The Canadian Orthoptic Society

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The word orthoptics comes from the Greek ortho meaning straight, and optikas meaning vision, and orthoptists are allied health professionals who specialize in the study of ocular motility and visual development. In conjunction with an ophthalmologist (eye physician and surgeon), the orthoptist examines and aids in the diagnosis of visual system dysfunctions involving vision, eye movement, eye alignment and binocularity. Orthoptics focuses on the non-surgical treatment of amblyopia and strabismus.

Orthoptists specialize in the non-surgical treatment of visual disorders such as amblyopia, strabismus and diplopia. The orthoptist is the front line in the assessment and diagnosis of these disorders, and works with the ophthalmologist in formulating and implementing treatment plans.

For example, amblyopia is the lack of visual development, or the loss of visual ability due to disuse of the eye. In order for vision to develop equally, each eye must be capable of forming a clear image of the viewed object. If one eye is turned off axis (strabismus), one eye has a higher refractive error than the other (anisometropia), or there is disease of one eye, then both of the eyes are not viewing the same object or are not receiving equal pictures. Discrepant input does not allow for binocular co-operation, and the brain shuts off the offending eye (suppression). This halts visual development in that eye and the vision stagnates, and in many cases, deteriorates.

It is the job of the orthoptist to aid in the examination of conditions that may lead to amblyopia, and to determine if amblyopia exists. As many of our patients are pre-verbal, the orthoptist must understand visual system development and integrate this with the knowledge of developmental milestones in order to make a sound judgement. To accurately assess visual capabilities, we use a variety of tests designed to work within the brief window of a child's attention. Amblyopia that is amenable to treatment (ie. not caused by disease) may require treatment with glasses, occlusion (patching), and/or penalization therapy (drops). Armed with complete information about the child's visual system, including a fundus exam performed by an ophthalmologist and correct refraction (measurement for glasses), the orthoptist is the front line person in monitoring and reinforcing the treatment plan, and in offering support and guidance for parents.

The role of the orthoptist is quite different in the diagnosis and management of diplopia (double vision). Frequently, orthoptists are called upon to assess the visual function of adult patients for whom binocular vision has been disrupted. Diplopia can manifest from a variety of causes such as ocular disease, systemic disease, vascular disease, trauma, or refractive errors. The orthoptic examination determines how the binocular visual system has been affected, often lending to diagnosis of underlying disease. The orthoptist then takes steps to manage the visual comfort of the patient. Double vision can often be treated with prism therapy, which relies strongly on the orthoptist's knowledge of visual principles and ability to integrate these therapeutically.

The orthoptist is involved in diagnosis and treatment of many other disorders. We play an active role in the care of many ocular conditions in conjunction with the ophthalmologist.

In Canada, orthoptists practice in many settings. They can be employed in the public sector in hospital based orthoptic clinics sponsored by provincial or federal government health departments. Others are employed within educational centers teaching the visual system to orthoptic students, students of other allied health professions, medical students, and ophthalmology residents. Orthoptists may work in a private ophthalmology office, alongside other ophthalmological staff and allied health care personnel. In Canada, an orthoptist cannot go into a private practice of his or her own. When practicing orthoptics, the orthoptist works under the auspices of a sponsoring ophthalmologist.

The orthoptist is responsible for a variety of investigations, depending upon their work setting. Orthoptics deals with the binocular visual system, but many orthoptists also take on other challenges within the eye care realm. Many are involved in visual field analysis, specializing in the performance and interpretation of neurological field tests. Others are involved in the research and clinical investigation of physiological eye movement and visual potential. Some Canadian provinces run visual screening programs for pre-school and elementary students where and orthoptists can play key roles in the development of protocol and the implementation of screening and analysis.

Today's Canadian orthoptist can work in many other settings, as the knowledge base gained in the orthoptic training centres provides a sound background for many ophthalmology-related careers. For example, orthoptists can be employed as vision researchers, vision screeners, low vision workers, pharmaceutical representatives as well as work in the area of equipment development and sales. Orthoptic training, and experience as an allied health professional provide the knowledge for advancement to managerial opportunities within the health sector, to academic positions, or to related ophthalmic fields.