Suits you, Sir! Employment options for today's optometrists

The face of optometric practice has changed perceptively during the past few decades. On top of the traditional High Street independent practice, a new breed of employment opportunities has emerged to entice optometrists. From laser surgery clinics to one-stop health centres and supermarkets, the choice is seemingly endless. So what motivates optometrists when choosing the right practice environment for them? OT spoke to some pre-registration and newly qualified optometrists to find out why they took the path they did

World-class eye care at London 2012

Dr Penny D'Ath and Professor David Thomson, from City University, London, were involved in the organisation of a team of practitioners who provided eye care at the Olympic and Paralympic Games. Here they reflect on their experienc

A Case of Dementia and Cataract in the UK

An elderly patient with Alzheimer’s disease had deteriorated with increasing confusion and clumsiness being attributed in part to visual deterioration. A right cataract extraction operation was performed and was successful despite the patient moving considerably during phacoemulsification due to lack of understanding. On examination, the operation appeared to be a success. However, unfortunately the patient’s symptoms were not improved. In the UK, decisions regarding eligibility of patients for surgery are judged on a case by case basis. This case has been fully anonymised in accordance with the BMJ guidelines which are considered to be the gold standard in the UK as it was impossible for capacity reasons to gain any meaningful informed consent from the patient. In addition, approval was sought and granted from City, University of London Research and Ethics Committee to publish this report

A Case of Sixth Cranial Nerve Palsy and Suspected Giant Cell Arteritis

Sudden onset of horizontal diplopia in an elderly patient can be due to giant cell arteritis. Although the patient reported was a vasculopath, a concurrent headache, mild reduction in visual acuity, scalp tenderness and raised inflammatory markers lead to a diagnosis of giant cell arteritis (GCA) and commencement of steroids. After an inconclusive temporal artery biopsy and resolution of visual acuity, the steroids were stopped, but within this time her hypertensive and diabetic treatment had been markedly disturbed. The rationale for treatment is discussed

Seeing you through London 2012: eye care at the Paralympics

Background The provision of eye care services for competitors and support teams is integral to the modern Olympic Games. The eye clinic for the London 2012 Paralympic Games employed a multidisciplinary team of eye care professionals using state-of-the-art instrumentation to provide the highest level of eye care. The detailed organisation of the eye care clinic at London 2012 is described in a companion paper which summarises the eye care clinic during the London 2012 Olympic Games. These two reports will aid in planning eye care clinics at future Games. Aim This paper summarises the organisation of the eye clinic and provides outline audit data relating to eye conditions encountered during the Paralympic Games. Results A total of 870 patients representing 102 countries attended the eye clinic. 274 (31.5%) were competitors; the remainder were trainers and support staff. No serious ocular injuries resulted from competitor injury in the field of play during the Paralympic Games, although seven patients were referred urgently to hospital eye services for conditions including orbital cellulitis, retinal detachment, exudative macular degeneration, corneal ulcer, Stevens-Johnson syndrome and macular oedema. A total of 749 spectacles, 14 pairs of contact lenses and 7 low vision aids were dispensed. Conclusions By combining excellent facilities and equipment with a multidisciplinary team of eye care professionals, we feel we provided the highest level of eye care, providing a legacy for future Games

Seeing you through London 2012: eye care at the Olympics

Background: Provision of eye care services for competitors and their support teams has become an integral part of the modern Olympic Games. Aim: To describe the organisation of the eye clinic at London 2012 over a 4-week period and provide outline audit data. Methods: The clinic employed multidisciplinary eye care professionals and utilised state-of-the-art instrumentation to provide the highest level of eye care. Results: A total of 1406 patients from 154 countries attended the clinic over the Olympic Games, of which, 276 were competitors. All individuals received a comprehensive refractive and ocular health examination. Minor ocular injuries, glaucoma, diabetic retinopathy and macular degeneration were among the conditions detected and managed. Most patients attended the clinic to have their refractive status checked: 973 spectacles and 50 pairs of contact lenses were dispensed. Conclusions: It is hoped that this account of the provision of eye care at London 2012 will assist with the planning of this service at future events

