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dispensing optics

August/September 2008 Volume 23 No 6


Dispensing Optics, PO Box 233, Crowborough TN6 9BD Tel: 01892 667626 Fax: 01892 667626 Email: [email protected] Website:

Aug/Sep 2008 Dispensing Optics 3


The Professional Journal of the Association of British Dispensing Opticians

Cover point

have been tireless in her efforts. I for one am extremely grateful for what they have achieved and, I am sure that in the years to come, members will be able look back at this landmark achievement as a significant moment in the development of the profession. This momentous achievement could not have come at a more opportune time as it coincides with the Association's policy of attempting to significantly raise the profile of the profession. The first part of that campaign will become clear at our new style conference being held in Manchester from 27 to 29 September. I hope as many members as possible take the opportunity to attend, for at least a part, of what promises to be an innovative and enjoyable weekend.

Volume 23 No 6 Editorial staff Editor Sir Anthony Garrett CBE Assistant Editor Barbara Doris BSc Production Editor Sheila Hope Email [email protected] Journal Consultant Ann Johnson Email [email protected] Administration Manager Deanne Gray Email [email protected] Dispensing Optics, PO Box 233, Crowborough TN6 9BD Telephone 01892 667626 Facsimile 01892 667626 Email [email protected] Website Advertisement sales Telephone 01892 667626 Facsimile 01892 667626 Email [email protected] Subscriptions Apply to Katie Docker ABDO, Godmersham Park, Godmersham Kent CT4 7DT Telephone 01227 733902 Facsimile 01227 733900 Email [email protected] Website ABDO CET CET Coordinator Paula Stevens BSc (Hons) MCOptom FBDO CL (Hons) AD SMC (Tech) Cert Ed ABDO CET, Courtyard Suite 6, Braxted Park, Great Braxted, Essex CM8 3GA Telephone 01621 890200 Fax 01621 890203 Email [email protected] Email [email protected] Website Continuing education review panel Jennifer Brower FBDO(Hons)LVA Cert Ed Andrew Cripps FBDO(Hons) Richard Harsant FBDO(Hons)CL (Hons)LVA Angela McNamee BSc(Hons) MCOptom FADO(Hons)CL FFDO Cert Ed Elvin Montlake FADO(Hons) CL LVA FFDO Linda Rapley BSc(Hons) FCOptom Cert Ed Alicia Thompson FBDO(Hons)SLD Journal advisory committee Nick Atkins FBDO (Hons) CL Richard Crook FBDO David Goad FBDO(Hons) CL Kevin Gutsell FBDO Ros Kirk FBDO Angela McNamee BSc(Hons) MCOptom FADO(Hons)CL FFDO Cert Ed Gillian Twyning FBDO Dispensing Optics is published by ABDO, 199 Gloucester Terrace, London W2 6LD Dispensing Optics is printed by Lavenham Press, Lavenham, Suffolk CO10 9RN © ABDO No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means whatever without the written prior permission of the publishers Dispensing Optics welcomes contributions for possible editorial publication. However, contributors warrant to the publishers that they own all rights to illustrations, artwork or photographs submitted and also to copy which is factually accurate and does not infringe any other party's rights ISSN 0954 3201

The Worshipful Company of Spectacle Makers


Foundation Degree Programme

These are exciting times for the Profession. In the June/July issue of Dispensing Optics we reported extensively about the developments at ABDO College, the introduction of our first Foundation Degree Programme and the plans (subject to validation) for a BSc Hons in Ophthalmic Dispensing. There is much that could be said about these exciting developments. However, at this stage, it is worth reflecting on what a major step forward this is and what a wonderful achievement for all concerned. For Jo Underwood the Principal and Michelle Derbyshire the Head of Distance Learning at ABDO College, it not only represents the culmination of many months of dedicated hard work but is also testimony to the very high quality of teaching and professionalism of the team at Godmersham. Jo and Michelle have been supported by the whole College staff and also by Rowena Shipley and Paula Hall who

The new GOS contract

Finally, we should record that the new GOS contract came into force on 1 August 2008. This meant a great deal of work and, in some cases, anxiety for many of our members who are practice owners. As an Association we have of course worked very closely with both the AOP and FODO and the joint advice that has been issued has been widely valued. I am particularly grateful, however, to Katie Docker and our small team in the membership department who have spent many hours working with members to overcome problems that they have had. As we go to press I am pleased to say that most issues have been addressed satisfactorily but that we are still engaged on one or two unresolved matters. Tony Garrett I

Average circulation 2007: 8526 per issue ABDO Board certification

4 Dispensing Optic s August/September 2008 Continuing education an d train ing

Why low vision? Part 1

In this first of two articles Jennifer Brower explains what low visual is and how it affects the individual, and dispels some of the common myths associated with it

CompetencIes covered: Low vision for dispensing opticians, visual function for optometrists Target group: dispensing opticians, optometrists

So, first of all, what is low vision? Low vision may be defined as a standard of vision below normal, which cannot be completely remedied by spectacles or contact lenses. Myth number one: low vision = low visual acuity. Low vision is not only classified by reduced visual acuity. Although we may describe a patient with cataracts and an acuity of 6/24 as a low vision patient, someone with tunnel vision may also be a low vision patient, despite a VA of 6/6. So this is why we talk about low vision, rather than low visual acuity. Myth number two: low vision work is all about magnifiers. The principle of magnification in low vision is based on enlarging the image where the central vision is damaged or reduced. Many low vision patients have central vision problems due to macular damage, and respond well to magnification, but there are also low vision patients with peripheral problems, as with glaucoma or retinitis pigmentosa, and a third category who have visual loss over the whole field, as in corneal dystrophy. To complicate the issue further, some patients may have more than one pathology affecting their vision. Elderly patients in particular may have macular problems with cataract, sometimes glaucoma as well. For these patients you will need to think very carefully about the impact magnification would have on their vision. Figure 1 shows a street scene viewed by someone with normal vision, Figure 2 simulates the vision with macular degeneration, Figure 3 cataract, and Figure 4 macular degeneration and cataract. Figure 5 simulates macular degeneration combined with both cataract and glaucoma ­ imagine just how difficult it is for someone like this to get around! Myth number three: low vision patients are all of registrable standard, needing strong magnifiers and other complex aids. Increased light and larger print sizes may be enough help for some patients, at least initially, the important thing to remember is that people's needs are not static and may change as their eye conditions advance. How low must the vision be to be classed as `low' vision? There is no definitive answer. A patient may read N6 under a bright spotlight in the consulting room but this can easily drop to N12 at home with a 60w ceiling light and the patient may have trouble reading the newspaper. The same patient may tell you he can read the morning paper by the window ­ what does that tell you about the importance of light versus magnification? A low vision aid ­ LVA ­ is a general description for something which helps or aids a person with low vision. It may be optical, such as a hand magnifier or telescope, non-optical, such as a reading lamp, large print book or filter, or electronic, such as a CCTV. LVA is also often taken to mean low visual acuity, but we have already seen that low visual acuity does not always feature in low vision. Myth number four: people must be registered to receive low vision support. A patient with low vision may be registered as sight impaired (partially sighted) or severely sight impaired (blind) but low vision services are available to anyone with reduced vision, generally regarded as someone who is having some trouble with everyday visual tasks. Registration carries some financial and support

This article has been awarded 1 CET point by the GOC. It is open to all FBDO members, including associate member optometrists. Insert your answers to the six multiple choice questions (MCQs) on the answer sheet inserted in this issue and return by 11 September 2008 to ABDO CET, Courtyard Suite 6, Braxted Park, Great Braxted, Witham CM8 3GA OR fax to 01621 890203, or complete online at Notification of your mark and the correct answers will be sent to you. If you complete online, please ensure that your email address and GOC number are up-to-date. The pass mark is 60 per cent. The answers will appear in our October 2008 issue.


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benefits but it is optional, and some patients decline to be registered. There are several reasons why a patient declines registration, some psychological, some through lack of information: it may be a sense of pride, not wishing to be recorded as disabled, it may be because the patient thinks independence will be lost, or it may just be an unwillingness to accept the visual problem exists. Sadly, there are also cases where the condition goes undiagnosed, so registration and help cannot be offered. This can happen with older patients, just because they do not present for eye examination, assuming that their eyes are bound to have deteriorated over the years. Professional awareness of low vision and the shortcomings in service provision is at an all time high, however, despite the best efforts of many, the provision of low vision services in the UK remains patchy and lacking common goals. Involvement of social services and health care professionals is common and generally provides good support to visually impaired people, but many services do not include dispensing opticians in their multi-disciplinary care team. Sometimes, optometrists are used purely as refractionists, passing the patient over to non-optically qualified people for low vision assessment and the supply of low vision aids. Legally, only dispensing opticians, optometrists and doctors may supply spectacles and spectacle mounted low vision aids to blind and partially sighted patients. Whilst non-optically qualified people can give valuable

help and may advise about lighting, some low vision aids and rehabilitation, access to optical aids other than simple magnifiers or distance telescopes is denied, either because of the legal restrictions, or simply because the aid cannot be dispensed effectively without knowledge of ocular pathology, optics and ophthalmic lenses. Myth number five: the stated power of a magnifier = the increased image size so reading a newspaper with a 2x magnifier makes the print twice the size. A common problem in the supply of magnifiers is finding a uniform classification to describe their magnifying power. Magnifiers are usually marked with their magnifying power as a guide, however there are two classifications of power based on the power of the lenses ­ nominal magnification or maximum magnification. There are also variations on the lens power, which may be the back vertex power or the equivalent power.


Nominal magnification, is a quarter of the lens power (F/4) so the magnification of an +8.00D lens is 2x. Nominal magnification is normally used for spectacle lenses, medium and high power magnifiers and telescopes. Maximum magnification is a quarter of the lens power plus one (F/4+1) so the maximum magnification of a +8.00D lens is 3x. Low power simple hand and stand magnifiers are often marked with the maximum magnification value. Factor in the working distance of the magnifier, and whether the patient is wearing spectacles or not, and the magnification varies even more! You can see that there really is no such thing as a standard 2x magnifier and the newspaper print will be magnified by different amounts depending on which so-called 2x magnifier you choose and the way in which it is used. This is a very important point when dispensing magnifiers but is

