A picture of optometry: three AOP Councillors share insights

Optometry on the High Street 

The landscape of optometry in the community is shifting, Rebecca Donnelly suggested, telling OT: “High Street optometry is undergoing a significant period of change and opportunity, shaped by technological advancement, shifting patient expectations, workforce pressures, and increasing NHS demand for primary care services to be delivered in the community.”

For franchisees and joint venture partners, the role requires a balance of clinical leadership and commercial acumen. Donnelly shared: “Success increasingly depends on being adaptable, forward-thinking, and committed to delivering high-quality patient care alongside a consistently excellent customer experience, all within a sustainable and competitive business model.” 

Recruitment, retention and skill development

A key challenge facing practices is the recruitment and retention of skilled clinicians and support staff, especially in rural and coastal regions. 

Donnelly explained: “With growing demand for clinical services, rising locum rates, and shifting workforce expectations, practices must work harder than ever to build stable, motivated teams to ensure the delivery of high-quality patient care.” 

Identifying the opportunities for community eye care, Donnelly pointed to the expansion of enhanced clinical services, such as minor eye conditions schemes, glaucoma monitoring, and post-operative care. 

“This means patients can access expert care more quickly and conveniently, while practitioners can develop advanced clinical skills, diversify their roles, and reinforce their position as vital healthcare provides,” she explained. 

The adoption of new technologies, such as artificial intelligence (AI) assisted diagnostics, teleoptometry, and advanced imaging, also mark opportunities for the profession – particularly in improving access to care. 

She suggested: “These tools improve diagnostic accuracy, boost efficiency, and enable remote and virtual hub consultations, increasing access for underserved populations.”

Donnelly also highlighted the benefits of an increased focus on patient-centric care for improving patient outcomes and satisfaction. 

She said: “A growing focus on patient-centric care and patient education allows practitioners to tailor treatments to individual needs, helping patients better manage chronic conditions like dry eye or glaucoma.” 

Shaping the profession

Pointing to one factor set to shape the profession over the next five years, Donnelly identified the abolition of NHS England and its integration into the Department of Health and Social Care. 

Finding the opportunity in this move, she said: “A united voice is important to ensure fair funding, enabling community optometry to play a stronger role in delivering accessible, high quality eye care.”

Donnelly described: “General ophthalmic services have been chronically underfunded to the point where practices have felt compelled to opt out of delivering these services.”

“This contrasts with Scotland, where the financial model makes it more viable for practices to remain engaged in delivering NHS eye care,” she added. 

Optometry in education and research

Dr Niall Hynes explained that optometry education is in a period of change as universities transition to offering Master’s programmes following the General Optical Council’s new education and training requirements. 

Reflecting on the changes to optometry education, Hynes shared: “I think it’s a fantastic opportunity to prepare students a little bit better, or give them that little bit more, particularly in the changing world of optometry at the moment and the hope that optometry is going to be involved with more clinical services in the future.” 

The implementation of Clinical Learning in Practice (CLiP), for those universities working with the College of Optometrists, will be a key focus in the coming years, he suggested.

Postgraduate qualifications will also remain critical going forwards, Hynes was quick to add.

Pointing to the shift in the use of optical coherence tomography from “being an option to being a necessity,” he said: “I imagine things are going to change even more so over the next 10 years for the graduates of today. That need for postgraduate education is going to be pivotal in a profession that keeps on progressing.”

Funding challenges

Funding is currently one of the biggest challenges facing tertiary education institutions, Hynes shared, whether the result of a fall-out from the pandemic, government decisions, the stagnation in fees, or the decline in international student numbers. 

“Optometry is an expensive course to run and it has to be properly funded. We need to ensure that all students are getting equal opportunities to flourish,” he said, adding: “I think it’s a challenge that can be overcome, but it’s certainly going to be a difficult few years for the university sector.”

The funding challenges are also seen in research, Hynes noted, suggesting the knock-on effect of this could mean fewer research projects, difficulties securing funding to present findings, and more PhD students self-funding. 

