tag:blogger.com,1999:blog-20645603942250729782024-02-07T02:19:40.126+00:00The life and times of an optometristRandom musings of a optometrist as I meander my way through life.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.comBlogger40125tag:blogger.com,1999:blog-2064560394225072978.post-20738002424628149752018-12-24T11:40:00.000+00:002018-12-24T12:08:31.395+00:00iCare trip to Negril, Jamaica, part 2So at the end of <a href="http://optometryiain.blogspot.com/2018/12/icare-trip-to-negril-jamaica-part-1.html" target="_blank">part 1</a> we had the clinic set up and we thought we were all set up and ready to go for the week, as a newbie how wrong were we?!<br />
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As refraction is the main part of what we do on a daily basis Heather and I started on team refraction with the aim of working out the best prescription we could for patients with the target of 20/40 (equivalent to 6/12 in UK which is the UK driving standards).<br />
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The patient journey started with crowd control and getting people into a queue then entering the church to be booked in and those at risk due to age or family history were seen at the nurses station for blood pressure and blood sugar check. Everyone then moved onto the vision station where their unaided vision, or vision with current glasses if applicable was tested using logMAR letters, numbers or tumbling Es depending on literacy and communication. After this they moved onto pre-testing where they had their interocular pressure measured, were dilated, and had auto-refraction to give us an idea of their prescription. The big station was triage where the patient had their eye health checked, retinoscopy to see if auto-refraction was right and a decision was made whether the patient needed refraction and prescription glasses, to see the doctors for a pathology check or if they just needed glasses for reading and sunglasses. (Everyone was given sunglasses to protect their eyes from the harmful UV of the Caribbean sun). The refraction station was next where a patient's prescription was checked and if needed we could also refer to pathology for a health check. The doctors in pathology were able to prescribe medication for glaucoma, refer for cataracts but also to send over to our laser team who were performing laser operations for glaucoma and diabetic retinopathy. After all this patients who needed prescription glasses were sent to the dispensary where the best glasses for the patient were found or made if needed.<br />
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For the first half of the week we also had a team who went out into local schools to screen children and refer to the main clinic later in the week. This team was made up of a couple of optometrists and a couple of students and at the end of the week we saw a few of the screened children coming through and helped them out.<br />
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Each day started with an early start with breakfast around 7:30 then meeting up with everyone at the buses at 8:00 for quick brief, making sure we had all equipment and drinks for the day then loading up onto the mini-buses for the 30 minute commute. Every morning we arrived at the clinic to find a queue of people which only seemed to increase as the day went on. Upon arrival we would organise drinks, move any tables and equipment needed, and in my case re-stick the tarpaulin covering the windows back up as it fell down every single day!<br />
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The doors opened at 9 and the queue would slowly start to filter through the stations which meant that it took about 30 minutes before I saw a patient but once they started they kept coming for pretty much the whole day. The patients varied between fairly normal hyperopic prescriptions on patients who could communicate well to patients with high prescriptions, often astigmatism, who struggled to understand the test and my accent. Astigmatism and hyperopia were definitely the trends of the week, rather than the myopes we tend to see in the UK. Lunch was cooked by a team of cooks from the other side of Jamaica who had been brought over specially for the week and you just tried to take a break in a slight lull when others from your section weren't at lunch. It was typical Jamaica fare of rice and beans, chicken and vegetables.<br />
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And then it was back to the grindstone of doing our best to help out as many patients as we could for the day and week. We closed the doors at around half 3 to 4 to allow the last patients to work their way through the system and be dispensed before we finished the day and had everything packed up for around 5 o'clock. And then it was back to the resort for around half five to six for a much needed cocktail and to enjoy the sunset.<br />
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The one exception was on Tuesday evening when we held a clinic for Sandals staff and we saw 65 staff within the 2 hours we had for the clinic, which was a great evening and a thank you to them for putting up with us all week.</div>
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In total our team of 49 volunteers served 2,682 patients in 5 days, performed 1944 vision exams in the clinic (not all had refraction) and 702 exams in local schools, 110 SLT laser surgeries (for glaucoma), 33 diabetic retinopathy PROP surgeries and distributed 739 pairs of prescription glasses (98 made in clinic) with 34 custom orders from the US. We distributed 1205 pairs of reading glasses and 2119 pairs of sunglasses. PHEW!</div>
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It was an amazing week and the two days of relaxation at the end were much needed before flying back to the UK and back to the routine day job. Seeing all the patients out there handicapped by simple visual problems that could be easily treated here in UK really showed how much we take our sight for granted and that there will almost always be a solution to any ocular problem we have via the NHS or private optometrists, and why it is so petty when people complain about the price of eye drops or a sight test (rant over).</div>
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Thank you to Great Shape Inc for organising the trip, Sandals for hosting us, everyone who donated to help us go and all our supporters. One love and bless up!Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com3tag:blogger.com,1999:blog-2064560394225072978.post-51824574643734255652018-12-08T18:45:00.000+00:002018-12-08T18:45:11.126+00:00iCare trip to Negril, Jamaica part 1At the end of October I flew out to Jamaica with a friend and colleague (Heather) as part of the iCare initiative run by <a href="https://greatshapeinc.org/" target="_blank">Great Shape Inc.</a>, an American charity that provides a variety of services to the people of the Caribbean including dentistry, teaching the teachers and eye care. The iCare initiative has been running for 9 years, this year was the 10th year. This year it ran two projects in Jamaica, and one in Turks and Caicos. I went to the second week in Jamaica which was based in the west of Jamaica in Negril.<br />
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After getting up very early, about 5:40, to get a 9:45 flight we were on our way to Miami for a few hours of wandering around shops and trying to buy stamps for postcards. For reference you can't buy stamps in American airports for some stupid reason! A few hours later we were on last short flight down to Montego Bay, and then another 90 minutes of transfer to the resort. By the time we got to the resort it was about 22:00 local time but felt like 4 in the morning to us! So it was quick check in, finding rooms, saying brief hello to room-mates for the week before passing out with exhaustion.<br />
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<tr><td class="tr-caption" style="text-align: center;">Bob Marley statue in Time Square</td></tr>
