“I get a lot of enjoyment out of helping people”

In fact, according to ABDO, only around 50 of over 6300 DO members reported themselves as working within the hospital eye service in April 2023.

OT spoke to Charlotte Scriven, senior hospital dispenser at Birmingham Midland Eye Centre (BMEC), about the value her role brings, and the differences she has found after moving from the High Street.

How long have you been at BMEC, and how long have you been in the hospital dispenser role?

I started at BMEC in January 2019. Before that, I was in community practice, in an independent.

This job came up – I’d met the person who did the role beforehand, and it sounded really interesting. I applied, because it sounded like a new challenge, and something different. 

How would you sum up your role in a few sentences? What does your job entail?

I work within the hospital eye service, directly with the optometrists, and as part of a multidisciplinary team including orthoptists, ophthalmologists, nurse practitioners and our eye clinic liaison officer (ECLO).

My role as a DO is to dispense patients with the best product for them at the time, which requires time and attention and the ability to manage the patient’s expectations. I manage my own diary so can ensure the correct appointment length for each patient.

I have a dedicated low vision clinic each week, which involves helping patients with their existing magnifiers, recommending new ones, ensuring they are managing in their daily life or offering additional support for this, and helping with their emotional needs too.

I am also actively involved in helping teach trainee ophthalmologists in focimetry for their refraction exams.

What would you say are the main differences from working on the High Street?

On the whole the patients are more complex, and have diagnosed eye conditions in most cases.

There is not the commercial pressure of conversion targets. Although we are still selling things, and the patients still pay unless they are eligible for help, it’s not about selling – my whole focus is about making sure that we have the best product for the patient, within their means. That can make it feel very different to High Street dispensing work.

I am in the lucky position that I can take risks when dispensing complex prescriptions with confidence, compared to on the High Street, where remakes could be more problematic.

What kind of things are you able to do that you were not able to do on the High Street, in terms of solutions for patients?

We see a lot of kerataconics. Often in High Street practice, it will be a case of, ‘you’re keratoconic – glasses won’t work for you.’ The patient might have tried glasses before and found that they haven’t worked, so they won’t try them again.

We have the ability to try things and modify things if they don’t work, and make a solution that works best for the patient, rather than having to think about how much it’s going to cost. If it doesn’t work, it’s never the end of the road. It’s more, ‘What can we do next? What will work better for this patient?’

Do you see more advanced pathology than you might see on the High Street?

Most of my time is spent dispensing patients with keratoconus or other advanced pathologies such as glaucoma, macular degeneration, diabetic retinopathy, and retinits pigmentosa.

We see a lot of paediatric patients along their journey, and these patients sometimes have advanced pathologies too.

I’m always learning things. I get a lot of enjoyment out of helping people, so I find it really rewarding

Do you also do specialised dispensing?

All of my work could be called specialised dispensing, as it often involves the use of specialist frames or lens options. Our hospital is also a regional referral centre for patients requiring ptosis prop fitting, and I regularly fit these. This is something I had not done in High Street practice, and I have been lucky to have good results.

Do you have any particular challenges in your role – particularly things that you did not encounter on the High Street?

We see a large proportion of special educational needs and disabilities (SEND) children, and also SEND adults, who I think get lost sometimes in community, because testing them is difficult, and being in a busy environment can be difficult.

Some of these patients have had difficult experiences in the community and are often worried about being discharged. Being able to provide a calm environment for them and being able to offer ongoing appointments to them can help put the patient and their carers more at ease. I work closely with the SEND specialist optometrists to achieve the best outcomes for each patient.

At the dispensary, we only have one patient at a time. It’s not overly busy, so there aren’t people in and out or lots of noise or chatter. It is a more subdued environment for them, so when they come in, it’s not quite as overwhelming as perhaps a High Street practice can be.

As the only DO here the patients get to know me and I get to know them, as I see them again and again and build a rapport with them.

We run a special schools clinic from the hospital – optometrists go out into the special schools and do the testing there for the patients, and there is always the option to come to us for the dispense. Some will go into the community, but some patients who require extra support come to us.

What do you enjoy most about your job?

It’s different – every day is something new. I’m always learning things. I get a lot of enjoyment out of helping people, so I find it really rewarding. Particularly within this area, it is quite unique – there aren’t any other hospitals that have a dispensary in the area, so other hospitals will send their patients into me when they struggle to get a dispense in the community or need that extra level of support or specialist frame fit. We see them here instead. It’s really nice to come into work. I work with a really supportive team. I really love my job.

What has been your biggest recent success?

Recently, when I saw a patient for ptosis props. He had previously been fitted with Lundie loops, and they were unsuitable for what he needed, and uncomfortable. He had taken delivery of them some years ago and never worn them, and we fitted him with nylon ptosis props instead.

Without the props he had really struggled, but they allow for better vision. They work, they do what we want them to do, and he’s comfortable in them. In the long run, it’s going to be better. He was very pleased with what we managed to achieve for him. In cases like that, you are making a real difference to somebody’s everyday life.

The standout moments are the little achievements, where actually you’ve just got a child wearing their glasses, which is so important

Can you identify a standout moment that you have had whilst you have been in the role?

Because what we do is specialised, I think there are those occasions where you see an autistic child who hasn’t been able to keep their glasses on, and it’s the second or third time you’ve seen them, and they’re now wearing their glasses. They’re happy to put them on, rather than screaming and trying to leave. That happens quite often. The standout moments are the little achievements, where actually you’ve just got a child wearing their glasses, which is so important.

I have dispensed an autistic little boy, and in the first appointment, he screamed when we tried the frames on. When we put the actual glasses with the lenses in on him, he became a different child. He was looking at everything; he was engaging.

His mum was absolutely beside herself. She couldn't believe it. She said, ‘he doesn’t pay attention to anything. He doesn’t look at anything.’ Because before, he couldn’t see. Now, he’s wearing the glasses really well – he gets upset when he’s not wearing them.

Working in a tertiary hospital with complex patients, the patients are often going through additional challenges and are often fearful of losing their sight. Being able to offer the correct advice and support information is important. As a standalone DO, supported by an amazing team, I feel I make a difference to all my patients.

All of these things are what it’s about – making patients see better. When they’re limited by other things they have going on, that little bit that you can give them is really important.

*ABDO self-reported data, 2023