Here are some articles and books we have found for you to assist you in your studies:

• New British Standard for Mounted Spectacles Optician 2009 (Ronal Rabbetts): DOWNLOAD
• Rx spectacle lens standards: Do we have what we need? Optician 20122 (Colin Fowler): DOWNLOAD
• Safety & Protective Eyewear (ABDO): DOWNLOAD
• Occupational Optometry (Carson): Link here to ABDO Bookshop (excellent book – worth purchasing – Jane)
• The ultraviolet confusion unravelled Optician (Rabbetts & Taylor) DOWNLOAD
• European Standards and Markings for Eye and Face Protection: DOWNLOAD
• Simple Dispensing (CET Article, Optometry Today (Duncan Counter): DOWNLOAD
• Complex Lens Dispesning (CET Article, Optometry Today) Andrew Keirl, Richard Paye) DOWNLOAD

STUDENTS DISPENSING READING LISTS (College of Optometrists) 

• Bennett, A.G. 1968 Ophthalmic Lenses Vol.1. Hatton Press. [OP]
• British Standards Institution 1997 BS EN 1836: Sun glasses and Sun glare filters.
• British Standards Institution 1989 BS 2738: Part 1: Tolerances on optical properties of mounted spectacle lenses.
• British Standard Institution 1991 BS EN 150 2738: Part 3: Presentation of Prescriptions.
• British Standard Institution 1997 BS EN 150 10322-1: Single-vision and multifarcal lens blanks.
• British Standard Institution 1997 BS EN 150 10322-2: Progressive power lens blanks.
• British Standard Institution 1997 BS EN 150 8980-1: Single-vision and multiforcal lenses.
• British Standard Institution 1997 BS EN 150 8980-2: Progressive power lenses.
• British Standard Institution 1997 BS EN 150 14889: Uncut finished lenses.
• British Standards Institution 1997 BS 8624: Measuring System for Spectacle Frames.
• British Standards Institution 1998 BS EN 150 12 870: Spectacle Frames-General Requirements.
• British Standards Institution 1997 BS EN 150 9456: Making of spectacle frames.
• British Standards Institution 1991/1994 BS 7394 Part 1 & 2: Complete Spectacles.
• British Standards Institution BS 3521 Parts 1,2,3: Glossary of Terms Relating to Ophthalmic Lenses and Specta- cle Frames.
• British Standards Institution 1994 BS EN 166, 167, 168: Personal Eye Protection.
• British Standards Institution 1985 BS 3062: BSS for Lens Material.
• Griffiths, A.I. 1994 Practical Dispensing. Association of British Dispensing Opticians.
• Jalie, M. 1984 (4th ed.) Principles of Ophthalmic Lenses. Association of British Dispensing Opticians. [£41.50]
• Jalie, M. & Wray, L. 1990 (3rd ed.) Practical Ophthalmic Lenses. Association of British Dispensing Opticians. [£49]
• Obstfeld, H. 1997 Spectacle Frames and their Dispensing. W.B.Saunders. [£55] Jalie, M. 1999 Ophthalmic Lenses and Dispensing. Butterworth-Heinemann [£55 with CDRom]

The proper interaction of the eyes under normal circumstances gives rise to Binocular Single Vision (BSV), however there are numerous conditions which can lead to a breakdown of the BV system.  The object of BV assessment is to establish the presence and severity of BV anomaly and then decide on the course of action should intervention be required.  The management plan should take into account such factors as the duration since onset of symptoms, the presence of an incomitant deviation and the potential risk of the anomaly to the development of the BV system

If you refer to the patient episode sheets you will note that  you are expected to have seen at least one patient with diplopia, one with symptomatic heterophoria and one with amblyopia.  Use these records to demonstrate evidence of your experience.

