04 December 2025
Reflecting on how technology has changed over the course of his career, Paul Morris describes a fundus camera at university.
“We weren’t allowed to use it because it printed out on Polaroid,” the Specsavers director of professional advancement recalled.
“That was not the deep and ancient past – it was 1999, so if you think of the evolution between that and what we have now, it is absolutely unbelievable,” Morris emphasised.
Fast-forward to 2025, and technology within optometry practices is vastly different to the days when Morris and his hospital colleagues huddled with a sense of quiet awe around the department’s only optical coherence tomography (OCT) device.
OCT is no longer solely the domain of secondary care, with devices present in more than 1000 Specsavers branches across the UK and Ireland.
As well as offering an unsurpassed view of the eye, OCT is increasingly being used as a window into systemic health. The vast quantities of data captured by OCT are a perfect complement for data-hungry artificial intelligence systems.
Morris, who is director of professional advancement at Specsavers, told OT that he is passionate about ensuring that the education and training of practitioners keeps pace with technological advancement.
“It’s one thing to have these technologies, but the other issue is how you utilise these tools for the benefit of your patients and practice,” Morris observed.
Reflecting on his tips for OCT scan interpretation, Morris cautioned optometrists against leaning too heavily on whether an image is red, amber or green.
“Avoid putting too much emphasis on the indicators that come out of the OCT scan, without looking at other factors,” he said.
Primary Eyecare Services clinical lead for glaucoma, Tom Mackley, told OT that OCT was not part of practice when he qualified in 1998.
“We relied on clinical examination of the disc, with a Polaroid photograph if you were very lucky. It wasn’t until the late 2000s that I saw OCTs in clinic and the initial emphasis was more on macula scanning,” he said.
Mackley, who works as a glaucoma specialist optometrist at Lancashire Teaching Hospitals NHS Foundation Trust, highlighted that glaucoma clinics are now heavily reliant on OCT.
“They are of central importance for both face-to-face and virtual diagnostic clinics,” he said.
Mackley highlighted that detecting small changes within the optic nerve head – a structure that has significant variation within the normal population – is no easy feat.
“Detecting early glaucomatous change in the optic nerve head is often difficult even for specialist clinicians,” he said.
“OCT has certainly helped but has brought in new challenges in terms of interpretation,” Mackley shared.
The technology enables earlier and more definitive diagnoses in borderline cases and enhances our ability to track disease progression with far greater precision
The IP optometrist emphasised that OCT is a tool that “must be used judiciously.”
“It is easily capable of missing definite disease and implying progression when there is none,” Mackley observed.
“We sometimes refer to ‘green disease’ in the hospital. In other words, the machine says it’s all green, but you look at it, you analyse the data, and you realise glaucoma is there,” he said.
Mackley highlighted the value of using visual fields tests in conjunction with OCT.
“With OCT, you can pick up structural change in the eye before there’s a visual field defect. However, structural change can be difficult to identify, particularly in certain eyes – for example with very short-sighted eyes,” he shared.
“What matters in the end is whether a patient experiences a change in their vision, and that’s what a visual field defect would be – a direct consequence of the disease that should agree with the structural findings,” Mackley said.
IP optometrist, Ian Cameron, of Cameron Optometry in Edinburgh, highlighted the “transformative” role that OCT has played within glaucoma care.
“It’s remarkable how integral it has become in just a few years, particularly in assessing the ganglion cell layer and nerve fibres, which are critical for diagnosing and monitoring glaucoma,” he said.
“The technology enables earlier and more definitive diagnoses in borderline cases and enhances our ability to track disease progression with far greater precision,” Cameron said.
IP optometrist, Michael O’Kane, of Specsavers Morningside and Cameron Toll, highlighted the value of OCT in being able to monitor change in patients.
He added that progression is central to the definition of glaucoma as a group of progressive optic neuropathies.
“The quality of your referral is much better if you can evidence progression or rate of progression,” he emphasised.
O’Kane shared that while he will take normative data into account, his focus is on establishing baseline data for the individual patient.
“It’s much more important to compare that person with their future self,” he said.
O’Kane emphasised the importance of ensuring that there are no issues with image capture.
“Did they move? Was the tear film terrible? Have you performed the same type of scan as was done previously?” O’Kane shared.
“You need to make sure the scan quality is good because you never know when you are going to need it,” he said.
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