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Behavioral Optometry?
August 20, 2014 11:25 AM   Subscribe

Daughter's optometrist is pushing behavioral optometry testing and treatment. It sounded legit when she was discussing it with me, but the handout is setting off alarm bells, and Googling it isn't any more reassuring. Does anybody have any experience with/knowledge of this type of testing and treatment? Is the optometrist pushing alternative medicine at me?

Every year, my 8-year-old daughter's optometrist asks if she is having trouble focusing in school. When I answered that she was having particular trouble this last year, she recommended a "Visual Efficiency Examination" and "Visual Perceptual Motor Testing," and discussed treatment for a possible vision processing disorder. The handout she gave me set off alarm bells when I saw the blurb about nutritional heavy metal detoxification, and when I looked up "behavioral optometry" and "vision therapy," I can't find that it's actually an evidence-based treatment.

For the record, I've just had her evaluated by a psychologist. No ADHD diagnosis, but is definitely a little behind on development in that area. It was recommended that I look into potential auditory processing issues, which I have planned.

(While I'm here asking about her optometrist, I may as well ask if a retinal scan is really necessary every year.)
posted by moira to Health & Fitness (14 answers total) 3 users marked this as a favorite
 
I've not heard that phrase, but we did vision therapy for a few years with a local opt; but that was after a computerized eye scan during a hearing test turned up a concern that was diagnosed as convergence insufficiency.

The five year old had the "visual habits" of a three year old because their eyes weren't tracking right/well. A few years of vision therapy helped bring them up to their age appropriate level. We could see the difference in how the child walked and focused physically.

Of the kids we co-therapied with, some had other visual problems including lazy eye and the certified therapists (some places use students, and require months-long commitments in advance, and hour-long sessions) defined specific treatment plans.

That phrase is used here (my opt is a member). Here is more information about vision therapy.

It might not be something she needs. It might be. I'd dig up someone that belongs to COVD and get a second opinion.

(The heavy metals toxicity sounds slightly woo to me but what do I know?
posted by tilde at 11:40 AM on August 20 [1 favorite]


Maybe seek a second opinion/find a new optometrist? I think you're right to feel the woo coming off those terms... I don't know if there's any evidence for the therapies your optometrist is recommending but the phrases you have in quotes don't turn up any hits at all in PubMed (a very large database of medical research).

Does your daughter have any specific eye disease risk factors? Does she wear eyeglasses? Most of the official guidelines on pediatric eye exams say that kids without vision problems only need an eye exam every other year.
posted by mskyle at 11:41 AM on August 20


Patient Precept the First: if you feel as though you are being strongly steered towards a particular course of ELECTIVE treatment (as opposed to "strongly steered towards having a malignancy removed"), it's a red flag.

Patient Precept the Second: if you are unsure as to whether a particular course of treatment is legit/science-based/evidence-based, do a site-specific Google search on PubMed for the term, e.g. site:http://ncbi.nlm.nih.gov "behavioral|behavioural optometry". If you only get a few hits, and they're not big, oft-cited studies, you are TOTALLY RIGHT to be skeptical/concerned.

In this case, I'd look for a new doc - it sounds like your doc is heavily invested in pushing this therapy, which strikes me as somewhat unprofessional. By the by, if you're in the Philly area, I have a recommendation for a great kid-friendly eye doc! :-)
posted by julthumbscrew at 11:43 AM on August 20 [6 favorites]


My son was diagnosed with a convergence disorder (exophoria) after being screened for other kinds of cognitive problems. He's wearing prismatic glasses as a mild form of therapy and might do some "vision training" on a computer-based program to help retrain the muscles. No dietary stuff was ever mentioned.

Seconding getting a another opinion, but from from an ophthalmologist not an optometrist.
posted by JoeZydeco at 11:44 AM on August 20 [6 favorites]


(I faced something similar earlier this year, by the way - my son's shrink began HEAVILY pressing neurofeedback in lieu of actual talk therapy. It wasn't easy to change doctors, but I'm glad I decided to stick to my evidence-based guns.)
posted by julthumbscrew at 11:46 AM on August 20 [1 favorite]


Get a second opinion from an ophthalmologist in a different practice. You've been seeing the same optometrist for several years now and have been made to feel uncomfortable by her suggestions a couple times, yes? Why are you still seeing her? There are plenty of eye docs out there.
posted by phunniemee at 11:46 AM on August 20 [1 favorite]


Agree to get a second opinion from an ophthalmologist (medical doctor who specializes in eyes) .
posted by radioamy at 11:48 AM on August 20 [1 favorite]


Friend of mine's daughter had it done years ago to good effect, so there's that.
posted by St. Alia of the Bunnies at 11:49 AM on August 20


And, regarding retinal scans, they're getting cheaper every year. If your doc offers a computerized one (like Optomap) that can be stored in the record, it provides an excellent baseline picture especially if your little one gets an eye injury and the doc needs to determine if the retina is in trouble. It's not a scam. Think of it like a dental x-ray.
posted by JoeZydeco at 11:50 AM on August 20 [4 favorites]


I was born with a convergence disorder (mine required surgery to correct) and I definitely went through what was basically PT for my eyes (both to train the muscles in my eyes to work correctly and to train my brain how to process the information) as a child in the 1970's. So it's absolutely a thing that people do.

However, whenever anyone starts talking about "nutritional heavy metal detoxification" I would run.
posted by anastasiav at 12:03 PM on August 20 [2 favorites]


To answer a couple of questions: she has an astigmatism along with nearsightedness in one eye which was leading to a bit of eye wandering. We found and corrected it early, and she doesn't seem to be having any trouble at all now. She does wear glasses.

The question has been asked every year. This is the first year the optometrist suggested behavioral optometry.
posted by moira at 12:05 PM on August 20


I would just see a second doctor. I'm a little confused as to why your optometrist would care about her not being to "focus in school" when it sounds like you mean "pay attention" not "see things properly." This weird. I'd ask another doctor.
posted by AppleTurnover at 1:05 AM on August 21


Thanks, guys. I did some further looking and found a joint statement from the American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Association of Certified Orthoptists that says, in part,
"Scientific evidence does not support the efficacy of eye exercises, behavioral vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex pediatric neurocognitive conditions. Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavioral vision therapy, or special tinted filters or lenses, are not endorsed and should not be recommended."
Since all of the standard tests show her eyes working perfectly, she is an avid and fast reader, and she gives no other indications that she is having vision troubles when wearing glasses, I just cancelled. We'll be going to a different doc next year.
posted by moira at 7:49 AM on August 21


And yes, she was definitely referring to ADHD symptoms. The brochure was explicit about that.
posted by moira at 7:58 AM on August 21


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