Orthoptists in Research Careers

Not all Orthoptists will have a purely clinical career.  Research is vital to our profession, ensuring we have a current understanding of how eye conditions can effect a population and how to treat our patients effectively.

Helen is an early career research orthoptist and this is her journey so far...

"I studied for a BMedSci (Hons) Orthoptics at The University of Sheffield, graduating in July 2016 with a first-class honours. I was subsequently offered a post at the University of Leicester as a research orthoptist in August 2016. I am also working on a part time PhD at the University of Leicester looking at phenotype-genotype relationships with the use of hand-held optical coherence tomography (OCT) and eye movement recordings.

We are working on many exciting projects in Leicester, however my current job role is focussed on working with a wider team at the university and IIIT (India) to introduce the application of artificial intelligence into paediatric ophthalmology with the use of OCT. I was grateful to be given the opportunity to present this work at BIPOSA conference 2019.

There is a fantastic variety of work associated with my post as a research orthoptist, ranging from working in theatres examining paediatric patients under general anaesthesia, to analysing clinical and genetic information, to writing up papers with the intention of publishing. I also work in a clinical post, therefore I usually have one day a week where I will examine paediatric and adult patients in a hospital setting. There are also plenty of great opportunities to develop your skills with various courses including statistics workshops and high performance computing training.

As an orthoptist, I also have the opportunity to teach a diverse range of individuals from international medical students to ophthalmologists in teaching environments such as clinics, lectures, small group workshops and one-to-one teaching. With my teaching experiences, I was subsequently awarded an Associate Fellowship of the HEA in 2019.

Following the completion of my PhD, I aspire to undertake a post-doctoral fellowship and develop my career towards becoming an academic clinician. Furthermore, I am interested to continue my involvement in a variety of teaching environments."

Orthoptists are improving lives every day

Patient stories are really important to show the impact orthoptists have on people’s lives. Strabismus can effect self esteem in patients of all ages. Patients report avoiding social situations and even job interviews. Read Leanne’s story here...


“During my younger years I was quite oblivious to how much my eye turned in, but once I got to high school age the other children made it very clear that I looked different.
The name calling began, I was called ‘boc eye’ and ‘gozzy’ to name a few.  I became quiet and kept myself to myself.  I remember growing a fringe and trying to use my hairstyle to keep my eye covered.  It absolutely affected my confidence during my school years. I was referred to an Orthoptic clinic where I had tests to measure the position of my eye and check if I could use my eyes together. At 15 I had my corrective squint surgery and even with the blood shot eye I instantly felt better and once the eye had healed I really did feel like a different person. Without the orthoptists and the ophthalmologist who did my operation, I feel that I would not have got a job as cabin crew when I left school and had the confidence to do all the amazing things I have done in my life.  I would not  be the person I am today.  Every child with a squint should have the opportunity to feel the same way I felt the day I had my operation.  Being an orthoptist must be a very rewarding job!”

Leanne has shared a baby photo and how she looks today. She is confident and happy and this is one reason why we love our job (we have many reasons).

Thank you Leanne for sharing your story.

Profile - Neuro Orthoptic Lead

For AHPs Day this year we are celebrating the specialised and extended roles of orthoptists.

Nicola Hirst is a lecturer at Liverpool University and lead for the neuro orthoptic service at Manchester Royal Eye Hospital.

“I enjoy being an AHP because I am able to help with diagnosing patients with complex eye movement problems and offer them options to manage their symptoms.
I find it rewarding to be able to make patients feel more comfortable and our role is important as we are often the first to identify a change in the neurological condition through their eye movements.
It can be challenging but I enjoy being able to adapt my assessment to meet the patients’ needs”

Patient story - functional squint surgery

Patient stories highlight the work orthoptists do and the positive impact we have on patients lives.

I developed a severe squint very suddenly due to stress on my eyes which was affecting my ability to complete everyday tasks and live my life comfortably.  I was monitored for two years and was givena Fresnel prism to assist my eyesight in the meantime. Eventually it was decided that I needed surgery as the squint worsened over time, even with the prism.  The care I was given over the two years was exceptional.  I was listened to and taken seriously throughout.  Strabismus surgery has changed my life.  For the first time in two years (and possibly longer) I am now able to adjust my focus from near to distance immediately.  I can read books with my glasses on again.  I can do my job of looking at paper information and data inputting without having to wear an eye patch.  I can see clearly again and my happiness has improved.  I could not be more grateful to the entire team of staff at Manchester Royal Eye Hospital.  The care I received was exceptional, they empathised with me every step of the way and my eyesight has never been better.  A squint affects not only how you look but how you function.  Strabismus surgery is vitally important.

