Neuro – Orthoptics and Ophthalmology2019-02-18T11:25:49+00:00

Neuro-Orthoptics / Ophthalmology Clinical Advisory Group

About the Clinical Advisory Group

The Neuro-Orthoptics / Neuro-Ophthalmology Clinical Advisory Group (CAG) is open to all members who have an interest in Neuro-Ophthalmology. This group will specifically cater for those that are actively involved in or wanting to develop dedicated out-patient orthoptic services and pathways for the assessment, treatment and monitoring of patients with neurological conditions e.g.  Idiopathic Intracranial Hypertension (IIH), Headaches, Space Occupying Lesions (e.g brain tumours), Demyelinating Disease (e.g Multiple Sclerosis) aswell as neuro-muscular conditions (e.g Myasthenia Gravis) and patients under investigation for ocular motor disturbances of unknown aetiology. These are patients that do not come under the remit of Neuro-Rehabilitation and members are directed to the Stroke and Neuro Rehab CAG for this.

Aim

To promote the specialist and extended roles of the Orthoptist in Neuro-Ophthalmology and support Orthoptists in developing their roles in the diagnosis and monitoring of patients with specific neuro-ophthalmic conditions as part of a Multi-Disciplinary Team.

Purpose

  • To share best practice and aim to develop evidence based care pathways for assessment and monitoring of ophthalmic signs of neurological conditions.
  • To develop, maintain and signpost sources of information for patients for ophthalmic signs/ symptoms of relevant neurological conditions.
  • To review and communicate relevant literature/ research evidence to members
  • To signpost, interpret and respond to relevant national guidance for neurological conditions.
  • Provide a communication network/ forum for those with an interest in Neuro-Ophthalmology.
  • To encourage high quality research and audit in Neuro-ophthalmology/ Orthoptics and develop and support collaboration between orthoptists in the UK and Ireland..
  • To provide CPD opportunities for orthoptists with an interest in Neuro-Ophthalmology in the form of an annual Study Day and sign posting to relevant conferences and articles.

Mission Statement

We will ………

  • Champion the specialist and extended roles of Orthoptists as Neuro-Ophthalmic Practitioners.
  • Encourage and support collaborative working, continued professional development and sharing of information between orthoptists and other professionals to ensure that our service users receive high quality, person-centered  neuro-ophthalmic care.
  • Disseminate good practice and develop care pathways in the field of Neuro-Ophthalmology/ Orthoptics through evidence, service review and use of other reliable sources.

Neurological Conditions

People with neurological conditions have a much higher incidence of eye and vision problems. These problems may include:

  • Reduced vision (may include changes to colour and contrast)
  • Blurred vision
  • Double vision
  • Visual field loss
  • Problems with eye movement
  • Nystagmus (constant uncontrolled eye movement)
  • Changes to visual perception

Orthoptists are experts in assessment of such problems and can usually offer treatment and advice to alleviate symptoms.

Multiple sclerosis, often abbreviated to MS, is a neurological condition that affects the nerves in the brain and spinal cord (the central nervous system). ‘Sclerosis’ means scarring or hardening of tiny patches of tissue. ‘Multiple’ is added because this happens at more than one place in the brain and/or spinal cord. The damage to nerves seems to be due to the immune system mistakenly attacking the nerve coating which is made of a fatty protein called myelin.

MS is the most common condition of the central nervous system affecting young adults. Over 100,000 people in the UK have MS which is about one in every 600. It is nearly three times more common in women than in men. There are a wide range of possible symptoms but eye and vision problems are one of the most common. These problems may include:

  • Sudden loss of vision
  • Blurred vision
  • Double vision
  • Problems with eye movement
  • Nystagmus

Orthoptists can monitor changes in eye signs as an indicator of disease activity as well as offering treatment and advice to alleviate symptoms.

MS Trust supports people affected by MS & supports specialist services https://www.mstrust.org.uk/

MS Society fund research, give grants, campaign for change, provide information and support & invest in MS specialists. www.mssociety.org.uk

Vision and MS information booklet: https://www.mssociety.org.uk/ms-resources/vision-and-ms-large-print-booklet

The NHS National Specialised Commissioning Team in the UK has acknowledged NMO as a rare neurological condition that requires specialist expertise and has funded several specialist services across the country NMOUK http://www.nmouk.nhs.uk/

People experiencing frequent headaches of unknown cause are advised to get their eyes checked. Headaches that are present towards the end of the day or following visual tasks could be due to a wide range of eye problems. If you have already been checked for glasses, then you may benefit from assessment by an Orthoptist. Headaches can also be a sign of other problems that may not be related to your eyes but can often be picked up by an eye test.

Idiopathic Intracranial Hypertension (IIH) is a rare neurological condition (affecting 1-2 people in every 100,00) of unknown cause defined by increased intracranial pressure (ICP) around the brain without the presence of tumour or disease. The increase of pressure within the brain can put pressure on the optic nerve causing visual loss and may also affect the nerves supplying the eye muscles resulting in double vision.

Orthoptists can measure visual loss as a way of monitoring the effect of changes in intracranial pressure and can also offer advice and treatment for visual loss and double vision.

IIH UK is working to promote awareness and campaigning for improvement for the lives of patients and families affected by IIH. http://www.iih.org.uk/.

People who have had a brain tumour, particularly those on and around the optic nerve and pituitary gland, often experience visual problems either as a result of the tumour or tumour treatment. Visual symptoms and signs may be the first sign of a brain tumour and can also be an important way of monitoring change and response to treatment.

People with who have had a brain tumour can experience a wide range of problems with their eyes and vision including:

Reduced vision

Double vision

Visual field loss

Brain Tumour Research aim to find a cure for brain tumours & to build a network of experts in sustainable brain tumour research. http://www.braintumourresearch.org/

The Brain Tumour Charity is the UK’s largest dedicated brain tumour charity, committed to fighting brain tumours on all fronts. www.thebraintumourcharity.org

HeadSmart UK campaign to reduce the time it takes to diagnose children and young people with brain tumours in the UK by educating healthcare professionals and the public about the symptoms of brain tumours in children & young people http://www.headsmart.org.uk/

The Pituitary Foundation gives support & information to anyone affected by pituitary conditions. They provided information to health professionals and campaign to raise awareness. http://www.pituitary.org.uk/information/publications/health-care-professionals/

There are a number of degenerative neurological conditions that result in problems with the eyes and vision for example Parkinson’s disease and Progressive Supranuclear Palsy. Parkinson disease affects 1 in every 500 people in the UK.

People with Parkinson’s can experience a range of problems with their eyes and vision including:

  • Blurred vision
  • Difficulty moving your eyes
  • Double vision
  • Dry eyes
  • Involuntary closure of the eyelids (blepharospasm)
  • Hallucinations
  • Problems with low light levels (contrast sensitivity)
  • Colour vision
  • Spatial awareness
  • Problems with glasses

Orthoptists are experts in assessment of such problems and can usually offer treatment and advice to alleviate symptoms.

Eyes and Parkinson’s information sheet: http://www.parkinsons.org.uk/content/eyes-and-parkinsons-information-sheet

PSP Vision Information Sheet:

http://www.pspassociation.org.uk/wp-content/uploads/2012/08/Vision.pdf?c19554

The PSP Association offers support and information to people living with PSP and CBD, while supporting research into these conditions and ultimately a cure for these conditions. http://www.pspassociation.org.uk

Parkinsons UK is the UK’s Parkinsons support and research charity. http://www.parkinsons.org.uk

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