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October 31 2014 vol 54:21
Winners of the AOP Awards 2014 are revealed
during a black tie gala dinner and ceremony
Charmant UK is celebrating its 20th anniversary
this month. OT speaks to the general manager
about how the company has developed in the UK
5 Celebrating the profession
6 Motorists ‘struggling’ to see
Over half of Britain’s 34 million motorists
struggle to see when driving after dark, a new
survey has found
7 Molecule allow brain to
rewire itself
Research findings could open new avenues
in the treatment of conditions such as
Alzheimer’s and amblyopia
8 TV CL warning
BBC Wales programme warns about the risks of
cosmetic contact lenses
News extra
10 Record breaking attendance
NOC’s Call to Action theme attracts biggestever audience
12 A good year for public affairs
The Optical Confederation’s public affairs team
shares some of this year’s highlights
Cover story
52 Binocular vision assessment
Andrew Millington provides an opportunity
for practitioners to test their binocular vision
competency with a range of images
24 Marking a milestone
Feature is online
14 Student news
15 Letters
16 Industry news
38 Diary dates/crossword
29 Urgent referrals
Community-based optometrist, Matthew
Jinkinson, discusses the urgent referrals made
by Stockport’s Minor Eye Conditions Service
32 Bringing definition to contact
OT speaks to Johnson & Johnson Vision Care
as it launches its new Define contact lens
37 Clinical roundup
OT reviews the latest offerings from websites
and apps to research papers
41 CET editor’s corner
OT ’s clinical editor, Dr Ian Beasley, offers an
overview of the latest CET
42 Chloroquine and
A look at the highlights of Specsavers’ celebritystrewn Spectacle Wearer of the Year Awards
46 Thyroid eye disease
19 Night of stars and specs
20 Eyeing up the frames
OT speaks to four eyewear companies that will
be exhibiting at 100% Optical 2015
23 Building for success
OT previews the National Eyecare Group’s annual
conference, which will be held next month
55 Jobs
The latest optical vacancies
58 Marketplace
A guide to optical products and services
26 Travelling care
Optometry undergraduate, Gemma Hill, shares
her experience of volunteering in South Africa
34 Changing dry eye management
OT reports on how TearLab is using osmolarity
as a biomarker for dry eye
36 Diversity at congress
Cover: Science Photo Library
Highlights from the British Congress of
Optometry and Vision Science
Super Optoms
31/10/14 CONTENTS
The first ever Alcon® Digital Consumer
Campaign created to raise awareness
about contact lenses and bring more
patients to your optical practices.
To find out more speak to your Alcon® Business Development Manager
or email [email protected]
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23/10/2014 15:36
Emily McCormick
[email protected]
THE WINNERS of this year’s AOP
Awards were revealed at a black
tie gala dinner and ceremony
which was attended by more
than 340 people last week
(October 23).
Held at the Hilton Metropole
Birmingham NEC, and hosted by
LBC radio presenter Julia HartleyBrewer, the annual Awards
recognise the achievements
of eye care professionals and
organisations which have gone
above and beyond the call of
Now in its fourth year, almost
26,000 votes were cast by the
profession and the public across
this year’s 11 categories.
Chief executive of the AOP,
Henrietta Alderman, said:
“The AOP Awards give us the
opportunity to celebrate the
extraordinary achievements of
the individuals and organisations
who give so much to the public
and the profession.”
“Congratulations to everyone
who was shortlisted for this
year’s Awards,” she added.
Optometrist Donald Cameron
was announced as the recipient
of the Lifetime Achievement
Award. Speaking about receiving
the accolade, Mr Cameron told
OT: “The nicest part is having my
chosen profession tell me that I
have made a difference during
my time as an optometrist.
“I feel really honoured and
privileged to find myself the
recipient of this prestigious
During the ceremony, the
AOP paid tribute to optometrist
Keith Holland with a Special
Recognition Award.
Mr Holland, who died earlier
this year, devoted his career to
improving children’s eye care
and establishing behavioural
optometry in the UK. Over 25
years, more than 20,000 children
were treated at Keith Holland &
Associates, the practice owned
by Mr Holland and his wife Clare.
Mrs Holland said: “We, as a
family, and the practice team,
who have pulled together so
fantastically since we lost Keith,
knew how special he was. It was
unexpected to have his unique
contribution recognised by the
profession as a whole. Thank
For more information, visit
Westminster eye health focus
THE VOICE of the optical sector
was had heard in Westminster
last week (October 20), as
representatives addressed MPs
at a meeting of the all party
parliamentary group (APPG) for
eye health and visual impairment.
Chaired by Lord Low of
Dalston, the APPG heard the
sector’s response to the recent
consultation from NHS England:
Improving eye health and
reducing sight loss – a call to
David Parkins, president of the
College of Optometrists, said:
“We can better manage capacity
and access right along the eye
care pathways by fully utilising
the skills of all the clinicians and
professionals in the pathway.”
Reviewing the year’s activities,
Lord Low said the group had
expanded its direct engagement
through legislation such as the
Care Bill and the Children and
Families Bill.
Lord Low highlighted the APPG’s
work with the RNIB and Ofcom to
make TV guides fully accessible
to visually impaired people, as
well as its work with the APPGs on
learning disabilities and dementia.
The APPG comes in the same
week that NHS England published
its Five Year Forward View (
ZL7pqo), which proposes ‘drastic
changes’ and looks to deliver more
services in an ‘out of hospital care’
David Hewlett, speaking
on behalf of the Optical
Confederation, said: “The APPG
has made excellent progress in
recent years in joint working with
other APPGs on older age, learning
disabilities and other disabilities.
Sensory impairment has a major
role to play in all these areas. It was
also good to have two very clear
perspectives on the Call to Action
pointing the way forward for
more care, safely delivered outside
hospital and in the community.”
To comment go to
Ebola advice
The AOP and the College of
Optometrists have released joint
advice for practitioners around
Ebola haemorrhagic fever.
Ebolavirus is extremely infectious
and is just one of the causes of viral
haemorrhagic fever, which causes
a characteristic viral fever with
diarrhoea and vomiting, and in
extreme cases, bleeding.
The joint statement advises
that if practitioners are contacted
by a patient who has fallen
unexplainably ill after visiting an
area affected by Ebola, they should
advise the patient not to visit the
practice but to attend their GP or
walk-in centre.
The full advice can be found on
the AOP website.
Money back offer
Optical Express has introduced
a money back guarantee for all
patients who undergo laser eye
surgery with the multiple.
Following a pilot study
last year, Optical Express has
pledged to offer patients a full
refund if they do not achieve
20/20 vision, or better.
During Optical Express’ trial
last year, thousands of patients
took advantage of a similar
offer and were treated with
iDesign iLASIK laser eye surgery.
Of those who underwent the
procedure, 0.1% who were
treated did not achieve 20/20
Vision 2020 chair
Nigel Clarke has been appointed as
chair of Vision 2020 UK, replacing
Nick Astbury, who stood down
from the role last month.
Mr Clarke has a background in
the healthcare and charity sector,
and is currently chair of the General
Pharmaceutical Council, as well as a
trustee of Partner Africa.
Commenting on his
appointment, Mr Clarke said: “The
potential for VISION 2020 UK as an
organisation really captured my
imagination, and I am so pleased
and excited to commence my new
role as chair.”
31/10/14 NEWS
Achievements of the
profession celebrated
Kirk & Kirk
wins award
31/10/14 NEWS
British eyewear
designers Jason and
Karen Kirk are celebrating after
winning gold in the prestigious
Hall of Frames Newcomer Award in
Stuttgart with their new company,
Kirk & Kirk.
The specific frame entered in the
competition was ‘Curie’ (pictured)
from Kirk & Kirk’s Vivarium collection.
“It is a great honour,” said Mr Kirk.
“The German and Swiss opticians
are among the best in the world
so for them to acknowledge our
work in this way is a great honour
and validation of a whole year’s
Bono has glaucoma
The frontman of Irish pop-rock
band U2, has admitted he wears
sunglasses indoors due to light
sensitivity caused by glaucoma.
Bono, 54, made the admission
while appearing on the Graham
Norton Show on BBC1, earlier this
month (October 17).
When host Graham Norton
quizzed the front man on his
‘trademark’ habit of wearing
sunglasses indoors, the singer
admitted: “This is a good place
to explain to people that I’ve had
glaucoma for the last 20 years. I
have good treatments and I am
going to be fine.”
Professor Whitaker
honoured by AOP
Professor David Whitaker has
been awarded an honorary life
membership of the AOP.
Retiring as senior vice president
of the Association, he was presented
with the accolade by chief executive
of the AOP, Henrietta Alderman, and
chairman of the AOP, Lyndon Taylor,
on Tuesday (October 28).
Professor Whitaker took up the
position of vice president of the
AOP in 2005, an appointment which
made him the Association’s first,
and only, academic vice president.
Appointed for another term in 2010,
Professor Whitaker became senior
vice president in 2012.
Over 50% of motorists
struggle with night driving
Emily McCormick
[email protected]
OVER HALF of Britain’s 34 million
motorists struggle to see when
driving after dark, while many
avoid driving at night altogether,
a new survey has found.
Commissioned by the Eyecare
Trust, in partnership with
insurer Westfield Health, 25% of
motorists questioned admitted
to having trouble focusing at
night, with 43% saying things
“looked blurred” when driving
after dark.
Released at the end of British
Summer Time as the clocks
went back, the results show
73% of drivers said that they had
experienced visual discomfort
from the glare of oncoming
The statistics highlighted in
the new survey show that it is
not surprising that more road
accidents occur at night than
during the day. In a three-year
study by insurance company
Zurich Connect, it was found that
road accidents increased by 11%
in the fortnight after the clocks
go back, when compared to the
previous two weeks.
Chair of the Eyecare Trust, Kelly
Plahay, explained: “Low light
levels at night cause the pupil
of the eye to become larger
and this can accentuate any
focusing errors – no matter how
minor – causing blur. At night it’s
therefore more important than
ever to wear a pair of spectacles
or contact lenses with an up-todate prescription.”
In addition, the survey found
that 31% of motorists refuse
to drive at night, while older
people often find night driving
particularly stressful.
Sight loss survey launched
THE CHARITY Fight for Sight
has launched a survey which
will assess the impact that
its research funding has on
people with sight loss.
The Fight for Sight Vision
Impact Survey (VIS) aims to
monitor when and how new
treatments for eye disease
reach the people who need
them and is established
one year after the charity’s
Sight Loss and Vision Priority
Setting Partnership (SLV-
PSP) which identified areas of
research which matter the most
to those with eye conditions.
A total of 2,220 people took
part in the SLV-PSP last year
which asked patients, eye
health practitioners and carers
to respond to questions about
the prevention, diagnosis and
treatment of sight loss and eye
conditions which they want
Following the publication of
the SLV-PSP results, Fight for
Sight has awarded over £3m to
46 projects which have worked
to directly address 10 of the 12
categories identified.
The VIS, which will be
performed annually, will
monitor the effect of the grants
awarded by Fight for Sight, and
other funding bodies, to find
out how closely new clinical
trials, tests and treatments
match the priorities set out in
the SLV-PSP.
Insight into community services
A PILOT project from the UK Vision
Strategy has revealed insights into
delivery improved services and
outcomes in local communities.
The Commissioning for
Effectiveness and Efficiency
(CCE) two-year project which
concluded last month, found that
delivering the services is ‘complex
and requires close collaborative
working, extensive patient
engagement, leadership, and an
evidence-based whole systems
The pilot worked with clinical
commissioning groups (CCGs)
in Bedfordshire, Gateshead, and
South Devon and Torbay to
develop sustainable collaborative
commissioning of services for eye
health and sight loss.
David Hewlett, speaking for the
Optical Confederation, of which
To comment go to
the AOP is a founding member,
said: “The CEE approach has been
very successful in promoting a
patient-centred, evidence-based
and collaborative approach to
commissioning and delivering
effective, efficient and integrated
services. We are now working to
finalise the lessons from across
the three sites to assist other
localities and specialisms wider
than eye health.”
Ryan O’Hare
ryano’[email protected]
BLOCKING KEY receptors in the
brain can enable it to rewire
itself and form new connections,
even after critical developmental
windows have closed. The
findings, from a US study, could
open up new avenues for
treating a range of conditions,
from Alzheimer’s to amblyopia.
During its development, the
brain goes through windows of
functional rewiring, in which new
connections between brain cells
can be formed. But this ability is
restricted in adulthood.
Scientists at Stanford
University in California,
discovered that a protein
receptor found on the surface
of brain cells, PirB, acts as an
‘on/off’ switch for the process.
Alzheimer’s eye
test funding
University of Dundee are set to
explore how a simple eye test
could be used to detect early
signs of dementia.
Working with the University
of Edinburgh, a team at
Dundee have developed
software which will analyse
thousands of images of the
eye, to measure a number of
small changes in ocular blood
vessels, which might indicate
important changes in the brain.
The project’s coordinator,
Professor Emanuel Trucco,
said: “There is the promise of
early warning in a non-invasive
way and there is also the fact
that we might even be able
to use the test to differentiate
between different types of
dementia.” The three-year
project is part of a larger £8m
package of funding from the
Engineering and Physical
Sciences Research Council.
In adulthood, proteins bind to
PirB, leaving it jammed in the
‘off’ position in order to stabilise
and maintain the brain’s existing
Flooding the brains of mice
with a ‘decoy’ version of PirB,
which mopped up the proteins
which would otherwise bind
to the PirB on the cell’s surface,
enabled the cells to form new
functional connections, even in
adult mice treated for as little as
one week.
Mice with one eye covered
during key developmental stages
could not see from that eye once
it was uncovered, as connections
in the visual cortex of their brains
failed to form. However, when
they received doses of the decoy
molecule, their brains were able
to adapt and ‘rewire’ to deal with
visual input from the previously
covered eye, partially restoring
Senior author on the paper,
Professor Carla Shatz, said: “This is
amazing because what this says
is that it is possible to induce
new synapses in adult brains.”
The research is published in
Science Translational Medicine
Over 80% wear
wrong frame size
EIGHT OUT of 10 spectacle wearers
in the UK and US wear a poorly
fitted frame, according to a study
performed by bespoke eyewear
company, Atelier Eyewear.
Performed through the
company’s website, the survey
asked specific visitors to submit
the measurements of their
current frame. They were then
measured by Atelier’s proprietary
measurements software UltraTool,
which provides accurate 3D scans
of the face and cranial features
The survey found that six out
of 10 people are wearing a frame
which has a bridge that is too tight,
while 65% are wearing a frame
which is too wide. Furthermore,
71% of spectacles wearers are
wearing a frame with temples
which are too short.
CEO of Atelier Eyewear, Tim de
Rosen, said: “Finding eyewear that
fits can be a real challenge.
“People sometimes choose a
certain style and base their decision
on the style rather than the fit.
That’s not the best decision for
them in the long term because
comfort and fit are by far and away
the most important aspects to
consider when buying eyewear.”
To comment go to
Uveitis MS link
Nearly 60% of patients with multiple
sclerosis (MS) and uveitis were
diagnosed with each condition
within five years, according to a large
retrospective study.
Data from over 8,000 patients
between 1985 and 2013 show that
MS was 18 times more likely to occur
in Americans with uveitis and 21 times
more likely in Europeans with uveitis,
than in those without the condition.
MS was diagnosed in 29% of
patients before uveitis, simultaneously
in 15% of patients, and after uveitis in
56% of patients.
Optom students in
Zambia project
Three UK optometry
undergraduates have provided
eye care in Zambia with Vision Aid
Overseas, in partnership with the
annual Irvine Aitchison Memorial
Fund (IAMF) bursary and the
Wiseman Memorial Fund.
Holly Higgins, Gemma Gould
and Muhammad Vali spent two
weeks in Lusaka, Zambia, to
provide refraction and dispensing
services through an outreach clinic.
More than 1,800 people
attended the clinic, with
the majority given free eye
examinations and spectacles.
A total of 90 optometry
undergraduates applied for the
three bursary places, which are
offered annually.
Google Glass addiction
A US man has become the first case of
diagnosed ‘internet addiction disorder’
relating to Google Glass.
Doctors report that the man began
to suffer withdrawal symptoms
without the device, after using it for up
to 18 hours a day, only removing it to
wash and sleep.
A study published in Addictive
Behaviours ( details
how the 31-year-old told councillors
that withdrawal symptoms were
“much worse” than withdrawing
from alcohol. When prevented from
wearing the device at work the man
would reportedly “become extremely
irritable and argumentative.”
31/10/14 NEWS
Decoy molecule allows
brain to ‘rewire itself’
TV warning over
Halloween CLs
Robina Moss
[email protected]
31/10/14 NEWS
CONTACT LENS practitioner, Loveleen
Browes, warned of the dangers of cosmetic
lenses in an interview with BBC Wales last
Ms Browes was interviewed for the
popular consumer rights programme,
X-Ray which ran a piece in the lead up to
Halloween about the increase in sales of
unlicensed cosmetic contact lenses.
Filming at her clinic in Neath, Port Talbot
Hospital, Ms Browes spoke to presenter Lucy
Owen (pictured right), with the BBC team
spending an afternoon with Ms Browes in
her clinic.
Ms Browes, an optometrist, has two
practices in Burry Port and Swansea,
covering all of Carmarthenshire, South Wales.
Speaking after the filming, Ms Browes said:
“Speaking on this programme will hopefully
highlight the importance of using primary
care contact lens practitioners for advice
before purchasing over the counter and
online zero powered lenses.”
Ms Browes added: “We are seeing in practice
an increasing number of acute eye care
presentations where members of the public
are not aware of the dangers of using these
lenses without following proper advice.”
