dispensingoptics · 2020-02-18 · dispensingoptics Dispensing Optics PO Box 233, Crowborough TN6 9BD Telephone: 01892 667626 Fax: 01892 667626 Email: [email protected] February 2011

dispensingopticsDispensing Optics

PO Box 233, Crowborough TN6 9BD

Telephone: 01892 667626

Fax: 01892 667626

Email: [email protected]

Website: www.abdo.org.ukFebruary 2011

3 Cover pointby Tony Garrett

4 Continuing Education andTrainingDo spectacles cause facial basal cellcarcinoma?by Sally Bates

14 Patient and practicemanagementAdapting your practice for peoplewith sight lossby Antonia Chitty

16 The Rx filesPart one: Anisometropia handled inan unusual wayby Peter Sanders

18 Newsbrief

19 The President’s diaryby Jennifer Brower

24 Optician IndexNovember 2010 summary

26 BCLA newsDevelop your contact lens skills atBCLA 2011

28 Disjointed jottings froma DO’s desk . . .Gone with the windby Nick Howard

29 Update on frequently askedquestionsby Kim Devlin

30 CET answersPaediatric eyecare - part three

31 Diary of Events

February 2011

We offer an outstanding range ofbenefits to our members not least afirst class CET package which wasdevised by and continues to bedelivered by Paula Stevens.

A succession of inspirational anddedicated Presidents supported firstlyby a Council and latterly by a Boardof active members has served to helpestablish ABDO as a leading opticalbody in the UK and abroad.

In the early years of the Associationsome leading members had the ideato form a ‘college of our own’. Tenyears ago Godmersham opened itsdoors to its first students. Since then,led by Jo Underwood, it hasestablished itself as a centre ofexcellence in optical training. This hasled to an increasing number of ABDOmembers who are graduates ofABDO’s own college. We are now onthe threshold of even greater thingswith the advent of the BSc (Hons)programme.

Over the coming months we will becelebrating some of the keymilestones in the progress of bothorganisations.

Tony Garrett �

A year of anniversaries2011 is a double celebration year forABDO. It is the 25th anniversary of theAssociation and, in March, wecelebrate the 10th anniversary of theopening of the ABDO College. Twovery significant milestones and bothones to be equally proud of.

In 1986, when ABDO was formed, ithad a total of 3,100 full members.Today that number stands at 5,560and it continues to rise year on year.ABDO has seen a vibrant and growingprofession establish itself and thebigger we get the stronger we areand that, in the end, will benefit thewhole membership.

Cover point

C O N T E N T S33 dispensingoptics

ABDO actively works inconjunction with:

The Worshipful Companyof Spectacle Makers

Front cover:Rupp+Hubrach SPORTSlenses with Arancia tintand Silver mirror coat

2 5 t h A n n i v e r s a r y1986 - 2011

Do spectacles causefacial basal cellcarcinoma?

IntroductionSeveral studies have demonstratedthat long term exposure to ultraviolet(UV) radiation from sunlight maycause cataracts and eye disease; it isalso considered a major risk factor forfacial basal cell carcinoma (BCC).

Spectacle lenses absorb significantamounts of UV therefore protectingthe wearer’s eyes and thesurrounding area, which is known asthe ‘periorbital’ area. Standardplastic spectacle lenses provide UVprotection up to the wavelength of350 nanometres (nm), and if UVcoated, they will absorb UV up to400nm.

Basal cell carcinoma is a commonmalignant tumour of the eyelids andconstitutes 85 – 90% of all malignantepithelial eyelid tumours at this site.Over 99% of BCC occur in whites,

This article has been approved for 2 CET points by the GOC. It is open to all FBDO members, includingassociate member optometrists. Insert your answers to the twelve multiple choice questions (MCQs)online at www.abdo.org.uk, or on the answer sheet inserted in this issue and return by 17 March 2011 toABDO CET, Courtyard Suite 6, Braxted Park, Great Braxted, Witham CM8 3GA OR fax to 01621 890203. Ifyou complete online, please ensure that your email address and GOC number are up-to-date. The passmark is 60 per cent. The answers will appear in our April 2011 issue.

acanthoma can mimic BCC4. This is athickening of the skin in response topressure and is non-threatening. If thepatient ceases spectacle wear orrelevant adjustments are made to theframe, the acanthoma will usuallyresolve within a few weeks or months.

The dispensing optician should beable to perform a diagnosis basedupon a simple inspection of thepatient’s orbital area, recognisingand knowing both the similarities anddifferences between BCC andacanthoma (Figures 1 and 2)5.

BackgroundBCC is the most common form of skincancer, affecting approximately onemillion Americans every year1. 90% ofeyelid malignancies are BCC whicharise from the basal cell layer of theepidermis around the periorbital area(Figure 3)3. This includes the medial

about 95% occur between 40-79years, with diagnosis at 60 years1.

Clinical reports by Heckmanndemonstrated that the periorbitalarea is prone to a high number ofcases of facial BCC2. This may seemsurprising taking into account the factthat the periorbital area is shelteredby the location of the eye itself beingsunken within the orbit and is lessexposed to UV radiation. Furtherprotection is provided by theexposed brows, cheeks, nose andeyelids.

Facial BCC may ulcerate, whereassuperficial BCC resembles dermatitis,psoriasis or eczema. If left untreated,dangerous lesions occur especiallynear the nasal canthus, invadingareas beyond the orbit, thereforebecoming lethal3. However, as acomparison, spectacle frame

44 dispensingoptics February 2011

CC--14877

Sally Bates considers the effectsof spectacle fitting and facialbasal cell carcinoma

CompetencIes covered: Optical appliances, ocular abnormalitiesTarget groups: Dispensing opticians, optometrists

Continued overleaf

and lateral canthus, the lid margin(Figure 4), the medial, lower, upperand lateral orbital segments2.

The purpose of this article is toincrease the optical practitioner’sawareness regarding facial BCC andinfluence good practice in framefitting, which will subsequently impacton the recognition and diagnosis ofskin conditions relating to spectaclewear. The intention is to alertpractitioners and students to potentialproblems associated with incorrectlyfitting frames.

It could be argued that BCC isdormant within the dermal layer ofthe skin and will naturally developdue to age or UV exposure. Howeverfrom my experience as a dispensingoptician, I have noticed thatspectacle wearers suffer dermalerosion where the frame is in contactwith the skin, specifically to the bridgeof the nose, the temples and thearea behind the ears.

It may be considered that the weightof the spectacles causes irritation tothe epidermis and could be acontributing factor in thedevelopment of facial BCC in theperiorbital area and behind the ears.

Location of facial basal cellcarcinomaParts of the body which areexcessively exposed to the sun havea high risk of BCC, particularly the

face, ears, neck, scalp, shoulders andback, it is predominantly commonaround the eye area and the nose6.

The apex of the nose and the helicalparts (rim) of the ears are the mostexposed facial areas to ultra violetradiation, receiving up to ten timesmore UV than the orbital region2. BCCof the eyelid is ‘typically located onthe lower lid (50%) (as shown in Figure5). The medial canthus (27%) uppereyelid (15%) and the lateral canthus

(6%) can also be affected’3.

The periorbital areas have high BCCfrequency, despite low exposure toUV, they are characterised by theirconcave shape, reduced skin tensionand the presence of skin folds7.

Patients at risk from basal cellcarcinomaThe people who are at the highest riskof developing BCC are those with afamily history of carcinoma, orpersons with fair skin, blonde or redhair and blue, green or grey eyes, asthese individuals have lesspigmentation in their skin and eyes tooffer protection from UV radiation7. Asreported by skincancer.org8 increasedoccurrence of BCC is found incommunities living closer to theequator or at high altitudes; this couldpossibly be due to the higher levels ofUV and infra red radiation. Thosemost affected are older than 50 yearsof age, presumably due to havingbeen more exposed to UV. However,as the number of new cases hassharply increased each year in thelast few decades, the average ageof patients at onset is steadilydecreasing.

Figure 1: Facial basal cell carcinoma at innercanthus (courtesy of the Skin Cancer Foundation)

Figure 5: A basal cell carcinoma originating in skinfolds

Figure 4: Basal cell carcinoma on lower lid margin

Figure 3: Structure of skin (courtesy of David Pipe and Linda Rapley)

Figure 2: Acanthoma on bridge of nose (courtesyof Dermatology Online Atlas)

Continuing Education and Training

Hairs

Pores

Stratum comeum

Stratum lucidum

Granular layer

Prickle cells

Basal cells

Arrector pili muscle

Sweat gland

Dermal papilla

Epidemis

Capillary loop

Reticular layer

Sebaceous gland

Hair follicle

Hair root

Hair bulb

Adipose tissue

Blood vessels

Continued overleaf


BCC is rarely seen in children, andonly occasionally in teenagers, unlessit is caused by an inherited geneticdisorder such as albinism producing alack of skin pigment, or earlyexposure to radiation1.

Contributing factors to thedevelopment of BCC may becontact with arsenic, exposure toradiation, open sores that resisthealing, chronic inflammatory skinconditions, complications of burns,scars or infections, or by abrasion ortattooing.

Until recently cases of men with BCChave outnumbered women, perhapsdue to a higher prevalence ofoutdoor occupations; such as farmworkers, sailors, road workers etc.However the number of reportedcases among women is graduallyincreasing, presumably caused bythe trend of excessive sunbathingand the use of tanning salons. Arecent skin cancer study showed thatpeople who overcame their skincancer had a greater risk thannormal of developing a second,completely different, cancer later inlife. All of these were oestrogendriven9.

The skinThe skin is formed from layers. Theepidermis is the outer layer of skinwhich contains the epidermal cells,including flat squamous cells andpigment producing melanocytes. Thedermis is the deeper layer of skinwhich contains the hair follicles, oiland sweat glands and blood vessels.According to American Society ofOphthalmic Plastic andReconstructive Surgery, skin cancerscan arise from any of these cells10. Abiopsy is usually required to confirmthe diagnosis of skin cancer.

Appearance of basal cellcarcinomaBCC may appear as a painlessnodule, or as a sore that will not heal.BCC is the most frequent form of skincancer, beginning in the stratumbasal layer of the skin and extendinginto the dermis to produce an openulcer11.

There may be ulceration, bleeding orcrusting on the skin and, if it occurson the eyelid, the eyelashes may bemissing or become distorted. Thenodule enlarges locally in theperiorbital area and there is littledanger that the cancer will spread(metastasize) to other areas of thebody if treated in time.

