Catherine Mancuso explores the evolution of orthoptics in Australia, examining advanced practice roles and how expanded scope improves patient access, efficiency, and eyecare delivery.
Like many medical and para-medical specialties, the origins of orthoptics are difficult to pinpoint. In the late nineteenth century, French ophthalmologist Louis Émile Javal treated his sister’s squint using stereoscopic exercises, while in 1864 Dutch ophthalmologist Franz Donders published work exploring the relationship between accommodation and convergence. These early contributions laid the foundation for the development of modern orthoptic practice.
Orthoptics emerged more formally in England in the early twentieth century. In 1919, Mary Maddox was trained by her ophthalmologist father to assist in the treatment of strabismus. She went on to establish the first orthoptic clinic at the Royal Westminster Ophthalmic Hospital in 1930, marking a significant step in formalising the profession.
The discipline was introduced to Australia soon after. The first orthoptic clinic opened in Melbourne at The Alfred Hospital in 1931, followed by the Royal Victorian Eye and Ear Hospital in 1933. Other hospitals across the country soon followed, embedding orthoptists as integral members of ophthalmic care teams. From these early beginnings, the profession has continued to evolve in response to changing patient needs and health system demands.
Today, orthoptists in Australia work across a wide range of settings, including public hospitals, private ophthalmology practices, dedicated orthoptic clinics, and community health services. Their scope of practice has expanded significantly and now encompasses subspecialties such as ocular motility, neuro-orthoptics, low vision services, diagnostic imaging, and ophthalmic assisting. This diversification reflects both advances in technology and the growing complexity of patient care.
In recent years, attention has turned to how allied health professionals can further contribute to addressing pressures on the healthcare system. In 2022, the Victorian Department of Health began developing Allied Health Advanced Practice roles, recognising the need for new models of care in a post-COVID environment. Increased demand, delayed presentations, and more complex health conditions have highlighted the importance of maximising the capabilities of the existing workforce.
Australia has more than two decades of experience with advanced practice roles in physiotherapy and nursing, supported by strong evidence of safety and quality outcomes. This history has helped pave the way for similar developments in other allied health professions, including orthoptics.
In 2023, with support from a Victorian Department of Health grant, the Royal Victorian Eye and Ear Hospital initiated a project to evaluate the impact of Advanced Practice Orthoptists (APOs) within its Acute Ophthalmology Service (AOS) clinic. The project was guided by the Department’s Allied Health Credentialling Competency and Capability Framework, which defines and classifies advanced practice roles.
An 18-month pilot program was implemented under established hospital governance structures. Two experienced orthoptists underwent targeted training and credentialling to expand their clinical responsibilities, particularly in assessing and managing patients with lower-acuity ophthalmic conditions. Their development was supported by an ophthalmology consultant acting as a clinical champion. Within this model, the APOs functioned at a level comparable to a junior ophthalmology registrar.
Advanced practice, at its core, involves clinicians working at the top of their scope, supported by additional education, formal credentialling, and robust governance. This approach allows all members of a multidisciplinary team to operate more effectively. Orthoptists can take on extended responsibilities, while medical specialists are freed to focus on more complex and high-acuity cases.
Evaluation of the pilot program demonstrated high levels of satisfaction among the APOs, the broader multidisciplinary team, and, importantly, patients. These findings support the view that enabling clinicians to work to their full scope can deliver benefits across multiple dimensions of care, including access, efficiency, and patient experience.
Following the pilot, several recommendations were endorsed by the hospital. These included adopting the APO role as part of routine service delivery within the AOS clinic and exploring opportunities to expand advanced practice roles across other areas of the organisation.
The development and integration of Advanced Practice Orthoptics reflects the profession’s long-standing adaptability and responsiveness to both patient needs and system pressures. It also aligns with international trends, particularly in the United Kingdom’s National Health Service, where similar models have been successfully implemented.
Positioned within a multidisciplinary framework, Advanced Practice Orthoptists offer a sustainable and scalable solution to workforce challenges. By enabling clinicians to work at the top of their scope, health services can optimise resources, improve patient access, and maintain high standards of care.
As demand for eyecare continues to grow, the evolution of orthoptics demonstrates how targeted innovation in workforce design can play a critical role in shaping the future of healthcare delivery.
About the author: Catherine Mancuso is a senior orthoptist and manager of diagnostic eye services at the Royal Victorian Eye and Ear Hospital, with more than 25 years’ experience.
References:
Lance P, Presidential Address, Transactions of the Annual Congress of the Orthoptic Association of Australia, Australian Orthoptic Journal, Volume 13, 1973-1974
State of Victoria, Department of Health, Allied Health Credentialling Competency and Capability Framework , 2016
Brown S, Through our eyes, The History of Orthoptics in Australia 1960-1991, Orthoptics Australia, 2025.
