The eye school - what is it?

What is the eye school?

The term "eye school" is understood to be institutions at university eye clinics, hospital departments and ophthalmological practices where orthoptists treat defective ocular movements (squint with and without double vision, nystagmus) in cooperation with ophthalmologists and examine and treat diminished visual acuity and all related syndromes.

Today, the name eye school only applies with restriction, because due to early diagnosis and new therapeutic methods the complicated treatment at school, which used to dominate the activities of the orthoptist, can be avoided in many cases. Several university eye clinics have specific departments for squint treatment (strabismology and neurophthalmology) and research.

What are orthoptists?

The qualification orthoptist belongs to the group of assistant medical professions. The word is of Greek origin and is composed of: ortho(s) = straight and opsis = see. Thus, the orthoptist works on "straight seeing"; it is the aim of this activity. The responsibility of an orthoptist is to assist in the prevention, recognition (diagnosis) and treatment (therapy) of squint diseases, diminished visual acuity (amblyopia) and nystagmus and their consequences.

Different examinations and therapeutic possibilities are available to the orthoptist for the different forms of the squint disease (orthoptics and pleoptics).

Children as well as juveniles and adults suffering from squint have to attend the eye school. The orthoptist´s job is to adjust the examination and the treatment to the requirements of the patient.
Further responsibilities of the orthoptist are the examination and rehabilitation of children and adults with impaired vision.

Orthoptists work at eye schools. They examine and treat squint diseases and their consequences in children and adults.

Causes of squint

nfantile squint may occur with an existing predisposition in the family, due to risk factors during pregnancy and birth, with an existing general physical weakness, e.g. due to infectious diseases, or due to the absence of needed spectacles. Squint may also originate from organic ocular changes, such as lens opacification or injuries.

Infantile squint may already become obvious shortly after birth but may also occur only within the course of the first years of life. The normal cooperation of both eyes develops in the first months of life, however, it remains rather sensitive against disturbancies until the 6th year of life. Sudden squint in adults, often accompanied by double vision, may be causes, for example, by paralysis of the tarsal muscle or my be the manifestation of a preexisting latent squint.

In addition, the number of patients with impairments in binocular vision independent of stress considerably increases, which is a result of the increasingly growing demands to our vision (e.g. at school or when working at a monitor). These impairments manifest in headache, paralexia, quick fatigue of the eyes, etc.

Alarm signs:

  • squint
  • missing when trying to grab
  • frequent tripping or bumping
    into closing of one eye
  • frequent blinking
  • reluctance at reading
  • paralexia
  • nystagmus
  • tilted position of the head
  • reported double vision, headache, smarting eyes, blurred vision

Causes of squint:


inherited    -     refractive error     -     external factors

Results of infantile squint:

Squint is not only a blemish, it is also an impairment of vision: If infantile squint is not diagnosed early enough and treated, in addition to the cosmetic damage other impairments originate:


Formation of a diminished visual acuity. The efficiency of vision in the squinting eye does not develop properly due to missing use.
Impairment of binocular vision. The development of the binocular vision is disturbed by the squint position in such a way that no normal binocular vision may be acquired.

The danger that a visual deficiency is not or too late diagnosed is minor in children with obvious squint angles. Unfortunately, the almost invisible and not obvious squint deviations with diminished visual acuity of one eye are more frequent and are mostly diagnosed too late. However, also in late diagnosed diminished visual acuities a therapeutic attempt should be made to create a "reserve eye".

The binocular vision can be improved by prescription of spectacles and possibly by a squint operation. A missing or unappropriate treatment of squint and diminished visual acuity will limit the future choice of profession. For example, defined visual criteria must be met to become a policeman, a metalworker, a taxi driver or a truck driver.

The earlier the squint and the diminished visual acuity are treated, the more successfully permanent damage can be avoided.

Results:

  • diminished visual acuity
  • limitation of the choice of profession

Examination and treatment of squint:

Usually, the eye is examined by an ophthalmologist prior to the attendance of an eye school, and in the case of an existing refractive error the necessary spectacles are prescribed; they must be worn permanently.

The orthoptist will determine the squint angle and the binocular cooperation. A series of examinations and therapeutic possibilities are available for the numerous forms of squint. For example, to remove the diminished visual acuity predominantly the occlusive therapy, i.e. covering of the eye with the better vision to activate the weak eye, is used.

If the diminished visual acuity has been removed, an attempt to improve the binocular vision can be made with a squint operation, unless the squint angle could be diminished sufficiently with the help of the spectacles.

The orthoptist will only carry out the preexaminations and treatments required for the squint operation. Also after surgery, regular control examinations, partially also treatments, are necessary, since a relapse into the squint angle and into the diminished visual acuity are possible.

Target:

  • early diagnosis of squint and diminished visual acuity
  • treatment and removal of the diminished visual acuity
  • cooperation of both eyes
  • elimination of the squint position