Mrs Elizabeth RalphMrs Elizabeth Ralph

Professional Services Consultant
Contact Lens Specialist

Contact: beth.ralph19@icloud.com

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Consultation via Webcam

Dry Eye Clinic Video

Latest News

LATEST NEWS! This column will carry the latest news for ADP-EyeCare patients and/or prospective patients. 

29/08/2020: Dry Eye Clinics commence in Leyland in September.

30/07/2020: The world unique InflammaDry test to detect and measure inflammation in dry eye and contact lens discomfort patients avalable from Beth Ralph and Andrew D Price

01/07/2020: As from learly September 2020 dry eye and contact lens patients can also be seen in Nantwich, Cheshire by Mr Andrew D Price. Email patients@adp-eyecare.co.uk

21/06/2020: As from late August 2020 dry eye and contact lens patients can also be seen in Southport, Merseyside by Mr Andrew D Price. Email patients@adp-eyecare.co.uk

12/06/2020: As of mid-June 2020 we are starting to put our Contact Lens and Dry Eye Clinics together in our diaries, extending and spacing appointments further apart so that safe distancing and clinical standard hygiene measure can be effective, this along with an anticipated demand for appointments indicates that patients who would like to see Beth or me are encouraged to contact us as soon as possible. Please email Andrew Price patients@adp-eyecare.co.uk  or Elizabeth Ralph beth.ralph19@icloud.com

23/05/2020:  Dry Eye Clinic Video published - watch here.

03/05/2020:  Remote non-urgent consultations with Andrew D Price, now available 7 days/week, day or evening by phone or Webcam Consult. Send initial email to patients@adp-eyecare.co.uk  

03/05/2020: A collaborative agreement between private ophthalmology and Andrew D Price at the Dry Eye/Contact Lens Clinic of ADP-EyeCare at Focus-In Opticians of Rhyl. See more.

04/04/2020: Lipiflow page discusses treatment. See In-Practice/Clinic Professional Treatments under Dry Eyes Clinic menu-point.

25/03/2020:  New feature of the ADP-EyeCare website is the downloadable, savable, optionally printable Contact Lens Referral documents with all fields open for text. Go to ADP-EyeCare where you will find it under the Contact Lens Menu Point.

 

 

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Mr Andrew D Price FBDO(Hons)CL MBCLA COA

Mr Andrew D Price FBDO(Hons)CL MBCLA COA

- Portfolio -


Andrew PriceMr Andrew D Price FBDO(Hons)CL, COA: As well as being a clinician, seeing patients in  Contact Lens, Dry Eye/Watery Eye and Myopia Management Clinics, I design and am a Principal Investigator in clinical trials, sit on the executive board of more than one eye care organisation, act as a industry/Professional Services Consultant, educator, lecturer and author. I have worked in the field of contact lenses, ophthalmology, laser eye clinics, dry eye and the ocular surface for 30+ years!

I hold Honours Fellowship of the Association of British Dispensing Opticians (ABDO) in Contact Lens Practice. I have received Certification in Ophthalmic Assisting during my work in ophthalmology practice in the USA. Experience encompasses managing/owning my own contact lens practice, working in practice in Laser Vision and Ophthalmology clinics in the UK and USA. I have had numerous articles published and presented over several hundred lectures and workshops on the subjects of contact lenses, dry eye disease and myopia management. 

I have published clinical trial reports, articles and conference posters on multifocal and toric contact lenses, and punctal occlusion/contact lens discomfort. I am an ABDO National Clinical Committee member, an ABDO Mentor, involved in numerous projects & ABDO representative in a number of organisations. Board member of Optometry Wales. Member of the British Contact Lens Association (BCLA).