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6 Dispensing Optic s August/September 2008 Continuing education an d train ing

a concept not usually embraced by non-optically qualified professionals. When you take into account the patient's spectacle prescription, distance and/or reading glasses, and the lighting conditions, the situation is further complicated. The moral of all this of course is not to rely on what is marked on magnifiers, but measure the power on a focimeter or compare the image size with a convex lens of known power. Myth number six: noting `3x given for NV' indicates the true magnification, type of unit and acuity. Incomplete records are the bane of a low vision practitioner's life. Was it really `3x'? Was the unit hand held, free standing, illuminated or spectacle mounted? Was it a hand magnifier, stand magnifier, spectacle magnifier or telescope? What was the working distance? Was the patient wearing distance spectacles/reading spectacles/any spectacles? If this information is not available from the notes, it is very difficult to offer advice to a patient ringing up to say he cannot get on with the unit. Including the make and model of magnifier in the patient's notes will help you or another practitioner identify the magnification and unit that was actually supplied. Myth number seven: patients who need magnifiers do not need spectacles. Low vision patients often tell you their spectacles are `no good' so they do not wear them. True, it seems rather pointless wearing spectacles when they hardly improve the acuity, so why should you advise patients to wear them? It is all to do with magnification and the quality of the image. Earlier we established that when you are trying to improve the visual acuity for patients with central vision problems you would normally use magnification. A hugely important consideration in all this is the patient's spectacle prescription as spectacles ensure a sharp image is formed on the retina, even though the patient may not receive a sharp image because of the ocular pathology. Without spectacles the image will be out of focus on the retina and the magnified image will be less clear. When magnification is not being used,

spectacles will improve the peripheral vision of macular patients and help with eccentric viewing. Myth number eight: dispensing opticians need specialist qualifications to do low vision work. You do not need special qualifications ­ you already have those as a qualified DO. Begin by asking yourself what LVAs you already have in your practice. Do you stock any hand held magnifiers? Do you stock sunglasses? How about reading lamps? Are there any large print books in your waiting room? Does your optometrist ever prescribe adds over +4.00D? Do you ever vary the add yourself? By dispensing +5.00D or +6.00D adds you are supplying a magnifying aid. Then ask yourself, do you routinely refer patients with reduced vision to someone else ­ the GP, the hospital, the social worker? What could you have done to help them yourself? Think to yourself how a high add works. In the absence of accommodation, the reciprocal of the add power is the working distance. Take a patient of 70 with virtually no useable accommodation. His preferred working distance for reading is 50cm, so for that you will be supplying a +2.00D add. Suppose the patient's record card shows that with this add he can read N10, but maybe he edits a newsletter for a local charity and has to read correspondence in smaller print. There are several solutions you can offer him. You could give him a 2x hand magnifier which should give him N5, although it can become tiring holding it in one hand, and he may want to read and make notes at the same time. Maybe suggest he gets everything photocopied larger, but this could be impractical. Perhaps offer a spectacle magnifier, low power reading telescope or even a large magnifier worn round the neck, or you can give him a reading acuity of N5, simply by halving the working distance to 25cm ­ which will double the image size ­ and increasing the add to +4.00D, not even a very high add. An advantage of this plan is that the patient can carry on with the `normal' option of just wearing glasses. Increasing the image size by enlarging

the object size is called relative size magnification (RSM) and examples are photocopying print larger, large print books and big number telephones. Bank statements, utility bills and library books are all available in large print. Our patient with N10 with a +2.00D add at 50 cm may be an avid reader and think how much more comfortable it would be for him to read a large print book at this working distance rather than standard print sizes at 25cm. He may also like playing cards with his friends ­ large print cards can be used by normally sighted people too! Increasing the image size by reducing the object distance is an example of relative distance magnification (RDM) and this system works well with TV. If a patient sits 4m away from her TV but cannot quite make out the subtitles, then sitting at 2m, half the distance, will double the image size, and may solve the problem. Moving nearer, to 1m, will quadruple the image size. Your patient may be young, with plenty of accommodation, but if the patient is elderly and the viewing distance is very close, you may have to add in some plus power to the distance spectacles, around +0.50D for 2m and +1.00D for 1m. If a patient needs more magnification than RDM can achieve, you can supplement with simple telescopic aids designed for TV. You can even combine relative size and relative distance magnification with a telescope ­ doubling the image size with a larger TV, sitting at half the distance and using a 2x telescope gives 2x2x2 = 8x magnification. I hope this article has started you thinking about what is involved in giving a low vision service, how you can incorporate it into your daily clinics and why we, as dispensing opticians, are so suited to this interesting and rewarding work. In the second article I will explain how the quality of the assessment will affect the outcome, suggest some solutions, and highlight some case histories. Jennifer Brower FBDO(Hons)LVA Cert Ed is a dispensing optician and low vision practitioner. She is chairman of the ABDO Low Vision Committee, a low vision examiner, Board member and GOC member. I

8 Dispensing Optic s August/September 2008 Continuing education an d train ing

Multiple choice questions (MCQs) - Why low vision? Part 1

1. In the absence of accommodation, which reading add is required for 20cm? a. +2.00D b. +4.00D c. +5.00D d. +2.50D 2. What is the maximum magnification of a +12.00D lens? a. 3x b. 4x c. 8.33x d. 12x 3. Which one of these is an example of relative size magnification: a. Distance telescope b. Large print book c. Flat field magnifier d. High add spectacles 4. Which one of these statements about nominal magnification is true? a. It is a quarter of the lens power. b. It is calculated as (F/4) +1 c. The nominal magnification of a +6.00D lens is 2.5x. d. It is used to classify simple hand magnifiers. 5. What would be the total magnifying power achieved by combining 2.5x RSM with 1.5x RDM and a 2x telescope? a. 6x b. 8x c. 5.5x d. 7.5x 6. Which one of these statements is untrue? a. Filters can be used as low vision aids b. The supply of spectacle mounted low vision aids is legally restricted c. Magnification may be calculated using the front vertex power of a lens d. The new term for partially sighted is sight impaired

The deadline for posted or faxed response is 11 September 2008 to the address on page 4. The module code is C-9167 Online completion - - after member log-in go to `CET online'

Occasionally, printing errors are spotted after the journal has gone to print. Notifications can be viewed at <> in the news section

Book review: Dictionary of Optometry and Visual Science

Calling all dispensing and optometry students! Do you find preparing for your exams a challenge, especially when the question paper requires knowing theory topics or definitions? If this statement applies to you, Michel Millidot's Dictionary of Optometry and Visual Science is a winner. This dictionary lists all optical terms in alphabetical order and then follows with a clear and concise definition. The definitions are easy to understand which in turn makes them easy to remember. Throughout my career in teaching ophthalmic dispensing, I have used this textbook to prepare all my lectures and help prepare model answers for past papers. Initially, the Dictionary of Optometry and Visual Science will help students define key terms in the final exams; however it will also be beneficial in preparing for the short notes questions. These questions require the students to list up to 10 statements of fact per topic, and alongside the students' lecture notes, Millidot's dictionary will make this manageable. On successful completion of the course, this book will not become redundant. This dictionary can be of future assistance in helping explain optical terms to the patients in userfriendly language and also help with the training of optical assistants, reception staff and trainee dispensing and optometry students. Gill Elstub FBDO CL Cert Ed is a full time lecturer at ABDO College, Godmersham, Kent I


This book, plus numerous other titles, can be purchased from the ABDO College Bookshop at or by contacting Justin Hall on 01227 733904 email [email protected]

BCLA news

32 BCLA Conference

`Held once again at the Hotel Metropole in Birmingham, this year's Brtitish Contact Lens Association conference was of particular interest since it was presided over by dispensing optician Nick Atkins. With this in mind, I broke with my usual tradition and left home at 5.30am in order to be there for the President's opening of the conference' writes David Goad.

This year's event was the largest conference yet, with a record number of delegates and with many attending from abroad, making it a truly international occasion. Following his opening speech, President Nick Atkins introduced optics' very own self-styled Ant and Dec, Professors Phil Morgan and Lyndon Jones. Their double act got off to a magnificent start ­ for five minutes, at which stage the Hotel and many parts of Birmingham completely lost all power. For us in the main auditorium it meant little inconvenience; for the speakers it meant skilfully carrying on with no presentation slides and no microphones. For those less fortunate it meant an extended wait in a dark lift. Such is the professionalism of the speakers, they were able to deliver their lectures with complete confidence and, despite the 20minute delay, finish spot on time. As Lyndon Jones wryly commented, "Perhaps we should scrap slide shows if it means we can get the same message across in less time!" The lecture programme is beyond the scope of this article but suffice to say, in my opinion, this was one of the most interesting conferences for some time. I certainly took more notes than for many a year. SiH lenses change the ever-shifting sands of the contact lens landscape. Generation two of Air Optix was launched by Ciba Vision. Called Air Optix Aqua, this new product has an `Optimized Ultra-Smooth' surface treatment, making it more 'wettable' and more consistent across the whole lens. This results in a 30 per cent improvement in the contact angle, compared with the first generation of Air Optix, a greater resistance to Lipid build up, and improved comfort throughout the duration of the month. Launching its new hyper DK GP lens the Quantum 141 and the Maxim 141, Bausch & Lomb showed that gas permeable lenses are far from dead. The company's dedicated help line 0870 850 7921- is in place to aid those whose RGP skills are a little rusty. Also new to the market is Bausch & Lomb's new Toric Daily Disposable. Since the

Continued overleaf


New for the show

With an increased exhibition size it would be impossible for me to discuss every exhibitor so I will only report on what was new and of particular interest to me. I apologise to those who I have left out and thank them all for their support. The conference wouldn't be the same, or even possible, without them. One of the big `firsts' was Johnson & Johnson's launch of the first daily disposable silicone hydrogel lens. Available later in the year it will be interesting to see how daily disposable

10 Dispensing Optics August/September 2008 BCLA news

upgrade from B&L's old daily lens, the release of the toric version has been long awaited.


New, at least to me, i-GO is approaching the UK market with a different twist based on marketing. Once an ECP has signed up, i-GO supply pre-screened patients for fitting and management. Online training and accreditation is a requirement prior to becoming an i-GO ECP. For more information visit Apart from its orthok lens, No 7 showcased two new products. Firmly backing the GP market, No 7 introduced ICON, said to be compatible with most popular GP designs and promoted as easy to fit, it comes in Boston EO and Boston XO materials as standard. All other materials available on request. Remember the hybrid lenses such as the `Saturn'? The concept is back with Synergeyes from No 7. With its Hydrogel skirt and GP centre, the new lens is said to be especially useful for astigmats, oblate corneas and keratoconus. It's also available in a multifocal. For online training visit or contact No 7. Showcasing RoseK lenses for keratoconus and Paragon CRT lenses for OrthoK, David Thomas Contact Lenses also majored on the Comfort O2, the rigid silicone hydrogel material. Visit their upgraded website at The Biofinity lens is just one of the range from Cooper Vision. This company's theme for the exhibition was `Clearly Contact Lens Experts' portraying its array of products as being suitable for 99% of all prescriptions. Likewise Ultravision's range, including the fortnightly disposable Menicon Premio silicone hydrogel, makes a useful addition to the practitioners `tool box'. On the solution front, Alcon introduced OPTI-FREE RepleniSH. As the name implies, developed for the silicone hydrogel market, the new solution contains TearGlyde to maintain surface wetting and comfort. Alcon

was also showing Systane lubricating drops and Alomide Allergy Eye Drops. The latter contains the mast cell stabiliser Iodoxamide which helps block allergic response. Complete MPS Easy Rub Formula showed that AMO was very much back in the frame of multipurpose solutions, as well as comfort/dry eye drops, with the enhanced range of Blink eye drops. On the subject of lubricating drops new to the market, Clinitas exhibited for the first time showing its range of dry eye therapy drops. Designed as complementary or stand-alone products, Ultra 3, Hydrate and Soothe complete the range. The number of manufacturers in this area demonstrates the strength of this multimillion pound market, most of which goes to pharmacies. Get serious and get a slice of the pie! New to the UK and revolutionary in being available at the point of care, Nidek's Tearlab, from Birmingham Optical caused a lot of interest. Within seconds tears are collected and the results displayed. This small portable device uses only nanolitres of tears to give an accurate measure of tear film, osmaolarity leading to swift evaluation of ocular surface integrity. As if the lecture programme and the exhibition wasn't enough, delegates were treated to top quality entertainment with an electric three violin and cello quartet, courtesy of Bausch & Lomb, and the one and many Rory Bremner - courtesy of Ciba Vision. Unfortunately, I was unable to attend the gala dinner but I'm told it was a memorable evening, so next year don't miss out, help make the UK contingent the largest at next year's British Contact Lens Association's 33rd Annual Clinical Conference in Manchester. David Goad is a partner in Proven Track Record and is general manager for the independent group Robert Frith Optometrists. He is in private practice with Jan Goad and Robert Frith. For more information on the BCLA and how to join, visit, email [email protected] or telephone +44 (0)207580 6661. I



