We commenced 2021 filled with optimism for the start of a new year and used our experience from 2020 to make the most of all available time for student learning. Once again, UNSW went into shutdown in June with student and staff unable to attend campus. We were able to continue telehealth consultations for patient care and student learning, but when it was obvious the lockdown was going to be extended, we negotiated a return to campus for essential patient care.
The clinic staff pivoted to online learning building on their experience from 2020. They worked with students delivering a wide variety of clinical experiences from communications skills, improving differential diagnoses and developing management plans. Small groups and individual sessions, with a variety of tutorials, case presentations, virtual patients, grand rounds, and journal clubs helped to maintain engagement for students and staff. The student experience has been enriched by these adaptations.
We have further embedded strict infection control protocols for students and staff and were able to resume student led essential patient care in September, transitioning to busier clinics once state regulations eased.
A highlight of the year was the three international grand round sessions held throughout the year. The sessions helped us to maintain close ties with our international placement providers. It was a delight to hear case presentations from Makerere University, Uganda, University of Alabama, USA and Hong Kong Polytechnic, Hong Kong and to meet with the many colleagues we have forged partnerships with over the years. The quality of presentations from these schools and our students was exemplary and we were able to exchange clinical experiences across the globe.
Our Clinical Optometry students have again shown a willingness to adapt to such major change with resilience, agility, and enthusiasm despite the impact of changes over two years of their program. The clinic team has once again been outstanding. They returned to campus whilst most other staff in the university have been working from home and committed to delivering excellent service to our patients while ensuring students gained the appropriate learning and demonstrated their competence.
Our clinical teaching has been generously supported by our Alumni who took on hosting our students in Private Practice Placements including replacements for when borders were closed, and our students could not travel overseas or interstate.
Many of these placements were organised with very short notice and in the context of the uncertainty of almost weekly restriction changes. The level of support, guidance and help given to our students was incredible and played a huge role in ensuring our students graduated this year. One of my favourite times of the week is spending an hour with students while they are on placement. I enjoy hearing about the range of experience, the insights they gain from their experience and the enthusiasm that comes from spending time with you (our hosts) whilst on placement.
In 2021, the clinic has been able to upgrade our equipment to enhance our diagnostic capabilities with a Zeiss CIRRUS 6000 OCT and Humphrey Visual Field Analysers (HFA 850 and HFA860) and improve telehealth and teaching capability with additional Topcon slit lamps from Device Technologies and Heine BIOs with cameras. In addition, the Dry Eye Clinic now also has a Lumenis Intense Pulsed Light (IPL) machine.
Our UNSW Optometry Clinic has been generously supported by industry for our instrumentation, contact lens and dispensing presentations and mentoring programs throughout the year.
A huge thanks to the community that creates our future profession: Alcon, BOC, Capricornia, Coopervision, Designs for Vision, Device Technologies, Eyetalk, European Eyewear, Essilor, Gelflex, Humanwear, Hoya, Innovative Contacts, Johnson and Johnson, Medmont, Menicon, Opticare, Optimed, Optos, Rodenstock, Shamir, SUNIX, and Zeiss for their continued support.
Dr Kathleen Watt
UNSW Optometry Clinic Director
UNSW went into shutdown in March and as a result the clinic was closed to the public for the first time in its history. While our face-to-face teaching was suspended, clinics were quickly transformed into virtual experiences and online patient simulations. The clinic staff took on the challenge and by working together were able to create exciting and contextually appropriate content to enable practical outcomes for our students. The transition to online also facilitated increased collaboration between academic and clinical staff.
Upon return from lockdown the clinic itself has undergone major reform. Not only with the addition of PPE, stricter hygiene protocols and social distancing restrictions, but the clinic structure itself. Students now perform a telehealth history and symptoms consultation with their patients prior to appointments. This has led to improved patient attendance, increased rapport, and enhanced patient outcomes. This change also facilitates student learning by giving them time to prepare for the patients. Protocols designed for COVID conditions have become routine in our clinical practice.
We were not able to welcome students on placement from overseas optometry school to our clinics this year due to travel restrictions. However, we were able to share some of our teaching experience with overseas optometry schools and we are planning to maintain those close ties with joint teaching sessions including online Grand rounds sessions in 2021.
The adaptation and incorporation of online teaching as an adjunct learning tool for practical based tasks has given students an enriched experience that has benefitted their training. Many of the innovative teaching that COVID made necessary will be used to enhance student experience into the future.
Students have shown a willingness to adapt to such major change with resilience, agility, and enthusiasm. Despite the challenges of 2020, we have had a highly successful and fruitful year filled with innovation and change. The clinic team has been outstanding and was recognised in the Dean of Science’s Staff Excellence Awards as recipients of the Excellence in an Operational Role Award Winners.
