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Huibert J. Simonsz - One of the best experts on this subject based on the ideXlab platform.
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Implementation of an Educational Cartoon (“the Patchbook”) and Other Compliance-Enhancing Measures by Orthoptists in Occlusion Treatment of Amblyopia
Strabismus, 2016Co-Authors: A. M. Tjiam, Sjoukje E. Loudon, W. L. Asjes-tydeman, G. Holtslag, E. Vukovic, M. M. Sinoo, Jan Passchier, H.j. De Koning, Huibert J. SimonszAbstract:ABSTRACTPurpose: This implementation study evaluated Orthoptists’ use of an educational cartoon (“the Patchbook”) and other measures to improve compliance with occlusion therapy for amblyopia.Methods: Participating Orthoptists provided standard orthoptic care for one year, adding the Patchbook in the second year. They attended courses on compliance and intercultural communication by communication skills training. Many other compliance-enhancing measures were initiated. Orthoptists’ awareness, attitude, and activities regarding noncompliance were assessed through interviews, questionnaires, and observations. Their use of the Patchbook was measured. The study was performed in low socio-economic status (SES) areas and in other areas in the Netherlands. It was attempted to integrate education on compliance into basic and continuing orthoptic training.Results: The Patchbook was used by all 9 Orthoptists who participated in low-SES areas and 17 of 23 Orthoptists in other areas. Courses changed awareness and att...
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How Dutch Orthoptists deal with noncompliance with occlusion therapy for amblyopia.
Strabismus, 2010Co-Authors: A. M. Tjiam, Sjoukje E. Loudon, W. L. Asjes-tydeman, G. Holtslag, E. Vukovic, M. M. Sinoo, Huibert J. SimonszAbstract:Background: We previously found that compliance with occlusion therapy for amblyopia is poor, especially among children of non-native parents who spoke Dutch poorly and who were low educated. We investigated conception, awareness, attitude, and actions to deal with noncompliance among Dutch Orthoptists.Methods: Orthoptists working in non-native, low socioeconomic status (SES) areas and a selection of Orthoptists working elsewhere in the Netherlands were studied. They were observed in their practice, received a structured questionnaire, and underwent a semi-structured interview. Finally, a short survey was sent to all working Orthoptists in the Netherlands.Results: Nine Orthoptists working in non-native, low-SES areas and 23 working elsewhere in the Netherlands participated. One hundred and fifty-one Orthoptists returned the short survey. Major discrepancies existed in conception, awareness, and attitude. Opinions differed on what should be defined as noncompliance and on what causes noncompliance. Some or...
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Objective survey of the prescription of occlusion therapy for amblyopia
Graefe's Archive for Clinical and Experimental Ophthalmology, 2004Co-Authors: Sjoukje E. Loudon, Jan-roelof Polling, Brigitte Simonsz, Huibert J. SimonszAbstract:Purpose To identify the variation within and consistency amongst Orthoptists when prescribing occlusion therapy for amblyopia in an objective survey. Methods A questionnaire was designed with five case examples of amblyopic children and distributed at annual meetings of Orthoptists in the Netherlands and Germany. It was filled in simultaneously within 15 min in complete silence to avoid any exchange of opinions between Orthoptists that would reduce variability. For each case the Orthoptists were asked to give their prescription of hours or days of occlusion. Results The questionnaire was filled in by 177 Dutch Orthoptists and 227 German Orthoptists. Their prescriptions of occlusion therapy were classified into five main regimens: part-time; part-time not every day; full-time; also occluding the amblyopic eye; alternating; and no occlusion therapy. The variation was large: the standard deviation was half the average prescribed hours of occlusion for each regimen in each of the five cases. All Orthoptists were assigned a rank number for each of the five cases depending on whether their prescription was above or below average. These five rank numbers were not consistently above or consistently below average value per case. Conclusions The number of prescribed hours of occlusion varied widely per regimen per case. Orthoptists were not consistently strict or lenient in their prescription of occlusion therapy.
