British and Irish Orthoptic Journal最新文献

{"title":"A Study to Assess the Feasibility of Utilising Virtual Reality for the Treatment of Accommodative and Vergence Infacility.","authors":"Alvin Munsamy,&nbsp;Husna Paruk","doi":"10.22599/bioj.175","DOIUrl":"https://doi.org/10.22599/bioj.175","url":null,"abstract":"<p><strong>Background: </strong>To assess the feasibility, as well as viability, of utilising gaming using virtual reality (VR) to treat accommodative and vergence infacilities.</p><p><strong>Methods: </strong>Forty-two emmetropic and asymptomatic participants between the ages of 18 and 30, with normal binocular visual function, were selected for the study in 2018. Participants with binocular accommodative infacilities and/or vergence infacilities comprised the study population. The binocular accommodative facilities (BAF) were assessed using amplitude-scaled facilities (probe lens = 30% amplitude of accommodation; test distance = 45% amplitude of accommodation). All those with less than 10 cycles per minute (cpm) were regarded as failing. Vergence facilities were assessed using 12 pd base out and 3 pd base in prisms. All those with less than 15 cpm were regarded as failing. The participants were separated into age-matched experimental and control groups. The experimental group played a fast-paced game using Samsung Gear VR (SM-R323), whilst the control group watched a television film projected onto a two-dimensional screen at a distance of one metre. Pre-test and post-test binocular amplitude-scaled facilities and vergence facilities were measured for both groups after exposure for 25 minutes.</p><p><strong>Results: </strong>There was a significant, mean increase in binocular accommodative facilities of 4.67 ± 5.05 cpm (p = 0.008) for the experimental group (n = 12). There was a significant mean increase in vergence facilities of 3.72 ± 3.18 cpm (p < 0.001) for the experimental group (n = 32). A statistically significant mean difference of 4.07 cpm (95%CI: 0.97, 9.19; p = 0.03) between the respective control and experimental groups was found for binocular accommodative facilities and 2.45 cpm (95%CI: 0.68, 4.22; p = 0.008) for vergence facilities.</p><p><strong>Conclusion: </strong>Binocular accommodative facilities and vergence facilities increased after 25 minutes of VR gaming in asymptomatic emmetropic participants with accommodative infacilities and vergence infacilities. However, due to the small-scale, unmasked and unrandomised nature of the study more research is needed to confirm the results of this study.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"127-133"},"PeriodicalIF":0.0,"publicationDate":"2021-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39345193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioural Adaptation to Hereditary Macular Dystrophy: A Systematic Review on the Effect of Early Onset Central Field Loss on Peripheral Visual Abilities.","authors":"Aishah Baig,&nbsp;David Buckley,&nbsp;Charlotte Codina","doi":"10.22599/bioj.177","DOIUrl":"https://doi.org/10.22599/bioj.177","url":null,"abstract":"<p><strong>Purpose: </strong>Hereditary macular dystrophies (HMD) result in early onset central field loss. Evidence for cortical plasticity has been found in HMD, which may enhance peripheral visual abilities to meet the increased demands and reliance on the peripheral field, as has been found in congenitally deaf adults and habitual action video-game players. This is a qualitative synthesis of the literature on the effect of early onset central field loss on peripheral visual abilities. The knowledge gained may help in developing rehabilitative strategies that enable optimisation of remaining peripheral vision.</p><p><strong>Methods: </strong>A systematic search performed on the Web of Science and PubMED databases yielded 728 records published between 1809 to 2020, of which seven case-control studies were eligible for qualitative synthesis.</p><p><strong>Results: </strong>The search highlighted an overall paucity of literature, which lacked validity due to small heterogeneous samples and deficiencies in reporting of methods and population characteristics. A range of peripheral visual abilities at different eccentricities were studied. Superior performance of HMD observers in the peripheral field or similarities between the preferred retinal loci (PRL) and normal fovea were observed in four of seven studies. Findings were often based on studies including a single observer. Further larger rigorous studies are required in this area.</p><p><strong>Conclusions: </strong>Spontaneous perceptual learning through reliance on and repeated use of the peripheral field and PRL may result in some specific superior peripheral visual abilities. However, worse performance in some tasks could reflect unexpected rod disease, lack of intensive training, or persistent limitations due to the need for cones for specific tasks. Perceptual learning through training regimes could enable patients to optimise use of the PRL and remaining peripheral vision. However, further studies are needed to design optimal training regimes.