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Category Archive for: ‘Clinical’
You get what you pay for.
I recently had a young chap in Kingscourt, enquiring about contact lenses. He did not require an eye exam as he had been recently tested elsewhere, and we contacted this optician to request a copy of the prescription. They faxed us a copy of his entire record card.
His entire record card had his prescription printed on it- I believe it was printed onto the record card before the optician got it- it was probably acquired with an autorefractor.
The only information written on the card was his visual acuity – how well he could see – with the (probably autorefractor) result, and one other piece of handwritten information – “routine test”.
It is sad to see that any professional would consider this to be an adequate eye examination- there was no questioning (or at least no record of questioning) about the lad’s general health, previous history with his eyes or problems that he, or the family may have. Legally, if it isn’t written down, it was not done!
There were apparently no tests such as eye control status- he has a squint and a lazy eye that was not recorded, and there was no record of any examination into the health of the inside of his eyes.
Unfortunately, eye exams done properly take time, and if your business is based on volume of spectacles sold, it is imperative to do as many tests as possible, and maybe more in a day.
You get what you pay for.
Had another one the other day, blank except for the information written “lazy Right eye”. It happens that it was the left eye that was lazy.
To be fair, the patient may have given the optometrist the wrong information, but equally, how long would it have taken to amend this?
At McLeish Optometrists we take 40 minutes to do an eye test. If you go elsewhere you may not have such a long test
Irish failing to get eyes tested
A recent survey by Behaviours and Attitudes interviewed 1000 people on behalf of the Healthy Eyes Campaign.
They found that 21% of the Irish population had never had a sight test, in the under 35s this figure rose to 36%.
The vast majority who had never had their eyes tested believed that they had 20/20 vision!
The survey also found that half of the Irish population have not had their eyes tested in the last 2 years.
The Federation of Ophthalmic and Dispensing Opticians (FODO) Ireland’s head of policy was quoted in Optometry Today, an Optometry Journal – “I was taken aback to discover that 21% of the Irish population has never had a sight test at all. Half of all sight loss is avoidable but without proper education and regular sight testing Ireland could be heading for a public health crisis.”
Most people are entitled to eye tests at no charge under either the HSE Medical Card scheme or through PRSI Optical Benefit….
RTE Nationwide
The RTE One programme Nationwide this evening was visiting the Waterford Institute of Technology, highlighting the research into, and importance of Macular Degeneration, particularly its early detection and treatment. It was an interesting programme, and obviously the team in Waterford are leading specialists, for sure in Ireland, but perhaps worldwide.
The programme can be viewed on the RTE.ie website – there seems to be a limit of the last ten episodes.
One thing I do think is worth a mention- virtually everyone interviewed decided to have their eyes checked because they had noticed that they were having problems – they felt their glasses were not sufficient, or noticed distortion. Recently the Royal National Institute for the Blind in the UK was campaigning to highlight the problem with symptom led eye examinations- they were imploring Optometrists to stress the importance of regular eye tests – ones where there were no symptoms!
Many problems can be detected before symptoms are noticed by the individual, though this may not necessarily be the case in Wet AMD. Anyone concerned about Wet AMD should put an Amsler grid on their fridge or noticeboard and check their vision weekly. An Amsler grid can be downloaded here.
Myopia Control with Contact Lenses!
Myopic Deterioration can be slowed with multifocal contact lenses.
A recent study has found that young myopic (shortsighted) contact lens wearers who were fitted with a specific type of multifocal contact lenses progressed at a slower rate than age matched peers. Although it was a small study, the results were still found to be statistically significant, meaning that there is very little likelihood that the results were different by chance alone. They found that the shortsight developed at half the rate of the control group.
This is a very interesting finding – 50% is quite a lot! at last there may be a way to slow down those children who seem to get worse, more shortsighted, at every visit.
Researchers believe that by making the peripheral vision slightly blurred using bifocal contact lenses (initially designer to help older people read with their lenses), the eye somehow knows to stop growing. This peripheral blurring will not affect the wearer’s vision significantly- peripheral vision is really only useful for movement detection.
Another study from a couple of years ago, in Australia used a lens design which was later licenced to CibaVision. Though Ciba have not yet released a contact lens specifically aimed at myopia control, there is mounting evidence that it can be effective at slowing those patients who seem to be constantly slipping.
Driving Vision and Glaucoma
Yesterday was the annual AGM of the Association of Optometrists, and also a study day- all Optometrists have to undertake a certain amount of Continuous Education and Training. At the moment this is voluntary, but will probably become compulsory in due course.
One of the lectures at the study day was about driving and vision, a subject that has become very topical of late. Particularly interesting I thought were a couple of videos which tracked the eye movements of Glaucoma patients when tested in a Hazard Perception Test. It had always been assumed that people who have a visual field deficiency will scan around, and move their head more to compensate for their problem, but as is mentioned here, the issue is that they may not even realise that they have a problem, and even if they are aware of an issue, they do not see the problem. If you don’t see something, you don’t think “I didn’t see that” – you just don’t see it.
The Hazard Perception test used eye tracking to follow the “Point of Regard” of normals and Glaucoma patients, also measured were reaction times – when would they hit the brakes? The study found that people with Glaucoma do not scan around more than normals – indeed one of the videos below show that they remain fixed almost exclusively on the car ahead, failing to notice the hazard of a car pulling out ahead, until the car they are following reacts to the threat.
Video Number 2 shows the Glaucoma patient’s Point of Regard in Blue, the normals are shown in red, it is quite noticeable how little the Glaucoma patient looks at other aspects of the driving scene – they completley fail to look at the pedestrian with the buggy, something all the normals are obviously worried about.
Video number 3 has superimposed onto it a representation of the patients field of vision- the more dense the areas of field loss, the darker the overlay. (It moves around because its position is relative to the fixation point, the blue dot. Remember that a Glaucoma patient will not see this blackness, they will just have blank areas, their brain will fill in the details as best it can.
The Glaucoma losses featured in Video 2 and 3 are mild to moderate – according to UK standards (where this study was done), this patient would still be legal to drive.
This shows that even if you do not feel that you have a problem, you should have your eyes regularly checked!
The full articles are available to read at these two links;
Exploring Eye Movements in Patients with Glaucoma When Viewing a Driving Scene
