Behavioural Treatment

Behavioural Information

Visual problems that prevent children from doing well in the classroom will NOT be uncovered by measuring eyesight alone, nor by most stereoscopic devices. The value of such school-screening methods is to identify those children who do not have normal eyesight.

VISION IS MORE THAN EYESIGHT

It is the ability to visualize, understand and apply the information that comes through the eyes. When using this guide and checklist we need to understand the difference between the terms SIGHT and VISION.

SIGHT is merely what results from the eyes’ responses to light shining into them and is measured by determining how well we can see different sized letters on a chart in the distance. VISION results from the child actively interpreting and understanding the information made available through the eyes.

Children with normal (20/20) EYESIGHT may not have these abilities. Therefore, learning problems are often related to vision problems. 

SO WHAT IS BEHAVIOURAL OPTOMETRY?

Behavioural Optometry is many things to many people even within the profession. The common link is the understanding of vision and how to encourage its development. It tends to be more holistic in its approach as it tries to incorporate the physical, neurological and developmental aspects of vision.

HOW IS A BEHAVIOURAL OPTOMETRIST DIFFERENT?

Behavioural Optometrists spend years in post-graduate and continuing education to master the complex visual programs that are prescribed to prevent or eliminate visual problems and enhance visual performance.

Not all optometrists practice Behavioural Optometry, which includes neurodevelopmental and functional optometry.

GOALS OF BEHAVIOURAL OPTOMETRY

The goals of Behavioural Optometric care are:

1. To prevent VISION problems and eye problems from developing
2. To provide remediation or rehabilitation for VISION or eye problems that have already developed (eg. eye turn, shortsightedness, visual sequelae of brain trauma etc)
3. To develop and enhance the visual skills needed to achieve more effective visual performance in the classroom, work place, when playing sport and following recreational pursuits

WHICH PATIENTS MAY BENEFIT FROM BEHAVIOURAL OPTOMETRY?

All patients will benefit from the more holistic approach but it is especially suited to those with eye motor control problems, lazy eyes, developmental delays, neurological damage or learning delays.

Although the majority of Behavioural Optometrists' patients are children, Behavioural Optometry may be suitable for patients of any age if their condition is likely to respond to this treatment.

SIGNS OF VISION PROBLEMS

Vision is a key sense in the classroom and plays a major role in reading, spelling, writing, board work, and computer work. Students tackle these tasks all day long, day after day. Each requires the visual skills of seeing quickly and understanding visual information that is frequently less than arm’s length from the eyes.

Many students’ visual skills are not up to the demands of these types of classroom learning situations. 

Clear eyesight is not all that is required for close vision tasks. Students must have a variety of scanning, focusing and visual coordination skills for learning and for getting meaning from reading. 

If these visual skills have not been or are poorly developed, learning may become more difficult and stressful and students typically may react in one of a variety of ways:

• Avoidance of near visual work
• Perseverance but with reduced understanding
• Discomfort, fatigue and a short attention span
• Adaptations such as the development of short sightedness or suppression of the vision of one eye

Visual stress reactions can help explain the discomfort, fatigue, changes in behaviour, altered eyesight and declining academic performance that often indicate a learning-related vision problem. 

Vision problems do not “cause” learning disabilities. However, poor visual skills can interfere with the process and impede remedial efforts. Vision is a foundation skill. Without a sound base, learning is like trying to build a house on sand. Good vision skills are essential to support learning.

Behavioural Optometrists may help their patients deal with visual stress by prescribing “support lenses". These lenses make it much easier for a child to use their visual system for various visually demanding tasks without stressing the visual system. 

Another fundamental approach is Vision Therapy. This is a sequence of activities prescribed by an optometrist whereby the child develops and learns to control their visual system to ensure it operates more efficiently. This in turn allows the child to understand and use visual information more effectively.

CHECKLIST

Some of these signs are on the following checklist. If a child routinely exhibits any of these signs it’s time to arrange for a behavioural vision evaluation. 

 Eliminating the visual problems that are contributing to these signs or symptoms can result in rapid improvement in the child’s school performance.

• Holding a book very close (only 15-20 cms away)
• Child holds head at an extreme angle to the book when reading
• Child covers one eye while reading 
• Child squints when doing near work
• Constant poor posture when working close
• Child moves head back and forth while reading instead of moving only the eyes
• Poor attention span, drowsiness after prolonged work less than arm’s length away
• Homework requiring reading takes longer than it should
• Child occasionally or persistently reports seeing blurring or double while reading or writing
• Child reports blurring or doubling only when work is hard
• Loses place when moving gaze from desk work to white board, or when copying from text to notebook
• Child must use a marker/ruler/finger to keep their place when reading
• Writing up or down hill, irregular letter or word spacing
• Child reverses letters (b for d) or words (saw for was)
• Repeatedly omits “small” words
• Re-reads or skips words or lines unknowingly
• Fails to recognize the same word in the next sentence
• Misaligns digits in columns of numbers
• Headaches after reading or near work
• Burning or itching eyes after doing near vision work
• Child blinks excessively when doing near work, but not otherwise
• Rubs eyes during or after short periods of reading
• Comprehension declines as reading continues
• Child fails to visualize (can’t describe what they have been reading about)

MANY CHILDREN HAVE 20/20 EYESIGHT

Behavioural Optometrists find that most children with learning-related vision problems have good distance eyesight but have great difficulty maintaining vision up close such as when reading and writing. 

