An Irish education

A range of topics were discussed during the two day meeting. These covered lens properties and developments along with topics of a broader interest to the audience. First up was Colin Fowler, director of undergraduate studies at Aston University, who spoke about simulating progressive lenses.
He began by welcoming the fact that people were now aware of progressive lenses; while it was easy to see a lens was progressive by looking through it, a visual inspection would yield little more. It is necessary, he said, to be able to simulate a lens to highlight the differences between existing and new lenses.
Media advertising didn't really help increase understanding especially when specific claims were made about lenses and unspecified power distribution patterns displayed. Plots cannot be used to identify a lens fingerprint, he said.
After running through a brief history of progressive lens types and the ways in which they have been measured, Fowler moved on to computer techniques. These, he said, offered new ways of simulating the performance of a lens. Simulating progressive performance was an interesting topic, he concluded, but at the moment we can't produce a perfect progressive, there are limitations.

dissatisfied patients
Dr Fiona Fylan, director of Brainbox Research, took a different tack with her talk on the evaluation of the Essilor patient checklist. This checklist is a method introduced to combat a Mintel finding that 44 per cent of optical practice patients were dissatisfied with their current practice and didn't intend going back. This could be for financial or medical reasons, she explained.
She illustrated this situation with the tale of an 85-year-old woman who was unhappy because her optician kept pointing her in the direction of the budget section of the practice. She finally went elsewhere and spent £560 on a designer frame and high-index lenses. Other patients reported changing their practice because they didn't feel they were being told enough about their consultation.
The checklist is a tool, she said, that allows practitioners to find out what their patients' needs are. It categorises patients into four types Ð visionaries, seekers, avoiders and stylists Ð and tailors their experience within the practice accordingly.
This didn't mean, she stressed, predetermining what the patient wanted because of the category they fell into, but what their needs were based on questioning. Her study of 100 patients found that in all cases the patient levels of satisfaction were improved by using the checklist. This included the eye examination, choosing frames and meeting the patient's needs.
Dr Fylan also said the survey found cost was not as high a priority as most practitioners think and that the patients didn't mind filling out the questionnaire.
The results presented at the Essilor symposium related to two upmarket independent practices that both had high levels of patient satisfaction before the checklist was used. Dr Fylan said results from two lower budget practices were currently being assessed and should show more marked improvements in satisfaction levels.

Sun damage
The third session of the day saw Andy Hepworth, professional relations manager at Essilor, talk about light, sight and Transitions lenses.
He outlined some of the latest findings on the damaging effects of ultraviolet radiation contained in sunlight and some attitudes towards sun damage. Hepworth said 10 per cent of all UV related skin cancers are found around the eyelids. The Beaver Damn study from the US also showed a clear connection between exposure to sun between the ages of 13 and 19 and 30 and 39 and age-related macular degeneration.
He added that while 92 per cent of people knew about the dangers of sun exposure only 6 per cent were aware that UV exposure had a detrimental effect on the eye. He said Essilor had worked hard to produce a range of lenses to combat the effects of the sun and provide healthy vision.
The benefits and technological features of lens coatings were the topics for Alain Colonna from Essilor France. He explained that scratches, reflections and smudges were the enemy of lenses. 'These all reduce the contrast of the image and reduce the efficiency of the lens. If you can reduce these enemies you can prolong the life of the lens,' he said.
Scientific evidence was now available which quantified the benefits of reducing the 'window effect' on lenses by using reflective coatings, he went on to demonstrate the safety advantages of reducing back-surface reflections. He described situations such as night driving and AR coating the back surface of sunwear as two clear cases where cutting reflections improved useful light transmission. He also looked at specific situations, such as computer work, where reducing external light reflections improved vision.
Moving to scratch resistance Colonna said the introduction of plastic had made the use of anti-scratch coatings essential, as the AR coating is both very thin and very brittle. This meant a soft dip coating is put between the AR and an outer scratch coating to allow the layers to dent rather than crack when impacted.
Keeping the lens clean at a microscopic level was about depositing elements that provided a smooth surface which repelled dirt, grease and water, said Colonna. Essilor's latest Crizal Alize coating used elements that did not allow water and grease to diffuse into the surface, thereby reducing tarnishing, he said.
In a complete change of pace Sonsoles Llopis Garcia, Essilor International professional relations manager, gave an outline of this year's Special Olympics that took place in Dublin earlier this summer. These games are the only competition that can use the Olympic name and are for competitors with learning impairments. The games were held outside the US for the first time this year and more than 7,000 competitors took part.
Garcia said Essilor was proud to be a corporate supplier to the games at which 1,000 polycarbonate spectacles were dispensed. Services supplied at the event included eye tests, refraction and screening and protective eyewear. She said 78 per cent of competitors had not had an eye test in the last three years, 37 per cent of those at the games were wearing glasses and 18 per cent of those were wearing the wrong prescription.

