Community-based optometry could be set for a shake-up when the government’s 10-Year Health Plan comes to fruition. If utilised and funded properly, the potential of optical practices on the high street could finally be realised. Beyond that, however, is a glimpse of another level of services that could help practices set themselves apart and revolutionise patient care.
In recent years, ophthalmic service providers have expanded greatly by opening clinics and offering treatments available on the NHS. These services have always been provided through secondary care, but a future where primary care optical practices deliver selective laser trabeculoplasty (SLT) and yttrium aluminium garnet (YAG) laser treatments is not beyond the realms of possibility.
In December 2021, a group of optometrists in the UK took part in a course where they were trained on new and advanced therapeutic techniques. Led by Dr Michael Johnson and Dr Deacon Harle, it was the first ever UK-based course and resulted in 25 optometrists being certified to deliver these treatments. It was said to broaden the imagination of what was believed to be achievable in an optometrist’s scope of practice.
Gerard Fernandes, optometrist and director at Lynne Fernandes Optometrists in Bristol, completed the course and says: ‘It was without doubt one of the most valuable and high-quality educational experiences I’ve undertaken.’
He does not personally deliver YAG or SLT at present but, in his role as a glaucoma specialist optometrist at Bristol Eye Hospital, he lists patients for these procedures. ‘These skills are absolutely within the scope of optometric practice, provided there is a standardised set of qualifications and ongoing hands-on experience to maintain competence and confidence,’ Fernandes explains.
Edward Farrant, optometrist and director at Earlam and Christopher in Somerset, has worked part-time in hospital eye services since 2007 and sees SLT and YAG patients once every two to four weeks.
‘All optometrists are capable and used to running their own patient list, capable of discussing eye health conditions to patients and answering questions. They are very familiar with the examination techniques used to identify patients that would benefit from laser therapy,’ he says.
Embracing the future
For optometrists performing laser treatment to become a more common reality, Fernandes says there would ideally be a nationally recognised qualification and, as with any technical skill, experience is essential.
‘For these procedures to be offered without ophthalmologist oversight, optometry as a profession would need to embrace robust audit processes ¬ both internal and external ¬ and ensure practitioners are confident in managing the rare but significant complications that can arise,’ he adds.
Farrant says for YAG, optometrists already routinely identify the capsule and posterior capsular opacification. For SLT, he adds that once an optometrist has a diploma in glaucoma, they will have the necessary gonioscopy skills.
‘They would also be familiar with the various lenses used in laser surgery. Therefore, any extra training needs to cover discussing and obtaining consent, the practical use of the laser and the ability to manage complications. IP qualification allows for the necessary prescribing of anti-inflammatory agents when required,’ he adds.
Closer to home
Fernandes believes any optical practice introducing these services in the future would need to ensure sufficient patient volume to maintain the necessary level of skill and consistency. ‘From our own explorations, the groundwork involves regulatory preparation, a comprehensive standard operating procedure, internal audits and readiness for external audit.
‘There is also the business consideration. In some cases, employing an ophthalmologist may appear cost-effective. However, in my opinion, optometry could offer significant other benefits. To achieve this, our leaders need to be clear on the unique value we can bring to such services,’ he adds.
Farrant says an optical practice would require registration with the Care Quality Commission, NHS funding and training on laser safety.
‘A clinical insurance policy would likely be needed to manage complications arising from laser surgery. Under the hospital, it is part of my employed role and is covered by the hospital policy too,’ he shares.
Some of the optometrists Fernandes employs provide YAG in a treatment centre and he says he recognises the potential clinical benefits and patient convenience of offering the service.
‘The main benefit is speed. Faster access to treatment can improve a patient’s quality of life sooner, delivered closer to home and in a familiar environment with professionals they trust,’ Fernandes adds.