OT February/March 2024 by TheAOP

Cover

THE CAREER PROGRESSION EDITION VERSION

AOP Council elections explained What will optometry look like in 2029? Westminster Eye Health Day insights

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February/March 2024 / Volume 64:01

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February/March 2024 Volume 64:01

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THE CAREER PROGRESSION EDITION

SAY YES Exploring the rewards of building a tailored career

/ www.optometry.co.uk

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Adam Sampson

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Changes that are on the horizon for the profession will shape the future of optometrists’ careers, writes Adam Sampson

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Later this month the AOP will open nominations for its 33 member-strong Council, with vacancies in a number of geographical areas. Find out more about the role of AOP Councillors and how to put yourself forward on page 88.

Years ago, there was a minor political incident when Oxford University voted to deny former Premier Margaret Thatcher an honorary doctorate. A few days later, I found myself discussing the vote with one academic, an ancient historian whom I knew hated her, but who had voted in favour. Pressed as to why, he said that as she had only been out of office for a decade, it was too soon to assess her legacy. Like historians, CEOs operate according to a different timescale from others. Yet whereas historians live in the past, the job of a CEO largely involves living in the future. While most of the AOP staff will be focused on the day-today, pleasingly delivering record levels of membership, legal support, educational activity and commercial income, for example, in contrast I am interested in the underlying trends, which play into the most vital part of the CEO role: plotting the right strategy for the organisation for the coming years. Before I took on the AOP role, I consulted, specialising in helping organisations devise strategies for the future. It taught me that not everyone is equally good at being able to focus on the future. For some, the challenges of the immediate are too overwhelming. Never did I feel this more than when, before Christmas, I joined a GOC consultation event on creating its strategy for the coming five years. What I wanted to be part of was a discussion of how the delivery of eye care might change over the coming decade. What I heard was a recitation of today’s challenges facing the sector. But, make no mistake, the tectonic plates are on the move and, as this edition of OT discusses, those changes will be important in shaping the future of the careers of today’s generation of optometrists. Of course, delivering to our current operational objectives is important in helping our members navigate the challenges they face. But, change is coming, change that will shape the future of all optometrists over the next few decades, and it is essential that we attempt to shape that change in such a way as to enable our profession to continue to deliver its mission to support the nation’s eye health. 0

Adam Sampson, AOP chief executive

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EDITOR’S PICKS -

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INSIDE THE JOURNAL

45 / FEATURE

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Insights from Westminster Eye Health Day

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Data connectivity, a focus on prevention, equity of access to eye care: The Eyes Have It set out clear policy asks during its third Westminster Eye Heath Day

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FOR OPTOMETRISTS, SPECIALTY OPTOMETRISTS, DISPENSING OPTICIANS AND CONTACT LENS OPTICIANS

50 Ocular ischaemic syndrome

53 The case for

measuring blood pressure in community practice

40 / FEATURE

24 / LIFE IN PRACTICE

34 / LIFE IN PRACTICE

How I got here

Pre-reg focus

In conversation with

Thea’s Navneet Gupta on developing his passion for optometry education

Specsavers pre-reg optometrist, Oran O’Connor, on preparing for Visit two

OT and JJV MedTech explore presbyopia and contact lens success

5 mins to read

3 mins to read

75 / WHAT’S HAPPENING

82 / WHAT’S HAPPENING

88 / AOP ON THE GROUND

What’s happening in…

Supplier insight How is vision correction tailored for presbyopes?

An explainer on…

A round-up of what to look out for in eyewear at 100% Optical

11 mins to read

60 Emerging light-based

Matthew Kaltenborn; EssilorLuxottica

and thermomechanical therapies for dry eye disease

66 Assessing and

managing digital eye strain in clinical practice

Don’t forget, OT now runs bimonthly Clinical interpretation exams and interactive CPD Videos online: www.optometry.co.uk/cpd

(9 2 mins to read

5 mins to read

The AOP’s Rohama Jan on the upcoming AOP Council elections

4 mins to read

February/March 2024 OT www.optometry.co.uk 5

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Contents, 1

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CONTRIBUTORS OT features a range of expert contributors who share their optometry expertise and insight. Here are some of those who helped us put this edition together

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What will the role of optometrists be in 10 years time?

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“It will involve further integration of technologies, telemedicine and remote consultations, sub-specialisations, and personalised medicine.” Dr Clare O’Donnell, head of optometry at Optegra

I could not live without, page 84 PRODUCTION CLIENT

“Leading a team independently managing a range of acute and chronic conditions across multidisciplinary boundaries delivering the best care for the patient.” Andy Britton, IP optometrist at Specsavers Haverfordwest

A conversation about..., page 36

Eyes on 100% Optical

OT takes a final look at the education programme and latest launches planned for 100% Optical As schedules are finalised and bags are packed for 100% Optical’s 10th anniversary show, as the official UK media partner, OT delves into what’s not to be missed at the three-day event later this month

Association of Optometrists

February/March 2024 Volume 64:01 Issn 0268-5485 ABC certificate of circulation 1 January 2022–31 December 2022 Editor: Emily McCormick emilymccormick@optometry.co.uk Deputy editor: Lucy Miller lucymiller@optometry.co.uk Features editor: Selina Powell selinapowell@optometry.co.uk Senior reporter: Kimberley Young kimberleyyoung@optometry.co.uk

“Our roles will be influenced by ongoing clinical research and become more specialised. AI will have an ever increasing impact on our ways of working.” Chris Steele, head of optometry services at Sunderland Eye Infirmary

You had me at hospital, page 29

Web content and social media manager: 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

Advertising: Jamie Dawson 020 3771 7201 jamie.dawson@thinkpublishing.co.uk Advertising production: aop@ccmediagroup.co.uk Art director: Grant Pearce Client engagement director: Kieran Paul Executive director: Jackie Scully

CPD enquiries: 020 7549 2076 CPDhelp@optometry.co.uk

Published bimonthly for the Association of Optometrists by Think Media Group 20 Mortimer Street, London, W1T 3JW Printed by Acorn Web, Normanton Ind Estate, Loscoe Close, Normanton, West Yorkshire, WF6 1TW

AOP membership and OT subscription team: subscriptions@aop.org.uk

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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OT and its wrapper are produced on paper from European mills meeting the highest quality and environmental standards. The journal and paper wrapper are fully recyclable.

February/March 2024 OT www.optometry.co.uk 7

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Contents, 2

Contents _

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ON THE GO

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Keep up-to-date with all things optics by following OT’s social channels

#EMILYMcCORMICK

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Ramadan ready

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OT’s Selina Powell and Laurence Derbyshire have met via Teams with optometrists to discuss how they will be celebrating Ramadan this year, including their advice for working during the month of fasting and reflecting www.optometry.co.uk/videos

Westminster Eye Health Day returned OT’s deputy editor, Lucy Miller, attended December’s Westminster Eye Health Day, calling for data connectivity, prevention, and equity in eye care access. Read more on page 45

www.optometry.co.uk

0 Read our latest content, updated daily online: www.optometry.co.uk

Learning for locums

OBE recognition

OT travelled to Birmingham for the AOP’s first locum clinical skills day, sponsored by Johnson & Johnson Vision. Watch videos with Bruce Evans and Matt Roney online

OT’s Kimberley Young and Laurence Derbyshire spoke to chief Welsh optometric adviser, David O’Sullivan, about receiving an OBE in the King’s New Year’s Honours List

www.optometry.co.uk/videos

WHAT TO READ, WATCH AND LISTEN TO ONLINE: OUR TOP FOUR

The year ahead

New skills guides

Orthoptics CPD

Our Contact Lens Guide

Read about ECPs’ wishes and predictions for the year ahead

Watch our four new domiciliary eye care video skills guides

OT’s latest CPD Video explores orthoptics for the busy practitioner

Read OT’s Contact Lens Guide, supported by CooperVision

www.optometry.co.uk/ the-2024-viewpoint

www.optometry.co.uk/ skillsguides

www.optometry.co.uk/CPD

www.optometry.co.uk/ contact-lens-guide

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OT explores the doors that open when optometrists step outside of their comfort zone _

WORDS: SELINA POWELL PHOTOGRAPHY: ALEX LLOYD JENKINS, GAVIN FORSTER

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t the heart of Rukaiya Anwar’s career is a leap of faith. It has seen her speak in rooms where few people look like her, ask questions that few have considered and approach problems that seem insurmountable with an attitude of calm perseverance. “I’m definitely a ‘say yes’ person,” Anwar told OT. “You can make an impact in more ways than one as an optometrist,” she added. This willingness to venture into unfamiliar territory can be seen more generally within the number of optometrists who are undertaking further qualifications. A 2023 member survey by the AOP found that four in 10 optometrists planned to pursue an additional qualification such as independent prescribing (IP) or MECSaccreditation over the next two years. Anwar shared that further learning both enhances her professional satisfaction and means she can provide better care for her patients. “Since qualification, I’ve seen so much change – whether that’s the way a sight test is done, or the equipment we have in practice, or new pathways that have been commissioned,” she said. “It’s really important that we as practitioners, as clinicians and as leaders, also move forward with the change that we’ve got happening around us,” Anwar highlighted. Anwar is an optometric adviser for Cardiff and Vale University Health Board and clinical lead for Primary Eyecare Services. Alongside this work, she is completing a PhD with Anglia Ruskin University and works as a locum optometrist for specialist clinics. For the past two years, Anwar has served as a council associate for the

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ÒPut yourself

out there because you won’t know what your strengths are until you do Rukaiya Anwar

General Optical Council (GOC). The role was created in 2022 to provide optometrists and dispensing opticians with their first step towards a board, committee or panel role. The role also addresses an imbalance between the background, experience and perspectives present within the profession as a whole, and those that are represented on council. Around eight in 10 council and committee members at the GOC are white – compared to four in 10 people within the professions they regulate. Only 15% of council and committee members are under the age of 45, compared to 63% of optometrists and dispensing opticians. Anwar shared that her motivation for applying to be a council

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not necessarily because they can’t read the leaflet that’s printed in English. Sometimes there are so many other mental barriers and emotional barriers that you have to break down before the message reaches that group of people,” Anwar observed. “Unless we’ve got representation from those communities, at a board level, we’re not truly going to understand where we can implement feedback to improve services and accessibility,” she said. In terms of her advice for other optometrists considering a leadership role, Anwar emphasised the importance of valuing the experience they bring to the table. “Lived experience is just as important as experience on a CV,” she shared with OT. “I think my biggest top tip is to really put yourself out there, because you won’t know what your strengths are until you do,” Anwar emphasised.

F associate was to gain experience in a governance role. “As a council associate, you’re not necessarily making decisions, but you’re observing the way someone speaks or holds a conversation or feeds back,” she said. “There’s an art to the etiquette that you learn in those meetings which can then be applied elsewhere,” Anwar shared.

Alex Lloyd Jenkins

Overcoming imposter syndrome Alongside the daunting nature of stepping forward to speak alongside more senior colleagues, Anwar has had to overcome doubts about whether she will be understood when few people share the same experiences as her. “When there’s no

one who looks like you at the table, you get that feeling of imposter syndrome. I’ve definitely struggled with that before, where you think ‘Am I really the person who’s in charge? Why are they looking to me? Little, five foot one, me?’” she said. Anwar believes that having a diverse range of perspectives can help with problem solving. For example, she grew up translating letters that would come through the post from English into Arabic for her grandmother. As an optometric adviser, she recently contributed to a discussion about why translating leaflets into different languages had failed to result in an increase in people accessing healthcare services. “It’s

ellow GOC council associate, Harry Singh Bhakar, has prioritised career development since qualifying in 2020. He has completed his medical retina certificate, supervised pre-registration optometrists, and secured a part-time hospital role. Bhakar shared that when he first started as a council associate, just putting his hand up to speak could be nerve wracking. “You wonder whether your idea might be complete nonsense, or actually a unique perspective, which they wouldn’t think about, because I’m at a completely different stage,” he said. When considering which qualifications to undertake, Bhakar considers whether a course is applicable to his scope of practice and whether he will be able to use the skills he gains. “Quite early on, I realised I didn’t want to sit in a test room for five days a week. I think it’s about what is going to spark your interest, and ►

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keep you enjoying what you do,” he said. As someone at an early stage in his career, Bhakar wants to explore the different opportunities that optometry can offer. “I want to gather a breadth of experience in optics in preparation for the future. The landscape in optics is changing and this is something I’ve seen first-hand within the GOC,” he said. “Being a part of driving change requires a broad spectrum of experience as that shapes strategic thinking,” he added.

Bouncing back PRODUCTION CLIENT

In the heart of the pandemic, like so many optometry practice owners across the UK, Kaye Winship was approaching each challenge day-byday. “I’d set myself a small goal and then I’d set myself bigger goals,” Winship explained. “During COVID-19, it was: ‘Get through this day. Get through this week. Get through this month’,” she said. Four years after the global pandemic that brought many businesses to a standstill, Winship’s commitment to steering her 98-year-old practice through an unprecedented time has paid off.

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She has invested in new equipment, overhauled her website and marketing strategy, and added a second consulting room to the building which is used for contact lens clinics, podiatry and hearing care. S Walton Eyecare has experienced growth of over 20% this year, with 1600 patients joining since April 2023.

hen asked how she has navigated challenges over 16 years of practice ownership – including two recessions – Winship emphasises the importance of an open mindset. “An open mindset makes you embrace everything around you, every day – whether that’s looking at the birds in your garden or facing challenges at work,” she said. “It’s the thought that you can achieve whatever you want to achieve by focusing in on a goal,” Winship added. Winship’s determination to overcome the challenges that her practice faced during the pandemic has also extended to addressing inequalities that affect her local area. Through her role on the

ÒI’ve seen

optometry as a lifelong career and passion Kaye Winship Northumberland, Tyne and Wear local optical committee, Winship has helped to identify and tackle healthcare inequalities. “I’ve seen optometry as a lifelong career and passion. And as a consequence, I’ve really tried to explore different aspects of the profession and keep my interest up throughout my career,” she said. She assisted in spearheading the reinstatement of the South Tyneside Paediatric Service, which was paused during the pandemic. Of the 316 local authorities in England, the area where Winship works – South Tyneside – is the 12th most income-deprived. South Tyneside is ranked in the bottom 30% of local authorities when it comes to health outcomes. And yet, when a patient presents at Winship’s practice with an urgent eye condition, there is no funding in place to provide treatment. “It absolutely

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breaks my heart because MECS is commissioned in 75% of the country now but not in this area, where there is evidence that it is needed,” she shared. “My aspiration is to have a minor eye conditions service commissioned in this area before I retire,” Winship said. South Shields is one of many areas across the UK that could benefit under work that is currently being undertaken to develop a standard service specification for minor and urgent eye care in England. The specification, which is being developed by the Local Optical Committee Support Unit alongside the Clinical Council for Eye Health Commissioning, could help to reduce variation between the eye care services that people receive in different areas of England. Winship describes herself as an “eternal optimist” when it comes

to the future of the profession. “Opportunities arise every day: what’s needed is the tenacity to recognise them and seize them. That’s what has kept me going,” she emphasised.

Sparking an interest Mohammed Hafejee first started working in an optometry practice as a teenager at the weekend, before training as a dispensing optician. He is now an optometrist with a long list of further qualifications to his name – and the owner of Airedale Opticians, with practices in Keighley and Cross Hills. Hafejee shared that his experience in different roles within optics – including at one point glazing – has helped him as a manager. “When you’ve spent time on the shop floor for a few years, you appreciate all the different customers and patients who come

in, and the demands of the job,” he said. Although Hafejee has previously worked as a store manager for a multiple practice, he enjoys the freedom that running his own business offers. He is able to tailor the care that he provides to the local population rather than following every memo sent from head office. “You get to make the decisions, and those are the decisions you live by – so you try to make the right choices, but you also learn from your mistakes,” Hafejee shared. Hafejee has completed further training in MECS, medical retina, and glaucoma. He is currently completing his IP qualification. He views further education as a way of both providing better care for his patients and enriching his professional life. Where some people might relax with their favourite box-set, ►

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On the frontline of the pandemic One of AOP Councillor Erica Campbell-Walker’s first memories is of an optometrist leaning toward her with an ophthalmoscope. “I remember seeing what looked like cracked mud, and there was this little dip,” she recalled. “I didn’t know it at the time but that was the macula,” CampbellWalker shared. Fast-forward to May 2020, and the optometrist was in a role about as far removed from that early experience of optometry as you could imagine. As a clinical contact caseworker, Campbell-Walker would call people to ask for intricate and often intimate details of their lives in order to stem the spread of a global pandemic. She would ask people who tested positive for COVID-19 where they had been, who they were with, and how close they were. Campbell-Walker

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Kaye Winship photographed at S Walton Eyecare

was trained in memory and recall techniques to help people recollect details as specific as what number bus they had caught or the shops they visited on a morning of chores. Although the conversations could often be uncomfortable, CampbellWalker appreciated the gravity of the task. “We were thinking that the information that we get from this could actually be saving lives,” she shared with OT. In the next phase of the pandemic, Campbell-Walker was involved in the vaccine effort – delivering up to 100 vaccinations on a single day. Over the course of 12-hour shifts, she calmed the anxious, fielded questions from the vaccine-hesitant

“My career is a

chocolate box of roles Erica Campbell-Walker

and the team received gifts from people looking forward to being able to leave their house for the first time in months. “I remember in the summer, someone got us ice creams,” she said.

uring the course of her career as an optometrist, Campbell-Walker has worked as a practice director and locum optometrist. After the pandemic, she returned to Oban to work for the optometrist who had first tested her eyes as a four year old – and prompted her interest in optometry – after learning that he was struggling to recruit. Campbell-Walker is now an optometry senior specialist lead for NHS Education for Scotland. She is currently working on a project that explores how virtual reality could be used to address the shortage of IP placements. During the simulation-based IP placements, optometrists interact with ‘simulated patients,’ who are actors, and examine ophthalmic conditions using the EyeSi virtual reality slit lamp.

Gavin Forster

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Hafejee will spend his evenings studying a course or researching a question he would like to know the answer to. “I’m a naturally curious person – I’m always wondering, ‘how is that? Why do we do that? How are you able to treat that?’” Hafejee shared. The optometrist aims to pass on his passion for further learning to his staff – who have studied everything from paediatric care to social media. “I will pay for any course that they want to do – whether that is related to optics or not,” Hafejee shared. “You know that saying by Plutarch, ‘The mind is not a vessel to be filled but a fire to be lit?’ I want them to find their thing that ignites that spark,” he said.

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“

Nobody is going to come and offer you a golden goose Ghislaine Dunn “My career is a chocolate box of roles,” Campbell-Walker added. “Because I’m doing different things, it keeps me fresh,” she said.

Ian Olsson

Ghislaine Dunn

In her role as an AOP Councillor, Campbell-Walker hopes to be able to influence some of the broader discussions that are happening within the profession. “This is a time where optometry is at a crossroads. If you want things to go in a different direction, if you want to know what’s happening, you need to be on the inside,” she emphasised.

hen Ghislaine Dunn started her IP course, she had just purchased her first optometry practice, which she rebranded and renovated in the first four months. Her two boys were aged five and six months. “I had a lot of hats on that year. I’m not quite sure how I got through it, to be honest,” she said. “Complete, dogged determination and lots of late nights,” Dunn shared. Dunn saw the qualification as a way of preparing herself in the event that low dose atropine receives regulatory approval for myopia management in the UK. She also thought IP would streamline her role as an optometrist in the glaucoma department at Addenbrooke’s Hospital. “I wouldn’t have to keep running to the doctor to ask them to make out a prescription for me,” she shared. Although optometry is a femaledominated profession, a 2023 member survey by the AOP found that men were at least twice as likely to aspire to manage their own business in optometry than women. Despite the challenges associated with balancing different roles, Dunn is glad that she persevered after turning down opportunities in the past due to family commitments. “Being a woman in your 30s can be really tough. You’ve got the demands of family and then establishing your career,” she said. “I think as soon as I had my second child, I was like, ‘Right, I can get on with my career now.’ And I took everything on all in one go.”

