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Journal of the Association of Optometrists
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CONTENTS
http://twitter.com/OptometryToday
March 23 2012 vol 52:6
30 36 45
News
5 Screening boost
Key bodies across the optical sector have
joined forces to help improve children’s vision
screening
6 Driving call
Fresh calls have emerged for older drivers to
be made more aware of eyesight issues
7 ‘Good progress’
The AOP Board of Directors has decided on
a change at the top ‘in view of the good
progress being made’
8 Comment
The AOP’s interim chief executive Richard
Carswell asks if optometrists have anything to
be grateful for?
12 News Extra
The Law Commission report into health
regulation could mean big changes for the
GOC
Cover story
30-31 Children’s eyewear
With the Easter holidays fast approaching,
OT looks at the latest children’s frames and
sunglasses on offer
Products
36-37 Industry news
A new brochure and MIDO success for Dunelm,
new frames from International Eyewear, plus a
special App from Hoya and also Trading Places
Profile/advice
18 Profile
AOP director Alison McClune looks to the future
of the association and AOP Scotland
26 Children reminder
Practitioners are being urged to highlight
youngsters’ eye health as the Easter break nears
34 Pension reforms
New rules for employers are set to take place,
starting this year and there will be a direct cost
Events
20 NOC launched
What delegates can expect from this year’s
conference which LOCSU is offering every LOC/
ROC a free place for
22-23 Education Destination
A preview of the two-day seminar in London
next month co-produced by SECO and the AOP
40 Diary dates
The upcoming optical events
Regulars
14,16 Business
Tips on creating a winning team and a strong
practice
28 Pre-reg focus
Advice on conquering Stage 2 exams
32 OT crossword
Our popular monthly prize competition
Clinical
42-43 VRICS: C-18426 O/D
Vision assessment in ocular
disease Part 4
By Dr Raymond Beirne. The last in our popular
series on vision assessment techniques in
ocular disease
45-48 CET 1: C-18550 O/D
Young children’s vision Part 3
Dr Margaret Woodhouse continues her series
by discussing how best to examine young
children, offering key points for conducting
procedures
49-53 CET 2: C-18459 O/D/CL
Ocular allergy and contact
lens wear
This article discusses the optometric
management strategies to maintain successful
contact lens wear in ocular allergic conditions.
Classified
54-57 Jobs
All the latest vacancies
58-62 Marketplace
Your guide to optical products and
services
Give us a call...
...Steve did!
01793 648607
outsideclinic.com
OT (the AOP 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 AOP or Ten Alps Publishing
Cover image courtesy of Zoobug
Feature is online
Video is online
www.optometry.co.uk

901003 60
Elizabeth Hurley
Sales force telephone numbers:
North West, North Wales & West Midlands Ryan James 07827 894734
North East and Scotland Stephen Raine 07827 894731
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South East and East Anglia Hannah Cawte 07827 894733
Telephone: 0121 585 6565
www.internationaleyewear.co.uk

NEWS
Action taken for kids
Key representative bodies
across the optical sector have
joined forces to help improve
children’s vision screening across
the UK.
The new UK Vision Strategy
Action Group aims to support
commissioners in the
implementation of school entry
vision screening for children
across the UK.
The group consists of
representatives from the Optical
Confederation, the College of
Optometrists, the RNIB, the Royal
College of Nursing, the Royal
College of Ophthalmologists
Paediatric Sub-Committee,
the British and Irish Orthoptics
Society, and the Institute of Child
Health and Vision Checks.
Supporting the UK National
Screening Committee (NSC)
policy which recommends that all
children aged four to five-yearsold
have their vision checked
in an orthoptic-led service, the
Action Group will work together
to launch recommendations to
aid commissioners in getting the
NSC’s policy implemented.
Programme director of the UK
Vision Strategy, Anita Lightstone
(pictured), said: “Although recent
high profile surveys indicate
that many children are being
screened, we still need to speak
with a single voice to persuade
commissioners to meet their
responsibilities to all children.”
AOP director of operations,
David Craig, added: “As we know
through our ‘Back to school’
children’s campaign – too many
young people are still missing
out on vital eye care. Recent
statistics report that one in
10 Primary Care Trusts do not
arrange vision screening for
children starting school – this
must change. The AOP actively
supports the Action Group’s
work to persuade commissioners
to meet their responsibilities to
all children.”
Free eye tests achieve aim
Free eye tests in Scotland
have been hailed a success by
economists at the University
of Aberdeen who have
concluded the policy has
closed the ‘health gap in eye
care between those living
north and south of the border’.
However, the study also
found that the uptake of
optometry services remained
low in poorer households.
The research team, led by
Dr Alexandros Zangelidis
(pictured), used data from
the British Household
Panel Survey and business
records from a multi-branch
private ophthalmic optician
company to assess uptake of
services and any demographic
divisions.
Dr Zangelidis said: “All
evidence, using different
indicators, points in the same
direction – people in Scotland
responded positively to the
free eye care policy. The
figures indicate a rise in the
number of people in Scotland
having their eyes examined
after the introduction of the
policy in April 2006.”
The results also revealed
that wealthier households
were more likely to have an
eye test, both before and after
the policy was introduced.
Commenting on the results,
chair of AOP Scotland, Kevin
Wallace, told OT: “We are
pleased to hear that this study
shows that the comprehensive
eye examination funded by
the Scottish Government is
encouraging more people to
visit their optometrist, which
will have a positive impact on
the eye health of the nation.
“The public are becoming
more aware of the benefits of
regular eye examinations to
detect problems early making
them much easier to treat.”
IN BRIEF
Bring your display
into focus with the
Number One choice in optical labelling
• Price labels, every kind
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• Lens labels, stock and
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• Contact lens packaging
labels
AOP elections
are extended
AOP members who have not yet
voted in this year’s council elections
have until April 5 to cast their vote.
Those who are yet to vote will
receive a letter in the post from the
Electoral Reform Services early next
week telling them of how to vote
before the April 5 extended deadline.
For more details on the elections,
visit www.aop.org.uk.about-theaop/council-elections
Business workshop
The AOP has joined forces with
Myers La Roche to host a workshop
aimed at helping practitioners
increase practice sales and profits.
The event will be held at the
AOP headquarters, London on May
21 from 4pm. The workshop will
cover topics such as, how to attract
new patients to the practice and
how to increase conversion rates
and dispensing values. For more
information and to book visit,
www.aop.org.uk
New OGS committee
chair named
Optometrist Nick Rumney has been
named chair of Optometry Giving
Sight’s UK National Committee.
Awareness Week
confirmed
Organisers of National Eye Health
Week have confirmed that the
annual vision awareness week
will be held on September 17-23.
• Dummy security sensors
• Coloured oval price
tickets
3 Isis Court, Wyndyke Furlong, Abingdon OX14 1DZ
Tel 01235 543993 Fax 01235 532118
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5
23/03/12 NEWS
News updated regularly at www.optometry.co.uk

NEWS
optometrytoday
MARCH 23 2012
Volume 52:6
ISSN 0268-5485
ABC CERTIFICATE OF CIrcULATION
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Safety of older drivers
bookshop
live
under investigation
Fresh calls have emerged
enewsletter
The UK Vision Strategy and
RNIB have been given grants
of around £200,000 each in a
£6.8m Department of Health
initiative to ‘test and develop
innovative approaches to
health and wellbeing’.
Cross-sector initiative the
UK Vision Strategy has been
given up to £230,000 to fund
and support three clinical
commissioning groups
in England to design and
evaluate sight loss services;
while the RNIB will use its
grant, of up to £200,000, to
train volunteers and those
who work in eye clinics to
VRICS
for elderly drivers to be made
more aware of eyesight issues
following a new report on older
drivers by the Parliamentary
Advisory Council for Transport
Safety.
The report looks into ways
older people can use transport
more safely including ensuring
that they are safe when driving,
recommending regular eye
tests and suggesting that
optometrists should be ‘ alert
to fitness to drive issues’, along
with pharmacists.
It adds that self-regulation
of a person’s own ability to
drive, including if they meet
eyesight requirements should
be the subject of further study
‘assessing the link between selfregulation
and crash risk’.
The advisory council report
adds: ‘health care providers
should be better supported so
that they can become more
effective in giving advice on both
physical and mental fitness to
drive.’
The AOP’s professional
adviser, Geoff Roberson told
OT: “This report highlights
many of the issues relating to
vision and driving the Optical
Confederation has been
lobbying about for some time;
that drivers should be more
aware of vision related driving
issues, act to ensure their own
safety and the safety of other
road users, make sure they have
regular vision checks and wear
their prescribed spectacles.”
Sight care causes given
share of £6.8m fund
provide support for those
with sight loss when they
are first diagnosed.
The charity confirmed
that training will be across
150 different locations and
the funding will also enable
it to set up a peer support
network for the newly
trained volunteers.
Head of evidence and
service impact at the RNIB
Philippa Simkiss told OT:
“Being told you are losing
your sight or have lost your
sight can be extremely
traumatic. It’s vital that
people are offered the
appropriate, and joined up,
support and services from
the point of diagnosis. This
funding will enable RNIB
to increase the support we
offer.”
Programme director of
UK Vision Strategy, Anita
Lightstone, added: “We
are delighted to receive
this funding boost. It
will enable us to put our
commissioning eye care
guidance into action
by supporting clinical
commissioners to design and
deliver effective eye care and
sight loss services.”
CET
Comment on the news via www.optometry.co.uk

NEWS
Role change as AOP
makes good progress
The AOP’s Board of Directors
has confirmed the association’s
acting chief executive Richard
Carswell in the post of interim
chief executive until 2013.
The decision was made at
the Board meeting last week:
“in view of the good progress
being made in developing the
association’s strategy for the
foreseeable future”.
The Board’s working party on
recruiting a permanent chief
executive has begun its work,
and the association will be
advertising the post later this
year. Mr Carswell will participate
in the process of recruiting the
new chief executive and ensuring
a smooth transition. The intention
is that the new chief executive
will deliver on the association’s
Looking to move jobs?
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Looking to move jobs?
The chief executive of the FMO,
Malcolm
co.uk/newsletter-
Polley (pictured), has
been admitted to the livery of the
sign-up
Worshipful Company of Spectacle
Makers, probably the oldest
optical organisation in the world
which was incorporated by Royal
vision and strategy from next year
onwards.
“It is important that the
association has a period of
Upload your CV to OT’s CV Uploader and let
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Charter in 1629, following his
broad career in optics.
Mr Polley is perhaps best
known for leading the Optrafair
team which stages the largest
UK optical show, held biennially.
He is also the manufacturing
industry representative for the
Optical Confederation, bringing a
wealth of industry experience and
knowledge to the role.
He started his optical life with
Clifford Brown Opticians in central
London on the dispensing side,
and after 11 years moved to the
Norville Group in Gloucester.
As sales and marketing director
there, he led the team for many
years and was actively involved in
both the frame and lens side of
the Norville business.
He was chairman of the FMO
stability in which to develop
our plans to improve services
to members,” Mr Carswell
told OT.
“With the profession facing
huge challenges, it is time to
look outwards and consider
the wider needs of the
association and its members.”
Mr Carswell took over the
day-to-day running of the
association when the then
chief executive, Bob Hughes
left the AOP in November. He
was deputy chief executive
for many years and is also
the association’s head of
regulatory affairs, advising
AOP members needing help
in their dealings with PCTs,
Health Boards and the GOS
contract.
New honour for Optrafair leader
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from 2004-6 and then became
chief executive in 2006. Plans
are already well underway for
Optrafair 2013, which will be
held at The NEC, Birmingham,
from April 13-15 next year.
Sign-up to OT’s
weekly e-newsletter
at www.optometry
co.uk/newslettersign-up
IN BRIEF
Optom torch bearers
Two optometrists have been chosen
as ‘inspirational people’ who will
carry the Olympic Flame as it travels
across the UK.
Dr Zahra
Jessa (pictured)
works in
independent
practice in
London. She
also does
refraction and low vision work and
some extended role clinics, working
at the Action for Blind Low Vision
clinics at Judd Street, London, part
of the RNIB. She is a liveryman of the
Worshipful Company of Spectacle
Makers and was awarded the
professional of the year accolade at
the Asian Women of Achievement
Awards in 2010.
Elaine Styles
(pictured) is the
chair of the Vision
Care for Homeless
OT’s dedicated jobs hub provides People charity advice
on writing a successful CV which and encourages cover letter
optometrists to volunteer their
services to enable it to offer free sight
care and free prescription glasses to
‘the most excluded in the UK’. The
announcement of her Olympic role
was made during afternoon tea at
the House of Lords on Tuesday led
by charity patron Lord Filkin CBE.
The event highlighted that it is the
only charity which runs free weekly
eye clinics for the homeless in three
Visit www.optometry.co.uk/jobs/job-tips locations in the UK. today
Sent out to over 6,500
professionals every Thursday
7
23/03/12 NEWS
News updated regularly at www.optometry.co.uk

NEWS
comment
Retention figures up
8
23/03/12 NEWS
More than 94% of
registrants successfully
applied for retention by
the March 15 deadline,
the GOC has confirmed.
In total 94.9%
completed their 2012/13
retention on time,
marking a 1.1% increase
from last year’s 93.8%.
Online retention for optical businesses was
introduced this year, whilst optometrists and
dispensing opticians were able to renew online
for the first time last year.
Philip Hallam, GOC head of registration, said:
“Online retention has made the process of
renewing GOC registration quicker and easier
for our registrants. Today’s (March 16) figures
show that last year’s improved application rate
was not a one-off. We’re delighted that fewer
registrants are putting their careers at risk by not
applying on time.
“Missing the GOC retention deadline is
serious. Those registrants who have not yet
applied now face an additional late fee, and if
they have still not applied
by March 31 they will be
removed from the Opticians
Registers. They should apply
for retention immediately
to ensure they can practise
during 2012/13.”
Those who missed the
March 15 deadline will now
be required to pay a £20 late application fee,
taking the cost of retention to £280. Registrants
who fail to apply by March 31 will be removed
from the registers on April 1, leaving them
unable to practise in the UK.
David Craig, aoP director of operations, said:
“I’m delighted to see the figure for retention
is higher this year than last. Some of those
not renewing will be retiring; and we wish
those practitioners a happy and well-deserved
retirement. But practitioners who intend to
continue to practise must get their renewal
completed before the deadline. The trouble
caused by failing to meet the timetable will
cause significant problems to those who
miss the boat.”
Boost for Welsh services
The Welsh Government
has made over £750,000
available to buy fundus
cameras for hospital eye
services (HES) across the
country.
A total of 18 cameras
will be purchased by the
six Local Health Boards in
Wales with a HES, which
will help them meet the
Welsh Government’s programme to
establish ophthalmic diagnostic and
treatment centres across Wales.
Health minister Lesley Griffiths
said: “Using the latest technology
delivers wider benefits to the NHS. It is
estimated an ophthalmologist using a
fundus camera will see 10 patients for
the cost of seeing one patient. Nurses,
technicians and orthoptists using the
camera will support a consultant-led
virtual clinic, freeing up the consultant
to see more patients.”
Optometry Wales
chairman Mike George
(pictured) added: “We
are fully supportive of
this commitment from
Welsh Government
and are pleased that
it will ensure that
the Government
endorsed ‘focus on
ophthalmology’
pathways are adhered to.
“Optometry Wales is committed
to enabling early detection and
treatment. We believe that this
funding will mean that we are
working closer to a seamless
integration of primary and secondary
care colleagues working together for
the benefit of the patient.”
• The Welsh Government has also
announced a rise in NHS Voucher
Values by an average of 2.5% from
April 1.
Grateful for what?
HAVE OPTOMETRISTS anything to
be grateful for? At a time of declining
salaries, it is possible to think that
there is little to celebrate. Yet,
anecdotal evidence suggests that the
sector is doing relatively well, given
the current economic climate.
Of course, the sector’s performance
is variable, depending on the area of
an optometric practice and the local
competition. Having just returned
from the north west of England, I
am surprised how busy some local
practices are. But there are other parts
of the country where some independent
practices are struggling to make ends
meet. The burden of low NHS fees and
alternative dispensing outlets make the
dilemma all the crueller: keep private
fees low and hope for higher sales; or
increase private fees and introduce fees
for supplementary procedures offered
to GOS patients?
It is worrying that dispensing
opticians wanting refracting rights
are pinning their hopes on the Law
Commission’s review (see page 12). Do
they not realise that there is a danger of
the whole edifice crashing down, once
a future reincarnation of Lord Rugby
gets his teeth into the Opticians Act.
Should we be grateful, for instance,
for the regulation of contact lenses in
this country?
The British system is not perfect.
Can we be sure that all Internet
suppliers of contact lenses in this
country only dispense against a valid
specification? Frankly, I don’t know.
While the system seems to work to the
benefit of the public, the jury is still out
on whether it works to the benefit of
the profession.
Richard Carswell,
AOP interim chief executive
Comment on the news via www.optometry.co.uk

