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
For those of you who don t already know what we do

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,

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% of fields 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 *Breakley1995,eye 200
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