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Objective survey of the prescription of occlusion therapy for amblyopia.
Graefes Archive for Clinical and Experimental Ophthalmology, 2004Co-Authors: Sjoukje E. Loudon, Jan-roelof Polling, Brigitte Simonsz, Huibert J. SimonszAbstract:Purpose To identify the variation within and consistency amongst Orthoptists when prescribing occlusion therapy for amblyopia in an objective survey.
Declan W Flanagan - One of the best experts on this subject based on the ideXlab platform.
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indemnity for Orthoptist delivered intravitreal injections
Eye, 2015Co-Authors: J Dacosta, Robin Hamilton, J Nago, Adam Mapani, E Kennedy, T Luckett, Carlos Pavesio, Declan W FlanaganAbstract:Sir, We thank Mall et al1 for their interest in our article relating to nurse-delivered intravitreal injections at Moorfields Eye Hospital (MEH).2 We appreciate the fact that the increasing demands for intravitreal injection therapy necessitate novel methods of service delivery. Nurses, as part of their practical professional training, are familiar with aseptic technique, administration of injections, and safe disposal of sharps. For this reason, it was decided to proceed with nurse training for intravitreal injections at MEH. Other allied health professional (AHP) groups within ophthalmology such as optometrists and Orthoptists are not usually practically trained in these procedures as they are not generally required as part of their regular professional practice. We note that professional approval from the British and Irish Orthoptic Society (BIOS) has been sought for Orthoptist-delivered intravitreal injections and also Trust approval. However, in the letter from Mall et al,1 there appeared to be no reference to medico-legal consultation on this new scope of professional practice for Orthoptists. At MEH, we obtained medico-legal clarification on the potential risk of clinical negligence related to nurse-delivered intravitreal injections as this was a novel method of drug delivery that did not have a standard published body of evidence to prove safety before we commenced the initiative. We obtained written confirmation of indemnity cover from the National Health Service Litigation Authority (NHSLA) for nurse-delivered intravitreal injections. We welcome the expansion of training in practical procedures for AHPs including Orthoptists. However, it is important that medico-legal issues are clarified in writing for Trust indemnity purposes with the NHSLA, and robust training with appropriate high level supervision and regular audit and competency reviews are implemented for patient safety purposes.
Konstandina Koklanis - One of the best experts on this subject based on the ideXlab platform.
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A Randomized Trial to Increase the Assessment Accuracy of Glaucoma and Optic Disc Characteristics by Orthoptists
Journal of Continuing Education in The Health Professions, 2019Co-Authors: Jane Scheetz, Konstandina Koklanis, Maureen Long, Myra B. Mcguinness, Meg E. MorrisAbstract:The aim of this study was to determine the accuracy of Orthoptists when examining the optic disc for signs of glaucoma, and to explore the impact of targeted clinical education on accuracy. In this randomized controlled trial, 42 monoscopic color optic disc images were presented to 46 Orthoptists who assessed the likelihood of glaucoma as well as optic disc size, shape, tilting, vertical cup-to-disc ratio, cup shape, depth, presence of hemorrhage, peripapillary atrophy, and retinal nerve fiber layer. The level of agreement with specialist ophthalmologists was assessed. Participants were then randomly assigned to an experimental group (targeted postgraduate education on optic disc assessment) or to no intervention. The educational program was designed to increase knowledge of the characteristic features associated with glaucomatous optic neuropathy. All participants re-examined the included optic disc images after a period of 6 to 8 weeks. The primary outcome measure was a change in agreement between attempts. The education group showed significant improvements between attempts for identifying hemorrhages (P = .013), retinal nerve fiber layer defects (0.035), disc size (P = .001), peripapillary atrophy (P = .030), and glaucoma likelihood (P = .023). The control group did not show any statistically significant improvement. The intervention group showed significantly more improvement when identifying hemorrhages (P = .013), disc size (P = .001), disc shape (P = .033), and cup shape (P = .020) compared with the control group. Orthoptists who received additional postgraduate online education based on principles of adult learning were more accurate at assessing the optic disc for glaucoma. These results highlight the value of continuing education to optimize clinical practice in allied health professionals.
