C-12342 Changes in the Posterior Segment with Age
20/11/09
The focus of this article is the changes found in the vitreous and retina as a person ages. Most ractitioners immediately think of age-related macular degeneration (AMD). However, we forget that the vitreous changes as we age, and these ageing changes are crucial in the evolution of posterior vitreous detachment (PVD), and the subsequent relationship with retinal detachment.
Avi Gurbaxani MRCOphth and Chris Hammond MD MRCP FRCOphth
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C-12407 Consequences and 'Treatment' of Colour Vision Deficiencies
20/11/09
This final article on colour vision reviews some of the consequences of colour vision deficiencies. In particular, people with such deficiencies need to be aware of the implications that might be placed on every day tasks such as driving, as well as tasks encountered in educational and occupational settings, and of the requirement for normal colour vision in some professions. This is followed by a discussion of the ‘treatment’ options available to colour deficient individuals, including colour-tinted lenses that aim to minimise the effects of the deficiency, and gene therapy that eliminates the deficiency.
Monika Formankiewicz BOptom MCOptom PhD
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C- 12339 Adverse Drug Reactions in Elderly People
06/11/09
An adverse drug reaction (ADR) is defined as 'an unwanted or harmful reaction experienced following the administration of a drug or combination of drugs, and is suspected to be related to the drug'. Virtually every drug is capable of producing unwanted side effects. Elderly people are more likely to experience such effects due to agerelated changes in drug metabolism and excretion, coupled with the co-morbidity and polypathology often associated with ageing.
Professor John Lawrenson BSc PhD MCOptom
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C-12174 Acquired Colour Vision Deficiencies
06/11/09
The first article in this series outlined the characteristics of congenital colour vision deficiencies, which are the consequence of an altered genetic code. Acquired colour vision deficiencies can occur in the course of an ocular or systemic disease, or as a side effect of medication or chemical exposure. The assessment of an acquired deficiency will often require a different approach than the assessment of congenital defects. As will become clear in this article, investigations of acquired colour vision defects in the same disease can sometimes yield different results. The discrepancies in the findings may reflect different patient or control groups, or the use of different tests in the assessment of colour discrimination.
Monika Formankiewicz BOptom MCOptom PhD
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C-12409 Management of Paediatric Visual Conditions
06/11/09
VRT: Visual Recognition Test
Miriam Conway and Lynne Weddell
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C-12168 Opening our Eyes up to New Toric Insights
23/10/09
Confidence in prescribing toric soft contact lenses has grown significantly and as such is no longer considered a speciality by many. This is thanks to the introduction of innovative designs and materials, which provide eye care practitioners with reproducible lenses that are predictable to fit and offer visual stability and comfort for their patients.
Ian Pyzer FBDO (Hons) CL FIACLE
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C-11998 Assessment of Colour Vision
23/10/09
The relatively high prevalence of inherited colour vision deficiencies and the optometrist's role as a primary care practitioner mean that colour vision defects are likely to be detected in the optometric practice. Some of the tests described in this article are frequently found in practice, but others are rarely seen outside of a university centre or a research institute. The aim of this article is to give an overview of a selection of colour vision tests. The design of these tests will be considered, and their advantages and limitations will be discussed.
Dr Monika Formankiewicz BOptom MCOptom PhD
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C-12170 Latest developments in Intraocular Lenses
09/10/09
The first intraocular lens (IOL) for cataract surgery was implanted by Sir Harold Ridley in 1950 at St Thomas' Hospital in London. As most of the early cases had a disastrous outcome, IOL implantation fell into disrepute and it was not until some 30 years later that advances in IOL design, surgical technique, viscoelastics and surgical instrumentation began to make IOL implantation a safer procedure. IOL implantation is now the accepted routine for cataract surgery and there have been major advances in IOL technology in recent years. The goal of cataract surgery in the 21st century has moved from restoring sight to correcting refractive error and improving the quality of the patient's vision postoperatively. This article outlines some of the currently available IOLs that forward this aim.
David Spalton FRCS FRCOphth, Elsie Chan FRANZCO
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C-11858 Normal Colour Vision and Inherited Colour Vision Deficiencies
25/09/09
Colour vision aids in the detection of targets, either when no luminance difference exists between the target and the background (isoluminance),or, more commonly, when the target is embedded amongst objects that vary in luminance. An example of the latter is a search for a coloured fruit amongst green leaves. Colour also helps us to group things, as patches of a scene that have the same colour are likely to belong to the same object. Finally, colour helps us to identify objects. This series of articles begins by describing normal colour vision and the inheritance of colour vision defects , how colour vision deficiencies can be detected, the consequences of such defect, and possible treatments.
