British and Irish Orthoptic Journal最新文献

Background: Patching therapy is the most common treatment for amblyopia (lazy eye) and is unsuccessful for approximately 40% of patients, leaving them with life-long unilateral visual impairment and increased risk of bilateral visual impairment later in life. Poor adherence to patching therapy is a major contributing factor in treatment failure yet we lack real-world understanding as to why this is a problem outside of controlled research studies.

Methods: In collaboration with patient contributors, we developed an online survey for past patients, parents/carers of children with amblyopia, health professionals, and schoolteachers. The survey included questions about when and where is best for children to wear the patch, the design of the patch, and facilitators and barriers to patching therapy.

Results: We received 631 responses to the survey (259 health professionals, 213 parents/carers, 110 people who patched as a child, 7 teachers, and 42 people matched to multiple categories). Healthcare professionals thought weekday (54.4% versus 14.3% preferring weekend and 31.3% no difference) and school (54.4% versus 21.6% preferred home and 23.9% no difference) patching was more successful. Past patients (52.4%) favoured 'force' as a technique to encourage patching; more than both health professionals (7.7%) and parents or carers (19.7%). Patients rated 'people making fun' of them as an important barrier to patching.

Conclusions: We describe surprising differences in stakeholders' responses to the survey questions about barriers to successful patching treatment. We suggest these differences are used as a guide for further work to explore stakeholder's social experience of patching.

Objective: Vision screening programs in children aged 4-5 years aim to address visual issues before they start school, supporting children's educational, developmental, emotional, and social well-being. This study evaluates attendance rates and barriers to attendance for children requiring follow-up in an urban hospital eye service after their initial screening visit.

Methods and analysis: Retrospective data on attendance, visual acuity, refractive errors, and presence of additional support needs (ASN) were collected from the National Database for preschool screening and the hospital electronic record system. Caregivers of children with missed appointments were invited for a telephone survey.

Results: First-time hospital attendance rate was 61%. Children with ASN were 1.8× more likely to miss two hospital appointments and had more incomplete tests compared to children without ASN. In children receiving a spectacle prescription, vision improved by 0.07 LogMAR in the better eye and 0.16 LogMAR in the worse eye. Barriers for attendance included being unaware of the appointment, ASN, hospital environment, scheduling and transport issues. Parents recommended information with the appointment letter in an accessible language for the child and caregiver, an appointment reminder text message and options for vision tests in the community or at school.

Conclusion: Whilst the initial uptake of vision screening is high, there is a significant proportion of children with incomplete screening tests or missed follow-up appointments. Greater attention should be placed on improving accessibility of the service for children with ASN, as they may be at greater risk of missing out on appropriate eye care.

Introduction: Clinical placements in allied health are crucial for students to develop skills in real-world settings. However, these environments can expose students to incidents of incivility, bullying, or harassment. Whilst much research has explored bullying in medicine and nursing, little is known about the rate or effect of bullying in smaller allied health professions. This study aimed to investigate the frequency of bullying incidents among final year orthoptic students and assess the consequential effects of this experience.

Methods: In this cross-sectional study, final year orthoptic students and graduates who had completed placements in the preceding year were invited to complete an online survey. The survey instrument was adapted from the Clinical Workplace Learning Negative Acts Questionnaire-Revised. Information on demographics, placement attributes, bullying experiences, and their effects was gathered. The data were analysed using descriptive statistics.

Results: A total of 20 individuals responded to the survey; 12 (60%) final year students and 8 (40%) graduates. Almost all participants (95%) reported experiencing at least one negative act whilst on placement, with 10 (50%) indicating they experienced bullying. Of these 10, all reported feeling humiliated by the incidents, and 90% reported a loss of confidence. Almost all students (90%) did not report the behaviour when it happened, with most students also being unaware of bullying and harassment policies of the university or health facility.

