In our day-to-day practice, we never know what eye disease is going to walk through the door. Whether you work in a small rural town or the hustle and bustle of the city, it is essential as an eye care practitioner to have a plan of action to be able to appropriately manage any eye emergencies that may arise. Without a triaging process in place for emergency cases, issues can arise in moments where time is of the essence.
Triaging can begin at the time of appointment booking and can start from before the patient even steps foot into the practice. Training staff who book appointments to ask relevant questions and identify red flags can help determine the urgency with which the patient is to be seen. Examples of red flags include moderate/severe eye pain, photophobia, redness of the eye, reduced vision and foreign body or penetrating eye traumas as well as flashes or floaters.
Once our patient is finally in the chair, where do we start?
Case History
A thorough history and symptoms-taking can go a long way, providing us with a working diagnosis as well as guiding our clinical investigation. In many cases, the aetiology can be determined based on symptoms and presentations as well as the patients’ experience. We can uncover risk factors, if current treatments are working, relevant medical histories, medications, and pre-existing conditions, all of which can also guide possible treatments to help patients. Important questions to ask include:
Is it unilateral or bilateral?Any discomfort or pain? Is it getting better or worse? Is the pain constant, intermittent, worse with eye movements? Where is the pain located?Any photophobia?Any loss of vision? Sudden or gradual loss? Total or partial loss? What was the pre-incident vision like? E.g. strabismus or amblyopiaAny discharge? Is it clear/mucus-like/sticky/yellow?Any redness or itchiness?Any recent trauma?Any surgeries? Previous refractive surgery? Was it done overseas (missed follow-ups)?Any systemic illness? Allergies? Medications?Are they a contact lens wearer? Are they compliant or overwearing their lenses? Are they currently using eye drops? How often? When did they last use them? How old is the bottle? Are they preserved?Has this happened before?Any flashes or floaters?Any diplopia?Any headaches? Where are they located? How often? Any history of migraines/visual auras?
The next step is to perform a detailed clinical examination.
Visual Acuity
It is of extreme importance to perform visual acuity testing in emergency eye cases, both as a visual measurement and for legal purposes. We must always keep in mind that a visual acuity of 6/6 does not necessarily mean nothing serious is occurring. Both eyes should be measured individually using occlusion, whilst being careful not to apply too much pressure to the covered eye. Improvement with pinhole indicates residual refractive error and a best corrected visual acuity should always be obtained in these situations.
Gross Observations
Do not forget to look at the patient as a whole! Check if there is anything immediately obvious, for example, if the eyes are at the same level or lacerations/bruises.
Cover Test and Motilities
Performing cover tests at both distance and near is important to assess for nerve palsies. Ocular motility testing is essential to ensure all extraocular muscles are working correctly. It is important to perform in cases of trauma (e.g. blow-out fractures) as well as for nerve palsies, in patients with diabetes, if any complaints of diplopia or systemic conditions such as thyroid eye disease. The Hirschberg test is simple and easy to perform and we can ask the patient to report any pain with eye movement or diplopia.
Slit Lamp Biomicroscopy
One of the most crucial parts of the red eye assessment. A systematic approach is best from anterior to posterior, looking at the:
Pupil Testing
Pupil testing is a crucial assessment of both the afferent and efferent visual pathways. We test for direct pupil responses as well as consensual, with the swinging torch test used to determine if a Relative Afferent Pupillary Defect is present. We must also measure the difference between pupil sizes in light and dark illumination as this can be used to diagnose certain conditions such as Horner’s Syndrome.
Intraocular pressure
Intraocular pressure is necessary to measure, with a normal range of 10-21mmHg and a difference greater than 2mm serving as a prompt for further investigation. High intraocular pressures can be indicative of acute angle closure, ocular hypertension, primary and secondary glaucomas (e.g. neovascular glaucoma) as well as certain types of uveitis (e.g. Posner Schlossman). A lower eye pressure in the affected eye could also be a sign of uveitis.
Gonioscopy
Gonioscopy is important to assess the anterior chamber angle and rule out angle closure. Check out our blog on gonioscopy here for further information: https://www.yoptoms.com/Blog/10498873
Ophthalmoscopy
We must always look at the posterior eye, dilating when indicated to rule out certain sight-threatening conditions such as retinal detachment or intraocular foreign bodies. A systematic approach involves assessing the optic disc, macula, blood vessels and retina both centrally and peripherally.