Optimising computer displays for normal and visually impaired users

Computers have become ubiquitous in the modern world and most people spend several hours each day viewing computer displays. With the advent of LCD flat panel displays and the increase in graphical processing power, computer displays have rapidly evolved from barely legible text displays to the modern graphical user interface. Despite the improvement in the design and legibility of computer displays, complaints of visual discomfort are still surprisingly common amongst computer users. In many cases, the problems stem from poor workstation design, inappropriate working practices or uncorrected refractive errors or binocular vision anomalies. However, the fact that symptoms often persist when these factors have been addressed suggests that the design of computer displays may be suboptimal in a number of respects. There is a vast literature relating to the ergonomics of displays and yet there is still a lack of good quality data on the effects of key parameters on user efficiency and reading speed. In particular, there is very little information about the potential benefits of changing screen colours. The first part of this thesis describes a series of experiments designed to systematically examine the effects of contrast, font size, font style, letter spacing, contrast polarity, antialiasing and screen colour on the comfort and visual efficiency of users with normal vision. A series of tests were devised to assess user efficiency including search tasks and modified versions of the MNRead and Wilkins Rate of Reading tests. In general, user efficiency judged by performance in these tasks proved to be remarkably immune to changes in screen parameters and it is concluded that the default settings used on most displays is close to optimal. Many subjects subjectively preferred a background colour other than white although this preference was seldom rewarded by a measurable improvement in efficiency. However, changing the background colour did seem to reduce the prevalence of asthenopic symptoms. The second part of the thesis describes a series of investigations designed to examine the potential benefits of changing selected display parameters for individuals with Age Related Maculopathy, Primary Open Angle Glaucoma and Retinitis Pigmentosa. Of particular interest was the effect of changing screen colours given the anecdotal evidence that some patients with these conditions gain some benefit from coloured lenses. The relatively small number of subjects and the heterogeneous nature of the groups limited the scope of the conclusions that could be drawn from this study. However, it is clear that the visual performance of many visually-impaired individuals can be greatly enhanced by the correct selection of screen parameters, particularly font size, contrast and in some case, colour. A computer programme to assist in the optimisation of these parameters was developed as the final part of this work

Normative data for optic disc vertical cup-to-disc ratio and intraocular pressure in London 2012 competitors and support teams

Background / Aims The aims of this study were to identify normative values in vertical cup-to-disc ratio (CDR) and intraocular pressure (IOP) measurements in a unique sample of competitors and non-competitors at London 2012 according to continents and geographical sub-regions and find a suitable tool for mapping results across the world. Methods Data from all patients seen in the eye clinic for the London 2012 Olympic and Paralympic Games were used in this study. Patients were categorized into countries using the United Nations Geographical Sub-regions classification. All patients underwent a full optometric eye examination and clinical details including cup-to-disc ratio were recorded. Intraocular pressures were also recorded via non contact methods using the Topcon TRK-1P. Data was analyzed using R statistical software and SPSS. Continent and sub-continent level choropleth maps were produced using GGPlot2 package. Results Our study used a sample of 2,077 patients for analysis. The mean age across all the continents ranged from 43.44 years in the Americas to 47.11 years in Europe with an overall mean age of 45.12 (SD = 13.62 years). A CDR was recorded in 1,566 right eyes (OD). A Games-Howell post-hoc test revealed that Africa had statistically significantly larger CDRs (0.34 +/- 0.16) than both Europe (0.29 +/- 0.12, p = 0.00) and Asia (0.31, 0.15, p = 0.04) in this unique sample. In addition, within geographical sub-regions, Western Africa had statistically larger CDRs (0.36 +/- 0.18) than Western Asia (0.27 +/- 0.14, p = 0.02), Eastern Europe (0.29 +/- 0.12, p = 0.01) and Northern Europe (0.29 +/- 0.13, p = 0.03). A total of 1,621 IOP measurements were recorded for the right eye (OD). A Tukey post-hoc test revealed that Oceania had statistically lower IOPs (15.45 +/- 2.57) than Europe (16.93 +/- 2.98, p = 0.01), Asia (16.95 +/- 2.80, p = 0.01), the Americas (16.53 +/- 2.73, p = 0.02) and Africa (16.41 +/- 3.17, p = 0.05).Within geographical sub-regions, Northern Africa had statistically significantly lower IOPs (15.85 +/- 2.92) than Western Africa (17.18 +/- 2.97, p = 0.02), Western Asia (17.58 +/- 2.83, p = 0.04) and Eastern Europe (17.10 +/- 3.06, p = 0.02). Finally, our study found that competitors had significantly smaller CDRs (U = 66583.50, p = 0.01).and lower IOPs than noncompetitors (U = 79544.50, p = 0.01). Conclusions This is the first study to map out cup-to-disc ratio and intraocular pressure in a unique sample of competitors and non-competitors at London 2012 by continent and geographical sub-regions. The authors hope that this data may have benefits globally and that data from future Olympic and Paralympic Games can be added to this information to produce larger, more comprehensive data sets in the future

Phase II study to evaluate combining gemcitabine with flutamide in advanced pancreatic cancer patients

A phase II study was undertaken to determine the safety of combining flutamide with gemcitabine, with response rate being the primary end point. Twenty-seven patients with histologically proven, previously untreated, unresectable pancreatic adenocarcinoma received gemcitabine, 1 g m−2 intravenously on days 1, 8 and 15 of a 28 day cycle, and flutamide 250 mg given orally three times daily. Treatment was halted if there was unacceptable toxicity, or evidence of disease progression. Toxicity was documented every cycle. Tumour assessment was undertaken after cycles 2 and 4, and thereafter at least every additional four cycles. One hundred and seventeen cycles of treatment were administered, median four cycles per patient (range 1–18). Gemcitabine combined with flutamide was well tolerated, with most toxicities being recorded as grade 1 or 2 and only nine treatment cycles associated with grade 3 toxicity. The most frequent toxicity was myelosuppression. One case of transient jaundice was recorded. The commonest symptomatic toxicity was nausea and vomiting. The response rate was 15% (four partial responses), median survival 6 months and 22% of patients were alive at 1 year. These results suggest antitumour activity of the combination therapy to be equivalent to single agent gemcitabine