In the public eye

Juanita Munroe attended Eyecare Express for an eye examination, conscious that her uncle had lost his sight to glaucoma at the age of 21. However, after a period of financial difficulty, she could not afford to pick up the new glasses that she had been prescribed.

“I was a little embarrassed to be honest,” she told OT.

“Obviously, you don’t want to go to your opticians and say, ‘I can’t afford my glasses right now,” she said.

With only £45 to last her to the end of the month after rent, electricity and gas were accounted for, Munroe ignored a series of reminders.

Then, one day, she reluctantly followed optometrists Yassar and Adeil Yousaf into the Woodford Green independent after they spotted her walking past.

“They sat me down and told me they wanted to offer me the glasses for free. I became all teary eyed, but in a joyful way. When someone offers that kindness, and you’ve never had it before, it brings a lot of happiness to your heart,” she said.

During Ramadan, the Yousafs began offering free sight tests and spectacles to those who might not otherwise be able to afford eye care – in doing so, playing their small part towards easing the cost of living crisis in their neighbourhood.

Yassar Yousaf explained to OT in June that the offer extended beyond Ramadan, with four hours allocated to the initiative each week.

“We have met numerous patients who are in these overwhelming, difficult situations,” he explained.

“If we can help one person see better, they can hopefully help themselves get into a better place,” Yousaf shared.

When someone offers that kindness, and you’ve never had it before, it brings a lot of happiness to your heart

Yassar and his brother Adeil do not come from a wealthy background and observed the financial struggles their parents experienced growing up.

“This has shaped who we are now. We remember something that our parents taught us and that is: the happiest person on this planet is not the one who gets more, but the one who gives more,” he said.

A survey of 2000 members of the public by the General Optical Council in 2023 found that most (58%) respondents had never felt uncomfortable visiting an optometry practice.

However, among those who had felt uncomfortable, the most common reason was the perceived pressure to buy contact lenses or glasses – with around one in five people reporting this as the reason for their unease.

Aaron Lewis, 23, shared with OT that it can take courage to go for a sight test.

“You worry about the eventual cost,” he said.

Lewis, who is currently looking for work, received his first pair of spectacles from Eyecare Express after experiencing headaches.

“It was definitely a stark difference in terms of the clarity I can see with the glasses and having peace of mind as well,” Lewis shared.

“I’m thankful I was able to go through this scheme without having to worry about how I am going to pay afterwards,” he said.

 

Bridging the gap

As part of its public perceptions research in 2023, the GOC uncovered racial differences in how comfortable different groups were within an optometry practice.

While 60% of white respondents said they had never felt uncomfortable in an optometry practice, only 44% of Asian or British Asian respondents and 40% of Black or Black British respondents reported the same experience.

 Bhavini Makwana is chair of BAME Vision – a voluntary group that aims to tackle inequalities in how people from underserved communities access eye care. 

Makwana shared that the cost attached to a sight test can prevent people from BAME backgrounds accessing eye care. This is supported by GOC research that found 15% of white respondents cited cost as a reason for being uncomfortable visiting an optician, compared to 29% of BAME respondents.

Makwana shared that among those who do access eye care, language can be a barrier.

“Some of the issues we’ve encountered is that people are not offered interpreters. Even though they’ve turned up, the value of that appointment is not there because they can’t fully understand what they have been told,” she said.

A stark example of this is a woman who spoke with Makwana after seeing a consultant for her deteriorating vision. A communication breakdown meant she came away from the appointment unclear about her diagnosis.

“She was going about her daily life with a macular hole, really worried about what to do next,” Makwana shared.

Turning to the steps that can be taken to make eye care more accessible, Makwana encouraged optometrists to use language that is appropriate for the patient and to avoid jargon.

If language barriers are an issue, Makwana recommended offering an interpreter, or asking if a patient would like a friend or relative at the appointment.

“It will be different for different people, because patients are unique. Generally, I think it helps to ask, ‘How can we make the appointment more accessible?’,” she said.

A long wait

Makwana’s own experience of waiting almost 15 years between her diagnosis with retinitis pigmentosa (RP) and being signposted to appropriate support has fuelled her motivation to address inequality.

“I do get joy out of supporting others. I don’t want anyone else to feel the way I did,” she said.

As a teenager, Makwana initially thought that her tendency to miss steps, walk into lamp posts, and not being able to see clearly in bright sunlight was down to exam stress.

She realised that something was seriously wrong during a school trip to Disneyland Paris when she had to rely on a friend to guide her through a darkened tunnel for a ride.

 

After being diagnosed with RP at the age of 17, a consultant told her that there was no cure, and her vision would deteriorate over time. For some people this could take years, while for others it could take months or even weeks.

“Those words really stuck with me. I was absolutely terrified that I would wake up one morning and be completely blind,” Makwana said.

For the next decade, Makwana would keep her condition secret from the people around her – afraid of how she would be perceived. The first person she told outside of her family was her future husband.

But her secret created challenges for fitting in – she was the clumsy daughter-in-law, who knocked over glasses, could not drive and struggled to make round chapatis.

It was not until 2012 – 15 years after her initial diagnosis – that Makwana’s husband spotted a poster for the charity RP Fighting Blindness (now Retina UK) during a check-up appointment at Moorfields Eye Hospital.

When she attended a support meeting with her husband, it was the first time she had met people with her condition.

“I cried, because I realised ‘This isn’t just me’. I felt like a weight had been lifted off me,” she said.

She recognised the adaptations she had made in isolation whilst others she met also did the same.

“For so long, I had thought I was struggling, but then I realised that it was ok to do things differently. We started showing each other the things we do to make life easier,” Makwana shared.