Third-World care
Continuing the theme of eyewear for the disadvantaged, Tym Marsh of Vision Aid Overseas gave a talk on that organisation's activities. In a heartfelt, and sometimes disturbing session, Marsh described VAO's work in Africa and the debilitating eye conditions many in the Third World have to suffer.
He described areas of Africa where 80 per cent of the population harbour eye disease and up to 5 per cent are blind. In some hostile regions there are areas five times the size of the UK with 60 million people without a single trained optometrist. On a brighter note, Marsh reported many positive stories to come out of VAO's work Ð situations where people's lives and fortune's have been restored by a simple pair of second-hand spectacles.
Often, lack of professional staff led to misconceptions about vision. Sometimes those visiting the clinics were believed to be blind but, in fact, simply had a large refractive error which could be corrected.
Continuing the theme of third-world eye care, Rachel North, a major supporter of VAO, delivered her talk on tropical eye disease. She said there were 45 million blind people in the world, and 80 per cent of them had conditions that were avoidable. Nine tenths of blind people lived in the developing world and by 2020 the number of blind will have doubled.
The biggest cause of blindness was cataract, accounting for 25 million cases. Glaucoma and trachoma both accounted for five million and childhood diseases some one and a half million. Other conditions, such as river blindness, trichiasis and chlamydia, added to the totals.
North said tackling such a massive task was a problem, particularly as there was a lack of professionals to perform operations, lack of drugs, poor sanitation and lack of education. Often, ignorance, malnutrition and lack of care led to blindness or 'traditional' remedies were used. In the worst examples this could result in cases where urine, petrol and other foreign objects were put into the eye in a misguided attempt to cure the patient.

find the Designer label
Bringing the conference back to everyday optometric practice life Dr Glynn Walsh, senior lecturer at Glasgow Caledonian University, shared his findings from a study into designer eyewear. The question the study sought to answer was: can patients tell a designer frame without its label?
What soon became apparent from the focus groups, said Walsh, was that little quirks such as nose pads did give the game away. However, the groups saw no increase in durability, robustness or quality in the designer eyewear. A 'blind' test on a selection of frames put the most expensive at the bottom on a number of quality indicators.
Walsh concluded that unless there was a very clear indication on the frame, patients simply couldn't tell the difference.

Scatter rates
Juan Bueno, associate professor at Murcia University in Spain, took post-Lasik intraocular scatter as his subject. He looked at a range of patients to see what effect refractive surgery had had on scatter rates. He made some interesting findings and also developed some novel measurement techniques along the way. His results showed that post-Lasik scatter did appear to be greater in those with a greater correction and in older eyes. His studies will continue.
Returning for a second presentation, Essilor's professional services manager Andy Hepworth gave an overview of Essilor's Opsys remote ordering facility. Hepworth said the system would match any available lens suitable for glazing into the prescription supplied by the user. The natural progression from this was the Presize remote edging facility, said Hepworth. This allowed the user not only to specify the lens but also to trace its shape. This was then surfaced and edged by an Essilor lab ready for glazing.
Hepworth gave a brief look at some of the tools available within the software that allowed 3D animations, calculations of edge thickness and reductions in weight to be displayed and used as an information tool for the patient.
He went on to outline Essilor's new Interview lens, now available in 0.8D or 1.3D power versions. This is a task-specific progressive providing wide, near and intermediate vision. It does not provide correction for distance vision but offers an enhanced option for those patients currently wearing single-vision reading spectacles.
The New Interview, that became available on October 1, offers two powers of regression. For the new presbyope 0.8D is recommended and a higher regression power of 1.3 for patients older than 55 years. Essilor says the lens takes into account the fact that most activity happens in the mid distance area. Wearers can therefore have corrected close vision while continuing to be aware of what is going on around them. The index of the lens material has been increased from 1.502 to 1.561 and can be glazed in a wider range of prescriptions.