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Our first day in Jamaica was spent acclimatising to the weather, in Heather's case the gym, in my case getting a sneaky scuba dive in and trying to recover from the jet-lag. We then went for a walk down towards the town of Negril to do some souvenir shopping, pick up some post cards and get a feel for the area. The locals were really friendly although a little confused that we actually wanted to walk the couple of miles down to town rather than get a taxi. We caught a taxi back after a successful trip round Time Square, yes the mall (collection of 20 shops) is called Time Square, so we could watch the sunset. The sunset in Negril is truly stunning.<br />
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<tr><td class="tr-caption" style="text-align: center;">Sunset with a photobombing pelican</td></tr>
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Sunday morning started with a brisk walk down the beach to enjoy the weather before fighting off the birds at breakfast, they really are persistent, before heading across the road to start the induction for the week, meet everyone and be told how it was all going to work for the week. We also donated some toys which are currently being donated to kids around Jamaica as part of the <a href="https://sandalsfoundation.org/" target="_blank">Sandals Foundation</a> toy drive. In total there were 49 of us ranging from optometrists, student optometrists, ophthalmologists, dispensing opticians, student dispensers, lab technicians. nurses and retired engineers. Most were from various parts of the United States with a few Canadians and Heather and I as the sole British representatives. A lot of people were returners with some having done as many as 7 previous trips with iCare and a few had already done the mission to Ochi 2 weeks before.<br />
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<tr><td class="tr-caption" style="text-align: center;">The iCare Negril team</td></tr>
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<span style="text-align: center;">In the afternoon we headed down to Little London, where our clinic would be based for the week. Little London is a pleasant 30 minute drive from the resort, if you can cope with the randomness of Jamaican drivers. We were based in the Fellowship Church of God and it's neighbouring church hall. We spent the afternoon rearranging the church so there was a nice flow through all the different sections of booking in, nurses, visions, pre-tests, triage, refraction, pathology, laser, sunglasses and dispensing/lab in the church hall. As you can imagine doing all this lifting and moving in 28 degree heat was a little hot and sweaty so we were all grateful when we had finished and were able to go back to the resort to get changed and relax for the evening before bracing ourselves for the week to come.</span><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">The church being set-up</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6v3ZV6XJaSqHaQ09HGYejHeOOSZTtKxyg6KPmZaBvvdh5TGpJkQv1c-CtshV7nOlyhQVA_olFYF01GKYYlhWUjsaODKtmF-xHoTA0c3XFD1WYVCihj0cUDjVmeZdUs4PdbQUNK2bq4dVf/s1600/htol109--1541125406731.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto; text-align: center;"><img border="0" data-original-height="1201" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6v3ZV6XJaSqHaQ09HGYejHeOOSZTtKxyg6KPmZaBvvdh5TGpJkQv1c-CtshV7nOlyhQVA_olFYF01GKYYlhWUjsaODKtmF-xHoTA0c3XFD1WYVCihj0cUDjVmeZdUs4PdbQUNK2bq4dVf/s320/htol109--1541125406731.jpg" width="287" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Boxes and boxes of lenses</td></tr>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTeEd0EWHwQIDKePAqTdn-2T8M057r8d_mMnLTs_C_4MWo2TNzNoofAHfLml1JwIyAGvifBm4LQUoRzj0397zz3opKWcJQ-JArB7r9V7RxySa0WSCtmPOhsAchj7NybAsXRtN1jZtgwibG/s1600/htol109--1541125406367.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTeEd0EWHwQIDKePAqTdn-2T8M057r8d_mMnLTs_C_4MWo2TNzNoofAHfLml1JwIyAGvifBm4LQUoRzj0397zz3opKWcJQ-JArB7r9V7RxySa0WSCtmPOhsAchj7NybAsXRtN1jZtgwibG/s1600/htol109--1541125406367.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglba2y6_gBrY2zNyJ-HpQaIHMXyheDoUUnP4mrmoHr9jIA_SFHufvzSIrvJz_q7kCDNW0712PE8_-Pj6p_KIEhUdxrvcW5GYpcUWI7EFKAUjau0cdlY4dwT2xmg08PmL0kupLCVK1i288y/s1600/IMG_20181028_154734.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="904" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglba2y6_gBrY2zNyJ-HpQaIHMXyheDoUUnP4mrmoHr9jIA_SFHufvzSIrvJz_q7kCDNW0712PE8_-Pj6p_KIEhUdxrvcW5GYpcUWI7EFKAUjau0cdlY4dwT2xmg08PmL0kupLCVK1i288y/s320/IMG_20181028_154734.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The church (right) and church hall (left)</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAR3x6Q_qLIX_tw9LLAu_5OGq58h4SMabhWmm-_N9TDmqAZz1HpSFrHNqy-ZbuWejorOuiwI27zv9fkKCQ9RVMGhBdhyax3iPPV3KMkG3xp4R-zjBiPk8WSwSq4jUITNhWEF6_sErgdrY3/s1600/IMG_20181028_160618.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAR3x6Q_qLIX_tw9LLAu_5OGq58h4SMabhWmm-_N9TDmqAZz1HpSFrHNqy-ZbuWejorOuiwI27zv9fkKCQ9RVMGhBdhyax3iPPV3KMkG3xp4R-zjBiPk8WSwSq4jUITNhWEF6_sErgdrY3/s320/IMG_20181028_160618.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Phoropter ready to go</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUsxmrFRcic5DtnxWwudKpdhyphenhyphenwnAr5Mxpr5D0T7oQJnACfBbGIszRVpDJUtdchpXNZEGn_dhOyUF-2J_-1ge4oiY9IlWlVvYxIcKBIW_4o1RZ2_m_Qrwhqjj5UqQbNInvAHPKJkcokyhyphenhyphen2/s1600/IMG_20181031_091945-01.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="990" data-original-width="1600" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUsxmrFRcic5DtnxWwudKpdhyphenhyphenwnAr5Mxpr5D0T7oQJnACfBbGIszRVpDJUtdchpXNZEGn_dhOyUF-2J_-1ge4oiY9IlWlVvYxIcKBIW_4o1RZ2_m_Qrwhqjj5UqQbNInvAHPKJkcokyhyphenhyphen2/s320/IMG_20181031_091945-01.jpeg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Trial lenses</td></tr>
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Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-70877706237426361872018-06-12T19:00:00.000+01:002018-06-12T19:00:01.942+01:00PolyopiaMyopia is short sightedness, hyperopia is long sightedness and diplopia is double vision, so what is polyopia? Polyopia is seeing more than one image, typically more than two (otherwise would just be classified as diplopia). It can be ocular, ie caused by a problem in the eyes so problem can be partially resolved by closing one eye or cerebral, caused by problem in brain.<br />
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I saw a lovely lady, aged 44, earlier in the week who had cerebral polyopia after having a stroke 14 years ago. If you looked at her eyes there was nothing wrong with them, normal discs, healthy maculae, clear media, everything was as it should be. Retinsocopy showed a minimal prescription of +0.25/-0.50x180 RE and +0.50/-0.50x180 LE so nothing significant there either. However the patient's vision and VA were 6/120 right, left and binocular and that was at a push. The problem was as the patient described it "I can see 24 images, 12 from right eye, 12 from left eye and they are all moving". So the problem wasn't that the eyes couldn't see, it was that the patient was seeing multiple moving copies of the image and wasn't sure which one was real. So the real test wasn't what could I do to improve the patient's sight, it was what I could do to reduce all the dancing images.<br />
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As the vision was poor, conventional methods of binocular vision assessment such as Maddox rod, Mallett fixation disparity won't work so it was purely subjective as to what felt best for the patient. As the issue was cerebral it wasn't as simple as just trying prism in one eye and then splitting for cosmesis, I needed to do each eye separately, and with no guide it was just purely a case of putting prism in different directions and finding out if patient found it was better or worse. In the end we found that 9 prism dioptre base in RE and 4 prism dioptre base in LE seemed to pretty much stop the movement in both eyes, which patient was amazed by and really pleased with.<br />
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Next up was reading, with any low vision patient this is always a compromise between clarity and comfort for working distance. Starting with +4.00 add we found this wasn't enough magnification for what the patient wanted so we starting increasing it. At the end we found a +12.00 add worked best for the patient which then meant we needed to increase the prism to help with the eyes converge.<br />
