On behalf of Hersenletsel-uitleg we asked an orthoptist to tell us something about the profession and what an orthoptist can mean for someone with a brain injury.

We hand the floor to Anne Marie.

 

Please note! This page contains information about referrals and health insurers. It is information that relates to the situation in the Netherlands. This may be different in other countries.

 

An orthoptist

• Examines vision: seeing, both up close and at a distance.
• Measures the correct prescription, possibly after administering eye drops.
• Determines the position of the eye, is it straight, squint or a hidden squint (tendency to squint).
• Assesses whether all twelve (2x6) eye muscles are functioning properly.
• Assesses whether the control of the muscles by the brain is good.
• Assesses the cooperation between the eyes and the eyes and brain.
• Is a paramedic whose independence and expertise is recognised and regulated in article 34 of the Dutch BIG law (healthcare professions).
• Has a guarantee of quality. This is regulated via a quality register for paramedics.

 

The orthoptist can conduct research, make a diagnosis and give advice on a therapy or advise a referral to other specialists.

 

Training and working in practice 

The training to become an orthoptist in the Netherlands is provided by the Hogeschool Utrecht and is a four-year bachelor's degree. After this, you can start working as an orthoptist. Most orthoptists work at an ophthalmology outpatient clinic of a hospital.

 

Some orthoptists work in optics and some have an independent practice. Orthoptists also work in visually impaired care.

Consultations in a hospital are (after referral by a doctor) fully reimbursed from the basic insurance.
At the optician's or in an independent practice, where no referral is necessary, it depends on the health insurer whether treatment is reimbursed.

An orthoptist is someone who works in eye care, specializing in the development of vision, the cooperation between the eyes and the eyes and brain (binocular vision including Fixation Disparity), and all deviations and disturbances of this.

 

Most people think of our profession as 'children with patches on one eye who are getting treatment for a lazy eye'. That is certainly part of the job, but we investigate and treat much more.

 

In addition to knowledge of the eye, we also have a thorough knowledge of the entire body. After all, many conditions present themselves with eye complaints.
Think of internal problems such as thyroid problems, neurological conditions such as MS and eye muscle paralysis after stroke/CVA.

 

Complaints for which an orthoptist can offer a solution

• Squinting
  
• Double vision
  
• Blurred vision, focus problems, restless vision
  
• Headaches
  
• Dizziness
  
• Combination of the above

 

Complaints in people with brain damage for which an orthoptist can offer a solution

• Nystagmus, shaking, swaying of the eyes. We investigate what form it is and what the possible cause is.

   

   

• Double vision, double vision occurs when people start to squint (strabismus). We investigate what causes someone to see double. Is there something that was always present underlyingly and can no longer be corrected or is it a muscle that does not work properly, a nerve that is not controlled properly? There can also be so-called gaze paralysis, which means that eyes can no longer look sideways or upwards together, for example.

   

   

• Blurred vision, restless looking, focus problems,

  After an injury, it is possible that the cooperation between the eyes, focusing (accommodating), following images or shifting the gaze causes problems.

 

• Dizziness, vertigo, with reduced eye cooperation or problems with gaze stabilization, dizziness can occur. 

Sometimes only with moving images, sometimes when one moves oneself. In addition to examining eye cooperation, as an orthoptiost we also examine the reflexes that are needed to have the gaze stable when the person or the world moves. (including the vestibular reflex and the optokinetic nystagmus). These reflexes are sometimes disrupted after injury.

 

• Headache, when the cooperation and focusing of the eyes requires so much effort, this effort can cause headaches, especially headaches that occur during the day or after visual tasks.

 

Treatment 

Treatment is started depending on the complaints.
In case of double vision, one eye is usually temporarily covered or, if possible, a temporary prism (fresnel foil) is used.
If double vision is still present after a period of stability, the person can undergo a strabismus operation. If the strabismus is very slight, prism glasses can help.
Only congenital nystagmus is treated with, for example, hard contact lenses and sometimes by means of an eye muscle operation to bring the eyes to the most restful position.
If, with acquired nystagmus, a gaze direction/gaze direction, for example to the right, is reduced, an operation can be performed.
Treatment is not always possible for acquired nystagmus. Outside the Netherlands, medication such as memantine or gamapentin is sometimes given.

 

Visual training

For complaints other than nystagmus and double vision, the orthoptist can provide visual training, possibly in combination with prism glasses.
Visual training is not only aimed at improving the cooperation between the eyes and eyes and brain, but also at increasing the load capacity. Gaze stabilization, focusing and the like are also included in the treatment.

Such a course usually lasts six months.

The patient should practice at home daily. Practice materials are usually provided on loan.
On average, a check-up takes place once a month to evaluate and possibly adjust the exercises.
If the exercises need to be intensified, it can sometimes happen that it is suggested to visit the practice weekly to practice with equipment.
As an orthoptist, you work alone, but you have close contact with other disciplines, such as an ophthalmologist, rehabilitation physician, neurologist, ENT doctor, occupational therapist and physiotherapist.

 

The difference between an orthoptist and an optometrist

 

The optometrist
Optometry means 'eye measurement' and optometrists are mainly trained to perform measurements and to look at the health of the eyes.
If they work in a hospital, an optometrist, under the supervision of an ophthalmologist, performs check-ups, measurements and various additional examinations.
An optometrist distinguishes between good/not so good.
Optometrists can also work in an optician's shop and then perform eye measurements and examine the eye to see if it is healthy or not.
In the Netherlands, some optometrists are specialized in binocular vision, they perform more measurements than just an eye measurement or prism measurement.
This group also provides visual training.

 

The orthoptist
Orthoptics literally means 'the study of seeing straight'.
Unlike an optometrist, an orthoptist has his own area of ​​expertise within ophthalmology.
An orthoptist independently diagnoses and treats disorders in the cooperation and development of the eyes.
These can be, for example, strabismus, double vision, lazy eye, refractive errors, prisms, headaches and reading problems. For example, the orthoptist advises the ophthalmologist with regard to the indication for strabismus surgery.
An orthoptist has a great deal of background knowledge regarding general health.

Anne Marie

Practice zicht en zien.nl

 

More information about orthoptists:

https://www.orthoptics.org/

https://college.mayo.edu/academics/explore-health-care-careers/careers-a-z/orthoptist/