Jane HanleyHead of Orthoptics

Belfast HSC Trust

Orthoptists Assess diagnose and treat children with

squints , amblyopia and visual problems

Assess diagnose and treat adults with diplopia and /or ocular motility disorders

Are Specialists in assessing vision in the non verbal patient

Interesting factsIt is said that 80% of learning occurs through visual

stimulation. Vision enables a child to appreciate form, colour, position and movement. It stimulates different aspects of development e.g. hand/eye coordination.

5-8 % of children may have a vision/eye problem. 15-20 people each year with amblyopia (lazy eye) in

one eye are registered blind in N.I. due to the subsequent loss of vision in the other eye through injury or disease.

11.8% of blind eyes in the population are blind from amblyopia alone

Amblyopia is the most common visual disorder of childhood (Fielder 2004

Orthoptics Currently

Provide Orthoptic led regional vision screening service across NI in accordance with National Screening Council approval and with community nursing and Education providers

Manage the provision of visual fields in some areas

Orthoptists in NIProvide previously mentioned Orthoptic Services

in more than 32 sites across province

33 Orthoptists in NI

Vision Screening in ChildrenRegionally agreed access criteria for referral to

Orthoptics from vision screening

In NI this is an Orthoptic led service as recommended by Hall and Elliman in” Health for all children “as approved by the Dept of Health, NSC,community nursing and education providers

This is screening for preventable and treatable eye

disease – Amlyopia(present in4.4% of population *)*the incidence and prevalence of amblyopia detected in childhood .public health 1991;105,455-462

Vision Screening in ChildrenAll school nurses and health visitors are

being /have been trained by Orthoptists post qualification to ensure this is a universal screen with same standards across the province

All 2 year olds will be seen by HV using Vision assessment tool (Sept 10)

All 4-5 year olds will have a vision testNI has the highest uptake of vision screening

across the UK e.g. in northern trust 96% of p1 s had recorded vision test

Joint working in NI-existing Orthoptic/Optometric Locations

Joint optometric /orthoptic paediatric refraction clinics in NI Belfast : RVH , Mater , Knockbreda, Bradbury,

Holywood Arches, Ballyowen, Carlisle*, Cupar St* South East Belfast : :Stewartstown, Downe, Ulster

Hospital, N’ards, Bangor, Lisburn HCSouthern :CAH, Daisy Hill*, Dungannon, Armagh,

Banbridge Northern: Antrim, B’mena, Carrick, Larne, Coleraine,B’money, W’abbey, Magherafelt, Cookstown, B’castle.Western: Altnagelvin, Erne, Omagh and satellite clinics* Clinics run with Ophthalmology

Referral to OrthopticsHealth Visitor

Others

Refraction media and

Fundus

Optometry GOS

Ophthalmology

OrthopticAssessment,

Diagnosis and Treatment plan

GP s OphthalmologySchool Nurse

Optometry GOS

Joint working/Children’s eye care Advisory Group Recommendations distributed to GOS

optometrists regarding paediatric practice in NI (April ‘09)

Forms provided to all GOS optometrists to be sent directly to Orthoptics for feedback (April ‘09)

Audit of above (Spring 10)

Vision Strategy/Vision2020The World Health Organisation’s (WHO)

Vision 2020 programme to eliminate preventable blindness by 2020, provides strategic context for service development. In the UK, stakeholders have developed a UK Vision Strategy inspired by the WHO’s initiative, and the former Secretary of State, Alan Johnson endorsed the aims of that strategy at its launch.

Glaucoma Management(skill mix and extended scope) Skill mix 83% of fields managed by Orthoptists are

performed by Band 3 Orthoptic assistants trained by Orthoptists using regionally agreed competency manual.

OCT managed and performed by Orthoptists in 2 trusts Joint Orthoptic/Ophthalmic clinic in western trust Orthoptist

carry out pressures, history,OCT with assistants doing fields

Extended scope -cataracts

One Orthoptist doing pre and post op cataract assessment

Patient put on waiting list and consented by Orthoptist

Trained by Ophthalmology

Stroke and Brain InjuryCurrently only substantive post is in Western

TrustUsing BIOS guidelines should be 0.2WTE per

stroke unitRegional Orthoptic approach to identify the

level of unmet need for Orthoptic assessment in stroke units

Often also need refractive advice about glassesOrthoptic 2 day Neuro-stroke course held in

Dublin and Belfast

Modernisation in Orthoptics

Grading for new patients in NI urgent /routine

Regionally agreed access criteria for referral to Orthoptics from Vision screening

Returning referrals that do not meet criteria

Training referrers with regionally agreed CD/manual

Future joint working

Special schools need Orthoptists to do vision assessments see “Hall and Elliman”health for all children increased incidence of vision problems(40-50%*)

Following Orthoptic assessment Refraction should be performed in school

Multidisciplinary working in paediatric Low vision clinics

*Breakley1995,eye 200

Future-Regionally agreed care pathwaysNI Orthoptists have agreed 5 care pathways

for common Orthoptic conditions

Way forward multidisciplinary care pathways as vast majority of children with amblyopia will see Orthoptist,Hospital Optometrist ,GOS Optometrist and Ophthalmologist

Joint working –Benefits of care pathwaysEnsure “Lean” working that every patient

contact is appropriate without unnessecery over testing

Open communication with every party understanding part in pathway

Ensures patient understanding ,trust ,confidence and prevents mixed messages resulting in poor compliance

Thank You