Through her experience working in different practices, Dunn observed how different approaches to running a business could succeed and fail. As the owner of Peters Opticians – a Hakim Group independent practice – she aims to create a supportive environment where people enjoy coming to work. “If you treat people well and fairly, then they will give back to the practice,” she said. Dunn enjoys passing on her enthusiasm for the profession to the next generation through her role as a supervisor at Anglia Ruskin University. In terms of her advice for younger optometrists, Dunn emphasised the importance of not waiting for the right role to come along. “I spent quite a lot of time thinking that opportunity would come to me. Sometimes you have to go out and find it. Nobody is going to come and offer you a golden goose.” Dunn, who in a past life sat quietly at the back of lecture theatres, afraid of saying the wrong thing, is now the one at the front asking questions. “Don’t be afraid of your own voice,” she shared with OT. She recently took up an opportunity to speak as a health expert on BBC Radio Cambridgeshire. “That was out of my comfort zone. But again, this is the me saying yes to everything. And actually, it was really good fun.” 0

Selina Powell OT features editor. Get in touch by email: selinapowell@optometry.co.uk

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CARDIFF

Photographer Gavin Forster captures Kaye Winship

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Photos were captured by a giant eye sculpture at a South Shields beach and in a cosy studio in Cardiff

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The Tyne Eye in South Shields is an 18 tonne concrete tribute to generations of women who would stand at the shore, searching the skyline for the ships that would return their loved ones home. This sculture, inspired by horizon-scanning, formed a fitting backdrop for an edition that focuses on charting new paths within optometry. Optometrist, Kaye Winship, was photographed beside the Broadbent Studio artwork and at her South Shields practice, S Walton Eyecare. She observed that photographer Gavin Forster and his assistant were knowledgeable about their craft. “It was incredibly windy at the beach and probably was not the easiest of photoshots from a technical point of view,” Winship shared with OT. “The photos taken at the coast with the eye sculpture were the realisation of something I’ve had in mind to do since the sculpture was created, so a dream of mine was realised,” she added. A bold wall hanging and thriving pot plants formed a backdrop to photographs of optometrist, Rukaiya Anwar, which were captured by Alex Lloyd Jenkins at the Cardiff studio, f/36. “The weather was super gloomy on the day of the photoshoot so getting the lighting right was a challenge for the photographer,” she said. “I had never taken part in a photoshoot previously, and am often on the other side of the camera lens, so this experience was incredibly fun,” Anwar shared with OT.

THANKS Optometrists Rukaiya Anwar, Kaye Winship Photographers Alex Lloyd Jenkins, Gavin Forster Art director Grant Pearce

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Framed patient compliments for S Walton Eyecare dating back to 1928

Behind the cover story

Kaye Winship at her South Shields practice, S Walton Eyecare

Kaye Winship is photographed by the Tyne Eye sculpture at Littlehaven, South Shields

Optometrist Rukaiya Anwar was photographed in a Cardiff studio

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Seeingbeyond

Life in practice contents

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LIFE IN PRACTICE

Career paths and personal development EDITED BY: LUCY MILLER

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A CONVERSATION ABOUT…

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Future gazing: what will optometry look like in five years’ time?

This issue’s must reads...

ONLINE EXCLUSIVE

24 29 30 HOW I GOT HERE

YOU HAD ME IP AND AT HOSPITAL ME

Professional education lead at Thea, Dr Navneet Gupta, on his love of teaching

Sunderland Eye Infirmary consultant, Chris Steele, shares his wisdom

The panel discusses encountering glaucoma as an IP optometrist

To read more about practitioners and their experiences in a range of settings, visit the OT website: www.optometry.co.uk/life-in-practice

“I’VE SPENT MY WHOLE LIFE TRYING TO ENHANCE OPTOMETRY AND BROADEN ITS SCALE”

Newly retired optometrist, Susan Bowers, looks back at her distinguished career in optics Read online: www.optometry.co.uk/enhanceoptometry

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HOW I GOT HERE

“IF YOU DON’T CARRY ON LEARNING AND DEVELOPING, YOU’LL BE LEFT BEHIND”

Dr Navneet Gupta, professional education lead at Thea, on how his passion for optometry education developed 24 www.optometry.co.uk OT February/March 2024

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HIGH

Life in practice _ very steep learning curve, but great to get a different perspective on the working world in optics.

Aged 10 or 11, I remember going to have an eye test. The experience was quite frightening. I had noticed floaters, but I didn’t tell anyone. During the sight test, I sat there afraid of what was going to be found. The minute the optometrist put yellow fluorescence dye into my eyes, I freaked out. He didn’t explain why he was going to put the drops in; he didn’t explain anything about what he had found. All he said to my dad was, ‘Everything is fine.’ I was relieved, but confused about what was going on. That was the first time I thought, ‘I want to know what these things are in my eyes.’ For years after that I was interested in biology. Putting that together with that experience is where the whole optometry story started for me.

I was at Zeiss Vision Care for just under two years, and then I moved on to become professional education lead at Thea. The focus is very much on teaching, training, CPD – the kind of things I enjoy, and that are my forte from having a clinical background.

“Working in the hospital was the impetus to do more continuing personal professional development”

I studied at Aston University. That was the start of the rest of my career, because it was my first exposure to research. My dissertation supervisor, Professor Shehzad Naroo, opened my eyes to academia, and really instilled my drive to do a PhD.

We’re starting to deliver dry eye and blepharitis-focused educational events to university students. We’re also engaging pharmacists, supporting their activities and education, which is new for me. It would be nice to grow a team at Thea, taking on management responsibilities and helping support education for all arms of the business, right across the country.

I completed my pre-reg, and then worked in practice for 15 months before returning to Aston University to start my PhD in October 2005. The PhD was on assessing visual function in presbyopia, developing a questionnaire to assess and measure patient satisfaction with presbyopic corrections. The second part involved looking into accommodating intraocular lenses and multifocal contact lenses and their performance, and measuring patient satisfaction.

The first role I went into after my PhD was as clinical editor for Optometry Today (OT). Working with OT was my first exposure of dealing with CET, as it was then. That was a fantastic space to learn how to write, edit, and publish appropriate materials. It also helped me build relationships with experts in all kinds of areas: dry eye, colour vision, pathologies of the eyes. I worked with OT for four and a half years.

Fundamentally, teaching is about being able to help someone to become a better practitioner.

NAME: Dr Navneet Gupta

ROLE: Professional education lead at Thea

LOCATION: West Bromwich

If you’ve got experience, the joy of being able to understand something and pass that on to somebody else for them to understand and make use of and become a better practitioner for their patients – that’s what makes me tick. I can categorically say that everything I’ve done has given me an experience that I’ve leaned on when I’ve gone into another role or another environment. I look at my career and think, “I’m so glad I did everything I’ve ever done.” 0 Read more optometry career journeys online: www.optometry.co.uk/how-i-got-here

I then started working for NewMedica in Nuneaton, at the George Eliot Hospital. I stayed

One tip for continuous learning throughout your career?

there for seven or eight years. Working in the hospital was the impetus to do more continuing personal professional development. I completed the independent prescribing qualification, which allowed me to manage more complex cases.

Absolutely do it, because the world is always changing. There’s so much coming, whether it’s artificial intelligence or independent prescribing. The role of the optometrist is going to become even more important than it is at the moment – you just have to look at the changes to the optometry Master’s programmes that are being rolled out. If you don’t carry on learning and developing, you’ll be left behind. You need to keep on top of things, not just for your own sake, but also for your patients’ sake, so you can make sure you’re offering the highest levels of service and care.

I joined Zeiss Vision Care in September 2021. That was my first foray into professional services. Supply chain and marketing were people I had never encountered before. It was a

February/March 2024 OT www.optometry.co.uk 25

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LIFE AS A LOCUM

VERSION

Life in practice _

REPRO OP SUBS ART

LIFE AS A LOCUM

My biggest locum challenge is… Being open

“MEETING NEW PEOPLE EVERY DAY IS REALLY NICE”

As a locum, I’ve adapted my days by…

to new ideas and new ways of working. Being a resident for two years, where I was almost in charge, I could say, ‘this needs doing.’ As a locum, you can’t always go in and say, ‘why is this not being done?’ You have to learn to communicate in better ways, and learn to adapt.

Being more on top of my notes, and not leaving referrals to the end of the day. Sometimes, I’ll do paperwork during my lunch to make sure it’s done before I leave.

Practices can make life easier for locums by…

PRODUCTION

Hannah Colclough, locum for multiples and Hakim Group independent practices in Merseyside and Cheshire, on how locuming has given her days a clear sense of purpose Before I became a locum, I was working...

CLIENT

For a multiple for two years, which is where I had also completed my pre-reg placement. My pre-reg lasted for two years, because of COVID-19, and I stayed there afterwards.

“You’re back to your clinical basics... you’re employed as an optometrist for the day”

When I started as a locum, I wish I had known… Not to panic. It seems like a big,

My favourite thing about being a locum is… You go in and feel like you have purpose. You know that you’re there just for optometry, for that day. When I was a resident, I was doing all the other jobs as well. Now, I can spend all my time with the patients. You’re back to your clinical basics, because that is your job – you’re employed as an optometrist for the day.

scary change, and it is. But once you get into it, it works out. You get used to different equipment, and meeting new people every day is really nice. Also, be prepped from the start. I started my prep a couple of months before, but I could have started even earlier. What took the longest wasn’t getting shifts, it was places allowing me to register with them. Make sure you’ve got your clinical references early.

Hannah Colclough

I made the decision to become a locum because... My personal circumstances

Cheshire and Merseyside

changed, and I moved location. A Monday to Friday role was also a lot nicer for me than doing weekend work. The continuing professional development aspect was appealing, too.

On my first day of locuming... I was so nervous. With Hakim Group practices, I was quite lucky, because it was nice and easy to settle into. But after I had done the first few tests, I was like, ‘Oh, it is just my job. I’ve just been put in a different practice for a day.’

At my previous role in a multiple, I created a locum pack, with information on referrals and how to use the equipment. On some locum days, you’ll find you’re in practice by yourself, and a lot of practice managers don’t necessarily know how the equipment works.

NAME:

LOCATION:

LOCUM FOR:

Seven months

My advice for new locums is... Be prepared, and stay on top of things. I had a three-month notice period, so almost from day dot, I was sorting out the business and the bank accounts, and making sure I had everything in place so that I could start locuming. If you’re not in the headspace to sort that out while you’re at work, you might have a month without income.

My last word on locuming is... Do your research on the practices. Research the parking. Knowing the area and being on top of things means your days tend to be a lot easier. You’re able to just go in and do your job. 0 Read more locum insights online: www.optometry.co.uk/life-as-a-locum

26 www.optometry.co.uk OT February/March 2024

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91OPTJAN24152.pgs 31.01.2024 12:42

*Driving (74%), reading (68%), travelling (62%), hobbies and social activities (43%), and the ability to work or volunteer (42%). tFrom the global Geographic Atrophy Insights Survey (GAINS)(N=203) conducted by The Harris Poll and sponsored by Apel Iis Pharmaceuticals in 2021. Online/telephone survey in participants> 60 years old from the US, UK, France, Germany, Italy, Netherlands, Sweden, Canada, and Australia. Participants self-reported they had been diagnosed with age-related macular degeneration, with dry age-related macular degeneration in ~1 of their eyes. They also had advanced atrophic age-related macular degeneration or advanced/late/late-stage dry age-related macular degeneration or advanced dry age-related macular degeneration or geographic atrophy in ~1 of their eyes and were experiencing ;,3 geographic atrophy symptoms out of a list of -15 symptoms.

Visit geographicatrophy.uk to discover more about GA or scan the QR code

References: 1. Sivaprasad S et al. Ophthalmol Ther. 2019;8(1):115-124 2. Jones D et al. Invest Ophth Vis Sci. 2022;4217-A0145. Available from: https://ivors.arvojournals.org/articleid=2781790 Accessed November 2023 3. Apellis & The Harris Poll. Geographic Atrophy Insights Survey (GAINS).2022.

Apellis

YOU HAD ME AT HOSPITAL

You had me at hosptial

VERSION

Life in practice _

REPRO OP

“OPTOMETRY IS HEADING IN NEW DIRECTIONS” Every edition, OT poses a series of questions to a hospital optometrist. This time: Chris Steele, consultant optometrist and head of optometry services at Sunderland Eye Infirmary ··-·-···-·-·-·-·-·-·-·-·-·-·-·-···-·-·-·-·-·-·-·-·-·-·-·-···-·-·-·-·-·-·-·-·-·-·-·-···-·-·

0 SUBS

Why did you decide to become a hospital optometrist?

ART

During my final year at City, University of London, having spent the summer after second year working as an optical assistant in a busy private practice in the City of London, several patients were referred to Moorfields Eye Hospital. I was fascinated about what had happened following referral and what treatment had been given for various conditions.

PRODUCTION

Do you do any other work or volunteering alongside hospital optometry?

CLIENT

In the early 1990s, I spent three months working in Africa. Firstly, I led a two-month trip to Kenya, delivering eye care in rural areas via Sight by Wings. A couple of years later, I returned as part of a Vision Aid Overseas team. Both were incredible experiences. I also worked regularly for multiples and independents until the pandemic, when my main hospital consultant optometrist job became more demanding.

What is the biggest challenge facing hospital optometry currently? An ageing population has significantly increased demands in ophthalmology in recent years, especially with the ever-growing number of new treatments available that often require the frequent follow-up of patients in outpatient clinics. The pressures on outpatient services to see more patients has increased enormously. People are living longer, increasingly with several co-morbidities. Many of our patients are much more complex to manage, so it often takes longer to see each patient in clinic. There is a pressing need to re-evaluate the scope of practice of hospital optometrists working within multidisciplinary teams in secondary care in the UK. Hospital optometrists are well placed to further expand their roles.

What would you say to optometrists on the High Street about working in a hospital? There are so many opportunities to further develop and maximise the use of your optometric skills within hospital optometry. Apart from enjoying the camaraderie of working

NAME:

Chris Steele

ROLE:

Consultant optometrist and head of optometry services at Sunderland Eye Infirmary

LOCATION: Sunderland

alongside a supportive, multidisciplinary team of staff, there are many exciting things happening right now, be it in research or in clinical practice. Many optometrists working in community practice may feel put off by some aspects of the hospital work, as it can be very different to High Street practice and there may be a perception that the type of work is overly challenging. However, with the right training and support optometrists are now able to practice in areas unheard of even just a few years ago, when only an ophthalmologist was considered worthy of such clinical undertakings. Times really are changing, and hospital optometry is heading in new directions. 0 Read more hospital insights online: www.optometry.co.uk/you-had-me-at-hospital

:........................................................................................................ ~

One surprising moment “During diabetic screening, a fine black line had contaminated the camera lens in one fundus image. It had to be something lodged within the artery. It transpired that the patient had recently undergone open heart surgery. The consultant suspected a suture remnant had travelled from the heart to the eye and lodged itself in the branch retinal artery. Asking the manufacturer of the material for details to prove causality had unforeseen consequences, as they responded as they would to a reported clinical incident, resulting in a temporary suspension of the suture material across Europe.”

February/March 2024 OTwww.optometry.co.uk 29

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VERSION REPRO OP SUBS ART

IP AND ME

CLIENT

OT presents a clinical scenario to three of its resident IP optometrists. Here, a MECS patient whose history reveals a failure to follow up on a glaucoma referral

Further questioning is needed on pro-dromal symptoms, or previous similar episodes. Evidence of iris whorling and/or glaukomflecken would be evidence of previous ............................................................................................................. ··················O significant episodes of acute raised IOP. I would also want to know whether there is a Glaucoma OT’s panel says... The scenario: Enhanced Case Finding or Glaucoma Ankur Trivedi (AT): Timely ‘An 80-year-old male patient Enhanced Referral Service in the area. management to preserve the presented for a Minor Eye Conditions remaining visual field and optic Service (MECS) appointment with nerve is a concern, but given Ceri Smith-Jaynes (CSJ): There eye pain and discomfort in both the possible recent escalation are many reasons for eye pain. At eyes. During history and symptoms, of symptoms I would look at the 27mmHg, the pressure isn’t currently it transpired that he had been possibility of there being a primary high enough to be causing pain, but referred for suspected glaucoma a angle closure element with a higher it could reach a much higher peak out year previously during a domiciliary intraocular pressure (IOP). of clinic hours. I’ll be referring him appointment, but had not taken the Van Herick could be used to gauge for glaucoma, but the urgency will referral letter to his GP. His pressure the angle, but better would be depend on whether I think the pain is was 27mmHg, and he had extensive gonioscopic examination. Is there caused by raised IOP. Acute glaucoma visual field loss and optic nerve any evidence of a narrow or closed rarely occurs simultaneously in both damage. How would you manage?’ angle, or any peripheral anterior eyes (although I have seen one patient in the past who this had happened to). synichae (PAS)?

THE AOP PANEL

PRODUCTION

ENCOUNTERING POTENTIAL GLAUCOMA AS AN IP OPTOMETRIST

Kevin Wallace

Ceri Smith-Jaynes

Ankur Trivedi

OCCUPATION: AOP clinical adviser IP QUALIFIED IN: 2012

OCCUPATION: Clinical multimedia editor IP QUALIFIED IN: 2018

OCCUPATION: AOP IP Councillor IP QUALIFIED IN: 2014

30 www.optometry.co.uk OT February/March 2024

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IP and me

The most important questions to ask

@)medmont

Ankur Trivedi: In this situation, the practitioner needs to ask themselves: do I have a higher qualification in glaucoma, as well as an IP qualification? Do I have good links with a local consultant ophthalmologist, ideally with a specialism in glaucoma? Ceri Smith-Jaynes: Taking a detailed history and symptoms is crucial here, including: do your eyes go red? Is your vision affected? Does the vision go foggy? Does this happen at the same time as the pain? Is the pain in both eyes at the same time? Does it always happen at the same time of day or night? How long does it last? What sort of pain?

His age is a risk factor. If he is a high hyperope or East Asian, my level of suspicion is raised. If he has mature cataracts, I’ll be concerned, but if he is pseudophakic he’s unlikely to get angle closure. Certain medications will also raise suspicion. The eye pain will need a full clinical work-up; I’ll be especially interested in the anterior chamber and angles with the slit lamp. We have OCT, but

“His age is a risk factor. If he is a high hyperope or East Asian, my level of suspicion is raised”

Getty/Nastasic

Ceri Smith-Jaynes I can only image the temporal and nasal angles with it. I’m not able to do gonioscopy. I may be an independent prescriber, but I wouldn’t treat glaucoma, ocular hypertension or primary angle closure myself. I don’t have a higher qualification in glaucoma and it’s not in my scope of practice. College of Optometrists’ guidance on independent prescribing states: “Optometrist independent prescribers may issue private prescriptions for any licensed medicines for conditions affecting the eye and the tissues surrounding the eye. This must be within your area of expertise and competence.” It adds that your ‘scope of practice’ is the limit of your own knowledge, skills and experience, in which you can be sure that you are practising

m idi ™

M t th n w Go d St nd d in o n Topog ph

safely, effectively and lawfully. For me, treating glaucoma just isn’t in my scope of practice. Those with a glaucoma diploma might handle it themselves. Kevin’s words ring in my ears from a lecture he gave: ‘Know your limits.’

Th w m dmo t m idi ™ dv c d Topog ph & comp t D ,alyser.

