The authors summarized history of orthoptists. Demand for orthoptists in ophthalmology is on the increase. However it was revealed a shortage in the number of orthoptists. If awareness of orthoptists is increased, it is expected that the number of students wishing to become orthoptists will increase, leading to a growth in those qualified in orthoptists, thus making a contribution to ophthalmology. A greater variety of PR activities are required in order to increase awareness

Abe, Haruki

Maeda, Fumiatsu

Niigata Regional Repository

38
Abstract
The authors summarized history of orthoptists. 
Demand for orthoptists in ophthalmology is on 
the increase. However it was revealed a shortage 
in the number of orthoptists. If awareness of 
orthoptists is increased, it is expected that the 
number of students wishing to become orthoptists 
will increase, leading to a growth in those 
qualified in orthoptists, thus making a 
contribution to ophthalmology. A greater variety 
of PR activities are required in order to increase 
awareness.
1. The first orthoptist and the start of 
education in orthoptics
Mrs Mary Lowndes-Yates (nee Maddox) was 
the first documented orthoptist to practice 
orthoptics [1]. She was the daughter of Dr. Ernest 
Maddox who worked in Bournemouth, and did a 
great deal to elucidate the problems of 
abnormalities of the ocular muscles and 
anomalies of binocular vision. In the treatment of 
these conditions he saw the possibilities of a new 
medical auxiliary profession and taught his 
daughter the principles of orthoptics.
Mary Maddox therefore became the first 
orthoptist. She moved from Bournemouth to set 
up a practice in London's Wimpole Street where 
she treated patients and taught others the skills 
learned from her father. In 1929 she was invited 
to join the staff of the Royal Westminster 
Ophthalmic Hospital (now the High Holborn 
branch of Moorfields Eye Hospital) and to open 
what in those days was called the “Squint 
Department”. In the 1930’s, institutions for 
training in orthoptics opened one after another, 
and a total of 22 orthoptists were nurtured in this 
way. Following this, investigations took place 
into the national program of education and 
examination by 1934. By 1937, the original 22 
orthoptists were joined by another 49, all of 
whom after a period of training had been properly 
examined by the Council's examiners and found 
to have sufficient knowledge and practical ability 
to carry out the work [1].
2. The establishment of a vocational school for 
orthoptists in Japan
In Japan, in 1970, the School of Orthoptics 
National Children’s Hospital, which was a one-
year national vocational school was created, 
starting the traditional education of orthoptists [2]. 
The following year in 1971 saw the establishment 
of the orthoptists act and the first state 
examination for orthoptists was conducted [2]. In 
1975, the School of Orthoptics Osaka National 
Hospital was founded as the second one-year 
vocational school for orthoptists [2], and in 1991 
the Kawasaki University of Medical Welfare was 
established as a four-year University for 
Perspectives on the role of orthoptists in Japan
Fumiatsu Maeda, Haruki Abe
Department of Orthoptics and Visual Sciences, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, 
Japan
Accepted: 6 August 2015
Corresponding author: Fumiatsu Maeda
Department of Orthoptics and Visual Sciences, Faculty of Medical Technology, Niigata University of Health and Welfare, 1398 
Shimami-cho, Kita-ku, Niigata 950-3198, Japan
TEL: +81-25-257-4752, E-mail: fumiatsu-maeda@nuhw.ac.jp
Invited article
39
Niigata Journal of Health and Welfare Vol. 14, No. 1
orthoptists [3]. Post-graduate education started in 
1996 [4], and it became possible to attain post-
graduate master’s degrees and doctorate degrees 
related to orthoptics. Orthoptic students receive 
education in a wide range of clinical skills which 
enables them to practice not only in the traditional 
areas of orthoptics but also within the field of 
general ophthalmology [5]. Following this the 
number of orthoptics vocational schools increased 
and these numbered 30 as of April 2015. 
3. Needs of the age in regard to orthoptists
The work at the time that the orthoptists act 
was established it was stipulated as follows “a 
person performing work, under the direction of a 
medical doctor, involving orthoptic training and 
the necessary examinations to enable those with 
defects in their binocular disability functions to 
recover such binocular function”. In fact, at that 
time, the main work was examinations and 
training in relation to amblyopia and strabismus 
in children. In 1993, the orthoptists act was partly 
revised and general ophthalmological tests, other 
than those that might cause severe harm to the 
body, began to be carried out by orthoptists. With 
the declining birth rate and aging society, there 
was an increase in age-related ocular diseases, 
and in the 1980’s orthoptics was the main work, 
but in recent years, the main work has started to 
change to general ophthalmological tests [6]. 
Further, recently, in addition to general visual 
function tests at ophthalmological clinics, and 
training guidance for strabismus and amblyopia, 
