AOP advice on safe referral Profile: Brian ... - Optometry Today

www.optometry.co.uk April 6 2012 vol 52:7 £4.95
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Journal of the Association of Optometrists
Profile: Brian
Tompkins
<strong>AOP</strong> <strong>advice</strong> on
safe referral
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News
5 GOC on the move?
Optics’ regulator is to investigate a move
away from its Harley Street base
6 Scottish strategy assessed
Preventing sight loss in Scotland has been
discussed at a high profile conference
7 Mystery shop at multiples
Branches of Specsavers and Boots Opticians
have been compared in a mystery shop by
The Guardian
8 Comment
The <strong>AOP</strong>’s interim chief executive Richard
Carswell discusses getting the best out of
your OT
10 News Extra
NICE has issued an updated guide on
commissioning services for people at risk of
glaucoma across England
Cover story
22-23 Education Destination
A preview of the lectures at the upcoming
inaugural two-day therapeutics seminar in
London co-produced by the <strong>AOP</strong> and SECO
Products
20-21 Industry News
Good news for Optix, the FMO discusses
the economy, plus new products for David
Thomas Contact Lenses, Signet Armorlite
Europe and OWP
Feature is online
www.optometry.co.uk
CONTENTS
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...Steve did!
01793 648607
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April 6 2012 vol 52:7
12 20 41
OT (the <strong>AOP</strong> and Ten Alps Publishing) accept no responsibility for products, goods or services that may be
advertised or referred to. Opinions expressed are not necessarily those of OT, the <strong>AOP</strong> or Ten Alps Publishing
Video is online
Profile/<strong>advice</strong>
14 Profile
Flamboyant optometrist Brian Tompkins
advises on making optics fun
16 A profitable exit
Techniques to help sell a practice
18 Referring safely
Clinical adviser to <strong>AOP</strong> legal services, Trevor
Warburton, advises on reducing risks
36-37 Pathway triumph
LOCSU has developed a new Community
Eye Care Pathway for people with learning
disabilities
Events
24 Optometry Tomorrow
A review of the College of Optometrists’ annual
conference
34 <strong>AOP</strong> Awards/NOC
Update on the accolades and a new
beginning for the annual conference
Regulars
12 Spectator
Biscuit budgets and recycling spectacles
for charity
28 Diary dates
The upcoming optical events
32 Students news
<strong>AOP</strong> student reps meet at annual forum
Clinical
38-39 VRICS C-18690 O/D
Advanced clinical techniques
Part 1
Optical Coherence Tomography by Ramesh
Sivaraj. The first in this series tests practitioners’
knowledge of posterior segment OCT of the
macular area
41-44 CET 1: C-18633 O/D
Ophthalmic public health Part 4
Healthy lifestyle equals healthier eyes. Dr Ruth
Hogg discusses how lifestyle changes can help
to reduce the risk of ocular disease
45-49 CET 2: C-18551 O/D
Retinoscopy in infancy
Cycloplegic vs. non-cycloplegic by Fabrizio
Bonci and Luigi Lupelli. This article reviews
cycloplegic and non-cycloplegic refraction
in infants
Classified
51-52 Jobs
All the latest vacancies
54-58 Marketplace
Your guide to optical products and
services

MODEL WEARS Ti 2006
titanium
0151 426 3907
continental-eyewear.co.uk

GOC considers office move
Chris Donkin
chrisdonkin@optometry.co.uk
THE GOC is to investigate a move
away from its Harley Street office
to more modern premises, the
regulator has revealed.
As part of its business plan and
strategic aims for the coming
years, the regulator will look
at the viability of relocating or
collocating to ‘modern fit-forpurpose
offices’.
GOC director of resources,
Jeff Cant, told OT: “As the office
is in a high value location any
move would have the probable
advantage of helping us to
reduce the costs of our facilities.
A TOTAL of 351 practitioners
learned about the effects of UV
on the eye, different solutions
and enjoyed a referral quiz at
last week’s Johnson & Johnson
Raising the Bar roadshows in
Manchester and London.
The pair of day-long events
covered a range of optical issues
with delegates able to collect
CET points from sessions which
included a fascinating look
at the latest research on UV
from professor Minas Coroneo
(pictured).
Delegates learned that many
‘fashion’ sunglasses are ineffective
at protecting the whole eye from
damaging rays and glare and
were advised to consider eyewear
solutions with a good all-round
protection, such as wrap style
“We are fully committed to
maintaining downward pressure
on retention fees and a move
could additionally enable us
to hold more meetings and
hearings in-house, reducing the
bill for hiring rooms in other
premises. A move to more
modern premises would also
help the team work more
efficiently and effectively.
“We will carry out a thorough
cost-benefit analysis before
any office move proposal is
presented to the council.”
Currently, the GOC is holding
its council meetings at hired
locations around London due
to lack of space in its office
during fitness to practise
hearings and other meetings.
Its March council meeting
was held at the Royal Institute
of British Architects, with the
previous one held at the Royal
College of Ophthalmologists,
both a short walk away from
Harley Street.
J&J roadshow hailed a success
frames or contact lenses offering
UV protection.
Later in the day professor
Lyndon Jones discussed the
merits of different types of
solutions for extended wear
contact lenses, Philip Morgan
covered contact lens materials
and Jeff Walline looked at the
options available for myopia
control.
Concluding the day, professors
Jones and Morgan tested the
audience’s skills in diagnosing
conditions causing red eye in
contact lens patients.
Head of The Vision Care
Institute, Kamlesh Chauhan, said:
“We were delighted to see so
many delegates at Raising the
Bar. From the feedback we have
received it seems that delegates
really benefited from the
interactive lectures by some of
the top international speakers.
“As part of our commitment
to helping eye care
professionals further their
learning, we hope the
success of the roadshows will
encourage colleagues to come
to The Vision Care Institute and
take part in one of the many
new courses we have available
in 2012.”
The series of roadshows will
return in October with guest
speaker professor Nathan Efron.
For more details, visit www.
thevisioncareinstitute.co.uk
To comment go to www.optometry.co.uk
NEWS
IN BRIEF
Voucher values
A handy leaflet detailing the
new optical voucher values will
be included for <strong>AOP</strong> members
in the next edition of OT (April
20). NHS voucher values rose
by 2.5% on April 1.
OC releases Youth
Contract guidance
The Optical Confederation
has released guidance on
Youth Contracts, a £1bn
Government programme
to encourage employers to
train and hire 18-24-yearolds.
The Youth Contract,
launched on April 2, contains
several initiatives including
apprenticeships, work
academies and an employer
incentive payment of up to
£2,275 for full-time roles that
last at least 26 weeks.
For more details, visit
www.dwp.gov.uk/youthcontract
CET correction
OT would like to apologise
for printing the incorrect CET
code with the questions for
the exam ‘Assessing visual
function: young children’s
vision part 3’ by Dr Margaret
Woodhouse on March 23,
2012. The correct CET code for
this exam is C-18550 O/D.
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06/04/12 NEWS

6
06/04/12 NEWS
IN BRIEF
Photograph contest
The BCLa is
calling for
submissions
for its annual
photographic
competition,
which closes on april 27.
professor James Wolffsohn,
a lecturer in the optometry
department at aston University,
will judge the competition
alongside contact lens expert
andrew Gasson.
professor Wolffsohn said: “if you
have taken a photograph of the
anterior eye over the last year that
you are proud of, whether it was
taken with a smart phone or a
sLr camera, we want you to
share it.”
Last year’s winner was antonio
Calossi (pictured) from italy.
For more information visit
www.bcla.org.uk
Specsavers launches
online help facility
Specsavers has launched an
interactive online source of
eye care <strong>advice</strong> called
‘Ask the optician’.
Visitors to the multiple’s
website can post a question
which will be answered by a
qualified optometrist ‘within
a few days’ by email, with
selected questions and
answers appearing on the
website.
New JOCEU chairman
Former
president of
aBDo Kevin
Milsom
(pictured)
has been
announced
as the new
chairman of
the Joint optical Committee for
the european Union, following
three years as vice chair of the
organisation. Cindy Tromans,
former president of the College of
optometrists has been appointed
vice chairman.
NEWS
Impact of Scottish Vision
Strategy since 2008 assessed
emily McCormick
emilymccormick@optometry.co.uk
The proGress made at
eradicating preventable sight
loss in scotland since the scottish
Vision strategy was established
in 2008 was assessed at a high
profile conference last month.
Despite scotland being seen
as a ‘world leader’ in some
aspects of eye care, with free
eye examinations introduced in
2006, the number of scots who
are blind or partially sighted is
expected to double over the next
two decades. statistics reveal that
one-in-six hospital appointments
in the country relate to eye
problems.
eye health specialists,
government officials and
Optos CEO Roy Davis wins IoD director award
The CEO of Optos, Roy Davis
has been named ‘Fife and
Central Scotland Regional
Director of the Year’ at the
annual Institute of Directors
(IoD) Scotland Awards.
Judges selected Mr Davis
CooperVision extends OGS support
emily McCormick
emilymccormick@optometry.co.uk
CooperVision has increased
its commitment to support
optometry Giving sight, the
charity has announced.
The contact lens giant
becomes a platinum sponsor
and pledges its support for two
years, extending its previous Gold
Global sponsorship, which it
announced last year.
president of CooperVision,
John Weber, said: “This is a very
significant commitment by our
company to an organisation
that we believe is having a
substantial impact on the delivery
sight loss charities gathered in
stirling to review the strategy’s
progress and to hear from the
country’s health Minister Michael
Matheson, chair of optometry
scotland, peter Carson, and chair
of the scottish eyecare Group, Dr
paul Baines.
Director of the rniB scotland,
John Legg (pictured), said: “The
for the accolade ‘because the
company’s financial performance
and development of innovative
new products, showcased
the strategic direction and
operational capabilities of an
excellent business leader’.
of sustainable eye care services
in under-served communities
throughout the world.
“as a global company, we
think it makes absolute sense to
actively support a global charity,
especially one which is doing so
much to promote and develop
optometry.”
Clive Miller, Ceo of optometry
Giving sight, added: “This is
To comment go to www.optometry.co.uk
scottish Vision strategy set its
targets high from the outset. But
this review will hear that we have
made tangible advances, and in
some cases, big steps forward.”
he then cited a pilot scheme
by nhs Fife trialling the scottish
Government’s new £6.6m
initiative to build high-tech digital
links between optometrists and
ophthalmology departments over
the next decade and reported
faster referrals for patients who
required immediate hospital
attention.
aop scotland chairman, Kevin
Wallace, said: “optometrists are
perfectly placed and equipped to
provide a preventative approach
to eye care. scotland has provided
a lead to the rest of the UK – but
we can still do more.”
Mr Davis commented: “I am
highly honoured and pleased
to win the award and it is
a testament to the efforts
of our employees that the
company has continued to
grow and succeed.”
a huge vote of confidence in
optometry’s efforts to eliminate
the backlog of uncorrected
refractive error by the year 2020.
“CooperVision’s support, along
with that of our existing donors
and global and national sponsors,
will help us to reach more people
in under-served communities
and transform the lives of
millions.”

Multiples scrutinised in
Guardian mystery shop
Chris Donkin
chrisdonkin@optometry.co.uk
BranChes oF specsavers
and Boots opticians have
been compared for their deals,
customer service and overall
offerings by The Guardian’s store
Wars section.
a representative from the
regular column visited the
specsavers and Boots opticians
practices on central London’s
Tottenham Court road on March
22 to enquire about two pairs of
frames and analyse the overall
service level.
Though both multiples
fared well in the newspaper’s
conclusion, overall Boots
opticians fared slightly better –
scoring 8/10 while specsavers
was rated 7/10. however in the
online readers poll, 61.8% of
respondents said they preferred
GOC removes 221
from its registers
FOllOwIng THE final
retention deadline of March
31, the gOC has removed 93
optometrists, 102 dispensing
opticians and 26 bodies
corporate from its registers.
It is now illegal for those
practitioners who have not
completed their 2012-13
retention to practise in the UK.
gOC head of registration,
Philip Hallam, said: “This year,
as in previous years, the vast
majority of our registrants
applied for retention on
time. This underlines to both
the public and the optical
professions that our registrants
understand the importance of
gOC registration.
“Only a small number failed
to apply, and they have now
left themselves unable to
practise until they are restored
to our registers.”
specsavers, with 23.9% opting
for Boots opticians and 14.2%
responding ‘someone else’.
in the article’s ‘lasting
impressions’ the reporter said
that specsavers had a ‘good
choice of frames, but i felt
bamboozled by the different
prices on offer – despite the clear
price policy’. The article added
that ‘clearly a lot of prices were a
minimum, and it was difficult to
make a meaningful comparison’.
heaLTh MinisTer Lord howe
has been announced as the
headline speaker for the Vision
UK 2012 conference, hosted by
the rniB.
The event, which takes
place at the Queen elizabeth
ii Conference Centre in
Westminster on June 12, has the
theme ‘improving outcomes,
increasing value’ and will cover
aspects of eye care in the new
nhs landscape.
as well as Lord howe,
the conference includes
presentations from Dr Clare
Gerada, chair of the royal College
of Gps; Dr selwyn hodge, chair of
the Council for the royal society
of public health; nick astbury,
chair of Vision 2020 UK and parul
Desai from the public health
team at Moorfields.
Topics discussed will include
preventable sight loss as a
summing up her Boots
experience, she said: ‘it all
felt a bit old fashioned, but
outstandingly professional
nonetheless’, and added she
felt staff answered more of her
technical questions.
Discussing the industry as a
whole, the author concluded
that: ‘i can’t help but feel the
pressure to make money through
expensive designer frames
could be taking priority over the
healthcare message’.
Commenting on the report,
a spokesman for specsavers
told oT: “We’re delighted that
specsavers convincingly topped
the people’s poll with 61.8% of
the vote.”
For the full analysis, visit www.
guardian.co.uk/moneymoney/
poll/2012/mar/23/storewars-specsavers-bootsopticians?newsfeed=true
RNIB reveals line-up
public health priority; improving
community eye care and sight
services and the launch of
‘seeing it my way – a quality and
outcomes framework for blind
and partially sighted people’.
programme director of
the UK Vision strategy, anita
Lightstone, said: “Vision UK 2012
is about improving outcomes
and increasing value. This is an
important challenge for health
and social care professionals
across the UK.
“Those who attend Vision
UK 2012 can find out about
how they can meet this goal
by innovating locally to drive
forward the UK Vision strategy
and ultimately improve services
for blind and partially sighted
people.”
For more information and to
book, visit www.vision2020uk.
org.uk/ukvisionstrategy
To comment go to www.optometry.co.uk
NEWS
IN BRIEF
Marathon couple
optometrist stephen poundall
of Vision express in norwich
will be joined by his wife Kirsty
(pictured) when they both
take part in the Virgin London
Marathon on april 22 to raise
money for the Childhood eye
Cancer Trust.
it will be Mr pundall’s
first marathon, but his wife
has previously completed
marathons in both London
and paris.
Keeler donation
Ophthalmic instrument
manufacturer Keeler has
donated ophthalmoscopes
and retinoscopes to Vision
Care for Homeless People,
a UK-based charity which
provides free sight tests
and spectacles to homeless
people.
Harinder Paul, CEO and
founder of the charity, said:
“The ophthalmoscopes
and retinoscopes donated
by Keeler, along with their
earlier donation of the
pulsair intellipuff, will help
us deliver the highest level of
comprehensive care to large
numbers of patients.”
New VAO centre
Charity Vision aid overseas
(Vao) has opened its fourth
vision centre in Zambia thanks
to the help of donations from
UK practices.
The new Livingstone centre
in the southern province
of the african country took
three weeks to establish, with
volunteers installing a refraction
room, diagnostic screening
room, glazing workshop and
dispensing room.
7
06/04/12 NEWS

