“It has grown my confidence in a way that I cannot even put into words”

Can you describe working as a hospital optometrist in one sentence?

Challenging but engaging, and really rewarding.

When and why did you decide to become a hospital optometrist?

I did my pre-reg in the community. Very soon after I qualified, I started to feel like I had hit a bit of a clinical plateau. I really wanted to challenge myself. I wanted to grow in terms of my clinical competence and my confidence as a clinician, so that’s when I stepped into hospital – to try and improve my skills and become a better practitioner.

Do you do any other work or volunteering alongside hospital optometry?

I do some locum days in the community. I also have an educational page on Instagram that goes through hospital optometry and clinical cases. I break down the signs and symptoms of interesting cases I come across and how to manage the patient. It’s so important to share knowledge, especially when it comes to the rarer cases. I have learnt so much from other optometrists and I hope my page can do the same for others. 

How does working as a hospital optometrist support you as a High Street optometrist?

The experience has grown my confidence in a way that I cannot even put into words. Before, I used to get nervous around the tricky paediatric cases – patients coming in with large squints, or if they were really amblyopic, or had really complex prescriptions. When you’re in hospital, you are the person who gets those referrals. Now, having hospital experience, I very rarely have to refer any of those complex cases, because I know what to do with them. It means that patient gets sorted there and then, and doesn’t have to wait months to be seen in secondary care.

Having hospital experience, I very rarely have to refer any of those complex cases, because I know what to do with them

On the other side, how does working on the High Street benefit you in the hospital setting?

Having that initial background in High Street optometry, because it’s not as fast paced as the hospital and because it’s not as intense, meant that I could really get that foundation down and have that confidence first. When I then stepped into hospital optometry, it meant I was already quite sure of myself in terms of my clinical abilities, so when I did get those challenging cases, I thought, ‘I know what to do with this. I can trust my judgement.’ High Street experience definitely built a good foundation.

What is the biggest challenge facing hospital optometry currently and why?

I know this is very cliché, but it is the waiting times. It is not uncommon for children’s amblyopia to be picked up late. Many children don’t come to their first eye examination until the age of six or seven, when something about their vision gets flagged at school. This, coupled with the long waiting times to access hospital care, means the window to improve their vision before the critical period ends is very small.

I had a patient, about two months ago, who was eight years old, with bilateral meridional amblyopia. The critical period is known to end at around eight, so if you try to treat the amblyopia at such a late stage it’s unlikely that it’ll improve the visual acuity by very much. His first ever eye examination in community was at the age of seven and his visual acuity was quite poor – around 6/12 and 6/15.

By the time he had been seen in hospital it was six months later, he was already eight, and that critical period window was closing. Especially with a visual acuity in that region, it is likely to affect their quality of life long-term, be it sports, learning, or even meeting the legal standard to drive later on. In a situation like this, six months is crucial, and a reduction in that waiting time has massive potential in improving the quality of the rest of their life.

It is not uncommon for children’s amblyopia to be picked up late

What is hospital optometry’s biggest success in the past three years and why?

One thing that I really like about my department is that it’s so varied. There are so many different clinicians. It’s a multidisciplinary team. Especially over the last few years, with the increase in shared care schemes, it’s great being able to bring all of our skills in conjunction with each other to give that patient the best outcome.

One thing that hospital optometry does really well is that it picks on the strengths of every single type of clinician, and pulls it all together. I know that if I have a really complex problem with a binocular vision issue, I can knock on the orthoptist’s door and they can advise the best management. If I’m struggling with something to do with a pathology, I can knock on one of the paediatric ophthalmologists’ doors, and they will come in and have a look at that child with me.

That’s one of many positives that hospital optometry offers that community doesn’t – a lot of community work is quite independent, whereas hospital optometry opens up a variety of clinicians to reach out to when you need them.

What is your biggest success in the past three years and why?

Stepping into hospital, I’ve really surprised myself with how much my clinical competence and confidence has grown. When I first went into hospital optometry, I was like, ‘It’s going be a really steep learning curve. I’m probably going to get really stressed. I don’t know if I’m capable.’

But actually, I’ve been able to take it in my stride. You surprise yourself in how quickly you end up picking up the clinical skills that you need. Even in the very short time that I have been in hospital, I already feel like I’ve grown as a clinician so more much than if I had stayed in community full-time.

What is the most surprising case you have seen in the hospital setting?

I saw a newborn. He was only three months old, and he had to have cataracts removed. Because baby’s eyes are so little, they aren’t big enough to put in intraocular lenses. They have to be seen by the optometrist and by the contact lens optician for a specialist contact lens, and also by the ophthalmologist to monitor the health of the eyes as the baby is growing.

His prescription is over plus 20 dioptres, so it’s really interesting looking after him and watching the changes in his eyes as he grows, especially carrying out retinoscopy on a child this little with that kind of prescription – it can be challenging. I then work together with the contact lens optician to find the best lens to fit, again factoring in that he’s only a newborn. It’s been a really unique experience.

That’s definitely the most interesting and surprising case that I’ve seen so far. We review him every four weeks and look after him as he’s growing. This case especially has taught me so much about paediatric ocular development. I think back to it a lot.

What would you say to optometrists working on the High Street about working in a hospital environment?

It's definitely, definitely worth doing it. I know that many optometrists get put off by the fact that NHS pay is a lot less than in community, but even if it’s just something that you do part-time, you will be surprised at how much you will grow as an optometrist, how much your competence and confidence will improve, and how many of those skills you can then take back to better the care you give your patients in community.

I mentioned earlier about being able to look after the tricky paediatric cases a lot more confidently on the High Street now. Children are complex: they can’t voice their symptoms the way an adult can, and it’s easy to refer them into the hospital for one thing without realising they actually have underlying pathology contributing to the problem.

Experience working on the other side, in hospital, grows your ability in being able to carry out the relevant tests to recognise these other underlying contributing factors, making for more accurate referrals and timely, relevant care for the patient. Even on a personal level, as you notice your growth as a clinician, you’ll be really proud of yourself too.

Anything else to add on the subject of working as a hospital optometrist?

One thing that I get asked about a lot is the journey of transitioning from being an optometrist who has done their pre-reg in the community, to then working in hospital after qualifying, and what that change was like. A lot of my peers say things like, ‘I can’t do hospital. It’s going to be too difficult, too complex. I’ve only ever worked in community, I’m not competent enough.’

But actually, I would encourage all optometrists to experience the hospital setting. The skills you learn are invaluable, and don’t worry – you will get support and the relevant training. You won’t be thrown into the deep end straight away.