BEHAVIOURAL OPTOMETRY

Behavioural optometrists are fully qualified optometrists (ophthalmic opticians) who have obtained additional post graduate qualifications. This is comparable to dentistry when a dentist can undertake additional training to become an orthodontist. In addition to the standard health and sight checks of an NHS eye examination, a behavioural optometrist also assesses visual information collection and processing (eye tracking and visual memory) and other aspects related to eye-brain interaction. 87% of learning occurs through vision and the motor visual system which means that even subtle issues can have a major impact on a persons efficiency and performance.This is especially the case with children where these systems are still developing. A useful analogy is to think of a person as a computer where most people are born with the necessary hardware to allow normal sensory skills to develop. The software is developed through a busy childhood of play, exploration and experience. If this software is not established properly, or is corrupted as a result of a traumatic brain injury at any age, it can result in problems with the visual system and therefore learning. If undetected, this can cause problems through into adulthood. Behavioral Optometrists explore these processes using an established series of tests that are age specific. A range of treatments are then applied to help patients learn and function more efficiently. In the UK and Ireland, the organisation that trains, accredits, registers and sets professional standards is The British Association of Behavioural Optometrists (BABO). This group is affiliated with the USA based College of Optometrists in Vision Development, where Behavioural Optometrists are referred to as Developmental Optometrists. At present In the United Kingdom and Ireland, the title Behavioural Optometrist is not a protected or restricted title which means some people claiming to be behavioural optometrists may not be qualified. The BABO website (www.babo.co.uk), lists all currently registered behavioural optometrists in the UK and Ireland.

Behavioural Optometrists can help people with a range of difficulties such as: Dyslexia, Dyspraxia or ADHD. Poor concentration, handwriting, comprehension and difficulties with reading. Difficulty with maths. Eye strain in the office including computer eye strain. Traumatic brain injuries. Eye turns (squints) and lazy eyes (amblyopia). Headaches, double vision, fatigue. Co-ordination, clumsiness, difficulties with ball and team games. Sports performance. Judgement of distance. Squeezing eyes to see clearly. Frequent eye rubbing. Closing one eye when trying to read. Tires when reading and/or comprehension drops with time. With specific learning difficulties such as dyslexia, the underlying visual issues may be a significant component for some people but not for others. A diagnosis of a specific learning difficulty on its own is not a good indicator of how much behavioural optometry can help that individual. To assess the suitability of our patient’s for behavioural optometry we ask individuals to complete a pre-screening questionnaire and to provide any reports from specialist teachers or other professionals. This information is assessed by a member of the optometry team who will advise on the best way to proceed.

Children who are under achieving at school, and often diagnosed as dyslexic or dyspraxia, frequently have a hidden vision problem that prevent them from reaching their true academic potential in the classroom. Many will have had a traditional eye test. This mainly tests clarity of vision but does not examine or understand the visual processes taking place in the child with learning difficulties or, indeed, the adult who has eye strain at work, or is unable to enjoy reading or sports. Once a traditional eye test has determined that there is no sight or clarity problem, vision is ruled out as a contributing factor in the learning difficulties and an opportunity is missed to give vital help. Reading, writing and spelling are all fundamental visual tasks and therefore the correct management of vision must be the first area that should be looked at when there are learning problems. The main visual skills for learning are: Fixation: Aiming the eyes or shifting rapidly from one object to another (reading from word to word). Tracking: Following moving objects smoothly and accurately (keeping your place when on a line; catching a ball). Binocular Vision: Seeing with both eyes and combining information received through each eye to make one mental picture. Using one eye and mentally shutting off the other is called suppression. Convergence: Turning the eyes toward each other to look at near objects (words at reading distance) and maintaining eye alignment comfortably and efficiently over time (attention span). Stereopsis: Determining relative distances between objects by looking at them from two different places (the two eyes) simultaneously. Field of Vision: The area over which vision is possible, including motion, relative position of objects in space, contrast and movement sensitivity in side vision (reading from line to line without getting lost on the page). Form Perception: Organising and recognising visual sensations such as shapes and noticing similarities and differences, for example the difference between 'was' and 'saw', 'that' and 'what', '21' and '12', 'e' and 'o' among others.