An ophthalmologist with a special interest in medical contact lens practice and low vision is the new President of the British Contact Lens Association. Sarah Janikoun began her year of office at the Association's recent Conference and Exhibition. Sarah currently works at St Thomas' Hospital in London where her role encompasses general ophthalmology, diabetic eye care, provision of the low vision service and paediatric contact lenses. She has a Harley Street practice which is primarily involved in contact lens troubleshooting. Commenting on her latest role, Sarah said, "The BCLA is an extraordinary society where so many strands of healthcare come together for the benefit of the professions and the lenswearing community. "I'm very keen to encourage all those interested in, or dealing in contact lenses to become part of our family, and I'm also concerned that the BCLA become even more responsive to its members' needs. We're about to embark on major research into the role of the BCLA and the services it provides. I shall try, during this year, to address some of the issues this raises." I


Numbers of delegates made this year's BCLA Clinical Conference the largest in its 32-year history. A total of 1,027 delegates registered over the four days of the conference, held from 29 May ­ 1 June. This is the second successive year that the event has attracted more than 1,000 delegates (2007: 1,019). Fifty companies had stands in the manufacturers' exhibition, which was spread over three halls for the first time. Including those who only attended the exhibition, there were an estimated 1,500 visitors to the event in total. This year, just over half of those registered (55%) were from overseas. Delegates came from 48 different countries, compared with 38 countries in 2007, and the largest overseas delegations were from Denmark (85) and the US (81), followed by Sweden (37) and France (35). The Clinical Conference is increasingly an important date on the international contact lens calendar and speakers from around the world were a prominent feature on this year's lecture programme. Principal Keynote Speaker Professor Deborah Sweeney, CEO of the Vision CRC in Sydney, Australia, told delegates, "Many of us consider the BCLA Clinical Conference to be the premier contact lens event worldwide." At the Gala Dinner held on 31 May, outgoing President Nick Atkins presented conference scientific programme officer Jonathan Walker with honorary life membership of the Association, in recognition of his contribution to the growing success of the conference over the 12 years in which he has been involved. Also awarded at the conference were 18 new BCLA Fellowships, a mark of esteem in the field of contact lenses which allows recipients to use the letters FBCLA after their names. The 2009 BCLA Clinical Conference and Exhibition will be held in Manchester from 28-31 May. I


BCLA awards new Fellowships for 2008

Eighteen contact lens professionals from the UK and overseas have become the latest Fellows of the British Contact Lens Association. The 2008 Fellowships were awarded at a ceremony held at the BCLA Clinical Conference in Birmingham on 31 May. Introduced in 2006 as a mark of esteem in the field of contact lenses and anterior eye, BCLA Fellowship allows members of all disciplines ­ optometric, dispensing, technical and medical ­ to use the letters FBCLA after their names. Applications are invited by 1 March each year and viva voce assessments take place at the annual conference. This year, for the first time, BCLA Fellows were invited to a special reception held prior to the conference Gala Dinner. Fellows also receive a yearly certificate to display in their place of work. A total of 77 BCLA Fellowships have now been awarded to professionals from 12 countries. More than half are based in the UK but Fellows come from as far afield as India, China and Australia, as well as from continental Europe. Although the majority of recipients are optometrists, the achievements of members from all sections have now been recognised in this way. BCLA Fellowship Consultant Professor James Wolffsohn commented: `Excellence in contact lenses requires a multi-disciplinary approach, from clinicians to academics, microbiologists to engineers. It's great that those who have achieved high esteem across this range now hold the BCLA Fellowship and there continues to be growing interest.' Fellowship application costs just £50 and all practitioners who are full members of the BCLA and have attended the Clinical Conference once in the last three years are eligible to apply. Points towards Fellowship can be gained in a variety of ways, including the submission of case histories from everyday practice. Professor Wolffsohn will be running an interactive discussion of real-life contact lens cases suitable for submitting for Fellowship at the PAC Conference in Birmingham on October 12. Call 01481 233674 for more details. · More information on Fellowship and an application form is available from the BCLA website. For further guidance on applications and case records contact Professor Wolffsohn at [email protected] I

12 Dispensing Optics August/September 2008 Low vision

Understanding the rehabilitation process

Candy Lawrence, who works with people who are severely sight impaired, understands how truly distressing and shocking losing sight can be. She strongly believes that dispensing opticians are in an ideal position to implement the early referral that can make such a difference to those in the early stages of significant sight loss

We gain most of our information about the world visually, therefore it is not difficult to see how devastating a severe sight loss can be. Most people, when considering this, will think in terms of practicalities. Indeed, this is of obvious importance but almost more crucial is the emotional aspect of sight loss which can cause people to become depressed and feel that life is meaningless. Rehabilitation workers are not psychologists and few are trained in counselling but all can help to alleviate feelings of depression by making practical changes to help people come to terms with visual impairment. We can offer services at any stage once a visual impairment has been diagnosed but early intervention from a rehabilitation point of view can make a huge difference. Difficulties can be greatly reduced and some pre-empted. Losing vision need not mean losing independence or adapting to a more meagre life style, although modifications will be necessary. Unlike other members of the inter-professional team, rehabilitation workers are unable to directly affect the progress or prognosis of a visual disorder, but we are able to assist the patient in dealing with the practical and emotional aspects, thus increasing their ability to live independent and productive lives. Here are two contrasting examples of helping deal with severe sight impairment: Members of my team worked with a gentleman with severe sight impairment following an operation to remove a brain tumour. The visual loss was instant and he went from someone who had enjoyed an active retirement, to a person unable to get himself to the toilet without assistance. A referral of visual impairment (RVI) was made by the hospital staff and rehabilitation intervention began while he was still in hospital. The RVI was closely followed by registration, certificate of visual impairment (CVI), then the intervention continued at home after he was discharged. sight impaired for two years before her husband, at the end of his tether, heard about our services, and made contact. It transpired that her registration had gone astray during a move into our area and we had no knowledge of her until her husband contacted us. For two years she had been led from her bed to her chair and back at night time. She had been fed, bathed and taken to the toilet by her husband and only left the house for medical appointments. It can be imagined how poor their quality of life was and how depressed they had both become. Despite this, the lady possessed a toughness of spirit that meant that she had not quite given up - the outcome may well have different if she had. We undertook an extremely lengthy rehabilitation program and this woman eventually became much more independent. However, it took more than twice as long as in the previous example and, because she had been in such a low state at the beginning, she never reached complete independence. With the rehabilitation process, the old adage `use it or lose it' holds very true and much remedial work needed to be done. The extremely unfortunate delay in her rehabilitation had caused two years of misery for the woman and her husband, much more work for everybody, a very lengthy intervention and probably a less successful outcome.

Continued overleaf

Losses and difficulties

We worked with him and his wife, who was almost more shocked than he was, for several months. After a while he started attending group sessions at the centre where he could discuss his feelings with other people experiencing the same losses and difficulties. Practical sessions included teaching cooking, orientation, mobility skills and information technology. After six months this patient was back to his normal cheerful and outgoing personality; he had started to cook meals, could go out alone using a long cane and had started to correspond with friends and family via email. A year later he was travelling to the centre by bus in order to work with the team as a volunteer, helping others as he himself had been helped. He remains severely sight impaired but is able to enjoy life again. His wife is relaxed, happy and extremely proud of her husband. Compare this with a lady I recently worked with. She had been severely

14 Dispensing Optics August/September 2008 Low vision

the case with children or people who have completely lost sight. We also help people of working age to stay in employment and assist education to support children with visual impairment within mainstream schools. It is possible to break the work into three main parts, advising, supporting and training. In order to offer full advice a rehab worker will need to have in-depth knowledge of what is available and how to access appropriate benefits and other services. They will need to understand the emotional and psychological affects of sight loss and be able to help people work through them. This may involve counselling and some rehab workers are qualified to undertake this. Those without the qualification will refer or support their service users simply by giving time to listen.


The rehabilitation process

Referrals for rehabilitation services can be received from any member of the inter-professional team, as well as from outside organisations and also from patients themselves. Rehabilitation can be done independently or in conjunction with other professionals, as in the first example. This allows patients to receive the medical care they need as well as the practical and emotional support that is vital if they are to come to teams with their visual problems and continue to live as they would wish. Dispensing opticians are in an excellent position to refer patients at an early stage, using the Letter of Visual Impairment (LVI). The rehabilitation process begins when the referral is received. This is followed by an assessment. Under Fair Access to Care, both social services and nonstatutory care providers are contracted to begin the assessment process within forty eight hours and to complete within twenty eight days. People referred should be contacted quickly and seen within a month although this response time can vary from area to area, depending on the availability of rehabilitation staff. First contact would normally be made by telephone and a rehab worker would begin the assessment process by asking appropriate questions in order to collect information to help achieve a successful outcome. This initial contact also establishes the working relationship and gives the team leader or manager useful clues as to the urgency of the referral. Having agreed on a mutually

acceptable time, the rehab worker will carry out a home visit or visits, to complete the assessment. He or she will be assessing problems and difficulties caused by the visual impairment and the family situation as a whole. Visual impairment does not just affect the person concerned but also those around them and, to work effectively, a rehabilitation intervention needs to take all factors into consideration. The assessment should be a holistic one, looking at the person as a complete human being and not one confined to visual problems. Visual impairment does not exist in isolation ­ it is intrinsic to that person as they are to their family and social unit. However, this does not mean that work will be undertaken that is appropriate to other professions, any part of the assessed needs that do not fall within the rehabilitation remit, will be referred on. Following the completion of the assessment, a plan of work will be devised and agreed in partnership with the service user and their family who will be fully consulted. The work of the rehabilitation service is very varied and in some cases the intervention may be quite short, comprising an assessment, possibly followed by advice on benefits or provision of equipment. In other cases it may be long-term and include training in independent living skills, orientation and mobility and alternative forms of communication including information technology. The work may be spread out over several months with one piece of work being completed and assimilated before the next part is undertaken. This is often

