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Neuro-Orthoptics
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The Intricate Connection Between Orthoptics and Neurology
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Optic nerve disorders
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Neuro-Orthoptics
Optic nerve disorders
Abstract
Optic nerve disorders represent a significant challenge in orthoptic practice, affecting the transmission of visual information from the retina to the brain. These conditions require careful assessment and management due to their potential impact on visual function.
Common Optic Nerve Disorders
1. Optic Neuritis
Clinical Presentation
- Sudden vision loss (usually unilateral)
- Reduced color vision
- Pain on eye movement
- Central or paracentral scotoma
Orthoptic Assessment
- Visual acuity measurement
- Color vision testing (particularly red desaturation)
- Visual field assessment
- Pupillary light reflex testing
Management
- Regular monitoring of visual function
- Documentation of recovery pattern
- Coordination with neurological care
2. Optic Atrophy
Types
- Primary: Direct damage to optic nerve
- Secondary: Result of chronic papilledema
- Consecutive: Following optic neuritis
Clinical Signs
- Pale optic disc
- Reduced visual acuity
- Visual field defects
- Impaired color vision
Orthoptic Evaluation
- Sequential visual acuity measurements
- Visual field charting
- Contrast sensitivity testing
- OCT imaging for nerve fiber layer thickness
3. Papilledema
Key Features
- Bilateral disc swelling
- Preserved color vision initially
- Enlarged blind spot
Assessment Protocol
- Visual field monitoring
- OCT documentation
- Systematic review of symptoms
Diagnostic Procedures in Orthoptic Practice
Essential Tests
1. Visual Function Assessment
- LogMAR visual acuity
- Contrast sensitivity
- Color vision (Ishihara and desaturation)
- Visual fields (confrontation and perimetry)
2. Pupillary Assessment
- Direct and consensual responses
- Relative afferent pupillary defect (RAPD)
- Swinging flashlight test
3. Specialized Testing
- Optical Coherence Tomography (OCT)
- Visual Evoked Potentials (VEP)
- Fundus photography
- Red desaturation testing
Management Strategies
1. Acute Cases
- Immediate referral when necessary
- Documentation of baseline measurements
- Regular monitoring of progression
- Coordination with neuro-ophthalmology
2. Chronic Cases
- Long-term visual function monitoring
- Adaptation strategies for visual impairment
- Patient education about prognosis
- Regular assessment of functional vision
3. Rehabilitation Approaches
- Visual aids prescription when appropriate
- Environmental modifications
- Occupational therapy referral
- Vision rehabilitation services
Follow-up Protocol
Short-term
- Weekly assessments in acute cases
- Documentation of visual recovery
- Monitoring for complications
- Adjustment of management plan
Long-term
- Regular intervals based on stability
- Annual comprehensive assessment
- Quality of life evaluation
- Update of rehabilitation strategies
Red Flags for Urgent Referral
- Sudden vision loss
- Progressive visual field defects
- New onset diplopia
- Severe headaches with visual symptoms
- Bilateral involvement
- Failed recovery despite treatment
Conclusion
Successful management of optic nerve disorders requires a systematic approach to assessment, careful documentation, and appropriate referral patterns. The orthoptist plays a crucial role in monitoring disease progression and coordinating care with other healthcare providers.
Note : This document serves educational purposes exclusively and does not constitute medical advice or treatment guidelines
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