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November 2013 Website dispensingoptics Dispensing Optics PO Box 233, Crowborough TN6 9BD Telephone: 01892 667626 Fax: 01892 667626 Email: [email protected] November 2013 Website: www.abdo.org.uk 3 dispensingoptics CONTENTS November 2013 Cover point 3 Cover point 4 Continuing Education and Training Charles Bonnet Syndrome by Richard Harsant 6 Frequently asked questions 8 Patient and practice management Business planning for beginners by Antonia Chitty 12 Profile From veterinary to optometry Getting the message across the Department of Health, Lord Howe, interview by Nicky Collinson It has been a very bUsy aUtUmn of to discUss a range of cUrrent and political activity. The Optical pending issUes. 14 Patient and practice Confederation was represented at all management Appraising staff three main Party Conferences by oUr The day after the minister’s meeting by Paul Surridge excellent PUblic Affairs team of Jenny the PUblic Affairs team had set Up a Gowen and Ben Cook. Jenny and visit by the chair of the HoUse of 16 Book review Ben organised a series of meetings Commons Health Select Committee, Practical Binocular Vision with ministers, shadow ministers and Rt Hon Stephen Dorrell MP, to a Assessment leading spokesmen as well as practice in his constitUency in Anstey by Peter Black organising a series of fringe meetings. at Opticare Opticians where, practice 18 BCLA news We also worked in collaboration with owners Shaishav Shah and Paresh Celebrate the Best of British at the Patel, were able to brief him on the oUr colleagUes from pharmacy and 10th BCLA Pioneers Conference aUdiology pressing home the cUrrent optical scene in Leicestershire message aboUt the level and range (pictUred above). Also present was 20 Optical bodies clarify position on of high qUality services which we, as a the LOC Chair for Leicestershire and CE-marked fluorescein strips profession, can deliver on the high RUtland, Vinesh Patel. street. 24 Member musings So far, Jenny and Ben have arranged Gone in 60 minutes by Dave Wright The conference season was followed over 80 constitUency visits for by a private meeting between Members of Parliament to local 26 Dispensing places representatives of ABDO, AOP, FODO practices and this initiative will Progression in store and LOCSU with oUr own minister at continUe to grow. We are constantly interview by Nicky Collinson battling against a strong headwind of other competing health interest 29 Black arts groUps and the wider political by Peter Black landscape bUt, the Government does 30 Newsbrief need Primary Care to work, and we are doing oUr very best to ensUre that 42 CET answers they Understand jUst how effective Instruments for ocular examination optics can be in delivering high part one: the ophthalmoscope qUality care to patients. Tony Garrett n 44 Disjointed jottings from a DO’s desk . DO on the run ABDO works in Partnership with: by James Conway 44 Optician Index 47 Diary of Events ABDO is a member of: Front cover: Porsche ABDO also actively works in conjunction with: Design P’8478 available from Rodenstock 01474 325555 The Worshipful Company of Spectacle Makers 4 dispensingoptics November 2013 Charles Bonnet Syndrome by Richard Harsant FBDO (Hons) CL (Hons) LVA Hon MIADO CompetencIes covered: Dispensing opticians: CommUnication, Low Vision Optometrists: CommUnication, OcUlar Disease Charles Bonnet Syndrome is a persistent or repetitive visUal syndrome, bUt patients attending phenomenon experienced by some hallUcinations High Street practices may also people with low vision. It is • FUll or partial retention of insight describe their symptoms. Eyecare Understood by low vision practitioners into the Unreal natUre of the practitioners shoUld Understand the bUt less so by eyecare practitioners hallUcinations condition to be able to reassUre their working in many High Street • Absence of hallUcinations in other patients. practices. The pUrpose of the article sensory modalities is to enable sUch practitioners to help • Absence of primary or secondary Prevalence and advise their patients who may delUsions Charles Bonnet Syndrome (CBS) is a experience sUch phenonomena now problem encoUntered by aboUt 15% or in the fUtUre. In simple terms patients “see” things of patients with visUal impairment2. It that are not really there. is therefore often encoUntered in Low Charles Bonnet was Swiss. He was a Vision (LV) clinics in patients who lawyer by profession, bUt he devoted Many patients are reticent, have retinal pathologies, particUlarly mUch of his life to stUdying embarrassed indeed frightened to those that affect the macUla. philosophy and natUre. In 1769 he discUss this phenomenon with Patients’ ethnicity does not appear reported that his 89 year old clinicians becaUse they fear they are to affect the prevalence. Most grandfather (whose vision was losing their sanity. patients will have a macUlar