education through inspiration
Raising The Bar
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The latest educational roadshow from THE VISION CARE INSTITUTE® arrives
this March, helping you and your staff drive higher clinical standards in practice
to benefit your patients.
A one-day programme
We have brought together top international speakers who are experts in their
field to share their latest research and clinical pearls, and help you raise the
clinical bar in your practice. These include:
• Professor Minas Coroneo
• Professor Lyndon Jones
• Dr Philip Morgan
• Associate Professor Jeffrey Walline
From the latest on UV, to current thinking on Myopia Control, Contact Lens
Materials and How Contact Lens Solutions Interact with the Eye, we have
an exciting programme of interactive lectures in store. Due to the success of
previous roadshows we urge you to reserve your place today.
The speakers are:
Professor Minas Coroneo
is Chairman of The Department of
Ophthalmology, University of New
South Wales and Prince of Wales
Hospital. He was involved in the
development of Trypan Blue as an
ocular dye and is currently exploring
uses of this dye in corneal surgery.
He oversees the Hospital’s largest rural and indigenous
health program, largest outpatient department and
surgical training program. His research interests include
development of a bionic eye and UV damage to the eye.
He is author and co-author of approximately 140 papers,
chapters in books, letters to editors, reports and theses.
Professor Lyndon Jones
is a Professor at the School of
Optometry and Director of the Centre
for Contact Lens Research at the
University of Waterloo. He graduated
in Optometry from the University of
Wales in 1985 and gained his PhD
from the Biomaterials Research
Unit at Aston University, Birmingham, UK in 1998. He is a
Fellow of the American Academy of Optometry and is a
Diplomate in Cornea and Contact Lenses. He is a Topical
Editor for Optometry & Vision Science and the current Chair
of the Research Committee of the American Academy
of Optometry. He has authored over 250 refereed and
professional papers, one text-book and given over 600 invited
lectures at conferences worldwide in over 30 countries.
Dr Philip Morgan is Director of
Eurolens Research and a senior
lecturer in optometry at The
University of Manchester, UK. Philip
is vice-president of the International
Society for Contact Lens Research
and secretary of the International
Association of Contact Lens Educators.
He has authored over 160 papers, primarily relating to the
clinical performance of contact lenses and the nature of the
UK and international contact lens markets.
Dates and Venues 2012
Wednesday 28th March
Thursday 29th March
fREE TO
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Bridgewater Hall, Manchester
Royal College of Physicians, London
9
CET POINTS
Associate Professor
Jeffrey Walline
is an Associate Professor at The
Ohio State University College of
Optometry. He received his Doctor
of Optometry degree from the
University of California, Berkeley
School of Optometry and his Master’s
degree and PhD degree from The Ohio State University
College of Optometry. Dr Walline teaches Vision of Children
and Specialty Contact Lenses to optometry students, and
he is a clinical instructor in the Contact Lens, Binocular
Vision and Pediatrics, and Primary Care Services at the OSU
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Don’t delay, book today.
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NEWS
10
23/03/12 NEWS
BRIEFING
‘Professional’ frames
theft warning
The managing director of an
independent practice has warned
fellow practitioners to beware of a
‘professional thief’ who stole 21
pairs of designer glasses from the
practice by slipping them into his
sleeve.
MD of Clamp Optometrists in
Cambridge, Daniel Hardiman-
McCartney, told OT that CCTV
showed the man dropping pairs of
rimless Lindberg frames down his
right sleeve and filling the gaps in
the shelves with surrounding stock
to avoid detection.
He added: “I am completely
shocked by the audacity of this theft,
it was clearly planned and they
knew exactly what they wanted,
as an independent optician to lose
the amount of stock in the current
economic climate is a very bitter
pill, although I am very grateful
no one was hurt during the incident.”
Sunny side up, but frame
sales stall the market
Sunglass sales showed a rise
of almost 10% in 2011 compared
to the previous 12 months, new
statistics from research company
GfK Retail and Technology UK
have revealed, with contact lenses
‘driving the market’ while frame
sales fell.
The figures reveal that over
586,000 pairs of sunglasses were
sold in the UK, with independents
showing a 4% rise and multiples
recording an 11.5% boost (a 9.9%
rise overall). Women’s sunglasses
proved to be the strongest
performers over the 12 month
period with sales value up 8.9%,
while men’s and unisex styles
saw a value decline of 7.6% and
7.1% respectively. Although both
plastic and metal designs showed
growth, plastic outperformed the
market by 5.9%.
GfK’s figures also provided good
news for the contact lens sector
describing it as the ‘key driver in
the optics market’ with a value of
£458m in the last year. The report
concludes that the main drivers of
this growth were in the multifocal
and daily toric modalities with
a rise of 12.4% and 18.7% yearon-year
respectively. The toric
segment now accounts for 19.8%
of disposable lens value sales.
The retail outlook for the year
wasn’t all good news though,
with the frames market falling
4% in value and 2.7% in volume,
dragging the optics market into
an overall decline for the year.
The only sector of the frames
market to show growth was the
relatively small premium end,
which showed a boost of 25% on
2010 figures.
Account manager at GfK,
Paul York, told OT: “The decline
suggests hard pressed consumers
have been increasingly looking to
reduce expenditure in the frames
category, the methods available
to do this being either delaying
purchases or buying a cheaper
product.”
The College reveals
its new president
Optometrist Kamlesh
Chauhan was named as
president of the College of
Optometrists on Monday
(March 19).
The official handover from
outgoing president, Dr Cindy
Tromans took place during the
College’s AGM in Brighton.
Speaking about his
appointment to the new role,
Dr Chauhan, said: “I am
proud to be the new president,
and I look forward to building
on the excellent work the
College and Cindy have done in
bringing eye care professionals
together to provide a more
integrated approach to patient
care.”
Dr Tromans added: “Having
worked closely with Kamlesh
over the past two years, I am
delighted that he will be
taking over from me.”
Optometrist David Parkins
becomes vice president having
been treasurer of the College
for five years, while Rob
Hogan replaces Mr Parkins as
treasurer.
Win a Vitabiotics hamper
Vitabiotics is offering OT readers
the chance to win a deluxe hamper
worth over £100 full of goodies
suitable for the whole family.
To be in with a chance of
winning the hamper, which
includes products from the
Wellwoman, Wellman and Wellkid
range, all you have to do is answer
the following question:
Visionace includes which of
the following nutrients?
a. Bilberry
b. Cranberry
Loganberry
Need a hint? Visit www.
visionace.com
Submit your answer via email
to louisewalpole@aop.org.uk by
midnight on April 1, 2012, with
the subject heading ‘Hamper’.
Please note that your details
will be passed onto Vitabiotics
who will draw out the winner.
Comment on the news via www.optometry.co.uk

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NEWS EXTRA
Regulators under scrutiny
The Law Commission report into health regulation could mean big changes for the GOC
12
23/03/12 LAW
The repeal of the Opticians Act,
an end to student registration, and
the reform of the GOC’s power to
register bodies corporate and fund
a consumer complaints service are
all very real possibilities of the Law
Commission’s current review into
health regulation in the UK.
The consultation paper, released
by the Commission on March 1,
follows a thorough investigation
into the inner-workings of the
GOC and the nine other health
and social care regulatory bodies
in the UK, with the ultimate aim
of establishing a ‘streamlined,
transparent and responsive system’
to regulation.
Tim Spencer Lane, a lawyer
working on the report for the Law
Commission, explained to OT what
the consultation could mean for
the GOC: “The review covers all
aspects of the GOC’s functions
– registration, the approval of
education, standards for practice,
and fitness to practise – and so its
potential impact is substantial.
Opticians Act
“The first main change would
be the repeal of the Opticians
Act 1989 (and all the rules and
regulations made under it) and its
replacement by a single Act which
would cover all 10 health and
social care regulators.
“The second main change
would be that, under our
proposals, the GOC would be
given broad powers to make its
own rules – which would not
have to be approved by the Privy
Council. We think this will give the
GOC greater flexibility to develop
and keep its systems of regulation
up-to-date in order to reflect the
changing circumstances of the
profession.
“The third main change would
“Under our proposals the GOC
would be given broad powers to
make its own rules”
be that all the powers of the
regulators would be the same. For
example, at the moment some of
the regulators (such as the GMC)
have powers to introduce systems
of case managers while others
(such as the GOC) do not. Under
our proposals all the regulators
would have the same powers to
make rules on such matters if they
wish to do so.”
He added that there were
several other points which could
change the role of the GOC,
including an investigation into
whether student registration
was still necessary given that the
GOC is the only health regulator
with a compulsory register for
undergraduates.
Also under review is the
GOC’s power to register bodies
corporate – which is also unique
to the GOC – and whether the
regulator’s power to fund a
consumer complaints service
should be retained.
A section especially relevant
given the current debate around
refraction training for DOs is the
review of ‘protected functions’
such as refraction. Mr Spencer
Lane added: “We are also
reviewing the use of protected
titles and protected functions
under the new legal framework
and whether some of these
could be reviewed, one such
area that has been suggested to
us is the area of refraction and
whether this should continue
to be restricted to doctors and
optometrists only.”
Chief executive and registrar
of the GOC, Samantha Peters,
said that the regulator welcomed
the review. She told OT: “The
Law Commission review will be
extremely important in shaping
the future regulation of all UK
healthcare professionals.
“We welcome its full and
comprehensive nature and
the tremendous opportunity it
provides to ensure that healthcare
regulators’ legal framework is bestplaced
to protect the public.”
Striking a balance
“I encourage everyone across
optics to engage with the Law
Commission throughout the
consultation process, “ she added,
“Any new legislation must strike
the right balance between
consistency and flexibility in
healthcare regulation. It should
also ensure that any new freedoms
for regulators are balanced by the
right accountability.
“This can only be achieved
with extensive stakeholder input,
so both the GOC and the Law
Commission strongly welcome the
input of the optical professions
and the wider public.”
The consultation closes at the
end of May. The full document is
available at www.lawcom.gov.uk
The review has examined
the work and scope of the
GOC as well as the other
health and social care
regulators:
• General Chiropractic
Council
• General Dental Council
• General Medical Council
• General Osteopathic
Council
• General Pharmaceutical
Council
• General Social Care Council
• Health Professions Council
• Nursing and Midwifery
Council
• Pharmaceutical Society of
Northern Ireland.
It also extends to include
the regulator of the other
regulators, the Council
for Healthcare Regulatory
Excellence.
Comment on the news via www.optometry.co.uk

Business
Create a winning team
and a strong practice
OT’s Chris Donkin picks up some business tips at J&J’s latest Practice Made Perfect roadshow
14
23/03/12 ROADSHOW
Positioning a practice to make the most of the local
market and building a strong team are vital to attract new
patients and retain existing ones, according to experts at the
latest roadshow organised by Johnson & Johnson
Vision Care.
Presented by optometrist and practice consultant, Peter
Ivins, and BCLA president and practice owner, Shelly
Bansal, the Practice Made Perfect (PMP) roadshow has
toured the country over the last month, sharing business
building advice with managers and owners.
First in the spotlight was Mr Ivins, who encouraged
delegates to study their demographic and create a clear
vision and mission statement to attract those people.
“Are you trying to attract the right sort of person?” he
asked the audience. “Have a look at who’s in your area. It
may well be you’ve got absolutely no wealthy achievers in
the particular area that you work in, so it’s not very sensible
to become a practice with very high prices and designer
frames – because that’s not the market you’ve got, you might
actually be playing in the wrong space.
“Before you start doing anything, understand where you
are right now and where you want to be. Once you know
that then it’s a good idea to have a mission statement for
your practice.”
Describing the importance of a clear, simple ‘non-cheesy’
mission statement, he added: “It defines what your practice
is all about, it’s your USP. A document that lets your staff
know how they should function and maybe it also lets
patients know why they should deal with you. It should be
very simple and patient focused.
“It’s a good start because it says ‘this is what I do, this is
the space I’m in and I know what my practice is all about.’
“Once you’ve got that mission statement and your
place in the market everything you do must support that
statement right down to the look of the stationery, your
uniforms, the look of your signage and the frame ranges.”
Building a bond
Following an exercise in creating a mission statement,
which Mr Ivins (pictured left) told delegates should be
a long, carefully thought out procedure in practice, he
described the importance of patient loyalty.
He added that a great way to create a bond was to be in
touch with patients ‘more than once every two years’, but
warned that the way people communicate is changing with
social media becoming more and more prevalent.
“Social media is something that you are going to have to
engage with whether you like it or not,” he told the gathered
managers and owners. “Ask for email addresses, get them to
write them down by having a form and ask them to fill it in,
I guarantee that this way almost everyone will give you both
their email and their phone number.
“If a new patient comes in have a pre-test questionnaire
and make that be part of it – if it’s an existing patient have
a questionnaire that says ‘we have some very valuable data
that we hold for you, we want to check it’s correct’ – print it
out and get them to check it for you.”
He added that social media is a good, cheap marketing
tool and a Web presence is a must. Although he
recommended a marketing budget of three percent of
practice turnover, he also gave some examples of small
things which can be done that can make a big difference
such as having up-to-date patient leaflets and using point
Continues on page 16

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BUSINESS
16
23/03/12 ROADSHOW
of sale materials for items such as contact lenses which
are often overlooked when arranging the dispensing and
waiting room areas.
“Before you start doing anything,
understand where you are right
now and where you want to be”
“You get people in your practice who aren’t patients,” Mr
Ivins said. “Some that are existing spectacle wearers who
might want to talk about things like contact lenses – so ask
them and make it easy for them.
“If you’re going to do that (encourage sales and
promotions in practice) you need to train your staff,
everybody in the team has to be engaged, it’s a good idea to
have incentives. It’s also a good idea to have targets like the
number of trials per day or per week.”
Team building
Following on inspiring discussion on loyalty, Mr Bansal
(pictured above with Mr Ivins) took to the microphone to
explain the value of team work in creating a high standard
customer journey, because he believes ‘satisfied’ is not a
good enough level any more, patients must leave feeling
‘wowed’.
“There’s great value in building a high performance team
and we can all do it if we really want to,” he told delegates.
“So the next thing you can do when you’ve set your goals
is look at your team – and I don’t mean to go and pick at
them – look at what people’s strengths and weaknesses are.
Look at how they can develop. Look at the team as a whole
– who’s dropping the baton? Who needs coaching? Who
needs to be told ‘we do this with every patient’?
“Look at the team properly so you can create the
‘complete customer journey’, think about the staff – Jessie
who sits in the backroom may be fantastic with all the
books, you never pay an invoice a day early or day late and
you never pay any more or any less than you should.
“These are great strengths, but unfortunately at lunch
Jessie has to work at the front desk and she’s not very
good at dealing with customers. This puts the rest of the
team under pressure. It’s not Jessie’s fault it’s our fault as
managers because we’ve not trained her.”
Mr Bansal added that a mission statement is an excellent
way to focus the team and give them an idea of the team
goal.
“It really upsets me when I talk to staff and they say
‘I’m just the receptionist, I’m just the DO or I’m just the
optometrist’, it’s the whole team that makes (the practice)
work and that can only work well if we all know where we
are, and that all starts with training together.
“When we practice we make mistakes, but learn from
them. When we make mistakes what do we do? Go away
and practice some more.
“Developing the team starts from the beginning with
an induction programme for every single member of
staff outlining the core competencies in the practice, the
minimum standards that are a ‘must’ for your practice and
the space that you are in.
“The difficulty is that you will probably have a member
of staff who has been there since eternity, we all call them
‘dragons’ and it’s difficult because they ‘know everything
already’.”
For these ‘dragons’ he recommends: “The way to engage
them is to say ‘this is a new format we are using for all
new staff and to protect you we have created a minimum
standard’. We know you do all of these things but if I don’t
have this paperwork in place the person who starts might
not, which might compromise you.”
For more business tips and advice, visit the business
section of the OT website on www.optometry.co.uk/
business
Boost your skills at an upcoming
roadshow
Following the initial series of PMP
roadshows, practitioners looking for
tips on how to boost their business
can take advantage of further events
later this year, also arranged by J&J.
Looking at the themes of the PMP
sessions in more depth will be a twoday
follow-up event at The Vision Care
Institute in Pinewood which is open to all practitioners, not just
whose who attended the original series of events. The contact
lens company added that a repeat of the original roadshow
was likely to be arranged for later in the year.
In addition, the Raising the Bar clinical roadshow goes on
a UK tour in mid-October following its two events in London
and Manchester on March 28 and 29. Headlined by renowned
international speaker Nathan Efron (pictured), the event covers
how to ‘drive higher clinical standards to benefit patients’.
For further details as they become available check OT Diary
and the online Events page, as well as on
www.thevisioncareinstitute.co.uk

