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Report

SDC2: Specsavers Nationwide Dispensers' Conference 2018

03/10/2018By Lewis Williams PhD
Following a successful first outing in 2017, the Specsavers Dispensing Conference once again embarked on a four-city lecture tour in August. LEWIS WILLIAMS was in attendance, both as a speaker and also to detail some of the event’s proceedings.

The second iteration of the Specsavers Dispensing Conference (SDC2) benefited from the extensive experience gained during the 2017 series, resulting in a smooth running set of lectures/workshops delivered by nine presenters. The success was a result of the presenters’ experience, choice of topics, and the small head-office team that ‘rode shotgun’ on all four events to ensure smooth sailing.

The SDC’s aim was to inform, educate, and reinvigorate optical dispensers around Australia, regardless of whether or not they are Specsavers’ employees/partners. In the absence of other, similarly broad initiatives, to some extent the SDCs are continuing/in-service education/training for optical dispensers – for that, Specsavers should be applauded.

Given the even greater success of the 2018 events, it is reasonable to assume that SDCs or similar endeavours will become annual features on the ophthalmic events calendar, just as the recent Specsavers Clinical Conference 7 (SCC7) is now firmly entrenched as a major CPD event for Australian optometrists irrespective of their place of employment.

It's all about the face

Returning presenter Ms Alicia Thompson, director of professional examinations at the Association of British Dispensing Opticians (ABDO), was accompanied in 2018 by her colleague Ms Miranda Richardson, ABDO’s assistant director of exams. Both delivered the program’s first lecture, which focused on the spectacle frame as being the most important aspect of dispensing, as far as the wearer is concerned.

Their presentation took delegates through the range of facial measurements required for good dispensing. To emphasise those factors, the subsequent in-presentation exercise was based on the delegates designing a paper cut-out spectacle frame front (chassis) incorporating the measurements taken on their partner.

With the ABDO-supplied four-colour pens at their disposal, some of the colourful ‘frames’ produced showed considerable buy-in and imagination by those in attendance. Steps were also taken to help delegates match particular facial characteristics with frame features that went a long way towards ensuring a suitable appliance was chosen that optimised wearer appearance and comfort, i.e. both technical/professional and cosmetic aspects are satisfied.

After morning tea, the two presenters ran optical prescription analysis workshops that set out to encourage critical thinking about written Rxs and possible problem detection as a preventative measure. Logically, that led to problem solving and the development of possible solutions.

Ultimately, those step were aimed at reducing wearer returns, remakes, and complaints – aspects of practice that nobody enjoys.

KEYNOTE SPEAKERS

Alicia Thompson

Miranda Richardson

James Gibbins

Trent McInerney

Vincent Nyugen

Timothy Haigh

A triumvirate of lecturers

Immediately after lunch, delegates were offered a choice of three concurrent lectures – How to Train Your Dispenser delivered by the Australian College of Optical Dispensing (ACOD)’s Mr James Gibbins; Tolerances: The How, When, and Why of Modern Optical Standards by RMIT’s Mr Timothy Haigh; and A Tick for The Ticktower: Certified Prescription Safety Eyewear by Rx Safety’s Mr Trent McInerney.

Gibbins has worked in optics for more than 35 years and has been an optics educator for over 20 years, having spent time in the NSW TAFE system and more recently as a partner in ACOD. He focused on the friendship and partnership between a practice’s trainee optical dispenser and the resident optical dispenser.

In a progressive optometric practice, he described the role of the optical dispenser as being major and valued, the manager of the retail and dispensing side of operations. They should interact with almost all visitors to the practice, work closely with the optometric practitioner while setting the ‘fashion tone’ of the practice, and be responsible for the generation of the bulk of the practice’s income.

Gibbins offered suggestions for recruitment ads, reasons to employ a particular person, interview protocols and probing questions, candidate induction, and the beginning of the successful candidate’s training. Importantly, the preparation for, and enrolment in, one of the Certificate IV Optical Dispensing courses available in Australia was detailed and issues such as who pays for the course, when the candidate would be out of the practice on course and successful course progress were also discussed.

