Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
MAY 2015 DISPENSING OPTICS NEWS , I NFORMATION an d E D UC ATION for OP TICI ANS Dispensing Optics MAY 2015 Contents 8. 29. 26. 17. 28. Features 30. 18. 32. Talking shop with Amy Rothwell Technology & innovation Contact lenses in the spotlight 20. Continuing Education & Training CET Answers Plastic fantastic by Joanne Abbott 26. Myopia control Myopia control with contact lenses by Martin Conway Preview BCLA Myopia Day “not to be missed” 34. Contact lenses with a difference by Keith Cavaye 25. Interview Sports vision Divergence excess: the tip of an iceberg? by Geraint Griffiths Regulars 5. DO Dispatches 6. Black Arts by ABDO president, Peter Black 28. Business Building your contact lens practice by Antonia Chitty 8. News 9. Letters 36. Jottings FRONT COVER Just don’t call me ‘Alcon Man’.... by Graeme Stevenson Image from stock 38. Jobs & Notices Dispensing Optics MAY 2015 3 Perfect all-round protection for exceptional vision. With the new high-tech coatings from Rodenstock. We can now set the highest possible standards with the latest generation of the Solitaire® family: perfect all-round protection - 365 days a year. The 3-year quality guarantee and additional 12 month no quibble guarantee* also ensures the highest possible customer satisfaction. NEW: 7ZLFHDVVFUDWFKUHVLVWDQWDV conventional AR-coated lenses. 2SWLPXP89SURWHFWLRQIURPVXQOLJKW incident from the front and from the side. 6ROLWDLUH® Protect Balance 2 reduces WKHDUWL¿FLDOEOXHOLJKWIURPPRQLWRUV smartphones and tablets - for natural well-being. * For Solitaire®3URWHFW%DODQFH6ROLWDLUH® Protect Plus 2 Model: R2364 Solitaire 2 ® DISPENSING OPTICS The Professional Journal of the Association of British Dispensing Opticians VOLUME 30 NO 5 EDITORIAL STAFF Editor Assistant Editor Managing Editor Email Design and Production Email Admin. Manager Email Sir Anthony Garrett CBE HonFBDO Jane Burnand Nicky Collinson BA (Hons) [email protected] Rosslyn Argent BA (Hons) [email protected] Deanne Gray [email protected] EDITORIAL/ADVERTISING Telephone 0781 2734717 Email [email protected] Website www.abdo.org.uk SUBSCRIPTIONS UK £140 Overseas £150, including postage Apply to Tom Veti Association of British Dispensing Opticians Godmersham Park, Godmersham, Kent CT4 7DT Telephone Email Website 01227 733922 [email protected] www.abdo.org.uk ABDO CET CET Coordinator Paula Stevens MA ODE BSc(Hons) MCOptom FBDO CL (Hons)AD SMC(Tech) ABDO CET, 5 Kingsford Business Centre, Layer Road, Kingsford, Colchester CO2 0HT Telephone Email or email 01206 734155 [email protected] [email protected] CONTINUING EDUCATION REVIEW PANEL Joanne Abbott BSc(Hons) FBDO SMC(Tech) Keith Cavaye FBDO (Hons) CL FBCLA Andrew Cripps FBDO (Hons) PG Cert HE FHEA Kim Devlin FBDO (Hons) CL Stephen Freeman BSc(Hons) MCOptom FBDO (Hons) Cert Ed Abilene Macdonald Grute FBDO (Hons) SLD (Hons) LVA Dip Dist Ed Cert Ed Richard Harsant FBDO (Hons) CL (Hons) LVA Andrew Keirl BOptom (Hons) MCOptom FBDO Angela McNamee BSc(Hons) MCOptom FBDO (Hons) CL FBCLA Cert Ed Linda Rapley BSc FCOptom DO Dispatches GENERAL ELECTION WAITING GAME As this issue of Dispensing Optics goes to press, we are in the final days of a very long election campaign. The outcome is very uncertain and we will have to see what changes, if any, will affect us in the eyecare sector. Issues such as business rates, the state of the economy, employment prospects and, of course, health spending have all been aired. All have an impact on us as a profession and the wider world of optics. The head Optical Confederation (OC) public affairs, Jenny Gowen, has been sifting through the small print of the various manifestoes and other relevant statements made during the campaign. This, coupled with the knowledge gained during the previous parliament from practice visits made by MPs and candidates, means we are in as good a position as possible to deal with the new administration when it takes office. However, like so much else in life, the devil is in the detail. Although we are electing a new parliament for the whole United Kingdom, it only directly affects England as far as health policy goes. The state of play in Scotland, Wales and Northern Ireland continues to change and diverge and we have to be aware of the differences between the four nations. GOS is still the one service that remains constant throughout the UK and we in the OC will be doing all we can to maintain that in the years to come. Sir Anthony Garrett ABDO general secretary JOURNAL ADVISORY COMMITTEE Richard Crook FBDO Kim Devlin FBDO (Hons) CL Kevin Gutsell FBDO (Hons) SLD Ros Kirk FBDO Angela McNamee BSc(Hons) MCOptom FBDO (Hons) CL FBCLA Cert Ed DISPENSING OPTICS IS PUBLISHED BY ABDO, 199 Gloucester Terrace, London W2 6LD DISPENSING OPTICS IS PRINTED BY Lavenham Press, Lavenham, Suffolk CO10 9RN © ABDO: No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means whatever without the written prior permission of the publishers Dispensing Optics welcomes contributions for possible editorial publication. However, contributors warrant to the publishers that they own all rights to illustrations, artwork or photographs submitted and also to copy which is factually accurate and does not infringe any other party’s rights ISSN 0954 3201 AVERAGE CIRCULATION: 9,025 Jan-Dec 2014 ABDO Board certification Dispensing Optics MAY 2015 5 PETER BLACK Our monthly column from the ABDO president The changing face of GOS ptics is changing faster today than at any point I can remember since deregulation in the late 1980s and, as usual, it is not all for the good. The new vigour with which NHS bodies are pursuing practices and practitioners following post payment verification visits is a symptom of this – and well-meaning practitioners, believing they are acting in the patient’s best interest, are now falling foul of the rules. My comments last month, that contractors may end up suing performers, were not meant to inflame tensions as they appear to have done in some quarters. I still believe that dispensing opticians working alongside optometrists remains the dream team for community optical services, and where improper claims are alleged it is absolutely vital that contractors and performers work together to understand each other and present a united front, as to be divided is to be conquered. One of the published Optical Confederation (OC) principles on this subject, agreed by all the members of the OC including the three representative bodies, ABDO, the Association of Optometrists and the Federation of Ophthalmic and Dispensing Opticians, is: “Contractors and performers (including locums) should cooperate in interpreting records, explaining prescribing and dispensing decisions and in resolving any claims issues.” O DON’T ‘JUST PUT IT THROUGH’ Depending on your location in the country, the interpretation of the rules by health authorities responsible for paying GOS claims has varied quite dramatically over the years. In the days of primary care trusts (PCTs) (and FPCs before them) in Wigan, for example, the rules used to be applied absolutely rigidly, with no exceptions except by prior approval. Yet when you had a patient in real need and rang for help, you would receive a sympathetic response in 6 Dispensing Optics MAY 2015 almost all cases. And you knew not to ring if there wasn’t a genuine need. Yet at the other end of the M58 in Merseyside, the PCT’s attitude was ‘couldn’t care less’ and everything was approved so easily that the PCT effectively allowed performers to make up their own mind as to whether the patient was in need. PCT staff acted as though their time was being wasted by an unnecessary inconvenience, so I suspect most practices gave up ringing for permission and just put through claims for patients they perceived to be deserving. Most will have acted in the very best interests of patients, which is after all a registrant’s raison d’être according to the General Optical Council Code of Conduct. It is clear now, however, wherever you are in the country, entitlements must be strictly controlled and precious NHS funds protected at all costs. It is absolutely essential that record keeping is exemplary and any early retest within the rules is coded correctly, and that the reasons for issuing vouchers for small changes in Rx or fair wear and tear are also recorded correctly on the records and the submitted forms. If at any point you are not 100 per cent sure that what you are claiming from the NHS is within the rules then you should consult ‘Making Accurate Claims’ via the OC website and if there is any doubt, contact your clinical commissioning group (CCG) for permission before supplying the patient. It seems ironic that practices are being held to such strict account by NHS auditors these days when many PCTs, their forebears and successors, had such lax systems themselves. I once remember being overpaid a substantial five-figure sum one month and contacting the PCT to explain we had been paid incorrectly. It seemed beyond their comprehension that they could have made a mistake, and they basically implied we were wrong and they had made the correct payment. This particular PCT, like many others, was completely unable to provide practices with lists of GOS Voucher patients for whom it was making payment and it took many months before the payment error was sorted out. To this day, although I believe all CCGs provide lists of sight test patients, some still do not provide lists of voucher payments even if they have been sent duplicate lists in with the claims. It seems ridiculous that an organisation that insists its contractors have a robust audit trail themselves, was until recently incapable of being audited itself. PCTs were abolished by the Health and Social Security Act 2012 and disappeared on 31 March 2013. At that time I was working dispensing three or four days per week and was surprised to see managers from the PCT calling on practices with contracts asking them to sign one as they didn’t seem to have anything on record. Is it those contracts, signed under pressure and perhaps false pretences, that are now coming back to bite? Perhaps it is time to propose reforms to GOS as part of our negotiations for more money. The standard attempt to negotiate an inflation linked increase in fees and get nothing or one per cent is wearing pretty thin with practitioners, so perhaps we should be asking for reforms to the information that is provided on the voucher for example so that illegal supply and fraudulent claims can be identified from the voucher itself? A note of the old Rx as well as the new Rx and the VA with each would be a good start, as would space for BVD for higher power prescriptions. A&E IN THE NEWS AGAIN Last month saw the publication of the winter A&E statistics across the UK with predictably dire results. One in 12 patients presenting at A&E wait more than four hours to be seen, considerably worse than the one in 20 target they wish to get down to. Every time I see these reports I can’t help wondering that the answer is staring us in the face – that community opticians and optometrists could help reduce this burden on A&E departments and patients alike. I’ve seen statistics that between three and five per cent of A&E appointments are eye related, and that easily half of those could be dealt with by ordinary community optical practices, and half of those could be dealt with by dispensing opticians, with the remainder easily looked after by contact lens opticians and optometrists between them. Therapeutically qualified optometrists would extend the practice’s capability to nearer three quarters of ophthalmic A&E cases. I have been at pains to mention this during the ‘everyday eye conditions’ discussion workshop I have presented at various area events. It is depressing how few members work at practices involved in minor eye conditions services (MECS) yet encouraging that the service seems to be gaining widespread support from commissioners in some regions as a cost-effective scheme that patients appreciate. Certainly those DOs who work with a MECS service often act as triage practitioners and thoroughly enjoy the variety and interest it offers them. There is probably an opportunity here for DOs to follow many other allied health professions in expanding our role in the issuing of a limited selection of pharmacy only medicines – especially for allergic conjunctivitis – and as it happens the GOC already has the powers to grant us this right under Part 5 of the Opticians Act. I would commend any DO to encourage your practice to participate in MECS whenever it becomes available, and if this isn’t looking likely get involved with your local optical committee and make it happen for the benefit of patients. It is reported that one in six ophthalmic A&E cases are for dry eye and blepharitis. What do we think happens to these patients in a general hospital A&E department when other patients present via an emergency ambulance, or with chest pains, or pregnancy complications? They inevitably go to the back of the queue and, as such, probably make up a substantial portion of the people who have to wait more than four hours for treatment. Not only that, they will probably meet up with an ill equipped doctor with little knowledge of eye problems who will quite likely give them poor advice. For example, we have all read typical NHS advice (echoed by the College of Optometrists and the Royal College of Ophthalmologists) to use baby shampoo for the treatment of blepharitis. Some go so far as to say that there are ready prepared products but they are ‘expensive’. This, of course, begs the question: why aren’t they available on prescription when research proves they are so much more effective? There is a bigger problem here of uncaring practitioners within an apathetic protectionist system that seems to have no reasonable thought for its patients. To label a blepharitis product expensive when a patient loses more than four hours of their life getting it treated and is then given poor advice is shameful, and even factually incorrect. For what it costs to park at my local hospital for four hours I can easily buy a month’s supply of blepharitis treatment – and that’s before any loss of a patient’s time, earnings, childcare costs etc, are taken into account. Many practices worry about patient waiting times if they get involved in MECS, PEARS and other on demand enhanced services, yet research shows that patients much prefer these services to be provided at the local community opticians. We need to consider that, even if we keep patients waiting for an hour, they will still probably be seen four times quicker than at hospital. For the good of your patients, it’s time your practice got involved. WHAT’S NEW ON EYECARE FAQ? New this month on Eyecare FAQ, you’ll find an infographic to share on cataract, FAQs on the disease as well as an optical lingo bingo card full of cataract related words. How many are you using every day? And do patients know what you mean? Love images? You can now find Eyecare FAQ on Instagram and Pinterest • www.pinterest.com/eyecareFAQ • https://instagram.com/eyecarefaq/ You can use any of the FAQ answers and images on your own blog or website. Follow, like and share these useful resources on your practice and personal social media channels, to help the public learn about eyecare and promote the role of the registered dispensing optician. Get involved with Eyecare FAQ, ABDO’s campaign to help consumers learn more about looking after their eyes, and the role of the registered dispensing optician. Eyecare FAQ is also at: • www.facebook.com/eyecarefaq • www.twitter.com/eyecarefaq • plus.google.com/+eyecarefaq • Or visit the website, www.abdo.org.uk/information-for-the-public/eyecarefaq/ Dispensing Optics MAY 2015 7 David Barnaby cuts the ribbon at the new practice FUN, FASHION AND CELEBRATIONS Patients, local business people and members of the optical industry helped Barnabys Opticians celebrate its 40th anniversary recently, as the company launched a new venture in “fashion and fun”. To mark a new chapter in the business’s journey, owner David Barnaby has joined forces with Louise and Chris Barrington to take the practice to the next level with new, larger premises in the centre of Bournemouth. Louise said: “Barnabys is now very much a dispensing focused practice, started by a dispensing optician 40 years ago, and now taking its next steps forward with another two dispensing opticians driving Barnabys forward. “We have always, and will always, stay faithful to our ideals and concepts, keeping Barnabys an optical boutique full of luxury eyewear and sunglasses. 