The following article about orthoptics was submitted by Olivia Heidrich on behalf of Orthoptics Australia. Soon after it was published, optometrist Dr Daisy Shu made a submission to clarify the role of the optometrist. This submission has been quoted.
Orthoptists are allied health professionals who play a vital role in securing beneficial outcomes for people with eye disease through their clinical expertise, patient engagement and support. Areas of expertise include:
- Diagnosis and orthoptic management of defects of binocular vision, ocular motility, and visual deficits related to neurological and systemic disease, such as brain injury and diabetes
- In the presence of ophthalmic disease, diagnostic procedures including refraction, perimetry, ultrasonography, tomography and electrophysiology
- Orthoptic management of strabismus and amblyopia
- Clinical monitoring of stable, chronic conditions such as glaucoma, diabetes and macular degeneration, and escalation to diagnostic services when indicated
- Quality patient education to achieve improved patient compliance and outcomes
- Health promotion through vision screening across the age spectrum
- Minimising the functional impact of vision impairment and facilitating a high quality of life for individuals with low vision
- Broadly influencing Australian eye care by transferring orthoptic knowledge and skills to ophthalmic industry
- Research and enquiry into ocular abnormalities and their management
Orthoptists work with diverse client groups including:
- the general population
- Indigenous Australians
- babies and children
- people with vision impairment
- people with disability
- people with brain injury
Orthoptists work autonomously or within a team in environments that may include:
- private orthoptic practice
- private ophthalmic practice
- the public hospital sector
- the community sector as primary health practitioners
- educational institutions
- non-government organizations
- ophthalmic industry
Role in a health care team and multidisciplinary health teams
Orthoptics is a profession which provides service and support directly to patients, their family and the health care team involved in the patient’s management. Information about vision standards and the visual capabilities of each patient is provided to medical professionals particularly ophthalmologists, neurologists and allied health practitioners, who are involved in the care of patients with disability.
One example is the integral role played in multi-disciplinary rehabilitation health teams, where Orthoptists diagnose complex eye and vision conditions, and ensure other professionals are aware of the patient’s visual status. This is an environment where expectations and actions must be matched to the patient’s visual situation for rehabilitation to be effective. The non-use or incorrect use of glasses, the presence of visual field (peripheral vision) loss and double vision are examples of defects which impact on general treatment outcomes. These are all conditions that can be identified by the orthoptist. The orthoptist can also implement management strategies that will minimise the impact of these conditions.
Another example is the role of the Orthoptist in remote rural Australian communities. Orthoptists form part of medical teams that visits remote Aboriginal communities to monitor vision health.
Orthoptists also play an integral role in community health demonstrated by their role in the Statewide Eyesight Preschool Screening Program (StEPS). Orthoptists conduct primary and secondary screening of young children for vision defects and also staff StEPS clinics sponsored by The Ministry of Health, NSW which provide ongoing care of children found to have eye and vision issues. Orthoptists also participate in delivering training for nurses and lay screeners within StEPS and are employed as local StEPS coordinators.
Scope of the Orthoptic profession
In the most recent Australian Bureau of Statistics Census there were over 700 orthoptists Australia wide. Currently Orthoptists are employed in a wide range of public, private and non-government organizations in all states of Australia, in metropolitan and regional areas.
Orthoptists with an Australian qualification are eligible to practice internationally.
Orthoptists provide cost effective eye care delivery. In co-shared services for chronic eye diseases e.g. glaucoma, an orthoptic service event demonstrates a cost saving of $81 (IPHA Tier 2 clinic), when compared to ophthalmology service events in NSW public hospitals.
Graduates from current courses readily find employment, particularly in regional, interstate and international locations. It is well recognized that the Australian ageing population will place increased demands on health services, particularly the need for eye care and low vision support. The recent implementation of the National Disability Insurance Scheme has raised the profile of professionals in the disability arena and this includes Orthoptists.
