Feature, Report

Hospital optometrist role a clinical and personal challenge

Early-career optometrist CLAIRE ONG is pursuing her passion in paediatric care in a newly created role at the Women’s and Children’s Hospital in Adelaide.

Ms Claire Ong was nearing the end of her first full year in the workforce and keen to pursue her area of clinical interest when a former lecturer alerted her to an intriguing role.

The Women’s and Children’s Hospital in Adelaide was seeking an optometrist for a newly created role as part of a six-month pilot, commencing in January 2023. One of the main goals of the role is to reduce the current long waiting periods for tertiary eyecare.

“I’ve been wearing glasses since I was young, and I’ve always been interested in optometry in terms of what an optometrist can do and how they can problem-solve,” Ong says. “Working with children and learning to manage and diagnose very specific children’s eye problems really caught my interest while studying at Flinders.”

Ong was looking for ways to expand her skills in the paediatric optometry field when one of her former lecturers – Ms Jacqueline Warren from Flinders University – notified her about a new position.

“Jacqueline was involved in a similar pilot at Modbury Hospital a couple of years ago. The Women’s and Children’s Hospital in Adelaide role was advertised on the ‘I Work for SA’ government website, and the job description was perfect, so I applied and here I am.”

When Insight spoke with Ong in January, mere weeks into the role, it was already proving to be a significant departure from her previous workplace experience.

An optical assistant at Specsavers for three-and-a-half years while studying at Flinders University, Ong then joined the company full time as a graduate optometrist in 2021 at its Norwood Place store.

She is now working at the Women’s and Children’s Hospital three days a week, and at Specsavers in Sefton Park two days. Ong is also undertaking the Australian College of Optometry’s Advanced Certificate in Children’s Vision this year to complement her hospital role.

“It is definitely a new experience going from corporate primary eyecare to a tertiary setting. It’s been a steep learning curve,” she says. “But it’s a good balance; Specsavers gives me the opportunity to serve the general community in primary eyecare and the hospital allows me to focus on a more targeted demographic in a tertiary care setting.”

It is the first time since the Modbury Hospital pilot that SA Health has introduced an optometrist into a hospital environment.

In 2020, Optometry Victoria South Australia backed a joint ophthalmology and optometry pilot at Modbury Hospital, costed at $50,000. Data from the pilot showed that 40-60% of the non-urgent waitlist could be effectively managed by optometrists in a collaborative care setting.

Warren, lead optometrist on the Modbury pilot, said that the pilot showed there is a solution.

“The Modbury pilot proved that wait times can be reduced with only a small amount of investment. It showed that by putting in place a system of collaborative care with optometrists, the number of patients unnecessarily waiting to see an ophthalmologist was reduced,” Warren said.

Similarly, the main goals for Ong’s role at the Women’s and Children’s Hospital are to reduce patient wait times, improve GP and community optometrist relationships, and set up outpatient clinics external from the hospital.

Women’s and Children’s Hospital in Adelaide.

The role

As the sole optometrist at the Women’s and Children’s Hospital, Ong is part of a highly-qualified specialised team comprising consultant ophthalmologists, registrars, junior doctors, orthoptists and nurses.

Because the position is a six-month pilot and funding is not yet secured for a permanent position, the hospital’s ophthalmology department is collecting data about the kinds of patients she is seeing, so it can provide numerical proof of the value of having an optometrist on staff.

The Women’s and Children’s tertiary eyecare median waiting time is 15 months, with the longest patient waiting 45 months to be seen as of 30 September 2022, according to the hospital.

“Most new referrals come from community optometrists and GPs, but we also get a lot of referrals from within the hospital. For example, kids with systemic diseases that can have ocular effects, they get sent through the ophthalmology department in the hospital, so there’s a lot of patients to see,” Ong says.

Her role has been created to explore how optometrists can be incorporated into the ophthalmology department which is heavily centred around a multidisciplinary care approach. It’s intended to resolve the sticking points in the system.

“At the moment in the hospital, the patient is given a referral, an orthoptist will do the initial workup, and then when it’s time for refraction and ocular health, they’ll send that off to the registrar or the consultant [ophthalmologist],” Ong explains.

“But sometimes the referrals that get sent through, they’ve either been waiting a long time so the problem has resolved, or the referral probably could have been sent through to a community optometrist.

“Therefore, some of the goals of incorporating an optometrist into the hospital are to see a higher volume of new patients so the department can start shaving down the waitlist and reduce the long wait times, and also increase the efficiency and the flow of the patient care within the hospital-based clinics and, being more resourceful of the consultants’ time.”