BCC is painless, usually there is noitching or change in skin colour, andcan often resemble non-cancerousskin conditions such as dermatitis,psoriasis or eczema. It begins as asmall, flesh coloured or slightly waxypapule11. This is a firm lump that doesnot contain fluid and varies in sizefrom a pinhead to 5mm12. It thenenlarges and assumes a rolled, pearlymargin which is often at the site of aprevious skin injury. As the noduleenlarges, the centre ulcerates andrefuses to heal. The centre becomesdepressed, and the rolled edgesbecome translucent, revealing manytiny blood vessels13. The centre maybe crusted which is usually painlessand may ulcerate and bleed. Theappearance is referred to as a‘rodent ulcer’

TreatmentWhen detected early and treatedappropriately there is an improvedchance of removing the tumourcompletely, minimising the amount ofskin tissue that needs to be removed10.

If the BCC is superficial, it may becured by an imiquimod cream, suchas Aldara, which is a form ofchemotherapy, otherwise, the BCC isremoved by radiation therapy orsurgically. Skincancer.org reports that the complete surgicalremoval of the tumour mayoccasionally cause facialdisfigurement and sometimesconsiderable destruction of theunderlying and surrounding tissue8.

BCC is almost always curable bysurgery, which is very effective whenperformed on the face. Surgery isusually performed under localanaesthetic and withoutcomplication. However; where theskin is delicate and thin, such as the

periorbital area, radiotherapy is oftenused in order to prevent damage6.

BCC cannot be transmitted throughtouch as it is a specific skin conditionindividual to the patient, therefore it isnot contagious.

AcanthomaCases are variously referred to asacanthoma fissuratum, granulomafissuratum and spectacleacanthoma. Due to the clinicalappearance, this condition is oftenmisdiagnosed as BCC, yet it is abenign condition. It appears as araised pink nodule with a longitudinalcentral fissure above or behind theear14.

This could be the result of a continualtrauma caused by the weight,pressure and friction of the slidingspectacle frame on the skin andmaceration which occurs withperspiration, particularly behind theear on the temporal bone and on thebridge of the nose15. The frame tendsto fit into the split of the skin at the siteof the lesion (Figure 6). By adjustingthe frame to the correct fitting, theremoval of pressure can solve theassociated problem within 3 to 4weeks. Acanthoma may also berelated to wearing hearing aids.

The differentiating features ofacanthoma compared to BCC arethe central fissured groove and theabsence of a ‘pearly edge’; theposition is at an exact site of pressureand the problem is resolved by notwearing the spectacles or hearingaid.

Figure 6: Acanthoma behind the ear due to apoorly fitting spectacle frame (courtesy ofDermatology Online Atlas)

Shamir Computer™ Shamir WorkSpace™

With quick and easy ordering of the lens designed to suit every client’s work needs:

Shamir Computer for sharp focus on your computer, papers on your desk, and your immediate office surroundings.

Shamir WorkSpace keeps vision sharp whether focused on the computer, a PPT presentation on the opposite wall, or while moving around your workspace.

For looking sharp in the office, Shamir advanced solutions are just what you need.

Tel: 01954 785100www.shamirlens.co.uk

Keeping the office in perfect focus just got easier

Shamir Computer™ Shamir WorkSpace™

With quick and easy ordering of the lens designed to suit every client’s work needs:

Shamir Computer for sharp focus on your computer, papers on your desk, and your immediate office surroundings.

Shamir WorkSpace keeps vision sharp whether focused on the computer, a PPT presentation on the opposite wall, or while moving around your workspace.

For looking sharp in the office, Shamir advanced solutions are just what you need.

Tel: 01954 785100www.shamirlens.co.uk

Keeping the office in perfect focus just got easier

Figure 7 a&b: Acanthoma on bridge of nose due to a poorly fitting spectacle frame (courtesy ofDermatology Online Atlas)

Figure 8: Xanthelasma

a b


Spectacle lensesThe hypothesis that UV radiation maybe disproportionately intensified by aspectacle lens has not beenconfirmed as yet2.

As previously stated standard plasticspectacle lenses (n=1.5), provide UVprotection up to wavelength 350 nm,and if UV coated, they will absorbUVA up to 400nm, this includes aselection of hi-index plastics lensesand all Transitions lenses.

UVA is the highest wavelength of UVlight and is the most dangerous as it isabsorbed by the cornea. It may bethe cause of cataracts, cornealdamage and in some cases retinaldamage7. The results of a studyconducted by Sherertz et al16 failed todemonstrate a photoprotective orexacerbating effect of eyeglasses orsunglasses on the occurrence ofperiorbital basal cell carcinoma.

Frame materialsSpectacle frames do not containcarcinogenic substances, thereforetumours of the nasal bearing surfacescannot be due to chemicals, but areinitiated mechanically.

When in contact with the skin, themetal or plastic spectacle framesmay erode the epidermal layer,therefore causing exposure to UV andaccelerating the BCC14. Over the past25 years there have been very fewmajor innovations regarding framematerials, with the exception oftitanium. Therefore, the availableinformation is dated and unchanged.Styles have developed with fashiontrends; however the frame materialshave stayed the same.

Titanium, pure gold and pure stainlesssteel are hypoallergenic and will notcause skin reactions, however othermetal materials are alloys whichcontain nickel. This includes platedmetals such as monel, rolled gold andflexon (memory metal) frames whichcontain a base metal comprising ofnickel, copper, manganese and zinc.Many spectacle frames are nowadvertised as ‘nickel free’.

Although plastic spectacle frames arethought to be generally suitable forpatients with sensitive skin, it has beenquoted that cellulose acetate framesdevelop a rough, matt surface afterprolonged wear and contact with theskin15. In certain patients, wearing anickel frame produces a form ofdermatitis and some types ofsynthetic plastic materials producesimilar effects in other individuals17.

Acetate frames are currently popular,however they are prone to problemsassociated with poor fitting andcoarseness on the bearing surface ofthe bridge (Figures 7a & b). Injectionmoulded plastics materials such aspropionate, SPX and Optyl aresmooth materials and less abrasivethan acetate making themlightweight and more comfortable towear.

Frame fittingFour reported cases concluded thatthe permanent pressure of thespectacle front (on the nasal flank)was the essential cause for the originof the patient’s skin cancer. It wasdeduced that a pathologicalincrease of cells may be caused bycontinuous epithelial lesions whichgradually appear on the skin.

Skin irregularities such as moles,tumours and xanthelasma (Figure 8)(raised yellow nodules associatedwith high cholesterol or uncontrolleddiabetes) should be free fromcontact with the spectacle frame.However, this consideration makesthe skill of frame fitting morechallenging to the optician.

DispensingsolutionsFrom personal experience I havefound that hard cellulose acetatepads and side end tips becomerough due to a build up of dead cellsand sebum, and chemicals withinproducts such as face cream, hairspray, perfumes, soap and smoke.The roughened end tips and padsshould be replaced byhypoallergenic silicone. Patientfeedback demonstrates they aremore secure to wear, as they arenon-slip. Hence, the spectacle framestays comfortably in place andlesions such as acanthoma do notoccur.

The aging skin becomes wrinkled,loses its elasticity and becomesthinner predominantly in the nasalregion. In elderly patients, spectaclesare therefore often uncomfortableand an abrasion of the skin may takelonger to heal, or may not heal atall14. Based upon my experience,older patients should have largersilicone nose pads fitted to theirframes as they distribute the weightof the spectacles more evenly overthe bridge of the nose (Figure 9).Alternatively, bioform pads areexcellent which contain a gel thatmoulds to the shape of the patient’sbridge.

Figure 9: Silicone pads

Continued overleaf

nose, the groove between nose andlip, and the lip and ear. From thisstudy, 31 patients were older than 60years of age. Most importantly, of 25cases with cancer in the region ofthe eyelid and the nasal flank, 15patients wore spectaclespermanently and 10 patientsoccasionally wore either readingspectacles or sun spectacles. It wasconcluded that because none of theframe materials were carcinogenic,the spectacle-induced cancer couldonly be the result of constantpressure and skin irritation at thepoints of contact between face andspectacle frame.

AccuMax Array20 carried out researchon 50 patients. Their ages rangedfrom 41 to 87 years and they hadbeen diagnosed with various types ofskin cancer. From studying the resultsit was deduced that 25 individualshad basal cell carcinoma, 20 of thegroup were males.

Of the reported 21 cases on thehead or face, only two were on thescalp, the remaining were nasal, andaround the periocular area includingthe canthus and the lower eyelid. Itwould be useful to know how manyof the remaining 19 patients worespectacles.

As cited by Obstfeld (1997),Heidenreich (1975) agreed with Otto(1958) and Miller (1972) ‘on the causeof facial cancer and stressed theimportance of an anatomicallycorrect fit of the front in the(spectacle) wearer’s nasal area’14.

Duty ofcareThe role of the dispensing optician isto advise the patient and to fit thespectacle frame and lensescorrectly. It is their duty torecommend and give adviceregarding the frame fitting, shape,material, colour and the suitability ofuse. Information should be given withreference to the lens material and UVprotective suitability wherenecessary. The patient’s lifestyle,occupation and hobbies must beconsidered in order to give the bestadvice possible.

The General Optical Council (GOC)codes of conduct recommend thata registered optometrist or dispensingoptician must make the care of thepatient their first and continuingconcern. It is their duty of care torefer patients to a registered medicalpractitioner or a hospital for medicaladvice21.

Often it is difficult for opticalpractitioners to determine thedifference between BCC whichcould be a danger to the patientand acanthoma which is non-threatening. The dispensing opticianis in an ideal position to look at thelids and eye area while measuringthe patient and fitting thespectacles.

It is important for the practitioner tobe able differentiate the BCC as ifleft untreated, according toeyecancer.com ‘the tumour cangrow around the eye, into the orbit,sinuses and brain. They arecommonly found on the lowereyelids, and almost never spread toother areas of the body’8.

The facial skin is quite tight as there isreduced tissue under the surface;therefore skin cancers on the faceare likely to be more aggressive.However, individuals regularly look attheir faces so they are generallynoticed at an earlier stage thanother parts of the body where theskin is looser and cancers are notdetected as early in development22.

Consultation is often delayed whenthe hidden areas of the outer ear areaffected, as they are not visible tothe individual7.