MECC Story - microvascular 6th nerve palsy

MECC Patient story – Microvascular 6th nerve palsy

A 67 year old male attended the Emergency Eye Department, complaining of double vision (diplopia). The patient was very anxious, having used an online search engine to look up the causes of diplopia. 

The patient was significantly over weight. He was taking medication for high blood pressure, high cholesterol and Type II Diabetes. The patient admitted that he didn’t always eat as he was advised to. 

The orthoptic finding were in line with a left 6th nerve palsy. I explained this to the patient, and discussed the possible causes. I advised the patient that the most frequent cause of 6thnerve palsy is microvascular dysfunction. This can be as a result of a number of factors, including; obesity, high blood pressure, diabetes and high cholesterol. 

The patient was somewhat relieved, but still very anxious that there may be a more sinister cause for his symptoms. I reassured the patient that we would, of course, check him over thoroughly to ensure we didn’t miss anything which needed urgent treatment. 

The patient admitted he did not really worry about his general health, and had not realised that the conditions he had been diagnosed with could cause serious health complications. I explained briefly how microvascular dysfunction can damage the small blood vessels, and how this in turn starves the surrounding tissues of the oxygen and nutrition it needs to function. The patient asked what he needed to do to get better. I advised that he follow the dietary recommendations he had been given, take his medications as prescribed, and try to be more active. I suggested that he see his GP if he needed further support to improve his general health. 

The patient had a number of tests run, including a variety of blood tests and an MRI of the brain and orbits. 

The blood tests showed no significant deviation from normal limits. The MRI scan showed no space occupying lesion. There was evidence of “chronic ischaemic change of the cerebral white matter” which was not thought to be of “clinical relevance”. It was concluded that the most likely cause of these changes is, again, microvascular dysfunction. 

The patient was given this information at their follow-up appointment 6 weeks after presentation. In this time, the 6thnerve palsy had begun to recover. The patient had made some lifestyle changes, and was keen to improve his general health.

The patient returned 3 months after the onset of his symptoms. The 6th nerve palsy had totally resolved and he had been asymptomatic over the previous few weeks. The patient had also lost a significant amount of weight, and no longer needed medication to control his blood pressure, or for his diabetes. 

I was very proud of the patient’s achievement, and very moved when he thanked me for the time I had taken to explain his situation. By making the patient more aware of the health risks associated with his general health concerns, it encouraged him to make positive changes to his lifestyle. The patient was discharged at this appointment. He returned 6 months after the onset of his 6th nerve palsy and gave a short interview which gave an insight into his journey. Below is a transcript of the interview:

Patient: I came in, I think it was the beginning of February, with developed double vision. I was referred by my GP and got an appointment the next day. So I came in the next day, quite worried, and was seen immediately. I spent about 4 hours initially, with various tests. I was told there had been a muscle collapse caused by a paralysed nerve, which was more or less 100% caused by diabetes. I was told I had to have a brain scan which scared the death out of me.  So to cut a long story short, I had a very good experience on that first day. I came back for the brain scan and then came back a couple of months later to check on the double vision which had improved by then, and was more or less told after that two months that I could be discharged. And in the mean time I decided to take myself in hand as it were with this weight problem and diabetes. But it did take about 6 weeks before it had sunk in. I remember the date, it was March 21st, and today’s September the 2nd, and in that period I’ve lost nearly 5 stone. I’m really focussed on it and committed, I’ve got my targets, so by the time I go on holiday next June, next year, Iwant to be down to a normal weight. My blood sugar reading at my GP improved dramatically. It’s just a question of carrying on now. I can’t give up smoking I’m afraid, so that’s the next piece in the jigsaw. But I have been getting a lot of exercise, and I’ve been doing everything that I know about. 

Orthoptist: Have you been doing it just yourself, or have you been to any support networks?

Patient: Well, I’ve joined with a friend, I’ve joined slimming world. That was at the beginning of May. I think they’re getting sick of me, because I’ve more or less since...I’ve won slimmer of the month twice, and slimmer of the week nearly about 6 times. To lose 5 stone in less than 6 months, I never thought I’d be able to do that. 

Orthoptist: That’s an amazing achievement. 

Patient: I never thought I’d be able to do it. If I can do it anyone can really.

A powerful patient story from a stroke survivor- Make May Purple

My Story.

On the 17 July 2017 I suffered a severe stroke and was admitted to Salford Royal Hospital where I remained until October, when I moved to the Devonshire unit in Stockport. In December of 2017 I suffered a second stroke and was readmitted to Salford Royal Hospital where I remained until I came home in April of 2018. 

