Category Archive for: ‘Clinical’

At least we have a standard!

In the U.K. as elsewhere there are minimum eyesight standards required to obtain a driving licence. This requirement is checked when the person sits their practical driving test -they need to be able to read a car number plated at 65 feet, 20 metres. However, this check is done once (unless you need to resit the driving test), and from then on, it is up to the individual to inform the DVLA if there are any reasons their sight, or other health issues might cause driving problems.

But how many people will willingly advise the DVLA?

I once saw a young lady in the Tennent Institute of Ophthalmology in Glasgow. I was measuring her field of vision using a Humphrey Field Analyser, which checks peripheral (round about) vision. She had a condition called Retinitis Pigmentosa, which caused her to have severely restricted peripheral vision. As I recall she had about a central 10 degree of vision, but little or no peripheral vision. This is what “tunnel vision” is.

This young mother knew that she should not be driving, but she still was. She admitted that she would clip a few kerbs and wing mirrors, and would NEVER drive with her kids in the car. It was unsaid, but I am sure she was aware that there were plenty other peoples kids around who were not in her car. She had been advised not to drive, but it was up to her to involve DVLA about that.

I have complained a good few times about the implementation of the updated Irish vision standards for driving, though these varying requirements now seem to have settled down, pretty much to what they were before the changes.

But at least there is an enforced standard here, which is what the UK is thinking to implement, so everyone on the road in Ireland should have adequate eyesight.

There is a report here from the AOP in the UK about driver’s vision, and a later similar topic from the BBC.


Optic Nerve Haemorrhage At 4 OClock

Glaucoma Suspects and Continuity of Care

Optic Nerve Haemorrhage at 4 to 5 O'Clock position

Optic Nerve Haemorrhage at 4 to 5 O’Clock position

I recently had a lady in who was last tested by us 7 years ago, but returned to us having visited an optician’s chain, twice apparently. Her last eye test was two years ago. She complained that her glasses were “never right”. Though they were not “not right enough” to complain, or have another eye test, until they broke.

She admitted that she was supposed to return to that optician’s after six months for a check up, but did not bother, and claimed to not remember why she should return.

One of her eyes showed classic signs of Glaucoma- she had a loss of optic nerve tissue in a specific area of the optic disc, and a flame shaped haemorrhage at the same place. Visual field testing was full- there seems to be no loss of vision in the eye which I suspect has a problem- this means that (IMHO) it has been detected early enough – flame shaped haemorrhages are incredibly suspect for glaucoma damage, and we will refer her on via the GP to see a specialist.

The Ophthalmologist specialist perhaps will not agree with me, but an optic nerve haemorrhage at an area of disc loss is very, very suggestive of Glaucomatous damage to the optic nerve. There were also other changes which were evident from the previous records, which also showed an increase in the cupping of the optic nerves – indicative of progressive (damaging) changes.

The Optic Nerve connects your eye to your brain, and is therefore rather important for your normal vision!

This elderly lady should have understood why returning in six months was required, it should have been explained in a way she understood, though perhaps it was and she just does not remember…..

Being a Glaucoma suspect is not the end of the world – it is an easily controllable eye problem. But first you must be diagnosed, and then controlled – slowly go blind, or put drops in the eyes at bed-time, maybe twice a day?

Hmmm – SLOWLY (AND PAINLESSLY) GO BLIND, or put drops in my eyes – I would rather not have to put drops in my eyes every day, but it is I think better that SLOWLY GOING BLIND!?!

My first suggestion, to most of my clients would be pick an optician, and stick with that optician – otherwise no-one will get to know your eyes!

This post is not “touting for business” – it is a suggestion that you should stick with the same Optometrist, the one who know your eyes and sight the best – the one who has your previous records!

My number two suggestion, which perhaps should be number one, is to regularly compare the vision from each eye individually, and call an Optometrist if there is any distortion or anomaly in either of the eyes.

Sligo Cataract Scheme Can Save 20,000 Hospital Appointments And Reduce Waiting Times

(The Association of ) Optometrists say Cataract Waiting Times Highlighted in RTE Investigates can be solved!

Optometrists have today said that lengthy waiting times for cataract treatment, as highlighted on RTE Investigates last night, can be reduced by making greater use of Optometrists.

Just to be clear, this news is NOT from last night!!

The Association of Optometrists Ireland said that a scheme has been developed and is successfully being applied in the North West called the ‘Sligo Post-Cataract Scheme’. It has proven highly successful in reducing waiting times for patients and in reducing costs in that region.

Under the scheme cataracts patients are co-managed by Optometrists in the community and Ophthalmologists in Hospital. The scheme simplifies the patient pathway and speeds up access.

AOI Chief Executive Sean McCrave called for the Sligo Scheme to be applied nationwide. “AOI together with the HSE has successfully trialled the ‘Post-Cataract Scheme’ in Sligo / the North West and it has proven clinically effective and brought cost savings.

“In the award winning scheme, Optometrists are provided with access to the hospital IT infrastructure and electronic patient records; and provided with training on the specific protocol to follow.

“Instead of two separate follow up appointments, one in the hospital and one with the community Optometrist, patients are given the option of a single appointment with their local Optometrist. This can be made at the patients’ convenience, in a local practice.

