Functional optometry
The behavioral optometry deals with "malfunctions that in healthy eyes occur due to an incorrect viewing patterns or a faulty vision development and problems of visual perception can cause" (as defined in WVAO, Scientific Association for ophthalmic optics and optometry ). Functional optometry is integrated as a sub-discipline in the specialist areas of ophthalmic optics and optometry and sees itself as a specialist science . In the USA , the country of origin of functional optometry, the term behavioral optometry is used synonymously .
Theoretical foundations
The quality of optical stimulus perception and processing ( seeing ) can only be partially assessed by assessing individual properties ( e.g. visual acuity ), whereby the performance of the visual system can also be influenced by the environment, individual behaviors and learned reaction patterns.
Functional optometry assumes that with increasing distance of our way of life from the natural origin, i.e. from the continuity of our development history , our perception would function less and less in the usual way without errors . The development of the child's perception in a big city apartment is so fundamentally different from a few generations ago that many stages of development no longer take place in the usual way.
In individual cases the combination of various negative factors can lead to problems with visual perception. These include, among other things, physical exertion ( asthenopia ), headache , red eyes, reading and spelling weaknesses (also as a visual component of dyslexia ), signs of fatigue at the computer workstation , etc. v. m. Functional optometry (behavioral optometry) developed from these assumptions and findings. In the USA it is part of the university course to become an optometrist .
Procedure
Functional optometry assumes that visual problems cannot always be solved by intervening at a single point (e.g. by prescribing glasses ), but rather the overall visual behavior must be changed (e.g. ergonomics , Lighting, workflow, etc.).
The core of functional optometry is the visual analysis , in which with the help of the medical history ( anamnesis ), numerous function tests (e.g. quality of subsequent movements , eye jumps , convergence near point , van Orden star, etc.) and a long series of measurements (so-called 21- Points-Measurement-OEP) a comprehensive overview of the client's visual situation would be achieved. From this it can be deduced at which points the visual system is working ineffectively and whether it can be trained if necessary ( visual training ).
Lack of proof of effectiveness for many areas of application
In 2000 and 2009, broad-based overview studies examined what scientific evidence was available for the effectiveness of function-optometric (= behavior-based) therapy strategies. The first study commissioned by the UK College of Optometrists found that such evidence was not available. The reason is that there has been a shortage of controlled clinical trials.
Only for three out of ten typical areas of application of functional optometry was there evidence in 2008 that the alleged therapeutic goals were achieved through the effect of functional optometry. For seven other areas of application, including a. Developmental delays in children, strabismus, and nearsightedness , there was insufficient scientific evidence for effectiveness. Appropriate therapies should be rejected from the perspective of evidence-based medicine .
Training and certification
The term "functional optometrist" is not legally protected by state recognition or professional regulations, similar to, for example, "eye trainer". In this respect, anyone can theoretically call themselves a functional optometrist without checking their level of knowledge or previous training. One reason for this is the fact that there is currently no political agreement on the extent and content of functional optometry within the training to become an optician or optometrist. In principle, everyone in Germany who has passed a master's examination as an optician is, according to the profession, entitled to perform ophthalmic services that are assigned to functional optometry. Further training or further education in functional optometry or certification as a functional optometrist is not offered by the central training center of the Central Association of Optometrists in Germany (ZVA) and is not part of the curriculum for optometrists. Corresponding seminars are therefore held at private institutes or companies over an entire seminar period of around 18–20 days. There is currently no uniform training concept, and it is pointed out that "the line between imparting neutral technical information and" company-related events "is not always sharply drawn".
One form of further training and the acquisition of a corresponding certificate is regulated in Germany by the Scientific Association for Ophthalmic Optics and Optometry (WVAO) , requires a passed master's examination in the optician's trade or an adequate training and includes the following points:
- Participation in the WVAO basic course as well as further advanced seminars consisting of
- Visual Analysis - 21 Point OEP (Optometric Extension Program)
- Functional tests
- LRS ( weak reading and spelling )
- Myopia
- General Skills
- Amblyopia
- Recognition of a code of honor
- Recognition of the procedural criteria for the visual training
- Recognition of the test guidelines
After successfully passing an exam, the WVAO certificate "Recognized specialist advisor for functional optometry" is awarded. The certificate is renewed annually through further training. After a period of two years without further training, the examination must be taken again.
Distribution in Germany
Functional optometry has been part of ophthalmic activities in Germany since around 1992. However, it is only offered by around 5% of practicing opticians. An increasing tendency in recent years is explained by the increasing establishment of functional optometry as a branch of the optician's business . In 2008, around 115 functional optometrists with WVAO certificates were listed at the WVAO. According to a survey among opticians, the largest area of application is with the group of children. Another focus is the consideration of increased visual stress at the workplace, as well as a visual increase in performance during sporting activities.
Background and significance
The approach and conclusions of functional optometry are viewed very critically in Germany. It is stated that in Germany there has so far been a lack of a clear definition and description of functional optometric content and its communication on a scientific and subject-specific basis.
