Behavioural Optometry

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Picture5ist1_2590952-young-reader At Strachan EyecarePlus our Optometrists follow the fundamental principle of Behavioural Optometry which means that we aim to maximise vision for the well-being of the whole person, not just the ability to read letters off the eye chart in our office.

Vision is the dominant sense, and impacts on all areas of human development and performance. Thus our objective is always to enhance and optimise visual performance. This is often achieved through the use of appropriate eye exercises or “Vision Therapy”, possibly as well as the use of glasses or contact lenses. Advice regarding appropriate “visual hygiene” may also be given.

Behavioural principles are particularly relevant to children and learning.

Childrens Vision & Learning Difficulties

At Strachan EyecarePlus our Optometrists have a special interest in children’s vision and visually related learning difficulties. Thus when we examine a child who is under-achieving, we follow an examination protocol consisting of two parts:

  1. PRIMARY OPTOMETRIC EXAMINATION: This is a “visual efficiency examination” and will determine the status of the “visual hardware”. It consists of a number of tests designed to determine if the child has healthy eyes and can see clearly and comfortably without undue effort or stress for long periods of time.This examination is an essential first step in our assessment of all children.It should be noted that the demands on a child’s eyes increase markedly as the child proceeds through primary school whilst at the same time their eyes are growing and developing rapidly, and so routine review of these skills is recommended at least every two years for all children, regardless of academic performance.
  2. DEVELOPMENTAL VISUAL PERCEPTUAL ASSESSMENT: This is a “visual information processing evaluation” and provides understanding of the “visual software” at the higher brain levels in the visual processing pathways after the eye itself. These tests probe the child’s ability to understand, interpret and remember what they see, together with the child’s ability to link vision to language.All tests used are well standardised, enabling us to determine whether your child’s present visual perceptual development is at the expected level for their age or grade. Such evaluation is recommended for primary school children who are experiencing learning difficulties, or who are not performing at the level it is felt they should be capable of. Perceptual assessment can also help in assessing a pre-school child’s “readiness” for school.

Screening tests of auditory skills, language and motor skills may also be included, and recommendations for referral to other appropriate specialists will be made on indication eg. Educational and Developmental Psychologists, Paediatricians, Educational Audiologists, Speech/Language Pathologists, Occupational Therapists, Behavioural Neurotherapy Practitioners, Tutors etc.

Screening testing with coloured overlays for pattern glare when reading can also be arranged on indication (‘Irlen Syndrome’ or ‘Scotopic Sensitivity Syndrome’).

It is important for parents to realise that children with excellent clarity of eye-sight as measured on a letter chart can still have visually related learning difficulties.

A Developmental Visual Perceptual Assessment will investigate the following skills:

  • Eye-Tracking: Students must be able to track their eyes accurately across a row of print and from the end of one row to the start of the next. Difficulty can cause students to lose place or skip words or lines which can affect reading speed, fluency and comprehension.
  • Visual discrimination: This is an extremely important skill – awareness of how things look different, or attention to visual detail, and is particularly relevant to the child who mistakes words or letters that look similar (eg. hat / hut) inspite of having ‘normal sight’ as measured on a letter chart.
  • Visual spatial skills: Laterality is the ability to know left and right on oneself, directionality is the ability to project these directions onto other objects out in space. Lack of confidence in these visual spatial skills may result in poor organisation of work on the page, and is often associated with reversals and inversions of letters, numerals and words (eg. b/d, was/saw).
  • Visual-Motor Integration (eye-hand co-ordination): This is the skill in which the brain guides movement of the hands based on the information it receives from the visual system. If the child has poor eye-hand co-ordination, handwriting will very likely be mess, disorganised and slow. These problems can be compounded if fine-motor skills and/or pencil grip are poor. Visual-motor integration is also important to many sports and crafts.
  • Visual Memory and Visualisation: Visual memory is the ability to recall visual material well enought to recognise it when seen again, whilst visualisation is the most highly developed form of visual memory, and is the ability to spontaneously form an image in one’s mind.Difficulties with these skills may be associated with poor sight word recognition or poor comprehension, and can also cause problems with copying tasks, spelling (particularly with the many irregularly spelt words of the English language) and maths (tables, mental arithmetic and geometry).
  • Visual Attention Span: This is the number of letters or amount of visual information which the child can “take in” and process accurately in one glance.Visual span is closely related to sight word recognition and thus to reading fluency – if the span is limited, then the child will have to rely on slow letter-by-letter “sounding out” strategies or will make wild guesses at words based only on the first few letters, thus will ofter mistake words with similar beginnings.
  • Visual-Verbal Integration: Visual-verbal testing gives an indication of expressive language ability and the speed of “Rapid Automatic Naming” (or RAN). Delayed RAN will result in slow disjointed reading as the child struggles to “see and say” quickly. This type of testing also gives useful insight to the child’s “cognitive style” (ie. impulsive vs. reflective).
  • Auditory Skills: Auditory analysis, or “phonemic awareness” is the ability to hear and analyse sounds and blends within words, a very important skill for reading and spelling. Auditory memory relates to how well we hear and retail verbal information. This relates closely to language development and in particular to the ability to follow oral instructions.
  • Visual-Auditory Integration: Reading demands the skill of matching visual symbols to their sounds or “knowing how a written word sounds our aloud”. Spelling works the other way, requiring the child to match sounds to visual symbols or “knowing how a heard word looks down on paper”. Testing will indication whether the child uses a more visual or phonetice approach to reading and spelling, which can be helpful in developing appropriate remedial strategies.

Recommendations

Following the assessment, reommendations will be given appropriate to your child’s needs.

In many cases informal recommendations regarding appropriate strategies and activities is all that is needed. However should significant deficits be found in any of the visual perceptual skill areas outlined above, then a Vision Therapy Program may be recommended for your child, as research and experience shows that appropriate daily Vision Therapy activities can help to develop and enhance visual perceptual skills, which in turn can make it easier for the child to learn. Thus there can be a positive impact on school achievement.

It must, however, be realised by parents that providing appropriate vision care, including developmental Vision Therapy, does not ‘cure’ learning problems, but it does provide a solid foundation of visual abilities that a learning team can build upon.  It will make it easier for the child to learn visually, and thus the child’s attention and concentration may also improve, but the child may still need educational remediation to catch up in areas where they are academically behind.

Fees

The Primary Optometric Examination is claimable through Medicare and we will BULK BILL whenever possible. Time allowed for this examination is 30 minutes.

The Developmental Visual Perceptual Assessment is not fully covered by Medicare and is not rebatable by private health funds. For further information regarding fees for this assessment please refer to the handout available from the ‘Resources and Handouts’  Menu above. The assessment  includes preparation of a detailed printed report. For school-age children this assessment takes 75 to 90 minutes, and for pre-school children, 30 minutes is generally allowed.