Conclusion: Bullying and incivility pose challenges for orthoptic students during placements. This study highlights gaps in policy implementation and underscores the need for effective measures to address this issue.

Purpose: In 2022, the General Optical Council initiated a call for evidence concerning the Opticians Act. This consultation aimed to gather input and evidence relevant to potential modifications to the Opticians Act. One piece of research that was commissioned aimed to investigate the role of orthoptists in refraction.

Method: We invited a range of eye care practitioners to participate in an online virtual focus group. Focus group discussions were audio-recorded, transcribed, and thematically analysed.

Results: Two focus group discussions involving sixteen eye care professionals were completed. Findings confirm some orthoptists are already performing refraction tasks within the hospital eye service, primarily with young children using cycloplegic retinoscopy. Participants indicated that, at present, orthoptists refract on behalf of ophthalmologists who issue spectacle prescriptions based on the findings of the orthoptist's refraction. Potential benefits of orthoptists undertaking refraction responsibilities were discussed including the ability to conduct retinoscopy in hospital paediatric clinics where services are in high demand and there is often a shortage of refraction appointments. This shift could lead to decreased NHS waiting times, fewer patient appointments, improved clinical decision-making, and facilitate the assessment of accommodative dysfunction. Overall, the group were positive towards orthoptists conducting refractions and issuing optical prescriptions but with specific conditions: limited to hospital settings, necessitating adequate postgraduate training, supervision by a hospital eye service consultant, and regular ocular health assessments.

Conclusion: This study assessed the involvement of orthoptists in present and prospective refraction services, including their potential to legally issue optical prescriptions. The research outlined both the potential benefits and mitigating strategies to address concerns if orthoptists could issue optical prescriptions.

Language is important. Words we use can be much more descriptive. We propose using the prefix reconstruction when describing strabismus surgery. This word emphaises that extra ocualr muscle surgery is much more that cosmetic, it is always functional even when restoring facial aesthetics that improve patients confidence and perception fo themselves to others.

Aim: The aim of this literature review was to determine if a consensus could be reached on whether amblyopia treatment causes distress to patients and/or their guardians, and if so, establish the impact of this reported psychological distress upon paediatric patients and/or their parents/guardians.

Methods: A systematic review of the literature was conducted of all publications written in English. Search terms included both MeSH terms and alternatives related to amblyopia and psychological distress. Evidence quality was assessed using an adapted Newcastle-Ottawa Score (NOS) and evaluation of the literature was used to form a narrative synthesis of the findings.

Results: Initial searches yielded 7,838 titles in total, with 25 peer reviewed papers published between 1999 and 2021 meeting the study inclusion criteria. Factors such as the presence of strabismus, moderate and severe amblyopic density, occlusive patch treatment and patching during school age increase the likelihood of experiencing distress as a result of amblyopia treatment.

Conclusions: Both parents/guardians and patients can experience psychological distress as a result of undertaking amblyopia treatment. School-aged children and those receiving occlusion therapy in the form of patching report higher distress than infants and young-children, and those receiving atropine occlusion therapy or refractive correction only. Further study measuring the physiological markers of distress such as Cortisol and BDNF, is recommended.

Objective: To investigate if the type of unilateral amblyopia can impact the improvement of visual acuity in amblyopic eyes during a longitudinal interventional study involving standard occlusion therapy in children.

Methods: A longitudinal and interventional study of 91 children, aged 3-9 years (6.12 ± 1.879) with amblyopia was undertaken. Amblyopia was unilateral and caused by either strabismus, anisometropia, or both. Amblyopia was divided into three levels of severity mild, moderate, and severe. Children underwent amblyopia treatment with standard occlusion therapy and were followed monthly, for eight visits.