See us at:

Kevin Wallace (KW): I am glad to hear

that Ceri has listened to me. That is an important point – both for legal reasons and practically, it is important to practise safely. Clearly this patient needs to be treated for glaucoma, and in the absence of anything indicating angle closure I would refer him urgently, flagging the advanced field loss. Obviously primary open angle glaucoma is not an urgent condition, but this patient has been left too long, so it is important to get prompt treatment to retain as much vision as possible. Diagnosis of glaucoma can only currently be made by an ophthalmologist, so it doesn’t matter if you have a glaucoma qualification. With this level of IOP, I wouldn’t normally initiate treatment, but if the patient cannot be seen fairly soon, it would be appropriate to discuss the case with an ophthalmologist and ask whether they would like to you initiate treatment. It doesn’t sound like the pain or discomfort is related to glaucoma, so after ruling that out I would do the usual investigations to look for common conditions like dry eyes and meibomian gland dysfunction, as well as considering uveitis. 0 If you are unsure about how to manage a scenario in practice, please contact regulation@aop.org.uk

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February/March 2024 OT www.optometry.co.uk 31

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VERSION

A DAY IN THE LIFE OF A BUSINESS OWNER REPRO OP

05:30

SUBS

I wake up 5.30am. The first thing I do is make a gratitude list, then I get up and go to the gym. If I don’t do that, my partner and I will walk the dog. I’m basically like a dog myself: I need fresh air, exercise and food.

09:00

ART PRODUCTION

I arrive at the practice around 9am. We’ve got a posh coffee machine; that was one of the first things I bought. I was laughing with my partner. He was like, ‘Hayley, you haven’t even signed a lease yet, and you’re researching which coffee machine you want to buy.’ We’ve also got some electronic diffusers, so we switch those on early, to make sure the practice is smelling lovely when the first client arrives at 9.45am.

“OUR EYES AND OUR SIGHT ARE THE MOST IMPORTANT THINGS WE OWN”

18:00 NAME:

Hayley Brunsden

ROLE:

CLIENT

Currently we have a few clients day-today, but they are sporadic. I spend a lot of time connecting with the local community, going around the local businesses and introducing myself. I’ve To unwind, connected with some private I read... dentists and GPs.

12:45

16:45 The last client comes out at 4.45pm. My colleague and I are both contracted until 5.30pm, but the practice closes at 5pm, to give us enough time to make sure the client is getting the service that they need – whether that’s new glasses, or a cup of tea. It also gives us time to get the practice completely clean and closed, ready for the next day.

Owner of Beaconsfield’s CBTR Opticians, Hayley Brunsden, talks OT through a working day that starts with weights and dogs walks and ends with a cosy crime novel

11:00

Lunch is leftovers from the night before. I’ll then go out for a wander around the block. For the second half an hour, I will be manning the front of house while my colleague goes for lunch.

tea and coffee, but also wine. If a client turns up early, I’ll offer them a drink and we’ll sit and have a chat ahead of their appointment.

Owner of CBTR Opticians

LOCATION:

Beaconsfield

JK Rowling aka Robert Galbraith’s Cormoran Strike novels

14:00 In the afternoon, we will hopefully have clients in. We’ve got an extensive drinks menu, including

My fantasy practice... Our eyes and our sight are the most important things we own, and such a worthy investment. We’ve got one consulting room at the moment, so I’d like the practice to be a bit bigger. A lounge bar would be cool too –

It’s me and my partner at home. We will usually walk the dog again in the evening. We’re members at David Lloyd, so sometimes we’ll go and have a relaxing spa session for an hour.

19:00 My partner and I are both vegan, so dinner is always packed with nutrients. Often, it’s a veggie curry or chili con carne.

22:00 My phone goes off half an hour before I go to bed. I plug it in, set my alarm, and that is it gone for the night. I always read before bed. Reading is my passion, and I like to escape into fiction. I’ll read anything, but often it’s a crime or detective novel. 0 Read about Hayley’s day in more detail on the OT website: www.optometry.co.uk/ a-day-in-the-life

somewhere to sit and relax. If I could be visited in practice by one influential person, it would be Elton John. My dad and I have Watford season tickets, and Elton John is our chairman. He’s made wearing glasses so cool and fun. He makes such a statement with them. I would love that, and I would love him as a client.

February/March 2024 OT www.optometry.co.uk 33

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day in the life

Life in practice _

Pre reg VERSION REPRO OP

I have very different patients each day, each with their own individual needs, and I need to be prepared for whatever patient situation I am faced with. Some days it might be mainly refraction, whereas on others I might be doing contact lens appointments. This variety has been useful for giving me experience in different areas – experience that will stand by me in my career. I also have time at the end of my day where I can ask questions to my supervisor and complete any admin or my logbook for that day. This time is very useful, as it allows me to stay on top of things.

PRE-REG FOCUS SUBS ART

“I’VE ENJOYED BUILDING RAPPORT WITH MY PATIENTS”

The value of a supervisor

Day-to-day variety

My supervisor, Gareth Campbell, has been very helpful through every part of my pre-reg placement so far, supporting me in patient scenarios where I’ve not yet had much experience, and helping me learn through seeing these patients. We chat a lot. He checks in with me to see if there’s anything I need help with, and is very supportive of my learning. I also have a great network of colleagues, who have helped me through my pre-reg to this point, making my experience smooth and enjoyable. I’ve liked building rapport with my patients and being able to help them. This has been particularly rewarding when patients have left positive reviews about me after their appointment. It makes me feel like I have achieved something and gives me an extra boost of confidence. Another standout moment has been attending the Specsavers Pre-reg Academy, where I was able to meet up with old friends from university as well as pre-reg optometrists from other universities. Being there allowed me to hear about their experiences as pre-regs, as well as gaining expert knowledge from the different facilitators, which will be priceless when conducting my assessments. 0 -

One aspect that surprised me about the pre-reg period is how different each day is.

Read more from our Pre-reg Focus contributors online: www.optometry.co.uk/prereg-focus

Oran O’Connor, pre-registration optometrist at Specsavers Newtownards, on preparing for Visit two and the value of his supervisor PRODUCTION

·-·-·-·-·-·-··-·-·-·-·-·-·-·-·-··-·-·-·-·-·-·-·-·-··-·-·-·-·-·-·-·-·····-·-·-·-·-·-·-·-O

CLIENT

At the time of writing, I have successfully completed my Visit one and am currently studying and gathering patient records for my Visit two, which is approaching and scheduled to take place in January 2024. I’ve already gained so much experience and learnt so much during my pre-reg placement with Specsavers. It has helped me build on the communication skills that I developed at university. This is important, because I’m seeing patients with individual needs and varying circumstances. I’ve further developed my clinical skills, applying and translating the knowledge gained at university to real life. I’ve also learned through pre-reg some of the best ways to manage patients – including having the confidence to give advice. I’m more confident in bringing patients back for dilation appointments or reviews if this is necessary.

NAME:

Oran O’Connor

ROLE:

Pre-registration optometrist at Specsavers

LOCATION:

Newtownards

LIZZIE SAYS My favourite part of the pre-reg is... Becoming more confident. There are moments where I notice how far I’ve come. Every day is gratifying, but there are some special days when it sinks in that I really can do this. My least favourite part of the pre-reg is... Feeling slow with testing. It can be hard to put knowledge into practice, and it can feel dejecting having to ask questions.

Before I started my pre-reg I wish I’d known... That it is difficult, and that’s ok. Sometimes you feel like it will never click, but things do come together. It’s worth the wait. Lizzie Shaw is a pre-registration optometrist at Moorfields Eye Hospital

34 www.optometry.co.uk OTFebruary/March 2024

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VERSION REPRO OP SUBS ART CLIENT

FUTURE GAZING: WHAT WILL OPTOMETRY LOOK LIKE IN FIVE YEARS’ TIME? Auto-refraction, AI, revamped education requirements and GOS contracts – with the strong possibility that High Street optometry could look very different in the near future, OT asked two practitioners for their predictions

··································································································································································································································O

Optometry in five years’ time Helen Tilley (HT): I’ve been in optics for

over 30 years now. I’ve worked within Optometry Wales, our Regional Optical Committee, and the General Optical Council, to make sure the profession moves with the times. We foresaw that, if the profession clinically skilled up, it would be much better prepared. In Wales, the Government understood this, and that’s why we have the new contract – because it believes glasses sales are not going to sustain businesses. If we had carried on as we were, we probably wouldn’t have a profession. There is unlikely to be an absolute necessity for optometrists to test

eyes. Certainly, booths are taking over the refraction side of things. Glasses can be made on 3D printers. The only way that the professional will survive, further down the line, is by upskilling clinically and taking work from the hospitals. The hope is that this will continue. Andy Britton (AB): I want to be

practising at the top of my optometry game. We should be aspiring, within the next couple of years, to more routinely be doing lacrimal lavage. More of us should be fixing punctal plugs. We should be looking at new technologies, including intense pulse light for meibomian gland

36 www.optometry.co.uk OT February/March 2024

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dysfunction, and at whether the evidence base is growing so that we can offer red light therapy for myopia management in practice. We need democratisation of myopia management, because 50% of the world’s population is going to end up myopic – but the cost of providing it is beyond the will of governments, in the current economic climate. Unfortunately, it is also beyond the financial threshold for many families. I wrote a paper on behalf of the Welsh Optometric Committee, which was then picked up by one of the clinical advisers to the Welsh Government and taken to Health Technology Wales. They established

Getty/GeorgePeters

PRODUCTION

A CONVERSATION ABOUT...

that myopia management is a valid and economical intervention for children with myopia, and that there should be a degree of funding on the NHS for orthokeratology and multifocal soft contact lenses. Myopia management is something that has to be mainstream within five years. HT: In Wales, it will become evident

over the next few months that we can operate at the top of our licence. We are taking work away from the hospital. We have been doing a glaucoma clinic for years now. That will become more autonomous, because we have higher qualifications. We have a low vision clinic within practice. For about 15 years, the low vision clinic has not been in the hospital. We’re doing a lot more clinically. A decade down the line, the businesses who don’t evolve may struggle.

The most important skill for optometrists of the future AB: Communication. Too many medical professionals might have been the smartest cookies at school, but we need to see an improvement in ability to communicate with people. If you communicate well, you get much more out of your patients. On a purely practical note, I think we’re going to see an explosion in independent prescribing. I think we can almost take that for granted. An ability to understand business is going to be important, along with more of an understanding that you can’t be just clinical or commercial. You’ve got to get that balance right. HT: Taking responsibility, making

decisions on clinical events that come through their practice, and

having the knowledge to back them up. It’s a skill I am passionate about. If somebody refers something because they don’t know what to do with it, I don’t think that’s going to be acceptable anymore. Taking responsibility is a big sea change that needs to happen within the profession.

The last word on where optometry should go next AB: I am quite old now, in optometry terms, but I still feel I’m practising at the top of my licence. I’m not trying to see as many patients as I can to get a conversion rate. I’m trying to do the best by every patient I see and trying to use my skills, and that has enabled me to have a job I still love after 27 years. I’m proud to call myself an optometrist. Specsavers has enabled me to develop my skills, see the patients that I want to see, and to formulate a model of eyecare that’s going to deliver enough capacity to make a real difference to secondary care. That’s key.

A conversation about

Thomson Software Solutions

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Monmouth, Monmouthshire

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01707 414 700 www.thomson-so�ware-solu�ons.com

91OPTJAN24157.pgs 31.01.2024 12:43

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EYES ON 100% OPTICAL

CLIENT

As schedules are finalised and bags are packed ahead of the 10th edition of 100% Optical, OT heard the latest on the education programme, exhibitor list, and upcoming launches

he attention of the UK optometry profession is turning to 100% Optical, taking place between 24–26 February. OT sought to gain the latest updates as the final details are revealed ahead of the show. Bookings opened in January for the packed education programme, curated by the AOP as the show’s official education partner. Discussing the event, Dr Ian Beasley, AOP head of education, and OT clinical editor, shared: “Professionals can expand their scope of practice through taking the opportunity to broaden their understanding and consolidate knowledge.” “Be open minded. Have a full look at the programme and see what areas appeal, or if you have an idea of what you already love, then pick out the relevant sessions of interest,” he advised. “The show provides a great opportunity to network,” he added. “In a world of hybrid education, there are benefits that only face-to-face events can bring; the serendipitous conversations in the breaks or at the water cooler, or bumping into people you wouldn’t expect.”

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In the countdown to the show, for delegates who have booked onto education sessions in advance, Beasley recommended taking the opportunity to review plans ahead of the event. “Due to popular demand, please cancel any sessions that no longer fit with your plans, to release capacity for others to attend,” he said. Beasley emphasised that space is reserved in the programme for walk-ins, and so delegates without bookings will have the opportunity to drop-in to sessions during each day of the show on a firstcome first-served basis.

Trends, launches and more The organisers at 100% Optical highlighted sessions that will explore the evolving trends, including analysts from Euromonitor who will discuss consumer trends for the year ahead, and Selin Olmsted, co-founder and creative director of Selin Olmsted Studio, who will deliver a session outlining nine trends defining eyewear in 2025. In the exhibition, Zeiss is set to host the UK launch of the Zeiss Atlas 500 corneal topographer on its stand (M300).

The solution offers corneal topography, pupillometry and dry eye assessment from a single device. Grafton Optical (stand M440) will host a giveaway of a QuickSee Free Handheld Auto Refractor. Those who book a QuickSee demonstration at the show will be entered into the prize draw. In the world of frames, Caron Eyewear is launching a new brand, ION, which will embrace unisex fashion. In addition, the show will see its largest presence of contact lens manufacturers ever, as Alcon joins the show for the first time. 100% Ophthalmology will debut this year as a co-located event with 100% Optical, with sessions sponsored by Birmingham Optical, Haag-Streit UK and Zeiss.

Professional development and practice OT heard from practice groups and community ophthalmology service providers about what delegates can expect to see from their booths and on-stand education programmes. Newmedica will be delivering education and information from its stand (M250), where delegates will be able to have a go at eye surgery using virtual reality headsets. A spokesperson said: “We will be running three CPD sessions each day. These cover a wide range of topics including general ophthalmology, effective communication and intraocular lens choice, and will be held in the Future Practice area.” Mahmoud Rabie, consultant ophthalmic surgeon and clinical director of ophthalmology for CHEC (Community Health and Eyecare), shared that visitors to the CHEC stand (B622) will be able to gain an experience of living with glaucoma, cataracts, and other eye conditions, then conduct a simulated gonioscopy assessment or wet age-related macular degeneration injection.

KEEP UP WITH OT AND THE AOP As the official media and show partners for 100% Optical, follow OT’s coverage of the show through social media and its dedicated webpage: www.optometry.co.uk/100-percent-optical Meet with experts from the AOP and attend a diverse range of CPD.

STAND W310

“Our clinical grade simulator spectacles will enable stand visitors to experience what eye conditions are really like for patients to live with every day. We’ll then show them how we treat these conditions at our community facilities and give visitors the chance to carry out the procedures themselves using our state-of-the-art surgical training equipment,” Rabie said. Grant Duncan, Specsavers director of professional development, said the on-stand CPD (L210) will feature the most popular sessions from the Professional Advancement Conferences, covering each of the core domains. “Topics include how wellness influences clinical performance, an independent prescribing session on how to deal with conditions affecting the anterior eye, the obstacles experienced by people living with low vision, an exploration of contact lens related conditions and a session dedicated to the provision of eye care for those experiencing homelessness,” Duncan shared. Hakim Group will gather at stand B250, with Sally Litchfield, head of people at Hakim Group, sharing: “Our focus at 100% Optical 2024 is to showcase our commitment to attracting the very best talent in the optical industry. We’ll be highlighting the exciting career and ownership opportunities we offer across our family of independent practices.” Luke Wren, head of business development at Hakim Group, added: “We are excited to connect with business owners, who are looking to explore the future possibilities for their independent practice as well as those individuals who don’t currently own a practice, and are looking into independent practice ownership as the next chapter in their professional career.” Here’s to a 2024 show of innovation, growth and connection. 0 Get in touch with OT to share your stories from 10 years of 100% Optical: newsdesk@optometry.co.uk

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100% optical

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Supporting presbyopic patients to achieve contact lens success Eye care professionals from the Vision team at Johnson & Johnson MedTech share their approach to educating patients on presbyopia

PRODUCTION

Bridging the presbyopia chasm Rachel Hiscox, professional education and development lead on the opportunity of multifocal contact lenses:

CLIENT

Despite the growing number of people with presbyopia, there is a ‘presbyopia chasm,’ with the percentage of multifocal lenses fitted in practices remaining low.1 In fact, whilst eight million out of the 15 million presbyopes (aged 45 years and older) in need of vision correction are open to wearing contact lenses, only 3% of these potential wearers are in a multifocal contact lens.2 A successful multifocal contact lens fit can provide eye care professionals (ECPs) with an opportunity to see the positive impact they can have on a patient, including quality of life improvements by enhancing day-to-day activities, such as exercise or working on a digital device. Multifocal contact lenses also have the potential to add value for practices, as 89% of contact lenswearing presbyopes are dual wearers and spend 3.2 times more annually than glasses-only wearers.3 Unfortunately, 62% of those over 45 years old will drop out of wearing contact lenses as they develop presbyopia due to their vision needs no longer being met.3 To help prevent dropout,

Johnson & Johnson has focused on innovation across the multifocal segment, aiming to improve the contact lens experience for presbyopes. The latest innovation, ACUVUE® OASYS MAX 1-DAY MULTIFOCAL, providing MAX comfort and MAX clarity* for all day comfort and clear vision, near far and in-between.**⁴ This ensures that the benefits of wearing multifocal contact lenses are maximised for the patient. ECPs play a vital role in empowering and educating their presbyopic patients about the contact lens options available to them. Johnson & Johnson helps support ECPs in fitting multifocal contact lenses through their extensive professional affairs team and numerous CPD programmes, offered face-to-face and online. The first three episodes of the Vision Matters Podcast by Johnson & Johnson focus on enhancing ECPs’ knowledge and skills to successfully manage presbyopes with a variety of optical solutions and can be easily accessed on Spotify and other platforms.

Rachel Hiscox Professional education and development lead

VOICES FROM THE VISION TEAM AT JOHNSON & JOHNSON MEDTECH ................................................................

Faye McDearmid

James Hall

Robyn Marsden

Optometrist and professional affairs consultant

MECS contact lens optician and professional affairs consultant

Optometrist and professional affairs consultant

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JOHNSON & JOHNSON MEDTECH

OT heard from three eye care practitioners on their approaches to presbyopic patients and multifocal contact lenses “There is a big grey zone between being comfortable and uncomfortable” Faye McDearmid, optometrist and professional affairs consultant: I think there are three types of presbyopes and you need to treat them all differently. There are people who have always had really good vision, and so when they experience presbyopia, it is the first time they have needed vision correction. Then there are people like myself, a long-term contact lens lover, who will get to a stage where it is harder to read with lenses in. Finally, there are people who are happy wearing glasses but find that a varifocal spectacle lens doesn’t suit their lifestyle. As a patient begins to experience presbyopia, I reassure existing contact lens wearers that they can remain in contact lenses, as they might not be aware of the different options available to them. For those who might require their first vision correction, this is an ideal opportunity to highlight the different solutions and say: “Let’s learn about you, and your visual needs on a day-to-day basis and see what we think is going to fit.”

“I THINK THERE ARE THREE TYPES OF PRESBYOPES”

Shutterstock

Faye McDearmid, optometrist and professional affairs consultant for Johnson and Johnson I have a lot of patients in my practice who play golf. I ask them: ‘If you were to pick one club, which one would you play the whole round with?’ When they say that they would never do that, I explain that it’s the same with vision solutions. You can have one that does everything, but it is probably not going to be perfect for everything. Whereas, if we can look at matching the benefits of each vision solution with a task, then we can get the best of all the technology. I always use the online fitting calculator. I know it inside and out, but I use it because it is so important that you choose the multifocal lens parameters that the manufacturer intends you to use. I plug the numbers into the calculator in front of the patient. I will explain that this is our starting point, but that I can provide them with more bias for distance or near vision depending on their experience of wearing the lenses.

