Allies in health

Cate Swannell
Med J Aust
Published online: 3 August 2015

Allied health professionals work hand in glove with medical staff to provide the best care possible for patients. Sue Silveira is an orthoptist who partners with ophthalmologists to provide eye care for children with vision impairment and low vision

From anaesthesiology assistants through psychologists, medical interpreters, podiatrists, social workers and surgeon’s assistants — allied health professionals fill the holes doctors can’t, or won’t.

It’s easy to forget sometimes that for every surgeon wielding a knife, there’s a team behind her preparing the patients, helping them recover, rehabilitate and return to the community as functioning, productive citizens.

Sue Silveira is one of that huge group of allied health professionals. She is a paediatric orthoptist.

According to the Orthoptics Australia website, orthoptics is “a discipline in eye healthcare specialising in the assessment, diagnosis and non-surgical management of eye disorders”.01

“Orthoptists were traditionally involved in the management of patients with eye movement disorders and specifically with strabismus (squint), double vision and amblyopia (lazy eye). Over the last several decades orthoptists have expanded their role and not only specialise in eye movement disorders but are also involved in the care of patients with eye disease such as cataracts, glaucoma, diabetic eye disease, age related macular degeneration, systemic or neurological vision disorders and low vision”, says the blurb.

Sue Silveira is proud of the work she does and the role orthoptists play, hand-in-hand with ophthalmologists.

“We’re quite proud of the fact that there are no professional boundary issues [between orthoptists and ophthalmologists]”, she tells the MJA.

In fact, it was an ophthalmologist who mentored Ms Silveira at the beginning of her orthoptics career.

“My best friend’s mum was an ophthalmologist and she had orthoptists working in her practice”, she says.

Ms Silveira graduated in 1984 and has spent most of her professional life working in practice with ophthalmologists. She has seen many changes in her profession over 31 years.

“There’s a recognition now of the role we have in eye care”, she says. “There’s a recognition that we have a stand-alone role to play, and not just as an adjunct to medical roles. We’re also involved in policy making.

“There are never enough medicos to go around and the fact is allied health can do a good job.”

Ms Silveira is a JAFF research fellow at the Royal Institute for Deaf and Blind Children (RIBDC) Renwick Centre in Sydney.

Part of her role is to manage the Australian Childhood Vision Impairment Register.2

“The aim of the Register is to collect data to build an accurate picture of Australian children with vision impairment”, she says. “The data is used by groups who provide services to children with vision impairment and also by researchers working in the field of childhood eye and vision disorders.”

“There was no data about childhood vision impairment in Australia until the register was set up [in 2008]”, she says.

“We have 1100 children between 0 and 18 years registered now and we’re starting to see trends in the data.”

Among those trends — 60% of registered children are boys; ages 7–13 years represent the biggest band of registered children, reflecting the time when children are starting school and families feel the need to do something; 65% of all diagnoses are for either cortical vision impairment, retinal dystrophy or albinism.

“Retinal dystrophy makes up 24% [of diagnoses and that’s] actually much higher on our list than in other countries”, Ms Silveira says.

Three-quarters of children on the Register also have nystagmus or “wobbly eyes”, and 50%–60% of them have intellectual disabilities.

“The challenge is encouraging people to register”, Ms Silveira says. “Visual impairment in children is rare. We think we should have about 3000 but recruitment is very hard.

“It’s an important project. Apart from collecting data which tells us causes and what services are needed, where, we can also align families with any research that’s happening, as well as new technology, apps and devices.”

She is also working in the academic wing of the RIDBC Renwick Centre, helping orthoptics students understand the processes of eye disease, clinical information and how this can lead to vision impairment.

Ms Silveira also hosts the Paediatric Vision Forum as an annual event, where paediatric eye and vision professionals exchange information on childhood eye vision care.3

1. Orthoptics Australia:
2. Australian Childhood Vision Impairment Register:
3. Paediatric Vision Forum:

  • Cate Swannell



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