Optometry student question??

[Lynn White]

Hi Conor,

As an optometrist with a huge interest in keratoconus, I think I can answer a lot of your queries from a professional point of view. As Anne said, at the last conference I spoke about trying to create a shared care system for keratoconus but that actually seems fairly unlikely, in England at least. With the different system in Scotland fro NHS examinations now, this may be a possibility there.

The issue at the moment is that the hospital clinics do a grand job of fitting lenses but not such a good job of ensuring people are kept "operational". By that I mean there are often very long waits for people to even pick up lenses (3 months is not an unusual time scale). This may not be a problem in normal CL wear but for a person with KC, it can mean the difference between seeing and being functionally blind. Shared care to me would mean that pick ups, routine after care and emergency visits could be carried out in the community. At the moment, though, experience of KC is poor in community optoms because they see so little of it and its hard to refer out of the hospital system because so few optoms have experience! This is a hobby horse of mine so I can supply you with lots of info! And I am SO glad you are including KC in your researches!

Anyway - all my contact details are below and feel free to email or give a ring if you want. I am lecturing to the Society on keratoconus in June so may even be able to say hi in person

Lynn

[Lia Williams]

Hi Connor,

I've also had experience of Hospital and High Street contact lens fittings. Here is my story:

I've worn corneal contact lenses for 34 years - the first 15 years for vanity, myopia and possibly mild astigmatism.

In 1990 I was told by an opticiam that my eyesight was 'up the spout'. That was my lowest point. She referred me to her colleague in the next town who fitted me, after several attempts, with some lenses which I wore happily for several years. I knew I'd been one of his challenges, but I was not aware of how much a challenge my eyesight was until I moved house and need to find a new optician.

I found an independent optician who was experienced in KC - but after three attempts on my right eye and two on my left he was unable to fit me successfully. This was another low point - an expert had told me my lenses needed to be replaced - but was unable to do so. I asked him whether I should be referred to the eye department of the local hospital and he replied that he was their expert and he didn't have the fitting sets to be able to fit me.

I then asked my GP to refer me to Moorfields and went for an appointment six months later. They also had several attempts to fit me, but a year after I set out to get a new pair I finally had a new pair of lenses. I've been with Moorfields now for 12 years and although I'd prefer to be able to go to a local optician rather than spending a day going to London they do prescribe me with what I need - a pair of lenses that don't ping out, give me 6/6 vision and can be worn for 15 + hours per day.

How bad is my KC? Difficult to say - beyond local specialists but not too much of a problem for Moorfields. I don't regard myself differently from anyone else who wears lenses for say myopia. It's just that my lenses are bespoke. I'm lucky that I now only need annual check-ups. I do dread Moorfields suggesting that the lenses need changing as any minor change has usually required trying several lenses over a period of several months to achieve success (not helped by each new lens taking a month or so to arrive).

Recently I have discovered that a colleague is using a local optician for his KC contact lenses. I'm not tempted to ask for a local referral as although this optician has access to all the latest KC lenses he has failed to fit my colleague who has gone back to glasses. My concerns about using high street opticians are that many of them do not see many cases of KC and therefore do not have the specialists skills, or the variety of lenses and fitting sets required to achieve a successful outcome. This is not helped by the time required to achieve a successful fit. At Moorfields my appointments with the optician vary in length (excluding waiting time) from 7mins (if every thing is OK) to over an hour (if new lenses are required).

The only downside of the hospital system is that I need to go to the high street for an eye test.

Lia

[Andrew MacLean]

AJ Elizabeth is the President of the Scottish Group and she is Moderator of the Scottish forum. She and I were invited to a meeting of the Scottish Contact Lens Society on Wednesday evening. Graeme is Chair of the Society, and Con was attending.

Con, I told you that you would find this a supportive place to ask your questions.

I was referred to my GP in Aberdeen by a high street optometrist (this was some years after another high street optometrist had told me that there was nothing that could be done), and my GP referred me to the eye infirmary in Aberdeen. They diagnosed Keratoconus and referred me to another high street optometrist who handled their contact lens work.

Shortly after that I moved to Glasgow and the high street optom in Aberdeen gave me an intriduction to the Eye Infirmary in Glasgow. They put me on the list of one of their surgeons. The service of the Eye Infirmary is now included in the profile of Gartnavel General Hospital.

