Staffordshire Local Optical Committee

Patient Information

What is an Optometrist?

What is a Dispensing Optician?

 

The Eye Examination

Common Eye Conditions

 

WHAT IS AN OPTOMETRIST?

Previously known as ophthalmic opticians, optometrists are trained to examine the eyes to detect defects in vision, signs of injury, ocular diseases or abnormality and problems with general health, such as high blood pressure or diabetes. They make a health assessment, offer clinical advice, prescribe spectacles or contact lenses and refer patients for further treatment, when necessary.

Optometrists study at university for at least three years and must participate in a period of assessed clinical training in practice, before being deemed to have the knowledge and skills needed to be registered. Once registered, they have the opportunity to take further qualifications (1.) and develop their interests in specialist areas of practice (e.g. independent prescribing).  Many optometrists also participate in community extended eyecare services, such as the minor eye conditions service/MECS, which are available free at the point of delivery to patients under the NHS.

All optometrists practising in the UK must be registered with the General Optical Council (2.), the profession’s regulatory body. When choosing an optometrist, look for the letters FCOptom or MCOptom after their name. It means that the optometrist is a fellow or member of the College and adheres to high standards of clinical practice. 

1. College of Optometrists “Training and qualifications” https://www.college-optometrists.org/cpd-and-cet/training-and-qualifications.html

2. General Optical Council https://www.optical.org/

 

WHAT IS A DISPENSING OPTICIAN?

The Association of British Dispensing Opticians (ABDO) represents over 5,700 qualified dispensing opticians in the UK who are registered with and regulated by the General Optical Council (GOC). All registered dispensing opticians have undergone a minimum of three years academic and practical training to qualify. Only dispensing opticians registered with the GOC can practise in the UK, or use the protected title dispensing optician.

Their specialist skills include professional advice on lenses for night driving, UV protection, prescription sunglasses, spectacles for VDU use, sports and safety eyewear.

Dispensing spectacles to children, to the visually impaired, or dispensing of contact lenses can only be undertaken by, or carried out under supervision of, dispensing opticians or optometrists registered with the GOC.

All dispensing opticians have the duty and ability to refer patients with eye conditions to a medical practitioner.

Contact lens opticians train for a further 1-2 years to achieve registration with the GOC, this gives them the skills and knowledge to fit contact lenses to the highest standards.

 

When purchasing eyewear ABDO always recommend that you seek the personal advice and services of a qualified optical practitioner so that your individual requirements can be fully assessed and satisfied.

For more information on Dispensing Opticians visit http://www.abdo.org.uk/information-for-the-public/

For more information about contact lenses visit http://www.abdo.org.uk/information-for-the-public/contact-lenses-2/

https://bcla.org.uk/Public/Consumer/Consumer_Information/Public/Consumer/Consumer_Information.aspx?hkey=c1e027d3-d774-49ce-a961-6cfb153bde56

 

 

EYE-CARE FOR ALL

Many of us think to have our teeth checked and those of our children, yet we forget to have regular checks on our eyesight and the health of our eyes.
There is far more to an eye examination than simply checking whether spectacles are needed. The eye can be an indicator of general health issues. For example, diabetes, high blood pressure and many other health problems can be detected in an eye examination.

For children, optometrists recommend a routine examination every 12 months unless otherwise advised. During adulthood the normal interval is 2 years but once over the age of 60 or with certain medical conditions or family eye problems,there may be a need for more frequent examinations. Your optometrist will advise you.

  

THE EYE EXAMINATION


During an eye examination you can expect to have some or all of the following procedures carried out.  The actual procedures carried out for each individual person will be determined by your Optometrist, taking into account your age, any symptoms you may be experiencing, your occupation, hobbies and any special visual requirements, also any medical or family history that could be relevant.

History and Symptoms
This is a very important part of the eye examination. 
Your optometrist will need to find out why you have come for an eye examination.
Are you experiencing any symptoms or having any problems with your vision? 
What are your visual requirements? ie occupation, hobbies, do you drive?
Have you had any problems in the past (ocular history)?
Are there any ocular problems in the family which may be hereditary?
Do you have any medical problems which could affect the eyes?


