What advice about liaising with hospitals do you offer student optometrists at the University of Portsmouth’s eye clinic?
Anthea Reid (AR): I tell them about what the most important information is that the hospital wants when a referral is made. I know from working in different parts of the country what different ophthalmologists believe should be managed in practice and what should go to the hospital, and that also comes into the discussion with the students. We also think about what the follow up should be – if we should see someone in six months or a year, or whether it’s something that requires a hospital opinion.
Hopefully what is coming across from me, and the other community optometrists who are supervising at Portsmouth, is that ophthalmologists are colleagues. It is useful to get to know the eye unit and to communicate in the way that it wants to be communicated with. That way, the eye unit finds them useful colleagues to work with rather than being frustrated by referrals that should be going elsewhere.
What are the common issues that you encounter in your role as a specialist optometrist at Bournemouth Hospital?
AR: A problem that I see at Bournemouth is when someone has written a referral that starts with a cataract issue and then mentions a tumour in the second paragraph. The initial paragraph is what gets read first if it’s busy and we’re going through referrals quickly. That important bit of information could get lost in the waffle at the beginning. It is important to make sure that the information is clear and concise so that whoever is receiving the referral knows what problem needs addressing.
“Hopefully what is coming across from me, and the other community optometrists that are supervising at Portsmouth, is that ophthalmologists are colleagues”
How should optometrists form relationships with ophthalmologists?
AR: It can be difficult for any community optometrist to build that relationship. It’s important to attend any lectures put on by ophthalmologists because that’s when you’ll find out about how the patient is dealt with within the hospital and what the ophthalmologists want to see.
Additionally, keeping in contact with the local optical committee is important, as is looking at its website for updates on the current referral guidance. Lots of areas will have different referral pathways for glaucoma and cataracts rather than urgent referrals – some will go to a community-based clinic, some will go to a hospital. Make yourself familiar with what the local clinical commissioning group does in regard to referrals.
If hospitals do send letters back, then it’s about reading them and checking that they’re happy. If there is any indication that they would have liked you to have managed something in a different way, that’s an opportunity to ask for clarity and to build links.
Do you think the relationship been the two professions has improved?
AR: The newer cohort of ophthalmologists are generally pro-optometry and have the mindset that other professions can take on extended roles. Optometrists in an eye unit often help junior doctors get through their refraction exams when they’re first starting out, which helps start a relationship. The fly-in-the-ointment can be when optometrists in the area do poor referrals as it stays in ophthalmologists’ minds.
“If there is any indication that they would have liked you to have managed something in a different way, then that’s an opportunity to ask for clarity and build links”
Why does hospital optometry appeal as a career?
Aarani Sivanesan (AS): Hospital optometry appeals to me because it involves working in a fast-paced and stimulating environment. It provides an opportunity for optometrists to be involved in more specialised areas of optometry, such as managing and treating patients with conditions like glaucoma, macular degeneration, paediatrics and post-operation cataract.
What have you learned from supervisors at the eye clinic about hospital optometry?
AS: Having supervisors who have a range of experiences in different clinical settings has allowed us to gain valuable information about the different career paths in optometry.
Hospital optometry provides an opportunity to work in a multidisciplinary team and provide care for more complex cases on a regular basis. As you extend your training and skills, it allows you to work in a multitude of different areas, so this means that each day is different and exciting.
The supervisors have been able to guide and support us when managing patients. It is important before making referrals to be sure that you have done everything that is within the scope of your practice, to help make the patient’s referral process easier and reduce the work load for other healthcare professionals, such as ophthalmologists. It is important to consider why you are referring and what the outcome is that you are expecting, for example, confirmation of a diagnosis.
“Hospital optometry appeals to me because it involves working in a fast paced and stimulating environment”
Have you made a referral from the eye clinic?
AS: Yes, for a patient who presented with a high intraocular pressure (IOP). It is important that you take a thorough history because the symptoms and previous occurrences can guide you as to what the potential diagnosis could be. To confirm diagnosis, IOP was first measured with a non-contact tonometer, followed by Goldmann applanation tonometry. As the IOP met the NICE guidelines for referral, the patient was informed about the reason for referral and the complications that can arise if a referral is not made.
What did you learn from this experience?
AS: When referring you must ensure that all steps are taken, within your scope of practice, to help diagnose the patient with the information you have provided. It is important to have a good understanding of the circumstances in which a referral is appropriate. Furthermore, good communication with the patient is essential to ensure they understand the urgency and to improve the referral process, as patient compliance is key.
What have you been taught about the referral process at university?
AS: Our lectures have allowed us to get an insight into the referral process for different conditions and the circumstances in which a referral should be made. Referral does not necessarily involve the hospital eye service in all instances, referral could be simply to the GP, for a blood pressure check-up.
“Collaborative care by optometrists and ophthalmologists is important to provide efficient patient care”
How have you been able to apply this in practice?
AS: Our eye clinic has provided us with a great opportunity to see more complex cases that have led to referring. This has allowed us to put our knowledge that we learnt in lectures into practise, as and when it applies. It also allows us to see that a case may look like it requires referral at the initial instance, but as you do further investigations, it may be a condition where it requires close monitoring by an optometrist instead.
Why do you think it is important for optometrists and ophthalmologists to work more closely together?
AS: Collaborative care by optometrists and ophthalmologists is important in order to provide efficient patient care. There is an increasing demand in the patient base and a reduction in the number of ophthalmologists and this highlights the need for a co-management and integrated eye care to provide the best and consistent eye care. Optometrists can undergo further training that would provide them with sufficient skills to reduce the pressure on the workload.
Are extended services an area you’d like to explore in your career, and, if so, why?
AS: I enjoy learning, and I am looking forward to training to provide extended services. The skills and knowledge obtained would allow me to manage more complex cases. It is important to encourage optometrists to consider extended services especially with the growing demand for the increased capacity in ophthalmic services.