The Richard Stead episode

Richard reflected on his journey from training as an optometrist to specialising in glaucoma and cataract surgery, and discussed how advances in treatment, growing NHS pressures, and closer collaboration with community optometrists are shaping the future of eye care.

Here are five things we learned about Richard and his clinical experience when recording The OT Podcast.

1 From optometry to ophthalmology

Reflecting on his early interest in eye care, Richard shared: “I always looked forward to seeing the optician, probably because I could actually see properly when I left.”

Opting to pursue a career in eye care, Richard initially studied optometry at the University of Manchester Institute of Science and Technology (UMIST) and completed a pre-registration year in community practice. During his pre-registration year he spent time in hospital settings, which helped spark his interest in the medical side of eye disease.

Richard’s exposure to hospital work during his optometry training proved decisive, he told OT: “the seeds were sown in my pre-reg year, when I enjoyed my time in the hospital.”

Motivated by this experience, he pursued medical training at the University of Leicester and later specialised as an ophthalmologist in glaucoma and cataract surgery.

2 Collaboration is key

Reflecting on eye care services today, for Richard strong collaboration between hospital ophthalmologists and community optometrists is required to meet the rising demand for eye care.

Having worked within both sectors, with ophthalmology services under increasing pressure, Richard believes that appropriately trained optometrists can play an important role in monitoring stable patients and identifying disease progression in the community.

He noted the importance of building strong professional relationships across the sector, sharing that: “Building those community relationships is a fundamental part of our ethos.”

Community optometry practices increasingly have access to advanced diagnostic technology, enabling them to contribute more effectively to shared care models, he told OT.

“If stable patients can be seen in the community by appropriately trained optometrists, this offers a great way forward,” he said, highlighting that these types of models support earlier detection, improve access for patients, and help reduce pressure on hospital eye services.

3 Cataract surgery and evolving treatment approaches

Richard explained that cataract surgery techniques continue to evolve, with advances making procedures smaller, faster and more efficient.

Cataract surgery can also create opportunities to address other ocular conditions at the same time, Richard said, explaining that nowadays surgeons increasingly consider combining cataract surgery with minimally invasive glaucoma procedures, explaining that Newmedica’s approach includes “considering MIGS at the time of cataract surgery when clinically appropriate.”

Richard described that MIGS implants “can be implanted, often at the same time as cataract surgery, to help tap into the physiological outflow and control the pressure in the eye.”

4 Glaucoma treatment advances

Richard has seen glaucoma management change considerably in recent years, with new research influencing treatment pathways and expanding therapeutic options.

Historically, patients were usually treated first with pressure-lowering eye drops, with laser or surgery considered later if medications were insufficient, he explained.

However, evidence from studies such as the LiGHT Trial has led to changes in national guidance.

Richard explained that “NICE guidance changed our treatment paradigm so that now we offer selective laser trabeculoplasty (SLT) as a first-line treatment.”

He also noted that surgical techniques have advanced at pace for glaucoma, sharing: “Since around 2015, there has been an explosion in minimally invasive glaucoma surgery (MIGS).”

5 NHS pressures and waiting lists

Richard described ophthalmology as “one of the busiest specialisms in NHS hospitals.”

He explained that many conditions, such as glaucoma, require lifelong monitoring, meaning that hospital clinics must manage large numbers of follow-up appointments in addition to new referrals. As a result, Richard acknowledged that waiting lists have grown significantly in many areas.

Richard warned that “the increasing demand for glaucoma care presents a significant challenge to the health service, often leading to appointment delays and potential vision loss.”

He explained that, in order to address these pressures, health systems are exploring new care pathways that include community-based monitoring, virtual clinics, and partnerships with independent providers.

“We need to decongest the hospital eye services, and I think optometry is perfectly situated for that,” he said.

The Richard Stead episode

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