Nicola S. Anstice

Purpose: Improving job satisfaction can mitigate workplace burnout, which refers to feelings of exhaustion and reduced professional efficacy, and preserve service quality. Understanding factors that improve job satisfaction is important, as a high proportion of Australian optometrists report burnout and conflicting pressures to meet financial benchmarks in the clinic. This study investigated factors impacting job satisfaction by assessing the demands placed on optometrists and resources available to manage workplace stressors. Methods: Optometrists were invited to complete an online survey probing demographic, employment, workplace and appointment book management characteristics. Their impact on job satisfaction was assessed using items from the job demands-resources model. Job satisfaction was elicited by the key outcome statements ‘ I have satisfactory career options and professional growth ’, ‘ I am satisfied with my income’ and ‘ I am satisfied with my current scope of practice and level of autonomy’ . The Clinician Experience Measure (CEM) was also administered for baseline purposes. Results: In total, 370 responses with a >50% completion rate were received, representing 5% of AHPRA-registered optometrists. The mean (SD) age was 36.1 (10.8) years, and 61.1% were female. Participants were least satisfied with career options and professional growth (22.5%) and income (24.6%), while only 43.0% were satisfied with their practice scope and level of autonomy. The lowest-scoring items on the CEM pertained to limited involvement in workplace decision-making. Expecting stable employment within the next year ( p = 0.004–0.01) and longer appointment waiting times ( p < 0.001–0.01) increased job satisfaction across all outcomes, while difficulty seeing emergency patients reduced satisfaction ( p < 0.001). Income ( p < 0.001), work setting ( p < 0.001–0.02) and follow-up appointment times ( p = 0.006) were also significant factors. Conclusions: Appointment schedules that allow for adequate follow-up time and can easily accommodate emergency consultations are the strongest modifiable factors available to employee optometrists for reducing workplace stressors. These findings can inform strategies for improving job satisfaction to optimise eyecare delivery.

To close the gap in eye health outcomes, optometrists must acknowledge the link between clinical and cultural safety, recognise Indigenous sovereignty, and accept the ongoing harms of colonisation. The Optometry Aboriginal and Torres Strait Islander Health Curriculum Framework requires optometry programmes to embed culturally safe and responsive eye care for Aboriginal and Torres Strait Islander Peoples in their curricula. However, the Optometry Council of Australia and New Zealand recognised a complementary Māori Health Curriculum Framework was needed. A Kaupapa Māori approach, drawing upon traditional cultural knowledge and embedding critical decolonising theories, was used to create the framework. Māori curriculum experts ensured the Framework privileged Indigenous knowledges, and a Māori Health Curriculum Framework Reference group, comprised of Māori and non-Māori optometry educators, guided the project. A common foundation for Māori health curricula in Australasian optometry programmes was created through an Indigenous-led, evidence-based process. The Framework incorporated nine key themes reflecting Māori worldviews and honouring the principles of Te Tiriti o Waitangi. The Optometry Māori Health Curriculum Framework is an example of active partnership between Māori and non-Māori to achieve an accreditation framework developed by Māori, with Māori, and for Māori through consultation, codesign, and collaboration.

Standardised paediatric vision screening programmes enable timely detection of refractive errors and other amblyopia risk factors. School-based programmes that use appropriate referral thresholds for distance visual acuity, combined with photorefraction, can improve detection of amblyopia and refractive errors in children. The Children's Eye Screening South Australia study evaluated the performance of a vision screening protocol for detecting common vision disorders in a school-based sample of children aged 7-9 years, while characterising prevalent vision conditions in this population. A total of 159 children from 15 schools underwent school-based screening, including distance and near vision, retinoscopy, photorefraction, stereoacuity, heterophoria and ocular alignment. All children who failed screening, and 10% of those who passed, underwent a comprehensive cycloplegic eye examination to establish a clinical diagnosis against which screening outcomes were compared. Screening test accuracy was evaluated using predefined fail criteria and diagnostic performance using the area under the curve (AUC) of Receiver Operating Characteristic curves. Twenty-eight children (17.6%) failed screening, and cycloplegic eye examination confirmed a vision disorder in 27 children (17.0% of the total sample), 16.4% had significant refractive errors and 2.5% had suspected amblyopia. Standard distance vision fail criteria (≥0.26 logMAR) demonstrated low sensitivity (33.3%), but improved to 59.3% using > 0.04 logMAR. Retinoscopy and photorefraction showed high screening test accuracy (AUC, 0.91 and 0.86). Combining distance vision with photorefraction significantly improved accuracy (AUC, 0.87, p < 0.001), with modest, non-significant gains from adding stereoacuity or heterophoria. Seventeen percent of a school-based sample of South Australian children aged 7-9 years were identified as having vision disorders, such as refractive errors and amblyopia risk factors, effectively detected using a combination of vision measurement and photorefraction. These findings support improved vision surveillance in children in South Australia, which could include an instrument-based vision screening programme with appropriate thresholds.

