From the Guidelines
An orthoptist is a valuable team member in the diagnosis and nonsurgical management of strabismus, working under the supervision of an experienced ophthalmologist, as stated in the most recent study 1. When it comes to managing conditions like strabismus, double vision, and other visual processing issues, orthoptists play a crucial role in evaluating and treating these conditions.
- They work closely with ophthalmologists to assess how well the eyes work together, measure the degree of eye turn, and evaluate depth perception.
- Orthoptists typically provide non-surgical treatments such as eye exercises, prism glasses, patching therapy for amblyopia, and vision therapy to improve visual function.
- Their expertise in eye muscle function and coordination makes them valuable team members in neuro-ophthalmology, pediatric ophthalmology, and general eye care practices. According to the latest research 1, orthoptists can be an asset in the examination, diagnosis, and nonsurgical management of strabismus, particularly when working under the supervision of an experienced ophthalmologist.
- This is also supported by other recent studies 1, which highlight the importance of orthoptists in the management of various eye conditions. In real-life clinical practice, if you're experiencing double vision, eye strain, or have a child with an eye turn or vision development concerns, an orthoptist consultation, under the supervision of an ophthalmologist, may be beneficial, as recommended by the most recent study 1.
From the Research
Orthoptist Role and Responsibilities
- Orthoptists play a crucial role in the assessment and management of strabismus and amblyopia, with most hospitals employing more than one system for assessment, including orthoptic assessment without refraction, combined orthoptist and ophthalmologist assessment, and entirely orthoptist/optometric systems 2.
- Orthoptists are involved in the initial assessment of patients in some units, while in others, they are involved only if response to treatment is poor or if surgery is required 2.
Assessment and Management of Strabismus and Amblyopia
- The assessment and management of strabismus and amblyopia vary across different units, with some using logMAR-based tests and others using different methods 2.
- Occlusion therapy, whilst wearing necessary refractive correction, appears to be more effective than refractive correction alone in the treatment of strabismic amblyopia 3, 4.
- Supplementing occlusion therapy with near activities may produce a better visual outcome compared to non-near activities after four weeks of treatment 3, 4.
Treatment Options for Strabismic Amblyopia
- Passive treatments such as occlusion, optical and/or pharmacological penalization, and Bangerter foils have been demonstrated to be potentially useful treatments for strabismic amblyopia 5.
- Active vision therapy is becoming a relevant therapeutic option in combination with passive treatments, especially during and after monocular therapy, in the attempt of recovering the imbalanced binocular vision 5.
- Recent research has proved new pharmacological options to improve and maintain visual acuity after occlusion treatment in strabismic amblyopia 5.
Audit and Review of Treatment Protocols
- An audit of the Royal College of Ophthalmologists strabismic amblyopia treatment protocol found that recorded vision at 6 weeks is more informative for making treatment decisions than that recorded at presentation 6.
- The 14 week review confers no benefit to those with reliable and improving visual acuity, and patients presenting with a large discrepancy in visual acuity do not improve after 14 weeks and could be occluded at 6 weeks 6.