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RX FACTOR
ProFile
July 2013
Specsavers global journal for all professional staff & students
All smiles in Sydney
Success for second ANZ clinical
conference
Pathway to
partnership
Meet tomorrow’s store directors
Talking shop
The value of a store visit
Hearcare
Try our pathology CPD crossword
tive
c
a
r
e
t
n
I
CET
part 2:
Red eye errals
ref
Urgent s and DOs
tom
- for op
Contents
This month’s ProFile really
demonstrates what a ‘best practice
without borders’ kind of organisation
Specsavers is. Fundamental to this
is the belief that a great idea is a
great idea, regardless of where it
originates, and that – with the right
cultural tweaks and in-country
execution – innovation will always
travel well.
Pathway, RX Factor, the
establishment of our industryleading clinical conferences… even
ProFile itself… are all great examples
of Specsavers initiatives launched
in one country and then shared
globally.
Let us know what initiatives are
working well in your region – and
any you’d like to see replicated
elsewhere.
Contacts
Email: [email protected]
Editorial UK/Europe:
Michaela Wakeford
Tel: 01481 232494
Distribution UK/Europe:
Debbie Williams
Tel: 01481 234897
Clinical editor:
Nigel Best MCOptom FBCLA FAAO
[email protected]
Editorial board
Nigel Best MCOptom FBCLA FAAO
Dr Catharine Chisholm PhD BSc (Hons)
4-5
Specsavers news
Round-up of Group and store-related stories
6
Industry focus
A look at what’s happening in optics
7
Professional Advancement Conference (UK)
Plenty of reasons to book for October event
8-11
Specsavers Clinical Conference (ANZ)
People, pictures and clinical pearls from SCC2 in Sydney
12 Optometry case study
Transient visual loss
13
DRP / Dispensing case study
Store image of the month, plus Dispensing Q&A
14-15 Pathway partnership programme
Meet the JVPs of tomorrow
16 Talking shop
The value of a store visit
17 Management matters
Survival of the fittest
18 Contact lenses
Making your contact lens conversations memorable
19
Hearcare news
Specsavers showcases AQP services at largest commissioning event
20
Hearcare CPD
Pathology crossword
21
BSHAA Congress 2013
Latest findings on digital noise reduction and frequency compression
MCOptom
22-27CET
Paul Morris BSc (Hons) Optometry MCOptom
Peter Larsen BSc Optometry
Chris Steele BSc (Hons) FCOptom DCLP DipOC
DipTp (IP) FBCLA
©2013 Specsavers Optical Group Ltd. All rights reserved.
The contents of this publication are strictly confidential.
The information is provided for Specsavers only and
must not be given to any persons or companies outside
the Group. Published with the support of the Specsavers
Product Support Fund.
2 RX FACTOR PROFILE July 2013
Red eye part 2: Urgent referrals
– interactive CET for optoms and DOs
28
In the spotlight with…
Welshman and Spanish store director Leighton Griffiths
Welcome
Show of strength
Our 2013 Clinical Conference (‘SCC2’) held in Sydney
last month rightly figures large in this month’s issue
of ProFile (pages 8-11). Across the globe, Specsavers
continues to embrace leadership in clinical and
professional education as part of the portfolio with
which we maintain our indomitable position as the
eye care provider of choice.
Our Professional Advancement Conference, attended
by practitioners from the UK and Republic of Ireland,
has built a reputation over many years as one
of the premier clinical conferences in the world.
It is no exaggeration to claim that last month’s
conference in Sydney now establishes Specsavers
as the international leader in optometric continuing
professional development in both hemispheres.
Having managed to wrestle Doug’s invite from him,
I was fortunate to be able to travel to Australia and
spend a few days with colleagues in the run-up, as
well as attending the conference itself. And what
I was able to observe was truly inspirational. The
clear ambition to build on already phenomenal
success, the optimism that Specsavers can provide
the platform and culture to truly meet the eye care
needs of the nation, plus the boundless energy to
achieve more, came across time and time again
when speaking with many of the delegates. It
is clear that, wherever in the world we have a
presence, Specsavers people jointly live up to the
values of being passionate about our customers, our
people, our partners and the communities in which
we work.
This month’s ‘Talking Shop’ column, by Simon Dunn,
(Swap shop – page 16) continues the theme of
learning from each other – something that can be
applied in all countries. So, too, does the report on
the exciting progress made with our Pathway partner
programme (page 14) – yet another example of how
joined-up thinking can benefit like-minded staff
across the globe.
It is no exaggeration to claim
that last month’s conference
in Sydney now establishes
Specsavers as the international
leader in optometric continuing
professional development in both
hemispheres.
A further shared experience – and one made
abundantly clear to me by attending the SCC – is
the emergence of a closer working relationship with
other health professionals (and ophthalmology in
particular). This is as apparent in Australia/New
Zealand as it is in Europe. Faced with an aging
population, and the number of over-60s growing
twice as fast as the number of ophthalmologists, it
is obvious that there will be an increasing demand
for our products and services. It is equally obvious
that, with our culture of focusing on the customer,
Specsavers is the ideal partner for engagement by
those responsible for commissioning healthcare
services in all the markets and sectors in which we
operate.
With one clinical conference under the belt, there is
another in the making, with just over three months
until the UK’s Professional Advancement Conference
on 13 October – and over 1,200 delegates already
booked to attend. This year’s event will be really
ground-breaking and more relevant than ever
with a programme that embraces the new CET
requirements for all practitioners. Plus – as our
Australian colleagues showed last month – it can
provide an excellent catching-up opportunity for
busy and geographically disparate professionals. I
would urge you and your clinical teams to sign up –
see page 7 for more details.
Paul Carroll
Specsavers Director of Professional
Services (UK & ROI)
RX FACTOR PROFILE July 2013 3
Specsavers news
RX Factor roadshow reaches Nordics
Content for the workshops was largely based on the UK model, with
input from UK course tutor David Brett-Williams who worked with the
Nordic training team and local optometrists to tailor the content to the
relevant regions. Store partners have also been trained to help deliver
the workshops alongside the Nordic Academy training team.
‘Specsavers equals good customer service. We want satisfied customers
who get professional help from service-minded practitioners. The RX
Factor is all about sharing ideas on how we deliver this,’ said Retail
Development Manager Søren Ringmann, who helped to facilitate one of
the Danish workshops.
Here’s what some of the delegates had to say:
‘It’s always interesting to share experiences with colleagues. This time
we got to listen to how other opticians express themselves in the eye
exam room and in the purchasing situation.’ Tone Myhren, Specsavers
Trondheim
Following on from its success in the UK and Australia/New Zealand,
the RX Factor for Optometrists development programme continues to
gather momentum with its first tailor-made workshops for Specsavers
practitioners in Norway and Denmark, and more to follow in Sweden
and Finland next month.
I really enjoyed the ‘Finish strong’ section which was about how to
finish an eye exam in the best way. This material was completely new
to me and we have never talked about it in courses or school.’ Frode
Leborg, Specsavers Sandefjord
‘The best part was, as a partner, taking on the leadership hat, daring to
try some new things. Also making sure we have the right people in the
right place in store.’ Anne-Lene Møller, Specsavers Middelfart
The first round of workshops, attended by optometrist and optician
partners, received incredibly positive feedback. A second round will see
all employed opticians invited to attend.
‘I’d definitely recommend RX Factor – I have already signed all my
optometrists up for Round 2. They will learn a lot and bring new ideas
back to the store.’ Mia Kjær Albertsen, Specsavers Hobro
Sweden launches
contact lens ‘webb-butik’
Working smarter
Customers in Sweden can now buy their contact lenses online direct
from Specsavers for the first time, with the launch of Specsavers’
‘webb-butik’ (online store). It follows the success of the launch of online
contact lens retailing in Australia and New Zealand last year.
A key message behind the new offering is that customers can buy
contact lenses online – as they can with other retailers – but still have
the back-up of help and advice from the opticians and teams in store.
Project leader for the launch, Matt Armitage, said: ‘It has been a huge
team effort to get the concept live, with heavy involvement from
colleagues in Sweden, the UK and Guernsey, the Copenhagen support
office and, of course, essential input from Australia.
‘Engaging with our partners has been a key focus, as it was in Australia,
and it was a definite high point when it got the full backing of all our
partners at the launch meeting.’
We all know that first impressions count and how we look at work
is just as important as how good the store looks when presenting a
professional image to customers. Specsavers iWear business wear was
launched to maintain consistent brand standards across the whole
team and is now our signature dress code across the world.
Seeing non-uniformed members of staff – especially senior staff – is
confusing for customers and dilutes the impression that the team
represents ‘one brand’. Which is why all senior staff, including
supervisors, managers and
optometrists, are expected
to wear iWear. Self-employed
practitioners are asked to
wear a dark blue business
suit and white shirt/blouse
to work and should be
provided with a Specsavers
tie or scarf when they get
into the store.
See Connect for how to
order and get credit on
iWear – plus, if you’re in
the UK, how you and your
colleagues could win a prize
of £1,000 for the bestdressed store.
4 RX FACTOR PROFILE July 2013
SCC2 raises cash too
Zealand’s South Island – some six hours’ flying
time and one required stopover from Alex’s
home base of Sydney!
Excitingly, this fund-raising exercise took
Specsavers ANZ’s total figure raised for The
Fred Hollows Foundation over the $500,000
benchmark for the first time. A big thank you
to everyone who contributed
A fantastic weekend was had by all at the
second hugely successful Specsavers Clinical
Conference in Sydney last month. The event
combined not just the clinical (see our full
report in pages 8-11) but also the charitable
in the form of a raffle in aid of charity partner
The Fred Hollows Foundation.
An amazing $25,000 was raised by partners in
the two weeks leading up to the conference,
with some fantastic prizes drawn at the
welcome cocktail party at the Sydney Opera
House the night before the conference. These
included an all-expenses paid trip to the
PAC – our sister conference in the UK – won
by Chadstone optometry partner Parmjeet
Mirwa (pictured front cover, with ANZ Director
of Professional Services Peter Larsen), and
a ‘golden ticket’ prize of having top designer
Alex Perry in-store for a super styling session.
