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Optics
and IT
surveyed
Fees cut
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online
enewsletter
A design for life
Introducing our interactive site for 2011

From the Marigold to the Macula
The alternative to the AREDS formula (Age related Eye Disease Study)
With Meso-Zeaxanthin
Before taking Macushield ® supplement
After taking Macushield ® supplement for 1year
Clinical trial shows that 100% of patients, both AMD and
Normal, respond positively to Meso-Zeaxanthin by
increasing their central macular pigment.
Macular pigment is believed to protect
against AMD development due to its light
filtering and antioxidant properties, and we
now have scientific evidence from the
MOST 1 trial, recently published in
CURRENT EYE RESEARCH, that shows
people can significantly increase their
macular pigment level following
supplementation with meso-zeaxanthin,
Lutein and zeaxanthin, as found in
Macushield®. This formula combines
powerful antioxidants that can help protect
eye tissue from blue light and free radicals.
It is designed specially to support macular
health.
This graph shows 4 patients (1 normal and 3 AMD), who had
a central dip in their Macular Pigment pre supplementation.
After only 8 weeks, following supplementation containing
Lutein, Meso-Zeaxanthin and Zeaxanthin, all patients were
able to rebuild their pigment profile to normal levels.
What to do next......
www.bondeyeoptical.co.uk
To order a FREE copy of the MOST research paper
or to purchase Macushield Supplements
Call Bondeye: 0121 772 3888 or visit www.bondeyeoptical.co.uk
Alternatively: For up to date research
results and training documents visit:
www.meso-z.com

December 10 2010 vol 50:24
optometrytoday
6
Comment
Christmas Best Wishes
AOP chief executive Bob Hughes appeals
to readers to get involved in their LOC
News
News
Pupils enjoy pilots
School students take part in optometry
workshops which are career building pilots
News
AOP elections
Changes to the Association’s elections
are announced
8
MHRA issues Alert
Certain contact lenses are identified as a
problem by the Medicines Health products
Regulatory Agency 5
6
12
Letters
Response to C retan VA feature
Read Nick Rumney’s letter, and others
too
News extra
Success at Blenheim
Dozens brave the weather to attend the
National Eyecare Group conference at
Churchill’s birthplace
Industry
Colorimetry Down Under
News on promotion for the
technique in Australia
Survey review
20
IT and the independents
We look at the results of this year’s Optisoft
IT survey which received hundreds of
responses from practitioners
10
14
20
24
Cover story
Event review
Longleat is great fun
This year’s AOP student conference
as reviewed by a second-year
student
Free CET
36
Web site renewed
January 1 will see the launch of
OT’s new-look web presence 36-37
38-39
Management op tions part 6
Professor Michael Doughty discusses
ocular surface and anterior
segment inflammation 42-49
tv Visit www.optometry.co.uk today

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NEWS
MHRA issues contact lens alert
voluntary recall of select lots of
JOHNSON & JOHNSON has
recalled nearly half-a-million
boxes of its 1-Day Acuvue TruEye
(narafilcon A) contact lenses
since the summer recall, it has
been reported. The reports
emerged as the Medicines
Healthcare products Regulatory
Agency (MHRA) issued a Medical
Devices Alert on the problem
this month.
The alert, available on the
MHRA’s website, www.mhra.
gov.uk, stated that lenses from
affected lots can cause stinging
because of higher than expected
levels of decanoic acid. The
affected lots, which have been
manufactured in Ireland, are
those with the first six digits
within the ranges 492237 to
492498, and 502080 to 502269.
It was in August that the
company announced a
1-Day Acuvue TruEye (narafilcon
A) following a limited number
of complaints in which wearers
described unusual pain upon
insertion.
In a statement updated this
month, a J&J spokesman said:
“The decision to expand the
voluntary recall follows the
company’s extensive review
of its manufacturing process
which identified the potential
for some lenses to have higher
than expected levels of a
processing aid used in 1-Day
Acuvue TruEye (narafilcon A), and
identified a small percentage of
contact lenses in the expanded
lots that do not meet internal
manufacturing requirements.
“Complaint monitoring
indicates no increase in healthrelated
complaints related to this
Massive deferment of eye
tests, multiple warns
AN ESTIMATED 400,000
people across the UK will
delay scheduled eye tests
until the New Year primarily
because of concerns about
budgets and the cost of
Christmas, Vision Express
has warned.
Omnibus polling for
Vision Express found that
one-in-five people due to
have an eye test this side of
Christmas admitted that they
will not be doing so.
Of those opting not to have
a test, 62% said they were
delaying their eye tests until
the New Year due to the cost
of buying replacement lenses
and eye wear.
Of those putting off eye
tests, 22% said that they
didn’t think that their
eyesight had deteriorated
sufficiently to warrant an
examination.
Brian Linnington, brand
strategy director at Vision
Express, said: “As the days
get significantly shorter and
the weather deteriorates, it is
essential that all of us have
optimum eyesight. We’re
very concerned that people
product variation. While these
reports, along with the findings
from the company’s continued
testing indicate a lower
likelihood of the occurrence of
stinging than the earlier recalled
lots, Johnson & Johnson Vision
Care is taking this action as a
precaution to provide wearers
with greater confidence that
they will experience the comfort
they expect from 1-Day Acuvue
TruEye (narafilcon A).
“Corrective and preventive
actions have been identified
for sources of variation and
will be implemented prior
to restarting production on
those manufacturing lines that
produced the affected product.
In the interim, 1-Day Acuvue
TruEye (narafilcon A) will
continue to be supplied via
other manufacturing lines.”
are putting off potentially
important eye examinations
at the time of the year when
good eyesight is critical.”
The number of pairs
of new glasses sold in
December typically falls
by around a third during
December according to GfK
data, of the 20 million eye
examinations carried out per
year in the UK.
IN BRIEF
Bonus scheme
launched
Eyeplan has introduced a profit
sharing bonus scheme amongst its
independent member practices.
The first Bonus Bonds have been
awarded to practices which have
100 or more customers signed up
to an Eyeplan scheme. A proportion
of Eyeplan’s profits will be shared
between registered practices for each
Bonus Bond Dividend awarded.
The company has confirmed it will
shortly introduce a discretionary
Bonus Bond scheme based on other
contributions such as recommending
another practice to Eyeplan.
Consultation to end
The Department of Health’s
consultation on proposals to offer
‘greater choice and control’ in the
Health Service for the majority
of NHS funded care will close
on January 14 2011. Healthcare
professionals and the public are
urged to offer their views to the
debate via the Department’s
website and other sources of
contact.
Nystagmus guide
The Nystagmus Network charity
has reprinted a guide which can
be useful for those who work with
children who have the involuntary
movement of the eyes. Early Onset
Nystagmus: A Parents’ Guide is
written by experts at Great Ormond
Street Hospital, and is available by
email at info@nystagmusnet.org or
by telephone 0845 634 2630.
Swedish expansion
Specsavers plans to open a dozen
more outlets in Sweden, the
country’s financial newspaper
Dagens Industri (November 29)
reports. The group entered the
country in 2004.
Best wishes from OT
OT would like to wish all its readers
and contributors a Happy Christmas
and a prosperous New Year.
The fortnightly journal will return
next year, when it celebrates its 50th
birthday, and will reappear with its
first edition of 2011 on January 14.
5
10/12/10 NEWS

optometrytoday
DECEMBER 10 2010
VOLUME 50:24
ISSN 0268-5485
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A SERIES of workshops
which aim to attract the next
generation of eye health
professionals have been
successfully piloted in seven
schools across the UK.
Organised by a Careers
in Optics Working Group,
representatives from major
High Street practices,
professional bodies and
leading universities teamed
up to highlight sciencerelated
post-16 studies
and career choices in the
classroom.
Co-developed by
education experts
Word&Pictures in partnership
with optometrists and
dispensing opticians, the science
and career roadshows are based
on the idea of ‘Living life in a new
dimension’ and aim to fit in with
the key stage three and four in
the national curriculum.
Students learnt about
illusions, light and sight in a ‘fun,
supportive environment’. They
NEWS
Optometry workshops
for pupils are piloted
TO CELEBRATE its new premises
Newcastle-based practice Michael
Afford Optometrists treated its
first-ever patient to a special day.
Mr Afford collected Elsie Wearn
(pictured foreground), who first
attended the business 30 years ago
when it opened, and brought her
to his premises to be first through
the door again. Once at the practice
Ms Wearn was greeted by his team
– including Jill Dickinson, Claire
Litster and Hazel Dalton (pictured,
background) – presented with
flowers and champagne, and her
choice of spectacles, ‘on the house’.
also watched a short 3D film
which aims to encourage them
to think broadly about their
career options.
Chair of the working group,
City University lecturer, David
Thomson said: “The Group aims
to raise awareness of optics as a
career choice in schools and sixth
form colleges. Optometry
and optics is developing
rapidly and is an exciting
option. We are working to
stimulate further interest in
the profession and to target
specific regions
where recruitment
challenges exist. It was
essential to think creatively
and to develop an
attractive, dynamic
campaign.”
One student at Rochester
Grammar School for Girls
where the workshop has
been piloted said: “I would
definitely recommend
optometry and optics as
a good career choice. I
enjoyed everything about this
activity, ten out of ten.”
The Working Group will
evaluate the pilot events at a
meeting this month.
To watch what happened
when the roadshow visited
Burlington Danes Academy go
to www.optometry.co.uk
Patient gets red carpet trip

Discounters warned by OFT
PRACTICES OFFERING discount
prices and deals are being
warned to ensure their prices are
not misleading – or risk facing
action from the Office of Fair
Trading (OFT).
The warning to retail
businesses comes after a market
study into the advertising of
prices, which established that
certain techniques used in
advertising online and in-store
can mislead customers and
potentially break the law.
While not necessarily illegal,
the specific techniques the
OFT highlighted as having the
‘potential to cause harm’ are: ‘drip
pricing’, where compulsory price
increases are added during the
buying process, ‘time-limited
offers’ advertised as ‘must end
today’ and ‘baiting’, where only
THE EYE Health Alliance has
welcomed the Public Health
White Paper, Healthy Lives,
Healthy People saying it hoped
the changes outlined would
‘ensure everyone in their local
community is aware of the
importance of eye health.’
The White Paper outlines
how funds from the overall
NHS budgets will be ringfenced
for spending on public
health, controlled largely by
local authorities, and also
creates the new body Public
Health England.
Head of public affairs for
the alliance, Heather Marshall
said: “The Eye Health Alliance
welcomes the publication of
the Public Health White Paper.
There are 1.8 million people in
the UK living with sight loss,
and this figure is set to increase
by 115% to nearly 4 million
people in 2050, largely due to
the ageing population. Much
a small proportion of stock is
available at the advertised price.
Chief executive of the OFT,
John Fingleton, said: “Pricing
practices used in a transparent
and fair manner can provide
customers with a helpful
shortcut to assess whether a
particular offer is a good or bad
deal. However, our research has
highlighted how certain tactics
can be used in a misleading way.
of the high level of avoidable
sight loss could be prevented
through regular sight-testing.
“We’re calling on all those
involved in public health
including the Government,
GP consortia, health care
professionals and especially
local authorities, with their
new public health
responsibilities, to work
together to ensure that
everyone in their local
community is aware of the
importance of eye health and
the need for regular sight tests
and early diagnosis to reduce
this public health
time bomb.”
“Misleading pricing is not
only bad for the consumer, it is
also bad for competition, and
creates an uneven playing field
between fair dealing businesses
that stick to the spirit of the
law, and those that push the
boundaries too far.”
Among the businesses
surveyed for the wide-ranging
report were Boots, Specsavers
and Tesco.
Alliance applauds White Paper
Health secretary Andrew
Lansley (pictured) said: “Too
often in the past, public
health budgets have been
raided by the NHS to tackle
deficits. Not any more. The
money will be ringfenced to
be used as it should be – for
preventing ill health.
“People’s health and
wellbeing will be at the heart
of everything local councils
do. It’s nonsense to think that
health can be tackled
on its own.
“Everyone should have
services tailored for them, at
the right times in their
life from the professionals
closest to them. With local
authorities in the driving
seat, supported by the latest
evidence on behaviour
change from Public Health
England, we will start seeing
significant improvements in
the nation’s health.”
IN BRIEF
Theft of £4k’s worth
Police are investing the theft of
almost £4,000 worth of designer
frames from a Salisbury practice.
A man is being sought for the
November 13 theft from Memory
Opticians and police have released a
CCTV image in connection with the
incident, according to the Salisbury
Journal (December 1). Readers
should contact PC Mark Harris if
they have any information on 0845
4087000.
Certificate advice
Members of the AOP have been
advised to tell PCTs their insurance
renewal ends on December 31,
and certificates will be issued
in February. A statement on the
Association’s website said: ‘The AOP
has learnt that some rather overzealous
PCTs are asking optometrists
for copies of their 2011 insurance
certificates already. The AOP advises
that the PCT should be told that the
renewal period for 2011 insurance
does not end until the end of
December and certificates will be
issued in February. In the meantime,
any PCT which is worried about an
optometrist’s insurance can look
up the practitioner on the GOC web
site, www.optical.org. Registration
with the GOC is, to all intents and
purposes, proof of insurance.”
Weather warning
As OT went to press ABDO was
monitoring weather conditions to
decide whether to run its Dispensing
and Contact Lens Examinations
this week at Birmingham’s Paragon
Hotel. “We are aware that some
people have theory examinations,”
said a spokesman, “and we sincerely
hope to run our examinations as
normal.”
Apple patent
Computer giant Apple has been
granted a patent for a projection
system that can enable multiple
viewers to simultaneously view 3D
images without the need for 3D
glasses.
7
10/12/10 NEWS

