Beyond the Prescription: What is Behavioural Optometry and Who Can It Help?

What is Behavioural Optometry?

 When we think about our vision, many of us simply consider whether we can see clearly. We often believe that if we have 20/20 vision, our eyes are perfect.

However, true vision is a far more complex process. It’s a dynamic skill that involves a sophisticated partnership between our eyes and our brain. Our brain constantly interprets the information our eyes gather, helping us make sense of the world around us.

This intricate system allows us to read, learn, work on computers, and enjoy our favourite activities with ease. But what happens when this visual system isn’t working as efficiently as it could be?

This is where behavioural optometry offers a different perspective. It looks beyond simply correcting sight with glasses or contact lenses. It focuses on how we use our eyes and how our brain processes visual information.

In this comprehensive guide, we will explore what behavioural optometry is. We’ll find how it differs from a standard eye test and uncover how its holistic approach can help individuals of all ages achieve more comfortable, efficient, and clearer vision.

Behavioural optometry is a specialised field that goes beyond simply measuring how clearly you can see. It examines how our visual system functions as a whole, focusing on the intricate connection between our eyes, brain, and body. Instead of just prescribing a lens to correct a refractive error, behavioural optometrists assess and address the underlying visual skills required for comfortable, efficient vision in daily life.

This includes evaluating key visual skills such as eye teaming (how well our eyes work together), focusing (the ability to maintain clear vision at various distances), and eye movements (how smoothly and accurately our eyes track objects). We also consider visual processing – how the brain interprets the visual information it receives. A behavioural optometrist understands that vision is a learned skill, and like any skill, it can be developed and improved.

Our approach is holistic, recognising that visual problems can impact learning, work performance, and overall quality of life. Unlike a standard eye test that primarily checks for 20/20 acuity and eye health, behavioural optometry assesses “functional vision” – how effectively you use your eyes in real-world scenarios.

How a behavioural approach differs

The key difference lies in the comprehensive assessment. A standard eye test typically focuses on identifying refractive errors (like myopia or hyperopia) and checking for eye diseases. While these are crucial components of eye care, they don’t always tell the full story of how a person’s visual system is coping with the demands of their environment.

A behavioural optometrist, on the other hand, conducts an in-depth evaluation that considers your personal and functional needs, your visual environment, and how you use your eyes daily. This allows us to develop personalised management strategies that go beyond just prescribing glasses. We look for subtle inefficiencies or dysfunctions in the visual system that may contribute to symptoms such as eye strain, headaches, or difficulty concentrating.

The core visual skills assessed

To provide this deeper understanding, we assess a range of core visual skills:

• Eye Tracking: The ability to smoothly track moving objects (smooth pursuit) and shift gaze quickly and accurately between targets (saccades). Poor eye tracking can affect reading fluency and sports performance.
• Binocular Vision (Eye Teaming): This refers to how well both eyes work together as a coordinated team. Issues here can lead to double vision, eye strain, or difficulty with depth perception.
• Accommodation (Focusing Flexibility): This is the eye’s ability to change focus from distant to near objects quickly and accurately, and to maintain clear focus over time. Problems with accommodation are often linked to near work-induced visual stress.
• Visual Perception: This encompasses how the brain interprets and organises visual information. It includes skills like visual memory, visual discrimination, and spatial awareness, which are vital for learning and understanding.
• Visual-Motor Integration: The ability to coordinate visual information with motor actions, essential for tasks such as writing, drawing, or catching a ball.

By evaluating these skills, we gain a comprehensive picture of your visual system’s strengths and weaknesses, enabling us to tailor solutions that address the root cause of any visual challenges.

The Link Between Modern Life and Visual Stress

Our modern lifestyle places unprecedented demands on our visual systems. The pervasive use of digital devices, coupled with increased near work for both education and employment, has led to a significant rise in visual stress. This constant engagement with close-up tasks, often under artificial lighting, can contribute to symptoms like visual discomfort, headaches, and tired eyes.

Conversely, a decrease in time spent outdoors has also been identified as a major contributing factor to visual health issues, particularly the global surge in myopia. The shift from an outdoor-centric lifestyle to one dominated by indoor, near-focused activities has created a perfect storm for visual adaptation, which can lead to eye strain and the progression of refractive errors.

