There was a collective cheer across the Optician editorial desk this week when our editor and publisher decided it was time to ‘break out’ the shorts. When he returned from the supermarket with tubs of ice cream, it was clear summer had arrived.
However, hot and humid conditions across the country last weekend caught people off guard, hampering sleep and leading to a range of ailments.
Sun burn, heat exhaustion and dehydration were the obvious ones, but not talking to patients about the impact of the weather on their eyes was tantamount to turning off the fan.
Ocular damage, dry eye and hay fever all have the potential to cause misery that the latest lenses, contact lenses, dry eye products and practice treatments can help avoid.
Meanwhile, attendance for eye appointments faced competition from a trip to the beach or picnic in the park. Some elderly patients would not have dared venturing out of the house as temperatures soared above 30°C in many parts of the country.
The Met Office warned people to take care when outside enjoying the warm weather, especially between 11am and 3pm, amid high UV levels. Pollen levels were also soaring across England and Wales and, while conditions were due to cool as the week went on, soaring temperatures remained a challenge for UK workforces.
Moving into the hottest months, therefore, optical employers must find a strategy to handle extreme temperature fluctuations. While there is a minimum temperature requirement of 16°C for workplaces without ‘considerable physical activity’ during the winter, there is no legal maximum limit. However, the TUC has called for employers to be prosecuted if working temperatures reach 30°C, and be forced to cool down the workplace when temperatures hit 24°C.
The right information
An optometrist in Northampton told Optician that while advice was needed, it should be proportionate.
Keyur Patel, of Tompkins, Knight & Son Optometrists, said: ‘It is not getting hot enough to be “dangerous” to the ocular surfaces. Patients are advised about the benefits of sunglasses for UV protection, which is higher when the sun is bright. Sunglasses offer safe and comfortable vision.’
Simple advice for patients would include buying sunglasses with a CE marking to guarantee their quality and ensure adequate UV protection, he said.
Meanwhile, escaping the sun for cooler indoor spots also presented issues during a heatwave.
‘With the increase in temperature, people are more likely to have air-con and fans blowing,’ added Patel. ‘If these are blowing directly onto the face they can potentially lead to increased evaporation of tears and levels of “dryness” discomfort.’
Much like with smoking cessation, obesity and diabetes, as healthcare professionals the conversation should not just be limited to vision.
‘Although our patients visit us about their eyes, it is important to inform them about staying hydrated when it is warmer as well as making sure their skin is adequately protected,’ he added.
Fortunately for Tompkins, Knight & Son Optometrists, patient ‘no shows’ were less of an issue. It has air-conditioning within the practice and testing rooms, plus a sun terrace for patients to sit, enjoy the weather and test out sunglasses in a natural environment.
Patel stressed the importance of offering patients and staff water as well as other refreshments.
When business heats up
As for the multiples, while Vision Express was unable to comment on the heatwave, a spokesperson for Specsavers said more patients were expected with symptoms associated with high pollen levels and warm conditions.
Dr Nigel Best, an optometrist at Specsavers Darlington and the multiple’s clinical spokesperson, said: ‘As the temperature rises so does the pollen level, practices can expect to see increasing numbers of patients presenting with symptoms suggestive of allergic conjunctivitis. Managing these patients falls more and more under the remit of the community optometrist, particularly those engaged in locally commissioned Mecs type services.
‘Community optometrists might also expect to see increased numbers of patients with symptoms suggestive of dry eye. Most dry eye has an evaporative element and sufferers can expect a worsening of these symptoms in warm conditions.’
Furthermore, studies by Specsavers have identified good weather as a common factor relating to the likelihood of a patient missing their eye appointment. However, being young, forgetful, booking too far in advance, and the onset of bad weather were also linked to no shows.
Dr Best said: ‘Anecdotally, many practitioners will have noticed a correlation between improving weather and the likelihood of patients failing to attend their appointments. You would expect this to be particularly problematic in busier practices where patients may be booking a few weeks in advance.
‘When the sun is shining, a text reminder or phone call reminding patients of their appointment becomes even more crucial than normal.’
He added that while the public health message that excessive UV exposure increases the risk of skin cancer was widely known, he believed the link between UV exposure and eye problems was much less well known.
‘Opticians should be mindful of both the short and long term risks of UV exposure and advise their patients accordingly. If anyone reading this article is not aware of the “peripheral light focusing” effect, it’s definitely worth familiarising yourself with it and considering it when advising on sunglass styles.
‘In particular, we need to remember that a high proportion of an individual’s lifetime exposure to UV occurs in childhood and educate parents and children accordingly. We should also be extolling the benefits of UV blocking contact lenses when appropriate.’
In a major contrast to the heatwave in England, areas north of the border were frozen stiff earlier this week. However, Black & Lizars, which operates 24 practices in Scotland, was prepared for an improvement in the weather after its own mini heatwave last month.
Morven Campbell, clinical services manager at Black & Lizars, added: ‘With rising temperatures and increased use of air conditioning, particularly in cars and offices, we tend to see more and more patients experiencing dry eye symptoms. This is especially prevalent in contact lens wearers. Thankfully there are many products on the market to ease the discomfort including drops, better lens materials and sunglasses that act as a physical barrier to dehydration.
‘On warm sunny days patients tend to think more about sun protection and many are aware that they should protect their eyes from harmful UV rays. As would be expected, we tend to see an increase in our sunglasses sales in the run up to summer.’
Meanwhile, the summer months also sparked party season for some, who needed to be reminded of contact lens compliance.
She added: ‘Long sunny days often go hand-in-hand with barbecues, parties, and greater alcohol consumption, which while often fun, many people forget to remove contact lenses and wake up with irritated eyes.
‘Black & Lizars would encourage patients to take sensible precautions with their vision while enjoying the summer weather, by wearing UV-resistant sunglasses, remembering to remove lenses, and generally practicing good eye hygiene. Follow these simple steps and enjoy the sun for as long as it lasts.’
The College of Optometrists has developed resources to help eye patients against excessive UV exposure. This included wearing sunglasses which are made to the required standards (BS EN ISO 12312-1:2013) or carry the CE mark. Advice in its new ‘Lifestyle and eyes’ booklet also recommends wearing a hat with a brim or a sun visor. Members can order one at www.college-optometrists.org/membership.free-patie...
Highbrow advice for the festival season
Optician clinical editor Bill Harvey (pictured left), himself hopeful of catching some rays at the Glastonbury music festival this weekend, underlines the importance of hydrating, protection, and a thick set of eyebrows.
‘The current heat wave should make a welcome change to those more used to the dank and drear of the typical UK climate. Obviously, higher temperatures bring problems, especially for those unused to such weather. The exposed ocular surface is vulnerable to a number of adverse factors during hot periods.
Hydration is essential and this is particularly so for the western adult, with many studies showing that recommended levels of hydration are rarely reached. This can influence a reduced tear volume and the resultant impact on comfortable maintenance of the ocular surface may be exacerbated when the temperature is a “dry heat” and humidity levels are low, resulting in increased evaporation from the ocular surface.
Another common problem, but one rarely written about, is the increased irritation from sweat or sun creams entering the eye – particularly for contact lens wearers. As good as the eyebrows are in protecting the eyes, care needs to be taken unless blessed, like me, with a set that Denis Healey would have been proud of.’