This was won by Amy Winter (pictured, above,
with Peter Larsen), optometry partner at
Specsavers Invercargill which, for those not
in the know, is at the very bottom of New
Over 1,200
already
booked
More than 1,200
optics and audiology
delegates have
already booked
for our 19th Professional Advancement
Conference – a record number with still three
months to go.
This year’s event, on Sunday 13 October in
Birmingham, UK, offers a really innovative
programme catering for all practitioner
competencies and with fully interactive CET
in all sessions. Some sessions, including peer
discussion and facilitator training, require
pre-booking and have been filling up fast, so
make sure you and your clinical teams don’t
miss out.
Check out page 7 for more details of what’s in
store and how to book, and keep an eye out
for the full programme in next month’s ProFile
and on Connect.
Norwegian optometry students
win trip to PAC
Also winning a trip to the Professional Advancement Conference in October were a team of final
year optometry students from Norway.
Specsavers has, for the last four years, sponsored the prize for best poster at the Buskerud
University College Institute for Optometry and Vision Science. This year’s winning project looked
at ‘How visual functions are affected by pupil size after dilation with Tropicamide’. The team
concluded that pupil size has minimal effect on visual acuity in young healthy patients, thus
patients’ visual acuity after dilation should not be an obstacle to using Tropicamide.
The project group
(pictured) were:
Shugufa Asefi, Gima
Rehani, Lisa Therese
Campanile, Beate
Kjeldstadli Solfjeld,
Petter Danielsen and
Jon Vegard Eliassen.
Enhanced
CET explained
If you’re still trying
to get to grips
with what the UK’s
Enhanced CET
Scheme means
for you, check out
this useful guide
from the General
Optical Council
– posted out as
a booklet to all
GOC-registered
practitioners at the end of last month,
and available electronically on the GOC’s
website www.optical.org, and on Specsavers
UK Connect. The booklet clearly lists
the number of points and competencies
required by different practitioner groups,
explains the peer discussion requirement
and how to manage your online CET
portfolio.
Remember – all CET articles
published in ProFile, and
all sessions at this year’s
Professional Advancement
Conference, carry interactive points
under the new scheme.
Win a conference
+ hotel weekend
package
Send in your best fundus and anterior eye
images to this year’s Specsavers Digital
Photography competition, and you could
be one of the lucky winners of a top-ofthe-range PENTAX digital SLR camera, or
even bag yourself a free pass with hotel
accommodation to your nearest Specsavers
clinical conference (e.g. October’s PAC in the
UK, or next year’s SCC in Australia)
This year’s competition has gone global
and the search is on to find the best images
captured in Specsavers stores around the
world. There’s plenty of chances to win a
prize, with categories for UK/ROI and ‘Rest
of the world’. But hurry, you’ve only got until
the end of August to send in your entries.
Simply email your images with a few
details about what’s shown,
along with your name and
store no. to gg.fundus@
specsavers.com, making sure
you remove any customer
information.
For full entry requirements
and tips on what the judges
are looking for, see Connect.
RX FACTOR PROFILE July 2013 5
Industry focus
Eye care
dominates
ministerial
must-read mag
Last month saw publication by
leading political and cultural
magazine New Statesman of a
supplement dedicated to eye
health. The magazine is required
reading in the UK for MPs, Peers
and the decision- makers in local
government. Included within was an
article by government minister Lord
Howe saluting the excellent eye care
which occurs in high streets across
the country every day.
Although many of his comments
would apply to the whole of the UK,
his own responsibility is restricted
to England. Here, he argues, it is
crucial that we get eye care right
and keep striving to improve it. He
points out that opticians, working
with doctors and others, now have
the power to plan and design local
eye health services that are better
tailored to local need. In recognition
of this, the Royal College of General
Practitioners has made eye health
one of its clinical priorities for
the next three years. Lord Howe
highlights that Local Professional
Networks (LPNs) will be a significant
factor in improving eye health
services because they will encourage
more joint working across sectors.
All good reasons why an increasing
number of Specsavers stores are
becoming involved in the delivery of
an expanded range of commissioned
services.
6 RX FACTOR PROFILE July 2013
Welsh pharmacists dispense
wider health advice
Cross-sector working is alive and well in
Wales, where pharmacies are stepping in to
lend a hand in getting the message about the
importance of good eye health. Throughout
July, pharmacies will be running a month-long
campaign which will highlight risk factors
that can cause sight problems in a joint
programme with Public Health Wales – further
evidence that public health professionals
are recognising the significance of eye
health alongside other major public health
issues such as dementia and obesity. While
pharmacists will be highlighting factors such
as diabetes and smoking to their customers,
they will also be making referrals where
necessary to community optometrists, with
local Specsavers stores ideally placed to
provide more detailed advice and guidance on
good eye care.
Australia exposes non-approved
lens importers
One of Australia’s main three optical trade
publications – mivision – ran a good oldfashioned expose story last month that has
had tongues wagging across the profession. It
turns out that quite a number of ophthalmic
lens suppliers – including some well-known
ones – are importing lenses into Australia
that are not yet registered with the Australian
Therapeutic Goods Administration (TGA).
All medical devices, including lenses, must
be included in the TGA’s Australian Register
Road testing
older motorists’
fitness to drive
While the UK awaits the outcome of the Driver
and Vehicle Licensing Agency tender process
for the contract for visual field testing, the
UK’s Optical Confederation has reported
on a seminar hosted earlier this year by
motoring charity The RAC Foundation about
the potential for self-assessment tools to be
used by older drivers in order to determine
their driving fitness. As in other forums,
ongoing concerns about the effectiveness of
the number plate test were expressed and the
fact that it was often necessary to wait until
people were completely unsafe before action
could be taken.
of Therapeutic Goods prior to being sold in
Australia. While not naming names, the article
then points to the list of registered importers
via the tga.gov.au website.
The report that accompanied the seminar
makes for interesting reading as it contains
analysis by some of the leading researchers
in the field. We may intuitively believe
that vision is the major consideration, but
the report explains why changes in other
cognitive, sensory and psychomotor abilities
can have a greater impact. The paper will
make fascinating reading for all practitioners
interested in the important societal need to
enable people to drive safely for longer – and
can be found at http://fodo.com/downloads/
Driving-Choices-for-the-Older-Motorist.pdf
Professional Advancement Conference
13 October 2013, ICC Birmingham, UK
Over 1,200 already booked for PAC 2013
No-one likes to feel CET is a drudge, which is why we’ve pumped up the value on the PAC programme this year,
taking full advantage of the competencies and learning styles now part of the UK’s Enhanced CET Scheme. So if you
are short of interactive points or a competency or two, you will be able to track them down and gain your full year’s
requirement of CET points in the process.
Totally interactive CET, and all
competencies covered…
Other great reasons to bring the
whole team….
However you choose to spend your day, you will be assured
that all sessions offer interactive CET points, and all practitioner
competencies are covered during the day.
•
Full day audiology programme for qualified and trainee
hearing aid dispensers and hearing care assistants.
•
Year-specific TDO sessions, including exam preparation; plus
supervisor news from the GOC
•
Full day pre-reg optom programme
•
Professional development and product sessions
•
Motivational personal development for all, led by Specsavers
partner David Brett-Williams
•
Extra CET quizzes
Peer discussions & workshops…
•
Networking with Specsavers colleagues from across the
Group
Engage with a fascinating programme of case studies and
conundrums developed by Specsavers partners Paul Morris and Dr
Nigel Best. Peer discussion topics include:
•
Chance to meet industry representatives, external suppliers
and Specsavers support teams
Enjoy a fully flexible programme of both practical and clinical
subjects from a superb team of illustrious guest presenters
including Professor Christine Purslow, Professor Stephen Parrish,
Dr Anna Kwartz, Mr Teifi James, Caroline Christie, Mr Leon Au,
Nick Atkins, Nik Sheen, Mr Daniel Morris, Dr Jo Watkins, Sally
Bates, Paul McCarthy and Head of Education and Standards at the
General Optical Council, Linda Ford.
•
Contact lenses for old and young (book on the 9-11am
sessions).
•
A choice of clinical topics including AMD and BV (book on any
session except 9-11am).
•
Dispensing peer discussions on communications, paediatric
dispensing and professional conduct competencies (no need
to pre-book).
Note: Peer discussion facilitator training must also be booked in
advance via Connect.
Pre-register and beat the queues!
Important changes to PAC registration process
GOC auditing of this event means that only practitioners who are
present for the entire session will get their CET points. We do not have
any scope for flexibility on this. If you are not in the session by the time
the presentation starts, unfortunately you will not be eligible for points.
Detailed programme information for all professional groups will be
published in August’s ProFile and on Connect. Thanks very much to
our sponsors for making it possible.
How do I book?
Search for ‘PAC’ either in the Optics or Hearcare tabs on the UK
Connect site and fill in the relevant booking form. You will also find
information on booking accommodation at preferential rates.
Email confirmations of delegate places and peer discussion places
booked before 30 June are being sent out after 1 July.
To ensure that queues at morning registration on the day
do not prevent anyone getting to the start of
the first session, we will send you
pre-registration details in
advance of the day. Please
keep this information safe and
treat it like a boarding pass for
a plane!
IT
ADM
ONE
Success in the
city for SCC
sequel
Clinical cases, CPD, cocktails and catching-up
with colleagues at the Sydney Opera House.
Our second Specsavers Clinical Conference
offered an impressive educational and
social programme for Australian and
New Zealand practitioners, as
Neale Pugh reports.
This year’s Specsavers Clinical Conference (known locally as SCC2)
swapped Melbourne for Sydney to welcome more than 400 people for
a weekend of professional development and networking.
Moving the event from mid-week to a Sunday also allowed delegates to
enjoy a welcome cocktail party at the Sydney Opera House the evening
before the conference – a great start to what has already become a
great event.
More than 320 Specsavers optometrists from Specsavers stores all over
Australia and New Zealand travelled to the event, which also played
host to 40 ‘guest’ optometrists, and a number of optometry school
students. As well as a very illustrious speaker line-up – drawn almost
exclusively from the world of ophthalmology – VIP guests included Colin
Waldron (Chair of statutory body The Optometry Board of Australia),
Andrew Harris and Genevieve Quilty (President and CEO respectively of
Optometrists’ Association Australia) and representatives of the Schools
of Optometry and the College of Optometrists. A full-house of optical
trade journalists was also present with Insight, mivision, Australian
Optometry and NZ Optics represented by a total of seven writers and
editors.
