To mark this year’s World Orthoptic Day (5 June), we spoke to Sandra Staffieri on her role as a Clinical and Research Orthoptist at the Centre for Eye Research Australia.
1. What role do orthoptists play in treating eye problems in kids?
Orthoptists undertake specific training to examine, diagnose, manage and treat a variety of childhood eye conditions, most commonly this includes strabismus (turned eye) and refractive error (glasses). A child’s vision develops from birth until around seven or eight years of age and any condition that affects the eyes can significantly affect vision development. Less commonly, a child can develop eye problems that are usually associated with adults – like cataract and glaucoma. These conditions can be quite devastating to the child’s vision development and treatment is not as straightforward, particularly in the case of cataract, as it would be in an adult.
2. How closely do you work with ophthalmologists on a day to day basis?
Orthoptists usually work in public hospital clinics or private practices with an ophthalmologist. Orthoptists are very much an integral part of the eye health care team, performing all the preliminary examinations and assessments prior to the examination by the ophthalmologist. Orthoptists and ophthalmologists will often discuss difficult cases and formulate the best management plan for that individual child or family.
In some cases, orthoptists will work in their own private practice with paediatric patients being referred for assessment or management of eye movement problems (strabismus) and vision loss (amblyopia). Orthoptists are also active in the area of paediatric low vision. Through organisations such as the Royal Institute for Deaf and Blind Children and Vision Australia, an orthoptist can assess children with significant vision impairment in their own home environment or school setting and then provide a report to assist parents or teachers to provide a safe environment for the child as well as suggest ways to best optimise their vision for learning.
3. Can you tell us about your work with the Centre for Eye Research Australia as a research orthoptist?
I have been extremely fortunate to have spent the last 10 years at the Centre for Eye Research Australia as a research orthoptist in the Clinical Genetics Unit. I have had the opportunity to work on many projects that involved assessing adults and children with different eye diseases or disorders, such as strabismus, cataract and glaucoma and then collect DNA samples to be sent for analysis. In this way, we are able to compare each individual’s eye problems – or lack of – with their genetic make-up and try to uncover the gene changes that result in their eye disease. We often look closely at families with hereditary eye disease as this gives us vital clues as to the possible gene changes that cause these conditions. This knowledge helps us better understand how these conditions occur and perhaps develop better treatments or strategies for earlier diagnosis to limit vision loss. It has been exciting to marry my clinical skills with research skills and be given the opportunity to be at the forefront of gene discovery, cutting-edge technology and gene-therapy which is on the horizon. After so many years looking after children with irreversible vision loss I can see the hope that research can provide for future generations.
4. You’ve done quite a bit of work in retinoblastoma care, can you tell us a bit about that?
I have been the Retinoblastoma Care Coordinator at the Royal Children’s Hospital in Melbourne for 23 years. What started out as essentially an administrative role, it has become much more than that. I coordinate all the care of children with retinoblastoma as there are many doctors, nurses, allied health personnel and teachers involved in each child’s care and treatment over many, many years. I also spend time counselling parents, providing information and assistance as required. With the support of a Centres of Research Excellence grant from the National Health and Medical Research Council (NHMRC), I was able to start looking at causes of delayed diagnosis for retinoblastoma in Victoria. The findings of this research paved the way for me to undertake a PhD to develop and evaluate an awareness program for parents to recognise and respond to the very earliest signs of the disease. I have been fortunate enough to be supported for my studies by an NHMRC public health Postgraduate Scholarship.
5. It must be hard working with children affected by serious eye conditions, such as retinoblastoma. What role does the orthoptist play in helping parents cope with the situation?
I spend a lot of time with parents not only at the acute stage – at first diagnosis and during treatment – but also in the months and years that follow to review the information they have been given and help them navigate their way through the health system. Not only does their child have cancer, they will also likely have a vision impairment of some kind. In addition, I support the survivors of retinoblastoma (many of whom we looked after a generation ago!) who then have their own children with the same disease. I spend considerable time answering questions they might have after they have been to see the genetic counsellor.