This year we would particularly like to thank the many generous Alumni who took on hosting our students in Private Practice Placements or replacement placements when borders were closed, and our students could not travel overseas or interstate. Many of these placements were organised on very short notice and faced the uncertainty of almost weekly restriction changes. The level of support, guidance and help given to our students was incredible and played a huge role in ensuring our students graduated this year.
And once again, the clinic has been generously supported by industry with support for our instrumentation, and contact lens and dispensing presentations and mentor programs throughout the year. Alcon, BOC, Capricornia, Coopervision, Designs for Vision, Device Technologies, Eyetalk, European Eyewear, Essilor, Gelflex, Humanwear, Hoya, Innovative Contacts, Johnson and Johnson, Medmont, Menicon, Opticare, Optimed, Optos, Rodenstock, Shamir, SUNIX, and Zeiss.
Dr Kathleen Watt
UNSW Optometry Clinic Director
Our clinic had an international feel this year as we welcomed students from the Polytechnic University, Hong Kong, Institut Superieur D’Optique (ISO), France, and for the first-time students from Aston University, UK and the University of Alabama Birmingham, USA. The students spent between two to six weeks in the clinic and were involved in our primary care and other focused interest clinics including advanced contact lenses and myopia control. Hosting students from overseas gives our students a better understanding of the education and practice of optometry around the world and opens placement opportunities for our students.
The final year Private Practice Placement was an enormous success due to the generous support of optometrists in greater metropolitan Sydney. Over 89 optometrists took on students throughout the 2019. The close mentoring, they receive has enabled students to develop and apply their clinical and professional skills and take an active role in the care and management of patients in all parts of a patient’s clinical care. By gaining experience an authentic workplace setting, they are better prepared for work on graduation. Our thanks go to the many Alumni who have taken students on for this experience.
This year UNSW transitioned from a two-semester academic year to three terms (T3). In each term the student course load is reduced compared to the semester timetable resulting in an equivalent load over a year. Students return to campus in early February and the final term finishing in December. Moving to three terms has had several positive impacts for our clinic. Students are on campus for longer throughout the year which has helped with our patient numbers. In the first half of the year, we only had our final year students in the clinic which gave us the opportunity to increase their clinical experience earlier in the year. Whilst there have been some adjustments required to accommodate this change, we are looking forward to another successful year of T3.
Once again, the clinic has been generously supported by industry with support for our instrumentation, and contact lens and dispensing presentations and mentor programs throughout the year. Alcon, BOC, Capricornia, Coopervision, Designs for Vision, Device Technologies, Eyetalk, European Eyewear, Essilor, Gelflex, Humanwear, Hoya, Innovative Contacts, Johnson and Johnson, Medmont, Menicon, Opticare, Optimed, Optos, Rodenstock, Shamir, SUNIX, and Zeiss.
Dr Kathleen Watt
UNSW Optometry Clinic Director
In 2018 we were excited to re-launch our Dry Eye Clinic with Dr Maria Markoulli (see video) as the clinical lead. The re-launch was prompted by the recently published report called the Tear Film and the Ocular Surface Society (TFOS) Dry Eye Workshop II (DEWS II). The UNSW Optometry clinic has re-aligned procedures for diagnosis and treatment to be consistent with the TFOS DEWSII framework, employing state-of-the art instrumentation for these purposes. In this clinic, the management of dry eye is tailored specifically to each patient following a comprehensive assessment. The Dry Eye clinic is equipped to serve our Alumni and colleagues who may either request a suite of tests or both a suite of tests and management of the condition.
Assoc/Prof David Pye and Dr Gavin Boneham conduct an Advanced Contact Lens Clinic on Wednesdays. They fit contact lenses to patients with challenging corneal conditions including post graft, advanced keratoconus, post refractive surgery and cosmetic lenses for conditions such as micro-ophthalmus, corneal injuries and congenital conditions. They are always happy to accept referrals from optometrists and ophthalmologists.
Our Myopia control practice continues to grow. We welcome Ms Rebecca Dang into the role of Staff Optometrist in collaboration with Dr Pauline Kang. The clinic offers an evidence-based practice approach to myopia control including low dose atropine, orthokeratology and bifocal contact lenses.
Our ‘Establishing and Managing an Optometry Practice’ course has just been completed is 8th year with Tony Simon facilitating. Tony brings and energy and enthusiasm to the course and gives the students great insight into the challenges and rewards of starting or managing optometry practices in Australia.
The UNSW Optometry clinic, students and staff thank Tony Cosentino of BOC Instruments for his long and valued association with the UNSW Optometry Clinic. He supplied the first AO phoropter heads to the clinic in 1972 and has been supporting the school ever since. With almost 50 years’ experience in the industry, he has seen a lot of developments in ophthalmic instruments.
Tony is keen to ensure that students have access to the technology of tomorrow whilst they are in the clinic. His continued commitment to future optometrists has been evident with loaning and continual upgrading of instruments. BOC Instruments supplied the clinic with an upgrade to the Tonoref III autorefractor, tonometer, keratometer and pachymeter.
