Saturday, 19 December 2015


It is often said that pre-reg is the loneliest time of an optoms career. It may seem weird when you are testing up to 10 patients a day plus talking to optical assistants and the rest of your team. However these are only 45 minute conversations about the same thing and although every effort is made to get to know the patient it is not a deep and meaningful.

What "they" are really talking about is the loneliness you feel being apart from the friends you have spent most of the last 3 years studying with, going out with and in many cases living with. Now you face working full time, studying when not in work, the stress of visits, working with different people and often living away from home. I'm slightly lucky in that I am living in the same house I did throughout my course and am working in store I did summer placement and worked part time in so I know everyone there and don't have to worry about living in a strange and different place.

It's not all doom and gloom though, your team in store will soon become like a second family and can help you find all those tricky patients you need for competencies and can sit as mock patients for visits. If you're really good some may even let you fit them with RGPs. With the rise of modern communication it is relatively easy to stay in contact with your course mates via whatsapp, facebook, facetime, phone, email, skype etc. I would thoroughly recommend setting up a chat with your closest friends so you can stay in contact, swap tips and generally just let off steam.

The other time for a good catch up is on various courses either run by the various multiples or recently by the College of Optometrists. Not only do these courses give you a great chance to learn a whole host of useful information, network with people from other universities, other stores, they are also a great time to sit down and have a chat with people you haven't seen for some time.

This is not intended as a depressing post, more just highlighting that you should make the most of time with friends at uni and to keep in contact with them throughout pre-reg for academic support and to try to keep you at the same level of sanity, whether that is completely sensible or totally loony!

Thursday, 29 October 2015

Children's eye health

Testing children can be a fun, exciting and at times frustrating experience. However it is one of the few occasions, other than emergencies, when you can make a real difference to an individuals sight and life. The reason for this is that children under the age of 8 or so (although some papers argue up to 12) are still in the plastic period where they can form new connections in the brain. This means that if a child has poor vision in one or both eyes, correcting it can mean extra connections in the brain and the child having equal vision.

At times the best option is to just prescribe glasses for full time wear . Fully correcting a child's refractive error can often stop a child developing amblyopia (a lazy eye) and can correct some types of squint. If the optometrist is monitoring the child then the child may well be recalled frequently to check their vision and how they are getting on with their glasses.

In other cases the optometrist may have to put drops into the eyes to dilate pupils and allow the eye muscles to relax. These drops do sting (quite a bit) so we suddenly become very unpopular after we have put the first drop in. However it does allow us to get the full prescription and can make all the difference between monitoring in practice with glasses or referring to be treated under the hospital eye service where drops are put in on almost every visit. Children are usually referred to the hospital if the vision stays uneven between the eyes or if there is a turn that they may be able to treat.

However it is not all doom, gloom, horrible patches and stinging eye drops. Correct a child's sight and they will be grateful and at times you can really make a difference to both their future and their now.

I tested a 4 year old whose mother had a lazy eye and was worried about her son developing a similar problem because of how it had affected her. Initial investigation showed a moderately high hypermetropic prescription which put the child at risk of developing a lazy eye or a turn, this meant we had to put drops in. I went from being quite nice to being horrible in one fell swoop as far as the child was concerned. After the drops had taken effect a bit more plus came out for overall refractive error of about +9.00 with -2.00 cyls. However after he had had time to adapt to wearing the trial frame he grew to appreciate the clarity he was seeing with compared to the without, so by the time he had chosen his glasses he was happy and I got a high five on the way out! I didn't get a chance to do the collection sadly but I can only hope it was similar to the viral video of Piper, the 10 month old.

Sunday, 4 October 2015

Eye health week

So last week was national eye health week which saw a blaze of promotion about the health of eyes from the College of Optometrists (which you can read about here). However an eye test doesn't just check the health of the eyes and prescription; it can also indicate a number of general health conditions and eyesight can have a profound impact on people's daily lives.

Take for example Mrs A who I saw a few weeks ago. She had previously been referred for cataracts 6 months ago, but had recently been told that there was still another 12 months or so to wait before she could have the operation. Although her vision was still reasonably good (6/9ish) she was having terrible trouble with glare and had recently had a couple of falls. To young, healthy people this may not seem that serious but to an elderly lady it can have a profound effect on their mobility, confidence and health with hip fractures having a 30 day mortality rate of over 9%. As it is up to the hospital who they see and when, we couldn't promise that she would be moved up the list but wrote a letter to the hospital explaining the effect it was having on her life.

