Orthoptics

Orthoptics (from the Greek words ortho meaning "straight", and optikas meaning "vision" ^[1]) is a discipline dealing with the diagnosis and treatment of defective eye movement and coordination (such as nystagmus), binocular vision, and amblyopia by eye care professionals.^[2] There are five areas of treatment for orthoptic problems:

• corrective lenses (spherical, cylindrical lens, prismatic and Fresnel lenses)
• strabismic-related orthoptics as an "eye exercise" is limited to the treatment of eye coordination problems by increasing the range of binocular fusion.^{[citation needed]}
• eyepatching
• pharmaceuticals, such as cycloplegics
• surgery

However the term orthoptics is sometimes used to refer simply to eye exercises which are a component of strabismic-related vision therapy.

Orthoptists

Orthoptists are Eye care professionals who specialise in the diagnosis and management of binocular vision problems.^[3][4] Orthoptists are represented worldwide by the International Orthoptic Association.

Orthoptics is usually studied as a primary or master's degree,^[5] or as a 2 to 4 years post graduate training course. Orthoptists usually work in close cooperation with Ophthalmologists, pediatricians, and sometimes neurologists. Continuing professional development and registration is required in most countries.^[6]

History

Orthoptists and ophthalmologists introduced a wide variety of techniques for the improvement of binocular function in the 1930s. The first pioneer was Mary Maddox, the daughter of an English ophthalmologist.^[7]

The orthoptic health care profession evolved and specialised as scientific development increased in the diagnosis, management and pre/post-surgical care of patients with strabismus, binocular vision abnormalities and specific pediatric disorders.^[8][9] Because of their lower prevalence and variational presentation, these were beyond the realm of a primary eyecare consultation at a spectacle shop (where most Optometrists work) and beyond the Ophthalmologists' demanding surgical workload and practice. Hence, Orthoptists began to specialize in hospitals with these problems throughout more than 20 countries.^[9][10]

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, negative relative accommodation) and pathological causes. 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^[3]:

• Primary activities
  • Ocular motility diagnosis & co-management^[11]
  • Vision screening
  • Assessment of special needs^[12]
  • Assessment and rehabilitation in neurological disorders^[13]
• Secondary activities
  • Low Vision assessment and management^[14][15][16]
  • Glaucoma assessment & stable glaucoma management^[17]
  • Biometry (includes sonography work)^[18][19]
  • Fundus photography & screening^[20]
  • Visual electrodiagnosis^[21]
  • Retinoscopy and refraction, such as using a phoropter to assess refractive errors^[22]
• Further activities
  • Specific outpatient waiting list initiatives to reduce the delay for children referred to the eye clinic (filter screening)^[23]
  • Joint multidisciplinary children’s vision screening clinics (orthoptics/optometry)^[24]
  • 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

References

1. ^ http://www.tcos.ca/about_orthoptics.html
2. ^ Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company, 1990.
3. ^ ^{a b} http://www.internationalorthoptics.org/download/1160331924_3.1._pr_01_rev_06.doc
4. ^ http://www.ranzco.edu/orthoptists-and-prescribing-in-nsw/view?searchterm=None
5. ^ http://www.latrobe.edu.au/orthoptics/
6. ^ Koklanis K, Georgievski Z. Continuing professional education programs for orthoptists. Insight 2009; Feb/March: 43. [PDF]
7. ^ 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. 
8. ^ Georgievski, Z; Koklanis, K; Leone, J (2007). "Orthoptists' management of amblyopia - a case-based survey.". Strabismus 15 (4): 197–203. doi:10.1080/09273970701631975. PMID 18058356. 
9. ^ ^{a b} Koklanis, K; Georgievski, Z (2009). "Recurrence of intermittent exotropia: factors associated with surgical outcomes.". Strabismus 17 (1): 37–40. doi:10.1080/09273970802678750. PMID 19301192. 
10. ^ http://www.internationalorthoptics.org/
11. ^ McCarry, B (1999). "Orthoptists' Current Shared Care Role in Ophthalmology". Br Orthopt J 56: 11–18. 
12. ^ 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.
13. ^ Fowler, MS (1991). "Orthoptic Investigation of Neurological Patients Undergoing Rehabilitation". Br Orthopt J 48: 2–7. 
14. ^ Enrica Colombo: The Orthoptist Visual-Therapist. Trans. VIIth IOC 1991, Ed G.Tillson, p 365.
15. ^ Fujita, J.; Aoki, S. et al. (2000). "Orthoptists in Low Vision Clinic". J.O.J. 28: 239–243. 
16. ^ Fitzmaurice, K. (1999). "Low vision rehabilitation: An update". Australian Orthoptic Journal 34: 9–14. 
17. ^ Amano, M.; Yamaguchi, N. et al. (1999). "Glaucoma Screening in Health Checkups". J.O.J. 27: 153–158. 
18. ^ http://www.australianorthopticboard.org.au/Registration/Registration.html
19. ^ Edwards, RS et al. (1999). "The Role of Orthoptists in Biometry". Br Orthopt J 56: 19–21. 
20. ^ 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. 
21. ^ JW Weiss, M Munck, E Muller-Feuga: The Orthoptist and Electro-Oculography. Trans. Vth IOC 1983, Ed.AP Ravault, Marlis Lenk, p 373-79
22. ^ http://www.ranzco.edu/orthoptists-and-prescribing-in-nsw
23. ^ 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.
24. ^ 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.