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Registrant-led peer discussion cases
Case booklet and guidance
Association of British Dispensing Opticians
3 IN
TE
RACTIVE CET PO
INTS
3 INTERACTIVE CET P
OIN
TS
Low vision cases
Page 2
Target Groups
Participant name:
GOC number:
Date:
Association of British Dispensing Opticians
Setting up a peer discussion group inyour practice
1. Go to your MyCET webpage and click on ‘SetupPeer Review Group’ in the left menu.
2. Complete your peer review group description.
3. As shown on the opposite page; complete the 5steps for each learning objective, using thenumbering and learning objective text from thisbooklet. Remember to ‘Save’ after each one.
4. Only apply for approval for the group(s) whowill be attending.
Important:• You can only apply for a group of 4 to 10participants.
• CET approval must be gained before thesession – there is NO post-approval.
• Give each participant a copy of this bookletto make notes and retain.
• Summarise briefly and note the outcome ofthe group’s discussions for each case.
For an expanded description of the approvalapplication process, go to:-
http://www.abdo.org.uk/wp-content/uploads/2013/06/Setting-up-a-Peer-Review-Part-1.pdf
(Member log-in required)
Paperwork needed for the session:Enough booklets for each participant.
Sign-in sheet from the GOC website:
https://www.optical.org/download.cfm?docid=9EB26EE1-2238-4C57B50EFC2CB7B4CA8F
Low vision cases
Suitable for:
Dispensing Opticians
Optometrists
Page 4Association of British Dispensing Opticians
Competencies Learning Objectives
Dispensing Optician
2.6.4 Demonstrates knowledge of theadvice and guidance regarding thesupply of optical appliances to registeredsight-impaired patients set by ABDO andthe College of Optometrists.
4.1.2 Can suggest appropriate lenses andframes with justification to the patient’sdriving and other lifestyle requirements, ormobility status.
6.3.2 Understands how the effects ofcontrast and glare contribute to thevisual quality of a patient.
6.2.2 Understands the different types offield loss and how they relate to apatients visual behaviour and needs
8.1.2 Understands and can recognisesymptoms relating to conditions whichmay lead to low vision
8.1.5 Understands how low visionconditions may progress and affectquality of life for the patient, and theoptions for treatment or management.
Optometrist
2.6.4 Demonstrates knowledge of theadvice and guidance regarding thesupply of optical appliances to registeredsight-impaired patients set by ABDO andthe College of Optometrists.
2.10.1 Understands the roles andresponsibilities of other professions withinthe practice team
4.1.5 Can suggest appropriate lenses andframes with justification to the patient’sdriving and other lifestyle requirements, ormobility status.
6.1.11 Understands how low visionconditions may progress and affectquality of life for the patient, and theoptions for treatment or management.
Your discussion of the four cases must lastat least 1 hour. You must discuss all four tocover the competencies and achievethe learning objectives. A list ofreferences is provided for further study atthe end. These can also be accessedduring the session to support thediscussion.
Low vision case set
Dispensing optician
Optometrist
Page 6Association of British Dispensing Opticians
Patient details
Mr Shipley age 75 and a retired GP hasbeen a regular patient to the practicesince it opened and has come to seekyour advice to improve his distance vision.
An eye examination was carried out atthe practice 2 months ago with the resultsas shown above.
Retest in 12 monthsThe records show that the only pathologywas a developing cortical cataract in theleft eye and some drusen in the right eye(location not specified on the record card).
The patient currently wears D35 bifocalsmade of CR39 with a hardcoat. He is aftersome yellow clip-ons to wear over hiscurrent spectacles to help with driving atnight because he’s read on a blog thatthey will help.
Low visionCase 1
Sphere Cyl Axis Prism Base
+2.00 -0.50 90
Add +2.50
VA 6/9+ R 6/18- L N5 R N6 L
Distance
Reading
NOTES:
RIGHT
Sphere Cyl Axis Prism Base
Distance
Reading
LEFT
NOTES:
+1.00 -0.75 45
Add +2.50
Suggested discussion topics
• What advice can you give him?
• Current driving standards in the UK
• Categories of tints and their suitability fordriving (daytime and night time)
• Suitability for cataract referral
• Methods to reduce glare e.g. MARcoating, cleaning of windscreen insideand out
Page 8Association of British Dispensing Opticians
NOTES:
Patient details
Mrs Cater is 84 years old and lives aloneon the ground floor in a warden-assistedblock of flats. She has several physicalimpairments and can only manage a fewsteps at a time before being out of breath.She is also unsteady on her feet and hashad 3 falls in the last year. One of thewardens organised a domiciliary eyeexam which resulted in the prescriptionabove for you to dispense.
She currently wears varifocals although it isunclear how old these might be (althoughher last eye exam was 4 years ago).
What would you suggest?
Low visionCase 2
Sphere Cyl Axis Prism Base
+2.00 -0.50 90
Add +3.50
VA 6/7.5 R&L N6 R&L
Distance
Reading
NOTES:
RIGHT
Sphere Cyl Axis Prism Base
Distance
Reading
LEFT
+2.00 -0.25 90
Add +3.50
Suggested discussion topics
• Causes of falls & advice
• Lens choice (material, form)
• Additional advice to maximise visualpotential (non-optical)
• LVAs?
• Other considerations relevant to hersituation
Page 10Association of British Dispensing Opticians
Sphere Cyl Axis Prism Base
Distance
Reading
NOTES:
RIGHT
Sphere Cyl Axis Prism Base
Distance
Reading
LEFT
Patient details
It is 5.00pm and Mr Jones attends thepractice to collect his new glasseswhich have been rushed through as apriority job. Mr Jones had broken hisreading glasses which are heldtogether with sticking plaster andpaperclips and only has one lens (theleft) as the other was smashed in a fall.
