One Queensland optometrist is helping his patients deal with short-sightedness while he considers his own longer-term prospects. Luckily, he has a prominent support network to lean on for help.
The saying goes that you can’t teach an old dog new tricks.
But in Toowoomba, Queensland, one seasoned optometrist has turned that on its head and is teaching timeless tricks to a new generation of families.
Optometrist Mr David Neilson may be near retirement, but until he moves into that new chapter later this year, there’s still plenty of well-travelled wisdom to impart for young parents and their potentially myopic children.
Now part of the George & Matilda Eyecare network, Neilson Eyecare balances the freedom of local care with the support of a national backbone.
Neilson is part optometrist, part teacher, part counsellor in the regional practice he has either worked in or owned for the past two decades.
Neilson Eyecare has been an optometry practice in Toowoomba under one name or another since the 1940s.
The two and half optometrists and five support staff (at time of writing they were looking for number six) work out of a beautiful 110-year-old house; they’ve still got some decades-old cards featuring pounds and notes in fountain pen.
The irony is that such things might be considered out-dated, museum pieces made redundant by newer technology, but it is the parental advice of a bygone era that people are now turning to to help preserve their children’s vision.
Neilson sees a broad spectrum of people in his business – from young families and their kids to patients in their 90s who have a strong connection with the 80-year-old practice.
But it’s the former that he is seeing a lot more of, and the risk of myopia is often why they are there.
“Traditionally we did better, myopia wasn’t as prevalent as other areas, because we’ve got backyards here, we’ve got farm kids,” he says, touching on the known benefits of two to three hours of minimum outdoor activity in preventing the onset or slowing the progression of myopia.
“But what I’ve noticed within the last couple of years is that there’s more screens in primary schools, so you’ve got more kids on the edge of it [myopia].”
That’s where Neilson comes in. He’s built a strong paediatric practice by working hard to keep kids from falling over that edge, which has to start early and involves plenty of pushing, prodding and counselling younger parents often reluctant to place rules on their children’s screen and outdoor time.
Many years of talking to parents, explaining how eyes work in an easy-to-understand way, has helped create a strong local following.
“It’s about preparing the parents,” he says, outlining his approach that relies just as much on sound technology as it does on straight talking.
“You can see there’s a predisposition to myopia in terms of visual inefficiency there, and certainly with family history.
“You look at mum and say, well you’re short-sighted and we want to try and prevent that happening, so you have the conversation early, so it’s on the parents’ radar.”
The difficulty is often that he is explaining a problem that has not really happened yet. “We are looking to change the mindset to prevention, rather than just waiting for the wheels to fall off.”
Convincing those parents that changes might be needed at home to keep myopia at bay can be a challenge.
For Neilson, the OCULUS Myopia Master and other equipment in his practice can help demonstrate the risk to parents and patients through axial length measurements, analysis software and easy-to-understand reports for parents. But it’s old-school parenting, common sense and the highlighting of consequences that really hammer it home.
“When you’ve got a parent who’s short-sighted, you explain, well you didn’t start off short-sighted. And then you start to talk about them about their journey. “They’ll say, ’When I was at uni, I couldn’t see the lecture boards’. And you question, ‘was it lecture boards that caused the problem?’. And they sit and start to think.
“Now I’ve got cause and effect in their minds,” he says, “and they haven’t actually talked about prevention or averting something, so you’re changing that mindset of the parent early on.”
His younger patients get the benefit of that advice as well.
“I’ll say it’s like fast food; some of it’s OK, but what if you ate hamburgers every day, what would happen?”
Neilson will then encourage his modern, young parents to consider advice of those from the past: stop watching that screen and find something to do outside.
“I’ll say to the parents, well, you know, we didn’t grow up with computers compared to what these kids are going to do now.”
If there’s an element of old-fashioned ‘tough love’ there, many parents appear to appreciate it. “Sometimes I feel like a broken record, but I think parents appreciate the fact that it’s not just in and out, bang, there you go. We’re here to be your optometrist, if not for life, then at least in the longer term.”
As well as the advice, Neilson outlines a plan for monitoring the development of myopia.
“The Myopia Master really helps with this,” he says. “It produces several graphs which we use to explain the child’s progress to the parents.
“We use a series of strategies – lifestyle factors, looking closely at binocular vision problems and prescribing accordingly, and the early use of atropine drops. We then have the range of DIMS lenses, myopia control soft contact lenses and ortho K.
“We have been doing this for quite a while. I even have a handful of patients who are still using their old Executive bifocal lenses [Myopialux]. They have had good success and are keen to keep things as is.”
That extra advice and time spent taking a parent through their own journey to help them understand the path their child might be on can create a bond between practice and parent, practitioner and patient.
It’s extra time that other optometrists might not be able to spare.
But Neilson says it’s something that many are prepared to pay a little extra for. They see it as an investment.
“We don’t bulk-bill,” he says. “It would be very tough to do all of that on the bulk billing. That’s the reality.
“People are happy to pay, but the responsibility is that you give a higher level of care and service to people.”
Neilson’s relationship with George & Matilda supports that philosophy.
His practice became part of the network last year, following the company’s acquisition of National Optical Care, a group that had already shared many of the same values around independent practice and clinical autonomy.
The move has brought even greater support behind the scenes, allowing Neilson and his team to focus more fully on patients while planning for the future.
He believes George & Matilda has improved its professional services and supports the network’s clinical work.
It holds regular conferences and there’s a chat group that brings practitioners together to support their clinical work and patient care.
And George & Matilda is now helping Neilson prepare for his own next chapter – retirement, of sorts, and a move to the coast with this wife.
When he announced that it was time to move on, he agreed to stay on for two years to support the transition for his team.
“The two-year handover has helped me deal with the staff, get the optometrist up to speed and in a good position where they can carry on practising the way we do.”
The partnership with George & Matilda happened during that transition and Neilson says the company has been a great support.
“G&M took the weight of management off our shoulders, so we could focus on patient care,” he says. “We’ve got a HR department we can call on and there’s purchasing and stock management.”
Mr Anthony Sargeant, national professional services manager at George & Matilda, says the goal is to make succession feel seamless, not surgical.
“We don’t take away what made a practice special. We back it,” he says.
“Succession should preserve trust, protect clinical independence, and make sure the team and patients are thriving long after the owner steps back.”
Retirement and succession planning can be scary subjects.
Neilson has had plenty of patients in his practice approaching that chapter and keen to talk about things other than their eyesight.
“Being a rural practice here, I get people off the farms, and the husband is scared to death of retiring and dying, and the wives have had enough for the farm. They just want to get off.”
He appreciates having George & Matilda to help with the tricky process.
“I remember this guy saying that getting into business is hard, but getting out of business is harder. We’re all going, ‘have I got enough super? How long do I work for?’. So I think the George & Matilda model, this business plan of buying these practices, this is a great exit strategy for a lot of people.”
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