The silver age

Alongside the message explaining services on offer at his Coatbridge practice, the owner of Tuite Opticians attended a welcome meeting for the town’s newest residents. 

The dispensing optician explained to OT that when his mother, Mary Jo Tuite, founded the business in 1972, she wanted the practice to serve every member of the community. “We are all someone from somewhere. We wanted them to know they are welcome in this town,” Tuite said.

This ethos has extended to the care Tuite and his team take when looking after the eye care needs of North Lanarkshire’s older residents. 

Through the practice’s domiciliary service, optometrist Stephen Kirley, has adapted the sight test to where the patient is most comfortable – which may be a kitchen, a living room or in one case a cupboard with the patient’s preferred light levels. 

After working for the practice for 19 years, practice manager, Michelle Campbell, has built up personal connections with the patients who phone to book appointments. 

“I know their voices and they know mine,” she shared.

She knows which patients may need a little bit more time, and who she should get the ramp out for in advance of their appointment.

On occasion, Tuite will spend his lunchbreak visiting a patient to repair their spectacles. All of the practice staff have received Dementia Friends training.
“A lot of people react immediately to seeing that badge,” Kirley shared. 

“They know that there's going to be friendly, supportive customer service provided to their loved one. They know that we're going to have the right training and level of expertise,” he said. 

In North Lanarkshire, as in many other areas of the UK, the proportion of people aged 65 and over is steadily rising. In 2011, 14.9% of the region’s population was in this category. 

The latest census data from 2022 reveals that 17.9% of the population in North Lanarkshire is now 65 or older. 

It is predicted that the population aged 80 and older will double over the next 40 years, while the population aged between 65 and 79 will increase by close to a third. 

The report highlighted that in some rural and coastal local authority areas of England, such as North Norfolk and Rother, one in three people are aged 65 or older. 

Kirley shared that in Scotland, some people in rural locations such as the Highlands may be 60 or 70 miles away from their nearest optometry practice. 
“If that practice doesn’t provide a domiciliary service, they may be disadvantaged in terms of receiving an eye examination,” he said. 

Around one in 10 patients of Tuite Opticians receive domiciliary visits, with staff travelling up to 45 miles to deliver eye care to North Lanarkshire residents.

“Just because you can’t come to the practice anymore shouldn’t mean that you can’t have an eye test,” Kirley emphasised. 

“We try to take the practice to the patient,” he added. 

Being able to visit a patient in their home provides Kirley with valuable information that he may not have received in a High Street setting – such as the distance they sit from the television and whether they have appropriate lighting. 

“Sometimes a domiciliary eye test can be as simple as making sure that when you’re visiting someone, they’re actually wearing the right glasses for the right task,” he said. 

“Regretfully through cognitive decline, some people will forget which glasses to use,” he explained. 

You’ve got to look after everybody

He added that there are also situations where patients have been wearing varifocals or bifocals for many years, but have forgotten how to switch focus with the lenses. 

In this case, it may be appropriate to switch a patient to single vision lenses. 

“Everything needs to be tailor made to that individual. It’s not a one-size-fits-all service,” he said. 

Kirley paid tribute to the approach taken by Campbell when booking appointments and triaging patients. 

“She is exceptionally good at gleaning information from patients to identify what needs to be put in place, whether that is in practice or through the home service, and we make all the relevant arrangements wherever possible,” he said. 

Campell gets a sense of the value of the domiciliary service in her role booking appointments. 

“When I make the initial call to book the appointment in, they can be so grateful that they’re even speaking to someone that day, which is quite heartwarming,” she shared.

“You can tell that they’re looking forward to the visit,” Campbell highlighted. 

Tuite shared that his mother, who was an optometrist, instilled in him the idea that practice staff should treat people as they would like to be treated. 

This focus has seen multiple generations of families return to Tuite Opticians for their eye care, over more than half a century. 

“Everyone is in business to make money, but it’s not always about the money. You’ve got to look after everybody,” he reflected. 

A personal approach

At the height of the pandemic, Francesca Fulgoni spent her evenings printing, folding, enveloping and franking between 400 and 600 envelopes each month. 

The Fulgoni Opticians newsletter did not contain product updates or discounts. Instead, Fulgoni offered updates on daily life, including news of a smallholding owned by her father and practice founder, John Fulgoni. 

“I would say ‘Hi, it’s Francesca here. Just to let you know that we started lambing’,” she recalled. 

For older customers of the Abergavenny practice, these monthly envelopes offered a glimpse into the world beyond social distancing.

Within Monmouthshire, around 26% of the population was aged 65 or older at the time of the latest census in 2021. 

