De Montfort’s new optometry degree: increasing eye care accessibility in diverse communities in the East Midlands

At De Montfort University (DMU) in Leicester, a new Master’s in optometry has welcomed its first students this autumn – and those in charge hope that it will increase access to eye care for residents living in in both rural and urban communities in the East Midlands.

Nikki Brooks, an associate dean of education in the Faculty of Health and Life Sciences at DMU, joined senior lecturer in optometry, Felicity Williams, and optometry programme lead, Andrew Coates, to speak to OT about the new course, which welcomed 40 students from a 156-strong application pool in the final week of September.

A focus on accessibility for both rural and urban communities

OT started by asking the DMU team about the reasons behind the decision to launch a new optometry degree in Leicester.

The reasons are two-fold, Brooks explained: a desire to bring eye care in the region out from mainly serving cities, and into rural communities that are currently lacking provision, paired with a positivity around how the Government’s NHS reforms might bring more work into primary eye care.

Brooks told OT: “In Leicester, we have quite a mixture: we have the city of Leicester, and then the surrounding areas of Leicestershire are very rural. What has come out of that was a local demand for optometry provision.”

DMU traditionally attracts a local student base and this is helpful because in neighbouring Nottinghamshire and Derbyshire there are no optometry courses available to create a pipeline for the workforce, Brooks noted.

She explained: “Currently within the Faculty of Health and Life Sciences, we have responsibility for nursing, midwifery, and pharmacy. It [optometry] seemed a natural fit, in terms of strategic expansion. We’re continuing to build on that, following the launch of the optometry programme.”

In the context of the 10-Year Health Plan, Williams noted: “Education has to look towards the horizon, to see what the future is going to look like in optometry in five or 10 years’ time.”

She emphasised: “Optometry is a priority, and we have a very busy local hospital, that we can see for ourselves is very stretched. Looking at what is going to be delegated to primary care and community care, it is very important that we are prepared for that future.”

Often, conversation centres on there being a saturation of optometrists in the Midlands, partly due to the large cohort graduating yearly from Aston University, whilst the issue of rural accessibility is not often mentioned. What would the DMU team say to readers who argue that that there is a lot of provision in the area already?

Williams told OT: “I’ve had this conversation with quite a few stakeholders, and right now there is a saturation, but that saturation is very central.

“There are pockets of need within the rural communities, whether that’s a difficulty of the industry to attract optometrists into rural areas, or a lack of optometrists available to do that work.”

She noted: “Right now, there may be a saturation, but in five years’ time, will that necessarily still be the case?”

Williams added: “When more responsibility goes out to community and to primary care, that is patient care, and more time spent within clinic, which means fewer people can be seen.

“We have got an ageing population, and that is not going to change in the next five years. This is preparation for the future.”

Looking at what is going to be delegated to primary care and community care, it is very important that we are prepared for that future

Widening accessibility to eye care

Supporting diversity and tackling inequality is an ethos that runs through DMU, Brooks told OT.

“We do a lot of activity at the university relating to that, so optometry is part of that strategic drive,” she said.

Within the Faculty of Health and Life Sciences, outreach work in communities is already embedded within other courses, Brooks explained.

“Our pharmacy students have been going out into deprived areas of Leicester, offering health education, and doing vaccination programmes,” she told OT.

“That has really had a positive impact on the local community. Moving forward, there is the expansion of that faculty-wide, bringing through nursing and optometry students.”

There are future plans to take more students out into communities, under supervision, and Brooks hopes that optometry will be part of that.

“There is a real drive: rather than waiting for the community to come to us, it’s [about] what we can do, and how we can go out to them,” Brooks said.

Coates noted that there are extremely deprived areas of Leicester, and that the Government’s Joint Strategic Needs Assessment has identified diabetic disparities within the local area.

“In optometry, sometimes we’re the first to identify those signs of diabetes, rather than a patient’s GP, when they come into a sight test,” Coates said.

“It’s identifying some of those areas where we may contribute to the population when we go out into the community, but also when patients come into the clinics themselves.”

Ensuring that students understand some of these inequalities, and how optometry can help support them, is also key, Coates said.

He explained: “Within DMU, there is a strong emphasis on inter-professional education and working together. From year one, students have mandatory requirements to have sessions where everyone comes together, to understand at the basic level where they fit in their roles.”

Key is ensuring that students understand where optometry fits alongside aligned professions like audiology and pharmacy, so health inequalities can be tackled holistically, Coates said.

He explained: “If someone has a grandmother with a hearing problem, she might also have problems seeing up close.”

Coates also noted that it is important for students to understand structural issues, for example that optical coherence tomography scans are based upon mostly Caucasian data.

“It’s understanding, even at a student level, that these facts and figures are often generated towards a European descent background, and that when you’re looking at patients, you need to realise that,” he told OT.

He explained: “Students need to understand how to approach these things and appreciate these differences, and know that what is normal for one person, or what risk factors may be inclined towards one group, might not be the same for the other.

