For Orthoptics Awareness Week 2024 (3-7 June), Australia’s peak body for the profession is
drawing attention to the expanded role orthoptists can play to contribute even more effectively
to a strained eye health system.
By Amanda French
Orthoptists are a crucial part of the eye health care workforce in Australia, working to screen, triage, diagnose and therapeutically manage a range of eye conditions, both independently and as part of the collaborative eye care team. Orthoptists also have particular expertise in the therapeutic management of amblyopia, strabismus and ocular motility conditions, and provide visual rehabilitation services.
In celebration of Orthoptics Awareness Week 2024, Orthoptics Australia is highlighting the positive impact of orthoptists working to their full scope-of-practice across a range of settings and practice areas.
This collection of articles compiled in this feature for Insight (below) demonstrate the varied roles and settings in which orthoptists work, as well as emphasise the positive impact of orthoptic work on eye health outcomes.
– Ms Navdeep Kaur’s cost-benefit analysis of an orthoptist-led versus consultant-led optic pathway glioma screening clinic for children with neurofibromatosis type 1 at The Royal Children’s Hospital, Melbourne shows significant benefits of orthoptist-led paediatric service delivery, with improved patient experience, reduced cost and reduced wait times.
– Ms Natalia Kelly’s private Vision Matters clinic provides a great example of innovative therapeutic management provided in autonomous orthoptic practice. The positive impact of visual rehabilitation strategies such as eccentric viewing training for improving quality-of-life for those with low vision is of particular note.
– Mr Cem Oztan discusses the application of his clinical skills as an orthoptist at Vision Australia at the top-of-scope of practice to a role as a ‘classifier’ for Paralympic and Blind sport. Such work supports participation of athletes with visual impairment in elite sports, allowing them to perform to their full potential.
It’s a timely topic, given the government’s ‘Unleashing the Potential of our Health Workforce’ Scope of Practice Review is well under way – and Orthoptics Australia has made its voice heard through subsequent rounds of consultation.
Orthoptics Australia is also undertaking work to further define current orthoptic scope-of-practice including, advanced and extended practice, and promoting the importance of facilitating orthoptic work at top-of-scope to foster effective and efficient eye health service delivery across Australia.
Unfortunately, there is much work to be done, with several barriers to orthoptists routinely working to the top of scope-of-practice. This includes, varied state and territory legislation, limited recognition of self-regulated health professionals within legislation, lack of awareness of orthoptic expertise and competencies, funding models for allied health and workplace culture.
This series of articles puts into focus the significant benefits of orthoptists utilising their clinical expertise at the highest levels including improved patient satisfaction and quality-of-life, more timely access to eye health care and more cost-effective service delivery.
There is so much to be gained from addressing current barriers and unleashing the potential of orthoptists.
Realising and harnessing the power of orthoptist-led clinics
By Navdeep Kaur
Traditionally, the neurofibromatosis type 1 (NF1) ophthalmic care model was incorporated into general consultant-led clinics to screen for an optic pathway glioma (OPG) at The Royal Children’s Hospital (RCH), Melbourne. Following a presentation about the lack of uniformity in NF1 OPG screening at an international conference, RCH chief orthoptist Ms Cathy Lewis was inspired to implement a new NF1 eye screening clinic at the RCH.
This was an opportunity to explore a different model of care adopting an orthoptist-led workflow. Using evidence-based research and collaboration with the hospital’s ophthalmology and neurology teams, a strict assessment protocol was developed for an orthoptist-led screening clinic for children diagnosed with NF1 and no known OPGs in 2016.
During the past 20 years, two factors have driven increased economic evaluations within healthcare. Firstly, the pressure on healthcare budgets has shifted the focus from only assessing clinical effectiveness to incorporating cost-effectiveness. Secondly, data collected from economic evaluations has been integral to funding, reimbursement and decision-making within healthcare.
At RCH, we conducted a cost-benefit analysis to assess if an orthoptist-led clinic was more cost-efficient than a consultant-led clinic for OPG screening in patients with NF1. Alternative models have been introduced across the allied health and nursing disciplines to increase patient access, manage long waiting lists, increase clinical efficiency and reduce unnecessary visits and costs.
Although multiple studies have assessed the clinical effectiveness of an alternative care model, they lacked a costing component where monetary difference is assessed. We aimed to assist evidence-based policy change with the allocation of ophthalmology screening resources and therefore promote future orthoptist-led models.
Our research demonstrated the cost-effectiveness of the orthoptist-led OPG clinic for NF1. From a hospital perspective, it significantly reduced appointment-associated costs. The orthoptist-led clinic resulted in a mean reduction of approximately $64 per appointment compared to the consultant-led clinic.
Moreover, it reduced the patient’s overall time spent in the clinic without compromising the quality of care, and provided an improved patient experience through reduced wait times/clinical interactions – and with no dilating eye drops. For the average patient, the total mean time reduction between the traditional care model and the orthoptist-led clinic was approximately 20 minutes, excluding waiting times. These findings underscore the potential of this service to lower healthcare costs, particularly in settings where resources may be limited.
Healthcare comes at a significant expense for societies, so our findings can help inform future policy regarding the allocation of ophthalmic screening resources and the promotion of orthoptist-led clinics. An increase in orthoptist-led models of care will allow timely, cost-efficient care without compromising patient outcomes.