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profile
Boosting specs appeal
Continuing the OT series looking at how the AOP is developing, Robina Moss talks to AOP director
Alison McClune who feels her role is to speak out for the majority of ‘ordinary’ optometrists
18
23/03/12 Profile
“At the end of the day
the vast majority of our
patients come to us
for specs, to help them
see better and I’m very
proud of that role,” she
explained. “Yes the health
checks are a valuable
part of our work but the
public perception of us is
in that vision correction
role. We have to shout
about it as much as the
extended role. We need
to be equally proud of
that to instil pride into
those who have just
qualified.
“Optometrists always want to do a
good job for their patients and for a
fair wage but many don’t necessarily
want to do the progressive work such
as glaucoma pathways. Many just want
to do a job they can be proud of as a
professional and as an individual. To go
home at the end of the day proud of
what they’ve achieved. I don’t always feel
we fill that gap and I like to think that’s
where I come in. I’m a voice for those
optometrists. That’s what I think I bring to
the table and to the AOP.”
Ms McClune has been an AOP director
since 2007 and an AOP councillor for 12
years. She qualified as an optometrist
from Glasgow Caledonian University in
1992 and works as a locum at various
practices in the Glasgow area. She is
also chairman of the AOP membership
committee.
“The AOP does provide an awful lot of
services, not just legal and defence. We
want to highlight the work that we do to
emphasise that support is just a phone
call away,” she told OT in London amid a
hectic meetings schedule.
The committee looks at all aspects of
the services for members such as the
membership benefits package offered.
“We also provide help for students,
supporting the work that the AOP’s
education adviser Karen Sparrow does,”
she added. “And we support the College/
AOP Benevolent Fund which works for
optometrists and their families.”
Ms McClune worked with the Children’s
Eye Health Campaign, which she is
enthusiastic about as an optometrist and a
mother of two.
Boost
Looking to the future, the AOP generally
is aiming to boost its communications
with members. “The new council elections
this month are on a more geographical
basis and there will be a push for getting
out more in the locality for face-to-face
meetings. We will also be looking at how
we communicate through OT and also
electronically through Blink,” she said.
Ms McClune began working as a locum
as there was no permanent position with
the company she was working for at
that time but found that she enjoyed the
variation. “I enjoyed working in
different practices and different
modes of practice,” she said.
As a Scottish councillor, she
has seen the changes to GOS in
Scotland which came about in
2006 as a result of devolution,
and the AOP lobbying of the
Scottish Executive.
“AOP ‘Making Accurate
Claims’ roadshows, headed by
AOP Scotland chairman, Kevin
Wallace, ran in 2011 to ensure
our members had a chance to
ask any regulation questions
directly,” she explained. “There
was also the presence of the
AOP legal team at the recent Eyecare
3000 event in Glasgow. AOP Scotland
continues to keep a keen eye on political
developments, and is now considering,
carefully, the impact independence may
have on AOP and Scottish optometry as
a whole.
“We are aiming to ‘beef up’ the AOP
service to members in Scotland so that
they don’t feel that for legal and defence
they have to contact the AOP in London.
It will be nice for AOP members in
Scotland to hear a Scottish voice when
they ring up.”
AOP Scotland is aiming to enhance
and reinforce its presence in Scotland.
“We want to provide more support on
a hands-on basis, on a more practical
level, having the right people available
if people are having issues with Health
Boards or the GOC,” she added.
“When the new AOP council is
established we will look at the way
forward for better representation of our
Scottish members. We want to see our
role increasing in Scotland to create more
local support. I look forward to playing
my part in that.”

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PREVIEW
NOC to provide vital
support from LOCSU
OT goes behind the scenes to find out what delegates can expect from this year’s National Optical
Conference (NOC) in Birmingham in October
20
23/03/12 PREVIEW
The NOC is a conference primarily aimed at Local/Regional
Optical Committees (LOCs/ROCs), optometrists, dispensing
opticians and optometric advisers. This year the annual event
will take place on October 18-19, at the Hilton Metropole,
Birmingham.
Director of operations and commissioning at LOCSU, Katrina
Venerus, feels strongly that every LOC and ROC should be
represented at the NOC 2012. She explained: “Once again
LOCSU will be offering every LOC and ROC one free place
at the NOC 2012. For anyone that hasn’t yet had the chance
to attend, the NOC is a fantastic opportunity to hear from
nationally renowned speakers on areas ranging from eye care
pathways and NHS reforms, to peer discussion, public health
and the ability to connect with fellow members in workshops,
discussion forums or over a coffee. This event is increasingly
seen as important to some of the most senior influential
figures in the NHS and beyond. NOC 2011 attracted nationally
renowned speakers, such as Helen Hirst, programme director
for primary care commissioning at the NHS Commissioning
Board, and Samantha Peters, chief executive of the General
Optical Council.”
Ms Venerus added: “I know, from the outstanding feedback
given by delegates for the NOC 2011, that people also found
the chance to hear about some of the success stories taking
place across the country really beneficial when developing, or
improving, the way they negotiate and deliver local eye care
services in their own region.”
Explaining why it was critical that the 2012 NOC’s
programme represents the interests of LOCs and ROCs, Ms
Venerus highlighted feedback received from a recent survey
carried out by LOCSU to find out what would be most useful
to members. Out of the 61 committees which responded:
• 93% said that they wanted a keynote address on the national
perspective on the NHS reforms
• 84% wanted a session on local professional networks
• 84% wanted to hear from other LOCs/ROCs presenting
evidence and outcomes from successful local services.
“The best NOC I’ve been to yet. A great black
tie event and both days of conference were
excellent. I left feeling very positive”
Comment from LOCSU NOC survey 2011
With LOCSU offering a free place for every LOC/ROC
committee again this year, practitioners are urged to put
the NOC 2012 in their diary. OT will publish updates on
the conference programme in the journal and online over
the coming months, and readers considering attending are
encouraged to register their interest by emailing NOC2012@
locsu.co.uk
Situated just 10 minutes from Birmingham International
Airport, the Hilton Metropole, Birmingham is one of the UK’s
largest conference hotels. Located on the site of the NEC, it has
good transport links to the city centre. It also boasts a fullyequipped
LivingWell Health Club and heated indoor swimming
pool for delegates who find they have some ‘downtime’.
The NOC 2012 will offer delegates an expansive exhibition
and offers excellent opportunities for companies which want
to reach key decision-makers in the development of local
eye health services across England and Wales. In addition to
exhibiting at the event, companies can also pick from a
variety of sponsorship packages – for details contact Steve
Grice at the Redactive Media Group on steve.grice@redactive.
co.uk or 020 7880 6220.

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EVENTS
AOP education adviser, Karen Sparrow reveals the expertise of the high-calibre practitioners who
will speak at ‘Education Destination’ on April 29-30 at the association’s headquarters in London
22 28
08/04/11 23/03/12 CET EVENT
NEXT MONTH’S therapeutics-focused event, ‘London 2012
Education Destination’, will bring together key speakers from
both sides of the Atlantic, mixing American experts with
homegrown UK talent.
Co-produced by SECO and the AOP, the two-day seminar
will be held at the AOP’s headquarters in London (April
29-30), featuring lectures from Dr Murray Fingeret, Dr Paul
Ajamian, Nick Rumney, professor John Lawrenson and Jane
Bell.
Speaking about why the ‘Education Destination’ is a must
attend event, Ms Bell said: “I think it is important for UK
On the American team is Dr
Murray Fingeret who is known
for his glaucoma expertise and
has been active in glaucoma care
in the USA for many years. His
current responsibilities include
chief of the optometry section
in the Department of Veterans
Administration in New York and he is
a clinical professor at the State University of New York’s College
of Optometry. He is also a Fellow of the American Academy
of Optometry, the National Academies of Practice and the
American Glaucoma Society, and sits on the Board of Directors
of the Glaucoma Foundation which funds groundbreaking
research into glaucoma and educates the public about the
disease and the importance of early detection.
Dr Fingeret has a long involvement with changing clinical
practice in the USA, lobbying, debating and advising the
optometric profession at the highest levels, including the
US Administration. He is a member of the medical eye care
committee, American Optometric Association. He is also a
founding member and past-president of the Optometric
Glaucoma Society, and currently its executive vice-president.
Amongst a number of awards for his work in the field of
optometry, Dr Fingeret is a recipient of the 2008 Distinguished
Service Award from the Optometric Glaucoma Society, the
2005 Carel C. Koch Memorial Medal from the American
Academy of Optometry, the 1996 Otsuka Glaucoma Educators
Award from the American Academy of Optometry and 1999
AMSUS Federal Service Optometrist of the Year award.
optometrists with an interest in optometric prescribing to
have the opportunity to attend an event that focuses on ocular
therapeutics.
“It is particularly relevant at this point in time as we
gradually increase the number of independent prescribing
optometrists in the UK. One of the greatest challenges for us is
to find a suitable placement in which to practise our hard-won
and recently-acquired prescribing status.”
Geoff Roberson, clinical adviser to the AOP, echoes Ms
Bell’s enthusiasm for extending our skills into therapeutics.
“Expanding scope of practice and developing the range
Paul Ajamian was instrumental in
starting the Omni Center in 1982, the
first Optometric Co-Management
Center in the country and hence
pioneered co-management in the
United States, allowing patients
to be referred by their local
optometrist directly to the Omni
Eye Services Centers for secondary and tertiary care, such
as same day cataract surgery. His team of optometrists and
ophthalmologists provide improved access to affordable eye
care for patients as an extension of optometric practice. Since
1984 he has served as center director of Omni Eye Services
of Atlanta. He serves as general chairman of the education
committee for SECO International, which sees him co-ordinate
the optometry education programme at the event each year
for around 9,000 delegates, the largest CE optometric event in
the States.
Ian Cameron, an independent optometrist from Edinburgh,
spent two weeks working with Paul at the Omni Centre in
Atlanta a few years ago. “Anything that would end up in an eye
hospital in this country is dealt with in this multi disciplinary
eye care centre. Specialist ophthalmologists run clinics
supported by a huge team of optometrists and support staff
seeing around 100 patients per clinic. Dr Ajamian himself deals
with anterior eye disease cases with a team of juniors working
up patients for him to examine and treat.
There seemed to be nothing they couldn’t deal with inhouse:
from retinal surgery and cataract to intractable uveitis
and microbial keratitis. This is a very impressive operation.”

of services offered is important for both the profession
and individual practitioners,” he said. “We must all
keep moving forward. Much hard work has gone into
obtaining prescribing rights for optometrists and we must
not squander this, nor waste the opportunity current
developments in healthcare provision in the UK present to
us. A move into therapeutic practice can provide an ideal
opportunity to embrace all of these opportunities, enhance
the services we can offer to our patients and increase our job
satisfaction. This course provides an ideal starting point for
those who are interested and a chance to meet and talk to
colleagues from the US who are already taking advantage of
their prescribing status.”
London 2012 Education Destination, supported by
Topcon, will be held on April 29-30 at the AOP headquarters
in London. It aims to provide a valuable opportunity for
optometrists to gain specialist IP points, and for those
just taking their first tentative steps into managed care
and expanded clinical pathways to gain 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 points for DOs where applicable.
The event has already attracted international bookings from
the USA, Russia, Australia and Greece so practitioners are
urged to book soon to avoid disappointment.
For more information about the programme, speakers,
social events and booking visit: www.eiseverywhere.com/
ehome/31864/50766/
Also on the home team is Professor
John Lawrenson who, following a
first degree in biochemistry at Cardiff
University, studied optometry at
Aston University and graduated with
a first-class honours degree. After a
pre-registration year at Moorfields
Eye Hospital professor Lawrenson
undertook postgraduate research at City University London,
receiving his PhD in 1992. He went on to complete a postdoctoral
research fellowship in Neuroscience at University
College London and subsequently returned to join the
academic staff at City University where he currently holds a
chair in Clinical Visual Science.
Professor Lawrenson’s research interests lie in the fields
of ocular therapeutics and ophthalmic service delivery.
Consequently, he is director of the Ophthalmic Public Health
research group at City University.
Professor Lawrenson was extensively involved in acquiring
prescribing rights for UK optometrists and the development
of educational curricula for this speciality. He is has also been
involved in the production of a number of resources to support
therapeutic prescribers.
23
23/03/12 CET EVENT
For ‘Team GB’ we have optometrist
Nick Rumney, who currently works
in full-time private practice at BBR
Optometry, Hereford, a standard setting
(ISO9000 & IiP) and award-winning
independent practice. He is a clinical
advisor and consultant to Topcon, as
well as a visiting lecturer at Manchester University and visiting
research fellow at Aston University.
BBR Optometry was the first UK practice to install a Topcon
3D-OCT and My Rumney now has over two years experience
of utilising it in High Street practice. Mr Rumney has published
over 40 papers in optometric journals, including OT, and
even the odd letter in the BMJ and Eye. He is an optometrist
member of Eyecampus, a multi-disciplinary group created by
Pfizer to promote and deliver high standards in CE to eye care
professions. He has been a fellow of the American Academy of
Optometry (AAO) since 1995 and in 2008 was appointed to the
International Admissions Committee for the AAO. Mr Rumney is
a fellow of the BCLA and has recently joined IACLE. In 2011 he
completed the didactic and clinical placement components of
independent prescribing.
Finally, to reflect grass-roots
therapeutics in the UK, Jane Bell will
also speak at the two-day event. She
is a self-employed optometrist with
over 30 years experience in different
types of practice including multiple,
hospital, health centre, independent
optometry owned and dispensing
owned practices. She provides a Primary Care Ophthalmology
Service within a Medical Centre, initially established by PCT
commissioners in 2002. This groundbreaking service has since
survived two procurement processes with the backing of
local ophthalmologists, GPs and PCT managers, resulting in
expansion of the service so that patients are referred from a
larger number of GP practices. They are about to become a
provider through NHS ‘Choose & Book’.
Ms Bell attained the College of Optometrists’ Diploma in
Therapeutics, Additional Supply, in July 2006 and Independent
Prescribing in July 2010. She is currently a director of the AOP
and chair of the Optical Confederation primary care committee.
She began working for the LOC Support Unit in January 2008
and is now a LOCSU adviser.

PREVIEW
An opportunity of
Olympic proportions?
Next issue’s supplement on sport discusses the opportunities London 2012 may offer your practice
24
23/03/12 Sport eyewear
AFTER MUCH anticipation, and
trepidation in some quarters, the London
Olympics are almost upon us – but how
can the world’s top athletes descending
on the Capital help the average optical
practitioner?
With the inevitable interest drummed
up in the events showcased, many
patients are likely to consider taking up a
new sport or outdoor pursuit for the first
time, and others who are already taking
part may be inspired to increase their
performance level and often performance
eyewear can help them achieve this
objective.
The opportunities afforded by sport
and performance eyewear are interesting
in terms of varying everyday practice,
providing patient satisfaction and can
also be potentially very lucrative – with
a small investment in increasing staff’s
knowledge on the latest technology
there is a possibility of making your
practice specialised or at the very least
providing a USP.
The next issue of OT features a 20-page
supplement on sports and performance
eyewear, with details on how certain
types of lenses and frames can enhance
the performance of your patients, as well
as the bottom line of your practice.
Enthusiasts are more than willing to
invest in the latest shoes, clothing and
equipment to improve performance, so
why not a pair of sports frames or contact
lenses, which could enhance their
performance further?
In fact, not only can the correct
eyewear sometimes help performance, in
many Olympic events protective eyewear
is a prerequisite whether the player needs
vision correction or not. Activities such as
archery, swimming, cycling and shooting
all require participants to wear some form
of specialist eyewear.
Although training is available for those
who want to specialise in sports vision
in practice, having a few sports frames in
stock could tempt the amateur runner,
cyclist or archer to try and improve
their performance using prescription or
protective specialist eyewear.
Often patients don’t even consider
contact lenses or specialist eyewear
because they are simply unaware of the
benefits. A little knowledge can go a
long way and who better to impart that
information than staff at your practice?
Many of your existing patients already
run, swim, play football, tennis, golf or
squash – the list is endless – and with a
couple of simple questions when they
arrive, you may uncover a pastime which
the right type of eyewear can enhance
their enjoyment and experience of.
Make sure you check the next issue
of OT for your guide to sport, and
performance eyewear, it could make a big
difference to your business.

