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Purpose: In the context of globalization, it is relevant for orthoptists to be aware of the profession practice conditions around the world. The aim of this study is to analyse the Orthoptist’s professional field across the different countries compared to France. The International Orthoptics Association cooperates in expanding orthoptics’ activities worldwide and is a benchmark where orthoptics is practiced.Methods: A study has been conducted within twelve IOA’s members (outside Europe). The associations and French orthoptists were contacted between the 2nd of November 2016 and the 15th of March 2017 to submit an online questionnaire. The survey dealt with demographic and socio-economic generalities on the orthoptics’ profession, as well as academic training, skills and opportunities offered by the orthoptist diploma (depending on the country of graduation), such as working in another country.Results: Out of the twelve countries studied, results were obtained for eleven of them. Orthoptics’ population density was diverse. With 1 orthoptist for every 215 000 inhabitants the median density showed a lower density than in France. The results confirmed that orthoptists around the world worked mainly in public hospitals. Orthoptics’ schools existed in six countries and the academic training was similar. The skills and rehabilitation methods were alike, however the visual field and the OCT were the only examination techniques for the functional exploration that were carried out by an orthoptist in all the country apart from Israel. Finally, migration policy was subjected to governmental regulation and diploma recognition for each country.Conclusion: On the one hand, this study has shown that IOA’s countries share a common basis in the training and certain skills, but on the other hand, that many differences between them still existed, especially with the French profession practice conditions.; Introduction : Dans un contexte de mondialisation des métiers, notamment ceux de la santé, il est pertinent pour des orthoptistes de connaître les modalités d’exercice du métier dans les pays du monde. Le but de l’étude est de comparer le métier d’orthoptie dans le monde par rapport à la France. L’association internationale d’orthoptie, l’IOA, est une organisation active dans le développement de l’orthoptie dans le monde et qui référence des pays dans lesquels le métier d’orthoptiste est pratiqué.Matériel et Méthodes : Une étude a été menée auprès des 12 pays membres de l’IOA hors Europe. Les associations ainsi que des orthoptistes françaises ont été contactées entre le 2 novembre 2016 et le 15 mars 2017 pour répondre à un questionnaire en ligne. Le questionnaire portait sur les généralités socioéconomique et démographique du métier d’orthoptie, la formation des orthoptistes, les compétences attribuées aux orthoptistes, ainsi que sur la migration des orthoptistes dans le monde et la possibilité d’exercice et d’équivalence.Résultats/Discussion : Des informations ont été obtenues pour onze pays sur les douze étudiés. La densité de la population orthoptique était très hétérogène, avec une médiane de 1 pour 215 000 habitants, inférieure à celle de la France. Les lieux d’activité étaient concentrés sur les établissements publics. Même si la formation n’était pas possible dans tous les pays de l’IOA, les formations dispensées étaient très similaires. Les compétences orthoptiques et les méthodes de rééducation utilisées étaient semblables entre les pays de l’IOA et la France. Dans la liste des examens complémentaires, seuls l’OCT et le champ visuel étaient pratiqués dans tous les pays de l’IOA, sauf en Israël. Enfin, la politique de migration était soumise aux différentes réglementations de reconnaissance et d’équivalence de chaque pays.Conclusion : En conclusion, cette étude a démontré que dans les pays de l’IOA, l’exercice de l’orthoptie possède une base commune, tant dans l’enseignement que dans certaines compétences, mais qu’il existe aussi de nombreuses différences entre eux, et surtout avec la France.

We try to show a relationship between strabismus and changes in reading skills.We have carried out a prospective study including 135 children from 8 to 11 years (French level CE2 to CM2). They were given an ophthalmologic and orthoptic examination and then divided into 4 groups: strabismus with vertical deviation without binocular vision, accommodative strabismus with binocular vision, accommodative strabismus without binocular vision and control group (children without strabismus). Each child took 4 validated reading tests: reading fluency, uncommon words reading, comparison of letters sequences without signification, searching "verbal index".Results are significantly lower in children with accommodative strabismus without binocular vision for two tests (reading fluency and uncommon words reading). In contrast, results for the two other tests do not differ significantly between the 4 groups.Our study demonstrated lowered reading skills in tests of reading fluency in children with accommodative strabismus without binocular vision.

