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Despite the advent of compulsory continuing education and the many training opportunities open to them, more practitioners today lack confidence in their contact lens skills than they did eight years ago when this question was first asked.2
What our research doesn't tell us is why this should be. Are contact lenses such a rapidly changing area of practice that there is a constant need to improve? Do some practitioners lack hands-on training and experience, or fit so few contact lenses that they have little confidence in their abilities? Or is skilled contact lens fitting becoming the preserve of a minority of specialist practitioners?
A look at who fits contact lenses and their fitting habits provides some clues. The average contact lens practitioner qualified in the early 1990s and is much more likely to be an optometrist than a DO. Unlike DOs, all optometrists are entitled to fit contact lenses from registration (ie entry level) but most spend just a small proportion of their time on contact lenses and fit only three new patients in an average week.1
Perhaps factors such as working in a practice with little opportunity for contact lens fitting, or where the range of lenses available is restricted, can lead to a lack of confidence among practitioners. Demographic changes and part-time working may also influence fitting habits.
One important consideration is that there is currently no requirement for optometrists who fit contact lenses to take part in contact lens-specific continuing education and training (CET) and no formal route for them to register a specialty in contact lenses as there is for CLOs. In fact our research shows that many optometrists do very little contact lens CET. The uptake of further qualifications among optometrists is also very low.
But lack of confidence isn't only the preserve of the optometric contact lens fitter. Almost as many CLOs as optometrists say their fitting skills could be improved and only small numbers of DOs each year go on to take a contact lens qualification.
The aim of this article, and the accompanying leaflet, 'See yourself as a contact lens practitioner?', for new recruits to the profession, is to explain the opportunities that contact lens practice presents and how to go about acquiring and enhancing your skills in this area.
What's in it for me?
Two recent Optician features have set out the clinical and business rationale for fitting contact lenses in detail.3,4 But perhaps some of the most compelling reasons for specialising are personal ones, such as to:
- Make your job more interesting, varied and satisfying
- Add further qualifications after your name
- Enhance your personal status and career prospects
- Create a stepping stone to more clinical areas of practice, such as therapeutics for optometrists or optometry for CLOs
- Make yourself more marketable, particularly when job opportunities are scarce
- And, not least, increase your earning potential.
In fact Optician's latest salary survey shows that employed CLOs earn, on average, nearly 30 per cent more than employed DOs. Investment in further training and qualifications, being a member of a specialist group or association, or simply undertaking more than the minimum requirement of CET and adding this to your CV, can give you a distinct advantage. Can you afford not to get more involved in contact lenses, especially since improving your skills is not difficult?
Where should I start?
Optometry and dispensing courses at UK universities and colleges aim to instil a basic level of contact lens knowledge and some experience in fitting and aftercare, although these are essentially practical skills and require regular and ongoing hands-on experience.
It is unlikely that students will handle more than a limited range of lens types so, for optometrists, pre-registration practice is an important time for getting your hands on a variety of different lenses and fitting them to real patients, as well as fitting as many contact lenses as possible.
Try to choose a pre-reg post that offers plenty of opportunity for contact lens work, a supervisor who is committed to contact lenses and a practice that has a good level of instrumentation. Employers may also run their own pre-reg and post-qualification training in contact lenses.
Several of the colleges and other providers offer starter and revision courses in contact lenses to help prepare for examinations. Courses are also available for qualified practitioners returning to contact lens practice or those in need of a general refresher. Workshop-type courses and mentoring schemes offer particular benefits in these circumstances.
For a comprehensive refresher in basic fitting techniques and lens types, the 12-part Essential Contact Lens Practice series published in Optician from March 2007 to January 2008 and available at www.opticianonline.net is a valuable resource. But again there is no substitute for a hands-on approach and regular contact lens work to build confidence.
Once you've mastered basic contact lens fitting and gained some experience you may want look out for courses in specialist lenses and techniques to extend the scope of your practice still further. Among the providers of hands-on training at all levels is the British Contact Lens Association. Proven Track Record also runs a range of events including an RGP fitting skills course.
Practice-based individual tuition is also available from companies such as Hertfordshire-based Innovative Sclerals (Ken Pullum), Contact Solutions Consultants in North Yorkshire (Andrew Elder Smith) and Kent CLO Tim Bowden (in preparation for ABDO exams and PQE).
What contact lens CET is available?
Technology changes rapidly so even the most competent contact lens practitioner will need to keep up to date with developments. Whether or not there is a legal requirement to do so, you owe it to your patients to update your knowledge, use the latest products and clinical techniques, and do the best job you can.
According to the General Optical Council, there are more opportunities for CET in contact lenses than any other area of practice. Yet nearly half of optometrists who fit lenses take part in contact lens CET only occasionally, once or twice a year at most.1 For all optometrists, and DOs whether they fit contact lenses or not, there is a need to keep up to speed with contact lens developments in order to give accurate advice to patients.
The GOC recently ruled out an early move to make contact lens CET compulsory for optometrists who fit contact lenses. However, under its proposals for revalidation, all practitioners may soon need to demonstrate competencies within their scope of practice and undertake appropriate CET. The College is trialling a voluntary Continuing Professional Development (CPD) scheme for optometrists to broaden their knowledge and skills beyond entry level and record their learning activities.
