Mike Hale You are now in the second and final year of your stint as president. How did you first get involved with the College of Optometrists?
Ed Mallen I owe a lot to this institution because the College funded my PhD when I was a research scholar. Without that funding, I wouldn’t be where I am now. After completing the PhD, I presented at Optometry Tomorrow, this was around 2007, and I just got chatting to a few people and then vacancies came up on the council. So, I stood as a councillor for the West Midlands because I was still locuming in that area at the time. I applied and I was successfully elected to the council.
I have a big interest in research, so I joined the research committee straight away and then I applied to be a trustee of the college, I think the following year, and became a trustee. My mentor in optics, Bernard Gilmartin, was chair of the research committee and then I took over from him in 2011. After five years I rescinded that role after being elected as vice president. Then last year I became president, which I still have to pinch myself about because it’s a great privilege and honour.
MH What was your focus for the first year in role?
EM The very first thing was learning as quickly as possible about everything going on because your perspective is suddenly on a different level. Then my main concern was thinking how I could have a positive impact. There’s a lot going on at the moment in the sector. We’ve got reviews of higher education going on, reviews of how we train people in the various professions, and we’ve got changes with government and with health policy. There’s also the issue and how to get across the message of what optometrists do and how to put across to policy makers the impact of eye care and how important it is.
We need them to look a little bit beyond the initial problem of whatever the eye condition is, to think about the whole cost of sight loss.
If somebody loses their sight at 70 and they’re going to live until they’re 90, you’ve got 20 years of social care costs, you’ve got 20 years of reduced quality of life, you’ve got 20 years with high risk of depression and other conditions. And it’s getting across that message, that if we get the right eye care for people in the right place, at the right time, by the right appropriately trained person, we can do a lot to prevent those 20 years of limited quality of life. Getting people to understand that is the key in my view.
MH Has your approach to this challenge changed in your second year as president?
EM Absolutely. I’m into the second year now and it is time to sharpen up that focus onto things like training. Optometrists do want to do more, I think, they want to expand scope of practice. We need to ensure that other health professions trust that training, and trust that increased scope of practice and support that ambition, because we want to do as much as we can to provide advanced care. We want to do that safely. We want to do that with limited risk to the patient, but where we can we want to increase the access of patients to various services. We’re thinking about things like the enhanced schemes that have been shown to be safe and effective and these need to be rolled out more. And in certain cases, they can save financial resource as well which is clearly a good thing.
There’s a keenness from the clinician side. There’s a tangible benefit that the patients see but then what we need to go with it is the capacity for training, particularly around placements. We need funding around that training and then we need commissioning of services so that it is a sustainable thing. That will be a key focus of this second year. After that I will be a past president and will try to share my experience to keep these things moving forward.
MH Going back to what you said about the role of president affording a new perspective, what have you learned from your time in the role?
EM I’ve learned a lot from discussions with other colleges, in depth discussions with professional bodies and regulators, and all of the different people I have been fortunate to meet from across the sector. It has been really enlightening to form links with the truly great people working across eye care. I really try to promote conversations across the various sectors and get people to work together as closely as possible.
MH What are your views on the future changes to undergraduate training?
EM With the GOC conducting its Education Strategic Review at the moment, the time is right to be looking at this. I think that we need to be looking beyond undergraduate training now actually. In all of this we need to remember that optometry is an interesting degree. It’s a clinical degree, but it’s also a scientific degree, and we need to make sure we always train optometrists to be good clinicians and good evidence-based practitioners so they can interpret scientific and clinical evidence. That is absolutely fundamental to what we do and needs to be there in any new model of training.
But we also need to think about that longer career path because we’re going down a route where we’re needing optometrists to be able to do more and specialise in glaucoma or medical retina or low vision or contact lenses or paediatrics. So we need to start to think really about how we do that. We have our College higher qualifications. We have independent prescribing, but we need to start to really think about how we develop training to take that into account perhaps. And how we foster ambition in undergraduates so they can see their career development beyond joining the GOC register as a fully qualified optometrist, and start to think about what they want to do beyond that and how they can contribute to patient care in a specialist way.
For that we’ve mentioned what we need already. We’ve mentioned the idea about commissioning and placements but we also need some really good role models, so that new people training and coming into the profession can look to these individuals and say, ‘wow, I want to do that’.
At the College we have the diploma ceremony in November where we admit the new diplomats to our profession. At the ceremony the newly qualified see people getting higher qualifications in glaucoma, getting independent and therapeutic prescribing. They see that and hopefully it encourages them to do the same. That’s the sort of awareness we need to foster to make sure people follow that path because it builds capacity for high quality eye care provision. And it will allow our patients to access that really vital care, maybe without the need to be referred into a hospital every time. We could give appropriate care in an appropriate place at an appropriate time.
MH Away from the College you are head of optometry at the University of Bradford. What are your current research interests?
EM At the moment, it’s a matter of when I get a chance to do research because I do a lot of teaching in additional to quite a big administrative burden. At Bradford, we’ve got three academic themes (innovative engineering, sustainable societies and advanced healthcare) and I’m leading on that for the university. So, I’m trying to pull together all of the health related stuff that the university does to form a strategy which is quite a big role as well as being head of optometry. With that in mind, my own research does sometimes have to go on the back burner but I’m currently focusing on various aspects around myopia, which has always been a particular interest of mine, in relation to neural science.
How we tolerate blurred images, how we adapt to them and also some things around some of the environmental factors that might be important in myopia progression, like artificial lighting and screen use. But I never get enough time in the lab, it’s really a shame.
MH On the subject of myopia, many people are relying on refraction to measure myopia progression under therapy. Is this enough?
EM The first thing to say is the refraction is always a fairly insensitive measure, if we’re looking at it over the short term. I think clinical interventions for myopia control will develop a lot over the next few years. I think it will become refined and I think we will look at comparing the different interventions to each other to see which one is the best. And when we do that, I think measurement of axial length, by some of the really excellent techniques we’ve got, will be really important because that will allow us to make those refinements. I think if you were to compare two interventions to each other and just look at the refraction over the course of a year, you may not be able to tease out the subtle differences between the different interventions. The axial length measurement techniques we have will give you the equivalent of about a tenth of a dioptre level of accuracy, which refraction won’t.
I think that we may get to a level of refinement of myopia control methods where we will need to be able to do that. You won’t have the necessary level of accuracy from just the refraction. But with the axial length data you may do because it’s much more precise. Of course not every optometrist has access to methods of measuring axial length, and practices may not want to invest in the equipment. But when you’re running a myopia control intervention, gold standard work would be measuring axial length regularly.