Orthoptics was introduced as an ocular motility assessment and therapy profession. Over time the profession has diversified and the modern orthoptist practices in many areas including, ocular motility assessment and therapy; diagnostic ophthalmic services, vision rehabilitation; neuro-orthoptics; refraction for treatment; paediatric vision screening, screening and monitoring of low acuity eye disease, and patient education. In each of these areas ongoing research is conducted to support the validity of the role of the Orthoptist.
In the report titled “Eye health labour force in Australia” (2009) by the Australian Institute of Health and Welfare it was revealed that between 2001 and 2006, the number of FTE orthoptists increased by 20%, whereas the increase for ophthalmology was 15%, and optometry 11%. From 2006 numbers of orthoptists have increased from 471 to over 700 as reported by ABS recently.
Relationship with other eye professions
The eye care team has multiple members, each of whom fulfils an important role in eye care. These members are described below:
Ophthalmologists are medical eye care specialists who by managing eye disease, improve and maintain the healthy function of the eye and visual apparatus including neurologically based vision defects.
Orthoptists are allied health professionals who have expertise in the assessment, education, therapy and rehabilitation of individuals with eye and vision conditions.
Optometrists are eye care practitioners who have expertise in the prescription of optical corrections. Practitioners have also developed skills in identifying eye diseases and monitoring progress of some basic diseases.
Optometrist Dr Daisy Shu says “Optometrists are health care practitioners at the front line of our eye care system in Australia. The role of the optometrist is to provide primary eye care ranging from sight testing and prescription of spectacles and contact lenses to paediatric, behavioural and low vision assessments as well as the diagnosis, treatment and management of various ocular diseases.
Optometrists are able to prescribe a wide range of topical ophthalmic therapeutic medications many of which are listed on the PBS and thus, can be provided to eligible patients at an affordable cost. Such medications include antibiotics, anti-inflammatory, anti-allergy and anti-glaucoma eye drops. Some examples of eye diseases that optometrists commonly treat include conjunctivitis, dry eye, corneal infections, uveitis, episcleritis and ocular allergies.
Optometrists also play an integral role in the health care team as many systemic diseases such as diabetes, high cholesterol, hypertension and multiple sclerosis can affect our eyes and hence, optometrists liaise closely with other health care professionals including the GP and other specialists to ensure that patients are cared for holistically. Optometrists also liaise directly with ophthalmologists in the co-management of patients with diseases such as glaucoma, macular degeneration and cataract.”
Ophthalmic nurses are specialised eye health nurses who conduct basic eye testing and contribute to the post-operative care of patients.
Optical dispensers are practitioners who ensure the correct dispensing and fitting of optical corrections.
Orthoptists are focused on achieving evidence to support their actions through research into strategies used that involve vision. Such research includes clinical patterns and higher level human function in areas of vision perception. A recent audit of the orthoptic profession shows research activity in clinical, laboratory, epidemiology, service delivery, rehabilitation, as individuals and as part of funded and unfunded research teams.
Support and cooperation of profession
Orthoptics Australia (OA) is the national organisation representing members in all states of Australia. The Association strives to advance the discipline of orthoptics and supports members in their professional practice and development. In doing so, OA holds an annual national scientific conference, and publishes a scientific journal titled the Australian Orthoptic Journal. OA also provides continuing education programs and represents the profession in negotiations with government bodies and related professions. OA with its members supports the entry level education of Orthoptists, most significantly in the unpaid supervision of students in the attainment of professional skills, provision of clinical data for educational presentations and research requirements.
The Australian Orthoptic Board
The Australian Orthoptic Board is the registration body for Orthoptists in Australia. The function of the Australian Orthoptic Board is to regulate the profession of Orthoptics in order to protect the public. The Australian Orthoptic Board holds a register of suitably qualified orthoptists and investigates the professional conduct and fitness to practise of these registered orthoptists.
In the Australian Orthoptic profession, credentials are verified by evidence of attainment of a recognised university undergraduate or post graduate orthoptic degree or its equivalent. Currently, Orthoptics can be studied at the University of Technology, NSW and La Trobe University, Victoria. Continuous registration with the Australian Orthoptic Board is dependent on mandatory ongoing professional development and education that has been assessed and accredited as suitable by the Australian Orthoptic Board.
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