In an aftercare, if you ask your patient whether everything is ‘okay’ with their contact lenses, they will typically say yes because they are worried to reveal a potential issue that might stop them wearing lenses. I ask my patients to rate how comfortable their contact lenses are out of 10 in the morning, the middle of the day, and the end of the day. Whatever the score is, I ask what would make it a 10? There is a big grey zone between being comfortable and being uncomfortable. We owe it to people to spend time considering: is the lens they are wearing still the one I would fit now, if they were a new client?

“I get my patients to enjoy presbyopia” James Hall, MECS contact lens optician and professional affairs consultant: For me, the worry is the potential for contact lens drop out as people become presbyopic, because of the perception that they will no longer be able to wear their contact lenses. As a contact lens optician, that is where I love to jump in and say: “No, in fact, you have more options now than you had before.” I see it as an opportunity to create a lifelong relationship with the patient. One thing I see pre-presbyopic, or presbyopic patients do now, which they never used to, is use their phone torch or take photographs and blow the image up to see better. Another indicator of presbyopia is that the patient stops doing things that they used to love. Often the reason they have stopped is because they can’t see and so think they can’t do it anymore. I explain that it’s a normal change. Presbyopic patients can feel like they are getting old, which is not a nice thing to go through – especially if you are the first one in your peer group. I talk to patients about presbyopia before they have the issue and tell them to give me a call when it happens so I can help them out. I’m passionate about discussing vision options for different activities and celebrating these with patients. They could have a multifocal contact lens 90% of the time but have a distance pair for when they go to watch football. I tell patients that, just because we fitted one lens, it doesn’t mean there isn’t another option. I give trial lenses to people who are happy in their contact lenses. As an analogy: I have a smartphone, and I’m pretty happy with it, but if somebody asked if I wanted to trial the latest model for a week or two for free, then I’d probably say yes. So even if somebody has no complaints, I might ask them to try a new lens and give me their feedback on it. ►

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IN CONVERSATION, 1

In partnership with _

IN CONVERSATION, 2

JOHNSON & JOHNSON MEDTECH

REPRO OP SUBS ART PRODUCTION

It’s really important to monitor a patient’s wearing behaviour. If a patient asks to cancel their contact lens or solutions subscription because they have a backlog, I will always ask why – because that means they are not wearing the lenses. We need to look out for those little cues. When you fit multifocal contact lenses and it becomes just a part of what you do, you see people’s lives transformed by them every day. I’ve had people tell me: “You’ve given me my eyes back.” I don’t worry about the odd one that doesn’t like them, because you will get that with glasses, but it doesn’t stop you selling varifocals. I get my patients to enjoy presbyopia instead of enduring it.

The power of a recommendation

CLIENT

You can choose to look at that if you wish, but if someone comes in and points out the Patients with presbyopia cat in the tree, you will look are most influenced by an straight through the window eye care professional when at the cat, and no longer see it comes to information the glass there. Your brain about contact lenses, switches focus.” Johnson & Johnson I explain that multifocal has found contact lenses tap into that, working with the brain. This breaks down a lot of barriers, of existing wearers use the lens because patients already have brand recommended to them by that skill, and realise this is their optician something they can work with. When fitting multifocal contact lenses, you have to of patients are unaware of consider both visual comfort multifocal contact lenses and physical comfort. Source: Johnson & Johnson data. As a patient approaches presbyopia, the tear film is less stable and contact lenses can be more difficult to wear from a physical comfort perspective. Personally, I find it vital to know the material properties of the contact “Materials really matter lenses available to me, so I’m confident that I am choosing the right material from the outset. in the presbyopic eye” Materials really matter in the presbyopic eye and Robyn Marsden, optometrist and professional affairs can affect both the physical and visual comfort. If consultant: Contact lenses give patients the your material can integrate well with the patient’s opportunity to have freedom from their glasses. tear film, it makes a difference to how they see I encourage dual wear with my patients; glasses because the tear film is the first surface the light are great, but it is about being able to give them rays encounter. If the tear film is as calm as a convenience and letting them know there are millpond and not disturbed by the material, you get choices in how they correct their vision. much crisper vision. As optometrists, we see people who are It’s also important to tell patients that, if we go for presbyopic multiple times a day, but for the patient a particular correction option and it isn’t perfect for it’s a new concept. One of the barriers to patients them, there are other options available. Make sure wanting to try multifocal contact lenses is that they they know they can come back to you. Whenever I fit might know that varifocal glasses require them to move their head, but because they don’t understand someone with a multifocal, I will follow them up a few days later to ask how it is going, and what their how this would work in a contact lens, they might vision and comfort is like. I will reiterate that if it be afraid they won’t be able to do it. The patients isn’t right, we can try another solution. 0 who are brave enough to ask will say: “How do I move it so I’m looking through the right bit?” As a profession, I think we’re probably missing a lot of people who just decide to not even ask about contact lenses. A list of references, along with the Educating patients is a really key part of our job. full series of In Conversation with Wherever possible, we should preempt presbyopia Johnson & Johnson MedTech, can and let patients know about the great solutions be found on the OT website. available for once it happens. I think one of the ways ACUVUE® Contact Lenses are indicated for vision to break down the barrier is letting them know correction. For detailed product description and safety that multifocal contact lenses are very different to information, please consult the Instructions for Use varifocal glasses, and work in a different way. or visit the Johnson & Johnson Vision website Most patients just want a simplified explanation https://jnjvisionpro.co.uk/instructions-for-use of how they work. I tend to use the raindrop analogy: “Imagine a drop of water on a window.

80%

>40%

Shutterstock

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Optometry Today

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Association of Optometrists

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n,e Eyes Have It ;, a partnersh;p of MacularSodety, F;ghtfor s;ght / v;siooFoundation,RNIB, Assodat;on of Optometrists, The RoyalCollege of Ophthalmolog;stsand RocheproductsLtd. Roehe has funded the activities of the partnership.

FIVE INSIGHTS FROM

Matthew Kaltenborn

WESTMINSTER EYE HEALTH DAY 2023 Data connectivity, a focus on prevention, equity of access to eye care: The Eyes Have It set out clear policy asks during its third Westminster Eye Heath Day _ WORDS: LUCY MILLER ►

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In focus, 1

In focus _

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eld at the Houses of Parliament in December, Westminster Eye Heath Day 2023 was underpinned by a new report that detailed seven key policy asks ahead of a 2024 general election. Commissioned by The Eyes Have It coalition, it is hoped that the Laying the foundations for the future of eye health in England report will provide a clear path of action towards a national eye health strategy. As Britain’s political parties shored up their manifesto plans, OT spoke to attendees from the eye health sector – including representatives from membership bodies and key sector charities – for their insight on where we are, and where we should go next.

PRODUCTION

Data connectivity is key

CLIENT

AOP chief executive, Adam Sampson, was unequivocal about the most vital eye health development that optometry should see in 2024: “IT connectivity is an absolute must for the next 12 months,” he told OT. ‘Data, connectivity and real-world evidence’ is the first point laid out in the report. So, what does that mean in practical terms? The report says: “NHS England should work with commissioners, clinicians and industry to increase IT connectivity and digital clinical image interoperability within and between primary and secondary care providers through the deployment of a single, consistent mechanism for image sharing,” adding that this would, “facilitate timely, secure and effective communication to improve patient care, streamline referral pathways, facilitate quality improvement and aid learning.” NHS Digital and the Department of Health and Social Care should also collect, publish and analyse more comprehensive data to support service and workforce planning and development and patient access to services, the report added. Optometrist and AOP Councillor, Tushar Majithia (pictured), agreed, whilst acknowledging that steps forward have already begun to take place. “We’re really hopeful that there will be more developments with regard to sharing of data, sharing of patient information between organisations to improve patient care, and greater development of pathways on a national level, to help reduce the backlog in waiting times,” he said.

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The key asks of a National Eye Health Strategy 1. Data, connectivity, and real-world evidence 2. Prevention, diagnosis and early intervention in an integrated system 3. Increased equity of access, support and patient empowerment throughout the patient pathway 4. Increase in the eye care workforce, alongside development and upskilling 5. Use of new technologies and treatment models 6. Investment into research for future treatments 7. Availability of treatments. Source: The Eyes Have It’s Laying the foundations for the future of eye health in England report, November 2023.

Optometry should be further utilised

Fellow optometrist and AOP Councillor, Josie Evans (pictured), highlighted how important Westminster Eye Health Day is in putting optometry at the centre of the conversation. “It’s really exciting that we’re raising awareness of optometrists, because they do so much excellent work in community eye care practices across the nation, and yet sometimes they aren’t utilised,” she said, adding, “hopefully we will come together to build a solution that lasts for the future and is sustainable and helps our patients.” Evans believes a solution that “allows us to be the first port of call for patients, that is commissioned across the nation, and that utilises independent prescribing, would be a really good place to start.” She added that “encouraging the prescribing powers of community optometrists, so that if we do suspect or have a clear diagnosis in the community, we can start with prescribing, treating and managing that patient before they get into the hospital so that their treatment isn’t delayed,” would be the ideal scenario. Outgoing chief executive of the Macular Society, Cathy Yelf, agreed that optometry needs to be given the space to step up.

Speaking about how to redesign the eye health system so that it meets capacity and works efficiently for both the NHS and for patients, Yelf said: “We know that the optometry profession is underused, and the only contract that we have nationally is for a very small part of the eye care services that optometrists could be providing. We can’t afford to waste this resource.” She added: “We have a strange system, where primary eye care is in the private sector and secondary care is in the NHS, and at the moment these two systems are not efficiently joined together. They need to be joined together. We need to look hard at the way eye care in primary care settings is commissioned and paid for by the NHS, otherwise we simply cannot expand the capacity enough. This is a vital resource, that needs to be employed properly.”

The whole eye health sector needs to be united in its purpose

across the field. At the moment, NHS services are under unprecedented demand.” This is a key reason why The Eyes Have It and the Laying the foundations for the future of eye health in England report is calling for a national eye care plan, Rivett said. Keith Valentine, chief executive of Fight for Sight/Vision Foundation, highlighted that “one of the things that has been important to The Eyes Have It is its pragmatism.” The organisation brings together stakeholders from optometry, ophthalmology, pharmaceuticals and the charity sector under one campaigning umbrella, and Valentine noted that he has seen “more coordination between organisations, and a willingness to be open in planning from professional bodies, charities, and the system itself.” He added: “The trick is to not spend too much time celebrating that we’ve got all the Lego bricks, and to start to build something out of them.”

MP Marsha de Cordova, hosting Westminster Eye Health Day, made it clear that “from industry to health to the voluntary sector, Success is often opportunistic together we must continue to push for this That’s the view of Sampson, who told OT change within eye health, and push for elements that Westminster Eye Health Day is an of the strategy to be included in all manifestos opportunity to engage “people who happen to be for all political parties ahead of the general passing; people who know MPs” – in short, those election in 2024.” who might have the ear of policymakers in an She added: “Our message is simple: everyone informal way. should have access to high quality eye health “That is really important,” Sampson said, care when and where they need it.” “in both reinforcing messages to MPs who are Ali Rivett, chief executive already engaged and seeking to of the Royal College of engage MPs Ophthalmologists (RCOphth), who have no previous experience told OT that, alongside in this.” workforce expansion and the So, what is the value of these commissioning of services in incidental interactions – over the a more sustainable way, his coffee table or in the cloakroom organisation’s other big ask is queue – in terms of political coordination between primary engagement? and secondary care – something “Let’s all remember that there that he would like to see will be a general election, at some Cathy Yelf, outgoing progress on by the end of 2024. point, during 2024,” Sampson said. chief executive of the “The Eyes Have It helps us He added: “That means that Macular Society talk in a coordinated voice there has got to be a target of across the sector,” Rivett said. getting engagement with all the He continued: “It’s not just the RCOphth political parties over the next 12 months, to talking about ophthalmology as a specialty. It’s make sure eye health does actually feature as across the eye care sector and community as a a major manifesto promise, and that the new whole, and that’s the value of this partnership. It government, whoever they might be, come in is more powerful for us to talk as a collective.” ready and equipped.” Rivett added: “The challenges facing Having an ear to the ground, it seems, is key ophthalmology aren’t just challenges for – whenever the general election might be, and ophthalmology, they’re challenges for patients beyond polling day too.

We know that the optometry profession is underused

►

February/March 2024

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“There has got to be a target of

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getting engagement with all the political parties over the next 12 months Adam Sampson, AOP chief executive

PRODUCTION Matthew Kaltenborn

CLIENT

Now is the time for optimism

Valentine believes that “we should be optimistic about the right investment and the right development in the system making a profound difference to what is possible.” “This report represents a really exciting opportunity for us to look forward to an environment where eye health, which is critical to the productivity of our country and to making sure employment rates are where they should be and that we’re dynamic and creative and forward looking, is got right,” he added. Sampson believes that Westminster Eye Health Day “gives an opportunity to reflect: Where are we? What have we achieved in the past 12 months? What is the trajectory, and what do we need to do next year?” “It’s really important that each year, we recognise what has gone well, what has gone badly, and what is still left to do,” he said. “It’s very positive.” Valentine added: “I think this is a moment for optimism, because the sector is pulling together to try and get something done. “The Government is acknowledging and is aware that there is a call for a national plan. There’s a degree of impetus to see a connection between the eye health of the nation and the country’s productivity and the way that it functions.” So, what comes next? How can the eye health sector ensure that the key points set out in The Eyes Have It’s report become actions rather than remaining as recommendations?

“The critical thing is not to overcomplicate things, and to focus on the things that are going to take us forward, but with a north star that it is simply not sustainable for us to continue like this,” Valentine said, He added: “We have not faced this level of sight loss within the community before, because the success of the NHS is that the population is living longer, and therefore experiencing these conditions. This is the right time to be fixing it. Technology is capable of doing that. Interoperability in the system is critical. But we must step forward together if we’re going to get it done.” Vivienne Francis, chief social change officer at Royal National Institute of Blind People, agrees that “there is goodwill” when it comes to improving eye health systems. “I think people are coming together and that there’s hope at the moment,” she told OT. “I think it is timely, because you juxtapose that with the scale. Around two million people have sight loss right now. By 2050 that will be four million, with costs to the NHS rising to around £33 billion. That urgency is there, and that need to come together to fix this now.” 0

Lucy Miller OT deputy editor. Get in touch by email: lucymiller@optometry.co.uk

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FOR OPTOMETRISTS, SPECIALTY OPTOMETRISTS, DISPENSING OPTICIANS AND CONTACT LENS OPTICIANS EXAMS CLOSE: 4 MAY 2024

Sponsored by:

SUBS

Alcon

SEE

BRILLIANTLY

Ocular ischaemic syndrome ART

0.5 CPD

This short article outlines the key features of ocular ischaemic syndrome (OIS), which is an uncommon but serious disorder that can be vision- or life-threatening.

POINTS

0 Dr Adel Ebraheem MD, MS, OD ............................................................................................ PRODUCTION

ANTERIOR COMMUNICATING ARTERY

Introduction

CLIENT

Transient visual loss (TVL) or amaurosis fugax (AF) can be either monocular or binocular. Transient loss of vision is a relatively common symptom that patients can present with to the ophthalmology or optometry practice. Sometimes it is challenging to differentiate between ocular ischaemic syndrome (OIS), central retinal vein occlusion (CRVO) or diabetic retinopathy. The underlying cause can be sight- and/or life-threatening, so it is important to confirm the diagnosis and aetiology through a systematic approach to investigation.

Circle of Willis The circle of Willis surrounds the stalk of the pituitary gland and facilitates vital connection between the internal carotid and vertebrobasilar systems, which feed blood to the forebrain and hindbrain. The anterior cerebral artery (ACA) and middle cerebral artery (MCA), which are the two primary branches of each of the right and left internal carotid arteries (ICAs), enter the cranial cavity and start to construct the circle of Willis. Following its union, the anterior communicating (ACOM) artery allows blood to travel between the ACAs. The posterior circulation is created by the basilar artery (BA), which is generated posteriorly by the left and right vertebral arteries, and its

MIDDLE CEREBRAL ARTERY

OPHTHALMIC ARTERY

INTERNAL CAROTID ARTERY

ANTERIOR CHOROIDAL ARTERY POSTERIOR COMMUNICATING ARTERY

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ANTERIOR CEREBRAL ARTERY

Uv 0 ~\) ....c::::::::~

--,_-=:-,,._

~_)

PONTINE ARTERIES

SUPERIOR CEREBELLAR ARTERY

-~~ BASILAR ARTERY

FIGURE 1

The circle of Willis

POSTERIOR CEREBRAL ARTERY

CPD 1, 1

50 Ocular ischaemic syndrome 53 The case for measuring blood pressure in the community

60 Emerging light-based and thermomechanical therapies for dry eye disease 66 Assessing and managing digital eye strain in clinical practice

branches, the left and right posterior cerebral arteries (PCA). The posterior communicating (PCOM) arteries connect the PCAs to the anterior circulation created by the ICAs to complete the circle of Willis (see Figure 1).

Retinal blood supply The ophthalmic artery (OA) is the first major branch of the ICA and enters the orbit within the optic nerve’s dural sheath, travelling into the optic canal beneath and to the side of the nerve. The central retinal artery (CRA), which is one of the OA branches, enters the meningeal sheath 10-12 mm behind the globe. The CRA enters the optic disc approximately nasal to the centre before branching superiorly and inferiorly; these then split into nasal and temporal branches. The short posterior ciliary arteries (SPCAs) are branches of the OA, which originate as one, two, or three branches that develop into 10 to 20 branches. They establish the vascular network within the choroidal stroma.

“OIS IS CHARACTERISED BY DOT HAEMORRHAGES AND MICROANEURYSMS IN THE MID-PERIPHERY, BUT IN CRVO, HAEMORRHAGES ARE FLAME-SHAPED” Ocular ischaemic syndrome (OIS) OIS is an uncommon, vision-threatening condition that is caused by severe carotid occlusive diseases. The elderly male population is affected more than women due to the higher incidence of atherosclerotic disease in men.1 OIS

occurs more commonly unilaterally with around 20% of cases showing bilateral OIS manifestations.2 The severity of OIS depends on the degree of carotid artery occlusion, the presence of collaterals and the chronicity of systemic vascular diseases.3 Healthy collateral blood circulation may act as a barrier to developing OIS even in the case of complete occlusion of the ICA. Although giant cell arteritis, Eisenmenger syndrome, and other inflammatory disorders are among potential aetiologies, atherosclerosis is the most frequent one.

Clinical manifestation of OIS OIS may be asymptomatic in some cases with signs identified during routine eye examination.4 Vision loss is the initial symptom of OIS and can range from 6/12 to counting fingers. Around 15% of patients complain of transient vision loss that lasts for a few seconds or minutes. Visual fields can vary from normal to different forms of impairment including central scotoma, nasal defect or centrocaecal defect.5 Transient sight loss can be caused by conditions that either raise the metabolic demands on the retina or lower the perfusion pressure, which shows that the ocular circulation is not stable enough to keep the ocular blood flow constant; this has been shown after exposure to strong light, posture adjustment, or mealtime. Fewer than 50% of patients present with eye pain,5 which may be due to a rise in intraocular pressure (IOP) or due to the ischaemic effect. The ocular pain is characteristically dull in nature and constant over the face, orbit or temple. The ischaemic pain increases when the patient stands upright, while lying down lessens the discomfort. Anterior segment signs include iris neovascularisation in 75% of cases and 20% of patients have an anterior

WHAT YOU NEED TO KNOW C-107185 LEARNING OUTCOMES 0 Optometrists will be able to

identify the signs and symptoms of ocular ischaemic syndrome to guide patient management 0 Dispensing opticians will recognise the signs and symptoms of ocular ischaemic syndrome.