Infection Control Procedures
Many ocular emergencies present as a red eye. With any red eye assessment, we must keep in mind certain procedures and precautions throughout the examination. These include washing our hands, wearing gloves if required, cleaning equipment using alcohol wipes as well as using minims or strips for assessment to avoid contamination (dilation drops and anaesthetic drops) and using separate tissues and fluorescein strips for each eye in case of viral infections.
Sight-threatening and life-threatening emergencies can manifest in many ways. Below is a summary guide of the Australasian Triaging Scale, a clinical tool used by emergency clinics such as Sydney Eye Hospital to determine the maximum waiting time for certain eye emergencies.
Triage Category 1: Immediate referral for life-threatening conditions.
Triage Category 2: Assessment and treatment required within 10 minutes, otherwise sight-threatening. Examples of conditions include chemical burns (irrigation to be initiated from the outset – no waiting!), penetrating eye traumas (place shield if possible), sudden painless vision loss (Central Retinal Arterial Occlusion) or severe ocular pain (acute glaucoma).
Triage Category 3: Assessment and treatment required within 30 minutes. Examples of conditions include painless vision loss (Central Retinal Vein Occlusion), presence of a hypopyon and an ‘8-Ball’ hyphema (total anterior chamber filled with blood). In these instances, there is a potential for adverse outcomes or relief of severe discomfort.
Triage Category 4: Assessment and Treatment start within 60 minutes, otherwise there is a potential for adverse outcomes or relief of severe discomfort. Examples include corneal foreign bodies (non-penetrating), painful red eyes, flash burns (secondary to welding), retinal detachments (with a positive history for trauma/injury) or a smaller hyphema.
Triage Category 5: Assessment and treatment within 2 hours. These conditions are less urgent and tend to be chronic or minor in nature. Examples include conjunctivitis, blepharitis, chalazion or dry eyes.
Cases of red eye are common in optometric practice and there can be a myriad of causes, some mild in nature that require chronic management and others acute that require immediate attention. If a patient presents with any of these red flags, same day referral to an ophthalmologist may be required.
My name is Edward Lee and I have been practising optometry for about 2.5 years now. I was born and raised in Sydney for 18 years before moving to brisbane where I went to university at Queensland University of Technology (QUT), graduated and started working at Specsavers indooroopilly for 2 years. Recently in 2021 I moved back to Sydney and have been managing an independent practice in parramatta called “Eyes Only”.
Tell us a bit about yourself
If I'm not testing eyes and scrolling/making tiktoks, you can catch me soaking in the sun.
Hobbies include anything outdoorsy: hiking, kayaking, walking by the water, tanning at the beach.
I’m also a bit of a travel bug and really enjoy solo travelling, sightseeing, taking in new cultures and enjoying all the yummy food and wine they have to offer. RIP to previous and future travel plans due to COVID-19 :(
What made you want to study optometry/be an optometrist?
My family was the biggest influence, we have a small family in Australia but nearly everyone is in the optical industry. My mother is an optometrist and my father has been in the optical industry managing 1001 Optical for the past ~30 years. My 2 uncles are in the optical industry and I also have an aunty that’s an optometrist. Growing up, all the chats at the dinner table were about eyes, glasses, contact lenses so I knew from a young age that this was what I wanted to do.
What inspired you to create an Instagram and TikTok page about Optometry?
It all started in the good old 2020 COVID lockdowns. Innocently downloaded tiktok to kill some time, fast forward 2 weeks and i found myself really enjoying and using the platform a lot.
I wanted to make videos on tiktok to reach and educate a younger audience. I thought to myself, people across the world may not have access to eye health advice/information and I wanted to make this more accessible.
I also wanted to change the perception that optometrists and health professionals are boring. I wanted to show that we also have a fun personality and I wanted to do this through educational content.
Now my content has been half about the eyes and giving advice where I can and half just having fun and jumping on tiktok trends (life’s too short not to have fun).
Where can we find and follow your page?
@edwardbisharalee on tiktok & @optometry_with_eddy on instagram
However, most of my content can be found on tiktok.