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"104-118"},"PeriodicalIF":0.0,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Post-Surgical Stereovision Surprise in an Adult With an Exotropia Since Infancy Previously Managed, at Two Years With Surgery.","authors":"Revelle A Littlewood,&nbsp;Martin Rhodes,&nbsp;John Burke","doi":"10.22599/bioj.174","DOIUrl":"https://doi.org/10.22599/bioj.174","url":null,"abstract":"<p><strong>Aim: </strong>To describe an unexpected sensory outcome in an adult male who is seeking ocular re-alignment for a psychosocially symptomatic large non-specific exotropia with suppression. The primary diagnosis was infant onset exodeviation of unclear diagnosis, was managed with bilateral strabismus surgery at two years of age, little memory of follow-up.</p><p><strong>Result: </strong>Measurable binocular single vision (BSV) was demonstrable following surgery at 17 years of age, albeit slowly between two weeks and six months postoperatively and subsequently enhanced. His newly acquired sub-optimal BSV led to symptomatic occupation-associated asthenopia. Following two subsequent operations over a 15-year period, he has stable, symptom-free ocular realignment within three prism diopters of orthophoria and performing tasks that require extended periods of near-vision activity.</p><p><strong>Conclusion: </strong>Delayed high levels of stereovision were unexpectedly achieved in an adult with infant onset exotropia with pre-operative sensory suppression that was surgically aligned to near orthophoria. The re-establishment of BSV in such a clinical scenario has to attain a level that is robust enough to meet an individual's social and occupational needs.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"97-103"},"PeriodicalIF":0.0,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Accuracy of GP Referrals into Manchester Royal Eye Hospital Orthoptic Department.","authors":"Martha Waters,&nbsp;Rachel Clarke,&nbsp;Laura England,&nbsp;Anna O'Connor","doi":"10.22599/bioj.168","DOIUrl":"https://doi.org/10.22599/bioj.168","url":null,"abstract":"<p><strong>Background: </strong>There is little research that examines the accuracy of paediatric referrals into secondary and tertiary care, particularly those from general practicioners (GPs) to ophthalmology and orthoptic departments. Inaccurate referrals could have a detrimental effect on service delivery and NHS funding as well as patient experience. Available evidence shows GP referral accuracy to range between 39% and 90% across different areas of medicine with accuracy of GP referral to ophthalmology between 56% and 66%.</p><p><strong>Methods: </strong>A retrospective case note analysis was carried out on 99 case notes to examine the accuracy of paediatric GP referrals (including those via the community optometrist) into the Orthoptic Department at Manchester Royal Eye Hospital (MREH).</p><p><strong>Results: </strong>GP referral accuracy was found to be 63% for strabismus cases, 50% for reduced vision/amblyopia cases, 45% for NAD cases, 100% of nystagmus cases and 92% of \"other\" cases. GPs were significantly less accurate than community optometrists (p = 0.01). Referrals from GPs alone had an accuracy rate of 65% compared to 87% of GP referral via community optometrist. Accuracy of referral appeared to improve with age, however this was not found to be statistically significant (p = 0.06).</p><p><strong>Conclusion: </strong>This study found orthoptic referral accuracy for GPs in Manchester to be similar to other areas of medicine. While acceptable compared to other areas of medicine, improving referral accuracy is essential to improve NHS spending, service delivery, and patient experience. To aid with this the aim is to design and implement a virtual training package that focuses on detection of strabismus to improve referral accuracy.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"91-96"},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Cyclotorsion Due to Medial Rectus Displacement Following Orbital Trauma.","authors":"Elspeth Green,&nbsp;Hannah Harwood,&nbsp;Shveta Bansal","doi":"10.22599/bioj.165","DOIUrl":"https://doi.org/10.22599/bioj.165","url":null,"abstract":"<p><p>We describe a rare case of cyclotorsion likely secondary to medial rectus and inferior rectus pathology in a patient with orbital trauma. Sequential orthoptic measurements including Hess charts are presented alongside relevant sections of the orbital CT scans over the course of the patient's treatment. Following the insertion of a plate to repair an orbital floor fracture, the patient developed cyclotorsion. A combined approach of sequential orthoptic assessment and imaging revealed the likely underlying mechanism. Inferior rectus mechanical restriction combined with displacement of the medial rectus pulley appear to be the likely culprits. Once the orbital plate was exchanged for a smaller sized plate the patient's symptoms and clinical features resolved. Although orbital plate malpositioning is not an uncommon event, medial rectus deviation as a cause of cyclotorsion has not previously been described. We discuss the alternative differentials for patients with similar orthoptic findings and how they were excluded.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"79-84"},"PeriodicalIF":0.0,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Botulinum Toxin in a Case of Acquired Periodic Alternating Nystagmus.","authors":"Nadia Venturi,&nbsp;Gillian Adams,&nbsp;Maria Theodorou","doi":"10.22599/bioj.170","DOIUrl":"https://doi.org/10.22599/bioj.170","url":null,"abstract":"<p><strong>Aim: </strong>To describe a case of acquired Periodic Alternating Nystagmus (PAN) with oscillopsia treated with botulinum toxin injections into four horizontal rectus muscles.