Mr Jones has an appointment tocollect his glasses with Jane themanaging dispensing optician.However she has had to go home earlybecause her daughter is unwell, leavingCaroline the optical adviser and Johnthe trainee dispensing optician to coverthe branch. Records show that Janechecked the glasses and they passedquality control. John decides to phoneAlan a registered DO and branchmanager in a neighbouring town threemiles away for advice.
Low visionCase 3
NOTES:
-3.50 -4.00 180
Add +3.50
V <6/60 R&L VA R6/9- L 6/12+ N5 R&L Px registered visually impaired due to Bi-temporal Hemianopia
-3.00 -5.50 1771⁄2
Add +3.25
Suggested discussion topics
• What should John do?
• Who is allowed to dispense to a sight-impaired patient?
• What steps should be followed at a lowvision spectacle collection?
• Is the spectacle prescription written toBritish Standards? What is the BritishStandard format for prescriptions?
• If this were a distance prescription,would you do anything differently?
Page 12
Sphere Cyl Axis Prism Base
Distance
Reading
RIGHT
Sphere Cyl Axis Prism Base
Distance
Reading
LEFT
Patient details
Marta Hertzberg, 14, is a new patient tothe practice, and her parents, whenmaking the appointment, wanted thepractice to know that she has ocularalbinism, because it’s not obvious, and soshe might need special attention. She hasbeen discharged from the HES and hasbeen advised to attend a communitypractice for her future eyecare needs.
Additional informationShe refuses to wear her spectaclecorrection. Photophobic.
Attends local comprehensive school. Hasa support worker in attendance forScience and Practical subjects.
Travels on school bus to and from school.
Teachers should provide enlargedhandouts, but this rarely happens.
Has recently started GCSE course.
Interested in make-up, clothes, popmusic, horse-riding.
Low visionCase 4 (Courtesy of Anne Eyre)
Association of British Dispensing Opticians
NOTES:
-7.00 -6.00
Suggested discussion topics
• What is ocular albinism and how does itdiffer from albinism?
• Comment on Marta’s prescription andvisual acuity.
• What might you dispense?
• What other associated ocular conditionsmight Marta have, and whatadvice/help could you give?
• What support is available for parentsand children with albinism?
NOTES: V <6/60 R&L VA R6/60 L 6/48 N12 R&L at 10cm (ceiling fluorescent) Ocular albinism
After the discussion…
Participants should complete thereflective learning statement tokeep.
Within 10 days of the discussion, thelead registrant must visit MyCET toupload the cases discussed, somenotes about the discussionoutcomes from the group, via the‘Make Declaration’ button. Youcan then upload the names andGOC numbers of the participantsfrom the attendance sheet.
More detailed information on thiscan be found athttp://www.abdo.org.uk/wp-content/uploads/2013/06/Setting-up-a-Peer-Review-Part-2.pdf
ResourcesLennon J, Harper R, Lloyd C, Biswas S. The role ofthe paediatric low vision service (MREH). 2008.http://www.mreh200.org.uk/media/15550/Tues_Cotton_1500_Julie%20Lennon.pdf
ABDO’s Advice and Guidelines at www.abdo.org.uk/advice-guidelines
The College of Optometrists’ Code of Ethics and Guidance forProfessional Conduct http://guidance.college-optometrists.org/guidance-contents/
Adult Community Optical Low Vision CommunityService Pathway. 2016. (Particularly Appendix 2: Information to be provided as partof the low vision assessment)http://www.locsu.co.uk/uploads/community_services_pathways_2015/adult_low_vision_pathway_rev_14_03_16,_v3_2.pdf
The Royal College of Ophthalmologists. Low vision – the essential guide forophthalmologists. 2014. [online] https://www.rcophth.ac.uk/wp-content/uploads/2014/08/2012_EXE_225_Low_Vision_BookD5-v4.pdf
Willoughby CE, Jackson AJ and Healey N.Albinism: What the GOS Optometrist Needs toKnow. 2010. https://www.researchgate.net/publication/277799183_Albinism_What_the_GOS_Optometrist_needs_to_know
HM Government. Driver and Vehicle Licensing Agency. AssessingFitness to Drive – a guide for medicalprofessionals. 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/618072/assessing-fitness-to-drive-a-guide-for-medical-professionals.pdf
You can also make use of search engines to findresources from reliable websites.
Caution: there is good information on theinternet, but you will also find opinions,misconceptions, and inaccurate information.
Page 14Association of British Dispensing Opticians
Following your discussions, please list what you have learned, where your knowledge hasbeen reinforced, any helpful tips you have picked up, and any topics you may wish toresearch further.
When you accept your CET points on MyCET after the session, you must complete asimilar reflection statement, therefore you are strongly advised to retain this booklet.
1. Summarise the clinical skills and competencies that were discussed during this session:
2. List the main things you learned from this session:
3. Describe how you will apply this learning in your practice:
4. Has this session identified any areas where further personal learning is needed?If so briefly describe these below:
Low vision case setPeer discussion reflective learning statement
ABDO CET5 Kingsford Business Centre, Layer Road
Kingsford, Colchester CO2 0HT
Telephone 01206 734 155 Fax 01206 734 156 General CET enquiries [email protected] CET event enquiries [email protected]
October 2017
© Association of British Dispensing Opticians