2015 looks like being a year full of celebrations and exciting challenges as the Dickensian heart and soul of Barnabys moulds its new surroundings ensuring none of its charm and magic is lost,” Louise added. OPTRAFAIR RUMOURS CONFIRMED The Federation of Manufacturing Opticians (FMO) confirmed rumours at last month’s Optrafair in Birmingham that the show would return to the NEC in 2016. Announcing the move during the threeday event from 18-20 April, Optrafair director Malcolm Polley said: “The NEC is Optrafair’s natural home and a popular venue with both exhibitors and visitors. It is accessible from all parts of the UK and the larger stand space allows the major technology companies in particular, to launch, showcase, as well as demonstrate new and existing products to maximum effect. Catching up with members at the Association “Optrafair is the show people who are Lounge at Optrafair 2015 serious about doing business attend. It is a great way for anyone involved in the optical industry to get inspiration each year and find the means to enhance their business”, added Malcolm. Optician will once again be the show partner, and the dates are 9-11 April 2016. Read our Optrafair 2015 report in next month’s issue. Jil Sander by Rodenstock HIGH-END RANGE DEBUT Jil Sander, the high-end luxury brand, has launched its new eyewear collection in collaboration with Rodenstock. Under the creative direction of Rodolfo Paglialunga, the sunglasses and spectacle models are divided into two lines: Core and Volume. Core features temples made of titanium coordinated with high quality acetate elements, combined with a progressive lens shape. Volume boasts rounded, filigree temples combined with the frame made of high quality acetate giving the spectacles their unique look, and the integral spring hinge ensures extreme comfort. NEW PARTNERSHIP FOR MASTER PROGRAMME The University of Hertfordshire has announced a new strategic partnership with Boots Opticians and the College of Optometrists to support the delivery of its new undergraduate training programme. Professor Soraya Dhillon, dean of the School of Life and Medical Sciences said: “ Through our partnerships with the College of Optometrists, Boots Opticians and clinical ophthalmology teams from East and North Herts NHS trust and Luton and Dunstable Hospital NHS Foundation Trust, we are developing inclusive and mutually beneficial relations that will improve the quality of our students learning experience.” FOND FAREWELL TO TRIO Frank Norville with Peter Turner 8 Dispensing Optics MAY 2015 Three long-serving members of the Norville Group have hung up their lab whites for the final time. Ray Simms enjoyed 45 years’ service with the group, all in Harrogate, starting under the Stigmat flag previously known as Harrogate Optical before its purchase by Norville. Peter Turner from the Norville Optical engineering field sales group and John Lane, operations director, have also now retired after 49 years of ophthalmic manufacturing across the Norville Rx network, including the start-up of the company’s Livingston laboratory. Frank Norville commented: “You cannot begin to even contemplate their huge contribution to manufacturing optics, only to say how lucky yesterday’s opticians were to benefit from such lifetime individual contributions – something the next generation is unlikely to ever see again.” @ HAVE YOUR SAY Email [email protected] or write to Dispensing Optics, PO Box 233, Crowborough TN27 3AB Letters DIVERGENCE EXCESS IN QUESTION Nick Howard recognised with historic award CLO ACCEPTS FREEDOM OF THE CITY Nick Howard, specialist contact lens optician at Benjamin’s Opticians in Skipton, has been awarded the Freedom of the City of London. Originally granted to allow professionals to carry out their trade or craft in the City, it is one of the oldest surviving traditional ceremonies in England, which today recognises those who have made a significant contribution in their field. Nick said: “As a northern lad who works from time to time in London, I am amazed and a touch overwhelmed that I was invited to apply for the Freedom. As a Freeman of the Worshipful Company of Spectacle Makers, I was given the opportunity to become part of the splendid tradition and heritage associated with this walled City.” Known as a key opinion leader on contact lenses, Nick is a regular speaker at conferences and events and has lectured at just about every university in the UK. He is pictured accepting the Freedom of the City with the Chamberlain of the Court and the Beadle. FREE PRODUCT DATA DIRECTORY The ADP Consultancy, owned and run by contact lens optician Andrew Price, has launched a free-to-use web-based directory of some 200 plus ocular health products. “The ethos of my company is to support and help practitioners and to provide better care for their patients, which directly helps build their practices,” said Andrew. “The Eye Drops Database fits in completely with that ethos.” Merton Beck Opticians is just one practice already using the database on all IT linked technology in its practice. Colin Jones, practice owner, said: “When it comes to advice and purchase of ocular health products, I want my patients to automatically think of me, not the supermarket or retailers of other non-eyecare products. There is a large market and clinical need, I have the skills and education, and now this excellent professional resource to help me help my patients.” The continuously updated directory is fully searchable, containing data on product indications, contra-indications/cautions, formulations and more. Visit www.eyedropsdatabase.co.uk MOVING ON UP Mark Keaney and David Straithe have been promoted to the role of senior sales manager at Continental Eyewear, to help the company expand and develop in the UK and overseas markets. “Having worked with both Mark and David for more than 10 years, I look forward to their further involvement in the company and continuing our success,” said Neal Grimason, sales and marketing director. “Mark will be concentrating on building our social media presence and export development, while David supports our exhibitions presence and promotional work.” I would like to say how much I enjoyed the March issue of Dispensing Optics, especially the sports vision articles. However, I would like to make a comment or two. On page 32, Geraint Griffiths says: “With divergence excess, it is vital to make sure that there is no latent hyperopia indicating over-accommodation”. Perhaps he could look at that statement carefully and then explain why, as I believe (digging myself a hole), that he has it backwards and he meant “convergence excess”. Later in the article, Geraint describes a patient as: “…slightly myopic by half a dioptre with some astigmatism and initially he appeared to be esophoric. When this small amount of myopia was corrected he became exophoric. He was controlling a decompensated phoria by using accommodation, habituated by a convergence insufficiency”. It would be very interesting to have an article dedicated to ideas like this with more explanation. Of course, as dispensing opticians we can all promote sports ability/confidence by suggesting sports specific eyewear to children – especially those who would struggle when told they cannot wear their everyday specs on the court/field. David Bridle FBDO West Sussex Geraint Griffiths replies David’s questions are certainly perceptive and I agree that my statement on divergence excess is, as David suspects, not as straightforward as it appears – and I should have elaborated on it. David’s second point about low myopes appearing to be esophoric also needs expanding – and I hope my response to Dispensing Optics goes some way to explaining both. Geraint Griffiths BSc Mech Eng, Dip Schoolvision, Dip Sportvision, MASvP, MSc Optometry MCOptom Leicester Turn to page 34 to read Geraint’s full explanatory response. We kindly reserve the right to edit contributions prior to publication. Follow us on Twitter @ABDOCollege and @MembershipABDO ABDO events and booking information can be found at www.abdo.org.uk/events Dispensing Optics MAY 2015 9 Beauty lens event Helen Perkins Dr Gary Gerber NICHE SPEAKERS AND TOPICS Proven Track Record (PTR) has announced the speaker line-up for its 10th anniversary Independents Day (i-Day) to be held on 6 and 7 July at the Hilton Birmingham Metropole. Themed ‘Niches for riches: supplementary services for happy patients and healthy profits’, this year’s event will feature a keynote from the USA’s Dr Gary Gerber, founder and ‘chief dream officer’ for the Power Practice, a practice building and consulting company whose mission is to help optometrists ‘power their professional and personal dreams’. Dr Gerber is also a prolific writer and speaker as well as an accomplished mentalist and magician. He is also the host of the Power Hour, US optometry’s only live talk radio show. Another highlight will be a session chaired by Andy Clark, where leading UK practice owners will share how they have successfully carved out a niche in their practices. PTR director, David Goad, said: “These speakers have top performing businesses and have successfully commercialised socalled niche supplementary services such as dry eye, advanced retinal care and sports vision. They will share their journey and key learnings on how to successfully implement these services.” Fellow director Nick Atkins added: “We plan to celebrate this landmark meeting with the most exciting and pertinent i-Day ever. We look forward to welcoming back many of the 600 plus ‘friends’ that have attended i-Day since 2005.” For more information and to book visit www.independentsday.co.uk COMPANY APPOINTS 24TH CLERK Helen Perkins will take over as clerk and chief executive officer of the Worshipful Company of Spectacle Makers (WCSM) at the WCSM’s court meeting on 2 June. Helen is the 24th recorded clerk and has more than 25 years’ experience as a chartered company secretary. She is currently company secretary of an AIMlisted global recruitment business based in the city. She said: “Prevention and treatment of visual impairment is just as important now as it was to the 17th century spectacle makers who founded the livery company. I am very pleased to have the opportunity to put my professional skills and experience to use as the new clerk.” WCSM master, Dr Christine Tomkins, said: “Helen will bring new skills to the post of clerk tempered with the right degree of respect for custom and practice that is required in this exacting appointment. We wish her great success and happiness in her new role.” MEDIA EVENT PROMOTES NEW LENS The Vision Express store on London’s Oxford Street hosted a consumer media event recently to celebrate the launch of 1-Day Acuvue Define contact lenses across its national network of stores. A glitzy roll-call of fashion editors were given the opportunity to trial the eyeenhancing contact lens from Johnson & Johnson Vision Care, and enjoy a personal make-up consultation with celebrity makeup artist Collette Casey. Consumers were also invited to experience the Eye Define Studio, which uses advanced digital imaging technology to show how the lens can accentuate the eyes. Ruth Graesser, Johnson & Johnson Vision Care marketing manager, said: “The iris-inspired design of 1-Day Acuvue Define enhances the natural appearance of a patient’s eyes and is a pioneering advancement, bridging the gap between standard contact lenses and coloured contact lenses. The opportunity for guests to trial the lenses at this event with Vision Express meant guests could see for themselves the difference the lenses make in enhancing the natural eye.” CONSULTATION ON NEW CODE OF CONDUCT The Association for Independent Optometrists and Dispensing Opticians (AIO) invited delegates at Optrafair last month to participate in a consultation process to help inform the provisions of a new consumer facing AIO Code of Conduct. AIO chairman, Peter Warren, said: “We have now set a timeline for the launch of our new Code of Practice that is designed to help inform consumers and prospective patients of the different service offerings that are available in the High Street and provide a distinguishing mark for independent practitioners who are committed to providing the highest quality of eyecare.” The consultation is seeking input under a number of key headings, which will then be considered by the AIO council in July. The AIO will start accepting Code registration applications from AIO members at its conference in Nottingham in October. For information about AIO membership and/or attending the AIO conference, telephone 0800 1300 486 or email [email protected] FOR THE MOST UP-TO-DATE ABDO EVENT DETAILS keep an eye out for the eNews landing in your in box, and the events section of the website, visit www.abdo.org.uk/events 10 Dispensing Optics MAY 2015 STEPPER titanium frames are half the weight of conventional metal frames, corrosion resistant and hypo-allergenic EYEWEAR FASHION THAT FITS Stepper UK Limited 11 Tannery Road Tonbridge Kent TN9 1RF 01732 375975 Stepper model 60068 New Polarised 1.6 sunlenses from Rodenstock NEXT GENERATION OF COATINGS Rodenstock has launched its latest generation Solitaire technology with new Solitaire 2 high-tech coatings. The functions of the ‘super’ antireflection (AR) coating include dust, dirt and water-repelling properties, climate-resistance, anti-static properties as well as an antifogging effect with Rodenstock FogFree. In addition, lenses with Solitaire 2 have special protection against scratches and are said to be twice as robust as conventional lenses with an AR coating. Through optimised UV protection against light that is incident from the front as well as the side, strain on the eyes is also reduced. In addition to these protective properties, the new high-tech Solitaire Protect Balance 2 coating reduces artificial blue light. Solitaire 2 demonstration lenses and modules for the Rodenstock Competence Centre are available from regional lens managers. * Rodenstock has extended its lens portfolio with new Polarised 1.6 sunlenses – available with either a Solitaire Silver Moon mirror coat or Solitaire Protect Sun coat. DAWSON IS DO OF THE YEAR James Dawson, a consultant dispensing optician at Serendipity Optical Consultants, took home the title of Dispensing Optician of the Year at the Optician Awards held in Birmingham last month. A self-confessed ‘industry geek’, James also works with Bondeye to develop a range of eye health products, and has been in the profession for 26 years. Hosted by comedian Ed Byrne in the Hilton Metropole Hotel on Saturday 18 April, the Optician Awards saw 17 awards handed out including Contact Lens Practitioner of the Year, which went to optometrist Ian Cameron, Fashion Practice of the Year James with comedian Ed Byrne to Eyeworks London, Family Practice of the Year to Curtis Opticians, Optical Assistant Team of the Year to Edmonds and Slatter, and Independent Practice of the Year to Buchanan Optometrists. CHECT POSTER CAMPAIGN The Childhood Eye Cancer Trust launched a new awareness campaign at Optrafair last month. A series of four posters, made using reflective ink, shows a close up shot of the eye of a real retinoblastoma survivor aged between two and five years old. The aim is for people to take a picture of the poster on their smartphones; the pupil of the child’s eye will appear bright white in the photo, in contrast to the seemingly healthy-looking eye in the poster. Optrafair visitors were able to try out the technology and find out more about retinoblastoma. www.chect.org.uk 12 Dispensing Optics MAY 2015 COMFORTABLE AND CLASSIC The new Stepper 60068 men’s frame has been styled to project a classic look that is lightweight and comfortable. “Frames like this are one of the Stepper brand’s cornerstones,” said Richard Crook, managing director of Stepper UK. “The SI 60068 is certain to become one of our best sellers. Constructed from titanium the frame’s weight is kept to a minimum so that despite its sturdy looks the frame doesn’t sit heavily on the face.” The style is available in Gold, Olive and Blue colourways. VISION UK SPEAKERS REVEALED The speaker line-up for next month’s Vision UK 2015 conference in London will include Dr Stephen Hicks, who is developing smart glasses for the visually impaired as part of the Oxford Smart Specs Research Group. Entitled ‘Working together to deliver the UK Vision Strategy’, the conference will be held on Thursday 18 June at Central Hall Westminster. For the first time delegates will be able to choose from one of five conference streams, focused on delivering aspects of the UK Vision Strategy and tailored for different professional interests. Other high profile speakers include: David Allen, chief executive of the Faculty of Public Health; David Cartwright, chair of National Eye Health Week; ‘Fashioneyesta’ and sight loss blogger, Emily Davison; and Paul Wood, Social Care Policy & Legislation, Department of Health. Find out more at www.ukvisionstrategy. org.uk and look out for our preview in next month’s issue. Looking for something different? Tel: 01452 510321 Fax: 01452 510331 Email: [email protected] Award for Silhouette Titan One RED DOT AWARD FOR “MASTERPIECE” New imagery for the Basebox collection GLOSSY NEW LOOK-BOOK Voted 2015 Optical Supplier of the Year at the Optician Awards, Eyespace has launched its 2015 catalogue showcasing more than 530 frames across 103 pages of glossy, lifestyle images. Detailed frame visuals are presented in an easy-to-navigate format, focusing on the refreshed Basebox collection and the company’s five other lines – on-trend Cocoa Mint, Jensen for men, luxury Louis Marcel, children’s brand Rock Star, and the Zips budget range. Brand new point-of-sale for the collections was launched at Optrafair last month. GLOBAL MYOPIA EXPERTS CONVENE At a recent joint meeting of the World Health Organisation (WHO) and the Brien Holden Vision Institute (BHVI), key scientists, researchers and clinical experts discussed the rapidly increasing prevalence and impact of myopia. They reported that myopia was now the leading cause of blindness in older people in Tajimi, Japan, and in Shanghai, China. Professor Brien Holden reported that the BHVI had estimated that five billion people would have myopia in 2050, with almost a billion having high myopia. He said that: “vision impairment and blindness was rising in children from uncorrected myopia and in adults from the pathological consequences of myopia later in life”. The meeting reviewed evidence on the epidemiology, aetiology, vision consequences, pathology, social and economic impact, morbidity associated with, and interventions that may be helpful in reducing the threat of myopia. Global public health expert, Dr Serge Resnikoff said that “a major contribution from the meeting was the definition and description of the retinal condition that causes blindness with myopia so that future surveys can accurately record the number of people with vision impairment and blindness from myopia.” Turn to page 26 to read more about myopia control with contact lenses. Global scientific meeting on myopia 14 Dispensing Optics MAY 2015 Silhouette’s Titan One frame has received the renowned Red Dot Design Award. Made from one continuous piece of titanium, award judges described the frames as “state-of-the-art” and “an impressive piece of design engineering.”