the scope of the work has increased to include 
participation in preventive medicine fields, such 
as the 3-year old health check and adult health 
checks carried out by local governments, and 
guidance on low-vision rehabilitation for people 
with visual impairment. 
4. Demand for orthoptists and recognition 
surveys
Demand for orthoptists in ophthalmological 
treatment is on the increase. Abe [7] took a 
questionnaire of the number of resources for the 
ophthalmological facilities in Niigata and 7 
neighboring prefectures, and it was found the 
against the ideal ratio of 3.1 orthoptists per 
facility, the actual number was 1.9, revealing a 
shortage in the number of orthoptists. Nohara et 
al. [8] discovered in her survey of Gifu prefecture 
that whereas most of the ophthalmological 
facilities within the prefecture were looking to 
employ orthoptists, the vocational schools in the 
prefecture could not fill their places, showing the 
current state in which it is not possible to keep up 
with the needs of recruitment. The cause of this is 
thought to be that awareness of orthoptists is still 
low. 
We will explain the results of our survey [9] 
into the level of awareness of orthoptists among 
University students. The survey method chosen 
was an anonymous Web questionnaire, in which 
the undergraduate students of University A were 
sent requests by E-mail. The questionnaire items 
were created with reference to the report of Satoh 
et al. [10], asking respondents to select the 
specialist fields they know.
Responses were received from 270 students. In 
order to eliminate bias, answers from students 
belonging to the vocational department of 
orthoptists were excluded from the data, and an 
analysis was performed on the answers from 243 
remaining respondents (Fig 1). According to the 
survey of Satoh et al. [10], awareness of nurses 
was 92.7%, and as this was 97.1% in our data, 
there was no significant difference. However, 
awareness of orthoptists in the survey Satoh et al. 
[10] was only 5.7%, our data showed this to be 
51.9%, which is a significant difference between 
the two (p < 0.01)．In the same way, the data of 
Satoh et al. [10] showed awareness levels of 
15.5% for physical therapists and 14.0% for 
occupational therapists, whereas in our data 
physical therapists were at 93.0% and 
occupational therapists were 90.1%, revealing a 
40
significant difference between the two (p < 0.01). 
These differences in University A were seen in 
the vocational fields of orthoptists, physical 
therapists and occupational therapists, and are 
thought to be affected by the fact that is a 
University concentrating on health, medicine, 
welfare and sport. However, the awareness levels 
of orthoptists in University A was significantly 
low compared to physical therapists and 
occupational therapists (p < 0.01)．Further, 
outside of the school, few respondents knew of 
orthoptists, and it is estimated that the actual 
Figure 1. The level of awareness of orthoptists and other special qualifications among 
University students (n = 243).
41
Niigata Journal of Health and Welfare Vol. 14, No. 1
awareness level is certainly not high [9].
It is difficult to say that the awareness of 
orthoptists is high compared to other medical 
professions, but, as was clarified in the survey by 
Abe [7], latent demand is high. There were an 
estimated 1.64 million people with visual 
impairment in 2007 in Japan [11]. Of these, 
187,800 were estimated to be blind. The 
prevalence of visual impairment in Japan 
increased with age and half of the people with 
visual impairment were aged 70 years or older. 
The prevalence of visual impairment was 
projected to increase from 1.3% of the population 
in 2007 to 2.0% by 2050 [11]. Visual impairment 
imposes substantial costs on society, particularly 
to individuals with visual impairment and their 
families [12]. Eliminating or reducing disabilities 
from visual impairment through public awareness 
of preventive care, early diagnosis, more intensive 
disease treatment, and new medical technologies 
could significantly improve the quality of life for 
people with visual impairment and their families, 
while also potentially reducing national health 
care expenditure and increasing productivity in 
Japan [12].
If awareness of orthoptists is increased, it is 
expected that the number of students wishing to 
become orthoptists will increase, leading to a 
growth in those qualified in orthoptists, thus 
making a contribution to ophthalmological 
treatment. It is clear that an increase in awareness 
would also lead to intervention by orthoptists in 
3-year old health checks, contributing to accuracy 
in the checks [13]. A greater variety of PR 
activities are required in order to increase 
awareness.
References
1. Lee BM. The first fifty years. Japanese 
Orthoptic Journal. 1982; 10: 70-87.
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of orthoptics in Japan. Japanese Orthoptic 
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Perspectives on the role of orthoptists in Japan

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Perspectives on the role of orthoptists in Japan

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