We are grateful to Gold Coast based optometrist Paul Graham on providing his perspective on behavioural optometry. Paul is a Fellow of the Australasian College of Behavioural Optometry, and the owner of Harmony Vision.

“Today, most people have a sense of what an optometrist does. But when I first graduated and told people what I did for a living, they’d say “opto-what? Is that something to do with teeth?” Most people associate optometrists with getting glasses or contact lenses but over time that our scope has grown and changed. Now, we check eye health and look for eye diseases like glaucoma and macular degeneration too.  And as of recently, optometrists can do extra training to become approved for prescribing eye medications to treat a limited range of eye conditions.

This ‘typical’ role is mostly based on enhancing or preserving the clarity of your sight. However, clarity of sight as measured by the size of letters on a distant letter chart is just a small part of the process of seeing.  It is estimated that 30-50% of the brain is involved in seeing, which includes guiding our actions, directing attention, balance and peripheral vision.  Much of this aspect of seeing has little to do with clarity.

This is where Behavioural Vision Care or Behavioural Optometry comes in.  Vision is an integral part of overall human behaviour.  Seeing, movement and communication are linked and interwoven closely. Behavioural vision care is not alone in this perspective, visual neuroscientists, like Janette Atkinson, also recognise in their research that vision and action in humans are not separate events in child development.

Behavioural optometrists take a holistic approach when it comes to the assessment and treatment of patients. In addition to eye health and sight, the person’s ability to easily direct attention (track and fixate), use the two eyes together as a team, maintain good focus and process visual information are assessed to make sure that the person is able to meet the visual demands of life, study, work and play. This approach recognises that:

Vision is learnt – We are born with the potential to see, but the act of seeing must be learnt with development and experience, in the same way that we are born with the potential to stand and walk, but need to learn how to do it. Poorly developed visual skills are associated with difficulties with academic performance, co-ordination and balance.

Vision integrates with other senses – It is estimated that at least one fifth of the visual pathway from the eyes is directed towards centres for integrating proprioception and vestibular input.  This pathway is not used for conscious seeing and this part alone is larger than the auditory system.  Poor integration can result in motion sickness, clumsiness or poor co-ordination and may result in dizziness or nausea when eye-strain is present.

Stress and injury modifies vision – Doing a lot of close work is recognised as putting cumulative stress on the visual system resulting in problems of concentration loss, decreased reading performance, headaches, sore/tired eyes and sometimes blur and/or double vision. Just as brain injury can result in difficulties with movement and speech, vision can also be affected.  A case history taken under BVC model asks a lot of quality of life and performance questions to ensure that all aspects that can be impacted by poor vision are identified.

Vision can be modified – Vision therapy is like physical therapy for the visual system and uses activities that assist a person to develop more efficient visual skills to improve concentration, co-ordination and reduce symptoms.  It is used when there are vision related attention and learning difficulties, eye-turns/lazy eyes, motion sickness, for sports vision and for visual rehabilitation after whiplash and brain injury.

Additionally, spectacles can be prescribed in way that reduces fatigue, stress and strain and not just to correct sight. This may include anti-fatigue lenses, prism and/or coloured tints.

The powerful changes in the quality of life people achieve in vision therapy or even with a fresh perspective on what prescription they wear is a very rewarding part of optometry.  For this reason, behavioural vision care is an integral part of our Gold Coast based Optometry and Vision Therapy Clinic www.harmonyvisioncare.com.au.

The Australasian College of Behavioural Optometrists (The ACBO) provides education for optometrists and vision therapists and maintains a membership database of those optometrists who have an interest in this area of practice. Individual professional interest and how actively a person practices in this area will vary.  Fellows of ACBO have undergone a formal accreditation process through the association. Visit www.acbo.org.au for more information.

The words in this article reflect the opinion of the author and not those of any third party or affiliated organisation mentioned.”