“There were a lot of vulnerable patients who were on their own,” Fulgoni shared. 

“People told us they liked the newsletters because they weren’t speaking to anyone or seeing anyone,” she said. 

Alongside the newsletters, Fulgoni travelled across Monmouthshire with her spectacle repair kit in the car. She sat in gardens repairing glasses and travelled beyond the reach of her navigation system to a property in the Brecon Beacons.

For a nurse who had broken her glasses, she glazed a pair of bifocals within eight hours – in time for her next shift. 

“We had to close our doors, but we were working behind the scenes,” Fulgoni recalled. 

“I think it kept us sane knowing that we were helping people,” she said. 

Fulgoni Opticians was founded in 1973 by Fulgoni’s father, an optometrist, and her mother, Wendy Fulgoni, who worked in the practice on reception. 

Over that time, the couple built close ties with the surrounding community, with multiple generations of families coming through the practice. 

“People have seen me grow up, because when I was born, my parents lived above the practice,” Fulgoni shared. 

“They saw mum pregnant with me, they saw me grow up and join the business,” she said. 

Rather than the silent and sparse waiting room you might find in a GP practice, Fulgoni Opticians aims to offer an environment that is similar to walking into someone’s living room. 

“We always say to people, ‘It’s more like a family – you are coming into our home’,” she said. 

“Mum is Welsh and Dad is Italian, so we have fresh Italian coffee that we brew each morning,” Fulgoni shared. 

Her father, who is now 78, still comes into the practice to check everything is in order and indulge in a raspberry ruffle.  

We always say to people, ‘It’s more like a family – you are coming into our home

A host of multicoloured velvet chairs, sofas and recliners add to the atmosphere of an eclectic family home.

“We had a refit a few years ago and I bought one crazy chair. They seem to have bred,” Fulgoni said. 

When it comes to patients who may be experiencing symptoms of dementia, Fulgoni has instructed staff to check the record card for their date of birth and then play music from the time of their teens and early 20s. 

She shared that this reminder of their younger years seems to have a calming effect. 

“They remember the songs and you can see them singing or tapping their feet,” she said. 

Fulgoni undertook her low vision qualification at Cardiff University two years ago. 

While she was initially hesitant about sitting exams again more than two decades after she first qualified, she loved the course and has enjoyed putting her new skillset into action. 

In one memorable case, she assisted a woman whose vision meant she could no longer knit.

The hobby had been an importance source of solace following the death of her husband. 

“We got a magnifying lamp, some brightly coloured wool and these LED knitting needles,” Fulgoni shared. 

“She came in 10 months later with a scarf she had knitted for my dog,” she said. 

Alongside the LED knitting needles, Fulgoni has purchased giant playing cards and puzzle books. Her low vision appointments inevitably overrun the allotted time. 

Fulgoni observed that loss of vision can often be tied into fears around a loss of independence and pride. 

“You might have someone who is embarrassed to ask his wife to read his bank statement or his medical notes,” she said. 

“We all want to keep going doing the things we enjoy for as long as we can,” Fulgoni emphasised. 

Staff at Fulgoni Opticians tailor their approach to the person before them – whether this means allowing more time for the appointment or having a chat over coffee after the sight test is done. 

“People aren’t numbers. Every person is a husband or wife, a son or daughter,” Fulgoni said. 

Pressure on secondary care in Northern Ireland

Over the 25 years between 1998 and 2023, the median age in Northern Ireland increased from 31 to 40 according to data from the Northern Ireland Statistics and Research Agency.

During the same time period, the proportion of the population aged 65 and older increased by 36%. 

Ophthalmologist, Professor Tunde Peto, has observed the effects of this trend within her clinics at the Royal Victoria Hospital in Belfast. 

“Yesterday, every patient I saw was born in the 1930s,” she shared. 

“My son, who was working as a clinic clerk at the time, said to me, ‘Mum, you do realise that everyone in clinic today was born during the rise of Hitler?’,” Peto recalled. 

While the population is ageing, the workforce within ophthalmology has not expanded at the same rate. 

Peto is one of only 36 full-time equivalent ophthalmologists working within Northern Ireland. 

This is a lower rate of ophthalmologists per head of population than in England, Scotland and Wales, with the Royal College of Ophthalmologists estimating that an additional 24 ophthalmologists are required in Northern Ireland to meet demand.

Remarkably, in the face of these workforce challenges, ophthalmology is the only specialty within Northern Ireland that has not seen an increase in its patient waiting list. 

“It is good news that our hard work is paying off,” Peto shared. 

However, these improvements in the hospital eye service waiting list have not been made without sacrifice. 

