Bridging the gap between optometry and hospital care

The crucial bridge between optometry and ophthalmology for optimum patient outcomes is taking on a new dimension in the West Midlands.

A faster route to treatment, with ophthalmology-standard diagnostic imaging, is being spearheaded by specialist optometrist Don Williams. Through his experiences of High Street optometry, plus several years of working in medical retina and glaucoma management with the NHS, New Medica, Ultralase, and now Healthharmonie, Don was aware of the need for good diagnostic data.

He set up the Edgbaston Eye Clinic six months ago and it is proving to be a highly effective conduit for treatment of a wide array of eye conditions.

“We know that so many conditions are missed, particularly what we refer to as silent conditions such as glaucoma, other ophthalmic and systemic conditions. You cannot get a good picture of what is going on with just a direct ophthalmoscope,” said Don.

Qualifying from Aston in 2004, Don continued with postgraduate qualifications in glaucoma, medical retina, refractive and cataract surgery from Ulster, whilst working for multiple opticians and eye surgery providers.

His suite of technology at the Edgbaston clinic includes the SPECTRALIS multi-modal imaging platform with MultiColor Module, BluePeak Module (blue laser autofluorescence) and Anterior Segment Module; Kowa’s Stereo 3D retinal camera; the Zeiss 840 with Goldman Kinetic visual field analyser; Keeler slit-lamp and camera with Kapture software; and the Visionix auto-refractor with corneal topographer.

Perhaps providing the template for a national care model, Don has perfected a protocol which is working very well as the interface between optometry and ophthalmology – not just in the Midlands, but with patients coming to him from far afield.

“Patients are referred by ophthalmologists and by optometry colleagues. Many eye care professionals are now recognising the importance of high standard eye care and in having the SPECTRALIS spectral domain OCT as the main diagnostic platform.”

He cites two recent examples –

“A 62 year old lady was referred by an optometrist for further investigations when she noticed the angle of the eye was rather narrow. The patient mentioned occasional headaches on waking. Gonioscopy revealed irido-trabecular contact in both eyes, and the brilliant Anterior Segment Module of the SPECTRALIS showed complete touch between iris and cornea. The patient had surgery and is doing well now.”

Another interesting case involved a coach driver who had had a number of falls –

“I segmented the posterior pole for the ganglion cell layer and this was absent in the upper macular hemifield. The retinal nerve fibre layer was virtually non-existent and visual field confirmed a total inferior field defect. It was a classic case of non-arteritic anterior ischaemic optic neuropathy with disc involvement.”

Never one to stop learning Don is just taking his IP exams and studying for his Ophthalmic Doctorate at Aston. He is looking to use the SPECTRALIS, and perhaps the OCT Angiography Module in his doctorate to examine the different layers of the retina or retinal vasculature. He also believes that this non-invasive way of picking up wet AMD will be increasingly significant with the ageing population.

“The SPECTRALIS is the gold standard OCT so it makes it much easier to compare findings with consultants. All the ophthalmologists that I work with expect a good clinical practice to have a SPECTRALIS as part of their diagnostic arsenal.”

He added –

“I love the clinical aspect of my job and know that I can manage my patients with confidence, and refer with confidence to either NHS or private consultants.”
Don Williams MCOptom BSc(Hons) PgDip Ref&Cat Surg Prof Cert Med Ret
Prof Cert Glauc
Consultant Optometrist

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