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Journal of the Association of Optometrists
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CONTENTS
http://twitter.com/OptometryToday
November 25 2011 vol 51:23
11 20 36
News
6 Bob Hughes leaves
The AOP pays tribute to its former chief
executive who has left to pursue a new career
7 Cataract crackdown
PCTs have been banned from cost-cutting
measures which have been hitting patients
waiting for cataract surgery
8 Comment
OT’s editor-in-chief David Challinor reflects on
the changes in retail and how events such as
the AOP’s Student Eye Opener Conference are
helping young practitioners prepare better for
their careers
11 VAT loophole to close
Companies undercutting UK suppliers by
selling low-value items from the Channel
Islands will now have to pay VAT
14 New optometry department
Plymouth aims to create something ‘exciting’
it was revealed at the official opening
Cover story
32-33 Magnificent seven
Seven universities took part in CooperVision’s
first-ever student competition and OT’s David
Challinor was one of the judges
Products
20-21 Industry news
‘Eyes heaven’ opens in London and the
Rodenstock Club celebrates its 20th anniversary
plus an important launch from Carl Zeiss Vision
28 Cases for specs and CLs
A look at distinctive cases which can help boost
footfall at the traditionally quiet time in practice
Regulars
24 Letters
Clarification on peripheral retinal degenerations
25 Christmas crossword
Our popular brainteaser
26 Diary dates
Details of the FMO Christmas Lunch and all the
latest optical events
38 Student news
A fully-funded studentship is being offered at
the new optometry department at Plymouth
University plus news from Aston, Glasgow
Caledonian and Cardiff
Events
30-31 AOP Council elections
Information on the important changes in
the upcoming election which features new
constituencies and additional seats
Features
16-17 New benefits scheme
The AOP has launched a privileges scheme for
members which includes savings on holidays,
dining out, car repairs, ‘phone bills, energy and
gifts
34-35 Practice excellence
Optix MD Trevor Rowley has opened a new
practice in York which takes technology and
high-end retail to a new level
Clinical
36-37 VRICS: C-17158 O
Vision assessment in ocular disease
Part 1. Dr Raymond Beirne tests our knowledge
of the assessment of vision and interpretation of
results for different types of ocular diseases
40-43 CET 1: C-17573 O
Referral refinement –
distortion of vision
Part 12. Mark Benson discusses how optometrists
should investigate and manage patient reports of
distorted vision, offering pertinent referral advice
for the most common causes
44-49 CET 2: C-17277 O/AS/SP/IP
Community-based
independent prescribing
Peter Frampton describes his work as an
independent prescriber in community practice,
offering advice on the management of various
conditions
Classified
50-53 Jobs
All the latest vacancies
54-58 Marketplace
Where to buy optical goods and services
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
Feature is online
Video is online
www.optometry.co.uk

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NEWS
Contact lenses rich with
info are nearer to reality
THE DREAM of contact lenses
providing wearers with digital
images and information in front
of their eyes came a step closer
this week.
A study reported that
researchers constructed a
computerised contact lens and
demonstrated its safety by testing
it on live eyes, with no signs of any
adverse side effects.
At the moment, the contact
lens device – which was tested
on rabbits – contains only a single
pixel but the researchers see this
as a ‘proof-of-concept’
for producing lenses with multiple
pixels which could be used to
display short emails and text
messages before a wearer’s eyes.
The device could overlay
computer-generated visual
information, say developers, and
be of use in gaming devices and
navigation systems. It could also
be linked to biosensors in the
user’s body to provide information
on glucose levels.
The contact lens, created by
researchers at the University
of Washington, USA, and Aalto
University, Finland, consisted
of an antenna to gather power
sent out by an external source,
as well as an integrated circuit
to store this energy and transfer
it to a transparent sapphire chip
containing a single blue LED.
One major problem the
researchers had to overcome was
the fact that the human eye, with
its minimum focal distance of
several centimetres, cannot resolve
objects on a contact lens. Any
information projected on to the
lens would probably appear blurry.
To combat this, the researchers
incorporated a set of Fresnel lenses
JMW 20 feet tall
into the device. Much thinner and
flatter than conventional lenses,
they were used to focus the
projected image on to the retina.
After demonstrating the
operation and safety of the
lens, the researchers state that
significant improvements are
necessary to produce fully
functional, remotely-powered,
high-resolution displays. For
instance, the device could be
wirelessly powered in free space
from approximately one metre
away, but this was reduced to
about two centimetres when
placed on the rabbits eye.
Co-author of the study, Professor
Babak Parviz, of the University
of Washington’s department of
electrical engineering, said:
“We need to improve the antenna
design and the associated
matching network and optimise
the transmission frequency to
achieve an overall improvement
in the range of wireless power
transmission.
“Our next goal, however, is to
incorporate some predetermined
text in the contact lens.”
The study was published in the
Institute of Physics publication,
Journal of Micromechanics and
Microengineering.
IN BRIEF
Tribute to lecturer
Dr Gary Baker, pictured, the
senior lecturer at City University’s
Department of Optometry and
Visual Science, has died. He was
59. Read the tribute to him from
his colleague, Ron Douglas, on
page 14.
Barbour Eyewear
launch
The new Barbour Eyewear
collection was launched by Norville
Eyewear last week. The high profile
launch took place at London’s
Sloane Club and will be featured in
our next edition.
Jailed for theft
A 24-year-old man who stole
thousands of pounds worth of
designer glasses has been jailed
for 20 months. Ahmed Ebrahimi
forced entry into Boots Opticians in
Croydon late on August 8, and took
£87,733 worth of stock, reported
www.thisislocallondon.co.uk.
5
25/11/11 NEWS
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entrepreneurs featured in promotional 20-foot high images
outside Queen’s banker Coutts in London’s Strand. His image
was part of the bank’s celebration of Global Entrepreneurship
Week. The Coutts caption for Mr Wells, who is pictured alongside
the founder of Coffee Republic Sahar Hashemi, reads: ‘Jamie
took on conventional opticians in a great example of using the
Web to disrupt traditional ways of doing business…’
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News updated regularly at www.optometry.co.uk

optometrytoday
NOVEMBER 25 2011
Volume 51:23
ISSN 0268-5485
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NEWS
Bob Hughes has left the
live
bookshop
AOP to pursue new career
AOP chairman David Shannon
paid tribute to his achievements:
“Bob has contributed to the
success of the AOP over nearly
seven years. During his time
as CEO, Bob has raised our
profile and that of optometry
significantly in Parliament and
with the public. He has been
central to enewsletter
the development of
much closer working relationships
with the other optical bodies
and especially FODO; a move
which created the Optical
Confederation.
“The AOP now has a substantial
new property that will enable
us to increase our services to
members within an attractive
working environment, and will
also help us contain running costs
VRICS
well into the future.
“We are a more powerful
national lobbying force than we
have ever been, as well as being
able to operate effectively locally
through the LOC Support Unit
which Bob pioneered and helped
to build. The profession speaks
with a much stronger voice now
and we are grateful for his work
and his enthusiasm. We wish him
well for the future.
“The AOP has not yet
appointed a successor; Richard
Carswell, deputy chief executive,
will head the AOP while a
successor is recruited. Richard
has been with the AOP for
many years and is widely known
and respected throughout the
profession.”
Bob Hughes said: “I am
proud to leave the AOP with
increased capabilities to promote
optometry, with friends in all
political parties and the NHS
administration, and a first class
defence team able to stand
alongside individual optometrists
as they come under attack.”
Space flights have an
impact on astronauts’ eyes
A NASA study has
concluded that lengthy
space flights can cause
a number of changes
in astronauts’ visual
systems, with some
problems appearing
to persist long after
the astronauts have
returned to Earth.
The study team,
which included a
number of ophthalmologists,
was reported in the journal
Ophthalmology.
The researchers studied
seven astronauts, all of
whom were about age 50
and had spent at least six
continuous months in space.
All reported that their vision
became blurry, to varying
degrees, while on the space
station. Vision changes
usually began around six
weeks into the mission and
persisted in some astronauts
for months after their return
to Earth. Researchers agreed
that the eye abnormalities
appear to be unrelated to
launch or re-entry, since they
occurred only in astronauts
who spent extended
time in microgravity.
In-depth examination
of the seven astronauts
revealed several
abnormalities. All of
the subjects had one or
more of the following
changes in the tissues,
fluids, nerves and other
structures in the back
of the eye:
• Flattening of the back of
the eyeball (five subjects);
• Folds in the choroid, the
vascular tissue behind the
retina, which is the light
sensitive area in the back of
the eye (five subjects); and
• Excess fluid around and
presumed swelling of the
optic nerve (five subjects).
CET
Comment on the news via www.optometry.co.uk

PCTs banned from
capping cataract ops
Health Secretary Andrew
Lansley (pictured) has banned
PCTs from cutting costs by
enforcing minimum waiting
times and capping the operation
numbers for procedures such as
cataracts surgery – which some
PCTs have reportedly been using
as a way to save money.
PCTs have until March to
remove any arbitrary rationing,
and, following the deadline,
all decisions which ‘impact on
patient choice’ will be made at
PCT Board level. The rules will
not apply to new commissioning
groups.
The move comes following an
investigation by the Co-operation
and Competition Panel into
any instances where PCTs were
limiting patient choice or not
acting in the best interests of the
taxpayer.
Announcing the measure,
Mr Lansley said: “This is just the
beginning of a range of measures
we hope to introduce to make
the NHS truly patient focused. I
want a health service that works
around patients – not the other
way around.
“PCTs have to manage
resources carefully but they must
do so without restricting patient
choice. That’s why I am taking
firm action today and banning
these unfair measures imposed
on patients.”
RNIB eye health campaigns
manager, Clara Eaglen, applauded
the move. “RNIB welcomes the
commitment by the secretary of
state for health to end minimum
waiting times and arbitrary caps
on surgery, “ she said. “Both these
problems were highlighted
earlier this year in a joint report
from RNIB and the Royal College
of Ophthalmology on access to
cataract surgery.
“However it is far from
clear whether the measures
announced will provide a
solution.”
Commenting on the measure,
head of commissioning policy
for the PCT Network, Elizabeth
Wade, said: “NHS commissioners
should ensure decisions about
changes to local services that
might reduce or delay access
to care are not arbitrary, but are
based on careful deliberation
of the available evidence and
likely impact on patients. Where
there is poor commissioning
practice, we should not support
it. Nobody wants decisions on
patient care taken in an arbitrary
fashion purely based on cost.”
Advanced ordering software
Rodenstock has
introduced an advance
ordering system which
enables practitioners to track
orders 24 hours a day.
WinFit Reference’s online
software allows users to
input orders directly without
relaying information to a third
party, therefore reducing the
risk of error. Practitioners can then
monitor the production of their
order using the system’s real-time
tracking function.
The programme can be
connected to multiple computers
in a practice and also links to
Rodenstock’s dispensing software.
A 3D online calculation module
can be used as an interactive
demonstration tool which shows
exact base curve, shape and
substance at any point on the
finished lens.
Debbie Bathgate,
Rodenstock lens product
manager, said: “We are already
receiving excellent feedback
about the new system which is
designed to make efficient use
of opticians’ time. Everything is
recorded and information can
be accessed at any time.
“While ‘phone, fax and
written orders are still available,
we hope that WinFit Reference
will be a welcome development
and be less time-consuming. Our
WinFit Reference team is on hand
to offer advice and assistance
when needed.”
BRIEFING
Health village 2
Chemist Lloyds pharmacy is to open
a second ‘Health Village’, which
includes an opticians, following the
first of the concept which opened in
London’s Brent Cross. The second is at
Thurrock, Essex, and will be unveiled
in December, the website reports
www.retailgazette.co.uk
Expanded recall
CooperVision has expanded its global
recall of its branded Avaira toric and
Avaira sphere contact lenses. The
recall was initiated due to the level
of a residue on certain Avaira lenses,
and the company has said there have
been reports of wearers experiencing
hazy vision and unusual discomfort.
A website – www.coopervision.com/
international-recall/gb – has more
details.
Pub ruling
A Norwich pub has won the right
to have tables and chairs outside
its premises, despite the protests
of a practice manager who claimed
drinkers nearby posed a nuisance to
his patients. Moss & Leakey’s David
Foskett objected but a committee
from Norwich City Council granted
the owners of The Murderers pub
permission to retain its outside
tables and chairs after a number
of nearby businesses said the
pub brought business to the area,
reported www.eveningnews24.co.uk
Optos buoyant
Sales are soaring at retina imaging
business Optos, the Scottish
company has reported. Pre-tax
profits for the year to September 30
were up 73% to £14m, and revenues
rose by 35% to £91m.
Name change call
A Northampton practice owner
has started a campaign to have
part of the town centre renamed
‘Eastgate’, it has been reported. John
Sheinman, of Sheinman Opticians,
is aiming for the historic origin of
the area where his outlet is situated,
to be recognised.
7
25/11/11 NEWS
News updated regularly at www.optometry.co.uk

NEWS
comment
GOC posts healthy
financial quarter
8
25/11/11 NEWS
THE GOC is seeking to
press ahead to maintain a
‘downward pressure’ on its
Low Income Fee, a meeting
of the council heard this
week.
A paper tabled by Jeff
Cant, the GOC’s director of
resources, reviewed a healthy
financial quarter for the
council. He reminded those
at Thursday’s Harley Street
meeting that 12 months ago
the council had agreed a 20% reduction in
fees for the year April 1, 2011-2012 to £270. It
also was agreed at that point that fees would
have to increase to £274 from April 1, 2012,
assuming the rate of inflation was at 4%.
Mr Cant stated that it was good to report
that saving in costs in a number of efficiency
measures – including a ‘significant redu ction’
in the use of costly legal advice – of £250,000
is expected in the year despite inflation
running at over 5% and a reduction in income
into the GOC’s coffers of around £150,000,
with the introduction of the Low Income Fee,
which he called ‘an excellent outcome’.
For 2012-2013 “we are fully committed
to deliver this,” he said, “and to seek
further economies from our Invest to
Save programme to enable us to maintain
Next week’s meeting
of the All Party
Parliamentary Group
on Eye Health and
Visual Impairment
will hear from
health minister Earl
Howe, one of the
leading figures in the
government’s team
aiming to change the
NHS.
The meeting, which will take place on
December 1 in Committee Room 1 at the
downward pressure on
the fee in future years”.
He invited the
council to reaffirm its
commitment, and that of
the GOC staff, to seek ways
of getting the best value
from the budget available,
‘driving out inefficiencies
and delivering on its aim
to provide high quality
public protection’.
The cumulative spend
for the year to September 30 of £2.1m is
£390,000 (16%) below budget.
This was predominantly due to:
· Lower than anticipated Fitness to Practise
case charges largely due to the increase in
work carried out in-house and the impact of
re-negotiated fees to cap case costs which
have been dependent upon the nature of
cases and work completed by law firms
·Criminal prosecution cases have increasingly
been resourced in-house, reducing the need
to employ law firms
· Lower than anticipated spend on
consultancy within the CEO’s office budget
to improve the policy formulation and
governance processes
· Greater cost awareness and focus on
achieving efficiency gains across all budgets.
Earl Howe speaks to APPG
House of Lords, will start
at 4pm. It is expected
that the meeting will
provide the group
with an opportunity to
discuss with Earl Howe
the proposed changes
to the NHS, in particular
Public Health Indicators
and the need for an Eye
Health Indicator.
The RNIB and the
College of Optometrists provide the
secretariat for the group.
What’s their
Viewpoint?
It’s encouraging to read the profile
of Trevor Rowley’s newly opened
practice, Viewpoint, which is featured
on pages 34-35.
Early indications for the upmarket
store are good, reinforcing the belief
that if you can spot an opportunity
in the market, and sense an audience
is there for a certain type of product
or service, sometimes success and
everything else can follow.
It seems eons ago, but when I first
wrote about the retail sector for a living
back in the late 1980s it felt there was
a lot more money available to invest
in the High Street generally, if not the
experimentation and niche areas we
see today.
I can’t help but also think of the
excellent clinical presentations I
witnessed recently at the CooperVision
student summit. Although optometry
degrees deliver the expertise working
in practice requires, being retail
savvy is often picked up during a
practitioner’s career.
A few years ago there was little or
no wider help for optometry students
heading towards their first professional
role. That is now changing, notably
because of events such as the AOP
Student Eye Opener Conference.
This weekend’s event, as it has done
for the last few years, will provide a
good networking opportunity for those
students who attend, and will also be
useful for delegates to hear the latest on
what employers expect in the early part
of a practitioner’s career.
Who knows what success stories will
emerge from the latest Center Parcs
audience in the future.
David Challinor, Editor-in-Chief OT
Comment on the news via www.optometry.co.uk

