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Drama at the NOC
We report from the national conference

November 12 2010 vol 50:22
optometrytoday
5
News
The way forward
Drama and encouragement were part of the mix
at last week’s National Optometric
Conference
News
News
Misleading ad censored
Advertising watchdog the ASA tells online
wholesaler not to repeat press advert
centred on pricing
Cover story
All the world’s a stage
Gill Brabner on the background to
last week’s LOCSU piece of forum theatre
5
VAT’S the way to do it
Start preparing now if you haven’t already
done so for the rise to 20% in January 7
10
14
Industry news
Events
Longleat long leap
We preview this month’s Student Eye
Opener conference in Wiltshire
24
Anyone for…tennis discounts?
Rodenstock offers 33% discount for repeat
orders after purchase of Wimbledon
Junior kit (see also page 7)
News Extra
Bosanquet reports
The respected Imperial College professor,
Nick Bosanquet, wants an eye care
services revolution
Products
Life through a lens
The latest contact lenses are featured
21
22
24
26
Diary Dates
Competitions
November crossword
Try to answer the clues and enter for
the £50 prize
Free CET
21
Pioneers and other dates
Our end-of-year round-up of optics’
events far and near 28
30
Bacterial infections
Management options for UK optometrists
part 5, by Professor Michael
J Doughty 34-41
tv Visit www.optometry.co.uk today

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NEWS
NOC dramatically debates
the way forward for optics
REPRESENTATIVES FROM optical organisations
Future relationships with GPs and commissioners
across the UK who attended last week’s National
formed the subject of one of the conference’s
Optometric Conference witnessed a stirring view of
high points, when four professional actors took
the future.
to the stage to perform ‘What’s the point of an
Presentations from political and professional
LOC’, (pictured). Acting out a scenario which
policy advisers and shapers were heard during the
many in the audience clearly had experienced, the
two-day event which concentrated on the political
drama set out a fictional and frustrating meeting
and policy-making opportunities that optometry
between optical and GP representatives over eye
currently has.
care planning. Scripted by LOCSU’s Gill Brabner,
An impressively argued report on the way ahead
the play got a strong reception from all who saw
for eye care under the coalition government which
it, and it was helpfully enacted again, this time
was available at the Heathrow venue, was one of the
with audience participation on how to practically
highlights of the NOC . Authored by the Professor of
improve relationships between both sides.
Health Policy at Imperial College, Nick Bosanquet,
There was also a well-attended exhibition which
his report is in response to this summer’s Equity
took place in parallel to the event.
and Excellence White Paper on the Health Service.
To view speeches from the conference,
Professor Bosanquet made the guest of honour
including other presentations, such as the director
address at the event’s dinner.
of thinktank Reform, Andrew Haldenby, and
Elsewhere at the conference, a survey of LOCs
economist-turned-strategist Roger Martin-Fagg,
found that there is much work to be done in
go to our web tv channel Ot.tv, via
communicating with the new GP-led consortia funding groups if optics’ www.optometry.co.uk. Next year’s NOC will take place on November 3-4
voice is to be heard (see below).
at the Chesford Grange Hotel, Warwickshire.
Survey: LOCs need to improve GP contacts
5
12/11/10 NEWS
RESULTS OF a survey of
Local Optometric Committees
carried out in September have
shown that LOCs need to work
harder to form stronger ties
with GP commissioning groups.
The LOCSU survey, the
results of which were revealed
at the National Optometric
Conference, were complied
from 65 LOCs who responded.
One of the most startling
results was that almost half
of the respondents admitted
they did not know well, or did
not at all, their GP leaders and
commissioning groups.
An encouraging one-in-four
said they did know them fairly
well (with another group,
5%, saying they know them
‘extremely’ well and 18%
claiming to know them
‘very well’).
Another question involved
how well the LOCs know their
local director of public health,
with 60% admitting they did
not know that person well, or
at all.
Additionally, 55% of
respondents revealed they
did not know their local patient
groups well, with an additional
20% admitting to not knowing
them well at all.
Aside from the encouraging
noises the survey has
for LOCSU itself – 85% of
respondents thought the
advice emerging from the
Unit was always or usually
appropriate and useful – the
results show that work still
needs to be done for the
profession to be listened to at
the negotiating table.
LOCSU is to take to the road
next year with a dozen events
to help LOC members improve
their negotiation skills, and
learn what is happening in
their area in commissioning
and GP consortia.
The tour will take in London
(Jan 24), Birmingham (Jan
27), Tunbridge Wells (Jan 31),
Manchester (Feb 3), Taunton
(Feb 7), Winchester (Feb
10), Nottingham (Feb 14),
Cambridge (Feb 17), Newcastle
(Feb 28), Leeds (March 3),
Cardiff (March 7) and Oswestry
(March 10).
For details contact Cameron
Mitchell on 020 7202 8156.

optometrytoday
NOVEMBER 12 2010
VOLUME 50:22
ISSN 0268-5485
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READY-MADE reading glasses
bought ‘off the shelf’ have been
exposed as having ‘serious flaws’
by this month’s Which? magazine.
The consumer title examined
14 pairs of ‘ready readers’ bought
from High Street stores and
found problems in half of those
purchased, emphasising to
readers that the glasses “could
cause eye strain, blurred vision,
headaches or double vision.”
Glasses tested with
prescriptions +3.5 to +4 were
found to have the most serious
problems. One pair from
Poundland contained the wrong
prescription, and frames from
branches of Sight Station and
Tiger were found to have optical
centres at different heights.
Which? advises readers to “buy
a spring-loaded pair – they’ll fit
better and be more durable” and
“If your prescription is above
+2.00, read with the glasses for a
NEWS
Which? probes ‘serious
flaws’ in ready readers
OVER 750 eye care
professionals from across
Europe travelled to Rome at
the end of October for the
CIBA Vision European Eyelife
Summit.
Under the theme ‘Learn.
Lead. Succeed together’,
the two-day event was
based around peer-to-peer
learning, with speakers
discussing topics including
emerging trends in contact
lens prescribing, lens fitting
in astigmatism, antimicrobial
innovation and myopia
control.
few minutes. Comfortable, clear
reading suggests the lens are
centred.”
Director of operations at
the AOP, David Craig, released
a statement to the national
press about the report stating:
“The article points out the risks
associated with their use. The
other danger is that buying
ready readers may mean that
the wearer feels that they do not
need to have a proper sight test.
Inma Perez-Gomez, head of
professional affairs for CIBA
Vision Europe, Russia and
Africa, said: “European eye care
professionals practice today in
ever-changing technological
and economic environments,
with increasingly educated
“Regular sight tests, especially
for the population who wear
ready readers (who tend to be
over-45, when nature leads
most of us down the path of
presbyopia and when more
serious eye conditions start to
become more frequent), are very
important. Not just for the issuing
of a correct prescription, but
also because it provides a good
health check of our eyes and can
even detect other, sometimes
fatal, conditions, such as brain
tumours.”
Which?’s ‘snapshot
investigation’ took in seven High
Street stores which sell ready
readers, Poundland, Marks &
Spencer, Sight Station, Primark,
Tiger, Boots and Foster Grants at
Superdrug.
• For reaction from OT readers
to this story, go to our website
www.optometry.co.uk
Rome contact lens summit
is hailed as a success by CIBA
consumers. This summit
was designed to help
professionals from the region
stay world leaders in the
use of technology, service
provision and consumer care.
“The event was a huge
success.”

VAT-man tells profession
‘get ready for 20% change’
PRACTICE OWNERS and
managers are being urged by the
Government to get ready for the
rise in VAT early next year.
The standard rate of valueadded-tax
will rise to 20% in less
than two months – on January
4 2011 – and retailers, including
opticians, will soon need to make
alterations to charge the new rate
on all standard-rated sales from
that date on.
A spokesman from HMRC
told OT that it was important
that businesses, such as optical
practices, prepare for the New
Year change as soon as possible.
“It’s worth getting your
business ready now as if you’re in
retail, you must use the new 20%
rate for all standard-rated takings
you receive on or after January 4.
The new VAT fraction for the 20%
rate is 1/6, used to calculate the
VAT element of standard-rated
gross takings.
“If your business issues VAT
invoices, you must use the new
20% rate for all VAT invoices
you issue on or after January
4, which are issued within 14
days, or a longer period that has
been agreed with HMRC, of you
providing the goods or services.”
From January 4, companies
may receive VAT invoices with
the new 20% rate, as well as VAT
invoices with the old 17.5% rate
for goods or services bought
before the rate changed. “In such
cases, you should claim back VAT
at the rate shown on the invoice,”
said the spokesman.
“And for completing a
VAT return, the deadlines for
submitting VAT returns remain
the same, so you should continue
to submit VAT returns in the usual
way – whether you send them
monthly, quarterly or annually.
For returns that span the change
in rate, you will need to add
together both the VAT on sales
charged at 17.5% and those
charged at 20%. You then put this
total in box 1 of your VAT return.”
In order to counter businesses
taking advantage of the VAT rate
change by making arrangements
that aim to apply the 17.5%
VAT rate to goods or services to
be delivered or performed on
or after 4 January 2011, antiforestalling
legislation has been
introduced.
Further details and other
important matters will be
included in our ‘Essential
Guide to the VAT Rate change’
coming shortly in OT.
Theft of ‘£170,000’ leads
to a two-year jail sentence
IN BRIEF
Optometrist elected
In what has been called an historic
win, the first American optometrist
was elected to the US senate
earlier this month. John Boozman,
OD, will take his oath of office in
January. The American Optometric
Association (AOA) backed his
campaign through its Political Action
Committee, which included radio
advertising which can be heard on
the AOA website.
Rodenstock offer
Our story on page 21 this week
regarding Rodenstock states that
the company will offer a 33%
discount on the Wimbledon Junior
Collection – however, this discount
applies to those business customers
who repeat order after purchasing
an initial Wimbledon Junior kit.
Scheme is a winner
The RNIB’s Bridge to Vision initiative,
which highlights the issue that
a third of people with learning
difficulties may also have sight
problems, has won a Herald Society
Partnership Award. Developed with
Glasgow Caledonian University
and Optometry Scotland the
scheme won the Scottish award for
being an ‘outstanding example of
collaboration that really benefits
service users.’
7
12/11/10 NEWS
AN OPTICIAN’S secretary
who stole £170,000 from
the practice where she
worked has been jailed for
two years.
Deborah Ayto, 51, from
Retford, near Nottingham
cheated Woolcotts
Opticians over a five-anda-half-year
period, a court
heard, after being given a
position of trust by
the company.
According to the Retford
Times Newspaper (October
28) Ms Ayto gave her
children private education
and two to three foreign
holidays a year, Nottingham
Crown Court was told.
Of previous good
character, she pleaded
guilty to four counts of
theft including more than
£59,000 in cash, over
£23,000 in cheques paid
to herself and £5,900 in
cheques to pay her own
utility bills.
It was reported that the
firm gave her a £300 leaving
present when she handed in
her notice in October 2008,
but within a month her crime
had come to light. She had
been paying herself £15.44
an hour instead of the going
rate of £8.50.
Ms Ayto’s husband had
lost his job in 2003, and
the couple had substantial
mortgage and school fees to
pay. Ms Ayto told the court
that he was unaware of
her actions.
Best design
Martyn Kemp, chairman of Martyn
Kemp Opticians, is pictured with
Helen Frances who is wearing her
own winning design t-shirt in a
competition the practice organised
to help Guide Dogs for the Blind.
The clothing is being sold for a £5
minimum at the firm’s ten practices
across the Sheffield area.