Experiencing the same difficulties

Rehab workers also have teaching skills since much of the work involves training people to adapt the way they do things to accommodate their low vision. This training could be something fairly basic, such as making a cup of tea, or as involved as using a long cane to travel safely in a busy city centre. Training usually takes place in the person's home, or home area, but in some cases this may be done in a group situation. This can be beneficial as it brings together people who are experiencing the same difficulties, helps to combat isolation and is timeeffective for workers. Group work is of most use in teaching life and communication skills and can be important in helping people to work through the negative emotions caused by sight loss; support groups play an important role in this, while orientation and mobility is best taught on a one-to-one basis. Rehabilitation work is as varied as the people we work with and it is impossible to describe every aspect in detail. However, two areas of training ­ Independent Living Skills (ILS) and Orientation and Mobility Training (OMT) - give a basic overview of the type of work that is undertaken. ILS simply means everything that is needed in day-to-day life and OMT allows people to move about safely in

doors and out. The problems identified at assessment will be addressed in order of priority and training programs devised. Most people who have recently acquired a significant sight loss will require some form of help with daytoday tasks and it is important that this is done quickly as being unable to care for yourself is very disabling and can also put people at risk. The rehab worker will look at teaching safe techniques and the provision of specialist equipment. If equipment is provided, it is vitally important the person is trained in its use. Adapting peoples' normal working methods can be more successful, long term, than introducing equipment that may either never be used, or cause more problems and anxieties than it alleviates. OMT aims to give people the ability to travel independently and may involve training in the safe use of various types of canes. Although the techniques used can be taught quite quickly, many lessons may be required before the person is safe and confident enough to travel alone. A typical mobility intervention would begin with an additional assessment, often involving taking that person outdoors to gain an understanding of their present level of independent travel and the problems they are experiencing. Let us suppose that the outcome of the assessment was that full long cane training was required. It would start with non-cane skills, sighted guide, upper and lower body protection, trailing and basic orientation; this would be undertaken indoors, usually in a large safe area. Basic cane skills would then be introduced. Only when all this has been mastered will the work move to an outside area. First, the visually impaired person must learn to walk in a straight line - not easy without sight. Most people will veer off-course to begin with and must learn to pick up the curb with the cane as well as the building line and then to correct themselves. They need to cope with obstacles such as street furniture, signs, lamp posts, pillar boxes, not to mention abandoned bikes, men up ladders and road works. As they



progress, the worker will introduce different routes of increasing difficulty, finishing with a busy town or city centre route and then teach safe road crossing techniques. The training will usually end when the person is able to do all this, as well as use public transport safely. All this can take a considerable length of time commonly two lessons a week for at least six months. As with all rehabilitation training, the safety of the person we are working with has to take precedence at all times but we must also take into consideration their personal choices and lifestyle. Our job is to provide people with reduced vision the skills, knowledge and motivation to live the life that they choose. Rehab workers will have had some training in the anatomy of the eye and basic eye conditions but will have nowhere near the depth of knowledge or training of a dispensing optician. However, because of the amount of time we can spend with people, we are in an excellent position to reinforce strategies for the best use of residual vision. This can be done formally, on request from a dispensing optician, or informally, as part of the rehab training program. Many dispensing opticians know their local rehab team well and have been making referrals for years but for others this will be a new experience and they may have little understanding of the work we do. Local rehab workers may not have existed, as there are still not enough qualified workers to go round, but all local authorities have a duty to

provide services for people who are registered sight impaired. Even if you are in an area without an adequate rehabilitation service, by making a referral you will, at least, highlight the need and some provision will have to be made. Having said that, our service is expanding and I hope that soon all dispensing opticians will have access to rehabilitation workers since, by working together, we are in a position to give the best possible service to the people we work with, helping them to move seamlessly between members of the inter-professional team, without delay or needless distress. In a perfect world we would all be based together and patients would have a `one stop shop' but until - or unless - that happens, the best we can do is to work together as far as possible. I also know from personal experience how rewarding this can be and how highly beneficial it is for the people we are all trying to help. Candy Lawrence is a qualified Rehabilitation worker and Mobility and Orientation Officer with many years experience of working with people with visual impairment. She has also managed teams of rehabilitation workers in Kent and the London Borough's as well as running a busy sight centre for many years. Candy also holds qualifications in management, counselling, gained at the University of Kent at Canterbury and a diploma in performance coaching. At present she is working as a trainer, passing on her experience to fellow rehab workers, members of allied professions and anyone who is working or in contact with people with visual impairments. I

16 Dispensing Optics August/September 2008 Profile

Best results for students - and patients

Lizzie Bartlam FBDO(Hons)LVA is dispensing instructor in optometry and clinics administrator in the Vision Sciences Department at Aston University. She recently won the title of Dispensing Optician of the Year at the Optician awards. Lizzie began her career as a receptionist and it was her colleagues at Aston that nominated her for the award, writes Ann Johnson

When Lizzie Bartlam worked as a practice receptionist, she was so impressed by the patient care demonstrated by the dispensing opticians she worked with, she decided to fund herself through her training as a DO. Qualifying in 1998 through the ABDO distance learning route, with block release at what was then Anglia Polytechnic University, she later qualified with ABDO Low Vision Honours in 2005. Lizzie has worked in her current role at Aston University since 1999. The dispensing clinic is a public access facility where students see patients under supervision. It is located in the Aston University campus Vision Sciences building in the city centre and has been providing an optometric service to patients in the West Midlands area for the past 40 years. The clinic provides eye examinations, contact lens assessments, low vision rehabilitation and manages binocular vision problems, as well as offering complete spectacle dispensing services. Lizzie greatly enjoys both the teaching and dispensing aspects of her work and is keen to always achieve the best results for all students and patients. As well as standard dispensing and repairs, Aston clinic sees many patients that have been referred through external practitioners. In dispensing, this includes people that require modifications such as ptosis props, as well as paediatric dispensing. Many patients have also been dispensed with coloured tints to aid reading difficulties. One afternoon each week she volunteers at Birmingham Focus on Blindness carrying out low vision assessments as well as running a low vision clinic within the University. Lizzie is also an examiner for ABDO and a tutor for ABDO Distance Learning Institute. As a theory examiner, she marks the anatomy papers, as well as tutoring and marking coursework for the 1st, 2nd and 3rd year trainees. She also tutors for the Low Vision Hons course. In addition, she has presented at several CET events for both optometrists and dispensing opticians. they have put in, as well as their positive attitude. Another of the highlights of my job is doing LVA assessments where I feel you really can make a difference to peoples' quality of life. In fact, the LVA course is one of the best things I have ever done. It is truly inspiring to be involved with LVA, and the fact that with every patient you are continually learning is very satisfying. You may consider the problem you have tackled is exceptionally small in the great scheme of things, then you get a call from a patient thanking you as they have managed to watch an England match for the first time in years (unfortunately, the LVA did not that year help England win for the patient). "Becoming a tutor for the DLI, was another of the best decisions I ever made. It's not easy taking on a distance learning course, and to do this students have to be committed and require assistance to help overcome the isolation they may initially feel. It's great to be in contact with and to assist people who are eager to learn - even if you may never get the chance to see them face to face." Lizzie explains that, during term time, the teaching and dispensing roles are actually highly connected. The


One of the reasons Lizzie so enjoys her work is the diversity it offers. She says, "As well as the contact with the patients and the students, I thoroughly enjoy teaching them within the clinic; this is one of the highlights of my job. It is so rewarding when they do well in their assessments due to the hard work


optometry students are instructed on how to approach the dispense, and then see the patient under the guidance of the dispensing instructor. "Once they have completed the dispensing to the best of their ability, you are there to ensure it is correct and the best that can be provided for the patient in meeting their individual visual requirements. You are there to check that all relevant advice has been given, the right measurements have been taken and that they are correct and, if not, to instruct the student how to put things right." The assessment procedure is to ensure students will be suitable in practice and possess a good overall professional manner with the patients, and also to assess their overall knowledge in dispensing matters. The same approach is applied to the LVA clinics where they see the patients with Lizzie and have an active role in the assessment. Birmingham Focus on Blindness, where she volunteers one afternoon a week, is a local charity aiming to assist people in the Birmingham area with visual problems. It has a range of departments covering all aspects to assist a person's well-being and quality of life. The charity provides everything from community services, which

involve visiting people at home to assess individual needs, through providing low vision assessments at their low vision clinic, to counselling services for those who are finding it difficult to come to terms with their visual problem. Lizzie says, "This is an exceptionally proactive organisation which has done wonders in ensuring that the people of Birmingham are aware of the difficulties encountered by people with visual problems, and the services that are available. I assist at the Low Vision Clinic, the director of which is Anita Morrision-Fokken and my role is to provide low vision assessments. "I became involved because I was desperate to do the Low Vision Honours course and, very soon after I started the course, Anita accepted the position of director of Low Vision Services. She was more than happy to help me through the course by inviting me to see patients in an attempt to obtain case records and put the theoretical knowledge I was learning into practice. I love this organisation for all the great work it achieves so I'm delighted to be able to continue to volunteer."

required for her kind of work, Lizzie cites patience, understanding, the ability to listen, a person who has respect for the patient and, most importantly, empathy. She explains, "You must try to put yourself in the patient's shoes. As long as people have the attitude that they wish to help as much as they can, then they will make a great practitioner. Also, I must add, someone who wishes to keep learning. We will always come across new challenges that require fresh ways to find solutions for problems." Lizzie firmly believes that dispensing is a great profession to be part of. She says, "There is so much more in which to involve yourself afterwards. Even if you don't wish to progress to further study, the whole learning curve you will be on for the rest of your professional career is exciting in itself. If anyone wishes to find out more about doing LVA or tutoring then they would simply need to contact the DLI office." I


When asked what special skills are

For details about ABDO courses and tutoring please call ABDO College on 01227 733901, or email [email protected] where a member of the DLI team will be happy to help you.

18 Dispensing Optics August/September 2008 Volu ntary work

Eyecare for the homeless

ABDO member Ronald Mattes found a new and rewarding professional interest in voluntary eyecare work with the homeless. Ann Johnson reports

A few years ago, independent practice owner and ABDO member, Ronald Mattes, read an article about voluntary work in the optical press. He was nearing retirement at the time and was interested in becoming involved. So he contacted the Vision Care for Homeless People, who were providing optical services at the Crisis Skylight centre in East London, and has been working there ever since. Ronald says, "The Centre is for homeless people and they can take advantage of a whole range of free activities including practical and creative workshops ranging from bicycle repair to performing arts. Each Monday they also have the opportunity to get their eyes tested by OO and DO volunteers who work there on a rota system. I visit every three or four weeks." organise equipment, the right location and the volunteers to run the clinic and, in September 2003, the charity was born. Optoplast, Nationwide Frame Repairs, The Outside Clinic and Zeiss. Ronald, who has run his own Enfield practice since 1974, says, "I am now past retirement age, although I still work in the practice on a part-time basis. What is so lovely about working at the Crisis Centre is it has nothing to do with business or making money and I find the work immensely rewarding in itself. It makes you realise how we are all living on the edge ­ and sometimes we can tip over into real difficulties. Most of the homeless people who visit are men, many of whom have left the family home when their marriages have broken up. They simply haven't been able to afford alternative accommodation. A lot of other people come from abroad." Harinder Paul says, "Right now what we need most of all are DO volunteers. I'd be grateful if any readers of Dispensing Optics, particularly from the Birmingham area, who can spare some time would contact us at the address below. One of our biggest breakthroughs has been that Boots Opticians is funding its OOs and DOs to work for us in their own time. Dollond & Aitchison have just agreed to do something similar and we are currently in talks with Specsavers. For more details about Vision Care and how to help, telephone 0207 017 2026, email [email protected] or visit I


Homeless people are frequently unaware that, when receiving financial benefits, they are eligible for an NHS eye examination and voucher towards spectacles. Very few practices provide spectacles totally free of charge and even a small charge may be unmanageable. Vision Care For Homeless People is registered as an opticial practice with the local health authority. This enables the organisation to claim funding from the NHS for those who are eligible for an NHS eye examination. This funding, together with some private donations has enabled them to run the service free for everybody who requires it, not just those receiving benefits. All professional staff are volunteers. There are now two centres in London with a new centre opening in Birmingham this September. Essilor is sponsoring this branch for the next three years and is supplying all glazing and lenses free of charge for the first year. A number of optical companies have been generous in their support of the initiative and, as well as Essilor, these include Horizon Optical, Birmingham Optical, Ocuco Relcon, Topcon, Keeler, Thompson Software Solutions,

Eyecare services

Vision Care for Homeless People is a charity set-up for homeless people to provide eyecare services to the vulnerable in an accessible, welcoming and safe environment. The idea was started in 2003 by four optometrists - Harinder Paul, Elaine Styles, Mohan Vaithianathar and Edwin Achu. The initial idea came from Harinder who originally trained and qualified as a dispensing optician. He had become aware of the lack of eyewear and eyecare for local people during his visits to the townships in South Africa. It took five months to

