Orthoptics

Hospital Orthoptics

We provide four different clinics:

• General Orthoptic Clinics
• Refraction Clinics
• Specific Literacy Difficulty Clinics
• Paediatric/Neuro-ophthalmology clinics held together with the ophthalmologist

General Orthoptic Clinic

A large proportion of the caseload consists of children and the assessment will be primarily looking at detection and measurement of squint, visual assessment and eye movement assessment. All the tests carried out on children are based on their age and abilities. If a patient is suitable for squint surgery or the parents wish to discuss their child’s eye condition, then an appointment is then made to see the Consultant Ophthalmologist.

Adults attend the Orthoptic department usually with symptoms of double vision (diplopia). This can be caused by a number of reasons, the main ones being:

• Trauma
• Thyroid Eye Disease
• Diabetes
• Hypertension
• Blow-out Fracture (fracture to the orbit)
• Multiple Sclerosis

Some adults are also re-referred for an assessment on a residual or uncorrected squint from childhood, which could possibly be further corrected.

The investigation of an adult usually consists of assessment of their eye position and movement. A machine called the Hess chart is used to provide a pictorial and repeatable record of the patients eye movements. This is vital for being able to monitor the progress of the patients eye condition.

A chart may also be plotted, if necessary, of the patient’s field of single vision. This gives us a chance to document how much double vision the patient has and how he/she would cope with it in every day life.

If a patient has constant or troublesome double vision, for some patient’s it may be possible to fit a plastic, temporary lens called a fresnel prism onto their glasses.

This prism is designed to eliminate double vision and can occasionally be used for eyestrain that is caused by abnormal ocular alignment. If the patient still needs to use a prism long-term, then this can be incorporated into their current glasses.

Some patients are found to have a condition known as Covergence Insufficiency, which is a weakness of the eye muscles that are responsible for pulling the eyes in to read.

A weakness or inability to do this can result in symptoms of frontal headaches, eye-strain, blurred or double vision. The Orthoptist diagnosis and treats this condition in most cases with a programme of eye exercises which aim to improve this muscle weakness and therefore eliminate the symptoms. The exercises are carried out at home and involve commitment and motivation on the patient’s part. 

Some patients are found to have a condition known as Convergence Insufficiency, which is a weakness of the eye muscles that are responsible for pulling the eyes in to read.

The Orthoptist diagnoses and treats this condition in most cases with a programme of eye exercises, which aim to improve this muscle weakness and therefore eliminate the symptoms.

Refraction clinic (glasses test)

This clinic is carried out in conjunction with an Ophthalmologist. This is done approximately once a year or as clinically required. This involves the instillation of dilating drops.

Specific Literacy Difficulties Clinic

Reading and writing difficulties can sometimes be caused by visual perception disorders or eye movement problems.

There are three main conditions that we assess and treat in relation to reading and writing difficulties:

• Meares-Irlen Syndrome (also known as Scotopic Sensitivity Syndrome or Irlen Syndrome)
• Abnormal eye movements
• Abnormal/weak binocular control of eyes

The Orthoptists are specially trained to recognise and treat these conditions.

Do we test for Dyslexia?
No. Only an Educational Psychologist can formally assess your child for this condition.

What tests will be done on my child?
A full standard Orthoptic assessment will be carried out which will include vision test, detection of squint, 3D vision and assessment of eye movements. If needed, a coloured overlay assessment will be carried out to see whether your child would benefit from reading with colour.

Meares-Irlen Syndrome

People who have Meares-Irlen Syndrome (also known as Scotopic Sensitivity Syndrome) suffer from a visual perception dysfunction, which affects the way in which the brain interprets the visual information which is sent through the eyes.

This condition cannot be detected by standard educational, visual or medical tests.

Meares-Irlen Syndrome is not a learning difficulty in the accepted sense. It is a complex and variable condition that can often coexist with learning difficulties such as Dyslexia, Dysgraphia, Dyspraxia, Dyscalculia, Dysphasia, Attention Deficit Disorder or Hyperactivity.

Treatment of this syndrome does not eliminate the need for remedial help.

This condition was identified in 1980 by an American Psychologist

The main symptoms of this condition are

• Glare from the page. This can include discomfort and difficulty concentrating when reading under florescent or bright light or reading on high gloss paper
• Headaches and sore eyes when reading. There may also be excessive blinking and rubbing of eyes
• Movement/blurring of print. Problems may include the print that shifts, shakes, moves, doubles or disappears
• Fatigue when reading

Some people experience these symptoms after a minute of reading, others find the onset of symptoms may take 10 minutes or so. The degree of symptoms also varies from person to person, the more marked the symptoms the greater the barrier to successful reading.

How do we test for this condition?
It is assessed by using various coloured sheets of plastic (overlays) which are placed over reading material to establish whether speed or accuracy is affected by a particular colour. If a colour is shown to be of use, then this will be given for a trial period to be used without prompting.

How do we tell whether the child has just chosen their favourite colour?
If the overlay is of novelty value only, it will not be used consistently over a period of time. The overlay will only be used if the colour is of benefit. A follow-up appointment will be given to assess the progress with a chosen colour.

What happens after it is established that colour can help your child to read better?
After a period of approximately 6 months, if the overlay has been used and shown to be of significant benefit, you may be referred on to an optician with specialised equipment to carry out a colorimetry assessment. This test determines the precise shade of colour needed and a pair of glasses can then be made with the appropriate precision tinted lenses.

Patients have been referred to this service from Ophthalmologists, Community Medical Officers, GP’s, School Nurses, School Special Educational Needs Co-ordinators, Occupational Therapists, Physiotherapists and Health Visitors.

The Orthoptic department are working in collaboration with the Special Education Needs department to ensure that all children who may be suffering from these problems are seen quickly.

Paediatric/Neuro Clinic

This clinic consists of mainly new patients with squint or double vision. Review patients are also seen for squint surgery listing or a general eye check.

The Orthoptist and Mrs Bagga work very closely on this clinic to discuss diagnosis and management of these patients.