BSc (Hons) Orthoptics Clinical Placement Focus 3 Year Overview Year 1 - Emphasis on remembering facts and understanding theory Placement Number/ Timing Placement I: Winter post Christmas (1week)

Syllabus Prior to Placement

Placement II: Spring/ Easter (2 weeks)

Classification and aetiological factors of heterophoria, heterotropia, & pseudo-strabismus Physiological mechanisms of the near triad and its’ individual components Classification, aetiology and investigation of amblyopia and amblyogenic factors Refractive errors - Hypermetropia, Myopia, Astigmatism, Aniseiokonia and Presbyopia Focimetry Estimating Refractive Errors by neutralisation Accommodation: Near point of accommodation Amplitude of accommodation Accommodative facility Investigation of all aspects of concomitant strabismus including taking a case history, making observations of an orthoptic patient, all levels of BSV, all aspects of convergence and measurement of strabismus

Placement III: Summer (3 weeks)

Retinal physiology Introduction to binocular single vision (including development and the neurophysiological theory) Theory and clinical assessment of light sense and form sense Mechanics of globe rotation and actions of the extraocular muscles Laws of ocular motility and muscle sequelae Theory and clinical assessment of each eye movement system Professionalism, health care ethics and diversity and equality

Placement Focus

To introduce the student to the clinical environment and Orthoptic clinical practice.

To gain experience in detection of latent and manifest strabismus, have the opportunity to demonstrate skills of assessing the different eye movement systems, visual functions and binocular function in different clinical scenarios.

To consolidate clinical skills acquired in year 1 and have the opportunity to classify strabismus/amblyopia in a clinical scenario and carry out all aspects of assessment on patients.

Year 2 – Emphasis on Application of knowledge to clinical situations Placement number/ timing

Placement IV: Autumn/ Winter – pre Christmas (4 weeks)

Syllabus Prior to Placement

Investigation and application of findings to management for amblyopia; Investigation and interpretation of findings of: esotropias and exotropias heterophoria and convergence insufficiency accommodative disorders.

Placement Focus

To gain experience in clinical investigation and management of mechanical and myogenic conditions and formulating management plans for patients with amblyopia. Consolidate experience of investigating concomitant patients.

Introduction to incomitant deviations with recap of muscle actions, sequelae characteristics of incomitant deviations; Investigation of incomitant deviations; Aetiology, investigation and management of mechanical and myogenic conditions. clinical skills: Exophthalmometer Performing Hess chart/Lees screen Interpretation of Hess chart Measurement of incomitant deviations (fixing eye and in 5 positions of gaze with PCT) Fitting Fresnel prisms

Placement V: Spring/Easter (3 weeks)

Placement VI: Summer (4 weeks)

Management of concomitant esotropia, exotropia, heterophoria, convergence insufficiency, and accommodative disorders. Differential diagnosis of incomitant strabismus. Aetiology, investigation and management of neurogenic conditions. Introduction to Eye Movement and Supranuclear disorders Investigation and Types of Nystagmus. Pupillary and lid disorders, (congenital and acquired) Introduction to Demyelination and Stroke Fifth, seventh and eight nerve disorders Visual Fields Clinical skills: Measurement of torsion (torsionometer and Maddox double rod) Measurement of an incomitant deviation in 9 positions of gaze

To gain experience in the clinical Investigation and management of neurogenic conditions and formulating management plans for concomitant conditions.

To consolidate all clinical skills acquired in year 2 and apply knowledge of investigation and management to all concomitant and incomitant conditions

Year 3 – Emphasis on critical analysis and Evaluation of clinical scenarios Placement number/ timing Placement VII: Autumn (4 weeks)

Syllabus Prior to Placement

Placement Focus

Expansion on: Professional behaviour, ethical considerations and organisational aspects of orthoptic practice Evaluation and review of current literature Clinical management, covering orthoptic, optometric and ophthalmological types of treatments

To allow the student to integrate knowledge and skills gained in year 1&2 In order to fully investigate all concomitant and incomitant (to include internuclear and supra nuclear) disorders and begin to formulate short and long term management plans for each patient.

The topic areas that the above are applied to are: Concomitant strabismus Incomitant strabismus Mechanical deviations Myogenic deviations Supranuclear and internuclear conditions Binocular vision disorders Amblyopia Nystagmus Placement VIII: Winter – post Christmas (4 weeks)

Placement IX: Spring (4 weeks)

Clinical investigation of the following in relation to all the conditions listed above, including their relevance and impact on management: Binocular vision Visual functions Ocular motility Evaluation of the patient’s condition and identification of the need for non-orthoptic investigations, including tests for: Myasthenia gravis Thyroid dysfunction Neurological impairment e.g. brain tumours Visual pathway dysfunction e.g. requiring electrodiagnostics Extended role of the Orthoptist: Stroke, MS, glaucoma, low vision etc.

To allow the student to further develop their skills as a clinician and gain confidence in independent thinking. Ensuring they are able to fully investigate all Orthoptic patients bringing in evidence based practice to enhance clinical decision making.

To allow the student the opportunity to operate as they would do once qualified and prepare for final clinical exams.