association of british dispensing opticians - do …contact taylor lenses on 01256 819992 do...

dispensingopticsDispensing Optics

PO Box 233, Crowborough TN6 9BD

Telephone: 01892 667626

Fax: 01892 667626

Email: [email protected]

Website: www.abdo.org.ukJune 2009

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ABDO actively works inconjunction with:

3 Cover pointby Tony Garrett

4 Continuing Educationand TrainingA drop of the wet stuff - part oneby Angela McNamee

12 Optrafair reviewInnovations all roundby Cliff Williams

18 Health and safety part fourAn appointment with theregulations: the powers of theinspectorsby Mike Hall

19 Optician IndexMarch 2009 summary

20 FramesFashion with passionby Ann Johnson

24 Patient and practicemanagementReduce costs - but not headcountby Anna West and Adam Rice

26 Newsbrief

26 Points from the President

28 News from Ireland

36 Disjointed jottings from aDO’S desk . . .Life after cataractsby Ian Anderson

37 Book reviewAbnormal Ocular Conditions

38 CET answersThe importance of spectacles forcontact lens wearers

39 Diary of Events

June 2009

The Worshipful Companyof Spectacle Makers

CET points and contact lensopticiansI was rather surprised by the findingsreported in Optician regarding theclaim that the number of contact lensopticians acquiring CET points werewell below the number of CLOs inABDO membership. I was even moresurprised that the GOC apparentlyhad serious concerns about this asthey had not relayed those concernsto the Association.

There are a number of points toconsider. First of all there are someCLOs who still work in optics inmanagement, manufacturing or saleswho retain their ABDO qualifications

but as they are not practising do notundertake the additional points. Theremay be a few members who aredeliberately flouting the rules but giventhe furore about the unjust additionalburden on CLOs few, if any, cannotbe unaware of this requirement.ABDO’s position is absolutely clear onthis, all the while that the GOC requiresthese additional points to be obtainedthere is no excuse for not doing so andthe Association cannot defend thosewho deliberately break the rules.

That said, we intend to make strongrepresentations again to the GOC thismonth about the absurdity of thecurrent situation whereby CLOs whoundertake extensive training and arigorous examination are expected togain extra points while optometrycolleagues, who do progressively lesstraining and who often fit few lenses,can happily sail on without having toobtain a single contact lens point. Ifpublic safety is an issue then the GOCneeds to act straight away.

Tony Garrett �

Cover point

C O N T E N T S33 dispensingoptics

Front cover:Trivex is thin, light, verystrong combined withexcellent opticalquality. For more detailscontact Taylor Lenseson 01256 819992

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4 dispensingoptics June 2009

This article has been approved for 2 CL CET points by the GOC (which can be confirmed as generalpoints by dispensing opticians or CLOs). It is open to all FBDO members, including associate memberoptometrists. Insert your answers to the twelve multiple choice questions (MCQs) on the answer sheetinserted in this issue and return by 16 July 2009 to ABDO CET, Courtyard Suite 6, Braxted Park, GreatBraxted, Witham CM8 3GA OR fax to 01621 890203, or complete online at www.abdo.org.uk. Notificationof your mark and the correct answers will be sent to you. If you complete online, please ensure that youremail address and GOC number are up-to-date. The pass mark is 60 per cent. The answers will appearin our June 2009 issue. C-11271

Life used to be so much easier forthe practitioner faced with a

patient who appeared to be sufferingfrom dry eyes. Dry eye preparationswere few; those in the practice weremainly targeted at contact lenswearers, and the non-wearers wouldgo to their GP, who would probablyprescribe Hypromellose.

Now the range of dry eyepreparations which is available in theUK market is staggering, andpotentially very confusing. How cantoday’s practice owner decide whichones to stock, and how can today’spractitioner decide which ones toprescribe?

This article attempts to answer thosequestions. In part one the signs,symptoms, causes and types of dryeye are outlined, as well as somealternative approaches to itstreatment. Part two will look at therange of currently available dry eyepreparations and their uses.

The tear filmThe traditional model of the tear film1

describes three layers: a superficiallipid layer, an aqueous layer, and an

innermost mucous layer. Other modelsof the tear film have been proposed2,3,and it now appears that there may bedissolved mucins throughout theaqueous layer, decreasing inconcentration from the glycocalyx ofthe corneal epithelium to the lipidlayer (Figure 1). When discussing dryeye and its treatment however it ismore convenient to relate this to thetraditional three-layered model, withreference also to the underlyingepithelial glycocalyx.

Whilst all three layers contribute tohydration and cleansing of theanterior eye, and to forming a smoothrefractive surface, each has its distinctfunctions.

Lipid layerSecreted by the meibomian glands inthe upper and lower lids, withprobable input also from the glands ofZeis (sebaceous) and Moll (sweat)5,the lipid layer is responsible forretarding evaporation of the tears. Italso forms a hydrophobic barrier alongthe lid margins which helps to preventtears from overflowing onto the skin,and skin lipids from contaminating thetear film.

CompetencIes covered: Contact lens practice, ocular abnormalities for dispensing opticians, ocular abnormalities for optometrists

Target group: Dispensing opticians, contact lens opticians, optometrists

A drop of the wet stuff -part one

In this two part article, Angela McNamee MCOptomBSc(Hons) FBDO(Hons)CL FBCLA Cert Ed, attempts todemystify the increasingly complex world of dry eyepreparations

Figure 1

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It contains cholesterol, waxes and fattyacids.

Aqueous layerSecreted mainly by the lacrimal gland(Figure 2) with a lesser input from theaccessory lacrimal glands of Krauseand Wolfring in the palpebralconjunctiva, the aqueous layerprovides oxygen to the cornea andhas antimicrobial properties.

It contains: water; electrolytes,including sodium, chloride, potassiumand bicarbonate; and proteins,including lysozyme and lactoferrin.

Mucous layerSecreted mainly by the goblet cells of

A definition of dry eyeIn 2007, an interested panel of expertsin dry eye disease produced, afterseveral years’ collaboration, a reporton the many aspects of dry eye4. Thedefinition contained in this huge bodyof work states that: Dry eye is amultifactorial disease of the tears andocular surface, that results in symptomsof discomfort, visual disturbance, andtear film instability, with potentialdamage to the ocular surface. It isaccompanied by increased osmolarityof the tear film and inflammation ofthe ocular surface.

Two sub-classes of dry eye have beensuggested6: tear-deficient (aqueous-deficient) dry eye, in which there is areduction in tear aqueous productionfrom the lacrimal gland; andevaporative dry eye, in which lacrimalgland aqueous production is normalbut tears are lost due to excessiveevaporation, for example in meibomiangland dysfunction (Figure 4).

What can cause or exacerbatedry eye?AgeIt has been shown that there is asignificant increase in both types of dryeye in subjects over the age of 40,and this affects both genders.Lacrimal gland function decreases atthe menopause, due to a reduction incirculating sex hormones, and tear-deficient dry eye is more common infemales7. 15% of over-65s havereported at least one symptom of dryeye often or all of the time8.

Changes occur in the meibomianglands with increasing age: theiropenings narrow, their rate ofsecretion reduces and there is a

the conjunctiva, the mucous layerensures adhesion of the aqueous layerto the ocular surface, and helps tostabilise the tear film.

It contains a gel-forming mucin knownas MUC5AC.

Epithelial glycocalyxSecreted by the corneal andconjunctival epithelium, the glycocalyx(literally ‘sugar coating’) covers themicrovilli and microplicae (projectionsand folds on the surface) of theepithelium, converting it from ahydrophobic to a wettable surface(Figure 3).

It contains a mucin known as MUC1.

Continuing Education and Training

Continued overleaf

Figure 2: Lacrimal apparatus and tear film

Figure 4: Classification and aetiology of dry eye from DEWS Report 2007

Figure 3: Epithelial glycocalyx

LacrimaldeficiencyPrimary

Secondary

Non-Sjogrendry eye Intrinsic

Evaporative

DRY EYE

Extrinsic

Meibomian oildeficiency

Vitamin Adeficiency

Disorders of thelid aperture

Low blink rate

Topical drugsPreservatives

Contact lenswear

Ocular surfacedisease eg

allergy

Drug actionAccutane

Sjogrensyndrome dry

eye

Aqueous-deficient

Reflex block

Lacrimal glandduct

obstruction

Systemic drugs

mucus layer

lacrimal gland aqueous layer

lacrimal sac

conjunctiva

lacrimal punctummeibomian glands

lipid layer

naso lacrimal duct

tear film

canaliculus

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travellers and in vertigo and Meniere’sdisease, can cause very dry eyes.Isotretinoin (Roaccutane), used insevere acne, can cause dry eyes.

The above list is by no meansexhaustive and interested readers mayconsult the British National Formulary14

or emedINFO15.

Environmental factorsVDU users are notorious for not blinkingenough. The greater exposure timebetween blinks can obviously increaseevaporation of tears but anotherfactor here, as in other situationswhere there is reduced blinking, isreduced ‘milking’ of the meibomianglands by the force of the orbicularismuscle, and a subsequently thinnerlipid layer16.

Other environmental factors include:working in dry situations, eg air-conditioning, flight cabin crew; notdrinking enough or drinking too manycaffeinated drinks.

DietMuch has been written about the roleof essential fatty acids (EFAs) inalleviating or preventing dry eye.These oils are known as ‘essential’because they are vital to health butcannot be manufactured in the bodyand must be obtained in the diet. Theimportant ones are Omega-3 andOmega-6. Omega-3, found in oily fishsuch as salmon and mackerel, and inflaxseed oil has been shown toimprove the quality of meibomiansecretions17 and to have anti-inflammatory properties; and Omega-6, found in evening primroseoil, and in some nuts and seeds, hasalso been shown to improve dry eyesymptoms by reducing inflammation18.It’s important to maintain the correctbalance between these two EFAs ,and a ratio no higher than 4:1 ofOmega-6 to Omega-3 is advisable19,22.In reality most western diets maycontain closer to a 10:1 ratio.

The antioxidant vitamins A, C and E,and also zinc, may play a role inreducing or preventing dry eye, andone study has shown increased gobletcell density and increased tear stabilityin subjects with marginal dry eye whotook a supplement containing theseand other vitamins and traceelements20.

reduction in their number (meibomiangland dropout)10. There is thereforelikely to be a disruption to the lipidlayer of the tears, leading to anincrease in evaporative dry eye. Also,since the goblet cells in theconjunctiva reduce in number withincreasing age11, there will be anassociated reduction in mucousproduction, and aqueous adhesionwill be affected.

Corneal hypoaesthesiaDecreased corneal sensitivity isanother important factor in tear-deficient dry eye, and a ‘vicious circle’feedback model has been described,whereby reduced lacrimal outputcauses corneal surface damage,resulting in further-reduced cornealsensation, which in turn feeds back tothe lacrimal gland causing a furtherreduction in lacrimal output, andultimately damage to the gland itself9.Subjects with corneal hypoaesthesiaare also likely to blink less frequently,with implications for meibomian glandsecretion, as discussed in‘environmental factors’ below.

Factors associated with reducedsensitivity include: increasing age;diabetes; corneal surgery, includingcataract surgery, refractive surgery,and corneal graft; and cornealdisease, particularly herpes simplexand herpes zoster infections.

Systemic diseaseSjogren’s syndrome, an auto-immunedisease affecting both lacrimal andsalivary gland output, is another causeof tear-deficient dry eye. This is muchmore common in the over-40s,particularly in females, and is oftensecondary to rheumatoid arthritis.

Diabetes has been shown to lead toan increase in dry eye, being morecommon in those with retinopathy12,13.

Sufferers of the inflammatory skincondition acne rosacea, who typicallyexhibit a red, butterfly-shaped rashacross the nose and cheeks, cansuffer from meibomian glanddysfunction, and hence evaporativedry eye.

Mild thyroid dysfunction may presentwith subtle signs of tear deficiency,and with mild eyelid retraction,causing increased ocular surfaceexposure. In advanced thyroid eye


Continued overleaf

disease (Graves’s disease) theseeffects are much more pronounced.

HIV infection may cause inflammationof the lacrimal gland, leading to tear-deficient dry eye.

MedicationsOther general health conditions maynot be problems in themselves but thesystemic medications used to treat themmay initiate or exacerbate dry eye.

HRTDry eye symptoms, which arecommon in menopausal women, maybe either improved or exacerbated bytaking HRT. Any changes which aredue to these medications are likely tobe stable as long as the brand anddosage remain constant.

Anti-allergy medicationsOral antihistamines such asterfenadine (Triludan) and loratidine(Clarityn) can cause tear-deficient dryeye. It should not be assumed thatthese are only used by those withallergies; the antihistaminediphenhydramine is found in thesleeping preparation Nytol and invarious cough and cold remediessuch as Benylin.

Anti-depressants and tranquillisersThe newer SSRI (selective serotoninreuptake inhibitors, Prozac-type) anti-depressants such as Fluoxetine andCitalopram are not associated withdry eye but older, tricyclic anti-depressants such as amitriptyline canreduce lacrimal secretion, as canphenothiazine tranquillisers (anti-psychotics) such as chlorpromazine(Largactyl).

Anti-hypertensive drugsMany classes of drug are used to treathigh blood pressure; of these, thebeta-blockers such as atenolol(Tenormin), and thiazide diuretics likeBendrofluazide, can cause reducedlacrimal secretion.

Miscellaneous other drugsThe beta-blocker propanolol, as wellas being a cardiovascular drug, is alsoused as an anti-anxiety drug and amigraine treatment. Like other beta-blockers this can cause lacrimalhyposecretion. Hyoscine (Buscopan,Kwells),used as an antispasmodic inirritable bowel syndrome and tocontrol motion sickness, both for

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Meibomian gland dysfunction (MGD)Well-functioning meibomian glandsare vital to a healthy tear film sincethe oil that they produce spreads overthe surface of the aqueous, to preventits evaporation. However this oil willonly do its job efficiently if it ismaintained at the correct temperature;too cold and it will solidify like lard andstagnate in the glands. People withmeibomian gland dysfunction appearto have the wrong kind of meibomianoil, whose melting point is too high. Intheir case, their normal eyelidtemperature is too cold to maintainthese secretions in their liquid form; thesecretions behave more like butter orlard than like olive oil.