Vision and Visual Acuity

When you view the sight test chart the lowest line of letters you can read is noted.
VISION is the lowest line read without spectacles
VISUAL ACUITY is the lowest line read with spectacles or correcting lenses
The line read is recorded as a fraction eg 6/12, 6/9, 6/6 this is known as Snellen acuity
The largest letter on the Snellen Chart is usually 6/60
The smallest letters are usually 6/5
The top number, usually 6, means the distance at which the test was carried out ie 6 metres. The bottom number is the smallest size of letters that you were able to see.
NORMAL VISION is 6/6 and is usually the next to bottom line (or on some charts two lines up from the bottom).  In the USA, normal vision is termed 20/20.


Oculomotor Balance
This determines whether the eyes coordinate and work together properly as a pair, e.g to see if there is a squint present. This may be assessed with you looking into the distance and also looking close-up


Motility
This checks whether each eye is able to look in every different direction. It is used to detect a defect in one or more of the eye muscles


Pupil Reflexes
This examines the reactions of the pupils to light
If the pupils do not react to light correctly it could indicate neurological problems


External Examination
The external eye can be examined with a light, or in more detail with the magnification of the SLIT LAMP.
The eyelids, conjunctiva, cornea, iris (ie coloured surround to the pupil) and lens are examined


Internal Examination
The internal eye is usually examined with the OPHTHALMOSCOPE. Sometimes drops are used to enlarge the pupils and enable a better view of the back of the with a VOLK LENS, which is always used in conjunction with a slit lamp.
By examining the various parts of the eye an overall picture can be obtained of the condition of  the eyes and also your general health in some cases.

Digital Fundus Photography
Digital fundus photography is nowadays available at most high street opticians practices.  A digital camera takes photographs of the back of the eye and accompanying software allows for further enhancements to the photos.  Digital fundus photography can be used to keep a precise record of the health of the eye for future reference.  If a deterioration in eye health is suspected, new photos can be taken and compared with the old, so allowing detection of subtle changes.


Refraction
This determines whether you are long-sighted, short-sighted, astigmatic, presbyopic, or have no optical error at all (emmetropic)
If you have a refractive error then a prescription for lenses needed to correct this will be determined by the optometrist.

 
Objective Tests
This is where the Optometrist observes the results of the test to determine roughly what lenses are required for you.  It gives a starting point before asking you questions but can also be used to determine a prescription in patients who are unable to read the chart eg very young children, or people with communication or learning difficulties
Either a RETINOSCOPE or an AUTOREFRACTOR  could be used


Subjective Tests
These are used after the objective tests have provided a starting point.  The optometrist asks the patient to choose between various lenses as to which gives the clearer vision.


Intraocular Pressure (IOP)

This measures the pressure of the fluid within the eye using a TONOMETER.
This can indicate the possible presence of GLAUCOMA.
A NON-CONTACT tonometer is often used which blows a puff of air at the eye.  Four readings are normally taken before calculating an average measurement.
Alternatively a GOLDMANN or PERKINS tonometer is used which actually touches the eye and so requires the use of an anaesthetic drop first.  This is sometimes referred to as the 'blue light' test because the instrument shines a blue light.  The contact tonometry methods used by community optometrists give very accurate estimates of  pressure and are the same as those used in hospital eye departments.


Visual Field Screening
This can indicate neurological problems and also detect the presence of GLAUCOMA.  The patient's 'all round' vision is assessed and the optometrist is looking for any areas where the patient cannot see or where the eye is not as sensitive as it should be.  These areas are called FIELD DEFECTS.


Colour Vision Test
This can determine if you have problems with colour vision.  Colour 'blindness' is normally a hereditary condition where certain shades of colours are more difficult, or impossible, to tell apart.  It is almost invariably only found in men.

