I was honoured at the end of July to be invited by Professor Jia Qu, Dean of School of Ophthalmology and Optometry & Eye Hospital, Wenzhou Medical University, to speak at Vision China 2017 International Forum on the Innovation and Development of Vision Health.
The venue, Hangzhou International Expo Centre, will have been seen previously by most readers as the venue for last year’s G20 Summit. Despite its marble lined floors and walls and palatial surroundings we were proudly informed that it took only a year to build. And if, like me, until a few months ago you had never heard of Hangzhou it is a small city by Chinese standards of a mere 9.2 million people (that is about the size of London, Birmingham, Edinburgh, Cardiff and Belfast combined) about 200km south of Shanghai.
Before I left the UK it had been in the news how China’s infrastructure building work was coming to an end and they would be turning their building companies to a new Silk Road and building infrastructure in Africa. I have to say it did not seem that way with small forests of tower blocks still in construction. China is clearly poised for further growth, especially in car ownership as the roads, outside of downtown areas were generally very quiet.
The 3,000 or so delegates could take their pick of continuing professional development in seven different tracks over four days with at least one or two sessions at any one time subject to simultaneous translation to appeal to both Chinese and English speakers. The cost, including lunches, RMB1,000 – around £125 – for the four days plus around £100 per night in the swanky conference hotel.
As can be seen from the scan of my conference handbook Vision China 2017 brought together eight different conferences and exhibitions under one umbrella – something perhaps the UK could consider in the future to free up our congested optical calendar?
The conference programme
So there really was something for every kind of eye care practitioner from orthoptics workshops to live cataract surgery by video link. As well as continuing education on new clinical techniques and international research trends delegates attended case analysis presentations, round table discussions, panel debates and enjoyed talent cultivation and knowledge contests.
The large exhibition had some familiar brands: Essilor, Zeiss, and Nidek were showing instruments; and contact lenses represented by Menicon, Alcon, Johnson & Johnson and Bausch & Lomb; but largely the 90 odd exhibitors were Chinese, with a few from Japan and Korea. The busiest stand, by a mile, was the bookshop, which had queues for much of the four days, no doubt as a result of the rather large plug it received during the opening celebrations.
The official opening ceremony was in stark contrast to anything you might see in the UK where organisers are lucky to assemble a reluctant audience for more than a few minutes at the commencement of proceedings.
At Vision China it was an intriguing four hours long but moved on at a rapid pace with short presentations from global experts in vision care as well as the great and the good from the Chinese ophthalmology and optometry scene giving the Professor Tianrong Miao Memorial Lectures.
The largest single section, of around half an hour, was reserved for the launch of the 3rd Edition of the National Optometry Textbooks. I found myself feeling a little jealous as a dozen or so books were launched ranging from amblyopia and paediatric eye care through to the diagnosis and treatment of ocular disease. As the authors and editors were presented with awards on stage it struck me how useful it is for everyone to work to an identical up to date syllabus.
There was also a clear implication that existing practitioners would be expected to upskill themselves to the new syllabus and therefore purchase and read the books. Hence there was a queue of hundreds at the book stand immediately following proceedings, buoyed by the promise of a signed copy if they got there quick.
The memorial lectures were an eclectic mix of eye care topics, whetting the appetite for longer sessions throughout the conference. I was struck by the similarity of debate between China and similar conferences in the UK and Europe. It seems we all face the same problems and have the same arguments and debates as to the best way forward to solve these problems.
Like the UK, Chinese patients referred urgently with suspected glaucoma are quite likely to go blind waiting, typically for a month, before being seen. And this is in densely populated urban areas where services are at their best.
As healthcare providers debate how to cope with the ever increasing burden then attention turns to ways of reducing demand. Currently in China people have their refractions as part of an eye health examination in hospital and then take a copy of their prescription to a glasses shop in the community.
The first suggestion was to set recall times to limit the number of eye health examinations a patient could have through their state health insurance as follows based on the prevalence sight threatening eye disease:
Sight test intervals
- Age <40 – every five to 10 years
- Age 40-54 – every two to four years
- Age 55-64 – every one to three years
- Age >65 – every one to two years
- Type 1 diabetic – five years
- Type 2 diabetic – one year
- Pregnant women – first trimester
- Glaucoma Px – one to two years
Although for younger patients these recall periods are somewhat longer than are recommended in the UK they are broadly in line with actual time intervals people leave between seeing an optometrist.