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The final problem is frame selection and getting some lenses to look good, but in my store that's for the dispensing team so I took my leave and left patient with our dispensing optician.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-16346452593345554762018-05-31T19:00:00.000+01:002018-05-31T19:00:08.523+01:00Lightning strikes twiceAbout a year ago I saw a 59 year old gentleman for a routine sight test, in fact it was his first proper sight test. Unsurprisingly he needed a pair of glasses to help with close work, whilst his distance was pretty good - just a little bit of astigmatism in one eye. What was more remarkable was a longstanding retinal detachment in his right eye inferiorly, it had sealed pigmented edges and was out in periphery so wasn't affecting his vision or likely to but in need of a referral. So after checking what I was seeing was what I thought I was seeing with a colleague I called the on-call ophthalmologist at the local hospital eye casualty and arranged an appointment to check it in a few days.<br />
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Fast forward a year and the gentleman comes back in noticing a line like floater in his vision in the right eye, no shadow or cobweb over vision and no flashes. The referral from last test had resulted in a check and a lot of cancelled follow-ups but no treatment. Having a check undilated I noted a Weiss ring showing a posterior vitreous detachment but also a faint silver line temporally so dilation was definitely indicated (I'd have dilated even without this just to check periphery). After a brief wait (and seeing another patient in mean time) I called patient back in to have a look. Most of the periphery was flat and normal, previous scar present and unchanged and then the silver line was a horseshoe shaped tear in temporal peripheral retina. So it was onto the phone to chat with the on-call ophthalmologist and explain the situation before writing a letter and sending the patient on their way to the hospital, after answering the obligatory "is this serious?" question. Answer - where it is currently no, but if it spreads and your macula comes off then yes, very.<br />
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So my total for retinal tears/detachments moves onto 2 in almost 3 years of practice so I'm slightly ahead of the average 1 every 16 months, although not sure if 2 in the same eye of the same patient should count as 1 or 2. Either way proof that lightning can unfortunately strike twice.<br />
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(For reference having a retinal detachment in the eye does make you more likely to have another one in same eye and the other eye).Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-55375314477981881742018-05-09T19:30:00.000+01:002018-05-09T19:30:07.802+01:00Vision overseasIn the UK we are lucky enough to have a very good eye care system with a vast array of multiple and independent optometrists who offer private sight tests for a range of fees and NHS sight tests for those with entitlement, including under 16s, over 60s, certain income related benefits and those deemed to be at risk (or everyone in Scotland). There are enhanced optical services, chargeable in some parts of England, free in Wales and Scotland, for acute eye problems and further investigations to aid referrals to the hospital eye service. The NHS hospital eye service provides treatment free at point of use for all manner of eye conditions from routine procedures such as cataracts (although maybe not within correct timescale) to emergency appointments for uveitis, foreign bodies or papilloedema. There is also private hospital eye service for people with insurance providing extra cover for orthoptics, cataracts and other routine procedures. However the same is not the same worldwide, even in America you need insurance to cover the cost of the sight test and any prescription glasses you might need - myopes really have it tough; and that's another first world country, it's much worse in the developing world.<br />
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A few days ago I saw an article from the <a href="https://www.nytimes.com/2018/05/05/health/glasses-developing-world-global-health.html?smid=tw-nytimesworld&smtyp=cur" target="_blank">New York Times</a> (high brow I know) about eye care in the developing world, in particular India. This section really struck me:<br />
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<a class="css-k0qyxd" href="https://www.iapb.org/news/latest-global-blindness-vi-prevalence-figures-published-lancet/" style="background-color: white; border: 0px; color: #326891; font-family: nyt-imperial, georgia, "times new roman", times, serif; font-size: 17px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; text-size-adjust: 100%; vertical-align: baseline;" target="_blank" title="">More than a billion</a><span style="background-color: white; color: #333333; font-family: nyt-imperial, georgia, "times new roman", times, serif; font-size: 17px;"> people around the world need eyeglasses but don’t have them, </span><a class="css-k0qyxd" href="https://visionimpactinstitute.org/" style="background-color: white; border: 0px; color: #326891; font-family: nyt-imperial, georgia, "times new roman", times, serif; font-size: 17px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; text-size-adjust: 100%; vertical-align: baseline;" target="_blank" title="">researchers say</a><span style="background-color: white; color: #333333; font-family: nyt-imperial, georgia, "times new roman", times, serif; font-size: 17px;">, an affliction long overlooked on lists of public health priorities. </span><a class="css-k0qyxd" href="https://vii-production.s3.amazonaws.com/uploads/research_article/pdf/51356f5ddd57fa3f6b000001/VisionImpactInstitute-WhitePaper-Nov12.pdf" style="background-color: white; border: 0px; color: #326891; font-family: nyt-imperial, georgia, "times new roman", times, serif; font-size: 17px; font-stretch: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; line-height: inherit; margin: 0px; padding: 0px; text-size-adjust: 100%; vertical-align: baseline;" target="_blank" title="">Some estimates</a><span style="background-color: white; color: #333333; font-family: nyt-imperial, georgia, "times new roman", times, serif; font-size: 17px;"> put that figure closer to 2.5 billion people. They include thousands of nearsighted Nigerian truck drivers who strain to see pedestrians darting across the road and middle-aged coffee farmers in Bolivia whose inability to see objects up close makes it hard to spot ripe beans for harvest.</span></blockquote>
It seems such a simple thing but even according to the <a href="http://www.who.int/blindness/Vision2020_report.pdf" target="_blank">World Health Organisation</a> up to 75% of blindness in the world could have been avoided. 60% of the the cases of blindness in 1996 were due to either cataract or refractive error. This could be prevented or cured with a simple 30 minute operation or a pair of glasses but isn't due to lack of care or money.<br />
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Even before I qualified I wanted to help give back to the world with my new skills, helping patients in the UK is great but with the exception of some emergency health appointments you are rarely making a significant difference to someone's life that they wouldn't be able to get elsewhere. Some of friends have helped out in Moldova, Romania, Uganda and elsewhere. For me the Caribbean has always had a special place in my heart, after I got married in Jamaica in 2006. Whilst there is some eye care available in the bigger towns and cities, if you have insurance, there is very little in rural parts with only 2 public health eye care providers for every 500,000 Jamaicans and no public health optometrists. 43% of Jamaicans have never seen or been treated for eye health problems in their lifetime! Because of this I am volunteering to help with Great Shape Inc on their iCare initiative in Jamaica this October. I will be doing some fundraising later on and will do my best to keep you updated on progress and what happens when I'm over there.<br />
