Following discussions with the British Association of Behavioural Optometrists (BABO) the College of Optometrists was keen to commission a fair and balanced review of the theory and evidence relating to behavioural optometry. The College commissioned Dr Brendan Barrett, a reader in vision science at Bradford University, to evaluate the currently available evidence and to make recommendations as to whether this supports the practice of behavioural optometry. Throughout the review Dr Barrett liaised with a member of BABO to discuss any areas which required clarification.
Abstract:
In 2000, the UK’s College of Optometrists commissioned a report to critically evaluate the theory and practice of behavioural optometry. The report which followed (Jennings, 2000) concluded that there was a lack of controlled clinical trials to support behavioural management strategies. The purpose of the present report was to evaluate the evidence in support of behavioural approaches as it stands in 2008. The available evidence was reviewed under 10 headings, selected because they represent patient groups/conditions that behavioural optometrists are treating, or because they represent approaches to treatment that have been advocated in the behavioural literature. They headings selected were: (i) vision therapy for accommodation/vergence disorders; (ii) the underachieving child; (iii) prisms for near binocular disorders & for producing postural change; (iv) near point stress & low-plus prescriptions; (v) use of low-plus lenses at near to slow the progression of myopia; (vi) therapy to reduce myopia; (vii) behavioural approaches to the treatment of strabismus & amblyopia; (viii) training central & peripheral awareness and syntonics; (ix) sports vision therapy; (x) neurological disorders & neuro-rehabilitation after trauma/stroke. There is a continued paucity of controlled trials in the literature to support behavioural optometry approaches. Although there are areas where the available evidence is consistent with claims made by behavioural optometrists (most notably in relation to the treatment of convergence insufficiency, the use of yoked prisms in neurological patients, and in vision rehabilitation after brain disease/injury), a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated.
The full report has been submitted to Ophthalmic and Physiological Optics (OPO) Journal, and is expected to be published in the coming months.