8
12/11/10 NEWS
NEWS
QiO adds its latest tool
QUALITY IN OPTOMETRY (QiO) has announced
an Information Governance audit as the latest
addition to its range of tools to assist GOS
contractors in achieving high standards in
optometric practice. It can be found at
www.qualityinoptometry.co.uk
The information held by a practice, both
electronic and manual, is valuable and often
confidential. Information Governance is
about having processes to help to ensure
that appropriate steps have been taken to
guard the information and ensure that it is
appropriately handled. Most of this is already
included in the legal obligations under the
Data Protection Act, and the Information
Governance audit helps contactors to audit
their compliance with contractual, legal
and regulatory responsibilities, as well as
with professional guidance. The audit tool is
based entirely on elements within the Level 1
(contract compliance) section of QiO.
Now there are revised levels dealing with:
funding clinical governance; enhanced
services; infection control; record keeping;
information governance.
Richard Carswell, acting head of LOCSU,
said: “With this new audit tool, LOCs now have
the opportunity to agree with their PCTs the
basis for a sensible information governance
arrangement. Whereas Connecting for Health’s
requirements are inappropriate for optometry,
Quality in Optometry’s audit tool meets
the needs of PCTs, contractors and patients
receiving Primary Ophthalmic Services.”
Trevor Warburton, chair of the QiO Review
Group, said: “The information governance
levels required within the QiO audit are within
that required by legislation and GOS contracts
and are commensurate with the level of
involvement that optometry has with NHS IT.”
Quality in Optometry is a joint project of
the Optical Confederation and the College of
Optometrists and includes a representative
from the Optometric Advisors’ Group.
Specsavers champions camera
OVER 60 journalists were shown the
“life-saving benefits” of using a fundus
camera at Specsavers’ flagship store
in London’s Tottenham Court Road,
with guest of honour TV doctor Hilary
Jones. Dr Jones is Specsavers’ new
health ambassador, and the media open
evening aimed to raise awareness that
the multiple is ‘the only High Street
opticians that has a fundus camera
in all 650 stores in the UK’. The event
explained to key national and Londonbased,
consumer journalists and media
representatives what a fundus camera
is, and promoted how it adds value to
an eye examination, “at no extra cost”.
Dr Jones emphasised the importance of
regular eye examinations and how the
fundus camera can be used to monitor a
number of conditions such as diabetes,
or to help detect other sight threatening,
and in some instances, life-threatening
conditions. All the guests were offered
free eye examinations, hearing screening
and frame styling throughout the
evening. Dr Jones is pictured at the
event with Mr Carroll (left), and store
director Mark Edgar and Colin Campbell,
Specsavers’ professional service director
for hearcare.
COMMENT
THREE JOTTINGS FROM
TWO CONFERENCES
Emerging from the hothouse of the
Heathrow Park Inn sauna, sorry, hotel we
see a profession growing in confidence.
Unusually the National Optometric
Conference heard from three economists
who put optometry within a wider
economic and political context. They
take the view that our model of patient
choice offers important advantages to the
Government to deliver better outcomes
and quality within restricted resources.
At the NOC dinner, Professor Nick
Bosanquet of Imperial College pre-trailed
his forthcoming health economics report
which will demonstrate how community
optometry and optics is capable of
preventing blindness and reducing costs
in secondary care.
The hospital optometrists conference
follows on, and is an important reminder
of our leading edge, vital to the wider
picture of expanding optometry without
fear of reducing clinical standards.
Despite NHS financial pressures, the
number of hospital optometrist posts is
still rising and they are moving into new
and exciting areas of work. Worryingly,
the long running NHS farce Agenda for
Change has halved the number of prereg
places in hospitals. We are seeking
alternative funding sources to bring the
numbers back to the level needed to
sustain the hospital profession.
Lastly, we were pleased to have
members of the GOC with us at the
NOC. Readers will know that I have,
occasionally, had a few criticisms of
the GOCs workings. (Well quite often
actually!) But the new broom that is
sweeping through Harley Street is
enormously welcome, and it is clear that
we now have a GOC prepared to listen,
share ideas and discuss difficult areas.
The profession and patients can only
gain from this quiet revolution.
Bob Hughes, AOP chief executive
bobhughes@aop.org.uk

I wish my practice could have:
interactive, hands-on training
professional advice
tailored to our needs
at my convenience
in my practice
You can.
Speak to your CIBA VISION ®
Business Development Manager.
© CIBA VISION (UK) Ltd, a Novartis company, 2010.
CIBA VISION and the CIBA VISION logo are trademarks of Novartis AG.

NEWS
Vision Express cries foul on
misleading ad by online firm
10
12/11/10 NEWS
A COMPLAINT against an advert
for a north-east spectacle wholesaler
claiming to be cheaper than three
High Street multiples has been
upheld by the Advertising
Standards Authority.
A regional press advert for On:
Spec, which is based in Newcastleupon-Tyne,
stated that undercover
researchers had proved glasses were
76% cheaper at On:Spec. Boxed text
went on to claim that On:Spec was
“76% cheaper than D&A”, “69% cheaper
than Specsavers”, and “75% cheaper
than Vision Express”.
Vision Express challenged the advert
on the grounds that it was misleading
because the company believed the
research referred to in the advert was
insufficient. The multiple also said that
the advert was misleading as it failed
to provide information which allowed
consumers to verify the company’s
claim.
In response to the complaint On:Spec
admitted that the comparisons were
based on spectacle prices at independent
and multiple practices in the north only
and said that, although all savings claims
should have followed the words “up
to” some of these had been “omitted
in error”.
The online company explained that
“it was difficult to present complex
price comparison data on their [own]
website in a form that would be readily
understandable to the public” and
therefore decided to make the findings
available in-store only.
Ordering the ad not appear in
its current form again, an ASA
spokesperson said: “Because On:Spec’s
ad did not explain how readers
could verify the price savings claims,
and because it was not possible for
consumers or competitors to check
the products and prices used in the
comparison themselves, we concluded
that the ad was misleading.”

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COVER STORY
All the world’s a stage –
including learning events
Gill Brabner discusses last week’s NOC drama, What’s a LOC for? and the strengths of using ‘forum
theatre’ at educational conferences
14
12/11/10 COVER STORY
FORUM THEATRE is a high impact way of getting a message
across, and audience participation is central to this approach,
so it’s a lively and energetic opportunity for delegates to have
fun whilst learning, writes Gill Brabner, LOCSU director of
education and training.
For the NOC event LOCSU had two objectives to meet – to
highlight to LOC officers the importance of preparing the
messages when presenting to their LMC/GPs; and to create
interest for our 12 Training & Development Roadshows which
will run from January to March 2011 (also see page 5).
The 10-minute role play scene at the NOC focused on
fictional Loxenbury LOC – and characters LOC Chair Martin
Clifford and Secretary Catherine Williams. Martin and
Catherine had arranged to present to their LMC only to arrive
and find that just two GPs were able to see them, and only for
15 minutes.
The drama was established to show the importance of first
impressions, of LOC officers demonstrating collaborative
working and how to be appropriately assertive when
meeting with other professionals. It also provided the perfect
opportunity to explore these issues with humour.
At the end of the piece Martin Clifford approached two
members of the audience for advice. LOCSU associate Katrina
Venerus and AOP CEO Bob Hughes enjoyed offering succinct
advice to our fictional LOC Chair much to the amusement of
the audience.
We then replayed the scene using the audience as directors.
They were invited to shout out ‘Stop!’ to pause the action as
soon as they saw something that needed to be changed and
to give the actors direction. A lively debate was conducted
across the conference hall as delegates took their opportunity
to create a different outcome to the scene.
We intend to use professional role-players during our
training session on negotiation skills which is a central
element of next year’s January to March roadshows.
The professional actors were Lee Moone, Robyn Lewis,
James Petherick, and Rachel Hankey, and the successful
staging of ‘What’s a LOC for?’ was due, in large measure, to
their skills.
Forum Theatre
The mini-play at the NOC is an example of Forum Theatre,
which provides a learning environment which is both
powerful and fun. Delegates are able to explore different
strategies for solving the problem that the scenes present.
Interviewing, or ‘hot-seating’, the characters enable the
audience to think about an issue from the ‘character’s’
perspective.
Audience participation is central to Forum Theatre.
Audience members can participate in a number of ways:
through listening and observing; re-directing the actors
to bring the scene to a different conclusion; support the
character working with their group; question the character
(hot-seating); take a part; take part in discussion groups.
The actors and facilitator can work with the audience
in the following ways: the facilitator will encourage open
discussion of the issues portrayed in the scenes; the audience
will be encouraged to re-direct scenes; the actors (staying in
character) will approach a group and ask for their support/
advice; the facilitator will invite the audience to interview
a character (again, hot seating); audience members who
are participating at a high level will be invited to join the
actors in a scene (if appropriate); the session will end with
facilitated discussion groups.
What’s a LOC for? is available to view on our web tv
channel Ot.tv at www.optometry.co.uk

INTERNATIONALeyewear
The Eschenbach Group Telephone: 0121 585 6565

NEWS
Colleges aim to source fresh
quality standard for glaucoma
16
12/11/10 NEWS
A NEW quality standard for glaucoma
will start to be formulated at a summit
meeting next month.
The College of Optometrists and the
Royal College of Ophthalmologists
have announced the ‘joint summit’ on
quality and efficiency in glaucoma care
for December 14, and the gathering is
aimed to allow a range of experts to work
together to determine the key aspects
of quality that the new standard for
glaucoma should include.
NICE has been commissioned by the
Department of Health to produce quality
standards to clarify what high quality
care looks like across specific diseases
and conditions. Quality standards are
a set of specific, concise statements
which act as markers of high-quality,
cost-effective patient care, covering the
treatment and prevention of different
diseases and conditions. Glaucoma is to
be included in the next raft of quality
standards to be drafted in 2010/11.
Dr Cindy Tromans (pictured),
president of the College of Optometrists,
said: “A key outcome of the summit
will be a unified position across
the eye care sector on the contents
of a quality standard for glaucoma.
This will be submitted to NICE as a
formal consultation response. As the
professional bodies for optometry
and ophthalmology the College of
Optometrists and the Royal College of
Ophthalmologists are ideally placed to
work together to input into a national
quality standard for glaucoma.”
Professor Stephen Vernon, consultant
ophthalmologist representing the
Royal College of Ophthalmologists
added: “Working in partnership to
maximise the service that community
optometrists and ophthalmologists are
able to deliver to the public is essential.
When NICE announced the publication
of a new quality standard on glaucoma
we recognised a timely opportunity
for the colleges to continue to work
collaboratively to contribute to an
essential area of eye care within
the NHS.”

