The ageing population, changing optometry education, and advancing clinical skills

The AOP Council welcomed new Councillors in June, representing optometrists and dispensing opticians all over the UK and across career stages.

To learn some of the key issues affecting the profession today, and the challenges that might arise in the future, OT heard from AOP Councillors: Bonnie Lam, representing undergraduate student optometrists, Johnathan Waugh in Scotland, Martin Sweeney in Wales, and Sarah White, representing dispensing opticians.

Advancing skills and scope

Optometrist and practice owner, Waugh, reflected: “I think, with the General Optical Council (GOC) changes to the undergraduate programme, and the potential de-regulation of refraction, we have faced some pretty big issues recently which we seem to have got through.”

“I think optometry is probably in a stronger position now than it was a few years ago, however, there are always risks going forward,” he said.

There is a trend towards higher clinical skills amongst the profession, Waugh suggested, though a balance is still required with providing appropriate remuneration for this work.

“In Scotland, thankfully our General Ophthalmic Services (GOS) examinations are paid at a higher fee, which gives us a little bit more income,” he noted. “It’s also given us a bit more scope to undertake more advanced clinical work in managing conditions, which is more interesting for all of us.”

One example has been the NHS Community Glaucoma Service, which is being rolled out across Scotland to enable patients who have lower risk glaucoma or ocular hypertension to be discharged to receive care from accredited providers in the community. The providers are independent prescribing (IP) optometrists who have completed the NHS Education for Scotland Glaucoma Award Training (NESGAT) qualification.

Waugh shared: “Having worked in the glaucoma service, I’m looking forward to this.”

 

Educational changes

Optometry student, Lam, also identified changes in optometry education as a key issue affecting the profession currently.

The change in the GOC’s education and training requirements has seen optometry schools refreshing and relaunching their degree programmes, moving to a Master’s model.

Lam shared: “I think many students are worried about what will happen if graduates are going to be completing a course that is more advanced than those who are currently on the pre-reg pathway.”

The new education requirements will see placements embedded into courses. 

Students have questions about what the new approach to patient-facing clinical experience will look like, Lam suggested.

While undergraduate optometry is changing across the country, the programmes may look particularly different in Scotland – delivered over five years and with an ambition to include independent prescribing training. 

The changes could be beneficial for pre-reg optometrists in Scotland, Waugh felt, explaining: “I think they will get a better experience from it. But it suddenly becomes a two-tier profession, which I think would be a shame.”

“I think the risk is not necessarily a bad one for Scotland, but it might be to the detriment of UK optometry, and I’ll do what I can to try and make sure that we don’t drift too far apart,” he added.

Considering the challenges facing the profession, Waugh suggested that there is a risk of the devolved nations “moving in slightly different directions.”

“I think it would be wrong for us all to separate and go our own ways, because we’ve got a lot to learn together,” he shared.

 

Waiting list pressures

Optometrist, Sweeney, shared that the key priority for him currently is: “How to progress further with the latest Welsh GOS scheme.”

The new contract came into effect in autumn 2023, bringing with it a new framework for service delivery in community optometry.

With the new contract in place, designed to enable optometrists and dispensing opticians to work to the top of their clinical licence, there could be new opportunities for the optometry profession, including in helping to address pressures facing eye care.

Sweeney told OT that coping with the strained hospital eye service is a challenge for the optometry profession, in particular determining: “how to best help our patients with that.”

“Waiting lists are bad and are not getting better. The hospitals are desperate to get cases out of the hospital eye service and moved somewhere else,” he shared.

“We are pushing on an open door. Previously, there was a lot of in-house resistance and protection of home turf. Those arguments don’t hold anymore. This gives us an opportunity to branch out our skills, and we should grab that opportunity,” Sweeney shared.

The biggest opportunity going forward is “pushing to further advance our clinical skills within the remit of Welsh GOS,” he added.

 

The ageing population

Dispensing optician, White, told OT: “The issue burning in my mind at the moment is forward planning for the population ageing and making sure that we have the ability to deal with whatever comes to us.”

The practice owner and director also agreed that one of the biggest challenges facing the sector in the past year has been the backlog in ophthalmology. She said: “I think it is the waiting lists and the fact that people are waiting to a point where they are losing some of their sight.”