I have found that some patients maynot even notice the appearance ofa carcinoma on the face as theythink it is a mole or a spot, whichcould be hidden using make-up.Alternatively their spectacles mayconceal the carcinoma, or it maynot be visible to the individual whenthey remove their spectacles; forexample in the case ofhypermetropes and presbyopicpatients.

Optical practitioners should ensurethat patients appreciate the benefitsof wearing UV protective lenses froman early age. The lens shape and sizeis important, as small frames do notoffer adequate protection andalthough large frames protect theperiorbital area, the wearer may beat risk from UV reflected from theback surface of the lenses18.

Increased awareness should befocused upon hypo-allergenic framematerials such as titanium, nickel-freestainless steel and injection mouldedplastics materials, as they are lesslikely to cause skin irritation.

CasestudiesA case study cited by Hague andIllchysyn19 demonstrated that onepatient had a reported ulceratedplaque below his eye. The clinicaldiagnosis was BCC.

However, following a biopsy andpatch test the results consequentlyshowed that this was due to areaction to nickel content in ill-fittingspectacle frame. The gold platinghad worn off the rims which restedupon the patient’s cheek andthereby caused the ulcerated area.The case study showed that contactdermatitis caused by an allergy tonickel actually mimics BCC. This wasa case of acanthoma.

A separate study analysed 62 casesof facial skin cancer14. The studyrevealed that the preferential areasof the development of facialcarcinoma were the inner canthusand lateral nose, the cheek and pre-auricular regions, the bridge of the

CCoonnttiinnuuiinngg EEdduuccaattiioonn aanndd TTrraaiinniinngg

MCQs overleaf

Arnould-Taylor Organisation Ltd,1977; page 6513.McGuinness H. Anatomy &Physiology therapy basics. 3rd Ed.Abingdon, Oxon: Bookpoint Ltd,2006; page 5614.Obstfeld H. Spectacle Framesand their Dispensing. London: W.B.Saunders Ltd, 1997; pages 92 and19315.MacDonald DM, Martin SJ.Acanthoma fissuratum-spectacleframe acanthoma. ActaDermatovener (Stockholm) 1975; Vol55, pages 485-488 16. Sherertz EF, Leshin B, Schappell D.Eyewear, Cataracts and PeriorbitalBasal Cell Carcinoma. Cutis. 1992Oct;50(4):p 312-3 17. Sasieni L.S. The Principles andPractice of Optical Dispensing andFitting. Worcester and London: TrinityPress, 1962; p 318. Rosenthal F, Alexander E, BakalianAE, Taylor HR. The Effect ofPrescription Eyewear on OcularExposure to Ultraviolet RadiationAmerican Journal of Public HealthVol 76 (10), 1986 Oct; p 1216-122019. Hague J, Ilchyshyn A. ContactPoints. Nickel allergy mimicking basalcell carcinoma. Contact Dermatitis.2006; Vol 54, p 344-35120.Noscomial infection (online) 2009.Available from http://www.biomedexperts.com/Abstract.bme/15753968/The_causes_of_skin_cancer_a_comprehensive_view (accessed 21December 2009)21.General Optical Council. Adviceand Guidelines on professionalconduct. 2009; Appendix A (1) GOCCodes of Conduct (online) 2005.Available fromwww.goc.org.uk (accessed 21December 2009)22. Buckman R. Cancer is a word, nota sentence. London: HarperCollinsPublishers Ltd, 2007; p 31

Sally Bates is a part-time lecturer atABDO College, responsible forteaching all elements of theprofessional practical examinationsand theory of communication skills.She is the proprietor of IdentityOptical Training and a self-employedlocum dispensing optician. �

suffer from periorbital facial basalcell carcinoma, particularly due tothe fact that there is an increase inthe number of reported cases ofBCC.

References1. Yanoff M, and Duker JS.Ophthalmology. 2nd Ed. St Louis:Mosby, 2004; p 7112. Heckmann M, Zogelmeier F andKonz B. Frequency of Facial BasalCell Carcinoma Does Not CorrelateWith Site-Specific UV Exposure. ArchDermatol, 2002 Nov, Vol 138: p 1494-1497 3. Taub MB. Ocular effects ofultraviolet radiation. OptometryToday 2004 Jun; p 34-38 4. Rook A, Burns T. Rooks Textbook ofDermatology Volume 1, 7th Edition.Massachusetts, USA: BlackwellScience Ltd, 2004; p 325. Rose LC. Recognising NeoplasticSkin Lesions: A Photo Guide. (online)1998 American Family Physician 1998University of Texas Health ScienceCentre, San Antonio, Texas Availablefrom http://www.aafp.org/afp/980915ap/rose.html (accessed 21December 2009)6. Tobias J, Eaton K. Living withCancer. Oxford: BloomsburyPublishing PLC London, 2001; p 128and 131 7. Young S, Sands J. Sun and theEye: Prevention and Detection ofLight-Induced Disease. Clinics inDermatology, 1998; Vol 16 p 477-485, 8. http://www.skincancer.org/basal-cell-carcinoma.html (accessedDecember 21 2009)9. Woollams C. Everything YouNeed To Know To Help You BeatCancer. Buckingham: Health IssuesLtd, 2005; page 227 10.American Science of OphthalmicPlastic and Reconstructive Surgery.(online) 2010. Available fromhttp://www.eyecancer.com/patient/Condition.aspx?nID=12&Category=Eyelid+Tumors&Condition=Basal+Cell+Carcinoma (accessed 14 June 2010)11. Seeley R, Stephens T, Tate P.Anatomy & Physiology. 7th Ed.McGraw-Hill International Editions,2006; p 15812.Gallant A. Principles andTechniques for the Beauty Specialist.Henley on Thames, Oxfordshire:

DiscussionFrom the findings it is obvious thatBCC is linked with exposure to UVradiation16. Much information ispublicised regarding the practice ofsafe sunbathing and wearing sunprotection, including facial creamscontaining high sun protection factor(SPF). Wearing sun spectaclescontinues to be a popular trend toprotect the eyes from UV damageincluding cataracts; however little ismentioned regarding periorbital skincancer.

It is apparent that good practicewith regard to the correct framefitting is vital to the needs of patientsin order to reduce the cases ofmisdiagnosis of BCC compared toacanthoma when related tospectacle wear. Cancer informationis constantly updated regardingrecognition, explanation andtreatment as the internet providescurrent and progressive details ofvital importance.

ConclusionOptical practitioners need to beaware of the significant differencesbetween facial basal cell carcinomaand acanthoma. This has an impacton everyday working practice,ensuring that the application andfitting of the individual patient’sspectacle frame is of paramountimportance.

The consequences of badly fittingspectacles could be the cause of anumber of problems associated withfacial BCC, for instance the erosionof the epidermis and exposure of thedermal layer where cancer cells arepresent. However, this is based uponanecdotal evidence, and is notscientifically proven.

There is little recent research into apossible link between spectaclewear and facial BCC. Publishedliterature regarding this subject islimited and therefore not enoughrelevant information was available toform a decisive conclusion.

It would be very useful to performfurther research to distinguish howmany spectacle frame wearers do


Multiple choice questions (MCQs):Do spectacles cause facial basal cell carcinoma?

1. Which areas of the skin suffer dermal erosion specificallylinked to spectacle wear?a. The bridge of the nose b. The area behind the earsc. Both a and bd. Neither a nor b

2. How is acanthoma caused?a. By wearing too much make upb. By wearing large nose padsc. By wearing a frame material containing nickeld. By the weight of the spectacles

3. Which statement about spectacle acanthoma is true?a. It should be treated surgicallyb. It is a form of spectacle-induced carcinoma c. It can be caused by hearing aids as well as spectaclesd. It can occur on the eyelids

4. How does acanthoma differ from facial basal cellcarcinoma?a. Acanthoma has central papule and there is an

absence of a ‘pearly edge’b. Acanthoma has a central fissured groove and there is

an absence of a ‘pearly edge’c. Acanthoma has a central fissured groove and a ‘pearly

edge’d. Acanthoma has a raised central area and there is a

‘pearly edge’

5. Which of the following is not a risk factor that maycontribute to the development of BCC?a. Contact with arsenicb. Exposure to radiationc. Having fair skin and blue eyesd. Being aged under 5 years

6. The epidermis:a. Has sweat glandsb. Is the deeper layer of skinc. Contains pigment producing melanocytesd. None of the above

7. What is the usual appearance of a basal cell carcinoma

on the face?a. A sore that will not healb. A dark spotc. A painful or itchy lumpd. A pink groove with a central fissure

8. Which statement is false about imiquimod?a. It is a form of chemotherapyb. It is applied topically as a creamc. It is known by the trade name of Aldarad. It is used to treat deep BCC

9. Which statement is true?a. Standard plastics spectacle lenses provide UV

protection up to 350nmb. Standard plastics spectacle lenses only provide UV

protection if they are tinted c. Standard plastics spectacle lenses only provide UV

protection if they are UV coatedd. Standard plastics spectacle lenses do not provide UV

protection

10. Which of the following may be a cause of a facialtumour?a. Any frame materialb. Any metal frame materialc. Poor frame fittingd. The frame material combined with poor frame fitting

11. Which statement about plastics spectacle framematerials is true? a. Cellulose actetate is less abrasive than injection

moulded frame materialsb. Silicone nosepads are hypoallergenicc. Propionate, SPX and Optyl frames can develop rough

surfaces after prolonged weard. None of the above

12. Which metal spectacle frame material does NOTcontain nickel?a. Monelb. Titaniumc. Flexond. Rolled gold

The deadline for posted or faxed response is 17 March 2011 to the address on page 4. The module code is C-14877

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 orsave your results letter, go to 'View your CET record'. If you would prefer to receive a posted results letter, contact the CETOffice 01621 890202 or email [email protected], printing errors are spotted after the journal has gone to print. Notifications can be viewed at www.abdo.org.uk<http://www.abdo.org.uk> on the CET Online page


Adaptations like installing a rampinstead of stairs and adding in aninduction loop can help too, as manyolder people experience sight loss incombination with another disability. Areasonable adjustment doesn’t haveto blow your budget; the size of yourbusiness is taken into account whendeciding what is reasonable.

Stephen Kill is a trained rehabilitationofficer and eye2eye manager forcharity SeeAbility, formerly theLondon School for the Blind. He hassome practical tips to help you makeattending your practice a welcomingexperience for anyone with poorsight.