I have worked with J & J Vision Care, Thea Pharma and others world-wide. I was an investigator in a diabetic clinical study for Duke University in the USA. Pioneered first clinical audit in UK Laser Vision Clinic on treatment outcomes. Developed world’s first ever IT subscription system delivering up-to-date data on CLs, solutions and ocular therapeutics, provided to UK Eye Care Professionals, universities, laboratories. Delivered live radio ‘phone-ins’ on contact lens subjects and produced journal articles on eye care and contact lenes. 

In February 2020 I took delivery of new equipment for improved diagnosis of dry eye and contact lens discomfort, the instrument, shown on the right, images the vital meibomian glands within the eye lid, it is the dysfunction of these glands that is responsible for the vast majority of dry eye and contact lens discomfort. An analysis report from this instrument can also be made available to an ophthalmic surgeon if you are considering refractive or cataract surgery, as part of the in-practice assessment, see here for more information.

 

Also in the same month an unique instrument (shown left) became part of my optional treatment alternatives, this is the much friendlier than it looks in-practice treatment to improve the function of the meibomian glands for both dry eye and contact lens discomfort. In April 2020 collaboration was agreed in North-Wales, where a local ophthalmologist would be available by referral to provide private specialist ocular surface diagnosis and treatment if required.

 

As we have learnt, in medical conditions, testing is key, therefore it was decided to obtain a unique assessment tool, available for use in dry eye, contact lens discomfort and pre/post eye surgery patients, this is the ‘InflammaDry’ test, currently the only way of measuring a specific inflammatory marker in clinic to detect and grade the presence of inflammation on the eye’s surface, with results available during the appointment. It is inflammation that is largely responsible for symptoms in the specific groups of patients mentioned. Dry eye or anti-bacterial drops are largely ineffective in these conditions – specific targeted management is needed. This ‘only one in the world’ test is used in my clinic, one of a handful of locations in Great Britain and Eire.

Results from a range of results demonstrating degrees of inflammation, otherwise unknown are shown in this image.

 

Please look through the further sections of this portfolio, I hope you will find it of interest! If you do, and think some of my wealth of experience may benefit you by seeing me in my North Wales, Nantwich or Southport clinics you can reach me by E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.  Eye Care and/or Healthcare Professionals can also use that email address and can find an optional Contact Lens Referral Form here and/or an optional Dry Eye Referral Form here.

Website

ADP-EyeCare

This website was launched in October 2019 with the intention of providing potential new patients with eneough information for them to make an informed decision on attending one of my clinics and/or supporting existing patients in the care they need as I see them for appointments in North Wales or Stoke-on-Trent. In December 2019 I welcomed Mrs Beth Ralph FBDO CL as an associate, based in the East Midlands you will find her specific personal portfolio here.

Ethos and specialities!

The website will have an ‘eye care' leaning, so will probably appeal to people who want to relate to an Eye Care Professional, in the same way they do to their doctor or dentist and like that relationship reciprocated. I, and many other Eye Care Professionals, like to think there is more to eye care than seeing someone once every two years. I hope you find the various sections of the website and this portfolio interesting. You will see that I am not a 'eye care generalist' my areas of speciality is the eye's (ocular) surface, so dry eye, blepharitis, contact lenses - especially for people who have had to stop wearing them, multifocal and astigmatic lenses, myopia control etc. I do not prescribe or dispense spectacles, although I like working (sharing care) with colleagues that do, either in the practice I work in or in other practices. 
 

As well as seeing patients - lectures/workshops! 

 

I thought patients might be interested in a flavour of the other things I do outside the clinic, especially as they relate directly to the clinical care and services I provide. Below is some of the eduction I provide to under-graduate and post-graduate Eye Care Professionals in the UK and world-wide. 

