Download Who`s Who – From Optometrist to Ophthalmologist

Who’s who? From
Optometrist to
Ophthalmologist… and
everyone in between.
A guide to everyone
involved in eyecare
Mary Bairstow VISION 2020 (UK)
Why do you need to know?
Many older people are needlessly living with
sight loss. Almost two thirds of sight loss in older
people is caused by refractive error and cataract.
Both conditions can be diagnosed by a simple eye
test. In most cases the person's sight could be
improved by prescribing correct glasses or
cataract surgery.
RNIB – Nov 2010
“Diagnosed and dumped”
Only 8 per cent of registered blind and partially
sighted people were offered formal counselling by
the eye clinic, either at the time of diagnosis or later.
In the year after registration, less than a quarter (23
per cent) of people who lost their sight say they were
offered mobility training to help them get around
independently.
RNIB – Nov 2010
Mrs Rose
• 64 years old – African Carribean recently
found she can’t see well for close work. Thinks
she needs reading glasses.
Ophthalmologist
Orthoptist
Eye Clinic Liaison Officer
Boots counter assistant
(“ready readers”)
Optician
Optometrist
Social Worker
Rehabilitation Worker
GP
The Optometrist
• Mainly work in ‘High Street’ practices – though some in
hospital eye departments
• Previously known as ophthalmic opticians – the
protected title – optometrist came into use in the 1980s.
They do what?
• Refraction – using instruments to determine lenses
to focus the eye
• Examine the eyes to detect defects in vision, signs of
injury, ocular diseases or abnormality and problems
with general health
• Tests may include – binocular vision, eye pressure,
peripheral vision , external and internal eye health
Next steps.....
• Her optometrist discovers – raised intra-ocular
pressure and signs of diabetic changes at the
back of her eye and refers her to the local
hospital with an Ophthalmology (Eye)
Department.
But in between........
Mrs Rose is ‘desperate’ for new spectacles so
she asks to see the dispensing optician - but
agrees to postpone buying glasses ‘til she is seen
at the hospital
The Dispensing Optician
• Trained to dispense and fit spectacles, contact lenses
and other optical aids
• Don’t ‘test eyes’ or produce prescriptions for glasses
– they work from the optometrists results
• Advise patients on types of lenses and spectacle
frames, including advice on style, weight
• There are 3 routes to qualification. Only qualified
opticians can register with the General Optical
Council (GOC)
The Ophthalmic nurse
• Based in hospital eye departments
• Ophthalmic training and experience
• Specialist practitioner roles – glaucoma and
additional roles
• Measure vision, explain treatment, assist in
theatre
And next .....The Ophthalmologist
• Medically trained doctor – working in clinics ( as an ‘eye’
physician) and theatre (surgeon)
• Examine, diagnose and treat diseases and injuries in and
around the eye.
• Use specialist equipment – slit lamps (microscopes
designed to examine the eye under magnification) and
ophthalmoscopes (lenses to look at the eye)
• After medical school they must do 7 years of special
training with ‘rigorous’ exams set by the Royal College of
Ophthalmologists
What they use
• Slit lamps
Scans of the back of the eye
Head mounted ophthalmoscope
•
•
©Brainerd Eyecare centre
© Royal College of Ophthalmologist
The Ophthalmic Technician
• Usually based in eye departments – they
undertake specific investigations including
testing of peripheral vision (visual field testing).
http://www.goodhope.org.uk/departments/eyede
pt/goldmanfield.htm
• They may take pictures of the eye using various
techniques, such as digital fundus imaging,
ultrasound and optical coherence tomography
(OCT).
Nobody sees you.....
• Meanwhile Mrs Rose has developed double
vision associated with her diabetes. Her eye is
turning down and out due to a third nerve
palsy.
© Ophthobook.com
The Orthoptist
© NHS North Lincolnshire and Goole Hospitals
Mostly working in the NHS as part of the ophthalmic team
Specialise in visual development, binocular vision
(how the eyes work together as a pair) and eye movements.
They test, assess and offer non-surgical treatment
(such as eye exercises) including:
• Children presenting with misalignment of the [turning]
•
•
•
•
eyes(strabismus/squint) or problems with vision development
Patients presenting with double vision (diplopia).
Lazy eye (amblyopia) and other visual disturbances
Low Vision
Other technical roles such as visual fields
All this talk of growing old
(When the drugs don’t work)
LASER treatment for diabetic retinopathy hasn’t
prevented macular oedema and so Mrs Rose’s
Ophthalmologist suggests certification as
Sight Impaired, referral to the Eye Clinic Liaison
Officer for advice and the hospital optometrist
for a low vision assessment.
Integrated care -Eye clinic support
• Eye Clinic Liaison Officers (ECLO), Support at
the Point of Diagnosis, help desk volunteers
• Information and sign posting for people in the
Eye Clinic (occasionally elsewhere)
• Links between health and social care
• Counselling often offered
• RNIB accredited course – developed in 00’s
• Different funding ‘models’
Eyes in Social Care
• Often specialist Sensory or VI teams with social
workers and rehabilitation workers or ROVI
(Rehabilitation Officer for people who are Vision
Impaired)
• Obliged to offer an assessment when in receipt of
a certificate of vision impairment (CVI) or a
referral of vision impairment (RVI - a form
designed to refer from the hospital eye service
[HES] – but rarely used)
• Assessment does not depend on certification
The ROVI or Rehab worker
• Mainly work for local authority though some based in local
voluntary societies
• Currently 3 courses ( 2 Degree level and one BTEC)
•
•
•
•
Initial assessment and registration as blind or partially sighted.
Emotional support
Specialist assessment – lighting, environment and equipment
Teaching guiding skills – mobility
and moving around
safely
• Low vision techniques
Skills and equipment
• Daily living skills training - helping people learn /
re-learn skills - cooking, cleaning, care of clothes
• Communication training - Braille, Moon,
deafblind manual, keyboard skills,
use of technology /digital equipment, phones
• Equipment - timepieces, liquid level indicators, raised
markings for appliances, talking labels and other
household gadgets
© RNIB
And talking of ‘professionals’
Mrs Rose
• She’s started her own peer support group with
help of her local voluntary society.............
• M
Mary Bairstow
[email protected]