Why did I train to be an Orthoptist? From an early age my sights were set on being an Optometrist. Whilst studying for my A-Levels I took a Saturday job, working for a large chain of Opticians. This work provided me with invaluable experience of working with the general public but it also gave me insight into the world of ‘high street’ Optometry. I decided that maybe Optometry wasn’t for me, so whilst still being very interested in eye health care, I looked to see if there were any alternatives; that’s when I came across Orthoptics!

Orthoptics is a relatively small profession; there are approximately only 1,450 Orthoptists currently in practice. The Orthoptic degree is offered at only three universities in the country, The University of Liverpool, the University of Sheffield and Glasgow Caledonian University.

Working as an Orthoptist is always interesting; no two patients are ever the same. Each patient is unique, both in their eye condition and also their individual needs and requirements. We deal with a lot of paediatric patients in Orthoptics, so we also see some highly amusing characters in clinic!

Orthoptists are often the first clinician’s paediatric patients and adults with diplopia (double vision) see when they attend an appointment at the Royal Eye Infirmary. Orthoptists investigate, diagnose and treat defects of binocular vision and abnormalities of eye movements; such as misalignment of the eyes (strabismus or squint), double vision (diplopia) and reduced vision (amblyopia).

Some eye conditions we diagnose may be indicators of other health problems, such as multiple sclerosis or tumour. Orthoptists therefore play an important role in helping to spot these serious conditions.

I enjoy running my own clinics and also that I work closely with other eye specialists such as Ophthalmologists, Optometrists, Nurses and HCA’s at the Royal Eye Infirmary.

Training students

We are a clinical placement site for all three universities, taking students on placement for around 23 weeks of the year. One of the aspects about my job I really enjoy is supervising Orthoptic students. It’s great to work with enthusiastic students who are keen to learn and enjoy seeing patients in clinic. Often the students may be assessing patient eye conditions first hand for the first time, which they have previously only read about; this can be a very enlightening experience to share with the student. Working as a clinical tutor can be time consuming and requires effort, but the pay back seeing students developing into reflective practitioners is extremely rewarding!

Where do I see the profession going?

The revised National Clinical Guideline for Stroke (RCP, 5th edition, 2016) lists Orthoptists as key members of the single multi-disciplinary team on stroke rehabilitation units. We are working with the stroke MDT’s at Derriford and Mount Gould to provide high quality Orthoptic care for patients who have had a stroke.

Orthoptists are increasingly working in extended roles within Ophthalmology in areas such as glaucoma and macular. Skills for working in extended role are being taught on the orthoptic degree and we currently have an Orthoptist about to start work in the field of macular.

We are one of only three centres of excellence for nystagmus. Whilst this extended role work is very exciting, it is perhaps a blog for another day!

Lizzie is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from Orthoptics, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.

Orthoptics was a profession I had never heard of when growing up

“It wasn’t until I looked into being an Optometrist at A-level that I came across Orthoptics”, says Dom Burdon.

So what attracted me to it?

Well I knew I wanted to work in some form of clinic setting which is why I was initially interested in Optometry, but once I learned more about Orthoptics I realised that it was much more up my street. This is because as Orthoptist’ we assess eyes and vision in a variety of patient’s, from babies to the elderly and from disabled people to severely unwell patients. This is not only at big hospitals such as Derriford but also peripheral sites such as Kingsbridge community hospital and primary schools too.

We treat and review patients for a long period of time. For example, I help provide treatment for reduced vision in the form of patching programmes in children, and treatment for double vision in the form of temporary prisms, which in my eyes makes it a very rewarding profession.

I know it’s a cliché, but the thing that really attracted to me to Orthoptics was the fact that no single day would be the same. This is due to the huge number of different cases that could walk through the door. In addition, as Orthoptists we really have to investigate patients using a variety of tests, so we can diagnose and see what treatment is most suited. For me, this keeps things very interesting.

I look forward to being able to specialise in many different clinics regarding vision here at the Royal Eye Infirmary and I feel privileged to be taught by my colleagues who have such a vast field of knowledge.

So, after not knowing what Orthoptics was at A-level five years ago, I can now understand and appreciate first-hand what impact we have on people’s lives of all ages, whilst most people still don’t quite understand or recognise Orthoptics as a profession.