Chief executive of Optometry Wales, Sali
Davis, said: “This was a great opportunity to
educate the public about the dangers of
wearing zero powered lenses and the role
that the primary care community practitioner
can play in raising awareness and helping to
prevent bacterial and other eye infections.”
The programme aired on BBC Wales on
Monday (October 27) at 7.30pm and is now
available on BBC iplayer.
Ceremony celebrates
professional success
OPTICAL TECHNICIANS and practice support
staff who passed examinations set by the
Worshipful Company of Spectacle Makers
(WCSM) this year were presented with
their certificates and prizes at a prestigious
ceremony in London last week (October 20).
The ceremony was attended by 116 people
and was held in the oldest complete livery
hall in the City of London, Apothecaries’ Hall.
It included the admission of 20 applicants into
the freedom of the WCSM.
Those admitted to the freedom of the
company at the event included Alan Tinger,
executive chairman of the LOC Support Unit,
(pictured with the new master of the WCSM,
Dr Christine Tomkins). Ian Humphries, deputy
chief executive at the College of Optometrists
and optometrist Dr Scott Mackie of the
General Optical Council were also admitted.
Others known in optics included Michael
Crossland, specialist optometrist in low vision
rehabilitation at Moorfields Eye Hospital,
Professor Joshua Silver of the Centre for Vision
in the Developing World in Oxford, orthoptist
Professor Anita Simmers of Glasgow
Caledonian University, eyewear designer
Jesse Stevens and Guy Wrench, principal
at exhibition stand system company, WMO
IN RECENT years,
the celebration of
Halloween seems
to have grown
in popularity.
Supermarkets stack
their shelves with
wicked treats and
ghoulish costumes, and TV channels fill
the airwaves with fright-fest movies.
One area that continues to see an
increase in sales is that of unlicensed
cosmetic contact lenses. Sounding a
cautionary note, this week the BBC Wales
consumer rights programme, X-Ray, spoke
to an optometrist, Loveleen Browes, who
stressed the importance of using primary
care contact lens practitioners for advice
before purchasing over the counter and
online zero-powered lenses, as well as
raising awareness to help prevent eye
infections (see opposite).
One company looking to challenge
perceptions in the UK about contact lenses
and their use is Johnson & Johnson. Speaking
exclusively to OT this week about the launch
of 1-day Acuvue Define contact lenses, J&J
managing director for the UK and Ireland, Dr
David Hall, explained why the timing is right
to launch a new concept of vision correction,
backed up by robust research (page 32).
Recognising in frank terms how coloured
lenses “have at times been negatively
received because they haven’t always worked
as well as people would have hoped,” Dr Hall
explained to OT that “bringing out a product
which enhances the natural beauty of the
eye embraces one of the first moments of
truths as to why someone would try contact
lenses – to improve their appearance.”
Also in this edition, OT revisits a
symposium from TearLab to find out how
the company is using osmolarity as a marker
for dry eye, and what this might mean in
terms of managing the condition in the
community (page 34). Plus, we hear from
the Optical Confederation’s public affairs
team, who have had a busy autumn at the
party conferences, including successful
introductions with Secretary of State for
Health, Jeremy Hunt, and Shadow Secretary
of State for Health, Andy Burnham (page 12).
With last week’s AOP Awards (page
5) and the National Optical Conference
(page 10) still fresh in the mind, OT has the
lowdown from both events – and look out
for the full reports in the next issue.
John White, OT managing editor
[email protected]
To comment go to
Contact lens lubricity comparable
to the cornea,1 to help prevent that
tired eye feeling2
Ultra-smooth surface
Low coefficient of friction
Representation of random interior lens section
HYDRACLEAR® PLUS: built-in wetting agent
Wetting agent
UV blockers
Representation of random interior lens section
-2.75 CYL
now available
ACUVUE® OASYS® with HYDRACLEAR ® PLUS is now shown to
have lubricity (coefficient of friction) comparable to the cornea.1
With such exceptional lubricity, the eyelid can glide easily over
the ultra-smooth surface, helping to keep your patients’ eyes
comfortable and free from feeling tired throughout the day. 2
To learn more, visit
All ACUVUE® Brand Contact Lenses have Class 1 or Class 2 UV-blocking to help provide protection against transmission of harmful UV radiation to the cornea and into the eye. UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing
eyewear such as UV-absorbing goggles or sunglasses because they do not completely cover the eye and surrounding area.
*The coefficient of friction (CoF) of the human cornea is 0.015; the CoF of ACUVUE ® OASYS ® is 0.010. The CoF of ACUVUE ® OASYS ® out of the package is not statistically significantly different from the human cornea (p=0.206), using t test on least-square means from the linear mixed model
and adjusted for multiplicity.
1. Wilson T et al. Comparison of Frictional Behavior of Human Corneal Tissue and Silicone Hydrogel Contact Lenses. BCLA Conference Poster Presentation 2014. 2. Sulley A et al. Large scale survey of senofilcon A contact lens wearers. Optom Vis Sci 2012 E-abstract 125443.
ACUVUE®, INNOVATION FOR HEALTHY VISION™, ACUVUE® OASYS® and HYDRACLEAR® are trademarks of Johnson & Johnson Medical Ltd. © Johnson & Johnson Medical Ltd. 2014. Johnson & Johnson Vision Care is part of Johnson & Johnson Medical Ltd.
4672 OASYS SMOOTH AD A4.indd 1
03/10/2014 15:32
Journal of the Association of Optometrists
OCTOBER 31 2014 VOLUME 54:21
ISSN 0268-5485
Record-breaking NOC
Emily McCormick
[email protected]
January 1 2013 – December 31 2013
Average Net: 21,145
UK: 20,625 Other countries: 871
31/10/14 NEWS EXTRA
community optometry in
supporting the new primary
Managing Editor: John White
care strategy of the NHS was
T: 020 7549 2071
E: [email protected]
highlighted at the National
Optical Conference (NOC) last
Deputy Editor: Robina Moss
T: 020 online
7549 2072
week (October 23–24).
E: [email protected]
With the timely Call to Action
Assistant Editor: Ryan O’Hare
theme of the annual conference,
T: 020 7549 2078
E: ryano’[email protected]
a recurring message which
featured prominently during the
Web Editor: Emily McCormick
packed two-day programme was
T: 020 7549 2073
E: [email protected]
how the optical sector must build
Multimedia Editorial and
on the Call to Action by working
Production Assistant: Jack Cochrane
in partnership with the primary
T: 020 7549 2074
care sector to establish and
E: [email protected]
deliver workable solutions.
Clinical Editor: Ian Beasley
A record-breaking number of
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were in attendance to
Multimedia Editor: Laurence Derbyshire
listen to speakers from across the
T: 020 7549 2075
E: [email protected]
health care sector was. Over 220
Multimedia Creative Editor: Ceri Smith-Jaynes
attended the event, more than
E: [email protected]
ever in the NOC’s history.
Advertising: Haley Willmot
Reflecting on delegate
T: 020 7657 1805
numbers, managing director of
E: [email protected]
the LOC Support Unit (LOCSU),
Design: Juanita Adu
Katrina Venerus, told OT: “The
fact that we had more delegates
CET enquiries:
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than ever before at this year’s
E: [email protected]
NOC, bringing a wide range
Bookshop enquiries: Kudzai Muronzi
of experiences and views,
T: 020 7549 2012
reflects the huge appetite that
E: [email protected]
exists among optometrists and
Production: Ten Alps Creative
opticians for playing a wider role
T: 020 7878 2323
in delivering NHS eye services.”
E: [email protected]
AOP Membership Dept:
AOP, 2 Woodbridge Street, London, EC1R 0DG
T: 020 7549 2010
Advertising and Production Office:
Ten Alps Creative, Commonwealth House, One
New Oxford Street, High Holborn, London
Published fortnightly for the Association of
Optometrists by Ten Alps Creative
Abacus eMedia, Bournehall House,
Bournehall Road, Bushey, Herts, WD23 3YG
T: 020 8950 9117
E: [email protected]
UK £130, OVERSEAS £175 for 24 issues
Calling for action
Taking to the stage for the
keynote address was national
primary care strategy lead for
NHS England, Taryn Harding,
who shared an early insight into
the recurring themes which
have emerged during the
organisation’s analysis of the
Call to Action. These included:
a lack of integrated IT systems,
frustration when developing
pathways, the better utilisation of
skillsets, a review of the general
optical services (GOS) contract
and the perceived accessibility of
a sight test.
During her talk, Ms Harding
reassured delegates that these
themes would be central to the
new approach of the NHS, which
would involve a partnership that
allows for radical change through
the building of primary care
services at scale.
Admitting that the profession
would no doubt face challenges
during the change process, Ms
Harding advised that: “Good local
relationships will get you through
the challenges.”
Confirming that NHS England
received over 400 responses from
the optical sector during the Call
to Action consultation, one of
the highest of all four calls, “this
shows an enthusiasm from the
profession for change,” she said.
While Ms Harding informed
the audience that the real value
of the Call to Action will be in
the work which is taken forward
as a result of the consultation
process, she explained that the
next steps would be to formally
respond to the Call in the
coming months.
“When we respond, we need
to show you that we have
listened seriously and that
we are taking you seriously as
eye health professionals,” she
As the fourth of NHS England’s
Call to Action, representatives
from general practice, dentistry
and pharmacy were on hand
to share their experiences and
To comment go to
advice with the optical sector.
Discussing their experiences,
GP and ophthalmology lead
for Gloucestershire clinical
commissioning group (CCG),
Dr Graham Mennie (pictured)
advised, “keep it simple and
make it deliverable,” while chief
executive of Pharmacy Voice,
Professor Rob Darracott said: “We
are certainly more aggressive
about where we want to be and
what we will do next.”
For Ms Venerus, the key
take home message from
the conference for delegates
was that: “At last the NHS has
acknowledged that it needs to
change, and just as important,
the community optical sector is
ready and willing to play its part
in providing more ‘out of hospital
care’ along with our colleagues in
general practice, pharmacy and
Reflecting on the next steps, Ms
Venerus confirmed that LOCSU
and the Optical Confederation
will work in partnership with
representatives from general
practice, pharmacy and dentistry
to hold NHS England to account
“in terms of creating some action
out of the Call to Action.”
Ms Venerus added: “NHS
England has called for it, we have
told them what to do and now we
need to help them to do it.”
• NOC2015willbeheldatthe
Hilton Birmingham Metropole
Hotel on November 5–6.
Introducing DAILIES TOTAL1®
The first and only water gradient contact lenses
In April 2013, Alcon launched
DAILIES TOTAL1® in the UK: the
first and only water gradient
contact lens. They’re being
heralded as ‘a new era in contact
lenses and a new era in comfort’.
So what is the DAILIES TOTAL1®
difference? And do they live up
to the hype? We asked some of
the UK’s leading independent
optometrists to share their
experiences following the global
evaluation study and in their
day-to-day practice.
Unlike any other lens available today,
DAILIES TOTAL1® water gradient
contact lenses graduate from 33%
water at the core to over 80%† at the
surface – approaching 100%† water
at the very outer surface. Through
this dramatically different core and
surface water content, Alcon has
created a contact lens that combines
high oxygen transmissibility for
healthy looking eyes with a highly
lubricious surface for exceptional
comfort which lasts to the end of
the day.
That’s the theory – but what about
in practice? Two independent
optometrists tell us what they think:
The nearest we
have had to
the holy grail.
The response
from patients
has been
9 out of 10 had the ‘wow factor’
compared to whatever they wore
before. And the tenth came back
three months later and said ‘I was
wrong, I should have said wow!’
The feedback was that from initial
insertion, they could hardly feel a
lens... And there were comments
saying ‘just the best ever’ and
definitely not wanting to go back
to their previous lenses. It’s a great
feeling to have that type of response
from patients.
The holy grail of a lens is comfort
that is the same as, or better than,
not wearing a lens. DAILIES TOTAL1®
contact lenses give us the nearest
we have had to that holy grail – and
that, to me, is exciting for the future.
From the level of success we’ve
had with DAILIES TOTAL1® contact
lenses, all patients will benefit from
So to any practitioner, I would say this
is the best lens we have had in our
armoury. Try them – you will see the
the chance to
wear contact
lenses again.
The major
feature, and
what makes DAILIES TOTAL1®
contact lenses so unique, is the water
gradient platform: the comfort that
patients will get with this lens and,
at the same time the high oxygen
Patients described the lenses as
‘soft’ – they had a soft, silky feeling.
Another patient said they felt ‘light on
her eyes’; it felt as if she didn’t wear
anything on her eyes. And a third one
said ‘very comfortable’.
Two of my patients couldn’t wear
their lenses for a long period of time.
At the end of the trial period, they
could wear DAILIES TOTAL1® contact
lenses for up to 10 hours a day!
They had trialled most of the
available daily disposable lenses
before they tried DAILIES TOTAL1®
contact lenses, so that feedback was
the best for me as a practitioner –
giving a patient the chance to wear
contact lenses again.
Gergana Dobson, Reading
Ian Chalmers, Cardiff
To find out more about DAILIES TOTAL1®
water gradient contact lenses, visit
† In vitro measurement of unworn lenses, Alcon data on file, 2011.
9935 © 2014 Novartis AG. DAILIES TOTAL1, the DAILIES TOTAL1 logo and the
Alcon logo are trademarks of Novartis AG.
9935-Alcon-water-gradient-testimonial-1pp.indd 1
23/10/2014 15:35
A good year for public affairs
The Optical Confederation’s deputy head of public affairs, Ben Cook, provides some of the year’s
highlights from the Public Affairs team
31/10/14 NEWS EXTRA
WITH A general election on the horizon
(May 2015), the Public Affairs team has been
busy throughout the year engaging with
ministers, shadow ministers, parliamentarians,
prospective parliamentary candidates,
councillors and primary care organisations, in
order to ensure that the role of community
optometrists and opticians is heard and well
understood in the public policy making arena.
One of the larger functions this year has been
helping the optical sector to submit strategic
responses to a range of consultations from
Government departments, NHS England,
select committee inquiries and relevant
agencies, such as the National Institute for
Care and Excellence. Over 25 responses have
been submitted so far this year, on subjects
ranging from NHS England’s Five Year Forward
View ( and the Calls to Action, to
the General Optical Council’s Strategic Plan for
the next three years.
Party conference season
This autumn, the Public Affairs team joined with
colleagues from the British Dental Association,
Pharmacy Voice and the National Community
Hearing Association to host an exhibition
stand at the Labour and Conservative party
conferences. Together, the coalition pushed
the key message that primary care comprises a
much wider healthcare workforce than just GPs,
and that the skills and expertise of professions
such as opticians, dentists, pharmacists and
audiologists are currently under-utilised by the
From the stand, visitors were able to view
the LOC Support Unit (LOCSU) interactive
Atlas of Optical Variation (
and community eye care briefings for each
constituency in England were available
and proved popular with MPs, prospective
parliamentary candidates and councillors.
The Public Affairs team met with a number of
ministers and shadow ministers, including the
Secretary of State for Health, Jeremy Hunt, and
the Shadow Secretary of State for Health, Andy
Burnham. One-to-one meetings were also
held with MPs at the Liberal Democrats’ party
conference and with the Special Adviser to
Public Affairs team at the Conservative Party conference (from left to right): Mike Hewitson, Pharmacy Voice;
Jenny Gowen, Optical Confederation; Iain Duncan-Smith MP; Jakob Stenkvist, National Community Hearing
Association; and Harjit Sandhu, National Community Hearing Association
the Secretary of State for Business, Innovation
and Skills.
Follow up activities from the conferences
are well underway, including MP visits to
local optical practices, and meetings in
Westminster, with a member of the House of
Commons Health Select Committee, and the
team is providing support to Councillors who
were keen to work with their Local Optical
Committees (LOCs).
Local influencing
Throughout the year, the Public Affairs team
has supported LOCs across the country to
organise visits for MPs to local optical practices.
A total of 19 MPs have visited a local practice,
to date, including the Minister of State for Care
Services, Norman Lamb and the Secretary of
State for Northern Ireland, Theresa Villiers.
Many of these visits resulted in the MP
writing to the local Clinical Commissioning
Groups and Health and Wellbeing Boards
encouraging uptake of local enhanced eye
care services (community services), tackling
barriers to better integrated eye care services
and ensuring eye health is kept high on the
agenda. Further information on MP practice
visits, can be found by visiting the OC website
While in Parliament, the team has been
tracking and briefing OC colleagues on lots of
Parliamentary legislation, including the Small
Business Bill, the Consumer Rights Bill and the
Deregulation Bill.
Henrietta Alderman, chief executive of the AOP
“This year the public affairs team, who are the glue within the
Optical Confederation, have been consolidating relationships both
with our primary care colleagues and, importantly, with decision
makers. They have met, communicated with and set up meetings
with parliamentarians on national issues affecting the eye health
agenda and at local level with practice visits.
“Whichever party (or coalition of parties) is successful in 2015, we can be
confident that there will be key players within them who have an understanding
of the major eye health themes and of the valuable, but under-utilised, expertise
of optometric practice in the community.”
To comment go to
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Affordable Innovation
Film competition launched
THIS YEAR’S AOP Film and Television Award
(AFTAs) competition has been launched.
Hosted annually, the competition calls on
optometry undergraduates from across the
UK to create an entertaining video, between
three to five minutes in length, which
encourages students to consider optometry
as a possible career option.
The winner will be revealed at the AOP
student ‘Eye Opener’ conference at Center
Parcs’ Sherwood Forest resort next month
(November 22–23).
