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From testing children, dyslexia and myopia control to vision and driving and integrating new technologies into practice, the AOP-organised education programme offered “a real mix of thought-provoking sessions,” the AOP’s head of education, Dr Ian Beasley told OT. 

Young eyes

The vision and eye health of the younger patients who walk through the practice doors was a hot topic this year, and one that Dr Maggie Woodhouse, who returned to the show by popular demand, focused on. 

As an expert in the field of testing the sight of young children with disabilities, Dr Woodhouse encouraged all optometrists to test children under school age, especially those with a disability, and offered delegates a series of tips on how to do so.

Focusing on practice appearance, the Cardiff University academic urged practice owners to enter the practice one morning on their hands and knees to see what it looks like from a child’s point of view. 

"Fit the test to the child, not the child to the test...You need a variety of tests to hand. If the child can't name a letter, use something else. If the child is said to hold a book too close, give the child a book"

Illustrating her suggestion, Dr Woodhouse showed practitioners a picture of a typical practice reception desk. She then showed the same shot from a young child’s view, pointing out that all they could see was the front of the reception desk towering above them and the tops of the people’s heads behind it.

Moving on to the sight test, Dr Woodhouse urged practitioners to talk to the child, not above them. “Note the parent’s major concerns and come back to them at the end of the sight test using the same language,” she advised.

She also urged optometrists to decide at the beginning what is essential to measure during the eye exam and recommended that they observe the child’s behaviour for their confidence level and mood, as well as their parent’s, for indicators on how to proceed.

“Fit the test to the child, not the child to the test,” she recommended. “You need a variety of tests to hand. If the child can’t name a letter, use something else. If the child is said to hold a book too close, give the child a book,” Dr Woodhouse suggested.

Emphasising the importance of testing children under the school age, Dr Woodhouse highlighted that the earlier a problem is discovered, the better the prognosis for putting it right and improving the child’s learning abilities.

“The prevalence of amblyopia in children is reported to be 2.95%, nearly 3%, but following treatment that reduces to 1.9% so the earlier you start treatment, the better the outcome,” she said.  

Testing in schools

Working primarily in special schools across England providing sight tests and dispensing spectacles to children with learning disabilities, SeeAbility’s Lisa Donaldson and Ned Saunders highlighted the importance of adapting clinical and practical routines to best support the needs of each patient. 

The duo revealed that there are an estimated 1.4 million people living in the UK with a learning disability. “This means around 1% of adult patients that practitioners see will fall into this category,” optometrist and clinical lead for SeeAbility, Ms Donaldson, highlighted.

Offering tips on adapting the clinical sight test, Ms Donaldson highlighted the importance of talking to the patient, not just their carer, and introducing ‘fun’ tools into the routine, referencing how a simple pen torch with a figurine on the end can be very effective.  

For Ms Donaldson, it is communication that is key. “Don’t make assumptions,” she said. “It’s important to always ask – there is nothing wrong with asking someone how they communicate, especially if they are non-verbal.”  

Dispensing optician Mr Saunders explained when it comes to dispensing, it is important to know your frames range inside out and only show the patient frames that are suitable for their needs. 

“While our optometrist performs the specialist sight test, I’m already thinking about what glasses would fit the child best,” he explained.   

“It’s hard to take back options once you have shown them to the patient. So be aware that frames, for this patient group in particular, must be flexible, strong and practical,” he added.   

Dealing with dyslexia

Remaining focused on the younger patient, Professor Bruce Evans used his CET-accredited talk to explain to optometrists the importance of adopting a “middle of the road” approach to their role in dyslexia. 

Professor Evans began his Main Stage session highlighting that dyslexia is an area that has attracted controversy and polarised views.

There were the “zealots” who claimed that visual factors cause dyslexia, he told delegates, adding that on the other hand, there were “deviants” who said that vision was irrelevant to dyslexia. However, he preferred the middle ground that “visual problems can sometimes occur in dyslexia.”

Professor Evans explained various approaches to dyslexia, including behavioural optometry, which took a detailed symptomatology and applied a holistic approach, looking at the child as a whole. 

He also discussed the value of coloured lenses and overlays but he cautioned optometrists to “listen to the patient’s symptoms and don’t overtreat.”

He warned practitioners to beware of bias and patients picking their favourite colour. “Be sceptical about what a patient says,” he told delegates, adding, “Most schools test with colour overlays, but the hope is that the test is refined by basic optometry.” 

Concluding, Professor Evans cautioned that “there are as many therapies as there are practitioners” and urged optometrists to educate themselves. “Every few years entrepreneurs come up with a test and ‘treatment’ for dyslexia,” he warned.

Myopia matters

While most myopia control talks focus on the theory of the condition, a look at myopia management strategies was welcomed when CooperVision’s European professional affairs manager, Elizabeth Lumb, took to the Main Stage. 

Ms Lumb explained that myopia is a big deal at the moment and affects all regions of the world. She shared how myopia was first noticed in the Far East, where prevalence has now reached such an extent that an emmetropic teenager in China is an outlier. 

Ms Lumb offered practitioners a three-step action plan to managing the condition among their patients, two thirds of which, she said, practitioners can already do with ease if they are not already. 

Ms Lumb’s first step involved assessing the patient’s risk of myopia, something that she stressed “all practitioners are well placed to do.” 

She referred to myopia’s genetic link, advising practitioners to: “Look at refraction at a young age, consider family history, but don’t let it be the only reason you discuss myopia with a child and their parents, and establish a management plan when appropriate.” 

Step two focused on behavioural management, during which Ms Lumb urged practitioners to look at the lifestyle of their young patients. “I believe that we can encourage people to spend more time outside, and if you are not doing this already, you should be,” she said.  