Rarely colour vision problems can be acquired later in life as a side effect of certain illnesses, eye disease or medication. These types of colour vision problems can affect both men and women.

Certain careers can be difficult or impossible if you have a problem with your colour vision.


Stereopsis

This test is used to check and measure how well a person can judge distances.  It also gives a good indication of how well the two eyes to work together. The test is used mainly in children and is valuable in the assessment of squints and amblyopia (so-called "lazy eye").  Both eyes must work well independently and in addition work well together to allow good depth perception.

 

COMMON EYE CONDITIONS

 What is amblyopia?

Amblyopia (lazy eye) is defined as “reduction of vision in one or both eyes that cannot be improved by spectacles alone”. It usually occurs before the age of eight. Infants born prematurely, or with low birth weight, are at a greater risk for the development of this condition. It is estimated that two to four percent of children have amblyopia. Amblyopia is usually due to conditions such as crossed eyes (strabismus) or a large difference in the refractive error between the two eyes. Vision in the amblyopic eye may continue to decrease if left untreated. The brain simply pays less and less attention to the images sent by the amblyopic eye. Eventually, the condition stabilizes and the eye becomes virtually unused. It is quite difficult to effectively treat amblyopia at this point. A comprehensive optometric examination can determine the presence of amblyopia. The earlier it is diagnosed the greater the chance for a successful treatment. In young children, patching the good eye may help the amblyopic eye to improve. In addition, to help improve vision function, vision therapy techniques may be used. Eyeglasses or contact lenses may be prescribed to correct any refractive errors. Early detection and treatment of amblyopia and correcting refractive errors is the key to ocular health. In most cases your optician will arrange a referral to an orthoptist who specialises in the detection and management of amblyopia and strabismus (squint).

 What is Strabismus (squint)?

 In children:

 A squint occurs when the eyes are not lining up properly and do not work as a pair. One eye may turn inwards, outwards or even up or down. When this happens in young children, the brain often learns to ignore the picture from the squinting eye to prevent the child seeing “double vision”. This can cause amblyopia (lazy eye) as the vision in that eye fails to develop properly. Squints may occur in children for a number of reasons, e.g. a need for glasses or a family history of squints. Treatments vary and may include spectacles, or sometimes an operation to correct the squint. The orthoptist is specially trained to decide the best treatment for the squint.

 In adults:

If a squint develops in an adult or older child their brain is unable to ignore the picture from the squinting eye and this causes “double vision”. Reasons for the onset of squint in an adult are many, but possible causes include diabetes, thyroid disease and injury (trauma). Double vision can often be corrected with prisms. The orthoptist can advise the best course of action depending on the symptoms and cause of the squint.

 What is Glaucoma?

Glaucoma is a degenerative disease of the optic nerve in which damage occurs to the optic nerve. One cause of this is when the fluid pressure in the eyeball is too high. This damage can cause severe vision loss and even blindness, if untreated. Glaucoma can generally be effectively controlled with prescription eye drops or other medicines which reduce the pressure in the eye. In some cases, surgery or laser treatment may be needed. All optometrists are trained to diagnose this condition. Is it considered normal to test for it routinely in the over 40s but also in younger persons sometimes.

 What are Cataracts?

If the normally clear lens in your eye becomes cloudy, it is called a cataract. As the lens becomes cloudy, vision becomes blurred and/or distorted. Spectacles or contact lenses can be prescribed to provide clearer vision until cataracts develop to the point that they impair vision. Then they need to be removed surgically. Nowadays this is most commonly done using a technique called phaco-emulsification and takes about 20 minutes. An intra-ocular lens (an implant) is usually used to replace the lens removed from your eye.

 What are flashes and floaters?