Now in its seventh year, the AOP student
conference offers undergraduates from
all nine UK-based university optometry
departments the opportunity to learn more
about the career options available to them
once they qualify, as well as tips on how to
apply for their pre-reg placement.
The event will combine education with the
opportunity to network and a gala dinner,
during which the AFTAs winner will be
Judging the AFTAs is the AOP’s head of
professional development, Karen Sparrow,
OT managing editor, John White, OT
multimedia creative editor, Ceri SmithJaynes, and OT multimedia editor, Laurence
Derbyshire (pictured).
Last year’s winner was the University
of Bradford which produced a David
Attenborough spoof. All of last year’s entries
can be watched at
This year’s entries must be uploaded to
YouTube and the link emailed to Ms SmithJaynes at [email protected]
by November 15.
For more information on the student
conference, visit
Glasgow Cal has a ball
Glasgow Caledonian
University have raised
£850 for Optometry
Giving Sight.
The money was raised
through a raffle at the
students’ annual Eye
Ball, which was held
this year at the Marriott
Hotel in Glasgow.
Attended by 160
and orthoptics
prizes in the raffle
were donated by
Keeler, Louis Stone
and Optical Express.
Student and Eyeball
organiser, Ruth Locke, told
OT: “We all decided that
OGS would be a wonderful
charity to donate money
Thank you!
to, as many of our optometry
students have been
providing sight care in
South Africa over the
summer, so it was all for a
cause we care deeply about.”
to all the students who have recently
attended the specsavers careers presentations.
we look forward to your applications.
OT student rep,
Karan Vyas,
discusses the
The eyes have it
column is all about
the website, The eyes
have it,
With content authored by University of
Michigan ophthalmologist, Jonathan D.
Trobe, the interactive website covers the
pathology of the eye and is useful for
optometry students across all three years
of study (four in the case of Glasgow).
Divided into two parts, the website
features a learning area and a quiz area.
The learning area is further split up
into multiple sections which explore
everything from the structure of the
eye, to diseases of the eye, including the
pathology of the ocular nerve head, red
eye, the side effects of systemic drug use
and congenital diseases.
The site explains the aetiology of each
disease, as well as possible treatment
options in a simple and concise way
which makes it easy to understand. It
also uses a variety of tools to explain
pathological changes, through the use of
images and diagrams, to create an easier
way to learn.
The quiz area of the site includes
the same sections as the learning area,
however, it tests the user on each area,
including multiple choice and case record
In addition to the site is The eyes have
it app, Although only
available on iOS (Apple), the app covers
many of the diseases which feature on
the website, as well as some additional
narrated animations.
Overall, despite its dated look, the
information available is a great resource,
especially when learning about
Demodex blepharitis
Dr Ian Beasley, OT clinical editor, optometrist
31/10/14 LETTERS
Many will have read the popular CET articles relating to
blepharitis management which featured in OT earlier in the
year, Blepharitis, but not as you know it (February 28, 2014)
and Demodex – at the root of the problem (August 1, 2014).
Both articles discuss the management of Demodex
blepharitis using tea tree oil (TTO) but go on to state that
this preparation is toxic to the ocular surface. Further
guidance from the authors’ stress that the procedure
should only be undertaken by experienced practitioners
and that care must be taken to avoid getting any oil into
the eye.
Gillian Bruce, CET author of Blephartis, but not as
you know it, commented: “It is important to raise
awareness of this less well known cause of blepharitis
amongst practitioners and that treatment of cases can
be undertaken by optometrists in practice.” However,
she stressed: “Treatment with tea tree oil is toxic to the
cornea and should only be undertaken by experienced
practitioners who are comfortable dealing with the
potential side effects of toxic keratitis.”
OT would like to reiterate this advice to practitioners and
also direct them to updated guidance by the College of
Optometrists on using TTO to treat Demodex blepharitis.
Within the guidance, the College states that: “Great care
is needed in the use of strong preparations of TTO so that
only lid tissue is treated, and afterwards the lid margins
should be carefully wiped with dry cotton buds in order to
remove residual TTO,” (
CL plant milestone
Global contact lens manufacturer CooperVision
has completed its latest phase of growth and
investment with the completion of a new 31,000 sq ft
manufacturing plant in Hampshire.
To mark the completion of work on the
building’s shell, a small opening ceremony was held
earlier this month (October 3) with a presentation
and the unveiling of an official plaque.
The site was acquired by CooperVision in March
of last year and required extensive renovation to
turn the old warehouse into a state-of-the-art
manufacturing facility. Production is scheduled to
commence during 2015.
Pictured is CooperVision’s executive vice president
of global operations, Fernando Torre, far left, with
the central engineering and facilities director for the
UK, Mark Foss, second left, and members of the new
plant’s senior management team.
RGP campaign
No7 Contact Lenses is encouraging rigid gas
permeable (RGP) lens wearers to consider regular
replacement of RGP lenses through its ‘Lenses for
Life’ planned replacement system. A set of printed
materials for wearers has been designed to be sent
out with patient reminder letters. They include a
reminder of the importance of regular contact lens
No7 is encouraging practitioners to participate in
the initiative by offering up to 30% upfront savings
on a wide range of contact lenses if a practice
registers patients onto its planned replacement
system before the end of the year.
Turning eyes
into art
STANDS WHERE people can have their own iris turned
into a piece of abstract art have been popping up at
practices and optical events around the country in the
last few months.
A new company, EyeConArt, recently launched in the
UK after a successful pilot in Asia. The company uses its
own technology to take a close-up photograph of the eye,
which it then edits to enhance the iris, showing its patterns and
vibrant colours. The image can be printed, enlarged and shared online.
EyeConArt founder, Jay Scott-Nicholls, told OT: “People
are always fascinated to get a look at their own
eye. One practice hired us to shoot the eyes of
their staff and then frame them as gifts to
celebrate its 10th birthday. Another had us
set up in the practice to shoot all their
customers for a week and create a huge
collage for their wall.”
CL extension
for astigmats
JOHNSON & JOHNSON Vision Care (J&J) has
introduced an additional toric cylinder of
2.75DC for Acuvue Oasys for Astigmatism.
The new toric range now has sphere powers
from -9.00DS to +6.00DS, five cylinder
powers (-0.75DC, -1.25DC, -1.75DC, -2.25DC
and -2.75DC) and 18 axes (10° to 180° in 10°
The Acuvue Oasys range is said to offer
coverage for up to 99% of astigmatic
and spherical patients, with nearly 5,000
parameter combinations for Acuvue Oasys
for Astigmatism.
According to J&J, the benefits of the
range for practitioners include simple lens
selection, whether patients are myopic,
hypermetropic or astigmatic, as well as a
93% first-fit success.
side up for Claudia
CLAUDIA SCHIFFER by Rodenstock eyewear collection has been expanded, with a new
range of colours in its sunglasses range to reflect this season’s catwalk trends.
The ‘Willow’ acetate sunglasses with gold-coloured metal temples are said to be
proving popular since the launch of the major collection in January. They are offered
in classic Havana and are now also available in pale pink, layered acetate for a more
retro look.
The ‘Chestnut’ design is now offered in two new colour variations. The style is
offered as a sporty bright blue frame with camouflage temples with a rubber-coated
surface. It is also available in a combination of transparent grey and burgundy red.
Both styles are following the oversized masculine trend on the catwalk this season.
The ‘Apple’ has been updated in a classic black. Inspired by autumnal shades, it is
also available with a Havana front, with contrast orange temples (pictured).
Previously only available in single colours, the best-selling style ‘Birch’ is being
updated, with a combination of different colours and prints. The oversized frames are
presented in a white acetate with an elegant contrast temple in warm brown.
The new look this season is a bold red, with contrast black and red marbled temples.
01474 325 555
New season colour
LINGERIE DESIGNER Janet Reger has unveiled her latest eyewear collection for Dunelm
The five new styles feature Reger’s design signatures, such as classic tortoiseshells and
feminine cat eye shapes. However, this season also sees the designer experimenting with
An eye-catching electric purple, in style ‘JR 4123 C3’ (pictured), and red in style ‘JR 4124
C2’, as well as salmon pink, are introduced into the glamorous new collection, with subtle
fade out effects in style ‘JR 4113 C3’ offering an update to the standard two tone frame.
Ms Reger explained: “My inspiration comes from designers like Tiffany, Karl Lagerfeld,
Victoria Beckham and Roberto Cavalli – it’s all about form, and this is where the Reger
name stands out, whether that’s in our lingerie or eyewear collections.”
Dunlem Optical managing director, Peter Beaumont, said: “The Reger brand goes from
strength to strength. This latest collection ticks all the boxes for modern women who
want a stand out look from their eyewear. It’s both current and classic.”
new frames to its Humphrey’s collection.
The unconventional brand has the theme,
‘Be different,’ and capitalises on the current
popularity of European styling. The brand is
synonymous with vivid colour, bold patterns,
texture and colour blocking.
The two new, ‘edgy’ frame releases are
models ‘583050’ and ‘583051’ and feature
a fashionable, matt finish. The multi-layer,
acetate models also feature an unmistakable
contrast metal brow.
The men’s style, ‘583050’ (pictured left)
sports a deep, angular eye shape and is
available in two colour options of black/red
and black/blue.
The women’s frame, ‘583051’ showcases a
striking feminine eye shape and is available
in two vivid colour combinations, brown/
red and petrol/mint green.
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NE Trade Ad (Opt/OT) V4.indd 1
04/09/2014 15:15
Night of stars and specs
OT ’s Robina Moss reports on Specsavers’ celebrity-strewn Spectacle Wearer of the Year Awards
“You would expect to
see me in something
colourful and
dramatic and that’s
how I shall continue
to be – a spectacle”
REALITY TV star Amy Childs, of The Only Way
is Essex fame, was revealed as Specsavers
‘Specs Style Star’ winner at the multiple’s
annual Spectacle Wearer of the Year Awards
(SWOTY) in London earlier this month
(October 7).
Ms Childs, who is now pursuing a career in
fashion, received her award from former Girls
Aloud singer and actress, Kimberley Walsh.
Ms Walsh performed in public for the first
time since having her baby, Bobby, drawing
in paparazzi to the London awards venue
near Trafalgar Square.
Ms Walsh, who has been a glasses wearer
for six years, had launched the search for
Britain’s best spectacles wearers earlier
this year and sang a number of hits at the
The Specsavers awards were held in aid
of the anti-bullying charity Kidscape and
attracted bespectacled stars including The
Saturdays’ Vanessa White, former Pussycat
Doll Kimberly Wyatt, celebrity chef Jean
Christopher Novelli, actor Larry Lamb and
reality TV star Rylan Clark, who were all
there to present awards to ‘ordinary’ British
spectacles wearers who look ‘extraordinary’ in
their glasses.
Other stars appearing on the night
included Blue singer and Strictly Come
Dancing contestant Simon Webbe, who
helped judge the competition, TV presenters
Dawn O’Porter, Tim Vincent and Darren
Kennedy, MasterChef Gregg Wallace and
Strictly Come Dancing dancers Ola and James
Jordan, as well as Eddie ‘the Eagle’ Edwards,
the first competitor to represent Great Britain
in Olympic ski jumping, and who once
appeared in a Specsavers television advert.
Colourful ‘80s TV and radio presenter Timmy
Mallet (pictured above) walked away with the
Services to Specs prize for a lifetime devoted
to wearing flamboyant specs, and Stephen
Webb from the BAFTA award-winning series,
Gogglebox, took home the Best Newcomer
award for his stylish appearance on the
Channel 4 show. Mr Webb said that his award
“will take pride of place in my living room now.”
Mr Mallett revealed that he has thousands
of pairs of spectacles and demonstrated his
landmark pairs, including the ones he wore
for his 1990 UK number one hit Itsy Bitsy
Teenie Weenie Yellow Polka Dot Bikini.
Mr Mallett said: “I believe spectacles can
make and frame a face and say something
about who we are. You would expect to see
me in something colourful and dramatic and
that’s how I shall continue to be – a spectacle.”
Ms Childs commented: “I’m so excited to
have won this award, I love being a glasses
wearer. Big geeky frames are my favourite at
the moment but I’ll be changing my glasses
regularly as I like to experiment with different
The awards, hosted by Kidscape
ambassador Gok Wan, saw Michaela Williams,
47 (pictured), from Bridgwater, Somerset,
presented with the overall Spectacle Wearer
of the Year 2014 prize, which included £10,000
in cash and a holiday to the Bahamas.
An auction held on the evening, run by TV
personality Christopher Biggins, brought the
total amount raised for Kidscape to £45,000
this year, and the overall total raised by
Specsavers for the charity in the last five years
to £200,000.
The new sit down dinner format to the
annual awards ceremony worked especially
well this year, attracting more store directors
and staff who could mingle with the
celebrities at the ceremony.
31/10/14 SWOTY
Eyeing up the frames
100% Optical will be returning to London in February for a second year. OT spoke to four eyewear
brands positioned to make an impact at the 2015 show
Oliver Goldsmith Glasses and
Claire Goldsmith Eyewear
31/10/14 EYEWEAR
Claire Goldsmith, managing director
Oliver Goldsmith Sunglasses was established in 1926, while
great-granddaughter, Claire Goldsmith launched Claire Goldsmith
Eyewear in 2009. An English brand, based out of London, Oliver
Goldsmith used to be run out of a factory in Poland Street back in
the 1920–30s, giving the brand a born and bred in London feel.
How would you describe the company’s eyewear design? For Oliver
Goldsmith Sunglasses, the collection is historic and iconic, with many styles
originally being worn by the likes of Michael Caine, Grace Kelly and Audrey
Hepburn. For Claire Goldsmith, the style is more contemporary; we like to
think of them as modern day vintage. With both my collections though, the
focus will always be on comfort, style and quality.
What is your top selling eyewear product? The Manhattan by OG
Sunglasses. It is a replica of the sunglasses worn by Audrey Hepburn in
Breakfast at Tiffany’s. Hepburn’s allure is quite astonishing.
Which countries are your best performing territories? Our best
performing territories are the US, France and Italy. Unfortunately the UK is
our smallest market – which we hope will change, but this will only come
from the support of independent boutique opticians and educating the
British public on all the wonderful independent brands that exist.
Continental Eyewear
Neal Grimason, sales and marketing director
Established in 1984 by Derek Cox who is chairman and managing
director, Continental Eyewear is based in the UK, and exports to more
than 30 countries throughout the world.
How would you describe Continental Eyewear’s look and feel? We
have a varied portfolio covering all styles and price sectors. All our ranges
are held in stock here in the UK for immediate delivery throughout the UK
and the rest of the world.
What products will you be showing at 100% Optical next year?
Jaeger and X-eyes will feature prominently at 100%. Jaeger, as stated
previously, is an iconic British brand. It is not aimed at the trendy 25-yearold; the target audience is the stylish individual for whom style overrides
fashion. As the saying goes – fashion comes and goes but style lasts
forever. Also, so many ‘names’ are here today and gone tomorrow – Jaeger
has been around for over 125 years – true longevity. X-eyes, because the
styles differ from the norm, are always an attraction at exhibitions. Many
new styles will be making their debut at 100%.
As a first time visitor to 100% Optical, why did you choose to
exhibit? There are many exhibitions around the world and we wanted to
visit 100% first before choosing to exhibit. We are keen for the UK market
to open up to the world of independent brands, such as us, so are happy
to be involved in the show this year.
Can you give OT an insight at this stage into what products you will
be showing at the 2015 event? We hope to be expanding the ‘CG Lite’
collection for the Claire Goldsmith brand, a collection of more refined
styles to complement the heavy acetate frames in our collection. We will
also be launching some wonderful vintage inspired sunglasses for Oliver
Goldsmith Sunglasses.
Peter Sunderland, company director
Created by Peter Booth and Jeremy Seton in the 1990s to deliver funky, fashionable frames
via a new English brand, Booth & Bruce England was acquired by FRAMED eyewear in March
2014. The company has relaunched its website, and begun a social media campaign “me,
myselfie and I” with #BandBSelfie.
How would you describe the company’s style? Booth & Bruce provides funky frames using
a mix of colorful acetates, and more muted tones. Traditionally more chunky and retro in shape
and design, we are complementing these designs with the new Here & Now collection, of more
lightweight, slimmer acetates in a great combination of colours.
What is your top performing eyewear product? From the new Here & Now collection, the
best selling frame to date is our new women’s frame BB106 in new colour ‘raspberry dream,’ as
modelled by Vicky Vivacious from Drag Queens of London in our advertising campaign.
Which countries are your standout territories? The UK is currently the best performing
territory. This is followed closely by the US, due to great acceptance at Vision Expo West
in Las Vegas.
As a first-time exhibitor at 100% Optical, why did you choose to exhibit? As the first 100%
Optical took place before FRAMED eyewear took ownership of Booth & Bruce, this year will be
the first time we exhibit in the UK. Following huge success at Silmo Paris, where we launched
the first phase of the Here & Now collection, we are excited to premier the second phase in our
home city. We have chosen 100% Optical to exhibit as we feel we need to support a fashion
forward, frame focused event on our own shores. London is a major player in the fashion field,
and yet our sector is vastly
underserved for exhibitions in
this area. 100% Optical is our
chance to show Milan, Paris and
New York that the British are here,
and we mean business.
Michel Henau
Marc Delagrange, designer and co-founder
The Michel Henau collection was launched in 2000 at Silmo by Marc Delagrange and his
wife, Marleen. The company is based in Belgium – the glasses are Belgian design, and the
frames are handmade in France.
How would you sum up the company’s eyewear look? Michel Henau frames are a
balance between shape, functionality and quality. Pure and structured shapes, timeless
What is your best selling eyewear product? Acetate frames are a strong performer such
as Sun2014 odorono B80, pictured left.
