Ophthalmology has one of the most competitive selection processes in the Australian medical training workforce. There are many pathways, but some choose to practise as optometrists before taking the leap into medicine.
The unconventional transition from optometry to ophthalmology is marked by a unique set of skills. The few that have made this journey say their time as primary eyecare providers has set them up for success, with a deeper understanding of the eye health ecosystem.
With insider knowledge in both spheres, these individuals emphasise the importance of collaborative care models and how bridging communication gaps can optimise patient outcomes.
To explore the intersect of these professions, Insight has spoken to two ophthalmologists who have come from optometry.
Best of both worlds
Dr Rajeev Naidu’s pursuit of optometry came with a stroke of serendipity. His early academic career saw him initially study commerce at the University of Sydney. However, it became evident early on that this was not his calling.
So, when Naidu visited the optometry clinic his family frequented, he left with an eye exam and a new ambition, having been convinced to pursue optometry by the optometrist.
After a year of commerce studies, Naidu switched to a combined Bachelor and Master of Optometry and Vision Science at the University of New South Wales. There, he was among one of the first cohorts to graduate with ocular therapeutic training in 2011.
In his first two years as a graduate optometrist, Naidu worked in regional clinics, including Albury-Wodonga. His return to Sydney marked a full circle moment, where he worked part-time with Barry Clennar in Parramatta, the optometrist who guided him into the field.
His stint as an optometrist in a country practice, saw him work closely with the local ophthalmologist. This provided him with insight into comprehensive patient care, including management, monitoring and referral. With this experience, he wanted to be there for the final patient outcomes.
“I just wanted that extra little bit of a challenge to provide care from the very start to the very end,” says Naidu, who is now a second-year ophthalmology registrar at Sydney Eye Hospital.
He continued his part-time work at Clennar’s practice while studying medicine at the University of Sydney. In his final year of medical school, Naidu worked in Dubbo and as a rural locum for OPSM. These optometric skills facilitated his success as an ophthalmology registrar.
With no backup plan or second priority medical specialty, he revels in the fact that he was accepted by RANZCO on his second admission attempt.
“If I had not been an optometrist prior to starting medicine, or ophthalmology training, life would have been infinitely harder as an ophthalmology registrar,” he says.
“From my experience as an optometrist, I have gained the skills of ocular examination, knowing patient follow up and knowing how patients perceive their eye health and the impact that eye disease has on them. And I believe that’s made me a little more insightful during my training as an ophthalmology registrar.
“I think that optometrists really do make good ophthalmologist because they have an idea of what is involved in patient community eyecare from the very ground level. I think that’s probably the biggest difference to someone who doesn’t have an optometry background.”
Currently, Naidu has plans for a paediatric fellowship once he finishes his training. He hopes to complete an overseas fellowship in either the UK or Canada.
As one of the few optometrists in ophthalmology, he says the transition has provided an opportunity to elevate the collaboration between both professions and highlights the importance of the relationship.
“I think the handful of us are able to make a bit of a difference to foster the collaboration between optometry and ophthalmology for the future,” he says.
Evidently, these individuals with their unique academic and professional backgrounds help strengthen that relationship between optometry and ophthalmology for the best possible patient outcomes.
This uncommon career transition involves two very different, yet essential facets of patient eyecare, expanding the scope of eyecare practice with the amalgamation of two distinct skillsets.
‘Optometry has helped me greatly’
For Dr Nicholas Toalster, some advice from a school counsellor led to him undertaking a bachelor’s degree in optometry. Upon graduation from the Queensland University of Technology in 2002, he completed six months in general optometry and a paediatric optometry practice.
During this time, a visit from the manager of a local ophthalmology practice marked the beginning of a notable career shift for Toalster. An offer of employment saw him work as a clinical optometrist for Gold Coast Ophthalmologists Dr Darryl Gregor and Dr Peter Heiner for several years.
Toalster had a yearning to practise beyond the scope of optometry. That’s when Heiner suggested he pursue medicine.
Toalster held his optometry registration through his medical studies by working at the clinic one day a week. After graduation, he worked as a junior medical officer in the Royal Brisbane and Women’s Hospital.
Initially assuming ophthalmology was too competitive for admission, he considered training as a general physician or rheumatologist. However, he made an application to RANZCO and was accepted, and completed his training at Sydney Eye Hospital where he was offered a fellowship as a corneal sub specialist.
Toalster’s career shift was not an isolated event, with some of his classmates in his medical cohort on a similar trajectory.
“There were at least four or five optometrists in my cohort, and I think three of those have gone on to become ophthalmologists,” he says.
Toalster completed a further fellowship in glaucoma sub-specialty training at the Royal Victorian Eye and Ear Hospital and then returning to the Royal Brisbane and Women’s Hospital in 2019 where he has remained since.
He describes his shift from optometry to ophthalmology as advantageous, citing that his unique skillset distinguishes him from others within the field. Integrating his expertise in both areas ensures the best possible outcomes by collaborating with optometrists.
“They’re both very different degrees, optometry and medicine. Back when I did optometry, it was very didactic and proscriptive compared to medicine, which was a bit more investigative where you had to work things out for yourself,” he says.
“Optometry has helped me greatly because I have insight into how optometrists practise. Whereas most doctors don’t know how a general community optometry practice in a shopping centre works. But the reverse is true as well. Optometrists often haven’t had the experience of working in a hospital doing after hours on call for example. Bridging those gaps has been a big part of what’s useful.”
Toalster notes the importance of his transferrable skills and their relevance to the RANZCO Collaborative Care for Glaucoma program where optometrists and ophthalmologists adopt a shared care arrangement for lower risk glaucoma patients.
“What could be done is bridge those gaps between what the two different professions experience, and the knowledge they bring to the table,” Toalster says.
In his clinic, there are professionals with a similar mindset but have not transitioned from optometry to ophthalmology just yet.
“In our practice we have a number of optometrists. They are drawn to working in ophthalmic practices, often after having done a placement with us, due to the increased scope-of-practice and clinical variety they see.”
Toalster believes that an expansion of the scope in optometry in recent years might see a reduction in career shifts, with incorporation of more therapeutic options including contact lens prescription and myopia management into optometry practice.