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investigating the effectiveness of an Orthoptist led diabetic retinopathy screening clinic
Australian Orthoptic Journal, 2016Co-Authors: Allanah Crameri, Konstandina Koklanis, Zeina Dayoub, Jana GazarekAbstract:Aim: To determine the effectiveness of the Orthoptist-led diabetic retinopathy screening clinic at Northern Health by investigating the diagnostic agreement between Orthoptists and ophthalmologists. Method: This study was a retrospective audit of 1,097 patients booked at the Northern Health Orthoptist-led screening clinic. The demographic data and clinical assessment findings were recorded for the 101 included patients (192 eyes). The Orthoptists' diabetic retinopathy diagnoses were compared with those made by the ophthalmologists using a kappa analysis. Results: Substantial agreement was observed between the Orthoptists and ophthalmologists in relation to the diagnosis and detection of diabetic retinopathy (k = 0.660, p Conclusions: Strong agreement was found between the Orthoptists and ophthalmologists when detecting and diagnosing diabetic retinopathy for patients attending the Northern Health Orthoptist-led clinic. This suggests that Orthoptists are able to effectively detect and diagnose patients with diabetic retinopathy in a hospital outpatient setting and provide a high level of care.
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Accuracy and Efficiency of Orthoptists in Comprehensive Pediatric Eye Examinations
American Orthoptic Journal, 2016Co-Authors: Jane Scheetz, Konstandina Koklanis, Maureen Long, Meg E. MorrisAbstract:To investigate the level of agreement between Orthoptists and medical practitioners in the comprehensive eye examination of children seen in an Orthoptist-led triage clinic. Patient records over a 6-month period were retrospectively reviewed. Those with a presenting complaint related to vision or ocular motility were triaged into the Orthoptist-led clinic and included in the study. Patients who did not meet the triage protocol and those who were not assessed by a medical practitioner at a subsequent appointment were excluded from analysis. The clinical findings from the Orthoptist and medical practitioner were collected and compared. In total, sixty-three patients were reviewed during the 6-month period and met the inclusion criteria. After the initial comprehensive eye examination with an Orthoptist, thirty-two were discharged from hospital and thirty-one were asked to return for a review appointment with a medical practitioner. Agreement between the Orthoptists and medical practitioners for the diagnosis of strabismus and/or amblyopia was 84.6% (κ = 0.649, P < 0.001). There was strong agreement between Orthoptists and medical practitioners for refractive error of the right eye [τ (19) = 0.352, P = 0.729] and left eye [τ (19) = 1.785, P = 0.090]. Fundus examination comparisons between the Orthoptists and medical practitioners showed very high agreement (95.7%). Orthoptists have the skills necessary to provide comprehensive care of children referred for ocular motility and/or vision related disorders. There was close agreement between Orthoptists and medical practitioners when performing comprehensive eye examinations. © 2016 Board of regents of the University of Wisconsin System, American Orthoptic Journal, Volume 66, 2016, ISSN 0065-955X, E-ISSN 1553-4448.
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indication for anti vegf treatment for neovascular age related macular degeneration based on optical coherence tomography interpretation decision agreement rate between Orthoptist and ophthalmologist
Australian Orthoptic Journal, 2014Co-Authors: Meri Vukicevic, Konstandina Koklanis, Jessica BoyleAbstract:Objective: Although Orthoptists play an integral role in the care of patients with chronic eye diseases, the clinical decision making of Orthoptists within this setting has not often been investigated. The aim of this study was to evaluate the inter-rater agreement between Orthoptists and an ophthalmologist in determining whether anti-VEGF treatment for neovascular (wet) age-related macular degeneration (AMD) is required based on optical coherence tomography (OCT) interpretation. Methods: A retrospective audit was conducted of patient data from a private ophthalmology practice. Data collected included details pertaining to patient demographics and clinical assessment, OCT retinal thickness, and the treatment decisions of five Orthoptists and one senior vitreoretinal ophthalmologist when interpreting OCT scans. The inter-rater agreement between the Orthoptists and the ophthalmologist was calculated as a percentage and the kappa (κ) statistic computed. Results: Of a total 669 treatment decisions made, on 619 occasions (92.5%) agreement was found between the Orthoptists and the ophthalmologist (κ = 0.85; 95%CI 3.43 - 1.26, p Conclusion: Agreement between the Orthoptists and ophthalmologist in AMD clinical decision making is very high suggesting that Orthoptists could potentially have a greater involvement in shared-care models within specialist eye clinics.