What are your top performing territories? Benelux, France, Italy, US and Japan. We are
just starting to work in the UK.
As a first-time exhibitor at 100% Optical, why did you choose to exhibit? We have
been working with just a few British customers for many years. We met them at other fairs
in Europe and they work really well with our collection. We feel that many people of the UK
may like the style of our frames, and that’s why we are participating in 100% Optical.
Can you give OT an insight into what products you will be showing at the 2015 event?
From the Silmo 2014 collection, there will be a continuation of the geometrical frames
of the previous 2013–14 collections. Real Lunettes Modernes, for which Michel Henau is
well known, has fused graphical art and frames. Again these frames are Belgian design,
combined with Italian acetate, and handmade in France.
100% Optical will
inspire you
WITH JUST over three
months to go, we are
beginning to feel the
excitement of having
thousands of new
eyewear lines for you to see at the 100%
Optical in February. As the show will be
30% bigger than last year, the breadth
and depth of the eyewear on show
grows, and we can guarantee that you
will leave the event next year with lots
of ideas and new ranges to impress your
The Royal College of Art’s eyewear
competition was a resounding success
last year, and was launched as a means
of searching out and promoting the
young talent who could become the
next generation of eyewear designers.
Some of last year’s finalists are now
forging a career in frame design and
showing promise – you might even see
some of their ranges at 100% Optical in
the next year or two. This year’s intake
look equally inspiring and are already
trawling through the archives of the
British Optical Association Museum
at the College of Optometrists for
inspiration. Such was the interest and
take up that the Royal College of Art
are looking to introduce a dedicated
eyewear course in the future.
Having the support of ABDO,
working in collaboration with the AOP,
on the new Frame Workshop will also
create one of the event highlights.
Algha Works will be supplying us with
machinery to allow visitors the hands
on experience of finishing an acetate
frame, polishing and fitting hinges.
Alongside this will be the chance to
get hands on with new 3D printing
technology, as well as working with
wood and other materials. Whenever
we talk to dispensing opticians about
this feature they get excited – everyone
wants to have a go. We are in the midst
of planning the fashion shows as well –
another massive hit from last year – and
we are looking at adding more shows
this year, alongside CET-accredited
content linked to fashion, trends and
In essence, 100% Optical has lots to
offer in 2015, and there will be more to
Nathan Garnett
100% Optical event director
31/10/14 EYEWEAR
Booth & Bruce
Building for success
OT ’s Robina Moss looks ahead to the National Eyecare Group’s annual conference for
independents next month which will feature 10 lectures, including a Peer Discussion
WITH THE theme of ‘building a better patient
experience,’ the National Eyecare Group (NEG)
Building for Success conference will be held
at the East Midlands Conference Centre in
Nottingham next month (November 16–17).
The event will offer eight CET points through
a mix of educational and business lectures,
with information and maps on a conference
app. (Pictured bottom left is speaker Teifi
James at last year’s event). There will also be an
exhibition and networking opportunities.
NEG business development director, Phil
Mullins, told OT: “We are very excited about
Building for success this year. With more
CET, including Peer Discussion, a stronger
exhibition and improved conference app, it’s
shaping up to be our best conference ever.
“There aren’t many events that are solely
for independent opticians, so our conference
offers a great chance for them to meet up with
other like-minded professionals and look at
what affects them and their business.”
He continued: “We would like to extend
a massive thank you to our sponsors and
exhibitors, all of whom are preferred suppliers
to the group, without whom we could not run
the conference. A particular thank you goes to
Heidelberg Engineering, which has helped us
create an exciting programme for the Sunday
afternoon, including our first Peer Discussion
With a stronger clinical content for 2014, the
conference will start with a focus on OCT and
glaucoma on Sunday November 16. There will
be two lectures, followed by a Peer Discussion
worth three CET points on integrating OCT
into managing glaucoma.
Monday (November 17) will begin with a
focus on the blue/UV light spectra and recent
lens coating innovations, offered by Andy
Sanders of Hoya. An overview of the Tridex
Lens Specialist Programme will follow later in
the day.
On the clinical side, there will be Up the
front, an interactive quiz about anterior and
adnexal lesions by optometrist Bill Harvey,
visiting clinician at City University London and
Plymouth University.
The business side of the programme will
then begin with Debbie Gigg, from The
Worshipful Company of Spectacle Makers,
looking at good HR practise and how it can
improve communication and performance
within the practice team. In Show me the
money there will be a demonstration of the
impact that a monthly payment eye care
scheme can have on a patient’s value to the
A two-part session, Seeing you and your
practice, through your patients’ eyes will
be led by Dr Helen Court, of NHS Education
Scotland and Jonathan Bench, from Alcon. The
second part has been developed with Patrick
Myers of Myers La Roche, and will look at the
factors that patients consider important when
they choose a practice.
Mr Mullins will conclude the day with a look
at the patient journey in the digital age in his
presentation, Engage and educate patients to
bring a greater understanding of their eye care
For more information on the conference visit
“With more CET, including Peer Review, a stronger
exhibition and improved conference app, it’s
shaping up to be our best conference ever”
a milestone
Charmant UK celebrates its 20th anniversary this month. OT’s Robina Moss speaks to the general
manager Louise Brunton (pictured) about how the company has developed in the UK
31/10/14 CHARMANT UK
FRAMES AND sunglasses company, Charmant UK, celebrated
its 20th anniversary last week (October 25). Having originated in
Japan in 1956, today the Charmant Group has major plants in the
US, China, Germany and France. It opened in the UK in 1994 with
the aim of selling ophthalmic frames and sunglasses from stock
located in this country.
“The logistics of bringing stock into the UK is quite time
consuming. There’s a channel to cross from Europe which is why
it’s an advantage to keep our stock here in London,” explained
Charmant UK’s general manager, Louise Brunton.
It means that the company was able to develop a 24-hour
turnaround. “We also provide replacement parts and single
frames if requested,” said Ms Brunton. “This means that if a patient
breaks their frame and needs a replacement part quickly, for
example if they are going on holiday, we can help the practice to
offer a speedy repair or replacement.”
Ms Brunton added: “I’m proud that our stock is readily available,
in particular spare parts. Although Charmant products are of
a very high standard and we don’t have too many issues with
them, it is helpful for independents that we can offer that
service, so that they in turn can offer a fast service to their own
Originally based in offices at Staples Corner, near Brent
Cross, the company expanded and moved to Acton, West
London, in 1998 to achieve full warehouse facilities.
The group is renowned throughout the world for its Charmant
Titanium Perfection frames, and is also popular in the UK for
licensed eyewear brands including Puma, Elle, Esprit and
Trussardi. It has held the licence for Esprit eyewear for 20 years,
with the Elle brand not far behind.
The UK company stocks frames, sunglasses, spare parts and
point of sale materials at its London warehouse. There are 10
employees based at the facility, with nine representatives on the
road covering all of the country, plus distributors in the Republic
of Ireland. Many of the team have been with the company a
long time, getting married and having children in that time, as
illustrated by the family photos on display around the customer
service office.
“Having the same rep for a long
time builds up a good bond of trust”
“Personally, I’m very proud of the continuity of our team
as it provides stability,” Ms Brunton told OT. “Having the same
representative for a long time builds up a good bond of trust
with the opticians. It’s the same with our customer services
team. They offer a friendly, personal service as they speak to the
same customers many times over. It’s not an automated service
From fashion to frames
Moving from the fashion industry, Ms Brunton joined
Charmant UK because she “liked the sound of the company
and was excited at the prospect of working for a Japanese
company.” In view of her past experience, there were other
benefits also. “Optics is a resoundly stable industry in a
buoyant country,” she told OT.
However, there have been challenges, such as the recent
economic recession. “You take the rough with the smooth,
however, on the whole we have done very well as we have
well designed products at a good price,” she explained.
Ms Brunton added: “Everyone was affected by the recession,
I am sure but the lesson for us at Charmant was how can we
better support our customers in tough times and to really
understand their challenges.
“We are well supported by our headquarters in Japan, our
director for Europe, Mr Mizukami and our colleagues abroad.
There is a good sense of pride in working for the Charmant
Group,” she added.
Ms Brunton has travelled to Japan and has met the group’s
chairman Mr Horikawa.
Many of the group’s employees meet up at the tradeshows
abroad, Opti, Mido, Silmo and Vision Expo East.
“I recently had dinner with a US colleague who remarked
on the closeness of the group. It is experiencing the same
rewards and the same local challenges that bonds you as a
global team,” she explained.
Regarding the company’s impact on the UK optical
sector over the last 20 years, Ms Brunton said: “Opticians like
Charmant. A lot of research and development takes place in
Japan and that follows through all of the company’s brands,
even the more simple frames. Technically, they are all of a high
Asked about the frames side of the operation, Ms Brunton replied:
“Through extensive research and development, Charmant
developed the material ‘Excellence Titan,’ a superior titanium
which gives the benefits of very flexible, durable hypoallergenic
frames. Titanium is more difficult to cut than other frame
materials and used to result in simple frame designs.”
She added: “Charmant has also developed laser-cutting
technology which now allows us to make more intricate designs.
We used both of these exciting new developments to launch our
beautiful Line Art by Charmant collection. It was first launched
globally in 2009 and has proved to be a big hit.”
Last year the company was one of the first to launch
designer brand frames using Ultem material, a thermoplastic
polyethermide which is said to be ‘ultra durable.’
“Ultem frames are very lightweight and flexible,” said Ms
Brunton. “They are so comfortable; you could run a marathon
in them. Ultem is available in both the Esprit and the Puma
collections and has proved very, very successful for us.”
Taking an overview, Ms Brunton added: “A lot of care and
attention goes into our products and that means they are well
made and reliable. Our eyewear is designed for comfort and fit,
yet they are also designed to look nice and Charmant frames are
truly beautiful.”
Asked about recent changes in the UK optical market, Ms
Brunton told OT: “Consumers in the last two years have become
more experimental, more open to design and colour, as well
as new materials and textures. We continue to strive to design
new and exciting products for consumers who want something
The company recently launched its autumn/winter collections
and is now working on its new spring/summer 2015 collections
which will be launched in January. A new website is also being
developed at
Looking to future plans, Ms Brunton concluded: “We are
staying here in the UK. We aim to continue as we are, supporting
independents by providing even better products at good prices,
backed up by great customer service and the knowledge that
Charmant will continue to bring eyewear to British and Irish
customers for many years to come.”
31/10/14 CHARMANT UK
like some other companies. “Our customer services team and
warehouse team will bend over backwards to help customers,
for example they will go into the warehouse and personally
source a frame to ensure that a customer gets top priority if
needs be.”
Well-known in the UK optical sector, Ms Brunton was
originally recruited to Charmant UK in 1997 as its finance
manager, and was promoted to general manager 10 years ago.
Born in Dublin, Ms Brunton moved to the UK as a teenager
and previously worked in the London-based fashion
manufacturing industry for 12 years on the financial side.
She worked in London’s West End for a Cypriot family
company, which made dresses for Dorothy Perkins and
Debenhams, as well as Etam and C&A. The fashion buyers had
their offices in London’s Oxford and Regent Streets above their
stores. The designers and manufacturing companies, such
as the one Ms Brunton worked for, were based in the streets
behind Oxford Circus and that area was commonly known as
London’s “rag trade” end.
“It was a tough market, with even tougher margins,”
reflected Ms Brunton, adding that the major recession in the
late 1980s meant that much of the manufacturing was moved
31/10/14 TRAIN OF HOPE
Travelling care
A team of 32 optometry undergraduates from Glasgow Caledonian University travelled to South
Africa this summer as part of a volunteer eye testing programme which saw a train travel to some
of the remotest areas of the country. Fourth-year student, Gemma Hill, shares her experiences
AS SOUTH Africa celebrates its 20th year
of democracy, I was lucky enough to be
one of the first UK students to volunteer
on board Phelophepa, the ‘train of
hope,’ which travels across the country
to deliver healthcare to communities
where there is often only one doctor for
every 5,000 people.
The train travels for 35 weeks a year,
visiting a different rural community
every week. It has 18 fully equipped
coaches which provide facilities for
health, oral and vision screening
programmes, as well as health education
awareness and community counselling
Phelophepa is owned and operated by
the Transnet Foundation, the corporate
social investment arm of South Africa’s
largest freight rail company, Transnet,
with which Glasgow Caledonian
University (GCU) has a five-year
agreement to support the project by
providing volunteers.
It is through this partnership that I,
and another 31 GCU optometry students,
were given the opportunity to travel to
South Africa to join the train’s eye clinic
for a two-week placement.
While I have fundraised for the global
fundraising initiative Optometry Giving
Sight for several years, it had been a
longstanding dream of mine to volunteer
and provide eye care in another country,
so this seemed like a good a time to start.
To help cover the funding that I
needed to travel to South Africa, I
applied to GCU’s Magnus Magnusson
Awards, an annual awards programme
run by the university which provides
grants to help students fulfil their
ambitions and dreams.
Part of the application process for the
awards was to present to a Dragon’s Denstyle panel of judges about the project
and the ways in which I, and the people
of South Africa, would benefit. Given
the nature of the project and my obvious
enthusiasm, this was something that was
very easy to do and I was delighted to
receive a Santander Magnusson Award.
With funding in place, I booked
my flights for July and bought the
equipment I needed to take with me,
along with some additional equipment
generously donated by GCU.
Travelling train
July came around quickly and before I
knew it, I was standing in Johannesburg
Airport awaiting a pick-up for the
six-hour journey to meet the train in
Kimberley, the capital of the Northern
Cape province of South Africa.
Although quite a developed town,
renowned for its diamond mines,
Kimberley is in the middle of nowhere
and it became obvious to me why the
train was needed.
I had the weekend to acclimatise to
my new surroundings before joining a
team of full-time professionals in the eye
A wake-up call at 6am and early
morning temperatures that even us Scots
of glasses and also gives them dignity.
Free services could make the patients
feel helpless and dependent.
Returning home
Having returned to Glasgow and
settled back into my home comforts,
I have had the opportunity to fully
reflect on my experience.
It makes me sad to think that South
African healthcare services are so
scarce that people rely on the train’s
annual visit to their community. They
queue for hours for healthcare that we
take for granted here in the UK.
A simple solution like a pair of
glasses changes their lives; it enables
them to read the blackboard clearly at
school for the first time or allows them
to find work to support their family. It
was humbling to witness how grateful
and happy the patients were to be
treated and helped.
“It is painful to witness the loss of quality of life
for those who have no access to healthcare”
child’s sight test is simply keeping
their attention just long enough to get
what you need. It was fortunate that the
children often had a much better grasp
of English than the adults, so we were
not slowed by the need for translation
to one of South Africa’s 13 dialects. I
found that, as the days passed, I became
more confident and testing the children
became my absolute favourite thing to
Performing the sight tests outside
turned out to be the most difficult part
of the job; the ground I was testing on
was dry and dusty and I found myself
cleaning my equipment obsessively to
no avail. As the sun set towards the end
of the days, there would almost always
be 10 to 20 patients left to see and I had
to use a pen torch to light up the Snellen
While eye tests were done for free, we
charged about £2 for a pair of glasses. I
found it heartbreaking that some of the
patients could still not afford to pay for
this, but I understand that it is important
to charge a nominal fee; it helps the
patients understand the value of a pair
I am grateful to Transnet and to
GCU for giving me this life-changing
experience. It has really improved
my optometry skills, boosted my
confidence and taught me a lot about
different people and cultures. All of
these things will help me greatly in
my final year at university and in my
To those who are offered a similar
opportunity at any point in their
optical career, I would urge them to
grab it with both hands. Go in with
low expectations, be wowed by the
spirit of those less fortunate, and come
back with a renewed awe for the way
in which we are able to live, work and
provide eye care here in the UK.
About the author
Gemma Hill is a fourth-year optometry
student at Glasgow Caledonian
University. She has previously been an
AOP student representative, and was
named Student of the Year at the AOP
Awards 2013.
31/10/14 TRAIN OF HOPE
are not used to, was nothing compared
to the stark realisation that, at 7.50am,
there were already hundreds of people
waiting outside for the services which
are provided on the train. People had
started queuing the night before and had
slept there so they could be first
in the queue.
While the patients waited outside
wrapped in winter coats and blankets,
by midday I had shed all my layers and
was baking in South Africa’s so-called
‘winter sun.’
The eye clinic was by far the busiest
department, with eight students testing
an estimated 160 patients a day. I found
the work incredibly hard, and if the
first day was not a big enough shock to
the system, the second brought the first
wave of children. To say this panicked
me is an understatement, as I had never
tested a child before.
I quickly found that the key to a
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Appropriate and accurate
urgent referrals
Community-based optometrist, Matthew Jinkinson, discusses the urgent referrals made by
Stockport’s Minor Eye Conditions service
The main set of standards for
appropriateness of referral by optometrists
to secondary care are the guidelines
published by the College of
The only paper identified that has
reference to referrals from a MECS/
31/10/14 AUDIT
NHS STOCKPORT commissioned a
Minor Eye Conditions Service (MECS)
to start on April 1, 2013, in response to
increasing capacity problems within the
eye casualty clinic at Stockport NHS
Foundation Trust (SNHSFT). Following
an audit of eye casualty patients it was
determined 20% of these patient could
have been managed in primary care.
(Parker S, 2012).
The tender was won by Stockport
LOC’s newly formed LOC Company,
Primary Eyecare (Stockport) Ltd, which
has since expanded to be a Greater
Manchester-wide LOC company, GM
Primary Eyecare Ltd. The service
provided by 21 practices with 38
practitioners who are accredited to the
service by complete the WOPEC/LOCSU
Pears module.