8
06/04/12 NEWS
NEWS
Sight linked to crashes
Chris Donkin
chrisdonkin@optometry.co.uk
INSuRANCE COMPANy Royal Sun Alliance
(RSA) has joined the profession’s call to action
on drivers’ vision following the release of
statistics reporting a rise in accidents in the
twilight hours at the start of British Summer
Time.
Accident rates between 4pm and 6pm
were around 9% higher on the week marking
the start of British Summer Time compared to
the previous three months, according to the
RSA’s claims data for last year and 2010.
RSA uK and Western Europe chief
executive, Adrian Brown said: “It’s often when
driving during twilight hours that people
first notice problems with their vision. Just
as an MOT and service is important for
keeping your car safe, regular eye tests are
vital to ensure your eyes are roadworthy too.
My <strong>advice</strong> to all drivers is to follow medical
<strong>advice</strong> and have your eyes examined every
couple of years.”
RSA recently launched its fitness to drive
campaign which highlights the dangers of
driving with poor eyesight and calls for: ‘the
current wholly inadequate number plate test
to be scrapped; for all learner drivers to have
their vision tested by a qualified professional
prior to applying for a provisional driving
licence and anyone renewing their driving
licence to have to prove that they have had an
eye examination within the last two years.’
Director of operations at the <strong>AOP</strong>, David
Craig, said: “We all know that the number
plate test is woefully inadequate, both in
itself and because the conditions in which it
is taken can vary so much. It is encouraging
to see RSA’s initiative and to hear this hard
evidence that vision plays a part in accidents.”
Tax changes welcomed
SMAll BuSINESSES look set to benefit
from tax and finance measures in this year’s
Budget, according to the Forum of Private
Business, but the organisation also warns
that the Government may not have gone
far enough.
The changes outlined by the chancellor
of the exchequer, were welcomed by the
Forum, however, it added that the smallest
firms, such as some independent practices,
must benefit from the new National
loan Guarantee and Business Finance
Partnership schemes.
Chief executive of the Forum, Phil Orford
(pictured), told OT: “The overall verdict is
that there have been some tentative steps
in the right direction, and perhaps the
beginnings of a road map for the future – but
for the next year or two, when many of these
policies kick in – what small businesses and
the economy need are confident strides
forward now. largely, that has not happened
in this Budget.
“We saw nothing on reducing the
mounting burden of business rates or fuel
duty via cuts and a real stabiliser to regulate
prices at the pump. These were omissions
– and while the Government is working to
improve access to funding and bring down
banks’ lending costs by implementing ‘credit
easing’, the National loan Guarantee Scheme,
there are concerns that the smallest firms in
most need of affordable finance will miss out.
“Further, we called for tax incentives to pave
the way for alternative lenders to compete
more effectively in finance markets dominated
by the big banks, but there was nothing on
this in the Budget.”
Mr Orford also praised the cut in
corporation tax and added: “The concept of
merging income tax and National Insurance
is a first step in what looks to be long overdue
reforms to the tax system for small firms, but
the chancellor could have gone further.”
to comment go to www.optometry.co.uk
commENt
GettING the best
out of YouR ot
OT (formerly Optometry Today) is a longstanding
offering to the <strong>AOP</strong>’s members
and the wider optometric community. But
how much is it valued by our members?
Inevitably, only those who read it are in a
position to reply. There are rumours that
some recipients even leave the magazine
unopened in its wrapper and never look at
it again. Such a reaction is unfortunate, to
say the least.
Without wishing to blow our own
trumpet too loudly, I think the <strong>AOP</strong> can
safely say that its magazine contains
a great deal of interesting and useful
news, information and expert <strong>advice</strong> for
practitioners. In fact, the news pages
in this issue have been updated with a
fresher look to get in even more optical
news.
OT is the primary means of
disseminating our <strong>advice</strong> on a wide range
of topics. Notice of new regulations,
CET grants, GOC renewal deadlines – all
appear in OT. Reading the magazine
certainly would have helped the member
who called me last year, having just heard
he had to register his glazing facility with
the Medicines and Healthcare products
Regulatory Agency – more than 10 years
after the event.
Of course, we must not rest on
our laurels. There is always room for
improvement. From a narrow point of
view, OT needs to do more to inform our
members of the <strong>AOP</strong>’s efforts across a
range of activities. More widely, OT needs
to be more investigative in its reporting.
To be sure, investigations require a lot of
resources. But we need to have a better
understanding of what is going on in our
sector. The livelihood of our members
could depend on it.
Richard Carswell
AoP interim chief executive

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NEWS EXTRA
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APRIL 6 2012
VoLume 52:7
ISSN 0268-5485
ABC CERTIFICATE OF CIRCULATION
January 1 2011 – December 31 2011
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NICe issues updated support
guide on glaucoma services
Emily McCormick
emilymccormick@optometry.co.uk
NICE HAS issued an updated
guide to support the
commissioning of high quality,
evidence-based services for
people at risk of developing
glaucoma across England.
The document, which is
designed for commissioners,
looks at commissioning
services for the referral,
diagnosis and monitoring of
those at risk of developing
glaucoma, which is classified
as people with ocular
hypertension (OHT) and
suspected chronic open
angle glaucoma (COAG).
However, it does not include
commissioning services for
people already diagnosed
with COAG. It also provides
support for the commissioning
of repeat measure and referral
refinement schemes.
The guide urges
commissioners to work with
a range of partners, including
clinical commissioning groups;
health and wellbeing boards;
ophthalmology, optometry
and social care providers and
service users to develop and
deliver the services.
The healthcare guidance
body stressed that, although
the guide draws on exisiting
NICE recommendations, it
doesn’t constitute formal
guidance and is intended as a
tool to help the NHS improve
patient care through effective
commissioning.
Dr John Sparrow, consultant
ophthalmologist at the Bristol
Eye Hospital and chair of the
Topic Expert Group for the
glaucoma quality standard,
said: “The NICE clinical
guideline and accompanying
quality standard on glaucoma
provide a blueprint for a
consistent national approach
to managing people with
chronic open angle glaucoma
VRICS
and the related precursor
conditions, OHT and suspected
COAG. This guide will ensure
that those responsible for
commissioning services for
people at risk of developing sight
loss from glaucoma are able to
do so on the basis of the best
available evidence.”
The guide, which was
published last Friday (March 30),
includes a commissioning and
benchmarking tool which aims
to help users determine the level
of service required locally and
to help identify the potential
savings linked to commissioning
services for people with OHT
and suspected glaucoma. It also
highlights the current high levels
of unneccessary referrals to the
hospital eye service for OHT and
suspected COAG, which could
be reduced through locally
commissioned schemes.
Optometrist and OT clinical
editor, Dr Navneet Gupta,
commented: “The updated
<strong>advice</strong> from NICE about
improving the commissioning
of services for people at risk
of developing glaucoma is a
welcome and timely addition to
help ease the burden placed on
hospital eye services, which was
created after the introduction of
the new referral guidelines for
OHT/suspected glaucoma.
“It is pleasing to see that many
areas in England are already
working on establishing referral
refinement schemes for OHT/
To comment go to www.optometry.co.uk
CET
tv
glaucoma, and some schemes
are already active.
“The information provided in
this updated <strong>advice</strong> from NICE,
however, will go a long way
to helping those who may be
struggling, or those who have
not yet begun, to implement
such a scheme in their area
by making the process clearer
and helping to ensure that the
scheme is fair for everyone
involved, from patients to
practitioners. At the same time,
it provides a template to be
followed to ensure there are
little national variations in such
schemes.”
David Craig, <strong>AOP</strong> director
of operations, added: “We
welcome the updated guide
from NICE for commissioners
on providing services for
people at risk of developing
glaucoma. It demonstrates
that NICE understands the
value of repeating pressures
and referral refinement in
a primary care setting and
that it also understands the
limitations of GOS. We hope that
commissioners will now ensure
that these services are provided
to patients wherever they live in
the UK. Of course, optometrists
are very well placed, well trained
and well equipped to offer these
services to their patients; we just
need the funds and a green light.”
• To read the guidance, go to
www.nice.org.uk and search
for ‘cmg44’.

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12
06/04/12 SPECTATOR
SPECTATOR
Taking the biscuit
Poor old lansley – despite the recent talk all being about
pasties, petrol queues and ‘granny tax’, he still can’t avoid the
headlines. According to news reports in last week’s national
press, he is (allegedly) responsible for the department of
Health’s biscuit spend, accused by the opposition of “losing
his grip on his own department’s reckless spending”. An
urgent review has been ordered after it was revealed that the
department has, since January 1, spent more than £109,000
on “tea and biscuits” for staff and visitors. But surely the
opposition ought to be congratulating the beleaguered Health
Secretary for having reduced this bill by over 40% from the
£194,000 spent during the same period when labour was last
in power?
‘real cost of recycled spectacles’ in last month’s optometry
and Vision Science concluded that the collection (by
opticians up and down the land) of recycled spectacles
should be discouraged as a strategy for eliminating
uncorrected refractive error in developing countries as it is
not a cost-saving method of achieving this. At first glance,
the paper appears to be dismissing what is, to the general
public in the UK, one of the most visible activities that the
charity, Vision Aid overseas, undertakes. The paper even
questions the ethics of practices collecting spectacles as it
may encourage further dispensing sales and infers that the
collection activity is in some way misleading the consumer
into purchasing glasses from an optician that supports
charitable activity. reading this, many practitioners may be
forgiven for thinking that they may as well stop collecting
spectacles, but hold on a minute. This very public activity
serves useful purposes beyond the obvious. Firstly, it creates
a visible profile (pictured) and encourages engagement with
the VAo charity from the public and opticians alike. Having
built an association and relationship with the charity, many
practitioners (and their staff) go on to engage in fundraising
activities and even to physically support VAo initiatives
on the ground in the countries in which they operate.
Secondly, recycling spectacles does provide a small part
of the solution to correcting refractive error in developing
countries (although by far the bulk of the answer lies in the
provision of new, rather than recycled spectacles). However,
the recycling activity could be made more effective with
some small improvements. The oVS paper highlights that the
proportion of recycled spectacles that can be reused is less
than 10% – but this could be improved if there was initial
sorting at the point of collection, for example, disregarding
all multifocals and critically dismissing any with scratched
lenses, worn or ‘tired’ frames.
Headlines of a more serious note were being made in last
weekend’s Financial Times regarding a potential over-supply
of 20,000 doctors. Most professions working within the NHS
To comment go to www.optometry.co.uk
are subject to NHS ‘workforce planning’ oversight. It is this
that lay behind the Government’s decision to open seven new
medical schools just over a decade ago (and has had similar
influence over the opening of new university departments for
dentistry and pharmacy). NHS Employers, the organisation
which negotiates NHS staff pay, commented that there is a
need to “get to grips with how the NHS plans its workforce”
thus acknowledging what we have always intuitively
known – that the NHS isn’t very good at workforce planning.
our own sector is, thankfully, not subject to such external
interference (and long may that continue). The cause of the
current concern, is realisation that by the end of the decade,
the number of junior doctors and medical students qualifying
as consultants will reach 60,000 compared with 40,000 today
– and there will not be jobs for that many consultants within
the NHS. Solutions being considered include the creation
of ‘sub-consultant’ posts (at presumably substantially lower
rates of pay) and a ‘managed programme of movement’ for
junior doctors to spend up to three years working elsewhere
in the EU. This may be a solution, which suits the EU, as
there are high vacancy rates for doctors in eastern European
countries. But what might appeal more to those younger
doctors who become disenchanted with the NHS, are the
lures of warmer climes, they will be aware that it isn’t only
optometrists who are in strong demand in Australia and
New Zealand.
Picture courtesy of Vision Aid Overseas

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14
06/04/12 Profile
profile
‘Make it entertaining’
Optometrist, lecturer and entertainer Brian Tompkins gives OT his unique outlook on optics
Flamboyant, excitable, engaging
and off-the-wall are all statements
you’re likely to hear if lucky enough to
catch one of brian tompkins’ lectures
on the conference circuit this year,
but there’s more to him than just an
optometrist with an unusual dress
sense, he’s a shrewd practice owner
who most of all wants to promote
that optics can, and should, be fun.
“How boring is it sitting in a
darkened room all day saying one
or two?,” he asks. “it bores anyone,
it must do. i think you need to
take what can be a massively fun
profession and take it to the next
level. Sure, we can help vision, we can
give people frames, but let’s enjoy it. Do a
dry eye clinic, do sports vision, whatever
it might be, just do something different,
don’t be a refraction machine.”
He believes in dazzling his patients with
‘a bit of theatre’ in the consulting room:
“We, as optometrists, are on stage in front
of every single patient. that one-to-one
stage is where we perform our art to
the best we can. it’s all about making it
entertaining, make them smile, know
what you’re doing and take some money
at the end of it. make life fun.”
Breaking the mould
Straight from leaving university, mr
tompkins knew he wanted to break the
mould in optics and recommends any
student qualifying now who is looking for
a bit of variety and fun in their career to
attempt a similar path to him and find an
inspirational mentor.
“i’d tell anyone to get working in an
independent, try not to become part
of the corporate machine, don’t be put
on to a conveyor belt where you have
no choice but to become a refraction
machine.
“at the end of the day, unless you
have some form of interest in it (your
profession) and actually enjoy what you
do, then there’s no point doing it.
“What was the whole point in
becoming an optometrist? try and find
something to hook your interest to get
in there and then try and find a mentor.
When i look at how i got through i realise
i worked with some seriously, seriously
nice people who were really interested
in their job and really took it to the next
level.
“try your best to be different and
try to be unique. Something that
takes you above that level of boring.
it’s difficult, you need to get some
lucky breaks along the way but it’s
the way to get through.”
Embrace 2012
He believes that it’s imperative for
everyone to keep abreast of modern
technology. “if you don’t use it (as a
business) you won’t survive – and
make sure you charge for it,” he
warns. “it denigrates our profession
by saying we’ll take a photo but we
won’t charge for it. i don’t charge for
taking the (retinal) photo, i charge
for spending my time telling them about
what they’ve got, explaining it to them – i
do a bit of theatre, ‘here is your eye, here
are the workings of your eye’, then a few
educational bits telling them what’s going
on. that’s what i feel we should all be
doing.”
With a schedule filled with lecture
spots at major conferences and a full
appointment book, mr tompkins is
certainly going to have another busy
spring, but he has no intention of slowing
down or – shudder at the thought –
retiring.
“Having just had a massive refurb at a
time when some of my friends are retiring
i just don’t see myself retiring, i have too
much fun. Why retire from something i
have fun doing? What am i going to do,
sit at home, dig the garden? that’s not my
bag. this profession has treated me very
well, i see great people on a regular basis,
classically Saturday mornings are like a big
café when i get people from a different
part of the country coming to visit, i don’t
want to lose that.”
An extended version of this
interview is available online at
www.optometry.co.uk

