Behavioural Optometry
What is Behavioural Optometry?
Vision is more than just good eye focus. Behavioural optometry looks at your eye health and ability to see with 20/20 vision, then adds to this an examination of the development and efficiency of the visual system and information processing by the brain.
Who is Behavioural Optometry for?
Both children and adults may benefit from the behavioral approach. When struggling to learn at school, assessments of visual efficiency and visual processing along with therapy programs to help to get the eyes up to peak efficiency, are all very useful parts of behavioral vision care. Behavioural Optometrists provide many treatment options that may assist a child with vision difficulties. Sometimes a carefully planned pair of glasses can support vision, or for some conditions a program of therapy involving exercises and activities can help. Our optometrist Clare Campitelli will provide you with specific recommendations about the findings from your vision examination. For additional information please follow this link to the Australasian College of Behavioural Optometrists.
There is also a resource of scientific information about aspects of Behavioural Optometry
Adults may benefit too, particularly when their visual system is not working optimally for them. We need our vision to be there for us when we walk, drive, use a computer or play sport. When our visual system works well we don't think about it, just like a comfortable pair of shoes. Behavioural Optometry may help when vision stress arises - this might be due to a change in workplace environment or increase in screen use , or may help to re balance the visual world of a person who has had a head injury. That's what behavioural optometry is about, having excellent vision to support you so you can get on with life.
Behavioural Optometry and Learning Difficulty
When a child is not reaching their full potential at school – the big question is “why?”
The visual input into our brains is enormous – approximately 1.2 million nerve fibres make up our optic nerves (the nerves which carry information from our eyeballs – to our occipital cortex at the back of our head). This is much bigger than any other input into the brain (such as from fingers, nose or ears).
While not every child’s problem is vision related, a behavioural optometrist can rule out vision as a significant cause of learning difficulty. The behavioural eye examination will assess for the following:
Eyesight and Eye Health
Can the eyes see clearly? Are the eyes healthy? This is the basis for any eye examination and is thoroughly investigated. Naturally a person with blurred vision may be deterred from learning efficiently.
Visual efficiency
Examining the eyes of a child should not stop with eyesight. Good eyesight does not mean that there is necessarily good vision. A person can see well, yet still be bothered by symptoms of an inefficient visual system. Headaches, eyestrain, and poor concentration can be due to poor focus control or difficulty with eye teaming or tracking. As a behavioural optometrist, Clare takes time to search for visual inefficiency which is very common in school children – particularly with the increase in screen use that commonly occurs from early primary school. Managing these symptoms and helping the eyes to focus and track more easily without straining, can often result in benefits such as improved reading efficiency, comfort, and enjoyment. Visual efficiency problems are often managed using prescription glasses.* Vision therapy is another tool used to help a person to improve visual efficiency.
* Vision screening outcomes of Grade 3 children in Australia: Differences in academic achievement.
Sonia L.J. White, Joanne M Wood, Alexander A. Black, Shelly Hopkins. International Journal of Educational Research. Volume 83, 2017, Pages 154-159
Visual stress syndrome
A very small percentage of people experience visual stress when looking at material with stark contrast (such as black text on a white page). Visual stress ( Meares Irlen Syndrome/Visual Stress - MISViS*) causes discomfort when looking at text, symptoms include the sensation that the words are moving on the page. This is not as common as visual inefficiency (above) but is a significant difficulty for some people. This visual stress (which is sometimes associated with forms of dyslexia) can be detected in a behavioural eye examination.
* The British Dyslexia Association. http://www.bdadyslexia.org.uk/dyslexic/eyes-and-dyslexia
* Computerised screening for visual stress in children with dyslexia. Singleton C. Henderrson LM. Dyslexia. 2007 May; 13(2): 130-51
Readalyzer tracking assessment
Children who are in Year 3 and above should be reading fluently. When we ask them to read aloud and the fluency is poor - it is difficult to know whether this child has a problem with the language/spoken aspect of reading aloud, or if it's a difficulty with the visual part of reading (or both) The readalyzer is an excellent tool for helping to pinpoint the difficulty. When using the readalyzer the child reads silently. The eye movements are tracked using infra red sensors. At the end of the passage there are a series of questions to test comprehension. If a child reads well in silence, with excellent eye tracking patterns we can tell that their reading difficulty is not visual. If the child has a poor eye tracking pattern however we know that there is a problem with visual eye tracking or at the very least visual attention.*
*Slow reading in children with anisometropic amblyopia is associated with fixation instability and increased saccades. Kelly KR, Jost RM, De La Cruz A, Dao L, Beauchamp CL, Stager D Jr, Birch EE. J AAPOS. 2017 Dec;21(6):447-451.e1. doi: 10.1016/j.jaapos.2017.10.001. Epub 2017 Oct 9.
https://www.acbo.org.au/for-patients/evidence/vision-learning-difficulties
Visual perceptual processing
This refers to a number of skills which our brain uses to take in visual information from our surroundings and integrate it with our other senses to create meaning and understanding. The processing of visual information gives meaning to what is seen. Behavioural Optometrists are able to assess visual processing ability in children who are struggling with literacy and learning. we do this using a series of standardized tests of visual perception. We look at processing skills such as visual anaylsis, visual spatial awareness, visual sequential memory, visual digit span ( chunking) and visualization( similar to working memory). Results are compared to aged based norms and we are able to see if a child is performing visually to the level expected for age. Therapy to improve visual processing skills can be prescribed when problems with processing are found.
Raven's Coloured Progressive Matrices Test
Clare uses this assessment as part of her visual processing assessment set. This is a visual pattern matching task but is devised by and used by psychologists to give a non verbal measure of intelligence. Clare has been trained to use this test and it provides a valuable addition to the other visual tests undertaken. Often a child who is underperforming at school is found to be very bright for their age - leading to a high level of frustration for them. She may also find that a child is not coping with visual pattern matching - indicating either a strong need for therapy or a need for further educational support or assessment.
Symptoms to watch for
Some of the more common symptoms of vision related learning difficulty are:
- Squinting or excessive blinking when reading/writing
- Looking very uncomfortable when reading/writing – (wriggling, holding the page close, moving the head excessively)
- Coming close to the board in order to see.
- Covering one eye
- Reversing words/letters/numbers when reading or writing (eg b/d/p/q on/no was/saw)
- Poor reading fluency
- Poor reading comprehension
- Skipping words or lines of text when reading
- Making mistakes on the little words (e.g: as/a /it/by) when they should be easy and well known.
- Gives up easily – is daunted by large amounts of text, or smaller text than usual – doesn’t want to read
- Academic under achievement
If you notice symptoms such as these or if you are concerned that your child is underachieving, examination by a behavioural optometrist is most certainly worthwhile.
Outcomes of a behavioural optometry examination might be:
- glasses to help the eyes to focus, point together or track the words on the page when reading
- vision therapy to develop vision when there is a " lazy" eye, skills such as eye tracking and/or to help visual processing skills such as understanding the orientation of letters (e.g.b/d/p/q)
- referral on to another professional to look at the problem from a different perspective ( ie Educational Psychologist, Speech Pathologist, Audiologist, Occupatioinal Therapist, Special ed Teacher)
This handy checklist of symptoms is a great resource for teachers/parents. Use when a vision problem is suspected. To score, give 0 to a symptom that never occurrs, 1 to a symptom that is "seldom', 2 if "occasionally", 3 if "frequently" and 4 if "always". A score of more than 20 on the checklist indicates that a vision problem is highly likely.*