The topics of functional optometry that go beyond the ophthalmic aspects are often part of the ophthalmological special disciplines of strabology and neuro- ophthalmology , with which the range of services and scientifically sound professional training is already covered by orthoptists and ophthalmologists in a high-quality and competent manner on a legally regulated basis . A related supply gap and the resulting increased demand have not yet emerged, at least in Germany and other German-speaking countries.
The professional associations of ophthalmologists and orthoptists ( Professional Association of Ophthalmologists in Germany and Professional Association of Orthoptists in Germany ) suggest that the range of services offered by opticians should be expanded to include medical-therapeutic activities due to increasing competitive pressure. In addition, a correspondingly low level of quality is expected in terms of the content and duration of the training, which could have a negative impact on health care. The risk of violating the Heilpraktikergesetz would be countered by describing "diseases" as "malfunctions" and replacing "therapies" with "training" in order to give the functional optometrist access to therapeutic action.
According to the company, functional optometry is only used in "healthy" eyes. In Germany, according to the professional regulations, it is reserved exclusively for doctors to judge whether the organ systems are healthy or not when the complaints are described.
Functional optometrists have not yet established a uniform and binding process for medical proof of the intact state of health of their clients, which could possibly assure them that their activities would be carried out on healthy eyes with healthy binocular vision.
In addition, the allegation that functional optometrists allegedly make diagnostic and medical-therapeutic treatment offers that are reserved for medical practitioners and are forbidden to them by the Heilpraktikergesetz as the practice of medicine requiring a license has not been clarified .
The subject of "functional optometry" is also controversially discussed within the professional group of opticians themselves. Professional representatives see certain aspects of functional optometry as a pseudoscience with esoteric treatment methods. They also fear for the positive appearance of optics in public. In addition, disputes with the professional groups of ophthalmologists and orthoptists are expected, because activities in functional optometry would already clearly exceed the diagnostic and therapeutic limits of ophthalmology. Furthermore, one suspects a lack of competence and qualification with regard to the necessary scientific and medical principles and knowledge.
Optimal care for clients and help with visual problems were rated positively by the opticians surveyed. In addition, securing the profession by strengthening professional competence and qualifications, as well as differentiating it from the ophthalmologist, also play a role in the positive view of functional optometry. In addition, the further development away from the pure craft and towards an expansion of one's own horizons with a differentiation from the standard opticians is viewed as positive.
A direct transfer of the US concept to German conditions is not possible for a variety of reasons. In addition to the fundamentally different focus areas of German and US optometrists, the underlying training content, professional regulations and legal bases also differ significantly from one another. It has not yet been clarified whether such a development in Germany is supported by the existing legal situation and professional regulations.
See also
Web links
literature
- Optometric Extension Program Foundation: Bibliography of near lenses and vision training research. Includes supplements on eye movements, juvenile delinquency and vision & traumatic (acquired) brain injury . Optometric Extension Program, Santa Ana CA 1997, ISBN 0-943599-90-3
- Carmen Koch: Functional Optometry. knowledge. how what why . WVAO, Mainz 2004, ISBN 3-935647-22-0 , ( WVAO library 17).
- Uwe Seese: Seeing - you have to learn. See - you can learn . BOD, Norderstedt 2007, ISBN 978-3-8334-9852-7 .
Individual evidence
- ↑ a b Functional Optometry Working Group of the WVAO - Quality Certificate Functional Optometry
- ↑ a b Barrett BT (2009) A critical evaluation of the evidence supporting the practice of behavioral vision therapy. Ophthalmic and Physiological Optics 29 (1): 4-25
- ↑ a b c Michaela Friedrich and Hans-Jürgen Grein: Functional optometry in German ophthalmic optics - an actual analysis, part 3 . Deutsche Optikerzeitung - DOZ, issue 9, 2008
- ↑ Seminar program of the ZVA-Bildungszentrum
- ↑ Curriculum Optometrist of the ZVA Germany
- ↑ Exemplary seminar plan from OPTONICA ( Memento of the original from February 25, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ WVAO code of honor for functional optometry (PDF; 89 kB)
- ↑ a b c d e Michaela Friedrich and Hans-Jürgen Grein: Functional optometry in German ophthalmic optics - an actual analysis, part 2 . Deutsche Optikerzeitung - DOZ, issue 8, 2008
- ↑ a b Survey by the Jena University of Applied Sciences in cooperation with the Central Association of German Opticians - ZVA . From: Functional optometry in German ophthalmic optics - an actual analysis, part 1 . Deutsche Optikerzeitung - DOZ, issue 7, 2008
- ↑ a b Michaela Friedrich and Hans-Jürgen Grein: Functional optometry in German ophthalmic optics - an actual analysis, part 4 . Deutsche Optikerzeitung - DOZ, issue 10, 2008
- ↑ Example of a training component in functional optometry ( memento of the original from February 25, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ^ Website of the WVAO - specialist advisor for functional optometry
- ↑ German ophthalmic optics and optometry in international comparison. ( Page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. In: Deutsche Optikerzeitung. DOZ. Issue 2, 2008, ISSN 0344-7103 , pp. 14-21.
