“You hear so many different stories”

Here, he explains why to OT.

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

I qualified about 10 years ago, and two or three years in, I did give domiciliary a go, as a locum with multiples. I didn’t really enjoy it, at the time. I felt out of my depth.

Five or six years later, owning my own practice, I realised that there were a lot of patients who were being recalled, who could no longer make it to our practice. There was a big number of people in our community, including our own patients, who could no longer come to see us, even though they had enjoyed our services in the past.

I needed to reconsider domiciliary, in order to start treating these people. That was my main aim: to look after the patients we already had. I started providing a domiciliary service at the start of 2025.

What do you enjoy most about domiciliary optometry and why?

The feeling of making eye care accessible, to those who otherwise wouldn’t be able to access it. That feeling, of going into someone’s house or care home, and taking eye care services to them – that’s the biggest thing. It’s a very rewarding job.

When I came back to domiciliary, with a bit more experience, there was more of a need for me to do it, rather than just dipping my toe in it and trying it out. I’m getting really into it and enjoying it, now.

What would you change about domiciliary optometry and why?  

The pre-visit notification. That’s a bit of a roadblock. It doesn’t include the weekends, so if you want to see someone on a Friday, and you’ve got the request, you might have to wait until the following Wednesday. That’s one thing that I would change. I don’t see why we have to do that. When someone comes in my practice, I don’t say, ‘I can’t see you today. I have to give the NHS a two-day notice.’  

I understand why you might have to give notice when you’re seeing 20 patients in a care home. But I don’t understand why you can’t go to someone’s house the same day. If it’s an emergency, that could be really life changing for someone. Wet macular degeneration or angle closure glaucoma needs urgent treatment. If you’re delaying by two days, it’s a bit of problem. 

What is the most common misconception you hear about domiciliary optometry and what do you say to demystify it?

One of the main misconceptions, which is one that I had myself, is that we cut corners and that we can’t do a thorough eye test. Nowadays, we have portable slit lamps, and digital portable cameras. We can do portable visual field analysis. We can do a very thorough eye test remotely, in the comfort of someone’s home or in a care home, as long as the patient has got capacity.

That was what I struggled with as well, at the start: knowing that I could actually do this. That’s why I didn’t feel comfortable with domiciliary initially, because I wasn’t sure about all the different gadgets and equipment. But now I know about them, and I’ve invested in them, I’m much more comfortable.

What is your most memorable moment as a domiciliary optometrist?

I performed an eye exam with a care home resident in his bedroom. He was really chatty, and was telling me about his acting career, and how he had run multiple businesses. He was talking about his whole life, telling me about directing films and acting at the same time.

His daughter came, towards the end of the eye test, and I said: ‘your dad has had a very eventful career and life, hasn’t he?’ She said, ‘Yes. Well, he was a postman for 40 years.’

He obviously had dementia, but because I was quite new to it, and because he was having a good day, I hadn’t been able to tell. He was making up the whole story. He had me fooled.

The take home from that is that every day is different, and you hear so many different stories. Every patient is a person, and you have got to treat them like that. Even if the stories aren’t true, it does make the day quite eventful.

Even the same person might present different personalities. Sometimes you do the eye test and catch them on a good day, and then on delivery day it’s totally different. It’s very varied. Before, I found that intimidating. Now, I find it more exciting. After so many years in practice, it’s refreshing to go into a day where you don’t really know what to expect.

After so many years in practice, it’s refreshing to go into a day where you don’t really know what to expect

What has been your most challenging moment as a domiciliary optometrist and why?

Patients who have high levels of dementia can be very difficult to test, especially if they’re having a bad day. Sometimes they can get quite violent. I want to attend more dementia courses, so I can become better at dealing with these kinds of situations.

After a difficult test, I always ask myself, ‘if another optometrist was to come in, could they have done a better or more thorough job?’ If the answer is no, I’m satisfied that I've done the best I can.

What is the one piece of advice you would give to those considering domiciliary optometry?  

You need to go out there and try it. I was told initially that you’re either in one camp or the other: domiciliary or practice. But I’ve found myself liking both settings. If you’re unsure about it, go on a shadow day and see what it’s all about. You might think, on the first day, that it’s not for you. But give it a good chance. Do it for a week, and ask questions, and you might actually find that it is for you.

When I speak to optometrists, they tend to be based in either practice or domiciliary. You don’t tend to find people who can do both. But obviously, with the way my business has evolved, and with the need that we have had, it forced me to revisit it, and that’s been for the better. I really recommend trying it.

What is the piece of kit you could not live without and why?

The ophthalmoscope. That is a very essential part of equipment, that you need to check the health of the eye.

Another piece of equipment that I’ve found handy recently is a handheld auto-refractor. For those low-capacity patients, who don’t really want to cooperate, that has been really useful.