Behavioral Optometrist/Developmental Optometrist

Do you ever refer your clients to a behavioral optometrist for an evaluation or vision therapy?  This post will explore what a behavioral optometrist, otherwise known as a developmental optometrist. We’ll also cover when individuals see behavioral or developmental optometry, and what the role of the occupational therapist in vision therapy is in working with this type of eye specialist.

behavioral optometrist or developmental optometrist

What is a Behavioral Optometrist?

A behavioral optometrist can also be called a developmental optometrist, or a functional optometrist.

Behavioral Optometry is a  growing subspecialty of optometry that uses vision therapy to go beyond the usual concerns of vision care. Strong vision is much more than being able to see 20/20.

Optometrists and ophthalmologists  provide eye exams that evaluate a patient’s overall eye health, visual acuity (20/20, 20/40 etc.), and the need for any corrective measures. They can diagnose various eye diseases, prescribe medication for treatment, and provide prescriptions for eyeglasses or contact lenses.  These tests don’t detect other visual disorders which can impact reading and learning, such as eye teaming (binocular vision), focusing, tracking and visual processing.

A behavioral optometrist uses a wide array of exams to study your vision. Many of the tests require you to answer verbally because they’re related to how you interpret your vision.  

Because of the connection between the brain and the eyes, behavioral optometrists do measure your sight, but also your brain’s response to what you see. 

Behavioral optometry acknowledges the brain’s connection to vision, and the impacts on behavior that poor vision can  have. 

They are concerned with how your eyes and visual system function, and are interested in how your behavior affects vision or how your vision influences your behavior. 

The behavioral optometrist, also known as a developmental optometrist, treats functional vision problems, including difficulties with binocular vision, eye movements and depth perception, as well as visual deficits following brain injuries. 

Developmental optometrists base their work on the principle that vision can be developed and improved, and done so by using prisms, lenses and vision therapy.

Behaviors Associated with Visual Difficulties

Behavioral optometrists notice the impact that poor vision is having on learning. They see the behavioral reactions, striving to uncover the reason and treatment.  They tackle getting the eyes and brain to work together. As a recent study noted, over 20 percent of children have vision problems that can impede their ability to reach their potential.

There are several maladaptive “behaviors”, or resulting actions, associated with visual difficulties:

  • Child gets frustrated with their vision
  • Maybe they struggle with sports and coordination, thus lose motivation to try
  • Your learner doesn’t like to work independently because it is more effective for them to rely on the vision of others
  • They have difficulty with visual tracking, often refusing to try and read
  • In writing/reading there are letter reversals, skipping words, 
  • They compensate for poor skills by using their finger to track words in a book
  • Tilt their head or lean very close to their work
  • Have difficulty with visual perception, especially finding objects and completing puzzles
  • Poor visual attention
  • Poor visual memory
  • Poor visual motor skills

Behavioral optometrists believe that these kinds of behaviors, as well as poor performance during visual tasks, are a sign of non-optimal visual skills.

Dr. Stanley Appelbaum, author of Eye Power: A Cutting-edge Report on Vision Therapy, studied the role of vision in children’s behavior. His unique approach to understanding the role of the eyes in learning involved “how eyes work together and move together and process information and store information and do something with the information.”

What do developmental optometrists work on

Developmental optometrists (behavioral optometrists) focus on specific areas of vision.  Some of the key vision skills include:

Many of these skills are targeted through vision therapy.

Vision therapy is a sequence of eye exercises that are used to improve the quality and visual efficiency. It is also called vision training. Vision therapy helps your eyes work more efficiently so that you can perform daily tasks, like reading and writing more efficiently.

Vision therapy is often carried out by optometrists, and vision therapists who work under the supervision of an optometrist.

When to Refer to a Behavioral Optometrist

As an occupational therapy practitioners, we see a host of vision and visual perceptual difficulties. 

It is always best to rule out visual acuity and vision difficulties either before beginning therapy interventions, or simultaneously. 

Imagine spending six months working on visual perception, eye hand coordination, and vision, only to find out your student can not see what is in front of them!

Below are some symptoms to watch for when considering referring to a specialist for an eye exam:

  • headache
  • eye strain/eye fatigue with close work (e.g. reading, writing, computer work)
  • fluctuating vision
  • blurry distance vision after prolonged close work
  • losing place while reading
  • re-reading lines and/or losing concentration when reading
  • words or letters seem to jump around

There is a big overlap between vision therapists, behavioral optometrists, and occupational therapists.  OT practitioners are trained to work on the 17 key vision skills outlined above.  It is within our scope of practice to address visual perception, visual tracking, eye movement, and visual motor skills.  