If left untreated, the familiar signs ofMGD will appear (Figure 5). These mayrange from a few bubbles appearing inthe lower tear meniscus, through clear,blister-like caps at the gland openings,onto obvious thickened yellow or whitesecretions protruding from the orifices,and eventually to gland dropout, atwhich stage the lid margins mayappear notched and irregular.

The lid wiperDuring normal blinking, only a smallsection of the lid margin actuallycontacts the optical surface. Knownas the lid wiper23 (Figure 6), it is situatedjust posterior to the meibomian glandopenings. In patients with dry eye, itseems that the tear film may be toothin to prevent damage to the lidwiper, caused by the friction ofrepeated blinking. The ensuingchanges to the epithelium of thissurface have been termed lid wiperepitheliopathy (LWE).

Inflammation and the dry eyecascadeAny form of dry eye can interact with

Osmolarity and tear film instabilityElectrolytes play an important role inthe aetiology of dry eye21. If water islost from the eye, either by decreasedlacrimal secretion or increasedevaporation, the concentration ofelectrolytes, such as sodium, potassiumand bicarbonate, will be greater, iethere is an increase in the osmolarity ofthe tears. We might think of this as thetears becoming more salty. The highlyconcentrated tears then start to drawwater from the ocular surface byosmosis, affecting first the conjunctivalsurface and then the cornea. Hencestaining in a dry eye subject alwaysappears initially on the conjunctiva.Corneal glycogen, essential for woundhealing, also reduces as osmolarityincreases.

The desiccated corneal cells lack themicrovilli and glycocalyx necessary torender the surface wettable, and thiswill manifest as a decrease in tearbreakup time. The ‘hyperosmolarity’also leads to a loss of conjunctivalgoblet cells, and hence a reduction inthe mucous component of tears,further destabilising the tear film. Dropscontaining hydroxypropylene guar(Systane) aim to bind to thecompromised, hydrophobic cornealsurface, increasing its wettability.Increased osmolarity of the tears canalso lead to an increase ininflammation, as discussed later.

The role of the lidsLid position and inadequate blinkingA wider palpebral aperture and/orincomplete blinking will lead to greaterexposure and evaporation of tears.Infrequent blinking will do the same,and will also reduce the frequencywith which the meibomian glands are‘milked’ by the orbicularis, aspreviously discussed16.

and exacerbate other forms of dryeye, as part of a vicious circle4, inwhich hyperosmolarity andinflammation are key players. In short,dry eye can cause inflammation andinflammation can cause dry eye . Thisis because increased osmolarity maylead to an increase in the presence ofinflammatory factors in the tears. Insome cases however inflammationoccurs as a precursor to dry eye, andSjogrens syndrome is an obviousexample. In other cases it is less easyto differentiate between cause andeffect.

Reduced lacrimal gland outputincreases the osmolarity of tears, aspreviously discussed. The ensuinginflammation may damage thelacrimal gland, further decreasing itsoutput, until eventually there isresultant corneal damage. Thecorneal damage then reducescorneal sensitivity, leading to areduction in blinking and a still furtherdrop in lacrimal output. In Sjogrenssyndrome however an autoimmunedisease causes inflammation of thelacrimal gland, and inflammation isthen the primary cause of reducedlacrimal gland function.

If tears evaporate too quickly, as inmeibomian gland dysfunction, theirosmolarity will then increase, andagain inflammation may occur. Thisinflammation may then damage theglands, further reducing their output. Insome cases however inflammationmay be the primary cause of themeibomian gland dysfunction, as inanterior blepharitis.

Hyperosmolarity also provokesinflammation in the conjunctiva,leading to a reduction in goblet cellsand mucin output. Without this

Figure 5: Meibomian gland dysfunction Figure 6: The lid wiper

Space

Tarsal conjunctiva

Ocular surface

Lid wiper

Melbomian gland orifice

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be exercised when advisingsupplementation, particularly if thepatient is already taking vitamins andminerals. Vitamin A, for example, canbe stored in the liver, and may lead totoxicity in high doses. Beta-carotenemay be a safer form of vitamin A, butthis has been linked to increases inlung cancer when taken by smokers,and higher intakes have beenassociated with an increased risk ofmacular degeneration in both smokersand non-smokers25.

VDU users can be advised of good‘visual hygiene’ measures, includingtaking frequent breaks, looking awayfrom the screen often, and theimportance of regular blinking. Screenposition is also important: too high andthe palpebral aperture will be wider,increasing evaporation. Hydration isalso important, and dry eye sufferersfrequently admit to not drinkingenough.

Meibomian gland treatmentBecause the secretions in MGDsufferers solidify at too low atemperature, treatment is aimed atwarming up the glands to soften theoil, and massaging to encourage itsdispersal. Traditionally patients havebeen advised to do this with a flannel,wrung out in hot water. Unfortunatelythe flannel doesn’t stay hot for verylong, and must be repeatedlyreheated and reapplied.Understandably patients find thistedious and time consuming. Otherapproaches suggested have includedusing a hot spoon inside the flannel, ora hot boiled egg!

Alternative warming devices exist,including the EyeBag; devised by anophthalmologist, this is a cloth bagfilled with flaxseeds, which can be

essential component, the aqueouscannot adhere to the ocular surface;the tears become less dilute, theyincrease in osmolarity, and furtherinflammation ensues, with its potentialfor inducing further damage to gobletcells, meibomian glands and thelacrimal gland.

The anti-inflammatory drugciclosporine (Restasis) is frequentlyused in the US as a dry eye therapy. Asimilar product is supplied as anunlicensed eyedrop in the UK byMoorfields Pharmaceutical.

Signs of dry eyeThe inferior smile stain of the cornea iswell-known sign of dry eye (Figure 7),but it is usually the conjunctiva whichdisplays the first signs, with bulbarhyperaemia, staining, and lid parallelconjunctival folds (LIPCOF) (Figure 8).

In the lids, the classic signs ofmeibomian gland dysfunction may bepresent, as may lid wiperepitheliopathy (see above).

The inferior tear meniscus may bereduced, and poor tear stability willpresent as a reduced tear break uptime.

SymptomsSymptoms of dry eye are often presentin the absence of obvious signs, butare still a valuable indicator that aproblem exists. They may includeburning, stinging, grittiness, irritation,dryness or wateriness. Symptoms maybe worse in air-conditioned orcentrally heated environments, or inthe presence of cigarette smoke orother irritants.

Several questionnaires exist to helppractitioners to diagnose the dry eye4,and the best-known of these isMcMonnies24.

What help can be offered to thepatient?AdvicePatients can be advised of theimplications of any medications thatthey may be taking, including alcoholand caffeine (both diuretics), and theymay be able to eliminate or reducethose which are not strictly necessary.

Diet and nutrition may be discussed,and supplements may be appropriatein some cases. However caution must

warmed in the microwave and thenplaced over the closed eyes. It willretain this warmth for about eightminutes, while the patient relaxes26.

Tear samplingBy extracting a sample of tear film andthen testing its osmolarity, the TearLabOsmolarity Test27 may enable dry eyeto be diagnosed in patients who havesymptoms without any obvious signs. Itcomprises a pair of handsets which fitinto a base unit (Figure 10). Beforeeach use, a handset is fitted with adisposable test card containing amicrochip. Within the microchip is atiny channel along which tears,collected from the lower meniscus, willflow by capillary action. Alsoembedded in the microchip are goldelectrodes which measure theelectrical impedance of the tearsolutes. This output is then convertedinto a quantitative measurement anddisplayed on the base unit. In additionto diagnosing dry eye, measurementsmay be repeated over time, tomonitor the effectiveness of anytreatment.

Punctal occlusionIf reduction in lacrimal gland output isthought to be the problem, closure ofthe ducts, to retain the tears for longer,may be attempted, rather like puttingthe plug in a sink. This simpleprocedure is usually carried out byophthalmologists or optometristsspecialising in dry eye management.Temporary plugs are often tried first;made from collagen, these graduallydissolve over about a week. If patientsexperience relief from symptoms,permanent plugs made from siliconemay be inserted. The devices may beinserted into the lower puncta initially

Figure 7: Smile stain Figure 8: LIPCOF. Two conjunctival folds are seen,just above, and parallel to, the lid margin

Continued overleaf

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but in some cases all four puncta areplugged (Figure 9).

Although termed ‘permanent’, thesesilicone plugs may easily be removedif necessary. Some have a head whichsits on top of the punctum and isaccessible; others are fitted further intothe canaliculus and may be removedby syringing. A truly permanentsolution is cautery of the ducts using aheated probe, sometimes performedby an ophthalmologist when thepunctum or the canaliculus is toolarge or lax to retain a plug.

Other treatments available via referralPatients may be referred to a hospitaleye department, where anti-inflammatory eye drops, such ascorticosteroids or ciclosporin (Restasis),may be prescribed (see above).Another newer treatment is withautologous serum eye drops. Theseare made using the clear part (serum)of a patient’s own blood, diluted withsaline, and transferred into dropperbottles. No preservative is added, andthe bottles need to be kept in thefreezer until use.

Drops, gels and spraysThe second article in this series willanalyse the ingredients in a largerange of dry eye preparations, anddiscuss the appropriateness of theirsupply and use.

SummaryDry eye disease is a complexsyndrome. Whilst a single factor mayinitiate the disease, once dry eye hasbeen present for some time, acascade of events ensues, withincreased tear osmolarity andinflammation becoming key factors inthe further development of thecondition. Eventually most of the

structures involved in producing thetear film may become compromisedor damaged. If the disorder can bedetected and treated early, it may bepossible to prevent or reverse some ofthis damage. Symptoms often faroutweigh signs and, when combinedwith history, may be also be morevaluable in ascertaining the presenceof dry eye.

Part two of this article will contain acomprehensive table of currentlyavailable dry eye preparations, ananalysis of their ingredients, and somesuggestions as to which ones to stockin the practice.

AcknowledgementsWith thanks to Alcon Labs for images 1and 3, and to Bausch & Lomb ImageBank for image 7.

The author has no commercial interestin any of the products described in thisarticle.

References1. Holly FJ and Lemp MA. Tearphysiology and dry eyes. Survey ofOphthalmol. 1977;22:69-872. Tiffany JM. Composition andbiophysical properties of the tear film:knowledge and uncertainty. Adv ExpMed Biol. 1994;350: 231–2383. Dilly PN. Structure and function ofthe tear film. Adv Exp Med Bio. 1994;350: 239–2474. 2007 Report of the Dry EyeWorkShop. Ocul Surf. 2007;5[2]:65-2045. Craig JP & Tomlinson A. Importanceof the lipid layer in human tear filmstability and evaporation. Br JOphthalmol. 2002; 86(12):1403 14076. Lemp MA. Report of the nationaleye institute/industry workshop onclinical trials In dry eyes. CLAOJ.1995;21:221-232

7. Albietz J. Prevalence of dry eyesubtypes in clinical optometricpractice. Optometry and VisionScience. 2000;77:357-3638. Schein OD, Munoz B, Tielsch J.M,Bandeen-Roche K, West S. Prevalenceof dry eye among the elderly. Am JOphthalmol. 1997;124(6):723-89. Mathers WD.Why the eye becomesdry: a corneal and lacrimal glandfeedback model. CLAOJ2000;26(3):159-6510. Den S, Shimizu K, Ikeda T, Tsubota K,Shimmura S, Shimazaki J. Associationbetween meibomian gland changesand aging, sex, or tear function.Cornea. 2006;25(6):651-511. Records RE. Physiology of theHuman Eye and Visual System.London: Harper & Row;197912. Touzeau O, Levet L, Borderie V,Bouchard P, Laroche L. Anteriorsegment of the eye and diabetesmellitus. J Fr Ophthalmol 2004;27:859-7013. Manaviat MR, Rashidi M, Afkhami-Ardekani M, Shoja MR. Prevalence ofdry eye syndrome and diabeticretinopathy in type 2 diabetic patients.BMC Ophthalmol. 2008; 2(8):1014. www.bnf.org (accessed March2009)15. www.college-optometrists.org(accessed March 2009)16. Linton RG, Curnow DH and Riley WJThe meibomian glands: aninvestigation into the secretion andsome aspects of the physiology. Br JOphthalmol. 1961;45:718-72317. Sullivan BD, Cermak JM, SullivanRM, et al. Papas AS, Evans JE, DanaMR, Sullivan DA. Correlations betweennutrient intake and the polar lipidprofiles of meibomian gland secretionsin women with Sjogren’s syndrome.Adv Exp Med Biol 2002;506:441–718. Kokke J, Morris J, Lawrenson J. Oralomega-6 essential fatty acidtreatment in contact lens associated

Figure 9: Removable plug in lower punctum Figure 10: TearLab

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dry eye Contact Lens and AnteriorEye. 2008; 31(3): 141-14619. Miljanovic B, Trivedi KA, Dana MR,Gilbard JP, Buring JE, Schaumberg DA.Relation between dietary n-3 and n-6fatty acids and clinically diagnoseddry eye syndrome in women. Am JClin Nutr. 2005;82(4):887-93.20. Blades KJ, Patel S, Aidoo KE. Oralantioxidant therapy for marginal dryeye. Eur J Clin Nutr. 2001;55(7):589-9721. Gilbard JP: Human tear filmelectrolyte concentrations in health

and dry-eye disease. Int OphthalmolClin. 1994;34(1):27-36, 22. Simopoulos AP. The importance ofthe ratio of omega-6/omega-3essential fatty acids. BiomedPharmacother. 2002;56(8):365-79. 23. Korb DR, Greiner JV, Herman JP,Hebert E, Finnemore VM, Exford JM,Glonek T, Olsen MC. Lid wiperepitheliopathy and dry eye symptomsin contact lens wearers. CLAOJ2002;28:211-216.24. McMonnies CW, J Am Optom

