I felt compelled to write to Channel 4 to complain about the Supershoppers Money Saving Special and its very poor level of journalism.
My first issue with the programme was that there seemed to be an objection to spectacles being fashionable or a fashion item. I would have to ask why are spectacles any different to any other item of clothing or footwear? Most people in the UK own one pair of spectacles and unlike a pair of trousers or a shirt will wear the same pair every day, for up to three years on average, before replacing them.
This long lifecycle requirement brought me to the subject of quality. The presenters suggested frames of equal or similar quality can be purchased online. This is simply not the case. All frames sold in the UK meet the relevant ISO standards and are CE marked accordingly. The material is of a generally higher quality and meets strict criteria for skin contact and interaction. The most basic frame material, cellulose acetate, is made from a combination of cotton and plasticiser. To process cotton is expensive and good quality acetates with a higher percentage of cotton and reinforced temples reflect this in the price. There was no investigation into why some frames may cost more than others, it was a simple case of ‘optician bad, internet good’.
Next they rolled out Dr Tony Grundy – a ‘strategic thinker’ with, as far as I can tell, no experience of optometry or the optical industry. He suggested that the optician’s practice is a quasi-medical front to flog spectacles. Personally, I found this to be insulting to those that have studied to qualify and care for people’s sight and health and also hugely misleading.
To become an optometrist requires three years of degree studying followed by a year pre-registration period under the supervision of a qualified practitioner. Optometrists carry out an eye examination of which only a part is dedicated to finding a prescription to correct ametropia. Optometrists are also able to detect, monitor and now treat eye disease, including diabetes, glaucoma, AMD and dry eye. In addition, they work ever more closely with hospitals to detect and refer as well as carry out Mecs to reduce pressure on hospital A&E departments. The requirement for spectacles is the result of scientific testing, not retail mumbo jumbo.
I should also say that if you are going to appear on national television extolling the virtues of internet spectacles you should probably be seen wearing a pair of spectacles that look good. Unfortunately, his own spectacles were bent at the bridge causing the temples to be higher than the bridge, they sat too low and they did not fit properly behind the ear. I assume he must have purchased them online and adjusted them himself using his huge knowledge and skill in the area, rather than being handed over to a ‘salesperson’. I prefer the registered and protected title of dispensing optician. Again, this requires level 6 education and focuses on understanding lenses, lens design and materials, frame design and materials, ocular anatomy and physiology.
A dispensing optician is not a salesperson. They are there to ensure the prescription provided by the optometrist can be used by the patient to meet their lifestyle needs. That may mean alteration of the given prescription to meet specific visual tasks, it requires careful questioning and understanding of the patients work and hobbies, something that cannot be done online.
Most egregiously, the programme appeared to suggest that it is OK to purchase spectacles for children in this way. As we are all aware that the supply of spectacles to those under 16, sight impaired or severely sight impaired is restricted by law. Specifically, the Opticians Act 1984 amended 1989 limits the supply of spectacles to these groups only by qualified and registered practitioners. Any researcher worth their salt should have been able to pick up on this. But to any parent watching this programme, they would have come away with the clear belief that ordering their children’s spectacles online is perfectly fine.
In the whole 15-minute segment they gave a single warning about varifocals being more complicated than other lens types and you should probably see an optician for these. It did rather dismiss the potential issues that could be caused from other lens types and prescriptions. As we know websites will ask for a PD, the pupillary distance. Most opticians will be reluctant to provide this as it is not really the relevant measurement to be used. What an optician will measure is the horizontal centration distance. This is the position of centre of the pupil in the frame that is to be worn. This matters more as almost no one has an equal split between left and right eyes and frames, especially plastics, may sit slightly to one side due to the shape of the wearers nose. But we are only able to measure this with the selected frame on the patient.
Most internet sites will therefore provide a ‘standard PD’ of 63mm. So, if we were taking an average prescription of -3.50D in both eyes, with actual optical centre of 68mm but ordered online and received the standard 63mm setting, this would result in 0.875 prism dioptres base out for each eye. A total of 1.75D prism base out. The ISO tolerance in BS EN 21987:2017 is 0.7 prism dioptres in each eye, a total of 1.4 prism. This is exceeded by a third of a dioptre. We all understand that ISO standards exist to protect the public from harm.
As can be seen in this simple example we are inducing prism which may result in muscle imbalance issues. Things get worse with higher prescriptions, or more complex lens designs where vertical centration becomes ever more important. The advantage of seeing a dispensing optician is that they have this understanding, and the skill set required to ensure that spectacles dispensed meet the relevant standards and quality.
I finished my letter to Channel 4 with the suggestion that if they truly want to understand the optical industry and just what it is that optometrists and dispensing opticians do to help and care for the nation’s vision, they should ask someone that knows. To date I have not had a response.
Jim Cox, dispensing optician, Eyoto
