If you order specs from an opticians, then when you collect them, they should be fitted. Sometimes that fitting means they fit well for the lifetime of that pair, other times addiitonal tweaks are required and sometimes it transpires that the chosen frame is never going to fit satifactorily and a new one needs to be picked. If you buy online then you have to hope that you are lucky and that they just happen to fit well enough without adjustments. Of course, online purchases are partly cheaper as those businesses are not paying for staff to do fitting and adjustments - they often rely on the goodwill of high st opticians, who help adjust specs that they have not sold - we do it, but it’s obvioulsy a slightly odd situation.

Fitting and adjusting specs is actually, in my opinion, much harder than it initially appears. It is always easier if the specs chosen are chosen with guidance - guidance that ensures they are the right size for the nose, head width and depth and crucially the prescription of the patient.

Specs have 3 contact areas - the nose, ears and temples. Ideally the weight should be distributed between those three areas. If not, then the specs might not be stable and slip and/or be uncomfortable. For example, if the length to the bend/hook on the sides is either too far back or too far forward the specs will be too weighted on the nose and slip/hurt/leave a red mark. If they bridge is too wide then this can lead to discomfort behind th eears as there is too much weight there. If the sides are splyed out too much the specs will slip off … the potential issues are endless.

So, if you buy from an opticians - then make sure your specs are fitted at collection - this shouldn’t just be asking you if “they feel alright”. If you find they are not right, then go back - a few tweaks can often be neede to get it right and some frames gradully loosen over time (with wear) and they need occasional fettles to keep them comfortable/stable.

If you buy online then ask the seller what they suggest.

People we see for eye tests are getting cataract surgery just a short number of weeks (most recent was 3 weeks) after we referred them. This sounds unbelievable when waiting lists in some parts of the UK are measured in years (just spoke to a Scottish friend who was very jealous). It’s good news as people with cataracts can start to struggle with everyday tasks in their work, rest and play. The use of the word “work” there is deliberate, as many people associate cataracts with old age, but referrals for people in their, for example 50s, are not unusual. These people are often a bit surprised when we tell them cataracts are the problem and usually need a bit more help in getting their head around it - than the average 78 yr old, who knows a lot of people who have had thier’s “done”.

If you are diagnosed with cataracts that need operating on, then you should be offered choice as to where you are referred. To quote the NHS website “If you're referred for your first outpatient appointment, in most cases you've the right to choose which hospital in England to go to”. Therefore from our point of view, it makes sense to pick one with shorter waiting times. There are often choices of going to the local NHS hospital or a private location, that provides services for the NHS - you don’t pay for either.

So, are there times when you might consider paying for cataract surgery - even if waiting times are short? There are and it relates to the type of artifical replacement lens that is used to replace the lens in your eye (that is no longer as clear as it was, to the extent it is reducing your quality of vision). NHS procedures (i.e. ones you don’t pay for) will only use single vision replacement lenses. Generally these will leave most people afterwards needing specs for close work task, like reading/looking at phone, but not much prescription in the distance - for tasks like driving/watching TV. Wheras a private provider can offer multifocal lenses, whihc aim to give you good viison at all diatances witohut the need for any spectacles (Budget £3-4K per eye for this).

Related to this, is the fact that one of the postive things about needing cataract surgery, is that is you have had a lifetime dealing with a high prescription (myopia/short sight / hyerpopia/long sight), then after the procedure you will no longer hae that high prescription anymore. That can be an amazing feeling for some poeple, who for decades have reached for their specs first thing every morning and then suddenly can wake up and see! This explains why you might know people who have had lens replaement surgery (privately), even though they didn’t have cataracts - just to eliminate their need for glasses …. (useful for people who are unsuitable for LASER surgery).

So, if you or a relative/friend/colleague who mentons cataracts make sure they know that the surgery works brilliantly, they might not need to wait as long as they were worried and that recovery is quick with great vision within hours of having the 20 minute op done.

We start with, “can we get you a coffee from John St Kitchen next door?”, but I accept that’s not an essential one. But, it’s significant as the questions you are asked at the start of the examination should take a while - long enough for you to drink a coffee. The questions should be purposeful and orientated around making sure the optometrist understands what visual issues you are (and are not) facing - in everyday life, at work and at play.

Open questions are vital - “are you having any problems with your eyes?” and specific follow ups are needed when the initial questions don’t raise in any issues. Many eye tests are rushed and the optom exudes an attitude of let’s crack on and don’t make this too difficult and the great polite British public are suckers for complying … then finding themselves pushed out to somoene eager to make a sale (15 mins later) when they realise the thing they were anxious about has not been addressed.

Communication and clinical skills are absolutely intertwined.

So, here are some things you should defintley be asked:

1. Why have you come for any eye test?

2. How is your vision? Far away, close up - on screens?

3. Do you have specs/contacts and when do you wear them?

4. Any other issues likes headaches …

5. What are the visual demands of your life? At work, rest and play?

There are obvioulsy loads more things to cover, but this is how it should start.

Check out the @ethicaloptician YouTube channel for more on this …