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Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-30039908573507106202018-04-30T19:19:00.000+01:002018-04-30T19:19:16.508+01:00Low visionBack with another random insight into patient's lives.<br />
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Visual impairment is a very subjective thing, I've seen people with best corrected VA of 6/12 (the legal driving standard) say their vision is fine, mostly non-drivers thankfully, and I've also seen people request referral for cataract, and be listed for surgery, with VA of 6/6+ in the affected eye because they feel they are getting glare and having problems whilst driving at night. I suppose it's all to do with how much of a problem their vision is causing them, which is why the cataract referral guidelines now make no link to VA and it's based on how the patient is being affected. I still try to put off patients with 6/6 VA, particularly if it's unaided, as they may well end up with worse vision after operation if the IOL isn't exactly the right prescription.<br />
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Low vision is also difficult to fully classify as some people don't want to admit that their sight is failing and using magnifiers is the last step to losing their independence. However just because you have low vision it doesn't mean you have to be downhearted, although there is an increased incidence of depression in patients with low vision.<br />
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A little while ago (read a few months as I haven't got round to writing this up) I had a patient in who had accepted his low vision and was thriving. Mr L, a gentleman in his mid 70s, came into the store and as he was being booked in the optical assistant asked how he felt his vision was with his glasses, to which the patient replied it was terrible. At this point the optical assistant was bracing herself for a rant about how we needed to do much better but the patient just commented that it wasn't any different from normal. The patient was then pretested and brought upstairs ready for the sight test. I quickly popped out of my room and grabbed the board to have a quick scan to see what the patient was like before calling them in, saw VA of 6/45 for both eyes from last sight test, and my heart sank. I was initially hoping it was a mistype for 6/4.5 but that would probably be a bit too much to expect for the average 70 year old (I have managed it at times). So I called Mr L in and started the test, it turned out that he had extensive dry AMD in one eye and had had wet AMD in the other eye but the treatment hadn't helped, just resulting with extensive macular scarring. This had happened about 10 years ago so patient had adapted to the poor vision, and whilst they couldn't drive or see much for close work they were confident getting around, albeit steadily. The test was more to just check there weren't any changes to the back of the eye, there weren't, rather than expecting any massive improvement in his vision. The actual refraction part of the sight test was relatively quick; retinoscopy will give a much better idea of prescription compared to subjective in this situation (especially when don't have a specialist low vision chart) then a quick subjective which surprisingly enough didn't reveal much of a change and certainly wasn't improving his vision in any substantial way so we left his spectacles as they are. Chatting with him after the test had finished I discovered he was registered severely sight impaired and had regular checks with the Welsh low vision service so had a range of magnifiers at home. He knew his vision was poor and that it wasn't going to get any better but was making the most of what he had and not letting it get him down.<br />
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So the moral of the story is just to make the most of what you've got, if you can improve it then take the opportunity.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-57645054279019624892017-08-28T19:00:00.000+01:002017-08-28T19:00:19.109+01:00Time fliesThanks to the joys of Facebook memories the anniversary of 2 major milestones happened this past few weeks - starting my pre-reg and passing my OSCEs and becoming fully qualified.<br />
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First up was 2 years since I started my pre-reg. Looking back at my records, confidence and test times it is easy to see that I have progressed a lot. When I started I was getting everything checked, wanted to dilate every older patient with smaller pupils, was making big unnecessary changes to prescriptions resulting in retests and remakes and taking up to an hour to test patients. It has taken a lot of practice, over 1000 patients during pre-reg alone and a lot of extra work outside of the store to keep knowledge up to date. In a timely reminder of when I started our new pre-reg has just started her optometry career after working with us for the last 2 summers on summer placements. It'll be interesting and exciting to see how she progresses and I will do my best to pass on knowledge from my experience and any tips on how to get through it.<br />
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(Edit due to delay in posting I've also had the memory that I'd had visit 1)<br />
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Secondly, and possibly more importantly, was the notification that I'd passed my OSCEs and was now fully qualified. I still remember not being able to sleep properly the night before and being awake well before the expected time of 9am for the results to be posted online. Thankfully they were up before then and I had passed. The other thing about that day was that I was off on holiday 2 days later, and so had to get all paperwork sorted and sent off to ensure it was all sorted by the time I got back. So whilst on holiday I was constantly checking my email for updates whether I had my GOC number and then getting my NHS number sorted before I got back so I could get straight back to testing upon return. Luckily mine all got sorted whilst I was away, and so unlike some friends in England waiting on Capita, I was able to carry on testing almost every patient without any problem.<br />
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Whilst I learnt a lot through pre-reg and it helped build my confidence in testing I know I still have an awful lot to learn. It is also not an experience I would want to repeat anytime soon. A lot of what is holding me back from quicker, more efficient testing is just having confidence in my own abilities and knowledge. That is one of my personal downsides that I need to keep working on but it's coming (slowly).Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-25837234529199582852017-07-23T17:25:00.001+01:002017-07-23T17:25:18.388+01:00An interesting cataract storyIt appears my posting on here is getting less and less frequent but that is mostly due to being busier and busier at work. However there is one story that I felt needs to be told.<br />
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Cataracts are clouding of the lens in your eye that sits just behind your pupil and enables you to change the focal length of your eye so you can see things close up and far away. Most commonly they are caused by age but can be congenital, brought on by diabetes or steroid use, electric shocks and trauma.<br />
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In this case Mrs A, a lady in her mid 40s came in for a routine check as she felt the vision in her left eye was getting worse and seemed blurrier than her right eye. Now initially I thought this might just be a slight difference in prescription but said it had been getting noticeably worse over the past couple of weeks. Finished off history and symptoms (one point of note but that's the spoiler) and moved onto checking visions - R 6/6 unaided L HM?! Ok so this was looking a little bit more than just a slight change in prescription. Cover test fine, pupils reacted normally but whilst looking at the pupil reactions got first clue as to what the problem was.<br />