NEWS
Colleges aim to source fresh
quality standard for glaucoma
16
12/11/10 NEWS
A NEW quality standard for glaucoma
will start to be formulated at a summit
meeting next month.
The College of Optometrists and the
Royal College of Ophthalmologists
have announced the ‘joint summit’ on
quality and efficiency in glaucoma care
for December 14, and the gathering is
aimed to allow a range of experts to work
together to determine the key aspects
of quality that the new standard for
glaucoma should include.
NICE has been commissioned by the
Department of Health to produce quality
standards to clarify what high quality
care looks like across specific diseases
and conditions. Quality standards are
a set of specific, concise statements
which act as markers of high-quality,
cost-effective patient care, covering the
treatment and prevention of different
diseases and conditions. Glaucoma is to
be included in the next raft of quality
standards to be drafted in 2010/11.
Dr Cindy Tromans (pictured),
president of the College of Optometrists,
said: “A key outcome of the summit
will be a unified position across
the eye care sector on the contents
of a quality standard for glaucoma.
This will be submitted to NICE as a
formal consultation response. As the
professional bodies for optometry
and ophthalmology the College of
Optometrists and the Royal College of
Ophthalmologists are ideally placed to
work together to input into a national
quality standard for glaucoma.”
Professor Stephen Vernon, consultant
ophthalmologist representing the
Royal College of Ophthalmologists
added: “Working in partnership to
maximise the service that community
optometrists and ophthalmologists are
able to deliver to the public is essential.
When NICE announced the publication
of a new quality standard on glaucoma
we recognised a timely opportunity
for the colleges to continue to work
collaboratively to contribute to an
essential area of eye care within
the NHS.”

INDUSTRYNEWS
TRADING PLACES
SEE20/20, the practice management software
specialist, has appointed Michael Silverberg
(below), as UK sales manager. He was lured
away from the family business, Silverberg
Opticians, in Liverpool, to be at the forefront
of the See20/20 UK sales drive. Mr Silverberg
was inspired to make the move after being
instrumental in managing implementation of
the system across the practice.
20
12/11/10 INDUSTRY NEWS
“It increased the efficiency and productivity
of Silverberg Opticians in many areas of the
business that was previously thought to be
unattainable without further capital investment
and increased manpower,” he said.
Mr Silverberg will be responsible for
supporting the launch of See20/20’s latest
dispensing and ordering module. Over 300
organisations and practices across the UK now
use the system.
Eyeplan, the
leading provider
of monthly
payment eye
care schemes
in the UK, has
strengthened its
marketing team
and support
services with the
appointment
of Dorothy Chandler (pictured) as marketing
executive. She is an English graduate with
three years of experience in healthcare PR, and
has worked for a number of major medical
manufacturers.
She will assist with customer management
and the delivery of Eyeplan’s PR and marketing
campaigns, primarily for Eyeplan’s associate
practices. The initiative connects practices
to their patients via direct mail, with
Eyeplan taking on the design, targeting and
management process on behalf of its associates.
Eyeplan has been successfully growing its
network since 1998.
Adding 3D
clip-ons
TD TOM Davies is launching stateof-the-art
3D clip-ons, designed to
be used with any TD Tom Davies
Bespoke frame. The clip-ons feature
passive polarized lenses using the
latest 3D technology and will be
available from December 1.
The lenses also benefit from an
anti-scratch coating.
CEO Tom Davies said: “3D home entertainment has arrived. 2010 has seen
the launch of high definition 3D televisions by the world’s leading electronics
companies and the creation of Europe’s first 3D TV channel, Sky 3D, last
month. Next year all new TVs will be 3D-ready, making 3D home entertainment
more accessible. We want our customers to experience the full benefit of this
technology, whilst being able to wear their TD Tom Davies spectacles. Our
clip-ons will ensure high levels of visual clarity and comfort, and an optimum
3D experience. ”
The clip-ons were previewed at Silmo when they also featured on French
national television and were again shown at Vision Expo West. They are
individually made to order through the company’s bespoke service. Opticians will
be able to offer them on all new orders and can make individual orders for existing
customers who wish to buy the clip-ons as an add-on accessory if they already
have a TD Tom Davies frame.
020 8392 0555

Blitzing
children’s
eyewear
Norville has launched Blitz Kidz,
a collection for children aged 12 months
to 12-years old. The 13 frames, in both
metal and plastic, have their own unique
detailing.
The smaller styles are designed to
be practical but with fun colours and
offered at “a fantastic price”.
To view the collection online, visit
www.norville.co.uk. A catalogue is
also available.
& 01452 510321
Online ordering
launched
The Optoplast Actman Eyewear
Company has launched a new online
ordering website at www.oaeyewear.com.
It hosts the company’s entire catalogue
of brands including Lambretta Eyewear,
Karen Millen Eyewear, Reykjavik Eyes and
Actman + Mico. Aiming to provide a
complete resource, any items from frames
to spare parts and marketing materials can
also be ordered online.
The creation of an advanced frame
search facility is seen as a major
achievement for the new site as it can
help opticians find frames for specific
requirements, including for example by
eye size, colour, material and gender.
“We’re always looking for ways in
which we can support our customers
and by giving them the option to order
their eyewear via the Internet, we can
help them reduce costs and improve
efficiencies in practice,” said director
Andrew Actman.
& 0152 526 2626
Anyone for tennis discounts?
Rodenstock has launched the Wimbledon
Junior collection of complete spectacles for
children, teenagers and young adults, each
offered with a 33% discount.
The eight new models offer a variety of plastic
or metal frames and are available in modern
colour options.
Frame product manager, Damien Klevge, said:
“The tie-in with the iconic Wimbledon brand has
proved extremely successful over the years and
the junior link is a welcome addition.
“From a very young age, children are exposed
to fashion and soon develop their own sense
of what looks good. This range of spectacles
aims to provide a fashionable frame which
exceeds their practical requirements for it.
“In addition, we will also provide a whole
merchandise package that enables practices
to effectively promote the collection to their
patients.”
As is customary with Rodenstock, the
collection is offered as part of a complete
spectacle package. A choice of Perfalit
(spherical) or Cosmolit (aspheric) lenses
in different materials are available and are
complemented by sun lens grade options
or ColorMatic lenses which offer 100% UV
protection.
& 01474 325555
A bio-inspired solution
Bausch & Lomb’s Biotrue, a multi-purpose solution
“inspired by the biology of your eyes” is now available
in the UK and Ireland. It is “bio-inspired” to work
like the eyes to help contact lenses stay clean
and moist.
“The development of Biotrue is the
result of Bausch & Lomb’s commitment to
developing innovations,” said Chris Carter,
senior marketing manager, Bausch & Lomb
Europe.
Biotrue was developed following
intensive studies. It is formulated to work
like the eyes with three bio-inspired
innovations. It is pH-balanced to match
healthy tears, helping to maintain the
eye’s natural condition and enabling
optimal activation of dual disinfectants. It
uses a natural lubricant found in the body
and in the eye, hyaluronan. The solution
also surrounds and protects lysozyme,
a protein found in tears, helping to
maintain its natural antimicrobial activity.
& 0845 6022 350
21
12/11/10 INDUSTRY NEWS

NEWS EXTRA
Bosanquet report proposes
a ‘revolution’ in UK eye care
22
12/11/10 THE BOSANQUET REPORT
COMMUNITY OPTOMETRY is ideally placed to take part
in the Government’s aim to provide better care at less cost, a
forthcoming report will conclude.
In his response to the Equity and Excellence White Paper,
Imperial College’s Professor Nick Bosanquet will launch his
Liberating the NHS: Eye Care next month. It will set out the
current scenario – of how the sector is providing a respected
service in the High Street – but it will urge policy makers to
help optometry play a bigger role in the Government’s drive to
produce high quality health care, but also to keep a tight rein
on public expenditure.
He will advocate the redesign of the provision of eye care
services on a nationwide basis to make the best use of all
available resources, including secondary care, with patients
placed at the centre of a ‘revolution’ in optical services.
‘The strength of primary eye care is that it is skilled,
equipped, flexible, and can be delivered in the community,’
the document will explain. ‘The strength of secondary eye
care is that it can deliver effective specialist care to patients
facing acute sight loss… the solution is to bring these two
sectors closer together with the patient at the centre.’
In his forthcoming report Professor Bosanquet welcomes
the Coalition Government’s decision to continue to keep eye
testing outside local bureaucratic arrangements.
‘The challenge for the new Public Health Service is to
encourage regular sight tests, particularly working age adults
who fund their own care,’ he writes, ‘to help prevent longer
term visual impairment… and burdens on the public purse.’
Although Professor Bosanquet states that community
eye care is a ‘model service’ which already exemplifies the
ambitions of the White Paper, he believes it can do more to
relieve pressure on other NHS services, and save money.
His recommendations include that the NHS Commissioning
Board commend to GP commissioning consortia the early
adoption of the LOCSU’s Glaucoma Referral Refinement and
Ocular Hypertension Monitoring Pathways.
Professor Bosanquet’s report also calls for NICE to deliver
rapid confirmation of national quality standards/pathways for:
community
the community
He advises that, unlike sight testing, enhanced services
would need to commissioned by GP consortia, but as with
sight testing, ‘the country cannot afford or need 150 or 300
different pathways’.
So Professor Bosanquet recommends that the NHS
Commissioning Board approve early adoption of the NICE
pathways/quality standards to GP commissioning consortia,
with the proviso that this should happen as soon as possible
to reduce pressure within the system.
Although he feels that the new GP commissioners will be
starting with a tough task of saving £20bn overall, eye care, he
believes, can be a lead success area for the new policy, where
patients and GP commissioners can show results before the
reforms are fully implemented in 2013.
‘The new GP commissioners will be seeking to show
reality,” enthuses Professor Bosanquet.