16
06/04/12 VAluATIoNs
ADVICE
Make sure your exit
is a profitable one
In the final article of our two part series, director of RA Valuation Services Mark Ridout discusses
techniques to help sell a business for a good price
ALL BUSINESS
owners should have
an exit strategy in
mind. This may
simply be a ‘wish
list’ reflecting the
owner’s desires, or
it could comprise
part of a detailed
formal business
plan.
Either way,
an exit strategy
should, ideally, be
planned at least
three years ahead
if a satisfactory
valuation and
successful transfer/
sale are to be
achieved. If you feel you haven’t got the experience, or the
time, to develop a plan, hire a consultant or someone who can
help you – it will almost certainly be a sound investment.
Preparing your business for sale
There are many things to do, most of them simple, if you
are planning to put your practice on the open market. For
example, you must ensure that the physical appearance is up
to scratch, as with selling a house, so called ‘kerb appeal’ is
vitally important.
“As with selling a house, so
called ‘kerb appeal’ is vitally
important”
When a homeowner wants to sell their house, they may
paint it, fix up a couple of things that needed to have been
done during the last few years, and polish the taps. Simple,
obvious, but unarguably effective. It is the same for practice
owners, they can improve the value of their practice by
making a few changes. First impressions count and can be the
difference between a successful, or unsuccessful, sale.
Be realistic about the value of your practice
Don’t underestimate the value of your business but do be
realistic. Bear in mind that prudent would-be buyers are
increasingly
commissioning
an independent
valuation to
ensure they are
paying no more
than a realistic
and fair price.
They are well
aware that some
practices have
declined in value
over the last
couple of years
and may drop
further still. They
will recognise
an over-priced
practice for what
it is.
Take <strong>advice</strong> from a professional valuer familiar with
the industry – never use guesswork. Whether you are a
purchaser or a vendor, a specialist valuer could save or make
you considerable money.
Be a professional manager as well as a
professional practitioner
Concentrate on the points listed in the previous article (OT
February 24, 2012) and above. Enlist professional help to
organise and plan. Listen to the experts. Most importantly,
be prepared with clear, up-to-date accounts showing an
attractive and well documented track record of profitable
growth. Like the homeowner, polish and a fresh coat of
paint will help with the kerb appeal. But remember that
the bank will want to see that the potential buyer can pay
back the loan. Ultimately, it all comes down to profit. Get
all of the above right and the financial figures will speak for
themselves.
• RA Valuation Services Limited is the <strong>AOP</strong>’s sole accredited
practice valuation specialist. In addition to RA’s exclusive
discount on practice valuations to <strong>AOP</strong> members, for a
limited time, RA is also offering a Practice Market Appraisal
Guide for small practices – ie, with a turnover less than
£100,000 – priced at only £350+VAT. See its website www.
RAValuationServices.com/<strong>AOP</strong> or contact them either by
telephone on 01425 402402 or email info@RAValuations.com

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18
06/04/12 STAYING SAFE
<strong>AOP</strong>ADVICE
Referring safely
Clinical adviser to <strong>AOP</strong> legal services, Trevor Warburton advises on reducing risk
SOME ISSUES just keep cropping up in
cases that pass through the <strong>AOP</strong>’s legal
department.
GPs don’t do urgent
Don’t send a referral to the GP with the
expectation that it will be dealt with
urgently, whatever you write in your
letter. Unless you are prepared to follow
up with a phone call to the GP to ensure
action is taken, and then to the patient
to ensure it happened, don’t rely on
the GP. You do not relieve yourself of
responsibility or liability by referring to
the GP if that referral pathway is later
deemed inappropriate.
If you have a patient with urgent
pathology in your consulting room, then
you want them out and into the right
hands as soon as possible.
Use the right pathway
If you have a dedicated local pathway for wet AMD, then make
sure you use it. If there is a pathway and you use an alternative
route, then you run the risk of delaying, and being accused
of delaying, the referral. If you are asked to fax the referral,
‘phone afterwards and check it was received. My staff now do
this as routine, and then make a note of the confirmation on
the record. Remember, you are responsible for the referral. The
contractor has a duty to ensure you are aware of the correct
referral pathways, but you can’t blame them if you don’t know.
Emergencies
If you have a dedicated eye casualty, then use it. Sometimes
they won’t accept patient walk-ins without a referral – mine
won’t. So when someone walks in and tells your receptionist
they have new floaters and you have no free appointments, you
may need to direct them to A&E. It’s best to try and direct them
to an A&E in a hospital with an ophthalmology department, so
the expertise will be on call if required.
When referring to casualty, give the patient your referral note
to take with them, or fax it in advance. If you ring to make the
patient an urgent appointment, ask who you are speaking to
and make a note of the name on the record. If they say they
will ‘phone the patient to make the appointment, check with
the patient that this has happened and don’t leave it more than
a day to do so.
Other procedures
If you decide other procedures are required as a part of the
sight test, eg, visual fields not performed in advance, then they
need to be carried out before the sight test is
deemed complete.
If you find, for example, that there is a field
defect, you might then refer, or repeat the
field test. In the latter case, you have reached
a conclusion to the test and are referring to
yourself for an enhanced service, regardless of
whether this is funded by the NHS, the patient
or yourself.
Locums
It can be particularly difficult requesting repeat
tests as an occasional, or one-off, locum. A
regular cause of difficulty is where a locum has
requested repeat tests and these were either
not carried out by the practice, or they were
carried out but no one looked at the results. To
stay safe, a locum should do two things; first,
they should refer these repeat tests, in writing,
to another optometrist within the practice and
note this on the record. Secondly, they should
keep a log of any requested repeat tests and
any urgent referrals, and check that these have been dealt with
– either when next in the practice or by ‘phoning to check.
Look back at records and photos
Don’t forget to look at the history. Check back to ensure the C:D
ratio you have observed is in line with previous observations.
If you take photos, compare them with previous ones. For C:D
ratios compare oldest and newest. It’s embarrassing to take
pictures and discover later that you missed an obvious change
because you didn’t look back. It should go without saying that
you must not take and store fundus images that you do not
examine. It may sound obvious, but it has happened and, sadly,
there was very obvious pathology visible which was missed
with the ophthalmoscope.
Failsafe procedures
If you are suspicious about a field, or any other abnormality,
and have booked a repeat test, you need to have procedures
in place to deal with the patient who does not turn up. If they
later develop a condition, you will need to show that you at
least tried to follow up. Make notes of DNAs on the record and
‘phone and make another appointment. If all else fails, write a
referral letter on the basis of your original tests and send it to
the patient with a covering letter asking them to take it to their
GP. Remember that, at this point, you don’t actually have the
patient’s permission to write direct to their GP. Staying safe
is a mix of common sense and ensuring that you have failsafe
procedures so patients don’t fall through the net. It is worth
reviewing practice systems to ensure they are fit for purpose.

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20
06/04/12 INDUSTRY NEWS
INDUSTRYNEWS
CONTACT LENS NewS
New products
for DTCL
DaviD Thomas Contact Lenses (DTCL) this week
began offering a new C2 multifocal silicone hydrogel
contact lens from Precilens, a leader in the specialty
contact lens market in France. The Northamptonbased
DTCL has also taken over the marketing and
distribution of solocare aqua all-in-one solution for
soft lenses in the UK and ireland.
Precilens CEo, Pierre Pitance, said: “The C2
multifocal contact lens is the latest achievement in
Precilens’ 30 years legacy in presbyopia. Precilens
was the inventor of the first soft progressive contact
lens in the 1980s. it has, since then, put presbyopia at
the heart of its R and D process.”
The C2 multifocal is a moulded monthly lens with
an optical design formed of two stabilised zones, a
near vision zone in the centre and a distance vision
zone at the periphery of the lens. Combined with a
progressive intermediate zone inbetween, the design
is said to offer enhanced depth of focus.
ophthalmology experts and optometry specialist
organisations have shown interest in the latest
Precilens product developments. among them is
the Jenvis Research institute, based in Germany
and cooperating with the optometry department
of Jena University, Germany, which will conduct a
comparative multi-centre study led at a European
level by Dr sebastian marx.
in the UK and ireland, the study will involve
Dr shehzad Naroo, who will explain further the
methodology and conclusions at a podium session
during the next
BCLa Clinical
Conference and
Exhibition.
The moulded
monthly multifocal
silicone hydrogel
contact lens will
be exhibited at the
conference next
month.
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646216
Optix news is good
The OpTIx two-day user group meeting last week
attracted almost 170 independent practitioners,
a rise of nearly 40 on the previous year. They were
entertained at the event dinner by BBC TV and radio
journalist John Sergeant, who is pictured with Optix
directors Trevor Rowley, Andrew harrison and John
Regan at the Champagne reception at Carden park
near Chester.
Mr Rowley gave a workshop emphasising the new
features in the Optix business management system,
especially a marketing module described as an “immensely powerful tool”. he also previewed
some of the new features coming in the next version of the software, including hTML emails,
which will give independents the ability to put images and signatures into their emails.
The new hybrid mail integration, “essentially a remote printing system” for recall letters proved
especially popular among the delegates.
“with the announcement of the increased 50p charge for second class letters, our new
integrated mail processing system is very timely, enabling independents to send letters for as little
as 37.5p, fully inclusive of postage, paper, printing, and envelope,” Mr Rowley told OT’s Robina
Moss at the event. “what makes our new system unique is that we print on ultra-high quality
120gsm paper using start-of-the-art digital printers. It can save an independent thousands of
pounds each year.”
& 01904 606611

Gok goes
more retro
TV sTyle guru gok Wan has launched
13 new styles to his popular gW by
gok Wan glasses, which build on the
retro-inspired look of the original range,
launched in February last year.
“My inspiration for this second
collection came from the 1940s and
1950s,” he told OT’s robina Moss at the
press launch in london. “I was interested
in the Hollywood look but what the stars
of that era might wear off screen when
they were not on camera.
“My first collection covered a wide
range of style and colours to test the
market and see what people like. It’s still
selling well but this range is more refined.
It’s designed to be workable, wearable
and versatile. There are cat’s eye shapes
for women and TV styles for men.”
All glasses in the range are sold at
specsavers and cost £99 which includes
single vision Pentax lenses and scratch
resistant coating as standard.
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cleaning. optiFog is targeted at wearers
who suffer from fog issues in everyday life
with temperature changes such as while
cooking, exercising or playing sport.
Practitioners wanting to find out more
about how they could join the centres are
asked to telephone Hilary King.
& 07917 061391
© Essilor International – RCS Créteil 712 049 618 – May 2011. © Optifog TM is a trademark of Essilor International. © Essilor ® is a registered trademark of Essilor International. Kodak and the Kodak trade dress are trademarks of Kodak used under license by Signet Armorlite, Inc.
Gang of four
AwARD-wINNINg
frames company Owp
has launched four
sophisticated women’s
models, 1358, 1359, 1360
and 2128. The Danish
company is encouraging
women to think of their
glasses as accessories, as
they would shoes, bags
or jewellery, and as part
of the initiative the new
frames are available with
fitting necklaces while
stocks last.
Using a new kind of
technology, acetate
partially encases the
stainless steel temples
in decorative patterns.
william Morris is the UK
distributor.
& 01279 600 042
Talking business
OVeR 70 representatives from the optical
industry heard about ‘the best means of
driving the UK economy forwards’ from
Britain’s top business leader and new director
general of the Institute of Directors (IoD),
Simon walker, pictured with FMO chairman
John Conway (left).
“This industry is a great example of Britain’s
strengths in advanced manufacturing and
there are clearly major opportunities across
the sector,” he said at the latest FMO meeting, held at the AOp’s new headquarters in London.
Mr walker’s presentation was followed by a question and answer session, with optical industry
bosses keen to hear his views on banking issues, salaries, government intervention and the way
forward for business.
“The missing link is confidence,” he told them. “A survey of 1,000 IoD members revealed that
companies were much more confident about their own prospects than they were for the wider
economy. The tantalising prospect is that if, and when, confidence does return, expenditure plans
could be dusted down and put into action relatively quickly. But if business is to have confidence
in Britain, Britain needs to have confidence in business.”
he stressed the need to improve leadership in business and company directorship by
highlighting the IoD’s Chartered Director Qualification, which the FMO chairman, John Conway
holds.
Companies represented at the FMO meeting included Rodenstock, Continental eyewear,
Optoplast Actman and Dibble Optical. After a networking buffet lunch, FMO members divided
into their industry-specific frame, lens and equipment focus groups to discuss current trading
conditions. Any companies wishing to know more about The FMO and attend the next regional
meeting on October 16 are asked to email Sandie Fisher at sfisher@fmo.co.uk
21
06/04/12 INDUSTRY NEWS

22 28
06/04/12 <strong>AOP</strong>/SECO SEMINAR
COVER STORY
Countdown to optics’
London 2012 seminar
The <strong>AOP</strong>’s new conference facilities will be buzzing at the end of this month for the two-day
seminar on therapeutics – London 2012 Education Destination. It will also have an international
feel, with an Australian addition to the multi-national list of delegates flying in to join the main UK
contingent. OT’s clinical editor Navneet Gupta looks at the packed programme
Day 1
Going the distance: clinical insights into
glaucoma diagnosis
Clarity over what many practitioners consider to be a grey
area in optometry, establishing the diagnosis of glaucoma, will
be offered at the seminar by Dr Murray Fingeret, chief of the
optometry section in the Department of Veterans Administration
in the New York Harbor Health Care System and a clinical
professor at the State University of New York. Dr Fingeret will
discuss the different tests to use (tonometry, the latest in optic
nerve analysis/imaging, visual fields and gonioscopy) and how
each is incorporated, along with the patient’s history into the
decision making process. The concept of using multiple tests
to corroborate whether glaucoma is present is more important
today, especially given the wealth of technology available.
Peak performance: evidence-based prescribing
in an optometric setting
Professor John Lawrenson, chair in clinical visual science at
City University, played a pivotal part in acquiring prescribing
rights for UK optometrists and the development of educational
curricula for this speciality. In this presentation, he will
consider the evidence base for treatment effectiveness and
how to balance likely benefits, and possible harms, when
considering prescribing. He will highlight the systematic
approach to use through various examples, displaying how
this can be incorporated into day-to-day clinical decision
making.
Because you’re worth a gold medal – why
investment in therapeutic training is a must
The number of experienced qualified optometrist independent
prescribers (IP) joining the specialist register has now
reached 150 and the UK has become the first country of the
EU to reach level four of the World Council of Optometry
framework. Nicholas Rumney, who is in full-time private
practice in Hereford with BBR Optometry, a standard setting
(ISO9000 and IiP) award-winning independent practice, will

