De la fragilité et de la plasticité de la fonction visuelle chez l’enfant naît le principe fondamental d’un dépistage précoce des troubles visuels. Des nouveaux appareillages tels la réfraction automatique portable, les tonomètres, les fonds d’yeux numérisés permettent d’améliorer la qualité de ce dépistage. Le problème qui se pose actuellement est celui du manque des ophtalmologistes auquel nous cherchons à palier par la réingénierie du métier de l’orthoptiste et par l’actualisation de leurs compétences grâce aux délégations de tâches.

The fragility and plasticity of visual function in children necessitates early detection and treatment of visual disorders. New approaches such as portable automatic refraction, tonometry and digital fundus examination have improved the quality of screening. The problem now is a lack of ophthalmologists. One possible solution is to redefine the role of orthoptists. The waiting time for an ophthalmologist appointment is very long in some parts of France (up to a year), because of a training quota established in the 1980s, as well as retirements (average age 52 years), and a concentration of specialists in the south of France and around medical schools. Today, France trains only 80 specialists per year, whereas twice as many are needed. Anglo-Saxon countries (US, Canada, United Kingdom) have created a profession — the optometrist — that is intermediate between the optician and the ophthalmologist. This profession is not recognized in France, yet optometrists are capable of detecting many anomalies and quickly referring a child to a specialist.