Orthoptist

As an orthoptist you'll specialise in diagnosing and managing a range of eye conditions that largely affect eye movement and visual development

Orthoptists treat patients of all ages with defects of binocular vision (how the eyes work together) and abnormalities of eye movement. Most of your work with babies and children will involve the investigation and management of strabismus (misalignment of the eyes/squint) and amblyopia (lazy eye), and you'll also have a lead role in childhood vision screening.

You can also specialise in the diagnosis and management of adults who have experienced a neurological episode causing an eye muscle/nerve weakness resulting in double vision. This may include cases of:

• acquired brain injury
• diabetes
• multiple sclerosis (MS)
• Parkinson's disease
• stroke
• idiopathic intracranial hypertension (IIH) - a build-up of pressure around the brain.

Orthoptists usually work as part of a hospital team, but may also work in community healthcare and schools (including special schools).

You'll work closely with ophthalmologists, optometrists, nurses and ophthalmic technicians, as well as with paediatricians, neurologists, teachers, health visitors, endocrinologists and other allied health professionals in multidisciplinary care.

Responsibilities

As an orthoptist, you'll need to:

• assess, interpret and diagnose eye position and eye movement disorders
• assess and interpret a patient's visual development
• investigate causes of vision and visual field loss
• formulate a treatment plan, which might include prescribing an eye patch, eye exercises or the use of prisms
• manage medicines
• refer patients for further tests or investigations
• work as part of a multidisciplinary team
• monitor patients' treatment and condition
• undertake general administrative duties relating to patient care
• contribute to service improvement and audit
• be aware of public health initiatives
• train students on placement and other health professionals, e.g. pre-registration optometry and undergraduate medical students
• be responsible for your own continued professional development (CPD) and mandatory training.

Salary

• Jobs in the NHS are covered by the Agenda for Change (AfC) pay rates consisting of nine pay bands. New graduates are usually employed in a Band 5/preceptorship post for at least 12 to 18 months, with salaries ranging from £27,055 to £32,934. There is no pre-registration year for orthoptics.
• On completing the preceptorship programme, you can apply for a specialist clinical role, earning between £33,706 and £40,588 (Band 6).
• Highly specialist or advanced orthoptists typically lead in a specific area of interest and play a key role in the management of services and staff. Salaries at this level can reach £47,672 (top of Band 7).
• Salaries for head orthoptists or director of services can range from £56,164 to £77,274 (Bands 8b to 8d) depending on the size of the department. Salaries may be in excess of this for director of therapies and health sciences roles.

Those working in London and the surrounding areas receive a high-cost area supplement of between 5% and 20% of their basic salary.

Salary levels for orthoptists working outside the NHS, for example, in academia, research and private practice, may vary.

Income figures are intended as a guide only.

Working hours

Clinical staff usually work a 37.5 hour week, although you may be required to work a set shift pattern, including weekends and evenings.

Part-time work, job shares, flexible working, secondments and career breaks may be possible.

What to expect

• Work typically takes place in hospital clinics, although you may visit community clinics, schools and health centres. You'll work closely with ophthalmologists and optometrists and contribute to multidisciplinary teams.
• Jobs are available throughout the UK. There are also opportunities to work abroad. Many countries accept the UK qualification but you'll need to take additional exams or tests to work as an orthoptist in some countries.
• Examining patients can be physically uncomfortable as you may be constantly leaning forwards or kneeling and using equipment at awkward angles. The work can also be physically demanding as you may have to move equipment and patients (from wheelchairs to examination chairs, for example).
• You may need to travel between hospital sites during the working day or to clinics, health centres and schools.

Qualifications

You'll need to complete either an undergraduate or postgraduate degree in orthoptics approved by the Health & Care Professions Council (HCPC) to work as an orthoptist. Undergraduate courses are offered by:

• Glasgow Caledonian University
• The University of Sheffield
• University of Liverpool

Courses last three years full time (four years in Scotland).

If you already have a 2:2 undergraduate degree or above in a relevant subject such as biological sciences, chemistry, nursing or psychology, you can apply for a pre-registration Masters course in orthoptics offered by UCL and the University of Liverpool. These courses offer an accelerated route to registration as an orthoptist and are full time for two years.

Course requirements vary between universities so check with individual providers for full details on what qualifications and experience are accepted for entry.

Courses are designed to develop your knowledge of how the vision system develops and how the eyes work together. They include a mix of theory and clinical practice. Placements may include hospital-based clinics, schools, special schools and community clinics.

During your studies you'll also have student membership of the British and Irish Orthoptic Society (BIOS), which gives you access to a range of benefits, including insurance cover if you're undertaking orthoptics practice supervised by a registered orthoptist or healthcare professional.

All eligible pre-registration undergraduate and postgraduate orthoptics students studying in England can receive funding support of at least £5,000 per year through the NHS Learning Support Fund. You'll also receive an extra £1,000 as orthoptics is a shortage specialism. You don't have to pay it back and are still able to access funding for tuition and maintenance loans from the Student Loans Company. For more information on funding available for courses in England and Scotland, see the BIOS website.

