Orthoptic Diagnostics in Bergamo: evaluation, diagnosis and rehabilitation of visual disorders

The Orthoptist (Orthoptic Diagnostic Technician) is a health care professional who specializes in the evaluation, diagnosis, and rehabilitation of visual disorders, particularly those involving eye motility and coordination. He deals with problems such as strabismus, amblyopia ("lazy eye") and other binocular vision disorders. The orthoptist collaborates with the ophthalmologist in the management of eye diseases and plays a key role in visual rehabilitation. 

What does an orthoptist do?

• Assesses and diagnoses visual disorders:

Uses specific tools and techniques to identify problems related to eye motility, binocular vision, and eye coordination. 

• Conducts visual rehabilitation:

Prescribes and performs exercises and therapies to improve visual function, correct vision problems, and prevent complications. 

• Collaborate with the ophthalmologist:

It works as a team with the ophthalmologist, especially in managing complex cases such as strabismus and amblyopia, and can assist him or her during examinations. 

• It deals with prevention:

It teaches patients of all ages how to maintain good visual health and prevent or manage vision-related problems. 

When to consult an orthoptist?

It is advisable to consult an orthoptist in case of:

• Strabismus: deviation of one or both eyes. 
• Amblyopia: reduced vision in one or both eyes. 
• Difficulty with eye coordination: problems focusing or following objects with both eyes. 
• Binocular vision problems: difficulty perceiving depth or seeing single images with both eyes. 
• Headaches or visual fatigue: especially if related to prolonged computer use or reading. 
• After eye surgery: for postoperative visual rehabilitation. 

Orthoptic examinations

Especially, orthoptic examinations are aimed at the identification of binocular vision abnormalities such as strabismus, amblyopia, and ocular palsy; they are aimed at pediatric patients but, also at adult patients who, for example, have visual disturbances that typically induce diplopia, visual field alterations, or postural alterations and consequently require orthoptic treatment for visual rehabilitation.

What does orthoptic evaluation consist of?

Orthoptic evaluation may include several tests, including: 

• Measurement of visual acuity: To determine the ability to see clearly at different distances. 
• Ocular motility assessment: To check the movement of the eyes in different directions and their ability to follow moving objects. 
• Convergence and accommodation test: To assess the ability of the eyes to work together to focus on nearby objects. 
• Binocular vision test: To test the ability to use both eyes together to create a three-dimensional image (stereopsis). 
• Test for diplopia: To check for double vision. 
• Strabismus test: To identify any misalignment of the eyes. 
• Specific examinations for color perception (color sense examination) and ocular motility study (Hess-Lancaster Test). 

Orthoptic techniques

Orthoptic techniques include:

• Measurement of visual acuity by means of optotypes (graphic symbols, Albini's E, letters or numbers).
• Measurement of fusion amplitudes, accommodation and convergence.
• Measurement of stereopsis through tests such as the Lang I and Lang II, Titmus or others.
• Evaluation of oculomotor disorders by testing for the study of ocular motility and measurement of any manifest or latent strabismus angle (horizontal, vertical, distance, near) by means of prismatic cues or by means of the symptophore.
• Tests for assessment of binocular ratios such as retinal matching and suppression.
• Testing of oculomotricity and testing for fusion and accommodative performance.
• Visual-perceptual testing in patients with ASD (specific learning disorders).
• Visual-postural testing for assessment of visual functional status in the context of postural assessment.

Orthoptic rehabilitation

Orthoptic rehabilitation makes use of: Orthoptic exercises (orthoptic training and visual training), occlusions and penalizations, prism therapy, optical aids training, visual hygiene education, etc..

Orthoptic rehabilitation is aimed at the treatment of:

• Amblyopia
• Eye motility deficits, or at least some of these: strabismus, ocular muscle paralysis and paresis, nystagmus
• Accommodative and fusional dysfunction
• Alterations in oculomotricity
• Asthenopathy (visual fatigue)
• Diplopia
• Visual field alterations (hemianopsia, etc.).
• Visual ergonomics for screeners and reading accessibility in dyslectics
• Binocular vision abnormalities and visual deficits that can create impaired posture or poor visual performance in athletes and sportsmen.

Orthoptic evaluation in children

This is a specialized checkup that is used to assess the function of the visual system, identifying any problems such as strabismus, amblyopia (lazy eye) or difficulty in binocular vision at an early stage. It is advisable to have the first orthoptic examination around 6-8 months of age, followed by checkups at age 3 and before the start of elementary school. 

What does orthoptic evaluation consist of?

Orthoptic evaluation includes a series of noninvasive tests that assess: 

• Visual acuity: the ability to see clearly. 
• Ocular motility: the ability to move the eyes in all directions. 
• Binocular vision: the ability of the two eyes to work together to create a three-dimensional image. 
• Sensoriality: the ability to perceive visual stimuli. 

When is it advisable to have an orthoptic examination?

• First visit (6-8 months): to rule out congenital pathology, strabismus or high refractive defects. 
• Second visit (3 years): to assess visual acuity, presence of stereopsis, and absence of visual axis deviations. 
• Third visit (5-6 years): to check for proper development of the visual system and absence of difficulties in binocular coordination, which could affect school learning. 

In what cases is it appropriate to anticipate the orthoptic examination?

Premature birth, Presence of strabismus or nystagmus, Lazy eye, Abnormal head position. 

The importance of early diagnosis:

Early detection of any visual problems is crucial because it allows early intervention with targeted treatments, such as corrective lenses, rehabilitation exercises or, in some cases, surgery. This can prevent permanent damage to the child's ability to see. 

Performance:

• Study of the visual field
• OCT Computerized Optical Tonometry
• Orthoptic evaluation
• Visuo posturology