So onto slit lamp examination, the right eye was fine, all looking healthy with no problems at all. Anterior segment of left eye, fine; onto the lens and there was a really dense cataract filling the entire lens. It was so dense that even with dilation I still couldn't get a view of the retina. Normally with that dense a cataract I would expect it to be congenital and patient to have no usable vision in that eye but the patient reported that had been fine previously (no previous record at the practice).<br />
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It's now time for the kicker - how it happened. The patient reported that a few weeks ago they had been boxing training and doing some pad work on uppercuts. The patient said they had thrown an uppercut but the pad had moved so instead of hitting a nice soft pad and stopping the punch continued and they had hit themself in the eye, which appeared to have caused a traumatic cataract to form over the space of past 3 weeks. Quite how they had failed to notice that vision was more than "a little blurry" I will never know.<br />
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Due to the history of trauma and the fact that I had no view of the retina I called the on-call ophthalmologist at the local hospital and described the situation. For normal cataract referrals we dilate and then send a letter to hospital and they are seen after a few weeks and placed on the list. For this patient I felt an assessment sooner rather than later was the best course of action and the ophthalmologist agreed to see them the following day at the eye casualty department. Unfortunately I haven't heard anything back from the hospital or patient to find out how they got on and what end result was.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-72287260717458325592016-11-04T20:08:00.001+00:002016-11-04T20:08:38.720+00:00Inter-linking disciplinesWhilst optometry and pharmacy have their rivalries at university; with the Cardiff Optometry/Pharmacy Varsity which pits the two courses against each other in a variety of sporting events. We also have our similarities; being public facing; analytical thinking; needing good communication skills and technical knowledge. However the biggest link between the two disciplines is that we are both involved in the primary health care sector; that is dealing with patients who present with particular problems, often of acute onset, and would like our specialist advice.<br />
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To this end it is good to foster good relationships with your local pharmacies so they know what you can supply or write signed orders for (the optometry version of a prescription). It also helps if they know a bit about the local minor eye care service (MECS) you can provide in England, or about the Eye Health Examination Wales (EHEW) which provides a similar service across all of Wales. This means that they can refer patients presenting with eye problems to you as a specialist part of primary care rather than sending them to their GP or to hospital, although this may be necessary in some cases.<br />
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As part of this for the past few weeks we have been having pharmacy students come into our practice and spend some time with us. During this time we explain the different parts of the eye care sector; dispensing opticians, optometrists, ophthalmologists, orthoptists and how we all work together to help patients. (Sorry to any contact lens opticians reading, you get lumped in with dispensing opticians I suppose). Whilst some have an idea of the different roles we all play, most have been surprised by how many roles there are and how they all come together. They sit in on a few sight tests to see how we explain ocular conditions and what side effects different medication can have on the eyes (few examples <a href="https://lapseofconcentration.wordpress.com/2016/04/07/common-medicines-1-painkillers/" target="_blank">here</a>). We also put them through the pre and post-screening we do routinely to help with their understanding of a routine test.<br />
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It's not just pharamacists that we, as optometrists, should be fostering better connections with; it's also GPs, the local hospital eye service particularly the on-call ophthalmologists who deal with everything we send from practice. This means that GPs can refer to the appropriate specialists and we can manage or refer appropriately. Feedback from all sides is important so we can all improve our knowledge and help patients better.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-55595311673632876232016-06-26T15:54:00.001+01:002016-06-26T15:54:05.900+01:00TimeAs I come towards the OSCEs I thought it fair to reflect on time. Time is a weird concept as Dr Who summed up:<br />
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Time comes up in several ways during pre-reg. Firstly the scheme for pre-reg is often a year, but can be extended up to 2 years depending on how the pre-registrant is getting on through the year. At first a year seems a very long time but to actually take the July OSCEs you need to have passed Stage 2 by early June, and if don't start to early August you're suddenly down to 10 months. Even when you start and you have that long it still seems relaxed until you get the date for your first assessment in 6-8 weeks. Whilst there are only 10 competencies in Visit 1 and it's more to get to know your assessor and see how you've been getting on, it is a nervous time. Then each successive visit is another 6 weeks and you're racing through the year. The trick is just to get your head down and get on with it all. If you're organised and have all your competencies planned then it's a lot easier to keep on track. </div>
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The next part is testing time, when I first started my pre-reg I was on 1 hour for testing, then often a gap to dispense the patient or to enable me to reflect on how the test had gone, also known as what the hell just happened. This long test is needed as you may be unfamiliar with the equipment; a little (or very) nervous; struggling to remember your routine; thinking about competencies; getting your supervisor to check everything and just generally being slow. When you're sitting in your introductory talks and you hear you will be expected to be testing to 30 minutes by the end of pre-reg, you laugh and feel very afraid. When you start and your supervisor tells you, you'll be testing to 30 minutes or so by the end, you feel even more afraid, especially if you watch an experienced optom test. However, slowly and surely you learn to smooth corners, become more efficient at Volk/retinoscopy/history and symptoms and you start to become quicker. Then just as you start to feel comfortable with a test time, you get 5 minutes lopped off your test time and the panic starts all over again. I'm currently on 35 minutes and will be staying at that until qualified but it feels okay and I can test most people within that time without rushing, although there are still some patients that take a bit longer that I need to work on. Having your testing time come down is a compliment (no, really), it shows your supervisor has confidence in you and your abilities.</div>
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The last part of time is your spare time, or more likely at times the lack of it. During pre-reg you not only have to concentrate on your tests, ensuring your records are up to scratch, filling in all the paperwork for the assessments and revise for your assessments; you also need to find time to relax and switch off. Pre-reg is a daunting year but it is even worse if you are trying to think about optometry 24/7 then burn-out is inevitable and you and your patients will suffer. Take time out to continue with your hobbies, see your friends, go out; maybe even have a holiday.<br />
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Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-1160997741958711622016-05-03T18:00:00.000+01:002016-05-03T18:00:33.580+01:00Communication difficultiesI was originally going to call this post "difficult patients" but then I realised that the patients weren't being difficult, they were doing their best to help given their circumstances. Difficult patients are ones that are being awkward by design, either not giving helpful answers, trying to pre-empt the question and second guess what you are trying to do; or malingering and trying to get glasses they don't actually need.<br />