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question time
Francesca Marchetti
AOP councillor and self-employed optometrist Francesca Marchetti works in both independents and
multiples. She also practises at the Midland Eye Institute and is a College of Optometrists’ councillor
10
25/11/11 QUESTION TIME
How are you?
I’m fine. Work’s very busy, enjoyable, in
particular the diversity of my work in
practice, as a councillor and a presenter.
What do you like about
working in optics?
I like absolutely everything, it’s as simple
as that. From all sides: the clinical area, the
fashion part, the people, the healthcare
element.
What’s the best thing that’s
happened in the profession
during your time working in it?
Compulsory CET. The great and the
good always did CET, but those isolated
practitioners didn’t realise they needed
to do it. It’s great for networking and
socialising and building the profession.
Who do you admire in the
sector?
I wouldn’t pick out any individual, just to
say every good, hard-working enthusiastic
optometrist.
Where are your favourite
places in the world that optics
has taken you?
Very close to home. In fact, Glasgow, where
I grew up. And also the House of Commons
as an AOP councillor and College of
Optometrists councillor.
Are you supersitious?
Slightly. I always throw salt over my left
shoulder. Never walk under a ladder.
What instrument could you not
do without?
Without a shadow of a doubt my Hamblin
Streak Ret’ bought for me by my father
for my 21st birthday. It’s never needed
servicing, apart from new bulbs.
If you were granted one wish
for the profession what would
you wish for?
Increased recognition of what we do as
optometrists, both in the clinical sector
and public sector. And having adequate
remuneration.
Do you have a favourite film
or TV show
La vita è bella (Life is Beautiful), the film.
Outside the profession, what
are your hobbies?
I love cooking – I’ve been on Ready,
Steady, Cook. Also running and skiing.
Sum up your feelings for the
next 12 months in five words.
No complacency, exciting, challenging,
positive.
Where do you go on holiday?
Barga, Italy where my family originates
from.
What are your favourite
products in the optical sector?
Blephaclean and Blephasol treatment for
blepharitis. They’re lovely products to sell
to women.
If you weren’t in the profession
what would you be doing?
A life coach, and presenter.
What’s your favourite singer or
musical group?
Frank Sinatra, childhood memories of
listening to his music with mum and dad
at home.
What do you put your success
down to?
The fact I’ve been open-minded to change
and adapted.
What’s your favourite time of
year?
Summer. I love outdoor living and the
more light hours the season brings.
Where would you spend your
perfect day?
Having a long, lazy lunch in my garden
with friends and family.
Any final thoughts?
Let’s move forward and look ahead,
embracing the challenges and turning
them into opportunities.
Question Time
Would you like to take our questions
and be involved in our regular Question
Time series? If so please write to David
Challinor, editor-in-chief of Optometry
Today by email at davidchallinor@
optometry.co.uk, or by post to: Question
Time, Optometry Today, 2 Woodbridge
Street, London EC1R ODG including
your contact details and availability.
Please be able to answer our questions
by telephone or email, and to provide a
good quality photograph of yourself.

Govt closes VAT loophole
NEWS
Companies undercutting
UK suppliers by selling lowvalue
goods such as contact
lens solutions from the Channel
Islands using the tax loophole the
Low Value Consignment Relief
will now have to pay VAT, the
government has announced.
The loophole closure is to
ensure there is no unfair tax
advantage as a result of trading
through – or from – the Channel
Islands compared to the rest of
the UK.
In the 2011 Budget, the
threshold for goods to qualify for
the Relief was lowered from £18
to £15, a measure which took
effect on November 1. This rate will
continue until it is abolished from
the beginning of April.
Explaining the reasoning behind
the policy change, exchequer
secretary to the Treasury, David
Gauke, said: “These reforms
will ensure that UK companies,
especially small and medium sized
enterprises, can compete on a
level playing field with those larger
companies with the resources to
set up operations in the Channel
Islands. By making these changes,
we are striking the best possible
balance between the costs of
collecting small amounts of VAT
and protecting the interests of UK
taxpayers and businesses.”
BCLA president, Shelly Bansal
(pictured), welcomed the move,
adding: “It remains to be seen
whether the change will lead to
a ‘fairer’ market for contact lenses
and care products, however, it
will undoubtedly affect those
companies that have used this VAT
loophole to ship contact lenses
and related products from the
Channel Islands via their online
businesses.
“Some may choose to absorb
the VAT costs within their
businesses, while others may
choose to increase their product
costs and/or close any distribution
businesses on the islands.”
11
College presents its diplomas
Three hundred newly qualified
optometrists celebrated collecting
their College of Optometrists
diplomas in front of 700 onlookers
at the graduation ceremony at
Westminster Central Hall, London.
As well as the presentation of
its diplomas, the College also uses
the ceremony to recognise those
who have made an outstanding
contribution to optometry locally,
nationally and internationally.
Anita Lightstone, John Adrian
Macdonald Jennings, Norbert
Cohn, Donald Cameron and
Colin Fowler all received Life
Fellowships with Peng Tee Khaw
being elected to the Honorary
Fellowship of the College, in
recognition of his outstanding
contribution to the optometric
profession.
College president Dr Cindy
Tromans told those receiving
the qualifications: “Today you are
beginning your career and we are,
rightly, celebrating this milestone.
But you must continue to develop
your skills, your knowledge and
your understanding throughout
your professional life.
“Since I qualified in 1986, there
have been many developments
in the profession. The increased
pace of science and technology
will mean that the changes
during your career are likely to be
even more profound.”
25/11/11 NEWS
FMO warns about allowance
Practice managers and
owners are being warned
by the FMO to take note
of next April’s changes in
Capital Allowance, which
include a reduction in annual
investment allowance from
£100,000 to £25,000.
Businesses considering
making large purchases such
as new technology, cars or
equipment have been urged
by the Federation to consider
the tax implications of doing
so before April 6, especially
if their financial year ends in
March or April.
FMO auditor, Irving Goldin,
told OT: “Even if your year
end is not March or April you
might be better off making
business purchases before
April as the reduction in
the allowance will be time
apportioned in accordance
with your financial year end.”
He also warned of a small
reduction, by 2%, of the
depreciation allowances –
which can include old assets
that are brought forward.
Companies are advised to
discuss details, especially of
hire purchase agreements,
with their accountants.
Mr Goldin added: “With
some careful planning, the
rules for capital allowances
can be maximised.”

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NEWS
14
25/11/11 NEWS
OBITUARY
Dr Gary Baker
It is with great sadness that I report
the death of Dr Gary Baker, aged 59,
a senior lecturer in the Department
of Optometry & Visual Science, City
University, writes Ron Douglas,
Professor of Visual Science and
deputy head of the department .
I first met Gary on the rugby
field almost 40 years ago when we
were both undergraduates at the
University of Sussex. After obtaining
a BSc in Experimental Psychology
in 1976, he also gained an MSc in
Neurophysiology in 1981 and a PhD
from London Guildhall University on
‘the gustatory system of cypinoid
fish’ in 1987.
He spent 12 years in the
world-leading laboratories at
the University of Oxford, and two
years with Michael Stryker at
the University of California, San
Francisco. During this time he
cemented his own international
reputation where his work, in
particular on the organisation and
development of the mammalian
retinal pathways, and on changes in
conduction velocity along individual
nerve axons remain gold-standards
in their fields.
He joined our Department
in 1999 and soon acquired a
reputation as an inspiring teacher
of ocular and visual anatomy and
function. He was enormously
popular among our students, being
a frequent nominee for University
Teaching Prizes voted for by the
student body, which he deservedly
won two years ago.
Gary also made significant
contributions to the running of the
undergraduate and postgraduate
programmes. He took on the
difficult roles of BSc Optometry
Programme Director in 2004, later
transferring his energies to the
task of coordinating the widening
of student participation via the
Foundation Degree in Ophthalmic
Dispensing run in collaboration
with City & Islington College.
He is deeply missed by
colleagues and students alike.
He leaves Maxine, his wife, and
two daughters, Bonny and Holly.
Plymouth aims to create
something ‘exciting’
THE new optometry
programme at Plymouth
University was officially opened
earlier this month.
The department, which
enrolled 36 first-year students
in September, is the ninth to
offer a BSc (Hons) degree in
optometry across the UK.
Local practitioners, LOC and
PCT insiders, as well as optical
industry representatives, attended
the launch and toured the newly
built state-of-the-art laboratories
based in the institution’s School of
Health Professions.
Pictures by Plymouth University
The FMO has honoured its
former representative on the
BSI standards panel, Derek
McLaren by awarding an annual
prize bearing his name to the
highest student in the ABDO final
qualifying exam.
The Derek McLaren Memorial
Prize was presented to the
winning student at the ABDO
graduation and Prize Giving
The course was established after
the university’s vice chancellor
Wendy Purcell spoke to a regional
director from Specsavers by
chance during a flight. Plans were
quickly put into motion and by
ceremony in Canterbury
Cathedral on November 23 by
Mr McLaren’s widow Christine.
“Derek would have been very
humbled, but also extremely
honoured, by this award in his
memory as optics was his life,”
she said. “He started his optical
career in the profession and later
moved to the industry, so this
award, combining the FMO and
June the university had gained
provisional approval for the
programme from the GOC.
Acknowledging the support
of FODO, Specsavers and
the College of Optometrists,
Dean of the Faculty of Health,
Education and Society,
Professor Richard Stevenson
said: “This celebratory event
is a huge milestone in the
journey of optometry at Plymouth.
It’s a statement that optometry
at Plymouth is here. Our doors
are open and we hope to create
something hugely exciting.”
Derek McLaren honoured
Pop star Max George from boy
band The Wanted was crowned
‘Celebrity Wearer of the Year’
at Specsavers’ Spectacle Wearer
of the Year awards last week
(November 15).
The annual event, hosted by
‘fashion guru’ Gok Wan and
actress Kara Tointon, marked
the 15th year of the awards
and was held at the Boiler
House in Battersea Power
Station, London.
Following a six-month
country-wide search for the
‘Spectacle Wearer of the Year
2011’, Lucie Stevenson from
Falkirk, Scotland (pictured)
was revealed as the overall
winner, receiving a 12-month
ABDO ticks all the boxes and is
most appropriate. “
Mr McLaren died in August.
Pop star shows specs appeal
modeling contract with MOT
Models, as well as a Caribbean
holiday for two.
A total of £10,000 was
raised for anti-bullying
charity Kidscape through the
competition and an auction on
the evening.
Other awards went to
Diversity dance member Perri
Kiely for ‘Best Newcomer’ and
past Strictly Come Dancing
contestant Nancy Dell’Olio for
‘Glamorous Glasses Wearer’.
Comment on the news via www.optometry.co.uk

enefits
Big discounts available
with AOP Privileges
16 28
08/04/11 25/11/11 COVER AOP PRIVILeGES
STORY
AOP members can now recoup a large amount of their
membership fees through savings on everything from phone
bills to family holidays, thanks to a brand new privileges
scheme launched by the Association.
In tight economic times it makes sound financial sense to
save money wherever possible and the exclusive discount
secured by the AOP, in association with benefits company
Parliament Hill Ltd, will help members make savings in all
areas of their lives.
“It is a great opportunity for AOP
members to make big savings”
Discounts available include: 5% discount on supermarket
shopping; savings on home telephone lines and broadband
through Shebang; lower rates on gym membership at outlets
across the country with an Incorpore membership; access
to an exclusive price comparison website which can help
members save on energy bills; training course savings and
even website design.
For practitioners looking to take a well-earned break from
work, company Superbreak offers London Theatre breaks
including a stay at a London hotel and tickets to see top
West End shows.
The AOP has also secured discounts with several more
relaxing destinations including breaks available with
CottageStayUK, a company which offers holidays in a
variety of relaxing rural locations not just in the UK, but
also France and Italy.
A choice of thousands of family holidays are also
available for practitioners looking to take the children away,
with an online discount of 8% available on holidays with
Thomas Cook.
Practice managers and owners can access discounts to help
them invest in business solutions such as: 45% off all Microsoft
Desktop Applications Training, including Word, Excel, and
PowerPoint using QA training solutions; SiteWizard offers a
30% reduction on its low cost website and eCommerce solution
provider; AOP Privileges members also receive 20% off annual
stationery and office supplies bills through the Buying Support
Agency.
As well as these deals, the scheme offers Cashback Gift Cards
which can be topped up with money and can be
spent at major retailers and offer between 5% and 15% cashback
when used for everyday purchases from the likes of Marks &
Spencer, ASDA, Sainsbury’s, Boots, Comet, Top Shop and B&Q.
Director of Parliament Hill Ltd, Andrew Holden told
OT: “In tough economic times every penny counts and
that is why AOP Privileges has been created. These offers are
only available to select user groups so they are not available
to the public, which means it is a great opportunity for AOP
members to make big savings.”
Available exclusively to members and their families,
AOP Privileges is easy to access, simply click on the ‘members
benefits’ area of the AOP website at www.aop.org.uk then click
‘AOP Privileges’ from the menu.

Eight top ways to earn back the cost of your AOP membership
1. Get an 8% discount online on thousands of holidays
from over 100 tour operators with the Thomas Cook
Holiday Club.
2. A Gourmet Society dining card can offer you
2-for-1 dining or 25% off your bill including drinks.
Choose from over 4,500 leading restaurants including
some Michelin-starred establishments. A national
Gourmet Society membership for 12 months has an
RRP of £69.95, but AOP members can get a 14-month
membership for just £24.95.
3. CottageStayUK is the UK’s leading cottage short
break member benefit, with fantastic cottage discounts
across the UK, France and Italy. AOP members receive
10% off all year round prices and special offers.
4. Vehicle Servicing Manager (VSM) uses the UK’s
largest network of independent garages to deliver
average savings of 30%, on all your car servicing and
repair requirements. With VSM you can also save 20%
on the cost of your next MOT.*
5. AOP members have access to exclusive mobile
‘phone contracts through Shebang, which is one of the
country’s largest retailers of mobile phones. Members
have access to all the latest network tariffs and handsets.
6. Member Energy’s new free energy price comparison
service will help you find the cheapest gas and electricity
suppliers in your area. The average saving for members is
currently £237* for dual fuel.
7. Cashback Gift Cards is an exciting new way of making
the most of your money! Earn cash back of between 5%
and 15% on everyday purchases from major retailers
including M&S, ASDA, Sainsbury’s, Boots, Comet,
Debenhams, Topshop, B&Q and many more.
8. Get beautiful
flowers and gifts
at amazing
discounted
prices
delivered
direct
to your
door with
Flowers
Direct, using the
10% AOP discount.
17
25/11/11 AOP PRIVILeGES
Example savings available
from AOP Privileges
• Save a minimum of £50 and as much as £250 on gym membership
• Save £33.60* with Superbreak on staying at a three star central
London hotel, including breakfast, with two top class adult tickets to
see Grease the musical on a Saturday evening
• Save £143.50* with CottagStayUK for seven nights at Knowle Farm
Cottage near Bude, Cornwall
• Save £187.20* with Thomas Cook on a seven night holiday for four
to Turkey
• Save £129.87* on an Excel level four course through QA
• Save £179.98* + VAT on a five page website design and launch with
SiteWizard
*Terms and conditions apply. See the website for further details. VSM not available in Northern Ireland. Member Energy available for households in
England, Scotland and Wales (mainland only). Member Energy average saving calculated using figures taken from November 2010 until April 2011.
Other savings used illustrative. AOP Privileges is managed on behalf of the AOP by Parliament Hill Ltd of 127 Cheapside, London, EC2V 6BT. Neither
are part of the same group as a provider.

