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Category Archive for: ‘Clinical’

Optometrists Disappointed No Alternative Offered To School-Exit Eye Screening
There has been a lot of discussion recently about allowing Optometrists in Ireland to see children – to take care of their eye care needs. Optometrists are already allowed to do most things required to deal with almost all children’s visual issues, but the sticking point is that the parent either goes (for free) to a community clinic, or goes to the local Optometrist, with no funding.
Below is a repost of a Press release from the Association of Optometrists;
A detailed pdf download is available here, but the answers is clear- it would be cheaper and more convenient to have the eye test government funded at the local Optometrist – very few children really do need to be seen in a hospital, and those that may would be seen much more quickly, if all of those children who did not need to be seen were to be examined elsewhere!
Call me a cynic, but there is a vested interest in having a very long waiting list to see the Community Ophthalmologist – what parent would wait the required year or so, when the child gets a letter home from school saying there is an issue, if they could possibly scrape together the money to be be seen much more quickly privately?
I have never personally been a fan of school screenings – I have seen many who have slipped through the net, and many more who failed, who were perfectly normal.
I used to work in Cumbria, England – there, the local health authority sent a Birthday card to every child at age Three, advising them that it was time to have their first (and free until 16 under the NHS) eye test. That is the best system I can think of, and to be brutally honest….many times a school screening is too little too late…
Some of this is recollection, but my son started at the Vale School aged 5. He started to wear spectacles in senior infants, as we found him to be short sighted. I do not think he had a school screening until second class, when he would have been probably 8 years old, and already wearing spectacles for 2 – 3 years. Perhaps he was off sick for the previous screening – I do not think so, but even if he was he should have been checked another day, where they would have found that he had been unable to see very much at all far away, though they would not know that his issue had been ongoing for 2 -3 years!! After a year waiting he may have been prescribed spectacles in the community clinic in Cavan (aged now 9). It is not good enough!
The most important message I can think of at this time is that parents must realise that it it their responsibility to to look after their child’s eye care – the state is not doing anything particularly useful for you or your child!
Here is the AOI press release;
Optometrists have expressed disappointment at a HSE decision to end routine eye screening of fifth and six class primary school children without offering any alternative – and called for major reform of children’s eye-care.
Primary School Principals have been written to advising them that the HSE primary school-exit eye screening service is to be discontinued with immediate effect – saying that there is a lack of evidence to support the effectiveness of the programme.
The Association of Optometrists (AOI) said it accepted that the effectiveness of the service was questionable, but removing a major part of the Primary School Children Optical Scheme and not replacing it, or reforming it, with something better is going to make outcomes worse.
AOI said that the move will further reduce eye-care services for children which are already highly compromised by waiting lists of up to five years for non-urgent cases and six months for urgent cases.
AOI’s Optometric Advisor Lynda McGivney Nolan called for commitment from the new Government to eliminate children’s eye-care waiting lists – by moving to a community based model of eye-care, similar to what has been successfully introduced in parts of the UK.
“Children’s waiting lists can be solved quickly by referring children directly from the school scheme to their local Optometrist. Under the current system in Ireland children are referred to HSE Community Clinics, or Hospital services where there are unacceptable delays.
“All children in fifth or sixth class who notice symptoms should be entitled to go to their Optometrist for an eye examination and for follow on treatment, or referral as required.
“There are 300 Optometry locations across the country with the skills, capacity and equipment to provide responsive and clinically effective eye-care.”
AOI said it understands that there have been regional variations in response to the HSE notice and that school-exit screening is still available in some parts of the country and has been ceased in others.
“This is typical of our eye-care services where there are unequal regional variations in service agreements. This further highlights the need to reform eye-care in Ireland to ensure equality of access and quality of service irrespective of where people live,” Ms. McGivney Nolan said.
The AOI said reforming to a community based model would not only eliminate waiting lists but also save the State money and improve health outcomes for children.
“On the estimation of a HSE Community Clinic examination costing €100 per visit and an Optometrist €60 per exam (plus other additional savings), annual cost savings of millions of euro can be achieved,” Ms. McGivney Nolan said.
