College of Optometrists

Many more children suffer from myopia than was the case 50 years ago: in parts of Asia, over 70% of children are now myopic and require some form of refractive correction to see clearly. A vast literature on possible causes of myopia and methods for controlling myopia progression has built up over the years and, until recently, distinguishing between hypothesis and real evidence has posed a significant challenge. Recent clinical trials of a variety of methods for controlling myopia progression have shown encouraging results and several methods are becoming commercially available. This article addresses the question: should we now be attempting to control myopia progression in a clinical setting? If so, what are the options?

Refractive surgery as a vision correction option for ammetropia and presbyopia is widely available and increasing competition between clinics has made this an affordable option for many. Advances in the field of both laser and non-laser treatments now mean that refractive surgery may be a viable option for an even greater range of patients. In the pursuit of spectacle-free wear, patients may well contact a clinic directly, but it is likely that they will seek an opinion from a trusted optometrist before doing so.

Located superiorly to the user's visual axis and positioned through a drilled aperture in a spectacle lens, a bioptic telescope is a miniature telescope of Galilean or astronomical design for use by those with low vision. The user habitually views through the spectacle lens for normal viewing and lowers the chin to view through the eyepiece of the bioptic telescope. Used mainly as a mobility aid by those with mild to moderate central visual impairment, a bioptic telescope provides a magnified image of a distance or intermediate target and thus improves resolution.

This article discusses the identification and presence of anisometropia. The effects on patients with anisometropia, such as aniseikonia and diplopia, are considered, as are the issues that the correction of anisometropia presents to both optometrist and dispensing optician. Lenses that are still currently available and which help to eliminate or reduce symptoms of off-axis vision to anisometropes to levels that are within tolerance are discussed.

Over the past few decades, the possibility of independence from spectacles and contact lenses by means of intraocularlens (IOL) implants has resulted in an exponential increase in the number of refractive lens exchange (RLE) and phakic IOL (pIOL) procedures performed. Today there are over 18 million IOL procedures performed worldwide each year (Market Scope LLC 2011). Increased awareness has led to raised and often unrealistic expectations. Therefore it is incumbentupon optometrists to become familiar with the different treatment options now available.

Retinoscopy is one of the core skills held by an optometrist and as an objective test proves invaluable in situations where communication is difficult or impossible, such as with children, individuals with special needs and non-verbal patients. In addition to measuring the optical power of the eye, the retinoscope can be used to detect opacities and structural abnormalities of the ocular media, including corneal and lenticular aberrations. This article describes how retinoscopy was used initially to detect an anomaly that warranted further investigation of a 6-year-old Caucasian boy. The anomaly was subsequently diagnosed as bilateral macular staphylomas, an outpouching of ocular tissue that can occur anywhere in the eye (Acers 1983, cited in Webber 1992).

Posterior cortical atrophy (PCA) is an early-onset dementia syndrome in which cortical degeneration leads to perceptual dysfunction. It is most commonly, although not exclusively, caused by Alzheimer's disease (AD). Unlike 'typical' amnestic AD, the histopathological burden (amyloid plaques and neurofibrillary tangles) is in the parietal and occipital lobes (Levine et al. 1993; Tang-Wai et al. 2004), causing brain shrinkage (atrophy) in these regions (Figure 1) and corresponding deficits in visuospatial and visuoperceptual processing (Lehmann et al. 2011), whilst episodic memory and insight are relatively preserved (Tang-Wai et al. 2004).PCA is often referred to as the visual variant of AD or biparietal AD.

Please note an error in question 4 was amended at 10am, 28 November. 'All screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost' (Gray et al. 2008). The routine recalling of people for sight tests has certain similarities to screening. This is because asymptomatic people are called by a healthcare professional to have an intervention, the aim of which is, partly, to ascertain their health. This is quite different from leaving people to have a sight test only when they have symptoms or concerns about their eyes. It is therefore important to consider whether this practice does more harm than good.

Prior to 2006, General Ophthalmic Service (GOS) arrangements in Scotland and England were similar. GOS eye examinations were not universally available and were only 'free' for those patients aged under 16 years of age; 19 years and under if in full-time education; 60 years or over; having a low income level; or if they qualified due to having certain conditions such as visual impairment, diabetes or a family history of glaucoma. Legislative requirements for the examination procedure were also the same across both countries and were defined by the Opticians Act (1989).

Charles Bonnet syndrome (CBS) is characterised by visual hallucinations in the presence of normal mental functioning in those with visual impairment. CBS is often undiagnosed due to lack of voluntary patient disclosure and limited clinician awareness. Eye care practitioners are ideally placed to screen for hallucinations. This paper outlines the demographics, clinical features, current theories of pathogenesis and management of this intriguing phenomenon. Simple strategies such as explanation, reassurance, advice and maximising vision are often all that is required. Individuals needing further help should be referred appropriately, as should those in whom another diagnosis is suspected.