Assoc. 1986;57(7):512-51725. Tan JS, Wang JJ, Flood V,Rochtchina E, Smith W, Mitchell P.Dietary antioxidants and the long-termincidence of age-related maculardegeneration: the Blue Mountains EyeStudy. Ophthalmology.2008;115(2):334-41 26. James, T. Eyebags of potential.Optician 2008; 236(6172):30-3227. Harvey, W. Tear Sampling inPractice. Optician 2008; 236(6168):32-34 �


1. Which one of the following is not part of the traditionalthree-layered model of the tear film?a. The mucous layerb. The epithelial layerc. The lipid layerd. The aqueous layer

2. Which one of the following is not true of the lipid layer?a. It contains fatty acidsb. It retards evaporation of tearsc. It is secreted by the meibomian glandsd. Its primary constituent is mucin

3. According to the 2007 DEWS report, which statement isnot true of dry eye?a. It produces symptoms of discomfortb. It is accompanied by reduced osmolarity of the tear filmc. It is a multifactorial diseased. t may cause damage to the ocular surface

4. Which one of the following occurs in the ageing tearfilm?a. Mucous levels reduceb. Meibomian gland production increasesc. Evaporation reducesd. Both types of dry eye reduce

5. Which one of the following is true regarding symptomsof dry eye?a. They tend to improve in centrally heated atmospheresb. They may include dryness or waterinessc. Smoking reduces themd. They always present along with obvious signs

6. Which statement is false in meibomian glanddysfunction?a. The secretions have a lower than normal melting pointb. The lid margins may appear notchedc. Bubbles in the tear meniscus may be an early signd. Inflammation may precede the condition

7. Which one of the following statements is true?a. Hyperosmolarity may lead to a reduction in goblet cellnumbersb. Staining in dry eye always appears first on the corneac. Corneal glycogen increases with increased osmolarityd. Desiccated corneal cells show increased microvilli

8. Which one of the following factors is not a cause of dryeye?a. Diabetesb. Increased corneal sensitivityc. Menopaused. Thyroid dysfunction

9. Which one of the following medications is not normallyassociated with dry eye?a. Citalopramb. Atenololc. Hyoscined. Loratidine

10. Which one of the following statements is true regardingnutrition and dry eye?a. Antioxidant vitamins may reduce tear stabilityb. Omega-6 may increase inflammationc. Omega-3 may increase meibomian gland secretionsd. Zinc may exacerbate dry eye

11. Which one of the following statements is false regardingthe lids?a. Lid wiper epitheliopathy may be caused by frictionb. A wide palpebral aperture enhances tear retentionc. In meibomian gland dysfunction the lid margins may

appear irregulard. Infrequent blinking may lead to greater evaporation of

tears

12. Which one of the following statements is true?a. The TearLab measures lipid layer thicknessb. The EyeBag reduces inflammation by cooling the eyesc. Smokers should be advised to take beta-carotene

supplementsd. Punctum plugs may increase tear retention time

The deadline for posted or faxed response is 16 July2009 to the address on page 4. The module code isC-11271

Online completion - www.abdo.org.uk - after memberlog-in go to ‘CET online’. You can also download yourresult letter after the closing date. Go to 'View your CETrecord' after log-in.

Occasionally, printing errors are spotted after the journal has gone toprint. Notifications can be viewed at www.abdo.org.uk<http://www.abdo.org.uk> on the CET Online page

Multiple choice questions (MCQs):A drop of the wet stuff - part one

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Trivex lenses

NXT - a Trivex based material from Taylor lenses

Cliff Williams FBDO visitedOptrafair and was impressedby the lens innovations ondisplay. Here he looks atOCTs, lens materials and lensdesign concepts

Spotlight on OCTMy initial thought whilst looking aroundthis year’s show was that you couldeasily be forgiven for thinking this was‘The OCT Fair’ and not Optrafair. Withreductions in OCT (optical coherence

tomography) pricing now starting fromjust over £40k +VAT, coupled withincreasing popularity amongstpatients, machine size reduction andease of use, now is the ideal time fordispensing opticians to embrace thistechnology. By investing in OCTtechnology, practices can provideadded value for employees andpatients by becoming experiencedpre-screening imaging experts. Withthis in mind, I have touched on threeexamples on display at Optrafair 2009to get you all thinking.

Carleton Optical offers two differentOCT machines, with their entry-levelmachine being the most affordable.Featuring easy-to-navigate softwareand good quality imaging, they arean excellent starting point. Like mostOCT machines, the only downside istheir width, which could be restrictivefor some locations. However, they areprobably the most affordable OCTunits available. Zeiss Cirrus HD-OCT isone of the most recent machines tocome to the market, compact indesign with an inbuilt display andcomputer it has one of the smallestfootprints so is space saving, very easyto use and affordable costing from£47k +VAT, which includes a five-yearwarranty maintenance contract.

The Topcon 3D-OCT starts from £47k+VAT (www.topconpositioning.eu) andis used in many hospitals for scanningprior to wet AMD (age-relatedmacular degeneration) injections ofLucentis. Ben from Topcon tells me youare able to send the file to the HospitalEye Service (HES) so the consultantcan review the patient remotely. Withthe addition of an external camerabody, fundus pictures can be takentoo. The downside is its size, however,Ben did show me that it could be setup on a single unit table quitesuccessfully for those with less space.

All of these machines allow areviewing station to be set up in theconsulting room so the patient canarrive, have visual fields, NCT, fundusphotography and OCT carried out bythe DO before seeing the optometristto review the images.

Enhanced patient optionsOptimed caught my attention with itsCaptiv8 online (www.optimeduk.com),which allows you to give patients areason to keep coming back to youfor their optical products. An annualsubscription provides unlimited accessto animations that you can email topatients. From a simple email shotabout a new product to individual

Innovations allaround


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emails sent to patients after their visit,you can inform them about eyeconditions. You can also simplyreinforce dispensing advice andproducts sold, so when they arrivehome your patients can show theirpartners and family exactly what,where and why they have made thepurchase decision. Optimed can alsoprovide superb promotional displaysfor in-practice demonstrations using i-Vue digital signage, which is anexcellent way to explain the latestinnovations.

Whilst at the show, I found out a bitmore about the Trivex lens material.Taylor Lenses (www.olympustaylor.com)is the UK distributor of Trivex in its semi-finished form to all participating,independently owned prescriptionhouses giving practices local accessto this unique product. Trivex is thecreation of PPG Industries, which alsodeveloped CR39 and Transitions. It is aunique product and ideal for allprescriptions up to +/-4.00DS; idealbecause it is the lightest and strongestlens material available today. It is alsoavailable in most popular lens forms aswell as Transitions. Due to its uniquestructure, it will not fracture or crackwhen glazed into a rimless mount andcan be edged to 1mm. It can be

surfaced to 1.2mm on minus powers.Trivex is resistant to most householdchemicals and is far less likely to sufferrimless hole erosion than theequivalent polycarbonate material.

Taylor Lenses also showcased NXT – aTrivex based material offeringexcellent and numerous dispensingsolutions with three pre-tinted, fourVaria photochromic, two mirrorcoated versions, polarised and

polarised photochromic semi finishedsingle vision options in 75mm and80mm. Using six and eight base curves,you can now replicate a plano highbase performance sunglass exactly inRx form so patients can enjoyfashionable styles with prescriptionsunglass lens options and you canbenefit from an additional valuabledispense. Trivex is also available inKodak, Hoya sold as PNX and Norvillein the atLast range.

Seiko Orgatech after boiling in water - see photograph below

Seiko boiling two lenses at Optrafair

Optrafair review

Continued overleaf

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Freeform on paradeLooking round the show, I saw severalsuppliers introducing new freeformvarifocal lenses. The majority willrequire additional measurements –face form angle, pantoscopic tilt andBVD. Most suppliers provide tools to dothis or you can consider the digitalcentration method (more on this in mynext article). If you have not trieddispensing freeform varifocal lensesthen look again, as this is a majorgrowth area. More and more lenseswill be made this way as it makes forsmaller quantities of lens stock forsuppliers. Higher order aberrationcompensation technology is nowavailable from Zeiss using personaliseddata, as well as from Essilor usingwavefront to design lenses based onstatic parameters (see later).

Seiko Optical (www.seiko-optical.co.uk), the originator offreeform inner surface varifocal lensdesign back in 1997, has just launchedSynergy X, allowing pantoscopic tiltcompensation to the inner surface.Basically, if the freeform inner surfacedeviates either side of ‘ideal’ then theperformance will tail off a little.However, by also measuringpantoscopic tilt, face form angle andBVD you can control and maximiseperformance. Seiko has also launchedthe Orgatech coating – which is totallyorganic and takes lens durability topreviously unimaginable heights. Thiswas demonstrated very radicallyduring the show by boiling a normalMAR coated lens alongside anOrgatech coated lens, whichdisplayed no crazing whatsoever. Ialso watched a metal ball weighing16gm dropped onto the normal MAR Continued overleaf

coated lens which shattered, while theOrgatech coated lens was unharmed– even after a 228gms metal ball wasdropped onto it . . . twice!

The newly launched Shamir AutographFreeFrame (www.shamir.co.il) featuresa minimum fitting height of 11mm. Itensures precision vision in all zoneseven with the smallest frames on themarket, by dynamically adjusting thecorridor length and moving thereading to the most optimal position inthe frame. By incorporating measuredpantoscopic tilt, BVD and face formangle, Shamir As-Worn Technologycalculates the necessary powerchanges from the trial frame positionto ensure the patient enjoys maximumbenefit from their prescription. If youdo not provide the additionalmeasurements, Shamir will use defaultsettings. This can simplify the orderingprocess but you may not gainoptimum performance.

Nikon Optical (www.nikonlenswear.co.uk)launched Presio Power, which is a dualpower progressive design. It featuresan enhanced central progressive frontsurface for fast adaptation, leavingthe back to carry a ‘reversed’progressive, power aberration andfilter surface, all available in 1.6, 1.67and 1.74 indices. Nikon proposes thisas an upgrade from anotherprogressive design, but mostimportantly it is designed for patientswith an add of +2.00D or above.Measurements for this lens are monoPD and vertical height with no needfor pantoscopic angle or face formangle.

Also recently launched is the Seestyle

Nikon double aspheric design, highbase custom-made single vision lens,ideal for high base frames. Nikon hascreated a simple plastic tool allowingassessment of the lens base curve inthe frame, helping you to order thecorrect base curve (three, five oreight) from Nikon to suit. In addition tothe assessed curvature, you will needto measure the face form angle andvertical heights (eye points). If you arean independent and wish support andtools to differentiate yourself profitably,then look no further than the newlylaunched Nikon Lenswear Consultantprogram.

Improving clarity of visionCarl Zeiss Vision (www.zeiss.co.uk/vision)had by far the biggest stand and its i-Profiler demonstrations were indemand all weekend in the stand’sdarkened rooms, showing howi.Scription is an all-inclusive productconcept. The basis of the computationof i.Scription lenses is an innovativeeye measuring system called i.Profiler.This analyses the eye with a highdegree of precision using wavefronttechnology and provides completeinformation on imaging properties, inparticular what are known as higher-order aberrations. The i-Profiler alsoprovides corneal topography andautorefraction lending itself well to useby a DO in a pre-screening role andproviding valuable information for theoptometrist.

Even though personally I am a poorcandidate, I have been trialling a setand feel a distinct improvementdriving at night with clearer road signs.Carl Zeiss Vision also demonstrated itsestablished Relaxed Vision Terminal.Using its new GT2 3D varifocal lens, thecompany has accepted thechallenge to synchronise binocularvision so perfectly that it createsimproved 3D vision. GT2 3D is a newgeneration of Zeiss progressive lensesthat ensures a natural 3D experienceand a new dimension of spatialperception for the wearer requiringonly mono PDs and eye points forordering.

Optrafair also saw the launch of theZeiss retail experience, which isdesigned to help practicesdifferentiate themselves in the retailing

Shamir Autograph FreeFrame Panorameter kit Nikon PresioPower showing the layers of the lens


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form angle, and the lens is available ina wide range of indices. Usingwavefront analyses at the design stageof the lens, Essilor has been able toensure that the beam of light passingthrough the lens is virtually aberration-free for any direction of gaze bylowering higher order aberrations. To fitthese lenses, you will need Essilor’scomprehensive measuring gauge, oryou can invest in Essilor’s Visioffice Unitto take the five measurements.

Essilor was also demonstrating its newCrizal Forte coating with Scotchguard,which won an Optician Award andcomes with a two-year, no quibbleconsumer guarantee againstscratching and manufacturingdefects, which is a very brave move.

Automated measuring units are nowavailable from many differentmanufacturers with more indevelopment. These instruments areworth considering to automaticallygain your five measurements forgenuinely bespoke freeform varifocals,namely mono PDs, heights,pantoscopic tilt, face form angle andBVD. Next time, I will cover in detailhow these instruments work, theirpotential benefits and ease ofintegration into the ordering process.

Cliff is constantly utilising the latest technology for his own Independent practice in Kirkcaldy, Scotland, and has recently become a regular keynote speaker on emergingophthalmic medical technology. If youwould like to contact him his emailaddress is [email protected] �


environment, creating a consumerexperience reflecting their needs.Working with a global brand partnersuch as Zeiss could help deliver aunique and compelling experience forconsumers and independentpractitioners.

Rodenstock (www.rodenstock.co.uk)have developed high technology forcost conscious consumers with theirnew back surface lens, the ProgressivLife Free which is available inColormatic, 1.5,1.54 and 1.6 indexmaterials with 14 or 18mm corridorlengths. Featuring up to 10% widervisual fields, up to 20% less swim effectit can provide greatly improvedperformance thanks to switching froma front surface progressive to a backsurface progressive lens surface. This isa unique Rodenstock development ofswitching surfaces on an existingdesign and is being trialled exclusivelyinitially in the UK, but manufactured inGermany. If this proves successful thenwe may see Rodenstock CNC lensgeneration here in the UK. If you wisha lens with fully individualisedparameters then RodenstockImpression is the lens giving thecompletely customised option and forthis you will also require pantoscopictilt, face form angle and BVD toprovide the individualised lens firstlaunched in 2000.