“It’s linking the disparities of what might be in the textbooks to what actually is true in real life.”

Artificial intelligence (AI) perpetuates these issues, Coates said.

He explained: “Research supports [the idea] that AI tends to heighten those stereotypes: it is the European normative research derived way of doing things.

“It’s creating more and more of an obstacle, and so we’re trying to break down those barriers and understand that things aren’t necessarily how they read on paper all the time.”

Williams noted that there is also an accessibility conversation that relates to students themselves.

“De Montfort University meets the student where the student is at,” she told OT.

“It is removing that student inequality, and making sure it’s a level playing field for everybody and that everybody has that equal opportunity.”

Williams added: “There are different ways that we tackle inequality, within the programme and within the faculty.”

Coates emphasised that at DMU: “We are trying to produce adaptable clinicians – not just technically competent graduates.”

Focus on communication and support from industry

Stakeholder engagement whilst designing the optometry Master’s course overwhelmingly suggested that communication is a skill that is missing from most optometry education, Williams revealed.

With this in mind, DMU optometry students will have 75 hours of mandatory patient time per year before they start their clinical learning in practice placements.

“They are going to have different experiences with different patient exposure, to start to understand that communication within practice,” Williams told OT.

She explained: “We are taking on board what the industry is saying and incorporating that into the teaching.

“Knowledge and application are two very different things. Part of that is learning how to learn and how to communicate.”

She emphasised: “One of our main roles as educators is to ensure that people have those basic, fundamental skills that are required for the profession, not just the technical and clinical skills.”

The course was planned with stakeholders from settings including hospitals and industry, and clinical skills and content for the first-year professional studies module have been developed accordingly, Williams said.

She noted: “Optometry is one of those wonderful disciplines that walks a fine line between education and industry. Whilst you need to have the education, you need to also have that industry experience to be very good at it.

“It seems obvious to be working with industry to create the content for the programme, and have industry inform what we need for the future.”

Brooks added that, when it came to what stakeholders considered important in terms of the course content: “There was a lot less focus on the business side. It was more about that patient in that clinic or retail outlet at that time. Those were the key things that the stakeholders that we spoke to felt were really important.”

The key aim is to create “industry-ready professionals,” Brooks shared.

She added: “The longer-term plans for DMU include expansion of optometry as a subject area. Our focus is very much on creating a clinically competent practitioner.”

The optometry landscape of the future

OT is interested in hearing the DMU team’s views on how optometry might have changed by the time the new cohort of students graduate in four years’ time.

Williams reflected: “I think it will be a different optometry landscape, just through the amount of responsibility that that will be delegated to community and primary care.

“It is going to be quite a competitive market for optometrists, with higher qualifications, for example. That is where they need to start separating themselves from the crowd,” she believes.

Having a brand new programme means that advances in AI and technology more widely can be incorporated as they develop, Williams added.

Coates believes that how primary and secondary care can adapt is going to take a lot of consideration, including in terms of how many duties are going to be delegated to primary care in the near future.

He noted that how much AI influences optometry will be based on uptake, and how much patients continue to value in-person communication with their healthcare providers.

We live in an on-demand society, where Amazon packages, spectacles and contact lenses can be ordered and delivered the next day, Coates acknowledged.

However, he remains positive – and believes that technology is unlikely to “remove communication or the usefulness of having a healthcare professional” within the next five years.

Although Coates believes that things are likely to look different in five years or within the next decade, the key purpose of educating the eye care practitioners of the future doesn’t change: “It’s preparing them for that fact: that you are a healthcare practitioner first,” he told OT.

Williams added: “One of the things that will change is the digitisation of the NHS. If optometry is linked in with the health record, that will definitely be a change for the better.”

Currently, Williams believes, “Most of the time optometrists are working blind – they’re only taking what the patient says and what the patient thinks is important.”

Coates added: “One of the advantages of the course is that it is new. We’re not bound by tradition, or how things have been.”

The course will be focused on evidence-based research, he explained.

He added: “This is contemporary optometry. This is where research is at. This is where technology, the Government, and population needs, are at.”

With changes to optometry education in recent years, DMU is “almost working alongside these changes as they are happening,” Coates noted.

Williams explained: “With the programme being new, the students have the ideal opportunity to help shape the future of it.

“De Montfort University is very good at taking student feedback and working that into changes. Our students will have the ability to shape education for the next cohort, and the cohort after that.”

She emphasised: “That’s a really important role to play in the industry. That consistent iterative reshaping by the students and by the stakeholders external to DMU is one of the greatest things about the programme.”

Brooks added: “There’s a lot of buzz around the optometry course. It has been hugely popular. It has surpassed our expectations, in terms of popularity on open days, and in clearing activity.”

The university was in a “very lovely position” to have a full cohort of students starting in September, she said.

Lead image: De Montfort University’s Hawthorn Building, home to the university’s Health and Life Sciences faculty