Obviously, opportunities to practice what has been learned in a course requires both some leeway by established practice staff and some supervision by them as well. He advised against indulging in criticisms of the course, its teachers, their methods, etc. although he acknowledged that getting involved in healthy debate was appropriate and supportive. He identified maths as a potential problem, especially if a student enters a course without significant high school mathematics, as that can make dealing with even basic optics a challenge for some.

Haigh’s lecture covered the standards that applied to spectacles and other optical appliances in Australia. The Australian standards are essentially ISO Standards-based, including the draft 2017 ISO Standards.

Standards dictate tolerances for key factors such as BVP (PPLs have somewhat more liberal standards), cylinder axes (smaller cyls have larger tolerances), prism (especially vertical), PDs, etc. Generally, the standards applicable take an ‘as worn’ approach, including ‘wraparound’ lenses and appliances.

Haigh cited Martin’s Rule as being the way to compensate for the oblique astigmatism introduced by tilting thin lenses. Before measuring PPLs or other lenses with inconspicuous manufacturer’s marking, Haigh advised the audience to reinstate the markings before any measurements are attempted. He noted that Hilco and Hoya offer mark-disclosing devices to assist that process.

Perhaps the most complex lecture of the three was given by McInerney, who spoke about standards in relation to safety eyewear. The Ticktower he mentioned in his title relates to the aligned vertical column of ticks used almost universally by standards organisations, e.g. Standards Australia has five white ticks on a red background.

He certainly disclosed just how complicated the compliance regime was and what that meant for any company supplying certified safety eyewear in Australia. The need for safety eyewear is huge with some 87,000 presentations to emergency departments in just 2 years up to mid-2015 and 52,000 people hospitalised for eye injuries over the 5-year period up to mid-2015.

Around 6% were ‘on the job’ injuries and males outnumber females 10:1. AS/NZS Standard 1337.1 tests eyewear ballistically for three levels of impact resistance (low, medium, and high) and includes dust, splash, corrosion resistance, and spectral transmittance. Other standards cover optical tolerances and offer advice on suitable eye protectors according to hazard, but do not include ionising radiation.

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McInerney detailed what is involved with his company (Rx Safety) acquiring a suitable licence from SAI Global. Included are a Quality Compliance system, e.g., ISO 9000, personnel training, instrument and machinery calibration and certification, and third-party testing (usually destructive) of finished products.

That is not the end of the matter as certification, once achieved, has to be maintained by a process nearly as complex that also involves further destructive testing. Staff retesting occurs at yearly intervals and traceability of all input materials is essential. He also explained one safety aspect that many may not be aware of – the current standards cover lenses only within a certain range of BVPs that can be certified.

Naturally, prescriptions are required outside the specified range (higher Rxs). In that circumstance, the appliance cannot be ‘certified’ as no standard applies and instead, provided it can withstand the normal tests, it is presented as a ‘compliant’ product, i.e. although it is outside the standard’s parameters it nevertheless meets the same safety standards.

Once safety eyewear is certified it means that lens strength, frame strength, and lens retention together meet requirements. Exposure to McInerney’s presentation puts safety eyewear in a whole new light and some admiration is due to suppliers of certified or compliant eyewear given the hoops, initial and ongoing, they have to contend with to be able to ply their trade legally.

Contact lenses

Because dispensers encounter CL wearers in their daily activities, I delivered a presentation on CLs, including types and their history, traps for the less experienced and unsuspecting dispenser, and vertex distance compensation issues, especially in high Rxs but with cyls below 4 D.

I also covered some optical considerations that are required when deciding on CLs or spectacles, e.g. significant anisometropia that is axial rather than refractive in origin is best treated with spectacles, not CLs, while swapping a spectacle-wearing myope who is also an incipient presbyope to CLs will most likely lead to them needing reading glasses immediately as they have a greater accommodative demand in CLs. Conversely, a hyperope under the same circumstances can probably stave off the need for reading specs for a time if they convert to CLs.

The issues of product substitution with CLs and CL care products was also covered in some detail. While my lecture was not intended to give dispensers all the answers, it was intended to give them the resources to tackle problems arising intelligently including when and what to refer to others in the practice if they are not equipped to deal with the problem themselves.

Blue light

Former academic and still active researcher Emeritus Professor Stephen Dain, tackled the fraught issue of blue light, the claims, the counter claims, and the reality. His opening statement was that ‘there are no safe wavelengths, only safe quantities’ and in a nutshell, that says it all.

