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a specialist in orthoptics

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/26 11:30:33」(JST)

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Orthoptics is a profession allied to medicine whose primary remit is the diagnosis and non-medical management of strabismus (squint), amblyopia (lazy eye) and eye movement disorders. ^[1] The word orthoptics comes from the Greek words ὀρθός orthos, "straight" and ὀπτικός optikοs, "relating to sight" and much of the practice of orthoptists concerns refraction and muscular eye control.^[2] Orthoptists are trained professionals who specialize in orthoptic treatment, but generally without any medical qualifications. With specific training, in some countries orthoptists may be involved in monitoring of some forms of eye disease, such as glaucoma, cataract screening and diabetic retinopathy ^[3]

History of Orthoptics

Orthoptics has a long history in supporting ophthalmic care. French ophthalmologist Louis Emile Javal, began using ocular exercises to treat strabismus (eye turns) and described the practice of orthoptics in his writings in the late 19th century. Mary Maddox pioneered the orthoptic profession and was the first documented orthoptist. She was trained by her father, Ernest E. Maddox, in response to increasing patient demand and time needed to examine and treat patients. Ernest Maddox was a reputed ophthalmologist as well as the inventor of various instruments for investigating binocular vision.^[4] Mary Maddox started her own practice in London in the early 1920s and her first hospital clinic opened at the Royal Westminster Hospital in 1928.^[3]^[5] The first Australian hospital clinic with orthoptists was established at the Alfred Hospital in Melbourne in 1931.

Education

At one time, orthoptics was the domain of ophthalmology, but ophthalmology has largely become a purely medical rather than behavioural or functional practice. Behavioural vision rehabilitation is today more broadly covered through doctors of developmental optometry and neuro-optometry, whose training includes ophthalmology, visual function, visual perception, visual rehabilitation, and orthoptics. Outside of colleges of optometry and related professional organisations, orthoptists traditionally have been trained on-site under the guidance of ophthalmologists. Developmental optometry has included orthoptics as part of basic training since AM Skeffington's work nearly 100 years ago. Bachelor and masters programs in Orthoptics are now offered in many countries in addition to optometry-based programs. Post-graduate programs such and professional doctorates and PhDs are also available. Currently, approximately 17 orthoptic programs are offered around the world. While orthoptic programs differ, students learn to assess, diagnose and manage ocular disorders. More information regarding orthoptic education can be found on the International Orthoptic Association website. Colleges of optometry worldwide offer orthoptics as part of their regular programming.

Orthoptic journals

Orthoptists make a significant contribution to research in eye health care and publish in many well-renowned ophthalmology journals. In addition, most orthoptic associations organize an annual conference and publish a national journal consisting of advancements and research developments in eye health care. Every four years the International Orthoptic Association also organizes a worldwide Congress. A variety of orthoptic journals and their table of contents can be found on the International Orthoptic Association website. The University of Liverpool also offers a search facility of various orthoptic journals that date back to the 1940s and the transactions of related meetings.

Current orthoptic practice

Orthoptists are mainly involved with diagnosing and managing patients with binocular vision disorders which relate to amblyopia, extraocular muscle balance such as with version, refractive errors, vergence, accommodation imbalances, (positive relative accommodation and negative relative accommodation). They work closely with ophthalmologists to ensure that patients with eye muscle disorders are offered a full range of treatment options. According to the International Orthoptic Association, professional orthoptic practice involves the following:^[6]

Primary activities
- Ocular motility diagnosis & co-management^[7]
- Vision screening
- Assessment of special needs^[8]
- Assessment and rehabilitation in neurological disorders^[9]
Secondary activities
- Low Vision assessment and management^[10]^[11]^[12]
- Glaucoma assessment & stable glaucoma management^[13]
- Biometry (includes sonography work)^[14]^[15]
- Fundus photography & screening^[16]
- Visual electrodiagnosis^[17]
- Retinoscopy and refraction, such as using a phoropter to assess refractive errors^[18]
Further activities
- Specific outpatient waiting list initiatives to reduce the delay for children referred to the eye clinic (filter screening)^[19]
- Joint multidisciplinary children’s vision screening clinics (orthoptics/optometry)^[20]
- Organisation/prioritisation of the strabismus surgical admissions list according to agreed criteria
- Assistance with surgical procedures