Best Form Evidence

Accurate history establishing the presence and duration of symptoms arising due to BV anomaly

Ability to assimilate test results in order to formulate a diagnosis of the BV anomaly

Logical management plan based on duration of any symptoms, test results and other risk factor

Understanding of management options available both within optometric practice and following referral to the Hospital Eye Service

Unacceptable Evidence

Inappropriate referral or treatment based on symptoms, signs and risk factors

Failure to identify patients who require treatment or onward referral due to their BV anomaly

What to study

Types of and indications for optical and non-optical methods of treatment of heterophoria and heterotropia

Causes of incomitant heterotropia and indications for referral based on symptoms and test results

Milestones in infant vision development

Examples of BV conditions that may require urgent referral

Limitations and relative merits of each type of optical and non-optical treatment, e.g. prisms vs. orthoptic exercises in convergence insufficiency

Pass/Fail criteria

Logical management decision based on presenting symptoms and test results

Knowledge of the range and basis of optical and non-optical treatment options and their indications

Understanding of alternative treatment options in the event that the chosen management plan is unsuccessful

Read more here

Last year saw the original nine categories receive nearly 6,000 individual votes online, while the Awards page on the OT website, www.optometry.co.uk/awards, gained more than 28,000 page hits from April to December 2011. The votes and web hits show the wonderful support that all the nominees received from readers and are a true testament to their hard work and dedication.

“It has made me realise what I do is so very worthwhile” Supplier Award 2011 winner, Josie Barlow, Ultravision

Read the rest of the article here: 

This competency does what it says on the tin.  To pass this the Assessor needs to witness via a variety of methods that an accurate, relevant history can be taken and recorded from a number of patients with history of different eye conditions.

Best Form Evidence

Most Assessors will witness one full routine during the first assessment, so the primary method of assessment will be Direct Observation of accurate history taking, on a patient.  It is prudent therefore to try and engineer a patient with some “history” or this competency may not be ticked off via this method of evidence.

As with all competencies one piece of evidence is not enough, so an Assessor will probably also look at and discuss a selection of Patient Records, the Logbook and possibly conduct a case scenario or role play.

Note: the competency states “accurate history” so if there is “no history” then the competency cannot be signed off.

Note: the competency states “range of optometric conditions”.  Therefore one patient episode alone will not achieve this competency. The Assessor will then need to observe supplementary forms of evidence to achieve sign off.  The easiest ways are by looking at patient records or by the Assessor creating a case scenario for a fictitious patient maybe in a “role-play” style.  They may provide an “incorrect” record to criticise.

When taking an accurate history, the trainee should remember to cover all relevant history.  If a positive (or sometimes negative!) response is attained then the trainee must consider the need to follow-up with further appropriate questions.

Points to cover include:

Previous eye exam

When, where, any dispense (incl C.L)

Contact Lenses

When, where, how long, current type, previous types, modality, compliance,                    solutions, last aftercare

Any previous/current spectacles

Type, tasks worn for, any adaptation

Condition, age

Any previous visits to doctor/HES/orthoptist

Why, when, treatment received, outcome

Ongoing, next visit, last visit

Any history as a child (if not covered in question above)

Note: Family history is a separate competency that has some overlap with this one.

The Assessor will look for appropriate questioning, sensible structured list of open/closed/leading questions and appropriate follow up.

As the competency clearly states “range of optometric conditions” so the Assessor will expect evidence from a “range of conditions” e.g. with orthoptic history, previous laser surgery, corneal infection, spectacles etc

An example from a record may look like this:

LEE 12/12 Hogwarts branch (records requested), has worn DV specs only since 8 years old, full time. Current gls 12/12, good condition. No C/L wear.

Hairbrush in right eye 24/12 ago, went to Gryffindor HES, given bandage contact lens for 2/52 with antibiotics, then discharged, not aware of any probs. No other problems as adult or child.

Unacceptable Evidence

Reasons for failing this competency basically revolve around not asking any history, enough history or following up history. Or not writing it down!

History: why did the College implement the move?

The College introduced the OSCE’s, or Objective Structured Clinical Examinations a few years back as a forward move to a system of pre-registration examinations that were seen to be less biased, impartial and non-discriminatory.

