Defining Behavioural Optometry involves understanding VISION and how it is different from EYESIGHT. In addition to the assessment of eye health and eyesight, behavioural optometry encompasses the contribution of general physical and mental development along with the development of the other senses.
WHAT IS EYESIGHT?
EYE SIGHT essentially refers to the physical attributes and performance of the many organic components involved in the visual system. Thus there is a high emphasis on structure, pathology and measurements of function of these components.
20/20 vision is a commonly quoted measure of normal VISION, yet it simply describes the sensitivity of the eye to see fine detail in the distance. This is certainly an important measurement but having 20/20 vision does not guarantee that a person can read. Reading requires good VISION.
WHAT IS VISION?
In most instances VISION uses EYESIGHT as its foundation. So understanding all aspects of traditional optometry is extremely important to a Behavioural Optometrist. Unlike Eyesight, which is strongly related to the performance of components in the visual pathway, VISION is a thought process. VISION combines information from many sensory systems to create a perception of reality.
VISION uses information from all the senses, including hearing, smell, touch and even the taste sense, which is then combined with information provided via EYESIGHT. All this is in turn processed, linked to memory and an image of the world or object is created. This overlay of the senses is evident in the Thalamus, a key component of the brain, which regulates which sensory modality is being accessed at any point.
VISION is learned, so understanding the normal developmental pathway of an infant, through to child to teenager to adult is extremely important to Behavioural Optometry. A child with limited environmental experiences is more likely to show abnormal development of VISION. Likewise a child with deficiencies in the physical structures that provide the
initial sensory information is also more likely to show abnormal development of VISION.
A child with a VISION problem may experience a learning delay that is not necessarily related to intelligence. Intervening to provide the stimulation required to encourage more normal development of VISION is one of the goals of Behavioural Optometry.
Many adults who once had normal VISION may experience poor VISION after sustaining head injuries, strokes, car accidents and neurological disease (such as Multiple Sclerosis) as brain function is often impacted. Behavioural Optometry aims to understand the role of brain function in VISION, thus providing opportunities to help these people.
VISION IS MOTOR
Society has become increasingly complex, requiring that VISION be used to complete tasks for which it was not designed. VISION is Motor. VISION creates a three dimensional reality that can be used to plan motor activities to allow physical interaction within the environment in order to survive.
Crossing a road uses VISION. Looking ahead and then to the left and right provides information about the distances of the key objects involved in the task. The mind then calculates if the body has enough time to take enough steps to cross the road before being hit by a car. Good VISION is essential to survival!
VISION is learned which is why parents hold the hand of a child crossing a road. VISION is learned, through experience and motor interaction within the environment. Abnormal VISION can be improved by providing an environment that triggers key developmental processes in an appropriate order. This is one of the key reasons why Behavioural Optometry integrates body movement activities within training programs. It is also why simple computer only programs are not as effective in treating VISION problems.
Treating VISION is the goal of Behavioural Optometry. Recent research into neural development has confirmed the validity of many of the strategies promoted by Behavioural Optometry. This research falls under the banner of Neuro Developmental Optometry and is an exciting new area of study.
Behavioural Optometrists use a wide variety of tools and modalities to achieve their goals. These include:
Lenses (single vision, bifocals, multifocals, tints, prisms and occlusive) to modify the sensory input from “EYESIGHT”
Gross motor activities to assist with integration of body knowledge with other senses, especially “EYESIGHT”
Eye exercises with specific goals to encourage an awareness of how information enters the visual system as well as an awareness (and hence control) of the ocular motor systems.
There are even more specific therapies such as syntonics, colorimetry and neuro feedback programs which some more experienced Behavioural Optometrists may adopt, depending on the patient profiles and goals in therapy.
There is no one specific mode of practice, although there is commonality in the goals. Some practitioners offer in-office therapy where all the work is done within the professional rooms under the guidance of a therapist. Others may use the in-office attendance simply to review findings and provide new activities to be performed at home under the supervision of a carer. Others may simply provide a software program to treat a disorder of VISION.
WHY EXPERIENCE MATTERS
The mode of practice typically reflects the knowledge base of the practitioner. Those more experienced tend to provide in-office or guided home therapy. Fellows of ACBO (FACBO) are also more likely to do so, having completed a rigorous program involving private study, open and closed book examinations, clinical research and oral assessment. Fellows are the most experienced and skilled members of ACBO, and are identified by a gold star and highlighted priority listing on the ACBO website member directory.
Different practitioners may describe their services in different ways. Those working with learning delayed children may call the assessment anything from a “visual perception examination” to “readiness for reading review”.
Each Behavioural Optometrist brings a unique approach to helping patients with a VISION problem, and may use a variety of treatments. Different practitioners have specialised in fields ranging from turned eyes to learning delays to brain injuries which in turn modifies the clinical models and approaches used.
GOALS OF BEHAVIOURAL OPTOMETRY
The goals of Behavioural Optometric care are:
- To prevent VISION problems and eye problems from developing
- To provide remediation or rehabilitation for VISION or eye problems that have already developed (eg. eye turn, shortsightedness, visual sequelae of brain trauma etc)
- To develop and enhance the visual skills needed to achieve more effective visual performance in the classroom, work place, when playing sport and following recreational pursuits.
WHICH PATIENTS MAY BENEFIT FROM BEHAVIOURAL OPTOMETRY?
All patients will benefit from the more holistic approach but it is especially suited to those with eye motor control problems, lazy eyes, developmental delays, neurological damage or learning delays.
Although the majority of Behavioural Optometrists' patients are children, Behavioural Optometry may be suitable for patients of any age if their condition is likely to respond to this treatment.
FREQUENTLY ASKED QUESTIONS
SO WHAT IS BEHAVIOURAL OPTOMETRY?
Behavioural Optometry is many things to many people even within the profession. The common link is the understanding of vision and how to encourage its development. It tends to be more holistic in its approach as it tries to incorporate the physical, neurological and developmental aspects of vision.
HOW IS A BEHAVIOURAL OPTOMETRIST DIFFERENT?
Behavioural Optometrists spend years in post-graduate and continuing education to master the complex visual programs that are prescribed to prevent or eliminate visual problems and enhance visual performance.
Not all optometrists practice Behavioural Optometry, which includes neurodevelopmental and functional optometry.
ASK THE FOLLOWING QUESTIONS:
Do you assess and treat children?
Do you test their vision at the reading/writing distance?
Will you provide a report on your findings?
Do you offer vision therapy, or do you refer to someone who does if it is indicated?
IS BEHAVIOURAL OPTOMETRY COVERED BY MEDICARE OR PRIVATE HEALTH INSURANCE?
Most initial consultation fees fall under the scope of Medicare. More specific services and Vision Therapy may or may not. It is essential to discuss this with your Behavioural Optometrist prior to commencing any program.
derived from the Australasian College of Behavioural Optometrists, with thanks.