Another view from an Orthoptist…

“Orthoptists are Allied Health Professionals and are crucial members of the NHS eye care team”, says Sue Hemelik.

We work closely with Opthalmologists to investigate, diagnose and treat defects of binocular vision and abnormalities of eye movement in patients of all ages from infants to the elderly, and we work in community clinics in Devon and Cornwall.

We also visit all foundation classes in Plymouth and South Hams area and carryout visual screening tests on all foundation children. As the visual pathways are developing up to the age of 8 years, it is very important we screen all four to five year-olds.

Although I qualified a long time ago, I still look forward to coming to work. I am extremely proud to be an Orthoptist.

Dom and Sue are writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from their Orthoptist colleagues, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.

Having qualified as Dental Nurse in 2005, I moved from working in a general dental practice to the Dental Specialities department at Derriford Hospital in 2007.

The dental department at Derriford Hospital is made up of three departments, Maxillofacial Surgery, Restorative Dentistry and Orthodontics. I joined the Dental Nursing team in the Orthodontic department, and absolutely fell in love with this branch of dentistry.

Orthodontics is the diagnosis, prevention and correction of irregularities of the teeth and jaws. The majority of work is using braces to straighten teeth. In the Trust we tend to see the patients who have more severe or complicated problems such as severe crowding, congenitally missing teeth, impacted teeth and those with cleft lip and/or palate. Our patients are mainly children, although we do treat some adults who are normally seen for a combination of orthodontics and jaw surgery.

I found working in the orthodontic department fascinating and knew I wanted to specialise in this area. Around this time, the first ever Orthodontic Therapists started to qualify from various Dental Hospitals around the country – this was a new role designed to support the work of Orthodontists.

An Orthodontic Therapist carries out many of the tasks that an Orthodontist does; taking dental records prior to and after treatment, fitting, adjusting and removing dental braces, seeing patients in an emergency with broken or damaged braces and supporting the patient with advice during their treatment. However an Orthodontic Therapist doesn’t carry out any treatment planning and must only work under the prescription of an Orthodontic Specialist or Consultant Orthodontist.

I knew that this was the qualification I wanted to achieve and set out gaining post-qualification certificates in Orthodontic Dental Nursing and the Oral Hygiene Educator certificate to be best prepared to apply for this post should one arise.

Fortunately, in 2014, the department decided to create a post for its first ever Orthodontic Therapist and after a rigorous selection day I was thrilled to gain the position of Trainee Orthodontic Therapist and started my new role in January 2015.

After a four week residential course at Bristol Dental Hospital, I spent the rest of the year working with patients at Derriford under the supervision of the two Orthodontic Consultants, and attending study days at Bristol. The course was very intensive and developing the new skills and manual dexterity required to place and adjust braces was taxing – the consultants had always made it look so easy!

The biggest part of developing my role for me though, was making the change from Dental Nurse to clinician. I had loved my time as a nurse; being on the other side of the chair was quite daunting. However, coming from a dental nursing background really makes me appreciate what a massively important part of the team the Dental Nurses are – there is no way I could do my job without the highly skilled individuals that help me. In December 2015 I obtained my Diploma in Orthodontic Therapy RCSEd and started working at Derriford Hospital as a fully qualified Orthodontic Therapist.

I find working as an Orthodontic Therapist so satisfying and really enjoy my job. I see my patients every six to eight weeks over a period of about two-years and during that time I find that I can really build a great relationship with the patient and their family.

Orthodontics is often the first time many children will experience anyone working in their mouth and on their teeth. I like to think that I can offer a gentle introduction to dentistry, as well as offering oral hygiene and diet advice that will help that child develop good habits to keep their teeth healthy throughout their life.

Seeing a child grow in confidence as their teeth straighten is so rewarding and nothing beats the sight of a beaming child (or adult!) on the day that their brace is removed and their beautiful smile is revealed.

Amanda is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from the AHPs and HCSs, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.

When I get home in the evening my son often asks, “what did you do at work today?” This is in between playing LEGO and reading books on dinosaurs…

What should I tell him? He knows and has an understanding that I work in the Hospital ‘making people better’.

