C-10316 Clinical Decision Making 6: Diagnosis of Visual loss; Posterior Segment
12/12/08
Symptoms of visual loss can present optometrists with a difficult clinical decision. Some conditions require no action except reassuring the patient, while others require immediate referral for a sight or life threatening condition. In this article we demonstrate the "SOAP-F" systematic approach to diagnosis of visual loss. This starts from the foundation of a good history. Asking the right questions can reduce the list of possible conditions, leading to a more purposeful examination for the signs that can confirm the diagnosis. We illustrate this approach with decision trees,which can be used as an aide memoire.
Graham Macalister PhD FCOptom DCLP Louisa Wickham MSc FRCOphth
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The genetics of primary congenital glaucoma
12/12/08
Primary congenital glaucoma (PCG) is a rare disorder accounting for between 0.01% and 0.04% of cases of total blindness.
Richard Armstrong
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C-8164 Visual Performance Post - Refractive Surgery
28/11/08
Advances in refractive surgical techniques have resulted in a higher proportion of patients achieving functional unaided vision following surgery. The development of aspheric ablation profiles and wavefront technology has improved the quality of visual acuity post-surgery and decreased the number of patients reporting reduced contrast vision and night vision problems. This article describes the typical recovery of visual funtion following the most common forms of refractive surgery, along with the outcomes reported in some of the most recent peer-reviewed articles in the field. For most post - refractive surgery patients, the assessment of visual performance involves no more than the measurement of snellen acuity. Despite the advances in laser technology, a minority of patients still suffer a permanent reduction in visual quality (contrast sensitivity). most commonly associated with an increase in higher order aberrations and/or intraocular straylight. An assessment of visual performance in the contrast domain is therefore an essential part of any post - refractive surgery eye examination.
Catharine Chisholm PhD BSc (Hons) MCOptom
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Staying out of trouble – Will your record keeping help or hinder?
27/11/08
Staying out of trouble – Will your record keeping help or hinder?
Trevor Warburton
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C-10134 Clinical Decision Making 5: Intraocular Pressure and Tonometry
14/11/08
The measurement of intraocular pressure (IOP) is perhaps most commonly associated with glaucoma. Glaucoma is the name given to a group of diseases that produce characteristic progressive optic nerve atrophy and associated visual field loss. According to the World Health Organisation, glaucoma is the leading cause of irreversible blindness and currently affects an estimated 61 million people - this number is expected to rise to almost 80 million by 2020. On average, around 2.1% of people aged 40 years and over have open angle glaucoma (OAG), but this prevalence varies substantially due to age (increasing by several per cent per decade) and racial background (1.4% in eyes of people of Asian origin and 4.2% of people with African origin).
Dr Kirsten E. Hamilton, PhD, B.Optom (Hons), MCOptom
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Short and Long-Term Complications of Refractive Surgery
31/10/08
Refractive surgery as with any surgery has intended benefits, but there are commonly side-effects and unintended complications associated with the procedures. The current dominant refractive surgical technique is excimer laser keratorefractive surgery, with the leading procedure in the UK being IntraLase femtosecond laser flap LASIK. Surface laser application as PRK (photorefractive keratectomy) or LASEK (Laser Assisted Epithelial Keratoplasty) is also commonly performed.
Julian D Stevens MRCP FRCS FRCOphth
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Clinical Evaluation of the Nidek ARK-530A Auto Refractor/Keratometer
31/10/08
The Nidek ARK-530A is an autorefractor/keratometer which contains both a refractometer and keratometer in one unit.
George Gibson and Leon Davies
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Encourage Compliance not Complacency
31/10/08
Compliance with instructions is a key issue for the eye care professional, the contact lens industry and, not least, the contact lens wearer. In this article we will first look at the latest research findings on the extent of non-compliance in contact lens wear, and the patient behaviour that poses the greatest risk of infection.
Karen Walsh and Jane Veys
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C-9568 - Clinical Decision Making 4 – The Red Eye
17/10/08
This article will concentrate on how to make a differential diagnosis of a red eye by observing and categorising the redness itself. After having done this, the article will describe two important signs that may also guide to the right diagnosis: corneal pathology and lid swelling.
