Clinical and research orthoptist JACINTA WALZ explores how orthoptists are uniquely placed to support patients experiencing vision loss, through initial presentation and diagnosis to therapy, management and rehabilitation.
For patients, the early part of the vision loss journey can be emotionally distressing, and the battery of testing and multiple doctors’ appointments can be tiresome and confusing. Here, the orthoptist is well-equipped to support patients with crucial education alongside empathetic and balanced patient education.
All experiences of vision loss have significant emotional, psychological, and functional implications for patients. In the case of unexplained vision loss these consequences can be exacerbated by multiple doctor visits, complex testing, and lengthy wait-times which extend periods of uncertainty and confusion.
The orthoptist is uniquely placed to be a human face and stable relationship for patients in an otherwise destabilising and often distressing process of vision loss.
Among this suite, visual electrophysiology plays a crucial role in assessing baseline function of the visual system to localise and diagnose disease. Testing itself, is a lengthy and highly specialised process and patients spend up to several hours with a clinician. During this time, questions regarding potential diagnoses, as well as the reasoning for and process for testing often arise. There is a general lack of understanding regarding the need for and process of testing in the general community, and often within the ophthalmic community as well. As a result, patients often present without a background understanding of why they need testing, or what it will look like.
During the appointment, therefore, technicians without ophthalmic expertise are faced with having to provide nuanced counsel or refer patient questions to their specialist at another time. Here, orthoptists are especially skilled to fill this gap, bringing a detailed ophthalmic understanding alongside empathetic patient counsel.
As specialised eyecare professionals, orthoptists are accustomed to providing disease-specific patient education in the clinical space to utilise a deep understanding of ocular anatomy and physiology and clinical experience. This expertise lends itself naturally to providing counsel and education for patients experiencing complex vision loss.
Guiding patients through complicated vision testing is part and parcel of the orthoptist’s role. Testing can be confronting, tiring, and disconcerting for patients when the process is not clearly described or explained. Precise application of electrodes, particularly corneal electrodes, requires detailed knowledge of the eye and visual system to ensure accurate results and protect patient safety. Excellent communication and empathy are also required to support patient cooperation and attention throughout assessment. A need that is only heightened when working with children, and patients with additional needs and disabilities.
In the suite of electrophysiology tests, each one targets a different structure or function of the visual system. While the various electroretinograms (ERGs) can look similar, each is designed to measure different retinal functions, from localised macular function in the pattern and multifocal ERGs, to global rod and cone function in the full-field ERG. To patients, these tests can seem repetitive and tiresome. Without clear discussion of the function of each test, attention can wane, affecting the reliability and accuracy of results, and introducing artefacts that can impact diagnostic interpretation. The technician’s understanding of ocular anatomy and physiology, and their ability to convey this clearly to patients is critical for supporting patients during testing to obtain accurate and meaningful results.
Beyond testing, once a diagnosis is made, orthoptists are well-equipped to journey with patients through accessing rehabilitative and therapeutic support, acting as either the connecting point between multiple external services or making recommendations within their own clinical framework to provide low vision support. Orthoptic expertise in explaining the implications of a diagnosis on functional vision and daily living can help support the patient beyond the testing environment, investing in their material functional needs especially in cases where treatment and recovery of vision is not currently possible.
Journeying alongside patients through their vision loss creates opportunities for orthoptists to work to their full scope of practice. From investigation, diagnosis and counsel, to accessing low vision support, the orthoptist is uniquely placed to be a human face and stable relationship for patients in an otherwise destabilising and often distressing process of vision loss. Creating spaces for these skillsets to be explored and developed to meet an ever-growing need in our healthcare system also supports the growth and development of the orthoptic workforce to provide higher quality, individualised healthcare that supports the patient’s direct needs and goals throughout their eyecare journey.
About the author: Jacinta Walz is a PhD candidate at University of Technology Sydney, and a clinical and research orthoptist and electrophysiology technician at the Save Sight Institute at University of Sydney.
