Perspectives

“I see enormous opportunities to reinvent our role in society”

It is easy to be despondent, but a positive new world is in our grasp – optometry simply needs to break out and find a new vision, optometrist Richard Edwards tells OT 

trees in glasses
Unsplash/BenHelisson
Thirty-seven years ago this autumn, I left home to start my optometry degree at Aston University and embark on a career in optometry. I was full of hope, optimism and excitement. It didn’t last long.

The following year, the government of the day deregulated the dispensing of spectacles to adults, and a few years later removed universal entitlement to NHS eye examinations and dental checks, introducing charges for eye examinations. These were seismic shifts that changed the sector permanently.

On reflection, I am hugely proud of how my profession adapted to its ‘new normal’ and rapidly evolved new business models and ways of working. Yes, there were casualties, including my employer at the time. But, by and large, we all got on with life in a new and increasingly competitive commercial environment. I actually think optics over the subsequent decades was an exemplar of how a profession can adapt to thrive in changing times and balance clinical and commercial dynamics, while delivering great patient care.

Since those tumultuous early years, we have seen technological developments and evolving consumer expectations that incrementally ratchet up the demands on our profession and yet, at its heart, our core function has not changed at all.

We refract in similar ways and, while we have infinitely better technology to examine the eye, many optometrists spend their time doing what we were doing in the 1980s. Relatively few have broken out to broader clinical roles in the management of eye conditions.

Most worryingly, the existence of our practices is still utterly dependent on the cross-subsidy of product sales to negate underfunded eye examinations and cover the ever-increasing costs of running a well-equipped practice.

While we have infinitely better technology to examine the eye, many optometrists spend their time doing what we were doing in the 1980s

 


And now COVID-19. Suddenly, we find ourselves once again grappling with an external disruption the likes of which we have not encountered for decades and the potential to change everything about our world. What will be the ultimate effect of the pandemic?

I am reminded of the remark by Chinese Premier, Zhou Enlai, who in 1972 when asked about the effect of the French Revolution 200 years before replied it was “too early to say.”

What is irrefutable is that there has been an acceleration in societal changes that is unlikely ever to be reversed. In August, 39% of non-food retail took place online in the UK, up 10% on last year.   

Although eyewear has been resistant to this, it will inevitably change. Can anyone really believe that the generations who live their lives online will really do anything else when they hit presbyopia?

It would be easy to be despondent. Yet I am more convinced than ever that a positive new world awaits the visionaries who can grasp onto new opportunities that this period of rapid disruption will bring.

Reasons to be cheerful

I see two enormous opportunities through which we can reinvent our role in society and carve out a prosperous future.

1. Management of chronic eye conditions
It is calculated by the RNIB that 80% of sight loss occurs in the over-65 demographic.

The Office for National Statistics (ONS) data in the Foresight Report 2016 indicates in the UK 14.7 million people are aged 60 and above, and by 2030 this is projected to be 20 million (ONS 2013). Projected growth in the over-65s demographic from 2010 to 2030 is 50%, over-85s it is 100% and as much as a seven-fold increase in centenarians. On top of which, the UK population could also have risen by 10% to 71 million.

A ‘multiplier effect’ behind this raw data is the expectation of ‘healthy life expectancy‘ in this rapidly growing demographic. The demand for management of eye conditions will grow significantly.

Even without the pressures of COVID-19, the hospital sector was never going to be able to cope with the demographic time bomb

 


Ophthalmology in the NHS is the largest outpatient department with 7.8 million appointments per annum.

The system is at bursting point before we ask the question of whether, post COVID-19, it is really the most appropriate environment for elderly people to attend for routine follow-ups. Similarly, the costs relating to sight loss were also starkly outlined in the Foresight Report.

Even without the pressures of COVID-19, the hospital sector was never going to be able to cope with the demographic time bomb, and optometry has to be the solution for meeting the majority of chronic eye health needs of society in the future.

2. Myopia management
The prevalence of myopia in many parts of the world has already reached epidemic proportions and the rapid evolution of new products and strategies in our armoury to manage myopia progression should create new opportunities. When policy makers, and, perhaps more importantly, the public understand the eye health risks associated with myopic progression then this could be a catalyst to redefine our role for years to come.

Reasons to be fearful

In the last year, I have been disappointed and concerned to see some of the reactionary responses from many of my peers to innovative change. To illustrate this concern, I would share an anecdote from a friend who teaches A level maths. He told me that last year his brightest handful of students went on to study to become chartered accountants. No surprise there, I hear you say – however, none of them went to university. They joined the big four accountancy firms on their degree apprenticeship schemes.

The routes by which people enter graduate professions has been evolving for some years, and yet the visceral response in optics to follow where other professions have already gone provoked an online petition of protest. I am not an apologist or advocate for degree apprenticeships – I don’t know enough of the detail. But I was disappointed to see the reaction to this potentially inclusive channel for people to join our profession. Surely, if we do not like the model proposed, we should work on it as a mature profession to see whether or not we can make it work, as other professions have already?

My plea

In order to the seize the emerging opportunities, we will need to create new, flexible career paths and specialisms that we can pursue throughout our careers. We also need to shift our collective mindset. The shift from CET to CPD signposts a potentially more forward-looking and aspirational expectation from our regulator. The reality, though, needs to move beyond CET, and not just the name – or the professions will not advance.

What we are trained to do will have to evolve in lockstep with how we are trained to do it. Again, COVID-19 will accelerate innovation and new ways of teaching for all disciplines. Optometry and optics will be no different, but we must embrace innovation and not resist it.

I know it is easier to define the problem than the solution, but I do believe we have to think our way into new ways of learning, behaving and practising. It doesn’t happen the other way around.

The challenge facing our profession is how do we ‘jump the tracks’ to get off the tramlines of traditional commercial thinking and product sales, and seize the opportunities around properly funded or charged-for eye health condition management, which will redefine and secure our future.

Some years ago, when going through some significant changes in my own career, a colleague shared a book with me that they said had helped them to think differently about how we manage our way through change. The book, Who moved my cheese? by Dr Spencer Johnson, is a parable in which we see how two mice each respond to significant change in their world. One thrives and the other…doesn’t.

I know it is easier to define the problem than the solution, but I do believe we have to think our way into new ways of learning, behaving and practising

 


It may not be a bad idea for all of us to take the time to read this short story, reflect on how we need to behave to play our own part in creating an exciting new future, and how we, both as individuals and as a profession, come out on the winning side. That way we can meet the needs of those who depend on us for vision, clinical care and confidence in their own eye health regimes. It is the role of the Optical Confederation Education Forum to help the Optical Confederation member bodies map that way forward.