Bianca Sallustio, FRCOphth, MRCOphth
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C-9912 Posterior Pathology
17/10/08
VRT: Visual Recognition Test
Rachael Peterson and Lisa Prokopich
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C-8162 Refractive Surgery - Presbyopic LASIK and Multifocal Intra-Ocular Lenses
03/10/08
Presbyopia is the loss of the ability for the eye to accommodate or change focus from viewing a distant object to viewing an object up close. This loss of functionality is due to a gradual loss of amplitude of accommodation that is provided by th crystalline lens. The loss of accommodation is a slow progressive process that begins from birth. At age 8. the average amplitude of accommodation is 14.00 to 16.00 diopters (D): it declines to 10.00 + 2.0 D by age 25. to 6.00 + 2.00 D by age 40. and to 1.00 D + by age 60 (figure 1). However, the effect of accommodation loss is only felt from the age of approximately 45 as it is at this stage when the residual focusing power of the crystalline lens cannot provide sufficient near vision. A person unable to maintain 3.00 D of accommodation for any length of time is considered to have symptoms of presbyopia occurs in100% of the population and as longevity increases, presbyopes now represent one of the largest groups of patients suffering from a refractive error.
Professor Dan Reinstein
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C-9521 Clinical Decision Making - Contact Lens Complications in Routine Practice
19/09/08
Contact Lens complications can affect the contact lens corrected visual acuity (VA), the lens comfort and wearing time and the lens condition. The problems arising can cause disturbances to the eyelids and ocular surfaces that can result in long - term changes and reduction in the contact lens tolerance. The clinician should try to help the patient overcome the lens - related problems, not only to promote satisfactory lens wear and to prevent the patient giving up contact lenses, but to prevent future ocular infections, inflammation and eye strain.
Christine Astin
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C-9696 Anterior Eye Pathology
19/09/08
VRT: Visual Recognition Test
Rachael Peterson
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C-8161 The Biomechanics of Keratorefractive Surgery
05/09/08
Corneal biomechanics is the study of the mechanical properties and the responses of the corneas. The cornea's remarkable transparency and strength allow it to contain the intraocular pressure (IOP), serve as a protective layer and act as the major refracting surface of the eye. the shape of the cornea , and hence it's refractive properties, is directly determined by it's ultrasound and biomechanical properties.
Nathaniel E Knox Catrwright
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Occupational Vision Hazards: Infrared Radiation and the Eye
05/09/08
The heating effect of the Sun in the form of infrared rays spans the wavelengths 780-10,000nm. As with ultra-violet radiation at the other end of the visible spectrum it is usually sub-divided into three regions, IR-A 780-1,400nm, IR-B 1,400-3,000nm and IR-C 3,000-10,000nm.
Janet Voke
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Clinical Decision Making II: The Painful Eye
15/08/08
This article is a guide for the optometrist on how to approach the problem of a patient presenting with a painful eye. As with any other medical problems, the sequence of steps in dealing with such a patient is: 1. History 2. Examination 3. Diagnosis and Treatment. A new classification is proposed that will make diagnosis fairly simple. After examining each condition, treatment options are discussed.
Bianca Sallustio, FRCOphth, MRCOphth
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C-9453 Dispensing Issues 4
15/08/08
VRT: Visual Recognition Test
Robert Cubbidge
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A Decade with Silicone Hydrogels: Part 1
15/08/08
The last decade has been incredibly significant for the development of contact lens (CL) materials. The launch of the first silicone hydrogels (SiHs) in the late 1990s represented a major milestone in CL material science.
Karen French and Lyndon Taylor
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C-8160 Refractive Surgery - Pre-Operative Assessment, Selection Criteria and Patient Counselling
25/07/08
Refractive surgery has made the transition from the fringes to the centre ground in contemporary ophthalmology, and is gaining increasing traction in the UK population as an alternative to contact kens waer or spectacle coreection. Key steps in pre-operative assessment are: procedure selection, risk evalution, and preoperative counselling. An Understanding of each of these elements is becoming integral to modern optometric practice.
Bruce Allan FRCS FRCOphth
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Could LV Work be your Calling too?
25/07/08
Low Vision does not only mean those who are on Severely Sight Impaired (Blind) or Sight Impaired (Partially sighted) registers.
Gaynor Tromans
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Clinical Decision Making I: Visual Field Interpretation
11/07/08
Visual field assessment provides a measure of the neural pathway integrity from eye to visual cortex. Certain patterns of visual field defect are associated with damage to specific regions of this pathway. Inaccurate test results can compromise interpretation leading to potentially serious consequences for diagnosis and ultimately the management decisions for that patient.
Shirley Ann Hancock PhD, BSc (Hons), MCOptom
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Keratoconus 2
11/07/08
The second article in this series will cover two relatively new treatment options for keratoconus, namely, intracorneal ring segments and corneal cross-linking with riboflavin and ultraviolet A.
