Behavioural Optometry

Behavioural Optometry is a whole-body approach to vision care.  The way that you interpret what you see does not depend solely on how clear your eyesight is.  A Behavioural Optometrist has a special interest in vision beyond the eye-ball.

choosingYour Behavioural Optometrist will not only consider the treatment of any eyesight difficulties but also the benefits of prevention, protection and enhancement of your visual system in order to improve all aspects of your visual performance.  Some Behavioural Optometrists focus on particular areas of practice such as children’s vision, sports vision, education and learning difficulties, stroke and head injury or even preventing short sightedness.

Goals of Behavioural Optometry

  • To prevent vision and eye problems from developing
  • To provide treatment for vision problems that have already developed (eg: eye turn, shortsightedness etc)
  • To develop and enhance the visual skills needed in the classroom, work place, when playing sport and having fun

To achieve these goals your Behavioural Optometrist may recommend:

  • Advice to prevent or reduce the possibility of eye problems developing
  • Appropriate prescription of glasses
  • Vision Therapy to enhance and develop vision

Defining Behavioural Optometry involves understanding VISION and how it is different from EYESIGHT. Traditional optometry is more involved with EYESIGHT whilst Behavioural Optometry is more interested in VISION.  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.

Eyesight

Eyesight 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.

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

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 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

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.

Which patients could 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.

Computer Vision Syndrome

There has been an explosion of electronic media in recent times and rather than just reading and writing we are now spending significantly more time looking at electronically produced information. All this means that we are spending much more time concentrating at near distance in a sustained way over extended periods of time. This is especially true in the younger generation and raises serious concerns for developing eyes and visual systems.

Research shows that 40 percent of 3 to 4 year olds use the home computer each day. Ninety percent of 15 year olds have mobile phones and more and more phones are now able to access the internet and social networking sites.

By age 12 children on average spend over two hours per day watching TV and two hours more on computer. By 18 these times have increased by another two hours. Additional school time and time spent on mobile phones mean that concentrated indoor tasks account for a significant percentage of waking hours.

Time spent on social networking sites has increased significantly in the last two years, and with this comes an increase in visual difficulties associated with using electronic media.

This has spawned the term “Computer Vision Syndrome”.

No Visual System is Perfect

Computers in themselves do not cause any damage to your eyes in terms of eye health or visual skills, but computer use is very visually demanding and will highlight any existing visual deficits.

Using computers means you have to:

  • Focus at one distance for long periods
  • Keep a posture that is not the same as most other visual tasks
  • Sit and attend for long periods
  • Look at a bright screen that may be flickering
  • Focus on electronically produced print that may be flickering

There is no research that shows that looking at a computer screen all day will actually create vision or eye problems. In fact research has shown that computer use will highlight any underlying problems that may pre-exist.

Signs of Trouble

You may experience some or all of the following:

  • Headaches
  • Eye strain
  • Irritation
  • Distance blur after computer use
  • Dry, red or itchy eyes
  • Glare

Avoiding Problems

When we spend prolonged periods staring at screens, the visual system can exhibit signs of stress such as discomfort around the eyes or distance vision not appearing as clear as it normally is.

There are a number of proactive measures you can take to ensure your eyes feel fresher and to protect your vision into the future.

Posture

Headaches after prolonged computer use may seem like they are due to eye problems, but poor posture may actually be the cause. Be aware of this, relax and breathe. Sit up straight. The screen distance should be arm’s length for desktop computers, a little more than reading distance for laptops, and tablets should be the same as reading matter – forearm distance from your nose.

Rest

Looking at a screen all day will mean that your eyes are focussing at just one distance. This would be the same as holding your arm horizontally without moving all day – would be tiring wouldn’t it? Well that’s what you’re asking your eyes to do when looking at a computer screen. Looking away from your screen and getting up for a break every now and then will help keep your eyes rested.

Behavioural Optometrists recommend taking breaks from computers, phones and tablets every 15 – 20 minutes to keep the eye muscles moving. Look up, focus on other objects around you, close your eyes and roll them widely a few times before resuming work.

Room Lighting

Ensure the room lighting is similar to the screen brightness.

Screen Brightness

Some people find glare more of a problem than others. If you can’t adjust the screen to a level that is comfortable, you should see a Behavioural Optometrist who can assess your binocular visual system and advise what is best for you.

Don’t Over-Do It

Vision develops better during activities such as reading and active play. Alternate periods of intense screen viewing with periods of outdoor play or sport, which require distance vision.

How can a Behavioural Optometrist Help?

  • They will discuss your specific requirements for computer use.
  • They will test and assess your focus and eye alignment systems.
  • They will check that your binocular vision system can maintain visual attention for periods of time.

Solutions may include:

  • Spectacles for computer use
  • Vision therapy
  • Visual hygiene advice
  • Drops for dry eyes

If you are short sighted (myopic) a Behavioural Optometrist can advise whether it is best to remove your glasses for sustained computer use. Behavioural Optometrists recommend that the entire family have their vision checked every two years, regardless of whether there is a vision problem or not. A regular eye test will reveal signs of eye strain and diseases, and ensure that the visual system is functioning optimally.

