Looking to the future: Why Scotland is at the forefront of delivering world-class eye care

As the University of the Highlands and Islands prepares to launch Scotland’s first new optometry degree in 50 years, lecturer Judith Banks explains why the profession has so much to offer and why Scotland is leading the way in providing world-class eye care.

I am no longer a particularly young person, but I remember clearly (for the most part) my school days, my time as an undergraduate and the twenty years of my career to-date. It was quite a different proposition to the challenges, opportunities and technological developments that young people and career changers face today.

My field is optometry and I think it’s safe to say that some of the advances made in this area would have been hard for most of us to accurately predict two decades ago.

glassesTraditionally, optometrists would largely be involved in assessing someone’s need for spectacles or contact lenses, providing these and detecting any disease or abnormality, with a view to referring to an eye clinic.

Over time, this role has evolved and optometrists can now offer a wealth of services. More eye conditions can be diagnosed and managed within a community practice setting. Some optometrists have additional qualifications to allow them to prescribe medicines and treatments, rather than referring to a GP or ophthalmologist. There is, in some areas, an opportunity to work in increasingly extended roles.

Technology too has moved forward, with tests like optical coherence tomography, where the layers of the retina (which are structures that are not normally visible) can now be imaged and inspected at your high street optometry practice. This has offered great advances in the care of those diagnosed with certain eye conditions and reduced the need for other, more invasive procedures.

Doctor and patient in ophthalmology clinicAs more of us live longer and more treatments and technologies become available, there will doubtless be increased demand on eyecare services. Hospital departments such as accident and emergency and eye clinics are already overstretched, and optometry is well placed to make a significant contribution towards addressing this issue. We can forge ahead with further evolving and refining the services we can offer and continue to support our patients and our hospital services. While there are challenges, this offers exciting opportunities. Indeed, it has been suggested that optometry practices could become “hubs of care in the community.”

Scotland has led the way with this, taking a big step forward in 2006 when universal, publicly funded eye examinations were made available to the entire population of Scotland, without means testing. In tandem with this, a new contract for delivering these services was negotiated with the Scottish Government. This required all optometrists offering NHS work to undergo additional assessment and required that all practices be equipped to a similar standard, in order to offer even more comprehensive eye health assessments to the public.

NHS Grampian went further, launching the Eye Health Network, which further embedded optometrists as a first port of call for patients with acute eye care needs. This service uses formal agreed protocols to achieve consistency of care, with support for optometrists from a Clinical Decision Unit. Audit of results has shown that it relieves pressure on the hospital eye clinic and on local GP practices. And so, we have already seen practices become the first port of call for many patients who would previously have gone straight to their GP or accident and emergency unit. It showcases what optometry can already offer from a public health perspective.

Doctor and patient in ophthalmology clinicHowever, despite the introduction of comprehensive eye examinations which are free at the point of need, uptake of this service varies. Research undertaken by the University of Aberdeen has shown that less people access eyecare from an optometrist in poorer socio-economic areas. Research by Glasgow Caledonian University has previously shown that access to an optometrist is fairly evenly available across all socio-economic areas. This suggests that another important area for optometry to explore is how to promote uptake of our services in areas where this has not traditionally been the case, identifying possible barriers and working to break them down.

The rate of change and the challenges of predicting how future services will look will probably require all of us to have a flexible approach, hone our problem-solving skills and think creatively. Of course, many optometry professionals do this to a great degree anyway, but nonetheless, it can be challenging to keep pace with change.

Inverness Nursing photoshoot, Centre for Health Science, March 2

Change is also afoot in the realm of optometry education, with the University of the Highlands and Islands developing a new BSc (Hons) optometry degree, due to welcome its first cohort of students in September 2020. There are many strands to the decision to develop this programme, including a dearth of optometrists across the Highlands, widening access to the profession and offering a programme that has a special interest in remote and rural practice.

Optometry is a discipline which has so much to offer; the opportunity to help others, diverse career opportunities, continued learning and development, scientific advances and research opportunities. It is a profession which has taken great strides over the last decades and, in Scotland, it can look forward to continuing to be at the forefront of delivering world class eye care services.


Judith Banks BSc (Hons) MCOptom DipTp (IP)

Lecturer in Optometry

University of the Highlands and Islands



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