There is a particular quote, Professor Bruce Evans explains, that has seen him through his professional life: “if you’re in a room where you’re the smartest person, you’re in the wrong room.”
It seems that Confucius, and by extension Evans himself, might have a good point: after making a point to seek out the most inspiring people he could from day one, Evans has built a career that has spanned from community optometry practice and a PhD in dyslexia and vision, to a quarter of a century as director of research at the Institute of Optometry in London.
It is a journey that has made him a highly respected name within the profession, and has led him to be named as the AOP’s Lifetime Achievement Award recipient for 2023 – something that was announced at 100% Optical yesterday (Sunday 26 February).
Rather than seeking individual praise, though, Evans believes that it is the teams that he has worked with that have shaped his achievements.
“All my life I’ve tried to work with teams of people that inspire me,” he told OT.
Teamwork is the theme of his career, he said: from the “brilliant clinicians” he has worked alongside in his Essex practice, Cole Martin Tregaskis Optometrists, and elsewhere, to his collaborators over 25 years at the Institute of Optometry.
Research, he explained, is a place where this collaboration “happens every day... Every research study involves putting together a team of people who will each bring something to that study, some expertise, some insight.”
“You want a diverse team, of different people. That’s really been the greatest fun,” he added.
Mentors (Emeritus Professor at the University of Essex, Arnold Wilkins, and previous AOP Lifetime Achievement winner, David Edgar, of City, University of London), have helped along the way, but Evans also name checks current colleagues (City, University of London’s Dr Rakhee Shah and Anglia Ruskin University’s Dr Peter Allen) as vital to his work.
“Over the years I have collaborated with more than 100 different people, in close to 100 different research studies, and every team has been huge fun to work with,” he said. “The doctorate students, in the teams that they’re involved in, tend to be the most important person in that team. Each of those students bring something that I wouldn't have envisaged they could have brought, and I’ve learned huge amounts from them as well.”
Career beginnings
Finding inspiration from the people around him started early for Evans.
“My first two mentors in my life were my parents, who were both very successful business people,” he explained.
An interest in science led him towards healthcare, he remembers, “because I think it’s nice to go home at the end of the day and feel that you’ve actually helped somebody.”
Finding himself also drawn towards business, he realised he had a choice between dentistry and optometry. Ultimately, he was “more interested in eyes than teeth – so, optometry it was.”
A pre-registration year being supervised by “inspirational young optometrist” Andy Franklin saw Evans begin to actively pursue paediatric optometry and contact lenses, the latter of which at the time was a rapidly changing area.
Speaking about Franklin, Evans said: “He’s a real deep thinker, a really thoughtful guy, and a brilliant clinician. He inspired me, and I ended up getting interested in the subjects he was interested in.”
He added: “Orthoptics is one of those subjects where, once you get a taste for it, there are so many unanswered questions, and it’s such a fascinating integration of visual processing with motor control. I got really interested in those topics.”
On qualification, the owner of the independent practice group he was working in gave Evans a practice to run, where he was able to specialise in children’s vision and contact lenses, complete a diploma in contact lens practice, and develop an interest in dyslexia and vision.
He explained: “I loved doing the diploma in contact lens practice and thought, ‘I really want to do some research.’ I started looking around for a PhD position.”
Moving into research
His initial curiosity about dyslexia and vision came from his immediate family, Evans explained: “From a young age, I knew that my father was a bit different. He was one of the deepest thinkers I’ve ever come across. And yet, when he read something, he was incredibly slow. His spelling was always idiosyncratic, ludicrous, and didn’t make sense.
“My younger brother, who is now a medic, had similar difficulties, and it turned out to be dyslexia. I became interested in whether vision had a role to play in that.”
This interest led him to Aston University, where as part of his PhD he interrogated what he describes as the “very weird claims” that were coming out of North America:
including that most people with dyslexia needed vision therapy, or coloured glasses.
“Wherever there are weird claims, there’s the need for an evidence base, a need for research,” Evans believes.
His work led to the conclusion that “some of these claims have something behind them, but vision isn’t the big story in dyslexia.”
There is, he explained, “a need for people with dyslexia to have visual problems ruled out, to make sure there's nothing there that's contributing to their difficulties.”
Now, as a result of Evans’ research, “there are a number of optometrists across the country who have specialised in providing relevant optometric care for people who struggle with reading,” he said.
Wherever there are weird claims, there’s the need for an evidence base, a need for research
Community practice and vision research
Evans bought Cole Martin Tregaskis Optometrists, in Brentwood, Essex, in the early 1990s, when the owners retired.
“I was really interested in a practice that was ethically sound, and that had a good clinical reputation,” he said.
He explained that the owners, Tony Martin and Tony Tregaskis, “were such nice people that we just had a gentleman’s agreement. We had no solicitors. We put in writing what we thought would be a fair way to transfer the practice to me, and a fair amount of money to pay, and that’s what we did, and it all worked perfectly. So, that ended up becoming my practice.”
Dyslexia and vision is a subject that he was able to focus the offering at the practice, where he had worked part-time whilst completing his PhD, around once he became the owner.
At the same time, he joined the Institute of Optometry as a senior lecturer, running clinics and building the Institute’s research profile. In 1998, he became director of research.