As the eye is the an extension of the brain and has some fine (and relatively easily visible) blood vessels, it can highlight a lot of systemic conditions. For example a small haemorrhage in the retina may be an early indicator of high blood pressure or diabetes, so in the cases I have seen one I have referred them off to the GP to have their blood pressure and blood glucose checked.

Just because a condition is controlled with medication it doesn't mean it won't cause any problems. Unfortunately medication used to control systemic conditions can also cause problems. Steroids for example are used as anti-inflammatories in conditions such as ezcema or asthma, but long term use can lead to early development of cataracts. It can be a delicate balance between controlling a condition and the ocular side effects. Vigabatrin is used to treat epilepsy to control seizures, however it can cause irreversible visual field loss. Therefore patients on Vigabatrin need to have frequent visual field screening to ensure they don't develop any field defects.

An eye test is not just a simple cause of determining whether someone needs glasses it is also a chance to examine how a patient's eyes are affecting their life and how the patient's life is affecting their eyes.

Tuesday, 1 September 2015

One month in...

I have now been a pre-reg for 4 weeks and so far I have managed to survive. I'm not going to lie and say it has all been plain sailing, there have been a few times already when I've wanted to curl up into a little ball and have a breakdown but with a bit of help from supervisors, other staff and friends I've made it through.

So what have I learnt?

1. I am fine with normal patients; routine sight tests even on older patients are relatively straightforward. This is a good thing as it will be my bread and butter going forward. I have managed some in 35 minutes which I was quite proud of. Older patients are taking me a bit longer but that is mainly due to wanting to be sure of health check.

2. When things go wrong or aren't quite what I expect then it tends to throw me. Sometimes I can recover within my appointment time and get it sorted, sometimes it does throw me for a little while and it takes a chat with my supervisors to talk me down.

3. Visit 1 wasn't as bad as I feared. It took some effort to get the competencies sorted, and I have one rolled over to visit 2 and that was only due to my record not being detailed enough on the print out. I know it's a cliche but pre-reg is a lot easier if you are organised. Have a look through your paperwork regularly with your supervisor and ask them for tips.

4. Most patients are nice. If you explain to them that you are still learning, the test may take a bit longer and you will get things checked then the vast majority are happy to give consent for records to be used and that they will have a thorough test.It also helps if when the patient is booked in with you if they are made aware of the situation so that you don't get the ones that need to be in and out of the test room within 20 minutes.

5. Keep your optical assistants and shop floor staff on your side. They are the ones who are booking most of your appointments so they can do some screening for you. They are also the people who may sit as test subjects for visit 1, for remembering how to do contact tonometry and trialling RGP lenses. If you can, give them a list of the types of patients you need to see (in plain English, not optom speak) and that should mean competencies are easier to come by.

I would like to thank Michelle for her support (and link). Michelle is a newly qualified optometrist working in Scotland who also blogged through her pre-reg year, lots of useful tips and interesting patient episodes can be found on her blog.

Tuesday, 11 August 2015

So it begins

After 3 years of studying, clinics, practicals, exams and a dissertation that was interesting but tiring, the time has come to step into the real world and enter the world of pre-reg.

The scheme for pre-registration (or pre-reg for short) is what optometry students have to go through before they are allowed to practice on their own unsupervised. The scheme consists of a series of visits during which 75 competencies need to be ticked off with observations on sight tests, contact lens fits and aftercares. A trip to see the hospital eye service similar to the visit to Bristol eye hospital in the third year is also required (if working in practice) along with at least 350 sight tests and 250 dispenses. At the end of it comes the dreaded OSCEs - a station exam with 1 minute to read the instructions and 5 minutes to perform the allotted task, rinse and repeat 17 times.

Before all that though, you have to start with your first patient. Now most people start with testing friends or members of staff who are nice, simple and let you find your feet. Not in my case, my first patient was a very nice 70+ gentleman with diabetes, a list of medication as long as your arm and the type of cataracts you hate as an optom. Still with a bit of faffing around; a combination of  trying to remember how to do a sight test and using a new system to record it all we got through it. The end result was a small change in prescription but as the cataracts were so dense, he was right on the driving limit, we called him back in for a dilation and referral later in the week. Eye health was all fine so he's been added to the queue for cataract extraction.

