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Beating the bug: dear OT, Congratulations on a great article describing the attempts to raise the profile of the devastating eye disease Acanthamoeba amongst patients (December 12, 2014, page 33).

Unusually, this article focused on the positive messages of awareness, the importance of hygiene, the avoidance of tap water and prompt recognition and treatment of Acanthamoeba keratitis by the most appropriately qualified practitioner.

I was struck by one quotation "one patient recounted positive experiences with a High Street multiple saying their service was excellent and that she was advised to see her GP immediately after she attended the practice with an eye infection"

I must admit that I stared at this with frank disbelief. A suspect microbial keratitis is a well-recognised ocular emergency and requires prompt referral and treatment into ophthalmology. Even assuming that the patient could get an appointment with a GP on the same day, the chances of finding one with the means to examine, the experience to diagnose and the knowledge of what to treat it with is practically non-existent. Any optometrist is better qualified and equipped to identify and differentially diagnose those anterior segment lesions that require emergency referral than any GP, potentially even a contact lens optician. In undertaking the discussions on optometrist prescribing 20 years ago, the biggest single reason for advancing into therapeutic optometry was as much about recognising those patients who needed immediate referral without treatment as treating a condition.


Acanthamoeba is a serious and devastating eye condition, one of the principal risk factors of which is contact lens wear, as are other serious microbial keratitis. The very best way to ensure better recognition of such emergencies is for optometrists to upskill their diagnostic and management skills and be the first port of call for all primary eye care presentations. The best way for a practitioner to upskill is to get IP qualified. IP is not all about treatment, it's about examination, differential diagnosis, experience, clinical management and, if appropriate, referral or treatment depending on guidance.

You cannot overestimate the culture change that comes with this development in scope of practice, not least that it enhances the recognition of your abilities with local GPs and ophthalmologists.

Nick Rumney, optometrist, Hereford

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Article Details
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Author:Rumney, Nick
Publication:Optometry Today
Article Type:Letter to the editor
Date:Feb 21, 2015
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