The synergies of audiology and optometry

Paul Surridge, chairman of the British Irish Hearing Instrument Manufacturers Association (BIHIMA) has experienced both sectors, having previously led SightCare as chief executive for 19 years, sharing: “I see so many parallels between the two.”

“The trend of opticians and audiologists working together has been underway for a number of years now and is a growth opportunity,” he said, adding: “As experts in the senses, there is a natural affinity between eye and ear specialists.”

Hearing care hasn’t always had the footprint in optical practices that it does now, explained Dave Murphy, managing director of Amplify Hearing, a business focused on bringing audiology and optometry together in practices, “then some of the big retailers realised the synergy between the eyes and the ears, and how they could leverage their optical business and include audiology.”

“I think it was always really difficult for independent optical practices to get involved in audiology,” he added. Now he estimates, anecdotally, that perhaps more than half of independent practices might have a relationship with audiology providers or services.

“But I know for a fact that it is growing,” he said, adding, “We’re onboarding an extra 100 practices this year.”

Ryan Leighton, the founder of The Hearing Care Partnership, and CEO of Leightons Opticians and Hearing Care, agreed that, “We’ve seen more people over the years starting to think about audiology and optometry running alongside each other.”

Since its launch in 2017, the Hearing Care Partnership has grown to around 170 practices.

While many of the national chains will have an audiology service, Leighton said. “In the independent sector, it seems like a lot more people are looking to introduce audiology alongside optometry because it’s clearly a very significant, natural fit for businesses.

“To the point where, if opticians are not part of audiology, it almost becomes a lack of a competitive advantage for them, particularly independents,” he said.

Rebecca Wagstaff, hearing aid audiologist at Amplifon, has also seen the competitive advantage hearing care can bring, sharing: “The smaller independents are now dipping their hands in because – competition wise – if you can provide hearing care and eye care in the same place, that is going to stop you losing your patient base to the bigger chains.”

The hearing care retailer operates day centres in 20 optical practices, making up two thirds of its locations.

Wagstaff noted that, as practices have such long-standing and strong relationships with their patient bases, “they want to keep that and nurture that. If there is an extra service that they can provide, it makes sense.”

Drivers of demand

Three key reasons practices might look to introduce audiology, Murphy suggested, include: “revenue, to help with footfall, and new patients coming into the practice, and as a defence mechanism – because if they didn’t have it – maybe the competition down the road did.”

However, more practices are also recognising “that this really is a clinically complimentary service,” he said.

Audiology has experienced a reduction in the availability of services in the NHS in England, which is leading more patients to turn to the High Street or private practices.

“That has driven the independent audiology market across the UK, not just in optometry settings, but across the whole sector,” Murphy suggested.

If services are less available in the NHS, the High Street can then act as an access point to audiology, he suggested: “We’re creating a route where people can be seen on the High Street, and create an audiology journey, without involving the GP and NHS.”

The pandemic has only increased pressures on NHS audiology in the past few years.

Leighton noted that, with lengthening waiting lists, “that means there are more people in the population, and in communities, who are looking for direction for hearing loss, and might be looking outside the NHS.”

Many GP practices have also not been providing wax removal services in recent years, “which is a huge demand item,” he said, adding that as a result: “There has been quite a big movement from the private sector to provide services to help people with earwax removal.”

Reflecting on the increasing need for audiology services, Leighton summarised: “There’s clearly a lot of demand from the ageing population. On top of that, we’ve got a previously very efficient NHS audiology provision across the UK, which has been struggling because of COVID-19. People are looking for a solution, so will look to providers of audiology services in the local community.

“I think certainly in the next couple of years we’re going to see increased demand. There is the potential, if done well, for a lot more patient footfall in optical practices,” he continued.

With these factors shaping the face of audiology provision, Wagstaff identified that visibility of services is key for patients.

“I don’t think what people are asking for has changed, just the numbers and the people that we are seeing,” Wagstaff shared. “I am seeing younger people, but a lot more who are wanting to have their ears checked. It starts that relationship – then a few years later they might come back if their hearing is not great and they remember the service they had.”

The relationship of optical practice and patient is important for supporting future hearing health, with practice team staff able to play a role in noticing when a patient might be struggling with their hearing.

“Because the patient has been going to this opticians for decades in some cases, they trust them and their judgement,” she said. “I think that relationship is key.”

Pressure and propulsion

Like in optometry, face-to-face activity in audiology halted when the country went into lockdown in 2020. Since reopening, personal protective equipment (PPE), social distancing, and regular cleaning between appointments has become the norm.

