Practising two different health disciplines in his daily life makes audiologist and optometrist LACHLAN SMITH’s career doubly interesting. He gives an insight into how this happened and why it works.
Dual qualifications in audiology and optometry not only make Mr Lachlan Smith unique in Australia but are a huge bonus for his patients.
The multi-skilled audiologist and optometrist estimates that one in four of his patients see him for both eye and ear conditions at his two Melbourne clinics. For elderly patients, particularly, the convenience of being able to see the same practitioner in the same clinic and often on the same day for vision and hearing problems, cannot be underestimated.
Hearing and vision work together and are processed by the brain to provide a total perception of the environment. Smith’s dual disciplines also work in synergy to provide comprehensive services through Smith Eye and Ear Solutions, located in Camberwell Junction and Moonee Ponds.
“Audiology and optometry complement each other,” he says. “It’s very convenient and some of the presentations go hand in hand. If you’re going to complement certain disciplines, this would be the way to do it.
“You don’t need a lot of physical space for audiology so that’s also beneficial.”
While some corporate networks are bringing audiology and optometry under the one roof, Smith says that, as far as he knows, he is the only practitioner in Australia who is qualified as and working as both an audiologist and an optometrist.
Often patients have been a loyal optometry patient, and have developed trust and rapport with him, making for a seamless transition to audiology client. The convenience of a one-stop-shop is valuable and sought after.
The same can be said for his Indigenous patients in remote north-west Queensland. Smith flies to Mornington Island every month to spend a week running eye and ear clinics. Patients include young children with otitis media that can interfere with learning, speech and socialisation, and older patients with hearing damaged from repeated ear infections when they were younger.
This remote work is funded by the Queensland Government which covers the cost of his visits.
Residents often need to travel distances for appointments so the convenience of having a health professional who can examine and treat eye and ear conditions simultaneously at one appointment is a rarity and a windfall for the area.
It’s also difficult for remote communities to attract health professionals, making the dual qualification a bonus.
Smith began the visits through Gidgee Healing, an Aboriginal Medical Centre based in Mount Isa, in 2020 and did them full time for about eight months including during the pandemic before continuing post-pandemic on a part-time basis.
“It’s hard to get patients to come in because of the lack of transport so when they do, if you offer both disciplines and follow-up on referrals, that’s where it’s most beneficial,” he explains. “Sometimes basic stuff is missed through administration errors or just not followed up, so it’s great to be able to pick that up.”
Grandfather’s war-related hearing loss
Smith became an audiologist first before becoming an optometrist. The journey started as a child due to his grandfather’s severe hearing loss triggered by noise exposure during the Second World War.
“It was back in the day when hearing aids weren’t much help,’’ he recalls. “I was around hearing loss a bit as my grandfather introduced me to it. I was looking for something a bit different for a career and had that exposure and it kind of fell into place.”
Smith graduated in audiology from the University of Queensland in 2011 and worked in Cairns for about 18 months for Amplifon before moving home to Melbourne.
In 2013 he opened an audiology clinic in his father Anthony Smith’s Moonee Ponds optometry practice. Smith believes this was Melbourne’s, and Australia’s, first clinic to combine the disciplines at a primary care level.
His father had bought the Moonee Ponds practice in 1996, and previously in 1979 a Camberwell optometry practice, founded by Mr Frank Slade in 1928.
“When I rented a room in Dad’s optometry clinic, Dad was cutting back towards retirement so only working part-time and I was working part-time in audiology,” Smith recalls. During this time, he realised he wanted to also be an optometrist so began studying the qualification at Deakin University, and combined with audiology consulting, this was a hectic period.
“I was among the first to graduate from optometry at Deakin and also among the oldest,” he says. “I think the other graduates thought it was a bit peculiar that I was still studying and what-not being one of the oldest in the cohort.
“Dad came to me with the idea for the dual clinic as he knew Boots and Specsavers in the UK had successfully integrated both services into one business, so it was not completely unprecedented.
“Dad’s clinic was well-established and had a loyal patient base, so we thought it could work well.”
After his father retired, Smith bought the business and it remains a family affair with his optometrist sister, Mrs Hayley Stewart, also working part time in both practices. Their father also continues to do some work there too.
Medical, pathology, counselling and rehab
When asked which he enjoys the most, the answer is, not surprisingly, both. Like most optometrists nowadays, Smith is therapeutically endorsed, so he can diagnose, treat and help manage eye-related medical conditions including age-related macular degeneration (AMD), glaucoma and diabetic retinopathy.
Studies have coincidentally shown a strong association between hearing loss and age-related eye conditions such as cataracts and AMD, suggesting common risk factors for both.
“Although optometry and audiology do complement each other, they’re very different,” Smith explains. “There’s more of a medical and pathology base in optometry, whereas there’s more counselling, handholding, and rehabilitation in audiology, which means audiology consults generally take longer.
“In audiology you might see the same person four to six times (close together for example) whereas in optometry, you probably see them once then not again for a while.”
Advantages of two clinical offerings
As Mr Steven Ross, then business development manager of hearing care solutions company, Sonova, told a large optical event in the UK in 2018, optometry and audiology are a good fit.
“The reason optometry and audiology should meet is because they share the same customer base: 97% of over 65-year-olds need some form of vision correction; 73% of 70-year-olds need some form of hearing correction,” Ross told Optometry Today.
“If you’ve already got the premises, you’ve got the front-of-house staff, you’ve already got the customers. One of the hard things is to get a database. You’ve already got it.”
It’s a recipe Smith has nailed, but not without concerted effort. For example, his optical dispensers and front-of-house staff have become well versed in both disciplines.
“That’s a big issue because if you are busy consulting, it’s handy if front-of-house staff have knowledge about both,” he adds.
Probably the main benefit of starting an audiology clinic in an established optometry business is the ability to attract and retain patients due to the existing client base, he says.
In his Melbourne clinics, Smith sees many children under age five and many people over 55 for both consultation types.
“If they’re having an optometry consult and it’s obvious they have a hearing problem, I mention I can do a hearing test, and alternatively if they’re asking leading questions about their eyes during an audiology consult, I suggest having an optometry consult,” he adds.
Other advantages of combining the two clinical offerings include sharing bookings systems, administration and costs.
Hearing aids are custom-made, so no extra storage or financial outlay is needed for stock. Audiology rooms don’t have to be soundproofed although they must be sound treated to an overall ISO calibration standard.
Smith does not find it difficult to swap hats.
“You get used to it and see patients in different rooms, each set up with different equipment,” he says.
“It takes a lot of time, effort and money but once it’s set up, it works well.”
