1. What is the difference between an Ophthalmologist, an Orthoptist, an Optometrist and an Optician?

An ophthalmologist is a medical doctor who has taken further advanced education to specialize specifically in the medical and surgical treatment of eye diseases and disorders. Some ophthalmologists sub-specialize in specific aspects of ophthalmic care, such as pediatric ophthalmology and strabismus. In some cases, but not all, an exam with an ophthalmologist may result in a prescription for corrective lenses. Ophthalmologists are normally accessed only by referral from a medical doctor or optometrist, and usually only in instances in which there is a specific medical concern related to the eyes.

An orthoptist is health professional trained in the diagnosis and management of strabismus (crossed eyes), amblyopia (lazy eye), diplopia (double vision) and other abnormalities of binocular vision (using the 2 eyes together).These include conditions relating to eye movements, eye coordination and vision. Orthoptists work closely with ophthalmologists, generally in hospital clinics or private practices.

An optometrist is a licensed health professional trained to detect and correct focusing errors, to screen for eye disorders and to prescribe treatment for specific eye conditions. Optometrists generally work in independent practice and no referral is required.

An optician is a professional who fits and adjusts optical aids such as eye glasses, contact lenses and/or low vision devices from prescriptions supplied by an ophthalmologist or optometrist.

2. What training and qualifications do Orthoptists have?

Orthoptists are trained at recognized centres in Canada. Each training centre has individual admission requirements; however, a Bachelor’s degree is a prerequisite at all centres. Orthoptic students train through classroom theory and clinical practice. Once the 24 month training period is completed, orthoptists must pass a national certification exam consisting of written, oral and practical sections.

Visit the "Becoming An Orthoptist" page for information about Canadian orthoptic training centres. All orthoptic training centres in Canada are accredited by the Accreditation Canada.

3. What do Orthoptists do?

Orthoptists evaluate and treat pediatric (infants and children) and adult patients with visual disorders, emphasizing binocular vision and eye movements. These visual disorders include patients with diplopia (double vision), amblyopia (lazy eye), strabismus (crossed eyes), low vision, and visual field defects. The majority of patients are children because of the nature of many binocular disorders. Orthoptists are uniquely skilled in diagnostic techniques, clinical interpretation, and therapeutic modalities.

4. What is Amblyopia?

Amblyopia is decreased vision in one or both eyes. There are many possible causes for amblyopia; however, with appropriate, early treatment (usually patching the good eye) vision can often be improved. It is a common vision disorder in children and is also known as “lazy eye”. Amblyopia is not correctable by surgery although if appropriate, surgery may become part of the overall treatment plan.

5. What is Strabismus?

Strabismus is a condition in which the eyes are not straight. This means one eye is viewing an object while the other eye is wandering in a different direction. It is usually a disorder of the eye muscles responsible for eye movements, but has many different causes. This condition is commonly known as “crossed eyes”.

6. What is Diplopia?

Diplopia is double vision, which is the result of seeing two images of a single object at the same time. The two images can be seen separating horizontally (side by side), vertically (on top of each other), tilted, or a combination of these in relation to each other.

7. How do I get an appointment to see an Orthoptist?

Making an appointment with an orthoptist starts with a visit to an ophthalmologist. In Canada, an orthoptist works with an ophthalmologist. The ophthalmologist performs a full eye examination and, if appropriate, will arrange an orthoptic appointment which may involve follow-up assessment and treatment.

8. What should I expect from an Orthoptic exam?

An orthoptic exam will begin with a medical history, including ocular and visual symptoms. A series of tests may include visual acuity testing, binocular vision assessment, eye alignment testing, eye movement testing, color vision testing and may determine the necessity for glasses (retinoscopy). Following some, or all of these tests, the orthoptist will recommend any necessary treatment, further testing and follow-up. Outcomes are then discussed with the referring ophthalmologist.

9. Why does my child need to wear glasses, or a patch, when s/he can see everything just as well without them?

Glasses may provide more benefits than simply improving vision. In some instances, they may be used to control strabismus. Sometimes only one eye needs glasses and the main objective of wearing glasses is to provide equal vision in both eyes. An eye patch is used to cover the good eye in order that the weaker eye receives an opportunity for proper vision development. The sooner the proper treatment is initiated, whether it is glasses and/or patching, the more successful treatment may be. Amblyopia therapy is most effective during early childhood.

10. What can I do if my child won't wear a patch?

Patching can be difficult for both the child and parents. As the good eye is usually patched, your child will initially see less. Over time vision in the lazy eye should improve and patching will become less demanding.

Here are some tips and strategies to make the process a bit easier:

• Try different brands of patches. Some brands are more irritating to a child’s skin than others. If you can find a brand that is more comfortable for your child to wear, s/he may be more likely to keep it on.
• Buy patches with kid friendly designs or decorate their patches to make it more fun.
Make a rule that your child can only do certain activities if s/he is wearing the patch. For example, the child can only play on the computer, watch TV or play video games, etc if s/he is wearing the patch.
• For babies and young toddlers, one of the best strategies is to distract them by playing with them and keeping their hands busy while patching, so they are less likely to rip the patch off.
• Have your child’s teacher explain why your child is wearing a patch. This will help encourage his/her classmates to be more supportive.
• Set up a calendar and reward system. Put a sticker on the calendar for every day that your child wears the patch. Explain that s/he will be rewarded once a set number of stickers have been accumulated.
• When the weak eye has very poor vision, your child may be very upset while wearing his/her patch. During patching therapy try to play games that involve his/her other senses; hearing, smelling, tasting and touch. If s/he can succeed at activities that involve music, fun sounds, tasty treats, identifying smells, touching hidden fun items in a bag, etc. s/he will feel more confident and happy. This will help to improve his/her desire to wear the eye patch and the weak eye will be getting vision development time.
• Be patient and persistent. Starting a patching routine will be difficult for you and your child but with a little persistence and imagination it will get easier.
• Keep in mind that the goal of patching is to stimulate the development of sight in the weaker eye, and the benefits of this can be permanent, and life-long. Patching is essentially only effective during the childhood years, so this opportunity to make a difference is limited.

If all your attempts to have your child wear a patch fail, discuss the obstacles with your orthoptist or ophthalmologist and they can suggest other approaches and methods to treat amblyopia.