The purpose of this audit was to
assess whether the tentative diagnosis
of referrals from the MECS to the
urgency clinic was appropriate. The
audit also examines the accuracy of
those referrals to secondary care to
ascertain if the diagnosis is being made
correctly and, if not, if there is a pattern
to the wrongly identified conditions.
At the time of this audit, six-months
worth of data were available; 1,451
patients had been seen within the
service, with 79.12% of patients being
exclusively managed within it.
PEARS service is Assessment of Wales
Primary Eye Care Service (Sheen et
al. 2009). This found that 75% of
optometric referrals were appropriate,
which acts as a good standard against
which this service can be compared.
However this paper does not specify
whether the referrals were made on an
urgent or routine basis.
To assess whether the optometrists
within the scheme are diagnosing
appropriately, we would expect to
find agreement with ophthalmological
diagnosis in between 72 and 89.3%
of cases, based on Assessment
of hospital optometrist versus
ophthalmologist diagnosis (Hau et al.
2007) and Assessment of accuracy of
optometrist diagnosis compared with
ophthalmologist (Sheen et al. 2009)
The appropriateness of referrals was
assessed by a panel of three optometrists
and an ophthalmologist. This part of
the audit looked solely at whether the
condition recorded on the Optomanager
platform by the optometrist, at the time
of assessment and referral, would appear
to be appropriate for referral to the
urgency service. This did not consider
whether the diagnosis is ultimately
correct but simply whether it would be
expected that the condition be referred
urgently. As a hypothetical example –
do we have a practice that is regularly
referring dry eye patients to the urgency
clinic when they should be dealing with
the condition themselves?
There were six months worth of data
available to the author to audit but it
was decided to take a four-month period
of referrals (May–August) as this follows
the time frames in the audits of a similar
service (Sheen et al. 2009).
To assess the accuracy of the
optometrist referrals, information was
collected following assessment by the
patient in the eye clinic. The author was
assisted by a consultant ophthalmologist
within the department who accessed
the outcome data. These data were
assessed for accuracy of diagnosis and
appropriateness of referral regardless
of accuracy. (As an example; if an
optometrist referred suspect anterior
uveitis, but the ophthalmologist
Number of patient episodes
31/10/14 AUDIT
Figure 1 Appropriateness of optometrist referral (was the referral appropriate based on outcome
of assessment?)
diagnoses closed angle glaucoma, this is
an incorrect diagnosis but appropriate
for urgent referral).
Between May and August 2013, 1,026
Patient episodes were recorded in the
Stockport MECS, of which 98 patients
were referred urgently to SNHSFT.
This gives a deflection rate (away from
urgency clinic) of 90.45%, it should be
noted some patients required routine
During the round table discussion
the author had access to the patient
episode data on the Optomanager IT
platform to allow the optometrists
notes to be considered in cases where
No, 24 (31%)
Yes, 53 (69%)
there was doubt about the referral being
appropriate or not. This was particularly
useful to see if the referral was made at
the first appointment, or at follow-up
or to explain the thinking behind some
A total 13.27% (13) of the 98 urgent
referrals were deemed inappropriate
based on the optometrist’s own
diagnosis and should have been
managed within the service (Figure 1).
Table 1 shows the conditions considered
to be inappropriate for urgent referral
to the eye department; of these the
most commonly identified condition
inappropriately referred urgently was
posterior vitreous detachment (PVD)
with no sign of retinal hole/tear/break
and a negative Shaffer’s sign. One of the
diagnoses of intraocular pressure (IOP)
with longstanding tropia should have
been referred to the eye department
routinely via the GP and the remaining
conditions could have been managed
within the service.
Of the appropriately referred
conditions, the five most frequently
diagnosed were anterior uveitis/iritis
(nine), retinal tear/hole (nine), wet AMD
(eight), corneal ulcer (seven) and branch/
central retinal vein occlusion (five).
Accuracy of referral
Figure 2 Accuracy of diagnosis by optometrist
(does the diagnosis of optometrist match that
of the ophthalmologist?)
Of the 98 urgent referrals from MECS, 77
were traceable. Unfortunately there were
21 untraceable referrals and these were
dismissed from analysis.
Figure 2 shows the number of correct
and incorrect diagnostics, this gives
68.8% of referrals where the hospital
outcome agrees with the optometrist’s
Analysis of the conditions wrongly
diagnosed by optometrists (Table 2)
show that posterior vitreous detachment
is most commonly misdiagnosed as
retinal hole/tear.
Optometrists are also diagnosing
herpes keratitis, scleritis and periorbital/septal cellulitis whilst
theophthalmologist examiningthe
patient finds a different diagnosis.
There was one episode recorded as
corneal abrasion by optometrist but
when ophthalmologist examined found
blepharitis, this is a difficult case as the
abrasion which was originally referred
may have cleared by the time the patient
presented in the clinic as corneal
abrasions have potential to heal in 24
hours, this does question the suitability
of referral as an attempt should have
been made to treat by the optometrist
and assessed again in 24–48 hours and if
no improvement then referral made.
Further analysis was carried out to see,
out of the 77 referrals, how many were
appropriate to be managed under the
HES, regardless of the correct diagnosis
by optometrist. This found that 70.1%
were appropriate to be managed (within
the HES assessment.
Firstly, this audit considered the
appropriateness of the referral to
urgency clinic based on the condition
diagnosed by the optometrist at
consultation (that is omitting whether
the diagnosis was actually correct or
not). This appeared to show a very good
level of performance, with 87% of the
conditions diagnosed by optometrists
being appropriate for urgent referral. This
compares very well to the standards that
found 75% of optometric referrals were
appropriate (Sheen et al., 2009)
Posterior vitreous detachment is
the highest recorded condition to be
inappropriately managed, possibly
reflecting the caution optometrists
have surrounding the management of
Diagnosis (by MECS practitioner at time of consultation)
No. of patients
Bacterial conjunctivitis
Conjunctival oedema
Corneal abrasion
Corneal epithelial defect
Punctate keratitis
Raised IOP (25mmHG) and long-standing
Fluorescein Strips
Fluorescein Strips
Table 1 Conditions referred which were deemed inappropriate
No. of episodes
Amaurosis fugax
Angle closure glaucoma
Anterior uveitis/iritis
Corneal abrasion
Corneal ulcer
Herpes keratitis
Malignant BCC/SCC/SGC
Marginal keratitis
Septal cellulitis/peri-orbital
Retinal tear/hole
Viral conjunctivitis
Table 2 Count of the conditions incorrectly diagnosed by optometrist
this condition, especially when severe
symptoms are present despite a lack of
actual signs of a tear.
Ophthalmologists agreed with 68.8%
of optometric diagnoses (that is were
correctly diagnosed by optometrist).
This is slightly less than that found in
the Welsh Eye Care Initiative (WECI)
audit where 72% of referrals were
correctly diagnosed. This could be due
to the WECI service being a more long
running service at the time of audit
(six years) compared to the six months
which the Stockport MECS service had
been running. It is reassuring to know
that of the traceable referrals, only
23 were deemed to have not required
HES assessment and therefore over the
four month period during which the
analysis was carried out MECS did not
significantly add to the burden of the
urgency clinic with too many unnecessary
reduction in potential referrals.
referrals – indeed, it produced a net
This audit has highlighted some
conditions where further training
100 sterile strips
individually wrapped
100 sterilepouches
in transparent
individually wrapped
in transparent pouches
Fully automated
Manufactured to
CE ed
and education can be given to MECS
practitioners to increase their confidence
and ensure their understanding. The
areas where this is required are the
diagnosis and differential diagnosis of
PVD, herpes keratitis, peri-orbital/septal
cellulitis and scleritis.
It would be useful to extend this audit
further and engage with the patients
involved to find out whether further
information can be gathered about those
patients where the hospital data was
not available, and also to contact those
patients who were not referred and
see if they experienced any problems
later or ended up under their general
practitioner or the ophthalmology
e: [email protected]
t: 01438 740823
31/10/14 AUDIT
Optometrist diagnosis
Bringing definition to the
contact lens market
A new contact lens, which combines vision correction with an enhanced beauty element,
will be brought to market in the UK by Johnson & Johnson Vision Care today (October 31).
OT’s Emily McCormick finds out more
TODAY JOHNSON & Johnson Vision Care (J&J) introduces
a new concept in contact lenses, which is designed to
enhance the natural beauty of the wearer’s eyes. Available
in two variants – Sparkle and Shimmer – 1-day Acuvue
Define contact lenses are able to provide a greater depth,
dimension and brightness to the eyes.
Talking to OT ahead of the launch, J&J managing director
for the UK and Ireland, Dr David Hall, explained: “Define
is a revolutionary and innovative product, which we
believe provides the opportunity to bring a significant
number of new patients into the contact lens category.”
Define was launched in Asia over a decade ago to great
success. Since then, J&J’s intention has always been to
bring the product to the European and North American
market “due to the strength of its concept,” Dr Hall
confirmed. However, it has always been a question of the
correct timing for the contact lens giant.
“A decade ago, the contact lens sector was in a very
different position in terms of penetration and, therefore,
at the time we launched the lens in Asia, the UK market
still needed to build on its fundamentals before we could
think about bringing an enhanced benefit lens to market,”
Dr Hall said.
Now confident that the timing is right to bring the new
concept of vision correction to the UK, J&J has invested
heavily in the product in technical terms to make sure that
it is right for the Western eye, and is backed up by ample
insight and research.
Expanding on this, Dr Hall explained: “We have spent
quite a lot of time and money on understanding the
potential market. Since Define was launched in Asia,
around 40,000 women have fed into the research which
comes behind the product.”
Defining potential
Define uses an innovative lens design which has never
been seen before and therefore provides a new opportunity
for the contact lens sector.
Research carried out by J&J indicates a large pool of
potential wearers for a product like Define, so much so
that Dr Hall is even more excited about the potential that
the product brings the sector than he is about the launch
J&J managing director for the UK and Ireland, Dr David Hall
“The interesting thing to come out of the research,” Dr
Hall told OT , “is the potential size of the opportunity
which Define offers.”
J&J’s research suggests that, of the five million potential
contact lens wearers available in the UK, one million
(20%) would say yes to a trial of Define, demonstrating
the potential growth opportunity that it could provide the
contact lens sector with.
“Define is one of the strongest concepts that we have
tested,” Dr Hall said, after sharing the positive research
findings. “It has the potential to bring more people in to
the sector, and potentially has the ability to kick start the
Trial and learn
Officially launched today, Define has been available for
trial through Boots Opticians since earlier this year.
“We chose to trial the contact lens in Boots first because
it is the number one health and beauty retailer in the UK,”
Dr Hall told OT. “It has a significant presence in cosmetics
already and knows our target market very well. Therefore,
trialling Define with Boots in the initial stages of launch
was important because of the credibility it brings as a
health and beauty retailer.”
Partnering with Boots Opticians provided J&J with the
opportunity to learn more about the marketplace in which
Define sits, as well as how it can best inform and teach
practitioners and patients about the new contact lens.
Dr Hall explained: “Define is a new concept, and while
we have done a whole bunch of market research that has
given us the information and confidence that we need to
take it to market, you can never be 100% sure until you go
out and test the product.”
As a result of the trial, J&J now has a better
understanding of how it can help practitioners understand
and sell Define, as Dr Hall explained when he spoke about
its ‘three key learnings.’
The first revolves around the practitioner being
proactive and being able to drive the right conversations
with patients, as Dr Hall explained: “It is critical for
practitioners to really get behind the needs of the person.
“If someone is sitting in their chair who has ‘ummed’
and ‘ahhed’ about contact lenses in the past, but not really
taken that leap of faith, potentially Define is the product
which will trigger them to try contact lenses due to its
enhancement element.”
The second aspect is finding the right patient for the
product, as Dr Hall admitted that it certainly appeals more
to women.
And, the third, which Dr Hall stressed as most
important, is getting the patient to have “a lens on eye
“It is one thing as a manufacturer to tell practitioners
and patients why a product is so great, but it is quite
another when a person actually tries it and sees the
natural reaction,” Dr Hall said.
Not a coloured lens
Dr Hall explained that it is of primary importance that
practitioners, and wearers alike understand that Define is
“not a coloured contact lens.”
Unlike traditional coloured contact lenses, “Define is
based on an iris-inspired design,” he stressed, “which
is significantly different from the concept of a coloured
contact lens where the pigmentation instantly changes the
natural colour of the eye,” he added.
Unlike coloured lenses, “which have at times been
negatively received because they haven’t always worked
as well as people would have hoped,” Mr Hall said, Define
is designed to “naturally enhance the natural beauty of the
iris and not cover it up.”
Reflecting on the potential which Define brings the UK
contact lens sector, Dr Hall said: “If we get this launch
right, if we do the right thing in terms of educating patients
about where they can get the product, the benefits of it and
what it can do for them, paired with getting practitioners
on board to drive it, I think it could be really interesting.”
next phase of growth,” he added.
Explaining why he believes the number of potential
wearers to be so high, Dr Hall said: “There are one million
potential contact lens wearers who have not come into the
category for whatever reason before, who could come in
for Define.
“Maybe in the past, the product simply hasn’t been right
for them. However, bringing out a product which enhances
the natural beauty of the eye embraces one of the first
moments of truths as to why someone would try contact
lenses – to improve their appearance – and takes it to the
next level.”
The UK launch of Define will take a two-pronged
approach which educates both the practitioner and the
consumer about the product. “We are running this launch
in a slightly different way to our standard contact lens
launches,” Dr Hall explained. “We will be combining
our standard professional engagement and education
programmes which focus on the benefits of the lens and
how to identify patients, with a significant consumer
investment in the marketplace.”
Revealing the importance of running a consumer facing
campaign in this instance, Dr Hall said: “We understand
that as well as driving more conversations between eye
care practitioners and patients, we also need to be driving
more people into store to talk to eye care practitioners
about this new type of product.”
Hot on the heels of the UK launch, the contact lens will
be introduced in Russia, with the US following suit a few
months later.
Changing dry eye
31/10/14 DRY EYE
OT ’s Ryan O’Hare reports on how TearLab is using osmolarity as a marker for dry eye, and the
potential for changing how the condition is managed in the community
LAST MONTH, at the annual meeting
of the European Society for Cataract and
Refractive Surgeons in London, TearLab
held a symposium (September 15) on
how its Osmality System is being used
to effectively manage dry eye patients
in optometric practice. The US-based
company is confident that wider use
of its diagnostic technology in the UK
could be used to help better identify,
classify and treat patients, saving the
NHS time, resource and money.
While dry eye may not be the most
urgent of clinical conditions, it is one
of the most common seen in optometric
practice, and can have a marked
impact on the patient’s life. Previous
studies have put its prevalence at
anywhere from 5–15% of the general
population, affecting as many as one in
10 women, and this year an analysis by
Companies & Markets has forecast that
the therapeutics market for dry eye will
reach $5.5bn (USD) by 2020.
Typically, administering fluorescein
drops can help to indicate if any of the
myriad symptoms could be due to the
condition. Beyond these, or in a more
intensive ‘workshop’ setting, other
measurements such as a five-minute
Schirmer test and tear film instability/
tear break-up time (TBUT), can be used
as key identifiers of the condition, as can
the Ocular Surface Disease Index (OSDI)
patient questionnaire.
Changing definition
In 2007, the International Dry Eye
Workshop (DEWS) set up a grading
Clinical studies
A number of studies are ongoing
to provide further evidence for the
efficacy of osmolarity as a biomarker in
practice. Interim results from a dry eye
prevalence study of almost 600 patients
in ophthalmology clinics in England
reveal that more than 72% of patients
had elevated osmolarity levels.
Francesca Harman, a consultant
ophthalmologist from Hillingdon
Hospital in West London and lead
researcher on the study, said that it
“shows the need for objective testing to
be introduced on the NHS.”
Presenting interim data from the
study, which compares osmolarity
Table 1 The TearLab dry eye disease scale based on measured osmolarity (mOsms/L)
against traditional dry eye
measurements as an indicator, Dr
Harman said that osmolarity “was
the single most sensitive sign” in
picking up dry eye. In 20% of patients,
hyperosmolarity was the only sign
of the condition in those who were
otherwise asymptomatic.
“Most dry eye patients are referred by GPs, we
need GPs to refer to an accredited optometrist”
TearLab’s Osmorality System is able
to measure the severity of dry eye based
on levels of osmolarity alone. By taking
a small tear sample from the patient
and measuring using a disposable chip,
it provides a value of the patient’s tear
film and categorises them accordingly
(see Table 1). Its creators say it provides
the ‘first objective and quantitative’ test
for dry eye, with osmolarity correlating
more closely with the DEWS score than
any other single measure. The context
in which the value is placed makes its
potential for use as a biomarker very
clear: ‘the higher the osmolarity, the
more severe the disease.’
Although the study is yet to finish,
the data suggest that the value may
provide clinicians with a better idea of
what’s going on, both in the absence of
symptoms and more generally. While
the research group aims to enrol a
total of 1,000 patients, the preliminary
findings show that the measure could
help to spot those patients who may
otherwise slip through the net using
traditional tests. “Tear break up time
is the least accurate, and we should be
thinking about other methods to pick up
dry eye,” added Dr Harman.
In practice
A pilot group is currently trying to
demonstrate how this might work
in the community setting, led by
ophthalmologist Guy Smith, who trains
optometrists in the area to carry out
testing with the TearLab system.
Based at the Great Western Hospital
in Wiltshire, Mr Smith is working
with practitioners in the area to use
osmolarity, alongside the traditional
battery of tests, to classify dry eye
patients and help to manage them more
appropriately in the community. He
explained how patients visiting a GP
with symptoms are likely to be placed
on hypromellose, which will often be
insufficient for treating their symptoms.