24 Dispensing Optics August/September 2008 Practice m anagem ent

Unfair trading regulations

On 26 May, one of the biggest changes to consumer legislation for 40 years took place when the Consumer Protection from Unfair Trading Regulations 2008 came into force. Advertising, marketing, sales, supplies, after-sales services and debt collection are all covered by new rules. Paul Burnley and Poppy Williams explain how this affects businesses and consumers

The new Regulations introduce a general duty not to trade unfairly, a prohibition against misleading or aggressive practices and, interestingly, it banned 31 specific prohibited commercial practices outright. The CPRs cover `Any goods or services'. The general duty not to trade unfairly is a `catch all provision' and will allow enforcers to take action against unfair commercial practices which do not fall into the banned practices category and which are not misleading or aggressive commercial practices. A commercial practice will be considered to be unfair if it `Materially distorts the economic behaviour of the average consumer with regard to the product'. This general clause is clearly far reaching but, broadly speaking, if consumers are treated fairly then traders are likely to be complying with the CPRs. The CPRs prohibit practices which are misleading (whether by actions or omissions) and which are likely to cause a typical consumer to take a different decision. A misleading action is a commercial practice which makes false statements about specific key factors, or itself, or in its presentation, is likely to deceive the average consumer about those specific key factors - even where the information is factually correct. For example, marketing a product in a way which creates confusion with competitors' products is a misleading action and is prohibited. Omissions of material information on a product, or providing that information in an ambiguous, manner may also be considered to be a misleading practice. The CPRs also prohibit aggressive commercial practices. These are commercial practices which by harassment, coercion or undue influence, significantly impair the average consumer's freedom of choice or conduct and are likely to cause them to make a different decision. In determining whether a commercial practice is aggressive, factors such as its timing, location, nature or persistence, the use of threatening or abusive language or behaviour, or any threat made to take any action which cannot in fact be legally taken, will be taken into account. This provision clearly seeks to cover scenarios such as doorstep traders or cold callers on the telephone, or if they are pressurising consumers. prove a breach of these prohibited practices. These prohibited practices include displaying a quality mark without having obtained the necessary authorisation, falsely stating that a product or service will only be available for a very limited time, and claiming to offer a promotion without awarding the prizes. A provision which may cause difficulty relates to the use of the word `free'. Describing a product as `free' or `without charge' is prohibited if the consumer has to pay anything other than the unavoidable cost of responding and the delivery of the item. Advertising, marketing, sales, supplies, after-sales services and debt collection are all covered by new rules. Even those who are not actually selling products to consumers themselves, will still have to take the CPRs into account if their business is directly connected with the sale or supply of a product to consumers. practices which occur before or after commercial transactions may also be affected. The OFT, Local Authority Trading Standards Services and the Department of Enterprise, Trade and Investment in Northern Ireland will all have a duty to enforce the CPRs. Enforcement Officers may use their powers to inspect goods and enter

Prohibited practices

The CPRs list 31 specific commercial practices which will always be regarded as unfair and are prohibited. Evidence of their likely effect on the typical consumer is not required to

business premises to investigate possible breaches of the CPRs. Where they have reasonable cause to suspect that a breach of the CPRs has occurred they will also be able to require traders to produce documents relating to their business but not those which are legally privileged. Enforcement officers may also seize and detain goods relevant to their investigations. Any intentional obstruction of an enforcement officer or making a deliberately false statement to an officer is a criminal offence. In addition to the OFT and Trading Standards Services other bodies, such as the Financial Services Authority, will be able to apply to the Court for an Enforcement Order to prevent a breach or breaches of the CPRs. If an enforcement order is obtained, any breach of it could be a contempt of court which could result in up to two years imprisonment and/or an unlimited fine.

Criminal offences

There are several criminal offences under the CPRs: contravention of the general duty not to trade unfairly; misleading actions; misleading omissions; aggressive commercial practices; specific unfair commercial practices (except numbers 11 and 28 ­ see website below). Both companies and individuals can commit offences under the CPRs. If you are found guilty of an offence under the CPRs then you could face on conviction in the Magistrates' Court, a fine of up to £5,000 or, on conviction on indictment in the Crown Court, a fine or imprisonment of up to two years - or both. The well-recognised but important defence of `due diligence' is the main defence available to businesses for breaches of the CPRs. To argue this defence successfully, it must be shown that the commission of the offence was due to a mistake, reliance on information given by another person,

the act or default of someone else, an accident or another cause beyond the accused's control. It must also be shown that all reasonable precautions were taken and all due diligence was exercised to avoid committing the offence or to avoid someone under his/her control committing it. It is not sufficient to show due diligence procedures were in place, it is also necessary to show they were applied in practice. Significantly, there is no defence to a breach of the general prohibition, but to be guilty of this offence a person must have knowledge of or be reckless as to the breach. The 31 banned Commercial Practices can be found on: shared_oft/business_leaflets/530162/oft 979.pdf Paul Burnley is a partner and Poppy Williams is a solicitor in the Litigation and Regulatory Group of DLA Piper UK LLP. I

26 Dispensing Optics Augus t/September 2008 Newsbrief





. . . and our very best wishes go to Emma Parkhurst Tubby of Area 2 and husband Craig, on the birth of Sebastian Rhys on 28 May 2008. Emma BSc(Hons) MCOptom FBDO CL works in the family business, Parkhurst Opticians, although she is on maternity leave at the moment. For the past year she has been secretary of the Doncaster Local Optical Committee and has been involved in setting up a promotion with the Primary Care Trust to encourage parents to get their children's eyes tested. I


The Association has come up with useful assistance for DOs returning after a break. ABDO's CET department has produced a CET Reregistration `emergency' pack for dispensing opticians. Specially designed for new registrants or those returning to the profession after a break, the pack includes a guide titled `In to practice' which contains useful and essential information for those seeking to quickly bring themselves up-to-date. Paula Stevens, ABDO CET Coordinator said, "We are conscious that there is a growing number of dispensing opticians coming back into the profession after a period of absence a return following maternity leave is a typical example. So the idea behind the pack is to offer these opticians a helping hand." The pack includes a stepby-step guide to registration with, managing your CET record, the DO's duty to refer and succinctly outlines the benefits of ABDO membership. As well as the `In to practice' guide, which is eligible for 2 CET points, the pack also contains a set of three elearning CDs: G Steps to effective communication - eligible for 3 CET points G Frame adjustments eligible for 4 CET points G The rimless renaissance eligible for 3 CET points All the CET in the pack is approved for optometrists as well as dispensing opticians. The price is £85 inclusive of P&P and VAT and the complete pack can be obtained by contacting Justin Hall at the ABDO College Bookshop, telephone 01227 733 904 or email [email protected] I



Committee held a meeting on 1 July to finalise details for the forthcoming 6 points CET day. The event takes place on Monday 15 September 2008, at The Arden Hotel, Solihull, alongside Birmingham Airport and the NEC. The day will commence with registration at 99.30am and will feature talks by Andy Hepworth of Essilor, Andrew Symons of Ciba Vision, Karen Walsh of Johnson & Johnson and a representative from Seiko Optical. In addition, Simon Paget of Ocuco Computer Systems will include a competition for a delegate to win an Ipod Touch during his presentation (see page 33). The day, which includes a hot and cold buffet lunch, with coffee and biscuits during breaks, will cost only £20 per ABDO member. For further information and bookings, please contact Ian Hardwick by email [email protected] or telephone 07814 558343. For the first time, Area 5 is offering an early bird booking option for our next CET day in Derby on Monday 2 March 2009. Finally, the Area 5 AGM will take place on Tuesday 7 October 2008; venue to be confirmed. Ian Hardwick, Area 5 Vice Chairman I


A big thank you to everyone who recently responded by completing and returning the questionnaire as part of the ABDO membership research project. Over 1,200 replies were obtained prior to the final deadline! Everyone who replied was entered into a prize draw with a chance to win Marks & Spencer vouchers. Drawn at random, the six lucky winners were: Daniel Shaw FBDO, Rainham - £100; Colin Henry, Ramsey FBDO - £50; Peter Spoerer FBDO, Morton - £50; Sarah Elizabeth Hartley FBDO, Whitehaven - £25; Aiden Finnegan, Hove - £25; and, Jameel Arastu BSc(Hons) MCOptom - £25. A detailed analysis of the survey is currently being prepared for presentation to the ABDO Board in September. I




ABDO's CET department has re-packaged and re-released its series of five e-learning CDs. Four of the CDs are approved for CET by the General Optical Council and carry multiplechoice questions (MCQs) and can provide CET points for either dispensing opticians or optometrists. The titles in the ABDO e-learning CD series are: G Frame and facial measurements - sponsored by Buchmann UK, eligible for 6 CET points and available at £65 per CD for ABDO members and £85 per CD for non-members. G Frame and facial measurements - sponsored by Buchmann UK, also available in a non-CET Student edition at £50. G Frame adjustments sponsored by Buchmann UK, eligible for 4 CET points and available at £35. G Steps to effective communication - sponsored by Nikon Optical UK, eligible for 3 CET points and available at £25.00. G The rimless renaissance sponsored by Rodenstock (UK), eligible for 3 CET points and available at £25.00. All prices are inclusive of P&P and VAT and these highly informative CDs can be obtained by contacting Justin Hall at the ABDO College Bookshop on 01227 733 904 or email [email protected] Paula Stevens, ABDO CET Coordinator said, "The series of CDs have been attractively re-packaged and, for the first time, all the CDs have attracted sponsorship from UK major companies. We are delighted by the support Buchmann, Nikon and Rodenstock have given us. Rodenstock and Buchmann have both launched sales promotions featuring the CDs that they have sponsored, thereby making them easily available to their customers and this has contributed to a dramatic increase in demand." Details of the respective ABDO CDs sales promotions, offered by Buchmann UK and Rodenstock (UK) are available by contacting either company directly. I


Last year, based on popular demand, ABDO Membership Services introduced a high quality desk name plate. Now, as part of the implementation of the Association's new corporate identity, the desk name plate has been redesigned to incorporate the new ABDO logo and is available to order. The `Toblerone' style desk name plate is constructed from a natural beech, solid hardwood block. There's an attached, stainless steel metal plate with the ABDO `stylised' logo in its corporate blue version and your name printed in black. This attractive new item, which will assist you in professionally promoting your qualifications and Association membership within your practice, is available at a cost of only £25 each inclusive of P&P and VAT. Ordering is easy, simply telephone ABDO Membership Services on 01227 733922. I


Modern living creates a multitude of strains and stresses on individuals and families which in turn affects life at work. Anxiety, bereavement, stress, addictions, family and marital problems can all take their toll, but those around you may not be the best to talk to or confide in. As part of the multitude of benefits offered to ABDO members is access to a Counselling Helpline. Counsellors have time to listen, are non-judgmental and can help find ways of overcoming these issues. All of the counsellors are trained to diploma level and the counselling service itself is an organisational member of the British Association for Counselling and is bound by its code of ethics and practice, and complaints procedure. Sequential counselling can be arranged, usually up to six sessions with the same counsellor. If the counsellor feels that face-to-face counselling would be beneficial then they will help find a choice of appropriate counsellors in the area (this may have to self funded). The service is provided for ABDO by DAS Legal Expenses Insurance Company. To contact them telephone 0117 934 2141 and quote your policy number. I


If you know of a dispensing optician, or a dependant of a dispensing optician, who might benefit from the ABDO Benevolent Fund, please get in touch with Barbara Doris on 020 7298 5102 or email [email protected] I