Finding the practiceThe first step in making a visit to yourpractice a positive experience is tolook at your exterior and entrance.Stephen Kill advises the following:• Mark up external steps edging with

colour contrast plus contrastinghandrail or grabrail

• Glass doors can be difficult tolocate; ensure that the door handle

Antonia Chitty gives some practical advice aboutmaking it easier for people with sight loss to findyour practice and book an appointment, and how toimprove your low vision services

should be able to access yourpractice, get eyecare and purchasespectacles as they need. You, as aservice provider, have an obligationto make reasonable adjustments toyour premises or to the way that youprovide a service. Sometimes it justtakes minor changes to make aservice accessible.

The EA means that you must makereasonable adjustments to yourpractice, and there are somepractical steps you can take. Youcould:

• Provide disability awareness trainingfor staff who have contact with thepublic

• Provide larger, well-defined signage• Create a range of leaflets in large

print• Have good lighting in all areas of

the practice, including corridorsand halls

• Use contrasting colours fordoorways, carpets, furniture, etc

• Have appointment cards availablein large print

Adapting yourpractice for peoplewith sight lossEveryone needs a regular sight test,

even if they have a visualimpairment. While some people withvisual impairments will be seen at theeye hospital, many will need theirregular eye examination to takeplace at a practice in the community.There are lots of things you can do tomake your practice easily accessiblefor people with sight loss, and tomake the experience of an eyeexamination easier and morebeneficial for them.

From 1 October 2010, the Equality Actreplaced most of the DisabilityDiscrimination Act (DDA). However,the Disability Equality Duty in the DDAcontinues to apply. The Equality Act2010 (EA) gives disabled peopleimportant rights of access toeveryday services. It is unlawful forservice providers to treat disabledpeople less favourably because theyare disabled. The service providermust not indirectly discriminateagainst a disabled person unlessthere is a clear reason to do so. Thismeans that people with sight loss


contrasts well with the background• People can also struggle with

heavy doors, particularly if being guided, carrying a cane or shopping bags

• Have a distinctive shop front that stands out visually from its neighbours

Indoor navigationNext, check out the practice interior.Kill lists several low cost and no-costways to improve accessibility: • Provide clear and wide pathways

to minimise tripping, which allow space for sighted guiding, long cane use or wheelchair access

• Provide good, clear and consistent lighting levels throughout

• Mark up internal steps edging with colour contrast and tactile strips plus contrasting handrail

• Offer verbal and physical guidanceas required

• Train staff how to guide someone with sight loss

Good communication makes a bigdifference, as Kill explains:“Receptionists ready to meet andgreet can boost people's confidencewhen they enter the practice.”

SupportKill advises, “Remember the person'ssight loss – they cannot seeeverything that is going on aroundthem. Explain what will happenbefore you do it.” As part of this, Killadvises the following:• Come out to meet the person and

introduce yourself• Talk to the person first. Do not

assume that communication will bewith a carer

• If supporting someone who is a wheelchair user, tell them where you are going and check that they are ready before you set off

Learning moreIf you want to learn more about lowvision there are lots of resources tohelp. Your local area CET events arelikely to include low vision, and thereis usually a CET element for low visionat the ABDO conference. The ABDOCollege offers a one-day low visiontaster course as well as a seven-month low vision honours course,which combines distance learning,practice-based learning and blockrelease. These courses contribute toCET points. To find out more, call01227 733901 or email

PPaattiieenntt aanndd pprraaccttiiccee mmaannaaggeemmeenntt

[email protected] or visitwww.abdocollege.org.uk

If you need further ideas to help youdevelop your practice accessibility,check out Look Up’s AdaptingAccommodation factsheet athttp://www.lookupinfo.org/eye_care/eye_care_factsheets/ (bottom of thepage).

Antonia Chitty is a former optometristwho writes on business and health.She is author of Sight Loss: TheEssential Guide (Need2Know BooksJanuary 2011 £9.99), a guide forstudents, patients and carers whichexplains causes of sight loss and offerspractical tips for every day life. �

Beverley Ricketts is a low vision dispensingoptician. She explains: “Every dispensingoptician is qualified to dispense low visionaids, and the skills you need for low visiondispensing are often the skills you are usingevery day for ‘normal’ dispensing. As thepopulation ages, you will find you need yourlow vision dispensing skills more often.Existing patients can develop conditions suchas AMD that cannot be treated. They maycome to you for visual help, but you couldalso be their first port of call for advicewhen they read about a new ‘cure’ for AMDin the media.” Stay on top of the researchand follow news so you can help people inthis situation.

Small additions to your practice can behelpful to older people and those with sight

loss. Beverley advises: “As an individual getsolder, less light will enter their eyes. Have atask light at the dispensing station and youcan demonstrate the benefits of tasklighting. If you are dispensing high adds, workwith your optometrist so you can advise thepatient on where to position the task.” Iffitting complex or telescopic lenses, all theregular factors you take into accountbecome even more critical, such as thecentring, the back vertex distance and the fitof the bridge. Beverley advises: “Morecomplicated spectacle dispensing can bereferred to a low vision specialist centre.Always have a low vision leaflet in yourpractice, which is a recognised method ofreferral into low vision services.”

Overall, it is important to remember that

you are not the only professional helpingpeople with low vision. If someone attendsyour practice, ask whether they are gettingsupport from the local authority. Keep largeprint leaflets from your local association forpeople with sight loss and have details oflow vision centres in your region. �

Dispensing low vision aids

Beverley Ricketts

Stephen Kill

In our new series, the Rx files, PeterSanders shares his approach to someinteresting dispensing cases he hasencountered in practice


The Rx filesPart one: Anisometropia handled in an unusual way

• A pair of polarised sunglasses withthe same combination• A pair of enhanced reading lensesfor balanced near and intermediatevision when doing prolonged closework

On collection, I have rarely seen sucha broad smile from a patient. She wasecstatic about her new spectaclesand was enormously pleased to beable to see in the distance and toread. The enhanced reading lenseswere also a great hit as she was doinga PhD, which involved doing a lot ofcomputer work. In short – a job welldone.

A few days after the aboveprescription was dispensed I had agentleman come in with an Rx of:R –7.50 / -1.50 x 180 add +2.00 L –5.00 / -1.50 x 180 add +2.00

He was wearing Varilux Physio, andwhen I asked if he was happy withthem the answer was yes. I thenquestioned him about his near visionand he admitted that it did tend tojump around a bit but then it alwayshad done. I supplied him with a shortprogressive zone lens in the right eyeand a long in the left eye. When hecollected the spectacles, headmitted that the near vision wasmuch better.

Peter Sanders FBDO director of C3rsand a manager of a busy practice inHertfordshire.

We invite readers to comment onPeter’s approach - please [email protected] �

for various reasons it would not work. Ithen proceeded to ignore all theadvice the manufacturers gave meand work out a theory of my own.

Wider choice availableThe basic rule in those days was tokeep the design of the lens based onthe same manufacturing theory. Inother words, do not mix manufacturers.I did not have much of a choice andthe lenses I used then were the ShamirGenesis and Piccolo. Now we not onlyhave a vast range of suppliers but therange of progression zones are greaterthan they ever used to be. To top it off,freeform manufacturing technologynot only balances up the centresbetter, but it keeps the designs thesame. This tends to works foranisometropia of up to 2.50D, however,for greater amounts of anisometropiawe should be looking at either a slaboff or a slab on. These lenses areavailable from Norville in the Ultordesign. So what is the difference?

A ‘slab off’ is worked on the back ofthe lens and is what is described as an‘invisible join’. In fact, it looks like acrease in the lens and works for adifference in prism of up to four prismdioptres vertical. This is only availablein CR39. A ‘slab on’ is on the front ofthe lens and is a semi visible line. This isavailable up to 8.00D in 0.50D stepsand up to 20.00D in 1.00D steps –again only in CR39.

So what did I supply this patient with inthe end? Three pairs of spectacles:• A pair of progressives with a shortprogression zone in the left eye andlong in the right

R +0.25/-0.50 x 90 4 prism out add +1.75L –2.25/-0.75 x 90 4 prism out add +1.75

A patient presented with the aboveprescription, and said she was wearingtwo separate pairs of spectacles.When I asked her if she hadconsidered progressive lenses, sheexplained that she had been told thatwith her prescription she could nothave them.

Let’s look at the options apart fromtwo separate pairs. We coulddispense:• Bifocals• Slab off• Franklin split • Different size segs• Progressive lenses• Slab on• Slab off• Or one option that most peoplewould not think of – different lengthprogression zones

We all know the theory of usingdifferent size seg bifocals to balanceup near centres – and if we don’t, weshould. Just to remind you: a roundseg bifocal produces base downprism; a 28 seg bifocal produces lessbase down prism than a 45 segbifocal; therefore why not apply thesame theory to progressive lenses.

We now have a wide choice ofprogression zones and by selecting ashorter progression zone and a longerone, we can balance up the nearcentres. This is a theory that came upin a conversation many years ago. Ispoke to various people on the lensmanufacturing side and was told that

over £78,000 worth offunding through AngliaVision Research, providessoftware and instrumentationfor specialised visionassessments not normallycarried out in routineoptometric examinations. Itwill provide for furtherclinical assessment onpatients, enhancedteaching and researchpossibilities forundergraduate optometrystudents and postgraduatevision science researchstudents, as well as seedingfor new research projectsby vision scientists.

Electrophysiologicalequipment allows for non-invasive, objectiveassessment of normal anddiseased retinas and theoptic nerve pathway tovisual cortex, in children

The new Evelyn Trust AngliaVision Suite is funded by agrant from the Evelyn Trust,which supports medicalresearch and healthcare inCambridge and thesurrounding area. Thefacility, which attracted

Anglia Ruskin University’sDepartment of Vision andHearing Sciences hasopened a new visiontesting and assessmentfacility to support teachingand research in optometryand the vision sciences.


Unveiling Anglia’s new vision testing facility

Helping patients decide about contact lensesthem?; and what type of lens is bestfor me? It is the third in a series ofBCLA leaflets for patients, aimed atencouraging healthy and safecontact lens wear and care. Theothers are: ‘Looking after contactlenses’ and ‘Buying contact lenses’.

BCLA President, Shelly Bansal, said: “AllBCLA patient leaflets are designed tosupplement and reinforce advicegiven by contact lens practitioners.Our latest leaflet will be invaluable in

The British Contact Lens Association(BCLA) has launched a helpful newleaflet for patients thinking abouttrying contact lenses, entitled:‘Wearing contact lenses’.