New design conceptsPixelOptics (www.pixeloptics.com)certainly had something completelydifferent on display – electronicfocussing eyewear. By using acombination of chemistry, electricityand optics these lenses allow for clearfocus from far to near and do so

without moving parts. The lenses lookno different from normal, but whenyou touch the purpose made frame acurrent is supplied changing the focusof the reading area. Repeatedtouching of the frame advances youthrough the changes back to distance.The spectacle frame carries smallbatteries in the slightly thicker legs.

PixelOptics also had Norville staff on itsstand promoting the atLast! EnhancedMultifocal lens using composite lenstechnology. Billed as ‘not aprogressive or blended bifocal’, thelens gives near, intermediate, farintermediate and distance zones with70% less power jump than anequivalent bifocal. With no externalsegment ridge, this lens is a viablealternative for non-tolerance varifocalusers who still wish to haveintermediate power. The concept isnot new and some of us will be oldenough to remember the SolaSmartseg, which had some of thecharacteristics; this new lens will help ina similar way.

PixelOptics also demonstrated Behold!– the world’s first composite high indexsingle vision lens, featuring an asphericTrivex front component and a 1.67index back surface, which enablesthinner centre thickness and greaterstability than ordinary 1.74 index lenses.

Essilor (www.essilor.co.uk) has recentlylaunched the Varilux Physio f-360drawing on design features of theoriginal Varilux Physio lens. It featurestwo major design concepts – WavefrontManagement and Point-by-PointTwinning. Ordering Physio f-360 alsorequires the pantoscopic tilt and face

Zeiss Cirrus HD-OCT with integrated computerand TFT screen in a compact design

Zeiss Retail Experience showing the i.profiler in use and the grey column RVT ready for digital centration

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In the first few parts of this series of articles, MikeHall covered, in very general terms, the duties ofemployers and employees under the Health andSafety at Work etc. Act 1974. This part delvesslightly further into H & S law, indicating whichregulations are the most often used, how they areused - and the powers of inspectors

Some Acts of Parliament; the Healthand Safety at Work etc. Act 1974,

for example are known as EnablingActs because the Act itself givespowers to a Minister of theGovernment to create furtherlegislation within the subject matter ofthe Act. This further legislation may bereferred to variously as ‘StatutoryInstruments, Regulations, Subordinate,Secondary or Delegated Legislation’.In this series of articles reference willbe made using the terms delegatedlegislation or regulations. Theseregulations, available from HSE Books,accompanied by the relevantApproved Code of Practice (ACOP),set out in more detail what theemployer should do in order todischarge his statutory duties.

The Health and Safety Commission(HSC) and the Health and SafetyExecutive (HSE) were, until veryrecently, the health and safety policymaking body and the inspectoratedivision respectively, appointed by theGovernment. The HSC was made upof between six and nine individualsrepresenting employers, employees,and other interested parties such asCBI, local authorities and otherprofessional organisations. The HSCusually proposed or draftedregulations to the Government; theresulting regulations, after dueparliamentary procedures, were thenissued, monitored and made to workby the Health and Safety Executive

(HSE) which was effectively theenforcement arm of the HSC. The HSC& HSE are now merged under thesingular banner of the HSE. Thisstreamlining will yield a more efficientservice and reduce much of thepaperwork burden placed onemployers by having to deal with onebody instead of two. Although theregulatory function remains extantthere are, however, some concerns inindustry regarding the merger and thesubsequent level of ‘policing’ of H & Smatters.

Risk assessment – the legalimperativeThe requirement for an assessment ofrisk is not explicitly stated in the 1974Act but is certainly implied by therequirements of the duties owed bythe employer under Section 2(1): ‘Theemployer shall ensure, so far as isreasonably practicable, the healthand safety at work of all hisemployees’ - there are similarrequirements in section 3(1) of the Actin respect to non employees, asindicated in part one of this series ofarticles.

Regulation 3 of the Management ofHealth and Safety at Work Regulations(MHSWR) clarifies the requirement forRisk Assessments (RA) to beconducted without equivocation.Note the word ‘shall’ – it is absolute:‘Every employer shall make a suitableand sufficient assessment of”:

(a) The risks to the health and safety ofhis employees to which they areexposed whilst they are at work; and(b) The risks to the health and safety ofpersons not in his employment arisingout of or in connection with theconduct by him of his undertaking.The Act makes no explicit requirementto record the findings of theassessment but yet again therequirement is made specific byregulation 3(6)(a) of MHSWR whichstates that:3(6) Where the employer employs fiveor more employees, he shall record:

(a) the significant findings of the assessment

Various other sets of regulations requirethat RA be carried out and recorded,eg Under the Control of SubstancesHazardous to Health Regulations 2002(COSHH), Regulation 6 covers RAconduct and recording. Under theProvision and Use of Work EquipmentRegulations 1998 (PUWER), therequirement is stated at Regulation 4which actually refers back to themandatory requirement of MHSWRthereby making the requirement toassess and record absolute. There ishowever, no requirement to repeatthe same assessments under thevarious and different regulations. If, forinstance, a risk assessment has beencarried out for a specific processwhich requires the use of machinery(say 85 per cent of tasking) and alsouse of a volatile substance, (15 per

An appointment with theregulations: the powers ofinspectors


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cent of tasking), the completeassessment could be made underPUWER and not be simultaneouslycovered under PUWER and COSHH.Provided that the RA is ‘suitable andsufficient’ and embraces the risks fromall parts of the process, the employerwill have discharged his statutory duty.

RA forms the back-bone of modern H& S law and in particular, the Six Packof regulations, which consists of the sixmost important pieces of delegatedlegislation covering H & Smanagement and is made up asfollows:• The Management of Health &

Safety at Work Regulations 1999• Workplace (Health, Safety &

Welfare) Regulations 1992• Health & Safety (Display Screen

Equipment) Regulations 1992• Manual Handling Operations

Regulations 1992• Personal Protective Equipment

Regulations 1992• Provision And Use of Work

Equipment Regulations 1998 (Allied to the Lifting Operations & Lifting Equipment Regulations 1998).

This so called ‘six pack’ and most otherrecent H & S delegated legislation isbased on European CommunityDirectives. Reference to elements ofthese regulations has and will bemade from time to time throughoutthis series of articles.

Health and Safety enforcement:As a rule of thumb, the Inspectoratedivision of the Health and SafetyExecutive (HSE) is responsible for theenforcement of H & S legislation in thecase of factories, including largeoptical manufacturing facilities,construction sites, quarries, offshoreinstallations etc. In offices, restaurants,warehouses and retail shops,enforcement is by the Local AuthorityEnvironmental Health Officer (EHO). Allinspectors, from whatever source, willto have been formally trained, (todegree standard) formally appointedand will carry a warrant card.

The powers of inspectors are broadand are categorised as:• The right to enter premises at anyreasonable time or at any time if theythink there exists a dangerous situation• To take with them a policeconstable if they think they may beobstructed• To take with them any other personeg a specialist• To take samples, measurements,

photographs etc• To direct that specific areas be leftundisturbed. (ie Isolated, taped off oreven guarded, pending moredetailed examination)• To test and/or confiscate articlesand substances• To inspect and take copies ofdocuments (but not documentsregarded as ‘privileged’ – egconfidential commercial documents,Product specifications and designs etal.). If any doubt exists, legalassistance should be sought• To interview any person and torequire them to sign a declaration thattheir answers are true• To seize and destroy or makeharmless anything which they believeto be an immediate serious risk tohealth and safety• To require any person to provideany other facility (facilities) that theperson can give, to assist the inspectorwithout let or hindrance

(NB: The person undergoing thesignature interview, indicated at bulletpoint eight above, may nominatesomeone else to be present if s/hewishes. No one else may be presentunless the inspector permits. Any

statement taken cannot be used inevidence against the person whogave it. If the Inspector decides that acriminal offence has been committed,such interviews would be conductedunder caution as directed under theprovisions of the Police and CriminalEvidence Act 1984 – PACE – if this isthe Case, legal advice should againbe sought).

At this stage, dispensing opticiansmight be wondering “What has all thisto do with me? I don’t havemachinery or dangerous substances inmy cosy little pactice.” All is about tobe made clear in the next articlewhich will deal with various regulationsand how they impinge on a largeophthalmic manufacturingorganisation and its conduct. It willalso draw comparisons with a smalldispensing optical practice.

Until then, ‘Stay Safe!’

For free and confidential advice onH & S matters, contact Mike Hall, H & SAdvisor to the Worshipful Company ofSpectacle Makers on (telephone andfax) 01825 764801 or [email protected] �

Health and safety part four

Optician IndexMarch 2009 summary

The full March 2009 Optician Index report waspublished in the 24 April issue of Optician.

• Turnover slows to negligible growth over the last 12 months• Whilst eye examinations are down 6% from last March, overall they still show

a 1% growth over the last 12 months• Dispensing is down by 2% over the year, mainly due to falls in bifocal and

progressive sales• Single vision is showing neither a rise nor fall for the year, bifocal lenses show

a 12% decline, though these are up by 2% from February. Progressive lenses are down 6% from February, and down 34% over the last 12 months

• Re-glazes are at 11% this month, last year the figure was 12%, and the trenddoes appear to be declining, perhaps due to the availability of cheaper frames

• Variable tints is a growth area, up to an average of 11% of all dispensing compared to 7% two years ago; Improvements in the technology of variable tints mean that this could be a growth area for the future. For example practices in the sample vary from less than 1% to 25% penetration of variable tints, so this is potential added value to dispensing and a product that patients may not be aware of

• AR coats continue to decline, down 10% on average over the year, applied to 38% of all dispensing

• Turnover per eye examination is down; £137.15, compared to £145.74 in March 2008

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Three innovative frame brands,each with a clear and individualidentity, highlight an emergingplatform for ground-breaking,niche-market frames in the UK,writes Ann Johnson

Fashion with passion


Tom Davies: “Having a frame designedand tailored for you is like acombination of having a suit made tomeasure and re-defining your ownstyle.”

Today’s arts and media world is muchabout breaking through boundariesand crossing-referencing in thecreative fields. Musicians make films,pop stars write poetry, film directorscurate art exhibitions. British spectacledesigner Tom Davies originally studiedfilm and television at the University ofEast Anglia before flying to China,aged 21 to work for an eyewearfactory. This background experienceeventually led him to shake up theeyewear industry by bringing the luxuryof bespoke to specs wearers.

Tom’s frames are expressly designedand handmade to suit a person’sphysical characteristics andcomplement their lifestyle. Cutting histeeth on the factory floor in China,Tom helped build production fromscratch while designing for brands theworld over. Returning to London in2000, he set up his own couturespectacles and sunglass business.Tom’s ready-to-wear line waslaunched in 2001 and, in 2008, heopened his own factory. He now offersa full bespoke service through hisglobal network of exclusive opticians.The TD Tom Davies luxury service hasbeen successfully growing for over ayear now and has expanded to theUS, France and Italy.

Tom believes that opticians should andcan become designers themselves,personally involved in creating for theircustomers. He says, “Having a framedesigned and tailored for you is like acombination of having a suit made tomeasure and re-defining your ownstyle. You can choose spectacles orsunglasses, ordered in exactly thecombination of colours and materialsyou prefer and have these designedto fit your face perfectly.

Each frame is hand-made for thecustomer using a combination oftraditional techniques and modernmachinery, in conjunction with theiroptician. Colours are based on theclient’s own natural colouring andmillimetre-perfect measurements aretaken at each stage. The Tom Daviesfactory produces the final bespokeframe to the highest specificationsand quality, with the client’s namediscreetly laser-engraved on theinside.

With the ready to wear collection,new models feature innovative colourcombinations and ‘architectural’shapes while maintaining Tom’ssignature balance, fit and distinctivedesign features. The full range includestitanium, rimless and bloc acetateframes.Tom explains, “The brand combinesdesign and comfort and allows you tocreate your own statement out of anaccessory. There isn’t really a targetmarket as such; bespoking glasses to

Round-eye look: TD141, colour 414

Imaginative side detail: TD143, colour 419

Dark, elegant frame with warm interior: TD127,colour 291

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FFrraammeess

mirror or enhance the features,personality and lifestyle of the wearerdefies the meaning of having a‘typical’ target market.”

Tom Davies will be playing a key roleat ABDO’s Conference and Exhibitionin Brighton.

Tom Davies: www.tdtomdavies.com

Jason Kirk: “If we are passionate aboutwhat we design, then people will bepassionate about wearing thedesigns.”

If Dorothy in The Wizard of Oz hadworn spectacles instead of hermagical ruby slippers, then they wouldhave been Saturn Phoebe in red from

Kirk Originals. The company’s history inspectacle design dates from 1919when Sidney and Percy Kirk convertedan old sewing machine into a lenscutter. Then, in 1992, Jason Kirkdiscovered a cache of his grandfatherSidney’s original frames in his fathers’optical practice and began selling theoriginal frames with sun lenses toLondon’s top designer stores.

In 1996 Kirk Originals opened its firstshop at Earlham Street, CoventGarden with offices downstairs. Then,in 97 Kirk Originals Manufactureopened a new factory to hand makeKirk Originals frames.

In 99 the company launched theLondon International Optics show topromote eyewear in the UK and, in

2001 the new Kirk Originals storeopened at 29 Floral Street, CoventGarden.

Today, Kirk Originals is a global brand.Jason Kirk says, “We believe that if weare passionate about what we design,then people will be passionate aboutwearing the designs”. This is theessence of Kirk Originals - passionatepeople creating some of the mostforward-looking eyewear in the worldbacked up by robust and imaginativemarketing ideas. Kirk Originals hasproduced two films ʻLook of Loveʼ andʻGrab an Eiffelʼ attracting half a millionviews on Youtube; Eye Tunes and EyeMovies are initiatives through whichartists associate themselves with KirkOriginals; kirkoriginals.com attractsmore than 80,000 hits every month.

