-year-old woman with low vision from congenital glaucoma. When she was at school she had to sit at the front of the class and use spectacle-mounted telescopes to see the board. She had heavy, large print textbooks and had to go to the school library to use a video magnifier. She was prescribed an assortment of low vision aids but admits she didn’t use them in school and thinks her education suffered because of this.

Her son, Max, is 14 years old. He also has low vision from congenital glaucoma. However, he can sit anywhere in the classroom, accesses the whiteboard and textbooks on an iPad, and uses his smartphone to magnify things when he goes out with friends.

This article summarises some of the developments in technology which enable Max to see more easily than Karen could when she was a teenager.

iPads and tablet computers iPads and other tablet computers have bright, highcontrast screens and are light enough to hold at a close working distance. Text can be enlarged and made bolder through the settings menu (under ‘Accessibility’ on Apple and Android devices, and ‘Ease of Access’ on Windows tablets). Text contrast can be reversed so it is white against a black background thereby reducing glare; this particularly helps people with photophobia or media opacity,1 but can also assist those with other causes of low vision. On Apple devices, ‘smart invert’ allows text contrast to be reversed without affecting the colour of images, and an ‘accessibility shortcut’ can be set up so that triple-clicking the home button quickly turns VoiceOver, Zoom, or Inverted Colours on and off.

Electronic textbooks can be obtained through the RNIB

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Bookshare service;2 this provides electronic versions of textbooks, which can be viewed on screen or printed in any font size and format. To stop every student receiving free textbooks, this service is limited to people who are visually impaired, or who have certain physical or learning disabilities. Reading books can be downloaded through the Kindle app or other providers. All libraries in the UK now have electronic and audio books available for download, using a platform such as Libby or Overdrive.

Older books which are out of copyright can be legally downloaded free of charge at Project Gutenberg.3 People with central field loss or very limited visual fields sometimes find scrolled text easier to read.4 MDevReader is an iPad only app, which scrolls writing across the screen at variable speeds.5 A fixation marker can be added to help people use ‘steady eye strategy.’6 This app was funded by the Macular Society and is free to download. The same group has developed a website called EV news, which displays news and email in the same way.7 At school, anything shown on an interactive whiteboard can be displayed on an iPad or other tablet using a screen sharing app such as TeamViewer or Splashtop; this will usually be arranged by the qualified teacher of children and young people with visual impairment (QTVI). Many students receive lesson slides in advance so they can follow along on their own laptop or tablet. Tablets can also be used in music lessons where enlarged music can be shown on the screen and a Bluetooth foot pedal can advance the pages.

In a 2014 study by the author, 132 people with visual impairment were asked how they accessed their electronic devices.8 Text-to-speech (VoiceOver on Apple devices, TalkBack on Android) was used by nearly half of those with low vision and by 96% of those who had no sight. As well as ‘speaking’ any words on the screen, these systems allow the touchscreen to be navigated without sight. When text-to-speech is activated, users need to double tap an icon to open an app. After one tap the device will say what has been touched and a double tap will confirm this action. It takes some time to get used to this technique, but experienced users can access their

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can be activated to highlight where the pointer is when the control key is pressed (Control panel>Mouse properties>Pointer options). On a Mac computer, the mouse pointer is made larger by quickly shaking the mouse, or dragging the trackpad left and right a few times.

Some people with visual impairment use voice-control on their computer to dictate text messages and emails, either by using Siri or Google Assistant or speech recognition software such as Dragon; others prefer typing. Touch typing is a useful skill for people with low vision and this is usually taught to children with visual impairment at school.

Many people manage with builtin accessibility options, but some features are only available when using additional software. For example, ZoomText will present text in any Figure 1 Vision-related accessibility settings on an Apple iPhone (left) combination of colours and will scroll and an Android phone (right). Image courtesy of Marcello Leucci text along the bottom of the screen.