28 Dispensing Optics Augus t/September 2008 Newsbrief





President of Transitions Optical, Brett Craig, has announced a four-year title sponsorship of the PGA TOUR event at Innisbrook Resort and Golf Club, in association with PGA TOUR Commissioner Tim Finchem and Copperheads General Chairman Peter Jones. The event, renamed as the Transitions Championship For Healthy Sight, will help raise awareness of the need for healthy sight, importance of vision care and the benefits of sightenhancing vision wear like Transitions lenses. The Championship (16 ­ 22 March 2009) will be held at Innisbrook's Copperhead. The event will include a week of tournamentrelated events, with Copperheads responsible for promoting, organising, managing and conducting the tournament. Brett Craig commented on the four-year title sponsorship, "Partnering with the PGA TOUR aligns well with our company and brand. The sponsorship presents a tremendous opportunity to educate consumers about the importance of healthy sight." I


At a recent charity auction, an optometry-themed tie has raised nearly £2,000 for Vision Aid Overseas. The auction was organised by Paul Surridge, the Sight Care Group's Chief Executive at Sight Care's International Conference in Budapest. Paul originally donated the tie for auction back in 2000, where it raised £860. Since then it has been donated back by the highest bidder and reauctioned every two years. Since the first time it was auctioned, the tie has raised over £5,000 for VAO. Jeremy Jalie, VAO deputy director commented, "VAO is very grateful to Paul and Sight Care for organising the auction and raising these funds. The auction of Paul's tie has always been very well supported and this year is no different". For more information on Vision Aid Overseas telephone 01293 535016 or visit I


The size of the UK contact lens market in 2007 was £186.1m as reported by the Association of Contact Lens Manufacturers (ACLM). This represents an increase of 4% on 2006. The market was made up of the sale of 483 million contact lenses. Market value comprised daily disposables (55 %), soft frequent replacement lenses (16 %), silicone hydrogels (21 %), soft traditional lenses (three %) and rigid lenses (five %). More than 760,000 people in the UK (23% of all wearers) wear silicone hydrogel contact lenses, an increase of 20% compared with 2006. 331,000 people use rigid lenses, accounting for 10% of all wearers. In total, 3,382,000 people use contact lenses in the UK, about 7% of all adults. I


In July, Sarah Lapham was appointed public affairs officer in the joint ABDO/ FODO/AOP Public Affairs department. Sarah will work closely with head of Public Affairs, Heather Marshall. She will help deliver the optical bodies' public affairs strategy including lobbying MPs, responding to consultation documents and organising the sector's presence at various NHS and political conferences with the aim of spreading the message about eye health. This is a crucial time for the sector as it gears up its activity in the run up to the next General Election. Sarah gained an MSc in European and Comparative Public Policy from the University of Edinburgh in 2007 after graduating with a BA (Hons) in Political Science from St Edward's University in Austin, Texas. She has been extremely active in the political system in her career so far. She worked as an events co-ordinator at the Governor of Texas' Mansion and later as an intern at the Governor's office and the House of Representatives in Texas. Sarah has also spent time working in the Scottish Parliament and in Westminster in the UK. Her experience of the political system on both sides of the Atlantic will be a great asset in her work for ABDO, FODO and the AOP and for the sector as a whole. Speaking on the appointment of the new public affairs officer, Heather Marshall said, "With her combined experience of different political systems and public health campaigning, Sarah will make a great contribution in delivering the public affairs' strategy for the optical bodies and the Eye Health Alliance." I

30 Dispensing Optics Augus t/September 2008 Newsbrief





During the Grand Opening Ceremony of the MAPO Fair 2008 (13th Optical Exhibition), MAPO Committee members, MAPO past Presidents, presidents from other associations, overseas guests from Indonesia, Singapore, China and the United Kingdom, exhibitors' representatives and special guests gathered at the Kuala Lumpur Convention Centre's Hospitality Lounge. The Opening Ceremony was officiated by President of MAPO, Kevin Siew and organising director of MAPO Fair 2008, Chew Yew Cheong. During the two-day exhibition, the MAPO Fair 2008 attracted 3,900 visitors making it a great successs. As part of the Fair, an academic ceremony was held when more than 100 graduates were presented with diplomas by Kevin Siew and Douglas Lee. The MAPO 23rd Anniversary Dinner was attended by guest of honour, Minister of Health, YB Datuk Liow TIong Lai, VIPs, the media, MAPO members, exhibitors and their guests. The night started of with a grand opening dance, followed by speeches, entertainment, the awards presentation and the donations presentations. I


Students at City & Islington College recently visited contact lens manufacturer UltraVision in Leighton Buzzard to gain an understanding of how contact lenses are designed, manufactured and tinted. This visit provided a useful practical experience, allowing the students to understand the technology and processes behind the contact lenses they will eventually be fitting in practice. Josie Barlow, clinical services advisor, gave an informative presentation to the students and they were shown around the manufacturing department by Gina Jennings, lens process manager. All UltraVision's Silicone Hydrogel lenses can be lathe-cut to the practitioner's requirements. The students were shown how this process works and were also given an indication of the new tinting process that has been developed for the HydroWave and hospital range of Silicone Hydogel products. I


Optrafair has launched the run-up to the 2009 show, 4-6 April at Birmingham's National Exhibition Centre. Industry leaders and international optical companies gathered in London in June for the official launch. Andrew Actman, chairman of show owners, the FMO said, "Our close co-operation with Managed Events, part of the NEC management will ensure we deliver value for every exhibitor, with a comprehensive range of stand options starting from just under £1,000." In 2009, the acclaimed CET lectures `OT LIVE' progress to adjacent suites outside the main hall, leaving more space for exhibitors, and a prime position, central stage, for catwalk shows and product launches, surrounded by fine dining. Cocktail and champagne bars bring a new dimension to hospitality in other areas of the show and the vital fashion aspect of modern optics is elevated to a dedicated Fashion Quarter. Optrafair is the largest optical gathering in the UK for the industry and profession. To book exhibiting space at Optrafair 2009 contact Jenny Chalmers on 0121 767 3309 or visit I


Students who have completed their ophthalmic dispensing studies, or qualified dispensing opticians would be eligible for a place on the contact lens course at City & Islington College, London. The course is day release, one day per week from 9am to 7.30pm, for one academic year starting September 2008. The options are to attend on Wednesday or Thursday. This course is designed to prepare for the CL Certificate theory exams of ABDO, and in addition to develop basic clinical skills in contact lens fitting and use of instrumentation. For further information, or to apply for a place, please contact Tony Harknett at [email protected] or Ian Forrest at [email protected], or alternatively telephone 020 7520 7489 I




Colin Lee Opticians, which has seven branches across Staffordshire and the West Midlands, is celebrating 30 years in business. The practice is looking forward to a number of anniversary events, including a major competition, and a dinner for its staff, many of whom have been with the company for a considerable number of years. The business is named after Colin Lee who, with wife Linda, set up the first branch in 1978. With help from Linda's brother, Clive Marchant, the trio fitted out the shop themselves, and used locum work to help pay for its running costs. Linda and Clive's father, John Marchant, then joined the company when he took voluntary redundancy, investing in equipment to set up the company's own workshop. When a second practice opened, business really took off, allowing Clive to join on a permanent basis when the third practice opened in Rugeley, in Staffordshire. Three decades on, the business now has a total of seven practices, and a combined turnover of £3 million. As well as developing the business, Colin Lee has played a major role in optical politics throughout his career. Currently chairman of the trustees of ABDO College, he was elected to ABDO council in the early 1980s, was President from 1996 ­ 1998 and has served on many committees. His responsibilities have taken him all over the country and to Malaysia and many European countries to publicise courses. In 1995, Colin was elected to the General Optical Council, where he spent seven years, becoming chairman of the Inter Professional Committee, the following year ­ the first dispensing optician to fill the post. In 1998, he was elected chairman of the Joint Optical Committee for the European Union, a Pan Optical committee trying to ensure a smooth integration of the various optical qualifications across the whole of the EU. Again, he was the first DO to take this position. In the last three years, Colin and Linda have taken a back seat from the day to day running of the company, with Clive Marchant now at the helm. Colin says, "Linda and I are still actively involved, and talk to Clive frequently. His abilities and attention to detail mean that we have every confidence in the long term future and success of the company." I

If you are looking for a real change send your cv to Jim Beard, Human Resources Manager on [email protected] or telephone +44 1978 663478

32 Dispensing Optics Augus t/September 2008 Newsbrief





The Fight For Sight Golf Challenge, now in its 13th year, was held on 2 July at Stoneleigh Deer Park Golf Club in Warwickshire where participants were challenged to chip over the River Avon on four holes! The event was held during the Royal Show Week. Over the past 12 years, in excess of £160,000 has been raised from the Golf Challenge for eye research. For those wanting details of next year's event ­ either to play and/or enter a team of four, email Clive Stone at: [email protected] For those who would like to support the event by sponsoring a hole, giving a prize for the auction or tombola, or would simply like to make a donation, contact Jenny Holt, Hill Wooton House, Hill Wooton, Warks CV35 7PP. Earlier in the year Clive Stone took part in the Fight for Sight sponsored sail across the Atlantic and raised £25,000 for the charity. I


Optometry Scotland (OS) unanimously elected Gillian Syme as its new chair at its AGM in Glasgow. Gillian succeeded Frank Munro who stood down after two years in office. Donald Cameron was elected unopposed as vice chair. Gillian, a director for Specsavers, has been with them for 13 years and was formerly vice chair of OS said, "It is of course a great honour to be elected chair of Optometry Scotland and to follow in such illustrious footsteps. I hope to be able to continue and build on the good work that has gone before. I am looking forward to my period in office and engaging with everyone in the profession as we take eyecare in Scotland, already a world leader, forward over the next few years." The OS AGM 2008 was held in the Radisson Hotel in Glasgow and attended by OS council members and observers from across Scotland, with representation from allied UK organisations. I


A series of five successful regional training days for ABDO college tutors have recently been held in London (hosted by ABDO), Manchester (hosted by BBGR), Birmingham (hosted by Dollond & Aitchison), Bristol (hosted by Essilor) and Edinburgh. All students of the ABDO College Distance Learning Institute (DLI) have their weekly assignments marked by ABDO College Tutors (the students undergo a three year course, with typically 32 weekly asignments, plus two twoweek block release sessions at ABDO College in Godmersham each year). The personal tutors are registered dispensing opticians, in daily practice, from across the UK profession and it is now compulsory for them to attend training workshops on a biannual basis. A total of 48 Tutors attended the workshops and ABDO College has produced a detailed course feedback report. The overall consensus is that there is an exciting future ahead for ABDO College, Tutors are very much looking forward to playing an active role and they found the training sessions highly informative. They were particularly impressed by the College's initiative to establish a Foundation Degree course in Ophthalmic Dispensing. Michelle Derbyshire, Head of ABDO College DLI commented, "It is vitally important that we ensure a consistency of the tutorial standards that we set to support our students. These compulsory workshops assist the Tutors in contributing to the College's reputation for high achievement, which has been emphasised in our students' examination results over the past few years. The workhops also provide us with valuable feedback for the development of future training sessions. I would particularly like to thank the sponsors, speakers and the tutors for making the workshops a great success." Another new development is that Transitions Optical, in conjunction with ABDO College, co-sponsored these events. Luca Conte, business manager and Kristin Manor, trade manager for Transitions Optical in the UK and Ireland attended the training session in Manchester. Commenting on the event Luca Conte said, "I would like to thank Michelle and her team for inviting Kristin and me to attend the Tutors meeting. We both felt rather privileged! It was very interesting to be exposed to another area of dispensing optics and the challenges that are faced. Transitions Optical is delighted be actively supporting ABDO College with education in optics." I




