Three changes that have shaped optometry in 34 years

But how has optometry changed in that time? As Nick Rumney marked his official retirement from BBR Optometry, in Hereford, in 2025 after 34 years in the practice, OT asked the optometrist to reflect on the biggest changes he has seen in the profession.

Here, Rumney told OT the top three changes that shaped optometry during the course of his professional career:

1 Political change

Rumney told OT: “The number one change has been the political change that occurred in 1989 when the NHS sight test was removed from a large proportion of the population.”

“The expectation from Government at that time was that the optometry profession would offer its services free, on the grounds that it would lead to a dispense and sale. The majority of practices said: ‘No, that is highly unprofessional and we should be charging a fee for the examination,’” he shared.

At that time, Bishop & Bishop, which went on to become BBR Optometry, had opted to charge a higher fee than many other practices.

“The practice had taken the view, like a lot of independents, that this was the opportunity to shine and differentiate,” Rumney said: “My former partners said: ‘We are delivering more, we’ve got better equipment. The ethos of the practice has got to be that the clinical side must be closer to standing on its own two feet’.”

When Rumney joined the practice in 1991, the fee for a sight test was £15, which he described as around a 50% uplift on what many others were charging.

“We have seen a drive to increase that fee component every two years, without fail,” he told OT, explaining that a full private eye examination fee with BBR Optometry is presently more than £130.

Rumney shared: “When you look at the inflation of the private sector in the majority of retail optics, it really hasn’t kept pace with what was being charged initially. We’ve got to a point in our practice where the differentiation is so high that approximately 40% of the income stream to the practice comes from the clinical fees of chair time.”

BBR Optometry

Nick Rumney, former chairman of BBR Optometry

2 Managing databases

The second change that has shaped optometry during Rumney’s career has been digital database management.

He said: “We have never lost a record on the computer, but files get mis-filed. We had the opportunity to completely remove the racks of filing cabinets from the ground floor because everything is fully IT-driven on what is effectively a paperless clinical record system.”

Those rows of filing cabinets now live in the practice’s basement and have not been touched for some time, Rumney suspects.

The practice joined Hakim Group in 2020, and Rumney notes that there are a variety of vehicles and systems for managing practice databases.

“To have your files in computerised form is the next great technological advance. Simple things like taking photographs, whether of the front of the eye or retinal photography, you can’t do without an index database,” he said.

3 Imaging technology

The third change, Rumney said: “Undoubtedly is optical coherence tomography (OCT). OCT has revolutionised what we can see and how we can analyse what is going on in the eye.”

This has also fed directly back into the differentiation of the practice. BBR Optometry began running its first OCT in 2007 – the first 3D OCT in an optometry practice in the UK.

Rumney explained: “It meant that we could legitimately increase our fee base because it is a relatively expensive piece of kit, but in terms of what it enables you to do, it massively improves your efficiency.”

“It has opened the door to optometrists all over the country so we can make better clinical decisions. These are patients who we no longer need to refer because we can monitor them and look after them. That feeds into the advancing scope of the profession,” he added.