AOI’s full position on reform of Irish eye-care, A Community Based Model for Eye-care, can be read at www.aoi.ie.
Further Information:
Association of Optometrists Ireland (01) 4538850
Ronan Cavanagh, Cavanagh Communications: (086) 317 9731

TAP WATER!! Never EVER…
I had a young man in earlier who was wearing a pair or Air Optix monthly replacement contact lenses, bought from an optician’s in Navan, from our prescription though.
He ran out of lenses about 1 month ago, so has been wearing this pair for two months now. To be fair the lenses looked in not too bad condition, but we cannot advise or condone wearing a medical device (which a contact lens is), for longer than it is designed, or licenced to be worn.
BUT…. he ran out of contact lens solutions also approximately 1 month ago, so he has been using — TAP WATER.
Tap water can commonly contain Acanthamoeba, which can cause devastating corneal infections – potentially sight threatening infection. Tap water does not kill bacteria, which will naturally be on the surface of the contact lenses – you need to clean the contact lenses and store them in an approved solution to kill off the the bugs which were not rubbed off. Acanthamoeba eat the “Biofilm” on the contact lens (the bacteria, mould spores, mucus and other contaminants which coat the lens during wear) so if there is no contamination on the lens there is less for an amoeba to eat. But if they get into your cornea, they will start eating the nerves in your cornea, which as you can imagine may “smart” a little. Often a “red flag” for an acanthamoeba infection is a very incredibly painful eye, with little sign that it should be so sore – it can take a while for the problems to begin to show up on examination.
Never ever ever store your contact lenses in tap water. You should not even ever allow water to get onto your contact lenses, which means thorough hand drying before handling the lenses (you did just wash your hands, didn’t you??) I gave him a new pair and told him to throw the old ones away. I also gave him some solutions to tide him over until his valuepack arrives.
This lad seems to have gotten away with it, hopefully, but I advised him (again) never to mix tap water with contact lenses. But I did advise him never to mix tap water with contact lenses when I originally fitted him, and taught him how to apply and remove them…. OK, that was a good few years ago, but just one more time…. DO NOT MIX TAP WATER AND CONTACT LENSES, AT ALL EVER!
We have a contact lens dos and don’ts on the website – it might not be a bad idea to have a quick refresher if you wear contact lenses.
When, and why, do your eyes get itchy?
A mast cell stabiliser, such as Opticrom, or Optrex for Hayfevery Eyes, is very effective to reduce the itching and discomfort experienced by a pollen allergy – commonly called hayfever. But who knew that there were so many common causes of an allergic reaction? – I for one thought that pollen was pollen! I was never a hay fever sufferer as a child, but recently developed an issue. Using this infograph, and also thinking about what caused my major problem, for me I reckon it is nettles! Once after strimming, I had a serious swelling of my eyes, where the conjunctiva was “spilling over my eyelids”! A couple of antihistamines and some drops later, things settled down. I still “suffer” from itchy eyes at certain times, but this year I am going to try drops for the nettle season to see how I get on! Last time I bought Opticrom locally it cost €11.22 – I recently found the package. You may need a couple or three bottles for your season, but if it reduces the problem, it may be worthwhile.
As a Scotsman, from Fife (the equivalent of a Cavan man), I bought a bottle, but having found out how much it cost, I didn’t open it, thinking that “I will use it if my eyes get worse”. I then promptly lost it, so it serves me right for being a meanie! But I did recently find it, and it is unopened, and still in date, I will try it, starting in June this year. Hopefully I can report back a success!
Scottish people, and Fife people in particular are not mean, I would imply Cavan men aren’t either – just a joke…. Billy Connelly reckoned that two Scotsmen invented copper wire, while fighting over a penny…
As the information suggests, though mast cell stabilisers are very effective, it may take a few weeks to make a difference, so attempting to find the cause of the itch is very insightful.
If you wear contact lenses, and have itchy eyes, perhaps all year round, or getting worse, it is more likely that you have a contact lens (or solutions) issue than a pollen issue – how much contact lens solution gets in the eyes every day compared to pollen? Have a contact lens check-up where you normally go.
