I took over an independent practice in 1982 and began my training in behavioural optometry in 1995, developing in-office vision therapy roughly three years later after extensive training with a US-based mentor Dr Wayne Pharr. During the past five years, public acceptance of vision therapy has taken off and we get increasing numbers of referrals from occupational therapists, educational psychologists and even local neurologists specialising in mild traumatic brain injuries as well as local schools. Due to our international reputation and website, we get referrals and patients from all over the world and many personal recommendations from our patients.

The week that Covid-19 restrictions first started to be recommended by various countries around the world, I was due to give a two-day presentation about behavioural optometry and syntonic phototherapy in Poland, which I thankfully cancelled just before travel restrictions were imposed.

When the lockdown came, our immediate question was ‘what should we do now?’ as many of our patients, had already undergone vision assessments and had been booked in for vision therapy.

What sort of things do we treat with vision therapy?

It is frequently quoted that one in four children have vision related learning difficulties. These visual problems are not related to refractive error but may be linked to eye tracking difficulties, convergence insufficiency, accommodative dysfunction, limited fusional reserves and restricted peripheral function. These conditions are very amenable to intensive vision therapy. Other groups we work with include those with strabismus, amblyopia and adults who have undergone brain injury or balance issues associated with vestibular problems, Alzheimer’s or Parkinson’s.

In the pre-Covid world, we worked very intensively, where the patients attended our practice for one hour, twice a day, five days per week for two weeks (totalling 20 sessions) followed by a month of home therapy. With the risks associated with Covid-19, we felt that this concept was no longer viable.

Like many behavioural optometrists around the world, we searched for answers and spent the first five weeks of lockdown, looking at all the techniques we used in the practice, and how we could change and develop for use in a home setting.

In support of the behavioural optometry community, Vivid Vision partnered with several relevant organisations to bring members the first-ever teleconference on vision therapy telemedicine. With ongoing seminars, workshops, demos, and online training, we continued to expand our knowledge and skills to provide the most current vision care that our patients rely on. For the month of April alone they had 2019 participants from 58 countries. They had 169 lectures provided by 103 presenters. Registration was by suggested donation and they raised over $38,000 (US) that went to DirectRelief.org for international Covid relief efforts. They have kept the platform going and have now reached over 2,360 colleagues from about 60 countries and continue to offer more lectures every day.

As a result of all this background and support, we have been working with up to five patients a day in single sessions, four to five days per week using Zoom, Webex and WhatsApp. The biggest problem for my practice is the ability to maintain internet connection, as I live and work in rural Dorset.

So unlike most optometrists, who were ‘on call’ for emergencies, we, like other behavioural optometrists who had developed remote vision therapy, were able to continue to work with some level of revenue coming in.

In the near post-Covid era, I do not see when we will be able to return to the way we worked previously in practice. The AOP has recently provided me with guidance that we can now resume vision assessments and vision therapy, but with the recommendation to reduce close contact as much as possible.

In view of this, we will be making greater use of patient questionnaires, online video pre- and post-discussion with parents and patients to reduce assessment times in the consulting and therapy rooms. We are currently planning on one day a week working in the practice and three days a week working remotely, with my therapist working from home or within the practice as needed.

Vision therapy is an incredibly satisfying and successful branch of optometry, which is rapidly developing worldwide.

Geoff Shayler is an optometrist practising in Wareham, Dorset.

  • For more information contact the British Association of Behavioural Optometry at www.babo.co.uk.