Sorry about the lateness of this post, I actually saved it as a draft by mistake instead of publishing it two weeks ago! 

In my previous post, I talked about the practical aspects of Visit 1.  Now, I’m going to talk about the other competencies assessed, starting with the boring bits:

2.1.2 Maintains confidentiality in all aspects of px care

Well, you could read the Data Protection Act (1998) in its entirety but that would take the rest of your pre-reg (seriously, check it out: http://www.legislation.gov.uk/ukpga/1998/29/contents).  

I would recommend looking out your uni notes on the topic and reading them instead. Make sure you know how long you have to keep records, what information you can give out and to whom. Consider different scenarios and how you should handle them – e.g. a daughter wishing to ask about a parent’s eye health (I’ve had this happen), an optom (from a different company) asking for patient details like Rx and VA, etc.

2.2.2 Is able to work in a multidisciplinary team

Hopefully, you are already settling into practice.  Know which parts of the eye test can be delegated to optical assistants (although results should always be checked by an optom and the OAs need to be properly trained, obviously).  

Ask your supervisor about shared care.  I can’t give you any tips because each region has its own system, which is actually a bit annoying since you may see patients in your practice from other regions.  Make sure you know what to do for Wet AMD, retinal detachments and other emergencies.  Also make sure you know what to do for more common ocular conditions – like a symptomatic cataract, corneal ulcers and abrasions.  Your region should have a retinal screening program for patients with diabetes so find out a bit about this.

2.2.3 Is able to work within the law and within the codes and guidelines set by the regulator and the profession

Well, you should know the basics of the Opticians Act and look over the GOC code of conduct (they sent you a little book when you first registered with them).  Again, these will probably be summarised in one of your uni courses so I would look to your notes rather than try and memorise the entirety of these documents.  Know your limits – that’s the main thing.

In my Visit 1, my assessor skimmed over these areas, obviously she found them as boring as I did.  

5.1.2 Instructs the patient in soft lens handling and how to wear and care for them

The main thing is, as always, safety.  I have a little checklist in my head that I go through at the end of the I&R/teach:

1) name and type of lens (daily, monthly, 2 weekly).  A few pxs I’ve met seem to think a monthly lens means they can wear it for 30 days, over a period of several months so make sure you are clear – it’s like food, once opened, it has 1/7/14/30 days before it “expires”.

2) maximum wearing time.  Also, don’t sleep in lenses (except EW, which has its own set of instructions at this point).

3) cleaning and caring for the lens:

a) rub and rinse.  I usually give a demo of this.  Tell the patients why they need to clean their lenses.  It’ll keep them in good condition so they will be comfortable and clear for longer.

b) which solution to use (usually MPS). I remind/tell pxs that saline and MPS are two different things since the saline is a lot cheaper and usually near multipurpose solutions.

c) don’t top up solution.

d) clean the case on a regular basis (because of biofilm build up).  I recommend washing in soapy liquid then leaving to air dry (once a week).

e) no tap water.

4) what to do if something goes wrong:

a) if the px can’t get their lenses out, come back into the practice or, if it’s late at night, their nearest A&E will be able to get it out.

b) if one or both the px’s eyes are sore or red, do not put the lenses in.  If they are sore and red with the lenses in, take them out.  If the lens feels uncomfortable and vision isn’t as good as it should be then the lens may be inside out.

5) warnings and tips:

a) no swimming or bathing in lenses (except dailies, which can be discarded afterwards).

b) lenses first, then make-up.

c) never share lenses (happens more than you’d think).

d) put reminder in phone about when to change lenses or get into a routine (this is for monthlies or 2 weekly lenses)

e) there is no “5 second rule” for contact lenses. If it’s on the floor, it’s game over.

6) importance of aftercares.  You want the px to see well and feel good in their lenses so you want to see them on a 6/12/24 month basis. 

6.1.1. Understands the risk factors for common ocular conditions

If you have a smoker, then you’ve pretty much got someone at risk of everything.

If you have a someone with diabetes, the chance of them having retinopathy is linked to the amount of control they have and the amount time they’ve been diabetic.  

ARMD is a risk for those with poor diets, smokers, people with a family history of ARMD.  Dry is a risk factor for wet.

Glaucoma risk factors include age (>40), family history, steroid use, race, thin corneas, high myopes.

Risk factors for cataracts: age, UV exposure, diabetes, glaucoma, uveitis, steroids and other medications, family history, trauma.

6.1.11. Understands the treatment of a range of common ocular conditions

Treatment of cataract is usually removal if it’s reducing a patient’s quality of life. There may be a VA limit that your local HES has set, i.e. refer only patients with a VA of less than 6/12.  Know the basics of phacoemulsification (I usually tell patients a little bit about the operation – most people like the bit about the tiny little hoover that sucks the broken up “cataract” out).

Dry AMD has no treatment although I would always mention leafy greens, stopping smoking and maybe taking some vitamins.  These will not improve the vision but may slow the progression.

Wet AMD is treated using Lucentis (and other anti-VEGF drugs) injected into the eye.  Make sure you know your local referral pathway for this.  The urgency of the referral may depend on VA so make sure you know about these.

Treatment for glaucoma depends on the type.  For closed angle, it could be an iridotomy or other surgical option and for open, it’s usually drops (beta blockers or prostaglandin analogues or carbonic anhydrase inhibitors).  Sometimes for OAG, a combination of different drugs may be used.  BTW, watch out for glaucoma patients with unnaturally long, thick lashes – this is a side effect of prostaglandin analogue eye drops!

 

Anyway, I’ve not meant this post to be exhaustive but hopefully, it’ll make you think a little about the different parts of Visit One and how you can prepare.  As I said before, this is an introduction to your assessor so make sure you make a good impression.  Dazzle them with your smile and professionalism as well as your knowledge!

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