NEHW – I didn’t come to see you in case you told me I had a brain tumour

September 21st, 2015

It’s National Eye Health Week this week and I thought I would mark it by showing the gulf between health care professionals and our patients! The title of this post polarises the views of my patients massively.

Some of my patients see health screening as an opportunity to detect disease early, ensuring early intervention. Early intervention means less treatment, less invasive treatment, shorter treatment and better treatment outcomes.

But human beings are not always motivated to apply rigour to their healthcare thinking. I meet patients every week who fail to report symptoms to the appropriate healthcare professional in case they get given bad news…and up until recently, I thought they were nuts!

These people are making an understandable but flawed assumption that any condition detected would be untreatable and therefore they are going to spoil what quality of life they do have, by worrying themselves sick. What you don’t know, can’t hurt you. Unfortunately, there is good reason to believe that these poor people are worrying themselves sick in any case and this is what leads them to their viewpoint.

There is indeed an interesting argument around untreatable conditions and whether patients are better off knowing or not. Some people would prefer not to know, and some will want to plan. Unfortunately, as patients it is impossible for us to advise our experts that you don’t want to know about that thing they’ve found…because you then know they’ve found a thing. Equally, it’s not ok for healthcare professionals to make the decision on behalf of patients that they do not want to know.

On balance, I still come firmly down on the side of assuming that I will be reassured by normal results coming back, that if I do have something it will be treatable, and if it isn’t, it will be managed better with active intervention. Indeed I would be able to plan my personal circumstances better if I know.

I liken it to crossing the road – if I look both ways I might still get run over, but it’s definitely less likely. We have the opportunity to manage the risk by taking pro-active positive steps with our health. So, have regular eye examinations…common things are common and rare things are rare. Don’t suffer permanent vision loss from a common, detectable, treatable condition, due to a fear of finding something statistically very unlikely.

Doing more for our patients with Autism

September 13th, 2015


Following a recent review of optometric care of our patients with ASD (Autistic Spectrum Disorder), we found out a couple of really interesting things.

Patients with ASD are more than 50% less likely to report for an eye examination, therefore they are much more likely to have an on diagnosed eye condition. The reasons that these patients are not accessing eye care is not clear.

It is possible that some people with ASD do not notice changes in their vision in the same way that a neurotypical person might do. It is also possible that parental anxiety regarding appointments in unusual environments may discourage them from making an appointment for their child. Also, healthcare professionals may be ignoring the idea of eye care, as they are concentrating on other areas.

These patients are often very sensitive to changes in their visual perception, and consequently any vision changes may be more troubling to them than to other patients. This means they may well need the care more.

As ever, we are keen to do our best to help, and very much welcome patients with ASD. We have made a couple of simple changes within the practice which hopefully will help.

We are now offering orientation appointments at no charge which allow patients to come and meet us, and familiarise themselves with the surroundings, without having to have any examinations performed.

We now also offer the service where we talk patients though what they can expect during an eye examination beforehand.

For more information, feel free to telephone us on 02890323341, or e-mail us at


“Andrew, have I got Kerry Katona’s ?”

May 12th, 2015




What is Keratoconus anyway?

I could write for about three days on what keratoconus is and how it affects people but in short, it is a condition which affects the cornea (the clear structure that lies over the pupil and iris). The cornea acts as the most powerful lens in the eye and consequently, the optical quality of this structure is crucial for good vision.

It is helpful to point out that the normal cornea is utterly incredible to begin with. It is the only living structure in the entire human body that is completely optically clear, the only structure in the entire human body which breaths for itself (from the air around us), and is the most sensitive structure in the entire human body with over 11,000 nerve endings per square millimetre.

I describe the cornea as being like steel reinforced concrete – it has a matrix gel (the concrete) and it has collagen fibres running through it (the steel reinforcement). It is the astounding regularity of the collagen fibres which gives the cornea its amazing optical clarity which is essential for visual function. Anything that causes these collagen fibres to become irregularly arranged causes the cornea to become cloudy. Just one example of this is the very clever pump which regulates the amount of water in the gel to maintain this regularity – to be honest, I find it incredible that it ever works to begin with!

Keratoconus is a condition where the collagen doesn’t work properly and the shape of the cornea becomes irregular resulting in reduced vision.

Do I have it?

Well, as it turns out, that’s a very good question. Keratoconus has a wide variety of different severities and presentations. There are a lot of people who are asymptomatic – they don’t have any problems at all and without specialist tests, neither they nor their optometrist would ever know.

The first tell-tale sign is often that the irregularity causes a prescription for glasses which changes more rapidly than usual or in an unusual way. But prescriptions for glasses often do this so in itself this doesn’t tell us what we need to know. The diagnosis can really only be made with analysis of the curvatures and thickness of the cornea using a number of specialist instruments and even then, there will be certain incidences where we miss it. There is a not very straightforward family link with keratoconus so if a family member has it, it is worth investigating.

What can be done?

Firstly it can be monitored – often it is not particularly progressive, so we do nothing more than watch it to see if it changes and talk to the patient about how they can manage symptoms and risk factors. Often the irregularity means that glasses do not give good vision and contact lenses are required.

There is a standing joke that the contact lenses we work so hard to design and fit aren’t really doing the work – it’s the tear lens created behind the contact lens, filling in the irregularity in the front surface of the cornea that corrects people’s vision. Designing the back surface of the lens is pretty tricky though – the keratoconic eye is a very very complex shape and all of them are different. And if I get it wrong, it can cause permanent scarring. To give you an idea, the lens which looks like a little clear bit of plastic less than a centimetre across, the back surface is designed, using over twenty different parameters, each of them accurate to five hundredths of a millimetre.

In order to get the very best performance possible, we use one of the widest ranges of contact lens manufacturers, types, materials and designs available anywhere in the UK – and there’s a reason for that. We have found the task isn’t easy and there is a lot to gain. Remember, many of our keratoconic patients can’t really see with glasses so contact lenses which give reliable crisp vision and all day comfort are very helpful.

Thankfully, there are loads of really innovative products and techniques available – and we are always scouring the journals for more. We use standard and specialist RGPs, piggy back with a range of different soft lenses, specialist soft lenses, corneosclerals and sclerals – we find that this gives us the best chance of getting a really good result for you.

More importantly, we stay hugely motivated to find the very best optical products for you. Regularly I find myself asking patients, “Yes, they are good, but are they good enough?” The question here is really whether the patient would like to put the time in to investigate other avenues. I joke that what we lack in skill, we make up for with pure tenacity!

Finally, we put it together with an aftercare package which enables you to pay monthly for everything we do. The aftercare means you can be sure you are looking after your eyes properly and investing in good eye health. Occasionally, the cornea becomes so irregular and thin that the care of a specialist is helpful, so we try to keep really good links with the local specialists who are at the top of the game .

If you would like to book a no-obligation appointment with us to discuss your keratoconus, give Ali or Emma a call on 02890 323 341 to book an appointment.