Orthoptist

Orthoptists specialise in diagnosing and managing a range of eye conditions that largely affect eye movement and visual development

You'll 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, diagnose and treat a wide range of eye position and eye movement disorders
• evaluate and monitor visual development in both children and adults
• investigate and identify causes of vision and visual field loss, including neurological conditions
• develop and implement a personalised 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 when necessary
• work as part of a multidisciplinary team that may include ophthalmologists, optometrists, neurologists and paediatricians
• monitor patients' treatments and conditions
• keep accurate patient records and undertake other general administrative duties relating to patient care
• contribute to clinical audit, service improvement and public health initiatives to enhance patient care
• train students on clinical placements and other health professionals such as pre-registration optometry and undergraduate medical students
• keep up to date with the latest developments in orthoptics through continuing 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 £29,970 to £36,483. There is no pre-registration year for orthoptics. With experience, salaries rise to between £37,338 and £44,962 (Band 6).
• Salaries for lead and advanced clinical practice orthoptists usually range from £46,148 to £60,504 (Band 7/8a).
• Salaries for head orthoptists or director of services can range from £62,215 to £85,601 (Bands 8b and 8c) depending on the size of the department.

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

Salary bands differ across the four countries of the UK. Pay negotiation happens annually at different times, so salaries will change when each country agrees their new pay award. Check your country's pay scales for the most up-to-date NHS salary information.

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 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). You'll typically need three A-levels (or equivalent) at BBB or higher, including a science subject to get a place.

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. Applicants with a non-science degree may be considered if they have recent relevant experience. These courses offer an accelerated route to registration as an orthoptist and are full time for two years.

Entry 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 BIOS.

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
• counselling skills to support patients and their families
• teamworking skills and a collaborative approach to work
• the ability to work independently, organising your own workload and appointments
• critical thinking and problem-solving skills
• good observational skills and attention to detail
• the ability to work under pressure in a busy environment
• patience
• excellent planning, organisation and time management skills
• self-motivation
• a flexible approach to work with the ability to adapt to changing service needs
• 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 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 role, is also useful. Work with children, people with special needs and older adults is particularly relevant. Other useful experience can include peer mentoring and charity fundraising, which both show that you're 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 in a hospital eye clinic, but you might also assess patients on hospital wards, such as stroke wards.

It's also possible to work in:

• adult care facilities
• child development centres
• community health centres
• community clinics
• private hospitals
• rehabilitation centres
• specialist children's centres.

You may also visit pre-schools, primary schools and schools for children with special needs to carry out vision screening.

There are also opportunities to work abroad in countries such as New Zealand, Australia, the USA and the United Arab Emirates.

Look for job vacancies at:

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

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 typically 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. Find out more about the support available to new graduates.

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, conferences and other networking opportunities that will help you keep up to date with developments in the profession. You'll have access to your own CPD page to log your activities, reflect on changes to your practice and upload relevant supporting documentation.

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

Most orthoptists are employed in the NHS, where there is an established career structure. Career prospects depend on gaining experience and expanding your role within the eye care team.

You can progress into more senior roles as you gain experience. For example, it's possible to become an advanced clinical practitioner (ACP). You'll need to be educated to Masters level and have a high level of autonomy, clinical expertise and advanced decision-making skills to gain a role as an ACP.

You may choose to specialise in an area such as:

• cataracts
• glaucoma
• low vision and nystagmus
• macular degeneration
• diabetic retinopathy
• neuro-rehabilitation
• strabismus management (pre/post-operative and assistant in theatre)
• stroke
• uveitis
• vision screening.

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. Posts are limited at this level.

You could also take on a senior leadership role that influences the role of orthoptics in the wider workforce, through involvement in:

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

Alternatively, you could move into a teaching role after getting 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 universities that provide training. 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.