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Jane Hanley
Head 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 facts
 It 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 NI
 Provide previously mentioned Orthoptic Services in
more than 32 sites across province
 33 Orthoptists in NI
Vision Screening in Children
 Regionally 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 Children
 All 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 test
 NI 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 HC
Southern :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 Orthoptics
Health
Visitor
Optometry
GOS
School
Nurse
GP s
Ophthalmology
Others
Orthoptic
Assessment,
Diagnosis and
Treatment plan
Optometry
GOS
Refraction
media and
Fundus
Ophthalmology
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/Vision2020
 The 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 Injury
 Currently only substantive post is in Western Trust
 Using BIOS guidelines should be 0.2WTE per stroke
unit
 Regional Orthoptic approach to identify the level of
unmet need for Orthoptic assessment in stroke units
 Often also need refractive advice about glasses
 Orthoptic 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(4050%*)
 Following Orthoptic assessment Refraction should be
performed in school
 Multidisciplinary working in paediatric Low vision
clinics
*Breakley1995,eye 200
Future-Regionally agreed care
pathways
 NI 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
pathways
 Ensure “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