“This combined appointment facilitates the Optometrist to examine the eye and carry out a refraction in one appointment and then enter the details on the electronic patient record held in the hospital. “With over 20,000 procedures a year, rolling out the Sligo protocol nationally would reduce out-patient cataract appointments by approximately 20,000 at reduced cost with no capital expenditure,” Mr. McCrave said.

There are 8,500 people currently awaiting cataract surgery and waiting times of up to four years in some parts of the country.

A repost of a press release from the Association of Optometrists Ireland, but the RTE details are here.


Sadly, and perhaps a little cynically, I feel that some eye doctors must have a vested interest in longer waiting times – longer waiting times are better for private work after all?

Rp 1182

Saline is not suitable to store contact lenses!

I had a young lady in on Saturday, looking for a contact lens case. She is a student and was home for the weekend, but forgot her case. She had purchased her usual contact lens solution in a nearby pharmacy, but they did not have any contact lens cases.

The solution she had purchased was LensPlus – a bottle of Saline – suitable for rinsing all types of contact lenses. But it is not suitable for storing contact lenses – it has no antimicrobial activity, at all. It is salty water, with a tiny amount of Hydrogen Peroxide, to prevent the solution itself becoming contaminated, but the Peroxide concentration is such that it will not kill bugs on a contact lens, and breaks down rapidly when exposed to light! I advised her that the solution was a bad choice, and that she should return to request a refund, but then she admitted that she had been using that one for ages with her lenses.

I gave her a trial pack of Optifree Puremoist, which has a bottle of correct solution in it, and a case. She was very grateful as “her eyes were killing her”, as she had slept in her lenses.

Daily contact lenses are supplied (Sterile) in salty water, but they are sterile until opened, and (should) only be used once! This student was wearing monthly lenses, which are also sterile until opened. After that first day, they need to be disinfected. Poor advice when she was taught about how to look after her lenses, I guess?

I cannot think of any disinfecting solutions which are supplied without a case these days, so please be aware – if the solution does not come with a new contact lens case in the box, it is likely because the solution is not suitable for storing/disinfecting your contact lenses!

You should probably be using a “multipurpose solution” – suitable to clean, rinse and store (disinfect) the lenses. Her solution was suitable for rinsing only.

Unless you were recommended a different care scheme, such as Hydrogen Peroxide based, which often requires a separate cleaner, and neutralisation before wearing the lenses, either with a different solution in the morning, an added tablet in the evening, or a platinum catalyst in the base of the barrel case, but these are less common these days – I would only recommend these types to people with very “allergic” or sensitive eyes. These solutions often have a red tipped bottle nozzle, to indicate it cannot go into your eyes. I’ve been there, and it SMARTS, more than a little!

Contact lens solutions can be bought in the pharmacy and in the supermarket, but READ THE LABEL, and if you are in any doubt, consult your contact lens specialist?

Best advice I reckon is do not change brands until you check with the optician – the number of people I see who do not know what they are using – “it is a white and blue bottle”, it has a yellow label, it is a square bottle……

More government funded eye tests (more “free” eye examinations!)

Good news and less good news.

As a one year “austerity measure”, the government removed most optical and dental benefits from those paying PRSI as a PAYE employee. This one year measure lasted rather longer than one year! I am not sure if this was taken away in 2008 or 2009?

At the Optometrist, entitled clients were still allowed a funded eye exam, but there was no help towards the cost of spectacles.

In the 2016 Budget, the government announced a broadening of the scheme, to include a contribution towards spectacles or contact lenses (about time!), also they increased the coverage to include those who were paying a Class S self employed stamp, and their dependent spouses for the first time.

I have also had confirmation that people who “dual qualify” – those who hold a medical card, but are also working, can choose which service they wish to use – if the Treatment Benefit authorises, we would suggest going that route every time – authorisation for a medical card sight test can take many weeks! That is the good news on the Treatment Benefit side.

Less good is the fact that we can no longer check your entitlement with verbal consent – we used to be able to get a person’s name and PPSn number over the phone and enquire to the Department if they would be allowed an eye exam. We now require your written and signed consent to ask this information, because of the upcoming European GDPR rules. (General Data Protection Regulations).

To confirm eligibility, all we need is your PPS number and your date of birth, but we do need to have signed and dated consent to do this.

We can also no longer enquire about any eligibility as a dependant spouse – we used to just require your and your spouse’s PPS numbers, but now you will need to send off a form, with your spouse’s signed consent to access this information.

Overall this is good news as many more people are now going to be entitled to a “Free” Eye Examination. It is not free, but it IS at no charge to you.

Most people should have their eyes checked every two years – don’t be fooled that just because you think you are seeing fine, that everything is OK. Seeing well is a great start, but Glaucoma is not called the “Thief of Sight” for nothing! Eye diseases are rare in young adults and children, but I could easily fill a good few posts about unexpected significant problems I have encountered in a routine, “no worries” eye exam!

Neither PRSI  nor Medical Cards  are supposed to be used for eye examinations in connection with employer VDU usage or employer Safety spectacles requirements. This is to ensure that the employee is not obliged to use their entitlement at any particular Optometrist.



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