8
10/12/10 NEWS
neWS
GOC cuts retention
fees for 2011-12
THE GOC has announced that its retention
fees for 2011-12 will be £270 for all fullyqualified
registrants and bodies corporate.
‘Subject to unforeseen circumstances’ the
council intends to hold retention fees level
for a period of three years, based on a lower
budget forecast. Based on current forecasts,
the Harley Street-based organisation plans to
absorb inflationary rises, the increase in VAT,
and the forthcoming levy by the Council for
Healthcare Regulatory Excellence (CHRE).
A spokeswoman for the council
commented that the last two years have been
expensive ones for the GOC. “In the current
economic climate we are particularly mindful
about reducing costs and passing these
savings on to our registrants.
“Alongside a continual focus on cost
savings, we have been improving our
performance, recognised and commended
by the CHRE. Our ‘Invest to save’ schemes are
beginning to bear fruit: the first phase of our
organisational restructure has taken place, and
our online retention system is about to go
live. We are now in a position to take forward
a longer-term plan which will create a stable
and resilient organisation.”
Anna Bradley, GOC chair, said: “We have
listened specifically to our registrants and
their professional bodies, and are also
introducing a low income fee of £170
for registrants whose income is less than
£12,000. We believe it’s critical in these
difficult economic times to encourage highly
professional dispensing opticians to stay
on the registers, and this underlines our
commitment to protecting the public.”
Satjit Singh, chief executive and registrar,
added: “We have taken the initiative,
scrutinised costs, and made some bold
decisions which will benefit registrants whilst
continuing to promote good eye care.”
The decision has drawn approval from
professional leaders as a step in the right
direction. Go to www.optometry.co.uk for
more reaction.
Parcs promotion rewards
24 independent winners
STAFFORD-BASED optometrist Jan
Goodwin is looking forward to a trip
to Center Parcs with her family, thanks
to a Hoya Lens promotion, which saw
24 independent practice winners
throughout the UK. Ms Goodwin is
pictured receiving her vouchers from
Hoya area sales manager, Paul Esp.
“It is a great prize and I will probably
be taking my husband and two children
to the Lake District once the weather
improves. We are all very keen on
archery which we should be able to
enjoy,” she said.
Her practice, Mincher-Lockett
Opticians, qualified for the prize through
the promotion for the iD FreeForm
progressives with Hi-Vision LongLife
coatings. Mr Esp said: “The promotion
was a great way to highlight the
combination of the new lens technology
and the internationally acclaimed coating
which is bringing high levels of customer
satisfaction, particularly amongst patients
who have had tolerance issues in the
past.”
comment
A ChristmAs messAGe
And A new YeAr wish
Our third student conference was just
fantastic. Double the number of students
and a real buzz from enthusiastic and
focussed young people determined to
learn everything they can about their
chosen profession. They showed equal
determination on the dance floor – but
that is a different story. What happens in
Longleat, stays in Longleat. (Hopefully
that applies to the video of me dancing to
YMCA!).
It is stating the obvious to say that
2011 will see changes for optometry
and optics. Scotland and Wales have
elections, with the potential for policy
shifts on the delivery of eye care. In
Northern Ireland, negotiations for a new
contract will come to a head. In England
we will engage with the National
Commissioning Board and seek a better
way of agreeing and remunerating
enhanced services and a reduction
in peaked cap bureaucracy. I have a
Christmas message for PCT staff. Before
you sign off yet another unreasonable
demand on practices, could you just
possibly read the contract? Consulting
QCs, especially out of hours, to fight
fatuous alleged contract breaches is very
expensive, and when we threaten legal
action it never goes down well. Reading
and understanding the GOS contract
would be so much cheaper and much
less stressful.
Change is all around us. The bits are
being thrown in the air and who knows
where it will all land? What we know
is that the future of the profession in
largely in the hands of your LOC, AOC or
ROC. Across the UK, local decisions will
dictate how we expand and grow. If I
may suggest a New Year’s resolution it is,
get involved. Join your LOC. The future
of your profession may just depend on it.
Bob hughes, AOP chief executive
bobhughes@aop.org.uk

education through inspiration
Vision For Life
educational roadshow
Coming to you soon
The Vision Care insTiTuTe is about to hit the road again, with this
year’s series of educational roadshows. always extremely popular, they
offer a unique opportunity to gain knowledge and experience in all aspects
of contact lens wearing and fitting, and are hosted by a wide range of
leading professional figures. This year, the theme of the event is Vision
For Life, exploring vision correction for the whole of your patient’s life,
and how this can help expand your patient base and profitability.
Last year’s educational roadshows were extremely successful, and
because we predict this year’s to be the same, call now and reserve your
free place, before it’s too late.
Dates and Venues 2011
Sun 6th February
Mon 7th February
Thu 10th February
Tue 15th February
Thu 17th February
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Leeds
London
Bristol
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CET
POINTS
The Booking Hotline – 0845 310 5347
THE VISION CARE INSTITUTE is a trademark of Johnson & Johnson Medical Ltd. © Johnson and Johnson Medical Ltd. 2010.

LETTERS
Sponsored by
Gratifying to see VA charts
My colleague, Catherine
big vision charts they are mostly
a logMAR chart over the same
such is eminently suitable for
Chisholm, is to be congratulated
for blind people and they need
range would run 6/19 [0.5], 6/15
refraction.
on tackling a difficult subject,
to be big !” – and have integrated
[0.4], 6/12 [0.3], 6/9.5[0.2], 6/7.5
I do make one plea. However
explaining visual acuity to
them into my routine practice,
[0.1], 6/6 [0.0], 6/4.8 [-0.1], 6/3.8
scientifically sound logMAR may
10
ophthalmologists, and European
ophthalmologists at that (Cretan
conference is host to VA focus,
OT November 26). My apologies
for being a little facetious but
as logMAR and its common use
teaching and a good few low
vision schemes up and down
the country. It is gratifying to see
that most display type VA charts
use logMAR ratings notably
the leading UK exponent the
[-0.2], 6/3 [-0.3]. This is nine levels
as opposed to just five (or at
best six). I did wonder if Professor
Spileers meant the inclusion
of additional lines around the
6/6 line on some Snellen charts
be, it is not intuitive in
the way that the Snellen fraction
is. Now that hospitals are
using logMAR, the situation is
complicated by the use of that
decimal term; what optometrist,
in clinical research for over 35
Thomson chart.
but as 6/6 is below what most
or ophthalmologist knows that
years grew out of optometry
I do wish to highlight the
consider normal acuity, this
0.3 logMAR is 6/12, for one thing
(Ian Bailey’s seminal paper
point made at the conference
appears unlikely.
but at what distance was it
being in 1976) it has really taken
by Professor Werner Spileers; he
There is good argument
measured (clearly stated in the
far too long to permeate into
is quoted as saying “establishing
(Westheimer, 1979) that the
Snellen fraction).
10/12/10 LETTERS
mainstream hospital practice,
particularly for the critical
issues of VA in amblyopia
management.
Twenty years ago I struggled
through airports and customs
with large Bailey-Lovie charts,
the refractive endpoint
sometimes benefits from the
additional lines for above
average acuity provided by the
Snellen chart”. I have never
been aware of such lines, most
Snellen charts adopting a
logMAR spacing is too fine as
there is significant potential
for overlap and end points
of refraction might include
additional letters accurately
read on the next line,
nevertheless it is, very roughly
I fundamentally believe
that in routine, non-research
clinical practice we should
use only logMAR scaling and
logMAR charts but use the
Snellen fraction to denote
the value.
arguing all the way for free
sequence of 6/18, 6/12, 6/9, 6/6,
speaking, a scale of just
freight – “yes of course they are
6/5 and possibly 6/4 whereas
noticeable difference and as
Nick Rumney via email, Hereford
What’s in a name?
I recently resigned from College membership and I received a letter
acknowledging this. It referred to my years of service to the ophthalmic
optical profession. This was certainly the profession I joined 30 years
ago but having changed the letters after my name several times, I really
believed I had finally become an optometrist! Still what does it matter?
What’s in a name? A name that means absolutely nothing to the average
person in the street. It’s what you do and how you do it that matters.
When I joined the profession I had a very clear idea of my role and
my place in the medical and commercial worlds. I leave a profession
unsure of its identity, a profession which has sold its soul to big business.
Optometrists do a great job but are manipulated by a force with far
more clout than any professional body. Thank you for allowing me to
keep my certificate. I was under the impression that I had worked for it,
but again I was mistaken.
Esther Brodie, Worthing
Ready-readers should be restricted
As a 92-year-old retired optometrist I
was interested to read the Which Report
(November 12 OT). Two or three years
ago I tried to start some research to
find the percentage of cases referred by
optometrists of pathologies found during a
routine examination, and also tried to get
RNIB and the GOC to use their influence
to have ready-readers restricted in some
way. Perhaps something along the lines
of sales of these devices should only be
made on production of proof that an eye
examination had been done within the
previous two years?
I have realised since I retired that my
prescribing of spectacles for reading only
could have been improved, for those
people who had never had a problem with
their vision until presbyopia arose. I now
think that small, or maybe larger cyls.
could be left out and a pair of equal power
spheres supplied. I remember many times
when patients had complained about
distortions, I suggested that the brain had
to re-adjust to the prescription.
Frank J Fox, via email
OT Letters, 61 Southwark Street, London SE1 0HL E: davidchallinor@optometry.co.uk The Editor reserves the right to edit letters and points out that the views expressed may not be those of the journal.

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NEWS
12
10/12/10 NEWS
IN BRIEF
Thank you
reviewers
OT would like to thank its article
reviewers for this year. Those
who contributed were Dr William
McIlhagga (University of Bradford),
Dr Juhyun Park (Lancaster),
Professor Bruce Evans (Institute of
Optometry, London),
Dr Vik Sharma (London
Ophthalmology Centre), Professor
David Edgar (City University), Dr Edi
Osuobeni (Anglia Ruskin University),
Professor David Elliott (University
of Bradford), and Aston’s Dr Mark
Dunne, Dr Chris Smith, Dr Frank
Eperjesi, Dr Leon Davies.
Sale completed
HAL Holdings has completed the
sale of the 60 strong Optifashion to
Luxottica Retail Australia, according
to ADP News (November 26). The
chain, a rival to Specsavers Down
Under, generates annual revenue of
AUD30m.
US educator
The American Health Assistance
Foundation has launched a new
educational website, Children’s
Corner for Macular Degeneration,
which aims to teach children about
the degenerative disease through
stories, interactive games and other
activities. The site can be viewed at
www.childrenscorner.org
African aid
Two global vision charities are
joining forces to provide access
to vitally needed eye care in the
Gambia. Sightsavers and OneSight
have announced a three-year
partnership starting in 2011 to
reach 80,000 patients with
sustainable vision care. It is
estimated 163, 000 Gambians
need spectacles every year.
Christmas donation
Cantor & Nissel has announced it is
sending a donation to RP Fighting
Blindness instead of sending
Christmas cards this year.
Growth of IT surveyed
INDEPENDENTS ARE embracing
IT as never before, according to
this year’s Optisoft survey.
The survey, which gathered
over 350 responses, is reviewed
in detail on pages 24 and 26,
and shows a shift towards using
patient reminders, GOS forms and
other areas being controlled by a
practice’s IT system.
Keith Sheers (pictured), Optisoft
managing director, commented:
“Around a third of the practices
responding to the survey this
year said they would be going
paperless in every possible area
in the near future.”
General Ophthalmic Services
forms are now being processed
Changes to AOP elections
THE AOP Board, with the
backing of its Council, has
agreed that from 2012, all
Council representatives
will be elected from nine
geographical constituencies
– six in England plus
representation from Northern
Ireland, Scotland and Wales.
The Board believes that
this will have the effect of
increasing competition for
electronically within the practice
by 23%, and a further 38% of
practices surveyed expected
this to become the norm in the
“near future”. Although just 6%
of practices are sending forms
places as all elections will be
for a number of places all up
for election at the same time.
Rule changes to facilitate this
will be brought before the
AGM in London on May 10.
The new Council elections
will be introduced in 2012,
and thereafter a third of the
constituencies will hold
elections every year. To
facilitate this, the Board has
electronically at present, this
is expected to grow by 35% in
the near future, following the
practice of many multiples.
“The speeding up of payment
and improvement in cash flow,
thanks to the later cut off date
for electronic submissions, is
a great plus on this aspect of
paperless communication,” said
Mr Sheers. “It also ensures that
the form is filled out correctly,
with an acceptance or rejection
notice normally arriving while
the patient is still at the practice,
allowing any discrepancies to be
rectified immediately – another
reason why the take up is so
good.”
decided not to hold Council
elections next year, so
existing Councillors will all
continue in office until the
elections in 2012.
Following representations
from a number of members,
the Board has agreed to
revert to first-past-the-post,
having experimented with
single transferrable votes
over the last three years.
Exhibitors get good advice
EXHIBITORS FOR next year’s
Optrafair have been given
valuable tips on how to get
the best out of the show from
experts at the FMO’s masterclass,
including pre-show promotion,
setting realistic targets and
following up leads.
Managing director of Answers
Training International, Simon
Naudi, explained to delegates
the importance of marketing
their stand pre-show and the
need to brief staff on how to deal
with customers: “Be clear of the
objectives for the whole team,” he
said, “no company needs people
there who are just giving away
brochures. First impressions count
and you have 12 seconds to
create that first impression
with visitors. Of this 7% will be
achieved through words, 38%
through tone and 55% through
body language.”
Mr Naudi added: “Remember
that activity over the three days
of the show equates to only a
small total of the results, and
that the team should be planning
follow-up activity with names,
email addresses and telephone
numbers.”

NEWSEXTRA
Blenheim Palace success may
see NEG run event in 2011
14
10/12/10 NEWS EXTRA
A NEW CET conference for independents was
hailed a success after over 100 practitioners
travelled in freezing weather to attend from
across the UK last week.
The inaugural conference by the National
Eyecare Group (NEG), was held at what has
to be a unique venue for optics: Blenheim
Palace, birthplace of Winston Churchill and
home of the eleventh Duke and Duchess of
Marlborough.
The theme was ‘Building for success’ and
the conference in Oxford was deemed such
a success that there are already plans to
hold similar events in future. NEG business
development manager, Phil Mullins said: “We
were delighted with the support shown by
all the members and suppliers who came
to Blenheim, despite the exceedingly cold
weather. We very much hope to repeat the
conference in 2011.”
The event offered five CET points, a poster
trail and a prize draw. A well-supported
exhibition was held in the palace’s Orangery
(pictured).
Entertaining optometrist Andy Clark
presented the keynote lecture, ‘The Expert’s
Edge’, looking at areas where independent
practice could be positioned as a centre of
excellence. He highlighted that dry eye is on
the increase yet few practitioners charge for a
specialist appointment. Other opportunities
were dyslexia, fashion, sports vision, contact
lenses, sunglasses, eye nutrition and eye
health.
To gauge a market he recommended
looking under Google for how many searches
the topics generated. He recommended six
ways of how an independent could find ‘their
edge’: know your market, find a winning
niche, sell what the market wants to buy in
the ways it wants to buy it, be excellent and
be different but stressed “above all, don’t risk
the business”.
Before becoming an expert he
recommended a practice owner consider:
Who in the practice could do it? Could it be
systemised? Did it require big changes? What
percentage of the budget would they commit
to promote it? More information can be found
on the website www.practicebuilding.co.uk
Bournemouth-based optometrist Craig
Wilcox focused on patient communication.
“We have a really great job, we get to change
people’s lives,” he told delegates, but added
that complaints to the Optical Consumer
Complaints Service were rising because of
poor communication.
He urged practitioners to “be there in
the moment” and warned that patients
immediately pick up if a practitioner is
stressed. Lower pitched voices and slow
speech convey authority and inspire
confidence, he said. He urged practitioners to
smile and to use the patient’s name a lot.
When discussing spectacles, he suggested
never referring to “a spare pair” but instead use
“emergency pair”. He recommended the use
of “fees” not “payments” and for them to be
separated from products.
He said to never mention problems when
saying goodbye but instead to ask the patient:
“Is there anything else you’d like to ask me?”
Patient literature or another appointment
could then tackle any issues. “Behind every
obstacle there is an unperceived opportunity,”
he concluded.
Hugh Greenway, MD of Reed Learning,
encouraged independents to learn for free
from the Internet. “Become your own teacher,”
he said. He suggested asking Google how
to use Google which could save time when
searching, and recommended independents
to use YouTube, and also the bookmarking
website www.delicious.com.

NEWS
Companies dig deep for WSD
16
10/12/10 NEWS
CONTACT LENS giant CIBA Vision
has raised more than £2,000 for
this year’s World Sight Day. And
lens company Essilor also helped,
raising £1,000.
By taking on the 2011
Challenge, employees at CIBA’s
headquarters in Southampton
dressed in school uniform and
participated in an awareness
exercise which tested their
knowledge on low vision and
sight loss. A bake sale, quizzes
and karaoke were also held,
and a team of employees even
completed the Great South Run.
Roger Lopez, managing
director of CIBA Vision UK and
Ireland, said: “The World Sight Day
Challenge is extremely important
to everyone at CIBA Vision.
“All of our activities are about
Donna Power (second from the right) receives Essilor’s contribution
raising funds to provide healthy
vision to as many people in the
world as possible, which in turn
offers a better life in general.”
The money will be divided
equally between Optometry
Giving Sight and Vision Aid
Overseas.
Donna Power, country
Boxes of best wishes
Staff from contact lens manufacturer
UltraVision collected 75 shoeboxes
filled with gifts this year for Operation
Christmas Child, run by international
relief organisation Samaritan’s Purse
UK. They will be donated to the Asian
republic of Kyrgyzstan. UltraVision’s
despatch manager, Julie Oldfield,
pictured, who organises the collection,
commented it was 12 more boxes than
last year. “This is fantastic”, she said.
“This year’s boxes will be distributed
in Kyrgyzstan to a lot of very excited
children.”
manager for Optometry Giving
Sight, said: “This is an incredible
contribution. Not only did CIBA
Vision raise record funds, but
they also utilised their entire
sales force to help register
practices to take part across the
UK, and we are so thankful for
their considerable support.”
Essilor has raised £1,000 by
also taking on the World Sight
Day Challenge this year. Staff at
the lens manufacturer’s branch
in Bristol held a ‘wacky costume
day’ at work and hosted a raffle
which saw prizes from an iPod
Nano to annual leave days up
for grabs. On the day executive
management staff could also
be seen providing a waitering
service in the staff canteen.
The money will also be divided
between Optometry Giving Sight
and Vision Aid Overseas.
Ms Power added: “The amount
raised this year was absolutely
incredible. They took the time to
think about how best to appeal
to their staff and have a great
time, whilst maximising the
potential.”

