Behavioural optometry involves an understanding of vision and how it is different from eyesight. Eyesight is seeing letters on an eye chart, while vision is something that is developed over time. It requires efficient functioning of the eyes, development of visual perceptual skills and integration of what we see with other senses. According to the Australasian College of Behavioural Optometrists the practice of behavioural optometry, “considers your vision in relation to your visual demands, such as reading, computers, and learning to read and write, to ensure your vision is working easily and comfortably. The way that you interpret what you see does not depend solely on how clear your sight is”. 
When we consider that one in four Australian children have a vision issue and one in five suffers from an undetected eye health issue which may impact their educational and social development; the need for comprehensive eye screening and treatment is paramount. The two most common vision issues in children – amblyopia (impaired vision in an otherwise normal eye) and refractive error (a problem with focusing light accurately onto the retina due to the shape of the eye) – can only be detected with monocular visual acuity screening.
Vision and learning
A child with an undetected vision problem may experience difficulty learning in the classroom. The task of “learning” requires efficient visual function. Eye movements, focusing (accommodation) and ocular alignment at different distances (vergence) are visual skills necessary for success in the classroom. These three aspects of visual function, if not working efficiently, can affect a child’s visual information processing and ability to learn. Concentration and comprehension will suffer when there is too much effort required for clear and single vision. A referral to a behavioural optometrist for further examination should be the next step.
Goals of behavioural optometry
The goals of behavioural optometry are no different from general optometry and include:
- the prevention of vision and eye conditions,
- the provision of evidence-based treatment for vision problems that have already developed, and
- confirmation that the visual system is developing normally and working effectively, as needed in the classroom, workplace or sports arena.
Assessment and treatment
To achieve these goals the behavioural optometrist would conduct a comprehensive assessment, involving much more than simply checking how well the child “sees” letters, numbers and shapes on an eye chart. The assessment will check clarity of sight at distance and near; the ability to align and focus the eyes; tracking and eye movements; processing of visual information, ability to sustain focus; eye teaming and the general health of the eyes.
Advice and/or treatment recommendations all depend on what the behavioural optometrist finds through examination. Simple advice such as increased playtime outside or getting the child to look up every 15 min or so from their book may be given to help prevent or reduce the possibility of eye problems occuring, or glasses may be prescribed to correct refractive errors. A behavioural optometrist may also prescribe the child vision therapy to develop functional vision and visual perception skills to age-appropriate levels, allowing the child to reach their potential.
The goal of vision therapy is to help “teach” the visual system to correct itself. Unlike glasses and contact lenses which compensate for issues within the eye, vision therapy aims to get the complete visual system working together correctly. The behavioural optometrist will design a program based on the specific visual needs of the individual child. Therapy may include the use of computer-assisted visual activities to train peripheral vision, eye coordination and depth perception.
Vision therapy is effective in treating:
- Amblyopia (lazy eye, wandering eye) “occurs in early childhood when nerve pathways between the brain and an eye aren’t properly stimulated, resulting in the brain favouring the other eye”.
- An intermittent form of Strabismus called convergence insufficiency which is “inability to keep the eyes properly aligned when reading despite good eye alignment when looking at distant objects”.
- Phorias which are subtle eye alignment problems that cause eye strain and fatigue when reading.
- Eye movement disorders occur when both eyes don’t move in perfect synchronicity with each other
- Accommodative (focusing) problems may be improved with vision training.
Steps to follow if you suspect your child has a vision problem
- Book a routine eye examination to rule out refractive errors such as myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism.
- If after the routine eye examination:
- no prescription glasses are required or there has been no change in your child’s current prescription,
- each eye has 20/20 vision – “a term used to express normal visual acuity (the clarity or sharpness of vision) measured at a distance of 20 feet”,  however,
- your child is still having difficulty learning in the classroom, reading or playing sports,
- Consider a comprehensive behavioural optometry consultation. As we have learned, a routine eye examination fails to assess all aspects of a child’s visual performance, such as eye teaming, focusing, depth perception, subtle eye movements, as well as visual-motor and visual-perceptual skills.
If you have any concerns about your child’s overall visual performance, call and book an appointment today with one of our experienced behavioural optometrists on 02 9528 6991