While there was mild easing of the lockdown through May it soon became clear to me that Mrs Moneo was becoming increasing irritated by the state of my hair. We encountered a ‘negative lockdown locks scenario’ which needed rectifying. Luckily, prior to the whole pandemic issue starting, Mrs Moneo had had the foresight to order basic necessities, one of which was a pet home grooming kit. I know she secretly always intended to use it on me rather than the dog and this is exactly what happened. The outcome was one of the best haircuts I have ever had. I can’t fathom out why I have, over the years, spent so much money getting my haircut given there was a perfectly good solution waiting to be discovered. I doubt whether I will ever visit a barber’s again.
My mind wandered back to optometry. Having discovered there are just as good ways of getting my hair cut, are others out there discovering just as good ways of doing a multitude of other things, one of which could be accessing eye care services and spectacles? I have no doubt that is the case. Does this present us with threats or opportunities? I believe that out of adversity we should try and make good flourish and this is one time when we have this opportunity. It is clear that the so-called new normal presents us with challenges but it also presents us with opportunities. Covid-19 Urgent Eyecare Service (Cues) has shown across the land that optometry and dispensing optics is more than capable of handling much of what used to be done in hospital eye clinics. Cues is supported by the Royal College of Ophthalmologists and our own College and has seen many CCGs across the country adopt the scheme when some may have been highly reticent to even consider Minor Eye Conditions Service (Mecs). We have seen a new dawn in terms of the services available at primary care outlets. We all knew prior to the pandemic that GOS was out of date and not fit for purpose. With the announcement of yet another fee freeze it is clear, after yet another abject failure, the Optometric Fees Negotiating Committee will never achieve a decent settlement with the NHS to make fees viable for NHS sight testing so now we should look to a new dawn.
As we move forward, we need to bear in mind that social distancing measures will play a part in all we do for some time to come. Therefore, it is time to design a new pathway though eye examination. I would like to paint a picture of the new world.
The major change in the new world will be the optometrist becoming the consultant at the end of the testing routine as opposed to doing most of the tests. All patients will be telephone triaged initially to allow more strategic use of the appointment book, something that is already being widely adopted by many. Symptoms history, general health, medication, etc, can be taken over the phone by means of a simple call or even Skype calls or Facetime. Patients could be called back prior to them attending the practice if the optometrist wishes early intervention. Skype, Zoom or such other interfaces could allow visual recognition for some problems. Acuity tests could be done at this stage. At the practice, the staff would carry out tests such as vision checks, visual fields, OCT, ultrawidefield and autofluorescent retinal imaging, autorefraction and subjective refraction. There is no legal bar to anyone carrying out a refraction and therefore this could be done by a DO, orthoptist, even a suitably trained staff member in many cases. All the results would be sent electronically to the optometrist’s consulting room where they would assess the patient remotely prior to seeing them. Results would be discussed with the patient being able to show them all the results on a screen from an appropriate distance. Having discussed the results, provided they were happy with the refraction results, they could sign off the necessary prescription, carry out any further checks such as slit lamp examination, tonometry, etc before releasing the patient back to the dispensing team. This is all made possible by use of modern imaging systems, networking of equipment and use of electronic patient records. Connectivity with the local ophthalmologists is also readily available via these systems.
There will be those that say this could never work, but of course the person that matters most here is the patient. I believe the enhanced care available by this system would have patients demanding it before too long. The acid test is does it, or will it, work? The answer is definitely yes. Pathways like this have been used by colleagues of mine in the USA for many years. The outcomes have always been increased patient care, and increased patient satisfaction, greatly increased optometrist job satisfaction.
We can create a new dawn, do we have the desire? Do we have those visionary leaders who can make it happen? This is the next generation of optometry. Let’s get the next generation of optometrists to design it and make it happen.