deteriorating) had begUn to pathology and VisUal AcUity (VA) in experience visUal hallUcinations. The hallUcinations may take the fairly the region of 6/60 to 3/60 Snellen. These might take the form of people, benign forms reported by Bonnet, bUildings and other everyday objects1. bUt some patients report giant The role of the low vision spiders and other more alarming practitioner Diagnostic criteria for Charles Bonnet objects. Many patients will become alarmed Syndrome (CBS) are generally and distressed by the symptoms they accepted to be: Dispensing opticians working in low are experiencing. A common fear is • The presence of formed, complex, vision clinics may be familiar with this that they may be the precursor to This article has been approved for 1 CET point by the GOC. It is open to all FBDO members, inclUding associate member optometrists. The mUltiple-choice qUestions (MCQs) for this month's CET are available on page 6 and online. Insert yoUr answers to the six MCQs on the inserted sheet or online at www.abdo.org.Uk. After log-in, go to 'CET Online'. Please ensUre that yoUr email address and GOC nUmber are Up-to-date. The pass mark is 60 per cent. The answers will appear C-32565 in the JanUary 2013 issUe of Dispensing Optics. The closing date is 12 December 2013. Continuing Education and Training dementia, and because of the handle this sort of situation, but one Please watch the following clips, and stigma that still exists about dementia way might be along these lines: answer the multiple choice questions: and other similar conditions the 1. London Conference 2012 Charles patient may be very reticent about “I don’t know if this has happened to Bonnet Syndrome. The Macular discussing them. you, but some people with your sort Society. www.youtube.com/ of eye condition find that they tend watch?v=QVOG5Ifbf4c Discussion however has been found to see things that they know are not 2. Visual Hallucinations - Charles to be helpful in many cases, and the really there, and I want you to be Bonnet Syndrome. The Macular hallucinations have been reported to aware of this so you don’t worry if it Society. www.youtube.com/ reduce in number and frequency happens to you. The area of the brain watch?v=bn_2KXw387s (note that following explanation by a that deals with vision is usually a very the link carries an underscore practitioner. This may be due to the active one when we have good before the ‘2’) patient knowing that they are not vision. It has lots to do, telling us 3. Charles Bonnet Syndrome - Living alone in experiencing them, and about all that is going on around us. If with macular disease. The Macular reassured that they are harmless. someone gets the sort of vision Society. www.youtube.com/ Many low vision practitioners have an problem that you have this area of watch?v=_NYuHdwgHRI (note that active policy on discussing CBS with the brain has much less information to the link carries an underscore patients in the “at risk” group. Doing process. In effect it becomes bored before the ‘N’) this may give comfort to patients who and makes things up that aren’t really 4. http://www.rnib.org.uk/livingwith are experiencing symptoms, but there.” At this point it is not unusual for sightloss/copingwithsightloss/ reticent about discussing them, and the patient to give a big sigh, and emotionalsupport/Pages/ also reduce the patient’s anxiety if say “thank goodness for that. I have emotional_sUpport_coUnselling.aspx they experience hallucinations at had that happen to me, but I didn’t (note that the link carries an some future date. like to tell anyone in case they underscore between emotional, support, and counselling.) thought I was going mad!” 5. http://www.rnib.org.uk/eyehealth/e Increasing age is statistically linked to yeconditions/conditionsac/Pages/ both low vision and to living alone. Grieving charles_bonnet.aspx The effects of CBS on vulnerable CBS can cause fear and depression in patients who may be recently the patients who experience it. The If you cannot open the YouTube links, bereaved can be quite devastating. effect may be compounded by the go to www.YouTube.com and search unrelated natural process of grieving for Charles Bonnet Syndrome. Select The role of the low vision practitioner that many people have when they from the search results. in assisting with the visual experience visual loss. This loss brings rehabilitation of these patients is to an emotional adjustment that people Alternatively, quick links to the video enable patients to lead their lives with need to make. The partial loss of any clips and the article text are available as high a degree of independence of our senses can involve a period of on the ABDO website: http://www.abdo. as possible in each individual case. mourning similar to the adjustment we org.uk/cet/charles-bonnet-syndrome/ make of the death of a loved one.
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