. “The Titan One Signature Collection is our masterpiece that unites the wearer and the eyewear,” said Roland Keplinger, head of design at Silhouette. “Receiving the award for this innovation, which is unique in the eyewear industry, is fantastic.” HANDY, ECO AND HYGIENIC EcoHydra, a new range of anti-microbial hand washes and sanitisers, is now available from Positive Impact (PI). The key active ingredient of the EcoHydra Antimicrobial Handwash is 0.1 per cent benzalkonium chloride, which is said to kill up to 99.9999 per cent of most commonly occurring bacteria and norovirus within 15 to 30 seconds. It also remains active and effective against microorganisms for four hours after drying. The EcoHydra Instant Hand Sanitiser does not require the use of water and, with its alcohol-free Base Technology formula, can be used repeatedly throughout the day with no damaging effects. PI joint managing director, Nick Atkins, said: “It is my experience that the products used in most consulting rooms are usually bought from local retailers and are designed for domestic use. Guarding against Hand hygiene cross-infection improvements, such as routinely using EcoHydra, are the simplest and most effective way to prevent cross-infection in practice.” Is ha ving the righ having rightt equipmen equipmentt import ant to to yyou? ou? important Glasses ar aree no different... different... One pair is never enough! Boost your sales with our Xperio multi pair promotion! From 1st January to 30th June 2015 order a pair of Xperio lenses and for an additional £1 per lens, receive a pair of clear lenses. You can upgrade the clear pair at a greatly reduced cost to match the design of the Xperio pair. p p g the order for the 2nd pair. p To benefit from this offer use the promotional code “2PAIR” when placing For www.bbgr.co.uk For full terms and conditions please refer to our website website www .bbgr.co.uk www.bbgr.co.uk www .bbgr.co.uk TTel: eel: 0844 880 1349 Always closer Brian Ellis at the handover REFRACTION KIT DONATED Hilco’s Signature Series CREATING A SIGNATURE LOOK Hilco has introduced its Personalised Signature Series of coordinating personalised lens cleaner labels and microfibre cloths. Each graphic is available on a 2oz. lens cleaner spray bottle and matching Classic microfibre cloths, creating an attractive signature appearance while promoting the practice. FRENCH CONNECTION Kirk & Kirk have teamed up with Eye Like of France to create a new collection of frames in a range of colourful, semi-transparent, sandblasted acetates. “Our goal was to create eyewear that complements the work of the designers that Eye Like carry, but that also espouses the values of the group: savoir-faire, passion, generosity and ethics,” said Karen Kirk, creative director of Kirk & Kirk. “We were attracted to working with Eye Like because we respect their approach to being an independent optician in the current environment,” added Jason Kirk, managing director. “As an independent eyewear designer, we need to work closely with retailers that reflect our values and have the capacity to sell our products.” As part of Vision Aid Overseas’ (VAO) Refraction Room Appeal initiative, equipment purchased from the UK worth more than £5,000 has been donated to four hospitals in rural Ethiopia. The facilities previously had no refraction equipment, despite having fully trained optometrists in place, who were not able to practise their profession. A handover ceremony was conducted at the Ras Amba Hotel in Addis Ababa, during which Brian Ellis, VAO founding chairman, gave a short presentation to the optometrists on some of the technical aspects of the equipment and how to maintain and care for them. NEW IN THE HOOD John Hood has joined Snowbird Finance as business development director to assist the company’s expansion in the optical sector. John joins the team from Carl Zeiss where he spent 20 years as a high-tech diagnostic equipment salesman. Simon Freeman, Snowbird MD, said: “John is a great addition to the team and his appointment demonstrates once more our commitment to being the leading provider of healthcare finance in the UK.” Niall Balfe of Vision Express MANCHESTER PRACTICE JOINS DIABETES STUDY Murrays Opticians in Moss Side is one of four Manchester-based practices to have been invited to work with the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester to take part in a study that will help in the fight against diabetes. Dr Mitra Tavakoli of the University of Manchester’s Centre for Endocrinology explained: “Manchester pioneered work for establishing the technique of corneal confocal microscopy (CCM) – a new, non-invasive eye test which can detect diabetic neuropathy in limbs in its earliest stages and used to image the eye – as a 16 Dispensing Optics MAY 2015 tool for diagnosing diabetic neuropathy at its early stages. “This study will closely monitor 400 patients over eight months in four community settings across Manchester to understand how early diabetic neuropathy diagnosis compares with retinopathy results and patient symptoms, and explore how to incorporate CCM into optometry practices.” Suhayel Issa, optometrist at Murrays Opticians, said: “By conducting this study we hope to pave the path to playing an even more important role in the fight against diabetes.” The research is funded by CLAHRC Greater Manchester and Heidelberg Engineering, with initial study results expected by the end of 2015. GREAT FINISH FOR FUNDRAISERS A team of runners from Vision Express Ireland was among over 200 entrants who battled the tough Aran Half Marathon for Temple Street Children’s Hospital recently – with the Blanchardstown practice’s Niall Balfe crossing the finish line first in just one hour 28 minutes. Cheered on by the hospital’s special events manager, Angela McNulty (pictured ), Niall achieved a personal best and posted one of the quickest half marathon times in the 10 years the renowned Aran Half has been held in partnership with the hospital. Retail associate Niall was part of a six-strong team from Vision Express, which has raised more than €5,000 for the charity during this event. Silhouette welcomes guests to its Chiswick head office RIMLESS CET DAY SUCCESS Silhouette hosted its second successful ‘Open office’ and CET rimless training day on 26 March, welcoming more than 70 customers to its UK head office in Chiswick, West London. Peter Black, ABDO president, delivered four CET rimless workshops and other activities including a practical dispensing discussion and an ocular conditions test, earning each guest five CET points. Participants travelled from around the country to take part in the workshops. The day included a tour of Silhouette’s offices, Q&A sessions with specialist Silhouette technicians, exclusive previews of new Adidas and Silhouette frames, as well as the chance to network over refreshments. Guests were also treated with Silhouette and Adidas goodie bags before they left. Hatty Scrace, Silhouette UK marketing and communications manager, said: “Our rimless training days are a wonderful way for us to meet our customers face to face and to spend valuable time together, helping them to feel confident working with our rimless glasses. We love meeting our customers and showing them the technical side of our frames. Often people don’t realise how easy it is to work with Silhouettes and it is very rewarding to see our customers leave feeling enthused and confident.” Silhouette will be running more ‘Open office’ and CET rimless training days later in the year. For more information, email [email protected] AREA 3 (NORTH EAST AND ISLE OF MAN): SOAPY CET AT PORT SUNLIGHT Report by Lorraine Wallbank, vice chairman On 8 March Area 3 hosted a CET event at the Leverhulme Hotel in Port Sunlight – the famous model village created by the Lever Brothers to accommodate workers in its soap factory. Registration was followed by a selection of hot food dishes and refreshments, to fuel Area 3 members participate in peer discussion Area 3 CET day’s sponsors delegates before the lectures got underway. First in line was an eye-opening lecture by Essilor’s Nick Hornsby on ‘Filtering blue light’. This was followed by Angela McNamee and Keith Cavaye facilitating a peer discussion session entitled, ‘All in a day’s work’. After a short break with refreshments, delegates were able to complete a VRT, ‘What is it to be done?’ Emmanuel Hannebicque from Bollé closed the day with her presentation on prescription sports eyewear, ‘Playing it safe’. In conjunction with all the lectures, Paul Hotchkiss from Silhouette ran an informative workshop on rimless repair and adjustments, adding his usual good humour to the day. At 5pm everyone seemed to have enjoyed the day and as we were at Port Sunlight with its soapy connections, we all made a clean getaway… We would like to say a huge thank you to all of our sponsors – Essilor, Eyespace, William Morris, Charmant, Bollé, Advanced Optical, Silhouette, Wolf Eyewear, the Eyewear Company and OWP, without whom these events would not be possible. Email your Area news and reports to [email protected] Dispensing Optics MAY 2015 17 Technology and innovation At the British Contact Lens Association (BCLA) conference and exhibition in Liverpool this month, the great and the good of the contact lens industry will be showcasing their latest technologies. We take a look at just a few of the innovations taking contact lens practice to the next level… Chance to try technology fused lenses Expanded sphere range for increased options Extended parameter range for unique lens offering 18 Dispensing Optics MAY 2015 INFUSION OF TECHNOLOGY FOR PRESBYOPES Safilens will be offering live fittings of its Fusion 1day Presbyo contact lenses at the BCLA conference and exhibition, being held at the ACC Liverpool from 2931 May. The first daily lens for presbyopia based on the company’s patented Fusion Technology, the Fusion 1day Presbyo is described as ensuring “incomparable, exceptional depth of field and sharp images for distance, intermediate and close-up vision, even for the most demanding myopes”. Fusion Technology incorporates a co-polymer made from Tamarind-Seed Polysaccharides (TSP) and hyaluronic acid (HA) into the contact lens. This synergy is said to heighten the well-known properties of TSP and HA in hydrating, lubricating and protecting the surface of the eye from mechanical stress caused by wearing contact lenses, thus promoting the re-growth of epithelial microvilli. The lenses are said to be quick and easy to apply, whilst offering excellent hygiene, comfort and practicality. Fusion 1day Presbyo is available with an 8.60mm base curve, 14.10mm diameter and powers ranging from +8.00D to -10.00D. TO BIOFINITY AND BEYOND CooperVision’s Biofinity XR significantly expands the range of sphere powers available, allowing practitioners to fit a greater number of monthly replacement lens patients including wearers with significant hyperopia or myopia. Available in powers from +8.50D to +15.00D (0.50 steps) and -12.50D to -20.00D (0.50 steps), the existing Biofinity line continues to be available in +8.00D to -12.00D powers. “The advanced design incorporated into both Biofinity XR and Biofinity lenses makes it easy for practitioners to have a high degree of fitting success, even for patients with more extreme needs,” said Dr Juan Carlos Aragon, CooperVision senior vice president, global professional and clinical affairs. Biofinity and Biofinity XR utilise Aquaform Comfort Science, combining a balance of high oxygen permeability, high water content, a naturally wettable material that resists deposits for all day comfort and an optimum modulus for a softer, more flexible lens. WORLD’S FIRST FLAT PACK CONTACT LENS ON SHOW The world’s first daily disposable flat pack contact lens, Miru 1day Flat Pack, will be showcased by David Thomas Contact Lenses/Menicon (DTCL) at the BCLA conference this month. A Gold Sponsor of the event, DTCL will be discussing the highly differentiated product which, when opened, presents itself on a unique dispensing platform with the outer surface of the lens facing upwards. The aim is to eliminate patient confusion about lens orientation and reduce the chances of touching the inner surface of the lens, and thus reduce the risk of harmful microorganisms or debris getting trapped between the lens and eye. The parameter range has increased recently and now includes plus powers up to +4.00D. Also on show will be the company’s Rose K2 Soft lens, an alternative for fitting the irregular cornea, particularly when rigid lenses are not successful, and MeniCare Pure, the newest multipurpose solution manufactured by Menicon to promote healthy RGP lens care. The product is the first solution formulated with natural ingredients as such -polylysine (instead of PHMB) as a disinfecting agent as well as vitamin C glucoside and hyaluronic acid. LENSES WITH THE GENTLE TOUCH European contact lens manufacturer mark’ennovy has launched additional designs for its Gentle 59 brand with Gentle 59 multifocal and multifocal toric for astigmatic and presbyopic patients. The new options join the existing Gentle 59 parameter range, which includes sphere powers of +30.00D to -30.00D in 0.25 steps and cylinder powers of 0.75 to -8.00 in 0.25 steps and all axes in one-degree steps. A wide range of parameters, 59 per cent water content, UV blocking and handling tint are some of the benefits of the range, along with ease of handling, a low co-efficient of friction of 0.05 and a low dehydration rate of less than one per cent. Multifocal and multifocal toric designs with different optical zone diameters for each reading add complete the individually made Gentle 59 contact lens family. Gentle 59 together with Gentle 80 – named Contact Lens Product of the Year at last month’s Optician Awards – and Saphir RX offer an optimum solution to meet the diverse needs of contact lens wearers, says the company. CONTACT LENS DEBUT WITH DESIGNER EDGE Mondottica International has launched its Mondottica Vision platform for its ‘designer contact lens business’. The initial programme features the designer brand, Anna Sui, available in a range of colours and motifs including the Anna Sui Rose, Lace and natural textures; in plano and a full range of prescription powers. Agreements have been signed or are pending for six Asian markets in Korea, China, Hong Kong, Singapore, Malaysia and the Philippines and the products will only be sold through eyecare professionals. Manufactured in state-of-the-art facilities in Korea and Taiwan using dual-layer coating technology and internationally recognised quality control methods, the lenses are licensed and approved by regulatory authorities worldwide. South Korea will also see the launch of a technologically refined collection produced with silicone hydrogel materials. Mondottica chairman, Michael Jardine, said: “After many years of research and development we are pleased to finally cut the ribbon on this wonderful programme, and we are thrilled that Anna Sui has agreed to be the leader in this new field of Designer Contact Lenses.” POST-SURGERY LENS THAT TICKS ALL THE BOXES KeraSoft Thin is the latest addition to UltraVision CLPL’s specialist range of KeraSoft contact lenses, and is designed to fit all irregular corneas, including post-refractive surgery, pellucid marginal degeneration (PMD) and other corneal irregularities. According to the company, the main ocular health benefit of KeraSoft Thin is a reduced centre thickness (0.20CT), which increases oxygen permeability and improves comfort. KeraSoft