To compare standard orthoptic tests with a novel digital 3D orthoptic platform, 3DeltaEasy(©) from Orthoptica(®).This study tests the 3D digital orthoptics platform, 3DeltaEasy(©) from Orthoptica(®) and compares it to the corresponding standard orthoptic tests. This platform consists of a computer equipped with dedicated software, a video projector and 3D liquid crystal glasses. Three tests were compared: Wirt test, measurement of horizontal and vertical phorias, and the horizontal fusional amplitude in convergence and divergence. A total of 102 subjects, 53 males (52 %) and 49 females (48 %), aged between 9 years and 72 years (mean age 33±16.4 years) were examined at the ophthalmologic department of the Brest Hospital (France) and included in this observational cross-sectional study. Subjects recruited in this study were patients requiring orthoptic screening or therapy. Patients without their optimal visual corrections were excluded. All patients underwent both ophthalmological and orthoptic examination including Wirt fly stereotest with polarizing spectacles, cover tests to evaluate and measure the horizontal and vertical deviation of the lines of sight, horizontal vergence ranges using prism bar and their equivalent tests implemented in the digital 3D orthoptic tests 3DeltaEasy(©) from Orthoptica(®).All data were processed using MedCalc Statistical Software version 14.12.0 (MedCalc Software bvba, Ostend, Belgium). The main result of this study is that 3DeltaEasy(©) and the classical Wirt test are correlated (Spearman's coefficient of rank correlation: ρ=0.74; P0.0001), cover tests are equivalent for intermediate and far vision (paired t-test; P=0.46 and P=0.51), and horizontal and vertical vergence range are comparable for distance vision (paired t-test; P=0.34 and P=0.94).New digital 3D tools could easily substitute for some orthoptic tests with better ergonomics. Eventually, by increasing the number of tests performed, it could substitute for nearly all tests.

We evaluated the indication of orthoptic evaluation for the management of orbital floor fractures in a prospective series.Forty-seven patients presenting with an orbital floor fracture were included in our prospective study. Consultations in orthoptics and maxillo-facial surgery were regularly carried out. Diplopia and motility were systematically assessed as well as a coordimetric examination according to Hess-Lees's technique.Nineteen percent of coordimetric motility disorders were observed among asymptomatic patients, after trauma. No diplopia or clinical motility disorder were observed 1 and 2 months after trauma, and coordimetric examinations came back to normal 2 and 3 months after trauma respectively for non-operated (26) and operated (21) patients.An orthoptic evaluation is necessary for the management of orbital floor fractures to diagnose the type of diplopia, motility disorders, and to indicate a coordimetric examination if diplopia is present. We suggest this orthoptic evaluation for patients presenting with diplopia between 5 and 10 days following trauma, 1 month after trauma for non-surgical treatment and 2 months after trauma for surgical treatment.

The fragility and plasticity of visual function in children necessitates early detection and treatment of visual disorders. New approaches such as portable automatic refraction, tonometry and digital fundus examination have improved the quality of screening The problem now is a lack of ophthalmologists. One possible solution is to redefine the role of orthoptists. The waiting time for an ophthalmologist appointment is very long in some parts of France (up to a year), because of a training quota established in the 1980s, as well as retirements (average age 52 years), and a concentration of specialists in the south of France and around medical schools. Today, France trains only 80 specialists per year, whereas twice as many are needed Anglo-Saxon countries (US, Canada, United Kingdom) have created a profession--the optometrist--that is intermediate between the optician and the ophthalmologist. This profession is not recognized in France, yet optometrists are capable of detecting many anomalies and quickly referring a child to a specialist.

