As part of the orthoptic team at the Royal Brisbane and Women’s Hospital (RBWH), I’m part of a multidisciplinary eye healthcare team, caring for patients with various ocular and systemic health issues.
More recently, the orthoptic team has been involved in the establishment of the Glaucoma Collaborative Care Clinic (GCCC). The aim of the program has been to guide collaborative care of patients who are identified as glaucoma suspects, at risk for future development of glaucoma and early but stable glaucoma patients.
The GCCC enlists the participation of the patient’s community optometrist and GP, to monitor their condition on a regular basis, with less frequent reviews at the hospital ophthalmology department. The RANZCO Referral Pathway For Glaucoma Management guidelines1 have been the basis for the development of the GCCC protocols.
The orthoptist’s role in the GCCC has been twofold: the accurate assessment of patients who may qualify for inclusion in a collaborative care program, and patient education.
The assessment involves key orthoptist skills, including identification of significant family and past ocular history, identification of systemic risk factors, OCT, visual field testing, pupil assessment, colour vision testing, Goldmann applanation tonometry and comparison with iCare tonometry, pachymetry, disc assessment and fundus photography to record disc appearance.
Orthoptists then interpret these results and classification is made according to the RANZCO guidelines. Our assessment is discussed with one of the ophthalmologists and a plan for appropriate patient management is made. If the patient qualifies for the collaborative care program, a report is prepared for the optometrist and GP, detailing our findings and outlining the requirements of the program.
Patient education is another essential skill to develop patient understanding of their condition or disease risk. We can also reassure the patient of their continued care and clarify how the GCCC program will work to achieve this.
Emphasis is given to the frequently asymptomatic nature of glaucoma and we stress the need to undertake regular testing with the participating optometrist. Keeping their optometry appointments increases the likelihood of any changes being identified and allows immediate referral back to the care of the hospital ophthalmology team.
The GCCC at RBWH is yet to have any patients return for routine or early review as requested by their local optometrist. At that point, orthoptists will be again integral to the determination of stability or progression of the patient’s condition, and to continued patient education. The GCCC team are enjoying the development of a collaborative relationship with community optometrists and GPs.
ABOUT THE AUTHOR: Marion Gaussen is a senior orthoptist at the Royal Brisbane and Women’s Hospital. She also works in two private ophthalmology clinics in Brisbane. She has been involved in glaucoma care for over 25 years.