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Specialisms within practice

There are many things within practice that an Optometrist can be trained in, and specialise in aside from the everyday refractions and contact lens appointments. These can range from the occasional Diabetic screening, through to Orthokeratology and Behavioural optometry. Some of the main specialisms are outlined below, with some information about each.

Glaucoma Screening

This is a scheme which differs between each PCT throughout the UK and will be organised in association with Local eye hospitals and Ophthalmologists. Optometrists individually, and as a practice can opt in to the scheme and will be able to liaise with, and learn from resident experts in the field, and refer patients accordingly.

Diabetic Screening

The National Service Framework for diabetes covers the prevention, identification and management of diabetes, together with surveillance for and management of complications. This includes complications of the eyes, kidneys, feet etc., along with rehabilitation and continuing care. There is an annex specifically dealing with diabetic eye disease. The NSF for diabetes was released in two parts and the first part, entitled 'National Service Framework Standards for Diabetes Services', dealing with standards to improve the care of people with diabetes, was published on 14 December 2001.  The Diabetes NSF Standards apply to England only. The final part of the Diabetes NSF - the Delivery Strategy - was published in 2003. It included the early milestones, service models, performance indicators and details of local implementation and national support for local action.

By 2006, a minimum of 80% of diabetics will have been offered screening for the early detection (and treatment if needed) of diabetic retinopathy as part of a systematic programme meeting national standards. The aim is to have 100% coverage by the end of 2007.

Quality Assurance Numbers

An optometrist involved in the national screening programme must grade a minimum of 500 patient episodes, whether these are actual patients seen or just the stand-alone screening of images doesn't matter.  This is designed to allow schemes more flexibility in the use they make of community optometrists.

AMD Screening

Age-related macular degeneration (AMD) causes severe visual loss and is the commonest cause of blindness in persons > 50years old in the western world. Two main forms of AMD occur: dry and wet. The dry form accounts for 90%, whilst the wet form occurs in 10% of all AMD. The severe visual loss in 90% of cases is due to the wet form of AMD which is characterized by choroidal neovascularisation (CNV). The majority of CNVs occur subfoveally. There is evidence that angiogenic factors, especially vascular endothelial growth factor (VEGF) and fibroblastic growth factor (FGF) play a significant role in the development and maintenance of CNV. High levels of VEGF have been demonstrated in CNV surgically excised from humans or animal experimental CNV It was previously estimated by research commissioned by The Macular Disease Society (MDS) that 21,000 new cases of wet AMD occurred in the UK each year. Current estimates by the Royal National Institute for the Blind (RNIB) and the National Institute of Clinical Excellence (NICE) indicate there may be 26,000 patients eligible for the new anti-VEGF treatments in the UK each year (compared to 7,000 currently eligible for  photodynamic therapy [PDT]) The management of an individual patient depends on the type of AMD present. Until recently, the management of wet AMD has been limited to laser photocoagulation, and PDT where applicable.

Similarly to diabetic screening, AMD screening is overseen on a local level, and optometrists can opt in to the scheme in order to support the local Eye hospitals, and can in some cases take part in supplementary training for additional AMD testing and treatment.

Colourimetry

Many children and adults who have reading or specific learning difficulties have subtle visual problems, which may prevent them from achieving their full potential at school or work. Often, these problems will only be detected through a series of specialised tests and techniques, which are outside the scope of a routine eye examination. These visual problems may cause symptoms such as sore eyes or headaches when reading, poor concentration or even avoiding reading altogether.

Optometrists can get involved in Colourimetry within certain practices where there is the need for the service in the community. Links can be formed with local charities as well, in order to offer another unique service to patients.

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Email: info@resourcing.uk.com