Orthoptics

Orthoptics is a profession allied to medicine whose primary emphasis is the diagnosis and non-surgical management of strabismus (wandering eye), 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 refraction and muscular eye control.^[2] Orthoptists are trained professionals who specialize in orthoptic treatment. 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]

History of Orthoptics

Orthoptics has a long history in supporting ophthalmic care. French ophthalmologist Louis Emile Javal, began using ocular exercises to treat strabismus (wandering eye) 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. Dr Ernest Maddox was a reputed ophthalmologist as well as the inventor of various instruments for investigating binocular vision.^[4] 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][5] The first Australian hospital clinic with orthoptists was established at the Alfred Hospital in Melbourne in 1931.

Education

Orthoptics may be studied as either a bachelor and masters programs in many countries, the option of 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.

Australia

Orthoptic programs are offered by the University of Technology Sydney and LaTrobe University, Melbourne. Students could either undertake a 4 year undergraduate/postgraduate combined degree or a 2 year postgraduate masters degree. Successful completion of either degree will enable graduates to register with the Australian Orthoptic Board.

United Kingdom

A 3 year Bachelor orthoptic degree programme is offered by the University of Sheffield and the University of Liverpool and a 4 year degree by Glasgow Caledonia University. Successful completion of the degree will enable graduates to register with the Health and Care Professions Council in the UK.

A distance learning Masters (MMedSci) degree in Vision and Strabismus is offered by the University of Sheffield.

United States

The University of Wisconsin School of Medicine and Public Health has a 24 month training program in orthoptics.^[6]

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:^[7]

• Primary activities
  • Ocular motility diagnosis & co-management^[8]
  • Vision screening
  • Assessment of special needs^[9]
  • Assessment and rehabilitation in neurological disorders^[10]
• Secondary activities
  • Low Vision assessment and management^[11][12][13]
  • Glaucoma assessment & stable glaucoma management^[14]
  • Biometry (includes sonography work)^[15][16]
  • Fundus photography & screening^[17]
  • Visual electrodiagnosis^[18]
  • Retinoscopy and refraction, such as using a phoropter to assess refractive errors^[19]
• Further activities
  • Specific outpatient waiting list initiatives to reduce the delay for children referred to the eye clinic (filter screening)^[20]
  • Joint multidisciplinary children’s vision screening clinics (orthoptics/optometry)^[21]
  • 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
• Troposcope
• Vision therapy
• Vision Rehabilitation

References

1. International Orthoptic Association document "professional role"
2. http://www.tcos.ca/about_orthoptics.html
3. Vukicevic, M., Koklanis, K and Giribaldi, M. Orthoptics: Evolving to meet increasing demand for eye service. In Insight news. March 2013: Sydney, Australia.
4. "Ernest Edmund Maddox (1863 - 1933)" (in French). 2006-06-03. Retrieved 2014-09-17.
5. 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.
6. University of Wisconsin School of Medicine and Public Health, Department of Ophthalmology and Visual Science, https://www.ophth.wisc.edu/education/orthoptic/626e660f.html
7. "Archived copy". Archived from the original on July 31, 2009. Retrieved May 16, 2009.
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. http://www.australianorthopticboard.org.au/Registration/Registration.html
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.
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. http://www.ranzco.edu/orthoptists-and-prescribing-in-nsw
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.