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AIR OPTIX, CIBA VISION, the AIR OPTIX logo and the CIBA VISION logo are trademarks of Novartis AG. © CIBA VISION (UK) Ltd, a Novartis company, 2010.

NEWS
New assessment centre aims to
support teaching and research
18
10/12/10 NEWS
ANGLIA RUSKIN University’s
Department of Vision & Hearing
Sciences has opened a new vision
testing and assessment facility.
It aims to support teaching and
research in optometry and the
vision sciences, and has the
potential to provide specialist
vision testing services to
patients from near its locality in
Cambridge.
The Evelyn Trust Anglia Vision
Suite, which attracted over
£78,000 worth of funding through
the departmental research group,
Anglia Vision Research, provides
the software and instrumentation
that will allow vision assessment
of a specialised nature that is
not normally found in routine
optometric examinations.
It has electrophysiological
(L:R) Dr John Siderov, head of department, with colleagues from the Evelyn
Trust, Adrian Frost and Catherine Thomas, officially opening the new Evelyn
Trust Anglia Vision Assessment Suite
equipment for non-invasive,
objective assessment of normal
and diseased retinas and
the optic nerve pathway to
visual cortex, in children and
adults. Also psychophysical
testing will allow for further
specialised visual assessment
as well as a complete colour
vision assessment in children
and adults, which, the university
says, is a unique facility in the
Cambridgeshire region.
The suite will also provide
enhanced teaching and research
possibilities for undergraduate
optometry students and
postgraduate vision science
research students, as well as
seeding for new research projects
by vision scientists.
The Evelyn Trust Anglia Vision
Suite has been funded by a grant
from the Evelyn Trust which
supports medical research and
healthcare in Cambridge, and the
surrounding area.
Head of department Dr John
Siderov said the university was
“extremely pleased and grateful”
to be awarded the grant.
Anglia Ruskin is one of the
largest universities in the East
of England with a student
population of 30,000, and also
hosts its University Eye Clinic, one
of the largest facilities of its kind
in the region.
Warburton elected
PAST
CHAIRMAN
of the AOP,
Trevor
Warburton
(centre) has
been elected
for Life
Fellowship to
the College of
Optometrists in recognition
for the ‘outstanding
contribution he has made
to clinical practice in the
profession’.
Mr Warburton accepted
his award at the College’s
Diploma Ceremony when
195 newly qualified
optometrists were welcomed
into the profession. Also
pictured (right) David
MacVeigh, who introduced
the award, and College
president
Cindy
Tromans
(left). The
optometrist’s
Life
Fellowship
marked his
third from
the College
having already received a
Foundation Fellowship as
well as one for submission
by portfolio two years ago.
Optometrist and senior
lecturer at Aston University,
Dr Leon Davies was also
present at the ceremony
which took place at
Westminster Central Hall,
London to accept The
Neil Charman Medal for
outstanding post-doctoral
research.

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INDUSTRYNEWS
TRADING PLACES
HOYA HAS appointed Joanne Copeland,
pictured, as regional training manager for the
South. She has worked in practice for several
years and is now visiting practices to train
dispensing opticians, optometrists and support
staff in the benefits of dispensing premium
lenses.
20
10/12/10 INDUSTRY NEWS
The training, which takes about an hour,
includes the use of the Hoyalux iD Comparison
Display which compares conventional lenses
with Hoya’s latest iD FreeForm technology. For
details, email j.copeland@hoya.co.uk
BAUSCH &
LOMB has
named Charl
van Zyl,
pictured, as
corporate vice
president and
commercial
leader, Europe,
Middle East and
Africa (EMEA).
This is a new
role and Mr van
Zyl will lead the company’s cross-functional,
EMEA operations team. He will also have direct
commercial responsibility for B&L’s emerging
markets in the region. He will be based in Zug,
Switzerland.
Mr van Zyl joined Bausch & Lomb in 2009,
serving as vice president, EMEA, for the
company’s pharmaceuticals business. In recent
months he has taken on additional region-wide
responsibilities.
Before joining the company, he was chief
executive officer for Jado Technologies, a
German biotechnology firm. From 2004 to 2007
he held positions at Novartis Pharma AG as head
of marketing and sales, pharma Europe, and
head of global marketing, ophthalmics.
Earlier in his career he held multiple positions
with Eli Lilly & Co, with responsibilities spanning
across Europe, Japan, the United States and
Latin America.
Color-ing happy
Down Under
COLORIMETRY AND the Intuitive Colorimeter MK3 from
Cerium Optical Products of Kent have been successfully
promoted Down Under for helping dyslexics and
migraine sufferers.
There was a surge in colorimetry practitioners last
year following a series of lectures organised on behalf
of the International Institute of Colorimetry, based in
London and sponsored by Cerium. Recently there was a
clamor for more information following articles in Australian vision journals and optometrist
Professor Bruce Evans, pictured, travelled from the UK to Australia to give lectures at two
universities and a college there. He was well-known, as a number of leading academics had been
contemporaries of his at Aston University. The lectures centred on using colorimetry in practice,
the treatment of specific learning difficulties and the added benefits to the practice overall.
Several colorimeters were purchased by interested optometrists and some even made the
journey of 3,000 miles from Perth in Western Australia.
International Institute of Colorimetry spokeswoman, Christine Fitzmaurice told OT that the
plan now was to organise a lecture tour in Australia next summer. She believes that once the
use of colorimetry is more embedded, it will quickly become a significant tool in aiding specific
reading problems and migraine there. “Australian vision professionals are open to new ideas and
the colorimeter offers a unique and efficient opportunity to help some children who are failing
educationally as well as some migraine sufferers,” she said.
01580 765211

Blue Bay
dreaming
The new Blue Bay collection of optical
frames and sunglasses from Safilo has
been designed for a young market with
a mix of pop colours and the slogan ‘For
dreamers only.’
The oval-shaped acetate Blue Bay
model 812, pictured, has high-impact
colours, such as cyclamen and wisteria,
white with red as well as red, white and
navy, navy and green, black, white and
yellow plus aubergine and orange.
The new PR campaign features
strong-impact graphic patterns
with linear geometries for boys
and romantic, pastel-shade flower
decorations for girls.
& 01423 520 203
Go bug-eyed
over PoS
Children’s eyewear specialist
Zoobug has launched a new range
of striking point-of-sale materials to
accompany its new collections launched
at silmo.
The materials include an 18-piece
tray, with Zoobug logo, a matching
six-piece stand, window posters and a
counter card featuring a boy wearing
Zoobug optical frames or sunglasses.
They are available with all minimum
orders of 24 pieces.
new colourful hard cases for
spectacles or sunglasses will be
available to order from February. They
will come complete with microfibre
“bug” lens cloth.
& 020 7251 8122
Lazer
sharp
fashion
tHe lazer Junior collection from
Continental eyewear has been
proving increasingly popular
recently as spectacles have
become a “must have” fashion
item for youngsters. the range
features metal and plastic designs
and combinations of both.
one of the best sellers is a
frame that was launched just
three months ago, model 2074.
it appeals to both girls and boys
and is available in four colours, black, burgundy, gunmetal
and lavender. the sides are differently patterned in the different colours so that if the child
returns to the practice and wishes to have the same frame they can, but with a totally different
look. the frame is available from stock for immediate delivery.
& 0151 426 3907
New Year, new lenses
BBGR’s AnAteo Progressive lens range receives a full makeover in January. In addition to
the established Anateo design, a new short-corridor version, Anateo Mini, will be introduced,
offering a minimum fitting height of 14mm.
Anateo Mio will replace Anateo PdM as the flagship in BBGR’s portfolio. Winner of the
2010 silmo d’or gold award, Anateo Mio is said to add a new dimension to personalised
progressive lenses by integrating an extra parameter into its design, the natural reading
distance.
this fourth parameter builds upon the individualisation offered by the current Anateo
family of lenses. they are designed to optimise the various lens zones according to the
shape of the eye (Anateo), the shape of the frame, the thickness of the lens and the wearing
conditions (Anateo PdM). In another new addition to the company’s range, trivex will be
available in all Anateo
lens designs from
January 5.
BBGR has also
developed eyetab,
a unique measuring
device “to allow
simple, precise
and professional
measuring of the
natural reading
distance”.
& 0844 880 1349
21
10/12/10 INDUSTRY NEWS

COMPETITIONS
Christmas 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.
22
10/12/10 CROSSWORD
across
1. First full length animated Disney movie (4,5)
8. South London tube station (7,6)
11. One part of a whole (4)
12. Step (5)
13. Small needle case (4)
16. Protruding balustrade (7)
17. Type of screwdriver (7)
18. Offered for finding criminals (7)
20. Missing from work (7)
21. Leave out (4)
22. Large beaver-like rodent (5)
23. Norwegian capital (4)
26. Festive season (9,4)
27. Type of marrow (9)
down
2. Home for the high flying set (4)
3. Rich (7)
4. More joyful (7)
5. Where the shop takings are kept (4)
6. One of the first Americans who invented
flight (7,6)
7. Refreshing drink after work (6,3,4)
9. Scottish city (9)
10. Parasitic plant brought indoors at
Christmas (9)
14. French river (5)
15. Store safely in a secure place, informal; (5)
19. Petrol driven cycle (7)
20. Placate someone (7)
24. Disposable pen (4)
25. Leave as it is (typeface) (4)
name:
address:
Send entries to OT, Christmas Crossword, 61 Southwark Street, London SE1 0HL to arrive
no later than January 10 2011.

Opti leads the way into
2011 with global brands
NEWS
LEADING WORLDWIDE
brands will be seen at the
curtain-raiser to Europe’s
optical trade fa ir calendar in
Munich next month.
Opti ’11 will present over
400 exhibitors plus special
areas of interest to visitors,
when it opens for three days
on January 28 at the New
Munich Trade Fair Centre.
Next year the show has
attracted names such as Luxottica,
Marcolin, Charmant and Alain Mikli.
“With the participation of these frame
manufacturers, the list of key players will
be even longer and more international
than in 2010,” said Dieter Dohr, CEO and
president of organiser, GHM Gesellschaft
für Handwerksmessen mbH.
“Once again more than 430
companies are expected in Munich from
all areas of the industry to exhibit their
lenses, frames, contact lenses and low
vision products. Our goal with Opti is
to cover the full spectrum of optics and
eyewear, for the benefit of our exhibitors
and visitors.”
British-based exhibitors
William Morris, Tom Davies
and Booth & Bruce will mix
with optical heavyweights
such as Safilo, Zeiss and
Hoya on the exhibition floor.
January’s show will
also have a new lecture
programme, where latest
technologies and marketing
concepts are explained
– with a simultaneous
translation in English, a feature that was
introduced at this year’s event.
In addition to lectures, Opti has also
introduced a new ‘Walk of Frame’ billed
as ‘a parade of innovations’, and alumni
table discussion.
For more information go to
www.opti-munich.com
23
10/12/10 NEWS

REVIEW
Use of IT is growing rapidly
within UK independents
24
10/12/10 IT IN PRACTICE
THE RAPID
Revealing not just
advance of
a desire for efficiency
electronic
but also a move to
communication
slash postage costs,
in High Street
more than 20% of
optics is
practices are now
highlighted by
sending reminders,
the 2010 Optisoft
orders and payments
Survey of IT in
electronically.
independent
Practice predictions
practices. This
see another 33%
year’s annual
expecting to use
report reveals
this means of
a strong shift
communication in
towards patient
the “near future” (see
Use of integrated equipment in practice (Optisoft survey)
reminders, GOS
tables). At the same
forms, diagnostics integration and ordering being controlled time fax and post usage is expected to decrease by 15%.
via the practice IT system.
Optisoft managing director, Keith Sheers said: “With
Broadband with email is now almost universal, with the some already ordering goods at home via the Internet, most
uptake being twice as much as expected from last year’s practitioners see that this is the future for all aspects of
survey, as practitioners realise that it is fundamental to their business life. Around a third of the practices responding
business and patients, and suppliers demand this means of to the survey this year said they would be going paperless
communication.
in every possible area in the near future, recognising the
The use of Internet search engines in looking for businesses fact that the technology is proven, saves staff time, is more
has not been ignored by the profession with 87% of the 360 efficient and cuts costs, especially in the current economic
responding practices now having a website.
climate.”
GOS forms are now being processed electronically within
the practice by 23%, and a further 38% of practices surveyed
expected this to become the norm, also in the “near future”.
Although the survey found just 6% of practices are sending
forms electronically now, this is expected to grow by 35% in
the future, following the practice of many multiples.
“The speeding up of payments and improvements in
cash flow, thanks to the later cut-off date for electronic
submissions, is a great plus on this aspect of paperless
communication,” said Mr Sheers. “It also ensures that
the form is filled out correctly, with an acceptance or
rejection notice normally arriving while the patient is still
at the practice, allowing any discrepancies to be rectified
immediately – another reason why the take-up is so good.”
Almost half of practices – 48% – are now using online lens
catalogues from the major lens suppliers, with a dramatic
23% growth over last year’s survey.
“Lens catalogues are now supplied with practice
management and lab ordering systems,” said Mr Sheers.
“This helps to speed up the lens selection process and
reduces any mistakes made during the dispensing process.
Many practices also like the option of prompting preferred
lens options for their dispensers. Our survey reveals a
predicted 20% increase in the use of online catalogues in the
Continued on page 26

AIR OPTIX ® AQUA MULTIFOCAL
is now the No.1
soft multifocal contact lens
No.1
in market share 1
and fits 2
For your presbyopic patients, fit the
No.1 soft multifocal contact lens
• For crisp, clear vision at all distances 3
• AIR OPTIX AQUA MULTIFOCAL outperforms monovision 4
• 96% of Eye Care Professionals agreed they would recommend
AIR OPTIX AQUA MULTIFOCAL to other professionals 5
• Provides better vision for driving 6
1. GFK market value share data weekly/monthly multifocal soft contact lenses Sept/Oct 2010.
2. GFK fit audit New fits Q3 2010. 3. amongst emerging presbyopes. 4. subjective ratings
from emerging presbyopes on a scale of 0 to 100, with 100 being excellent satisfaction.
5. Rappon J, Bergenske P. AIR OPTIX AQUA MULTIFOCAL contact lenses in practice. Contact
Lens Spectrum. 2010;25(3):S7-9. 6. CIBA VISION data on file, 2008.
© CIBA VISION (UK) Ltd, a Novartis company, 2010. AIR OPTIX, the AIR OPTIX logo,
CIBA VISION and the CIBA VISION logo are trademarks of Novartis AG.