Phoebe from the Kirk Originals Saturn collection (nominated for a Silmo D’Or award for design in 08

Juliet from Kirk Originals Saturn collection Bobcat from the new Kirk Originals Turbo collection

Continued overleaf

DO June.qxd:1 21/5/09 15:00


The brand is worn by the likes of U2,Oasis, Mick Jagger, Elton John andPenelope Cruz. Gary Oldman woreKirk Originals in ‘Batman - The DarkNightʼ

Jason Kirk says, “Placing glasses incontext with music, TV and cinemahelps portray a positive image, afashion item - and a fashionable item.By positioning the eyewear at a levelof secondary importance behind theartistic content, Eye Tunes and EyeMovies re-enforce the integration ofglasses in art and culture.”

The frame collections comprise: theSaturn collection which offers surfaceshine in coloured crystals while theinterior is an ‘explosion of glitter. TheJet-Turbo collection boasts a boldstripe racing along the side. Turbocombines aluminium, wood andacetate. The Sculpture collectionprovides a daring combination ofacetate and acrylic with a strong andvibrant colour palette. This rangeincludes the Silmo D’Or Award winning‘Jean’ sunglasses. Last, but not least,The Kirk Heroes collection is based onfictional, historic characters from the

Kirk family. Asymmetric designs comein bright and exciting colours. All theKirk Heroes have Facebook accounts.

Kirk Originals says its ‘out of the box’approach to design, marketing andretailing is “. . . helping change theoptical world from traditional andconservative to a rainbow coloured,designer party”.

Kirk Originals: www.kirkoriginals.com

Booth and Bruce: “We seek in-yourface styles that are both hard toignore, and even harder to forget.”

Booth and Bruce is an imaginativeand resourceful eyewear collectionthat ignores the rules. This brand’sphilosophy challenges the wholeconcept of spectacles as a merefashion accessory. Take a look at thewebsite; it invites you to, quite simply,“. . . re-invent your world.”

The aim of Booth and Bruce England isto deliver a potent combination offreewheeling urban adventure, anddaring design – giving British eyewearsomething not seen before. It is just thiskind of marketing and designphilosophy that exemplifies the bravenew world of frame design – eyewearthat ventures determinedly andseamlessly into peoples’ lifestyles.

Peter Booth and Jeremy Setton beganproducing frame designs when theyowned their own optical stores inLondon and Brighton. In 1999 theybegan selling designs to other storesand Booth & Bruce England was born.These days they concentrate ondesigning full-time. Their aim is tocreate what they describe as“organised chaos” that echoes theirown lifestyles “. . . and distils Britain ofthe 21st Century.”

They say, “Our frames are a meltingpot of styles and ideas; our publicity iswacky and provocative. We combineshimmering colours with their ownvivacity, and seek in-your face stylesthat are both hard to ignore, andeven harder to forget . . .”

Booth and Bruce England:www.boothandbruce.com �

The new shape for 2009 from Booth and Bruce England is “bigger, bolder and better”: style P016, colourred on brown crystal

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The Chartered Institute of Personnel and Development’schief economist is warning of an ‘avalanche’ of redundanciesas more and more employers prepare to make job cuts. Withthis in mind, Anna West and Adam Rice consider some of thepractical ways of restructuring or reducing costs - withoutreducing headcount.

Changing terms and conditionsHow far can employers go to changeterms and conditions in the currenteconomic climate? Employers mightbe thinking of altering shift patterns,reducing overtime, freezing wagelevels, minimising bonuses, or cuttingback on pay or benefits such ascontractual sick pay, holiday pay andprivate medical insurance.

Some of these changes may beauthorised by the employmentcontract - such as a slight change inrole or hours. There is usually noguarantee of an annual pay rise andthe contract might allow the employerto withdraw a discretionary benefit atany time. However, it is worthremembering that even if a benefit isdescribed as non-contractual ordiscretionary, the employee may stillbe entitled to it if it has been providedconsistently over time. Even if theemployment contract permits somechanges, the employer must still actreasonably, for example, by givingemployees reasonable prior notice ofany changes.

Of course, the safest route is to seekthe employee's agreement to thechange. Employees are more likely torespond positively if the employer isopen with them about the businessrationale and can point to some otherbenefit such as avoiding the need tomake redundancies.

Alternatively, or if employees refuse to

agree, employers may try to impose achange unilaterally, arguing that thosewho continue to work without protestimpliedly agree to the change.However, employees who object tothe changes may resign and claimconstructive dismissal or refuse to workunder the new terms, forcing theemployer either to dismiss them or letthem continue on their old terms.More likely in the current economicclimate is for an employee to agree towork ‘under protest’ and seekdamages for any loss they suffer as aresult of the change such as the salarylost from a pay cut or reduced hours.

Employers with cogent businessreasons for cutting pay or benefitsmay perhaps find it safer to dismissemployees and re-engage them onrevised terms if their earlier attempts topersuade employees to consentchanges have failed. Providedemployees are given proper notice ofdismissal, they will have no claim forbreach of contract. Conversely,employees may have unfair dismissalclaims, but employers who haveacted reasonably by consulting withemployees about possible alternativesetc, will have a better chance ofdefending these, particularly if thecredit crunch means that theemployer can show that jobs wouldbe at risk or the business would suffer ifcut-backs are not made.

If the cut-backs could lead to 20 ormore employees being dismissed, or

resigning and claiming constructivedismissal, the employer will have anadditional duty to consult trade unionsor employee representatives beforetaking the decision to make the cut-backs.

Battening down the bonushatches?Can employers facing financialdifficulties cut back on staff bonuses?If the bonus is contractual and theemployer has promised to pay aparticular bonus, it is difficult to goback on that, even in the currentclimate. It is worth remembering thatan entitlement to a bonus might befound not only in the employmentcontract, but also in a verbal promiseor an email from a manager, orthrough custom and practice wherethe bonus has been paid year onyear. In these circumstances, failure topay is likely to be a breach ofcontract, giving the employee theright to claim damages or resign andclaim constructive dismissal.

On the other hand, if the bonus isdiscretionary, employers will usuallyhave greater scope for reducing itssize. Provided objectively justifiedfactors are considered and clearlydocumented, it will be difficult for anemployee to challenge the size of adiscretionary bonus. Having clear andobjective reasoning for any bonusdecision will also help shield againstdiscrimination claims. Nevertheless,employers who anticipate awarding

Reduce costs - butnot headcount


DO June.qxd:1 21/5/09 15:00

smaller bonuses than in previous yearsmany want to manage staffexpectations to avoid disappointmentwhen bonuses are announced.

Employers should remember that evendiscretionary bonus schemes may notallow nil payments: depending on thebonus criteria and targets, a refusal topay a bonus at all may be anunreasonable exercise of theemployer's discretion.

Difficulties may also be faced byemployers who wish to change theirbonus structure part way through thebonus year. The risk here is thatemployees will have an expectationof being rewarded for their effortsbased on the existing structure. It is,therefore, much easier to introducechanges at the start of a bonus year. Ifa change to the bonus schemeaffects 20 or more employees, theemployer may face the additionalconsultation duty referred to above.

Reducing hours – a quick fix?Reducing staff working hours may beanother way of cutting salary costs

and overheads. However, unless theemployment contract specificallyallows for this, it can only be done byagreement with employees. In thecurrent climate, employees who areotherwise facing large-scaleredundancies may be prepared toagree to a temporary reduction inhours and pay.

Without agreement, forcingemployees to work reduced hours andtake a pay cut would, almostcertainly, give employees the right toresign and claim constructive dismissal.If the reason for the reduction isredundancy, employees may also beentitled to statutory redundancy pay.Employers proposing pay cuts should,therefore, communicate the businessrationale to staff clearly and explorealternatives with them in an effort toget them on side.

Employers looking for an alternative tocutting hours and pay might betempted to lay staff off - stand themdown temporarily without pay - for aperiod. However, a lay-off wouldbreach the employment contract

unless the contract allows theemployer to lay staff off, which isuncommon, and employees may stillbe able to claim a statutoryredundancy payment where the lay-off continues for an extended period.

Other practical ways of temporarilyreducing salary costs may includeencouraging staff to take sabbaticalsor unpaid leave. Alternatively,employers can seek requests from staffto work flexibly through part-time,homeworking or job-sharing. However,employers who actively encourageflexible working requests will then needto have clear and objective groundsfor accepting and rejecting them. Inaddition, agreeing a flexible workingrequest would normally result in apermanent change to workingpractices, unless the partiesspecifically agree otherwise. Employersshould, therefore, be clear if onlyagreeing to a temporaryarrangement.

Anna West and Adam Rice arespecialists in employment law at Citysolicitors, Travers Smith. �

Practice management

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Points from thePresident

Tony Garrett, a prizewinner and Barry Duncan Tony Garrett, a student winner and Barry Duncan Kevin Milsom, Tony Garrett and Barry Duncan


Friday 17 AprilFlight was ideal, not thatmany lumps and bumps!Due to the time differenceand flying time, we arrivedat Singapore at about6.15pm. That would normallypresent no problems,however, we were on the6.45pm flight to KualaLumpar. Slightly anxious,Kevin and I headed out ofthe aircraft and proceededinto the terminal to find Marksorting things out. What weexperienced next wasbizarre to say the least. Ihave seen this happen onthe television and films butnever expected to beinvolved personally. With nohesitation the ground staffhad us on a buggy flyingthrough the terminal withKevin and I on the veryback. I think it’s fair to sayneither of us are theslimmest and I suspect wewere slightly raised at thefront as a result. It was veryfunny although I am not surethe scores of passengerswho we nearly ran over feltoverly amused. Regardless,we got on the flight safeand sound – although theelderly Italian lady I satbeside did not appear to bevery happy with us fordelaying the flight. Thedownside of the hecticbuggy trip was that ourluggage never got on thesame flight and dulyfollowed us up to KL. Finallywe got to the hotel afternear enough a full day oftravelling. By this time, theonly thing we wanted to dowas get to bed and preparefor the days ahead.

children. Just beforeheading to the airport, therewas a call from KatieDocker who had a fewquestions from members.Katie and I speak prettyregularly; and sometimes Iget a bit of a row if I speakbroad Scottish! Got theflight from Edinburgh toLondon where I met up withKevin Milsom, MarkChandler and AliciaThomson. Kevin has beentremendous since I tookover as President and I reallyvalue his support. He is fullycommitted to doingwhatever he can for ABDOand the profession, and it isessential he stays involved.Mark and Alicia do a terrificjob in examinations, takinggreat pride in what they do.Did a quick shop in DutyFree; Kevin always likes toget the good aftershaveand other cosmeticsalthough he does tend togive the hair gel a miss! Weall got on the evening flightto Singapore, which turnedout to be the airbus; I tendto be happier on the biggerplanes for some reason as Iam not the greatest flyer.Tried to get my head downfor a few hours, as I knewthe next few days weregoing to be busy.

meetings etc, occupyingmost of the diary, thereappears to be not enoughhours and days in the weekat present. Managed to getsome time with the family,which is essential, andreceived my ordersregarding presents from the

Thursday 16 AprilIntended spending timewith the children today,however, I needed tofinalise some activity in thepractice and I had one ortwo loose ends to tie upwith ABDO. With businesspicking up a bit and

In previous articles of Dispensing Optics, many members will have picked up that we havea relatively large membership in the Far East and conduct examinations in Malaysia twice

a year. In recent times, we have started to run exams in Singapore after a long absence.Lots of activity needs to happen to ensure longevity for these projects. With this in mind, Ithought I would share with you my experiences on my recent whistle stop tour ofSingapore and Malaysia . . .

Those planning to sit the Winter 2009 practicalexaminations for the Certificate in Contact Lens Practiceshould note that the closing date for registering supervisorsand practices for provisional approval is 31 July 2009.

Registration documents are available upon request fromthe Examinations and Registration Department on 01227732921 or email [email protected]

Seven year rulingThose with partial success in the examinations for theCertificate in Contact Lens Practice qualification shouldnote that from 1 March 2009, candidates will be requiredto retake any element/s of the Contact Lens Certificateexaminations which were passed seven years or morepreviously.

This ruling has been introduced in the light of the everadvancing status of contact lens practice and relates totheory examinations or sections of the practicalexamination.

This change does not affect those who already hold theCL Certificate or Advanced CL Diploma.Rosemary Bailey, Chief Examiner, Contact Lens Practice

Winter 2009contact lens examinations

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Mark Chandler, Alicia Thompson, Tony Garrett, a student, Kevin Siew MAPO President and Barry Duncan

Newsbrief

heading down to Singaporeto meet with Elaine Grisdale.Elaine has worked tirelesslyto make things happen inthe Far East and it was vitalwe went down to supporther. After a quick briefingmeeting we headed outwith Steve Lim, President ofthe SOP. In Singapore, wehave started a programmeto upgrade existingopticians and pleasinglySteve passed his FBDOexams last December. Thatnight we had theopportunity to present thosewho graduated with theirFBDO diplomas. It was sucha great honour for me to dothis and once again I had agreat evening. Similar to ourevent in Canterbury it gaveme enormous pleasure andenjoyment; certainlysomething I will miss in a fewyears’ time. Both theSingapore and Malaysianpeople are terrific and showgreat hospitality andwarmth, which is fantastic.Everyone had a greatevening and once againthe kilt seemed to go downwell. I was starting to get thefeeling that Tony might bekeen to have a little shot ofthe kilt!