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Profile of the Australian orthoptic workforce 2012/13
Australian Orthoptic Journal, 2014Co-Authors: Konstandina Koklanis, Meri VukicevicAbstract:Purpose: This paper presents the findings of the Orthoptics Australia 2012/13 orthoptic workforce study. Methods: An online survey was sent to Orthoptics Australia members and promoted to non-members by colleagues, via social media and at various continuing education events. Data was collected from October 2012 to April 2013 using the online survey tool Survey Monkey. Results: Four-hundred-and-fifteen Orthoptists completed the online survey. Results indicate that the female to male ratio is 9.6:1 with the average age of Orthoptists 37 years and 61.5% of Orthoptists under the age of 40. The majority (81.7%) of Orthoptists reside in New South Wales or Victoria and most (81.1%) work in metropolitan areas. Orthoptists work in a diverse range of clinical areas, including advanced practice, with 91.8% working in specialist public or private eye clinics, 52.8% working full-time and 42% having a career interruption at some point. Overall 27.2% of Orthoptists indicated that they would be leaving the profession within the next five years. Conclusions: This study provides a valuable dataset which should be further explored with finer analysis of the workforce.
Sjoukje E. Loudon - One of the best experts on this subject based on the ideXlab platform.
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Implementation of an Educational Cartoon (“the Patchbook”) and Other Compliance-Enhancing Measures by Orthoptists in Occlusion Treatment of Amblyopia
Strabismus, 2016Co-Authors: A. M. Tjiam, Sjoukje E. Loudon, W. L. Asjes-tydeman, G. Holtslag, E. Vukovic, M. M. Sinoo, Jan Passchier, H.j. De Koning, Huibert J. SimonszAbstract:ABSTRACTPurpose: This implementation study evaluated Orthoptists’ use of an educational cartoon (“the Patchbook”) and other measures to improve compliance with occlusion therapy for amblyopia.Methods: Participating Orthoptists provided standard orthoptic care for one year, adding the Patchbook in the second year. They attended courses on compliance and intercultural communication by communication skills training. Many other compliance-enhancing measures were initiated. Orthoptists’ awareness, attitude, and activities regarding noncompliance were assessed through interviews, questionnaires, and observations. Their use of the Patchbook was measured. The study was performed in low socio-economic status (SES) areas and in other areas in the Netherlands. It was attempted to integrate education on compliance into basic and continuing orthoptic training.Results: The Patchbook was used by all 9 Orthoptists who participated in low-SES areas and 17 of 23 Orthoptists in other areas. Courses changed awareness and att...
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How Dutch Orthoptists deal with noncompliance with occlusion therapy for amblyopia.
Strabismus, 2010Co-Authors: A. M. Tjiam, Sjoukje E. Loudon, W. L. Asjes-tydeman, G. Holtslag, E. Vukovic, M. M. Sinoo, Huibert J. SimonszAbstract:Background: We previously found that compliance with occlusion therapy for amblyopia is poor, especially among children of non-native parents who spoke Dutch poorly and who were low educated. We investigated conception, awareness, attitude, and actions to deal with noncompliance among Dutch Orthoptists.Methods: Orthoptists working in non-native, low socioeconomic status (SES) areas and a selection of Orthoptists working elsewhere in the Netherlands were studied. They were observed in their practice, received a structured questionnaire, and underwent a semi-structured interview. Finally, a short survey was sent to all working Orthoptists in the Netherlands.Results: Nine Orthoptists working in non-native, low-SES areas and 23 working elsewhere in the Netherlands participated. One hundred and fifty-one Orthoptists returned the short survey. Major discrepancies existed in conception, awareness, and attitude. Opinions differed on what should be defined as noncompliance and on what causes noncompliance. Some or...