Like many significant changes in any organisation, these changes were met with some degree of resistance. However, the College recruited a large team of experienced examiners who were set the task of creating the content of each station, and were therefore heavily involved in the development of the new exam system. The knowledge and experience gained from years of cumulative examiner experience ensured that the outcome of each station had a single purpose: to ensure that the trainee would be ‘safe to practise.’ So these exams are less of the radical change than was originally expected and are rather an onward development of the old system. In summary: similar content, different method, fairer system.

Love them or hate them, and we all have our opinions, they are here to stay. But the OSCE’s are not a new concept by any means and neither have the College reinvented the wheel when redesigning them. OSCEs have been around for some time and what the College has done is to closely look and study OSCE’s already in place with allied health professions such as medicine, and have adapted them for optometry.

The term objective in this setting means that the exams are designed to move away from subjective vivas. There is almost no examiner interaction and each examiner is there to ensure that you complete the test in a safe and orderly manner before marking the station when you exit. Therefore there is no need to work on your interaction with the examiner or worry what they are going to ask you. However, what this does mean is that you must focus on your interaction with the patient instead.

Preparation

Trainees may take confidence in the fact that they have already come so far in their training year. In achieving the Stage 2 pass, trainees have been assessed in all core competencies by experienced assessors. So the OSCEs are, if you like, a check test to validate those results.

The most commonly asked question trainees ask is ‘where do I start?’ Whilst almost anything may be examined in the OSCE’s, there is no point going back to the beginning. You can’t possibly cover it all. And neither should you need to.

First of all, these exams are clinical based, it says so in the title. So if you have to have a focus at all, be it on the practical. There are four key areas of focus that I would recommend you cover, all of which contain significant pass/fail criteria:

1. Investigation

2. Interpretation

3. Management

4. Communication

Investigation:

This is where you may be asked to demonstrate a technique. Here the examiner will mark you on how well you use the equipment, how you communicate with the patient, and how you explain the test.

Example – use of an Amsler Chart

You may be asked to use this technique on a patient. But before you pick up the chart take a step back and think. What should you do first?

• Check if the patient requires a near correction.
  • Ask them to wear it.
• What working distance should you hold the chart?
  • Is there a tape measure?
  • If so, use it.
• Which chart is the most appropriate to use for the presenting complaint (there are several)
  • Select the correct one.
• What lighting should you use?
  • Is there a lamp on the table?
  • If so, use it.
• How do you explain the test to the patient?

The way you set up and perform a test will give the examiner a great deal of information on whether or not you understand the purpose of that test. So look at all of the equipment that is there.

Selective Attention and the Invisible Gorilla

Candidates who are so focused on one thing may miss the obvious. This is called selective attention. A well known experiment, available to watch on You Tube illustrates this beautifully (simply Google: ‘selective attention test’). You are asked to watch a short film of two teams of three basketball players. One team are wearing white and the other team are wearing black. Each team has a ball and are throwing it to each other whilst they all intermingle. You are asked to count how many passes the white team make to each other. The viewer will focus so closely on the white team that nine times out of ten, they will not see the man in a gorilla suit walking into the room, waving and then walking out again. Highly amusing a worth a look. But then transpose this to the OSCE cubicle.

Myself and a colleague set up a cubicle to ‘test’ this theory. Students were asked to select the most appropriate Amsler chart for the presenting condition and perform the technique accurately. Everything they needed was on the table, including a tape measure, which is critical to set the correct working distance of the test plates. However, not one person used the tape measure. And yet the test requires that a working distances accurately measured and each student had been taught this. Each student was so focused on choosing the correct Amsler plate that they failed to actually see the tape measure. Even when the tape measure was placed on top of the book of Amsler plates, they simply moved it out of the way. So, take a look at everything in the room. Try to see the whole picture. Whilst we can try to design stations without an invisible gorilla, there are some that we cannot avoid.

Interpretation: methodical and logical

Some stations may ask you to look at the data presented, and perhaps make a judgement call. For example, you may be asked to interpret a prescription, make an order or communicate the data to a patient. When you are presented with a page of information work through it logically, there may be red herrings, additional information that may not be relevant. But that is the same for most patients sitting in your consulting room chair. For example if you are given a fundus photograph don’t go straight for the obvious lesion in the centre, do what you would normally do when performing fundoscopy. Start at the disc, work your way our along the vessels etc. Did you see the melanoma in the far periphery? Another invisible gorilla just waiting to be overlooked.

