What is an orthoptist?
An Orthoptist is an allied health professional who functions as a mid-level provider, primarily in a pediatric or neuro-ophthalmology setting. Orthoptists have high levels of responsibility and complex diagnostic and therapeutic duties. They differ from technicians in educational background, and length and complexity of formal training. They differ from optometrists in that they are not independent providers.
An orthoptist’s focus is on the evaluation and non-surgical treatment of disorders of vision, eye movements, and eye alignment in children and adults. An orthoptist specializes in visual function assessment and neuromuscular anomalies of the eyes.
Orthoptists are recognized by the American Medical Association and they work similarly to a Physician’s Assistant or Nurse Practitioner alongside ophthalmologists. Orthoptists are eligible for membership to the American Association of Certified Orthoptists, their national professional organization.
The practice of orthoptics is multi-fold. Clinical orthoptics may be practiced in a variety of physical locations including hospitals, clinics, private offices, and academic medical institutions. Individual positions may be designed to meet the needs of both employer and employee. Orthoptists treat many non-surgical disorders of ocular motility and binocular vision including, but not limited to amblyopia, convergence insufficiency, and accommodative esotropia. Patients may be referred for sensorimotor evaluation from within the practice, or from the medical community, for assessment of amblyopia, pre- and post-operative strabismus, and complaints relating to binocular function. Orthoptists also perform other tasks that would otherwise be performed by the ophthalmologist such as returning patient phone calls, completing forms, preparing referral letters, or educating patients, students, or office staff. Orthoptists may also participate in clinical research or education of medical students, residents, fellows, and orthoptic students.
The American Orthoptic Council (AOC) establishes the requirements for education in Orthoptics, accredits teaching programs able to meet those requirements, examines and certifies candidates who complete training, sets continuing education goals for periodic recertification, and oversees the ethical aspects of orthoptic practice in the United States. The AOC consists of representatives of the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the American Association of Certified Orthoptists, the American Ophthalmological Society, and the Canadian Orthoptic Council.
Most AOC-accredited Orthoptic Programs are affiliated with the Accreditation Council for Graduate Medical Education (ACGME)-accredited medical schools in the United States. A baccalaureate degree is required for entrance into an orthoptic program. Orthoptic students must complete a 24-month program of study in an accredited Orthoptic Program, and successfully pass both a written and an oral/practical board examination given by the AOC in order to obtain national certification. The certificate issued by the Council signifies that the Certified Orthoptist has successfully completed the training and examination process, has met the standards for certification, and is ethically and otherwise in good standing. Orthoptists must re-certify every three years, showing proof of continuing education that includes attendance at scientific meetings.
Orthoptists can positively impact a practice by increasing the volume of patients that a physician can see per clinic day while improving the quality of care. They may also generate revenue by managing patients under the supervision of the ophthalmologist. The addition of one full-time orthoptist to a practice has been known to result in a 40% increase in patient volume with a concomitant increase in surgical practice. By convention, compensation is commensurate with education and experience. In the absence of an established pay schedule, orthoptists may be salaried according to scales that are in place for nurse practitioners who hold comparable positions. Appropriate adjustments should be made for orthoptists who have been awarded faculty appointments, have achieved additional certification, and for those who hold senior, supervisory, or administrative positions.
Certified orthoptists are utilized in a variety of ways in the United States. They may be deemed an employee or function as an independent contractor. Some examples currently in practice are:
- The orthoptist sees patients at the same site as the supervising ophthalmologist, or at a satellite office. These patients may be referred to the orthoptist for sensorimotor evaluations, management of amblyopia, convergence insufficiency, accommodative esotropia, and other non-surgical disorders of ocular motility and binocular vision from the supervising ophthalmologist’s practice, or from the medical community. The orthoptist is an employee of the hospital or clinic, and fees for orthoptic services are collected by that employer.
- Several physicians in one geographic area who individually do not have the need for a full time orthoptist may "share" the services of one orthoptist who may travel from office to office throughout the week. The orthoptist generates fees for the office where she/he is working, and each office pays her/him a salary. One physician at each site functions as the supervising ophthalmologist for that site.
- Several ophthalmologists in the same multi-specialty practice refer patients to the orthoptist for sensorimotor evaluation and treatment as a physician extender.
- The orthoptist works side-by-side with the supervising ophthalmologist as technical support for his/her clinics, performing the preliminary examination of each patient (which may or may not include cycloplegic retinoscopy) prior to the examination by the ophthalmologist. The orthoptist may also accompany the surgeon to the operating room and function as the scrub nurse or first assistant. Alternatively, the orthoptist may see follow-up patients on her/his own schedule while the ophthalmologist is in the operating room.
Ethical Standards of Orthoptic Practice
Certified orthoptists are bound by a Code of Ethics as specified by the AOC. Among other things, this code requires that orthoptic services be rendered only under the overall supervision of an ophthalmologist.