Behavioral Optometry

Behavioral optometry also known as "Functional 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."

History

Behavioral optometry is considered by some optometrists to have its origins in orthoptic vision therapy. 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.[3]

Research

In 1944-1945 the Wilmer Eye Institute of Johns Hopkins Hospital 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 charts, 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 Sacks 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.