Portal de Periódicos da CAPES

Specialist practitioners

2017; Elsevier BV; Volume: 40; Issue: 4 Linguagem: Inglês

10.1016/j.clae.2017.06.004

1476-5411

Shehzad A. Naroo,

Corneal surgery and disorders

A couple of years ago I wrote an editorial called ‘Specialist contact lens fitting’ and essentially what I was asking is what defines a contact lens as being a specialist fit [ 1 Naroo S.A. Specialist contact lens fitting. Contact Lens & Anterior Eye. 2013; 36: 105 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ]. Is it the product (i.e. the lens), is it the patient and their underlying condition, or it is the practitioner? Although it is probably a combination of all those things I would argue it is largely the practitioner that is ‘special’. In that editorial I was exploring what would be deemed as entry level practice and what would be deemed as advanced or specialist skill. To achieve a specialist level a practitioner may engage in further training or more often they develop an interest in a specific area and develop that skill set through gaining as much experience as possible. For example in the UK if an optometrists wishes to gain the speciality of Independent Prescribing then this requires further formal training, followed by gaining some additional experience of clinical observation and then maintaining that level in the future by demonstrating specific continued education and training in that field. The College of Optometrists in the UK has higher qualifications in the field of Contact Lenses, Glaucoma and other areas too. The BCLA is looking at developing specialist areas too and may start to offer specific course too. At the 2017 BCLA Conference in Liverpool there were many talks and posters themed around Dry Eye and its Management. This was very timely of course because the Tear Film and Ocular Surface Society (TFOS) released the Dry Eye Workshop’s 2nd report, known as DEWS II, in 2017. The DEWS II offers an updated definition of what dry eye disease is and provides the evidence base from the peer reviewed literature to support best practice. Issue 6 of CLAE in 2017 will be a special themed issue around the topic of Dry Eye and will include the excellent presentations of the European Dry Eye Network (EDEN) early career researchers. The ten of them presented short talks at the BCLA and for most of them it was their first conference presentation and to do that on such a huge stage must have been very daunting. Other papers will also be included in the themed issue in 2017 and the Guest Editor will be Professor James Wolffsohn. At the BCLA conference many new diagnostic and treatment devices were on display in the exhibition area. Nick Rumney, of BBR Optometry Ltd in Hereford, gave a nice overview of current treatment options, and his colleague Jessica MacIsaac talked about implementing a dry eye service in routine practice and the business case around that. So how do you get started, how do you become a Dry Eye Practitioner? In the past I have lectured on co-management in refractive surgery and primary eye care practitioners can have two levels of involvement, what I have called passive or active. The passive involvement is to just answer patient queries, the active involvement is to promote the treatment and have the relevant instrumentation to take necessary measurements such as a pachymeter and a corneal topographer. Another analogy could be sports vision – there are many practitioners who claim to be involved in sports vision, however, in reality the range of involvement can be so varied. If a practice is close to where many footballers live and they frequent that practice to buy their eyewear does that practitioner qualify as a sports vision specialist? What if the practitioner sells specific sports eyewear? What if the practitioner advises a sports team? Professor Gail Stephenson was without a doubt a Sports Vision practitioner. She worked with the Manchester United football team (as well as being the Head of the Directorate of Orthoptics and Vision Science at the University of Liverpool). When she sadly died in 2015 Sir Alex Ferguson, former Manager at Manchester United, read a eulogy at her funeral, which was attended by many of the sportsmen she worked with. She and her work were obviously an important and well-respected part of the training programme. Similarly, Professor Michel Guillon, this year’s BCLA Medal Winner, has been working with the Chelsea football team for many years. I have worked with Michel on some other Sports Vision projects [ 2 Dalton K. Guillon M. Naroo S.A. The Importance of the Penalty Kick in the Modern Game of Football. European Journal of Sports Science. 2015; 10: 815-827 Google Scholar , 3 Dalton K. Guillon M. Naroo S.A. Ocular Dominance and Handedness in Golf Putting. Optometry and Vision Science. 2015; 92: 968-975 Crossref PubMed Scopus (9) Google Scholar ] and again without a doubt he is a Sports Vision practitioner. The Sports Vision practitioner firstly needs to have some specialist skill, and this may or may not be after formal training but will certainly be after years of experience in that field. Secondly, the person would need to have specialist diagnostic instrumentation and possibly even instrumentation to aid vision training. Finally, they would be able to implement a differential management approach based on the individual sportsman’s needs. If someone was to call themselves a Contact Lens Specialist we would expect them to have years of experience of unusual contact lens fitting, maybe higher qualifications, appropriate diagnostic equipment (such as a corneal topographer) and be able to manage a wide range of fitting with a wide range of lens options to manage all types of contact lens requirements. . So applying the same criteria to dry eye practice. Does the person have the specialist skill, do they have specific diagnostic equipment and do they have the means to offer different treatments? So if we are going to implement dry eye clinics in our practices, and there certainly seems to be a need for that in many regions, then let’s do it properly by utilising best practice. Otherwise the patient will simply go to their local pharmacy where they often do not get the appropriate management [ 4 Bilkhu P.S. Wolffsohn J.S. Naroo S.A. Management of Dry Eye in UK Pharmacies. Contact Lens and Anterior Eye. 2014; 37: 382-387 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar ]. The DEWS II report has extended evidence base for what types of dry eye conditions there are, risk factors, diagnostic tests and even management options, and is a great template for implementing best practice.