Learning from patients and evidence

8 May 2019
Spring 2019

A message from the Clinical Editor, Kieran Loft MCOptom.

I would like to start by giving you an update about JD, the patient who featured in the case study in the Winter 2019 issue of Acuity (‘A reminder of the ocular effects of excessive alcohol and tobacco consumption’).

I’m pleased to report his recovery is sustained, as is his teetotalism. Visual acuity is stable (0.18 logMAR N5 BEO) and his colour vision has shown partial recovery on City test, with 2/10 plates normal, 3/10 plates protanomalous, and 5/10 plates deuteranomalous in the right eye, and 6/10 plates normal and 4/10 deuteranomalous in the left eye. 

Although he still has a degree of red-green colour vision defect, this is much improved, and subjectively he can see traffic lights again. Most impressively, he has found employment in the civil service, as a manager tackling homelessness and anti-social behaviour. In his words, he is keen to “pay it forward” for the support he has received. This inspiring turnaround is a lesson in itself: people in difficulty can, given the right motivation, treatment and support, become successful and contribute significantly to society again.

However, there is another lesson to learn from JD. Recently he required emergency surgery. When he told the doctor looking after him that he was recovering from alcoholism, the doctor started behaving very differently toward him. JD, understandably, took offence to this. He told the doctor that their demeanour was unacceptable and explained his recovery and new job role. Quite a serving of humble pie for the doctor, who promptly apologised. As healthcare professionals and, frankly, as people, it is important that we acknowledge our unconscious biases, and avoid judging others based on small snapshots of their history or personality.

In this issue of Acuity, we tackle some areas of practice that are constantly evolving – including modern management of dry eye disease. The vast number of ocular lubricants on the market is bound to cause confusion to the unfamiliar practitioner. Léa Surugue provides insight into the most recent developments and other treatments available for difficult cases of dry eye. Recalcitrant, symptomatic dry eye can significantly affect quality of life, so don’t ignore it; if you can’t treat in-house, refer. Many optometry practices now offer dry eye services and it is important to know your local providers and referral pathways.

Sometimes, the decision of how to treat a patient can be difficult. John Lawrenson explains his approach to writing the College’s Clinical Management Guidelines, in our interview. Using an evidence-based approach to practice can make these decisions easier, and ensures your patient is getting the best care.

Issue 4 completes our first year of Acuity. We look forward to receiving more comments, case studies and suggestions from members going forward into our second year.

People in difficulty can, given the right support, become successful and contribute to society again


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


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