College of Optometrists

The optometrist uses both objective and subjective methods to examine eyes. With a young child they will rely on objective methods. These include looking inside the eye with a special torch (ophthalmoscope) to make sure the child's eyes are healthy, and shining another torch (retinoscope) into the child's eyes to see whether or not they need spectacles. Vision can be assessed by either showing the child pictures and watching whether or not they look at them (if they are too young to identify them) or by asking them to match letters from the letter chart to those printed on a card the child or his parent is asked to hold. Children do not need to be able to read to do these tests. An optometrist can also examine a child's eye muscles by getting them to follow a torch as it is moved around them, and see whether or not they have a squint by covering one eye up and then the other one. Their 3-D vision can be assessed by asking them to look at a special card where pictures stand out at you if you are using both eyes together. If the child is not using both eyes together they will not be able to see the 3-D pictures.

Children can have their eyes examined as soon as they are old enough to open their eyes. They do not have to be able to read the letters, or even speak (although it helps if they can !). If there is a family history of a lazy (amblyopic) eye, a squint, or needing very strong spectacles as a young child, it is vital that you take your child for an eye examination. Ask your optometrist at what age they would recommend you take their child to see them. There is no charge for children under 16 to have their eyes examined under the NHS.

There are several factors which may cause a squint. A squint may be caused simply because a child is long sighted and needs to accommodate to see clearly without their spectacles. The accommodation makes the eyes turn in without the child's spectacles, but they may not have a squint whilst they are wearing them. Alternatively, a squint may be caused by a muscle imbalance. Squints often run in families so if you have a family history of a squint it is important to have your child's eyes examined. Children can have their eyes examined at a very young age (see next question). www.moorfields.org.uk/EyeHealth/Squintstrabismus

A lazy eye is one that is healthy but does not see as well as it should, even with spectacles or contact lenses. It is caused when the eye does not have a clear image reaching the back of the eye when the patient is young (under 7 years of age). This can happen if the child has a cataract or a squint, or simply if they need spectacles but don't wear them. The degree of laziness can be reduced if the child has corrective treatment (such as wearing spectacles or patching the good eye to force the lazy one to work) when they are young. Children do not tend to notice if they have one eye that does not see as well as the other one, and if they do notice it they don't always realise that it is not normal (after all most people can write better with one hand than with the other, so why shouldn't a child expect that most people can see better with one eye rather than the other). This is one reason that all children, particularly those with a family history of similar eye problems in childhood, should have their eyes examined before they start school.

Most people who have poor colour vision are born with the condition (it is congenital). It is hereditary and mainly affects males. There is no cure for congenital colour defects, but some people find it useful to have special tinted spectacles or contact lenses where the tint in one eye is different from that in the other. Although this does not restore the appearance of colours it may enable you to be able to distinguish between certain colours more easily by comparing the appearance of the colour through one eye with that through the other. However, this will not enable you to get a job which is not open to those with defective colour vision.

Tinted lenses which look coloured change the colour of things you look at through them. If both lenses are tinted the same colour (as is usually the case) this will change the colour of everything you look at through them and may make certain objects difficult to see. Because a tint reduces the amount of light that enters your eyes, we do not recommend you use tinted lenses for driving at night, or in conditions of poor visibility where light is at a premium.

There are several tests for colour vision. You may be asked to look at different coloured objects or dots and identify a pattern which is in a different colour, or you may be asked to match dots which appear to be of the same colour. Some colour vision tests may involve you matching or distinguishing between lights of various colours.

Some organisations which require the correct recognition of coloured signals (principally transport groups such as the Civil Aviation Authority, railways, maritime, naval and air force) depend upon a standard lantern test which imitates actual signal systems. Their use is confined to the trade task of recognition of coloured lights, principally red, green, yellow and white. Lantern tests require the naming of standardised coloured lights of controlled luminance, colour and size, usually in a dark room.

This is not a test that is usually done in community optometric practice, but some of the optometric universities provide this test. It is therefore suggested that if you want to have this test done you contact one of the numbers below

Aston University
Website
Optometry Clinic Reception 0121 204 3900

Cardiff University
Website
Eye clinic 02920 874357

City University
Website
Colour vision clinic 020 7040 0262
j.birch@city.ac.uk

Glasgow Caledonian University
Website
Eye clinic 0141 331 3377
eyeclinic@gcu.ac.uk

Oxford Eye Hospital
Website

University of Manchester
Website
0161 306 3860

Most people, particularly if they are short sighted, have some floaters inside their eyes. These appear as little black spots or 'flies' which appear to float around in front of your sight. They move when you move your eyes and are normally more obvious when you are looking at a plain pale background (like a cloudless sky). They are normally quite innocent, but if you get a shower of floaters, if you see lots of floaters after you have banged your head, or if you see flashing lights in your eyes or a 'curtain' or 'veil' in front of your eyes you should seek urgent medical attention. More information on floaters can be found on www.moorfields.org.uk/EyeHealth/Floaters