Ong described her role as having two main objectives.

“The first objective is clinical, so being able to increase the efficiency, and see some of the more routine patients or some of those patients that are an emergency walk-in. The second objective is more of an advocacy-based role. There was an emphasis in the job description about advocating for the optometrist to deliver high quality, evidence-based paediatric care and to assist the Women’s and Children’s Hospital in their pursuits to expand,” she says.

“At the moment, there’s talk of setting up an external outpatient clinic in the northern suburbs of Adelaide. There’s a lot of kids in the suburbs who need eyecare attention. Unfortunately, a lot of those children and their families don’t present to their appointment at the hospital due to the distances involved, and a general lack of understanding of how important eyecare is for young people. Hopefully taking the clinic to them will allow them to be seen, and also take the more routine or stable cases out of the hospital so that it frees up consultant time to see more new patients or more urgent cases.”

While the hospital is well-equipped with imaging technology and a slit lamp in every consulting room, Ong brings personal equipment to make her more comfortable assessing young patients.

As well as improving efficiency, she will be critical to improving the relationships between intersecting health professions.

“There’s an emphasis on creating more robust and more efficient interpersonal relationships between GPs and the hospital, community optometrists and the hospital, and GPs and optometrists, because the hospital ophthalmology department is a multidisciplinary care model designed to maximise patient outcomes, proving high quality evidence-based care to patients. However we recognise that GPs and optometrists in the community have first-rate skill sets – we want to further bridge the gap about how they can inter-refer to each other and how they can help and educate each other more.”

Ong says the Women’s and Children’s Hospital is envisioning more connection with community optometrists, educating them about what the ophthalmology department does, and finding ways to empower optometrists to help them manage their own paediatric patients.

“Sometimes optometrists don’t feel comfortable managing a paediatric patient even though it is within their scope to manage them. But they don’t feel comfortable, or they feel like they don’t have the equipment to manage, so they send the patient to the hospital,” Ong says.

“Perhaps in the future, when we have a larger network of optometrists who feel confident and comfortable in managing paediatric patients, other optometrists can inter-refer to these paediatric optometrists to see whether hospital referral is necessary. It’s about promoting and empowering community optometrists to be more involved in paediatric care.”

For Ong, her new role is proving not only to be clinically challenging but personally challenging too, learning to find her way in a wider healthcare setting.

“It’s really highlighted to me the different ways the team work together. It’s a very symbiotic environment. In terms of an optometrist, and where we sit in the community, we’re quite used to working independently, but as a hospital department, we’re trying to figure out where an optometrist sits in terms of the end goal – increasing efficiency – and what kind of patients I’ll eventually see independently,” Ong says.

Perhaps the steepest part of her learning curve has been the exposure to a range of pathology she didn’t experience during her first year working at Specsavers.

“I’ve learned a great deal in a short time – there is a broad range of ocular pathology that affects a paediatric population that wouldn’t ordinarily be seen in the community because of ongoing management within the hospital. One condition I’ve seen is retinopathy of prematurity (ROP). At the hospital, the ophthalmology consultants check the retinas of the premature babies because their retinas are underdeveloped. Sometimes premature babies can have blood vessels where they’re not supposed to be. Ophthalmologists then continue to monitor children that have been identified as having ROP, whether they require treatment or not, due to their high risk of developing future complications such as strabismus or high prescriptions,” Ong says.

“I have the opportunity to screen a lot of patients with juvenile idiopathic arthritis – this is particularly important because uveitis caused by this condition may be asymptomatic, and has detrimental consequences if left untreated. There is strabismus of many types caused by cranial nerve palsies and eye movement disorders that are rare to come by in community practice. Children with genetic disorders such as rare mitochondrial or muscular diseases also come through the clinic to be screened or managed for associated eye complications.

“There are children affected by retinoblastoma being managed, and ophthalmology play a role in co-managing those affected by brain tumours and other forms of cancer. We work in a dynamic space where consults have to be adapted to suit very young children, patients with developmental delays, and physical disability. It’s a very mixed bag with pathology and patient types that I wouldn’t normally see.”

Ong’s role within a hospital ophthalmology department is indicative of how optometry’s scope-of-practice has changed and become more integral to eye health – but she will have to wait until July to know if she will be a permanent member of the multidisciplinary team at the Women’s and Children’s.

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