Who are Orthoptists? And Are They Similar to Ophthalmologists?

February 26, 2021 The Ed Psych Practice No Comments Referrals Binocular Vision Disorder, Eye Exercises, Eye Patches, Eye Specialists, Ophthalmologists, Opticians, Optometrists, Orthoptists, Prism, Visual Skills

Takeaway: Orthoptists are eye specialists who can screen your child for eyesight and vision issues, and offer practical, non-surgical solutions. Unlike ophthalmologists, they’re not medical doctors but are great ‘first responders’ for eye care.

To thrive in school, your child needs to be able to see well. And ‘seeing’ is more than just about having 20/20 vision.

There’s a complex set of skills that go into seeing properly. First, there’s ‘visual acuity’, or the ability to see things at different distances. So, your child needs to be able to see the whiteboard (relatively far away), a computer screen (closer), and the writing in her book (closest). But she’ll need to change focus rapidly, too — for example, when she switches her gaze back and forth between the whiteboard and her textbook. She’ll also need to track objects, like when her teacher moves up and down the classroom. Plus, even if her eyes are working fine, her brain needs to process and respond to what she sees — for example, making sense of the pictures in a book, or creating a mental image of the story you’re telling her. And outside class, she’ll have to coordinate vision and movement — say, moving her legs to kick a football. There’s so much more to vision than 20/20 vision!

Your child’s day becomes so much harder if she struggles with any of these visual skills. And you’ll soon begin to notice the signs.

Young children often can’t tell you that they have vision issues because they assume everyone sees the way they do. But you can learn to spot some of the signs. Your child might get frequent headaches, lose interest in things quickly, keep rubbing her eyes or covering one eye while trying to read, tilt her head to one side, hold books up close, or try and avoid reading altogether. Older children might be able to tell you that their eyes get tired quickly or see double when focussing for more than a few minutes. And you might notice physical differences like a squint or a lazy eye. You’ve got to be attentive, though, because your child might be branded as troublesome or slow when, really, her eyesight is the problem. It’s quite common for teachers to mistakenly assume an uninterested child has ADHD, for example, when she’s actually just bored because she can’t see properly.

Your child’s vision is so important that there are four different eye specialists who can help her: ophthalmologists, optometrists, opticians and orthoptists.

Here’s a brief summary of what they all do:

Ophthalmologists are medical doctors. They’ve spent about six years in medical school, followed by eight more years of specialised training. They perform eye tests, diagnose eye diseases and vision issues, operate on eyes, treat using medicines, and write prescriptions for glasses and contact lenses.
Optometrists are eye specialists too, but without the medical degree. Instead, they have a bachelor’s degree in optometry which takes about four years to complete. They focus on screening for eye abnormalities and offer non-surgical solutions like prescribing glasses and contact lenses.
Opticians make, fit, and tweak the glasses and contact lenses that ophthalmologists and optometrists prescribe. They train for anywhere between a few months to a couple of years at an opticianry school.
Orthoptists are a lot like optometrists, but there’s a key difference. An optometrist focuses on understanding the structure of the eye. In contrast, an orthoptist focuses on understanding vision — i.e., how the eyes work together and interact with the brain. An orthoptic degree is a 3-year course with a lot of hands-on experience in different hospitals.

Orthoptists are an excellent first point of contact for eye issues.

Ophthalmologists are ideally suited for more complicated eye problems — especially those that need surgery. But for preliminary screening, you won’t need someone with such advanced training. Here, an orthoptist is the perfect option. She’s got the experience to handle frontline eye issues and figure out solutions, but is more affordable and accessible than an ophthalmologist. She can help you figure out if your child’s vision is developing on track, if one eye sees worse than the other, if her eye movements are coordinated, if her eye muscles work well, if she sees colours properly, and so on. An orthoptists can also refer your child to an ophthalmologist if needed.

Orthoptists assess children of all ages and specialise in a few niche issues.

They need an unusual skill set. They have to be empathetic and compassionate to care for your child and understand her needs. But they must also have finely-tuned observation skills, a sharp mind, and seasoned deductive reasoning. The following are some of the issues they’re trained to diagnose and treat.

1. Lazy eye (amblyopia)

Here, one eye’s vision is weaker than the other because its nerve pathways to the brain haven’t been properly stimulated. We can correct this using exercises that target the visual cortex (the part of the brain that processes sight) or by prescribing glasses.

2. Eye turning inwards or outwards (strabismus)

Sometimes your child’s pupil might start ‘wandering’ inwards (towards the nose), outwards, upwards, or downwards. This leads to symptoms like double vision and blurred vision. Often it’s caused by amblyopia, a weak eye muscle, or a nerve that’s not working properly. We can correct strabismus by prescribing the right glasses, suggesting relevant eye exercises, or referring your child to an ophthalmologist for surgery.

3. Droopy eyelid (ptosis)

Some children are born with weak eyelid muscles or nerves, causing eyelids to droop — which blocks light from reaching the eye and might even change the eyeball’s shape. An orthoptist can test your child’s vision to assess the cause and effects of ptosis. Often, surgery is the best solution but simple tweaks can help, too. For example, fitting glasses with plastic frames that help keep eyelids open.

4. Wobbly eye (nystagmus)

This is one of those hard-to-treat conditions where a child’s eye ‘wobbles’, making it harder for it to settle on a target. You might notice your child tilting her head because the wobble gets better in that position, making it easier to see. If your child was born with nystagmus, it’s unlikely to be completely fixable (although surgery can help) and she might need to register as sight-impaired so she can get extra support. But if she wasn’t born with it, it likely developed because her brain struggles to balance her body. And we can correct this with medication.

An orthoptic assessment can take anywhere between 15 minutes to an hour, and you’ll get a range of fixes to help improve your child’s vision.

An orthoptist will give your child a series of sensory and vision tests and then make a diagnosis.

Prescribing glasses is often enough to solve the problem.
Simple eye exercises can help, too. For example, she might hold a pencil in front of your child and slowly move it side to side, up and down, forwards and backwards. Your child will need to focus on the pencil without moving her head. A variation of this is to use two pencils held an inch apart instead, repeating the process and getting faster each time. You’ll be asked to help your child repeat the exercise for a set number of minutes, a few times every day.
An eye patch over the ‘strong’ eye can help fix the other ‘weaker’ one. That’s because it forces the weak eye to pick up the slack and work harder, which stimulates and strengthens its vision.
‘Prism’ lenses are another useful orthoptic tool. They deflect light and alter the timing of when it enters the eye, making the brain change how it processes sight.
Modifying your child’s environment sometimes helps — for example, redoing the lighting at home.
For surgeries or other advanced measures, the orthoptist will refer you to an ophthalmologist.

Are you concerned that your child has vision issues? Consider consulting an orthoptist.

The Ed Psych Practice offers consultation, advice, and problem solving for parents, nurseries, schools, and colleges, in London. We have psychologists and therapists who can help assess your child and offer guidance and support.

Phone: +44 (0) 78 3344 7356
E-mail: Office@TheEdPsych.com

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