James R Cox FBDO Locum Dispensing

18/05/2018

Love TD BESPOKE

17/01/2018

The new Optomap at Dominic Tunnell Opticians already proving it's worth.

Early success for the new Optomap at Dominic Tunnell Opticians.

Our patient came to us on Friday complaining of flashing lights. She had previously been seen at another opticians who had failed to find any cause.

We took an Optomap Ultra-Widefield Image which revealed a Horseshoe Tear in the periphery of her right eye. The picture of the eye below shows what can be seen with a traditional Fundus Camera and also the position of the retinal tear. This clearly shows the benefit of Ultra-Widefield Imaging over other forms of retinal viewing.

Our patient said “The photograph made all the difference” when attending Kidderminster Hospital as the Doctor there was also struggling to find the tear. She went on to say she was “really impressed by our customer care”.

Our patient has now had laser surgery to repair the tear and is expected to make a great recovery.

If you would like to know more about Ultra-Widefield Imaging or to book an appointment at Dominic Tunnell Opticians please call on 01905613020 or email on eyecare@tunnellvision.co.uk.

06/01/2018

I thought I would share this Ted Talk by Simon SInek. I first watched this about 3 years ago and it has stuck with me ever since.

Although the title is about How Great Leaders Inspire Action the big take away is about understanding your WHY.
As he says "people don't buy what you do they buy why you do it".

I think this is important for all of us to remember and to think about. Do we do what we do to make money or do we do what we do because we want to give people the very best eye health care possible? What I think is interesting is that you can often tell a persons why or a company's why from the way they interact with you. Once you know your WHY it will inform every interaction you have with your patients/customers.

"people don't buy what you do they buy why you do it". The trick is to find people that believe what you believe and they will find other people that believe what you believe and they will come to you to buy what you sell because they buy why you do it not what you sell.

Whats my WHY? I believe that every person has the right to be informed about the all the products available to help improve their vision and lifestyle. So if the best options are Zeiss Drivesafe 1.74n in milled aluminium frames but they could get by with CR39 SV in small plastics frames, then its my role to set out those options and everything in between, explain clearly the differences in performance and usability and price and allow them the choice. And I believe that no one is treated any differently because they chose a £69 complete price pair or a £1500 Buffalo Horn frame with X design Progs.

So please spare 20 minutes and watch Simon and really listen to the message and if it sticks with then think about your WHY and see how it changes your behaviours.

Simon Sinek has a simple but powerful model for inspirational leadership -- starting with a golden circle and the question "Why?" His examples include Apple, Martin Luther King, and the Wright brothers ...

05/01/2018

The Optos Daytona Optomap Wide Field Scanner. see the big picture.

25/08/2017

Great new range of frames in at Dominic Tunnell Opticians The independent optician in Worcester.

09/08/2017

This simple conversion opens up a whole new range of frames that will fit well and be comfortable for a whole host of people that otherwise would not be able to wear a fixed bridge frame.

05/05/2017

Strange feeling to have your letter printed in full. Hopefully we can get some real momentum behind this and we can make a change.

27/04/2017

Many of you may have seen the article regarding the petition in Optician magazine and also the letter regarding the evidence, or lack of, for regular sight tests for drivers.
Below is a copy of the response I have sent to Optician magazine. I don't know if it will be printed but there is some interesting stuff about legal standards and human behaviour.

Also Boots are back in the news, this time due to face a FTP panel over the assertions made for their Blue Protect Coating. Despite the way it was portrayed on Watchdog and some of the claims made there is some evidence that Blue Light may be harmful, some of that evidence is set out in my previous post.

