What is an Orthoptist? By Mr Joe McQuillan

​At Clinica London we have three Orthoptists who support the Paediatric Ophthalmology, Neuro-Ophthalmology and Strabismus consultants. They see children and adult patients for motility assessments and treatment. They see DVLA patients for driving visual standards testing.

Orthoptists are allied medical professionals who are experts in binocular vision. This is the term used to describe eye movements, the visual field and how the eyes work together. Orthoptists are concerned with diagnosing and treating defects in binocular vision in children and adults.

What qualifications do orthoptists have in comparison to others in the field? Orthoptists differ from Optometrists and Opticians. Orthoptists are a small group of highly skilled specialists.

​What do patients experience before seeing an orthoptist?

Your Ophthalmologist will recommend when you or your child should see an Orthoptist. The DVLA also refers patients to our Orthoptists for specialized visual field testing. Your GP or Optometrist can also refer you to one of our Orthoptists. You can self-refer yourself or your child.

It is sometimes difficult for patients to know when to book an appointment with an orthoptist. Here is a list of symptoms that require an orthoptist’s expertise:

• Childhood Lazy eye (Amblyopia) – Vision in one eye is poorer than in the other hence the term “lazy eye”. This is most common in children under the age of 5 years and is the result of the visual cortex (the part of the brain that senses vision) not developing the pathways to function correctly. Lazy eye can be associated with the need for glasses, a visible strabismus (squint) or droopy eyelid (ptosis). The orthoptist measures the vision, the binocular movements, the stereopsis, the degree of strabismus, and works with the Paediatric Ophthalmologist to treat the lazy eye with glasses and /or patching, and with the Oculoplastic surgeon when there is a ptosis.

• Strabismus (Squint) – This is the term given to the condition of misalignment of the eyes. This occurs when there is an incorrect balance of the eye muscles that manifests itself with one eye being misaligned with the other in various possible ways. This can occur in children or adults, and may occur as part of the developmental process or have a neurological cause. The orthoptist measures the misalignment and helps in treatment, including planning Strabismus surgery plus the post operative care.

• Double vision / Blurred vision – Patients who develop a sudden double or blurred vision can see an orthoptist to diagnose the condition as there are various reasons as to why this may happen. This is most commonly in adult patients as a result of a neurological cause. The Orthoptist measures the amount of double vision and helps with special prisms or exercises to treat the double vision. Sometimes these patients proceed to strabismus surgery.

• Ocular head postures – Patients who feel that their eye seems to feel more comfortable when they place their head in a certain position can see an orthoptist to determine the reason for this. Parents will often notice their child holding their head, seeking a comfortable position. This condition can be the result of various problems, so an orthoptist is needed to determine the cause. It can be caused by a congenital or acquired nerve palsy motility problem. An example is an adult patient with thyroid eye disease who develop double vision and moves their head position to chin up, so as to avoid double vision when they look up.

• Ptosis (Drooping Eyelid) – Parents often notice their child’s droopy eyelid from a very young age. It is important to see an orthoptist to determine if the eyelid is causing problems in the child’s vision. This is normally the result of weak eyelid muscles. The child will adopt a chin up head position in order to see out well from under the eyelids.

What tests do orthoptists carry out?

Orthoptists carry out vision, stereopsis, cover tests, range of eye movement and visual field tests to establish the level of vision, measure the double vision, diagnose strabismus misalignment and tests movement of the eyes in various positions.
Orthoptists also assess a child’s vision and their ability to perceive depth through 3D vision testing. They use a machine called the synoptophore to measure very fine degrees of stereopsis.
Orthoptists carry out special driving visual field testing for the DVLA.
What treatments do orthoptists give?

Sometimes, orthoptists may refer the patient to an ophthalmologist for glasses or surgical treatments. However, they can treat certain conditions by subscribing to specialized orthoptic exercises as well as eye patches, prisms, glasses filters, special lenses and other.

Orthoptic services at Clinica London

Children: The Orthoptist’s role looking after children – Clinica London
Adults: What does the orthoptist do for adult patients? Part 1 – Clinica London
What does the orthoptist do for adult patients? Part 2 – Clinica London

The three highly experienced consultant orthoptists at Clinica London are:

Mr Joe McQuillan, Consultant Orthoptist, specialist in paediatric, trauma motility and adult neuro-orthoptics.

Mr Greg Richardson, Consultant Orthoptist, specialist in paediatric, and adult neuro-orthoptics

Mr Vijay Tailor, Specialist in paediatric and adult strabismus