ADVERTISEMENT FEATURE
Leading the Way with New Fits
Hayley Wainer, owner of City Opticians Hawkes & Wainer in Leadenhall Market describes
how embracing new technology and innovation is integral to a successful practice.
Based in the historic Leadenhall Market
(Diagon Alley in the Harry Potter films)
Hawkes & Wainer have seen their fair
share of changes over the years having
been established in the City of London
since 1919. They embrace change and
actively seek new and better ways to
run their business so that Hawkes &
Wainer can remain a thriving practice.
We asked Optometrist and owner
Hayley Wainer about some of the
initiatives that have helped her and her
team to maintain a successful practice.
Wainer explains: “To survive in business,
particularly in the City, you need to
be flexible. Our patient population
is predominantly in the insurance
business and associated industries. Our
challenge is dealing with discerning
individuals who not only demand a first
class service from us but as they spend
their working lives negotiating it’s in
their nature to request the best deal
possible. For that reason we run a very
flexible fee structure, which delivers
exactly what our patients are looking
for. Flexibility is particularly important
for our contact lens business. My father
Ivan, the figurehead of our practice,
has been fitting contact lenses for over
forty years and they are integral to
our business. I would say that during
“I have felt for some time
now that CIBA VISION
is really supporting
independent practitioners,
which is a key factor in
our success”
these difficult economic times our
contact lens business has continued to
grow thereby allowing us to continue
to invest in the clinical care we offer.
Certainly the support we have received
from CIBA VISION over the past few
years has played a large part in that.”
With such a challenging patient
population we wanted to know what
Hawkes & Wainer has done to maintain
a successful contact lens business and
explore the role that CIBA VISION has
played in this.
“I have felt for some time now that
CIBA VISION is really supporting
independent practitioners, which is a
key factor in our success”, said Wainer.
“For example the new trade terms
for the new products that have been
launched over the past few years; it
all helps independent practitioners
to grow and maintain their business.
Furthermore, the educational
initiatives that the company has
introduced over the past few years
have been excellent. I have been lucky
enough to attend the MBA part 2,
which I found to be incredibly helpful
and thought provoking and have
now implemented a great deal of
this into our daily practice. We have
had some fantastic sessions from the
CIBA VISION Practice Academy, where
qualified eyecare professionals have
carried out staff training at Hawkes &
Wainer and I have also attended many
roadshows at which I have gained
a tremendous amount of clinical &
business knowledge that I have then
been able to apply in my practice.”
Hawkes & Wainer recently ran a
Big Fit promotional day, which is
the latest campaign offering from
CIBA VISION. “What a great idea”,
enthused Wainer, “It is so important
to keep attracting new customers.
Inevitably we lose some patients when
they move away from the Leadenhall
Market area so we need initiatives
such as the Big Fit to replace them.
The help we got from CIBA VISION
in setting this up was fantastic. The
company provided all the supporting

www.cibavision.co.uk
What Can A Big Fit Day Do For Your Practice?
Help your practice engage with more people and the benefits of contact
lenses
Encourage them to experience clear vision without glasses
Help your practice grow in patient numbers and revenue
Big Fit days have resulted in up to 35 contact lens trials
To find out how your practice could benefit from a Big Fit event
contact your local CIBA VISION Business Development Manager.
literature and they even organised the
promotional team who handed out
leaflets and encouraged customers to
come into the practice and try contact
lenses. All in all setting this up was very
easy and stress free. The day itself went
well and we found it to be an effective
way to increase new contact lens fits.”
As technology advances and healthier,
more comfortable lenses come on to
the market practitioners have a duty
of care to ensure that their patients
are in the best possible contact lenses
for their needs; something that is
very important to the Hawkes &
Wainer team. They are a big contact
lens practice and have a lot of pre
“The new trade terms
from CIBA VISION are very
fair and very transparent.
I feel like someone has
finally taken notice of the
independent practitioner.”
and early presbyopes in the practice
and are currently fitting a significant
number of them with AIR OPTIX ®
AQUA MULTIFOCAL – even existing
daily disposable lens wearers. “These
are demanding patients who were
committed to their daily lenses but
are now absolutely delighted with
the AIR OPTIX ® AQUA MULTIFOCAL
lenses. They are happy because I have
preserved their binocularity and they
can read. Remembering that our
patient population is predominantly
involved in the insurance world, this
is incredibly important for them. The
comfort level is also excellent from
morning right through to night-time.
Quite simply our presbyopic patients
love these lenses. New fits are vital to
our business and something that we
are always looking out for.”
Have the new trade terms from
CIBA VISION had an impact on the
practice? This is a new initiative from
the company designed to grow the
whole contact lens market. The new
pricing system recognises the role of
independent practitioners in actively
recommending, fitting, and providing
after care services for contact lenses.
In brief, all CIBA VISION customers
who fit contact lenses will qualify for a
fitting discount of 8%, customers who
actively promote CIBA VISION contact
lenses and utilise the company’s EASI
online ordering scheme will qualify
for an additional 3% discounts. The
system has been designed to be
transparent and fair.
“The new trade terms from
CIBA VISION are very fair and very
transparent. I feel like someone has
finally taken notice of the independent
practitioner. It’s very refreshing for a
company to offer single practices such
as ours these kinds of discounts. We
are a large practice but haven’t always
qualified for such discounts. This fairer
system helps us to be as competitive
as possible.”
© CIBA VISION (UK) Ltd, a Novartis company, 2011. AIR OPTIX, the AIR OPTIX logo, CIBA VISION and the CIBA VISION logo are trademarks of Novartis AG.

INDUSTRYNEWS
20
25/11/11 INDUSTRY NEWS
News update
Limited edition
for Christmas
Rimless eyewear
manufacturer,
Silhouette, has
launched a limited
edition Crystal
Glamour eyewear
model which will
be available in
time for Christmas
but only by special
request and for a short time only. Crystal
Glamour is part of the company’s successful
Crystal Collection which was launched earlier in
the year. The accessory eyewear is designed to
attract attention at any festive gathering as it is
strewn with delicate fine cut crystals, including
on the lightly tinted lenses themselves. Each
of the 38 faceted crystals on each lens is set
individually by hand, making each piece
unique.
Crystal Glamour is intended to be the first in
a series of festive, special edition collector items
from Silhouette. Each will be made to order.
& 0208 987 2434
Boost for lab
The quality
management
standard ISO9001
has been achieved
by Tant Laboratories
which it believes
will help drive up
efficiency and win new business. The project
involved 12 months of preparation looking at all
Tant’s internal procedures.
Lenstec Group MD, Nigel Castle, said: “It’s a
fantastic achievement for Tant to achieve ISO
accreditation that provides a consistent base
for improving the process flow through the
laboratory. Tant Labs has recently undertaken
robot production investments and training
programmes to support this achievement.
“We find our customers support our
investment in achieving recognised standards
that keep us in the forefront for producing
consistent quality.”
The company has a new All-In-One
Catalogue out which includes a promotion for
Trivex and Emporium kids frames.
& 01279 653 785
20 years of benefits
Rodenstock Club is celebrating its 20th anniversary
by offering independent opticians even more reasons to
join the popular frames loyalty initiative.
The Club was founded in 1991 solely for
independents, and has evolved to provide a unique
portfolio of products as well as rewards package. The
benefits for being a Rodenstock Club member include
contributions to local advertising, branded open days,
loyalty bonuses, annual training and early
bird promotions.
Members receive full marketing support
to increase their sales and attract new
customers. It includes direct marketing,
advertising templates, public relations,
product imagery and point of sale
merchandise.
Members are also eligible for the annual
awards, this year taking place at the recently
refurbished Savoy in London. The award
winners will join Rodenstock in Florence to
experience the renowned club hospitality.
& 01474 325555

‘Eyes heaven’
launched in
London
High fashion, handmade frames
company Cutler and Gross has launched
a bespoke frames service by opening
The Museum above its Knightsbridge
store, featuring a permanent display of
1,000 of its iconic frames and sunglasses.
The Museum’s Lacquered Room in total
houses over 4,000 frames and sunglasses,
dating from 1969 to the present day.
Despite the economy, the company’s
turnover is up 50% this year, on top of the
50% increase last year and as part of the
expansion, an additional workshop was
bought in Italy.
Bespoke service
The bespoke service was officially
launched at an exclusive event for 120 of
the national fashion press, which included
OT’s Robina Moss and various film crews.
The shop at 16 Knightsbridge Green is just
behind Burberry’s flagship store and was
specially decorated in keeping with the
theme of the last collection, Hong Kong
Love Story (pictured left).
The bespoke service opens up the
service previously used by celebrities and
pop stars but is available by appointment
only. An eyewear stylist helps clients
select a frame from one of the archive
designs or choose a unique style, colour
and material combination to create
their own one-off eyewear. Colours can
be matched to a customer’s clothing
and there are even acetate frames
incorporating newsprint and lace.
“The Museum really is eyes heaven,”
said chief executive Majid Mohammadi.
“There are no limitations on what we
can do. We have the biggest collection
of glasses to choose from and if a client
wants something else we can still do
it. We can give them exactly what they
want.”
The launch event was held after recent
Fashion Weeks and the company’s new
biannual magazine was handed out. It can
be viewed online at www.cutlerandgross.
com and is part of an initiative to
educate clients about the brand and the
craftsmanship behind the frames.
& 020 7581 2250
Greater precision
Carl Zeiss Vision believes it has raised the
bar even higher for precision refraction and
centration as the newly launched i.Profiler
plus and i.Terminal 2 systems are said to
be achieving a new level of excellence for
individualised precision lenses.
i.Profiler plus and i.Terminal 2 (pictured)
lay the ideal foundation for generating the
most individualised vision profile available
from Zeiss. All the measurements are then
incorporated into the company’s precision
lenses ensuring they reflect the wearer’s
personal vision profile.
Measurement is said to reach new
heights of precision, speed and ease of use
for a fast processing time with increased
sales and satisfied patients.
i.Profilerplus combines an autorefractor,
keratometer, aberrometer and corneal
topography in a single system. In about 30 seconds the i.Profilerplus system analyses all
parameters needed for the use of lenses featuring i.Scription technology with accuracy to the
nearest 1/100 dioptre.
After including i.Scription technology in their product offering, eye care professionals have
been recording an average increase of 27% in their lens sales revenue, and of 15% in the
number of lenses sold.
With the i.Terminal 2 centration system in addition to refraction, precise centration data
ensures optimal adaptation of the lenses to the eyes of the wearer. Both systems are also the
winners of the 2011 reddot design award.
& 0845 300 7788
Three for the kids
There are nine new frames in the three Actman Junior ranges, which are designed to
appeal to fashionable youngsters, reflecting the latest grown-up look but keeping a colourful
character. The emphasis is on affordable, robust design with frames that ‘are cool for kids and
kind on the pocket’. Cookie is a bold acetate full rim for girls. It is offered in ‘shocking’ pink
and blue with the slightly more understated colours of light pink and purple available for a
subtler look and also tortoiseshell for a more grown up look.
Teddy is a full rim metal boys’ frame available in a dark red, dark blue with highlights of
lime green and a reddish brown with cream detail. Jellybean is a unisex metal frame. It has
the look of a stylish supra but keeps the stability needed for a robust child’s frame by still
maintaining a full rim metal.
& 0151 526 2626
21
25/11/11 INDUSTRY NEWS

22
25/11/11 SPECTATOR
SPECTATOR
‘Every little helps’ as chancellor
removes VAT exemption
In the same week that the government announced its
plans to remove (rather than simply reduce as previously
announced) VAT exemption for low value goods – otherwise
know as ‘consignment relief’ (LVCR) imported from the
Channel Islands – any cost-conscious contact lens wearer
who is also considering the possibility of cosmetic surgery
may also find that VAT has just been added to that bill also.
Some cosmetic procedures are exempt from VAT if their main
purpose is the protection, maintenance or restoration
of health, but updated guidance from HM Revenue &
Customs (HMRC), makes it clear that patients will only avoid
paying the tax if they have been diagnosed with a medical
condition. There are reports that HMRC anticipates this
will raise a further £500m in tax every year, dwarfing the
anticipated recovery of £200m a year through the abolition
of LVCR. For the impoverished chancellor, it may be a case
‘every little helps’, and encouragement for the government
to search out further examples of apparently lax taxation
arrangements.
Foraging for savings wherever they can be made is evidently
symptomatic of the economic climate, as were the headlines
in the last edition of OT of: ‘AOP resists fee pressures,’
and ‘Challenging market affects Boots Opticians.’ We will
encounter daily
examples of
the impact of
the economy
on both our
professional
and personal
lives for the
foreseeable
future, so it was
all the more
encouraging
to read about
the positive
messages being
presented to
the sector at the
recent NOC,
by those from outside the profession. Of course, at times like
these, the sector needs to work together to prepare for the
upturn which will eventually come – a quote often attributed
to Sir Richard Branson applies here – “in good times fortunes
are made; in tough times empires are built”. Virgin Money’s
recent acquisition of Northern Rock is evidence that he has
the confidence to follow his conviction, and so should our
sector, as, according to one of the NOC keynote speakers:
“You hold more power than you realise.”
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The Royal College of Nursing chose last weekend to fire a
broadside at the government by claiming that changes in the
NHS will result in 56,000 job losses among doctors, nurses,
midwives and other NHS staff. Accepting that the RCN may
have presented an unbalanced argument, it is inevitable,
with approximately 70% of the NHS budget being spent on
staffing, that staff will be affected by efficiency gains. But it
is not the case that every job removed will result in a worse
outcome for patients (official government figures show that
while the number of managers will be reduced by 13%,
the equivalent fall for nursing staff is likely to be nearer to
1%). And if the stress of the process causes some to seek
support from an understanding GP that they may be signed
off as long-term sick, then that too is about to become more
difficult if the findings of a government-backed review, due
to be published this week, are implemented. Arguing that
people should be signed off for long-term sickness by an
independent assessment service and not GPs, co-author of the
report, Professor Carol Black said the current system was not
working for anyone. While a spokesman for the Department of
Work and Pensions offered: “The economy loses £15bn in lost
economic output each year due to sickness absence and we
cannot continue to foot this bill.” No doubt the chancellor has
spotted this one as well.
For more comment visit www.optometry.co.uk

LETTERS
Sponsored by
Clarification on retinal degenerations
24
25/11/11 LETTERS
Re the article on Peripheral Retinal
Degenerations (OT September 30, p44-
48), with all due respect to the authors of
this article, I would be grateful if you could
clarify the section on CHRPE and FAP. In
the article it states that ‘When CHRPE are
found in groups, known as bear tracks, it
is worth.........in case they are a sign of rare
inherited condition of the bowel known
as FAP’. I wonder if you could research/
clarify this for me because I had previously
understood that multiple CHRPE in the
same area of the fundus (bear tracks)
were not usually suspicious (look at
http://www.opticianonline.net/assets/
getAsset.aspx?ItemID=1921). However,
multiple bilateral (spread out/isolated in position) CHRPE or
atypically shaped (especially fish shaped or oval), and those with
a depigmented halo, were the ones to ask about family history
of gastrointestinal problems. This is the newest article I can find
regarding CHRPE:
Optical Coherence Tomography of Retinal and Choroidal Tumors,
Emil Anthony T. Say, Sanket U. Shah, Sandor Ferenczy, and Carol L.
Shields http://ukpmc.ac.uk/articles/PMC3145171/
Having spent time Googling the literature seems to be somewhat
contradictory. I would be really grateful if you could shed some light
on this as I am now rather confused! As CHRPE are such a common
finding I think it’s important to have a clear understanding. A couple
of years ago one of the DOCET CET quarterly review CD’s covered
this topic but of course I can’t find it!
Rachael Smith, optometrist
Graham Macalister, optometrist at Moorfields Eye Hospital, replies:
Thank you for your enquiry, we are glad to have the opportunity
to expand a little on the topic of CHRPE. The vast majority of these
pigmented lesions are innocuous and do
not require referral. Typically they occur as a
solitary lesion in one eye. There is a variant in
which multiple lesions are grouped together
in clusters giving the impression of paw prints
(Bear tracks). These are usually confined to one
quadrant and are present in only one eye. Bear
track CHRPE do not warrant referral. However
suspicion should be roused when there are
multiple CHRPE-like lesions which have a
haphazard distribution with no grouping. These
could be pigmented ocular fundus lesions of
familial adenomatous polyposis (POFLs)1 and
since they are associated with an inherited form
of colon cancer referral would be warranted.
They sometimes have an atypical shape such as
pisciform (fish tail) or fusiform (spindle), but the
diagnostic criteria with the highest specificity/
sensitivity for POFLs includes the detection of
at least four small pigmented lesions, or two lesions of which one
is large (>25% of disc area)2. Also the presence of multiple bilateral
lesions appears to be a highly specific marker for POFLs (95–100%
specificity) 3. Remember that CHRPE are very common and POFLs
are very uncommon. Optometrists should feel free to refer any
pigmented lesion that they are not sure about, but a good guideline
would be to monitor CHRPE without referral unless they meet all of
these three criteria:
• multiple (4 or more)
• Not in groups (ie not bear track)
• Bilateral
References
1. Coleman P, Barnard S. Congenital hypertrophy of the retinal
pigment epithelium: prevalence and ocular features in the optometric
population. Ophthalmic and Physiological Optics. 2007 27 (6),
547–555
2. Tiret, A, Taiel-Sartral, M, Tiret, E, et al. Diagnostic value of fundus
examination in familial adenomatous polyposis. Br J Ophthalmol
1998;81: 755–758.
3. Morton, DG, Gibson, J, Macdonald, F, et al. Role of congenital
hypertrophy of the retinal pigment epithelium in the predicitve
diagnosis of familial adenomatous polyposis. Br J Surg 1992;79:
689–693.
OT Letters, 2 Woodbridge Street, London EC1R 0DG E: davidchallinor@optometry.co.uk The Editor reserves the right to edit letters and points out that the views expressed may not be those of the journal.