The eight-page leaflet presents aseries of common questions andanswers to help patients decide ifcontact lenses are right for them, andwhich type to choose. Questionsinclude: what are the benefits ofcontact lenses?; can anyone wear

Specialist teaching and researchfacility opened in Cambridge

Sightsavers and OneSight have begun a three-yearpartnership designed to reach 80,000 patients withsustainable vision care. The programme aligns with theGambia National Eye Care Programme, which deliversprimary, secondary and tertiary level eyecare services toits population.

The main goals of the partnership are: to strengthen theexisting primary eyecare centres; to establish two localoptical workshops, including community screening forrefractive errors and referrals to the secondary eyecareunits for further treatment; and to establish three self-screening vision centres in the country’s five administrativeregions. The charities will also provide training for two localoptometrists and 12 optometric technicians. �

Two global vision charities join force

promoting successful contact lenswear, and helping new wearers tomake the right decisions about lenswear and care along with professionalguidance from their contact lenspractitioner.”

BCLA patient leaflets can be orderedby emailing [email protected], or bydownloading an order form from theBCLA website (BCLA members only).Alternatively, telephone 020 75806661. �

and adults. Psychophysicaltesting will allow for furtherspecialised visualassessment as well as acomplete colour visionassessment in children andadults, a unique facility inthe Cambridgeshire region.

Dr John Siderov from AngliaRuskin said: “We wereextremely pleased andgrateful to be awarded thegrant from the Evelyn Trustand are delighted to havegot to the point where theEvelyn Trust Anglia VisionSuite in Cambridge is nowopen.”

Our photograph shows (l-r)Dr John Siderov, head ofdepartment, withcolleagues from the EvelynTrust, Adrian Frost andCatherine Thomas, officiallyopening the new facility. �

London to Parisbike challenge The President’s diary

The Presidents meet

Newsbrief

This summer Fight for Sightchallenges you to cyclefrom London to Paris in justthree days and raise vitalfunds for eye research.

Pedal through historic townsand sleepy villages, rideacross rolling countrysideand cycle along the wideParisian boulevards to finishat the city’s most famouslandmark – the Eiffel Tower.Participants will have time toenjoy the sights, sounds andtastes of Paris beforeboarding the Eurostar backto London.

Book your place in thissponsored cycle ride andhelp Fight for Sight to findways of preventing andtreating blindness and eyedisease. For moreinformation visitwww.fightforsight.org.uk/fundraising or contact the Fightfor Sight events team on 0207929 7755, [email protected] �

A few weeks ago I wasinvited to Dublin to visit theIrish President’s officialresidence, Áras anUachtaráin, and to meetthe President herself, MaryMcAleese. PresidentMcAleese is the secondfemale President of Ireland,and has been in officesince 1997, following formerPresident Mary Robinson.The official residence is amagnificent building, set inthe peaceful surroundingsof Phoenix Park, just outsideDublin.

Our visit started in the mainstate reception room,featuring Italian fireplaces,handwoven carpets andcrystal chandeliers.Paintings of formerpresidents lined the wallsand huge picture windowslooked out on to thebeautiful gardens. We stoodin this lovely room while thePresident welcomed usindividually and spoke afew words to each of us inturn.

Photography wasencouraged and thefriendly staff offered to takea group photograph witheveryone’s camera as akeepsake.

The daintiest of teasfollowed, during which thePresident came over toevery group for a chat. Shewas absolutely charming

and appeared genuinelyinterested in ourbackgrounds. After tea thePresident’s aide,resplendent in a uniformheavy with gold braid andshiny buttons, took us on atour of the beautiful housewhilst explaining its history.The visit was a unique andmemorable event, and Iwas proud to be able torepresent the Association inthis way. My thanks go tothe organiser, OptometryNorthern Ireland, for invitingme to join the group.

I have recently sent a letterout to you asking for yourhelp in gathering evidenceof illegal and poor qualitydispensing which yourpatients may haveencountered from internetsuppliers or unregisteredsellers. The letter provides atemplate for your patientsto complete and sign,which will be used as partof a dossier of evidence forthe GOC and Departmentof Health. The aim is toexpose the shoddy andinaccurate dispensingwhich abounds, and tohighlight the advantages ofusing dispensing opticiansto dispense spectacles.

All evidence is welcome,whether an example ofpoor frame fitting,inaccurately centred lensesor simply substandardservice. Just recently I was

contacted by a member ofthe public dissatisfied withinternet PPLs, which shecould not use, and whowas still waiting for a refundafter seven months.

To complement thisinitiative, the Board islooking at ways ofrecruiting more people intothe profession andencouraging employers touse us rather thantechnically challengedindividuals. We will besupported in our efforts bythe other members of theOptical Confederation, andI am determined to doeverything possible to getthe message across to therelevant parties.

I am delighted that the firstholders of the BSc (Hons)degree in OpticalDispensing Studies (ODS)will be graduating thismonth and I look forward tomore of you achieving thisprestigious qualification.The degree is awarded inassociation with CanterburyChrist Church University anddemonstrates a furtheropportunity for professionaldevelopment offered byABDO. The BSc (Hons)degree course is open toFBDO members registeredwith the GOC and moreinformation on the coursecan be found on the ABDOCollege website.

Jennifer Brower

If you have a jobvacancy in yourpractice, please

remember that theSituations Vacant sectionin the Bulletin Board area

of the ABDO websiteprovides you with a

quick and easy facility toadvertise completely

free-of-charge. �

Conlons duo deliverspecs to Ghana

The recently launched report,‘Liberating the NHS: eye care – makinga reality of equity and excellence’ byProfessor Nick Bosanquet, reveals thatcommunity eyecare could achieve ahigh quality service at a reduced costby transferring hospital outpatientservices into the community.

The report found that an estimated onethird of out-patient follow-upappointments could be delivered inlocal optical practices. ProfessorBosanquet, of Imperial CollegeLondon, presents the case for morecommunity eyecare, which would helpensure that eye conditions aredetected and treated early, reducing

the high level of avoidable blindnessand creating an estimated saving ofup to £4bn a year.

In the report the Professor calls forpolicy makers to enable optometry tohave a bigger role in achieving thegovernment aim for high quality localhealthcare services at a reduced cost.He identifies community eyecareprovision as a ‘model service’, whichalready exemplifies the ambitions ofthe Health White Paper. ProfessorBosanquet advocates the roll out ofestablished and successful localeyecare services on a nationwidebasis to make the best use of allavailable resources.

He said: “By 2050 the number ofpeople living with sight loss is set toincrease by 115 per cent to almostfour million people, unless urgentaction is taken now. The NHSurgently needs to free up capacity inhospital eyecare services. Re-engineering eyecare services, as Ipropose, is the only way of meetingthis challenge.”

John Baron MP, co-Chair of the AllParty Parliamentary Group on EyeHealth and Visual Impairmentwelcomed the report and said:“Transferring hospital out-patients tothe high quality care of optometristscould not only speed up theirtreatment but also save the NHSbillions of pounds a year. It wouldalso free up hospital capacity totreat sight-threatening conditions.” �

Bosanquet report reveals ways to savesight and money

Ian and Alice on a mission in Ghana


Two key members ofConlons staff recentlyreturned from Ghanawhere they took 800 pairs,or £10,000 worth, ofspectacles that Conlons,with the help of Shamir whosupplied the lenses,

donated to the charity EyeAid Africa.

During the one-week trip,optometrist Alice Joycefrom the Formby branchand Ian Hechle, branchmanager and dispensing

optician from Conlons inBarrow, performed morethan 1,000 sight tests andhelped to distribute morethan 1,500 pairs ofspectacles. Alice and Iantravelled to Ghana as partof a team from the charityEye Aid Africa.

Ian said: “The experiencewas very moving andserved to emphasise howimportant good eyecareis. In Africa, access tooptical services, as well ascost, prohibits many frombeing able to see clearly,if at all. It was clear itwould be a busy weekwhen on the first day we

dispensed 227 pairs ofglasses and on the secondday we had to buy a largenumber of ready readersand low minus glasses fromthe market. This exercisewas repeated again laterin the week and by thetime we finished at theend of the week, we hadprescribed and dispensedaround 1,500 pairs ofglasses.”

For every pair of spectaclesConlons customers buy,they receive two free pairs.One pair is donated tohelping improve eyecare inAfrica and the other is forthe customer to keep. �

ABDO Benevolent Fund If you know of a dispensing optician, or adependant of a dispensing optician, who mightbenefit from the ABDO Benevolent Fund, pleaseget in touch with Barbara Doris on 020 7298 5102or email [email protected] or write toher at ABDO, 199 Gloucester Terrace, LondonW2 6LD. �


Fruits of World Sight Day Challenge fun

Doing their bit for WSD Challenge

Half the men they used to be

Professionals urged to lobby on eye health

Staff at companies andpractices across the UKtook the World Sight DayChallenge last October to

Following the publication of the government’s public healthWhite Paper, which failed to mention eye health as a publichealth issue in England, the UK Vision Strategy is urging alleye health professionals to lobby the Department of Healthfor its recognition.

UK Vision Strategy programme director, Anita Lightstone,said: “This is a very disappointing omission given theDepartment of Health’s expressed support of the aim of theUK Vision Strategy to prevent all avoidable sight loss.Without more efforts to integrate prevention and improve

Readers may recall a piecepublished in DispensingOptics early last year onbehalf of Lee Price of PhillipsOpticians and Nigel Castleof Lenstec as they embarkedon a major weight losschallenge to raise moneyfor their chosen charities.

Well, since 10 March 2010Nigel has lost an amazingseven stone three pounds,while Lee has lost astaggering 12 stone four-and-a-half pounds. Lee hithis target weight on 10December 2010 andmanaged to stay teetotalbetween 1 January and 22December.

“We have both passed

beyond our wildest dreamsthe challenge we setourselves last December,”said Lee. “We havesupported each otherthrough thick and thin andencouraged each otheralong the way with someruthless banter. We are nowembarking on our nextchallenge to keep theweight off by remaining at‘fat club’. Thank you to allthose who have contributedthus far and have givenboth of us your generousand valuable support.”

For more details of theirachievement andfundraising, visitwww.lenstec.co.uk/thechallenge.htm �

case finding in mainstream public health activities,thousands of people will continue to lose their sightunnecessarily.”