The next couple of patients were relatively normal, then the last patient had some pigmentary changes at the macula so was given an Amsler grid as a precaution to keep checking for distortion. However, as with all patient led checking you do have to wonder how much the patient will follow the instructions.

The rest of the week has been a mix of normal sight tests, with a higher percentage of diabetics than the general population, with a couple of double appointments where kind people have booked me a contact lens aftercare/fit in with the sight test. I'm sure I'll learn how to do those efficiently but it wasn't what I wanted in my first week. Words will be had with my colleagues on the shop floor if that continues, although I do need them on my side to help with the competencies and sit as guinea pigs for my visits - so the words might not be that stern.

Friday was a bit more relaxed as due to having hearcare in the store there wasn't a room for me to test in. This meant my supervisors had a couple of extra patients to fit in and I got to make a start on my dispensing numbers. Even with a calmer day I was still tired at the end of the week, it's been 3 years since I worked full time and my body has forgotten how hard it can be to get up every day and go to work.

Despite all the struggles I have made it through week 1. However with pre-reg there is no such thing as a fully relaxing day off; studying needs to be done, competencies need to be organised, CET needs to be earned and the list goes on...

Wednesday, 8 July 2015

Photochromic clothes

I'm sure you've all heard of photochromic lenses before, the ones that change colour as you move from inside to outside. They may be called reactions, transitions, photochromatic, reactolite or any other name but they're all the same thing essentially. Built into the lens is a substance that reacts to UV light which then causes the lens to darken - the exact mechanism depends on the manufacturer and lens material.

So where am I going with this?

The answer is photochromic clothes. A company called Photochromia have developed a way of inserting photochromic materials into ink used to print onto hats, T-shirts and trousers so now your clothes can change colour when you go outside. Unlike Global Hypercolour (anyone remember that from the 90s) which reacted to heat, therefore showing where and how much you were sweating (ew!) these clothes will react to UV light.

Whilst the designs may not be to everyone's tastes I think some of them are quite funky, especially the idea behind Schrodinger's cat, and it is an interesting use of the technology, it's definitely a whole new take on the term wearable technology. You can read more about it and buy the clothes via their kickstarter page which has reached its target so the clothes will be made. Who knows what designs other companies will come up with and where it will go from here?

Thursday, 2 July 2015

I'm back - an update

Wow, didn't realise it had been that long since I had written an update. It's been a busy 3 months mainly full of revision, revision, more revision and then exams, exams and more exams. However at the end of it all I have finished my 3 years of studying at Cardiff with a 2:1 in optometry and am looking forward to graduating in mid-July.

After finishing all the exams and the obligatory nights out to celebrate, it was time to relax and make the most of the little time I had left with my friends before they scattered to the winds (well South England). So after a quick trip back to Bath and a few rounds of adventure golf it was time to bid everyone fair well, with the stinging words of the sassy Deku tree ringing in my ears.

Why don't you try a game that requires less skill? Like sleeping!

After that, rather than just sit around moping or doing something sensible like relaxing in the sunshine I decided I was going to learn basic level Japanese on an intensive course. I've been interested in Japanese for a while and did a taster session with the Student's Union a few months back and love the culture. Rather than taking the straightforward choice of doing the course in my busy evenings, I took the opportunity to make the most of my last few days of studentship and do the course with the university. It was hard work but good fun so I doubled down and did stage 2 of the beginners course the week after. I'm glad I did it, now just need to keep the knowledge and understanding up and growing.

Right back to the eye related topics from next post.

Tuesday, 31 March 2015

Bristol eye hospital

Hello once again,

After handing in my dissertation a week ago - freedom! Last week it was my turn to head off to Bristol Eye hospital to have a look at what happens when we refer a patient and how they are managed under the hospital eye service.

Of course this means having to get up rather early to get to the hospital for 9 am, leaving Cardiff at 7:30 am. I hate early mornings!