Inserm French collective expert's report describes sensory disorders screening. However, the causality link with learning disorders remains questionable. In auditory disorders, there are high-level proof recommendations: early and intensive treatment improves language development, at least partially. For visual disorders, consensus conferences recognize their high frequency in learning disorders but there is no proof of a direct causality link. Currently, in learning disorders, orthoptic treatment is not recommended as a specific therapy. In France, despite medical ignorance about orthoptic assessment, absence of reference values and lack of therapy benefits evaluation, orthoptic treatment is usually prescribed, without any objective criteria. This article makes a literature review concerning the link between learning and sensory disorders. It also describes a typical orthoptic assessment with vision and optic musculature evaluation, and reports its results in a prospective comparative study in three populations (controls, dyslexic and Developmental Coordination Disorders [DCD] children). Strabismus or binocular vision disorders are frequent in DCD. Combined ocular motor function is almost constantly disturbed in DCD (90 %), whereas 34 % of dyslexic children and only 13 % of controls are concerned. Visual disorders are therefore present in learning disorders but also in normal population. Orthoptic assessment results must be interpreted in a multidisciplinary evaluation context.

Orthoptic and ophthalmologic consultation is an essential step in the diagnosis and treatment of learning disorders, particularly in children with dyspraxia. Such a specialized consultation allows identification of cognitive visual disorders, especially oculomotor or visual-spatial impairment, which disrupt the cognitive processes involved in key academic tasks such as reading or handwriting. It is therefore essential to screen and manage these disorders early in order to implement a rehabilitation plan and counsel educators so as to facilitate learning. After describing cognitive visual disorders in the context of dyspraxia, we discuss principal signs, assessment and ophthalmologic and orthoptic management as conducted in our practice. Several clinical cases illustrate our approach.

Non-contact biometers have many advantages including the delegation of tasks to orthoptists. This study analyses the reliability of measurements comparing contact and non-contacts techniques.Comparative measurements were taken on 86 eyes of 45 patients (mean age: 74 years; 44.4 % males) in preoperative phacoemulsification by three orthoptists with experience in this task. Each patient had non-contact measurements (Lenstar LS 900, Haag-Streit) and contact measurements (corneal biometry and ultrasound pachymetry with OcuScan RXP, Alcon) and a keratometry refractometer (TONOREF II, Nidek). The axial length data, pachymetry, power of the intraocular lens (SRK/T formula), anterior chamber depth, and the average keratometry were analyzed by paired comparisons.The non-contact biometer was ineffective in 5.8 % of cases (Parkinson's disease, two cases; dense posterior subcapsular cataracts, three cases). The non-contact pachymetry was statistically significantly higher (546.4 μm vs. 538.6 μm; p0.001). The axial length was significantly longer for the non-contact measurement (23.21 mm vs. 23.05 mm; p0.0001). In 25.9 % of patients, this difference was greater than or equal to 0.3mm and affected the power of the implant chosen. The anterior chamber depth measured on non-contact biometry was statistically greater (3.33 mm vs. 3.03 mm; p0.0001). However, there was no significant difference regarding the average keratometry (43.82 D vs. 43.78 D; p=0327).Besides the infectious benefit for patients, absence of cleaning and decontamination of biometric probes, non-contact measurements using Lenstar are an example of a safe activity that can be delegated to assistants. This technique has been used to optimize the refractive outcome of 25.9 % of our patients undergoing refractive cataract surgery.

Strabismus is characterized by a manifest deviation of the visual axes and secondary sensory deteriorations. Strabismus is a frequent affection which primarily involved the child, during early life. It is a frequent and severe disease (3 to 4% of the French population), if untreated the prognosis is severe with the functional loss of deviated eye. The clinical picture, and the prognosis depend considerably on the age of onset. Strabismus is always linked to amblyopia, explaining the need for a rigorous examination and adapted treatment the earliest possible: a collaboration between paediatrician, general practitioner, ophthalmologist and orthoptist is essential.