All parents and survivors are provided with a lot of information that is often complex and difficult to understand, at a time when they are very anxious and distressed. My role is very much one of counselling and explaining the disease again, the treatment options and prognosis. In the acute stage, parents can be very worried about a red eye or some new sign or symptom. I like to think they can call me at any time and together we can decide if they need to be seen urgently, and if so, I can facilitate that. Yes, it is hard sometimes, because you do develop a relationship with the child and the family over time but I guess I am only doing what think I would want someone to do for me if I were in their shoes. I cannot begin to imagine, even after all these years, how it must feel to be told your child has eye cancer – because usually, they are not even sick.
6. What’s the most challenging part of your role?
It is my privilege to care for children with retinoblastoma and their families, but the most challenging thing is feeling helpless. Sometimes there is nothing more that can be done and the child needs to have their affected eye removed. They might have gone through many months of invasive treatments including chemotherapy, and we still lose the war. Sometimes we lose the war for both eyes.
I guess the other difficulty is wondering if the child might have been able to be diagnosed earlier, the outcome might have been different. The two most common signs of retinoblastoma are a white pupil or an eye turn. The child will be otherwise well, so it is common for these early signs to be overlooked simply because parents don’t know any different. In developed countries, the child will lose their eye and might need chemotherapy, but they will survive. In developing countries though, they will likely lose their life. It is challenging for me to think that the majority of children in a developing country with retinoblastoma will die because of delayed diagnosis when really it is the most survivable paediatric cancer in a developed country.
I look forward to my research perhaps developing a sustainable and cost-effective program to raise awareness of these early signs of retinoblastoma. Looking further ahead I hope to be able to examine how such a program might be adapted and implemented in developing countries to save lives.
This is a reminder that today (1/5) a number of MBS item changes are coming into effect.
Today the Department of Health released the following documents with further information about these changes. These documents contain explanations about the changes to MBS ophthalmology items that come into effect today.
Fact sheet: Changes to Ophthalmology MBS items
Newsletter: Amended Ophthalmology MBS items
To mark ANZAC Day this year, we interviewed Dr William Glasson on what it’s like working as a consultant ophthalmologist in the Australian Army.
1. Can you tell us a bit about your role as a consultant ophthalmologist to the Australian Army?
I’ve been part of the medical side of the Australian military for approximately 35 years. I was a 5th-year medical student when I first joined. During school, I was a cadet so having experience in the military, I saw it as a great opportunity to work as a doctor in the military force. I’m still an active Reservist. I’m a Lieutenant Colonel in the army and I was a medical officer for an artillery unit based in Southeast Queensland for 10-15 years. Now I work at a consultant level at the military base where I provide eye services and advice to the Department of Defence around the list of medical conditions people can/can’t have in the army and what we’ve agreed to accept in terms of visual limits, visual acuity, colour vision, etc. My role involves a lot of advice around policy to the Australian Defence Force for both soldiers working on the frontline as well as those working in the rear aspects of the military force.
2. What are the most common eye injuries you see working on the frontline?
I like to think of eye injuries in terms of military or non-military related. Obviously, non-military related eye problems are similar to those of the general community such as conjunctivitis, vision problems, etc. For the most part, we’re dealing with a group of young and healthy individuals needing glasses or contact lenses. They usually present with general complaints or refractive errors but there are some cases where there is trauma to the eye – blunt injuries to the eye, some even penetrating the eye, although we do make sure there are preventative measures in place such as wearing protective glasses where it’s needed.
In terms of the back of the eye, we don’t see too many problems because they are a younger generation. We do get some who have diabetes so we need to keep a check on them and follow up on any treatment plans.
In terms of those that are on the frontline or those injuries that occur during military operations, the big one would be explosive injuries and IEDs that send pieces of sharp shrapnel through the air which can penetrate one or both eyes. In the worst-case scenario, this can lead to blindness or losing your eyes. Injuries from IEDs was one of the major issues during operations in Afghanistan and the Middle East particularly.