The UK Vision Strategy is urging all eye health professionalsand service users to get their voices heard by writing to theDoH to request that a document about eye health bespecifically created, along with those planned for obesity,smoking and mental health. Practitioners can fill in the DoHonline consultation form at www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm �

At CIBA Vision headoffice in Southampton,staff participated in a‘simulation’ of commoneye health problems tohelp them understandsome of the everydayissues faced by peoplewith sight loss. They alsodressed up in schooluniform and took part inquizzes, a mammothbake sale and karaoke.A team from thecompany joined in theGreat South Run, helpingit raise more than £2,000– its greatest amount yetfor the annual charityevent.

“The World Sight DayChallenge is extremelyimportant to everyone atCIBA Vision,” said UK andIreland MD Roger Lopez.“All of our activities areabout raising funds toprovide healthy vision toas many people in theworld as possible, which

in turn offers a better life ingeneral.”

Meanwhile at Essilor UK,staff took part in a ‘wackycostume day’, raffles and acanteen waiter service,where executivemanagement served staffmembers and clearedtables. The company raised£1,000, which will beequally shared betweenOGS and VAO forsustainable projects. “Theday was great fun and itwas fantastic to seeeveryone pull together,”said Mike Kirkley, Essilor UKmanaging director.

Our photograph shows thecheque handover at EssilorUK. Pictured from left areMaureen Lee, purchasingco-ordinator, Claire Knight,executive PA, Amy Williams,finance and commercialadministrator, Donna Power,OGS country manager, andMike Kirkley, Essilor UK MD. �

help raise money forOptometry Giving Sight(OGS) and Vision AidOverseas (VAO).

Practices rewarded atannual Club Awards

Rodenstock MD, Dietmar Rathbauer (second left), and national salesmanager, Ian Harrison, with Chris Jenkins and Kelly Bloomfield from BurnettHodd & Jenkins

Talented classical soprano,Alexandra Webster, whoworks at Leeds-basedBrosgill Opticians as adispensing and contact lensoptician and is a part-timetutor at Bradford College,has recorded a CD to raisemoney for Vision AidOverseas (VAO).

Alexandra, who is also anABDO practical examiner,studied music atHuddersfield Universitygraduating with a BMus in1995. As a classical soprano,she competes throughoutthe North of England andhas achieved many firstprizes and awards, been asemi-finalist at the LlangollenInternational Eistedffod anda finalist at the CardiganEistedffod. Recent concertperformances include thosein Edinburgh, Bamford andWhitby.

All proceeds from the saleof Alexandra’s self-titled CD,which costs £5 and featurespieces from well knownoperas to Gershwin andCole Porter, will go to VAOsince her father funded theentire cost of recording andproduction. Alexandra is anactive member of VAOhaving volunteered in 2006as part of a team deliveringdirect service clinics inSenegal. To purchase theCD, contact Alexandra byemail at [email protected] or viamyspace.com/alexandrawebster. �

Newsbrief

products will be launchedthroughout the year andsome key debuts will beshown at Optrafair. MrRathbauer then presentedthe awards. In total there

The prestigious DorchesterHotel in London was thesetting for the annualRodenstock Club Awardswhich rewarded thewinning practices from2010.

Practices competedthroughout the year in awide variety of productcategories, with the overallCentre of Excellence for2010 being Burnett Hodd &Jenkins of Sidcup, Kent.Categories includedRodenstock premium lensproducts, sports lenses,Rodenstock frames andPorsche Design eyewear.Burnett Hodd & Jenkinswere recognised forshowing “tremendousloyalty to the completeRodenstock portfolio oflenses and frames” andmanaged to hold off closecompetition from the tworunners-up, ColemanOpticians of Norwich andMartin Steels Optometrist inStorrington.

The luncheon was served inthe traditional Dorchesterballroom with typicalChristmas fare. Guests notonly enjoyed the food andwine but also star of Mockthe Week and 8 Out of 10Cats comedian, AlunCochrane.

Rodenstock UK managingdirector, DietmarRathbauer, explainedplanned developments for2011. New lens and frame

were almost 100 ticketsavailable to win, with thewinners jetting off to Athensto enjoy the legendaryRodenstock Clubhospitality. �

Hitting the highnotes with charity CD

Raising standards at secondMAPO conference

Learning deaf communication Council opticians representative,Thomas Kok

VIPs


Thanks to Alcon’s exclusivesponsorship, MAPOmembers were able toattend the event at verymuch subsidised rates. Thepurpose of the CPDprogramme was to providean opportunity andencourage members andeyecare practitioners toupgrade themselves.Delegates were able togain new theoreticalknowledge, updatepractical skills and enhancetheir level of professional

competence. Overall theyachieve a higher standardof practice, knowledgeand skill in their profession.

This year’s topics, chosenby MAPO educationchairman, Walter Chai andhis team, covered dry eye,phakic intraocular lens,age-related maculardegeneration, keratoconus,cataract surgery andoptions of intraocularlenses, lasik, autism, the lensmaterial Trivex, how

ophthalmic lenses aremade and the importanceof multi-coated lenses.Other related topicsincluded epilepsy, GreenEarth, eye diseases andvisual impairment,prescribing solutions forcontact lens disinfectionand comfort, and the deafcommunity.

On the second day of theconference, an opticianrepresentative to theMalaysia Optical Council(MOC), MAPO’s pastpresident Thomas Kok, andMAPO membershipchairman, Chan Kok Khei,briefed attendees with the

latest news and informationregarding MOC andMAPO. Mr Kok talked aboutthe enforcement of theOptical Act, the election oftwo representatives for thenew term and nominationdate, responsibility of therepresentatives, someoutstanding issues andrecommended actions forregistered opticians. MrChan spoke about thebenefits of membershipand important upcomingevents for next year.

The Association’s 26th AGMwill be held on 20 March,following an educationalprogramme. MAPO Fair2011 will be held on 23 and24 April with plenty ofexciting activities plannedby exhibitors.

* MAPO recentlyannounced a newunderstanding with theSingapore OpticianryPractitioners (SOP), its fellowassociation in Singapore, tocooperate and work inpartnership towards thebetterment of theirrespective members andoptical industries. Membersof one association will beable to share in the samebenefits enjoyed by theother. Members of SOP willbe invited to attend MAPOFair 2011, while members ofMAPO will be invited toattend SOP Conference,and so on. �

Some 230 delegates attended the second MAPO(Malaysian Association of Practising Opticians) NationalCPD (continuous professional development) Conferenceon 13 and 14 November 2010.

•Eye examinations reduce by almost 4% on October, a 1% improvement on November 2009 and the annual growth figure remains positive at 3½ %

•NHS tests, as a percentage of the total number of tests, are up 1% from last month

•Total dispensing increased by 2% from last month, with and bi/tri focals and progressive lenses going up by 14% and 6% respectively and single vision falling by 3%

•Total turnover is up by 1% on October and 8% higher than November last year. The annual growth figure is positive at 10%

•Turnover per eye examination rose by £3.84 from last month to £144.19•Photochromics increased by 1% to 13% of dispensing

Optician Index - November 2010 summary

Develop your contact lensskills at BCLA 2011

First-time delegates at last year’s conference


Taking place in theManchester ConventionComplex between 26 and29 May, BCLA 2011 isoffering a new track on theSaturday dedicated tothose who are looking forpractical, hands-oncontact lens education.Topics will include: ‘How tobe successful with softtorics’ with Dr PhilipMorgan; ‘How to choosethe right soft lens for yourpresbyopic patients andthe pearls of multifocalsuccess’ with CherylDonnelly; ‘How to choosethe right care regime forboth patient and lens’ withNick Atkins; and ‘How tointroduce and fit RGPs inyour practice’ with AndrewElder Smith.

This session will also look atrelevant business issues,such as ‘How am I doing?Using your practice metricsto ensure success’ withPatrick Myers, and ‘HowKPIs [key performanceindicators] changed mypractice’ with Martin Russ.Finally, Jayne Schofield willcover the importance ofpatient communicationand understanding bodylanguage in successfulcontact lens practice.

So much on offer foreveryoneOf course, this is just one ofa number of excitingcontact lens CET sessionson offer at this year’s event,

themed ‘Learn Today –Practice Tomorrow’. Otherhighlights include:• Clinical Spotlight on therapidly developing field ofmyopia control• New session on contactlenses and general health• Non-clinical Thursdayevening lecture on ‘Funwith visual illusions’• Top 10 Tips Challengewith leading expertspresenting clinical pearls forcontact lens practicesuccess• Patient compliancesession looking at who is theweakest link – patient orpractitioner• BCLA Medal Lecture byProfessor Mark Willcox on‘Increasing the safety andcomfort of contact lenswear’• Irving Fatt MemorialLecture by Dr JacintoSantodomingo on‘Controlling myopiaprogression with Ortho-k’

There will be, as always, anaction-packed exhibitionon the Friday, Saturday andSunday, which is free andopen to everyone includingaccompanying persons.New for 2011 will be anexhibition pavilion, whereexhibitors and sponsors willbe running short sessions ona variety of interesting andpertinent topics. This year’scomprehensive line-up ofclinical presentations andworkshops covers topicssuch as UVR prescribing,

orthokeratology fitting andtroubleshooting, tearanalysis, scleral lenspractice and soft multifocalfitting.

Of course, with the BCLAit’s not all hard work and noplay. The 2011 socialprogramme will ensure thatthe conference is theperfect place to catch upwith colleagues, make newacquaintances and partywith the best of them. Theprogramme begins withwelcome drinks foreveryone on the Thursdayevening, continues with theFriday evening Patron’sEvent sponsored byJohnson & Johnson VisionCare, again open to all,and culminates with thesplendid annual GalaDinner, which this year hasa fantastic Bollywoodtheme.

Booking lines are nowopen, and provisionalprogrammes can bedownloaded from theBCLA website atwww.bcla.org.uk. Don’tforget that you will qualifyfor an early bird discount ifyou book before 11 March.

Free places up for grabsIf you are a full BCLAmember based in the UK orRepublic of Ireland, whohas never before attendeda BCLA ClinicalConference and Exhibition,

then why not takeadvantage of an exclusiveoffer of 150 free places fornew delegates. Availablethanks to the support ofNew Delegates Sponsors,CIBA Vision, Johnson &Johnson Vision Care, Alcon,CooperVision, Bausch +Lomb and Topcon, theoffer includes a pass for theSaturday and Sunday,accommodation forSaturday plus a GalaDinner ticket. See theleaflet enclosed with thisissue of Dispensing Opticsfor details of how to apply,or click on ‘New DelegateOffer’ in the BCLAConference section atwww.bcla.org.uk

Book now for free CETworkshopsBCLA members are advisedto book early to secure aplace on one of theAssociation’s free specialistor basic workshops, eachworth four contact lens CETpoints. See Diary of events,page 31, for details of thespring programme.

