Ann L. Webber

There is potential to expand the number of collaborative care and multidisciplinary team-based care models that optometrists are involved in, working at full scope to deliver high quality patient care. Ongoing work to generate research evidence, change policy and secure long-term funding is needed to support implementation. Implementation of new models of multidisciplinary team-based care or collaborative care can support quality healthcare delivery and the sustainability of future health systems. This narrative review synthesises research on models of multidisciplinary team-based care or collaborative care that involve optometrists in Australia and New Zealand. Outcomes related to patient health and experience, health service delivery including costs, and practitioner experience including workforce satisfaction were extracted from published evaluations. Additionally, barriers and facilitating factors to implementation were synthesised from identified studies. In total, 12 models of care were identified, most were task shifting or task sharing models between optometry and hospital-based ophthalmology for managing eye conditions. These collaborative models were developed to address long waiting lists for hospital-based ophthalmology services, and their implementation resulted in a corresponding decrease in waiting times for appointments. However, patient health outcomes, patient, and practitioner experiences were seldom reported. In primary care settings, models of multidisciplinary team-based care (n =3) were generally well-received by patients and practitioners. However, more objective measures may help quantify the social and economic benefits of these models. Despite the impetus for multidisciplinary team-based care, barriers to wider implementation persist. Implementation science can help identify strategies to overcome barriers to adopting evidence-based models of care. Future studies should incorporate economic evaluations, to inform advocacy and policy, to generate system-level change that support health organisations to deliver multidisciplinary team-based care. Finally, future work should consider embedding the patient perspective from outset to ensure that models of care are people-centred.

A systematic review and meta-analysis were conducted to understand the extent to which saccadic latency is impacted by different types of aetiologies. Nine studies were included in the meta-analysis, from 232 amblyopes and 140 controls. Longer saccadic latencies occurred in amblyopes compared to controls. A large and significant effect size (ES) was found when viewing with the amblyopic eye (g = 1.17, I² = 43.69%, p < 0.0001), followed by binocular viewing (g = 0.70, I² = 25.87%, p < 0.0001). However, no significant ES was found with fellow eye viewing (g = 0.12, I² = 42.86%, p = 0.320). Largest ES was noted for mixed amblyopia in the amblyopic eye (g = 1.79, I² = 0%, Q = 0.05, 95% CI = 1.70 to 1.87), followed by strabismic and anisometropic amblyopia, indicating that deficits in saccadic latency are dependent on the amblyopia type (p < 0.001). A positive association was found between saccadic latency and increasing hyperopic refractive error for the amblyopic eye (p = 0.004). A significant increase in saccadic latency ES with age was found for the fellow eye (p = 0.048) and binocular viewing (p = 0.004) conditions, but not for the amblyopic eye viewing (p = 0.077). Saccadic latency is most delayed in the amblyopic eye, particularly in mixed amblyopia, with smaller delays under binocular viewing condition. An increase in saccadic latency is observed with higher levels of hyperopia and as age progresses. These findings highlight the utility of measures of saccadic latency as a way of distinguishing between different types and severities of amblyopia, which may be useful in its diagnosis and treatment.

Effective paediatric eyecare requires up-to-date knowledge and skills. Effective tele-mentoring and continuous education can significantly improve clinical confidence and ensure comprehensive care for paediatric patients. Project ECHO (Extension for Community Healthcare Outcomes) is a proven interactive case-based tele-mentoring for medical practitioners. A Paediatric Eyecare ECHO was implemented with Australian optometrists to evaluate its acceptability as an education modality and impact on self-reported confidence in clinical knowledge and competency. Eight weekly, hour-long ECHO sessions on paediatric eyecare topics, informed by a learning needs assessment survey, were conducted. Each session included a brief didactic lecture by an expert, case presentations by participating optometrists and interactive discussions. Participant engagement, satisfaction, likeliness to implement knowledge, and competence were evaluated. Online questionnaires (5-point scale) with open-ended questions were administered before, during, and after the programme. Quantitative data were analysed descriptively and inferentially, while qualitative data were thematically analysed. Fifty-four optometrists registered for the ECHO with 98.1% attending at least one ECHO session. Forty-four of 54 ECHO programme registrants participated in the programme evaluation. Initial self-reported competencies showed knowledge deficits (score 85%) and were likely to implement knowledge gained (>88.6%). Competence ratings increased significantly by +0.51 (Z = 4.3, p < .001). Qualitative feedback highlighted an appreciation for case-based presentations but a desire for more detailed clinical management and vision therapy information. The Paediatric Eyecare ECHO showed positive outcomes for optometrists in respect of engagement, satisfaction, likeliness to implement knowledge and self-assessed competency in treating paediatric patients. In addition to paediatric eye care case management, this model holds promise for interactive education in other ocular conditions managed by optometrists.

