The Complete Guide for Parents to Orthoptics for Children

Who it's for, when to get checked and what's important to know

Early detection and the right treatment allow children to see well and enjoy every moment 

What Is Orthoptics?

Orthoptics is the field that examines and treats the way both eyes work together: eye movements, the coordination between them and the brain's ability to combine the two images into one. This is different from a regular visual acuity test, which only checks how well each eye sees. The orthoptist is a certified professional who works in collaboration with an ophthalmologist. They diagnose strabismus, lazy eye and coordination difficulties, and build a treatment plan such as patching or exercises. A child can see 6/6 in an eye exam and still struggle because of a coordination problem, which is why this exam has its own value.

Who Is It For?

An orthoptic exam is suitable for any child with a suspected problem in how the eyes work together, from infancy to adolescence. Usually children come with a referral from an ophthalmologist or pediatrician.

• Children with strabismus – constant, or one that appears only sometimes, for example when tired.
• Children with lazy eye or suspected lazy eye – after an eye exam that found a difference between the eyes.
• Children with a large difference in glasses prescription between one eye and the other.
• Children who complain while reading – headaches, eye fatigue, double vision or letters that "move".
• Premature babies and children with a medical background – for example genetic syndromes, cerebral palsy or developmental delay.
• Children with a family history of strabismus or lazy eye.
• Children after a concussion who have difficulty focusing and reading.

Vision Problems That Require an Orthoptic Exam

Most of these problems are treated successfully when detected early, so it is important to know them.

 Good to know:Lazy eye is "silent" in most cases. The child doesn't complain because they don't know it's possible to see differently, which is why periodic screening exams are the main way to detect it.

When Should a Child Be Examined?

Every child needs a first eye exam in preschool, even without any complaint, and an orthoptic exam at any stage where there is a suspicious sign. The best treatment window for lazy eye is at young ages, up to about age 7–8, although older children can also benefit from treatment.

 Signs that justify an exam at any age: 

• An eye that turns in or out, even if only sometimes.
• Closing or covering one eye, especially in bright light.
• A constant head tilt when looking at something.
• Headaches, eye rubbing or fatigue after reading and screens.
• Double vision, skipping lines or losing their place when reading.
• Holding objects very close to the face, or unexplained clumsiness.
• A white reflection in the pupil in a flash photo – requires seeing an ophthalmologist without delay.

What Does the Exam Look Like?

The orthoptic exam is painless, non-invasive and usually takes about half an hour to an hour. It is built like a game, so even toddlers cooperate.

• Conversation with the parents – what you've noticed, medical and family history.
• Visual acuity test – with pictures, shapes or letters, according to age.
• Cover test – the examiner covers one eye at a time and checks whether the other eye moves.
• Eye movements – the child follows a toy or light in all directions.
• 3D vision and coordination – with special glasses and pictures.
• Convergence – how close the child can keep their gaze on an object approaching the nose.

Sometimes the exam is combined with pupil-dilating drops at the ophthalmologist, to measure an accurate glasses prescription. The drops may blur vision and cause sensitivity to light for a few hours. How to prepare your child: 

• Explain simply that it's an exam of "games with the eyes" and that it doesn't hurt.
• Book an appointment at a time when the child is awake and not hungry.
• Bring existing glasses, summaries of previous exams and a referral letter.
• If drops are expected, bring sunglasses and don't plan reading or homework afterward.

Common Treatments

Treatment is determined by the diagnosis, age and severity, and sometimes several treatments are combined. Persistence at home is the most important factor for success.