Autumn is here and it’s a time of change as all of nature prepares for the coming winter months. Change is part of our life-cycle, but in practice I find it is often something we resist and question. Why change something when we are all just fine performing tasks as we are now? If something new is introduced that may add to the time needed for a patient, rather than embrace it, there can initially be resistance.
One recent change for us is our OCT. It’s a great piece of equipment, but we have to ensure it is used in the correct way, to enhance the eye examination as opposed to over-reacting to a divergence from normal, flagged up in a patient with no real symptoms. All our optometrists have had detailed training on the analysis of OCT results and have access to the Specsavers Professional Network on Yammer where they can seek support for any unusual findings or questions.
The big change began with our support colleagues who need to offer it to any eligible patients upon booking their appointments. People generally don’t have a deep understanding of what we can find in an eye examination, despite the efforts made by our professional bodies and others to highlight its importance. They are unlikely to agree to an additional test (at a cost) without a good reason being explained to them. We therefore needed our colleagues to explain the test simply and concisely so patients could understand the benefits and decide whether or not to take up the offer of an OCT as part of their eye examination. This involved a lot of training and sharing examples of what can be seen with an OCT and the advantages of having the scan done.
Now that we have had OCT for a couple of months our support colleagues are starting to see patients benefit from it. Initially they just had to take our word for it and introduce something new into their routine which they were not feeling entirely confident about.
From our optometrists there was a slight fear of there being a finding they could not explain. Would it increase referrals? We were adamant that we did not want to put any extra pressure on an over-stretched ophthalmology department. They were also concerned about timing of their eye examinations and how would they incorporate it into their routine.
For our pre-registration optometrist it has added to their steep learning curve. Even though it isn’t a competency on the College scheme for registration, by doing the training and looking at scans they are developing a much deeper understanding of the anatomy of the eye and different eye conditions, which can only help develop them into the best optometrist they can be. As I tell trainees, this is what the pre-registration year is all about, rather than a checklist of competencies.
Having embraced the change, we are all seeing examples of the benefits of OCT and are even getting patients requesting it because friends and family have had a scan and been impressed by what it shows.
We also find that it enables us to fine tune our referrals into secondary care, providing more information about a patient’s eye health to ensure the correct urgency. It really is like a final piece in the jigsaw for those patients with unexplained symptoms who you would be referring anyway, enabling us to confirm and demonstrate our suspected diagnosis of what is happening, as well as for additional information to help monitor and screen for conditions.
A classic example recently was a patient with known dry macular degeneration. She attended with no real symptoms and seemingly no change in refraction. However, having opted to have an OCT, it revealed a very small area of subretinal fluid centrally, which would not have been detected by traditional examination. Yes, she knew to monitor with an Amsler and yes, she would have probably developed symptoms which she would have recognised, but she was very grateful that the OCT scan enabled her condition to be detected one stage earlier in the disease process.
Embracing change is sometimes hard, and at times unnecessary, but when it is to benefit our patients’ eye health and develop us all to become better optometrists, it is never a bad thing.
Judy Lea is optometrist director of Specsavers, Longton, Staffordshire.