highlight the benefits of undertaking therapeutic training. He
will update delegates on the development and enacting of
therapeutic capability among optometrists in other countries
too.
Team GB vs Team USA – the Big Debate: care
regimes both sides of the pond
Great Britain and the USA will go head-to-head in what is
anticipated to be a lively debate where top clinicians will
discuss the therapeutic management of a variety of diseases,
and will compare and contrast the modalities available in
both countries. Dr Fingeret, professor Lawrenson and Mr
Rumney will be joined by Dr Paul Ajamian, centre director
of Omni Eye Services of Atlanta, USA, the first optometric
co-management centre in the USA. A truly international
perspective on disease management which will hopefully
whet the appetite for optometrists to join the growing
community of therapeutic prescribers.
Carrying the torch? Working in community
ophthalmology
If the Big Debate wasn’t treat enough, the next presentation
by Jane Bell, an independent prescribing optometrist with
over 30 years’ experience, a director of the <strong>AOP</strong> and chair of
the Optical Confederation primary care committee, is sure
to put the icing on the cake by describing how to utilise IP
in a community ophthalmology service. She will provide
information about commissioning similar services in different
parts of the country and will take attendees on a journey
through a typical ‘day in the life of an IP practitioner’. Her
presentation will include some fascinating case studies to
really show what optometrists are capable of.
Day 2
Going for gold: my favourite cases
As the event heads into the home straight, Dr Ajamian will
present a number of timely and challenging cases which
are likely to be encountered in optometric practice. He
will demonstrate how to manage them through the latest
pharmacology and technology.
Sprint or marathon? 21st century glaucoma
therapy
To update practitioners on the latest developments, Dr
Fingeret will describe new glaucoma treatments, juxtaposing
therapy today with where therapy may be in the foreseeable
future. The concept of risk will be described, as well as new
medical and surgical interventions.
Could OCT be a gamemaker in optometric
practice? A hands-on guide
Optical Coherence Tomography (OCT) has revolutionised
the diagnosis and management of several ocular diseases,
including age-related macular degeneration and diabetic
maculopathy. In this presentation, Dr Fingeret and Mr
Rumney will talk about this fascinating imaging technology
and how it allows layer-by-layer assessment of the retina and
optic nerve. The instrument’s excellent resolution allows
features to be recognised which previously were not visible,
and this has notable clinical applications for detecting and
managing both glaucoma and retinal conditions.
The winning difference: modern-day
cataract care
As the two-day event nears the finishing line, Dr Ajamian
will provide optometrists with the fundamentals of how to
co-manage cataract surgery patients, looking at the important
aspects of pre and post-operative care of patients.
If the clinical programme wasn’t enough to entice you,
then the accompanying social events, including a London
City Bus Tour, afternoon tea at The Ritz and the London Eye
Experience, are sure to make for an enjoyable educational
event.
The London 2012 Education Destination runs from April
29-30 and provides a valuable opportunity for qualified
optometrists to gain specialist IP points and for those just
starting to take an interest in this field, it offers guidance and
knowledge in a growing field of optometry. Fourteen COPE
and GOC Specialist (IP) and general optometry points have
been applied for, as well as DO points where applicable.
For more information, please visit www.eiseverywhere.
com/ehome/31864/50766/
Alcon Pharmaceutical is the headline sponsor for the event and
urges interested optometrists to attend. “Alcon is pleased to be
the patron sponsor to the inaugural <strong>AOP</strong>/SECO Therapeutics
Seminar. In recent years, we have been delighted to see the
growing interest of the profession in fulfilling many of the
unmet needs in patient care through therapeutics,” said Damon
Cooke, Alcon Pharmaceutical, business unit head, UK and
Ireland. “As a world leader in eye care, Alcon is keen to promote
and support optometrists in their professional development.
We hope that many more optometrists will choose to attend
what promises to be a pioneering and stimulating event.”
23
06/04/12 <strong>AOP</strong>/SECO SEMINAR

24
06/04/12 OPTOMETRY TOMORROW
EVENTS
CET by the seaside
Annual Optometry Tomorrow conference attracts record numbers, OT reports
More than 270 practitioners flocked to the sunny south coast
for the College of optometrists’ annual optometry tomorrow
conference last month.
held in Brighton for the second time in the event’s history,
the Cet packed two-day event offered over 45 lectures,
seminars and workshops, which focused on ‘hot topics’ such
as aMD treatment, independent prescribing and business
skills. and, with this year’s lectures assigned under the themes:
‘therapeutics’, ‘research’, ‘CPD’ and ‘refresher’, delegates could
easily select the sessions of most interest to them.
optometrist rob hogan’s (pictured
left) seminar on appraisals –
‘appraisals – I’m an optometrist... get
me out of here’ – drew a full crowd,
highlighting practitioners’ desire to
learn more about improving their
business management skills, which Mr
hogan commented is not taught at
university.
navigating his audience, delegates were identified as
‘employees who receive appraisals’, ‘employees who carry out
appraisals’ or ‘employers performing appraisals’, whilst all had
the common interest of wanting to find out the ‘right way’ to
appraise and be appraised.
During the session, which gave delegates an overview of how
appraisals can lead to a more efficient business, managers were
encouraged to hold appraisals and staff were urged not to be
intimidated by them as “generally the people who are doing the
appraisals don’t feel confident either”.
the newly appointed College treasurer explained: “appraisals
are necessary for developing people and improving the
company. they are a way of monitoring the standards that you
are trying to achieve for your business.”
offering listeners a variety of ways to carry out appraisals, from
assignment and task led assessments to psychometric tests, Mr
hogan, advised: “Whatever template you use for your appraisals,
the important thing is to give people notice of this type of thing.
agree a time and get the environment right. It shouldn’t be
done in a coffee room with people walking in and out; that isn’t
fair to anybody. the consulting room is the classic place to hold
appraisals.”
other tips included: create an action plan for future objectives
and meet regularly to discuss progress; agree any necessary
support and development; close positively and write up
feedback.
he underlined the importance of both parties preparing for
the appraisal, as well as returning to the feedback regularly:
“You need to prepare, and prepare well, and that’s both parties’
responsibility.”
an important point which Mr hogan warned about was
the salary aspect often associated with appraisals. he said:
“Personally, I don’t think salary should be the reason you are
performing an appraisal, but if previous targets have been met
and your business is doing well you should reward staff.”
he later added: “I think if your business wants to be seen
as ethical, caring and moral, everybody should see a similar
percentage increase in their salary if your business is able to
afford it.”
elsewhere at the conference, optometrist rakesh Kapoor
(pictured above) discussed how regular clinical audits could
help increase the quality of patient care and prevent ‘trouble’
occurring.
Despite clinical audits being “generally feared by most
practitioners”, Mr Kapoor drew on his own experience to reveal:
“In the long run you find that morale does improve when you do
such audits.”
explaining the benefits of establishing regular clinical audits
in practice, the visiting lecturer at aston, anglia ruskin and City
universities, and GoC FtP committee member, said: “It can have
a substantial improvement in the quality of services to patients
and users; in an audit we can make things better, we can see
where our weaknesses are and where to improve.”
he added: “It prevents problems re-occurring and reduces
the chance of litigation and disciplinary action, which is very
important.”
other elements of practice which audits can help improve
include: better utilisation of resources, reducing risk, improving
effectiveness of care and better access to care.
• optometry tomorrow 2013 will take place on March 17-18
in nottingham.

Mobile: 07799 685779 www.advancedeyecareresearch.co.uk
Aston Court, Kingsmead Business Park,
High Wycombe, Buckinghamshire HP11 1LA
Telephone: 01494 616038
Fax: 01494 616001
Contact:
Mr. Chris Jamieson
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26
06/04/12 BOOK REVIEW
2012 conference
Monday April 23rd 2012
Hilton East Midlands Airport Hotel
Change a childs
future...
Up to 60% of children have the
pre-disposing signs to simple Dyslexia.
More children than ever are leaving primary
school unable to read or write
– a coincidence?
PROGRAMME includes:
The childrens eye care initiative - Polly Dulley
The cumulative effect of prescription & colour on
eye-tracking and reading performance
- Chris Coakley
Underachieving, academically able children
- Michael Gilsenan
Irlen tints and the Schoolvision assessment
of dyslexic patients - Olha Lac
Reading speed, migraines and coloured
contact lenses - Alexandra Cook
The principles of visual psychology
- Geraint Griffiths
Learning difficulties and ametropia
- Damaris Anderson
Gaining recognition for the Schoolvision Practice
- Umar Jussab
Schoolvision workshop
SOCIAL EVENING, SUNDAY 22ND APRIL
Dinner, live entertainment & awards
(Package price available, inc. accommodation)
FOR BOOKINGS AND INFORMATION, GO TO
www.schoolvision.org.uk
Or Phone: 0116 2363113
REVIEW
Normal Binocular Vision – Theory, Investigation and
Practical Aspects. Optometrist Zuzana Freidin reviews
the latest book by David Stidwell and Robert Fletcher,
published by Wiley-Blackwell
IF YOU ever wondered as a student why
there were so many books and articles on
binocular vision, you were not alone. Many
books contain a welter of information
about normal and abnormal conditions,
and treatments, making it difficult, if not
confusing, for the reader to pull together
the whole picture, let alone grasp how
the different parts fit together.
As its name Normal Binocular Vision
indicates, the aim is to help the reader
DAVID STIDWILL
AND ROBERT FLETCHER
NORMAL
BINOCULAR
VISION
THEORY, INVESTIGATION
AND PRACTICAL ASPECTS
understand the concepts and structure of normal binocular vision. The
authors have decided to leave out anomalies and their management,
and to just concentrate on presenting a complete overview of normal
binocular vision. They felt that the student who understood normal
binocularity would be better able to study its abnormalities as the next
step.
The structure and sequence of the topics shows that the authors
have extensive interest, dedication and experience teaching.
The 12 chapters of the book are divided into three categories:
1. The development and characteristics of binocular vision
2. The effects of errors in binocular motor control and in sensory fusion
of the two images
3. The assessment of binocular vision parameters.
To illustrate the points and explanations in the text, the
authors explain the concepts, anatomy, actions, experiments and
measurements graphically, using copious black and white and some
colour diagrams, photographs and drawings. The short revision quizzes
at the end of each chapter require filling in missing word/s. There are
six appendices, one of which provides explanations of when and why
different terms are applied to a condition, eg, tropia/strabismus/squint.
Another appendix describes simple experiments which are quite easy
and fun to do, aiding the reader further in comprehension of the topic.
The glossary of terms acts as a handy summary of the text.
Although written for students of optometry and psychology,
students of ophthalmology will also find the topic easier to grasp
through the study of this book.
For those who have already long delighted in the subject, the book
provides many clear insights and new takes on some of the areas
discussed, as well as an opportunity to catch up on new concepts and
understanding of its aspects.
This book is definitely a must for all who want to, or need to,
understand how normal binocular vision works; and it should be a
recommended standard study text.
• Zuzana Freidin is an employed optometrist, working in Cambridge,
who also supervises students in clinics once a week at Anglia Ruskin
University. Ms Freidin qualified at City University and has an interest in
binocular vision having taught the subject abroad.
RRP £42.99 OT Foyles online bookshop price £38.69 (10% off).
Visit www.optometry.co.uk/bookshop and click on the Foyles
link.

Now
with
Epsom Downs 30th April
Start Finish Lecture
Speaker
6.55 7.00 Welcome Ian Berry
7.00 7.20 OCT interpretation - Learning how
to describe what you see
7.20 7.40 Keynote address: Offer patients
more with OCT technology
7.40 8.00 Management of wet AMD, the
evolving role of Optometrists
8.00 8.20 Multi-modality fundus imaging and
simultaneous SD-OCT
Bill Harvey,
City University
Romana Hashim,
Optometrist
Dr Femi Adekunle
Novartis
Ian Berry
8.20 8.40 Can you afford not to have an OCT? Simon Wardle,
Performance Finance
Chester Racecourse 2nd May
Start Finish Lecture Speaker
6.55 7.00 Welcome Ian Berry
7.00 7.20 OCT interpretation - Learning how
to describe what you see
Chris Mody
7.20 7.40 Keynote address: Offer patients Niall O‘Kane,
more with OCT technology Optometrist
7.40 8.00 Management of wet AMD, the Dr Femi Adekunle
evolving role of Optometrists Novartis
8.00 8.20 Multi-modality fundus imaging and
simultaneous SD-OCT
Martin Long
8.20 8.40 Can you afford not to have an OCT? Simon Wardle,
Performance Finance
Buffet available at 6.30pm Free to attend
To book your FREE place visit: http://is.gd/horsesforcourses
www.heidelbergengineering.co.uk 01442 345372
Warwick Racecourse 1st May
Start Finish Lecture Speaker
6.55 7.00 Welcome Ian Berry
7.00 7.20 OCT interpretation - Learning how
to describe what you see
7.20 7.40 Keynote address: Offer patients
more with OCT technology
7.40 8.00 Management of wet AMD, the
evolving role of Optometrists
8.00 8.20 Multi-modality fundus imaging
and simultaneous SD-OCT
Chris Mody
Daniel Hardiman-
McCartney, Optometrist
Dr Femi Adekunle
Novartis
Martin Long
8.20 8.40 Can you afford not to have an OCT? Simon Wardle,
Performance Finance
Hamilton Park Racecourse 3rd May
Start Finish Lecture Speaker
6.55 7.00 Welcome Ian Berry
7.00 7.20 OCT interpretation - Learning how
to describe what you see
Chris Mody
7.20 7.40 Keynote address: Offer patients
more with OCT technology
7.40 8.00 Management of wet AMD, the
evolving role of Optometrists
8.00 8.20 Multi-modality fundus imaging and
simultaneous SD-OCT
Alice McTrusty
Optometrist
Dr Femi Adekunle
Novartis
Ian Berry
8.20 8.40 Can you afford not to have an OCT? Simon Wardle,
Performance Finance
These educational Roadshows look at all aspects of OCT and how this can dovetail into your practice, allowing you to offer your patients
a more comprehensive examination and become more profi table.
Learn from the experience of our Keynote Speakers. Find out more about the Wet AMD opportunity with Novartis. Discover a creative way
of fi nancing OCT technology. Experience how easy the SPECTRALIS OCT is to use, even on the most diffi cult patients.
Anticipated fi nish time 9pm.
Worth
1 CET Point
Be certain Stay Ahead to back of the The right Field horse With