The first morning I was in optometry, which for the most part consisted of refraction with a bit of slit lamp funduscopy. Some features of our typical routine seem to go out the window, so no history and symptoms (or fairly minimal), no binocular vision, no motility etc. I suppose a lot of those have been done elsewhere or before so will only be done if needed. In this clinic I got the chance to see some keratoconic patients and see just how the condition affects their vision, recurrent erosion syndrome and an endothelial graft after Fuch's endothelial dystrophy. It was good to see some of these rarer conditions and to see the type of patients that are managed under the hospital.

The afternoon was spent in surgery. After dressing up in some very attractive raspberry scrubs and stylish orange crocs, it was time to go and watch some operations. The first two were fairly simple cataract phacoemulsifications and IOL insertions or in simple terms cataract removal. The last operation was a little bit trickier, the removal of an IOL that had become opacified, so needed to be removed and replaced. This was really interesting to watch to see how the surgeon adapted the procedure. The first two were good to watch to better understand what we would be referred patients with cataracts would undergo, the final operation was just intriguing. You can see what is involved in a cataract operation on the video below (not if you're slightly squeamish).

After another early start on Tuesday, it was a trip to outpatients - in particular medical retina. This clinic featured patients who were being monitored for follow up after treatment at the hospital, but also an inpatient who the doctor had seen earlier in the day. These patients had often been referred from the diabetic screening service (a must for any diabetic patient), but also included branch and central retinal vein occlusions, uveitis and adult vitelliform dystrophy.

The afternoon was spent in a shared care clinic focusing on glaucoma, although neither of the patients we saw in our time there had glaucoma. Instead they had ocular hypertension and were borderline, hence why they were being monitored under the hospital.

The final morning saw a trip to casualty, as an observer not as a patient. This was split into two parts, one watching the optometrist in the eye casualty, the other in the triage station with the nurses. Before we saw any patients I had a chat with the optom and learnt how they got into hospital placement (via independent prescriber is the answer). Then it got interesting - a patient with a large patch of their corneal epithelium missing after being poked in the eye by their 14 month old son, suspected uveitis and then a retinal detachment complete with tobacco dust. With the nurses I got to see how they triage patients; check vision, quick slit lamp exam and what they are able to do - remove small foreign bodies, give out drugs, refer to different departments as necessary. Patient wise I saw some interesting cases, 5 corneal ulcers on same eye (!), a foreign body due to a granule from an exfoliating facewash and chemosis (which looks worse than it is).

Overall I really enjoyed my time at the hospital (despite the early starts) and it's made me think a little more about what I want to do after I qualify. I would like to thank all the staff at the hospital for putting up with all us students asking stupid questions and getting in the way and the patients for letting us have a look at their eyes despite some serious conditions.

Sunday, 22 February 2015

Reclaim the Night march

This is a slight departure from my normal, irregular ramblings in that it isn't directly about optometry, rather it's about something I got up to this last week and feel strongly about.

Reclaim the night is a series of marches in various cities to highlight the issue of violence against women and how they don't feel safe walking the streets at night (and at times during the day). The movement started in the 1970's in response to police telling women to stay off the streets as the Yorkshire ripper was still at large. Since those days the rape conviction rate has remained extremely low, with only 1070 convictions in 2013/2014 despite 12,000 men and 85,000 women being raped.

While I may not be able to stop people being raped in person, I can help highlight the issue and do my best to help cut down the prevailing "lad" culture. This makes some men foolishly think that it is okay to grope, harass, cat-call and intimidate women all in the name of "banter". This is no better exemplified by Dapper Laughs who was due to perform at Cardiff University Students Union on Friday before a successful campaign to stop him performing at the Union by one of the guest speakers (you can read more about that here and here). 

Women shouldn't have to be afraid to walk the streets at night for fear of attack. They shouldn't have to put up with being groped in night clubs, they shouldn't be afraid to say no to men and they shouldn't be blamed if a man attacks them. Alcohol, what they are wearing, where they are - nothing is an excuse for a man to attack a woman EVER!

Because of this I took part in the Reclaim the Night Wales march held in Cardiff last Friday. The event was organised by NUS Wales and included students from Cardiff University, other universities and the rest of Wales. After making banners we walked round Cardiff city centre making a lot of noise and drawing a lot of attention to highlight the issue as much as possible. This was followed some very brave and thought provoking speeches back at Y Plas.

I am proud to identify as a feminist and commit to doing my best to raise awareness of the issues that women face and trying to stamp out sexist behaviours whenever I encounter them.

Rant over.