</p><p><strong>Method: </strong>A 22-year-old woman presented with sudden onset PAN. The only abnormality found following extensive investigations was bilateral superior cerebellar peduncle atrophy on MRI. Various treatment options were discussed, with reasonable response to baclofen, less so to gabapentin. However, she was keen for a longer-term solution without medication-related adverse effects. She was offered weakening of all four horizontal rectus muscles recessions, either with botulinum toxin or surgery, and she opted for the former to simulate the effects of surgery. 2.5 units of Dysport were injected into each horizontal rectus muscle without adverse effect.</p><p><strong>Results: </strong>Off all treatment, Snellen Visual Acuity (VA) was 6/12 in either eye with oscillopsia as a result of the PAN. Post-botulinum toxin VA was 6/5 and 6/6 on the right and left respectively, with both subjective and objective improvement in the nystagmus and oscillopsia.</p><p><strong>Conclusion: </strong>Botulinum toxin has an important role in the nystagmus and strabismus clinics. Depending on the circumstances, it may be used as either long term treatment, or for surgical planning to simulate the effects of surgery. In this case, the effects were equivalent to high dose of baclofen and four horizontal rectus muscles recessions, which she underwent when the effects of the botulinum toxin had worn off. Botulinum toxin could be considered as a treatment option in acquired PAN, particularly in women of childbearing age and/or if intolerant or refractory to medical treatment, but ideally not as a long-term treatment option.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grey Filter Contact Lens as Therapeutic Option for Acquired Reduced Binocular Visual Performance.","authors":"Hans van Vliet,&nbsp;Hinke Marijke Jellema,&nbsp;Carla Nieuwendaal,&nbsp;Ruthie Lapid-Gortzak,&nbsp;Frans Riemslag,&nbsp;Ivanka van der Meulen","doi":"10.22599/bioj.169","DOIUrl":"https://doi.org/10.22599/bioj.169","url":null,"abstract":"<p><p>Disturbing binocular problems can be too complex to be treated in such a way that comfortable binocular single vision is restored. The grey filter contact lens could offer a safe and clinically useful way to help these patients.</p><p><strong>Background: </strong>In unilateral acquired reduced visual performance or intractable diplopia the binocular performance often is less than the performance of the better eye, possibly leading to complaints of binocular visual functioning. The hypothesis is to use a grey filter contact lens on the affected eye to obtain more binocular visual comfort. The grey filter changes the binocular central visual image in the brain through delaying the image of the affected eye and has minimal effect on the peripheral vision. The purpose of this study was to evaluate the effect of the grey filter contact lens on the reduction of patients' binocular complaints in daily life.</p><p><strong>Methods: </strong>In 19 consecutive patients with unilateral acquired reduced visual performance or intractable diplopia a grey filter contact lens was fitted. The contact lens was chosen from six available filters with different transmissions, based on patient preference. The chosen filter contact lens was fitted according to the normal practice of contact lens fitting.</p><p><strong>Results: </strong>The results of 18 patients are reported, one patient was lost to follow-up. Twelve patients (67%) reported good results when wearing the grey filter contact lens. Five patients (28%) discontinued wear of the grey filter contact lens because their binocular visual complaints disappeared during filter contact lens wear and remained absent after contact lens wear was terminated.</p><p><strong>Conclusion: </strong>The grey filter contact lens is a clinically useful, safe, and easily reversible treatment option for patients with binocular visual complaints due to an acquired monocular reduction in visual quality.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"62-69"},"PeriodicalIF":0.0,"publicationDate":"2021-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of the First Peak of the COVID-19 Pandemic on a Paediatric Ophthalmology Service in the United Kingdom: Experience from Alder Hey Children's Hospital.","authors":"Megan Wood,&nbsp;Judith Gray,&nbsp;Ankur Raj,&nbsp;Jose Gonzalez-Martin,&nbsp;Damien C M Yeo","doi":"10.22599/bioj.164","DOIUrl":"https://doi.org/10.22599/bioj.164","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic has led to significant service loss across the NHS, and ophthalmology is one of the greatest affected specialties. We attempt to quantify the impact of the first peak of the COVID-19 pandemic on a paediatric ophthalmology unit in a children's hospital in the United Kingdom (UK) and report lessons learnt to aid in the recovery of the service.</p><p><strong>Methods and analysis: </strong>Two eight-week periods of clinical activity were compared; one during the first UK peak of the COVID-19 pandemic and the other during a similar period the previous year. Four areas of clinical activity were included in the study: outpatient clinic appointments, theatre activity, outpatient referrals to ophthalmology and ward reviews. Appointment data was collected from departmental databases.