The future of Orthoptic/ Optometry interface

1. The future of Orthoptic/ Optometry interface Jane Hanley Head of Orthoptics Belfast HSC Trust

2. Orthoptists • Assess diagnose and treat children with squints , amblyopia and visual problems • Assess diagnose and treat adults with diplopia and /or ocular motility disorders • Are Specialists in assessing vision in the non verbal patient

3. Interesting facts • It is said that 80% of learning occurs through visual stimulation. Vision enables a child to appreciate form, colour, position and movement. It stimulates different aspects of development e.g. hand/eye coordination. • 5-8 % of children may have a vision/eye problem. • 15-20 people each year with amblyopia (lazy eye) in one eye are registered blind in N.I. due to the subsequent loss of vision in the other eye through injury or disease. • 11.8% of blind eyes in the population are blind from amblyopia alone • Amblyopia is the most common visual disorder of childhood (Fielder 2004

4. Orthoptics Currently • Provide Orthoptic led regional vision screening service across NI in accordance with National Screening Council approval and with community nursing and Education providers • Manage the provision of visual fields in some areas

5. Orthoptists in NI • Provide previously mentioned Orthoptic Services in more than 32 sites across province • 33 Orthoptists in NI

6. Vision Screening in Children • Regionally agreed access criteria for referral to Orthoptics from vision screening • In NI this is an Orthoptic led service as recommended by Hall and Elliman in” Health for all children “as approved by the Dept of Health, NSC,community nursing and education providers • This is screening for preventable and treatable eye disease – Amlyopia(present in4.4% of population *) *the incidence and prevalence of amblyopia detected in childhood .public health 1991;105,455-462

7. Vision Screening in Children • All school nurses and health visitors are being /have been trained by Orthoptists post qualification to ensure this is a universal screen with same standards across the province • All 2 year olds will be seen by HV using Vision assessment tool (Sept 10) • All 4-5 year olds will have a vision test • NI has the highest uptake of vision screening across the UK e.g. in northern trust 96% of p1 s had recorded vision test

8. Joint working in NI-existing Orthoptic/Optometric Locations

9. Joint optometric /orthoptic paediatric refraction clinics in NI Belfast : RVH , Mater , Knockbreda, Bradbury, Holywood Arches, Ballyowen, Carlisle*, Cupar St* South East Belfast : :Stewartstown, Downe, Ulster Hospital, N’ards, Bangor, Lisburn HC Southern :CAH, Daisy Hill*, Dungannon, Armagh, Banbridge Northern: Antrim, B’mena, Carrick, Larne, Coleraine, B’money, W’abbey, Magherafelt, Cookstown, B’castle. Western: Altnagelvin, Erne, Omagh and satellite clinics * Clinics run with Ophthalmology

10. Referral to Orthoptics Health Visitor Ophthalmology Others School Nurse GP s Optometry GOS Orthoptic Assessment, Diagnosis and Treatment plan Ophthalmology Optometry GOS Refraction media and Fundus

11. Joint working/Children’s eye care Advisory Group • Recommendations distributed to GOS optometrists regarding paediatric practice in NI (April ‘09) • Forms provided to all GOS optometrists to be sent directly to Orthoptics for feedback (April ‘09) • Audit of above (Spring 10)

12. Vision Strategy/Vision2020 • The World Health Organisation’s (WHO) Vision 2020 programme to eliminate preventable blindness by 2020, provides strategic context for service development. In the UK, stakeholders have developed a UK Vision Strategy inspired by the WHO’s initiative, and the former Secretary of State, Alan Johnson endorsed the aims of that strategy at its launch.

13. Glaucoma Management(skill mix and extended scope) Skill mix 83% offields managed by Orthoptists are performed by Band 3 Orthoptic assistants trained by Orthoptists using regionally agreed competency manual. OCT managed and performed by Orthoptists in 2 trusts Joint Orthoptic/Ophthalmic clinic in western trust Orthoptist carry out pressures, history,OCT with assistants doing fields

14. Extended scope -cataracts • One Orthoptist doing pre and post op cataract assessment • Patient put on waiting list and consented by Orthoptist • Trained by Ophthalmology

15. Stroke and Brain Injury • Currently only substantive post is in Western Trust • Using BIOS guidelines should be 0.2WTE per stroke unit • Regional Orthoptic approach to identify the level of unmet need for Orthoptic assessment in stroke units • Often also need refractive advice about glasses • Orthoptic 2 day Neuro-stroke course held in Dublin and Belfast

16. Modernisation in Orthoptics • Grading for new patients in NI urgent /routine • Regionally agreed access criteria for referral to Orthoptics from Vision screening • Returning referrals that do not meet criteria • Training referrers with regionally agreed CD/manual

17. Future joint working • Special schools need Orthoptists to do vision assessments see “Hall and Elliman”health for all children increased incidence of vision problems(40-50%*) • Following Orthoptic assessment Refraction should be performed in school • Multidisciplinary working in paediatric Low vision clinics *Breakley1995,eye 200

18. Future-Regionally agreed care pathways • NI Orthoptists have agreed 5 care pathways for common Orthoptic conditions • Way forward multidisciplinary care pathways as vast majority of children with amblyopia will see Orthoptist,Hospital Optometrist ,GOS Optometrist and Ophthalmologist

19. Joint working –Benefits of care pathways • Ensure “Lean” working that every patient contact is appropriate without unnessecery over testing • Open communication with every party understanding part in pathway • Ensures patient understanding ,trust ,confidence and prevents mixed messages resulting in poor compliance

20. Thank You