Thank you for raising the profile of the petition I started linking the provision of Motor Insurance to Visual Standards. Unfortunately due to the General Election and subsequent dissolution of parliament all open petitions have been closed. It is my intention to restart the petition after the election, sadly none of the signatures already posted will transfer to the new petition so, if you have signed the original please go back and sign again.
In response to the letter from Colin Fowler on a similar subject.
With regards to the lack of data regarding visual acuity and a link to motor accidents, I would question whether the lack of evidence is due to there being no link or because the evidence is not being collected. The Visual Standards for Driving in Europe Consensus Paper published January 2017 states “ there is no requirement for vision to be measured by the police authorities at the time of a crash in most EU countries”. Having been involved in two non-fault motor accidents I can confirm that neither my or the other parties vision was checked post-accident.
I have met and worked with optometrists that would report a patient to the DVLA and also those that wouldn’t. The difficulty is knowing when to report given the grey area that exists around vision standards for driving and the fear of having to “be prepared to defend your decision”. For example;
Royal College of Ophthalmologists Guidelines Visual Standards for Driving
“Poor visual acuity is prescribed as a relevant disability for the purposes of Section 92 of the 1988 Road Traffic Act thus;
“the inability to read in good light ( with the aid of corrective lenses if necessary) a registration mark fixed to a motor vehicle and containing letter and figures 79.4mm high at a distance of 20.5 metres.”
This corresponds to a binocular visual acuity of approximately 6/10 on the Snellen chart.
The number plate standard is absolute in law and is not open to interpretation.”
So there is no absolute Snellen equivalent to the number plate test but the only test that counts in law is one that is open to many variables from outdoor light conditions to the background colour of the number plate itself. A study by BJL Burton and J Joseph (Changing visual standards in driving:but a high proportion of eye patients still drive illegally. 2002) when comparing the number plate test to the Snellen chart, stated;
“the use of a number plate is important since Snellen acuity is known to be a poor predictor of an individuals ability to meet the required standard for driving; this is probably because of differing symbol format, lighting levels, and other conditions involved”.
“unfortunately some number plates are easier to read than others and a “good light” is not defined in law so the test is not standardised”
Additionally Currie, Bhan, and Pepper writing in the BMJ, Reliability of Snellen charts for testing visual acuity for driving:propective study and postal questionnaire, found
“26% of patients with 6/9 vision failed the number plate test, and 34% with 6/12 vision passed it. Of the general practitioners advising patients with 6/9 vision, 76% said the patients could drive, 13% said they should not drive, and 11% were unsure. Of the general practitioners advising patients with 6/12 vision, 21% said the patients could drive, 54% said they should not drive, and 25% were unsure. The level of acuity at which optometrists, opticians and ophthalmologists would advise drivers against driving ranged from 6/9-2 (ability to read all except two letters on the 6/9 line of the Snellen chart) to less than 6/18.”
Given the wide discrepancy in when a practitioner feels someone should be reported and the lack of a standardised test it is no wonder a practitioner may fear having to “defend their decision” in front of FTP panel.
In 2014 BRAKE19 found “overwhelming agreement (87%) that drivers should be required to produce evidence of recent sight tests when renewing licences. Currently the renewal of a driving licence with a visual assessment requirement occurs between every ten years in Bulgaria, Estonia,, Hungary, Italy Latvia, Spain and Turkey to never in the UK, Austria, Belgium, Czech Republic and others”.
This means that in the UK, someone with 6/12 (50%) vision may pass the number plate test on the day of their test and never have a sight test for the remainder of their lives and still drive a car.
The same survey found that “46% of drivers who reported that they needed corrective glasses or contact lenses for driving, 12% admitted to driving without them in the past 12 months”.
I wonder if they would have driven without them if it was a requirement of their motor insurance as well as their licence.
In the same study by BRAKE19, “of the 54% who reported no need for corrective glasses or contact lenses for driving one in three (33%) reported that they had not had an eye test in the past two years”.
It also found “one in five (19%) drivers reported delaying visiting an optician after noticing problems with their vision”.
It is clear that we cannot rely in self reporting.
The final point raised was regarding who would pay for this. Holding a driving licence is a privilege not a right and as part of that privilege a driver has a duty to ensure that they are fully fit to drive. It is not unreasonable to have to pay maybe £40 (although as we know a test can be obtained for much less) every two years to ensure your ability to see clearly when driving. There are also other benefits to keep in mind from having regular sight tests, firstly the health benefits and early detection of many diseases. The possible improvement in every-day tasks from better vision but also the potential for a reduction in insurance costs. Better vision means earlier hazard perception. This in turn means earlier reactions leading to fewer accidents. Fewer accidents means lower risk for insurers and less risk means lower costs for drivers.

11/11/2016

I have posted an amended version of my bog post onto the facebook post.

