The Reading Edge – Behavioural Optometry Programme

What is Behavioural Optometry?

Children and adults need good vision to perform daily tasks. However, vision is not just how accurately you can see. It is actually a fine motor skill which develops and improves over during childhood. Usually, children develop these skills through childhood activities such as playing and exploring.

However, sometimes these skills aren’t sufficiently developed, which is where we come in! 80-85% of what we learn is visual, so even slight problems with vision can have a huge impact on development and learning and performance at work.

Behavioural Optometrists examine your eyes but also the neurological processes involved in seeing. We examine your vision in relation to visual demands such as looking at screens, reading and writing, playing sports or activities like dancing or working in an office.

We help people work out if there are areas of their visual system that function less well than the average and how to develop and expand those limits.

1. Image acquisition

How do the eyes see: do the muscles around them work well enough to point the eyes at the object of interest? Consider simple activities such as reading a book or catching a moving ball. Do these muscles have enough stamina to keep focused on the object? When reading more than one page of text, does the text stay clear and the vision stay stable?

2. Visual processing

Can you make sense of what you are seeing? Is there a clear visual signal between the eyes and the brain? The brain decides what you are seeing based on experience, expectations and the algorithms it has developed to analyse your vision.   

3. Resulting action

What are you going to do about what you see and what your brain has processed? Will you move your hands to catch the ball? When you are reading an exciting paragraph in a book, can you picture the scene?

What is BABO?

BABO is the British Association of Behavioural Optometrists. It is the governing body that provides and maintains a register of accredited Behavioural Optometrists. All members require ongoing training and learning to remain on the register thus ensuring Behavioural Optometrists are up to date with knowledge and experience.

What age do we assess kids?

We usually see children who are 7 to 8 years old. When kids move from year 2 to year 3 at school, their ability to read evolves beyond just learning words to actually understanding what they are reading. If a child has visual difficulties, they often crop up during this period because they may start to fall behind compared to their peers.

We do see some children who are 3 to 5 years old if they have significant difficulties that need addressing as soon as possible. And of course, we see adults too!

What difficulties require an assessment?

In school, any delays in learning or performance indicate the need for a Behavioural Optometry assessment. An investigation is essential for someone with ANY of the following:

• Children and adults with squints, strabismus, amblyopia or lazy eye
• Convergence Insufficiency
• Difficulties with Visual Tracking
• Dyslexia, dyscalculia or any other specific learning difficulty
• Difficulties with handwriting, maths, reading or comprehension
• Children above the age of 8 who are missing words or lines when they are reading 
• Developmental coordination disorder (dyspraxia)
• Those who have received speech and language therapy
• Anyone who requires Occupational Therapy (OT)
• People with hypermobility
• Asperger’s Syndrome, Autism, ASD 
• Children with developmental delays
• Children and adults with cerebral palsy
• Myopia/Short-sightedness management

Do we test adults?

If visual difficulties are not detected during childhood they can continue into adulthood. We see adults for a variety of difficulties including:

• Eye strain and fatigue at work or when using a computer/screen
• Double vision or squints/amblyopia
• Diagnosis of dyslexia or dyspraxia patients
• Traumatic Brain or Spine Injuries
• Multiple Sclerosis
• Stroke patients
• Cerebral Palsy

What tests are performed at an assessment?

An assessment involves a large battery of tests that investigate visual function and performance. This goes far beyond checking the sight. We need to understand how the eyes take in visual information, how long can they keep working before they get too tired to work properly. How does the brain and visual system make sense of the visual information, can it sift through the data quickly and efficiently or does it start to forget some important pieces or recognise things incorrectly?

We strive to ensure the tests are evidence-based and have scientic reseach and studies that back our investigations especially when it comes to comparing the results against the average. Majority of the results use standardised testing methods. A minority of the results and conclusions are based on our expert oberservations from our experience learned over 10 years of examining children and adults who have difficulties with their visual system. We will explain which results are based on research studies and which are expert opinion.

What are the visual skills essential for reading?

Beyond visual acuity (the clarity of vision), every child needs to have a number of skills in order to read effectively:

• Eye movement control: moving the eyes together to point at a target
• Eye focusing: focusing on both near and far objects
• Eye alignment or eye teaming: the eyes working together
• Central vision or visual acuity: 20/20 vision 
• Peripheral vision: seeing what’s on either side of you whilst your eyes are pointing forward
• Depth awareness: distinguishing between near and far objects 
• Colour perception: distinguishing between different colours
• Visual perception: understanding and deciphering the visual input 
• Memory: short-term memory (working memory) and processing of memory to picture the scene or situation (children with short-term memory difficulties may have above average long-term memory)

For a more comprehensive list see my Essential Visual Skills blog post.