Visit Events on the BCLAwebsite for details andregistration for workshopsand evening scientificmeetings, or [email protected]. If youare not yet a BCLAmember, visit theMembership area to readabout the extensivemembership benefits nowavailable. �

BCLA news

If you’re new to contact lenses, or returning to contact lens practice after a break, thenthe British Contact Lens Association (BCLA) Clinical Conference and Exhibition in May isthe place to hone your skills, writes Vivien Freeman, BCLA secretary general

Disjointed jottings from a DOs desk . . .

A funny thing happened on the way to my practice seminar, writes Nick Howard

Stepping outside the ‘comfort zone’ ofthe consulting room was one of themain reasons I applied for the positionof Practice Academy Consultant withCIBA VISION. A darkened room withlittle to no natural light was beginningto take its toll after 25 years and afresh challenge with undoubtedlynew, uncharted and interestingexperiences was inevitable. Six monthsdown the line, I was beginning to feela lot more confident, bordering onsmug, having clocked up over a 100hours of presentations to groups largeand small, with many entertaining andunpredictable moments along theway. Nothing in the manual, however,prepared me for the events of oneparticular afternoon.

Shaw, a small suburb two miles to theEast of Oldham, was my destination. Ihad visited the practice twice beforeso I shouldn’t have needed to use mysat nav. However, I decided it wasbetter to err on the side of cautiondue to me having a quite legendarilypoor sense of direction. Arriving apleasing and polite 35 minutes earlyfor my 5.15pm talk, my mind was stillrunning through the essential ‘oneliners’ necessary to emphasise thecrucial PowerPoint slides and drive themessage home.

Something was wrong. Parking waseasy; there was a small patch ofwaste ground at the back of thepractice and an area used for themarket on market day, but the stallswere empty and plenty of free parkingwas available. Something was verywrong. My ‘sixth sense’ was trying to

kick in but my mind was racingthrough – ’45 per cent of wearers napor sleep in their lenses’, ’12 per cent ofwearers drop out of lenses per year’…I am sure that was a one way street,but it cannot be . . . ‘Turn left’ blurtedout the sat nav.

A shout, a scream, an over-revvingengine; that car stopped, that onegoing too fast. That is too tight, he willcatch my wing mirror – ‘the wettingangle is actually reduced by 33 percent with the addition of the bondedplasma surface treatment’ – what theheck was going on? A bag of rubbishhad been jettisoned from a car and itscontents were now flying ‘tickertape’style down the street. So why wasevery man, woman and dog so eagerto keep the streets of Shaw so clean?‘Lipid deposits are kept to an absoluteminimum’ . . . Still trying to park thecar, I clunked into reverse gear andlooked over my shoulder to make thefinal manoeuvre when the pennyfinally dropped; this was no bag oflitter, this was real hard cash. I hadinadvertently and totally unwittinglystumbled into the middle of a bankrobbery.

By this time two special policeconstables were on the scene, onemale and one female, and I stoppedfor a moment to observe a little of thequite farcical and hilarious ensuingpandemonium. Teenagers, old ladies,well dressed businessmen, workmen offbuilding sites all joined in the frenzy tocollect the loot, which had beenexplosively dyed a deepish pink as therobbers escaped, then quickly

Gone with thewind

abandoned their bounty. This wassurely unspendable cash, but it did notseem to matter as the mix of £10, £20and £50 notes fluttered crazily in thebreeze – and just as bad luck wouldhave it, the wind was behind me. It wasan amazing sight and for a moment,my presentation ‘one liners’ were thelast thing on my mind. ‘Gone with thewind’ seemed more appropriate.

People seemed to arrive fromeverywhere and I was completelyuncertain as to who was collecting themoney for ‘return’ purpose and whowas trying to make a fast,opportunistic few quid. The excitedteenagers seemed to be best at the‘snatch’, the poor police having thesame problem as me, trying to workout the ‘goodies’ from the ‘baddies’.How I wished I had the energy andspeed off the mark as that particular12-year-old. Wow, a clean catch anda clean pair of heels – that’s what Icall a run for your money. My thoughtsquickly turned to CIBA’s ‘teenage’module and the obvious benefits ofhaving crystal clear vision with noperipheral limitations quickly sprang tomind. Social, physical and sportingachievers – there seemed to be plentyhere, I wondered how many werecontact lens wearers . . .

Jolted back to sensibility, sirens werenow wailing from just about everyangle and there seemed to be moreflashing lights than a Trafalgar SquareChristmas tree. Police vans wereappearing from all directions and thelooters were suddenly gone almost asquickly as they had appeared. Yes, I

Nick Howard


think 'Gone with the wind' was aboutright and I started to hum the verywell known 'Tara's theme' with somegusto.

Gulp. My mouth dropped wide openas I realised that I had arrived in thetown at exactly the same time as therobbery had occurred and, worse still,sitting diagonally across my passengerseat was a black cylinder, about 5ftlong which did rather resemble a tankbusting grenade launcher. This wasgoing to take some explaining. Almostwithout hesitation, quite seamlessly,the well practised verse kicked backin: “Well officer, I’ve come to talkabout the clinical benefits ofupgrading to silicone hydrogels andmaintaining patient loyalty. The oddlooking cylinder on the seat is myprojector screen of course”.

Seen it all beforeA moment or two later, grinning butshaking my head in almost disbelief, Ientered the practice by the front door.“There has been a bank robbery,” Iexclaimed to the momentarilyunaware staff. “What, another one?”Blissfully unaware at this particularmoment, the staff were all engaged in‘end of day’ procedures, cashing up,writing orders or tidying up. All dutiestemporarily, but immediatelysuspended. Seemingly, bank andbuilding society robberies arecommonplace in this town; this wasthe third this year. I felt rather foolish.

Was this Shaw, or had I arrived in somediverse reincarnation of the Wild West?I looked down at my recently polished,shiny black shoes wondering if mycowboy boots would have been abetter choice of footwear, andhummed a few more bars of Gonewith the Wind. There was a dash to theback door by all staff to see what wasgoing on, but the ‘real’ action waspretty much all over and there wasnot a lot left to see.

All giddy and a touch excitable, it wasnow up to me to deliver anoutstanding talk on the benefits ofupgrading, improving lifestyle,generating more income etc; thismight be tricky. With my projectorscreen carefully positioned to coverthe main shop window, we weretreated to the sound of speeding,wailing vans at regular intervals, butthe session was delivered with nohitches to speak of and if I daresaymyself, was an outright and pleasingsuccess, especially given theextraordinary background.

An hour and a half later, all packedup, we locked up and left thepractice by the back door. The wholearea by now was almost completelydeserted and taped off, presumablyfor forensic investigation, with just afew youngsters careering aroundexcitedly on their bicycles. There werejust four cars left – mine and those ofthe three staff, looking rather desolate

and out of place. The town hadeffectively closed an hour earlier. Itwas almost dark and a little eerie. Ipeered into the gloom. Was that acrisp packet fluttering down the streetor . . . ? I loaded my suspicious lookingpresentation equipment back into mycar – bulging briefcase, a smallsuitcase on wheels and of course myanti-tank grenade launcher – underthe keen and watchful eye of morethan a few police officers. All in aday’s work.

The front page of the OldhamEvening Chronicle the following daycarried the headline ‘Dash for cash’,and a suitably graphic account ofevents from a number of eyewitnesses. The hooded, armedrobbers escaped with a massive£67,000, which was hurriedly hurledout of the window of the escape carwhen the security dye exploded.Nobody was hurt or injured. There wasno mention of how much money waseventually recovered, nor was thereany mention of a mature, smartlydressed gentleman carrying agrenade launcher, humming thetheme to Gone with the wind.

Nick Howard FBDO (Hons) CL is acontact lens optician in alarge independent practice in Bury(north Manchester) and a practiceacademy consultant delivering CET-approved presentations on behalf ofCIBA VISION in the North West. �

It has been nearly a year now that I’ve been answering thesequeries. The original idea was that queries received regularly atMembership Services could be brought to the attention of thewider readership of the journal.

Like Topsy, it just grew and grew! I thought the number of querieswould reduce as I worked my way round all aspects ofprofessional conduct but quite to the contrary, they keep coming,more and more complicated and always a challenge.

Unlike so many journals, we do not have a policy of the “Editor’sword is final” and the questions raised from the FAQ are allseriously considered by the Advice and Guidelines working group.

Update on frequently asked questionsby Kim Devlin FBDO (Hons) CL

One such query was about my piece on ready readers. I said“guide the purchaser to the correct power for the usage of thespectacles”. Much debate ensued! Was I encouraging members totest sight? Truthfully I hadn’t considered that aspect of myadvice.

We agreed in the group that no advice as to the correct powershould be given, unless an up-to-date prescription was to hand(perhaps neutralising a broken pair of spectacles?)

So you see there is always room for discussion and interpretation,please keep your queries coming, and any comments you mayhave on my answers, you never know, I might learn something!

DDiissjjooiinntteedd jjoottttiinnggss


CET answers: Paediatric eyecare - part three

1. Which one of the following is not a reason for correctlycentring a spectacle lens?a To position the lens where the paraxial prescription is

most effectiveb To reduce unwanted differential prismatic effectsc To control the thickness at the optical centre of a lensd To reduce the possibility of the formation of ghost imagesc is the correct answer. Of the four options given above,centration does not affect the thickness at the optical centreof a spectacle lens.

2. Which method of measuring the interpupillary distanceshould be using when dispensing spectacles for a child with anystagmus?a Use a penlight to locate the corneal reflexes distance-

fixated eyesb Measure the distance between the nasal and temporal

canthic Measure the distance between the nasal and temporal

corneal-scleral marginsd Measuring the distances between the nasal and

temporal pupil edgesb is the correct answer. Neither a child’s eye movements norproblems like strabismus or amblyopia influence themeasurement of an “equivalent” interpupillary distanceobtained using this technique. The other methods are difficultto use if the eyes are rapidly moving and may give rise tosignificant error.