Fun surprise fact you can also find me on @optoms_of_ig as I occasionally make a few relatable optometry memes for fun and laughs.
Tell us about your typical day or week as a business owner? What do you find are the most challenging aspects and most rewarding?
Typical day for me would include coming into work in the morning, checking in with my team and having a quick scan of the diary for upcoming appointments and jobs that need to be processed/collected.
Once the diary has been checked and managed, I'll usually scan through all the store emails to make sure nothing is being missed and return any missed phone calls or voicemails.
As the day progresses, we will have patients stroll in for their consultations and try to give them the best eye testing/glasses processing experience possible.
Most challenging aspect would be ensuring my staff and my patients are well looked after. Sometimes this can be quite tricky in the face of confrontation or when differences in opinions/arguments arise between customers and staff.
Most rewarding aspect would be having return customers duck in as they are doing their shopping to just pop in and say hi, or returning customers that wanted to duck in and tell us how amazing their glasses/eye test experience was.
How do you keep up with the optometry world?
Mainly through chatting with colleagues, friends and instagram/tiktok.
Do you have any advice for young optometrists out there who would like to pursue their passion but haven’t quite gotten started?
Just get started. I think too many people (myself included) focus too much on planning and researching their passion and constantly procrastinate and push back the start date. The best way to learn is from experience, it’s okay to make mistakes, to learn from them and do it better next time round. Nobody will be perfect on their first attempt and it’s all a learning process.
This year, I had the absolute privilege of being part of the Optometry Australia student leadership program for 2021. Due to the volatile situation around Australia, the program was celebrated as a virtual fest where we received our certificates, hampers, and gifts to mark the end. Now, when I went into this program, my expectations were very simple.
My perception was that we would be spending the weeks learning more about Optometry and the industry and how to conduct ourselves on a day-to-day basis. However, what we learned as participants of this program was far greater than what I could perceive.
Throughout the weeks, I learnt some of the most valuable lessons about the importance of leadership and being an effective role model than what I may have ever learned during my course. Through facilitation and discussions, we were exposed to the realities of what it means to be an effective leader in the modern day, adapting to the various changes in technology and healthcare in the future and how we need to focus on reflection as a powerful tool to understand what type of leader we are and ways that we can work to improving ourselves towards the type of leader we aspire to become.
Here are three powerful lessons that I learnt about leadership and how it quite poetically relates to my career towards becoming an Optometrist.
1. Take one step back to take two steps forward
When we are so focussed on completing our courses and deadlines, we often forget to take a breath and understand the underlining lessons that we learn from this process. The value of adapting to ever changing situations, how to manage pressure in an effective manner, ensuring that our motivation and goals align with each other etc. The lesson I learned at the program was that sometimes, to become an effective leader that can inspire several people, we need to take responsibility in identifying when we need to reflect upon our actions and the processes in which we are acting in and look at ourselves to discover ways to improve on. Self-improvement in areas such as communication is such an integral component in patient centred care and often, we don’t realise the need to reflect upon how we interact and take the necessary course of action to improve that. Whether this be enhancing the etiquettes we use, our choice of words and vocabulary or even body language, we need to understand that this is a continually improving learning experience. It may take a bit of time but in the long term, this an investment we should be making for ourselves.
2. Being a health advocate, before being an Optometrist.
There is a quote by Simon Sinek where he states that: “A leader’s job is not to do the work for others, it’s to help others figure out how to do it themselves, to get things done, and to succeed beyond what they thought possible.” I learned that being an Optometrist or any healthcare professional means being an advocate. Patients exist in a complex socio-political sphere that is constantly changing and impacting their overall health. Social injustice brings about disproportionate issues in many demographics. Taking the approach that we are leaders in understanding these social determinants and constantly advocating for better ways to conduct practice in our clinics, better patient communication and consistently learning new material that will inadvertently help patients is an approach that we need to take, especially with the changes in healthcare in the near future. We must be better humans and advocates before we can become better professionals.
3. Adaptability is our greatest strength.
Staying on the Simon Sinek trend, as he was an individual we analysed quite deeply during the program, he stated that: “Leaders are the ones who have the courage to go first, to put themselves at personal risk to open a path for others to follow.”
