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HomemifeatureBehavioural Optometry Changing Perceptions and Changing Lives

Behavioural Optometry Changing Perceptions and Changing Lives

There has been a groundswell of interest in Behavioural Optometry in recent years, particularly from young optometrists and graduates. This area of optometry is a serious practice fuelled by scientific research, coupled with a desire to provide holistic care and to achieve greater professional satisfaction. As the association formed to support its practitioners, the Australasian College of Behavioural Optometrists (ACBO) is working towards recognition of behavioural optometry as a specialised field of practice.

Behavioural optometry can change lives and build practices by gaining the long-term loyalty of patients and their families, says Veronica Kypros, the Chief Executive Officer of ACBO.

She said the intensive and often regular treatments required for this area of practice enable optometrists to build more intimate patient relationships that don’t typically occur in traditional optometry practices.

“Depending on the diagnosis, behavioural treatment can be time-consuming. If, for example, a patient requires vision therapy, the course of treatment will usually take place once a week for 10 weeks and then the patient may get exercises to do at home. Over this time, strong relationships form and a real sense of trust develops.”

behavioural optometry was seen by many as
a bit fringe, but in reality, we use many of the same vision tests that regular optometrists use

The types of vision problems that behavioural optometrists commonly look to correct include: poor eye-movement control, problems with accommodation, convergence insufficiency, difficulties sustaining visual attention, poor visual-motor integration, weak visual form perception and poor visual memory.

Optometrist Bernie Eastwood, who is the Vice President of ACBO, said correcting these problems can positively impact every aspect of a patient’s life. “Our eyes guide our motor movement – that’s why we have them – and so if you have problems with your visual system then it’s going to impact your motor movements and vice versa. The two can’t be separated, particularly in child development,” said Ms. Eastwood, who practises at The Focal Point Optometrist in Perth.

“As behavioural optometrists, we look at vision processing or the way the brain interprets what the eye sees – and we aim to get the focus, teaming and mechanical actions of the eyes and vision processing working together to help adults and children with problems with learning and movement.”

Rebecca Jamieson, a Director at ACBO and owner of behavioural optometry practice Bayside Eyecare in Melbourne, said often a patient’s problem isn’t immediately identifiable as an issue associated with vision. “We work with children and adults. The child who is clumsy, who runs into things or makes poor spatial judgments, who appears well but is unable to process the information their eyes are seeing.

“Some of the adults we see have sustained head injuries but many have lived with a vision processing problem all their lives. Because they’ve been clumsy or had poor hand-eye co-ordination they’ve avoided particular hobbies or career paths. Often they’ve spent their lives putting themselves down for their inadequacies.”

Ms. Jamieson said the perception of behavioural optometry has changed over time. “In years gone by, behavioural optometry was seen by many as a bit fringe.But in reality, we use many of the same vision tests that regular optometrists use.”

Stepping Off The Treadmill

Ms. Jamieson trained to practise as a behavioural optometrist in 2002. “I felt I was on a treadmill working in regular optometry so I decided to do my Masters in Behavioural Optometry at UNSW. From the very first lecture I thought, ‘Yes, this is what I’m meant to be doing.’ That’s still the way I feel. It’s physically and mentally challenging but I get a great deal of satisfaction from being able to assist people.

“I often think, if those kids hadn’t come to see me to get their visual processing problems sorted, they wouldn’t have progressed academically. Potentially they’d have experienced self-esteem issues, career issues, and other flow-on effects. I’ve helped them and that’s the greatest buzz I get out of it.”

Ms. Eastwood’s reason for turning to behavioural optometry was similar.

“I left optometry because I felt I wasn’t able to help kids who had learning issues. I did a graduate diploma in teaching but still, I found I didn’t necessarily get a good scientific base that would enable me to really help children learn. I did some locum work with John Palassis, who is a behavioural optometrist, and he suggested that if I combined what I’d learned as a teacher with what I could learn from ACBO, I’d find the skills I needed.

“John was right – the Fellowship program extends our knowledge further into what the vision system actually does – so we understand how to help people with learning difficulties, turned eyes, head injuries or autism.”

Increasing Interest

Veronica Kypros said the interest Ms. Eastwood and Ms. Jamieson have in taking a holistic approach to patient care, and their commitment to making a difference, is typical of the growing number of optometrists who now practise behavioural optometry.

“Behavioural optometrists want to raise the bar – for altruistic reasons, many of them want to do something that will make more of a difference to people. They also want to challenge themselves professionally – and this is a more intensive area of practice than working in a regular optometry practice,” she said.

“Interestingly, we’ve had quite a ground-swell of younger members joining over the past three years – young optometrists who are getting involved from the get-go. I imagine this could be because of the heightened interest in holistic practice we’re seeing across all allied health fields.”

Ms. Jamieson said another reason could be the increasing scientific evidence pointing to the benefits of behavioural optometry and the neuroplasticity of the brain, which enables people of all ages to learn new behaviours.

ACBO is leading the way with initiatives such as online education, and providing the profession with access to the research and scientific backing to support this practice philosophy, including papers on neuro-optometric rehabilitation and research into convergence insufficiency. ACBO is also running continuing education programs aimed at the novice as well as more experienced practitioners to build a greater understanding of this area of practice. For me, it’s the ‘go-to’ for all resources on behavioural optometry,” said Ms. Jamieson.

Recognition Deserved

Within a competitive profession, offering behavioural optometry can be an effective way to differentiate your practice.

This is something ACBO is currently preparing to fight for and business consultant Mark Overton is helping them do that. “There is no question, there are areas of unique knowledge and practice in optometry that should be formally recognised in both the professional and public interest. ACBO will prepare a case for recognition through the appropriate channels,” he said.

“ACBO’s membership boasts a high proportion of Fellows. The Fellowship program is an intensive three-year process that can be commenced after two years of ACBO membership. ACBO Fellows are acknowledged leaders in the fields of neurodevelopmental optometry, children’s optometry and optometric disability care. This deserves to be recognised,” said Ms. Kypros.

“This is also about the duty of care we have as a profession to let the public know who has extra knowledge in particular areas so that they receive the best vision care possible. It’s about gaining the public’s trust.”

Ms. Jamieson said acknowledging specialisations would help with inter-practitioner referrals. “It’s useful for
a primary practitioner to be able to identify the best person to refer on to by their specialty.”

Ms. Jamieson recently became the first behavioural optometrist to be listed on the panel to provide vision services to children with disability through the Federal Government’s Better Start program. “This is a huge opportunity for all optometrists – but our members especially – because behavioural optometrists are generally more interested in working with children with a disability than regular optometrists,” said Ms. Kypros.

“If we can get a good representation by behavioural optometrists on this government approved board, we’ll set a precedent – something to point to that clearly demonstrates behavioural optometry’s area of speciality.”