Part of the reason for having an eye examination is to check the health of your eyes. An eye examination will include the tests for glaucoma. These are looking at the back of your eye (ophthalmoscopy), which is done on everybody; measuring the pressure inside your eye (tonometry) and checking your visual fields. Tonometry and visual field tests are recommended as good practice if you are at risk of glaucoma. From the results of these tests, your optometrist will be able to tell whether or not you have glaucoma. If s/he is not sure about the results of any of these tests s/he may either refer you to your doctor, or ask you to return to have the tests repeated on a different day. If you have glaucoma you are normally unaware of it, as it is normally quite painless and affects your sight very gradually. It is therefore very important that you have your eyes examined regularly, particularly if you are at a higher risk of glaucoma.

A recent study (the ARED study mentioned above) looked at whether or not a particular dietary supplement reduced the incidence of cataract. It was found that it did not.

Glaucoma is usually treated using eye drops and/or an operation. The aim of current treatment is to reduce the pressure inside the eye.

A recent study (the Age Related Eye Disease study - ARED study) showed that some dietary supplements may reduce the incidence of Age Related Macular degeneration. Further detail can be found at www.rcophth.ac.uk

Providing a retinal detachment is caught early enough it can be treated by an operation. There are several different types of operation, but all aim to reattach the retina to the back of the eye. Further information can be found on: www.moorfields.org.uk/EyeHealth/RetinalDetachment/view and www.rcophth.ac.uk

Dry eyes can be either due to a problem with the quality of the tears or with the quantity of tears available. The differences may depend on age, diet, health, contact lens wear, atmosphere or occupation. Depending on the cause the treatment may be hot compresses or just the use of tear supplements. Your practitioner will be able to advise after further investigation.

This is when the lens inside the eye becomes cloudy. The treatment for this is surgery.

People who are diabetic may find that their sight becomes blurry, so that they need a change in their spectacle prescription, or they may see parts of their vision missing. They are also more prone to cataract. If you get any of these symptoms you should consult your optometrist. More information on diabetes can be found on www.diabetes.org.uk

Your contact lens practitioner must give you your contact lens specification once the fitting is completed. This is unlikely to be until you have worn the lenses for a reasonable length of time, so that your practitioner can assess whether or not they are suitable for you. The exact moment at which fitting is completed is a matter for professional judgement (usually at least 6 months).

Most modern contact lenses are safe, if they are handled correctly and you go for regular check-ups and take the advice of your practitioner. Further information on the types of contact lenses can be found on: www.bcla.org.uk

Contact lenses must be sold by, or under the supervision of, a registered optician. They must also be to a recent prescription (within one year). Some internet companies are able to supply contact lenses but you must make sure that you have your contact lens check-ups done regularly.

It can sometimes be difficult for a new contact lens wearer to determine whether a soft lens is inside out or not. If it is inside out it is unlikely to damage your eye - all that will happen is that it will feel uncomfortable, your vision may be blurry, and it may come out of your eye (or on to the white of your eye).

There are some micro-organisms which live in swimming pools which can cause very serious eye infections if they get into your eyes. We suggest you discuss this with your contact lens practitioner.

Some people find that bifocal contact lenses work well enough for them to see everything they need to see. The problem with bifocal contact lenses is that, unlike bifocal spectacles, it is not easy for the wearer to look through different parts of the lens for different tasks, as the lenses move with the eyes. There are many different designs of bifocal and multifocal contact lenses so you may find that you are more successful with one design than the other. This is best discussed with your contact lens practitioner. Further information can be found on: www.bcla.org.uk

Because contact lenses actually touch your eyes they must be clean and sterile before you insert them. It is possible to get eye infections even if you do not wear contact lenses, but the risk of contracting an eye infection is greater if you wear contact lenses (particularly if you use tap water on your lenses or wear them overnight). Modern contact lenses, if fitted and handled properly, are a very safe form of vision correction, but you should discuss this with your contact lens practitioner.

Astigmatism can be corrected using contact lenses. These may either be toric soft lenses, or toric or conventional gas permeable lenses. Your practitioner will advise you as to the best type in your case. Further information can be found on www.bcla.org.uk

Some contact lenses are designed so that they can be worn overnight but extended wear does increase the risk of serious contact lens problems. Therefore, you should discuss this with your contact lens practitioner to decide whether or not these are suitable lenses for you. Further information can be found on: www.bcla.org.uk

There is a significant increased risk of eye infection if tap water is used with your soft contact lenses - bugs that live in the water can cause devastating eye infections, the risks are less so with hard gas permeable materials. It is safest not to use tap water at all but to use sterile saline solution instead.

