It was with some incredulity that I read your recent editorial and the letter from Ms Cotton (19.06.09).
Whatever the modality the risk of microbial keratitis is increased by at least five times if contact lenses are worn on an extended wear basis. In my view the prescribing of 'extended wear', except in exceptional circumstances, continues to be irresponsible and possibly negligent practice.
Given the extremely high numbers of contact lens patients this practitioner is seeing it will not be long before she encounters a patient in great pain and possibly permanently visually compromised. And Ms Cotton they will not be smiling!
Christopher Kerr
Croydon, Surrey
May I comment on an article in Optician (29.05.09). Following a fitness to practise committee hearing it was reported that I had failed to comply with conditions laid down by the FTP committee in November 2007.
My record keeping had been brought to the attention of the GOC following a visit in March 2005 by the local health board post payment verification (anti fraud) team including the optometric adviser.
By February 28 2008 I was to attend a one-to-one tutorial at a university department, this to be a minimum of three hours on record keeping and was complied with.
By June 30 2008, I was to have undergone a further six hours on record keeping. This was impossible to fulfil. Despite strenuous efforts on mine and the AOP’s part, nowhere in Britain could we find even a further hour, let alone six. The GOC, Vantage, and others were contacted at this time to no avail.
For 9/10 months of this year there are no conditions on my practising. They will start again in November and then there will be a further review in approximately two years’ time.
Forty years with no patient complaints, over a thousand records with no hint of fraud, 80 CET points in the present cycle and two follow visits with the LHB finding no fault with current record keeping still left the committee anticipating my future record keeping will be found wanting.
OW Stevens
Llanelli
Glaucoma and NICE are very topical at the moment and Bill Harvey’s article (19.06.09)highlights a number of valuable points.
It is very important that we remain clear about the distinction between detecting signs, and diagnosing OHT or glaucoma. An NCT is likely to detect signs or suspicions of raised pressure, and although some would argue that its specificity (detection of normals) is not as good as Goldmann this does not make it an unsuitable instrument to use for case finding in the context of what will mostly be GOS sight tests. Patients are then referred for diagnostic tests, which NICE says are outside the normal competencies of optometry.
Where NICE is insisting on GAT is in the diagnosis and monitoring rather than referral. Of course, it is open to PCTs to commission enhanced services to confirm pressures by repeated Goldmann prior to referral.
I personally think it unlikely that most practices will be involved in diagnosis in the near future, but I do think that many may find themselves involved in refining referrals and monitoring OHT, so I endorse Bill’s conclusion that many practices will find they need to acquire a slit-lamp mounted Goldmann tonometer in the near future.
I am not entirely clear where the quoted comment from NICE on monitoring OHT came from: ‘We came to the conclusion that we do not agree. Optometrists without further qualifications do not have all the competencies for monitoring.’ But I suspect they may actually have been referring to the monitoring of glaucoma, not OHT. Certainly the chair of the NICE Guidelines review group stated that he believed the core competencies of optometry covered the monitoring of OHT.
In the same issue of Optician there is an excellent article by Paul Spry (who was on the Guideline Development Group) and Robert Harper in which they say: ‘…monitoring OHT/suspects is within the competency framework of all registered optometrists…’ That certainly concurs with my own understanding of the NICE position.
Trevor Warburton
Clinical Advisor, AOP Legal Services
Should we all increase our practice security to prevent our used trial contact lenses falling into the hands of terrorists? Could this be the new ‘Dirty Bomb’ that terror groups could unleash on the public.
Who in their right mind could consider the new proposals seriously? I accept that some practitioners might have contact lens patients diagnosed with HIV or similarly infectious condition. In those circumstances I accept that used lenses etc are a potential hazard.
However, the average used contact lens is less toxic that the majority of things we regularly flush down the toilet or the plug hole. If used contact lenses are such a toxic bio-hazard surely all contact lens wearers should be obliged to dispose of their used lenses in a safe way.
If the authorities ever suggested that the public should dispose of their used contact lenses as a potential hazard it would be treated as a joke. We should do the same. Unfortunately, as a profession, we are seen as an easy target that will ‘Do as it is told’ or perhaps the waste disposal industry has infiltrated the Environment agency and the PCTs.
Don’t tell the Environment Agency about the nose pads we regularly replace, I dread to think what terrible organisms might be living on them.
Edward Ukleja
Peepers Opticians Banbury