Colm McAlinden and Jonathan Moore
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Refractive Surgery - Laser Refractive Surgery Procedures
27/06/08
The aim of this article is to discuss modern refractive laser procedures and provide an introduction to surgical techniques, outcomes, and complications of laser refractive surgery. The optometrist as a front-line eye care provider must have a good background of general information on refractive surgery and its options. The ultimate goal is to be able to co-manage refractive surgery patients with refractive ophthalmic surgeons with the aim of giving patients the best possible advice and eye care.
Vincenzo Maurino MedC BQOphth Christophe Nguyen MD
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Dispensing 6: Spectacle Lens Design - New and Future Developments
13/06/08
Recent years have seen impressive developments in some areas of spectacle lens design, but others have appeared to stagnate. In this article some of the more recent developments in spectacle lens technology are discussed, as well as some comments about possible future trends.
Colin Fowler PhD FCOptom
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C-9195 Dispensing Isssues 2: Special Appliances
13/06/08
VRT: Visual Recognition Test
Lizzie Bartlam
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Optometric Management of Posterior Segment Eye Disease – Malignancies of the Posterior Segment
30/05/08
Malignancies of the posterior segment are uncommon, but improved patient survival and visual outcome requires early diagnosis and treatment. The most common malignancy of the posterior segment is probably choroidal metastasis from a distant primary tumour. Of the primary intraocular malignancies, choroidal melanomas are the most frequently encountered in adults and need to be differentiated from choroidal naevi and other benign fundal lesions; retinoblastomas are the most common intraocular malignancy encountered in children. Lymphomas typically present in older adults and their diagnosis can be challenging and require specialist investigation. The epidemiology, clinical features, diagnosis, and treatment of each of these are discussed below.
Simon Taylor MA FRCOphth
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New Trends in Intraocular Lenses: Part 2
30/05/08
Recent advances in the field of refractive surgery have produced a shift in our ability to effectively and safely treat a wide range of refractive errors at any age.
Andy Bourne and Milind Pande
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Dispensing for Sport - Eye Dominance
16/05/08
The strength of vision science is its ability to measure visual performance, encouraged by the need to diagnose and treat ocular pathology. The relationship between vision and occupation (and the importance of dispensing in sport) is less well understood. It appears a link is missing between vision and occupation including sport, which may also affect a general understanding of orthoptics and binocular vision. This is an understanding of eye dominance.
Geraint Griffiths
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C-9011 Dispensing Issues 1: Measurement and Verification
16/05/08
VRT: Visual Recognition Test
Leon Davies and Tony Gibson
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C-7983 Optometric Management of the Posterior Segment Eye Disease Vascular Disorders of the Retina
02/05/08
In the field of medical retina, diagnosis is becoming more accurate with the introduction of new imaging techniques and better image resolution. However, despite all the advancements in ophthalmology, there is no substitute for a sound foundation of knowledge coupled with a careful patient history, detailed examination of the eye and referral to the appropriate ophthalmic speciality when needed.
Miss Brinda Muthusamy MBChB, MRCP,MRCOphth
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Vision Deficits in Disabilites
02/05/08
Ophthalmologist, orthoptist, optometrist and even optician are titles the general public often finds confusing.
Christine Fitzmaurice
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C-8899 Dispensing Issues 4 - Occupational Dispensing
18/04/08
Eye-care practitioners are frequently consulted by both employers and individuals to advise about protective eye-wear in the workplace: in addition they can dispence appropriate protection. Since non-prescription devices are readily available from manufactures of safety equipment to the general public.The optometrist or ophthalmic dispenser may limit their role to prescription safety spectacles alone. Legally it is the responsibility of employers to carry out a risk assessment in order to minimise health hazards at work and select and provide suitable protective equipment. Accordingly eye-care practitioners may be consulted to help in that process, and advise, including making on-site visits. More often they will simply be asked to supply appliances to cover risks which have already be identified by others. Since assessors must be adequately trained and qualified, all eye-care personnel who prescribe and dispence must be familiar with the types of eye protection available and be able to identify a specific appliance from it's markings, to advise on it's suitability for a particular situation or purpose.
Dr Janet Voke
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C-8923 Contact Lenses 4: Lens Fit
18/04/08
VRT: Visual Recognition Test
Rachael Peterson and Gina Sorbara
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The Art and Science of Prescribing Glasses
18/04/08
Should the power of glasses be exactly what has been determined by objective and/or subjective refraction or should the power occasionally be adjusted to help patient adaptation and/or comfort?
David Elliott
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C-7982 Retinal Detachment: A New Perspective
04/04/08
Retinal detachment is a relatively uncommon ophthalmological condition, which may lead to blindness despite the success of modern surgical techniques. Optometrists are in a unique position to identify and educate individuals most at risk and in some cases help prevent retinal detachment with prompt referral to retinal surgeons. This article will concentrate on (i) the most common type of detachment - rheqmatogenous retinal detachment, (ii) the importance of posterior vitreous detachment (PVD) and (iii) how to identify high-risk patients.