Our research shows that the most common type of contact lens CET undertaken at present is articles in journals, used by 83 per cent of those involved in fitting lenses, followed by courses and meetings organised by manufacturers (53 per cent). Computer-based learning (37 per cent) and events organised independently of industry are the next most used.
Surprisingly, hands-on courses and workshops are used less often (11 per cent) although this probably reflects a lack of availability rather than interest. These courses may require time out of the practice to attend but it is worth seeking them out, especially for learning new techniques.
Manufacturers sponsor much of the CET currently provided but there is a growing trend towards separating generic education from commercial presentations on new products. Both are important in keeping up to date with developments. Likewise, getting out of practice and meeting colleagues can be combined with journal, CD or online distance learning. Although there is no requirement to use a variety of CET formats as there is for some professions, it is desirable to do so.
Among the many UK providers of CET, the BCLA offers a range of hands-on courses, half-day conferences and evening meetings which are currently free to members, as well as journal-based CET.
The BCLA Clinical Conference includes clinical presentations and workshops as well as lectures, product presentations and a full manufacturers' exhibition. It offers the opportunity to network with other contact lens practitioners from the UK and worldwide. Members also have free access to around 50 online lectures from UK and international specialists, via the BCLA website.
Other national and regional organisations dedicated to contact lenses, such as The Scottish Contact Lens Society, Irish Contact Lens Society and North East Contact Lens Society, offer CET opportunities. Most of the major conferences have some contact lens content alongside other topics, as do local events such as ABDO, AOP and Local Optical Committee area meetings. Many employers also provide their own CET for qualified staff.
Manufacturers' websites are a good source of online CET and information on company-run courses, which are usually free of charge. The Bausch & Lomb and CIBA Vision Academy websites and The Vision Care Institute's new site all offer approved CET. The Institute is Johnson & Johnson Vision Care's purpose-built education facility that offers a range of generic courses with practical experience.
Among other commercial providers, Replay Learning provides various types of CET including distance learning via CD and online (NetLectures), conferences, day courses and hands-on practical workshops. The Institute of Optometry in London also offers occasional courses in contact lenses.
Table 1, although not exhaustive, lists contact details for some providers of dedicated contact lens courses, CET and tuition in the UK and Ireland.
What other resources will I need?
Education is one aspect of becoming a skilled contact lens practitioner but information on developments in contact lenses is another important element.
Keeping up to date with the journals not only provides regular CET but also industry news and the latest research findings. The UK-based practitioner journals are an important source of information and can be supplemented by peer-reviewed journals either dedicated to contact lenses or with extensive contact lens content.
Table 2 lists some of the publications and literature sources most useful to contact lens practitioners. Many of these are available online, although for refereed journals normally only the table of contents and abstracts are free of charge. The College of Optometrists can provide members with the MyAthens service to access the full text of articles in a range of journals. To find individual papers in the contact lens literature, a PubMed search by topic or author is usually the best bet.
The library of your professional organisation or educational institution may also be able to help. Most stock hard copies of the latest journals that you can access and some may also copy a paper and send it to you for a small fee. The British Library offers a similar service.
Evaluating research findings and using them to make the best decisions for patients is an important part of contact lens practice. Making sense of research data presented at conferences, in journals and, not least, in manufacturers' sales and marketing materials can be daunting. Veys and Schnider have published a useful review of the essential elements of clinical research and key questions to help practitioners critically evaluate comparative clinical study results.5
Textbooks are the traditional route to acquiring theoretical knowledge of contact lenses and clinical practice, and a valuable resource for practitioners throughout their careers. The classic text is Contact Lenses by Philips and Speedwell, now in its 5th edition. The main optometry and ophthalmology publishers list a range of contact lens titles, from basic fitting to advanced techniques. Search www.elsevier.com or visit www.opticianonline.net for the latest titles.
The ABDO College and College of Optometrists websites both give recommended reading lists for their further qualifications (see below) which are a useful source. Visit your professional association or local university/college library to see the latest books, or look out for publishers' stands at conferences and exhibitions.
Increasingly, websites and e-newsletters are used to deliver contact lens information as well as education. Some of these resources are listed in Table 3. News, CET and features from Contact Lens Monthly are available at www.opticianonline.net where you can also sign up for the Optician Direct e-newsletter.
The BCLA sends out regular News Updates of contact lens news from the lay and professional press and News Alerts when a major story breaks. The US journal Contact Lens Spectrum has a weekly e-newsletter of contact lens stories, Contact Lenses Today. Both of these are now archived on their respective websites. The website siliconehydrogels.com is a comprehensive resource on these lenses and sends out a monthly digest of new features on the latest research findings.
Recent additions are I-site, an e-newsletter from the Netherlands aimed at RGP contact lens specialists, and ContactLensResearch.com, a new website set up by the US-based Foundation for Contact Lens and Cornea Research that provides video commentary from leading researchers plus other resources and links.
