Behavioral optometry (also known as "functional optometry") is an expanded area of optometric practice that uses a holistic approach in the treatment of vision and vision information processing problems.^[1] The practice of behavioral optometry incorporates various vision therapy methods and has been characterized as a complementary alternative medicine practice.^[2] A review in 2000 concluded that there were insufficient controlled studies of the approach^[3] and a 2008 review concluded that "a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated."^[4]

Contents 1 History 2 The Baltimore myopia study 3 Oliver Sacks 4 See also 5 References 6 External links 6.1 National and International Organizations

[edit] 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.^[5] A.M. Skeffington was an American optometrist known to some as "the father of behavioral optometry".^[6] Skeffington has been credited as co-founding the Optometric Extension Program with E.B. Alexander in 1928.^[6]

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 (eg 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.^{[citation needed]}

[edit] The Baltimore myopia study

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.^[7] 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. The training was summarised by Dr. Skeffington as follows

The visual training rests on the postulate that seeing is a learned act and is therefore susceptible to training. A system of differential analysis was employed to discover the type of distorted pattern resulting from undesirable visual practices. Spheres, cylinders, prisms, and targets were employed in this training program with the idea of reorganizing the visual behavior patterns that the visual skills, including acuity, can be improved significantly. This method of visual training has neither in theory nor practice any relation to the so-called Bates theory, and in theory and practice it involves no deviation from the known and accepted theories and facts of physiology and neurology of the eye or the experimental psychology of vision. It has its inception in the work of optometrists, stemming from the standard literature on learning. The records of this development from its start exist in the optometric literature, and are covered in the papers of Drs. George Crow and Harry Fuog, S. K. Lesser, Leslie B. Burdette, Marguerita Thoma Eberl and others, in the Optometric Extension Program, articles on training in the files of the Optometric Weekly, the American Journal of Optometry, and other publications.

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."

[edit] Oliver Sacks

In 2006, neurologist Oliver Sacks published an anecdotal case study about "Stereo Sue", a woman who had regained her stereo vision, absent for 25 years, after undergoing vision therapy.^[8] Sacks does not detail exactly what exercise regime was followed by the patient.

[edit] See also

• Journal of Behavioral Optometry
• College of Optometrists in Vision Development
• Eye care professional
• Pseudoscience
• Optometry
• Orthoptist
• Visual perception
• Vision therapy

[edit] References

[edit] External links

• The Journal of Behavioral Optometry
• LookSmart Definition

[edit] National and International Organizations

• Australasian College of Behavioural Optometrists (ACBO)
• British Association of Behavioural Optometrists (BABO)
• College of Syntonic Optometry
• Neuro Optometric Rehabilitation Association