Thin is said to be ideal for corneas where reverse geometry is required or maximum oxygen transmission is the main point of concern. The lens is available in a choice of two materials: a three-month 74 per cent water content silicone hydrogel material, and a durable annual lens in a high water content 77 per cent hydrogel material. New options for astigmatic and presbyopic patients Designer lenses launch in Asia markets Specialist lens with ocular health benefits THREE CLEAR REASONS TO EXPLORE THE RANGE Following the success of its first biocompatible silicone hydrogel monthly contact lens, Beyond, Clearlab’s new Beyond for Astigmatism range offers a complete range of cylinders (up to -2.25) and axes (by 10) from +4.00D to -8.00D. Based on the same material as Beyond, Beyond for Astigmatism uses Clearlab’s patented dynamically stabilised lens design. Also new from the company is Eyedia, a multipurpose solution equipped with conditioning agents and moisturiser to improve comfort and promote the hydration of the lens. Eyedia effectively removes proteins and lipid deposits, and eliminates loose debris, caused by environmental contamination, from the lens. The solution is approved for use with hydrogel and silicone hydrogel contact lenses. See these products at the BCLA conference, as well as Clearlab’s Clearcolor 1-day cosmetic lenses. Stand visitors will also be in with the chance of winning a premium make-up experience in a luxury spa hotel. Next month’s product spotlight is on dispensing tools and instruments Clearlab’s Beyond range has been expanded Dispensing Optics MAY 2015 19 COMPETENCIES COVERED Dispensing opticians: Contact Lenses Contact lens opticians: Verification and Identification, Contact Lenses Optometrists: Contact Lenses IMPORTANT: CLO competency requirement Contact lens opticians will notice that this article is approved for the Contact Lens competency of Verification and Identification. This competency is rarely offered by CET Providers, so will remain active until December 2015. CLO ABDO members are strongly recommended to complete the article and answer the multiple choice questions so that they can ensure that their CLO competency requirements are met. Contact lenses with a difference n modern contact lens practice, opticians could be forgiven for feeling that nearly all contact lenses, especially those on a regular disposable modality, are all very similar. However, when details of products are closely examined, most offer some differences of design, material or packaging. A review of the Association of Contact Lens Manufacturers’ (ACLM) Contact Lens Year Book1 soon demonstrates this. But beyond this, and without delving into the true specialist contact lens types, there is also a group of contact lenses that clearly demonstrate some unique features, making them worthy of note for contact lens I by Keith Cavaye FBDO(Hons)CL FBCLA opticians (CLOs) and all other optical practitioners with an interest in different product availability. The purpose of this article is to describe a small number of these differing lenses, pointing out their usually unique feature(s) and particular benefits. It must be emphasised that this list is not exhaustive, but limited by space on this occasion. The author would like to make it clear that inclusion in this article is not a recommendation or guarantee of all benefits explained, but generally based on the manufacturer’s descriptions and guides. Only single vision lenses will be described here, although some products are available as astigmatic or multifocal options. DAILY DISPOSABLES This extremely popular modality has seen a large expansion of choices over the last few years, sometimes leaving the practitioner uncertain of the genuine differences. Indeed the 2014 edition of the ACLM Contact Lens Year Book, which only includes products produced by its members, lists 102 single vision choices from just four manufacturers2. A brief summary of parameters and specifications available for the three daily disposable lenses described here are shown in Table 1. MIRU 1 DAY The Miru 1 day Menicon Flat Pack, by David Material Water Content DK (traditional units) TD (mm) BOZR (mm) Power Range (D) Miru 1 Day hioxifilcon A 57% 19 14.20 8.60 -0.50 to -10.00 Dailies Total 1 delefilcon A 33% core >80% surface 140 14.10 8.50 -0.50 to -10.00 Proclear 1 Day Omafilcon A 60% 25 14.20 8.70 +8.00 to -12.00 Table1. Key features of the daily disposable lenses described This article has been approved for 1 CET point by the GOC. It is open to all FBDO members, including associate member optometrists. The multiple-choice questions (MCQs) for this month’s CET are available on page 24 and online. An answer sheet for posted or faxed entries is available for download on ABDO’s Dispensing Optics log-in page. Online entry: log in to www.abdo.org.uk, and follow the centre section link to ‘CET Online’.Please ensure that your email address and GOC number are up-to-date. The pass mark is 60 per cent. The answers will appear in the January 2016 issue of Dispensing Optics. The closing date is 12 December 2015. 20 Dispensing Optics MAY 2015 C-39983 Figure 2. The outer surface prominent on opening Miru Figure 1. Extremely thin packaging of Miru 3 pack Thomas Contact Lenses/Menicon, is a daily disposable contact lens made of hioxifilcon A, with a water content of 57 per cent and an oxygen permeability of 19 traditional units3. As with many lenses, claims are made regarding excellent wettability and low dehydration rates3, but the obvious difference with Miru is the packaging, which leads to improved patient handling and reduced risks of microbial contamination4. Each foil strip contains three lenses, but can realistically be described as ‘flat packed’, as the total thickness is only 1mm or 0.04 of an inch thick. As there is just 0.2ml of solution in each foil, its lightweight packaging makes it very portable in a wallet or handbag (Figure 1). When opened correctly, the outer surface of the lens is always facing up, ready to be picked up and placed on the eye (Figure 2). This reduces the possibility of a lens being inside out – surely a step forward for patients who struggle with this aspect of wear. It also reduces any chance of touching the inner surface of the lens, minimising the risk of microorganisms or debris being trapped under a lens. In an ‘in house’ test conducted by Menicon4, fingers were contaminated with a standard sample of staphylococcus aureus bacteria before removing lenses from the package. Inner and outer surfaces of the lenses were then cultured separately so that bacterial growth could be observed for each surface individually. On the inner surface of the Miru 1day lens, no bacterial growth was observed. DAILIES TOTAL 1 Described by Alcon as the first water gradient contact lens5, this interesting concept aims to combine the benefits of silicone hydrogel with both high and low water content material in one lens. Made from delefilcon A, the structure of this design has a core of silicone hydrogel, low water content (33 per cent) material forming the bulk of the lens, leading to a claimed transmissibility of 156 traditional units at -3.00D5, with a Dk of 140 units. This is the highest transmissibility of any daily disposable available to date. But perhaps the really unique feature is that as the surfaces of the lens are approached from the centre, both front and back, a transition occurs in the water content, leaving the surface of the lens with a water content of more than 80 per cent (Figure 3). These two surfaces each account for around six per cent of the central lens thickness. The anticipated benefits are a very breathable contact lens, but with a wettable, lubricious and extremely low modulus surface giving improved comfort. PROCLEAR 1 DAY Proclear 1 Day from CooperVision has been on the market for a number of years, so why would it be included in this article? Well, it still has some ‘differences’ that make it stand out from the crowd. Between 50 and 75 per cent of all contact lens wearers suffer from dry eye symptoms6. Proclear was designed to combat dehydration, making lens wear comfortable for longer periods. It was developed with phosphorylcholine (PC) technology, which has both positive and negative charges on the molecules. Such molecules are known as zwitterionic7, with the intended benefit of allowing the lens to bind tightly with water, thereby resisting dehydration. The manufacturer claims this also reduces dry spots and protein deposition on the lens surface. Another benefit of this product, which warrants inclusion here, is the extended power range available. It is one of a very few lenses that a myope of -12.00D can wear (Johnson & Johnson Vision Care also offer this high power in their daily range), but more unusually for a daily disposable Figure 3. Schematic of cross section of Dailies Total 1 Dispensing Optics MAY 2015 21 lens, hypermetropic patients requiring +8.00D can also be accommodated, making it a very useful tool to have in the practice armoury (Figure 4). Figure 4. Proclear 1 Day from CooperVision Figure 5. Lathing process as used by mark’ennovy Steps BOZR (mm) 6.80 to 9.80 0.30 Total Diameter (mm) 13.00 to 16.00 0.50 Power (D) -30.00 to +30.00 0.25 Cylinder (DC) -0.75 to -8.00 0.25 Axis (degrees) All 1 Addition (D) +0.50 to +4.00 0.50 Table 2. Parameter range of Saphir Rx by mark’ennovoy 22 Dispensing Optics MAY 2015 SAPHIR RX The range of contact lenses expands rapidly as we move into disposable modality of up to one month, which generally encompasses weekly, two weekly and monthly disposable lenses. Indeed, the ACLM Contact Lens Year Book lists 29 products in this category8, with an increasing share of the products (more than 40 per cent) now being silicone hydrogel material. Generally, these lenses are moulded, needing extremely accurate moulds to be manufactured at high cost. This, in turn, tends to limit the parameter range available to the practitioner. Unusually for a monthly replacement lens, mark’ennovy uses a lathing process to produce Saphir Rx (Figure 5). This offers the opportunity to produce an almost unlimited range, by individually making lenses in Filcon V3, a silicone hydrogel material. Filcon V3 has a high water content of 75 per cent, which in turn leads to its low modulus of 0.29 (MPa)9, and mid to high oxygen transmission of 60Dk9. The actual parameter range includes powers from -30.00D to +30.00D and total diameters up to 16mm, whilst also including a choice of radii. The full range is shown in Table 2, which can also incorporate toric, multifocals and toric multifocals. Due to this unusual availability, apart from the more standard prescriptions, the manufacturer recommends Saphir Rx be considered for high refractive error, steep or flat corneal curvature, irregular cornea and patients who need differing overall diameters. With these choices, there will surely be very few patients that are unsuitable to try monthly disposable contact lenses. DUETTE HD Moving away from everyday contact lens practice a little, the Duette HD range (there is a Duette HD progressive for presbyopes) from No7 Contact Lenses seeks to offer a premium performance by combining the optical performance of rigid lenses with the comfort of soft lenses. This is a true hybrid lens, with a central rigid gas permeable (RGP) portion of 8.5mm in diameter, bounded by a soft skirt of 14.5mm diameter (Figure 6). Good oxygen permeability is achieved by using silicone hydrogel for the skirt, of hemlarafilcon A lenses are described as ‘reverse geometry’ designs and are usually, but not always, fitted with the aid of a topographer. They also need to be worn overnight to achieve the required modification to the prescription. They are available from a number of UK suppliers including Scotlens, David Thomas Contact Lenses, Bausch + Lomb, Northern Lenses and No 7 Contact Lenses. Hopefully, this short review of easily available, but slightly different contact lenses on the UK market will open the eyes of readers and encourage opticians to research all options available to better serve our patients. Figure 6. The Duette HD hybrid design material with 84 Dk (traditional units) and Petrafocon A, 130Dk for the rigid centre. Visually, rigid lenses are usually considered to give the best quality and naturally correct the majority of corneal astigmatism with the tear layer that is trapped between the lens and cornea. The manufacturer suggests up to 6.00DC may be corrected without the need to incorporate toroidal surfaces on the lens. Due to the soft skirt, there is less lid interaction compared to traditional RGP lenses, resulting in initial comfort approaching that of a soft lens. No 7 Contact Lenses suggests that patients who would benefit from a fitting would include astigmats unhappy with soft lens vision, RGP wearers who are finding their lenses less comfortable and those who have failed with other options. The recommended BOZR (mm) 7.10 to 8.30 in 0.20 steps Total Diameter (mm) 14.50 Power (D) +10.00 to -15.00 Water Content Skirt 32% Skirt Curvature Flat, Medium, Steep Table 3. Parameter range of Duette HD by No7 Contact Lenses replacement schedule is six months. As more than one material is being used in these lenses, the care procedure is a little more complicated. One option is to disinfect using a peroxide system and store in a multipurpose solution. Parameters are shown in Table 3. CONCLUSION In conclusion, and somewhat out of the remit of this article, the author points out that there are also true specialist lenses to be explored. An example of this category are RGP lenses for orthokeratology. In general, these lenses go against the traditional mode of RGP fitting, where the back surface of the lens attempts to follow the curvature of the cornea by a series of increasingly flatter curves as the lens edge is approached from the centre or by using an aspheric design following the same principle. Orthokeratology aims to reduce ametropia, usually myopia, by reshaping the cornea. Simply, this is achieved by fitting a lens with a central curve flatter than the cornea, surrounded by a steeper first peripheral curve, then with more traditional ‘fitting’ curves outside this to aid stabilisation and tear exchange. An unusual ‘bulls eye’ fluorescein pattern results. The combination of a flat central curve and steep mid-peripheral curve induces central corneal flattening (and so reduces myopia) as a result of changes in fluid pressure10. Such REFERENCES 1. Association of Contact Lens Manufacturers (ACLM) Contact Lens Year Book 2014. 2. ACLM Contact Lens Year Book 2014. p. 30. 3. Technical details from David Thomas Contact Lenses. 4. Menicon in-house test data. 5. Alcon Product Guide (September 2014). 6. The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye Workshop. Ocul. Surf. 2007 5 (2): 93-107. 7. Collins English Dictionary. 8. ACLM Contact Lens Year Book 2014. Pages 34-36. 9. Made-to-Measure Contact Lenses, mark’ennovy. 