There are four treatment alternatives available to the Behavioural Optometrist and often these are combined in a vision care programme. Compensatory Lenses These merely help the person to see more clearly if the patient does not wish to participate in further vision care. Treatment or Therapy Lenses Lens prescriptions may be modified using yoked prisms or bifocals to guide the vision to operate more efficiently by reducing stresses caused by near-centered tasks such as reading and working on screens. Colour Overlays and Precision Tinted Lenses The use of coloured overlays and lenses has been proven to benefit a group of people with reading difficulties who have a condition known by three different names – Visual Stress, Myer-Irlen Syndrome and Scotopic Sensitivity Syndrome. Long term, those who benefit from colour are a very small subgroup of people with learning problems but for these individuals this is a significant improvement. The symptoms of this syndrome are: glare from a page of text, headaches when reading, sore eyes when reading and movement/blurring of print. The onset of symptoms varies and may depend on lighting conditions, style of text and quality of paper. If these signs and symptoms are present, a test is conducted to establish if there is an improvement in reading speed and accuracy with the use of coloured overlays. This is reviewed after three months of use. If the improvement is significant, the patient graduates to coloured spectacle lenses which are more convenient and benefit both reading and writing. The exact colour required is individual to each patient and is determined using a precise instrument called an Intuitive Colourimeter. The lenses are then manufactured by a specialist laboratory. In some cases, prescribed tinted lenses are used as tools to beneficially alter human behavior and immediately allow patients to alter their perception of the world around them. This changes how they function in their environment, reduces visual stress and improves visual task performance. Modern life is highly demanding on our visual systems: long working hours, small artificially lit environments and prolonged use of smart phones and screens has made spectacles a useful tool. This can be thought of as being similar to using a good pen to aid handwriting or football boots instead of sandals for football. Despite their benefits: the NHS does not fund most therapy lenses or precision tints Optometric Vision Therapy (VT) VT is a step-by-step, development-based series of activities and procedures that the patient practices over time to facilitate the development of a more efficient and comprehensive visual process. The programme is individually tailored based on the results of a Behavioural Optometry Visual Assessment. Therefore, VT cannot be done without first having a full assessment. The programme takes 6-18 months to complete, with weekly or fortnightly sessions of 30 minutes with the optometrist. This is combined with home VT by the patient. Home VT activities are key to the success of the programme. These are not an optional extra. At each in-practice session you will be given three to five ten minute activities, which will take 30 to 50 minutes per day. They do not need to be done in one block andit is often better to split the activities between morning, afternoon and evening. The timing of the home and in practice therapy is vital- if the person doing VT is tired or irritable then VT will be very much more difficult. We realise that for many people who lead busy lives this will be difficult but for the programme to succeed this will have to be a priority. The person undergoing the vision therapy and, in the case of children their parents, must be committed to the programme, as there will only be an improvement when the activities are followed consistently. In everyone’s interest please think carefully before commencing the programme as to whether you can make this commitment. To help you assess this we now insist that everyone considering doing VT completes VT Taster Sessions. VT Taster Sessions – These are normally scheduled as three in practice sessions at least a week apart together with home VT. This enables someone to properly assess if they will be able to sustain the full VT program. It also allows the optometrist to assess how quickly someone will respond to treatment (their neural plasticity) which enables a better estimate of the likely duration of the vision therapy (VT) program. The NHS does not fund vision therapy.

In our behavioural optometry clinics, we do not diagnose specific learning difficulties. For those seeking such diagnosis there are several avenues that can be pursued. For dyslexia screening, there are several reputable dyslexic screen tests that are widely used by schools. These are normally administered by specialist teachers, some of which are available on-line who will normally give a probability score. More in-depth screening can be done by having an educational psychologist assessment which will provide insights ,not only on dyslexia, but also other specific learning conditions. They will then give guidance on how the individual can be helped to improve their performance. Other learning difficulties such as Attention Deficit and Hyperactivity Disorder ADHD and the range of Autistic Spectrum Disorders (ASD) can be assessed by specialist pediatricians.

Behavioural optometry is not funded by the NHS so we want to ensure that we can make a significant difference to someone before we start. This is why we require individuals to complete a pre-screening questionnaire and to provide any reports from specialist teachers or other professionals. This information is assessed by one of our optometry team who will advise the next step to take. After reviewing the questionnaire, patients we are able to help are invited to attend an assessment of which there are two types: Initial Vision Assessment is the first type and lasts one hour. It allows us to compare key indicators of each patient to a normal population of the same age. A three page report of findings is produced which will contain specific recommendations such as therapy spectacles, vision therapy, further assessment or referral to another specialist. It can also provide robust evidence for the patient to receive extra time in both internal and external examinations depending on the results. The Full Behavioural Optometry Assessment follows on from an Initial Vision Assessment and is a more detailed investigation of vision and also aspects of development which have a huge effect on learning visual skills. These assessments normally take 80 minutes, but are can be split into several shorter sessions to allow for more representative results. The additional aspects assessed relate to some underlying factors which affect vision development such as retained primitive reflexes and gross motor control. Aspects such as sensory integration are also assessed as are visual processing skills, both motor enhanced and motor reduced. This gives us a much more comprehensive understanding of what is happening and allows us to address, during vision therapy, the underlying issues as well as the symptoms. These assessments are undertaken to develop a vision therapy programme and should be seen as a step towards treatment rather than an end in itself. These assessments also give us base line measures which allows us to quantify any improvement in function after treatment. The tests and measurements required are not covered in a routine NHS sight test or an eye examination and are therefore essential. All the treatments provided must be individualised using the information gained from assessments as they are not a one size fits all solution. The assessments are quite challenging so clinics are in the morning rather than the afternoon when individuals can be tired which will cause difficulty obtaining reliable data. We cannot offer behavioural optometry appointments at weekends. Please fill out the relevant questionnaire at the bottom of this page and return it to us for evaluation along with any relevant reports from other professionals.

At this time, behavioural optometry - both assessments and treatments - are not funded by the NHS. This means that these services must be funded by the individual. Where optometric vision therapy is undertaken the total cost of therapy will vary depending on the length of time to achieve the desired outcomes. The program can range from 6 to 18 months. Every patient will begin with a Behavioural Assessment before therapy begins and finish with a reassessment once the course has completed. This will track the improvements made as a result of the therapy. Behavioral optometry services are not currently available under the National Health Service. It falls outside the terms of service for our contract with the NHS. Listed below are the private fees for all behavioural optometry: Behavioural Optometry Price List: Initial Vision Assessment - £195.00 Advanced Behavioural Optometry Assessment - £220.00 Binocular Vision Assessment - £260.00 Vision Re-assessment - £150.00 Visual Therapy (VT) Per Session £67.00 Colorimetry Assessment £85.00 Assessment for colour overlays £45.00 Vision Therapy Package (these must be paid in advance): 10 vision therapy sessions - £610.00 Taster sessions (3 sessions) - £190.00 Specialist VT Spectacles: Yoked Prism £20.00 (additional cost to normal lens price) Bifocal Lenses £85.00 (if not covered by the NHS) Computerised Vision Therapy: Perception Training Skills £160.00 HTS £160.00 Dynamic Reader £90.00 Amblyopia Program £160.00 Fees are subject to change so please confirm current prices at time of booking.