NEW 90ml Flight-Pack now available
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of biocompatible disinfection, 1 proven lens cleaning, 2 and enhanced wettability 2,3 they deserve.
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Call Alcon ® on freephone 0800 092 4567 or visit: www.optifree.com
References: 1. Andrasko G, Ryen K. Optometry 2008;79(8):444-454. 2. Schachet J et al. Poster presented at AAO2006. 3. Data on file. Alcon Laboratories.
OFR/JAD/0410/WBR

PRODUCTS
Contact lenses in focus
24
12/11/10 CONTACT LENSES
OT looks at a selection of the latest contact lenses currently available to practitioners
Acuvue
Boasting ‘the widest power range of any daily disposable for
astigmatism,’ Johnson & Johnson’s 1-Day Acuvue Moist for
Astigmatism contact lenses also utilise accelerated stability design
(ASD) to increase comfort for wearers.
ASD, which is found in all Acuvue brand contact lenses,
harnesses the natural pressures of the eye lids to balance the lens
in place and quickly realign if it rotates out of place, J&J claims.
Marketed as using Lacreon technology to reduce friction, and
utilising a built-in wetting agent, the lens is designed to retain
moisture throughout the day to increase patient comfort.
0800 022 4222
Clariti
Clariti 1day from Sauflon is a silicone hydrogel lens containing more than
three times the level of oxygen required for optimal ocular health.
Makers also claim ‘outstanding levels of wearer comfort’ are experienced due
to the low modulus and exceptional wettability and high water content.
The range is now available in all powers from -0.50 to -10.00 and +0.50 to
+8.00, and are supplied exclusively to patients through High Street eye care
practitioners. Bradley Wells, Sauflon’s UK sales director, added: “Clariti 1day is
available at a price point which allows practitioners to upgrade patients from
old conventional hydrogel lenses to the latest generation silicone hydrogel
material for little or no extra cost.”
020 8322 4222
Air Optix
The Air Optix for Astigmatism contact lens from CIBA Vision will soon be
available in expanded parameters, resulting in increased patient coverage
from 88% to 99%.
This silicone hydrogel toric lens benefits from a ‘high first lens fit success
rate, fast and predictable fitting characteristics, outstanding stable vision
and all day comfort’ according to manufacturers.
Release dates for the lenses in the new parameters will be featured in
OT as soon as they become available.
0800 336 655
Kerasoft
Ultravision’s
Kerasoft IC soft
contact lenses
are designed to
fit all irregular
corneas
including post
laser refractive
surgery, pellucid
marginal
degeneration
and other
complex
irregularities.
The lens
has a
number of
configurable
lens parameters including customisable periphery design
and sector management control, which can be fully tailored
to meet the needs of the individual eye. Ultravision also
organises a number of workshops to advise practitioners on
how to fit the lens.
0800 585 115

If they’re comfortable here,
1,2
they’re comfortable anywhere.
ACUVUE ® OASYS ® contact lenses give that “no lens feeling” 1 ,
even when using a computer.
When working at a computer we blink five times less 3 , leading to dryer eyes and discomfort.
ACUVUE ® OASYS ® delivers a unique combination of smoothness, breathability,
flexibility and wettability to ensure patients experience a lens so comfortable they’ll
forget they’re wearing them 1 .
Eyes are also shielded by the highest level of UV protection 4,5 of any reusable lens.
Talk to your patients today about why ACUVUE ® OASYS ® is the best choice for
computer use.
www.jnjvisioncare.co.uk
1. JJVC Data on File 2006. 84% of patients using the computer more than 25 hours a week agreed strongly/somewhat that ACUVUE ® OASYS ® made them forget they were wearing lenses. N=174. 2. Young G, Riley CM, Chalmers RL, Hunt C. Hydrogel lens comfort in
challenging environments and the effect of refitting with SiH lenses. OVS 2007; 84; 4: 302-308. 3. Patel S, Henderson R, Bradley L et.al. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci, 1991;68:11 888-92. 4. UV absorbing contact lens are
not substitute for UV-blocking sunglasses as they do not completely cover the eye and the surrounding area. 5. JJVC Data on File, 2010. ACUVUE ® , ACUVUE ® OASYS ® , HYDRACLEAR ® and SEE WHAT COULD BE are trademarks of Johnson & Johnson Medical Ltd.
© Johnson & Johnson Medical Ltd. 2010. Johnson & Johnson Vision Care is part of Johnson & Johnson Medical Ltd.

PREVIEW
Longleat leap for Eye Opener
OT’s Emily McCormick previews this month’s sold-out AOP student conference
26
12/11/10 STUDENT CONFERENCE
THE AOP is preparing for its sold-out student ‘Eye Opener’
conference which kicks off at Center Parcs in Longleat in
a fortnight’s time (November 26-28).
Entering its third year, the Association has moved this year’s
event to the Wiltshire-based Center Parcs village after spending
the first two years in Butlins’ Skegness resort.
During the annual two-day conference students will once
again be able to benefit from up-to-date career advice, meet
potential employers from practice and industry, network, and
have fun.
Mixing lectures with leisure, the meeting will open with
a treasure hunt where eight teams of three – one team
representing each of the universities – will battle to solve a
number of optical related clues and make it to the finish the
quickest.
A lecture in the morning on the first day of the conference
entitled ‘Where will optometry take you?’ aims to broaden
delegates’ minds to the practise options available to them
once they have qualified. Representatives from the multiple,
independent, laser, hospital and domiciliary sectors, as well as
academia, industry and charity will give students an overview
of what a career in each area of optometry could hold for them.
Later in the day the AOP’s education advisor, Karen Sparrow,
will be demystifying the pre-reg process with a talk on ‘What
you didn’t know you didn’t know about how to get a pre-reg’.
Question and answer sessions held throughout the day will
allow undergraduates to quiz potential employers and speakers
about what it is really like to work in a particular optical sector
and company.
As keynote speaker optometrist and entrepreneur, Imran
Hakim will close the first day’s programme with a lecture on
‘Life beyond the Dragon’s Den’.
Commenting on the conference, Mr Hakim told OT: “I’m
hoping that by sharing the ‘rollercoaster’ of a journey that
has been my life since qualifying as an optometrist, budding
graduates will realise that there are many different paths they
can go down to shape their career.
“A ‘9 to 5’ appointment book isn’t for everybody, neither
is running your own practice, but if you can find the career
choice that is best suited to your personality and aspirations
then as somebody once said, ‘Find something you love to do
and you’ll never have to work a day in your life’.”
The second day of the conference will see Innovative
Optical Training (IOT) founders Anna Kwartz and Steve
Parrish return for a talk on ‘Planning for your pre-reg’. As
optometrists, assessors and examiners themselves – Ms Kwartz
completed her pre-reg with Mr Parrish – the pair run various
pre-reg revision courses across the UK.
The popular AOP Student Eye Ball returns on the Saturday
evening, giving students the opportunity to meet their fellow
peers from the eight universities across the UK. The winner of
the inaugural AOP Film and Television Awards (AFTA) will
also be announced at the Ball. Students have until Monday
(November 15) to enter their film to be in with a chance of
winning.
After lunch circuit training, an opportunity to see the
Parcs’ Christmas Wonderland display and the chance to take
advantage of Center Parcs entertainment facilities after the
meeting closes make up the rest of the social timetable.
Students will once again be picked up from their respective
university campuses by coach on the Friday (November 26)
before the ‘Eye Opener’ and be dropped back on the Sunday
(November 28) evening.
More details on the event are available on the Student AOP
Facebook and Twitter pages, as well as through the Student
section on the AOP website, www.aop.org.uk

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DIARYDATES
Pioneering debates
The BCLA hosts its 7th Pioneers Conference this
month at the Royal Society of Medicine with a
variety of contact lens-related debates and lectures
which have been CET-approved.
Professor Lyndon Jones will discuss ‘comfortable
contact lenses – a realistic dream for 20/20?’ in his
Pioneers Lecture which closes the November 23
event. The afternoon session includes Professor
28
James Wolffsohn on ‘Simplified recording of soft
contact lens fit’ and ‘Alcohol versus a portable sink’
by Penny Spence.
The lecture programme runs from 12.30pm until
7.30pm and the exhibition will be open until 6pm,
12/11/10 DIARY DATES
NOVEMBER
12 Sight Care Group, MWB Business
Exchange, 43 Temple Row, Birmingham,
‘Market for results’ seminar
(www.sightcare.co.uk)
14 Glasgow Caledonian University and
NHS Education for Scotland, St John’s
Hospital, Livingston ‘Binocular vision and
additional exam techniques’ (Karen.reid@
gcal.ac.uk)
15 UltraVision, Head Office, Leighton
Buzzard, Bedfordshire, ‘KeraSoft IC
workshop’ fitting techniques, 9.30am
(workshop@ultravision.co.uk)
15 Sight Care Group, Comfort Inn, 20
Dunsilly Road, Antrim, ‘Market for results’
seminar SEE ABOVE
16 Sight Care Group, Comfort Inn, 20
Dunsilly Road, Antrim, ‘Confident frame
styling, adjustments, dispensing and
collection’ seminar SEE ABOVE
17 Sight Care Group, MWB Business
Exchange, 9-10 Andrew Square, Edinburgh
‘Market for results’ seminar SEE ABOVE
17 South Staffs Optical Society, Cannock
Cricket and Hockey Club, Church Lane,
Hatherton, Cannock, ‘Corneal collagen cross
linking’ with buffet, 6.30pm (suecutts@
talk21.com)
18 Sight Care Group, MWB Business
Exchange, 9-10 Andrew Square, Edinburgh,
‘Confident frame styling, adjustments,
dispensing and collection’ seminar
SEE ABOVE
21-23 Schoolvision, Hilton East Midlands
Airport Hotel, Derby, ‘Schoolvision diploma
course’ (www.schoolvision.org.uk)
21 Glasgow Caledonian University and NHS
Education for Scotland, St John’s Hospital,
Livingston ‘Binocular vision and additional
exam techniques’ SEE ABOVE
22 TMR, Holiday Inn, Oxford Street, London,
‘Optical assistant/receptionist course one’
(info@tmr.co.uk)
22 Sight Care Group, MWB Business
Exchange, Bristol Castlemead, Bristol,
‘Confident frame styling, adjustments,
dispensing and collection’ seminar SEE ABOVE
NEW… 23 NIOS, Beechlawn House Hotel,
Dunmurry, County Antrim, Northern
Ireland, ‘Legal night’ lectures start at 7pm,
refreshments from 6.30pm (lizgillespie.nios@
btopenworld.com)
23 TMR, Holiday Inn, Oxford Street, London,
‘Optical assistant/receptionist course two’
SEE ABOVE
23 Sight Care Group, MWB Business
Exchange, branch TBC, London, ‘Confident
frame styling, adjustments, dispensing and
collection’ seminar SEE ABOVE
23 BCLA, Royal Society of Medicine, 1
Wimpole Street, London, ‘BCLA pioneers
conference and 7th pioneers lecture’
www.bcla.org.uk
NEW… 24 TMR, Holiday Inn, Oxford Street,
London, ‘Commercial dispensing’ 6 CET points
SEE ABOVE
NEW… 24 J&J, The Vision Care Institute,
Pinewood, UK, ‘Healthy eyes and
healthy practices’ 6 CET points (www.
thevisioncareinstitute.co.uk)
NEW… 24 Sight Care Group, MWB Business
Exchange, branch TBC, Manchester, ‘Confident
frame styling, adjustments, dispensing and
collection’ seminar SEE ABOVE
NEW… 24 ABDO, Canterbury Cathedral,
Canterbury, Kent, ‘Graduation ceremony’
(www.abdo.org.uk)
NEW… 25 TMR, Holiday Inn, Oxford Street,
London, ‘Optical management and marketing’
3 CET points SEE ABOVE
NEW… 25 Sight Care Group, MWB
Business Exchange, Ballitol Business Park
East, Newcastle, ‘Confident frame styling,
adjustments, dispensing and collection’
seminar SEE ABOVE
NEW… 26 Sight Care Group, MWB Business
Exchange, 43 Temple Row, Birmingham,
‘Confident frame styling, adjustments,
dispensing and collection’ seminar
SEE ABOVE
NEW… 26-28 Student AOP, Center Parcs,
Longleat Forest, Wiltshire, ‘Eye Opener
Conference’ (www.assoc-optometrists.org)
NEW… 28 ABDO North East, Village Hotel,
Leeds, ‘Annual CET day’ (www.abdo.org.uk)
NEW… 29 Royal College of General
Practitioners, 1 Bow Churchyard, London EC4,
‘2nd national primary care ophthalmology
conference’ SEE ABOVE
for more details and to book visit www.bcla.org.uk
NEW… 29 National Eyecare Group, Blenheim
Palace, Oxfordshire, ‘Building for success’ oneday
conference (p.mullins@nationaleyecare.
co.uk)
DECEMBER 2010
NEW… 1 ABDO North West and the Isle of
Man, Thistle Hotel, Haydock, ‘AGM and CET
meeting’ (rs.morris@btopenworld.com)
NEW… 3-4 UK and Eire Glaucoma Society,
Church House, Westminster, London, ‘Annual
meeting’ (www.glaucoma-societyuke.org)
NEW… 5 Glasgow Caledonian University
and NHS Education for Scotland,
Glasgow Caledonian University, Glasgow
‘Communication skills in optometry’
SEE ABOVE
NEW… 7 BCLA, British Association of
Dermatologists, London, ‘Receptionist course’
SEE ABOVE
NEW… 7 North London AOP, City University,
London, ‘Wet Macular Degeneration’ 1 CET
point (stevedross10@hotmail.com)
NEW… 7 NEOS, The Harvey Suite,
Ravensdene Lodge Hotel, 55 Consett Road,
Lobley Hill, Gateshead, ‘Vision in Parkinson’s
disease’ 7.15pm (Simonraw44@hotmail.com)
NEW… 8 South Staffs Optical Society,
Golden Orient, Hurricane Close, Stafford,
‘Christmas dinner’ (suecutts@talk21.com)
NEW… 8 UltraVision, Head Office, Leighton
Buzzard, Bedfordshire, ‘KeraSoft IC Workshop’
workshop and fitting techniques, 9.30am
SEE ABOVE

