Rolling news channels in the Republic of Ireland are pre-occupied by a single burning issue the country had little say in just a few years ago.
Pundits have been left scratching their heads and it is not long before taxi drivers bring it up on a trip across town.
The subject on everyone’s lips is not the decision by a famous St James’s Gate stout brewery to branch into lager, but Brexit.
In contrast, coverage of its potential impact on Ireland was somewhat obscured by campaign buses and anti-migrant posters when the British people came to cast their vote in June 2016.
Now, as Brexit negotiations make a stumbling start, Ireland has reasons to worry and optical businesses know they would not be immune.
Still bruised from a post-2008 financial crisis that hit the Irish Stock Market and property prices hard, Brexit delivered Ireland with a sucker punch just as the green shoots of recovery returned.
This is primarily because the bulk of Irish imports and exports are to and from the UK, and from March 2019 unlikely to be bound by any EU free trade agreement.
For optical practices, ordering frames and lenses could become more expensive, while Irish suppliers of optical appliances and software to the UK market also rely on preferential tariffs.
But Irish optics has other reasons to be positive. Having shifted its regulatory framework to Coru, optometrists and dispensing opticians in the country can increase their scope of practice and win new credibility.
Healthy Eyes Awareness Week, each January, now provides a regular opportunity for Irish practitioners to promote eye health and drive the agenda for regular eye exams. This is especially important in demographics where pathways need improvement, such as child eye screening. Research linked to last year’s campaign found that 21% of the Irish population had never even had a sight test, rising to 36% of those under the age of 35.
The country’s Health Service Executive (HSE), meanwhile, has published a first ever national review of primary eye services, although eye care centres were proposed in favour of the existing network of high street practices. This is much to the frustration of the Association of Optometrists Ireland.
Nothing soft about Brexit
On the first morning of an autumnal trip to Dublin, Optician caught up with the CEO and founder of Irish practice software firm Ocuco, Leo MacCanna.
We meet at ‘rock n roll hotel’ the Clarence, which is co-owned by two of the city’s finest exports – U2’s Bono and the Edge.
MacCanna, involved in programming since the age of 12, has created a practice management, lab and e-commerce software empire also making noises the world over. His outlook is to continue looking for overseas expansion and this will particularly pay off should Brexit bite closer to home.
He tells Optician: ‘We are not Irish, British or North American – we are a global company. It was always our ambition to be global.
‘We have really tried to build globalisation into our DNA. We have built our teams in different time zones to manage this and taken on a diverse management team.’
‘The UK is our home market but as an Irish firm you automatically look around the world too.
‘In larger markets, you can set up a software company without even looking abroad. But when you start up a software company in Ireland your immediate instinct is to look overseas. The market is too small to be viable on its own.
‘We are developing a real name for ourselves in the US market. Most of our growth in the past five years has come from there, so for us it is where the action is at the moment.’
Indeed, half of Ocuco revenues, representing €10-15m, is now in North America and the company employs 75 people in the continent with four offices there.
Another quarter comes from European markets and a quarter from UK and Ireland. Overall annual revenues stand at €25m and Ocuco’s practice management software is now number one in seven countries, including Ireland.
Ocuco HQ
Thanks to its diverse geographical portfolio, Ocuco is well positioned to withstand the potentially damaging effect of Brexit. Nevertheless, MacCanna is keeping a keen eye on developments in Brussels and the knock-on effect across the British Isles.
He says: ‘In general, the Irish economy is growing again and we are very proud of our Irish customer base.
‘While Brexit may not impact Britain or Europe so much, it will devastate Ireland because 37% of the country’s GDP trade is with Britain.
‘That will in turn affect Irish optical businesses. It will affect your local man and indigenous businesses worst but multinationals should be OK.’
Ocuco’s flagship software suite for independents, Acuitas, incorporates a range of point of sale, practice management and e-commerce tools. It is used by 2,000 independents worldwide.
Indeed, as patients demand a full user experience both online and offline, e-commerce has become a fundamental requirement of any software offering. Busy independents often do not have the time or resources to create something bespoke for themselves but must do so to remain competitive.
MacCanna tells Optician that Irish customers are embracing e-commerce more than most, for both bookings and purchases. Ocuco’s e-commerce solutions now represent around 3-6% of its sales.