Screen reading software such as JAWS devices extremely quickly with these systems. It was and SuperNova allow a greater variety of voice types assumed that the 4% of blind users surveyed who didn’t and speeds. They can also read with more detail, such as use text-to-speech used a refreshable Braille display, announcing every punctuation mark and capital letter. which consists of pins which rise and fall to present text Smartphones, smart homes in Braille.

Figure 1

Desktops and laptops On Windows computers, text can be quickly enlarged by pressing the control key and scrolling the mouse wheel. For extended work, Windows Magnifier can enlarge either the entire screen or a small portion of it and can be set up in the control panel under ‘Ease of access.’ VoiceOver works on a Mac computer in the same way as on an iPad, and the Windows equivalent is called Narrator. To help find the mouse pointer, it can be enlarged in Windows settings, and a shortcut

and other devices

Accessibility features are built into all smartphones and can be customised through the device settings (see Figure 1).

Synapptic is an operating system which can be installed on Android phones and tablets and provides a simple accessible interface using text-to-speech and large print, high contrast icons. Phones and tablets can be bought with Synapptic preinstalled or it can be downloaded onto existing devices.

Many people with visual impairment use ‘smart

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Figure 2

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Figure 2 Magnifier apps: reading a best before date with iPhone magnifier (left); setting a cooker dial with Super Vision+ (right)

home’ devices such as Google Home, Amazon Alexa, and Apple HomePod to access the Internet, to play music or radio stations and to control their television, room lights, or heating system.9 Audio description of television programmes is available through set-top boxes and on Netflix, Amazon Fire TV, and Apple TV. Some people like to read large print on an electronic ink display like the Amazon Kindle, although this display has lower contrast than a tablet computer or smartphone.10 The author’s research showed that electronic readers are more popular with older people with visual impairment.8

Apps In the author’s 2014 study, people were asked what apps they used on their smartphones and tablets.

Obviously, people with low vision use similar apps as those without visual impairment such as Facebook, BBC, Google, weather and podcast apps. However, some apps are particularly useful for people with visual impairment. iPhones have a built-in magnifier app (quickly switched on with the accessibility shortcut) which uses the camera to enlarge distance or near objects, with up to about 10x magnification. In the study, 51% of people

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with low vision reported using their phone camera in this way for ‘spot’ tasks such as train departure boards, price labels, best before dates and street names. As Max points out: ‘Nobody looks twice at me using my phone to zoom in - they all just think I’m taking a selfie!’ The LED camera flash on a phone can be used as a torch in dim environments.

If people dislike the magnifier app built into their device, there are many others which can be downloaded.

Super Vision+ is a popular magnifier app, developed at Massachusetts Eye and Ear Infirmary, which includes image stabilisation and large-button controls (see Figure 2). They have recently developed a version called SuperVision+ Goggles, which can be used with a cheap virtual reality headset such as Google Cardboard.

Apps are available to help people use public transport (see Figure 3). The National Rail app shows which platform a train will leave from, removing the need to use a telescope to look at departure boards. It also has an alarm function to alert users when they are approaching their stop. Citymapper, Buses Due and other free apps can be used to identify which bus will be the next one to arrive at a bus stop. Uber and other taxi apps can help, especially in unfamiliar environments.

Navigation apps such as Google Maps give step-bystep directions over earphones and many people ask Siri or Google Assistant ‘Where am I?’ when finding their way. Blindsquare is a navigation app which works indoors and outside and provides additional context to nearby places. For example, on a car or bus journey it will announce interesting places which are passed and when walking it will report the position of pedestrian crossings.

It can even look up the menu for a restaurant you are passing, and other visually impaired users can leave information on the app – for example, ‘The men’s toilets are on the left of the bar,’ or ‘Braille menu available.’

Microsoft Soundscape provides information on the immediate surroundings using ‘3D sound.’ When wearing stereo headphones objects are announced in their real position – for example, the name of a shop you are passing on the left will be heard in the left ear only.

Users can set a ‘beacon’ on a point of interest and use their headphones to be guided towards it. It is wise to use bone conduction headphones with Soundscape as they don’t block the sound of traffic or approaching hazards.

