C-14078 Low Vision 2: Visual Aids
16/08/10
VRICS: Visual Recognition and Identification of Clinical Signs
Dr Keziah Latham
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C-14156 Borderline to Moderate Dry Eye
13/08/10
In this article, the aetiology of dry eye disease will be considered, along with a consideration of the utility of different diagnostic tests. Legislation relevant to treatment availability and optometric access to dry eye products will be covered followed by consideration of ingredients and indicated uses, product selection and follow up. A brief consideration will be given to the availability of a special lubricant at additional supply (AS) level, and also how an optometrist may be part of co – management of more severe cases of dry eye.
Prof. Michael J Doughty, PhD
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Visual Signs and Symptoms of Parkinson's Disease
13/08/10
Parkinson’s disease (PD) is the commonest neurodegenerative disorder in which the patient exhibits the symptoms of ‘parkinsonism’, viz., a range of problems involving movement, most typically manifest in PD itself, but also seen in closely related disorders such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and to some extent in dementia with Lewy bodies (DLB). It is a common disease throughout the world although less prevalent in China, Japan and in the Afro-Caribbean population. On average, the disease is believed to aect 1/750 of the population and calculated on this basis, there would be more than 100,000 cases in the UK. The prevalence of PD increases with age reaching a peak in the 7th decade of life after which it declines. Under 40 years of age, the prevalence in males (28/100,000) is greater than in females (15/100,000) but this trend is reversed in the 7th and 8th decades (females 645-830/100,000; males 465-736/100,000). There are two aspects of PD of particular interest to optometrists. First, PD patients can develop a range of visual problems including those aecting eye movements, pupillary function, and complex visual functions involving the ability to judge distance or make out the shape of an object. Second, the symptoms of PD can be treated successfully using a variety of drugs, some of which have significant ocular adverse reactions (OAR). This article describes the general features of PD, the dopamine neurotransmitter system and its relevance to eye symptoms, the visual symptoms reported in PD, and the OAR that have been reported.
Richard Armstrong
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C-14068 Cranial Nerves Supplying the Extraocular Muscles
30/07/10
Dr Simon Grant PhD Oculomotor, trochlear or abducens nerve palsies are relatively common, but pose challenges for clinical management. They may be congenital or acquired and can occur in isolation, in combination, or in association with other neurological symptoms, with their appearance and prognosis depending importantly on the aetiology and location of the underlying cause. This article reviews the anatomy of these cranial nerves, highlighting potential causes of damage between their nuclei of origins in the brainstem and termination on the extraocular muscles (EOMs), and so aims to provide a basis for informed diagnosis of ocular motor palsies in their various forms
Dr Simon Grant
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Laser Treatment for Floaters - the use of YAG Vitreolysis
30/07/10
Floaters can affect 1% of the population and may be idiopathic or related to retinal tears, myopia, trauma and post-uveitis. The vast majority result from vitreous syneresis and many patients complain bitterly about the visual disturbances they cause – particularly when driving, golfing, using computer screens and reading. The internet abounds with patients alluding to their problems e.g. www.oneclearvision.org. They have been (incorrectly) informed by eye care professionals that “you will learn to live with them” or “they will for of their own accord” or “there is no safe treatment” I hope to reassure you at least that there is a safe and effective cure – Yttrium Aluminium Garnate (YAG) vitreolysis, which has been available for nearly 20 years. With correct counselling you can prevent your patients suffering the annoyance and even depression caused by floaters.
Brendan J Moriarty M.A (cantab), M.B, B, Chir, F.R.C.S., F.R.C. Ophth., M.D
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Retinal Directional Sensitivity
30/07/10
Previous articles by the author have already discussed the importance of ocular aberrations on the quality of the retinal image. Associated with this is the influence of pupil size, in particular because of diffraction effects that can occur for very small pupils and spherical aberration for larger pupils. Furthermore, pupil size plays a substantial role in conferring depth of field in space, both of which allow a small range of tolerable blur and therefore maintain optimum visual acuity (VA)
Dr Janet Voke
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Sample Size Estimation and Statistical Power Analyses
16/07/10
The concept of sample size and statistical power estimation is now something that optometrists that want to perform research, whether it be in practice or in an academic institution, cannot simply hide away from. Ethics committees, journal editors and grant awarding bodies are now increasingly requesting that all research be backed up with sample size and statistical power estimation in order to justify any study and its findings. This article presents a step-by-step guide of the process for determining sample size and statistical power. It builds on statistical concepts presented in earlier articles in Optometry Today by Richard Armstrong and Frank Eperjesi.