Monika Formankiewicz
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C-11924 Profiling Glaucoma
11/09/09
Glaucoma is the leading cause of irreversible blindness worldwide, yet the majority of patients with glaucoma are unaware that they have the disease. It has been predicted that with our ageing population, the number of people in England and Wales suffering from glaucoma will increase by at least a third over the next two decades. The purpose of this article is to provide a brief overview of the pathophysiology behind primary open angle glaucoma (POAG) and the clinical signs that are indicative of the disease. Finally, the impact of glaucoma on patient quality of life will be considered.
Aachal Kotecha PhD, Alexander Spratt MRCOphth
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C-11680 Long-Term Post-Operative Complications
21/08/09
Patients who have undergone uncomplicated cataract surgery with normal postoperative recovery are usually discharged from hospital care after two weeks with instructions to attend for an eye examination with their optometrists after a further four weeks. The main reason for this is to update the patient's spectacles as the prescription will have altered since cataract surgery, and to ensure that the eye has continued to settle down once all postoperative medication has ceased. This article completes this series by informing the optometrist in routine practice about the types of complication that may occur and be seen at this late postoperative stage, along with other long-term complications that may occur even months or years after surgery.
Michelle Hanratty BSc MCOptom
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Optometric Remedication for Problems caused by Vision Display Unit use
21/08/09
Since the development of the computer, a number of health factors have been studied in relation to its use. Now that most businesses and homes have computers, both physical and visual symptoms may become more prevalent.
Geoff Shayler
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C-11794 Contact Lenses for the Over-40's
31/07/09
Presbyopes always want the vision they had when they were younger and many new presbyopes will think of themselves as getting old. This makes the management of this group a challenge and the psychology of dealing with this age group difficult at times. In general, the three main options in contact lenses for those over 40 are (i) simple reading spectacles worn when needed, (ii) monovision for those who can tolerate it or (iii) the multifocal/bifocal route. This is true for both rigid gas permeable (RGP) and soft, or silicone hydrogel lenses, whether an existing wearer or new to contact lenses. The other issue the practitioner needs to take into account with this age group is the tear film. As one gets older the quality, quantity, or both, of the tear film changes and never for the better. Many new presbyopes, however, are very motivated to stay feeling young so are very willing to try the contact lens option.
Judith Morris BSc, MSc, FCOptom, FIACLE
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C-11539 Early Post-Operative Complications
17/07/09
This article is the second in a three-part series discussing complications associated with cataract surgery. The first article discussed the complications associated with the actual procedure and it's preparation. The present article discusses the complications that can arise early post-operatively, which can occur at any time from the day of the surgery up to a fortnight after the operation. Later complications that occur after this time will be described in the final article of this series. Post-operative assessment of the patient on the day of surgery is vital as this will detect most early complications related to the procedure such as leakage of the wound, dislocation of the intraocular lens (IOL) and iris prolapse.
Louise Stainer BSc (Hons)
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C-11702 Systemic Diseases of Old Age
03/07/09
As Benjamin Franklin famously said "...nothing can be said to be certain except death and taxes." Although some people do seem to avoid paying taxes, and the average life expectancy has risen dramatically during the last century (Figure 1), death will eventually come to us all. The average Briton can, at present, expect to live to an age of 78.7 years, with women living around five years longer than men. Obviously, life expectancy varies enormously throughout the world (from 84.2 years in Macau to only 32.2 years in Swaziland).
Professor Ron H. Douglas, BSc PhD
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C-11440 Intraoperative Complications
19/06/09
Cataract surgery is the most commonly performed operation worldwide. Technological progress has enabled major advances in this procedure. However, as with any surgery there are inherent risks, some of which are related to the increased complexity of the operation. There are four main forms of cataract extraction surgery: intracapsular (ICCE), extracapsular (ECCE), phacoemulsification (PHACO) and manual small incision (MSICS). This article is the first of three that identifies the more common complications that occur intraoperatively during phacoemulsification and intraocular lens (IOL) implantation. Future articles will describe the early and late post-operative complications that may occur.
