For all eye care professionals, the advancement of practice technology has dramatically changed their approach to daily workplace tasks.
The work carried out by optometrists is subject to seemingly ever increasing technological development and augmentation. So which changes have been most significant in terms of revolutionising the optometrist role?
‘Over the course of my career, although many will say various types of retina imaging, I’d have to say that database networks are the big underlying change,’ says Nick Rumney, an independent IP optometrist practising in Hereford. ‘We always had imaging – slit lamp and fundus – but no means of indexing them. Digital databases have led to CNC controlled manufacture; ophthalmic freeform lenses and contact lenses, indexing of patient records, communication with colleagues, you name it.’
Rumney is positive that these changes have been beneficial to patients, albeit with a caveat.
‘Undoubtedly technology has improved the lot of patients, as long as the advances are embraced to mutual benefit and not used as some sort of cheaper marketing toy. Offering imaging, or free imaging, to all is no benefit to anyone unless you investigate and examine properly. Use it to actually change your practice to a medical model not just pretend.’
In the past 10 years, Rumney highlights the emergence of OCT as the most significant development.
‘The immediate accessibility to technology. With a good business plan it’s all affordable and you can use it, benefit your patients, improve your clinical capability, take on more responsibility and improve your bottom line. Of this, OCT has been the transformational element that has allowed the independent to thrive and take on the myth of the all-encompassing multiple chain. It made it instantly easier to differentiate. If you charge £5 more, but do little more than a multiple, there is no difference. If you charge double and do much more it’s easy to differentiate.’
Kirit Patel, optometrist in an independent practice in Hertfordshire, also feels patients have benefitted.
‘I would say that we optometrists have put our hands in our pockets and invested in equipment for the benefit of the patient. As such, we could be very useful and save the NHS a substantial amount as there are a huge number of enthusiastic and capable optometrists happy to serve and deliver.
‘Technology has allowed the optometrist precision within a consulting room from accurate refraction using phoropters, digitally logging patient history, recording and storing anterior and posterior images, allowing to monitor changes over time. OCT scanners are now the norm within a consulting room. Coloured lens prescribing for visual stress, eye tacking for dyslexia, Hess screen for nerve palsy and electro-diagnosis are now part and parcel of modern optometric practice. So an optometrist is akin to a pilot who is in charge of various equipment to enhance patient’s vision and when necessary refer the patient to either their general practitioner, ophthalmologist or neurologist for further medical tests or treatment.’
Patel’s practice, Radlett Opticians, was decorated as Technology Practice of the Year at the 2017 Optician Awards. He feels consistently investing in technology over the years has more than paid off.
‘Patients regularly comment on how advanced the equipment is and ask to see what is new since their last test,’ says Patel. ‘Our practice referral letters have images and scans attached even for simple cataract cases so that there are no ambiguities when the patient is seen by the specialist. We document every eye pathology and since we upgraded our OCT to angio-OCT we have a better understanding of retinal pathology and, more importantly, we are able to relay and explain things to patients. Glaucoma patients have full work up with pachymetry, gonioscopy, visual fields, retinal nerve fibre analysis as well as retinal ganglion cell distress monitoring with Diopsys electro-retinogram. Recently we have been involved in treating dry eyes patients with intense pulse light E-Eye system successfully.’
Looking ahead to the future, Rumney feels that big changes are coming.
He adds: ‘The technology behind myopia control will bring refractive modification to the optometrist consulting room. When sight testing is deregulated – not refraction as that can already be done by anyone delegated – and prescribing spectacles jumps past even DOs, new technology will enable optometrists and dispensing opticians to step up to a full non-surgical ophthalmic role. Every technological advance is both threat and opportunity. Embrace it.’
Role of the DO
Fiona Anderson, president of ABDO, reflects on the changes technology has brought to the dispensing optician role and where it may go in the future.
She finds that technology allows her to keep an effective presence in her Aberdeen independent practice in addition to presidential responsibilities.
‘I actually had a day out of the practice yesterday but the diary management component of our practice management system (PMS) means I can still be in touch anyway,’ says Anderson. ‘If someone wants to see me, they can call me, I can access the diary and book them in remotely.’
Asked to identify the technological change affecting the dispensing optician most in recent years, Anderson is in no doubt.
‘It has to be the developments in lens research and technology,’ she says. ‘I think that has been the biggest change and one that has affected all practices to one degree or another. With the rise of freeform, you can more or less make anything now within reason. In the past you were stuck with what was produced, now you can manipulate things. For the patients that means that things that were out of range previously can be solved by bespoke solutions. The dispensing optician role has changed due to this ability, there is a need to deal with these possibilities.’
Anderson explains how ABDO has rejigged its training process for dispensing opticians, in order to better prepare them for work in this area.
‘We are currently working with a new syllabus and, as part of the final qualifying exam, candidates will actually be required to dispense a fully bespoke tailor made lens. This ensures that the student is ready to engage with the latest technology that they will use in practice. The student will also be expected to discuss with the examiner what that lens is, the additional measurements they need to take for that specific lens and talk about fit and advice to the patient. So that has already been incorporated into the final qualifying exam, which will be put to students for the first time in the summer of 2018 as it takes that three years to cascade through.’
OCT has completely accurate anterior assessment
Working closely with a lens laboratory is an area that Anderson feels the modern dispensing optician needs to embrace.
‘In order to deliver the latest lens technologies, you need a strong relationship with your lab. You need to be talking to a lab technician. It’s no good just having someone at that end who is just pressing the buttons, what they do affects the overall performance of the lens. You can make something cosmetically better but can affect the optics. So you need to know how far to push things, you want things to look good but at the end of the day it is an optical appliance and has to perform its function.’
Again this is an area that ABDO is prioritising through tweaks to the qualification pathway, in this case by adding another case record in the qualifying exam. To fulfil this candidates have to visit a manufacturing facility and write the visit up as an essay case record detailing the processes observed.
‘A lot of the students wouldn’t be exposed to anything like that otherwise, so I think that’s a really good idea, particularly if they can go somewhere with freeform surfacing. Seeing with their own eyes how quick it is and clean it is, is quite something. We’ve worked with the FMO to provide different partners across the various fields of optical manufacturing,’ she adds.
Digital measuring devices are another technology that dispensing opticians have had to get to grips with in recent years.
‘With these it is important that proper training is given. If the device’s slightly tilted or something is not done correctly you will get an error in the measurements that will manifest itself when the lens is made up. In that case the patient won’t get the best possible prescription and the best possible use out of their specs. It should be remembered as well that a device is often designed specifically for use with the manufacturers’ lens range. No doubt with these lenses, if you do take the measurements accurately they do perform much better.’
‘Overall the job is more complex and challenging now but, also, is very rewarding because there is nothing better than a patient putting on their specs and saying “wow”. The latest technologies allow us to achieve this for a wider range of patients than ever.’
The future
Looking ahead Anderson is confident that the dispensing optician role can continue to be enhanced rather than diminished by future technological advances.
‘There are apps on phones that can give fairly accurate refraction results, and frames can be ordered online but I don’t think optical professionals will ever be replaced by a machine. People come to practices because they want that face to face expert interaction with a professional. As more and more technology comes in, I would like to see dispensing opticians as the natural custodians of it, perhaps in areas like pre-screening and the refraction side of things. As more and more of these automated systems come into place I could see a good case for the dispensing optician to be the person in charge of them, almost like triage.’