References

^ International Orthoptic Association document "professional role"
^ http://www.tcos.ca/about_orthoptics.html
^ ^a ^b Vukicevic, M., Koklanis, K and Giribaldi, M. Orthoptics: Evolving to meet increasing demand for eye service. In Insight news. March 2013: Sydney, Australia.
^ "Ernest Edmund Maddox (1863 - 1933)" (in French). 2006-06-03. Retrieved 2014-09-17.
^ Helveston, EM (2005). "Visual training: current status in ophthalmology". American journal of ophthalmology 140 (5): 903–10. doi:10.1016/j.ajo.2005.06.003. PMID 16310470.
^ http://www.internationalorthoptics.org/download/1160331924_3.1._pr_01_rev_06.doc
^ McCarry, B (1999). "Orthoptists' Current Shared Care Role in Ophthalmology". Br Orthopt J 56: 11–18.
^ K.Fitzmaurice, H Maclean "A Method of Assessing Visual Performance Applicable to Multi-Handicapped Children." Trans. IXth IOC, 1999 Ed.Cynthia Pritchard, Marli Kohler, Dagmar Verlohr, p 111-5.
^ Fowler, MS (1991). "Orthoptic Investigation of Neurological Patients Undergoing Rehabilitation". Br Orthopt J 48: 2–7.
^ Enrica Colombo: The Orthoptist Visual-Therapist. Trans. VIIth IOC 1991, Ed G.Tillson, p 365.
^ Fujita, J.; Aoki, S. et al. (2000). "Orthoptists in Low Vision Clinic". J.O.J. 28: 239–243.
^ Fitzmaurice, K. (1999). "Low vision rehabilitation: An update". Australian Orthoptic Journal 34: 9–14.
^ Amano, M.; Yamaguchi, N. et al. (1999). "Glaucoma Screening in Health Checkups". J.O.J. 27: 153–158. doi:10.4263/jorthoptic.27.153.
^ http://www.australianorthopticboard.org.au/Registration/Registration.html
^ Edwards, RS et al. (1999). "The Role of Orthoptists in Biometry". Br Orthopt J 56: 19–21.
^ Georgievski, Z; Koklanis, K; Fenton, A; Koukouras, I. (2007). "Victorian orthoptists' performance in the photo evaluation of diabetic retinopathy". Clinical & Experimental Ophthalmology 35 (8): 733–738. doi:10.1111/j.1442-9071.2007.01576.x. PMID 17997777.
^ JW Weiss, M Munck, E Muller-Feuga: The Orthoptist and Electro-Oculography. Trans. Vth IOC 1983, Ed.AP Ravault, Marlis Lenk, p 373-79
^ http://www.ranzco.edu/orthoptists-and-prescribing-in-nsw
^ VK Lantau et al: State of the Rotterdam Amblyopia Screening Project. Trans. IXth IOC, 1999 Ed.Cynthia Pritchard, Marli Kohler, Dagmar Verlohr, p 39-45.
^ G.Schalit et al: A New Model for the Evaluation and Management of Strabismus, Amblyopia and Refractive Error in Children. Trans. IXth IOC, 1999 Ed.Cynthia Pritchard, Marli Kohler, Dagmar Verlohr, p 357.

English Journal

Development of Manifest Strabismus and Reduced Visual Acuity Following Initial Normal Orthoptic Examination/Pseudo-strabismus Under the Age of 30 Months.

Garretty T.Author information St James Hospital , Leeds , England.AbstractAbstract Aim: To evaluate the incidence of manifest strabismus and the visual acuity found at 5-year vision screening in those who were referred with concerns of strabismus under the age of 30 months and were initially diagnosed by an orthoptist with either pseudo-strabismus or "no abnormality detected" (NAD). Method: Data were collected for children who were seen between April 2007 and March 2008 and diagnosed as above. Notes were retrieved and the database of visual acuity at screening was examined. Results: 248 children were diagnosed as NAD or pseudo-squint on their first visit. 82 were discharged at their first appointment and 166 were offered follow-up. Notes were retrieved for 208 (84%). Of those followed up, 4 (1.9%) were later found to have a heterotropia (2 esotropes, 2 exotropes). Vision screening results were available for 207 (83.5%). Of these, 172 (83%) passed and 35 (17%) failed vision screening. 2 were found to have microtropia and 1 was esotropic. There was no statistically significant difference in the rate of referral from visual screening between the general population and those who were seen and discharged on their first visit (x(2 )= 1.76, p = 0.67 risk ratio = 0.98 [95% CI 0.89 to 1.08]). Conclusion: The incidence of undiagnosed esotropia in this group is between 2.4% and 3.4%. The risk of failing visual screening is the same as the general population.
Strabismus.Strabismus.2014 Mar;22(1):26-31. doi: 10.3109/09273972.2013.877944. Epub 2014 Feb 10.
Abstract Aim: To evaluate the incidence of manifest strabismus and the visual acuity found at 5-year vision screening in those who were referred with concerns of strabismus under the age of 30 months and were initially diagnosed by an orthoptist with either pseudo-strabismus or "no abnormality detec
PMID 24512635

Evaluation of optic nerve head using a newly developed stereo retinal imaging technique by glaucoma specialist and non-expert-certified orthoptist.

Asakawa K1, Kato S, Shoji N, Morita T, Shimizu K.Author information 1*Department of Orthoptics and Visual Science, School of Allied Health Sciences †Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan.AbstractPURPOSE: To evaluate the reproducibility and interexaminer consistency in analyzing the optic disc parameters using a newly fundus stereoscopic camera, and their correlation with parameters of the Heidelberg Retina Tomograph II (HRT II) was also examined.
Journal of glaucoma.J Glaucoma.2013 Dec;22(9):698-706. doi: 10.1097/IJG.0b013e318264be18.
PURPOSE: To evaluate the reproducibility and interexaminer consistency in analyzing the optic disc parameters using a newly fundus stereoscopic camera, and their correlation with parameters of the Heidelberg Retina Tomograph II (HRT II) was also examined.METHODS: This study examined 53 eyes of 53 he
PMID 22936277

Ocular manifestations of autism in ophthalmology.

Black K1, McCarus C, Collins ML, Jensen A.Author information 1Department of Ophthalmology, Greater Baltimore Medical Center, Baltimore, Maryland.AbstractPURPOSE: To highlight the ocular manifestations of autism spectrum disorders in a retrospective chart review of the Greater Baltimore Medical Center (GBMC) among children in the pediatric ophthalmology practice setting.
Strabismus.Strabismus.2013 Jun;21(2):98-102. doi: 10.3109/09273972.2013.786733.
PURPOSE: To highlight the ocular manifestations of autism spectrum disorders in a retrospective chart review of the Greater Baltimore Medical Center (GBMC) among children in the pediatric ophthalmology practice setting.DESIGN: Retrospective chart review. Forty-four patients diagnosed with an autism
PMID 23713930