Orthoptics

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Orthoptics is a profession allied to eye care profession 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]

Effectiveness[edit]

For children, there is evidence that orthoptics can be more effective at treating convergence insufficiency than home-based training; for adults the evidence is not consistent.[4]

History[edit]

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.[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[edit]

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
  • 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[edit]

References[edit]

  1. ^ International Orthoptic Association document "professional role"
  2. ^ http://www.tcos.ca/about_orthoptics.html
  3. ^ a b Vukicevic, M., Koklanis, K and Giribaldi, M. Orthoptics: Evolving to meet increasing demand for eye service. In Insight news. March 2013: Sydney, Australia.
  4. ^ Scheiman M, Gwiazda J, Li T (2011). "Non-surgical interventions for convergence insufficiency". Cochrane Database Syst Rev (Systematic review) (3): CD006768. doi:10.1002/14651858.CD006768.pub2. PMC 4278667Freely accessible. PMID 21412896. 
  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. 
  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). "vision rehabilitation". 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.