“You have to look at the whole picture”

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

It can be very professionally and emotionally challenging, but incredibly rewarding.

How long have you worked as a hospital optometrist?

Since I qualified, which was 2016. I did my pre-registration training in a very supportive multiple practice. As soon as I qualified, I wanted to try a hospital job, which would give me a bit more clinical work. I took a one-year fixed term contract, thinking it would be a year of me trying out what a hospital was like, and then probably going back to the community. I haven’t left hospital optometry since. It’s been eight years now.

Why did you decide to become a hospital optometrist?

Throughout pre-reg, I really enjoyed the hospital side of things. I really enjoyed the more clinical aspect. I found the cases that you see in a hospital, rather than in community, more interesting. I thought I’d give it a go, and I didn’t think I'd be here for as long as I have been. But I loved it, and I found more of a passion for the profession there, so I decided to carry on.

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

I’ve just been accepted as a council associate with the General Optical Council (GOC). I’m still very new to the role. It’s a two-year post, and I will hopefully get some experience of the inner workings of the GOC and what it’s like to be part of the Council. It’s brand new, so we’ll see how that goes over the next couple of years. I’m excited to get into something a little bit different.

You also work as a locum in practice. How does your hospital role support you in your High Street optometry work?

Immensely. When I used to work in the community, it was quite early in my career, so that might play a part of it in terms of confidence. But since I’ve worked in hospital, I’ve seen all the complex and unexpected cases that come through, and when you go back into the community, that’s less frequent.

When I see somebody with pathology in the community, I feel more confident in how to explain it to the patient, how to manage them, and in knowing how urgently they need to be referred. That comes from having known what happens on the other side. I can give the patient a bit more information about what their journey will be like after referral, which I think a lot of people who haven’t experienced hospital optometry won’t really know themselves, in order to be able to explain that to the patient.

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

They go hand-in-hand. On the High Street, you’re able to refine your routine and know what a patient wants in terms of screening for eye examinations, but also wanting information about glasses and contact lenses. So, when I see patients in the hospital in a contact lens clinic or a refraction clinic, I’m able to have that understanding of what it’s like when they go back to the High Street. I know what’s happening, and can offer advice to my patients when they are being discharged from the hospital. It’s about giving the patient as much information as possible about what’s out there, and their options.

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

I had a patient in a contact lens clinic. He was keratoconic, in his early 30s, and he was a fitness instructor, so very fit and well. He said, ‘I feel like my vision is getting worse.’ A lot of people might think that was the keratoconus getting worse, or contact lenses not being right or needing to be adjusted.

When I was testing his vision, he was only reading down one side of the chart, which seemed very unusual. Sometimes you get strange things with keratoconics, where if they move their head they can see a bit more clearly. But it just didn’t seem quite right. I did a bit more examination, and sent him for a visual field test.

He ended up having bitemporal hemianopia, which is a potential sign of a compressing lesion or tumour. I urgently referred him to A&E and to neurology, and they found that he had a pituitary tumour.

It was all very quick, and he was very grateful that I took the time to do those extra tests. It made me realise that, if something doesn't feel right, just because you’re in a contact lens clinic, it doesn’t mean you just focus on the contact lenses. We’re optometrists at the end of the day, so you have to look at the whole picture.

What would you say is the biggest challenge facing hospital optometry currently?

The main challenge is probably the opportunities outside of the hospital, which are perhaps more financially rewarding for optometrists as a profession.

Working within hospitals, especially NHS hospitals, is incredibly rewarding, and that’s one of the reasons why I've stayed. But increasingly, with the cost-of-living crisis and other costs, people are starting to look elsewhere and think about private jobs, rather than working within the NHS.

The challenge is retaining and motivating optometrists to stay within hospitals. But actually, the scope of work is expanding. So, if it is the type of work that that you want to do, that’s great. There are more and more opportunities. But I think the challenge is keeping people, from a financial point of view.

How do you think optometrists can be supported in moving past that issue and potentially having it resolved?

With the Agenda for Change, there are changes within salary bandings and that kind of thing. Over the past eight years, I’ve seen that change for the better.

But there are growing numbers of private hospitals, and for optometrists who of course want to earn more and do better in their careers, it’s very easy to be swayed. Doctors and nurses have unions, but there’s not really anything for optometrists. Perhaps that’s the answer – that there needs to be more support from an independent voice.

What would you say is hospital optometry’s biggest success within the past three years?

I know COVID-19 was over three years ago, but we’ve seen the aftermath of it. It’s been quite positive for optometrists within the hospital system, because we’ve been able to prove that we can do more extended roles, and that there’s more scope for the skill set that we have.

During the pandemic, I was working at Liverpool Royal University Hospital. During its peak, junior doctors were deployed. They had gaps in their clinics that needed filling, and so optometrists were taken into eye casualty and trained up, and there was a lot more push towards optometrists working in different areas.

Since then, it has continued, and got better and better. At Moorfields, you now see optometrists working in every sort of specialty.

We’ve been able to prove that we can do more extended roles, and that there’s more scope for the skill set that we have

What would you say is your biggest success in the past three years?

I’m currently working towards a Master’s degree in advanced clinical practice in optometry and ophthalmology. I think my personal success is just in trying to collate as much experience, education and qualifications as I can.

In the past three years, I completed my independent prescribing qualification. I’ve done numerous modules for this Master’s, which have given me a lot more of the theoretical knowledge behind managing cases, and also things like clinical leadership and research and statistics skills. So probably that – working towards furthering my education.

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

You get surprised all the time. Patients will come out with things that you weren’t expecting them to say, and it completely changes your track and how you manage them. In the past, when I’ve worked in low vision clinics, sometimes I’d see patients who would prefer just to have a chat, and are not coping well mentally.

Sometimes you don’t expect that, and you realise that, actually, what they need is somebody to talk to, and perhaps some supportive advice on where they can get further help, and not necessarily a pair of glasses that day. It’s about adapting to who is in front of you.

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

Oh, it’s incredible. If you want more interesting, varied cases, and a way to challenge yourself, and you want to try something new, then hospital optometry is great. It’s worth a try, and I think everyone can do it if they want to.