The perfect lens
Drawing the symposium to a close was event veteran Professor Mo Jalie, of the University of Ulster, Coleraine, with his presentation on the search for the thinnest lens. He said the raison d'etre of the dispensing optician was the perfection of prescription lens design, but what was important was what controlled the thickness of that lens. This boiled down to form, index, shape and diameter. 'How much control do we have over these elements?' he asked.
Curvature and asphericity were controlled by the prescription and index with a limited input from patient and practitioner. Shape and diameter was also decided upon jointly. The thickness, however, was decided by the surfacing lab. While for glass this may have been 1mm, the flexibility of plastics pushed this out to 2mm, higher-index materials could go down to 1.5mm or 1mm at the extreme.
Professor Jalie said minus lenses were suited to being cut down from an 80mm blank, but this was not the case with a plus lens. It was clear then that sphere, cylinder and prism elements would combine at different axes to determine edge thickness.
'When these elements are taught to students they are taught how to discover the thickness of each separately, while optical technicians are taught how to find the thickest point on a lens with all these elements combined,' he said.
As lens shapes had become a feature of eyewear, various formulae had been used to determine the thickness of a given prescription with given cyls, spheres and prisms at given axes. Forty years ago a technician would have been able to imagine where the thinnest point on the lens was, but various innovations had now made that the domain of the computer.
In everyday life the thickness of a lens was determined by a computer or by a technician with tables, said Professor Jalie.
'What control does the practitioner have?' He gave the audience a quick history of lens calculation methods. While in the early years, maths was the order of the day, circles, the four meridian system, elipses and Fourier series had all been used to describe the topography of lenses.
In the early days of computing, technicians didn't always take to the introduction of new technology. Professor Jalie recounted the fate of one early Hewlett Packard 9815 that went missing from a lab in Dublin in 1975. It was discovered five years later when the river Liffey was being dredged.A range of topics were discussed during the two day meeting. These covered lens properties and developments along with topics of a broader interest to the audience. First up was Colin Fowler, director of undergraduate studies at Aston University, who spoke about simulating progressive lenses.
He began by welcoming the fact that people were now aware of progressive lenses; while it was easy to see a lens was progressive by looking through it, a visual inspection would yield little more. It is necessary, he said, to be able to simulate a lens to highlight the differences between existing and new lenses.
Media advertising didn't really help increase understanding especially when specific claims were made about lenses and unspecified power distribution patterns displayed. Plots cannot be used to identify a lens fingerprint, he said.
After running through a brief history of progressive lens types and the ways in which they have been measured, Fowler moved on to computer techniques. These, he said, offered new ways of simulating the performance of a lens. Simulating progressive performance was an interesting topic, he concluded, but at the moment we can't produce a perfect progressive, there are limitations.

dissatisfied patients
Dr Fiona Fylan, director of Brainbox Research, took a different tack with her talk on the evaluation of the Essilor patient checklist. This checklist is a method introduced to combat a Mintel finding that 44 per cent of optical practice patients were dissatisfied with their current practice and didn't intend going back. This could be for financial or medical reasons, she explained.
She illustrated this situation with the tale of an 85-year-old woman who was unhappy because her optician kept pointing her in the direction of the budget section of the practice. She finally went elsewhere and spent £560 on a designer frame and high-index lenses. Other patients reported changing their practice because they didn't feel they were being told enough about their consultation.
The checklist is a tool, she said, that allows practitioners to find out what their patients' needs are. It categorises patients into four types Ð visionaries, seekers, avoiders and stylists Ð and tailors their experience within the practice accordingly.
This didn't mean, she stressed, predetermining what the patient wanted because of the category they fell into, but what their needs were based on questioning. Her study of 100 patients found that in all cases the patient levels of satisfaction were improved by using the checklist. This included the eye examination, choosing frames and meeting the patient's needs.
Dr Fylan also said the survey found cost was not as high a priority as most practitioners think and that the patients didn't mind filling out the questionnaire.
The results presented at the Essilor symposium related to two upmarket independent practices that both had high levels of patient satisfaction before the checklist was used. Dr Fylan said results from two lower budget practices were currently being assessed and should show more marked improvements in satisfaction levels.