Management

Here you may be asked to communicate the management of the presenting condition to a patient. For example, you are asked to interpret the data given and manage the patient accordingly, by communicating this information to the patient and successfully addressing their fears or anxieties. Of course it does mean that you must make the correct judgement call on your referral. Consider the following when you are making a referral: Who? When? Why? Where? How? Wherever possible put a specific time to your referral. ‘Soon’ is too vague. The examiner wants to hear you give the patient a more specific timeframe, such as ‘same day.’ When I tell my children they are going to the swimming pool ‘soon,’ this could be in twenty minutes time, or it could be some time next week. Everyone’s interpretation of ‘soon’ is quite different. That said, we rarely get to the pool in time.

Communication

Your techniques, your methods and how you present yourself when talking to patients is critical. It says a lot about you and your understanding of their condition, and your abilities. Not surprisingly then Communication has a significant weighting in these exams. However, if you ultimately miss a diagnosis, no matter how ‘communicative’ you are (and some of you are very effective) you will fail the station. After all, if you inappropriately refer, you are not ‘safe’ to practise. So work consistently on the patient journey and their experience. You need to be able to communicate effectively, appropriately and accurately. Focus on how you ask questions, how you develop your questions in line with the patient’s responses and ensure that you are able to extract every last relevant detail from the patient.

Who are the patients?

In the past the College used real patients for the exams. For example there was always a diabetic fundus, someone with a longstanding palsy and someone with cupped discs. But to ensure a fair an equal system then all trainees should have seen the same patient at each exam centre and clearly this is not feasible. Furthermore, these patients were notoriously hard to come by. So such days are also gone. And I must say I am glad too. In the past I have spent hours on end trying to secure appropriate patients for exams and courses with minimal success. So what we do now is to have trained actors. It may sound an unrealistic concept but for the purpose of these exams it works well, and is extremely effective. It is not who you see here but it is the scenario that the actor is given to act out that is important and this adds to the consistency of these exams. So if you think your spied your motility patient in the last episode of Dr Who, the chances are you are probably correct. Where an actor is used you can rest assured that they have been given enough detail to be able to act out their role. The actor will then respond to you in the manner that they have been asked. For example, they may have been asked to play a patient that is nervous about going to hospital. So don’t treat this like an artificial situation that it probably is. Just talk to them in the same manner you would if they had visited your own practice.

The killer station: is there or isn’t there?

Well, if the exams are to remain objective then no, there is not. There is no one single station that you must pass, or all is lost. However, in each station there will be similar pass/fail criteria year on year. Are you safe to practise? This has, and always will be the ‘killer’ for want of a better word, because if you are not safe then you cannot be allowed to practise. And I think that we can all agree with that one. Referral criteria is not something you can find in a book, and comes primarily from your experience in practice, so in conclusion whilst preparing for these exams:

1. Focus on continuing to consolidate your practical skills

2. Focus upon your ability to interpret data in a quick and methodical fashion

3. Focus on your referral criteria and the patient journey

4. Focus upon your communication skills

And don’t forget to look for the man in the Gorilla suit. There is one at every exam centre, just asking to be overlooked. Good luck!

Jane Macnaughton MCOptom

Booking Now: A Trip to the OSCE’s: CLEARVIEW Training’s Mock Exam Course for OSCE Preparation.

Lucentis costs about £700 an injection, and Avastin £60 – but Avastin is not officially approved for eye conditions.

Novartis, which markets Lucentis in the UK, is taking legal action against four NHS trusts for using the cheaper drug.

The company says the use of Avastin – developed to treat cancer – is undermining patient safety.

Read more if this story here from the BBC Health website

Articles will be available for GOC registered Optometrists and Dispensing Opticians, Contact Lens Opticians and Independent Prescribers and will be in different formats including Text based and VRICS quizzes.  All answers may be submitted online and points are uploaded at the end of every month (if you are in a hurry then tickle our tail fins and we can see what we can do to help…)

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