28
06/04/12 DIARY DATES
APRIL
12 No 7 Contact Lenses, Sidney Little Road,
Hastings, Future proof contact lenses (www.
no7contactlenses.com)
NEW… 16 TMR, venue confirmed on
application, Newcastle upon Tyne, Optical
assistant/receptionist course one (info@tmr.
co.uk)
16 Warwickshire <strong>AOP</strong>, The Venture Centre,
University of Warwick Science Park, Coventry,
Casualty lecture (susan@susanrbowers.co.uk)
16 University of Warwick, Coventry,
Ophthalmic imaging course begins (www.
warwick.ac.uk)
NEW… 16 Hospital of St John and St
Elizabeth, 60 Grove End Road, London, NW8,
International development in optometry
lecture (www.hje.org.uk)
NEW… 17 TMR, venue confirmed on
application, Newcastle upon Tyne, Optical
assistant/eeceptionist course two SEE ABOVE
17 Optos, Hilton Euston, London, WC1H, Optos
Daytona and OCT roadshow (www.optos.com/
register)
17 J&J, The Vision Care Institute,
Pinewood, Berkshire, Presbyopia and its
management with contact lenses (www.
thevisioncareinstitute.co.uk)
DIARYDATES
Improve your imaging skills
The University of Warwick’s ophthalmic imaging postgraduate certificate
module begins this month with students being given an understanding
of the concepts and theories surrounding the issue.
There will also be a practical section to the course, which includes an
advanced understanding of the processing, compression and storage of
digital imaging.
For more details on this and other courses available, including June’s
Diabetes and the Eye module, visit www.warwick.ac.uk
18 Optos, Hilton Stansted Airport, Essex,
Optos Daytona and OCT roadshow SEE
ABOVE
NEW… 18 TMR, venue confirmed
on application, Newcastle upon Tyne,
Commercial dispensing SEE ABOVE
18 No 7 Contact Lenses, Sidney Little
Road, Hastings, Ortho K and topography
day SEE ABOVE
19 Optos, Radisson Blu, Bristol, Optos
Daytona and OCT roadshow SEE ABOVE
NEW… 19 TMR, venue confirmed on
application, Newcastle upon Tyne, Optical
management and marketing SEE ABOVE
20-22 EAOO, Dublin, Ireland, Annual
conference (www.eaoo.info)
21 WOPEC/Optometry Wales, Cardiff
University, Cardiff, Welsh National
Optometric Conference (www.wopec.
co.uk)
23 UltraVision, Commerce Way, Leighton
Buzzard, Bedfordshire, Interactive
workshops (workshop@ultravision.co.uk)
24 SBK Healthcare, The Hatton,
Farringdon, Managing change in your
ophthalmology service course (www.
sbk-healthcare.com)
25 Optos, Hilton Manchester Airport,
Manchester, Optos Daytona and OCT
roadshow SEE ABOVE
NEW… 25 Toolbox Training and
Consultancy, Belfast, Northern Ireland,
Business in practice session (www.
toolbox.ch/course)
25-26 J&J, The Vision Care Institute,
Pinewood, Berkshire, Returning to work
confident and refreshed SEE ABOVE
26 Optos, Hilton Newcastle Gateshead,
Newcastle upon Tyne, Optos Daytona and
OCT roadshow SEE ABOVE
27 J&J, The Vision Care Institute,
Pinewood, Berkshire, Presbyopia and its
management with contact lenses SEE
ABOVE
27 No 7 Contact Lenses, Sidney Little
Road, Contact lenses – it’s everybody’s
business SEE ABOVE
29-30, <strong>AOP</strong>, 2 Woodbridge Street,
London, EC1R, London 2012 Education
destination (www.aop.org.uk)
MAY
10 No 7 Contact Lenses, Sidney Little
Road, Improve your contact lens
confidence SEE ABOVE
13 WOPEC, Anglia Ruskin University,
Cambridgeshire, Gonioscopy event
(mackens@cardiff.ac.uk)
NEW… 14 Hospital of St John and St
Elizabeth, 60 Grove End Road, London,
NW8, All things retinal lecture SEE ABOVE
14 Macular Disease Society, Edinburgh,
Top doctors roadshow (help@
maculardisease.org)
14 No 7 Contact Lenses, Sidney Little
Road, Hastings, Fitting presbyopic
contact lenses SEE ABOVE
15 Macular Disease Society, Belfast, Top
doctors roadshow SEE ABOVE
NEW… 16 NIOS, Templeton Hotel,
Templepatrick, Co Antrim, Contact lens
day (lizgillespie.nios@btopenworld.com)
NEW… 21 <strong>AOP</strong> and Myers La Roche,
2 Woodbridge Street, London, EC1R,
How to increase sales at your practice
workshop SEE ABOVE
See more events at www.optometry.co.uk/events
21 Warwickshire <strong>AOP</strong>, The Venture Centre,
University of Warwick Science Park,
Coventry, Myopia control lecture SEE ABOVE
21-22 J&J, The Vision Care Institute,
Pinewood, Berkshire, Healthy eyes and
healthy practices and managing the
astigmatic patient combined course SEE
ABOVE
NEW… 23 Kent and Medway LOC, Russell
Hotel, Boxley Road, Maidstone, Kent, AGM
and lecture (davidflacey@aol.com)
24 Macular Disease Society, Manchester,
Top doctors roadshow SEE ABOVE
24-27 BCLA, ICC, Birmingham, Annual
Clinical Conference and Exhibition (www.
bcla.org.uk)
29 ABDO Golf Society, Moseley Golf Club,
Birmingham, Challenge Cup (m.stokes67@
ntlworld.com)
NEW… 29 Bexley, Bromley and Greenwich
LOC, Charlton Athletic FC, The Valley,
London, SE7, AGM and lecture on laser
refractive surgery (davidflacey@aol.com)
JUNE
NEW… 11 Hospital of St John and St
Elizabeth, 60 Grove End Road, London, NW8,
Paediatric optometry lecture SEE ABOVE
12 Hampshire LOC, Chilworth Manor,
Southampton, AGM and CET event
(www.hampshireloc.org.uk)
NEW… 12 Vision UK 2012, Queen Elizabeth
II Conference Centre, Broad Sanctuary,
London SW1P (www.vision2020uk.org.uk)
14 Macular Disease Society, Newcastle,
Top doctors roadshow SEE ABOVE
18-19 J&J, The Vision Care Institute,
Pinewood, Berkshire, Returning to work
confident and refreshed SEE ABOVE
19 Carl Zeiss Education, Manchester,
OCT course (www.zeiss.co.uk)
NEW… 19 Macular Disease Society,
Inverness, Top doctors roadshow SEE ABOVE
NEW… 20 Carl Zeiss Education,
Manchester, Visual fields course SEE ABOVE
NEW… 25 University of Warwick, Coventry,
Postgraduate certificate course begins
SEE ABOVE

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30
06/04/12 <strong>AOP</strong> MEMBER BENEFITS
UPDATE
<strong>AOP</strong> Member Benefits
– debt collection tips
The Office of Fair Trading (OFT) has recently published its updated Debt Collection Guidance.
OT asked London House Services to provide an overview of what the changes to the guidance
could mean to <strong>AOP</strong> members. The company is an <strong>AOP</strong>-endorsed service provider
“The updaTed guidance sets out the standards
expected of all businesses engaging in the
recovery of consumer credit debts, including
banks, law firms and tracing agents as well
as traditional debt collectors,” London
house Services’ regional partner, John
Whitewood, told OT. “It also sets out
specific business practices which the OFT
considers to be unfair or improper, such as
using Facebook and Twitter and other social
networking sites to contact debtors, as well
as contacting debtors at unreasonable
times, or at inappropriate locations,
for example when they are a
patient in hospital.”
In summary, the guidance:
• Warns against misuse
of continuous payment
authority to recover debts,
such as making recurring
attempts to recover a single
repayment
• highlights the responsibilities
of all parties involved in the
debt recovery process,
including creditors, for
the quality and level
of information they
maintain and exchange
with others, in order to avoid the wrong person being pursued
for a debt
• provides greater clarity on the OFT’s position on issues such as
reasonably queried and disputed debt and statute-barred debt
• Makes debt recovery businesses aware that they should
adopt appropriate practices and procedures for dealing with
particularly vulnerable debtors.
Clear standards
The OFT’s director of consumer credit, david Fisher said: “In the
present economic climate, with many people, including those
who may be particularly vulnerable, in financial difficulties, this
updated guidance makes clear the standards the OFT expects of
all businesses involved in debt recovery.”
The guidance also states that, when communicating with
debtors, businesses must make sure that all communication is
clear, accurate and done so in a transparent, truthful, and fair
manner. You must not mislead your legal position with regards
to debts and the recovery of those debts. Businesses should not
engage in physical or psychological harassment of debtors, or
third parties. unfair methods of recovery are not accepted and
those visiting debtors must not act in a threatening or unclear
manner and charges associated with debt collection must not
be levied inappropriately.
having clear and appropriate processes in place with a view
to ensuring customer data is accurate and adequate is essential
to ensure all reasonable steps are taken to only contact actual
debtors and valid debts are pursued for payment.
London house Services provides aOp members help to

manage debt recovery issues. These services include debt
collection and supplying credit status checks on individuals
and companies, as well as financial consultancy.
• If you are an aOp member and would like to contact
London house Services, call 01934 863 616 or email John
Whitewood at taunton@lh-services.co.uk
London house is fully regulated and a member of the
Credit Services association. The company has offices
throughout the uK and operates both on a pan-european
and international basis.
These are a few basic things to remember if you are
recovering debts. In the guidance, ‘Debt collection, OFT
guidance for all businesses engaged in the recovery
of consumer credit debts’, there are a number of
overarching principles of consumer protection and
fair business practice which apply to all debt recovery
activities:
In general terms, businesses should:
• Treat debtors fairly – debtors should not be subjected
to aggressive practices, inappropriate coercion, or
conduct which is deceitful, oppressive, unfair or
improper, whether unlawful or not
• Be transparent in their dealings with debtors and
others – information provided should be clear and
should not be confusing or misleading
• Exercise forbearance and consideration – in particular
towards debtors experiencing difficulty – we would
expect businesses to work with debtors with a view to
providing them with reasonable time and opportunity
to repay debts and, where appropriate, to signpost them
to sources of free independent debt <strong>advice</strong>
• Act proportionately when seeking to recover debts,
taking into account debtors’ circumstances – actions
taken in respect of arrears or default should give proper
consideration to available options and the likely effect
of such actions on the debtor (taking account of the
information available to the business at that time)
• Establish and implement clear, effective and
appropriate policies and procedures for engaging with
debtors and other relevant parties, including having
appropriate mechanisms for responding to reasonably
queried and disputed debt (and other) complaints
• Establish and implement clear, appropriate and
effective policies and procedures for identifying and
dealing with particularly vulnerable debtors.
Optometry Today April 280x90mm:Layout 1 29/3/12 12:46 Pag
Diabetic Eye Disease
(City & Guilds Certificate in Diabetic
Retinopathy Unit 302)
1st – 2nd May 2012
This module will provide optometrists with the ability to identify
clear diagnostic criteria, referral guidelines and information
regarding different modes of treatment following the in-depth
analysis of presenting features. The course will include
face-to-face teaching with e-learning.
Speakers will include:
Miss Gillian Vafidis
Dr Byki Huntjens
Dr Rachel North
Contact Lens Practice
13th – 15th June 2012
This module has been devised to enable optometrists to
deal more confidently and effectively with the management of
contact lens patients in the community and will include fitting
contact lenses in patients requiring therapeutic lenses, those
with pathological dry eye, high prescriptions and following
surgical procedures.
Speakers will include:
Ms Caroline Christie
Ms Lynne Speedwell
Mr Daniel Ehrlich
Glaucoma
16th – 18th July 2012
This module will provide optometrists with the ability to
gain comprehensive theoretical and practical knowledge
of the glaucomas. The course is accredited by the College
of Optometrists and forms the Professional Certificate
in Glaucoma.
Speakers will include:
Mr Gus Gazzard
Mr John Salmon
Mr Andrew Scott
Mr Rizwan Malik
Each module costs £730 (plus £80 exam fee for Glaucoma).
CET points will be available. Completion of the examination that
follows each module will enable accumulation of postgraduate
credits which can be used towards a Postgraduate Certificate,
Diploma or MSc in Clinical Optometry.
To apply, please contact Rita Kaur on 020 7040 3934
or rita.kaur.1@city.ac.uk
www.city.ac.uk/pgoptometry
31
06/04/12 <strong>AOP</strong> MEMBER BENEFITS

32
06/04/12 STUDENT NEWS
STUDENTNEWS
Glasgow wins Optics cup
STUDENTS FROM Glasgow Caledonian
University arose victorious to be named
winners of Opfest 2012.
Hosted by Aston University on March
9-10, the cross-university sporting event
was attended by representatives from
seven of the nine optometry schools
across the UK.
Glasgow’s win sees them secure the
Optics Cup from Bradford University,
who have won since the competition
was re-established three years ago.
The annual ‘sports day’ opened with a
sports-themed fancy dress night on the
Friday (March 9), before students kicked
off the tournament with a game of tug of
war the following morning. Other sports
held throughout the day included,
football, volleyball, netball and
dodgeball. In the evening students met
for an ‘Around the world in 80 dishes’
themed dinner and Awards ceremony.
To read a full account of the event
by organiser Jeff Clarke, visit www.
studentaop.org.uk
Having a Ball at Ulster University
OPTOMETRY STUDENTS at the
University of Ulster held their annual
Eyeball last month and raised £360 for
the Mozambique Eyecare Project, in
association with OGS. Hosted on March
9 at The Galgorm Manor, Ballymena, the
event gave students the opportunity to
raise money for charity.
In the lead up to the Ball, students
raised funds through a bake sale, a
night out in Belfast and a raffle.
Third-year undergraduate Edna Kelly
was drawn as the winner of the raffle,
taking home a full Keeler student set
donated by Ulster Anaesthetics.
For more information on the
Mozambique Eyecare Project, visit
www.mozeyecare.org
Aston holds CL fair for students
A NUMBER of major contact lens companies
attended Aston University’s Contact Lens Fair, taking
the opportunity to talk to optometry students about
their products. During the fair, each business was
invited to give a 30-minute presentation to the 130
undergraduates who attended, providing delegates
with an overview of the company, the products they
offer, and what they have ‘in the pipeline’.
• Pictured is CooperVision’s Mark Chatham
presenting student Anisa Graham with a pair of
headphones after she correctly answered the
contact lens company’s student quiz competition.
Sponsored by
Dining in the dark
THE OPTOMETRY undergraduates named as
<strong>AOP</strong> reps for the 2012-13 academic year met in
London last month at the annual student forum.
Hosted by the Association at its Clerkenwell
headquarters, students had the opportunity
to get to know each other, discuss various
student benefits and talk about what more the
<strong>AOP</strong> could do for students. The day-long event
closed with dinner at Dans Le Noir, a restaurant
where you dine in the dark and are served by
blind or partially sight waiters.
<strong>AOP</strong> director, Ed Bickerstaffe, said: “We had yet
another group of very enthusiastic optometry
undergraduates brought together to share ideas
for university events, as well as discuss national
charity fundraising plans. Each year we build the
<strong>AOP</strong>’s support for students, taking on feedback
from the forum on subjects such as web
content and the Eye Opener conference.
“The university reps are there for you
[students] as well, so please get to know them
and use them to feedback any ideas to the <strong>AOP</strong>
on improvements we can make to our services.”
This year’s reps are: Sonam Ruparelia (Anglia
Ruskin University); Niloufar Ahmadpour (Aston
University); Dan Varcoe (University of Bradford);
Alison Fletcher (Cardiff University); Sasha
Junega (City University); Gemma Hill (Glasgow
Caledonian University); Neema Ghorbani
(University of Manchester); Avi Sond (Plymouth
University); and Louise Cagney (University of
Ulster). The OT student rep is Aston University’s
Gaumaya Gurung.
To read a full account of the forum authored
by Mr Varcoe, visit www.studentaop.org.uk

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34
06/04/12 AWARDS AND NOC
UPDATE
Make your nomination
The <strong>AOP</strong> Awards are your chance to nominate those who should be recognised for their work
The nominaTions for this year’s aoP awards are starting to
come in, so act now and submit your nominations. Don’t leave
it until it’s too late. These are unique awards within the industry
because the recipients are nominated by their peers and voted
for by the profession. The nine 2011 categories received a total of
nearly 6,000 votes, with 28,000 page hits on the awards section
of the oT website last year.
The aoP awards headline sponsor has been confirmed as
CooperVision, which is also the category sponsor of the Contact
Lens Practitioner award. The contact lens company’s UK and
ireland marketing manager, Rob healey, said: “The aoP awards
proved a great success last year and it was fantastic to be a part
of them in their launch year. To demonstrate CooperVision’s
support further, we are delighted to be the awards headline
sponsor and look forward to an even more successful and
entertaining evening.
“With the promotion of these awards coming earlier in the
year, it is sure to provide a lot of high calibre nominations, and
with that in mind, we are pleased to sponsor the Contact Lens
Practitioner of the Year award.”
To nominate, visit www.optometry.co.uk/awards and click
on the desired category. alternatively, post your nomination,
remembering to include the nomination category name, to: aoP
awards (Category), The aoP, 2 Woodbridge street, London, eC1R
0DG. You will need to provide contact details for yourself and
the nominee/s, plus an explanation of why that person or group
deserves to be included for the category selected.
All nominations must be received by May 31, 2012. Any
nominations received after this date will not be considered.
All shortlisted nominations will be voted for by OT readers,
except for the Lecturer Award and Lifetime Achievement Award.
Winners of these categories will be decided by a panel of judges.
NOC 2012: A new beginning
RECOGNISING THE
importance to the entire
optical sector of raising the
profile of local community
eye care services, the NOC
2012 will have a new name.
Organised by
the <strong>AOP</strong> on behalf of
LOCSU and the Optical
Confederation, the
event, previously known as the National Optometric
Conference, will be renamed the National Optical
Conference from this year. The change in name
reflects the increasing contribution made by eye care
professionals from across the sector in the development
of local eye care services throughout England and Wales.
It also represents a new phase for the event.
As well as being the annual highlight for Local and
Regional Optical Committee members, the NOC 2012
is a great opportunity for people to learn how the NHS
reforms will change the way eye health services will be
delivered in the coming years. David Craig (pictured),
director of operations at the <strong>AOP</strong>, said: “The conference
is the only forum for our sector to get together and
discuss the politics and the practicalities of practice.
Dispensing opticians and, indeed lay people, can be
contractors, so it is right that the title of the conference
recognises the contributions that can come from all
sections of our community.
“The NOC has always been open to all who want to
attend. Its name should reflect that inclusivity, so that
not only are people able to attend, but they should feel
welcomed and their contributions valued.”
Whether you are simply interested in, or are already
heavily involved in, redesigning local eye care
services, the NOC is your chance to learn about the
latest developments from highly regarded nationally
renowned speakers. It is also a chance to network,
as well as celebrate the success of LOCs and ROCs in
making services work well in so many areas to the
benefit of thousands of patients. The NOC 2012 will
be held on October 18-19, at the Hilton Metropole,
Birmingham. Programme details and booking
arrangements are being finalised, but if you want to
register your interest, email your details to NOC2012@
locsu.co.uk or visit www.locsu.co.uk
For an extended version of this article, visit www.
optometry.co.uk/noc-2012

NOMINATE NOW
Category sponsors:
Headline
sponsor:
Awards
2012
www.optometry.co.uk/awards
Nominations must be received by May 31, 2012.