Continuous development as eye care professionals presents an opportunity to help address some of these growing challenges.

White suggested: “Upskilling is a way to try and get more into primary care so that it can be dealt with, and so we are not adding to the waiting lists that people are sitting on.”

For White, upskilling is a major opportunity for dispensing opticians in particular, especially in the areas of dry eye and myopia management.

“We can, whether in the short-term or long-term, reduce the burden and need for secondary care appointments and that has got to be a benefit,” she said.

“From a dispensing optician’s point of view, the more ability you have, the more independence you have in certain situations,” White shared, adding that this also improves job satisfaction.

At an AOP Council meeting on 5 June, White discussed the challenges facing dispensing opticians when it comes to continuing professional development (CPD). Find the report on OT.

Lam agreed that the question of how optometry can advance services to meet the needs of the ageing population poses a key challenge for the profession going forwards.

“I think it is a good thing that we can encourage more optometrists to undertake further study in higher certifications,” she suggested.

Giving the example of glaucoma, Lam shared that seeing more patients in the community could mean only sending those patients who really need the hospital service into secondary care.

 

Artificial intelligence

The application of artificial intelligence (AI) presents some opportunities for the profession, Lam suggested, but this area of technology also presents ethical and regulatory questions that need resolving.

“Of course you want to provide a better service to the patient and AI can help us a lot. But we still have to find the balance,” she said, adding: “I think it’s probably one of the most exciting areas in optometry.”

Waugh also sees the emergence of AI as an area of both opportunity and risk for the profession.

Considering the role that AI could play in the future, Waugh shared: “As a clinician, I’m still uncomfortable with machines taking over the investigative work I do. I’m happy for technology to be taking the images, which I then interpret. I don’t really want AI to be taking on my clinical work, so I think there is a risk.”

In the future, it is possible that practices will differ in their approach to technology, with some taking the automated route and others remaining on a more traditional path.

“Technology is there to support what we’re doing,” Waugh said. “I think for each individual, it’s about doing what you’re comfortable with, doing it well, and seeing where the future goes.”

AI is already used in the diabetic screening service that Waugh is a part of, helping to grade some images.

“This actually saves us time and effort, although the grading isn’t always accurate,” he noted.

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OT asks: How do you think the public view the optometry profession? Do you think this has, or is, changing?

OT asked the AOP Councillors how they feel the public views optometry.

Waugh acknowledged that the situation is slightly different in Scotland, where eye examinations have been free for all since 2006 and optometry is the first port-of-call for eye related issues. Despite this, Waugh said that he still encounters the question: “How much will this cost?"

“There is still a lot of work to be done in changing perceptions, reminding people that it doesn’t have to be an expensive thing and that healthcare and eye care are separate from the sale of spectacles,” he said. “It’s certainly better and is gradually changing, but a bigger change would be beneficial to the patients and to us.”

While some of the public, particularly those who may have experienced an eye condition, have a good understanding, Waugh shared: “A lot of people who feel they have ‘perfectly good eyes’ don’t understand the risks that they face, that worsen as they age,” he shared.

Sweeney also felt that direct experiences of optometry’s role in addressing eye issues is shaping perceptions.

“It is definitely changing for the better, especially with those who end up using the various minor eye conditions pathways,” he shared.

Having moved to the UK from Hong Kong, Lam has seen the differences in the role of optometrists between the two countries, suggesting: “Here optometrists have more of a primary care role.”

The difference between the two models is something that patients moving to the UK might not be aware of, she noted.

Lam also suggested education is needed amongst the general public: “It is like they don’t know why you should have your eyes checked every two years, and believe it is only when they want to buy new glasses or contact lenses.”

White told OT: “I think people are getting more invested in their eye care. Since the pandemic there has been such a focus on health that people are more aware of their own health, and eye care is included in that.”

She continued: “I think there is a number of people that are more invested in making sure they have got the best tests, are having optical coherence tomography scans, and want to have as much as they can screened to put their mind at rest.”

More education on eye health is still needed to engage the rest of the population, particularly with the importance of routine eye examinations and screening.

White explained: “From the feedback I was getting, there is still a perception that you only get your eyes tested when you need new glasses.”

“I think there is work to do to explain in a stronger message: get the screening done, get the eye test done, even if you’re not getting new glasses,” she said.