Orthoptist management of amblyopia is feasible

September 15, 2005

Orlando—An independent amblyopia clinic staffed by orthoptists could decrease physician workload. It would also be well received by patients, according to David Morrison, MD.

Unfortunately, it would not generate significant revenue in a hospital-based setting, where orthoptists cannot charge for professional services, concluded Dr. Morrison, assistant professor of ophthalmology and pediatrics, Vanderbilt University Medical Center, Nashville, TN.

In a private practice setting, an established patient code can be used to bill for a visit with the orthoptist, Dr. Morrison said, although the charge is nominal.

Questionnaire development

To evaluate patient satisfaction, the investigators developed a questionnaire for parents that inquired about their comfort level in having follow-up visits with the orthoptist, availability of appointments, and whether concerns and questions were adequately answered.

Ninety parents completed the entire questionnaire. Nine omitted specific questions, and two declined to participate. Items that were omitted were considered to be negative responses because the investigators felt that some parents may have found it easier to omit a question rather than posit a negative response. Also, the questionnaires were reviewed to determine whether several questions were omitted on the same form. In general, said Dr. Morrison, there was no pattern indicating that multiple questions were disregarded, indicating that this assumption was correct. Thus the researchers gave the maximal potential number of negative responses as opposed to guessing why a question was left blank.

Based on these criteria and assumptions, 3% to 8% of patients were dissatisfied with appointment time, level of comfort seeing the orthoptists, or their ability to answer questions, Dr. Morrison said.

Asked about the availability of appointments with orthoptists (physician appointments were not addressed), 42/99 were very satisfied, 50/99 were satisfied, 3/99 were dissatisfied, 3/99 were neither satisfied nor dissatisfied, and one did not respond. In addition, 43/99 were very comfortable seeing an orthoptist, 44/99 were comfortable, 5/99 were uncomfortable, 1/99 was very uncomfortable, and 6/99 were neither comfortable nor uncomfortable.

Asked about the information orthoptists provided about their child's condition, 91/99 replied that the orthoptists adequately answered their questions, 2/99 felt that answers were inadequate, and six did not respond.

How the clinic works

Several years ago the ophthalmology department at Vanderbilt set up a clinic in which orthoptists could independently manage cases where a pediatric ophthalmologist had previously diagnosed amblyopia in children. Under the guidance of that ophthalmologist, the orthoptists continued to monitor the children until their vision reached a specified endpoint, Dr. Morrison said.