Our Orthoptist
Katy Wall, BSc (Hons)
Our Orthoptist, Katy Wall BSc (Hons) Orthoptics, trained in a hospital setting before specialising in Visual Processing Difficulties (VPD). Katy has been part of an Orthoptic SEN (Special Educational Needs) team, visiting specialist SEN schools to complete Orthoptic assessments in addition to leading the Reception Vision Screening programme.
Since moving to Cornwall in 2019 she worked for the Royal Cornwall Hospitals as an Advanced Orthoptist and embarked on the role of leading the development of the Stroke-Orthoptic and SEN service until 2023. Katy now practices privately allowing her to dedicate longer appointments and more personalised care to each and every patient.
Katy is also proud work as a Clinical Tutor at the University of Plymouth, supporting Optometry students in the binocular vision clinic.
Katy is very skilled at diagnosing and managing conditions related to binocular vision, or how both eyes work together as a pair. During the examination she will assess how well the muscles around the eyes work to keep the eyes aligned and balanced. She will also assess your ability to maintain clear, focused vision at all distances and how well you can adapt your focusing strength.
Who could benefit from the Orthoptic Clinic?
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Those suffering from double or shadowed vision when looking straight ahead or in a certain position. This can be constant or may come and go.
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Those who wish to reduce their dependence on, or reduce the strength of prismatic glasses or where it is not possible to add more prism into glasses.
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Those who struggle to maintain focus on close work or struggle changing focus between distance and near.
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Those with symptoms of Visual Stress or Visual Processing Difficulties
Visual Stress & Coloured Overlay Assessment
Visual stress is a condition that causes discomfort when reading black text on a white page. The high contrast ‘striped’ effect is thought to cause a brain cell over-excitation response. The result can be visual symptoms such as seeing words move/shimmer, rivers/patterns, blurred vision and difficulties reading black text on the board. Glare and bright lights can worsen symptoms.
Visual stress can cause reading difficulties and discomfort. Signs include fidgeting when reading, blinking/rubbing the eyes. Glare and bright lights can worsen symptoms. Research has shown that 15 to 20% people suffer with some level of visual stress, although not everyone finds it debilitating.
The visual cortex is the part of the brain involved in processing visual information. The cells in this area become overstimulated by the ‘striped’ pattern of black text on a white background which is specific to certain-sized stripes/text. A handful of well-spaced words in a large font-size would not stimulate visual stress (e.g. in early readers’ books). For this reason, a visual stress diagnosis in children under 7 years of age is rarely appropriate. Where there are more sentences per page, the text size typically decreases, which thereby amplifies the ‘’pattern’’ effect and gives rise to symptoms.
Coloured overlays/filters work by changing the wavelength of light entering the brain as a person reads. This means that the information is redirected slightly, which dampens the brain’s over-stimulatory response. The colour required is specific to each individual, and in the first few months of using an overlay, it is common for the required colour to change. For most, a coloured overlay or basic coloured filter lenses work well to reduce visual stress symptoms in a simple, cost-effective way. Occasionally, patients will need a very specific colour to relieve their symptoms. In these cases, the colour will need to be determined by the use of a colourimetry machine.
Who Can Experience Visual Stress?
Visual stress can occur as an isolated condition in an otherwise healthy individual, with approximately 20% of the general population being affected. The prevalence is reported to be slightly higher in those with other conditions, including dyslexia, multiple sclerosis and migraine sufferers. It’s important to be aware that whilst coloured overlays/filters may reduce symptoms, it does not improve the condition itself. The use of these should be considered as ‘symptom management’ rather than a ‘treatment’ or a ‘cure’
Can an overlay be used without an assessment?
Many schools and educational professionals are now providing children with coloured overlays; however we strongly recommend that any child suspected of suffering from visual stress or visual processing difficulty has a full eye examination and binocular vision assessment as using an overlay without a proper assessment can lead to the masking of other treatable visual problems.
The terms Meares-Irlen syndrome and scotopic sensitivity syndrome are frequently used around the topic of coloured overlays and lenses but neither of these terms will be used or diagnosed in the clinic. You may notice a lot of the symptoms described in these syndromes overlap with ‘Visual Stress’.
Below are some of the symptoms of visual stress:
Orthoptic Visual Processing Difficulties (OVPD) clinic or Specific Learning Difficulties Clinic (SpLD) can positively impact a child’s learning journey, too. Following VPD input and equipping them with the visual tools they need to access their curriculum more effortlessly, patients gain a new-found confidence which in turn empowers them to move forwards and fulfill their true potential.
What will happen at my appointment?
1. Review of Questionnaire
You may be asked to complete a short questionnaire before your appointment so that Katy can assess your vision needs and see which issues are causing you the most problems.
2. Your First Appointment
Katy will undertake an Orthoptic assessment to test your vision, eye movements and binocular vision to see how well aligned your eyes are and how much control you have over maintaining this alignment. She will assess your convergence which is the ability to keep the eyes aligned well for close work to avoid double vision and also your focusing abilities.
If a complete VPD assessment is indicated, Katy will also assess your saccades (eye tracking ability) to check their accuracy as difficulties with these can cause reading difficulties, particularly with losing place, skipping/re-reading words. She will test for visual stress and, if appropriate, carry out a coloured overlay assessment. Finally, she will assess 7 separate visual perception skills which are necessary for everyday activities such as writing and learning. Difficulties with these skills can contribute to problems such as letter reversals and difficulties copying from the board.
3. Follow-up Appointment
For general orthoptic appointments, your follow-up appointment is likely to be very similar to the first assessment, checking for improvement in the condition.
For VPD patients Katy may re-test any troublesome areas from the previous appointment and amend your treatment plan accordingly. She will check your progress with the coloured overlay (if appropriate) and continue working through any unfinished assessments.
4. Summary Letter/ Report Writing
After the assessments are completed, Katy will create a detailed explaining any difficulties found, along with treatment advice and management strategies. You will be sent a copy of this. With your consent, a copy will also be sent to your school/college/workplace with guidance of how they can support you.
Requirements
Up-to-Date Eye Test
Before we book you an appointment in our orthoptic clinic, we will make sure that you have an up-to-date eye examination, if not, we will first book you in for an eye exam with one of our Optometrists. This is important to first check whether glasses could help to improve your vision or symptoms and to check that your eyes are healthy.
Minimum Age
The minimum age for the VPD clinic is 7 years. Children should be familiar with letters/phonics and have begun reading, even if finding it difficult. If you have specific concerns about a younger child, please contact us for further advice. This age limit is only for the visual processing tests- Katy is qualified and happy to assess patients of any age from babies and beyond, to ensure that their eyes Are working together and that vision is developing as it should.
Fees
A general Orthoptic appointment is up to an hour long and costs £100
A full Visual Processing Disorder assessment can require up to 2.5 hours of clinic time and costs £250. This may be split over 2 separate appointments.
Reports: full VPD written reports for school are charged at £40 and are completed after the full assessment.
Coloured Overlays cost from £2 per sheet.
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If you would like further information or to speak to a member of our team, get in touch today