LINDEN CHEN discusses the critical role of early intervention and collaboration for improved paediatric eye health outcomes, and how the StEPS service achieves this.
In my current role as the StEPS coordinator for the Sydney Children’s Hospital Network (SCHN), I have the privilege of overseeing this highly successful program across the South Eastern Sydney Local Health District (SESLHD) and the Illawarra-Shoalhaven Local Health District (ISLHD). As an orthoptist by trade, I bring niche, clinical perspectives to this vital community health initiative. My previous experience as a clinical orthoptist at a private ophthalmology clinic has provided me with a sound understanding of the complexities of paediatric eye health and the critical role of early intervention.
Orthoptists play a pivotal role in the StEPS program, working to the top of our scope to improve efficiency, access, and overall quality of paediatric eye care. In addition to being an orthoptist myself, I manage two dedicated orthoptists – Angela in SESLHD and Suzy in ISLHD.
“Moving forward, it is essential to continue supporting and acknowledging the critical contributions of orthoptists within the healthcare system.”
Their roles include triaging referrals for further assessment and facilitating and maintaining the program’s successful referral pathway and model of care. Angela and Suzy also provide comprehensive secondary vision screening for children requiring further assessment.
They conduct additional vision tests tailored to a child’s developmental level and comprehensively investigate binocularity. Furthermore, they assist in transitioning families to timely diagnostic assessment services and contribute to the training of vision screening staff. The accuracy of orthoptic referrals is also well-documented in Orthoptics Australia president Dr Amanda French’s academic paper, which highlights the success of the program and reliability of our referral processes.1
The program’s success also hinges on collaboration with various stakeholders, including parents, carers, and staff of schools, preschools, and childcare centres. Additionally, collaboration across the state is essential, as I am honoured to work alongside StEPS coordinators from different NSW local health districts.
The community health framework also allows us to interoperate with other disciplines within community care. One recent example involved a child who presented to a community dental service and was referred to StEPS for potential strabismus.
The child in question did not attend any preschool or childcare facility and was found through StEPS to have reduced vision as well as an accommodative strabismus. By spreading awareness and collaborating with other medical and health professionals, we extend the program’s reach and effectiveness, ensuring more children are screened, even those who do not regularly attend childcare or schooling facilities.
A key strength of the StEPS program is its focus on reaching vulnerable communities, including Aboriginal and Torres Strait Islander populations. As a free and highly mobile service, StEPS significantly reduces barriers to accessing eyecare. My team travels extensively, bringing vision screening directly to preschools, childcare centres, and remote communities.
This mobility ensures that all children, regardless of their socio-economic background or geographical location, can receive essential vision screening. By providing accessible and equitable eye care, the StEPS program embodies the principles of universal access to health services as advocated by the World Health Organization’s Universal Eye Health Action Plan.2
Each year, over 10,000 children across the state are screened, identifying those with vision problems who might have otherwise remained undetected. Early detection allows for timely treatment, which can dramatically improve a child’s vision and quality of life. It is no secret that early intervention in eyecare, especially detecting and treating refractive error and amblyopia, significantly improves visual outcomes. The StEPS program has demonstrated high effectiveness, with consistent overachievement of the 80% target screening rate (key performance index) in several years.1 The program continues to outperform this target across the state.
Working to the top of our scope allows orthoptists to play a vital role in enhancing the efficiency and accessibility of eyecare, ensuring that more children benefit from early vision screening and intervention. By focusing on early detection, fostering collaboration, and maximising our professional capabilities, we significantly impact the lives of children, their families, and the broader community.
Moving forward, it is essential to continue supporting and acknowledging the critical contributions of orthoptists within the healthcare system. By highlighting our achievements and advocating for our profession, we can ensure that orthoptists remain integral to providing high-quality and equitable eye health care. It is therefore a privilege to be part of such an influential program.
About the Author: Linden Chen obtained his Masters of Orthoptics in 2014 at the University of Sydney. He worked as a clinical orthoptist at Marsden Eye Specialists before becoming the StEPS Coordinator at Sydney Children’s Hospitals Network.
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References
1. French, A. N., Murphy, E., Martin, F., de Mello, N., & Rose, K. A. (2022). Vision screening in children: The New South Wales Statewide Eyesight Preschooler Screening (StEPS) program. Asia-Pacific Journal of Ophthalmology, 11(5), 425-433.
2. World Health Organization. (2014). Universal Eye Health: A Global Action Plan 2014-2019. Geneva, Switzerland: World Health Organization.
