WHAT IS AN ORTHOPTIST?
Orthoptists are highly-skilled in the assessment of vision difficulties and have particular expertise in the assessment of children and patients with special educational needs or learning disability. They are experts in visual development, binocular vision and eye movements. Specialist VPD Orthoptists help identify and treat any visual processing difficulties to give your child a smoother learning journey for life.
The Process
1. Review of Questionnaire
Before I meet you I will request that you complete a simple ‘signs and symptoms’ questionnaire so that I can assess your vision needs and which issues are causing the most problems.
2. Your First Appointment
I will undertake an Orthoptic assessment to test your vision, eye movements and binocular vision to see how well aligned your eyes are and how much control you have over maintaining this alignment. I will assess your convergence which is the ability to keep the eyes aligned well for close work to avoid double vision and also your focusing abilities. These tests tell me more about the cause of your symptoms.
If you’re having a complete VPD assessment (2.5 hours), I will also assess your saccades (eye tracking ability) to check their accuracy as difficulties with these can cause reading difficulties, particularly with losing place, skipping/re-reading words. I will test for visual stress and, if appropriate, carry out a coloured overlay assessment. Finally, I will assess 7 separate visual perception skills which are necessary for everyday activities such as writing and learning. Difficulties with these skills can contribute to problems such as letter reversals and difficulties copying from the board.
I will provide your first coloured overlay (if required) and will provide treatment packs if any exercises are needed to improve specific skills. It is sometimes necessary to postpone the visual stress assessment until after treatment if I find certain vision or binocular vision difficulties. This is why it’s important to test for these before using overlays and coloured filter glasses.
3. Follow-up Appointment
For general orthoptic appointments, your follow-up appointment is likely to be very similar to the first assessment as I will be checking for any changes to your condition.
For VPD patients, your appointment will be much shorter than the first. I may re-test any troublesome areas from the previous appointment and amend your treatment plan accordingly. I will check your progress with the coloured overlay (if appropriate) and continue working through any unfinished assessments. Most patients will complete all aspects of the examination in the appointment times allocated. Very rarely will further appointments be required after these, but this is something I cannot guarantee. My findings and the amount of treatment required will influence this, as will your engagement with any exercises given.
For the VPD package to be valid you do need to complete the follow-up appointment within the recommended timescale. Any longer than this means that more of the initial tests have to be repeated which calls for a longer appointment time.
4. Summary Letter/Report Writing
After the assessments are completed, I will create a detailed report (average 8 pages) explaining any difficulties found, along with treatment advice and management strategies. You will be sent a copy of this. With your consent, a copy will also be sent to your school/college/workplace with guidance of how they can support you.
Requirements
Up-to-Date Eye Test
Before our appointment, please ensure that you have had a recent eye examination at an opticians, and that you have a copy of results to bring along. Bring along any glasses that you have been prescribed, and ensure that your child is old enough to be assessed.
Minimum Age
The minimum age for the VPD clinic is 7 years. Children should be familiar with letters/phonics and have begun reading, even if finding it difficult. If you have specific concerns about a younger child, please contact me for further advice. This age limit is only for the visual processing tests- I’m qualified and happy to assess patients of any age from babies and beyond.
THE ASSESSMENT
1. ORTHOPTIC ASSESSMENT
The Orthoptic assessment is an essential component of your initial VPD appointment. It is different to an eye examination carried out at the opticians due to the fact that some problems are subtle enough to be missed by anyone other than an Orthoptist, but significant enough to impact on learning, particularly if left untreated.
During your Orthoptic assessment we will do a Visual Acuity test (to check how well each eye sees individually)- this will be done with glasses on (if your child already has prescription glasses). I will assess how well the eyes work together as a pair by carrying out binocular vision tests. This assesses how easily control of binocular vision is lost.
I will also assess the function of the extra-ocular muscles (muscles around the eyes), as well as assessing the ability to focus (your ability to change focus to see clearly at all distances).
Advice about treatment will be given for any problem found in this section. In some cases, it may mean postponing the remainder of the VPD assessment. Of course, you will be informed if the condition detected is suitable to be treated within the NHS Orthoptic service.
2. SACCADES/TRACKING
Various types of eye movements are used throughout the day to look at and help to interpret visual information.
Saccades are the ‘fast eye movements’ used to quickly look from one thing to another, for example when looking at the window and then towards to the door.
When reading and writing, very small saccades are used to move the eyes accurately from one word to the next. Difficulties with this can cause significant fatigue (or frustration/avoidance) when reading, along with frequent skipping/re-reading of words and jumbling up letters. Inaccurate saccades can also cause excessive movement of the head or jaw when reading.
