“I’ve been able to specialise in a field that I really enjoy”

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

No one day is ever the same.

How long have you worked as a hospital optom?

Since 2015, so nine years.

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

I was a pre-registration hospital optometrist, at University Hospitals Coventry and Warwickshire. I went into hospital optometry as a pre-reg because I wanted to do something different, and I didn’t particularly want to do a High Street optometry role at that stage.

I was fortunate to end up doing my pre-registration year in a hospital. I’ve never really looked back – I’ve always stayed within the hospital eye service. Over the nine years since being a pre-reg, I’ve been able to go into different roles, and that has allowed me to specialise in a specific niche, which I really enjoy doing.

My job involves cornea and cataracts. The cornea role involves seeing complex corneal diseases, which can vary from corneal pathology all the way to post-graph patients, but also unstable keratoconics and dry eye patients.

The cataract services involve pre and post-operative cataracts patients. We work alongside a consultant, and so we are also involved in making lens choices for these patients. 

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

I do quite a few different things. I’m currently on the Aston University programme to become a doctor of optometry. I’m beginning my research stage, which is the PhD phase of the programme.

I’m also a director of a pre-registration company for students and for qualified optometrists, Out of the Box Optics. We hold OSCE days for pre-regs and provide support for students, and alongside that we do a lot of charity work. We work closely with Vision Care for Homeless People (VCHP). Our event in February, Optoversity Challenge, gets all the universities together to raise money for VCHP.

I also work at an independent practice twice a week. I’m based in specialist contact lens fitting there, so I do a variety of different contact lenses, varying from complex soft lenses to scleral contact lens fitting.

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

The experience that I’ve gained from hospital optometry – the specialist contact lens fitting that we do within the hospital service, such as fitting keratoconics or fitting complex contact lenses – is applicable to the independent practice that I work for. These are patients who are happy to pay privately to be fitted with these types of lenses. The hospital work has allowed me to specialise in this in the community. If I didn’t do the hospital work, I don’t think I would be fitting those types of contact lenses on patients in the community.

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

I don’t do any contact lens fitting anymore in the hospital eye service, so the High Street keeps me up to date with contact lens knowledge, and aware of what new lenses are on the market.

Equally, because of the advanced clinical job that I now do with the hospital service, I don’t do any routine eye testing or retractions within the hospital anymore. It’s quite good to keep my core skills as an optometrist in the community. If I completely specialised, I don’t think I would be keeping up with those skills.

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

The first thing is probably the pay. We probably don’t get remunerated that well for the work that we do as hospital optometrists, especially when we’re very experienced. If you worked on the High Street or in the community, I think you’d probably progress a lot more quickly than you would in a hospital department.

The other one is the pressures of the NHS and waiting times. An example is the cataract clinics that we do at St Thomas’ Hospital. Working in a hospital in central London, we have extremely busy clinics, and you have to time manage. But also, you have patients who are waiting a really long time. It’s a stressful environment, because you’re working alongside other teams in the clinic as well. Maybe training optometrists to do some of these clinics in the community, instead of just having them within the NHS or within hospitals, is something that could work, because we don’t have the capacity in the hospital.

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

The Hospital and Specialty Optometrist Conference (HSOC) that the AOP held in September in Manchester. It was great because it wasn’t just for hospital optometrists – there were independent prescribing (IP) optometrists there as well.

More optometrists are coming out with IP, and I think the conference is a great way to network. There are some really skilled non-hospital optometrists out there, who really benefited from the lectures and talks over that weekend.

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

Taking the leap of moving on from the trust where I did my pre-registration year. I was at Coventry and Warwickshire for eight years or so. It’s really hard to make a jump when you feel so comfortable with your work colleagues and the environment that you’re working in, especially when your colleagues have known you from being 22 and fresh out of university.

I really put myself out of my comfort zone, to firstly even apply for a role that was not local to home. But I’m really proud, and I think it’s the best decision that I’ve made.

It can be hard at the time, and you may think that you’re making a bad decision. But on reflection, it’s really refreshing seeing how another hospital works and the way the clinics are run. I speak to old work colleagues, and I’m saying to them, ‘maybe the cataract clinic needs to work like this instead, or maybe this is a way to make the clinic more efficient?’ I’d probably say that’s one of my achievements from the past three years.

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

At St Thomas’, I saw a lady who had an acanthamoeba. She had been seen in eye casualty, and referred to the cornea clinic, but she still had the amoebas present within her corneas. She was sent to Moorfields to have scrapes and things for it.

The corneal consultant then decided to do a corneal graft on her. Seeing this patient come in every Thursday morning for almost a year, it’s been really interesting to see how her eye has reacted, and the way things are changing. Unfortunately, she still doesn’t have great vision, but the graft is going in the right direction, which is great.

Additionally, I’ve also seen corneal cystinosis, a rare renal condition that forms crystals within the cornea. There are probably about 100 patients in the UK who have this disease, and we probably have 30 or 40 of them at St Thomas’. I run a clinic once a month where I monitor and manage these patients. It’s super pretty to see. Once you see it, it just looks incredible. 

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

Give it a go, if it’s something that you’re keen on getting involved with, or if you want to develop more clinical skills. I’d suggest, even if it’s for a day or two, to take the plunge and apply.

Even if you do it for a really short time, you’ll still find it valuable, and you’ll come out with a lot of skills that you will take with you as an optometrist. I’ve got friends who have done something similar, who have come to me and said, ‘Shall I apply? Shall I give it a go?’ and have done exactly that. They’ve said they’ve learned a lot of core skills, maybe in paediatrics or contact lenses, or even in more complex refracting.

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

I really enjoy it. You get to work with such a big, varied team, which you probably don’t get the privilege of doing in any other setting. It’s an amazing environment, where you can really thrive.

Now, nine years in, I’ve been able to specialise in a field that I really enjoy. That’s from building all those skills from early in my career, and then progressing and learning as I’ve gone along.

One valuable moment

Krupa Mistry

“A year ago, in January 2024, a team of us from my old job over at Coventry and Warwickshire, along with a group of consultants, optometrists and nurses from across the UK, came together and volunteered in Cambodia.

“We were providing cataract surgery for patients who didn’t have access to any healthcare. The skills of pre-assessment and post-assessment that I learned from being a hospital optometrist allowed me to help carry out that voluntary work. The patients were so appreciative. It made a world of difference for them to be able to see after they had had surgery. Some of these patients travelled 12 or 13 hours from remote villages, to come to this hospital to have their surgery done. That’s a time where I felt quite appreciated for the role that I do as an optometrist.”