ABDO in the regions

OSCEs day at the ABDO National Resource Centre

In this month’s update from ABDO’s regional leads, Abi Crutcher (Wales) charts her experience in becoming a minor eye conditions services qualified contact lens optician. We also provide an update on ABDO’s involvement in a review of one of the Wales General Ophthalmic Services (WGOS) manuals.

Having qualified as a dispensing optician (DO) back in the dark ages, then a few years later as a contact lens optician (CLO), I was more than ready for another challenge. So when ABDO announced that it was developing an extended services qualification in order for CLOs to expand their scope of practice to deliver minor eye condition services (MECS), I was one of the first in the queue. It took a while for the necessary red tape to be resolved here in Wales, but I was finally able to start the course in the summer of 2019.

The theoretical side of the course consisted of a number of multimedia modules, with multiple choice questions at the end of each module. I found the modules very interesting and insightful. Some of the topics were familiar from my contact lens practice, but I enjoyed the revision as it had been a while since I qualified. Other modules were on topics that I had only touched on previously, such as glaucoma, age-related macular degeneration and other retinal conditions, and these gave me much more in-depth knowledge.

Although, as a CLO, I only deal with anterior eye problems, having this background knowledge gives me a more holistic view of an eye problem – and helps me to recognise when I should be signposting or referring on to an optometrist. I was able to complete the modules at my leisure, with each one earning me one CPD point.

All that glitters

Performing foreign body removal

After completing the modules, I was then able to book onto an ABDO Extended Services Day at the National Resource Centre (NRC) in Birmingham. I was not at all sure that I was looking forward to learning how to remove a foreign object from someone’s cornea, but I need not have worried. We were provided with polystyrene heads, which had jelly ‘eyes’, covered in glitter.

We practised removing the specks of glitter with various implements, such as PVA spears, needles and tweezers, and I was pleased to discover I had a fairly steady hand and was able to remove glitter with no damage to the ‘eye’.

Then it was on to learn practical Goldmann applanation tonometry. This proved a little more daunting because we were practising on one another and learning how to access the anterior eye in more detail; but as the day progressed we became more confident and skilled. The day ended with a peer discussion looking at case studies covering various scenarios we might be faced with in practice.

Following the practical day, my objective structured clinical assessment (OSCE) was booked for the following March. The intervening weeks were spent practising tonometry on my unsuspecting friends and measuring their Van Herricks, with lots of revision of the modules to make sure I could perform confidently on the day.

The OSCE consisted of seven stations, three of which required us to perform a practical task: tonometry, calibrating a tonometer, and assessing anterior chamber depth. The remaining four stations involved diagnosing anterior eye conditions, differential diagnosis, discussing management plans, referral and patient interaction.

Although I had been quietly confident before the day, I fluffed the tonometry, so was advised that I needed to re-sit just that part. The only problem was, that by the time I got my results, we were in lockdown due to the Covid-19 pandemic. I was finally able to re-sit in April 2021, nearly two years after I had started. To the relief of my long-suffering friends, I passed on this occasion.

Putting skills it into practice

Starting out in practice with my new MECS qualification was a little daunting, especially when faced with my first foreign body removal. But I work with a fantastic team of clinicians , who were always willing to check anything I wasn’t sure about. I now see several patients a week – and any anterior eye problem is likely to be booked in with me, leaving time for the optometrists to see the other posterior sight-threatening problems.

We work closely together, and there have been a couple of occasions where we have been able to co-manage patients and utilise each other’s skillsets. I enjoy the variety that MECS work brings to my day, and it is very satisfying to be able to resolve problems for patients without them having a long wait in A&E or for a GP appointment.

Here in Wales, the MECS (WGOS2) service is nationwide, so my skills are transferable should I wish to relocate. There is growing demand for the service, so there is plenty of scope for those wishing to gain an additional qualifications. If you are a CLO looking for the next step in your career, I can definitely recommend the ABDO Extended Services Course.

Booking is now open for the next ESD on 31 March, with the subsequent OSCE scheduled for 6 May. Funding from Health Education England is still available for a limited number of places, so early booking is advised.

Find out more and book a place. 

Updating the WGOS manual

ABDO works closely with Optometry Wales (OW) – the professional and representative body for all primary care optometrists, DOs and optometric practices across the nation. It plays a key role in advocating for the interests of eyecare professionals and ensuring that the public in Wales receives high-quality eyecare services.

ABDO recently supported a review of one of the Wales General Ophthalmic Services (WGOS) manuals, which serves as a key resource for practitioners and contractors delivering NHS-funded eyecare across the nation. The updated WGOS 1 and 2 manual was shared with the Eye Care Wales Committee, and ABDO, as a member of the OW Board, was invited to provide feedback and commentary.

In brief:

WGOS Level 1 (Core General Ophthalmic Services)
• Scope:
o Provides routine eye examinations, sight tests, and optical prescriptions
o Includes the detection of eye diseases or conditions (e.g. glaucoma, cataracts)
o Focuses on general eye health and vision correction
• Primary goal:
o Ensuring that all patients have access to basic, high-quality eyecare

WGOS Level 2 (Enhanced Eye Care Services)
• Scope:
o Provides enhanced services for patients at higher risk of eye disease
o May include additional tests (e.g. dilated fundoscopy, intraocular pressure monitoring, or field testing)
o Often used for monitoring conditions such as glaucoma or diabetic retinopathy
• Primary goal:
o Early detection and monitoring of eye conditions to prevent vision loss

ABDO has sought clarity within the manuals on a few issues such as eligibility of DOs to hold contracts and roles within the NHS GOS service, as well as requesting an update on the working arrangements for extended services CLOs working within the nations eye health system.

Abi Crutcher FBDO CL Prof. Cert. LV is ABDO’s regional lead in Wales. Get in contact with Abi direct by emailing acrutcher@abdoregions.org.uk