Earlier this year Professor John Flanagan was appointed Dean of Optometry at University of California at Berkeley, which is ranked highly among the best academic institutions in the world. Professor Flanagan is British and launched his stellar career graduating in Optometry and Vision Sciences at Aston University, Birmingham in 1980.
Nick Rumney: You are the new Dean of Berkeley, arguably the top school of optometry in the world. How have the first few months gone?
Professor John Flanagan: A steep learning curve, it’s a wonderful place both geographically and culturally and optometry here is steeped in history. There is a great team of researchers, clinicians, staff and students. We have a relatively small class size with 65 professional graduate students in each of the four years and 38 PhD graduate students in one of the largest Vision Science research programmes of its kind. We also have one of the longest standing K12 NIH (National Institutes of Health) clinician scientist programmes anywhere in the country.
It’s a time of renewal, many of the famous names here are either retired or retiring – Tony Adams, Ian Bailey, Cliff Schor, Ken Polse, Ralph Freeman – so we are actively recruiting. It is exciting and positive.
NR: I was once advised that US optometry and medical schools rely on other science disciplines for research and teaching because the pool of those with an OD and PhD is so small, is that still the case?
JF: To a certain extent yes, someone with an optometry degree and a PhD [often referred to as an OD PhD] is always in demand in the US and we are in a cycle where many of the strongest research schools are recruiting. There is also an increased demand due to the number of new programmes, although research is not uniformly considered a priority. Interestingly, many OD PhDs find a home within ophthalmology.
NR: So what would you say to the UK optometrist aspiring to a career in research or teaching? Does UK research prepare you well for the future or is the US model better structured?
JF: The US (North American) model is structured differently with many taught components in the PhD programme. While I’d hesitate to say it’s better or worse, I’d encourage any aspiring optometric researcher at undergraduate level in the UK to open their mind to the possibility of research training in the US. It’s already acknowledged as a wonderful place to undertake post-doctoral research so don’t underestimate the possibilities at the postgraduate level. There are frequent scholarships and funding available and overseas student fees are rarely an obstacle because of this. I’d encourage any optometrist with an interest in specific or even general areas of research to email the Associate Deans of Research at any of the US schools with active research programs.
NR: Some have said the best clinical optometry in the UK matches the best in the US, Australia, Canada and we do appear to punch above our weight in peer reviewed research and publication etc. Overwhelmingly though, the UK is seen as behind the curve in professional scope of practice. What do you see as the barriers to the development of the profession in the UK?
JF: I’m always surprised at this as the potential has always been there. There are many fewer ophthalmologists in the UK, and most are surgeons or sub-specialists. There is, and has been for many years, a need for access to primary, medical eye care. There is a great opportunity for optometry to press its case and fill the void. Obviously remuneration has been an issue both in academic funding and in primary care but once in a position of influence, for example in the HES, optometry has punched above its weight. It would seem to be just in pockets in England but Scotland and Wales are beacons of development. I’m sure there are many factors, and I’m too remote to be an expert, but the lack of recognition within the NHS and overt commercial interests must figure high.
The pre-reg year, whereby the bulk of clinical training is outside the responsibility of the academic institutions, is unique to the UK. When combined with the funding models for the three-year programme, it would seem challenging to advance scope and clinical training.
Having said that, it’s not all plain sailing elsewhere. There is a concern in many jurisdictions at the growth in the number of schools and the quality of the evidence of any significant undersupply. In the UK you have at least one new department, there have been several in Australia and many in the US. Certainly there are concerns that the pool of potential candidates has failed to keep pace.
NR: What about the changing demographics of the population? Surely that could benefit optometry?
JF: I’d put it the other way round. Optometry is a uniquely accessible profession in eye care and clearly we will have a significant role to play in non-surgical primary care in the future. Long-term chronic conditions such as glaucoma, diabetic eye disaese and macular degeneration cannot be managed without our future participation. Although surgery is not on the cards for UK optometry, it certainly is here in the US, in particular for minor lid lumps and bumps, and the increasing use of lasers. However, the latest dialogue here is with regard to optometry’s role in full scope primary care, that is the management of chronic systemic disease and our contribution to public health issues such as vaccination and immunisation. Again it can be argued that optometry is uniquely well placed.
