Behavioral optometry
Encyclopedia
Behavioral optometry is an expanded area of optometric practice
that claims to use a "holistic" approach to the treatment of vision and vision information processing
problems. The practice of behavioral optometry incorporates various vision therapy
methods and has been characterized as a complementary alternative medicine
practice. A review in 2000 concluded that there were insufficient controlled studies of the approach and a 2008 review concluded that "a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated."
. However, Vision therapy
is differentiated between strabismic/orthoptic vision therapy (which Orthoptists and Ophthalmologists practice) and non-strabismic vision therapy. A.M. Skeffington
was an American optometrist known to some as "the father of behavioral optometry". Skeffington has been credited as co-founding the Optometric Extension Program
with E.B. Alexander in 1928.
Part of behavioral vision care is concerned with impact of visual "skills" on performing visual tasks. Various behaviors and poor performance during visual tasks may suggest non-optimal visual skills. For example this could manifest as eyestrain symptoms experienced during visual tasks, or adopting poor posture (e.g. leaning in too close to visual material). Another example, could be difficulty understanding maps, difficulty recalling visual information, difficulty completing jigsaws and difficulty drawing/copying/interpreting visual information.
Claims have been made that behavioural optometry can aid with cognitive, behavioural or language disorders such as ADHD and dyslexia
, although there is no evidence to support these claims. It is therefore popular among parents who may not want their children to be stigmatised by being labelled with a cognitive or language impairment, as it claims that poor vision is the "real" cause of their disorder.
in Baltimore undertook a study of the use of behavioral optometry in the treatment of myopia. The training was undertaken by A. M. Skeffington and his associates, who traveled to Baltimore for the purpose, but who used a clinic outside the hospital, and were carefully kept apart from the staff in the Wilmer Institute who assessed their progress. The 103 candidates were school students and young adults with uncomplicated myopia. Independent examination before and after training was undertaken using Snellen chart
s, and use of a retinoscope after introduction of a cycloplegic agent. The examining physicians "were impressed by a psychologic improvement in a number of patients. Some patients while exhibiting no material change in their visual acuity, were nevertheless convinced that they saw better and that they used their eyes with greater satisfaction to themselves." The objective results were as follows. Of the 103 subjects:
The report's author concludes "With the possible exception of educating some patients to interpret blurred retinal images more carefully and of convincing some others that they could see better even though there was no actual improvement, this study indicates that the visual training used on these patients was of no value for the treatment of myopia."
A review of behavioural optometry in 2000 concluded that there were insufficient controlled studies of the approach and a 2008 review concluded that "a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated."
published a case study about "Stereo Sue" (Susan R. Barry
), a woman who was strabismic and stereoblind since early infancy and who developed stereo vision after undergoing vision therapy. Barry, a professor of neurobiology, later published a memoir, Fixing My Gaze: a Scientist's Journey into Seeing in Three Dimensions, describing the therapy, the science underlying it, and her experience with it.
Optometry
Optometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists, or Doctors of Optometry, are state licensed medical professionals trained to prescribe and fit lenses to improve vision,...
that claims to use a "holistic" approach to the treatment of vision and vision information processing
Visual perception
Visual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision...
problems. The practice of behavioral optometry incorporates various vision therapy
Vision therapy
Vision therapy, also known as visual training, vision training, or visual therapy, is a broad group of techniques aimed at correcting and improving binocular, oculomotor, visual processing, and perceptual disorders."-Historical development:...
methods and has been characterized as a complementary alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
practice. A review in 2000 concluded that there were insufficient controlled studies of the approach and a 2008 review concluded that "a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated."
History
Behavioral optometry is considered by some optometrists to have its origins in orthoptic vision therapyVision therapy
Vision therapy, also known as visual training, vision training, or visual therapy, is a broad group of techniques aimed at correcting and improving binocular, oculomotor, visual processing, and perceptual disorders."-Historical development:...
. However, Vision therapy
Vision therapy
Vision therapy, also known as visual training, vision training, or visual therapy, is a broad group of techniques aimed at correcting and improving binocular, oculomotor, visual processing, and perceptual disorders."-Historical development:...
is differentiated between strabismic/orthoptic vision therapy (which Orthoptists and Ophthalmologists practice) and non-strabismic vision therapy. A.M. Skeffington
A.M. Skeffington
Arthur Marten Skeffington was an American optometrist known to some as "the father of behavioral optometry". Skeffington has been credited as co-founding the Optometric Extension Program with E.B. Alexander in 1928...
was an American optometrist known to some as "the father of behavioral optometry". Skeffington has been credited as co-founding the Optometric Extension Program
Optometric Extension Program
The Optometric Extension Program is an international, non-profit organization dedicated to the advancement of the discipline of optometry through the gathering and dissemination of information on vision. The mission of OEP is to advance human progress through research and education on vision, the...
with E.B. Alexander in 1928.