36 28
06/04/12 LOCSU PATHWAY
DEVELOPMENTS
Learning disabilities
pathway introduced
PEOPLE WITH learning
disabilities are 10 times more
likely to have eye problems, yet
they are less likely than the rest
of the population to have access
to the right care at the right time
(statistics from the RNIB report).
Despite this, many adults with
learning disabilities have never
had a sight test.
Recognising the need to
improve access to eye care
services for people with learning disabilities, LOCSU has
developed a new Community Eye Care Pathway.
The pathway is based on successful learning disability
services provided by community optometrists in a number
of areas in England. It has been developed in partnership
with Mencap and SeeAbility to ensure that the proposal
fully reflects the needs of people with learning disabilities.
Katrina Venerus (pictured above), LOCSU director of
operations and commissioning, said: “This pathway will
help LOCs to make the case to commissioners and increase
eye care provision for this vulnerable group in our society –
often ‘unseen’ in terms of health provision.”
People with learning disabilities might not attend an
opticians for an eye examination for a number of reasons.
First, neither themselves or their carer could be aware of any
vision impairment. Second, they may be reluctant to attend
a practice through fear of the process, or their carer may feel
they would be unable to participate or read the letters on the
letter chart.
Experience has shown that a sight test for a patient with
moderate to severe learning disabilities will require at least
45 minutes, alongside subsequent visits, before the patient is
comfortable with the testing environment, or the practitioner
is satisfied that the sight test has been fully completed. In
this case an enhanced service is needed to ensure adequate
time can be allocated for the sight test and the preparation
and reporting that is involved.
Optometrist and chair of Bexley, Bromley and Greenwich
LOC, Gordon Ilett – who has a special interest in examining
patients with learning disabilities – said: “The opportunities
for optometrists presented by the adoption of the LOCSU
pathway includes engagement with other professionals
involved in providing for this group of people, and longer
appointment times for patients with complex needs, allowing
optometrists to communicate effectively with patients and
carers.”
Paula Spinks-Chamberlin, director of SeeAbility’s
specialist services, added: “Our research shows that there
are an estimated one million adults in the UK with learning
disabilities. They are 10 times more likely than the rest of

“This pathway will help LOCs to make the case to commissioners and
increase eye care provision for this vulnerable group in our society –
often ‘unseen’ in terms of health provision”
Katrina Venerus, LOCSU director of operations and commissioning
the population to be blind or partially sighted, and six out
of 10 will need glasses, and people with severe or profound
learning disabilities are the most likely to have serious sight
problems.
“SeeAbility welcomes the launch of this local pathway.”
Head of campaigns and policy at Mencap, David
Congdon, commented: “The LOCSU pathway has a vitally
important role to play in improving the eye health of people
with a learning disability and is a key tool to making sure
that more people access the services that they need.
“The eye health component of annual health checks
for people with a learning disability also provides an
opportunity to help identify problems with people’s
eyesight and ensure they are referred to appropriate
services.”
For more information, visit www.locsu.co.uk
How more time can benefit
patients with a learning
disability – an example
Jimmy has Down’s syndrome and severe learning disabilities, with
no verbal communication. He lived with his parents until they
became too infirm to look after him and consequently, moved
into a small group home. He had always been very lively and his
idea of mischief was to drink everyone’s tea if they put their cup
down, or to run and hide behind supermarket displays when out
shopping with his carers.
Jimmy started to become withdrawn and was worried or
became agitated if left on his own. He no longer ‘stole’ tea and
would shuffle rather than walking confidently. When he first
attended for an eye examination he refused to open his eyes, and
the whole appointment was spent chatting to him and his carer
and drinking tea. A further appointment was made and, despite
minimal cooperation, it was quickly established that he had dense
cataracts in both eyes. A referral was made to a sympathetic
ophthalmologist, explaining the changes in Jimmy’s behaviour
and his reluctance to cooperate with examination procedures.
Following surgery, the practice received a letter from the
hospital which stated: ‘Despite the inability to obtain any formal
visual acuity, surgery was successful, and we assume Jimmy can
see well as he is back to his old ways, drinking other people’s tea
and ran off and hid during a supermarket visit. Please see and
refract if possible’.
Jimmy continues to attend regular sight tests and his
cooperation is gradually improving. His functional vision is good
and he enjoys life to the full.
Benefits of the pathway
The pathway gives LOCs the basis for a proposal to tailor the
delivery of sight tests to meet the needs of people with learning
disabilities in their local area.
The benefits of the pathway are that it allows:
• People with more complex learning disabilities to access
NHS eye care services (eg, a sight test and any necessary visual
correction) in a community setting like everyone else
• More time to familiarise patients and their carer with the
procedures and equipment during the sight test and also gives
time for repeat visits to complete procedures where needed
• Better preparation for patients through linked specialist
information, provided by SeeAbility, minimising stress for patients
• Easily understood feedback from optometrists to the patient,
regarding sight test results, using SeeAbility’s ‘Feedback from the
optometrist about my eye test’ form.
37
06/04/12 LOCSU PATHWAY

38
06/04/12 VRICS
VRICS
Visual Recognition
and identification
of clinical signs
Sponsored by
readers are encouraged to discuss the cases in this Free vrics with their colleagues, conduct simple
internet searches, and use the references provided to complete the multiple choice questions (mcqs).
Please note that there is only one correct answer for each mcq. complete the vrics test online at
www.optometry.co.uk/cet/exams
A
AdvAnced clinicAl Techniques PArT 1: OPTicAl
cOherence TOmOgrAPhy
cOurse cOde: c-18690 O/d
1. What macular anomaly is mOsT likely to be present in the
scan shown in image A?
a. Central serous chorioretinopathy
b. Wet age-related macular degeneration
c. Macular hole
d. Macular oedema
2. When does a patient with the condition shown in image A
need to see an ophthalmologist?
a. No referral is required, monitor routinely every year
b. Refer if a patient has been symptomatic for under 1 year
c. Refer if a patient has been symptomatic for at least 1 year
d. Refer only if a patient has bilateral presentation
3. how is the condition shown in image A treated?
a. Observation only, no treatment is conducted
b. Pneumoretinopexy
c. Focal laser photocoagulation
d. Vitrectomy with gas infusion
ramesh sivaraj, ms, dnB, Frcs ed Ophthalmology
Ramesh Sivaraj is a consultant ophthalmologist & clinical lead for diabetic retinopathy at the Heart
of England NHS Foundation Trust. After completing specialist training in Birmingham he took an
advanced Medical Retinal & Uvea Fellowship at Moorfields Eye Hospital. His special interests are
age-related macular disease, diabetic retinopathy, retinal vascular disease and uveitis.
4. What macular anomaly is mOsT likely to be present in the scan
shown in image B?
a. Diabetic macular oedema
b. Vitreo-macular adhesion/traction
c. Macular hole
d. Dry age-related macular degeneration
5. Which of the following clinical features will be present on
ophthalmoscopic fundus examination of a patient with the
condition shown in image B?
a. Macular haemorrhages
b. Macular microaneursyms
c. Retinal striae
d. None of the above
6. When does a patient with the condition shown in image B
need to see an ophthalmologist?
a. Refer only if the patient is symptomatic
b. Refer even if a patient is asymptomatic
c. Refer only if the VA is worse than 6/60
d. No referral is required as it always resolves itself
Astigmatism: potential is all around you. Maximise it!
9th July 2012
2198 VRICS Banner 420x30_ASTIGMATISM v4.indd 1 29/03/2012 14:05
B

cOnFused ABOuT ceT requiremenTs? www.cetoptics.com/cetusers/faqs/
Sponsored by
imPOrTAnT inFOrmATiOn: Under the new Vantage rules, all OT CET points awarded will be uploaded to its website by us.
All participants must confirm these results on www.cetoptics.com so that they can move their points from the “Pending Points record” into
their “Final CET points record”. Full instructions on how to do this are available on their website. The closing date for this examination is
June 1 2012. ceT points for this exam will be uploaded to vantage on June 11 2012.
2 Free ceT POinTs
Approved for Optometrists 4 Dispensing Opticians
references to aid completion of the exam:
Q1, Q2 & Q3: http://www.ncbi.nlm.nih.gov/pubmed/7852702
Q4, Q5, & Q6: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162296/?tool=pubmed
For more information on all our courses, please visit:
www.thevisioncareinstitute.co.uk
4
Q7, Q8 & Q9: http://www.patient.co.uk/doctor/Macular-Oedema.htm
Q10, Q11 & Q12: Binns A (2011) Assessment & Management of AMD: Referral Refinement Part 4,
OT, May 20.
LARGER SCALE IMAGES ARE AVAILABLE ON THE OT WEBSITE (Simply click on the image when completing the exam online)
c d
7.What macular anomaly is mOsT likely to be present in the scan
shown in image c?
a. Focal diabetic macular oedema
b. Diffuse diabetic macular oedema
c. Wet age-related macular degeneration
d. Central serous chorioretinopathy
8. Which of the following factors can influence the condition
shown in image c?
a. Duration of diabetes
b. Systemic diabetes control
c. High cholesterol
d. All of the above
9. What is the mOsT appropriate treatment for the condition
shown in image c?
a. Observation only, no treatment is required
b. Laser photocoagulation
c. Anti-VEGF intra-vitreal injections
d. Vitrectomy
10. What macular anomaly is mOsT likely to be present in the
scan shown in image d?
a. Diabetic macular oedema
b. Wet age-related macular degeneration
c. Evolving macular hole
d. Cystoid macular oedema
11. What clinical signs and symptoms are likely to be associated
with the condition shown in image d?
a. Macular exudates
b. Recent onset distortion of central vision
c. Macular haemorrhage
d. All of the above
12. What is the mOsT appropriate course of action to take for the
condition shown in image d?
a. Refer to an ophthalmologist urgently if VA is better than 6/96
b. Refer to an ophthalmologist urgently regardless of VA
c. Refer to an ophthalmologist routinely
d. Referral is not required, monitor in practice yearly
2198 VRICS Banner 420x30_ASTIGMATISM v4.indd 2 29/03/2012 14:05
39
06/04/12 VRICS

optometrytoday live
CET Video
online enewsletter
Femtosecond laser
cataract surgery
C-18628 O/D
Publication date March 23 2012 Closing date May 22 2012
Over 300,000 cataract operations are performed in the UK each year. Lasers play a major part in
eye care, but until now cataract surgery has always been performed using traditional surgical
instruments, relying on the skill of the surgeon. Laser Cataract Surgery offers safer, quicker and
improved outcomes by eliminating the potential for human error in performing delicate parts
of the procedure that may lead to complications and loss of optimum visual function. This video
details how the femtosecond laser can be used for accurate capsulorhexis, lens fragmentation
and corneal incision and compares this to conventional methods.
Sponsored by
2 CET
points
For more information, log on to
www.optometry.co.uk
You must be logged in to the CET section of the OT website before you can watch this video and take the exam. A hint button is now available for each
question and will take you to the section of the video that relates to the question. The closing date for MCQ submissions is May 22 2012. Points will be
uploaded to CET Optics up to 10 days later.