Sunday’s clinical programme provided attendees with the latest
research and advice on subjects ranging from glaucoma to vitreoretinal
surgery (see pages 14 & 15 for clinical highlights). During breaks in the
day, delegates were able to catch up with old friends, meet new ones
and visit supplier stands as well as try out the latest consulting room
equipment in fully equipped mock-up rooms.
Sponsored by:
8 RX FACTOR PROFILE July 2013
Peter Larsen, ANZ Director of Professional Services, said that he was
delighted with how the day had gone. ‘Certainly the feedback we had
during and after the event has been extremely positive. The addition
of the Opera House welcome party met with universal approval and
the CPD programme has, I believe, hit the nail on the head in terms of
content and practical application. There was so much useful material
for optometrists to take back to their consulting rooms. CPD is great
but the whole purpose of CPD is to improve our clinical knowledge.
Sunday at the Hilton did just that for me and, I am sure, all of our
optometrists.’
SCC3 is planned for 14/15 June 2014 and will be eagerly anticipated –
wherever it might be.
SCC has managed in two years to leapfrog
the competition and confirm its standing
as a leading optometry conference in
Australia and NZ. An excellent event uniting
Specsavers optometrists, promoting
professionalism and supporting the
community through solid fundraising.
Rob Pietrini, optometrist partner, Shell Harbour
Supported by:
The weekend was great;
I thought the conference
and speakers were very
informative and relevant. I’ve
definitely picked up a few
extra tips and it really makes
me, as an optometrist push
towards clinical excellence.
Overall it gave me such
a positive vibe towards
becoming a Specsavers
partner.
Peter La, optometrist, Upper Mt
Gravatt
Not only did we enjoy a
‘cocktail or two with a view’
at the Sydney Opera house
on Saturday, but it proved
to be a very informative,
interesting and CPD packed
Sunday session. Great
chance to catch familiar
faces and trade notes with
fellow directors. Can’t wait
for SCC 2014.
Matthew Bennett, optometrist
partner, Rosny
This year’s SCC was again
proof of Specsavers’
commitment to delivering
world class optometry
advancement in Australia.
Clinton Fisher, optometrist
partner, Rundle Mall
RX FACTOR PROFILE July 2013 9
Specsavers Clinical Conference (ANZ)
Tips from the top
Camberwell optometry partner Neale Pugh offers his take-home
highlights from the Specsavers Clinical Conference in Australia.
Myths and misconceptions that can lead to suboptimal
outcomes in glaucoma diagnosis and management
Professor Jonathan Crowston, Director, Centre for Eye Research Australia, Head of
Ophthalmology, University of Melbourne
Back by popular demand, Prof. Crowston
presented a critical approach to the parameters
used for glaucoma diagnosis and monitoring and
a broader perspective on management of the
condition. The main messages for the audience
were:
• Careful examination of the optic disc is
essential.
• No single sign is pathognomic of glaucoma.
•
•
•
Visual field anomalies need to be confirmed
and repeated.
Monitoring of the optic disc and retinal
nerve fibre layer is essential in managing a
patient with glaucoma.
These requirements are patient specific
and the frequency of review should be
determined by levels of IOP.
An update on the management of AMD and diabetic
retinopathy
Dr Alex Harper, Head of Medical Retina, Eye and Ear Hospital, Melbourne
Dr Harper covered the most recent research
and views on prevalence, new classifications,
clinical features and the latest treatment options
for both conditions. Particular relevance was
presented to the optometric audience on clinical
decisions they could make on investigations they
should undertake on these patients and referral
criteria they should consider including:
•
•
Always dilate diabetic patients with even a
single haemorrhage.
•
•
Be cautious when referring diabetic patients
•
with cataract – 1 in 5 have an increase in
their DR post cataract surgery. Optimise
vision and review regularly.
New classification of small drusen (63
microns or half diameter of central retinal
vein) “Drupelets”.
Drupelets – not AMD. Normal age related
changes, no clinical risk of developing AMD.
Essential to instruct patients in use of
Amsler Chart at home. Any acute symptoms
– urgent referral.
Vitreoretinal surgery made surprisingly understandable
Associate Professor Dr Alex Hunyor, Associate Professor of Ophthalmology,
Macquarie University / Vitreoretinal Surgeon, Sydney Eye Hospital / Director, Retina
Associates
Dr Hunyor discussed the major elective
vitreoretinal problems, such as:
•
•
•
The clinical features, diagnosis, and
treatment of macular hole, epiretinal
membrane, and vitreomacular traction.
The essentials, symptoms, signs and
treatment of retinal tears, posterior
vitreous detachments and retinal
detachments.
Referral guidelines for ERM. If there are no
10 RX FACTOR PROFILE July 2013
symptoms and VA is normal – review using
retinal photography/imaging..
•
60% of retinal detachments are in the
superior temporal quadrant.
•
The clinical red flags for retinal detachment
are:
−−
Any retinal/vitreal haemorrhage.
−−
Cells in the vitreous.
−−
Shadows in vision or reports of vision
looking like ‘oil on water’.
Can eye, can’t eye?
Dr Trevor Gray, Consultant Ophthalmologist, Auckland Hospital Eye Department,
Clinical Senior Lecturer in Ophthalmology, University of Auckland
This was a review of the latest techniques for
corrective surgery, the procedures, their safety
outcomes and results achieved for the patient.
•
LASIK is the most common procedure, but
wavefront PRK is preferred for low myopes
at risk of trauma (police, armed forces
personnel, some sportsmen).
•
The partnership between the
ophthalmologists and the optometrist is
very important in co-management of the
post-surgery patient.
Genetics and myopia
Professor David Mackey, Professor of Ophthalmology / Director, Centre for
Ophthalmology and Visual Science, University of Western Australia
Prof. Mackey reviewed the latest literature on the
genetic and environmental factors associated
with myopia. These included:
•
Epidemic of myopia in Asia.
•
The heritability of myopia.
•
Syndromic myopia.
•
Genome wide association studies for myopia
and its component measures.
•
Outdoor activity and its influence on the
development of myopia.
Acute inflammatory eye disease
Associate Professor Anthony Hall, Director of Ophthalmology, Alfred Hospital
Melbourne
This presentation gave guidelines on how to
assess, diagnose and manage acute ocular
surface inflammation and properly assess intraocular inflammation. Referral guidelines were
given for each condition, which included:
• Seasonal allergic conjunctivitis, viral
conjunctivitis and bacterial conjuctivitis.
• Keratitis – marginal keratitis, sterile contact
lens related keratitis.
• Episcleritis.
• Acute anterior uvietis.
All conditions required a detailed organised
history followed by a detailed examination for
differential diagnosis.
• When examining for potential anterior
uveitis:
−− Always dilate.
−− Turn the lights down and the slit lamp
magnification up.
−− Can not diagnose without also
examining the posterior eye.
Evolving the eyecare model to meet changing needs
Paul Carroll, Specsavers Director of Professional Services (UK/ROI)
Paul outlined the evolution of optometry in
the UK over the past 25 years, which has seen
significant development of local co-management
initiatives between optometry, ophthalmology
and other stakeholders such as GPs. Key points
were:
• Demand for eye examinations set to
increase by 20% over next 25 years.
• Increase in number of glaucoma cases by
approximately 1/3.
•
•
•
•
50% of loss of sight in the UK preventable.
Demand for ophthalmology services is
increasing faster then ophthalmologists can
be trained.
Co-management systems in Scotland and
Wales have reduced need for referrals,
thereby reducing load on ophthalmology.
Co-operation between ophthalmology and
optometry through co-management to be
developed further to meet the increased
demand.
RX FACTOR PROFILE July 2013 11
Optometry case study
Transient visual loss
by Giles Capmbell, optometrist, Specsavers North Lakes, Australia
History
•
A 56 year old male presented c/o blurring in the inferior nasal
quadrant of the left eye for 3 days which then resolved but
returned again after 1 week.
•
GH – hypertensive
•
POH – none
•
FOH – none
•
Carotid artery ultrasound
•
Fasting blood sugar
•
Cholesterol
Discussion
A Hollenhorst plaque is a cholesterol embolus seen in a retinal artery.
Signs and symptoms
•
Bright yellow/ white plaque often seen at a retinal arteriole
bifurcation.
•
These plaques tend to break up and move and may not be seen at
subsequent visits.
•
Patients may be asymptomatic or experience transient episodes of
partial or complete monocular visual loss (amaurosis fugax).
Aetiology
•
The embolus is composed of cholesterol often from an ulcerated
ipsilateral carotid artery plaque.
•
Associated with hypertension and hypercholesterolaemia.
•
If blood flow is sufficiently impaired retinal ischemia can result in
the tissue distal to the blockage.
Examination
Management by optometrist/
ophthalmologist
•
Best corrected visual acuity RE 6/6
LE 6/7.5
•
The emboli themselves require no treatment as blood can often
flow through an apparently complete blockage.
•
Amsler – blurring inferior nasal corner left eye
•
Retinal embolus indicates significant systemic vascular disease.
•
IOPs R 13mm Hg, L 12mm Hg
•
Refer to GP for further investigation / possible onward referral.
•
See left eye digital retinal photo
Provisional diagnosis
•
Hollenhorst plaque lodged at bifurcation of superior temporal
artery.
Referred to ophthalmologist for
further investigation
•
Confirmed diagnosis and requested following tests:
12 RX FACTOR PROFILE July 2013
Investigations / treatment
•
Carotid ultrasound
•
Fasting glucose and lipids
•
Blood chemistry with cardiac enzymes
•
Treat underlying vascular disease
•
Treat carotid stenosis if required (carotid angioplasty)
•
Aspirin therapy
DRP - Image of the month
Optic nerve head drusen
by Sophie Simmmonds, optometrist, Specsavers Teignmouth, UK
Diagnosis: Optic nerve head drusen
Aetiology: Calcified concretions at the level
Differential diagnosis: Papilloedema,
of the lamina cribrosa believed to result from
an accumulation of axoplasmic derivatives.
glial tissue on the optic nerve head,
myelinated nerve fibres, high hypermetropia.