Shall I tell him of the great team in Plym Theatres? Of the ODPs, the nurses, ASP, PCS, Healthcare Assistants, receptionists and Serco staff who all work together to make sure that our patients and visitors have the best possible experience during this stressful time? Or should I talk about the Anaesthetists, Surgeons, Opthalmic, Maxilio-Facial and Dental Nurses, Physios, Radiographers and play specialists who bring their individual skills into the department and integrate together into our unit?

I can tell him of being the person who greets nervous families and gets them ready for theatre. Checking all the details and getting more information, all to keep the child safe. Liaising with Surgeons and Anaesthetists so that we ensure our patients wishes and expectations are met. Applying ‘Magic Cream’ on nervous hands and reassuring all that it is going to be OK. Linking with wards to make sure beds are available and they are ready for continuing care.

I can speak of working with the Anaesthetist, checking the equipment and preparing the Anaesthetic Room for our first patients. Welcoming scared children and stressed parents and with a mix of distraction, humour and smiles putting them at their ease. Ensuring that the child drifts off to sleep in a smooth manner and their airway is secured to ensure their continued safety. Being aware of the child’s needs during the operation, whilst ensuring everything is ready for the next patient and with the Anaesthetist keeping that child safe on the transfer and handover to recovery. I could tell him about doing this in MRI, CT scan or for the sick child in the Emergency Department, Children’s High Dependency Unit and main theatres.

I could say about being one of the scrub team, preparing all the equipment and sets for routine, and some very not routine operations. Getting my hands wet and scrubbing for a very diverse range of procedures from eyes to Orthopaedics and ENT, to Urology and many others in between. Or of circulating and looking after the needs of the surgeon and scrub practitioner throughout the procedure.

I could describe working in Post-Operative Recovery, the initial handover from theatre, ensuring the patient has a secure airway and are out of pain and at no risk of bleeding. Of catching the wriggly toddler as they roll around on the trolley, comforting the child who has had their tonsils removed or reassuring the teenager that their procedure has gone well.

Or into second stage and reuniting children with their parents, making sure that their pain is controlled, their fears allayed. Providing food and drink to hungry kids and getting everything ready to discharge some home and some for on going care in other departments.

I think I will say it was a good day and the sick people got better, now let’s read that book.

Mark is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from ODPs, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.

My name is Dave Adams and I’m an Optometrist at Plymouth Hospitals NHS Trust. This title, Optometrist, is probably confusing some people at this point. So briefly, let me clear up some of the differences between the roles that sound similar!

Optometrists: We test eyes and dispense spectacles and contact lenses – working in hospital, independent opticians and multiple opticians (like Boots, Specsavers and Vision Express).

Orthoptists: They measure squint angles and take on the role of measuring visual development in children.

Ophthalmologists: Eye doctors who have done a medicine degree and then specialise in eyes.

We all work together with the goal to help people see better, or to save and preserve their eyesight. Hospital Optometry is very much a team sport and that is because of how important our eyesight is – in my opinion vision is the most important sense as 70% of the world is taken in via our eyes.

I guess the aim of this blog is to get you, the reader, an insight into what I do, and why I enjoy doing it.

No doubt about it, careers fairs and the like do not prepare you for a very competitive job market. Optometry is available as a degree at 10 universities and there is (for now) still a shortage of Optometrists. Yes we sit in a dark room all day (sounds dull), but the job is interesting (honest!). Every pair of eyes is different, and 30 years on since qualifying I still find the next patient as interesting as the last.

So this week I’ve seen, amongst others, a contact lens patients with an eye disease called keratoconus – the only way they can see to drive is with gas permeable contact lenses.

I ran a paediatric clinic and prescribed a strong (really strong) pair of glasses to a five-year old, which were his first pair of glasses. This has enabled him to be able to see the blackboard now.

I’ve got an ongoing saga with patient who also wears super-strong prism glasses to prevent her seeing double vision (Diplopia). I’ve sorted out the Diplopia, but it has left her with slightly blurred vision for distance; this is probably due to the way the lenses have been manufactured but I’ll need her to trial the new prescription first.

And, very recently, I managed to even spend the whole day without using any lenses at all (I hear the gasps). New patients suffering with Macula disease (commonly known as age-related Macula degeneration, or AMD) are screened by the Optometrists in the hospital for potential treatment (including laser, injection or surgery). Half of our work in the hospital involves these extended roles with not a spectacle or contact lens in sight!