REVIEW
26
10/12/10 IT IN PRACTICE
near future.”
Frame catalogues,
which need refreshing
frequently, lend
themselves well to
being online due to the
seasonal changes and
39% of practices are now
using these.
Just 2% of respondents
to the survey are still
functioning without any
kind of computer system,
and the use of hardware
revealed an interesting Above: Use of IT functions in optics (Optisoft survey)
“It is most likely that
the current economic
climate is making
practitioners realise that
they need to keep a close
eye on their profitability
and the factors which
affect this,” added Mr
Sheers.
In much the same vein,
some 35% of respondents
were part of a buying
group, enabling them to
negotiate more attractive
pricing.
trend away from “clone”
computers – which are
often unable to compete
on the service of the
bigger manufacturers –
towards a greater uptake
of Hewlett Packard and
Apple which is expected
to continue. Overall
winner in hardware
was Hewlett Packard at
41%, and Apple on 9%
The growth of
integration between
optical equipment and
practice management
system was significant
as practices realise that
to remain competitive
they must invest in
equipment, particularly
as the multiples
promote a more
comprehensive eye
but expected to grow by
examination as the norm
Above: Use of on-line catalogues, 2009 v. 2010 (Optisoft survey)
19% in the near future.
in TV advertising.
Support of practice management systems seems to be
shifting towards one provider for hardware, software and
support, as demonstrated by 48% of respondents. The use of
a local IT man has fallen by 4%, a trend which is expected to
continue as practices prefer to have a single point of reference
for more sophisticated systems.
Fundus cameras were revealed to be the most popular item
of equipment, used by 40% of those surveyed and with 56%
expecting to have this technology “in the near future”. Slit
lamps and field screeners followed at 33% with at least a 10%
increase expected.
OCT was significant with 8% of respondents claiming to
The use of generic software revealed some interesting
have this technology but with an additional 21% expecting
results with current usage revealed as 94% for word
to make this investment soon, showing a marked shift from
processing, 93% email and 42% desktop publishing, with a
last year’s survey when the number of OCTs in practice was
10% increase expected soon.
negligible.
Most interesting was the monitoring of business activity,
Marketing was also a focus for the survey with 28%
with 81% using a spreadsheet, and monthly-managed
using a video dispensing system, with this expected to rise
accounts and benchmarking, or Key Performance Indicators,
dramatically to 49% soon; 40% have a practice newsletter and
increasing by 10% from last year to 39%.
this is expected to rise to 65%; 37% use direct mail and this
is expected to rise to 60%, and, most dramatically with 13%
currently using email marketing, this is expected to rise to
62% soon.
In terms of IT spend, 62% spent less than £5,000 in the
past three years; 14% spent between £5,000 to £8,000 in the
past three years and 17% spent more than £8,000, with the
remaining 7% declining to comment.
The respondents were revealed to make up a good regional
representation of the UK in the survey, and are based in the
following areas: 13% East Anglia; 13% Midlands; 13% north
east; 10% Scotland; 9% Central Southern; 8% south west; 7%
south east; 5% Wales; and 4% Northern Ireland.
The 2010 Optisoft Survey of Independent Practices
is published by the York-based company. For more details
contact Optisoft via www.optisoft.co.uk

AIR OPTIX ® AQUA
MULTIFOCAL
provides better vision for driving *1
The No.1 fitted multifocal contact lens
by UK practitioners 2
*Compared to monovision, based on subjective ratings by emerging presbyopes 1. CIBA VISION data on file 2008. 2. GfK data Q2 2010.
© CIBA VISION (UK) Ltd, a Novartis Company, 2010. AIR OPTIX, the AIR OPTIX logo, CIBA VISION and the CIBA VISION logo are trademarks of Novartis AG.

BUSINESSBUILDING
Explain, maintain, retain
We conclude the Best Practice 10 series with Mike Broadhurst’s views on retaining patients
28
15/01/10 10/12/10 INTEVIEW
BEST PRACTICE 10
NOTHING HELPS to focus the mind better than realising that
you’ve got something wrong and it is going to cost you dearly.
This happens throughout life – that’s how we learn. Most of
the pain associated with this is frustrating but short-lived.
Many of these incidents become distant memories as life,
work, children take over our thoughts. However, the longterm
effect of losing a patient’s loyalty becomes a long-term
cost – loss of annual income from them, their family and their
recommendations.
Many years ago a patient returned to me after an absence of
three years. She had gone to her friend’s practitioner and had
been refitted with one of the “newer GP materials”. Her friend
had been told of the benefits of this wonderful new material,
had been refitted and was thrilled with the results.
My patient had been “disappointed” that I had not offered
the opportunity of having a trial with this “new” product and
had followed her friend. On her return to me I was mortified.
For the previous four years our practice had been in the top
10 practices in the UK for fitting this material – I just hadn’t
thought to talk about it to all of my patients.
This was one of my very first lessons in how I should
improve communication of new products to patients. I’ll
never know how much this episode cost my practice but I
don’t want it to happen again.
Communication with our patients regarding all new
product types, innovations in the optical world, and thoughts
on where the contact lens world is moving should be
considered at contact lens appointments.
The most appropriate type of contact lens for each person
should be discussed with the patient so that the decision to
try a particular lens is a collaboration.
Explaining why a particular lens type is selected for initial
fitting is vital in ensuring the patient’s best interests have
been considered. Being realistic around patient expectations
is important, as promising all-day wear to every wearer is
much harder to attain than majority day wear to most. The
benefits of spectacle wear for evenings/weekends not only
ensures that patients keep in touch with the visual challenges
sometimes experienced with spectacles, but it makes it easier
to manage occasional use around any contact lens issues.
It also keeps the patient in touch with how up-to-date their
spectacle correction is – both optical and cosmetic.
Contact lens checks should become contact lens reviews –
an opportunity to assess a patient’s needs, both current and
future.
I know some contact lens practitioners who try a new
contact lens product on a patient every time s/he attends.
Personally, I prefer to tell them about all new products
whether currently available in their prescription or not. Soft,
daily/monthly lenses for astigmatism (in most prescriptions)
were pie in the sky not too long ago. Yet now we have a
plethora of lens types available to us. Tell patients about
what “excites” you in this ever changing market – multifocals
that work, astigmatic lenses that don’t rotate, extended wear,
silicon hydrogels, or combinations of all of the above.
Managing patient expectations is obviously very important
at the initial contact lens fitting – understanding the patient’s
lifestyle is equally important in ongoing care of contact lens
wearers. Don’t be afraid to offer any patient the chance to try
a new lens/material/solution, but only if there is a tangible
benefit that can be seen by the wearer. The benefits of silicon
hydrogel are well-known to most practitioners, but if moving
to this type of lens causes the patient a different problem they
believe “I can’t wear this lens as long” compared to “these
will keep my eyes healthier for longer”.
If this is the case consider if the patient needs to move
towards silicon hydrogel or may this patient benefit from
delaying the change until the next generation of design is
launched?
The more a patient visits a practice, the more opportunities
s/he has of seeing your new range of sunspecs for the summer,
tinted cosmetic lenses near Christmas or simply the new
range of spectacle frames that become more appealing every
year. Uninformed patients can often be the most dissatisfied
and the first to go to mail order or an internet supplier of
products.
Patients who are satisfied their practitioner is
knowledgeable, engaging and clinically competent are more
likely to remain loyal. Up-to-date leaflets help to reassure
the patient that their practitioner is using current lens types
and materials and confident handling of the patient in the
consulting room enforces this.
Retaining current patients is much more cost-effective than
trying to attract new ones. Communication, practitioner skills
and knowledge maintain and retain patients for life, which is
so vital for your business.
Mike Broadhurst is an optometrist with three practices in
the north west. Secretary of North & West Lancs LOC, he is
optometric advisor to three PCTs, and Director of Optometry
Support Services Ltd www.optomss.co.uk

PRE-REGFOCUS
Sponsored by
30
10/12/10 PRE-REG FOCUS
Magnification explained: Part 2
Director of Clearview Training, Jane Mcnaughton, concludes her discussion on magnification
Why +4.00D?
Magnification is merely a comparison of the old
object distance to the new object distance. For
example, if we cannot see the number plate
of a car, we move up closer to it, the retinal
image size increasing all of the time. If a patient
moves in towards the television by half the
total distance then the image of the television,
or the retinal image size, will increase by a
factor of two. This is termed relative distance
magnification: Magnification = Old object
distance / New object distance.
When establishing near magnification, as
in the above method, we call the old object
distance 25cm. By everyone choosing to use
the same distance as their starting point, we can
all be talking from the same hymn sheet. This
starting point is called Unit Magnification. For
example, if a patient needed to bring the print
in to 12.5cm in order for it to be seen, then the
retinal image size is 2x larger than it was when it
had been held at 25cm: M = 25/12.5 = x2.
What the lenses do is to merely focus the
retinal image of the object at the given distance,
in this case a +4.00D addition for a 25cm
working distance, and a +8.00D addition for
a 12.5cm working distance. Alternatively, the
patient may wish to use their accommodative
effort, if they have it. Thus it is typical for a visually
impaired child to hold text very close to achieve
‘magnification’ of the print or object.
From the above equation, and on the
assumption that 25cm is the conventional ‘old’
object distance, we derive the magnification
formula, M = F/4: +4.00D @ 25cm 1x (by
convention); +8.00D @ 12cm 2x; +10.00D@
10cm 2.5x; and+20.00D @ 5cm 5x etc. From this
we can call the +4.00D add or ‘unit magnification.’
Each successive addition of another 4 dioptres
adds another unit of magnification.
From a practical viewpoint, this method
quickly establishes the estimated magnification
a patient will require to see an object of a given
size, most typically, the printed text (see box
below).
This acuity reserve is calculated as the ratio
of the target acuity to the patient’s threshold
acuity (with a device). For sustained reading
tasks, this ratio has been estimated to be
between 2:1 and 3:1. For example, if a patient
needs to be able to read newsprint successfully,
(N8 approx.), then we need to consider enough
magnification for him or her to be able to read
at least N4 or better. If the patient is given
an aid with which he can only achieve N8,
then it is less likely that reading newsprint will
be sustained for any length of time and the
outcome will be deemed less successful.
However, for survival or spot reading, an
acuity reserve of 1:1 is all that is considered
necessary, and a patient can have a magnifier
that allows him or her to work close to
threshold. Usually in such cases, giving
an unnecessarily strong magnifier would
compromise the patient’s field of view and
further reduce the working distance of the task.
One advantage of using this step-by-step
method is that for each additional unit of
magnification added in the trial frame, the
patient should see an improvement, which
helps in restoring confidence. Nevertheless,
+3.00/-1.00×165 = 6/24+2 +4.00/-1.25×180 = 6/60
LogMAR 0.54 LogMAR 1.00
Add +2.75 = N10@ 30cm Add +2.75 = N24@32cm
Add+4.00 = N6@ 25cm Add +4.00 =N24@ 25cm
Add+6.00 = N5 fair @ 17cm
Add+8.00 = N5 well @ 12cm
complained that the short working distance was
there are many patients who resist the close
working distance that each additional lens
brings, and this could indicate a challenge if a
spectacle magnifier is to be prescribed.
It is also worth mentioning that patients with
a recent central scotoma often do not show
an improvement with each addition. This may
indicate the need for eccentric viewing training.
The above method describes the minimum
magnification required to view a high contrast
near acuity test card, of pre-determined size.
However, the amount of magnification that is
prescribed will depend upon other factors:
During the previous ‘work-up’, the minimum
magnification required for a patient to reach
the target acuity has been estimated. Whilst this
minimum amount of magnification may be all
that is necessary to look at a washing machine
dial or a can label, it is not possible to work at or
on this threshold for sustained or fluent reading
tasks, such as reading the newspaper or a novel.
For sustained reading, more magnification will
be required than what has previously been
estimated. In other words, the patients will keep
a degree of acuity in reserve.
more tolerant of the shorter working distances
N5 (approx a +6.00D or +8.00D lens) is the power
near VA

optometrytoday
Clinical performance of
‘comfort-enhanced’ daily
disposable soft contact lenses
Online article
The latest clinical article to appear online
James Wolffsohn, Olivia Hunt, Ashok Chowdhury
Over the last 10 years much has been written
about discomfort amongst contact lens wearers,
particularly at the end of the day, and that this
contributes to some patients dropping out of
lens wear each year. There have been several
studies to support this assertion. Discomfort,
particularly towards the end of the day, is a major
cause of contact lens discontinuation. Dry eye
symptoms are the most common complaint,
with over 70% of wearers reporting symptoms
late in the day, and approximately one third
of these discontinue lens wear as a result.
About the Authors
James Wolffsohn is the deputy Dean of Life and Health Sciences at Aston
University and a Professor of Optometry. Olivia Hunt is the Principal Clinician of
the Optometry Clinics at Aston University and final year tutor. Ashok Chowdhury
is a Clinical Instructor in the Optometry Clinics and a lecturer at Aston University.
To see the complete article, log on to
www.optometry.co.uk

DIARYDATES
Get back into the
training groove
Education and entertainment with a twist of tartan will be the
flavour of the month in January as practitioners make their way
to Glasgow Marriott for Eyecare 3000 on the 16th and 17th.
Up to 16 CET points will be available over the two days as
delegates can take their pick from a wide-ranging program of
lectures and workshops tailored to fit a variety interests and
specialisms.
It’s not all education though. Socialising and dancing will be
in abundance with a drinks reception on the evening of the
15th, Sunday brings the dinner dance with a disco, the Scott
Mackie Dancers and the sounds of the Paul McKenna Band.
For more information see www.eyecare3000.com
34
10/12/10 DIARY DATES
Alan Robertson, Glasgow: Scotland with Style
DECEMBER 2010
10 FMO, Hilton Hotel, Paddington, London,
W2, ‘Christmas lunch’ (sfisher@fmo.co.uk)
JANUARY 2011
11 NEOS, The Harvey Suite, Ravensdene Lodge
Hotel, 55 Consett Road, Lobley Hill, Gateshead,
‘Acute red eye’ 7.15pm (simonraw44@hotmail.
com)
16-17 Eyecare 3000, Marriott Hotel, Glasgow,
‘Annual conference’ CET points available
(www.eyecare3000.com)
17 Lancashire Optical Society, Swallow Hotel,
Preston, ‘Photochromic lenses; the new
standard lens’ (ruthcuth@btinternet.com)
24 LOCSU, AOP offices, 61 Southwark Street,
London, ‘Regional training roadshow’
(cameronmitchell@locsu.co.uk)
26 Wessex Optical Society, Circle Bath
Hospital, ‘Vascular disease and the eye’
6.45 pm, 1 CET point on offer (Samantha.
sousa@circlepartnership.co.uk)
27 LOCSU, Radisson Blu Hotel, Queensway,
Birmingham, ‘Regional training roadshow’
SEE ABOVE
31 LOCSU, Salomons Centre, Broomhill Road,
Tunbridge Wells, ‘Regional training roadshow’
SEE ABOVE
FEBRUARY 2011
1 NEOS, The Harvey Suite, Ravensdene Lodge
Hotel, 55 Consett Road, Lobley Hill, Gateshead,
‘Dots, blots and haemorrhages. A guide to
medical retinal problems’ 7.15pm SEE ABOVE
2-3 J&J, The Vision Care Institute,
Pinewood, Berkshire, ‘Returning to work
confident and refreshed’ two day course,
18 CET points (www.thevisioncareinstitute.
co.uk)
3 LOCSU, Ramada Piccadilly, Portland
Street, Manchester, M1 4PH, ‘Regional
training roadshow’ SEE ABOVE
NEW… 6 Eyecare 3000, Hilton Hotel,
Belfast, 6 CET points on offer SEE ABOVE
6 Glasgow Caledonian University and NHS
Education for Scotland, Dundee, venue
TBC ‘Communication skills in optometry’
(Karen.reid@gcal.ac.uk)
7 LOCSU, Maunsel House, North Newton,
Somerset, ‘Regional training roadshow’
SEE ABOVE
10 LOCSU, Winchester Royal Hotel, St Peter
Street, Hampshire, Winchester, ‘Regional
training roadshow’ SEE ABOVE
14 LOCSU, Belfry, Mellor’s Way,
Nottingham, ‘Regional training roadshow’
SEE ABOVE
14 Lancashire Optical Society, Swallow
Hotel, Preston, ‘Surgeons’ choice’
(ruthcuth@btinternet.com)
15 BCLA, 76 Portland Place, London,
‘Scientific evening meeting’ (www.bcla.
org.uk)
17 LOCSU, Menzies Hotel, Barr Hill,
Cambridge, ‘Regional training roadshow’
SEE ABOVE
28 LOCSU, Copthorne Hotel, The Close,
Quayside, Newcastle, ‘Regional training
roadshow’ SEE ABOVE
MARCH 2011
NEW… 2-6 SECO, Georgia World Congress
Center, Atlanta, USA (www.seco2011.com)
3 LOCSU, Park Plaza, Boar Lane, Leeds,
Yorkshire, ‘Regional training roadshow’
SEE ABOVE
NEW… 4-6 MIDO, Fieramilano, Milan, Italy
(www.mido.com)
7 LOCSU, WOPEC, Cardiff University, Cardiff,
‘Regional training roadshow’ SEE ABOVE
9 South Staffs Optical Society, Cannock Cricket
and Hockey Club, Church Lane, Hatherton,
Cannock, ‘The OCT in practice’ with buffet,
6.30pm (suecutts@talk21.com)
10 LOCSU, Lion’s Quay, Moreton Mt Weston
Rhyn, Oswestry, Shropshire, ‘Regional training
roadshow’ SEE ABOVE
14 Glasgow Caledonian University and NHS
Education for Scotland, Inverness, venue
TBC ‘Binocular vision and additional exam
techniques’ SEE ABOVE
14 Lancashire Optical Society, Swallow Hotel,
Preston, ‘Lutein and Zeaxanthin for protection
against AMD: fact or fiction?’ (ruthcuth@
btinternet.com)
NEW… 20-21 College of Optometrists,
Aintree Racecourse, Liverpool, Merseyside, L9
5AS, ‘Optometry tomorrow 2011’
(www.college-optometrists.org)
NEW… 28 Maui Jim, Brooklands Hotel,
Weybridge, ‘CET party – training with the
Hawaiian twist’ free but places are limited
(0800 980 1770)
NEW… 29 Maui Jim, Aztec Hotel, Bristol,
‘CET party – training with the Hawaiian
twist’ free but places are limited SEE ABOVE
NEW… 30 Maui Jim, National Motorcycle
Museum, Birmingham, ‘CET party – training
with the Hawaiian twist’ free but places are
limited SEE ABOVE
NEW… 31 Maui Jim, Hilton Hotel,
Manchester, ‘CET party – training with the
Hawaiian twist’ free but places are limited
SEE ABOVE
APRIL 2011
NEW… 1 Maui Jim, Holiday Inn,
Bloomsbury, London, ‘CET party – training
with the Hawaiian twist’ free but places are
limited SEE ABOVE
NEW… 4 Maui Jim, Morrison Hotel, Dublin,
‘CET party – training with the Hawaiian
twist’ free but places are limited SEE ABOVE
NEW… 6 South Staffs Optical Society,
Cannock Cricket and Hockey Club, Church
Lane, Hatherton, Cannock, ‘Contact lens
complications’ with buffet, 6.30pm SEE
ABOVE
NEW… 9-11 Optrafair, Birmingham NEC
(FMO: 020 7298 5123)
NEW… 14 BCLA, 76 Portland Place,
London, ‘Scientific evening meeting’
SEE ABOVE