Floaters are small, semi-transparent or cloudy specks or particles within the fluid inside the eye that become noticeable when they move within the line of sight. They may also appear with flashes of light. The inner part of your eye is filled with a clear, jelly-like fluid known as the vitreous. Occasionally, small flecks of protein and other matter become trapped during the formation of the eye before birth and remain in the vitreous body. Floaters may also be caused by the age related deterioration of the eye fluid or its surrounding parts or by certain injuries or diseases. Almost everyone sees a few floaters at one time or another. They can occur more frequently and become more noticeable as you grow older. If you notice a sudden change in the number or size of the floaters, you should contact your optometrist right away for an examination to be sure they are not the result of a more serious problem.

 What is “Dry Eye”?

The tears your eyes normally produce are necessary for overall eye health and clear vision. Dry eye occurs when your eyes do not produce enough tears or produce tears which do not have the proper chemical composition. Dry eye symptoms can result from the normal ageing process, exposure to environmental conditions, problems with normal blinking, or from medications such as antihistamines, oral contraceptives or antidepressants. Dry eye can also be symptomatic of general health problems, or other diseases. If dry eye is untreated it can harm your vision. Common treatments include the use of lubricating eye drops but there are other ways to help which may be more useful in particular cases.

 
Effects of diabetes on the eye

Diabetes and its complications can affect many parts of the eye. Diabetes can cause changes resulting in short-sight, long-sight, and premature presbyopia (the inability to focus on close objects). It can result in cataracts, glaucoma, a breakdown of eye muscle co-ordination (strabismus) and in decreased corneal sensitivity.

Visual symptoms of diabetes include fluctuating or blurred vision, occasional double vision, loss of visual field and flashes and floaters within the eyes. Sometimes these early signs of diabetes are first detected in a routine eye examination. The most serious eye problem associated with diabetes is diabetic retinopathy. This occurs when there is a weakening or swelling of the tiny blood vessels in the retina of your eye, resulting in blood leakage, the growth of new blood vessels and other changes. Early detection is critical because if untreated, blindness can result.

During your visit to your optometrist, we can diagnose potential vision threatening changes in your eye that can be treated to prevent blindness. It is important to monitor and control your diabetes as much as possible to minimise your risk of developing retinopathy. Several factors that increase the risk of developing retinopathy include smoking, high blood pressure, drinking alcohol and pregnancy.

 Diabetic Retinopathy Screening

 All diabetics should have their eyes examined at least annually. In Staffordshire there is a central register of diabetic patients held by the Health Authority. This register is used to write to diabetics to remind them when they are due for an eye screening appointment.

 Diabetic Retinopathy Screening is carried out by accredited optometrists within Staffordshire and will involve drops being put in your eyes to make the pupils bigger and photographs being taken to record the health of your eyes. These photographs are stored centrally within the county to allow for audit checks to confirm the accuracy of the screening process.

Because not all optometrists are accredited, you may be asked to attend a different optometrist to the one you normally use for your eye examinations. This is OK because all that is happening is your Diabetic Retinopathy Screening and you can still go to your normal Optometrist when your eye examination is due.

 

 

 

Community Eye Care Pathways

 Community Eye Care Services

Community Eye Care services: Introduction

For many years the Department of Health has been trying to encourage delivery of more routine and minor emergency eyecare outside the hospital, and into community optical practices. The aim of this is to free up capacity in the hospital, and to help cope with increasing demand from both the ageing population and new technologies such as wet age-related macular degeneration (AMD) treatments.

Here in Staffordshire, community optical practices are successfully and safely delivering  enhanced services as part of local eye care pathways which link into the hospital as appropriate.

This means that patients with a range of eye health problems are diagnosed, and often treated, by specially trained community optometrists situated in local practices, without the need to travel to hospital. This is the main advantage of this service, as getting to and negotiating a large hospital may be daunting, especially for old or frail patients. Other key benefits are:

  •  Increased choice for patients – they may be able to attend a practice close to home, or one with which they are familiar
  • Speedy assessment – many practices can offer appointments within a few days.
  • Convenient appointment times – many practices can offer weekend or evening appointments.
  • Explanation of eye problems – most optometrists will have time to discuss eye health problems with the patient, and to answer questions, providing valuable reassurance. 

A description of each of the community eye care pathways is provided below.