•r~ 8 chamber reaction. The IOP can be low, normal or high.6 Haemorrhages, microaneurysms, constricted arteries, tortuous veins and neovascularisation of the optic disc, retina, or both, are common retinal abnormalities. The retinal haemorrhages due to carotid occlusive disease are usually deep and located in the midperiphery of retina.6

Differential diagnosis It is important to differentiate between OIS, diabetic retinopathy (DR) and central retinal vein occlusion (CRVO). The retinal veins in OIS are dilated but not tortuous; however, in DR, the veins are typically dilated and beaded, and in CRVO, they are dilated and tortuous. OIS is characterised by dot haemorrhages and microaneurysms in the mid-periphery, but in CRVO, haemorrhages are flame-

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“GIVEN THE SERIOUS IMPLICATIONS OF OIS, IT IS IMPORTANT FOR PRACTITIONERS TO BE AWARE OF THE KEY CLINICAL FEATURES TO HELP IDENTIFY CASES IN PRACTICE AND MANAGE PATIENTS”

ART PRODUCTION

shaped, present in the nerve fibre layer in all quadrants. In DR, dot and blot haemorrhages are located mainly in the posterior pole. Hard exudates are common in DR, but they are absent in OIS and rare in CRVO. OIS is characterised by the presence of macular telangiectasia. In contrast, optociliary shunts are one of the main findings in CRVO, and intraretinal microvascular abnormalities (IRMAs) are common in advanced degrees of DR.

CLIENT

Medical investigation Carotid artery auscultation An aberrant vascular sound called a carotid bruit can typically be detected by placing a stethoscope over the carotid artery. The sound of blood rushing through a constricted area of an artery is known as a bruit. It is often helpful to ask the patient to hold their breath during the auscultation. There are three anatomical locations in which carotid bruit can be detected: the base of the neck; the midcervical area; and the angle of the jaw.

Fluorescein angiography OIS can be diagnosed with the aid of fluorescein angiography.7 Normal fill times for the choroid are five seconds after the dye first appears in the choroidal vessels. Most eyes with OIS exhibit patchy or delayed choroidal filling. In eyes with OIS, arterial and early- and late-venous circulation durations are likewise lengthened.

Indocyanine green (ICG) angiography ICG angiography enables a more accurate assessment of choroidal vascular anomalies.8 Both the armto-choroid circulation time and the

intrachoroidal circulation time are prolonged.

Electroretinogram (ERG) While the a-wave of the ERG relates to activity of photoreceptors, the b-wave corresponds to activity of Müller and/ or bipolar cells and represents the functional condition of the inner retinal layer. There is ischaemia of the inner and outer retina in eyes with OIS, where both the retinal and choroidal circulation are impaired, leading to a reduction in the amplitude of both the a- and b-waves.9

Visual evoked potential (VEP) After being exposed to severe light stimulation (photostress), VEPs in OIS exhibit an increase in latency and a decrease in amplitude which improves after surgical correction of carotid artery occlusion.

Treatment Management of OIS should involve retina and glaucoma, cardiology and vascular surgeon specialists. Steroids are used as topical therapy to reduce anterior segment inflammation and cycloplegics to stabilise the blood-aqueous barrier and restrict iris movement to lessen the chance of a spontaneous hyphema. In cases of elevated IOP, ocular hypotensive medications that lower aqueous outflow, including topical and/ or oral carbonic anhydrase inhibitors, are used. In patients with ocular neovascularisation, panretinal photocoagulation may be beneficial. In case of development of neovascular glaucoma, it is frequently necessary to do trabeculectomy

using antimetabolites or aqueous shunt implants. Treatment of iris neovascularisation and cystoid macular oedema (CMO) complicating OIS may require intravitreal antivascular endothelial growth factor (anti-VEGF). Carotid artery endarterectomy should be performed to remove the cholesterol plaque from the carotid arteries.

Prognosis At five years, the total mortality rate for OIS patients is 40%, with myocardial infarction (typically 67%) and cerebral infarction (19%) being the two main causes of death.2 Neovascularisation of the iris has been demonstrated to be a poor prognostic sign, progressing to counting fingers or worse in 80% of patients who initially had this complication at presentation or who developed it within three months of initial diagnosis.

Conclusion Given the serious implications of OIS, it is important for practitioners to be aware of the key clinical features to help identify cases in practice and manage patients accordingly. 0

To read this article online, access the references and take the exam, visit: www.optometry.co.uk/cpd

Dr Adel Ebraheem

is one of the teaching faculties at the University of Maryland in the ophthalmology and visual sciences department.

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The case for measuring blood pressure in community optometry This article describes scenarios where measuring blood pressure can be useful in community optometry practice.

CPD POINT

ART

0 Dr Ross Henderson PhD, MCOptom, DipTp(IP), DipGlauc

PRODUCTION CLIENT

determine the systemic and pulmonary BP. The main contributor to peripheral vascular resistance ·······································································································O is the diameter of blood vessels. The autonomic nervous system Introduction alters BP, with the sympathetic There are many reasons why nervous system having a major measurement of blood pressure (BP) effect on the vascular diameter can be appropriate in optometric compared to the parasympathetic practice: system. Both systems affect the • Increasingly optometrists are the contractibility of the heart with first port of call for emergency the sympathetic system causing eye care and some of these increased contractibility and the presentations are associated with parasympathetic system causing hypertension decreased contractability. Sudden • Retinal signs of hypertension are changes in BP, for example, difficult to detect and have poor upon standing, are detected by specificity baroreceptors, which activate • Severe hypertension needs urgent the sympathetic pathways and attention which may be delayed increase BP. These neural changes if BP is not measured by the are short-acting, whereas longer optometrist lasting changes in BP occur due to • BP and pulse measurement are hormones such as catecholamines, relevant in glaucoma management. renin, natriuretic peptides and vasopressin. Catecholamines, such Hypertension is the leading as adrenaline and noradrenaline, modifiable risk factor for are secreted by the adrenal glands cardiovascular disease.1 It is and have a vasoconstrictive effect estimated to affect 32% of adults in on the blood vessels. The kidneys England and is undiagnosed in three influence BP with the release of out of 10 cases.2 An optometrist may renin, which interacts with the be the only health professional that angiotensin system correcting low a patient attends, so hypertension BP by reducing excretion of fluid could be missed if it is not proactively and constricting blood vessels. looked for in these cases. Natriuretic peptides have opposing effects to the renin-angiotensin Physiology of blood pressure system causing dilation of blood The physiology of BP is complex, vessels. Vasopressin acts to and the following description is increase BP by influencing heart only to allow a basic understanding output and constricting blood of the key concepts.3 BP is required vessels. In addition, nitric oxide to provide adequate perfusion released from the endothelium of organs. Cardiac output and of blood vessels causes dilation, peripheral vascular resistance

WHAT YOU NEED TO KNOW C-107196 LEARNING OUTCOMES

0 Optometrists and dispensing

opticians will recognise the ocular manifestations of hypertension 0 Optometrists and dispensing opticians will recognise the indications for measuring blood pressure in community optometry.

•r~

whereas endothelin-1 (ET-1) causes constriction. Other chemicals such as prostaglandins, histamine and bradykinin also act locally on blood vessels. The peak measured pressure is the systolic pressure, which is due to contraction of the left ventricle. After the heart empties blood from the ventricle, the aortic valve shuts and the heart muscle relaxes, and the BP falls in arteries to the diastolic level.

Hypertension Hypertension can be ‘essential’ where the underlying cause is unknown; this accounts for 90–95% of cases. The remainder of cases

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The Keith-Wagener-Barker (KWB) hypertensive retinopathy classification Mild generalised retinal arteriolar narrowing or sclerosis

No symptoms

Grade II (more marked hypertension)

Definite focal narrowing and arteriovenous crossings. Moderate to marked sclerosis of the retinal arterioles. Exaggerated arterial light reflex

No symptoms

Grade III (mild angiospastic retinopathy)

Retinal haemorrhages, exudates and cotton wool spots. Sclerosis and spastic lesions of retinal arterioles

Symptomatic

Grade IV (severe hypertensive retinopathy)

Severe grade III and papilloedema

Reduced survival

SUBS

Grade I (mild hypertension)

ART PRODUCTION

TABLE 1

Classification of hypertensive retinopathy

CLIENT

are secondary due to primary aldosteronism (Conn’s syndrome), kidney and thyroid disease, stress, sleep apnoea or medications like steroids.3 Raised BP over a prolonged period causes blood vessel thickening. Lifestyle choices, such as smoking, can also cause stiffening of the vessels, which can lead to hypertension.4 Risk factors for essential hypertension include:5 • Being overweight • Lack of exercise • Excess alcohol, caffeine or salt • Poor intake of fruit and vegetables • Smoking • High stress level • Age over 65 years • Relative with high BP • Black African or Caribbean descent • Living in a deprived area. Action should be taken on the most abnormal reading, diastolic or systolic. Systolic is viewed as being most important by some due to its association with cardiovascular disease.6 However, diastolic is more likely to be raised in younger individuals compared to older patients so action should occur based on any abnormal measure.7 Pharmaceutical lowering of BP

has been shown to reduce the risk of cardiovascular events across a broad range of ages (21 to 85+ years), although a systematic review acknowledged that studies tend to under-represent the very elderly, frail, those with multimorbidity and polypharmacy.7

Hypertensive crisis Hypertensive crisis is where the BP is >180/120mmHg and there is eye, brain, heart, or kidney damage which can be accompanied by blurry vision, dizziness, headache, seizures, change in mental status and other general health symptoms. Practitioners may see retinal haemorrhages and/or papilloedema (malignant hypertension) and/or retinal oedema. BP may need to be lowered over minutes to hours with parenteral medication in a hospital setting. Differential diagnosis is with

“LIFESTYLE CHOICES, SUCH AS SMOKING, CAN ALSO CAUSE STIFFENING OF THE VESSELS, WHICH CAN LEAD TO HYPERTENSION”

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hypertensive urgency where BP is above 180/110mmHg, but the patient is stable and there is no organ dysfunction. These patients may respond to oral medications over the course of one to two days.3 Surprisingly, nearly 4% of people in a UK population treated for hypertension are unaware that they have high blood pressure at this level.8

Presenting signs and symptoms and hypertension Subconjunctival haemorrhage Subconjunctival haemorrhage (SCH) has been shown to be a significant indicator for hypertension. In a relatively young group of patients with SCH (mean age 55 years), 46% had hypertension (defined as >160mmHg systolic or >95mmHg diastolic) compared to 23% of controls.9 Patients with hypertension also mentioned straining or eye rubbing as possible causes of their SCH so care should be taken not to jump to a conclusion about cause without checking BP. In addition, even patients on anticoagulation drugs may need their BP checked as anticoagulation may not be the cause of their SCH.10 To support this view, patients with SCH are at increased risk of stroke.11

CPD 2, 2

PATHOLOGY, RETINA, SYSTEMIC DISEASE 6

Retinal vein occlusion

Optical coherence tomography

The strongest association in patients with vein occlusion is hypertension, with 64% of those with the condition having hypertension compared to 36% in controls.12 Hyperlipidaemia is also present in 35% compared to 17% in controls. Diabetes is only slightly more prevalent at 14.6% compared to 11% in controls. Patients with retinal vein occlusion (RVO) should be referred urgently to their general practitioner (GP) for medical management and investigation, alongside urgent ophthalmological referral.13 Treatment of hypertension may improve macular oedema.14 In younger patients, or those prone to thrombosis, there may need to be tests for rare thrombotic disorders.15 It may be worth checking BP in case it is very high and emergency referral is required.

Paracentral acute middle maculopathy (PAMM) is seen as hyper-reflective wedge-shaped patches in the middle retinal layers which are thought to reflect ischaemia in this area of high perfusion demand (see Figure 1).18 One small study reported a very strong association of chronic PAMM with hypertension,19 and they have even been shown to be present in the fellow eye of patients with unilateral RVO.20 Central serous chorioretinopathy is also associated with untreated hypertension.21

Amaurosis fugax Patients presenting with a transient, painless loss of vision will usually be referred via local stroke or giant cell arteritis pathways, as an emergency, so it is unlikely that there will be a need for the optometrist to measure BP. However, when symptoms are not clear cut, BP measurement may help with onward referral.

Headaches Hypertension is usually asymptomatic; however, patients can occasionally present with headache or visual disturbance.22 Headache and hypertension at mild or moderate levels has a complex and possibly non-causal relationship.23 However, headaches can be caused

by a sudden rise in arterial pressure to 180/120mmHg or above with hypertensive encephalopathy.24 This type of headache is diffuse, pulsatile and aggravated by physical activity.25 While raised BP is rare in children, secondary causes are significant and the presenting symptom may be a headache.26

Diplopia Hypertension has a strong association with sudden onset diplopia. Of those presenting at a UK eye casualty with a cranial nerve palsy, microvascular aetiology was the most common cause by far with 50% of cases attributed to hypertension, 27% to diabetes and 15% to both conditions.27

Retinal signs The Keith-Wagener-Barker (KWB) hypertensive retinopathy classification was introduced in 1939 before pharmacological treatment for hypertension. Therefore, there

Optic disc haemorrhage Optic disc haemorrhage (ODH) is associated with glaucoma, hypertension, low BP and posterior vitreous detachment. Raised BP may be found in patients with or without a glaucoma diagnosis so it may be useful to check BP if a disc haemorrhage is seen.16 Other risk factors, such as a large cup-todisc ratio, pseudoexfoliation and migraine, may be relevant in patients without diagnosed glaucoma.17 Diabetes can be associated with an isolated ODH, but the risk may be related more to the possibility of developing glaucoma rather than a sign of uncontrolled diabetes.16

FIGURE 1 A 65-year-old male patient presented with a blind spot with onset two days. Top section shows a hyperreflective area in the outer plexiform layer which is an acute PAMM. Bottom section shows the lesion two months later, now a chronic PAMM with thinning of the outer plexiform layer. He was referred to his GP for cardiovascular checks

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arteriole narrowing are associated with current and past BP whereas focal arteriole narrowing, retinal haemorrhage and cotton wool spots are associated with current BP status.32 Grade 1 and 2 retinal signs are difficult to differentiate from normal ageing of vessels hence measuring BP in these cases may be useful.33 Grade 3 and 4 retinal signs are generally associated with end organ damage and can be used to trigger treatment in milder levels of hypertension.34 It is important to note that all these signs may be associated with diabetes or metabolic syndrome, so BP measurement is only part of the picture. Metabolic syndrome may present with obesity, BP within the pre-hypertensive range and abnormalities of blood sugar and blood lipids.35 Based on retinal photography, retinal microvascular signs are not uncommon in adults 40 years of age and older, even in those without history of diabetes and hypertension. Both prevalence and incidence of between 2–15% have been reported for various retinal microvascular lesions.29 Retinal microvasculature may also be related to small vessel disease in the brain.36 Detecting high BP from observing retinal vessels is challenging and so to reduce uncertainty and unnecessary referrals, it may be appropriate for community optometrists with suitable training to measure BP as part of a locally commissioned scheme.

ART PRODUCTION CLIENT

FIGURE 2 Cuff 2cm above elbow and align air bladder with middle finger

were more cases of grade 3 and grade 4 at that time compared to nowadays, and consequently increased mortality (see Table 1). Narrowing of arterioles is associated with hypertension.28 Tortuosity, focal narrowing and arteriole reflex brightening are

also associated with high BP.29 Measuring the arteriovenous ratio is problematic due to branching patterns, veins may dilate in diabetes due to hypoxia30 and narrowing can be difficult to detect without objective quantification.31 Arteriovenous nicking and retinal

BP (mmHg)

Low BP

Normal BP

Pre-high BP

Refer

Refer urgently or as emergency

Systolic

Below 90

Up to 120

121–139

140–180

>180

Below 60

Up to 80

81–89

90–110

>110

Diastolic

TABLE 2

Referrable levels of BP (note that cut-off for aged over 80 years differs)

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PATHOLOGY, RETINA, SYSTEMIC DISEASE 6

“MEASURING BP WHEN IT IS INDICATED IS NOT ONEROUS AND IS VALUED BY THE PATIENT WHO WILL HAVE A GREATER APPRECIATION OF THE HEALTH BENEFITS OF EYE CARE” Glaucoma and BP Ocular blood flow has been implicated as a factor in the development and progression of glaucoma.37 Blood flow in the optic nerve head is determined by the perfusion pressure which is the difference between arterial pressure and intraocular pressure (IOP) and resistance to flow from the vessels: Blood flow = mean BP–IOP/ resistance to flow38 Low blood pressure and/or raised IOP can lead to poor perfusion if the blood vessels are unable to adjust the flow. The ability to alter the flow is called autoregulation and this can adjust the flow when BP changes but there are limits to how much adjustment can be made. Both low and high BP are associated with an increased incidence of glaucoma and low BP is a factor in the progression of glaucoma.39 Treating high BP can delay the onset of glaucoma;40 this might seem counterintuitive given that mean BP is reduced by treatment, however, calcium channel blockers or renin-angiotensin-aldosterone medications reduce resistance to flow so ocular blood flow should be maintained.37 For patients with glaucoma who progress despite adequate IOP control, dips in BP should be considered. BP normally falls at night, but this can be exacerbated by systemic and topical beta blockers (BB). An association between dips in BP and BB use was found to be a risk for visual field loss progression in normal tension glaucoma (NTG) and as a result it has been suggested to avoid using BB eye drops in the evening.41 In addition, taking

systemic hypertensive medications in the morning may also be option42 although this may be less effective at controlling BP and cardiovascular events.43 Conditions such as sleep apnoea should also be considered.44 Vascular dysregulation is also linked to NTG. Vasospasm causes local ischaemia associated with optic nerve damage to the unique circulation of the nerve.45 In patients with glaucoma there may be abnormalities of ET-1 which can cause unstable blood flow and be a vascular cause of ODH. According to Flammer, individuals with this condition are often slightly built, susceptible to cold and stress and tend to have low BP.45

Measuring pulse, BBs and heart block Pulse rate is normally 60–100 beats per minute (BPM) and most sphygmomanometers will give a measure of pulse rate. Fewer than 50BPM is considered bradycardia (although this may be normal for athletes).46 Topical BB and oral BB both slow the pulse rate and can also cause or exacerbate heart block. Heart block causes symptoms of fainting, dizziness, breathlessness and chest pain. Arteriovenous heart block is where the signals are delayed or blocked between the atria and the ventricles. Firstdegree heart block in some can be asymptomatic and they may opt to stop BBs whereas second- and third-degree heart block may need a pacemaker. A study in 2007 found that in an Australian population there was co-prescribing of topical BB with oral BB in 20% of patients with glaucoma.47 Patients taking both

types of BB are more likely to have a pulse rate of less than 50BPM, which could be associated with heart-block. In conclusion, when prescribing a topical BB, it is recommended to check pulse rate first.48

Measuring BP Most monitors in a GP practice are automatic BP monitors.49 Most patients who consent to treatment are suitable for these monitors, but it is advised that they are not used if the patient has pulse irregularity, for example, atrial fibrillation.34 The procedure for using a BP monitor is as follows: 1. Patient is seated with arm supported level with heart, and given five minutes to relax 2. Ideally, BP should be measured on a bare arm but if patient has a thin layer of clothing this should not affect the reading too much50 3. Place cuff on upper arm with centre of air bladder over brachial artery (see Figure 2) 4. Take reading and record it 5. Measure on other arm and if >15mmHg difference repeat measures 6. If remains >15mmHg difference use measures from arm with higher reading 7. Refer to GP if BP is abnormal. Note that: • White coat hypertension affects up to 20% of patients • Ambulatory 24-hour BP may be offered if the measures are abnormal30 • Calibration is occasionally an issue (13% of monitors out by 3mmHg in pharmacies)51 • Aim for a target clinic BP below

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140/90 mmHg in people aged under 80 years with treated hypertension • Aim for a target clinic BP below 150/90 mmHg in people aged 80 years and over, with treated hypertension.34

ART PRODUCTION CLIENT

It should also be considered that: • Healthy adults (aged over 40) without diagnosed hypertension should have their BP checked at least every five years or more frequently if BP is in prehypertension range • BP should be checked every year in patients with type 2 diabetes • People diagnosed with hypertension are recalled annually by their GP practice for BP check, bloods (urea and electrolytes, lipids, HbA1c) and urine albumin to creatinine ratio • The GP practice will also look for a postural drop in BP, particularly in elderly people or those with known vascular disease, diabetes (especially in cases of poor control) or multimorbidity/polypharmacy. If there is a significant postural change, then they will use standing BP as the target.