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The first patient, Mrs D had come in complaining of loss of central vision so mistyping letters on her keyboard. This sounds like, and is to an extent, a case of <a href="http://optometryiain.blogspot.co.uk/2016/04/wet-amd.html" target="_blank">wet AMD</a>; however the twist is that the patient was a mute and so couldn't speak. Given that a large part of the sight test involves talking to the patient and them responding it does throw a large spanner into the works. However it doesn't mean that the test is impossible, you just need to think on your feet and be flexible in how you and the patient approach the routine. In the case of Mrs D she brought a wipe clean little white board and pen with her and a pre-typed note detailing the main problems she was having. Given this and the previous record, working out the likely cause of the problem was the easy part but getting more detail was needed. So given the resources it was a case of asking the patient to write down what they could see and relying on nodding or shaking of head if things were getting better or worse. With the situation I knew subjective wasn't going to be great so concentrated on history and getting a good look at the macula to check for problems. If it had been a normal sight test then it may not have been as easy.<br />
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The other tricky patients are those who don't fully understand you, either due to not speaking English very well, thankfully I haven't had any Welsh only speakers (not far enough into the valleys); or due to dementia. In these cases you often have to rely on a relative or carer to help with history and symptoms either by telling you the problem or acting as interpreter. Performing a full subjective routine can take a bit longer and it really depends on how much the patient can understand and, in the case of dementia, respond. You really just need to play it by ear and if you can't get a response, try a different method or just rely on objective measurements i.e. retinoscopy, although this is best done using previous prescription as a starting point to help with accuracy and time. However that doesn't mean that you can't help the patient, you still need to do your best to get an accurate result and recommend what you believe is best for the patient.<br />
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Mrs H was a patient I saw with quite advanced dementia a few weeks ago, reviewing her previous records (always a good start) I noticed that last time she had come in with a carer who didn't know much about her and the family weren't getting involved, and that we had dilated her due to fairly dense cataracts. Having seen this I admit to approaching the appointment with a fair element of dread, but had booked out next appointment in case I overran. When Mrs H arrived she had her son with her, which was good that he should know a bit more detail about her situation. Once in the test room it became clear that Mrs H couldn't hold a full conversation so whilst directing the questions to her, I was expecting (and getting) the answers from her son. It turned out she used glasses for watching TV and they had broken, hence the test; she couldn't read anymore so near vision wasn't an issue. Having established vision and current acuity as best I could with the broken glasses I moved onto ophthalmoscopy and walked straight into some pretty dense cataracts, so in went a drop of Tropicamide 1.0% to dilate the pupils. Whilst the pupils were dilating I put the previous prescription into a trial frame and moved onto retinoscopy; thinking back I could have done it without trial frame to make patient more comfortable but I always end up getting the axis wrong. After finding a small change I tried subjective using large steps and bracketing to refine it a little, but vision was still rather reduced. By this point Mrs H's pupils had dilated sufficiently for me to check there wasn't any other problem with the fundus, there wasn't and that the reduction in vision was just due to the cataracts. A quick double check with the ret and it was done. (I have found that if dilating it is always best to check ret at end as well, even if not changing prescription, just to see if you are in right ball park). I discussed my findings with her son, but he wasn't keen to proceed with the cataract surgery; which I understood, the lady was over 90, frail and would need a general anaesthetic - a very high risk patient. After documenting everything, including reasons why referral declined, I found someone to help with the dispense and briefed them on the patient's needs i.e. basic TV glasses and handed them over. All in all it only took a little longer than my normal testing time (the joys of being on 35 minute tests) and I felt quite happy (and relieved) with the results.<br />
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It is patients like these that force you to re-assess how you approach communication with patients, it doesn't just affect these types of patients, it follows through into all patients; or at least I am trying to let it follow through into all patients. Optometry is very much about communicating with patients, some are easier than others but the common factor throughout all patients is you (or me) - the optometrist.<br />
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<br />Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-64166299888317431002016-04-21T18:00:00.000+01:002016-04-21T18:00:00.517+01:00Wet AMDYes, I have finally returned to blogging after a long hiatus. Pre-reg is a busy year and it has been hard to balance work, study, trying to relax and writing this blog. The good news is that I have now passed Stage 2 of the year so it is coming to an end (at last). Just the OSCEs left in a few months, but that's a subject for another day.<br />
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This blog however is about a lovely lady Mrs D who came in to see me a few weeks ago. She had last been to the practice over 2 years ago when we had spotted she had some small haemorrhages from the blood vessels below the retina at the back of her eye and referred her off to the hospital to be treated. She came back in on a Saturday afternoon with no problems but wanted some new varifocals as current ones were a bit old and she felt vision wasn't as good as it had been. However she wasn't complaining of any of the typical wet AMD symptoms of loss of central vision or distortion. She was still under the hospital, having been seen 10 days before her sight test, although she had not had an injection on the last visit. To make things a bit more complicated she was amblyopic in her right eye, BCVA of 6/45, so her left eye was very important to her.<br />
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I had run through history and symptoms, no major problems reported and checked vision with current glasses, 6/120 with balance lens in right, 6/9 in the left. No major BV problems and given that she had IOLs in both eyes I was pretty confident that a lens opacity wasn't the problem. Being optomistic I expected a small refractive change and to send her on her way with a new set of varifocals. So I moved onto the slit lamp examination to check everything. Right eye was fine, some drusen at the macula but nothing too bad and no problems with the retina, so onto to the left. Anterior eye, fine; lens capsule, clear IOL with no posterior opacification; disc, healthy; macula... Hang on what have we here, a few small haemorrhages. The macula appeared flat but subjective showed a little hyperopic shift implying some oedema. After having my supervisor double check we agreed that she should be referred back to the HES to be seen as soon as possible so I filled in the referral form and faxed it over. However it was a Saturday so I wasn't expecting anything to be picked up and dealt with until Monday.<br />