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COMPETITIONS
November crossword
This issue we continue our monthly crossword series. So why not
enter our competition before the closure date. The winner will
receive £50 in Marks & Spencer vouchers.
30
12/11/10 CROSSWORD
ACROSS
1. Also known as ‘The Millennium Wheel’ (6,3)
8. Inserted into the eye to give better vision (7,6)
11. Arm bone (4)
12. Aromatic herb of the parsley family (5)
13. Nothing, nil (4)
16. Cares for other people’s children (7)
17. Golf club, used for getting out of bunkers (7)
18. Becomes anxious (7)
20. Famous master of ‘escapism’ (7)
21. Give out (4)
22. Subside (5)
23. Curved symmetrical structure, spanning an
opening (4)
26. Celebrated comic duo sharing a name (3,3,7)
27. Short hairs fringing and protecting the
eyes (9)
DOWN
2. Sworn statement (4)
3. Pours the wine (7)
4. Without You singer, Harry ------- (7)
5. Common nick-name for an USA visitor (4)
6. Returning to a law-abiding life! (5,8)
7. Those profiting from a Trust or a Will (13)
9. Famed villian on November 5th (3,6)
10. Turn the gaze to a given direction (4,5)
14. Hard-wearing material for jeans etc. (5)
15. Adverb, indicating vague movement in
an area (5)
19. A layer of earth between topsoil and
bedrock (7)
20. Cooked sausages served in a long roll (3-4)
24. Remain, don’t leave (4)
25. ---- Diamond, TV personality (4)
Name:
Address:
Send entries to OT, November Crossword, 61 Southwark Street, London SE1 0HL to arrive
no later than December 7 2010.

BOOK YOUR TABLE
FOR THE 35TH VISION CHARITY BALL
SUPPORTING BLIND AND
VISUALLY IMPAIRED CHILDREN
This will take place on
SATURDAY 4TH DECEMBER 2010
THE GREAT ROOM, GROSVENOR HOUSE
PARK LANE, LONDON
This star studded charity event will be the place to be and be seen.
Don’t miss your chance to mingle with prominent figures of the media
and TV industry as we recreate 1930’s Chicago.
STARRING
"astonishing"
DELIVERING THE MAGIC ON
BROADWAY!
Treat you and your guests to a sumptuous dinner, an evening of high
class entertainment and help raise funds to improve the lives of blind
and visually impaired children.
FOR BOOKINGS PLEASE CONTACT:
Sadie Groom at: Sadie@bubblesqueak.co.uk
or telephone: 01442 877 850
Sponsorship and advertising opportunities are also available.
For more information visit:
www.visioncharity.co.uk/winterball

PRE-REGFOCUS
Sponsored by
Magnification explained: Part 1
32
12/11/10 PRE-REG FOCUS
AS A low vision practitioner, I am amazed at
how many different ways you can calculate the
amount of magnification patients require prior
to demonstrating low vision aids, writes Jane
Macnaughton, director of Clearview Training.
There is a myth that because maths is
involved, magnification is difficult. Students and
trainees often struggle with the basic concepts.
However, when it comes to prescribing
magnification, like all things optometric, you just
need a good, methodical routine.
What I emphasise to my trainees is that
following a detailed task analysis and discussion
on the patient’s needs, we should only need
to show the patient three of four magnifiers to
determine which would be the most suitable for
the task.
I appreciate that I’m over-simplifying things
here. However, magnification in its basic form is
merely comparing an old situation with a new
one. So for the purpose of the assessments, I
would expect trainees to have tried and tested
one or two of the following methods before
discussing them with their assessor.
For the purpose of this article I’ll leave out the
maths which could be incorporated. At patient
level I am most keen to determine their needs
rather than split hairs over formulas. You will
however need your 4x table.
1. Using the charts
There is a direct mathematical relationship
between letter size notations on the Times New
Roman Faculty of Ophthalmologists reading
chart: N12 is half the size of N24; N6 is half the
size of N12; N9 is twice the size of N4.5. For
example, if a patient sees N10 with their current
spectacles then you would assume they require
an additional 2x magnification to see N5.
This method is quick and useful for patients
with relatively good distance and near acuities. I
would use this method in the clinic for follow-up
patients where there is a small step up required.
However, it is not an accurate method to use
Figure 1: The patient is given a +4.00D addition with
a working distance of 25 CM
when the VA is poor as there will be other factors
affecting the result.
2. The ‘divide by three’ rule
This rule gives an estimation of near acuity
based on the distance acuity. For example, if
the distance acuity is 6/24, then the expected
near acuity should be approximately 24/3 =
N8 at a working distance of 25cm. However,
this is only an estimation as patients with low
vision rarely exhibit this relationship in practice.
Reading acuity does not correlate well with
distance visual acuity and significantly less so
with visually impaired patients. Patients with
AMD for example, will often demonstrate a
significantly reduced near acuity than you would
be expected from their distance acuity, due to
the presence of a central scotoma. Posterior
subcapsular cataracts can also give anomalous
results. The cataract is close to the nodal point
of the eye and despite relatively good distance
acuity, the near VA is often be quite poor.
Furthermore, pupillary constriction will enhance
the influence of scotomata and opacities. And
finally, as reading is a complex visual task, the
choice of near target used will have a bearing
upon near acuity. For example, if constructed
sentences are used as a target then it is easy for
a patient to guess subsequent words on a page
from the meaning of the text.
3. Using a low vision routine
This technique is a well-established methodical
Figure 2: The reading addition is increased to +8D
with a working distance of 12.5CM
routine and gives a good foundation for which
the rest of the consultation is based. Most low
vision practitioners will use this method in some
format or another. It is certainly my preferred
starting point, and one that I have had no need
to tamper with over the past 20 years that I have
been practising low vision.
• Begin by establishing the patient’s baseline
near acuity with a +4.00D addition at 25cms.
If you find the near target does not come into
focus at this distance you need to recheck the
end point of your distance refraction (Figure 1).
• If the level of VA is less than what the patient
needs to achieve the desired task, then start
by increasing the addition in the trial frame
until the desired acuity is met, usually in +4.00
D steps. Don’t forget to explain the reduced
working distance, and demonstrate the effect of
illumination (Figure 2).
• When the desired near visual acuity is met, the
magnification of the high reading addition thus
demonstrated will give the practitioner a starting
point magnification with which to demonstrate
the device of choice, such as a hand magnifier.
• Record patient handling, motivation and
achieved VA with each aid shown. With higher
magnification, it is important to demonstrate
that an increase in magnification means a
smaller field of view and a smaller magnifier.
• The second part of this article will be published
in OT on December 10.
For references see www.optometry.
co.uk