CET CONTINUING
EDUCATION
& TRAINING
1 FREE CET POINT
Approved for: Optometrists 4 Dispensing Opticians 4
OT CET content supports Optometry Giving Sight
Healthy lifestyle equals
healthier eyes
OPHTHalmIC PublIC HEalTH PaRT 4 C-18633 O/D
Dr Ruth Hogg, bSc, PhD, mCOptom
Age-related sight loss is a major public health concern given the increasingly
aged population and due to changes in demographics in most Western
societies. People in the UK are living nearly 30 years longer now compared
with 100 years ago and increases in life expectancy are continuing at a rate
of approximately four months per year. Major advances in the treatment
of conditions such as heart disease and cancer are enabling people to live
long enough to develop classical degenerative conditions associated with
ageing, such as Alzheimer’s disease, cataract and age-related macular
degeneration (AMD). This article discusses the important relationship
between lifestyle and ocular disease and it is hoped that eye care practitioners
are encouraged to promote healthy living amongst their patients.
major threats to vision with
ageing
The main causes of visual impairment
in those aged 75 years and over in the
UK were identified by a large study
of over 14,500 people from general
practices. 1 Surprisingly, the principal
cause of visual loss was uncorrected
refractive error. Other causes of visual
impairment (binocular VA of less
than 6/18) and sight loss identified
were AMD (52.9%), cataract (35.9%),
glaucoma (11.6%), myopic degeneration
(4.2%) and diabetic eye disease (3.4%).
All of these, with the exception of
myopic degeneration, share a degree of
similarity in their underlying aetiology
in that oxidative stress is known to
play a significant role. Oxidative stress
results from an imbalance between the
production of reactive oxygen species
(ROS) and the human body’s ability to
detoxify them or repair the resulting
damage. Smoking, obesity, and a
poor diet are known to increase the
amount of oxidative stress in the body.
Inflammation is also an important
factor in AMD and diabetic eye disease,
with smoking, obesity, lack of physical
activity and poor diet also known to lead
to an increase in inflammatory mediators
that can lead to disease development.
All of these diseases have a nonmodifiable
genetic component so
some people will be more predisposed
to experiencing them than others.
However, the priority is to reduce the
modifiable risk factors as much as
possible, as a means of either preventing,
or delaying, the onset of disease.
lifestyle and eye disease
amD
Oxidative stress is considered a major
pathogenic mechanism in the human
body and is thought to play a pivotal role
in the development of AMD. The retina
is particularly susceptible to oxidative
stress due to its high oxygen utilisation,
the presence of photosensitisers such as
rhodopsin and exposure to intense light
conditions. Components of the retina,
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Figure 1
Early posterior subcapsular cataract (courtesy of
Prof David Elliot & Konrad Pesudovs)
such as photoreceptor outer segments,
by virtue of their high polyunsaturated
fatty acid content, are particularly
vulnerable to oxidative damage resulting
in the formation of lipid peroxides.
Diet
Various aspects of diet have been
associated with a risk of AMD. Several
epidemiologic studies and clinical
trials have demonstrated that diets high
in antioxidant nutrients (vitamins C
and E, carotenoids such as lutein and
zeaxanthin, and fruit and vegetables
rich in these nutrients) or zinc, are
associated with a decreased occurrence
of AMD, 2 while a high dietary intake
of fat is associated with a higher
prevalence or incidence of early,
or late stage, AMD. 3 Higher intakes
of fish or omega-3 fatty acids were
associated with lower rates of AMD. 3
Other dietary characteristics such as
eating foods with a low-glycaemic
index, or overall diet quality, as
characterised by a ‘healthy eating
score’, 4 have also been reported to be
important in reducing risk. Data from
a longitudinal study of approximately
10,000 women in the USA showed that
those with the highest “healthy eating
scores” compared to those with the
lowest, had 46% lower odds for early
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AMD, emphasising the importance
of ensuring the entire diet is
appropriate as opposed to just
specific nutrients. Also of note is
a recent report from the Rotterdam
study, 5 which stratified risk on the
basis of both genotype and diet
and found that risk of AMD for
those with the high-risk genotypes
could be reduced significantly
by intake of zinc, antioxidants
and omega-3 fatty acids. This
suggests it is important to advise
patients with a family history
of AMD on good dietary intake.
Exercise
Very few studies have reported
specifically on the relationship
between AMD and physical
activity. The Beaver Dam Eye
Study found, within their 15-year
follow-up study, that exercise three or
more times per week or walking several
blocks each day reduced the incidence
of neovascular AMD, 6 while the National
Runners Health Study found that those
who undertook higher doses of vigorous
exercise had a significantly lower risk
of AMD. 7 Recently, a study in the USA
reported that women in the highest
quintile, compared with those in the
lowest quintile for physical activity, had
54% lower odds for early AMD. 8 Although
more data is required to confirm these
associations, it is known that increasing
physical activity is an effective method
of improving cardiovascular health.
body mass index
Many studies have investigated the
relationship between body mass index
(BMI) and AMD. A recent meta-analysis
of prospective studies evaluating clinical
risk factors found an adverse risk for
late AMD when being overweight/
obese. 9 Data from a population-based
cohort study in Australia showed that
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Figure 2
Cortical cataract (courtesy of prof David Elliot and Dr Konrad Pesudovs)
middle-aged people who lost 3% or
more of their waist:hip ratio over time
had 29% lower odds of any form of
AMD, while the beneficial impact of
reducing waist:hip ratio for those who
were obese was even more dramatic
(59% lower odds of developing AMD). 10
Smoking
Cigarette smoking has been shown to
markedly influence the risk of progression
to neovascular AMD, with a four-fold
increase in prevalence reported. 11 The
incidence of AMD is also higher in pastsmokers
and a dose-response relationship
has been observed with current smokers,
who are at substantially higher risk
than past-smokers. However, statistical
modelling has shown that cessation of
smoking results in an average reduction in
risk of AMD by 6.7% after one year, and
a further 5% reduction after five years of
cessation, 12 confirming that even stopping
smoking later in life can have a significant
impact in reducing the risk of AMD.
Cataract
Oxidative stress is clearly involved in the
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aetiology of age-related cataract
development and therefore,
many of the associations mirror
those found with AMD, albeit
usually being less strong.
Diet
Some of the studies that have
evaluated the relationship
between AMD and nutrition
have also looked into
associations with cataract.
A review article13 concluded
that data from observational
studies appears to suggest a
beneficial effect of vitamin C
and E intake in reducing the
risk of cataract, while results
from randomised controlled
trials were inconsistent.
Exercise
Physical activity is not considered a
recognised risk factor for cataract. 14
body mass index
Several studies have reported an
association of increased risk of posterior
subcapsular (Figure 1) and cortical (Figure
2) cataracts with higher BMI. 14 However,
the relationship with nuclear cataract is
less clear (for a full review see Asbell et al. 14 )
Smoking
Smoking is considered a significant
risk factor for the development of
nuclear cataract, with the research
literature demonstrating a clear dose
response. 14 Smoking is also associated
with posterior subscapsular cataract
and cortical cataract, although the
relationships are not as strong. 14
Diabetic retinopathy
Diet
The maintenance of good blood sugar
control for people with type 1 and type
2 diabetes is a major priority, as stability
and control is related to decreased risk
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of developing diabetic
complications including
retinopathy or maculopathy.
General guidelines for diet
should be provided by a
patient’s GP or diabetic
specialist, and usually
include reduction in the
intake of carbohydrates,
preferential intake of
complex carbohydrates
and low glycaemic index
foods, restricted intake of
sugar, high intake of fibre,
lower intake of saturated
fats and lower intake of salt.
Elderly people with type 2
diabetes in particular often
struggle with the change in
dietary pattern required after diagnosis.
So it is worthwhile reinforcing these
messages during the eye examination
and, in particular, if retinopathy or
maculopathy is apparent (Figure 3).
Reports in the research literature15 also
suggest that dietary supplementation
with certain micro-nutrients such as
chromium, isoflavones with soy proteins,
and vitamin E, may be beneficial,
although most studies investigating
this are quite small and therefore lack
statistical power to make firm inferences.
Exercise
Increasing physical activity is a
well-accepted method for primary
prevention of developing type 2
diabetes and indeed the increasingly
sedentary lifestyle adopted in both
Western and Asian countries alike are
causing concern of increasing diabetes
prevalence of epidemic proportions.
Across the world governments and
public health practitioners are attempting
various strategies for increasing activity
in different age groups. It is increasingly
appreciated that greater levels of
physical activity may also be important
for preventing diabetic complications
Figure 3
Diabetic retinopathy (courtesy of prof Rachel North)
by improving glycated haemoglobin, an
important biomarker of diabetes severity,
even in the absence of weight loss. 16
body mass index
Obesity is strongly related to the
development of type 2 diabetes and
usually a priority within the medical
management of this condition is
weight reduction. However, within
public health literature it is widely
recognised that long-term weight loss
is very difficult to achieve. A metaanalysis
has reported that diet plus
exercise rather than diet alone is better
for achieving goals, although weight
regain is common with both strategies. 17
Smoking
Smoking is an accepted independent
and modifiable risk factor for the
development of type 2 diabetes and
hence diabetic eye disease. A recent
large cohort study demonstrated that, 12
years after smoking cessation, a person’s
risk level can return to normal even if
this is typically accompanied by weight
gain, which inherently increases the
risk of type 2 diabetes. The data showed
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an increased risk of diabetes
for approximately three years
after smoking cessation,
before a fall in risk occurred. 18
Therefore, the long-term
benefits of smoking cessation
far outweigh the weight
gain risk in the shorter term.
Glaucoma
Diet
Oxidative stress and the
formation of reactive oxygen
species are known to play
a significant role in the
development of primary open
angle glaucoma (POAG). 19
However, some studies20,21 have reported decreased risk
of POAG associated with
higher vitamin E intake and increased
servings of kale and carrots. One study
reported increased risk of POAG with
a higher intake of vitamin C. 21 These
inconsistent results suggest preliminary
evidence that glaucoma may be related
to dietary intake but more research is
needed to clarify the relationships. 22
Exercise
Very few studies have focused on the
relationship between glaucoma and
physical activity. Overall, exercise
appears to have a beneficial effect in
reducing the risk of POAG, although in
most studies the sample sizes were too
small to be able to make firm inferences.
In addition, none of the studies provided
sufficient information to enable <strong>advice</strong>
to be compiled regarding the optimal
level of exercise, the duration, or type of,
exercise, and whether a person’s initial
fitness level or degree of exhaustion
impacted the final outcome. 22 Two
of the studies that reported a drop in
intraocular pressure (IOP) following a
period of aerobic training showed that
the effect may dissipate when exercise
is stopped; in one study, IOP levels
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returned to their original level three weeks
after the training program was stopped. 22
body mass index
Glaucoma is related to BMI and obesity
due to its relationships with hypertension,
diabetes and insulin resistance, which are
all known to be linked to higher BMI. It is
thought that obesity may increase blood
viscosity and episcleral venous pressure
and also damage aqueous flow from the
eye, thereby increasing the likelihood of
glaucoma development. 22 Despite reports
from various epidemiological studies
linking glaucoma to obesity, a literature
review concluded that, although
evidence exists for a link between higher
BMI and high IOP, the link between
glaucomatous optic neuropathy is less
clear due to numerous confounding
factors complicating the associations. 23
Smoking
It is well known that smoking increases
the risk of vascular disease and, given
the likely vascular aetiology of POAG
(disrupted optic nerve head blood flow),
smoking is also thought to be related to
POAG. However, a recent meta-analysis
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of all of the existing studies showed
no association between glaucoma
and either current, or past, smoking. 24
Conclusion
This article has shown that adoption of
general principles of a healthy lifestyle
(stopping smoking, maintaining a normal
BMI, taking regular exercise, and eating
fruit and vegetables) have the potential
to prevent or delay the onset of the major
threats to sight in the elderly. During the
eye examination, eye care practitioners
as public health professionals should
take every opportunity to reinforce
the link between healthy lifestyle and
maintaining healthy eyes. In particular,
patients at high risk, for example those
module questions Course code: C-18633 O/D
1. all of the following are related to oxidative stress EXCEPT:
a) Age-related macular degeneration
b) Myopic degeneration
c) Cataract
d) Glaucoma
2. all of the following are reasons why the retina is sensitive to
oxidative stress EXCEPT:
a) The presence of photosensitisers such as rhodopsin
b) High oxygen utilization
c) Exposure to intense light conditions
d) High polyunsaturated fatty acid content of the retinal pigment
epithelium cells
3. People with a family history of amD should be advised to eat:
a) High glycaemic index foods
b) Foods high in omega-3 fatty acids
c) Foods low in Lutein and zeaxanthin
d) A high fat diet
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with a family history of AMD, diabetes or
glaucoma, should be strongly encouraged
to consider their lifestyle if wanting to
reduce the risk of, or delay, developing
similar problems. As the visual loss
associated with AMD, cataract, diabetic
eye disease and glaucoma is known
to have substantial personal, social
and economic costs, delaying onset by
even a few years is a worthy objective.
about the author
Dr Ruth Hogg is a lecturer at the Centre
for Vision and Vascular Science at
Queen’s University Belfast. She qualified
as an optometrist in 2000 from the
University of Ulster and was awarded
a PhD from Queen’s University Belfast
in 2005. Her research is focused on
the early detection and prevention of
advanced AMD, and through this she is
also involved in working with the RNIB
to promote ophthalmic public health.
References
See www.optometry.co.uk/
clinical. Click on the article title and then
on ‘references’ to download.
PlEaSE NOTE There is only one correct answer. all CET is now FREE. Enter online. Please complete online by midnight on may 4, 2012 – You will be unable to submit
exams after this date. answers to the module will be published on www.optometry.co.uk/cet/exam-archive. CET points for these exams will be uploaded to Vantage
on may 14, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates
4. based on current scientific evidence, what <strong>advice</strong> should NOT be
offered to a patient with a family history of glaucoma and IOP of
22mmHg, in order to prevent or delay developing the same condition?
a) Stop smoking
b) Increased and prolonged physical activity
c) Maintain a healthy BMI
d) Eat foods rich in vitamin C
5. Which of the following should a patient with type 2 diabetes NOT do?
a) Restrict their intake of sugar
b) Decrease their intake of low glycaemic index foods
c) Lower their intake of salt
d) Increase their intake of fibre
6. Increasing physical activity can be encouraged to prevent or delay:
a) Diabetes and AMD
b) AMD and cataract
c) Myopic degeneration and diabetes
d) Cataract and myopic degeneration
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Retinoscopy in infancy:
cycloplegic versus non-cycloplegic
C-18551 O/D
Fabrizio Bonci, Dip. Optom (ITA), MCOptom
Luigi Lupelli, Dip. Optom (ITA), FAILAC, FIACLE, FBCLA
The assessment of refractive status in very young children is often
not conducted in the same manner as for adult patients. In particular,
the child’s age, their co-operation and dynamic refractive status will be
key factors which influence the accuracy of refraction. For this reason,
it is often necessary to choose procedures which inhibit or minimise
accommodative activity. This can be achieved by fogging with positive
lenses or rousing the tonic (resting) accommodation (dry refraction),
or with pharmacological agents (wet refraction). This review article
compares the two approaches, focusing on the retinoscopy techniques.
Dry retinoscopy
Static retinoscopy
The patient views a distance target (foursix
metres) so that accommodation is
presumed to be static and in a relaxed
condition. The fixating eye (contralateral
to the one being examined) should be
adequately “fogged” with a positive lens
(resulting in an “against” movement seen
on the retinoscopy swipe). 1 For children,
maintaining fixation at this distance
can be difficult and new computerised
test charts generally provide dynamic
and more interesting targets to view
than a standard spotlight (Figure 1)
to help with this. It is also possible
to download a number of videoclips,
especially cartoons, with different
animations. Practitioners should also
consider not using a phoropter or trial
frame when conducting retinoscopy
on a very young child, as this can be
intimidating for the child. It is preferable
to use single trial lenses or a lens rack.
Speed during retinoscopy is essential
when performing this technique in
young children, especially as they
maintain fixation only for very short
periods of time. In cases of fluctuation of
accommodation, the practitioner should
Figure 1
Examples of exciting targets presented by computerised test charts during retinoscopy. Different face
expressions allow to the practitioner to talk to the child to maintain attention on the target (Courtesy of
Thomson Software Solutions, UK)
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follow the “with” movement, ignoring the
occasional “against” movements seen.
Yeotikar et al. 2 evaluated the difference
in refractive error in non-strabismic
children between the ages of seven years
and 16 years, using static retinoscopy
under two conditions – first by fogging
the contralateral eye with a positive
lens and second with cycloplegia using
cyclopentolate 1%. The study found
that the average difference in refractive
error between these two conditions
was only 0.29DS more hypermetropic
with cyclopentolate, highlighting the
accurate results that can be obtained
when there is adequate accommodative
control during static retinoscopy.
Furthermore, Chan and Edward3 suggested a calculation which can be
used to match the dry retinoscopy result
to that which would be obtained using
cyclopentolate 1%, in children between
three and a half to five years of age. The
astigmatic component is kept the same
whilst the spherical component found
in both meridians is multiplied by 1.45
and a value of 0.39D is added. However,
this depends on an accurate static
retinoscopy result having been obtained.
Mohindra retinoscopy
The Mohindra technique, also known
as near retinoscopy or near monocular
retinoscopy, carries the main advantage
of being child-friendly and requiring less
co-operation from the child. 4 In this case,
the stimulus is the dimmed light source
of the retinoscope in a darkened room.
The darkness of the room will facilitate
the child to keep their attention on the
retinoscope’s light. The retinoscope
is held at a distance of 50cm (errors in
distance are not clinically relevant),
with hand-held trial lenses used to find
the neutral point. The accommodation
activity during the examination is small
and the same in both eyes. It is important
during the examination to keep the light
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of the retinoscope on the child’s pupil
(to see the retinal reflex) for only a short
period of time so as not to stimulate
accommodation; subsequently the
optometrist’s attention should be focused
on the pupil, watching for maximum
dilation (indicating no accommodation). 5
The procedure should be carried out
with one eye occluded, preferably by the
parent, while the other eye is evaluated.
However, Wesson et al. 6 confirmed that
there is no substantial difference in the
result if binocular fixation is allowed
(Figure 2); indeed this can be useful if the
infant is resistant and becomes agitated
with occlusion. Several people advocate
neutralisation of the two principal
meridians of the eye separately, using
loose spherical trial lenses. However,
Saunders and Westall7 confirmed that
the accuracy of the technique can
be improved using a combination of
spherical and cylindrical lenses instead.
Once the retinoscopy result is obtained,
the refractive error was originally
calculated by adding -1.25DS to the
gross finding. 8,9 Saunders and Westall7 have reported that the accuracy can be
improved if -0.75DS is added instead,
for children aged between zero to two
years, and -1.00DS added for those
children over two years of age. They
also affirmed that the result achieved
by the Mohindra procedure in children
between six months and four years of
age is similar to wet retinoscopy (using
cyclopentolate 1% – see later), with
a difference of only 0.50DS. Others
have reported similar results, 10 and
certainly no differences greater than
1.00DS, 11 whilst similar results were
also obtained for children with Down’s
syndrome12 and even in adults. 13
The Mohindra technique is useful for
practitioners in Europe who are not
permitted to used cycloplegic agents, 14
whilst there are benefits for conducting
frequent follow-up assessments without
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Figure 2
Mohindra retinoscopy. Hand-held trial lenses are
placed in front of both eyes whilst the child fixates
the retinoscope light. The procedure should be run
in darkened room (the high level of room light in
this image was for photographic purposes only)
repeated use of cycloplegic agents. 15
One must remember, however, that the
accuracy of results will naturally depend
on the practitioner’s experience. 16
Cycloplegic agents
Control of accommodation in children
of pre-school age is more commonly
achieved by pharmacological means,
using cycloplegic agents such as
cyclopentolate and tropicamide; atropine
can only be used by therapeutically
qualified practitioners. All of these drugs
are muscarinic receptor blockers, thus
they work by blocking the muscarinic
receptors in the ciliary body, which
in turn prevents accommodation.
A mydriatic effect is concurrently
achieved by inhibiting muscarinic
stimulation of the iris sphincter muscle.
An ideal cycloplegic would have no
ocular and systemic adverse effects.
Also, it should produce a rapid onset of
cycloplegia, blocking accommodation
completely for an adequate period
of time, before swiftly restoring
accommodative ability. 17 Several
studies have reported both ocular
and systemic side effects (especially
using atropine) in those children who
have had a cycloplegic refraction,
in addition to expected mydriasis
and cycloplegia, as detailed later. 18
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Drug selection and instillation
Cycloplegia is an invasive technique
which can be uncomfortable, or even
distressing, for the child. This is notably
so because the acidic pH of the cycloplegic
agent leads to stinging on instillation.
Some practitioners advocate the use of a
local anaesthetic prior to instillation of
the cycloplegic agent; proxymetacaine
0.5% is the drug of choice as it stings less
than other topical anaesthetics. However,
this is not always recommended due to
the risks associated with an anaesthetised
cornea. To facilitate the application
of cycloplegics, cyclopentolate has
been instilled in spray form onto the
eyelashes and the closed upper lid. 19
Practitioners should also be conscious
of their instillation technique, since
different degrees of cycloplegia between
the eyes can occur, especially if the
child does not keep their eyes open wide
enough and/or if there is significant postinstillation
tearing (which is very likely).
As such, practitioners can opt to instil
the higher concentration of cycloplegic
agent and/or instil further drops if
regular review (eg, periodic measurement
of the amplitude of accommodation)
reveals differing levels of cycloplegia.
Differences in the main cycloplegic
agents are summarised in Table 1. The
optometrist should select an appropriate
agent considering factors such as the
patient’s age and whether they have
dark, or light coloured, irides. Adequate
cycloplegic effect could be achieved
with tropicamide in a teenage patient
suspected of having latent hypermetropia,
for example, whereas cyclopentolate
is likely to be required for an infant
suspected of having an accommodative
esotropia. Those with light coloured
irides may exhibit an increased response
to drugs as compared with darkly
pigmented irides, and therefore a lower
concentration/dose ought to be selected.
Overdose of cycloplegic agent has to
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e avoided in children with Down’s
syndrome or those affected by cerebral
palsy, trisomy 13 and 18, and other
central nervous system (CNS) disorders.
This is because toxicity increases in
these people, especially children, which
causes stimulation of the medulla
and the cerebral centres, leading to
hallucinogenic effects similar to those
caused by LSD drugs. 20,21 These reactions
generally occur within 20-30 minutes
after administration. 22 Tropicamide
1% should be considered in these
children as opposed to cyclopentolate.
Cyclopentolate
Cyclopentolate 0.5% or 1.0% is
commonly used by practitioners as
the cycloplegic agent of choice for
paediatric examinations. The cycloplegia
achieved is not too deep, as compared
with atropine, but it is quicker in
onset, often achieved after 30 minutes
from its administration. Recovery of
accommodation is typically between six-
12 hours after instillation whilst mydriasis
resolves by 24 hours after instillation.
Although full cycloplegia is achieved
with atropine, the cycloplegic refractive
results obtained with cyclopentolate
are comparable in “normals”, 23 high
hypermetropic children24,25 and also
those children with strabismus. 26,27
For children under the age of three
months, it is advised that two drops of
cyclopentolate 0.5% are used as opposed
to 1%. 28 This is becasue drug absorption
through the conjunctival epithelium and
skin is more rapid in infants compared
to adults, 29,30 due to immature metabolic
enzyme systems in neonates and young
children, which may prolong the effects
of the drug. 31,32 The main side effects
of cyclopentolate include incoherent
speech, hallucinations and disorientation,
psychosis and visual disturbances. 33,34
Tropicamide
This is an anti-muscarinic drug
with short-lasting effect on the pupil
(mydriasis) and on accommodation
(cycloplegia) at the 1% concentration.
Although tropicamide is mostly used for
mydriasis, to examine the optical media
and the ocular fundus, several studies
have suggested that this drug can be used
for a cycloplegic effect. 35 In particular,
it is a cycloplegic agent that can at least
detect latent hypermetropia, for example
in school children, teenagers and those
in their early 20s, with otherwise normal
refractive status and/or with moderate
hypermetropia, 36 as well as for children
during the post-natal period. 37 In adult
patients undergoing refractive surgery, a
study showed no significant difference
in cycloplegic refraction between
tropicamide 1% and cyclopentolate
1%. 38 In the same patients, however,
the study showed that cyclopentolate
was more effective than tropicamide
in reducing accommodative amplitude
in adult myopes (near-point testing).
Atropine sulphate
This is a natural alkaloid extracted
from the deadly nightshade (Atropa
belladonna) plant. Its administration
is justified in children of pre-verbal
age or when other cycloplegic agents
fail to produce a satisfactory level of
cycloplegia. Atropine is administrated
three times a day during the three days
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Mydriasis Cycloplegia
Agent Concentration Max effect Recovery
time
Max
effect
Recovery
time
Atropine 0.5-3.0% 1-2 hours 7-12 days 60-180 min 6-12 days
Cyclopentolate 0.5-2.0% 30-60 min. 1 days 25-75 min 6-12 hours
Tropicamide 0.5-1.0% 20-40 min 6 hours 20-35 min 4-6 hours
Homatropine 2.0-5.0% 40-60 min. 1-3 days 30-60 min 1-3 days
Scopolamine 0.25% 20-30 min 3-7 days 30-60 min 3-7 days
Table 1
Cycloplegic and mydriatic effects amongst the main cycloplegic drugs used in optometric practice
before the eye examination. Associated
mydriasis decreases in two weeks after
the refractive examination. This drug is an
antagonist of the muscarinic acetylcholine
receptors, thus it dampens mediation of
the parasympathetic nervous system. As
a result, systemic absorption of atropine
can lead to difficulties with swallowing
food (opposed effects of the vagus nerve),
inhibition of the salivary glands leading
to a dry mouth, and reduction of sweating.
Atropine can also increase firing of the
sino-atrial node (SA) and conduction
through the atrio-ventricular node (AV)
of the heart, leading to tachycardia. It
also decreases bronchial secretions,
which can make breathing difficult.
Other side effects that have been reported
include dizziness, nausea and sensation
of being unbalanced and allergic
reactions of the eyelids and conjunctiva.
Atropine is able to pass through the
blood-cerebral-barrier and alter the state
of consciousness of the child. Therefore,
in order to minimise the systemic
absorption of atropine, the practitioner
can gently press the punctum of both eyes
and keep the patient’s head tilted back.
A recent study39 compared the
cycloplegic efficacy of homatropine 2%
and atropine 1% in children between the
ages of four and 10 years by retinoscopy
and automated refraction. As expected,
the study reported that homatropine
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produced a significantly lesser cycloplegic
effect than atropine, with residual
accommodation being greater (1.80±0.40D
with atropine vs 3.10±0.50D with
homatropine; p

