Bee stings and retinopathy of prematurity: working in the paediatric eye clinic

Here, Smith tells OT about her recent successes, hospital optometry’s biggest upcoming challenges, and why the hospital eye clinic provides a learning environment like no other.

Can you describe working as hospital optometrist in one sentence?

It’s very collaborative, interesting and exciting.

How long have you worked as a hospital optometrist?

I have worked as a hospital optometrist since my pre-reg. I did my pre-reg at Moorfields Eye Hospital in 2014 and I’ve been full-time in the hospital eye service since then.

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

I’m from a family of hospital optometrists. My mum and dad both did hospital pre-regs, and my dad was head of the hospital in Plymouth for a long time, so I always knew that I wanted to do a hospital pre-reg if I could get one.

They encouraged that need, as a pre-reg, to try the hospital, with the thought that I would see everything whilst I was training, and that was a really good safe space to see it all in.

I was fortunate that I started working at Moorfields, and I loved it. It suited me really well. You see a range of different patients and different cases, and no two days are the same. I really loved that, so I’ve never left.

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

I’m a Brownie leader. I’m an active Girlguiding member, and I look after all the Brownie units in Bath as district commissioner, as well as being Brown Owl at my unit.

I really enjoy being part of Girlguiding. It’s such a great network of friends and opportunities. I can bring a lot of those management and leadership skills from optometry into my Guiding role as well, which is nice.

Can you name one moment that has made your job feel valuable?

One of the best things about working in the hospital is that you do have quite a lot of moments where your job is valuable – maybe fitting a keratoconic, where you can get the patient to driving standard with a contact lens, for example. That is such an amazing feeling.

Also, I do a lot of sight tests for children with additional needs. When they come in wearing their glasses, that’s such a sense of achievement. I’m really glad I took that extra time to get that prescription. You need to build up their trust and build up that relationship, then when they come in wearing those glasses and they can see better, it’s a really good feeling.

We had a 10-year-old paediatric patient who was stung in the eye by a bee, and it actually left the sting in her eye

What is the biggest challenge facing hospital optometry currently and why? How can the profession support, or how can this be resolved?

We hear a lot about the ageing population. I work a lot in paediatrics, and we don’t necessarily hear about the other side of it.

Modern medicine, which is a wonderful thing, means that we see a lot more children with a lot of additional needs: for example, premature children surviving from 23 weeks, which is really young, and they have significant eye problems. These children, who are treated for retinopathy of prematurity, have got significant refractive error, and a number will have visual impairments.

As hospital optometrists, we’re really well-suited to take on that extended role and help see some of the more complex paediatric cases that are arising. They are really interesting, and rewarding, but it is also quite tricky to find the capacity to see them. I think a lot of hospitals will find that they outgrow their spaces, because the demand has increased so much.

But that’s also a good opportunity for community optometrists and community practices. The 10-Year Health Plan does talk about care in the community, so it’s a really good opportunity to utilise our colleagues in primary care, to make sure we are offering the best care locally for patients, instead of having to take them to the hospital every time.

Looking at the special school service, that’s also a much better environment for those children than coming into the hospital. We know that, but it’s about having the support from community to build the service.

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

Hospital optometry has adapted really well since COVID-19 to utilise our virtual streams.

Here in Bristol, but in other trusts as well, we are using virtual pathways and having optometrists review data and create new protocols and pathways, meaning the patient backlog has been managed really effectively.

I think a lot of hospitals would have struggled without optometrists, which has made us feel much more valued as part of our workforce. It has made management realise how useful we can be.

Working in a hospital is really collaborative. You’re part of a massive team, so you’ve always got somebody to ask, including the consultant

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

I was recently appointed as service lead, and I’ve really enjoyed starting this role. We have supported a few new starters, who have come from community, and it has been really good to see them develop and enjoy hospital work as much as I do. They all started with one or two days, and they have wanted to increase their days, which has been really great.

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

We had a 10-year-old paediatric patient who was stung in the eye by a bee, and it actually left the sting in her eye. She had it removed, and then she needed sutures afterwards.

The consequence is that she now has corneal scarring, so we see her with the view of maybe fitting a contact lens. It has been really interesting, but when you read it, you think, ‘surely, that can’t have happened?’ The number of children we see who have had unfortunate eye accidents – they really are resilient.

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

In general, we are really friendly. I would just say, give it a try. Working in a hospital is really collaborative. You’re part of a massive team, so you’ve always got somebody to ask, including the consultant.

The other optometrists I work with in Bristol are amazing. They are so knowledgeable, so you do feel really well supported. It’s interesting, different work. Even though the cases are more complex, you’re not working on your own. You do definitely have that support, which is great.

Do you have anything else to add on the subject of working as a hospital optometrist?

The changes to optometry training, with the start of clinical learning in practice placements (CLiP), is a bit of a worry. The pathway that I and a lot of colleagues did, the hospital pre-reg, is going to change. I hope that students and newly qualified optometrists will still be able to learn about working in a hospital.