Prevalence: Approximately 0.5-1% of the
Signs: Bilaterally (in approximately 70%
of cases) elevated optic discs with irregular
margins and retractile hyaline deposits
visible on the disc and surrounding area. The
drusen are often not visible in children only
becoming detectable with ophthalmoscopy by
the mid teens. For this reason, in childhood,
the appearance can be confused with early
papilloedema.
Symptoms: Often patients are
asymptomatic and remain so throughout the
progression of the condition. Occasionally a
mild reduction in best corrected visual acuity
is found.
general population, primarily Caucasians.
Significance: Optic nerve head drusen
can compress both the nerve fibres and
blood supply in the lamina cribrosa resulting
in visual field loss. The most common visual
field defects are nasal steps, enlarged blind
spots, arcuate scotomas, sectoral field loss
and altitudinal defects. They also increase
the likelihood of choroidal neovascular
membranes forming close to the optic nerve.
Management: Refer to ophthalmology
for confirmation of diagnosis (often with
ultrasonography) and ongoing monitoring
every 6-12 months. Patients should be advised
to self monitor their vision periodically
because of the risk of choroidal neovascular
membrane formation.
Dispensing case study
The importance of ‘wearing in’ progressives
by Steve O’Leary, Director of Product for Australia & New Zealand
Female
Cx: Bernadette Murphy
Age: 48 years old
Occupation: Receptionist at a veterinary practice
RX: RE: +0.75/- 0.50 x 70
LE: +0.25/ -0.25 x115
Add +1.75 DS
Bernadette has previously worn single vision reading glasses but
has recently decided to give progressives a go as she needs to keep
taking her glasses off to speak to customers at the counter, which she
finds quite annoying.
She was dispensed a pair of Independence Pro HD (B corridor) in a
30mm deep frame. She was hesitant about them at collection, but
decided to give them a try.
Ten days after collecting them she returned to the store, complaining
about not being able to use them as she was not getting clear vision
when looking at the computer screen or processing credit card
payments. The distance vision seemed fine.
Steve says:
I would start by marking up the lenses with Bernadette’s PD and
the ordered heights and confirm that the placement is in line with
Bernadette’s line of sight.
Checking confirms that this is the case.
Where to now?
The next check should be to see how
Bernadette is using her glasses – we may
have made incorrect assumptions about
the placement of her computer screen.
It turns out that she has her screen standing low on the desk, placing
the top of the screen in line with her collar bone, much lower than
one would expect.
It is important to demonstrate and explain to Bernadette the layout
and requirements for her (or in fact any) progressive lenses. This can
be achieved by asking her to fix her gaze at a point on the screen and
observe the changes that occur as she moves her head up and down.
When checking the position of the credit card machine standing on
her desk, it turns out that it is to the left of her computer. She is only
turning her eyes towards it, not her head, which results in her looking
through the lens periphery, the soft focus area of the lens.
It needs to be re-iterated that the lens is a great all rounder, but has
a number of different focal points, the correct one needing to be
used for different tasks. It’s a bit like new shoes that need to be worn
in, before they become ‘comfortable slippers’. Like those shoes, it is
important to put the new glasses on in the morning and leave them
on all day, even if it is a bit uncomfortable to start off with!
It is always important to mention this during the dispensing process
as it is much easier to convince customers of this sometimes
necessary process if they have been given this info before they
encounter those challenges.
RX FACTOR PROFILE July 2013 13
Pathway
Ready to take
the next step
What is Pathway?
Pathway is a free, intensive 24-week
course which identifies and prepares
experienced Specsavers practitioners
and managers to become the JVPs
of tomorrow. This ground-breaking
programme represents a massive
investment in current employees
who live our values and culture, to
provide them with the knowledge and
development they need to take up the
reins, and play a lead role in the future
of the business.
Pathway – our new recruitment process for
aspiring JVPs – has proved a huge success in the
UK and Australia/New Zealand, with the first intake
of candidates now primed for partnership. As the scheme
prepares to go global, we talk to some ‘Pathwardians’ to find
out what they and their stores have got out of it.
The course has been so successful in
the UK that it was launched in Australia
and New Zealand late last year and
there are further plans for it to be rolled
out in the Nordics and the Netherlands
this year.
What’s involved?
Pathway takes six months and consists
of an Intake day followed by three
two-day modules (Culture & Brand,
Finance & Business Awareness, and
Leadership). Students also work on
a specific project, and attend a final
assessment centre, where they are
gauged on their suitability to become
JVPs.
How do I find out more?
For more information, visit:
specsaverspathway.co.uk
UK contact:
[email protected]
ANZ contact:
[email protected]
Netherlands contact:
[email protected]
There is more than one intake a year.
After completing an application form,
would-be candidates undergo a
telephone interview and/or face-toface assessment before being formally
invited to participate in the next
Pathway group.
14 RX FACTOR PROFILE July 2013
‘Pathway has made me a better
employee’
Amanda Bazzacco, Specsavers Robina, Australia
‘Pathway has given me knowledge and
experience in areas that I wouldn’t be able
to access anywhere else. Networking with
people from different stores and learning
from experiences is fantastic. With Pathway, I
am building a strong foundation of knowledge
that is helping me gain the right tools for my
future (hopefully!) as a Specsavers JVP.
‘The best thing I have learnt so far is what it
takes to be a better leader and help a team
go towards success. I know what the tools
are, how I can access them and what support
I have within Specsavers. Pathway has made
me a better employee – I am a lot more aware
of what I can do and how to help people in
different areas.’
‘I will stay in touch with my fellow students.
We speak quite often and it’s great to see how
we are all going.’
‘Pathway has shown me I could
be a great JVP one day’
Karen Cluness, Specsavers Aberdeen, UK
opportunity to improve whenever I can. It was
Chris Howarth [UK Director of Professional
Recruitment] who talked me through the
potential that Pathway could provide. I was
sold.
How did you prepare for the course
– any tips?
The first induction day really set the scene and
gave me clear expectations that it was going
to be a fulfilling yet challenging course. I was
under no illusions that this was going to be an
easy ride! My advice would be, be prepared to
work hard and put the time in and you’ll come
out of it with exciting new and enhanced skills.
What were your first impressions
of the course?
What’s your background?
I worked for Vision Express for 17 years and
had started to become frustrated by the low
priority that was placed on the values of the
people by the company. I joined Specsavers in
September last year as business development
manager at the Aberdeen store, and with
the longer term option of becoming a joint
venture partner.
Why did you apply for the Pathway
course?
It’s really important to me that, after a long
time in the industry, I continue to broaden my
knowledge, be better organised and learn how
to improve profits and have a better business.
The economic climate in retail is also a stark
reminder that I need to keep ahead of the
game, maintain core skills and take the
This is, without a doubt,
the best development
course I’ve ever
undertaken. It’s miles
above any other in the
way it’s structured and
organised.
My loyalty to my store is
heightened and I know
I can help develop the
business, the practice
and the team, so we’ll all
benefit from Pathway.
I will pursue a JVP
opportunity in the future,
but in the short term I’ll
be putting into practice
everything that I’ve learnt
and be making the most
of the network of support
going forward.
What has the course given you?
This is, without a doubt, the best development
course I’ve ever undertaken. It’s miles above
any other in the way it’s structured and
organised. Pathway is a fantastic development
tool and the whole course was far better
than I expected. The quality of the course
content, the contributors and the sessions are
outstanding. I realised immediately this was
going to be challenging, absorbing and very
intense.
I met some amazing people and had fantastic
support. The speakers were charismatic and
inspiring and the support network is vast. My
business acumen has improved and I have
a far better understanding of the financial
aspects. I have learnt so much more and
enhanced the skills I already had – I know I
can add a great deal of value to Specsavers
in a variety of ways. It’s made me realise
how important culture and values are for a
successful business and has proven to me that
I could be a great JVP in the future.
What was the time commitment
required to succeed?
What was the final assessment
like?
If you really want to get the most out of the
course and succeed, you need to put in 100%
in throughout the whole six months. As well
as the series of two-day events, you also
complete a project – all on top of your day job.
So, there is a lot of personal time you need to
put in, especially to complete the project. You
need to organise yourself and your day job,
take advantage of the great resources, such
as the reading list, and really make a start on
your project right at the beginning. The time
really does fly, so get a head start early on.
This part is a real test of your strengths.
It’s not just about what you’ve learnt along
the way, but also tests the way you conduct
yourself in a team and during the group
exercise. It was fun and intense at the same
time. You’re being assessed throughout the
whole course so you need to stay switched on
and keep with the pace. If you like a challenge,
this is for you!
What would be your advice to
others considering Pathway?
You need to understand your commitment to
this development programme. You need to
really want it and be prepared to put passion,
time and energy into it. That way you’ll get
the most out of it.
Now that you’ve qualified, what
does the future hold?
My loyalty to my store is heightened and I
know I can help develop the business, the
practice and the team, so we’ll all benefit from
Pathway. I will pursue a JVP opportunity in
the future, but in the short term I’ll be putting
into practice everything that I’ve learnt and
be making the most of the network of support
going forward.
RX FACTOR PROFILE July 2013 15
Talking shop
Swap shop
Doing a store visit – or hosting one – is a great opportunity to take
stock, says Simon Dunn.
I started my career in optics as a trainee dispensing optician with
Dollond & Aitchison. In those days, like most 19-year-olds, after being
in the job for a year or so, I thought I knew it all. D&A was a very big
company and had been around for a long time. My view of the optics
world was very clearly defined and I knew exactly what customers
wanted and how opticians sold spectacles and contact lenses – easy!
That is, at least I thought I did until I left and started work for
American Optical as a lens consultant. My job was to travel the length
and breadth of the country talking to multiples and independents,
persuading them to use our spectacle lenses and surfacing laboratory.
The first thing I quickly learnt was how differently other opticians
viewed the world. Where I had previously believed there was only ‘one
true way’ to run an optical business, within weeks I began to realise
that there were actually hundreds. Everyone had a different idea on
what best practice should look like. And the great thing for me was that
it forced me to change my previously very narrow view of the optics
world.
