AHPs in profile - Margaret Hancock and Farah Naqvi, orthoptists from Children’s Community Orthoptic Services.

In the lead up to AHP Day on Monday 14 October 2019, we are sharing an interview a day from some of our Allied Health Professional staff.

Today's features our very friendly orthoptists, Margaret Hancock and Farah Naqvi from Children’s Community Orthoptic Services.

Children's orthoptists

What made you become an orthoptist?

F – I wanted to do something that involved children that was clinical. During my A-levels, I was interested in pursuing medicine; my teacher asked me if I’d be interested in eyes and biology. I looked up optometry and orthoptics, the latter appealed to me more.

M – I wanted to work with children and within the medical field. I heard about orthoptics by accident – a leaflet fell out when I was with having careers advice and it really appealed to me.

What is orthoptics?

M – An orthoptist detects and treats any eye problems such as reduced vision, squints and lazy eyes. Most of the children we see are aged up to seven years. We can offer a range of treatment and therapies, including eye patches, eye exercises, and glasses. Older children normally attend a local optometrist but those with a squint, focusing difficulties or problems with eye control can be seen by the orthotpist. We have a link to the ophthalmologist (eye doctor) via the Manchester Royal Eye Hospital (MREH) for those who need squnt surgery or further investigations into their vision problems.

We provide an orthoptic service in the community and in special schools in Manchester. It works well to assess the children at school, in an environment that they are familiar with and in the company of a teacher that they are comfortable with; it reduces stress and after the assessment they go back into class and carry on with their school day! We provide the teachers with valuable vision information about the children to maximise their learning potential.

F – A lot of the parents and children look forward to seeing us because we can make such a big difference to the quality of the lives of children. In addition to treatment, the orthoptist provides useful advice, information and can signpost to useful websites that can help parents to find out what vision care is available in their area after they have been discharged.

F - In addition to treating patients, we as a department, are geared towards evidence-based practice. The team is very dedicated and continued professional development and audit is encouraged so we can provide the best care possible.

M – Our role is really multifaceted, there is an element of counselling required as parents struggle to adjust to the news that their child has a vision problem. We work to empower the whole family and listen to their concerns. We have to be very tactful when questioning parents as we may also pick up on other conditions, as the eyes are only one perspective of the child. During consultations, we can pick on issues with language, communication, hearing, development – we can then prompt parents with questions and refer them to the right service.

A multi-disciplinary approach

M - We work as a multi-disciplinary team, with health visitors, school nurses, paediatricians and GPs, who can all refer children to our service and ring us for advice. We also monitor people not attending appointments or accepting treatment as part of our safeguarding procedures. It is important to communicate this with colleagues as it may be indicative of another issue.

F - We receive a lot of referrals form school health visual screening service, which are carried out alongside the height, weight and hearing assessments. Annette Dillon, the Lead School Orthoptist, has developed a training programme to train the school nurses so they are able to carry out orthoptic tests independently and refer to us, to help us find the children most in need of our service. Since the training, we have received more referrals which are specifically targeted to our service.

F – Our service is easy to access. We try to signpost as much as we can. We are one of the few services that accept direct referrals from parents.

Misconceptions about orthoptics

M - People often confuse us with opticians, who prescribe glasses and ophthalmologists who are eye doctors. However, we are orthoptists, we specialise in eye movement, vision development and squint.

M – When we participate in public engagement activities, such as National Eye Health Week, we find out a lot about how people perceive us. Most have never heard of an Orthoptist! Parents are often surprised that we can assess the vision of very young children and babies. There is a misconception that children have to be able to know their letters to have an accurate vision test but that’s not true – we have a lot of skills that allows us to assess these youngsters’ eyes. The earlier you can pick up an issue, the better we can treat them. We only have a small window of opportunity as the visual system matures by age seven.

Making a difference to people’s lives

F – When a child walks in with a parent, we may be the first service that they have been in contact with. We have enough training to be able to identify other conditions and help to direct parents to other services. We see a whole range of children from routine to more complex needs children that often need a multi-disciplinary approach.

M – Our work is so rewarding. Parents are often devastated at the beginning of the treatment journey and by the end of it, we have been told that we have transformed their lives. It can be the little moments that are the most moving – one occasion that stays with me was when a little girl with very reduced vision was prescribed glasses for the first time. Her mother told me that she said, “Mum, I’ve just noticed the freckles on your nose”.

M – Treatment can have a big impact on a child’s development. 80% of learning is done through vision. The ones that worry me are the teenagers who are said to be doing badly at school, or are being told off for being disruptive – it can be an issue with sight rather than behaviour.

The best bits

M - It is so rewarding and such a buzz. I’ve been in the role so long that I now see the next generation coming in with their children – we’re like orthoptic grandmothers! We are part of the community, people know us.

F – Before school health commenced their screening programme, we used to undertake the eye screening in schools. I had noticed a child in nursery with an advanced squint. The mum hadn’t given consent to do any screening but I could see the squint and that she was struggling at school. I refused to give up, I managed to track down the mum and speak to her in her first language and discovered that the mother didn’t understand the letter. Eventually she consented for her daughter was treated. The daughter is now a studying to be a dentist. It was the most rewarding thing.