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Objective survey of the prescription of occlusion therapy for amblyopia
Graefe's Archive for Clinical and Experimental Ophthalmology, 2004Co-Authors: Sjoukje E. Loudon, Jan-roelof Polling, Brigitte Simonsz, Huibert J. SimonszAbstract:Purpose To identify the variation within and consistency amongst Orthoptists when prescribing occlusion therapy for amblyopia in an objective survey. Methods A questionnaire was designed with five case examples of amblyopic children and distributed at annual meetings of Orthoptists in the Netherlands and Germany. It was filled in simultaneously within 15 min in complete silence to avoid any exchange of opinions between Orthoptists that would reduce variability. For each case the Orthoptists were asked to give their prescription of hours or days of occlusion. Results The questionnaire was filled in by 177 Dutch Orthoptists and 227 German Orthoptists. Their prescriptions of occlusion therapy were classified into five main regimens: part-time; part-time not every day; full-time; also occluding the amblyopic eye; alternating; and no occlusion therapy. The variation was large: the standard deviation was half the average prescribed hours of occlusion for each regimen in each of the five cases. All Orthoptists were assigned a rank number for each of the five cases depending on whether their prescription was above or below average. These five rank numbers were not consistently above or consistently below average value per case. Conclusions The number of prescribed hours of occlusion varied widely per regimen per case. Orthoptists were not consistently strict or lenient in their prescription of occlusion therapy.
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Objective survey of the prescription of occlusion therapy for amblyopia.
Graefes Archive for Clinical and Experimental Ophthalmology, 2004Co-Authors: Sjoukje E. Loudon, Jan-roelof Polling, Brigitte Simonsz, Huibert J. SimonszAbstract:Purpose To identify the variation within and consistency amongst Orthoptists when prescribing occlusion therapy for amblyopia in an objective survey.
J Dacosta - One of the best experts on this subject based on the ideXlab platform.
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indemnity for Orthoptist delivered intravitreal injections
Eye, 2015Co-Authors: J Dacosta, Robin Hamilton, J Nago, Adam Mapani, E Kennedy, T Luckett, Carlos Pavesio, Declan W FlanaganAbstract:Sir, We thank Mall et al1 for their interest in our article relating to nurse-delivered intravitreal injections at Moorfields Eye Hospital (MEH).2 We appreciate the fact that the increasing demands for intravitreal injection therapy necessitate novel methods of service delivery. Nurses, as part of their practical professional training, are familiar with aseptic technique, administration of injections, and safe disposal of sharps. For this reason, it was decided to proceed with nurse training for intravitreal injections at MEH. Other allied health professional (AHP) groups within ophthalmology such as optometrists and Orthoptists are not usually practically trained in these procedures as they are not generally required as part of their regular professional practice. We note that professional approval from the British and Irish Orthoptic Society (BIOS) has been sought for Orthoptist-delivered intravitreal injections and also Trust approval. However, in the letter from Mall et al,1 there appeared to be no reference to medico-legal consultation on this new scope of professional practice for Orthoptists. At MEH, we obtained medico-legal clarification on the potential risk of clinical negligence related to nurse-delivered intravitreal injections as this was a novel method of drug delivery that did not have a standard published body of evidence to prove safety before we commenced the initiative. We obtained written confirmation of indemnity cover from the National Health Service Litigation Authority (NHSLA) for nurse-delivered intravitreal injections. We welcome the expansion of training in practical procedures for AHPs including Orthoptists. However, it is important that medico-legal issues are clarified in writing for Trust indemnity purposes with the NHSLA, and robust training with appropriate high level supervision and regular audit and competency reviews are implemented for patient safety purposes.
