What's the Difference Between a Neuro-Optometrist and a Developmental/Behavioral Optometrist?

Many people are unaware of the differences between an optometrist, a neuro-optometrist, and a behavioral or developmental optometrist. Sure, they sound alike but the services they provide are quite different. And if you, or someone you know, has a vision problem that cannot be corrected with glasses or contact lenses this blog is for you.

So that we're on the same page, let's talk about the educational differences between a general optometrist, a residency trained optometrist, and a developmental/behavioral optometrist. All optometrists must graduate from an accredited optometry school and pass a national test demonstrating competency. The next step is choosing a state in which to practice. An optometrist must then pass a separate test in that state in order to be granted a license to practice optometry.

Optometrists can choose to work in a private or commercial practice setting; or can instead elect to apply for acceptance into a formal residency training program. Residency is the only formal training beyond optometry school available to optometrists.

An optometric residency program is an additional year of postdoctoral advanced training dedicated to a specific field of study such as neuro-optometry, pediatrics, disease, etc. Residency is research and outcome based training, completed in a university or V.A. medical clinic or hospital setting. If an optometrist has not completed a residency program they do not have formal, in-depth, specialized training and are instead considered a general optometrist.

Some general optometrists choose to begin working as developmental or behavioral optometrists following graduation from optometry school. This does not require any additional formal postdoctoral education, and is instead an emphasis in treating functional vision problems. Typically developmental or behavioral optometric treatment is not based on current research or medically accepted standards of care.

Some optometrists elect to pursue Board Certification. In optometry, only the American Board of Optometry has developed a national Board Certification Examination. Board Certification by the American Board of Optometry is recognized by the Association of Schools and Colleges of Optometry, the American Academy of Optometry, and the American Optometric Association. No other optometric board certification meets the requirements of these national organizations. This is important to know because one developmental/behavioral organization does grant the status of “board certification” to their members. However, this type of board certification does not meet the stringent requirements of the American Board of Optometry.

Let's explore the types of care provided by a general optometrist, a residency trained optometrist, and a developmental/behavioral optometrist.

• General optometrist: A general optometrist is the vast majority of all optometrists. General optometrists provide eye exams, glasses and contact lens prescriptions, and treat minor emergencies such as eye infections. Think of a general optometrist as you would a primary care physician. General optometrists are trained to identify abnormalities and refer patients to specialists requiring secondary to tertiary care.

• Residency trained optometrist: A residency trained optometrist has completed an additional year of specialized training within a sub-specialty area of vision care. These sub-specialties are neuro-optometry, pediatrics, disease, contact lenses, etc. It is important to note that a residency trained optometrist can provide the same care as a general optometrist with the added benefit of sub-specialty training and expertise.

• Developmental/behavioral optometrist: A developmental/behavioral optometrist is a general optometrist who chooses to practice a type of optometry that is considered more closely aligned to alternative medicine – with no additional formal training. Developmental/behavioral optometrist use a number of unorthodox ideas and practices related to visual processes which are not supported by research nor considered conventional within the optometric and medical community.
   

Individuals (children or adults) seeking care beyond that provided by general optometrists or ophthalmologists usually have a vision problem that has not been corrected with glasses or contact lenses. These vision problems can be diplopia (double vision), suppression, vergence deficits, etc. and are classified as binocular vision dysfunction. It is not uncommon for these vision problems to be long-standing, for patients to be told they will have to learn to adjust, or be prescribed occupational or vestibular therapy to learn compensatory techniques. For some people adopting a more sedentary lifestyle or forgoing the love of reading becomes the new norm. However, others want to correct the vision problem and regain their previous lifestyle, self-confidence and independence.

For those who choose to correct binocular vision dysfunction, the best choice is a residency trained neuro-optometrist. Why? The answer is easy. A residency trained neuro-optometrist is well qualified to accurately diagnose the various types of binocular vision dysfunction. They have been trained in a medical setting and have extensive experience diagnosing and treating a wide-range of neuro-visual conditions resulting from injury, systemic disease, and degenerative conditions. Neuro-visual conditions are highly complex and require the care of a well-qualified expert, such as a residency trained neuro-optometrist.

There are some people who choose to to explore alternative medicine to treat binocular vision dysfunction. Keep in mind binocular vision dysfunction is a neuro-visual condition, proceed with caution and only after exhausting efforts to find a residency trained neuro-optometrist. It is also important to compare the length of treatment programs if you are considering developmental/behavioral care. Typically, length of treatment is shorter under the care of a residency trained neuro-optometrist because the treatment methods used are based on proven research that is results oriented. Length of treatment under the care of a developmental/behavioral optometrist is typically longer in duration because unproven treatment methods are used, and often considered experimental.

A residency trained neuro-optometrist uses age and grade normed standardized testing along with medically accepted, research based testing protocols to accurately diagnose the specific deficient and prescribe treatment. A developmental/behavioral optometrist typically adapts and develops testing and treatment protocols in-house, based on personal experience with their relatively small group of patients. Conversely, research based testing and treatment uses large, randomized groups of patients and studied by both optometrists and ophthalmologists.

If you suspect, or are considering treatment for, binocular vision dysfunction we encourage you to make an appointment for an assessment with a residency trained neuro-optometrist. Be sure to ask where the doctor completed residency and in which sub-specialty of care. This is the only way to know if the doctor has completed a residency in neuro-optometry. Do your homework, ask the questions. You'll be glad you did.