Fast forward a few years and I find myself as a joint venture partner
with Specsavers. In the initial start-up and first couple of years there
was an in-built need to seek guidance from Specsavers’ support teams
and other more experienced directors. After a while, I found I had
become comfortable with the business and, without realising it, had
once again found my ‘one true way’. This time I had even drawn it
myself, but the limitations and damage to my business were the same
– stagnation of ideas. As committed and passionate as I was about
my store, there was no substitute for visiting other great Specsavers
stores.
As a global super-brand it seems crazy not to tap into
the wealth of experience that so many fellow JVPs
have.
We have all heard the classic “I
learned more in the bar the night
before than at the meeting”
comment. Being able
to visit those
people
As a global super-brand it seems crazy not
to tap into the wealth of experience that so
many fellow JVPs have.
from the bar in their store is often an amazing experience as you see a
version of their ‘one true way’ that you haven’t even thought of.
Many successful businesses have mentor programmes. It is pretty easy
to create something similar ourselves, though. Visiting other stores and
having them visit yours creates enormous opportunity to learn. But in
my experience, to get the best results it has to be a ‘warts and all’ open
visit.
Probably the two most common reasons we don’t do this as often as we
should are:
1.
Time – Too busy. Keep meaning to. Never quite happens.
If it’s important, you find a way – if it’s not, you find an excuse.
2.
Fear – Very few people like to be told they are wrong. It can be,
well, challenging. The point is, it isn’t about being right or wrong,
just different. There simply isn’t ‘one true way’.
In 13 years, I have only ever been refused a store visit once and find
that my peers are only too pleased to share their experience with me.
I have played host to hundreds of visits from other JVPs. Often they
take ideas away with them but they also always leave ideas for me to
develop too. A real win-win.
In such a difficult economic climate, are we getting the best value from
one of the most valuable, under-utilised resources Specsavers has – us!?
Simon Dunn is DO director at Specsavers Nottingham, UK.
16 RX FACTOR PROFILE July 2013
Management matters
Survival of the fittest
by Emma Davis, Head of Retail Leadership & Management Training
It doesn’t seem like nearly a year since
London hosted the Olympic Games, with its
motto of ‘Inspire a generation’.
From the Games emerged many stories
of triumph and excellence that have the
capacity to inspire us all, not just in a sporting
context. In the UK, for example, we recently
heard from former Paralympic swimming
gold-medallist Mark Woods who spoke at the
Specsavers Partners and Managers seminars –
delivering a clear message about the need for
leaders to ensure the whole team is striving
for the same result.
Looking back at last year’s Olympics, one
story stands out for me as a shining example
of how what was once great performance can,
over time, move into mediocrity.
Two Slovakian brothers, Pavol and Peter
Hochschorner, were the team to beat in their
chosen sport, C-2 slalom canoeing. These guys
won gold in 2000, 2004 and 2008. They were
competing in the 2012 Olympics as the triple
gold medal winners, world champions and,
arguably, the best in their class.
In 2008 their winning time of 190 seconds was
17 seconds quicker than their winning time in
2004, and 47 seconds faster than their gold
medal winning time in 2000.
Looking at their previous results and form, the
gold was theirs…. So, on 2 August 2012 the
Hochschorners raced down the waters in a
time of 108 seconds – an amazing 82 seconds
quicker than their gold medal-winning time
of 2008.
Yet 108 seconds did not get them gold, it
didn’t even get them silver. A time 82 seconds
quicker than 2008 only warranted a bronze
for Pavol and Peter. You see, even though the
Hochschorner brothers had been training and
improving, so had everyone else.
Two teams from the same country – Great
Britain – romped home with gold and silver,
with times just two seconds quicker than the
brothers. To rub salt into their wounds, Great
Britain hadn’t even got onto the podium since
the sport was introduced in 1972. Clearly
some serious work had been going on in the
‘Team GB’ camp in the four years prior to the
Games.
It’s both an inspirational and cautionary tale.
If you are the best you can be, and never give
up, the prize can eventually be yours… even
after years of striving. But also, being number
one isn’t a time to become complacent. Like
Pavol and Peter, you can be beaten by the
unexpected.
At Specsavers, we’re already number one
in many of our markets, and striving for top
position in those that we aren’t – i.e. the gold
When the smallest of margins can mean the difference
between winning and losing, how do we keep improving on our
past performance?
standard professionals on the high street.
We know who our rivals are, we know they
are striving to achieve record weeks and
sight test volumes like ours, and provide
world-class health care to all. So, when the
smallest of margins can mean the difference
between winning and losing, how do we keep
improving on our past performances?
By inspiring our teams to want to be the best
they can be, to keep raising the bar so our
performance never becomes mediocre. And to
always be watching over our shoulder.
Want to know more about the
management development available to
you in Specsavers? Why not check out
Connect Learning for the workshops
running in your region.
RX FACTOR PROFILE July 2013 17
Contact lenses
Making your
contact lens
conversations
memorable
As part of this year’s ‘GRO your contact
lens business’ initiative, Reah Hughes
from the UK Product Team takes a look
at some practical ways practitioners can
influence contact lens growth.
Discussing contact lenses at handover stage means that patients are more likely to remember
your recommendation.
Talking contact lenses
MAZE figures for April 2013 showed that, while nearly 82% of our
customers received a handover from the test room, only about a
third remember discussing contact lenses. Despite most patients
being suitable for contact lens wear, the option isn’t being routinely
offered. Are there any tools to contribute to a memorable contact lens
conversation?
Recommendation during handover has a powerful impact. As a
trusted practitioner you can discuss contact lenses in relation to the
patient’s optical needs and personal requirements. Including the Purple
Ticket (an invitation for customers to take advantage of a contact
lens free trial) at the handover stage is a tangible reminder of that
recommendation.
More than 90% of customers are suitable for contact lens wear, even
if it’s on an occasional basis, and all patients expect to have all options
offered to them. Routine discussion of contact lenses during handover
will lead to increased interest. Highlighting the benefits of contact
lenses – especially when linked to the customer’s needs and interests –
builds on the customer relationship and encourages loyalty.
So how can you effectively personalise the recommendation?
Needs and preferences
There are many opportunities to link contact lens wear to specific
needs and interests. Listen out for activities and interests your patients
have which could be made easier with the use of contact lenses.
Activities/hobbies – Sport is an obvious one, but there are plenty of
other types of activity, e.g. walking (especially in the rain!), decorating
or simply going on holiday.
More than 90% of customers are suitable for
contact lens wear, even if it’s on an occasional
basis, and all patients expect to have all
options offered to them.
18 RX FACTOR PROFILE July 2013
Technology – Clear vision at both near and far is increasingly
important with the growth in use of tablet devices such as iPads,
especially while watching TV. Talking to your early presbyopic patients
about the advantages of multifocals expands their options and plants
the seed for future fits.
Cosmesis – There are clear cosmetic benefit, especially for high
prescriptions. Patients don’t have to be either spectacle or contact
lenses wearer. Why not offer contact lenses as an additional product to
glasses for a change of look?
Maximising trials
The free trial continues to be an important tool in encouraging interest
in contact lenses. However, research shows that over 50% of customers
either fail to complete the trial or stop wearing lenses within a couple
of weeks of completion.
There are three key reasons for dropping out:
• Service
• Comfort
• Handling
A follow-up phone call during the trial will build on the relationship
developed in the test room and will help tackle issues before they
become a reason to cease wear. Outlines for these calls are included
in the GRO pack received by stores. Should the customer have clinical
concerns – perhaps with vision, comfort or an ocular issue – the staff
member making the call has been directed to inform a qualified
member of staff. This more informal contact with the patient at an early
stage is an ideal opportunity to develop customer loyalty, leaving a
lasting impression and instilling confidence in the practice as a whole.
Sharing ideas
For more information and ideas, ask the contact lens champion in your
store for access to the ‘GRO your contact lens business’ folder in your
store. There are also extra resources in the ‘GET more contact lens
customers’ section of Connect, see Products > Contact lenses > GRO >
GET.
Hearcare news
Catching the
ear of GPs and
commissioners
AQP services on show at high profile
commissioning event
Colin Campbell, Prof. Kevin Munro and Dr Sarah Jarvis at the Specsavers
plenary session.
Anyone wishing to be considered as a
provider of NHS services was at the Excel
Conference Centre in London last month for
The Commissioning Show 2013 – the largest
national event for clinical commissioning,
attended by the majority of GPs and
commissioning groups with an interest in Any
Qualified Provider.
As such, Specsavers Hearcare had a
substantial presence in the form of an
exhibition stand in the main hall, where
delegates could learn about the success of
Specsavers’ audiology services and look at
the patient satisfaction scores in their own
areas, whilst GPs were able to undertake an
interactive audiology quiz on a Specsavers
giant iPad.
Specsavers also hosted a plenary session
entitled ‘AQP and adult hearing loss - warts
and all’ for attendees to feedback on our
current AQP service or to find out more about
the service for future access. The Q&A session
was framed by three presentations delivered
from three perspectives on the first phase of
AQP for adult hearing loss.
Prof. Kevin Munro (Ewing Professor of
Audiology) made the economic argument in
favour of addressing unmet hearing needs;
GP and media medic Dr Sarah Jarvis gave
the GP view of commissioning services from
Specsavers, while Director of Professional
Services Colin Campbell offered thoughts on
Specsavers’ own experience of Phase 1 AQP.
The consistent view from all present was
that, whilst the changes to the NHS resulting
from the Health and Social Care Bill – and,
in particular, the changes introduced by the
AQP initiative – have been both complex
and controversial, the initiative works well
in relation to adult hearing loss and makes
sense to both GPs and patients. Opening up
the service is helping to increase customer
knowledge, reduce stigma and improve
outcomes. So, in this respect, AQP for adult
hearing is in many ways transcending the
controversy and is being seen as a victory for
the current government adjustments to NHS
provision.
Said Colin: ‘It was a tremendous two days
for Specsavers Hearcare, and extremely
worthwhile in terms of cementing our
credentials as the provider of choice for NHS
hearing aids. The plenary session was a real
highlight and created useful dialogue and
debate which will enable us to inject even
more innovation into our customer and
GP-facing service.’