I have had several lenses in my time; including RGP's, Rose K and a scleral. I have tried soft lenses, hybrids and even piggy backing but with no success.

In 2003 I suddenly became contact lens intolerant and was registered blind. I had one PK graft in December of that year, and when that operation had recovered to the point where I was able to wear glasses I had a DALK graft in my remaining eye. At about that time I ran into difficulty with a cataract.

I now wear glasses for my right eye, and an RGP on my left eye. This combination gives me better than 6/6.

It was really nice to meet you on Wednesday. All the best.

Andrew

[rosemary johnson]

Lia, why do you need to go to the High St for an eye test?
- that is, why do you need an eye test in an optician's if they aren't then going to do anythign for you?
Rosemary

[Lia Williams]

Rosemary,

Good question!

I need an eye test because Moorfields only 'examine the front of the eye'. I know it seems ludicrous that I traipse all the way up to town to the top eye hospital and they only do half a job! The bits they don't do is the glaucoma check, examine the retina etc. and provide me with a prescription for back-up glasses. The good bit is my eye sight is so bad that last time I qualified for a free eye test. The back-up glasses however were totally useless. Thank goodness that I didn't pay for a fancy frame and ultra thin lenses. The back up glasses I use are 12 years old and give me some vision, enough to find my way around the house in the morning and read (just). The trouble is that when people see me with glasses they I assume I can see! Although the above mentioned colleague did describe them as 'scary' when I took them to work to give my eyes a rest when I was having a series of bad eye days.

Lia

[Elizabeth Mair]

Hello Con,
It good that you are on the website.
Back to your original question. I wore hard lenses (Not RGP) from age 18, but when I went to a new High street optometrist soft lenses were all the rage, so I was persuaded to change to them.I had one normal soft lens like cling film and a toric len which was thick and jelly like.For a year I went back to the optometrist almost weekly to say that my vision had changed.He rarely believed me until he checked. Eventlually after a year when he had had enough I was referred to an opthalmologist at Hairmyres in E Kilbride, then to the Contact lens clinic at Gartnavel where I've had various types of RGPs ( last ones were Aquasil (made by Scotlens) and I have been using Kerasoft type lenses the last few years-have tried all the Kerasoft lenses but get best vision with the K2s although my wearing time is less than with the K3s. The Hospital contact lens clinic deals with all my contact lens things really well, but I still see a High street optometrist every 2 years because they check other things in my eyes which the contact lens clinic doesn't have time to do, plus they sort out the best prescription for glasses for me.

If they Scottish KC group can help you let me know. I 'm sure I can encourage people to be case studies for you if you need any one.
The Scottish KC group meeting today with Malcolm Louch was very good. He wished that he had brought equipment to look at our eyes closely, because you don't often see several people with KC together.Maybe you will manage to the next Scottish group meeting - details will be on the website.

[cmcerlean]

Thanks again for the very detailed posts everyone, this is much more infromative than the stuff in the textbooks.

At the moment I'm concerned mostly with identifying the point at which the optom needs to refer for more specialised help from the hospital/ophthalmologist and what the proceedure is for doing this. At present my contact lens skills are pretty limited, just being able to get a soft or RGP in and out of any eye is challenging enough for me! Next year I'll be working for the same company as Graeme (Scottish CL Society) so maybe I can get a bit more involved with actual cases at this point, looking forward to it.

Best get back to the books.....

[Andrew MacLean]

Conor

Please do stay in touch with us; it is always good to meet a student optometrist who is taking a particular interest in keratoconus.

Andrew

[Louise Pembroke]

I only went to an optician when I was about 14 because all the girls in my class were going to see this guy cos he was good looking!! So obviously I had to do my duty and check him out, he must have wondered why all these teenage girls were getting eye tests. Anyhow he gave me glasses but I got a referral to the ophthalmologist pretty quickly, he knew it was KC but didn't tell me. I had soft lenses from the hospital C/L dept and glasses from him until glasses were no longer viable as a backup and I needed a transplant at 20. I've only just returned to seeing a high street optometrist for glasses in addition to a hospital RGP for reading cos I'm middle aged bah..