Sun damage
The third session of the day saw Andy Hepworth, professional relations manager at Essilor, talk about light, sight and Transitions lenses.
He outlined some of the latest findings on the damaging effects of ultraviolet radiation contained in sunlight and some attitudes towards sun damage. Hepworth said 10 per cent of all UV related skin cancers are found around the eyelids. The Beaver Damn study from the US also showed a clear connection between exposure to sun between the ages of 13 and 19 and 30 and 39 and age-related macular degeneration.
He added that while 92 per cent of people knew about the dangers of sun exposure only 6 per cent were aware that UV exposure had a detrimental effect on the eye. He said Essilor had worked hard to produce a range of lenses to combat the effects of the sun and provide healthy vision.
The benefits and technological features of lens coatings were the topics for Alain Colonna from Essilor France. He explained that scratches, reflections and smudges were the enemy of lenses. 'These all reduce the contrast of the image and reduce the efficiency of the lens. If you can reduce these enemies you can prolong the life of the lens,' he said.
Scientific evidence was now available which quantified the benefits of reducing the 'window effect' on lenses by using reflective coatings, he went on to demonstrate the safety advantages of reducing back-surface reflections. He described situations such as night driving and AR coating the back surface of sunwear as two clear cases where cutting reflections improved useful light transmission. He also looked at specific situations, such as computer work, where reducing external light reflections improved vision.
Moving to scratch resistance Colonna said the introduction of plastic had made the use of anti-scratch coatings essential, as the AR coating is both very thin and very brittle. This meant a soft dip coating is put between the AR and an outer scratch coating to allow the layers to dent rather than crack when impacted.
Keeping the lens clean at a microscopic level was about depositing elements that provided a smooth surface which repelled dirt, grease and water, said Colonna. Essilor's latest Crizal Alize coating used elements that did not allow water and grease to diffuse into the surface, thereby reducing tarnishing, he said.
In a complete change of pace Sonsoles Llopis Garcia, Essilor International professional relations manager, gave an outline of this year's Special Olympics that took place in Dublin earlier this summer. These games are the only competition that can use the Olympic name and are for competitors with learning impairments. The games were held outside the US for the first time this year and more than 7,000 competitors took part.
Garcia said Essilor was proud to be a corporate supplier to the games at which 1,000 polycarbonate spectacles were dispensed. Services supplied at the event included eye tests, refraction and screening and protective eyewear. She said 78 per cent of competitors had not had an eye test in the last three years, 37 per cent of those at the games were wearing glasses and 18 per cent of those were wearing the wrong prescription.

Third-World care
Continuing the theme of eyewear for the disadvantaged, Tym Marsh of Vision Aid Overseas gave a talk on that organisation's activities. In a heartfelt, and sometimes disturbing session, Marsh described VAO's work in Africa and the debilitating eye conditions many in the Third World have to suffer.
He described areas of Africa where 80 per cent of the population harbour eye disease and up to 5 per cent are blind. In some hostile regions there are areas five times the size of the UK with 60 million people without a single trained optometrist. On a brighter note, Marsh reported many positive stories to come out of VAO's work Ð situations where people's lives and fortune's have been restored by a simple pair of second-hand spectacles.
Often, lack of professional staff led to misconceptions about vision. Sometimes those visiting the clinics were believed to be blind but, in fact, simply had a large refractive error which could be corrected.
Continuing the theme of third-world eye care, Rachel North, a major supporter of VAO, delivered her talk on tropical eye disease. She said there were 45 million blind people in the world, and 80 per cent of them had conditions that were avoidable. Nine tenths of blind people lived in the developing world and by 2020 the number of blind will have doubled.
The biggest cause of blindness was cataract, accounting for 25 million cases. Glaucoma and trachoma both accounted for five million and childhood diseases some one and a half million. Other conditions, such as river blindness, trichiasis and chlamydia, added to the totals.
North said tackling such a massive task was a problem, particularly as there was a lack of professionals to perform operations, lack of drugs, poor sanitation and lack of education. Often, ignorance, malnutrition and lack of care led to blindness or 'traditional' remedies were used. In the worst examples this could result in cases where urine, petrol and other foreign objects were put into the eye in a misguided attempt to cure the patient.

