Since 1863, audiology and optometry have been intertwined in the Australian healthcare system to some degree. In the modern practice era, they are providing a complementary service and means to attract and retain patients. And as Insight discovers, the cost of entry may not be as high as some think.
At the largest optical event in the UK in 2018, audiology companies invited to attend were asked why optometry and audiology are a good fit and how optometry practitioners could integrate hearing services into their practice.
Mr Steven Ross, then business development manager of hearing care solutions company, Sonova, said optometry and audiology service similar demographics.
“The reason optometry and audiology should meet is because they share the same customer base: 97% of over 65-year-olds need some form of vision correction; 73% of 70-year-olds need some form of hearing correction,” Ross told Optometry Today.
He said integrating audiology into an existing optometry practice was relatively straight forward.
“You’ve already got the premises, you’ve got the front-of-house staff, you’ve already got the customers. One of the hard things is to get a database. You’ve already got it. The cost to start up is minimal,” Ross said.
“The key thing is trying to find the right person that fits the business needs. A lot of opticians, especially independents, differentiate themselves by customer service. If they go into partnership with someone, they’ve got to really find that person who has the same values and beliefs as them.”
Closer to home, a few months before the UK conference, Specsavers launched audiology services into a handful of existing optometry practices in Australia – that number has now grown to 238 out of 356 Australian stores. Meanwhile, one independent practitioner has achieved the rare career feat of becoming dually-qualified in optometry and audiology.
Insight spoke to both to understand the challenges and benefits of this approach, as well as to Australia’s only hospital that provides eye and ear care.
A family affair
An unassuming principal owner of an independent practice with two locations in Melbourne holds a unique place in the profession: he is one of few, if not the only, in Australia who is a qualified optometrist and audiologist.
Mr Lachlan Smith is owner, director, principal audiologist and optometrist at Smith Eye and Ear Solutions (formerly Anthony Smith Optometrist), Melbourne’s first combined optometry and audiology practice, located in Moonee Ponds and Camberwell Junction.
Smith first graduated with a Masters in audiology from the University of Queensland and worked in Cairns for two years, before returning to his home state of Victoria.
He wanted to work in his own practice, ultimately incorporating audiology into his father’s established optometry practice in Moonee Ponds.
“Dad came to me with the idea. He knew Boots and Specsavers in the UK had successfully integrated both services into one business, so it was not completely unprecedented. His optometry clinic of 35 years was well-established and had a loyal patient base, so thought it could work well,” he says.
“After adding an audiology service to Dad’s optometry clinic, I then started studying optometry, completing a Masters from Deakin University. When Dad retired, I bought the business, and now perform eye and ear consultations in both the Moonee Ponds and Camberwell Junction practices.”
Optometry is second nature in Smith’s family; he is supported by his sister, who is a part time optometrist in the business, plus additional support staff. Until recently, Smith Eye and Ear Solutions operated a third practice in Caulfield, but it closed during COVID-19.
“On an average day, I might see eight audiology patients and two or three optometry patients. I have separate rooms at both clinics (Moonee Ponds and Camberwell Junction) and move back and forth between rooms throughout the day,” he says.
“It generally works well. Audiology consultations typically take longer, as there is more conversation, counselling and communication involved, and case history takes longer. Conversations with audiology patients can also draw out issues with their eyes and vision.
“The association between hearing and vision issues increase as patients get older, they go hand-in-hand. Patients are often a little surprised that I’m qualified in both fields but recognise the convenience of that, as a logical progression. It often pops up in conversation with patients that I’m dually qualified and they will remark ‘I could just come here’ for both their hearing and vision needs.”
Smith says his combined skills are particularly convenient for patients in rural areas, where it’s hard to get consistent services. He provides audiology and optometry services to Indigenous communities in northwest Queensland, funded through Check-up, a state government agency, and is chief audiologist at Hearing Choices, an organisation connecting independent audiologists.
From a business perspective, he says combining audiology and optometry services capitalises on the cost of leasing premises.
