College of Optometrists

This paper reviews the role of the optometrist in the medical management of glaucoma in light of the recently published National Institute for Health and Clinical Excellence (NICE) 2009 Guideline Diagnosis and Management of Chronic Open Angle Glaucoma and Ocular Hypertension. This Guideline is the first ever to include recommendations on service provision.

Articles: (1) The Conjunctival Response to Soft Contact Lens Wear: A Practical Guide (2) Medical Management of Chronic Open-angle Glaucoma (3) Vortex Keratopathy and Fabry Disease: A Case Series Highlightling the Role of the Optometrist (4) Ocular Genetics in Clinical Practice (5)Customer Service Leadership in Tough Times.

This article presents models of behaviour derived from the authors’ research, and explain how they drive a culture of customer service excellence, and strong business performance. The behaviours are as relevant to those in independent practice as to those who are leaders of teams within a multiple organisation.

In this review we discuss how both the ophthalmologist and optometrist are in a unique position to detect the presence of these initial ocular manifestations of a genetic disorder. A specific clinical and genetic diagnosis provides the patient and family with a framework for discussions on prognosis, treatment and the heritability of a condition.

This paper provides an overview of what is known about how the conjunctiva responds to soft contact lens wear, describing changes such as hyperaemia, staining, indentation, epithelial flaps, lid parallel conjunctival folds, papillary conjunctivitis and lid wiper epitheliopathy. In addition suggestions are offered on how to optimise the observation and grading of these changes, and, where appropriate, options for management.

Fabry is an inherited, life-threatening disease characterised by episodes of severe pain and irreversible organ failure. It is rare, with incidence ranging from 1:40 000 to 1:60 000 males. Several ocular signs have been described in Fabry disease: the most consistent is vortex keratopathy, which appears in up to 95% of male patients and 88% of females. These corneal changes present during childhood and have been reported in a 2-year-old boy. Eye care professionals are in the unique position of being able to detect ocular signs of the disease more than a decade before systemic symptoms are likely to lead to a diagnosis. End-organ damage may be limited with early ERT in appropriate patients diagnosed at this early stage.

Our understanding of the epidemiology of contact lens-related microbial keratitis has benefited from a number of large, welldesigned studies. These include the first studies in the late 1980s through to recent studies which examined silicone hydrogels and daily disposables. In this article the evidence is reviewed from this body of research and the most important findings are summarised for the benefit of optometrists who seek to provide evidence-based preventive care in their contact lens practice.

Understanding the elements of effective supervision will mean that supervisors can ensure that they give their trainees a solid grounding in the skills needed to begin unsupervised practice. Direct observation with focused feedback has been shown to have a positive effect on trainee development and patient outcome. The quality of the supervisory relationship has been identified as probably the most important factor for effective supervision. The other main factors are: • Direct observation and clear feedback • Structured supervision with regular timetabled meetings • Giving trainees an input into the supervisory process

Albinism is a relatively rare, often misunderstood condition. The plight of those living with albinism in Tanzania is a far cry from that of individuals affected in the UK. The complex classification and array of phenotype manifestations provide clinicians with a challenging diagnosis. The characteristic ocular features and defects associated with albinism are hurdles the practitioner must overcome in order to provide ocular comfort, and to maximise visual development. There is a pressing need for further research in albinism to develop evidence-based guidelines and to support practitioners and parents. Since the first investigation by St Hilaire (1832) (Kinnear et al. 1985, Oetting et al. 2003), our knowledge about albinism has increased markedly, but this review highlights key areas lacking explanation and insight.

Articles: Albinism: What the GOS Optometrist needs to know Clinical Decision Making for Optometrists in Management of Red Eye Epidemiology of Contact Lens-related Microbial Keratitis How to be an effective Supervisor Soft Contact Lenses for Irregular Cornea