</p><p><strong>Results: </strong>During the first peak of the pandemic, outpatient clinic appointments were reduced by 87.2%, ophthalmic surgery by 90.9%, outpatient referrals to ophthalmology by 50.2% and ward reviews by 50%. The number of actual cancelled appointments was 1377, of which 6.8% were triaged as suitable for teleophthalmology.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic has dramatically restricted clinical activity in the ophthalmology service. Paediatric ophthalmology is vulnerable to capacity issues and the consequences of delayed or cancelled appointments. Departments must adapt quickly and maximise capacity to help reduce the backlog and treat patients effectively and safely. Solutions such as teleophthalmology have potential although can be difficult in the paediatric population.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"56-61"},"PeriodicalIF":0.0,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertical Tropia Following Horizontal Transposition Surgery.","authors":"A Thomas,&nbsp;P Watts","doi":"10.22599/bioj.160","DOIUrl":"https://doi.org/10.22599/bioj.160","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to determine the prevalence of vertical tropia following horizontal transposition of both vertical rectus muscles (HToVR) in patients with Duane syndrome or sixth nerve palsy.</p><p><strong>Methods: </strong>This retrospective study included patients with Duane syndrome or sixth nerve palsy who had undergone HToVR muscles. Data collected included: age, gender, diagnosis, laterality, pre-operative angle of deviation, type of surgery and post-operative angle of deviation at one week, three months and six months. Information on the use of botulinum toxin (BT) ipsilateral medial rectus (MR), additional surgery was performed, and the presence of preoperative and postoperative binocular function and any vertical deviation was collected.</p><p><strong>Results: </strong>There were 11 patients, eight patients with a diagnosis of Duane syndrome and three patients with a diagnosis of sixth nerve palsy. The mean age of the patients was 13 ± 14.79 years (range 5-55 years), four were female. The prevalence of post-operative vertical tropia was 54%. The mean vertical deviation for distance, was 7.6^ ± 2.94 (SD) (range 3^-9^). Stereoacuity was present preoperatively in 5 patients and 8 postoperatively. No patient developed diplopia or received further surgery for the vertical tropia. Of the six patients who had intraoperative BT at the time of the HToVR, four developed a vertical deviation.</p><p><strong>Conclusion: </strong>The prevalence of vertical deviation following HToVR muscles was 54% in our series. None of the patients with an induced postoperative vertical deviation reported diplopia or required further surgery for it.</p>","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"51-55"},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilising the Orthoptic Skill Set to Improve Access to Eye Care for Adults with Severe/Profound Learning Disabilities-A Service Evaluation.","authors":"Kathy Diplock,&nbsp;Jignasa Mehta","doi":"10.22599/bioj.162","DOIUrl":"https://doi.org/10.22599/bioj.162","url":null,"abstract":"Intro: There is a wealth of research evidencing the high incidence of visual impairment (VI) and poor uptake of eye care services by adults with learning disabilities (LD). Despite this, very few authorities within England currently provide the additional support required by those with severe/profound LD (S/PLD). Method: By means of an initial funded pilot study, an unmet need was evidenced locally and a small service established to improve access to eye care for adults with S/PLD. Operational since 2007, this service has provided evidence to support the campaign for a nationally funded eye care pathway. This service evaluation outlines the initial service set up, aims and objectives, and provides an analysis of the current service by means of a detailed breakdown of service-user outcomes during a sample 5-year period. Results: Orthoptic home visits (OHV) revealed high levels of strabismus (54.4%), refractive error (43.3%), cataracts (23.3%), and many other ophthalmic conditions (29%). Over a quarter of the adults with LD (26.6%) were certified as VI and 61% of people were provided with tailored strategies, the majority of which were for visual processing difficulties. Conclusion: The prospect of a nationally funded eye care pathway for adults with LD in England is now a real possibility. This service model has identified a clearly defined unmet need and illustrates the unique skill set orthoptists can offer to address this health inequality. Requiring minimal financial outlay and flexible enough to be integrated into any future national eye care framework, this service has ensured that access to eye care is truly equitable for all people with LD.","PeriodicalId":36083,"journal":{"name":"British and Irish Orthoptic Journal","volume":"17 1","pages":"41-50"},"PeriodicalIF":0.0,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39198579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}