Eye care is the fourth largest sub-category within the P meds section

ICP explains how pharmacy staff can get more involved in ear care, using an otoscopy pilot service as an example

Ear wax and swimmer’s ear are common reasons why people visit a pharmacy. Both of these conditions can often be treated with over-the-counter products. But a new six-month otoscopy service pilot in Warwickshire, funded and monitored by Numark, is looking at other ways in which pharmacists can become involved in ear health and distinguish between common problems, such as infections, wax build-up and glue ear. Numark hopes to develop a proposal for a pharmacy-based otoscopy service, with the ultimate aim of getting a service commissioned.

“Our aim with this otoscopy pilot is to collect evidence to show that, given the appropriate training and support, community pharmacy can play a greater role in reducing the burden on the NHS,” says Laura Reed, Numark’s service development manager. “The pilot already clearly demonstrates that without this service patients would be attending GP appointments (and possibly out-of-hours services) for conditions that could be diagnosed and treated successfully within a community pharmacy.”

Leyes Lane Pharmacy in Kenilworth is involved in the pilot and staff have found considerable demand for the service within the local community. “Many people come into the pharmacy complaining of earache and usually need to be referred to their GP straight away,” says dispenser Amy Hill. “With this service, we can assess ear problems and decide whether customers need to see their GP or can be treated within the pharmacy. The service is proving to be very successful and saves many customers from making an appointment at their local surgery.”

Otoscopy benefits

Amy Hill and pharmacy owner Caroline Eley have discovered there’s far more to otoscopy than they had realised and, in particular, how relevant it is within the pharmacy setting. “Numark organised our training with specialist nurses,” says Ms Hill. “We learnt so much about ear anatomy, why problems occur and how to identify them. Very dark wax in the ear can be a sign of a cholesterol problem, for example. If we notice this, we can do cholesterol testing here in the pharmacy and then refer patients to their GP if necessary. Changes in potassium levels can cause problems with the ear, and some medication can affect potassium levels, so we always ask customers which medication they are taking, as well as about any underlying medical conditions.”

The otoscopy service provides an ideal opportunity to recommend over-the-counter products and offer advice on ear health in general. “At the moment, ear wax is the only problem we can treat in the pharmacy itself,” says Ms Hill. “Hopefully this will change in the future – one day, for example, community pharmacies may be able to treat minor ear infections with antibiotic drops.”

“During our training, we learnt which ear wax softening products the specialists recommend and why. We stock a good range of products, including olive oil, sodium bicarbonate and popular brands. Customers who are treated for ear wax have a follow-up otoscopy appointment. Many customers will say wax softening drops haven’t worked for them. But, after a discussion, we realise they haven’t been using them correctly. We explain how to use the drops, and then arrange to see the customer again to make sure the drops have worked the second time.”

Eye health

Pharmacies can offer customers more over- the-counter products for eye conditions than for ear problems. But according to Mandeep Mudhar, Numark’s director of marketing, eye care is probably one of the most under- promoted categories in pharmacy. “Thinking about how many diseases and conditions the eyes are associated with, such as allergy, colds and flu, diabetes, hypertension, etc, it’s not a category that can be ignored,” he says.

“Pharmacists and counter assistants play an important role in providing advice to customers regarding eye and ear care. While these appear to be small categories for community pharmacy, among Numark members, eye care is the fourth largest sub-category within the P meds section, taking 5.4 per cent. It is larger than sleep and women’s health. Within GSL, this story changes and its category share is 2.5 per cent.”

The ear and eye care categories should be merchandised together, near or next to allergy products, creating a link between general eye health and allergy eyes. “Optrex is the beacon brand for eye care (the one customers look for on the shelf, regardless of whether they intend to buy it) so should be the lead in the category,” says Mr Mudhar.

“Ensure Optrex is merchandised to the left-hand side of the shelf and position larger to smaller pack sizes from left to right. Own label equivalents should be positioned directly next to their branded counterpart to offer customers choice and a value alternative. The Numark brand sells well in the eye category. Cosmetic eye products, which includes eye whiteners and eye brighteners, should also be merchandised in this section.”

Eye problems are often associated with allergies, which can occur at any time of the year, not just the hay fever season. According to a survey of 2,000 people by Bausch + Lomb, for the launch of its detergent-free Biotrue daily eyelid wipes, 26 per cent of adults struggle with allergies that affect their eyes. More than half say hay fever triggers red, itchy eyes, while four in 10 blame pollen from trees and other plants, and a third say their symptoms are brought on by exposure to dust.

Experts say doctors should explore ways to avoid the long-term use of antihistamines and other medications. Francesca Marchetti, an optometrist and advisor to WINK, an independent eye-care panel supported by Bausch + Lomb, says: “As allergies become more prolonged and problematic, it becomes very important to target the most troublesome symptoms – such as itchy eyes – and look at strategies that don’t involve long-term use of antihistamines or steroids. It’s well known that oral antihistamines can cause drowsiness but some patients find antihistamine eye drops can potentially lead to dry eye problems and headaches and steroid drops can lead to much more serious problems, including glaucoma and cataracts.”

Almost half of participants surveyed by OnePoll on behalf of Biotrue re-wetting drops say they suffer from eye problems such as stinging and burning and eye redness on a regular basis. And 32 per cent of respondents suffer from dry eye, specifically due to long periods in front of the computer or using devices such as tablets and mobile phones. Air conditioning and exposure to wind are also key triggers.

Dry eyes are a common problem, but customers need to see their optometrist if symptoms persist, even if they are mild. Dry eyes can be a side effect of medication or a sign of an underlying chronic medical condition, such as Sjögren’s syndrome, lupus or arthritis. According to Sandi Sims, marketing
manager at Cambridge Healthcare Supplies, many people with eye or eyelid infections tend to self-diagnose, so it’s essential that pharmacy staff’s knowledge of the eye care category is up to date. “Asking simple WWHAM questions can help determine whether an eye health problem is something that can be easily self-treated with an OTC product, or whether more specialist intervention is required,” she says. “Golden Eye offers both non-antibiotic drops and ointment options. We find, in particular, that the use of ointment is more popular than drops.”

Long-term health

Regular sight tests are essential for maintaining healthy eyes, but lifestyle measures are also important in the prevention and management of certain eye conditions. Poorly controlled diabetes can increase the risk of cataracts and diabetic retinopathy, while smoking is the biggest risk factor (after ageing) for age-related macular degeneration (AMD). According to the Your Vision Matters campaign, which organises National Eye Health Week, 60 per cent of people living in the UK have no idea that what they eat can affect the health of their eyes.