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Behavioural Optometry Services | Cheltenham

WHAT IS BEHAVIOURAL OPTOMETRY?

Behavioural Optometry is a specialised area of optometry that looks beyond simply checking eyesight and prescribing glasses. It explores how the entire visual system is functioning, how vision has developed, how it’s used in everyday life, and whether it’s supporting you as well as it could be.

While standard eye exams focus on how clearly you can see, behavioural optometry considers how effectively you use your eyes to gather, process and understand visual information. Since over 80% of learning is visual, even small inefficiencies in the visual system can affect reading, concentration, coordination and comfort, especially in children.

A behavioural optometrist will consider developmental history, physical coordination, eye movements, and visual processing skills to understand whether there are underlying visual challenges. These may not always show up on a routine eye examination but can have a significant impact on learning and performance.

With this insight, a personalised strategy can be developed to improve visual function. This may include prescription lenses, changes to learning habits, or a tailored programme of vision therapy. These evidence-based interventions are designed to make the visual system more efficient, and when vision works better, everything else tends to feel easier too. The aim of behavioural optometry is to help people use their vision more efficiently and comfortably, supporting confidence, learning, and daily activities.

Vision is the dominant sense, and provides over 80% of the information we receive about the world around us. Most of our memories are of visual information, and our ability to visualise is crucial to thinking. Anything which interferes with this will affect how we learn, and may also cause a range of symptoms including strain and fatigue. With children this will often affect their desire to learn – particularly through close work, and will affect the development of their reading and writing. Some difficulties can affect balance and coordination, whilst others can leave a child exhausted by even short periods of study.

However it is the more subtle difficulties that can affect performance without causing symptoms that can be hardest to recognise. These can affect a child’s success in an apparently unexplainable way, leading not only to underachievement, but a sense of failure.

Below is a very brief guide to some of the issues affecting vision. It is a complex area, and no two individuals will have just the same pattern of difficulty – or have the same requirements. It is only after a comprehensive visual investigation that we can understand just what makes an individual ‘tick’, and what can be done to help.

Refractive Error – The most basic eyesight requirement is a clear retinal image, unaffected by excessive long or short sight. Often this is the only visual skill to have been assessed in routine sight checks.

Poor Convergence – the way the eyes team together and work as a pair. This is the commonest area of difficulty, and accounts for over half the symptoms associated with reading difficulties.

Poor Focusing – the way the eyes adjust to see something clearly up close. Reduced focus in adults is expected in the forties, but in children is usually ignored or not even suspected.

Poor Scanning or Tracking – the way the eyes move around the visual world to access and take in information. Problems here cause place- keeping difficulties as we read, and may affect spatial localisation as well as making us less aware of our surroundings.

Spatial Awareness – Our eyes provide a ‘Space map’ of the world around us, and the accuracy and completeness of this ‘map’ determines how well we react with our surroundings. The better our spatial awareness, the better our interactions with the world.

Perception – All of the above skills provide inputs that give us information. Perception is about what we do with that information, and how we make sense of the myriad of sensory stimuli we receive at any moment in time. Attention, speed of action and concentration are all products of perception, and problems with any of these will impact on our learning.

Please use the checklist below to see if we can be of help, but remember that these will not necessarily identify everyone we can help. If you are in any doubt, please contact us to see if we can assist. Many individuals develop excellent strategies to cope and to avoid overt pain or discomfort. These strategies can include unusual postures, distraction techniques – and simple downright avoidance! Children especially have limited experience of what others are seeing or perceiving – to them how they see is how everyone sees. They will not think to say that something is hard, assuming it is like that for everyone, so because a child does not mention a problem does not mean they don’t have one!

Some common signs of difficulty include:

  • Often loses place when reading
  • Misses out words or re- reads the same word
  • Needs to use a finger or marker to keep their place
  • Quickly becomes tired when reading
  • Experiences transient blurred or double vision during close work
  • Complains of words “moving about”, “shimmering”, or “dancing” when reading
  • Has difficulty copying from board down on to paper
  • Complains of headache (usually around the temples or eyes) after close work
  • Has poor concentration for close work
  • Short and often decreasing working distance
  • Continuous reading is inaccurate, yet they can read single words quite easily
  • Has difficulty “taking in” what they are reading, and have to read something several times for meaning
  • Poor coordination at near, typically shown as bumping into, or knocking things over, yet may be good at sports. This might have been identified as ‘dyspraxia’, but may simply be a vision problem.
  • Reluctance to play with jigsaws and similar puzzles.
  • Difficulty with spatial concepts in maths
  • Irregular and untidy handwriting
  • Travel sickness
  • A strongly phonetic pattern to spelling

If you have any queries or doubts about whether your child would benefit from a visual assessment then please contact the practice and we will gladly help.

