Can I help anyone out there?

[Ali Akay]

Hi everyone.My name is Ali Akay.I am fortunate enough not to have KC but I am an optometrist with a special interest in KC.I visit a number of hospital eye departments fitting contact lenses to patients who need them for medical reasons. Nowadays the biggest group is undoubtedly keratoconics, so I am familiar with the problems and frustrations of KC sufferers. As this forum is essentially a support forum for sufferers I am not sure if I qualify to join but I am happy to contribute. I am not sure what the story is regarding Lynn White, and perhaps it's not wise to offer professional opinions on this forum as, apart from everything else, there's vast range of opinions amongst optometrists for managing KC and it would be difficult to say who is right and who is wrong.I am most probably biased but will try to be objective!

[Susan Mason]

Hello Ali

I would say welcome to you and personally I don't see the harm in you posting and of course you are entitled to your own opinions, after all it is a free country and I am sure that none of us with KC are without common sense.

Most of us are already well aware about the different opinions of the many medical professionals and also the good old postcode lottery system, where dependant on where you live can sometimes seem to influence how many different types of lenses are tried.

Basically at times it can be dreadful after all we are aware it could in most cases be worse however all of us have one common goal, to be able to see and do so for long enough to live our everydays lives, go to work feed our children etc. This can sometimes be a little fraught if you only have one lens and can only wear it for a limited amount each day.

As I said, yes I know it could be much worse however I can't see what harm yours or for that matter Lynn Whites posts can have.

best wishes
Susan
(frustrated mother)

[Ali Akay]

Hi Susan
The lottery system is very unfortunate. Another factor historically has been abolishment of GP fundholding system. Despite its limitations it gave GPs the means to refer patients to any hospital they wished which was particularly useful when a patient moved away but wished to stay with his/her existing practitioner.The current PCT structure makes it virtually impossible for GPs to refer patients outside the area. The consultant at the local hospital is able to do a ECR (extracontractural referral) but they would normally do this only if their contact lens practitioner accepted he was out of his depth. Unfortunately the patient is usually asked to "keep persevering" when some patients would be willing to travel hundreds of miles to see their existing practitioner through HES, and some resort to going private which is wrong and should not be necessary.I am not sure what the answer is but the incidence of KC is undoubtedly on the increase and there probably arent enough practitioners with appropriate expertise

[GarethB]

I think it is good optoms are now looking at this site. We probably ask more questions here of each other than we dare ask our optom who we should be asking!

If it helps in the understanding of KC and can help those you treat all the better, perhaps others will do the same. It would also be good for us to understand why optoms have to do things in a certain way so perhaps we become more understaning and patient with each other.

Welcome to the forum.

Gareth

[jayuk]

Ali

Good to see you post here

I think between yourself and Lynn; everyone who reads what you say can make there own decisions. Clearly, due to the nature of this board and its status it cannot be seen as pushing a lens etc. Howevever saying that if there is a lens out there that is a good option, ie Sclerals , Kerasoft, Rose K than I dont see no harm in it being mentioned from you guys. Clearlt youd have to mention the fact that your are an Opticians (which you have) and cover your post from any direct action!

On the same issue, can I ask how old you and and how long you have been fitting KC patients and your lens experience?.(IGNORE THIS; I JUST USED MY BRAINS AND CHECKED YOUR WEBSITE! )

Fitting KC patients is an art that ONLY comes from experience.....sad but true. So a post grad with 2 years at a CL Clinic probbaly isnt someone whom Id go to for a lens fit...........no offence!.....

[Ali Akay]

You are so right about the importance of experience Jayuk.The sad thing is most optometry graduates nowadays know very little about rigid gas permeable lens fitting.Even the advanced DCLP (Diploma in Contact Lens Practice) qualification does not require real expertise.With so many one fit disposable lenses serving 80% of the population there isn't enough incentive for optoms to have to improve their expertise in fitting the relatively small number of "complex" cases

[jayuk]

Ali

Indeed I agree...but then now you are talking about money!...see its not important as company / lens manufacturer cant make alot of money..my case was/is an example...at one stage for 2 years I had a change every 6 months...now many manufacturers change them for free within 6 months...therefore they dont make money!.......wierd i guess...but money makes the world go round!.......

I also agree that finding a good lens fitter is THE most hardest thing to do!....

[Lynn White]

Hello Ali...

Glad to see you here. I had not been posting much because it was generally felt that only one professional here was a bit unbalanced. I had said I would not come back until there was at least another practitioner on here... so I am very glad you came on!

To leap straight in, I agree with what you have said above but would perhaps say its a bit chicken and egg - since most complex cases are seen in hospitals, they do not even turn up on private practice doorsteps, thus no incentive to hone one's skills.

When I started out, such cases were contracted out, so I cut my teeth on the most complex cases the hospitals could throw at us. After they were taken back into the hospital service, I think gradually the overall expertise in the country died as new graduates were not exposed to challenging cases.

Jay's point is also very valid. Because of cross subsidies in private practice - ie money earnt from sales of frames and lenses subsidises the NHS fees - return of money on chair time is a priority in many high street chains.

It is hard to see where all this will end - but I think the profession is determined to improve its expertise and the now legal requirement for CET (Continuing Education and Training) means that we can maybe start to interest more practitioners to involve themselves in more complex contact lens fittings.

Lynn

[Ali Akay]

Hi Lynn
I was fortunate that when I started my pre-reg year my supervisor was attending a large hospital eye department as contact lens practitioner.Hence I was exposed to complex fittings from the start and attended theatre sessions with him fitting aphakic babies with contact lenses which was a great influence.It was obviously much later on when I was let loose on the patients but my early exposure gave me the confidence I needed. I guess it's much harder as you say for a graduate nowadays to get the opportunity to gain experience. We are sometimes approached by optoms who want to "watch over" and we always try to accommodate them.It does seem right for all complex patients in a hospital catchment area to be managed by the same practitioner(s) as long as there are enough practitioners to give a reasonable service. This brings us to funding and most hospitals are unable to increase their contact lens budgets as they have too many other targets to meet!

[Lynn White]

Ahh thats interesting! I too was involved with fitting aphakic babies - and I was priveleged to follow them through to adulthood as we got them referred back out to us as they grew up. Small world!

Where I would actually start to diverge from what you are saying is that hospital environments are not really the place to interact with patients. I left hospital clinics because I found that patients could not just "pop" in when they had problems. I could deal with them much better in private practice - with NHS vouchers of course. Plus - hospital coverage varies drastically with areas.

I have recently been drawing comparisons with cataract funding - its amazing how fast we can get cataracts operated on now that we have direct referral rights. I see no reason why we cannot set up specialised contact lens contracts along the lines of diabetic and glaucoma systems - it costs a lot less for us to see a patient compared to a hospital appt!

You spend a lot of time in hospitals.. I spend my time dealing with this in private practice.. so between us we should cover most eventualities!

Lynn