Appendix 3: Eye Health Professions: Summary Profession Definition Key functions Qualifications/training Ophthalmologist Is concerned with the anatomy, physiology and diseases of the eye. Explain diagnostic and treatment procedures to patients Obtain medical histories from patients Administer diagnostic tests Diagnose eye conditions Provide surgical treatment Provide medical treatment Prescribe/administer medication, including drops and injections Provide post-surgery follow up Provide routine check ups once condition stabilised 6 years medical undergraduate education 2 + years postgraduate prevocational training 5 years vocational (RANZCO) Ophthalmic technician Helps ophthalmologist collect data and measurements to allow the correct diagnosis and treatment of eye diseases and problems Perform simple eye exams Assist with eye surgery Explain diagnostic and treatment procedures to patients Obtain medical histories from patients Administer diagnostic tests Measure and recording vision Test eye muscle function Provide contact lens education Administer eye medication Maintain optical and surgical instruments No formal NZ qualification Internationally, 1 year certificate or diploma In NZ, ophthalmic technicians typically have an orthoptists, optometry or nursing degree as well as ongoing clinical training in developing technology and visual disorders. Ophthalmic technologist Same as ophthalmic technician but has more training and expanded responsibilities As above, plus Perform ophthalmic clinical photography and fluorescence angiography Perform electrophysiological and microbiological procedures Supervise other ophthalmic staff No formal NZ qualification Internationally, 2 year associate degree Ophthalmic assistant Works with ophthalmologists to provide eye care to patients. Conduct eye tests Measure vision and test eye muscular function Apply eye dressings Show patients how to properly use contact lenses No formal NZ qualification Internationally, 1 year certificate or diploma On-the-job
Nurse Practitioner Works collaboratively as part of ophthalmic team as well as independently Explain diagnostic and treatment procedures to patients Obtain medical histories from patients Administer diagnostic tests Diagnose eye conditions Prescribe/administer medication, including drops and injections Provide post-surgery follow up Provide routine check ups once condition stabilised Fluorescin staining of the cornea Remove foreign body 3 years - BHSc / Registered Nurse Clinically approved Masters degree Minimum of 4 years experience in specialty Optometrist Is concerned with eyes and related structures, as well as vision, visual systems, and vision information processing Examine clients' eyes and visual systems to diagnose vision problems and eye diseases. They provide correction and other treatment when required Bachelor of Optometry (BOptom), University of Auckland (4 years + 1 year biomedical science prerequisite) Vision hearing screening technician Screen vision and hearing for any problems that may require attention Test vision and hearing, primarily in children Refer on as necessary National Certificate in Vision and Hearing Screening being considered for registration with NZQA at Level 3 1 year academic and on-the-job General practitioner Deals with the anatomy, physiology and diseases of the whole body, may have an area of special interest. Measure visual acuity and conduct pinhole testing Conduct external exam of eye Evert eyelid Exam pupil and red reflex Assess ocular movement and conduct cover test Conduct visual field test by confrontation Conduct direct ophthalmoscopy Test colour vision Fluorescin staining of cornea Remove foreign body Advise on correct application of eyepad and when to use one Recommend seeing other eye health professional Refer to ophthalmologist 6 years medical undergraduate education 2 + years postgraduate prevocational training 3 years vocational (RNZCGP), eye health one of about 40 components in GP training
Pharmacist Concerned with medication, their use and their composition and reactions with each other Provide patient information on prescription only, pharmacy only and over the counter medication Provide medication for conjunctivitis (medication now pharmacist only rather than prescription only) Recommend seeing other eye health professional BPharm (4 years)
Table 1. Referral Numbers by Category – National Referral Guidelines 2000 Category Criteria Examples (Not exhaustive list) Number of Referrals in past month 1. Immediate • Trauma not able to be treated conservatively • Painful red eye with significant loss of vision • Sudden severe vision loss • Painful diplopia • Surgical trauma to the lids, orbit, ocular structures. • Penetrating eye injuries • Retained intraocular foreign bodies • Hyphaema • Chemical burns • Corneal ulcer • Acute glaucoma • Ischaemic ocular conditions eg.temporal arteritis • Third nerve palsy 52 164 113 18 PERCENTAGE REFERRED TO PUBLIC SYSTEM 65% 2. Urgent • Sudden visual loss • Neurological conditions threatening permanent damage if treatment delayed • Diabetic conditions with loss of vision • Retinal detachment /haemorrhage • Vitreous Haemorrhage • Disc Oedema • Other cranial nerve palsies • Acute field defects • Retinopathy 198 95 127
• Painful red eye with loss of vision • Traumatic conditions • Neoplasms • Infective conditions • Iritis • Herpes Zoster/simplex • Corneal foreign bodies • Orbital blowout fracture • Corneal abrasions • Blunt trauma • Intraocular malignancy • Acute dacryocystitis • Unresponsive conjunctivitis 113 98 23 122 PERCENTAGE REFERRED TO PUBLIC SYSTEM 62% 3. Semi - Urgent • Lid Tumours • Moderately progressive diabetic conditions • Misc conditions threatening permanent damage if treatment delayed • Infective disease • Orbital disease •BCC’s and SCCs • Vision threatening retinopathy • Retinopathy in pregnancy • Entropion • Chronic dacrocystitis • Proptosis -displacement of globe • Thyroid eye disease 85 136 162 54 31
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Draft Uveitis Stream A ? Yes Stream A- 90+% Acute -Self presented - Previous uveitis episode -Referral Stream B- -Referral by GP other specialists (outside ophthalmology) Atypical Letter triaged to sender ? Cons/NP Pt attends clinic & waits Nse does V/A Further investigation Investigation Pt S/B 1. Active uveitis 2. Chronic Mild Active Severe active 6 mnthly / Fullmedical workup Minimum of No immunosuppres s n