  • Lecture: “Contact Lens Discomfort and Evaporative Dry Eye – The Missing Link?”  - The over-riding cause of the high contact lens dropout rate has been and remains lens discomfort, this has not changed even with the most advanced lens and material designs available to us. Corneal hypoxia …a problem solved. However contact lens discomfort remains, wearing times are low and dropout rates high in the contact lens population. Are we close to identifying a missing link?
  • Lecture: “Treat the cause of dry eye, not the symptoms” - The prevalence and causes of dry eye. Where various alternative practical solutions will be discussed that can and have been used in high street practice to address the common evaporative dry eye in both contact lens and non-contact lens wearers. The reasons why some approaches work and others don't will be explored.
  • Skills Workshop: “Managing Evaporative Dry Eye – A Skills Workshop” - The diagnosis and management of dry eye is within the natural field and range of skills of eye care clinicians (optometrist and CLO). Extend your skills. You will be able to practice slit-lamp examination of the lid margins and express meibomian glands, also observe the ocular surface using different surface stains.
  • Discussion Workshop: “Managing Evaporative Dry Eye – A Discussion Workshop” - Understand why optical practices are better positioned than the pharmacist, GP/Hospital Eye Service to offer solutions to very often long standing patient problems. The workshop will help you understand the importance of the tears film's quantity and quality, and how this can be assessed using techniques and aids that are readily available in practice to help your dry eye/contact lens patient.
  • Lecture: “The role of MF SCLs in Myopia Control” - Myopia is the most common ocular disorder and is generally the result of abnormal elongation of the eye. Vision can be improved with spectacles, contact lenses and refractive surgery, however these do not address the underlying abnormal enlargement of the eye. Myopia places substantial burdens both on individuals and society and increases the risk of eye disease later in life. Can multifocal contact lenes play a role in myopia control?
  • Demonstration & Discussion Workshop: Eye Drop User Review (EDUR) - The Eye Drop User Review Demonstration and Discussion Workshop will enable High Street Eye Care Professionals to play a vital part in the safe and effective use of eye drops by patients. Improving the use of eye drops by patients has long been over looked but is a vital part of such therapy. A short slide presentation and lecture on the non-effect of not instilling effectively will be combined with hands-on experience on yourself and workshop partners.

Demonstration & Discussion Workshop: Eye Drop User Review (EDUR).

  • Past presentations: “ The whole presentation and associated workshop was excellent” – Gloucester Optometrist, October 2016. “Thoroughly interesting and practical” – South Wales CLO July 2016. “Very good clear information ..” – Oxford IP, September 2016. “One of the best lectures I have heard … excellent, visuals and discussions” – Elgin, Optometrist, 2013.  “Dear Andrew, many thanks for the interesting lecture last evening, I wish they could all be like that” – Cardiff DO, 2014.

 

More lectures/workshops! 

  • Discussion Workshop: “How to set up a Dry Eye/Allergy Eye Clinic” - The Tool Kit has everything you need to launch your Dry Eye/Allergy Eye Service; modifiable patient leaflets,  screening questionnaires, GP letters, patient mailers, record cards etc. An in-practice meeting with follow-up support. 
  • Discussion Workshop/Programme: “The Enhanced CL Exam & Assessment Tool Kit” - All the essentials to address this long-standing problem, increase income and offer your patient’s an unique approach; modifiable patient leaflets,  screening questionnaires, patient mailers, record cards etc. An in-practice meeting with follow-up support.
  • Skills Workshop: “The role of punctal occlusion (PO) and its practical skills” - When would  punctal occlusion be used, what are the risks, benefits and options? Hands on teaching with punctal occluders. Full support included: Informed Consent forms, pre and post-treatment protocols, fees discussion etc. 
  • Advanced Dry Eye Management Workshop: To include lid debridement, demodex diagnosis and treatment and punctal occlusion and its role in Dry Eye and Contact Lens Discomfort.
  • Recent presentations: "Excellent lecture and workshop. Excellent speaker and presentation packs to enable instant set-up of the Dry Eye clinic. Andrew has developed wonderful templates to help with the set-up and continuation of the Dry Eye clinic. Much appreciated" - PB, BSc(Hons) MCOptom Dip ScV, Principal Optometrist & Director, Midlands.