Results: A significant improvement in visual acuity was observed in all assessment visits across the three types of amblyopia, with a mean improvement of (0.30 ± 0.184) LogMAR. Specifically, anisometropic amblyopia with (0.28 ± 0.18) LogMAR, strabismic amblyopia (0.31 ± 0.18) LogMAR, and mixed amblyopia (0.31 ± 0.18) LogMAR. No significant differences were found between the improvement in visual acuity during the eight control visits and the types of amblyopia (r = 0.174, p = 0.182). However, a significant correlation was observed within all groups in the mean improvement in visual acuity and the severity level (r = 0.712, p = 0.034).

Conclusion: Amblyopia types do not appear to significantly affect the improvement in visual acuity; however, the initial severity of amblyopia may be a key factor influencing the degree of visual recovery achieved with occlusion therapy.

Care for people with idiopathic intracranial hypertension (IIH) needs improving and I think orthoptists are in a perfect position to help. The problems with IIH care are multi-fold:  People with fulminant IIH are still losing sight due to delayed diagnosis or mismanagement.People with IIH often have a poor quality of life due to disabling chronic headaches and poor mental health.There is a lack of access to evidence-based weight-loss interventions and support.Weight stigma in healthcare remains pervasive and damaging and disproportionately impacts women.Functional vision loss and headaches in IIH can complicate the interpretation of visual function which can have implications for management.There is a lack of evidence to support treatment options. Below I will describe the issues in more detail and outline the ways in which we as orthoptists can help this patient group.

Background and objectives: The absence of the orthoptic profession in Spain contrasts with its value and recognition in other countries. This study aimed to gauge Spanish ophthalmologists' interest in including and promoting orthoptists in paediatric and strabismus departments. Secondary objectives included assessing interest in requesting orthoptists, involvement in their training, and aligning their competencies with European standards.

Methodology: Participants were recruited via WhatsApp and flyers during the 30th SEEOP Congress in May 2023 and invited to review a report on orthoptists' significance followed by completing a 12-question online survey. Profile questions were asked via multiple-choice options. Opinions on integrating orthoptists to enhance care quality, training involvement, and alignment with European standards were rated using a Likert scale. Open-ended questions captured themes, and comments.

Results: Forty-two paediatric and strabismologists in Spain participated, mostly hospital-employed with advanced degrees, 90% supported integrating orthoptists into their teams, with 83% interested in having them in their workplace. Nearly 90% believed that collaboration between ophthalmologists and orthoptists would improve care quality and reduce waiting lists, and 83% supported promoting this within national medical organisations. Additionally, 90% advocated level 4 advanced European-standard training for orthoptists and 25% were neutral about participating in training orthoptists. Participants emphasised the importance of qualified orthoptists for treating eye movement abnormalities, distinguishing them from other eye healthcare professionals and advocating for collaboration rather than replacement.

Conclusions: This initial survey of paediatric ophthalmologists and strabismologists in Spain highlights support for orthoptists as allied health professionals, though garnering support for their training could be challenging. These conclusions should be considered in light of methodological, sample size, and resource limitations. The survey serves as a pilot for the future, suggesting improvements to explore the feasibility of introducing orthoptists in Spain.

Introduction: The treatment options available for Superior Oblique Myokymia (SOM) previously included surgery and systemic drugs, with the addition of beta blockers from the early 1990's. This case review aims to examine the efficacy of topical timolol (0.5%) as a treatment for SOM in the short and long term.

Methods: This is a retrospective case series review on a group of patients identified with this condition who have been assessed and treated with topical timolol 0.5% (off-label), within the same district and general hospital over a period of four years.

Results: Six patients were identified from the case review. Five out of the six patients were treated with the use of off label timolol 0.5%. One patient declined treatment due to other systemic conditions and another later discontinued treatment due to change in cardiac status. Two of the patients required increased dosage from OD to BD to achieve success initially. All the patients treated were symptom free at eight weeks and remained symptom free at six months follow-up. None of the patients in the cohort reported significant side effects.

Conclusion: This case series highlights the efficacy of the use of off label timolol 0.5% for the management of SOM with an 80% success rate for those treated with the drug.