Over the past 25 years, the Institute has moved from ad-hoc research into a structure that can support doctoral and post-doctoral students, Evans explained, and has developed long-standing relationships with City, University of London (“our neighbour across the river”) and London Southbank University, less than half a mile away in Elephant and Castle.
Now, after more than two decades at the helm, Evans is taking on a new role with the Institute, as a senior research fellow – something that he says will allow him to go in “slightly new directions,” and to “pursue a few of the passions that I’ve put to one side over the years.”
His plans include collaborating with Anglia Ruskin University to build on research into the use of coloured filters for people with reading problems, and to facilitate a randomised control trial of myopia control interventions with a team at City, University of London.
He also plans to spend more time on his work as an expert witness, “because there’s a need there to try and get a fair outcome for the patient, but equally a fair outcome for the practitioners who are involved.”
Of course, this means that the Institute of Optometry is in the market for a new director of research. Personally, Evans would like to see a new director with an independent prescribing qualification (an area that he believes would benefit from a great deal more research) or an interest in medical retina.
“I think it is a big opportunity for the Institute,” he said. “We’re hoping that we will attract somebody who has got different research interests to me, so I can still pursue the areas I’m interested in.”
The aim is to recruit someone who “can really build on what we’ve done so far, and move research in a new direction.”
Looking to the future
Whatever direction the Institute, which last year celebrated its 100th birthday, takes over the next quarter century remains to be seen. But for the foreseeable future Evans will still be present, arriving on an electric Lime bicycle and contributing to the profession’s future from within its textbook-lined walls.
“I honestly think it’s never been a more exciting time to be an optometrist,” he shared. “There are so many diverse opportunities now. The way that hospital optometry has grown in my career is amazingly impressive. I look at colleagues working in hospitals, and they’re doing things that we would never have dreamed that optometrists would be doing.”
He is excited about potential for myopia control and therapeutics, especially in community practice.
“We’re at a time now where the NHS is recognising that patients don’t want to go to hospital unless they have to,” he said. “The NHS can’t afford for people to go to hospital unless they have to. So, community optometry is really in the right place at the right time. There’s a huge opportunity for us to help the NHS and help our patients by taking activities that hitherto have only been done by the hospital eye service, and making them happen in optometry.”
He added: “That’s happening across the country already, in conditions like glaucoma and in Minor Eye Conditions Services, but I think we’ll see a great expansion. It’s a hugely exciting time for optometry, and particularly for community optometry.”
Unsurprisingly, given the value he places on collaboration, Evans’ top piece of advice for young optometrists entering the profession is to find mentors: “People to work with who you find inspirational, who you want to be like, and who you think you can learn a lot from.”
Any other tips? “Pursue the jobs in optometry that you will find most interesting, not necessarily the ones that will pay you the highest salary. And lastly, invest in the future. The best way of investing in a future career is to do those high qualifications. There are great ones now that weren’t around when I was young: things like therapeutics and medical retina are exciting topics, that will open lots of doors to a young optometrist and give them lots of opportunities in the career ahead of them.”
At the same time, he emphasised the value of core optometry: of not forgetting the basics that underpin the profession.
“I think it’s really important that, despite these exciting areas that the profession is expanding into, we don’t forget core optometry,” he said. “Every time I work in practice, and I’m still in practice every week, I see a patient with a basic optical or binocular vision problem that they need to get a solution for. It will be causing them symptoms; it will be affecting their quality of life. A good refraction and a good orthoptic work-up are what many patients need to solve their symptoms.
“So, at the same time as expanding into new areas, there’s a great need not to forget our core activity. That’s a way that we can help patients, day-in and day-out.”
If he was entering the optometry now, Evans would still want to split his time between research and practice. It is something that he believes offers the best of both worlds.
“Practice is great because a patient walks in, and a bit later they walk out seeing better, and that’s just a wonderful thing,” he said. “That’s a great gift that we can give people, and it is marvellous to do that and get that immediate response.”
At the other end of the scale, though, “research is wonderful, because you can help many more people in the longrun. But a typical research study takes two to five years, from when you first have the idea to when it’s finally written up and published. That’s a long, slow burn.
“So, mixing the immediacy of clinical practice with the slightly slower process of research is a way of keeping sane and enjoying both aspects: of the short-term and the long-term.”
Finally, how does Evans feel about receiving the AOP’s Lifetime Achievement Award?
As might be expected, his first instinct is to credit other people.
“It is a real surprise, a huge honour, and a slight sense of impostor syndrome, because I know lots of people in the profession who I think deserve it much more than me,” he said. “[I have] a huge sense of gratitude, because it is really a reflection of the teams that I’ve worked with and of the people that have inspired me.
He added: “I’ve mentioned my parents, and the huge influence they still have on me. But equally, my wife is an outstanding optometrist, who specialises in electrophysiology of vision, and her inspiration is there. We’re lucky enough to have two grown-up children, both involved in vision science or optometry, who are equally inspiring. Those people really are the people who deserve the award as much as I do.”
Practice is great because a patient walks in, and a bit later they walk out seeing better, and that’s just a wonderful thing
Professor Bruce Evans received the AOP’s Lifetime Achievement Award at the AOP Excellence in eye care reception, headline sponsored by CooperVision and hosted on the Sunborn Yacht, London on 26 February. The award was sponsored by CooperVision.
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