Arundhati Dev Borman and Arabella Poulson
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C-8737 Dispensing 3: The Low Vision Patient
21/03/08
One of the great misconceptions amongst patients attending optometrists is that new spectacles can solve all their visual problems. Unfortunately, for those diagnosed as having untreatable ocular pathology, this is not the case. Confirmation of this comes from the definition of low vision which was adopted by the Low Vision Services Consensus Group in 1999 and states that 'A person with low vision is one who has an impairment of visual function for whom full remediation is not possible by conventional spectacles, contact lenses or medical intervention and which causes restriction in that person's everyday life'.
Jennifer Lindsay and Professor A. Jonathan Jackson
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C-8739 Contact Lenses 3: Instrumentation
21/03/08
VRT: Visual Recognition Test
Rachael Peterson
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Optometric Management of Posterior Segment Eye Disease: Macular Disorders
07/03/08
This third article of the Optometric Management of Posterior Segment Eye Disease series will concentrate on the differential diagnosis and clinical signs and symptoms of macular disorders. Emphasis is placed on decision-making skills and available treatments will be reviewed where appropriate
Louise O'Toole
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Data Methods in Optometry
07/03/08
Part 8: Principle components analysis and factor analysis
Richard Armstrong and Frank Eperjesi
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Dispensing 2: Complex Lens Dispensing
22/02/08
With reference to the terminology used by the General Ophthalmic Services (GOS), the expression complex appliance is defined as an optical appliance with at least one lens which has a power in any one meridian of plus or minus 10.00 or more dioptres, or is a prism-controlled bifocal lens.
Andrew Keirl and Richard Payne
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Variations in Appearance of the Normal Eye due to Differences in Pigmentation and Deposits
22/02/08
The vast majority of patients examined in primary eye care have normal, healthy eyes. To discriminate between ocular disease and the normal eye, it is essential to know the many presentations that a normal eye can make and a collection of photographs of normal variations due to differences in pigmentation and deposits is presented to supplement the information provided in atlases of ocular disease. The following is adapted from Clinical Procedures in Primary Eye Care (Elliott DB, 3rd edition) and its associated website (http://evolve.elsevier.com/Elliott/eyecare/).
David B Elliott and C Lisa Prokopich
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C-8419 Contact Lenses 2: Complications
22/02/08
VRT: Visual Recognition Test
Rachael Peterson
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Optometric Management of Posterior Segment Eye Disease: Optic Nerve Anomalies
08/02/08
As the saying goes, the eyes are a window to the soul. They are also a window to the brain, and one can discover a number of conditions, sometimes life-threatening, affecting the brain by their effect on optic nerve appearance and function.
Omar Mahroo and Chris Hammond
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Variations in Appearance of the Normal Optic Nerve Head
08/02/08
The vast majority of patients examined in primary eye care have normal, healthy eyes. To discriminate between ocular disease and the normal eye, it is essential to know the many presentations that a normal eye can make and a collection of photographs of these normal variations at the optic nerve head is presented to supplement the information provided in atlases of ocular disease. The following is adapted from Clinical Procedures in Primary Eye Care (2007, 3rd edition) and its associated website (http://evolve.elsevier.com/ Elliott/eyecare/).
Professors David B Elliott and John G Flanagan
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Dispensing 1: Simple Dispensing - Easy, Isn't it?
25/01/08
The term 'simple dispensing' can cover a multitude of sins, but here we will be discussing the elements of dispensing that could be considered as Best Practice. Although only possible to cover these aspects briefly, the text will look at some of the perhaps forgotten or neglected aspects of dispensing simple prescriptions. Areas outside this will be dealt with in a later article on Complex Dispensing which will cover such matters as high power lenses, dispensing for children, and anisometropic prescriptions.
Duncan Counter
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Visual Requirements for Driving
25/01/08
Just over 70% of the population hold a driving licence, and in today's society, driving is viewed by the majority as a right. With an ageing population, however, the proportion of people who fail to meet the visual requirements is increasing and eye care practitioners need to be in a position to advise patients during the eye examination.
Catharine Chisholm
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Optometric Management of Posterior Segment Eye Disease - Examining the Posterior Segment
11/01/08
In this first article of the Optometric Management of Posterior Segment Eye Disease series, the various instruments used to examine the posterior segment and the techniques of ocular examination are discussed. The interpretation of examination findings and use of auxilary equipment is also detailed.
Louise O'Toole
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