COMPETITIONS
Christmas crossword
This issue we continue our popular crossword series. So why not enter our competition before
the closing date of December 30, 2011. The winner will receive £50 in Marks & Spencer vouchers
Name:
Address:
across
1. Parasitic plant which
encourages closeness between
couples! (9)
8. Encouraging start – but fails
to maintain impetus! (5,2,3,3)
11. Distressing teenage
affliction (4)
12. Musical term (5)
13. Singing voice (4)
16. Streamlined engine
cover (7)
17. Expanse of treeless
grassland (7)
18. Part of a vehicle’s cargo
from which revenue is
obtained (3-4)
20. A model of its kind (7)
21. London district (4)
22. Type of terrier (5)
23. Spoken word (4)
26. Clear evidence of
autumn (7,6)
27. Railway compartments for
passengers (9)
down
2. Abbreviate date (4)
3. Following closely behind (7)
4. Competition applicants (7)
5. Not closed (4)
6. In the distance (1,4,3,5)
7. Roman designation of
the A5 (7,6)
9. Ceremonial parade (5,4)
10. Energy conversion
unit (5,4)
14. Smaller version (5)
15. Relating to birds (5)
19. Assists the person
washing-up (7)
20. Decorative leaves (7)
24. Appeal (4)
25. Lacking colour (4)
25
25/11/11 CROSSWORD
Send entries to OT Christmas Crossword, 2 Woodbridge Street, London EC1R 0DG by December 30, 2011. You can now enter OT’s Crossword competition
online at www.optometry.co.uk.

DIARYDATES
26
25/11/11 DIARY DATES
Book now for FMO meal
FMO members and their guests can once again enjoy a fun Christmas
lunch this year, organised by the Federation on December 15 at the
Paddington Hilton Hotel in Central London.
To capture the event a series of photographs will be taken of those
who form the FMO’s individual sector Frame, Lens and Equipment
Focus Groups.
Prior to the lunch, at 1pm, its AGM will be held. For more details,
contact: 020 7298 5123 or sfisher@fmo.co.uk.
NEW… 7 WOPEC, School of Optometry
and Vision Sciences, Cardiff University,
Maindy Road, Cardiff, New accreditation
PEARS/WEHE Winter 2011 SEE ABOVE
NEW… 12 Northern Optometric Society,
Manchester Conference Centre, Manchester
Eye surgery lecture SEE ABOVE
NEW… 13 WOPEC, School of Optometry
and Vision Sciences, Cardiff University,
Maindy Road, Cardiff, WLVS practical
training day two SEE ABOVE
14 UltraVision, Head Office, Leighton
Buzzard, Bedfordshire, KeraSoft IC
workshop and fitting techniques
(workshop@ultravision.co.uk)
NEW… 15 FMO, The Hilton Hotel,
Paddington, London, Christmas Lunch
(www.fmo.co.uk)
JANUARY
9 Lancashire Optical Society, Swallow
Hotel, Preston, Glaucoma management in
secondary care (janelbarker@yahoo.co.uk)
NEW… 15-16 Eyecare 3000, Hilton Hotel,
Glasgow, Annual conference run by Replay
Learning (www.eyecare3000.com)
NEW… 16 Warwickshire AOP, The Venture
Centre, University of Warwick Science
Park, Coventry, Therapeutic treatment
of the anterior segment lecture (susan@
susanrbowers.co.uk)
NEW… 23 Northern Optometric Society,
Manchester Conference Centre, Manchester,
Current and evolving treatments for diabetic
retinopathy SEE ABOVE
30 BCLA, 76 Portland Place, London, Evening
meeting (events@bcla.org.uk)
FEBRUARY
NEW… 6 Northern Optometric Society,
Manchester Conference Centre, Manchester,
Onocology lecture SEE ABOVE
NEW… 6 Nottingham and Derby Optical,
Wolloughby Hall, Nottingham University
Park Campus, Nottingham, Visual field loss
lecture (NDOS@live.com)
NOVEMBER
NEW… 28 Northern Optometric Society,
Manchester Conference Centre, Manchester,
Contact lens comfort lecture (www.
northernoptom.com)
DECEMBER
NEW… 4 Wales Optometry Postgraduate
Eductaion Centre (WOPAC), School of
Optometry and Vision Sciences, Cardiff
University, Maindy Road, Cardiff, Disk
dilemmas (http://www.wopec.co.uk/events)
NEW… 6 NEOS, Holiday Inn Express,
Waterloo Square, St James Boulevard,
Newcastle Upon Tyne, Electronic eyes for the
blind (neosoptoms@hotmail.co.uk)
NEW… 6 North London AOP, City University,
Northampton Square, London EC1, Flashes
and floaters (stevedross10@hotmail.com)
NEW… 7 College of Optometrists, Ramada
Plaza Gatwick, South East regional event
(www.college-optometrists.org/southeast)
NEW… 9 Northern Optometric Society,
Manchester Conference Centre, Manchester,
Peer review session SEE ABOVE
NEW… 10 NEOS, Holiday Inn Express,
Waterloo Square, St James Boulevard,
Newcastle Upon Tyne, LASER lecture SEE
ABOVE
13-15 Opti ’12, New Munich Trade Fair
Centre, Munich, Germany (www.optimunich.com)
NEW… 7 NEOS, Holiday Inn Express, Waterloo
Square, St James Boulevard, Newcastle Upon
Tyne, Glaucoma management SEE ABOVE
13 Lancashire Optical Society, Swallow
Hotel, Preston, Modern management of
keratoconus and irregular corneas
SEE ABOVE
NEW… 20 Northern Optometric Society,
Manchester Conference Centre, Manchester,
Allergy lecture SEE ABOVE
briot Hi res optom 2day.indd 1 26/10/2011 15:46
See more events at www.optometry.co.uk/events

2012
36th BCLA
Clinical Conference & Exhibition
INTERNATIONAL CONVENTION CENTRE, BIRMINGHAM, UK
Competing for
Excellence
Conference
24 – 27 May 2012
Exhibition
25 – 27 May 2012
The one event you cannot afford to miss!
• Renowned international speakers
• More than 40 CET points
• Programme tailored to your needs
• UK’s largest FREE contact lens industry exhibition
Registration opens in January 2012
Save over £100 on your delegate fee –
become a member of the BCLA today.
Be part of the BCLA Clinical
Conference - inviting
submissions now for:
• Papers/Posters/Abstracts
(Deadline: 13 January 2012)
• Photographic Competition
(Deadline: 27 April 2012)
Visit www.bcla.org.uk
to find out how you can get involved
Book your
place by
9 March 2012 to
receive the early
bird discount.
Follow us on
and
Patron Platinum Gold
Abbott Medical Optics
Optometry Today
Sauflon
Topcon
British Contact Lens Association, 7/8 Market Place, London, W1W 8AG, UK
+44(0)207 580 6661 +44(0)207 580 6669 events@bcla.org.uk www.bcla.org.uk
@

PRODUCTS
Case in
point
28
25/11/11 ACCESSORIES
Distinctive cases for spectacles and contact lenses
can help boost footfall and profits at the traditionally
quiet time in the practice which is fast approaching.
Robina Moss looks at the latest on offer to give your
patients an unusual Christmas stocking filler idea
Christmas
CL cases
Optipak, a UK
designer of
contact lens cases,
has introduced a
range of new fashion
themed contact lens
cases and Christmas
themed cases
(pictured). The attractive
compact displays each
hold 12 cases and are
designed for counter top
retailing. Made from premium
plastic the cases come with
rubber washers to give a leak proof
seal. To see the range visit www.optipak.co.uk
& 0208 322 4210
On-trend coverings
New in Dunelm’s cases this year are on-trend denim coverings, as well as
an array of print patterns including everything from flags
(pictured) stars, hearts and polka dots to the more unusual
Wellington boots, cupcakes, animal prints and nautical
themes.
“We also offer various free accessory packages when
ordering frames from our Janet Reger, John Rocha and
Paul Costelloe designer ranges,” said Dunelm director Peter
Beaumont. “With Paul Costelloe, consumers take away not
only their new designer frames, but a tasteful brown leather
case and purple cloth, all packaged in a
specially designed gift bag featuring one of
the designer’s own unique sketches.”
To view the ranges, visit www.
dunelmoptical.co.uk.
& 01388 420420
Bespoke options
The new ‘J65’ case (pictured) is one of a new series of
colourful cases that Caseco has introduced which can be
viewed on www.caseco.co.uk. There is a wide range of
models available for all ages. The company also provides a
range of bespoke options on cases, microfibre cloths and
lens cleaning liquids.
“In this difficult business environment, our customers have
appreciated the innovation and colour range of our bespoke
options,” said MD Peter Wood. “They may be a necessary
purchase but we can use creative ways to ensure these
products have a marketing impact.”
& 01580 890111
Cute and FDA-approved
Optisafe offers FDA-approved 3D contact lens cases in
six cute animal shapes – froggy (pictured), piggy, hippo,
elephant, fish and bear. They are easily identified left and
right screw top cases which come individually wrapped in
poly bags. They are suitable for storing all contact lenses
and carry the CE marking of conformity (Medical
Devices Directives 93/42 EEC). To see the range visit
www.optisafe.co.uk
& 07703 174560

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Cardioace ® advanced formula includes
vitamins, minerals and antioxidants, plus
vitamin B1 to help maintain a healthy heart.
Cardioace ®
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phytosterols to help maintain a healthy
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Recommended by leading UK optometrists
Expert nutrition to help maintain heart health
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Vitamin supplements may benefit those with
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40
YEARS

EVENTS
AOP Council elections
THE AOP will shortly be holding its elections for AOP
councillors to serve on Council from May 2012.
All AOP members are entitled to stand for election,
optometrist members to represent optometrists.
30 28
08/04/11 25/11/11 COVER COUNCIL STORY ELECTIONS
New constituencies
From 2012, optometrists will be elected to represent
geographical constituencies. Previously, some optometrists
represented members through geographical constituencies
and others through modes of practice (employed and selfemployed
optometrists). Councillors elected in 2012 to
represent geographical constituencies will continue to
represent the interests of members as employed and selfemployed
optometrists.
From 2012, the geographical constituencies will be larger
than the previous constituencies and represented by more
than one councillor. Previously each constituency was
represented by one councillor. Voting optometrist members
of the Association, including hospital optometrists, each have
one geographical constituency in which they vote to elect
representatives to Council.
To represent a geographical constituency a candidate must
be nominated, seconded and elected by optometrist members
who are entitled to vote in that geographical constituency.
Councillors representing geographical constituencies need not
represent the constituency in which they are entitled to vote.
The changes to constituencies were adopted by the AOP
Board of Directors in January 2011.
The table below shows the new geographical constituencies
and the number of AOP members who will be elected to
represent each constituency.
The chart on page 31 sets out the postcodes which
fall within each constituency. Members have previously
Councillors
Constituency
5 East of England & East Midlands
5 London
5 North West England
5 South East Coast & South Central England
nominated their geographical constituencies according
to where they lived or worked. These were allocated to
constituencies on the AOP membership database by postcode.
For the 2012 elections, the postcodes have been transferred
to each member’s new constituency. Each member’s new
constituency was set out on the AOP Membership Renewal
Notice which was sent to all members recently. Members
should check that their new constituency is their chosen
geographical constituency according to where they live or
work and, if the information is incorrect, to amend it on the
AOP website in accordance with the guidance below.
Additional seats on Council
In addition to the elected optometrists on Council, a
dispensing optician member is elected to represent dispensing
opticians. Dispensing opticians do not have a geographical
constituency. A further five members are appointed to
Council, one each to represent the following members:
hospital optometrists, academic optometrists, newly qualified
optometrists, pre-registration optometrists and undergraduate
student optometrists.
5 South West England & West Midlands
5 Yorkshire & Humber & North East England
2 Northern Ireland
4 Scotland
3 Wales
Transitional arrangements
In May 2012, all elected seats on Council will be due for
election. Following the elections in 2012, in order to establish
the working of the new Council there will be no elections
in 2013. Thereafter one third of the seats on Council will
be elected annually by rotation. On August 12, 2011, AOP
Chairman, David Shannon, drew lots for the geographical
constituencies which will be elected by rotation from 2014.

1. East of England & East Midlands: AL, CB, CM, CO, DE, IP, LE, LN, LU, MK, NG, NN, NR, PE, SG, SS, WD
2. London: BR, CR, DA, E, EC, EN, HA, IG, N, NW, RM, SE, SM, SW, TW, UB, W, WC
3. North West England: BB, BL, CA, CH1-4, CH>8, CW, FY, IM, L, LA, M, OL, PR, SK, WA, WN
4. South East Coast & South Central England: BN, CT, GU, HP, KT, ME, OX, PO, RG, RH, SL, SO, TN
5. South West England & West Midlands: B, BA, BH, BS, CV, DT, DY, EX, GL, GY, HR, JE, PL, SN, SP, ST, SY1-8, SY11-15, TA, TF, TQ, TR,
WR, WS, WV
6. Yorkshire and The Humber & North East England: BD, DH, DL, DN, HD, HG, HU, HX, LS, NE, S, SR, TS, WF, YO
7. Northern Ireland: BT
8. Scotland: AB, DD, DG, EH, FK, G, HS, IV, KA, KW, KY, ML, PA, PH, TD, ZE
9. Wales: CF, CH5-8, LD, LL, NP, SA, SY9-10, SY>15
31
These are: 2014: East of England and East Midlands, London,
Northern Ireland; 2015: North West England, South East
Coast and South Central England, Scotland; 2016: South
West England and West Midlands, Yorkshire, Humberside
and North East England, Wales. The dispensing opticians’
representative will next be due for election in 2013. New
student representatives will be appointed in 2012 and the
other appointments will next be made in 2013.
2012 eleCTiONs
The elections for seats on the AOP Council will be conducted
between December 2011 and May 2012.
In accordance with the byelaws, to elect the new Council,
the period of service of all current elected AOP councillors
will terminate at the annual general meeting in 2012.
Councillors elected to represent the new constituencies will
take their seats on Council following the AGM in 2012.
All AOP members entitled to stand for election to Council
may do so.
Council nominations for 2012
1. In December, guidance and a nomination form, in pdf
format, will be put on the AOP’s website and emailed to
AOP members whose email the association has. Members
who wish to receive a paper copy should contact Steven King
(contact details right).
2. A reminder about the election nomination process
and timetable will be published in OT and e-mailed to
members in Blink and Optometry Today in January 2012.
3. Members who wish to stand for election to the Council
in May 2012 must return the duly completed nomination
form to the AOP before 12 noon on January 27, 2012.
Updating your voting constituency
Optometrist members have only one constituency, a
geographical constituency which has been allocated
according to the postcode of each member’s mailing address.
Please visit the AOP website, www.aop.org.uk, to check your
constituency is correct. To do this click on “Members’ Area”.
There log in via the “Secure Area Login” page. If you need
to register before logging in, do so by following the links on
the page. Once you have logged in to the secure area, click
on “Update My Details”. You will find your geographical
constituency under “Mailing Information” where, if your
constituency is incorrect, you can change to the correct
constituency by selecting either “Home” or “Business” as
appropriate. While visiting the website, please take the
opportunity to review the contact details, especially the
email address the association has for you, and update them
if necessary.
If you are unable to check the website yourself or have noone
to do it on your behalf, please contact the Membership
Department (email membership@aop.org.uk or telephone
020 7549 2010), AOP staff will check the website and make
any necessary changes for you.
Geographical constituencies must be updated before
January 20, 2012 to ensure that you will be sent the correct
constituency ballot form which will be prepared at the end
of January.
2012 election timetable
Following the close of nominations on January 27, the 2012 election
timetable will be as follows:
January 27 Notify candidates if they have been returned
unopposed. Request personal details and election addresses from
candidates in constituencies where elections will be held. Closing
date: February 17.
March 2 Electoral Reform Services will e-mail voting instructions to
members in constituencies in which elections are being held. Voting
will be conducted over the Internet. Elections close on March 23.
March 23 Inform candidates of the results. Send new councillors
forms for self-nomination for the Board elections. Forms to be
returned by April 6.
April 6 Despatch voting papers for the elections to the Board of
Directors. Elections to the Board close on April 20. (Councillors
may not serve on the Board of Directors during their first year on
Council.)
April 20 Notify councillors of the outcome of the Board elections.
May 15-16 Annual General Meeting and Council meeting.
Further information about the elections and appointments to
Council and the role and duties of AOP councillors is available on
the AOP website or from Steven King (e-mail: stevenking@aop.org.
uk; telephone: 020-75 49 20 18).
25/11/11 COUNCIL ELECTIONS