“In terms of physical space, audiology consulting rooms don’t need to be big, and optometry equipment is not huge, so you can make it work, not only in terms of rent, but administration staff too. They can perform dual administrative tasks.”
Smith says unlike optometry’s retail component, where showcasing a range of frames is de rigueur, audiology doesn’t require practitioners to have stock on hand, as hearing aids are typically custom-made and ordered as needed.
In this regard, Smith says the biggest advantage is being an independent practice and having the freedom to choose suppliers.
“A lot of audiology clinics are owned by hearing aid companies, which means they only sell a particular type of hearing aid. It also means their advice can be compromised by financial dividends.”
Unlike in the eyecare sector, where ophthalmologists are prohibited from owning an optometry clinic, Smith says the same is not true in audiology, where ear, nose and throat (ENT) surgeons can and do own audiology clinics.
For example, ENTs own Neurosensory, a chain of 24 audiology clinics across Queensland, New South Wales, Victoria and Tasmania.
But regardless of ownership, it’s patient trust that trumps all else, Smith says.
“Some clinics in the past have tried and failed to combine optometry and audiology services. One network in particular had 30 clinics nation-wide, but it wasn’t a success and the reason for that, I believe, is trust,” he explains.
“If you’re incorporating audiology into an existing optometry clinic, and the patient is seeing a different clinician every time, they don’t develop a rapport. Generally speaking, audiology patients need to be seen more regularly than optometry patients, so if their regular practitioner changes, there needs to be a good reason for that.”
Changing minds
To some extent, particularly in the UK, optometry and audiology are established bedfellows, with Specsavers and Boots both offering hearing care and eyecare under one roof, the former for at least 18 years.
The concept is newer here. Specsavers launched audiology services in existing optometry practices in Australia at the end of 2017, and in 2019 in New Zealand.
Specsavers ANZ chief audiology officer Mr Nick Taylor, a qualified audiologist with more than 20 years’ experience, has been an integral part of the integration.
“Why introduce audiology to optometry?” English-born Taylor, who previously worked at Specsavers in the UK, asks rhetorically. “Our customers want convenience, they want more than one service in one place, not separate appointments in separate locations. The convenience of both services under one roof is a big driver.
“In the UK, the majority of audiology services are provided by the National Health Service (NHS), so patients had to go to hospitals to receive audiology services, when they’re much happier to go to an optical store for their hearing care. That’s the origins of the UK model.”
Taylor, who has been in Australia for five years, says it’s important to emphasise to the public that Specsavers optometrists are not providing hearing care – it’s provided by qualified, experienced audiologists, a professional discipline in its own right.
“Because Specsavers is established in optics, it makes more sense to build audiology into optometry stores. We’re a trusted brand,” he says, with the firm this year being recognised in both optometry and hearing services categories in Reader’s Digest magazine’s most trusted brands consumer survey.
“Our ambition is to have audiology services in all our optometry stores, everywhere. Out of our existing 356 optometry stores, 238 offer audiology services. Over the next three years, we will aim for all Specsavers stores to offer optometry and audiology services,” Taylor says.
He says the decision of which stores offer audiology services largely comes down to physical capacity to fit a dedicated soundproof and sound-treated audiology consulting room fitted with the latest testing equipment. Taylor adds that nothing specialist is required for front-of-house, as practices can utilise existing staff to welcome patients, and there is little or no retail space required for hearing solutions.
If a patient needs hearing aids as a result of a hearing loss assessment, they are custom ordered for the individual patient, who then receives a full fitting.
“Unlike spectacles, we don’t have stock on display. Generally speaking, people start losing their hearing in their mid-20s, but it’s a slow deterioration, which people begin to notice in their late 50s or early 60s. Many people think hearing aids are not fashionable, often referred to as ‘beige bananas’, but actually they are more sophisticated and discreet than ever before,” he says.