Also, laser is used a lot these days in terms of military equipment so people that are exposed to laser beam injuries need to be assessed and treated according to whether the damage is to the front or the back of the eye.
Troops on the ground are exposed to extremely harsh conditions – dust is a major issue and they get dust and dirt in their eyes. They’re exposed to extreme heat, high wind and high UV conditions which put the eyes at risk. There’s also the potential to be exposed to chemical injuries so it’s very important to ensure that the eyes are adequately protected in these tough conditions.
3. What would a typical day look like for medical corps? What’s involved?
A typical day in the medical corp can be quite similar to running a general clinic. You’re dealing with the typical things that the younger generation would present with such as conjunctivitis, pterygium, sore eyes, red eyes – those common conditions that we see in the mainstream community and those you would see in a typical eye clinic. You’ll also see people who wear glasses that will come in because their glasses are broken or their scripts are wrong or they wear contact lenses and they’ve developed an infection. So, contact lens related injuries and issues are not uncommon.
Not that we want contact lenses worn frontline. In fact, only those in non-frontline positions can wear contact lenses so we have a range of issues related to that.
4. How is working as a military ophthalmologist different to working in a clinical setting?
The pathology you see is very similar. But, generally, you are working with young, healthy people and what they present with is usually very different to what you’d see in your day-to-day ophthalmology clinics where you’re mainly dealing with older patients who have cataracts, macular degeneration, etc. This would take up 90% of your time in general ophthalmology.
Whereas, in the military, you’re working with young people and you’d mostly be dealing with refractive errors. Occasionally, you’ll come across those with a family history of glaucoma or another condition which you might treat.
Given the extreme conditions troops are exposed to, you also need to educate them on maintaining their eye health – wearing sunglasses, how to treat blepharitis and keeping dust out of their eyes.
5. How did you spend ANZAC Day this year?
One of my family members was an ex-prisoner of war. He was taken in Singapore and fought in the Borneo campaign. When he was captured, he was taken to Sandakan, which is in Borneo, and he was brutalised for five years while he was imprisoned. He eventually came back to Australia, went on to study medicine and became a very successful doctor. So in honour of him and to commemorate fallen ANZACs, my wife and I help to organise a formal service at the Sandakan memorial in New Farm, Queensland.
To mark ANZAC Day this year, we interviewed RANZCO Fellow and Colonel, Dr Viki Andersons AM RFD, on what it’s like working as a consultant in the Army Reserves.
Dr Viki Andersons
1. Can you tell us a bit about your role as Colonel in the Army Reserves?
I am currently serving as a Consultant in the Reserves but have in the past been Commanding Officer of the 3rd Field Ambulance (the unit of Private John Simpson Kirkpatrick) and later 3rd Health Support Battalion. That unit was deployed to East Timor where I served as the Commanding Officer of the United Nations Military Hospital.
2. What are the most common eye injuries you see working on the frontline?
The types of injuries encountered on the ground would be penetration of foreign bodies and chemical burns to major penetrating eye injuries. Recently there have been soldiers that have lost eyes in blast injuries. There is also some evidence that the shock waves from nearby blasts can have a detrimental effect on retinal ganglion cells similar to the concussive effect on brain cells.
3. What would a typical day look like for medical corps? What’s involved?
Basically, the army medical corps exists to look after those soldiers that put themselves in harm’s way for us. It is a privilege to be able to do that. All of the army’s medical specialists are in the reserve and are deployed when their particular skill set is required. It is felt by our military that eye injuries should be dealt with at high-level facilities so ophthalmologists are not deployed as such. I do often provide medical advice over the phone.
4. How is working as a military ophthalmologist different to working in a clinical setting?
While it is rare, I have performed eye surgery in the military setting and here it was essentially the same as at home except that it was in a tent.