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MANAGEMENT OPTIONS FOR UK OPTOMETRISTS PART 5
Bacterial infections of the
conjunctiva and peripheral
cornea
COURSE CODE: C-14743 O/AS/SP/IP
Professor Michael J. Doughty, PhD
This article discusses the aetiology and demographics of acute and sub-acute
infections of the conjunctiva and peripheral cornea as caused by bacteria,
including those associated with contact lens wear. The rather complex
legislation relevant to access and use of topical ocular anti-infectives and
antibiotics, extending to additional supply (AS) and independent prescriber
(IP) levels, will be reviewed. Specific consideration of product ingredients
and their expected pharmacokinetics will be covered, leading to an outline
of the indicated uses by optometrists including follow-up guidelines.
Changing legal background -
use and supply of anti-infectives
Special access provisions, within the
broad context of the Medicines Act,
have been progressively updated over
the years to define optometric access
to anti-infective drugs. These updates,
or statutory instruments, do not define
the nature or severity of the eye disease
that might be treated, but there are some
relevant Clinical Management Guidelines
(CMGs) from the College of Optometrists,
principally those for ‘Conjunctivitis
(bacterial)’ and ‘Keratitis (marginal)’.
UK optometrists were allowed to
use and supply eye drops containing
chloramphenicol from the late
1980s onwards. Reclassification of
chloramphenicol multi-dose eye drops,
and then the ophthalmic ointment, to
P medicines occurred in 2005 and
2007, respectively, along with further
laws that allowed optometrists to
sell and supply any P medicine,
providing it was in the course of their
professional activity, ie, the so-called
emergency stipulation for P Medicines
access and use was removed. These
products (eg, diamidine anti-infectives
and P medicine chloramphenicol) are
marketed with guidelines for their
use, and for chloramphenicol these
differ slightly from those for the PoM
products. The Statutory Instruments in
2005 also removed optometrist access
to framycetin, with fusidic acid eye
drops substituted. Both chloramphenicol
and fusidic acid products can be used,
supplied and sold by optometrists. Stocks
can be obtained by wholesale trading, or
the optometrist may also access these
products for a named patient and via a
pharmacist, by a written (signed) order.
Mechanisms of action of drugs
Antibacterial drugs can slow down
or stop further replication of bacteria
(bacteriostatic) or can kill bacteria
(bactericidal). There is also a notable
selectivity of drug action according to the
bacterial type, usually broadly classified
on the basis of being gram-positive
or gram-negative, with sub-categories
according to whether they grow best in
culture under oxygen-rich (aerobic) or
oxygen-deficient (anaerobic) conditions.
The vast majority of suspected
bacterial infections of the conjunctiva
and peripheral cornea are managed
without culture tests for identity of
type or actual sensitivity to specific
drugs, but rather a ‘shotgun’
therapy undertaken, ie, to
expose the ocular surface with an
excess of antibacterial drugs and see
if it responds (see later).
The various antibacterial drugs
have different mechanisms of action
targeted at the permeability of the inner
cytoplasmic (cell) membrane of bacteria
and/or their intermediate metabolism,
at the protein synthesis mechanisms of
bacteria, at the mechanisms by which
the outer cell wall is assembled or at
the DNA replication mechanisms of
the bacteria. 1,2 Some of these drugs
are available to non-therapeutically
qualified optometrists, some to AS level

optometrists and also to IP optometrists.
If a suspected bacterial infection of the
external eye fails to respond to the initial
shotgun therapy, the bacteria may be
resistant to the ‘entry level’ drugs and
so referral to a therapeutically trained
optometrist (or an ophthalmologist) can
provide access to different types of drugs
to which the bacteria may be sensitive.
Overview of bacterial
infections of the external eye
and their presentation
One type of blepharitis can be infectious,
where poor eyelid hygiene most
commonly leads to colonisation of
the eyelashes with the same bacteria
found on the skin, eg, Staphylococcus
epidermidis and S. aureus. These are
not visible in a clinical setting (although
can be seen with an electron microscope;
see OT September 17 2010) but can lead
to the development of acute-onset focal
infections that are visible clinically. These
are most commonly of the eyelash follicles
(sometimes with the glands of Moll and
Zeis) and give rise to a stye or external
hordeolum (see OT September 17 2010).
An infectious blepharitis, if not
managed properly, can easily lead to
development of blepharoconjunctivitis
whereby the bacteria infect the mucous
membranes of the conjunctiva as well
as the eyelid margins, and can also be
associated with a marginal keratitis
(see next article in this series). As part
of the innate immune response (see
OT October 15 2010), the conjunctiva
not only reacts with development of
redness (Figure 1) but also a discomfort
usually described as a burning
(rather than an itching) sensation. 3,4
The conjunctiva is normally covered
with the tear film which provides
defense against infective organisms,
especially bacteria. 5 Antibacterial
substances such as lysozyme are notably
active in dissolving the outer cell
walls of staphylococcus sp., so should
limit bacterial levels to a minimum
or low level. Logically, a bacterial
blepharoconjunctivitis or conjunctivitis
Figure 1
External eye appearance in a mild case of
blepharoconjunctivitis to illustrate redness of the
conjunctiva and eyelid margin. The eye has been
stained with fluorescein (see text). Courtesy of Dr.
Paul Cutarelli, MD, first published in Optometry
Today, July 3, 1998.
will develop as and when the levels of
bacteria exceed the protective functions
of the tear film and the capacity of the tear
film drainage to remove bacteria from the
ocular surface. 5 If a patient already has
suboptimal tear properties (eg, because
of chronic dry eye disease, allergic
conjunctivitis or acne rosacea), they are
at higher risk for developing bacterial
blepharoconjunctivitis or conjunctivitis.
As bacteria numbers increase, the
innate immune reaction produces
pronounced vasodilatation that allows
for emigration of white blood cells from
fenestrated capillaries into the loosely
compacted conjunctival parenchyma and
eventually onto the conjunctival surface.
The net result is a mixture of rapidly
proliferating bacteria, white blood cells
and some mucous from goblet cells, a
mixture referred to as mucopurulent
discharge. A bacterial conjunctivitis is
generally diagnosed on the basis of signs
and symptoms at first presentation, and
likely to include early morning ‘glued’
eyes that result from the mucopurulent
discharge that accumulates in the
fornices and seeps out between the
closed eyelids (Figure 2). 6-9 Substantial
generalised eyelid oedema should not be
present and the superior palpebral fold
(sulcus) should be evident. If not, referral
to ophthalmology should be considered
for systemic antibiotic treatments. 10
Such discharge can be expected to be
associated with a generalised redness
of the bulbar and palpebral conjunctiva
(which may sometimes be remarkable).
The condition is more likely to be
bilateral, but can be asymmetrical
in its initial presentation. At the
earliest development of symptoms, the
quantity of discharge may only be very
slight, but can develop substantially
over just 24 hours. Cultures
from human eyes diagnosed with
presumed bacterial conjunctivitis
have revealed that different
bacteria can be present (Figure 3).
A positive culture of viable bacteria
from the eyelid margin or the lower
fornix is not uncommon, even though
the actual number of bacteria (in colony
forming units – CFUs) can be very
small (especially in a nominally ‘clean’
eye where eyelid hygiene is good).
Therefore, as illustrated in Figure 3, the
commonest isolate was S. epidermidis
(STAPHE), followed closely by S.
aureus (STAPHA). 11-13 Ocular isolates of
S. epidermidis are usually considered
non-pathogenic as they are part of the
‘normal’ flora of the eyelid margin,
while S. aureus should be considered
a pathogen especially if showing
resistance to the cell wall synthesisinhibiting
antibiotic methicillin (MRSA).
Other bacteria such as Haemophilus
influenzae and Streptococcus
pneumoniae are not uncommon causes
of an infected throat that can accompany
a bacterial conjunctivitis, thus the
moderately high incidence of positive
cultures (designated as HAEMOPH
and STREP in Figure 3) for bacterial
conjunctivitis, especially in children.
For the most part, even when quite
substantial discharge is present, the
ocular surface will likely only stain
diffusely with fluorescein, indicating
intact barriers. A more serious infection
of the external eye can develop, even due
to so-called non-pathogenic organisms,
because of the presence of even the
smallest focal lesion on the surface. If the
initial number of bacteria (‘bacterial load’)
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Figure 2
Typical presentation of an acute onset bacterial
conjunctivitis with a notable flush (‘pink eye’)
and obvious mucopurulent discharge with slight
crusting nasally. Courtesy of Dr. Bianca Sallustio,
MD, first published in Optometry Today October
17, 2008
or other pathogens was high (including
on a soiled contact lens), then even
non-virulent strains are more likely to
establish themselves on a compromised
ocular surface and so result in a
serious infection. Low numbers of a
particularly virulent bacterial strain (or
other microorganism) can overwhelm
even the highest levels of defenses
and barriers, especially that
of the cornea and an infection
(keratitis) develops. A notable
pathogen, such as Pseudomonas
aeruginosa, would be expected
to invade even healthy tissue
and make a lesion, but such
pathogens are much less
common when a bacterial
conjunctivitis is diagnosed
(see Figure 3; PSEUDOM). 11-14
However, with certain risk
factors (eg, contact lens wear),
a check should be made with
slit lamp biomicroscopy
for any sign of surface
lesions or ulcers (Figure 4).
Even a suspected
peripheral ulcer of this type
should be considered for
antibacterial drug treatment, even
if just for prophylaxis (see later). In
rare cases, a true infected ulcer can
develop in the corneal periphery
and pseudomonas should always be
Percentage of isolates in studies (%)
100
80
60
40
20
0
considered in a contact lens wearing
patient presenting with an acute-onset
red eye (CLARE), and the patient
usually referred to ophthalmology.
In the majority of cases, non-bacterial
causes of an infectious conjunctivitis
are essentially identified as a result of
failure to respond to an initial treatment
with antibacterial drugs. Notable
exceptions to this, which should be
considered as part of the diagnosis,
are infections of the eyelid margin and
eyelashes associated with mites or lice
(see OT September 17 2010) or viral
infections (ie, EKC or especially Herpes
simplex); neither would be expected
to produce a mucopurulent discharge.
These cases should be referred to an
IP optometrist or ophthalmologist.
Treatment options
The treatment options really depend
on the bacteria type, antibacterial drug
mechanisms and level of training. A
non-specific ‘treatment’ for recurrent
mild bacterial infections of the
external eye is to reduce the bacterial
HAEMOTH
PSEUDOM
STAPHA
STAPHE
STREP
Bacterial isolate (aerobes only)
Figure 3
Survey of culture results from cases of presumed
bacterial conjunctivitis over a 50-year period
(1955 to 2005). From Doughty & Dutton. 6
Copyright College of Optometrists.
load by improving lid hygiene (see
OT September 17 2010). This should
always be considered for recurrent
mild infections, since such ‘lid scrubs’
can hopefully reduce the number of
viable bacteria without exerting any
specific bactericidal or bacteriostatic
effect. They should also be considered
to control the condition after a course
of anti-infective drug therapy. These
lid scrubs are non-medicinal products
that can be supplied by all optometrists
(see OT September 17 2010).
The next level of drugs is represented
by the diamidines, namely propamidine
and dibromopropamidine. These are
also available to all optometrists and
are chemical agents (ie, anti-infectives
not antibiotics) best described as
general-purpose bacteriostatic agents.
They were introduced in the 1940s and
have several effects including blocking
a cell membrane-sited ‘permease’
transport system for uptake of purine
nucleotides; 1,2,15 the bacteria are
therefore unable to synthesise adequate
quantities of precursors for DNA, RNA
or even protein synthesis, and
so fail to thrive. Other secondary
effects on this intermediate
metabolism also likely achieve
the bacteriostatic effect.
It is largely unknown as to
what type of resistance can
develop to these drugs and/or
whether resistance is a problem
with their ophthalmic use. The
sulphonamides or ‘sulfa’ drugs (eg,
sulphacetamide sodium) inhibit
folic acid-linked intermediate
metabolism of bacteria and
these drugs had substantial use
from the late 1940s, showing
efficacy against common grampositive
bacterial eye infections.
These drugs were available to
optometrists in an ‘emergency’,
but commercial products were
discontinued in the late 1980s when it
became recognised that their efficacy was
declining, most likely due to resistance.
The mainstay of treatment of bacterial