These apps do not replace white canes, guide dogs or mobility training, all of which are still useful.

Perhaps the most impressive visual enhancement app currently available is Seeing AI (see Figure 4). Developed

by Microsoft and available free of charge for Apple devices, this artificial intelligence (AI) app contains a

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Figure 3

Figure 3 Navigation apps: National Rail (left); Citymapper (centre); walking directions on Apple Maps (right)

range of features which use the phone camera, including colour recognition, banknote recognition (particularly useful in the USA, where all banknotes are the same size) and product identification (where the user scans a barcode and is told what the product is). Its main function is reading text; by using the camera, it will read print aloud in several languages, including English, German, French and Japanese. It works best for printed text, but makes a reasonable attempt at deciphering handwriting and can also recognise faces. Users take photos of friends or family members in the app. When the app sees that person approaching, it announces who it is. If the app does not recognise the person, it makes an estimate of their age and expression (for example, ’a 29-year-old woman looking angry’). Android alternatives include Synapptic, Speak! and EnvisionAI, which is soon to be launched on the Google Glass wearable device.

Be My Eyes is an app which uses humans, rather than AI, to answer questions. To use Be My Eyes, the person with visual impairment makes a live video call and asks a question, such as ‘What is the best before date on this packet?’, or ‘Which platform do I need for the train to Glasgow?’ The volunteer will respond in real time. This service is good for subjective questions like, ‘Does this

banana look ripe?’ or ‘Does this plant need watering?’

There are stories of people being given incorrect information from this app, such as being told the wrong dose of a medicine. For critical or important tasks, it is wise to have a more reliable strategy.

Keeping up to date It is inevitable that practitioners will read this article and think, ‘Why didn’t the author mention this app?’ or, ‘What about that product?’ New apps for visual impairment are released nearly every week, existing products are updated very frequently, and some services are discontinued. It can be challenging to keep up to date in this quickly changing field.

Good sources of information include: In Touch on BBC Radio 4 and BBC Sounds; the excellent Tech Talk on RNIB Connect Radio (also available as a podcast); and the American podcast Cool Blind Tech. For Apple users, the AppleVis website is a comprehensive resource which is great for answering questions like, ‘Why can’t I do this since the last software update?’11 Other very useful websites include Sight Advice FAQ,12 Vital Tech,13 and AbilityNet.14 One of the joys of working in low vision is learning

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Figure 4

About the author

REPRO OP

n Dr Michael Crossland is a senior optometrist at Moorfields Eye Hospital and an honorary senior research associate at University College London.

He graduated with a BSc in optometry from Aston University in 1998 and was awarded a PhD by the University of London in 2004. He works in adult and paediatric low vision clinics at Moorfields and has published more than 40 peer-reviewed journal articles on low vision. He is particularly interested in the impact of visual impairment on children and new technology for people with low vision.

SUBS

their glasses through to those with no perception of light.

Practitioners are advised to experiment with accessibility settings on their own devices, to download some of the apps mentioned in this article and to share this information with those who need it.

ART

Exam questions and references

PRODUCTION CLIENT

Figure 4 Seeing AI: object recognition (top left); product identification (top right); face recognition, with the correct age (bottom left); handwriting recognition (bottom right)

from the people who come into the clinic. The author usually asks patients, ‘What new strategies are you using?’ This often leads to someone whipping out their smartphone and saying, ‘Have you seen this?’ and demonstrating a new app or setting.

Does technology mean that people don’t need to attend low vision clinics? Not at all. First of all, low vision clinics can share advice about technology and new devices. Secondly, having the correct refractive correction to see these devices is important. Finally, there are times when using technology isn’t appropriate, for example, at a theatre. Traditional magnifiers have the advantage of being quick and easy to use with no start-up time, they are usually cheaper and tend not to fail in an important situation. It is always wise to advise patients to carry a simple optical magnifier with them as a fallback device.