COVER STORY
Magnificent seven
32 28
This autumn saw the launch
of CooperVision’s first-ever
student summit competition.
It involved reaearch studies
from seven universities, and
David Challinor – who was
part of the judging panel –
reports
08/04/11 25/11/11 COVER STUDENT STORY SUMMIT
IT WAS an unseasonally warm day
on the south coast when lecturers and
students representing seven universities
travelled to CooperVision’s plant
near Southampton to contest the first
‘student summit’.
The competition was the brainchild of
the contact lens company’s professional
relations manager Karl Aberdeen, who
introduced the day, which included a
tour of the business, networking meals
and social activities.
But it was the students’ contact lensrelated
presentations that took centre
stage. Each university team gave its
presentation before a team of judges
from the universities and optical press.
Bradford University’s student duo
of Pat Frils and Barney Norris presented
their work on Peripheral Refraction in
Soft Contact Lenses early in the day.
From their research, the pair
concluded that different soft lens
designs can produce significantly
different peripheral refractions,
with some lenses appearing to give
a relatively hyperopic peripheral
refraction.
Their work was well-received, though
they agreed more research was needed
in this area.
Aston’s Steve Wright and Maryam
Mousavi discussed Oxygen Saturation
in the Limbal Region at Baseline and
During Contact Lens Wear. From their
study of 25 people aged 18-61, they
found no effect due to age or sex, with
short-term contact lens wear providing
little effect, however some regional
differences in oxygenation were
concluded.
Cardiff’s Katie Demery outlined her
work, Investigating Visual Performance
of Cosmetic Contact Lenses, using
examples from popular culture before
discussing her research which involved
10 subjects. She found that comfort
levels were severely reduced with
cosmetic contact lenses, and though
vision was unaffected clinically one of
her subjects complained of an ‘annoying
orange glow’ in the periphery. She also
noted that, in terms of corneal thickness,

The panel decided that Bradford’s Pat Frils
and Barney Norris should collect the prize...
there was significantly more central and
inferior swelling with cosmetic lenses.
Importantly she concluded that
unregulated supply of cosmetic contact
lenses could have serious implications
for patient ocular health.
The University of Ulster’s Owen
Coyles led a presentation on Non-
Invasive Measurement of Tear Meniscus
Height (TMH) and Tear Break-Up
Time (NITBUT). In his research, he
found no significant correlation found
between NITBUT and lower lid tear
meniscus, height (LTMH). Therefore, it
cannot be assumed that an individual
with a larger tear volume indicated
by the presence of a large lower tear
meniscus will have a more stable tear
film and yield a longer NITBUT and
vice versa. However, a highly variable
nature of tear film stability giving
large differences in NITBUT between
individuals and when taking multiple
recordings at the timed intervals is, in
his opinion, due largely to variations in
individual’s vertical palpebral aperture
and tear component production.
Glasgow Caledonian University’s
Lesley Thom spoke of The Cornea in
Diabetes Mellitus, looking at how the
cornea is affected by diabetes and how
important is this in contact lens wear.
Using OCT equipment she concluded
there was a slight increase in CCT (and
IOP). Also, some trends which are
appearing in the analysis of research
work currently in progress included a
slight decrease in ECD (especially in CL
wear); increased COV of cell size, and
lower percentage of hexagonal cells.
City’s Chloe Waterton discussed
Factors Influencing the Fit and
Selection of Contact Lenses for
Presbyopic Patients in Practice in
her presentation. In her research, she
surveyed 42 presbyopic patients ranging
from 47 years to 71, divided them
equally into multifocal, monovision and
single vision.
Her conclusions included that it is
not in the patient’s best interest to have
one multifocal design, and that cost is
not readily a negative factor if the lens
works out well for the patient in terms
of comfort and vision. Also that the
correction of presbyopia in contact lens
wearers should be treated on a ‘case-bycase’
basis, but success was dependent
on patient motivation, and the patient’s
expectations must be managed by the
practitioner.
The final presentation was from the
University of Manchester students
Sundeep Kaur and Smaira Fazil. They
had carried out an investigation of the
sensitivity of the marginal and tarsal
conjunctiva in soft contact lens wearers
and non-contact lens wearers. One
of its aims was to map the sensitivity
of the cornea, limbus, palpebral
conjunctiva and marginal conjunctiva
in soft contact lens wearers and noncontact
lens wearers. The pair studied
20 subjects – 10 contact lens wearers
and 10 non-wearers – and in terms
of aeshesiometry, results found no
difference between the groups, though
with a trend towards less lid margin/
wiper sensitivity in contact lens
wearers. The pair said their research
warrented further investigation with a
larger sample size.
After a lengthy and detailed
discussion by the judges it was decided
that Bradford’s Pat Frils and Barney
Norris should collect the winner’s prize
for their work, Peripheral Refraction in
Soft Contact Lenses.
After the presentations, the
celebration continued with a sailing
tour of Portsmouth’s historic docks,
and then a meal at one of the city’s
most lively restaurants.
Other participants
included:
University Lecturers
Dr Rebekka Hietmar – Aston University
Dr Catharine Chisholm – Bradford
University
Arnold Cochrane – University of
Ulster
Dr Graeme Kennedy – Glasgow
Caledonian University
Dr Katharine Evans – Cardiff University
Caroline Christie – City University
Judges on the panel
Dr Rebekka Hietmar – Aston
University
Dr Catharine Chisholm – Bradford
University
Arnold Cochrane – University of
Ulster
Dr Graeme Kennedy – Glasgow
Caledonian University
Dr Katharine Evans – Cardiff University
David Challinor – Optometry Today
33
25/11/11 STUDENT SUMMIT

PROFILE
Viewpoint of
excellence
Optix MD Trevor Rowley has opened a new practice in York city centre which takes technology
to a new level and surpasses what you would expect of an optometric software pioneer, believes
OT’s Robina Moss who attended the official opening
34 28
08/04/11 25/11/11 VIEWPOINTORY
PROFILE
The new practice in Feasegate is called Viewpoint and is
the first UK centre of excellence for Nidek featuring the latest
technology from the company in its prescreening and consulting
rooms.
The practice has the world’s first new Nidek AFC-330 Fundus
camera, which is approved for diabetic retinopathy screening
and is virtually operator-free. It also has the new Nidek OPD
Scan III which introduces a new technology to the market which
it is believed ‘will revolutionise a practice and the clinical
information available to the optometrist’. Within 60 seconds it
can take nine measurements from both eyes including a night
vision assessment. There is also a Nidek RS-3000 OCT and
the three consulting rooms each have Nidek RT-5100 Auto
Phoropters linked to the new Thomson 3D Xpert Chart.
Viewpoint is also a showroom to illustrate what Optix software
can achieve in practice and is an ‘eyewear ambassador’ for
Boucheron frames from Paris. Such is the calibre of the retail
space that Cartier unusually supported the new practice.
The business has been relocated from a narrow building
nearby which had the practice on four floors. Mr
Rowley (pictured) has had a practice in York since
1985 and wanted to expand into larger premises
when the lease ran out. Viewpoint now has 15
staff with a new optometrist and dispensing
optician currently being recruited.
The new practice was a former Halfords
which was completely renovated to
offer a large retail space all on one floor.
The attention to detail is inspiring with
marble, backlit Onyx on the walls to
highlight the designer frames with
lighting controlled from the reception
desk.
There is also Smart glass which goes
opaque when it senses movement, thus
ensuring privacy for patients in the
clinic behind the reception area and
customers in the prestige area. iPads
have been installed with a special App
to show with a slide of the fingertips
when a consulting room is in use. Even
the patient’s toilet has real stone on the
walls and would not look out of place
in a five-star hotel.

35
“I know some will be shocked that we bought six iPads at £800-£900 each
to use as signage but it makes the right statement of what we’re about...”
25/11/11 PROFILE
“It’s all about creating the right impression,” explained Mr
Rowley. “I know some will be shocked that we bought six
iPads at a cost of £800-£900 each just to use as signage but it
makes the right statement of what we’re about. Our ethos is
uncompromising excellence in everything. We’re going for the
‘wow’ factor and I’m proud to say that we’ve achieved it.”
Visitors to the official opening agreed. “It’s the finest
practice in Europe, that’s why we chose it as our first UK
centre of excellence,” said Chris Tyler, CEO of Nidek UK. “It’s
simply outstanding for the customer journey, from the range
of frames through to the use of lighting to display them. It has
great footfall and enables us to showcase our technology in
the ideal retail environment.”
Viewpoint financial controller Andrew Harrison explained:
“We’ve spent well in excess of £700,000 on the new practice
but it’s quality not quantity which counts. The quality of the
eye examination is already spreading by word of mouth. We
can already see that it’s swiftly paying back, with the average
dispense around £600.”
The practice is situated in a fashionable shopping area near
the famous York Minster. Tourism is York’s biggest industry
and visitors from abroad have already purchased frames
at the practice to have glazed when they return home. The
practice has also benefited from people who visit York on a
regular basis. It opens on a Sunday, has a wide catchment
area and has been a particular hit with women who can buy
the latest high-end frame without having to travel to London.
The frames collections are impressive and include Cartier,
Lindberg bespoke frames and Ørgreen. There is also Gold &
Wood, Porsche Design, Martin & Martin, Tom Davies bespoke
and the Blac exclusive range from Denmark. There are Tom
Ford frames, gotti from Switzerland, Paul Smith, Lafont and
an entry range from Jimmy Choo with frames from £170. The
most expensive frames retail at around £2,500. At the official
opening representatives from Oliver Peoples, Maui Jim and
Fred attended to show the new ranges for next year. The
lenses offered include Rodenstock, Zeiss and Nikon.
“This is high-end retail,” explained Mr Rowley. “We have
arranged specialist staff training to help the staff move from
contact lenses to selling high end frames.”
The newest member of staff is DO Michael Blenkisop who
has grown up in optics as his parents and his sister all work in
the sector. So what attracted him to the new practice?
“I was attracted by the uniqueness of the offering,” he said.
“There’s a real buzz about the place and I love that we offer
the best eye care and eye wear.”
The practice is an inspiration but there were lessons learned
along the way for other practice owners. “You have to have it
very clear in your mind what you want even with excellent
shopfitters such as we had,” said Mr Rowley. “You have to
be there all the time as they don’t see issues in the same way.
Even though they were passionate about the job at the end of
the day they are not opticians and it is all about the details.”
And his advice for other practitioners considering a new
practice? “It’s all about making a statement. Decide what the
market needs in your area and just go for it,” he said.

VRICS
Visual Recognition
and Identification
of Clinical Signs
Sponsored by
This FREE VRICS test should be completed online by clicking on the “VRICS Test” button at http://www.otcet.co.uk/
and answering the Multiple Choice Questions (MCQs) using the associated images. Please note that there is only
one correct answer for each MCQ. The associated reading list provides useful help for completing the MCQS.
Successful completion will result in two CET points. VRICS regularly appears in Optometry Today.
Vision Assessment in Ocular Disease Part 1
Course Code: C-17158 O
Dr Raymond Beirne, BSc (Hons), MCOptom, PhD
About the author
Dr Raymond Beirne is an optometrist and lecturer at the University of Ulster. He is responsible for
the Advanced Examination Techniques undergraduate module and his main research interest is
visual function in the ageing eye and ocular disease.
36
1. When assessing the optic nerve head of a patient with the visual
field defect shown in Image A, which of the following is the most likely
appearance to be found?
a) C:D ratio of 0.6, ISNT rule obeyed
b) C:D ratio of 0.6 with significant superior neuro-retinal rim loss
c) C:D ratio of 0.6 with significant inferior neuro-retinal rim loss
d) C:D ratio of 0.6 with nasal neuro-retinal rim loss
25/11/11 VRICS
A
2. Which of the following techniques is LEAST likely to improve the early
detection of the visual field defect shown in Image A?
a) Frequency doubling technology
b) Short-wavelength automated perimetry
c) Optical coherence tomography
d) Heidelberg Edge Perimeter
3. Which of the following statements about the colour vision test shown in
Image B is FALSE?
a) It is a colour arrangement test
b) It can detect protan, deutan and tritan colour vision defects
c) It can reliably differentiate between dichromats and anomalous trichromats
d) The test uses 85 different coloured caps
B
C
4. Which of the following options BEST describes the result shown in Image
B?
a) Normal
b) Protan defect
c) Deutan defect
d) Tritan defect
5. Image C shows the VA and contrast sensitivity results of a patient with
early nuclear sclerotic cataract in their right eye. If the VA test was carried
out at 4 metres what is the patient’s logMAR VA?
a) 0.20
b) 0.08
c) 0.32
d) 0.38
6. Which of the following statements about the contrast sensitivity test
used to obtain the results in Image C is true?
a) The patient should wear their habitual reading prescription for this test
b) The result is the lowest triplet where one of the three letters in a triplet is read
correctly
c) The contrast sensitivity score is based on Weber contrast
d) A working distance of two metres should be used
Presbyopia and Its Management with Contact Lenses
25th November and 12th December 2011

