Every business is unique and therefore operates a slightly different model. From the practice that is set up to be clinically-focused and derive the majority of its turnover from fees, to those that are built on spectacles income, and everything else in between.
When it comes to technology, there are a range of ways that equipment, such as optical coherence tomography (OCT), can be integrated into practices. OT speaks to three practices that have each integrated OCT into the patient journey in different ways.
Eyesite, an independent opticians with six practices based across the south east, has offered OCT in all of its practices for around eight years now. While support staff are educated on the device to enable them to discuss its benefits with patients, it is the role of the optometrist to take and interpret the image.
This approach was a decision based on the clinical ethos of the business, managing director of Eyesite, Jim Green, told OT.
OCT scans are performed in what Mr Green describes as screening suites. These suites contain a range of equipment on which the optometrist screens patients while offering ‘eye education,’ which involves speaking to the patient about their live findings, as well as their eye care expectations.
When discussing missed pathology, the managing director highlighted that this approach also ensures that there is a tight and closed loop on where errors can occur.
Every new patient to Eyesite will receive an OCT on their first visit.
“OCT is built into our eye examination model, enabling every new patient who comes to Eyesite to have an OCT performed,” Mr Green highlighted. He explained that taking an OCT gives the opticians a baseline measurement for every patient and ensures that optometrists can make an informed eye care recommendation for the patient for their next visit.
With a clearly defined business model that focuses on the clinical, Eyesite offers patients a tier of eye examination options: the extended eye test, the advanced eye test and the advanced gold eye test, which includes OCT.
It is this advanced gold eye test that all new patients at Eyesite receive at a discounted rate. “We actively discount for new patients,” Mr Green acknowledges. “There has to be an element of absorbing the cost as a marketing fee on the basis that we are highlighting our services. By doing this, we hope to become known and trusted by our patients because we offer a high level of care and it is absolutely with the intention of being able to recommend the best examination for them thereafter,” he explained.
This method has proven effective for Eyesite, with nearly 100% of new patients opting for OCT when it has been recommended when they return for their next eye examination.
Eyesite employs a professional training manager who is responsible for putting together a training programme on equipment, which includes OCT. Each practice also has a clinical lead who will run the training and make sure the team understands it, Mr Green shared.
For Mr Green, while it is the optometrist who takes and interprets OCT, it is still important for the whole practice team to understand and be able to speak to patients about the device. Therefore, every member of the team receives training.
“Everybody has to understand what an OCT does and how it does it so they can articulate that to patients. For support staff, it is about describing what each piece of equipment does in a patient-friendly way. Then it is up to the optometrists to delve deeper with the science behind it, if the patient wants to know,” Mr Green said.
“Because the name is so technical, we do have to make sure that we are using patient friendly-language when we are describing OCT and have found that likening it to an ultrasound, for example, works particularly well,” he added.
“OCT is built into our eye examination model, enabling every new patient who comes to Eyesite to have an OCT performed”
At Specsavers in Chelmsley Wood, OCT scans are taken by optical assistants who have been fully-trained to use the device, as well as educated in how to recognise a successful scan, optometrist director, Sukhwant Drake, told OT.
Ms Drake confirmed that while the practice is part of the Specsavers portfolio, it has the freedom to decide who, when and where the scans would be taken by as part of the patient journey.
“We have opted for optical assistants to perform the scans so it does not impact on the optometrist’s time. They are performed before the sight test as this works well with our already well-established pre-screening journey, and the optometrist then interprets the image and speaks to the patient about it during the examination,” she explained.
“The benefits that this process brings is that it frees up the optometrist’s time and it is a lot more efficient use of other people’s time,” she added.
The Chelmsley Wood practice welcomed the Nidek OCT around six months ago and of the two OCT devices that Specsavers recommends to its stores, Ms Drake said it selected Nidek due to its easy-to-use nature.
The store director highlighted that while in-depth training for both clinical and non-clinical staff was provided by the manufacturer at point of installation, this was complemented by a series of compulsory online training modules for all optometrists that is run by Specsavers.
“Regional training events and the annual Professional Advancement Conference have since helped advanced and instill the knowledge of our optometrists,” she added.
Sharing how support staff felt about taking on the additional task and responsibility, Ms Drake said her team were “really excited” by the prospect.
“Of course, at first they were a little nervous about having this new piece of machinery, but after they received training, they couldn’t wait to offer the service – they knew it would be enabling them to provide an even better level of eye care to the customer,” she emphasised.
Commenting on what happens if the optometrist feels an OCT should be taken as a result of the eye test, Ms Drake confirmed that this is fine.
For Ms Drake having simple yet effective processes in place is key for avoiding missed pathology. “On our database there is a procedure for flagging when a patient has had an OCT. The optometrist can access this from their monitor in the testing room in order to interpret the image,” she confirmed.
“It may make some clinicians worried that it will show too much, but the benefits of having it are unbeatable. I could not imagine practising without on”
When in Scotland
For optometrist Eilidh Thomson, who practises at Black & Lizars in Davidson’s Main, Edinburgh, OCT scans are taken by fully-trained support staff after the patient has had their sight test.
“During the appointment, there is always a discussion between the optometrist and the patient about OCT and, if it is recommended, it is taken after the eye examination has finished,” Ms Thomson told OT.
The optometrist highlighted that the requirements of the scan are detailed in the optometrist’s handover to a member of the clinical support team, who will then take the image. “Support staff do not give the patient any indication of the result of the scan, that’s completely the responsibility of the optometrist,” she emphasised.
“However, if, as a clinician, I suspect a particular condition or outcome from the OCT, which is why I am requesting a scan, I will let the support team know, just so they don’t get a shock when they are taking the scan,” she shared.
Images are saved centrally for the optometrist to review from the testing room. It is then the role of the optometrist to interpret the image and feed back to the patient, she confirmed.
Ms Thomson first encountered OCT as a pre-reg optometrist with Black & Lizars, with her supervisor teaching her about interpretation. “OCT is one of those things that you learn by knowing what’s normal. The more normal images you see, the more likely to are to spot something abnormal when it arises,” she said.
As OCT is currently provided free of charge at Black & Lizars, it tends to be offered to most patients, Ms Thomson explained. “Whilst it is performed on the recommendation of the optometrist, I personally like to always have a baseline image on record,” she added.
Ms Thomson believes that performing the scans after the sight test is the most efficient process for the patient and the optometrist. “If OCT is done during pre-screening, you can find yourself repeating it following the results of the eye test,” she said.
When discussing responsibility for missed pathology when using OCT, Ms Thomson said she has a high level of confidence in the processes used at the practice where she works and trusts her support colleagues.
“We have an open door policy and I trust that if a clinical support colleague was struggling to take an image or had an issue with the piece of equipment, they would come to me and ask for help,” she said.
Ms Thomson emphasised that OCT is an invaluable tool to have in practice. “You will never regret having an OCT,” she said. “It may make some clinicians worried that it will show too much, but the benefits of having it are unbeatable. I could not imagine practising without one.”