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

update
Kids’ vision reminder
26 28
23/03/12 children’s eye health
Recent statistics report that
one-in-10 Primary Care Trusts do not
arrange vision screening for children
starting school. As the Easter holiday
nears, it is a good time to remind
parents about the importance of
children’s eye health.
For some children, having a sight
test could be the difference between
being confident or withdrawn socially,
to being disruptive or doing well
academically. For 10-year-old Sophie Gadner (pictured),
having a sight test and being prescribed spectacles resulted
in improved school grades. Sophie’s mother, Yvonne Gadner,
explained: “I first took Sophie to the optician when she was
eight-years-old after her school recommended it because she
had been disruptive in class. They recommended a sight test
and a dyslexia test. Before this, I had no idea what the right age
was to have a child’s sight tested.”
After being prescribed spectacles to correct her vision,
Ms Gadner noticed a number of changes in her daughter’s
academic achievements. “Since being prescribed glasses,
Sophie is more interested in reading,” she
said. “She’s finding her class work easier
and her grades have improved which is
great.
“Visiting the optometrist has been a
positive experience all round.”
Ms Gadner and Sophie aren’t alone.
Mother Melanie Wisher took her daughter
Emily to the optometrist when she started
school and a teacher expressed concern.
Ms Wisher said: “The optometrist said
Emily’s vision was quite bad and potentially she may never be
able to drive, which really hit home. I was concerned it would
impact on her life decisions, not just her learning at school
and development, but also later in life. If this had been picked
up earlier, my feeling is that she would have been able to
read before she went to school, which would have helped her
educational and social development.”
A free online campaign resource pack is available to
all practitioners, which includes information leaflets for
parents, template letters for schools and a poster. For more
information, visit www.aop.org.uk/childrenseyehealth
Optical Leads
(Six vacancies across England)
The potential to increase the number of local eyecare services commissioned by the NHS in England
is significant and Local Optical Committees (LOCs) have expressed a need for hands-on support from
professionally trained negotiators in writing and presenting business cases to local commissioners.
For 2012-14, we are seeking to appoint six Optical Leads whose role will be primarily focussed on
working with and on behalf of LOCs to maximise the opportunities to expand local eyecare services.
About LOCSU
Our purpose is to support
Local and Regional Optical
Committees to increase the
role of optometrists and
opticians in delivering high
quality eyecare services in
the community.
About You
You will need to demonstrate a good understanding of the sector and have a real passion for
developing business cases and negotiating with commissioners. You will need to be available for
a minimum of eight days per month.
We welcome applications from experienced and enthusiastic individuals from all parts of the
optical sector. Job description and application form can be downloaded from our website
www.locsu.co.uk
A competitive daily rate is offered in addition to the opportunity to work with some of the top
influencers in the optical sector.
Closing date for receipt of applications is 5pm, Friday 20th April 2012.
Short-listed applicants will be invited to attend an interview in London on either
Wednesday 9th May or Thursday 10th May 2012.
For an informal discussion about the role, please contact Katrina Venerus,
Director of Operations and Commissioning at LOCSU at katrinavenerus@locsu.co.uk
A46584 LOCSU Advert 130mm186mmV2.indd 1 14/03/2012 09:18

Optos is Building The Retina Company
Coming soon the next generation in
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Optos – enjoy all the benefits of
optomap ® in a compact, easy to use,
cleverly designed, desktop unit.
New Product Roadshows
April 17th – London Euston
April 18th – London Stansted
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April 26th – Newcastle / Gateshead
Now available, the OptosOCT SLO with microperimetry.
This combination of the latest technologies gives you very powerful
tools for disease detection, diagnosis and management.
Find out more by attending one of our Roadshows
which include lectures on Retinal Imaging and OCT
in Primary Care Optometry*.
Speakers include Simon Barnard, Simon Browning
and Brian Tompkins.
For further information, visit www.optos.com/register,
call 0808 100 4546 or email ukinfo@optos.com
*CET approval pending.
Optos plc
Queensferry House
Carnegie Campus
Enterprise Way
Dunfermline, Fife
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Tel: 0808 100 4546
Fax: 01383 843 333
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and Daytona is a trademark of Optos plc. GM00094 / 1
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PRE-REGFOCUS
Sponsored by
Conquering Stage 2 exams
28
23/03/12 PRE-REG FOCUS
“CONGRATULATIONS. If you have reached
this stage. You have been judged
competent in 75 different areas, so give
yourself a pat on the back and know you
are ready to take on Stage 2,” writes Optical
Express newly-qualified optometrist Amar-
Kaash Gandecha (pictured).
“Stage 2 can be looked at as a
‘condensed’ version of all of your previous
visits, purely designed to skim over some
of what you have already been deemed
competent on, and to get a second
opinion on your skills and knowledge
from a different assessor. The feel of Stage
2 will probably be more formal than your
previous visits because you haven’t had
a chance to build any rapport with your
new assessor.
The visit consists of three parts – the
first of which is the assessment of a
routine eye exam on a presbyopic patient
in 45 minutes. Although this is what
you do every day, there are some subtle
differences:
• Tonometry and fields are not required,
and the use of an auto-refractor is
prohibited
• The patient’s current spectacles,
prescription or VA will not be made
available to you
• You must use the College recording
sheet.
It is important that you familiarise
yourself with the College recording sheet
and consult with your supervisor on how
exactly to record your findings on the
sheet. Practice using the record card on
every patient you examine at least three
weeks prior to your assessment to ensure
your recording is seamless on the day. It
may also have been a while since your
supervisor sat in on an eye test with you
and you may have picked up a few bad
habits, so try and arrange this. I gave some
helpful hints and tips for your routine eye
exam in a previous article (OT, October 14,
2011) and it is worth looking at this again.
Next, you will be given 40 minutes to
perform a soft contact lens fitting and
aftercare (approximately 20 minutes for
each). For the fitting section you will
be given K readings, spectacle Rx and
visual acuity for one of the patient’s eyes,
along with a fitting scenario ie, patient
motivation and wearing time. You can
assume that all other slit lamp findings are
normal and the patient is suitable to be
fitted with contact lenses. You must then
take pre-fitting measurements, make an
appropriate first lens selection and insert
the lens into the patient’s eye:
• Know your contact lens materials. You
should recommend a silicone hydrogel
lens for longer wearing schedules
• If the assessor bypasses the usual time
allowed for the lens to settle into the eye
due to time constraints, be aware that the
fit will appear flatter than if it was allowed
settling time
• Assess the fit and suggest any
modifications
• All fitting information, along with your
final lens specification (brand/type,
base curve, diameter and Rx), should be
recorded on the College recording sheet
• You must remove the lens and check the
cornea of the patient.
For the aftercare, you are to assume
that the patient is new to the practice and
has booked for an aftercare appointment.
You must take a relevant history and
symptoms, perform an over-refraction,
assess the lens fit, carry out an anterior
eye slit lamp examination, including
tear assessment, and finally, advise the
patient on your findings, along with
an appropriate recall date – again, all
recorded on the College recording
sheet. The assessment of over-arching
competencies through a review of patient
episode records is the final part of the
assessment:
• The assessor will sample at least two
patient episodes from each of the six
competency groups. Ensure that all of
your patient records are easily accessible in
your room, and arranged by competency,
in order to ensure fluency during the
assessment
• The assessor will always use field plots
and images – these won’t be anything out
of the ordinary so be aware of common
conditions. Take time methodically
studying and describing what you are
looking at before jumping straight into a
diagnosis
• You will be heavily scrutinised on how
you manage patients when presented
with a scenario, so know when and when
not to refer, and be aware of local and
national protocol on referral urgency.
Don’t be nervous, be organised and
hard-working in your preparation and
practice your routine.
Good luck.

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Program highlights include:
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PRODUCTS
Mini me frames on trend
With the Easter holidays just around the corner, OT
looks at what new children’s frames are on offer
30
23/03/12 CHILDREN’S FRAMES
Bollé
Bollé’s sunglasses collection for kids – Bollé Kids – is based on the same
properties as Bollé’s adult range, the sunglasses manufacturer tells OT –
‘protection, technology, quality and style’.
The Prince frame (pictured in shiny blue with smoke lenses), like all Bollé Kids
sunglasses, is designed to be flexible and lightweight so that the sunglasses
stay on, keeping the child’s eyes protected on long sunny days.
The frames, suitable for seven to 10-year-olds, have polycarbonate moulded
lenses with a carboglass coating, and are scratch and impact resistant,
designed to withstand even the most active of children.
Exceeding the industry standard with 100% UVA/UVB protection, parents
can be assured that their child’s eyes will remain protected when wearing the
sunglasses.
& 020 8391 4700
Continental
Eyewear
Recent introductions to Continental
Eyewear’s Lazer Junior children’s
eyewear collection are the 2078
model for girls (pictured) and the
2080 frame for boys.
The current Lazer Junior collection
consists of over 30 styles, with each model
available in three or four colours.
Sales and marketing director, Neal Grimason, told OT: “We are constantly releasing new styles as we are very aware of the increased frequency of
visits a child makes to their optician.” Both of the new metal frames have detailed sides with a different design used on each colour frame available.
This aims to allow wearers to have two frames with the same shape front but an overall different appearance. Mr Grimason added: “Recent years
has seen a dramatic improvement in the appearance of children’s frames both from a style viewpoint and the use of colour. It is evident that
children are discerning in their taste in eyewear and very aware of what they want.”
& 0151 426 3907
Orange Eyewear
Orange Eyewear’s Junior range aims to offer ‘value’
frames for children and teenagers in a variety of
fashionable colours. The stainless steel frames, which
have acetate sides, are available in sizes from 44 to 50 and
come with child-friendly spring hinges.
Catering for boys and girls, pictured is the ORK 106 in
black, which is available in sizes 48-17 and 51-17, and in
the colours gun and purple.
& 0161 773 5555

Brulimar
Brulimar will launch kids collections under its Lee Cooper and
Pineapple eyewear brands. The introduction of the children’s
ranges for boys and girls retrospectively follows the popularity of
the company’s adult frames for both brands.
With a combined total of more than 30 new frames released
on the market, both ranges will ‘tap into the trend for adultstyle
frames, with a focus on sleek and stylish eye shapes and
sophisticated, modern temples’, Brulimar confirmed.
The 16 Lee Cooper designs for boys include aviator-shaped
frames (pictured below) and denim-inspired colours, whilst the 15
new Pineapple frames for girls (pictured above) range from vibrant
florals to animal-print temples.
Managing director of Brulimar, Howard Librae, said: “Pineapple
Eyewear has experienced phenomenal popularity since we
launched the adult range in 2010. By incorporating state-of-the-art
eyewear materials with such a well-loved London brand we are
expecting fierce demand across the UK and Europe.”
& 0845 130 1415
Zoobug
Children’s eyewear specialist Zoobug’s spring 2012 optical
collection is retro-inspired and features a broad choice of metal
and acetate frames for boys and girls alike.
Updating popular designs and introducing new styles, the
optical frames range is suitable for children aged two-12 years.
Drawing inspiration from the vintage trend popular amongst
adults, whilst staying true to the British brand’s ‘innovative’ and
‘child-friendly’ frames, stripes and marbling effects have been
introduced for boys, and laser engraving and crystals for girls.
Director of Zoobug, Julie Diem Le, explained: “The frames
in my new optical collection are inspired by the vintage
trend, but I have interpreted them so the shapes are perfectly
adapted to small faces.
“Zoobug’s approach to fashion is always exciting, and we
love to serve up super stylish frames for kids. But that’s not all.
This collection is designed in the best interests of the child, in
terms of the durability, ease of wear and overall comfort with
new end tips and well designed nose bridges.”
Iconic to Zoobug is its original ‘Daisy’ frame (pictured) which
has received an update with jewel tones. The acetate frame has
been cut ‘to make this style even more fun’, says the company.
New sizes for the frame, which is available in pale pink, purple,
raspberry and red, include 40-17 and 43-17
New for boys is the ‘Stomp’ frame which Zoobug describes as
evoking a retro feel. Available in green, blue, red and beige, the
acetate stripe model comes in sizes 43-16 and 46-16.
& 0207 251 8122
Dunelm
Dunelm’s WhizKids range grows by 11 this season, with new
optical frames reflecting the adult trend for all things retro.
The new optical styles include chunky frames with deep sides in
bright colours, floral, polkadot and mosaic designs for girls, and
football and fish details for boys.
The latest additions to the collection mean that the range now
totals 67 optical frames and 39 sun frames.
Pictured is the WhizKids Seneca spectacles model which reflects
the two-tone design which is popular this season. Red and cream
in colour with star pattern sides, the frame is already proving to be
a bestseller in the new range, Dunelm confirmed.
Aiming to ‘offer something for all’, a selection of plain plastic and metal frames
in more subtle, muted colours are also available for the ‘more conservative customer’.
Speaking about the changing children’s frame market, director of Dunelm, Peter Beaumont, said: “Shapes are unashamedly big and bold, with
children embracing them and wearing them very much as a fashion accessory, rather than seeing them as something to be embarrassed about.
This is a testament to how far the category has come – children’s optical frames have lost that old stigma almost entirely because of the vast
improvement in style.”
& 01388 420420
31
23/03/12 CHILDREN’S FRAMES

COMPETITIONS
March crossword
Try your luck in our popular crossword competition for the chance to win £50 in shopping vouchers
32
23/03/12 CROSSWORD
Name:
Address:
A5 lanscape_Layout 1 20/02/2012 15:19 Page 1
across
1. Association of British
Dispensing ------ (9)
8. War-time security official (3-4, 6)
11. Vegetarian food (4)
12. Thrillers’ author, ----- Francis (5)
13. Admired for brave deeds (4)
16. Pressed into trousers (7)
17. Casual summer footwear (7)
18. Formation initially seen on
RADAR (7)
20. Bantu weapon (7)
21. Food, commonly known as (4)
22. Cable carrier (5)
23. Ash, elm etc. (4)
26. High ranking Naval officer at
the Battle of Trafalgar (7,6)
27. Sentry-go (5,4)
down
2. Place where ships can dock (4)
3. Frozen tapering pieces of ice (7)
4. Moving towards the centre (7)
5. Average, typical or standard (4)
6. Length of a boxing match (7,6)
7. British Military commander, died
at Khartoum (7,6)
9. Accusation of guilt (2,1,6)
10. Join in a secret agreement to
do something wrong or illegal (9)
14. Yoga posture (5)
15. Mediterranean plant type (5)
19. Salubrious region of London (7)
20. Decorated (7)
24. ‘God’, a religious epic by Victor
Hugo (4)
25. Ink blemish (4)
Send entries to OT March Crossword, 2 Woodbridge Street, London EC1R
0DG by April 16, 2012. You can enter OT’s Crossword competition online
at www.optometry.co.uk. The winner of OT’s January Crossword was
optometrist Ken Forster from Kendal, Cumbria. He wins a £50 Marks &
Spencer shopping voucher.
OCANZ Applicants Practical Skills Training Course
Tuesday 29th May 2012
An intensive 1-day practical skills training course hosted by Aston University Optometry Department,
for UK optometrists undertaking the OCANZ examinations in 2012.
Delegates will benefit from working in small groups whilst gaining supervised clinical experience in the
following areas:
• Contact tonometry
• Gonioscopy
• Head mounted and slitlamp BIO
• Binocular vision assessment
Course fee £450 per delegate. For further information, please email optometrycpd@aston.ac.uk
or visit http://www1.aston.ac.uk/lhs/cpd/courses/optometry/
www.aston.ac.uk/lhs

Achieve your goals
Exmouth Rowing Club 8K Regatta 2011
Steve, Super Optom
Give us a call...
...Steve did!
Call and speak to Jim Gilbert today: 01793 648607 email: jim@outsideclinic.com