The age at which contact lenses can be fitted depends upon the maturity of the child. This is a matter for the professional judgement of the practitioner. Older people may find they have problems handling contact lenses and may also find that their eyes are too dry to wear contact lenses. Again, this should be discussed with your practitioner.

This is the name for contact lens check-ups. It is important to ensure that you have regular contact lens after care, at least once per year, to ensure that the contact lenses are suitable for you and are not harming your eyes. Even if you are not having any problems with your lenses, the aim of the after care is to spot problems before they may become serious.

Readymade reading spectacles to correct presbyopia (which is the condition which happens as we get older and need a prescription to read but not to see in the distance) only can be sold by anyone. These spectacles are limited in that they have a maximum prescription of +4 Dioptres and right and left lenses are identical. You should not avoid having your eyes examined regularly (at least every 2 years) as an eye examination does not only check your sight but it also examines the health of your eyes. Many conditions, such as glaucoma, are more common as we get older and do not cause any symptoms until permanent visual loss has occurred.

Short sight is usually caused because the eye is too big or the cornea is too steeply curved. That is why it tends to happen during the growth spurt of puberty. Whilst you cannot control how large (or long) your eye becomes, some people believe that wearing rigid contact lenses may slow down the progression of the short sight by reducing how steep the cornea becomes.

Only if they are needed for VDU and no other task (e.g. reading)

There is no evidence that sitting close to the TV causes any harm to the eyes. Television should be watched with the lights on, rather than off, as this should be more comfortable because otherwise it is like looking at a (big) torch.

There is no evidence to suggest that wearing spectacles makes you more dependent on them. Most people need to wear spectacles more as they get older, particularly if they are long-sighted, and wearing spectacles does not increase (or decrease) this dependence. If you go short sighted when you are in your teens this is because your eyes are growing (short sighted eyes are too big) and this also tends to get worse whether or not you wear your spectacles. What people find is that, when they get their first pair of spectacles their vision is so much clearer and more comfortable with the spectacles than without them, they are reluctant to use the effort to see without them. They are then surprised when they take their spectacles off that their vision is apparently worse without them than they remember it being. In fact, their vision is not actually worse without specs than it was before they had the spectacles, but they have become accustomed to seeing more comfortably because they have spectacles.

If you are dissatisfied with the service or conduct of your optometrist you should try to resolve any difficulties directly with the practice. In most cases your problem will be successfully resolved without difficulty. If you cannot reach an amicable agreement with your practice you can refer the matter to your local Trading Standards Officer or local NHS organisation via your practitioner (NHS patients only). Alternatively, you may refer to one of the following bodies: Optical Consumer Complaints Service PO Box 4685 London SE1 6ZB If your complaint involves serious professional misconduct then your complaint can be referred to: The Registrar The General Optical Council 41 Harley Street London W1N 2DJ

The College is not able to do this at present. Details of registered optometrists are held by the General Optical Council, and published annually on the Opticians Register which should be available from your library. Optometrists and Dispensing Opticians are listed alphabetically and by postcode. This is now also available online www.optical.org

The publication "At a Glance Guide to the Current Medical Standards of Fitness to Drive" is revised and updated twice yearly in Spring and Autumn. The booklet represents the recommendations of the Secretary of State's six expert Honorary Medical Advisory Panels on the medical standards for licensing as applied throughout Great Britain by DVLA's medical advisers. The standards aim to reflect current clinical practice including advances in technology, coupled with an understanding of relevant risk factors for safe driving. The publication can be downloaded in PDF format at www.dvla.gov.uk/at_a_glance/content.htm Hard copies of the booklet are available on request for a fee of £4.50 (cheques made payable to DVLA Swansea) from Drivers Medical Group, DMDG, DVLA, Swansea SA99 1DF Tel: 01792 766770

The term 'optician' covers all types of opticians: ophthalmic, dispensing and manufacturing. An ophthalmic optician is now known as an optometrist and is qualified to examine eyes, recognise disease, prescribe and fit spectacles and contact lenses (providing they are on the appropriate opticians register). A dispensing optician is qualified to fit spectacles, and may have done additional qualifications to enable them to fit contact lenses too (in which case they call themselves 'Contact lens opticians'). A manufacturing optician makes the spectacles.

The prescribing and dispensing of spectacles are very closely linked and it would be in your best interests to have your spectacles dispensed where you have your eyes examined. It is often more difficult to resolve any problems you may have with your spectacles when prescribing and supply are separated.

If you go to a high street practice, you will have your eyes examined either by an optometrist, or an ophthalmic medical practitioner (OMP). OMPs generally work in practices called 'Medical Eye Centres', and are doctors who have chosen to specialise in examining eyes.

No.

As often as is necessary.

Any 'user'. This is defined in the Regulations as an employee who habitually uses display screen equipment as a significant part of his normal work.