RX FACTOR PROFILE July 2013 19
Hearcare CPD
Pathology crossword
Co
as p mplete
art o
f yo
ur
C
PD
for t
his
mon
th
Once you have
completed the
crossword, take a
copy and keep it in
your CPD portfolio,
along with a
completed CPD record
– these can be found
on Connect Learning.
Answers will be
published in next
month’s ProFile.
Across
3
Property of pinna
5
Abnormally sensitive hearing
7
Pain in the ear
12
Chalky patches of scarring on the ear drum
13
Bony growths
15
Inflammation of the skin lining of the outer ear
16
Having rapid onset
17Pinna
19
One of the nerves supplying the outer ear
21
Means double hearing
24
An auto immune cause of hearing loss
26
The practice to reduce or eliminate contaminants
28
Surgical repair of the tympanic membrane and ossicular chain
29
A loss that arises before the acquisition of language skills
30
A very contagious viral infection that involves the parotid and
salivary glands - may lead to permanent hearing loss
31
Discharge, infected pus
32
A hormonal cause of hearing loss
20 RX FACTOR PROFILE July 2013
Down
1
2
4
6
8
9
10 11 14 18 20 22 23 24 25 27 The end result of long-standing pressure or infection problems
in the middle ear. This forms when the ear drum is sucked
inwards to form a pocket in which skin cells collect
The degeneration in hearing we experience as we get older
Where the sufferer’s subjective sensation of loudness increases
with increasing input stimuli at a more rapid rate than normal
Metabolic disorder that may manifest itself in enlarged hands
and feet
Benign tumour of the eighth nerve
Remodelling and overgrowth of bone in inner or middle ear
A type of non-organic hearing loss
Rapid eye movements
This produces episodes of fluctuating low frequency
sensorineural hearing loss accompanied by a feeling of fullness
in the ear, vertigo, tinnitus and nystagmus
Fungal infection of the outer ear
In both ears
Condition causing an excessive white cell count in the blood
– this can affect the cochlea through the stria vascularis,
producing a bilateral sensorineural hearing loss
Disturbance of balance
Condition described by Thomas Willis in the 17th Century
Arising from medical treatment
Increased fluid pressure in the inner ear
BSHAA Congress 2013
Separating the gen
from the noise
Nick Taylor looks at some of the latest
findings on digital noise reduction and
frequency compression, from
world-renowned expert and BSHAA
Congress speaker Dr Todd A. Ricketts.
Dr Ricketts’ BSHAA Congress presentation – Hearing aid features across
manufacturers: what really works and clinical implications – discussed
current hearing aid technologies such as digital noise reduction, digital
feedback suppression, wireless signal routing, high frequency extension
and frequency lowering, from the perspective of their effectiveness in
the laboratory and what we know about their impact on user benefit
and satisfaction. This included recent data examining how the open
fitting interacts with the prescriptive method, and patient-specific
factors affecting preference for open versus traditional custom styles,
along with implications for selection, adjustment and counselling
related to specific features.
Here are his thoughts and findings on two of those features:
1. Digital noise reduction
Dr Todd Ricketts
2. Frequency compression
Frequency compression works by the application of a linear frequency
transposition with cut-off frequency/compression ratio relationships
usually set by manufacturer. For the typical target of patients who have
a high frequency loss to the extent that audibility through traditional
amplification would be difficult, the potential benefits of this type of
‘frequency lowering’ are:
•
Improved speech recognition for certain high-frequency speech
sounds.
The two most common forms of digital noise reduction are:
−−
Due to limited audibility in the traditional frequency range.
•
−−
Due to limited audibility in the “extended” frequency range.
•
Gain lowering: Reduce gain in a given channel if the primary
signal (in that channel) is estimated to be noise (often based on
amplitude modulation and other factors).
Fast filtering (Spectral subtraction, Wiener filter, etc): An
attempt is made to reduce/cancel/subtract noise that occurs in the
frequency gaps between speech information and/or the temporal
gaps between words and syllables
•
Improved awareness of environmental sounds.
•
Potential to reduce feedback - if fitted open, feedback may be an
issue limiting gain in the traditional high frequency region (2 - 4.5
kHz).
Important: The processing does nothing when speech is present in
a channel (even if noise is also present). No effect on SNR within any
channel at that instant.
What we know from many years of DNR hearing aid research (primarily
from lab tests) is:
•
Numerous lab studies have all found the same thing: No
advantage for DNR for speech understanding in background noise.
•
There are data showing significant improvement for ease of
listening and preferred signal quality.
•
So the evidence for the effectiveness of DNR is:
•
•
Real and clear positives!
−−
Most customers expected to improve listening comfort.
−−
Some systems will improve sound quality for speech in noise.
A few limitations
−−
Limited audibility in this region is expected to affect speech
recognition.
−−
If audibility is not limited in this region, frequency
compression is expected to have no benefit for high
frequency band limited signals and potential decrement.
For full band signals, receiver limitations may prevent audibility in
the extended (4.5 - 9 kHz) high frequency range.
−−
Limited audibility in this region may affect speech
recognition: particularly for /s/
−−
If audibility is not limited in this region frequency
compression is expected to have no benefit.
From the research available, Dr. Ricketts concluded that frequency
compression:
•
Provides better audibility for /s/.
•
Doesn’t seem to ‘help or hurt much’ for the average hearing aid
user.
Can improve feedback issues with open fittings.
−−
A significant improvement in speech recognition in noise is
generally not expected.
•
−−
DNR can reduce audibility for steady state signals (sometimes
this includes music).
Dr Ricketts is Associate Professor at Vanderbilt Medical Center,
Director of Graduate Studies in the Department of Hearing and
Speech Sciences, and Director of the Dan Maddox Hearing Aid
Research Laboratory.
In conclusion: Whilst there are certainly benefits, we hoped for a little
more!
RX FACTOR PROFILE July 2013 21
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Red eye part 2: Urgent
referrals by Chris Steele, BSc(Hons) FCOptom
DCLP DipOC DipTp(IP) FBCLA
Outline:
Red eye is the cardinal sign of ocular inflammation, many patients presenting to
their eye care practitioner in the first instance. There are myriad causes of red eye
ranging from the self limiting and innocuous to those which can threaten sight
and even life. Eye care practitioners must be able to differentially diagnose the
benign from the serious and manage appropriately. This article will remind the
eye care practitioner of urgent causes of red eye which can present to community
optometric practice ensuring that, when patients present with red eye disease, the
urgent cases can be identified and managed appropriately.
About the author:
Chris Steele graduated from City
University in 1988 and qualified in July
1989 after his pre-registration year
at The Royal East Sussex Hospital,
Hastings. He is Consultant Optometrist,
Head of Optometry at Sunderland
Eye Infirmary (SEI) in Sunderland.
Over the past 19 years he has developed a wide range
of extended roles involving hospital optometrists
undertaking cataract, anterior segment, diabetes,
glaucoma, paediatrics and medical retina case loads.
He has authored over 50 publications re: glaucoma,
diabetes, specialist medical contact lenses, refractive
surgery and clinical risk management and has
undertaken many presentations both nationally and
internationally on these topics.
Introduction
Gonococcal conjunctivitis
In the first part of this series conditions requiring emergency (same
day) referral were discussed. In this second part, a range of red eye
conditions requiring urgent referral (within 48 hours) are considered.
Gonoccal conjunctivitis is a rare disease characterised by an acute
purulent conjunctivitis with lid oedema, marked conjunctival
hyperaemia, chemosis with or without membrane formation and
prominent per-auricular adenothathy. Treatment involves systemic
and topical antibiotics.
Conjunctivitis
Most cases of conjunctivitis, from whatever cause are usually selflimiting, but there are a few exceptions where urgent referral may be
required.
Infective conjunctivitis
Infective (bacterial) conjunctivitis usually does not actually require
medical treatment as most cases spontaneously resolve in 10-14
days. However topical antibiotics are often prescribed to expedite
the resolution of bacterial conjunctivitis by as much as a few days. An
exception to this is where the infective conjunctivitis is caused by a
sexually transmitted infection (STI) e.g. chlamydial (sero-types D and
K), or gonococcal infection.
22 RX FACTOR PROFILE July 2013
Chlamydial conjunctivitis
In chlamydial infection which typically affects sexually active young
adults, eye lesions present about one week following sexual exposure
which is often associated with a non-specific urethritis or cervicitis.
There is a mucopurulent discharge and large opalescent follicles
seen in the fornices, or in more severe cases, across the entire tarsal
plate. Pre-auricular adenopathy is a common finding but fever and
pharyngitis are absent. A drooping lid may also be present.
Epithelial keratitis is the most frequent finding with associated
marginal infiltrates and a superior micropannus. Treatment involves
the use of topical tetracyclines antiobiotic ointment four times a day
for 6 weeks and systemic antibiotics including Azithromycin 1mg
single oral dose, Erythromycin 250mg four times a day for 6 weeks
or Doxycycline 100mg a day for 2 weeks. Liaison with the GenitoUrinary Clinic, to exclude other STDs and advise on treatment of
patient and partner(s), and on future avoidance is an essential part of
the management. Untreated chlamydial infections may lead to pelvic
inflammatory disease (PID) and infertility in women, and infertility
and joint inflammation in men.
Neonatal conjunctivitis
Babies under 4 weeks with neonatal conjunctivitis should be referred
to secondary care urgently. Neonatal conjunctivitis may be caused
by infection or be a toxic response to topical eye treatments. The
most important causes are: gonorrhoea (which can result in a serious
localized infection) and chlamydia (which can be associated with the
development of pneumonia).
Vernal keratoconjunctivitis
There are five main types of ocular allergy: seasonal allergic
conjunctivitis, perennial allergic conjunctivitis, vernal
keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), and giant
papillary conjunctivitis (GPC).
VKC and AKC are chronic, bilateral, and severe forms of allergic
ocular surface inflammation affecting mainly children (typically boys
up to 14 years of age) with exacerbation often during spring time
but it can occur at any time of year (figure 1). These two relatively
uncommon types of allergic eye disease can cause severe damage
to the ocular surface, leading to corneal scarring and vision loss
if not treated properly and promptly, thus making urgent referral
appropriate in acute exacerbations of the condition.