In addition to all the support we have already received, BOC Instruments has donated over $70,000 worth of equipment to the clinic. This very generous donation is highly appreciated as it will allow the clinic to continue to provide our students and patients with access to the latest diagnostic equipment available
When I was first invited to practise at the provisional eye clinic at the Newtown Asylum Seeker Centre, I was elated that the efforts of myself and colleague/dear friend Homma Ebrahimi (through our honours research project) had culminated into a working pathway for Asylum Seekers with no access to Medicare to be able to have both comprehensive ocular examinations, and access to relevant goods such as spectacle correction or therapeutic eye drops.
But anticipation rarely mirrors experience; upon entering the facility, I was greeted by a middle-aged woman with blood red hair, styled with blunt bangs, and an edgy undercut. She was dressed in tartan pants tucked into knee-high socks, suspenders, and a beanie. Health Manager Kerry. My inner/repressed Avril Lavigne was screaming. I knew this place was going to be something.
After becoming so accustomed to automated procedures in corporate Optometry (à la autorefractor, NCT, automated phoropters, and retinal photography), working at ASC has brought me back to foundations and allowed me to re-examine my appreciation of the art of Optometry. Be it the gold standard of applanation tonometry, or the benefits of natural viewing posture with trial frame refraction (particularly relevant to patients who use eccentric directions of gaze), this clinic has also reminded me of the benefits of these foundational techniques that cannot always be obtained from automated contraptions. Keeping it real though, that is not to say that retinoscopy and refraction for a high astigmat with no method of focimetry besides ‘lens neutralisation’ is an art form that I look forward to partaking in! So, if anyone has a spare focimeter to donate, it would be much appreciated! On that note, I would like to thank UNSW Optometry Clinic and the Essilor Vision Foundation for being so generous in donating their equipment and prescription spectacles, respectively.
I have gotten to know the stories of each patient I see and have learnt so much about how the patient’s circumstance and state of mind influences the approach we as clinicians should take with communication. For instance, I have a young patient who had fled 3 countries and remained stateless** through it all. Never having a place to call home, never having given rights, or living in a place where he is not a second-class citizen imparted a severe distrust in institutions within him. Of course, that would account for his fearful and distrustful stance upon first meeting me. It is our role as primary care givers to disarm that fear by getting to know the patient. And this goes beyond the traditional confines of optometry. Many would agree that our field can be one of the least confronting or invasive type of health care assessment, and in my experience here, I could see how I functioned as a portal for trust in the health care system. Said patient had poorly controlled diabetes and a complex related to insulin therapy, even though he terribly needed it. As a result, he has a cataract causing vision in his left eye to be best corrected to 6/48, no improvement with pinhole. It stemmed from the memory of his mother passing away while taking insulin medication (even though it wasn’t the cause of her passing). Through building rapport, (in this case as simple as bonding over how the pinhole worked!) I was able to open the dialogue on his diabetic management, and warm him to the idea of insulin therapy.
One fundamental lesson I have learnt is not to make assumptions about asylum seekers; I have seen the spectrum from patients who were too embarrassed to request free single vision spectacles, and another who presented to the ASC wanting breast augmentation surgery!
Through my work at the ASC, I have learnt how to communicate despite language barriers, and less predictably, got the opportunity to have an in-depth understanding of the patient, with access to blood work, medications taken, and emotional histories. My experience here has shown me the value in and encouraged me to pursue knowledge of the patient’s health status more formally, and to be more patient. I was surprised to know that this kind of impact is universal across patients of all backgrounds; the practice I work at formally is in an affluent area, and one day I detected an epiretinal membrane with vitreo-macular traction in a patient on routine review. She was from China, visiting her daughter on holiday. She came back into the practice a few months later for a clinical review, and I was met with the predictable reaction of front of house asking if it could be a ‘quick one.’ Upon probing I found that because of her diagnosis here, she developed a confidence in the surgeries available in Australia, and so arranged for a second trip back here just for the operation. After the membrane removal, the patient developed a cataract, and wanted counselling on its cause and prognosis, because she had felt so much trust from her first consultation with me. I was thankful for my experience with ASC because it allowed me to have the patience and understanding that really embodies the value of ‘quality and continuity of care’ as opposed to being overly fixated on convertible tests… patients are people too!
Aside from my clinical life, having such an active role at the ASC has helped me in my personal life and pulled me out of an inner slump and into an active mindset. It continues to be both a challenging and rewarding experience.
The school welcomed students from The Hong Kong Polytechnic University School of Optometry and Vision Science and the Institut Superieur D’Optique in France in July this year. Students from Hong Kong were on a four-week placement while the students from France spent six weeks in the clinic. It was fascinating to learn from the students how eye care is delivered in different parts of the world and to compare their training. The feedback we received from the students was overwhelmingly positive. The clinic patients were also impressed. In addition to all the benefits of having international guest, hosting students on placement has given our students the opportunity to attend international placements on exchange.