 

MINOR EYES CONDITION SERVICE (MECS) 

Also known as the Acute Eye Service in North Staffordshire.

Aims of a MECS service

  • A MECS consultation provides a timely assessment of the needs of a patient presenting with an eye condition (usually within 24 hours of the patient presenting to the practice if the condition is deemed urgent, or within 14 days if deemed non-urgent)
  • Reduce unnecessary visits to the hospital eye service or A+E
  • Reduce the pressure on GP practices
  • Quick access to high quality eye services
  • Appropriate and timely referral to the hospital eye service when necessary

Who can provide the service?

  •  Specially trained and accredited community optometrists and dispensing opticians.

What is a “Minor Eye Condition”?

Basically something that has changed with your eyes recently (usually within the last three days). This includes but is not limited to:

  • Red eyes
  • Sore/painful eyes
  • Sudden onset of blurred vision or loss of vision
  • “Flashes and floaters”

 Getting a MECS appointment

  • Referral by your GP or practice 
  • Referral by a pharmacist
  • Self referral by the patient to an accredited practice

  A list of South Staffordshire participating practices can be found here

  A list of North Staffordshire participating practices can be found here.

   

DIRECT ACCESS CATARACT REFERRAL

 If you are found to have a cataract you can now be referred directly by an accredited optometrist (COSI) to the hospital which performs the surgery. This avoids the need for you having to be referred via your GP who would then have had to arrange for an initial appointment to be made at the hospital. The COSI performs what would have been the initial appointment at the hospital which is a more detailed, dilated examination of your eyes to ensure there are no other problems with your eyes which may result in either surgical complications, or not gaining a benefit from the cataract surgery.  The COSI will be able to advise you if the cataract is ready for surgery or if referral is not yet warranted.  However, the COSI will be sympathetic and responsive to individual cases where the cataract might be causing particular visual discomfort, or impinges on the patient’s ability to work or drive.

 Most optometrists in North and South Staffordshire are accredited to carry out direct access cataract referrals.  A list of participating practices can be found here.

The Cataract Decision Aid is a 5 step guide to patients considering whether or not to undergo cataract surgery.  It gives them all the information that they need to enable them to compare the available options, weigh up the pros and cons, and help them to decide if surgery is right for them at this time.  The information is explained clearly through short videos guides and other tools.

Link: < http://sdm.rightcare.nhs.uk/pda/cataracts >

 

POST-OPERATIVE CATARACT FOLLOW-UP

After a cataract operation, where there have been no complications from the surgery and you don't suffer from any other eye conditions, the hospital may give you a choice of accredited high street opticians practices who can perform your follow up appointment within 6 weeks after the operation. This service is available to patients in both North Staffordshire and South Staffordshire. 

This saves you from having to return to the hospital outpatients for follow-up. The Optometrist examines your eye to ensure that it has healed and to ensure there are no complications developing as a result of the surgery. Your vision is also checked at this appointment to ensure that you have a good visual outcome.

These examinations involve you having drops in your eyes to dilate your pupils in order to gain a clearer view of the back of the eye, so will cause your vision to be blurred for a few hours after the examination, it is therefore not advisable to drive for 6 hours after these examinations.

 The advantage of these appointments being performed by accredited community optometrists is that they can be arranged more locally to where you live, parking is more convenient and there is often more choice of days and times than can be offered by the hospitals.  A list of participating practices in North Staffordshire and South Staffordshire can be found here.