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A few days later I had a phone call from one of the ophthalmic secretaries saying they had picked up the referral and wanted to know how soon I thought they should be seen. They were thinking of a few weeks, whilst I thought it should be sooner as existing patient, vision was reasonably unaffected at the time so a better chance of a good outcome and due to the poor vision in the other eye. After pushing back she was booked in for just over a week later.<br />
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Fast forward to last week and I see her name in my diary booked in to see me to check refraction before looking at new varifocals. She had been off to the clinic for another Lucentis injection and had noticed the improvement in her vision. I had a quick look at the fundus and although there were still lots of drusen (they aren't going to go) there was no sign of any haemorrhages. Refraction showed she had basically gone back to her old prescription. As she left the test room she thanked me for looking after her, and I advised her to return if anything felt a bit different or to call the HES to get appointment moved up.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-70233475029676286962015-12-19T15:12:00.001+00:002015-12-19T15:12:32.372+00:00LonelinessIt 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.<br />
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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.<br />
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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.<br />
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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.<br />
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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!Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-78789907886028975492015-10-29T18:00:00.000+00:002015-10-29T18:00:01.058+00:00Children's eye healthTesting 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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com2tag:blogger.com,1999:blog-2064560394225072978.post-509484119087341412015-10-04T13:00:00.000+01:002015-10-04T13:00:06.716+01:00Eye health weekSo last week was national eye health week which saw a blaze of promotion about the health of eyes from the College of Optometrists (<a href="http://www.visionmatters.org.uk/home/home" target="_blank">which you can read about here</a>). 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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-72217668827043829302015-09-01T10:39:00.002+01:002015-09-01T10:39:42.319+01:00One 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.<br />
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So what have I learnt?<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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<a href="https://lapseofconcentration.wordpress.com/">https://lapseofconcentration.wordpress.com/</a><br />
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<br />Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-43805799403660419852015-08-11T12:41:00.000+01:002015-08-11T12:41:13.750+01:00So it beginsAfter 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.<br />
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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 <a href="http://optometryiain.blogspot.co.uk/2015/03/bristol-eye-hospital.html" target="_blank">Bristol</a> 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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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...Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-25502244901394999102015-07-08T12:03:00.000+01:002015-07-08T12:03:50.262+01:00Photochromic clothesI'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.<br />
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So where am I going with this?<br />
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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.<br />
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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 <a href="https://www.kickstarter.com/projects/1451786608/photochromia-creating-a-future-where-garments-resp/description" target="_blank">kickstarter page</a> 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?</div>
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<br />Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-56940316450384340532015-07-02T17:39:00.000+01:002015-07-02T17:39:36.116+01:00I'm back - an updateWow, 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.<br />
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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.<br />
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<tr><td class="tr-caption" style="font-size: 12.8000001907349px;">Why don't you try a game that requires less skill? Like sleeping!</td></tr>
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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.<br />
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Right back to the eye related topics from next post.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-37474636427226332272015-03-31T12:51:00.002+01:002015-03-31T12:51:39.402+01:00Bristol eye hospitalHello once again,<br />
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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.<br />
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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!<br />
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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.<br />
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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).<br />
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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.</div>
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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.<br />
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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).<br />
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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.</div>
<br />Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-69345015930902012702015-02-22T12:25:00.000+00:002015-02-22T12:25:00.287+00:00Reclaim the Night marchThis 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.<br />
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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.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheonMhh7KbDscd2PF-zmzN-5Ggvp9VHvkYtJK7zbfMavtkS2CRfUJjn16hYuSGDWUK1pOIhjo-UnyBfB4EhI0pggdU5-xTv5xLuv1uTb3BrXotHY8C0yuCntxzQuwdnY5fE4Vxv_KOX_vb/s1600/DSC_4777.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheonMhh7KbDscd2PF-zmzN-5Ggvp9VHvkYtJK7zbfMavtkS2CRfUJjn16hYuSGDWUK1pOIhjo-UnyBfB4EhI0pggdU5-xTv5xLuv1uTb3BrXotHY8C0yuCntxzQuwdnY5fE4Vxv_KOX_vb/s1600/DSC_4777.JPG" height="320" width="180" /></a></div>
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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 <a href="http://www.vice.com/en_uk/read/dapper-laughs-banned-cardiff-university" target="_blank">here</a> and <a href="http://www.dailymail.co.uk/news/article-2814569/ITV-star-Dapper-Laughs-misogyny-row-students-demand-cancellation-university-gig-laddish-rape-jokes.html" target="_blank">here</a>). </div>
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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!</div>
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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.<br />
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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.<br />
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Rant over.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-24705455100210672782014-10-19T13:30:00.000+01:002014-10-19T13:30:00.852+01:00Three weeks into third yearIt's now three weeks into 3rd year and I've just about survived all my clinics without killing, hurting or mentally scarring my patients (I think I have anyway).<br />
