How I got here

“There’s a lot of work we can do in terms of health inequalities”

Optometrist and Gloucestershire LOC chair, Alvaro Borges, on his beginnings in Portugal and how he uncovered a passion for challenging health inequality

alvaro borges

In Portugal, my dad started his optical career as a sales representative.

In my early teens, I used to accompany him to optical practices, while he carried heavy trolleys full of the latest trend in frames. When I was 16, I helped him set up his first practice. We designed everything and put the practice together, the two of us. It was exciting to be part of that journey.

There were very few graduate optometrists in Portugal at the time, and ophthalmologists dominated the world of optics. This, together with becoming myopic, made me want to pursue a career in optometry. I didn’t want to become a doctor. I wanted to examine people’s eyes and make their lives better.

I did part of my undergraduate degree and pre-reg in Barcelona.

In 2005, I wanted to be part of the ERASMUS programme and study optometry abroad. The rumour at the time was that the programme was available to all the university undergraduate degrees, except optometry and vision sciences. I refused to accept this and enquired directly with the student exchange office. There was a printing error on the ERASMUS guide and, in fact, there were a couple of options available. That day, I learned never to trust rumours. My life would change forever after this. I did the first semester of the fourth year of my year optometry degree in Barcelona that same year. I learned two new languages, had lots of fun, and met my partner. I had to return to Portugal for my last semester and to arrange my pre-reg, but I liked Catalonia so much that I managed to secure access to the EU Leonardo da Vinci programme and do my pre-reg in Barcelona.

In 2009, I opened my own practice. It was the beginning of the financial crisis and it hit Portugal extremely hard.

It was one of the worst financial crises in the last 100 years and I couldn’t have chosen a worse year to open my first optical practice. After all the hard work and savings put into it, it was heartbreaking to endure days with very few patients and dispenses.

The following three years were very painful. Regardless of how much effort I put into building the practice, nothing seemed to work. In 2011, the Portuguese economy had to be bailed out by the International Monetary Fund and the austerity programme started.

I felt that enough was enough. In 2012, the UK was still part of the European Union and the recognition, expertise and level of practice from UK optometrists was miles away from any other European country. I already had a sister-in-law in the Midlands, so I thought, “Okay, I’ll try my luck. I’ll go to the UK.”

I came to the UK without any real prospects.

First, you have to undergo a conversion process with the General Optical Council (GOC). The GOC was incredibly thorough in understanding my level of expertise and experience. That reassured me that they had a strict process in place, but of course, my anxiety levels were through the roof. I was already living in the UK, with no guarantee that I would be able to practice here.

The GOC asked me to do a hospital placement, which was incredibly hard to arrange.

For two months I called all the hospital eye departments in a radius of 100 miles, every single day. Eventually, I found an orthoptist at Shrewsbury and Telford Hospital NHS Trust who helped me with the timetable, finding a supervisor optometrist, and navigating all the admin and contracts. I attended a lot of clinics in all sorts of ophthalmology specialties, orthoptics, and advanced contact lenses. Despite the two-hour commute, that was an interesting time and a steep learning curve.

While I was doing that, I found a practice in Cheltenham that had a vacancy for an optical assistant. I already had experience dispensing and glazing, and adapted quickly to the job. The workplace atmosphere was excellent, and some of those work colleagues are still close friends. Soon after, I got my qualification recognised and started working as an optometrist.

Specsavers in Cheltenham was the first practice I worked with.

I’m incredibly grateful to Specsavers Cheltenham, because they were the only ones willing to take me in as an optical assistant and later as an optometrist while I was still doing my optometry title conversion.

I was eager to join the LOC the moment I learned about it.

I have always valued the opportunity to support the optical community. It was a very useful, interesting, and life-changing experience. I met people from all walks of life, from different optical practices and beyond. I learned about commissioning, consulting, and hospital trusts. This opened up my world to a much wider range of people than I would have ever met if I had stayed in my testing room.

I love seeing patients, but I was always eager to push the boundaries and do something else. The LOC seemed like the right way to engage with other people and organisations.

My interest in reducing health inequality came because of a particular incident.

I was working in practice when, during my lunch break, I approached a rough sleeper. The moment I kneeled to talk to him, I noticed a right hypopyon with severe hyperaemia. I had never seen it before in practice. I convinced him to come to my testing room, and I arranged for him to be seen and treated that same day.

This experience made me think about inequalities in eye health. I had assumed that vulnerable people had access to free eye tests. I realised that people who suffer from health inequalities are less likely to seek out care, and we need to reach out to them and make sure they have easy access to the care they need and deserve.

People who suffer from health inequalities are less likely to seek out care, and that we need to reach out to them and make sure they have easy access to the care they need and deserve


In May 2022, Gloucestershire Integrated Care System (ICS) was the first in England to fund a homeless eyecare clinic.

The project was initiated by the LOC, with support Vision Care for Homeless People, and provides help to people who are experiencing vision issues, or who haven’t been able to access eye tests. This is an example of how health inequalities can affect people. It shows that those in a particular group can experience unfair differences in healthcare. This project has demonstrated how early intervention can help homeless people. Since then, I’ve been advocating with the ICS for further efforts to tackle health inequalities in eyecare.

During the pandemic, an LOC colleague and low vision practitioner explained how when he visited one of his patients at her home, he found the partially sighted lady living in the dark, without heating.

She couldn’t see the writing on the energy bills. She failed to pay, and they cut the service.

This episode prompted me to consider an NHS-commissioned domiciliary low vision service that includes assessment, follow-up, and the provision of high-quality vision aids. A domiciliary Low vision pilot service began at the start of June.

Currently, I work at an independent practice two days a week.

I also work for the Local Optical Committee Support Unit (LOCSU) as an optical lead, supporting LOCs in the South West, South East and West Midlands. I have chaired the Gloucestershire LOC since 2019.

In my free time, I volunteer at the Gloucester Homeless eye clinic. I am a father of three and I value spending time with my young family, as they grow up too quickly.

I’m also involved with innovative IT solutions for imaging sharing between primary and secondary care.

NHS Gloucestershire has launched a new project called Community Ophthalmic Link (COL). This project allows optometrists in primary care to access patients' Hospital Eye Service imaging, GP discharge letters, and diabetic eye screening records in real time. This is already having a positive impact on the local health system. For example, it has led to a reduction in referrals to secondary care. Additionally, it has helped optometrists to better understand patients' diagnoses, treatments, and management plans. This allows more autonomous management of patients and has allowed care to be provided closer to home. This is important because it can help to reduce health inequalities.

My career so far has been marked by pushing the boundaries and getting out of my comfort zone.

I've learned that the best way to grow is to face my fears, push outside of my comfort zone, and keep moving forward. This is true for both my personal and professional life.