5. How did you spend ANZAC Day this year?
On Anzac Day I attended the Dawn Service at my unit’s barracks then had breakfast there with the unit. After that, the unit travelled to the Adelaide CBD and marched as a unit in the ANZAC Day march. The 3rd Health Support Battalion has subunits in several states and provides a large number of medical specialists, nursing officers, pharmacists and combat medics for a range of deployments around the world.
I am very proud of the fact that our military deeply considers moral and ethical questions in all of our military interventions and always endeavours to treat local populations with respect and dignity. This makes our job as medicos a humbling experience and as I said earlier a distinct privilege.
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To celebrate this year’s International Women’s Day, we spoke to some inspirational women in the field of ophthalmology. A/Prof Deb Colville is an ophthalmologist from Victoria who is trained in paediatric ophthalmology, public health, women’s health, gender and medical education, health policy making and leadership. Through her international travels, A/Prof Colville has investigated the evidence that links women doctors’ (including women ophthalmologists’) occupational health in relation to women’s health globally. A/Prof Colville has received an Australian Medical Association Women in Medicine Award and is currently on the RANZCO Women in Ophthalmology Advisory Group.
Dr Deb Colville with her son James
1. Why did you choose ophthalmology as a career?
Patients value their eyes so much. I wanted to do surgery, and the ophthalmic surgeons I worked with early did such neat, beautiful craft work! I was inspired.
2. What has your experience been like working as a woman in ophthalmology?
I have enjoyed my life as a female ophthalmologist. I count myself as highly privileged to have such training and belong to the community of ophthalmologists.
3. What are some of the changes you want to see in the field?
I would like to see ophthalmology drawing on the strengths of its women in this field. The culture of ophthalmic practice and training is impoverished by ignoring these strengths.
4. As the theme for this year’s International Women’s Day is Be Bold for Change, what do you think has been the ‘bold’ moment in your career?
My ‘bold’ moments are proudly speaking out publicly when I see intense and flagrant sexism, and supporting other women (and men) to do the same. I think it takes a particular kind of courage for us to speak loudly about gender matters within the affairs of surgical-related colleges. It is difficult – one feels churlish to call out something that isn’t right within that same culture that has nurtured my career and learning. I am still learning how to do this,
and to support others to shout this call out loud. The experience of the punishment that is meted out is sometimes extraordinary, yet the outcomes later are worth it to me. The social movement about being bold in acting on the connections between women doctors’ health, workplace dignity and good patient care is what I want to be a part of.
5. What advice would you give to new female graduates starting out in ophthalmology?
Women are not the problem. It’s the male-oriented origins of the medical culture that will need to change to improve ophthalmic care. I believe that both men and women in ophthalmology need to work for change, not just men alone, nor women alone.
6. Can you tell us a bit about the work you’re doing with RANZCO’s Women in Ophthalmology Advisory Group to address gender imbalances in ophthalmology?
The RANZCO Women in Ophthalmology Advisory Group are working to promote women in leadership in the College, and women’s full participation in all College affairs, (not just the obvious ones).
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To celebrate this year’s International Women’s Day, we spoke to some inspirational women in the field of ophthalmology. Dr Di Semmonds is the Vice-President of RANZCO and a member of the RANZCO Diversity and Inclusion Committee. She has also held several senior positions on various College boards and committees. She has been Chair of the College Board; Chairman, Vice-Chairman and Hon Secretary of the RANZCO NSW Branch; Chairman of the National Scientific Congress; member of the Federal Qualification and Education Committee; and member of the Overseas Trained Specialist Panel. Dr Semmonds is a general ophthalmologist with interests in cataract and refractive surgery. She runs her own private practice in St Leonards, Sydney and is a visiting medical specialist at Sydney Eye Hospital. In our interview with Dr Semmonds, we look at what measures RANZCO is taking to address gender imbalances in the field, and how women like Dr Semmonds are making an impact to achieve greater female representation/gender equality in ophthalmology.
Dr Di Semmonds1. Why did you choose ophthalmology as a career?