Louise Stainer BSc (Hons)
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C-10558 Digital Imaging and Screening for Diabetic retinopathy
05/06/09
The National Screening Committee has stated that "All people with diabetes aged 12 years and older should be offered screening for sight - threatening diabetic retinopathy using digital photography," Digital imaging offers several advantages such as archiving, ease of viewing, evidence of progression, quality assurance, patient education and immediate indication of ungradeable images. Knowledge of key aspects of digital imaging technology and performance therefore underpin screening for diabetic retinopathy in the UK. The final article in the 'Optometric Management of Diabetic Eye Disease' series aims to discuss the technical aspects of digital imaging related to diabetic screening as well as provide an indication of how computers can be used to automatically screen for sight - threatening retinopathy.
Christopher C. Hull, PhD
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C-11112 Clinical Protocol and the Role of the Eye Care Pratitioner
22/05/09
This series of articles has described various aspects of visual characteristics of reading dificulties and the background behind techniques such as the use of coloured filters in helping to reduce the difficulties that are experienced. The present article, which is the last in series, aims to describe a clinical protocol that can be used by the busy eye care practitioner for the investigation and management of such patients. It also describes the testing techniques that can be used for the various assessments. Warning: DO NOT LOOK AT FIGURE 7 IF YOU HAVE MIGRAINE OR EPILEPSY.
Dr Peter Allen, Prof Bruce Evans, Prof Arnold Wilkins
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C-10557 Non-Retinal Complications of Diabetes Mellitus
08/05/09
Diabetes mellitus (DM) ia a chronic disease that occurs when a) the pancreas does not produce enough insulin (insulin dependent diabetes or Type 1 diabetes), which is typically of early onset or b) when the body cannot effectively use the insulin it produces (maturity onset or non-insulin dependent diabetes). Type 1 diabetes can be regarded as an autoimmune disorder in which there is destruction of the pancreatic islet cells in a genetically susceptible host. The world is currently experiencing a global epidemic of this incurable disease and the human and economic costs are enormous. Predictions estimate a doubling of the number affected from 180 million reaching an estimated 366 million by 2030. The global increase in diabetes is attributed to increased life expectancy, urbanisation and changes in lifestyle and diet. Although previously recognised as a disease of the developed world, diabetes is becoming increasingly prevalent in the Developing World. In India alone, the number affected is expected to reach 80 million by 2030. Unforunately, the majority of the burden from the disease is also now predicted to lie in low income countries and in those of working age.
Shaheen P Shah MRCOphth MSc
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C-10855 Vision & Reading Difficulties Part 4: Coloured Filters - How Do They Work?
24/04/09
This article is the fourth in a series of five about vision and reading difficulties. The first article provided a general overview and the second covered conventional optometric correlates of reading difficulties (e.g. binocular vision problems). The present article continues on from the third article by describing the use of coloured filters in treating a condition now known as visual stress. Visual stress is often associated with reading difficulties, but also a variety of other neurological conditions. This article concentrates on the possible mechanisms for the benefit from coloured filters, beginning with obvious peripheral factors. The terminology for this condition has changed over the years (e.g. Scotopic Sensitivity Syndrome, and Meares-Irlen Syndrome) and the issue of terminology is discussed at the end of this article. Warning: DO NOT LOOK AT FIGURE 6 ON PAGE 28 IF YOU HAVE A MIGRAINE OR EPILEPSY.
Wilkins, Allen, Evans
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C-111 Ocular Investigation and Management Techniques
24/04/09
VRT: Visual Recognition Test
Navneet Gupta
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Evaluating and Recording Soft Contact Lens Fit
23/04/09
Life through the lens: The OT guide to contact lenses. Evaluating and Recording Soft Contact Lens Fit.
Professor James Wolffsohn, Ophthalmic Research Group, Life and Health Sciences, Aston University
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C-10560 Monitoring and Controlling Diabetes
10/04/09
Diabetes mellitus (DM) is defined as a group of metabolic diseases characterised by hyperglycaemia resulting in defects in insulin secretion, insulin action, or both secretion and action. It is essential to control plasma glucose levels in order to reduce the risk of diabetic complications. Other complications, such as hypertension, also need to be considered.
Professor Rachel North PhD MSc FCOptom
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Lenses for Colour Vision Deficiency and Reading Difficulties in Optometric Practice
10/04/09
Colour vision deficiencies are usually inherited failures to recognise a full spectrum of colours, leading to confusions between groups. The most common colour vision deficiency in Europe is the partial-green deficiency known as 'deuteranomaly', which is found in approximately 6% of the male population
David Harris
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C-10717 Vision & Reading Difficulties Part 3: Coloured Filters - Do They Work?