[CaptionComponent="902"]NR: What would you say is your greatest achievement?
JF: Without doubt starting the Optometric Glaucoma Society with Tom Lewis, Murray Fingeret and Mike Patella. Established 14 years ago as an academic home for researchers and clinicians interested in glaucoma we now have a membership of 110 and attracted 140 to the meeting here in Denver. It is a meeting restricted to members and guests but it’s a place that attracts top speakers and passes on immediate research and clinical insights to those most interested. Educate the educators, both in design and in fact.
Additionally, it always wraps into the first day of the American Academy Educational meeting, bringing key speakers to a wider audience (over 6,000 optometrists and student optometrists attended AAO Denver 2014). Its an excellent and somewhat unique partnership.
NR: As a member and a regular attendee I have been fascinated to hear the great speakers in glaucoma research; Claude Burgoyne, Don Hood, Harold Quigley, Ron Hawerth, even more so to hear great UK researchers not often seen by UK optometrists; Sir Peng Tee Khaw, Keith Martin and Ted Garway-Heath.
JF: Yes, its multidisciplinary and there is little or no point scoring here, it’s largely apolitical.
NR: I am sure that you are aware of the impending court case on optometric scope of practice in glaucoma in Australia, is this sort of conflict a good thing for patients and the public?
JF: To be honest I don’t know the details. I gather that the legal debate is more technical than clinical, about whether one profession can or should decide on the scope of practice of another. Here optometry has developed because it has strong political leadership and tends to make the case for its own scope of practice, state by state.
NR: Despite five years of independent prescribing in the UK we only have 275 independent prescribers registered and no sign of any generation of new optometrists emerging from university already qualified in the future. How important do you think it is for optometrists to be trained to prescribe as they enter professional practice?
JF: I’ve already mentioned the situation where clinical training takes place outside the academic institutions, which is unusual even within the UK, for a clinical discipline. It will certainly be interesting to watch the development of professional licensure with prescribing being a post-graduate qualification. Should it remain so there will clearly be a split profession.
I very much see the optometrist as an essential link in a primary health care chain. IP is about accessibility of treatment and patient centric care.
NR: What have been the key influences in getting to where you are?
JF: I had a terrific high school education initially in Swaziland and latterly in Yorkshire. My key academic influences include Neville Drasdo, Bernard Gilmartin, Jake Sivak, Graham Trope and David McCleod, but I will never forget my pre-reg year in Croydon with Chris and Jonathan Kerr. Tuesday evening grand rounds, with real patients, at Mayday hospital was a seminal influence, along with teaching clinics at the old London Refraction Hospital. Terrific.
NR: Returning to our first question. You are a UK trained optometrist at BSc and PhD level. Do you pinch yourself to think you are Dean of one of the top schools of optometry in the world?
JF: Of course, although there have been other international Deans in the US, people like Tony Adams (Australia) and Dennis Levi (South Africa) here in Berkeley, I’m told I am the first British Dean so it is nice to think a bit of over there is doing well over here! It is a true honour not only to be the Dean of Optometry, but also to serve on the Council of Deans for such a remarkable institution.
I have remained a proud member of the College of Optometrists throughout my career despite being part of a worldwide diaspora of British optometrists. There was much regret having to resign my GOC registration when the indemnity requirements were introduced in 2005 as I believe the ‘Brits abroad’ have a great deal to offer the UK’s optometric community. I remember once hearing post-war Brits described as the Greeks of the modern world; you certainly don’t have to dig deep anywhere in the world to find Brits embedded in research and clinical teaching.
For more information on the Optometric Glaucoma Society visit www.optometricglaucomasociety.org
Nick Rumney is chairman of BBR Optometry and also chairs the International Admissions Committee of the AAO