10. Downie L, Orthokeratology: a clinical overview. Optometry Today 2015 10 January, pp 44-48 KEITH CAVAYE FBDO(HONS)CL, SMC, FBCLA is currently working as an independent locum contact lens optician and consultant. For nine years he was a sessional lecturer at Anglia Ruskin University. His previous positions include professional services manager Indigolighthouse Group, contact lens product manager at Dollond & Aitchison, and contact lens services manager at Boots Opticians. He is also a past British Contact Lens Association council member, ABDO board member and past GOC council member, still serving on various GOC committees. Other optical interests include ABDO contact lens practical examiner, member of the ABDO Contact Lens Committee and chairman of ABDO CET Committee. He has published various articles on contact lens-related subjects. Dispensing Optics MAY 2015 23 MCQs Multiple choice questions: 1. Which statement is incorrect regarding the Miru 1 day Menicon Flat Pack lens? a. There is 0.2ml of solution surrounding each packaged lens b. This lens is made of hioxifilcon A c. In its package the outer surface of the lens is always facing down d. Each foil strip contains three lenses 4. Complete the sentence correctly. The Proclear 1 Day lens is designed… a. with special technology enabling molecules to have only positive charges b. with the power range from -8.00 to -12.00 c. in delefilcon A material d. to reduce dehydration 2. Complete the sentence correctly. Orthokeratology attempts to reduce myopia by… 5. Which statement is correct? a. The Saphir Rx lens is available with an addition from +1.00 to +3.00 b. Hemlarafilcon A material has a traditional unit Dk value of 84 c. Filcon V3 is a true hybrid material d. The ACLM Contact Lens Year Book 2014 shows that more than 60 per cent of listed disposable extended wear lenses are made from silicone hydrogel material a. b. c. d. fitting a lens with a central curve flatter than the cornea employing a lens with inverse geometry design having a flatter mid-peripheral curve restricting wear to daytime only 3. Complete the sentence correctly. The Duette HD contact lens… a. attempts to link the optical performance of soft lenses with the comfort of rigid lenses. b. has the peripheral area made of hemlarafilcon A material c. has a central portion with a diameter of 14.5mm d. is available with a back optic zone radius between 7.40 and 8.60 6. Complete the sentence correctly. A ‘bull’s eye’ fluorescein pattern may result from… a. prolonged use of extended wear lenses b. high water content lenses with a low modulus c. fitting a lens with a central curve flatter than the cornea, and a steeper first peripheral curve d. a well-fitting rigid gas permeable lens www.abdo.org.uk Contact lenses with a difference by Keith Cavaye FBDO(Hons)CL FBCLA THE DEADLINE FOR POSTED OR FAXED RESPONSE IS 12 DECEMBER 2015. The module code is C-39983. Online completion - www.abdo.org.uk - after member log-in go to ‘CET online’ After the closing date, the answers can be viewed on the 'CET Online' page of www.abdo.org.uk. To download, print or save your results letter, go to 'View your CET record’ after the closing date. If you would prefer to receive a posted results letter, contact the CET Office 01206 734155 or email [email protected] Occasionally, printing errors are spotted after the journal has gone to print. Notifications can be viewed at www.abdo.org.uk on the CET Online page ALCON ‘GIVES IT A GO’ WITH £5K CAMPAIGN GIVE IT A GO! FREE first mon m th’s supply for your next 6 patients! Sector growth initiative 24 Dispensing Optics MAY 2015 Alcon is investing £500,000 in a ‘Give it a go’ campaign to drive contact lens sales in the independent sector. A range of point-of-sale materials, designed to encourage patients browsing frames to plump for a contact lens trial, includes frame tags, mirror clings, posters, strut cards and placement guidelines. Specially designed frame tags means contact lens and frames can be promoted simultaneously. Patients are offered a free month’s supply of the latest products in the Alcon portfolio. The company stated: “Alcon understands the importance of growing the contact lens patient base in the independent channel and hopes that independent practitioners will use the ‘Give it a go’ campaign to engage their patients with contact lenses and generate incremental sales.” GIVE IT A GO! Fra ame tags A5 strut card ds Mirro or stickers Six of the following questions were presented online to entrants to comply with the GOC’s best practice specifications for this type of CET 1. The term polymer, in the context of spectacle frame production, means: a. The substance has in-built tensile strength and elasticity b. The bonds between molecules in chains can be broken and re-attached c. Molecules are bonded together in long repeating chains d. Combining many large monomer molecules into a chain held together by covalent bonds c is the correct answer. A polymer is a chemical compound where molecules are bonded together in long repeating chains. These materials have unique properties and can be tailored depending on their intended purpose. They can be man-made and occur naturally as in rubber. 2. Complete the sentence correctly. The quality of cellulose acetate material is largely determined by: a. the filtration process and the quality of the fine, silky fibres which adhere to the seeds of the cotton plant b. the type of plasticiser used in the paste and its reaction with acetic acid c. the method of extrusion employed to form the basic material d. the length of time taken for the partial hydrolysis process to occur a is the correct answer. Best quality cotton linters and an extensive filtering procedure are required to produce the best quality product. 3. Which statement is true about cellulose propionate? a. It is a thermosetting epoxy resin b. It is less transparent than cellulose acetate c. The production process is by injection moulding d. The material is lighter than SPX c is the correct answer. The routing technique is not appropriate for this material. 4. Spectacle frames made from SPX material sometimes have in-line glazing. This is because: a. it has a tendency to shrink when heated b. of the need for cold glazing c. the rims can be made very thin d. an injection moulding process is used in frame manufacture c is the correct answer. Because the material can be made very thin and remain stable, there would not be sufficient material to include a conventional groove to accept the lens bevel. 5. Which statement is false concerning the material Grilamid? a. The softening point is 85 degrees C b. Frames need to be cold glazed c. It is made up of four sub-groups of long-chain aliphatic polyamides d. There is an average of 16 or more carbon atoms in the basic structure. d is the correct answer. There is an average of 12 or more carbon atoms. 6. Complete the sentence correctly. The epoxy resin Optyl is: a. 20 per cent lighter than other thermo plastics b. successfully adjusted at up to 80 degrees C c. affected by some types of cosmetics d. considered to be hyperallergenic a is the correct answer. At least 80 -120˚C is needed to adjust this material; it is not affected by chemicals or cosmetics and is hypoallergenic. 7. Which statement best describes the injection moulding process? a. There are four stages in which temperature and pressure are gradually increased b. Pressure, friction and heat are used to force molten material into machined moulds c. Polymer is forced into a mould in three zones, the second allowing air to intrude d. A mould is machined to an accuracy of 1/100mm and molten polymer poured in b is the correct answer. All three factors are required to prepare the polymer for moulding. 8. Which statement is true? a. Cellulose acetate frames are generally produced by moulding b. Nylon polymers contain a high percentage of plasticisers c. In-line glazing requires a nylon cord d. Cellulose propionate is likely to shrink if over heated d is the correct answer. This becomes critical over about 70˚C. To download, print or save your CET result letter, go to www.abdo.org.uk. Log-in and go to 'View your CET record'. Plastic fantastic by Joanne Abbott BSc(Hons) FBDO SMC(Tech) FOR THE MOST UP-TO-DATE ABDO EVENT DETAILS keep an eye out for the eNews landing in your in-box, and the events section of the website, visit www.abdo.org.uk/events Dispensing Optics MAY 2015 25 Do current designs provide sufficient control of the development of myopia in children? asks Martin Conway’ Myopia control with contact lenses he growth in the prevalence of myopia in children has been well documented and is now acknowledged to be of epidemic proportions. Theories as to the cause of myopia in children have been suggested for centuries, but in recent years well-controlled studies have provided us with vital clues as to what can trigger the eye to elongate. At present, the prevalence of myopia is highest in Asia. A study published in Investigative Ophthalmology and Visual Science (IOVS) in November 2012 by Jing Sun, Jubo Zhou, Peiquan Zhou et al, showed that of 5,060 university students examined, 95.5 per cent were myopic, with a mean prescription of -4.12D. More worrying was the finding that 19.5 per cent of them had myopia of -6.00D or more, with all the attendant problems that this might cause in later life. T FOCUS ON ENVIRONMENTAL FACTORS The problem of myopia is also worldwide and has developed within two generations. Whilst there may be a predisposing genetic link making the Asian eye more prone, the fact that it has developed so quickly means Time spent outdoors may reduce the progression of myopia 26 Dispensing Optics MAY 2015 that most researchers are looking at environmental factors as the main culprits. The changes that have occurred in the way children are spending their playtime has dramatically altered over the decades. Children growing up in the 1950s and 1960s spent little time in front of the TV and were allowed to play outdoors. Today’s parents live in fear, real or imagined, of traffic and/or predators and are less likely to allow children unsupervised playtime outside of the home. TV and other screen-based activities such as game consoles have kept children glued to a screen, sometimes at distances much shorter than the normal reading distance. A study published in IOVS in December 2012 by Cindy Karouta and Regan Scott Ashley, into the correlation between light levels and the development of form deprivation myopia (FDM), concluded that the level of protection against FDM increases with increasing light intensity and daily exposure to 40,000 lux almost completely prevents the onset of FDM, and once myopia is established, halts further progression; 40,000 lux is the equivalent of sitting outside on a very sunny day. For comparison, an overcast day would provide 1,000 lux per hour and the average home 250. The time required would be two hours per day for prevention of FDM. Despite this evidence, there is little chance of changing behaviours that have become such an intrinsic part of modern life, so we must look for optical solutions to the problem. For many years, some practitioners believed that by fully correcting myopia in a child, we would somehow encourage it to grow and so they routinely under-corrected by as much as -0.75D to reduce the accommodative effort. This has proven to be not only ineffective, but in fact contributes to the problem. Bifocal spectacles, again for the alleviation of accommodative effort, have also been used to try to achieve the same effect. OPTICS OF MYOPIA CONTROL There is a significant difference between the minimal impact that GP lenses have on myopic progression, compared with that obtained with an ortho-k lens. Why should that be the case? There has also been a significant variance in the rates of retardation obtained in various studies, conducted using similar groups and similar lenses. Some have claimed that myopia progression was slowed by as much as 63 per cent, whereas another was as low as 36 per cent. What could possibly explain those differences? Studies have shown inconsistent rates of control If we look at the way an ortho-k lens works and the image shell it produces, then we may find a theoretical answer for what appears to be a tremendous variance in outcome. Work done by Jennifer Choo in 2008 showed that in ortho-k, the central epithelium is compressed, whereas that under the reverse curve zone is expanded to produce the typical profile seen in ortho-k. Topography also reveals that an oblate curve is produced by the epithelium, which gives an equal but opposite power at the periphery of the optic zone. If a -1.00D change is achieved in the central 2.00mm, then an equivalent +1.00D effect occurs at the periphery of the zone. The studies conducted previously, using Ortho-k produces an “ equal and opposite” effect on peripheral power conventional ortho-k designs, recruited candidates generally with a prescription of between -1.00D and -4.00D in the spherical power, and under -1.25D in any cylindrical error. If the myopia control effect is dependent upon the amount of plus generated at the periphery, then those studies with a cohort of lower-powered myopes would achieve less retardation than those studies whose cohorts’ average myopia was closer to 4.00D. This may explain why there was such variance in the outcomes of those studies. Eddie Chow of Toronto demonstrated an enhanced myopia control effect when using an aspheric ortho-k design, which produced increased plus at the periphery compared with traditional designs. It would appear, therefore, that there is a direct link between the plus power produced in the periphery and the amount of myopia control exerted. We need to develop lenses that produce Ideal image shell required to achieve full myopia control an image shell that, independent of the central power, will produce more plus in the periphery. This concept applies to both ortho-k and soft lenses. PUTTING IT INTO PRACTICE As the public become more aware of the prevalence of myopia and the implications for their children, and as they also become aware of potential remedies that may exist, practitioners will increasingly need to be familiar with the products that are available. Current contact lenses, whether ortho-k or soft multifocals, may have an effect on the development of myopia in a given child, but at present a practitioner cannot guarantee what the outcome is likely to be over a treatment period of several years. Ortho-k, in the UK at least, is fitted by very few specialist practitioners. Those who fit children may well do so in the hope that the wearing of this type of lens will reduce the progression of myopia in that child. Certainly the parents of the child will be hoping for such an effect, in return for potentially many years of paying for the product. At present, it is impossible for a practitioner to guarantee that outcome, as most lenses supplied in the UK are of conventional spherical design. The correct amount of peripheral plus required to achieve complete control is yet to be determined, but best estimates put it at around three to four dioptres. This means that using conventional ortho-k lenses, the child needs to be at least -3.00D to achieve any meaningful slowing of the myopic progression. Ideally, we would like to intervene at the earliest possible time to nip the myopia in the bud, certainly before the prescription has reached -1.00D and that lens needs to produce a central treatment zone to correct the -1.00D axial myopia at the fovea, but then produce an image shell that moves the peripheral image forward of the retina by the equivalent of three to four dioptres. Current lenses do not achieve this. A child going into ortho-k at -1.00D will have a slowing down of the rate of increase, but will still progress, albeit more slowly than otherwise. As the short-sightedness reaches the -3.00D to -4.00D level, the increased plus produced in the periphery will begin to take effect and the slowing of the progression will begin to stabilise the prescription at around the -3.00D to -3.50D level. Many practitioners will count this as a success, particularly if the parents are -6.00D or more. Lenses do exist which, in clinical trials, have not only halted the progression of myopia, but in some cases reversed the initial level slightly. They do this by creating an image shell similar to that shown in the illustration. This optical effect may also be produced in a soft silicone lens that may be worn as a conventional daily wear lens for those parents who do not wish to go down the ortho-k route. This type of lens is a ‘work in progress’ and not as well documented as the ortho-k version, but initial results are promising. COMMERCIAL POSSIBILITIES In January 2015, Contamac entered into a multi-year intellectual property agreement to commercialise and distribute custom silicone hydrogel and GP lenses for myopia control with the Brien Holden Vision Institute. Work is now underway to develop lenses in both soft and ortho-k designs that will give a more predictable outcome for a given prescription. We are at the beginning of an exciting process that will bring effective and predictable myopia control with contact lenses. This has been a brief introduction to the concept of myopia control using contact lenses. For more detailed information and background clinical studies that have helped formulate the current understanding of the subject I recommend http://www.myopiaprevention.org/ Martin Conway FBDO, FIACLE, FBCLA is head of professional services at Contamac. Dispensing Optics MAY 2015 27 This month, Antonia Chitty looks at strategies to encourage more of your patients to try contact lenses Building your contact lens practice ontact lenses come with many benefits. Imagine the bride who doesn’t want to wear specs on her wedding day, but never thought she was suitable for contact lenses. You’ll earn her life-long gratitude every time she looks at her wedding photos if you are the person who suggests or fits her with lenses. Consider the keen rugby playing teen, who is devastated to learn he is myopic. Again, a thorough discussion of the pros and cons of contact lenses can make a difference to this person’s life. Then, look at the figures, what makes your practice the most profit? And, looking in more depth, what offers more profit for fewer practitioner hours? Contact lenses by direct debit must come high up the list of profitable offers for many practices. For a check every six months, you have money coming in monthly. It’s good to step back and take a systematic look at how to increase the number of people wearing contact lenses. C In this article we will address three key areas. To start with, have you thought about ways to attract new people to your practice? We will then look at converting existing spectacle wearers to contact lenses. Finally, we’ll look at ways to encourage current lens wearers to upgrade or buy other products. ATTRACTING NEW PATIENTS This whole article could be about attracting new people to your practice. It can be easier to sell to your existing customer base, but there is always a turnover in any practice as patients die or move away, and some practices, such as those in towns with a university, may find that their turnover is much more rapid. Look at the turnover of patients that you have in your own practice. Make a point of asking new patients where they heard of you