Other US sources include the American Academy of Optometry and American Optometric Association sites. Both of these organisations have dedicated contact lens sections. Websites of the major contact lens research centres, such as the Institute for Eye Research in Sydney, are also worth a look to read about current R&D.
Manufacturers provide a wealth of valuable information on contact lenses as well as the latest product details. Several now have educational websites with useful resources in addition to online lectures and CET. CIBA Vision's Specialist Club and Forum provide an opportunity to network online with other contact lens practitioners and The Vision Care Institute site has clinical insights, fitting tips and news from the journals.
Specialists in keratoconic fitting may want to join the Keratoconus Group, which directs patients to its members' practices. The BCLA has a similar postcode search facility for consumers to locate its members around the UK.
The ACLM Contact Lens Year Book, published annually, is the essential guide to contact lenses, care products and materials available in the UK and is invaluable for checking lens availability and specifications. Full BCLA members in the UK receive a free copy of the Year Book each year as part of their membership package and final-year students can pick up a copy at the ACLM/BCLA presentations at each college and university.
What further contact lens qualifications are available?
DOs must hold an approved contact lens qualification and register a specialty to fit contact lenses, currently the ABDO Contact Lens Certificate (FBDO CL) or Diploma in Advanced Contact Lens Practice (FBDO (Hons) CL). These qualifications are also open to optometrists.
The College of Optometrists offers a Diploma in Contact Lens Practice (DipCLP) to members and fellows who have been registered for at least a year. City University runs a modular MSc course which includes a Contact Lens Practice certificate, involving a combination of lectures and practical experience. Visit www.city.ac.uk for a syllabus and fees.
Although not a qualification, the BCLA has a Fellowship scheme that entitles successful applicants to use the affix FBCLA as a mark of esteem in contact lenses.
ABDO qualifications
The ABDO CL Certificate qualification is in two parts: theory and practical. Candidates can sit the practical exam after 224 hours' experience in practice under supervision. In most cases this is 12-18 months after the theory exams, although it can be taken at the same time as the theory if the candidate has sufficient practical experience.
The syllabus for the ABDO Diploma in Advanced Contact Lens Practice is in five units: toric lenses, presbyopic correction, remedial fittings and current knowledge, followed by 12 case records. All five must be taken within a three-year period and passed within five years.
Table 4 lists the three colleges that are currently offering courses in preparation for these qualifications, with details of the course requirements and format. Contact the individual colleges for the costs of these courses which are often (but not always) met by employers.
College of Optometrists Diploma
The DipCLP is open to College members and fellows who have been registered for at least a year. Currently under review, the diploma is a modular programme with two certificates (A and B) which must be completed within five years. Some candidates may be exempted from all or part of a certificate if they can demonstrate success in an assessment of a similar syllabus.
The exam for each certificate is split into three sections: clinical portfolio and viva written exam and station exam. Full details of the syllabus for both certificates are in the 'Higher Qualifications Information Pack' on the College website.
BCLA Fellowship
BCLA members of all disciplines can apply to become Fellows and use the affix FBCLA after their names. Candidates are awarded points and undergo a viva voce assessment based on the evidence presented. Points are awarded for submitting case histories from everyday practice but any combination of achievements, including a DipCL or FBDO (Hons) CL, can count towards Fellowship. Applications must be made by March 1 each year and Fellowships are presented at the BCLA Clinical Conference.
How else can I use my contact lens expertise?
Once you have acquired the expertise to become a skilled contact lens practitioner there are many other avenues open to you in everyday practice and beyond, such as:
- Get involved in clinical trials by becoming an investigator
- Do your own, practice-based research
- Take on a professional services or technical role in industry
- Undertake medical contact lens fitting in the hospital eye service
- Specialise in therapeutics and become an independent prescriber
- Take a career progression degree course in optometry
- Become a contact lens lecturer or workshop presenter
- Join a faculty for one of the contact lens manufacturers
- Stand for the BCLA Council to represent your peers.
However, there is no need to move jobs, or out of the consulting room, in order to make the most of your improved skills. It may be that you want to carry on in your current role but just do a better job. Nor is it necessary to spend all of your working day on contact lenses in order to become proficient. There is satisfaction in being able to offer patients a choice of vision correction and carry the job through yourself.
Whether you see one contact lens patient a week or 100, each relies on you to give the best possible advice and each deserves a level of competence that shows you are serious about contact lenses. If you were that one patient you would expect no less. The days of dabbling in contact lenses are well and truly over. ?
? In future issues of Contact Lens Monthly, we will be reviewing some of the resources available to help you become a skilled contact lens practitioner.
References
- Ewbank A. Who fits contact lenses? Optician, 2009237:6198 12-17.
- Hutchison G. Consumer and practitioner attitudes to contact lenses. Optician, 2001221:5795 17-20.
- Efron N. Why fit contact lenses? Part one Clinical reasons. Optician, 2009238:6309 24-31.
- Russ M. Why fit contact lenses? Part two - A business decision. Optician, 2009238:6214 14-17.
- Veys J and Schnider C. Evaluating clinical research for your practice. Optician, 2009 234: 6118 22-25.