“For approximately three months, the supply of hearing aids and hearing care ceased. This had a far-reaching impact; hearing tests could not be conducted, and patients were not able to be fitted with hearing aids,” Surridge commented.

In the second lockdown, audiology was recognised as an essential care service and able to remain operational. Since then, hearing aid sales rapidly returned to pre-pandemic levels, Surridge said.

“Combine this with the phenomenal speed that the manufacturers and health care providers set up remote services and fittings, and you have a sector that is now fully recovered and in growth once again,” he reflected.

“The industry worked together to establish remote provision, in a safe and accessible way using clever technology solutions, which has really advanced the sector,” he added. “Not only has it allowed people to access their audiologist on a more frequent basis for check-ups and tuning, all from the comfort of their home, but it has also allowed audiologists to understand their patients’ needs in a real-world setting.”

Audiology providers adapted their services to meet the needs of patients through the challenges of the pandemic.

Describing how audiology changed during the pandemic, Murphy told OT: “the growth in the audiology market is fuelled by technology. What we saw with the pandemic was suppliers and manufacturers delivering technology in three months, that they would otherwise have rolled-out over 24 months.”

Technology enabling remote access to hearing instruments, and therefore creating the space for remote appointments and clinics has been “fantastic” Murphy emphasised, “because it gives the patient choice.”

Leightons moved to host phone or Zoom calls with patients who were experiencing hearing loss, or had an issue that needed resolving.

The calls often included the person with hearing loss, and an important partner who could understand the patient’s hearing loss, to discuss their lifestyle, symptoms and history.

“That enabled our audiologists to get a pretty clear idea of where that patient was struggling,” Leighton explained. When patients could be seen in practice again, having already had the pre-assessment online meant the audiologists could provide an abbreviated hearing assessment at a time when distancing was still required where possible.

The provider also introduced calls from the dedicated patient support team pre- and post-appointment, to ensure patient understanding and satisfaction, and remote services, such as ongoing aftercare, have been implemented.

“That’s enabled us to do things in a more effective way, for patients who maybe can’t get into the practice and want to be seen about their hearing and whether it has changed, the audiologist can remotely reprogramme their hearing aids,” Leighton highlighted.

Wagstaff expects that some of the measures introduced during the pandemic will continue longer-term, though otherwise clinics have regained a sense of normality.

Telephone triage already existed in a form for the business, as a lot of the front of house staff are clinic care co-ordinators, with some trained on hearing aid repairs.

While some appointments could be provided remotely for existing patients, enabling hearing aids to be fixed and posted to the patient, for example, remote appointments pose a difficulty when it comes to new patients as the audiologist needs to be able to look inside the patient’s ear, Wagstaff highlighted.

“Like you would with eyes, we need to be able to check for other health issues,” she said.

A holistic service

Where optical practices offer audiology services, the providers agreed that patients benefit most from the convenience of having both services in one place, and enhanced service.

For practices considering future-proofing their business, Leighton said, “it’s important to consider different services that can provide a really great patient service experience and value. From our point of view, optometry and audiology are a great fit in that regard.”

This could also support patient loyalty and advocacy, Leighton suggested: “What you will hopefully see is a stronger foundation of patients within your database in the local community, and more awareness, and therefore you should be able to build a stronger and more sustainable business.”

Sharing her experience, Wagstaff explained that she, and the optical practice she works in, both have access to her diary to make appointments: “I’m only there one day a week, but it is full every week.”

The partnership approach means that practices are able to retain their patient base, and also don’t have the initial outlay to buy the audiology equipment, or to employ and train a member of staff.

For the audiology provider, the partnership means greater visibility, Wagstaff noted, which ultimately helps more people to access hearing care.

The delivery models that both professions operate on also share similarities. Surridge said: “They have a shared experience of retail, navigating the changing High Street, and the dual public/private offering.

“They are both healthcare practitioners providing an ‘aid’ for a person’s condition, be it a hearing instrument or spectacles and contact lenses,” he added.

Reflecting on the reasons practices might engage with the audiology sector, Murphy said: “On a more holistic level, it is about the clinical relationship between eyes and ears and making sure the health and wellbeing of patients is first and foremost.”

“It’s clear that audiology is here and is here to stay inside the optical space,” he continued, recommending a collaborative engagement of optical associations and organisations with audiology and the hearing care sector.

“Let’s create an environment where it works for everybody,” he concluded.