Peto has concerns about whether the workload placed on ophthalmologists in order to meet demand in Northern Ireland is sustainable. 

“We are working insane hours and there is a very high risk of burnout,” she said. 

“You are acutely aware that there is nobody to replace you,” she emphasised. 

She highlighted that optometrists in Northern Ireland are playing a greater role in clinical care.

“We have a very good working relationship with optometrists. They have direct referral rights, and they are already keeping some of their patients in practice,” she said. 

You are acutely aware that there is nobody to replace you

A pilot in Northern Ireland that saw patients managed by independent prescribing (IP) optometrists in primary care reduced the weekly workload of Belfast Eye Casualty by an average of 10% over an eight-month period in 2023.

IP optometrist and Optometry Northern Ireland vice chair, Brian McKeown, shared that the pilot helped to reduce pressure on secondary care while also utilising the skills of IP optometrists in practice.

“Patients were very grateful that we were able to manage them to resolution in practice and they didn’t have to travel,” McKeown said. 

The initiative was an extension of the Northern Ireland Primary Eyecare Assessment and Referral Service (PEARS) – dubbed PEARS Plus. 

McKeown shared that staff working within secondary care were grateful for the pressure PEARS Plus took off eye casualty.

“There is a real human impact for those people working in a high-pressure hospital environment,” he said.

Delays in follow up care

Ophthalmology is currently the busiest outpatient specialty within secondary care. Data from NHS England shows there were 8.9 million ophthalmology appointments in 2023–2024, with the next busiest specialty (trauma and orthopaedics) fielding 7.3 million annual appointments. 

Progress has been made on addressing lengthy waiting times exacerbated by the COVID-19 pandemic, with cataract surgery the focus of increased NHS spending and private sector activity. 

However, the Royal College of Ophthalmologists (RCOphth) has highlighted the importance of rebalancing activity within ophthalmology, so that clinically higher-risk conditions – such as complex glaucoma and wet age-related macular degeneration – are not neglected. 

Professor Ben Burton, RCOphth president, shared that 67% of patients in ophthalmology are already being seen within the 18-week referral to treatment target –meeting the NHS benchmark of 65% that all specialties are expected to meet by 2026.  

“We must not ignore follow-up patients however,” he emphasised. 

“We have serious concerns about the number waiting for follow-up appointments, which are often for sight threatening conditions such as glaucoma and AMD,” Burton shared in a statement.

The patient perspective

In February 2022, Matt Weale was rushed to hospital after a routine sight test revealed that the intraocular pressure (IOP) in his left eye was 46 mmHg. 

The 54-year-old sales manager was told that he would receive a follow-up appointment in three months’ time, but by the end of May, he had received no word about when he would next be seen. 

“At that stage, my vision was starting to change in my left eye. I was becoming sensitive to light and losing some of my peripheral vision,” he told OT. 

“I began chasing the appointment up and they would say ‘Sorry, we are just really busy after COVID-19.’ It got to the point where my wife was becoming worried,” Weale shared. 

After repeatedly phoning the hospital in July, Weale received a phone call confirming that his appointment had been scheduled for November – six months after the date he was told he would receive follow-up care. 

Weale booked a private appointment with a glaucoma specialist who found that the IOP in his left eye had risen again.

“The alarm bells went off and I was taken to hospital again. They said I would need a trabeculectomy, but the waiting list to see the surgeon was another three to four months,” Weale shared. 

Using his private health insurance, Weale underwent a series of procedures, including selective laser trabeculoplasty, cyclodiode laser and trabeculectomy, to try to preserve the vision in his left eye.  

Weale highlighted that he worried about patients who had to rely on being seen through the NHS. 

“If I wasn’t in the financial situation I’m in, I probably would have gone blind in my left eye waiting for that first appointment,” he shared. 

While Weale’s vision was stable when he spoke to OT in December 2024, he described his vision as like looking at a picture with television interference, with the image becoming blurrier from bottom to top.

“I will never know how much vision I lost because of delays, but I don’t think they would have helped,” he said. 

If I wasn’t in the financial situation I’m in, I probably would have gone blind in my left eye waiting for that first appointment

As his vision deteriorated to the point where he could no longer drive, Weale gave up his job as a sales manager – which previously saw him driving more than 50,000 miles each year to visit clients at different locations across the country. 

He stopped playing football and performing in a band. Where previously he would have been comfortable speaking in front of hundreds of people, as his vision deteriorated, he developed symptoms of anxiety and depression. 

“I lost all confidence,” he shared. 

As a relatively young glaucoma patient, Weale wonders how other older patients manage to navigate the healthcare system in order to receive timely care. 