“It costs the patient time having an
ineffective treatment, it costs the NHS a
small amount of money paying for that
ineffective treatment, and also costs
the GP time trying to sort these patients
out,” he told delegates.
“The DEWS report is really very
good at recommending a treatment
regimen once [patients] are graded,” he
explained, but added that the testing
is the weak link in the chain. By
carrying out a range of tests, including
osmolarity, a composite score is
generated which corresponds with the
DEWS report, classifying the patient
and indicating a suitable treatment
Pointing to the importance of patients
having a ‘route back’, he added the
caveat that there was a need to ensure
that “if things aren’t going to plan in the
community, then they can come back”
to the hospital eye clinic.
“To make it work is going to take
pulling all of the strands together,” said
David Goad, general manager of Robert
Frith Opticians, who is working with
Mr Smith to deliver the model. “Most
dry eye patients are referred by GPs,
we need GPs to refer to an accredited
optometrist,” he added.
The proposed model comprises a
network of accredited optometrists,
who would be trained by a community
ophthalmologist – in this case, Mr
Smith. All participating, accredited
optometrists would have a TearLab
system in practice, providing
consistency of measurements. This, said
Mr Goad, would provide “an objective,
recordable and comparable” result, with
the ophthalmology clinic able to use the
data directly.
“We hope that we’re going to be
operating within the next couple of
months,” he offered, adding: “I’m really
excited, because I think this could be a
change to the way we measure dry eye
in this country.”
31/10/14 NEHW
system to classify the severity of the
condition ( Based on a
range of measurements, including; tear
break up, corneal staining, questionnaire
score and checking for meibomian gland
dysfunction; the DEWS score grades
patients from 1 – mild and episodic, to 4
– severe and/or disabling and constant,
suggesting a suitable treatment regimen.
But the committee also changed the
definition to incorporate elevated tear
concentration, or hyperosmolarity, as a
key factor accompanying inflammation
of the ocular surface.
Diversity at congress
OT’s clinical editor, Ian Beasley, shares highlights from the annual British Congress of Optometry
and Vision Science 2014, held in Wales last month
31/10/14 BCOVS
A HIGHER than usual police presence
on the streets of Cardiff on Monday
September 8 was no doubt related to
the hosting of the NATO summit, rather
than anticipation of unruly behaviour
from delegates attending the annual
British Congress of Optometry and
Vision Science (BCOVS) in the city.
Nevertheless, the two-day event, hosted
in rotation by university optometry
departments, once again proved popular
with academics, PhD students and postdoctoral researchers from around the
UK, keen to share the latest output from
their labs.
After a generous injection of preevent caffeine, the opening session was
in full swing by 9.30am. Practitioners
were welcomed with a diverse range of
presentations on offer, which included
the impact of perimetric stimuli area
on response variability across the
visual field, the effect of age on visual
short-term memory, and intriguing
observations on the vision and finemotor control in high-level cricketers.
Programme highlights
Presenting on the busy programme
was Professor Chris Tyler, famed for
his invention of the first random-dot
stereogram resulting in the popularised
‘Magic Eye’ images. His current
interests concern the consequences
of traumatic brain injury on human
vergence dynamics. Another highlight
on day one was keynote speaker Cathy
Williams, from Bristol Eye Hospital,
who shared her experiences of working
with children in her role as consultant
paediatric ophthalmologist.
The first day concluded with a
drinks reception followed by a wellattended meal at the popular Bellini’s
restaurant in the heart of the city, giving
the opportunity for delegates to catch
up with colleagues and meet new
acquaintances in a relaxed environment.
Despite delegates looking a little
fragile after a long first day and an even
longer evening for a brave few, day
two saw another round of impressive
presentations with representation from
the universities of Ulster, Cardiff, Aston
and Glasgow. Once again a range of
topics were up for discussion, with
insight into screening strategies for the
diagnosis of keratoconus in Down’s
syndrome, and the promise of a useful
clinical tool for practitioners giving
nutrition advice to patients with, or at
risk of age-related macular degeneration.
High calibre presentations
The meeting drew to a close with the
eagerly anticipated prize awards, a
task made difficult for the judges who
witnessed a high calibre of oral and
poster presentations. Although last
year’s winner for best presentation,
Andrew Logan from Glasgow
Caledonian University, delivered
another absorbing talk on a novel test
for face perception, he missed out to
the worthy winner, Samantha Strong,
from the University of Bradford, with
her research presentation Comparing
contralateral and ipsilateral differences
between human motion areas TO-1 and
TO-2: An fMRI-guided rTMS study.
Lesley Doyle, from the University
of Ulster, was highly commended
for her discussion on Exploration of
accommodative deficits and vergence
eye movements in Down’s syndrome.
The prize for best poster was awarded
to Glasgow Caledonian University’s
Marianne Piano, for her contribution
Perceptual visual distortions in
juvenile amblyopia, with Corinne
Fulcher, University of Bradford, also
acknowledged for her poster Duration
after-effects demonstrate spatial
Taking little credit for the
overwhelming success of the event,
organiser Professor Rachel North simply
said: “Thanks to all of the delegates for
making BCOVS 2014 such a vibrant and
interesting meeting.”
In keeping with tradition, the
abstracts are due to be published in
November’s issue of Ophthalmic and
Physiological Optics, the research
journal of the College of Optometrists.
With the location of next year’s meeting
still up for debate, the organisers will
have a tough task to match the standard
of the event in recent years.
OT reviews the latest clinical websites, apps and research papers on offer
by Kong, G, O’Neill, E, Gurria, L et al. free
evaluation (GONE) is a joint project with
the Royal Victorian Eye and Ear Hospital,
Centre for Eye Research Australia and the
University of Melbourne, Australia
Designed for use by ophthalmologists,
optometrists and orthoptists, it is
also useful for students and anyone
interested in eye health. The resource,
available as a website and an iPad app, is
designed to test and improve optic disc
assessment skills.
by Pumpun, free
THIS APP is designed to help you select
trial powers for Bausch & Lomb’s (B+L)
PureVision2 for Presbyopia multifocal
contact lenses and to aid refinement if you
need to improve distance or near vision
during the trial.
Simply enter the spectacle refraction
(without BVD) for right and left eyes,
including reading add and dominant eye,
and the app gives an initial lens power
recommendation. If the vision needs a
tweak, the calculator will give a new power
options based on the fitting guide, with
tips about room illumination. There are
supporting documents within the app
and a YouTube link to B+L’s ‘mechanism of
action’ video. A useful tool, but only if the
practitioner fits these lenses regularly. CSJ
Content: ● ● ● ● ❍
Usability: ● ● ● ● ❍
Value for money: N/A
GONE breaks down the skill of optic
disc examination into segments. The
user is shown a series of 42 optic
discs and asked to rate a number of
parameters for each, including: disc
size and shape, nerve fibre layer loss,
presence of haemorrhage and likelihood
of glaucoma. Users have 90 seconds to
assess each disc and results are shown in
detail at the end.
Users can compare their results with
other clinicians at varying levels of
experience, with results used to refine
the program and for research purposes.
This is an ongoing research project with
a total of 3,894 participants worldwide,
1,539 of which are optometrists.
Personally, I enjoyed the test and it
pays to take time to really stop and think
about disc assessment. CSJ
Content: ● ● ● ● ❍
Usability: ● ● ● ● ❍
Value for money: N/A
Contact Lens Toric
by Bausch & Lomb, free
THE SECOND Bausch & Lomb (B+L) app
can be used to calculate the initial trial lens
for all B+L soft toric contact lenses. Users
select the lens type they want, enter the
spectacle refraction and the recommended
trial lens power is shown in a bar below.
Then enter any rotation observed on the
eye and adjust the slider for the BVD and
the calculator will give the correct lens to
order. If entering a refraction out of range,
it will still calculate the theoretical power,
so practitioners can choose an alternative
contact lens. This, combined with a BVD
calculator, means the usefulness is not
confined to B+L products. Handy. CSJ
*Both apps require iOS 6.1 or later and
are compatible with iPhone, iPad and iPod
Content: ● ● ● ● ❍
Usability: ● ● ● ● ❍
CSJ Ceri Smith-Jaynes
Value for money: N/A
Blue filters
This paper by Lavric and Pompe
evaluated whether blue-filtering
intraocular lenses (IOLs) have any
impact on visual function.
A total of 30 patients with senile
cataracts in both eyes had an ultra
violet (UV) IOL implanted in one eye
and a UV + blue-light filtering IOL in
the other eye. The findings show no
significant difference in colour vision or
contrast sensitivity with blue-filtering
Lavric, A et al.
DOI: 10.1097/OPX.0000000000000390
Contact lenses
Thinning epithelium
Jiaxu Hong and colleagues suggest
long-term wear of soft contact lenses
(SCL) may result in thinning of the
corneal epithelium.
In this study of 40 SCL wearers
(two years or more) and 40 non-SCL
wearers, the group used OCT to
measure epithelial thickness at central,
paracentral and midperipheral zones of
the cornea.
The data show a significant reduction
in epithelial thickness in the SCL group
versus controls.
Hong, J et al.
DOI: 10.1097/OPX.0000000000000410
Lutein and zeaxanthin
Caroteinoid supplementation in 92
young, healthy adults led to significant
improvements in visual processing
speed, in this paper from Emily R Bovier
and colleagues.
They found that increasing macular
pigment density through supplements
of lutein and zeaxanthin resulted in
faster reaction times (up to 10%) and
critical flicker fusion thresholds.
The authors report the mechanism
“may involve fundamental changes to
cellular activity.”
Bovier, ER et al.
DOI: 10.1371/journal.pone.0108178
To access papers by DOI numbers, visit
31/10/14 CLINICAL
Students urged to book now
THE AOP is urging students who
wish to attend its Student Eye
Opener conference next month
to book as soon as possible to
avoid disappointment. Now in its
seventh year, the event is returning
to Center Parcs but for the first time
will be going to its Sherwood Forest resort in Nottingham (November
22 – 23). The two-day event is for all nine UK-based university
optometry departments and will include a gala dinner. For more
information, visit
NEW…3 Topcon University, George
Washington Hotel, Newcastle NE37 1PH.
Topcon Educational Symposia
NEW…3 Nottingham and Derby Optical
Society, Springfield Hall
Station Road, Sandiacre NG10 5BJ.
Corneal cross linking (
NEW…4 North East Optical Society, Jurys
Inn Hotel, Scotswood Road, Newcastle upon
Tyne NE1 4AD. CET lecture, Ocular tumours
([email protected])
NEW…6–7 Hertford Optometry and
Contact Lens Practice, The Salisbury
Arms, Fore Street, Hertford SG14 1BZ.
Specialist contact lens and sclerals meeting
([email protected])
NEW…7 Institute of Optometry, 56-62
Newington Causeway, London SE1 6DS.
Colorimetry in vision and education seminar
NEW…10 Lancashire Optical Society,
Brockholes Centre, Junction 31, M6 Samlesbury,
Preston PR5 0AG. Contact lens peer discussion
group ([email protected])
NEW…10–11 The Vision Care Institute
of Johnson & Johnson Medical, Pinewood
Campus, Nine Mile Ride, Wokingham
RG40 3EW. Returning to work –
confident and refreshed course (www.
NEW…11 SBK Healthcare Events,
DoubleTree by Hilton, 1 Auburn Street,
Manchester M1 3DG. Managing demand
in your ophthalmology service (
NEW…11 Surrey and South West London
branch of the AOP, Bourne Hall, Spring
Street, Ewell KT17 1UF. A vision for help
beyond optometry ([email protected]
NEW…12 Topcon University, Aston
University School of Life and Health
Sciences, Aston Triangle, Birmingham
B4 7ET. Topcon Educational Symposia
NEW…16–17 National Eyecare Group,
East Midlands Conference Centre, University
Park, Beeston Lane, Nottingham NG7 2RJ.
Building for success annual conference (www.
NEW…17 BCLA, Royal College of
Physicians, 11 St Andrews Place, Regents
Park, London NW1 4LE. BCLA Pioneers &
Visionaries Conference (
NEW…17 Midland Optical Society, The
Birmingham Medical Institute, 36 Harborne
Road, Birmingham B15 3AF. CET lecture:
Vitreomacular traction and advances in
4 The AOP, Holiday Inn Cardiff City
Centre, Castle Street, Cardiff CF10 1XD.
AOP Peer Review Roadshow
18 The AOP, Gipsy Hill Hotel, Gipsy Hill
Lane, Exeter, Devon EX1 3RN.
AOP Peer Review Roadshow
22–23, The AOP, Center Parcs,
Sherwood Forest, Newark,
Nottinghamshire, NG22 9DN. AOP
Student Eye Opener Conference
Practitioners are advised to
book as soon as possible to avoid
Publicise your event for free
through OT magazine and online
Simply send FULL details before
November 6, 2014 by emailing
[email protected] or
write to Robina Moss, OT deputy
editor, 2 Woodbridge Street,
London EC1R 0DG.
1. November 5 (7, 5)
1. Goes well with a broomstick (7)
7. Bus terminal (5)
2. Marital (7)
8. Soldier’s lodging (7)
3. Completely uninformed (2, 3, 4)
11. Crystal radio component (7)
4. Funny bone locale (5)
12. Speak softly (7)
5. King Arthur’s mother (7)
13. Peace award (5)
6. How sweet the sound of this
14. Pact (9)
hymn (7, 5)
16. One across was his demise (3, 6)
9. Cider source (5)
19. Merlin’s forte (5)
10. Abnormal protrusion of the
21. Pyrenee’s republic (7)
cornea (12)
23. Spanish wine punch (7)
15. Providing opposition (9)
24. Astronomical event (7)
17. Alpine warble (5)
25. Girl’s name meaning ‘beloved’ (5)
18. Degenerate (7)
26. Monkeys write about the big
19. Least possible (7)
apple anag. (3, 4, 5)
20. Flowery spots (7)
22. Mayle’s “____ in Provence” (1, 4)
Send entries to OT October Crossword, AOP, 2 Woodbridge Street, London EC1R 0DG by November 20. The winner of OT’s September competition was dispensing optician
Chris Burdis, of County Durham, who wins a £50 M&S giftcard.
Biotrue ONEday for PRESBYOPIA
Next Generation 3-Zone
Progressive Design™
Oxygen level the open
eye needs for healthy,
white eyes
Cornea’s water
content for all-day
Lipid layer using a surfactantenriched lens surface to retain
moisture and shape throughout
the day
UV protection1 to help protect
eyes along with sunglasses.
To order contact:
UK: 0845
1. Helps protect against transmission of harmful UV radiation to the cornea and into the eye. WARNING: UV-absorbing contact lenses are NOT substitutes for
protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses because they do not completely cover the eye and surrounding area. The
effectiveness of wearing UV absorbing contact lenses in preventing or reducing the incidence of ocular disorders associated with exposure to UV-light has
not been established at this time. You should continue to use UV-absorbing eyewear as directed. NOTE: Long term exposure to UV radiation is one of the risk
factors associated with cataracts. Exposure is based on a number of factors such as environmental conditions (altitude, geography, cloud cover) and personal
factors (extent and nature of outdoor activities). UV-blocking contact lenses help provide protection against harmful UV radiation. However, clinical studies
have not been done to demonstrate that wearing UV-blocking contact lenses reduces the risk of developing cataracts or other eye disorders.
BL 1393 BODfP 1pp Trade C #4 130514.indd 1
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ROI: 1800 409077 Fax 1800 409083
Email: [email protected]
Order online:
13/05/2014 15:48
Clinical editor’s corner
We have a broad range of CET on offer in this issue with the opportunity for optometrists to tick off no less than six out
of their eight core competencies. With content suitable for independent prescribers and coverage of some of the harder
to reach competencies for dispensing opticians, it’s a good chance to get ahead before we enter the final year in the
current cycle.
Ian Beasley
Expires in
Chloroquine and hydroxychloroquine
– optometric considerations
Christian French discusses the
potential for ocular adverse
reactions to chloroquine and
CET 2 PAGE 46 28
Expires in
Thyroid eye disease
31/10/14 CET
CET 1 PAGE 42 28
Optometrist, Mark Petrarca
provides detail on thyroid
eye disease with an overview
of the ocular findings and
management interventions.
Expires in
Binocular vision assessment
Andrew Millington presents a
range of images covering the
binocular vision competency.
Expires in
Nutrition and the eye: AREDS demystified
Nutrition counselling is an essential
part of optometric practice.
This video reviews the latest
literature concerning nutrition and
supplements including a discussion
of AREDS 2, the role of omega-3 fatty
acids, carotenoids, vitamins, and
trace minerals in ocular disease.
In the next edition...
CET events in November
7 Institute of Optometry, Colorimetry in clinical optometry education
11 SBK Healthcare, DoubleTree by Hilton, Manchester. Managing demand
in your ophthalmology service (
For the latest CET visit
Sponsored by
Chloroquine and hydroxychloroquine –
optometric considerations
Christian French MOptom (Hons), MCOptom
31/10/14 CET
Optometrists play a key role in identifying the possibility of ocular adverse reactions to systemic medication.
This article discusses the potential ocular manifestations that may be observed in patients taking
Course code: C-38251 | Deadline: November 28, 2014
Learning objectives
To be able to ask appropriate questions relating to systemic medication
(Group 1.1.1)
To be able to produce records with appropriate detail relating to advice on potential ocular adverse
reactions to systemic medication (Group 2.2.4)
To be able to understand the use of colour vision testing to identify acquired defects resulting from
systemic medication (Group 3.1.4)
To be able to recognise ocular adverse reactions to systemic medication (Group 6.1.15)
Learning objectives
To understand the potential for adverse ocular reactions to systemic medication
(Group 1.1.4)
To be able to ask appropriate questions relating to systemic medication
(Group 2.1.1)
About the author
Christian French is an optometrist working in private practice. He teaches in the undergraduate optometry clinics at Aston University and has
previously authored CET on the ocular implications of systemic disease.
