Orthoptics treatment for children

Orthoptists assess children of all ages, from young babies to school-aged children. They usually assess the vision with letter or picture tests but can use other methods if this is not possible. They also assess the position of the eyes and how well they work and move together as a pair.

Your Orthoptist will be able to provide you with useful information about your child’s visual ability, such as whether or not they have a squint (turn in the eye) or amblyopia (a lazy eye). They will also be able to refer your child for a paediatric glasses test or eye doctor appointment if necessary.

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Vision screening

The UK national screening committee recommends that Vision Screening should be offered to all children aged 4-5 years. We have an Orthoptic led service with a dedicated vision screener.

Vision screening takes place at Torbay area schools, Newton Abbot Hospital, Paignton Health and Wellbeing Centre, and Castle Circus Health Centre.

We screen approximately 3000 children a year, and 7-8% of this group are found to have reduced vision.

If your child has missed their screening appointment you can be referred by your GP, health visitor or school nurse.

Reading difficulties

The Orthoptic department offer a service which aims to establish whether any visual perception or ocular defects may be contributing to a child’s difficulty with literacy skills.

This involves a full Orthoptic Assessment and may involve an assessment for coloured overlays which have been well documented in the treatment of literacy difficulties.

Approximately 5% of the population are severely affected by Visual Stress and 20% to a lesser degree.

Paediatric Low Vision Clinic

The Paediatric Low Vision Clinic is a service offered to children from birth to school leaving age with visual impairment. The aim of the clinic is to explore the level of vision your child has, how this may impact them day to day and to offer practical solutions where possible. This may include magnifiers, lighting adaptations and technology.

It is usually your Ophthalmologist or Visual Impairment Advisory Teacher (TVI) who arranges a referral to the clinic. Referral occurs at a point when they feel your child would benefit from extra help with activities at home, school, hobbies or outdoors.

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Joint Optometry appointments

If a glasses test is advised for your child, a special appointment will be made for this. An Orthoptist will perform a full Orthoptic assessment, involving a vision test and assessment of binocular vision.

Following this, the Orthoptist will need to put in dilating eye drops into both eyes. These drops are important as they allow us to examine the health at the back of your child’s eyes, and also to help us assess if there is any refractive error (need for glasses).

You will then be asked to return to the waiting room where the dilating drops take about 20-30 minutes to work.

An Optometrist will then perform a glasses test by holding lenses in front of the eyes and shining a light through each lens. At this point, they will be able to prescribe glasses if necessary.

You will be given an NHS voucher to take to an Optician of your choice. Every child is entitled to one glasses voucher per year. The hospital is not able to provide a voucher for a spare pair of glasses or sunglasses unless there are exceptional circumstances at the discretion of the hospital optometrist. You may buy extra pairs at private cost.

Your child will then be monitored in their glasses in the Orthoptic department. Most children have a repeat glasses test once every 12 months.

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Amblyopia treatment

Occlusion, by patching or eye drops, is one of the main treatments prescribed by Orthoptists. If your child has been found to have an amblyopic eye (a lazy eye), then we will start treatment to try and strengthen the vision in the weaker eye.

Patching treatment

This is done by putting an eye patch over the ‘good eye’ to try and stimulate the vision in the weaker eye.

Patching is only a treatment for vision and will not make the eyes look straighter if your child has a squint.

The amount of patching prescribed varies from child to child. Your Orthoptist will advise you of an appropriate treatment regime and work with you to aim to get the vision in a lazy eye to the best it can be.

Patching can be a struggle, as by making a child use their lazy eye, they are not able to see as well as they have been used to with both eyes open. It is really important to persevere with treatment as early childhood is the most critical period of visual development. Research suggests that after the age of 7-8, the potential to improve vision in a lazy eye decreases dramatically

Your Orthoptist can give you tips to make patching go more smoothly, and we often find that nursery/ school are very supportive if you decide you want to patch at school.

Atropine treatment

Drops are put into the eye with the better vision to temporarily stop it from focusing; this encourages the use of the ‘lazy eye’ therefore improving the vision. The effects of blurred vision can last for one week after last instillation, and the pupil can stay dilated for up to two weeks. 1 drop is inserted into the non-amblyopic eye, on Saturday and Sunday mornings (Your Orthoptist will advise you if this should be any different).

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