Community care

OT  speaks to Stanley Keys about his experience working in the eye department at Raigmore Hospital

Stanley Keys
What is your working day like? 

I currently work in the busy eye department at Raigmore Hospital, Inverness. It is a really interesting place to work as we serve a wide geographic spread of patients across the Highlands and Islands. No two days are the same – I can either be involved in a range of clinics, mainly specialist glaucoma clinics, cataract assessments, contact lenses and paediatrics. I also enjoy time out of the clinic to help with service development and educational activities.

Some days might begin with a short flight to islands, such as Lewis or Orkney, to deliver clinical care to these communities, which adds a really nice variety to my job.

My role only began last February, so the phrase ‘each day is a learning day’ certainly applies. The day can begin with a cycle from our house about 10 miles west of Inverness to take in some of the fantastic scenery that we have on our doorstep.

Which aspect of your current role inspires you the most?

In this region of Scotland, we often have patients who might travel from around 120 miles to attend an appointment. This certainly sharpens your resolve to give the best level of care that you can for that patient.

I also admire the team of professionals and clinical staff who work hard to deliver care across the region and our various peripheral, despite the obvious challenges this presents. This has certainly given me a new sense of challenge in trying to bring about solutions to some of the hurdles we face in delivering eye care.

Where do you see the direction of optometry heading in the next five years?

I think there is already a changing emphasis in the work of optometrists, which has been happening over the past decade. In hospitals we are doing more specialised clinical roles than ever before. It is now not uncommon to see optometrist colleagues in hospital performing certain laser procedures and delivering intravitreal injections.

In community practice there is certainly a shift towards managing certain anterior eye conditions in practice, and undertaking the monitoring of patients before referral is necessary. Developments such as the Scottish contract and the Minor Eye Conditions Service in the rest of the UK, will hopefully help to ease the demands on secondary care. I think over the next five years, we are going to see this shift continue. I hope that at some point, no matter where you are in the UK, the public perception of optometry will be that we are the first port of call for any non-emergency ocular conditions. We need to be well-equipped with the skills and knowledge to help effectively manage the conditions that don’t require the expertise and intervention of our ophthalmology colleagues.

In due course I also believe that the emphasis of income for community optometry should shift towards what they are providing clinically rather than commercially – though how this happens might be the million-dollar question.

Who and what has been most influential in steering your career path?

I have been really fortunate from my time in Dundee initially as a pre-reg in Boots Opticians, to moving into Ninewells Hospital when I qualified, to work with a wide range of greatly experienced colleagues from whom I was able to learn a great deal. More recently with my move to Inverness this process is continuing. I have always been a believer of watching and listening to those around you who have genuine expertise and trying to learn from them.

What do you regard as being the most influential development to impact upon the clinical role of practitioners in recent years?

In hospital practice the advent of anti veg-f treatment for wet age-related macular degeneration has had a huge impact on our roles in the last decade, with many practitioners having to develop their knowledge and skills to help deliver this service.

In general the advent of independent prescribing is having, and is going to have, a big effect on our role as a profession.

Finally, constantly improving imaging techniques such as optical coherence tomography are really enhancing what we can do. This has been well established in macula care for several years, but is now genuinely starting to become useful in glaucoma care. It will be really interesting to see how this area develops in the coming years. However, I always urge caution that technology is there to support clinical knowledge and acumen, not to replace it.

If you had the power to change any aspect of the current remit of optometrists what would it be?

I like the concept of the community optometrist being the primary professional that the public should seek attention from when they have a non-emergency eye condition. With the correct training that optometrists could manage more conditions in practice and be paid appropriately for clinical skills rather than an over-reliance on the commercial aspect of the profession, which is currently vital in terms of running a viable practice.