Global Perspectives

Please share with us your background.

I was fortunate to grow up in Bavaria, one of the most beautiful areas of Germany. It’s close to the Austrian border and has fantastic mountains, lakes, and nature. There is so much to do outside in this area, such as hiking, climbing, skiing, and biking, as we have about 12 natural lakes within a 10-km radius with strong winds in spring and autumn; thus, wind surfing and sailing are among the classic sports there as well.

When I began my education in the 1980s, optometry was not a known profession in Germany, so becoming an optometrist was a longer process. Wearing glasses, undergoing strabismus surgery as a young child, and having an interest in crafts shaped my interest in this profession.

Tell us about your training.

In Germany, the study of optics falls under the umbrella of the Chambers of Crafts, and thus I started as a trainee for the mandatory 3 years, after which I joined the appropriate college in Munich. This was a 2-year full-time course from which I graduated as a Certified Optician and Master Optician/Optometrist. Nevertheless, I felt that this level of education was insufficient to meet patients’ needs of fitting contact lenses, providing low vision aids, and performing refractive surgery. Consequently, I studied optometry in Philadelphia at Salus University, formerly the Pennsylvania College of Optometry. Shortly after, I also graduated as a hearing aid professional to have the full spectrum of skills, as many vision impaired patients also wear hearing aids. A couple of years later, I started my part-time PhD program at Cardiff University in the United Kingdom, with two fantastic supervisors, Paul Murphy, OD, PhD, and Christine Purslow, OD, PhD, who specialize in dry eye and contact lenses.

Describe your practice.

After graduating, I worked as a store manager in an optical shop and presented at different conferences offering workshops. I eventually founded Dr. Heiko Pult Optometry & Vision Research as a second foothold, and a couple of years later, I got married, and my father-in-law asked me to manage his company together with his daughter, my wife, Britta Riede-Pult, MSc, Dipl.Ing (FH), who is also an optometrist. We have since been the CEOs of his business, Horst Riede GmbH, for almost 25 years. This company consists of three clinical practices and optician shops, and we offer the full spectrum of optometry, from dispensing glasses to fitting low vision aids and contact lenses, with a focus on specialty lenses (our proportion of rigid gas permeable lenses is around 30%). We also offer full eye examinations and fit patients with hearing aids. We have 30 employees, from administrative staff up to fully certified optometrists.

I work about 55 hours in the clinic, where my daily tasks are divided evenly between practice management and patient care, concentrating mainly on patients with specialty needs. Added to this is my work at my research institute and as a fellow at two universities (Figure 1). A varied bouquet of different tasks makes each day fascinating.

What is the state of health care and eye care in Germany?

The German system is based on craftsmanship, meaning you first need to complete 3 years of training to graduate as a dispensing optician. Having done so, you can obtain a Master of Optics degree by completing at least a 1-year part-time course. Then, you can register at the Chamber of Crafts to run an optician shop, dispensing glasses, fitting contact lenses, performing refractions, fitting low vision aids, and offering vision screenings.

Alternatively, after training as a dispensing optician, you can attend a College of Optics/Optometry, in which most programs last about 2 years. You can also study at a University of Applied Sciences in Optics/Optometry directly after high school, which can confer both a Bachelor and Master's degree. Graduates of these latter two courses of study are allowed to call themselves optometrists, but they do not have more or different rights from a Master of Optics. If you are a Master of Optics and have attended a special, short-term workshop related to optometry, you can also use the professional title “optometrist.” This is not because of reaching a certain skill level, but because “optometrist” is not a protected job title and is not regulated much in Germany, an unsatisfactory situation for those German optometrists who have extensive academic training in the field.

A new association was recently founded that allows you to register as an optometrist only if you are educated in accordance with UK or US principles. The association is working to push that change towards creating an autonomous, educated, and regulated health care profession.

By law, optometrists are allowed to screen patients for various conditions and diseases and to provide recommendations on treatment options, but not to use medications or to diagnose; these services are left to the ophthalmologists. However, this is a grey area, and based on my background, I am able to do in Germany pretty much what I would do in the United Kingdom, where I am also registered as an optometrist. It’s mainly a question of wording and communication to the patient. Optometric services in Germany are mostly not covered by the national health insurance, except for individuals with significant visual impairment and for children, but services of ophthalmologists are covered. As it takes up to 6 months to get an appointment with an ophthalmologist for a regular eye examination, more patients are beginning to trust in optometrists and pay for our services out-of-pocket. In addition, many ophthalmologists refer to us, as they are often snowed under with patients.

What does your scope of clinical practice include?

I specialize in ophthalmic eye examinations, binocular vision, pediatrics, specialty contact lenses, and dry eye. I am also often the last stop for patients with uncommon problems that have not been successfully resolved by my colleagues.

Do you participate in any outreach programs?

My wife is a member of Zonta International and I am a member of Rotary International, so it feels natural to give. This starts with supporting sports clubs, especially youth programs, and sponsoring national and international projects. We offer screening days at schools, as well as home services and services in care homes. Recently, we fit around 100 pairs of spectacles for free, in cooperation with Carl Zeiss AG, for Ukrainian refugees between February and May. In my younger years, I founded a development aid project with two colleagues in a country in West Africa called Burkina Faso. We built up an optician department and lab, where we educated two habitants to run the lab and fit glasses, including performing refractions (Figure 2).

What are some technological advances you find particularly exciting?

Artifical intelligence (AI) would allow us to detect pathologies at the earliest stage, which is commonly asymptomatic, and give us the chance to screen the population easily, comfortably, and from wherever. We would then be able to prevent visually significant pathologies, such as glaucoma, more effectively and start treatment much earlier than we do now. AI would also make a fantastic tool for developing countries and those with a low density of health care practitioners. This is even an issue in some rural regions of Germany, as many professionals tend to settle and practice in large cities.

Another factor that will be important is greater availability of simplified, less expensive instruments. You can now check the fundus by simply using your smartphone, plus some optical adapters. Combining this with AI or use of telemedicine will be a game-changer in those rural areas, where medical care is less accessible.

What are some fun facts about you?

In my professional and personal activities, I always like to be in motion. In my life outside of optometry, I enjoy spending time with my family and children, and I love being in the mountains. I live in Weinheim now, close to Heidelberg, which being in the Rhine valley is likely the warmest and most humid area in Germany. Some of our neighbors have lemon trees in their gardens. This means no snow, even in winter times. Therefore, I often visit the mountains close to the area where I grew up, skiing. I love to do high-level skiing and hut-to-hut winter traverses, as well as some mountain climbing (Figure 3). In the summer, I often mountain bike in the hills behind our house and go windsurfing with my wife on the coast of the North Sea.