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Behavioural Optometry

Behavioural Optometry Blog

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”. [1]

Australian statistics

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.

Vision therapy

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”.[2]
  • 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”.[3]
  • 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.

    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



    How often should I have my eyes tested?

    eye test in Jannali

    As an optometrist, I am regularly asked: “how often should I have my eyes tested?” Keep reading for my recommendations, but first some interesting facts about our eyes and the statistics surrounding eye health both globally and locally here in Australia.

    An essential factor for living a quality life is good vision. The world in which we live is made visible to us because we have the gift of eyesight. There is continued debate about how many senses human beings actually possess but the big five: vision, hearing, smell, touch, and taste are undisputed. Of all the organs involved in our senses, it is the eye that allows us to receive the most information about our environment, with as much as 80% of all impressions coming first through our eyes.

    A deterioration in our vision isn’t always as a result of the ageing process. There are many diseases of the eye that can occur at any age, so the earlier we start looking after this most complex system, the greater the chance of us maintaining healthy vision throughout our life stages. Ensuring we have regular and thorough eye examinations with an optometrist is essential. Good eyesight isn’t just about seeing well, it’s also a significant factor in lifelong learning, retaining independence and quality of life.

    Eye health globally and in Australia

    According to the World Health Organisation (WHO)

    “… globally, it is estimated that approximately 1.3 billion people live with some form of vision impairment, that the leading causes of vision impairment are uncorrected refractive errors (URE) and cataracts and that up to 80% of these impairments are considered avoidable.”[1]

    According to the Australian Institute of Health and Welfare (AIHW), in Australia, “…more than half (54%) of all Australians report having at least one long-term eye health condition, with nearly half the population wearing glasses or contact lenses.”[2] For those over the age of 55 years, this figure rose to 95%.

    The National Eye Health Survey 2016 funded by the Australian Government “… to determine the prevalence and major causes of vision impairment and blindness in Australia”[3] found that, “the main causes of vision impairment in both Indigenous and non-Indigenous Australians were uncorrected refractive error (URE) (63.39% in Indigenous Australians and 61.69% in non-Indigenous Australians) and cataract (20.22% in Indigenous Australians and 13.93% in non-Indigenous Australians).”[3] They concluded that “… approximately 90% of vision impairment and blindness among both Indigenous and non-Indigenous Australians is preventable or treatable.”[3]

    These statistics may appear shocking, especially when we consider that almost all vision impairments and causes of blindness are either preventable if diagnosed early, or treatable, but it does highlight the importance of regular eye examinations.

    How often should my child’s vision be tested?

    Good vision is imperative for a child’s development. They can not be expected to develop academically, physically or socially if they are unable to see properly. Optometry Australia states that up to 20% of Australian children are affected by an undetected visual impairment, which will be impacting on their development. As a result of this, “Optometry Australia recommends that children have a full eye examination with an optometrist before starting school and regularly as they progress through primary and secondary school, to allow them the best chance of reaching their full potential.”[4]

    Paying attention to your child’s behaviour when they are at home and at play can give you some indication of whether they are having trouble with their vision. Babies may not follow an object with their eyes, they may not make eye contact, they may not respond to a bright light being turned on or their eyes may move rapidly from side to side (nystagmus). Older children may squint, sit closer to things they are watching, rub their eyes, get tired after doing intensive work with their eyes like reading or seem overly clumsy, bumping into things or falling often. Your child’s teacher may also notice some of these signs in the classroom and should let you know.

    How often should I have my eyes tested once I turn 40?

    After the age of 40, it is common to experience changes in your vision. Some changes are age-related whilst other changes may be due to the fact that as we age into our fifth decade, we become at greater risk of developing certain eye conditions such as:

    • Presbyopia – “a normal condition in which your eyes become less able to focus on objects close-up”[5] While not preventable, it can easily be treated with prescription glasses or contact lenses.
    • Glaucoma – “is the name given to a group of eye diseases where vision is lost due to damage to the optic nerve.”[6] Can be hereditary but irreversible damage will occur if not diagnosed early.
    • AMD – or macular degeneration, “is the name given to a group of chronic, degenerative retinal eye diseases that cause progressive loss of central vision, leaving the peripheral or side vision intact.”[7] AMD can also be hereditary, is incurable but responds to treatment if caught early.
    • Diabetic retinopathy – “occurs when the tiny blood vessels inside the retina at the back of the eye are damaged as a result of diabetes. This can seriously affect vision and in some cases cause blindness.”[8]
    • Cataract – “clouding of the lens inside the eye, causing a gradual loss of vision. Cataracts are very common and can be easily removed and replaced with a plastic lens via surgery.”[9]

    I recommend a comprehensive eye examination every two years between the ages of 40 and 65. This interval may vary dependent on disease risk factors, previous ocular history and whether glasses or contact lenses are currently worn. Obviously, if your vision changes in any way or an eye injury occur, you should book an appointment with your optometrist. As we have learned from the statistics above, it is always better to have an eye examination and be sure, than to neglect your eye health resulting in a disease process developing.

    How often should I have my eyes tested once I turn 60?

    It’s a fact of life that our eyesight changes as we age, often significantly. Having said that however, poor vision and eye health should not be accepted as a way of life and ignored. Many senior members of our community don’t follow the recommended advice of annual eye examinations simply because they think there is nothing that can be done to improve their vision.

    I would like to encourage all those over the age of 60 to have an eye examination each and every year and seek advice from your optometrist on the best treatment available for your particular case. The eye conditions that become more prevalent after the age of 40, also apply to those over 60. By being well-informed and educated about your individual eye health, you will be more able to recognise changes before a sight-threatening disease can become irreversible.

    Another health promoting reason for having an eye examination every year is to help prevent falls and other accidents. The risk of falls in the over 60’s age demographic is real and in many cases, can be incapacitating. Breaking a hip or damaging your spine can take away your independence in a flash. Avoid falls and other unnecessary accidents and get your eyes checked every year!!

    According to Guide Dogs “correct early diagnosis, treatment and support can ensure eyesight is preserved. The signs of eye disease are hard to spot, so having your eyes tested is a simple and vital factor in maintaining healthy eyes.”[10]

    You don’t need a referral to see an optometrist – you can simply make an appointment. Medicare subsidises eye examinations for all Australian children and permanent residents, so you don’t need private health insurance to get your eyes checked. Simply make an appointment today and get on the path to lifelong eye health.


    1. World Health Organisation. 2018. Blindness and visual impairment. [ONLINE] Available at: [Accessed 7 May 2019].
    2. Australian Institute of Health and Welfare. 2015. 1 in 2 Australians affected by eye problems higher for Indigenous Australians. [ONLINE] Available at: [Accessed 7 May 2019].
    3. Vision 2020 Australia. 2016. The National Eye Health Survey 2016. [ONLINE] Available at: [Accessed 7 May 2019].
    4. Health Direct. 2017. Presbyopia. [ONLINE] Available at: [Accessed 7 May 2019].
    5. Glaucoma Australia. 2017. What is glaucoma. [ONLINE] Available at: [Accessed 7 May 2019].
    6. Macular Disease Foundation Australia. 2017. What is macular degeneration. [ONLINE] Available at: [Accessed 7 May 2019].
    7. Vision Australia. 2018. Diabetic retinopathy. [ONLINE] Available at: [Accessed 7 May 2019].


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