Orthoptist

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An orthoptist (from Greek ορθοπτική orthoptiké , German 'straight vision' ) is a preventive , diagnostic and therapeutic specialist trained in ophthalmology , whose specialty is strabology (the study of strabismus ) and neuroophthalmology, according to a training and examination regulation and with state recognition (Doctrine of the neurologically caused eye diseases). This also includes the specialist areas of the eponymous orthoptics and pleoptics . The comparatively young occupation belongs to the health professions in Germany and is a health profession regulated by federal laws . It found its origin around 1930 in Great Britain by Mary Maddox , daughter of the English ophthalmologist Ernest E. Maddox . From there it made its way to German-speaking countries in the 1950s.

Organization, training and job description

Orthoptic departments can be found in eye and rehabilitation clinics, early intervention centers for the visually impaired, as well as in many ophthalmological practices. They are popularly referred to as visual schools . The professional association Orthoptik Deutschland e. V. (BOD), in Switzerland the Swiss Association of Orthoptists (SVO / ASO) and in Austria the Association of Graduated Orthoptists of Austria (VDOÖ). In Germany, orthoptists are trained at 14 specialist schools for orthoptics , all of which are affiliated with universities . The first German educational institute for orthoptists was founded in 1954 by Curt Cüppers in Gießen. The full-time vocational training lasts three years with a minimum of 4,500 hours, 1,700 of which are theoretical and 2,800 practical. This is completed after appropriate examinations with state recognition. In Austria, as part of the Bologna Process, the transition to training at a university of applied sciences with an academic degree took place. In the winter semester of 2006, the first year started at the Salzburg University of Applied Sciences , which was completed in summer 2009 with the title Bachelor of Science in Health Studies BSc . The University of Applied Sciences in Vienna FH Campus Wien followed in 2010 with the completion of its first course.

In Germany, there are also intensive efforts to academicise the training. For example, the Orthoptist School at Heidelberg University Hospital offers a bachelor's degree in Interprofessional Health Care (B.Sc.) , which includes both a state qualification as an orthoptist and the acquisition of the academic degree Bachelor of Science (B.Sc.).

Main areas of activity

Orthoptists are bound by medical instructions. Nevertheless, her field of activity is characterized by a high degree of personal responsibility with regard to diagnostic and therapeutic services.

Treatment of functional poor eyesight

A main area of ​​activity is the prevention, diagnosis and therapy of poor eyesight, especially in early childhood. Various pleoptic procedures are available for this , which deal with the treatment of functional impaired vision ( amblyopia ). Differentiated options, such as occlusion treatments, penalization and other apparatus-based procedures, are the focus.

Disorders of binocular vision, strabismus, nystagmus

An essential area of ​​responsibility of an orthoptist is the conservative diagnosis and therapy of all forms of sensory and motor disorders of the binocular vision ( binocular vision ), such as congenital or acquired strabismus , eye paralysis and nystagmus , but also ocular-related forced head postures . In particular, the extensive, often apparatus-based diagnostics has a high priority here, as it supports the indication for strabismus and nystagmus operations to a decisive extent . In many cases it also forms an important basis for assessing systemic and neurological diseases ( neuro-ophthalmology ).

Therapeutic measures can be found in - partly apparatus-based - exercise treatments to improve binocular vision, as well as special glasses adjustments - often with the use of prism lenses .

rehabilitation

For some years now, the orthoptist's range of tasks has increasingly expanded to include the areas of rehabilitation for the visually impaired and low-vision training . It is about the care and rehabilitation of patients with acquired visual disorders after brain damage , for example through stroke , tumors , accidents or other neurological diseases. The orthoptic rehabilitation here is trying to reduce visual and cognitive deficits, develop strategies to compensate and train the application of seeing in everyday life. Computer-aided processes are also used.

Neuroorthoptics

In addition to orthoptics, the field of neuroorthoptics has developed, in which orthoptists are significantly involved. The activities required here are of an interdisciplinary character and, in addition to general orthoptics and ophthalmology, also affect neurology with the associated special examination procedures when it comes to afferent and efferent disorders of the oculomotor system. Neuroorthoptics can be seen as a sub-area of neuroophthalmology .

Education, advice and motivation

Almost all clinical pictures that orthoptists deal with are long-term events that usually have to be looked after over a period of years. An essential aspect here is an extensive and detailed explanation of the current situation, the creation and communication of a forecast , as well as an intensive motivation of those affected, often also due to declining or fluctuating compliance .

Need and importance

The orthoptist's fields of activity move steadily between those of related professions, such as opticians , ophthalmologists , pediatricians , occupational therapists , low-vision trainers, neurologists or rehabilitation trainers . For several years this has raised the question of the future need for an independent professional profile. A study and needs analysis carried out for this reason, which was carried out in Switzerland in 2007, came to the conclusion that there will also be a qualitative as well as quantitative need for the profession of orthoptist in the future. It was then also shown that the central areas of competence ( core competencies ) are sufficiently different from those of other occupational profiles to justify a separate occupational profile with appropriate training. The services of orthoptists could not or only insufficiently be covered by other professions and represent an important contribution to health care . It is pointed out, however, that the demand will increase slightly in the next few years, but the absolute number of practitioners will also generally increase in the future will be small, which must also be expressed in the number of trainees. There are currently around 2,400 orthoptists working in Germany.

According to the Swiss study, there is also a need to expand the range of services, for example with regard to operational assistance, refractometry , perimetry, etc. In addition, there is general complaint about the importance that the job description has. Here, the experts involved are calling for action, for example in the form of greater support from ophthalmologists and more intensive lobbying .

The need for one's own professional profile also results from the scope of the ophthalmological specialist training . According to the current training regulations of the German Medical Association, a doctor only needs proof of "50 examinations and findings of non- paretic and paretic positional and movement disorders of the eyes" according to the documentation of further training according to the (sample) further training regulations (MWBO) , a comparatively small and insufficient depth of training in this specialist area.

literature

  • Herbert Kaufmann : Strabismus. 3rd, fundamentally revised and expanded edition. Georg Thieme Verlag, Stuttgart 2004, ISBN 3-13-129723-9 .
  • Katja Bossow: From the beginning of the strabismus treatment to the emergence of the profession of orthoptist. In: Würzburg medical history reports. Volume 23, 2004, pp. 528-534, here: pp. 530-534.

Web links

Individual evidence

  1. ↑ Training and Examination Ordinance for Orthoptists (OrthoptAPrV) - Laws on the Internet (PDF)
  2. ↑ Orthoptists Act of November 28, 1989 in a consolidated version, last amended by Art. 19 G v. April 18, 2016 | 886
  3. ^ Federal Ministry of Health - Health Professions
  4. ↑ David Stidwill: Orthoptic Assessment and Management. Blackwell Scientific Publications, Oxford 1990, ISBN 0-632-02776-2 .
  5. ↑ Training institute for orthoptists at the Gießen-Marburg University Hospital
  6. ^ BOD website - training
  7. ^ "Interprofessional Health Care" course of study. Heidelberg University Hospital.
  8. ^ Information from the Giessen-Marburg University Hospital. ( Memento of the original from July 28, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.ukgm.de
  9. ↑ Professional Association Orthoptik Deutschland e. V.
  10. ↑ Study and needs analysis on the job profile of the orthoptist of the Swiss Office for Educational Issues AG (BfB), 2007 (PDF; 723 kB)
  11. ↑ Documentation of the advanced training in accordance with the (sample) advanced training regulations (MWBO) on the specialist training in ophthalmology , version of June 26, 2010 and February 18, 2011. (PDF) German Medical Association