As a child, I enjoyed doing fine things with my hands; I liked to create little objects with match sticks and would sew my own clothes. So, it was a natural progression wanting to do something that involved using my hands. I was intrigued by the surgical side of medicine and microsurgery. I chose ophthalmology as a specialty as I was inspired by ophthalmologists that I had met as a young doctor. The surgery was fascinating. People often value their sight above the other senses and to be able to help people to see again is a great privilege.
2. What are some of the challenges you’ve come across over the course of your career and how have you overcome these?
I think that everybody has their challenges when doing a medical degree. As a medical student, you are growing up at the same time as becoming a young doctor so you are trying to work out who you are whilst looking after other people. Working long hours and spending all your spare time studying was also challenging.
3. What has your experience been like working as a woman in ophthalmology?
For me it was important to find an area of medicine that would be a good fit in terms of having a family. There are of course challenges in studying, working full time and bringing up children but I think this applies to women in general who are working full time in any field. It’s about finding the balance between your work and your private life. I was happy with both my work and the challenges that came with it and so I was happy to face those challenges. I’ve also had some wonderful male mentors who were incredibly supportive throughout my career.
4. As the theme for this year’s International Women’s Day is Be Bold for Change, what do you think has been the ‘bold’ moment in your career?
I believe the ‘bold’ moment for me was setting up my own solo practice. You don’t get any training in the business aspect of ophthalmology so it can be difficult setting up your own solo practice or becoming part of a group practice. However, I was very lucky in having a wonderful secretary who was very experienced and of great help to me.
5. What advice would you give to new female graduates starting out in ophthalmology?
Love what you do! Ophthalmology is an interesting, challenging and rewarding career. We are very fortunate to be able to have such an impact on people’s lives and it is a privilege to be an ophthalmologist.
6. As Vice-President of the College, how important do you think it is to see women in senior roles in organisations like RANZCO, which have traditionally been very male dominated?
I think that it is very important for women to be in senior roles in any organisation as they bring a different perspective to the team. In fact, research shows that there are many benefits to having female members on boards and the College is no different. I believe that having female representatives in our committees allows for more balanced discussions.
7. Can you tell us a bit about the work you’re doing with RANZCO’s Diversity and Inclusion Committee?
The College Board and Council aims to have 35% female representation on all committees. The Diversity and Inclusion Committee takes the lead in suggesting and overseeing the implementation of initiatives that further this aim and the aim for greater diversity and inclusion more generally. It is important to explain to our College members as to why we are committed to having more female representatives in senior roles and to fostering respect for each other regardless of, and even in celebration of, our differences. Of course, it goes without saying that all members, male or female, are required to have appropriate credentials and qualifications that meet the need of the role. Thankfully, that is not hard to find within the membership of the College!
Definition
Orthoptists are eye care professionals who are university trained in the diagnosis, assessment and treatment of vision and eye disorders. Orthoptists work with people from all age groups and are integral members of the eye health care team.
Skill-set
Orthoptists have a particular expertise in:
– Diagnostic testing and clinical investigation of patients with eye diseases such as cataract, macular degeneration, diabetes and glaucoma (which are the most common causes of blindness in our community).
– Clinical assessment and non-surgical management of eye misalignment and eye movement disorders.
– Assessment and rehabilitation of patients with low vision.
– Visual rehabilitation for stroke patients who have lesions that affect the visual centre of the brain.
– Vision screening and detection of vision problems in the pre-school population enabling early intervention and prevention of visual disability.
Places of work
– Orthoptists predominately work in specialist eye clinics and public hospitals where they monitor eye disease, provide clinical and technical support to ophthalmologists and provide treatment which includes eye exercises and prescribing glasses.
– Rehabilitation and low vision agencies.
– Vision and medical research centres and universities.
– Eye care and pharmaceutical industry providing technical expertise about eye care products as well as the sale and promotion of diagnostic and surgical instrumentation.
Relationship with ophthalmologists
– Orthoptists work alongside and in close collaboration with ophthalmologists in both the private and public sector.