find the Designer label
Bringing the conference back to everyday optometric practice life Dr Glynn Walsh, senior lecturer at Glasgow Caledonian University, shared his findings from a study into designer eyewear. The question the study sought to answer was: can patients tell a designer frame without its label?
What soon became apparent from the focus groups, said Walsh, was that little quirks such as nose pads did give the game away. However, the groups saw no increase in durability, robustness or quality in the designer eyewear. A 'blind' test on a selection of frames put the most expensive at the bottom on a number of quality indicators.
Walsh concluded that unless there was a very clear indication on the frame, patients simply couldn't tell the difference.

Scatter rates
Juan Bueno, associate professor at Murcia University in Spain, took post-Lasik intraocular scatter as his subject. He looked at a range of patients to see what effect refractive surgery had had on scatter rates. He made some interesting findings and also developed some novel measurement techniques along the way. His results showed that post-Lasik scatter did appear to be greater in those with a greater correction and in older eyes. His studies will continue.
Returning for a second presentation, Essilor's professional services manager Andy Hepworth gave an overview of Essilor's Opsys remote ordering facility. Hepworth said the system would match any available lens suitable for glazing into the prescription supplied by the user. The natural progression from this was the Presize remote edging facility, said Hepworth. This allowed the user not only to specify the lens but also to trace its shape. This was then surfaced and edged by an Essilor lab ready for glazing.
Hepworth gave a brief look at some of the tools available within the software that allowed 3D animations, calculations of edge thickness and reductions in weight to be displayed and used as an information tool for the patient.
He went on to outline Essilor's new Interview lens, now available in 0.8D or 1.3D power versions. This is a task-specific progressive providing wide, near and intermediate vision. It does not provide correction for distance vision but offers an enhanced option for those patients currently wearing single-vision reading spectacles.
The New Interview, that became available on October 1, offers two powers of regression. For the new presbyope 0.8D is recommended and a higher regression power of 1.3 for patients older than 55 years. Essilor says the lens takes into account the fact that most activity happens in the mid distance area. Wearers can therefore have corrected close vision while continuing to be aware of what is going on around them. The index of the lens material has been increased from 1.502 to 1.561 and can be glazed in a wider range of prescriptions.

The perfect lens
Drawing the symposium to a close was event veteran Professor Mo Jalie, of the University of Ulster, Coleraine, with his presentation on the search for the thinnest lens. He said the raison d'etre of the dispensing optician was the perfection of prescription lens design, but what was important was what controlled the thickness of that lens. This boiled down to form, index, shape and diameter. 'How much control do we have over these elements?' he asked.
Curvature and asphericity were controlled by the prescription and index with a limited input from patient and practitioner. Shape and diameter was also decided upon jointly. The thickness, however, was decided by the surfacing lab. While for glass this may have been 1mm, the flexibility of plastics pushed this out to 2mm, higher-index materials could go down to 1.5mm or 1mm at the extreme.
Professor Jalie said minus lenses were suited to being cut down from an 80mm blank, but this was not the case with a plus lens. It was clear then that sphere, cylinder and prism elements would combine at different axes to determine edge thickness.
'When these elements are taught to students they are taught how to discover the thickness of each separately, while optical technicians are taught how to find the thickest point on a lens with all these elements combined,' he said.
As lens shapes had become a feature of eyewear, various formulae had been used to determine the thickness of a given prescription with given cyls, spheres and prisms at given axes. Forty years ago a technician would have been able to imagine where the thinnest point on the lens was, but various innovations had now made that the domain of the computer.
In everyday life the thickness of a lens was determined by a computer or by a technician with tables, said Professor Jalie.
'What control does the practitioner have?' He gave the audience a quick history of lens calculation methods. While in the early years, maths was the order of the day, circles, the four meridian system, elipses and Fourier series had all been used to describe the topography of lenses.
In the early days of computing, technicians didn't always take to the introduction of new technology. Professor Jalie recounted the fate of one early Hewlett Packard 9815 that went missing from a lab in Dublin in 1975. It was discovered five years later when the river Liffey was being dredged.