Bruce JW Evans

City, University of London · Division of Optometry and Visual Science

A talk aimed at support staff and eye care practitioners on myopia management

Clinico-legal matters affecting optometrists, including civil litigation and General Optical Council Fitness to Practice cases. The presentation discusses prevention, process, and how to survive and learn from these worrying cases.

A presentation for optometrists and DOs on myopia management.

An interactive presentation of real cases of binocular vision anomalies seen in community optometric practice. The presentation interacts with the audience through multiple voting slides when, using smartphones, the delegates can anonymously vote for various options. The options are real-world clinical decisions about tests, diagnoses, and manageme...

To the Editor, The recent review of optometrists' referral accuracy and contributing factors by Carmichael et al. 1 is a timely addition to the literature. In their final summary paragraph, the authors stated that 'Overall, based on this review optom-etrists' referral accuracy can be considered suboptimal' and 'One could argue that optometrists are...

Presentation for community optometrists giving practitioner-friendly methods of detecting, diagnosing, and managing binocular vision anomalies.

Recent research on the management of keratoconus is summarised, with the implications for community eye care practitioners. Advice is given on clinico-legal risks and suggestions for safe practice are made. It is noted that clear referral criteria have been lacking and there is a need for increased awareness among community optometrists of the avai...

INTRODUCTION Non-strabismic binocular vision anomalies (NSBVA) are prevalent and require treatment if causing symptoms or if the presentation is likely to deteriorate if left untreated (Evans, 2021). PURPOSE To compare and contrast the main approaches to the diagnosis and management of NSBVA. METHODS The following PubMed searches were carried out....

The increasing prevalence of myopia has been likened to an epidemic and raises serious health concerns in view of the link between myopia and increased risk of ocular pathology in later life (e.g., retinal detachment, glaucoma, myopic macular degeneration). Traditionally, eye care practitioners (ECPs) have played a passive role in myopia management...

Presentation aimed at community optometrists who are not binocular vision specialists, with an emphasis on approaches to the diagnosis and management of binocular vision anomalies that are suitable for community optometric practice (primary care optometrists).

How to detect and manage binocular vision anomalies for locum optometrists.

Randomised controlled trials are essential to validate interventions as they control for many sources of bias. However, this presentation notes that they are not sufficient and real-world observational studies are required as well.

Clinical uses of fixation disparity presentation (20 minutes)

A summary of the assessment, diagnosis, and treatment of common binocular vision (orthoptic) anomalies, stressing approaches that are applicable to optometric practice.

A presentation for eye care practitioners on myopia management. Why it is necessary, how to practise myopia control, when, and who should be doing this.

Purpose: To develop a series of equivalent passages of text in Italian, according to the principles of the Wilkins Rate of Reading Test (WRRT), suitable for both clinical examination and scientific research when equivalent stimuli are needed to compare performance in repeated-measure designs. Method: Fifteen high-frequency Italian words (matched...

Purpose Myopia prevalence is increasing in the UK in teenagers, but little is known about younger children. We hypothesise that if the “myopia epidemic” is affecting young children, there will be increasing prevalence of bilateral reduced unaided vision (V) at vision screening at age 4-5y. Methods Retrospective anonymised data from computerised...

Video quiz on incomitant deviations - no videos included

A guide to orthoptic conditions likely to be seen in optometric practice: how to investigate and manage them.

1990-2023 Bruce Evans for regular tweets on optometric research Myopia control practitioners: https://myopia.care Handout: ResearchGate, Bruce JW Evans DISCLOSURE The speaker has received funding for lectures, key opinion leader/product feedback, and research from:

A multicentre study was undertaken recently to evaluate both practitioner and patient acceptability of a new one-day disposable silicone hydrogel contact lens; the sorafilcon A material Hoya One Day lens. This article describes the study and its results.

Purpose: To evaluate the efficacy of a myopia control spectacle lens (DIMS) at slowing the progression of myopia in a population of European children in comparison with 0.01% atropine and combined DIMS and atropine. Methods: The study was a non-randomised experimenter-masked prospective controlled observational study of individuals aged 6-18 yea...

This CPD article provides a practical approach for the investigation and management of incomitance.

Purpose: Myopia prevalence has increased in the UK at age 10-16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4-5 years of age. Methods: Retrospective anonymised da...

Strabismus affects about 2-3% of the population, so it is likely to be encountered by a full-time CO once or twice in a typical week. The new edition of the textbook, Pickwell’s Binocular Vision Anomalies,1 contains nearly 100 pages dedicated to the topic, citing numerous recent research papers. When writing the book, I hoped it would be a useful r...