27/03/09
This is the third article in a series of five on Vision and Reading Difficulties. The first article provided a general overview of learning disabilities and specific learning difficulties (SpLD). It outlined the role of the optometrist in helping people with SpLD. The second article covered conventional optometric correlates of reading difficulties (e.g. binocular vision problems) This article and the next will describe the use of coloured filters to treat a condition now know as "visual stress", which is often associated with reading difficulties; the symptoms of visual stress were described in Part 1. The terminology for this condition has changed over the years (e.g. Scotopic Sensitivity syndrome, Meares-Irlen syndrome). Terminology is discussed more in Part 4.
Arnold J Wilkins, Bruce JW Evans, Peter M Allen
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C-10559 Diabetes: Indications for Treatment
13/03/09
It is estimated that there are currently 180 million people word-wide affected with diabetes. Diabetes is the leading cause of blindness for people under the age of 65 years in the Developing World. The prevalence and incidence of diabeties in our modern society is currently on the increase. It is important to recognise this and the impact it has on the provision of care to the diabetic patient in the ophthalmic setting. It is also important to realise the overall impact of diabetes on the eye. Although this article concentrates on the retina, diabetics can suffer a myriad of signs and symptoms: cataracts, cranial nerve palsies, pupillary abnormalities, neovascular glaucoma; and are more susceptible to vein and artery occlusions and ocular ischaemic syndromes. The treatment of such conditions should ideally be based on current scientific evidence and clinical trials showing the effectiveness of the treatment provided. However, itis important to consider each individual patient and their specific needs as well as taking into account the experience of the practitioner administering the treatment needed.
Dr Brinda Muthusamy MRCP MRCOphth
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C-10577 Vision & Reading Difficulties Part 2: Optometric Correlates of Reading Difficulties
27/02/09
In this second article of the series on vision and reading difficulties, the optometric factors (for example refractive error and orthoptic function) that may be associated with reading problems are discussed in detail. The first article of this series introduced the correlates of, and interventions for, reading difficulties that have been supported by evidence-based research. This present article describes the optometric correlates more specifically, providing details of the aspects of visual function that ought to be considered for further investigation.
Bruce JW Evans, Peter M Allen, Arnold J Wilkins
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C-10556 Features of Diabetic Retinopathy and Grading Protocols
13/02/09
Diabetic retinopathy is a chronic progressive sight-threatening disease of the retinal microvasculature. People with diabetes are 25 times more likely than the general population to become blind. In developed countries, diabetic eye disease represents the leading cause of blindness in adults under 65 years of age. In 2003, it was estimated that there were 194 million people, or 5.1% of the adult population worldwide withdiabetes. With the epidemic of obesity that is currently being experienced in the developed world, it is predicted that this fiqure will rise to 333 million, or 6.3%, by 2025.
Louise O'Toole FRCSI(Ophth), MRCOphth, MMedSci FEBO
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C-10508 Vision & Reading Difficulties Part 1: Specific Learning Difficulties and Vision
30/01/09
This article is the first in a series of five about vision and reading difficulties, and provides an introduction and an overview of learning disabilities and specific learning difficulties. It outlines the role of the optometrist in helping people with such problems; it describes the symptoms that optometrists should look for and it provides an introduction of the evidence-based approach. The second article in this series will cover the optometric and orthoptic correlates of reading difficulties. Articles three and four will describe the use of coloured filters, including background, techniques, evidence, and mechanism. The final article will draw together the themes in the series of articles and discuss the clinical protocol and the role of the eye care practitioner in managing visual factors associated with reading difficulties.
Dr Peter Allen, Prof Bruce Evans, Prof Arnold Wilkins
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C-10413 The Time Bomb of Diabetes
16/01/09
This article highlights the need for appropriate management of diabetic patients, in order to improve both their ophthalmic and their systemic health. The microvascular and macrovascular complications of diabetes are discussed as well as some of the newer treatments. As the incidence of diabetes is rising, it is important that an optometrist has a good working knowledge of this systemic disease. It is important that there is good communication between the optometrist and the patient’s GP as the management of diabetes calls for a multidisciplinary approach.
Louise O'Toole FRCSI(Ophth), MRCOphth, MMedSci and FEBO
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Data Methods in Optometry
16/01/09
Part 9: Experimental design and analysis of variance
Richard Armstrong and Frank Eperjesi
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