An independent view

21 AIO

Bringing the optical community back together The Association for Independent Optometrists and Dispensing Opticians (AIO) is aiming to bring the profession back together as a community at its autumn conference next month. “One of the negative aspects for the world of optics over the last 18 months has been the loss of all the physical events that bring people together as a professional community,” said AIO chairman, Christian French. “Arguably it is independents who are most greatly affected as they often operate with little regular interaction with fellow practitioners.

“Whether it is 100% Optical – and in pre-Covid times Optrafair – or much smaller intimate affairs such as the NEG or AIO conferences, there is a real feeling of community when members of the optical world gather together,” continued Christian. “And it goes beyond the common bond of patient care and even language; it is about comradery and friendship. With the best will in the world, Zoom, Teams, Google Meet and so on do not work for exhibitors.

“Seeing frames in person, playing with new instruments and assessing equipment just can’t be replicated virtually. AIO members have been unequivocal in their desire to get back to physical conferences and it is significant that the events planned for the autumn all seem to be focused on the independent sector.

“The AIO will hold its 2021 conference at Chesford Grange, Kenilworth, on 9 and 10 October. It is not the case, however, that we should simply revert to the world of events pre-Covid. Double vaccination notwithstanding, the effects of Covid can still be extremely harmful for the vulnerable, regardless of age. Conference organisers will be particularly sensitive about ensuring that their events are staged so as to afford the greatest protection and safety for delegates and exhibitors alike.

“A combination of asking for evidence of double vaccination and negative Covid tests, and a scrupulous approach to cleanliness and sanitisation are likely to be the order of the day. This will certainly be the case for the AIO conference,” Christian concluded. Find out more about the 2021 AIO conference at www.aiovision.org

AN INDEPENDENT VIEW

To NHS, or not to NHS?

There has been a lot of discussion on various online forums of late about whether or not independents should opt out of the NHS GOS contract and go completely private. Indeed, there are a number of practices that have already made the move and, generally, the feedback from these practices has been positive. As a result, there is a growing number of practices considering dropping the NHS contract. ‘To NHS or not to NHS’ raises a lot of questions and issues. First of all: is it feasible for all independents to go completely private? The answer to that is: no. There are many practices where location and surrounding demographics dictate that it is impossible to make such a move; indeed, some of these practices may be almost entirely dependent on the GOS contract. Equally, the communities they serve are often highly dependent on these practices to access good quality eye health care. It is also the case that some practices that could make the move, feel that to opt out of the contract and adopt a wholly private model is in some ways abandoning those people in their communities that are dependent on accessing NHS services. Further, the range of NHS eyecare services in England can differ hugely from one postcode to another depending on which services the local clinical commissioning group has decided to put in place. This can make a significant difference when making a decision to opt out of the NHS contract. However, there are real attractions to not being constrained by the pitiful GOS fee and the tension that it creates in respect of offering patients a thorough eye examination where others only deliver a simple 20-minute refraction service. Not to mention all the bureaucracy of claiming under the contract and frequently having to chase for payment. Yet making a decision to go entirely private is not easy, and can even be rather frightening. Every practice is different, and the considerations may vary greatly from one location to another; there is no magic formula that fits all. The subject of going private (or not) will form a dedicated workstream at the AIO conference on 9 and 10 October with an expert panel session and one-onone clinics. To book a place or find out more, contact Lin by emailing lin@aiovision.org or calling 0800 1300 486.

Case Study Series Biofinity® toric multifocal, from CooperVision CASE #1: 66-year-old retired cyclist

Grow with your astigmatic presbyopes

Patient Background

This case reports on the successful contact lens fit of a retired 66 yearold-man who was a long-term patient of the practice. Retirement had reduced his near and computer screen viewing demands and left him with more time to pursue a new hobby of cycling. In fact, he spent most of his newly found free time out on the road. He reported that it was frustrating to not be able to see his navigation computer on the handlebars of his bike clearly and was motivated to wear multifocal contact lenses for that reason. Although his current contact lenses gave him the near vision he required, they were not performing well in terms of comfort.