Bhavna Prajapati, Mark Dunne and Richard Armstrong
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C-13991 Dry Eye in the Contact Lens Wearer
16/07/10
The relaxation of laws pertaining to the practice of optometry in the UK provides practitioners with an opportunity to not only develop their own internet and skills in the diagnosis and management of anterior segment conditions (as opposed to just referring such patients)’ but also to provide opportunities for interaction with other health care professionals. As a basis for trying to cover the scope of optometric practice in the UK in 2010, this series of articles will cover the therapeutic management of ocular conditions that may be commonly encountered in UK optometric practice. This article continues from the previous series on contact lenses, by discussing the management of dry eye in the contact lens wearer
Michael J Doughty, PhD
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C-13990 Extraocular Muscles: Anatomy and Clinical Investigation
02/07/10
Human visual is perception is a sensory-motor system in which the sensory input produced by light on the eye needs to be combined with ocular position and movement in order to provide us with a meaningful visual experience. This serried of articles aims to explore eye movements and binocularity in terms of the motor function, binocular alignment and the consequences of misalignment of the visual axes. Interpretation of sensory signals will be discusses in so far as they can be an important diagnostic toll for ocular motor problems. This article describes the extra-ocular muscles (EOMs), their contribution to this sensory-motor relationship, the investigation of eye movements and the disease processes that can affect the EOMs and their accounts
Alison Finlay MCOptom DBO
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Ray Tracing for Laser Corneal Refractive Surgery
02/07/10
It seems almost unbelievable that despite technological advances in medicine and ophthalmic surgery, we still use the Nobel Prize-winning Gullstrand Eye Model (Figure 1), developed in 1911, to calculate ablation profiles used during corneal laser surgery. Gullstrand’s schematic eye is one of the most widely accepted models and almost every corneal laser refractive procedure to date has been performed using this model. It works well for the average eye and most eyes treated are average. Certain patients, however, have a higher chance of needing enhancement surgery, specifically those with non-average characteristics with regard to corneal curvature/axial length relationship and/or aberrations. This is as a direct result of using the Gullstrand model, which was found to fit the average eye very well but to do less well for the outlier eyes. Currently, laser epithelial keratomileusis (LASEK), laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) procedures are based on this model. Even the more advanced ablation profiles such as Wavefront-Optimized, Topography-Guided, Custom-Q and Wavefront-Guided, which is known to measure the entire optical characteristics of the eye, are all calculated using this 100-year-old model.
Arther Cummings and Clare Maguire
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C-13862 Using Contact Lenses in Sport
18/06/10
One of the most common reasons prospective contact lens patients will cite for their motivation to try lenses will be sport or exercise; indeed, practitioners should expect to see more of these types of patients as the number of people taking regular exercise across the UK steadily increases – now seven million adults in England regularly take part in some type of sport. This means that, typically, at least one in eight people across the UK may have visual needs where sporting activity should be considered, and there are many reasons why their optical management should include contact lenses. This article presents several of the important aspects to consider when prescribing contact lenses in sport.
Dr Christine Purslow
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C-13640 Low Vision 1: Assessment of Visual Function
18/06/10
VRICS: Visual Recognition and Identification of Clinical Signs
Dr Keziah Latham
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C-13921 Management and Investigation of Vascular Conditions
04/06/10
The previous article in this series discussed the investigation and management of retinal conditions that may be seen in clinical optometric practice. The present article covers the more common vascular conditions of the eye that could be encountered. This article does not, however, discuss diabetic retinopathy, since this topic has been compressively covered in previous articles in Optometry Today.
Louise O'Toole
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Refractive Surgery For Presbyopia - Case Histories
04/06/10
Sir Harold Ridley pioneered intraocular lenses (IOLs) in the late 1940s, when he carried out the first implantation at St Thomas’ Hospital, London, in 1949. However, their use did not become widespread until the early 1990’s. This was largely due to limitations of extracapsular cataract extraction techniques, which made implantation of IOLs “in the bag” (as is the case in phacoemulsification techniques) difficult. The early implants were rigid polymethlmethacrylate (PMMA), and required a large incision site to introduce into the globe. Also, the lenses were unwieldy once in the globe. Exact positioning was on the most part down to fortune. Modern IOLs, in contrast, are implanted into the capsular bag once the lens material has been removed. This is possible to a large degree thanks to the flexible nature of the IOL.
Andy Bourne BSc MCOptom
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C-13861 Contact Lens 5: Legal Aspects of Contact Lens Practice
21/05/10
During 2008-2009, the General Optical Council (GOC) received 150 complaints, of which five involved contact lenses. In a seemingly increasing world of litigation and culture of ‘blame’, it is essential that all eye care practitioners keep abreast of the legal, ethical and professional obligations surrounding all aspects of their work. In particular, there have been several important alterations in the area of contact lens practice over the last few years, and this article presents the answers to a series of common questions in order to review those changes with clear guidance on current best practice.
Dr Christine Purslow PhF, MCOptom, FBCLA, FIACLE
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C-13747 Management and Investigation of Retinal Conditions
07/05/10
This article is the first of two that will success the investigation and management of retinal and vascular conditions. The article describes both macular and peripheral retinal diseases whilst a second article will discuss vascular abnormalities of the retina.
