Consider all options

30 April 2020
Spring 2020

Reflecting on practice in a time of pandemic.

First and foremost, I hope this edition of Acuity finds you and your family safe and well in the midst of this global health crisis. While only urgent care is currently being carried out in light of the COVID-19 pandemic, this gives us time to reflect on our practice and improve ourselves as clinicians in preparation to provide top-quality eye care when normal life resumes. 

Blindness from keratoconus is rare, but this doesn’t diminish the effect it can have. Most patients are young and eager to get on with their lives, but quality of life can be affected simply by receiving the diagnosis. Reliance on RGPs can cause discomfort, inconvenience and hypoxic complications from overwear. As the disease becomes more advanced, patients face the difficult decision of whether to undergo corneal transplant.

However, we are in a golden age of keratoconus management. Corneal cross-linking (CXL) means progression can be halted at an early stage, meaning that far fewer young patients with keratoconus today will need to make that choice. Not only that, many can maintain good vision in spectacles if treated at the first signs of progression. Early diagnosis is key to success. Today, optometrists must be very aware of the risk factors associated with keratoconus, and the early signs that may suggest it. Retinoscopy can be a very effective screening tool for keratoconus, and it is vital that optometrists do not lose this core skill. Consultant Ophthalmologist Damien Lake provides a timely review of CXL

COVID-19 gives us time to reflect on our practice and improve ourselves as clinicians

Another godsend for patients with keratoconus is the resurgence of scleral contact lenses. A scleral lens vaults the whole cornea, bathing it in a reservoir of fluid, protecting it from the outside world, resting stable and comfortable on the sclera. But they aren’t just for irregular corneae – dry eye, dusty environments, and high corneal astigmatism are just some examples of where scleral lenses come into their own. They’re easier to fit than you may think, and new materials mean the old concerns about reduced oxygen transmission are not such a problem as they once were. Adrian O’Dowd outlines why you might want to consider fitting them, regardless of what kind of practice you work in.

Of course, approaching any treatment with a patient, optical or otherwise, requires excellent communication skills. Empathy is essential to building a healthy dialogue. Even when we have these skills, patients are their own people when it comes to making a decision, and we need to be sensitive to their unique set of circumstances. Carina Bailey explores some of the psychological aspects of how decisions are made. Understanding these might help us to help our patients, which ultimately is what we all want to do.


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


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