infections of the conjunctiva (and
probably many cases of peripheral
cornea conditions) is with the antibiotic
chloramphenicol. This is a protein
synthesis inhibitor and with its broad
spectrum of activity can be expected
to affect the protein synthesis of many
types of bacteria, a notable exception
being some pseudomonas strains. 16-18
It was originally made available to
all optometrists as PoMs (eg, PoM
Chloromycetin eye drops and ointments,
generic PoM Chloramphenicol eye
drops and ointments, and the PoM
Minims Chloramphenicol; British
National Formulary, 2010). There is no
obvious evidence that its overall efficacy
has declined over the many years it has
been used for external eye infections,
with resistance routinely found
to only be at a low level (c. 10%).
An inappropriate chronic use and
overuse of chloramphenicol eye drops
or ointments prompted a considerable
degree of professional concern in the
1980s over its routine selection as a
short-term, all-purpose topical ocular
antibacterial for conjunctivitis. 19
However, the evidence provided to
support a case for stopping this routine
use was clearly not substantial enough
for the products to be withdrawn in
the UK. Indeed, quite the opposite
has happened as chloramphenicolcontaining
eye products were
reclassified as P Medicines (eg, Golden
Eye Antibiotic drops and ointments,
Brochlor eye drops and ointments,
as well as several generic products
from major pharmacies such as Boots
Infected Eyes eye drops), with any UK
optometrist being able to sell and supply
these under the proviso that their use
should be undertaken with a little
more care and organisation (see later).
Fusidic acid is another antibiotic
directed at protein synthesis of bacteria,
available in a special viscous eye drop/
gel. Its site of action is different to
chloramphenicol and it has a narrow
spectrum only. 20 Notwithstanding,
providing it is not used when the
Figure 4
Localized surface micro-lesion (peripheral ulcer)
staining positively with sodium fluorescein in
a contact lens wearer. Reproduced with kind
permission from the Bausch & Lomb Picture Library.
possible pathogens causing the
conjunctivitis are those associated with
bacterial infections of the throat (ie,
streptococcus and haemophilus sp.),
it should have an equivalent efficacy
to chloramphenicol eye drops or
ointment and work on 90% of patients.
From 2005, an ophthalmic fusidic
acid preparation, as PoM Fucithalmic,
became available to all optometrists.
AS-trained optometrists can also access
two other antibacterial drugs, namely
bacitracin and polymyxin B. Bacitracin
was introduced in the 1950s as a narrow
spectrum antibiotic that interferes with
the synthesis of the cell wall, especially
in gram-positive bacteria, 21 while
polymyxin B non-specifically increases
the permeability of the membrane of
common gram-negative and grampositive
organisms. 16 Both drugs
generally exert concentration-dependent
bacteriostatic then bactericidal effects
at higher levels, and are routinely used
in combination. Such an option is
available in the form of PoM Polyfax
eye ointment. Another drug option for
AS-trained optometrists was listed in
the 2005 legislation changes. This was
trimethoprim, which inhibits folic acidlinked
intermediate metabolism, 22 but
commercial products were discontinued
in the UK at about the same time.
IP optometrists have access to any
ophthalmic antibacterial drugs for use
as part of their professional practice
with the general caveat that they
should only be used when there is
an appropriate level of professional
experience and competence. So, for
example, a substantial mucopurulent
conjunctivitis developing in a newborn
infant is designated in the current CMGs
as a condition requiring urgent referral
to an ophthalmologist. Options to an IP
optometrist include the aminoglycoside
antibiotics with gentamicin, like
framycetin once available to UK
optometrists, being considered to be able
to block protein synthesis in a broad
spectrum of gram-positive and gramnegative
bacteria (providing resistance to
the antibiotics has not developed). 13,14,18
While commercially available (eg, PoM
Genticin eye drops) and on some NHS
regional formularies, its recommended
use however, is unlikely to include
routine cases of bacterial conjunctivitis.
The same applies to another protein
synthesis inhibitor, chlortetracycline,
a tetracycline antibiotic widely used
in the 1950s and 1960s. 23 Ophthalmic
commercial products are no longer
available but may be prepared and
made available by specialist NHS
pharmacies for use on special cases.
Another aminoglycoside is neomycin,
available in combination with bacitracin
and another cell membrane-active
antibiotic gramicidin (PoM Neosporin)
that might be used as a broad-spectrum
antibiotic approach for managing corneal
abrasions (see next part of this series).
The last antibacterial drug option
generally available to IP optometrists
is that of the fluoroquinolone drugs, eg,
ofloxacin and levofloxacin. These are
also broad spectrum but inhibit bacterial
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DNA replication rather than
protein synthesis, 24 and are
100
generally bacteriostatic.
However, at the present time,
while these drugs (eg, as PoM 80
Exocin and PoM Oftaquix)
can be expected to be
effective, neither is advocated 60
for routine use for commonly
presenting bacterial
conjunctivitis. They should 40
be reserved for use for more
stubborn or severe infections
not responsive or susceptible 20
to chloramphenicol or the
aminoglycosides. Even
chloramphenicol eye drops 0
may still be used for a
0.0 0.2 0.4 0.6 0.8 1.0
marginal, non-ulcerating
keratitis, as a prophylaxis.
Time after instillation (Hours)
Another option, ciprofloxacin
(PoM Ciloxan eye drops
Figure 5
and ointment), would be considered
Expected time-related changes in the tear film
suitable as an initial monotherapy
for suspected infectious ulcers of
concentration of chloramphenicol after presentation
the peripheral (or central) cornea, to the surface of human eyes as eye drops. Data
with or without cultures being taken. taken from Hanna et al. 25
Drug concentration in tears (%)
Pharmacokinetics of topical
antibacterial drugs
Products containing anti-infective drugs
can be presented to the human eye in
three ways, namely as an ophthalmic
solution (eye drops), eye ointments or
special very viscous solutions. For eye
drops containing dibromopropamidine,
no pharmacokinetic data appear to have
been published. However, the timedependent
changes in the concentration
of this drug in the tear film, after
presentation to the conjunctival surface
as a 0.1% solution, would be expected
to be similar to that reported for
chloramphenicol (Figure 5); 1,25 these eye
drops were specified to also contain some
hypromellose polymer, an inclusion
that would increase the retention time.
In relative terms, immediately after
instillation, the drug concentration in
the tears will be 100%, but this will
decline rapidly as the volume of the eye
drops is rapidly washed away through
the puncta and down the nasolacrimal
duct. The relative concentration can
be expected to be only half the initial
value within about five minutes if the
eye drops contained hypromellose, and
within only one or two minutes without
hypropmellose. 1 Regardless, within
30 minutes of instillation of such eye
drops, only a small fraction (ie, less than
0.1% concentration) would expected
to be present, a level that is likely to
be below that required to exert a useful
bacteriostatic effect. If the same drug were
presented to the eye as a small ribbon
(0.5cm to 1cm long, extruded into the
lower fornix), then a remarkably different
time-related profile of drug concentration
is expected, extending to some five
hours (Figure 6). 25 The practical
consequences of this clinical
pharmacokinetics will be discussed later.
The concentration of chloramphenicol
in eye ointments is usually 0.5% w/v
rather than the 1% w/v in eye drops.
While there is still a
relatively fast initial wash
out as the ointment is
likely squeezed out over
the eyelid margins, around
half of the initial drug is
still measurable in the
tear film after 30 minutes
and coating of the eyelid
margins likely serves as
a reservoir to feed small
quantities of the drug
back into the tear film
over an extended period
of time. 26 There is thus a
slow secondary decline
in drug concentrations
over perhaps some three
hours. If the eye was
irritated, and there was
not much soothing effect
from the application of
the lubricating ointment, then reflex
tearing would be expected to enhance
the rate of washout, eg, half washout
may be as short as 20 minutes and
secondary washout complete within
two hours. Notwithstanding, the
ointment application provides an
extended time period of antibiotic
drug coverage of the ocular surface.
Similar effects would be expected for
dibromopropamidine or polymyxin
B and bacitracin eye ointments.
The use of a special viscous eye
drop, with the viscosity provided by a
carbomer ‘gel’ formulation similar to
that used for various ocular lubricants
in dry eye (see OT August 13 2010),
substantially extends the time period
of antibiotic drug coverage from
that achievable with inclusion of
hypromellose polymer into eye drops;
the drug retention time can extend out to
12 hours (Figure 7). As the profile shows,
the use of such carbomer-based eye
drops can be expected to provide similar
initial time-dependent delivery over
the first one-two hours to that of an eye
ointment, and an even further prolonged
secondary drug delivery. Such effects
can be attributed both to the viscous