While OT practitioners can perform more basic visual exercises with children, only an optometrist experienced in vision therapy can prescribe therapeutic lenses, filters and prisms to significantly impact the functioning of their visual skills.

As a “seasoned therapist” I feel very comfortable addressing the key vision skills. I am quick to refer to an ophthalmologist or optometrist to rule out visual acuity differences, but dig through my OT Toolbox for a long while before jumping to a vision therapist or behavioral ophthalmologist. 

If after a few sessions I hit a roadblock, or my treatment strategies are not working, I will then consider reaching out to other specialties.  This is not a “rule” or “procedure”, but my own treatment strategy after 30 years of clinical practice. 

What is the Role of the Occupational Therapist in Vision Therapy

Occupational therapy practitioners can work in conjunction with vision therapists to provide a great team approach to learning.  

I have often incorporated the same exercises the vision therapists are using in my treatment sessions in order to have carryover of skills.  Members of the OT Toolbox can find all of the resources associated with vision and visual perception in one convenient location. Click here to sign up, or access this information.

Behavioral Optometry Exercises

As with any skill, practice makes things better. Your eyes require exercise like any other body part. The rest of the body gets a lot of work during the day, however the eyes are often open and staring ahead. 

It’s important to work on their flexibility and agility. This can be done with vision training exercises.

Here are some vision exercises that might be used by a developmental optometrist:

The 10-10-10 Rule

The 10-10-10 rule in behavioral vision therapy is a technique used to reduce eye strain and fatigue when performing near work activities, such as reading or using a computer.

The rule suggests that after every 10 minutes of near work, you take a 10-second break to look at an object 10 feet away. This technique helps to reduce the strain on the muscles responsible for focusing up close and can prevent the development of symptoms such as headaches, eye strain, and blurred vision.

By following the 10-10-10 rule, you give your eyes a chance to relax and adjust to a different distance, which can help to reduce the risk of developing vision problems associated with prolonged near work.

Eye-Finger Exercise

The eye finger exercise is a technique used in behavioral optometry to improve eye teaming skills, specifically convergence, which is the ability of the eyes to move inward to focus on near objects.

During the exercise, the patient holds a small object such as a pen or a pencil with both hands, positioning it between their eyes at arm’s length. The patient then slowly moves the object towards their nose, keeping their eyes fixed on it, until the object is about 5 cm away from their nose. They then move the object slowly back to arm’s length while still keeping their eyes focused on it.

This exercise helps to train the eye muscles responsible for convergence, which can improve eye teaming skills and reduce symptoms such as eye strain, headaches, and double vision.

Varying Focus Exercise

The varying focus exercise is a technique used in developmental optometry to improve the ability of the eyes to change focus, also known as accommodation.

During the exercise, the patient looks at a chart with different sized letters or shapes. The chart is placed at a distance that is comfortable for the patient. The patient then alternates their focus between two points on the chart, one closer and one farther away. This exercise can be done by gradually moving the chart closer or farther away, or by using lenses that change the focus of the chart.

The varying focus exercise helps to improve the flexibility and responsiveness of the eye’s focusing system, which can improve overall visual function.

Clock Face Exercise

The clock face exercise is a technique used in both behavioral and developmental optometry to improve eye movement skills, specifically saccades, which are quick, coordinated movements of the eyes from one point to another.

During the exercise, the patient is asked to imagine a clock face and to look at each number on the clock in a specific order, such as 12-6-3-9-1-7-2-8-4-10-5-11. The patient is instructed to move their eyes quickly and accurately from one number to the next without moving their head.

The clock face exercise helps to improve the speed, accuracy, and coordination of saccadic eye movements, which are essential for reading, tracking moving objects, and other daily visual activities.

Other vision activities:

Here is a post on the OT Toolbox reviewing books related to vision.  Another interesting post explores whether the problem is visual or attention

Behavioral optometrists, like chiropractors, operate outside the realm of established medicine and largely rely on their own alternative methods to achieve results.  For this reason, there are people who are resistant to referring to or hiring a behavioral optometrist.  As with any alternative treatment methods, do the research, then provide an unbiased option to inquiring parents, letting them decide their plan of care.  

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

behavioral optometrist or developmental optometrist

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