After I left the Critical Care Unit at Salford, and moved onto the rehabilitation wards, I became aware that my vision had been affected and I informed the doctors on the ward that I had severe double vision and I was finding it hard to focus. Initially my concerns were dismissed by the doctors and they were only focussed on my physical rehabilitation. The ward had a number of physiotherapists, occupational therapists and rehab assistants who were all working on my mobility and getting my limbs functioning. There was nobody on the ward with specialist knowledge of issues relating to vision and despite repeated requests my husband and I were unable to get the ward staff to bring in a specialist. 

When the physiotherapists were working on my mobility I repeatedly told them that I could not see properly so could not walk or climb stairs. The double vision made it extremely difficult and scary to try to go up steps and although I kept telling the rehabilitation staff this they did not seem to take my concerns on board. 

As my strokes had affected both sides of my body I needed to work to get both of my arms and hands working. I was given sets of blocks to put into holes but this again proved very difficult because of my double vision. 

The doctors on the rehabilitation wards eventually gave me an eye patch to put on my right eye to ‘mask’ the double vision. This did help but was not helping to correct or resolve the double vision, it just covered it over. One of the doctors told me to alternate which eye I wore the patch on and one of them said to keep it on one eye, contradicting each other and making me feel that they did not know the correct way for me to use the patch. When the eye patch broke the ward found it difficult to find a new one and I was often left without an eye patch.

There was very obviously a lack of understanding and expertise on the wards regarding problems with vision resulting from a stroke and the lack of a worthwhile response from the Doctors was both disappointing and upsetting. I felt that my concerns about my vision were ignored and despite repeated requests to see a specialist I was not referred to one. My husband took my concerns to the senior staff on the ward and they said on more than one occasion that a referral to the eye hospital had been done. While in hospital I did not get to see anyone about my sight.

With my vision impaired I found the strokes much harder to cope with and being unable to see properly made simple things like going to the toilet much more difficult. I often felt unsafe being out of bed so preferred to stay there rather than try to mobilise. No-one seemed to understand the impact that the double vision had on both my recovery and my emotional state. 

I honestly feel that the lack of care related to my vision slowed down my recovery and kept me in hospital longer than necessary. The double vision made it so much more difficult to walk and go up steps, use walking aids and read or write. If there had been some input from the eye specialists at an earlier stage of my rehabilitation I would have been able to mobilise much quicker and so my physical recovery would have been that much faster.  The psychological impact of my impaired vision is impossible to describe. To be in a position where your vision has been rendered almost ‘useless’ and have your concerns disregarded by the rehabilitation staff is truly soul destroying and many times during my recovery I felt like giving up, seeing no point in continuing to fight if I was never going to be able to see properly again. I often wonder if other patients, in similar situations to mine, give up trying to recover because they have lost their vision and so do not get better.

At the beginning of May 2018 I attended my first appointment to see an Orthoptist at Manchester Royal Eye Hospital. We met Carly Hegarty and I was able to give her a full description of my history in terms of my strokes and my problems with my vision. I was very surprised when Carly said that before we left the hospital she would be able to do something for me. After a lot of tests and measuring of my eyes Carly fitted a prism to a pair of glasses and the effect on my vision was immediate and astounding. My double vision was instantly resolved. Both my husband and I were somewhat emotional when Carly corrected my vision and the relief was fantastic. As well as relief I felt a lot of anger. I could not understand why, if the cure was so quick and simple, I had been left with double vision for so long. 

After initially fitting the prism, the Eye Hospital have carried out Toxin injections into the muscle around my eye to make the correction of the double vision more long term, doing away with the need for the prisms. This again is a fantastic process, allowing me to see properly and improving my quality of life immensely. 

I spent a total of approximately nine months is hospital, and every day of that was both difficult and distressing. Recovering from a stroke is probably the hardest thing a human being has to endure and I feel that the lack of input from an Orthoptist at an early stage extended my stay in hospital and increased the distress I endured. The distress is of course impossible to quantify but the extended stay in hospital is not. Had my sight been investigated and resolved at an earlier stage then I would have learnt to mobilise much earlier and therefore been discharged sooner. If the time I spent inhospital had been reduced by just ten percent I am sure that the saving to the hospital would be more than the annual cost of employing an Orthoptist. If this saving was multiplied by the number of patients like me, stuck in a rehabilitation ward without anyone looking into the effects of the stroke on theirvision, the financial benefits of putting Orthoptists into the wards would be huge. 