CONFUSED ABOUT CET REQUIREMENTS? www.cetoptics.com/cetusers/faqs/
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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
January 27 2012. cet points for this exam will be uploaded to Vantage on February 6 2012.
2 FREE CET Points
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Dispensing Opticians
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References to aid completion of the exam:
Q1 & Q2: http://webeye.ophth.uiowa.edu/ips/PerimetryHistory/index.htm
Q3 & Q4: Formankiewicz, M (2009). Assessment of Colour Vision: Colour Vision Part 2.
OT, 23rd October
Q5 & Q6: http://www.scribd.com/doc/59085894/Pelli-Robson-ETDRS-Score-Sheet-Instructions
Q7 & Q8: Hancock, S (2008). Clinical Decision Making I: Visual Field Interpretation. OT, 11th July
Q9 & Q10: Binns, A (2011). Assessment & Management of AMD: Referral Refinement Part 4.
OT, 20th May.
Q11 & Q12: http://webvision.med.utah.edu/book/part-viii-gabac-receptors/psychophysics-of-vision/
7. Which of the following statements about the test result shown in
Image D is FAlse?
a) The results could account for overall depression in sensitivity due to cataract or
pupil miosis
b) The results are for a patient’s right eye
c) The results could account for a retinal cause as the midlines are not respected
d) The results are reliable
37
D
8. Which of the following is the most likely cause of the test result
shown in Image D?
a) Cataract
b) Lid ptosis
c) Glaucoma
d) Patient fatigue
9. Which of the following best describes the appearance of the test result
shown in Image E?
a) Metamorphopsia
b) Hemianopia
c) Paracentral scotoma
d) Central scotoma
25/11/11 VRICS
E
F
10. Which of the following assessments would be LEAST useful to
conduct when investigating the cause of the test result shown in
Image E?
a) Binocular indirect ophthalmoscopy of the macula
b) Monocular visual acuity
c) Monocular contrast sensitivity
d) Confrontation visual fields
11. Image F illustrates which of the following psychophysical methods
that can be used for obtaining a visual sensitivity threshold?
a) Descending method of limits
b) Bayesian staircase method
c) Fixed step size staircase method
d) Ascending method of limits
12. In a clinical context, which of the following statements about
the psychophysical method used for obtaining the visual sensitivity
threshold illustrated in Image F is FAlse?
a) This method is completely free from errors of habituation and anticipation
b) The threshold can be measured as the average of several reversal points
c) This method is faster at estimating threshold than the method of constant stimuli
d) When used in perimetry, starting stimuli are visible to the observer
For more information on all our courses, please visit:
www.thevisioncareinstitute.co.uk

STUDENTNEWS
Sponsored by
38
25/11/11 STUDENT NEWS
‘Blinded’ to mark WSD
An optometry student spent 24
hours ‘blind’ to mark this year’s World
Sight Day last month.
Wearing special eyewear to block out
light, Aston University undergraduate
Jeff Clarke tried to carry on with his
day-to-day routine such as attending
lectures, going to the library and making
dinner.
Relying on his classmates to direct
him around campus, Mr Clarke had to
A Halloween party is the latest event
organised by optometry undergraduates at
Glasgow Caledonian University to raise money
for their forthcoming Eye Ball.
The students (pictured) raised £368 through
ticket sales for the event which was held at a
local student venue in Glasgow’s city centre.
Costumes on the night included Where’s
Wally?, Minnie Mouse, the cast of the Wizard of
Oz, Cruella Deville and many more.
New department seeks PhD student
The newly opened optometry department at Plymouth University is
seeking a PhD student for a fully-funded studentship starting early
next year. The three-year fixed term research project will be based on
the ‘post-operative assessment of modern intraocular lens designs and
the assessment of the biomechanics of the anterior eye’.
The successful candidate would have the unique opportunity to get
quickly adapt to avoid injury and mess
whilst eating.
Third-year and AOP council student
rep, Mr Clarke said: “It was a very
challenging day as I had taken for
granted how much I rely on my vision.
I quickly realised it was going to be a
long and difficult day when I woke up
and couldn’t check my emails or text
messages.
“Throughout the day, I was amazed to
hear how many people were inspired by
our event and who mentioned that they
had never realised how much they take
for granted their sight until they saw us
stumbling around the campus.”
A pub quiz organised by the
university’s Optics Society marked the
annual day and helped raise money for
the cause.
Combined the events raised more than
£200, which will be divided between
Optometry Giving Sight and Vision Aid
Overseas.
Essilor awards Cardiff Prize
Cardiff optometry students Robin Clayton and Daniel McGhee have
been named this year’s recipients of the ‘Essilor Prize’.
Whilst Mr Clayton received the award for best performance in
dispensing in the second year, Mr McGhee was awarded the prize for the
same unit in the third year.
Pictured is Mr Clayton (pictured right) being presented with the award
from Essilor professional relations manager Andy Hepworth (left) and head
of optometry and vision science professor Tim Wess (centre).
Hair-raising
Halloween party
involved with a new optometry programme, have access to stateof-the-art
research facilities and could attend conferences overseas.
Applicants must hold a first or 2:1 degree in optometry and be able
to start in January or April, 2012. For further information on the
opportunity telephone Phillip Buckhurst on 01752 588884. The deadline
for applications is December 1.

OT CET Video
C-17876 O/D/CL: The Tear
Film in Contact Lens Wear
The cause of dry eye is multi-factorial and can
affect contact lens wear resulting in drop-out.
However, newer contact lens materials are
available to help practitioners reduce dry eye
symptoms by lubricating the eye during
contact lens wear. In this video, learn about
the difference between these materials and
which performed the best in a recent trial
undertaken by Professor James Wolffsohn of
Aston University.
You must be logged in to 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 December
31 2011. Points will be uploaded to CET Optics up to
10 days later.
SPONSORED BY
www.optometry.co.uk

CET CONTINUING
EDUCATION
& TRAINING
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40
25/11/11 CET
Distortion of Vision
to
Referral REFINEMENT Part 12 C-17573 O
Mark Benson, MB, ChB, MSc, FRCS, FRCOphth
Metamorphopsia, or distortion of vision, is an important visual symptom,
particularly if it is the chief reason for a patient seeking optometric
assessment. It often indicates serious underlying pathology, and it always
demands thorough history-taking and examination. There are many causes
of visual distortion, but in most cases with underlying ocular pathology
the problem is in the macula. This article discusses the more common
causes of such symptoms, including epiretinal membrane, macular hole,
age-related macular degeneration (AMD), non-AMD choroidal neovascular
membranes, central serous retinopathy (CSR) and vascular maculopathies.
Epiretinal Membrane
An epiretinal membrane (ERM) may be
thought of as a delicate sheet of glial
“scar” tissue that has formed on the
surface of the retina in response to some
sort of retinal upset. By far the most
common cause is posterior vitreous
detachment (PVD), which probably
causes slight trauma of the retinal
surface, not in itself sufficient to lead to
symptoms. A healing response ensues,
with the formation of a glial membrane.
Like any scar tissue this then contracts,
Figure 1
“Punched-out” appearance of full-thickness
macular hole, with surrounding sub-retinal fluid
leading to a wrinkling of the retinal
surface. This anatomical distortion of
the retina, usually involving the macula,
may then produce distortion of vision.
In some cases the anatomical change is
associated with a pathophysiological
effect leading to associated waterlogging,
or oedema, of the macula
with further worsening of vision.
Sometimes an ERM may be a sequel
to previous retinal vascular occlusion,
or retinal laser treatment or surgery.
Macular Hole
For reasons that have yet to be
established, macular hole is much more
common in females than in males.
Unlike ERM, most are not associated
with PVD. Indeed, it is the nonseparation
of a contracting vitreous
face, leading to tangential traction
across the fovea that is thought to be
the cause of the condition. Initially
this traction produces a detachment
of the fovea – known by the misnomer
stage I macular hole. The vitreous may
separate at this stage to give a PVD,
but if not, then the fovea may dehisce
For the latest CET visit www.optometry.co.uk/cet
give a small hole – the stage II fullthickness
macular hole (FTMH). Over
time this hole enlarges, and there is
often seepage of fluid beneath the rim of
the hole to give the classic appearance
of the “punched-out” FTMH (stage III)
(Figure 1). Eventually the vitreous may
separate to give a PVD, a stage known
as stage IV FTMH. Note that there is
no loss of retinal tissue, and the hole
hardly ever leads to retinal detachment
(but can in high myopes). Central vision
usually settles at around 3/60-6/60
acuity in an untreated case, and in 10%
of people the condition is bilateral.
Age-Related Macular
Degeneration (AMD)
Referral refinement of AMD has been
discussed previously in this series (see
OT May 6 2011 and May 20 2011) and
it is probably the most important of
the causes of distortion because it is
increasingly common and can often be
treated. The condition is more common
with advancing age. In its “dry” form it is a
degeneration affecting Bruch’s membrane
and the retinal pigment epithelium
(RPE), with secondary changes in the
retina. The subject may have noticed a
preceding slight reduction in vision,
with difficulty in making out detail,
and poor reading vision in conditions of
reduced illumination. These symptoms
Figure 2
Myopic fundus with pigmented juxtafoveal
choroidal new vessels

elate to the “dry” degenerative changes.
As Bruch’s membrane is compromised,
blood vessels may grow through from
the choroid to directly underlie the
retina, particularly beneath the central
macula. These vessels are fenestrated,
and thus leak fluid, which pools
beneath the macula and penetrates into
41
it. This is “wet” AMD. As the macula
is lifted the vision becomes distorted.
The new vessels proliferate beneath
the elevated retina and spread out,
gradually being replaced by “scar”
tissue. The vessels may bleed, and this
Figure 3
Angioid streaks with parafoveal scar from choroidal
new vessels.
Figure 4
Scattered hypo- and hyper-pigmented lesions of
presumed ocular histoplasmosis syndrome
may result not only in sub- and intraretinal
haemorrhage, but occasionally in
breakthrough bleeding into the vitreous.
Increasingly, those affected by AMD
are becoming aware that distortion of
vision may herald the onset of the wet
form of the condition. Note, however,
that dry AMD may also cause some
distortion. This is usually mild, and
fairly static, unlike wet AMD where the
distortion worsens almost day-by-day.
Non-AMD Choroidal
Neovascular Membranes
and PIC scattered foci of inflammation
occur, resulting in the characteristic
appearance of these conditions, with
sub-retinal hypo-and hyper-pigmented
lesions (Figure 3). Blunt ocular trauma
may lead to large, curvilinear breaks
in Bruch’s membrane, which may be
complicated at a later date by the growth
of CNV. Angioid streaks is a hereditary
condition resulting in a degeneration
of Bruch’s membrane and the RPE. It is
named thus because the resulting breaks
in Bruch’s membrane resemble blood
vessels on cursory examination (Figure 4).
bilaterality even when there have been
no subjective symptoms from that eye.
Vascular Maculopathies
There are many vascular abnormalities
of the fundus that may affect the
macula, but those most often
seen in optometric practice are:
• Diabetic maculopathy
• Branch retinal vein occlusion
• Central retinal vein occlusion
Diabetic maculopathy is one of the
chief causes of visual loss in people
with diabetes and a common cause
25/11/11 CET
Although AMD is by far the most
common cause of choroidal new
vessels (CNV), there are many
Central Serous Retinopathy
(CSR)
of sight impairment registration.
Retinal vein occlusions are a relatively
common cause of sudden visual loss
other underlying aetiologies that
In stark contrast to macular hole, this
in one eye. In all of these conditions
may lead to this same end-point:
condition is much more common (20x)
macular oedema may ensue. In the
• Myopia (Figure 2)
in males than females. It typically affects
case of diabetic maculopathy there is
• Sub-retinal inflammatory conditions
a younger age group, most commonly
usually evidence of retinopathy, in the
e.g. presumed ocular histoplasmosis
in the third and fourth decades. Those
form of microaneurysms, flame-shaped
syndrome (POHS) (Figure 3), punctate
affected by CSR may have several or
haemorrhages, so-called cotton wool
inner choroidopathy (PIC)
many episodes, so the subject may
spots, and exudates. In the case of
• Trauma
report previous episodes of distortion.
retinal vein occlusion there are scattered
• Angioid streaks (Figure 4)
The pathophysiology of the condition
flame-shaped haemorrhages, and larger
• Idiopathic CNV
is not fully understood, but it seems to
blot haemorrhages, sometimes with
The common factor with these
be related to a temporary breakdown in
cotton wool spots. The distribution of
conditions is compromise of Bruch’s
those mechanisms that control fluid flow
the haemorrhage is in one quadrant of
membrane and this is what allows
across the retina, such that fluid pools
the fundus, in one hemisphere, or in all
new vessels to grow into a sub-retinal
beneath the retina. There are usually
quadrants, for branch, hemi- and central
position. In some myopes, breaks in
associated pigmentary changes in the RPE
retinal vein occlusions respectively.
Bruch’s membrane may be seen on
(Figure 5), and subtle RPE abnormalities
It is unusual for distortion to be
fundoscopy as “lacquer cracks”. In POHS
in the fellow eye may indicate
the presenting symptom for these
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42
25/11/11 CET
maculopathies, even when macular
oedema is demonstrable, and indeed
distortion may be a minor symptom
for the patient, if present at all. It is
not uncommon, however, for patients
with macular oedema to complain of
micropsia. This occurs because the
macular oedema effectively spreads
the photoreceptors further apart, and
the image is hence seen as smaller. The
opposite effect sometimes occurs with the
surface-wrinkling maculopathy of ERM.
Taking the history
Not surprisingly, the symptoms of
distortion and reduced VA tend to go
together. If there is distortion, then that
is often described by the patient as their
chief complaint. Sometimes, however,
it is only mentioned as a symptom after
some prodding. If the symptom is not
offered by the patient, but they complain
of reduced central vision or other
central visual abnormality, then you
should ask if their vision is distorted.
If there is a scotoma, is it absolute,
or can the patient see “through” it?
It is important to ask about the duration
of the symptom: distortion that has been
present for twelve months is unlikely
to require same-day assessment. It is
also important to determine the degree
of recent change in the symptom. As
mentioned above, fairly static distortion
of a mild degree is not infrequently
present in dry AMD, whereas the wet
form of the condition, in the acute stage,
often produces distortion which can
be seen to worsen day by day. This is
also true of CNV of other aetiologies.
The distortion of macular hole and
of ERM usually reaches a steady
state, with VA of about 6/60-3/60 in
macular hole, and better than this in
ERM. Is there a history of previous
visual distortion? If so, particularly
in a young to middle-aged male, then
this is strongly suggestive of CSR.
Figure 5
Central serous retinopathy (CSR)
Is there a history of previous visual
loss weeks, months or even years
prior to the distortion? The patient
may describe the sectorial visual
field disturbance associated with a
previous retinal vein occlusion; or
they may volunteer the information
that they have had such an event.
Note the age of the patient,
and ask if they have diabetes. Is
there a history of ocular trauma?
Examination
The VA may give some clue to the
aetiology in stable distortion, with
macular hole typically around 6/60 to
3/60, and ERM 6/9 to 6/24 (there are
exceptions, of course, and note that VA
in ERM is likely to steadily worsen before
stabilising); note whether the patient
uses eccentric fixation, or has to “search”
for the letters. Is the patient myopic?
There may be no clinical signs in the
anterior segment, although a history
of ocular trauma may be corroborated
by pupillary sphincter ruptures,
lens subluxation, or phacodonesis.
In people with diabetes, and those
with suspected previous vascular
occlusion, you should examine the
iris carefully for evidence of rubeosis
iridis prior to dilatation of the pupil.
It is unwise to venture an opinion on
the macula without first dilating the
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pupil. Before focussing on the macula
however, examine the vitreous (see
OT October 28 2011). A PVD is likely
in ERM and unlikely in macular hole.
Examination of the macula at the slitlamp
with the hand-held condensing
lens (e.g. 90D or 78D) allows stereoscopic
assessment of macular elevation. Look
for the signs of degenerative AMD
(drusen and pigmentary changes). Can
you discern a sub-retinal membrane? Is
there sub-retinal blood? Look for lacquer
cracks in a myopic patient; these can be
very subtle (Figure 2). Can you see the
sub-retinal, vessel-like abnormalities
radiating from the disc that are typical
of angioid streaks (Figure 3)? With this
condition, the RPE often has a stippled
or granular appearance. Can you see
the scattered, well-demarcated, hypoand
hyperpigmented lesions of PIC or
POHS (Figure 4)? In the latter the lesions
are often scattered in the peripheral
fundus, particularly inferiorly. Can
you see the classic “punched-out”
appearance of a macular hole, which
is usually surrounded by a “halo” of
slightly elevated retina (Figure 1)? Does
the macula have the sheen of an ERM,
possibly with corrugations of the retinal
surface? Do you see the scattered flame
haemorrhages of a retinal vein occlusion
(Figure 6), or the microaneurysms, flameshaped
haemorrhages, cotton-wool spots
and exudates of diabetic retinopathy?
Optical coherence tomography (OCT)
is a useful ancillary investigation in
these cases. It is non-invasive, and
provides a cross-sectional “picture” of
the macula, which aids in confirming
the presence of an abnormality
and in making the diagnosis.
Management
Of the causes of metamorphopsia
discussed above, it is CNV that demands
the most urgent management. The drugs
Lucentis and Avastin have proved very