Upon graduation, you'll be eligible to register with the HCPC and practise autonomously as an orthoptist. You can also apply to become a full member of BIOS. BIOS is also a member of the International Orthoptic Association and Orthoptistes de la Communauté Européenne (OCE).

Skills

You'll need to have:

• communication and interpersonal skills (written and oral) in order to explain conditions and treatments to your patients
• the ability to form a good rapport with colleagues at all levels
• the ability to empathise with patients
• teamworking skills and a collaborative approach to work
• problem-solving skills
• the ability to work independently, organising your own workload and appointments
• good observational skills and attention to detail
• the ability to work under pressure in a busy environment
• patience
• good time management skills
• self-motivation
• flexibility and adaptability
• general IT skills
• a good attitude to self-directed learning
• reflective practice skills.

You'll also need good manual dexterity and excellent hand-eye coordination.

Work experience

Competition for a place on an orthoptics course is intense. At interview you'll need to show you have a good understanding of what orthoptics is and how it fits in with the different eye healthcare professions.

You're advised to observe an orthoptist in practice before applying for a place. This will show your interest in - and commitment to - the profession.

Visit the BIOS website for details on how to arrange a work shadow opportunity, or to contact your local orthoptic department for advice. Remember to include details of relevant work experience in your university application.

Experience of working in a caring, wellbeing or healthcare environment, either in a paid or voluntary capacity, is also useful. Work with children, people with special needs and the elderly is particularly relevant. Other useful experience can include peer mentoring and charity fundraising, which both show that you are willing to use your own time to help others.

Find out more about the different kinds of work experience and internships that are available.

Employers

Most orthoptists work for the NHS. You'll usually work in a hospital eye clinic, but might also assess patients on hospital wards, such as stroke wards.

It's also possible to work in community health centres, community clinics or specialist children's centres. You may also visit primary schools and schools for children with special needs to carry out vision screening.

There are also opportunities to work in private practice.

Look for job vacancies at:

• Health Jobs UK
• International Orthoptic Association (IOA) - vacancies overseas (available to members)
• NHS Jobs - for vacancies in England and Wales.
• NHSScotland Jobs

Hospital orthoptic departments may notify the academic departments at Glasgow Caledonian, Sheffield, Liverpool and UCL universities directly of any vacancies.

Professional development

Once qualified and in your first job, you'll receive support from a preceptor - a more experienced orthoptist who will help you settle into the working environment. The BIOS preceptorship programme has been specifically designed for new graduate orthoptists to consolidate clinical skills and support autonomy.

In order to stay registered with the HCPC, you must keep a record of your continuing professional development (CPD) activities and renew your registration every two years.

BIOS members have access to a range of events and conferences. These events allow you to network with colleagues and keep up to date with developments in the profession.

As a BIOS member you'll have access to your own CPD page to log your activities, reflect on changes to your practice and upload relevant supporting documentation.

Members of BIOS working in the UK are also members of the British Orthoptic Society Trade Union, which provides employment support and advice.

CPD training modules and events for orthoptists at all stages of their career are offered by some of the institutions providing orthoptics degrees. There are also opportunities to undertake research at PhD level.

Career prospects

There are usually excellent employment opportunities for qualified orthoptists. Most are employed in the NHS, where there is an established career structure. Career progression depends on gaining experience and expanding your role within the eye care team.

There are many opportunities to work at the top of your clinical licence, with the development of advanced clinical practice and extended role practice. Specific areas of advanced and extended roles may include:

• cataracts
• glaucoma
• low vision and nystagmus
• macular degeneration
• medical retina
• neuro-ophthalmology
• paediatric ophthalmology
• strabismus management (pre/post-operative and assistant in theatre)
• stroke
• uveitis.

Orthoptists can move into teaching roles after obtaining appropriate clinical experience. BIOS runs the Clinical Tutors' Course, which is a good starting point if you wish to pursue a career in academia. You could work towards becoming a lead clinical tutor, developing relationships with the universities. You can deliver ad hoc lectures or take on a full-time academic post. Academic staff usually undertake a mix of teaching, administrative and research activities.

There are many ways that you can continue to be involved in research after your degree, including engaging with the evidence base in your day-to-day work as a health practitioner. You could support, or be directly involved in, clinical research delivery, or further develop your career as a clinical research lead. Orthoptists can specialise in health research while retaining their clinical work.

There are also opportunities to take on management and leadership roles and influence the role of orthoptics in the wider workforce, through involvement in:

• mentoring
• operational management
• project management
• quality improvement
• commissioning
• digital leadership
• sponsored secondments.

It's possible to progress through the grades and eventually take up a clinical management post. As the head of an orthoptics department, you'll have responsibility for a team of staff and managing a budget whilst retaining your clinical work.