Symptoms typically include intense ocular itching, lacrimation,
stringy mucus discharge causing blurred vision, photophobia and
difficulty opening eyes on waking. The severity of symptoms is often
asymmetrical. The initial conjunctival reaction consists of hyperaemia
and chemosis, followed by diffuse papillary hypertrophy (> 1mm
in diameter) most marked on the superior tarsus. The papillae
then become even larger developing a “flat-topped” cobblestone
appearance. The limbal area becomes hyperaemic, odematous
and irregularly thickened giving rise to mucoid nodules containing
eosinophils and degenerative epithelial cells, known as Trantas’ spots.
Corneal changes usually involve the upper third with the development
of a punctate epithelial keratopathy. These may lead to macroerosions (coalescent epithelial loss) and ultimately plaques deposited
on Bowman’s layer that prevent re-epithelialisation. Sub-epithelial
scarring may also result which is often ring-shaped.
In milder cases (without active limbal or corneal involvement)
mast cell stabilisers e.g. gutt. Sodium Cromoglicate 2%, gutt.
Lodoxamide 0.1%, gutt. Nedocromil Sodium 2% may be prescribed.
If there is active limbal or corneal involvement urgent referral to an
ophthalmologist is required. Acute exacerbations usually require use
of topical steroid e.g. gutt. Predsol 0.5%, plus regular monitoring:
hence the need to refer to an ophthalmologist.
Adenoviral conjunctivitis
Adenoviral conjunctivitis is the most common cause for a red eye[1].
Viral conjunctivitis is often associated with a recent infection of
the upper respiratory tract, a common cold, and/or a sore throat.
Symptoms include watery discharge and variable itchiness. Viral
conjunctivitis usually starts in one eye that later becomes bilateral.
For many cases general alleviation/ palliative treatment is within the
scope of all practising optometrists. The initial principal treatment
usually involves ocular lubricants. It is important to consider the use
of preservative free ocular lubricants where patients are expected to
be on long term treatment. This is to avoid development of sensitivity
reactions to active ingredients or the preservatives used. Where
pseudo-membrane or keratitis is involved in more severe cases, then
urgent referral is required[2].
The spectrum of disease encountered varies from mild to severe
which is dependent on the serotype involved[5]:
•
Serotypes 1-11 and 19 primarily cause a follicular conjunctivitis;
•
Serotypes 3, 4, 5 and 7 cause a pharyngoconjunctival fever;
serotypes
•
Serotypes 3, 4, 8, 11, 19 and 37 typically cause acute
conjunctivitis
•
Serotypes 8, 9, and 37 typically cause epidemic
keratoconjunctvitis
•
Enterovirus 70 causes acute haemorrhagic conjunctivitis (very
rare)
The variety of serotypes and their varying initial polymorphic
presentations are often those of a non-specific “pink eye”. This
disease will spread quickly where the following pre-disposing factors
arise[3]:
•
Recent cold or other upper respiratory tract infection
•
Low standards of hygiene
•
Crowded conditions e.g. schools, clinics, camps, military
barracks
•
Eye clinics (transmission by virus on clinicians’ fingertips, slit
lamp biomicroscopes, tonometer prism heads etc.)
Adenovirus infections consist of a biphasic process during which
an infection cycle is followed by an inflammatory phase. The
inflammatory phase tends to begin 7-10 days post infection. In the
late phase clinical diagnosis may become more reliable but, even if
an accurate diagnosis is made it is often too late. Virus can be shed
and patients may be contagious for at least 2-3 weeks as the virus
is so resilient and easily transmitted. This is mainly by hand to eye
contact, respiratory droplets and commonly through contact with
ophthalmic equipment.
Figure 1
Where a patient has been diagnosed with the condition the consulting
room concerned should not be used for any other patient until all
surfaces and instruments have been washed down with Milton, then
thoroughly rinsed with detergent. One study showed that nearly 50%
of infected persons had positive cultures grown from swabs of their
hands[4].
RX FACTOR PROFILE July 2013 23
CET / CPD
To minimise the spread of infection, clinicians’ hands should be
rubbed with alcohol hand gel between every patient and ideally
washed with soap and water, adhering to all local infection control
guidelines. Alcohol gel however is not effective against adenovirus.
Although Gutt. Chloramphenicol 0.5% four times daily for 7 days is
sometimes recommended, the use of antibiotics in viral conjunctivitis
is usually unnecessary and is not supported by the evidence base[5].
Use of antibiotics may sometimes cause allergy or other adverse
reactions that can complicate the clinical picture. The rationale for
clinicians to consider prescribing antibiotics is where it is believed
there is a risk of concomitant bacterial infection.
Severe adenoviral infection with corneal involvement is characterised
by focal white sub-epithelial opacities which develop beneath
epithelial lesions (figures 2&3). These are thought to represent an
immune response to the adenovirus, which sometimes can give rise
to a transient mild anterior uveitis.
Topical corticosteroids e.g. Gutt. Predsol 0.5% four times daily or
Gutt. Fluorometholone (FML) four times daily will help reduce pain,
photophobia and reduced vision owing to potential corneal scarring.
However their use may also reduce the body’s ability to eliminate the
virus, prolonging viral shedding. Some reports suggest that disabling
sub-epithelial infiltrates are increased when steroids are used[6].
Therefore timely use of topical steroid has to be carefully considered
but justified in cases where there is significant potential risk of
scarring and vision loss which may be permanent.
Unless there is a definitive diagnosis caution should be exercised
with the initial use of steroids during the acute stage. This is because
acute herpes simplex virus (HSV) infection (3-5% of cases) without
associated skin lesions or corneal involvement (dendritic ulcers) can
present clinically indistinguishably from adenoviral conjunctivitis.
Inadvertent corticosteroid use in presumed adenoviral conjunctivitis
which is actually HSV (or even acanthamoeba infection) may lead to
keratitis, severe corneal damage and grounds for medico-legal action
in some cases.
Herpes simplex keratitis
Herpes simplex virus (HSV) eye disease is an important cause of
ocular morbidity and a very common cause of corneal opacification
and visual loss worldwide. Approximately 90% of the UK population
is seropositive for this double stranded DNA virus. HSV eye disease
can have a highly variable and unpredictable course. HSV eye has
a predilection for mucous membranes innervated by the trigeminal
Vth cranial nerve and this disease may manifest as blepharitis,
conjunctivitis, epithelial keratitis (dendritic or geographic), stromal
keratitis (necrotizing or non-necrotising), endothelitis and or iridocyclititis.
History of previous attacks of herpes simplex infection is a key
diagnostic feature. Inflammation with attendant structural damage
and scarring is responsible for most of the visual impairment
encountered with HSV eye disease. Topical and systemic antiviral
agents e.g. Aciclovir are the mainstay of treatment. Corticosteroids
are powerful anti-inflammatory agents which must be used cautiously
and appropriately with this condition.
HSV is categorised into two main types: HSV-2 generally infects the
genitalia i.e. ‘below the waist’ and is sexually acquired. The much
more common HSV-1 generally infects ‘above the waist’ and has
a predilection for the orofacial area (i.e. lips, face, eyes). Primary
infection usually occurs in childhood, following which the virus lies
dormant in the trigeminal ganglion. Although initial attack is subclinical and is often unnoticed by the individual, recurrence can lead
to destructive sequelae. Reactivation of the virus is often triggered in
HSV seropositive individuals if their general health is poor, stressed
or fatigued and particularly if there is immunodeficiency. Systemic
or topical steroids, or other immunosuppressive drugs may also be
possible aggravating factors[7].
Once reactivated the virus travels along branches of the trigeminal
nerve to cause local infection e.g. cold sores or herpes keratitis.
Potential reactivating stimuli include: sunlight (UV), fever, extreme
heat or cold, infection (systemic or ocular) and trauma (ocular).
Figure 2
HSV not only affects the anterior segment, but can also affect
(rarely) the posterior segment causing retinal necrosis. It is therefore
recommended that consideration is given to performing a dilated
pupil, vitreous (checking for haze) and fundus examination is
performed on all patients exhibiting signs of HSV eye disease. HSV
eye disease can be divided into four main categories:
•
Epithelial
•
Stromal
•
Disciform keratitis
•
Metaherpetic ulcer (trophic keratitis)
Herpes simplex epithelial keratitis
Figure 3
24 RX FACTOR PROFILE July 2013
Typically, patients with HSV keratitis present with blurry vision,
extreme photophobia, pain, redness, and epiphora. If on clinical
recurrences 4% v 9% respectively. One of the consequences of this
important study is that now patients with more than one attack of
HSVK in a year are commonly managed with long term oral Aciclovir.
After resolution of dendritic epithelial keratitis, non-suppurative
sub-epithelial infiltration and scarring can occur just beneath the
area of previous epithelial ulceration, resulting in a “ghost” image of
the previous dendrite within the anterior stroma. The lesion usually
resolves without additional therapy, but may leave a permanent
imprint of prior epithelial keratitis.
Figure 4
Where herpes simplex epithelial keratitis only is involved this
condition is well within the scope of practice of a community
based independent prescriber[11]. However for community based
optometrists urgent referral is recommended if the condition is
“acute, or if recurrent but severe or with stromal involvement”
(figure 5) [11]. In cases where the epithelium is not healed after seven
days referral to an ophthalmologist is also recommended in the
College of Optometrists Clinical Management Guideline.
examination only the epithelium is involved, this is characterised
by arborising fluorescein staining dendritic ulcers. Terminal end
bulbs distinguish from other possible causes of dendritiform lesions
e.g. varicellar zoster, healing corneal abrasions and acanthamoeba
infection. As with many corneal conditions corneal sensitivity may
also be reduced (figure 4).
Herpetic epithelial keratitis may occur unilaterally or bilaterally
(most often in patients with atopic disease) and accompanied by a
blepharoconjunctivitis, involving lesions of the lid and a follicular
response of the conjunctiva. In addition, a palpable pre-auricular
lymph node may be present.
Medical management is relatively straight forward with HSV epithelial
disease. Topical Aciclovir 3% instilled five times daily for two weeks
is usually sufficient to resolve the dendritic ulcer(s) in most cases.
