Behavioral Optometry 
and Occupational Therapy Collaboration


Should I consider a treatment approach that includes both vision therapy and occupational therapy? Behavioral Optometrists and Occupational Therapists have been sharing ideas and collaborating for many years. When a patient is seen by one or both professionals, parents often wonder if they need both or which to do first. In trying to explain each role, we will hopefully provide some clarity for parents.

Let’s take one example of a visual and motor skill: eye-hand coordination. New research in https://www.science.org/doi/10.1126/science.abq2960 from the Institute of Neurosciences, states that eye-hand coordination begins in the womb before we are born. It requires the use of several visual and motor skills. Proprioception is used to determine where we are in space, where our body parts are, and where one body part is in relation to another. The eyes make saccadic movements to find and fixate on a target before the hand makes the movement. The eyes make pursuit eye movements when tracking a target in motion. Optimal coordination between the eye and hand relies on the relationship between the visuo-perceptual, ocular, and appendicular motor systems. We need our eyes to help determine the movements of our hand, therefore leading to the need for collaborative care in many cases. 

The role of the Behavioral Optometrist is to focus on the entire visual system, not just visual acuity. A Developmental Optometrist is different from a Primary Care Optometrist. In primary care, the doctor provides a comprehensive eye exam which determines any refractive errors, provides a glasses/contact lens prescription, checks the overall health of the eye to diagnose and treat any ocular disease or conditions, and screens for any functional visual issues. If diagnosed with visual dysfunction, a referral is made to a Behavioral Optometrist. The Behavioral Optometrist specializes in the ability to use your eyes to receive information, process it, and to efficiently use that information in your daily activities. A developmental vision exam will test for 17 visual skills (https://www.optometrists.org/vision-therapy/guide-vision-and-learning-difficulties/the-17-key-visual-skills/) necessary for learning, reading, writing, sports. They will also test for any visual processing deficiencies to ensure the brain properly translates what the eyes see. If any functional or processing deficiencies are found, the appropriate treatment will be Optometric Vision Therapy. An integral part of treating the visual system is the systematic use of lenses, prisms, filters, occlusion, specialized vision equipment, visual exercises, and computer based visual programs in conjunction with sensorimotor treatment. The Behavioral Optometrist emphasizes the role of vision as primary and movement skills as foundational.

The role of the Occupational Therapist is to focus primarily on movement and balance abilities with vision being a foundational part of the sensory system. They use therapeutic techniques to improve, rehabilitate, or maintain a person’s motor skills and overall ability to perform everyday activities. They can develop performance skills, teach self-regulation strategies, recommend assistive devices, help with environmental modifications, or prescribe prosthetics and wheeled mobility. Occupational Therapists can provide vision therapy exercises for eye movements, scanning, and visual processing. However, they are not allowed to use patches, prisms, lenses, binocular instruments, or specialized optometric specific programs or equipment without a license in optometry just as Developmental Optometrists cannot prescribe any of the equipment listed above.

Because these issues often do not exist in isolation, it is important that a collaborative approach to treatment is taken. The goal in the collaborative treatment of a mutual patient is for all professionals to discuss all deficiencies, prioritize per diagnosis, and develop a treatment plan in which all professionals contribute. Often, patients are most successful when both treatments are done simultaneously. For parents contemplating one treatment over the other due to time or finances, the order of importance will depend on the diagnosis. The Developmental Optometrist has access to all the prescriptive visual tools and equipment needed to properly treat any visual dysfunction. The Occupational Therapist has much more knowledge and access to gross and fine motor exercises and equipment. The ultimate answer is patient dependent; you have to make the most educated decision for you and your family with the guidance of both professions along the way.

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