"Hi Andrew, Many thanks for your wonderful tuition yesterday. You gave me great confidence right from the start and your patience was amazing. I quite surprised myself that I was actually able to fit the plugs" - DP BSc MCOptom, South-West.

 

 Punctal Occlusion Workshop 

 

  • Education & Skills Workshop: “The role of punctal occlusion (PO) and its practical skills”. Ideal for ECPs already managing DE.
  • Theory of PO, education, evidence
  • Indications
  • Benefits (you and your patient)
  • Contra-indications
  • Risks (you and your patient)
  • The importance of the fully informed consent form – provided free
  • Decision tree, pre- and post-Tx protocols
  • Pre-PO patient examination
  • PO options (removable v dissolvable)
  • Selection of and hands-on with forceps
  • Selection of loupe v slit-lamp
  • Importance of lighting, patient/practitioner positioning
  • Observe placement, hands on teaching, successful placement, use 'Nelson' (image far right) to practice on!
  • Fee discussion
  • Certification of successful completion (for any Professional Indemnity Insurance requirements)
  • "Hi Andrew, Many thanks for your wonderful tuition yesterday. You gave me great confidence right from the start and your patience was amazing. I quite surprised myself that I was actually able to fit the plugs" - DP BSc MCOptom, South-West.
  • “Andrew’s hands on training session on punctal plugs was extremely informative and a confidence builder. It has been instrumental in helping us build up our dry eye clinics” – PB BSc(Hons) MCOptom Dip ScV

 

To my ECP colleagues - extend your DE/CL service, raise income - all with no financial/time investment

 

  • Full Spectrum Service: For practices that want to extend their patient services but haven’t got time and resources to initiate it - I can provide a full spectrum Dry Eye (DE)/Contact Lens (CL) clinic to your practice including marketing and administrative support. This enables you to provide a full unrivalled service to help your DE and CL patients, extending your eye care, increasing patient recommendations, improving CL patient retention and raising income.
    From appropriate ocular surface products, to in-practice treatments including moist heat meibomian gland expression to lid debridement to punctal occlusion I (or one of my fully trained CLO or Optometrist colleagues) can provide all this to your patients with appropriate management, all seen as provided by your practice. All will increase your income.
  • Stand Alone or Combined CL/DE Clinic: The above service can simply provide a first class-class combined CL/DE clinic or supplement your normal CL clinics. This may well free up extra-time and/or offer extra clinic days for more general eye exams and spectacle dispensing. Early 2018 – Myopia Control CL prescribing added to my clinics in your practice, providing yet another service and income stream and extending the care you provide to your patients
  • Proven record: I have built a successful combined daily DE/CL clinic from nothing in a small town practice, faced with all the normal challenges you probably have, and can do the same for you. Lest you think I am only interested in the more difficult cases, I also look after patients that wear daily disposable lenses twice a week very well!                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    

Clinical Trials

 

I design, conduct and deliver in-practice clinical trials, and have issued reports on cross-over trials involving market leading multifocal contact lenses, specialist multifocal contact lenses, toric contact lenses and punctal occlusion and contact lens discomfort (CLD). Patients have started to benefit from these results.

As an Eye Care Professional who works in typical UK practices, I know that providing ‘real world’ data derived from a practice environment. obtained from a fellow practitioner can be hugely impressive. If a company can show results for patients seen on a ‘wet Wednesday in Wigan’ this carries a lot of weight with other practitioners! I take a very keen interest in in-house trials, statistical significance, box and whisker charts etc, however whether they should or not, most UK Eye Care Professionals do not.

I have published results from a punctal occlusion clinical trial carried out in two typical High Street practices in NW England and North Wales, the results are hugely impressive and are something all practitioners can relate to. The trial’s clinical poster was accepted for the BCLA CC in 2017, which in turn generated an optometry journal article – all resulting in increased product sales. This type of result could be available to you. Also two separate clinical trials on multi -focal lens prescribing (presented at Optrafair 2018) have been completed again with useful practical results.