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 3 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

WEBSITELAUNCH
A New Year, a new start –
OT launches new website
Whilst everyone is welcoming in the New Year next month, OT ‘s online presence will go live with a
new re-designed website. Emily McCormick reports
36
10/12/10 WEBSITE LAUNCH
TO BE launched on January 1, 2011, the
improved website has been designed
to offer its average 18,000 a month
users a more simplified way to access
educational materials and keep abreast
of the latest optical developments.
The redesigned website makes
everything from taking CET exams and
finding archived clinical articles, to
buying optical products and discovering
a new job much easier.
Regular readers will not only notice
that some areas have been renamed but
that functionalities across the board
have been widely enhanced.
Users are encouraged to register
with OT online to take advantage of
a number of features, which are only
available to those who register. For
instance, when completing the few
easy steps that are required to register
with the website, users will be asked to
highlight their professional interests.
By doing so, any new content which is
published on optometry.co.uk since a
user has last visited will be tagged and
highlighted to them in the ‘My Tagged
Items’ box when they return.
Marketplace
Arguably, the
section which
has undergone
the biggest
transformation
is Marketplace
(previously
known as
Where to Buy).
Unrecognisable
as the listing
service which is
currently used,
the area will
offer sellers a
visually more
enticable way
to promote their
products and will be easier for buyers to
locate what they are looking for.
Advanced searching options will
see potential buyers able to search
using keyword, category and location
options. When searching, users will
find that entries include a lot more
information to help them make the right
purchase choice. When selling on OT
Marketplace, companies are encouraged
to upload product pictures, company
catalogues and details of their latest
offers. In a bid to provide users with the
best possible service, sellers advertising
on the site will also be able to update
their information.
Jobs
Previously
known as
‘Recruitment’,
the renamed
‘Jobs’ section
has been
designed to
operate as
much more
than a simple
job searching
tool. The site
can now be
utilised by
both those
searching
for their
next optical
position and by companies seeking to
fill vacancies.
An invaluable Job Tips hub,
populated with information to help
professionals search for their next
career move, will help users produce
a job winning CV and cover letter, as
well as warn them about the pitfalls to
avoid. Just as importantly, it is free to
use.
When you have written your CV and
are ready to begin your job search, we
urge you to upload your CV to the site
using our ‘CV Uploader’ facility where
a wide range of optical companies can
view your CV when considering any
vacancies they may have open.
When advertising on OT Jobs,
employers – from the small independent
to the large multiple – are encouraged to
upload a profile of their business for job
seekers to browse and learn more about
their potential employer.
Focusing on the needs of the
employer, we have responded to
requests to make placing an advert for
a vacancy quicker and easier, and will
allow companies to book online going
forward.
Furthermore, the ‘Jobs’ site is still
a job search tool at its core. What
readers will notice, however, is that
searching for that elusive position
has been made a lot easier. As well
as a general keyword search being in
place, a new advanced search option
allows job seekers to search for specific
roles, specify salary desirability and
view vacancies within a specified mile
radius from their home. And, to make
the job search process as hassle-free as
possible, users who find a job that takes
their fancy can
save it in ‘My
Favourites’
where it can
easily be found
when they
return to the
site – if you
register of
course!
Events
As an area
which is
equally utilised
by users to
advertise an
event as by

those looking for events to attend,
the event section will undergo some
massive developments.
Presently the oT website solely
displays details of events via a calendar
tool. excitingly, from January, visitors
to the site will be able to additionally
see events highlighted in both list
and map formats. Whilst the newly
introduced list format aims to provide
users with an easy to read overview of
each month’s events, the map view tool
allows users to search for events within
a specific area range. by simply typing
in a postcode and the distance you are
willing to travel from that postcode,
the tool will highlight all events taking
place within that radius.
As always, users wishing to advertise
anything from an LoC meeting or a
CeT conference will be able to submit
an event online. However, when doing
so the information required from them
will be a lot more specific. In requesting
details such the venue, including the
address and postcode, users trying to
located meetings close to home can do
so with ease.
Users registered on the oT website
can also save any event that they find
of interest to their ‘My Favourites’
where it will remain in the easy
locatable box anytime they return to the
site until they delete it.
Multimedia
During the site’s revamping process
oT’s online television station, ot.tv
has been renamed. From launch ot.tv
will become defunct, with all videos
– news, features and events – being
located under the new umbrella,
‘Multimedia’. Responding to feedback
from oT readers, the decision was made
to merge the two platforms in order to
ease access and make the content easier
to find and watch.
As always users will be able to submit
their comments on any video they have
watched, with previous comments
being displayed underneath each
video. However, users will also be able
to rate a video using the site’s newly
established star rating system. Readers
and users alike will be pleased to hear
that news and feature content on the
site will be separated going forward.
Viewed in mirroring formats, users can
comment, rate and add any news or
feature story
to their ‘My
Favourites’.
CET
As the most
viewed page
on the oT
website,
developers
have worked
hard to
maintain the
functions
that users
said they
liked, such
as having a
PDF of all exam articles available on
the CeT landing page, and added a
number of new functionalities to make
the process easier and clearer. Along
the exam journey practitioners will find
prompting instructions, will have the
ability to skip to and from questions,
save and return to an exam later, and
see recommendations for books – and
in the future events which they can
attend – relating to the topic area.
The correct answers for each exam
will now be automatically emailed once
the exam has closed to everyone who
sits the exam. As will a certificate for
all those who pass an exam.
A new personal Grade book can be
used by practitioners to track their
progress on oT CeT exams. It is also
where users can easily see which exams
they have passed or failed and how
many points they have collected.
Coming Soon
Practitioners using oT’s CeT site
after launch will notice that we have
included a ‘Your Learning outcomes’
box within the Grade book.
This section is designed to allow oT
CeT users to record their reflective
learning comments as they take an
exam, be it CeT, VRICS or CeT Video.
This facility is in development and
is only available as a text box in your
Grade book until March 2011. This text
box will allow you to record all of your
combined learning outcomes, however
as from March we will introduce this
function to each exam enabling you
to link your reflective learning to the
relevant exam which will show on your
certificate for you to keep in a portfolio.
oT will also launch enhanced
functioning to users’ Grade books in
March. A new Personal Development
Plan function will enable users to
schedule oT CeT to ensure they meet
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Additional benefits
Those who opt to register with the
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37
10/12/10 WEBSITE LAUNCH

REVIEW
38
10/12/10 EYE OPENER
Snow and success for 2010
Eye Opener student conference
Second-year Anglia Ruskin undergraduate, Julie Polczyk reports on this year’s sold-out AOP event
AS 190-plus optometry undergraduates arrived at Center Parcs
in Longleat for the third annual AOP Student Conference they
were greeted by a picturesque Winter Wonderland – with real
snow included – and it was clear to see from their faces that
the weekend was going to be a hit.
For the first time in the conference’s history representatives
from all eight optometry universities attended, with another
50 eager students vying for a place on a waiting list. In
fact, the buzz from the conference had spread so far that
undergraduate Ryan Gustas from the School of Optometry at
Indiana University travelled from America for the occasion.
Since it’s birth three years ago the two-day meeting has
grown and grown, with a bigger exhibition, more sponsors
and even more activities this year.
Kicking off the ‘educational’ side of proceedings, students
were treated to a whistle stop tour of the various career
options available to them upon qualifying.
Different pathways
Perhaps the most obvious option of joining a multiple
was covered by Paul Richie, a regional manager for Boots
Opticians, who spoke about working in a High Street practice
and the possible career progression it offers. Whilst not
discounting the independent route, David Shannon, AOP
chairman, was on hand to talk about the freedom afforded
by the autonomy of independent practice. However, he was
mindful of the difficulties in being up against the ‘multiples’
and the challenges that this might present.
The pathway into hospital optometry proved popular, with
more than 80% of the crowd saying they were interested in
securing a place in the competitive field. Consequently, when
Nadeem Rob, a hospital pre-reg graduate himself, took to the
stage and strongly encouraged delegates to explore the field
he had their full attention. He explained: “You don’t need
to be the highest qualified graduate for a hospital pre-reg
placement, but you do have to be the right sort of person. And
if I can do it, so can you.”
Mr Rob’s talk certainly seemed to spark a lot of interest
amongst the undergraduates, with most of the subsequent
question-and-answer session directed towards him.
However, academia shouldn’t be discounted as University
of Bradford lecturer Dr Catharine Chisholm pointed out when
she spoke about the full gambit of challenges open to the
optometrist with an interest in research, as well as the benefits
of foreign travel.
Campaigning on behalf of domiciliary optometry was AOP
counsellor Ed Bickerstaffe, who was a domiciliary optometrist
himself. Whilst Mr Bickerstaffe was enthusiastic about the
area in which he works, he advised students that it is most
definitely a route to consider for the future rather than directly
after the pre-reg period as it is prudent to get some experience
of working in practice first. “You may well be out there on
your own, with no colleague next door to ask for a second
opinion,” he warned.
As the first ‘Circuit Training’ session began students
breathed a sigh of relief that thankfully it did not involve
push-ups and sit-ups, but instead was eight 15-minute
problem solving workshops. Students got stuck into the
practical workshops on toric contact lens fitting, experiments
in behavioural optometry, ophthalmoscopy and OCT, and

39
there was even a workshop from Lloyds TsB on how to write
a business plan.
An ‘Ask the Employers what is it really like’ Q&A perked
students up before lunch and they took full advantage of
the opportunity to grill recruitment staff from ‘the big four’
– Boots Opticians, specsavers, Vision Express and Optical
Express – with some pithy questioning certainly putting them
on the spot.
Inspirational talk
In between learning delegates took the opportunity to
explore the exhibition which included representatives from
conference sponsors Optical Express, Vision Express, Boots
Opticians, specsavers, Buchmann, Keeler, CIBA Vision,
Johnson & Johnson, and Lloyds TsB. Charities Vision Aid
Overseas, Optometry Giving sight and the RNIB were also
present.
“Anything is possible if you are
willing to take risks...”
Keeping true to the promise of fully demystifying the
pre-reg year, it was AOP education advisor Karen sparrow
who had the job of explaining the pitfalls of sorting out a
pre-registration placement. And providing students with
vital tips about the OsCE, head of education at the College of
Optometrists, Jackie Martin’s speech was keenly listened to
by all.
Optometrist and entrepreneur, Imran Hakim closed the
first day of the conference with what delegates called an
‘inspirational’ talk on the possibilities outside of optometry.
Mr Hakim described his iTeddy journey and his belief that
“you should never stop dreaming”. Although a qualified
optometrist his life has taken a different path to that
envisaged by most students as the usual career progression,
showing that anything is possible if “you are willing to take
risks and make mistakes,” he said.
Despite early snowfall and plummeting sub-zero
temperatures, students braved the walk through Longleat
Forest to saturday night’s Gala Dinner. They arrived peeling
off layers of scarves, hats, gloves, wellies and Uggs, to reveal
glamorous party dresses and smart suits for the annual AOP
Eyeball.
At the Ball – during which the dancing hardly stopped –
Bradford students were named winners of the first AOP Film
and Television Award (AFTA) for their amusing film ‘show
me your fovea’ which can be watched at http://bit.ly/hB5ga4
Coming back next year
With a few blurry eyes in sight, double act Dr Anna Kwartz
and Professor steve Parrish, directors of IOT, opened lectures
on the final day of the conference. students quickly livened
up though, as the duo’s talk was full of useful information on
planning your pre-reg and advice on the right questions to
be asking when faced with a placement proposal – the two
inflatable CIBA Vision eye people props may have helped
this too.
A delegate at last year’s conference, pre-reg optometrist
Ellen Fletcher, returned to host a Q&A session about life as a
pre-reg. students fired question after question at Ms Fletcher
knowing what a good opportunity it was to have someone
speaking from first-hand experience about the period.
The conference certainly proved to be a hit amongst
students, speakers, sponsors and exhibitors alike. First-year
Anglia Ruskin undergraduate, Natalie Keates told OT: “I think
the conference has been really interesting and I’ve learnt how
to apply for my pre-reg and what to expect when I get there.
“I’ll definitely be coming next year, and in my third-year
if I can too.”
Ms Kwartz said: “We really enjoyed it and were very
impressed at how beautifully organised the whole event was,
All the delegates were clearly getting a lot out of the day.”
senior lecturer at Cardiff, Dr Christine Purslow added:
“Well done everyone – my students were buzzing with
news of it all.”
10/12/10 EYE OPENER

VRICS
VISUAL RECOGNITION
AND IDENTIFICATION
OF CLINICAL SIGNS
The following FREE Visual Recognition and Identification of Clinical Signs (VRICS) test should be
completed online by clicking on the VRICS test button at www.otcet.co.uk. Respondents should
use the six images/photos to answer the12 associated Multiple Choice Questions (MCQ). Please
note that there is only one correct answer for each MCQ. Successful completion of the VRICS test
will result in two CET points. VRICS regularly appears in Optometry Today.
40
10/12/10 VRICS
Diabetes and the Eye 2: Diagnosis and Management
COURSE CODE: C-15140 O/D Professor Rachel North
A
1. The Hess plot shown in Image A was measured in a patient with
Diabetes Mellitus (DM). Which of the following statements regarding
this result is FALSE?
a) The patient will complain of horizontal diplopia
b) This defect occurs more frequently in patients with Type 2 DM than
Type 1 DM.
c) The patient will exhibit a convergent squint
d) The patient will have a bilateral ptosis
2. Which of the following statements regarding the management of the
condition in Image A and the patient in Question 1 is FALSE?
a) Treatment with botulinum injection is an option
b) Corrective strabismus surgery may be required
c) Prismatic correction is a treatment option
d) Intervention is always required in such cases
3. Which of the following statements about the condition shown in
Image B is FALSE?
a) This condition can cause increased intraocular pressure (IOP)
b) The condition represents normal dilated iris blood vessels
c) This condition is associated with fibrous tissue formation
d) This condition is treated by pan-retinal photocoagulation
B
4. What is the MOST appropriate grade of diabetic retinopathy that
would be associated with the condition shown in Image B, according
to the National Screening Committee?
a) P0
b) R1
c) U
d) R3
5. Which technique has been used to obtain the picture shown in
Image C?
a) Fluorecein angiograhy
b) Red free fundus photography
c) Optomap imaging
d) Optical conherence tomography
C
6. What is the MOST appropriate grade of diabetic retinopathy that
would be associated with the condition shown in Image C, according to
the National Screening Committee?
a) R1
b) R2
c) R3
d) P