 Most school screenings only test the sharpness of distance eyesight. As a result many vision problems that can impact on learning go undetected. 

Parents and teachers who understand and can identify the signs and symptoms can detect learning-related visual problems in a child. 

Behavioural optometric intervention in the management of children and adults with learning disabilities helps to eliminate any vision problem that may obstruct learning.

 Current research indicates that some people with reading difficulties have co-existing visual and language processing deficits. For this reason, a vision examination that assesses those factors influencing learning is vital. 

IN SUMMARY

• Vision problems can and often do interfere with learning
• People at risk of learning-related vision problems should be evaluated by an optometrist who provides diagnostic and management services in this area
• Problems in identifying and treating people with learning-related vision problems arise if the definition of vision is limited to clarity of sight and healthy eyes
• The goal of optometric intervention is to improve visual function and alleviate associated signs and symptoms
• Prompt treatment of learning-related vision problems enhances the ability of children and adults to perform to their full potential
• People with learning problems require help from many disciplines to meet the learning challenges they face. Behavioural Optometric involvement constitutes one aspect of the multi-disciplinary management approach required to prepare the individual for lifelong learning

Vision Therapy

Vision therapy (also referred to as visual training) is a program aimed at remedying and enhancing an individual’s visual abilities. Its function is to:

• Treat existing visual problems such as amblyopia (lazy eye), eye alignment problems, eye coordination problems, poorly sustained near focus, inadequate eye-hand coordination and immature perceptual development
• Enhance the efficiency and comfort of visual function
• Help prevent some visual problems 

Each program of vision therapy must be designed to suit the specific needs of the individual, both in terms of their visual profile and their goals. Diagnostic testing, training procedures and the use of lenses and prisms may be integral components of the successful treatment of a vision problem. The frequency of consultation, the amount of home training and the duration of a course of vision therapy will vary depending on the nature and severity of the problem being treated and the specific needs of the patient.

Vision therapy is not used to strengthen eye muscles, but to improve the coordination and efficient functioning and processing of the visual system.

Vision Therapy for Children and for Learning Difficulties

We all know that a child's development can vary immensely from child to child; it is perhaps not as well known that vision also develops! This also means that vision can be trained or learned through appropriate structured vision therapy.

Example:

Unfortunately, like all skills and for various reasons, there is sometimes a delay in a child’s course of development of their visual skills. These delays can cause problems with a child's learning ability. In fact in some cases children are not visually ready to read until well after 5 or 6 years of age.

Your child's vision may be clear enough but they may not have developed the appropriate visual skills for reading. When reading, it is necessary for a child to keep their place along a line of text (tracking skills) as well as keeping the page in focus at the same time (focussing skills). A child with tracking or focussing difficulties is therefore more likely to have difficulty with reading.

To read left to right partly requires tracking skills but also involves visual-spatial skills. It is important to understand that reading from left to right is actually a culturally and educationally imposed requirement. In many cultures, reading is vertically arranged or in some cases, is arranged from right to left. A child who has not understood or adequately organised the necessary aspects of visual spatial will most likely have difficulty with learning to read.

The level of demands on visual skills required for reading increases throughout a child's learning years. Primary visual skills required for early readers are listed below:

Tracking and Saccades:

Scanning from letter to letter, word to word, looking ahead and predicting text, moving from one line to the next.

Visual Memory:

Skills required for word recognition and copying tasks, for example in writing, spelling and reading.

Short Term Visual Memory:

Recalling information presented quickly.

Sequencing

Recognising the order of number or letters in words. Left to right progression when reading and writing.

Visual Discrimination:

Recognising subtle visual differences, ie between letters (b/d) and words (was/saw or big/dig), reducing reversals and confusion and thus improving overall recognition. Reversals are common in younger children. However, if a child has persisting reversal issues a Behavioural Optometric assessment should be considered to see if Vision Therapy can assist.

Focussing Skills:

The ability to maintain clear focus at a particular point (a word on a page) and the ability to rapidly change focus from one point to another (copying from the board to the book).

Vision Therapy can assist, overcome or minimise some learning difficulties by reducing visual inefficiencies.

Vision Therapy for sports

Have you ever heard someone say 'that player has great vision'?

Sports commentators often describe a player's ability to accurately judge where other players or the goals are without looking, as 'great vision'.

This ability has nothing to do with the player's 'clarity of vision'; it is about peripheral awareness and efficient visual function. Some sports people have these skills naturally, others need to learn to develop them!

Vision training activities are a structured series of exercises designed to maximise the efficiency of specific visual skills required for all different types of sports.

Examples of how vision therapy can assist your game:

1. Tennis: overhead shots require locating exactly where the ball is while looking upwards and aiming the eyes in this position; this is not a natural skill but it can be improved. Vision therapy can also assist your general groundstrokes, and calculating the length of shots is related to eye-hand coordination.
2. Cricket: Vision therapy may be utilised to increase visual efficiency of one or both eyes. Many players have found improvements in fielding (judging the flight of the ball). Some batsmen have also noted improvements in seeing the ball more clearly as it leaves the bowler’s hand.
3. Football: peripheral (side) vision awareness can be developed with sports vision therapy. Activities involve improving central visual skills and then co-ordinating these skills with peripheral awareness.

So if your sport involves vision (and let’s face it - most do) then consider a vision examination and talk to your nearest Behavioural Optometrist about your specific sport and its visual requirements.

If you want to improve your sporting abilities, first try to improve your visual abilities!