He says: ‘It is about our customers being able to provide omnichannel services to their patient base, including making appointments online or replenishing of contact lenses and spectacles. We see e-commerce being an extension of services to the existing customer base rather than an expansion of it.
‘The internet high street has become very crowded, and it’s hard to compete with larger companies. All this is too much for a busy practice to handle, but Ocuco allows you to protect your customer base from predation online.’
Improving its technology is also high up the priority list. It re-invested €7.8m in research and development last year, meaning for every euro a customer spends Ocuco re-invests €0.33 in R&D, MacCanna adds.
Since Ocuco was founded in Ireland during the 1990s, it has found growth through entering new markets, creating independent and multiple revenue streams and snapping up rival providers including See 20/20, which it acquired in 2014.
In January, Wells Fargo’s Technology Finance unit funded Ocuco’s acquisition of Dutch PMS provider B&F Groep, as part of a €23m credit line extended to it.
However, keeping independence is crucial to MacCanna in a market where he knows dealing with a specialist you trust means so much.
He says: ‘We’ve had many approaches but the optical industry needs an independent software supplier.
‘Very few companies have been able to come in and compete successfully in the UK market, they just don’t have the same clinical and retail experience as the UK suppliers. In the UK, we’ve been able to use one [clinical] to drive the other [retail].
‘We are a pure software company. It has been 22 years and we are still learning. As from the start we are focused on the optical vertical but going global.
‘Getting technology right isn’t just about money. Buying software is a very sensitive thing and your software company has access to your patient database, so it seems strange you would entrust that information with a competitor, which is why we have kept the company independent.’
A profession in flux
As suppliers step up their game to serve the Irish optical market, optometrists in the country are also going through a regulatory transition poised to increase their scope of practise.
In November 2015, regulation of optics was transferred from the Opticians Board to the Health & Social Care Professions Council (Coru).
The Association of Optometrists Ireland (AOI) welcomed the changes, which included the repeal of the Opticians Act, which had restricted scope of practice of optometrists in Ireland and become ‘an enormous barrier to professional progress’, it said. The regulation of dispensing also transferred to Coru.
As part of the changes, continuing professional development (CPD) became a statutory requirement, with approximately 60 hours of CPD standard for a two-year cycle. Registrants became subject to a new code of conduct and were open to fitness to practise complaints.
Understandably, the transition left some in the profession feeling a sense of worry. However, the AOI pledged at the time that ‘nothing would change overnight’ and have since worked out to be beneficial.
Peter McGrath, chair of Coru’s optical registration board, tells Optician during a meeting in Dublin: ‘There was some initial nervousness we were going to be changed into this new regulator.
‘From a registrant point of view though, what was coming down the line was very good and my experience with a lay majority on the board has been absolutely superb. People are there because they are interested to be there.
‘Protecting the public is central to everything that was done following the consultation. There was nothing to fear, this was all just good practise.
‘In addition, people have been doing CPD for a long time here. For some other professions [under Coru] that was the first time CPD became a statutory requirement. It is also quite wide-ranging in terms of how you can get your CPD.’
‘The changes will continue to be beneficial as things evolve.’
McGrath, who is a director of Specsavers Optical and Hearing Centres in the city, also tells Optician of the poor state of child eye screening in Ireland, which is currently referred onto hospitals. It was a theme that would reoccur in other interviews during the trip.
McGrath says: ‘It would be a huge benefit to the parents and the child to do this in a cost-effective way.
‘If a child needs to be referred into the system they can do that when there might be a backlog due to a refractive error, for example.
‘A lot of optometrists here have skills they want to utilise. We can do a lot more than we are able to at present.’
However, to absorb some of the pressure on hospital eye departments, Ireland’s high street optical practices will first require a stronger flow of newly qualified professionals. At present, with just a single course available in the Irish capital, most students study at UK universities and some never return to their home town.
And here lies another example of exposure to Brexit, as McGrath explains: ‘Brexit is very much a factor here in the Republic, both in terms of doing business and the free movement of people, including the ability of Irish students to study optometry in the UK.
‘The only optometry course at Dublin is restricted by the number of graduates they can take on. There is now a shortage of optometrists and dispensing opticians in the country.’
