Orthoptics

Last updated

Orthoptics is a profession allied to the eye care profession. Orthoptists are the experts in diagnosing and treating defects in eye movements and problems with how the eyes work together, called binocular vision. These can be caused by issues with the muscles around the eyes or defects in the nerves enabling the brain to communicate with the eyes. Orthoptists are responsible for the diagnosis and non-surgical management of strabismus (cross-eyed), amblyopia (lazy eye) and eye movement disorders. [1] 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 disorders of binocular vision and defects of eye movement. [2] Orthoptists are trained professionals who specialize in orthoptic treatment, such as eye patches, eye exercises, prisms or glasses. They commonly work with paediatric patients and also adult patients with neurological conditions such as stroke, brain tumours or multiple sclerosis. 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. [3]

Contents

Effectiveness

For children, there is evidence that orthoptics is more effective at treating convergence insufficiency than home-based pencil or computer training; for adults the effectiveness is less evident. [4]

History

Orthoptics has a long history in supporting ophthalmic care. French ophthalmologist Louis Emile Javal began using ocular exercises to treat strabismus (squint) 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. [5] 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. [3] [6] The first Australian hospital clinic with orthoptists was established at the Alfred Hospital in Melbourne in 1931.

Current orthoptic practice

Orthoptists are mainly involved with diagnosing and managing patients with binocular vision disorders which relate to amblyopia, eye movement disorders, 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: [7]

Qualifications and training

In the US, students of orthoptics must attend two years of fellowship training. As of 2019, there were thirteen programs affiliated with medical facilities or universities in the US and three in Canada offering an orthoptic curriculum. [22] In the United Kingdom, the orthoptic degree is a full time three-year course, including hospital placements to develop and refine clinical skills and specialism. [23]

Admission criteria vary from school to school; however, national regulations require completion of a baccalaureate degree prior to sitting for the national certifying exams. A personal interview is customarily part of the admissions process. In the UK the majority of orthoptists are employed by the NHS in hospitals or community eye services. They contribute to the wider eye care teams, alongside ophthalmologists and optometrists.

See also

Related Research Articles

<span class="mw-page-title-main">Ophthalmology</span> Field of medicine treating eye disorders

Ophthalmology is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders. A former term is oculism.

<span class="mw-page-title-main">Esotropia</span> Form of strabismus

Esotropia is a form of strabismus in which one or both eyes turns inward. The condition can be constantly present, or occur intermittently, and can give the affected individual a "cross-eyed" appearance. It is the opposite of exotropia and usually involves more severe axis deviation than esophoria. Esotropia is sometimes erroneously called "lazy eye", which describes the condition of amblyopia; a reduction in vision of one or both eyes that is not the result of any pathology of the eye and cannot be resolved by the use of corrective lenses. Amblyopia can, however, arise as a result of esotropia occurring in childhood: In order to relieve symptoms of diplopia or double vision, the child's brain will ignore or "suppress" the image from the esotropic eye, which when allowed to continue untreated will lead to the development of amblyopia. Treatment options for esotropia include glasses to correct refractive errors, the use of prisms, orthoptic exercises, or eye muscle surgery. The term is from Greek eso meaning "inward" and trope meaning "a turning".

<span class="mw-page-title-main">Strabismus</span> Eyes not aligning when looking at something

Strabismus is a vision disorder in which the eyes do not properly align with each other when looking at an object. The eye that is pointed at an object can alternate. The condition may be present occasionally or constantly. If present during a large part of childhood, it may result in amblyopia, or lazy eyes, and loss of depth perception. If onset is during adulthood, it is more likely to result in double vision.

<span class="mw-page-title-main">Amblyopia</span> Failure of the brain to process input from one eye

Amblyopia, also called lazy eye, is a disorder of sight in which the brain fails to fully process input from one eye and over time favors the other eye. It results in decreased vision in an eye that typically appears normal in other aspects. Amblyopia is the most common cause of decreased vision in a single eye among children and younger adults.

<span class="mw-page-title-main">Diplopia</span> Double vision

Diplopia is the simultaneous perception of two images of a single object that may be displaced horizontally or vertically in relation to each other. Also called double vision, it is a loss of visual focus under regular conditions, and is often voluntary. However, when occurring involuntarily, it results in impaired function of the extraocular muscles, where both eyes are still functional, but they cannot turn to target the desired object. Problems with these muscles may be due to mechanical problems, disorders of the neuromuscular junction, disorders of the cranial nerves that innervate the muscles, and occasionally disorders involving the supranuclear oculomotor pathways or ingestion of toxins.

<span class="mw-page-title-main">Eye examination</span> Series of tests assessing vision and pertaining to the eyes

An eye examination is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, ophthalmologist, or an orthoptist. Health care professionals often recommend that all people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye diseases are asymptomatic.

Pediatric ophthalmology is a sub-speciality of ophthalmology concerned with eye diseases, visual development, and vision care in children.