Conclusion New technology has made life easier for many people with visual impairment. The approaches described in this article can be used for patients with any level of vision, from someone with presbyopia who has forgotten

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

This CET will expire on the 28 December 2020 for points to be allocated to the current year of the cycle. It will reopen on 1 January 2021 and expire on 5 March 2021 for those that want points allocated in 2021. 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 ‘MyGOC’ on 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.

Course code: C-76564 Deadline: 28 December 2020 / 5 March 2021

Learning objectives n Be able to advise patients with low vision on technological solutions to support their needs (Group 1.2.4) n Be aware of apps and accessibility options that are available to help patients with visual impairment (Group 4.2.1) n Be able to advise patients with low vision on technological solutions to support their needs (Group 1.2.4) n Be aware of apps and accessibility options that are available to help patients with visual impairment (Group 6.3.1)

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VRICS VERSION REPRO OP

Measurement devices for dispensing

1

CET

POINT

Jim Cox FBDO SUBS

This VRICS feature considers different approaches to taking dispensing measurements using a range of devices

ART

Optometrists

Dispensing opticians Image B

Image A

PRODUCTION CLIENT

01 The correct name for the device in the image is: a) Lens rule b) Pupillary distance (PD) ruler c) Frame rule d) Optical centre (OC) measure 02 Which of the following statements is false? a) Monocular OCs are measured in the plane of the frame b) Monocular PDs are measured in the plane of the patient’s face c) OC and PD measures are always different to each other d) Monocular OCs are a better measurement for ensuring accurate lens centration than monocular PDs 03 When measuring the PD for intermediate distance using a pupillometer you should: a) Rotate the dial to ∞ b) Rotate the dial to 35cm c) Leave the dial where it is as it will not influence the measurement d) Rotate the dial to the distance that most closely matches the patient’s intended working distance

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04 The device shown in the image is designed to measure: a) Binocular and monocular OCs b) Pupil size c) Binocular and monocular PDs d) Vertical heights 05 The light reflex seen on the pupil is coincident with the: a) Pupil centre b) Visual axis c) Illumination source d) None of these options 06 The ability to mask each eye in turn when using this device is of benefit when the: a) Pupil reflex is in a different position in each eye b) Pupil sizes are different to each other c) Patient has a strabismus d) Patient is monocular

Image C

VRICS

About the author n Jim Cox is a dispensing optician and has worked in both multiple and independent practice as well as the manufacturing industry. In his career he has been a store manager, area manager and business owner.

Currently he works as a product owner for Eyoto Group Ltd.

Image D

07 With respect to the device shown, which of the following is true? a) Measurements are 100% repeatable b) Algorithms make adjustments to measurements for patients with strabismus c) The patient’s head and body position have no effect on measurement accuracy d) Measurements are more accurate than a pupillometer

10 With respect to the device shown, which of the following is true? a) User error can be greater than with floor-standing systems b) They can compensate for poor posture c) They can take all of the same measurements as a floor-standing system d) Results are more repeatable than with other methods

08 When using a digital device with a reference clip which of the following is false? a) The frame should be fitted before taking measurements b) It is important to ensure that the dummy lenses are clean c) The patient should stand in a natural and comfortable position d) The practitioner should explain clearly what is going to happen and why

11 When should the use of this device be avoided? a) When the frame is too small b) When the patient has a strabismus c) When the frame is too big d) When the irides are too dark

09 A patient is wearing a pair of spectacles with a length to bend that is too short, which has induced a pantoscopic angle of 20°. How much would the lens need to be vertically decentred if the frame is not adjusted before the measurement is taken? a) 5mm b) 7.5mm c) 10mm d) 20mm

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

This CET will expire on the 28 December 2020 for points to be allocated to the current year of the cycle.

It will reopen on 1 January 2021 and expire on 5 March 2021 for those that want points allocated in 2021. You will be unable to submit exams after this date.