David is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from Optometry, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.

You have already had an introduction to Neurophysiology from my colleague, Lucy Nye, who described how the profession has had to think differently about recruiting trainees and as a result, developed a very hands-on, vocational approach to training.

In this way, Plymouth has been a victim of it’s own success and produced prize winning practitioners who are quickly snapped up by other departments. It can be quite disheartening when departments have invested so much time and effort into developing new recruits and it is fair to say our focus now is very much on developing a strong team which will hopefully make leaving that much harder!

It truly is an exciting time to be working in Healthcare Science

I know it is a cliché, but In Neurophysiology, no day is ever the same. Here in Plymouth we provide a full range of investigations on all types of patients. So, the morning you may be wiring a three-year old up for overnight home video monitoring and in the afternoon you could be testing a patient for progressive eye disease with electroretinography. Our work is as varied thanks to the types of patients we see which, for me, is what attracted me to the profession. The only horizon we have yet to explore is intraoperative monitoring for brain and spinal surgery, something that may change in the future.

The introduction of Modernising Scientific Careers (MSC)

This has pushed Healthcare Science to the fore, recognizing the many different specialities (in excess of 40) and the need for a robust career pathway. It acknowledges the great contribution that the different professions make to patient care. Although this workforce comprises approximately five percent of the total healthcare workforce in the UK, their work underpins 80 percent of diagnosis’ (NHS Employers, 2014).

Lucy described the route to Practitioner level training, but MSC now continues to Healthcare Scientist (Masters Level) and Consultant Healthcare Scientist (Higher Specialist Scientist Training, Doctorate Level). In Neurophysiology, we did not have previous recognised pathways to these levels.

My next step

Recently, I have been fortunate in gaining a place on the HSST program, due to start in September, which is a taught programme run by a consortium of universities.

It is going to be a long, tough course but I am motivated by the challenge and the need to break barriers. In Neurophysiology there is shortage of medics which has left us wanting in the past and this will in part address this but, also, I am motivated by lack of women in the more senior roles within the NHS.

MSC has the potential to change the status quo which will hopefully inspire more to take the challenge. After all, the profile of the workforce (in Neurophysiology at least) is predominantly women.

Nikki is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from Neurophysiology, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.

My name is Lisa Clive and I am a Clinical Psychologist working in Paediatrics since 2007. I love my job which involves working with children and their families with chronic illness and medically unexplained symptoms.

Every day brings new opportunity to support children, their parents and staff.  I love meeting children and their families and through therapy that supports them to develop their coping skills and recognise their own resilience and strengths. Working with children is great as they bring so much creativity and energy which together we harness to bring about positive change. Being in this job one of the most important things I have learnt is how resilient children are, and how easy it is as adults to underestimate their capacity to cope with even the biggest of health challenges.

A really important part of my job is helping children and families develop and share stories of their experiences which can often be quite fragmented.

As Psychologists we call this building a narrative and the research shows us that this capacity to tell stories in our lives increases resilience and supports positive coping. Certainly clinically, I see so much change happening through this process; whether it is the adolescent who wants to build a story of their cancer journey as a child, or the young children who are trying to make sense of their medical experiences.

An example…

Recently I had so much fun with a delightful four-year old who very eloquently told me about the scary bits of his treatment and then together we wrote a story and began to think about what they would like to have done when the scary things happened.

What scared this child, was the number of medical professionals in the room when difficult interventions happened. So, with great glee, he told me how he wished he could have been a lion and roared and roared and scared the doctors away. We had great fun developing his roaring skills and building his story of developing his bravery as a lion and now he has been able to cope with ongoing complex medical treatment. It was interesting to reflect on this with the adults who supported him had not realised what had scared him most.

The lesson for me is to listen to the child so we can support them and don’t be afraid to have fun and be playful. It is amazing the power of play for children and how through play and laughter they can work through challenging experiences, after all play is how young children share their stories and experiences with us.

Something to take away…

As a Psychologist working with children I can’t emphasise enough the importance of taking the time to truly listen children big and small, have fun with them and be playful. It is amazing what a difference this can make even in the most challenging situations.

Lisa is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from AHPs and HCSs across the Trust on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.