There are only two mechanisms for retinal damage, thermal (short-term only) and biochemical (can be short or long-term). It has been known since 1971 (Harwerth and Sperling) that blue light can damage the retina in the short-term but the retina’s natural repair mechanisms can effect complete repair of such damage. Permanent problems only arise when the damage is beyond the retina’s repair capability.

To establish safe quantities the following imbalance must prevail for there to be no problem: Maximum Accessible Exposure (MAE) < Maximum Permissible Exposure (MPE). Because of the yellowing of the ageing eye, age is a significant reducer of the risk factor posed by blue light.

The link to AMD is not especially strong, but studies imply that more than 7 hours per day of direct, high levels of sunlight exposure increases the risk of neovascular AMD. While early age exposure to sunlight when the eye’s light transmission is at a maximum is suspected of contributing to AMD, the results from epidemiological studies are contradictory. The level of circulating anti-oxidants hasn’t been shown to be relevant unless the level is in the lowest 25%.

Importantly, when compared by total energy and wavelength, LED light sources can be shown to pose no additional blue risk than more traditional light sources. To put all the data in perspective, Dain calculated the following figures to reach dangerous limits:

  • Computer worst case: Uncomfortably bright screen setting: 243 days of continuous use

  • Computer 1 hr per sitting: Normal screen setting: 1,900 days (Cease counting after 10,000 seconds [2.8 hr] however, as effects are not cumulative

  • Worst case outdoors: 9 days

  • Sun direct: 8 seconds

  • Exposure to a slit-lamp: 3 minutes (there is a message for all of us in that figure)

Dain’s conclusion: LEDs are the way of the foreseeable future. Blue light can be a hazard but at normal indoor exposure levels, the risk level is ‘vanishingly small’. He suggested the use of warm white LEDs if the user is still worried.

However, outdoors is an entirely different matter and is far more hazardous potentially at least (staring at the sun directly is the only proven risk e.g., solar retinopathy). Regardless, he believes that even outdoors, the risk is “pretty small”.

His take home messages were: generally, it is invalid to extrapolate data from acute studies to those based on chronic exposure, as dosage is only cumulative up to a certain time point, and repair takes over. He doesn’t believe that it’s possible to carry out studies that would show reducing blue light would have beneficial or deleterious effects on AMD incidence.

Risk factors of AMD were age, genetics and well down the list is blue light in nature – those factors are not modifiable. Modifiable risk factors include smoking and possibly diet. There is a possibility that blue light might be protective against myopia but the jury is still out on that issue.

His parting advice was to set computer monitors to the yellowest possible, brightness to a minimum, and use a free app that modifies the screen colour after sunset. Choose LED light with a colour temperature around 3,000K and wear sunglasses outdoors, preferably with a wraparound design to reduce the incidence of solar ophthalmo-helioses, such as pterygia.

Overall, Dain’s presentation was a comprehensive treatise on blue light and, given the current level of interest in the issues surrounding blue light, a timely topic that was very well received in all cities. The strong delegate engagement with the lectures delivered during SDC2 means that it’s highly likely the series will continue and evolve further.



Driving and vision

Professor Joanne Wood from QUT’s School of Optometry and Vision Science is a world renowned expert on driving and vision and her presentation did not disappoint. She began with overviews of current legislation, comparing and contrasting states, and noted the differing requirements for commercial and ordinary licences. Wood also reviewed re-test regulations for older drivers around Australia.

She then discussed current research thinking and detailed some of the studies she and her team had completed or are currently undertaking, with cars modified suitably and driven in the real world in Brisbane city or on the closed-circuit Mount Cotton Driver Training Centre near Brisbane. Using simulations, she demonstrated the road and car vision experienced by drivers with various ocular diseases especially glaucoma, diabetic retinopathy, cataract, and AMD.

Overlapping safety issues were also addressed, especially peripheral awareness of smaller objects (children and animals), people, other cars, traffic lights, etc. It’s probable that the content of Wood’s lecture was as relevant to the delegates themselves as it was to their role in discussing related matters with their clients.


Editor’s note: Vincent Nyugen’s presentation has not been reviewed as the author presented at the same time.

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