What the last year or so has taught us is that the health sphere is unpredictable. There will be uncontrollable factors and issues that arise in rapidly changing dynamics that we will not be able to keep up with. Acknowledging this change and not giving into the inertia is a productive step that we need to practise as healthcare professionals. We are accountable for how we react to the different obstacles and changes on the road that we have. In every sense of the word, resilience is the strength that will allow us to continue making progress and grow as professionals and as human beings.
The landscape of healthcare is constantly changing, and it requires us to change with it. If I had to take one point from my experience in this program, it is that we need to focus on the fundamentals of leadership and how we can work to inspire the people around us. This is an interdependent ecosystem that we exist in, and we need to work together, adapt together and bounce back together to ensure sustainability and fulfilment in how we see our profession.
About the writer: Jahin Tanvir
Jahin Tanvir is a 20-year-old third-year Optometry student at the Univerisity of Canberra, policy adviser, keynote speaker, author, and multicultural youth advocate. With a penchant for being multifaceted, Jahin possesses a strong background in youth advocacy and healthcare in leading youth-led organisations.
In 2021, Jahin received the 2021 Young Canberra Citizen of the Year in Individual Community Service as well as recognition in the 7NEWs Young Achiever awards for NSW/ACT in the category of community service. Jahin is also a young media spokesperson trained by the Economic Media Centre as part of the Centre for Australian Progress, providing expert media comment on multicultural people's experiences in Australian communities.
Hello! My name is Niv and I’m a vision science graduate from UNSW. I’m currently working as the Health Promotion Coordinator at Macular Disease Foundation Australia. I’m a born and bred Canberra girl who moved up to Sydney for uni. I currently live in Petersham with my fiancé, where I binge on true crime documentaries and charcuterie boards.
After graduating, how did your career path evolve?
I wasn’t too sure what I wanted to do after I graduated! Having a Vision Science degree is so great because you have such a wide array of opportunities at your feet, however by the same token it can also be an overwhelming choice. I toyed with the idea of doing a PhD, but decided that I needed a break from uni (for a bit!) I considered research, but couldn’t find anything I was passionate about. When speaking to my honours course convener she suggested I explore non-for-profit work. I started looking at what was out there and stumbled across the Macular Disease Foundation Australia (MDFA). Although I admit I’m much more of an anterior than posterior eye girl, I loved the idea of working in health promotion and education.
I’ve been at MDFA for just over a year and a half as their Health Promotion Coordinator. I spend most of my time speaking to patients who have been diagnosed with a macular disease, as well as involved in other patient-focused initiatives and advocacy work. Getting to be the first port of call after a patient has visited their eye specialist is a great feeling. I can provide them with all the support and advice they may require during an otherwise very overwhelming time.
Every day in my role is different, and my desire to help people in this capacity originated at UNSW and has since been strengthened at MDFA.
What does your typical day or week at work look like?
A typical week at work prior to COVID-19 was very different to what it is now. Currently it’s all working from home, which I’m very fortunate to do. As I mentioned, I spend most of my time speaking to patients on the phone. Many come to us quite distressed after just receiving a macular disease diagnosis from their optometrist or ophthalmologist. I speak to them about their condition in layman terms and offer support services and resources that may assist them on their journey.
I also work with data a lot, which I surprisingly enjoy. I’m in charge of pulling patient and health care professional data and statistics for our community and try to manipulate them in a digestible way.
Another big component of my job is coordinating education sessions for seniors i.e. those most at risk of age-related macular degeneration. As you would all well know, prevention and early detection is key, so we work with our community to ensure their armed with the best resources to reduce their risk or slow progression of macular disease.
What are some obstacles you have experienced, and how did you overcome them?
My honours research project was investigating the role of intense pulsed light in contact lens discomfort. The inclusion criteria for participants was particularly niche and made it quite difficult to obtain the number of participants required for stats purposes.
Despite all our best efforts, I didn’t manage to get as many as I needed. Instead of scrapping the entire project, I pivoted to a completely different research proposal. I kept the participants I had, and created a small-scale, intimate version of my project where I could follow each participant individually. I also started writing additional papers to explore other aspects of my research, which in turn led me to publish two papers in CXO which was super exciting!