I work with an Independent Project Manager with experience in organizing and managing clinical, technical, and writing projects through initiation, planning, execution, and close-out. Major responsibilities include identifying and qualifying investigators, conducting protocol initiations, monitoring study progress, designing and managing clinical trial database, descriptive and statistical analysis, interim and final reporting, IRB updates, and writing professional meeting abstracts.

I believe the clinical trials I have conducted and the interest I take in all reseach in my field directly benefits my patients - please see below. 

 

How does the work I do benefit patients?

rubber ducks

Not every contact lens patient is the same, your eyes are as unique as finger prints, no one else in the world will have the same eyes as you! You may well benefit from having contact lenses prescribed for you as an individual?

 

Hamster

Are you going round and around looking for a solution for your dry eye problem?

 

 

Most 'off-the shelf' solutions to patients eye care needs work resonably well for most people. However a significant percentage do not for a sizable number of patients, you may well be one of them. My unique experience, skills, research and education (that I receive and I give to others) enables me to help contact lens and dry eye/blepharitis patients, that otherwise I could not.

In the field of contact lenses, there have been recent amazing developments in product research, design and development, giving the possibilities of better vision - for distance and near and better comfort for longer, my work directly helps patients I see. For children, now the exciting possibility of reducing the progression of their myopia (short-sight) so their prescription is less strong when an adult. 

We know so much more about the ocular surface now than we did, even five years ago. The eyes surface and lids can not only directly be involved in the dry eye problem but adversely effect succesful contact lens wear. We know how to accurately diagnose the particular problem and the answers to them. Surely the cycle of 'trialing' one contact lens after another that doesn't seem to make a significant improvement the and trial and error process of picking eye drops off the shelf should be a thing of the past!                                                                                                                                                                 

Publications/Presentations

Publications

  • Price, A D, Long, B. ‘Management of contact lens discomfort with punctal occlusion therapy’ (2017). Optometry Today. October 2017, pp 78-82.
  • Price, A D. ‘Topical eye therapy, Understanding dry eye: part 1’ (2017). Dispensing Optics. November 2017, pp 26-27.
  • Price, A D. ‘Topical eye therapy, Understanding dry eye: part 2’ (2017). Dispensing Optics. December 2017, pp 31-32.
  • Price, A D. ‘Topical eye therapy, antibiotics’ (2018). Dispensing Optics. March 2018, pp 30-31.
  • Price, A D. ‘Insuring your insured’ (2018). Dispensing Optics. April 2018, pp 34.
  • Price, A D. ‘Aiding glaucoma treatment’ (2018). Dispensing Optics. June 2018, pp 26-27
  • Price, A D. ‘Topical eye therapy, ocular hypotensives’ (2018). Dispensing Optics. July 2018, pp 24-25.
  • Price, A D. ‘Topical eye therapy, anti-allergy & anti-inflammatory’ (2018). Dispensing Optics. November 2018.

Presentations

  • Presenter, Discussion Workshop: Price A D, Prof Simon Barnard. ‘Instrumentation to Aid Specialist Lens Fitting’. Scottish Contact Lens & Ocular Surface Society, November 2016
  • Presenter, Poster sessions. Price A D, Long B. ‘Management of contact lens discomfort with punctal occlusion therapy’. British Contact Lens Association Clinical Conference, 9-11 June 2017, Liverpool, UK.
  • Presenter, Poster sessions. Price A D, Long B. ABDO Contact Lens Uncorrected Cylinder (CLUC) Trial’. ABDO stand, Optrafair, 14-16 April 2018, Birmingham, UK
  • Presenter, Demonstration Workshop. ‘Ocular surface staining, subjective non-invasive break-up time and tear meniscus height’. British Contact Lens Association Clinical Conference UK, 10 June 2018, London, UK.
  • In addition to these around 300 other presentations to professional conferences, meetings and webinars.

 

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