The increasing prevalence of myopia has been likened to an epidemic and raises serious health concerns in view of the link between myopia and increased risk of ocular pathology in later life (e.g., retinal detachment, glaucoma, myopic macular degeneration). Traditionally, eye care practitioners (ECPs) have played a passive role in myopia management...

Evidence is reviewed for successful approaches to myopia control (myopia management) that are suitable for community optometric practice in the UK. Research on the impact of the COVID-19 pandemic on myopia onset and progression will be reviewed. It is argued that this has increased the need for optometric involvement in myopia control and that all...

Purpose This paper discusses a collaboration between sociologists and optometrists that involved, first, an investigation of communication and interaction in eye examinations and, second, a transformation of the findings into assessable impact. The purpose of this paper is to demonstrate how from the start of this project close cooperation between...

Paediatric optometry

Binocular vision anomalies and the community eyecare practitioner

Workshop on some key paediatric optometric tests

Communication tips for practising optometrists

A summary of interventions for myopia control, and the influence of COVID-19 on myopia prevalence

The presentation describes the binocular vision basics that every eye care practitioner needs to know to survive in everyday practice.

OBJECTIVES: This audit assesses communication between community optometrists (COs) and hospital eye service (HES) in Scotland and England. METHODS: Optometric referrals and replies were extracted from six practices in Scotland and England. If no reply was found, replies/records were copied from HES records. De-identified referrals, replies and reco...

Photophobia is a complex disorder that can involve aversion not simply to bright light but to spatial patterns, colour and flicker. The use of tinted lenses to reduce photophobia in neurological diseases has a long history. Rarely has the possibility that different individuals might require lenses individually tailored to their needs been considere...

The historical background to the use of colour to assist reading is summarised in this chapter. Recent developments in the optometric use of coloured filters are the result of techniques for tinting plastic ophthalmicSeeSeeoptometrist lenses that permit the selection of spectral transmission for coloured glasses on an individual basis. The two new...

The components of a clinical optometric examination are explained, and how they relate to ocular health, visual fields, colour vision and refractive error. The possible associations with reading difficulty and techniques for treatment are set out. It is concluded that refractive errors, visual acuity, and ocular pathology are not correlates of deve...

There are several visual pathways that convey different types of information to the brain. We review evidence that in dyslexic individuals there is a deficit in one of these pathways, the magnocellular pathway-dorsal (transient; M-D) pathway. A large body of research supports an M-D deficit as a correlate of dyslexia, but the evidence that the defi...

In this chapter we review studies in which precision tints have been used in a variety of neurological disorders, including photosensitive epilepsy, autism, migraine, cluster headache, visual snow, stroke, multiple sclerosis and concussion. Whilst the evidence regarding these topics is preliminary and indicative rather than conclusive, the effects...

The main binocular vision and accommodative anomalies are considered in turn: strabismus, heterophoria, convergence insufficiency, binocular instability, accommodative insufficiency, and accommodative infacility. For each of these conditions, any associations with reading difficulties are reviewed, including their cause. The treatment of these cond...

A wide range of treatments of reading difficulty have been proposed and marketed, often with little appropriate evaluation. Several that relate to vision are discussed in this chapter, including the training of saccadic and pursuit eye movements, treatment of ocular dominance, some elements of behavioural optometry, and cerebello-vestibular (balanc...

The chapter describes research on the use of coloured filters for people with visual stress. There is a large body of research, and the chapter concentrates on systematic reviews and randomised controlled trials. The use of coloured lenses in those with reading difficulties remains controversial, and reasons for the controversy are discussed. It is...

This chapter starts with an introduction outlining the evidence-based approach, and a flow-chart summarising the typical procedure for investigating visual factors that may be relevant to reading difficulties. The limitations of a diagnosis of exclusion, as applied to visual stress, is discussed. Symptoms are considered in detail, noting that many...

This chapter is aimed at researchers and clinicians. It starts with reflections on visual stress. The multifactorial nature of reading difficulties is noted. Recommendations are made for research on both these topics, priorities for research, both concerning vision and reading difficulties and noting some of the pitfalls of research in this field t...

In this chapter we describe the various coloured filters that are used in the assessment and treatment of patients: how many are needed and why, and what their physical characteristics should be. Other tools that are used in the investigation of visual stress are also briefly described, including adaptations to digital displays (computer screens),...

The various possible mechanisms whereby coloured filters might improve symptoms and reading speed are reviewed. The chapter starts with the straightforward mechanisms that are well-understood in terms of physics and biology. These include light scatter, retinal mechanisms, ocular accommodation (ocular), binocular vision anomalies, magnocellular-dor...