and what attracted them to your practice. Whether it is word of mouth, advertising, a special offer or an attractive shop window, make note to build on what succeeds. If there are Step back and look at how to grow your contact lens business 28 Dispensing Optics MAY 2015 particular barriers to accessing your practice, think what you can do to overcome them. Getting permission to put an A-frame sign at the top of the road, displaying a big arrow, can help if your practice is down a side street. If word of mouth is one of the leading reasons people come to you, make a point of discussing the health benefits of an eye examination, and asking people if they have any friends who don’t get their eyes examined regularly. To hone the type of person you attract to your practice, look at the age and gender profile of your current contact lens wearers, and consider how you can approach more of this type of person. Do more of them live in a particular part of your area? Think about where and how you can reach them. For example, if many of your contact lens wearers are also commuters, you may choose to create an advertising campaign highlighting your contact lens specialisms with an advert on the wall at the train station, and back it up with adverts in the free magazine or newspaper that is on offer at the station. Make sure that you include an offer, as this not only helps attract people, it also gives you a way of tracking if your advertising is working. Think carefully about the exact nature of your offer: it may be better to offer something extra rather than simply cut the price because people who choose where to buy their lenses based on price may not be loyal customers. CONVERTING SPECTACLE WEARERS Once you have looked at attracting more people to your practice, then the next step is to convert existing spectacle wearers to contact lenses. Spectacles and contact lenses can be complementary products, suitable for different activities and occasions. Many people will consider themselves unsuitable for contact lenses, perhaps because of their age or because Victoria Loveday is a dispensing optician at the Eye Centre in Thornton Heath, near Croydon. She says: “What we try to do to boost contact lens patients is to offer comfort trials. This works well as people try lenses while choosing their specs and then if they like them, they can book in for a fitting. The optometrist asks the patient if they would like to see better while choosing glasses and when they say yes, they just explain that they can apply a lens to their eye so they can see. “If people are nervous or worry lenses will hurt, we just offer to let them feel it. Silicone hydrogel lenses are great and people are always surprised how comfortable they are from the start. For people with astigmatism, try and go for best vision sphere; we also have a bank of multifocal lenses. The optometrist does a corneal staining check before and after insertion and removal. “The comfort trial boosts the fittings they were told years ago their prescription wasn’t suitable. The range of contact lenses available is now much greater and many more people can try lenses, and succeed with them, so it is up to you and the practice team to show people that contact lenses are a possibility for them. Part of this is a numbers game: the more people you offer lenses to, the more will try them. Making sure that the optometrist suggests contacts lenses is one way to do this; their recommendation will come with added clinical weight. It can take up to seven opportunities to consider a new idea before people try something new, so make sure that you explain how contact lenses are now suitable for more people in your practice newsletter, and back this up with advertising, staff recommendations, materials available in your practice and/or a window display. Understanding your patient can help you demonstrate how contact lenses can help them. For example, a sporty person may want lenses for one reason, a fashionista for completely different reasons, and you need to shape your explanations of the benefits to match their motivations. Another suggestion is to offer lenses to people to aid in choosing frames. This was done in the EASE study (Enhancing the Approach to Selecting Eyewear); read the Victoria Loveday more than just offering a fitting, we have found, and it usually only takes an extra five minutes for the checks. Generally the uptake of a further contact lens trial is usually about 70 per cent when you get the wording right and gain confidence offering it.” case study for one dispensing optician’s view on how it works in practice1. of frames, ask the rep if they can help to ensure that the promotion works for the practice bottom line as well as offering value to patients. This is when it is vital to have the email address of your patients. Send them a message at the start of the offer, and remind them again as it comes to a close. People need several reminders to act. Point out the benefits in your offer, such as how your new range of designer spectacles can complement an outfit, so people desire the product on offer. So, if you would like more contact lens patients in 2015, invest some time this month in planning a strategy to boost the numbers of people entering your practice, the numbers trying contact lenses for the first time, and the add-on sales to current patients. Create a plan for your practice and make sure that every member of the team is briefed and equipped to make contact lenses a key part of what you offer this year. UP-SELLING TO EXISTING WEARERS The final element in this strategy to boost your practice’s contact lens business is to encourage current contact lens wearers to spend more. With the dominance of daily disposables, solutions are no longer a significant business, but there are plenty of other purchases that you can encourage contact lens wearers to make. Remember, they already know you, like you and trust you; regular check-ups lead to a good professional relationship. Make sure that you offer them something that makes them feel valued, because they are of great value to your practice. Some practices offer an ongoing discount on spectacles or sunglasses but this can be taken for granted. Instead, why not create a programme of shorter, seasonal offers, perhaps for one month every quarter: sunglasses for summer, an offer on coloured lenses in the run up to Halloween or Christmas, and an offer on spectacles, plus an explanation of why contact lens wearers can benefit from having specs too, at any time of the year. Make the offer time limited and compelling; 10 per cent off probably won’t cut it. If you are offering a particular range REFERENCE 1. Atkins NP, Morgan SL and Morgan PB (2009) Enhancing the approach to selecting eyewear (EASE): A multi-centre, practice-based study into the effect of applying contact lenses prior to spectacle dispensing Contact Lens & Anterior Eye 32: 103–107. Dispensing Optics MAY 2015 29 Amy Rothwell, Bausch + Lomb head of eyecare marketing (left), speaks to Nicky Collinson about how the company is supporting CLOs in practice Bio-inspired eyecare NC: What is your primary goal currently in terms of product and service development in the UK marketplace? AR: As a company we have been pioneers in eyecare for over 160 years and the creators of many optical ‘firsts’. For instance, we were responsible for the first soft contact lenses. Just recently we introduced the Biotrue ONEday for Presbyopia, an innovative breakthrough which incorporates 3-Zone Progressive Design technology to deliver excellent near, intermediate and distant vision. Today, the company’s commitment to excellence in the eyecare profession is stronger than ever and we continually invest in research and development to create the latest eyecare product ‘must haves’. While product development is key, so too is the need to support independent eyecare practices. That’s why we have created and continue to develop bespoke customer programmes such as the Biotrue ONEday challenge, to help practitioners drive patient trials and education. Those taking part in the Challenge will be offered customised practice support materials and a patient incentive programme. Patients who trial the lens can enter a free prize draw to win a trip for two to New York and everyone who takes part will receive a £10 money off voucher redeemable at the originating ECP practice1. NC: How important are supplementary eyecare products to help build patient loyalty and practice business? AR: This sector is very important to our business. We have diversified our portfolio to include dry eye products and innovations like our Biotrue rewetting drops, which can be used alongside our contact lenses to provide a healthier eyecare experience for the patient. NC: How do your products support CLOs to encourage new fittings and reduce patient drop-outs? AR: Drawing inspiration from nature is a fundamental part of our strategy. For 30 Dispensing Optics MAY 2015 example, Biotrue ONEday lenses are made from a premium hydrogel material called HyperGel, which locks in water during the manufacturing process. This lack of dehydration allows the material to stay wet, maintain its shape and provide consistent comfort all day. With patients working longer days, lenses are often worn for more than eight hours, and Biotrue ONEday lenses have been shown to retain moisture for up to 16 hours2. By using innovative materials like HyperGel, the CLO can be confident fitting our Biotrue ONEday lenses, and the customer can immediately feel the difference. Biotrue ONEday for Presbyopia is our latest new lens on the market and a very good example of where we have listened to the needs of the patient. A common challenge for patients suffering from presbyopia can be distorted peripheral vision, making it difficult to judge stairs for instance. The lens incorporates 3-Zone Progressive Design technology to deliver excellent near, intermediate and distant vision. NC: What additional support can you offer the practice team to ensure they have the right knowledge to tailor products to their patients’ specific needs? AR: We can offer a variety of education and business initiatives for practice teams that can be bespoke. For instance we have a dedicated team that go into the practice to deliver workshops around working hours and product training geared to all levels of staff. In addition, we offer CET distance learning via our academy training scheme. NC: What role does your company have in helping to grow the contact lens market in general? AR: Comfort, improved eye health and vision needs remain at the heart of our research and development. However, what makes us so different to our competitors is that we draw inspiration from nature with all of our lens innovations. Nature is a good starting point for answers to scientific and technical problems; scientists and engineers are increasingly turning to nature for inspiration. ‘Bio-inspiration’, which we created a few years ago and which is very much our strategic backbone, is a discipline that studies and learns from nature’s best ideas to generate breakthrough products and technologies. Bio-inspiration is a proven method for developing new products but it does not mean the same thing as ‘green’ or ‘natural’. So, the Biotrue multi-purpose solution we have on the market makes wearing contact lenses easier on people’s eyes, because it matches the pH of the tears and uses a lubricant found in the eyes, as well as keeping key beneficial tear proteins active. This means the wearer gets continuous comfort and superior disinfection. NC: It’s the BCLA conference at the end of this month. What will you be focusing on during this event? AR: We’ll be focusing on all areas of our vision care business, including our full range of monthly and daily brands as well as our entire GP portfolio. We will also be telling visitors to our stand about the exciting, new innovative sclerals range via live demonstrations and an ‘Ask the expert’ panel. Come and meet the team at Stand 25 in the ACC Liverpool (29-31 May) to hear more. REFERENCES 1. Subject to terms and conditions. 2. Twenty-four subjects participated in a randomised, double masked, contralateral eye study to evaluate water loss of Biotrue One day, Acuvue Moist and 1 Day Acuvue Trueeye. After four, eight, 12 and 16 hours of wear, lenses were removed and immediately weighted (wet weight). The lenses were then completely dried and re-weighted (dry weight). The relative percentage water loss was then calculated for each lens from the wet and dry weight. EVERYTHING A CONFERENCE SHOULD BE T he 2015 ABDO Conference and Exhibition will be held at Manchester Central - an award winning venue located in the heart of city centre Manchester. The ABDO Conference and Exhibition is the premiere event for dispensing opticians and is also hailed as one of the most convivial and rewarding networking events in the UK optical calendar. SOCIALISE PARTY ABDO FUN NETWORKING GALA DINNER DANCING GOLF DAY OLD FRIENDS GOOD COMPANY GOOD FOOD CATCH UP NET WORKING • CONFERENCE • EXHIBITION NEW CONTACTS RELAX ALL WELCOME • A unique event in the 2015 optical calendar • Opportunities to network with convivial company • Meet friends old and new • Make new contacts • All optical professionals and students are welcome to attend • To reserve a place at the pre-conference golf tournament email [email protected] ONLINE BOOKING AVAILABLE SOON via www.abdo.org.uk/events Association of British Dispensing Opticians CITY BREAK ABDO CONFERENCE AND EXHIBITION Sunday 20 and Monday 21 September 2015 Manchester Central PRE-CONFERENCE GOLF TOURNAMENT Saturday 19 September 2015 PRE-CONFERENCE WELCOME PARTY Saturday 19 September 2015 Wolfson Reading Room, Manchester Central Library ABDO GALA DINNER Sunday 20 September 2015 The Midland Hotel, Manchester A unique Myopia Management Day will open this month’s BCLA conference in Liverpool Myopia day “not to be missed” unique educational event, dedicated to current research, understanding and strategies in the management and control of myopia, the British Contact Lens Association (BCLA) Myopia Management Day will take place at the ACC Liverpool on Friday 29 May on the first day of the Association’s 39th conference and exhibition. “With commercial products now in development to specifically address the ‘global epidemic’ of myopia, the BCLA is providing eyecare practitioners with a definitive guide to myopia management in everyday practice,” said BCLA president, Susan Bowers. “Never before have we seen so many global leaders come together in one room to debate the subject; this is a rare and exciting opportunity not to let pass.” A HOT SCIENTIFIC TOPIC Taking place as a stand-alone event, the day will be chaired by Professor James Wolffsohn, Professor Brien Holden and Dr Noel Brennan, and will offer attendees the chance to gain up to five CET points. The programme, which is subject to finalisation, will include: Dr Nicola Logan will make the case for spectacle treatments 32 Dispensing Optics MAY 2015 • ‘Epidemiology and the public health time bomb’ by Ian Flitcroft (UK) • ‘The case for spectacle treatments’ by Dr Nicola Logan (UK) • ‘Pharmaceutical treatments’ by Dr Janis Orr (UK) • ‘Multifocal contact lens treatments’ by Professor Brien Holden (Australia) • ‘Orthokeratology treatments’ by Professor Pauline Cho (Hong Kong) • Live ortho-k fitting’ with Shelly Bansal (UK) • ‘Risk/benefit analysis: can we afford to do nothing?’ by Kate Gifford (Australia) • ‘Review of current practice across the globe: BCLA survey’ by Professor James Wolffsohn (UK) The day will conclude with a panel debate on: ‘Clinical guidelines – what should we do for the person in my chair and what will the future look like?’ Dr Brennan, Professor Pat Caroline (USA) and keynote speaker, Dr Loretta Szczotka-Flynn (USA), will also join the panel. This will be followed by a Partner Sponsor presentation by CooperVision, after which Kate Gifford will focus on all delegates the risk/benefit analysis are invited to enjoy the BCLA Welcome Reception in the exhibition hall at 6pm. Delegates staying on for the Saturday of the conference will be able to attend a followup session to Shelly Bansal’s live ortho-k fitting, entitled ‘The morning after….’ This will take place at 9.30am in Hall 3. There will be a further follow-up on the Sunday at 3pm. Commenting ahead of the event, presenter Kate Gifford said: “Myopia control is a hot scientific topic, and its translation Focus will be on the best solutions for individual patients into clinical practice is fascinating, evolving and challenging. Contact lens options currently have the strongest research results for myopia control, yet the practitioner must balance the risk of intervention with the risks of myopic pathology, which escalate alarmingly with myopia progression. “Although future cataract, maculopathy and retinal detachment may seem quite distant prospects, the risk comparison to that of contact lens complications is bound to surprise you, and motivate you into determining your approach to myopia management for your paediatric patients,“ Kate added. Dispensing and contact lens optician, Shelly Bansal, added: “This is a ‘must attend’ event for every practitioner – optometrists, contact lenses opticians and dispensing opticians – where we can learn how to manage and create strategies to deal with an issue that we are faced with on a dayto-day basis. The exciting and unprecedented programme will provide invaluable insights into myopia control so that we can offer our young patients the best advice and care to safeguard their future.” The day costs £175 for BCLA members, or £295 for non-members, and includes lunch, morning and afternoon refreshments, exhibition entry and the BCLA welcome drinks reception from 6pm in the exhibition hall. Delegates may also attend the day as part of their full conference delegate package, for which group booking discounts of up to 20 per cent for 10 or more delegates are available. PRACTICAL AND BUSINESS SESSIONS As well as the Myopia Management Day, this year’s BCLA conference will run a dedicated business session on Saturday 30 May, chaired by Ross Grant of ToolBox Training Consultancy. Speakers include Justin Bazan on ‘The impact of the online shopper’, Peter Ivins on ‘Achieving success BCLA CONFERENCE KEYNOTE ADDRESSES • Professor Fiona Stapleton (Australia): BCLA Medal, ‘Can we prevent contact lens related microbial keratitis?’ • Dr Michael Read (UK): Irving Fatt Memorial Lecture, ‘Understanding contact lens discomfort: in the blink of an eye’ • Dr Nicole Carnt (Australia): Dallos Award, ‘The relationship between environmental sources and the susceptibility and severity of Acanthamoeba keratitis in the UK’ • Professor James Wolffsohn (UK): ‘Presbyopia correction – the final frontier?’ • Dr Loretta Szczotka-Flynn (USA): ‘Ongoing search for factors associated with CIEs during soft lens wear’ on contact lens practice in the digital age’, Jason Burkinshaw on customer service, Sarah Morgan on ‘Helping patients with what they don’t know’ and Ross Grant on ‘Adapting management style to suit your people’. The session will also include the 2015 BCLA Da Vinci Award Lecture, to be delivered by Ben Cook on ‘Objective comparison of counterfeit contact lenses to genuine contact lenses’. There are more CET workshops than ever before this year – 15 in total – and free for the first time. The workshops will cover topics such as binocular vision, dry eye, keratoconus, sclerals, gonioscopy, presbyopia, communication, slit lamp techniques and more. Rapid fire sessions lasting only six minutes each will pepper the programme, providing delegates with up-to-the-minute research facts and stats, supplemented by sponsor showcases outlining the latest technologies, and 15minute educational courses on subjects such as binocular vision and contact lenses, Demodex, dry eye therapies, surgical correction of presbyopia and how to miminise contact lens dropouts. Scientific papers will cover RGPs, UV damage to the corneal epithelium, the effect of continuous wear lenses on central corneal thickness and ocular surface – plus much more. The 2015 BCLA Industry Award winner will be announced at the BCLA Dinner, to be held at the Liverpool Anglican Cathedral. In keeping with the Liverpool/Beatles connection, the evening will have a 1960s pop music theme. CONTACT LENS AND TECHNOLOGY SHOWCASE This year’s BCLA exhibition will get underway at 1pm on Friday 29 May – with all visitors invited to stay on for the aforementioned welcome drinks. As always there is no charge to enter the BCLA exhibition and visit the world’s leading manufacturers and suppliers showcasing everything from the latest contact lens technologies and ocular health nutritionals to practice management software and anterior eye instrumentation. Enjoying centre stage in the exhibition will be the Beatles-themed BCLA stand, where visitors can find out about the latest membership offers, and how to be in with the chance to win one of several great prizes during the conference. The Exhibitors’ Pavilion will once again provide visitors with practical tips and advice at bite-sized drop-in learning sessions. The timetable of presentations, along with a complete list of exhibitors, will be available prior to the event on the BCLA app and website, www.bcla.org.uk The Exhibition will also give visitors the chance to catch up with this year’s sponsors and premium exhibitors, which are: Alcon (Partner); CooperVision (Partner); Johnson & Johnson Vision Care (Partner); Topcon (Gold & Technology); David Thomas Contact Lenses (DTCL)/Menicon (Gold); mark‘ennovy Personalised Care (Premium); and Scope Ophthalmics (Premium). Inma Perez, head of professional affairs, EMEA, Alcon Vision Care, commented: “Comfort through technology will dominate Alcon’s programme and stand this year. We have 13 Alcon supported clinical posters and other presentations providing delegates Three-day BCLA exhibition will showcase the best from industry with scientific findings on the technologies that make our company a leader in vision care, from improved permeability and wettability technologies in contact lens and lens care, to consistent surface performance of our monthly disposables.” Nigel Mallinson, managing director for the UK & Ireland at CooperVision, commented: “We are delighted to be showcasing our newly expanded portfolio, including the world’s only full family of silicone hydrogel daily disposable contact lenses. We’re also going to be highlighting the Biofinity range of reusable contact lenses, as well as helping practitioners grow their practice through offering key insights as part of the business track sessions.” Andy Yorke, managing director of Topcon GB Medical, commented: “With technology moving faster than ever before, Topcon is committed to the delivery of an advanced education programme in support of all of its ECPs at this year’s BCLA conference in Liverpool and are once again delighted to be the preferred equipment provider.” Gill Narramore, sales and marketing manager for DTCL, said: “We are delighted to be a Gold Sponsor once again. It’s an exciting time for us – and the BCLA – with a completely new venue this year. As there isn’t a conference in 2016, we are determined to make this a year to remember. We have some new and exciting products for delegates, with Steve Newman coming over from Singapore to talk about Miru 1day, Paul Rose from New Zealand on Rose K2 Soft, and Jac Santadomingo from Spain to present on MeniCare Pure RGP Solution.” Gary Daniels, UK sales director of mark’ennovy, said: “With this year’s new location, a strong line-up of presentations and industry key opinion leaders, the mark’ennovy team are looking forward to welcoming BCLA delegates to our stand. Our theme for this year will be ‘Meeting every patient’s visual needs’ with premium custom-made contact lenses. BCLA 2015 is not to be missed.” Tom Freyne, commercial director of Scope Ophthalmics, said: “Scope Ophthalmics is delighted to be partnering with the BCLA as it’s a great forum for leading optical professionals. It gives us the opportunity to showcase the most innovative ocular surface disease (OSD) products and provide education on how to diagnose and treat OSDs effectively.” Pre-registration for the exhibition is available on the BCLA website, but it’s also possible to register at the ACC on the day. Download the latest conference programme, and book a place, at www.bcla.org.uk or via the BCLA mobile app. Paper abstracts will be available ahead of the event from the BCLA app and website. Dispensing Optics MAY 2015 33 Following statements made in the March issue about divergence excess1, which led one reader to write in, Geraint Griffiths expands on this oft-confusing subject Divergence excess: the tip of an iceberg? et’s begin with definitions: divergence excess (exophoria) and divergence insufficiency (esophoria) are descriptions of heterophoria that occur in the distance. Convergence insufficiency and convergence excess occur at near. The origins of divergence insufficiency and convergence excess can be confusing. Is it because the medial recti are very strong, or that the accommodation is stronger than normal? Accommodation insufficiency: both these conditions in fact are related to weak accommodation, or a small tight lens, which requires a lot of innervation to make it move. The accommodation/vergence reflex (AVR) triggers the eyes to converge for a given amount of accommodation, because invariably when the eyes accommodate it is to look at, and converge onto, a near object L (unless it is flat screen generated 3D – but that is another story). Separate to this reflex is the ability to converge the eyes independently of accommodation, by direct innervation of the medial recti. This is needed to rapidly converge onto an approaching object. This reflex is separate to the AVR because accommodation is much slower than convergence. Convergence is critical in sport because this feeds information to the brain based on depth perception and position, which allows the subject to anticipate the arrival of the ball for instance. It is far more important to judge position and speed than to see detail clearly. When the eyes are working normally the extra-ocular muscles allow the eyes to follow the ball with the accommodation following on. When the visual system is led by the accommodation, for instance when there is a weakness or paresis in one or Face form, horizontal inclination or dihedral angle is a critical measure of the wrap in the dispensing of sports appliances 34 Dispensing Optics MAY 2015 both of the medial recti, it becomes very slow and tight. It finds it very difficult to change fixation and tracking becomes inefficient whether it is in sport or tracking individual characters at near. COMPARISON WITH HERRING’S LAW If someone has a small tight crystalline lens typically in hyperopia, or simply an inability to accommodate (something from which many children suffer) a large amount of innervation to the ciliary muscle achieves little movement of accommodation. The same innervation to the extra-ocular muscles causes a much bigger effect. You could compare this with Herring’s Law of equal innervation in sudden onset squint, when the non-paretic eye overacts. If the medial recti are also weak, then it’s possible to believe there is nothing wrong. In reality, it could be that excess accommodative effort is being used (via the AVR) to control the convergence insufficiency. Adults become very skilled in this and sometimes the only clue is that they are myopic. Latent hyperopia associated with accommodation/convergence insufficiency can co-exist with divergence excess. DIVERGENCE EXCESS Divergence excess is not well understood and orthoptic textbooks tend to say it is difficult to treat. Subjects deal with it using the AVR. In a hyperopic subject, this might make them appear emmetropic. In a myopic subject, this might increase their apparent myopia. Both may exhibit a degree of latent hyperopia or pseudo myopia. In my example given in Antonia Chitty’s article1, which David Bridle questioned (see Letters page 9), the degree of divergence excess was being reduced by the AVR. Therefore, divergence excess could be the tip of an iceberg; the visual system on the point of breakdown, attempting to manage a latent divergent squint by over-accommodating. Divergence excess controlled in this way is quite difficult to measure, especially when it is habituated and co-exists with convergence insufficiency. In practice, some of the most intractable visually related difficulties in children respond well to prism control. In attention deficit hyperactivity disorder (ADHD), prism of the order of four dioptres base-in right and left can change the personality of the child (or adult). Often the same prism is needed for reading. In divergence excess, the possibility of latent hyperopia must be eliminated by a careful distance refraction using Humphriss binocular balance (+0.75 blur), then remeasuring fixation disparity (FD). FD can increase once the latent hyperopia is revealed. In habituated accommodation excess, this investigation is not easy and the process has to be started at the near point to begin to unravel the visual stress this causes. This usually means a near addition supported by the appropriate base-in prism. This will gradually weaken the hold of an accommodation/convergence insufficiency. IMPORTANCE OF MEASURING EYE DOMINANCE This answer to David’s question might seem complicated, but it follows a logic based in mainstream optometry and dispensing principles and an understanding of eye dominance. One of the reasons many colleagues have difficulty with binocular vision is that the importance of eye dominance has never been properly taught. To prescribe a prism, you need to know which is the dominant eye. Splitting a prism or putting it in front of the wrong eye will not achieve the required effect. Mallet always said that the eye with the slip should be the one with the prism. Sport and Schoolvision Assessments are based on seven diagnostic elements of visual performance. A deficiency in any one of these will lead to occupational deficit The other reason why knowing the dominant eye is important is that it divides the population into two dominance types. Type I Dominance is right eye, right hand and right foot; Type II Dominance is a left tendency in eye, hand or foot. These two types are physiologically different, not just visually but in personality and psychology. This is a reflection of how important vision is to interpreting the world about us. When these two types are not taken into account in sport science or school vision, any effect will be confounded. The intervention will have a different effect in the two types, which effectively cancels out any statistical significance. PROBLEMS UNDER THE SURFACE David’s question to me was perceptive. What he saw was the tip of the iceberg and it didn’t make sense. What is revealed under the water is the extent of the problem our profession (ophthalmic optics) has in fully appreciating the importance of the work we do. The second point David made about low myopes appearing to be esophoric needs expanding. I hope the above goes a little way to achieving that. One of the problems with academic research, which informs undergraduate education, is that it finds it difficult to relate to general practice. One group by definition is populated by career academics who are skillful in the scientific method. In the other, practitioners are experienced in the realities of High Street practice, but do not have the ability or time to describe these realities in scientific terms to their academic colleagues. It is likely that if there is going to be a breakthrough in the understanding of vision in sport and school and all other occupations, it will come from outside the university system. The discovery of the importance of eye dominance, which was recently brought upto-date in Dispensing Optics2, led to the diploma courses in Sport and School Vision. These takes place over a period of four or five months and include a project, statistical course work and revision. It continues with interactive membership of the Association of Sport and Schoolvision Practitioners (ASvP) This sounds a long time, even though the didactic part of the course is only three days, but it is a measure of how entrenched we are in the traditional approach to optometry and dispensing. Increasingly, we are being pushed apart as though one is not related to the other. In truth, we are part of the same whole, commercially and clinically. Until dispensing optics and optometry become equal partners, the unique role we have in the prevention of ocular, systemic and psychological morbidity will not be realised. For more information visit www.sportvision.co.uk and www.schoolvision. org.uk REFERENCES 1. Chitty A (2015) Sports eyewear and eyecare. Dispensing Optics 30; 3: 31-33. 