I’m guessing the moral of that story is don’t be afraid to pull a Ross Geller and pivot, pivot, pivot when necessary.
Where do you see yourself in the future?
I’m not too sure what the future holds. Career-wise, I hope to still be working in the education/innovation space within the general field of eye health. On a more personal level, I hope that I get to have my wedding (COVID-pending) and I hope that I still love true crime and blue cheese!
What do you know now that you wished you knew when you were a student?
I wish I didn’t sweat the small stuff. Failing one weekly quiz isn’t going to be the end of the world. As someone who can be a tad perfectionistic at times, if one thing didn’t go my way I felt that I may as well just chuck the whole thing out.
Learning to persevere through the setbacks was a lesson that took me a few years to truly understand. Gaining that state of mind really changed the game for me.
What advice would you give to a vision science student who is pursuing a career as a vision scientist?
Vision science is a pretty broad field, so it can become overwhelming when considering job prospects. Uni will unintentionally give you so many opportunities for growth and new interests, so grab them with both hands. It’s cliché, but I think I still wouldn’t have found my niche if it wasn’t for saying yes to every opportunity that came my way. Those opportunities may just open doors to things you didn’t even know were in your reach.
Why did you start up a business and how did you go starting it up?
We wanted to venture out of being an employee and practice how we wanted to practice. We started our practice because we are passionate about providing holistic and evidence-based eye care that was patient-focused.
We first started off as a part-time practice from home in 2018. This operated after-hours and we also provided home visits, because we noticed a gap in the industry in these 2 areas. Starting up a practice involved doing a lot of research into how to run a business and learning about all the legal and financial aspects behind it. Megan did a Certificate IV in New Small Business, which was a good starting point. We also had discussions with other colleagues and other consultants.
Our patient base started to grow and we realised that we were outgrowing our space and entertained the idea of expanding to a full-time practice in a shopfront. By October 2020, we expanded our practice to a shopfront in Wentworth Point.
Should I take over a business or start brand new?
This is a big decision and it really is up to the individual. There are definitely pros and cons to both options and it is important that you weigh these up thoroughly and seek professional advice before you make a decision.
For example, taking over an existing business means that you already have an existing patient base. This has advantages in cash flow. However, this may also mean inheriting procedures and systems which you may not necessarily agree with. Making changes to these systems may lead to loss of some of your existing clientele.
Alternatively, starting brand new means it is a clean slate and you can set your practice how you want it from the beginning. However, it will take time to build a reputation and patient following.
These are just some things you need to consider before you make your decision.
What are some key points I should consider when going from employee to employer?
If you want your business to succeed, be prepared for long hours, taking work home and doing a lot of things outside the consult room. It is a steep learning curve because you now need to learn your legal obligations as well as be well organised in your administrative and managerial duties. However, we think it is incredibly rewarding in the long run because we are now able to do what we are passionate about without restriction.
How is your work life balance as a business owner?
Work life balance is an incredibly challenging aspect of being a new business owner. Aside from running a business, we both have other commitments and hence this is an area we are still working on HAHA ^^”.
What was the biggest obstacle you encountered during your journey, and how did you overcome it?
Work life balance and time management would be the biggest obstacles that we have encountered so far.
We have been working on these areas by improving efficiency within the workplace and scheduling in personal time so that it is not all work. We hold each other accountable so that we both don’t stray from our goals. Having a good support network really helps especially during challenging periods.
What advice would you like to give to all the YOs that are interested in opening their own business?
Running a business is like planting a tree. Do your due diligence and make sure you think it through before you make the decision. Plan it out. You need to find the location and prepare the land first. Then, you will plant the seed, nurture it, and protect it from the storms. Trees do not grow overnight. It takes time before you can reap the rewards.
There are many benefits associated with owning a business. However, be prepared to work hard as it is a massive investment and time commitment and expect some personal sacrifices along the way.
Tell us a bit about yourself and how you got into optometry
Simon: Like a lot of people, I didn’t really know what I wanted to do after high school. But the reason why I end up picking optometry was because pretty much everyone in my family – parents, sister, grandparents, uncles and aunties all wear glasses. I on the other hand somehow ended up emmetropic so I thought maybe I could become an optometrist to help the family out.