The growing challenge of short-sightedness

Myopia, commonly known as short-sightedness or nearsightedness, is a vision condition where distant objects appear blurry because light focuses in front of the retina. This is typically due to the eyeball growing too long, a phenomenon known as axial elongation. The statistics are stark: myopia impacts nearly 30% of Americans, and this number has nearly doubled since 1971 [American Optometric Association]. Globally, the situation is even more critical, with the number of Americans with myopia having nearly doubled since 1971 [National Eye Institute]. In East and Southeast Asia, a reported 80-90% of children with 12 years of schooling have myopia, signalling a global “myopia boom” [PubMed: 25788077]. More than one-third of children worldwide were nearsighted in 2023, and this is projected to rise to nearly 40% by 2050 [CNN].

The causes of myopia are complex, involving a delicate interplay of genetic and environmental factors. Studies have consistently shown that children who have one or both parents with myopia are more likely to develop the condition themselves [Studies]. Twin studies further highlight the genetic component, reporting a significantly higher correlation of myopia prevalence in identical twins than fraternal twins [PubMed: 16899164, PubMed: 23329669, PubMed: 23620424]. Genome-wide association studies (GWAS) have even identified 24 genomic variants associated with a 10x increase in the risk of myopia [PubMed: 23396134].

However, genes alone cannot account for the rapid worldwide increase in myopia prevalence [PubMed: 12010207]. Environmental influences play a crucial role. Prolonged engagement in close-up activities like reading or using a computer, often referred to as “visual stress,” can cause myopia to worsen [Studies]. Excessive use of digital devices such as computers, tablets, and smartphones is also a significant contributor to myopia progression [Studies, PubMed: 34625399]. This phenomenon, where modern lifestyle choices contribute to the development and worsening of vision problems, is often referred to as behavioural myopia causes.

Conversely, a lack of time outdoors may also cause myopia to worsen [Studies]. Research suggests that spending time outdoors reduces the risk of developing myopia [PubMed: 23644222, PubMed: 18294691, PubMed: 26372583]. The mean illuminance outdoors (up to 100,000 lux) is significantly higher than typical indoor values (350-500 lux), and this high-intensity light may be responsible for the protective effect of outdoor activity against myopia progression [PubMed: 26567790, PubMed: 23662955, PubMed: 23557736, PubMed: 22169102, PubMed: 19516016, PubMed: 20445123, PubMed: 27560692]. Health conditions like diabetes can also cause myopia to develop and get worse [What Causes Short-Sightedness: Reasons for Myopia ].

The increasing prevalence of myopia is not just a matter of needing stronger glasses; it’s a significant public health concern. High myopia (typically defined as -6.00 diopters or more) significantly increases the risk of serious eye conditions later in life, including retinal detachment, glaucoma, cataracts, and myopic macular degeneration, which can lead to irreversible vision loss [PubMed: 24099276, PubMed: 32347918]. Therefore, managing myopia, especially in childhood, is crucial to protect long-term eye health.

Managing myopia with a behavioural optometry mindset

Given the multifaceted nature of myopia, effective management requires a comprehensive approach. Behavioural optometry focuses on slowing down or controlling the progression of myopia, rather than merely correcting the symptoms. Our goal is to mitigate the risk of developing high myopia and its associated complications.

Several advanced strategies are available for myopia management:

• Atropine Eye Drops: Low-dose atropine eye drops have been shown to be effective in slowing myopia progression in children [PubMed: 28293653, PubMed: 21963266]. Studies have explored various concentrations, with 0.01% atropine often found to be effective with minimal side effects [PubMed: 24315293, PubMed: 26271839].
• Orthokeratology (Ortho-K): These are specially designed gas-permeable contact lenses worn overnight to temporarily reshape the cornea. They provide clear vision during the day without glasses or contacts, and numerous studies, such as the LORIC and ROMIO studies, have demonstrated their effectiveness in slowing myopia progression in children [PubMed: 26704137, PubMed: 15875367, PubMed: 22969068, PubMed: 26636396].
• Specialty Soft Contact Lenses: Products like MiSight® 1 day (omafilcon A) Soft (Hydrophilic) Contact Lenses are specifically designed to slow myopia progression in children. These prescription daily disposable lenses are indicated for children aged 8-12 with specific refractive errors (-0.75 to -4.00 D SE, ≤ 0.75 D astigmatism) [MiSight.com/safety]. They work by providing peripheral defocus, which is believed to signal the eye to slow its growth.
• Myopia Control Spectacle Lenses: Innovations like MiYOSMART spectacle lenses utilise D.I.M.S. (Defocus Incorporated Multiple Segments) technology to provide clear vision while simultaneously creating a peripheral defocus effect to slow eye elongation. Other options, such as anti-fatigue or progressive-addition lenses (PALs), have shown a statistically significant, though small, reduction in myopia progression in children compared to single vision lenses.

