Paul Ratcliffe did not expect to be nominated for the Optician Awards’ Covid Heroes Award, ‘let alone win it.’

‘I was very surprised and humbled to have won,’ he says. The optometrist thought the awards night was ‘mostly nerve-racking’ as his category was one of the last to be announced. ‘I tend not to make a habit of needing to go on a stage in front of a room full of people,’ he says, adding: ‘It was of course, very gratifying to find that my efforts had been recognised by such a large audience and across the industry in general.’ Judges commended Ratcliffe for being ‘totally selfless, going above and beyond and a credit to the profession’.

Challenging times

When Covid-19 led to the suspension of routine appointments, Ratcliffe said he was ‘determined to do something to help keep patients and colleagues safe and enable OutsideClinic to continue delivering clinical eye care.’ The domiciliary provider sees thousands of vulnerable, older patients every month, making the need to ensure their safety even more important. During his time on furlough, Ratcliffe came up with the idea to create a breath shield for use during an ophthalmoscopy with a PanOptic. A visor would not work as it prevented practitioners from getting an ophthalmoscope close to their eye – they needed a shield that could attach to the ophthalmoscope.

‘The intention was for the shield to be a bespoke design for the Welch Allyn Panoptic, which I have been using for nearly 18 years in domiciliary eye care, so I had a good understanding of how it feels to work with this instrument,’ he says. Ratcliffe does not have a design or engineering background and he originally trained as a dispensing optician. ‘I just tried to employ a logical thought process to the task at hand. Winging it, in a logical manner, you might say,’ he adds.

Home experiments

Due to the lockdown restrictions, Ratcliffe was unable to shop around for parts, so he experimented with things around the house. He began by cutting up two litre plastic milk bottles and then drilling holes into plastic clipboards. The design needed to be bigger and heavier, so he added clips, which attached to the handle for stability. Next, Ratcliffe made a paper mock-up of the design to the correct size, with hole and clip positions, so he could better visualise his intent. He ordered a sheet of A3 perspex and open and closed grommets online. He realised that adding bends down either side of the shield would help to deflect his breath away from the patient, add rigidity and remove the risk of a potentially sharp edge coming into contact with the patient’s nose.

‘With the help of my dad, a workbench and a heat gun, we put bends in the plastic, drilled the holes and fitted the grommets,’ he says, adding: ‘The grommets are the type that an electrician would use to safely pass wiring through a metal sheet inside a wall.’ The blanking grommet enables one hole to be closed off while the other hole is in use by the panoptic eyepiece, thereby preventing the user’s breath from passing through the shield.

‘To examine the other eye, you rotate the shield through 180 degrees, swap the blanking grommet to the other hole and use the open one on the Panoptic,’ he adds. Ratcliffe spent many hours refining the design over the following weeks to make it ‘more effective, more robust and more comfortable’.

Ta dah!

OutsideClinic’s leadership team was delighted with the result and asked Ratcliffe to help undertake the manufacture of the device for all of the company’s 100 clinicians. He contacted a plastics engineering company to make final adjustments and perfect the design, before painstakingly fitting 200 grommets to the 100 breath shields. ‘They weren’t difficult to fit, but it took a few hours,’ he says. The final version is ‘easy-to-use, lightweight, transportable, simple to clean, non-invasive and doesn’t hinder Panoptic use’. ‘Most importantly, it provides an additional layer of safety and reassurance to patients and optometrists. Many patients said they felt safer to book an appointment after being told about the device,’ he says.

More than 120 breath shields have been produced to-date, improving the safety of more than 100,000 often vulnerable and older patients. OutsideClinic and Ratcliffe also shared the device with other businesses in the sector – at zero cost – so that they too could keep their patients and staff safe. Ratcliffe says: ‘I’m happy to have been part of a solution to one of many problems in what has been a difficult time for a lot of people and I hope that the breath shield inspires other optometrists to develop innovative solutions to future challenges.’ While he has no design projects currently on the go, Ratcliffe says that he has ideas ‘rolling around’ his mind, which may be acted upon in the future.

Watch this space.