KD Wallace Eyecare: Modernizing Screening in UK Community Practice

The evolving role of UK community optometry

Community optometrists in the UK play a central role in the early detection and monitoring of glaucoma. For many patients, the optometry practice is the first point of contact for visual field screening, identification of glaucoma suspects, and follow-up before referral to hospital eye services.

This responsibility is becoming increasingly important as demographic pressures reshape the healthcare landscape. According to the Royal College of Ophthalmologists in The Way Forward – Glaucoma report, the UK population aged over 75 is projected to increase by more than 80 percent between 2010 and 2035, while the population aged over 85 will more than double. In parallel, glaucoma prevalence is projected to rise by 44 percent between 2015 and 2035, with ocular hypertension increasing by 16 percent and glaucoma suspects by 18 percent. These figures point to a sustained rise in demand for visual field monitoring and long-term follow-up.

At the same time, hospital eye services are under significant strain. The current situation has been described as “a perfect storm of increased demand” driven by an ageing population requiring long-term care. Outpatient ophthalmology activity has increased by around 40 percent over the past decade, and backlogs remain a persistent concern.

As further highlighted in The State of the UK’s Eye Health 2022 report, NHS eye care services are facing record waiting lists, with hundreds of thousands of patients awaiting ophthalmology appointments. The report documents cases where delayed follow-up has contributed to avoidable vision deterioration, underlining the urgency of improving capacity and care pathways.

As a result, efficient glaucoma services are becoming essential to the future care model. Community optometrists are increasingly responsible for early detection, routine testing in asymptomatic patients, referral refinement, and reducing unnecessary hospital visits. Yet they must deliver this expanded role within standard appointment times, limited space, and rising expectations around patient comfort and experience.

With glaucoma cases projected to rise by nearly half over the next two decades, faster, reliable, and patient-friendly visual field testing is no longer a convenience. It is a structural requirement for sustaining community-based eye care and easing pressure on secondary services.

About the practice: KD Wallace Eyecare

KD Wallace Eyecare is an independent optometry practice based in Edinburgh, Scotland. The practice serves a broad community patient base and places strong emphasis on efficient, patient-friendly care within the structure of standard appointment times.

The clinic performs between 25 and 50 visual field examinations per month, primarily for screening and routine community testing, as well as providing a brand new community glaucoma service. As is typical in UK community optometry, many of these patients are asymptomatic individuals undergoing precautionary checks, alongside glaucoma suspects who require monitoring before potential referral to secondary care.

The practice is equipped with both a Humphrey Field Analyzer (HFA) and the VisionOne™ VR-based perimeter. While the HFA remains available when needed, VisionOne™ has become the primary screening device in daily practice. Having both systems on site has allowed Kevin Wallace to compare traditional bowl perimetry and VR-based perimetry directly in real-world clinical conditions.

Over time, VisionOne™ has become his preferred tool for routine screening, as well as for patients who struggle with conventional perimetry. This side-by-side experience provides valuable insight into how newer technologies can integrate into, and potentially improve, established community workflows.

The challenge: Limitations of traditional visual field testing

Before integrating VisionOne™, KD Wallace Eyecare relied primarily on conventional perimetry systems such as the Humphrey Field Analyzer (HFA). While clinically established, traditional bowl perimeters come with practical constraints in a busy community setting.

Startup and calibration can be slower, patient positioning more demanding, and the equipment itself is fixed and non-portable. For certain patients, especially those with posture difficulties or reduced mobility, maintaining the required position during testing can be challenging. In some cases, patients struggle to complete the examination at all, or fatigue affects the reliability of the results.

Operationally, this can reduce flexibility within appointments and requires careful management of patient flow around a single, stationary device. For a community practice focused primarily on screening, where efficiency and patient cooperation are essential, these limitations become particularly relevant.

Implementation: How Kevin Wallace integrated VisionOne™

Picture : the PeriVision system (in the center on the table) fits neatly into the practice and does not require a dedicated room like traditional perimeters.

Kevin Wallace introduced VisionOne™ primarily as a screening tool within his routine community optometry workflow. In daily practice, it is used for quick confirmation that a patient’s visual field is normal, as a first-line screening tool during standard eye exams, and for patients who have previously struggled with traditional bowl perimeters. It is also particularly useful in situations where faster throughput is required without compromising clinical reliability.

In terms of testing strategies, Kevin Wallace mainly uses the 24-2 program with the SORS strategy, as well as supra-threshold protocols for rapid screening. While the practice still has a Humphrey Field Analyzer available, VisionOne™ has become his preferred option whenever appropriate.