‘gel’ coating the eyelid margins
(so serving as a reservoir
of drug) and to the carbomer
actually adhering to the cornea
and conjunctival surface.
Clinical use of antiinfective
drugs for
bacterial infections
There are four inter-related
aspects to clinical use of
antibacterial drugs for the
external eye. These are: (a)
evaluation and diagnosis
(especially of the severity of
the presenting condition),
(b) selection of the most
appropriate product to treat
the condition, (c) selection of
the most appropriate schedule
of use of the particular product
chosen (including how long
it should be used for), and (d)
Drug concentration in tears (%)
100
80
60
40
20
consideration of the follow-up required.
Prophylactic use of antibiotics (including
for corneal abrasions) will be considered
in the next article of this series.
For management of mild or suspected
cases of bacterial conjunctivitis or
blepharoconjunctivitis, diamidine
treatment is appropriate as an initial
measure. The two drug options available
in the UK are propamidine, in the form
of P Brolene and P Golden Eye eye drops,
and dibromopropamidine, in the form of
P Brolene eye ointment and P Golden
Eye ointment. The original Golden Eye
ointments contained yellow mercurial
oxide, but the active ingredient was
changed to a dibromopropamidine,
which is also used in topical skin
antibacterial preparations (also available
as P Medicines). Use of propamidine
eye drops on a QDS basis would be
appropriate, with the patient needing
to be told that if the condition does not
respond promptly, then further attention
should be sought. This may simply
be to then try antibiotic eye drops (eg,
chloramphenicol), either supplied by the
optometrist or via a pharmacist; either
provider should take time to instruct the
0
0 1 2 3 4 5
Time after application (Hours)
Figure 6
Expected time-related changes in the tear
film concentration of chloramphenicol after
presentation to the surface of human eyes as an
ophthalmic ointment. Data taken from Hanna et
al. 25
patient that the use needs to be intensive.
With the expected pharmacokinetics
for chloramphenicol eye drops, current
recommendations for the use of these P
medicines is for the drops to be instilled
every two hours during waking hours for
the initial 48 hours. This will mean that
there are only short periods when the
surface is not exposed to a suitable level
of antibiotic. After 48 hours, dosing can
then be reduced and overnight coverage
with the companion ointment products
(eg, P Brochlor eye ointment, P Golden
Eye Antibiotic eye ointment) added at
some stage as appropriate (even during
the first 48 hours if necessary). For older
children (above the age of two years) and
elderly people, management of many
cases of bacterial conjunctivitis might
be more effective with the use of the
ointments QDS from the outset, since a
much better coverage would be expected.
The P Medicines
are not indicated for
use in infants.
When a patient
presents with an obvious
bacterial conjunctivitis
(eg, Figure 2), then
cleansing needs to be
the first step. Any signs
of discharge, no matter
how slight or substantial,
should be removed by
cleansing. A simple
approach, especially
applicable to children
or old people, is to use
cotton wool repeatedly
wetted with warm water
and wiping the eyelid
margin and periocular
skin from inner to outer
aspects. Dried discharge
(‘crusting’) may take
several wipes to soften. The water
should be clean, and some may get
into the eye. Additional cleaning of
the conjunctiva and fornices is better
done with a sterile eyewash product,
with patients being advised that the
discharge can be contagious (so ocular,
facial and hand hygiene is important
to stop spreading and/or transmission).
After cleansing, the P medicines
containing chloramphenicol can be used
as just indicated above, with it being
important that the patient understands
that treatment should be continued for a
couple of days after a cure is apparently
achieved. With the availability of
numerous P medicines containing
chloramphenicol, the PoM products
have all but become redundant for
routine optometric practice, although are
likely still prescribed by GPs for patients
presenting with a bacterial conjunctivitis.
An alternative to chloramphenicol,
for patients presenting with an obvious
bacterial conjunctivitis, is to use the
fusidic acid product; 4,6,8,12,26 this can be
used in infants. The pharmacokinetics
of this product is such that intensive use
is not required. This may be especially
39
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useful if, for example, the
patient is unable to readily
comply with a two-hour
dosing with eye drops or
even QDS use of ointments.
This may be because the
patient is a younger child,
when a parent or caregiver
needs to instill the drops,
but care should be taken
not use PoM Fucithalmic to
treat bacterial conjunctivitis
associated with a bacterial
throat infection (see earlier).
Similar considerations apply
to elderly people, when, for
example, manual dexterity
problems may limit their
ability to regularly apply
eye drops or ointments. A
standard dosing with PoM
Fucithalmic is twice daily
(BDS), with the usual duration of the
treatment being for at least five days.
However, if the condition is considered
moderate or even severe, then the
initial treatment can be QDS (ie, every
four hours or so) for the first day.
Optometrists may sell and supply
PoM Fucithalmic, but it is likely
easier to access it via a written order.
If a written order is being used, then
details should be on the supply and
labeling instructions to the pharmacist,
eg, “supply 1 tube Fucithalmic for
morning and evening use, both eyes,
for five days”. The written order
should also include details of the
patient’s name, address and age, and
be on stationary that clearly indicates
the optometrist’s registered practice.
Fusidic acid viscous eye drops may
also be useful in cases of infectious
blepharitis. 27-29 This might be
considered as an ‘unlabelled use’, but
is a useful alternative to chronic use of
chloramphenicol eye ointments. Whilst
the viscous eye drops are instilled into
the lower fornix, providing there is
adequate retention, then the antibiotic
would be expected to seep out and coat
the marginal zone of the eyelids and even
Tear film fusidic acid concentration (%)
70
60
50
40
30
20
30
0
0 4 8 12
Time after instillation (Hours)
Figure 7
Plots to show time-related changes in fusidic acid
levels in the human tear film after instillation of a
single drop of a Carbomer-based viscous eye drop
into the eye of healthy volunteers. Data presented
with a logarithmic smoothing, with the fusidic
acid concentrations in μg / mL. From Doughty &
Dutton. 20 Copyright College of Optometrists.
get around the bases of the eyelashes.
The necessity of using the eye drops
or ointments as indicated, needs to be
stressed to the patient (or their parent/
guardian for paediatric cases), and that
treatment should continue for two days
after a ‘cure’ has been achieved. This
recommendation applies even if the
course of treatment was just five days.
For a milder infection, a sufficient
improvement may have occurred in
just three days such that the patient
considers that they no longer need
to bother with using their eye drops.
Follow-up should be as appropriate,
depending on the severity of the
condition and the expected compliance
of the patient. As a guideline, as the
optometrist is directly or indirectly
initiating the supply, the patient should
be advised to return if the condition
gets worse, and this is best indicated
on the patient records.
This advice can be
facilitated by providing the
patient with a business card
(or similar) with practice
telephone number. A patient
will, in all likelihood, be
prompted to seek further
attention if the condition
does not resolve in a few
days, and so there is no
formal requirement for a
specific follow-up visit (eg,
at 48 hours or after five days
of treatment), providing
the patient has been given
instructions as to when
and where to seek further
attention. This follows the
same sort of procedures
used in UK accident and
emergency departments. 30,31
Notwithstanding, there
is no reason why an optometrist
cannot choose to see a patient for a
specified follow-up visit (eg, at 48
hours) if they feel that it is appropriate.
Summary
Despite a rather muddled rationale
behind changes in the laws pertaining to
access to anti-infectives and antibiotics,
current UK optometrists do have the
means to therapeutically manage many
types of common ocular bacterial
infections from the outset, and should
only need to refer if they are uncertain
about the diagnosis or a condition gets
worse despite the initiation of treatment.
About the Author
Professor Doughty has been teaching
ocular pharmacology, as well as many
aspects of ocular physiology and eye
disease, for over 25 years and authored
books on the subject. He has held the
post of research professor at Glasgow-
Caledonian University, Department
of Vision Sciences, since 1995.
References
See www.optometry.co.uk and search
‘references’

Module questions
Course code: C-14743 O/AS/SP/IP
1. Which of the following is a characteristic sign associated with onset
of blepharoconjunctivitis?
(a) Dry eye sensation
(b) A burning discomfort
(c) Marked mucopurulent discharge
(d) Redness of the lid margins and bulbar conjunctiva
2. Which of the following bacteria would be the MOST likely cause
of a severe conjunctivitis with marginal keratitis?
(a) Staphylococcus epidermidis
(b) Staphylococcus aureus (methicillin sensitive)
(c) Haemophilus influenzae
(d) Pseudomonas aeruginosa
7. Which of the following drugs can exert effects on protein synthesis
of bacteria?
(a) dibromopropamidine
(b) framycetin
(c) chloramphenicol
(d) All of the above
8. What is the expected time period for half of an antibiotic eye drop
to be washed from the ocular surface?
(a) About 5 minutes or less
(b) 20 to 30 minutes
(c) One hour
(d) About 3 hours
41
3. A mucopurulent discharge is:
(a) A special mucous secretion from the glands of Moll and Zeis
(b) Derived from the glands of Krause in the lower fornix
(c) A mixture of bacteria, mucous and white blood cells
(d) Secreted from the lacrimal gland following infection
4. Which of the following is a major component of the action of
dibromopropamidine?
(a) Dissolving the cell wall of gram-positive bacteria
(b) Increasing the permeability of bacterial cell membranes
(c) Blocking a cell membrane purine transport system
(d) Specifically inhibiting DNA synthesis of bacteria
5. Current products of Golden Eye ointment contain which active
ingredient?
(a) propamidine
(b) dibromopropamidine
(c) yellow mercuric oxide
(d) chloramphenicol
6. Eyelid hygiene products should be effective in milder cases of
bacterial conjunctivitis because they:
(a) Have a selective action on gram-positive bacteria
(b) Should exert a general non-specific bactericidal effect
(c) Should be able to remove all bacteria from the lid margins
(d) Contain specific antibacterial / anti-infective chemicals
9. Which of the following statements about a carbomer-based
ophthalmic formulation of fusidic acid antibiotic drug is TRUE?
(a) It is only suitable for patients with dry eyes
(b) It can be used in infants
(c) It ensures rapid wash out of antibiotic from the eye
(d) It provides broad-spectrum coverage against many bacteria
10. Which of the following statements about Pharmacy (P) Medicine
eye drops that contain chloramphenicol is TRUE?
(a) They are not recommended for children under 2 years of age
(b) They are generally not recommended for use in children
(c) They should only be used in children after a culture test
(d) They should be used cautiously in the elderly because resistance
develops easily
11. Which of the following products can be provided to a patient
via a written (signed) order?
(a) chloramphenicol eye ointment
(b) fusidic acid viscous eye drops
(c) Minims Chloramphenicol
(d) All of the above
12. Which of the following drugs works to block DNA synthesis and
assembly in bacteria?
(a) fusidic acid
(b) gramicidin
(c) ofloxacin
(d) gentamicin
12/11/10 CET
PLEASE NOTE There is only one correct answer. All CET is now FREE. Enter online. Please complete online by midnight on December 15 2010 - You will be unable to submit
exams after this date – answers to the module will be published on www.optometry.co.uk

6 CET
credits
available
Ot.tv Guide
PAC Conference coverage
In association with Specsavers, Ot.tv is delighted to bring you a selection of
lectures filmed at the 2010 PAC Conference. For those who were not able to
attend, or for any delegates wishing to recap, we have three CET accredited
lectures available to view online at www.optometry.co.uk
The lectures available are:
• Peripheral retinal degenerations: Dr William L. Jones looks at common retinal
lesions that are encountered in the peripheral fundus, providing advice about
techniques for examining the retinal periphery and distinguishing between sightthreatening
and non-sight threatening degenerations.
• Silicone hydrogels – are we there yet?: Paul Chamberlain
examines silicone hydrogel contact lenses, advising on the
successful fitting of these lenses, reporting on various related research studies
and providing an overview of potential complications of wear. This lecture is
sponsored by Sauflon.
• Visualising the end result: Paul McCarthy discusses the best approach to
take when optimising the cosmetic and optical performance of spectacle lenses,
including consideration of lens thickness calculations, frame choices and the
design of free-form lenses.
Each of these three videos are accompanied by 12 MCQs, with 6 CET points available in
total for optometrists, 4 available for dispensing opticians and 2 points for contact lens
opticians.
SPONSORED BY
www.optometry.co.uk

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