Oral Aciclovir is not indicated if the patient is prescribed topical
Aciclovir 3%. In cases where patients are unable to instill eye drops
or where corneal epithelial toxicity develops, oral Aciclovir 400mg
five times daily is just as effective as topical treatment[8]. Sometimes
corneal debridement with a cotton bud soaked in anaesthetic is
useful to remove virus laden epithelial cells, thus reducing the viral
load present and speeding up recovery. This may also reduce the
risk of spread to the stroma leading to inflammation and potential
scarring[9]. Topical corticosteroids are contraindicated in the
treatment of active HSV epithelial keratitis.
Herpes simplex stromal keratitis
Since treatment of stromal keratitis may become prolonged with
use of steroids and associated with significant ocular morbidity, all
patients seen in community practice with stromal HSVK should be
referred urgently to an ophthalmologist within 48 hours.
The effectiveness of topical steroids in the treatment of stromal
disease associated with HSV was demonstrated in the Herpetic Eye
Disease Study. This double masked, placebo controlled trial provided
unequivocal evidence for the use of topical steroids in treatment
of active stromal HSV eye disease. In the steroid plus trifluridine
(antiviral) group, resolution was significantly reduced i.e. 26 days
compared with 72 days for sham controls, with no difference in
recurrence rates[10].
A second Herpetic Eye Disease Study, published in 1998, investigated
the effects of using oral Acyclovir (400mg twice daily). This study
revealed a significant reduction in a single recurrence (19% v 32%
in the Aciclovir and placebo groups respectively and for multiple
Figure 5
Scleritis
Scleritis is an inflammatory disease affecting the sclera, which may
involve the anterior and/or posterior segments of the eye. Anterior
scleritis is characterised by diffuse redness and severe eye pain,
whereas posterior scleritis only, will not present with redness of the
anterior segment or with any significant pain.
Anterior scleritis accounts for 90% of cases. This is characterised by
hyperaemia of superficial and deep episcleral vessels which do not
blanch when vasoconstrictors e.g. as gutt. phenylephrine 10% are
applied.
The 4 sub-types of anterior scleritis are as follows:
Diffuse anterior scleritis is characterised by widespread
inflammation of the anterior sclera accounting for approximately
60% of cases. This is the most common form of anterior scleritis as
well as the most benign (figure 6).
Nodular anterior scleritis is characterised by one or more
erythematous immovable, tender inflamed nodules on the anterior
sclera (figure 7). On cursory examination this may resemble nodular
episcleritis. Approximately 20% of cases progress to necrotizing
scleritis.
Necrotizing anterior scleritis with inflammation is the most severe
form of scleritis which presents with a gradual onset of pain (later
becoming extreme) and localized redness with potential for marked
RX FACTOR PROFILE July 2013 25
CET / CPD
scleral damage (figures 8a &8b). This form frequently accompanies
serious systemic collagen vascular disorders including rheumatoid
arthritis. Necrotizing anterior scleritis with corneal inflammation is
also known as sclerokeratitis.
Necrotizing anterior scleritis without inflammation most
frequently occurs in patients (females > males) with long-standing
rheumatoid arthritis; it is due to the formation of a rheumatoid
nodule in the sclera and is notable for its absence of symptoms.
Necrotizing anterior scleritis without inflammation is also known as
scleromalacia perforans. Scleritis coexists with a serious systemic
disease in almost one half of cases; the underlying problem is
frequently a connective tissue disorder[12].
Figure 6
Rheumatoid arthritis is the underlying disease for approximately
one sixth of patients suffering from scleritis, and approximately 1%
of patients with rheumatoid arthritis will develop scleritis at some
point in the course of the disease[13]. Scleritis associated with RA is
due to the development of a rheumatoid nodule on the sclera and is
associated with an increased risk of mortality[14].
Posterior scleritis (10% of cases) involves sclera posterior to the
equator and the eye is often white. This is associated with a high
risk of exudative retinal detachment, macular oedema and optic disc
oedema.
Scleritis is a sight-threatening condition. The College of Optometrists
Clinical Management Guideline recommends first aid measures (e.g.
analgesia) only and immediate referral, preferably by telephone to
the on-call ophthalmologist[15].
Other connective tissue and autoimmune diseases seen with scleritis
include the following:
Figure 7
•
Systemic lupus erythematosus (SLE)
•
Polyarteritis nodosa
•
Seronegative spondyloarthropathies - Ankylosing spondylitis,
psoriatic arthritis, reactive arthritis
•
Wegener granulomatosis
•
Relapsing polychondritis
•
Sarcoidosis
•
Inflammatory bowel disease
•
Sjörgen syndrome
Episcleritis
Episcleritis is a common benign, self-limiting, frequently recurrent
Figure 8a
Figure 8b
26 RX FACTOR PROFILE July 2013
Figure 9
disorder that typically affects young adults (figure 9). It is seldom
associated with a systemic disorder and never progresses to a true
scleritis. In recurrent cases where discomfort is annoying, topical
steroids may be considered. Referral is not usually necessary.
Other non red-eye conditions requiring urgent referral include:
• Symptoms or signs suggesting CMV and Candida retinitis
• Commotio retinae
• CRVO with elevated IOP
• Acute dacryoadenitis
• Acute dacryocystitis
• Disc haemorrhage (although a splinter haemorrhage in a patient
with known glaucoma does not require urgent referral)
• Sudden onset diplopia;
IOP>35 mm Hg (and <45mmhg);
• Retinal detachment if not an emergency
• Acute metamorphopsia
• Proliferative diabetic retinopathy
• Retinal transient ischaemic attacks (TIAs) (amaurosis fugax)
• Retrobulbar/ optic neuritis
• Suspected ocular malignancy
• Oculomotor nerve palsy (sudden onset diplopia)
•
Retinal vein occlusion
Conclusion
The second part of this series has discussed a range of red
eye conditions that require urgent referral by the optometrist.
Appropriate clinical signs and symptoms are discussed for each
condition. In the third part, those red eye conditions requiring less
urgent referral (within a month) will be discussed.
References
A full reference list is available to view with the online version of this
article on Connect Learning (lms.specsavers.com).
GOC’s Enhanced CET Scheme
The UK’s Enhanced CET Scheme requires practitioners to reflect
on learning.
The learning objective for this unit of CET is:
•
Practitioners will have an enhanced understanding of the
signs, symptoms and management of red eye conditions
requiring urgent referral.
Consider how you will use the learning from this article to
enhance your patient care and what changes reading this article
will make to the way you practise. Further reflection questions
will be asked on the GOC website. Considering these questions
and entering your reflections on the website will help you gain
more from your CET, and enable you to fulfil the Enhanced CET
requirements.
Global Digital Photographic Competition
Could you be the best Specsavers photographer in the world?
WIN
a new PENTAX Q10
Digital SLR camera
Fundus & anterior images
• 1 overall global winner – digital SLR camera,
plus entry and hotel accommodation for you
or a colleague from your store to attend your
nearest Specsavers clinical conference
• 2 x UK/ROI – camera prizes
• 2 x Rest of the world – camera prizes
Email your 2012/13 images to: [email protected]
Including: Your name / store name & no. / brief clinical description
For full competition details, see Connect
RX FACTOR PROFILE July 2013 27
In the spotlight with...
Leighton Griffiths
Four-time UK store partner on setting
up in Spain
What is your history with Specsavers?
I’m probably one of the longest-standing Specsavers partners. Back in
1979, I worked for Doug Perkins for a few years before opening up my
first store in Wales in 1988. During my years in Wales, I was partner
in four Specsavers stores - Newport, Spytty Road, Cwmbran and
Pontypool – and had three when I decided to make the move to Spain
to open up a new store in Marbella.
What prompted the move?
I have always wanted a change of lifestyle and Spain ticked all the
boxes, offering a new challenge, a new language and a new culture.
How easy was it to open a store in a different country?
The experience I gained from running my Specsavers stores back
in the UK gave me the knowledge I needed, as the store model is
basically identical and we adopt the same processes and levels of
professionalism. The business development team were there to
support myself and my business partner, Nerea Galdos-Pujana,
from start to finish, making the process run as smoothly as possible.
There have been a few issues since opening, as legislation in Spain
is very different, which is why it’s so important to have a Spanishspeaking business partner and support from head office to help with
communications.
‘The best part has got to be the people
contact. My store in Spain is a lot smaller than
I was used to, so it means I get to do a bit of
everything and be more hands-on.’
Describe your typical working day
My working day is very different to the usual 9-5. I work shifts – one
week I will start at 10am and finish at 6pm, and the following week I
will work 1pm until 9pm. This gives me the opportunity to enjoy the
Spanish way of life. I can finish at 6pm and still enjoy the sunshine as
it’s light until 9pm in the evening, and when I have the mornings off I
can have a round of golf before work, which is a great start to the day.
I have so much more time to enjoy hobbies and relax with my family.
Leighton and fellow Marbella partner Nerea Galdos-Pujana.
What is the best part of having a store in Spain?
The best part has got to be the people contact. My store in Spain
is a lot smaller than I was used to, so it means I get to do a bit of
everything and be more hands-on – similar to the early days of when
Specsavers opened in the UK.
I have found that the working environment here in Spain is more
relaxed. Each day you meet a mix of nationalities that come into store,
who are very well travelled and interesting. Even the drive to work
each morning is a lot easier. I now own a scooter and it takes me five to
10 minutes to get to work with parking outside the store all year round.
And what about the challenges?
Conducting tests in Spanish is certainly very challenging but managing
to achieve this gives me a lot of job satisfaction. I have started Spanish
lessons twice a week and have picked the language up fairly quickly.
The majority of people here in Spain do speak English but I am
enjoying learning it.
Is it a career move you’d recommend?
Having a Spanish partner is crucial, along with Spanish speaking staff.
We are very lucky we have four Spanish staff working in store, two of
them have optical qualifications and the other two are new. Running
the actual store over here has given me a great change of lifestyle; I
would recommend it to anyone.
How has your family found the move?
How have you been accepted in your new community?
It was quite easy for both me and my wife as our children are at an age
where they are self-sufficient – two of them are living in Australia and
the other two are studying in the UK, making Spain a regular holiday
home for them – so we only had ourselves to consider when making
the move.
We’ve been really welcomed by both the ex-pat and local communities.
We have an excellent store team here, and the support and training
from Specsavers is gratefully received. In Spain, Specsavers can
provide employees with good rates and stable conditions, making it a
good working environment for all.