To evaluate the status of low-vision rehabilitation carried out by the orthoptists in the North of France. This study was a preliminary step in setting up a network between different vision professionals for the management of age-related macular degeneration (AMD) the North of France.The ASO (Association Septentrionale d'Ophtalmologie) conducted a survey funded by the URCAM (Union Régionale des Caisses d'Assurance Maladie) with the FAQSV (fond d'aide à la qualité des soins de ville). The survey was based on the analysis of two forms sent to orthoptists of the North region of France.The survey analyzed 46 responses (a representative sample with 69% responses) providing a description of the orthoptists of the North of France: 19% males, 81% females whose mean professional experience was 13.3 years. Thirty-four percent of the orthoptists have had training in low-vision rehabilitation. This training was given during the university courses for 21% of responders and during a postgraduate course for 79%. Of the orthoptists surveyed, 64% worked in a private context, 9% in a public context, and 27% in both public and private contexts. Their main activity was in their own private practice for 60%, in an ophthalmologist's office for 20%, in a public institution for 16%, and a private institution for 4%. The mean number of patients treated was 70 per week per orthoptist, with 21% working mostly with children, 36% working mainly with adults between 16 and 60 years of age, and 7% with the elderly, whereas 36% reported no specificity related to patient age. The mean number of patients dealt with for low vision related to AMD was 4.1 per month per orthoptist. The average number of patients dealt with for low vision with no relation to AMD was 1.5 per month. The prescriber of low-vision rehabilitation was an ophthalmologist for 88.9% of the orthoptists and a general practitioner for 11.1%. Questions addressed to AMD patients: at the beginning of the survey, 83.8% of the patients did not have sufficient visual acuity to be able to read a text of current size (Parinaud 4); 40.4% of the patients required help for everyday life, and 59.6% were autonomous. For 7.1% of the patients, low-vision rehabilitation was carried out less than 1 month after the stabilization of retinal lesions, but in 35.3%, rehabilitation was carried out more than 2 years after lesions were stabilized. The main request of the patients involved improvement of near vision (89.9%).This survey will be a preliminary step in setting up a regional health network coordinating the ophthalmological and orthoptic management of AMD.

The aim of this work is to report our rehabilitation scheme and outcome in patients with acquired oculomotor palsy.We cared for 10 patients with oculomotor palsy between January 1996 and March 1998 at the Casablanca University Hospital. Our orthoptic rehabilitation scheme was based on reinforcing the patient's sensorial potential using a prism dioper and motor capacities by soliciting vergency and version movements.The 10 patients (7 males, 3 females, mean age 39.5 years) had unilateral IV palsy (n =3), bilateral IV palsy (n= 1), unilateral VI palsy (n= 2), bilateral VI palsy (n= 1), partial unilateral III palsy (n= 1) and dissociated bilateral III palsy (n= 2). Mean delay to initiation of rehabilitation was 49 days and mean duration for treatment was 3 months. We achieved total recovery in 50% of the cases and partial recovery in 40%. Intermittent diplopia persisted in 10 per thousand of the cases. These results differ slightly from those in the literature where total regression is reported in about 50% of the patients after therapeutic abstention.This small series is insufficient to validate our method. The results obtained do however show that rehabilitation is safe and should be applied more widely in patients with oculomotor palsy.

The aim of the study is to evaluate the results obtained in treatment of Intermittent Exotropia with the therapeutic programme applied at the Orthoptic Centre of Sassari Oculist Clinic. 250 patients were considered; 176 completed treatment. The patients were divided into four groups according to the kind of treatment adopted: orthoptic exercises, surgery (double recession of lateral rectus), exercises and surgery, no therapy. Results were evaluated by measuring the acquired state of orthophoria or residual exotropia: less than 10 prismatic diopters (excellent result); residual exotropia between 11 and 20 prismatic diopters (unsatisfactory result); residual exotropia20. The highest percentage of excellent results was found in those patients who underwent surgery but only among those who completed the therapy with cycles of orthoptic exercises. Conversely, the worst results were evident in patients who followed no therapeutic programme.

Antisuppressive occlusion is an intermittent occlusion prescribed in order to eliminate suppression. This way, the system of vergences is reactivated which results in a stabilisation of the position of the eyes and reduces asthenopic complaints. Miotics are used to treat a recent or intermittent convergent squint. Miotics can equally be used to remove positive glasses and to reduce a visible postoperative recurrence.

Studies have shown recently that the occurrence of a pure accommodative strabismus has to be treated immediately with a full optical correction to preserve the stereoscopy. The use of little prisms can be very useful to complete the medical treatment. The dysfunction of the oblique muscles is not frequent and often without clinical signification. The interest of a surgical overcorrection, specially if it is cyclo-horizontal, to suppress the spectacle is not proven.

