Experience of Digital

Photography as an
Extended Orthoptic
Role

Andrew Fox
 Development of Service
™ Staffing difficulties following purchase
™ Orthoptic led from August 2000
™ Proviso of substantive transfer
™ Initially only digital, later some film based
™ Initially 1 Orthoptist
™ Now 4 Orthoptists & 1 Medical Photographer
 Training Cascade
Key Trainer Cascade Training
™4 days work ™12 sessions
shadowing - Familiarisation with camera
™ 2 months
experience with - Work Shadowing
in-house service - Supervised Experience
™ Development of
training program, - Distant Supervision
guidance notes and - Review throughout
procedures
 Clinics with Photography Support
™ Medical Retina
™ Glaucoma
™ Vitreo - Retinal
™ Anterior Segment
™ Paediatric
™ Ocular Plastics
™ Eye Casualty
 Imaging
™ Colour Fundus Images
™ Red Free Fundus Images
™ Fundus Fluorescein Angiography
™ Indo Cyanine Green Angiography
™ Slit Lamp Photography
™ Ocular Coherence Tomography
 Equipment
• Fundus Camera
• Slit Lamp Camera
• Network System
BENEFITS OF DIGITAL PHOTOGRAPHY
™ Instant knowledge of image quality
™ Instantly available for viewing
™ Networking of images (a must)
™ No film / development costs
™ Reduction in administration time
™ Diagnostic Database
™ Easy export for presentations / e.mail
™ Comparison over time on screen
™ Digital image manipulation tools
™ Linkage to Electronic Patient Records
DISADVANTAGES OF DIGITAL PHOTOGRAPHY

™ Poorer quality than well taken film based

(but clinically acceptable)
™ Computer and network gremlins

™ Greater capital start up costs

™ Software License costs

 Service Management
™ Provision of cover for clinics
™ Some nurse led FFA clinics
™ Equipment and database management
™ Audit of photographs for quality and
teaching value
™ Strategic planning of service
 Multi-Disciplinary Team
™ Medics

™ Nurses

™ Orthoptists / Medical Photographer

 Nurse led FFA / ICG Clinics
™ Nurse & Orthoptist / Photographer
™ Separate to consultant clinic
™ Within consultant clinics
™ Aiming toward one-stop clinics
™Investigation
™Reporting
™Treatment
 Professional Development
™ Expansion of Skills

™ CPD accrued through training

™ CPD through audit

™ Increased knowledge of Ophthalmology

 Further Developments
™ Training for orthoptists in OCT

™ Training for orthoptists in ICG

™ Potential development of Scanning Laser

Ophthalmoscopy

™ Potential involvement in Photo Dynamic

Therapy
 Limitations
™ Decreased involvement in core Orthoptic role

™ Clinics must be covered therefore:-

- Reduced flexibility of study & annual leave
- Reduced orthoptic time to cover absence
- Will ease with increase in photographer time
™ Identification of adequate budget for running &
development of the service has been an interesting
challenge
 Advantages
™ Professional Development
™ Variety of work
™ Teaching Opportunities
™ Increased integration with Nursing
Medical & Photography staff
™ Raised profile of Orthoptic Department
™ Wider Departmental role
 On Balance + + + + +
™ An excellent opportunity for my team
™ Undoubtedly a factor in retention and
recruitment of staff to the Department
™ Well within our capabilities
™ Has allowed development of the service
™ Is an example of the value of skill mixing
™ Multi-disciplinary working