Where can we follow your adventures?
Instagram - @campingwithus
Video of our van build: https://www.youtube.com/watch?v=lB6OyX0VbAU&t=8s&ab_channel=Campingwithus
How did you get into what you’re doing in your time outside optometry?
Being optometrists, we do spend majority if not all of our working day cooped up inside a room. Both of us love being outdoors so we try to get out when we can to balance it out and mobilize those joints that get stiff from sitting all day.
Our van life journey started when NSW went into lockdown last year. Like majority of us we weren’t able to work. Being locums we both didn’t have work for a few months so we decided be productive and tick off a bucket list item which is to travel Australia in a van. We needed a van first of course so we started researching, learning from youtube videos and ended up spending about 3 months building our travel home.
Tell us about your most memorable experiences
One of my (Simon) favourite hobby is fishing. Being able to travel to all places in Australia allows me to target different species that are more local to a certain area. When we went down to Victor Harbor in South Australia, I wanted to tick off Bluefin Tuna off my list. Managed to hook up a 15kg fish and we spent the next week trying to finish eating it. We love being able to rock up to a place, pull out a chair and table, eat what we catch and enjoy the beautiful scenery Australia has to offer.
Do you find it easy to juggle your optometry career and your other passions?
Both of us have locummed for at 5+ years now and it has its ups and downs. One of the reasons why we decided to locum was because it gives us the flexibility to travel. I guess we are quite lucky to be able to do what we do as there aren’t many professions that allow you to take months off at a time. There are times where jobs can be scarce but in general, we try to load up on jobs during the busier periods and take time off when it gets quieter. So far it has worked well for us.
Does time away from optometry help you appreciate it more?
We definitely think so, we both love what we do at work but at times you do feel burnt out so it really helps to get away from it every now and then.
Just do it! If you keep holding off for whatever reasons there will always be a reason to not do it. Sometimes it just takes a leap of faith to get the ball rolling. Be open minded and flexible. Live with no regrets.
Gonioscopy is an important technique that enables viewing of the iridocorneal angle and allows assessment and diagnosis of different eye conditions.
Best practice standards for accurate diagnosis of Glaucoma are detailed in the National Health and Medical Research Council (NHMRC) guidelines. These include a comprehensive medical history (to identify risk factors), a full eye examination (including gonioscopy), an assessment of visual function (visual field analysis) and measurement of intraocular pressure.
Reasons for performing gonioscopy – what am I looking for?
Open-angle Glaucoma versus Closed-angle Glaucoma
Gonioscopy is important to perform in both patients with Glaucoma and patients that are considered Glaucoma suspects. It is a crucial box that needs to be ticked on your Glaucoma work-up checklist, to determine if an angle is wide open, narrow or closed. It can also detect the presence of peripheral anterior synechiae (PAS), a sign of chronic angle closure, and in certain instances can be used to break these aberrant connections of iris to anterior angle structures.
Occludable angles
An angle is considered to be occludable when the pigmented trabecular meshwork (PTM) is visible in less than 90 degrees of the angles’ circumference. This is determined using gonioscopy with the patient in primary gaze. If a patient is deemed to have an occludable angle, this is an indication for laser peripheral iridotomy (LPI).
Secondary glaucomas
Gonioscopy allows for the identification and appreciation of subtle findings such as pigmentation within the angle. Secondary glaucomas like Pigment Dispersion Glaucoma (PDG) will demonstrate very dark pigmentation of the trabecular meshwork (even, tiramisu pattern). In Pseudoexfoliation Glaucoma (PXG), white fluffy material can be seen in the trabecular meshwork. Sampaolesi’s line can be present in both PDG and PXG and is visualised as a dark pigmented line situated anterior to Schwalbe’s line.
Angle recession
Angle recession occurs due to rupture of the longitudinal and circular ciliary muscle fibres following ocular trauma. With gonioscopy, this appears as a localised area of iris bending posteriorly instead of running flat and can also be seen as widening of the scleral spur. Since patients can develop Glaucoma secondary to angle recession after days, months and even years, it is important to perform gonioscopy in cases where there has been ocular trauma both recently and in the past.