Previous lens wearing experience

He was an existing contact lens wearer, and prior to becoming presbyopic had successfully worn soft toric contact lenses for many years. Due to the lack of lens choice in his prescription he had initially coped with the onset of presbyopia by wearing reading glasses for close work. Early attempts at fitting toric multifocal contact lenses had not been successful due to poor vision with the lenses that were available at the time. The ability to achieve a good visual outcome was further complicated by a retinal hemorrhage in 2015 that reduced best corrected visual acuity in his right eye to 6/12. He was currently wearing a single vision Biofinity® toric lens in his right eye, and a multifocal toric lens from another manufacturer in his left eye. The trouble with this approach was that the difference in lens comfort was very noticeable between each eye, with the lens in the left eye being consistently less comfortable than the Biofinity® toric in his right eye. Knowing he was able to achieve a comfortable wearing experience with the Biofinity® material made him an obvious candidate to try Biofinity® toric multifocal in his left eye as soon as they were available.

Biofinity® toric multifocal lens fitting notes

His spectacle refraction was

R: -11.25/-1.25 x 55

L: -4.75/-1.25 x 140 with +2.25D reading addition While it is important to use the manufacturer’s fitting guide to suggest initial trial lenses, occasionally a patientspecific situation can alter that standard approach. This case was a little different due to the presenting best correctable visual acuity the patient could achieve and the desired modified monovision prescription outcome. This led to the following prescription being trialed in the left eye, with no change to the single vision lens in his right eye:

The lens settled quickly in the left eye and when assessed after fifteen minutes showed less than five degrees of rotation. Lens centration and fit were optimal and the lens was rotationally stable showing no difference compared to the single vision Biofinity® toric lens in the right eye. The patient achieved binocular vision of 6/7.5 and N6 for distance and near, respectively. He reported the overall quality and clarity of vision at intermediate and near met his expectations, while at distance this even exceeded his expectations. Most importantly given his previous experience, lens comfort was found to be equally good in both eyes. No further adjustments were needed to the prescription.

Case outcome and lessons learned

In this particular case the patient made a point of calling the office post-fit to proactively report how much he was enjoying the new lens. His distance and near vision were both working well, especially when cycling. Moreover, the ability to wear a pair of lenses from the same contact lens brand family meant he was no longer aware of any difference in comfort between his eyes. A pair of top-up near vision spectacles had been prescribed for very small print, but he reported that he seldom needed to use them. This case illustrates how Biofinity® toric multifocal can be used for more challenging situations. This patient required only one multifocal lens and was already an advanced presbyope. With the right counseling early on, the patient understood the benefits of the modified monovision approach and was aware some top up may be required for detailed close work. In fact, as highlighted above, his expectations were exceeded, and the flexible options delivered by the Biofinity® family of contact lenses enabled him to be successfully fit.

Chris Worsman qualified as an optometrist at the age of 20 in 1983, becoming the youngest ever registered optometrist in the UK. He is currently the senior optometrist at Viewpoint, one of the largest contact lens practices in the UK. He is passionate about contact lens fitting and has been a principal investigator in many contact lens related clinical trials over the years. He is a regular invited guest on round table discussions. Final lens prescription

Biofinity® toric RIGHT LENS Biofinity® multifocal toric LEFT LENS

Sphere power -9.00

Sphere power -4.50

Cylinder power -1.25

Axis 40

Cylinder power -0.75

Axis 140

Add power +2.50 (D lens)

AVAILABLE PARAMETERS

Sphere power (DS) -10.00 to +10.00 in 0.25 steps or 0.50 steps beyond +/-6.50

Cylinder power (DC) -0.75 to -5.75 in 0.50 steps

Axis

5° to 180° in 5° increments

Add power +1.00, +1.50, +2.00, +2.50 in both D and N center designs