The reasons are practical and workflow-driven. VisionOne™ offers easier and faster setup, a quick startup process, and streamlined patient registration. Patients can keep both eyes open during testing, which feels more natural. Kevin Wallace also reports improved fixation performance in many cases and appreciates the real-time gaze fixation monitoring provided by the system.

As he explains:

“I use the VisionOne system mainly as a screener, particularly when I want a quick test just to verify someone’s visual fields are full. I also always use it for people who have had trouble using a traditional field screener.”

Patient experience: Comfort and acceptance

One of the most noticeable changes after introducing VisionOne™ has been patient acceptance. According to Kevin Wallace, approximately 95% of patients prefer VisionOne over traditional visual field testing. The format feels more modern and engaging, and particularly younger patients respond positively to experiencing new technology as part of their eye exam.

Many patients describe the test as less intimidating than conventional bowl perimeters. The headset format, the ability to keep both eyes open, and the guided flow of the test contribute to a calmer and more natural experience.

For patients with physical limitations, the benefits are even more apparent. Those with posture difficulties or challenges maintaining a fixed position in traditional perimeters often perform better with VisionOne™. Some patients who were previously unable to complete an HFA test are able to complete the VR-based test without difficulty. Reduced physical strain during testing further improves cooperation and reliability.

As Kevin Wallace notes:

“Almost all patients prefer this test over traditional visual fields too, particularly younger patients who enjoy doing it and seeing the latest technology.”

Overall, VisionOne™ supports better engagement during testing, reduced fatigue, and a higher level of comfort, all of which contribute to a smoother and more patient-friendly screening experience.

Workflow transformation: One year of efficiency gains

Since integrating VisionOne™ into daily practice, Kevin Wallace has observed a clear shift in how visual field testing fits into his clinical workflow. What began as a screening tool has, over the course of a year, become the preferred device for routine community testing.

One of the most immediate improvements was operational flow. VisionOne’s quick startup time and smooth patient registration process allow visual fields to be completed within the same appointment, without asking patients to return later or move between rooms. This contrasts with traditional perimetry systems, which often require more preparation time, positioning adjustments, and supervision.

Compared to conventional bowl perimeters, VisionOne reduces setup complexity, simplifies patient positioning, and minimizes physical constraints. Patients can keep both eyes open during testing, and real-time gaze fixation monitoring provides reassurance about test quality. The intuitive interface and compact box design, including its integrated charging cable, make the system easy to manage in a busy optometry setting.

As Kevin Wallace explains:

“The quick startup time and patient registration process is ideal and allows me to complete the appointment without bringing patients back.”

After one year of use, the impact is clear. Screening is faster, appointments run more smoothly, and visual field testing integrates more naturally into routine consultations. Kevin reports high patient satisfaction, reliable fixation performance, and improved efficiency.

“I have enjoyed using the VisionOne system for the last year. It is popular with patients and efficient to use in community practice.”

For KD Wallace Eyecare, VisionOne has evolved from a complementary device to a central component of modern, efficient glaucoma screening.

Key takeaways: Supporting community eye care at scale

The experience at KD Wallace Eyecare illustrates more than a local workflow improvement. It reflects how innovation at practice level can contribute to addressing wider structural challenges in UK eye care.

As outlined in the introduction, the UK is facing a projected 44 percent rise in glaucoma cases by 2035, alongside significant growth in the over-75 and over-85 population groups. At the same time, hospital eye services are experiencing increasing outpatient demand and ongoing capacity constraints. In this context, community optometry plays a critical role in early detection, monitoring, and referral refinement.

The case of KD Wallace Eyecare shows how VR-based perimetry can support this expanding responsibility by offering:

• Faster screening without compromising reliability

• High patient acceptance, with around 95 percent preference compared to traditional testing

• Better usability for patients with posture or mobility limitations

• Both-eyes-open testing combined with active fixation monitoring

• Seamless integration into routine community appointments

  
  

By reducing friction in testing and enabling efficient in-appointment screening, VisionOne™ helps practices manage higher patient volumes while maintaining quality standards. Faster, more comfortable testing can encourage adherence, support earlier detection, and make more frequent monitoring feasible when clinically indicated.

For independent practices across the UK, this is not simply a matter of convenience. It represents a practical response to growing demand: improving access to reliable visual field testing, supporting primary care capacity, and contributing to a more sustainable model of glaucoma care nationwide.

Importantly, VisionOne™ is supported by ongoing clinical validation and research initiatives, ensuring that workflow efficiency is matched by diagnostic reliability.