 

 GLAUCOMA SERVICES IN THE COMMUNITY

  •  Glaucoma is the name given to a group of eye conditions, in which the nerve responsible for eyesight is damaged leading to ‘blank’ patches in the off-centre vision. It can be associated with raised pressure within the eyes, but not always.  There are various types of glaucoma: chronic open angle glaucoma (COAG) is the most common. It has no symptoms in the early stages, but slowly and painlessly destroys sight if it is not detected and treated.
  • Ocular hypertension (OHT) is a condition in which although pressure inside the eye is raised above the normal level, it has not yet caused detectable damage to the optic nerve/vision.  However, OHT is an important risk factor for the future development of glaucoma.
  • In the past, all clinical investigations involving glaucoma diagnosis and monitoring were carried out exclusively in the hospital setting. This fact, coupled with the increase in ageing population, has put unprecedented demands on the Hospital Eye Service and caused long delays in appointment dates.
  • The LOC has worked alongside the clinical commissioning groups (CCGs) and local hospital eye departments to establish a network of accredited community optometrists (COSIs) in Staffordshire, who are expertly trained to carry out a range of clinical glaucoma investigations. These include Glaucoma Referral Refinement and Ocular Hypertension & Suspect Chronic Open Angle Glaucoma monitoring, all of which are designed to neatly link up with the Hospital Eye Service and GP surgeries.
  • When appropriate, patients are referred into these schemes directly by their own optometrist or Hospital Eye Service/Ophthalmology department.
  • Over the past couple of years, these community services have provided safe management of patients at potential risk of developing glaucoma from high street opticians’ practices and avoided the need for lengthy hospital appointments. The feedback from patients seen under these schemes consistently attests to the excellent care given by COSIs within the relaxed atmosphere and local convenience of the opticians’ practices signed up to the glaucoma community eye care services.

 NB. There are regional variations within Staffordshire regarding availability of certain Glaucoma community services. If you require more specific information, refer to the Staffordshire map of community eye care services or contact the LOC office.

 

PAEDIATRIC SHARED CARE SERVICE IN NORTH STAFFORDSHIRE

  •  When a child is born, the visual system is immature and begins to develop during the first weeks of life and the process continues up till 7-8 years of age. This normal development of vision is dependent on the brain receiving equally clear, focussed images from both eyes. Any obstacle to this will result abnormal development of vision and result in Amblyopia or ‘lazy eye’. Possible causes of such interruption to normal visual development can be refractive error (Eg: long sightedness, short sightedness, astigmatism), strabismus (squint), cataract and other abnormalities of the eye.
  • However, if this anomaly is detected early enough and corrected by spectacles and/or medical/surgical means, the child can still develop ‘normal’ vision and enable a good quality of life. It is worth remembering that a child will not complain about their eyes or vision in the same way as an adult. This fact highlights the importance of vision screening for all children. One way this can be done is by an eye test with any high street Optometrist. Orthoptists are NHS health professionals who investigate, diagnose and treat defects of binocular vision and abnormalities of eye movement. They tend to work closely with NHS Ophthalmologists and community Optometrists.
  • In North Staffordshire, we have an award winning Paediatric shared care service. This partnership between UHNS Orthoptists and specially trained community Optometrists (COSI’s) has been running for 8 years. All children in North Staffordshire are screened by an Orthoptist when in their reception year at school (this provides excellent coverage ~98% coverage). In addition to the school screening, Orthoptists will also receive referrals from non-accredited Optometrists, GP’s, health visitors/community Paediatrician and also from within hospital eye clinics.
  • All those children found to have reduced vision in one/both eyes are referred to a COSI to carry out a specific Paediatric eye examination. This involves the instillation of Cycloplegic eye drops to examine the health of the eyes and determine the need for spectacles. If required these spectacles are then dispensed by a registered Optician. The results are then fed back to the Orthoptist as well as the GP. The Orthoptist will then review the patients in the hospital eye clinic or in 1 of 17 outside community clinics. The Orthoptist will then periodically refer the child back to the COSI in future, when a repeat examination is required.
  • There are now 22 COSI’s in 19 different practice locations involved in the Paediatric shared care service spread across North Staffordshire. This partnership between UHNS Orthoptists and community Optometry has been a continued success in making sure children have the best vision possible at such a crucial stage in their life. Parents have found these community services valuable, easily accessible and a vital step in the well-being and future development of their children
  • For further information on this service, refer to the Staffordshire map of community eye services or contact the Staffs LOC office

 

 

 

 

 

 

 

 

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