Behavioral optometry

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Behavioral optometry is a type of complementary and alternative medicine which encompasses a number of unorthodox ideas and practices related to visual processes.[1][2] In general, behavioral optometrists attempt to improve vision and well-being using eye exercises and lenses in ways which depart from conventional optometry. Therapists aim to treat a broad range of conditions including visual impairments, neurological disorders and learning disabilities.

Many of the ideas associated with behavioral optometry lack a clear scientific basis. Research, where it exists, is of low quality. A few of the techniques used align with medical evidence, but most do not.[2]

Techniques[edit]

In a 2008, vision scientist Brendan Barrett published a review of behavioral optometry at the invitation of the UK College of Optometrists. Barrett wrote that behavioral optometry was not a well-defined field but that it was sometimes said to be an "extension" to optometry, taking a holistic approach: practitioners of the therapy use techniques outside mainstream optometry to "influence the visual process". Barrett discussed these techniques under ten headings:

  1. Vision therapy for accommodation/vergence disorders – eye exercises and training to try and alleviate these disorders. There is evidence that convergence disorders may be helped by eye exercises, but no good evidence exercises help with accommodation disorders.
  2. The underachieving child – therapies claimed to help children with dyslexia, dyspraxia and attention deficit disorder – a "vulnerable" target market. There is no evidence that behavioral optometry is of any benefit in relation to these conditions.
  3. Prisms for near binocular disorders and for producing postural change – the use of "yoked" prisms to redirect a person's gaze and bring about a range of claimed benefits including postural improvements and increased wellbeing. There is a lack of evidence for the effect this approach may have.
  4. Near point stress and low-plus – the use of special lenses to adjust near-field vision, even for people who would not normally need glasses. This is claimed to bring about postural benefits and relieve visual stress. Some research has been carried out in this area and its effectiveness remains "unproven".
  5. Use of low-plus lenses at near to slow the progression of myopia
  6. Therapy to reduce myopia
  7. Behavioural approaches to the treatment of strabismus and amblyopia
  8. Training central and peripheral awareness and syntonics
  9. Sports vision therapy
  10. Neurological disorders and neurorehabilitation after trauma/stroke.[2]

Barrett noted the lack of published controlled trials of the techniques. He found that there are a few areas where the available evidence suggest that the approach might have some value, namely in the treatment of convergence insufficiency, the use of yoked prisms in neurological patients, and in vision rehabilitation after brain disease or injury—but he found that in the other areas where the techniques have been used, the majority, there is no evidence of their value.[2]

Conceptual basis and effectiveness[edit]

Behavioral optometry is largely based on concepts which lack plausibility or which contradict mainstream neurology, and most of the research done has been of poor quality.[3] As with chiropractic, there seems to be a spectrum of scientific legitimacy among practitioners: at one extreme there is some weak evidence in support of the idea that myopia may be affected by eye training;[2] at the other extreme are concepts such as "syntonic phototherapy" which proposes that differently colored lights can be used to treat a variety of medical conditions.[3]

A review in 2000 concluded that there were insufficient controlled studies of the approach.[4] In 2008 Barrett concluded that "the continued absence of rigorous scientific evidence to support behavioural management approaches, and the paucity of controlled trials in particular, represents a major challenge to the credibility of the theory and practice of behavioural optometry."[2]

Behavioral optometry has been proposed as being of benefit for children with ADHD and autism – this proposal is based on the idea that since people with these conditions often have abnormal eye movement, correcting this may address the underlying condition. Evidence supporting this approach is however weak; the American Academy of Pediatrics, the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus have said that learning disabilites are neither caused nor treatable by visual methods.[5]

History[edit]

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.[6] A.M. Skeffington was an American optometrist known to some as "the father of behavioral optometry".[7] Skeffington has been credited as co-founding the Optometric Extension Program with E.B. Alexander in 1928.[7]

Research[edit]

A review in 2000 concluded that there were insufficient controlled studies of the approach[4] and a 2008 review concluded that "a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated."[2] There is some question as to the value of such assessments, as most behavioral domains, such as psychology and education do not lend well to the strict requirements of evidence-based medicine (EBM). Indeed, many common medical practices also have not been supported by EBM, such as off-label use of medications, or use of medication for learning and reading disabilities.

See also[edit]

References[edit]

  1. ^ Wolraich M, Dworkin PH, Drotar DD, Perrin E (2008). Developmental-behavioral Pediatrics: Evidence and Practice. Elsevier Health Sciences. p. 556. ISBN 0-323-04025-X. 
  2. ^ a b c d e f g Barrett BT (2009). "A critical evaluation of the evidence supporting the practice of behavioural vision therapy". Ophthalmic Physiol Opt (Review) 29 (1): 4–25. doi:10.1111/j.1475-1313.2008.00607.x. PMID 19154276. the continued absence of rigorous scientific evidence to support behavioural management approaches, and the paucity of controlled trials in particular, represents a major challenge to the credibility of the theory and practice of behavioural optometry. 
  3. ^ a b Novella S (28 October 2009). "A Science Lesson from a Homeopath and Behavioral Optometrist". Science-Based Medicine. Retrieved March 2015. 
  4. ^ a b Jennings (2000). "Behavioural optometry – a critical review.". Optometry in Practice 1 (67). 
  5. ^ Wolraich et al. 2008, pp. 269-270.
  6. ^ Birnbaum MH. "Behavioral optometry: a historical perspective." J Am Optom Assoc 1994 Apr;65(4):255-64. PMID 8014367.
  7. ^ a b "A.M. Skeffington, O.D.: The Father of Behavioral Optometry." Visionaries (Reprinted from January–December 1991 Issues of Review of Optometry) Review of Optometry. Accessed February 5, 2012.

Further reading[edit]