12 Which of the following is not generally a concern when using the device shown? a) Parallax error b) Convergence c) Head position d) Background lighting

Course code: C-76290 Deadline: 28 December 2020 / 5 March 2021

Learning objectives n Be able to take accurate measurements using a range of devices and understand the limitations of the different techniques (Group 4.1.3) n Be able to take accurate measurements using a range of devices and understand the limitations of the different techniques (Group 4.1.4)

December 2020/January 2021

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VRICS 1

Dispensing

VRICS VERSION REPRO OP

Visual fields in neuroophthalmic disease

1

CET

POINT

Dr Daniel Epshtein OD, FAAO SUBS

This series features four cases of neuro-ophthalmic vision loss. Readers are invited to review the images and access additional resources where required to answer the questions.

ART

Optometrists Image A

Image B

PRODUCTION CLIENT

L

L

R

A 30-year-old male patient presented with sudden blurred vision in the upper half of his left visual field, worsening over a three-hour period and then stabilising. Visual acuities were R 6/6 and L 6/12. An afferent pupillary defect was noted in the left eye along with 360-degree disc oedema, most prominent inferiorly. The right eye was unremarkable.

A 47-year-old female patient presented complaining of progressively worsening blur in her left eye for one year. She reported taking a supplement for iron deficient anaemia. Visual acuities were R 6/6 and L 6/9. No pupillary defect was noted.

Fundoscopy was unremarkable. 24-2C visual fields were undertaken.

01 This patient most likely has a lesion of the: a) Left optic nerve b) Right optic nerve c) Chiasm d) Right occipital lobe

04 Which term best describes this visual field findings? a) Bitemporal hemianopia b) Homonymous hemianopia c) Vertical meridian defect d) Binasal hemianopia

02 What is the most likely aetiology of this defect? a) Left non-arteritic anterior ischaemic optic neuropathy b) Left optic neuritis c) Stroke in the area of the left optic tract d) Left neuroretinitis

05 The most likely cause of this visual field defect is: a) Temporal lobe stroke b) Pituitary tumour c) Glaucoma d) Parietal lobe haemorrhage

03 What radiological investigation is most likely to be undertaken? a) Computerised tomography (CT) of the head without contrast b) Magnetic resonance imaging (MRI) of the orbits without contrast c) MRI of the orbits and brain with and without contrast d) MRI of the orbits and brain without contrast

06 What radiological investigation is most likely to be undertaken? a) MRI of the brain with special attention to the chiasm, with and without contrast b) MRI of the brain and orbits with and without contrast c) CT of the orbits d) MRI of the orbits

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Image C

VRICS

Image D

L

R

A 52-year-old male patient presented for routine examination.

Fundoscopy revealed cup-to-disc ratios of R 0.60 and L 0.65.

A glaucoma work-up was undertaken.

07 Which term best describes this visual field finding? a) Bilateral nasal step b) Bitemporal hemianopia c) Pie on the floor d) Pie in the sky 08 The visual acuity is most likely to be: a) R 6/60 L 6/60 b) R 6/30 L 6/30 c) R 6/12 L 6/12 d) R 6/6 L 6/6 09 This visual field defect is most likely caused by a lesion in the: a) Optic chiasm b) Left temporal lobe c) Right temporal lobe d) Right parietal lobe

L

R

A 78-year-old male patient presented complaining of bilateral sudden vision loss. Best corrected vision was 6/18 in each eye. Fundoscopy was unremarkable with visual field plots as shown in the image.

10 What term best describes this visual field? a) Bitemporal hemianopia b) Binasal hemianopia c) Right homonymous hemianopia d) Dense nasal steps 11 The visual field defect is most likely caused by a lesion in the: a) Right optic tract b) Left occipital lobe c) Left parietal lobe d) Right temporal lobe 12 When reading, this patient will most likely have difficulty: a) Finding the next word in a sentence b) Finding the beginning of the line c) Reading very large print d) Seeing objects on the left side of his visual field

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

This CET will expire on the 28 December 2020 for points to be allocated to the current year of the cycle. It will reopen on 1 January 2021 and expire on 5 March 2021 for those that want points allocated in 2021. You will be unable to submit exams after this date.