ADVICE
Employers should act
now on pension reform
New rules for employers are set to take place starting this year, OT asked Rachel O’Donoghue,
director of Buzzacott, financial planning to explain some of the changes
34
23/03/12 PENSION REFORM
WORKPLACE PENSION
provision will be
revolutionised by key
reforms introduced in the
Pension Act 2008. The
changes take effect from
2012 and will affect all
UK employers, whether
companies or not-for-profit
organisations.
Government estimates
suggest that around seven
million people are undersaving
for retirement. As a
result, the pensions reforms
place the onus on employers to ensure that individuals save
for retirement.
For the first time, all employers will automatically have
to enrol all eligible employees into a workplace pension
scheme which meets or exceeds certain legal standards. In
addition, all employers will be required to pay into a pension
scheme on behalf of employees. Employers will have to
comply with the new legislation, even if they already offer a
pension scheme to employees.
“There will be a direct cost to all
employers”
a qualifying pension scheme,
this can be an employer’s
existing pension scheme as
long as it meets the minimum
criteria. Alternatively, there
is an option to use the new
workplace pension scheme; the
National Employment Savings
Trust (NEST).
Qualifying schemes offer
a more comprehensive and
flexible pension arrangement
than NEST, potentially offering
a greater range of investment
options, higher levels of
permitted contributions and possibly no up-front charge on
contributions.
NEST aims to provide a basic, low cost pension scheme
and is generally targeted at organisations that employ low-tomoderate
earners and do not have, or do not wish to use, their
own qualifying scheme for all employees.
Charges will be applied to cover the set-up costs for NEST.
In addition, there will be an ongoing administration and
investment management charges.
Buzzacott is a financial planning firm company which
recently ran seminars on the changes. To contact a member of
its financial planning team email enquiries@buzzacott.co.uk.
For more information visit www.buzzacott.co.uk
The new regulations will be rolled out between 2012
and 2017; the date companies will be affected from is
dependent on the size of their largest PAYE scheme, with
those employing fewer than 50 people in their largest PAYE
scheme given more time to prepare.
Costs involved
There will be a direct cost to all employers in the form of a
compulsory pension contribution for all eligible employees –
a minimum of three per cent of their ‘qualifying earnings’ by
the end of the phasing-in period. Complying with the autoenrolment
rules may also place a considerable administrative
burden on employers.
Employers must ensure pension contributions are paid into
Positive steps employers should take
1. Identify the likely cost impact (both of contribution and
implementation)
2. Consider the options available for mitigating the costs
3. Phase in contributions over a number of years
4. Consider whether any existing pension schemes meet
the criteria
5. Investigate how any existing pension schemes can be
improved/amended
6. Prepare for the administration requirements
7. Review the opportunity to create a National Insurance
saving that could be used to further reward employees, or
help fund the cost of increased contributions
This article is prepared to keep readers abreast of current developments, but is not intended to be a comprehensive statement of law or current practice. Professional
advice should be taken in light of your personal circumstances before any action is taken or refrained from. No liability is accepted for the opinions it contains, or
for any errors or omissions. Buzzacott Financial Planning is the trading name of Buzzacott Financial Services Limited, registered office is 130 Wood Street, London,
EC2V 6DL. Authorised and regulated by the Financial Services Authority © Buzzacott Financial Services Limited December 2011. All rights reserved.

A guide to: i-vue
Content Driven Digital Signage
Educate and Entertain your patients in the waiting
area to promote your products and services.
Fed-up of those old, tired
magazines in the waiting
area? Do you want to
energise your practice
with modern technology
that doesn’t cost the earth?
It’s time you
looked at i-Vue…
Engage patients in the waiting area with i-Vue. Only i-Vue uses CAPTIV8 3D animations that have been meticulously
developed to add a real WOW to your practice by delivering content that will help grow your practice.
Amazing Content
i-Vue includes a full library of the highest quality 3D animations.
With content covering everything from frames, lenses, contact
lenses, eye diseases and surgery there’s something for everyone.
Not only that, your i-Vue subscription includes
ALL new animations (developed approximately monthly).
Live updates!
i-Vue allows you to easily create playlists and add personalised
messages. What’s really amazing is that you can do this from any
web browser and your i-Vue/s will update automatically!
All at an affordable monthly cost
www.optimed.co.uk
Tel: +44 (0) 2476 444 118
Email: info@optimed.co.uk

INDUSTRYNEWS
Trading places
In new roles
Optix Software has expanded its support
team to eight, with two new appointments to its
York-based offices. Optix support desk manager,
Lee Atkinson, (pictured left) explained that the
continual growth of the number of practices
using the business management software had
inevitably led to more support resources being
required.
36
23/03/12 INDUSTRY NEWS
“The queries we receive from our customers
range vastly in terms of their experience of IT
issues and skills,” he said. “We simply enjoy
supporting and advising them all on how to gain
the most benefit from our system. With the face
to face training they receive, and our annual
conference, we get to know all of our customers
personally, which is important to us, even those
in Trinidad.”
Adam Eamonson (pictured centre) joins the
company with experience in marketing, IT and
customer service. Anthony Holdsworth (pictured
right) has much experience in customer support
within the retail industry and with bespoke
software.
The Optix annual user group meeting is next
week on March 27 and 28 at Carden Park, near
Chester. The after dinner speaker is broadcaster
and journalist John Sergeant.
GetLenses, the UK’s
largest online contact
lenses retailer, has
appointed Ashley
Mealor (pictured) as
marketing director. He
is based in the London
office and has over 12
years’ experience in
the marketing sector,
having held positions
within major brands such as O2, Betfair and
British Airways.
His role will include continuing to grow the
company’s 30% online market share in the
UK, while also implementing new marketing
strategies within Europe, following the retailer’s
recent rapid expansion into Ireland, Italy and
Holland. The company has sales of over £8m and
100,000 active customers.
Changing image
HeIDelberg eNgINeeRINg has launched
MultiColor Scanning Laser Imaging as ‘a new
dimension in multi-modality fundus imaging’
with the Spectralis product family. Some UK
optometrists are using the Spectralis system
which is said to be the only one which allows
them to choose the imaging modules they
require and offers simultaneous OCT with all
models.
Heidelberg, based in Hertfordshire, is taking
over the distribution of its products from
Haag-Streit UK on April 1 and there will be
‘a big push’ into optometry afterwards.
The new imaging modality was unveiled at
the World Ophthalmology Congress in Abu
Dhabi. “The combination of MultiColor fundus
imaging and SD-OCT in a single device elevates the Spectralis multi-modality platform to a new
level of diagnostic power,” said Kester Nahen, VP of global marketing and business development.
For information on the complete range of modular SD-OCT and visual fields visit the website
www.HeidelbergEngineering.co.uk.
& 01442 345370

In the pink
after MIDO
Dunelm Optical has unveiled its
new collections in the latest 2012
catalogue, after previewing the new
styles at MIDO in Milan earlier this
month.
There are almost 800 optical and
sun frames featured in total with
140 new collections from renowned
international designers Janet Reger,
Paul Costelloe and John Rocha. There
is also a wide selection of own-brand
styles, including Julian Beaumont,
(pictured left is JB752 ), Retro,
Chantelle and Whiz Kids.
Dunelm director, Peter Beaumont,
said: “This year we’ve really excelled in
the style stakes with our new frames
and we genuinely believe there is
something to suit every taste, and
pocket, in the new brochure.
“We opened up seven new countries
in Milan this year and doubled the
orders we did last year, so we are, of
course, thrilled. The show itself was
busier than it has been in a few years
which was encouraging news for the
industry as a whole.”
& 01388 420420
OT industry
news online
OT’s industry pages have proved so
popular that we’ve now introduced a
separate section on the OT website to
give practitioners more in depth news
on the latest product innovations and
launches.
Go to www.optometry.co.uk to help
keep you at the cutting edge of optics
and to boost your business.
Optical companies: you can reach
your customers in a new and exciting
way. To be involved simply email
your press releases and pictures to
OT deputy editor Robina Moss at
robinamoss@optometry.co.uk or write
to her at 2 Woodbridge Street, London,
EC1R 0DG.
Three of
a kind
INTeRNaTIONal eYewear has launched three new TR90 models – Eyestuff Tickle, Sketch and
Muddle which are designed to appeal to children between the ages of four and 12.
The frames feature the technologically advanced TR90 material and a grown-up eye shape,
which remains suitable for children’s prescriptions. The Swiss TR90 material is good to use for
children, as it is flexible, durable, lightweight and resistant to perspiration. An adjustment wire in
the temple tips, alongside a quirky elliptical tip shape, adds interest and practicality.
A stand out frame within the new collection is Muddle, a full rim combination model with cute
temple designs. It is available in a size of 45-17-130 in three vivid colour options of juicy orange,
flamingo pink and bonza brown (pictured).
Extensive and carefully planned market research was carried out by the company in creating
the new models. It included organising focus groups, consulting local dispensers and drawing on
the in-depth knowledge gained over the years creating the popular Eyestuff kids’ collection.
To celebrate this launch, Eyestuff is also offering a display package for any independent
optician looking for ‘all the fun of the fair’ within their practice.
& 0121 585 6565
New App
for orders
Hoya has launched the Hoyanet App which is
designed to free up practice managers from being
tied to the practice by enabling them to keep in
touch with the laboratories and lens supplier and
track the progress of Hoya orders, even when they are
miles away.
The App is free to download and already being used by
more than 60 customers who can keep up to date with lens
releases and check the status of orders at the tap of a finger.
The App also enables them to also switch from one practice
account to another, without needing to log in and out.
“It is now easier than ever to focus on the key issues
which keep the customers coming back,” said Hoya
sales support manager, Carl Pearson.
The new App is compatible with iPhone 3GS,
iPhone 4 and iPads. Details are available
from the Apple App Store or by emailing
supportingyou@hoya.co.uk
& 0845 3300 984
37
23/03/12 INDUSTRY NEWS

Minimal
operator training
required
Free image
viewing via a
web browser on
a tablet or PC
Easy-to-use
intuitive
touch screen
The DRS non-mydriatic retinal camera . . .
*
all of this for just £9,995
The fully-automated DRS nonmydriatic
retinal camera has been
designed to maximise patient flow
without compromising on image
quality.
Minimal operator training
Its compact, ergonomic design
features an integrated PC with an
easy-to-use intuitive touch screen
and requires minimal operator
training.
Acquisition of the posterior and
anterior segment
It offers automatic (or manual)
acquisition of the posterior and
anterior segment, providing
alignment throughout the live image.
It supports single or multi-field
acquisition protocols, providing seven
different standardised 45° fields.
Automatic mosaic composition is
supported and the DRS also boasts
measuring tools such as; area vessel
calliper and relation ‘cup-to-disc’.
Images in just 30 seconds per eye
The DRS automatically senses the
patient, self-aligns to the target eye,
focuses the retina, adjusts the flash
level and captures the image – all in
less than 30 seconds.
Haag-Streit, a name you can trust
The DRS is supplied and supported
by Haag-Streit, so quality, accuracy
and reliability are assured.
Key features & benefits
• Approved by the UK National
Screening Committee for use in
the NHS Diabetic Eye Screening
Programme
• Stereo mode, with 3D viewer
• Captures both eyes in one minute
• Automatic (or manual) acquisition
of the posterior and anterior
segment
• Minimal operator training required
• Easy-to-use intuitive touch-screen
• Integrated PC with 160Gb hard
drive
• Wi-Fi and ethernet connection.
For further information on the DRS non-mydriatic retinal camera, please
telephone us on (01279) 456255, email drs@haag-streit-uk.com or
alternatively, visit www.haagstreituk.com/drs
* Excludes VAT and table
(01279) 456255
drs@haag-streit-uk.com
Follow us on Twitter @HS_UK

update
AOP Member Benefits
– Cashback Gift Cards
AOP Privileges is a free membership benefits package which has been put together with the goal
of saving members’ time and money. The ‘Cashback Gift Cards’ scheme is just one of the benefits
offered to AOP members. OT explains how it works
39
the AOP membership
‘Cashback Gift Cards’ scheme
is designed to help with
household budgeting and
saving money.
To qualify for this free
service, AOP members are
required to register by visiting the ‘Cashback Gift Cards’
website www.aop.org.uk click on member-services/memberbenefits/aopprivileges.
Every time you load money onto a
retailer’s reloadable card you could earn up to 15% cashback.
Some AOP members are already using the benefit and
saving on a monthly basis. One example is a member who
spent £5,000 in B&Q and earned £400 back in one fell swoop.
Another member earned £304.50 last year, mainly through
grocery shopping for the family. When asked what she spent it
on she simply said ‘me’.
Just decide how much money you want to spend with each
retailer every week or month and load your budget onto the
gift cards. The cashback you generate can be easily transferred
to any of your cards, meaning that the cashback you earn
in one store can be spent in another. You will also still earn
on other loyalty schemes you use such as Nectar, Boots
Advantage and the Costa Coffee Club.
For example, if you do your grocery shopping at ASDA,
you would select an ASDA Gift Card to stretch your budget.
If you typically spent £250 per month, you would earn
£130.50* net ‘cashback’ per year. This can then be spent on
the family’s weekly shop.
Saving for an occasion or a big expense? Why not
accumulate your cashback and when you are ready you can
load it onto a card from any of the retailers in the scheme. For
example, you can load the cashback onto a B&Q card to put it
towards a DIY project. You could buy Christmas presents or
even update your wardrobe.
Why not use the online, interactive savings calculator to find
out how much you could potentially save by using ‘Cashback
Gift Cards’? Simply enter your estimated ‘spending per month’
for the categories shown online and then click the ‘calculate
savings’ button to see your savings.
‘Cashback Gift Cards’ charge £1 per month membership fee,
but as this is taken from the ‘cashback’ you earn, membership
is effectively free.
Here’s how it works in five easy steps:
1. Begin by visiting the Cashback Gift Cards website www.
aop.org.uk click on member-services/member-benefits/
aopprivileges
2. Sign up to register (this only takes a couple of minutes)
3. To qualify for this member benefit deal, you must enter the
reference code: AOPO
4. A username and password will be emailed to you
immediately
5. You can then login to your account
Once logged in you can choose which card you would like
to have sent to you from a range of your favourite stores.
Choose from Topshop, Topman, B&Q, Boots, M&S, ASDA,
Comet, Debenhams and many more. Once your cards have
arrived in the post you can return to the site time and time
again to load them ready for use.
Cashback will be added to your account every time you load
a card.
23/03/12 AOP PRIVILEGES
• Terms and conditions apply. See website for further details. Example
used is illustrative. Example base charges included in net saving. AOP
Privileges is managed on behalf of the AOP by Parliament Hill Ltd of
Floor 3, 127 Cheapside, London, EC2V 6BT. Neither Parliament Hill

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
John Lawrenson, PhD MCOptom
Nicholas Rumney, FCOptom FAAO
April 29 th & 30 th
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.
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
For more information visit www.aop.org.uk
Produced by