Vision therapy (VT), or behavioral optometry, is an umbrella term for alternative medicine treatments using eye exercises, based around the pseudoscientific claim that vision problems are the true underlying cause of learning difficulties, particularly in children. Vision therapy has not been shown to be effective using scientific studies, except for helping with convergence insufficiency. Most claims—for example that the therapy can address neurological, educational, and spatial difficulties—lack supporting evidence. Neither the American Academy of Pediatrics nor the American Academy of Ophthalmology support the use of vision therapy.

Convergence insufficiency is a sensory and neuromuscular anomaly of the binocular vision system, characterized by a reduced ability of the eyes to turn towards each other, or sustain convergence.

An eye care professional is an individual who provides a service related to the eyes or vision. It is any healthcare worker involved in eye care, from one with a small amount of post-secondary training to practitioners with a doctoral level of education.

<span class="mw-page-title-main">Worth 4 dot test</span>

The Worth Four Light Test, also known as the Worth's four dot test or W4LT, is a clinical test mainly used for assessing a patient's degree of binocular vision and binocular single vision. Binocular vision involves an image being projected by each eye simultaneously into an area in space and being fused into a single image. The Worth Four Light Test is also used in detection of suppression of either the right or left eye. Suppression occurs during binocular vision when the brain does not process the information received from either of the eyes. This is a common adaptation to strabismus, amblyopia and aniseikonia.

<span class="mw-page-title-main">Hypertropia</span> Condition of misalignment of the eyes

Hypertropia is a condition of misalignment of the eyes (strabismus), whereby the visual axis of one eye is higher than the fellow fixating eye. Hypotropia is the similar condition, focus being on the eye with the visual axis lower than the fellow fixating eye. Dissociated vertical deviation is a special type of hypertropia leading to slow upward drift of one or rarely both eyes, usually when the patient is inattentive.

The red reflex refers to the reddish-orange reflection of light from the back of the eye, or fundus, observed when using an ophthalmoscope or retinoscope. The reflex relies on the transparency of optical media and reflects off the fundus back through media into the aperture of the ophthalmoscope. The red reflex is considered abnormal if there is any asymmetry between the eyes, dark spots, or white reflex (Leukocoria).

<span class="mw-page-title-main">Pinhole occluder</span> Ophthalmological testing tool

A pinhole occluder is an opaque disk with one or more small holes through it, used by ophthalmologists, orthoptists and optometrists to test visual acuity. The occluder is a simple way to focus light, as in a pinhole camera, temporarily removing the effects of refractive errors such as myopia. Because light passes only through the center of the eye's lens, defects in the shape of the lens have no effect while the occluder is used. In this way, the ophthalmologist, orthoptist or optometrist can estimate the maximum improvement in a patient's vision that can be attained by lenses to correct errors of refraction. This can be used to distinguish visual defects caused by refractive error, which improve when the occluder is used, from other problems, which do not. The pinhole occluder can also be used in testing visual acuity in mydriatic patients. In this case, the pinhole occluder compensates for the inability to contract the iris assisting the eye in obtaining a retinal projection similar to that of a non-cycloplegic eye.

The International Orthoptic Association represents over 20,000 orthoptists, in over 20 countries.

<span class="mw-page-title-main">Stereopsis recovery</span>

Stereopsis recovery, also recovery from stereoblindness, is the phenomenon of a stereoblind person gaining partial or full ability of stereo vision (stereopsis).

The Universitäts-Augenklinik Düsseldorf is the department of Ophthalmology of the University Hospital of Düsseldorf in Germany. It is an internationally renown centre for corneal transplantation, ocular surface disease and management of associated disorders ranging from Glaucoma to oculoplastic surgery. Further subspecialist expertise is established for the diagnosis and surgical and medical treatment of vitreoretinal and macular disorders as well as strabismus.

Bagolini striated glasses test, or BSGT, is a subjective clinical test to detect the presence or extent of binocular functions and is generally performed by an optometrist or orthoptist or ophthalmologist. It is mainly used in strabismus clinics. Through this test, suppression, microtropia, diplopia and manifest deviations can be noted. However this test should always be used in conjunction with other clinical tests, such as Worth 4 dot test, Cover test, Prism cover test and Maddox rod to come to a diagnosis.

<span class="mw-page-title-main">Prism fusion range</span>

The prism fusion range (PFR) or fusional vergence amplitude is a clinical eye test performed by orthoptists, optometrists, and ophthalmologists to assess motor fusion, specifically the extent to which a patient can maintain binocular single vision (BSV) in the presence of increasing vergence demands. Motor fusion is largely accounted to amplitudes of fusional vergences and relative fusional vergences. Fusional vergence is the maximum vergence movement enabling BSV and the limit is at the point of diplopia. Relative fusional vergence is the maximum vergence movement enabling a patient to see a comfortable clear image and the limit is represented by the first point of blur. These motor fusion functions should fall within average values so that BSV can be comfortably achieved. Excessive stress on the vergence system or inability to converge or diverge adequately can lead to asthenopic symptoms, which generally result from decompensation of latent deviations (heterophoria) or loss of control of ocular misalignments. Motor anomalies can be managed in various ways, however, in order to commence treatment, motor fusion testing such as the PFR is required.