Course code: C-76296 Deadline: 28 December 2020 and 5 March 2021

Learning objectives n Be able to interpret visual field defects (Group 3.1.5)

About the author n Dr Daniel Epshtein currently practices in a hospital-based 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.

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VRICS 2

Neurology, visual fields & diagnostics

ICLW VERSION REPRO OP

Marketplace Services and products for the practitioner

SUBS

THE GOVERNMENT PPE PORTAL South London practice owner, Nevin Govindasami, on how vital the government PPE service has been this autumn

ART

I COULD NOT LIVE .

WITHOUT..

PRODUCTION CLIENT Getty/bondarillia

I

run a handful of practices in South London. Our practices are small, with hugely mixed patient demographics across the areas.

During the first four weeks of lockdown we were closed, as per the majority of practices. When we opened to offer urgent and emergency eye care, the government’s personal protective equipment (PPE) portal was not yet available.

PPE was imperative in order to stay safe when seeing patients, although initially face-to-face consultations were not frequent as most were performed remotely. As time progressed, the need for face-to-face appointments increased, due to the amount of hospital and GP referrals sent to us. These ranged from the standard lid lumps and flashes/ floaters to painful red eyes. Differential diagnoses were imperative to be able to assist in management strategy.

Patients really needed to be seen, so I sourced our own PPE. This was expensive as there were limited suppliers, and the few that were available were charging a huge amount due to the demand. As we approached

Having easy access to PPE has made life so much easier over the past few months. Having one supplier is great – there is no need to go between different June, we were helped by our suppliers, which saves time and money.

Local Optical Committees The portal has definitely helped our (LOCs), which managed staff to know that there is somewhere to source PPE at a very reliable that they can source PPE from. reasonable fee.

This was something they were worried When routine exams were about before it launched. allowed, we opened our doors The fact that the PPE supply has fully. Appointments filled up been approved for our specific needs is quickly and we were soon crucial. Before, we had a lot of questions booked up weeks in advance. about what type we required to ensure The PPE cost had risen as new safety, what to order, how often to PPE between each patient was change it, and so on. We were often required, including gloves, ordering from UK-based companies, aprons and face masks. This had a huge however the delivery packaging was impact on business costs. from China, which was worrying.

The expansion of the portal to cover We will continue to use the portal for NHS optical contractors happened in as long as we need to keep a supply of August and was welcomed. The portal PPE coming into our practices. I find it was easy to use from the beginning. efficient and incredibly user-friendly.

We had an email invitation allowing us A limit on the amount you are able to register, so we could start ordering to place in one order means stocks are immediately. sufficient, preventing abuse of “It was as easy as It was as easy as the service. Initially, supplies on registering for an registering for an the PPE portal were low, so we online shopping continued to source our own online shopping account.

PPE to keep sufficient stocks. account” Equipment Presently, supplies are very ordered via the portal only takes around much in stock, meaning it is easy to keep four days to arrive. It’s a fantastic service our practices stocked with supplies.

– it’s delivered straight to one of my The portal has been fantastic in practices, and then I distribute it to my assisting our practices. Staff and patients other three. We order hand sanitiser, are very happy. The PPE is supplied at aprons and face masks once a week. no charge, which is a great help with Face masks are important, as they are the ever-increasing costs that we have to required for both staff and patients. We take on. Thank you to the PPE portal. give hand sanitiser to patients as soon as they walk into the practice, and in Register for and access the PPE portal the testing room. Gloves and masks using your NHS email. Call 0800 876 are used by all staff, with aprons used 6802 if you have any questions. by the practitioner. These are changed More guidance can be found here: between patients, so you can imagine https://bit.ly/333xyoj how many we get through.

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Secret Life

LAST WORD 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 PRODUCTION CLIENT

Rosedale Photography

ART

M

Locum dispensing optician, Sarita Harrar, on the dog walking business she started during lockdown, Up Pup and Away

“If it was a Mary Poppins video, there would have been birds twittering around my head” 98 www.optometry.co.uk

y dog died on Valentine’s Day this year. Then lockdown happened. Because I am a locum dispensing optician, I had zero work. My one legal outing was to walk my friend’s dog. We were disinfecting the lead and then passing the pooch between each other in a socially distanced way.