What is visual tracking?

Visual tracking is the ability to control where we aim or fixate our eyes or gaze. It is the skill that allows us to keep our eyes on target when looking from one object to another, from word to word in a book or following a moving object through the air, such as a frisbee or a ball.

For more see my post about Visual Tracking. 

What is convergence insufficiency?

Convergence insufficiency is an eye teaming problem, which means that the eyes do not work well together. This causes difficulties primarily with near vision - working with objects close to your eyes or reading.

For more information see my post about Convergence Insufficiency. 

What do you need to know about dyslexia and vision?

Dyslexia is a language learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling.

Studies are increasingly showing links between dyslexia and visual problems. Although vision problems do not cause dyslexia per se, they can co-occur and identifying any visual problems may help alleviate some symptoms of dyslexia.

For more see my Dyslexia blog post, click here>>

What do you need to know about dyspraxia and vision?

Dyspraxia, also known as developmental coordination disorder, affects both spatial vision and coordination. Children may perform less well than expected in daily activities for their age or appear clumsy.

Research shows that vision therapy can help develop both spatial vision and coordination skills.

For more see my Dyspraxia blog post, click here>>

What are the next steps? 

As you can probably tell, these visual problems can be hard to asses but at Central Vision Opticians we provide tests for a range of difficulties and can offer you bespoke advice on what to do next. If you think your child has attention or learning difficulties it’s worth getting checked by a behavioural optometrist - call us to book an appointment or to ask for some advice.

We will also soon be launching an exciting new online assessment tool!

What is vision therapy?

Vision therapy is designed to correct vision problems and help people achieve a clear and comfortable binocular vision. Unlike glasses or contact lenses, vision therapy trains the entire visual system to correct itself.

Programmes of vision therapy are usually made up of a series of exercises prescribed by a behavioural optometrist. Like with physiotherapy, the exercises gradually strengthen the visual system by continually reinforcing neurological and visual skills.

Recent studies show that vision therapy can correct problems that interfere with reading and learning at school. However, adults can also benefit. Research into neuroplasticity has shown that we can retrain the brain even later in life.

Vision therapy trains visual organisation between the body, visual system, visual-spatial awareness, vestibular system, balance, coordination, proprioception (feedback from the joints about their spatial position) and motor skills. Developing good eye movement and focusing skills with high accuracy and increased stamina. Ensuring the eyes can work together

Vision therapy can be used to correct:

• amblyopia (lazy eye)
• strabismus and convergence insufficiency (a form of strabismus)
• binocular or alignment vision problems
• eye movement disorders
• accomodative (focusing) disorder
• visual-perceptual disorders
• vision problems related to developmental disabilities or brain injuries

Vision therapy can also help with computer vision syndrome and digital eye strain. These are increasingly widespread problems affecting anyone who uses computers or digital screens.

For more advice on screens and eye health, click here.

Does the NHS provide this service?

Behavioural Optometry isn’t covered by the NHS because in most cases there are no issues or difficulties with health. The NHS tends to work on each part of the body individually, while the visual system affects many areas of performance from balance and coordination, to playing sports and understanding information when reading. Therefore doctors and professionals within the NHS do not often link differing areas of function even though they should take an approach that understands the entire person and their general performance.

How much does it cost?

Each child and adult is different, so are their visual needs and the areas where they may find difficulties. The assessment is bespoke and specific to you or your child. We have tried to use broad categories for each type of assessment. Sometimes it may be necessary to investigate deeper, other people may not need the full assessment.

Our current prices are here.

How do I know if I need an assessment?

Here are a few of the symptoms of some common visual problems to look out for.

What evidence is there that Behavioural Optometry can help my child?

Behavioural Optometry has been understood, studied and practiced clinically for over 70 years. It draws a wealth of evidence-based practice from advanced optometry including binocular vision assessments, orthoptics, accommodative function (focusing) and eye movements. It also draws research-based knowledge from neuroscience, neurodevelopment, educational psychology, occupational therapy and physiotherapy. Majority of the assessment and treatment techniques have clear evidence (references available on request - hundreds of peer-reviewed paper and research). Some areas of assessment and treatment rely on observation and experience of the practitioner. Our assessments have a mix of both but are overwhelmingly evidence-based.