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I'll start with the lectures, they've been challenging, interesting and scary at the same time. From the sheer amount of detail in abnormal ocular conditions to the real life knowledge of occupational optometry via the life changing low vision and special assessment. First year is all about bringing everyone up to the same level and getting people used to the university way of teaching whilst instilling basic principles and some background knowledge. Second year builds on this and you start to learn practical applications such as binocular vision and contact lenses. Third year is where it all comes together, it's all about applying principles in practice and smoothing out the rough edges in knowledge and patient interaction. It is knowledge gained in third year is what I will be using on a daily basis in my future career, assuming it actually goes into my brain.<br />
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Onto clinics, which are the main part of the third year, I've had 2 primary care patients, 1 contact lens patient, sat in on 3 special assessment clinics, done 2 dispenses and 1 collection. What have I learnt from all that? That at the moment I am nowhere near ready to see patients unsupervised or finish my degree. Have they really been that bad, probably not but they have certainly shown how much more I have to learn. The main problem has been me getting myself into a flap and not following a logical order with tests or allowing small little things to throw me and knocking my confidence for the rest of the test. Both my first contact lens and primary care were a bit of a fluster and whilst I recovered in primary care, I was still a mess at the end of my contact lens clinic. Thankfully I had a really nice patient who knew what they were doing for the teach but it still really annoyed me that I was such a mess. The plan, is to create a little crib sheet so that I have something to refer to if I lose the plot again. I don't intend to constantly refer to it, that would ruin the flow of the test but at least it gives me a fallback and hopefully writing it out will settle things in my mind better. The other main learning I have taken away from primary care is the need to refine my funduscopy technique with Volk style lenses, I should have plenty of time for that during my dissertation (more on that in a bit).<br />
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Special assessment has been the most challenging clinic but the most rewarding at the same time. I've seen three very different patients, a young child with Down's, a 44 year old with severe learning difficulties and a 14 year old who really didn't need to be in the special assessment clinic. The tests have shown just how much a simple eye test can vary based on the patient, from using glowing gloves as a fixation target for ophthalmoscopy to having music on to calm a patient down so you can test them.<br />
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Finally my dissertation: "<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Can an everyday mobile phone camera be used to image
the retina instead of an expensive commercial retinal camera?". This was my first choice based on my previous history with mobile phones and I'm really looking forward to the challenge and gaining the experience with Volk style lenses. I've got lots of ideas where to take this, possibly too many for the time and word count I have for the project but it's going to be fun.</span>Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-32416429880460312132014-09-28T12:38:00.001+01:002014-09-28T12:38:18.265+01:00Third year beginsSo after a busy summer of working various placements I do have an offer for a pre-reg position, a new weekend job and a slightly healthier bank balance even if I would have preferred to have a little more time to relax. Now however it is almost time for third year to begin.<br />
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Last week was Freshers week, my 7th in total, and I managed to survive (just) despite having a cold develop and being knackered the entire week. Wednesday especially I was walking round like a zombie for no real reason. The week was spent organising OPSOC and signing up members, new merchandise launches on Monday and then getting and trying to decipher my clinic timetable.<br />
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To be fair it's not that bad once you figure out the pattern and know which group you're in but just a bit scary the first time you see it. Overall mine isn't too bad apart from a few Thursdays towards the end of term when I go 9-6 straight with no breaks - it's going to hurt!<br />
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I am looking forward to starting back again, seeing real patients and learning more, although the first few weeks maybe a bit sketchy. The main thing I want to know is what I am going to write my dissertation on, get that in a week or two, as I actually want to start writing it mainly as I have a feeling the second semester is going to get hectic. I will probably not be saying this once I have the title and started it but that's life.Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-4870548182364241592014-08-08T20:09:00.001+01:002014-08-09T18:23:10.407+01:00It's not easy being greenToday I have been helping out as a victim, sorry volunteer, for a summer research project at Cardiff university. These projects are undertaken by students between second and third year to help gain an insight into research ready for third year projects and to see if a PhD or Masters would be something they would be interested in. The projects also help to keep Cardiff at the leading edge of eye based research that the school of Optometry and Vision Science is so renowned for.<br />
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Today I have been helping with a project funded by <a href="http://optometryiain.blogspot.co.uk/2014/03/coopervision-tour.html" target="_blank">Coopervision</a> being conducted by one of my friends comparing the effects of over the counter blepharitis treatment compared to baby shampoo. In particular it is looking at the effects of the scrubs on ocular comfort and staining. This has resulted in me having fluoroscein and lissamine green put into my eyes, leading to me having a fetching shade of green eyeshadow for most of the day.<br />
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Still it's a small price to pay to help for driving research forward.</div>
<br />Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0tag:blogger.com,1999:blog-2064560394225072978.post-50130224804573971432014-08-01T14:00:00.000+01:002014-08-01T14:00:00.288+01:00From blue to green<div dir="ltr" id="yui_3_16_0_1_1406841696056_1903" style="background-color: white; font-family: 'Helvetica Neue', 'Segoe UI', Helvetica, Arial, 'Lucida Grande', sans-serif; font-size: 12.727272033691406px; padding: 0px;">
So after 6 weeks at Boots in Swansea last week I started a 4 week placement at Specsavers to see how the two companies compare and which one I would prefer to do my pre-reg with if I am lucky enough to get offers.</div>
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<span style="font-size: 12.727272033691406px;">The first thing that struck me was the similarities in pre-tests and the handover coming out of the room, then the differences in offers - both lens types and the pricing. Learning all the lens types will be tricky and having done some dispensing with Boots I thought I would be good to go with Specsavers. WRONG! Single vision is fairly similar but the differing offers and types of varifocal mean there is still a lot to learn especially with the lab instore. I am actually looking forward to spending more time in the lab looking at how glasses are made and what the differing tolerances are which I feel is going to be a good start to third year.</span></div>
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So far I have been enjoying this placement just as much as my first in a different way. The staff are really friendly and have been nice enough to invite me out on the staff night out on Saturday and I've seen a lot more pathology, which has been good. I even managed to successfully diagnose a patient's sub-conjunctival haemorrhage this afternoon (I didn't tell patient but checked with optom afterwards and I was correct).</div>
Anonymoushttp://www.blogger.com/profile/13050441963146893034noreply@blogger.com0