Louise O'Toole
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C-13550 Dealing with Complex Prescription and Surgical Cases
23/04/10
Complex and high refractive errors are perhaps more pertinet cases for contact lens fitting, and therfore, practioners should have the necessary skills to be able to fit lenses for such patients. This article discusses contact lens options for patients with high ametropia and high cylindrical prescriptions, including keratoconus, as well as more specialist surgical cases that can give give rise to complex refractive surgery. This will include both older, more established methods of vision correction, such as scleral and rigid gas (RGP) lenses, and more modern options such as custom-lathed soft toric lenses and hybrid designs
Sophie Taylor-West BSc (Hons) MCOptom and Nigel Burnett Hodd BSc FCOptom Dip CLP
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C-13554 IP Management of Open Angle Glaucoma - Case-based Clinical Studies
09/04/10
Glaucoma is the second-leading cause for blind registration and the most common cause of preventable blindness in the UK. Approximately 480,000 people in England are estimated to have primary open angle glaucoma (POAG) that accounts for around one million outpatient visits per year. Various population-based studies in the Developed World suggest that approximately 50% of glaucoma remains undiagnosed. This article presents some case studies that will help eye care practitioners with the detection and management of glaucoma
Saurabh Goyal FRCOphth, FRCS, MS
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C-13462 The Ocular Surface in Contact Lens Wear
26/03/10
Solving symptomatic problems of a contact lens wearer often forms the primary focus of patient aftercare and management. However, observing the mechanical and physiology impact of contact lenses on the ocular surface also forms a fundamental part of management of out contact lens patients. Not only is it important to observe the cornea, but also the conjunctiva and eyelids. This article reviews the current understanding of some of the most frequently seen reponses of the ocular surface to contact lens wear, and the recommended methods for their examination and observation
Dr Christine Purslow
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C-13472 Medical Management of Glaucoma
12/03/10
Although glaucoma is largely managed by ophthalmologists in a hospital setting, there are many optometrists who are intending, or already are, practising glaucoma management in a shared care setting, either in their own practice, in a hospital or at a polyclinic. This article is aimed to provide an overview of management of glaucoma by optometrists, to equip them with the necessary skills to perform this service. Before discussing the actual medical management options, it has to be emphasised that correct diagnosis based on the patients history and examination is an essential precursor to correct treatment.
Stephen Bryan MA FRCS FROphth
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Data Methods in Optometry
12/03/10
Part 10: Non-linear regression analysis
Richard Armstrong and Frank Eperjesi
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C-13056 The Interaction Between Contact Lenses and the Tear Film
26/02/10
The tear film during contact lens wear differs greatly from that in the non-lens-wearing eye. This interaction between contact lenses and the tear film is a complex and a dynamic one which influences several aspects of ocular physiology as well as patient safety, vision comfort. Appreciating the potential influence of this interaction is important in the recognition of adverse signs and consequently, in the management of contact lens patients
Dr Christine Purslow
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C-12823 Macular Pigment, Origin, Function and Clinical Value
26/02/10
It has been known for more than two centuries that the yellow colouration often observed in the macular region of the eye is due to a high concentration of pigment. The two hydroxycarotenoids, lutein and zeaxanthin, of which macular pigment is composed are not actually synthesised by the human body.
Dr Janet Voke
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C-12918 Refractive Surgery Techniques and Complications Part 1
26/02/10
The following FREE Visual Recognition and Identification of Clinical Signs (VRICS) test should be completed online by clicking on the VRICS test button at www.otcet.co.uk. Respondents should use the 12 images/photos to answer the 12 associated Multiple Choice Questions (MCQ). Please note that there is only one correct answer for each MCQ. Successful completion of the VRICS test will result in two CET points. VRICS regularly appears in Optometry Today.
Mohammed Muhtaseb
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C-12758 Understanding the Basics of Ocular Aberrations
12/02/10
It is widely known that defects in the image-forming properties of lenses are common. An aberration is a distortion of an image of an object that is caused when rays of light do not exactly obey the laws describing perfect optical systems.
Dr Janet Voke
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C-13104 Ocular and Medical Emergencies in Practice
12/02/10
There are some ocular emergencies which are visually threatening and must be appropriately managed to prevent irreversible blindness. There are also some medical emergencies which can present with ocular signs and, if mismanaged, can result in death of the patient.
Louise O’Toole
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C-12756 Current Materials and Care Regimes - Implications for Clinical Practice
29/01/10
Choosing the most appropriate lens type and care regime for your patient is crucial to minimise patient dropout, But even the most enthusiastic contact lens practitioner can feel daunted by the large number of both lens options and care products available to them for recommendation, and of course, the situation is dynamic one. This first article in he series aims to highlight the most pertinent developments, whilst also taking the opportunity to revise important principles about the classification and chemistry of lens materials and care regimes.
Dr Christine Purslow
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C-11411 Common Entoptic Phenomena and their Clinical Significance
29/01/10
C-11411 Common entotpic phenomena and their clinical significance
Dr Janet Voke
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C-12870 The Management of Diabetic Retinopathy without Laser
15/01/10
C-12870 The management of diabetic retinopathy without laser. Module 12 Part 1: Clinical Optometry Before the advert of laser therapy, diabetic retinopathy was treated by pituitary ablation. This was undertaken either as a neurosurgical procedure involving craniotomy , or by implantation of radioactive seeds in the pituitary gland. This could only be carried out in small proportion of patients because of the risk involved. The procedure induced regression of retinopathy in the majority of patienst, but a significant proportion dies of complications
Jonathon Dowler
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