Orthoptics

Orthoptics is the treatment of irregularities of the eyes, especially those of the eye muscles that prevent movement. Including:

  • Amblyopia (lazy eye): Amblyopia is reduced vision in one or both eyes despite no structural abnormality of the eye. Amblyopia occurs in childhood and may be caused by a squint, high refractive error in each eye, unequal refractive errors and by conditions that deprive the eyes of visual input such as cataracts and droopy eyelids (ptosis). Treatment includes eye patches (occlusion) and eye drops (atropine penalisation).
  • Adult and paediatric squints:  Squints are a misalignment of the eyes. Treatment may include glasses, botulinum toxin and surgery.
  • Eye movement disorders: Eye movement disorders may be caused by injury, disease, neurological or congenital disorder which affects the eye muscles or nerves supplying these muscles.
  • Binocular diplopia (double vision): Binocular diplopia (double vision) may occur in the presence of eye movement disorders or squint. Treatment may include eye exercises, glasses and prisms, botulinum toxin or eye muscle surgery.
  • Binocular vision defects: Binocular vision defects are an inability to use both eyes together.

We offer a range of services, including:

  • Adult and paediatric orthoptic appointments: These appointments will be at Epsom and St Helier hospitals.
  • Pre-school vision screening: These screenings will take place at St Helier Hospital, Wrythe Green Surgery, Patrick Doody Clinic Wimbledon, Poly Clinic Mitcham and Jubilee Health Centre Wallington. The UK National Screening Committee (NSC) recommends that all children aged between four and five years should have their vision checked in an orthoptic-led service. All children aged between four and five years who live in the London Boroughs of Merton and Sutton are offered a visual screening check with an orthoptist at one of the above locations. To arrange an appointment, please call  020 8296 3825.
  • Specific learning difficulties assessments: Specific learning difficulties assessments, including visual symptoms which may be associated with dyslexia, take place at St Helier hospital. Some people, such as dyslexics, experience difficulties learning to read. The orthoptist will assess binocular vision (ability to use both eyes together), accommodation (ability of the eyes to focus) and tracking (ability to follow a line of writing) and discuss any visual discomfort and distortions associated with reading. Treatment may include exercises and/or coloured overlays.
  • Visual field clinics: Visual field clinics are held at St Helier, Epsom and Leatherhead hospitals. On arrival, please report to the eye unit reception.  If you are only attending for a visual fields test you will not require drops. If you have a copy of your current glasses prescription please bring this to your appointment.

General information

Our hospitals are teaching hospitals therefore you may be seen by a student. Please inform the receptionist if you do not wish to be seen by a student working under supervision.

You will be seen in order of appointment time, not arrival time. Whilst we endeavour to see patients on time, please note that some cases are more complex and may require additional time with the orthoptist or doctor causing clinics to run behind. From time to time we may also be required to see extra patients from the emergency eye clinic.

Occlusion/eye patch treatment

Your child may be advised to have occlusion / patching treatment to improve the sight in the weaker or 'lazy eye'.

A 'lazy eye' is a lay term for an eye that is healthy but has poor vision. This may be due to a squint, refractive error (a need for glasses) or anything else that causes blurring of vision early in life. The proper term for 'lazy eye' is amblyopia.

Patching (occlusion) is carried out to force the lazy eye to be used. If it is done at a young enough age, even surprisingly poor vision may be improved to a high level.

However, if patching is started later or not worn as instructed, only a small amount or no improvement may be achieved. After seven / eight years of age there is little possibility of any improvement at all.

Patching is continued as long as there is an improvement in vision. A maintenance regime of patching may be indicated when there is a possibility that the vision may slip back.

Patching can be stressful for both the parent and the child. If your child is uncomfortable wearing a patch your job as a parent becomes all the more difficult.

If your child is old enough it is important to explain to them that they are having a patch to encourage the lazy eye to work - it is hard because they are using the eye with the poor vision.

Try to patch whilst the child is occupied, drawing, colouring, reading or watching television are all useful activities. Nursery or school is the ideal place and often achieves the best results quickly.

A child should be made to feel special and important because they are wearing a patch. If possible it is sometimes helpful to ask friends or relatives to assist you.

Normally, the patch is placed on the child's face with any glasses worn on top. Most patches do not cause any allergic reaction but if the skin becomes irritated, sooth the area of skin under the patch with a hypoallergenic moisturising cream or ointment.

We offer two types of patch, and some children get on better with a certain type so let us know if you have any problems.

When your child is having patching treatment, it is important to keep all your appointments, even if treatment has not been as successful as planned. On regular visits we can check for improvement and help with any problems you may have encountered.

Please feel free to contact us if you have any queries or problems regarding treatment.

What to expect on your first visit

Children's orthoptic appointments

Your child will normally be seen by both the orthoptist and the ophthalmologist (eye doctor) or optician on their first visit.

The orthoptist will take a case history prior to examining your child's eyes and assessing their vision. The appointment with the orthoptist takes about 20 minutes.

Your child may then require eye drops to dilate (enlarge) their pupils. This aids the ophthalmologist/optician to check the health of the eyes and assess any need for glasses (refraction).

The eye drops (cyclopentolate) usually take about 30 minutes to work. Your child's near vision will become blurry for several hours and they will become sensitive to sunlight. It is therefore advisable to bring sunglasses/sunhat.

The effects of the drops wear off within 24 hours. Please note parental consent is required for eye drops.

Your child will then be examined by the ophthalmologist/optician who will provide you with a diagnosis and treatment/management plan, if required.

Please allow up to two hours for your child's first appointment. The second appointment (orthoptist only) is usually quicker and will take only 20 - 30 minutes.

Adult orthoptic appointments

You will be seen by an orthoptist and ophthalmologist. Please note these appointments may be on different days.

You may require drops to dilate your pupils prior to seeing the ophthalmologist. These drops may blur your vision for several hours so please do not drive to your appointment.

If you are only seeing the orthoptist or are only attending for a visual fields test you will not require drops.

Please allow 40 minutes for an orthoptic appointment.

If you have a copy of your current glasses prescription, please bring this to your appointment.

Atropine occlusion in children

What are the effects of atropine?

Atropine has two effects when instilled in the eyes:

  • dilates the pupil (makes the black part of the eye larger);
  • stops the eye from focusing properly - blurring the child's vision temporarily.

Atropine will cause blurred vision that may last up to seven days or more after using it. The pupil may remain dilated for up to 14 days before returning to normal size.

As the pupil is dilated, your child may be uncomfortable in bright sunlight, so a hat or sunglasses can be used. If your child has a squint, you may notice that the normally 'straight' eye is now turning. This indicates that the 'lazy' eye is being used.

Very occasionally some children may be allergic to the atropine. If the eyes become red, painful, the child appears flushed with a raised temperature, or a skin rash appears discontinue the use of the atropine immediately and inform the Orthoptic department on 020 8296 3802 or, if out of hours, your GP.

If your child should need to attend a GP appointment, any hospital appointment or an A&E department, always explain that you are using atropine eye drops in one eye.

Useful links

www.squintclinic.com (opens in a new window)

www.RCOphth.co.uk (opens in a new window)

www.nystagmus.co.uk (opens in a new window)

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