By combining these innovative treatments with lifestyle advice focused on reducing visual stress and increasing outdoor time, we can proactively manage myopia and protect our patients’ long-term eye health.

What to Expect from a Comprehensive Vision Assessment

A comprehensive vision assessment with a behavioural optometrist goes far beyond a standard script check. It’s an in-depth exploration of your entire visual system, designed to uncover not just what your vision is, but how it functions and how it impacts your daily life.

During your assessment, we will ask you in-depth questions about your medical history, visual symptoms, daily activities, and lifestyle. This lifestyle assessment helps us understand the visual demands you face at work, school, or during hobbies. We then perform a series of specialised visual skills tests that evaluate eye tracking, binocular vision, accommodation, and other visual skills. This allows us to identify any inefficiencies or underlying issues that might be contributing to visual discomfort or reduced performance. The goal is to develop personalised solutions that address your specific needs.

Who can benefit from behavioural optometry?

Behavioural optometry offers significant benefits to a wide range of individuals:

• Office Workers: Those who spend long hours in front of screens often experience digital eye strain, headaches, and fatigue. We can identify visual inefficiencies contributing to these symptoms and provide solutions to improve comfort and productivity.
• Students: Children and young adults who struggle with reading, learning, or concentration may have underlying visual processing difficulties. Our assessments can pinpoint these issues, leading to targeted interventions that support academic success.
• Adults with Visually Demanding Jobs: Professions that require precise visual skills, such as surgeons, artists, or tradespeople, can benefit from optimising their visual systems for peak performance and reduced strain.
• Individuals with Persistent Visual Discomfort: If you experience chronic eye strain, headaches, or blurred vision despite having “20/20” acuity, a behavioural assessment can uncover hidden functional problems.
• Children with Developing Vision: Early detection and management of visual skill deficits, especially those related to myopia progression, are crucial for healthy visual development and preventing long-term complications.

Personalised management strategies

Based on the findings of your comprehensive assessment, we will develop a personalised management plan. This may include a combination of strategies:

• Vision Therapy: A customised program of visual exercises designed to improve specific visual skills like eye tracking, focusing, and eye teaming. This is akin to physical therapy for the eyes and brain.
• Specialised Spectacle Lenses: Beyond standard prescriptions, these might include lenses with specific tints, prisms, or designs (like those used for myopia control) to reduce visual stress and improve visual function.
• Contact Lens Options: Including specialty soft contact lenses (like MiSight) or Orthokeratology lenses for myopia management, offering both vision correction and control over progression.
• Lifestyle and Environmental Advice: Recommendations on ergonomics, lighting, screen time habits, and the importance of outdoor activity to support overall visual health.

Charting a Clearer Path for Your Vision

At the core of behavioural optometry is the understanding that vision is a dynamic process, not a static state. It’s about empowering you to take proactive control of your visual health, rather than simply reacting to problems as they arise. Our personalised approach means we consider your unique needs, lifestyle, and visual goals to chart a clearer path for your vision, ensuring comfort, efficiency, and long-term well-being.

Frequently Asked Questions about Behavioural Optometry

Is behavioural optometry only for children? While many children benefit from behavioural optometry, it is certainly not limited to them. Adults, especially those experiencing visual stress from prolonged screen time, demanding work environments, or persistent visual discomfort, can greatly benefit from this comprehensive approach to eye care. It helps individuals of all ages optimise their visual skills for improved comfort and efficiency in their daily lives.

How is it different from a standard eye test? A standard eye test primarily focuses on measuring visual acuity (e.g., 20/20 vision) and checking for eye diseases. Behavioural optometry goes a step further by assessing how you see, not just what you see. We evaluate a wide range of functional visual skills, including eye teaming, focusing flexibility, and eye movements, to understand how effectively your visual system functions in real-world situations.

Can it cure short-sightedness? Behavioural optometry does not “cure” short-sightedness (myopia) in the sense of reversing it entirely. Instead, our focus is on myopia management and slowing its progression, especially in children and adolescents. We achieve this through various strategies, including specialised spectacle lenses, specialty contact lenses like MiSight, Orthokeratology (Ortho-K), and atropine eye drops, alongside lifestyle and environmental advice. The aim is to reduce the rate of myopia progression, protecting long-term eye health and reducing the risk of associated complications.

Your Vision, Our Focus

Behavioural optometry provides a deeper understanding of your vision, recognising its profound impact on your daily life. It’s about optimising the entire visual system for comfort and efficiency, fostering a proactive partnership for lifelong eye health. If you’re experiencing visual discomfort, struggling with visual tasks, or simply want a more comprehensive assessment of your eye health, we can help.

Book an appointment with us today.