Defining Indispensable – Part I: The Patient Journey

Larger than life

I shelter under the awning of Cliff Williams The Independent Optician, grateful for the foresight of the architect. At 9 am sharp, Cliff Williams unlocks the door and ushers me into the cozy confines of his domain. As expected, he’s an amiable and assertive fellow.

After exchanging pleasantries, I mention the unwelcome rain. “Lovely spot you’ve got here, Cliff, but I’m less impressed with the weather in Kirkcaldy.” 

“It could be worse,” he says. I believe him. “And it’s Kirk-aw-dy – we don’t pronounce the ‘c’ or the ‘l’,” Cliff adds in an accent that makes it sound easy. Now you all know. 

Cliff decides that the best way to answer my question about “differentiation for independents” (before I’ve even asked) is for me to enjoy the patient journey – the full tech tour (or more formally, the Zeiss Vision Experience). But as we walk over to his first “toy,” the Visulens 550, Cliff hints at another reality: Even more so in a post-pandemic era, people of a certain age have firmly decided that their savings are best spent on the things they enjoy – and their ability to enjoy them, which includes looking after their precious eyesight and seeing as clearly as possible. They are willing to pay a premium. “They don’t want to settle for second best,” Cliff says. “And they don’t need to.”

The chin rest factor

Cliff is proud of his space – but even prouder of his optical armamentarium. “How many chin rests were you on at your last eye test?” he asks.

“Two, I think.” 

“Ah well – you’ll be on a few more here,” he grins.

Cliff explains how most people think nothing of investing in the latest smartphone technology – happily handing over many hundreds of pounds to access the latest features. Optometry should be no different, he says – technology is always moving forward and each new iteration brings powerful new insights about eye health. And if you can clearly – or, even better, memorably – explain the benefits of more advanced instrumentation to patients, they won’t want to go backwards. “Just like they don’t want to go back to their Nokia 3310,” Cliff notes.

Cliff diligently passes me through just some of the key technology in his practice – enthusiastically describing each piece of equipment in detail as we go. And he delights in creating my 3D avatar using the VISUFIT 1000’s nine mutually calibrated cameras and “many millions of data points” (45 million, to be precise). 

In the meantime, a key member of the team has arrived: Optometrist Scott McKay (notably, also an independent prescriber). Scott is driving the Visuscreen 500 and Visuphor 500, the digital slit lamp, and the CLARUS 500. Starting with the results from the i.Profiler Plus, the softly-spoken Scott guides me through a streamlined workflow with the most calm, conscientious, and caring “bedside” manner. He captures 200 degree ultra-wide field retinal images with the CLARUS 500 – and shares a personal story about finding the unexpected (see Defining Indispensable – Part III). I feel thoroughly cared for.

Donuts, butterflies, and tablecloths – a summer picnic for the eyes

Finally, we reach the “pièce de résistance” – the CIRRUS 6000 AngioPlex. OCT has played an indispensable role in Cliff’s practice both clinically and financially since 2009, when Cliff invested in the CIRRUS 4000. But this latest bit of kit sits at the top of the Zeiss OCT food chain and takes pride of place in Cliff’s fully networked practice – the altar of a Zeiss shrine. (Remember: Cliff’s patients don’t want second best.) He describes how he was the first optician in the UK to invest in the CIRRUS 6000. But, ever the pioneer, Cliff isn’t worried about the initial cost; he has proven to himself (and his accountant) time and time again that investment in the right – the best – technology always pays off. Cliff has come up with the canny combination of attracting the right patients, providing a premium service with the best technology, and giving them many reasons to return.

Cliff performs numerous scans of my eyes – all red lines and flashes (more technically, 100,000 A-scans per second) – “Try to keep still, but don’t worry too much – the machine automatically pauses, if you blink or move your eyes,” he says. Next, he reaches to the back of the machine to pick up a small wooden case with a brass fastener. Inside are two additional lenses that he fastens to the CIRRUS one after the other with satisfying magnetic snaps; he’s also going to perform corneal, anterior segment, and wide angle-to-angle imaging… 

I’ve seen a fair few OCT images in my time (one privilege of working on The Ophthalmologist for many years), but it’s clear that the CIRRUS 6000 raises the bar. Cliff & Scott walk me through my scans – paying particular attention to memorable analogies. “This should look like a donut or a small volcano,” Cliff says, pointing to the 3D macular visualization and thickness map. “We like to describe this as a tablecloth,” he notes, referring to the segmented retinal pigment epithelium (RPE) map in 3D. “A tablecloth should be flat; if we see molehills, it indicates dry AMD.” 

“And this is good because it should look like a butterfly,” Cliff says, with accompanying hand motions of it flying away – he is referring to my healthy looking retinal nerve fiber layer (RNFL) thickness heat map (based on a 6mm x 6mm cube of data).

“OCT angiography is a real game changer for the practice and the patient,” Cliff exclaims, sharing yet more striking images of my retinal microvasculature – worthy of a small exhibit in the Tate Modern. Essentially a non-invasive angiogram of the eye, captured in seconds, this technology provides vascular detail capable of identifying early diabetic changes in patients prior to them being diagnosed as such. Again, the word indispensable springs to mind – such knowledge would not be available without the CIRRUS 6000 Angioplex.

He also discusses my pachymetry map, which can highlight any corneal irregularities (don’t worry, he says, no one is perfect), with Scott and Cliff going into some detail about the predictive power of OCT goniotomy for angle closure glaucoma – measuring my iridocorneal angle on the fly, while we talk. All the more impressive is how Scott can see the reports pop up on his screen, which is also running ZEISS Forum, alongside all the other images so everything can be reviewed at a glance.

It is notable that I remember these details not because of a video or voice recorder, but because of Cliff’s infectious enthusiasm and ability to use such striking visual metaphors. In practice, Cliff says, this means that patients come back specifically wanting to see their donuts and butterflies – and asking if their tablecloths are still flat and devoid of molehills.

Right now, especially thanks to the CIRRUS 6000, Cliff Williams Independent Optician maintains his edge – not only over many other practices, but even over many NHS ophthalmologists, some of whom have taken to sending Cliff “interesting” cases for imaging. Cliff is proud to oblige.

I would walk five hundred miles…

Anecdotally, Cliff tells me about one of his new customers – from Harrogate (250 miles away) – who booked an appointment (and a train ticket), having been lured by the most advanced technology, the promise of Zeiss lenses, and “the ultimate in accurate lens centration.” A couple of weeks later, Cliff delivered the new glasses himself (he was passing through, delivering specs all around Scotland and England) and enjoyed a chat and a cup of tea with his thoroughly delighted customer in his kitchen – “more of a friend now,” he smiles.

Some would say traveling 500 miles for an eye test and spectacles is extreme. It is. But let me end with this: I didn’t just leave Kirkcaldy (a 300-mile journey ahead of me) with the results of an “eye test” – I came away with total peace of mind. And I suspect, especially for Cliff’s regulars, that’s entirely the point.

Read more in this series:

Defining Indispensable – Part II: The Practice Owner’s Perspective
Defining Indispensable – Part III: The Optometrist’s Perspective