“The specialists always call me young man because most of the patients they see are in their 80s and 90s,” he said. 

“I’ve spoken to a lot of older people with glaucoma in waiting rooms. You’d be amazed by how many say ‘I was supposed to be seen every six months, but I haven’t been here for two years’,” Weale shared.  

He told OT that one of the hardest parts of his condition is the gradual change in his vision. His brain will adjust to the information that it is receiving from his left eye, and then his vision will deteriorate again. 

Explaining the way that his eye condition plays tricks on him, Weale describes a cloudscape on the wall at Worcestershire Royal Hospital.

“When I look at it with just my good eye, I can see very distinctly where the blue is and what shape the clouds are. When I use my other eye, all of the clouds change places. Some of them disappear,” he said. 

His world completely changes depending on which eye he is looking through – and when he uses both he has a vague feeling of seasickness. 

“I always consider myself lucky, because it is one eye,” he said. 

“For people who are losing both eyes, I can’t imagine what it would be like,” Weale emphasised. 

Glaucoma UK head of research, Joanna Hodgkinson, shared that the charity is committed to funding research which seeks to improve delays in diagnosis and treatment. 

“Unfortunately, many people with glaucoma still face long waiting times and delayed appointments,” she emphasised. 

Optometrists with patients who have glaucoma and would like information, advice or support can refer them to the Glaucoma UK website. A range of assistance is available, including a Glaucoma helpline. 

The role of ECLOs

In Somerset, according to data from the Office for National Statistics, one in four people are aged 65 or older. This is significantly higher than the average across England and Wales – where only around one in five people (18.6%) fall into this age category.

Ceri Hudson moved from Dorset to Somerset to take up a role as an eye  clinic liaison officer (ECLO) in 2017.

Based at Musgrove Park Hospital, in Taunton, Hudson offers information and guidance, as well as practical and emotional support, to people with sight loss.

It is estimated that there are around 25,000 people living in Somerset who are blind or partially sighted, with around one in three people in this category over the age of 85.

“Most of the people I see are over the age of 75, although I also support children, young people and families too,” she shared.

She told OT that she takes time with people who have received a sight loss diagnosis.

“It can be a really scary thing to go through,” Hudson shared.

“I can take the time to listen, acknowledge their feelings and allow them to start to process what they are going through,” she said.

 

Hudson said a common fear among patients is that they will lose all their sight, recalling a man who told her following his diagnosis that he was glad he was able to see his grandson at Christmas.

“People are really scared of going totally blind. Now, for most people, that won’t happen. But for those who do, it is making them aware that there are services and support available,” Hudson shared.

Hudson can connect people with a range of Royal National Institute of Blind People (RNIB) services and resources – including support groups where people can meet others with sight loss.

“It gives a sense of community and makes people realise they are not alone,” she said.

Those who would prefer not to meet face-to-face can make use of RNIB’s telephone support groups, while people who find it difficult to travel can make use of Somerset Sight’s volunteer visiting service. 

I really enjoy supporting people who might be struggling and showing them that they can remain independent with appropriate adaptations and support

The charity also has a mobile van that provides advice on a range of aids and equipment, which people can then purchase to use at home.  

“I really enjoy supporting people who might be struggling and showing them that they can remain independent with appropriate adaptations and support,” Hudson emphasised.

There are factors Hudson considers for older people with sight loss that might not apply in a younger age group.

For example, they are more likely to have other conditions alongside their sight loss – such as hearing loss.

“They may struggle with hearing their name being called in a clinic waiting room, for example,” she said.

“We work closely with the falls team if there are mobility issues and an increased risk of falling,” Hudson explained.

Part of her role is being aware of older people’s ability to adapt to technology.

“I know of a woman who is 98 and is loving her iPad,” Hudson shared.

“She hadn’t really used technology before, but Somerset Sight helped her to embrace it and she has not looked back,” she said.

Hudson, who has retinopathy of prematurity, nystagmus and myopia, can also provide tips on how she navigates situations as someone with sight loss.

“I don’t tend to inform people that I have sight loss because I appreciate that every condition is different,” she shared.

“But it does mean I am able to give specific examples of support available,” Hudson highlighted.

For example, if patients say that they struggle with glare from car headlights at nighttime – a challenge Hudson also experiences – she can give tips on useful equipment for counteracting this challenge, such as anti-glare shields.

Around four months after starting as an ECLO, Hudson was matched with her guide dog, Lucy.

She shared with OT that she initially found talking with people about their sight loss daunting after previously working in an office administration job.

“Having Lucy has helped massively. She is my icebreaker,” Hudson emphasised.

“I am a lot more confident with her by my side,” she said.