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Summary
A certified orthoptist (CO) is a nationally licensed medical professional who handles rehabilitation and specialized testing in the field of eye care. Working under the direction of an ophthalmologist, orthoptists provide corrective training to restore visual function in conditions such as children’s amblyopia and strabismus, and carry out the precise tests needed to diagnose and treat conditions such as glaucoma and cataract.
The work of an orthoptist falls broadly into the following four areas.
- Orthoptic training: for problems with using both eyes together, such as amblyopia and strabismus, we provide training aimed at restoring visual function.
- Visual function testing: they perform the many tests that are essential for ophthalmologists to make an accurate diagnosis, such as visual acuity, eye pressure, and visual field.
- Screening: at checkups such as the 3-year-old health checkup, they play a role in finding problems in a child’s eye development early and linking them to appropriate treatment.
- Low vision care: for people whose vision has declined because of illness or injury, they advise on choosing and using visual aids, and help maintain quality of life.
While ophthalmologists take on every medical act, such as diagnosing eye diseases, performing surgery, and prescribing medicine, orthoptists support medical care as partners to the doctor through testing and rehabilitation. Their role is also clearly different from that of a “certified spectacle-making technician,” who specializes in making glasses.
The Legal Definition and Role of an Orthoptist
A certified orthoptist (CO) is a medical technician with a national qualification under the Orthoptists Act enacted in 1971. By law, the work is defined as “carrying out, under the direction of a physician, corrective training to restore binocular vision function in people with impaired binocular vision function, and the tests needed for it.”
This includes two important points.
One is “under the direction of a physician.” Orthoptists do not make a diagnosis or decide on a treatment plan themselves. They are trusted members of the medical team who always work with the ophthalmologist and carry out specialized tests and training based on the treatment plan the physician has set.
The other is the term “binocular vision function.” It refers to the ability of the right and left eyes to work as a team and for the brain to combine their information into one, so that we see things in three dimensions. If this function does not develop well, it can lead to conditions such as “amblyopia,” in which vision in one eye fails to develop, or “strabismus,” in which the two eyes are not aligned. Orthoptists are specialists in this binocular vision function.
The Four Pillars of Orthoptic Work
The specialized work of orthoptists originally centered on training for amblyopia and strabismus, but it has now spread across eye care in general and rests mainly on the following four pillars.
1. Orthoptic training: rehabilitation for the eyes
The core of an orthoptist’s work is orthoptic training. The main targets are children’s “amblyopia” and “strabismus” during the important period when visual function is developing.
Orthoptists carry out specialized tests even on children who cannot yet explain their symptoms well, and they plan and carry out a rehabilitation plan that does not require surgery, tailored to each child. It is a highly specialized field that could be called “physical therapy for the eyes.”
2. Visual function testing: gathering the data that supports diagnosis
The quality of eye care depends on how accurate the test data can be. Orthoptists are partners who provide the objective, precise data that ophthalmologists need to make an accurate diagnosis and set an appropriate treatment plan.
The work ranges from basic tests such as visual acuity and eye pressure measurement, to visual field tests that check how glaucoma is progressing, and the preoperative tests needed for cataract surgery. These tests, done with specialized equipment, are the foundation of high-quality eye care.
3. Screening: contributing to early detection of disease
Orthoptists play an important role not only inside clinics and hospitals but also in public health in the community.
A typical example is taking part in the 3-year-old health checkup run by local governments. Age 3 is very important for the development of visual function, and whether problems such as amblyopia are found and treated at this time can greatly change how well the child recovers. As specialists, orthoptists take part in this screening and contribute to finding easily overlooked eye problems early.
4. Low vision care: support for quality of life
Supporting people whose visual function has declined because of illness or injury, and who cannot get enough vision even with glasses or surgery, is also an important part of an orthoptist’s work.
This care is not just about measuring vision. They listen carefully to the difficulties patients have in daily life, choose aids such as magnifiers and light-shielding glasses, and teach how to use them. They help people make the most of the vision they have left and keep living in their own way.
Division of Roles Among Professionals in the Eye Care Team
Eye care in Japan rests on cooperation among professionals with different roles. There are mainly three professions, “ophthalmologist,” “certified orthoptist,” and “certified spectacle-making technician,” and their roles are clearly distinguished by law and other rules.
| Item | Ophthalmologist | Orthoptist | Spectacle-making technician |
|---|---|---|---|
| Main role | Eye specialist physician | Medical-related professional | Glasses specialist |
| Qualification | National medical license | National orthoptist license | National skills certification |
| Main work | Diagnosis, drug treatment, surgery | Visual function tests, orthoptic training | Making glasses, measuring vision, fitting |
| Prescribing medicine | Allowed | Not allowed | Not allowed |
| Surgery | Allowed | Not allowed | Not allowed |
| Main workplace | Hospitals, clinics | Hospitals, clinics | Optical shops |
- An ophthalmologist is a physician who has graduated from medical school and the only professional with the authority to carry out all diagnosis, treatment, and surgery of eye diseases. As the leader of the eye care team, the ophthalmologist bears final responsibility for treatment.
- As described above, orthoptists carry out tests and training under the direction of the ophthalmologist and support medical care with specialized skills.
- A certified spectacle-making technician is a national skills certification that began in 2022, for specialists in making glasses. They have the skills to choose the best lenses to match a customer’s needs and to adjust frames. They do not carry out medical acts such as diagnosis and treatment. This new qualification system has further clarified the division of roles, in which ophthalmologists and orthoptists handle “medical care” and spectacle-making technicians handle “providing vision correction devices.”
Japan’s Orthoptists From an International Perspective
Japan’s orthoptist system is distinctive by world standards and has established a firm position.
Differences From “Optometrists”
In countries such as the United States and the United Kingdom, a profession called “optometrist” handles primary eye health care (primary eye care). Optometrists can diagnose conditions such as glaucoma, prescribe medicine, and in some cases even perform minor surgery, and have wide authority.
On the other hand,there is no national qualification for optometrists in Japan. In Japan, medical acts such as diagnosis and treatment are the exclusive work of ophthalmologists. Glasses can be made at an optical shop without a doctor’s prescription.
Because of this difference in systems, orthoptists’ role in public health becomes more important in Japan. In Europe and the United States, regular eye exams by optometrists lead to early detection of disease, but in Japan such opportunities are limited, so screening such as the 3-year-old health checkup done by orthoptists is an important line of defense for protecting the nation’s eye health.
A Profession Established, in Numbers
Orthoptists are a profession that continues to grow steadily in Japan.
- History: The law was enacted in 1971 as a national qualification, giving the profession a history of more than 50 years.
- Numbers: The number of licensed orthoptists increases year by year, reaching about 19,000 as of April 2023. This is the largest number in the world, and Japan can be called a world leader in this field.
- Education: To become an orthoptist, one must complete a training program designated by the national government and pass the national examination. The pass rate for new graduates is very high at 98.7%, showing that a high-quality education system is in place.
In this way, orthoptists are steadily trained, and it can be said they are an established profession with a high level of expertise.