factors for binocular vision anomalies
the refraction should be performed
under cycloplegia. Tropicamide seems
to be as effective as cyclopentolate
for measurement of refractive error
in most non-strabismic infants,
particularly at the 1% concentration, so
it should be considered more often in
paediatric eye care in order to reduce
the possibility of adverse reactions.
Module questions Course code: C-18551 O/D
PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on May 4, 2012 – You will be unable to submit
exams after this date. Answers to the module will be published on www.optometry.co.uk/cet/exam-archive. CET points for these exams will be uploaded to Vantage
on May 14, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates
1. Which of the following statements is TRUE?
a) Atropine produces cycloplegia within 2-3 hours and recovery of
accommodation in 2 days
b) Cyclopentolate produces cycloplegia within 30 minutes and
recovery of accommodation in 12 hours
c) Homatropine produces cycloplegia in 20-30 minutes and recovery of
accommodation in 24 hours
d) All of the above
2. Which pharmacological agent should be considered in a child
with Down’s syndrome?
a) Atropine
b) Homatropine
c) Cyclpentolate
d) Tropicamide
3. When should Mohindra’s retinoscopy technique be
performed?
a) In all children
b) Only in children aged 7-10 years
c) Only in young children with moderate astigmatism
d) In pre-verbal children
Where there is suspicion of a binocular
vision anomaly, cyclopentolate
should be the agent of choice.
About the authors
Fabrizio Bonci is an optometrist and
clinical research fellow at the division
of clinical neuroscience and mental
health, Imperial College, London, and
the Faculty of Medicine, Charing Cross
4. How should Mohindra’s retinoscopy technique be performed?
a) In darkness, fixation being on the retinoscope light, using hand held lenses
b) In room lighting, fixation being on a high contrast target at the retinoscope mirror
c) In darkness, fixation being on a spotlight at 6 metres, using hand held lenses
d) In room light, fixation being on a high contrast target at 6 metres, under
cycloplegia
5. Which of the following statements regarding cycloplegic refraction is
TRUE?
a) It should be considered in children with high hypermetropia or strabismus
b) It should be considered in every child at every sight test
c) Atropine is the cycloplegic of choice for a 5-year-old child
d) Objective automated refraction should be used for prescribing decisions
6. Which of the following is NOT a side effect of cyclopentolate?
a) Incoherent speech
b) Hallucinations
c) Mydriasis
d) Conjunctival hyperaemia
For the latest CET visit www.optometry.co.uk/cet
Hospital, London. Luigi Lupelli is an
optometrist, professor in contact lenses
at the Faculty of Science, Department
of Physics, (Optics and Optometry)
at the University of Roma Tre, Italy.
References
See www.optometry.co.uk/
clinical. Click on the article title and
then on ‘references’ to download.
49
06/04/12 CET

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Band 8a £38,851 - £46,621 per annum
37.5 hrs Ref: 427-2012DJ100
We are seeking to appoint a Head Optometrist responsible for the
delivery of Optometry services within the Ophthalmology department
at Royal United Hospital, Bath. You will be working as part of a
multidisciplinary team of six Consultant Ophthalmologists with
a range of specialist interests, Orthoptists and Nursing teams.
You will continue to develop the service providing a broad range of
skilled core and specialist clinical input including adult and paediatric
refraction, contact lenses, low vision assessment, glaucoma shared care
and Age Related Macular Degeneration (lucentis). You will be managing
your own complex case load and have significant experience within
hospital eye services. You will also be responsible for the ongoing
development of the service in order to both manage the increasing
demands and to work with key stakeholders in order to establish efficient
and high quality patient pathways.
This post is ideal for someone with excellent interpersonal and
communication skills, team focus, initiative and the ability to deliver
a high standard of patient care.
If you require any further information regarding this post or to arrange
an informal visit please contact Sarah Canning, Head of Optometry on
01225 824609.
The Royal United Hospital Bath NHS Trust is working towards equality
and diversity and welcomes applicants from all sections of the community.
We also promote flexible working to help staff achieve a healthy work
life balance.
Closing date: 22 April 2012.
For full details of our current vacancies, an insight into working life
at the RUH and to apply, visit: www.ruh.nhs.uk or telephone:
01225 821142 (24 hour).
We welcome applications from all sections of the community.
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live
CET
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Opticians (Sevenoaks) have
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Dispensing Optician (nearly
qualified considered) to join our
busy, dynamic practices.
VRICS
Experienced Optical Assistant or DO
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CET
Part Time Optometrist
required for Nottingham practice Sundays +
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VRICS
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06/04/12 JOBS
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Do You Share Our
Passion for Excellence?
You can’t teach excellent customer service – we believe it’s in your genes.
Our delivery of patient care may seem a little old fashioned, but it allows
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Our approach is centred on three simple words: Time, Care and Quality.
Simple words, but not always easy to deliver in practice.
And when you’ve been in optics as long as we have it
becomes second nature.
We currently have vacancies for people passionate
about optics so, if you share our passion, we’d like
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Optometrists
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All positions come with exceptional salaries,
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• CV to nd the most suitable candidates
www.optometry.co.uk/jobs

14 CET & COPE APPROVED HOURS*
Speakers for London 2012 Education Destination
Paul C. Ajamian, OD FAAO US SPEAKER
Jane Bell, FCOptom DipTp(IP)
Murray Fingeret, OD FAAO US SPEAKER
April 29th & 30th April 29 The Association of Optometrists, in partnership with SECO International, are proud to be hosting a
2-day CET/COPE program focusing on therapeutics and optometrist prescribing. This program also
offers social events and group tours.
th & 30th This will be the first CET event in the Association of Optometrists' prestigious new central London
headquarters and education venue. The event will focus on optometry as a specialist area with sessions
targeted at therapeutics, prescribing rights and the contrasts between UK and US patient care pathways.
*APPLIED FOR
John Lawrenson, PhD MCOptom
Nicholas Rumney, FCOptom FAAO
For more information visit www.aop.org.uk
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