mi profession

CASA-credentialled, and a lecturer and practitioner at Deakin University, Daniel Thomson was looking for more. And so he jumped into Optometry Australia’s new Advanced Practice Recognition program.

I graduated from Deakin University in 2017 and recently returned to work at the university as a lecturer in optometry. As part of this role, I practise at the Deakin Collaborative Eye Care Clinic in my areas of interest: glaucoma, dry eye management including intense pulsed light (IPL) therapy, and speciality contact lens fitting including orthokeratology and scleral contact lenses. I also offer my services as a Civil Aviation Safety Authority (CASA) credentialled optometrist in my hometown of Bendigo.

I’ve always had a keen interest in understanding disease pathophysiology. Glaucoma presents a particularly interesting disease entity because its molecular basis is not yet fully understood; there is involvement of multiple ocular structures from anterior to posterior.

Diagnosis and ongoing management of the disease is a clinical challenge I am always up for, often using state-of-the-art equipment to identify disease onset and progression through a structure-function relationship. What I enjoy most is that glaucoma forces me to think critically and problem solve, while providing individualised care and forming long-term patient relationships.

When I saw Optometry Australia’s Advanced Practice Recognition (APR) program in glaucoma described, I saw it as an invaluable learning opportunity; a platform to access more advanced CPD, and an opportunity for specific networking beyond the usual conferences and other CPD events.

As I learned more about the APR program, I also recognised its potential to elevate optometrists’ role in the provision of glaucoma care and to support the creation of optometry-to-optometry referral pathways that improve access to the highest-quality care. Enrolling became a no-brainer, despite the anticipated workload.

MANAGING THE COMMITMENT

Completing the program was a significant commitment. Without a research background, I was required to complete a logbook detailing my care for 90 glaucoma patients. I also had to include an evidence-based justification and reflection on each, which proved time consuming; I completed it outside of work hours around family commitments (and had to give up a few rounds of golf!).

Additionally, I had to submit two 3,000-word case reports. Fortunately, I already had two patients in mind for these case reports, and having recently submitted articles to Optometry Connection, I breezed through this process.

I have always found case reports an excellent learning exercise as they force you to challenge your views through a relatively short scoping literature review. The clinical pearls identified can also be valuable to other clinicians.

My first case report described the care of a patient with normal-tension glaucoma (NTG) and considered the systemic risk factors and impact of these on the specific pathophysiology. The report also explored management considerations unique to NTG. My second case report detailed the use of polygenic risk scores (PRS) in glaucoma. Polygenic risk scoring is a new clinical tool that is useful in the risk stratification of glaucoma suspects, sufferers and ocular hypertensives. My case discussed how this tool may change patient management.

Completing both case reports has directly improved my practice in these areas. In NTG patients, I now have a framework for managing unexplained progression despite meeting intraocular pressure targets. Additionally, I have a framework for applying PRS for risk stratification.

BUILDING ON COLLABORATIVE CARE

As glaucoma ophthalmologists become increasingly overloaded, collaborative care relationships are becoming ever more important. Currently, optometry does not have specialities; however equally, the profession is not monolithic. Practitioners have diverse special interests and differing levels of confidence when managing ocular diseases.

APR credentials can help ophthalmologists identify optometrists who are suitably skilled and experienced to collaboratively care for their glaucoma patients. Additionally, APR credentials can help optometrists, who do not have glaucoma management experience, identify colleagues they can refer patients to.

Personally, as demand for Deakin University’s glaucoma clinic grows, I will continue to put my learnings from the APR program into practice and pass my knowledge onto students in my teaching activities.

As trends and scope of practice change, optometrists, as the overwhelming providers of primary eye care, have an opportunity to make an enormous contribution to their local health system. The APR program can help optometrists fulfil their professional potential and provide a higher standard of care for patients in the community, in line with integrated people-centred eye care principles.

Daniel Thomson graduated from Deakin University in 2017. CASA-credentialled, he is a lecturer and practitioner at Deakin University. Mr Thomson recently completed Optometry Australia’s Advanced Practice Recognition program in glaucoma management.