SCOPE OF PRACTICE for Certified Orthoptists (CO®)

Introduction

Orthoptists are proven and integral members of the U.S. healthcare system. The boundaries of each orthoptist’s scope of practice are determined by these parameters: Education and experience; policies of employers and facilities; and the needs of the patients.

The U.S. Department of Labor Employment and Training Administration (ETA) lists Orthoptists (profession 29-1199.05) under the category of Health Diagnosing and Treating Practitioners. This is the same category shared by Nurse Practitioners and Nurse Anesthetists. The ETA divides jobs into zones according to the extent of preparation needed to enter the field: the knowledge, skills, and experience necessary; the tasks; work activities; work context; and, tools and technology used in the execution of duties. There are five such “Job Zones.” Orthoptics is categorized in Zone Five: Extensive Preparation Needed.

Orthoptists are employed in a multi-specialty field that is composed of many professionals including but not limited to ophthalmologists, allied health technicians, nurses, surgical assistants, and other eye-care team professionals. In an adjunctive capacity, an orthoptist works exclusively with an ophthalmologist as a physician extender and community liaison to allow the ophthalmologist to expand his or her services while maintaining quality care. Orthoptists are qualified to assist in the diagnostic evaluation, treatment, management, and care of patients with deficiencies and abnormalities that affect eye alignment, vision development and the visual system. The scope of practice allows orthoptists to perform tasks in accordance with laws and regulations that permit the physician to delegate patient care.

Education and Experience

An Orthoptic Fellowship Program curriculum extends over 24 continuous months. There is an advanced program offered for candidates that have an undergraduate degree along with a COMT or COT certification to complete the program in less than the full two years. Training begins with classroom instruction in basic medical sciences. This is followed by clinical rotations. Students complete at least 2,000 hours of supervised clinical practice with orthoptic instructors and a minimum of 1,250 patient encounters. All CO® Fellowship Programs offer certificate degrees to graduates.

The American Orthoptic Council® (AOC®) develops requirements for the education, training, and recertification of orthoptists. The American Orthoptic Council® consists of representatives of the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the American Association of Certified Orthoptists, the American Ophthalmological Society, American Academy of Pediatrics, the North American Neuro-Ophthalmology Society, the Canadian Orthoptic Council, and The Canadian Orthoptic Society. Currently the AOC® Accreditation Committee accredits programs that meet the Standards and Guidelines.

National Board Certification and Continuing Education

To be eligible to take the national board exams, the orthoptist must be sponsored by the program director of an AOC® or CoA-OFP accredited orthoptic program. Orthoptists holding current certification or licensure in a foreign country may apply to the AOC® for certification. To practice in the United States, Certified Orthoptists®, CO® , must graduate from an accredited orthoptic fellowship program and pass the written and practical certifying examination developed by the American Orthoptic Council®. To maintain their national certification, orthoptists must sign a Code of Ethics and complete the required hours of continuing medical education (CME).

The certificate issued by the American Orthoptic Council® signifies that the Certified Orthoptist® has successfully completed the program and examination process, has met the standards for certification, and is ethically and otherwise in good standing. Like other health care professionals, after graduation, orthoptists continue learning in the clinical work environment and through CME. It is not a license to engage in the practice of orthoptics and does not replace or necessarily fulfill any requirements of state or local agencies pertaining to the practice of a healthcare profession.

Core Competency domains:

● Patient care

● Medical knowledge

● Professionalism, interpersonal and communication skills

● Technical, critical thinking, diagnostic and scientific skills

● Patient education

● Community and health services

Scope of Practice

The responsibilities of Certified Orthoptists® include assisting in the diagnostic evaluation, management, treatment, education, and care of patients with medical and surgical conditions affecting the complex visual system. The scope of practice of Orthoptists includes, but is not limited to, visual acuity testing on patients of all ages, sensorimotor examinations, and refractions. The practice of orthoptics is multi-faceted. Clinical orthoptics may be carried out in a variety of physical locations including hospitals, clinics, private offices, and academic health centers. Individual positions may be designed to meet the needs of both employer and employee as well as of patients and their caregivers. Orthoptists treat many non-surgical disorders of ocular motility and binocular vision including, but not limited to, amblyopia, strabismus, asthenopia, diplopia and nystagmus. Patients may be referred from the ophthalmologist’s practice for sensorimotor evaluation, assessment and management of amblyopia, non-surgical strabismus, pre- and post-operative strabismus evaluation and measurements, and other disorders of ocular motility and binocular vision. Orthoptists may also participate in clinical research and education of medical students, residents, ophthalmology fellows and orthoptic fellows.

Practice Patterns

Certified Orthoptists® work in a variety of ways in the United States. In some cases, the orthoptist sees patients at the same site as the supervising ophthalmologist, or at a satellite clinic. Most commonly, the orthoptist is an employee of the hospital or clinic. Other examples of practice patterns include:

● The orthoptist earns a salary and generates fees for the office where she/he is working. One physician at each site functions as the supervising ophthalmologist for that site.

● Several ophthalmologists in the same multi-specialty practice refer patients to the orthoptist for sensorimotor evaluation and treatment as a physician extender.

● The orthoptist works side by side with the ophthalmologist performing the preliminary or follow up examination of patients, which may or may not include cycloplegic retinoscopy or trial of prisms.

● The orthoptist may see follow-up patients in a separate orthoptist clinic or individual orthoptist template. Professional fees currently paid are that of the Sensorimotor Exam code: 92060, Orthoptic Training: 92065, refraction: 92015, low level professional fee: 99211, and/or a facility fee: Q3014 (depending on the clinic location).

This document has been approved by the AOC Executive Committee; 2/07/2023