effective in the treatment of CNV
then referral need not be urgent. State
with various underlying aetiologies,
on the referral that the diagnosis is
but if good vision is to be salvaged or
ERM because, as for macular hole, this
retained, then the CNV must be treated
will help to ensure that the patient
in its early stages. This is because the
is directed to a vitreo-retinal clinic.
membrane usually grows rapidly, and as
When patients are counselled
it does so it tends to form a layer of subretinal
scar tissue which permanently
regarding macular conditions some
will baulk at the idea of surgery,
43
separates the overlying retina from
particularly if they are elderly. It should
the underlying RPE and choroid.
be pointed out to them that age is rarely
Furthermore, the passage of fluid into
a contraindication to vitreo-retinal
the retinal substance causes a disruption
surgery, which is increasingly carried
of its normal cellular architecture
which has physiological consequences.
Hence, patients with CNV should be
referred urgently for assessment and
treatment. Same-day assessment via an
ophthalmic emergency is not usually
necessary, provided the optometrist
has established a rapid written referral
route (e.g. via fax) to a rapid-access
macula or retinal clinic. 1 Since referrals
to secondary care may be screened by
non-medical personnel, you should
state clearly on the referral that the
patient has distortion of vision and
that you suspect CNV, or wet AMD.
If you are unable to refer directly
to a clinic providing rapid access
for these cases, then referral to the
ophthalmic emergency service may be
necessary to ensure prompt treatment.
If the diagnosis seems to be CSR
(e.g. distortion with moderately
reduced vision, with no evidence
of CNV or sub-retinal blood, and no
pre-disposing condition for CNV, in
a young or middle-aged patient) then
there is little urgency. This condition
is often self-limiting, and generally
the first step in management is to
allow a period of several months for
this to occur, before active treatment
Figure 6
Central retinal vein occlusion
diabetic retinopathy or retinal vein
occlusion should be treated promptly.
These patients should be referred
urgently, but same-day assessment
is not necessary. Again, it helps to
indicate on the referral that diabetic
or retinal vascular disease is present.
Macular holes require a surgical
treatment, and it is known that the
shorter the history, the greater the
chance of a successful outcome from
surgery. However, on the scale of vitreoretinal
urgency these patients would
generally be placed in the “moderate”
category, with a wait of weeks to months
for surgery on the NHS. 2 There is little
to be gained, therefore, from sameday
ophthalmological assessment.
They should be referred as urgent,
with the referral indicating that the
diagnosis appears to be macular hole.
Epiretinal membranes pass through
stages in their development: they form
as delicate glial sheets then go through a
contractile phase before remaining fairly
static, although macular oedema may
evolve. The vast majority of ERMs seen
in optometric practice are in this third
out under local anaesthetic on a daysurgery
basis. The patient may still
have many years ahead of them, and
they cannot be sure that the “good” eye
will remain in good health: a time may
come when they rely on the currently
“bad” eye. Furthermore, the retina
is relatively intolerant of anatomical
and physiological disturbance, and
with retinal conditions in general,
the sooner they are treated the greater
the chance of a satisfactory outcome.
The results of surgery for ERM, and
particularly for macular hole, are very
good nowadays, but early intervention
is important. It is no good for the patient
if they decline referral for surgery and
then change their mind five years later
because the “bad” eye has become
the best prospect for useful vision!
About the author
Mark Benson is a director of the
Midland Eye Institute, and consultant
ophthalmic surgeon to the Heart of
England NHS Trust for whom he runs
retinal and cataract services. He is
senior clinical lecturer to the University
of Birmingham, a section editor for the
journal Eye, and an examiner for the
Royal College of Ophthalmologists.
25/11/11 CET
is considered. Of course, if there
is doubt about this diagnosis, and
stage: they have stabilized. Hence, when
you are counselling patients, you can
References
you feel CNV could be present, then
tell them that it is very likely that their
See
http://www.optometry.co.uk
you should refer urgently as above.
symptoms will not worsen significantly.
clinical/index. Click on the article title
Macular oedema secondary to
If you are confident of the diagnosis
and then download “references”.
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Community-based
Independent
Prescribing
Course Code C-17277 O/AS/SP/IP
Peter Frampton MSc, FCOptom, BAppSc(Optom) (AUS), DipTp(AS),
DipTp(SP), DipTp(IP)
Community-based independent prescribing (IP) optometrists tend to
work in isolation, an intimidating concept. However, for IP to impact on
commissioning consortia by saving money whilst improving access to care,
promptness of care, and appropriateness of care, the services need to be
driven from a community perspective. Optometrists need to be the GPs of
community eye care. Based on audit results of IP activity of the author, this
article highlights the role of IP in community practice, with the hope that this
will encourage much greater uptake in these qualifications by optometrists.
The College of Optometrists¹ states that
practitioners ‘must only ever prescribe
within your level of experience and
competence’. This means that whilst
some IP practitioners will feel confident
in diagnosing and treating conditions,
others will feel more comfortable with
monitoring already diagnosed cases,
Figure 1
Total acute presentations of cases requiring IP intervention over a 12-month period. KEY: SLK = superior
limbic keratitis; BCC = basal cell carcinoma; EBMD = epithelial basement membrane dystrophy
eg, glaucoma and those with ocular
hypertension. Indeed, practitioners
should always practice within their
own capabilities and confidence levels.
Audit results
Over the 12 month period from June
2010 to June 2011, the author’s practice
therapeutically managed on average
about 3 cases per day. Audit results
during this period are shown in Figure
1, which displays the total breakdown
of acute or unplanned presentations
that required IP intervention. Only
cases requiring IP ability were included
in the audit. Many presentations were
manageable under core competency
levels of skills eg, mild seasonal and
perennial allergic conjunctivitis and
dry eye, and were not included in
these figures. Tear deficient dry eye
conditions were only included when
requiring Sjogren investigations or
prescription only medications (POMs).
Figure 2 displays the breakdown
of patients investigated/managed for
glaucoma. Patients with glaucoma
were only included if they were
not under routine HES care, were
stable and discharged to our care,
or patients not yet diagnosed and
under regular review for progression
or ocular hypertension (OHT).
All assessments carry private charges.
Northumberland does not have a shared
care scheme for acute presentations and
apart from in-house information and
reactive education of the healthcare
community via GP reports, there is no
advertising of IP services. Regardless,
the practice receives regular referrals
from GPs, who are aware of the private
charges, as well as pharmacies and selfreferrals.
Patients not prepared to pay
the fees are directed to the HES. The
data presented must be considered a
very conservative estimate of the total
level of activity possible within the
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community, if official Care Trust funded
and promoted services were provided.
Bacterial keratitis
Treating suspect bacterial keratitis
within the community, and without
access to laboratory facilities and
cultures, is controversial. Ray-
Chaudhuri² states that suspect
bacterial keratitis requires a corneal
scrape and culture. There are no
exclusion criteria. However, of the five
cases of suspected bacterial keratitis
that the author referred to the HES,
four were treated empirically with
ofloxacin, without cultures; all four
were treated intensively, indicating
infective (bacterial) keratitis was
suspected. The fifth patient, a contact
lens wearer with no history of trauma,
referred with a central corneal lesion
was diagnosed at the HES as having
a corneal abrasion and treated with
chloramphenicol. Only at the 24 hour
review appointment was bacterial
keratitis diagnosed, the patient
hospitalised and treated with fortified
antibiotics and cultures taken. Why the
conflict in approach? Culture yields as
low as 63% have been reported,³ while
over 80% of ulcers respond well to
empirical broad-spectrum treatment. 4
Significant predictive factors for
treatment success or failure are lesion
size, promptness of presentation,
the patient’s age, co-existing corneal
pathology and use of topical steroids. 4
A general reduction in immune
competence would also contribute.
It is further suggested that young
patients with small ulcers should
respond well with empirical treatment
and would be unlikely to be culture
positive. Conversely, older patients
(>60 years) with large ulcers (>5mm)
are at 5.5x greater risk of primary
treatment failure. It has also been
suggested that resistance is unlikely
Figure 2
Management of patients diagnosed with glaucoma by IP optometrists. KEY: PDSi = pigment dispersion
syndrome; PD = pseudoexfoliative glaucoma; NTG = normal tension glaucoma; OHT = ocular
hypertension; COAG = chronic open angle glaucoma; AACG = acute angle closure glaucoma
with community-acquired keratitis. 5
Many of these observations have been
amalgamated into the objective ‘1, 2, 3’
guidelines, which suggest that bacterial
keratitis presentations showing ≤1+
cells in the anterior chamber, being
≤2mm in size and with a lesion edge
≥3mm from the cornea centre are
not potentially sight threatening,
are unlikely to be culture positive,
and so could reasonably be treated
empirically with a fluoroquinolone. 6
Clinical decisions should be
made based on severity, symptoms,
compliance and ease of access to
laboratory facilities. If a decision
to treat empirically is taken it must
reflect each individual presentation
and the practitioner’s confidence;
the ‘1, 2, 3’ guidelines lend objective
support for such decisions. Certainly
all cases of suspect bacterial keratitis
managed by the author’s practice
have been treated successfully.
When prescribing antibiotics, one
must also be wary of inappropriate
use, which falls into two categories:
incorrect diagnosis and subtherapeutic
dosing.³ An intensive
therapeutic strategy, with initial
loading dose and subsequent hourly
daytime dosage and nocturnal cover,
is instigated whenever bacterial
keratitis is suspected within the
practice; the potential risk with subtherapeutic
dosing is too high. In
the case of marginal keratitis, this is
always treated more conservatively
with polyfax qid; steroids are not
considered necessary in all cases.
Viral keratitis
GOC guidelines 7 state: ‘Independent
prescribers take responsibility
for the clinical assessment of the
patient, establish a diagnosis and
determine the clinical management
required, (including prescribing
45
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I. Ocular Symptoms
(at least one)
II. Oral Symptoms
(at least one)
III. Ocular Signs
(at least one)
IV. Histopathology
V. Oral Signs
(at least one)
VI. Auto-antibodies
(at least one)
Primary Sjogren’s
syndrome diagnosis
Secondary Sjogren’s
syndrome diagnosis
where necessary).’ Implicitly the
choice of treatment is contingent
on correct diagnosis. If we cannot
diagnose we should not be allowed
to treat. Regardless, the College of
Optometrists’ Clinical Management
Guidelines prepared for IP optometrists 8
recommend that no treatment should
be instigated by the optometrist for
Dry eyes >3 months
Foreign body sensation in the eyes
Use of artificial tears >3x per day
Dry mouth >3 months
Recurrent or persistently swollen salivary glands as an
adult
Drink liquids to swallow dry foods
Schirmer’s test, (without anesthesia) ≤5 mm/5 mins.
(Substitute less uncomfortable Phenol red thread test)
Positive vital dye staining (van Bijsterveld ≥4)
(Substitute lissamine green)
In minor salivary glands, focal lymphocytic sialoadenitis
with a focus score of 1, defined as a number of
lymphocytic foci per 4mm of glandular tissue
Unstimulated whole salivary flow (≤1.5 mL in 15 mins.)
Abnormal parotid sialography
Abnormal salivary scintigraphy
Anti-SSA (Ro) or Anti-SSB (La) or both
a. Any 4 of the 6 criteria, must include either item IV
(Histopathology) or VI (Auto-antibodies/Serology)
b. Any 3 of the 4 objective criteria (III, IV, V, VI)
In patients with a potentially associated disease (for
instance, another well defined connective tissue
disorder), the presence of item I or item II plus any 2 from
among items III, IV and V
Table 1
Revised International Classification Criteria for Sjogren’s Syndrome. Adapted from Vitali et al. 14
new presentations of viral (Herpes
Simplex) keratitis ‘because this could
make confirmation of the diagnosis by
the ophthalmologist more difficult’.
Herpes Simplex Keratitis isolated to
the epithelium is confidently treated
within the practice with topical
aciclovir 5 times per day for 10 days.
Presentations with interstitial and
inflammatory components are more
likely to be referred, as they usually
require chronic care and fall beyond
the financial scope of a private
practice. However, prophylactic
systemic aciclovir has been prescribed
for patients with previously
treated Herpes Zoster Keratitis.
Sjogren’s syndrome
Sjogren’s syndrome is classically
under-diagnosed, with delays of up to
11 years reported. 9,10 Jonsson et al. 10
also suggest that the delay in diagnosis
is, in part, due to a lack of awareness
of the disease among health care
professionals. Optometrists should
have access to objective and subjective
techniques to improve sensitivity and
specificity of diagnosis. The sicca
symptoms cause significant quality
of life morbidity, 11 as well as a range
of more significant co-morbidities,
some life threatening. 9,10 Significant
morbidities directly attributable to
dry eyes and mouth can include
mouth sores, malnutrition, oral
candidiasis, sleep disruption with
secondary fibromyalgia, accelerated
dental caries, bacterial conjunctivitis,
corneal ulceration and vision loss. 12
There is no single infallible test for
Sjogren’s syndrome; 13 diagnosis must
assess ocular and salivary components
as well as differentiate between
primary and secondary disease.
Vitali et al. 14 presented the ‘Revised
International Classification Criteria for
Sjogren’s Syndrome’, which is a 6-item
criteria set with demonstrated value
as a diagnostic tool (Table 1). Items
I to III can be readily incorporated
into routine optometric practice.
The Sjogren’s Classification protocol
was considered necessary for 22
patients in the author’s practice. Two
were referred to secondary care for
a full work-up with salivary gland
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iopsies, two were co-managed with
the GP, and five were considered to
be suffering from keratoconjunctivitis
sicca (KCS), but all had reports sent
Corneal abrasions & foreign
bodies
Twelve cases of foreign body removal
or corneal abrasions were managed in
is treated independently in the
practice; the primary consideration
is the patient’s best interests.
The author has managed four specific
to GPs or Rheumatologists. Milder
the practice. One patient with blunt
cases of glaucoma in community
cases are managed within the practice
penetrating foreign body trauma
practice. One of these was an 81-year-old
typically with hyaluronates and
mucolytics; steroids have not been
employed as yet. Included in the group
of patients with dry eye are some
cases of Bell’s Palsy, which were comanaged
with the GP who prescribed
systemic steroids, and lagophthalmos.
presented with positive Seidel sign;
the patient was referred immediately to
the HES, who were notified prior to the
patient’s arrival. Other blunt traumas
included one who was managed with
Ibuprofen and another who required
referral for a magnetic resonance
gentleman with advanced age-related
macular degeneration (AMD), with
logMAR visual acuity of 1.6 and who
had obvious glaucomatous optic nerve
head cupping. Concerned about the
political ramifications, the glaucoma
consultant at the local hospital was
47
imaging (MRI) scan and was found
contacted and the clinical management
Inflammatory conditions
A significant number of inflammatory
conditions were treated by the
author’s practice; iritis, episcleritis,
limbitis, pinguecultitis, vernal
keratoconjunctivitis (VKC), atopic
keratoconjunctivitis (AKC) and
seasonal and perennial conjunctivitis.
Iritis was the most significant
condition encountered and was
managed using a specific procedure
whereby repeated instillation of
2.5% or 10% phenylephrine was
conducted to break synechiae. This
was in direct response to the clinical
experience gained from dealing
with acute iritis and exemplified the
need to constantly re-assess practice
performance. Mandatory is a dilated
fundus examination of both eyes to
ensure the inflammation is limited to
the anterior chamber and, of course,
monitoring for steroid responders.
A number of unidentified
inflammatory episodes were also
treated by the author’s practice. All
to be suffering from concussion; no
treatment was given to this patient.
Three cases of eye drop toxicity
were also encountered. One patient
took many months to regain
their visual clarity but all were
managed with patient education.
Infective conditions
The five cases of blepharitis included
in the audit were serious and chronic
enough to require systemic antibiotics
(100mg doxycycline for 6 weeks).
A severe case of conjunctivitis was
also observed, diagnosed as angular
(Moraxella) conjunctivitis, which has
an appearance in the lateral canthi and
can easily be mistaken for episcleritis;
significantly however, the conjunctivitis
was bilateral and there was some
associated blepharitis and discharge
indicative of an infective aetiology.
All cases of pre-septal cellulitis were
successfully treated with 250mg
amoxicillin after ensuring that there
was no history of allergy to penicillins.
plan explained prior to treatment. The
proposal to treat to protect peripheral
vision was positively received, reenforcing
the author’s confidence
while enhancing inter-professional
communication and co-operation.
The author has also prescribed
medication for patients with ocular
hypertension and chronic open
angle glaucoma (COAG); all were
elderly and patient mobility and
limited access to eye care at the
HES was a prime consideration.
Intervening with non-compliant
patients has been necessary on several
occasions. The most significant was on
Christmas Eve 2010; an elderly patient
with a blind left eye and COAG in the
right eye. With no medication list he
simply knew he had three eye drops
but had stopped using one. Intraocular
pressure (IOP) in the right eye was
40mmHg (Goldmann applanation
tonometry - GAT). The HES was
contacted and this conversation
revealed that the gentleman was
25/11/11 CET
were successfully managed and
although a definitive diagnosis is not
Glaucoma
supposed to be instilling atropine and
predforte into the blind eye for ocular
always evident, this highlighted the
There is ongoing debate as to
comfort and xalatan in the right eye. It
confidence needed in differentiating
whether IP qualifications should
transpired that the patient had stopped
an external inflammatory event from
permit the diagnosis and treatment
taking the xalatan but to compensate
an infective; where a practitioner
of glaucoma independently. Despite
was putting the predforte into his
does not possess this confidence,
this debate, or its ultimate outcome,
right eye. The author confirmed with
referral to ophthalmology is advised.
within specific constraints glaucoma
the ophthalmologist that he would re-
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enforce the treatment modalities with
can be compared to HES treatment.
of care to be quantified but not the
the patient, by stopping the patient from
Text books and the College of
specificity. A diagnosis must be
instilling predforte in the right eye, and
Optometrists’ Clinical Management
considered the best hypothesis.
48
25/11/11 CET
immediately re-prescribing xalatan. The
author ensured that the GP was aware so
that he/she could provide ongoing repeat
prescriptions. Upon review a few weeks
later, IOP in the right eye was 18mmHg.
Patients that were referred by the
practice for closable angles all had
iridotomies or cataract extraction.
One patient was referred for
progressive normal tension glaucoma
(NTG) but this was not confirmed
and the patient was discharged.
Referral for suspect COAG was
confirmed in all but one case. This
patient had been monitored for some
time and while the diagnosis of frank
COAG was not confirmed, the patient
has not been discharged from HES
and is being monitored. This rather
reflects the dislocation of optometry
and ophthalmology. The patient had
been monitored in the community
for several years and was referred
with a high suspicion of progressive
neuropathy. However the HES will base
Guidelines 8 outline treatment
strategies but doses and schedules
are not usually specified. Reviewing
HES treatment modalities will help
but several invaluable web resources
are available. Indispensable are the
electronic British National Formulary
(BNF) 15 and e-medicines; 16 both are
current and evidence-based resources.
Importantly e-medicines outlines
medical management for specific
ocular conditions, listing drugs,
doses, schedules and common adverse
drug reactions. Both web resources
require registration but are free. Indepth
information for specific drugs
is listed in their Summary of Product
Characteristics (SPCs) obtainable from
Electronic Medicines Compendium. 17
Reflective practice has led to significant
modification of clinical practice.
Introduction of generic information
leaflets with medication names, dosages,
schedules and potential adverse reactions
All episodes need to be monitored
until resolution but the accuracy of
the diagnosis cannot be confirmed.
Optometrists need to work to their
own clinical confidence, which only
comes with experience. Good relations
with ophthalmology are important
and reasonable and ingenuous
enquiries are invariably well received.
Rapport with ophthalmology is a
great support and it is always worth
confirming with consultants that they
do not mind being contacted directly;
HES clinics, particularly glaucoma
clinics, are overloaded and direct
communication and referral is an
area where primary and secondary
care can work together, benefiting all.
Peer reviews are invaluable too.
The small quorum of Northumberland
based IP practitioners meet quarterly
to discuss cases and the mix of
community and hospital based
optometrists brings a breadth of
experience to the discussions. The
any diagnosis on its own data collation.
can be readily printed, allowing a
practice protocol for managing iritis
The patients not referred for
clinical receptionist to re-enforce patient
can be attributed to the advice given
ocular hypertension were found to
education and improving compliance.
by hospital based IP optometrists
comfortably fall outside the treatment
guidelines based on age and central
corneal thickness (CCT) and in the
absence of any signs of frank glaucoma.
Discussion
An essential process for IP practitioners,
and highly recommended for all
optometrists too, is the instigation of
an outcome audit system ensuring
every patient is followed-up. Whether
managed solely by the optometrist,
co-managed with the GP or referred
to the HES, every episode must
represent a learning experience. A
Another response to clinical
experience was the introduction of
a practice dispensary. Best practice
would recommend prescribing via a
second party, guaranteeing a double
check. The practice dispensary was
introduced because, especially on
Saturdays, patients are not always able
to obtain the drugs required promptly
from local pharmacies; 24 hours or
even 36 hours may elapse. Drugs
stocked include aciclovir, predforte,
fluorometholone (FML), olopatadine,
ofloxacin, and diclofenac eye drops.
About the author
Peter Frampton studied optometry
in Brisbane, Australia, and moved to
Britain in 1986. He attained a Masters
Degree in Ocular Therapeutics
from Bradford University and has
Additional Supply, Supplementary
Prescribing and Independent
Prescribing qualifications. He has
recently been made a Fellow
of the College of Optometrists.
References
diagnosis and management plan
If dispensed the author’s practice
See
http://www.optometry.co.uk
should be prepared which, if not
charge a private prescription cost.
clinical/index. Click on the article
personally managed to resolution,
Outcome audit allows sensitivity
title and then download “references”.
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Module questions
PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on
December 23 2011 – You will be unable to submit exams after this date – answers to the module will be published on
www.optometry.co.uk. CET points for these exams will be uploaded to Vantage on January 2 2012.
Course code: C-17573 O
1. Epiretinal membrane:
a) May be caused by previous retinal vein occlusion
b) Causes continuous worsening of vision due to distortion
c) Is always present when a PVD has occurred
d) Requires treatment in the vast majority of cases
2. Which of the following statements about a full-thickness
macular hole is TRUE?
a) It can be excluded if a PVD is present
b) It does not occur in males
c) It does not lead to retinal detachment
d) It may reduce central vision to 3/60
3. Age-related macular degeneration:
a) Is always in the “wet” form if distortion is present
b) Is characterized by retinal wrinkling
c) Requires urgent assessment if distortion has been present for 2 weeks
d) Can always be treated with Lucentis or Avastin
Course code: C-17277 O/AS/SP/IP
1. Which of the following statements is FALSE? IP optometrists:
a) Must only prescribe within their level of experience and competence
b) Must take responsibility for clinical assessment, diagnosis and management,
prescribing where necessary
c) Must contractually adhere to the College of Optometrists’ Clinical
Management Guidelines
d) Must lodge an interest in acute eye care, glaucoma or both
2. Considering the factors that affect treatment of bacterial keratitis,
which one of the following lists is INCORRECT?
a) Patient age, immunocompetence, general health
b) Steroid use, co-existing corneal pathology, gender
c) Size of the lesion, promptness of presentation, location of lesion
d) Hospital vs. community infection, therapeutic dosage level, patient
compliance
3. Which of the following statements regarding the classification
criteria for Sjogren’s Syndrome is TRUE?
a) Item I or II plus two from Items III, IV,V, and VI indicates secondary Sjogren’s
4. Central serous retinopathy:
a) Usually have some pigmentary changes in the RPE
b) Only occurs in males
c) Requires urgent treatment
d) Is now usually treated with Lucentis or Avastin
5. Choroidal new vessels (CNV):
a) Resemble lacquer cracks
b) Can give rise to presumed ocular histoplasmosis syndrome (POHS)
c) Are the chief cause of angioid streaks
d) May result from compromise of Bruch’s membrane in a variety of conditions
6. Which of the following statements about distortion of vision is TRUE?
a) It often denotes serious underlying eye disease
b) It often demands urgent assessment in a secondary care setting
c) It may be best managed surgically, even in patients of advanced age
d) All of the above
b) Any 4 items, as long as IV or VI are included, indicates primary Sjogren’s
c) Sensitivity & specificity of referral can be improved if optometrists assess 4 of the 6 items
d) Phenol red thread is quicker but less comfortable than Schirmer strips
4. Which of the following is LEAST useful for obtaining information on drug doses and
adverse reactions?
a) Text books
b) E-medicine papers for the condition diagnosed
c) The SPCs of individual drugs from electronic medicines compendium
d) Most up-to-date BNF
5. Vital processes to incorporate into community practices include:
a) Outcome audits
b) Peer reviews
c) Modification based on local needs and experience
d) All of the above
6. Which combination of ocular condition and treatment is CORRECT?
a) Blepharitis: day 1 loading dose of 100mg bid then 100mg doxycycline 1x daily for 6 weeks
b) Herpes Simplex Keratitis (Epithelial): 3% aciclovir ointment 5x daily for 10 days
c) Preseptal Cellulitis: 250mg amoxycillin every 8 hours for 10 days
d) All of the above
49
25/11/11 CET

