Orthoptics

Orthoptics is a profession allied to medicine whose primary remit is the diagnosis and non-medical management of strabismus (squint), amblyopia (lazy eye) and eye movement disorders. The word orthoptics comes from the Greek words ὀρθός orthos, "straight" and ὀπτικός optikοs, "relating to sight" and much of the practice of orthoptists concerns refraction and muscular eye control. Orthoptists are trained professionals who specialize in orthoptic treatment, but generally without any medical qualifications. With specific training, in some countries orthoptists may be involved in monitoring of some forms of eye disease, such as glaucoma, cataract screening and diabetic retinopathy

History of Orthoptics

Orthoptics has a long history in supporting ophthalmic care. French ophthalmologist Louis Emile Javal, began using ocular exercises to treat strabismus (eye turns) and described the practice of orthoptics in his writings in the late 19th century. Mary Maddox pioneered the orthoptic profession and was the first documented orthoptist. She was trained by her father, Ernest E. Maddox, in response to increasing patient demand and time needed to examine and treat patients. Ernest Maddox was a reputed ophthalmologist as well as the inventor of various instruments for investigating binocular vision. Mary Maddox started her own practice in London in the early 1920s and her first hospital clinic opened at the Royal Westminster Hospital in 1928. The first Australian hospital clinic with orthoptists was established at the Alfred Hospital in Melbourne in 1931.

Education

At one time, orthoptics was the domain of ophthalmology, but ophthalmology has largely become a purely medical rather than behavioural or functional practice. Behavioural vision rehabilitation is today more broadly covered through doctors of developmental optometry and neuro-optometry, whose training includes ophthalmology, visual function, visual perception, visual rehabilitation, and orthoptics. Outside of colleges of optometry and related professional organisations, orthoptists traditionally have been trained on-site under the guidance of ophthalmologists. Developmental optometry has included orthoptics as part of basic training since AM Skeffington's work nearly 100 years ago. Bachelor and masters programs in Orthoptics are now offered in many countries in addition to optometry-based programs. Post-graduate programs such and professional doctorates and PhDs are also available. Currently, approximately 17 orthoptic programs are offered around the world. While orthoptic programs differ, students learn to assess, diagnose and manage ocular disorders. More information regarding orthoptic education can be found on the International Orthoptic Association website. Colleges of optometry worldwide offer orthoptics as part of their regular programming.

Orthoptic journals

Orthoptists make a significant contribution to research in eye health care and publish in many well-renowned ophthalmology journals. In addition, most orthoptic associations organize an annual conference and publish a national journal consisting of advancements and research developments in eye health care. Every four years the International Orthoptic Association also organizes a worldwide Congress. A variety of orthoptic journals and their table of contents can be found on the International Orthoptic Association website. The University of Liverpool also offers a search facility of various orthoptic journals that date back to the 1940s and the transactions of related meetings.

Current orthoptic practice

Orthoptists are mainly involved with diagnosing and managing patients with binocular vision disorders which relate to amblyopia, extraocular muscle balance such as with version, refractive errors, vergence, accommodation imbalances, (positive relative accommodation and negative relative accommodation). They work closely with ophthalmologists to ensure that patients with eye muscle disorders are offered a full range of treatment options. According to the International Orthoptic Association, professional orthoptic practice involves the following:

• Primary activities
  • Ocular motility diagnosis & co-management
  • Vision screening
  • Assessment of special needs
  • Assessment and rehabilitation in neurological disorders
• Secondary activities
  • Low Vision assessment and management
  • Glaucoma assessment & stable glaucoma management
  • Biometry (includes sonography work)
  • Fundus photography & screening
  • Visual electrodiagnosis
  • Retinoscopy and refraction, such as using a phoropter to assess refractive errors
• Further activities
  • Specific outpatient waiting list initiatives to reduce the delay for children referred to the eye clinic (filter screening)
  • Joint multidisciplinary children’s vision screening clinics (orthoptics/optometry)
  • Organisation/prioritisation of the strabismus surgical admissions list according to agreed criteria
  • Assistance with surgical procedures

See also

• Bates method
• Convergence insufficiency
• Diplopia
• Dissociated Vertical Deviation
• Esotropia
• Exotropia
• Eye care professional
• Eyepatch
• Glasses
• Haploscope
• International Orthoptic Association
• Pediatric ophthalmology
• Pinhole glasses
• Strabismus
• Vision therapy
• Vision Rehabilitation