- MON 9 2015
7, 8, 7
9 February
Excel London
100PC_optical_banner_187x28.5.indd 1
02/09/2014 16:33
Hydroxychloroquine is an analogue of
chloroquine, a drug most commonly
associated with the treatment of malaria.
The drug is also encountered in optometric
practice as a treatment option for
autoimmune disease. Chloroquine retinopathy
was unknowingly observed by Cambiaggi
in 1957 in a patient being treated with the
drug for systemic lupus erythematosus.1
However, because the retinopathy continued
to worsen after cessation of the drug, it
was not initially linked to chloroquine, and
it was a further two years before a case
of chloroquine retinopathy was correctly
identified.2 Hydroxychloroquine overtook its
parent molecule when studies revealed that
it had a comparable efficacy with significantly
less incidence of the toxic retinopathy.3 Since
that time, hydroxychloroquine has been
used in the treatment of rheumatoid arthritis
and systemic lupus erythematosus – both
conditions where the human body’s own
immune system begins to attack its own
healthy cells. The drug also shows promise
in immunological complications; it has
been found to reduce levels of plasma RNA
infected by the human immunodeficiency
virus (HIV), leading to a more stable disease
progression.3 While the drug has its benefits,
the major complication encountered
with chloroquine-based medications is
the associated retinopathy, and most
importantly, as shown by Cambiaggi’s paper,
its continuation after cessation of drug
intake. The risk of retinopathy developing
with hydroxychloroquine is much less than
its parent molecule,4 but given its relatively
widespread usage and the severity of the
retinopathy that can be caused, an awareness
Figure 1 Early chloroquine maculopathy
by healthcare professionals, particularly
optometrists, is crucial.
The actual pathophysiology of chloroquine
retinopathy is still not well understood and
while the stages of retinopathy development
have been categorised and are welldocumented, the actual mechanisms behind
them remains a mystery.4 Both chloroquine
and hydroxychloroquine are known to bind
to melanin molecules,5 which are prevalent
throughout the sub-retinal levels, thus meaning
that with long-term use, a combination of drug
build up in the choroid and retinal pigment
epithelium and the naturally slow excretion
rate of chloroquine from the body increases
the risk of ocular side effects.6 This could also
account for the disease progression after the
drug has been discontinued as the drug will not
be immediately excreted from the system. The
drugs are also known to affect the metabolism
of the photoreceptor cells. What remains
unclear is why the damage of cells adopts the
classic ‘bull’s eye’ pattern around the macula,
a hallmark of the condition, since there is no
structure or arrangement within the retina
which correlates to this pattern.4 Studies are
on-going, and a recent investigation has found
that chloroquine affects visual transduction
by altering the kinetics of an ion abundant in
the retina that is involved in the conversion
of light to a neuronal stimulus. Impeding
this transduction may help to account for
the decreased retinal activity and possibly
take us a step closer to understanding the
mechanisms more fully.7
Dosage risks
Chloroquine has to be present in the
bloodstream for a prolonged period and
at a relatively high dose for there to be a
significant risk of developing retinopathy.6,8
For chloroquine, the average daily dose is
250mg and if taken for less than a year (or a
cumulative dose of 100g) the risk of retinal
side effects developing are considered
negligible. This risk increases sharply when
the cumulative dose is higher – for example,
a 250mg dose taken daily for three years
(amounting to a cumulative dose of 300g)
carries a much higher risk of toxicity. There
are documented cases, however, where a
cumulative dose of more than 1000g has not
exhibited any pathological side effects.8
Hydroxychloroquine, in contrast, is
considered the safer variant,8 as daily doses
less than 400mg are not considered to carry
any risk of causing retinopathy although
practitioners should consider the possibility
if the patient is exposed to a high cumulative
Figure 2 Fluorescein angiography of chloroquine maculopathy
For the latest CET visit
31/10/14 CET
Systemic side effects
Retinopathy is not the only consideration
when taking chloroquine as systemic
toxicity is also possible. Gastrointestinal
disturbances (such as loss of appetite or
feeling nauseous), headaches or lightheadedness and skin reactions, such as
rashes or pruritus (itching of the skin)
are all recognised adverse reactions to
31/10/14 CET
Effects on colour vision
With the progression of the retinopathy,
colour perception can also be disturbed,
typically manifesting as blue-yellow deficits
and associated protanomalous defects in
the red end of the spectrum.9 Clinically, this
would manifest similarly to a congenital
tritanomalous defect causing problems
with violet, blue and green colours. With
time, this defect develops into more of
a red-green defect. The implication that
this poses on the use of routine colour
vision tests in the examination of a patient
taking chloroquine is that they are mostly
designed to detect congenital red-green
defects, and so the earlier, subtle colour
perception changes in the blue-yellow
region of the spectrum could be missed
by these tests. The most sensitive tests
for detecting these changes are the
Hardy-Rand-Rittler pseudo-isochromatic
plates (HRR) and the Standard Pseudoisochromatic Plates – Part 2 (SPP-2),9
the latter of which has been designed
specifically for the screening of acquired
blue-yellow defects.10 Ishihara is not
considered to be sensitive enough to
detect these changes. Given the early loss
of blue-yellow colour perception, it has
been suggested that blue-yellow perimetry,
which has previously been used in
glaucoma screening, may be well suited to
monitor and detect these earliest changes.11
Figure 3 Advanced maculopathy
Stages of retinopathy
The progression of chloroquine retinopathy
can be broken down into five stages.8 Firstly,
in pre-maculopathy vision is normal with a
mild defect in colour vision, presenting as a
red-deficient scotoma in a parafoveal region
4–9° from fixation. Sensitive colour vision
tests are required for this. It may also be
possible to detect a mild defect on Amsler
grid testing. If intake of chloroquine is ceased
at this point, visual function often returns to
normal. Continued usage of the drug leads to
the development of early maculopathy, which
features vision dropping to 6/9 – 6/12 with a
paracentral scotoma and the earliest signs of
the classic ‘bull’s eye’ macular lesion beginning
to show (see Figure 1, page 43).11
The central fovea appears as an isolated,
pigmented island, surrounded by an
annulus of atrophied, depigmented retinal
pigment epithelium, itself encompassed by
a hyperpigmented region. Since the fovea is
relatively unscathed, central vision remains
reasonable. Given the location of the defect
this may be pictured more effectively with
fluorescein angiography than conventional
fundus examination techniques (see Figure 2,
page 43).
Once this stage has been reached, cessation
of chloroquine will not necessarily halt the
progression of retinopathy. In moderate
maculopathy, vision reduces further to
Points for Optoms, DOs, CLOs and IPs
6/18–6/24 and the macular lesion becomes
more pronounced as the atrophy develops.
With advanced maculopathy, the atrophy of
the retinal pigment epithelium is much more
widespread and vision drops further to 6/36 –
6/60 (see Figure 3).
End-stage maculopathy leaves the eye with
severely reduced visual acuity and the extent
of atrophy within the retinal pigment
epithelium means that the choroidal vessels
beneath become visible (see Figure 4). There is
attenuation of the retinal arterioles and in the
peripheral retina, bone spicule pigment clumps
can be observed. Optic nerve pallor and near
total visual field loss may be present along with
an extinguished electro-retinogram (ERG).12
Other ocular effects
Besides the classic retinopathic and colour
perception changes, chloroquine can have
other effects on the visual system. Similar to
patients taking amiodarone, chlorpromazine
and tamoxifen, those taking chloroquine
can exhibit whorl-like corneal deposits, or
verticillata, similar to vortex keratopathy,6,13
or a Hudson-Stähli pigmented line found
running horizontally across the lower third of
the cornea. These deposits can appear as early
as three weeks into treatment with chloroquine
and are known to disappear when the drug is
stopped. Given their early onset, presence of
these corneal changes could be an indicator
of incipient retinopathy developing. There
is the rare possibility of chloroquine causing
myasthenic syndrome, and this is even less
often reported with concurrent retinopathy. In
one such incidence, the treating medical team
felt that there was likely to be a pre-existing
deficiency at the neuro-muscular junctions,
which led to the onset of the myasthenic
symptoms, which had been exacerbated by
the chloroquine. Myasthenic syndrome as a
general side effect to the medication is known
to resolve once the drug is stopped.12
Reflective learning
Having completed this CET exam, consider whether
you feel more confident in your clinical skills – how will
you change the way you practice? How will you use this
information to improve your work for patient benefit?
Given the presenting signs and symptoms
of chloroquine retinopathy a number of
conditions can be give rise to a similar
presentation.13 Early macular changes,
including the granular appearance, could
potentially be mistaken for signs of age-related
macular degeneration. The characteristic ‘bull’seye’ maculopathy is more limited in its possible
causes. Stargardt’s disease, cone dystrophy and
benign concentric annular macular dystrophy
can all give rise to a similar appearance but
through an efficient history and symptoms,
a structured list of possible diagnoses can be
built up and medical history including past and
current medications would reveal chloroquine
or hydroxychloroquine usage.
Upon referral, more in-depth investigations,
including ERG can help to give a clearer
indication. Presence of corneal deposits would
also rely on a thorough medical history to
reveal any other medications linked with
vortex keratopathy.
Optometric considerations
Screening for chloroquine retinopathy is not
performed in the UK, unlike North America,
where patients taking the medication are
routinely monitored for any changes which
may indicate the development of retinopathy.14
The argument for not screening is the
increasingly rare occurrences of toxicity being
reported, particularly with awareness of the
side effects and appropriate dosages. In terms
of relevance to the practising optometrist,
what must be considered is that since there
is no screening program for patients taking
this medication, it becomes more important
for the routine eye examination to include
appropriate investigations. The tailoring of
Figure 4 End-stage maculopathy
the eye exam to include the use of one of
the aforementioned colour vision tests or a
central visual field examination (including
Amsler grid testing) would be wise, along
with a full slit-lamp examination to check
for both corneal deposits and any signs of
retinopathy. Digital retinal imaging or optical
coherence tomography (OCT) would be
useful and allow a more detailed analysis
at subsequent visits. A combination of tests
will yield the most sensitive and specific
investigation into the drug and any potential
adverse reaction, since it has been noted
that patients suffering from chloroquine
retinopathy can exhibit visual field changes
yet have a clinically normal OCT scan and
vice versa.15 Feedback of these findings to
the prescribing clinician both ensures interprofessional communication but also an
increased awareness of the capabilities of the
optometrist in patient co-management.
Consideration of patients who may not
be suitable from an optometric perspective
An increased awareness of the potential
adverse effects of the drug will lead to
a tailored eye examination allowing the
practitioner to educate the patient on signs
and symptoms to be aware of and ensure any
such changes can be detected at the earliest
Exam questions
Under the enhanced CET rules of the GOC, MCQs for this exam appear online
at Please complete online by midnight on
clinical, click on the article title
November 28, 2014. You will be unable to submit exams after this date. An-
and then on ‘references’
swers will be published on and CET
to download.
points will be uploaded to the GOC every two weeks. You will then need to
log into your CET portfolio by clicking on ‘MyGOC’ on the GOC website (www. to confirm your points.
31/10/14 CET
Differential diagnosis
to take chloroquine
should also be noted
and communication
with the prescribing
clinician regarding
such concerns may
also be required.
Since the earliest
stages of toxicity
manifest themselves
as subtle parafoveal
function loss,
any pre-existing
maculopathy may
mask these changes,
and if severe enough
may even make the
toxicity screening
tests difficult to
perform at all. Despite there being no specific
evidence, it should be noted that older
patients might not be suitable to take the
drug. If they have macula changes present
it may make them more susceptible to
developing chloroquine retinopathy as the
macular may already be compromised. A final
consideration, though again no evidence
exists to support the claim, is the possibility
of a genetic predisposition to develop
chloroquine retinopathy. Nevertheless, a
positive family history of toxicity should
be recorded and these patients monitored
Sponsored by
Thyroid eye disease
Mark Petrarca BSc (Hons) MCOptom
31/10/14 CET
Optometrist, Mark Petrarca details the clinical features of thyroid eye disease covering the ocular manifestations,
prevalence, underlying patho-physiology and treatment options for the patient.
Course code: C-38256 | Deadline: November 28, 2014
Learning objectives
To be able to elicit relevant detail from patients with thyroid eye disease (Group 1.1.1)
To be able to recognise the ocular features of thyroid eye disease (Group 6.1.13)
To be able to investigate binocular vision anomalies resulting from thyroid eye
disease (Group 8.1.2)
Learning objectives
To be able to explain to patients about the implications of thyroid eye disease
(Group 1.2.4)
To be able to understand the management options for binocular vision anomalies
resulting from thyroid eye disease (Group 7.1.5)
To be able to understand the ocular manifestations of thyroid eye disease
(Group 8.1.5)
Learning objectives
To be able to understand the natural progress of thyroid eye disease (Group 1.1.1)
To be able to elicit relevant detail from patients with thyroid eye disease (Group 2.1.1)
About the author
Mark Petrarca is an optometrist currently undertaking medical and surgical training at St Bartholomew’s Hospital and the London School of
Medicine and Dentistry.
- MON 9 2015
7, 8, 7
9 February
Excel London
100PC_optical_banner_187x28.5.indd 1
02/09/2014 16:33
Thyroid eye disease (TED) is a condition in
which ocular abnormalities are associated
with disorders of the thyroid gland. TED
has the potential to cause permanent
visual impairment, ocular discomfort, facial
disfigurement and a significantly reduced
quality of life.1 This article will provide
both an introduction to thyroid disease
and an overview of the associated ocular
abnormalities that are relevant to the eye care
Structure and function of
the thyroid gland
Pituitary Gland
The thyroid gland is located in the anterior
31/10/14 CET
neck beneath the larynx (voice box) and sits
on both sides of the trachea. It consists of two
large lobes connected by a narrow strand of
thyroid tissue called the isthmus. The gland is
highly vascular and richly supplied with nerves
from the autonomic nervous system.
The thyroid gland is composed of over a
million follicles (acini). Each follicle is lined
by a single layer of secretory epithelial cells,
surrounding a colloid-filled centre. These
cells secrete thyroglobulin, a precursor of
the thyroid hormones, into the colloid. On
activation the thyroglobulin is re-absorbed,
converted into the thyroid hormones
triiodothyronine (T3) and thyroxine (T4), and
then released into the circulating bloodstream.
The thyroid hormones are important
regulators of the body’s metabolism.2
Regulation of the thyroid
T3, T4
Figure 1 Negative feedback regulation of the hypothalamic-pituitary-thyroid axis
The production of thyroid hormones is
regulated by both the hypothalamus and the
pituitary gland. The hypothalamus is located
the release of thyroid stimulating hormone
at the base of the forebrain beneath the
(TSH). This enters the bloodstream and travels
thalamus and posterior to the optic chiasma. It
to the thyroid gland, where it binds to the TSH
an over-secretion of thyroid hormones and
coordinates the endocrine system and acts as
receptors on the thyroid gland and stimulates
affects about one percent of the population.5
a bridge between this and the nervous system.
the production of T3 and T4. Once the required
It is usually caused by an autoimmune disease
It translates neural messages from the cerebral
thyroid hormone levels have been achieved,
known as Graves’ disease, but other causes
cortex into chemical (hormonal) signals called
the T3 and T4 feedback to the hypothalamus
include thyroiditis (inflammation of the thyroid
‘releasing hormones’; one of these is called
and the pituitary gland, inhibiting further
gland), toxic adenomas (benign thyroid
thyrotrophin releasing hormone (TRH) and
release of TSH and TRH.
hormone producing tumours), toxic nodular or
Hyperthyroidism is a condition that results from
Together the thyroid gland, pituitary gland
multinodular goiters (nodular growths on the
and the hypothalamus form the hypothalamic-
thyroid gland), thyroxine overdoses and excess
hypothalamus and optic chiasma, within a
pituitary-thyroid axis, a form of negative
iodine dietary intake. The thyroid gland is often
bony hollow of the sphenoid bone. The TRH
feedback control system (see Figure 1), which
enlarged and when it becomes visible in the
secreted by the hypothalamus reaches the
is used to maintain the levels of thyroid
neck it is known as a goitre.
pituitary gland via the portal veins and causes
hormones within narrow limits.3, 4
acts on the pituitary gland.