Case 1: Hypertensive urgency Female, 80 years old, presented for a routine examination. She mentioned mild headaches when using her Kindle at night. She thought she needed new spectacles to solve this. General health was reported as normal. She was observed to be overweight. She was not taking any medication. Scattered flameshaped retinal haemorrhages were found in both eyes; this was the only abnormality detected. The optometrist had received training in measuring and interpreting BP to a set protocol as part of a locally commissioned healthy living service and they found the patient’s BP to be 223/117mmHg. As the patient was relatively asymptomatic, her GP

The AOP view • Optometrists are required to recognise and work within the limits of their competence • The medical malpractice insurance included with AOP membership covers blood pressure and atrial fibrillation screening, when performed as part of a locally commissioned healthy living service. Practitioners should ensure that: • they have completed appropriate training which can be verified; and • they are following the protocol provided by the service; and • their employer has approved them to carry out this role Further guidance on insurance cover for extended roles can be found on the AOP website.52 was phoned (rather than calling 999), and she was seen that morning and prescribed BP medications. She returned subsequently to the optometrist for routine checks; her retina appeared normal at those visits and her BP was under control with three blood pressure medications.

Case 2: BP measurement helps when there is uncertainty about presence of retinopathy A new, male patient, 70 years old, presented for an eye examination complaining of cloudy vision in his left eye. He reported that he was in good health but hadn’t seen a doctor for many years. He was not taking any medication. His retinal photograph showed possible copper wiring but as this finding was uncertain (and there was no previous retinal photography to compare to) measuring BP can be helpful. BP was 176/105mmHg with a pulse rate of 57BPM. Repeat measures were BP 177/98mmHg and a pulse rate of 59BPM. Ironically, he had a BP monitor at home that

his wife used for her hypertension, but he hadn’t used it. His cloudy vision was due to a cataract in his left eye. Following the framework of the local healthy living protocol, the optometrist referred the patient to his GP for further cardiovascular checks.

Conclusion This article has highlighted scenarios where a BP measurement in community optometric practice can assist in the referral and management of a patient and may save sight or even save a life. Measuring BP when it is indicated is not onerous and is valued by the patient who will then have a greater appreciation of the health benefits of eyecare. However, as measuring and interpreting BP readings is not part of core competency for optometrists, this should only be undertaken as part of a locally commissioned scheme in agreement with the practitioner’s employer, to ensure that training is given with clear protocols for patient management in place.52

Acknowledgements The author would like to thank Dr Caitlin Whittaker, Dr Donald Stewart, Steven Whittaker, Stuart McConnachie and Linda Hunter for comments and contributions on earlier versions of this article. 0

To read this article online, access the references and take the exam, visit: www.optometry.co.uk/cpd

Dr Ross Henderson

is a community specialty optometrist working in Perth, Scotland. He is also an educational supervisor for NHS Education for Scotland.

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Find out more at coopervision.co.uk/practitioner/myopia tUsing measuredand modeleddata, pooledacrossages(8-17), MiSight• 1 day slowed myopiaprogressionby an averageof approximately50%. t12 months post-treatment, evidenceindicatesthat no accumulatedmyopiacontrol benefitswere lost following 3 or 6-years of MiSight®1 day wear (on average,for childrenaged 8-15 at start of wear). Instead,eye growth reverted to expected,age-normalrates. 1. ArumugamBet al. ModellingAge Effectsof Myopia Progressionfor the MiSight 1 day ClinicalTrial.Invest.OphthalmolVisSci.2021; 62(8): 2333. 2. ChamberlainPet al.A 3-year RandomizedClinicalTrialof MiSight Lensesfor Myopia Control.Optom VisSci.2019; 96(8): 556-567. 3. ChamberlainPet al. Lang-term Effect of Dual-focusContact Lenseson Myopia Progressionin Children:A 6-year Multicenter Clinical Trial.Optom VisSci.2022; 99(3): 204-212. 4. ChamberlainPet al. Myopia progressionon cessationof Dual-Focuscontact lenswear: MiSight 1 day 7-yearfindings. Optom VisSci.2021; 98(E-abstract): 210049. 5. ZadnikKet al. FactorsAssociatedwith RapidMyopia Progressionin School-agedChildren.Invest.Ophtho/mol.Vis.Sci.2004; 45(13): 2306. 6. HammondD,ArumugamB,et al. Myopia ControlTreatmentGainsare Retainedafter Terminationof Dual-focusContact LensWearwith no Evidenceof a ReboundEffect. Optom VisSci.2021; 98(E-abstract): 215130.

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0 Dr Jeremy Chung Bo Chiang PhD, BOptom (Hons), BSc

PRODUCTION CLIENT

(TFOS) also highlighted the growing contribution of diet, cosmetics, societal challenges, excessive digital screen use ··························································································O and environmental conditions of the modern era in exacerbating DED.3 The diagnosis of DED has improved Introduction over the years enabling more precise The impact of dry eye disease (DED) monitoring of patients’ ocular surface continues to increase worldwide with health. However, developing treatments debilitating consequences on the quality that can control this chronic condition of life of affected individuals, as well as and confer longer symptomatic relief to the burden on work productivity and our patients remains a major challenge healthcare systems.1 A recent study in DED management. As meibomian demonstrated that one in three of the gland dysfunction (MGD) is one of the UK population is affected by DED with primary contributors to DED with up major risk factors including female to 80% of dry eye patients having the sex, sleep duration and systemic or condition,4 tremendous effort has been ocular comorbidities.2 The recent series dedicated to improving the health and of lifestyle reports published by the function of the meibomian glands. Tear Film and Ocular Surface Society

The rise in light-based treatments including intense pulsed light (IPL) therapy followed closely by low-level light therapy (LLLT) were primarily observed in the dermatological field for treating skin conditions and improving the appearance of facial wrinkles, spots and scars.5,6 Incidental improvements observed with the use of these treatments on the signs and symptoms of MGD and DED, led to the development of IPL,7 and the recent innovation of LLLT, specifically for ophthalmic applications.8 This article summarises the hypothesised mechanisms of action of these light-based therapies and also details the evidence around the clinical improvements observed with these treatments. The article will

FIGURE 1 Different wavelengths of light used for low-level light therapy (LLLT) or photobiomodulation. Images courtesy of the Espansione Group (Funo, Italy)

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also briefly summarise a new form of treatment based on the concept of thermomechanical action.

Mechanisms of action underlying IPL and LLLT Several commercialised IPL systems have been developed for treating DED including OptiLIGHT (Lumenis, Yokneam, Israel) and E-Eye (ESW Vision, Houdon, France). Each system differs in terms of their design, although the wavelength of light used is usually around 590 to 600nm with fluence directed on the skin usually determined by Fitzpatrick skin classifications, which will be described later.9 In addition to facial skin aesthetic improvements, IPL has also been used to treat pathological skin disorders particularly rosacea and acne. As it is thought to cause the lysis of aberrant microvasculature and hence reduce telangiectasia in patients with rosacea, a similar mechanism of action has been hypothesised for the treatment of MGD, which is also commonly associated with telangiectatic blood vessels.10 Such reduction in aberrant microvasculature may also reduce inflammation, with dermatological studies also showing upregulation of anti-inflammatory cytokines including interleukin 10 (IL-10)11 and reduction in proinflammatory cytokines such as tumour necrosis factor alpha (TNF-α);12 this has been supported by a recent metabolomic study showing improvement in inflammatory levels in meibum analysed following IPL treatment.13 As Demodex proliferation is closely linked with the pathogenesis of MGD and certain skin conditions, especially rosacea, IPL could reduce mite population by inducing death14 and alleviate the microbial load on the ocular surface. LLLT incorporates a series of light emitting diodes (LEDs)

with wavelengths of light ranging from 390 to 700nm and 780 to 1100nm.15 While evidence for its mechanisms of action on the ocular adnexa is limited, it has been proposed that there are differential impacts depending on the wavelength used (see Figure 1). Blue wavelengths purportedly have more of an impact on bacterial growth,16 yellow wavelengths target the lymphatic system, which reduces swelling, while red or near-infrared wavelengths stimulate heating or energy production through increased adenosine triphosphate (ATP) production.17 The term ‘LLLT’ has been widely used in the ophthalmic field; however, a more accurate term known as photobiomodulation therapy has been proposed by various groups with the following definition: ‘Photobiomodulation is the mechanism by which nonionising optical radiation in the visible and near-infrared spectral range is absorbed by endogenous chromophores to elicit photophysical and photochemical events at various biological scales without eliciting thermal damage.’15,18 The heat produced by these processes mainly in the mitochondria of cells is hypothesised to melt any viscous or solidified meibum which improves its expressibility and quality. Other suggested mechanisms include anti-inflammatory effects, antioxidative impact, promotion of tissue repair and neural recovery.15,19 However, more mechanistic clinical studies are required to investigate the basis of these processes in relation to the ocular surface, eyelids and meibomian glands. As a clinical note, IPL and LLLT are often intended to be used as an adjunctive or complementary treatment alongside established therapies such as meibomian gland expression and warm compresses, rather than in isolation.

WHAT YOU NEED TO KNOW C-107170 LEARNING OUTCOMES

Optometrists and dispensing opticians: 0 Optometrists and dispensing opticians will e able to describe the role of light-based and thermomechanical therapies for managing dry eye disease to patients relative to their scope of practice 0 Optometrists will be able to identify when it is appropriate to use light-based and thermomechanical therapies for managing dry eye disease 0 Dispensing opticians will recognise the role of light-based and thermomechanical therapies for managing dry eye disease. Contact lens opticians: 0 Contact lens opticians will

be able to describe the role of light-based and thermomechanical therapies for managing dry eye to contact lens patients 0 Contact lens opticians will be able to identify contact lens patients that could benefit from light-based and thermomechanical therapies for managing dry eye disease.

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FIGURE 2 Administration along the lower lid region using the eye-light system (Espansione Group, Funo, Italy) at the Aston University Dry Eye Clinic: (A) the IPL system; (B) the LLLT system. Images courtesy of the Aston University Dry Eye Clinic

Findings from clinical studies on treatment efficacy IPL alone As IPL has been introduced for meibomian gland and ocular surface treatment much sooner than LLLT, only randomised controlled trials (RCTs) will be discussed here as these are regarded as the most rigorous scientific method for testing a hypothesis. A Cochrane systematic review conducted in 2019 which evaluated three RCTs found a scarcity of high-quality evidence for the effectiveness of IPL in treating MGD specifically.20 While the review found evidence of improvements in sodium fluorescein tear breakup time and tear osmolarity with IPL, there was a very low level of certainty in the potential of IPL to improve dry eye symptoms, non-invasive tear break up time, corneal fluorescein staining and meibomian gland orifice plugging. Adverse events have been reported by two of the included trials including pain21,22 and burning.21 More recent RCTs

since the Cochrane review continue to demonstrate potential benefit from IPL treatment in MGD, including improved dry eye symptomatology, tear film stability and meibomian gland function lasting for a few months following completion of the treatment protocol.23-26 Further impact on the ocular surface includes the reduction in bacterial load on the eyelid margin23 and lowering of tear proinflammatory mediators.27

IPL+LLLT The use of IPL together with LLLT in a treatment regimen has been increasingly adopted by eye care practitioners with a purported synergistic impact on alleviating MGD and DED. This approach was popularised by the Espansione Group (Funo, Italy) which has devised the commercially available eye-light machine incorporating both treatment modalities. Typical protocols reported by studies include three to four

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treatment sessions over a period of one to three months with each session separated one to three weeks apart.28-33 It should also be noted that the LLLT involved in these studies mainly uses the red wavelength light. Early retrospective studies demonstrated the safety of this combined treatment, with significant improvements in dry eye symptomatology and tear breakup time.8,29,31 Prospective studies following patients during and after the treatment regimen have also recapitulated these findings with improvements in ocular surface disease index (OSDI) scores and surrogate measures of tear stability such as tear breakup time and lipid layer thickness noted up to three to six months after the final treatment session.28,30,33 Other changes such as Schirmer test findings remain equivocal potentially due to the different populations of patients included across these studies (MGD28 versus Sjögren’s syndrome30 versus patients with systemic pathology and

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ocular surgeries).31 Hence, readers are urged to consider these factors when interpreting the findings of the aforementioned studies and applying the treatment to their own clinical settings. No adverse events or facial and ocular side effects following these combined treatment regimens were reported by any of the studies. As with IPL alone, a recent study assessing tear film inflammatory mediators showed a significant reduction in proinflammatory cytokines including IL-1β and IL-17F as well as lowering in matrix metalloproteinase 9 (MMP9) levels and MMP9/ tissue inhibitor metalloproteinase 1 (TIMP-1) ratio.34 Comparative studies have also been conducted to investigate the potential differences in treatment regimens. A study that compared patients treated with IPL alone versus patients treated with IPL+LLLT showed a significant improvement in OSDI scores and lipid layer thickness in both groups.32 The IPL+LLLT group showed statistically significant improvement in Schirmer test results from baseline, which may indicate enhanced aqueous tear production as the authors postulate that LLLT has a more widespread impact on the adnexal regions, while IPL alone is usually limited to treatment of lower eyelid regions.32 However, the distribution of sex and patients with comorbidities such as diabetes and history of cataract surgery varies between the two groups, which may impact on the translatability and interpretation of these findings. While the collective findings of these studies seem to point towards some benefits of IPL+LLLT in improving DED symptoms and tear film stability, more comparative studies with pre-specified populations would improve the ability to compare its efficacy in relation to other treatment modalities.

LLLT alone Given the potential for LLLT to confer a therapeutic impact over a larger area

“DEVELOPING TREATMENTS THAT CAN CONTROL THIS CHRONIC CONDITION AND CONFER LONGER SYMPTOMATIC RELIEF TO OUR PATIENTS REMAINS A MAJOR CHALLENGE IN DED MANAGEMENT” compared to IPL, researchers have also investigated the potential of LLLT alone in alleviating DED signs and symptoms. A RCT demonstrated improvements in signs of dry eyes including enhanced fluorescein corneal and lissamine green conjunctival staining scores when a LLLT system developed originally for dermatological use (Healite, Lutronic, Goyang, Korea) administered twiceweekly over three weeks was compared with placebo treatment.35 A comparative study, which randomised participants to receive either LLLT or IPL, showed that LLLT alone had a greater improvement in Standard Patient Evaluation of Eye Dryness (SPEED) symptom scores and tear volume.36 Further research, particularly into the underlying mechanisms of these light-based therapies specific to the ocular surface and adnexa, would help provide more insight into the potential differences in therapeutic impact between these treatment modalities.

Thermomechanical action Tixel (Novoxel, Netanya, Israel) is a treatment that has recently been introduced based on the concept of thermomechanical action which also originated from dermatological use in reducing wrinkles. Putative mechanisms of action include liquefaction of inspissated meibum, and reduction in inflammation and bacterial load through rapid application of heat; this is done through a four-by-six ceramic matrix of pyramid-shaped pins (400°C for 6ms). A total of three treatments, two weeks apart has been reported by studies to be effective at improving dry eye symptoms and tear breakup time.37,38

While no side effects or adverse events have been reported, there is yet to be a standardised approach for using this instrument for MGD treatment, with variations in the number of shots per eyelid, skin contact duration and use of anaesthetic reported. As with IPL and LLLT, the exact mechanisms of action also remain unknown and require further investigation.

Clinical tips and takeaways At the dry eye clinic at Aston University, the author and colleagues are currently prescribing IPL+LLLT treatment with the eye-light system (Espansione, Funo, Italy) for patients with MGD. The Pult meiboscale grade of the lower eyelid39 and Fitzpatrick skin classification9 outlined below are required to calibrate the optical radiance output, which ranges from 59J to 69J. A series of five pulses is administered along the lower lid regions with the patient and practitioner wearing appropriate protective eyewear (see Figure 2). LLLT is then administered using the provided meibomask with red wavelength LEDs for 15 minutes. An initial course of four IPL+LLLT sessions, two to three weeks apart is usually prescribed, followed by a topup session three to six months later depending on MGD severity and level of dry eye symptoms the patient is facing. Some clinical takeaways from the author’s experience using this machine include: • It is important for practitioners to ensure they take a detailed history and are fully aware of any photosensitising medication taken by patients prior to IPL treatment – IPL

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treatment may have a risk of inducing hyper- or hypo-pigmentation, blister formations or burns when used concomitantly with these drugs. Common medications in this group include amiodarone and tetracyclines such as doxycycline. Hence, patients taking these medications and who are interested in IPL should be counselled on the potential side effects. Using LLLT alone without prior IPL could be an alternative as use of photosensitising medications is not a contraindication. A patch test should be done with a single pulse of IPL at the inner wrist to assess for any reactions such as skin breaking or blistering. Patients should also be advised to bring sunglasses to wear as they may be more sensitive to bright stimuli following treatment sessions. Skin repair or sun-protection cream could be applied to soothe the skin following therapy • Practitioners should be aware of the Fitzpatrick skin type scale and understand how to apply it in practice to categorise a patient prior to IPL treatment - the Fitzpatrick classification was developed for grading skin type based on the tendency to sunburn and ability to tan, ranging from grade I (very fair skin which always burns and never tans) to grade VI (black skin which tans easily but never burns).9 IPL is contraindicated for patients with darker skin grades (grades V to VI) as they tend to have a higher risk of developing side effects such as hypopigmentation or scarring • Lid margin debridement and expression – as mentioned earlier, IPL and LLLT is meant to be an adjunct treatment to the suite of other effective interventions for MGD including lid margin debridement and therapeutic expression of the meibomian glands. Microblepharoexfoliation could also be considered for enhancing lid hygiene. These procedures may be synergistic

The AOP view ● The medical malpractice insurance included with AOP membership covers work which is within the normal scope of practice for optometrists. This includes treatments such IPL and LLLT, provided that: The practitioner has received appropriate training and feels competent to offer the treatment and the treatment is for an eye condition (other parts of the body would be outside the scope of normal optometric practice). ● The AOP’s view is that these procedures should be performed by a registered optometrist and should not be delegated to practice support staff. ● There are some light procedures that would not be covered by the insurances included with AOP membership, such as using red and infrared lasers for integration of primitive reflexes, but the use of IPL and LLLT for anterior eye conditions both fall within the scope of normal optometric practice. ● The AOP advises members to be mindful of the College of Optometrists’ guidance around the importance of not overstating the case for intervention where the current evidence for the benefit may be weak. For example, the College of Optometrists’ current guidance on the use of IPL40 says: ‘Intense Pulsed Light (IPL) therapy has been recommended for the management of meibomian gland dysfunction (MGD). However, a 2020 Cochrane Review found a lack of evidence as to the effectiveness and safety of this treatment modality. (GRADE*: Level of evidence = low, Strength of recommendation = weak).’ ● Please note that some local authorities require premises to be licenced before they can offer light treatments. For example, the London Authorities Act 1991 confers powers on local authorities in London to require premises to be licensed for providing light treatments, and practitioners wishing to provide treatments in these areas may need to obtain a notice from the GOC. The AOP contacted the GOC about this in February 2018, and they confirmed that they would be happy to provide a local authority with a notice, if this was required in order to provide light therapies for the treatment of dry eye, but they would be unable to confirm that a registrant was competent to provide IPL treatments as this is not a GOC core competency. Therefore, they felt it would be a matter for individual registrants to demonstrate their competence in this procedure. If you are not the practice owner, you may wish to bring this to their attention, so they can confirm whether any such licencing is required in your area.

due to the subsequent heat conferred by the light-based therapies, although more research needs to be undertaken to determine the mechanisms of action of these therapies and how they aid established conventional treatment modalities.