My friend was saying that I needed to start dog walking. I had never had the guts to do it before, but on the last day of May, I posted on Facebook that I was setting up a dog walking business.

We were blessed with amazing weather over summer. Just being out and about and walking in the fresh air is the best thing about dog walking. One of the dogs is a little golden cockapoo called Oakley, who looks like a human in his face.

I love him to bits.

The first time I picked him up, I had this massive grin on my face as I was walking him.

I was so happy to just have this pooch by my side. The sun was shining and things could not have been better. If it was a Mary Poppins video there would have been birds twittering around my head.

It has been a community effort. The husband of one of my good friends is a graphic designer and offered to design a logo for me. It

was my brother who came up with the name for the dog walking business, Up Pup and Away. When the leaflets came, all of my friends offered to post them on their roads and in the surrounding neighbourhood.

For me, starting the dog walking business has given me excitement. It has made me realise how amazing the people around me are, with all the help that I have had.

They have rallied around me and come together.

Dogs are always so happy to see you and they don’t hold grudges. You get to know what the dogs like and don’t like. I get the lowdown from their owners before the walk and treat them how I would treat my own dog.

I had my dog Maya from when she was a puppy and I didn’t realise how much it would break me when she went. She went how humans would want to go. She had eaten, she had a little bit of a play and then she went in her own bed.

The kids couldn’t understand why she had to die on Valentine’s Day. We know as adults that it can be any day, but they just couldn’t get it.

In the end, I just had to say to them, ‘She actually went on the best day. Valentine’s Day is a day of love.’

December 2020/January 2021

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Inner covers spread

VERSION REPRO OP SUBS

Nothing is more important to us than delivering the highest standards of product quality and service to you and your patients.

That’s why we’ve invested significantly to bring our MyDay® product range back to the market – moving forward to be fitter, stronger and smarter than ever.

ART

FITTER – An aggressive expansion plan delivered through unprecedented manufacturing investment.

STRONGER – Over 300% increase in capacity.* SMARTER – A flexible stock management process with dual-sourcing to deliver uninterrupted supply.

PRODUCTION

MYDAY® – MOVING FORWARD TO BE BETTER THAN EVER FOR YOU AND YOUR PATIENTS.

CLIENT

The SEED 1dayPure EDOF delivers continuous clear vision over a wide range of distances without compromise. Unlike multifocal lenses, the optics provide a constantly varying power profile, ensuring visual performance is not dependent on pupil size or lens centration.

Designed by the Brien Holden Vision Institute, SEED 1dayPure EDOF delivers excellent results for early/pre-presbyopia and visual stress. Available in powers from +5.00 to -12.00 DS, there are 3 different depth of focus types allowing you to cater for a wide range of patients.

A MEMBER OF THE SEED GROUP

www.seed-uk.co.uk

0800 585 115

info@ultravision.co.uk * Capacity increase between 2018 and projected 2021.

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INSIDE High Street horizons

years

£9.95 REPRO OP

December 2020/January 2021 Volume 60:09

ART PRODUCTION CLIENT

We want to support all of our members to tackle racism and other forms of discrimination.

Email ARET@aop.org.uk

DISCOVER MORE

www.aop.org.uk/discrimination

THE HIGH STREET HORIZONS EDITION

Whatever you have experienced, our ARET can offer an empathetic ear and talk you through your options.

December 2020/January 2021 / Volume 60:09

SUBS

Our anti-racism and equality team (ARET)

www.optometry.co.uk

/ www.optometry.co.uk

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Contact to find out more...

www.seed-uk.co.uk

A MEMBER OF THE SEED GROUP

0800 585 115

info@ultravision.co.uk

91OPTDEC20100.pgs 30.11.2020 16:56

Outer covers spread

VERSION

Journal of the Association of Optometrists