The pituitary gland is found beneath the
Patients with hyperthyroidism typically
For the latest CET visit
of commonly used anti-thyroid drugs that are
effective in reducing the production of thyroid
hormones. Treatment with one of these drugs
typically lasts between six months and two
years and results in a long-term remission
in around half of patients once the drug is
Radioiodine is a radioactive isotope of iodine
(131-I) that is taken up and concentrated by the
thyroid gland. In most people the radioactivity
is sufficient to gradually destroy the thyroid
tissue, over six weeks to six months after a
31/10/14 CET
single dose. Following the treatment, patients
are monitored for under activity. This is because
patients can switch from hyperthyroidism to
hypothyroidism, a relatively common side effect
of the treatment and has become an accepted
consequence. Hyperthyroidism is a far more
serious condition, whereas hypothyroidism
presents less of a threat and once controlled
with thyroxine replacement has no side effects.7
Thyroid surgery
Patients who have been unsuccessful with
anti-thyroid drugs or are deemed unsuitable
for radioiodine therapy are offered a surgical
Figure 2 Magnetic resonance imaging of the orbits, showing congestion of the retro-orbital
space and enlargement of the extraocular muscles indicated by the arrows
solution. Surgery to remove most or all of the
thyroid gland (subtotal or total thyroidectomy)
is another way of permanently treating
present with general features that are caused
Treatment of hyperthyroidism
thyroid over activity. However, like radioiodine
by an increased basal metabolic rate (BMR).
treatment, hypothyroidism is a commonly
Such features include; weight loss, sweating,
Beta-blockers are a group of drugs that
recognised side effect.9
tremor, heat intolerance, agitated/nervous
are used to treat some of the symptoms
disposition, and general fatigue. Cardiac
and manifestations of hyperthyroidism. In
function can be affected due to increased
particular, they can improve palpitations, slow
Hypothyroidism is due to an underactive
beta-adrenergic activity, leading to symptoms
the heart rate down and improve tremors.
thyroid gland and results in a deficiency of
of palpitations caused by tachycardia and atrial
However, they have no effect on curing the
thyroid hormones. Thyroid hormones are
fibrillation. Neuromuscular functions can be
thyroid overactivity.
essential for normal development between
birth and puberty and a deficiency causes
reduced resulting in muscle weakness. Other
signs include diarrhoea, vomiting, infertility
Anti-thyroid drugs
irreversible mental retardation. Hypothyroidism
and disorders in menstruation.6
Carbimazole and propylthiouracil are examples
can be caused by Hashimoto’s thyroidism,
Points for Optoms, DOs, CLOs and IPs
Reflective learning
Having completed this CET exam, consider whether
you feel more confident in your clinical skills – how will
you change the way you practice? How will you use this
information to improve your work for patient benefit?
Class 0
No physical signs or symptoms
Class 1
Only signs
Class 2
Soft tissue involvement
Class 3
Class 4
Eye muscle involvement
Class 5
Corneal involvement
Class 5
Sight loss due to optic nerve involvement
Table 1 The NOSPECS classification for eye changes in TED
iodine deficiency or secondary to previous
treatments of hyperthyroidism. Many of the
31/10/14 CET
general features seen in hypothyroidism
are the opposite of those associated with
hyperthyroidism. A reduced BMR leads to
weight gain, cold intolerance, slowing of
activity, constipation and bradycardia. Other
signs include a pale, puffy face, coarse/
thinning hair and loss of the outer third of the
eyebrows and altered mental state.6
Treatment of hypothyroidism
Figure 3 Bilateral lid retraction
Hypothyroidism is predominantly treated
with thyroxine (or levothyroxine). The aim of
patients with all forms of clinical TED is about
are seen in patients with autoimmune
the treatment is to reverse the symptoms of
6:1. Although it is more common in women,
hypothyroidism, either Hashimoto’s
hypothyroidism by normalising the blood
men tend to exhibit a more aggressive form
thyroiditis Hashitoxicosis or atrophic
TSH levels by negative feedback. Treatment
of the disease.
thyroiditis. The remaining 10% of cases are
with replacement thyroxine is almost always
A significant modifiable risk factor for TED
Thyroid eye disease
seen in patients with normal thyroid function.
is cigarette smoking.14 Smokers are up to six
When thyroid function is normal, the eye
times more likely to develop TED. Genetic
condition is referred to as euthyroid Graves’
factors also appear to play a role in TED, but
Approximately 30-50% of patients with
their specific contributions have yet to be fully
thyroid disease will experience ophthalmic
TED is an autoimmune disorder, in which the
manifestations, and of these patients 3-5%
Graves’ disease, Graves’ ophthalmopathy
and TED
body produces antibodies to the receptor
is the most common orbital disorder in adults
worldwide and the leading cause of unilateral
The name Graves’ disease describes an
These antibodies bind to the TSH receptor
and bilateral proptosis (exophthalmos),
autoimmune disorder that affects the
and chronically stimulate it leading to an
acquired strabismus, and lid retractions.
thyroid, eyes and skin, whereas Grave’s
increased production of thyroid hormones
ophthalmopathy refers specifically to the
(T3 and T4). This, in turn, causes the clinical
ocular manifestations of Graves’ disease.
symptoms of hyperthyroidism.
will develop sight-threating disorders. TED
Risk factors
for thyroid stimulating hormone (TSH).16
Graves’ ophthalmopathy and thyroid
It is believed that the thyroid gland and
presents with an incidence of 16 women per
eye disease are terms that are often used
the ocular adnexa share a common antigen
100,000 and three men per 100,000. Incidence
interchangeably in the literature, as ocular
which is recognised by the antibodies.
rates for TED also show an apparent bimodal
manifestations of thyroid disease are mostly
Antibodies binding to the extraocular
peak for both men and women. The age of
associated with Graves’ disease. Approximately
muscles initiate a cascade of events that
onset is typically 40 to 44 years and 60 to 64
80% of all patients with TED have the
lead to the release of cytokines and other
years in women, and 45 to 49 years and 65 to
autoimmune hyperthyroid disorder known
inflammatory mediators, resulting in
69 years in men.12 The female to male ratio of
as Graves’ disease. However, 10% of all cases
proliferation of orbital fibroblasts, expansion
Epidemiological studies suggest that TED
For the latest CET visit
of adipose tissue and enlargement of
and is demonstrated by asking the patient to
extraocular muscles. This inflammatory
look downwards. The upper eyelid will follow
increase in the periorbital and orbital
but with a slight delay (von Graefe’s sign).
structures is responsible for the ocular
Soft tissue inflammation
manifestations of TED.
Patients will report orbital pain as a
Clinical features
consequence of the inflammation and swelling
TED begins with the active phase, in which
of the soft tissues and discomfort due to
there is periorbital and orbital inflammation
the increased intraorbital pressure. There is
leading to the onset of ocular symptoms. This
often notable conjunctival hyperaemia and
phase usually lasts between one to two years
might also be associated with oedema of the
before it spontaneously remits. The active
conjunctiva and eyelids as well as enlargement
phase is then followed by a plateau phase,
of the lacrimal gland.24
where symptoms generally stabilise or may
31/10/14 CET
show some improvement before entering the
Figure 4 Proptosis in thyroid eye disease
there is reactivation of TED.
Proptosis (exophthalmos)
There is a limited space inside the orbit and
inactive phase.18 However, in 5-10% of cases
a classification system known as ‘NOSPECS’
so as the tissues swell, the eyeball is pushed
was developed to provide a framework in which
forward. Patients with TED will, therefore,
associated with TED does not necessarily
to assess the severity of disease (see Table 1,
present with a non-pulsatile axial proptosis
correlate with thyroid function. TED can
page 49).21
(see Figure 4). The severity of proptosis can
The course of ophthalmic changes
precede or succeed the thyroid disease,
be quantified and monitored by either an
majority of patients.19 It is a bilateral condition
Ocular manifestations of
thyroid eye disease
in the majority of patients and it is common
The most common and specific clinical finding
for the disease progression to be asymmetric.
of TED is eyelid retraction, occurring in about
Ocular motility dysfunction
It is unusual for unilateral eye disease to occur,
91% of these patients. This is followed by
Enlargement and fibrosis of the extraocular
affecting only 5% to 14% of patients.20
proptosis (62%); motility dysfunction (43%);
muscles leads to restricted eye movements. The
pain (30%); epiphora (23%); and compressive
inferior rectus muscle is the most commonly
optic neuropathy (6%).22
affected, followed by the medial, superior then
usually within 18 months of each other in the
Diagnosis and grading
Diagnosis of TED is largely clinical, based
exophthalmometer or radiologically with
orbital scans.
lateral rectus with ocular movements usually
on a thorough patient history and typical
Lid retraction
worst on upgaze.25 Patients frequently complain
ocular examination findings. All patients
In healthy individuals, the upper eyelid rests
of diplopia in the morning, which gradually
presenting with TED for the first time should
at 1-2mm below the superior limbus (corneal-
improves and then worsens again on tiredness.
have endocrinological referrals so that the
scleral junction) and the lower eyelid just below
Others may suffer constant vertical diplopia and
appropriate thyroid specific blood tests can
the inferior limbus. However, in patients with
will adopt an abnormal head tilt to compensate.
be performed to evaluate thyroid function.
TED there is a gradual retraction of the eyelids
Diplopia is often the most debilitating visual
Occasionally, imaging investigations such
due to fibrosis of the eyelid muscles resulting in
symptom in TED, affecting 17% of patients.
as CT and MRI may be needed to confirm
exposure of the underlying sclera (Dalrymple’s
swelling and inflammation of the orbital
sign). Patients, therefore, present with a
restriction is an increase in the intraocular
tissues (see Figure 2, page 48).
characteristic startled appearance or ‘stare’. Lid
pressure (IOP) of the eye, particularly when in
retraction is one of the earliest signs of TED (see
upgaze. IOP can increase 6mmHg or more in
Figure 3, page 49). Lid lag may also be observed
upgaze compared to the primary position.26 It
Thyroid eye disease can present with a
variety of signs and symptoms. For this reason,
Points for Optoms, DOs, CLOs and IPs
A secondary consequence of muscle
is believed that the increased orbital congestion
fistulas, idiopathic orbital inflammation
contributing to the autoimmune response.33
and tightening of the inferior rectus muscle
(pseudotumour), and orbital tumours. In such
Glucocorticosteroids and orbital radiotherapy
blocks episcleral aqueous outflow.
cases, orbital imaging performed in hospital
are often used together due to their synergistic
may be needed to differentiate between these
effect.34 The glucocorticosteroids provide a
rapid improvement while the radiotherapy
A consequence of upper lid retraction,
proptosis and tear film deficiency is an
increasingly exposed cornea. Patients may
report symptoms of gritty, irritable eyes,
photophobia and blurry vision. Examination
of the cornea may reveal superficial keratitis.
In severe cases it can lead to corneal ulceration
and perforation.27
Dysthyroid optic neuropathy
The optic nerve emerges from behind the
eyeball and travels posteriorly towards the
back of the orbit to enter the optic canal. Along
its path it can become compressed, inflamed,
ischaemic or mechanically stretched by the
abnormally enlarged surrounding extraocular
muscles and orbital tissues leading to
dysthyroid optic neuropathy (DON). Signs of
optic neuropathy can include a drop in visual
acuity, colour vision abnormalities, visual field
defects, afferent pupillary defects or optic disc
swelling. Patients of Asian origin appear to be
at a greatest risk of developing DON as it is
believed they have a tendency for shallower
orbits, which increases the likelihood of its
occurrence.28 Optic neuropathy of this nature
delivers a longer more sustained effect. An
Management of thyroid
eye disease
unfortunate side effect of both treatments is
that they contribute to cataract formation.35
Smokers should be encouraged to participate
TED is a condition that is best managed using
a multidisciplinary approach with a team
in cessation strategies. Studies have confirmed
of healthcare professionals collaborating
that smoking decreases the efficacy of orbital
together to give the patient the greatest overall
radiotherapy and systemic corticosteroid
care.29 Patients with TED are, therefore, likely
treatment, and increases the risk for progression
to receive treatment from ophthalmologists,
of disease after radioactive iodine treatment.36
Orbital decompression is a surgical
endocrinologists, general practitioners,
optometrists and orthoptists. Treatment for TED
procedure that is used when the optic nerve
is dependent upon the severity of the disease.
is compromised, or there is cosmetically
However, in all cases the main aim of treatment
unacceptable proptosis or chronic corneal
is be to minimise harm to the eyes during the
exposure. The surgery involves removal of bony
active inflammatory phase of the disease and
components of the orbit creating extra space
correct any long-term complications that remain
for the swollen orbital contents to expand into
once the disease has entered the dormant
thereby relieving pressure on the optic nerve
phase. Fortunately the majority of patients
and reducing proptosis.37 It does not, however,
have only mild complications and do not
correct problems of diplopia, and so further
require specific or aggressive treatment. Studies
extraocular muscle corrective procedures
have shown that most patients will require no
would be required. Surgery to treat diplopia
treatment or supportive measures only.
and improve cosmetic appearance of the lids
Optometrists are ideally placed to provide
many of these supportive measures. If
corneal dryness becomes an issue, ocular
is usually performed once the disease has
entered the dormant phase.38
lubricants can be used to minimise symptoms
of gritty, irritable eyes. Prismatic corrections
In general practice, optometrists will examine
(or patching) can be beneficial in cases of
many patients with thyroid abnormalities,
diplopia.31 If, however, TED is severe, more
with the vast majority already receiving medical
specific and aggressive therapy is required.
care. However, some patients will present
High dose glucocorticosteroids such as
to the optometrist first with eye complaints.
When considering a diagnosis of TED it is
prednisolone, which have anti-inflammatory
Practitioners should, therefore, always be
important to consider other diseases that
and immunosuppressive properties, are used.32
aware of the various signs and symptoms,
Orbital radiotherapy is used for its general
be able to provide supportive measures if
is considered an emergency and needs to be
seen and treated by a hospital eye department
Differential diagnosis of TED
may present similarly. Other orbital diseases
that need to be considered include orbital
anti-inflammatory effect and ability to target
appropriate, and refer patients that require
or preseptal cellulitis, carotid-cavernous
the lymphocytes infiltrating the orbit and
further investigations and treatment.
Exam questions
Under the enhanced CET rules of the GOC, MCQs for this exam appear online
at Please complete online by midnight on
clinical, click on the article title
November 28, 2014. You will be unable to submit exams after this date. An-
and then on ‘references’
swers will be published on and CET
to download.
points will be uploaded to the GOC every two weeks. You will then need to
log into your CET portfolio by clicking on ‘MyGOC’ on the GOC website (www. to confirm your points.
31/10/14 CET
Exposure keratopathy
Binocular vision
Andrew Millington MSc, MCOptom
31/10/14 VRICS
This assessment provides an opportunity for optometrists to meet their CET requirement for the binocular
vision competency with a range of images presented by optometrist, Andrew Millington.
Course code: C-37505 | Deadline: December 26, 2014
Learning objectives
To be able to understand the tests used to assess binocular vision in children
(Group 7.1.3)
To be able to identify children presenting with an anomaly of binocular
vision (Group 8.1.5)
Learning objectives
To be able to understand the tests used to assess binocular vision in children
(Group 7.1.5)
About the author
Andrew Millington has worked in a number of clinical settings since graduating from Cardiff University in 1986. For the last 20 years he has
co-owned a successful community-based family run practice. He has an active role in the Special Assessment Clinic at Cardiff University, where
he is responsible for undergraduate teaching as well as performing eye examinations. He also teaches the Master’s degree course modules for
Paediatric Optometry and Learning Difficulties.
Images A, B and C courtesy of BIB Ophthalmic Instruments. Image D courtesy of Keeler Ophthalmic Instruments
- MON 9 2015
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9 February
Excel London
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Exam questions
Under the enhanced CET rules of the GOC, MCQs for this exam appear online
at Please complete online by midnight
clinical, click on the article title
on December 26, 2014. You will be unable to submit exams after this date.
and then on ‘references’
Answers will be published on and
to download.
CET points will be uploaded to the GOC every two weeks. You will then need
to log into your CET portfolio by clicking on ‘MyGOC’ on the GOC website
( to confirm your points.
Which of the following statements regarding the test
type shown is incorrect?
a The test is available in two versions
b It requires the patient to wear polarising filters
c The card should be held at 40cm from the patient
d It can be used to grade stereo acuity to 200”
02 If a patient records stereo acuity of 600” with this test
they will be able to see:
a Cat, car and star (Version I)
b Cat and star (Version I); star and elephant (Version II)
c Cat, star (Version I); star, truck and elephant (Version II)
d Truck, elephant and moon (Version II)
The star on Version II of the test will be visible to
a With stereo acuity of 60”
b Who are monocular
c With stereo acuity of 600”
d All of the above
Which of the following statements regarding the
instrument shown is incorrect?
a It is useful for diagnosing decompensated heterophoria
b It is used to measure dissociated phoria
c It detects fixation disparity
d It measures the aligning prism/sphere that eliminates
the fixation disparity
05 The instrument should be used in combination with:
a Red/green filters
b Cross-polarising filter
c No filter
d Bagolini lenses
06 Which of the following statements is correct?
a The instrument has a peripheral fusion lock
b The instrument has a central fusion lock
c The instrument has a foveal suppression test
d The instrument principally tests amplitude of
For the latest CET visit
31/10/14 VRICS
Visit for all the information about enhanced CET requirements
08 Which of the following statements regarding the
test shown is incorrect?
a It can measure stereo acuity in the range 600-15”
b It is also available as a screening test for younger
children and infants
c Parallax movements can provide monocular cues
d Specially designed polarising filters for use with infants
are required
31/10/14 VRICS
Which of the following tests is shown in the image?
a Randot test
b Frisby test
c TNO test
d Titmus test
09 The normal stereo acuity for a six-month-old when
using this test would be:
a 60”
b 15”
c 600”
d No stereopsis at this age
The test shown is used to measure:
a Associated phoria
b Fixation disparity
c Convergence
d Dissociated phoria
Which of the following statements regarding the
test is incorrect?
a It helps the practitioner to decide if the heterophoria is
b It is useful for measuring the size of heterophoria
c It can be used to monitor the magnitude of the
heterophoria over time
d It can be used to measure vertical and horizontal
Which of the following statements relating to fusional
reserves is incorrect?
a They can be measured using a prism bar
b They indicate the patient’s ability to overcome their
c Percival’s criterion states that the fusional reserve that
opposes the heterophoria should be equal to the
d Sheard’s criterion states that the fusional reserve that
opposes the heterophoria should be at least twice the
References to aid completion Visit, click on the article title and then on ‘references’ to download.
Points for Optoms, DOs, CLOs and IPs
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