It is particularly important that parents try to prevent their children from rubbing their eyes, though it is easier said than done – if they are itchy, prevent them from itching – eye rubbing is thought to be a major (perhaps THE major cause) of Keratoconus!

What is a Pterygium?
A pterygium is a benign overgrowth of the conjunctiva, the tissue which lines the eyelids and the white of the eye. This overgrowth grows over the cornea (the clear window of the eye) and eventually can begin to obscure vision.
Pterygia are very common in people who live in areas of high ultraviolet radiation – sunny places, and also those who lived in very dusty places. Obviously people from Africa (but other areas too) will have a double “whammy” of both increased risk factors. People who surf also commonly get them – it is often also called “Surfer’s Eye”. People with dry eyes and those who live in windy conditions also have an increased risk.
A pterygium (named after the Greek for a Fly’s Wing – the insect’s wing) is so called because it does look a little similar to the wing of a fly, except that it is made of eye tissue and not by a fly. Fly wings also do not look as red as a pterygia, but that is where they got their name.
In years gone by, there was little to be done for a pterygium – no treatment until or unless it began to encroach into the area of the pupil, when it would affect the eyesight. This was because the pterygium would generally recur, so early treatment would mean more treatment in the long term. Not all cases will continue to grow towards the centre of the cornea – some will just stop growing of their own accord, so those who are not going to have them fixed should have regular check to make sure it is stable.
Pterygia can be uncomfortable causing
- Burning
- Gritty feeling
- Itching
- Sensation of a foreign body in the eye
- Blurred vision
The modern way to deal with a pterygium is to do a conjunctival transplant, where the pterygium is removed, and a piece of conjunctival tissue from under the upper eyelid (which has rarely ever seen the light of day – no UV and very little dust in there) is transplanted to the area the pterygium was removed from. Because the growth does disrupt the regularity of the corneal fibres as it grows it does cause corneal scarring, so modern thoughts would be to treat it sooner rather than later, but again, not all of them do require removal.
They almost always occur in the nasal part of the conjunctiva, and can occur at any age.
I believe F1 driver Nico Rosberg has one in his left eye, but I read (somewhere) that for the time being he has decided not to have it fixed, though the eye does apparently sometimes give him issues during hot races.
Diagnostic Contact Lenses
We have a few patients who regularly call seeking free trial contact lenses. Most of these “clients” have never bought any contact lenses from us- they just request more free diagnostic lenses. All of these “clients” are also all advised that they must return for a contact lens check before we can finalise their prescription and ensure that the lenses are fitting properly, so that they do not harm their eyes.
Mostly, having issued trial contact lenses, we will not see them again for 6 months, when once again they are looking for more trials, because they have a Christmas party, or they have a “family wedding tomorrow”, and as they have no contact lenses we cannot check them in their eyes. As an aside “free trial” diagnostic lenses are not free, we pay for them, at the very least we pay for shipping.
I find this a difficult situation- I need to see the lenses in their eyes, ideally after about 4 hours of wear on the day- soft contact lenses almost always look to fit well when just inserted- but if they wear all of the diagnostics, how am I supposed to check them?
We have to fix this – we cannot issue contact lenses on an ongoing basis to people who do not have a valid contact lens prescription!
The only solution to this is that no trial contact lenses will be issued without a check appointment being booked, and if the client fails to show for that appointment, no further lenses will be issued. We do try very hard to be accommodating, but there was a chap due to come in for a contact lens check in Kingscourt on Saturday, who has been “trialling” contact lenses on and off since 2012, and once again he did not show for his check appointment. He recently stated that he “might get his eyes tested this year”. His spectacle prescription is now out of date, and we have never finalised his contact lens prescription- he won’t be getting any more contact lenses, at all, ever, from us!
I would personally like to apologise for this, but we are legally and professionally responsible for all contact lenses issued – they are classed as medical devices, and it seems that there are numerous patients in Kingscourt, who have been “trialling” contact lenses, sometimes on and off, for over four years.
No more. They will be issued with one pair to apply 4 hours before their appointment, if they do not show……