10/11/2016

This week I was going to write about the Myopia Epidemic and Myopia Control but after last night’s on the I guess Blue Light may be a more pertinent topic.
So Watchdog went undercover in and Express and set about rubbishing claims about Blue Light Protection. It is probably fair to suggest that neither company did themselves any favours based on what was said by their employees. It was selling by fear. There was misinformation, lies and scaremongering. It showed a lack of understanding on the part of the employees and possibly a pressure to sell the product to hit a target to maximise profit.
That is clearly unethical, the role of a Dispensing Optician is to advise the patient based on need, whether that is prescription, work requirements, hobbies, or lifestyle factors. That brings me on to the fact that the staff pictured at Boots, except for one person, appeared to be Customer Advisors, not Dispensing Opticians. One person appeared to be wearing the DO uniform and we are not aware if they are qualified or not, however if they are qualified they need some intense retraining.
Watchdog however are guilty of unfairly portraying Dispensing Opticians as unethical snake oil merchants by repeatedly using the label DO when showing someone who appeared to be an unqualified advisor. The BBC should make clear the qualifications of the people pictured and if they are not DO’s they should apologise and make clear the level of knowledge and understanding required to be a dispensing optician and should a patient want to ensure they are getting the best advice based on their need and not a company profit margin then they should request to see a Qualified Dispensing Optician.
But what about the facts of what was said?
Watchdog claimed that there was no evidence for harm from Blue Light emitted by LED/LCD bulbs or screens and that there was no evidence that Blue Light filtering lenses provided any benefit.
A study in 2004 (found at this link) http://www.sciencedirect.com/science/article/pii/S1350946204000412
By T.H Margraina, , , M Boultona, J Marshallb, D.H Slineyc
“ Studies of human macular pigment density and the risk of AMD progression following cataract surgery lend further weight to the hypothesis that blue light exposure has a role in the pathogenesis of AMD but the epidemiological evidence is equivocal. On balance the evidences suggests but does not yet confirm that blue light is a risk factor for AMD. Given the socio-economic impact of this disease and urgent need to identify modifiable risk factors, future work should include a large-scale clinical trial to evaluate the effect of blue blocking filters on AMD progression rates.”
So more work needs to be done but we cannot discount Blue Light as a potential risk factor.
Up until the late 20th century the only Blue Light Exposure that humans had was from the sun. We woke to it, worked through it and slept when it set. AMD was not really known until more recently and its increase in prevalence has coincided with an increased longevity and the introduction of artificial blue light sources. That may be causation or it may be coincidence, we simply do not know.
What we do know, though is that the body appears to have a natural defence against a blue light damage. At the central fovea the body produces a yellow pigment called Meso Zeaxanthin. Meso Zeaxanthin is synthesised by the body from Lutein and Zeaxanthin and is only found in the one unique place in the body, at the fovea. So what does it do?
“ There is a growing and evidence-based consensus that MP is important for optimal visual performance, because of its blue light-filtering properties and consequential attenuation of chromatic aberration, veiling luminance, and blue haze. It has also been hypothesised that MP may protect against age-related macular degeneration because of the same optical properties and also because of the antioxidant capacity of the three macular carotenoids. “
J M Nolan1, K Meagher1, S Kashani1 and S Beatty1 2013

Meso Zeaxanthin appears to be the bodie’s natural defence against blue light damage and also works as an anti-oxidant to remove free radicals and protect against AMD. On its own it may well have been enough to protect against retinal cell damage when the only source of harmful blue light was from the sun. But today we have blue light emitted from smartphones, laptop screens, TV’s, energy saving light bulbs, xenon discharge bulbs. Our exposure to blue light is greater than our ancestors and combined with increased lifespans could well be attributable to increasing levels of AMD. Meso Zeaxanthin is destroyed daily and replaced by our bodies. In order to do this we need to ensure we obtain sufficient levels of the beta carotenoids to synthesise Meso Zeaxanthin. Unfortunately modern western diets are not great for this hence we also suggest supplements such as Thea Nutrof or Macushield (and others) to help replenish our beta carotenoids.
In a modern world with poor diets, increased screen time, and longer lives should we not be offering every option to help protect our patients sight?
Blue light filters may not be proved to work to prevent retinal cell death but it cannot be doing harm. In conjunction with other measures it may help to reduce incidences or AMD. The important thing is to be clear with our patients. Just yesterday I had a patient who was interested in Blue Light Filter Lenses for work as she was a VDU user. However after discussion I explained that I doubted they would be of use as she would only be using with the VDU. Had she been wearing them all day then she would have had reduced levels of blue light exposure from all sources and she may therefore have benefited from the potential protection offered.
The jury will be out on Blue Light filters for a while after last night’s programme but personally I see no harm and a potential benefit as long as it’s discussed appropriately.

Age-related macular degeneration (AMD) is a major health problem in the developed world accounting for approximately half of all blind registrations. Current treatment options are unsuitable for the majority of patients and therefore the identification of modifiable risk factors that may inform dise...

31/10/2016

Thought for the day.
According to Brake road accidents caused by poor driver vision are estimated to cause 2900 casualties and cost £33 million in the UK per year.
As opticians we regularly see people who barely meet the driving standard or do not meet it and are driving without vision correction either because they are unaware they do not meet the legal standard or because they feel they don't need the help.
I have often thought that the visual driving standard is remarkably low to be uncorrected and that self referral for an eye examination is a very trusting method to ensure drivers will meet that standard. Again self referral to the DVLA to advise that sight correction is needed is also likely to result in drivers not reporting the need due to the fear of losing their licence.
So what if your car insurance was linked to the eye examination and the driver eyesight standards?
If when renewing your car insurance you were required to provide a copy of your up to date prescription with uncorrected visions and corrected VA's stated. If Spectacles were required to meet the standard it was stated that spectacles had been purchased and that, as on the continent, you had to have a spare pair in the car would this help reduce the number of vision related accidents on the roads?
Personally it seems to me logical, the majority of people would not drive without insurance though many drive unaware that they would not meet the legal driving standard. If you could only get your car insurance by having a sight test and confirming that spectacles, if required, are purchased then that has to be a win for everyone.
Firstly the roads should be safer with fewer poorly sighted drivers.
Secondly there should be fewer vision related accidents.
Thirdly as a result insurance payouts should reduce leading to lower insurance premiums.
Fourthly regular eye examinations can lead to early detection of many other health problems and early detection means early interventions and better outcomes.
What are your thoughts?