A summary of the diagnosis and management of microtropia. Published in Optometry Today.

The COVID-19 pandemic has led to increased use of digital devices and, for some people, less time spent outdoors. Research indicates an associated increase in the prevalence of myopia in children. The evidence for this and the health implications is summarised. The role of eye care practitioners in managing this condition is reviewed. Prolonged com...

2. Synopsis of Content: This should set out what registrants will cover, why and how. It may take the form of lecture notes, questions to be posed, discussion points, scenarios used, slides presented or other content to be covered. The form this content will take will depend on both your own internal record-keeping processes, and on the mode of del...

5 Collaborator; independent researcher 6 Collaborator; University of Essex Handout: www.researchgate, Bruce JW Evans for regular tweets on optometric research DISCLOSURE The speaker has received funding for lectures, key opinion leader/product feedback, and research from:

Diagnosis and management of non-strabismic binocular vision anomalies - why are there so many different approaches? Type: Lecture Topic: ’See the Future Unfold’ Vision and Eye Health for Eye Care Professionals Authors: B. Evans; London/United Kingdom Purpose To review and contrast the main approaches to diagnosing non—strabismic binocular vision a...

Purpose To evaluate practitioner and patient acceptability of a new one day disposable contact lens (sorafilcon A). Setting Community optometric practices in Hungary, Finland, Netherlands, and UK. Method Following ethical approval, 138 patients who were already wearing one day spherical contact lenses for myopia were refitted with a new one day s...

Purpose: to assess the inter-session repeatability, inter-examiner reproducibility and within subject variability for associated phoria measurements using the Mallett Unit Test Conclusions: Differences < 1 Δ are not considered clinically significant. Inter-session and inter-examiner differences were lower than 1 Δ. They were also lower than the wit...

Reviews the relevance of myopia control for eyecare practitioners and the main approaches to myopia management. Research on Hoya MiyoSmart is reviewed in some detail. The timing of myopia control is discussed, together with the personnel who should be disseminating this information to patients and carers. Caveats and limitations are noted.

This article is now (2 Feb 2022) published online in OPO: https://onlinelibrary.wiley.com/doi/10.1111/opo.12948 Purpose: Community optometrists, through routine eye examinations, identify patients with disease or ocular abnormalities requiring referral to the hospital eye service. In many cases no reply to the referral letter is received, resulting...

Purpose: Community optometrists, through routine eye examinations, identify patients with disease or ocular abnormalities requiring referral to the Hospital Eye Service. In many cases no reply to the referral letter is received, resulting in some patients being re-referred unnecessarily, potentially increasing the number of other patients who lose...

The Doctoral support programme within the School runs every year for PhD and for Professional Doctorate students. This programme is intended to complement the supervision sessions provided by your supervisory team. The aims of the programme are to: ▪ Develop an 'inter-collegiate' support network between students ▪ Give students an opportunity to me...

Summary of the diagnosis and management of common binocular vision (orthoptic) anomalies by community optometrists

This presentation discusses the differential diagnosis of visual stress. Diagnostic criteria are discussed, together with the conditions that need to be excluded. The College of Optometrists professional guidance is highlighted. The relevance of the underlying condition with which visual stress is associated is discussed. The presentation is availa...

The presentation reviews recent research on myopia, its prevalence and impact. The talk concentrates on myopia control - methods that can be used by practising optometrists to slow myopia progression. In most European countries, optical methods are most widely used and these on average slow myopia progression by approximately 50%. In individual cas...

Purpose: Accommodative support (AS) lenses are a low add progressive addition spectacle lens designed to ease symptoms in computer vision syndrome (CVS). The study aims to investigate if (1) AS lenses improve CVS symptoms; (2) binocu-lar/accommodative functions predict a benefit from AS lenses and (3) wearing AS lenses for six months impacts on bin...

Sorafilcon A is a new daily disposable silicone hydrogel lens manufactured by Hoya, a global manufacturer of vision care products. A study was designed to evaluate the lens using an approach that closely replicates the in-clinic conditions under which new brands of contact lenses are typically trialled. The pragmatic approach adopted avoids some li...

Most people have a heterophoria, and it occasionally causes symptoms and requires treatment, when it is described as decompensated. This article summarises the symptoms and clinical signs of decompensated heterophoria, prioritising the tests that are most useful for detecting symptomatic cases. A simple algorithm is described, and treatment approac...

