Helping patients see straight

The Report: June / July 2007 vol.28 num.3


ngela Bernaldez laughs good-naturedly when shes asked what, exactly,an orthoptist does. Clearly, she is used to meeting people who have noidea what this specialized profession is about.

Bernaldez, who works at Royal Jubilee Hospital in Victoria, is one of approximately 150 orthoptists in Canada, and one of only two employed by the Vancouver Island Health Authority to provide services for the whole VIHA region.

The word itself gives clues to its meaning, for anyone with a slight knowledge of Greek: -ortho" is the Greek for straight, and -optikas" means vision. -An orthoptist is a diagnostician who deals with eye alignment problems," Bernaldez explains succinctly. Typical eye alignment disorders include ambylopia, commonly called lazy eye; strabismus, often ... if somewhat inelegantly ... called cross-eyes; and binocular vision.

Many of Bernaldez patients are infants and children. Two per cent of children have eye alignment problems, she says. The good news is that, if the problem is detected in time, amblyopia can often be completely reversed using simple, non-pharmaceutical and non-surgical methods.

-The good old basic eye patch is just incredible in reversing many of these disorders," she says. In many cases, disorders centre around a disparity of vision between the two eyes. The affected person then relies increasingly on the good eye, and the weaker eye just gets weaker. The eye patch is used to cover the stronger eye so the weaker one is forced to work.

Early detection and intervention is key, Bernaldez says, citing the example of her own son. He was diagnosed with an eye alignment disorder at two and a half. -We got eye glasses to correct the unequal refraction and we did some patching therapy." The problem was corrected and her son, now 12, no longer wears glasses.

Many eye alignment problems are not visible and children learn to adapt, which means they can go undetected unless children receive the proper diagnostic screening. Unfortunately, says Bernaldez, the Vancouver City Health Department eliminated the preschool screening program a number of years ago. -Now we are relying on the parents," she says with a sigh.

Bernaldez urges parents to not only follow doctors recommendations to have their childs eyes examined at birth, but also to arrange regular followup exams.

At the same time, she stresses that eye alignment disorders are not just childhood diseases.

Angela Bernaldez
Royal Jubilee Hospital

-Two to four per cent of adults are affected by eye alignment disorders. They acquire them from trauma such as a blow to the head that affects the nerves, or diseases such as diabetes, thyroid disease, neurological diseases, or MS. Typically the symptom is sudden onset double vision.

-Or we see adults who had the problem as a child and did nothing but now want to do something because its a visible problem and they work with the public."

Sometimes the problems can be corrected with eye exercises; others may require surgical intervention. The orthoptists assessment is instrumental in deciding the best course of treatment.

Bernaldez trained at the Vancouver Eye Care Centre, which now operates out of Vancouver Childrens Hospital. -This is a very specialized program because most of the training is one on one. They only take two people every two years," she says. The 24-month program required a minimum of two years post-secondary education in an applicable field.

Bernaldez had recently completed her Bachelor of Psychology degree and was planning to study social work when she heard about the orthoptics program from a friend. It immediately interested her and she applied. She finished her training in 1988, and worked in the private sector in Vancouver for over eight years before moving to Victoria and her position at Royal Jubilee in 1999.

-What I like about my work is that Im almost like a detective. I get the history, gather all the information available and help solve the problem for the patient. Its just like a puzzle. You have to fit everything together and make sense of it."

Being in such a small professional community, orthoptists feel the impact of downsizing and cuts when they happen. She has first-hand experience of what its like when an important job is cut, and through her persuasive powers and commitment to her profession, was able to reinstate the position. Her advocacy skills have led her to getting involved with union, and this year Bernaldez attended her first HSA convention this year.

-It was a real eye opener," she says. -This is my first year as a general steward and I want to be more involved. Being actively involved in the union can stop the elimination of important jobs." She wants to educate the public about the services her profession offers, and to advocate for increased understanding of eye alignment problems, their diagnosis and treatment.

-I feel we need to create more public awareness about eye care, especially in the pediatric community. Its a shame if a child is overlooked when they could have had their vision repaired. It shouldnt happen. Education will help prevent this," she says.