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Orthoptists are the clinical specialists in eye movement disorders, squint, lazy eye and binocular vision problems. They are a central part of the specialist private eye service for children, and at Clinica London our orthoptists are often the first person a child sees and the clinician who monitors their progress over time. Whether your child has been referred with a suspected squint, has failed a vision screening test, or needs specialist monitoring for a known condition, our orthoptic team provides thorough, age-appropriate assessment and a clear picture of what is happening with your child's eyes. You do not need a GP referral to book a consultation.
An orthoptic assessment at Clinica London is comprehensive and adapted to your child's age and the reason for the appointment. The specific tests used will depend on the clinical question, but a full assessment typically covers the following core areas.
Each eye is tested separately to establish how sharply it can see. Age-appropriate tests are used: picture matching cards and preferential looking tests for younger children, and letter charts for school-age children. Any difference in acuity between the two eyes, or any reduction below age-appropriate norms, is investigated further.
The cover test reveals whether the eyes are aligned or whether a manifest or latent squint is present, performed at both near and distance. Ocular motility is assessed by checking eye movements in all directions of gaze, looking for any restriction that might indicate a muscle palsy or mechanical cause.
The degree of binocular cooperation between the two eyes is assessed using a range of specialist tests. These establish whether the child has full fusion, peripheral fusion only, or suppression of one eye, an important finding that helps characterise a squint or amblyopia.
Where indicated, dilating drops are instilled to allow an accurate measurement of the true refractive error, and a dilated examination of the retina and optic nerve, carried out by the paediatric ophthalmologist. Dilation is always used for a first-time squint assessment, unexplained reduced vision, or any structural concern.
You can book directly with Clinica London without a GP referral. If your child is covered by private medical insurance, your insurer may require a GP referral letter before authorising treatment. We recommend checking your policy before booking. Our team is happy to help with any queries.
Book a paediatric orthoptic assessment →Our orthoptists are experienced in working with children of all ages and temperaments, including very young children, anxious children and those with additional needs. They use play-based and age-appropriate techniques throughout, and take as much time as needed to obtain reliable results. There is no pressure and no rush.
The orthoptist begins by taking a careful history: the reason for the appointment, any concerns you or teachers have noticed, your child's medical background, family history of squint or eye conditions, and any previous testing or treatment.
Visual acuity is tested in each eye separately, eye alignment is assessed with cover testing at near and distance, eye movements are checked in all directions, and binocular vision and stereopsis are tested using age-appropriate methods.
If cycloplegic drops are needed, they are instilled and the waiting time used for further tests or a break. Once dilated, refraction and a fundus examination are carried out by the paediatric ophthalmologist working in tandem with the orthoptist.
The orthoptist and ophthalmologist explain clearly what they have found and what it means. Where a management plan falls within orthoptic scope of practice, such as a glasses prescription, patching regime or exercise programme, this is provided with written instructions.
Where the assessment identifies something requiring a medical decision, prescribing or surgical consideration, the orthoptist arranges a consultation with one of our paediatric ophthalmologists, often at the same visit. The orthoptist and ophthalmologist work in tandem.
Most children with strabismus, amblyopia or binocular vision problems require regular follow-up. Follow-up appointments are typically led by the orthoptist, with ophthalmology involvement at key decision points. A clear monitoring plan is agreed at the end of each appointment.
Orthoptic assessments at Clinica London are carried out by our dedicated orthoptic team. They are the specialists your child will most frequently see, and they bring a combination of clinical expertise, patience and genuine care for the children and families they work with.
Specialist orthoptist with experience in paediatric vision assessment, amblyopia management, strabismus assessment and binocular vision, across all age groups from infancy to the teenage years.
Specialist orthoptist experienced in paediatric eye assessment, strabismus management and amblyopia treatment, working with children from infancy through to the teenage years.
Specialist orthoptist with expertise in children's visual assessment, fundus examination, binocular vision testing and orthoptic exercise programmes.
Thorough, age-appropriate assessment for your child's vision and eye alignment. No GP referral needed.
Book a paediatric orthoptic assessmentAll fees are for private appointments at 140 Harley Street. Cycloplegic refraction and fundus examination are included in the assessment fee where clinically indicated.
| Appointment | Fee |
|---|---|
| Orthoptic assessment (new patient) | £150 |
| Orthoptic follow-up | £150 |
| Combined paediatric ophthalmology and orthoptic assessment | From £450 |
| Paediatric ophthalmologist's new patient and follow-up consultation | £300–£450 |
| Cycloplegic refraction (paediatric ophthalmologist), included within a combined assessment | Included |
| Fundus examination (paediatric ophthalmologist), included within a combined assessment | Included |
Our orthoptists assess a broad range of conditions in children and, where relevant, in adults. The most common presentations are listed below.
The orthoptist establishes whether reduced vision is due to a refractive error (a glasses prescription) or true amblyopia, where the brain has not developed full use of one eye, or a combination of both. Identifying the cause matters: a refractive error is corrected with glasses, while amblyopia requires additional treatment, typically patching, to stimulate use of the weaker eye.
Strabismus is a misalignment of the eyes, which can be constant or intermittent and can affect one eye or alternate between both. The cover test is the key clinical test used to detect and characterise a squint. Our orthoptists assess the type, direction, size, frequency and cause, and work with the ophthalmologist to plan appropriate management.
Problems with binocular vision are a common and frequently overlooked cause of headaches, eye strain, difficulty reading and poor concentration. Convergence insufficiency, where the eyes struggle to converge accurately at near, is the most common binocular vision disorder in this age group, and responds well to orthoptic exercises (vergence therapy).
Nystagmus is an involuntary rhythmic movement of the eyes that can be congenital or acquired. Orthoptists play a central role in assessment and monitoring: measuring visual acuity at the null point, assessing head posture, and monitoring progression over time in coordination with ophthalmology and, where relevant, neurology.
Direct assessment of the back of the eye, including the retina, macula and optic disc, is carried out by our paediatric consultant ophthalmologists after dilating drops. Children in whom no clear cause for reduced vision is found at the level of eye movement assessment or refraction will always have a dilated fundus examination.
Establishing whether a child needs glasses is most accurately done with cycloplegic refraction, using eye drops to relax the focusing muscles so the true refractive error can be measured. Our orthoptists work closely with our paediatric ophthalmologists to ensure prescriptions are appropriate for the child's age and clinical picture.
Orthoptists are university-trained allied health professionals who specialise in the assessment and non-surgical management of conditions affecting eye movement, eye alignment and binocular vision. They are the clinical experts in:
At Clinica London, our orthoptists work in close collaboration with our paediatric ophthalmologists. For many children, the orthoptist carries out the main clinical assessment and ongoing monitoring, with the ophthalmologist involved for prescribing, clinical decision-making and cases requiring medical management. This integrated model means your child benefits from specialist expertise at every stage.
Orthoptists are not optometrists. While an optometrist can assess vision and prescribe glasses, orthoptists have specific specialist training in eye movement disorders, squint, amblyopia and binocular vision that goes considerably beyond a standard optometric assessment. For any child where a squint, lazy eye or complex visual problem is suspected, an orthoptic assessment provides a level of clinical depth that cannot be replicated in a high-street optical setting.
No GP referral needed. Speak to our team at 140 Harley Street.
Book a paediatric orthoptic assessment
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