Feature, Orthoptics Australia

OAW 2021: No day the same in this orthoptist’s clinic

I’ve been a clinical orthoptist for six years and it has been incredibly rewarding. Currently, I am the orthoptist to Dr Ross Fitzsimons who specialises in strabismus and refractive surgery. Additionally, it offers opportunities to run my own orthoptic clinic within the practice.

My clinic allows me to see a variety of patients, including managing children with amblyopia, controlling myopia progression in children and young teenagers and providing management options for diplopia. I’m fortunate to have autonomy to manage these patients, as well as in collaboration with the ophthalmologists. Because the practice also has an associated day surgery, I assist the surgeon by seeing post-operative cataract surgery patients and pre-op patients for corneal markings for toric and other intraocular lenses.

Linden Chen.

In a multi-doctor practice, my clinic serves as a hub for ophthalmologists and their patients to provide comprehensive orthoptic assessment and treatment options where necessary. I can spend more time with patients who require either orthoptic treatment or opinion and I’m able to thoroughly engage in patient education, which I believe is essential for providing the best patient care.

To illustrate the benefit of private orthoptic services in a large ophthalmology practice, a recent example was a 77-year-old man who presented with near horizontal diplopia due to convergence insufficiency and a poorly controlled near exophoria secondary to advanced Parkinson’s disease. Managing this type of strabismus can be difficult as convergence exercises are sometimes ineffective and the risks of strabismus surgery can outweigh the benefits. Practical treatment often involves prism glasses or occlusion. In this case, the patient also had moderate nuclear cataracts, blepharitis and dry eyes which may have exacerbated his symptoms. He preferred to stay in a wheelchair for the assessment as due to his risk of falls.

Working in collaboration with his ophthalmologist, I fully utilised my clinic to relieve his symptoms as much as possible, including a careful refraction with base-in prisms, in-depth patient education and counselling of realistic expectations as well as short- and long-term management. The patient loves reading and preferred to remain binocular, so occlusion was not the treatment of choice. With these findings, I provided a full report to the ophthalmologist and our collaboration meant that he could read much more comfortably at home.

This example is merely a snapshot in the day of an orthoptist. There are many other patients with a wide range of conditions who would benefit from orthoptic care and I am fortunate to have the facility and accessibility to do so.

Our practice is heavily involved in exciting new clinical trials in retinal diseases and glaucoma. Many other clinics worldwide are also conducting research in these areas, which means research into strabismus can be often overlooked. Working with Dr Fitzsimons and the strabismus team allows us to attempt to bridge this gap and there is a seemingly endless amount of strabismus and paediatric related research areas to explore. Recently with the combined efforts of Dr Fitzsimons, Dr Elizabeth Baek, Dr Parth Shah and myself, we published our research paper comparing objective and subjective ocular torsion in normal patients, which to our knowledge had not been explored up until now1 . There are several follow-up projects planned related to this.

Orthoptics is an incredibly rewarding profession. There are many individual and altruistic benefits one may find with many chances to learn and grow with continuous learning and teaching.

ABOUT THE AUTHOR: Linden Chen obtained his Masters of Orthoptics in 2014 at The University of Sydney and has been working as a clinical Orthoptist at Marsden Eye Specialists for seven years. His interests include strabismus, paediatrics and neuro-ophthalmology.

References 

  1. Baek, S.J., Chen, L.Z., Shah, P.R. and Fitzsimons, R., 2021. Comparison of Subjective and Objective Torsion in Normal Patients. Journal of Pediatric Ophthalmology & Strabismus, 58(2), pp.112-117.

More reading

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OAW 2021: The role of an orthoptist in clinical trials

OAW 2021: Playing a greater role in glaucoma care

OAW 2021: Blindness, low vision and the orthoptic assessment

OAW 2021: Clinical research and a new retinal camera