Orthoptic indications for contact lens wear

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Nearly all primary eye care examinations in this country are carried out by optometrists. Conservative estimates suggest about 5 per cent of patients seen in a typical primary eyecare practice will have orthoptic anomalies,1 meaning all primary care optometrists need to have a working knowledge of orthoptics, even if they specialise in contact lenses.

There are some orthoptic conditions that contraindicate certain types of contact lens wear. For example, monovision is contraindicated in binocular vision anomalies that are prone to decompensate, such as some cases of strabismus, incomitancies, or poorly compensated heterophoria. People with superior oblique palsies often adapt by holding text higher than usual which may contraindicate alternating vision multifocals, including spectacles and contact lens designs.2