“There’s always somebody to learn from”

Could you describe working as a hospital optometrist in one sentence?

Being able to deliver the highest level of clinical care to those that most need it.

Why did you decide to pursue a career in hospital optometry?

Initially, it was the variety of experience that I could gain by doing a hospital pre-reg placement. Not only are you seeing patients for refraction, which we would do in community practice, but you’re then seeing what happens to them afterwards when they have got referrable disease, and the treatments that they undergo. Also, the contact lens work is very different to High Street practice, as is the low vision work that is still predominantly done in secondary care.

That’s what started me on this career path. Obviously, compared to 24 years ago, in hospital optometry especially, there has been massive shift in the roles that optometrists are taking on in a hospital setting. Most optometrists are no longer doing core work or low vision services. They are in the sub-speciality clinics: glaucoma, A&E, external disease, cataract, medical retina. They are essentially providing the same level of care as our medical colleagues.

Compared to 24 years ago, in hospital optometry especially, there has been massive shift in the roles that optometrists are taking on

Do you do any other work alongside hospital optometry?

I’m full-time at Moorfields Eye Hospital, but I do one day a month in a local independent optometry practice. I’m also a College of Optometrists examiner for the objective structured clinical examinations (OSCEs), and an examiner for the Moorfields UCL postgraduate course.

Does working as a hospital optometrist support you when you practise on the High Street?

Yes, immensely. It’s an independent practice, so it has quite a lot of Minor Eye Conditions Service patients. The practice also sees a lot of myopia control and low vision patients, some medical contact lenses, and glaucoma refinement. It offers gonioscopy appointments, which most practices won’t do, but the one I work in does, purely because the optometrists all work in a hospital as well, which enables it to offer those services.

Do take any skills from practice into the hospital setting?

Primary care is a bit more advanced on things such as developments in in contact lenses and spectacle lenses. Even though it’s one day a month, 12 times a year, working in High Street practice enables me to find out the latest on the different types of spectacle lenses. Also, myopia control is not offered under secondary care currently.

Can you identify one moment that has made your job feel particularly valuable?

I go back to this story quite a lot. I saw a patient in the medical contact lens clinic. I remember it very clearly. It was the 21 December. A lady in her late 30s came with her child. The woman was a very high myope, about –25.

I was seeing her in the contact lens service, and it was the first time we’d seen her. I refracted, and her glasses were quite out of date. She was wearing about –16 when she was actually –25, so she had very poor vision. I fitted her with contact lenses, and had them manufactured that same day because we have an in-house lab that makes rigid gas permeable lenses.

Once she had the new lenses, we booked a low vision appointment for her on the same day, so she could get some magnifiers and read with the new lenses. It was the first time, she said, that she could see her daughter sitting across the room from her, and her daughter was seven years old. Her daughter was on the other side of the testing room, and she was in tears because she could see her.

It was the first time, she said, that she could see her daughter sitting across the room from her, and her daughter was seven years old. Her daughter was on the other side of the testing room, and she was in tears because she could see her

What is the most surprising case you have seen in the hospital setting?

I had a patient that was referred by urgent care. The local optometrist picked up that there was a field defect, but it didn’t really match with anything.

They came in. They weren’t complaining of any other symptoms, and all other examinations were completely normal. They didn’t have the usual things that would suggest that they should have a field defect of any kind. They weren’t the right age for having a stroke; it didn’t appear that they had any other problems going on in terms of the back of the eye, that would cause the field defect.

So, it was suspected that there could be something like a tumour causing it. They had an MRI done, and it revealed that they had part of their brain missing. There was a blank space where brain tissue should have been.

It had been long-standing, and had probably been there since birth. They never knew about it. They’d lived their life happily, and it was just an incidental finding. You don’t come across that very often.

What do you think is the biggest success in hospital optometry in the past three years?

Playing a bigger role in the post-COVID-19 society. There have been more roles in terms of virtual review, and more independent optometry-led clinics that have come post-COVID-19. I think that’s probably the biggest thing: the increase in responsibility and in the roles that we’ve been given.

And has your biggest professional success been in the past three years?

Creating business cases that were approved to allow us to run those kinds of clinics. Getting them set up with the right staffing, and moving the professional along in that way.

What the biggest challenge facing hospital optometry currently?

Probably is NHS pay, which obviously we’ve heard a lot about in the past two years with the nursing strikes and then the junior doctor strikes.

Optometrists are paid under the same grading as all NHS staff, which is via Agenda for Change and is set nationally. Whilst the nursing staff have much bigger unions, for hospital optometry, you’re probably looking at about 1000 individuals in the whole of the NHS, so it’s a very small proportion of NHS staffing. We get rolled into ‘allied health professionals,’ even though we're not allied health professionals.

I think that’s probably the biggest challenge: how do we encourage staff or future staff to want to stay in hospital optometry, when the pay outside is greater than what they can get for doing more complex work in the hospital setting? Especially when you have alternative health providers that are doing NHS work and can pay their staff more, because they don’t have to fall under the Agenda for Change pay scales.

How do we encourage staff or future staff to want to stay in hospital optometry, when the pay outside is greater than what they can get for doing more complex work in the hospital setting?

How do you think that issue can be resolved?

One of the big things we have been working on is development of career pathways for optometrists, as a way to encourage people to stay in the hospital setting, going through from entry level, all the way to trying to create consultant optometrist posts, which are at the forefront of what they can do within sub-speciality clinics.

If we can get that kind of thing set up, that might encourage staff to stay within the NHS hospital setting more than elsewhere, because they can see that there’s a line of travel that they can get to. But that involves the hospital management and service agreeing that they need to have these posts. That’s obviously work that needs to be ongoing, not just at Moorfields, but across the whole of the country.

The other challenge is probably going to be with the new Education Training Requirements and the new degree format. It looks less and less likely that the traditional hospital pre-reg route or placement will be suitable, because of the way that that year is designed.

That is going to be a challenge, because most people who do their pre-reg in a hospital tend to stay in a hospital. So, how do we encourage people to come into a hospital setting when they have never worked in a hospital setting?

What would tell optometrists working on the High Street about working in a hospital environment?

I don’t think there’s a right or wrong thing for somebody to do in the profession, because it is all dependent on what they enjoy doing. I couldn’t imagine running 10 different practices and managing that, but some people love it.

Hopefully we can get better integration between primary care and secondary care, which is coming with direct referrals: being able to respond to primary care optometry, and getting primary care optometry involved in secondary care, along the lines that they have in Scotland.

All of these things open the profession up to developing itself. That’s really what I think everybody wants: how can we develop ourselves in the profession, so we don’t stagnate?

Is there anything else you want to say that on the subject of hospital optometry?

It’s a really great group of people to work with, because they’re all very similar in mindset. They’re there for the clinical work. They’re there for helping patients. There’s always somebody to learn from. I think that’s the thing that you may not get in primary care optometry, especially if you’re in a single practitioner setting. There is always somebody that you can go and ask who has got clinical experience.