It is a huge disappointment to know that, despite the NHS providing life saving care to me on an enormous scale, they are missing the opportunity to improve people’s recovery and quality of life at an early stage by not providing expertise on vision related aspects of strokes during rehabilitation within the hospital. 

I would also like to add that the care and compassion that Carly showed from the first time I met her was fantastic. She and the rest of the team in the eye hospital are very caring and dedicated and what they can do is truly life changing. I do not think that people elsewhere in the NHS are aware of, or fully appreciate, what they can do. In my case the NHS missed an opportunity to improve my quality of life, aid my recovery and save themselves an enormous amount of money by providing this care and treatment much earlier. Hospital beds are being tied up because people who have suffered strokes are not getting the treatment they might need. Fortunately I was able to communicate relatively soon after my stroke and make people aware of my double vision. Unfortunately no-one in the rehabilitation wards had the knowledge or ability to offer any treatment or address my concerns. 

Now that I am at home, and continueing to get better, I appreciate my vision being correct more than I can put into words. The Orthoptists are a fantastic and dedicated team and what they can achieve is life changing. They have drawers full of prisms each of which can correct someone double vision almost instantly and there are hospital beds full of people who have had strokes and could benefit so much from the early intervention of the Orthoptists service. I very much hope that the NHS can see the need to bring these two things together and see the benefits to both the patients and the service itself.

I, and my husband, would like to thank the Manchester Royal Eye hospital, and in particular the Orthoptist service, for their help and for improving our quality of life. What they do is truly impressive and I hope that the service is expanded and made available to more patients, provided earlier where appropriate, and continues to have a positive effect on more lives. We would also like to thank Carly for her care and understanding during my treatment. She has a great understanding of just how important my vision is to me and showed real determination to resolve my condition. 

From Patient To Orthoptist - Read about Vienna-Jaye's ambassador role here

#HelloMyNameIs Vienna-Jaye and I am an Orthoptist in the Eye Department at Dorset County Hospital. I graduated from the University of Sheffield in 2017, I had previous personal experience of Orthoptics when I was much younger. I was seen by an Orthoptist pretty much from birth until the age of 6 years old. I’m lucky enough to currently work with one of the Orthoptists that treated me when I was a child! I have worn glasses since I was 18 months old and had patching treatment as well as squint surgery. 

 Orthoptics is a relatively small profession, I’ve found that people have usually only heard about it if they have been seen by an Orthoptist or they work in a hospital. Orthoptists are able to practice as soon as they have qualified due to the wide range of placements undertaken during study at university. Whilst studying at Sheffield I went on a total of 33 weeks of placements, from Leeds all the way down to Torquay in Devon!

Earlier this year I was honoured to be given the opportunity to curate the @NHS Twitter account. This is run by patients and NHS staff for a week with free reign to share messages and engage with the public. I used this opportunity to promote Orthoptics as a profession and increase people’s awareness of what we do. I used photos, videos and polls and had over 665,000 impressions in a week, in other words my posts were seen a lot!

Outside of social media I’ve been involved in other outreach events too. I volunteered at a national careers fair in November and spoke to hundreds of students, teachers and parents about Orthoptics. We were able to show people what some patients with Nystagmus or ‘wobbly eyes’ see everyday with a virtual reality app on a mobile phone. Orthoptists often see patients with Nystagmus regularly as we can monitor, manage their condition and provide advice and support.

Closer to home I’ve been invited to speak at several local schools about Orthoptics and my journey into the profession. I’ve spoken at my old secondary school and local primary schools. I’ve even been on television promoting Orthoptics! Most recently, I was at a launch event for ‘Inspiring Dorset’, this allowed lots of people from a variety of professions to speak to year 4 and 5 children at a local school about our jobs. We were able to make children aware of jobs they’d never heard of and start to break down their stereotypes about who can do certain jobs. If you are an Orthoptist and keen to talk to local school children about your job, sign up to www.inspiringthefuture.org and you could be invited to these events too!

In my day job I’ve taken on the role of Work Experience lead for Orthoptics, this means that I am responsible for organising shadow days for any students (aged 16+) from schools interested in finding out if Orthoptics could be for them. Contact your local Orthoptic department if you want to find out more.

I really enjoy spreading the message about Orthoptics and encouraging people to find out more about what we do. If you want to find out more, have a look at www.orthoptics.org.uk or search #ISeeTheDifference on Twitter. 

Vienna-Jaye Burchell

New Graduate Rep, EPDC for BIOS

Orthoptist, Dorset County Hospital