2. Griffiths GW (2013) Match! Finding the best lenses of sport – the science. Dispensing Optics 28; 4: 4-8. Geraint Griffiths BSc Mech Eng, Dip Schoolvision, Dip Sportvision, MASvP, MSc Optometry MCOptom is managing director of SVUK and Optical3 Ltd in Leicestershire. He is founder and CEO of the Association of Sport and Schoolvision Practitioners (ASv.P), and an examiner for the College of Optometrists. Dispensing Optics MAY 2015 35 Contact lens practice is both tricky and satisfying, writes Graeme Stevenson O ften colleagues say to me that I have the best job in optics as a contact lens optician. Well they could be correct in thinking that – however, it is not an easy job. Let me start by declaring that the role of a contact lens optician is wonderfully varied and satisfying and one I have loved for almost all of my 30 years in optics. It is the same things that make contact lens practice both tricky and satisfying at the same time; these being contact lenses and, of course, patients. There are a huge variety of contact lenses out there at the moment and the materials and power ranges ensure that more of our patients than ever before can wear contact lenses. Of course finding out about this array of lenses takes a great deal of our time, in particular, learning about the theoretical material properties of the lenses. The other problem with all those lenses is actually fitting them to real life patients and listening to their personal experiences about them. This is why I like to try as many different lens types as possible – both in my own eyes and also in the eyes of my patients. In doing so, I learn about lots of different lens types and, as such, I refrain from calling myself a ‘Johnson & Johnson Man’ or an ‘Alcon Man’. I also don’t get too hung up on knowing the power ranges and prices of all the available contact lenses. That is exactly what my Association of Contact Lens Manufacturers Contact Lens Year Book and company price lists are for. We also find that the ranges at the extremes of the power ranges are being expanded so often that it is near impossible to keep them in our heads. ARRAY OF PATIENT PERSONALITIES And now on to the other essential item in contact lens fitting – and that is the patient. Our contact lens wearers range from eight years old to 90 years old and, of course, within that age range there is also a considerable range of personalities. We also have lenses varying from plano cosmetic lenses to -35.00DS. In my experience, contact lens wearers are far more demanding than spectacle only wearers. They are also likely to do more research on the internet than non contact lens wearing patients. Many of them can be very demanding of us and our practice colleagues. However, when it comes to being appreciative of what we do for patients, our contact lens patients are head and shoulders above the rest for saying thank you. I briefly mentioned the range of personalities we have wearing contact lenses and, indeed, I could write numerous articles on that subject alone. I still believe that many practice staff don’t fully understand our contact lens wearers and the difference that contact lenses make to their lives and, in particular, to their confidence. When those patients ‘need’ a contact lens for their Saturday night out, colleagues often say 36 Dispensing Optics MAY 2015 to me, “Why can’t they just wear their specs?” For many of our contact lens wearers, this is akin to wearing their mum or dad’s clothes for a special social event! Many of these patients have really nice spectacles but just don’t feel confident wearing them in certain social or sporting situations. For a whole variety of reasons, our contact lens wearers just love their contact lenses and, thankfully, with modern lenses many can wear their lenses almost all day with no adverse effects. The human mind is rather complex and in some situations, all that matters is how that individual feels and contact lens wearers certainly tell us that they feel great when wearing their contact lenses. CONTACT LENSES OF THE FUTURE We have benefited greatly from the advances in modern technology in the contact lenses we use every day for our demanding patients. Lenses are more breathable, they are deposit resistant and have hugely wettable lens surfaces. We even have a range of single use daily disposable silicone hydrogel lenses for our patients. However, we have seen reports in the mainstream media of some really exciting contact lens projects. I am hugely sceptical of these projects and I seriously doubt that many, if any, will ever see the light of day as commercial projects. Let us have a little look at some of these research projects and assess their prospects for the future. One of the most interesting projects has been the Telescopic contact lens from Ecole Polytechnique Fédérale de Lausanne, Switzerland. The lens is aimed at those suffering from age-related macular degeneration and similar low vision patients. The lens works by incorporating an extremely thin reflective telescope inside a 1.5mm lens. Internal mirrors bounce light around, thereby expanding the perceived size of objects and magnifying the view. The lens can provide up to 2.8x magnification, which could be a huge boost to those with low vision. In theory this is a wonderful idea – especially if it can bring hope to those individuals who have lost some of their precious sight. At this moment in time, the lens is a scleral, which is 1.55mm thick. Even with fenestrations in the lens there are bound to be severe limitations to oxygen transmission. This will ultimately have an effect on corneal physiology and also the physical comfort of the lens. Given that these lenses are being designed with low vision patients in mind, might they be very difficult to handle? There has also been some debate recently regarding contact lenses to monitor the blood sugar levels of patients. Presently there is an ongoing research project between Alcon and Google into this very lens. I understand that the lens would be linked to a smart phone app, which would be used to detect colour changes to assess blood sugar levels. The reputations of the companies involved tell me this project may well be a success. However, this idea has been postulated for many a long year and we have yet to see a commercial version come to light. The best options for success, in my opinion, could well be lenses that provide the slow release of either a glaucoma medication or an anti-histamine. The main reason for this is that such lenses only require an adaption or modification of currently available lenses, and could be fitted to existing lens wearers who are either hayfever or glaucoma sufferers. Whether any or all of the above futuristic lenses will see the light of day will ultimately depend on companies making a commercial case for them. Such products will need to be commercially viable (i.e. make money) for both the manufacturers and also opticians. Of course, if such projects were easily made into money-making concerns then many different and innovative contact lenses would already be available. There is also the question of how the lenses will be regarded for product licensing. Such licensing can be hugely expensive and that could well be the thin red line for many of the contact lens manufacturers. MOVES ON MYOPIA CONTROL One developing product we can be sure will come to the marketplace is the contact lens designed for myopia control. We already have the CooperVision MySight lens in the Far East and many are trialling orthokeratology as a means of controlling myopia progression. Interestingly, Contamac the materials development company, has linked up with the worldleading Brien Holden Vision Institute (BHVI) to develop and commercialise myopia control contact lenses. Given the reputation of the BHVI for research and bringing these products to life, we are expecting big things from this collaboration. The prevelance of myopia is increasing, with numbers of high and extreme myopia being huge amongst the Far Eastern Asian population. Bifocal spectacles and atropine drops have also been tried, however, the use of contact lenses would appear to have the greatest potential. It would also appear that two to three hours per day of outdoor activity may also have a protective effect from myopia. Of course, there are other benefits to the outdoor activity, which is not quite within the remit of the regular optician. Quite what effect myopia control lenses will have on halting myopia progression remains to be seen. Early intervention is vital, as is communication that the lenses will not prevent the patient becoming myopic at all. Is it all worthwhile? Of course, all these ideas are great in theory and will continue to excite PhD students and the press alike for many a year to come. However, I sadly think we will see very few of these ideas as commercially available products in my lifetime. Though I may yet be proved wrong on that… GRAEME STEVENSON FBDO (HONS) CL is a contact lens optician in Glasgow, is a past chairman of the Scottish Contact Lens Society and a former member of the ABDO Contact Lens Committee. Frequently asked questions answered by Kim Devlin FBDO (Hons) CL PRESCRIPTION COPY CONUNDRUMS “Can I have a copy of my prescription?”: the words that frustrate every one of us – especially when the patient is standing there with the very piece of paper in their hand. ”Oh, is that it?” they say, a bit disappointed. This question from a member is a variation on that perennial request: a parent wanted the ‘prescription’ of their child’s spectacles but they had been made to a Hospital Eye Service (HES) voucher and prescription a year before. How should that be handled? Such variations to the usual request set me thinking – is it the practice’s prescription to give? When an HES prescription is brought in to your practice, your heart sinks a little. Often a child, the Mum has brought little Jonny in straight from the eye clinic; they are hyper having been confined for hours while drops ‘take’ then messed about with lights and strange frames, the last thing they want is you. You, of course, have to explain the peculiarities of the system to a Mum who is worried and exhausted and in no position to take in the information. Then you have to crawl around the floor after little Jonny, coaxing him to stay still while you take the PD. Meanwhile in the back of your mind you just know you’ll wait six weeks minimum for the hospital trust to pay you. Then, when the Mum wants to buy another pair from somewhere else, you might feel a little hard done by… The HES form that was brought in to you has long since been submitted back to the hospital for payment – so what can you give them? If you’re clever, you might well have taken a photocopy of the form, to keep on file, should there be a query. A photocopy of a photocopy isn’t wonderful, especially when the handwriting is indecipherable anyway. What to do? This, I think, is best handled by writing out a copy prescription from your records. Great care must be taken with the wording of the document; this is a case where checking on ABDO’s Advice and Guidelines for the exact form of words, indeed a suggested layout (2.9 and Appendix J), is a very good idea. You will notice that it is suggested that the name and General Optical Council number of the optometrist is stated on the document which, of course, in this circumstance, you do not know. It would be sufficient to say: ‘Name of refractionist not known – eye examination conducted under the HES on [date on form]’. As always, when you give such a document you are liable for any errors you might make, check and double check that everything is correct and complete before it is handed to the parent. This is a service you are offering, there is no reason why you shouldn’t make a charge for such a service. If the parent doesn’t wish to pay, they may of course seek the information from the HES. On the other hand, you may feel that as a gesture of goodwill you are prepared to waive the charge. It is entirely up to you. Kim Devlin is chair of ABDO’s Advice and Guidelines Working Group Past FAQs are available for reference on the ABDO website at http://www.abdo.org.uk/frequently-asked-questions Dispensing Optics MAY 2015 37 Optician Index - February 2015 summary • Total practice turnover increased by five per cent from January to 173 Index points and this is half a per cent higher than February last year • Total eye examinations improve by seven per cent to 108 Index points on January and this is five per cent higher than February last year • Sample average total dispensing increased by seven per cent from last month to 100 Index points • Volume of bi/trifocal and progressive lenses show positive annual growth • Percentage of eye examinations which are NHS continues to increase slightly and this month is just above 76 per cent The full February 2015 report was published in the 27 March issue of Optician MANAGERIAL DISPENSING OPTICIAN OPTISAVERS LTD, LIVERPOOL, UNITED KINGDOM We are an independent retail Opticians, offering excellent customer service to patients within the Merseyside area. The company has been established for 28 years and has built up a loyal clientele Desired Skills and Experience The candidate in question will have a thorough knowledge of current lenses available on the optical market including all the latest varifocal spectacle lenses They should have the ability to communicate at all levels, both with patients and with staff They should be experienced in management skills and teamwork They should be able to achieve set sales targets outlined by the company They should be generally highly motivated and be prepared to set an example to the rest of their team They should be articulate and of smart appearance Excellent conditions including good competitive salary, bonus system, private healthcare ABILITY TO: • Exceed expectations. • Increase Customer Loyalty and Satisfaction Contact Details: Mr R. Specter Director Optisavers Ltd [email protected] 07768 469 750 NEW ‘THROUGH THE PIN-HOLE’ SERIES PARTICIPANTS WANTED OSCAR WINNING DISPENSING OPTICIAN REQUIRED FOR BUSY INDEPENDENT PRACTICE Tired of the mundane 9-5? Want to be challenged every day? Can you create order out of chaos? Can you motivate and articulate well whilst delighting patients? COME JOIN OUR PRACTICE IN LONDON SW11 AND MAKE A DIFFERENCE EVERY DAY (Trainee DOs and those contracted to remain in their current role considered) DOES YOUR PRACTICE OFFER SPECIALIST SERVICES IN, Email [email protected] or call 07850 099336 FOR EXAMPLE, DRY EYE, PAEDIATRICS, SPORTS VISION, LOW VISION AND/OR OTHER NICHE AREAS? We’re looking for member practices to feature in a new ‘Through the pin-hole’ series showcasing the fantastic work that ABDO members are involved with above and beyond ‘the everyday job’ of dispensing ABDO President’s Consultation Day Email [email protected] to register your interest in taking part To place an advert, telephone 0781 273 4717 or email [email protected] 20 May 2015 To be held at the offices of the Association of Optometrists 2 Woodbridge Street London EC1R 0DG Booking deadline for the June issue is Thursday 7 May Special rate for ABDO members 38 Dispensing Optics MAY 2015 To book your place, email Jane Burnand at [email protected] abdo COLLEGE Let us further your career ABDO College provides comprehensive education for dispensing opticians and is currently accepting applications for a range of different courses. Some of the reasons why you should make ABDO College your first choice to either start or further your career in optics are: • An extensive range of courses to suit your individual needs • Dedicated and experienced academic staff • Friendly and supportive learning environment • Consistently high theory and practical examination results • Helpful course tutors • Vibrant and positive attitude towards students • Committed to the furtherance of dispensing optics • Established by the profession for the profession • A proven track record of success CONTACT LENS CERTIFICATE The Contact Lens Certificate course provides an ideal opportunity for opticians to further their career by specialising in contact lenses. The course leads to the ABDO Level 6 Certificate in Contact Lens Practice qualification, enabling registration on the General Optical Council specialty register for contact lens dispensing. For further information and application forms for these and other courses, or to request a copy of the ABDO College Prospectus, please contact the ABDO College Courses Team on Course features • A one year course commencing in September 2015 • Two separate weeks block release at Godmersham • Block release accommodation can be provided ABDO College Operational Services, Godmersham Park, Godmersham, Canterbury, Kent CT4 7DT Entry requirements • ABDO Fellowship Diploma and GOC registration or for existing students a successful pass in the final theory examinations • Qualified, registered optometrists and ophthalmologists are also eligible to enrol Application deadline: August 2015 KEEPING EXCELLENCE IN YOUR SIGHTS 01227 738 829 (Option 1) or email [email protected] www.abdocollege.org.uk www.twitter.com/abdocollege A COAT FOR EVERY OCCASION FIVE NEW ADVANCED LENS COATINGS FROM SHAMIR SHAMIR GLACIER PLUS™ UV First in a line of advanced lens coatings, offering enhanced durability, easy maintenance, extra visual comfort, and comprehensive double-sided UV protection. SHAMIR GLACIER™ ACHROMAT A IC UV A crystal clear coating, keeping eyes bright and adding no residual colour to the lens. SHAMIR GLACIER™ BLUE UV Five times more effective protection against the harmful rays of artificial light than any existing conventional lens coating. SHAMIR GLACIER SUN™ UV Designed for sunwear, leaves sunglass lens tint unchanged and protected from fading. SHAMIR GLACIER™ ANTI-FOG Instead of double-sided UV protection, rear surface of lens repels fogging during strenuous activity. No special sprays or cloths needed to activate anti-fog feature. FOR ANY NEED, SHAMIR ADVANCED LENS COATINGS HAVE GOT YOU COVERED! E-SPF is relevant for Glacier Plus UV, Glacier Achromatic UV & Glacier Blue UV With 25X more UV protection than going without eyewear* * E-SPF® is a global index rating the overall UV protection of a lens. E-SPF® was developed by Essilor International and endorsed by a 3rd party expert. A lens rating of E-SPF® 25 means that an eye protected by the lens will receive 25 times less UV exposure than an unprotected eye. E-SPF and E-SPF design are trademarks of Essilor International and used with permission. SHAMIR UK LT L D. [email protected] WWW.SHAMIRLENS.CO.UK