Completing Stage one as a pre-reg hospital optometrist

My day-to-day schedule in the hospital is varied, and structured around a range of clinics – every week includes time in core optometry clinics like refraction, specialist contact lenses, and low vision.

Then, depending on the week, I spend time in specialist ophthalmology clinics, eye casualty, and orthoptics. This variety has been invaluable in helping me develop a broad clinical skillset while gaining exposure to more complex cases than I would typically see in primary care.

With regards to dispensing, I currently attend a practice one day a week.

This is now transitioning to a full day of routine testing within the same practice, which will be valuable for gaining experience and developing a better understanding of the seamless transition between primary and secondary care.

Since I started my pre-registration placement, my days have become more hands-on, whilst I continue to work under supervision.

Initially, much of my time was spent observing and easing into clinics as well as familiarising myself with hospital systems and workflows. As my confidence has grown, I have been able to take a more active role in patient assessments by carrying out consultations, performing investigations, then presenting my findings and suggested management plans to senior clinicians for review and discussion. This supported approach has been key to developing my clinical confidence while maintaining safe and effective patient care.

At the time of writing, I am working through Stage one of the Scheme for Registration. I’m currently working towards my Visit two, which is next week.

I have been able to take a more active role in patient assessments by carrying out consultations, performing investigations, then presenting my findings

My biggest learning so far is that, when it comes to specialist contact lenses, there is no single approach that fits every patient.

Many of the corneas seen in clinic, such as post-graft, keratoconic, scarred, or ectatic corneas, are all unique and require careful individual assessment. This has reinforced the need for flexibility in clinical thinking, adapting lens choice and fitting strategies to each patient rather than relying on a fixed set of rules.

A challenge I have overcome is ensuring I gain a broad range of patient encounters that align with the Stage one competencies, especially those more tailored towards primary care while working in a hospital setting.

By actively seeking opportunities and making a conscious effort to gain specific encounters, I have been able to develop the relevant skills and evidence.

One highlight from the past two months was when I observed a patient with a Boston Keratoprosthesis. Seeing this advanced intervention firsthand and the complexity of the case, including the patient’s visual rehabilitation and ongoing management, was fascinating and highly educational.

One important learning experience occurred while I was carrying out a low vision assessment for a patient with late-stage dry age-related macular degeneration and geographic atrophy.

The patient had been coping well, and everything initially seemed straightforward. However, during the history, they mentioned new flashing lights and floaters. This required me to further investigate and adapt my assessment.

I discussed this with the patient by explaining clearly and calmly what the new symptoms could indicate, and why further assessment was needed.

I reassured them that while it may not be serious, it’s important to investigate promptly, outline the next steps, and answer any questions they have to ensure they feel informed and supported. It was a valuable experience in responding to unexpected findings and prioritising patient safety.

Hospital optometry can feel daunting at first, but every clinic, no matter how challenging, offers valuable experience

My advice for my pre-reg peers is to ask questions and make the most of the learning opportunities around you.

Hospital optometry can feel daunting at first, but every clinic, no matter how challenging, offers valuable experience. Working alongside colleagues with a wide range of expertise provides the perfect environment to learn and pick their brains.

I have balanced work with study by using a Filofax I was gifted to set goals and create a general study plan alongside my clinical work.

Reflecting on unique patient cases has helped me consolidate my learning and build knowledge without feeling overwhelmed.

I’ve very recently started an Instagram account for optometry, @insight.byzak, which I think will be a fun way to engage with cases and share learning points, whilst still technically ‘revising.’