Neovascularisation of the angle
Gonioscopy can be used to detect growth of new blood vessels in the anterior chamber angle. These abnormal vessels are leaky and can cause inflammation. It can also lead to scarring and narrowing of the angle. Gonioscopy should be performed in patients at risk including those with a history of Central Retinal Vein Occlusion, proliferative Diabetic Retinopathy, or other retinal ischaemic conditions.
Helpful Gonio Acronym
Contraindications
Corneal or conjunctival inflammation or infection
Lacerated or perforated globes.
Hyphaema present
Significant corneal abrasions or erosion
Significant epithelial basement membrane dystrophy
NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma 2010 https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp113_glaucoma_1204 04.pdf
Herschler J. Trabecular damage due to blunt anterior segment injury and its relationship to traumatic glaucoma. Trans Am Acad Ophthalmol Otolaryngol .1977;83:239
I was inspired by my mentor and boss at the time who was (and still is) so driven and passionate about what she does and what she believes in. I wanted to create an environment where I could do the same - inspire a team and inspire my patients. I went through a 6-9 month program (called ‘Pathway’ which is run by Specsavers) to develop myself and to learn about the people and business aspect of being a business partner and employer. I had a lot of support from my mentors who helped me assess what opportunities were suitable for me from both a lifestyle and finance perspective. I had my accountant assist me in valuing potential business’ to ensure I also had professional advice.
There are pros and cons to both. The main advantage of taking over a business is that it has an established database and customer awareness of the store and its services and values.
Starting a brand new store allows you to create your own “brand” and culture, and enables you to build your own team from the bottom up. It will depend on your personal preference, however you should assess the potential you see in the business, and how able and quickly you believe you can grow it. A lot of research and due diligence is required for both avenues.
Do a lot of research (e.g. reading, courses, talking to other employers and colleagues) to understand thoroughly both the finance and business side of it, as well as the leadership side to being an employer.
Be clear on your “Why” before you dive into “what” needs to be done and “how” you will make it happen.
How did your business survive COVID?
We remained open the whole time (for urgent care) in order to service our community. Our customers were very grateful for this service and it also allowed us to gain new customers. Many of our customers had to hold off their “routine eye examination” for several months, hence when the lock down eased, we knew we would get an influx of customers returning. In order to both survive and thrive, we needed to be strategic with extending our trading hours to ensure we were able to capture all existing and new customers by looking after their eye care needs in a covid-safe manner.
It was a big adjustment when I initially started, as “work” can easily carry on at home and on days off. I’ve since learnt that planning ahead is key. I schedule quality time with my family and friends, and also block out time for myself to do things I enjoy. To keep myself accountable, I also schedule time slots in my calendar to fit in exercise, journaling and meditation. Having my own “me time” allows me to reflect my day/week and reassess when I'm “off balance”. I don’t always get it right and sometimes life can throw new challenges at you, however a balanced lifestyle is one of my goals and is something I’m consciously striving towards.
Tell us a bit about yourself and how you got into optometry?
My name is Austin and I am currently in my 3rd year of practice. I chose optometry out of an interest in helping people and also healthcare. I currently work at an independent practice in Dubbo, in Central Western NSW, having previously practised in Broken Hill in Far West NSW. Relocating to rural Australia has naturally allowed me to develop professionally as well as personally. It has provided me many unique opportunities, including doing visiting clinics in smaller towns in Central Western NSW, being able to carry out clinical duties in the public ophthalmology clinic, doing a nursing home visit, and also is carrying out optometry duties at the Macquarie Correctional Centre in Wellington, NSW. I’ve also rekindled some old hobbies through meeting like minded individuals in the rural towns that I have worked in. The article will focus on my work at the correctional centre and also more generally my experience of working regionally.
Tell us about your typical day testing at a prison? What do you find are the most challenging aspects and most rewarding?
A typical day testing at the Macquarie Correctional Centre starts with a check-in and equipment screening. Before entering the premises, I am required to run through a checklist of equipment being brought into the correctional centre’s clinic. As a visiting optometrist, the clinic is conducted with portable equipment, including a trial lens set, portable slit lamp, ret and DO, BIO, diagnostic drops and the spectacle frames. I am then equipped with a personal duress alarm to be worn onsite. Afterwards, I am escorted through the grounds to the clinic where I am met by the clinic staff and set up the room for my eye examinations.
