Who Are Behavioural Optometrists? And Why Are They Special?

August 30, 2021 The Ed Psych Practice No Comments Referrals Behaviour Optometrists, Developmental Difficulties, Functional Visual Skills, Hand-eye Coordination, Learning Difficulties, Lenses, Vision System, Visual Performance

Takeaway: Behavioural optometrists help children improve their vision, and this is about more than just fixing faulty eyesight. They apply decades of research and theory to explore your child’s eye-brain connection and use a holistic approach to improve her quality of life.

‘Eyesight’ and ‘vision’ are two different things. And we need both of them in order to see the world around us.

There are two different processes at work when you’re looking at something. First, there’s eyesight — that is, the physics of light entering your eye, getting diffracted by the eye’s lens, and falling on the retina. When we think of having 20/20 eyesight, we’re referring to these technical aspects of seeing things. (Note: By 20/20 eyesight, we mean that what you’re able to see 20 feet away is what you should be able to see 20 feet away.) But there’s more to ‘seeing’ than this because there’s a second process taking place in your brain. And this is the process of decoding what the light entering your eye is telling you — a process we call ‘vision.’ Your brain has to do a lot to decode the data it receives. For example, if you’re in a park, your brain has to separate the children playing in the foreground from the trees in the background. It also has to recognise the colour and shades of colour of those trees. And it has to spot the football kicked your way and track its progress so you can duck when necessary.

Behavioural optometrists are unique in that they tackle these more complex problems with vision.

Optometrists usually test eyesight using standard charts, and they prescribe things like glasses and contact lenses to correct the problems they come across. Behavioural optometrists are similar in that they help fix eyes, but they also take on the challenge of teaching the brain to process what it sees. I.e., they tackle both eyesight and vision. And this is a complicated challenge because it means understanding the neurology (the ‘brain’ part) of sight. But it’s worth the effort because about 20% of any population will have problems with vision even though their eyesight is perfectly fine. (Note: that’s why the exercises behavioural optometrists prescribed in the early days — i.e., the 1920s — seemed miraculous. They often restored sight without using glasses or other physical aids.)

A behavioural optometrist in training first needs to understand the various components of vision.

There’s a lot that goes into vision, especially because it involves the eyes and the brain. For example, when your child gets to a birthday party, her brain (and eyes) have to work as a team to do a series of things. First, they have to take in all the people in the room — which means switching focus from person to person. They also have to track moving objects (like the friend walking towards them) and figure out how far away these objects are (like if the friend comes closer for a hug). Then, they’ll have to recognise what’s happening to the side of them (like another friend trying to catch their attention) — i.e., use their peripheral vision. And they’ll also need to create a ‘mental image’ of new people they meet so that they can remember their faces for next time. Behavioural optometrists need to assess about a dozen of these sorts of skills when trying to troubleshoot what’s wrong with your child’s vision. Plus, they’ll have to explore your child’s visual problem-solving style. For example, does she need to touch things to process what they are (instead of just looking at them)? Or does she pay attention to visual details (instead of glossing over some important visual cues)?

Behavioural optometrists also need to understand how vision develops, to know when to step in and help.

Vision is something that children refine over time, and they do it through experience and practice. For example, babies initially want to touch, smell, and taste anything they come across. It’s how they learn about the world around them. But soon, they internalise these attributes and connect them with sight. So, an older child can simply look at an apple and know what it would feel like to crunch into it, taste it, smell it, and so on. These inner representations of the outer world are called ‘schemata,’ and they help us quickly make sense of everything we experience. Behavioural optometrists need to understand this complex interrelation of sight, vision, schemata, and more. And they’ll need to know how this interrelation develops.

There’s so much to learn, though. And behavioural optometrists need to spot mechanisms that aren’t always immediately obvious.

Sight, vision, and the world around us are intricately connected. For example, a simple thing like poor spatial awareness (i.e., knowing where your body is in relation to the things around you) can have a ripple effect on other parts of a child’s life. Poor spatial awareness means she’ll find it hard to tell ‘left’ from ‘right.’ And so she’ll struggle to remember the order of letters and numbers when reading. ‘18’ looks the same as ‘81’ if directions (and number orders) aren’t clear to you. Behavioural optometrists need to understand that helping a child learn the difference between 18 and 81 might not be just about the numbers. Rather, they might need to tackle a whole other issue first.

As parents, we might not recognise subtleties like these in our children. But, thankfully, we don’t need to. We just have to be able to recognise the more basic signs of eyesight/vision difficulties.

Pay close attention if your child complains of regular headaches (especially if they’re centred around the eyes) or is easily disturbed by bright lights. It’s a sign that her visual system is being overloaded at one or more points. Also, vision problems often pop up when your child is reading. So, she might read slowly, miss out or re-read words, and have trouble understanding what she’s reading (especially during longer sessions). You might also notice that she needs to run her finger under the sentences she’s reading, or that she tilts her head or squints her eyes — as if to get a better look. And of course, there are the more obvious signs like bumping into things, stumbling down stairs, struggling to see the writing on whiteboards in school, etc.

Once you’ve spotted some of these issues, a behavioural optometrist can conduct a formal assessment and start problem-solving.

Assessments usually take about an hour or two to complete and involve testing your child’s eye movements, focusing skills, depth and colour perception, coordination, handwriting, and more. You’ll also have a chance to share her medical history and some of the issues you’ve observed around the house. The behavioural optometrist will then piece this data together to understand how your child experiences the world around her. Remember, it’s this experience (not just your child’s eyesight) that the optometrist is improving. So, although she might suggest different types of lenses to use, she’s equally likely to prescribe vision exercises (more complex than simple eye exercises) and lifestyle changes.

If you’re interested in exploring how a behavioural optometrist can help your child, consider setting up an appointment with us.

The Ed Psych Practice offer face-to-face and online assessments, consultation, advice, and problem-solving strategies for parents, nurseries, schools, and universities in London. We have psychologists, paediatricians, and therapists who can help assess your child and offer guidance and support. To consult with us or set up an appointment:

Phone: +44 (0) 78 3344 7356
E-mail: Office@TheEdPsych.com

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