– Relationship is similar to that which exists between radiographers and radiologists.
– Orthoptists may join RANZCO as Associate Members.
– The RANZCO Annual Scientific Congress and the Orthoptics Australia Annual Scientific Conference are held around the same time and at the same venue each year which fosters the professional relationship between orthoptists and ophthalmologists to enhance patient safety and eye care delivery.
Education & Training Centres in Australia
MELBOURNE, VICTORIA
La Trobe University: Faculty of Health Sciences, Department of Clinical Vision Sciences
Undergraduate entry: Bachelor of Health Sciences/Master of Orthoptics – 4 Years
Graduate entry: Master of Orthoptics – 2 Years
For further information visit http://www.latrobe.edu.au/courses/orthoptics
SYDNEY, NEW SOUTH WALES
UTS: Graduate School of Health, Discipline of Orthoptics
Graduate entry: Master of Orthoptics – 2 Years
For further information visit http://orthoptics.uts.edu.au
More information
Orthoptics Australia: https://www.orthoptics.org.au/
Orthoptics Australia (OA) is a national organisation representing members in all states of Australia, as well as members from other countries, including New Zealand, United Kingdom, Singapore, Malaysia and Hong Kong. OA strives to promote and advance the discipline of orthoptics in public hospitals and ophthalmology practices, and to actively seek and implement career and work benefits and opportunities for its members.
International Orthoptic Association: https://www.internationalorthoptics.org/
Promotes orthoptics worldwide, providing information and support to national bodies and individual orthoptists while helping to maintain and improve standards of education, training and orthoptic practice. The IOA represents orthoptists in more than 22 countries around the world.
This Orthoptics Awareness Week (27 February – 3 March) we reflect on the vital role of orthoptists and the relationship they share with ophthalmologists as part of the eye care team. Alanna Lyndon, an orthoptist based in Hobart, Tasmania tells us about her work.
1. What do orthoptists do?
Orthoptists are university trained, allied health professionals who predominantly assist ophthalmologists by performing tests or measurements, which help them to diagnose and treat people with eye disease. An orthoptist’s role varies depending on the clinic or doctor they work for. Some specialties include paediatrics and eye movement disorders, low vision, refractive treatment or research.
2. How do orthoptists work with ophthalmologists?
In most cases, orthoptists perform the required vision assessment and tests needed prior to the ophthalmologist seeing the patient. Orthoptists also help with patient education, IOL calculations, managing clinic flow and liaising with medical or technical representatives. Traditionally an orthoptist’s role was limited to the non-surgical management of eye movement disorders, however as technology has advanced so too has our role.
3. Why did you choose orthoptics as a profession?
In high school we were encouraged to do work experience. At the time I was thinking about becoming a Physiotherapist. My next-door neighbour was an orthoptist and suggested I attend the eye clinic. I really liked the mix of working with children and the elderly.
4. What does your typical day look like?
Every day is busy! Most of my time is spent doing refractive and orthoptic assessments, field tests and angiograms. Our practice is involved in many research projects, so it is our job to conduct the tests required for this. Other times I assist in LASIK and cataract surgery.
5. What kind of patients do you work with most?
All kinds. Children with strabismus, young adults having LASIK and the elderly with glaucoma and macular degeneration. The variety is what makes the profession interesting.
6. As the theme for this year’s Orthoptics Awareness Week is Orthoptics Australia Wide, how would an orthoptist’s work in Tasmania differ from someone working in Sydney or Melbourne?
A clinic in a rural setting is very different. I’ve recently returned from working in Melbourne and have really noticed the change. The best thing about Tasmania is working alongside other health professionals such as registrars, registered nurses and ophthalmic technicians. In Tasmania I find I need to be a ‘jack of all trades’, being able to perform all tests required by the doctors. On the other hand, the large number of Specialist Doctors in Melbourne allows for orthoptists to focus on specific areas, such as retinal or refractive, and become highly specialised in those areas.
