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Managing Eye Health in Goondiwindi

Goondiwindi, on the MacIntyre River in Queensland near the New South Wales border, is best known for being home to “The Goondiwindi Grey” – that champion racehorse Gunsynd – who reigned supreme in the ‘70s. Other than that, the town of 5,600 people revolves around agriculture, mining and engineering.

It’s here, that optometrist Steven Smith chose to buy into a practice 21 years ago, 350km south west of his home town of Brisbane.

Steven Smith says taking on a practice in Goondiwindi is a decision he will never regret. Back then, in 1995, he was a relatively young optometrist looking for a tree change.

“I graduated from Queensland Institute of Technology (now QUT), in 1982, completed my diagnostic drugs certificate in 1990. I’d been living and practising in Brisbane and I was looking for a change in direction.

“I heard that optometrist Graham Todd was retiring and that his younger partner (Ross Cooper) was buying him out. Ross was looking for a business partner and so we made contact. Buying into what is now known as Cooper and Smith Optometrists was the best decision I ever made. Goondiwindi is a great place to live and I’ve got a great business partner. Ross runs our Moree practice 120 km away in Northern NSW and I’m based here.”

With no ophthalmologist in town, and a two hour trip to visit an eye specialist… the role of a regional optometrist quickly expands

Steven said living and working in a small town gives him the greatest opportunity to immerse himself in his professional career while also making the most of his free time. “I love that everything is close. It’s a five-minute leisurely bike ride to work; in less than 10 minutes I can have my kayak in the water for a relaxing paddle along the MacIntyre River; and I get involved in a good selection of sporting activities (golf, football, cricket, squash, netball, TaeKwonDo, and regular trips to the gymnasium).”

He said he also enjoys Goondiwindi’s cultural life, which offers local theatre groups, the annual Gourmet in Gundy Food and Wine Festival; an art gallery, museum, movie theatre… the list goes on.

A Different Kind of Working Experience

“I think the best thing about country practice is that you get the opportunity to talk to your patients and get to know them as people with real lives, families, aspirations, and challenges. As a multigenerational practice, I see everyone from the newborn to the geriatric population – and the scary thing is I have been here so long I am now starting to see the children of those I first saw when they were children.”

Along with everyday refractions and managing patients with glaucoma, cataract and wet and dry macular degeneration (having gained his Graduate Certificate in Ocular Therapeutics in 2007), Steven said he removes foreign objects from eyes on a daily basis, often removes sutures and on occasion, has diagnosed less common and more frightening eye diseases such as birdshot retinopathy and retinoblastoma.

With no ophthalmologist in town, and a two hour trip to visit an eye specialist in Toowoomba, Steven said the role of a regional optometrist quickly expands.

“Over the years we’ve had a number of visiting ophthalmologists and that’s great. They’ve all been fabulous. We’ve worked together really well. They come into the practice and are able to use our equipment, and I find their perspectives on managing different eye conditions very instructive. But unfortunately there isn’t enough work here to keep them here.

“As a consequence of that, I’ve been co-managing patients with ophthalmologists here since before therapeutics prescribing. Often ophthalmologists will ask GPs to refer patients on to me for this very reason.

“I regularly co-manage patients post-surgery, for instance ocular adnexa, and anterior and posterior segment cataract (from day-one post-op), pterygium, oculoplastics, glaucoma (laser and incisional), retinal (including retinal detachment, epiretinal peel). Ongoing co-management of patients with glaucoma and uveitis are the most common,” said Steven.

He said co-managing patients is now second nature, however it’s always good to know there is an ophthalmologist on the end of the line if complications arise.

“I’m very comfortable co-managing most conditions and if I have any concerns at all, I always call the referring ophthalmologist to talk over the patient’s eye condition and the approach. When you’re working in any profession, you need to know your limitations – you need to know when to send a patient on to a specialist,” he said.