DIARYDATES
NEW… 18 Optos, Hilton Stansted Airport,
Essex, Optos Daytona and OCT roadshow
SEE ABOVE
18 No 7 Contact Lenses, Sidney Little Road,
Hastings, Ortho K and topography day SEE
ABOVE
NEW… 19 Optos, Radisson Blu, Bristol,
Optos Daytona and OCT roadshow SEE
ABOVE
MAY
NEW… 10 No 7 Contact Lenses, Sidney
Little Road, Improve your contact lens
confidence (www.no7contactlenses.com)
NEW… 13 WOPEC, Anglia Ruskin
University, Cambridgeshire, Gonioscopy
event (mackens@cardiff.ac.uk)
NEW… 14 Macular Disease Society,
Edinburgh, Top doctors roadshow (help@
maculardisease.org)
Cardiff University hosts WNOC
Practitioners in Wales have the opportunity to learn about
optometry and the law, rocs, public health and a variety of clinical
topics at the Welsh National Optometric Conference (Wnoc) next
month.
Organised by WOPEC and Optometry Wales, the conference takes
place on Saturday April 21 at Cardiff University’s School of Optometry
and Vision Sciences with a black-tie dinner held in the evening at the
near-by Radisson Blu Hotel.
Tickets for the cet-accredited event are still available from the website
www.wopec.co.uk
MARCH
27 J&J, The Vision Care Institute, Pinewood,
Berkshire, Managing the astigmatic patient
(www.thevisioncareinstitute.co.uk)
3 NEOS, Holiday Inn Express, Waterloo Square,
St James Boulevard, Newcastle upon Tyne,
The eye in systemic disease (neosoptoms@
hotmail.co.uk)
20-22 EAOO, Dublin, Ireland, Annual
conference (www.eaoo.info)
NEW… 21 WOPEC/Optometry Wales,
Cardiff University, Cardiff, Welsh National
Optometric Conference
(www.wopec.co.uk)
23 Ultravision, Commerce Way, Leighton
Buzzard, Bedfordshire, Interactive
workshops SEE ABOVE
NEW… 24 Kensington, Chelsea and
Westminster Local Optical Committee, The
Chapel, Chapel Street, London, NW1, AGM
(kcw.loc@gmail.com)
24 SBK Healthcare, The Hatton,
Farringdon, Managing change in your
ophthalmology service course (www.sbkhealthcare.com)
NEW… 14 No 7 Contact Lenses, Sidney
Little Road, Hastings, Fitting presbyopic
contact lenses SEE ABOVE
NEW… 15 Macular Disease Society,
Belfast, Top doctors roadshow SEE ABOVE
NEW… 21 Warwickshire AOP, The Venture
Centre, University of Warwick Science Park,
Coventry, Myopia control lecture SEE ABOVE
NEW… 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… 24 Macular Disease Society,
Manchester, Top doctors roadshow SEE
ABOVE
41
23/03/12 DIARY DATES
28 North Yorkshire LOC, National
Railway Museum, York, CET day (www.
northyorkshireloc.co.uk)
3 No 7 Contact Lenses, Sidney Little Road,
Hastings, Next generation hybrids (www.
no7contactlenses.com)
NEW… 25 Optos, Hilton Manchester
Airport, Manchester, Optos Daytona and
OCT roadshow SEE ABOVE
NEW… 24-27 BCLA, ICC, Birmingham,
Annual clinical conference and exhibition
SEE ABOVE
28 UltraVision, Commerce Way, Leighton
Buzzard, Bedfordshire, Interactive workshops
(workshop@ultravision.co.uk)
12 No 7 Contact Lenses, Sidney Little Road,
Hastings, Future proof contact lenses SEE
ABOVE
25-26 J&J, The Vision Care Institute,
Pinewood, Berkshire, Returning to work
confident and refreshed SEE ABOVE
NEW… 29 ABDO Golf Society, Moseley
Golf Club, Birmingham, Challenge Cup
(m.stokes67@ntlworld.com)
28 BCLA, 76 Portland Place, London, Evening
meeting (www.bcla.org.uk)
28 ABDO, Shamir Head Office, Shamir Bridge
House, Saxon Way, Bar Hill, Cambridge, Area 4
CET meeting (abdoarea4@gmail.com)
29 Nidek, Aston University, Birmingham,
Pentacam users day (www.nidek.co.uk)
APRIL
2 Nottingham and Derby Optical Society,
Wolloughby Hall, Nottingham University Park
Campus, Nottingham, Complex dispensing
lecture (NDOS@live.com)
16 Warwickshire AOP, 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… 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 SEE ABOVE
NEW… 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, AOP, 2 Woodbridge Street, London,
EC1R, Education destination with SECO
(www.aop.org.uk)
JUNE
NEW… 12 Hampshire LOC, Chilworth
Manor, Southampton, AGM and CET event
(www.hampshireloc.co.uk)
NEW… 14 Macular Disease Society,
Newcastle, Top doctors roadshow SEE
ABOVE
NEW… 18-19 J&J, The Vision Care
Institute, Pinewood, Berkshire, Returning
to work confident and refreshed SEE ABOVE
NEW… 19 Carl Zeiss Education,
Manchester, OCT course SEE ABOVE
Place your event on OT’s diary dates section – for free. If you have any diary dates which you would like to publicise, please don’t hesitate to contact us. OT goes to every registered optometrist and
dispensing optician in the UK. Send full details for inclusion in the next issue before March 27 to Chris Donkin by emailing chrisdonkin@optometry.co.uk or call him on 020 7549 2074. NEW...denotes this
event that has not been printed in Diary Dates previously. You can place your event on our website, also for free, click on www.optometry.co.uk for more details.

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
Vision Assessment in Ocular Disease Part 4
Course Code: C-18426 O/D
Dr Raymond Beirne, BSc (Hons), MCOptom, PhD
About the author
Dr Raymond Beirne is an optometrist and lecturer at the University of Ulster where he teaches
on the BSc (Hons) Optometry course and the fully online distance learning MSc in Clinical Visual
Science. His main research interest is visual function in the ageing eye and ocular disease.
42
1. Which visual field test strategy has been used to acquire the results
shown in Image A?
a) Swedish interactive threshold algorithm strategy
b) Supra-threshold screening strategy
c) Zippy adaptive threshold algorithm strategy
d) Single intensity screening strategy
23/03/12 VRICS
A
2. For which of the following clinical scenarios is it NOT appropriate to use
the test results shown in Image A to help make a final clinical decision in
optometric practice?
a) If a patient is complaining of headaches
b) If a patient has normal IOP but has optic discs that are suspicious of glaucoma
c) If a patient wishes to know if they are suitable to drive a car
d) If a patient appears to have tilted discs on Volk lens examination
3. Which of the following visual function tests would be LEAST useful in
assessing a patient with the fundus appearance shown in Image B?
a) Amsler Grid
b) Photostress recovery time
c) Preferential hyperacuity perimetry
d) Stereopsis
B
4. Which of the following could increase the risk of vision loss in a patient
with the fundus appearance shown in Image B?
a) If the patient is a smoker
b) If the patient has suffered choroidal neovascularisation in the fellow eye
c) If the patient has had previous cataract surgery carried out on this eye
d) All of the above
5. Which of the following statements about the test results shown in
Image C is true?
a) The patient has essential anisocoria
b) There is damage to the parasympathetic innervation to the right eye
c) There is damage to the sympathetic innervation to the left eye
d) There is a total afferent pupil defect in the left eye
C
6. Which of the following signs would suggest a recent onset Adie’s pupil if
a 40-year-old female presents with the test results shown in Image C?
a) Relative afferent pupil defect
b) Very slow near pupillary reaction in the affected eye
c) Ptosis on the affected side
d) Iris heterochromia
Astigmatism: potential is all around you. Maximise it!
27th March and 9th July 2012
2358 VRICS Banner 420x30_ASTIGMATISM.indd 1 12/03/2012 10:20

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
May 4 2012. CET points for this exam will be uploaded to Vantage on May 14 2012.
2 Free cet Points
Approved for Optometrists
4
Dispensing Opticians
4
References to aid completion of the exam:
Q5 & Q6: Bremner, FD (2000). Pupil Abnormalities OT, 7th April.
Q1 & Q2: Hancock, S (2008). Clinical Decision Making I: Visual Field Interpretation. OT, 11th July Q7 & Q8: http://webeye.ophth.uiowa.edu/ips/perimetryhistory/FDP/index.htm
Q3 & Q4: Binns, A (2011). Assessment and Management of AMD: Referral Refinement Part 4. Q9 & Q10: www.contrastsensitivity.net/csc.html
OT, 20th May.
Q11 & Q12: www.scribd.com/doc/59085894/Pelli-Robson-ETDRS-Score-Sheet-Instructions
LARGER SCALE IMAGES ARE AVAILABLE ON THE OT WEBSITE (Simply click on the image when completing the exam online)
7. For which of the following clinical scenarios is it LEAST appropriate to
conduct the test shown in Image D?
a) If you suspect that a patient has a branch retinal vein occlusion
b) If you suspect visual field loss due to hydroxychloroquine toxicity
c) If you suspect that a patient has anterior ischaemic optic neuropathy
d) If you suspect that a patient has a glaucomatous optic disc
43
D
8. Which of the following statements about the visual field defect shown
in Image D is FALSE?
a) It could be described as being altitudinal
b) It shows an absolute scotoma in the superior field
c) It respects the horizontal mid-line
d) The plot is unreliable due to fixation errors
9. Which one of the following statements about the test and results shown
in Image E is true?
a) It uses a 6-alternate forced choice psychophysical method
b) It is a letter based contrast sensitivity test
c) Both eyes have abnormal contrast sensitivity at moderate spatial frequencies
d) It indicates that both eyes should have similar high contrast visual acuity values
23/03/12 VRICS
E
10. Which other clinical test can provide additional information about the
right-hand side of the graph shown in Image E?
a) Mars contrast sensitivity test
b) Regan test chart
c) Pelli-Robson contrast sensitivity test
d) Melbourne edge contrast sensitivity test
11. What would be the equivalent Snellen distance VA for the left eye of
the patient whose clinical data is shown in Image F?
a) 6/60
b) 6/24
c) 6/12
d) 6/6
F
12. Which one of the following statements about the contrast sensitivity
data shown in Image F is true?
a) There is severe loss in both eyes
b) There is severe loss in the right eye and normal results in the left eye
c) There is moderate loss in both eyes
d) There is severe loss in the right eye and moderate loss in the left eye
For more information on all our courses, please visit:
www.thevisioncareinstitute.co.uk
2358 VRICS Banner 420x30_ASTIGMATISM.indd 2 12/03/2012 10:20