Conclusion While there is some evidence regarding the treatment efficacy of emerging lightbased and thermomechanical therapies in DED, a lot more needs to be done in terms of understanding the exact mechanisms of action underlying the clinical improvements observed; these include the impact on microvascular structures or inflammatory processes

specific to the ocular adnexa and ocular surface. This, along with an increase in well-designed RCTs, would further contribute to the strengthening of existing guidelines around the use of these treatments. 0

To read this article online, access the references and take the exam, visit: www.optometry.co.uk/cpd

Dr Jeremy Chiang

is a postdoctoral research associate at Aston University. He is an adjunct lecturer at the University of New South Wales, Australia.

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Assessing and managing digital eye strain in clinical practice This article provides an overview of digital eye strain and strategies to improve the clinical management of the condition.

CPD POINT

ART PRODUCTION

0 Danielle Beeson BSc (Hons), MCOptom, Prof Cert Med Ret, AFHEA, Professor James S Wolffsohn BSc (Hons), PgCertHE, MBA, PhD, PFHEA, FSB, FAAO, FCOptom, FIACLE, FBCLA and Dr Amy Sheppard BSc (Hons), SFHEA, PhD, MCOptom

CLIENT

the development of musculoskeletal disorders; these are defined as injuries and/or disorders of the muscles, tendons, cartilage, joints, and spinal discs.2-5 Globally, approximately 1.71bn people live with musculoskeletal disorders making it the highest ·····························································································O contributor to the global need for rehabilitation.6 Introduction Screen time has also been linked to Digital technologies have transformed obesity.7 Previous research has shown the world in which we live. Globally, we are more connected than ever that for every one hour increase in before, a wealth of learning resources screen time, there was a 40% increased is easily accessible, remote working odds of obesity in children.8 Obesity is becoming increasingly common increases the risk of severe health and large amounts of information can conditions, psychological problems be stored in relatively small spaces. and has a detrimental economic Across the population, digital devices impact. Recent data published by the are used extensively for both social UK government showed that obesity and professional purposes. Indeed, costs the NHS £6bn annually, a figure 94% of UK households have access to which is expected to rise to over the Internet with UK adults (age 15+ £9.7bn per year by 2050.9 years) spending an average of almost It is well documented that exposure four hours online per day; 98% of UK to blue light can hinder sleep as it children (age three to 15 years) go suppresses the release of the sleeponline, with tablets and smartphones promoting hormone melatonin.10-13 As being the most popular digital devices digital device screens emit blue light, used in this age group.1 viewing them before bed can result in a shorter sleep duration.14 LongAs digital device usage has reached saturation in most age groups, adverse term sleep problems increase the risk health effects are becoming more of developing obesity, hypertension, prevalent. Prolonged digital device cardiovascular disease, type 2 diabetes usage is believed to be associated with mellitus and psychological issues.15

Digital eye strain Digital eye strain (DES), also known as computer vision syndrome (CVS), describes the range of visual and ocular (and musculoskeletal) effects that may be experienced with prolonged use of digital devices such as computers and smartphones.16-18 DES has been a recognised health problem for over 20 years and has high prevalence levels; values of up to 98% have been reported in adults, but around 72% is more typical.19

Symptoms Symptoms of DES include blurred vision, diplopia, difficulty focusing at near, asthenopia, headache, tired and sore eyes, dryness, burning, tearing and irritation, along with musculoskeletal issues such as neck and shoulder pain and back ache. A variety of questionnaires have been developed to identify DES sufferers and grade the severity of symptoms.20 The most used questionnaire within DES research studies is the CVS-Q (see Table 1); this questionnaire uses a single rating scale to assess the frequency and intensity of 16 symptoms. The questionnaire asks about symptoms that occur when using a digital device, but not whether they occur with non-digital tasks.

“AS DIGITAL DEVICE USAGE HAS REACHED SATURATION IN MOST AGE GROUPS, ADVERSE HEALTH EFFECTS ARE BECOMING MORE PREVALENT. PROLONGED DIGITAL DEVICE USAGE IS BELIEVED TO BE ASSOCIATED WITH THE DEVELOPMENT OF MUSCULOSKELETAL DISORDERS” 66 www.optometry.co.uk OT February/March 2024

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To calculate the severity of symptoms, the ‘frequency’ column score (‘never’ = 0; ‘occasionally’ = 1; ‘often or always’ = 2) is multiplied by the ‘intensity’ column score (‘moderate’ = 1; and ‘intense’ = 2), so the following severity scores can be obtained: 0 (0x1 or 1x0); 1 (1x1); 2 (1x2 or 2x1); and 4 (2x2). However, following Rasch analysis, the research group responsible for designing the CVS-Q decided on three categories for the severity score: 0, 1 (1x1), and 2 (1x2, 2x1, 2x2). The severity scores for each symptom are then added together. The maximum score which can be obtained is 32. A score of six points or more is considered diagnostic of the condition.21 Despite its use in research settings, the CVS-Q is not in widespread clinical use.

Risk factors and their management Refractive errors Uncorrected refractive errors can lead to blurred vision, asthenopia, diplopia and frontal headaches.22 Correction of refractive errors, particularly astigmatism and presbyopia, is an important intervention in DES sufferers.20,23-25 The law in the UK states that employers must arrange an eye test for display screen equipment (DSE) users if they ask for one and provide spectacles if an employee needs them specifically for DSE use.26 As digital devices are viewed at variable distances, multiple pairs of single vision spectacles may be required by some presbyopes for adequate vision across the range of demand levels.20,27 The two-inone design of bifocals provides distance and near, or intermediate and near vision correction at a relatively low cost; however, users can experience image jump when transitioning between the different optical prescriptions. Desktop monitors are generally placed at, or just below, primary gaze, therefore, the positioning of a standard bifocal spectacle lens near segment may be

inappropriate for this task. When viewing a computer screen, bifocal users experience significantly more neck and back discomfort compared to when single vision lenses are used.28,29 Multifocal lenses provide a continuous change in power, supplying distance, intermediate and near vision correction without the wearer having to switch between multiple pairs of spectacles. However, the design of these lenses encourages a person to hold their head in a more forward position30 leading to greater degrees of occipital extension which increases the risk of musculoskeletal disorders and headaches.31 Occupational lenses are specifically directed at people who spend a lot of time in a computer environment and are significantly better than general purpose multifocal lenses in reducing the perception of DES.32,33 Accommodative support lenses are a low-add progressive addition spectacle lens designed to ease DES symptoms in pre-presbyopes; however, recent studies have shown equivocal results. A 2020 study found that individuals with good amplitudes of accommodation may prefer a low reading add of +0.75D when using a desktop computer to help ease symptoms.34 In contrast, a 2022 study found no significant improvement in the symptoms of individuals wearing a low reading add of +0.75D compared to those who did not wear them.35

Binocular vision anomalies Binocular vision anomalies are characterised by blurred vision, asthenopia, diplopia, dizziness, and headaches, and are caused by the inability to maintain visual focus on an object with both eyes. Vergence anomalies include decompensated heterophoria, convergence insufficiency, poor vergence facility, convergence excess, divergence excess and divergence insufficiency. An individual with a binocular vision anomaly is likely to

WHAT YOU NEED TO KNOW C-107203 LEARNING OUTCOMES 0 Optometrists and dispensing

opticians will be able to explain strategies for managing digital eye strain to patients relative to their scope of practice 0 Optometrists and dispensing opticians will identify factors that contribute to digital eye strain relative to their scope of practice.

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experience symptoms of eye strain during sustained near vision tasks,27 therefore, it is important to manage non-strabismic binocular vision anomalies by correcting refractive errors, or by using plus lenses and/or appropriate vision therapy.36

Accommodative anomalies Accommodative anomalies include accommodative insufficiency, accommodative infacility, accommodative excess and lag of accommodation. If left untreated, individuals are likely to experience tired or sore eyes, intermittent blurred vision, difficulty in focusing, ocular pain, diplopia and frontal headaches.37,38 Correcting refractive errors, prescribing plus lenses (if appropriate) and issuing orthoptic exercises can alleviate symptoms.36

Dry eye and ocular surface disease The three main factors which are considered responsible for

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a. Frequency

b. Intensity

Never

Occasionally

Often or always

Moderate

Intense

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1 Burning 2 Itching 3 Feeling of a foreign body

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4 Tearing 5 Excessive blinking 6 Eye redness

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7 Eye pain 8 Heavy eyelids 9 Dryness

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10 Blurred vision 11 Double vision 12 Difficulty focusing for near vision 13 Increased sensitivity to light 14 Coloured halos around objects 15 Feeling that sight is worsening

16 Headache

TABLE 1 The CVS-Q questionnaire21

contributing to dry eye symptoms when using a digital device are blinking characteristics, gaze angle and room humidity. When using a digital device, the mean blink rate reduces and the proportion of incomplete blinks increases.17,39-41 When viewing desktop computers, the eyes are usually in primary position. Both changes in blinking patterns and a higher viewing angle exposes a greater area of the ocular surface resulting in the loss of tear film homeostasis, ocular surface

dryness, lid wiper epitheliopathy and visual fatigue.27,42,43 Many officebased computer users are exposed to low humidity conditions caused by ventilation fans and air conditioning units. Low humidity causes tear evaporation and thinning of the tear film resulting in dry eye symptoms.44,45 The two most accepted questionnaires to assess dry eye symptomology are the Ocular Surface Disease Index (OSDI) and the five-item Dry Eye Questionnaire (DEQ-5).46 A score of 13 or more in the OSDI47,48

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and six or more in the DEQ-549 are indicative of DED; however, to diagnose dry eye disease (DED), ocular surface symptoms must be present alongside other signs of the condition.50 The key signs of a loss of homeostasis of the tear film are impaired tear breakup time, hyperosmolarity and ocular surface damage. Treatments to relieve dry eye symptoms include tear replacement, tear conservation, eyelid treatments, anti-inflammatories, local

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“GIVEN THE HIGH PREVALENCE OF DES, IT IS ESSENTIAL THAT PRACTITIONERS CAN PROVIDE APPROPRIATE ADVICE AND MANAGEMENT OPTIONS TO THEIR PATIENTS” environmental considerations, complementary medications and dietary modifications. As blinking dynamics are affected during screen use, blink training may also be a very helpful management strategy to reduce symptoms of dry eye and DES.20

Nutrition The World Health Organization (WHO) describes malnutrition as deficiencies or excesses in nutrient intake, imbalance of essential nutrients, or impaired nutrient utilisation. While certain vitamin deficiencies, such as vitamin A and C, have an established link to ocular surface compromise, associations with other systemic nutritional deficiencies are less well established.19 In relation to DES, the 2023 TFOS Lifestyle: Impact of the digital environment on the ocular surface report identified that oral omega-3 fatty acid supplements can improve DES symptoms and tear film stability. Berry extracts (bilberry, bog bilberry, and maqui berry) also showed improvements in visual fatigue and dryness symptoms while antioxidants do not appear to provide any benefits to DES sufferers.19

Workplace ergonomics Inappropriate seating can cause people to adopt awkward postures which can lead to discomfort, back pain and upper limb disorders. The Health and Safety Executive (HSG57) gives very specific guidance on how to ensure workplace seating is safe and suitable for all, but essentially the seat needs to adjust in height to meet the needs of a range of users, the backrest needs to give firm support to the lower and the middle part of the back, the height of armrests should not be too low or too high and any worker who

cannot easily place their feet flat on the ground, when using the seat adjusted to the correct working height, needs a footrest.51

Glare Reflected images can produce a veil of light, also known as reflected glare, over a portion of a display screen. Since reflected images form at distances other than that of the screen surface, ocular accommodation and convergence tend to fluctuate,52 which may negatively impact the user’s binocular vision system, leading to symptoms related to visual fatigue and reduced task performance. Glare can be reduced by closing or shielding windows, turning off lights and using anti-glare screen filters.

Screen time Individuals who work on digital devices for prolonged periods of time should take regular breaks. The 20-2020 rule instructs digital device users to briefly look away from the screen for at least 20 seconds to a distance of at least 20 feet (6m) away after every 20 minutes of continuous work. The 20-20-20 rule seems to be an effective strategy for reducing DES and dry eye symptoms but is only a short-term fix.53

Blue light As previously mentioned, exposure to blue light can affect sleep. Although a recent systematic review suggested that blue light-blocking spectacle lenses may help people with insomnia,54 there is not enough detail about the studies to draw that conclusion.55 There is also no evidence to support the use of blue-blocking lenses as a clinical treatment for DES.56,57 The College

of Optometrists reiterates this in their positional statement which states: ‘If optometrists are selling blue-blocking lenses, they should make their patients aware that there is no strong evidence that blue-blocking spectacle lenses will improve visual performance, alleviate symptoms of eye strain, or improve sleep quality.’58

Conclusion Given the high prevalence of DES it is essential that practitioners can provide appropriate advice and management options to their patients. As DES is a symptom-based disorder, management requires a holistic approach involving the correction of refractive errors, treatment of binocular vision and accommodative anomalies, appropriate management of ocular surface disease and providing ergonomic recommendations to improve comfort when using digital devices. 0

To read this article online, access the references and take the exam, visit: www.optometry.co.uk/cpd Danielle Beeson graduated from Aston University in 2016 and is undertaking a PhD on DES under the supervision of Professor James S Wolffsohn and Dr Amy Sheppard. Professor James S Wolffsohn is head of the school of optometry and head of the department of audiology at Aston University.

Dr Amy Sheppard is an optometrist and senior lecturer and deputy head (education) at Aston University’s Optometry School.

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INDUSTRY IN 2024: WHAT IS TO COME?

Euromonitor International’s Natasha Cazin shares key themes to expect, and business representatives share their expectations for innovation www.optometry.co.uk/industry2024

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LAUNCHES TO LOOK OUT FOR

OT look at launches in myopia management, corneal topography, and eye health

SUBS

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ART

Myopia management

LENSES

PRODUCTION

Shamir has released a new lens for myopia management, Shamir Optimee, designed with children’s wellbeing and ergonomics in mind. The lens integrates Shamir FocusFlow defocus technology, providing a clear central vertical zone with the prescription.

shamir.com/uk CLIENT

3 2

Healthy eyes _ SUPPLEMENT

The Body Doctor has become the exclusive distributor for MacuHealth in the UK, bringing its MacuPrime and ReMind supplement brands to the market. The supplements are backed by clinical trials at the Nutrition Research Centre Ireland, MacuHealth shared.

the-body-doctor.com

Understated luxury _

SUNGLASSES

Linda Farrow has revealed a new masculine collection, the Black Series, with 11 sunglass designs and 15 ophthalmic shapes. Two aviator models stand out from the collection, the ‘Enzo’ (pictured), with layered titanium and side shields, and the ‘Edano,’ which features 3mm thick solid grey lenses in a rimless silhouette.

lindafarrow.com

_ SPECTACLES

Charmant has revealed its Ad Lib autumn/winter eyewear range containing 10 new frames channelling inspiration from pop culture, sport and technology and playing with 3D, colour, and brow line detailing.

Corneal topographer

_ EQUIPMENT

Grafton Optical has launched the OS1000 corneal topographer from SBM Sistemi, a two-in-one system with complete corneal topography analysis and an all-in-one dry eye assessment. The system offers an in-clinic workflow with reports and follow-ups.

graftonoptical.com

Colour in 3D

charmant.com

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5 launches

What’s happening

Filter Careers Location

> >

Must-haves

Date Added

VERSION

What’s happening in...

REPRO OP

EYEWEAR AT 100% OPTICAL?

The collections, styles and accessories to look out for at the show -

....................................................... .

SUBS ART PRODUCTION

A LITTLE FUN

A BUSTLING STAND

Millmead Optical Group is launching a Mr Men and Little Miss eyewear collection designed for children. Bringing the characters to life, the range will include frames that are comfortable and colourful.

Mac Eyewear has a busy show planned but central to the showcase will be the relaunch of La Matt, Kaos, and Genesis collections – bringing the ranges from Area 98 back to Mac Eyewear to build on its success with Coco Song.

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....•······

millmeadopticalgroup.com

maceyewear.co.uk

CLIENT

COLLECTION CONTRAST SUN, SAND, SPECS Woodys Eyewear presents the Colorado campaign, set in the desert. The new launch features 42 models, with a focus on comfort.

Einstoffen shares its Raw & Noble collection with irregular and symmetrical shapes balanced with soft lines, and drawing on materials like wood, titanium, gold and silver.

INCLUSIVE FRAME DESIGN Minus Eyewear makes its 100% Optical debut with frames for individuals with high myopia. The brand has recently started supplying NHS dispensing hospitals.

tradersandmakers.com

woodyseyewear.com

VISUAL CONTRAST

minus-eyes.com

Coti Vision brings its latest launch, the ‘Duetto’ glasses chain made from recycled acrylic and lightweight aluminium.

cotivision.com

CONNECTED BY AN OCEAN Blackfin Eyewear has expanded the Pacific line with four new optical styles including a unisex design, ‘Sonoma,’ available in antique gold or gunmetal.

blackfin.eu February/March 2024 OT www.optometry.co.uk 75

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What's happening in...

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What’s happening VERSION

Me and my glasses

REPRO OP

CAROLINA LOBER

SUBS

The image consultant shares her favourite styles and discusses her partnership with 100% Optical

Spectacle wearer since: two years old Years in industry: 12

O·················

ART PRODUCTION

What does vision and eye health mean to you?

CLIENT

It means everything. Many people aren’t aware of the importance of visual health. I’ve experienced the distress of not seeing well, and it’s horrible. ............................................................... .

78 Frames in Carolina’s eyewear wardrobe

Carolina picks frames to express herself and ‘elevate a look’

Due to my style and personal preferences, I mostly choose frames with a butterfly shape. I prefer warm colours such as gold, Havana, green, turquoise, white, black, coral, and red. I like acetate, but I also opt for minimalist touches with metal frames or rimless glasses. My favourite is a red frame with a cat’s-eye or butterfly shape. I find it super sophisticated, and its colour lifts my spirits.

I express myself with glasses. The choice depends on the image I want to project at any given moment: creative, approachable, distant, sophisticated, or confident. Or I will pick frames to elevate a look. My style icon is, without a doubt, Iris Apfel. Her style and pioneering spirit are a great source of inspiration for me.

I am an image consultant. Before working in the optical sector, I worked in fashion. I’ve applied my image consulting knowledge to

glasses, observing the effects frames can have on one’s image. I’ve been working in the optical industry for 12 years now.

I recommend that eye care professionals, during frame consultations, apply image consulting knowledge. Most people want, not only to see well, but to also look good. This will enrich an eye care professional’s advisory discourse and enhance the optical experience. I would encourage them to embrace more colour to inspire clients to do the same. I provide tools to give colour combination recommendations.

I participated in 100% Optical last year and was delighted. It is a dynamic, innovative and fun fair. It’s an honour that the team want to include me. I recommend opticians do not miss 100% Optical; it’s an opportunity to discover new brands and professionals in the field.