Simon Paget FBDO, a professional services consultant for Ocuco is offering a 90-minute CET presentation entitled `The practice of the future (is here now)' which is approved for 1.5 CET points for both optometrists and dispensing opticians. Simon says, "As a DO coming into contact on a daily basis with independent practices, I have become aware that a few practitioners do not have a computer at all. Most are not aware of the full extent to which computerisation is available now, and will impact on them in the near future." This is a genuine and generic attempt by one qualified optician to inform others of what is, and soon will be, available. Ocuco has generously agreed to supply sponsorship for these meetings and also to include a `Spot to Win' prize during the presentation of an iPodTouch. Any local optical meetings or societies who are interested in hosting a meeting should contact Judith Geare on 0870 060 0428. I


Staff at Richard Ward Opticians in Odiham, North Hampshire, recently returned from a trip to a Ugandan children's home where they formally handed over keys to a new £20,000 Toyota Hilux 4x4. Dispensing optician Richard Ward, and optometrists Toby Howcroft and Debbie Young returned from this, their second working trip to the home, where they gave eye tests to hundreds of adults and children. The practice raised the money over the past year with the help of the Ugandan Children's Trust who claimed the gift aid on money raised and made a substantial donation of their own. Other organisations that contributed included Rotary International and Inner Wheel, together with many individual donations from customers of Richard Ward Opticians. For more details visit www.richardwardopticians. I


Doncaster PCT has teamed up with their Local Optical Committee to promote children's entitlement to the free NHS Sight Test. The `Doncaster Vision for Life' campaign runs until 1 September and features posters on local buses, local cinema advertising and coverage in the local press. Leaflets with more information about eye health and NHS eye care services have been distributed to all families in the Doncaster area. The campaign has been backed by the Eye Health Alliance which aims to promote a better understanding of the health benefits of regular eye tests and seeks to reduce avoidable sight loss in the UK. Only around a quarter of children in the UK have had an eye test in the last year, despite being entitled to a free NHS sight test and help with the cost of glasses through the NHS voucher scheme. The `Doncaster Vision for Life' campaign aims to ensure that the number of children in Doncaster accessing eye care is higher than the national average. Practices in the area have also been asked to collate statistics on the number of children they see before and during the campaign, and how many children required refractive correction. This will provide valuable information about the take up of eye tests amongst children and young people. Alan Parkhurst, Chair of Doncaster Local Optical Committee said; "This is a great example of partnership working, not only with the PCT but with the Eye Health Alliance. Everyone can get involved by displaying posters in the practice and completing the evaluation form." Heather Marshall, Head of Public Affairs for the Eye Health Alliance said; "Good eye health is crucial to ensure a child develops to the best of their ability but many parents aren't aware of the health benefits of a sight test or that children are entitled to a free NHS Sight Test." All practices in the Doncaster area have received posters and leaflets publicising the campaign. Evaluation sheets have been distributed to practices which will enable the PCT to evaluate the effectiveness of the campaign. If you have any queries please contact Andrea Stothart at the PCT on [email protected] I

34 Dispensing Optics Augus t/September 2008 Letters

Letter to the Editor

Disjointed jottings . . . June/July issue

Oh dear, Oh dear, Oh dear . . . Before I had finished the article I had guessed that the author was from Tup North. This is the sort of person that CET is aimed at. Why should we be judging what people can afford and what they can't? I am sure that he would still be selling V2 lenses if they were still available. If a lens manufacturer offered him a free pair of lenses for himself, would he take a pair of budget lenses? Therefore, why should he not offer the best to his customers and let them make the choice as to whether they want the latest technology to get the best possible vision - or to stick with the old design lens? If a customer is wearing a multi design PPL lens (as they all are now) and the Rx has changed, especially on the add, then the lens design will have changed. So, although he thinks he is giving the same lens design as before he is not. Lens manufacturers do not make new lenses for the fun of it but to produce a better product. Just because there are no fancy buttons to push, as on a mobile phone, does not mean that there is no advanced technology in producing the product. This is where the skill of the dispensing optician comes in - to sell something that is abstract. If he cannot do that then he is doing the public a disservice. We have to be enthusiastic, not only about the latest styles in frames, but also the latest designs of lenses. The statement that "Patients don't normally give a tinker's tool about lenses" is only true if we do not educate them on the latest lenses available to suit their visual needs. As a dispensing optician I very rarely supply standard reading lenses as the near visual requirements for most people is not just for reading but is for a near vision environment. If I were to take John Pike's view, I would be supplying standard reading lenses, unless someone mentioned that they had a problem at intermediate. As for supplying two or three pairs to fufil the patient's full visual requirements, from what I gather from going round the country, it is quite absurd that they are reluctant to buy one pair let alone two or three. If I can do it why can't others? We have to change the attitude of the dispensing optician to one that is more positive about the products this enthusiasm will then be communicated to the patients. In the end you have a win, win situation, where the patient gets a better product with better more comfortable vision, and the dispensing optician not only gets more turnover, but patients that enjoy wearing their spectacles. Peter Sanders FBDO, Hertfordshire I

John Pike replies . . .

I'm afraid that Mr Sanders has misinterpreted the point of my article, which was to highlight the patients' attitude to new lens technology, not my own. I was trying to show how difficult it is to dispense high-tech lenses in the shadow of relentless advertising for cut-price spectacles. My patients always receive the best lenses that they can afford, which may be different from the lenses I would recommend if money were no object. Mr Sanders is fortunate to practise in an area where most of his clients can afford his recommendations. Up here in the frozen north, some of ours have to downgrade their lenses because of the cost. Is Mr Sanders a presbyope? Is he recommending upgrades to his varifocal wearers based purely on the scientific evidence? I've just taken delivery of my fourth pair of freeform progressives and can honestly tell no difference whatsoever between any freeform lens and my previous standard 'multi design'. If I had been advised by an optician to upgrade to freeform when I was already perfectly happy with my existing lens design, I would have felt cheated and would probably not return to the practice. I do, however, dispense freeform lenses in any situation where I feel the patient will benefit from these. I also feel that new wearers of progressives should be encouraged to wear the latest technology, to maximise their chances of success. I also dispense 'office' lenses, high index and multicoatings on a daily basis. Yes, Mr Sanders - I do undertake CET, have achieved my required points and have two further CET events in my diary. And now I must finish this black pudding, put on my flat cap and take the whippet for a walk. John Pike FBDO, Solihull, West Midlands I

We welcome contributions to our Letters to the Editor page which we reserve the right to edit. If you would like to air your views please write to The Editor, Dispensing Optics, PO BOX 233, Crowborough TN6 9BD or send an email to [email protected]

36 Dispensing Optics August/September 2008 From a DO'S desk . . .

Disjointed jottings

A true story about internet sales and bespoke tailoring

Elaine Grisdale asks: Is it me, or does anyone else have trouble saying "No"?

There are positive sides and negative sides to not being able to say "No". The positive side, in this case, is that by putting pen to paper I am stepping in for someone who had to pull out at the last minute and am helping out my friend Sheila Hope at Dispensing Optics. The negative side is that I'm writing this on 30 June for a 2 July publication deadline with a mountain of other stuff on my `To Do' list. Technically, I should have said "No" but it was a golden opportunity to sit down and make contact with you all before our forthcoming annual conference in Manchester this September. Talking of which, I have just received my posh frock in the post. I usually spend a fortune on posh frocks and accessories which only then get worn maybe once every few years as they tend to get photographed and people (usually women) remember that you have worn them before. This is why men are so lucky, as their dinner or lounge suits usually look pretty much of a muchness from one year to the next (sorry guys !) Well, with the credit crunch in the air and all the bills going through the roof, I ventured onto the internet and decided to have my dress made in China for a third of the price of one over here. I have a friend who lives that way and his shirts always look immaculate and of very good quality, so it spurred me on to try the system out. There were many dresses on offer - all of them fabulously hung on models or actresses photographed at red carpet events with their faces blacked out. I ended up with an Angelina Jolie number pre-impending motherhood ­ although to my distress, I do rather more resemble the heavily pregnant with twins version! After choice of model and colour, I had to take a whole host of measurements, some of them a little tricky to undertake on my own. I have to say that I am delighted with the result except for the length. It is unfortunately about three to four inches too long, so I think that I must have dropped a clanger somewhere along the line. I will now be seeking out a UK seamstress to have the swathes of chiffon cut down. I suspect that the alterations here will probably cost as much as the dress from over there. This inevitably made me think of people buying their specs over the internet ­ how many of them must get the PD wrong. The majority I should think.


in fact a false economy for the majority of them.

Valued clients Lobbying

Concentrating on that subject for the moment, I have had a lot of correspondence recently from members asking if they should give the PD out with the prescription. Some internet providers have been lobbying people and have suggested that we are breaking the law if we do not provide this measurement. This is completely untrue. The PD is not a required part of the prescription. The PD is, for the moment at least, considered as part of the dispensing, rather than the prescribing process. As shopping habits change and we spend more and more time in front of our PCs surfing the net, increasing numbers of people are tempted, for whatever reason, to buy their spectacles in this way and for some reason they think that we, local friendly opticians that we are, should provide both PD details and also a free adjustment and after sales service. I don't think so! It is about time that we, as a profession, took a stand and made our patients aware of the fact that internet shopping for spectacles is I was recently contacted by David Samuels from EyeSite in Reading who has published a dispensing and adjustment fee policy. The tone of his policy was spot on ­ what the charges are and why we have to charge the fees mentioned. There is flexibility for the adjustment service for old and valued clients where the old and valued clients feel even more valued when they are told that there is usually a fee for the service but, because of their years of loyal custom, they are exempt (unless I presume, if they have been on the internet and ruptured the loyalty built up over the years). Dispensing charges are charges for the service element only of the spectacles and the savoir faire of the dispensing optician. EyeSite explains to patients that if the dispensing element were to be separated from the products, this charge is what is what the dispensing element would be charged at. In their case they have chosen £40 for SV, £65 for bifocals and £75 for varifocals. The patients are informed that these fees

include pupillary measurement, checking the spectacles, varifocal or bifocal measurements where applicable, initial fitting and lifetime of adjustments. There are a number of good reasons for promoting a dispensing fee and adjustments fee policy : · To be transparent and seen to be co-operating with those who prefer to buy their spectacles online. You are offering them a service which must be paid for. (I am not expecting the seamstress to adjust my posh frock for nothing). · To educate patients to understand that the reason spectacles online are cheap is because there is no dispensing/adjustment service element included. · To convince patients that it is, in fact, just as cost effective to purchase spectacles from your practice, when the cost of the dispensing service is understood. Personally, I think it is about time that we should promote our know-how and be proud to charge for our time and expertise. In any profession time is money ­ I can think that recently I have spent £45 for 30 minutes with the hygienist at the dental surgery, £60 for 45 minutes with an acupuncturist, and when I went for an initial consultation with the surgeon to talk about a forthcoming gall bladder operation, the 15 minute chat with a laying of hands for about 30 seconds on the offending area, was charged through my health insurance at £120. Anyway, back to the conference and not being able to say "No". I am

currently on my fourth day of the Atkins Diet and eating only protein. I have a week to lose 5kg (I know, in my dreams . . .). Recently I was in Singapore and, due to amazing hospitality, fabulous food, and not wanting to offend my hosts, I put 5kg on in a week. I've done okay so far losing 2kg in three days but I have just slipped off the wagon (they say that confession is good for the soul ­ so confessing to the readership of 9,000+ should be making me feel wonderful). This is where the not being able to say "No" comes in again. I was catching up in front of my computer yesterday ignoring my ten year-old daughter and so she set to work in the kitchen and made me a lovely cake to cheer me up and stave off boredom for her. I resolutely said to her that I didn't want any (even though it looked delicious) due to said diet. The look of rejection and disappointment on her face was heart-wrenching. So, once again, I said "Yes" when I should have said "No" - but for a good reason. I am looking forward to sweeping up and down the stairs of the magnificent Manchester Town Hall at our very special Conference Gala Dinner on 28 September. Hopefully, my dress will be shortened by then, it won't have cost an arm and a leg and I will be looking more like the post rather than the premotherhood Angelina, probably sometime before she's got her original figure back! Elaine Grisdale is Head of Professional Services for ABDO. ABDO Conference details are on page 35 I