James Turner is our dedicated Behavioural Optometrist here at Keith Holland Opticians, bringing over 20 years of experience as a specialist optometrist and more than 11 years of expertise in behavioural optometry. With only around 50 qualified behavioural optometrists in the entire UK, James is part of an elite group with advanced training in how vision affects learning, development and performance. His calm, thoughtful approach and deep understanding of visual function help patients of all ages, particularly children and those with visual processing challenges, to achieve their full potential.

W H O . A N D . H O W . W E . C A N . H E L P

A behavioural vision assessment can benefit almost anyone, but some groups in particular can gain enormous benefit from our help. These include children and adults with any of the following patterns of difficulty:

  • Dyslexia
  • Reading difficulties
  • Dyspraxia
  • Coordination problems
  • Autism
  • Attention difficulties – including ADD
  • Brain Injury – especially following brain trauma
  • Neuro- developmental delay

We do not pretend in anyway to ‘cure’ any of the above conditions. However it is well recognised that visual problems are usually a significant factor in all of the above conditions. Treating these issues can greatly reduce the impact of the condition on general living and learning.

ASSESSMENT.

WHAT'S INVOLVED DURING AN ASSESSMENT?

We offer several forms of assessment dependent on the age of the subject, and the nature of the difficulties.

We offer a thorough 80 minute assessment at your first visit. We look at all the key visual and developmental aspects of learning which include investigations of primitive reflexes and motor coordination. After the first assessment; we will tailor a further program to include visual processing, visual exercises and coloured overlays. Our tailored assessment program takes into account the personal needs of each individual and is suitable for all ages above 5 years old. Please call the practice your assessment today.

May not require such a full range of testing, and we normally see them for an hour, but if the problems are complex, a two hour visit may still be necessary. Adults with brain injury will normally be seen for two hours.

Prior to your appointment, we send you a detailed questionnaire to provide background information on what difficulties your child is facing at school and at home. This information is reviewed by our specialist behavioural optometrist and a phone call is booked with him to discuss your child’s individual needs.

On the day of your phone consultation, James will begin by discussing any points raised in the questionnaire and gain a deeper understanding of your child’s visual difficulties. During this phone consultation  James will  carefully structure a  series of visual efficiency tests to gather essential data on how your child’s visual system is functioning and book the in person clinical assessment with you and your child.

It’s essential that a parent or guardian attends the behavioural optometry consultation with their child. These sessions are highly interactive and involve detailed discussions about your child’s development, behaviour, visual habits and challenges, all of which you’ll have unique insight into. Your input helps us build a full picture of your child’s visual world, ensuring the most accurate diagnosis and tailored treatment plan. Parents also gain valuable understanding during the consultation, which is key to supporting and reinforcing visual strategies at home and school.

During the assessment a number of clinical tests will be carried out; these will look at not only their ability to ‘see’ but the way  the eyes focus, coordinate and track when reading, as well as how they handle and process visual information.

This aims to investigate how they function in a classroom environment.  From this a greater understanding on the impact their visual system has on their learning profile can be obtained.  James will share his findings and observations with you and outline his recommendations of support.

After the assessment a dedicated FBDO optician will personally guide you through your bespoke programme, ensuring you feel confident and supported every step of the way. Should corrective eyewear be advised, they will assist you in selecting the finest options available, crafted with precision to meet your child’s individual needs.

Our commitment to your care continues beyond your visit. Within one to two weeks, you will receive a detailed, yet accessible, report summarising your assessment and the next steps. We also maintain regular contact to monitor your progress and offer ongoing support whenever you need it.

Following your child’s assessment, several treatment pathways may be recommended, tailored specifically for them. Patients either engage in in-office programmes attend weekly therapy sessions over approximately four months, followed by a comprehensive review with an optometrist to assess progress, or opt for home-based programmes, with follow-up therapy sessions usually occuring every four weeks, with an optometrist review around six months later. Throughout, our priority is to adapt and personalise your care plan to suit your lifestyle and goals.

With patients from over 60 countries, we pride ourselves on delivering world-class care that seamlessly fits your unique needs, wherever you are.