Vision screening is important for detecting undiagnosed vision conditions that are common in school-aged children. However, current vision screening protocols are poor at detecting vision conditions that are most common in the Aotearoa New Zealand paediatric population. Uncorrected refractive error and amblyopia are the most common causes of visual impairment in children. The most appropriate vision screening method depends on the refractive error profile of the population. This study aimed to: estimate the prevalence of refractive errors and amblyopia risk factors among children living in Aotearoa New Zealand; describe previous participation in preschool vision screening and determine the diagnostic accuracy of potential screening methods. Children aged 7-10 years received comprehensive eye examinations, including cycloplegic refraction, in their school. Eye examination results were assessed for refractive error and amblyopia risk factors. The sensitivity and specificity of individual vision tests for detecting any vision conditions was calculated to assess the most effective tests for vision screening. Eye examinations were completed for 237 children and cycloplegic refraction data was available for 220 of these children. Significant refractive error (need for glasses) was detected in 23.6% of children (7.7% myopia, 7.7% hyperopia, 15.0% astigmatism). Amblyopia risk factors were detected in 9.1% of children. Preschool vision screening had been completed by 78.5% of children. Distance visual acuity screening alone had a sensitivity of 39% for detecting vision conditions, with addition of the Spot Vision Screener improving sensitivity to 65%. Astigmatism is the most frequent refractive error among children aged 7-10 years living in Aotearoa New Zealand. Distance visual acuity screening alone is ineffective in detecting refractive error in children in Aotearoa New Zealand. Further research investigating refractive errors across the paediatric population in Aotearoa New Zealand is required to determine the optimal timing and appropriate protocols for school-aged vision screening.

Aim: This study aimed to determine adherence with follow‐up from the New Zealand pre‐school vision screening programme. The study also examined associations between pre‐school vision screening outcomes and cognitive measures assessed at the 54‐month follow‐up in the Growing Up in New Zealand study cohort.Methods: A cross‐sectional retrospective record review of pre‐school vision screening outcomes and hospital ophthalmology records with linkage to Growing Up in New Zealand cohort study data.Results: Of 176 children referred from vision screening, 21.6% did not attend a referral appointment. Of 138 children who attended a referral appointment, 21.0% did not attend one or more follow‐up appointments. Ethnic differences were observed in attendance at referral appointments (attended Māori 13%, Pacific 22.5%, European/Other 64.5%; not attended Māori 26.3%, Pacific 28.9%, European/Other 44.7%; P = 0.04) and follow‐up appointments (attended Māori 11.9%, Pacific 15.6%, European/Other 72.5%; not attended Māori 17.2%, Pacific 48.3%, European/Other 34.5%; P = 0.001). Vision screening outcome was significantly associated with letter naming fluency scores (P = 0.01) but not name and numbers scores (P = 0.05).Conclusions: Non‐attendance at referral and follow‐up appointments limits the efficacy of vision screening, particularly for children of Māori and Pacific ethnicity. Children referred from vision screening achieve lower scores on letter naming fluency, a key predictor of reading ability in later childhood. Equity‐based improvements are required to ensure that all children referred from vision screening receive appropriate follow‐up eye care.

Vision disorders in children impact health-related quality of life, with early detection and intervention improving outcomes and educational performance. Eye health professionals should be aware of paediatric vision screening guidelines and their development to understand the components of local programmes and the differences in sensitivity and specificity between protocols. High-quality clinical practice guidelines (CPGs) for vision screening enable the early detection of common vision disorders; however, they require rigorous development to ensure optimal accuracy in detecting vision disorders, enabling timely interventions. This study evaluated the quality of available vision screening CPGs on vision screening of children in Australia and New Zealand. A systematic search of academic databases, guideline databases, professional associations and Google search engines was conducted to identify relevant paediatric vision screening CPGs. Four independent reviewers used the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument to assess the quality of individual guidelines and scores were aggregated and reported as the percentage of the total possible score across the six AGREE II domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. Initial 2,999 items were evaluated, with seven guidelines included. AGREE-II quality score agreement ranged from 43.3% to 95.8%. All guidelines scored >60.0% in the scope and purpose, however, most had poor scores of <26.5% in the rigour of development and <3.3% in editorial independence domains. All guidelines recommended screening using measures of habitual distance vision. Of the guidelines developed for use in Australia and New Zealand, most guidelines scored poorly when assessed against the AGREE II tool, because of lack of editorial independence and rigour of development. Paediatric vision screening guidelines should prioritise systematic review of literature to inform practice and include statements regarding competing interests.

Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Māori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice. This article highlights the emergence of culturally safe practices in the Australian and Aotearoa New Zealand optometry curricula over the last five years incorporating Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities. Whilst there is still much work to do to achieve the goal of graduating culturally safe optometrists, this paper focuses on features that enable or impede progress in the development of culturally safe practices within the optometry programmes to improve eye health equity for Indigenous recognise the diversity of Indigenous cultures across Australia and NZ.

Australian and New Zealand Indigenous cultures are instantly recognisable in any international forum. Aboriginal Australian culture, in particular, is revered as the oldest continuous living cultur...