A multidisciplinary vision for eye care

For the past six months, early career optometrist Claire Ong has been at the forefront of an exciting pilot project at the Women’s and Children’s Hospital Network (WCHN) in South Australia.  

The WCHN had been in search of an optometrist to join their diverse and highly skilled paediatric ophthalmology team, consisting of consultant paediatric ophthalmologists, consultant sub-specialist ophthalmologists, ophthalmology registrars, orthoptists, medical residents and outpatient nurses.

The goal of the pilot was to evaluate how a multidisciplinary approach to eye care could effectively reduce patient waiting times, and minimise the number of unnecessary referrals in the tertiary eye care system. It also aimed to improve relationships and communication between community optometrists and the WCHN paediatric ophthalmology department.

Driven by a passion for paediatrics, and wanting to further expand her skills in this space, Claire applied for the position advertised by the WCHN, was successful, and commenced the project in January 2023. This was the first time since the Modbury Hospital pilot, led by fellow South Australian optometrist Jacqueline Warren, that SA Health has introduced an optometrist into a hospital setting.

What was the aim of the optometry pilot?

Claire: One of the main goals of the pilot was to identify the clinical skills that an optometrist can perform within a tertiary hospital setting, and explore how optometrists can be integrated into an established, multidisciplinary team dynamic.

In the role, some key responsibilities involved developing glasses prescribing guidelines for those working in the paediatric ophthalmology department, improving current department resources, such as updating glasses prescription forms, and developing teaching resources for medical and orthoptic placement students. We are also developing a paediatrics teaching presentation for the final year Flinders optometry students.

Another key aspect involved improving relationships and communication between community optometrists and the WCHN ophthalmology department. Sometimes optometrists are not comfortable managing a paediatric patient even if it is within an optometrist’s scope of practice, whether it be due to not having the correct equipment or confidence, so the patient is referred to the hospital. With this pilot, we wanted to promote and empower community optometrists to be more actively involved in paediatric care.

Can you elaborate more on the idea of setting up external outreach clinics?

Claire: We are exploring the feasibility of an external allied health-led (optometrist, orthoptist and paediatric trained outpatient nurse) outreach clinic to form an early “hub-and-spoke” model for South Australian children requiring secondary level ophthalmic care.

What were the long-term goals of the project?

Claire: By integrating an optometrist into a hospital environment, the long-term goal was to safely increase the volume of patients seen by the paediatric ophthalmology department while still ensuring the continued provision of high-quality, evidence-based eye care.

There was also a significant focus placed on educating and empowering community optometrists and GPs in the paediatric eye care field to see and manage more patients, thereby effectively reducing the number of unnecessary referrals into the tertiary eye care system. We also aim to educate and form relationships with the next generation of clinicians and have worked collaboratively to increase the volume of medical and orthoptic placement students that we take on, with the vision of hosting optometry placement students in the future.

What did you learn?

Claire: I’ve witnessed that a symbiotic, multidisciplinary approach to paediatric ophthalmology is highly effective. There is an overlap of skills and knowledge between eye care professionals within the team. For example, an optometrist is particularly useful in performing cycloplegic retinoscopy, anterior eye and dilated fundus exams, subjective refraction (when indicated) and ophthalmic imaging.

Additionally, patients attending sub-specialist clinics such as Ocular Oncology or Oculoplastics can have additional testing done on the day by the staff optometrist, rather than also having to also attend the general clinics for glasses prescriptions or visual development checks.

What are your next steps?

Claire: I’m excited to say that in July, WCHN has approved the extension of the pilot for another six months! This highlights how important paediatric ophthalmology services are in South Australia and the benefits of multidisciplinary care.

Learning the ropes of paediatric ophthalmology and public health has been a steep learning curve, and it’s been a privilege to learn from and work with such passionate, experienced and knowledgeable eye care professionals.

The pilot’s extension is a testimony of the team’s hard work and persistent advocacy for collaborative eye care, and I love being a part of it.

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In May 2023, Optometry Australia convened a Collaborative Care Symposium to enable optometrists to share their experiences, learn from each other and provide insight into how their collaborative care models could be more broadly rolled out across the health system. Read more about the Collaborative Care Symposium here.