A one hour presentation for community optometrists on latest developments on myopia control. The emphasis is on interventions that can be prescribed now, without the need for specialist skills, that make myopia control within the reach of all community optometrists.

Presentation on the role of visual factors in dyslexia, including conventional optometric factors (e.g., binocular instability), magno deficit, behavioral optometry, and visual stress. Controversies (e.g., the use of coloured filters) will be discussed.

Objectives This audit assesses communication between community optometrists (COS) and hospital eye service (HES) in Scotland and England. 1 Methods Optometric referrals and replies were extracted from six practices in Scotland and England. If no reply was found, replies/records were i copied from HES records. De-identified referrals, replies and rec...

Tips for eyecare practitioners about introducing myopia control into their everyday clinical work.

The presentation will begin with an overview of the different types of eye care practitioners. The visual conditions that are correlated with dyslexia will be reviewed, including binocular instability and, more controversially, sensory visual stress (Meares-Irlen Syndrome; which is corrected with coloured filters). It will be noted that these condi...

The article summarises the main reasons for prescribing or treating binocular vision anomalies. The commonplace scenario, when an optometrist examines a patient who already has prism in their spectacles, is discussed and also new case where a prismatic prescription is being considered for the first time. The use of prisms in decompensated heteropho...

Purpose: This study describes the design and application of a range of online clinical vignettes for measuring the impact of Continuing Education and Training (CET) and identifying unwarranted variation in optometric decision-making concerning referrals to secondary care. Methods: Twenty computerised vignettes were developed to assess clinical and...

Presentation (slides in Polish) at Polskie Stowarzyszenie Soczewek Kontaktowych virtual conference, May 2021. Presentation title: Myopia control, binocular vision, and accommodation. Thank you to Bartosz Tomczak for translation. For full details of the conference: https://www.optometria2021.pl/pl/

This presentation is part of a satellite meeting at the European Academy of Optometry and Optics annual conference. The satellite session is on Myopia Control and this presentation is about how practitioners can facilitate myopia control in community eyecare practices.

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. The description is below. Now in a fully up-to-date 6th Edition, Pickwell's Binocular Vision Anomalies provides a practical...

The presentation will start with an overview of specific learning difficulties, including dyslexia, and of the role of the eyecare practitioner. The controversy surrounding this topic will be discussed, emphasizing the need for conservative clinical practice. The visual conditions that are correlated with dyslexia will be reviewed, including visual...

Presentation, courtesy of Hoya, on myopia control, under the headings of Why? - myopia prevalence is reviewed, increasing in all countries, including UK, increasing risk of pathology in later life. How? - recent research on methods of myopia control (management), including an innovative new spectacle lens (MiyoSmart) that complements historical con...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. This chapter considers the main types of comitant strabismus and, for each, presents a clinical guide of the management opti...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. Undertaking eye examinations of young children can be challenging and the objectives and age-appropriate tests are reviewed...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. This chapter describes eye exercises that are used to treat decompensated heterophoria under three main headings: developmen...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. The classification of exophoria is summarised as basic (mixed), divergence excess, and convergence insufficiency exophoria s...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. Heterophoria requires treatment (if decompensated) if it is causing symptoms, decreased performance, or is likely to deterio...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. The actions of the extraocular muscles are summarised, as an understanding of these is necessary for the diagnosis of incomi...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. Sensory changes in strabismus are broadly classified as binocular (diplopia, confusion, suppression, anomalous retinal corre...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. This chapter describes techniques for investigating and managing comitant strabismus. A step-by-step approach to detecting p...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. Microtropia is a small-angled strabismus with individual cases demonstrating some of the following features: anisometropia,...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. Hyperphoria can occur secondary to other conditions (e.g., horizontal heterophoria, high myopia, tilted spectacles) and thes...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. This chapter provides an overview of the management of heterophoria. The importance of regularly checking for pathology is s...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. The nature and types of esophoria are summarised, noting the strong relationship with hypermetropia and the need to carefull...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. The prevalence of anisometropia is described, and the problems it can cause in terms of unwanted prismatic effects and anise...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. Nystagmus is defined and the main types of nystagmus are reviewed: infantile nystagmus syndrome (INS), latent nystagmus (usu...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. An assessment of binocular function is noted to be an essential element of any thorough eye examination and it is most appro...

N.B., I am afraid I cannot supply copies of the text of this book, but it can be bought from www.elsevier.com/books/pickwells-binocular-vision-anomalies/evans/978-0-323-73317-5 or via Kindle books, or borrowed from libraries. The definition, diagnosis, classification, and prevalence of amblyopia are reviewed. The chapter concentrates on the commone...