JOBS
To place an advertisement call 020 7878 2347
or email vanya.palczewski@tenalps.com
Super OptOmS - Hampshire, Dorset & Sussex
Call Jim on:
01793 648607
or visit: outsideclinic.com
mObile OptiCal aDviSOrS - Warwickshire & West London
COmmerCial SuppOrt - M4 Corridor
(qualified DO to work within professional services dept)
50
25/11/11 jobs
David Austen Optometry
25th Nov OT Strip.indd 1 18/11/2011 16:09
45-46 Church Gate • Loughborough • LE11 1UE
www.austenoptometrists.co.uk
Part-time Optometrist required - Our practice
consists of 4 Optometrists with 1 Dispensing
Optician and 7 clinical assistants. We have the latest
equipment including OCT, Optomap, slit-lamp digital
imaging, topographer, colorimeter, pachymeter etc.
All Optometrists have full professional freedom and
contribute to the running of the practice. Further
courses and training will be arranged if required.
Contact: Matthew Austen MSc BSc(Hons)
Phone: 01509 263881 (day)
01509 672584 (evening)
mausten@austenoptometrists.co.uk
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NORWICH
OPTOMETRIST REQUIRED
FULL TIME/PART TIME
For a busy independent practice,
established 1916
Full support staff
Comprehensive salary package
Please apply to Crozier Collinson
Dipple & Conway Opticians Ltd
19 Castle Street, Norwich,
Norfolk, NR2 1PB
Or email your details to
crozier@dippleconway.co.uk
www.dippleandconway.co.uk
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Visit our website www.homerton.nhs.uk/workforus
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Optometrists &
Dispensing Opticians
Locum work to suit your
needs across the UK
CaLL Catherine on 0121 451 2707
or email info@ teamlocum.com
team Locum is an employment agency
The Homerton is the closest hospital to the London 2012 Olympic and
Paralympic Games Park and is the designated hospital for the Park.
The Hospital has easy access to the M11and Stratford International
railway station, with major improvements to transport planned in the
lead up to the Games.
tv
Diabetes Eye Screening Service
Optometrist and Diabetes
Eye Screening Primary Grader
Band 6: £30,633 - £40,406 pa inc pro rata
One year fixed term
This post is based at Homerton University Hospital NHS
Foundation Trust
We are looking for optometrists to work for one half-day session per
week grading retinal images as part of our busy and friendly diabetes
eye screening service, working alongside other professionals in the
diabetes team.
Practical knowledge of diabetic eye disease and some knowledge
of the national screening scheme is needed. Full training in the use
of specialised grading software, and in grading skills, will be given
to the successful candidate.
For further information and/or to arrange an informal visit
please contact: James Beckett, Programme Manager, email:
james.beckett@homerton.nhs.uk
For an application pack please visit our website
www.homerton.nhs.uk/workforus and apply online quoting
the reference 293-10743
Closing date: 9 December 2011.
Visit our website www.homerton.nhs.uk/workforus
tv
The Trust welcomes applications from candidates wishing to
job share, with or without
bookshop
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Committed to Equal Opportunities.
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THE PLEASURE OF YOUR COMPANY IS REQUESTED BY
Doug & Dame Mary Perkins
CO-FOUNDERS OF SPECSAVERS
MANCHESTER - 8TH DECEMBER &
LONDON - 10TH & 11TH DECEMBER
YOUR PERSONAL INVITE
TO MEET DOUG & MARY FOR A ONE-TO-ONE ON
JOINING SPECSAVERS IN AUSTRALIA & NEW ZEALAND.
From 8th December to 11th December there will be full day and evening events held in Manchester and London.
You will be able to find out more about how you can join Specsavers in Australia & New Zealand, hear some success
stories, meet a partner who has already left the UK and now owns a share of a successful store in Australia and
find out what opportunities still exist in these exciting and growing countries. You will learn about how Specsavers
have become market leaders in an incredibly short period of time and which towns and cities are still waiting for a
Specsavers store to open.
You need to be a Retailer, Dispensing Optician or Optician and be experienced in working in a
volume environment, preferably but not essentially with experience in Specsavers.
To register your interest in booking a place for your meeting simply email
anz.opportunities@specsavers.com or call Jerry Dunn on 07799 581 281.
We welcome enquiries from everyone and value diversity in our workforce.

Looking for your
next career move?
OT’s dedicated Job
Tips Hub offers free
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OT’s jobs section is here to help you in your job search,
advertising the latest job vacancies and providing hints and tips
when writing your cover letter and revamping your CV.
• Sign up to OT ’s free automated Job Alerts to find out as soon as
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• Let potential employers find you by uploading your CV to OT’s
CV Uploader. Companies looking to fill vacancies can search our
database and view your CV to find the most suitable candidates
www.optometry.co.uk/jobs

MARKETPLACE
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place an advertisement call
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O p h t h a l m i c
a c c O u n t a n t s
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Accountants
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For A Free Consultation Contact Desirie Lea ACA on: 0151 348 8400
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Computer Systems
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Tel: 01904 606611
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Software tailored to your
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SOFTWARE WITH VISION
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* Terms and conditions apply. ** Indicative, based on typical 5 year lease. Not including annual support.

MARKETPLACE
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place an advertisement call
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Computer Systems
Equipment
Equiment For Sale
FOR SALE
Frames
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Manufacture & sales of:
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25/11/11 MARKETPLACE
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Tel: 0161 336 9000
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email: contact@northern-lenses.co.uk
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56
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optometrytoday
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MARKETPLACE
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Practice For Sale
PRACTICE FOR SALE
Expanding East Anglian Market town.
Reason for sale - retirement.
Lease 6+ years.
Wonderful opportunity for ambitious Optom.
T/O £225K. Low overheads. All offers considered.
Reply to Box no. 384412
email:vanya.palczewski@tenalps.com
optometrytoday
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on optometry.co.uk to reach more than
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Practice Fittings
optometrytoday
Looking to sell
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Please online call
020 7878 2347
25/11/11 MARKETPLACE
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Looking to sell anything from a
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Please call 020 7878 2347 bookshop
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Practice Management
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MARKETPLACE
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Practice Fittings
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To discuss your options with one of our designers or
for a copy of our “Directory of Practice Design” phone: 01594 546385
The Style Design Company - www.style-design.com

AOP endorsed services for
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Call us on 0845 608 5084
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Aon Limited is authorised and regulated by the Financial Services Authority
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For full details please contact:
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As an optometrist you qualify for
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YOUR HOME MAY BE REPOSSESSED IF YOU DO
NOT KEEP UP REPAYMENTS ON YOUR MORTGAGE.
Special terms available to members of the
Association of Optometrists. To see if we can help,
call us on 0845 845 0829
Lines are open 8am to 6pm on weekdays (10am to 6pm
Wednesdays).Telephone calls may be recorded and monitored.
Applicants must be 21 or over
and a fully qualified accountant,
actuary, barrister, dentist,
medical doctor, optometrist,
pharmacist, solicitor, teacher
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2. Li, B., Ahmed, F., Bernstein, P. (2010). Studies on the singlet oxygen scavenging… Arch Biochem Biophys, 504 p.56-60.
3. Connolly, E. E, et al. (2010). Augmentation of Macular Pigment following supplementation… Current Eye Res, 35 (4) p.335-351.