“I value anything that keeps my working life varied”
Inverness optometrist, Stanley Keys, on finding a passion for teaching and why stronger links between hospitals and community optometrists are vital
21 July 2022
At school I always enjoyed the sciences.
When it came to work experience, I spent a week shadowing the local optometrist. He had recently set up his own practice, and I found it really interesting. I thought, ‘it’s a bit of both: there’s the clinical side, but you’re running your own practice.’ The chap that I was sitting in with was very much his own boss. He would take a Tuesday afternoon off to go fishing. I thought, ‘he’s got it sussed.’ Other people in my family had gone into medicine, however the working pattern in optometry probably appealed to me more.
Overall, I thought optometry seemed like a good balance: working with patients, and developing a business aspect also appealed. Not that that’s really what I've ended up doing – since qualifying I have been in hospital optometry and not gone into having a practice. But work experience set me off on the path to becoming an optometrist.
I studied at Glasgow Caledonian from 1998 to 2002.
My brother had moved from Northern Ireland and was already studying in Glasgow, so I’d been across and thought it was a fun place. My class was very easy going, and everybody got on. It was a very positive student experience – plenty of learning and plenty of socialising. One highlight was lifting the annual optometry five asides trophy in fourth year.
My pre-reg was with Boots Opticians.
Initially it was due to be in Edinburgh, but there was a change in supervisor, and so at the last minute I was assigned to go to Dundee. This little twist of fate proved to serve me very well. I'd never been to Dundee before but was grateful to have a pre-reg position with a really good practice. Once I graduated, I went and met my supervisor and instantly recognised that she was a very experienced, very good optometrist. That served me well in my pre-reg year. I saw a broad mix of patients and did a lot of contact lens work. She was an incredibly good teacher and actively encouraged me to see more complex patients to build my experience. I ended up staying in Dundee for quite a few years after qualification. It changed the direction of the next few years of my life, and the next stage of my career.
I hadn’t set out to be a hospital optometrist.
It wasn’t on my radar. I thought I’d work in practice for a while; maybe set up on my own. But during my pre-reg year I was put into Ninewells Hospital in Dundee once a week, and I got to know the team there. When I was about to qualify a post came up for a new optometry job in the hospital department. I applied, thinking it was an interesting opportunity as hospital optometry roles didn’t come up very often. So, my view was, ‘I can try it for a year or two, and see whether I enjoy it, and I've always got the option to go back to the community if it isn’t for me.’
I was doing a lot of core hospital optometry roles: low vision work, paediatric work, specialist contact lenses.
As soon as I started there, I realised that I was detached from the commercial aspect of optometry, which I liked. I also realised I was amongst a much bigger team of people, who had a lot of experience and a lot of knowledge and from whom I could learn and develop. It almost felt like being back at the start of my pre-reg again. I really enjoyed the feeling of always learning, and was fortunate to be in a positive, friendly department. I did some locum work in practice but soon felt that hospital optometry was more suited to me longer term.
I stayed at Ninewells from 2003 until 2016.
In that time, I was fortunate to do what was then the College of Optometry glaucoma diploma. I started with the core clinics, and that led to glaucoma and macular degeneration clinics. I was also supported in obtaining my independent prescribing (IP) status in 2010, which has been invaluable. The role that I had when I started was completely different five or 10 years later. That helped my clinical experience, and my ability to do extended roles going forward.
Ninewells is a university hospital, so we were often teaching medical students or pre-regs.
I enjoyed that variation – it wasn’t wall-to-wall clinics. When I was in my 20s, I wasn’t much older than the people I was teaching, so I could relate to them and enjoy that aspect of my role. Teaching in different settings is something I've developed and worked on, particularly over the past 10 or 12 years, for example with writing CPD for Optometry Today.
I value anything that keeps my working life varied, so that no two years are the same. I think it's quite easy in optometry to plod along and day-in-day-out be doing quite similar work. I enjoy having something to work towards. If that helps to contribute to the standards of eye care or helps others in terms of their educational or technical knowledge, so much the better.
The pandemic forced us to work more closely with our colleagues in community optometry, for them to see patients and for us to communicate with them, and for patients to be treated closer to home
For the past six years I’ve worked in the main hospital in Inverness, where I do a lot of glaucoma work and some eye casualty, amongst other clinics.
We cover a big geographic area. When the pandemic hit, we were trying to avoid patients having to make a three-hour journey to the hospital, potentially for something minor that could be treated in community practice. The pandemic encouraged closer working with our community colleagues with increased communication and more co-management of patients. This has further endorsed that it is vital to have good working relationships between the hospital eye service and community optometry, and that we should be working much more closely together.
Inverness has always been an area where there has been difficulty in getting independent prescriber placements, so over the past year, myself and colleagues have been working to support our community optometry colleagues to come in to complete those.
There is also a scheme in Scotland called NESGAT, which is doing additional training for people who are IP qualified, so that we can discharge some of our lower risk glaucoma patients to be managed in the community. We've been working to accommodate those placements and help our colleagues through that process.
Recently, I was asked to assess three of the candidates who have just come through the NESGAT process. It was a very positive experience. Seeing people putting in quite a bit of work to obtain this qualification – it’s very commendable. The second part is to get the right funding from government so that they're getting paid for that work and that this scheme benefits patients, community optometry, and the hospital service.
Within the hospital, I've recently been made head of our optometry department while a colleague is on secondment.
We’re also getting a new-build facility for the Highlands, a dedicated eye unit with orthopaedics. The transition from our current hospital site to the new facility will be later this year, which is an exciting prospect for our service here in Highland Scotland. It should increase the potential for teaching: doing IP placements and NESGAT placements, as well as increasing our capacity to deliver our service.
We’re always learning new things clinically, doing casualty clinics within the hospital or laser techniques, for example. It keeps you engaged and motivated when you’re learning a new skill and doing something that expands your scope of practice. You feel as that there’s progress for us as clinicians, but also for the profession. If we can be seen to be doing these things, and hopefully doing them well, that’s a positive step.
I’ve had a lot of great experiences in optometry.
In my 20s I did a few trips with Vision Aid Overseas to Ethiopia. I found it a fantastic experience. The travelling, the clinical work, meeting the people there and the great friendships made along the way – I enjoyed everything about it.
From a professional point of view, I gained a fellowship with the College of Optometrists in 2012. It was a nice moment, to reflect on my career to that point and where it might lead to in the future.
I've been lucky to speak at a few events and give lectures, most recently back in Northern Ireland at the start of December.
It was great to be able to go back home and teach about emergency eye conditions and share my experience with colleagues. I find things like that enjoyable and fulfilling.
I always want to encourage positive working relationships between hospital eye services and community optometry, trying to develop what everybody is doing. It’s to the patient’s benefit, and that’s key. If you can treat patients closer to home and make access to care easier for them by not relying on hospital services for every significant eye condition, that's to the benefit of patients as well as to optometrists as professionals.
I’m not sure I have been particularly ambitious – possibly I’m more of an ambler.
I have found that, as I have gone through my career ,different opportunities have cropped up, with one thing leading to another. I don’t know if it’s ambition, or just curiosity – being open to change and progress.
My plan B?
The careers I was interested in were optometry and architecture – two pretty different things. Ultimately though, when I was making university choices job security and opportunities in optometry seemed more reliable.