Visions of expansion

Professor Steele gave OT his thoughts on exciting research developments and the importance of optometrists expanding their scope of practice.

How did your career progress?

Shortly following graduation, I was selected to do a one-year fellowship at the Gesell Institute of Child Development. This started a lifetime of interest in the area of child development, especially as it relates to vision development. I became chief of the paediatric service at Southern College of Optometry and have served in that position for just over 25 years. I have been involved in organised optometry since the mid-1980s, serving as chair of the American Optometric Association (AOA) paediatric and binocular vision committee, and currently serve as chair of the AOA InfantSEE and children’s vision committee. I am a past president of the College of Optometrists in Vision Development, and the Optometric Extension Program Foundation. I serve on the continuing education committee of the Southeastern Educational Congress of Optometry (SECO), with specific emphasis on the paediatric track and also the student programme. Recently, I was appointed as SECO international ambassador. All of this involvement has given me a broader perspective of the nature of our wonderful profession and the manner in which we can serve patients.

When did you move into paediatric optometry research?

I am primarily a clinician. In addition to my responsibilities at the Southern College of Optometry, I had a private practice for 40 years. My study and teaching is based on developing observations during a vision assessment that other professions use to determine things like meeting developmental milestones, determining risk for autism, and preparing children for school readiness. The use of vision is a significant component of each of these and more, yet it is too often a neglected area of inclusion in eye examinations by the eye care professions. My drive is to promote understanding of these links and advocate this to the professionals outside of eye care who work with children every day.

What are your current interests?

Since I retired from practice, I have been able to concentrate my interests and investigations at Southern College of Optometry on the critical links between vision and overall development, vision and autism, as well as evaluating a developing infant’s ability to regulate focusing and attention. These are some very exciting clinical observations that I am sharing in teaching and continuing education lectures and seminars. For instance, researchers are now able to identify children at risk for autism through careful evaluation of eye movements. Also, several studies show a very direct link to social interaction, which is critical as the child develops. I suggest it is time to take these observations to direct patient care as optometrists evaluate eye movements and focusing for every patient examined. Likewise, as we evaluate the process of visual function with tools such as retinoscopy, we have a clearer assessment of a child’s ability to attend and sustain their attention. If a child has difficulty sustaining attention, assessment of vision should be one of the items at the top of the list.

What can UK optometrists learn from US optometrists’ advancements in their scope of practice over the years?

I believe there are several things. Despite what many think, the US is mostly rural so physical access for many patients is often difficult at best. It takes a core of very dedicated individuals to initiate and continue this process. My advice is to work to ensure that you are prepared to take on these responsibilities through education, observation and practice, and include all optometrists in this process so it is not included piece by piece.

Would you encourage UK optometrists to gain their independent prescribing qualification?

Absolutely, although it can be a long and arduous process. It is important to ensure that the optometrists are involved in their community in order to demonstrate their availability and the need within the community. It must be demonstrated that the need exists and other access is limited. I suggest thinking of the entire country rather than just larger cities, as access can be more difficult in rural areas.

What are the subjects of your two presentations at Therapeutics London 2016?

My first course is The Infant Examination and Autism. This course will assist the optometrist in the examination of an infant and young child and in recognising the visual signs and symptoms of autism during an examination. We will also provide guidance in developing a management plan when risk is suspected.

My second course is Just Look – It Involves More Than Retinoscopy. I am known for the concept of using the retinoscope to observe the development of the visual process and using those observations to guide management. In this course, I am extending it into other areas of examination and assessment to develop guidance and management of such conditions for the patient.

It is my goal within these courses to, not only provide education, but to help optometrists further recognise the necessity of expanded efforts,  whether with therapeutic pharmaceuticals or with similar efforts in recognising ways to help patients as independent privileges are being pursued.

Therapeutics London will be held at the Holiday Inn, Bloomsbury, London on 25–26 September. To find out more, visit the AOP website.