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 March 2 2012. Points will be
uploaded to CET Optics up to 10 days later.
optometrytoday
CET Video
live
online
enewsletter
Femtosecond laser
cataract surgery
2 CET
points
C-18628 O/D
Publication date March 23 2012 Closing date May 22 2012
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Assessing visual function I
Young childREN’s visION PART 3 C-18550 O/D
Dr Margaret Woodhouse, BSc (Hons), PhD, MCOptom
Assessing visual functions in young children can often be perceived as being
challenging. This article looks at how practitioners might ensure that each
test is successful by making simple modifications to procedures and by
choosing ability-appropriate tests. The author does not suggest that the
practitioner examine a child in the order described in the article; choosing
the order of test procedures will be covered in the next article of this series.
Distance visual acuity
There are a number of tests available and it
is worth investing in a variety. Those based
on logMAR principles are advantageous.
At the very least, practitioners should
use tests which offer the same task at all
acuity levels, and have equal steps in
acuity. Ideally, norms and repeatability
(the variation in score for the same patient
tested on two occasions) data should be
available, as this enables the practitioner
to recognise a change in visual function.
For example, if a child’s acuity on a
second examination is different by an
amount less than the repeatability of the
test, then the likelihood is that there has
been no real change. If the difference is
greater than the repeatability, you can
be more confident that VA has changed.
Figure 1
From the position of Joshua’s eyes it is easy to
predict that the picture on the Cardiff Acuity Test
card is at the bottom. Picture courtesy of Mike
O’Carroll
Preferential-looking
For very young children, tests based on
preferential looking (PL) are the most
reliable. Teller (available in the US) or
Keeler Acuity Cards (in the UK) use black/
white grating targets placed within one
half of a grey card. These are suitable for
infants under 12 months of age. Beyond
the first year, children find gratings rather
boring and it becomes difficult to hold
their attention. The pictures used in
the Cardiff Acuity Test are much more
attention-grabbing and are suitable for
the toddler age group. Each picture is
made up of a black/white outline and
is positioned at the top or bottom of a
grey card. The average brightness of the
black/white target matches the midgrey
of the background, so that when the
target (grating or picture) is beyond the
acuity limit, it is invisible against the
background. Thus, if a child reliably looks
towards the target, the practitioner can
assume that it is within the acuity limit,
but if the same child then fails to look
towards a finer target, the practitioner
can assume that the acuity limit has been
exceeded. The crucial element in the use
of PL is objectivity. The practitioner must
NOT know the position of the target.
For the Teller/Keeler Cards,
practitioners should ‘twirl’ each card
before presentation, whilst for the Cardiff
Acuity Test the three cards available for
each acuity level should be shuffled. Begin
with a large, easily visible target. Attract
the child’s attention straight ahead and
then quickly present the card. For Teller/
Keeler Cards, look at the child through the
peephole; for the Cardiff Acuity Test, look
around the edge of the card held at your
eye level. Note the child’s eye movement
and estimate the position of the target
(Figure 1). Check your decision; if you are
correct, repeat at the same acuity level.
If you score two out of two correct, then
move to a finer acuity level. If you make a
wrong guess on one occasion, move back
to a larger target. The end point is the finest
acuity for which you have scored two out
of two correct. As with any procedure,
once you are skilled, short cuts are possible
and advisable to avoid the child becoming
bored. Indeed, practitioners need to be
quick, as the child may have looked at the
target and then looked away before you
are in position. For both types of PL test,
repeatability and norms are available. 1,2
PL, by its nature, is a resolution task
and does not involve crowding. It does,
therefore, tend to give a better acuity result
than a recognition task and can miss subtle
differences in acuity between the two
eyes, which might indicate amblyopia. 3
It is, therefore, important to perform an
optotype test with crowding, when a child
is old enough. Remember, however, that
if you are monitoring a child over time,
acuity may well appear to drop when a
different test is introduced; in this instance
there may be an argument for using both.
Kay Pictures
Kay Pictures are the most commonly used
optotype test for young children in the
UK. These use pictures determined by
a research study to be the most readily
recognised by young children. 4 The
range of tests provides flexibility, as there
is a single-target and a crowded-target
version (both logMAR based), and both
come with a matching card for children
45
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who are not yet ready to name out loud
and interspersing easy targets with hard
(Figure 2). Many children with speech
ones will be needed. Never end with the
delay use Makaton or SignAlong, both
‘failed’ level. For every child, always return
being simple signing systems that aid
to an easy level – let the last thing the child
development of language. Each of the
remembers be getting the answer right.
pictures in the Kay test has a sign that
For adult patients, VA is typically
46
can be easily learned by a practitioner.
Norms for the test are available in the
measured several times; monocular
and binocular, with and without old
research section of the supplier’s website.
and new correction, adding up to nine
acuity tests. It would be a rare child who
Lea Symbols
tolerates repeating a test so many times.
These tests use four symbols that have the
Therefore, practitioners should prioritise
advantage of ‘blurring’ to a similar shape
the main VA measurements required eg,
at threshold. Thus, guessing is difficult and
if amblyopia is suspected, monocular
23/03/12 CET
the end-point is sharper than for pictures
or letters. The tests come in a variety of
formats, and logMAR crowded versions
are available, although norms appear to be
published only for uncrowded versions. 5
Letter Acuity Charts
Older children will, of course, be ready
to use a letter chart. However, a full chart
can be daunting since the child reading
the top line will be aware of all the other
lines below waiting to be tackled. Much
more child friendly is the Keeler logMAR
Crowded test, which presents only one
line at a time (in uncrowded and crowded
versions). It also has a matching card for
children unsure of letter naming, and
norms are available 6,7 (note that when the
test was first developed it was described
in literature as ‘Glasgow Acuity Cards’).
Although the Kay Pictures and Keeler tests
appear similar on cursory examination,
they are calibrated for different distances;
the Kay Pictures test is calibrated in
Snellen terms for six metres and in logMAR
for three metres, while the Keeler test is
calibrated in both for three metres. Thus
the acuity level labelled 6/12 is twice the
size in the Kay test as it is in the Keeler test.
Figure 2
The Kay Picture Test (crowded version)
particular variation (such as matching,
signing). Secondly, record the distance
at which the test was conducted, since
in refractive error and visual impairing
conditions such as nystagmus, VA may
vary with distance; it is not acceptable
to convert an acuity score eg, 3/12 is not
necessarily the same as 6/24. Thirdly, note
which eye was tested first for monocular
acuity, and fourthly, record the confidence
with which you measured acuity. This
allows an apparent difference in acuity
next (or last) time to be put into context.
If a child is very nervous or distracted,
this may affect the acuity measured.
When VA is measured, it is usual
to begin with an easy target and move
progressively to more difficult levels, until
the patient cannot read any more ie, in
order to determine what a patient can see,
we have to determine what they cannot
see – we force the patient to fail. For some
children this technique is fine; children
can be very competitive and some love
to show how clever they are. For other
acuity is clearly important, but is there
a need to measure binocularly? If the
child wears glasses constantly, is there
a need to measure uncorrected acuity?
When measuring monocular VA, use
a variety of occluding items as some
children may tolerate a sticky patch, others
their mother’s hand, whilst others might
prefer to wear a pair of spectacles with one
opaque lens. If a child objects to continued
occlusion, swapping between eyes at each
acuity level can be successful and becomes
fun as everyone tries to remember which
eye comes next. While measuring acuity,
never take your eyes off the child. They
can peek very quickly around an occluder.
Never scold a child who does this – he/
she is simply trying to do what you are
asking, which is to name the picture or
letter. It may be that they don’t even realise
they are doing it with the ‘wrong eye’.
Near visual acuity
In the UK, near acuity is usually assessed
by a reading task and the result recorded by
print size. Reading charts aimed at children
are available, but the most well known
(using text from Peter Rabbit and Thomas
the Tank Engine) require such a high
children, the technique is less successful,
reading age that any child who can read
Measuring acuity
particularly for those with special needs or
them should also be able to read the adult
For any acuity test, it is essential to
who are used to failing, as the test simply
versionThe Maclure test offers text graded
record four things in addition to the
reinforces their poor self-esteem. For these
by age so that a child can be offered a task
score. Firstly, note the test used and any
children, lots of praise should be offered
appropriate to their reading ability. Because
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acuity, this may be very close. The same
advice regarding test procedures for VA
should be followed for CS testing too.
Refraction
Conventional refraction techniques involve
Figure 3
The Cardiff Contrast Test
the task is so dissimilar to distance acuity
charts, reading acuity cannot be compared
with, or predicted from, distance acuity.
For children not yet reading, a near
Kay Pictures card (Figure 2) or the
Cardiff Near Test (the latter is not PL but
a naming or matching test) can be used.
These two tests are calibrated for Snellen
or logMAR acuity. As they are similar
in construction to distance tests, they
allow a comparison between distance
and near acuity. They do not allow the
prediction of text enlargement for reading
in a child with visual impairment.
Contrast sensitivity
Contrast sensitivity (CS) measurement
forms an important part of adult low vision
assessment and the same would apply for a
child with (suspected) visual impairment.
It may also be useful in the assessment of a
child with special needs and with binocular
vision problems such as amblyopia. There
are fewer tests available for CS than for
VA, but nevertheless a very wide age
range can be assessed. The most common
chart for older, able, children is the Pelli-
Robson letter chart, for which adult norms
exist. 8 For younger children, the Cardiff
Contrast Test (Figure 3) can be used as a
naming, signing or PL test, and norms are
available in the manual. Some children
with special needs may respond better to
static retinoscopy with accommodation
controlled by distance fixation and
fogging lenses, followed by refinement
with subjective routine. Only the oldest
children will be able to participate in a
subjective routine. In general, younger
children will answer a question by telling
you what they think is the right answer
(after all, this is what they are trained to
do in school). A question to which there
is no obvious answer (“which is better,
one or two?”) is totally bewildering to a
child and so practitioners must rely on
objective techniques instead. An article
in the next issue of OT will discuss the
use of cycloplegia and non-cycloplegic
(Mohindra) techniques in more detail, but
some general pointers are offered here.
When using Mohindra retinoscopy,
practitioners should remember that some
children are afraid of the dark. As such, lower
the lights slowly, and once in the dark keep
talking to reassure the child. When using a
cycloplegic method, talk to the child about
drops beforehand and show their drops
going into a doll’s or teddy’s eyes. Don’t
tell the child that they won’t hurt, because
they will, and you will lose the child’s
trust. Use terms like ‘sting’ or ‘fizz’ and do
tell the child how brave they are once the
drops are in. Insert the drops as quickly
as you can. Do not prolong the anxiety.
Wearing a trial frame restricts the field
of vision, which can be frightening for a
child. As such, keep a hand-held mirror
nearby so that the child can see him/
Figure 4
Ellie doesn’t mind wearing the trial frame briefly
trial frame, which may only be essential
for measuring cyl axis. A later article will
discuss the interpretation of refractive
findings and guidelines for prescribing.
Accommodation
Accommodation may be the most
neglected aspect of children’s vision,
since it is easy to assume that children
have ample and active accommodation.
Recent studies have shown that the
majority of children with Down’s
syndrome 10 and cerebral palsy 11 have
defective accommodative responses,
even when distance refractive errors
are fully corrected. The prevalence of
accommodative disorders among typical
young children appears unreported.
Accommodation is quick and easy
to measure and, given that children
spend much more time looking at
near objects than far, must provide
important information about a child’s
ability to overcome hypermetropia
and perform prolonged schoolwork.
Dynamic retinoscopy is a reliable
objective means of determining accuracy
of accommodation, and a modified version
of the Nott technique has been validated
and norms established. 12 The technique is
illustrated in Figure 5. The child, wearing
a distance correction if prescribed, attends
47
23/03/12 CET
the smiling face in the Hiding Heidi test. 9
herself before the lights go out, to take
to a detailed target set at a known distance.
CS should be measured at low
away that fear (Figure 4). Remember that
The instrument depicted in Figure 5 is
spatial frequencies and therefore the
trial frames are uncomfortable so consider
the UC-Cube, which has various self-
test should be placed at a distance for
holding spherical and cylindrical lenses
illuminated targets and is calibrated for two
which the targets are well within the
manually for each eye instead. Minimise
distances, 20cm and 25cm. Use the shorter
child’s acuity limit; for a child with poor
the time that the child needs to wear the
distance for younger children. Since
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distance refractive errors are corrected, the
practitioner need examine only one eye, in
one meridian. Begin with the retinoscope
alongside the target, with the child telling
you about the picture (or with the parent
pointing to the picture to hold attention).
If a child is accommodating accurately,
the reflex will be neutral. A ‘with’ reflex
indicates under-accommodation and
an ‘against’ reflex over-accommodation.
Leave the target in place and move away
from or towards the child to find neutral
– this is the point to which the child is
actually accommodating. A neutral point
beyond the norms (shown on the UC-
Cube rule) indicates an accommodative
anomaly. This may suggest a binocular
problem deserving further evaluation,
or an accommodative spasm or deficit.
Dynamic retinoscopy as described
above does not measure amplitude of
accommodation, the function typically
measured in adults. Young children do
not understand the concept of blur so a
push-up method is inappropriate. The
reverse of this, a push-down method, can
children and by making simple changes
to established procedures, the interested
practitioner can quickly gain skills in
examining even the youngest child. The
next article will continue this discussion by
looking at other aspects of visual function.
48
Figure 5
The UC-Cube in use for dynamic retinoscopy
About the author
Maggie Woodhouse is a senior lecturer
at the School of Optometry and Vision
Sciences, Cardiff University, where she
specialises in paediatric optometry. She
runs the Special Assessment Clinic,
which caters for patients of all ages with
disabilities. Her particular interests are
visual development in children with
Down’s syndrome and the impact of
visual defects on education. The author
has a financial interest in the Cardiff
Acuity Test, the Cardiff Contrast Test,
the Cardiff Near Test and the UC-Cube.
sometimes be used, whereby a target with
very fine detail (letters or pictures) is first
deliberately placed too close to the child
and then slowly moved away; the child is
asked to name the letters or targets as soon
as they can see them. This technique will
slightly under-estimate the amplitude, as
there will be a reaction time delay between
the targets becoming clear and the moment
the child names them. Nevertheless, it
will provide a subjective measure as well
as allowing the practitioner to note the
child’s ability to maintain convergence.
23/03/12 CET
References
Conclusion
See www.optometry.co.uk/
clinical. Click on the article title and then
on ‘references’ to download.
By investing in a few tests developed for
Module questions Course code: C-18446 O/D
PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on April 20, 2012 – You will be unable to
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1. All of the following describe the repeatability of a test, EXCEPT:
a) The practitioner’s confidence in the result noted on the second occasion
b) The difference in test result that would mean a clinically significant
change
c) The average difference in results between two measures taken under
the same conditions
d) The practitioner’s confidence that visual function has changed over time
2. The correct procedure for measuring acuity by the Cardiff Acuity
Test includes:
a) Ensuring pictures in successive presentations are at opposite ends of
the card
b) Noting the position of the picture then quickly presenting the card to
the child
c) Going back to a larger target if the examiner cannot tell the picture
position
d) Moving the card closer to the child until he or she looks at the picture
3. An acuity test that incorporates crowding is preferable because:
a) Uncrowded tests are likely to give a poorer acuity score
b) The task is equal at every acuity level
c) Crowding improves the repeatability of the test
d) It is more likely to detect small interocular differences
4. All of the following could explain a reduction in acuity at a second test
of a child, EXCEPT:
a) A different test was used on the second occasion
b) The child may have peeked over the occluder on the second occasion
c) The child is more distracted on the second occasion
d) A refractive error may have increased by the second occasion
5. In Nott dynamic retinoscopy:
a) A neutral reflex indicates normal accommodation
b) A ‘with’ movement indicates the child is accommodating to a point between
the retinoscope and the target
c) An ‘against’ movement means the practitioner should move closer to find
neutral
d) Accurate accommodation is indicated by a change from “with” to “against”
within a 5cm range
6. Making an eye examination child-friendly may include all of the
following, EXCEPT:
a) Using a trial frame for a limited time only
b) Repeating a test several times so that the child becomes familiar with it
c) Alternating between eyes during an acuity test
d) Using a recognition task to measure amplitude of accommodation
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Ocular allergy and
contact lens wear
C-18459 O/D/CL
Paramdeep Singh Bilkhu, BSc (Hons), MCOptom
Dr Shehzad A Naroo, BSc (Hons), MSc, PhD MCOptom, FBCLA
Prof James S Wolffsohn, BSc (Hons), MBA, PhD, MCOptom, FBCLA
Allergy is a condition where the body produces an over-reaction or
hypersensitivity to normally harmless substances known as allergens. The
prevalence of allergy in Europe is between 15% and 20% 1 and is expected
to increase with estimates up to 50% by 2015. 2,3 Although genetics play an
important role in susceptibility, the increase in prevalence is reported to be
the result of modern lifestyle, 4 being associated with improved hygiene 5
and increased antibiotic use. 6 Environmental factors such as increased air
pollution, climate change and increased planting and importation of allergenic
plant species may also be involved. 7,8,9 Of those who suffer from allergy,
approximately 20% experience a form of ocular allergy. 10 This article discusses
optometric management strategies that can be employed to maintain
successful contact lens wear in patients who have allergic eye conditions.
Ocular allergy includes a group of distinct
clinical entities, typically associated
with the conjunctiva, and includes
seasonal allergic conjunctivitis (SAC),
perennial allergic conjunctivitis (PAC),
vernal keratoconjunctivitis (VKC), atopic
keratoconjunctivitis (AKC) and giant
papillary conjunctivitis (GPC). 11,12,13 Other
allergic eye conditions include contact
allergy to topical medication, such as
anti-glaucoma agents, 14,15 and microbial
allergy, such as phlyctenulosis caused
by hypersensitivity to tuberculoprotein. 16
The most common form of ocular allergy
is SAC (90% of cases) followed by PAC
(5% of cases). 12 Together with GPC,
which is frequently associated with
contact lens wear, SAC and PAC are most
likely to be encountered in optometric
practice. VKC and AKC are rare and often
managed in the hospital eye service due
to their sight-threatening potential. 11
In the UK, the prevalence of ocular
allergy in patients attending optometric
practice has been estimated at 8%. 17 Due
to the increasing prevalence of allergies as
a whole, a significant proportion of the 3.6
million contact lens wearers in the UK 18
have ocular allergies, which has been found
to be a common cause of drop out from
contact lens wear. 19 In addition, patients
with existing seasonal allergies had five
times increased risk of developing ocular
symptoms during contact lens wear. 20
Thus, it is important for practitioners
to identify these conditions in order to
manage them more appropriately with
respect to maintaining contact lens wear. 21
Seasonal and perennial allergic
conjunctivitis
SAC occurs on a seasonal basis and is
often triggered by exposure to grass,
tree and weed pollens but can also be
caused by outdoor moulds, all of which
peak at different times of the year. 12,22
SAC may exist alone or accompany
seasonal rhinoconjunctivitis (hay fever),
Figure 1
Allergic conjunctivitis. Courtesy of Professor
Michael Doughty, Glasgow Caledonian University
which involves both nasal and ocular
symptoms. 12 The signs and symptoms of
SAC usually develop gradually but can
also occur suddenly following exposure to
the offending allergen; the severity is often
associated with pollen counts. 11,23 Signs
and symptoms include itching, tearing,
eyelid oedema, chemosis (conjunctival
oedema) (Figure 1) and sometimes a
papillary reaction. 11,12,23 PAC can occur all
year round and is caused by house dust
mites, insects, animal dander and indoor
moulds. 22 The signs and symptoms of
PAC are similar to SAC but are usually
milder and have seasonal exacerbations
in severity. 24 Despite SAC and PAC being
relatively mild forms of ocular allergy, they
can significantly impact on an individual’s
quality of life eg, reduced school
performance and work productivity. 25,26,27
The economic impact can be profound,
with SAC estimated to cost £124 per
year for someone in employment. 26
The pathophysiology of both SAC
and PAC is an IgE-mast cell mediated
hypersensitivity reaction. 22 It is triggered
by exposure to the allergen, leading to a
series of complex immunological events;
these are coordinated by a variety of
inflammatory mediators with the mast
cell playing a central role. 28,29 The allergen
reacts with specific IgE antibodies bound
to the surface of a sensitised mast cell,
causing linkage of the IgE molecules
and resulting in an influx of calcium
49
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50
Allergen
Pollen and outdoor
moulds
House dust mites
Avoidance Strategies
• Minimise outdoor activities when symptoms are known to develop
• Plan outdoor activities by monitoring pollen levels using TV, the Internet and radio
• Wear close fitting sunglasses and avoid rubbing eyes when outdoors
• Wash hands after being outdoors and wash hair regularly before sleeping
• When indoors, close windows and doors leading outside
• Use air conditioning, circulate air internally and close windows when in a vehicle
• Wash bedding regularly (temperatures at least 60⁰C)
• Damp dust and vacuum entire house weekly
• Regularly clean curtains, upholster carpets and any areas that may gather dust
• Reduce humidity to 30-50% in the home with a de-humidifier
23/03/12 CET
Figure 2
Pollen attached to a contact lens surface (image
from a confocal scanner)
ions into the mast cell. This initiates
mast cell degranulation, releasing preformed
inflammatory mediators such as
histamine, which causes the signs and
symptoms of allergic conjunctivitis. 22,29
The hypersensitivity reaction is divided
into two phases; 30,31 the early phase
described above occurs immediately
and lasts clinically for 20-30 minutes, 32
whilst the late phase may occur 3 to 12
hours after the initial reaction 30 and
symptoms can last up to 24 hours. 22,31 The
late phase is characterised by sustained
mast cell activity, production of newly
formed inflammatory mediators derived
from arachidonic acid, and infiltration
of leukocytes and Th2-lymphocytes at
the site of inflammation. 22,28 The yearround
signs and symptoms of PAC are
caused by chronic mast cell activation
and Th2-lymphocyte infiltration. 22,32
The primary aim of treatment in
SAC and PAC is to avoid exposure
to the allergen through avoidance
strategies 33-38 (Table 1). However, this is
not always possible and people must
then seek therapeutic strategies instead.
Allergic conjunctivitis and
contact lens wear
Contact lens wearers who suffer from
allergic conjunctivitis are often managed
by temporarily ceasing lens wear, as the
Animal dander
• Avoid contact with animals
• Remove pets from home or do not keep at all
• Regularly vacuum and clean entire home
• Wash hands and clothes, avoid rubbing eyes or nose after contact with animals
Table 1
Allergen avoidance measures for seasonal and perennial allergic conjunctivitis
causative allergen(s) might attach to the
surface of the lens (Figure 2) and prolong
exposure to the ocular surface (and
therefore increase signs and symptoms of
allergic conjunctivitis). 12,39,40 Furthermore,
it is not normally advisable for contact
lens wearers to apply topical anti-allergic
medications with the lenses in situ, as
they may bind to the lens matrix and cause
toxicity reactions with continued wear. 40
Although this is less of an issue with daily
disposable contact lenses, modern topical
anti-allergic medications have now
been designed to be applicable during
contact lens wear, in mild to moderate
cases of allergic conjunctivitis, owing
to twice daily dosage. In fact, Brodsky
et al. 41 demonstrated increased wearing
time and contact lens comfort after
instillation of olopatadine hydrochloride
0.1% before contact lens insertion
compared to a placebo in patients with
allergic conjunctivitis. Likewise, Nichols
et al. 42 showed significantly increased
total and comfortable wearing times
following instillation of epinastine
hydrochloride 0.05% prior to contact
lens insertion, compared with re-wetting
drops alone, in patients with a history of
allergic conjunctivitis and contact lens
intolerance during the allergy season.
Unless other tissues (such as the nose
and throat), are involved in the allergic
reaction, systemic anti-histamines
should be avoided as they may cause
drying of mucous membranes (including
the conjunctiva), which can exacerbate
ocular symptoms and reduce the
removal of allergens by tear flushing. 43
Contact lens wearers who suffer from
ocular allergy symptoms might also
benefit from increased lens replacement
frequency and strict compliance with rub
and rinse cleaning regimes to minimise
exposure to allergens on the lens
surface. 20,40 The use of daily disposable
lenses would be beneficial, as they
maximise replacement frequency and
eliminate the need for lens maintenance.
Indeed, one study 44 reported that 67% of
patients found improved comfort with
daily disposable contact lenses compared
with only 18% of patients using a fresh
pair of their habitual reusable lenses.
There was also associated reduction
in bulbar and palpebral hyperaemia,
corneal staining and lid roughness. 44
Wolffsohn and Emberlin compared two
Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates

daily disposable contact lenses (one with
variation between signs and symptoms. 50
enhanced lubricating agents) to each other
Although contact lens chemistry plays an
and to no lens wear using a conjunctival
important role in surface deposition (type
allergen challenge test, in patients with
and extent), there is no correlation between
confirmed systemic and ocular allergy to
this and CLGPC severity. 51,54,55 Porazinski
grass pollen. 45 They found that the severity
and Donshik 55 found no significant
of “burning” and “stinging” symptoms
were significantly reduced with the lens
containing the enhanced lubricating
agent. 45 The duration of symptoms was
also shorter (by 1.7-2.0x) with lens wear
compared to allergen exposure of the naked
eye. 45 Signs of bulbar hyperaemia, corneal
and conjunctival staining and palpebral
conjunctival roughness were significantly
reduced with contact lens wear compared
to no lens wear, suggesting that lenses
provide a barrier effect to allergen
exposure. In addition, limbal and palpebral
conjunctival redness were significantly
lower with the lenses containing the
enhanced lubricating agent, suggesting
that lubrication of the ocular surface
further limits the allergic reaction. 45 Based
on this evidence, the majority of patients
with allergy or allergic conjunctivitis
can remain in their contact lenses,
particularly if they are daily disposables
or contain enhanced lubricating agents.
If symptoms persist, topical antiallergic
medications with twice daily
dosing (olopatadine hydrochloride 0.1%,
epinastine hydrochloride 0.05% or
nedocromil sodium 2%) can be prescribed
(by the patient’s GP or by optometrists with
therapeutic qualifications) to allow patients
to continue contact lens wear. 21 The drops
must be inserted when the lenses are not
on the ocular surface. Where the contact
lens wearer still remains symptomatic,
temporarily ceasing wear and initiating
topical (and systemic when necessary)
anti-allergic medication is necessary
until signs and symptoms resolve.
Figure 3
Contact lens associated Giant Papillary
Conjunctivitis. Courtesy of Andrew Gasson, London
variety of aetiologies associated with
mechanical irritation of the palpebral
conjunctiva, such as in contact lens wear,
exposed sutures and ocular prostheses. 46,47
Existing allergic (atopic) conditions are a
risk factor for GPC, particularly seasonal
allergies, 48 whilst elevated serum levels
of IgE have also been found in 44% of
patients with GPC. 49 The severity of
signs tends to be greater too, but this
was not found to have a bearing on the
patient’s ability to wear contact lenses. 50
Contact lens associated Giant Papillary
Conjunctivitis
GPC is predominantly encountered in
contact lens wear, occurring with any type
of contact lens but being more common
with soft lenses (85% of cases) than
hard lenses. 47,51 Contact lens associated
GPC (CLGPC) is usually bilateral and
characterised by the presence of giant
papillae (0.3-1.0mm in diameter) and
hyperaemia on the superior palpebral
conjunctiva (Figure 3), excessive contact
lens movement and intolerance, increased
mucous production and symptoms such as
burning, itching and irritation. 47,52 CLGPC
is often the result of mechanical irritation
to the superior palpebral plate due to
poor contact lens design and fitting and/
difference in signs and symptoms of CLGPC
between FDA type I (low water content,
non-ionic) and type IV (high water content,
ionic) materials even though the latter
is more prone to surface deposits. 56,57,58
Indeed, this could be because the deposits
are formed of inflammatory cells in the
allergic response itself. 54 It is, therefore,
reasonable to advise patients to cease
contact lens wear, regardless of the material,
to remove the offending cause of CLGPC.
There is, however, variation in the
incidence of CLGPC with different contact
lens materials, wear modality, replacement
frequency and cleaning regime. 47,55,59
Continued use of old lenses and poor lens
care are risk factors for the onset of CLGPC
symptoms. 59 Hence, contact lens cleaning
(rub and rinse) and disinfection is strongly
advised to minimise surface deposit
build-up in reusable lenses, whilst the
addition of enzymatic treatment once or
twice weekly might also be necessary. 47,50
Refitting patients who experience CLGPC
to new lenses of the same material offers
some success in reducing the recurrence
of CLGPC (61-66%), but greater success
(77-95%) can be achieved by changing the
lens material or increasing replacement
frequency. 50,55,60,61 Refitting patients from
HEMA to a RGP lens can reduce the
recurrence of CLGPC by 80%; 50 the latter
has been attributed to the smaller diameter
of RGP lenses, which reduces the area in
contact with the palpebral conjunctiva
for mechanical irritation and exposure to
surface deposits. 53 RGP lenses are also easier
to clean and therefore there is less build-up
51
23/03/12 CET
Giant Papillary Conjunctivitis
(GPC)
or an immunological response to protein
deposits on the lens surface. 51,53 CLGPC has
been classified into four different stages
of deposits compared with soft lenses. 50,53
Discontinuation of contact lens wear
usually brings about resolution of CLGPC
GPC is a form of ocular allergy with a
(Table 2) 52 but there may be considerable
within four weeks for moderate signs and
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CLGPC Stage Symptoms Signs Treatment Options
52
1 • Occasional itching after lens
removal
• Minimal mucous discharge in
the morning
• Normal tarsal papillae
• Minimal to mild conjunctival hyperaemia
• Some contact lens surface deposition
• Increase replacement frequency
• Encourage strict cleaning (rub and rinse) and
disinfection
• Introduce hydrogen peroxide cleaning and unpreserved
saline if unresponsive
• Consider changing lens polymer or switching to daily
disposable lenses
2 • Itching
• Increased lens awareness /
decreased lens tolerance
• Increased mucous discharge
• Increased size of papillae, some over 0.3mm
diameter
• Mild conjunctival hyperaemia and thickening
• Contact lens surface deposition
• As for stage 1, but introduce enzymatic cleaning (onetwo
times a week) for frequent replacement lenses
• Mild blurring of vision
23/03/12 CET
3 • Increased mucous discharge
• Increased lens awareness
• Excessive lens movement
• Blurred and fluctuating vision
upon blinking
4 • Complete lens intolerance
• Excessive lens movement and
decentration
• Mucous may cause eyelids to
• Tarsal papillae increase in size (>0.3mm) and
number
• Marked conjunctival hyperaemia and thickening
• Scarring and staining of papillae apices
• Contact lens deposition
• Large papillae (coalescence)
• Papillae apices scarred, flattened, and stained
• Contact lens surface becomes deposited soon
after insertion
• Cease lens wear, monitor until symptoms, corneal
staining, inflammation, and papillae resolve (four weeks)
• Initiate use of 2% sodium cromoglicate (one drop four
times daily)
• Refit with RGP lenses
• As for stage 3, but refit with either daily disposable or
RGP lenses
stick together in the morning
Cases resistant
to above
treatment
• Cease lens wear, initiate pharmacological treatment with sodium cromoglicate (one drop four times a day) and monitor until signs and symptoms
have resolved
• Papillae may not reduce in size, but hyperaemia and inflammation must resolve
• Referral to an appropriate practitioner for advanced pharmacological therapy
• Treat as stage 4 when appropriate
Table 2
Classification and treatment of contact lens associated Giant Papillary Conjunctivitis (modified from Allansmith et al. 54 )
symptoms, but may take longer for severe
cases. The papillary signs may persist
unchanged or may reduce in diameter
slowly for a considerable length of time.
Contact lens wear may continue when
symptoms resolve, provided the cornea
is not compromised (ie no staining)
and the eye is free of inflammation. 47,50
As such, it is advisable for patients
to be refitted from their current type
of contact lens after a period of lens
wear cessation, and this is reportedly
more successful (94%) at preventing
recurrence of CLGPC than refitting
during an episode of CLGPC (78%). 50
The use of topical ocular medication
to modulate the inflammatory response
in CLGPC is usually reserved for cases
resistant to conventional management
(as described above). This involves the
use of mast cell stabilisers eg, sodium
cromoglicate. 47,50,62 Approximately 75%
of patients with moderate to severe
CLGPC who do not respond to standard
treatment can continue with contact
lens wear after treatment with 2% or 4%
sodium cromolyn following a period of
lens wear cessation. 59,60,63 In the UK, 2%
sodium cromoglicate is available to nontherapeutically
trained optometrists in a
pack size of 10ml and given the supporting
literature it can be used to treat resistant
CLGPC in normal contact lens practice.
The non-steroidal anti-inflammatory drug
(NSAID) suprofen 1% used four times
daily has also demonstrated efficacy in
treating CLGPC, 64 but this is not available
in the UK. The steroid loteprednol
etabonate has also demonstrated efficacy
in treating the signs and symptoms
of CLGPC in several randomised
controlled trials. 65,66,67,68 However, the
use of steroids by optometrists requires
further therapeutic training to at least
supplementary prescribing level
and careful monitoring, owing to the
potential risk of cataract and increase
in IOP, which may lead to glaucoma
with long-term or prolonged use. 69,70,71
Summary
Ocular allergy is a common cause of
contact lens wear drop out, and its
prevalence is increasing. However,
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identification of the major subtypes of
ocular allergy – seasonal and perennial
allergic conjunctivitis and giant papillary
conjunctivitis – and appropriate
management by changing the contact
lens type, material, replacement
frequency and cleaning regime, allows
successful contact lens wear in the
majority of these patients. The use of
topical anti-allergic medications may be
required alongside temporarily ceasing
lens wear followed by altering lens type
and wearing pattern, when symptoms
persist, but this is only required in severe
cases and those with corneal involvement.
of Contact Lens Educators. Professor
James Wolffsohn is deputy executive
Dean for Life and Health Sciences
at Aston University, teaching and
researching in the field of the anterior
eye. He is also a past president of the
British Contact Lens Association.
About the authors
Paramdeep Singh Bilkhu is an optometrist
and PhD student researching ocular
allergy and dry eye disease management
at Aston University. Dr Shehzad Naroo
is a senior lecturer at Aston University,
teaching anterior eye topics. He is also
president of the International Association
References
53
See www.optometry.co.uk/
clinical. Click on the article title and
then on ‘references’ to download.
Module questions Course code: C-18459 O/D/CL
PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on April 20, 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 April 30, 2012. Find out when CET points will be uploaded to Vantage at www.optometry.co.uk/cet/vantage-dates
1. The first line of treatment of seasonal and perennial allergic
conjunctivitis in contact lens wearers is to:
a) Cease contact lens wear
b) Avoid exposure to the allergen
c) Use a mast cell stabiliser when the symptoms occur
d) Use an anti-histamine when the symptoms occur
2. In the UK, the prevalence of ocular allergy in patients
attending optometric practice is approximately:
a) 3%
b) 8%
c) 15%
d) 20%
3. Topical anti-allergic medications should:
a) Not be used in contact lens wearers
b) Only be prescribed by independent prescribing optometrists
c) Be applied on the contact lenses in situ to ensure slow release
d) Be applied when contact lenses are not in place on the eye
4. Enhanced lubricating daily disposable lenses:
a) Should not be worn by patients with ocular allergies
b) Offer a barrier effect to allergens unlike other contact lenses
c) Offer additional allergen flushing to reduce signs more than other contact lenses
d) Reduce the duration of ocular allergy symptoms more than other contact lenses
5. Refitting patients from HEMA to RGP contact lenses, reduces GPC by
approximately:
a) 20%
b) 40%
c) 60%
d) 80%
6. Patients with moderate to severe CLGPC who do not respond to standard
treatment should:
a) Cease contact lens wear permanently
b) Be able to wear their current lenses successfully after a break
c) Be treated with 2% or 4% sodium cromolyn and maintain contact lens wear
d) Be treated with 2% or 4% sodium cromolyn following a period of lens wear cessation
23/03/12 CET
For the latest CET visit www.optometry.co.uk/cet

JOBS
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54
23/03/12 JOBS
2 X PRE-REGISTERED DISPENSING OPTICIANS
Fixed Term 12 months Ref: D1- 461
Trainee Band 5 (75%) - £20,117 p.a. inc.
37.5 hours per week
We are delighted to announce an opportunity for pre registered dispensing opticians to
work in the Optometry Department. This is the largest department of its type in the UK. The
department provides a comprehensive optometric support service, low vision service,
contact lens service, spectacle dispensing service and optometric extended role. We play a
major role in the training of ophthalmic professional staff and we have laboratories for
spectacle glazing, lens surfacing and contact lens manufacturing.
Moorfields Eye Hospital is a post-graduate teaching hospital of international acclaim,
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London, at City Road, but we have a large and growing number of interdisciplinary
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The successful applicants will undertake varied work, including dispensing of high
prescriptions and specialist devices, for children and adults as well as glazing. You will be
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Applicants must be registered with the GOC as a Student Dispensing Optician. We are
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Please call 020 7566 2023 for informal enquiries and ask for Dan Ehrlich, Head of Optometry,
or Tony Charman, head of Spectacle Dispensing & Manufacturing.
To apply for this post please apply online at www.jobs.nhs.uk CV’s will not be accepted in
application for this post, it is essential that applicants complete the online application
form in full.
The Human Resources Department can be contacted on 020 7566 2981.
Closing date for receipt of application forms:
Saturday 7th April 2012
Working Towards Equality of Opportunity
OPTOMETRIST
Band 7, plus 17% recruitment and retention premium
(£30,460-£40,157 plus 17% RRP)
Two positions for Optometrists have become available in the Shared Care
Department at Bristol Eye Hospital.
One post is full time (37.5 hours/wk), and is focussed on work in the retinal
service, specifically in provision of care to patients with age-related macular
degeneration (AMD).
The other post is part time (22.5 hours/wk), and includes work in the retinal
service (AMD; diabetes) and also post-operative assessment of patients who
have undergone cataract extraction.
Both positions may include work in other abnormal ocular conditions.
The post-holders will be GOC registered and have substantial post-registration
experience. Evidence of extended role practice or hospital eye service
optometry would be advantageous, although neither are pre-requisites for the
position.
Informal enquiries regarding this position are encouraged. For further
information please contact Dr Paul GD Spry, Optometrist Consultant/Head
of Shared Care, Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX,
telephone 0117 342 1438 (direct) or 0117 342 1437 (messages) or email
paul.spry@uhbristol.nhs.uk
To apply for these vacancies please visit our website
www.uhbristol.nhs.uk/work-for-us/
Shared Care Optometrist (part time) ref: 387-S-257
Retinal Shared Care Optometrist (full time) ref: 387-S-259
Closing date for applications: Friday April 27th 2012.
Interview date: Afternoon of Tuesday May 29th 2012.
An equal
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Optometrists &
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NUSYTE OPTICIANS
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APPLY TO
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Full-time DISPENSER
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We are looking for a dedicated and
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Please send CV to Ian Underwood at
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team Locum is an employment agency
Enthusiastic clinically minded
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Owning and running your own practice has always been a key goal for ambitious professionals and
Specsavers, the UK’s original and largest Joint Venture partnership, can help you realise your ambition.
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Locations for Optometrist Joint Venture Partners required in: Brixham, Cirencester,
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Instruments
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optometrytoday
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bookshop
optometrytoday
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MARKETPLACE
To
place an advertisement call
020 7878 2344 or email tom.hocking@tenalps.com
Practice Fittings
optometrytoday
Practice For Sale
PRACTICE FOR SALE
(STAFFORDSHIRE)
Modern town centre practice
Turnover approx. 65k
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ene
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Box no. 391200
tom.hocking@tenalps.com
020 7878 2344
PRACTICE FOR SALE
GLASGOW
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BOX NO 391521
tom.hocking@tenalps.com
23/03/12 MARKETPLACE
optometrytoday
For more
Marketplace visit
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marketplace
live
Optical Practice
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County Tyrone
No Reasonable
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Jobs
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Practice Management
enewsletter
We are looking for an Optometrist for 3 or more
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Bradford on Avon practices.
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The job involves all aspects of optometry including
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Repairs
You will be working in a friendly relaxed
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We are offering an excellent salary.
Please contact Martin Bull on 01380 725802 or
martin.bull@nixonshaw.co.uk
online
enewsletter
VRICS
optometrytoday
Looking to sell anything from a second-hand piece of
equipment to your practice. Advertise in OT and reach 20,038
potential buyers. Please call Tom Hocking 020 7878 2344
live
bookshop
CET

MARKETPLACE
To
place an advertisement call
020 7878 2344 or email tom.hocking@tenalps.com
Practice Fittings
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2. Stiegemeier MJ, Fahmy M, Thomas S. Beating back SAC. Optometric Management. 2008; 43(9): 84-85. © CIBA VISION (UK) Ltd, a Novartis company, 2012. DAILIES AquaComfort Plus, DAILIES
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