3. Which condition gives rise to anisocoria?a Cataract b Strabismusc Horner’s syndrome d Retinoblastomac is the correct answer. Horner’s syndrome causes miosis (andhence anisocoria) in the affected eye.

4. What is the material of choice in paediatric dispensing?a Crown glass b CR39c PMMA d Trivexd is the correct answer. For both optical and mechanicalreasons Trivex is the material of choice.

5. Which statement is correct?a When measuring the interpupillary distance in the case

of strabismus each eye must be occluded in turnb The suggested value for the pantoscopic angle of a

child's frame is 5°c The vertex distance has no effect on the transverse

chromatic aberration produced when viewing through off-axis points on a spectacle lens

d The measurement of interpupillary distance using the distance from the nasal canthus to the temporal canthus gives rise to significant error and should not be used

a is the correct answer. Alternate occlusion should always beused when measuring the interpupillary distance of a child witha strabismus.

6. Which statement is correct?a The Super Lenti lens is available in both resin and glass

materialsb The use of high refractive index materials will always

result in a heavier finished lensc The Rodenstock Lentilux lens is manufactured using a

resin materiald When dispensing medium to high plus lens, the uncut

size used is of no consequencea is the correct answer. The Super Lenti lens (Norville) isavailable in both resin and various glass materials.

7. Which statement is correct?a If a high powered plus lens with a spherical back vertex

power is manufactured with a convex prolate ellipsoidalsurface, aberrational oblique astigmatism will be reduced

b If a high powered plus lens with a spherical back vertex power is manufactured with a convex prolate ellipsoidalsurface, both aberrational oblique astigmatism and distortion will be reduced

c Ring scotoma and the Jack-in-the-box effect are not eliminated with polynomial aspheric designs

d The lens of choice for a high powered plus lens of spherical back vertex power is one that incorporates an atoroidal surface

b is the correct answer. If a strong plus lens with a sphericalback vertex power is manufactured with a convex prolateellipsoidal surface, both aberrational oblique astigmatism anddistortion will be reduced.

8. For the prescription -2.00/-2.00 x 60, what would thenotional power be along the 180 meridian?a -2.00 D b -3.00 Dc -3.50 D d -4.00 Dc is the correct answer. In this example the angle between thecylinder axis and the meridian in question is 60°. To obtain thenotional power along the 180 meridian we therefore need toadd three-quarters of the cylinder power to the power of thesphere.

9. Which of the following prescriptions would be ideal forthickness reduction by surfacing?a +2.00/+4.00 x 90 b +2.00/+4.00 x 180c +2.00/+4.00 x 45 d +2.00/+4.00 x 135b is the correct answer. If thickness reduction techniques areused during surfacing, optimum results are obtained if thecylinder is equal to or higher than the sphere and the plus-cylinder axis lies close to the horizontal.

10. When dispensing bifocals for children to correctaccommodative esotropia, what would be the mostappropriate segment choice and most likely positioning?a A large flat or curved top bifocal, top position at pupil

centreb A large round segment bifocal, top position at pupil

centrec A large flat top bifocal, top position at lower limbusd A small curve top bifocal, top position 2mm above

lower limbusa is the correct answer. A large segment bifocal with a widetop, set where it is impossible for the wearer to avoid use of thesegment for most near vision functions will give the mostsuccessful results when it is necessary to dispense bifocals for achild.

11. The feature of the Rodenstock AS C40 bifocal is thata The segment is decentred inwardsb The segment is decentred outwardsc The segment contains base in prismd The segment contains base out prismb is the correct answer. The Excelit AS is a CR39 40 x 25 mmcurved top bifocal with the segment on the convex surface ofthe lens. The segment is outset by 4 mm in order to discourageconvergence for near.

12. A negative addition can be used for the control of which ofthe following conditions?a Orthophoriab Convergence excessc A convergence weakness exophoriad Heterophoriac is the correct answer. A negative near power can be used tosimulate accommodation and therefore convergence.

After the closing date, the answers can be viewed on the 'CET Online' page of www.abdo.org.uk. To download, print or save yourresults letter, go to 'View your CET record'. If you would prefer to receive a posted results letter, contact

the CET Office 01621 890202 or email [email protected]

FebruaryNo7 Contact Lens - Fitting courses,places are free on a first come firstserve basis and all CET-approved,lunch will be provided, the trainingsuite at No7, Hastings. Presbyopia Day,speakers Dr Caroline Hodd and SteveWright, 9 CET points, 22nd. AstigmatismDay, speakers Dr Caroline Hodd andSteve Wright, 6 CET points, 15th. Ortho Kand Topography Day, 1st. For furtherdetails visit no7contactlenses.com orcall 01424 850620

February 6Eyecare 3000 - Conference andexhibition, Belfast Hilton Hotel, Belfast.For details visit www.eyecare3000.com

February 16Area 4 (East Anglia) - 'The Colour ofVision' with Phil Gilbert FBDO (Zeiss), 1CET point, Holiday Inn, Brentwood. Forfurther details contact Kate [email protected]

MarchBCLA - ‘Advanced toric multifocal lensfitting’ with Susan Bowers, Coventry(specialist) 2nd; ‘How to fit SynergEyesand SoClear lenses’ with Nigel BurnettHodd, London (specialist) 7th; ‘Basicgas permeable contact lens fitting’with Felicity Gill, Monmouth, Wales 8th;‘Basic soft toric contact lens fitting’with Keith Cavaye, London 8th;‘Optical coherence tomography andtopography’ with Ben Turley, London(specialist) 9th; ‘RGP lenses: whenyou’re stuck between a rock and ahard place’ with Professor JonathanJackson, Belfast (specialist) 10th; ‘Howto take the perfect photograph’ withBrian Tompkins, Northampton(specialist) 15th. For further details visitEvents on the BCLA website or [email protected]

MarchMaui Jim CET party - CET SunglassTraining Events, Freeform training witha Hawaiian twist, free for dispensingopticians, optometrists, receptionistsand technicians, WeybridgeBrooklands Hotel 28th, Bristol AztecHotel 29th, Birmingham NationalMotorcycle Museum 30th, andManchester Hilton Hotel 31st, 7-9pm.Places are limited, please book nowon 08009 801770.

MarchNo7 Contact Lens - Fitting courses,places are free on a first come firstserve basis and all CET accredited,lunch will be provided, the trainingsuite at No7, Hastings.Presbyopia Day,speakers Dr Caroline Hodd and SteveWright, 9 CET points, 15th. AstigmatismDay, speakers Dr Caroline Hodd and

Steve Wright, 6 CET points, 7th, 29th.Ortho K and Topography Day, 23rd.Irregular Cornea and KeratoconusDay, Dr Caroline Ho, 6 CET points, 1st,22nd. For further details visit no7contactlenses.com or call 01424 850620

14 MarchArea 5 (Midlands) - CET day, RiversideCentre, Derby. The committee isputting together a new agendagaining delegates around six CETpoints and the day will cost £20 perABDO member, £45 per non-memberincluding coffee/tea and a hot/coldbuffet lunch. Bookings are being takenon a first come, first served basiscapped at a maximum of 80delegates. For further information or tobook your place, contact, IanHardwick on 07814 558343 or [email protected]

AprilMaui Jim CET party - CET SunglassTraining Events, Freeform training witha Hawaiian twist, free for dispensingopticians, optometrists, receptionistsand technicians, London Holiday InnBloomsbury 1st, and Dublin's MorrisonHotel 4th, 7-9pm. Places are limited,please book now on 08009 801770.

AprilNo7 Contact Lens - Fitting courses,places are free on a first come firstserve basis and all CET accredited,lunch will be provided, the trainingsuite at No7, Hastings.Presbyopia Day,speakers Dr Caroline Hodd and SteveWright, 9 CET points, 11th, 18th.Astigmatism Day, speakers Dr CarolineHodd and Steve Wright, 6 CET points,12th, 27th, Ortho K and TopographyDay, 7th, 28th. For further details visitno7contactlenses.com or call 01424850620

April 9-11Optrafair 2011 - The NEC, Birmingham.For further details visitwww.optrafair.co.uk

May 6ABDO 25th Anniversary - Celebrationluncheon at Plaisterers’ Hall, 1 LondonWall. Further details to be releasedshortly

May 18ABDO - President’s Consultation Day,199 Gloucester Terrace, London W26LD - all members are welcome butplaces are limited - to reserve a place,email [email protected]

May 26-29BCLA - 2011 Clinical Conference,Manchester Central. For further detailsvisit www.bcla.org.uk �

dispensingoptics

www.abdo.org.uk

The Professional Journal of the Associationof British Dispensing Opticians

Volume 26 Number 2 of 12

EDITORIAL STAFFEditor Sir Anthony Garrett CBEAssistant Editors Jane Burnand and Barbara

Doris BScProduction Editor Sheila HopeEmail [email protected] and News Editor Nicky CollinsonEmail [email protected] Manager Deanne GrayEmail [email protected]

ADVERTISEMENT SALESTelephone 01892 667626Email [email protected]

SUBSCRIPTIONSUK £100 Overseas £110, including postageApply to Tom VetiABDO, Godmersham Park, GodmershamKent CT4 7DTTelephone 01227 733922Email [email protected]

ABDO CETCET Coordinator Paula Stevens MA ODE BSc

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

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

CONTINUING EDUCATION REVIEW PANELKeith 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

Paul McCarthy FBDO PG Cert HE FHEA

Angela McNamee BSc (Hons) MCOptom

FBDO(Hons)CL FBCLA Cert Ed

Edwin Moffatt FBDO

Linda Rapley BSc FCOptom

Susan Southgate FBDO PG Cert HE FHEA

JOURNAL ADVISORY COMMITTEENick Atkins FBDO (Hons) CL

Richard Crook FBDO

Kim Devlin FBDO (Hons) CL

Kevin Gutsell FBDO

Ros Kirk FBDO

Angela McNamee BSc (Hons) MCOptom

FBDO (Hons)CL FBCLA Cert Ed

Gillian Twyning FBDO

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

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

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

ISSN 0954 3201

Average circulation 2010: 8753 per issue - ABDOBoard certificationABDO members are welcome to attend Area meetings in any area they wish

Diary of events

Documents

dispensingoptics · 2020-02-18 · dispensingoptics Dispensing Optics PO Box 233, Crowborough TN6 9BD Telephone: 01892 667626 Fax: 01892 667626 Email: [email protected] February 2011