The third step is optical management. While summarising the management options available to practitioners, Ms Lumb stressed that when selecting a management option, practitioners must assess and determine if the benefits of a method outweigh the risks involved.

Don’t cry over dry eye

While lifestyle is a feature referred to in myopia management, as a generation grows up with an increased use of screen-based technology, there are a number of associated vision risks that emerge. One of them is dry eye, as senior contact lens optician, Ros Mussa, pointed out.   

An increase in daily screen time has led to a dry eye “epidemic,” she told delegates, highlighting the case of a 12-year-old video game enthusiast with blepharitis symptoms more common among pensioners.

“There is a problem out there and it’s not based in any particular social group,” she emphasised. “It’s going to affect all of us. It’s an epidemic that is global,” she added. 

Ms Mussa explained that dry eye was a lifestyle-based disease. People who spent long amounts of time in front of a screen had a greater risk of developing the condition as they did not blink as often.

Optometrists were well placed as a profession to manage dry eye, Ms Mussa emphasised, adding she would often offer treatment for the condition even though a patient had not directly raised it as a concern. 

“The patient will say after treatment, ‘I didn’t think it was bad but I can now see better and my eyelid moves easier’,” Ms Mussa concluded. 

"There is a problem out there and it's not based in any particular social group...It's going to affect all of us. It's an epidemic that is global"

Sight loss impact

Regular sight tests and diagnosis aside, unfortunately sometimes sight loss is inevitable. And it was the impact of sight loss that consultant ophthalmologist, Rosemary Robinson, focused on. 

During her presentation, Ms Robinson detailed the different phases of coming to terms with sight loss, including trauma, shock and denial, mourning and withdrawal, and succumbing and depression. The final stage was reassessment and reaffirmation, she said, explaining that in this stage a patient began to view themselves as essentially the same as before their sight loss.

However, at some stage, many people who experience vision loss felt broken and no longer whole, she explained.

Losing the ability to see familiar faces and sights was a significant loss, she told delegates.

The face has it

Picking up on losing the ability to see familiar faces and sights, the University of Bradford’s Dr Andrew Logan spoke in detail about ocular diseases associated with impaired facial recognition, which included age-related macular degeneration (AMD) and glaucoma. 

Dr Logan said that, regardless of the cause of the impairment, it could have a very negative impact on a patient’s quality of life. 

However, he highlighted that it was unlikely that a patient would come into an optometrist with facial recognition problems as their chief complaint. 

“For optometrists, the key thing is to exclude an ocular disease as an explanation for these symptoms. Clearly if a patient has AMD that explains why they can’t recognise faces, but if the macular looks healthy, perhaps it’s worth not dismissing the patient’s symptom of impaired facial recognition,” Dr Logan emphasised. 

The academic is currently working on a project to quantify the impact that AMD has on visual sensitivity to faces and he hopes to develop a test that can quickly and accurately determine how good an individual is at facial recognition. 

Dr Logan concluded: “It’s a real puzzle – how can we look at so many faces and yet we can reliably and accurately sort one out from the other.”

From the patient to practitioner

Intertwined with the lectures that focused on patient care were talks about the profession more broadly, its potential disruptors and its future.

Returning to the event to speak to delegates about the changes that the profession is currently facing, co-founder of Specsavers, Doug Perkins, warned optometrists that ignoring these changes would be at their peril.

Highlighting technology as the top risk factor that the profession should be aware of, Mr Perkins also listed advances in telephonic refraction and automatic refraction as areas of concern. However, it is the NHS, which Mr Perkins described as being “in continuous crisis,” that holds an opportunity “not to be missed” for optometry.

The number of people losing their sight will rise by one third over the next 10 years, Mr Perkins stressed, while outpatient departments, such as ophthalmology, are already struggling to cope with the 37% rise in patients experienced.

“We have to face the facts and accept that the current model for ophthalmology is not working,” Mr Perkins said, highlighting that in order to change this, for optometry’s benefit, “we need to change the kind of commitment and skills we currently have.” 

Dr Logan concluded: “It’s a real puzzle – how can we look at so many faces and yet we can reliably and accurately sort one out from the other.” 

While Mr Perkins placed the current number of EOS-skilled optometrists at 500, he said that this needed to reach at least 5000 if optometry wanted to make the transition into enhanced eye care services. “I believe that we need 5000 optometrists experienced, educated and accredited to perform the full scope of optometry services.”

“The call is going to come, as long as we are prepared for it. And to be prepared, we must educate ourselves, gain accreditation and get experience,” he concluded. 

Trained and ready  

Messages around the NHS, and ophthalmology in particular, being in crisis also featured in optometrist Ian Cameron’s talk as he opened saying: “The NHS is in crisis and nowhere is this more obvious that in ophthalmology.”

“Yet in this crisis, there is opportunity,” he stated, explaining that the growing demand of ophthalmology services provides optometrists with the opportunity to upskill and drive the profession forward clinically. 

Mr Cameron has secured his IP qualification and encourages all practitioners to do the same. 

Last year, Mr Cameron also completed an IVT injection course at Moorfields Eye Hospital and recommends other optometrists do the same.

“Performing these injections is easy and optometrists will find it a lot easier than many of the ophthalmic nurses who are currently trained for the task because we are used to using our fine motor skills in a way that most of those nurses are not,” he shared.

Mr Cameron predicted cataract surgery as another potential route for optometrists to progress into. He has successfully completed a basic surgical skills course at the Royal College of Surgeons in Edinburgh.

Mr Cameron reflected on how these newly-acquired skills could help him as the profession develops, saying: “The long-term goal is not to perform these procedures in a hospital setting, but to do them in practice.”

100% Optical 2018 will take place on 27–29 January.