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are available on their website.
About the author
Professor Rachel North is an optometrist at the School of Optometry & Vision
Sciences, Cardiff University. Areas of research interest include the investigation
of functional and structural changes in Diabetes Mellitus and Glaucoma, using
psychophysical, electrophysiological and digital imaging techniques.
Associated Reading:
1. www.retinalscreening.nhs.uk
2. Louise O’Toole (2009) Features of diabetic retinopathy
and grading protocol. Optometry Today February 13
3. Brinda Muthusamy (2009) Diabetes: Indications for
treatment. Optometry Today March 13
4. Rachel North (2009) Monitoring and controlling
diabetes. Optometry Today April 10
5. Shaheen Shah (2009) Non-retinal complications
of diabetes mellitus. Optometry Today May 8
7. Which of the following statements regarding the lesions X and Y
shown in Image D is TRUE?
a) These are pre-retinal haemorrhages that have occurred due to rupture
of new vessels
b) They are commonly seen in Type 2 DM
c) These findings are indicative of an anoxic retina
d) These are vitreous haemorrhages
41
D
8. Which of the following is NOT an indicated management strategy
for the lesion labelled as X in Image D?
a) Vitrectomy
b) Pan-retinal laser photocoagulation
c) Prescription of oral systemic steroids
d) More efficient systemic glycaemic control
9. A patient with the macular condition shown in Image E has a visual
acuity of 6/18. Which of the following statements about this condition
is FALSE?
a) It is more common in patients with Type 1 DM
b) It occurs due to capillary drop out
c) It is associated with cotton wool spots
d) It has a good prognosis for resolution
10/12/10 VRICS
E
10. Which of the following statements about the condition shown in
Image E is TRUE?
a) Vitrectomy should be performed
b) Intra-vitreal steroid injections should be given
c) Fluorescein angiography will show areas of retinal non-perfusion
d) Pan-retinal photocoagulation should be performed
11. Which of the following statements about the condition shown in
Image F is FALSE?
a) It is non-recurrent
b) It can cause ptosis
c) It is associated with Type 1 DM
d) It is usually due to hypercholesterolemia
12. Which of the following is NOT an indicated management strategy
for the condition shown in Image F?
a) Cryotherapy
b) Surgical excision
c) Carbon dioxide laser treatment
d) Chemical cauterization eg, with trichloroacetic acid, for deep lesions
F
Acknowledgements
The author would like to thank the All Wales Diabetic Retinopathy Screening Service, Optos Plc, and
the Media Resources Centre of the University Hospital of Wales , for providing images for this VRICS.

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10/12/10 CET
MANAGEMENT OPTIONS FOR UK OPTOMETRISTS PART 6
Ocular surface and anterior
segment inflammation
COURSE CODE: C-15087 O/AS/SP/IP
Professor Michael J. Doughty, PhD
In this final article of this series, the management of a range of fairly
common mild-to-moderate inflammatory conditions of the anterior
segment is discussed. Many of these conditions, such as complex cases
of blepharitis, blepharoconjunctivitis, limbal and peripheral corneal
infiltrates, non-perforating abrasions, and foreign bodies, can present
to and be managed by an optometrist, especially those with additional
supply (AS) therapeutic qualifications. Pharmacological options range from
artificial tears and lubricants to topical analgesics and the therapeutic use
of cycloplegics; the latter are more likely to be utilised by optometrists
trained to independent prescriber (IP) level, as highlighted later.
Aetiology of ocular surface and
anterior segment inflammation
The sub-epithelial connective tissue
(parenchyma) usually contains
inflammatory cells, including additional
white blood cells (eg, macrophages) that
have initially non-specifically migrated
from the dilated capillaries into the
conjunctival tissue in response to the
inflammatory stimulus, followed later
by specifically recruited white blood
cells (eg, polymorphonuclear leucocytes
- PMNs) that migrate to the region where
the foreign antigens are located. 1,2 These
cell types, especially the former, along
with mast cells, can release inflammatory
mediators from granules in the cells.
These non-specific mediators include
histamine and certain prostaglandins.
As inflammation develops, the natural
cell complement of the conjunctiva and
peripheral cornea becomes affected and,
in turn, these cells also provide a source
of further inflammatory mediators mostly
of the prostaglandin type (see later).
When a generalised inflammatory
response of the anterior segment
develops, a patient is likely to report
some type of ocular discomfort,
including foreign body sensation,
which can progress to a dulled pain
feeling that may also be associated
with a progressive development of
photophobia. In rare cases far more
substantial pain can develop, especially
as associated with eye movement,
because of the generally inflamed tissue,
which includes the extraocular muscles
and their connective tissue sheaths.
Part of the general discomfort is caused
by general or localised vasodilatation
and tissue oedema that accompanies
the inflammation. For the most part, in
the majority of cases of anterior segment
inflammation, the tissue oedema is
superficial and associated with blood
vessels close to the conjunctival surface,
whether this is at bulbar, palpebral or
fornical regions, or a combination of
these. This can often result in the patient
wanting to rub their eyes and actually
worsening any redness and puffiness of
the conjunctiva and lid margins. Overall,
these responses are all inflammatory
in nature, but can be associated with
bacteria or carry the risk of being infected.
The redness can, however, be more
localised to a certain region of the
ocular surface (bulbar or palpebral
conjunctiva) and this forms the basis
(in part) of a differential diagnosis for
the various conditions. Vasodilatation
of the more superficial vasculature
across the bulbar conjunctiva should
be self-evident (especially if assessed
by slit-lamp biomicroscopy), but any
concern that deeper lying blood vessels
have been affected (ie, as in scleritis)
could be checked with a simple
‘blanching’ test, ie, instil phenylephrine
2.5% eye drops and assess the
extent of clearing of the hyperaemia.
Conditions such as contact lens
associated papillary conjunctivitis
(CLPC) are well defined by the
terminology, ie, the inflammation is
clearly associated with papillae, which
are located across the tarsal surface
and associated with localised regions
of thickening (hyperplasia) of the
conjunctival epithelium. The progression
of the inflammation and thus the increase
in the grade of CLPC 3 could therefore

e localised to the hyperplastic
regions, and while this has not been
well-documented in systematic
studies, it is likely associated with
increased risk of discrete focal
‘staining’ with sodium fluorescein
(NaFl) across the tarsal plate. In
related conditions such as vernal
keratoconjunctivitis (VKC) or atopic
keratoconjunctivitis patients with
conjunctival or corneal conditions,
the hyperplasia is so substantial
that the ‘hardened’ focal regions of
the palpebral surface are sufficient
to essentially cause mechanical
damage to the corneal epithelium
and a central or more peripheral
‘shield’ ulcer can develop. 4-6
Accompanying the CLPC can be
an aggregation of white blood cells under
and/or within the palpebral conjunctiva
(whereas the normal, non-inflamed
palpebral conjunctiva and parenchyma
should contain few, if any, white blood
cells). Illustrated in Figure 1 is a high
magnification electron micrograph from a
rabbit with mild follicular conjunctivitis, 1
where a presumed PMN (white arrow) and
macrophages (black arrows) are found
in abundance. A likely consequence
of the presence of these inflammatory
cells is an alteration of the goblet cells
and their secretions of mucous. As
a result, in some cases of ‘follicular’
conjunctivitis, and more especially in
VKC, it is entirely possible that a thick
‘mucoid’ discharge may line the furrows
or groves between papillae and follicles,
and also be present at the lower fornix.
Such aggregates of white blood
cells may also invade the superficial
epithelium of the limbus and even the
peripheral cornea, having migrated from
the peri-limbal vascular arcade. As with
the conjunctival epithelium (Figure.
1), the corneal epithelium cells will
become increasingly disorganised by the
presence of extra cells (ie, the invading
macrophages and even PMNs). This has
a very important consequence since a
cluster of white blood cells will distort
the superficial (squamous) cell layers and
the immediately underlying intermediate
Figure 1
Transmission electron micrograph of the palpebral
conjunctiva, to show the presence of goblet cells
with slightly heterogeneous paler-staining granules
associated with the presence of white blood
cells (marked by white and black arrows) within
and under the conjunctiva. Copyright Australian
Association of Optometrists. Reproduced from
Doughty and Bergmanson 2
(wing) cells, so progressively disrupting
the tight junctions between superficial
epithelial cells. In early stages of an
inflammatory response affecting the
limbus and/or peripheral cornea, the
surface may not be ‘broken’, ie, the
white blood cell infiltrates are under
the surface. However, at some stage,
the surface may be breached as in
some cases of limbitis associated with
reaction to contact lens care solutions,
in contact lens associated peripheral
‘ulcers’ (CLPU) (OT, November 12
2010), or a range of other inflammatory
conditions affecting the limbus. 4-6
The focal inflammation may also be
a reaction to microorganisms and/or
their metabolic products, eg, to bacterial
toxins (see later), or in later stages of
epidemic keratoconjunctivitis (EKC)
associated with adenoviral infections.
The infiltrates, usually more easily seen
in the peripheral cornea, have a circular
shape reflecting aggregation around
a focal site where the stimulus
for white blood cell migration is
located (Figure 2). In conditions
such as VKC, the aggregates can
become sufficiently dense to be
evident as raised limbal nodules.
Any infiltrate cluster can result in a
compromise of the surface barrier and
the net result is discrete regions of
NaFl ‘staining’ (Figure 2). Whenever
there is a break in the surface, no
matter how small, there will be
continued migration of white blood
cells to that location (see later). In
management of these inflammations,
the goal is both to reduce the
aggregation of white blood cells and
promote their removal, and to regain
the integrity of the ocular surface
barriers especially across the cornea.
There are several relevant College
of Optometrists Clinical Management
Guidelines (CMGs) that should be
consulted, namely ‘CL-associated
papillary conjunctivitis’, ‘Keratitis – CLassociated
infiltrative’, and ‘Keratitis –
marginal’, ‘Ocular Rosacea’, ‘Episcleritis’,
‘Corneal abrasion’ and ‘Recurrent
corneal epithelial erosion syndrome’.
Pharmacology of antiinflammatory
drugs and
options for optometrists
Anti-inflammatory drug treatment, for
the types of conditions outlined above,
are mainly directed towards controlling
the inflammatory response, but also
promoting wound healing. In general
terms, macrophages underpin the
initial inflammatory response and then
are largely responsible for removing
(by phagocytosis) those secondarily
recruited PMN leukocytes so as to end
the inflammatory reaction. The latter is
especially important in cases of recurrent
corneal erosion syndrome (see later)
where the failure to completely re-heal
the epithelial surface drives a recurrent
cycle of recruitment of inflammatory
cells that re-disrupt the epithelial barrier.
The prostaglandins that drive the
inflammatory response are derived from
43
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10/12/10 CET
Figure 2
Limbal epithelium infiltrates of white blood cells,
also extending just into peripheral cornea, arising
from an inflammatory response to a contact lens
care solution. Image courtesy of the Bausch & Lomb
picture library [www.bausch.com/en_US/ecp/
resources/image_libary].
cell membrane phospholipids, both
externally and internally. A sequence
of enzyme-mediated reactions results
in the release of a pro-inflammatory
precursor molecule, a ‘lipid autoacid’
called arachidonic acid (a type of
unsaturated fatty acid), with a cell
membrane-associated phospholipase A2
enzyme being a notable activity. This
enzyme activity is indirectly regulated
by natural immune modulators such
as glucocorticosteroids and can be
inhibited by exogeneous cortisosteroids
used as anti-inflammatory drugs. 7,8 The
mechanism of inhibition, by drugs such
as hydrocortisone and prednisolone,
is complex; both are used as eye drops.
It involves both that the corticosteroid
binds to the affected cells and be
translocated to the cell nucleus, and that
there is an elaboration of an intracellular
peptide messenger called lipocortin-1.
If the inflammatory response is not
blocked at this level by exogenous
corticosteroids, then continuing activity
of phospholipase A2 results in more and
more arachidonic acid being produced to
start an inflammatory cascade involving
cycloxygenase COX-1 and COX-2
enzymes. 8,9 In normal tissues, there will
always be some COX-1 activity to convert
arachidonic acid into pro-inflammatory
prostaglandins, but this conversion
is augmented by an inducible COX-2
(ie, higher levels of enzyme produced
in chronically inflamed tissues) that
will produce the same or other proinflammatory
prostaglandins. All of
these cyclooxygenase activities can
be inhibited by aspirin-like drugs, the
Non-Steroidal-Anti-Inflammatory Drugs
(NSAIDs). The NSAID most relevant
to management of anterior segment
inflammation is diclofenac eye drops.
In more recent years, increasing
attention is being given to other natural
pro-inflammatory biochemical pathways
and anti-inflammatory mechanisms
involving ‘protective lipid mediators’. 2
There are three aspects of these that
deserve consideration for future
therapeutic options. The first of these is
the enzyme lipoxygenase (specifically
LOX-15) that is present in the epithelia,
and generates both an anti-inflammatory
and ‘pro-inflammatory resolving’
prostaglandin-like molecules such as
lipoxin A4. The lipoxin pathway is
considered important in inflammation
and epithelial resurfacing control. Other
unsaturated fatty acid-type products
from this pathway such as 12(S)- and
15(S)-HETE have been shown in animal
models to be substantially elevated
following continuous wear of contact
lenses, associated with development
of inflammatory cornea oedema and
corneal neovascularisation. 10 A set of
other lipoxin pathway-related molecules
are peptides such as the resolvins, which
have been reported in animal studies to
reduce the severity of experimentallyinduced
ocular surface inflammation. 11
The resolvins are derived more from
another polyunsaturated fatty acid
(PUFA) which has received considerable
attention in relation to inflammation of
the ocular surface and the Meibomian
glands, namely the omega-3 compound
docosahexaenoic acid (DHA). 2,12
Contact lens wear-related
papillary conjunctivitis and
related conditions
As noted in the previous article
(OT, November 12 2010), the ideal
management of CLPC involves
discontinuation of contact lens wear
followed by a four-times-daily (QDS)
regimen of a mast cell stabilizer such
as sodium cromoglicate. 13-16 The logic of
such a treatment might be questioned
since sodium cromoglicate is not
considered to have any constitutive
anti-inflammatory activity; the removal
of the stimulus to inflammation should
help and better results might be obtained
with other mast cell stabilisers/antieosinophil
drugs such as lodoxamide or
nedocromil sodium (both available to AS
optometrists). The treatment, whilst the
patient has stopped lens wear, should be
continued until the eyelid inner surface
is quiet and any ‘staining’ of papillae is
reversed. 13,14 Depending on severity, most
resolution should take two to four weeks,
after which the dosing could be reduced
to TDS or BDS for a further two to three
weeks to ensure complete resolution. 14,16
This approach should work for mild
to moderate CLPC, but more severe
cases of GPC (with notable conjunctival
hyperplasia) may require a short
period topical corticosteroid treatment.
This would require referral to an IP
optometrist (preferably one specialising
in conta ct lenses) or an ophthalmologist.
The topical corticosteroid therapy should
reduce conjunctival vessel leakiness
within a few hours, 17 reduce PMN
leukocyte recruitment and migration
into the conjunctiva (extravasation), 18,19
and reduce any further elaboration
and secretion of other inflammatory
mediators by the leukocytes. 20 A short
term topical ocular corticosteroid
regimen (eg, prednisolone 0.5% or 1%
gtt, QDS, for two to three weeks) may be
beneficial in substantial cases of GPC, as
opposed to CLPC, associated with soft
lens wear. 21 By current perspectives,
regular lens replacement, improved
lens hygiene and patient education are
considered the mainstay of preventing
CLPC/GPC from developing in the first
place, 22 but a short course of topical
ocular corticosteroids can be used simply
to manage discomfort, photophobia