While Specsavers audiologists on occasion have refer patients to ear, nose and throat (ENT) consultants, Taylor says there is not a referral system in audiology equivalent to Oculo in the eyecare space.
He says the biggest challenge is to educate Australians that Specsavers provides eye and ear care.
“Specsavers’ name is synonymous with ‘specs’ and eyes. It’s a process to educate people that optometrists are not providing hearing tests – we employ fully qualified audiologists. We’re offering convenience and customer service,” he says.
While Specsavers is active in the eye health space in Australia, involved in programs like KeepSight that is aiming to prevent vision loss to diabetes, it is at the very early stages of hearing care awareness, taking part in Tradies National Health Month for the past two years which, amongst other health risks, promotes protection against hearing loss caused by excessive workplace noise.
Cross-pollination
The Royal Victorian Eye and Ear Hospital is Australia’s only specialist eye, ear, nose and throat hospital, and the origins of that, says CEO Mr Brendon Gardner, dates back to 1863.
“The Eye and Ear founder, Andrew Sexton Grey, started work at St Mark’s Ophthalmic Hospital and Dispensary for Diseases of the Eye and Ear in Dublin. After he moved to Melbourne, he set up the first iteration of the Eye and Ear in 1863 with one bed, treating eye and ear diseases for underprivileged people in Melbourne,” he explains.
“From those humble beginnings the Eye and Ear has grown to become an internationally recognised leader in clinical service delivery, teaching, and research in both ophthalmology and otolaryngology and the largest public provider of ophthalmology and ENT services in Victoria.”
The hospital delivers more than half of Victoria’s public eye surgery and all of Victoria’s public cochlear implants.
“Hearing and vision impairment are strongly age-related. With an ageing population that is living longer, the prevalence of sensory loss associated with hearing and vision loss remain key health issues, particularly for Aboriginal and Torres Strait Islander peoples. From that perspective alone, along with potential synergies for research, it makes sense for services to be co-located,” Gardner says.
He says it is also well known that hearing impairment can be associated with a greater risk of cognitive decline in the elderly, so optimising both eye and ear care is extremely important, especially within an ageing population.
“I think we all want to age well as a society.”
Integrating eye and ear care in a clinical setting like a hospital also brings other advantages, including opportunities for doctors to cross-pollinate ideas across their different specialities and collaborate in the research domain.
“We cross-pollinate regularly in Emergency Departments. From a medical perspective, I understand that some conditions such as orbital cellulitis, where there is an abscess pressing on the eye, is co-managed by ophthalmology and ENT, as the underlying problem is often a sinus infection which can cause vision loss if not rapidly treated,” Gardner says.
“We also cross-pollinate with emergency medicine, as many eye and ENT emergencies are seen in general Emergency Departments. We train 28 emergency registrars per year from Victoria’s general Emergency Departments on assessment and treatment of eye and ENT emergencies.”
Breakthrough innovations like the cochlear implant are also filtering through to new vision solutions for people with blindness and vision impairment.
In 2012 the bionic eye was born – led by the Centre for Eye Research Australia, the Bionics Institute, the University of Melbourne, the University of New South Wales in a collaboration as Bionic Vision Australia, with the Eye and Ear as the clinical partner – paving the way for vision loss innovation in Australia.
Fast-forward to 2021, with the completion of second-generation trials, participants can now use the device to perform everyday activities in and out of the home. Associate Professor Penelope Allen, the Eye and Ear’s Head of the Vitreoretinal Unit and Principal Investigator at CERA leads this research.
“The hospital was instrumental in preparing for the first-in-human surgeries, and in the postoperative care of the participating patients,” Gardner says.
“When developing the surgical approach, the trial saw a unique collaboration between eye surgeons and ENT surgeons. In particular, Professor Robert Briggs and his extensive experience with cochlear implants made this collaboration successful.”
Gardner adds there is also collaboration between ENT surgeons with ophthalmologists, in particular the oculo-plastic surgeons, for the management of certain conditions such as nasolacrimal obstruction and thyroid eye disease.
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