Tuesday 21 AprilThe last day and we had afull agenda. Steve picked usup for a meeting with theOOB (the equivalent to theGOC). Our objective was tocreate strong links betweenthe SOP, OOB and ABDO.We were keen to ensurethat appropriate standardswere reached andpleasingly, so were the

Saturday 18 AprilFor all those who have beenfortunate to get out to theFar East, one of the thingsthat happens is that yoursleeping pattern is disturbed– big time. You don’t know ifyou are coming or going.Decided to get myself upearly and head down to thegym for a run. I was intraining to do the halfmarathon in Dunfermline inMay so wanted to keep thetraining going – but washugely disappointed thatmy fellow ABDO colleaguesdeclined to join me!Breakfast was goodbecause we picked up withTom Veti and Jim Russell,who were over to look afterthe stand at the MAPOConference. Jim is alwaysfull of energy and it wasgreat to catch up. Weheaded over to the officialopening where the DeputyHealth Minister was present.I was asked to sit beside herat the official opening as aVIP (I still have to pinchmyself when things like thathappen). We had ameeting with Mr Tan fromthe teaching instituteimmediately afterwards todiscuss one or two issues weface in Malaysia. It was thentime for the graduationwhere I got the kilt on forthe occasion. There were137 graduates, which is trulyfantastic and a great creditto them all. Afterwards, Tonyand I had our photos takenwith quite a lot of thegraduates which was greatfun. Not sure if it was my kiltor Tony all gowned up?After a quick freshen up, we

other parties. It is our hopethat teaching of the FBDOcourse will begin within twoyears and the CL coursewithin the next 12 months.Elaine gave an extensivepresentation to the OOB,which went down well. Afterthe meeting we hadanother meeting with Stevefor a full debrief. All thingsseemed pretty positive andthe mapping out of thepathways was done.Finished! Elaine and Iheaded back to the airportto get on the plane forManchester. Clearly theweek had taken its toll aswe both slept for the bestpart of nine hours.

Wednesday 22 AprilArrived back in Manchesterand already the fall-outfrom the trip had started. Allof the examiners were stillout there with a full week inMalaysia and time down inSingapore at the end. Aliciaand Mark were in meetingsonce again so be in nodoubt, the activity did notstop there – we just haddifferent people going in tobat. Got back to Edinburghand collected the children.Presents went down well soall’s well that ends well.Needed to have an earlynight as I had to get backto work in the morning. It’salways good to get back tomy day job and remind myboss who I am.

So there it is, a week in mylife as ABDO President.

Barry [email protected]

went on to the MAPOdinner which once againwas fantastic. This yearMAPO did very well andhad about 700 people in forthe evening. We gotourselves back to the hotelwhere we met up with theexaminers who had justarrived. Quick refreshmentswere followed by bed,absolutely done in.

Sunday 19 AprilOnce again got up andhad a quick run. Anotherbusy day, as we had twomeetings before 2pm whichproved to be veryproductive. By this time Iknew I needed to get anhour on the way back tothe hotel to tick off theshopping list; it was definitelynot worth heading homeempty handed. Got myselfinto Chinatown for whatcould be described as anSAS style shopping eventthat turned out to be highlyproductive and cleared theway for me to concentrateon the rest of the trip. In theevening we had a goodmeeting with MAPO. TheMAPO Committee were allin good spirits after theirconference so it was a niceevening to chat and discusshow we will continue todevelop. Kevin and histeam work very hardpromoting the role ofopticians in Malaysia andwe have formed a verysolid working relationship inthe past few years.

Monday 20 AprilUp nice and early onceagain as Tony and I were

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Areanews-round


Area 5 (Midlands): Line-upalmost finalised

The Area 5 committeerecently booked venues forits next two CET days, whichwill take place on Monday14 September 2009 at theArden Hotel, Birmingham,and Monday 15 March 2010at the Riverside Centre,Derby. The committee iscurrently finalising the line-up of CET-approvedspeakers for the ArdenHotel, which will earn alldelegates attending thewhole day a minimum offive CET points. The cost for

the day is just £20 per ABDOmember, which includes teaand coffee served at eachinterval, and a free hot andcold buffet lunch.

Bookings are now beingtaken for the Septemberevent, and as these daysare now so well attended,places will be allocated ona first come first servedbasis. For further information,or to book your place,please telephone IanHardwick on 07814 558343or [email protected] �

New Rodenstock Progressiv Life Free is a freeformprogressive lens with a ‘price sensitive’ market positioning.Offering a higher performance than conventionallymanufactured progressives due to a reduced base curveeffect, this 3D back surface progressive lens offers up to a 10per cent wider visual field, up to 10 per cent less astigmatismand up to 20 per cent less swim effect compared toconventional Rodenstock progressives. In short, it bringsbetter visual comfort and much faster adaptation.

Rodenstock UK lens business manager, Debbie Bathgate,explained: “Many consumers like the idea of freeformtechnology and we are keen to ensure that price is not abarrier to experiencing the improved technology. This newlens comes with the reassurance of a quality brandedproduct and we are expecting strong demand.”

Progressiv Life Free, also available as a ColorMatic option,comes in two corridor lengths of 14mm and 18mm. �

‘Affordable’ freeformtechnology

New freeform option

News from Ireland

In the May news I mentioned theintroduction of the Tom Keane Awardfor Industry Rep of the Year. Theaward is sponsored by AOI and COSI.This year’s finalists were: ReginaRedford from Carl Ziess Vision;Geraldine McDonagh of SouthernOptics; Paddy Forbes ofWestmidlands Optical; AnthonySweeney from LR Precision Optics;Janis Quaine from CIBA VISION;Valerie Slattery of Studio Eyewear;and Lynn Fraser from Essilor Irelandand an IADO Committee member.The overall winner was Valerie Slattery.

The award is a fitting tribute to Tom,who was a true gentleman andstrived to deliver the best service rightthrough to the final customer. During

the turbulent period following Tom’ssad passing, Valerie Slattery workedtirelessly to ensure the smooth runningof Studio Eyewear. I witnessed at firsthand the very difficult task she had intaking over at that time. DeirdreO’Sullivan of Carl Zeiss Vision presentedValerie with her award. She is aworthy winner and I’m sure Tomwould be very proud!

Practices being ‘tested’There have been reports that somepersons may be calling into opticalpractices with a third partyprescription to buy spectacles. Theyappear to be attempting to gatherevidence that non-qualified staff areperforming dispensing functions. Anumber of practices have been

‘tested’ in this respect. Membersshould ensure that they conform tolegal requirements of dispensing in allcases. It is likely that a case may betaken to the Opticians Board ifsufficient evidence is obtained toprove that non-qualified staff aredispensing, which is not permittedunder the Act.

Finally, best wishes go to my verygood friend, Elaine Poole FAOI whowill marry Donough Murphy on 6June in Wexford. I’m sure there willbe a huge turnout of optometristsand dispensing opticians on the day!

Jill Flaherty FBDO MIADOTo contact Jill telephone 087 2661649 oremail [email protected] �

Worthy award winner

DO June.qxd:1 21/5/09 15:00

Newsbrief

VAO’s new CEO, Dr Natalie Briggs Porsche driving treat in store

Cathy Ramsden of J&R Bottomley Opticians, , haswon an exciting tutored track day at Silverstone in aPorsche Carrera courtesy of Rodenstock and Porsche UK. MsRamsden won her prize after entering Rodenstock’s prizedraw at Optrafair to promote Porsche Design Eyewear.

The other winners were Ros Young of Regal Optical Centre,Boston, who will enjoy an off-road day in a PorscheCayenne, and Emma Lynch of Conlons Opticians, Ormskirk,who will be treated to a luxury weekend of pampering atChampneys. �

Tym Marsh has retired fromVision Aid Overseas (VAO)after 10 years heading thecharity. His successor asCEO is Northern Ireland bornDr Natalie Briggs, whoseprevious appointmentsinclude executive directorfor the educationdepartment of the RoyalCollege of Surgeons ofEngland, and Dean ofFaculty for Business andManagement at BromleyCollege of Further andHigher Education. She hasalso been a trustee of theSteel Charitable Trust andfellow of the CharteredInstitute of Personnel andDevelopment.

Previously Dr Briggsmanaged the delivery ofeducation and trainingcourses for surgical teams inGhana, Sri Lanka, India andthe Middle East andsupported training inAustralia and Hong Kong.During 2008, she worked ona development project forthe Fistula Hospital inEthiopia to create a clinicalskills centre.

Dr Briggs joins VAO as itcelebrates its 25thanniversary and theorganisation moves tostrengthen its support andcommitment to VISION2020, the global initiative forthe elimination of avoidableblindness. �

Doctorappointed ashead of VAO

Fantastic prizesdished out

Awards willrecognise MDcarersThe Macular Disease Society(MDS) is launching its firstever awards programme torecognise excellence in thecare of people with maculardegeneration (MD). Theawards cover clinicalservices as well asrehabilitation and emotionalsupport, and will recognisethe work of campaigners,fundraisers and volunteers inthe Society’s 175 localsupport groups.

MDS chief executive, TomBremridge, said: “There is agreat deal of good practice,innovation and dedicatedwork involved in caring forand supporting people withMD. We want toacknowledge that and tothank those who areproviding excellent services.We also want to thank thepeople who work so hard forthe Macular Disease Societyand its members.

Anyone who knows of aperson or team whodeserves recognition for thework they do is encouragedto nominate them for one ofthe awards. Individuals andteams can also nominatethemselves. The closing datefor entries is 30 June andpresentations to the winnerswill be made at the MDSannual conference inLondon on 19 September.For an information packtelephone the MDS on 01264 350551 or visitwww.maculardisease.org �

Advertise on the ABDO websiteIf you have a job vacancy in your practice, pleaseremember that the Situations Vacant section in theBulletin Board area of the ABDO website provides youwith a quick and easy facility to advertise completelyfree of charge. �

Frontline practice staff will be catered for at this year’sIndependents Day (ID09) event at the National MotorcyleMuseum, Birmingham, on 2 July. The decision by organiserProven Track Record (PTR) to include a mini-programmefor optical assistants follows increased attendance at theannual CET event by non-professional staff.

Support staff training guru Sarah Morgan will run the two-and-a-half hour parallel track, which is sponsored by CIBAVISION. There will be two sessions; the first is entitled ‘Howmuch are your contact lenses? Where do we start?’ andwill look at what’s new in contact lenses and positiveapproaches to promoting contact lenses in practice. Thesecond, entitled ‘I’d like to make an appointment’, willreview confident appointment making and how tostructure the diary for business success.

The theme of ID09 is ‘Driving retail sales in a recession’ andit will feature top business people offering their bestadvice for surviving the economic downturn. This is thefifth meeting open exclusively to independentpractitioners and features CET workshops from sponsors.

To book a place, visit www.independentsday09.co.uk �

New track for frontline staff

DO June.qxd:1 21/5/09 15:00

Halifax

A Midlands-based opticaldirector is focusing onfundraising after accepting achallenge to complete acoast-to-coast bike ride. MikeCody of Colin Lee Opticiansis planning to cycle off-roadfrom Sunderland on the eastcoast, across to Whitehavenon the west, and then backagain, in just four days.

Mike, 43, from Solihull willcover the 270 miles with ateam of four friends in aid oftwo charities – Breast ofFriends and Vision AidOverseas (VAO). Breast ofFriends is a Midlands breastcancer charity, which hasbeen supporting Linda Lee,co-founder of Colin LeeOpticians and a fellowdirector, during her illness.

Having worked for thecompany since 1992, when

he joined as manager of theRugeley practice, MIke isnow in charge of its contactlens division. He joined theboard of directors during thecompany’s 30th anniversarylast year. “I had a bike forChristmas, and before I knewit, talk had turned to doing abike ride for charity,” heexplained. “The other fourare all proper cyclists, and Iam by far the least fit of thegroup. I am now wonderingwhy I agreed to make thiseven harder by going off-road, but it will just make memore determined than everto complete it.”

Mike is scheduled to start theride on June 11, so to sponsorhim online visitwww.justgiving.com/coasttocoastvisionaid andwww.justgiving.com/coasttocoastbreastoffriends �

Mike gets on hisbike for charities

Have you gotthe SA-X factor?

A customer satisfaction survey hasconfirmed that Stepper UK is on theright track when it comes to customerservice. Its survey of 179 customersshowed that 78 per cent were ‘verysatisfied’ with delivery and that 98 percent rated Stepper as ‘good’ or‘excellent’ (66 per cent rated Stepperas ‘excellent’).

Putting customer service first hasalways been one of the key prioritiesin developing Stepper in the UK. “We

believe that providing quality, goodfitting product alone will not keepcustomers coming back,” explainedStepper MD, Richard Crook. “Youhave to maintain the brand valuesthroughout the customer experience.”

Stepper has a consistent next daydelivery of 99.8 per cent. The surveyrevealed that over 94 per cent ofthose questioned would be orderingStepper products within the next 12months. When asked “Would you

recommend Stepper to anotheroptician?” – almost 98 per cent saidyes.

“We’re delighted,” added MrCrook. “These results are veryencouraging, but we won’t beresting on our laurels. There’salways room for improvement indelivery, customer service andwe’ve some great new products inthe pipeline.” �

Customers reveal their satisfaction

Mike Cody in trainingSearch for the SA-X factor


Opticians are beinginvited to compete in a‘SA-X factor’ style name-that-lens competition bySignet Armorlite.

The contest is in support ofthe company’s newlylaunched SA-XOccupational Lens, with aToshiba laptop as thewinning prize.

Claire Cooke, SAE productmarketing manager, said:“Naming a lens issomething that lensmanufacturers do on aregular basis, and theyhave to consider suchthings as the product’sfeatures and benefits. Butwho better to know whatname will work and whatname won’t, than thecustomer?”

SA-X Occupational Lens(as it is called whilst aname is being discovered)is designed to improvevision and increasecomfort when working in aclose proximityenvironment such as acomputer based office.Once the winning namehas been chosen by ‘thejudges’, SA-X’s new namewill be used on all futuremarketing material andcommunications.

For details of the SA-XOccupational Lens,including competition rulesand an entry form,telephone 01452 887410 [email protected] competition closingdate for Dispensing Opticsreaders is Friday 19 June. �

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Ready-readers forall appetites

Attractive ready-readers

Newsbrief

Buchmann UK MD, Andrew Brandi,has come up with a novel marketingapproach to selling ready-readers . . .“I wonder if any opticians havethought of approaching localrestaurants with the offer of a set of+1.00 to +3.50 half eyes to ensuretheir diners can enjoy the wine list tothe full,” said Mr Brandi.

Distributing new collections from theB&S Shoptic catalogue, Buchmannbrings together flex hinge,lightweight, stylish metals in full andhalf rim styles, several in stainlesssteel and others in bright, highquality acetates. Filigree sides andfloral relief acetate come together inblack with green, black with cherry,

black with blue, or tortoiseshell,cherry, blue and aqua. Availablewith a 12 or six-piece acrylic displaystand, the range has something forall tastes.