and also improve appearance by
reducing conjunctival hypaeremia. 23
Long-term and/or extended wear of
contact lenses may result in marginal
keratitis, which is a mild-to-moderate
inflammatory response that is often
refractory to management. While the
tarsal plate may not show an exaggerated
reaction, such inflammatory reactions
now likely include a hardening of
the palpebral conjunctival infiltrates.
Corneal infiltrates and even larger deep
stromal infiltrates, as opposed to small
and localized peri-limbal infiltrates, can
also develop. 3,16,24,25 Such conditions are
less likely to be acute in presentation but
progressive. A further extension of such
reactions may be the development of
neovascularization or deeper infiltrates
(in the palpebral conjunctiva, corneal
epithelium or stroma) both of which are
the clear signs of an extended recruitment
of inflammatory cells in response to
persistent irritation. It is likely that
any patient with such infiltrates will
show low grade corneal and bulbar
conjunctival staining with NaFl. The
presence of just a mild inflammation,
as might be expected in many cases of
contact lens wear-associated superior
epithelial arcuate lesions (SEALs), can
likely be managed without corticosteroids
(ie, discontinue lens wear). The more
substantial cases are likely accompanied
by notable peri-limbal reaction, the
presence of neovascularisation, perilimbal
or peripheral corneal infiltrates
with an accompanying anterior
chamber reaction. For these, along with
stopping contact lens wear for several
weeks, an aggressive but carefully
monitored treatment with topical ocular
corticosteroids may well be needed. 16,24
Similarly cautious use of topical
ocular corticosteroids might also be
appropriate to help manage the initial
gross inflammatory response in contact
lens associated acute red eye (CLARE),
concurrently with intensive antibiotic
coverage. Some might argue that it
is best to discontinue lens wear and
let the eye quieten down on its own,
Figure 3
Presumed angular blepharo-conjunctivitis caused by Staphylococcus sp. Associated with slight limbic
reaction and peripheral corneal infiltrates. Figure courtesy of Gartnavel Hospital Eye Department, Glasgow.
but the presence of tissue oedema
and substantial peripheral infiltrates
may need the judicious use of strong
anti-inflammatory drugs such as
corticosteroids. Patience is required
in monitoring such patients to decide
on the most appropriate intervention.
A case can be made that substantial
signs of inflammation need to verified
and carefully documented before
corticosteroid use is justified. The
efficacy of the topical corticosteroid
therapy should be assessed with the
expectation of reduced symptoms and
biomicroscopy performed to confirm
the reduction of oedema, quieting of
the vasculature, reduction in infiltrates
and anterior chamber reaction. 26 The
infiltrates should be examined (and
graded) to check for resolution. 27 For
contact lens wearers, it can be noted
that the removal of the offending contact
lens in itself should reduce most of the
exogenous inflammatory stimulus and
so the steroid therapy is really to arrest
the further development of inflammatory
cell recruitment and to promote recovery.
Contact lens wear might be reconsidered
after a suitable abstention (eg, a few weeks
after cessation of corticosteroid therapy).
Overall, the same principles for use
and follow-up of corticosteroids would
apply for cases of non-specific keratitis
associated with limbal inflammation
in the absence of contact lens wear, ie,
more substantial cases of limbitis or
superficial (punctuate) limbal keratitis
including those associated with
VKC, 4,5 or atopic keratoconjunctivitis. 6
Marginal keratitis in the
absence of contact lens wear
As noted earlier, non-infectious
inflammatory conditions such as VKC
can be associated with marginal keratitis
and can even progress to substantial
corneal epithelial problems such as noninfectious
(shield) ulceration. There
is another cause of marginal keratitis
that has an association with infectioncausing
bacteria but is not necessarily
infected. Such a condition used to be
referred to as a ‘sterile inflammation’,
now recognised to be a rather special
inflammatory response to toxins secreted
by bacteria eg, from certain strains of
Staphylococcus aureus, S. epidermidis or
the Propionibacterium acnes associated
with rosacea and related conditions. 28,29
These spread from the eyelid margins via
the tear film to the edge of the cornea,
and can result in additional marginal
infiltration and even ulceration of the
superficial corneal epithelium at the
45
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limbus, 30-33 which will likely show
as punctuate localised staining with
NaFl. This is more likely to occur
when there is a hypersensitivity
to the toxins, and would be
a limbitis or superior limbic
keratoconjunctivitis (SLK) with
an indirect infectious aetiology.
Such toxins can also be a cause of
peripheral infiltrates in a contact
lens wearer that may be mistaken
for peripheral infectious ulcers.
They can progress, if not managed
carefully, to the development
of severe corneal ulceration.
That the condition is largely
inflammatory in nature can be
established by the nature of the
signs that can include notable ‘angular’
blepharitis (Figure 3) associated with
both a limbal inflammatory reaction
and peripheral corneal infiltrates.
If the signs indicate infection (ie,
the presence of some mucopurulent
discharge as opposed to simply
excessive lacrimation), then antibiotic
treatment would be appropriate, eg,
with chloramphenicol or even fusidic
acid viscous eye drops. 32,34 Good eyelid
margin hygiene should also reduce the
recurrence of the condition, but recurrent
and stubborn inflammatory episodes
may also need topical corticosteroid
treatment (eg, prednisolone 0.5% QDS
for a few days) to generally quieten the
eye, reduce lacrimation and photophobia
as well as reduce further development
of corneal infiltrates .27,30,35 As an
inflammatory condition, some limbitis
cases may respond to topical mast cell
stabilizers (eg, regular use of sodium
cromoglicate over one month). 31 Adjunct
measures could also include the use of
dark sunglasses, as well as the as-needed
use of artificial tears to promote comfort.
Other conditions where marginal
infiltrates can occur include sequelae
following adenoviral infections. In some
cases it may prove difficult to distinguish
between infiltrates being associated with
bacterial toxins or a similar immunemediated
response to the virus in
Figure 4
Plot to illustrate relative effects of use of a surface
analgesic (diclofenac eyedrops; blue line; data from
Aragona et al. 44 ) as compared to a topical ocular
anaesthetic (oxybuprocaine eyedrops; red line;
data from Naase et al. 45 ) on the touch sensitivity of
the corneal surface to a nylon filament.
epidemic keratoconjunctivitis (EKC),
ie, the former could also be spread from
one eye to the other and even between
individuals if peri-ocular and facial
hygiene were poor. Notwithstanding,
if substantial infiltrates are seen to be
developing then judicious use of topical
corticosteroids is again appropriate.
Non-perforating foreign body
injury and trauma to the
anterior eye
Abrasions or other forms of nonpenetrating
foreign body injury to the
cornea or conjunctiva will likely elicit
initial pain followed by considerable
discomfort associated with an
inflammatory response. In contact lens
wearers, this could be caused by grit
under the lens or a fingernail during
lens insertion or removal. As recognised
many years ago, as long as there is
an open “wound” (ie, an epithelial
defect), macrophage and then leukocyte
recruitment is likely to continue. 36 The
sooner a superficial wound resurfaces,
the faster the secondary recovery
stage of the inflammation (see later).
In A&E as well as in optometric
practice, coverage with an antibiotic
will likely be considered appropriate,
eg, chloramphenicol eye ointment
or fusidic acid viscous eye drops. 37
Substantial eyelid patching is no
longer recommended. 38,39 Patients
need to be instructed to continue
the antibiotic coverage for a few
days, whether this be QDS for
chloramphenicol or BDS for fusidic
acid. In many cases, however,
infection is not apparent nor does it
develop but the antibiotic coverage
is a sensible precautionary measure.
Since the abrasion can be rather
painful, systemic analgesics are often
required. Lesser presentations can often
be managed with the patient’s preferred
systemic analgesic but there is only
limited data from organised trials as to
whether an oral NSAID (eg, ibuprofen 400
mg, TDS) is sufficient or whether patients
would be better managed with an NSAIDnarcotic
combination (eg, paracetamol
500 mg with codeine or dihydrocodeine 7
to 8 mg QDS); these options are available
as P Medicines in the UK, for use by adults
(not children less than 12 years of age).
AS and IP-trained optometrists can
also access the same topical NSAIDanalgesic
preparation as used in some
A&E departments, namely diclofenac
sodium eye drops. This is available
in unit-dose form as PoM Voltarol
Ophtha. The successful use of eye drops
containing an NSAID in the management
of corneal abrasions has been reported
in organised trails, with the key effect
being improved patient comfort through
reduced blepharospasm from the
analgesic activity (Figure 4). 40,41 This
surface analgesia is different from surface
anaesthesia, ie, the patients are still able
to sense a foreign body (or similar) and
feel if anything touches their eye. A single
use of a topical ocular anaesthetic may
well be a necessity to allow a patient’s
eye to be opened and examined after an
abrasion or foreign body injury, but is not
to be used as a means of controlling pain

in the longer term. 9,43 While (sadly)
this is still sometimes done (either by
a health care professional prescribing
the eye drops, or self-initiated by a
patient after ‘stealing’ a bottle of the
‘magic’ eye drops from the attending
health care professional), the selfuse
of a topical anaesthetic can
result in such devastating corneal
problems that a transplant is needed.
Thus there is an important
distinction between surface
analgesia and anaesthesia which
can be assessed by measuring the
mechanical (touch) sensitivity of the
cornea with the nylon filament of a
Cochet-Bonnet aesthesiometer, 44 the
longer the filament length (in mm)
that can be detected, the greater the
sensitivity. Similar results would
be expected if a dry Q-tip or wisp
of soft tissue paper were touched to
the eye. As shown in Figure 4, even
repeated use (four drops repeated at
five min intervals) of diclofenac 0.1%
eye drops would not be expected to
reduce touch sensitivity by more than
25% in a normal eye, while a single
drop of topical anaesthetic should
essentially remove corneal touch
sensitivity within five min or less. 45
The usually recommended use
of diclofenac for corneal abrasions
would likely be to instil two or more
drops prior to the antibiotic, with the
patient being supplied with a few
more single dose units (eg, one or two
packs of 5) to repeat the treatment
over the next two to three days on a
QDS basis. It would likely be better
to recommend such regular use to
ensure good antibiotic coverage,
rather than reducing to BDS (as
might be acceptable for adequate
analgesia). Even much longer-term
use of topical ocular NSAIDs (eg, as
a routine post-operative treatment
for several weeks after cataract
surgery) has not been reported
to produce much more surface
analgesia to that shown in Figure 4.
The main issues in following-up
management of abrasions, especially
of the cornea, are to consider how well
the wound is healing (with appropriate
NaFl staining assessments). Many
mechanical wounds should show good
signs of healing within 24 hours and if
this does not occur then the eye should be
considered at risk for recurrent episodes
of un-healing and re-healing, a condition
now usually referred to as recurrent
corneal epithelial erosion syndrome.
A series of deep and centrally located
abrasions from a paper edge cut are show
n in Figure 5. The abrasion may also be
geographic (ie, covering a large area).
Some will advocate routine short-term
management of substantial abrasions with
a large diameter ‘bandage’ soft contact
lens, 46,47 although such patients need to
monitored carefully for lens adhesion
or other complications. 48 The bandage
lens can be of the daily disposable type
so avoiding any issues in lens care and
disinfection. 49 Bandage (soft contact)
lenses have been used concurrently with
an NSAID such as diclofenac (preferably
in its unit-dose preservative-free form,
PoM Voltarol Ophtha), 50,51 and may also
be used with antibiotics (eg, Minims
chloramphenicol) on a BDS basis. 52
Either of such treatments need to be
carefully monitored by regular follow-up.
The logic behind use of a bandage lens,
with or without adjunct medications that
could even include topical corticosteroid
therapies, 53,54 is to promote re-adherence
of the lifted edges of the epithelium
and so facilitate spreading of dividing
Figure 5
Substantial central corneal abrasion from paper
edge. Image courtesy of the Bausch & Lomb picture
library [www.bausch.com/en_US/ecp/resources/
image_libary].
epithelial cells across the abraded
region. The use of a bandage lens may, in
itself, reduce the dull discomfort (pain)
of the abrasion so making additional
topical analgesia unnecessary (although
systemic analgesics may still be
wanted). Eyelid movement across lifted
edges of an abrasion may exacerbate
this and/or the non-wetting surface of
the lesion may adhere to the overlying
palpebral conjunctiva (which is likely
to be inflamed due to the response to
the abrasion). The latter may result in
well-known characteristic symptoms
that should alert the patient (as well
as the optometrist) that recurrent
erosion is a problem; the symptoms
typically involve sudden-onset ‘sharp’
pain in the affected eye on waking or
even during sleep as the movement
of the lids detaches the epithelium. 55
Other symptoms will include tearing,
photophobia and blurred vision as the
eye responds to the re-wounding of
the corneal (or conjunctival) surface.
Once recurrent erosion episodes have
started, it may take many weeks,
months or even years to resolve. 48
Current opinion on the mainstay
of management of recurrent erosion
syndromes is to keep the eye well
lubricated, day and night. 56 This
involves use of preservative-free
simple artificial tears (as needed) and
application of a preservative-free bland
ointment (eg, P Lacrilube or P Simple
Eye Ointment) prior to retiring to bed
for as long as it takes such that a
re-current episode does not occur.
Patients should be reviewed
regularly (eg, once a month) to
assess the condition of the corneal
epithelium and the epithelial
interface with the corneal stroma
for any signs of disturbance,
breaks or inflammation. This
inflammation could extend
to the corneal endothelium
(eg, as pseudoguttata) or even be
evident in the anterior chamber as
flare and even cells as the bloodocular
barrier is compromised by
ongoing development of inflammation.
47
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Figure 6
Mild localised reddening of conjunctiva and
episcleral tissue of unknown aetiology. The slight
mucous accumulation at the inferior fornix should
be noted as well. Figure provided Courtesy of
Gartnavel Hospital Eye Department, Glasgow.
Therapeutic use of mydriatic/
cycloplegics
Over many years of largely ad-hoc
and anecdotal evidence, it has become
customary to provide a special sort of
palliative therapy for cases of corneal
abrasions and foreign bodies. This
has involved the use of a mydriatic/
cycloplegic. Its use could also be
considered in the immediate aftermath
of a recurrent erosion episode. It is
a controversial issue with different
arguments being presented as to whether
it serves to reduce reactive miosis (ie,
relieve pupil spasm that can occur with
substantial release of prostaglandins into
the anterior chamber following activation
of the innate immune response) and/or
ciliary (body) spasm, or whether the use of
the cycloplegia serves to reduce ongoing
cell-mediated inflammation by beneficial
reduction of blood flow in the uveal and
iris vasculature. In either case, anecdotal
accounts indicate that photophobia
could be reduced as well if there really
was an inflammatory response. An
equally important issue is more one of
preventing sequelae from substantial
intraocular inflammation and whether the
immediate use of a cycloplegic/mydriatic
will reduce the risk of iris adhesions to
the crystalline lens that could ultimately
develop into posterior synechiae.
Traditional cycloplegics included
atropine (eg, 0.5% or 1% eye drops used
BDS, or 1% ointment applied prior to
pressure patching) and homatropine (2%
or 5% administered at least BDS). Both
would be expected to exert extended
‘therapeutic’ effects on the iris and ciliary
body (along with similarly prolonged
effects on vision due to substantial
mydriasis and cycloplegia) and both of
these are available to AS optometrists.
However, the non-therapeutically trained
optometrist can only access the shorteracting
cyclopentolate for this purpose and
so the frequency of instillation may need
to be increased to TDS, or even QDS in
substantial abrasions and/or those with
darkly pigmented irides, for example.
Other inflammations of the
anterior segment
There are numerous other commonly
occurring inflammatory conditions
of the anterior segment that may
present to optometrists. These
include cases of chronic allergic
conjunctivitis unresponsive to routine
treatments (OT, November 12 2010),
advanced presentations of VKC (again
unresponsive to mast cell stabilizer
treatments), ocular rosacea, episcleritis
(of various aetiologies) and, of course,
intraocular inflammations of the
anterior segment associated with the
iris and anterior uvea. It will sometimes
be a dilemma to assess the cause of
such problems (Figure 6) and there
is likely no substitute for seeing such
conditions on a regular basis to establish
a diagnosis and be able to manage them
on a long-term basis. For any patient
with recurrent or chronic inflammatory
conditions of the anterior segment, two
other issues also need to be considered;
namely whether their condition is the
result of an allergic reaction to ocular
or peri-ocular pharmaceuticals or
products (eg, follicular conjunctivitis),
and whether this is the result of an
interaction with other (systemic)
medications (including those for any
other form of allergic condition), which
will need to be carefully reviewed.
As noted earlier, any ‘red eye’ with
an inflammatory aetiology (including
episcleritis) will likely respond in the
short term to being kept adequately
lubricated (to offset the effects of
persistent lacrimation) and some
comfort be realized with the judicious
use of a topical ocular decongestant
(eg, naphazoline eye drops). Antiallergy
drops (eg, mast cell stabilizers)
might also have been tried in cases
where allergy is a factor. All of these
conditions can however progress to the
stage where routine use of topical ocular
corticosteroids is needed and sometimes
on a chronic basis. 7,57 Such therapeutic
options are available to IP optometrists
where safe and effective management
of these conditions can be realised.
Summary
A range of fairly common mild-tomoderate
inflammatory conditions of
the anterior segment can present to
optometrists. Many of these conditions
can be managed by optometrists,
especially those with AS and IP
qualifications, and can include more
complex cases of blepharitis and
blepharoconjunctivitis, limbal and
peripheral corneal infiltrates and nonperforating
abrasions and foreign bodies.
Pharmacological options range from
artificial tears and ocular lubricants, to
mast cell stabilisers, topical analgesics
(NSAIDs) and the therapeutic uses of
cycloplegic drugs such as cyclopentolate.
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-15087 O/AS/SP/IP
1. For anterior segment inflammation, the phenylephrine test:
(a) should indicate if pupil dilation is excessive
(b) should provide an indication of how deep any dilated vessels are
(c) will only work if dilute (0.125%) solutions are used
(d) should be carried out for every patient presenting with a red eye
2. In limbal or peripheral corneal infiltrates, the ocular surface:
(a) can be breached as white blood cells emigrate through the epithelia
(b) will rarely stain with fluorescein because the leukocytes stop this occurring
(c) will only be affected if neovascularization is also present
(d) is unlikely to show any signs of vasodilation
3. Which of the following drugs acts as an indirect inhibitor of
phospholipase A2 enzyme?
(a) sodium cromoglicate
(b) naphazoline
(c) diclofenac
(d) hydrocortisone
4. Which of the following daily doses of lodoxamide eye drops would
be commonly recommended to treat grade 2 CLPC?
(a) As needed with or without contact lens wear
(b) BDS whilst continuing contact lens wear
(c) QDS after discontinuing lens wear
(d) QDS whilst continuing lens wear
5. Toxins associated with development of marginal keratitis come from
which organisms?
(a) Staphylococcus aureus
(b) Staphylococcus epidermidis
(c) Propionibacterium acnes
(d) Any of the above
6. For stubborn and recurrent cases of marginal blepharitis, which of
the following treatments can be considered?
(a) prednisolone 0.5% eye drops QDS for a few days
(b) artificial tears as needed for comfort
(c) sodium cromoglicate eye drops for a month
(d) all of the above
7. The following therapeutic drugs are available to additional supply
optometrists EXCEPT:
(a) nedocromil sodium
(b) prednisolone phosphate
(c) diclofenac sodium
(d) cyclopentolate
8. Which of the following statements about superficial limbal keratitis
is TRUE?
(a) It can result from inflammatory reactions to contact lens care solutions
(b) It can be seen in some chronic cases of vernal keratoconjunctivitis
(c) It can be observed in some patients with atopic skin conditions
(d) All of the above
9. Which of the following would be a suitable narcotic analgesic for
optometric use in cases of corneal foreign body injuries?
(a) ibuprofen
(b) dihydrocodeine
(c) diclofenac
(d) aspirin
10. Which of the following statements about pharmacologically-induced
topical ocular analgesia is TRUE?
(a) It would reduce corneal sensitivity to touch by up to 25%
(b) It would remove a patient’s ability to sense further contact or abrasion
from a foreign body
(c) It would promote eyelid closure as a protective (relaxing) mechanism
(d) It would produce equivalent effects to repeated use of oxybuprocaine or
proxymetacaine
11. Which of the following would be a routinely recommended dose for
diclofenac after a corneal abrasion?
(a) QDS for 2 days with or without antibiotic coverage
(b) A single use of the eye drop once only, followed by chloramphenicol for 1 day
(c) As needed over the following 2 to 3 weeks
(d) Every hour for the first day, then reduce gradually
12. Which of the following statements is about the use of cyclopentolate 1%
following a non-penetrating foreign body injury to the eye is TRUE?
(a) Only a single drop is usually used because it is a strong cycloplegic
(b) Dosing may need to be rather frequent (QDS) to obtained the desired effect
(c) The drug may induce an unwanted ciliary spasm
(d) Its effects would be routinely expected to be at least as good as using atropine
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students’ performance to enhance their learning as well as providing
clinical optometry services in the University Eye clinic.
Benefits include: final salary pension scheme, generous annual leave
entitlement, flexible working opportunities and interest free travel to
work loan.
Closing date 24 December 2010
For further details and to apply please visit our website
www.anglia.ac.uk. If you have any queries please
contact our recruitment team on 0845 196 4758
or email jobs@anglia.ac.uk
We value diversity at
Anglia Ruskin University and
welcome applications from all
sections of the community.
bookshop
51
10/12/10 RECRUITMENT
CE