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Yourlocal Lions Club collects spectaclesthat are no longer neededto be recycledand used to improvethe eyesightof childrenand adults in other countries.SinceVisionAid Overseasis no longer recyclingspectacleswe have become a lead in this field. Here'show you can help.

Makecontactwitti

Step 4: OurRecycle for Sight volunteers select thosespectacles suitablefor recycling. Noneof ourspectacles aresentto landfill- ALLarere-used.

Are you interested in volunteering with Lions? Step forward and join us:

~ #LionsGetlnvolved

Call us on Tel: 0345 833 9502 or Email:

enquiries@lionsclubs.co.uk

Please quote OT when calling or Visit: lionsrecycling.co.uk

@ Fight against diabetes

Support childhood cancer initiatives

Relieve hunger

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Protect the environment

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VERSION REPRO OP

TREND WATCH

Optometrist and lifestyle blogger, Lizzy Yeowart, on the perfect eyewear for the winter to spring transition. See more from Lizzy on her Instagram page at @WHATLIZZYLOVES OT’s Instagram Trend Watch

WITH LIZZY YEOWART

@ OPTOMETRY_TODAY

SUBS

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•••••••••••••·

·••'

‘Sycamore’

ARCHITECTURAL CRAFTSMANSHIP ART

OGI Eyewear has updated the shape of its ‘Sycamore’ style by juxtaposing a thicker profile from the top view of the acetate and a thinner profile from the front.

Spanish brand, Kaleos, has collaborated with Barcelona-based architecture firm, Arquitectura-G, to create a capsule collection.

kaleoscollection.com

ogieyewear.com/collection/ sycamore

PRODUCTION

GEOMETRIC STYLES Gigi Studios has introduced ‘Romina’ to its Vanguard collection; a handcrafted frame made of laminated acetate.

gigistudios.com

‘Jacinto’

CLIENT

93-year-old Italian artist and designer Cleto Munari has launched his first eyewear collection, focusing on bold, multi-layered shapes in custom-made Mazzucchelli acetate.

ADAPT TO COMFORT

cletomunarieyewear.com

‘Tribeca’ by Blackfin is an optical frame fabricated from a single titanium block, made in Italy at the Blackfin Black Shelter Sustainable Factory.

blackfin.eu

WHAT’S HOT? Lizzy's top frame picks this edition

‘Elodie’ The ‘Elodie’ flat-top statement style in winter white is designed in collaboration with model and ambassador for body inclusivity, Charli Howard.

lindafarrow.com

TOP TREND:

White hot frames Trending now is white hot eyewear, perfect for the end of the ski and winter sports season and the eagerly anticipated transition into spring and summer. White epitomises timeless elegance and whispers of expensive sophistication. White frames will always turn heads and draw second glances, whether glazed as a sun or an optical style.

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Trend watch

What’s happening

DRY EYE Rr'VOLUTION

A powerhouse of knowledge, education, expertise and award-winning products. We're inviting you to join our exclusive community of pioneers as we help you improve the lives of your patients one dry eye at a time.

Speak to our team at The Body Doctor today

BTB

What’s happening VERSION

Behind the brand

REPRO OP

WOODYS EYEWEAR

Melanie Scott, UK country director for Woodys Eyewear, on the colourful and fashion-forward brand SUBS

O···················································· The brand turned 10 years old in 2023

A privately-owned company passionate about people and product. Visionary and caring -

Melanie Scott

ART

Three facts about Woodys 0 The company is owned PRODUCTION

and run by the founder, Josep, and his aunt Maria 0 Every frame has a small piece of wood in the side as a reminder of the wakeboards that inspired the founder to explore eyewear design 0 The company has recently moved into a new office, which has been built with sustainability at the centre.

CLIENT

What is the latest collection and why does it stand out from the crowd? The latest fashionable colours are always at the forefront. Luckily, the UK market is changing and becoming far more excited by colour. Woodys Eyewear’s mix of acetate and titanium also enables us to launch unusual shapes and designs.

What is Woodys’ approach to sustainability? We work with bio and recycled acetate in the majority of our products. The frame cases are 100% recycled, and we use recycled paper and cardboard in our packaging. The office generates all of its energy from solar panels. This is one of the benefits of a location in Spain.

What are the biggest opportunities that you see currently in eyewear? Woodys Eyewear is still relatively unknown in the UK, whereas we are very strong in Europe. The opportunity is for us to build awareness in the coming years.

How would you describe the business environment for independent optometry practices in the UK and Europe currently? And how does Woodys seek to work with its customers? Challenging to say the least. Optical outlets are more considerate to style and fashion, and style studios are growing. Making the experience of purchasing something unique and unusual is fun and motivates the consumer to be more adventurous. Service and value for money is always key. We often surprise our customers with the price we offer for the quality. This drives sales in a very positive way.

Have you seen any changes in consumer demand and behaviours? Price versus quality is a key driver. UK consumers are also becoming more considerate of fashion. There is a slow change from having only one pair of spectacles. Women buying frames with a new outfit is growing sales. 0

2013 Woodys Eyewear launched

Melanie’s favourite frame: ‘SABINE04.’ A tri-colour laminated acetate with nickel-free metal in a round-butterfly shape

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VERSION

Supplier insight

REPRO OP

PRESBYOPIA

Manufacturers and suppliers discuss the technology behind their designs 0 SUBS ART PRODUCTION CLIENT

anufacturers across ophthalmic lenses and contact lenses are utilising technology to create innovative designs to enhance vision and comfort for presbyopes. EssilorLuxottica launched its Varilux XR series lens in 2023 to meet the needs of presbyopes, with a design that utilises behavioural artificial intelligence (AI) to “respect the natural behaviour of the eye.” Alan Pitcher, commercial director for wholesale lenses at EssilorLuxottica, explained that through AI digital twin technology, “we were able to study patient’s visual behaviour.” By modelling object positions and visual behaviour in a 3D environment, Pitcher said,

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“it is possible to define the exact object positions relative to each wearer’s head, according to their behaviour.” Meena Paur, global medical adviser at EssilorLuxottica, added: “If we know the wearer’s posture and behaviour while reading, it is possible to personalise the design of the progressive lens in accordance with the wearers needs.” Near Vision Behaviour personalisation can be integrated into the lens for further tailoring. Pitcher suggested: “Designing a lens that meets the changing needs of this growing cohort of patients means that practices have the best visual solution available to recommend to them at that time.”

EssilorLuxottica

How is vision correction tailored for presbyopes?

“Patients are looking for a solution that can accommodate their visual needs and lifestyle but at the same time provide effortless vision, regardless of the viewing distance. For the practice, this demonstrates they have the latest solutions available to offer their patients and differentiates them from others,” he said.

Designing for astigmats Rakhee Thakrar, senior professional affairs associate Vision Care, UK and Ireland, for Bausch + Lomb, highlighted that contact lens wear declines markedly from 45 years of age according to the Vision Needs Monitor (2013). Astigmats make up a large proportion of emerging presbyopes, she suggested, sharing: “Presbyopic astigmatic patients are interested in contact lenses just like other presbyopes. Historically, there have not been many readily available soft contact lens options to select from.” “Presbyopic astigmatic patients who only wear spectacles are more likely than other spectacle-only wearers to perceive barriers to contact lens wear, less likely to be aware of multifocal contact lens options, and furthermore, are less likely to report having been recommended a multifocal contact lens by their eye care practitioner,” Thakrar continued. To address the needs of this cohort of patients, the company introduced the Bausch + Lomb Ultra Multifocal for Astigmatism. The range has been expanded to 3280 parameters. Thakrar explained: “The lens incorporates an advanced lens design, combining the revolutionary comfort of MoistureSeal Technology, the stabilisation geometry of OpticAlign Design and proven 3-Zone Progressive Design for stable, seamless vision at all distances.” The lenses require two spectacle add powers across the range and feature a 3-Zone Progressive Design for clear vision and transitions across distances. Discussing the design of the lens, Thakrar shared: “Bausch + Lomb researchers integrated a broader investigational approach and took seven key biometric variables into account, including: refractive error, pupil size, higher order aberrations, corneal curvature, axial length, anterior chamber depth and residual

accommodation measured across nine viewing distances ranging between 25cm and 6m.” The lens also combines the material Samfilcon A, made incorporating the MoistureSeal Technology.

Going virtual Jai Kudo Lenses, part of the Millmead Optical Group, introduced the Kudos system which utilises virtual reality (VR) technology to create a bespoke lens based on gaze dynamics. James Conway, CEO of Jai Kudo Lenses, told OT: “Using VR, we are able to capture each individual’s eye movements and use this heat map data to create a progressive lens design for each individual.” Emphasising that there is no base design for the lens, Conway added: “Each lens design is completely unique and tailored to how each individual uses their eyes. We are using cutting-edge technology to take lens dispensing to new heights in every way.”

45 The age from which contact lens wear declines “markedly”

Source: Vision Needs Monitor (2013).

“Patients are looking for a solution that can accommodate their visual needs and lifestyle but at the same time provide effortless vision” Alan Pitcher, commercial director for wholesale lenses at EssilorLuxottica Patients are guided through a VR experience with the use of a headset that then captures points and directions of gaze. The data is then analysed into frequency of use maps for near, intermediate and distance visual ranges. A 19-digit code is created and sent to the Jai Kudo Lenses lab to create the lens. This approach aims to minimise oblique astigmatism, provide a wider range of natural vision, and reduce potential adaptation issues. The system also features Kudos Coach, a VR simulation that takes patients through an educational experience of using progressive lenses, breaking down misconceptions around varifocals. Speaking to OT at the UK launch of the device, Conway suggested that Kudos could provide differentiation to independent practices. 0

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Supplier insight

What’s happening

ICLW VERSION REPRO OP SUBS ART

I COULDN’T LIVE WITHOUT… PRODUCTION

My academic work Dr Clare O’Donnell, head of optometry at Optegra, on how her academic background benefits clinical research embarked on by the hospital group

Practical applications My training as an optometrist, my time in academia, my PhD, and later my MBA, meant I was a strong candidate for the Optegra role. They wanted somebody with clinical research and teaching experience, and management knowledge. To be able to interpret current literature is important in eye healthcare. It’s a sector that is

rapidly changing. With an ageing population, the demands on healthcare are increasing. We must look at how we meet that changing demand. Part of my job is to look at new advances, whether new lens types, new drugs, or other treatments to improve outcomes for patients. Age-related macular degeneration is a growing area. Next year, we’re going to see new advances and treatment offerings. My research experience means I can make recommendations as to what could be a great addition to Optegra’s service offerings.

Giving knowledge back Being an academic enabled me to apply for a grant with some of the key players in ophthalmic research across Europe, which has funded two PhD students. They were tasked with looking at how sometimes the treatments we apply to patients can highlight if they’ve got a dry eye issue. It highlighted the importance of making sure these things are addressed before we operate. I’m proud of the fact that we were able to provide that training for up-and-coming researchers. Had I not had academic experience, I wouldn’t have been able to apply for grants, supervise PhD students, understand the research outcomes, or integrate those new learnings within our business. The training, foundations and experiences that I’ve had as a clinical and academic optometrist have meant that I’ve got this fantastic job now. That academic experience has been hugely impactful to me. 0

Getty/filo

CLIENT

ithin a year of qualifying as an optometrist, I was invited back by Glasgow Caledonian University to teach. From the beginning of my career, I have been involved in teaching trainee optometrists. I learned a lot through teaching others. You have to make sure you’re well informed. It came to the point where I enjoyed that half day of teaching as much as the other things I was doing in my week. Later, whilst teaching in New Zealand, I applied for a clinical teaching assistant job at the University of Manchester, where I completed a PhD in contact lenses. That period enabled me to do many different things. I was teaching half the time, training optometry students from first right through to final year, as well as medics who came in from hospitals. I was able to present my research all over the world at conferences; my work was published in internationally renowned journals. I would wholeheartedly recommend an academic career for anybody who has even a slight inclination to try it out, because it’s so diverse.

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"This a great job for optometrists to provide that clinical excellence, to make sure your patients receive the best possible care. This is the job that you signed up for when filling out your UCAS form" Tom Critchley, Principal Optometrist, SpaMedica

Do you have a passionfor patient care and strive for clinical excellence?You could be the perfect fit for our growingteam of talented optometrists. • Great work life balance- Only 1 in 4 Saturdays • Continuoustraining and development • Biannualbonuses

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An exciting opportunity has arisen for an ambitious and enthusiastic Optometrist to join our expanding Optometry department at Mersey & West Lancashire Teaching Hospitals Trust.

The successful post holder will help carry out core optometry roles, with an opportunity to explore extended roles in AMD, Glaucoma and post-op care.

Closing date: 22/03/24 Apply now via NHS jobs Job reference: 409-5679512-C

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Term:

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Requirements:

Minimum 5 years' experience

Since 1969, Cutler and Gross has been at the forefront of optical design - as disrupters and pioneers whose legacy has been much imitated, but never surpassed . Recruiting forward-thinking, creative, customer-focused Optometrists with excellent communication skills to join our Spitalfields and Bath stores. For more information, please visit www.cutlerandgross.com/careers To apply, please send a CV and cover letter to mw@cutlerandgross.com February/March

2024 OT www.optometry.co.uk

VERSION REPRO OP SUBS

ON THE GROUND AT THE AOP

What is the AOP looking for in a Councillor? OT finds out ahead of the 2024 election process

ART

POLICY

PRODUCTION

AN EXPLAINER ON... AOP COUNCIL ELECTIONS

CLIENT

NAME:

Rohama Jan

ROLE:

Policy officer

The AOP Council is usually made up of 33 Councillors, with 13 elected to represent members in their geographical constituencies, and the rest appointed to designated positions representing particular groups within our membership. A ranage of the AOP Council’s geographical seats are up for election in constituencies across England, Scotland, Wales and Northern Ireland. There are also four appointed positions available for application, representing undergraduate members, pre-registration members, newly-qualified and early career members, and dispensing optician members. Our Council is representative of the diversity of the profession. We have Councillors across different career stages with different backgrounds, professional experiences and priorities. This diversity enables involvement with Council to be a learning experience for everyone. Councillors bring their own experiences, opinions and concerns, and those of the members they represent. We encourage Councillors to communicate with the wider membership and use this feedback to NOMINATION inform their TIMELINE involvement Applications open in the AOP on 15 February 2024 Council and close on meetings which 14 March take place three

88 www.optometry.co.uk

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times each year. By listening to this depth of perspectives, the AOP is better able to represent our members’ interests in policy-making and influencing of Government and bodies like the General Optical Council (GOC), and to improve the support we provide to members. Council meetings are also a great opportunity for networking with others in the profession. There is likely to be a geenral election this year, and the AOP will be pushing the political parties to keep eye care on the agenda. The GOC will be consulting on the individual professional standards that registered optical professionals must work within. Our Council will help inform the AOP’s response to these changes. The GOC will also be reviewing its regulation of optical businesses,

AOP Explainer

AOP chairman:

Emma Spofforth

“Representing your profession at AOP Council presents a key opportunity to influence national AOP policy and guidance that is key to shaping the future of optometric practice across the UK. I was encouraged to apply for AOP Council by colleagues who were former Councillors, who had input into the important work of the AOP and overseen change across our regions.”

0 Read more information on the AOP Council and the work of AOP Councillors on the Association’s website. For those interested in becoming a Councillor, a description of the role can be found at: www.aop.org.uk/council

Scan the QR code to read and watch OT content about the Council elections, featuring highlights from Councillors who are stepping down this year.

Pixabay/Nile

A review of AOP activity in the last two months

AOP campaign shines light on delays The AOP has shared findings from a survey of more than 1000 optometrists which revealed how patients are turning to private treatment in the face of long waiting lists for secondary NHS care.

www.aop.org.uk/sightwontwait

Pixabay/FreePhotos

and we will represent the views from across our employee, locum, and employer members that this will affect. Members don’t need to have masses of experience to become an AOP Councillor. They simply need to be interested in making a difference to the future of the profession. They will need to attend three meetings a year and spend time communicating with colleagues to be able to bring their views to meetings along with your own. Current Councillors have said that our Council is a great networking opportunity, and a chance to learn from each other as well as contribute to debates. They also find the meetings friendly and fun. Nominations will open on 15 February. Members can put themselves forward for a Council position before applications close on 14 March. Voting will open on 28 March and close on 23 April. The AOP engages a specialist company to manage the election process. Voting is anonymous and confidential. Members will receive emails with links to the details of who is standing in their constituency, and a unique link so that they can cast their vote. As a member, it is a great opportunity to influence who is representing you on the AOP Council.

Rewind

GOC statutory notices advice

AOP student reps share top tips

The AOP’s legal team has issued advice to members on the GOC’s decision to seek permission for statatory notices, including registration and FTP information, to be sent by email.

Throughout autumn, the AOP student reps took over the Instagram account to share their top tips for studying, wellbeing, and work-life balance.

www.aop.org.uk/gocnoticesbyemail

www.instagram.com/ association_of_optometrists/

Coming up at the AOP 0 100% Optical 24-26 February

Don’t miss the big stories from the 10th edition of the show. Follow along at: www.optometry.co.uk/100-percent-optical

0 AOP spring/summer events End of February

Check your communication preferences under the MyAOP section of the website to stay up to date as the AOP releases its spring/summer education programme.

0 Voice of optometry research April

AOP members will have the opportunity to share their views on topical issues impacting the sector as the AOP launches a new Voice of Optometry research survey.

February/March 2024 OT www.optometry.co.uk 89

91OPTJAN24131.pgs 31.01.2024 14:19

A final thought

VERSION

A final thought _

REPRO OP SUBS

A SHIFT IN PRACTICE

ART

Pre-reg optometrist and AOP Councillor, Priya Tanda, reflects on the profession’s progress during her optometry career to date

PRODUCTION CLIENT

“

I believe that over the next 10 years, with optometrists currently acquiring a wider skill set and providing advanced eye care within the community, the profession will move more towards the role of doctors

Since childhood I had my hopes set on working within healthcare. Helping people on a daily basis was something vital I wanted to do, but initially I was unsure of what path to take. Through my early education I undertook work experience in a variety of healthcare professions – in hospitals, GP surgeries and in optometry practices – to help guide me in picking a career that would be right for me. Through working at an independent opticians close to home, my love for optometry began, and later so did my applications for optometry at university. As I now come to the closing stages of my pre-reg period, my experiences through my training year have given me huge insight into life as a newly-qualified optometrist. Having attended university during COVID-19, I have already seen a shift in the way we have practised during my optometry career. Hospitals have longer backlogs and, although the pandemic was four years ago, we are still adjusting in both High Street and hospital settings. There have been developments in further training for optometrists and increasing community services, which I believe will emerge further still in the future, allowing optometrists to build their skill sets further and provide readily available enhanced eye care. During my pre-reg, I have learnt how diverse optometry can be and how there are many routes in further qualifications and training. Upon qualification, I would like to gain more hospital experience, allowing me to expand my skill set outside of a High Street setting. My professional interests include myopia control and technology within optometry – areas that I see changing and developing in the early stages of my career, which I am keen to get involved with. I believe that over the next 10 years, with optometrists currently acquiring a wider skill set and providing advanced eye care within the community, the profession will move more towards the role of doctors. With more optometrists able to prescribe with independent prescribing, and getting higher qualifications, we are the first port of call for managing, and often treating, eye conditions. 0

PRIYA’S TOP READS

You had me at hospital

Pre-reg focus

100% Optical

Insight into working in a hospital optometry setting

Read about the current experiences of pre-reg optometrists in different settings

A must-read for those planning on attending the show this month

PAGE 29

PAGE 34

PAGE 38

90 www.optometry.co.uk OT February/March 2024

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