Working in partnership
Optometrist, Don Williams, on how his practice is rewriting the rule book and allowing ophthalmologists and optometrists to work together more closely
22 October 2018
Edgbaston Eye Clinic is an optical practice with a difference. Patients can expect eye examinations and contact lens fitting alongside dry eye, glaucoma and medical retina clinics, as well as a diagnostic investigation service. However, it does not stock or sell spectacles.
Based within what is described as ‘the medical quarter’ in Birmingham, the clinic was opened by optometrist Don Williams in October last year. The aim, Mr Williams told OT, is to “bring back the traditional values of eye care in a non-pressurised glasses sales environment.”
“Edgbaston Eye Clinic was created on the advice of a few consultants who I have known and worked in close collaboration with for a number of years,” Mr Williams explained. “The whole idea was to create a practice to bridge the gap between optometry and ophthalmology, and bring them as close together as possible,” he added.
For Mr Williams, the main benefit of this type of model is the support network that it enables him to build with ophthalmology professionals.
“A consultant is always at the end of a text. We cross-refer patients and the system just works,” he emphasised.
As a result, Mr Williams has built strong relationships with local ophthalmologists and GPs, who refer patients to him for diagnostic support and ophthalmic imaging.
Prior to establishing Edgbaston Eye Clinic, Mr Williams worked in independent practice where he began building relationships with local ophthalmologists, including consultant ophthalmic surgeon, Dr Marie Tsaloumas.
Today, Mr Williams has a range of ophthalmologists working out of his clinic on a private basis. This includes Dr Tsaloumas, glaucoma surgeon Imran Masood, and oculoplastic surgeon Yajati Ghosh, working in collaboration with him on a private basis.
Dr Tsaloumas first met Mr Williams three years ago. During that meeting, the optometrist approached her to discuss the equipment that he had access to in the independent opticians where he was working and how he could support her professionally.
“Geographically the practice was very near to the private hospital where I work and I thought I would give it a try,” Dr Tsaloumas told OT. “I sent a few private patients for visual fields and macular scans and they all came back saying how pleased they were and how thorough Don was and that the service provided was good value for money. On visiting the practice, I was very pleased and our relationship has grown from there,” she shared.
Having close relationships with ophthalmologists brings both patient and business benefits, Mr Williams emphasised.
“Working in close collaboration with consultants brings a wealth of knowledge and expertise and allows me to offer the best possible service to my patients – it’s as simple as that. You just cannot beat the experience gained by working with these experts; it is like having a real life ‘encyclopedia’ available almost on a daily basis,” he said.
The whole idea was to create a practice to bridge the gap between optometry and ophthalmology, and bring them as close together as possible
Rules of referring
For Dr Tsaloumas, who has more than 20 years’ experience in the sector, having good relationships with optometrists has always been important. “I have always had really good relationships with optometrists; I refer to them and they refer to me – I’ve always thought optometrists are great,” she said.
Discussing the basis of a good working relationship, for Dr Tsaloumas the secret is to listen. While the ophthalmologist acknowledges that some of her younger consultant colleagues may be more easily frustrated when a referral turns out to be unnecessary, for Dr Tsaloumas it is always “better to be safe than sorry.”
“Sending a disgruntled letter back to an optometrist following an unnecessary referral doesn’t achieve anything because the optometrist may hesitate to refer in the future when it is necessary,” she stressed. In addition, an opportunity for learning has been missed.
Ultimately, the importance of the optometrist/ophthalmologist relationship is for the benefit of the patient, Dr Tsaloumas highlighted. “If an optometrist rings me to send an urgent referral, I have always accepted it,” she said adding: “While there are a lot of different pathways for receiving referrals, realistically, if an optometrist is worried enough to ring and ask for advice, ophthalmologists should appreciate that concern and try to see the patient urgently or recommend an eye casualty.”
When trying to build these types of relationships locally, Dr Tsaloumas suggests that optometrists begin by working a session or two in a hospital setting on a weekly basis.
“Eye departments are overwhelmed. They are desperate for optometrists to work alongside ophthalmologists in the department and see patients,” Dr Tsaloumas said candidly. “This establishes relationships that are mutually beneficial – the eye department gets an extra pair of experienced hands and the optometrist gains experience with lots of weird and wonderful conditions. They also get a feel for how local ophthalmologists work, assess and treat patients. It’s a win-win for everyone,” she emphasised.
Earlier this year, Mr Williams’ path crossed with ophthalmologist and president of the Royal College of Ophthalmologists, Mike Burdon. “I have worked with Don when I have patients who have problems that I think are refractive. He has proven very capable of confirming that and discussing with patients the appropriate treatment,” Mr Burdon told OT.
As an ophthalmologist, working with optometrists is important to Mr Burdon because aspects of eye care, such as refraction, are better placed and performed by the optometrist, he argues. “There is a whole load of optometry-related science that we, as ophthalmologists, rely on that is much better expressed by an optometrist,” he said.
While this trio of professionals understand the benefits that can be reaped from working together, they acknowledge that these relationships are not necessarily quick or easy to form.
Sharing why he encourages both professions to work hard on developing mutually beneficial relationships, Mr Burdon said: “Both sectors are involved in eye care. In the UK, most patients who end up in eye departments have started their journey by being identified by optometrists. Fundamentally, optometrists underpin the work of ophthalmologists and we should recognise that and the valuable work they do in screening the population in an increasingly systematic fashion.”
For Mr Burdon, key to building these relationships is for optometrists to let their local ophthalmologist department know what they have an interest in and that they are willing to work with them.
Through his role with the Royal College of Ophthalmologists, Mr Burdon and the College are working with organisations such as the College of Optometrists to support the development of additional training, as well as the development of clinical roles in ophthalmology for optometrists, eye nurses and orthoptists.
There is no point in having a certificate that says ‘I can do that,’ you need to show you can. To build confidence you need to work with someone so they can see you can deliver
And while many optometrists are capable and keen to upskill, Mr Burdon points out that “there is no point in having a certificate that says ‘I can do that,’ you need to show you can.”
“To build confidence you need to work with someone so they can see that you can deliver,” he said.
Mr Burdon predicts that in the future, optometrists will start doing sessions in hospital ophthalmology clinics, as well as community clinics that are led by ophthalmologists.
“Once that is achieved, I think some of the work that ophthalmologists perform in hospitals will move into the community,” he added.
He emphasised: “I don’t think the relationship between optometry and ophthalmology has ever been stronger. We all see what the common aims are – high quality patient care in appropriate locations.”
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