Part of behavioral vision care is concerned with impact of visual "skills" on performing visual tasks. Various behaviors and poor performance during visual tasks may suggest non-optimal visual skills. For example this could manifest as eyestrain symptoms experienced during visual tasks, or adopting poor posture (e.g. leaning in too close to visual material). Another example, could be difficulty understanding maps, difficulty recalling visual information, difficulty completing jigsaws and difficulty drawing/copying/interpreting visual information.
Claims have been made that behavioural optometry can aid with cognitive, behavioural or language disorders such as ADHD and dyslexia
Dyslexia
Dyslexia is a very broad term defining a learning disability that impairs a person's fluency or comprehension accuracy in being able to read, and which can manifest itself as a difficulty with phonological awareness, phonological decoding, orthographic coding, auditory short-term memory, or rapid...
, although there is no evidence to support these claims. It is therefore popular among parents who may not want their children to be stigmatised by being labelled with a cognitive or language impairment, as it claims that poor vision is the "real" cause of their disorder.
Research
In 1944-1945 the Wilmer Eye Institute of Johns Hopkins HospitalJohns Hopkins Hospital
The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...
in Baltimore undertook a study of the use of behavioral optometry in the treatment of myopia. The training was undertaken by A. M. Skeffington and his associates, who traveled to Baltimore for the purpose, but who used a clinic outside the hospital, and were carefully kept apart from the staff in the Wilmer Institute who assessed their progress. The 103 candidates were school students and young adults with uncomplicated myopia. Independent examination before and after training was undertaken using Snellen chart
Snellen chart
A Snellen chart is an eye chart used by eye care professionals and others to measure visual acuity. Snellen charts are named after the Dutch ophthalmologist Herman Snellen who developed the chart during 1862...
s, and use of a retinoscope after introduction of a cycloplegic agent. The examining physicians "were impressed by a psychologic improvement in a number of patients. Some patients while exhibiting no material change in their visual acuity, were nevertheless convinced that they saw better and that they used their eyes with greater satisfaction to themselves." The objective results were as follows. Of the 103 subjects:
- 30 showed some improvement on all measures
- 31 showed overall improvement, but not on all measures
- 32 showed no overall change
- 10 showed deterioration of vision
The report's author concludes "With the possible exception of educating some patients to interpret blurred retinal images more carefully and of convincing some others that they could see better even though there was no actual improvement, this study indicates that the visual training used on these patients was of no value for the treatment of myopia."
A review of behavioural optometry in 2000 concluded that there were insufficient controlled studies of the approach and a 2008 review concluded that "a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated."
Case studies
In 2006, neurologist Oliver SacksOliver Sacks
Oliver Wolf Sacks, CBE , is a British neurologist and psychologist residing in New York City. He is a professor of neurology and psychiatry at Columbia University, where he also holds the position of Columbia Artist...
published a case study about "Stereo Sue" (Susan R. Barry
Susan R. Barry
Susan R. Barry is a professor of neurobiology at Mount Holyoke College and the author of Fixing My Gaze: A Scientist's Journey into Seeing in Three Dimensions. Barry was dubbed "Stereo Sue" by neurologist and author Oliver Sacks in a 2006 New Yorker article with that name...
), a woman who was strabismic and stereoblind since early infancy and who developed stereo vision after undergoing vision therapy. Barry, a professor of neurobiology, later published a memoir, Fixing My Gaze: a Scientist's Journey into Seeing in Three Dimensions, describing the therapy, the science underlying it, and her experience with it.
See also
- Journal of Behavioral OptometryJournal of Behavioral OptometryThe Journal of Behavioral Optometry is a peer-reviewed medical journal published by the Optometric Extension Program Foundation. It covers clinically relevant behavioral, functional, and developmental aspects of the visual system...
- College of Optometrists in Vision DevelopmentCollege of Optometrists in Vision DevelopmentThe College of Optometrists in Vision Development is an international, non-profit optometric membership organization that provides education, evaluation and board certification programs in behavioral and developmental vision care, vision therapy and visual rehabilitation...
- Eye care professionalEye care professionalAn eye care professional is an individual who provides a service related to the eyes or vision. It is a general term that can refer to any healthcare worker involved in eye care, from one with a small amount of post-secondary training to practitioners with a doctoral level of education.-Current...
- PseudosciencePseudosciencePseudoscience is a claim, belief, or practice which is presented as scientific, but which does not adhere to a valid scientific method, lacks supporting evidence or plausibility, cannot be reliably tested, or otherwise lacks scientific status...
- OptometryOptometryOptometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists, or Doctors of Optometry, are state licensed medical professionals trained to prescribe and fit lenses to improve vision,...
- Orthoptist
- Visual perceptionVisual perceptionVisual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision...
- Bates methodBates MethodThe Bates method is an alternative therapy aimed at improving eyesight. Eye-care physician William Horatio Bates attributed nearly all sight problems to habitual strain of the eyes, and felt that glasses were harmful and never necessary...
- Vision therapyVision therapyVision therapy, also known as visual training, vision training, or visual therapy, is a broad group of techniques aimed at correcting and improving binocular, oculomotor, visual processing, and perceptual disorders."-Historical development:...