Advanced technology

Hynes suggests AI holds opportunities for the profession, sharing: “It has the potential for some fantastic progression in how we deal with imagery and OCT analysis for things like glaucoma and medical retina.”

There is a balance to strike, however, Hynes emphasised: “As academics we need to be teaching that AI should be used responsibly. This means having the skills to use it correctly with checks and balances in place.”

The technology should be used for the good of patients and the profession, he added. 

“We are in uncharted waters at the moment, so it is the entire profession working together. As academics, it is helpful to know what the profession expects of us and how they want to use AI. We need to be listening to the profession and using that to prepare students as best as possible for this brave new world,” he said.

Changes are also underway on a more localised level, Hynes shared, such as the changes in Wales to enable optometrists to certify vision impairment, or the joint statement by the AOP and the College of Optometrists which called for a review of the driving and vision standards. 

“I think there is potential in optometrists being proactive and associations listening to their members, discussing these issues, and formulating ways of moving forwards,” he said. 

Optometry in domiciliary

Parminder Kaur told OT: “I would best describe domiciliary as a growing sector of optometry – we’re constantly evolving.”

Awareness of the service has grown amongst patients in recent years, with the demographic typically associated with this form of practice expanding to younger patients.

Identifying challenges for this sector, however, Kaur shared: “I think that the pre-visit notification (PVN) is the biggest, ultimate hindrance in domiciliary.”

Describing the PVN as “our Achilles’ heel,” Kaur suggested it means that patients have to wait longer for a sight test, so waiting times are longer, and also means that domiciliary optometrists cannot provide urgent care. 

For patients in care homes, where the PVN notice period is significantly longer, this can have a particularly detrimental effect. 

Pre-visit notifications

Kaur said: “I’ve seen so many patients in both their homes and care homes who have an uncorrected prescription that, if it was corrected at the right time, could make such an impact to their overall wellbeing and, in cases of cognitive impairment, their awareness.”

Emphasising the “frustration” the PVN restrictions can cause for patients and practitioners, she said: “Fundamentally, all of our patients deserve the same level of access to care. Patients who suffer with cognitive impairment should have the same level of access to care as someone at home, and as someone who can get to the High Street.”

“Without removing that barrier to accessing eye care, it is very difficult to move forward,” Kaur said. 

The effects are also seen at a business-level, Kaur shared, as it is difficult to move appointments to fill spaces left by last-minute cancellations. 

“It is very difficult to navigate that from a business point of view,” she said. 

Removing the PVN would open a number of avenues for domiciliary optometry, Kaur suggested: “The scope of what we can do would increase massively. If we can provide urgent access to eye care, that will shape the future of domiciliary. It will allow us to upskill our clinicians. It will reduce the pressure on hospital services and eye casualty and develop those shared care pathways.”

It can be a challenge to recruit clinicians who are at an earlier point of their career, or in certain areas of the country, to domiciliary. If services could be expanded, this would create more opportunities for career development and growth, potentially going some way to address the recruitment challenge, Kaur noted. 

“I know that in Wales, domiciliary optometrists now have access to urgent eye care services. It's really exciting,” she said.

Culture-shift and growth opportunities

Kaur also noted a culture-shift as more patients seek domiciliary services from a younger age, and so are managed in domiciliary for a longer period of time, suggesting this could present opportunities in areas such as diabetic screening and monitoring.

“There are a lot more growth opportunities now, in comparison to probably five years ago,” Kaur said, adding: “I think in the future there will be more opportunities for clinicians to own their own businesses and joint venture partnerships.”

Domiciliary is an amazing place to work

“Domiciliary provides a variety which you don’t often see on the High Street because every patient and environment is so different,” she said, adding: “You have to constantly adapt your working style and I think it makes you more confident as a clinician.”

As a new member of the AOP Council, Kaur is keen to use her platform to advocate for domiciliary. She told OT: “My agenda is to get rid of the stigma around domiciliary, make it exciting, and re-invent it as what domiciliary actually is, rather than what people think it is.”