Collaboration With Other Medical Providers

“I also work closely with the GPs to diagnose and manage patients with all kinds of diseases. Sometimes it’s the GPs sending me patients with acute disease presentations, following trauma and motor vehicle accidents or cerebrovascular accidents for instance… sometimes it’s me sending patients to GPs having identified other conditions.”

At a Rotary meeting a few years back, a GP told the story of how, on his very first day as a GP in Goondiwindi, Steven had saved a life by referring on a patient with high blood pressure. Steven explained the turn of events in greater detail. “I examined the patient’s retina and could see there was a problem, so I immediately checked his blood pressure and it was ridiculously high. I sent him straight on to the GP for monitoring and treatment. Had I not done so, the patient was likely to have had a stroke,” he said.

Steven also collaborates with medical providers in his local area through the Chronic Disease Management Network (cdmNet), an online web-based service designed to help practices take a systematic approach to managing patients with chronic disease. “This is a fantastic program allowing the collaboration of medical and paramedical health practitioners to share information and better manage patients with chronic diseases including diabetes. Anecdotally my impression is the co-ordinated management of these patients has led to improved management and better outcomes as demonstrated by a reduction in the occurrence and severity of diabetic eye disease in our community,” he said.

Scope for Improved Service Delivery

Steven said there is plenty of scope to improve the delivery of eye services to regional Australia but this will require extensive collaboration and careful planning. “Improvement of eye health in rural Australia is all about the provision of services and to do this it must be made economically viable with improved incentives and programs; and better co-ordinated to prevent the duplication of services and waste of precious resources.

“There are some great organisations/ideas out there like The Fed Hollows Foundation, Ideas Bus, and the Brien Holden Vision Institute but I think services could be more efficiently and cost effectively delivered if all providers took the time to research the services already available in areas they are considering visiting; and if they were to communicate with local providers to ascertain whether additional / alternative services would benefit the local population or whether the practitioner may like to work in conjunction with them.”

He said the recent advent of teleconferencing item numbers paved the way for improved accessibility to specialist care, by reducing travel times and its associated cost; which in turn reduced the risk of non-attendance; and time wasted for minor or inappropriate referrals.

From his own perspective, Steven said leaving the practice to deliver health services to people who live outside Goondiwindi, has its challenges. “The logistics of travel are daunting at times (I travel to St George, which is only two hours away, but a day trip means driving at the worst possible times, dawn and dusk). I’ve had more than my share of animal strikes, fatigue, time out of practice, and vehicular wear and tear.

“The financial return is also poor as the greater proportion of these clients are on Centrelink. I tend to view the trip as more a community service for the socially disadvantaged (but then again I still do home and retirement village visits). Certainly the whole delivery of optometry services to smaller and remote centres would become totally unviable should the Visiting Optometrists Scheme be downgraded or abolished.”

Steven says despite the challenges, he won’t be running away. “I love my job and I really enjoy living in Goondiwindi so I’m here for the long-haul. Optometry is a fantastic profession which has, and continues, to evolve into a most engaging career.

“On a side note, I would like to publically express my deepest respect and most sincere appreciation to the teaching institutions and their staff; and Optometry Australia, its office bearers and staff for their tireless and often unrecognised effort in making optometry the great profession it is today.”

A Day in the Life of a Regional Optom

mivision asked Steven Smith about a few of the stand-out experiences and insights he’s had since practising optometry in Goondiwindi.

Most uncommon diagnosis: “That’s easy – serpiginous chorioretinopathy.”

Most left field presentation: “The first time the local vet brought in a dog for tonometry.”

Most frightening diagnoses: “Retinoblastoma, advanced choroidal melanoma.”

Most challenging case: “An emergency presentation by a patient with angle closure glaucoma. I treated the patient by the text book, using topical intraocular pressure drugs. The intraocular pressure was brought down to acceptable levels within a few hours and I referred the patient on for medical management / laser iridotomy. The patient had no long-term vision loss.”

Greatest daily challenge: “Just running a business in challenging economic times. It’s important to keep your finger on the pulse and adapt quickly.”


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