For a copy of the 2009 B&S Shopticcatalogue, telephone01634 662306. �

DO June.qxd:1 21/5/09 15:00

ABDO College deadlinedates for new courses

Orphansbenefit fromeyecaremission

Foundation Degree in Ophthalmic Dispensing CourseFellowship Dispensing Diploma CourseABDO College now offers two distance learning pathwayoptions on the route to becoming a qualified dispensingoptician - the Foundation Degree in Ophthalmic DispensingCourse and the Fellowship Dispensing Diploma Course. TheCollege, which is dedicated to providing first class training,supportive friendly staff and personal tutors, hasannounced it is now taking applications for the new 2009intake. Applications for both courses must be received by14 August 2009.

Theory Revision CoursesTo assist DO students with their revision, ABDO College isrunning a range of twelve-week correspondence coursesfor theory revision. These courses are available in the keydispensing subjects of optics, ophthalmic lenses, visualoptics, anatomy & physiology and also contact lenspractice, visual optics and anatomy and low vision optics(paper one). The courses start on 10 August and theapplication deadline date is 23 July 2009.

For further information on any of the above courses contactDLI at ABDO College on 01227 733 901 or email:[email protected] �

A novel treatment for dry eye


New ActiMist Eye Spray forrelief of dry eye proved ahit with opticians whenmanufacturer Optrex took itto Optrafair recently. It wasthe first time the companyhad exhibited at an opticaltrade show. Said JessicaGlover, assistant brandmanager for Optrex: “Theshow was amazing. Wegave away 3,000information packs and 300people trialled the product.Opticians have respondedso well and the showopened up a lot ofopportunities for us.”

Unlike standard eye drops,Optrex ActiMist Eye Spray issprayed directly ontoclosed eyelids, making itan ideal alternative todrops. The liposomes in thespray gently migrate acrossthe surface of the eyelid,collecting at the edges ofthe eyes. When the eyeopens, the lipid mixturemoves into the eyes whenblinking, helping to repairthe delicate lipid layer andrestore the balance ofmoisture in the eye.

ActiMist can be used withcontact lenses in situ, andby those who haveundergone laser eyesurgery. It is available insmall sterile spray canisterscontaining 100 doses andcan be used whilst wearingmake-up. For furtherinformation visitwww.optrex.co.uk or call0500 455 456. �

Kenilworth independent,Keith Murphy, has visitedthe Ukraine to provideeyecare to a group oforphans who have neverhad an eye examination.Taking Rodenstock,Continental and Dunelmframes, donated by thecompanies, Mr Murphytested sight and dispensedframes to around 160children, aged betweenfour and 16 years, at theNove Selo StateOrphanage inPidvolochiskyi.

Mr Murphy was joining ateam of 19 volunteers fromthe Ballynahinch BaptistChurch in Northern Ireland,who along with a localUkrainian church, areworking with the childrenand helping to refurbish theorphanage. The frames arebeing made up byRodenstock at its Northfleetlaboratory free of charge.

“The children have neverhad eye checks and thenearest free eyecare is inLviv, a city three hours driveaway. We hope to makequite a difference to thechildren and I am verygrateful to the companieswho, through their support,made this trip possible,”said Mr Murphy. �

Novel dry eyespray is a hit

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Head-turningstyles

Move toBBGR

Blaby DO shinesat awards ceremony

DO Joanne Benfield with herOptician Award

Oasis Chicory in three colours Nick Browning

A revolutionary new online consulting tool from Silhouetteallows spectacle wearers to choose their frames in a virtuallyeffortless way. Silhouette’s Virtual Mirror – at www.silhouette.com/virtualmirror – provides a personal consultation andhelps customers determine which custom made and handtailored frames suit their face – in three simple clicks.

The wearer can choose from one of the four face shapes onthe website or upload their own picture onto the virtual mirror.They can then try out different frame shapes, and view thechosen frame in depth, including surface and design, to geta real close up view. �

Four new styles have beenadded to the OasisEyewear collection fromAndrew Actman. There arenow 56 styles in thecollection, which isdesigned for a youthfulfemale audience. Eachstyle is available in threecolours with optionsranging from rounded, softand sensual to more edgy,hard lined and individual.

New model Chicoryfeatures wrappings oflayered acetate in threecolours, all with atortoiseshell finish. The eyeshape is oval and narrow,drawn with a neat line tomake the front noticeablydark, while the light andtranslucent undersideprovides a brightcontrasting hue for theface. For further detailscontact Andrew Actman on020 8544 9888. �

Former Shamir MD, NickBrowning, has joined BBGRas business developmentdirector. Commenting onhis new role, Mr Browningsaid: “The opportunity towork with BBGR’s provenproduct portfolio, highcalibre management teamand undoubted growthpotential proved anirresistible package. I amparticularly excited by thedesign and dispensing ofBBGR’s digitally surfacedlenses, where I believeAnateo is a clear leader inits class.” He added: “I feela clear opportunity existsfor suppliers to helppractitioners prosper,through an innovativeapproach to product,pricing, promotions andrelationships. At BBGR UK,we plan to lead the marketin these activities.” �

Newsbrief

Joanne Benfield, DO atEdmonds and SlatterOpticians in Blaby, wasdelighted when she wasannounced a runner-up inthe category of DispensingOptician of the Year at therecent 2009 OpticianAwards.

Ms Benfield, who ismanageress of the Blabypractice, and hercolleagues attended thered carpet awards night atthe National MotorcycleMuseum where they weregreeted by ‘paparazzi’ anda Marilyn Monroe look alike

in keeping with theHollywood theme. Theawards were hosted by starof TV’s Nine out of Ten Cats,Jason Manford, and afterthe prizegiving there wasdancing to a live band anda charity casino with all ofthe proceeds donated toVision Aid Overseas.

April marked anotherlandmark celebration atEdmonds and SlatterOpticians when itslaboratory administrator,Lynn Shalvey, celebratedher 15th year with thecompany. She waspresented with wine and abouquet of flowers by TimCole, business partner, whosaid: “In today’s economicclimate it makes arefreshing change to see asmall company able toflourish due to hardworking,longstanding loyal staffmembers.” �

Growing theAsia markets

Virtual frame selection tool

Singapore-qualifiedoptician, Wong Kok Roon,has joined the CeriumGroup as regional salesmanager. He will headCerium’s team serving thegrowing markets in Asiafrom the Singapore offices ofCerium Technology. Wonggained his qualification in2008 following a coursecovering the variousmodules of dispensing andrefraction at SingaporePolytechnic. He has held topmanagement posts with big-name Singapore ophthalmiccompanies AmericanOptical and Visitech, wherehe had managementresponsibility for prescriptionlaboratory operations. �

ABDO BenevolentFundIf you know of adispensing optician, or adependant of adispensing optician, whomight benefit from theABDO Benevolent Fund,please get in touch withBarbara Doris on 0207298 5102 or [email protected] or write to her atABDO, 199 GloucesterTerrace, LondonW2 6LD. �

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Commenting on the award, MichèleActon, Fight for Sight’s chiefexecutive, said: “Professor Marshall’spioneering work on laser technologyfor refractive surgery and researchinto the mechanisms underlying age-related macular degeneration andother eye conditions have had ahugely beneficial impact on thetreatment of patients. We aredelighted to see that the

distinguished contribution he hasmade to the prevention andtreatment of blindness and eyedisease has been recognised by thisprestigious award.”

Fight for Sight’s other ambassador isProfessor Peng Tee Khaw of the UCLInstitute of Ophthalmology andMoorfields Eye Hospital, who is also aFellow of the AMS. �

Fellowship for charity ambassador

Fight for Sight ambassador, Professor John Marshall of King’s CollegeLondon, has been elected as a Fellow of the Academy of Medical

Sciences (AMS). He is one of two F4S ambassadors appointed in recognitionof their contribution to eye research and to the charity’s work.

Enhanced multifocal‘at last’ . . .

Nordic region continues soft lens domination

Golf seasontees off

Shamir UK’s new technical lenscatalogue contains full productdescriptions and technical data,providing a comprehensive guide todispensing Shamir lenses. TanyaHenderson-Storey, UK productdevelopment manager, said: “Thenew Shamir Lens Catalogue has beendesigned with practice dispensingteams in mind. It is a must havedispensing guide that is quick andsimple to use and will prove to be aninvaluable dispensing tool in anypractice.”

For a copy of the catalogue, contactyour local area representative or callthe Shamir customer service team on01954 785100.

* Shamir would like to thank all of theentrants who took part in the recentShamir/Transitions prize draws atOptrafair and offers itscongratulations to all the winners. �

Easy-to-uselens guide

Swinging into action With atLast! lenses – and without


The 2009 golfing seasonswung into life with arecent golfing event jointlyhosted by See20/20 andNikon. Around 40 industryprofessionals enjoyed 18holes on the championshipForest of Arden course,followed by an evening ofcelebrations andcommiserations. After athree-course meal,presentations were madeto the winners along with

the all-important boobyprize for the gentlemanwho broke his driver on thethird hole. Each player wasvideoed on the first teeand received professionaltuition from the AspirationGroup, which organisedthe day’s events. The nextgolf day will be inSeptember. Anyone who isinterested in joining inshould [email protected] �

The new atLast! ‘enhancedmultifocal’ from Norville isdesigned to replace linedmultifocals and restore theintermediate vision thatbifocal wearers have foundmissing. Unlike traditionalflat tops, atLast! is said toprovide patients with anexpansive intermediatevision with 70 per cent lesspower jump at the top ofthe segment. All this,according to Norville,

means a new ‘fourth zone’of far intermediate is nowavailable for the flat topbifocal and trifocal wearer.

atLast! provides distancevision correction pluscontinuous vision from 14inches to about five feet –and it is appealingcosmetically since thesegment is virtuallyinvisible. Call NorvilleLenses 01452 528686. �

The sixth pan-European study on thesoft contact lens and lens caremarket has revealed that the Nordicregion continues to have the highestnumber of soft lens wearers. The dataused in the report is gathered fromEuromcontact member companies toinvestigate the size of nationalcontact lens wearer bases. On the

basis of this data, the highest overallpenetration rate is in the Nordicregion, with 8.9% of all adults (up2.9% on 2007). Daily disposables areworn by more than 4% in the Nordicregion, followed by the UK andIreland, with 3.2%. For a copy of thefull report contact the ACLM on01380 860418. �

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Newsbrief

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Disjointed jottings from a DO’s desk . . .

Ian Anderson did not realise the value of post-cateract operation care, until he underwent theexperience for himself

Another birthday under the belt and Icontinued to think of myself asyounger than I actually was. Thenalong came one of those lifeexperiences that suddenly jolt you intorealising you are getting older - likethe college reunion, and meetingpast trainees who are now happilymarried with grown up children.

Imagine my shock, when, after aregular eye examination, I was told Ihad a cataract forming! This happensto the elderly, people in their seventiesand eighties - not to me in my lateforties.

When, many years ago, I first startedwork in dispensing, the operation tohave a cataract removed wascomparatively new. There were nointer-ocular implants; you simplyended up with thick old lenses. Atleast things have progressed sincethen.

With my own experience, my mainconcern was that my vision would notbe altered too much. In practice Ihad seen some awful results, such ashigh cylinders and anisometropia,which affects judgement of speedand depth. I was still working and hadan active life. Well I thought so -changing the TV channel by remotewas enough effort.

The date of the operation arrived andI went trembling into the local day

surgery clinic. All a bit nerve-wracking.Many drops in the eye, followed by abit of a wait. Then, taken into theoperating theatre with lovely classicalmusic playing (or was that just in mymind?)

Everything was so whiteAll over nice and quick; no problemsat all. Instructions were given as towhat I could do - damn I could notmake the bed or weed the garden!When I first took the eye guard off,WOW, the vision was amazing. Afterliving through a fog for months I wasnow able to see with both eyes. My‘new’ eye was so clear andeverything was so white. But, bycontrast, my un-operated eye was likelooking through an amber tint.

At last back to normal with only dropsto finish and then an eye examination.The resulting prescription was good. Inow had slight mono-vision and I nolonger needed glasses for distance -or so I thought. Just for convenience Igot some varifocals - a near pair forreading in bed, and a pair for theVDU.

Then I began to notice that my drivinghad become very cautious. I wasslower and hated reversing into aspace. I put this down to an age thing– or maybe stress? Until one day Iwore my varifocals for driving andbelted down the motorway as normal(well within the speed limit, of course).

I then realised my depth ofperception had been compromised.In addition, replacing screws andseeing varifocal markings hadbecome a problem.

Another issue was glare. Walkinghome I got dazzle from every streetlight I passed and, since I was stillclubbing it, I became adept at findingdark corners so the lights did notbother me. I had heard of capsulethickening but had no idea of theeffect it had on vision . . . until now.

All this I put up with as my other eyehad developed a cataract and Iunderwent the same procedure allover again. So how old am I? Withboth eyes done, is there a portrait inmy attic ageing very rapidly?

Then my vision was back to normalonce more and now everything islovely and white. However, capsulethickening in the centre of one eyeand the top of the other eye haddeveloped which makes life difficult.So I read with one eye and wear apatch on the other when out at clubs!

Visual requirementsThe cataract operation is verycommon these days and yes, theresults are fantastic. But in myexperience, there seems to be littletime spent with the optometrist andthe ophthalmologist regarding thepatient’s visual requirements, what to

Life aftercataracts


Ian Anderson

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expect, possibilities of mono-vison,and capsule thickening. How wouldthese be likely to affect a patient’slifestyle?

Personally, I found it difficult to explainmy own resultant problems and, eventhen, no great importance was putupon them. I began to feel I wasbeing a nuisance and condemned toa life of dark corners, dazzle fromlights and not replacing screws(whoopee!).

When I now see post-cataractpatients, I am able to explain moreeasily the problems they mayexperience. A patient who has alwaysworn glasses may now not have to,but he or she could feel moreconfident and comfortable wearingthem. Extra protection from ultra violetlight is also important - 'cause it is verybright out there.