RECRUITMENT
To place an advertisement call
020 7878 2313 or email haley.willmott@tenalps.com
Christmas.
Trees.
What will Christmas 2011 hold for you?
If you're looking to break out of the cities and
suburbs in 2011 with a career that takes you
closer to nature then look at the current
opportunities within the Rayner Group.
Most of our practices are just a stone's throw
from some of the most dramatic, beautiful
and rural parts of the country.
52 50
Plus, you'll be working within an established, yet dynamic, international organisation
with diverse interests and expertise across optics
If you'd like to join us as we start our second century of operation please contact
us by letter or email at the address below.
17/09/10 12/12/10 RECRUITMENT
Optometrists
West Wales
West Yorkshire
Wiltshire/Berkshire
Cumbria Coast
Lincolnshire
South Yorkshire
G R O U P
Locum Optometrist
Essex/Suffolk
Dispensing Managers
Cumbria
Lincolnshire
Derbyshire
Mobile Dispenser
Yorkshire
Lowndes House, The Bury, Church Street,
Chesham, Bucks HP5 1DJ
Email: working@rayner.com
All positions come with
exceptional salaries,
private medical care
and pension.
TIME FOR A
LIFESTYLE CHANGE
Come to Australia or New Zealand
Make a difference to the lives of people in a new
community and change the direction of your
future.
Luxottica is the leading provider of eyecare and
eyewear across Australia and NZ.
Candidates should hold either current Australian
registrations or be willing to sit the OCANZ
competency exams to become registered to
practice.
We now offer assistance with a comprehensive
upskilling and mentoring program, written and
supported by Dr Emma Gillies.
Assistance with: working visas, relocation and
permanent residency.
To start your journey with Luxottica, contact
Cheryl Nichols on
cheryl.nichols@luxottica.com.au

“I helped to
improve her focus.”
Geeta has worked for The Outside Clinic for 5 years,
she enjoys working with people who really
appreciate the service we provide.
We need more people like Geeta!
So if you’re interested in a rewarding career,
get in contact.
For the latest vacancies
please visit
www.outsideclinic.com/vacancies.html
Contact Jim Gilbert for more details:
tel: 01793 648607
email: jim@outsideclinic.com

RECRUITMENT
To place an advertisement call
020 7878 2313 or email haley.willmott@tenalps.com
McCartney Maxwell Ltd
54 50
A different approach to
Optical recruitment
Why are we different?
Optometrists
Dispensing Opticians
CLO’s
Retail Managers
Optical Assistants
Optical Recruitment at its Best!
17/09/10 10/12/10 RECRUITMENT
Visit www.jonesoptical.co.uk
and click the tab
“Bespoke Recruitment”
Or call us on
0121 4550774
For Vacancies in your area . . .
call or email:
Tel: 01793 725200 (M) 07771 900229
email: info@mccartney-maxwell.com
www.mccartney-maxwell.com
FULL TIME
OPTOMETRIST
GREENOCK (Near Glasgow)
Excellent opportunity for a friendly, enthusiastic
Optometrist to join our large modern independent
practice. We are looking for applicants who have very
good interpersonal skills, and who like going the extra
mile to provide excellent customer service.
Benefits of working for Reid Mackellar Opticians
• Competitive Salary package plus Bonus
• Excellently equipped, modern, air conditioned
practice
• Friendly team of Optometrists, Dispensing
Opticians and Optical Assistants
• 30 / 40 Minute appointments
• Full Training provided
Please apply with full CV to: Campbell Mackellar
Reid Mackellar Optometrists, 86-90 West Blackhall Street,
Greenock, Inverclyde, Scotland, PA15 1XG, or e-mail your
CV to info@reidmackellar.co.uk Please visit our website.
www.reidmackellar.co.uk • Telephone 01475 721744
Practice For Sale
SW Sheffield
Well established practice for sale
due to retirement of owner.
Turnover £89,000 approx
Asking Price £45,000
Leasehold premises
Email: terminaleyes@hotmail.co.uk
Practice Wanted
PRACTICE
WANTED
Practice wanted in West of
Scotland. Please reply in
strictest confidence to:
fiona.optical@hotmail.co.uk or
call 01505 862722
optometrytoday
RECRUITMENT
If you would like to reach 20,203
professionals in Optometry Today and
an extra 10,000 on the Optometry Today
website please call 020 7878 2313
live
boo

Accounts
Over 20 years
working with
owners of
Independent
Opticians
• VAT issues
• Tax planning
• Succession strategies
• Valuation
• Accounts & payroll
Contact Marc Bennett
on 020 7433 6940
(or email mb@aelp.co.uk)
for a free copy of our special
report on "Practice valuations
and tax planning"
www.aelp.co.uk
WHERE TO BUY
Accounts
MORRIS & CO
CHARTERED ACCOUNTANTS
Ophthalmic MORRIS accOuntants & and CO advisOrs
• Vat (Including Partial CHARTERED Exemption) ACCOUNTANTS
• Business & Taxation Planning
• Locum and Practice Accounts
• Valuations
• Payroll Bureau
For A Free Consultation Contact Desirie Lea ACA on: 0151 348 8400
Email: specs@moco.co.uk Web: www.moco.co.uk
Chairs
MO
C O
Computer Systems
MO
C O
To place an advertisement call
020 7878 2313 or email haley.willmott@tenalps.com
Computer systems
Over 1000 independent UK opticians
use Ocuco software
Affordable software to suit Independent’s
budget and requirements:
Reception, Retail, Optometry
Imaging, Workshop
In-store or hosted remotely
Purchase, lease or rent
We have the solution, now is the time
PH: 0800 912 1004 info@ocuco.co.uk
*
Indicative, based on typical 5 year lease costs
SOFTWARE WITH VISION
See20/20
TM
From
only £55
per month *
Practice Perfection
Instant marketing
100701_OT Ad_Orange_Purple.indd 1 04/08/2010 15:04:11
The world’s first web-based, ophthalmic
practice management software
Appointment Booking
Patient Management
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Dispensing & Ordering
Sales: 0845 6120 141
Payments & Sales
Direct Debit Payment Manager
Text & Email Messaging
Business Intelligence Reporting
www.see2020.co.uk
55
10/12/10 WHERE TO BUY
Cases
Software made Simple
From £50 per month
Goldline Cases
Cases
was 35p
now Only 25p
Islington Large Leather Cases
Min Order Qty 400
now Only 28p
MF Cloths
from
was 55p
now Only 45p
Min Order Qty 250
Tel +44(0)121 236 4549 CBS
Min Order Qty 400
www.optisoft.co.uk 0845 2301230

Works like your eyes.
Easier on your eyes.
multi-purpose solution
Inspired by the
biology of your eyes
Contact your Bausch + Lomb sales representative or call customer services on:
0845 602 2350 1800 409 077
Email: orderline@bausch.co.uk | Order online: www.bauschonline.co.uk

WHERE TO BUY
Instruments
To place an advertisement call
020 7878 2313 or email haley.willmott@tenalps.com
Lens cleaning cloths
Tel : 01527 501077
Saving You Money
ONE ONLY
ZEISS
HUMPREY
720i FIELD
SCREENER
BE QUICK !!
CURRENTLY FOR SALE
EX-DEMO Frastema 3 INSTRUMENT COMBI UNIT
Frastema Traslatore Combi c/w 88AD chair
Meccanottica 9610 Combi c/w chair
Hanson Haag Streit style Slit Lamp 6-40x, 3DJ
Topcon SL2E Z style Slit Lamp 10-25x, 2DJ
Topcon OM4 Keratometer, 3DJ, internal read
Nikon OH303 Keratometer, 3DJ, internal read
EX-DEMO Nidek AFC210 Fundus Camera
EX-DEMO Nidek RT3100 Autophoropter
Henson 3200 Field Screener c/w table & Printer
Dicon LD400 Field Screener c/w table & printer
Keeler Pulsair EasyEye Tonometer
CALL US NOW ON 01527 501077
GOODS REFURBISHED UNLESS OTHERWISE STATED
with a six month parts & labour return to base warranty
Hanson Instruments, 8 Little Forge Rd, Redditch. B98 7SF
OPTICAL DOCTOR
Repair & Maintenance of ALL
Ophthalmic Instrumentation
Lenses
Practice fittings
mewscraft
optometrytoday
Practice fittings
57
10/12/10 WHERE TO BUY
online
ene
Specialists in
Optical Interiors
Optical instruments are at the heart
of your practice....
How healthy are yours?
A unique nationwide repair service
From a simple display to
a complete shop re-fit
info@mewscraft.com
www.mewscraft.com
Tel. 0845 643 9041
BiB Group
Holdings
Limited
Tel: 00 44 (0)1438 740823
Fax: 00 44 (0)1438 356093
Email: service@opticaldoctor.co.uk
optometrytoday
WHERE TO BUY
live
bookshop
CET
Marketing
advert .indd 1 10/09/2010 16:17
online
enewsletter
Practice fittings
VRICS
tv
1 0 0
9 5
7 5
2 5
5
0

WHERE TO BUY
To place an advertisement call
020 7878 2313 or email haley.willmott@tenalps.com
Practice fitting
58
10/12/10 WHERE TO BUY
Invest in a sales driven Store Graphics interior
with our exclusive low cost finance package.
Sales Driven
interiors
One-stop service
I N T E R I O R S I N O P T I C S
Contact us now for your free practice appraisal
01454 413 000 www.storegraphics.co.uk sales@storegraphics.co.uk
The UK’s Leading Practice Designers and Manufactures
“Nice People to deal
with and we found their
quote to be the
most competitive”
Designed Interiors and Bespoke Furniture
To discuss your options with one of our designers or
for a copy of our “Directory of Practice Design” phone: 01594 546385
The Style Design Company - www.style-design.com

Works like your eyes.
Easier on your eyes.
multi-purpose solution
Inspired by the
biology of your eyes
Contact your Bausch + Lomb sales representative or call customer services on:
0845 602 2350 1800 409 077
Email: orderline@bausch.co.uk | Order online: www.bauschonline.co.uk