The Gracis biprism appears to be the best actual method of testing eye fixation as early as 6 months. It is the appropriate test for microstrabismus screening. The treatment of the late onset microstrabismus is more simple than the treatment of the early onset microstrabismus, where the dominance of fixation is stronger. If the calibrated filters are sufficient in the first case, the optical penalisation (+ 2 D to + 3 D) on the dominant eye is the best long-term treatment in primary microstrabismus. Based on the specific aspects of the early onset strabismus, such as bi-ocularity and latent nystagmus, optical penalization without atropine offers an alternative long-term method to occlusion without any trouble of visual development of the fixating eye.

In addition to aniseikonia, binocular factors are to be taken into consideration for refractive surgery. If important exophoria can be a contraindication to refractive surgery, this surgery can be indicated in cases of marked esophoria at near and distance vision. It can then prevent the need for prismatic treatments which become necessary in these cases.

The postural displacements on a statokinesimetric plateform of squint-eyed children during short monocular lighted stimulations show that their postural regulation is different from that of normal children of the same age. The provoked amplification of the displacements is larger, their direction is no more systematized but once adopted it remain stable. The orthoptic treatment associated with prismus lenses and postural reeducation often allows to double their postural performances.

Oculomotor visual input of the postural system can be modified with a small powerful prism from 1 to 4 dioptries. The determination of features acting on postural tonus through visual and oculomotor input is difficult. It is necessary to examine postural and oculomotor consequences of each optical correction.

Results obtained in 142 cases out of a total of 1.460 patients with non-accommodative strabismus treated and follow-up for 15 years are analyzed. Basic treatment was sensorial, started at a very early stage, supplemented by surgical correction of the mechanical defect. Complete recovery was obtained in 76 p.cent of cases, good vision with a very small angle (2-4 dpt.) microtropia in 17 p.cent, and a residual angle of 8-15 dpt. ni 7 p.cent. Similar results were obtained in small angle and congenital strabismus cases: following orthoptic therapy alone in 25.7 p. cent of patients, and after a single operation in 69.2 p.cent. No case of secondary divergence occurred and results remained stable during the 15 year period due to the fusion lock. It is the only treatment of surgical undercorrections and of the rare recurrences, and probably a causal treatment of spasms. Results suggest that sensorial physiological treatment should be basic treatment; A.R.C. should become as obsolete as excentric fixation amblyopia; this treatment emphasizes the crucial role of the orthoptist who really cures the strabismus. It is the "historical transition" of Jampolsky.

In a group of patients suffering from amblyopia, the authors confront the results after orthoptic treatment with data provided by functional and electrophysiological examination. In 37 patients the clinical diagnosis of functional amblyopia had been made, but in 8 of these cases complimentary functional and electrophysiological examinations showed organic perturbations. This explains the failure, in these cases, of the orthoptic treatment. In the remaining 29 patients, clinical forms of functional amblyopia were found. In this group, the authors studied 20 cases showing no improvement with treatment: in 15 out of the 20 the VERs were pathological. In the 9 remaining cases which have showed improvement the VER'S were never abnormal. VER study can be undertaken, without general anaesthesia, as from 3 to 4 years of age. The authors conclude that all clinical forms of amblyopia should undergo VER investigation: patients showing pathological changes should be excluded from orthoptic treatment, from which they have no possibility of deriving benefit.

Sector occlusion, already described in 1953, has been used regularly since Berrondo's first publication on the subject in 1967 by a great number of ophthalmologists and orthoptists for convergent concomitant and sometimes divergent strabismus treatment. Sectors limit the field of fixation of each eye, in order to modify the optomotor reflex to restore and maintain the sensory and motor alternation. The mostly used sector designs are the symmetrical or asymmetrical binasal ones. The way of action of middle, narrow or broad, straight or oblique, or eventually "V" shaped binasal sectors can easily be analysed; their application does'nt present any particular difficulties; their reproduction is easy. Such is not the case of the so called "buridanization", location/observation and other numerous sophisticated shapes suggested by Berrondo. Sector-occlusion indications, advantages and disadvantages, limits and counter-indications are related in details. There is no doubt that binasal sectors represent a major acquisition for concomitant strabismus visual reeducation; they are irreplaceable in the treatment of congenital strabismus.