38 Dispensing Optics Augus t/September 2008 CET answers

Answers to `Under pressure - part 2'

1. Which of the following is not a glaucomatous visual field defect? a. A diffuse loss of sensitivity b. Arcuate scotomas c. A nasal step d. A bi-temporal hemianopia Glaucomatous visual field defects include diffuse loss of sensitivity, arcuate scotomas within the central 25º which usually respect the horizontal midline, nasal step, hemifield loss and a small remaining central or temporal `island of vision' in advanced cases. Therefore d is correct. 2. Which of the following is the earliest visual defect associated with primary open angle glaucoma? a. Arcuate defects b. Isolated paracentral scotomas c Total loss of the superior hemifield d Total loss of the inferior hemifield The earliest glaucomatous visual field defects are usually isolated paracentral scotomas. These commonly occur in the superonasal quadrant and correspond to glaucomatous changes in the inferior NRR. Therefore b is correct. 3. When examining the visual field of glaucoma patients and glaucoma suspects, which of the following has become the clinical standard? a. Examination of central visual field to 10º b. Examination of central visual field to 25-30º c. Examination of the full visual field d. Examination of the binocular visual field b is correct. As examination of the central visual field (2530º) has become the clinical standard for the assessment of glaucoma patients and glaucoma suspects. 4. With regard to visual field assessment, which of the following statements is correct? a. Full-threshold tests are ideal for screening. b. Suprathreshold tests use single stimuli only. c. Full-threshold testing is the gold-standard examination for the assessment of glaucoma suspects and for monitoring progression of the disease in patients with established glaucoma. d. The threshold of a location within the visual field is usually defined as the brightest stimulus that can be seen. c is correct. Full-threshold testing is more time consuming but this technique is the gold-standard examination for the assessment of glaucoma suspects and for monitoring progression of the disease in patients with established glaucoma. 5. The measurement of central corneal thickness is known as? a. Tonometry b. Manometry c. Pachymetry d. Keratometry c is correct. The measurement of central corneal thickness is known as pachymetry. 6. In the UK, for subjects over 40 years of age, the prevalence of primary open angle glaucoma (POAG) has been estimated to be: a. 1% b. 2% c. 3% d. 14% a is correct. In the UK the prevalence of primary open angle glaucoma (POAG) has been estimated to be 1% for subjects over 40 years old, 4% for subjects over 75 years old and 14% in individuals over 80 years of age. 7. Which of the following is a controversial risk factor for developing primary open angle glaucoma? a. Raised intra-ocular pressure b. Diabetes c. Myopia d. Positive family history of glaucoma Recognised risk factors for primary open angle glaucoma include raised IOP, age, race, a thin cornea, family history, genetics, myopia, history of steroid and anti-depressant use, diabetes (although the role is controversial) and a history of a vascular event. With regard to diabetes, two major studies did find an increased risk for developing POAG if diabetic. However, other population based studies have found the relationship to be absent. Therefore b is correct. 8. The central thickness of a normal cornea is usually taken to be: a. <555 m b. 555 m-588 m c. >588 m d. 1 mm b is correct. A normal corneal thickness is taken to be 555 m-588 m. A CCT of <555 m is considered to be thin and a CCT >588 m is considered thick. 9. In the medical treatment of primary open angle glaucoma, dorzolamide (Trusopt) is an example of: a. A beta-blocker b. A carbonic anhydrase inhibitor c. An alpha agonist d. A prostaglandin analogue b is correct. As dorzolamide (Trusopt) is a carbonic anhydrase inhibitor. 10. Which of the following drugs causes eyelash growth and iris hyperpigmentation? a. timolol (Timoptol) b. Pilocarpine c. bimatoprost (Lumigan) d. dorzolamide (Trusopt) c is correct. As recognised side effects of the prostaglandin analogues are eyelash growth (especially Lumigan), eyelash hyperpigmentation and iris hyperpigmentation. 11. Allergic conjunctivitis is a major side effect of: a. Alpha agonists b. Beta-blockers c. Prostaglandin analogues d. Parasympathomimetics a is correct. The major side effect of Alpha agonists such as brimonidine (Alphagan) is allergic conjunctivitis. 12. Which of the following drugs used for the treatment of primary open angle glaucoma have the greatest potential for causing serious systemic side effects? a. dorzolamide (Trusopt) b. brimonidine (Alphagan) c. timolol (Timoptol) d. latanoprost (Xalatan) c is correct. Timolol (timoptol) is a beta-blocker which at one time, was the principal drug used for the medical treatment of glaucoma. However, beta-blockers have systemic side effects that affect the respiratory system, cardiovascular system and the central nervous system. The systemic side effects of beta-blockers are potentially serious and can be fatal. These include bradycardia, hypotension and bronchospasm. I

The answers to `Ophthalmic lens materials and properties' will appear in our October 2008 issue

Diary of events

G September 1 - ABDO College - Revision course for 1st Year students sitting the ABDO Autumn Preliminary Theory Examination. For further details telephone 01227 733901 or email [email protected] G September 3-4 - ABDO College - `Getting started', twoday course at Godmersham run by ABDO College to prepare students for the ABDO Contact Lens Practical Examinations in Summer 2009. For further details telephone 01227 733901 or email [email protected] G September - Sight Care Group ­ `Intro to optics', Bristol, London, Manchester, Newcastle, Birmingham, Belfast, Scotland. For further details contact Sight Care Group on 01256 781522 or email [email protected] G September - Sight Care Group ­ `Confident frame styling, adjustments and dispensing', Newcastle, Belfast, Bristol, London, Birmingham, Scotland, Manchester. For further details contact Sight Care Group on 01256 781522 or email [email protected] G September - November - Sight Care Group ­ `Managing and motivating staff', Newcastle, Bristol, London, Birmingham, Manchester, Scotland, Belfast. For further details contact Sight Care Group on 01256 781522 or email [email protected] G September - December - Identity Optical Training Optical Assistants Course, divided into five sessions covering communication skills, frame styling, frame materials and adjustments, the latest lens information and basic dispensing techniques. The course will prepare delegates for the Worshipful Company of Spectacle Makers examination, which is optional. A VRQ (Vocationally Related Qualification) Level 2 Certificate will be awarded upon the candidate's successful written exam. Five-week course, Tuesdays 1pm ­ 6pm, £300, ABDO, 199 Gloucester Terrace, London. For further details contact Sally Bates on 020 8504 0967 or email [email protected] G September 9- ABDO Golf Society - Stercks Martin Salver, Olton Golf Club, Solihull, Birmingham. For more information, and for anyone wishing to join the ABDO Golf Society, contact Mike Stokes 01204 411722 or email [email protected] G September 9 - Area 2 (North East) ­ Contact lens talk, sponsored by Coopervision, Quality Hotel, Selby Fork (A1/A63) Leeds LS25 5LF. For further details contact Keith Dickinson on 0113 293 7456 or email [email protected] G September 15 - Area 5 (Midlands) ­ CET day, 6 CET points, £20 including tea and coffee and a hot/cold buffet lunch, the Arden Hotel, Birmingham. For further information and booking details, email Ian Hardwick at [email protected] or telephone 07814 558343. G September 17 - BCLA - Dr Sarah Janikoun will deliver the 2008 Presidential Address `Visual rehabilitation ­ I can see clearly now...', 1 CL CET point, at the Royal Society of Medicine, 1 Wimpole Street, London W1. For further details contact visit or email [email protected] G September 22 - Total Marketing Resource (TMR) - Oneday training course for optical assistants/receptionists course one, 9am-5pm, Jurys Hotel, Bristol. For further details contact Tony Tindale on 01252 625187 or visit G September 23 - Total Marketing Resource (TMR) - Oneday training course for optical assistants/receptionists course two, 9am-5pm, Jurys Hotel, Bristol. For further details contact Tony Tindale on 01252 625187 or visit G September 24 - Total Marketing Resource (TMR) - Oneday training course `Commercial dispensing', 6 CET points, 9am-5pm, Jurys Hotel, Bristol. For further details contact Tony Tindale on 01252 625187 or visit G September 25 - Total Marketing Resource (TMR) - Oneday training course `Optical management and marketing', 6 CET points, 9am-5pm, Jurys Hotel, Bristol. For further details contact Tony Tindale on 01252 625187 or visit G September 27-29 - ABDO - ABDO National Conference and Exhibition, The Midland Hotel, Manchester. For further details visit G September 28 - ABDO - ABDO Annual General Meeting followed by the ABDO Benevolent Fund Annual General Meeting, The Midland Hotel, Manchester. For further details visit G October - November - Sight Care Group ­ `Patient communication, complaint handling and service excellence', Newcastle, Scotland, Bristol, London, Birmingham, Manchester, Belfast. For further details contact Sight Care Group on 01256 781522 or email [email protected] G October 7 - Area 5 (Midlands) ­ AGM, venue to be confirmed. For further details email Ian Hardwick at [email protected] or telephone 07814 558343. G October 15 - Area 11 (London) ­ 'Growing a healthy contact lens business' by Jayne Schofield, 1 CL point, Royal National Hotel, 38/51 Bedford Way, London WC1H 0DG. For further details contact Hishu Monji, email [email protected] G October 30 - November 2 - Silmo 2008 - Visit or contact Promosalons UK, Michele Jackson on 020 8216 3109 or email [email protected] G November - Sight Care Group ­ `Effective practice management and marketing', Bristol, London, Birmingham, Manchester, Belfast, Scotland, Newcastle. For further details contact Sight Care Group on 01256 781522 or email [email protected] G November - December - Sight Care Group ­ `Maximising practice dispensing', Belfast, Scotland, Newcastle, Bristol, London, Birmingham, Manchester. For further details contact Sight Care Group on 01256 781522 or email [email protected] G November 12 - Area 2 (North East) ­ `The practice of the future (is here now)', sponsored by Ocuco, 1.5 CET points. For further details contact Keith Dickinson on 0113 293 7456 or email [email protected] G November 18 - BCLA - 5th BCLA Pioneers Conference, half-day CET course followed by Pioneers Lecture by Professor Nathan Efron, at the Royal Society of Medicine, 1 Wimpole Street, London W1, free-of-charge and open only to BCLA members and new members joining before the event. For further details contact visit or email [email protected] G November 26 - ABDO Graduation and Prizegiving Ceremony ­ 7 pm, Canterbury Cathedral, Canterbury, Kent. More details to follow. I

ABDO members are welcome to attend Area meeting in any Area they wish to

Member Email addresses

When CET results notification emails are sent out after each CET article, we receive a number of them back as undeliverable. A good many of them are from Yahoo, Hotmail, Googlemail and BTInternet, which we know have quite stringent spam/junk filters. Please check the email address that we have for you (you can do this on the ABDO website), and if it is correct, you should be able to alter your junkmail settings (usually through the internet service provider (ISP) webmail facility, not your email programme) to allow emails from our results-only email address, [email protected] and our `instant result' email sender, [email protected] Please note to contact the CET Department and ensure a prompt response the following email address is still valid [email protected]


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