The purpose of this study was to evaluate higher-order visual processing and executive function in adults with amblyopia and/or strabismus under habitual binocular viewing conditions and to explore their association with functional capabilities and vision-related quality of life (VRQOL). This study included 114 adults (23 with amblyopia, 52 with amblyopia and strabismus, 20 with strabismus, and 19 healthy controls). Assessments included visual acuity and binocular function score (BFS), visuo-cognitive tests (Useful Field of View [UFOV], Trail Making Test [TMT], and Stroop Color and Word Test [SCWT]), and functional tests (fine motor skills [FMS] and reading rate). Group differences were evaluated using ANOVA, and regression models assessed the contribution of clinical and cognitive measures to functional outcomes and VRQOL. Performance significantly varied across groups (F(3,108) = 753, P < 0.001), for all three visuo-cognitive tests (UFOV F(3,108) = 2.982, P = 0.034; TMT F(3,108) = 5.289, P = 0.002; and SCWT F(3,108) = 4.068, P = 0.009). Adults with amblyopia and/or strabismus had significantly slower completion times on UFOV, TMT, and SCWT compared with healthy controls (P < 0.05), with pronounced deficits in divided attention, visual search, and cognitive flexibility. Performance among the three visuo-cognitive tests was strongly correlated (r's³ = 0.7, P = 0.01). Regression analyses revealed that SCWT times significantly predicted FMS and reading speed, explaining 42% and 31% of the variance, respectively. Psychosocial VRQOL scores were significantly influenced by the presence of strabismus (P = 0.001), whereas functional impact scores were associated with BFS (P = 0.04) and UFOV times (P = 0.02). Amblyopia and/or strabismus in adults are associated with executive function deficits, poorer functional performance, and reduced VRQOL. These findings highlight the long-term visuo-cognitive and functional consequences of abnormal visual development and underscore the need for targeted interventions.

Collaborative eye care, where the skills of health professionals are utilised to their maximum capability, enhances patient outcomes. Optometrists are highly skilled eye care practitioners and yet their involvement in collaborative care is relatively limited. The aim was to understand the barriers and enablers to optometrists working in collaborative eye care within Queensland and identify key factors that affect optometry involvement. A mixed-methods approach comprised three parts. A) Survey of optometrists working in Queensland asking for their opinion on collaborative eye care. B) Interviews with optometrists working in public hospitals in Queensland. C) Responses from both the survey and interviews were deductively coded to the Theoretical Domains Framework (TDF) to identify barriers and enablers to collaborative eye care. The survey included 21 Likert-scaled questions and 9 free-text questions. Structured interviews asked questions about working in a collaborative eye care environment, transcripts were downloaded and checked for accuracy. Key TDF domains were mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) to identify potential intervention functions to support collaborative eye care. Survey responses were received from 41 optometrists and 10 interviews were conducted. The Likert section of the questionnaire demonstrated strong internal consistency (Cronbach's alpha = 0.837) and response variation to individual questions (Friedman Chi-Square = 233, p = 0.001). Key enablers included optometrists having strong professional networks, effective communication pathways, high confidence in clinical skills and proximity to specialist care. Collaboration was constrained by inadequate referral pathways, lack of recognition of the role of optometrists and inadequate remuneration. Identified intervention strategies include enhancing capability through mentorship, restructuring environments to include shared information platforms, appropriate renumeration, and professional development opportunities. Critical enablers and barriers to collaborative eye care amongst Queensland optometrists were identified. Addressing the lack of infrastructure, professional recognition, and financial incentives could strengthen collaborative practices.