My vision was very difficult for sevenyears until the time both eyes weredone. Things are now just gettingback to normal and I have learnedthrough first-hand experience that thebest benefit, apart from sight, is beingable to communicate more easilywith post-cataract patients and helpthem through their difficulties.

Ian Anderson is chairman for Area 11(London), works in the DispensingDepartment at the Institute ofOptometry and as a locum. �

In a world where super bugs are onthe increase and hospitals areovercrowded, as registered opticiansit is essential we know about ocularpathology and how to differentiatebetween conditions. Patients aremore likely to contact their optician ifsomething has affected their eyes orvision and, as registered opticians, wehave a ‘duty to refer’ the patientappropriately. The difficulty occurswhen complications have similar signsand symptoms but need differentmanagement techniques - and hereis where Abnormal Ocular Conditionsis essential reading.

One of the main benefits of this bookis the organisation of the pathologicalconditions. There is a contents pagehighlighting the ocular structures thatcan be affected, and the commonconditions found in that structurefollow. In addition, there is a tablecomparing different red eyeconditions which allows the user toeasily differentiate between commonconditions. Each condition is split intothe signs, symptoms, cause andtreatment, which enables the patientto get the appropriate care.

Primarily, the book focuses onpathology and how to manage it.However, it also has informativechapters on referrals, optometricdrugs and a glossary of terms. Thismakes the book easy to understand,enabling explanations to patients in alanguage they will understand.

The referral chapter will help thepractitioner feel confident aboutwhen to refer, what to include in areferral letter and what to do with thereferral letter in order to comply withThe Optician’s Act.

Abnormal Ocular Conditions isessential reading for anyone whoneeds more information on commoneye conditions and how to managethem in practice. It is also useful forfinal qualification exams inophthalmic dispensing andoptometry.

Reviewed by Gill Elstub FBDO CL CertEd, full-time lecturer at ABDO College,Godmersham �

Abnormal Ocular Conditionsby David Pipe and Linda Rapley, published by the Associationof British Dispensing Opticians, ISBN 0900099372

Book review

ABDO COLLEGE BOOKSHOPThis book, plus numerous other titles, can be purchased from the ABDOCollege Bookshop at www.abdo.org.uk or by contacting Justin Hall on

01227 733904, email [email protected]

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The answers to ‘Multifocal contact lenses - from opportunity to success’ will appear in our July 2009 issue

Answers:The importance of spectacles for contact lens wearersby Dr Christine Astin1. A 25-year-old van driver wears –3.00D soft lenses 16 hours aday, giving 6/5 R & L. Why should he also buy spectacles?a. Better cosmesis obtainedb. To drive legally if he has eye infectionsc. Better vision for night driving in spectaclesd. To gain the advantage of an anti-reflection coating

when drivingb is the correct answer. The unaided vision for the –3.00D myopewould not be legal for driving. It’s best to have good spectacles forlegal driving VA, in case of a contact lens (C L) problem. Theseshould not be dark tinted spectacles as he may need to drive inpoor illumination, eg at night.

2. A 30-year-old shift worker at a timber yard wears –3.00D mid-water monthly disposable soft lenses each day. Why should hewear spectacles at work?a. So it won’t matter if he falls asleepb. To protect the eyes from trauma and dusty atmospheresc. So that he appears more serious and officiald. Because he sometimes has to drive a fork-lift truckb is the correct answer. At a timber yard, suitable spectacles areimportant as safety protection e.g. if a plank fell on the worker. Theairborn sawdust would also adhere to the soft CLs, often remainingeven after cleaning, leading to serious ocular abrasions andinfection.

3. Why may a busy 30-year-old –5.00D myopic actress benefitfrom spectacles?a. To rest her eyes after many hours of lens wear on stage

in hot bright lightsb. She feels a colourful high fashion pair will attract

publicityc. She can read scripts easier than in lensesd. All of the above and it’s easier to clean makeup off

spectaclesd is the correct answer. The actress wears CLs on stage in a hot dryatmosphere, but spectacles allow the eyes to rest from CLs, soprevent ocular discomfort and redness. Prolonged wear of CLsincreases the chance of grease and make-up deposits build up,greasy vision, discomfort and infections of the eyes. Suitable high-fashion spectacles would increase publicity and attention andreading scripts is easier in her spectacles as the convergence andaccommodation effort is less than when wearing CLs.

4. Which is the most likely reason a chemistry teacher may preferspectacles?a. To more easily see the pupils at the rear of the classb. To make him look like a fierce headmasterc. They are quicker to put on in the morningd. Because the chemical fumes discolour his contact

lensesd is the correct answer. In some lessons a chemistry teacher has todeal with toxic liquid splashes and fumes. Suitable spectacles canact as safety protection for the eyes. CLs do not offer this and canoften retain the toxic chemicals, prolonging ocular inflammationand damage.

5. Why may a –5.00D myopic 40-year-old librarian withconvergence insufficiency sometimes prefer spectacles to contactlenses?a. They disguise her deviating eyeb. They make her eye muscles exercise morec. They help her to appear professionald. She needs to converge to a lesser extent in spectacles

than in lensesd is the correct answer. As the librarian does prolonged near workher eyes get tired and the control of her convergence insufficiencydecreases. In CLs she has to maintain full convergence effort, butin her –5.00D spectacles she gets base in prismatic effect for eacheye, so needs less convergence.

6. When may a +8.00D hyperope aged 45 prefer spectacles tocontact lenses?a. When he goes to watch a football matchb. When he plays rugby or football

c. When he reads newspaper football results with spectacles down his nose

d. When trying on football kitc is the correct answer. At age 45 the hyperope has earlypresbyopia and strains reading tiny near print. If he pushes his+8.00D spectacles down his nose this increases the back vertexdistance and can give an extra +0.50D effective power to help.

7. Which is the most likely reason a monovision contact lenswearer may benefit from wearing spectacles over her lenses?a. For better stereopsis and comfort at prolonged near

tasks like sewingb. To prevent splashes in the eyes if painting a ceilingc. To protect the eyes from grass debris if lawn mowingd. To disguise the red eyes caused by lens overweara is the correct answer. The usual reason for wearing ‘top-up’spectacles over monovision CLs is to balance the vision in the twoeyes and improve stereopsis.

8. A 50-year-old computer worker (non-driver) wears R & L +3.00Dintermediate power contact lenses. Which is the most likely reasonfor spectacles over lenses?a. To see across the street on travelling homeb. To prevent ocular damage from uv raysc. For comfort by tinting computer screen wordsd. To prevent future increase in presbyopiaa is the correct answer. The presbyopic worker may prefer CLs forintermediate range. He puts ‘top-up’ spectacles over these CLs tosee distance range when travelling.

9. A housewife age 60 likes her varifocal contact lenses. Whenmay she sometimes want spectacles to wear over her lenses?a. To hide the wrinkles under her eyesb. To read tiny print of ingredients on food wrappersc. To protect her eyes from furniture polish vapourd. To relax her eyes if watching televisionb is the correct answer. Varifocal design CLs may be good ingeneral use, but to read tiny near print on food wrappers extranear power can be given by ‘top-up’ spectacles.

10. A 65-year-old golfer likes his varifocal contact lenses. Why mayhe sometimes want spectacles over his lenses?a. To hide the wrinkles under his eyesb. To prevent the car heater from drying his lensesc. To give a tint so his pupil size is larger than the lens

centre near portiond. To provide monovision so he can see the golf tee easierc is the correct answer. In bright light the golfer’s pupils may be assmall as the centre near portion of his varifocal CLs. Tintedspectacles over his CLs encourage his pupils to dilate and allowlight rays through the distance portion of the lenses.

11. When may a 25-year-old dentist benefit from spectacles overher contact lenses?a. To appear less scary to childrenb. To protect from water spray and flying tooth debrisc. To protect from patients arm movementsd. To protect when taking X-rays of teethb is the correct answer. A dentist would benefit from spectacleprotection from spray and debris during dental treatments, andthey would also offer some protection from strong blue and UVlights used for curing fillings.

12. A 30-year-old carpenter wants cheap contact lenses just forplaying rugby. When may he benefit from wearing spectacles overhis lenses?a. To prevent mud splashing in the eyes when playingb. To get sponsorship from a sunglass companyc. To prevent hay fever as hayfield is near the sports

groundd. To correct residual astigmatism for better vision driving to

the gamed is the correct answer. Spherical soft CLs are cheaper than toricdesign lenses. Cheap spectacles to correct residual astigmatismcan be put over CLs for detailed tasks like driving

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London, £75. For further detailscontact Sally Bates as above

June 28Area 11 (London) - CET Day, TheHoliday Inn, Bloomsbury. For furtherdetails contact Hishu Monji on02078373276 or [email protected]

September 8ABDO Golf Society - Stercks MartinSalver, Olton Golf Club, Solihull,Birmingham. For more information,and for anyone wishing to join theABDO Golf Society, contact MikeStokes 01204 411722 or [email protected]

September 13Area 6 (West Wales) - CET Day, VillageHotel, Coryton, Cardiff 6.5 CET points,further details to follow. For furtherdetails contact Kevin Milsom by [email protected]

September 14Area 5 (Midlands) - CET Day, theArden Hotel, Birmingham. For furtherdetails telephone Ian Hardwick on07814 558343 or [email protected]

September 16BCLA - Presidential Address, RoyalSociety of Medicine, London. Forfurther details visit www.bcla.org.uk orcontact Vivien Freeman on 020 75806661 or email [email protected]

September 17-20Silmo 2009 - Paris. For further detailscontact Michele Jackson atPromosalons (UK) on 020 8216 3109 oremail [email protected]

October 3-52009 ABDO Conference and Exhibition- Hilton Brighton Metropole, Brighton.For further details contact the ABDOConference Office (Event ExchangeLtd) on 01225 869 000 or [email protected] or visitwww.abdoconference.co.uk �

JuneCIBA VISION Academy for EyecareExcellence - second series of‘Maintaining the EDGE’ roadshows:June 16 National Motorcycle MuseumBirmingham; June 17 MacdonaldHotel Manchester; June 18 MarriottHotel Leeds; June 22 Clarion HotelLiffey Valley Dublin; June 23 MarriottHotel Slough/Windsor; and, June 24Royal Society of Medicine CentralLondon. to book visitwww.cibavisionacademy.co.ukor call 0845 058 3949

June 9Area 9 (South East) - AGM, 7.30pm,buffet 7pm, Hickstead Hotel, BurgessHill turn, A23. For further details contactRhys Williams on 01444 257722 or [email protected]

June 11Area 7 (West Country) - CET Day,topics to be confirmed, up to 7 CETpoints available, Gypsy Hill Hotel. Forfurther details contact DebbieAnderson [email protected]

June 14Area 12 (Scotland) - CET Day, 5 CETpoints, sponsored by Essilor, Addidas,Nikon, Zeiss and OWP UK, The TreetopsHotel, Aberdeen. For further detailsBrenda Rennie [email protected]

June 14Identity Optical Training - ABDO FinalYear Mock Practical Exams (oldsyllabus) London, £75. For furtherdetails contact Sally Bates on 020 85040967 or email identity@sallybates

June 16Area 1 (North East) - ‘Freeform yourway to a new lifestyle’, presented byHOYA UK, CET approved, RavensworthArms, Lamesley, hot/cold buffet at7pm, lecture at 7.45pm. [email protected] for details

June 21Identity Optical Training - ABDO FinalYear (FQE) Mock Practical Exams,

ABDO members are welcome to attend Area meetings in any area they wish

The Professional Journal of the Associationof British Dispensing Opticians

Volume 24 Number 6 of 12

EDITORIAL STAFFEditor Sir Anthony Garrett CBEAssistant Editors Jane Burnand and BarbaraDoris BScProduction Editor Sheila HopeEmail [email protected] Editor Ann JohnsonEmail [email protected] Editor Nicky CollinsonEmail [email protected] Manager Deanne GrayEmail [email protected]

ADVERTISEMENT SALESTelephone 01892 667626Email [email protected]

SUBSCRIPTIONSApply to Katie DockerABDO, Godmersham Park, GodmershamKent CT4 7DTTelephone 01227 733902Email [email protected]

ABDO CETCET Coordinator Paula Stevens MA ODE BSc

(Hons) MCOptom FBDO CL (Hons) AD SMC(Tech)

ABDO CET, Courtyard Suite 6, Braxted Park,Great Braxted, Essex CM8 3GATelephone 01621 890202Fax 01621 890203Email [email protected] [email protected]

CONTINUING EDUCATION REVIEW PANELJennifer Brower FBDO (Hons) LVA Cert Ed

Andrew Cripps FBDO (Hons)

Richard Harsant FBDO (Hons) CL (Hons) LVA

Angela McNamee BSc (Hons) MCOptom

FBDO (Hons) CL FBCLA Cert Ed

Elvin Montlake FADO (Hons) CL LVA FFDO

Linda Rapley BSc (Hons) FCOptom Cert Ed

Alicia Thompson FBDO (Hons) SLD SMC(Tech)

JOURNAL ADVISORY COMMITTEENick Atkins FBDO (Hons) CL

Richard Crook FBDO

Kevin Gutsell FBDO

Ros Kirk FBDO

Angela McNamee BSc (Hons) MCOptom

FBDO (Hons) CL FBCLA Cert Ed

Gillian Twyning FBDO

Dispensing Optics is published byABDO, 199 Gloucester Terrace, London W2 6LD

Dispensing Optics is printed byLavenham Press, Lavenham, Suffolk CO10 9RN© ABDO No part of this publication may bereproduced, stored in a retrieval system, or transmittedin any form or by any means whatever without thewritten prior permission of the publishers

Dispensing Optics welcomes contributions forpossible editorial publication. However,contributors warrant to the publishers that theyown all rights to illustrations, artwork orphotographs submitted and also to copy whichis factually accurate and does not infringe anyother party’s rights

ISSN 0954 3201

Average circulation 2008: 8654 per issue - ABDOBoard certification

Diary of events

dispensingoptics

www.abdo.org.uk

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