“Working in hospital gives you a lot of confidence in diagnosing and pathologies”

Here, he tells OT about his most valuable moments and the current biggest challenges that hospital optometry faces.

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

It’s highly interesting, varied, and we have established ourselves very much an indispensable part of an interdisciplinary team.

How long have you worked as a hospital optometrist?

I did my pre-registration placement in hospital, and I qualified in 2007 – so almost 20 years, including my placement.

When and why did you decide to become a hospital optometrist?

In the first instance, I was offered a training opportunity that I felt I couldn’t turn down, despite having to relocate some distance. While I had other long-term goals in mind, this was the opportunity that seemed to open more doors to those opportunities. However, soon into my training, it became very apparent that hospital optometry was where I wished to continue pursuing my career.

Do you do any other work or volunteering alongside hospital optometry?

I have a role on the AOP’s Hospital Optometry Committee. I also work at Cardiff University, doing some tutoring and assessing for the glaucoma courses. I do a very occasional bit of locum work as well, with a High Street independent practice.

How does working as a hospital optometrist support you as a High Street optometrist?

Working in hospital gives you a lot of confidence in diagnosing and pathologies. In terms of eye diseases, it helps you determine what is urgent, and what needs referring. It’s certainly a useful skill to have, to be familiar with pathologies and how they are managed in the hospital setting.

How does working on the High Street benefit you in the hospital setting?

I’ve only done around a dozen days in High Street optometry, over the years – it is very sporadic. But it’s certainly useful to know the pressures that High Street optometrists are under, and the referral pathways they are working with. It gives you a lot more empathy and respect for what they’re achieving.

In the practice I work in, they’re very much into extended roles. It’s the realisation that a lot can be done in High Street – there is a lot that does not need to be referred to hospital. The primary care optometrist is vital for the ongoing success of secondary care.

The primary care optometrist is vital for the ongoing success of secondary care

What is the biggest challenge facing hospital optometry currently and why? How can this be resolved?

We’re grappling with the new training scheme – the clinical learning in practice (CLiP) placements. It hasn’t been at all obvious how hospitals are going to accommodate that.

One big concern for hospital optometry at the moment is that the pre-registration placement used to provide a major source of recruitment. Newly qualified hospital optometrists who had been through the hospital pre-reg would often be kept on and would be instantly familiar with the role. That’s not necessarily going to be the case with the new CLiP placement, as things stand, although I am encouraged that there seems to be recent progress in making the scheme more compatible with the needs of the hospital eye service.

Hopefully there is going to be a programme in place, but it is still uncertain. That’s a big challenge: how we’re going to encourage people into the hospital eye service, especially with competition from private providers.

Supervising pre-regs has increased the appeal of my work through the years, and I know I’m not alone in missing that aspect of our work. There is a strong appetite to train optometrists to have the necessary skillsets for working in the hospital setting early in their careers.

What is hospital optometry’s biggest success in the past three years and why?

The demands on the hospital eye service are forever increasing and the traditional model of ophthalmologists providing the majority of eye care is no longer sustainable. As hospital optometrists we have, over many years, stepped up to the mark of meeting the challenge of providing more and increasingly advanced eye care.

In such an environment, it’s often difficult to identify specific moments or events that define our improvements, but when we look back over three years or longer, we’ve been doing more and more complicated work, especially in glaucoma services, diabetes, and medical retina.

There has been ever-increasing responsibility, and we’re doing this more autonomously and in more settings. It has been a gradual stepping up, as we always have done. Whatever gets thrown at us, we absorb it, not only maintaining, but often improving standards of eye care.

What is your biggest success in the past three years and why?

My role has always been a clinical one. The many patients where I feel I’ve contributed to making a difference to their lives will always stick with me as my greatest successes.

It’s vitally important to keep our careers patient-focussed. Patients always attend with an issue, and it should be our focus for them to leave our clinic happier or at least more reassured, even in those circumstances where we are unable to help them clinically.

Hospital optometrists make significant contributions to all services, including the extended roles, but the ones where we often see an immediate difference are in the core services.

The many patients where I feel I’ve contributed to making a difference to their lives will always stick with me as my greatest successes

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

Years ago, when I was working in Liverpool, there was a young girl with advanced learning difficulties. For her best interest, her care-plan ended up going through court.

She was put under general anaesthetic for her ultrasound biometry and advanced cataract surgery. I was responsible for the biometry lens measurements. The surgery made a spectacular difference to her life. Her care home reported that she went from spending her entire day just hugging a pillar to walking around, investigating her environment and engaging with the other residents. She was described as much happier and totally transformed.

I was surprised at how complicated the provision of health care can become for those in dire need. In this case, treatment was only provided after many years and best-interest meetings at the highest of levels.

This case will always stick in my memory, and I do feel some pride that I was involved, albeit in a relatively small way. It was a huge team: surgeons, the legal side, and nurses. Whilst she was under anaesthetic, they brought in other disciplines, including dentists, to give her a good check over.

What would you say to optometrists working on the High Street about working in a hospital environment?

I’ve spoken to quite a few High Street optometrists, who seem to feel there’s a bit of a barrier to them working in hospital. I can understand this: you get into your comfort zone, and you get used to your own skills. I’m very well supported in my independent, but I would really struggle to just go straight into High Street practice.

But I would say, make inquiries. We’re always open to recruiting people from the High Street. I’ve known some excellent hospital optometrists who have come from the High Street setting. You don’t have to make a full jump. There are a lot of people who work part-time in High Street and part in hospital. That’s a very common thing to do, and those staff are very valued in departments.

Anything else to add on the subject of working as a hospital optometrist?

My feeling is that the majority us are very happy in our roles. I’m not saying there are no issues, but we are happy. We enjoy it, we want to stay; we’re very motivated.

There are also very good hospital optometry communities. Where I am, there’s a north west hospital optometry group, and every region of the UK has a representative group for hospital optometrists.