“We need to keep pushing the frontiers of the profession”
Ian Cameron, owner of Edinburgh’s Cameron Optometry, on his biggest challenges as an independent prescriber and how the qualification drives the profession forward
10 February 2022
I became an IP optometrist because…It’s always been a big part of our practice at Cameron Optometry. We’ve specialised in complex contact lenses, which exposes you to a lot of anterior segment disease. We also had strong partnerships with local GPs for decades, so spent a lot of time managing eye disease as best we could with signed orders and Patient Group Directions (PGD.) As soon as IP became available we jumped in with both feet – it was the next natural step to be able to treat a wider range of conditions more effectively.
My first prescription was…Good question. I can’t honestly remember as it was 10 years ago, but I do remember my hand quivering a little bit within the first fortnight of getting my prescription pad, when I had to write my first prescription for steroids for a new presentation of anterior uveitis.
As soon as IP became available we jumped in with both feet – it was the next natural step to be able to treat a wider range of conditions more effectively
My latest case was…
The Scottish Government is funding a national scheme to allow IP optometrists to treat complex eye conditions
The case that kept me up at night was…Oh plenty, especially in the early days. I can remember a lady with a something very mild (I can’t remember exactly what), and I prescribed fluorometholone and set follow-up for three days. She didn’t turn up for a week and then came in at 8.30am with her eye completely swollen shut and the anterior chamber in a total shambles, with uveitis. I sent her straight to the eye hospital, who needed to inject her with steroids to get it under control. It all turned out ok in the end, but I felt physically sick for at least two days worrying about it.
My most memorable case was…A weird bilateral uveitis. I prescribed steroids, but it didn’t get better. I eventually referred the patient, but it turned out she had acute retinal necrosis and went completely blind in one eye and then subsequently died a week later from an unrelated cause. I nearly fainted when I got the call one week saying she was blind, and then the following week that she had died. Her vision was fine when I referred her, but I’m a bit more wary these days.
When you look at how far we’ve come, performing cataract surgery doesn't seem too far away to imagine
My ambitions for the future of IP are…We need to keep pushing the frontiers of the profession. IP was a great leap forward, and leads us naturally towards minor surgical procedures, including selective laser trabeculoplasty (SLT) and YAG intravitreal injections. Optometrists are already doing all this, but the goal is to be allowed to carry these out independently in practice rather than at hospital clinics.
Longer term I’d like to see some optometrists trained to perform simple cataract surgery. That might sound outlandish, but my dad summed up his career like this: “When I qualified in 1976 I couldn’t write ‘cataract.’ On the day I retired I wrote ‘RE: g. predforte qds.’“ When you look at how far we’ve come, performing cataract surgery doesn’t seem too far away to imagine.
Being IP qualified has helped the reputation of the practice I own by…Keeping us at the forefront of clinical optometry. We’ve always wanted to manage the greatest range of conditions in practice, so IP has just allowed us to continue to do that.
We are well known by GPs, other practices and patients for being able to deal with complex eye issues, and that’s generated a lot of new patients
The benefits IP brings the business are…I think reputation is important. We are well known by GPs, other practices and patients for being able to deal with complex eye issues, and that’s generated a lot of new patients. For my optometrists, it brings variety and clinical interest. IP helps you learn new things and pick up new skills. If you’re bored in your work as an optometrist, do IP.
Patient response to my IP skills has been…I’m not sure they noticed. They are so used to attending us rather than the GP that it’s not felt like much of a shift. We prescribed with PGDs and signed orders for many, many years prior to having IP, so it’s been a seamless move from a patient point of view. When we told them early on, most just said “were you not already able to do that?”
The implications of IP on other areas of optometry are…
If you look at the likely trajectory of optometry in the next few decades – minor surgery, atropine for myopia, drops for presbyopia, YAG, SLT, increasingly complex shared care – IP is prerequisite for almost all of these things. If you want to be ready to develop into these new areas in the future, you are going to need your IP. There are benefits to your practice now in doing more, and benefits for the future in that you’ll be ready to do new things.