Orthoptist RAFAL AL-QASEER describes how collaboration with ophthalmologists in orthoptic-led clinics ensures the best patient outcomes.
I graduated from the Master of Orthoptics course at the University of Technology Sydney (UTS) in 2020, and have since been working across all three Marsden Eye Specialists locations (Castle Hill, Parramatta and Penrith). At Marsden Eye Specialists, various orthoptic-led clinics provide specialised care to our patients including paediatric and strabismic, myopia control, dry eye, keratoconus progression monitoring, and refractive screening.
“Overall, orthoptic-led clinics elevate the standard of care and emphasise precision, collaboration, and patient-centredness in the field of eye health.”
Currently, I oversee the paediatric and strabismic clinic, as well as the myopia control clinic under the guidance of Dr Ross Fitzsimons, an expert in strabismus and refractive surgery.
In private practices, time constraints often hinder the ability to conduct thorough orthoptic examinations. This is where orthoptic-led clinics prove invaluable. The clinics’ role extend beyond routine assessments and – in collaboration with ophthalmologists – involve a nuanced approach to identifying and managing vision disorders with precision.
Consider a scenario where a patient reports intermittent diplopia with prior visits to different practices yielding no diagnosis. A standard examination reveals a 2-dioptre esophoria. In our orthoptic clinic, prolonged occlusion and prism adaptation tests, which take up to 1.5 hours, reveal an undetected 32-dioptre esotropia. Similarly, a patient with vertical diplopia finds no relief from prisms.
However, a detailed orthoptic exam using the synoptophore reveals that the main issue is subjective torsion in down gaze, hence prisms will not help. Such cases underscore the crucial role of orthoptic-led clinics in uncovering latent issues. The results also guide surgeons towards effective treatments and surpass the limitations of conventional examinations.
Orthoptists also play a crucial role in paediatric eye health. Children diagnosed with amblyopia at Marsden Eye Specialists are referred to our orthoptic clinic for tailored management, ensuring seamless collaboration with referring ophthalmologists. The same happens with the myopia control clinic, where patients are referred to the orthoptic clinic to closely monitor their results while they are on low dose atropine or other treatments.
Conducting orthoptic assessments for paediatric patients demands clinicians with exceptional communication and counselling skills. These capabilities are pivotal in establishing a rapport with both the young patients and their families. Through effective communication, orthoptists can provide precise information that reassures families and provides the best possible outcome for the patient.
In our refractive orthoptic-led clinic, orthoptists conduct comprehensive 60-minute assessments – including contact lens trials where suitable – to determine the best outcomes for our patients. Given the complexity of these cases, a brief 10- or 15-minute consultation may not cover all necessary aspects. Therefore, multiple visits are often required to explore different options, such as monovision, to ensure a tailored and effective approach to vision correction.
The dry eye clinic involves detailed testing which identifies the cause and type of dry eyes. The orthoptist then prescribes a home management regime and performs appropriate in clinic treatments.
Similarly, in our keratoconus progression monitoring clinic, patients undergo corneal topography and refractive assessments, with ophthalmologists reviewing the findings to inform ongoing care plans. This clinic also encompasses collagen cross-linking procedures which heavily involve the orthoptist.
The implementation of orthoptic-led clinics within private practice settings – exemplified by the comprehensive approach at Marsden Eye Specialists –represents a significant advancement in eyecare. These specialised clinics address the limitations of time-constrained conventional examinations. Through the employment of thorough assessments and specialised tests, orthoptists can collaborate closely with ophthalmologists to uncover latent issues and provide nuanced management strategies.
The role of orthoptists extends beyond clinical duties to include patient education and support to ensures individuals understand their conditions and treatment options. Through their dedication and expertise, orthoptists contribute significantly to improving patient outcomes and enhancing the quality of eyecare services in private practice and hospital settings. Overall, orthoptic-led clinics elevate the standard of care and emphasise precision, collaboration, and patient-centredness in the field of eye health.
About the author: Rafal Al-Qaseer graduated from UTS with a Master of Orthoptics in 2020. She has paediatric and strabismic special interests and practises at Marsden Eye Specialists in Sydney.
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