Orthoptics research

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• Research degrees

  Doctor of Philosophy

  Master of Orthoptics (Research)

• Supervisors

  French, Amanda	Development and progression of myopia; vision testing methods and the epidemiology of visual impairment, amblyopia and strabismus
  Golzan, Mojtaba	Ocular imaging techniques; Mechanical and structural properties of retinal vessels; Dynamic physiological interactions between the eye and the brain
  Rose, Kathryn	Public health approaches in eye care for the prevention, detection and early intervention of  eye conditions such as childhood refractive error, strabismus and amblyopia  and the visual function of people who have had a stroke.

• Current Research Projects

  An evaluation of vision screening protocols in young children	This thesis aims to identify the ideal age for childhood vision screening and whether visual acuity alone is sufficient in detecting childhood ocular conditions or, if additional tests are required. Two vision tests which are used within NSW for vision screening are compared and the barriers to accessing tertiary eye care are investigated.
  Supporting patient-centred orthoptic care for patients with communication impairments	This project involves surveying orthoptists to investigate current confidence levels and knowledge about communicating with patients with dual visual and communication impairments. Focus groups with orthoptists and speech pathologists as well as interviews with patients from this population will be conducted to further understand and investigate their perspectives. This information will then be used to guide the development of training and/or resources to assist with the assessment and management of patients with dual visual and communication impairments.
  The role of ocular biometrics and validated objective measures of environmental exposures as determinants of myopia risk	This research primarily involves the validation and comparison of a novel monitoring device which is able to objectively quantify two major environmental factors for myopia; near work and light exposure. Non-invasive methods to assess myopia risk and refractive progression will also be explored.
  Predicting Glaucomatous Progression Using Dynamic Imaging Applied to a Novel Tablet-based Ophthalmoscope	This thesis determines the feasibility of a novel tablet-based ophthalmoscope in detecting SVPs and objectively quantifying them. SVPs are also assessed as a dynamic vascular marker of glaucoma compared to established clinical structural and functional markers.
  Visual rehabilitation of stroke survivors: Improving the referral pathway and access to care	This project is a two-stage study with a focus on care provision for stroke survivors with visual impairment. The study aims to determine current post-stroke vision care practices in NSW, identify the vision care needs of Australian stroke survivors, and develop a post-stroke vision care pathway that will help to meet these needs by providing evidence based guidance to stroke care providers.

• Previous Research Projects

  Content.

  Development of vision and strabismus in childhood: prevalence and risk factors	Analysis based on the Sydney Childhood Eye Studies of population-based representative samples using gold standard techniques, provided insight into the prevalence of strabismus in Australia and associated risk factors. There was an increase in prevalence with age, predominately due to a higher incidence of intermittent exotropia in older children. Of those risk factors related to strabismus, it was determined that refractive errors and birth-related factors are the most pertinent to the development of strabismus in children. Further, the Neonatal Vision Study, a prospective longitudinal cohort study of infants admitted to neonatal intensive care units (NICU) investigated the normal development of vision and ocular motility in these infants. Age norms for premature and low birth weight infants across various measures of ocular function, beyond visual acuity were determined. This study indicated the appropriate age to provide vision screening for infants admitted to NICU may be at six months, as testability is high and it is early enough to provide intervention for detected conditions.
  The evaluation of a vision screening tool for the detection of vision problems in stroke survivors	A significant number of stroke survivors do not receive appropriate or timely intervention for experienced visual problems. This is mainly contributed by the fact that there is no current standardised vision assessment in place for patients admitted to hospital for stroke. There are many factors that contribute to this gap in care, with a key factor centred around manpower, and general accessibility to eye care services.  Many hospitals do not have onsite or regular access to specialist eyecare services, such as Orthoptics or Ophthalmology, especially in regional and rural areas of Australia. One solution is the implementation of a specifically designed vision-screening tool that can be easily administered by non-eye care health professionals (NECHP) caring for stroke survivors.  The vision defect in stroke screening tool (S-ViST) has been successfully validated in its ability to identify pre-existing and newly acquired vision defects in stroke survivors and is available for use by all NECHP’s employed within NSW Health hospital services who care for stroke survivors. In addition, to support effective administration and referral management of patients identified with vision problems via S-ViST, a “Vision defect in stroke” eLearning module was developed, with access now available via the NSW Health continuing education platform HETI. It is hoped that both resources, the vison-screening tool and the accompanying eLearning module, in the absence of specialist eye care services can provide a temporary solution to meeting the visual needs of stroke survivors.
  The role of eye movement dysfunction in concussion	The concussion epidemic is a serious concern. Affected athletes may suffer debilitating neurological sequalae, impacting both their in-game performances and quality of life.  Currently, a wide range of neurocognitive tests examining memory, balance and manifesting symptomology are used to aid a physician in the diagnosis of a concussion. Evaluation of a popular visual-based assessment device, the King-Devick test, indicated up to 30 attempts are required to obtain an accurate baseline score. Using digital eye-tracking techniques, experienced rugby athletes demonstrate superior eye movements compared to the normal population. Previous history of concussion within the last 12 months demonstrate no impact on these conjugate eye movements. Assessment of nine concussions in the acute phase using an orthoptic tool, the Royal Air Force (RAF) Rule, demonstrated 89% with reduced accommodative amplitudes and 33% with receded convergence. This PhD research has contributed knowledge regarding the importance of eye movement assessments within the concussion paradigm.