The range of skills of orthoptists has become very broad, but remains little known. However, more and more of them work alongside ophthalmologists or alone in their own practice (12 in Loir-et-Cher). This is the case of Malvina Beltrami who moved to the Contres health center a few weeks ago. The orthoptist screens, re-educates, rehabilitates and explores visual function, from infants to the elderly. “We are in the business of functional vision, which is how you use your eyes. We do not need the same capabilities as a hundred years ago, our eyes are now overloaded by screens”explains Malvina Beltrami. The orthoptist reminds us that the optimal position, the elbow at 90° and the screen at 40 cm, is very little respected.
“We remain very little known and the patients who are sent to us by the ophthalmologist or the general practitioner often wonder what they are doing there.confirms Marie Guilbaud, regional delegate of the National Autonomous Union of Orthoptists, working in Tours. However, our scope of intervention is very broad. » Orthoptists can in particular specialize, this is the case of Malvina who is a specialist in oculomotor paralysis; she wrote scientific articles on the subject and taught courses at the faculty of Tours, Caen and Paris. “It is related to neurology, it is the dysfunction of a nerve which causes strabismus. Patients see double but it is linked to a neurological problem following a stroke, certain degenerative diseases such as multiple sclerosis, inflammatory diseases such as Horton’s disease, accidents and trauma, such as whiplash in a car. » To remedy this, you need to put prisms on your glasses to stop seeing double. This is personalized equipment, which must be tested with patients. “It’s magical for patients because seeing double is very debilitating. In the elderly, it is a cause of falls. »
“Work around neurodevelopmental disorders for children”
With the elderly, the orthoptist can also stimulate low vision. “It’s complicated for those around you to understand because there are holes in the visual field. They must be taught to use what vision they have at any given moment. » With a Goldman visual field, the orthoptist moves a light to find areas that are still performing well. Another part of his work, post-stroke rehabilitation, to help patients recover gestures that we do reflexively. “The orthoptist needs to invest in equipment, which is why we have help with installation from the regional health agency”adds Marie Guilbaud.
“In terms of rehabilitation, we also work on neurovisual disorders, from vision to cognitive processes. Color and movement are processed in different spaces of the brain; the visual scene must then be reconstructed. The eyes are already a part of the brain. » Melvina Beltrami, for example, works on dys disorders, which are still poorly understood. “Reading is an energy-consuming act for these children. If we can ensure that eye movements, location, and visual memory become less energy-consuming, the child can devote more time to understanding. The tests allow us to separate the motor part from the cognitive part and we re-educate both. »
For all dys disorders, the child compensates enormously. “We need to evaluate whether this compensation is effective or not, to either give him another method or improve his own. » The orthoptist has a space in her office dedicated to children where she helps them in their rehabilitation, sometimes with simple tools such as the game of 7 errors, a naval battle, in order to work on other eye movements. Orthoptists are therefore required to work in coordination with other health professionals, and not just ophthalmologists.
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> Orthoptists carry out prescription renewals for glasses, and since 2024 have even had access to the first prescriptions. They can therefore follow a patient who has never seen an ophthalmologist between the ages of 16 and 42 and will carry out vision examinations with refraction, with subsequent reading by an ophthalmologist. All this in order to free up medical time.
> The orthoptist is a paramedical profession, whose school is linked to the faculty of medicine; the course lasts three years. There are 158 of them working in the Centre-Val de Loire region, 71 of whom are self-employed, the others being employees either of a hospital structure or an ophthalmology practice. In Loir-et-Cher there are 24, half of whom are independent, with two recent installations. “At the Tours school, we try to send students everywhere for internships in the region. Our union SNAO asked the ARS for zoning to be established as for the installation of pharmacists, in order to better distribute orthoptists across the territory”explains Marie Guilbaud.
> Prevention is an important part of the profession. In addition to screening for diabetic retinopathy, orthoptists are also involved in screening children, the DP20. It will be implemented in Loir-et-Cher with the CPAM and National Education in 2026.
