Orthoptics is a highly specialized field of health care that focuses on the diagnosis and treatment of eye movement disorders and binocular vision. Most often associated with pediatric ophthalmology, orthoptists can also play a key role on a neuro-ophthalmology or oculoplastic team, as their assessment helps in the diagnosis and management of complex patients.

Here, I outline the various roles filled by orthoptists along with advice on qualifications and training for this role.

Background

Orthoptists are knowledgeable about several key areas, including ocular anatomy and physiology, visual development, and neurologic functions that pertain to eye movements, visual processing, and binocularity.

As clinicians, orthoptists use their comprehensive understanding of the etiology, diagnosis, and treatment of strabismus (misalignment of the eyes) to help identify and manage these patients. Strabismus affects all ages. In adults who are visually mature, eye misalignment can cause double vision, which has a devastating effect on quality of life by impacting daily activities such a reading and driving. Strabismus can also cause headaches and difficulty with depth perception, which can also significantly impact a person’s quality of life.

In children, orthoptists work hard to achieve equal vision and, where possible, binocularity; this can only be achieved in early childhood and missing the window in which visual development can be manipulated will have lifelong, and irreparable, consequences. This is most clearly demonstrated in the critical role orthoptists play in the diagnosis and treatment of amblyopia. Amblyopia occurs when the brain favors one eye over the other, leading to reduced vision in the weaker eye. Orthoptists can help to identify amblyopia (or strabismus, which can lead to amblyopia) earlier and work with patients and their parents to improve vision in the affected eye with eyeglasses, patching, and other treatments.

Qualifications and training

A certification in orthoptics is a post-graduate qualification; the successful completion of a bachelor’s degree is required before sitting the certifying exams (a multiple-choice exam and a practical exam) administered by the American Orthoptic Council (AOC) to become a certified orthoptist.

There are 16 established training programs in the United States. The location and contact details can be found on the joint American Association of Certified Orthoptists (AACO)/AOC website (www.orthoptics.org ). Orthoptic training is clinically based, and each program has its own application process and course prerequisites. All courses are 2 years, but advanced-standing status can be awarded to individuals who already possess a COT or COMT qualification; this can reduce the training period to as little as 12 months.

Certified orthoptists must maintain their AOC certification with accredited continuing medical education hours, many of which are provided by the AACO.

Duties performed

Orthoptists assess a wide range of ophthalmic conditions and visual disorders, making the workload varied, interesting, and intellectually stimulating.

Orthoptists use a variety of techniques to assess eye alignment and identify the underlying cause of the problem. They examine how the eyes move individually and as a pair; misalignment is measured with prisms to quantify the size of the deviation. Prism measurements often confirm the etiology of the strabismus.

The diagnosis of ocular motility disorders is not always straight forward; thus, a key to an orthoptists’ success is being able to establish a good rapport with a patient. This allows them to gain a thorough history from an adult patient or an accurate exam for a pediatric patient.

Orthoptists also work with patients to develop a treatment plan, which may include exercises, eyeglasses, or surgery. Therefore, being personable and possessing an analytical mind good at recognizing patterns are highly desirable skills for orthoptists.

Orthoptists often fill other roles besides assessing and counseling patients. These roles can include study coordinators, retinopathy of prematurity coordinators, office managers, or faculty staff members in teaching hospitals. Some orthoptists gain further certification in surgical assisting to aid their providers during surgery. Many orthoptists come into the field through another ophthalmic profession, which gives them a very wide skill set, and their level of seniority in the clinic team can make them excellent candidates for these additional duties.

Conclusion

Orthoptists are highly trained professionals who work closely with other healthcare providers to deliver comprehensive care for patients with a range of eye conditions. Many enjoy a certain degree of autonomy; managing established amblyopia patients or adult strabismus who are most appropriately treated non-surgically. As a mid-level provider, an orthoptist has the knowledge, and gains the experience, to not only clinically manage but also emotionally support patients through their diagnosis and treatment plan. OP

Sally Murray, CO, is a certified orthoptist working for a private pediatric ophthalmology clinic in Portland, OR. She obtained her primary degree in orthoptics from the University of Liverpool in 2008. In 2016, she earned a post graduate diploma in vision and strabismus from the University of Sheffield through their long-distance learning program. She is a published author and very active member within the orthoptic community.