With an ageing population in Ireland, hospital primary care needs help and particularly in more remote regions.
‘Optometry is in a great position to step in, but must have the right number of optometrists and dispensing opticians in those areas,’ McGrath adds.
This will require the training of local professionals to deliver such services in both urban and rural communities.
The point is reiterated during an interview with Garvan Mulligan, chair of the FODO Ireland Executive Committee, who points out that just 25 optometry students can enrol at Dublin each year.
Following Brexit, they could face overseas student fees, while regulatory changes under Coru have also made conversion up to six months longer upon returning to Ireland.
If new courses are set up in Ireland following Brexit, a flood of EU students could potentially shun the UK to study within the EU instead. ‘But then we could be educating a lot of people who would go back home afterwards,’ adds Mulligan.
Mulligan pinpoints three priorities for FODO Ireland, which was officially set up in 2012 and now represents 56% of the profession.
Priorities include the government’s review of primary eye care services, addressing the shortage of optometrists in the country and a Healthy Eyes campaign slated for January.
Speaking about the primary care review, he says: ‘We have to bring that back to focusing on optometry.’
Mulligan feels optometry has been left at the sidelines of the review, which instead recommends new ‘primary health care units’, seemingly without considering practices on the high street. The units would take services including glaucoma and cataract care out of hospitals, but need an extra 63 optometrists to staff.
Instead, he wants the government to better utilise public-private partnerships, to end current regional variations in the delivery of eye care – no more evident than in Waterford, where Mulligan practises. He says children under 12 in the county face 18-month waiting lists for a regular eye exam.
Mulligan adds: ‘It should not depend on post code whether you get good optometric care or bad optometric care. You not only have to build the units, you must equip them and staff them.
‘We are trying to deliver the eye care because there is a big saving if you use us as optometrists. We go to college for four years to study the eye so we are suitably qualified to look at these things.
‘If you run the figures on this it makes perfect sense. There is an ageing population out there so we need to know what we are going to do going forward.’
Nevertheless, he remains hopeful the units will be scrapped in favour of high street eye care ‘when people do the figures’.
He goes on to support national frameworks for this.
He says: ‘We think anything that should be done should be done nationally, but each area may decide to set up that process and go down the route of public-private partnership instead.
‘When you get into local divisions I don’t think the patient is the focus in the end.’
Meanwhile, he also points out that a large proportion of Ireland’s workers are self-employed, and FODO Ireland has successfully lobbied for their inclusion for eye exams under employer contribution scheme PSI. From October 7, this also includes free spectacles and PSI goes onto a government portal on October 27.
‘That will also be a big game changer for optics in Ireland,’ he adds.
A tearful goodbye
Before bidding farewell to Dublin, Optician is invited to visit the headquarters of another Irish optical firm reliant on healthy trade both at home and abroad.
Optician Award-winning Scope Ophthalmics offers an interview slot with founders Tom and John Freyne, now commercial sales director and commercial director of the west Dublin based firm.
Scope Ophthalmics founders Tom and John Freyne
Having served the healthcare sector since 1952, Scope now employs 88 people across offices in Ireland and the UK. The brothers are expecting 42% revenue growth this year and products are in all the key multiples together with 1,750 direct and 500 indirect independents.
Scope’s products now include dry eye drops, the BlephEx blepharitis treatment, lid scrubs and Tearlab to diagnose and manage ocular surface disease.
The Freyne brothers, third generation of the founding family, are in agreement about Ireland’s obvious exposure to Brexit.
Tom says: ‘What we are seeing at the moment is uncertainty due to Brexit, and this is trickling through to customers. You always worry about different things but I don’t think it will change our ability to do business.’
John adds: ‘The uncertainty is the issue. There are an awful lot of people talking about it but until something happens then, while there is an issue, we have to be as adaptable to the situation as possible.’
And while Brexit is dominating the news agenda in Ireland, the country shares high street dynamics with its UK neighbours too.
John says: ‘Optometry in Ireland has similar challenges to the UK market. Multiples are targeting the urban centres and while the independents can offer better service they have to be more cost conscious.
‘One of the biggest priorities for us is to maintain a long-term relationship with all customers.’
Therefore, optometry in Ireland shares many challenges with the UK, and knows the building of bridges, rather than the closure of borders, is key to overcoming them.