I perform a typical eye test, with a history, refraction, ocular health check, some gross binocular vision tests and also do the dispensing in cases where glasses are required. Not having access to additional testing such as OCT, perimetry, fundus photography and wide field imaging can leave you feeling ‘handcuffed’ at times, especially when you suspect certain presentations such as glaucoma, visual field defects, macula changes or unexplained headaches. Inmates cannot simply attend a private practice externally to perform the indicated tests. In cases like these, clinical decision making is important and referral necessary.
I work closely with Justice Health and Forensic Mental Health Networkmedical and nursing staff, who facilitate ophthalmology care, including cataract surgery. The Network provides care to the 30,000 people who move through the NSW adult correctional system each year; with many experiencing higher rates of chronic and complex health conditions than the general community. Clinicians working in this setting are positioned with a unique opportunity to respond to the health needs of these individuals, who commonly have had minimal contact with mainstream health services in the community.
An inmate I saw for the first time towards the end of last year had a family history of glaucoma in his mother, large cupping in both eyes, and IOPs of 26mmHg in each eye. Based on the risk factors, I decided to commence him on Xalatan Eyedrops despite not having all the pieces of the clinical puzzle. I was fortunate to follow up this inmate on my subsequent visit and note a satisfactory pressure reduction. The most rewarding part is that inmates appreciate the eye examination service provided as many have been without glasses.
On leaving the clinic, I am escorted back to the check-in area and once again go through the equipment checklist before leaving the facility.
Do you have any goals for your optometry career?
Further experiences in optometry will allow me to formulate these goals, however the most fulfilment is gained in helping those who most need help. It is a matter of continuing to do so.
What keeps you sane outside of your work life? Do you have any hobbies or passions you pursue?
I do enjoy a few different hobbies; the two main ones are tennis and art, which allow me to channel my active and creative sides. I feel these hobbies have allowed me to form connections within the communities I’ve immersed myself into, and that this is a crucial component in the overall success and/or fulfilment in regional stints.I often get called upon to make the controversial line calls in tennis since “I’m the optometrist”.
Broken Hill Artwork and Tennis
Interactions with local artists in the Broken Hill and Dubbo regions.
What advice would you give to other optometrists who may be looking to venture beyond conventional optometry?
Have an open mind in trying new things as you can be pleasantly surprised by what new opportunities bring you.
Once upon a time, every year January that ticked around, I would scramble to Kmart for the $5 diaries and jot down my "3 goals for the year". Then I'd put my pen down, close the book and be satisfied. That's how it works right? Surely by the time December comes around, you would have achieved those goals... and keep in mind they were the same 3 goals every year:
1. Spend more quality time with friends and family
2. Be more health conscious
3. Some career/education aspiration goal
Truth be told, I never followed through or even self-reflected during the year to see if I was on the right path or direction. Although now I no longer write goals down every January, this is what I learnt about goal setting and accountability that I follow now.
Be more specific
I was failing because everything was too broad. I wanted to spend spending quality time with "friends and family", but did this mean hitting up the 500 Facebook acquaintances every Sunday? I started singling out people and groups I truly wanted to build relationships with and making more of a conscious effort.
Holding true to your word
It's tempting and easy sometimes to find excuses to not attend events, meetings or even meet-ups. However, most of the time we at least put in some effort to stay true to our word if we said we were going to attend. But, it's even easier to make excuses to not do or commit to something, if the only person keeping you accountable is yourself.
Accountability
This was and still is one of the hardest things for me to grasp. I am weak-willed at best and self-accountability is difficult. So I bought apps, books, made friends and accountability partners to keep me on track.
Micro-Goals
I had to be honest with myself - I was never going to read a book a week, become an Instagram fitness star and learn Spanish all within a year. So instead I set mini-goals and celebrate mini-wins. Maybe just 20 pages a night before bed? Start off by going to the gym? Learn and practice a handful of phrases a week?
Review and reset
I stopped waiting until December to review and realise I had made no progress, then consequently remaking the same goals. I became more realistic and also honest with myself - if I saw I had set visions that were far beyond my potential at that time, I would readjust and reset them.
Now, in no way, shape or form am I perfect - but this is what simply is working for me!
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