3. Visual Stress & Coloured Overlay Assessment
Visual stress is different to what people may refer to as ‘eye strain’. It is the name given to the condition where the brain is triggered specifically by black & white stripes/patterns, resulting in visual discomfort.
Visual stress can cause reading difficulties and discomfort. Signs/symptoms include fidgeting when reading, blinking/rubbing the eyes, seeing patterns in text, and noticing words blur and jump/move. Glare and bright lights can worsen symptoms. Research has shown that 15 to 20% people suffer with some level of visual stress, although not everyone finds it debilitating.
The visual cortex is the part of the brain involved in processing visual information. The cells in this area become overstimulated by the ‘striped’ pattern of black text on a white background which is specific to certain-sized stripes/text. A handful of well-spaced words in a large font-size would not stimulate visual stress (e.g. in early readers’ books). For this reason, a visual stress diagnosis in children under 7 years of age is rarely appropriate. Where there are more sentences per page, the text size typically decreases, which thereby amplifies the ‘’pattern’’ effect and gives rise to symptoms.
Coloured overlays/filters work by changing the wavelength of light entering the brain as a person reads. This means that the information is redirected slightly, which dampens the brain’s over-stimulatory response. The colour required is specific to each individual, and in the first few months of using an overlay, it is common for the required colour to change. For most, a coloured overlay or basic coloured filter lenses work well to reduce visual stress symptoms in a simple, cost-effective way. Occasionally, patients will need a very specific colour to relieve their symptoms. In these cases, the colour will need to be determined by the use of a colourimetry machine (which unfortunately is not a service I am able to offer at present). Evidence would suggest that specific colours are always necessary, however from experience I find that most patients don’t or won’t wear coloured glasses and manage well with a combination of overlays and adaptations (I will provide guidance on managing symptoms with coloured paper, line spacing etc.)
Who Can Experience Visual Stress?
Visual stress can occur as an isolated condition in an otherwise healthy individual, with approximately 20% of the general population being affected. The prevalence is reported to be slightly higher in those with other conditions, including dyslexia, multiple sclerosis and migraine sufferers. It’s important to be aware that whilst coloured overlays/filters may reduce symptoms, it does not improve the condition itself. The use of these should be considered as ‘symptom management’ rather than a ‘treatment’ or a ‘cure’.
Can an overlay be used without an assessment?
Some educational professionals are able to supply pupils with a coloured overlay. It is also possible to purchase an overlay or coloured glasses online without any assessment. Whilst this may reduce symptoms, using an overlay without having first had a visual and orthoptic assessment can result in underlying (often, treatable) conditions being masked. As an Eye Care Professional, I will not offer a coloured overlay assessment as a standalone appointment without prior completion of the first two VPD sections.
Important Note:
The terms Meares-Irlen syndrome and scotopic sensitivity syndrome are frequently used around the topic of coloured overlays and lenses but neither of these terms will be used or diagnosed in the clinic. You may notice a lot of the symptoms described in these syndromes overlap with ‘Visual Stress’.
4. VISUAL PERCEPTION SKILLS
There are seven visual perception skills included in the VPD assessment. Whilst this section is entirely optional, completing it can provide a good indication of strengths/weaknesses in skills that are heavily depended upon in many areas of learning. This can be useful information when trying to maximise learning potential, potentially for somebody who is finding learning difficult.
You can opt to have all 7 areas assessed, or we can discuss (along with the use of your completed ‘signs and symptoms’ questionnaire) which of the following sections are most relevant:
- Visual Memory skills
- Visual Discrimination skills
- Visual sequential memory skills
- Visual discrimination skills
- Visual form constancy skills
- Visual closure skills
- Visual figure ground skills
Visual Processing Difficulties
IMPORTANT Please note that if an eye examination if not carried out prior to your appointment, or if you don’t bring your prescribed glasses with you, your appointment will be postponed. This will incur a loss of your booking fee, so please do ensure that you have both of these things before you leave home! In the event of needing to cancel your appointment please notify me at your earliest convenience to reschedule.
Missed appointments will incur a loss of your £50 deposit.
Service Page FAQ’s
Why shouldn’t I just buy a coloured overlay online?
While coloured overlays can help with visual stress, using them without a professional assessment can be risky. Symptoms of visual stress often overlap with treatable eye muscle issues (like convergence insufficiency). If you use an overlay without an Orthoptic check, you might be masking a muscle problem that could be corrected with simple exercises, rather than just masking with an overlay to get by.
Do I need a referral?
No referral is needed. You can email me directly to book an appointment. However, you’re welcome to send any relevant reports from other professionals for me to read before your appointment. With your consent, I will liaise with school teachers, SENCOs, dyslexia assessors, employers etc. to provide a joined-up approach to your or your child’s care.