Something old, something new

Sometimes, progress is made not by inventing something new, but by looking at something that’s been around for a long time in a new way, says Kieran Loft.

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Blood pressure has been measured non-invasively using fairly accurate sphygmomanometers since 1881 (Booth, 1977), and hypertension is a well-known risk factor for many serious diseases, such as heart attack and stroke, as well as ocular disease, including retinal vein occlusion. Yet more than 5.5 million people have undiagnosed hypertension (British Heart Foundation (BHF), 2018). Compare this with the “mere” 300,000 with undiagnosed glaucoma (International Glaucoma Association, 2019) who we, as optometrists, worry about on a daily basis. We carry out optic disc assessment, visual fields, intraocular pressure measurements, and sometimes disc OCTs to try and identify the 2% of over-40s (NICE, 2017) who have glaucoma. Of course, this is very important work, but perhaps we could add in a quick blood pressure test to help identify the 24% of the population (BHF, 2018) who have hypertension? Léa Surugue addresses the public health services optometrists can provide, with insights into how “healthy living optical practices” have been piloted in Dudley, and Laura Edwards’ interesting research into optometrists offering stand-alone eye health checks in unusual settings.

As well as innovative ways to look at old subjects, sometimes we need to overhaul our outlook on something we think we know well. Coloured lenses “for dyslexia” are controversial in optometry. However, the current literature suggests that we should think of coloured lenses and overlays as a treatment for visual stress, not a treatment for dyslexia, and that other investigations are vital before turning to these therapies. Treating visual stress may aid someone who has concurrent dyslexia, but specialist teaching and other provisions will be required to treat the dyslexia itself. Adrian O’Dowd explores this.

Both of these articles highlight the need for optometrists to undertake specialist training to further their practice in areas outside the core competencies. It is essential that optometrists maintain their knowledge via CET and CPD, especially in expert fields. As new technologies such as widefield imaging, fundus autofluorescence and of course OCT become widely available, it is possible that suitably trained optometrists may even become more involved in monitoring ocular cancers in the community. Carina Bailey talks to some of the country’s leading ocular cancer specialists about just this, and provides a valuable insight into the services provided by the few highly specialist ocular oncology centres here in the UK.

As we explore these interesting aspects of clinical practice that optometrists can develop, I think it’s important to remember to acknowledge our own limitations. Always work within your sphere of competence and if in doubt seek a second opinion, via referral if necessary – remember, even consultant ophthalmologists do this.  



Kieran RG Loft MSc BSc (Hons) MCOptom DipTp (IP)

British Heart Foundation. (2018) High blood pressure: how can we do better? (accessed 20 December 2019).

Booth J. (1977) A short history of blood pressure measurement. Proceedings of the Royal Society of Medicine 70(11): 793-9.

IGA. (2019) Prevalence. (accessed 20 December 2019).

NICE. (2017) Glaucoma: diagnosis and management. (accessed 20 December 2019).


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