Retinal birefringence scanning (RBS) is a method for detection the central fixation of the eye. The method can be used in pediatric ophthalmology for screening purposes. By simultaneously measuring the central fixation of both eyes, small- and large-angle strabismus can be detected. The method is not invasive and requires little cooperation by the patient, so it can be used for detecting strabismus in young children. The method provides a reliable detection of strabismus and has also been used for detecting certain kinds of amblyopia. RBS uses the human eye's birefringent properties to identify the position of the fovea and the direction of gaze, and thereby to measure any binocular misalignment.

References

  1. ↑ International Orthoptic Association document "professional role"
  2. ↑ "TCOS.ca :: The Canadian Orthoptic Society". Archived from the original on 2008-06-11. Retrieved 2008-07-02.
  3. 1 2 Vukicevic, M., Koklanis, K and Giribaldi, M. Orthoptics: Evolving to meet increasing demand for eye service. In Insight news. March 2013: Sydney, Australia. By Enyeribe Uzoma Emmanuel.
  4. ↑ Scheiman M, Kulp MT, Cotter SA, Lawrenson JG, Wang L, Li T (Dec 2, 2020). "Interventions for convergence insufficiency: a network meta-analysis". Cochrane Database Syst Rev. 2020 (12): CD006768. doi:10.1002/14651858.CD006768.pub3. PMC   8092638 . PMID   33263359.
  5. ↑ "Ernest Edmund Maddox (1863 - 1933)" (in French). 2006-06-03. Retrieved 2014-09-17.
  6. ↑ Helveston, EM (2005). "Visual training: current status in ophthalmology". American Journal of Ophthalmology. 140 (5): 903–10. doi:10.1016/j.ajo.2005.06.003. PMID   16310470.
  7. ↑ "Archived copy". Archived from the original on July 31, 2009. Retrieved May 16, 2009.{{cite web}}: CS1 maint: archived copy as title (link)
  8. ↑ McCarry, B (1999). "Orthoptists' Current Shared Care Role in Ophthalmology". Br Orthopt J. 56: 11–18.
  9. ↑ K.Fitzmaurice, H Maclean "A Method of Assessing Visual Performance Applicable to Multi-Handicapped Children." Trans. IXth IOC, 1999 Ed.Cynthia Pritchard, Marli Kohler, Dagmar Verlohr, p 111-5.
  10. ↑ Fowler, MS (1991). "Orthoptic Investigation of Neurological Patients Undergoing Rehabilitation". Br Orthopt J. 48: 2–7.
  11. ↑ Enrica Colombo: The Orthoptist Visual-Therapist. Trans. VIIth IOC 1991, Ed G.Tillson, p 365.
  12. ↑ Fujita, J.; Aoki, S.; et al. (2000). "Orthoptists in Low Vision Clinic". J.O.J. 28: 239–243.
  13. ↑ Fitzmaurice, K. (1999). "Low vision rehabilitation: An update". Australian Orthoptic Journal. 34: 9–14.
  14. ↑ Amano, M.; Yamaguchi, N.; et al. (1999). "Glaucoma Screening in Health Checkups". J.O.J. 27: 153–158. doi: 10.4263/jorthoptic.27.153 .
  15. ↑ "Australian Orthoptic Board".
  16. ↑ Edwards, RS; et al. (1999). "The Role of Orthoptists in Biometry". Br Orthopt J. 56: 19–21.
  17. ↑ Georgievski, Z; Koklanis, K; Fenton, A; Koukouras, I. (2007). "Victorian orthoptists' performance in the photo evaluation of diabetic retinopathy". Clinical & Experimental Ophthalmology. 35 (8): 733–738. doi:10.1111/j.1442-9071.2007.01576.x. PMID   17997777. S2CID   8661627.
  18. ↑ JW Weiss, M Munck, E Muller-Feuga: The Orthoptist and Electro-Oculography. Trans. Vth IOC 1983, Ed.AP Ravault, Marlis Lenk, p 373-79
  19. ↑ "Orthoptists and Prescribing in NSW, VIC and SA — Ranzco". Archived from the original on 2011-09-30. Retrieved 2009-05-13.
  20. ↑ VK Lantau et al: State of the Rotterdam Amblyopia Screening Project. Trans. IXth IOC, 1999 Ed.Cynthia Pritchard, Marli Kohler, Dagmar Verlohr, p 39-45.
  21. ↑ G.Schalit et al: A New Model for the Evaluation and Management of Strabismus, Amblyopia and Refractive Error in Children. Trans. IXth IOC, 1999 Ed.Cynthia Pritchard, Marli Kohler, Dagmar Verlohr, p 357.
  22. ↑ "Become an Orthoptist 2022".
  23. ↑ "How do I become an orthoptist?".
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.