Reference: Kaur, N., Lewis, C., Staffieri, S., Ruddle, J., Goranitis, I., Stiles, J., & Dabscheck, G. (2023). Cost Analysis of Orthoptist-Led Neurofibromatosis Type 1 Screening Clinics. The British and Irish orthoptic journal, 19(1), 26–34. https://doi.org/10.22599/bioj.288.
Helping vision impaired athletes realise their potential
By Cem Oztan
I have been involved with classification of vision impaired and blind athletes nationally since 2007 and internationally since 2011. Low vision services are delivered by a broad range of disciplines and social systems throughout the globe, with the primary focus of improving the patient’s use and rehabilitation of their residual vision, or use of other senses in the case of blindness.
Low vision is an important scope in the continuum of care in eye health outcomes and orthoptists play a pivotal role. Numerous studies on the impact of low vision and blindness have identified many findings; reduced quality-of-life, dependence, mobility and falls, fractures, subsequent injuries, mental health, cognition, hearing impairment, mortality, amplified effects of other conditions, and complications in the management of other conditions. Also, other conditions affect the management of eye disease.
Recent studies are finding people with vision impairment and blindness with sports participation show improvement to general health, social inclusion, balance, motor skills, communication, teamwork and positive relationships within all domains of quality-of-life.
Paralympic and Blind sports offers opportunities for all athletes who are blind or have significant vision impairment to compete in various levels of competition. It exists to provide opportunities for athletes who have a competitive disadvantage in non-Paralympic sport.
To determine an athlete’s eligibility for Paralympic and Blind sport, a group of officials, known as classifiers (traditionally ophthalmologists and now includes orthoptists), assess athletes to determine how their impairment influences their sport ability, regardless of their level of training or development.
Classification is used to group athletes with similar levels of impairment into classes for equivalent competition. In this way, classification ensures that winning is determined by athletic skill, fitness, power, endurance, tactical ability and mental focus, the same factors that account for success in sport for athletes who are able-bodied. The outcomes of Paralympic and Blind competition become based on athletic performance rather than on differences that exist in the athletes’ vision.
Working to my full scope-of-practice in providing sports classification for athletes with vision impairment and blindness has benefitted patients in receiving a timely and efficient person-centred service, while allowing me to display the full breadth of clinical expertise and care, especially with basic refractive care and detection of disease. Unleashing the potential of allied health professionals by working to the full scope-of-practice is long overdue and exciting. Especially in the case of orthoptists, our role has been long recognised in the safe, timely, cost effective and positive outcomes for the public in eye health services.
Orthoptist’s expertise translates into powerful real-life moments
By Natalia Kelly
Vision Matters is a private orthoptic practice in Melbourne. We offer innovative services at the forefront of low vision care and vision rehabilitation. Our focus is on optimising the visual and ocular motor systems to improve quality-of-life in those who experience vision difficulties.
We work with clients of all ages with visual challenges including binocular vision dysfunction, ocular and neurological vision impairment, vestibular disorders and deafblindness.
At Vision Matters, we specialise in extended evidence-based orthoptic practice across three divisions including, biofeedback training, neuro-orthoptic intervention and learning difficulties.
Our orthoptic-specific interventions include restorative techniques (including eccentric and null point training, prisms, etc.) and compensatory approaches (including visual field awareness, sensory integration, etc.) which is complemented by assistive technology, when required. Each client has a carefully considered, tailored intervention program curated for their needs.
To support patients with retinal pathologies, I developed a novel approach to eccentric viewing (EV) training. EV is a technique that enables a person with central vision loss to look off centre to view an object. My advanced EV training program combines visual and auditory biofeedback technology with home exercises. A retrospective study was conducted looking at the effectiveness of this program.
The recently published outcomes showed all participants had significant improvements in distance and near acuity, contrast sensitivity and fixation stability. Additionally, clients who underwent this training reported reduced symptoms of depression and improved participation in hobbies and social activities.
My passion for neurological vision impairment inspired me to offer neuro-orthoptic services. When supporting clients with complex needs, I work collaboratively with families and other professionals to ensure there is a cohesive approach to achieving common goals. During therapy sessions, I’ve had the privilege to witness children with cerebral visual impairment (CVI) roll for the first time, recognise and respond to Auslan and write their name. Additionally, my work with a stroke client has helped them regain their ability to read gardening magazines and move around their home without experiencing dizziness related to vestibular-ocular dysfunction.
More recently, we started supporting children with autism, ADHD and non-specific learning difficulties. These clients commonly present with visual processing difficulties, reduced binocular functions and atypical ocular movements. These visual challenges obstruct their ability to access their vision for learning. Implementation of simple vision strategies has made a difference to the child’s ability to use their vision for learning. Additionally, educating teachers and parents/guardians in how the student can access their vision for academic learning has been essential in creating pathways for accessible learning.
My work at Vision Matters is unbelievably rewarding and I’m fortunate to work in the vision rehabilitation space. My orthoptic training, experience and skills have armed me with a unique perspective to make a positive impact on individuals experiencing vision difficulties.
More reading
Orthoptics Awareness Week: Personifying collaborative care
Orthoptics Awareness Week 2022: Where in the world can orthoptics take you?
Orthoptics Awareness Week 2021
