“It’s nice to say yes to any opportunity”
Independent prescribing optometrist, Josie Evans, explains how the ‘narrow door’ of optometry has opened up a wealth of career possibilities
29 September 2023
I was thinking about doing medicine for a long time.
I did the University Clinical Aptitude Test, which is one of the assessments to study medicine. It was fairly last minute, before we had to submit our final choices, that I chose optometry instead.
Role: Independent prescribing optometrist at Linklater Warren and Moorfields Eye Hospital
I went to the University of Manchester, which was incredible.It was the best experience. The optometry school there is wonderful. I personally think they’ve got the best supervisors. They were really hands on, and they just wanted to get the best out of us as individuals. The undertones of the optometry school were ones of hard work and humour. It was light-hearted, and the supervisors were really fun and engaging, which made us want to do even better for them.
I still speak to some of the supervisors today. If I see them at conferences, I run over and say hi. For them, we’re just one of many students, but for us, they’re the people who inspired us to get through the degree. I made friends for life at Manchester.
I wanted to do my pre-reg at an independent practice, and I emailed a dozen independent practices in or around London, but I didn’t hear back from any of them.I was speaking to somebody at an AOP meeting in my capacity as a student rep, saying how hard I was finding it to get into an independent practice. They put me in touch with Gordon Ilett, who was director of Linklater Warren at the time. That’s how I got an interview. It’s all down to the AOP that I found a pre-reg placement.
I was fortunate during my pre-reg.
My supervisors were really supportive. I remember writing a list of about 15 questions over the weekend and coming in first thing on Monday and quizzing them to get as much knowledge as I could. I had a really nice experience, because I had ample time to do the assessments. I wasn’t rushed on that side of things. It was a nice learning curve.
I have stayed at Linklater Warren ever since.
This summer, I had been there for six years. It’s gone really quickly, but then when I look back on my pre-reg it feels like a lifetime ago.
During lockdown, I was working in practice with just one other colleague, who was a dispensing optician.We were having so many emergency patients come in to see us, and we could diagnose what their conditions were, but then I couldn’t manage them. I had to refer them either to a different practice or to the hospital for management. I felt like if we were in that scenario again, I would want to be able to do more for our patients.
With optometry, once you go in one door it opens up many others
I started teaching at the end of 2020, as a visiting clinical tutor at City, University of London.
I was working on practical skills with first and second-year students. The students were really fun, really interesting, and you could see how much they progressed over that short time. They went from not knowing how to do a technique to doing it almost perfectly at the end of the year. That was really nice to see.
Through City, I met Giovanni Montesano, an ophthalmologist and a research fellow with the Crabb Lab.
He was looking for a research assistant to help him with his PhD. I started doing that, and we also co-lead a separate project. The research was looking at structural perimetry, using optical coherence tomography data to determine the starting points of the visual field test, with a goal of trying to make it quicker and more accurate. We definitely made it quicker. Accuracy was similar with healthy subjects, but we need to research it a little bit further on comatose patients, to see how that works with them.
We got some good data, presented at the Imaging and Perimetry Society, and won an award. That was a monumental moment, because I’d never presented my own work before. It was daunting, but rewarding. We are writing up the paper at the moment.
With optometry, once you go in one door it opens up many others. It’s nice to say yes to any opportunity, because you never know where it will take you.
I did my independent prescribing (IP) course at the University of Hertfordshire.
We’d regularly have case discussions, where we could bring examples to the table and ask experienced IP practitioners how they would manage them. The IP course was fantastic, not only from a prescribing perspective, but also for a general understanding of how the body works and the reaction to medication. There was a lot of theory that was more than what we would explain to patients. It was about understanding the immune system, and how everything reacts. That was really interesting.
Long-term, I think IP is preparing us for the future.
I’m hoping that lots of emergency eye care and even stable monitoring of glaucoma, for example, gets moved into the community. Equipping ourselves with all the qualifications and the knowledge that we need to manage this will allow that pathway to flow more smoothly when it does arrive. I hope IP is the future of optometry and I hope it supports patients to get accessible eye care right on their doorstep, as opposed to having to travel hours for it. I passed in March 2022.
I started working at Moorfields Eye Hospital two days a week in September 2022, doing specialist optometrist work in extended role clinics: glaucoma, cataracts, paediatrics, and low vision.
Starting a new job when you’re so used to another job is quite daunting at first, but I settled in easily. I had come across Moorfields colleagues at other events, so it was a familiar team.
It is really great work, and it’s nice to delve a bit deeper into how I can manage a patient. When I started at Moorfields I was recently qualified as an IP optometrist, so it is nice that I can get lots of experience prescribing in the hospital, as part of a team. If I’m not sure on something, I can ask a specialist in the particular condition and can help make sure the management aligns with what the patient needs. It has been good for building confidence in terms of prescribing.
I hope IP is the future of optometry and I hope it supports patients to get accessible eye care right on their doorstep, as opposed to having to travel hours for it
Alongside Moorfields, I’m in High Street practice three days a week.
What’s really nice about Linklater Warren is that if I am at a conference and I see something I think could help our patients, I can bring it to our directors and say, ‘would we be able to initiate this? This sounds like something that could really help.’ The directors are brilliant, and are constantly expanding clinically. In each branch, we’ve got a very different demographic. You see a whole range of conditions, and you have to be able to communicate with a wide variety of different patients. It’s a nice challenge, from that point of view.
Since January 2021 and I have also been a member of Johnson & Johnson Vision’s (JJV) Junior Faculty.
I mainly teach virtual classes for undergraduate and pre-reg optometrists, and facilitate peer reviews and discussion workshops for qualified optometrists.
I’ve been thinking about a PhD for a very long time, but I’m not sure what I’d give up to do it, because I enjoy what I do so much.
Another avenue is to consider having my own practice at some point. But I’m in quite a happy place at the moment, so I’m just going to learn and absorb as much as I can, particularly from the hospital, which is quite new for me.
In a couple of years, I’ll probably think about making a more permanent mark in either direction. If there were more days in the week, I’d do everything – two days practice, two days hospital, and two days research. I just need to work out what to prioritise. In the long-term, 10 years down the line, I’ll hopefully have made a decision.
My milestone moment is probably developing our myopia management and what we can offer to patients.
We’ve recently purchased an instrument that can measure axial length, which will really help identify whether myopia is progressing or not. We offer almost all interventions for myopia. That has been a really nice highpoint.
Also, working closely during lockdown with one of my other IP colleagues, a Linklater Warren director, Matthew. He really coached me into how we could co-manage a patient. Those have been the two main areas that stand out.
When people first think about optometry, they think of it being limiting.
But I feel like it’s just a narrow door, and as soon as you go through it, the room opens up and it’s huge. You realise it’s full of possibilities, and there are so many things we can do, which is really exciting. We’re fortunate that we can do a bit of everything within our week, so we don’t have to be in one setting. Utilising that means we can be flexible and adaptable.
It sounds cheesy, but I don’t think so. I applied a few times for hospital jobs before I got the one I’m in now. One regret could be not getting those, but actually, I think it worked out for the right reasons. It allowed me to do IP first, and to take up more responsibility with JJV. So, I would probably say no regrets.
However, if I was going to give my previous self some advice, it would be: “if you’re unsure, always check.” Many times, I’ve gone home and worried about something that I could have easily checked with a colleague. That’s general advice I wish I had had sooner: if in doubt, just ask. It’s better that you go home and sleep a full night than wake up worrying. That’s the only thing I wish I had known earlier. Other than that, everything has happened for the right reasons. I’m a firm believer of that.