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.

Cool for School

Preparations for the first day of school are many; uniform, school bag, lunch box, favourite toy or book – all in preparation for the adventure and discovery of learning and life at school.  But in this excitement and anticipation, many parents overlook the most important learning system their child has their eyes and vision.

While your child might have had their immunisations, physical or dental check ups, what about how well your child processes information once they’re in the classroom? Has that been checked?  How do you know your child is really ready for school, and what do you need to do to make sure?

Getting ready to learn

Ensure your child is ready to learn by testing the development of their vision and hearing.  In that way, you can expose a removable roadblock that might otherwise interfere with their learning.

It’s reassuring to know that a child’s vision problems can be detected and prevented before affecting their performance at school.  A child who has learning-related visual problems can usually be taught to learn better through the use of lenses for near work and optometric visual training.  Then, these learning tools become as important as the pens, pencils, books and computers they will use throughout their schooling years.

A school eye test may be too little, too late

Many children receive a school eye test once they’re at school, but unfortunately these tests often only detect the most obvious eye defects.

Usually it’s the Snellen wall chart that tests if your child can see letters from a distance.  That’s the chart with a large black letter on the first row, two smaller sized letters on the second row and then progressing down the chart to the smallest letters along the bottom row.  This test doesn’t measure your child’s abilities to see at a near, reading or writing distance – the distance where most learning takes place.

Some eye specialists also test for ‘refractive error’, but that test too does little more than the Snellen test.  Vision is a complex process and seeing clearly, measured by the Snellen test, is only one part of the process.

The connection between vision and achievement

Vision is critical to learning; it’s your child’s most dominant system for getting information.  Vision is a mental process; it involves working out where objects are in space, their form, distance and colour, the control of speed and direction of movement.  Though once thought to be inherited, these abilities are also learned – they develop and change throughout life.

Our best learning takes place when we use both of our eyes together, efficiently.  Learning is easier when we combine visual information with the information we receive through our other senses such as hearing, touching and moving.  So if our eyes aren’t working as a team the impact on processing information and in turn learning can be dramatic.

To do all of the things required at school – solve maths problems, play ball sports, read and understand information – your child needs clear sight… and much more.

A little about lenses

Lenses can be prescribed for many reasons and correcting acuity is just one reason.  Lenses can be prescribed for near tasks such as reading, crafts and computer use, making vision easier.  They also aid slow or poor focusing, imbalance of the eyes and other visual problems.  Lenses help make sight clearer – both near and far – and lenses for near can reduce the stress of reading.

What is Myopia?

This medical term describes when a person cannot see distance objects clearly without the need for a corrective minus lens. The traditional view is that light entering the eye from the distance is focussed too early and so the image is blurred. It is also known as near-sightedness or short-sightedness.

People with myopia are often those who enjoy reading or using a computer a lot, but this doesn’t necessarily mean that their near vision is better than those who do not have myopia.

How common is myopia and when does it start?

In Australia, it is estimated that 20% of adults have myopia and it is generally accepted that the first symptoms of myopia are experienced around puberty. In Asian cultures where children start learning characters at 3 years old, the prevalence of myopia can be as high as 80% of the population.

Recent research has suggested careful screening of children at age eight may help identify those children who are at risk of developing myopia. The scientific community also now agrees that myopia is associated with environmental factors that are responsible for its progression.

Current research is investigating the interaction of prolonged focussing effort with close tasks, eye lid pressures and poor lighting as aetiological factors in the development of myopia. However the exact mechanism is still not known.

What can be done?

Currently there is no cure for myopia. However, recognising that prolonged near tasks may be a contributing factor for the genesis of myopia, your behavioural optometrist will advise you on proper posture, working distance, lighting and other techniques to help reduce the impact of near visual stress.

A lens to make distance viewing clear is the simplest treatment, but is not necessarily the best correction for myopia. It compensates for the distance blur but does not treat any focussing and eye-teaming problems that may also be present and which may be contributing to the myopic progression. Your behavioural optometrist may need to prescribe special spectacle lenses such as enhanced near vision lenses, bifocals or multifocals as a way of clearing the distance blur and at the same time assisting in treating the focusing or eye-teaming problems. Vision therapy may also need to be applied.

Other corrective options available are contact lenses, surgery and accelerated orthokeratology. Clinical trials have indicated that wearers of rigid gas permeable lenses and orthokeratology lenses show a decreased rate of myopia progression.

Orthokeratology involves using a specially designed contact lens to reshape your cornea while you sleep. Upon waking you remove the lens and enjoy good daytime vision without the need for spectacles or contact lenses. Orthokeratology is reversible and so does not permanently cure your myopia.

If you require more information on Behavioural Optometry please visit www.acbo.org.au