I cried, because I realised ‘This isn’t just me’. I felt like a weight had been lifted off me

 

It is Makwana’s own experience that causes her to bristle when terms like ‘hard to reach’ are used to describe groups that face challenges accessing care.

“I wasn’t hard to reach. I attended my appointments every year,” she said.

“There were 15 years’ worth of opportunities for professionals to tell me about mental health, practical and emotional support and signpost me to services,” Makwana emphasised.

She believes that the solution lies in involving the community groups that a service is trying to reach.

“Attitudes need to change from the design stage to delivery,” she said.

“If you’re going to do the same thing over and over again, then guess what, you’re not going to reach new audiences,” Makwana shared.

She is determined that other people will have a different experience to the one she went through as a 17-year-old.

“There is a huge world out there, even with sight loss,” Makwana shared.

Aside from the need to support patients with conditions that affect their vision, Makwana highlighted the importance of offering inclusive services to ensure early diagnosis and treatment.

“We know that half of sight loss is preventable, but it is only preventable if you have the information and eye care in an accessible format,” she said.

The role of independent prescribing

In 2023, for the first time since the GOC began its annual public perception survey, more UK residents selected an optometry practice (36%) as their first port of call for an eye problem than a GP practice (33%). 

This is a substantial shift since the first survey in 2015 – when 54% of patients selected a GP practice and only 19% selected an optometry practice.

However, disparities exist between the four nations of the UK. People are more likely to present to an optometry practice if they woke up with an eye problem in Northern Ireland (49%), Scotland (46%) and Wales (39%) than in England – where less than a third of patients (30%) state that an optometry practice would be their first port of call.

 Hannah Thomas is an independent prescribing (IP) optometrist and the director of Parish and Green EyeCare practices in Talbot Green and Pencoed. The majority of patients who attend the practice receive NHS-funded care.

Thomas has observed a shift in how people perceive optometrists since she qualified in 2011.

“During the pandemic, you could see that patients were starting to understand that you should go to your optometrist for an eye problem,” she said.

Alongside changes to care during COVID-19, Thomas believes that the growth of IP and extended care schemes in the community also contributed to changing attitudes.

Being able to provide care that was traditionally offered within hospital has seen patients appreciate the clinical nature of Thomas’ role.

“Before they may have thought we were just there to get their glasses, but now I know my patients perceive me as a clinician,” she said.

I want to see patients naturally thinking of us as the first port of call

 

Patients will recommend to their friends and family members that they visit an optometrist if they have an eye problem, while local primary care providers are also referring patients to Thomas’ practice.

“The GP practices and pharmacists in my local area will say to patients ‘If you’ve got an eye problem, go to your optometrist’,” she said.

The roll out of a new national contract for optometry in Wales has helped to remove inconsistencies in where patients could access services.

However, Thomas highlighted that a remaining hurdle is getting a better geographical spread of IP-qualified optometrists so patients do not have to travel long distances for care.

“At the moment, patients don’t necessarily see every practice as a clinical environment. But as we develop more IP optometrists, virtually every practice will have an IP or one next door,” she said.

Thomas would like to reach the point where attending an optometry practice for eye problems is engrained in “public consciousness.”

“I want to see patients naturally thinking of us as the first port of call,” Thomas emphasised.

Newfound respect

Dean Porter, a Pontypridd IT delivery executive, first attended Parish and Green EyeCare in 2019 for the treatment of anterior uveitis.

After a stressful period at work involving 60-hour weeks, Porter began experiencing headaches and his eye became bloodshot.

Porter told OT that his symptoms culminated in an unplanned return from a work trip to Brighton in order to receive treatment.

“On the train trip back, I was covering my eyes because the light sensitivity was so bad,” he shared.

After initially receiving treatment through the hospital, Porter visited Thomas’ practice and was impressed with the level of personalised care.

“It is quite a scary position to be in when there is something wrong with your sight. Going in to see Hannah provides me with that reassurance,” he shared with OT.

In contrast to his experience in hospital, Porter said that Thomas has the time to talk through options for managing the condition and discuss any concerns he might have.

“The optometrist seems to be in tune with the patient’s needs. You’re not just a number,” he shared.

Porter appreciated the convenience of being able to receive a prescription for the medication he needs from a High Street practice.

He shared that the experience has shifted his perception of the services that optometrists can offer.

“It has opened up my appreciation and respect for what they can do,” Porter said.

 

The common good

Cardiff University lecturer, Dr Grant Robinson, was inspired to undertake IP training after seeing firsthand the benefits of this specialist care during the pandemic.

“I was away from home and my mother called me, distressed, saying that she had this painful, red eye that had been getting worse,” Robinson said.

After his mother was diagnosed with viral keratitis through the hospital, she received follow up care from an IP optometrist.

“That was game changing for her. It was so much more convenient than going to hospital and there was less stress,” Robinson said.

“Seeing the tangible difference an IP optometrist can make gave me the push to enrol in the IP programme,” he highlighted.

Robinson believes that the pandemic accelerated a change in the public perception of optometrists in Wales.

He highlighted that staff at optometry practices across Wales communicated with each other in order to share best practice and offer support, as well as forming connections with other healthcare providers.

“Commercial considerations were put aside. It was about ensuring that we used our expertise in order to help people,” Robinson observed.

“I think that collegiate effort to continue to provide eye care during the pandemic has been recognised by patients,” he said.

Reflecting on differences in public perception between England and Wales, Robinson highlighted the advantages of rolling out change as a smaller nation.

“I think in England, it’s slightly more fragmented,” he emphasised.

“We benefit from the fact that we have more uniformity across the profession. For patients, that means that it doesn’t matter where they are in the country – the message will be the same,” he said.