oct ewj 24 online - Flipbook - Page 39
During the 1980’s, OO’s increasingly started to be
referred to as optometrists, and this became the new
protected title, nowadays anybody can call themselves
an optician.
Author
Richard Manns
I have been working as an optometrist across southern
England and Wales since 1975.
The duties of optometrists are hard to define; when I
qualified in 1975 I believed that it was obvious that the
scope of optometrists (or ophthalmic opticians as I was
then titled) would expand to taking over routine checks
on stable patients, and to the issuing of simple prescriptions for dry eye and eye infections. This is only
slowly and patchily coming in, almost fifty years later!
I opened my first practice in 1984, and eventually
owned, with my wife, 6 practices. As such I dealt with
many queries about optometry and ophthalmology.
We sold the last practices in 2016, and since then I
have worked as a locum, mainly as holiday and sickness cover for friends. I have been an adjudicator for
the Optical Consumer Complaints Service, the Association of Optical practitioners’ council, and have been
a member and chair of the Local Optical Committee.
The optometrist that most people meet will be
working in the high street. Their duty is to refract, that
is, find the correct prescription for glasses or contact
lenses to get the clearest vision for the patient at whatever distance the patient wants. Whilst doing this, they
are obliged to check the eyes for abnormalities and if
any are found, to refer the patient to secondary care,
usually a hospital, for further investigation.
I thus have dealt with refraction, glaucoma, cataracts,
retinal detachments, tumours of the eye, squints, orthoptics and trauma in patients in all age groups from
paediatric to geriatric.
During the last few years I have studied how optometry is performed in China, India, Vietnam, Peru, Sri
Lanka and Japan. I have done some charity work in
an orphanage in Darjeeling, India, and at present am
engaged in training Optical Clinical Officers in
Uganda so that they can refract.
Whereas refraction has stayed much the same now as
when I qualified, checking the eyes for disease has
changed massively. Checking the eye pressure has become the norm, with increasingly accurate non-invasive techniques. Because the regulations have not kept
up with the technology, any abnormalities seen on the
new Ocular Coherence Topographers (OCT’s) have
to be referred, resulting in more referrals to hospitals.
This causes bad feeling between the primary and secondary care systems. More bad feeling is generated
when hospitals do not reply to referrals. A few years
ago the NHS decided that optometrists could only get
paid for eye examinations at certain intervals, except
under certain conditions, so unless there are local
schemes, all flashes and floaters, or post cataract problems, or dry eyes, have to be referred to the hospital,
or treated privately, causing more bad feeling.
As a high street optometrist, I believe that I can
comment on the expected practice by a high street
optometrist more accurately than an ophthalmologist
or a hospital optometrist.
Tel: 01179 422 537
Professor Jonathan Pinkney
Jonathan Pinkney is Professor of Endocrinology and Diabetes at the Peninsula
Some optometrists work in hospitals, accepting lower
pay in return for the more interesting cases and the ophthalmologists’ acceptance of responsibility for the patient. I worked in a hospital briefly, but wanted to look
after my patient, and not be just part of a system, so I
have spent most of my working life in the high street.
Schools of Medicine and Dentistry and Honorary Consultant Physician in
Endocrinology and Diabetes at University Hospitals Plymouth NHS Trust. He
qualified from London University in 1985 and has held senior clinical and
academic appointments in Bristol, Liverpool and Plymouth.
Professor Pinkney has completed the Bond Solon Expert Witness training and he
holds the Cardiff University Bond Solon (CUBS) certificate. Professor Pinkney
undertakes the preparation of medicolegal reports relating to medical problems
associated with diabetes, obesity, endocrinology (hormones and metabolism), and
acute general medicine, in which fields he has many years of clinical experience
Some optometrists can be found in laser clinics, I have
a biased view of such clinics because I usually see the
patients where things have gone wrong.
and a wealth of expertise on all aspects of clinical management and the long term
consequences of diseases.
Specific areas of expertise and medicolegal interest within the field of diabetes
include the drug and other medical treatment of diabetes, the occurrence and long
term treatment and risks associated with complications of diabetes (vascular
Some optometrists practice ‘behavioural optometry’
or prescribe tinted glasses as a treatment for dyslexia.
In the absence of controlled experiments to prove that
such treatments work, I am reluctant to practice in
either of these ways, but I have seen some very
impressive results.
disease, retinopathy, nephropathy, neuropathy and diabetic foot problems), and
the risk factors for, and occurrence and management of hypoglycaemia,
hypoglycaemia and driving, and forensic aspects of hypoglycaemia.
Specific areas of interest and expertise in the field of obesity include causes of
weight gain, medical effects of weight gain, weight loss treatments including
bariatric surgery, medical side effects and complications of bariatric surgery, and
the impact of obesity and its treatment on long term health and mortality.
Specific areas of interest in endocrinology include diseases of the thyroid, adrenal
and pituitary glands, calcium and vitamin-D metabolism and reproductive
Increasingly, optometrists are prescribing contact
lenses to children for myopia control, once again, I
have seen some impressive results, but I am not sure
about the effect such treatment has once the child
reaches adulthood.
endocrinology.
General areas of medicolegal interest and previous experience within these
specific disease areas include the correct application of evidence-based clinical
practice to patient management, long term risks of complications, the risk of
treatment side effects, and life expectancy.
Mobile: 07884 376647
Email: Jonathan.Pinkney@plymouth.ac.uk
Luckily, a few areas of the NHS are accepting
prescriptions written by suitably qualified optometrists, I can only hope that this expands to the
rest of the country.
EXPERT WITNESS JOURNAL
BSc, MB BS, MD, FRCP.
Professor of Diabetes, Endocrinology and Obesity
Peninsula Schools of Medicine and Dentistry
University Hospitals Plymouth NHS Trust
University Medicine Level 7, Plymouth, PL6 8DH
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