Purpose: The purpose of this study was to assess fine motor skills and reading proficiency in adults with amblyopia and/or strabismus, and to determine how these relate to clinical measures of vision and self-reported vision-related quality of life. Methods: Fine motor skills (Manual dexterity - Bruininks-Oseretsky Test of Motor Proficiency [BOT-2]) and reading performance (International Reading Speed Texts [IReST]) were assessed in 23 adults with non-strabismic amblyopia, 20 with non-amblyopic strabismus, 52 with both amblyopia and strabismus, and 19 with normal visual development. Visual acuity and binocular function score (BFS), obtained from stereoacuity and presence/absence of suppression, were also determined. Vision-related quality of life was assessed with the Amblyopia and Strabismus Questionnaire (A&SQ) in those with amblyopia and/or strabismus. Statistical analysis included ANOVA and multiple regression models. Results: Participants with amblyopia and/or strabismus exhibited poorer performance in all five manual dexterity sub-items and the overall standardized score (P < 0.05). The reading rate was significantly slower across all amblyopia/strabismus groups (P < 0.05). Poorer fine motor skills and slower reading performance were associated with each other (R = 0.29). Clinical visual characteristics (visual acuity [VA], BFS, and presence of strabismus) explained 39% of the variance in fine motor skills score (R² = 0.39), however, these explained only 6% of the variance in reading speed (R² = 0.06). Self-report of functional ability related most to BFS, whereas psychosocial impact related to the presence of strabismus. The clinical and functional characteristics predicted 4% of the variance in functional impact score (R² = 0.038) and explained 16% of the variance in psychosocial impact score (R² = 0.16). Conclusions: The functional and psychosocial effects of amblyopia and strabismus are common and persist into adulthood, with outcomes inadequately accounted for by clinical measures of vision.

Purpose: The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional collaboration and the facilitators that contribute to its success, and assessed changes in optometrists' satisfaction since the pilot phase of the collaborative care programme. Methods: Qualitative deductive and inductive content analysis was applied to open‐ended free‐text survey responses collected in 2018 from the optometrists involved in the Program's pilot phase. The responses were coded using the Theoretical Domains Framework (TDF) to categorise barriers and facilitators into key themes. Key behavioural determinants were mapped to the COM‐B (Capability, Opportunity, Motivation‐Behaviour) elements of the Behaviour Change Wheel model to identify intervention strategies. Intervention recommendations were derived from behaviour change mapping and compared with programme quality improvement initiatives. A cross‐sectional explanatory survey informed by the TDF was conducted within the current 2023 cohort, and a longitudinal comparative analysis was carried out using data from the 2018 survey. Results: Among the 97 surveys distributed in 2018, 44 respondents participated; from this group, 38 individuals contributed a total of 200 free‐text responses. Facilitators (240 comments) outnumbered barriers (65 comments). Key facilitators were accessible and timely care, professional development, confidence and positive outcome beliefs. Barriers included communication, information handover, credibility, relationships and skill gaps. Optometrists actively engaged in the programme in 2023 reported heightened satisfaction with their involvement, increased confidence and greater engagement in paediatric eyecare delivery. However, challenges in clinical information transfer persist. Conclusion: The interprofessional collaborative model of paediatric eyecare has contributed efficiencies within the health system by building paediatric care capacity in the community, fostering professional credibility and promoting interdisciplinary trust. Insights gained should prove valuable for other paediatric eyecare services exploring hospital‐to‐community care models.

Clinical relevance: Valid and updated clinical indicators can serve as important tools in assessing and improving eyecare delivery. Background: Indicators for diabetic eyecare in Australia were previously developed from guidelines published before 2013 and then used to assess the appropriateness of care delivery through a nationwide patient record card audit (the iCareTrack study). To reflect emerging evidence and contemporary practice, this study aimed to update clinical indicators for optometric care for people with type 2 diabetes in Australia. Methods: Forty-five candidate indicators, including existing iCareTrack and new indicators derived from nine high-quality evidence-based guidelines, were generated. A two-round modified Delphi process where expert panel members rated the impact, acceptability, and feasibility of the indicators on a 9-point scale and voted for inclusion or exclusion of the candidate indicators was used. Consensus on inclusion was reached when the median scores for impact, acceptability, and feasibility were >= 7 and >75% of experts voted for inclusion. Results: Thirty-two clinical indicators with high acceptability, impact and feasibility ratings (all median scores: 9) were developed. The final indicators were related to history taking (n = 12), physical examination (n = 8), recall period (n = 5), referral (n = 5), and patient education/communication (n = 2). Most (14 of 15) iCareTrack indicators were retained either in the original format or with modifications. New indicators included documenting the type of diabetes, serum lipid level, pregnancy, systemic medications, nephropathy, Indigenous status, general practitioner details, pupil examination, intraocular pressure, optical coherence tomography, diabetic retinopathy grading, recall period for high-risk diabetic patients without retinopathy, referral of high-risk proliferative retinopathy, communication with the general practitioner, and patient education. Conclusion: A set of 32 updated diabetic eyecare clinical indicators was developed based on contemporary evidence and expert consensus. These updated indicators inform the development of programs to assess and enhance the eyecare delivery for people with diabetes in Australia.