Another means of reducing the burden on eye hospitals, familiar to us in the UK, was the notion of more work being devolved into the community. In China this will likely take the form of private ‘Doctors Groups’ and a robust debate and panel discussion was conducted over the period of a couple of hours. With doctors (including optometrists) currently working for the state within a hospital environment the notion of private practice is clearly appealing to those with an entrepreneurial bent.
One speaker from Taiwan told of senior partners earning the equivalent of £3million within a few years of setting up their own practice employing doctors and optometrists. Professor Jia Qu on the other hand could see that this could cause a drain of talent from the state sector and questioned the fairness of the state paying for the education and training of doctors only for them to then go off in competition with the state sector. A familiar argument we have seen in the UK.
Another area of potential change is for optometrists to become involved in optical shops providing refraction services where they are needed. The ABDO team had been invited by the Eye Hospital of Wenzhou Medical University to explore the balance between the professional and the commercial in a four-hour session entitled ‘Continuing medical education: professional and business operation of an optometry centre’.
The ABDO team with other delegates
After being welcomed by Professor Bao Jinhua, Elaine Grisdale, ABDO’s head of professional services and international development introduced our session in Mandarin to be sure of the loudest applause of the day.
Julian Wiles of Performance Lenses borrowed liberally from Sun Tzu’s Art of War and his own book Thinking Allowed – a simple how to guide to running a successful optical business in his talk entitled ‘the secrets of owning and running a successful modern optical business’.
Fellow ABDO examiner, and lecturer in dispensing at the University of Manchester, Andrew Stokes gave two presentations on prescription analysis reminding delegates of the essence of professional ophthalmic dispensing and that selling tailor-made free-form lenses without taking the bespoke measurements is in nobody’s best interests.
My first session was entitled ‘Professionalism in a commercial world’ and explored the various modes of practice and regulation worldwide before exploring in detail the standards of practice the GOC imposes upon registrants in the UK and warning that where eye care practitioners behave unethically or rip off their customers governments can be relied upon to regulate.
I then talked about ‘Selling professionally in a professional environment’ demonstrating that professionalism and commercial success are not incompatible. As my audience was made up of ophthalmologists who have specialised in optometry I took the view that selling should be like a consultation with a doctor – ask lots of questions, listen to the patient’s answers, make a diagnosis, offer a solution to the problem – which appeared to resonate with the audience after the few seconds lag of simultaneous translation. The key was to offer informed choice and never to pre-judge your customer.
Elaine Grisdale closed off the session with a glimpse into a possible future in ‘Preparing for tomorrow, how dispensing will change’. The concept of change is not lost on an audience of Chinese professionals. China already has the widest acceptance of mobile phone payment, and Alibaba, the world’s largest retailer, only two weeks earlier had opened China’s first staff-less shop Taocafe in Hangzhou which uses a combination of facial recognition, biological sensors and radio frequency tagging to charge your digital payment system as you leave the store via specially designed gates. The aim is to have 100,000 staff-less stores within three years.
We visited a virtual hospital while we were in China, an online platform that connects patients with real healthcare practitioners who can advise and prescribe remotely or urge the patient to seek a face to face appointment. A live counter proudly showed over 450million patient episodes year to date, and clocked them up at a rate of about 1,500 per minute.
Quite the most inspiring experience of my short stay in China was interviewing candidates for their Rising Stars programme which offers 16 people per year the chance of international educational experience including spending time at the University of California at Berkeley, the State University of New York, and ABDO College in Kent. Whether it is ensuring the people of rural Tibet do not have to travel thousands of miles to replace their spectacles, eliminating preventable blindness, or researching how to halt progressive myopia I have no doubt these leaders of the future will do their country proud and will be speaking themselves at a Vision China conference in the years to come.
Peter Black is a director of Orbita Black, a GOC accredited CET provider and management consultancy, and an ABDO practical examiner and past president.