Career in Focus: From Rural Practice to Hospital-Led Clinics

How the ACO’s Advanced Certificate in Glaucoma became the "official backbone" for a career in hospital optometry

In 2019, Hiromi Yoshikawa was practising in a rural setting, where the distance between patients and specialists often placed optometrists on the front lines of glaucoma management. Facing an increasing number of cases that required treatment initiation and close monitoring, she realised that clinical intuition was not enough. She was looking for what she calls an "official backbone" of training.

Fast forward six years, and the view from Hiromi’s consulting room looks a little different. Now a Clinical Optometrist at Gold Coast University Hospital (GCUH), she is no longer just managing cases; she is building systems. Hiromi has gone from advocating for optometrists to join medical teams to working directly in consultant-led clinics. Her career since 2019 illustrates how advanced education can take a practitioner from the side-lines of glaucoma care to a leading role in the clinic.

We caught up with Hiromi to discuss the lasting impact of her training and why she believes the certificate was "the beginning, not the end."

 

Background & Career Path

Can you briefly describe your current role and clinical setting, and how your career has evolved since completing the Advanced Certificate in Glaucoma (ACG)? 

Hiromi: I had the privilege to take the new position 2 years ago as a clinical optometrist at Gold Coast University Hospital. I currently work in the consultant clinics and optometry-led clinics. Being that my role is a new position within the hospital, I have also been involved in advocating for optometry roles within the hospital as well as building systems for optometry practicing in the hospital. My clinical involvement has evolved significantly since I completed Advanced Certificate in Glaucoma. I have spent more hours working directly with ophthalmologists over the last few years and I have been involved in the educational/clinical groups within Optometry Australia.

What motivated you to enrol in the ACG at the time? 

Hiromi: I was working in a rural area when I enrolled myself in Advanced Certificate in Glaucoma, facing more cases needing initiation of glaucoma treatment and monitoring between patient's ophthalmology appointments. I wanted to gain an official backbone in glaucoma training to boost my confidence and ensure patient's safety and management efficacy. 

 

Impact of the Course

How did the Certificate influence your confidence or clinical decision-making? 

Hiromi: ACG has certainly helped in gaining clinical confidence and to hold my expectation high in the continuing education. Many ophthalmologists have also shown their interest in knowing what ACG has offered and how it differs from the university training, and it is encouraging to know that there is a certain level of approval from many ophthalmologists in holding ACG to warrant participation in glaucoma management.

Are there specific skills or knowledge from the course that you still draw on in your day-to-day practice, five years on? 

Hiromi: Every little piece of information I gained during the course has impacted my practice along the way; however, I found some glaucoma studies (i.e. OHTS study, NTG study) still very useful and referring to in daily practice. I found the lectures on secondary glaucoma, paediatric glaucoma and glaucoma surgeries more informative compared to the university lectures as well as the medication preference on children and pregnant patients.

 

Broader Perspective

How was your advanced glaucoma training perceived by colleagues or supervisors in hospital or academic settings?

Hiromi:  I have had a few inquiries about ACG from hospital ophthalmologists at GCUH and RVEEH in relation to the building of optometry-led glaucoma clinic. I felt that having an official extra training in glaucoma certainly attracted some interest from ophthalmologists and gave them reassurance. However, I think that ophthalmologists heavily rely on trust that is built on observing and confirming clinical competency of an individual optometrist, sharing their clinical preference and criteria, and open communication that is done at an appropriate stage of disease progression.

Looking back, what has been the most lasting professional benefit of the course? 

Hiromi: The most lasting professional benefit of completing ACG is the building a solid platform of confidence, engagement and clinical basic to further explore the way I can involve in glaucoma management in a different environment with a different demand. Completion of ACG was not the final place in glaucoma management but it was rather the beginning to search for more opportunities and potentials for me.

 

Final thoughts

For Hiromi, moving from rural practice to a major university hospital was built on a foundation of evidence-based training. Her journey shows that advanced qualifications are less about the title and more about the clinical authority they provide. With a solid educational background, practitioners can better navigate complex co-management and advocate for the growing role of optometry in hospitals.

Her final recommendation to those considering further study? 

“I would recommend ACG to any optometrists at any career stage especially if they are interested in actively participating in glaucoma diagnosis and management, because the course provides a strong basis of evidence-based clinical knowledge and opportunities to connect with experienced peers and local ophthalmologists for co-management. It also boosts confidence and commitment in our role in glaucoma.”